Peds Cardiac

  1. Cardiac Output
    • CO=HR X SV
    • the volume of blood ejected by the heart in 1 min
  2. Stroke Volume
    • Preload, afterload, and contractility
    • amount of blood ejected by the heart in any one contraction
  3. Preload
    Volume of blood returning to the heart or circulating blood volume
  4. Afterload
    resistance against which the ventricles must push to pump blood out
  5. contractility 
    efficiency of the myocardial fiber shortening or the ability to pump
  6. Chest X-ray
    • heart size and configuration 
    • pulmonary blood flow
  7. Preop for cardiac cath
    • teach child about procedure
    • -what they will feel, hear, and see
    • -videos, picture books, tour of cath lab
    • may need to withhold morn meds
    • NPO 
  8. Cardiac Cath complications
    Pulses distal to site may be weaker for the first couple of hours but will gradually increase in strength and then be equal and symmetric
  9. If a postop cardiac cath pt has a soaked bandage, what do you do?
    direct continuous pressure 1 inch above the site
  10. What is CHF most likely related to?
    Most commonly related to defects (VSD is the mosti common)
  11. Why would you see CHF in kids?
    • related to defects
    • increased risk with maternal chronic illness like diabetes, poorly controlled phenylketonuria, alcohol consumption, exposure to environmental toxins or infections
    • highly related to trisomy 21,13,18
  12. What is the normal heart rate for a newborn?
    • Awake- 100-180
    • Sleep- 80-160
  13. What is the normal HR for 1 wk- 3 month?
    • 100-220- awake
    • 80-200- sleep
  14. What is the normal HR for 2 month - 2yr?
    • 80-150 awake
    • 70-120 asleep
  15. What is the normal HR for 2yr-10yr?
    • Awake- 70-110
    • Asleep- 60-90
  16. What is the normal HR for 10 yr- adult?
    • 55-90 awake
    • 50-90 asleep
  17. What are examples of ACE inhibitors?
    Catopril, enalapril, lisonopril
  18. What is the apical pulse that you would withhold dig?
    • Infants and young children >90-110
    • Older children > 70
  19. Dig Toxicity
    • bradycardia, nausea, freq vominting
    • visual and neuro disturbances
  20. What parents need to know about administering dig:
    • regular intervals
    • administer to the side back of the mouth
    • do not mix with food or fluid
    • if child has teeth- rinse with water or brush teeth
    • if dose is missed or vomited do not repeat dose
    • if more than 2 doses are missed call HCP
    • keep in safe place- pref locked cabinet
    • if OD suspected call nearest poison control
  21. Nutrition for child with CHF
    • Increased calories 
    • feed immediately after awakening 
    • ensure good rest before feeding
  22. What should you monitor with an infant with CHF?
    Weight- same scale same time of day
  23. How would you decrease risk of CVA in a child in a hypoxic state?
    Give fluids
  24. What position should you put a child in during a hypercyanotic spell?
    Knee to chest- reduces the venous return from th elegs and increases systemic vascular resistance wich diverts more blood into pulm artery
  25. What can a left to right shunt lead to?
    increased pressure to the pulmonary artery which leads to pulm edeam which leads to CHF
  26. VSD and ASD are categorized as:
    increased pulmonary blood flow
  27. PDA- Patent Ductus Arteriosus is surgically closed to prevent what?
    increased pulm blood flow--> CHF
  28. Increased Pulmonary Blood Flow
    • ASD
    • VSD
    • PDA
    • Atrioventricular canal
  29. Decreased pulmonary blood flow
    • tetralogy of fallot
    • tricuspid atresia
  30. Mixed blood flow
    • transposition of great arteries
    • total anomalous pulmonary venous return
    • truncus arteriosus
    • hypoplastic left heart syndrome
  31. obstruction of blood flow from ventricles
    • coartation of aorta
    • aortic stenosis
    • pulmonic stenosis
  32. Tetralogy of fallot
    • ventricular septal defect
    • pulmonic stenosis
    • overriding aorta
    • right ventricular hypertrophy
  33. A mother of a child with congenital heart disease is worried about letting him play with other kids?
    • most do not need to restrict activity
    • treat child normally and allow self limited activity
    • decide which sports need to be restricted with cardiologist
  34. Prepping kid for heart surgery
    • Educate on procedure and what to expect before after and during
    • reduce anxiery, improve pt cooperation
    • ICU tour may be wanted- avoid frightening sights
    • review importance of deep breathing, ambulation, drinking and eating after surgery
  35. What do you do if a kid has a fever after surgery?
    Notify HCP
  36. Suctioning with a child after heart surgery
    provide oxygen before and after
  37. What is a worrisome amount of chest drainage?
    • more than 3ml/kg/hr
    • 5-10ml in any 1 hr
  38. If a child with VSD is not feeling well and has been having fevers, what should the nurse tell the parents
    Tell them to bring them in
  39. Who is at a high risk for infective (bacterial) endocarditis?
    • congenital anomalies, previous heart surgery, indwelling catheters
    • artificial heart valves 
    • previous Dx of IE
    • CHD 
    • cardiac transplant with cardiac valvulopathy
  40. What are the clinical manifestations of rheumatic fever?
    • carditis
    • polyarthritis
    • chorea
    • erythema maginatum
    • subcutaneous nodules
    • arthralgia, fever
    • elevated ESR & C reactive
    • positive strep test
  41. Why do you typically get rheumatic fever?
    a previous infection of groub A beta hemolytic streptococci

    • TX penicillin
    • children who have had it are at risk to have again
  42. What is the therapeutic management of kawasaki's disease?
    • Salicylates like aspirin to reduce inflammation and fever
    • IVIG- early intervention to reducve fever and incidence of coronary artery abnmormalities
  43. How do you get an accurate measurement of BP to dx HTN?
    • Sitting postition on at least 3 diff occasions
    • make sure child is quiet and relaxed
    • make sure cuff fits
  44. What is the HTN drug related to angiotensin II?
    ACE inhibitors
  45. Cholestoral screening- when do you want to check
    • Obesity
    • Family Hx of elevated cholesterol or early heart disease
    • cigarrete smoking
    • diabetes type I or II
    • hypertension
  46. What is the leading cause of death after cardiac transplant?
    • Initially rejection
    • long term CAD
  47. What are the discharge instructions for cardiac cath?
    • Remove pressure dressing 1 day after cath
    • cover site with a bandaid, change daily for 2 days
    • keep site clean and dry
    • avoid tub bath for 3 days
    • older children may shower 1st day after
    • observe for signs of redness, swelling, drainage, bleeding, fever
    • monitor cardiac cath leg for coolness
    • notify HCP if any are observed
    • child should avoid strenuous activity for several days
    • may attend school
    • may resume reg diet without restrictions
    • use acetaminophen or ibuprofen for pain
    • keep follow up appts per practitioner instructions
Card Set
Peds Cardiac
Test #5