Wong: Pediatric Nursing - Cardiovascular

Front 1

Fetal Circulation: Ductus Venosus -

Back 1

Shunts blood past portal circulation

Front 2

Fetal Circulation: Ductus Arteriosus -

Back 2

Shunts blood past the lungs

Front 3

Fetal Circulation: Foramen Ovale -

Back 3

Shunts blood past lungs

Front 4

Right Side of Heart:

Back 4

SVC/IVC
RA
Tricuspid Valve
RV
Pulmonic Valve
Pulmonic Artery
Lungs

Front 5

Left Side of Heart:

Back 5

Pulmonary Veins
LA
Mitral Valve
LV
Aortic Valve
Aorta/Lg. Arteries/Capillaries/VC

Front 6

Cardiac Output:

Back 6

Volume of blood ejected from heart in 1 min.
CO = HR x SV

Front 7

Stroke Volume:

Back 7

Amount of blood ejected by heart in any 1 contraction

Front 8

3 Factors that Influence Stroke Volume:

Back 8

Preload
Afterload
Contractability

Front 9

Preload:

Back 9

Volume of blood returning to heart

Front 10

Afterload:

Back 10

Resistance against which ventricles must pump when ejecting blood

Front 11

Contractility:

Back 11

Efficiency of the myocardial fiber to act as a pump

Front 12

Subtle Symptoms of CV Dysfunction:

Back 12

Duskiness w/ feeding & exertion
Dyspnea w/ physical effort
Fatigue
Sweating w/ feeding
Excessive sweating
Expiratory grunt
Squatting
Clubbing (LT)
Failure to Thrive

Front 13

Diagnosing CV Dysfunction:

Back 13

Radiography
ECG
Echocardiography
Cardiac Catheterization

Front 14

Radiography:

Back 14

Permanent record of heart size and configuration, it's chambers and great vessels

Front 15

ECG:

Back 15

Detects arrhythmias, muscular damage, hypertrophy, effects of electrolyte imbalance

Front 16

Echocardiography:

Back 16

Uses high frequency sound waves obtained by a transducer to produce an image of cardiac structure

Front 17

Cardiac Catheterization:

Back 17

Uses radiopaque catheters placed in peripheral blood vessel and advanced into heart to measure pressures and oxygen levels in heart chambers & visualize heart structures & blood flow patterns.

Front 18

Defects of Increased Pulmonary Flow:

Back 18

Patent Ductus Arteriosus (PDA)
Atrial Septal Defect (ASD)
Ventrical Septal Defect (VSD)
Artioventricular Canal Defect (AVC)

Front 19

Defects of Increased Pulmonary Flow: Patent Ductus Arteriosus (PDA)

Back 19

Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close w/in the 1st weeks of life.

Front 20

Patent Ductus Arteriosus (PDA): Symptoms -

Back 20

May Be Asymptomatic
CHF
Full Bounding Pulses
Machine Like Murmur

Front 21

Patent Ductus Arteriosus (PDA): Treatment -

Back 21

Prostaglandin Inhibitors
Surgical Ligation

Front 22

Patent Ductus Arteriosus (PDA): Risks -

Back 22

Bacterial Endocarditis
Pulmonary Vascular Obstructive Disease later in life

Front 23

Defects w/ Increased Pulmonary Flow: Atrial Septal Defect (ASD) -

Back 23

Abnormal opening RA and LA that allows blood from the higher pressure LA to the lower pressure RA. Larger the hole larger the problem.

Front 24

Atrial Septal Defect (ASD): Symptoms -

Back 24

May be Asymptomatic
CHF
Murmur

Front 25

Atrial Septal Defect (ASD): Treatment -

Back 25

Surgical Patch Closure

Front 26

Atrial Septal Defect (ASD): Risks -

Back 26

Bacterial Endocarditis
Atrial Dysrhythmias

Front 27

Defects w/ Increased Pulmonary Flow: Ventrical Septal Defect (VSD) -

Back 27

Abnormal opening between the RV and LV. Blood goes from higher pressure LV to lower pressure RV.

