Peds Test #2

Front 1

abnormal growth of cells

Back 1

neoplasm

Front 2

growth is limited, may not be life threatening

Back 2

benign

Front 3

there is progressive growth of the tumor and it will spread to other sites if not removed

Back 3

malignant

Front 4

The heart, blood and blood vessels makes up what system?

Back 4

Cardiovascular system

Front 5

When the heart pumps, it sends what and what through the bloodstream to cells?

Back 5

Oxygen and nutrients

Front 6

When the heart pumps, it send oxygen and nutrients throught the bloodstream to cells and allows what product to subsequently be removed from cells and sent to the lungs or kidneys for extraction?

Back 6

Waste products

Front 7

What can also regulate hormones, enzymes and antibodies to body systems?

Back 7

The heart

Front 8

What can change rate and force to adapt to the needs of the body at any given time?

Back 8

The heart

Front 9

Most cardiac disorders in children happen secondary to a?

Back 9

Congenital anomaly

Front 10

What kind of disorders can be aquired from diseases such as rheumatic fever, or Kawasaki Disease, among others?

Back 10

Cardiac disorders

Front 11

Normal Circulation

Where does normal circulation begin?

Back 11

Inferior/Superior Vena Cava

Front 12

Normal Circulation

Where does blood flow to from the inferior/superior vena cava?

Back 12

Right atrium

Front 13

Normal Circulation

Through what valve does blood flow through when traveling from the right atrium to the right ventricle?

Back 13

Tricuspid valve

Front 14

Normal Circulation

Where area of the heart does the blood enter when flowing through the tricuspid valve from the right atrium?

Back 14

Right ventricle

Front 15

Normal Circulation

When blood flows from the right ventricle to the pulmonary artery, what valve does it flow through?

Back 15

Pulmonary valve

Front 16

Normal Circulation

When blood flows from the right ventricle through the pulmonary valve, what area does it enter?

Back 16

Pulmonary artery

Front 17

Normal Circulation

Where does blood flow to from the pulmonary artery?

Back 17

Lungs

Front 18

Normal Circulation

Where does the blood flow to from the lungs?

Back 18

Pulmonary veins

Front 19

Normal Circulation

Where does blood flow to from the fulmonary veins?

Back 19

Left atrium

Front 20

Normal Circulation\

Where does blood flow to from the left atrium through the mitral valve?

Back 20

Left ventricle

Front 21

Normal Circulation

What valve does blood flow through when it moves from the left atrium to the left ventricle?

Back 21

Mitral valve

Front 22

Normal Circulation

What valve does blood flow through when it flows from the left ventricle to the aorta?

Back 22

Aortic valve

Front 23

Normal Circulation

When blood flows from the left ventricle through the aortic valve, what does it enter?

Back 23

Aorta

Front 24

The temporary flap opening between the atria?

Back 24

Foramen Ovale

Front 25

Carries blood from the liver to the inferior vena cava in fetal circulation?

Back 25

Ductus Venosus

Front 26

Connection between the pulmonary artery and the aorta (helps bypas lungs in fetus)?

Back 26

Ductus arteriosus

Front 27

Volume of blood pumped by the ventricles each minute.

Back 27

Cardiac output

Front 28

Can be calculated by multiplying stroke volume by the heart rate?

Back 28

Cardiac output

Front 29

What is affected by preload, contractility, and afterload?

Back 29

Cardiac output

Front 30

Volume of blood a ventricle ejects during systole?

Back 30

Stoke volume

Front 31

Volume of blood in the ventricles at the end of diastole (time right before contraction)?

Back 31

Preload

Front 32

Resistance against which the ventricles must pump when ejecting blood?

Back 32

Afterload

Front 33

Ability of the cardiac muscle to act as an efficient pump?

Back 33

Contractility

Front 34

Between right and left atrium. Should close after the cord is clamped and over the next few weeks after birth?

Back 34

Patent foramen ovale

Front 35

Remember, lungs are not working until after?

Back 35

birth

Front 36

Assessments of Children with Cardiac Disorders

Begins with a thorough history and a what?

Back 36

Physical assessment

Front 37

Assessments of Children with Cardiac Disorders

Illnesses, medications, radiation, etc, are examples of what?

Back 37

Pregnancy history

Front 38

Assessments of Children with Cardiac Disorders

Does the infant or child fatigue easily when eating, start sweating, have shortness of breath, weight gain, are part of?

Back 38

Feeding patterns

Front 39

Assessments of Children with Cardiac Disorders

Find out if they have frequent respiratory?

Back 39

Infections

Front 40

Assessments of Children with Cardiac Disorders

Will you find out if they have had cyanosis?

Back 40

Yes

Front 41

Assessments of Children with Cardiac Disorders

In infants, this may only include feeding?

Back 41

An intolerance to exercise

Front 42

Assessments of Children with Cardiac Disorders

Electrocardiogram (ECG), X-ray, Echodardiogram, Phonocardiagram, Exercise testing, Labs, and cardiac cath?

Back 42

Diagnostic Tests

Front 43

Assessments of Children with Cardiac Disorders

A diagnostic test concerning rate, thythm, state of the heart, presence or absence of hypertrophy, ischemia or necrosis, and electrolyte imbalances?

