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Pediatric

Congenital Heart Disease of Children

QuestionAnswer
Cardiac malformation occures during the first ____ weeks in utero 8
Name the 4 fetal circulation structures of the heart Foramen ovale, Ducus arteriosus, Ductus venosus and Umilical veins and arteries in the umbilical cord
An obstructive defect of the heart invoving localized narrowing of the Aorta Coarctation of the Aorta
Coarctaion of the Aorta causes the ____ ventricle to generate a high systolic pressure Left Ventricle - has to pump harder to try and get the blood through the narrowing of the Aorta
Coarctation of the Aorta has left ventricle increase or decrease afterload Increased
Which part of the body has hypertension with Coarctation of the Aorta; what Sx can you experience? Upper body - carotid pulses bounding, HA, Dizziness, epistaxis (nosebleed), fainting and potential for CVA
What are the manifestations of lower body Coarctation of the Aorta Hypotension of lower extremities, femoral pulses weak or absent, leg muscle cramp during exercise and lower extremities cool
a valvular heart disease caused by the incomplete opening of the aortic valve. Or narrowing/stricture of the Aortic valve. aortic valve stenosis
T/F aortic valve stenosis in children may be life threatening True Due to progressive rapid CHF - blood does not go anywhere They may have critical aortic stenosis-valve completly not functional->CHF
Most children with aortic stenosis have restricted activity b/c of potential for progressive stenosis and ____ sudden death
Which developmental alteration is most affected by congenital heart diseases (gross motor, fine motor, or cognitive) Gross motor - secondary to limited cardiac output b/c children lack energy and strength (cognitive impairment only if severe hypoxia)
____ complex is a complication R/T increased pulmonary blood flow Eisenmenger complex (left to right shunt)
When blood volume increases to the lungs (Eisenmenger complex), the pulmonary vessles do what hypertrophy, thicken, diminish in diameter, lose elasticity, increase resistance and cause pulmonary hypertension
What defects cause an increase in pulmonary blood flow ventricular septal defect; atrial septal defects and patent ductus arteriosus
Most common form of CHD? ventricular septal defect-the oxygenated blood goes back into Right ventricle from left
What direction of blood flow is ventricular or atrial septal defect shunted left to right (from higher to lower pressure)
A left to right shunt moves oxygenated or deoxygenated blood to the right ventricle oxygenated (returned to the right side of the heart to be carried back to the lungs)example is ASD
With increased pulmonary blood flow defects what happens to respirations and pulse increase
____ is the inability of the heart to pump an adequate amount of blood to the systemic circulation to meet the body's metabolic demands congestive heart failure
Manifestations of pulmonary congestion tachypnea(yes it's in the book), dyspnea, respiratory distress, exercise intolerance and cyanosis
manifestations of systemic venous congestive heart failure in children periorbital edema, weight gain!!!, ascites, hepatomegaly, neck vein distention (older child)
Manifestations of Congestive Heart Failure in infants: edema in periorbital and sacral area, diaphoresis at rest, retractions with grunting, and the !!!classic sign of poor feeding and failure to thrive!!!No Neck vein distention due to short fat neck!!!!
Maternal risk factors for congenital heart disease Maternal Illness--!!!rubella first 7 wks!!!, CMV, toxoplasmosis, viral illness, insulin dependent,Maternal drug use--drug therapy, fetal alcohol syndrome, Maternal age over 40yo
Genetic risk factors for congenital heart disease familial mother 16%, father 1-4%, and chromosomal aberrations like Down's Syndrome(90% have some type of heart problem)
How does a fever impact a child with congenital heart disease increase metabolic rate and oxygen demand
How does a respiratory infection affect a child with congenital heart disease hypoxemia in cyanotic child
vomiting and diarrhea affect a child with congenital heart disease loss of electrolytes = impaired myocardial performance. Potential for digitalis toxicity R/T hypokalemia. Dehydration = Thrombus formation with polycythemia.
CHF leads to decreased intake of ____? Prolonged length of time to feed due to trouble sucking breathing and swallowing simultaneously and ____ after taking small amout of feeding decreased intake of nutrients; falls asleep
Position an infant with CHF ____ during and 30 minutes after a feeding semiupright position (yes the notes came straight from the book - shouldn't it be fowlers or simi-fowlers? what exactly is simiuprigt??)
