Term
| Heart anomalies that develop in utero and manifest at birth or shortly thereafter |
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Definition
| Congenital Heart Disorder |
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Term
| Congenital heart disorders occur in |
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Definition
| 4 to 10 children per 1000 live births |
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Term
| How are congenital heart disorders categorized? |
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Definition
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Term
| List the acyanotic heart defects: |
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Definition
a. ventricular septal defect (VSD)
b. atrial septic defect (ASD)
c. Patent Ductus Arteriosus (PDA; Increased Pulmonary Blood Flow)
d. Coarctation of the Aorta (Obstruction of Blood Flow from the Ventricles)
e. Aortic Stenosis (AS; Obstruction of Blood Flow from Ventricles) |
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Term
| What are the characteristics of all acyanotic heart defects? |
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Definition
a. left-to-right shunts or increased pulmonary blood flow
b. Obstructive defects |
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Term
| List the cyanotic heart defects: |
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Definition
a. tetralogy of Fallot (decreased pulmonary blood flow)
b. truncus arteriosus
c. transposition of the great vessels (mixed blood flow) |
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Term
| What are the characteristics of all cyanotic heart defects? |
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Definition
a. right to left shunts or decreased pulmonary blodd flow
b. mixed blood flow |
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Term
| Congenital heart defects may also be classified using |
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Definition
| Hemodynamic classification |
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Term
| What are the Hemodynamic classifications? |
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Definition
A. Increased pulmonary flow defects: (ASD, VSD, PDA)
B. Obstructive defects (coarctation of aorta, AS)
C. Decreased pulmonary blood flow defects (tetralogy of Fallot)
D. Mixed defects: (TGV, TA) |
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Term
| Characteristics of Ventricular Septal Defect (VSD; Increased Pulmonary Blood Flow) |
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Definition
a. there is a hole between the ventricles
b. oxygenated blood from left ventricle is shunted to right ventricle and recirculated to the lungs
c. small defects may close spontaneously
d. large defects cause Eisenmenger syndrome or congestive heart failure and require surgical closures |
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Term
| Characteristics of Atrial Septal Defects (ASD; Increased Pulmonary Blood Flow) |
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Definition
A. there is a hole between the Oxygenated blood from the left atrium
B. oxygenated blood from the left atrium is shunted to the right atrium and lungs
C. Most defects do not compromise children seriously
D. Surgical closure is recommended before school age. It can lead to significant problems, such as congestive heart failure or atrial dysrhythmias later in life if not corrected |
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Term
| Characteristics of Patent Ductus Arteriosus (PDA; Increased Pulmonary Blood Flow) |
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Definition
A. There is an abnormal opening between the aorta and the pulmonary artery
B. It usually closes within 72 hours after birth
C. If it remains patent, oxygenated blood from the aorta returns to the pulmonary artery
D. Increased blood flow to the lungs causes pulmonary hypertension
E. It may require medical intervention with indomethacin (Indocin) administration or surgical closure |
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Term
| Characteristics of Coarctation of the Aorta (obstruction of blood flow from ventricles) |
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Definition
A. there is an obstructive narrowing of the aorta
B. The most common sites are the aortic valve and the aorta near the ductus arteriosus
C. A common finding in hypertension in the upper extremities and decreased or absent pulses in the lower extremities
D. It may require surgical correction |
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Term
| Characteristics of Aortic Stenosis (ASt; Obstruction of Blood Flow from Ventricles) |
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Definition
A. It is an obstructive narrowing immediately before, at, or after the aortic valve (it is most commonly valvular)
B. Oxygenated blood flow from the left ventricle into systemic circulation is diminished
C. Symptoms are caused by low cardiac output
D. It may require surgical correction |
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Term
| Tetralogy of Fallot is a combination of 4 defects: |
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Definition
A. VSD
B. Aorta placed over and above the VSD (overriding aorta)
C. Pulmonary stenosis (PS) that obstructs right ventricular outflow
D. Right ventricular hypertrophy (the severity of pulmonary stenosis is related to the degree of ventricular hypertrophy and the extent of shunting) |
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Term
| TA, in which one artery (truncus), rather than |
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Definition
| two arteries (aorta and pulmonary)arises from both ventricles |
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Term
| TGA, in which the pulmonary artery leaves the left |
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Definition
| ventricle and the aorta exits from the right ventricle |
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Term
| Tetralogy of Fallot (Decreased Pulmonary Blood Flow) consists of 4 defects: |
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Definition
PS
VSD
Overriding aorta
Right ventricular hypertrophy |
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Term
| In Tetralogy of Fallot, cyanosis occurs because |
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Definition
| unoxygenated blodd is pumped into the systemic circulaton |
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Term
| In Tetralogy of Fallot, there is a decrease pulmonary circulation that occurs because |
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Definition
| of the PS (pulmonary stenosis) |
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Term
| In tetralogy of Fallot the child experiences |
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Definition
| "tet" spells, or hypoxic episodes, they are relieved by the child's squatting or being placed in knee-chest position |
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Term
| Tetralogy of Fallot requires |
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Definition
| staged surgery for correction |
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Term
| What condition is common in children with cyantic defects? |
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Definition
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Term
| In Truncus Arteriosus the pulmonary artery and the aorta do not |
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Definition
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Term
| In Truncus Arteriosus, one main vessel recieves blood from |
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Definition
| the left and right ventricles together |
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Term
| In Truncus Arteriosus, blood mixes in right and left ventricles through |
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Definition
| a large VSD, resulting in cyanosis |
