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PEDS > lecture 8 [cardiovascular + congenital heart dysfunctions] > Flashcards

lecture 8 [cardiovascular + congenital heart dysfunctions] Flashcards

1
Q

why is the pressure higher in the right side of the heart than the left side of the heart?

A

venous return into the heart starts in the right atrium

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2
Q

why does the aorta have a higher pressure than the pulmonary artery?

A

the aorta determines the stroke volume of the heart, thus the cardiac output to sustain the body

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3
Q

what is congestive heart failure?

A

the heart fails to effectively circulate blood

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4
Q

CHF is the most common complication in children with heart defects

A

true

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5
Q

s/s of left heart failure

A
  • pulmonary edema
  • crackles
  • rhonchi
  • wheezing
  • orthopnea
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6
Q

s/s of right heart failure

A
  • peripheral edema
  • HTN
  • hepatomegaly
  • ascites
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7
Q

what are the general s/s of CHF?

(6)

A
  • tachycardia
  • tachypnea
  • weight gain (from excess fluids)
  • anorexia
  • clubbing
  • retractions
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8
Q

a patient has a CXR showing an enlarged heart, what condition does the patient have?

A

CHF

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9
Q

what are the medications for CHF?

A
  • Digoxin (inotrope)
  • ACE inhibitors
  • Furosemide (diuretics)
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10
Q

what are the side effects of Digoxin?

A
  • diuresis
  • increased PR interval
  • bradycardia
  • nystagmus
  • NV
  • hyperkalemia
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11
Q

what are the pharmacological actions of Digoxin that cause bradycardia?

A
  • negative chronotropic
  • positive inotropic
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12
Q

what are the nursing actions for Digoxin before administering it to a patient with CHF?

A

small children: hold when HR < 90 & do not give more than 1mL
older children: hold when HR < 70

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13
Q

what is the therapeutic range for Digoxin?

A

0.8 - 2mcg/ L

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14
Q

why does the nurse need to question an order for Digoxin when a child’s Potassium levels show less than 3.5mEq?

A

the effects of the medication will increase

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15
Q

what are the ACE inhibitors typically given to children?

A
  • Enalapril
  • Capoten
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16
Q

wha is the MOA of ACE inhibitors?

A

reduces cardiac afterload

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17
Q

what are the side effects of ACE inhibitors?

A
  • hypotension
  • cough
  • diuresis
  • hyperkalemia
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18
Q

what are the s/s for hypokalemia?

A
  • muscle weakness
  • hypotension
  • dysrhythmia
  • drowsiness
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19
Q

what are the s/s of hyperkalemia?

A
  • muscle weakness
  • twitching
  • bradycardia
  • V-fib
  • oliguria
  • apnea
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20
Q

what are the s/s of hypoxemia?

A
  • cyanosis
  • polycythemia
  • clubbing
  • squatting
  • hypercyanotic episodes
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21
Q

what is the nursing management for a patient with CHF?

A
  • improve cardiac function
  • descrease cardiac demands
  • improve oxygenation
  • maintain nutrition
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22
Q

what can a nurse do to help decrease a patient’s cardiac demands?

A
  • cluster care
  • bed rest
  • monitor for infection
  • continuous checking of skin (prevent impairment)
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23
Q

what can a nurse do to help improve tissue oxgenation?

A
  • HOB elevated
  • O2 therapy
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24
Q

what are the congenital heart defects that increase pulmonary blood flow?

A
  • atrial septal defect
  • ventricular septal defect
  • patent ductus arteriosus
  • atrioventricular canal
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25
Q

what is PDA (patent ductus arteriosus)?

A

the failure of the fetal duct between the pulmonary artery & aorta to close, leading to increased pulmonary blood flow

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26
Q

what is the complication for PDA?

A

CHF

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27
Q

what heart sounds the nurse will hear in a child with PDA?

A

murmurs

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28
Q

what are two ways that PDA can be resolved?

A
  • Indomethacin
  • surgery
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29
Q

what is an atrial septal defect?

