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146 Cards in this Set
- Front
- Back
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What is the direction of fetal blood flow starting from the IVC to the head?
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IVC via the DUCTUS VENOSIS --> right atrium --> through the foramen ovale --> left atrium --> left ventricle --> aorta --> provides blood to the upper extremities and the head
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Describe fetal blood flow from the head to the placenta.
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Blood flows from the head and returns to the Right atrium via the SVC --> right ventricle --> out the pulmonary artery, but bypasses the lungs through the ductus arteriosus --> descending aorta --> umbilical arteries --> placenta
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At what stage of gestation does the heart and great vessels develop?
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weeks 3-8 of gestation
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Describe the heart sounds of a neonate compared to an adult.
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Higher pitched and of greater intensity
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What do neonates depend on to maintain cardiac output? Why?
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adequate HR and rhythm because they cannot increase their stroke volume
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Why are neonates very dependent on calcium, glucose and blood volume?
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Because their myocardial muscle is less efficient and has fewer organized myocardial muscle
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What section of the heart has the most problems post surgery in pediatrics?
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The AV node and conduction system
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What is cardiac output?
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Volume of blood ejected by heart in 1 minute
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Describe preload.
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Volume of blood returning to the heart
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What is the resistance against which ventricles pump when ejecting?
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Afterload
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The ability of cardiac muscle to act as an efficient pump is know as the ____?
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Contractibility
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What are the requirements needed to have adequat systemic profusion?
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Appropriate heart rate
-Adequate circulating blood volume -Low pulmonary vascular resistance -Capillary permeability -Tissue utilization of O2 |
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What are 2 maternal illnesses that can increase the risk for developing cardiac anomalies?
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DM and Lupus
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What are the infections women can have during pregnancy that have been found to increase the likelihood of developing heart anomalies?
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Herpes; Coxsaki; Cytomegalovirus; parvovirus
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What are 2 titers that should be check when a woman becomes pregnant?
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MMR and varicella
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Which classes of medications have been found to increase the risk for cardiac anomalies?
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Dilantin and amphetamines; and recreational drugs and alcohol
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What are the important factors to obtain in the health history of the infant?
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1. Feeding patterns
2. weight gain 3. Development 4. Incidence of respiratory infections and breathing problems 5. Color changes 6. exercise intolerance, edema, chest pain, palpatations, neuro problems 7. Recent infections or toxic exposure |
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What are the signs of respiratory distress in children?
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Circo-oral cyanosis, become blue when they cry, very lethargic, expiratory grunting, trachypnea, nasal flaring
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What are the areas that retractions can occur in respiratory distress?
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Subcostal, Substernal, intercostal, suprasternal, supraclavicular
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What is the best way to take BP for infants and kids?
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4 extremities and compare upper and lower
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What is the best way to find coarctation in children?
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4 extremity BPs
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What cardiac features should be palpated in children?
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PMI and for the presence of thrills
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Where is the PMI located?
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5th intercostal space on the left side
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During the physical assessment, what should the nurse look for in terms of the pulses?
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Quality and symmetry
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What type of edema is most commonly seen in children with cardiac issues?
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Periorbital edema (around the eyes)
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What is the possible diagnosis if the hepatic and splenic boarders can be palpated in children?
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CHF
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What are the lungs sounds that should be listened for if CHF is thought to be present?
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wheezing, crackles and rhonchi
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What is the best place to find diastolic murmurs?
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Herbs point
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What are the proper things to record when a heart murmur is heard?
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1. location where the murmur is heard best
2. Time in cycle S1 or S2 3. intensity: in relation to position 4. loudness |
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When is a murmur considered innocent?
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When it goes away when the child sits up
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What time in the cycle are murmurs heard most often?
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S1
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How are murmurs graded?
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Always over 6
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What is the incidence of heart murmurs?
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5-8/1000 births
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What is the most common congenital heart anomaly?
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VSD
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what % of CHD are of unknown etiology?
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90%
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Where does blood prefer to flow?
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From area of higher presure to low pressure and takes the path of least resistance.