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Term
| In Truncus Arteriosus, increased pulmonary resistance results in |
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Definition
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Term
| Truncus Arteriosus requires |
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Definition
| surgical correction; only the presence of the large VSD allows for survival at birth |
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Term
| Transposition of the Great Vessels (Mixed Blood Flow) has the following characteristics: |
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Definition
A. The great vessels are reversed
B. The pulmonary circulation arises from the right ventricle
C. This is incompatable with life unless coexisting VSD, ASD, and/or PDA is present
D. The diagnosis is a medical emergency. The child is given prostaglandin E (PGE) to keep the ductus open |
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Term
Heart Defect Acronyms
1. VSD
2. ASD
3. PDA
4. AS
5. TGV
6. TA
7. PS
8. CHD
9. FTT
10. CHF |
|
Definition
1. ventricular septal defect
2. atrial sepal defect
3. patent ductus arteriosus
4. aortic stenosis
5. transposition of the great vessels
6. truncus arteriosus
7. pulmonary stenosis
8. congenital heart disease
9. failure to thrive
10. Congestive heart failure |
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Term
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Definition
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Term
| Manifestations of Congenital Heart Disease (CHD) |
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Definition
1. Murmur (present or absent; thrill or rub)
2. Cyanosis, clubbing of digits
(usually after age 2)
3. Poor feeding, poor weight gain, failure to thrive (FTT)
4. Frequent regurgitation
5. Frequent respiratory infections
6. Activity intolerance, fatigue |
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Term
| The following are assessed in Congential Heart Disease |
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Definition
1. heart rate and rhythm and heart sounds
2. pulses (quality and symmetry)
3. blood pressure (upper and lower extremities
4. history of maternal infection during pregnancy |
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Term
| Heart rate of a child increases with |
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Definition
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Term
| Nursing diagnoses of Congenital Heart Disease |
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Definition
A. Decreased cardiac output related to...
B. Activity intolerance related to ...
C. Delayed growth and development related to... |
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Term
| Infants may require tube feeding to |
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Definition
| conserve energy. Infants being tube fed need to continue to satisfy sucking needs |
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Term
| A child with cardiovascular dysfunction need to maintain nutritional status: feed small |
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Definition
| frequent feedings and provide high calorie formula |
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Term
| In a child with cardiovascular dysfunction maintain hydration - polycythemia |
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Definition
| increases risk for thrombus formation |
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Term
| For a child with cardiovascular dysfunction maintain |
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Definition
| neutral thermal environment and plan frequent rest periods |
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Term
| For a child with cardiovascular dysfunction organize activities so as to |
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Definition
| disturb child only as indicated |
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Term
| For a child with cardiovascular dysfunction administer |
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Definition
| digoxin and diuretics as prescribed |
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Term
| For a child with cardiovascular dysfunction monitor |
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Definition
| for signs of deteriorating conditions or CHF |
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Term
| For the child with cardiovascular dysfunction teach |
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Definition
| family the need for prophylactic antibiotics prior to any dental or invasive procedures die to risk for endocarditis |
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Term
| For the child with cardiovascular dysfunction assist with diagnostic tests and support family during diagnosis. Three tests are: |
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Definition
1. ECG
2. Echocardiography
3. Cardiac catheterization (conducted when surgery is probable or as an intervention for certain procedures) |
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Term
| Risks for cardiac catheterization are similar to those for a child undergoing cardiac surgery which are: |
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Definition
a. arrhythmias
b. bleeding
c. perforation
d.phlebitis
e. arterial obstruction at the entry site |
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Term
| Child requires reassurance and close monitoring of the following postcatheterization: |
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Definition
a. vital signs
b. pulses
c. incision site
d. cardiac rhythm
e. prepare family and child as able for surgical intervention if necessary |
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Term
| Prepare child as appropriate for age and do the following: |
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Definition
1. show to ICU
2. Explain chest tubes, IV lines, monitors, dressings, and ventilator
3. show family and child waiting area for families
4. use a doll or a drawing for explanations
5. provide emotional support |
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Term
| Basic differences between cyanotic and acyanotic defects: |
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Definition
A. Acyanotic: Has abnormal circulation, however, all blood entering the systemic circulation is oxygenated
B. Cyanotic: Has abnormal circulation with unoxygenated blood entering the systemic circulation |
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Term
| CHF - Congestive heart failure is more often associated with |
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Definition
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Term
| Condition in which the heart is unable to pump effectively the volume of blood that is presented to it. |
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Definition
| Congestive Heart Failure (CHF) |
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Term
| CHF is a common complication of congenital heart disease because |
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Definition
| it reflects the increased workload of the heart caused by shunts or obstructions |
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Term
| Two objectives in treating CHF |
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Definition
1. to reduce the workload of the heart
2. increase cardiac output |
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Term
| Nursing assessments for Congestive Heart Failure |
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Definition
a. tachypnea, shortness of breath
b. tachycardia
c. difficulty breathing
d. cyanosis
e. grunting, wheezing, pulmonary congestion
f. edema (face, eyes of infants), weight gain
g. diaphoresis (especially head)
h. hepatomegaly |
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Term
| Nursing Diagnoses for Congestive heart failure |
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Definition
a. decreased cardiac output related to...