Front 28

Ventrical Septal Defect (VSD): Symptoms -

Back 28

CHF
Murmur
Frequently assoc. w/ other defects

Front 29

Ventrical Septal Defect (VSD): Treatment -

Back 29

Pulmonary Artery Banding
Suture or Patching

Front 30

Ventrical Septal Defect (VSD): Risks -

Back 30

Bacterial Endocarditis
Pulmonary Vascular Obstructive Disease

Front 31

Defects w/ Increased Pulmonary Blood Flow: Artioventricular Canal Defect (AVC) -

Back 31

Incomplete fusion of the endcardial cushions.Large opening in the center of the heart which allows blood to flow between all four chambers. Common in DS children.

Front 32

Artioventricular Canal Defect (AVC): Symptoms -

Back 32

Mod - Sev. CHF
Murmur
Mild cyanosis w/ crying

Front 33

Artioventricular Canal Defect (AVC): Treatment -

Back 33

Banding
Patch Closure

Front 34

Artioventricular Canal Defect (AVC): Risks -

Back 34

Bacterial Endocarditis
Pulmonary Obstructive Vascular Disease

Front 35

Defects w/ Decreased Pulmonary Flow:

Back 35

Tetralogy of Fallot
Tricuspid Atresia

Front 36

Defects w/ Decreased Pulmonary Flow: Tetralogy of Fallot -

Back 36

4 Classic Defects:
VSD
Aorta laying over VSD
Pulmonary Stenosis
Right Ventricular Hypertrophy

Front 37

Tetralogy of Fallot: Symptoms -

Back 37

Cyanosis
Murmur
Tet Spells

Front 38

Tetralogy of Fallot: Tet Spells -

Back 38

Acute spells of cyanosis w/ hyperpnea (deeper more rapid respirations). May occur during crying, defecating of feeding.

Front 39

Tetralogy of Fallot: Treatment of Tet Spells -

Back 39

Calm infant
Place in knee to chest position
Give blow by O2
Call for assistance
IV Morphine
Fluid Replacement

Front 40

Tetralogy of Fallot: Treatment -

Back 40

Surgical Repair

Front 41

Defects w/ Decreased Pulmonary Blood Flow: Tricuspid Atresia -

Back 41

Failure of tricuspid valve to develop resulting in lack of communication between RA and RV. PDA allows child to remain alive.

Front 42

Tricuspid Atresia: Symptoms -

Back 42

Cyanosis
Tachycardia
Dypnea
Hypoxemia
Clubbing (LT)

Front 43

Tricuspid Atresia: Treatment -

Back 43

Prostaglandin to maintain patency of PDA
Surgical Repair

Front 44

Tricuspid Atresia: Risk -

Back 44

Bacterial Endocarditis

Front 45

Obstructive Defects:

Back 45

Aortic Stenosis
Pulmonic Stenosis
Coarctation of the Aorta

Front 46

Obstructive Defects: Aortic Stenosis -

Back 46

Narrow aortic valve d/t thickened or deformed valve cusps.

Front 47

Aortic Stenosis: Symptoms -

Back 47

Murmur
Decreased CO2
Faint Pulses
Hypotension
Tachycardia
Poor Feeding
Exercise Intolerance

Front 48

Aortic Stenosis: Risks -

Back 48

Bacterial Endocarditis
Coronary Insufficiency
Ventricular Dysfunction

Front 49

Aortic Stenosis: Treatment -

Back 49

Balloon Angioplasty
Aortic Valvotomy
*Rarely results in "normal" valve*

Front 50

Obstructive Defects: Pulmonic Stenosis -

Back 50

Narrowing at the entrance to the pulmonary artery.