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Where is the pressure in the heart greater?
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The left side of the heart
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The resistance in the pulmonary artery is (greater/less) than in systemic circulation?
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Less
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The pressure in the aorta is (less/greater) than in the pulmonary artery?
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Greater
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List the 4 hemodynamic classifications.
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1. Increased pulmonary blood flow
2. decreased pulmonary blood flow 3. obstruction to blood flow out of the heart 4. Mixed blood flow |
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Which ASD occurs at the lower end of the septum?
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Prmum
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A secundum is a ____?
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ASD in the center of the septum
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What is the name of the ASD that occurs at the junction of the SVC and right atrium?
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Sinus venus defect
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In an ASD, where does the blood ususally travel?
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Gets shunted from the left to the right aftrium
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What is a common complication of ASD?
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Right atrial and ventricular enlargement
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Does ASD have a high mortality rate?
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No; less than 1%
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What are the symptoms of ASD?
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1. may be asymptomatic
2. may develop CHF 3. murmur is audible |
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What are the 2 treatment options for ASD?
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1. Cath lab closure device
2. surgically inserted patch |
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which heart defect can wait to be repaired at school age?
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ASD
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What is the name of the VSD that takes place in the muscle layer?
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Swiss cheese holes
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What occurs in a VSD?
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1. increase in pulmonary blood flow
2. Increase pressure in R vent --> hypertrophy |
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What syndrome can result in an untreated VSD?
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Eisenmenger syndrome
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what is Eisenmenger syndrome?
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Development of pulmonary HTN that causes hypertrophy and increase resistance to blood flow into the lungs. Can actually cause the pressure in the right vent to exceed the left and thus causes deoxygenated blood to be pushed into the Left atrium. BLOOD MIXING and cyanosis
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What are the symptoms of VSD?
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1. CHF common
2. Murmur audible |
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What is age that most VSDs are repaired?
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By 1 years old
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What can occur if you have a low ASD continuous with a high VSD?
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AV canal
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What is an AV canal?
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incomplete closure of endocardial cushions
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What defect causes blood flow between all 4 chambers of the heart?
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AV canal
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What is the most common heart defect in Down's syndrome?
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AV canal
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What are the symptoms of AV canal?
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1. CHF
2. murmur audible 3. mild cyanosis that increaes with crying |
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What are the complications of treatment of AV canal?
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1. Heart block 2. CHF 3. MV regurg 4. arrhythmias 5 pulm HTN
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What device may be necessary following repair of an AV canal?
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pacemaker
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Where does blood flow increase with a PDA?
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in the lungs
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What two structures are connected in a PDA?
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The aorta and the pulmonary artery
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why does blood flow increase to the lungs in a PDA?
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Because the pressure in the aorta is greater than in the pulmonary artery which are connected in a PDA
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What is the common treatement for PDA?
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Indomethacin: prostaglandin inhibitor
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why are children with PDA often given ibuprofren?
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Because the NSAIDS are prostaglandin inhibitors that can close the PDA
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Which section of the heart often hypertophies with PDA?
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right ventricular
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What is a coarctation of the aorta?
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Localized narrowing near insertion of the ductus arteriosus
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Where does the pressure increase in a COA?
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in the head and extremities
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The pressure in the body and lower extremities with COA is often ___?
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Low
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What is the best diagnostic method for COA?
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4 point BPs
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What type of classification would be given to COA?
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Obstructive defect
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List the symptoms of COA.
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↑upper extremities BP
- ↓lower extremities BP - bounding upper extremities pulses - weak pulses in lower extremities - CHF in infants - older children – headache, dizziness, leg pain |
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How can an COA be treated?
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Resection of constricted section
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What are the 3 types of aortic stenosis? Which is the most common?
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1. valvular stenosis*
2. subvalvular stenosis 3. supravalvular stenosis |
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What defect has a narrowing or stricture of the aortic valve?
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Aortic stenosis
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Because there is decreased cardiac output with kids who have Aortic Stenosis, these kids are often found to be ____ when checking vital signs.
