1
Q
What are the two broad classifications of congenital heart defects?
A
- Acyanotic (increased pulmonary blood flow)
- Cyanotic (decreased delivery of oxygenated blood to body)
2
Q
what is the major complication that occurs with acyanotic heart defects?
A
- congestive heart failure
- as a child with an acyanotic defect grows, they may become cyanotic
3
Q
what are some acyanotic heart defects?
A
- patent ductus arteriosis
- atrial septal defect
- ventricular septal defect
4
Q
what is patent ductus arteriosis?
A
- where the ductus arteriosis remains open (should normally close around 14 hours after birth)
- occurs more commonly in premature infants (less than 28 weeks)
- can be present with other heart defects
- makes up 5-10% of congenital heart defects
- occurs in 1/2000 term infants
5
Q
what is an atrial septal defect?
A
- where a hole is present between right and left atria
- this may be because foramen ovale doesn’t close
- some ASDs will close spontaneously
- can sometimes be identified by noting a pulse deficit
6
Q
what is a ventricular septal defect?
A
- an opening between the two ventricles
- the most common of all defect
- only 15% large enough to cause CHF
- creates pulmonary vascular resistance and treatment depends on size and how much resistance
7
Q
how are acyanotic lesions managed?
A
- digoxin
- diuretics (to prevent pulmonary congestion)
- oxygen
- elevation of head of bed (also prevents pulmonary congestion)
- surgery
8
Q
what are cyanotic defects?
A
- heart defects that result in decreased oxygen delivery to body
- may be because of circulating unoxygenated blood or decreased volume of flow
9
Q
What is Tetralogy of Fallot?
A
- a cyanotic heart defect with four features:
1) ventricular septal defect
2) pulmonary stenosis
3) overriding aorta
4) right ventricular hypertrophy 2ndary to stenosis - results in mixing of oxygenated and deoxygenated blood flowing to body
10
Q
what is a TET spell?
A
a spell of extreme hypoxemia
-caused by too much blood mixing and not enough oxygen reaching the body
11
Q
what positions may a child experiencing a TET spell take and why?
A
crouching or the fetal position
-raises the systemic vascular resistance and forces more blood to heart and lungs
12
Q
How is tetralogy of fallot treated?
A
- beta blockers
- morphine (slows respiration rate)
- prostaglandin E1 (if closure of PDA is life threatening prostaglandin keeps open)
- surgery ideally by 4-6 months old
- adequate hydration
- supplemental oxygen
- antibiotics prophylactically to prevent endocarditis
13
Q
how and why does the ductus arteriosis normally close?
A
-the cutting of the umbilical cord, oxygen exposure and decrease in prostaglandin normally closes this just after birth
14
Q
what are the four defects that define tetralogy of fallot?
A
1) pulmonary stenosis (narrowing of pulmonary valve)
2) right ventricular hypertrophy (this usually occurs because of the increased work of pumping into narrow and thickened pulmonary valve)
3) over-riding aorta (gets blood from right and left ventricle because it over-rides to right side)
4) ventricle septal defect
15
Q
what are symptoms of tetralogy of fallot?
A
- child may squat when experiencing a tet spell to increase systemic resistance making it harder for blood to go into aorta and therefore more goes to lungs
- lower spO2
- cyanosis
- shortness of breath
- rapid respiration rate
- clubbing of fingers and toes
- poor weight gain
16
Q
its tetralogy of fallot a cyanotic or acyanotic defect?
A
cyanotic as the over-riding aorta collects deoxygenated blood from the right ventricle, the VSD most often shunts right to left because of the right ventricular hypertrophy and there is less circulation through lungs because of the pulmonary stenosis
17
Q
what is congestive heart failure?
A
- occurs when heart muscle is unable to pump enough to meet up with body’s demands
- ventricles can’t pump sufficiently to body and so blood and other fluids back up into lungs, abdomen, liver, and lower body
- fluid builds up around heart contributing to inefficiency of pumping
18
Q
what is a symptom of a tet spell?