An infant with CHF needs to increase their caloric intake to ____calories per kg/day 150
Formula has how many clories per oz 24-30 calories per oz strategies concentrate formula; Polycose-1g carb load; MCT oil-Medium Chain FAtty Acid
It is important to remove fluid and sodium with congestive heart failure; how is this done diuretics (monitor output 1ml/kg/day min, monitor edema, and infants should have 6-8 wet diapers per day). Fluid restriction (except infants)-wt daily Also sodium restriction; no table salt; Avoid highly salty foods
How much weight gain should be reported for a child with congestive heart failure infant over 50 grams per day. children over 200 grams per day
How can tissue oxygenation be imporved for a child with congenital heart disease? Nurising interventions to help improve tissue oxygenation? cool humidified oxygen!!;Nursing interventions - Monitor respiratory rate 1 full min; Report signs of respiratory distress (tachypnea, dyspnea, nasal flaring, grunting, retractions); Monitor skin color, monitor 02 saturation
nursing actions for digoxin administration check dosage with another nurse, check apical pulse one full min., monitor for digitalis toxicity, serum digoxin level and serum potassium level
Withhold Digoxin if heart rate is too low - how low is too low for infants, young and older children? infants under 110, young child under 90, older child under 70
Infants rarely receive more than ____ml (0.05mg/1ml) of (Digoxin) in one dose - red flag if more one ml
Why is increased urine output a sign of Digoxin effeciveness better kidney perfusion
Terapeutic serum digoxin range 0.8 - 2.0 ng/ml
Signs of Digoxin toxicity Bradycardia, arrhythmia (may be only sign in children), Anorexia; !!!!N/V (RED FlAGS N & V)!!!
Which electroyte interferes with Digoxin too much K+ (hyperkalemia), a K+ losing diuretic will enhanse the effects of Digoxin
Do not administer Digoxin if missed more than ____ hours four hours Do not administer & do not increase the next dose, before that time go ahead and give the missed dose
T/F Lasix should clear adventitious lung sounds of a pt with congestive heart failure True - breath easier
When providing K+ to a child who has taken Lasix (K+ wasting diuretic), why would you mix with fruit juice disquise bitter taste and prevent GI problems
Ductus Arteriosus is a ____? Ductus Arteriosus is a fetal sturcture that closes after birth.
____ maintains the patency of the ductus arteriosus in preterm infants Prostaglandin - potent vasodilator (use b4 surgical intervention)
____ a prostaglandin inhibitor is given to preterm infants before 10 days old to close the ductus arteriosus Indomethacin - also ductus arteriosus benefit from Digoxin(digitalis) and diuretics
Why is it important to close the ductus arteriosus in a preterm infant before 10 days old #1 reson is to Prevent pulmonary hypertension - also - irreversible changes in the lungs and potential reversal of pressure
Mixed blood flow total anomalous pulmonary venous connection is when ____ connect to superior vena cava All four pulmonary veins (results in oxygenated blood being dumped into unoxygenated blood vena cava and mixed blood enters the right atrium
Mixed blood flow hypoplastic left heart syndrome is when the ____ is underdeveloped left ventricle
complications of cardiac catherization dysrhythmias, hemorrhage at the site or perforation during procedure, thrombosis, dehydration from volume deficit and infection
Why is it imortant to palpate pulses & check temperature distal to the cath site thrombosis - the extremity will be cool and pulses weak
If there is bleeding post cardiac cath, apply direct continuous pressure one inch above the insertion site for ____ minutes and notify ____ 10-15 minutes and notify cardiologist
Why is it important to monitor fluid needs carefully post cardiac cath inadeuate fluids could promote potential for thrombus formation
Tetralogy of Fallout (cyanotic heart defect) has 4 heart malformations which present together what are they ventricular septal defect (hole in septum), pulmonic stenosis (narrowing at pulmonic valve), overriding aorta (hole in septum just under the aortic valve), and right ventricular hypertrophy.
_____ spells is an abrupt occlusion of blood flow to lungs - typical in morning following crying, deficating and feeding hypercyanotic spells - causes a right to left shunt
Nursing mgs of a hypercyanotic spell place infant in knee-chest position immediately, comfort, administer 100% O2 face mask, Morphine to relax smooth muscles and dilate pulmonary blood vessel and decrease anxiety, and notify physician.
