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Peds Exam 3
Cardiovascular Dysfunction day 1 pt 1
| Question | Answer |
|---|---|
| Cardiovascular Disorders in Children | Congenital Heart Defects (CHD) Acquired Heart Disease |
| Congenital Heart Defects (CHD) | structural abnormalities that are present at birth, symptoms aren't always present but the deformity is still there |
| Heart Development begins to form by | 3rd week gestation |
| when does heart conduction start | it starts beating on day 22 |
| when do valves form | 4-5th week |
| when is heart development completed by | 8th week |
| heart <7 years | heart more horizontal Apex higher in chest Below 4th intercostal space is where you listen and affects where you place EKG |
| Fetal Circulation bypasses | fetal liver and lungs |
| what supplies O2 and removes CO2 | placenta |
| fetal shunts | Fetal ductus venosus Foramen ovale Ductus arteriosus |
| lungs inutero | Collapsed lungs- high pulmonary resistance |
| what side of the heart has more pressure inutero | R>L |
| resistance | amount of force the heart has to work against to get blood to flow somewhere |
| what are the chambers of the heart separated by | septum |
| prostaglandins at birth are generally | low |
| prostaglandins at birth in premies are | high which cause shunts to remain open |
| ductus venosus | umbilical cord to IVC |
| foramen ovale is | between RA and LA |
| ductus arteriosis | pulmonary aorta to aorta |
| cessation of placental blood flow is caused by | clamp of umbilical cord |
| beginning of respiration causes | Lowers pulmonary vascular resistance (PVR) Pressures begin to change |
| what side of the heart has more pressure after birth | L>R |
| where does the left side of the heart bring blood to | body |
| where does the right side of the heart bring blood to | heart |
| what is blood shunting | too much blood going to 1 area, decreases blood flow to other places |
| changes at birth | Cessation of placental blood flow Beginning of respiration Systemic & pulmonary circulations distinct Pressure on L > R |
| what keeps ductus arteriosus open? | Prostaglandin E1 (PGE1)- vasodilator |
| Reopening Ductus Arteriosus | Lifesaving in neonates with ductal- dependent cardiac lesions Only way to get blood to either the lungs or body |
| critical heart defect requires | surgery within year and if they don't get that surgery they are incompatible with life |
| congenital heart defects | Anatomic structural heart abnormality- alters blood flow |
| shunt | abnormal blood flow |
| influences of congenital heart defects | genetic and environmental (like moms lifestyle during pregnancy) influences family history |
| etiology of CHD | unknown, but large genetic component and other congenital anomalies |
| increased morbidity and mortality with CHD | Premature Low birth weight Genetic syndrome Multiple cardiac defects Age at time of surgery |
| mortality of congenital heart defects | <10% |
| complications of congenital heart defects | Heart failure Hypoxemia Growth delay Developmental delay Pulmonary vascular disease |
| #1 most common birth defect | congenital heart disease |
| hemodynamics blood flow components | pressure resistance |
| hemodynamics blood flow pressure | blood flows from high pressure to low pressure greater pressure gradient (difference) - faster the flow/more blood into area |
| hemodynamics blood flow resistance | blood takes path of least resistance higher resistance- slower rate of flow |
| components of altered blood flow in CHD | open shunts narrowed passage causing increase resistance |
| altered blood flow in CHD- opening between atrium or ventricles | Blood shunts (flows) from left to right Ventricular defect worse than Atrial |
| altered blood flow in CHD- opening between oorta and PA | blood shunts from systemic to pulmonary |
| altered blood flow CHD if narrowing that causes increased resistance | blood backs up before obstruction blood flow decreases beyond obstruction |
| what is an example of a narrowing | stenosis |
| what trumps pressure | resistance! |
| if there is a defect where pressure is higher in aorta, where does blood go | from aorta to pulmonary artery to lungs |
| if there is a septal defect, where does the blood go | left side of heart to right side |
| Classification of CHD: Hemodynamic characteristics that defects can cause | increased pulmonary blood flow decreased pulmonary blood flow obstruction of blood flow (decreased pulmonary or systemic blood flow) mixed blood flow |
| defects that increase pulmonary blood flow | Patent ductus arteriosus (PDA) Atrial septal defect (ASD) Ventricular septal defect (VSD) Atrioventricular canal (AV canal) |
| defects that cause increased pulmonary blood flow are causes by | Communication along septum or abnormal connection between great arteries (PA and aorta) |