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Tachycardic
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why is pulmonary vascular congestion associated with aortic stenosis?
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Due to back up of blood from the left ventricle. There is an increase in afterload
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What are the SxS of aortic stenosis?
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faint pulses
- hypotension - tachycardia - poor feeding - exercise intolerance - chest pain - dizziness with standing |
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The ross procedure is often used in the treatment of what disorder?
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Aortic stenosis
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Explain the Ross procedure.
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* aortic valve replaced with pulmonic valve, then pulmonic valve replaced with homograph valve.
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What congenital anomaly should be in place to help manage pulmonic stenosis? Why?
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PDA because this will allow blood flow from the aorta in to the lungs to increase pulmonary profusion
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How do you keep the PDA open?
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Give prostaglandins
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What happens to blood flow with pulmonic stenosis?
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decreased pulmonary blood flow with right ventricular hypertrophy
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Why can pulmonic stenosis cause cyanosis?
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Right ventricular hypertrophy
↓ Right ventricular failure ↓ ↑Right atrial pressure ↓ Reopening of PFO ↓ Shunting of blood to left atrium ↓ Systemic cyanosis |
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What are the treatment options for pulmonic stenosis?
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angioplasty or valve replacement
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Tetrology of Fallot is classified as what type of anomaly?
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Defect with decrease pulmonary blood flow
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What are the 4 defects that make up the tetrology of Fallot?
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1. VSD
2. pulmonic stenosis 3. overriding aorta 4. right ventricular hypertrophy |
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Children with this type of heart defect are often chunky? Why?
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TOF: because their parents overfeed them to prevent crying which causes extreme cyanosis
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Where does the pulmonic stenosis often occur in TOF?
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below the valve: subvalvular stenosis
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What are the symptoms of TOF?
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Cyanosis and Tet spells
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What is the best way to deal with a TET spel?
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Place the child in knee to chest position; administer 100% O2 and IV fluids; Have morphine available;
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What is the palliative Tx for TOF?
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Blalock-Taussing shunt
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What is the Blalock-Taussing shunt?
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Enastomose the subclavian artery off the aorta to the pulmonary artery to send more blood to the lungs
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What is involved in the total repair of TOF?
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Push aorta twoards left vent; repair pulmonary stenosis by fillet of tissue; close the VSD with a pericardial patch
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What age is the complete repair of TOF often done by?
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Age 1
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What defect is described as having NO communication from right atrium to the right ventricle?
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Tricuspid atresia
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What defects must be in place to help deal with tricuspid atresia?
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ASD or PFO; PDA and VSD
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What is the mortality level for tricuspid atresia?
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High mortality
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What are the symptoms of tricuspid atresia?
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cyanosis
- tachycardia - dyspnea - clubbing |
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What are the 3 surgical treatments for TA?
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1. Blalock-Taussing
2. Bidirectional Glenn 3. Modified Fontan |
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What is a bidirectional Glenn?
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Procedure done between 6-9 months, they enastomose the SVC to the pulmonary artery
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What is the modified fontan?
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second procedure to enastomose the IVC to the pulmonary artery
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What does the bidirectional glenn and fontan accomplish in terms of TA treatment?
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Allows for complete passive blood flow on the right side of the heart to the lungs
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What is the biggest complication of the surgical procedures to fix TA?
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Clots do to stagnant blood from lack of pressure. Put on coumadin
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How old are the children that receive the fontan?
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usually around 2 years old
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What is transposition of the great vessels?
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The PA leaves the left ventricle and the aorta leaves the R vent. Systemic blood is deoxygenated
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What are the symptoms of Transposition?
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cyanosis and cardiomegaly
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What anomalies should be present to maintain life with transposition?
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PDA; definitely an ASD and maybe a VSD
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What CHD has higher pressure in the pulmonary artery than in the aorta?
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Transposition of the great vessels
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What are the Tx options for transposition?
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Prostaglandin E for PDA, arterial switch with preimaplanting coronary arteries
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Describe a hypoplastic left heart.
