1
Q
An invasive procedure that can be used to diagnose a congenital heart defect and repair certain heart defects by inserting a catheter into the femoral artery and threading it up to the heart
A
Cardiac catheterization
2
Q
Cardiac Catheterization pre-op nursing care
A
NPO for 6-8 hrs, assess for allergies to iodine or shellfish, assess kidney function (BUN, creatinine), assess and mark distal pulses
3
Q
Cardiac catheterization post-op nursing care
A
Check insertion site for bleeding, check extremity distal from insertion site to ensure adequate circulation (pulses, cap refill, color, temp), increase fluid intake to flush contrast dye, position patient in supine position with affected extremity straight for 4-6 hours**
4
Q
Anatomic abnormality of the heart that causes altered blood flow
A
Congenital heart defect
5
Q
Risk factors for increased risk of CHD
A
Exposure to teratogen during pregnancy, maternal smoking and alcohol use, maternal medical conditions such as diabetes
6
Q
S/S of CHD
A
Depends on defect present. However, many of the defects cause: HF, hypoxemia, murmurs
7
Q
CHD nursing care
A
Provide frequent rest periods and small, frequent meals, provide O2 and high calorie formula as ordered by provider
8
Q
CHDs that increase pulmonary blood flow
A
Atrial septal defect (ASD), ventricular septal defect (VSD), AV canal defect, patent ductus arteriosus (PDA)
9
Q
CHD characterized by a hole in the septum that separates the left and right atria
A
Atrial septal defect (ASD)
10
Q
S/S of ASD
A
May be asymptomatic, but can cause S/S of HF and murmur
11
Q
A systolic murmur with a wide fix splitting of S2 may be present with what CHD?
A
ASD
12
Q
ASD treatment
A
Closure of hole through cardiac cath or surgical patch
13
Q
Hole in the septum between the left and right ventricles
A
Ventricular septal defect (VSD)
14
Q
S/S of VSD
A
S/S of HF, murmur
15
Q
A loud systolic murmur at the left sternal boarder is present with which CHD?
A
VSD
16
Q
Treatment for VSD
A
Surgery to suture or patch the hole
17
Q
A hole in the center of the heart that allows blood to flow between all four chambers; instead of a mitral and tricuspid valve, there is a single AV valve
A
Atrioventricular (AV) canal
18
Q
S/S of AV canal
A
S/S of HF, loud systolic murmur
19
Q
Treatment of AV canal
A
Surgical patch closure and valve reconstruction
20
Q
CHD in which the fetal artery that connects the aorta and the pulmonary artery fails to close after birth
A
Patent ductus arteriosus (PDA)
21
Q
S/S of PDA
A
Machine-hum murmur, bounding pulses, wide pulse pressure
22
Q
PDA treatment
A
Indomethacin, coils to occlude PDA during cardiac catheterization
23
Q
CHDs that result in decreased pulmonary blood flow
A
Tetrology of fallot, tricuspid atresia
24
Q
CHD that is a combination of four different defects PROV: pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect
A
Tetrology of fallot (TOF)
25
S/S of TOF
Cyanosis, hypercyanotic “tet” spells, systolic murmur
26
Intervention for tet spells
Place child in knee-chest position to increase blood flow to lungs
27
PDA treatment
Surgical repair within first year of life
28
CHD in which the tricuspid valve fails to develop
Tricuspid atresia
29
S/S of tricuspid atresia
Cyanosis, tachycardia, dyspnea, clubbing
30
Treatment for tricuspid atresia
Multiple surgeries including shunt placement, glen procedure, fontan procedure
31
Congenital heart defects that cause obstructed heart flow
Coartation of the aorta, aortic stenosis, and pulmonary stenosis
32
Narrowing of the aorta that occurs after blood is supplied to the upper extremities, but blood flow to the lower extremities is impaired
Coarctation of the aorta
33
S/S of coarctation of the aorta
Upper extremity HTN and bounding pulses, poor lower extremity perfusion causing weak pulses, cool skin, and pallor
34
Coarctation of the aorta treatment
Balloon angioplasty and stent placement, surgical removal of narrowed section of aorta, Antihypertensives
35
Narrowing of the aortic valve that decreases blood flow to the whole body
Aortic stenosis
36
S/S of aortic stenosis
Hypotension, decreased pulses, tachycardia, poor feeding, exercise intolerance
37
Aortic stenosis treatment
Balloon dilation or valvotomy
38
narrowing of the pulmonary valve which obstructs blood flow to the lungs
Pulmonary stenosis
39
S/S of pulmonary stenosis
Systolic ejection murmur**, cyanosis, cardiomegaly, HF
40
Pulmonary stenosis treatment
Balloon dilation of valvotomy
41
Congenital heart defects that result in mixed blood flow
Transposition of the great arteries (TGA), total anomolous pulmonary venous connection, truncus arteriosis, hypoplastic left heart syndrome
42
Congenital heart defect in which the aorta and pulmonary artery connections to the heart are reversed resulting in PDA or septal defect
Transposition of the great arteries (TGA)
43
S/S of TGA
HF, SOB, cardiomegaly, cyanosis, hypoxia, murmurs, fatigue, poor growth
44
TGA treatment
Prostaglandins to keep PDA open, surgery within 1st week of life to reverse connections and correct defect
45
Congenital heart defect in which the pulmonary veins are connected to the right side of the heart instead of the left atrium resulting in oxygenated blood being pumped right back into lungs; this defect requires ASD in order for patient to survive
Total anomalous pulmonary venous connection (TAPVC)
46
S/S of TAPVC
Cyanosis, dyspnea, poor feeding
47
TAPVC treatment
Surgical repair to connect pulmonary veins to left atrium
48
Congenital heart defect in which there is a single vessel or trunk rather than a separate pulmonary artery and aorta. Patient will also have VSD causing mixing of blood.
