PEDS Cardiac RAT

Heart Failure Left Sided

CHOP Cough Hemoptysis Orthopnea Pulmonary Congestion (crackles/rales)

Congenital Heart Defects

Congenital heart defects or acquired heart defects are most common Could be born with them Or result of infections, autoimmune responses, environmental factors, or familial tendencies

Heart Failure Right Sided

HEAD Hepatomegaly Edema (bipedal) Ascites Distended Neck Vein

the best way to assess cardiac function

I&O

Decreased Pulmonary Blood Flow Tetrology of Fallot

Patho: in the heart TOF-Tetrology of Fallot S/S: decreased O2 cyanosis polycythemia clubbing nails anorexia fatigue growth failure weak cry TET spells: "hypercyanotic spell" can lead to seizures, CVA, or death because of decreased O2 harsh systolic murmur 4 complications: pulmonary stenosis; VSD; overriding aorta; right ventricle hypertrophy squatting: opens up airways for child cluster care O2 decrease crying nutrition: space meals Decreases O2: feeding, crying, pooping

Acquired Heart Disease Rheumatic Fever

Patho: inflammation disorder: heart, joints, connective tissue, CNS peaks @ school age family hx autoimmune disorder: strep S/S: carditis; polyarthritis; chorea (St. Vitus Dance, can last up to 3 months); subcutaneous nodules (non-tender bumps); erythema marginatum (giraffe spots) Hx of RF, fever, strep Dx tests: erythrocyte sed.; antistrepolysin; titer; ECG changes Drug: penicillin; salicylates (ASA); steroids (corticosteroids); aspirin (arthritis) bed rest: promote! chorea: five small frequent meals; increased muscle activity (increased kcal requirements) stay away from stress/sickness/smoking

Lesions w/a Mix of Saturated and Desaturated blood Transposition of Great Vessles

Patho: oxygenated blood and deoxygenated blood are mixed together "transposition of Great Vessels": most common right and left side have switched no O2 to the body lungs O2 to itself S/S: cyanosis & hypoxemia tachycardia, dyspnea, increased respirations cardiac murmur decreased feeding, GF, low energy, weak crying, lethargy HF polycythomia clubbing nails bacterial endocarditis, emboli, stroke prostaglandin E: keeps PDA open only treatment is surgery

Mixed Defects

Tetrology of Fallot some babies are born with holes in the septum. these holes allow blood to mix between the two sides of the heart.

Heart Failure Origin

The LEFT side of the heart if the LUNG has edema (crackles, abnormal lung sounds) The RIGHT side of the heart if the REST of the body has edema (hands, feet, literally anywhere else)

The Heart

Tricuspid Valve: 3 leaves Mitral/Bicuspid Valve: 2 leaves Atrial ventricular valves: the tricuspid and mitral valves; first sound you hear when you listen with stethoscope Semi-lunar valves: S2; second sounds you hear; pulmonic and aortic valve

Cardiomyopathy

a disease of the heart muscle the myocardium becomes abnormally enlarged, thickened, and/or stiffened such that the heart can no longer contract or relax normally. eventually the heart loses its ability to pump blood effectively and irregular heartbeats and heart failure may occur. leading reason for heart transplants and sudden deaths in children.

Patent Ductus Arteriosus

abnormal blood flow occurs between two of the major arteries connected to the heart. before birth, the two major arteries--the aorta and the pulmonary artery--are connected by a blood vessel called the ductus arteriosus. this vessel is an essential part of fetal blood circulation

Kawasaki's Disease

acute systemic vascularitis large vessels enlarge and strain the heart high risk for cardiogenic shock S/S: bulbar conjunctiva of eyes; strawberry tongue; rash; desquamation of hands and feet; hypercoagulability, aneurysm risk; ESR elevated, C-reactive protein

The nurse is preparing to teach a course for parents of children with cardiac disease. She has identified CPR, vital signs, medications, and disease entities as essential topics. What essential topic mentioned in the text should also be included?

anatomy and physiology of the cardiovascular system

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? a) immunoglobulin b) red blood cell count c) white blood cell count d) anti-streptolysin O titer

anti-streptolysin O titer

signs and symptoms of peripheral edema in children are not likely to include which of the following?