Front 51

Pulmonic Stenosis: Symptoms -

Back 51

May be asymptomatic
Murmur
CHF
Cyanosis (severe)

Front 52

Pulmonic Stenosis: Risks -

Back 52

Bacterial Endocarditis
Ventricular Hypertrophy

Front 53

Pulmonic Stenosis: Treatment -

Back 53

Balloon Angioplasty

Front 54

Obstructive Defects: Coarctation of the Aorta -

Back 54

Localized narrowing of the aorta near the ductus arterosis

Front 55

Coarctation of the Aorta: Symptoms -

Back 55

Increased pressure in head & upper extremities
Decreased pressure in body and lower extremities
*BP and Pulse vary between upper and lower extremities

Front 56

Coarctation of the Aorta: Treatment -

Back 56

Balloon Angioplasty

Front 57

Mixed Blood Flow Defects:

Back 57

Transposition of the Great Vessels
Truncus Arteriosus
Hypoplastic Left Heart Syndrome

Front 58

Mixed Blood Flow Defects: Transposition of the Great Vessels -

Back 58

No communication between systemic and pulmonary circulation. PDA keeps patient alive.

Front 59

Transposition of the Great Vessels: Symptoms -

Back 59

Dependant on severity and PDA:
Cyanosis
CHF
Depressed Functioning

Front 60

Transposition of the Great Vessels: Treatment -

Back 60

Surgery - arterial switch

Front 61

Mixed Blood Flow Defects: Truncus Arteriosis -

Back 61

One artery arises from the heart and forms both aorta and pulmonary artery

Front 62

Truncus Arteriosis: Symptoms -

Back 62

May be asymptomatic
Variable cyanosis
Poor growth
Activity intolerance

Front 63

Truncus Arteriosis: Risks -

Back 63

Bacterial Endocarditis

Front 64

Truncus Arteriosis: Treatment -

Back 64

Surgical Repair

Front 65

Mixed Blood Flow Defects: Hypoplastic Left Heart Syndrome -

Back 65

Underdevelopment of the left side of the heart.

Front 66

Hypoplastic Left Heart Syndrome: 4 Common Defects -

Back 66

Hypoplastic left heart & ascending aorta
Coarctation of the aorta
Aortic and mitral valve defects
Progressive deterioration and cardiovascular collapse if PDA closes

Front 67

Hypoplastic Left Heart Syndrome: Symptoms -

Back 67

Mild Cyanosis
CHF until PDA closes

Front 68

Hypoplastic Left Heart Syndrome: Treatment -

Back 68

Multi-stage surgical repair

Front 69

Congestive Heart Failure:

Back 69

Inability of the heart to pump an adequate amount of blood to systemic circulation to meet body demands.

Front 70

CHF: Causes -

Back 70

Volume Overload
Pressure Overload
Decreased Contractility
High Cardia Output Demands

Front 71

CHF: Manifestation Classifications -

Back 71

Impaired Myocardial Function
Pulmonary Congestion
Systemic Venous Congestions

Front 72

CHF: Symptoms of Impaired Myocardial Function -

Back 72

Tachycardia
Inappropriate Sweating
Oliguria
Fatigue/Weakness
Restlessness
Anorexia
Weak Peripheral Pulses/Pale Cool Extremities
Hypotension
Gallop Rhythm
Cardiomegaly

Front 73

CHF: Symptoms of Pulmonary Congestion -

Back 73

Tachypnea
Dyspnea
Retractions (infants)
Flaring Nares
Exercise Intolerance
Feeding Difficulties
Cyanosis
Irritability
Wheezing/Crackles/Grunting/Cough

Front 74

CHF: Symptoms of Systemic Venous Congestions -

Back 74

*Weight Gain
Hepatomegaly
Peripheral Edema
Ascites
Neck Vein Distension

Front 75

CHF: Signs of Impending Heart Failure -

Back 75

Increase in:
Weight
Pulse
Cyanosis

Front 76

CHF: Goals of Treatment -

Back 76

Improve Cardiac Function
Remove Accumulated Fluid and Sodium
Decrease Cardiac Demands

Front 77

CHF: Medications to Improve Cardiac Function -

Back 77

Digoxin
ACE Inhibitors

Front 78

CHF: Digoxin -

Back 78

Increases contractility
Slows conduction through AV node
Enhances diuresis

Front 79

CHF: Digoxin Toxicity -

Back 79

Bradycardia
Nausea
Vomiting
Visual Disturbances

Front 80

CHF: Digoxin Administration -

Back 80

2 RN's check dosage
1 min. apical pulse
Hold if pulse below 100
Monitor I&O
Between 0.8-2ug/L

Front 81

CHF: ACE Inhibitors -

Back 81

Blocks conversion of angiotension I to angiotension II.

