week 3 : cardiac care peds

Question 1

what can go wrong ?
name the 2 things that could go wrong ?

Answer 1

congenital heart effect ( CHD )
acquired heart disorders (AHD)

Question 2

describe what congenital heart defect means ?

include some examples

Answer 2

anatomical abnormalities present at birth

examples :
ventricular septal defect (VSD )
tetralogy of fallot (4 heart defects)

Question 3

what undergoes acquired heart disorders ( AHD ) : what is this description

give examples

Answer 3

disease or abnormalities that occur after birth

examples:
infection
autoimmune responses
environmental factors
family tendencies

Question 4

what is this describing : child is born with a heart has not formed normally in utero

Answer 4

congenital heart defect ( CHD )

Question 5

what is ventricular septal defect

Answer 5

when the child is born with an opening between the two ventricles, normally these chambers are not connected but with a vsd there is an opening.

Question 6

true or false. VSD there is an opening and this can be very small opening, so for these children when there’s small opening there wont be alot of abnormalities cardiac functioning

Answer 6

true

Question 7

true or false. Another kid could be born with a large opening or multiple opening between the ventricles - large opening allows blood move abnormally to the heart , left ventricle is under higher pressure than the right , blood moves from high to low pressure - oxygenated move to deoxygenated - more impact

Answer 7

true

Question 8

tetralogy of fallot ( 4 heart defects )
what are the 4 defects

Answer 8

overriding aorta
ventricular septal defect
right ventricular hypertrophy
pulmonic stenosis

Question 9

what is right ventricular hypertrophy

Answer 9

it is thicken - this right ventricle has large volume of blood flow
pump harder to try to keep up with workload

Question 10

what is pulmonic stenosis

Answer 10

pulmonary vein is more narrow allowing less blood to leave the ventricle with each contraction
and so again that would contribute to increased volume in the right ventricle

Question 11

when would acquired heart disorders ( ADH ) occur ?

Answer 11

during their childhood

Question 12

recall that infection undergoes acquired heart disorders (AHD)

Answer 12

cardiac infection for example : after covid infection myocardititis , inflammation in the heart muscle

Question 13

what undergoes environmental factors for ahd

Answer 13

exposure to environment that could be harmful to the heart pollution or chemicals or toxins

Question 14

whats an example of autoimmune responses for ahd

Answer 14

strep infection can lead into rheumatic fever fever this usually involves endocardial or the inner lining of the heart - target heart valves

Question 15

what is overriding aorta

Answer 15

in a normal heart, the left ventricle empties into the aorta now in tetralogy of fallot the aorta is actually open over the top of the vsd and so whenever the ventricles contract we get the blood from left and right ventricle entering the aorta - the issue with that deoxy blood is going to enter the into systemic circulation

Question 16

CHD : what are the symptoms ?

Answer 16

vary between the asymptomatic and severe symptoms

Question 17

what are the two major symptoms of CHD

Answer 17

cyanosis and heart failure

Question 18

what is this describing : slight blue or purple tinged in membranes around the mouth, tips of finger, abdomen and chest

Answer 18

cyanosis

Question 19

name the symptoms of CHD :

Answer 19

abnormality in vital signs - lower cardaic output- pulses weak heart and decreased in bp

tatchycardia
weak peripheral pulses - decreased bp

Question 20

lack perfusion on the other parts of the body for infants CHD

Answer 20

usually incontinent - check their diapers working harder than normal - sweating

anorexia
decreased u/o
sweating ( inappropriate )
weakness/fatigue

Question 21

chd : symptoms ( respiratory )

Answer 21

tatchypnea
dyspnea
flaring nares
wheezing
grunting

Question 22

this is more common in babies and not adults

Answer 22

nose flarring

Question 23

this is unique to babies - sound when they have hard time breathing

Answer 23

grunting

Question 24

true or false. usually babies do not make any noises, grunting, usually not making noises but resp distress usually will make sounds

Answer 24

true

Question 25

chd :the blue symptoms

Answer 25

wt gain peripheral edema ( esp perioribital ) neck vein distention ( children ) ascites

Question 26

all signs of fluid overload, when fluid is being retained when heart cannot keep up ( fluid leave blood vessels and go into third spacing )

Answer 26

weight gain and ascites

Question 27

CHD - diagnostic tests procedures for cardiac diagnosis

Answer 27

chest xray ecg encho exercise test cardaic mri cardaic catherization ( angio )

Question 28

what are the important points to remember

Answer 28

stressful ( for child and parent ) important to communicate information at an age appropriate level for child and parent/care giver

Question 29

child must stay still or most tests (what do we utilize)

Answer 29

immobilizers mild sedative psychological preparation distraction ( movie, music )

Question 30

the child is going to stay still in that time immobilizers with cloths and velcro they do not hurt the infants ( keep the limbs still ) need still so clearer image true or false?

Answer 30

true

Question 31

one of the complications of congenital heart defects is cyanosis or when the child suddenly turns blue due to lack of oxygen . Why is this occurring ?