Back 43

Electrocardiogram (ECG)

Front 44

Assessments of Children with Cardiac Disorders

This diagnostic test is used to find heart size, pattern of blood flow, and pulmonary vascular markings?

Back 44

X-ray

Front 45

Assessments of Children with Cardiac Disorders

This is the primary diagnostic tool for heart disease. Studies the movement and dimensions of the heart and size of chambers, thickness of walls, vessels and valves?

Back 45

Echocardiogram (ultrasound of the heart)

Front 46

Assessments of Children with Cardiac Disorders

Diagram of heart sounds put into eletrical energy by a microphone?

Back 46

Phonocardigram

Front 47

Assessments of Children with Cardiac Disorders

When resting, what is the position if younger?

Back 47

Knee-chest positions

Front 48

Assessments of Children with Cardiac Disorders

Older children may what when resting?

Back 48

Squat

Front 49

Assessments of Children with Cardiac Disorders

Does the child have a history of any what abnormalities such as Down's syndrome, turner syndrome, trisomy 18?

Back 49

Chromosomal

Front 50

Assessments of Children with Cardiac Disorders

Vital signs, height, weight (compared against standards of other children), are part of what assessment?

Back 50

Physical

Front 51

Assessments of Children with Cardiac Disorders

Skin color, including pallor or cyanosis are part of what assessment?

Back 51

Physical

Front 52

Assessments of Children with Cardiac Disorders

PMI/Apical pulse are part of what assessment?

Back 52

Physical

Front 53

Assessments of Children with Cardiac Disorders

Thrills are part of what assessment?

Back 53

Physical

Front 54

Assessments of Children with Cardiac Disorders

Central and peripheral pulses (check for quality and symmetry), are part of what assessment?

Back 54

Physical

Front 55

Assessments of Children with Cardiac Disorders

Body and extremity temperatures (warm upper and cool lower), are part of what assessments?

Back 55

Physical

Front 56

Assessments of Children with Cardiac Disorders

Check blood pressure in all extremities is part of what assessment?

Back 56

Physical

Front 57

Assessments of Children with Cardiac Disorders

Checking for edema is part of what assessment?

Back 57

Physical

Front 58

Assessments of Children with Cardiac Disorders

Checking for clubbing is part of what assessment?

Back 58

Physical

Front 59

Assessments of Children with Cardiac Disorders

Auscultating heart sounds is part of what assessment?

Back 59

Physical

Front 60

Assessments of Children with Cardiac Disorders

Auscultating lung sounds (check for crackles, work of breathing, again check position of comfort when resting) is part of what assessment?

Back 60

Physical

Front 61

Assessments of Children with Cardiac Disorders

Activity tolerance is part of what assessment?

Back 61

Physical

Front 62

Assessments of Children with Cardiac Disorders

Checking for normal growth and development is part of what assessment?

Back 62

Physical

Front 63

Assessments of Children with Cardiac Disorders

Inability of the heart ot pump an adequate amount of blood to the systemic circulation to meet the body's metabolic demand?

Back 63

CHF

Front 64

Assessments of Children with Cardiac Disorders

Clinical manifestations of this include tachycardia, sweating, decreased urinary output, weakness, pale, cool extremities, fatigue, weak peripheral pulses, retractions, tachypnea, cough, nasal flaring, and weight gain?

Back 64

CHF

Front 65

Assessments of Children with Cardiac Disorders

Less 4-6 may have severe anemia?

Back 65

HgM

Front 66

Assessments of Children with Cardiac Disorders

If cyanosis increases with crying, it is related to?

Back 66

Heart

Front 67

Assessments of Children with Cardiac Disorders

If cyanosis decreases with crying, is is related to?

Back 67

Lungs

Front 68

Assessments of Children with Cardiac Disorders - Diagnostic Tests

Uses treadmill to see if pulmonary circulation increases to meet increased demands of the body?

Back 68

Exercise testing

Front 69

Assessments of Children with Cardiac Disorders - Diagnostic Tests

ABG's, CBC, electrolytes. May have increased RBC's (polycythemia), may have increased ESR?

Back 69

Labs

Front 70

Assessments of Children with Cardiac Disorders - Diagnostic Tests

Checks oxygen sats in chambers, pressure, cardiac output, stroke volume, and any anatomical abnormalities?

Back 70

Cardiac Cath

Front 71

Assessments of Children with Cardiac Disorders - Diagnostic Tests

Keep what at 95% unless known heart problem?

Back 71

Oxygen

Front 72

Treatment - Medications

To remove fluid and sodium (decrease preload)?

Back 72

Diuretics

Front 73

Treatment - Medications

Is potassium losing diuretic?

Back 73

Lasix

Front 74

Treatment - Medications

Is potassium sparing diuretic?

Back 74

Aldactone

Front 75

Treatment - Medications

What type of medication improves contractility?

Back 75

Inotropes

Front 76

Treatment - Medications

Digoxin what type of medication?

Back 76

Inotrope

Front 77

Treatment - Medications

Increases contraction, slow HR, slows conduction, increases renal perfusion, increases cardiac output, decreases heart size, relieves edema?

Back 77

Digoxin

Front 78

Treatment - Medications

Give loading dose until blood levels are therapeutic, then maintenance dose given?

