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DSCC Peds Cardio
DSCC Pediatric Cardiovascular Dysfunction
| Question | Answer |
|---|---|
| In infants and children, the heart lies more _______________ in the chest. | Horizontally |
| The apex of the heart extends into the _____ intercostal space until the age of 7. | 4th |
| Fetal oxygenation of blood occurs in the ___________. | Placenta |
| The heart develops between __________ gestation. | 4-8 weeks |
| Fetal vascular resistance is _________. | High |
| The __________ __________ allows blood to flow from R atrium to L atrium. | Foramen ovale |
| The _________ _________ shunts blood from the pulmonary artery to the descending aorta. | Ductus arteriosus |
| The _________ _________ shunts most of the blood supply around the fetal liver. | Ductus venosus |
| As the lungs expand at birth, _________ of the pulmonary vessels & _________ pulmonary vascular resistance occurs. | Dilation; decreased |
| When the umbilical cord is clamped, an _________ in the systemic vascular resistance occurs causing an increased pressure on the _________ side of the heart. | Increase; left |
| Closure of the foramen ovale usually occurs _____________________. | Shortly after birth |
| Closure of the ductus arteriosus usually occurs _____________________. | 2-3 weeks after birth |
| After birth, the _________ _________ enlarges d/t increased pressure. | Left ventricle |
| Acyanotic | Congenital abnormalities of the heart in which mainly oxygenated blood enters the systemic circulation |
| Shunt from LEFT--->RIGHT side of the heart, therefore reoxygenating blood. | Acyanotic |
| Cyanotic | Abnormalities in which deoxygenated blood mixes with oxygenated blood and enters the systemic circulation |
| Shunt from RIGHT--->LEFT side of heart, therefore deoxygenated blood because systemic blood bypasses the lungs and is ejected into the aorta. | Cyanotic |
| This measures the amount of O2 available for tissue delivery: | Pulse oximetry |
| O2 sat should be | 95%-100% |
| Low O2 means | Hypoxia (a reduction of O2 supply in the tissues) |
| Chronic hypoxia leads to: | Polycythemia (an excess of RBCs) |
| Why is there little cardiac reserve (the work that the heart is able to perform beyond that required of it under ordinary circumstances) during infancy? | Muscle fibers cannot expand and stretch to increase stroke volume (the amt of blood ejected from the L ventricle during each heartbeat) |
| How is cardiac output (CO) determined? | HR x SV = CO (heart rate & stroke volume |
| Infants can't vary _____ so they increase _____ to increase _____. | SV; HR; CO |
| Pediatric indicators of cardiac dysfunction: | -Poor feeding -Tachypnea/tachycardia -Failure to thrive/poor weight gain/activity intolerance -Developmental delays -+Prenatal hx -+Family hx of cardiac dz |
| This is done for dx and tx of cardiac dysfunctions: | Cardiac catheterization |
| Educational topics for parents c cardiac catheterization: | -Invasive procedure=informed consent -Child(pt) will be NPO 4-6 hrs prior -Child(pt) will need to remain very still --->"sandbag" |
| Pre-procedural nursing care for cardiac catherterization: | -Assess for allergies -Mark location of pedal pulses with an "X" |
| Post-procedural nursing care for cardiac catheterization: | -VS -Dressings -Fluid intake (strict I & O because dye has a strong diuretic effect) -Blood glucose levels (because pt has been NPO) |
