CONGENITAL HEART DEFECTS I
Defects with increased pulmonary flow (___ to ___ shunting) include: (3)
Defects with increased pulmonary flow (left to right shunting) include:
1. atrial septal defect
2. ventricular septal defect
3. patent ductus arteriosus
Defects with decreased pulmonary flow and/or mixed defect: (2)
Defects with decreased pulmonary flow and/or mixed defect:
1. tetralogy of fallot
2. transposition of the greater vessels (arteries)
Defects obstructing systemic blood flow: (1)
Defects obstructing systemic blood flow:
1. Coarctation of the aorta
Nursing management for heart failure includes:
1. ______ and ventilation: sit upright to ______ work of breathing, monitor _____ __, chest PT, suction, and ______ used for a vasodilator
2. ______ cardiac function with ACE inhibitors, d_____, and d_____
3. Nutrition: _______ metabolic rate with heart failure can require up to ____ calories/kg/day
4. Rest: limit activities based on energy level
Nursing management for heart failure includes:
1. Oxygen and ventilation: sit upright to decrease work of breathing, monitor pulse ox, chest PT, suction, and oxygen used for a vasodilator
2. Increase cardiac function with ACE inhibitors, diuretics, and digoxin
3. Nutrition: increased metabolic rate with heart failure can require up to 150 calories/kg/day
4. Rest: limit activities based on energy level
Goal for treatment of Acute Rheumatic Fever: prevent ______ damage, manage inflammation and fever with ________ and _ _ _ _ _s, eradicate bacteria with a 10-day course of ________ or Erythromycin for the acute phase.
Goal for treatment of Acute Rheumatic Fever: prevent cardiac damage, manage inflammation and fever with steroids and NSAIDs, eradicate bacteria with a 10-day course of penicillin or Erythromycin for the acute phase.
Moderate to large ventricular septal defect can lead to heart _____, pulmonary _______, and a ______ (lower L sternal border, harsh).
Very large defect can lead to __________ syndrome: _______ pulmonary vascular resistance leads to severe pulmonary hypertension and _____ ventricular hypertrophy> leads to ____ to ____ shunting of blood, resulting in ______ and chronic hypoxia.
Moderate to large ventricular septal defect can lead to heart failure, pulmonary infections, and a murmur (lower L sternal border, harsh).
Very large defect can lead to Eisenmenger syndrome: increased pulmonary vascular resistance leads to severe pulmonary hypertension and right ventricular hypertrophy> leads to right to left shunting of blood, resulting in cyanosis and chronic hypoxia.
Patent ductus arteriosus clinical manifestations include: _______ pulses, _____ diastolic BP, widened pulse pressure, _____ continuous murmur, ____pnea, and ____cardia.
Patent ductus arteriosus clinical manifestations include: bounding pulses, low diastolic BP, widened pulse pressure, harsh continuous murmur, tachypnea, and tachycardia.
Managing a TET spell includes:
____ to ____ position, supplemental __, IV fluids, ____ approach, morphine sulfate, and _________ (0.1 mg/kg IV)
Managing a TET spell includes:
Knee to chest position, supplemental O2, IV fluids, calm approach, morphine sulfate, and propanolol (0.1 mg/kg IV)
Acute Rheumatic fever occurs after Group _ streptococcal infection. Most common in ages 5-15 years.
Major difference between scarlet fever and ARF:
1. Onset: SF arises ______ after streptococcal infection while ARF is ______.
2. Symptoms: SF= rash and ________ tongue, ARF= _____ pain, heart inflammation, and neurological symptoms.
3. Complications: SF can lead to ___, while ARF leads to long-term risks like rheumatic heart disease.
Acute Rheumatic fever occurs after Group A streptococcal infection. Most common in ages 5-15 years.
Major difference between scarlet fever and ARF:
1. Onset: scarlet fever arises immediately after streptococcal infection, while ARF is delayed.
2. Symptoms: SF=rash and strawberry tongue, ARF= joint pain, heart inflammation, and neurological symptoms.
3. Complications: Scarlet fever can lead to ARF, while ARF leads to long-term risks like rheumatic heart disease.
In Kawasaki Disease, ____ are elevated in the acute phase, and ______ are elevated in the later phase.
In Kawasaki Disease, WBCs are elevated in the acute phase, and platelets are elevated in the later phase.
Management of ventricular septal defect:
- Child <2 years old, small to moderate defect:
- Large to very large defect:
Management of ventricular septal defect:
- Child <2 years old, small to moderate defect: usually close spontaneously by age 2
- Large to very large defect: surgical closure (stitch or plug) to prevent heart damage and failure
Tetralogy of Fallot includes the following 4 defects:
1. _______ stenosis
2. _ _ _
3. Overriding _____
4. _____ ventricular _________
Tetralogy of Fallot includes the following 4 defects:
1. Pulmonary stenosis
2. VSD
3. Overriding aorta
4. Right ventricular hypertrophy
Clinical therapy for transposition of the greater vessels includes
1. Medical: prostaglandin E1 to keep the ductus ________ open, d______, and d_____
2. Surgical: (palliative) balloon atrial _________ or (corrective) arterial switch
Clinical therapy for transposition of the greater vessels includes
1. Medical: prostaglandin E1 to keep the ductus arteriosus open, diuretics, and digoxin
2. Surgical: (palliative) balloon atrial septostomy or (corrective) arterial switch
Infective _________ is an infection of the endothelial surfaces in the heart (chambers, septum, or valves).