b. impaired gas exchange related to... |
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Term
| In CHF monitor vital signs |
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Definition
| frequently and report signs of increasing distress |
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Term
| In CHF assess respiratory |
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Definition
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Term
|
Definition
| head of the bed or use infant car seat |
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Term
|
Definition
| oxygen as prescribed and also administer digoxin and diuretics as prescribed |
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Term
|
Definition
frequently,may be every shift for infants
report any unusual weight gains |
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Term
| In CHF provide low sodium |
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Definition
|
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Term
|
Definition
| infants if unable to get adequate nutrition by mouth |
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Term
| When frequent weighings are required weigh client |
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Definition
| on the same scale at the same time of day so that accurate comparisons can be made |
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Term
| An inflammatory disease that is the most common cause of acquired heart disease in children. |
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Definition
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Term
| Rheumatic fever usually affects the |
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Definition
| aortic and mitral valves of the heart |
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Term
| Rheumatic fever is associated with an |
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Definition
| antecedent beta-hemolytic streptococcal infection |
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Term
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Definition
| collagen disease that injures the hear, blood vessels, joints, and subcutaneous tissue |
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Term
| Lab findings for Rheumatic fever |
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Definition
a. elevaated erythrocyte sedimentation rate (ERS)
b. Elevated ASO (antistreptolysin O)titer |
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Term
| Nursing Assessment for Rheumatic Fever |
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Definition
a. chest pain, shortness of breath (carditis)
b. tachycardia, even during sleep
c. migratory large joint pain
d. chorea (irregular involuntary movement)
e. rash (erythema marginatum)
f. subcutaneous nodules over bony prominences
g. fever |
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Term
| Nursing Diagnoses for Rheumatic Fever |
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Definition
Decreased cardiac output related to ...
Risk for injury related to ... |
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Term
| In Rheumatic Fever monitor vital signs and assess for |
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Definition
| increasing signs of cardiac distress |
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Term
| In Rheumatic Fever encourage bed rest and |
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Definition
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Term
| In Rheumatic Fever reassure family and child that chorea |
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Definition
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Term
| In Rheumatic Fever administer prescribed medication such as |
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Definition
a. penicillin or erythromycin
b. aspirin for antiinflammatory and anticoagulant actions |
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Term
| Penicillin G (Bacillin IM) is used in rheumatic fever as |
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Definition
| prophylaxis for recurrence of rheumatic fever |
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Term
| Adverse Reactions to Penicillin G (Bacillin) IM |
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Definition
| allergic reactions ranging from rashes to anaphylactic shock and death |
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Term
| Nursing Implications for Penicillin G (Bacillin) IM |
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Definition
a. Penicillin G is released very slowly over several weeks giving a sustained level of concentration
b. have emergency equipment available wherever medication is administered
c. always determine existence of allergies to penicillin and cephalosporins; check chart and record and inquire client and family |
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Term
| An acute systemic vasculitis that can cause damage to vessels, including the coronary arteries that supply blood flow to the heart. The disease can bring about permanent damage to the main arteries to the heart resulting in the formationof an aneurysm of the coronary artery. |
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Definition
| Kawasaki Disease (Mucocutaneous Lymph Node Syndrome) |
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Term
| What causes Kawasaki Disease (mucocutaneous Lymph Node Syndrome? |
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Definition
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Term
| Who usually gets Kawasaki Disease? |
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Definition
| Usually seen in children younger than 5 years of age |
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Term
| What are the three phases of Kawasaki Disease? |
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Definition
| Acute, subacute, and convalescent |
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Term
| Kawasaki disease is a leading cause of |
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Definition
| acquired heart disease in children |
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Term
| Early treatment of Kawasaki disease is essential to decrease |
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Definition
| chances of permanent heart damage |
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Term
| Characteristics of the Acute phase of Kawasaki Disease |
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Definition
a. high fever for more than 5 days
b. conjunctival redness, strawberry tongue
c. red swollen hands and feet |
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Term
| Characteristics of the Subacute phase of Kawasaki disease |
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Definition
| includes peeling of the hands and feet |
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Term
| The Convalescent (last) phase of Kawasaki Disease starts when |
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Definition
| all signs are gone and ends when lab values have returned to normal |
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Term
| Nursing Diagnoses for Kawasaki Disease |
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Definition
a. Impaired skin integrity related to...
