Ped Cardiology Crisis 2 BSN3

20-5%

Coronary artery aneurysms are seen in ____________ of children with untreated Kawasaki Disease

- Tetralogy of Fallot (TOF)

Cyanotic defects with decreased PBF (Pulmonary Blood Flow)

Hypoplastic Left Heart Syndrome (HLHS)

Cyanotic defects with increased PBF (Pulmonary Blood Flow)

Transposition of the Great Arteries (TGA)

Cyanotic defects with variable PBF (Pulmonary Blood Flow)

Patent Ductus Arteriosus

Ductus Arteriosus does not close after birth (goes to aorta to the lungs); Detected by a murmur; Can be medically managed (Diuretic, Digioxin) if it doesn't work then we have to close it

Foramen Ovale (between R atrium and L. atrium) Ductus Arteriosus (p. artery and aorta)

Fetus has two holes in heart that close after birth which are what?

Ventricular Septal Defect

Hole between the left and right ventricle (blood that goes fro the left to the right)

Atrial Septal Defect (ASD)

Hole in wall between the two atriums (blood goes from left atrium to right antrium back to the lungs); Can cause CHF

abrupt onset high fever (5 days of fever), inflammation of eyes (conjunctiva) & throat, strawberry tongue, skin rash with peeling, lymph node enlargement

How does Kawasaki Disease present itself?

Respiratory problem

If a baby is blue is it respiratory or cardio problem?

HR

If cardiac output is decreased in a kid- _________ is the only thing that will increase

-Circulatory changes at birth -Normal circulation through the heart -Normal pressures within the heart

In order to make sense of CHD we need to understand what 3 things?

1. high 2. low 3. low 4. high

In utero, ____1____ pressure in lungs and ___2___ in systemic side, when born pressure in lungs is ___3____ and pressure on the systemic side is ___4____- this also causes the holes to close

Bacterial Endocarditis

Infection of valves & inner lining of heart; Sequela of bacteremia, esp. in children with valve disorders; Organisms: strep, staph, other gram negative bacteria, fungus, esp. candida

Hypoplastic Left Heart

It does not develop left heart; something wrong with the mitral blood so no blood flow got to the left ventricle

Aortic Stenosis

Narrowing of the aortic valve

Pulmonic Stenosis

Narrowing of the pulmonic valve

Coarctation of the Aorta

Occurs outside the heart; Weak distal pulses

3

On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease? 1. Cracked lips 2. Normal appearance 3. Conjunctival hyperemia 4. Desquamation of the skin

Perfusion

The act of pouring through or over; especially the passage of a fluid through the vessels of a specific organ

1. first 2. 4th and 7th 3. 8 4. 21-22 5. 3rd

The cardiovascular system is the ___1____ system in the embryo to begin functioning; Develops primarily between the _____2_____ week of gestation; Heart has four chambers by ___3____ weeks; Heart begins to contract days ___4_____; Blood can be seen circulating through the "body" as early as the ___5____ week.

3

The clinic nurse reviews the record of a child just seen by a health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? 1. Pallor 2. Hyperactivity 3. Exercise intolerance 4. Gastrointestinal disturbances

2

The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement made by the parents indicates a need for further instruction? 1. "A balance of rest and exercise is important." 2. "I can apply lotion or powder to the incision if it is itchy." 3. "Activities in which my child could fall need to be avoided for 2 to 4 weeks." 4. "Large crowds of people need to be avoided for at least 2 weeks after surgery."

1

The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess the urine output? 1. Weighing the diapers 2. Inserting a urinary catheter 3. Comparing intake with output 4. Measuring the amount of water added to formula

3

The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess the infant for which early sign of HF? 1. Pallor 2. Cough 3. Tachycardia 4. Slow and shallow breathing

4

The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction? 1. "I will not mix the medication with food." 2. "I will take my child's pulse before administering the medication." 3. "If more than 1 dose is missed, I will call the health care provider." 4. "If my child vomits after medication administration, I will repeat the dose."

