The Child with a Cardiovascular Disorder

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Questions and Answers

What is the primary cause of death during the first year of life among congenital anomalies?

Cyanotic heart defects

Congenital heart defects (correct)

Acyanotic heart defects

Respiratory anomalies

What does hypothermia during cardiac surgery help to reduce?

Surgeons' anxiety during the procedure

Blood flow to the heart

Need for oxygen in body tissues (correct)

Recovery time for the patient

Which heart defect typically involves the mixing of oxygenated and deoxygenated blood?

Atrial septal defect

Ventricular septal defect

Single ventricle heart defect (correct)

Patent ductus arteriosus

Which of the following is a common characteristic of a ventricular septal defect?

It may close spontaneously during the first year of life Signup and view all the answers

In which direction does blood flow in a left-to-right shunt due to an atrial septal defect?

From the right atrium to the left atrium Signup and view all the answers

Which condition is characterized by a failure of proper closure of the vessel connecting the pulmonary artery and aorta after birth?

Patent ductus arteriosus Signup and view all the answers

What is a common symptom of rheumatic fever?

Joint pain Signup and view all the answers

Which statement about primary and secondary hypertension in children is true?

Secondary hypertension is often due to underlying medical conditions. Signup and view all the answers

Which factor is considered preventive for hypertension in children?

Regular physical activity Signup and view all the answers

What is a notable manifestation of Kawasaki disease?

High fever Signup and view all the answers

Which sign is NOT typically associated with congenital heart defects in infants?

High blood pressure Signup and view all the answers

What developmental stage is critical for the cardiovascular system in a child?

Between the third and eighth week of gestation Signup and view all the answers

What condition may come from incomplete cardiovascular development in a child?

Congenital heart defects Signup and view all the answers

Which of the following factors can lead to congenital heart defects in children?

Drug intake or maternal illness Signup and view all the answers

What is the primary purpose of chest tubes in postoperative care?

To remove secretions and air from the pleural cavity Signup and view all the answers

Which statement about the drainage system for chest tubes is correct?

It must be airtight to prevent lung collapse Signup and view all the answers

What is a common cause of death post cardiac transplant?

Infection and rejection of new tissue Signup and view all the answers

Which of the following is NOT a characteristic of the cardiovascular system in infants compared to adults?

Higher stroke volume Signup and view all the answers

What is the role of padded Kelly clamps in chest tube management?

To emergency clamp tubes if a break occurs Signup and view all the answers

Which congenital heart defect is characterized by an opening between the right and left ventricles?

Ventricular septal defect Signup and view all the answers

What is the recommended position for a child experiencing a tet spell?

Knee-chest position Signup and view all the answers

In cases of congestive heart failure, what symptom is likely to indicate left-sided heart failure?

Backup of blood into the lungs Signup and view all the answers

What type of heart defect involves narrowed pulmonary artery and right ventricular hypertrophy?

Tetralogy of Fallot Signup and view all the answers

Which of the following is a common symptom observed in hypoplastic left heart syndrome?

Cyanosis Signup and view all the answers

What is the definition of acquired heart disease?

A cardiac problem that occurs after birth Signup and view all the answers

What is the primary goal of treatment for tetralogy of Fallot?

Increase pulmonary blood flow Signup and view all the answers

What distinguishes the boot-shaped appearance of the heart observed in tetralogy of Fallot?

Dextroposition of the aorta Signup and view all the answers

What role does Prostaglandin E1 play in infants with hypoplastic left heart syndrome?

It maintains ductus arteriosus patency Signup and view all the answers

What should nursing care after cardiac catheterization include?

Monitoring vital signs Signup and view all the answers

Which of the following is NOT a common complication of congenital heart defects?

Pulmonary fibrosis Signup and view all the answers

How should nutrition be managed in children with congenital heart disease?

Prevent dehydration and promote optimal growth Signup and view all the answers

Why is antibiotic prophylaxis important before dental care for children with heart disease?

To avoid bacterial endocarditis Signup and view all the answers

What is a consequence of patent ductus arteriosus (PDA) when it does not close properly after birth?

Oxygenated blood circulates excessively through the lungs. Signup and view all the answers

What characteristic symptom differentiates coarctation of the aorta in terms of blood pressure?

Significantly lower blood pressure in the lower extremities than in the upper extremities. Signup and view all the answers

Which of the following treatments is most appropriate for a child with coarctation of the aorta who is experiencing significant symptoms?

Surgical resection of the narrowed aorta and end-to-end anastomosis. Signup and view all the answers

Which key echocardiographic finding is often associated with tetralogy of Fallot?

Narrowing of the pulmonary artery. Signup and view all the answers

What is a common symptom seen in infants with tetralogy of Fallot as they grow older?

Cyanosis and clubbing of the fingers. Signup and view all the answers

When observing a child post-surgery for coarctation of the aorta, which issue should be prioritized for monitoring?

Signs of hypertension and abdominal pain. Signup and view all the answers

What compensatory mechanism occurs in the body of a child with decreased pulmonary blood flow due to congenital defects?