Answer 31

this tends to happen when there are defects that reduce blood flow to the lungs or defects that cause a mixing of deoxygenated and oxygenated blood.

Question 32

what is this describing : hyper cyanotic spells or tet spells can occur suddenly . Is this true or false

Answer 32

true

Question 33

true or false. teralogy of the fallot happens when the baby is in distress?

Answer 33

true

Question 34

what is cyanotic episode referred to ?

Answer 34

hypercyanotic spells

Question 35

CHD - cyanosis when does this often occur ?

Answer 35

often occur during blood draw or iv insertion ( child is upset )

Question 36

how will the nurses manage chd - cyanosis management ( nursing intervention )

Answer 36

place infant in knee chest position administer 100 percent oxygen giver morphine remain calm

Question 37

why is the baby placed in a knee chest position during CHD - cyanosis

Answer 37

to reduce venous return to the leg which is desaturated

Question 38

this helps to keep the baby relax , its sedative and also causes significant vasodilation both the venous and arterial beds

Answer 38

morphine

Question 39

CHD : heart failure management goal of care : improve cardiac function what are the 3 meds

Answer 39

ace beta blockers digoxin

Question 40

improve cardiac function : when it comes to heart failure management : this is done primarily in the use of cardiac medication slows the heart rate and lower the blood pressure and together decrease the cardiac workload

Answer 40

true

Question 41

nursing care for chd : heart failure management : improve cardia function

Answer 41

dose calculation assess vital signs pre and post med admin monitor for digoxin toxicity assess patient response

Question 42

why would we check for dig toxicity?

Answer 42

because of the narrow theurepetic index

Question 43

what are the symptoms of dig toxicity

Answer 43

nausea, vomitting, as well as bradycardia and dysrthimias

Question 44

just read : it is important to watch the kids activity and energy level

Answer 44

true

Question 45

CHD: Heart failure management goals of care : remove excess fluid what are the interventions ?

Answer 45

diuretics fluid restriction na restricted diet

Question 46

what are the nursing care that undergoes removing excess fluid

Answer 46

dose calculation vital signs monitor ins and outs monitor weight

Question 47

CHD : Heart failure management goals of care : decrease cardiac demands when the heart is weak , we do not want to stress it: interventions and nursing care

Answer 47

keep infant temp normal treat infections reduce breathing effort ( semi fowlers ) sedate irritable child provide restful environment

Question 48

true or false. we do not want the baby to get cold, why is that ?

Answer 48

because babies will be using a lot of energy ( starts shivering ) more clothing and blanket and room is good temp

Question 49

it is important to treat infections when it comes to decreasing cardiac demands, why

Answer 49

as they occur, this is stressful for their system, more energy and co diligent - swelling, redness, this should be reportedly immediately

Question 50

why would we want the baby to be in a semi fowlers position to decrease cardiac demands

Answer 50

working hard to breathe- allow expansion - allows fluid to go at the bottom of the lungs instead of spread out on the back of the lung an reducing oxygen exchange

Question 51

how does sedation help for babies?

Answer 51

could help them relax and decrease workload on the heart

Question 52

chd : heart failure management goals of care : improve tissue oxygenation interventions and nursing care

Answer 52

monitor oxygen saturation administer supplemental oxygen as ordered ( cool humidity ) assess pt's response to oxygen reduce resp distress

Question 53

true or false. maintain mucous membrane by adding cool humidity when administering supplemental oxygen

Answer 53

true

Question 54

true or false. nutrition is often challenging -they lack energy an difficult time breathing , suck and usually starts crying- cant breathe

Answer 54

true

Question 55

what are the interventions for maintaining nutritional status

Answer 55

feed when well rested ( feed as soon as they wake up so they are well rested )

Question 56

true or false. frequent shorter feeds is recommended for babies. BONUS : WHY?

Answer 56

yes , because no longer than 30 minutes, harder to breathe if longer, give them breaks

Question 57

supplemental gavage feedings if required, when it comes to maintaining nutritional status

Answer 57

using ng tube into the stomach, and adminsitering formula that way

Question 58

why would we use calorie dense formula for babies when we want to maintain their nutritional status ?

Answer 58

because these babies have high metabolic rate, increase hr and resp rate

Question 59

CHD : surgical management. Is it true that Approximately 50% of children with a CHD will require some type of surgery. similar to adults what are we assesing for ?

Answer 59

this is true. bleeding and arthymias

Question 60

CHD : family education nurses will teach families how to manage at home what is it ?

Answer 60

medication ( esp signs of toxicity ) activity tolerance/rest nutrition ( high calorie needs ) signs of deterioration ( what to do )

Question 61

just read this : working or not working important to recognize : dig toxicity just like with adults : parents have to recongize too much and interventions to sit down for a while adn let heart recover balance diet and eduate calories ( hgih metbaollic needs ) what to do whentehh are not eating or dinrking who to contanct when to bring the child back further assesments : activity tolerance getting worse seeing more sob more coughing more any sign cardiac output is detrorating