| Increased Pulmonary Blood Flow Defects: | -Patent ductus arteriosis (PDA) -Atrial septal defect (ASD) -Ventricular septal defect (VSD) -Atrioventricular canal defect (AV Canal) |
| Untreated pulmonary overcirculation leads to: | -CHF -Pulmonary HTN -Eventually death |
| Increased pulmonary blood flow defects result from: | Abnormal connection between two sides of heart (either septum or great vessels) |
| Increased pulmonary blood flow defects lead to _________ blood volume on the ________ side of the heart. | Increased; right |
| Decreased systemic blood flow happens as a result of: | Increased pulmonary blood flow defects |
| Patent Ductus Arteriosus (PDA) | Failure of fetal ductus arteriosus to close within 2-3 weeks after birth |
| Allows oxygenated blood to shunt from the AORTA (high pressure) to the PULMONARY ARTERY (low pressure) | Patent Ductus Arteriosus (PDA) |
| S/S of Patent Ductus Arteriosus (PDA) (depending on the size of shunt): | -May have no symptoms -Show S/S of CHF -MACHINERY-LIKE MURMUR -WIDENED PULSE PRESSURE (range between SBP & DBP) -Bounding pulses |
| Dx of Patent Ductus Arteriosus (PDA): | -CONTINUOUS MACHINERY-LIKE MURMUR -Echocardiogram (ultrasound of heart) |
| Medication for tx of Patent Ductus Arteriosus (PDA): | Indomethacin (prostaglandin inhibitor) (Indomethacin works by causing the PDA to constrict, and this closes the blood vessel.) |
| Tx for Patent Ductus Arteriosus (PDA): | -Surgical LIGATION of patent vessel (thorascopic) -Nonsurgical: placement of COILS to occlude PDA via cath |
| Atrial Septal Defect (ASD): | Abnormal connection between the left & right atrium |
| Allows oxygenated blood to shunt from LEFT ATRIUM ---> RIGHT ATRIUM (d/t increased pressure in the left side) | Atrial Septal Defect (ASD) |
| Atrial Septal Defect (ASD) leads to: | INCREASED: -VOLUME on the RIGHT side -SIZE of RIGHT ATRIUM & VENTRICLE -SIZE of PULMONARY ARTERY |
| S/S of Atrial Septal Defect (ASD): | -May have no symptoms -CHF -SYSTOLIC MURMUR WITH FIXED SPLIT 2ND HEART SOUND |
| Dx testing for Atrial Septal Defect (ASD): | -Chest X-ray -Echo -Cardiac cath -ECG |
| Tx of small Atrial Septal Defect (ASD): | Surgical patch closure |
| Tx of large Atrial Septal Defect (ASD): | Open repair c CARDIOPULMONARY BYPASS BEFORE SCHOOL AGE |
| Ventricular Septal Defect (VSD): | Abnormal connection between the right and left ventricles |
| Oxygenated blood shunted from LEFT VENTRICLE--->RIGHT VENTRICLE | Ventricular Septal Defect (VSD) |
| Ventricular Septal Defect (VSD) leads to: | -LEFT HEART ENLARGEMENT -PULMONARY VENOUS CONGESTION |
| S/S of Ventricular Septal Defect (VSD): | -CHF (common) -HOLOSYSTOLIC MURMUR @ LEFT LOWER STERNAL BORDER -Failure to thrive -Tachypnea/dyspnea |
| With Ventricular Septal Defect (VSD), there is an increased risk for: | -BACTERIAL ENDOCARDITIS -Pulmonary vascular obstructive dz |
| Dx testing for Ventricular Septal Defect (VSD): | -Chest X-ray (showing cardiomegaly & increased pulmonary blood flow) -Echo |
| Tx for Ventricular Septal Defect (VSD): | -Palliative: pulmonary artery banding -Surgical: Dacron patch (preferred) -Prophylactic: antibiotics to prevent ENDOCARDITIS |
| Atrioventricular Canal Defect (AV-Canal): | Incomplete fusion of septum in the atrium and ventricle; also involves AV valves: creates a large central AV valve that allows blood to flow between all 4 chambers of the heart |
| This is a common cardiac defect in infants with DOWN SYNDROME: | Atrioventricular Canal Defect (AV-Canal) |
| S/S of Atrioventricular Canal Defect (AV-Canal): | -Moderate-severe CHF -Loud systolic murmur -MILD CYANOSIS WITH CRYING |