Back 78

Digoxin

Front 79

Treatment - Medications

Given twice daily in kids. Don'tgive if apical heart rate <100 in infants, <80 in children, <60 in adults. Common side effect of toxicity in children is nausea/vomiting?

Back 79

Digoxin

Front 80

Treatment - Medications

Type of medication used to decrease afterload?

Back 80

Angiotension-converting enzyme inhibitors (ACE)

Front 81

Treatment - Medications

Captopril and enalapril are examples of what type of medication?

Back 81

Angiotension-converting enzyme inhibitor (ACE)

Front 82

Treatment - Cardiac Cath and Surgery

Pre-op care include vital signs to establish?

Back 82

Baselines

Front 83

Treatment - Cardiac Cath and Surgery

May withhold what for 24 hours prior to surgery?

Back 83

Digoxin

Front 84

Treatment - Cardiac Cath and Surgery

Check height and weight, ease fears of child and?

Back 84

Parent(s)

Front 85

Treatment - Cardiac Cath and Surgery

Post-op care x-rays are done after?

Back 85

surgery

Front 86

Treatment - Cardiac Cath and Surgery

The child is what before leaving the OR?

Back 86

weighed

Front 87

Treatment - Cardiac Cath and Surgery

Hemorrhage, shock, postcardiac surgery syndrome, and postperfusion syndrome are what?

Back 87

Complications

Front 88

Treatment - Cardiac Cath and Surgery Nutritional Support

What is the daily weight gain goal for newborn?

Back 88

15-30 grams per day

Front 89

Treatment - Cardiac Cath and Surgery Nutritional Support

What kind of feedings?

Back 89

Small and frequent

Front 90

Treatment - Cardiac Cath and Surgery Nutritional Support

Oral feeding time should be?

Back 90

limited

Front 91

Treatment - Cardiac Cath and Surgery Nutritional Support

Gavage if?

Back 91

necessary

Front 92

Treatment - Cardiac Cath and Surgery Nutritional Support

Formula should be?

Back 92

concentrate

Front 93

Treatment - Cardiac Cath and Surgery Nutritional Support

Reflux issues should be?

Back 93

managed

Front 94

Congenital heart defects

What percent of newborns are born with a congenital heart defect (higher in preterm infants)?

Back 94

8%

Front 95

Congenital heart defects

They are equal in males and females, but certain defects have a what preference?

Back 95

gender

Front 96

Congenital heart defects

They are caused by failure of a heart structure to progress in?

Back 96

utero

Front 97

Congenital heart defects

Some are?

Back 97

familial

Front 98

Congenital heart defects

Increased pulmonary blood flow, decreased pulmonary blood flow, obstruction to blood flow, and mixed blood flow are?

Back 98

The categories of congenital heart defects

Front 99

Congenital Heart Defects

Involve blood flow from the left side of the heart (which has greater pressure) to the right side of the heart (less pressure) through some type of abnormal opening or connection between the great arteries?

Back 99

Defects with increased pulmonary blood flow.

Front 100

Congenital Heart Defects

These include VSD, ADS, AVC, and PDA?

Back 100

Defects with increased pulmonary blood flow.

Front 101

Congenital Heart Defects

May have s/s of CHF, frequent respiratory infections, and pulmonary hypertension?

Back 101

Defects with incresaed pulmonary blood flow.

Front 102

Congenital Heart Defects

Most common type of disorder of congenital heart defects?

Back 102

VSD

Front 103

Congenital Heart Defects

Opening is present in the septum between the left and right ventricles, causing increased pulmonary blood flow?

Back 103

VSD

Front 104

Congenital Heart Defects

What does VSD stand for?

Back 104

Ventricular Septal Defect

Front 105

Congenital Heart Defects

Because pressure is greater in left ventricle, the blood shunts from left to right (acyanotic)?

Back 105

VSD

Front 106

Congenital Heart Defects

Blood is shunted from the ventricle directly across the open septum into the pulmonary artery (doesn't go into the aorta and out into the body like it should?

Back 106

VSD

Front 107

Congenital Heart Defects -VSD

May not be evident at?

Back 107

birth

Front 108

Congenital Heart Defects

When the infant is about 4-8 weeks of age, shunting begins and the baby demonstrates symptoms of fatigue, poor growth, dyspnea, tachypnea, murmur along left sterna border at the third or fourth interspace. May also have a thrill?

Back 108

VSD

Front 109

Congenital Heart Defects

Diagnosis made via echo, x-rays, MRI?

Back 109

VSD

Front 110

Congenital Heart Defects

Up to 85% are small enough they close on their own?

Back 110

VSD

Front 111

Congenital Heart Defects

If moderate in size, they may be closed with cardiac cath?

Back 111

VSD

Front 112

Congenital Heart Defects

Large ones (greater than 3mm)require open-heart surgery. Try to schedule before 2 years of age to prevent complications of pulmonary HTN or endocarditis?

Back 112

VSD

Front 113

Congenital Heart Defects

May use Dacron patch to suture into place to occlude the space if large enough?

Back 113

VSD

Front 114

Congenital Heart Defects

What does ASD stand for?

