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N220 Peds CV
N220 Peds Cardio
| Question | Answer |
|---|---|
| Failure of the artery connecting the aorta and pulmonary artery to close within the first few weeks of life. | Patent Ductus Arteriosus |
| The continued patency of the Ductus Arteriosus allows blood to flow... | Blood flows from the higher-pressure aorta to the lower-pressure pulmonary artery, causing a left-to-right shunt. |
| Clinical Manifestations of Patent Ductus Arteriosus | s/s of CHF; FTT; Machinery-like murmur; Bounding pulses; Tachypnea >70; Tachycardia >170; Increased RV pressure & hypertrophy. |
| Medical Management of PDA | IV Prostaglandin Inhibitor (to close ductus); IV Indocin (stimulates closure of the ductus arteriosus in premature infants); Lasix (to promote diuresis & decrease cardiac workload). |
| Abnormal opening b/t the atria allowing blood from the higher-pressure left atrium to flow into the lower-pressure right atrium. | Atrial Septal Defect |
| In ASD, blood shunts from LA into RA to RV, causing? | RV hypertrophy due to increased blood flow/volume, in which blood begins to pool,& eventually clots at the bottom of the RV, increasing the risk for thromboembolism. |
| Clinical Manifestations of Atrial Septal Defect | Decrease in growth(FTT); s/s of CHF; Murmur; At risk for: Atrial dysrhythmias, caused by atrial enlargement; Pulmonary Vascular Obstructive Disease; Emboli |
| Heart defects that INCREASE pulmonary blood flow. | Patent Ductus Arteriosus, Atrial Septal Defect, Ventricular Septal Defect, Aortic Stenosis, Coarctation of the Aorta |
| Heart defects that DECREASE pulmonary blood flow. | Pulmonic Stenosis, Tetrology of Fallot |
| Pulmonary congestion occurs bc of increased pulmonary blood flow & obstruction of systemic flow. | Transposition of the Great Arteries. |
| Heart defects that obstruct systemic blood flow, which inevitably increase pulmonary blood flow. | Aortic Stenosis, Coarctation of the Aorta, & Hypoplastic Left Heart Syndrome. |
| Pressure in the LV increases & promotes oxygenated blood through the defect to the RV, bc high-pressure blood is mixing w/ low-pressure blood, causing an increased pressure on the PA. | Ventricular Septal Defect |
| Blood is shunted from the LV to the RV, then the increased blood volume is pumped into the lungs, which become congested with blood. | Ventricular Septal Defect |
| Tx is conservative when no signs of CHF or pulm. HTN are present;Surgical patching is performed when poor growth is evident;Prophylaxis for infective endocarditis is required;May also require positive Inotropic Agents (Dopamine/Isuprel) to increase CO. | Ventricular Septal Defect |
| The blood cannot move past the obstruction, so it backs up into the LA & then into the lungs, causing CHF & pulmonary edema. | Hypoplastic Left Heart Syndrome. |
| Stenosis of mitral & aortic valves associated w/a small non-functioning LV that obstructs systemic blood flow. | Hypoplastic Left Heart Syndrome. |
| Clinical Manifestations of Hypoplastic Left Heart Syndrome. | Signs are initiated w/ the closure of the ductus arteriosus & include s/s of CHF in the first few weeks of life, progressive cyanosis,tachycardia, tachypnea, dyspnea, retractions, hepatomegaly, low CO, weak or absent peripheral pulses, & murmur. |
| Clinical Therapy for Hypoplastic Left Heart Syndrome. | Meds for CHF - Digoxin & Inotropic Agents; Prostaglandin for ductal patency. |
| Surgery is a curative treatment for | Hypoplastic Left Heart Syndrome. |
| Narrowing or constriction in the descending aorta, often near the ductus arteriosus, obstructing systemic blood outflow. | Coarctation of the Aorta. |
| The reduction of blood flow causes lower BP in the legs, & higher BP in the arms, neck, & head. | Coarctation of the Aorta. |
| Brachial & radial pulses are full. Femoral pulses are weak or absent. | Coarctation of the Aorta. |
| When is post-op HTN common, and why? | Post-op HTN is common after resection of the coarcted portion of the aorta bc the body is use to a lower BP due to the obstruction, however, after surgical repair the body is receiving higher pressures bc the obstruction is resolved. |
| Important nursing intervention following surgical repair of coarctation of the aorta. | BP is tightly managed & kept low so there is no excessive pressure on the fresh suture lines post-op. |
| Post-op HTN is managed by... | IV Na+ Nitroprusside or Amrinone, followed by oral Captopril, Hydralazine, &/or Propranolol. |
| To prevent HTN at rest and during exercise, when is it recommended to perform surgery of the coarcted aorta? | Before 2 years of age (Aorta is nearly adult size by age 4 to 8 years). |
| Narrowing of the aortic vavle, which leads to resistance to blood low in the LV, decreased CO, LV hypertrophy, & pulmonary vascular congestion. | Aortic Stenosis. |
| Clinical Manifestations of Aortic Stenosis. | faint pulses, hypotension, tachycardia, poor feeding, activity intolerance, chest pain, dizziness when standing for long periods, & murmur. |
| Lifelong infective endocarditis prophylaxis is required for... | Aortic & Pulmonic Stenosis. |
| Narrowing at the entrance to the PA causing RV hypertrophy & enlarged PA, which causes impaired blood flow to the lungs. | Pulmonic Stenosis. |
| Cyanotic heart defect that is characterized by a combination of four defects. | Tetrology of Fallot |
| Pulmonic Stenosis, RV Hypertrophy, Ventricular Septal Defect, & Overriding of the Aorta are characteristic of which defect? | Tetrology of Fallot |
| Cyanotic defect that is characterized by elevated pressures in the right side of the heart, causing right-to-left shunting. | Tetrology of Fallot |
| The degree of pulmonic stenosis determines the severity of symptoms caused by the cyanotic heart defect, Tetrology of Fallot. If the infant is extremely cyanotic at birth, what will be required? | Immediate surgery |
| Clinical Manifestations of Tetrology of Fallot. | Polycythemia(not enough blood to the lungs, bone marrow increases production of RBC), hypoxic spells, metabolic acidosis, poor growth, clubbing from chronic hypoxia, activity intolerance, systolic murmur. |
| A child with Tetrology of Fallot may assume what position of comfort during exercise? | Toddlers instinctively squat or assume a knee-chest position to reduce venous blood flow from the lower extremities & to increase SVR, which diverts more blood flow into the pulmonary artery. |
| Management of Cyanotic Spells. | Place in knee-chest position until stable, administer 100% oxygen and morphine |
| The PA is the outflow tract for the LV, & the Aorta is the outflow tract for the RV. The body is essentially getting deoxygenated blood. | Transposition of the Great Arteries |
| Another defect such as septal defects or PDA must be present to permit blood to enter the systemic circulation &/or the pulmonary circulation. | Transposition of the Great Arteries |
| A multisystem, febrile inflammatory disease that is a delayed complication of untreated group A beta-hemolytic streptococcal pharyngitis. | Rheumatic Fever |
| Clinical Manifestations of Rheumatic Fever. | Following a strep infection, some pts experience sudden fever & joint pain, rash, abd pain, chorea, epistaxis, & cardiac involvement. |
| Prevention of Rheumatic Fever. | Prompt & adequate tx of strep infection w/ oral Penicillin. |
| What is done to prevent recurrence of Rheumatic Fever in a pt who has already been affected by the disease? | Penicillin is taken daily for at least 5 years or longer after the initial infection. |
| An acute febrile disease of children, marked acutely by fever, rashes lymphadenopathy, & irritability, & chronically by late cardiac complications, including coronary artery aneurysms & Myocardial infarction. | Kawasaki Disease |
| Clinical Manifestations of Kawasaki Disease | Fever is present on the first day of illness & may last from 1 to 3 weeks.The child has bilateral nonpurulent conjunctivitis, polymorphous rash, cervical lymphadenopathy,digital swelling&desquamation.Lips are dry, cracked,& child has a strawberry tongue. |
| Panvasculitis of the coronary arteries (huge inflammed arteries) is characteristic of what? | Kawasaki Disease |
| The most serious complication of Kawasaki Disease is cardiac involvement. Abdominal pain, vomiting, & restlessness are the main symptoms of what? | An acute MI in children. |
| Treatment of Kawasaki Disease | IVIG (gamma globulin) decreases inflammation of the blood vessels, preventing coronary artery dilation; Daily ASA therapy will also decrease the risk of coronary artery dilation, but must be continued for 2 weeks or until symptoms subside. |
| Nursing interventions for Kawasaki Disease | Monitor cardiac status, I&O, daily wt, v/s;Provide symptomatic relief:mouth care, lubricating ointment to lips, hands & feet, loose clothing, & nutritional support w/clear liquids, cool, soft foods. |
| Potential complications of Kawasaki Disease | Coronary artery aneurysm, MI, ASA toxicity, Allergic rx of IVIG,& death. |
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