Term
| 2 clinical consequences of congenital heart defects in pediatrics |
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Definition
1. Heart failure: inability for the heart to pump an adequate amount of blood to the systemic circulation
2. Hypoxemia: Referes to an arterial oxygen tension that is less than normal and can be identified by a decreased arterial saturation or a decreased PaO2 |
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Term
| What are some factors of acquired cardiac disorders in pediatrics? |
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Definition
-Infection
-Auto-immune responses
-Environmental factors
-Famial tendencies |
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Term
| Which heart defect has the worst prognosis? |
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Definition
| Hypoplastic left heart syndrome--some centers reporting mortality rates of about 10%, but a lot mulitcenter series reports a mortality rate of about 30% |
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Term
| Those with chronic hypoxemia develop what two physiologic changes? |
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Definition
1. Polycethemia: an increased number of RBCs, increased the oxygen carrying capacity of the blood. It increases of the blood and crowds out clotting factors.
2. Clubbing: a thickening and flattening of the tips of the fingers and toes |
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Term
| What is "Blue spell" or "tet spell" |
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Definition
| Hypercyanotic spells, and they may occur in any child whose heart defect includes obstruction to pulmonary blood flow and communication between the ventricles. The infant becomes acutely cyanotic and hyperpneic because sudden infundibular spasm decreases pulmonary blood flow and increases right-to-left shunting. |
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Term
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Definition
| An inflammatory disease that affects the cardiovascular system and causes damage to blood vessels in the body. The cause is unknown and it usually presents in children under 5 years of age. |
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Term
| What are hallmark signs of Kawasaki Disease? |
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Definition
| Has 3 phases, the acute phase, subacute phase, and convalescent phase. To diagnose, children must have a fever for more than 5 days along with 4 of 5 clinical criteria which are: 1. Changes in the extremities (acute phase: edema, erythema of the palms and subacute: soles or peeling of the hands and feet); 2. Bilateral conjunctival inflammation without exudate; 3. Changes in the oral mucous membranes, such as erythema of the lips, oropharyngeal reddening, or “strawberry tongue”; 4. Polymorphous rash; 5. Cervical lymphadenopathy (one lymph node >1.5 cm) |
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Term
| 2 types of cardiovascular dysfunction in children |
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Definition
-Congenital: monitor for heart failure, hypoxemia
-Acquired: Occurs after birth, seen in normal heart or abnormal heart |
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Term
| Classification of heart defects |
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Definition
1. Acyanotic:
-Raised pulmonary blood flow (Atrial septal defect, ventricular septal defect, patent ductus arteriosus, atrioventricular canal)
-Obstruction to blood flow from ventricles (Coarctation of aorta, Aorta stenosis, pulmonic stenosis)
2. Cyanotic
-Lowered pulmonary blood flow (Tetralogy of fallot, tricuspid atresia)
-Mixed blood flow (Transposition of great arteries, total anomalous pulmonary venous return, truncus arteriosus, hypoplastic left heart syndrome) |
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Term
| Symptoms of cardiac dysfunction in child/infant |
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Definition
-Heart murmur
-tires while eating
-FTT, low weight for height
-Sweats while eating (diaphoretic)
-Cyanosis, worsens with feeding or activity level, pallor
-Irritable weak cry
-Clubbing
-Difference in peripheral pulses
Additional symptoms in the older child:
-Chest pain
-Decreased activity level
-Syncope
-Abnormal growth chart pattern |
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Term
| Vital signs in the child with cardiac dysfunction |
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Definition
-HR: tachycardia in the absence of fever, crying, or stress
-Tachypnea, even with rest, chest retractions indicate respiratory distress, possibly resulting from congestive heart failure |
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Term
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Definition
-Pressures on the left side of the heart are normally higher than pressures in the right side of the heart
-If there is an abnormal opening in the septum between the right and left sides, blood flows from left to right |
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Term
| Clinical manisfestations of left to right shunt |
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Definition
-The infant is not cyanotic
-Tachycardia due to pushing increased blood volume
-Cardiomegaly due to increased workload of the heart
-Dyspnea and pulmonary edema due to the lungs receiving blood under high pressure from the right ventricle
-Increased number of respiratory infections due to blood pooling in the lungs promoting bacterial growth |
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Term
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Definition