ascites

Newborn Circulation

at birth, the umbilical cord is clamped and the baby no longer receives oxygen and nutrients from the mother. with the first breaths of air, the lungs, begin to expand, and the ductus arteriosus and the foramen ovale both close. the baby's circulation and blood flow through the heart now function like an adult's

Congenital Heart Disease

atrioventricular septal defects coarctation of the aorta tetralogy of Fallot transposition of the great arteries ventral septal defects

Which of the following describes an expected difference in the assessment of subjective findings with a child?

because preverbal children cannot communicate what they feel, the nurse must ask the parent

Fetal Heart Circulation

blood enters the umbilicus to the umbilical vein-->liver-->portal circulation and inferior vena cava-->right atrium-->foramen ovale-->head and upper extremities-->left atrium-->left ventricle-->pulmonary artery-->descending aorta the right side is more significant than the left side when umbilical cord is clamped, pressures rise and the left side takes on the higher pressures of the heart ventricles are the highly muscular portions: left ventricle is the work horse of the heart Everything is meant to grow the fetus Reduce the other processes and get growth and maturity for organs Bypass lungs in fetal circulation Oxygenated blood goes into the umbilical vein; then into the inferior vena cava, right atrium, foramen ovale (hole in right and left side; should close after birth), left atrium, left ventricle, pulmonary artery, descending aorta Superior vena cava largest in adults, goes to the brain

Any forces impeding the flow of blood out of the heart affect afterload. Factors that relate directly to assessment of afterload include which of the following

blood viscosity; blood pressure; pulmonary vascular resistance

Which cardiac symptom commonly experienced by adults is less common in children?

chest pain

Tetralogy of Fallot

children exhibit bluish skin during episodes of crying or feeding "Tet spell" causes low oxygen levels in the blood; this leads to cyanosis the classic form includes four defects of the heart and its major blood vessels: ventricular septal defect (hole betwen the right and left ventricles); narrowing of the pulmonary outflow tract (the valve and artery that connect the heart with the lungs); overriding aorta (the artery that carries oxygen-rich blood to the body) that is shifted over the right ventricle and ventricular septal defect, instead of coming out only from the left ventricle; thickened wall of the right ventricle (right ventricular hypertrophy)

Hypoplastic Left Heart Syndrome

complex and rare heart defect present at birth; the left side of the heart is critically underdeveloped. the left side can't effectively pump blood to the body, so the right side of the heart must pump blood to the lungs and to the rest of the body. S/S: cyanosis; rapid, difficult breathing; poor feeding; cold hands and feet; being unusually drowsy or inactive

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? a) cracked lips b) normal appearance c) conjunctival hyperemia d) desquamation of the skin

conjunctival hyperemia

What is the most accurate description of changes associated with right-to-left shunting of cardiac blood flow

cyanosis and cardiac enlargement

Beta-Blockers (metoprolol)

decrease blood pressure decrease heart rate increase vasodilation may cause hypoglycemia

Calcium Channel Blockers (amlodipine)

decreases heart rate has some relaxation affects

Cyanotic Defects

defect that cause decreased pulmonary blood flow mixed blood flow events occurs before the lungs Some examples include Tetralogy of Fallot, transposition of the great vessels, hypoplastic left heart syndrome.

ACE Inhibitors

easy on the kidneys interrupt the renin-angiotensin vasodilation decreased vascular resistance decreased BP reduce afterload decrease aldosterone secretion--decreasing preload

Contractility of Heart

efficiency of the heart how fast the heart is beating and the stroke volume

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? a) pallor b) hyperactivity c) exercise intolerance d) gastrointestinal disturbances

exercise intolerance

Arteries

go AWAY from the heart

Veins

go back to the heart (vacuum)

Activity intolerance is often identified as a nursing diagnosis for the child with cardiac disease. Choose the intervention most directly related to this diagnosis

group nursing care actions

Cardiac Output

heart rate x stroke volume

Long QT Syndrome

heart rhythm condition that can potentially cause fast, chaotic heartbeats. these may trigger fainting spells or a seizure. in some cases, the heart can beat erratically for so long that it causes sudden death. detected through ECG

Coarctation of the Aorta

high BP before point of coarctation low BP beyond point of coarctation the narrowing of the aorta, the large blood vessel that branches off your heart and delivers oxygen-rich blood to the body. when this occurs, the heart must pump harder to force blood through the narrow part of the aorta.

