Exam 2- Cardio Flashcards by Kalyn21Blessing .

Murmurs that come and go; account for 50% of murmurs in children

Functional (innocent) murmurs

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Functional murmurs are always louder during _________states, like: (4)

high cardiac output
-fever
-exercise
-anxiety
-anemia

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most common type of murmur; present in children grades 1-3

-Still’s Murmur

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Stills Murmur:
-Type of murmur
-Best heard at:

-Functional (innocent) Murmur
-left lower sternal border (LLSB)

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Murmurs that occur when your blood travels through a leaky or narrowed heart valve; caused by heart disease

Pathologic murmur

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primarily anatomic abnormalities present at birth that result in abnormal cardiac function; most common form of cardiac disease in children

Congenital heart disease

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Consequences of congenital heart defects fall into two broad categories; children can have both, although usually they occur independently

-heart failure
-hypoxia

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Indications of congenital heart disease located in cardiac history: (5)

-poor weight gain
-poor feeding habits
-faitgue during feeding
-frequent respiratory tract infections and difficulties
-evidence of exercise intolerance

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Common tests used in assessing cardiac function/diagnose heart disease: (4)

-electrocardiography
-echocardiography
-cardiac magnetic resonance imaging
-cardiac catheterization

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cardiac catheterization procedures can be divided into three groups:

-diagnostic procedures
-interventional procedures
-electrophysiology studies

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provides important information about oxygen saturation of blood within the chambers and great vessels, pressure changes, changes in cardiac output or stroke volume, and anatomic abnormalities

diagnostic cardiac catheterization

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Nursing care post-cath: monitoring for:

-signs of bleeding
-impaired circulation of distal extremity
-dysrhythmias
-infection

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prenatal factors that may predispose children to congenital heart disease (3)

-maternal chronic illnesses (diabetes)
-alcohol consumption
-exposure to environmental toxins and infections

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Congenital cardiac disorders are divided into 4 groups:

-defects that result in increased pulmonary blood flow
-obstructive defects
-defects that result in decreased pulmonary blood flow
-mixed defects

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Acyanotic heart condition either (2)

-increase pulmonary blood flow
-obstruction to blood flow from ventricles

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Cyanotic heart conditions either (2)

-decrease pulmonary blood flow
-produce mixed blood flow

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Types of defects that result in increased pulmonary blood flow (4)

-Atrial Septal Defect (ASD)
-Ventricular septal defect (VSD)
-Patent ductus arteriosus
-Atrioventricular canal

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Types of defects that obstruct blood flow from ventricle (3)

-Coarctation of aorta
-Aortic stenosis
-Pulmonary stenosis

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Types of defects that decrease pulmonary blood flow (2)

Tetralogy of Fallot
Tricuspid atresia

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Type of defects that result in mixed blood flow (4)

-Transposition of great arteries
-Total anomalous pulmonary venous return
-Truncus arteriosus
-Hypoplastic left heart syndrome

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hole in the septum between left and right atria; LA with higher pressure empties into RA

Atrial Septal Defect (ASD)

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S/S of ASD & VSDp (4)

-heart murmur
-palipitations
-tachycardia
-decreased peripheral pulse

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ASD & VSD management

Atrial septal defect may be closed using cardiac catheterization of Teflon repair

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Foramen ovale usually closes:

few hours to 24 hours after birth

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Hole in the septum between the left and right ventricle; LV with higher pressure empties into RV

Ventricular Septal Defect (VSD)

Double open heart (high opening between RV and LV, low between RA and LA) creates a large central AV valve that allows blood to flow between all four chambers of the heart

Atrioventricular canal defect (AVC)

AVC is common in kids with:

Down Syndrome

S/S of AVC (3)

-moderate to severe HF -characteristic murmur -mild cyanosis that increases with crying

occurs when the ductus arteriosus (between the aorta dn pulmonary artery_ fails to close after birth; causing left-to-right shunt

Patent Ductus Arteriosus (PDA)

S/S of PDA (4)

-Bounding pulse -Wide pulse pressure -Machine-like murmur -HF

PDA treatment Medication: Surgical:

M: Indomethacin S: Litigation (closed heart procedure)

Heart condition that includes 4 different effects; common win children with Trisomy 21

Tetralogy of Fallot

Defects included in Tetralogy of Fallot

-Ventricular septal defect (VSD) -Pulmonary stenosis -Overriding aorta -Right ventricular hypertrophy (RVH)