| Tx for Atrioventricular Canal Defect (AV-Canal): | -SYMPTOMATIC TX OF CHF PRIOR TO SURGERY -Surgery: complete repair with patch WITHIN 1ST YEAR OF LIFE |
| Decreased Pulmonary Blood Flow Defects: | -Pulmonic Stenosis (PS) -Tetralogy of Fallot (TOF) -Pulmonary or tricuspid atresia |
| Increases the workload on the heart and can lead to CHF: | Decreased Pulmonary Blood Flow Defects |
| In Decreased Pulmonary Blood Flow Defects, if septal opening is present, higher pressures lead to ________ __ ________ shunting of blood, which leads to cyanosis. | RIGHT-TO-LEFT |
| Pulmonic Stenosis (PS): | Narrowing of the entrances to the pulmonary artery |
| Causes resistance of blood flow that leads RIGHT VENTRICULAR HYPERTROPHY & decreased pulmonary blood flow | Pulmonic Stenosis (PS) |
| S/S of Pulmonic Stenosis (PS): | -May have no symptoms -MILD CYANOSIS -WITH SEVERE IN NEWBORNE: LOUD MURMUR AT UPPER LSB & CYANOSIS -WITH SEVERELY ILL: MURMUR MAY BE SOFT D/T DECREASED CO |
| Dx testing for Pulmonic Stenosis (PS): | -Chest X-ray (cardiomegaly) -Echo |
| Meds for Pulmonic Stenosis (PS): | PROSTAGLANDINS (to maintain patency of DA in critical pts |
| Transventricular (closed) valvotomy (Brock Procedure): | Surgical tx for INFANTS with Pulmonic Stenosis (PS) |
| Pulmonary valvotomy c cardiopulmonary bypass: | Surgical tx for CHILDREN with Pulmonic Stenosis (PS) |
| The 4 defects that make up Tetralogy of Fallot (TOF): | -Ventricular septal defect (VSD) -Pulmonic stenosis (PS) -Right Ventricular Hypertrophy -Overriding Aorta |
| Tetralogy of Fallot (TOF): | Deoxygenated blood shunted through VSD directly into the AORTA leading to INCREASED RIGHT VENTRICULAR PRESSURE |
| In Tetralogy of Fallot (TOF), the amt of pulmonary blood flow and degree of cyanosis depends on _____________________________. | The severity of the pulmonic stenosis |
| S/S of Tetralogy of Fallot (TOF): | -Cyanotic OR acyanotic -Loud systolic murmur -HYPERCYANOTIC EPISODES ("TET SPELLS") during activity, crying or feeding |
| Dx of Tetralogy of Fallot (TOF): | -Chest X-ray (BOOT-SHAPED HEART) -Echo |
| Tx during TET SPELL in Tetralogy of Fallot (TOF): | -Infants: place them in knee-chest position -Children: may squat |
| Tx for Tetralogy of Fallot (TOF): | -Palliative: BLALOCK-TAUSSING SHUNT to assure pulmonary blood flow until surgery -Surgical: Complete repair involving closure of VSD, resection of the infundibular stenosis with pericardial patch placement to enlarge the right ventricular outflow tract |
| Tricuspid Atresia: | Tricuspid valve fails to develop leading to no communication between R atrium & R ventricle |
| Blood flows through the ASD or a PFO to the LEFT side of the heart & through a VSD to the RIGHT VENTRICLE & out to the LUNGS | Tricuspid Atresia |
| Tricuspid Atresia leads to: | COMPLETE MIXING of deoxygenated and oxygenated blood in the LEFT SIDE OF THE HEART |
| S/S of Tricuspid Atresia: | -Cyanosis -Tachycardia -Dyspnea -CLUBBING & HYPOXEMIA IN OLDER CHILDREN |
| Meds for Tricuspid Atresia: | -Continuous in fusion of PROSTAGLANDIN E1 (to keep PDA open until surgery) -Digoxin -Diuretics |
| Mixed Defects: | -Transposition of Great Arteries/Vessels |
| Transposition of Great Arteries/Vessels: | The great vessels (AORTA & PULMONARY ARTERY) are transposed or reversed |
| The PULMONARY ARTERY leaves the LEFT VENTRICLE & the AORTA exits from the RIGHT VENTRICLE---> 2 CLOSED CIRCULATION PATHWAYS | Transposition of Great Arteries/Vessels |