A

hole between the atria where the foramen ovale failed to close or due to another unrelated reason that leads to increased pulmonary blood flow

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30
Q

how does PDA present in a patient?

A
  • rales
  • HF
  • bounding pulses
  • systolic murmur
  • wide pulse pressure
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31
Q

what are the manifestations of ASD?

A
  • loud, harsh murmur w/ a fixed split second heart sound
  • HF
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32
Q

what is ventricular septal defect?

A

a hole in the septum between the ventricles that cause an increase in pulmonary blood flow

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33
Q

VSD is the most common congenital heart defect

A

true

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34
Q

what is an atrioventricular canal?

A

a large hole within the middle of the heart that includes valvular defects & holes in between the chambers

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35
Q

what are the congenital mixed defects that can be found in children?

A
  • transposition of the great vessels
  • total anomalous pulmonary venous return
  • truncus arteriosus
  • hypoplastic left heart syndrome
36
Q

what is the transposition of the great arteries?

A

a condition in which the aorta is connected to the right ventricle instead of the left, & the pulmonary artery is connected to the left ventricle instead of the right

37
Q

what is total anomalous pulmonary venous return?

A

part of the pulmonary vein shunts into the SVC (resulting to increased blood flow into the RA)

38
Q

why does the right side of the heart hypertrophy in TAPVR?

A

it becomes overworked due to the amount of blood it receives & pumps

39
Q

the left side of the heart in TAPVR remains small

A

true

40
Q

children with TAPVR typically have ASD or PDA to help compensate with abnormal blood flow

A

true

41
Q

if the child with TAPVR has no other defects, what is the priority action?

A

surgery

42
Q

what is truncus arteriosus?

A

failure of septum formation between the right & left ventricles, and the pulmonary artery & aorta fail to divide

43
Q

when does the surgical repair for truncus arteriosus need to happen?

A

within 1 month of life

44
Q

why is there more blood flowing into the lungs with truncus arteriosus?

A

there is less vascular resistance in the pulmonary artery

45
Q

what is the second most common CHD?

A

hypoplastic left heart syndrome

46
Q

what is hypoplastic left heart syndrome?

A

undervelopment of the left side of the heart, aortic valve, aorta, left ventricle, & mitral valve

47
Q

what are the manifestations of hypoplastic left heart syndrome?

A
  • pulmonary edema/ congestion
  • mild cyanosis
  • cold hands & feet
48
Q

which other defect usually accompanies hypoplastic left heart syndrome?

A

PDA

49
Q

which medication is used to keep PDA?

A

IV prostaglandin E

50
Q

what are the obstructive defects of the heart?

A
  • coarctation of the aorta
  • aortic stenosis
  • pulmonary stenosis
51
Q

what is coarctation of the aorta?

A

narrowing of the part of the aorta that is distal to the ascending vessels

52
Q

what are the manifestations of coarctation of the aorta?

A
  • elevated BP in upper extermities (> 20mmHg difference)
  • bounding pulses in upper extremities
  • cool skin in lower extremities
  • nosebleeds (epistaxis)
  • absent femoral pulses
53
Q

what is aortic stenosis?

A

narrowing of the aortic valve

54
Q

what are the therapeutic procedures for aortic stenosis?

A
  • balloon angioplasty
  • aortic valvotomy
  • Norwood procedure
55
Q

what is the hallmark heart sound the nurse will hear in aortic stenosis?

A

bruit

56
Q

what is pulmonary stenosis?

A

it is the narrowing of the pulmonary valve or pulmonary artery that results in obstruction of blood flow from the ventricles

57
Q

what are the therapeutic procedures for pulmonary stenosis?

A
  • balloon angioplasty
  • brock procedure
  • pulmonary valvotomy
58
Q

what are the manifestations of pulmonary stenosis?

A
  • systolic ejection murmur
  • cyanosis
  • cardiomegaly
  • HF
59
Q

what is bacterial endocarditis?