S/S of Tetralogy of Fallot (6)

-Cyanosis -Hyoxia -Systolic murmur -Anoxic spells -Clubbing of fingers and toes -Poor growth

Diagnosis of Tetralogy of Fallot (2)

Chest X-ray ECG

Treatment of Tetralogy of Fallot

Surgical intervention: -shunt placed until able to repair -complete repair within first year of life -Done in stages

hole in septum that separates the heart's left and right ventricles

ventricular septal defect (VSD)

pulmonary valve is narrow

Pulmonary stenosis

defect in the aorta; aorta is shifted to the right and lies directly above the VSD (aorta grows out of both ventricles rather than just left ventricle)

Overriding aorta

right ventricle thickening

right ventricular hypertrophy

Tricuspid valve fails to develop and RV atrophy; consequently, no communication from RA to RV; blood flows through an ASD or patent foramen oval to the left side of the heart and through a VSD to the right ventricle and out to the lungs

Tricuspid atresia

S/S of tricuspid atresia (5)

-cyanosis -dyspnea -tachycardia -hypoxemia -clubbed fingers

Treatment of tricuspid atresia

Surgical shunt placement in 3 stages

narrowing of pulmonic valve; leads to HF, RV hypertrophy, and arrhythmias

Pulmonary stenosis

S/S of pulmonary stenosis (4)

-systolic ejection murmurs -possibly asymptomatic -some mild cyanosis -cardiomegaly

treatment of pulmonary stenosis

balloon angioplasty w/ cardiac catheterization

narrowing of aortic valve

aortic stenosis

s/s of aortic stenosis: infants (4)

-faint pulse -hypotension -poor feeling tolerance -tachycardia

s/s of aortic stenosis: children (4)

-exercise/ activity intolerance -dizziness -murmur -chest pain

aortic stenosis treatment (2)

balloon dilation w/ catheterization valve replacement may be required later

aortic and pulmonary stenosis both lead to _______ because:

-hypertrophy of the ventricular walls -work hard to pump blood through the narrowed valves

obstruction of blood flow due to narrowing of the descending aorta causing slow peripheral return

coarctation of the aorta

S/S of coarctation of the aorta (7)

-High BP in upper extremities as compared to lower extremities -Bounding pulse at upper extremities; cool skin at the lower extremities -Weak femoral pulse -HF in infants -Dizziness -Headache -Fainting in older children

Treatment of coarctation of the aorta (4)

-Balloon angioplasty for infants and children -Replacement of stents for adolescents -Complete anastomosis to repair -Require lifelong monitoring

Ballon angioplasty steps (3)

-balloon inserted in narrowed area -balloon inflated, flattening plaque -artery is widened, blood flow improvement

Stent placement with balloon angioplasty steps (4)

-Build up of cholesterol partially blocking blood flow through artery -Stent w/ balloon inserted into partially blocked artery -Balloon inflated to expand stent

Complex cardiac anomalies that all involve the mixing of O2 saturated systemic blood with the de-saturated pulmonary blood flow

Mixed blood flow defects

Condition where the aorta is connected to RV instead of LV and pulmonary artery is connected to LV instead of RV

Transposition of great vessels

In transposition of great vessels, _______ or defect must exist in order to oxygenate blood

PDA

S/S of transposition of great vessels (4)

-cyanosis -cardiomegaly -HF -O2 stats are always in the 80s, no matter how much oxygen is given

Transposition of Great Vessels treatment

Corrective repair surgery in early infant (first 2 weeks of life)

single vessel trunk coming from the ventricles due to failed separation between the left and right ventricles

Truncus arteriosus

S/S of truncus arteriosus (6)

-HF -Lethargy -Heart murmurs -Cyanosis -Poor feeding -Delayed growth

treatment of truncus arteriosus

surgical repair within first month of life, another valve is inserted

most fatal heart defect; complete underdevelopment of the left side of the heart; Right side must maintain BOTH systemic & pulmonary circulation

Hypoplastic left heart syndrome

In Hypoplastic left heart syndrome, _______ & ______ act as a shunt to help initially; once they close, baby dies

forman ovale & ductus arteriosus

S/S of hypo plastic left heart syndrome

-HF -lethargy -Cysonisis

Hypoplastic left heart syndrome treatment

-Surgical procedure done in 3 stages -heart transplant usually required

3 procedures to help correct hypo plastic left heart syndrome

-Norwood procedure -Glenn procedure -Fontan procedure

an extensive inflammation of small vessels and capillaries (acute systemic vasculitis); without treatment, progresses to involve the coronary arteries, causing aneurysm formation in about 20% of children

