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42 Cards in this Set
- Front
- Back
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Congenital defects
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anatomic abnormalities present at birth abn. cardiac function
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Consequences of congenital heart defects (two broad categories)
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1. congestive heart failure
2. hypoxemia |
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Acquired cardiac disorders
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disease processes or abnormalities that occur after birth
seen in normal heart, or in presence of CHD |
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Pediatric indicators of Cardiac Dysfunction
HISTORY (6) |
1. Poor feeding
2. Tachypnea/tachycardia 3. Failure to thrive/poor wt gain/activity intolerance 4. Developmental delays 5. Prenatal and birth history 6. Family history of cardiac disease |
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Infant history
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poor feeding associated with:
- fast breathing - inability to keep up - poor wt gain - sweating with feeds - fatigue increase - color changes |
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Infant history
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wt gain and development
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Older children and adolesents history
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Exercise intolerance (inability to keep up physically)
Presence of edema Respiratory problems Chest pain Palpitations neurological problems (fainting and HA) Recent infections Toxic exposures |
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physical exam
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1st tachycardia
Later... bradycardia Tachypnea may indicate CHF Hypertension dx by SERIAL BP measurements |
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If baby is upset... bp can
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increase
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Hypertension with coarctation of aorta
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systolic BP difference b/t upper and lower extremity
Upper: hypertension and bounding pulses Lower: lower BP and reduced pulses in legs |
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Physical Exam
Inspection |
Presence of all pulses
Distended neck veins (late sign) Clubbing of fingers peripheral cyanosis edema BO Resp status Skin color (cyanosis) |
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Physical Exam
Inspection continued |
Position of comfort (HOB should be up)
Overall nutritional status Est. PMI and AI Thrill Quality of check cavity (crackles) Quality and symmetry of pulses Warmth of extremity Presence or absence of edema Locate hepatic and splenic borders (organ enlargement) |
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Thrills
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the sound of a thrill is a soft vibration over the heart that reflects the transmitted sound of a heart murmur
reflects the circulation of the blood |
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Physical exam
Palpation |
Apical Impulse
PMI Cap Refill |
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Apical Impulse
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Most lateral cardiac impulse, may correspond to the apex
Lateral to the left midclavicular line and 4th ICS in children over 7 yrs At the LMCL and 5th INC in children under 7 yrs |
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PMI
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Point of maximal intensity
area of most intense pulsation Usually same site as AI (not always) Do not use PMI and AI interchangeably |
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Capillary filling time
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central site = forehead
peripheral site = top of head brisk = <2 seconds |
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Prolonged refill may be associated with
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poor systemic perfusion
cool ambient temperature |
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Heart sounds
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Opening and closing of valves and vibration of blood against wall of vessel and heart
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Heart sounds should sound
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1. clear, crisp, distinct (not blurred)
2. nor be weak or bounding 3. same rate as radial pulse 4. rhythm regular and even |
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Sinus arrhythmia
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heart rate increases with inspiration and decreases with expiration
to differentiate sinus arrhythmia from abnormal arrhythmia have child hold breath (will remain stead if normal) |
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Murmurs
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heart sounds that reflect flow of blood withing the heart
may occur in systole or diastole or both, can occur in a normal heart in periods of stress: increased CO, anemia, fever, rapid growth can reflect abnormalities in hear vessels |
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Innocent murmurs
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normal cardiac anatomy and cardiac function (occur in up to 80% of all kids at sometime)
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Lung sounds assessment
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Crackles
Wheezing Grunting Decreased or absent breath sounds |
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Cardiac function diagnostic tests
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Radiologic imaging (CXR)
ECG (Holter monitoring, exercise stress test) Echocardiography Cardiac Catheterization Exercise stress test Cardiac magnetic resonance imaging |
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ECG
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change electrodes every 1-2 days bc they are irritating to the skin
assess the pt, not the monitor |
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Read about cardiac catheterization
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4-5 Qs on this section in the book
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Radio plaque catheter inserted through peripheral blood vessel into the heart
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Usually combined with angiography (contract material is injected through catheter into circulation
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Cardiac cath provides information
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O2 sats within the chamber and great vessels
pressure changes within these structures CO or SV anatomic abnormalities diagnostic interventional electrophysiologic |
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Cardiac cath types
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right sided venous (most common in children)
left sided arterial |
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Cardiac cath nursing care
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1. Ht = cath selection
2. Wt 3. History of allergic reaction (some iodine based contrast solution) 4. Signs and symptoms of infection (severe diaper rash, may cancel bc use femoral pulse) 5. assess and mark pulse locations (both feet) in dorsalis pedis and posterior tibial and their presence and quality 6. O2 sats in children with cyanosis |
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7. Preparation
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SA child and adolescent, destription of cath lab, chronological explanation of procedure using senses, prep materials (books or videos) that are all geared to child's developmental level, expected length of procedure, description of child's appearance post procedure, usual post procedural care
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Preprocedural for cardiac cath
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sedation, NPO (polycythemic infants = IV fluids to prevent dehydration, neonates = dextrose solution up to 2 hrs prior to procedure to prevent hypoglycemia) and may hold AM meds
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post procedural cardiac cath
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cardiac monitor
pulse ox observation-important pulses below site for equality and symmetry (may be weaker first few hrs and then increase in strength) Temp and color of affected extremity (cold and blanching may = obstruction) VS = esp HR q 15 mins counted for 1 full min to assess for dysrhythmias or bradycardia |
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Post procedural continued
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BP esp hypotension (hemorrhage from cardiac perforation or bleeding at site)
Dressing (evidence of bleeding or hematoma in femoral or antecubital area) Fluid intake (IV and oral) adequate hydration |
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Infants following cardiac cath
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are at risk for hypoglycemia, they have labile glucose levels, and should receive dextrose containing IV fluids and have blood glucose levels checked
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Bleeding post cardiac cath
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direct continuous pressure applied 1 inch above percutaneous skin site to localize pressure over the vessel puncture until it stops bleeding
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Possible bed rest
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affected extremity in straight alignment for
venous cath 4-6 hrs arterial cath 6-8 hrs May be held on parent's lap with leg in correct alignment |
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Acetaminophen w or w/o codine or Ibuprophen with occusive waterproof dressing
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best
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see teaching instructions
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2011: p1350
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Etiology of congenital heart disease
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Genetic
Environmental Maternal: Chronic illness alcohol consumption exposure to environmental toxins and infections Family hx of cardiac defect in parent or sibling |
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Altered hemodynamics pg 1351
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Pressure gradients
P on R side < P on L side |