A

infection of valves & endocardium caused by Strep, Staph, & Candida

60
Q

s/s of endocarditis

(8)

A
  • fever
  • Roth’s spots
  • Osler’s nodes
  • Janeway lesions
  • arthralgia
  • murmur + tachycardia
  • splinter hemorrhage
  • septicemia
61
Q

what are the diagnostic results that show in endocarditis?

A
  • increased ESR
  • vegetations present in echocardiogram
62
Q

what is the primary preventive measure for endocarditis?

A

administer prophylactic ABX prior to dental procedures

63
Q

what is Rheumatic fever?

A

an inflammatory disease that occurs as a reaction to Group A strep infection

64
Q

s/s of Rheumatic fever

(7)

A
  • Aschoff bodies (tiny lesions of the heart)
  • carditis
  • murmur
  • polyarhritis
  • rash in trunk & extremities
  • subcutaneous nodules
  • CNS involvement (uncoordination + involuntary mvmnts)
65
Q

what are the medications that can treat Rheumatic fever?

A
  • penicillin G
  • sulfadiazine
  • penicillin V
66
Q

what is Kawasaki diease?

A

acute systemic vasculitis that follow viral infections & toxic exposures

67
Q

Kawasaki disease is the leading cause of acquired heart disease in children

A

true

68
Q

ecstasia is one of the major complications of Kawasaki disease, what is it?

A

an aneurysm caused by overdilation of coronary artery

69
Q

s/s of Kawasaki disease

(6)

A
  • red eyes
  • fever
  • ring around the iris
  • strawberry tongue
  • nonblistering rash on the perineum
  • joint pain
70
Q

what are the medications for Kawasaki disease?

A
  • IV globulins
  • aspirin
71
Q

wat are the cardiac defects that lead to a decrease in pulmonary blood flow?

A
  • Tricuspid atresia
  • Tetralogy of Fallot
72
Q

defects that decrease pulmonary blood flow often have septal defects such as ASD or VSD & allow deoxygenated blood to enter the circulatory system

A

true

73
Q

what is Tetralogy of Fallot?

A

it is an overaching defect that usually includes a set of 4 other defects

74
Q

what are the conditions that are included under Tetralogy of Fallot?

(4)

A
  • pulmonary stenosis
  • overriding aorta
  • right ventricular hypertrophy
  • VSD
75
Q

s/s of ToF

(4)

A
  • cyanotic spells (Tet spells)
  • polycythemia
  • systolic murmur
  • clubbing
76
Q

what is the surgical procedure to resolve ToF?

A

shunt placement (as a primary measure until surgical repair is tolerated)

77
Q

how are Tet spells relieved?

A

squatting position (bringing knees to chest)

78
Q

what is tricuspid atresia?

A

a full closure of the tricuspid valve

79
Q

which septal defect usually accompanies tricuspid atresia?

A

ASD

80
Q

what are the stages of the surgical procedure for tricuspid atresia?

(3)

A
  • shunt placement
  • Glenn procedure
  • modified Fontan procedure
81
Q

increased pulmonary blood flow causes acyanosis

A

true

82
Q

decreased pulmonary blood flow causes cyanosis

A

true

83
Q

a pediatric patient is admitted presenting cardiac difficulties, what does the nurse expect to be ordered throughout their stay?

(6)

A
  • CXR
  • ECG
  • ECHO
  • cardiac catheterization
  • stress test
  • MRI
84
Q

what does a CXR show in regards to the heart?

A

size & position

85
Q

what are the nursing responsibilities before cardiac catheterization?

(4)

A
  • determine allergies to iodine & latex
  • mark their pulse sites
  • obtain baseline O2 sats
  • determine presence of diaper rash
86
Q

what are the nursing responsibilities post-cath procedure?

(6)

A
  • stop bleeding
  • immobilize extremities
  • determine if pulses are gradually increasing
  • VS
  • bed rest 4-6 hrs
  • neuro checks of extremities
87
Q

auscultation landmarks of the heart

APTM

A

PEDS (11 decks)

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