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54 Cards in this Set
- Front
- Back
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congenital heart disease
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abnormal development of structures of the heart or major vessels of the heart
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congenital heart disease (maternal exposure to agents)
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- alcohol
- lithium - coumadin - retinoic acid - sex hormones |
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congenital heart disease (maternal condition or infection)
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- viral infections
- diabetes - systemic lupus erythematosus - PKU phenylketonuria |
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genetic/syndrome factors related to congenital heart disease
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- trisomy 21
- turner syndrome - digeorge syndrome - heterotaxy syndrome (organs reversed) - VACTERL syndrome |
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congestive heart failure
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heart is unable to pump sufficient cardiac output to meet metabolic demands of the body
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causes of CHF
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- congenital heart disease (excess pressure/volume load)
- non structural myocardial factors - dysrhythmias |
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CHF CM (low cardiac output)
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- tachcardia
- decreased peripheral perfusion (blue feet) - cardiomegaly - oliguria |
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CHF CM (pulmonary congestion)
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- tachypnea
- retraction, nasal flaring - cough |
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CHF CM (systemic venous congestion)
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- hepatomegaly
- edema (coccyx, genital, face. adults lower limbs) - pleural/percardial effusions |
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CHF s/s
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- **irritability**
- diaphoresis - poor feeding (too tired to eat) - failure to thrive - low urine output |
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CHF management
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- myocardial efficiency: digoxin, afterload reducers
- minimize volume overload: diuretics - decrease cardiac workload - adequate nutrition: increased calories d/t increased HR |
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CHF provide adequate nutrition
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- small frequent feedings
- position during feeding - high caloric feeding - gavage feeding - gastronomy tube |
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CHF parent support/teaching
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- manage high stress level
- feeding education/support - medication administration - when to call the provider (when seeing s/s) |
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cyanosis
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blue color of skin and mucuous membranes d/t increased concentration of reduced hemoglobin. 80-85% O2 stat
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causes of cyanosis
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- intracardiac mixing
- decreased pulmonary blood flow |
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cyanosis CM
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- blue color at lips, nailbeds, mucous membranes
- tachypnea - increased crying - long term: polycythemia |
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cyanosis management
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- **O2 not usually effective
- child will usually limit self - interventional cardiac cath - surgery |
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work up for congenital heart disease
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- H & P
- chest x ray - ECG - echocardiogram - cardiac cath |
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pre cath procedure
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- vital signs, pulse ox
- mark pedal pulses - labs: coagulopathies, CBC, electrolytes |
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post cath procedure
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- assess peripheral pulses
- direct pressure on site if bleeding - keep leg still to prevent further bleeding |
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patent ductus arteriosis
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opening that causes mixing of blood
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how is patent ductus arteriosis corrected
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coil occlusion: coil threaded up aorta and create thrombus to close the hole
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atrial septal defect
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blood flow from LA -> RA through atrial septum. >9mm large needs to be treated. if left untreated heart will be enlarged.
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correction of atrial septal defect
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atrial septal defect occlusion device
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coarctation of the aorta
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narrowing/stenosis of the aorta
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classic finding of coarctation of the aorta
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arm BP > leb BP by 10+mmHG
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correction of coarctation of the aorta
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w/surgery but can cause scarring which can require additional surgery
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pulmonary stenosis
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hypertrophy of RV which can cause CHF.
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correction of pulmonary stenosis
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balloon valvuloplasty
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post cath problems
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- dysrhythmias
- thrombosis - vessel dissection - bleeding at the site |
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post cath nursing
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- assess recover from anesthesia
- vital signs, pulse oximeter - assess cath site - assess perfusion distal to cath site - keep leg still |
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ventricular septal defect
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> 9 mm must be repaired, btw 2 ventricals
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tetralogy of fallot
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- pulmonic stenosis (primary defect)
- overriding aorta - ventricular septal defect - rt. ventricular hypertrophy |
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tet spell
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pulmonary congestion. increased pressure in the lungs, more breathless. pull legs to chest. and meds to reduce pressure on the heart
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transposition of great arteries
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normal O2 stat < 70. complete absence of tricuspid valve. requires corrective surgery
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tricuspid atresia
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lack of tricuspid, surgery upon being born to create opening
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discharge teaching
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- review of defect and repair
- when to call the practitioner - medications - activity limits - diet - wound care - FU appointment |
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bacterial endocarditis
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infection of endocardium and intracardiac valves.
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which children are at highest risk of bacterial endocarditis
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CHD (valvular abnormalities, prosthetic valves, high pressure shunts)
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bacterial endocarditis (pathophysiology)
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- organisms grow on area of endocardium that has been exposed to abnormal blood streaming, jet of blood or turbulance
- thickened endocardium prediposes growth of pathogens - vegetation, fibrin, thrombi form on valves - risk of emboli to CNS, lung, spleen, kidney |
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bacterial endocarditis (portals of entry)
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- dental work (antibiotics before dental work)
- cath with UT - cardiac surgery - indwelling lines |
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bacterial endocarditis CM
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- insidious onset
- unexplained low grade, intermittent fever - malaise, headaches, myalgias, arthralgias, diaphoresis, weight loss - new or changed murmer - splenomegaly |
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bacterial endocarditis Dx
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- positive blood culture
- prolonged PR - cardiomegaly - anemia - increased ESR, WBC - hematuria - vegetations seen on ECG |
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bacterial endocarditis Tx
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- high dose IV antibiotics
- periodic blood cultures to check response to Tx |
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bacterial endocarditis prognosis
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- 80% success if treated early
- death from CHF, MI, emboli, cardiac perforation - high risk pts (infants, resistant organisms, fungal infection) |
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bacterial endocarditis nursing
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- oral health and care
- teach need for specifics of subacute bacterial endocarditis prophylaxis - high index of suspicion for children with CHD - teach symptoms of subacute bacterial endocarditis |
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kawasaki disease
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- acute systemic vasculitis
- males > females - self limiting |
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kawasaki disease etiology
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- unclear
- infectious agent - late winter, early spring outbreaks |
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kawasaki disease pathophysiology
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- inflammation of small and medium size vessels
- pancarditis (inflammation of heart) - decreased left ventricular function - aneurysms - deadly |
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kawasaki disease Dx
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5 of the following including fever
- fever > 5 days - bilateral conjunctival injection w/o exudate - strawberry tongue - extremity edema, erythema and desquamation - rash - cervical lymphadenopathy |
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kawasaki disease s/s
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- unresponsive high fever
- fussy and inconsolable - temporary arthritis |
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kawasaki disease lab
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- increased WBC
- increased sedimentation rate - increased LFT - thrombocytosis - baseline and serial echocardiograms |
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kawasaki disease management
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- high dose IVIG
- aspirin - warfarin if giant aneurysms (> 8mm) |
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kawaksaki disease nursing
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- control fever
- monitor for cardiac decompensation - quiet environment - soft foods - symptomatic relief (cool cloth, meticulous oral care) |