4

The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis? 1. Immunoglobulin 2. Red blood cell count 3. White blood cell count 4. Anti-streptolysin O titer

-Bacterial Endocarditis -Rheumatic Fever -Kawasaki Disease -Hypertension -Hyperlipidemia

What are some Acquired Cardiovascular Disorders?

-Volume Overload -Pressure Overload -Decreased Contractility

What are some Causes of Heart Failure (HF)?

-Improve cardiac function - digoxin -Remove accumulated fluid - diuretics -Decrease cardiac demands - ACE inhibitors (↓ afterload) -Improve tissue oxygenation - O2 -Family care

What are some HF - Management Goals?

-Impaired myocardial function: ↑HR , diaphoretic, fatigued, pallor -Pulmonary congestion: tachypnea 60/min, hypoxemia, inability to feed, poor wt. gain

What are some Heart Failure manifestations?

-Excess fluid volume r/t volume overload and HF -Ineffective breathing pattern r/t pulmonary congestion -Imbalanced nutrition < body requirements r/t ↑ energy expenditure and ↑feeding effort -Deficient knowledge r/t unfamiliarity with disease process, intervention, management, home care

What are some Nursing Diagnosis for Child with CHD?

-Cyanosis -Decreased CO2 -Metabolic acidosis -Abnormal heart size -O2 challenge test = PO2 < 150

What are some characteristics of a cardiac problem?

-Cyanosis -Increased CO2 -Respiratory acidosis -Normal heart size -O2 challenge test = PO2 > 150

What are some characteristics of a pulmonary problem?

-Chest x-ray -ECG -Holter monitoring -Echocardiogram-confirm CHD without cath -Cardiac Catheterization

What are some diagnostic tests?

-Diuretics (dose, schedule) -Daily weights -I&O (compare to normal for child's weight) -Respiratory assessments -Oxygen as needed -Prevent exposure to illnesses -Feeding schedule (breastmilk or ↑calorie formula) -Determine parent's readiness to learn -Teach via various methods -Answer questions...reinforce

What are some interventions for Child with CHD?

-high doses of antibiotics; prophylactic antibiotics (limited use) -Education for parents/patients

What are some treatment options for Bacterial Endocarditis?

Cyanotic and Acyanotic

What are the Classifications of CHD?

-Appropriate weight gain -Adequate I&O -No respiratory distress / infections -Color within normal limits -Good feeding without increased work of breathing -Parents able to care for child and recognize signs of distress

What are the Desired Outcomes / Goals for Child with CHD?

#1 Pulmonary Stenosis (RVOT obstruction) #2. RV hypertrophy #3. Overriding aorta #4. VSD

What are the four elements of Tetralogy of Fallot?

The ventricles

What chambers of the heart have more pressure in them?

good oral hygiene

What is a way to prevent Bacterial Endocarditis?

pressure that has to be overcome to pump blood to the body

What is after load?

Stroke volume X HR

What is cardiac output?

-Cyanotic infants should be placed on oxygen -Cyanotic CHD should be suspected when there is minimal increase in O2 saturation or arterial PO2 when the infant breathes 100% oxygen

What is included with Hyperoxia: Oxygen challenge test?

circulating volume

What is preload?

-Comfort - knee chest position (decreases pressure) -Oxygen - vasodilator - cannula or face mask -IV fluids - NS 10ml/kg boluses -Narcotic - Morphine IM, IV or subq / intranasal Fentanyl - less traumatic -Surgery is always needed

What is the Treatment of TET Spells?

SVC/IVC- R. atrium- Tricuspid valve- R. ventricle- pulmonic valve- pulmonary arteries- lungs- pulmonary veins- l. atrium- mitral valve- l. ventricle- aortic valve- aorta- body

What is the circulation through the heart?

Prevent coronary artery aneurysms

What is the goal of treatment with Kawasaki Disease?

-Health History (gestational age, birth wt...) -Prenatal factors: maternal rubella, alcoholism, lupus, medications (insulin, lithium, seizure meds) -Chromosome abnormalities (Down Syndrome, DiGeorge, Trisomy 18 / 13) -Physical Exam - PERFUSION, Color,Skin temperature -Quality of pulses, HR, cap refill -Auscultation (murmur? breath sounds) -Diagnostic Tests

What should be included in assessment of cardiac function?

