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HESI Pedi: Cardiovascular Disorders

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Terms in this set (37)

Cyanotic heart defects
3Ts
Tetralogy of Fallot
Truncus arteriosus [TA]
Transposition of the great vessels [TGV]
Acyanotic heart defects
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosis
Coarction of aorta
Aortic stenosis
Increased pulmonary blood flow
Atrial septal defect ASD
Ventricular septal defect VSD
Patent ductus arteriosis PDA
Obstruction of blood flow to ventricles
-coarction of aorta
-aortic stenosis
-pulmonary stenosis
Decreased pulmonary flow
Tetralogy of Fallot
Mixed blood flow
-transposition of great vessels
-hypoplastic left heart syndrome
Atrial septal defect
•Abnormal opening between atriums that allows left-to-right shunting of blood
•Increased pulmonary flow
•Decreased systemic flow
•Acyanotic
ventricular septal defect
•Abnormal opening between ventricles that allows shunting of blood from left to right to pulmonary artery
•Increased pulmonary blood flow & pulmonary hypertension
•Right ventricular hypertrophy
•Impaired gas exchange
•Most common defect
•If CHF is not present, 20-60% of them close with in the 1st year of life
•Only be concerned if the kid starts having s/s
patent ductus arteriosus
•Blood under pressure from aorta is shunted to pulmonary artery (left to right)
•Results in:
1. Oxygenated blood to re-circulate through pulmonary circulation
2. Increased vascular pressure
3. Left ventricular hypertrophy
4. Increased pulmonary blood flow
coarction of aorta
•Narrowing of the aorta obstructs systemic blood flow
•Causes decreased systemic perfusion
•Decreased pressure & weak pulses distal to defect (body & legs)
•Increased pressure & bounding pulses proximal to defect (head & arms)
aortic stenosis
•Narrowing of aortic valve prevents blood flow to systemic circulation
•Left ventricle hypertrophy
•Acyanotic
pulmonic stenosis
•Obstruction of blood flow into pulmonary artery
•Causes right ventricular hypertrophy and decreased pulmonary blood flow
tetralogy of fallot
4 things that must be present to be TOF
1. Pulmonary stenosis
2. VSD
3. Overriding aorta
4. Hypertrophy of right ventricle

•Decreased pulmonary blood flow which results in increased RV pressure and right to left shunting through VSD
tricuspid atresia
•Tricuspid valve fails to develop
•No communication from the right atrium to the right ventricle
•Blood flows through ASD or PFO to left side of heart & through VSD to right ventricle and lungs
•Decreased pulmonary blood flow
transposition of great vessels/arteries
•Pulmonary artery arises from left ventricle while the aorta exits from right ventricle
•Results in NO communication between pulmonary and systemic circulation
•Patent foramen ovale is the most common defect of TGV
hypo plastic left heart syndrome
•Underdevelopment of left side of heart
1) Includes left atrium & ventricle
2) Mitral valve
3) Aortic valve
4) Aorta
•Most blood flows through PFO
•Descending aorta receives blood from PDA supplying systemic blood flow
When does the PDA typically close?
72 hours after birth
What drug do you give to close the PDA?
Indomethacin (Indocin)
What does HTN in upper extremities and decreased/absent pulses in lower extremities indicate?
Coarctation of the Aorta
How could you relieve a child's TET spells?
The child experiences "tet" spells, or hypoxic episodes; they are relieved by the child's SQUATTING or being placed in the KNEE-CHEST position.
What is a common manifestation in children with cyanotic defects?
POLYCYTHEMIA is common in children with cyanotic defects.

Polycythemia increases risk for thrombus formation. Nursing care? Maintain hydration.
Which congenital heart defect is considered a medical emergency? What do you administer until surgery can occur?
Transposition of the Great Vessels (Mixed Blood Flow) The diagnosis is a medical emergency.

The child is given Prostaglandin E (PGE) to keep the ductus open.
Which type of defect is CHF associated with?
Congestive heart failure is more often associated with acyanotic defects.
Acyanotic
Which type of blood enters systemic circulation?
Acyanotic: Has abnormal circulation; however, all blood entering the systemic circulation is OXYGENATED.
Cyanotic
Which type of blood enters systemic circulation?
Cyanotic: Has abnormal circulation with UNOXYGENATED blood entering the systemic circulation.
What must a nurse absolutely do prior to administering digoxin to a child?
Prior to administering digoxin, nurse must take child's APICAL PULSE for 1 MIN to assess for bradycardia. Hold dose if pulse is below normal heart rate for child's age.
When do you administer digoxin?
Give 1 hour before or 2 hours after meals. Do not mix with formula or food.
What is an EARLY SIGN of digoxin toxicity in children?
Vomiting or "spitting up" in infants
What are symptoms of digoxin toxicity?
FAM VADD

Fatigue
Abdominal pain
Muscle weakness

Vomiting
Anorexia
Diarrhea
Drowsiness
When frequent weighings are required, weigh client on the same scale at the same time of day so that accurate comparisons can be made.
HESI Hint :)
What is the most common acquired heart disease in pediatrics?
Rheumatic fever
What bacteria is associated with rheumatic fever?
Beta-hemolytic streptococcal infection
What drugs would you give to a child with rheumatic fever?
Penicillin or erythromycin
ASPIRIN (antiinflammatory and anticoagulant)
Kawasaki Disease (Mucocutaneous Lymph Node Syndrome)

Describe the three phases.
Has three phases: acute, subacute, and convalescent.

Acute phase:
1. High fever for more than 5 days
2. Conjuctival redness, strawberry tongue
3. Red swollen hands and feet

Subacute phase: peeling hands and feet

Convalescent (last) phase: starts when all signs are gone and ends when lab values have returned to normal.
What do you give to treat Kawasaki Disease (Mucocutaneous Lymph Node Syndrome)?
Administer intravenous immunoglobulin (IVIG) as prescribed.

Treat high fevers with acetaminophen and aspirin (salicylate therapy) as prescribed.
What are two objectives in treating CHF?
CHF is a common complication of congenital heart disease. It reflects the increased workload of the heart caused by shunts or obstructions. The two objectives in treating CHF are to reduce the workload of the heart and increase cardiac output.
What are the S/S of Rheumatic Fever?
Fever
Chest pain, shortness of breath (carditis)
Tachycardia, even during sleep
Migratory large-joint pain
Chorea (irregular involuntary movements)
Rash (erythema marginatum)
Subcutaneous nodules over bony prominences
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