Back 114

Atrial Septal Defect

Front 115

Congenital Heart Defects

Abnormal opening at any point in atrial septum that permits left-to-right shunting of blood?

Back 115

ASD

Front 116

Congenital Heart Defects

The opening may be small, as when the foramen ovale fails to close, or septum may be completely absent?

Back 116

ASD

Front 117

Congenital Heart Defects

More common in girls?

Back 117

ASD

Front 118

Congenital Heart Defects

Because blood flow is from left to right (oxygen to deoxygenated) there is a stronger contraction of the left side of heart, causing an increase in volume in the right side and ventricular hypertrophy and increased pulmonary artery blood flow?

Back 118

ASD

Front 119

Congenital Heart Defects

Harsh systolic murmur heard over 2nd or 3rd interspace (pulomic area) secondary to extra amount of shunted blood?

Back 119

ASD assessment

Front 120

Congenital Heart Defects

Many young children and infants have no syptoms and small ASD's may not be diagnosed until preschool years or later. May have CHF, easily fatigued, poor growth with large ASD's?

Back 120

ASD assessment

Front 121

Congenital Heart Defects

Diagnosis made with echo that shows right ventricular overload?

Back 121

ASD assessment

Front 122

Congenital Heart Defects

Surgery done between 1-3 years. If it is not closed, the cild is at risk for infectious endocardities and possible heart failure. If not repaired in girls, it could cause emboli in pregnancy?

Back 122

Therapeutic Management ASD

Front 123

Congenital Heart Defects

May need open-heart surgery or interventional cardiac cath?

Back 123

Therapeutic Management ASD

Front 124

Congenital Heart Defects

What does AVC stand for?

Back 124

Atrioventricular Canal Defect

Front 125

Congenital Heart Defects

Also known as endocardial cushion defect?

Back 125

AVC (Atrioventricular Canal Defect)

Front 126

Congenital Heart Defects

All four heart chanbers with this defect?

Back 126

AVC

Front 127

Congenital Heart Defects

It is rare, surgery is always necessary?

Back 127

AVC

Front 128

Congenital Heart Defects

What does PDA stand for?

Back 128

Patent Ductus Arteriosus

Front 129

Congenital Heart Defects

The ductus is necessary to connect the pulmonary artery to the aorta in the fetus. If it fails to close at birth, blood will shunt from the aorta to the pulmonary artery (deoxygenated) secondary to increased pressure in the aorta?

Back 129

PDA

Front 130

Congenital Heart Defects

The are twice as common in girls than boys, more in higher altitudes?

Back 130

PDA's

Front 131

Congenital Heart Defects

Incidence is as high as 20% in preterm infants?

Back 131

PDA's

Front 132

Congenital Heart Defects

On exam, child has wide pulse pressure. Diastolic low because of peripheral resistance. May hear a continuous murmur, possibly thrill?

Back 132

PDA's

Front 133

Congenital Heart Defects

Also has tachypnea, full bounding pulses, poor development, risk for respiratory infections and endocardities?

Back 133

PDA's

Front 134

Congenital Heart Defects

ECG may be normal. Echo shows visualization of the patent ductus. Cardiac cath not usually needed?

Back 134

Diagnoses of PDA's

Front 135

Congenital Heart Defects

If it doesn't close at birth, the patient may be prescribed IV indomethacin or ibuprofen, wheich are both protaglandin inhibitors?

Back 135

Treatment of PDA's

Front 136

Congenital Heart Defects

Prostaglandin inhibitors help lower PGE levels and close the ductus. Side effects of indomethacin could be decreased glomerular filtration, impaired platelets and diminished GI and cerebral blood flow?

Back 136

Treatment of PDA's

Front 137

Congenital Heart Defects

Ibuprofen is becoming drug of choice because of fewer side effects. If the meds don't work to close the ductus, may need insertion of Dacron-coated stainless-steel coils via cardiac cath when child is 6 months to 1 year?

Back 137

Treatment of PDA's

Front 138

Congenital Heart Defects

Large ones may be closed by surgical ligation, but not open heart surgery?

Back 138

Treatment of PDA's

Front 139

Congenital Heart Defects

Causes blood flow to be obstructed because a vessel or valve is narrower than usual. This causes pressure to be increased before the narrowing occurs and decrased after the narrowing. Because of this, the blood flow can't reach the intended site, lungs or body and the heart builds up with pressure?

Back 139

Disorder with Obstruction to Blood Flow

Front 140

Congenital Heart Defects

Pulmonary stenosis, aortic stenosis and coarctation of the aorta are?

Back 140

Disorders with Obstruction to Blood Flow

Front 141

Congenital Heart Defects

Makes up 10% of congenital heart anomalies
Leads to right ventricular hypertrophy
Is a narrowing of the pulmonary valve or the pulmonary artery distal to the valve?

Back 141

Pulmonary Stenosis

Front 142

Congenital Heart Defects

May have no symptoms and grow normally?

Back 142

Mild pulmonary stenosis

Front 143

Congenital Heart Defects

Will have dyspnea and fatigue with exertion. Systolic murmur with a fixed split S2 and possible thrill in pulmonic area?

Back 143

Moderate pulmonary stenosis

Front 144

Congenital Heart Defects

In severe pulmonary stenosis, may have?