Truncus arteriosis
49
S/S of truncus arteriosus
HF, murmurs, cyanosis, poor feeding
50
Truncus arteriosis treatment
Surgical repair within first few months of life
51
Congenital heart defect in which the left side of heart and associated structures are underdeveloped resulting in PDA and ASD
Hypoplastic left heart syndrome
52
S/S of hypoplastic left heart syndrome
Cyanosis, HF, cold extremities, lethargy
53
Hypoplastic left heart syndrome treatment
Prostaglandins to keep PDA open until surgery. Surgery done in three different stages (Norwood procedure, Glenn shunt, fontan procedure)
54
General S/S of HF
Poor feeding, tachycardia, activity intolerance, pallor, weak pulses, cardiomegaly
55
S/S of L sided HF
Tachypnea, dyspnea, nasal flaring, retractions, wheezing
56
S/S of R sided HF
Peripheral edema, ascites, hepatomegaly, JVD
57
Labs associated with HF
Elevated hBNP
58
HF treatment
Digoxin, diuretics (furosemide), beta blockers, ACE inhibitors
59
HF nursing care
Ensure child is upright when feeding, use a nipple with enlarged opening (decreases energy used while feeding), provide high-calorie formula, provide frequent rest periods, take pulse before administration of digoxin (Hold if below 90 bpm for infant, hold if below 70 bpm for older children)***, monitor for S/S of digoxin toxicity (N/V, bradycardia, dysrhythmias), closely monitor serum digoxin levels (therapeutic range between 0.8-2)
60
S/S of hypoxemia
Cyanosis, tachypnea, dyspnea, clubbing, polycythemia (elevated RBC production)
61
Hypoxemia treatment
O2, morphine, IV fluids, knee-chest position for cyanotic episodes to improve blood flow to lungs
62
Infection of the inner layer of the heart
Infective endocarditis (IE)
63
S/S of IE
Fever, malaise and lethargy, loss of appetite, splinter hemorrhages**, petechiae, murmur, muscle and joint pain
64
Labs associated with IE
Elevated ESR and CRP
65
IE treatment
IV antibiotic therapy via PICC line over 2-6 weeks, valve repair or replacement if IE resulted in valve damage
66
IE family teaching
Prophylactic antibiotics will be needed prior to dental work or invasive procedure/surgery
67
Inflammatory disorder of the heart, blood vessels, and joints
Rheumatic fever
68
Rheumatic fever key risk factor
Partially treated or untreated strep throat infection
69
Labs associated with rheumatic fever
(+) GABHS, (+) ASO titer, elevated ESR and CRP
70
Diagnosis of rheumatic fever
Jones criteria; diagnosis requires two major criteria present OR one major and two minor criteria present
71
Jones major criteria for diagnosis of rheumatic fever
1. Carditis (inflammation of heart — can lead to murmurs, pericardial friction rub, cardiomegaly, arrythmias, and CHF), polyarthritis (painful swelling of joint), 2. erythema marginatum (non-pruritic rash on the trunk and limbs), 3. chorea (involuntary muscle movements, 4. non-tender subcutaneous nodules
72
Jones minor criteria for diagnosis of rheumatic fever
Fever, arthralgia (joint pain), elevated ESR or CRP, prolonged PR interval
73
Rheumatic fever treatment
Long-term penicillin administration, bed rest
74
The systemic inflammation of the blood vessels in the body (vasculitis)
Kawasaki disease
75
What are the three phases of Kawasaki disease?
Acute, subacute, and convalescent phase
76
S/S during the acute phase of Kawasaki disease
High fever (over 102 F) lasting for 1-2 weeks and will be unresponsive to antipyretics, various areas of erythema on body (eyes, chapped and cracked lips, oral mucosal membrane, palms and soles), arthritis, enlarged cervical or neck lymph nodes, cardiac symptoms such as dysrhythmias and myocarditis
77
S/S of subacute phase of Kawasaki disease
Fever resolves but patient has arthritis, peeling skin around nails, palms, or soles.