| _________ to _________ shunt occurs in Transposition of Great Arteries/Vessels. | RIGHT; LEFT |
| S/S of Transposition of Great Arteries/Vessels: | -Cyanosis -NOT RESPONSIVE TO O2 -Progressive cyanosis-->hypoxia-->acidosis -CHF -Cardiomegaly |
| Dx of Transposition of Great Arteries/Vessels: | -CLINICAL PRESENTATION (giving 100% O2 & pt not showing any improvement) -Echo -Cath |
| Tx of Transposition of Great Arteries/Vessels: | -Stabilize infant -MECHANICAL VENTILATION -Prostaglandin (to promote retrograde flow through PDA) -Surgical: arterial switch procedure performed in 1st weeks of life |
| Defects that Obstruct Systemic Blood Flow: | -Aortic Stenosis (AS) -Coarctation of the Aorta (COA) -Hypoplastic Left Heart Syndrome (HLHS) |
| Increase workload on one or both ventricles, leading to CHF if untreated: | Defects that Obstruct Systemic Blood Flow |
| Aortic Stenosis: | Stricture of the AORTIC valve |
| Causes resistance to blood flow in LEFT VENTRICLE, decreased CO, LEFT VENTRICULAR HYPERTROPHY & pulmonary vascular congestion: | Aortic Stenosis |
| S/S of Aortic Stenosis: | -SYSTOLIC EJECTION MURMUR -FATIGUE & SYNCOPE -DECREASED PULSE PRESSURE -POOR FEEDING HYPOTENSION |
| Dx of Aortic Stenosis: | -Chest X-ray -Echo (to measure) |
| BALLOON DILATION IN CATH: | 1ST LINE TX for Aortic Stenosis |
| Coarctation of the Aorta (COA): | Localized narrowing near the insertion of the ductus arteriosus |
| Results in increased pressure PROXIMAL TO THE DEFECT (HEAD & UPPER EXTREMITIES) & decreased pressure DISTAL to the OBSTRUCTION (BODY & LOWER EXTREMITIES): | Coarctation of the Aorta (COA) |
| Collateral circulation _________ the coarcted area to supply blood to the _________ extremities. | Bypasses; lower |
| In Coarctation of the Aorta (COA), LEFT VENTRICULAR PRESSURE & workload are _________. | Increased |
| Resistance of blood flow OUT of the LEFT VENTRICLE--->LEFT VENTRICLE HYPERTROPHY: | Coarctation of the Aorta (COA) |
| S/S of Coarctation of the Aorta (COA): | -CHF -SEVERE ACIDOSIS -Hypotension in INFANTS -WEAK-ABSENT FEMORAL PULSES -Systolic murmur -Hypertension in UPPER EXTREMITIES -LOWER BP IN LOWER EXTREMITIES -Fatigue -HA -LEG CRAMPS -SHOCK -RUPTURED AORTA -AORTIC ANEURYSM -STROKE |
| Dx of Coarctation of the Aorta (COA): | -Clinical exam -Echo -ASSESS BP IN RIGHT ARM & ONE OF THE LOWER EXTREMITIES -MRI (to examine collateral circulation) |
| Important consideration for post-op of repair of Coarctation of the Aorta (COA): | -MUST CONTROL POST-OP HTN (IV: Milrone, sodium nitroprusside; PO: ACE inhibitors or beta-blockers) |
| Hypoplastic Left Heart Syndrome (HLHS): | Underdevelopment of the LEFT side of the heart |
| Hypoplastic LEFT VENTRICLE & AORTIC ATRESIA that is NOT capable of cardiac fx: | Hypoplastic Left Heart Syndrome (HLHS) |
| S/S of Hypoplastic Left Heart Syndrome (HLHS): | -Cyanotic WITHIN HOURS OF BIRTH -CARDIAC COLLAPSE |
| Tx for Hypoplastic Left Heart Syndrome (HLHS): | -Prostaglandin (to maintain ductal patency & ensure systemic blood flow) -Surgery: multi-step approach; cardiac transplant |
| Pulmonary Artery HTN: | A group of rare disorders that result in an elevation of pulmonary artery pressure |
| S/S of Pulmonary Artery HTN: | -Dyspnea c exercise -Chest Pain -Syncope |
| Viagra: | A drug used in the tx of Pulmonary Artery HTN |
| Management of Pulmonary Artery HTN: | -Symptomatic -Supplemental O2 -Vasodilators -Oral calcium channel blockers |
| Bacterial/Infective Endocarditis: | Inflammation of the lining, valves & arterial vessels of the heart. |
