Term
| What is involved in a pediatric cardio exam? |
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Definition
Plot ht. and Wt.
V/S blood pressures in upper and lower extremities
Inspect for cyanosis, chest enlargement or asymmetry, clubbing, distended veins
Auscultate heart and lung sounds
Palpate quality and symmetry of all pulses |
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Term
| Wht lab/diagnostic tests are performed for a cardio exam. |
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Definition
Chest X ray
EKG
Echocardiogram
MRI
CBC - polycythemia is often associated with cyanotic heart defects |
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Term
| What are the Acyanotic cardio anomalies? |
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Definition
Ventricular Septal Defect (VSD)
Arterial Septal Defect (ASD)
Patent Ductus Arteriosus ( PDA)
Coarctation of the Aorta |
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Term
| What are the Cyanotic Cardio. Anomalies? |
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Definition
Tetralogy of Fallot (TCA)
Transposition of the Great Vessels |
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Term
| What is the Nursing Care for a Pediatric Cardiac Catherization? |
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Definition
Femoral veins used for access
Before procedure:
Prepare child for the procedure based of developmental stage, level of understanding and past experience
After the procedure
Neuro checks to affected extremity
Keep extremity distal to the site extended for 6 hrs.
Check insertion site dressing for bleeding
Monitor VS and urine output |
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Term
| What are the Nursing Diagnosis Associated w/ ped. cardio. disorders? |
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Definition
Dec. cardiac output
Alteration in tissue perfusion
Excess fluid volume
Imbalanced nutrition: less than body requirements
Pain
Risk for infection
Delayed growth and development
Knowledge deficit
Fear/anxiety |
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Term
| What are the S/S of Heart Failure in a pediatric patient? |
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Definition
Tachycardia
Cardiomegaly
Dec. peripheral pulses
Mottling of the extremities
Resp. distress
Hepatomegaly
edema
JVD
Dec. urine output
failure to thrive
dec. exercise tolerance
dec. |
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Term
| What are the Nursing interventions for a ped. pt. w/ HF? |
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Definition
Dec. energy expenditure and provide adequate rest
Red. resp. distress. O2 administration,
positioning
Provide adequate nutrition, high calorie feeding may be req.
Mtr. I&O daily weights
Promote growth and development
Educate and support pt. and family |
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Term
| What meds. are administered in a ped. pt. w/ HF? |
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Definition
Digoxin - slow the heart and inc. myocardial contractility
ACE Inhibitors - to dec. afterload
Diuretics
Potassium supplement - if diuretic is potassium depleting |
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Term
| What congenital defects cause inc. pulmonary blood flow? |
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Definition
Atrial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
Patent Ductus Arteriosus (PDA) |
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Term
| What congenital defect causes obstruction of the blood flow leaving the heart? |
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Definition
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Term
| What congenital heart disease causes mixed blood flow? |
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Definition
| Transposition of the great arteries |
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Term
| What congenital heart disease causes dec. pulmonary blood flow? |
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Definition
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Term
| What are the S/S and complications of Atrial Septal Defect (ASD)? |
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Definition
S/S
Dyspnea, tachypnea, fatigue after exertion, murmur, clubbing
Complications:
Atrial arrhythmias, heart failure, resp. infections, mitral valve prolapse, growth retardation |
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Term
| What is the Treatment and Nursing Care for ASD? |
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Definition
Tx:
ASD's may close w/o tx.
Tx. CHF w/ meds.
Sx. repair may be needed
NI's:
Mtr. V/S,
Provide adequate nutrition,
Mtr. G & D,
Provide for periods of rest,
Prevent infections (antibiotic prophylaxis),
Prepare child for tests/surgery, Support and educate family |
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Term
| What are the S/S and complications of VSD? |
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Definition
S/S:
Dyspnea, tachypnea, fatigue after exertion, murmur
Complications:
HF, Ventricular hypertrophy, Resp. problems, bacterial endocarditis, growth retardation |
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Term
| What is the Tx. and NI's for VSD? |
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Definition
Tx:
Up to 85% of VSD's close w/o tx.
Tx. w/ digoxin and diuretics if CHF is present.