Kawasaki disease

Kawasaki disease: Occurs most frequently under age ____, with peak incidence in _____ age group

-5 years -Toddler

Kawasaki disease: -Cause is _______, thought to be ________, but is not spread by person to person contact -Most cases occur in ______ & _______ -Lasts ______ in 3 phases:

-unknown, infection -late winter & early spring -6-8 weeks; acute, sub-acute, & convalescence

Kawasaki disease s/s: (8)

-Fever for 5 calendar days -Bilateral conjunctivitis -Strawberry tongue -Abdominal pain -Rash -Cervical Lymphadenopathy -Peeling hands -Swollen joints

Kawasaki phase: high fever unresponsive to antipyretics

acute phase

Kawasaki phase: begins with resolution of fever, lasts until all clinical signs have resolved

Sub-Acute phase

Kawasaki phase: Child is MOST at risk for development of coronary artery disease

Sub-acute phase

Kawasaki phase: All clinical symptoms have resolved Lab values indicating inflammatory response have not resolved Completed when lab values are normal

Convalescent phase

Kawasaki diagnosis

Based on lap tests and X-ray/ECG to show inflammations

Kawasaki diagnostic labs (4)

CBC CRP ESR Serum albumin

Kawasaki treatment (3)

-administration of intravenous immunoglobulin (IVIG) & high dose (80-100mg/kg/day divided into 6 hours) of aspirin -teach family that irritability can last for 2 months -Encourage ROM exercises

systemic inflammatory autoimmune disease that occurs after a throat infection from group A beta-hemolytic streptococcus (GABHS) bacteria; can change cardiac values; affects heart, blood vessels, CNS, Joints, and skin

Rheumatic fever

Major S/S of rheumatic fever (4)

-polyarthritis -carditis -sydenham's chorea -erythema marginatum

Minor S/S of rheumatic fever (2)

-fever -subcutaneous nodules

Lab diagnosis of Rheumatic fever: (4)

-Elevated anti-streptolysin-O titer -Elevated C-reactive protein level (CPR) -Positive throat swab -Elevated erythrocyte sedimentation rate (ESR)

Rheumatic fever treatment (4)

Antibiotics: Penicillin, penicillin G, sulfadiazine anti-inflammtory agents

Rheumatic fever interventions (4)

-encourage compliance of the medication regimen even when symptoms start to disappear -assess for allergic reaction to medication -assess and treat pain -encourage bedrest

medication improves myocardial contractility

Digoxin

Digoxin consideration:

listen to apical pulse for full minute hold if < 90 in infants, <70/min in children

Digoxin is potentially dangerous drug because the margin of safety between ___, ____, and __ doses is very narrow

therapeutic, toxic, and lethal

Checking for toxicity while on digoxin

-normal serum level 0.5-2 mcg/L -abnormal can indicate toxicity

T/F: if a child vomits while on digoxin, you should read minister dose

False; should not read minister because you don't know how much was absorbed

T/F: if child misses a dose of Digoxin, it is ok to give them the dose as long as its been past 4 hours

False, should only give missed dose if within 4 hour window of scheduled time; if outside window, hold dose

If child misses 2 or more doses of digoxin:

call the provider

Diet of child on heart meds should be: (2)

-high in potassium -calorie dense

BP med most common for children

-ACE inhibitors (captopril or enalapril)

Clinical manifestations of heart failure (3)

-Impaired myocardial function -Pulmonary congestion -Systemic venous congestion

S/S of distinctive of impaired myocardial function (4)

-Fatigue/Weakness -Pale/cool extremities -Weak peripheral pulse -Decreased B/P

S/S distinctive of pulmonary congestion

-Dyspnea -Retractions -Flaring nares -Exercise intolerance -Cyanosis -Weezing

S/S distinctive of systemic venous congestion (2)

-Peripheral edema, especially periorybital -Neck bein distention

S/S of heart failure (general) (4)

-Tachycardia -Sweating -Decreased urinary output -Gallop rhythm

Exam 2- Cardio Flashcards

(100 cards)