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*underdevelopment of the left side of the heart
*Aortic atresia |
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What congenital anomalies should be present to maintain life with HLH?
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Requires PFO or ASD and definitely PDA. VSD would do nothing here because the aorta is underdeveloped
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What are the SxS of HLH?
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mild cyanosis with CHF; deterioration after the PDA closes
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What are the surgical proceudres done to treat a HLH?
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1. Norwood
2. Bidirectional Glenn 3. Modified Fontan |
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What is the norwood procedure?
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take the pulmonary artery and anastomose to make it the aorta
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What anomaly can never be corrected with HLH and why?
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ASD because you must have O2 blood go back into the right atrium. Left side of the heart becomes the right side
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Why are children with HLH often more in need of transplant?
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Because their heart poops out quickly since the right side must provide circulation to the body, when it is not designed to do that.
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What is truncus arteriosis?
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The major artery that bifurcates the PA and the aorta never bifurcates. Have blood from R and L ventricle entering the same vessel and have all mixed blood to lungs and systemic system
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What is total anomalous pulmonary venous circulation?
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When pulmonary venins enter somwhere other than the Left artrium
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What are the 4 major causes of CHF?
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1. Volume overload --> Left to right shunts
2. Pressure overload --> obstructive defect 3. decreased contractibility --> cardiomyopathy 4. High cardiac output demands --> sepsis, anemia |
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What symptoms are seen in R sided heart failure?
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Edema and hepatomegaly
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Respiratory distress and congestion are associated with ____ sided heart failure?
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Left
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What cause the SxS of CHF?
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↓ myocardial contraction, ↑afterload & ↑preload
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what are the SxS of CHF
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> tachycardia
> diaphoresis > easily fatigued > tachypnea > dyspnea > mild cyanosis > retractions, grunting > wheezing, cough > poor profusion > hepatomegaly > edema, weight gain > developemental delays |
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List the drug classes used in the management of CHF.
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1. Digoxin
2. ACE inhibitors 3. Diuretics |
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What does digoxin do?
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↑cardiac output
- ↓heart size - ↓venous pressure - relief of edema |
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Name to 2 common ACE inhibitors.
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Captopril and Enalapril
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What are the common signs of dig tox?
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vomiting; bradycardia; and arrhythmias
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What must be done prior to administering Digoxin?
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Apical HR. Below 110 in infants: HOLD!! Below 70 in kids: HOLD!!!
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What CHF drugs must first have a BP before administering?
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ACE inhibitors
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Which diuretic is potassium sparing?
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Aldactone
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What diet restrictions are common with CHF?
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Na and fluid
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What are some non-medical ways to decrease cardiac demands?
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1. Provide neutral thermal environment
2.Treat existing infections 3. Decrease effort to breath 4. Provide rest periods |
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How can a nurse help improve tissue oxygenation for patients with CHF?
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Only use cool HUMIDIFED O2
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What should the feeding time be for children with CHF?
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q3 hours and finish in 30 mins
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For children with CHF, what technique might need to be used during feeding?
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Gavage if they cannot take all the food PO in 30 minutes
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What type of nipple should be used in CHF patients?
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soft preemie nipple
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What position should you feed children with CHF in?
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sei-upright
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What is an easy way to help a child with CHF increase their calorie intake?
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Find formula that is more caloric for the same volume
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What are 2 consequences of hypoxemia?
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1. polycythemia: due to increase RBC production
2. clubbing: thickening and flattening of tips of fingers and toes |
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Describe a child who was cyanotic since birth.
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Small; poor weight gain; dyspnea on exertion; and fatigue easily
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Explain the danger with polycythemia.
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Because you have increase RBC, the blood becomes thick and can cause clots. Must keep well hydrated to prevent this
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What does the knee to chest position do for circulation during a Tet spell?
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decreases venous return from legs to the heart (desat blood)
increase systemic vascular resistance which can divert more blood to the pulmonary artery |
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What does morphine do during a tet spell?
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relaxes tissue spasms of the subvalvular pulmonic stenosis
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