Upgrade to remove ads
Only $2.99/month

Peds Exam 2 Cardiovascular

Terms in this set (47)

palpation for pulses
babies: brachial and femoral
kids: radial and pedal
bell
low pitch
Diaphragm
high pitched
electrocardiogram
-done FIRST!
-measures electrical activity of the heart and takes about 15 minutes
-electrodes are color coded: white for right, green or red for ground, black for left
echocardiography
-ultrasound recording of heart function
-takes about 1 hour, very stressful for children and they must lie quietly in supine position
-young children and infants may need mild sedation
-a distraction video is often helpful
Cardiac MRI
-define unresolved anatomic pathways when a child may have poor acoustic windows or a complex structure
-noninvasive imaging technique, used to determine ventricular mass and volume
preoperative care for Catheterization
-get weight and height for accurate drug calculations
-severe diaper rash may be a reason to cancel the procedure if femoral access is required
-assess and mark distal pulses
-NPO for 6-8 hours before procedure
-know their allergies; cannot be allergic to iodine!
-symptom of infection would be reason to cancel
postoperative care for Catheterization
-keep leg straight for 4-6 hours for venous or 6-8 hours for arterial
-IV fluids
-Vital signs every 15 minutes, then 30, then 1 hour
-look at puncture site/ dressing for bleeding
-check pulses distal to site
-cover Cath insertion site w/ adhesive dressing and change daily for 2 days
-keep site clean and dry
-use acetaminophen for pain
congenital heart disease
-result from some interference in the development of heart structures during fetal life
-nutritional intake: only eat for 30 minutes, lavage, and then rest
increased pulmonary blood flow
-blood is going back to the pulmonary artery
-blood moves from the left side to the right side
-ASD, VSD, and PDA
decreased pulmonary blood flow
Tetralogy of Fallot
Tricuspid atresia
patent ductus arteriosus (PDA)
-failure of ductus closure after birth
-the connection between the aorta and pulmonary vein
-might close in couple day or weeks
-increases workload of the left side of the heart
-indomethacin helps close this!!
clinical manifestations of patent ductus arteriosus (PDA)
-may be asymptomatic or show signs of HF, machinery-like murmur, widened pulse pressure and bounding pulses result from runoff blood from the aorta to the pulmonary artery
treatment fo patent ductus arteriosus (PDA)
-cardiac Cath or ligation
-give prostaglandin E
atrial septal defect (ASD)
-passageway or hole in the septum that divides the right atrium from the left atrium
-if the ASD is small, many infants have spontaneous closure around 18 months
-if it does not close spontaneously by the age of 3, the child will most likely need surgical intervention
clinical manifestations of atrial septal defect (ASD)
-most children are asymptomatic, characteristic systolic murmur with a fixed split second heart sound, may be a diastolic murmur
ventricular septal defect (VSD)
-abnormal opening between the right and left ventricle
-varies in size from pinpoint to entire sputum
-increased pulmonary blood flow
clinical manifestations of ventricular septal defect (VSD)
-small VSD is asymptomatic, heart failure is common, Lous holosystolic murmur heard best at the left sternal border
-heart failure can result in children with unprepared VSD
Tetralogy of Fallot
composed of 4 defects:
1. pulmonary stenosis
2. VSD
3. overriding aorta
4. right ventricular hypertrophy
clinical manifestations of Tetralogy of Fallot
-bluish skin during episodes of crying or feeding called "tet spell"
tet spell
anoxia, hypoxia episodes,
put knees to chest to increase systemic vascular resistance and improve pulmonary blood flow
tricuspid atresia
-Valve between right atrium and right ventricle fails to develop
-foramen ovale and PDA must remain open to maintain minimally adequate oxygenation- give prostaglandins
clinical manifestations of tricuspid atresia
-cyanosis, difficulty feeding, tachypnea
Coarctation of the Aorta
-localized narrowing of the aorta with the restriction of blood flow
-causes pressure to increase proximal of the defect and decrease distally
-blood pressure increases in the heart and upper portions of the body and decreases in the lower parts of the body
clinical manifestations of Coarctation of the Aorta
