Test 2
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| congenital heart defects associated with genetic abnormalities | when caring for a child with a syndrome, just know that there are certain possible heart defects that you should be concerned about
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| Congenital Heart Defects | a child born to a mother/father who have a congenital heart defect are at increased risk for having a congenital heart defect
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| what happens if the ductus doesn't close? | increased pulmonary pressure, decreased systemic pressure
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| PDA - premature Tx | Indocin/Indomethacin; Lateral thoracotomy
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| PDA - infant and older Tx | transcatheter coil closure
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| prostaglandin E inhibitor | Indocin and Indomethacin.
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| Prostaglandin E | keeps the ductus open. an inhibitor closes it.
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| lateral thoracotomy | surgical ligation of the ductus
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| transcatheter coil closure | catheter up vena cava, RA, tricuspid valve, to pulmonary artery, leave the coil in the ductus, blood clots around it, clots off ductus.
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| PDA | Patent Ductus Arteriosus. blood flows from aorta into pulmonary arteries.
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| VSD | Ventricular Septal Defect- blood flows from LV to RV
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| what happens with VSD? | pulmonary pressure increases, systemic pressure decreases.
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| ASD | Atrial Septal Defect - blood flows from LA to RA.
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| What is the management for ASD or VSD? | treat CHF. surgical - interventional cardiac catheterization or open heart surgery (vortex patch). atrial dysrhythmias (electrical pathway is interrupted).
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| what types of cardiac conditions do you see CHF? | ASD, VSD, PDA, AS, CoA, cardiomyopathy, rheumatic heart disease, Kawaskai's disease, Duchenne muscular dystrophy, and much more.
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| CHF - Management Goals | improve cardiac Fx. remove accumulated fluids and Na+. decreased cardiac demands. improve tissue oxygenation.
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| CHF Meds | Digoxin. Diuretics. O2.
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| Dig Tox S/Sx | anorexia. nausea. vomiting. pulse irregularities.
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| CHF - Nursing Management | avoid increasing cardiac demands. monitor weight. admin meds/O2. accurate/strict I&Os. protect from infection.
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| interventricular cardiac catheterization | insert device into septum, open "umbrella", pull back a bit, open other "umbrella", now the hole is closed.
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| ADS and VDS closer with device risk | Atrial Dysrhythmias. these devices go right what the electrical current goes.
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| obstructions to systemic blood flow | aortic stenosis coartication of the aorta.
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| aortic stenosis | valvue doesn't open all the way. not much blood can leave the heart, decreased systemic blood flow.
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| effects of AS | poor tissue perfusion, cyanosis. increased workload for LV --> LV hypertrophy, blood into the lungs. exercise intolerance.
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| coartication of the aorta (CoA) | narrowing outside of the heart. lower BP in lower extremities (<8mmHg diff = significant).
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| why is BP normal or near normal in upper extremities with CoA? | upper extremities get their normal blood flow usually, through the subclavian arteries.
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| CoA Tx | end-to-end anastomosis
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| decreased pulmonary blood flow causes | pulmonary stenosis (subvavular, valvular, peripheral). Tetralogy of Fallot.
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| Pulmonary stenosis | depends how much blood is getting to the lungs (can be incompatible with life). will likely be cyanotic.
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| Pulmonary Stenosis Tx | catheter through the vena cava, open balloon to open the valve, then pull out the balloon.
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| Tetralogy of Fallot (what is the Tet?) | 1. VSD. 2. pulmonary stenosis (below or at the level of the valve). 3. overriding aorta (sites over the ventricular aorta). 4. R ventricular hypertrophy.
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| "pink tet" | not a severe FoT. not too much pulmonary stenosis. no/little blood blood passing into the aorta.
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| when is FoT usually repaired? | at birth.
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| What is a "tet spell"? | activity, L valve narrows, less blood to lungs, child turns very dark blue.
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| What will a ToF child do when having a "tet spell"? | squat down.
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| Decreased pulmonary blood flow Tx | prostaglandin E. O2 management. surgery.
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| decreased pulmonary blood flow - prostaglandin E | to keep the ductus open until new ductus can be made (through surgery).
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| if a child is cyanotic for a long period of time, what could they develop? | polycythemia
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| polycythemia | Hgb and Hct increase. cyanotic, kidneys think the need more RBCs, make more RBCs, drive Hgb and HCt up. blood is thicker, espeically on hot days (dehydrated - more hemoconcentrated)
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| decreased pulmonary blood flow surgery | palliative (give us time before we can do something else - BP shunt). Corrective (fixes the problem).
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| Blalock-Taussig Shunt | a gortex shunt that connects the pulmonary system to the arterial system.
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| Mixed-Blood flow defects | Transposition of the great vessels. ToF (mixing of the blood happens).
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| transposition of the great vessels | pulmonary arteries aries from the LV, aorta from the RV (vice versa from normal).
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| Mixed Blood Flow Tx | prostaglandin E. possible balloon atrial septostomy. O2 management (will never be at 100% unless surgically corrected). surgery. cyanosis.
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| Acquired heart disease | rhuematic fever. Kawasaki's disease
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| Rheumatic Fever | 2º to GABHS.
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| GABHS | group A beta-hemolytic strep. untreated, can cause acute glomerular nephritis or rheumatic fever.
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| Rheumatic Fever - Major Sx | carditis. migratory polyarthritic. erythema marginatum. chorea. subcutaneous nodules.
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| Rheumatic Fever - Dx | requires 2 major sx, or 1 major sx and 1 minor sx.
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| Rheumatic Fever - Minor Sx | fever, arthalgis, hx of RF, increased ESR or C-reative protein, prolonged PR interval.
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| Rheumatic Fever Management | antibodies. anti-inflammatory medications. supportive therapy.
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| Rheumatic Fever Complications | if untreated can lead to rheumatic heart disease.
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| Kawasaki's Disease - Sx | fever > 5 days and 4 of the following: bilateral conjuctivitis; mucosal changes; changes in extremities; truncal rash; cervical lymphadenopathy.
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| Kawasaki's - management | IV gamma globulin. salicylata (ASA). support.
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| Kawasaki's - complication | usually do well w/ tx. coronary artery abnormalities/aneurysms. pericardial effusion. myocardial inflammation. death.
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| kawasaki's phases | acute - 8-12 days. subacute - 10-14 days. convalescence - 6-10 months.
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| Cardiovascular Risk Factors | Hyperlipidemia. Hypertension
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| Hyperlipidemia - risk factors | family. diet.
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| Hyperlipidemia screening | age 2+ w the following risk factors: known familial hyperlipidemia. CV before age 55. BP >90% for age, sex, and height. diabetes. BMI > 85%.
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| hypertension | screen children yearly. signif HTN 95th and 99th %ile. severe > 99%ile. on at least 3 separate occasions. if 2º, treat underlying cause. otherwise, change diet and lifestyle.
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