Pediatric Nursing: Circulation Issues
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Questions and Answers

What is a characteristic sign of a Patent Ductus Arteriosus (PDA)?

  • Cyanosis
  • Increased heart rate
  • Stunted growth
  • Machinery-like murmur (correct)

Patients with Tetralogy of Fallot typically experience increased pulmonary blood flow.

False (B)

Name the four heart anomalies associated with Tetralogy of Fallot.

Pulmonic stenosis, Right ventricular hypertrophy, Ventricular septal defect, Overriding aorta

Increased preload is caused by _____ of blood from one ventricle to another.

<p>shunting</p> Signup and view all the answers

Match the following terms with their definitions:

<p>Preload = End diastolic volume that stretches the ventricle Afterload = Pressure against which the heart must work to eject blood Cardiac Output = Amount of blood pumped by the heart in a minute Stroke Volume = Amount of blood ejected by the left ventricle in one contraction</p> Signup and view all the answers

What is a common surgical treatment for Patent Ductus Arteriosus?

<p>Surgical ligation of the parent vessel (D)</p> Signup and view all the answers

Surgical and non-surgical procedures for managing PDA have a 0% mortality rate.

<p>True (A)</p> Signup and view all the answers

What is the relationship between increased blood pressure and afterload?

<p>Increased blood pressure contributes to increased afterload.</p> Signup and view all the answers

What is a primary reason for shock in children?

<p>Hypovolemia (B)</p> Signup and view all the answers

Decompensated shock is characterized by normal organ function.

<p>False (B)</p> Signup and view all the answers

What are two observable signs of compensated shock in children?

<p>Tachycardia and irritability</p> Signup and view all the answers

PDA stands for Patent ________ Arteriosus.

<p>Ductus</p> Signup and view all the answers

Match the type of shock to its primary characteristics:

<p>Compensated Shock = Normal blood pressure with increased heart rate Decompensated Shock = Organ dysfunction with tissue hypoxia Irreversible Shock = Thready weak pulse and coma Shock in General = Inadequate tissue perfusion</p> Signup and view all the answers

Which of these is NOT a focus of therapeutic management in shock?

<p>Physical therapy (C)</p> Signup and view all the answers

Prior to birth, screening for critical congenital heart disease is done through physical examination.

<p>True (A)</p> Signup and view all the answers

What type of fluid administration is crucial during the therapeutic management of shock?

<p>Intraosseous access</p> Signup and view all the answers

In the case of PDA, blood flows from high pressure aorta to low pressure ________ artery.

<p>pulmonary</p> Signup and view all the answers

Which of these conditions is not characterized by increased pulmonary blood flow?

<p>Tetralogy of Fallot (C)</p> Signup and view all the answers

What factors determine cardiac output?

<p>Stroke volume and heart rate (B)</p> Signup and view all the answers

Cardiac contractility is the force a muscle can generate dependent on stretch or load.

<p>False (B)</p> Signup and view all the answers

List two manifestations of pulmonary congestion.

<p>Tachypnea and dyspnea</p> Signup and view all the answers

Prolonged hypertrophy leads to loss of effective __________ contraction.

<p>myocardial</p> Signup and view all the answers

Which of the following is NOT a medication used to improve cardiac function?

<p>Antibiotics (D)</p> Signup and view all the answers

Gallop rhythm is a sign of impaired myocardial function.

<p>True (A)</p> Signup and view all the answers

What is the purpose of elevated head positioning in cardiac care?

<p>To improve breathing and reduce venous return.</p> Signup and view all the answers

In systemic venous congestion, one possible manifestation is __________ edema.

<p>peripheral</p> Signup and view all the answers

Match the following signs/symptoms with their corresponding conditions.

<p>Tachycardia = Impaired Myocardial Function Cough = Pulmonary Congestion Weight gain = Systemic Venous Congestion Dyspnea = Pulmonary Congestion</p> Signup and view all the answers

Which nursing action is critical in the management of a child with heart failure?

<p>Monitor for changes in heart sounds (A)</p> Signup and view all the answers

Blalock-Taussig Shunt is a type of elective repair for heart defects.

<p>False (B)</p> Signup and view all the answers

Identify one therapeutic goal for the management of cardiac dysfunction.

<p>Improve cardiac function</p> Signup and view all the answers

One implication for children born with Tetralogy of Fallot is the transition to __________ care.

<p>adult</p> Signup and view all the answers

Which of the following is a symptom of impaired myocardial function?

<p>Pale cool extremities (C)</p> Signup and view all the answers

Daily weights are unnecessary in the care of a child with cardiac issues.

<p>False (B)</p> Signup and view all the answers

Flashcards

What is Shock?

A medical condition in which the body's circulatory system fails to deliver enough oxygen-rich blood to the tissues, leading to cellular dysfunction and potential organ failure.

What is Compensated Shock?

A type of shock where the body is still compensating for the decreased blood flow. Vital organs are functioning normally, but the body is working harder to maintain circulation.

What is Decompensated Shock?

A type of shock where the body's compensatory mechanisms are failing. Tissues are becoming hypoxic, metabolic acidosis is developing, and organ function is starting to deteriorate.

What is Irreversible Shock?

