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Peds <3 Disorders

Early signs of CHF Tachycardia, tachypnea, profuse scalp diaphoresis, fatigue, irritability, sudden weight gain, respiratory distress
CHF Interventions I&O, daily weight, facial/dependent edema, lung souds, semi-Fowler's, decrease environmental stimuli, cool humidified O2, small, frequent feedings, sedation, digoxin, ACE inhibitors, Lasix, K+ supplements, limit fluids, monitor Na
Left sided failure symptoms Crackles, wheezes, cough, dyspnea, grunting (infants), head bobbing (infants), nasal flaring, orthopnea, periods of cyanosis, retractions, tachypnea
Right sided failure symptoms Ascites, hepatosplenomegaly, JVD, oliguria, peripheral edema, weight gain
Defects with increased pulmonary blood flow (Blood flow from L side to R side of heart; s/s of CHF)Atrial septal defect, atrioventricular canal defect, patent ductus arteriosus, ventricular septal defect
Atrial Septal Defect (ASD) Opening between the atria causing increased flow of oxygenated blood into the R side of the heart; R atrial and ventricular enlargement; s/s of decreased CO, maybe s/s of CHF. Tx: Cardiac cath, open repair with cardiopulmonary bypass
Atrioventricular canal defect Results from incomplete fusion of the endocardial cushions; associated with Down syndrome; murmur present; CHF s/s, cyanosis with crying, s/s decreased CO. Tx: Pulmonary artery binding or complete repair via cardiopulmonary bypass
Patent ductus arteriosus Ductus arteriosus (artery connecting aorta to PA) doesn't close; machinery-like murmur; asymptomatic or s/s of CHF, widened pulse pressure and bounding pulses, s/s of decreased CO; Tx: Indomethacin (indocin), prostaglandin inhibitor, cardiac cath, surgery
Ventricular septal defect Opening between the R and L ventricles; many close spontaneously in 1st year; murmur present; s/s of CHF and decreased CO. Tx: cardiac cath, open repair with cardiopulmonary bypass
Obstructive defects (Anatomical narrowing causes obstruction of blood flow; s/s of CHF, may be asymptomatic) Aortic stenosis, coarction of the aorta, pulmonary stenosis
Aortic stenosis Narrowing or stricture of the aortic valve; results in decreased CO, L ventricular hypertrophy, pulmonary vascular congestion; murmur, s/s decreased CO, exercise intolerance, chest pain, dizziness. Tx: Cardiac cath, aortic valvotomy, valve replacement
Coarctation of the aorta Localized narrowing; BP higher in upper extremities than lower; s/s CHF and decreased CO; HA, fainting, epistaxis. Tx: balloon angioplasty, mech vent and meds to ^CO, resection, graft
Pulmonary stenosis Narrowing at entrance of PA causing R ventricular hypertrophy and decreased pulm bloodflow; murmur, cyanosis, s/s of decreased CO, s/s CHF. Tx: cardiac cath, valvotomy
S/S of decreased CO Decreased peripheral pulses, exercise intolerance, feeding difficulties, hypotension, irritability, restlessness, lethargy, oliguria, pale/cool extremeties, tachycardia
Defects with decreased pulmonary blood flow (Obstructed pulm bloodflow and a defect- ASD or VSD- between the L and R side are present; pressure on R side increases, exceeding the L side; desaturated blood shunts R to L. Hypoxemia, cyanosis). Tetralogy of Fallot, tricuspid atresia
Tetralogy of Fallot VSD, pulmonary stenosis, overriding aorta, and R ventricular hypertrophy. Murmur, cyanosis ("blue spells" or "tet spells" relieved by squatting), poor growth, clubbing. Tx: palliative shunt; complete repair in 1st year
Tricuspid atresia Failure of tricuspid valve to develop; no connection between R atrium and ventricle, blood flows through ASD or patent foramen ovale to L side and a VSD to the R ventricle; results in mixing of unO2 and O2 blood in L side
Tricuspid atresia s/s and Tx Systemic desaturation, pulmonary obstruction, decreased pulmonary blood flow, cyanosis, tachycardia, dyspnea, chornic hypoxemia, clubbing. Tx: cardiac cath, surgery
Mixed defects (Sat and unsat blood mix, causing system desaturation; pulm congestion, CO decreases, CHF s/s) Hypoplastic L heart syndrome, total anomalous pulmonary venous connection, transposition of the great arteries, truncus arteriosus
Hypoplastic left heart syndrome L side underdeveloped resulting in hypoplastic L vent and aortic atresia; cyanosis s/s CHF until ductus arteriosus closes then cyanosis worsens and CO is decreased leading to death unless treated. Tx: mech vent, prostaglandin (keep PDA open), transplant
Transposition of the great arteries PA w/ L ventricle, aorta w/ R ventricle; no connection between systemic and pulmonary circulation; severely cyanotic, cardiomegaly; septal defect or PDA allow communication. Tx: prostaglandin, balloon atrial septostomy during cardiac cath, surgery
Total anomalous pulmonary venous connection Pulmonary veins don't connect to R atrium, results in mixed blood returning to R atrium and shunting from R to L through ASD; R side hypertrophies, L side small; s/s CHF, cyanosis. Tx: corrective repair,
Truncus arteriosus Failure of normal separation and division of bulbar trunk into pulmonary artery and aorta; blood from both ventricles mixes; desaturation, hypoxemia, murmur, cyanosis CHF, poor growth, activity intolerance. Tx: surgery
Cardiovascular defects interventions Vitals, respiratory status (nasal flaring, accessory muscles, crackles, rhonchi, wheezes), reverse Tredelenburg, O2, ET tube, s/s of CHF, fluid restrictions, high-calorie diet, max rest, cardiac cath
Rheumatic Fever Inflammatory autoimmune disease; affects connective tissue of heart, joints, subq tissues, and blood vessels of CNS; manifests 2 wks after strep infection
Rheumatic Fever Assessment Low-grade fever that spikes in later afternoon, ^ antistreptolysin O titer, ^ ESR, ^ C-reactive protein, Aschoff bodies
Rheumatic Fever Interventions Vitals, control joint pain w/ massage and hot and cold, bed rest, penicillin, salicylates, anti-inflammatory agents, seizure precaustions
Kawasaki Disease Acute systemic inflammatory illness; aneurysms can develop
Kawasaki disease acute stage Fever, conjunctival hyperemia, red throat, swollen hands, rash, enlargement of cervical lymph nodes
Kawasaki disease subacute state Cracking lips/fissures, desquamation of skin on fingers and toes, joint pain, cardiac manifestations, thrombocytosis
Kawasaki disease convalescent stage Child appears normal, but signs of inflammation my be present
Kawasaki disease interventions Temp, assess heart sounds, rate, rhythm, edema, strict I&O, soft foods and liquids (not too hot or cold), daily weights, passive ROM, aspirin, immunoglobulin IV
Created by: kahadzima1