A
-becoming blue as a result of not enough oxygen reaching body
19
Q
why may prostaglandin be given for cyanotic heart conditions?
A
to keep ductus arteriosus open until other defects can be repaired. this opening in the aorta allows for more blood to circulate past lungs
20
Q
how soon after birth is the ductus arteriosus normally closed?
A
14 hours
21
Q
is a patent ductus more or less common in premature infants?
A
more. occurs in approximately 80%
22
Q
how does circulation change at birth?
A
before birth, blood from placenta is supplying oxygenation to fetus
- the ductus venosus allows blood into inferior vena cava which goes into right atrium
- from right atrium, blood passes through the foramen ovale, which is an opening between the two atria to allow for most blood to bipass lungs (which are not yet functioning)
- blood that does go to right ventricle goes into pulmonary artery, but some of that blood then goes though ductus arteriosus and also bipasses the lungs
- these three opening normally close at birth when systemic vascular resistance increases after the cord is cut
23
Q
what is cardiac catheterization?
A
- insertion of catheter through an artery/vein into the heart
- performed under fluroscopy
- can measure pressures within heart, oxygen saturation, blood flow patterns, structural information)
24
Q
what are complications that can occur because of cardiac catheterization
A
- arrhythmias
- bleeding
- cardiac perforation
- cardiac tamponade
- CVA
- contrast agent reactions
- hypercyanotic spell
- local vascular complications
- infection
25
what is endocarditis?
an inflammation of the inside lining of the heart chambers and valves
- this is a risk for those with heart defects because their circulation is abnormal
- may also occur around surgical sites or because of IV drug use
26
how can endocarditis be diagnosed?
- blood culture and sensitivity
- serology for certain bacteria that may be hard to detect in blood cultures
- CBC for elevated WBC and/or low grade, microcytic anemia
- ECG
- chest x-ray
27
why may a child with congenital heart defects not reach developmental milestones at the expected time?
- tired
- not socialized the same due to illness and hospitalization
- may not be getting adequate intake
28
what is the third most common cause of death in children?
congenital heart defects
29
what can cause congenital heart defects?
- changes that normally occur just after birth do not
- teratogens
- chromosomal abnormalities
- maternal factors
- chance
- familial link
30
what determines cardiac output in children under 5?
heart rate
though CO = HRxSV, until the age of five when the heart muscle is fully developed, HR is the biggest factor/determinent
31
what can cause acquired heart disorders?
- infections
- autoimmune responses
- environmental
- familial tendencies
32
what chromosomal abnormalities may be associated with congenital cardiac defects?
- deletion at Chromosome 22
- down's syndrome (trisomy 21)
- turners syndrome
- trisomy 13
33
what are signs and symptoms of congenital heart disorders?
- tires easily
- lethargy
- cyanosis
- decreased cap refill
- decreased peripheral pulses
- respiratory distress
- CHF
- abnormal cardiac rhythms
- cardiac murmur
- failure to thrive
34
what may be heard on auscultation if a child has a heart defect?
a murmur (the sound of which may vary depending on the defect)
35
when does the heart and great vessels develop during gestation?
during the first 3-8 weeks
note: this means that often women do not know they are pregnant and increases the risk of teratagen exposure
36
what are the three shunts that are normally present before birth and typically close a few days after birth?
```
ductus venosus (from placenta into inferior vena cava)
ductus arteriosus (between aorta and pulmonary trunk)
foramen ovale (between right atrium and left atrium)
```
37
how does gas exchange change in the heart at birth and why?
gas exchange switches from the mother's system and placental blood flow to the baby's lungs
this occurs when the cord is cut and vascular resistance increases, increasing PO2 in the aorta which results in the ductus arteriosus theoretically shutting
38
what does the assessment finding of a murmur indicate?
that blood is flowing with higher than normal pressure through a narrowed valve, vessel or shunt
this may also be because a shunt exists ;)
39
how is an echocardiogram used to assess a heart?
