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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
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