-Occurs when pressure in the right side of the heart is greater than the left side of the heart (resistance of the lungs is abnormally high; pulmonary artery is restricted)
-Deoxygenated blood from the right side shunts to the left side
-Hole in septum + obstructive lesion = deoxygenated blood from the right side of the heart shunts to the left side of the heart and out into the body |
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Term
| Clinical manisfestations right to left shunts |
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Definition
-Hypoxemia: the result of decreased tissue oxygenation
-Polycythemia: increased RBC production due to the body's attempt to compensate for the hypoxemia
-Increase viscosity of the blood = heart has to pump harder
-Potential complications include thrombus formation due to sluggish circulation, or brain abscess or stroke due to un-oxygenated blood bypassing the filtering system of the lungs |
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Term
| Examples of diagnosis r/t shunts |
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Definition
-Left to right shunts: Atrial septal defect, ventricular septal defect
-Right to left shunts: Pulmonary stenosis; tetralogy of fallot |
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Term
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Definition
-Major manifestation of cardiac disease
-Under 1 yr of age due to congenital anomaly
-Over 1 yr with no congenital anomaly may be due to acquired heart disease |
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Term
| Clinical manifestations of Heart Failure |
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Definition
-Systemic venous congestion: weight gain, hepatomegaly, edema, jugular vein distension
-Pulmonary venous congestion: tachypnea, dyspnea, cough, wheezes
-Compensatory response: tachycardia, cardiomegaly, diaphoretic, fatigue, failure to grow |
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Term
| Nursing interventions for Heart failure |
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Definition
-Fluid restriction
-Diuretics: Lasix (potassium wasting) or Aldactone (potassium sparing)
-Bed rest
-Oxygen
-Small frequent feedings: soft nipple with supplemental NG for adequate calorie intake
-Pulse oximeter
-Sedatives if needed |
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Term
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Definition
-Digoxin increases the force of the myocardial contraction
-Take an apical pulse before every dose of digoxin. If bradycardia is detected. General rule is: <90-110 beats/min for infant and toddler; <70 beats in the older child (toddler-adolescent); <60 beats in the adolescent
-Call physician before administering the drug |
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Term
| Signs of Digoxin Toxicity |
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Definition
-Bradycardia/Dysrythmia
-Arrhythmia
-Nausea, vomiting, anorexia
-Dizziness, headache
-Weakness and fatigue |
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Term
| Ventricular septal defect |
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Definition
-Opening in the ventricular septum
-Left-to-right shunt
-Right ventricular hypertrophy
-Deficient systemic blood flow |
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Term
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Definition
-Congenital narrowing of the descending aorta
-80% have aortic-valve anomalies
-Difference in BP in arms and legs (severe obstruction) |
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Term
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Definition
-Obstruction of blood flow from right ventricle
-Hypertrophy of right ventricle
-If severe cyanosis due to right-to-left shunt |
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Term
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Definition
-Most common cardiac malformation responsible for child over 1 year
-4 Components
1. VSD
2. Pulmonary stenosis: narrowing of pulmonary valve
3. Overriding of the aorta: aortic valve is enlarged and appears to arise from both the left and right ventricles instead of the left ventricle
4. Hypertrophy of right ventricle: thickening of the muscular walls because of the right ventricle pumping at high pressure |
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Term
| Clinical manisfestations of tetralogy of fallot |
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Definition
-Dependent on degree of right ventricular outflow obstruction
-Right-to-left shunt
-Clubbing of digits
-"Tet" spells: treated by flexing knees forward and upward
-Severe irritability due to low oxygen levels |
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Term
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Definition
-Unknown origin; inflammation of vascular system
Symptoms:
-High fever
-Conjunctivitis: no drainage
-Strawberry tongue
-Edema of hands and feet
-Reddening of hands and feet
-Reddening of palms and soles
-Lymph node swelling |
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Term
| Interventions for Kawasaki diseas |
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Definition
-Intravenous gamma globulin
-High dose of ASA while in hospital
-Low dose of ASA upon discharge
-Base-line echocardiogram to assess coronary artery status |
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Term
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Definition
-Poorly understood inflammatory disease
-Most often late school age children and adolescents
-Involves joints, skin adn heart (specifically mitral valve)
-If we can treat strep throat, we can treat |
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