Back 144

Cyanosis

Front 145

Congenital Heart Defects

ECG or Echo to show right ventricular hypertrophy?

Back 145

Diagnosis of Pulmonary Stenosis

Front 146

Congenital Heart Defects

Balloon angioplasty via cardiac cath is treatment of choice. A catheter with an uninflated balloon at its tip is put into the stenosed area of the heart and inflated. This breads valve adhesions and relieves the stenosis. Normal lifespan after procedure?

Back 146

Treatment of Pulmonary Stenosis

Front 147

Congenital Heart Defects

Worse than pulmonary stenosis?

Back 147

Aortic stenosis

Front 148

Congenital Heart Defects

Prevents blood from passing easily from the left ventricle of the heart into the aorta. This causes increased pressure and hypertrophy of the left ventricle?

Back 148

Aortic stenosis

Front 149

Congenital Heart Defects

Pressure in the left atrium can also occur, causing back pressure in pulmonary veins and may be pulmonary edema?

Back 149

Aortic stenosis

Front 150

Congenital Heart Defects

7% of congenital cardiac abnormalities?

Back 150

Aortic Stenosis

Front 151

Congenital Heart Defects

Most children are asymptomatic, but have murmur. May have a thrill. Child may occassionally complain of chest pain after exercise, but doesnt' have exercise intolerance. May have weak peripheral pulses, may faint and feel dizzy. CHF in symptomatic infants?

Back 151

Assessment of Aortic Stenosis

Front 152

Congenital Heart Defects

Sometimes this is detected in school age children during sports physicals. Sudden death can occur when the amount of oxygen needed by the heart on exertion exceeds what is available?

Back 152

Aortic Stenosis Assessment

Front 153

Congenital Heart Defects

ECG or echo?

Back 153

Diagnosis of Aortic Stenosis

Front 154

Congenital Heart Defects

Stabilize with beta-blocker or calcium channel blocker. These reduce cardiac hypertrophy before the problem has been corrected. Usually have balloon valvuloplasty during cardiac cath?

Back 154

Aortic Stenosis Treatment

Front 155

Congenital Heart Defects

For severe defects, may need surgery. Some children may need artificial vlave replacement, in which case they need anticoagulation or antiplatelet therapy and prophylaxis against endocardits?

Back 155

Aortic Stenosis Treatment

Front 156

Congenital Heart Defects

Narrowing of the lumen of the aorta?

Back 156

Coarctation of the Aorta

Front 157

Congenital Heart Defects

6% of congenital heart disease?

Back 157

Coarctation of the Aorta

Front 158

Congenital Heart Defects

More often in boys?

Back 158

Coarctation of the Aorta

Front 159

Congenital Heart Defects

Leading cause of CHF in first few months of life?

Back 159

Coarctation of the Aorta

Front 160

Congenital Heart Defects

Occurs either preductal (between subclavian artery and ductus arteriosus) or post ductal (distal to the ductus arteriosus)?

Back 160

Coarctation of the Aorta

Front 161

Congenital Heart Defects

Because blood can't pass through, blood pressure increases proximal to the narrowing and decreases distally?

Back 161

Coarctation of the Aorta

Front 162

Congenital Heart Defects

Elevated upper body blood pressures that can cause headache and vertigo. Infants display irritability. These children may also have nosebleeds and CVA's?

Back 162

Assessment of Coarctation of the Aorta

Front 163

Congenital Heart Defects

If small, absence of palpable femoral pulses may be present, or possibly absent brachial pulses?

Back 163

Assessment of Coarctation of the Aorta

Front 164

Congenital Heart Defects

As child grows older, may experience leg pain, secondary to decreased blood supply. Have lower BP on lower extremities?

Back 164

Assessment of Coarctation of the Aorta

Front 165

Congenital Heart Defects

May have pale lower extremities and weak pulses?

Back 165

Assessment of Coarctation of the Aorta

Front 166

Congenital Heart Defects

May be made with history and assessment findings. BP usually 20mmHg higher in upper extremities. Also use echo, MRI, ECG or x-rays?

Back 166

Diagnosis of Coarctation of the Aorta

Front 167

Congenital Heart Defects

Interventional angiography (balloon dilation) or surgery, which involves removing narrowed portion of the aorta and the new ends are anastomosed.
May use graft of subclavian artery if extensive narrowing?

Back 167

Treatment of Coarctation of the Aorta

Front 168

Congenital Heart Defects

Treatment also consists of using digoxin and diuretics before surgery to reduce CHF. May need antihypertensives. May need repeat balloon angioplaty at adolescence?

Back 168

Treatment of Coarctation of the Aorta

Front 169

Congenital Heart Defects

Include Transposition of Great Arteries and Hypoplastic Left Heart Syndrome?

Back 169

Disorders with Mixed Blood Flow

Front 170

Congenital Heart Defects

Blood mixes from pulmonary and systemic circulation within the heart chambers. This causes deoxygenation of systemic blood flow, but may not have cyanosis?

Back 170

Disorders with Mixed Blood Flow

Front 171

Congenital Heart Defects

Mixing is necessary for survivial?

Back 171

Disorders with Mixed Blood Flow

Front 172

Congenital Heart Defects

May have pulmonary congestion?