Increased Pulmonary blood flow

hole in the atrium left aorta to right right sided HF hole in ventricles Pulm-da aorta: connection that shouldn't be there

Increased Pulmonary Blood Flow ASD, VSD, PDA, AV

increased lung blood flow Patho: holes in atria, ventricles, aorta, AV canal ASD: smaller problem VSD: bigger problem PDA: indomethocin (NSAID) AV: XL problem, seen in Down Syndrome, ASD, VSD SX: GF; decreased wt. gain; decreased O2; respiratory difficulties ex: increased respiratory rate, dyspnea, orthopnea, coughing, nasal flaring; fatigue; increased sweating: eating or exercising; HF: crackles in lungs; cardiac murmur PDA: pulm + aorta; increased bounding pulses PDA should seal before delivery deoxygenated blood going into body surgery to fix this VSD: more pressure in right ventricles; hypertrophy leading to HF; bacterial endocarditis AV: usually seen in Down Syndrome; bigger hole seen in HF; usually on HF meds; surgery to repair usually open heart Meds or Surgery: patch or cauterization adequate nutrition small frequent meals: 5 times a day 1) nipple feeding 2) semi-upright position 3) burp 4) rest decrease crying episodes

Ventral Septal Defect

increased pulmonary blood flow a hole in the heart, is a common congenital birth defect. the hole occurs in the wall that separates the heart's lower chambers (septum) and allows blood to pass from the left to the right side of the heart.

Atrial Septal Defect

increased pulmonary blood flow an ASD is a hole in the part of the septum that separates the atria--the upper chambers of the heart.

Acyanotic Defects

increased pulmonary blood flow obstruction to blood flow ventricles occurs after the blood has circulated through the lungs-hence not low oxygen is the issue. Some examples of this would be pulmonary stenosis, coarctation of the aortic, ventral septal defects. This leads to clubbing of the fingers and polycythemia (needing to increase red blood cells and stimulate erythropoietin)

Digoxin

increases force of contraction decrease heart rate enhances diuresis by renal perfusion therapeutic level of digoxin: 0.5-2 ng/mL antidote: Digibind

Acquired Heart Disorders

infections autoimmune responses environmental factors familial tendencies

Meds to know

inotropes (digoxin): enhances myocardial function ACE inhibitors: reduce afterload Beta-Blockers (metoprolol): inhibit receptor sites Calcium Channel Blockers (amlodipine): disrupts movement of calcium

Edema and fluids already in the body

left sided HF

Obstruction of OUTflow Coarctation of Aorta, Pulmonary Stenosis, Aortic Stenosis

more backed up into the heart Patho: aorta, pulmonic valve, aortic valve Coarctation of Aorta: HF; top half of body increased blood flow; bottom half of body decreased blood flow and decreased temp; 4 bp's on extremities; twisting like a straw in the aorta Pulmonic Stenosis: HF; RV increased work; Ventricle hypertrophy; cyanosis; cardiac murmur Aortic Stenosis: HF; increased resistance LV-LV hypertrophy; faint pulse; tachycardia; hypotension; decreased feeding; no exercise; cardiac murmur; decreased crying surgery to repair: usually a patch monitor for: hypotension; HF; cyanosis and hypoxemia; nutrition HF: extra pressure ruptured aorta cardiac murmur

Right Artery Right Vein

non-oxygenated blood goes into the pulmonary artery to the lungs

Left Artery Left Vein

oxygenated blood goes into the aorta to the rest of the body

Left Sided HF

oxygenated blood becomes congested jugular veins engorged pink, frothy sputum tachypnea hypoxemia cyanosis weight gain or loss costal retractions pulmonary edema orthopnea with tripod position wheezing and coughing