Increased production of red blood cells. Signup and view all the answers

Study Notes

Cardiovascular Disorders in Children

Cardiovascular System Differences: The infant's cardiovascular system differs anatomically and physiologically from an adult's. Pulse, respiration, blood pressure, and hematological values vary until the child ages. Chest walls are thinner due to less subcutaneous tissue. Newborn circulation differs from fetal, and capillary function is immature. Heart rate is higher, and stroke volume response to decreased cardiac output is limited. Heart abnormalities are often due to embryonic defects.
Signs of Cardiac Pathology: Failure to thrive, cyanosis/pallor, neck vein pulsations, tachypnea/dyspnea, irregular pulse, clubbing of fingers, fatigue during feeding/activity, excessive perspiration are common signs of congenital heart problems. Bradycardia can indicate impending arrest due to hypoxia.
Congenital Heart Defects (CHD): CHD occurs in approximately 8 out of 1000 births and is often apparent before the first year. Some, like mitral valve prolapse, may manifest later. They can be caused by genetic, maternal (e.g., drug intake, rubella), or environmental factors. Fetal echocardiography can detect CHD in high-risk pregnancies. CHD are categorized as cyanotic or acyanotic based on the presence of cyanosis; more accurately, based on effects on blood circulation (increasing/restricting/decreasing pulmonary flow, and mixed oxygenated and non-oxygenated blood).

CHD Classifications & Descriptions

Atrial Septal Defect (ASD): An abnormal opening between the right and left atria. Blood flows from the left to the right atrium, often without symptoms; recognized by a murmur. Diagnosed by cardiac catheterization, ECG, and echocardiography. Sometimes closes spontaneously. Repair is done with a Dacron patch. Low-dose aspirin therapy is common post-repair.
Ventricular Septal Defect (VSD): Most common CHD, involving an opening between the right and left ventricles. Increased pressure in the left ventricle forces blood to the right ventricle. Characterized by a loud, harsh murmur. Often closes spontaneously during the first year; minor defects might be corrected later. Surgery uses hypothermia and cardio-pulmonary bypass during open heart surgery to close the hole with sutures or a synthetic patch.
Patent Ductus Arteriosus (PDA): Failure of the ductus arteriosus to close after birth. Blood flows from the aorta (higher pressure) to the pulmonary artery, increasing pulmonary flow potentially leading to dyspnea, wide pulse pressure, and a machinery-type murmur. More frequent in girls. Treatment varies by severity. Indomethacin/Ibuprofen can cause closure for premature infants. Coils can be inserted via cardiac catheterization. Surgery is possible.
Coarctation of the Aorta: Narrowing of the aorta, causing increased pressure proximal to the defect and reduced pressure distally. Characterized by different blood pressures and pulses in upper and lower extremities. X-rays may show rib notching. Treatment may include surgery (anastomosis) or percutaneous balloon angioplasty with stent insertion in older children.
Tetralogy of Fallot: Four heart defects: pulmonary artery stenosis, right ventricular hypertrophy, dextroposition of the aorta, and VSD. Causes unoxygenated blood to flow into the general circulation, leading to cyanosis. Characteristic is a squatting position for easier breathing. Tet spells (hypercyanotic episodes) are possible. Diagnosis is aided by chest X-ray (boot-shaped heart), ECG, 3D echocardiography, cardiac catheterization. Treatment includes temporary shunts or complete open heart surgery.
Hypoplastic Left Heart Syndrome: Underdevelopment of the left side of the heart, often requiring a three-stage surgical procedure or a transplant.

Acquired Heart Disease

Congestive Heart Failure (CHF): Occurs due to inadequate cardiac output. Manifestations differ based on the affected side of the heart (right or left) with systemic symptoms like cyanosis, pallor, tachypnea, tachycardia, feeding difficulties, weight gain, edema, and frequent respiratory infections. Care emphasizes reducing heart workload, improving respiration, maintaining nutrition, preventing infection, reducing anxiety, and supporting parents.
Treatment and Nursing Care: Medications like digitalis (e.g., digoxin) or ACE inhibitors are administered to manage CHF. Diuretics (e.g., furosemide) help reduce edema. Fluid and nutrition management, along with careful monitoring of vital signs, are necessary to prevent complications.

Rheumatic Fever (RF)

Pathophysiology: An autoimmune disease due to untreated group A beta-hemolytic streptococcal infection of the throat. It affects joints, heart, CNS, skin, etc., causing connective tissue damage, particularly affecting the heart valves causing, mitral valve scarring.
Manifestations: Symptoms can vary from mild to severe, appearing 1-6 weeks after a strep infection. Classic signs include migratory polyarthritis, skin lesions (erythema marginatum), chorea, and carditis. Other signs include abdominal pain, fever, pallor, fatigue, and unexplained nosebleeds. Elevated ASO titer supports diagnosis.
Treatment and Prevention: Antibiotic therapy (e.g., penicillin or erythromycin) is a first step to eliminate strep infection and long-term antibiotic prophylaxis to prevent recurrence. Rest, pain relief, and management of cardiac failure (if present) are also crucial. Prompt and adequate treatment of strep throat is vital for prevention.

Systemic Hypertension

Pathophysiology: High blood pressure in children, often linked to increased cardiac output or peripheral resistance. Diagnosis requires confirmed blood pressure readings across multiple occasions.
Normal vs. Elevated: Normal blood pressure is below the 90th percentile for age, height, and sex; elevated blood pressure falls between 90th and 95th percentile.

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Description

Explore the anatomical and physiological differences in the cardiovascular system of infants compared to adults. Learn about the signs of cardiac pathology and the prevalence of congenital heart defects (CHD) in children. This quiz will enhance your understanding of how these conditions manifest in early development.