Back 172

Disorders with Mixed Blood Flow

Front 173

Congenital Heart Defects

Decreased cardiac output?

Back 173

Disorders with Mixed Blood Flow

Front 174

Congenital Heart Defects

S/S of CHF, mild to moderate hypoxemia?

Back 174

Disorders with Mixed Blood Flow

Front 175

Congenital Heart Defects

The aorta comes from the right ventricle instead of the left and the pulmonary artery from the left ventricle instead of the right. This causes the blood to enter the heart from the vena cava to the right atrium then to the right ventricle and into the aorta to the body while being deoxygenated and it returns again by the vena cava?

Back 175

Transposition of the Great Arteries

Front 176

Congenital Heart Defects

More blood enters heart from pulmonary vein then goes to the left atrium to left ventricle and out the pulmonary artery to lungs to be oxygenated and then to left atrium?

Back 176

Transposition of the Great Arteries

Front 177

Congenital Heart Defects

This on is eequal to having 2 parallel circulations?

Back 177

Transposition of the Great Arteries

Front 178

Congenital Heart Defects

This defect is incompatible with life?

Back 178

Transposition of the Great Arteries

Front 179

Congenital Heart Defects

Occurs more often in large newborns?

Back 179

Transposition of the Great Arteries

Front 180

Congenital Heart Defects

More in boys?

Back 180

Transposition of the Great Arteries

Front 181

Congenital Heart Defects

5% of congenital heart defects?

Back 181

Transposition of the Great Arteries

Front 182

Congenital Heart Defects

Cyanosis (that doesn't improve with oxygenation), hypoxia, acidosis, CHF, tachypnea, growth failure?

Back 182

Assessment of Transposition of the Great Arteries

Front 183

Congenital Heart Defects

Echo, ECG?

Back 183

Diagnosis of Transposition of the Great Arteries

Front 184

Congenital Heart Defects

If no septal defect exists or if too small to allow mixing to sustain life, need to have PGE (prostaglandin) administered to keep PDA open until surgery?

Back 184

Treatment of Transposition of the Great Arteries

Front 185

Congenital Heart Defects

A balloon atrial septal pull-through operation is done to enlarge the septal openings in the first few days of life. Surgical correction done from 1 week to 3 months of age and involves an arterial switch procedure?

Back 185

Treatment of Transposition of the Great Arteries

Front 186

Congenital Heart Defects

Survival rate is 95% with surgery?

Back 186

Transposition of the Great Arteries

Front 187

Congenital Heart Defects

Rare disorder, only 1-3% of congenital heart defects?

Back 187

Hypoplastic Left Heart Syndrome

Front 188

Congenital Heart Defects

Left ventricle is nonfunctional?

Back 188

Hypoplastic Left Heart Syndrome

Front 189

Congenital Heart Defects

May have absent or stenosis of mitral and aortic valves?

Back 189

Hypoplastic Left Heart Syndrome

Front 190

Congenital Heart Defects

Non-functioning left heart can't pump blood into systemic circulation, causing right ventricle hypertrophy?

Back 190

Hypoplastic Left Heart Syndrome

Front 191

Congenital Heart Defects

Mild to moderat cyanosis
Tachypnea, decreased peripheral pulses, poor peripheral perfusion, pulmonary edema, shock, death
Diagnosis - echo
Treatment - Prostaglandin therapy to maintain a PDA, inhaled nitrogen to decrease PO2, 2-3 stage surgery is possible, heart transplant is ultimate treatment?

Back 191

Hypoplastic Left Heart Syndrome

Front 192

Congenital Heart Defects

Involve some type of obstruction to pulmonary blood flow?

Back 192

Disorders with Decreased Pulmonary Blood Flow

Front 193

Congenital Heart Defects

Usually a vascular or valvular malformation?

Back 193

Disorders with Decreased Pulmonary Blood Flow

Front 194

Congenital Heart Defects

ASD or VSD may also be present?

Back 194

Disorders with Decreased Pulmonary Blood Flow

Front 195

Congenital Heart Defects

High right-sided pressure?

Back 195

Disorders with Decreased Pulmonary Blood Flow

Front 196

Congenital Heart Defects

Decreased sats?

Back 196

Disorders with Decreased Pulmonary Blood Flow

Front 197

Congenital Heart Defects

Hypoxemia, cyanosis?

Back 197

Disorders with Decreased Pulmonary Blood Flow

Front 198

Congenital Heart Defects

Tricuspid Atresia and Tetralogy of Fallot?

Back 198

Disorders with Decreased Pulmonary Blood Flow

Front 199

Congenital Heart Defects

Right to left shunts always?

Back 199

Cyanotic

Front 200

Congenital Heart Defects

Extremely serious because this valve is completely closed so no blood from right atrium to right ventricle?

Back 200

Tricuspid Atresia

Front 201

Congenital Heart Defects

Blood pases through the patent foramen ovale into left atrium, bypassing lungs and oxygenation. If PDA remains open, child can get oxygenated. Need continuous IV Prostaglandin until surgery?

Back 201

Tricuspid Atresia

Front 202

Congenital Heart Defects

10% of children with cardiac anomaly?