| in defects that cause increased pulmonary blood flow, blood flows from | high pressure on left side to low pressure on right increased blood flow to right |
| defects that cause increased pulmonary blood flow can lead to | pulmonary congestion which can possibly lead to HF |
| symptoms of increased pulmonary blood flow defects | Tachypnea →dyspnea →pulmonary edema Recurrent respiratory infections Rales/crackles or wheezes Pulmonary hypertension and vasoconstriction Increased calorie expenditure Feeding issues Poor weight gain –Failure to thrive (FTT) |
| what syndrome can result from defects that cause increased pulmonary blood flow | Eisenmenger Syndrome |
| Patent Ductus Arteriosus (PDA) is the | Failure of ductus arteriosus to close |
| Patent Ductus Arteriosus (PDA) causes | Increased blood flow to lungs |
| Patent Ductus Arteriosus (PDA) connects | PA and aorta |
| Patent Ductus Arteriosus (PDA) is common in | KNOW premature babies because prostaglandin levels never dropped and O2 is low |
| nursing assessment for Patent Ductus Arteriosus (PDA) is dependent on | size |
| what to assess for in Patent Ductus Arteriosus (PDA) | Asymptomatic to HF Machinery-like murmur Cardiomegaly Widened pulse pressure Bounding peripheral pulses Respiratory insufficiency- tachypnea, dyspnea Possible Failure to thrive (FTT) |
| why are there Bounding peripheral pulses in Patent Ductus Arteriosus (PDA) | because body is trying to compensate for increased runoff |
| why is there a widened pulse pressure in Patent Ductus Arteriosus (PDA) | blood flow out of aorta is running off into pulmonary artery |
| PDA Management of a newborn | KNOW Indomethacin (prostaglandin inhibitor) Ibuprofen (NSAID) |
| what does Indomethacin do | allows ductus arteriosus to close |
| side effects of meds | everyone cannot receive meds |
| if all other treatment fails for newborn with PDA, | use acetaminophen |
| PDA management: Occlusion during interventional catheterization | Coil within vessel- if small Plug- shaped device- if larger |
| PSA management: surgical | Ligation Visual/video assisted thoracic surgery (VATS) |
| Atrial Septal Defect (ASD) is a | minor heart defect |
| Atrial Septal Defect (ASD) | Hole in septum between L and R atria Blood shunts left to right |
| Atrial Septal Defect (ASD) is | asymptomatic because not very high of blood flow |
| nursing assessment of Atrial Septal Defect (ASD) | Often asymptomatic except murmur HF- Rare |
| nursing management of Atrial Septal Defect (ASD) | Monitor Closure during interventional cardiac cath Open heart surgery- rarely done now |
| what to monitor for in Atrial Septal Defect (ASD) | Small ASD’s close on their own May cause problems in adulthood if left untreated |
| open heart surgery for Atrial Septal Defect (ASD) | Patch procedure (pericardial patch or Dacron patch) for large defects Usually done before school age (if necessary) |
| how long to wait to surgically close ASD | 3 years |
| small ASDs usually close on their own by | 18 months |
| Ventricular Septal Defect (VSD) is the most common | CHD in children |
| Ventricular Septal Defect (VSD) | Abnormal septal opening between R and L ventricles Blood shunts L to R into pulmonary artery so increased blood flow to lungs |
| Ventricular Septal Defect (VSD) symptoms are | severe because there is higher pressure gradient |
| nursing assessment for Ventricular Septal Defect (VSD) depends on | location and size |
| nursing assessment for Ventricular Septal Defect (VSD) | holosystolic murmur pulmonary congestion-> RV hypertrophy-> HF failure to thrive (FTT) |
| children with Ventricular Septal Defect (VSD) do | good for first few weeks and then they start to get symptoms |
| holosystolic murmur in Ventricular Septal Defect (VSD) | loud, harsh at left sternal border louder with small defect |
| Ventricular Septal Defect (VSD) management | monitor surgical closure palliative- PA banding |
| Ventricular Septal Defect (VSD): monitor | Without worsening symptoms Small to moderate- may close on own (20-60%) |
| Ventricular Septal Defect (VSD): surgical closure | Moderate/large defects with persistent signs of compromise |
| Ventricular Septal Defect (VSD): palliative PA banding | If have other defects Temporary fix until complete surgical repair |
| Atrioventricular Septal Defect AV Canal | Endocardial cushion does not form properly Opening between atrial and ventricular septum - can be 1 big hole or 2 separate holes |
| Atrioventricular Septal Defect AV Canal is common with | Down syndrome |
| Atrioventricular Septal Defect AV Canal results in | increased circulation of blood to lungs |
| in Atrioventricular Septal Defect AV Canal, | blood shunts left to right |
| Atrioventricular Septal Defect AV Canal leads to | respiratory issues and heart failure, FTT |
| management of Atrioventricular Septal Defect AV Canal | Surgery 3-6 months complete AV canal Surgery 6-18 months partial |
Created by:
leh195