| Bacterial, enterococci & fungal infections: | Causes of Bacterial/Infective Endocarditis |
| S/S of Bacterial/Infective Endocarditis: | -Fever -Fatigue -MUSCLE ACHES -NEW OR CHANGING MURMUR -S/S of CHF |
| Tx of Bacterial/Infective Endocarditis: | -Antibiotics/antifungals: 2-8 week therapy -Tx CHF if present -ASSESS VALVE DAMAGE (valve replacement may be needed) -Prophylaxis: 1 hour before procedures (IV or may use PO in some cases) -Look for "VEGETATION" when doing an echo |
| Rheumatic Fever (RF): | Inflammatory dz that occurs after Group-A streptococcal pharyngitis (Strep throat) |
| Affects JOINTS, SKIN, BRAIN, SEROUS SURFACES & HEART: | Rheumatic Fever (RF) |
| What is the most common complication of Rheumatic Fever (RF)? | Rheumatic Heart Dz (RHD) |
| Rheumatic Heart Dz (RHD): | Causes damage to the heart valves as a result of Rheumatic Fever (RF) |
| S/S of Rheumatic Fever (RF): | -RASH on TRUNK & proximal part of extremities -ASHCROFT BODIES: inflammed lesions in CONNECTIVE TISSUE |
| Dx of Rheumatic Fever (RF): | -Based on JONES CRITERIA: The presence of 2 or more major signs & evidence of a recent streptococcal infection |
| Management of Rheumatic Fever (RF): | -Eradication of hemolytic streptococcus -Prevention of permanent cardiac damage -Palliation of other symptoms -Prevention of recurrence of Rheumatic Fever (RF) |
| Prevention of Rheumatic Heart Dz (RHD): | -Tx of strep: -Penicillin G, IM x 1 -Penicillin V, PO x 10 days -Sulfa, PO x 10 days -Erythromycin (if allergic to above), PO x10 days |
| Tx of Rheumatic Fever (RF): | -Antibiotics for strep -Aspirin for carditis/inflammation -Steroids -Long-term antibiotic prophylaxis |
| Most children ________ ________ from Rheumatic Fever (RF). | Recover fully |
| Nursing Interventions for Rheumatic Fever (RF): | -Prevention (throat cultures, completion of antibiotic regimen) -Monitor temp -Bed rest -Admin meds -Home teaching |
| Kawasaki Dz | Monocutaneous lymph node syndrome; acute systemic vasculitis of unknown cause |
| 75% of cases of Kawasaki Dz are in children under age ____. | 5 |
| In Kawasaki Dz, there is an increased risk of _________ _________ _________. | Coronary artery aneurysm |
| Common in children of Asian or Pacific Island descent: | Kawasaki Dz |
| S/S of Kawasaki DZ: | -In extremities: EDEMA, ERYTHEMA,PEELING OF HANDS & FEET -BILATERAL CONJUNCTIVAL INFLAMMATION -In oral mucous membranes: ERYTHEMA OF LIPS, OROPHARYNGEAL REDDING ("STRAWBERRY TONGUE") -Polymorphous rash: on body, palms of hands & soles of feet |
| One lymph node larger than 1.5 cm; seen in Kawasaki Dz: | Cervical lymphadenopathy |
| Tx of Kawasaki Dz: | -IV Immunoglobulins (IVIB, IVIG) -Aspirin |
| Why is the initial dose of aspirin given to a pt with Kawasaki Dz & why is it continued afterward? | -Anti-inflammatory dose initially -Antiplatelet dose after fever decreases |
| What should the nurse monitor for in a pt with Kawasaki Dz? | Coronary artery aneurysms -Occurs in 5% of those tx c IVIG -Small aneurysms may resolve spontaneously -Stenosed coronary arteries may require bypass operation |
| An important thing for parents to know if their child has Kawasaki Dz: | Do not get child vaccinated with LIVE VIRUS VACCINATIONS! |
| Systemic HTN is typically _________ in peds pts. | Secondary |
| In peds, HTN is gerally secondary to: | -Structural abnormality -Underlying pathology |
| Some causes of HTN in peds are: | -Renal Dz -Cardiovascular Dz -Endocrine or neurologic disorders |
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