Back 202

Tetralogy of Fallot

Front 203

Congenital Heart Defects

Four anomalies - pulmonary stenosis, VSD, overriding of the aorta, hypertrophy of the right ventricle. Have elevated pressures in right side and blood is shunted from the area of increased pressure into left ventricle and overriding aorta?

Back 203

Tetralogy of Fallot

Front 204

Congenital Heart Defects

15% of children with this disorder have a deletion abnormality of chromosome 22 or other chromosome disorder?

Back 204

Tetralogy of Fallot

Front 205

Congenital Heart Defects

Newborns may have cyanosis right after birth, but as they become more active. Polycythemia occurs, dyspnea, growth retardation, clubbing, squatting or kee-chest position for comfort, syncope, hypoxic episodes (know as tet spells or hypercyanotic spells). Loud, harsh murmur?

Back 205

Assessment of Tetralogy of Fallot

Front 206

Congenital Heart Defects

Known as tet speels or hypercyanotic spells?

Back 206

Hypoxic episodes

Front 207

Congenital Heart Defects

Based on history and physical symptoms, labs (polycythemia), echo, ECG, cardiac cath?

Back 207

Diagnosis of Tetralogy of Fallot

Front 208

Congenital Heart Defects

Correct the heart defects at 1-2 years of age?

Back 208

Treatment of Tetralogy of Fallot

Front 209

Congenital Heart Defects

Knee-chest position first, give morphine, oxygen, propranolol?

Back 209

Treatment of hypercyanotic episodes

Front 210

Congenital Heart Defects

In the Tetralogy of Fallot, temporary or palliative surgery is called?

Back 210

Blalock-Taussig procedure

Front 211

Congenital Heart Defects

Temporary or palliative surgery called the Blalock-Taussig procedure may be done to create a shunt between aorta and pulmonary artery. This let blood leave the aorta and enter the pulmonary arter, oxygenate in lungs, and return to left side of the heart, the aorta, and the body?

Back 211

Treatment in Tetralogy of Fallot

Front 212

Congenital Heart Defects

No palpable pulse in right arm after surgery because subclavian artery is used. Never do blood pressures or venipunctures in the right arm?

Back 212

Treatment in Tetralogy of Fallot

Front 213

Acquired Heart Disease

An inability of the heart to pump an adequate amount of blood to the systemic circulation to meet the body's metabolic demand?

Back 213

Congestive Heart Failure

Front 214

Acquired Heart Disease

Clinical symptoms - tachycardia, sweating, decreased urine output, fatigue, anorexia, weakness, cool, pale extremities, weak peripheral pulses, decreased BP, dyspnea, tachypnea, retractions, wheezing, weight gain, grunting, hepatomegaly?

Back 214

Diagnosis of CHF

Front 215

Acquired Heart Disease

Chest x-ray, enlarge heart and increased pulmonary vascular markings?

Back 215

Diagnosis of CHF

Front 216

Acquired Heart Disease

Improve contractility, decrease preload, reduce afterload, and decrease cardiac demands?

Back 216

Treatment of CHF

Front 217

Acquired Heart Disease

Digoxin is what type of drug?

Back 217

Inotropes

Front 218

Acquired Heart Disease

Give at scheduled times, take apical pulse prior to administration, monitor levels
S/S of toxicity-nausea, vomiting, bradycardia, dysrhythmias?

Back 218

Digoxin use to improve contractility in the treatment of CHF.

Front 219

Acquired Heart Disease

Lasix, Bumex, and Aldactone are what type of medication?

Back 219

Diuretics

Front 220

Acquired Heart Disease

Monitor potassium (hypokalemia increases risk of dig toxicity)
S/S of dehydration
Fluid and salt restriction?

Back 220

Diuretics used to decrease preload in the treatment of CHF

Front 221

Acquired Heart Disease

Captopril and Enalapril are?

Back 221

ACE Inhibitors

Front 222

Acquired Heart Disease

Monitor for hypotension?

Back 222

ACE Inhibitors used to reduce afterload in CHF

Front 223

Acquired Heart Disease

Comfortable neutrothermic environment
Treat infections
Semi-fowler's position
Uninterrupted rest
Decreased anxiety (sedation)
Good nutrition
Oxygen as needed?

Back 223

How to decrease cardiac demands in the treatment of CHF

Front 224

Acquired Heart Disease

Infection of the valves or inner lining of the heart?

Back 224

Bacterial Endocarditis

Front 225

Acquired Heart Disease

Microorganisms grow on the valve or endocardium forming vegetations. They may break off and travel to other parts of the body?

Back 225

Bacterial Endocarditis

Front 226

Acquired Heart Disease

Unexplained low grade fevers
New murmur or change in existing one
Malaise
Anorexia/weight loss
Myalgias/arthralgias
?

Back 226

Clinical Manifestations of Bacterial Endocarditis

Front 227

Acquired Heart Disease

CBC-increased WBC
Sedimentation rate-increased
Blood cultrues - positive
Echocardiogram - visualize abscess
?

Back 227

Diagnosis of Bacterial Endocarditis

Front 228

Acquired Heart Disease

Antibiotics - high doses for 4-6 weeks IV and po to treat
Surgery - valve replacement, drain abscess, remove vegetation
Prophylaxis - antibiotics prior to invasive procedures?