b. Decreased cardiac output related to... |
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Term
| In Kawasaki Disease what is seen in the child during the disease process? |
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Definition
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Term
| For Kawasaki's Disease, administer which medications? |
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Definition
a. administer intravenous immunoglobulin (IVIG) as prescribed
b. treat high fevers with acetaminophen and aspirin (salicyclate therapy) as prescribed |
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Term
| For Kawasaki's Disease monitor cardiac status by documenting the child's |
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Definition
a. intake and output
b. daily weights |
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Term
| For Kawasaki's Disease, minimize skin discomfort with lotions and |
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Definition
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Term
| For Kawasaki's Disease, initiate |
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Definition
| meticulous mouth care and monitor intake of clear liquids and soft foods |
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Term
| For Kawasaki's Disease, support family as they |
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Definition
| comfort child during periods of irratibility and provide discharge teaching and home referral |
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Term
| Prior to administering digoxin, nurse must take child's |
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Definition
| apical pulse for 1 minute to assess for bradycardia. Hold dose if pule is below normal heart rate for child's age |
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Term
| Therapeutic blood levels of digoxin are |
|
Definition
| 0.8 to 2.0 ng/mL (nanograms/millileter |
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Term
| For digoxin, families should be taught |
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Definition
| home administration of digoxin |
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Term
| For digoxin, administer on a regular basis do not |
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Definition
| skip or make up for missed doses |
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Term
| Give digoxin 1 hour before or |
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Definition
| 2 hours after meals. Do not mix with formula or food |
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Term
| Prior to administration of digoxin take |
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Definition
| child's pulse and know when to call the caregiver |
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Term
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Definition
| a safe place, locked container/cabinet |
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Term
| Nurse must be acutely aware of digoxin |
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Definition
| toxicity signs. A small child or infant cannot describe feeling bad or nauseated |
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Term
| What is a common sign of digoxin toxicity? |
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Definition
| Vomiting is a common early sign. It can be overlooked in infants because they often "spit up" |
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Term
| Neurologic signs of digoxin toxicity are |
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Definition
| fatigue, muscle weakness, drowsiness |
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Term
| What can increase digoxin toxicity? |
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Definition
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Term
| Differentiate between right to left and left to right shunt in cardiac disease. |
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Definition
| A right-to-left shunt bypasses the lungs adn delivers unoxygenated blood to the systemic circulation causing cyanosis. A left-to-right shunt moves oxygenated blood back through the pulmonary circulation. |
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Term
| List 4 defects associated with tetralogy of Fallot. |
|
Definition
VSD
overriding aorta
pulmonary stenosis
right ventricular hypertrophy |
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Term
| List the common signs of cardiac problems in an infant. |
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Definition
| Poor feeding, poor weight gain, respiratory distress, infections, edema, and cyanosis |
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Term
| What are the two objectives in treating CHF? |
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Definition
| Reduce the workload of the heart and increase cardiac output. |
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Term
| Describe nursing interventions to decrease the workload of the heart. |
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Definition
| Give small, frequent feedings or gavage feedings. Plan frequent rest periods. Maintain a neutral thermal environment. Organize activities to disturb the child only as indicated. |
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Term
| What position would best relieve the child experiencing a tet spell? |
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Definition
| Knee-chest position or squatting. |
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Term
| What are common signs of digoxin toxicity? |
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Definition
| diarrhea, fatigue, weakness, nausea, and vomiting, the nurse should check for bradycardia prior to administration |
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Term
| List 5 risks in cardiac catheterization. |
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Definition
| arrhythmia, bleeding, perforation, phlebitis, and obstruction of the arterial entry site |
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Term
| What cardiac complications are associated with rheumatic fever? |
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Definition
| Aortic valve stenosis and mitral valve stenosis |
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Term
| What medications are used to treat rheumatic fever? |
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Definition
| penicillin, erythromycin, and aspirin |
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