- it generates and ultrasound image
- allows assessment of location and relationship of cardiac structures as well as cardiac function
- measures heart's parts, looks at valve function, size of defects, and estimates gradient of blood flow
- non-invasive, with no radiations
40
a patient is scheduled to have an echocardiogram and tells you they are nervous because they don't understand the procedure. What do you tell them?
- an echocardiogram is an ultrasound of the heart
- is non-invasive
- there is no radiation exposure
- looks at cardiac structures including chambers and valves
- can see defects and size them
- can be used to estimate direction and speed of blood flow
41
what type of defect is most common?
- ventricular septal defect
| - about 40% of all defects
42
what may be done to manage a patent ductus arteriosus?
- give indomethacin and/or ibuprofen (these inhibit prostaglandin and decreased prostaglandin can cause PDA to close)
- have a fluid restriction for 2 days, then gradually increase fluids
- use diuretics if needed
- oxygen therapy
- surgical ligation (usually between 1.5-2.5 years of age)
43
what may be done to manage an atrial septal defect?
- cath lab closure or open heart surgery if appropriate
- if asymptomatic, monitor
- if symptomatic, give diuretics and digoxin
44
what are some general management strategies for cyanotic cardiac conditions?
- prostaglandin E1
- adequate hydration
- supplemental oxygen
- cath lab for atrial septostomy
- surgery
- antibiotics to prophylactically prevent endocarditis
- biopsy in prep for transplant possiblity
- treat anxiety
- make sure pt gains around 20-30 grams per day of protein and enough calories
45
what is the nursing care involved for a patient who will be having a cardiac catheterization?
- NPO
- sedation
- explain procedure
- apply topical numbing agent (can take up to an hour to work, longer it is on, the deeper the numbing)
46
what kind of nursing care is provided post-catheterization
-monitoring for complications like perfusion compromise, infection, respiratory compromise, altered renal function, pain, hypothermia
-blood work - cbc, lytes, wbc
-
47
what is extremity perfusion compromise?
- can be a complication of cardiac catheterization
| - arterial perfusion compromise of an extremity or venous obstruction
48
-what are signs of arterial perfusion compromise of an extremity?
- pallor
- mottling
- diminished strength of extremity pulse
- cool temperature
- delayed capillary refill
49
what are signs of venous obstruction perfusion compromise of an extremity?
- edema of extremity
| - duskiness with normal cap refill
50
what are some serious complications of endocarditis?
- CHF
- blood clots
- arrhythmias
- glomerulonephritis
- severe heart valve damage
- stroke
- brain abscess
- jaundice
- neurological or nervous system changes
51
how long can antibiotic therapy for endocarditis take?
up to 6 weeks is common
52
how is endocarditis treated?
- with an IV antibiotic that is appropriate to the specific organism causing the infection
- this is usually long-term (~6 weeks)
Nursing Obstetrics & Pediatrics
flashcards
Decks in class (26)
# Cards
-
prep for quiz 1133
-
Midterm Prep121
-
Autism39
-
Pain & Palliative Care41
-
Neural Tube Defects & Neuro Concerns51
-
textbook questions for obstetrics29
-
childhood cancer55
-
alterations in GI functions46
-
fluid resuscitation4
-
pediatric obesity33
-
growth and development64
-
pediatric cardiac issues52
-
respiratory concerns89
-
Mental Health Disorders38
-
Meningitis and Seizures84
-
Genetic Disorders20
-
Pharmacotherapy in Children2
-
Cariology11
-
health challenges in labour and birth43
-
health challenges in the newborn63
-
postpartum health challenges24
-
health challenges in pregnancy53
-
Infant Nutrition33
-
intimate partner violence15
-
food security0
-
pain measures during labour10