Left side

What side of the heart has a greater O2 sat?

close the holes in heart (changes the pressure in the heart) and to get the secretions out

When baby is born, we want them to cry in order to do what?

1. Circulatory 2. changes 3. shunts

With Fetal and Postnatal Circulation, we need to understand ____1_____ changes, Pressure ____2____ and Closure of _____3_____

1. blood flow 2. harder

With Tetralogy of Fallot, Pulmonary artery is so skinny because of lack of _____1_____during growth; RV hypertrophy- occurs because it is working ____2____ and because of VSD

1. Ductus arteriosus 2. R. ventricle

With fetal circulation, Some blood will follow the same path as a normal heart goes but is stopped by the ___________1________ and goes to the brain; There is still blood flow that goes to _________2_______ and lungs in order for that body part to develop

Fetal

_____________ Circulation - vital organs receive max. concentration of O2 blood > High pressure in lungs diverts blood flow to body

Postnatal

______________ Circulation - circulation through heart assumes pathway allowing oxygenation of blood by lungs and delivery O2 blood to system

Heart Failure

heart's inability to circulate blood to maintain sufficient cardiac output to meet the metabolic demands of the body

TET Spells

increased in pressure in the thoracic cavity

Acyanotic

left to right shunts

Cyanotic

right to left shunts

Balloon Angioplasty of CoA

the stretching of an artery that is narrowed

4

A child with rheumatic fever will be arriving to the nursing unit for admission. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? 1. "Has the child complained of back pain?" 2. "Has the child complained of headaches?" 3. "Has the child had any nausea or vomiting?" 4. "Did the child have a sore throat or fever within the last 2 months?"

4

A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse administer the oxygen to the infant? 1. During sleep 2. When changing the infant's diapers 3. When the mother is holding the infant 4. When drawing blood for electrolyte level testing

A,B,E

A nurse is assessing an infant who has coarctation of the aorta. Which of the following findings should the nurse expect? (Select all that apply.) A. Weak femoral pulses B. Cool skin of lower extremities C. Severe cyanosis D. Clubbing of the fingers E. Heart failure

B,C,E

A nurse is assessing an infant who has heart failure. Which of the following findings should the nurse expect? (Select all that apply.) A. Bradycardia B. Cool extremities C. Peripheral edema D. Increased urinary output E. Nasal flaring

B

A nurse is caring for a 2-year-old child who has a heart defect and is scheduled for cardiac catheterization. Which of the following actions should the nurse take? A. Place on NPO status for 12 hr prior to the procedure. B. Check for iodine or shellfish allergies prior to the procedure. C. Elevate the affected extremity following the procedure. D. Limit fluid intake following the procedure

A,E

A nurse is caring for a child who is suspected of having rheumatic fever. Which of the following findings should the nurse expect? (Select all that apply.) A. Erythema marginatum (rash) B. Continuous joint pain of the digits C. Tender, subcutaneous nodules D. Decreased erythrocyte sedimentation rate E. Elevated C-reactive protein

C

A nurse is providing teaching to the mother of an infant who has a prescription for digoxin. Which of the following instructions should the nurse include? A. "Do not offer your baby fluids after giving the medication." B. "Digoxin increases your baby's heart rate." C."Give the correct dose of medication at regularly scheduled times." D."If your baby vomits a dose, you should repeat the dose to ensure that he gets the correct amount."

Kawasaki Disease

Acute systemic vasculitis, especially the coronary arteries; Cause is unknown (more common under age 5 and of Asian ancestry)

-Atrial Septal Defect (ASD) -Patent Ductus Arteriosus (PDA) -Ventricular Septal Defect (VSD)

Acyanotic defects that Increase PBF (Pulmonary Blood Flow) are what?

-Coarctation of the Aorta (CoA) -Aortic Stenosis -Pulmonic Stenosis

Acyanotic defects that obstruct PBF (Pulmonary Blood Flow)

Transposition of the Great Arteries

Aorta comes off right ventricle and the pulmonary artery comes off the left ventricle; only way they get oxygenated blood is through the ductous artiouses