EX:
Catopril
Enalapril
lisinopril

Front 82

CHF: Treatment of Fluid Accumulation -

Back 82

Diuretics
Fluid Restriction

Front 83

CHF: Treatment to Decrease Cardiac Demands -

Back 83

Minimize metabolic needs (avoid cold stress)
Treat infection
Reduce breathing effort (semi-fowlers)
Sedation
Rest
Frequent small meals
Administer ordered O2

Front 84

Hypoxemia:

Back 84

Arterial oxygen tension (or pressure) that is lower then normal. Identified by measuring arterial oxygen saturation (SaO2) or PaO2.

Front 85

Hypoxemia: 2 Physiological Changes -

Back 85

Polthycemia
Clubbing

Front 86

Hypoxemia: Polthycemia -

Back 86

Increased number of RBC's

Front 87

Hypoxemia: Clubbing -

Back 87

A thickening and flattening of the tips of the fingers and toes.

Front 88

Acquired Cardiovascular Disorders:

Back 88

Bacterial Endocarditis
Rheumatic Fever
Kawasaki Disease

Front 89

Bacterial Endocarditis:

Back 89

Infection of the valves and inner lining of the heart. Most commonly caused by Strepococcus viridians but many also be caused by Staphlococcus aureus or Candida albicans

Front 90

Bacterial Endocarditis: Symptoms -

Back 90

Low grade fever
Anorexia
Malaise
Headache
Weight loss
New/different murmur
Osler Nodes
Janeway Spots

Front 91

Bacterial Endocarditis: Diagnosis -

Back 91

Echocardiogram
ECG
Blood Cultures

Front 92

Rheumatic Fever:

Back 92

An autoimmune illness resulting from a systemic inflammatory collagen disease that follows a group A beta hemolytic streptococcal infection.

Front 93

Rheumatic Fever: Compilications -

Back 93

Rheumatic Heart Disease

Front 94

Rheumatic Fever: Aschoff Bodies -

Back 94

Inflammatory hemorrhagic bullous lesions in connective tissue, blood vessels, brain, joints, pleura

Front 95

Rheumatic Fever: Prevention -

Back 95

Screen all sore throats

Front 96

Rheumatic Fever: Treatment -

Back 96

Antibiotic
Aspirin
Bed rest
Long term antibiotic prophylaxis

Front 97

Kawasaki Disease:

Back 97

Mucocutaneous Lymph Node Syndrome. Acute systemic vasculitis of unknown cause.

Front 98

Kawasaki Disease: Diagnostic Criteria -

Back 98

Fever lasts 5+ days
5 of 6 of the following:
Bacterial conjunctivitis w/out exudate
Changes in oral mucosa (erythema, dryness, lip fissures, strawberry tongue)
Changes in extremities (peripheral edema, erythema of palms/soles, peeling of hands/feet)
Cervical lymphadenopathy
Polymorphous rash

Front 99

Kawasaki Disease: Risks -

Back 99

Damage to CV system
Leading cause of acquired HD in US (scarring)

Front 100

Systemic Hypertension:

Back 100

Consistent elevation of B/P

Front 101

Systemic Hypertension: Causes -

Back 101

Renal dysfunction
CV dysfunction
Endocrine dysfunction
Neurologic dysfunction
Drugs

Front 102

Systemic Hypertension: Symptoms -

Back 102

Frequent headaches
Dizziness
Vision changes

Infants:
Irritability
Head banging/rubbing
Night screaming

Front 103

Hyperlipidemia:

Back 103

Increased amount of lipids. Play and important role in producing atherosclerosis leading to coronary artery disease

Front 104

Hyperlipidemia: Plaque Detection -

Back 104

May be seen as early as 2yrs old.