78
S/S during convalescent phase of Kawasaki disease
No clinical manifestations, but abnormal labs may be present
79
Abnormal labs associated with Kawasaki disease
Elevated CPR and ESR, decreased albumin levels
80
Criteria for diagnosis of Kawasaki disease
Fever for over five days and four of the five symptoms including: conjunctivitis, rash, extremity changes (redness of hands and feet, peeling skin), adenopathy (enlarged lymph nodes), mucosal changes (red cracked lips, red mucus membranes, strawberry tongue) — hint: remember CREAM
81
Kawasaki disease treatment
IV immunoglobulin, high dose aspirin
82
Kawasaki disease nursing care
Monitor cardiac function (d/t carditis), monitor daily weights and I&Os, educate family that live immunizations should NOT be administered to child for 11 months (varicella, MMR)
83
Disorder characterized by decreased hemoglobin due to insufficient intake of iron or some kind of malabsorption syndrome that results in decreased absorption of iron
Iron deficiency anemia
84
Key risk factor for iron deficiency anemia in children
Excess intake of cows milk
85
S/S of iron deficiency anemia
Fatigue, pallor, SOB, tachycardia
86
Labs associated with iron deficiency anemia
Decreased Hgb, Hct, RBCs, MCH, MCV, and ferritin
87
Iron deficiency anemia treatment
Iron supplementation: iron sulfate (PO), iron dextran (IV or IM; use z-track method for IM administration to prevent leakage of med into subq tissue)
88
Iron deficiency anemia family teaching
Increase child’s intake of iron-rich foods (green veggies, meat, raisins, iron fortified foods), vitamin C INCREASES absorption of iron while calcium DECREASES absorption of iron (take with iron supplements with OJ, but avoid taking them with milk)
89
Family teaching for child who takes liquid iron
Use straw and brush teeth after to prevent staining of teeth; green or tarry-like stools are expected
90
An autosomal recessive genetic disorder that results in chronic anemia, pain, infection, and organ damage
Sickle cell anemia
91
Sickle cell anemia risk factors
Family hx, African American, middle eastern or Mediterranean descent
92
S/S of sickle cell anemia
Pain, fatigue, swollen hands and feet, jaundice
93
Sickle cell crises can be brought on by
Infection, stress, or dehydration
94
Sickle cell crisis characterized by severe pain
Vaso-occlusive
95
Treatment of vaso-occlusive sickle cell crisis
Around-the-clock opioid administration
96
Sickle cell crisis that occurs when sickle cell blood vessels become trapped in the spleen which lead to enlargement of spleen and severe anemia
Splenic sequestration crisis
97
Sickle cell crisis usually caused by a viral infection (fifth disease) in which bone marrow stops producing RBCs leading to severe anemia
Aplastic crisis
98
Labs associated with sickle cell anemia
Decreased Hct
Increased reticulocytes, WBCs, and bilirubin
99
T or F: all newborns are screened for sickle cell anemia
True
100
Blood test that measures Hgb levels and assesses for abnormal types of Hgb
Hemoglobin electrophoresis
101
Sickle cell anemia treatment
Pain management (opioids), antibiotics (infection), IV fluids, blood products, oxygen therapy, hydroxyurea (can reduce sickling of blood cells and prevent vaso-occlusive crisis)
102
Sickle cell anemia family teaching
Encourage adequate fluid intake, prevent infection (hand hygiene, avoid crowds, stay up to date with vaccines), seek immediate medical attention if child has fever or S/S of infection
103
Group of genetic disorders characterized by defective hemoglobin formation and anemia
Thalassemia
104
S/S of thalassemia
Pallor, jaundice, decreased appetite and growth rates, enlarged liver and spleen, deformed facial bones
105
Thalassemia treatment
Frequent blood transfusions, chelation therapy to decrease build-up of iron from blood transfusions
106
X-linked recessive disorder that causes deficiency in clotting factors
Hemophilia
107
Hemophilia ___ results in a deficiency of clotting factor 8 and hemophilia ___ results in a deficiency of clotting factor 9
A; B
108
S/S of hemophilia
Excess bleeding and bruising, joint pain and swelling, decreased ROM
109
Labs associated with hemophilia
Elevated aPTT, decreased factor 8 or 9; NOTE: platelet count and PT will NOT be affected
110
Hemophilia treatment
Factor replacement
111
Hemophilia family education
Prevent bleeding (no NSAIDs or aspirin, avoid IM injections), engage in PT to maintain ROM, NO contact sports, RICE acute bleeding (rest, ice, compression, elevation)
112
Interventions for epistaxis (nose bleed)
Lean head forward, maintain pressure with thumb and finger on soft spot of nose for 10 minutes, apply ice pack to bridge of nose; packing with epinephrine or cauterization may be indicated for persistent bleeding
113
Epistaxis family teaching
Keep nose lubricated and use cool mist humidifier in room, avoid blowing nose forcefully
NCLEX: Pediatric
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