Sx. repair if necessary
NI's:
Mtr. V/S,
Provide adequate nutrition,
Mtr. G & D,
Provide for periods of rest,
Prevent infections (antibiotic prophylaxis),
Prepare child for tests/surgery, Support and educate family |
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Term
| What is Patent Ductus Arteriosus (PDA)? |
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Definition
| Failure of fetal dectus arteriosus to close after birth resulting in a blood vessel connection the pukmonary artery to the aorta |
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Term
| What are the S/S and complications of PDA? |
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Definition
S/S:
Bounding pulses, visible precordial pulsations, machine-like murmur, wide pulse pressure
Complications:
Heart Failure |
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Term
| What is the Tx. and NI's for PDA? |
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Definition
TX:
Administer indomethacin to close the defect
SX. repair may be needed
NI's:
Mtr. V/S,
Provide adequate nutrition,
Mtr. G & D,
Provide for periods of rest,
Prevent infections (antibiotic prophylaxis),
Prepare child for tests/surgery, Support and educate family |
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Term
| What is Coarctation of the Aorta? |
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Definition
| Narrowing of the aorta at the transverse aortic arch or in the area of the ductus arteriosis |
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Term
| What are the S/S of Coarctation of the Aorta? |
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Definition
Blood and pulse pressures greater in the arms than in the legs
C/O leg pain
Strong brachial pulses,diminished femoral pulses
lower extremities cooler than upper extremeties
irritability
dizziness
HA, fainting, existaxis, CVA |
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Term
| What is the Tx. and NI's for Coarctation of the Aorta? |
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Definition
Tx:
Mgmt. of CHF;
Digoxin & Diuretics
Corrective Sx. to remove narrowed portion or repair with graft(by 2 yrs. old)
NI's
Assess for HF, hypotension, murmur,
Support and educate family |
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Term
| What is Tetralogy of Fallot? |
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Definition
Consists of 4 defects:
VSD
Aorta overriding VSD
Pulmonary stenosis
Hypertrophy of the Right Ventricle
"DROP"
Defect (VSD), Right Ventricular Hypertrophy, Overriding aorta, Pulmonary Stenosis
Cause Unknown but associated w/ fetal alcohol syndrome |
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Term
| What are the S/S or Tetralogy of Fallot? |
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Definition
Cyanosis "Tet Spells"
Low SaO2 levels, clubbing
Polycythemia
Activity Intolerance, fatigue
Poor feeding
Growth retardation
Systolic murmur |
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Term
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Definition
Occur when O2 demand exceeds supply
Often precipitated by crying, feeding, defecation
Hypercyanosis, tachypnea, poor muscle tone, LOC, CVA's, seizures and death |
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Term
| What is the TX. and NI's for TOF? |
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Definition
O2, MSo4, Inderal, Prostaglandin E1 to maintain a patent ductus arteriosus until Surgery, Sx. repair (1-2 yrs. old)
NI's:
Prevention of "Tet Spells", emboli,
and endocarditis (prophylactic antibiotics)
improve oxygenation( knee-chest position, O2, Morphine)
Support and educate family |
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Term
| What is Transposition of the Greart Arteries? |
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Definition
| The positions of the gerat arteries are reversed from the normal position. Aorta emerges from the rt. ventricle and the pulmonary artery emerges from the l. ventricle |
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Term
| What are the S/S of Transposition of the Great Arteries? |
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Definition
Cyanosis from birth, hypoxia,tachypnea,
tachycardia, cardiomegaly, hepatomegaly, systolic murmur, exercise intolerance, fatigue,
*Incompatible with life* |
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Term
| What is the Tx. and NI's for Transposition of the Great Arteries? |
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Definition
Tx:
This defect results in a medical emergency
Stabilization - treat acidosis
Administer Prostglandin E1 to maintain patency of the PDA until Sx. is performed
Corrective surgery to switch the positions of the major vessels, (1wk - 3 mos. old)
NI's:
Mtr. VS, I & O
Improve oxygenation
meds. as ordered
supportive care until Sx.
Prepare for Sx.
Support and educate family |
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Term
| What is Kawasaki Disease? |
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Definition
Acute systemic vasculitis
Usually afffects pt.s <5 ; rarely > 8
more common in males
S/S Usually dissappear in 5-6 wks. w/o residual damage. Occasionally coronary artery damage remains |
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Term
| What are S/S of Kawasaki Disease? |
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Definition
Conjunctivitis (non-draining)
Rash
Edema, Erythema of hands or feet
Adenopathy
Mucosal involvement (erythema, strawberry tongue, fissures, or crusting)
fever for >5 days + 4 of the above symptoms |
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Term
| What is the TX for Kawasaki disease? |
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Definition
Salicylate therapy - initially given in an anti-inflammatory doses then in low dosages until the platelet count has returned to normal or indefinitely if there is coronary artery involvement
IV immunoglobulin (IVIG)- reduces the duration of the fever and the incidence of coronary artery abnormalities |
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Term
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Definition
Inflammatory disorrder that can involve the heart, joints, connective tissue, and CNS
Leading cause of preventable childhood heart disease
Occure w/in 2 - 6 wks. of strep infection
Prognosis dependant on degree of heart damage |
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Term
| What are the S/S of Rheumatic Fever? |
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Definition
Carditis
Polyarthritis
Chorea-sudden involuntary movements of the extremities
Subcutaneous nodules
Erythema marginatum
Fever
Arthralgia |
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Term
| What is the Tx. and NI's for Rheumatic Fever? |
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Definition
Penicillan/Erythromycin (acute & prophylactically)
Salicylates, EKG, Echocardiogram
NI's:
Administer Meds. as ordered
Promote Bed Rest
Reposition Frequently
Assist w/ ADL's as needed
Alleviate anxiety
Educate and support patient and family |
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Term
| What is the point of maximum impulse for auscultating the apical heartrate of a child? |
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Definition
< 7 : just lateral to the LMCL 4th ICS
> 7 yrs. : 5th ICS |
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