high BP and bounding pulses in the arms, weak or absent femoral pulses, and cool lower extremities with lower BP, signs of HF in infants
Aortic stenosis
-narrowing of the aorta that reduces the flow of blood into this large vessel, which causes the left ventricle to work harder than normal
-left ventricle hypertrophies
clinical manifestations of Aortic stenosis
signs of decreased CO with faint pulses, hypotension, tachycardia, and poor feeding, exercise intolerance, chest pain, and dizziness when standing for long periods
surgical repair of Aortic stenosis
balloon dilation via cardiac catheterization
Transposition of the Great Arteries (TGA)
-pulmonary artery and aorta are transported from their normal position
-often diagnosed within the first few days of life
clinical manifestations of Transposition of the Great Arteries (TGA)
significant cyanosis of the PDA closes, those with large septal defects or a PDA may be less cyanotic but have symptoms of HF
therapeutic management of Transposition of the Great Arteries (TGA)
administrate IV prostaglandin E may keep DA open to temporarily increase blood mixing and provide an O2 sat of 75% or to maintain CO
corrective surgery of Transposition of the Great Arteries (TGA)
-performed at age 4-7 days
-balloon atrial septostomy usually done as soon as diagnosed
-surgical correction: switching arteries into their anatomical position
hypoplastic left heart syndrome (HLHS)
all structures on the left side of the heart are severely underdeveloped minimal left ventricle
-mitral and aortic valves are completely closed or very small
-left ventricle is non-functional
clinical manifestations of hypoplastic left heart syndrome (HLHS)
-mild cyanosis and signs of HF until PDA closes then progressive deterioration with cyanosis and decreased CO, leading to cardiovascular collapse
therapeutic management of hypoplastic left heart syndrome (HLHS)
-neonates require stabilization with mechanical ventilation and inotropic support preoperatively
-a prostaglandin E infusion is needed to maintain ductal patency
options of care for hypoplastic left heart syndrome (HLHS)
palliative, cardiac transplantation, or three-stage reconstruction surgery
Truncus arteriosus
Failure of normal septation & division of the embryonic bulbar trunk into the pulmonary artery & aorta resulting in a single vessel that overrides both ventricles
-blood from both ventricles mixes in common great artery causing desaturation & hypoxemia
-murmur is present, moderate-severe CHF, cyanosis, poor growth, activity intolerance
surgery is necessary
clinical manifestations of Truncus arteriosus
-moderate to severe HF and variable cyanosis, poor growth, and activity intolerance
-there is no holosystolic murmur at the left sternal border with a diastolic murmur present if truncal regurgitation is present
heart failure
results from myocardial failure in which the contractility or relaxation the ventricle is impaired
right sided heart failure
right ventricle is unable to pump blood effectively into the pulmonary artery, resulting in increased pressure in the right atrium and systemic venous circulation
left sided heart failure
left ventricle is unable to pump blood into the systemic circulation, resulting in an increased pressure in the left atrium and pulmonary veins
assessment of heart failure
-activity intolerance
-poor feeding, poor weight gain, hepatomegaly, splenomegaly
-impaired myocardial function
-pulmonary congestion
diagnostics of heart failure
-chest x ray: showing cardiomegaly
-ECG: ventricular hypertrophy
-Echo: determine the cause such as congenital heart disease
meds to improve cardiac function
-digoxin: do not give if baby has HR < 90 and kids < 70
-beta blockers
-lisinopril or captopril
nursing interventions to decrease cardiac demands
-provide a neutral thermal environment to prevent cold stress in infants
-treat any existing infections
-reduce the effort of breathing
-use meds to sedate irritable child
-child is fed at first sign of hunger rather than waiting until they cry because the stress of crying exhausts the limited energy supply
-smaller feedings every 3 hours
-monitor temp because hyper and hypothermia increase the demand for O2
rheumatic fever
delayed sequel of groups of streptococcal pharyngeal infection 2-3 weeks after strep throat
treatment of rheumatic fever
-penicillin
-anti-inflammatories
YOU MIGHT ALSO LIKE...