Back 228

Medical treatment of Bacterial Endocarditis

Front 229

Acquired Heart Disease

Growing problem due to poor diet, sedentary lifestyle
Some can also be familial?

Back 229

Juvenile Onset Heart Disease

Front 230

Acquired Heart Disease

Family history of premature heart attack/stroke
BMI>97%
Hypertension
Dyslipidemia
Smoking
Hyperinsulinism/type 2 diabetes?

Back 230

Cardiac Risk Factors related to Juvenile Onset Heart disease

Front 231

Acquired Heart Disease

Body makes cholesterol and is obtained by food we eat
LDL - low density (fat clogging)
HDL - high density (transport LDL out)
Triglycerides - storage form of fatty acids, transports digested fat to fat cells and muscle?

Back 231

Cholesterol related to Juvenile Onset Heart disease

Front 232

Acquired Heart Disease

Weekly associated with heart disease
More indicative of pending type 2 diabetes
Simple sugars elevate level most
Greatest risk is pancreatitis (level>500)?

Back 232

Triglycerides related to Juvenile Onset Heart disease

Front 233

Acquired Heart Disease

Total cholesterol > 170
LDL >110
HDL < 45
Triglycerides >120
Typical profile - TC=220, LDL=105, HDL=30, Trig=300
?

Back 233

Dyslipidemia - Increased lipids in blood serum

Front 234

Acquired Heart Disease

Lifestyle changes (5-2-1-0)
Diet - decrease sugars, decrease fat and increase fiber. Should have 5 servings of fruit/veg, skim milk, limit eating out, watch school meals, eat breakfast
Limit screen time to 2 hours/day
Exercise - 60 minutes of moderate intensity per day
No sugar sweetened beverages
No smoking or exposure?

Back 234

Lifestyle changes to decrease risk of Juvenile Onset Heart Disease

Front 235

Acquired Heart Disease

Family history
Lipid Profile (TC=370, LDL=260, HDL=50, Trig=75)
Lifestyle changes
Statin Medication (over age 10)
Monitor liver enzymes?

Back 235

Familial Hypercholesterolemia

Front 236

Cancer Drugs

Must be both pre and post hydrated to maintain kidney function.
Common complication is hemorrhagic cystitis, Mesna is used to counteract this (proctectant). Sometimes given before chemo, but always given after, sometimes in one hour bag, followed by 3-6 doses in 3 hour intervals. Causes acute myelosupression, esp. severe decrease in platelets, causing increase risk for bleeding. May be a cause for SIADH (discuss this). Useful in sarcoma and leukemia?

Back 236

Cytoxan, Ifosafamide

Front 237

Cancer Drugs

Can cause renal and hepatic toxicity, may cause ototoxicity, myelosuppression, sever n/v. Often given with Mannitol which is given over 6 hours to help clear out drug and maintain kidney function. Must monitor every shift, weights and strict I/O. Check hearing before every dose?

Back 237

Cesplatin & Carboplatin

Front 238

Cancer Drugs

This is used with slightly higher incidence of renal dysfunction?

Back 238

Cisplat

Front 239

Cancer Drugs

Also called anthracycline antibiotics?

Back 239

Doxorubicin & Adriamycin

Front 240

Cancer Drugs

Increased risk for cardiomyopathy if reach more than maximum life time dosage. When given in dilute solution over 48-96 hours or at low weekly doses, cardiotoxicity decreases. Need to have echo or MUGA prior to chemo administration. Causes severe mucositis and myelosuppression.
May color the urine red.
Extravasation and tissue necrosis can occur with IV administration?

Back 240

Doxorubicin & Adriamycin

Front 241

Cancer Drugs

Causes peripheral neuropathy, obstipation or constipation. Useful for most cancers. ALWAYS GIVEN IVP, DEADLY IF GIVEN INTRATHECALLY! It is also a vesicant?

Back 241

Vincristine

Front 242

Cancer Drugs

Must keep urine alkaline, 6.5 or greater, to decrease chances of renal toxicity. Leukovorin is a rescue drug required to avoid prolonge healthy cell exposure. Given over 24 hour infusion or over 4-6 hours of a high dose infusion. May also cause severe mucositis. Useful in leukemia, lymphoma and osteosarcoma?

Back 242

Methotrexate

Front 243

Cancer Drugs

Severe mucositis, peripheral neuropathy, fever & chills during infusion, myelosuppression, fluctuations in BP duing infusion. Monitor BP every 15 minutes during one hour infusion. Make sure patient has assistance when getting up, so as to not get dizzy. Vesicant?

Back 243

Etoposide

Front 244

Cancer Drugs

Enzyme that deprives tumor of essential amino acids so they block protein synthesis. Causes severe allergic reactions, pancreatities, n/v and liver damage. Also can cause abnormalities?

Back 244

L-Aspariginase

Front 245

Cancer Drugs

Stops DNA synthesis by stopping transcription. Common agents are prednisone, used with leukemia in induction therapy. S/E are cushingnoid appearance, elevated BP, elevated glucose, myelosuppression, peptic ulcer, sodium & fluid retention?

Back 245

Hormonal Agents