Assessment finding of an infant admitted to the hospital reveal a machinery-like murmur on auscultation of the heart and signs of heart failure. The nurse reviews congenital cardiac anomalies and identifies the infant's condition as which disorder? a) aortic stenosis b) atrial septal defect c) patent ductus arteriosus d) ventricular septal defect

patent ductus arteriosus

Peds Cardiac Surgery

patho: surgical correction open heart or closed heart surgery closed heart: usually PDA and uses ligation or burning Pre-op: child's level of understanding; practice post-op procedures (turn, cough, deep breathe); educate parents; pre-op baseline data (VS, labs, I&O, activity/rest) Post-op: prevent injury/complications (monitor VS & circulatory; neurological status; observe surgery site for intactness/drainage/infection); position (HOB 30 degrees); O2 @ prescribed rate; humidification "Swan's Catheter": PAWP ECG readings: 24-72 hours or longer

Right Side

pushes blood into the lungs

Afterload of Heart

resistance the ventricle must overcome to eject blood out of the heart dependent on left ventricle

Intrinsic Conduction System of the Heart

sinoatrial node right atrium left atrium atrioventricular node left ventricle right ventricle

Stenosis

stenosis prevents the valve from opening properly, forcing the heart to work harder to pump blood through the valve. aortic valve stenosis is a narrowing of the aortic valve.

what mechanism describes the effect of valvular defect or disease on cardiac function?

stiff or leaky valves require ventricles to pump with a greater force of contraction, which weakens the cardiac muscle.

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? a) pallor b) cough c) tachycardia d) slow and shallow breathing

tachycardia

Stroke Volume

the amount of blood ejected by the left ventricle in one contraction normal value of about 1 cc/kg amount of blood pushed out in each heart beat preload, afterload, and contractility

Oxygen

the money of the body

Right Sided HF

venous return becomes congested tachycardia poor appetite peripheral edema weight gain ascites increased capillary refill cold extremities mottling of skin fatigue

Preload of Heart

volume of blood returning to the heart

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? a) weighing the diapers b) inserting a urinary catheter c) comparing intake with output d) measuring the amount of water added to formula

weighing the diapers

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? a) during sleep b) when changing the infant's diapers c) when the mother is holding the infant d) when drawing blood for electrolyte level testing

when drawing blood for electrolyte level testing

S1

○ Atrial ventricular nodes ○ Valves between tricusbid and mitral ○ Systoli occurs when it is going out Dystoli occurs when the chambers are filling

Decreased Pulmonary blood flow

"Blue cyanosis" Tetralogy of Fallot Tet spells: crying causes them to become cyanotic

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? a) "Has the child complained of back pain?" b) "Has the child complained of headaches?" c) "Has the child had any nausea or vomiting?" d) "Did the child have a sore throat or fever within the last two months?"

"Did the child have a sore throat or fever within the last two months?"

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? a) "A balance of rest and exercise is important." b) "I can apply lotion or powder to the incision if it is itchy." c) "Activities in which my child could fall need to be avoided for two to four weeks." d) "large crowds of people need to be avoided for at least two weeks after surgery."

"I can apply lotion or powder to the incision if it is itchy"

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? a) "I will not mix the medication with food" b) "I will take my child's pulse before administering the medication" c) "if more than 1 dose is missed, I will call the health care provider" d) "if my child vomits after medication administration, I will repeat the dose."

"If my child vomits after medication administration, I will repeat the dose"

Outflow Problems

"Obstruction Cardiac Chamber" arteries are blocked or narrowed, coarctation aorta, stenosis

Mix of saturated and desaturated O2 blood

"Trans of Great Vessels" mixture of O2, transformation aorta is connected to right ventricle, not the lungs right and left sides are mixed up, not getting O2 just recycling deoxygenated blood

Normal Beats in Children

140 resting heart rate bradycardia is anything below 90-100 tachycardia is anything above 200 in newborn and 160 in 2 year old need to assess child to determine if normal or not AV node: 80-120 beats

Listening to Heart

Apple Pie To Make ○ Aortic ○ Pulmonic ○ Tricuspid ○ Mitral ○ Erbs point Place stethoscope to point of maximal impulse 5th intercostal mid-clavicular region Free-hand, palpate carotid artery Sound at same time as pulse is the S1 Mitral is in sync with carotid Neonates tend to have a lot of murmurs Still in transition; things haven't all closed Usually insignificant unless causing problems Common in neonates is hypoxemia SOB By one year of age, left ventricle is same size as right ventricle May see hypoxemia