Physical exam findings include: ____ spots, _______ lesions, _____ nodes, and ________ hemorrhages
Infective endocarditis is an infection of the endothelial surfaces in the heart
Physical exam findings include: Roth spots, Janeway lesions, Osler nodes, and splinter hemorrhages
Feeding guidelines for infants with heart failure: smaller volumes of concentrated formula (24-27 cal/oz), feed every 3 hours for ___ hour(s), _____ care and allow for rest periods, gavage feed if respiratory rate is >___/min, may need up to ___ cal/kg/day
Feeding guidelines for infants with heart failure: smaller volumes of concentrated formula (24-27 cal/oz), feed every 3 hours for 1/2 hour(s), cluster care and allow for rest periods, gavage feed if respiratory rate is >60/min, may need up to 150 cal/kg/day
Clinical manifestations of atrial septal defect:
-Small to moderate: usually ________
-Large defect: ______ failure, poor ______
Clinical manifestations of atrial septal defect:
-Small to moderate: usually asymptomatic
-Large defect: heart failure, poor growth
Transposition of the _____ Vessels (arteries) occurs when the _____ rises from the _____ ventricle and the _______ _____ rises from the _____ ventricle.
Corrective surgery is needed within _____ of life.
Clinical manifestations: cyanosis, ____pnea, fatigue, growth failure, _____ failure
Transposition of the Greater Vessels (arteries) occurs when the aorta rises from the right ventricle and the pulmonary artery rises from the left ventricle.
Corrective surgery is needed within days of life.
Clinical manifestations: cyanosis, tachypnea, fatigue, growth failure, heart failure
Infants with tetralogy of Fallot are at risk for polycythemia, _________ (_ _ _) spells, metabolic ______, poor growth, clubbing, and exercise intolerance may develop.
Infants with tetralogy of Fallot are at risk for polycythemia, hypercyanotic (TET) spells, metabolic acidosis, poor growth, clubbing, and exercise intolerance may develop.
Kawasaki disease is generalized systemic vasculitis (inflammation of the small blood vessels throughout the body) characterized by an erythematous ____, edema on the ____ and ____, peeling, ________ tongue, and cervical lymphadenopathy.
Kawasaki disease is generalized systemic vasculitis characterized by an erythematous rash, edema on the hands and feet, peeling, strawberry tongue, and cervical lymphadenopathy.
WBC elevated in acute phase, PLT elevated in later phase.
__ of the 6 following diagnostic criteria must be met for the diagnosis of Kawasaki Disease:
1. ______
2. Bilateral conjunctival inflammation without ______
3. Changes in oral mucous membranes: erythema, dryness, and fissuring of lips
4. Changes in extremities: ______, erythema of palms and soles, peeling of _____ and _____
5. Polymorphous _____
6. ________ lymphadenopathy (lymph node swelling of the neck)
5 of the 6 following diagnostic criteria must be met for the diagnosis of Kawasaki Disease:
1. fever- very high fever (38.9-41.1C)
2. Bilateral conjunctival inflammation without exudate
3. Changes in oral mucous membranes: erythema, dryness, and fissuring of lips
4. Changes in extremities: edema, erythema of palms and soles, peeling of hands and feet
5. Polymorphous rash
6. Cervical lymphadenopathy (lymph node swelling of the neck)
The ductus arteriosus connects the _____ to the _______ ______. Patent ductus arteriosus is the failure of it to close within the first _____ of life. This defect causes _______ workload of the left side of the heart and _______ pulmonary pressure> ______ ventricular hypertrophy.
The ductus arteriosus connects the aorta to the pulmonary artery. Patent ductus arteriosus is the failure of it to close within the first weeks of life. This defect causes increased workload of the left side of the heart and increased pulmonary pressure> right ventricular hypertrophy.
**DAILY DOUBLE**
_________ often stimulates closure of the ductus arteriosus in infants.
**DAILY DOUBLE**
Indomethacin often stimulates closure of the ductus arteriosus in infants.
Coarctation of the _____ is a narrowed area that causes bounding pulses and increased blood pressure in the _____ extremities and weak pulses with decreased blood pressure in the _____ extremities.
Older children may develop nose bleeds, headaches, or ________ from the hypertension.
Coarctation of the aorta is a narrowed area that causes bounding pulses and increased blood pressure in the upper extremities and weak pulses with decreased blood pressure in the lower extremities.
Older children may develop nose bleeds, headaches, or dizziness from the hypertension.
Phases and S/S of Kawasaki disease:
1. Acute phase (__-__ weeks): fever, conjunctival hyperemia, ___ throat, swollen hands, rash, enlarged cervical lymph nodes
2. _______ phase (2-6 weeks): cracked lips, fissures, joint pain, thrombocytosis, cardiac manifestations
3. Convalescent phase (__-__ weeks after fever onset): appears _______, signs of inflammation may still be present
Phases and S/S of Kawasaki disease:
1. Acute phase (1-2 weeks): fever, conjunctival hyperemia, red throat, swollen hands, rash, enlarged cervical lymph nodes
2. Subacute phase (2-6 weeks): cracked lips, fissures, joint pain, thrombocytosis, cardiac manifestations
3. Convalescent phase (6-8 weeks after fever onset): appears normal, signs of inflammation may still be present
Those most at risk for infective endocarditis include children with _______ valves used for repair in the heart and children getting _____ procedures.
Management includes follow up, repeat _____ ______, repeat ECHO, and prophylaxis in high-risk children.
Those most at risk for infective endocarditis include children with prosthetic valves used for repair in the heart and children getting dental procedures.
Management includes follow-up, repeat blood cultures, repeat ECHO, and prophylaxis in high-risk children.