Why is it important maintain hydration for persistent hypoxemia of a cyanotic congenital heart disease pt? erythropoiesis (RBC production) is stimulated causing increased RBC (polycythemia) and increased blood viscosity, and risk for thrombus formation. (thick blood)
How much is too much chest tube drainage after cardiac surgery more than 3ml/kg/hr for 3 or more hours and more than 5mg/kg for any one hour. Also need to report less than 1ml/kg/hr urine output
Why is it important to wait 48 hours post-op to report elevated temperature The first 48 hours is due to inflammation, after 48 hours the inflammation goes down and that is about the time an infection causes a fever
What is the single most powerful nonpharmacologic method of pain relief available to the child Parents
why is it important to administer bacterial endocarditis prophylaxis after cardiac surgery? can cause bacteremia, an infection of valves and inner lining of the heart.
How is bacterial endocarditis prophylaxis tx administered after cardiac surgery 4-6 week IV antibiotics
What type of heart anatomic abnormalities->abnormal cardiac function are present at birth and may not be manifested for weeks or months? Cogenital heart defects
Aquired cardiac disorders have disease process related to what 4 things? 1. Infection 2. Autoimmune response 3. Environmental factors 4. Familial tendencies
What is the #1 most important things for pregnant moms to do for their baby? Have prenatal care
What are the two older classifications of CHD? Acyanotic-pink, some may become cyanotic Cyanotic-usually blue color-mucus membranes, nail beds, skin; some may be pink; may develop CHF
What does mixed blood mean? That Oxygenated and non oxygenated blood are mixed together
Obstructive Defects; Increased Pulmonary Blood Flow; Decreased Pulmonary Blood flow; & Mixed blood flow are all newer classifications of ____? These are Hemodynamic Alterations of CHD (congenital Heart Disease)
Coarctation of the aorta causes ___ pressure proximal to the defect (head/upper extremities) and ____ pressure distal to the obstruction (body/lower extremities). Coarctation of the aorta causes increased pressure proximal to the defect (head/upper extremities) and decreased pressure distal to the obstruction (body/lower extremities).
What are the obstructive defects of CHD? 1. Anatomic obstruction to blood flow out of the heart 2. Essentially acyanotic defects 3. There is no mixing of blood unless there is a coexisting lesion
How long do you need to take the pulse for in CHD? 1 FULL minute
The older child with ___ stenosis progressive; Mild-observe and do nothing; Moderate/severe - likely to develope obstruction. They have restricted activity bc of potential for progressive ___ & sudden death Aortic Senosis; bc of potential for progressive stenosis and sudden death
In CHD developmental alterations of Fine motor is ___ impaired? less impaired
IN CHD developmental alterations of Cognitive is most have ___ ability; Mental impairment with Certain ___ syndromes and SEVERE ____? Cognitive most have normal ability; mental impairment-certain genetic syndromes and SEVER HYPOXIA
In CHD it is important to promote normal ___ & ___ activities? social and physical
What do you want to encourage the parent of a child with CHD? May need referral to infant stimulation program; discourage overprotectiveness (no bubble); Encourage discipline/limit setting; Encourage play w/ other children; Help parents accept child's limits; Foster independence and promote self exteem
Open heart; Closed heart procedures; staged procedures are all surgical interventions for ___? CHD
It is important to prepare a preschooler for cardiac surgery by doing what? Gear to developmental level, simple concreate wording; Involve parents to promote security; Visit ICU at time of minimum activity; Equipment on doll-play sessions
___ is the abnormal connection between two sides of heart - either septum or great vessels? Congenital Heart Disease-Increased pulomanry blood flow
In Congenital heart disease left to right shunt -> increased blood vloume ___ heart? right
In what disorder is the movement of blood from systemic to pumonary circulation - more oxygenated blood, acynatic? Congenital heart disease
Pulmonary Congestion in congenital heart disease is r/t what 4 things? !!!Frequent respiratory infection!!! (stasis of blood); Congestive Heart Failure; Potential bacterial endocarditis; Progressive pulmonary vascular disease
___ is a complication r/t increased pulmonary blood flow (increased volume of blood to the lungs)? Eisenmenger Complex
In ____ complex their is a potential shunt reversal left to right shunt becomes a right to left shunt? Eisenmenger Complex
What do the pulmonary vessels due in Eisenmenger Complex? Pulmonary HTN!!!; Hypertrophy; Thicken; Diminished vessel diameter; Vessles lose elasticity due to constant pressure; and progressive increase plumonary vascular resistance
Manifestations of impaired myocardial function in Congestive Heart Failure in Children? TAchycardia, fatigue, weakness, pale cool extremities, decreased BP, Decreased Urine, Diopheresis, mottled skin
What are the 3 catagories of congestive heart failure in children? Impaired myocardial function; Pulmonary congestion; Systemic venous congestion
Cogenital Heart Disease Parental Coping--___ mother; ___effectively; Provide ___ information; Help family ___ with the effects of the disorder; __parent for what they do and give them resources. Reassure mother-not responsible for anomaly; prepare effectively-procedures, surgery, etc; provide consistent information; help family cope with the effects of the disorder; Praise pt for what they do and give them resources like support groups.