A type of shock where the body's organs are failing and the patient is at high risk of death. There is often very low blood pressure, rapid heart rate, and slow or irregular breathing.

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What is Patent Ductus Arteriosus (PDA)?

A congenital heart defect where the ductus arteriosus, a blood vessel that connects the aorta and the pulmonary artery during fetal development, fails to close after birth. This causes an increased flow of blood to the lungs.

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What are the Hemodynamic Implications of PDA?

The increased blood flow to the lungs caused by PDA puts an extra workload on the heart, causing pulmonary congestion, increased lung pressure, and potentially heart failure.

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What is Decreased Pulmonary Blood Flow?

A condition where there is a decrease in the flow of blood to the lungs, usually due to narrowing or obstruction of the pulmonary valve.

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What is Obstruction of Blood Flow Out of the Heart?

A condition where there is obstruction of blood flow out of the heart, usually due to narrowing or obstruction of the aortic valve.

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What is Mixed Blood Flow?

A condition where there is a mixing of oxygenated and deoxygenated blood in the heart, usually due to a hole in the septum between the heart chambers.

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How is Critical Congenital Heart Disease Screened for?

A prenatal ultrasound, physical examination, and oximetry screening (measuring oxygen levels in the blood) are all methods used to identify critical congenital heart disease in newborns.

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What is Pulse Oximetry Screening for Newborn?

A method of assessing the oxygen saturation of blood in different parts of the body to identify congenital heart defects.

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Patent Ductus Arteriosus (PDA)

A congenital heart defect where there is an abnormal opening between the aorta and the pulmonary artery, resulting in oxygenated blood flowing back into the pulmonary artery. This can lead to symptoms like heart failure and a distinctive "machinery-like" murmur.

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Tetralogy of Fallot

A condition characterized by four heart abnormalities: pulmonic stenosis (narrowing of the pulmonary valve), right ventricular hypertrophy (thickening of the right ventricle), ventricular septal defect (hole in the wall separating the ventricles), and overriding aorta (the aorta sits over both ventricles instead of just the left).

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Stroke Volume

The amount of blood that the heart pumps out with each beat.

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Preload

The volume of blood in the ventricle at the end of diastole (relaxation).

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Afterload

The pressure the heart must work against to eject blood during systole (contraction).

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Cardiac Output

The amount of blood pumped by the heart per minute. It's a measure of how efficiently the heart is working.

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Heart Failure

The condition in which the heart doesn't pump blood effectively, leading to a build-up of fluid. This can be caused by a variety of factors, including heart valve problems, coronary artery disease, and high blood pressure.

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Hypertrophic Cardiomyopathy

A condition in which the heart muscle is abnormally thick. This can make it harder for the heart to pump blood effectively.

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What is Cardiac Output?

The amount of blood pumped by the heart in one minute.

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What is Stroke Volume?

The volume of blood ejected from the left ventricle with each heartbeat.

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What is Heart Rate?

The number of times the heart beats per minute.

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What is Cardiac Contractility?

The force and speed with which the heart muscle contracts at a given preload and afterload.

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What is Heart Failure?

A condition where the heart is not able to pump blood effectively, leading to a buildup of fluid in the lungs and body.

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What is Tachycardia?

A rapid heart rate.

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What is a Gallop Rhythm?

An abnormal heartbeat rhythm with an additional sound heard during the heartbeat.

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What is Cardiomegaly?

An enlargement of the heart.

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What is Orthopnea?

Difficulty breathing, especially when lying flat.

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What is Tachypnea?

An increased respiratory rate.

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What is Peripheral Edema?

Swelling of the body, especially in the ankles and legs.

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What are Medications to Improve Cardiac Function?

Medications that help to improve the function of the heart by increasing its contractility.

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What is Cardiac Catheterization?

A medical procedure that involves inserting a catheter into a blood vessel to study the heart and blood vessels.

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What is Surgical Intervention for Heart Defects?

An operation to repair a heart defect or improve blood flow to the lungs.

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Study Notes

Circulation Concerns of a Pediatric Client

  • Learning Outcomes: Apply core principles of family-centered care and relational care in pediatric nursing practice and teaching; Apply evidence-informed knowledge, critical inquiry, and clinical judgment to pediatric clients and families; Describe a holistic approach to assessment, planning, implementation, and evaluation in pediatric care; Discuss common political, ethical, and economic issues in pediatric care.

  • Goals of the Class: Describe immediate interventions for children experiencing circulatory concerns; Explore nursing roles and responsibilities in caring for children with shock, congenital heart disease (PDA or Tetralogy of Fallot); Discuss the Pediatric Cardiac Inquest's impact on nursing.

Shock in Children

  • Shock (circulatory failure) is a complex presentation.
  • Characterized by inadequate tissue perfusion (not enough blood flow to tissues) that leads to metabolic demands and eventual organ failure.
  • Causes in children include hypovolemia (low blood volume), altered peripheral vascular resistance, and pump failure.

Types of Shock

  • Compensated Shock: Vital organ function is maintained by compensatory mechanisms. Blood flow is normal or increased, and fluids may shift. Signs include apprehension, irritability, unexplained tachycardia, and normal blood pressure.
  • Decompensated Shock: Characterized by tissue hypoxia, metabolic acidosis, and eventually dysfunction of all organ systems. