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N114 Cardiac
N114 - Cardiovascular dysfuction
| Question | Answer |
|---|---|
| What is an atrial septal defect? | Septal wall defect allowing blood to flow from left atrium to right atrium, also called a left to right shunt. |
| What is the pathophysiology of an atrial septal defect? | An opening between the atria, foramen ovale fails to close, increased pulomary blood flow. |
| What symptoms are associated with an atrial septal defect? | Often asymptomatic if defect is small, dyspnea, fatigue, poor growth,soft systolic murmur in pulmonic area, CHF, |
| What tests are used to diagnose an atrial septal defect? | Echocardiogram or cardiac catheterization |
| What is a ventricle septal defect? | Septal wall is incomplete allowing blood to flow from left ventricle to right ventricle, left to right shunt. |
| What is the pathophysiology of an ventricle septal defect? | Increased pulmonary blood flow, left to right shunting is caused by higher pressure in left ventricle. |
| What symptoms are associated with an ventricle septal defect? | Tachypnea, dyspnea, poor growth reduced fluid intake, palpable thrill, systolic murmur at left lower sternal border, s/s of CHF |
| What tests are used to diagnose an ventricle septal defect? | Electrocardiogram and radiology detect larger septal defects |
| What nursing diagnoses are associated with an atrial or ventricle septal defect? | Anxiety, ineffective family coping, risk for impaired growth and development, risk for infection, imbalanced nutrition: less than body requirements, impaired gas exchange. |
| What would you teach the family about atrial or ventricle septal defect? | Explain the purpose of tests & procedures, teach supportive nutrition, reduce stress on heart, promote rest, support growth and development.Teach s |
| What nursing care is associated with anxiety, ineffective family coping? | Assess coming mechanisms of family, provide family with information about condition |
| What nursing care is associated with Risk for impaired growth & development? | Treat child as normally as possible. Teach parents that children are more comfortable when they know what to expect. Promote mental development activities as appropriate for age and condition. |
| What nursing care is associated with risk for infection? | Limit exposure to individuals with infections, Promote good pulmonary hygiene – change position, use percussion and postural drainage, Prophylactic antibiotics when undergoing surgical or dental treatments to prevent subacute bacterial endocarditis. |
| What nursing care is associated with imbalanced nutrition: Less than body requirements? | Offer small frequent feedings, Use soft nipple for infant to ease the stress of sucking, Organize nursing care to allow for rest |
| What nursing care is associated with impaired gas exchange? | Promote good pulmonary hygiene, monitor I & O, limit fluids as ordered, administer diuretics as ordered, change position every two hours. |
| What planning & intervention is associated with atrial septal defects? | Surgical closure or patch of defect, transcatheter device closure during cardiac catheterization, nursing management of child |
| What planning & intervention is associated with ventricle septal defects? | Occasionally spontaneous closure occurs, surgical patching if failure to thrive occurs |
| What is coarctation of the aorta? | It is the narrowing of the descending aorta restricting blood flow leaving the heart. |
| What is the pathophysiology of coarctation of the aorta? | Narrowing or constriction of the descending aorta, often near the ductus arteriosus, progressive disorder that leads to CHF. |
| What assessment findings can be seen with coarctation of the aorta? | May be asymptomatic. BP difference of 20 mm between upper & lower extremities, brachial & radial pulses full, femoral pulse weak. Headache, vertigo & epistaxis, exercise intolerance, left ventricular hypertrophy, dyspnea, CVA |
| What nursing diagnoses are associated with coarctation of the aorta? | Ineffective tissue perfusion (renal), risk for injury, activity intolerance, deficient knowledge |
| What therapeutic management is used with coarctation of the aorta? | Balloon catheterization, surgical resection & patch, prophylaxis for endocarditis, rebound hypertension occurs in immediate postoperative period. |
| What family education is associated with coarctation of the aorta? | Prepare for tests and procedures, teach s/s of worsening condition, educate on administration of cardiac & vasoactive drugs |
| Which defects increase pulmonary blood flow? | Atrial septal defect, ventricular septal defect, patent ductus arteriosus |
| What defect causes decreased pulmonary blood flow? | Tetralogy of Fallot |
| What defect causes obstruction to blood flow? | Coarctation of aorta |
| Which defect causes mixed blood flow? | Transposition of great arteries, pulomonary & aorta |
| What factors contribute to congenital heart defects? | Maternal rubella during pregnancy, alcholism, age over 40, type 1 diabetes. Genetic factors: sibling with heart defect, parent with congenital heart defect, chromosomal aberration, other noncardiac congenital anomalies. |
| What does the ductus arteriosus do in the fetus? | carries blood from pulmonary artery to aorta & avoids non-functioning lungs |
| When does the ductus arteriosus close? | Functional changes occur within minutes of birth with complete closure in 10-15 hours. Permanently closed by 3 weeks and becomes ligamentum arteriosum |
| What changes take place with the pulmonary blood vessels? | Are narrowed vessels in fetus which increase resistance in lungs to blood flow, dilate at birth, begins with first breath. |
| What is the foramen ovale? | It provides a one way opening between R & L atria so blood can avoid non-functioning lungs. Closes when pressure in LA becomes higher than RA. |
| How does the foramen ovale change at birth? | Cord clamping elevates systemic resistance. Decreased pulmonary resistance allows blood to flow to lungs. Functional within minutes of birth, permanent by 3 months, becomes fossa ovale. |
| What is the ductus venosus? | This sunts blood from umbilical vein to inferior vena cava away from immature liver. |
| What changes take place in the ductus venosus? | Closed by clamping of cord, blood begins to travel through liver. |
| What is a patent ductus arteriosus or PDA? | Failure of the fetal ductus arteriosus to close withing the first weeks of life. It is the artery connecting the aorta and pulmonary artery. |
| What is the pathology of PDA? | it is a left to right shunt, blood from high pressure aorta flows directly into the low pressure artery and pulmonary circulation. Results in increased workload that can cause CHF. |
| What are the clinical manifestation of PDA? | Asymptomatic if defect is small, CHF with large defect. Characteristic machine-like murmur, bounding pulses. |
| What is the treatment for PDA? | Medical treatment - administration of Indocin, a prostaglandin inhibitor, successful in closing a patent ductus. Surgical - ligation of the PDA via a left thoracotomy incision. Coils can be used to occlude the PDA during a catheterization. |
| What makes of Tetralogy of Fallot? | A ventrical septal defect, pulmonary stenosis, right venticular hypertophy, an overriding or misplased aorta. |
| What is the most important factor of a tetralogy of fallot? | The degree of pulmonary stenosis will determine clinical presentation, timing of surgery & preoperative management. |
| What clinical manifestation can be found with a tetralogy of fallot? | Manifestations can vary greatly depending on the degree of pulmonary stenosis, loud systolic murmur, cyanosis, clubbing, squatting, poor growth. At risk for emboli, stroke, brain abscess & seizures. |
| What is a tet spell? | A tet spell or hypercyanotic episode is usually caused by crying, feeding or defication. Characterized by hypoxia, pallor & tachypnea. |
| How it tetralogy of fallot treated? | During hypercyanotic episode, place patient in knee to chest or squatting position. Complete surgical repair usually performed during 1st year. |
| What is the pathophysiology associated with transposition of great arteries? | Unoxygenated blood enters the right atrium to right ventricle then goes out into systemic circulation. Oxygenated blood flows into left atrium to left ventricle then back to lungs. No oxygenated blood is getting tinto systemic circulation. |
| What is an infants only chance at survival of a transposition of great arteries? | An atrial septal defect, patent foramen ovale or patent ductus arteriosus that allow mixing of oxygenated and unoxygenated blood. |
| What are the clinical manifestation of transposition of the great arteries? | Signs & symptoms of CHF, progressive cyanosis, tachypnea |
| What is the treatment for transposition of the great arteries? | To maintain intracardiac mixing - prostaglandin E1 is given to prevent ductus arteriosus from closing. Sometimes an artificial atrial septic defect is created. |
| What is the patho of right-sided heart failure? | The right ventricle is unable to pump blood effectively; results in increased pressure in right atrium and systemic venous circulation. Can cause enlarged liver & spleen. |
| What is the patho of left-sided heart failure? | Left ventricle is unable to pump blood into the systemic circulation, result is increased pressure in left atrium & pulmonary veins, causes lungs to become congested with blood & pulmonary edema. Left = Lungs |
| Why is digoxin (Lanoxin) the drug of choice? | It has a more rapid onset. Beneficial effects are increased cardiac output, decreased heart size, decreased venous pressure, and relief of edema. |
| What are some considerations in using digoxin? | Therapeutic serum levels are 0.8 to 2.0 micrograms per L, monitor potassium levels, calculations must be checked by second nurse, check apical pulse for one minute - call MD if below 90-110, daily weights |
| What are common signs of dig toxicity? | Nausea, vomiting, anorexia, bradycardia, dysrhythmias |
| How can you decrease cardiac demands? | Rest in imperative to decrease energy requirements & cardiac workload. Group care |
| How can you improve oxygenation & decrease oxygen consumption? | Use supplemental cool, humidified oxygen, semi-fowlers position, place infant in infant seat |
| What is rheumatic fever? | A diffuse inflammatory condition of the connective tissue. Primarily the heart, joints, subcutaneous tissue, brain & blood vessels. |
| How is rheumatic fever contracted? | Rheumatic fever follows an untreated or partially treated strep infection. Usually 2 to 6 weeks. |
| What is the pathophysiology of rheumatic fever? | It is felt to be an autoimmune response to group A strep that initiates connective tissue damage. Primarily affects heart, CNS & joints. |
| What are the major manifestations of rheumatic fever? | Carditis, polyarthritis, erythema marginatum, Chorea or St Vitus Dance, Subcutaneous nodes |
| What are the minor manifestations of rheumatic fever? | Arthralgia & fever, supporting evidence of recent strep infection |
| How is rheumatic fever diagnosed? | The presence of two major or one major and two minor manifestation with supportive evidence of recent strep infection. |
| How is rheumatic fever treated? | Penicillin or erythromycin to treat strep infection. Aspirin is given as anti-inflammatory agent. Corticosteroids may be given. Bedrest until inflammation has resolved. |
| What is the etiology of Kawasaki syndrome? | A defective immune response to an infectious process is thought to be responsible. Possibly an exotoxin produced by staph, dust mites, exposure to rug shampoo, Rickettsiae. |
| How is an infant under 3 months protected from Kawasaki syndrome? | Acquired immunity from mother or natural immunity through subclinical infection. |
| What does Kawasaki syndrome affect? | It affects the blood vessels. It causes inflammation of blood vessels primarily the coronary arteries. |
| What happens during the 1st 10 days of Kawasaki syndrome? | Infiltraion & hypertrophy of vascular vessels. Ectasia is greater than normal sized coronary arteries. Pacarditis is inflammation of entire heart. CHF in some children. |
| What happens during days 10-40 of Kawasaki syndrome? | Decrease in inflammatory process, but vessels have undergone destructive changes. Coronary artery aneurysm can develop at this stage. |
| What happens after 40 days of Kawasaki syndrome? | Aneurysms & dilation usually regress in 1-2 years. Can develop progressive stenosis & calcification of affected cornary arteries. Death can occur caused by myocardial ischemia. |
| How is Kawasaki syndrome treated? | Intravenous immune globulin (IVIG) & aspirin therapy. Most beneficial if given during 1st 10 days. |
| What is Carditis? | It is the inflammation of the heart valves - most frequently the mitral valve. |
| What is polyarthritis? | Swollen painful joints, migrating from one area to another. |
| What is erythema marginatum? | Red, painless, non pruritic skin lesions, primarily affects trunk and inner surfaces of extremities. |
| What is Chorea or St. Vitus Dance? | Sudden aimless, irregular movements of extremitites, involuntary facial grimaces, speech distrubances. Can occur years after initial illness. Aggravated by anxiety, relived by rest. |
| Where are the subcutaneous nodes found? | Located over bony prominences, nontender swelling. |
Created by:
jrb265
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