How can you help an infant with Congenital Heart disase minimize fatigue? Feed at first sign of hunger; feed no more than 30 mins at a time; Night feeding-IMPORTANT to meet metabolic needs; Promote rest before & after feeding; frequent, small feeding q3hrs; soft nipple-moderately enlarged hole; NG feeding may be necessary
How can you as a nurse decrease the workload of the heart (CHD pt) by providing neutral thermal environment. Give examples of how you can do this. Avoid extreme environmental temps; Monitor body temp q2-4 hrs; Hypothermia-blanket, radiant heater
How can you help prevent and treat infections of a CHD pt? report fever; handwashing; routine immunizations; antibiotics-existing infection or preventive before invasive procedures
How can you provide rest/decrease stimuli in a child with congenital heart disease to decrease workload of their heart? Organize care to provide frequent rest periods/sleep; anticipate child's needs; respond promptly to crying/distress; adjust physical activity as needed; decrease anxiety
Why should a pt with CHF/respiratory difficulties be in Semi-fowler's position? Stratiges for doing this? To prevent abdominal organs from exerting pressure on diaphragm, promote greater expansion of lungs, and reduce effort of breathing. Stratiges for doing this is to elevate HOB and Infant seat.
What is the normal potassium range? 3.5-5 mEq/L
____ is related to use of potassium-losing diuretic; enhances the effects of digoxin; and there is a potential for toxicity? Hypokalemia
What does digoxin do to the contraction of the heart? Digoxin slows and strengthens contraction of the heart
What do you need to teach a parent about giving digoxin to their children? Check dosage 2x, Timing-give @ regular intervals-usually q 12 hrs & give 1 hr before/2 hrs after feedings; Do not mix w/ food or fluid; use syringe not dropper in bottle; Admin carefully to side & back of mouth; Check appical pulse & call dr pulse too low
If a child vomits after digoxin is given what should you do? DO NOT Repeat giving the med;
When giving digoxin it is important to watch for __ and provide safety? toxicity
Lasix signs of effective response are: ___ urine output; ___ edema (eg periorbital, sacral); ___ wt; ___ of adventitious lung sounds? Increased urine output; Decreaced edema; Decreased wt; clearing of adventitious lung sounds
when giving lasix it is important to Monitor urine output ___ wet diapers/day; administration time with infants is it important; and to monitor for hypo or hyper kalemia? Monitor urine output 6-8 wet dipers/day; administration time-not as important with infants (adults morning); Monitor for HYPOkalemia-muscle weakness, fatigue, apathy, irritability
What foods can you find potassium in? oranges,bananas,grapefruit, prune juice, canned apricots, peaches, potatoes, carrots, milk
In CHD it is important to report signs of ___ & ___ to a physician? Signs of CHF and Signs of infection
What are some signs of CHF? Poor feeding; wt loss; periorbital edema; diaphoresis-espcially at rest; fewer than 6-8 wet dippers/day; pulmonary symptoms-grunting, retractions
What are some signs of infection? elevated temperature; respiratory infection
A failure for a fetal ductus to close results in _ to __ shunt through patent ducts. Blood enters from the ___ to the ___(mixes oxygen rich blood from the higher pressure ___ to the lower pressure ____ putting oxygen rich blood back into the lungs) Left to right shunt through patent ductus. From the Aortic Arch to the Pulmonary Artery (mixes oxygen rich blood from the higher pressure aorta to the lower pressure pulmonary artery putting oxygen rich blood back into the lungs)
In Utero the blood enteres the PA from the RV and is divereted through the ___ to the aorta; away from the nonfunctioning lungs? ductus arteriosus ONLY IN UTERO does the blood flow this way
A failure of the ductus arteriosus to close after birth results in increased volume of ____ blood that is recirulated to the lungs? oxygenated blood
What does a PDA mumer sound like? Where is it heard? It is continuous throughout ___ and ___? PDA murmur sounds Harsh, rumbling, machinery-ike murmur; heard in second left ICS-aortic; continuous throughout systole and diastole
CHF in PDA __ to ___ shunting: increased volume of blood is recirculated to the lungs and results in ___? left to right shunting-increased volume of blood is recirculated to the lungs; results in volume overload
Created by: cgwayland on 2008-06-11



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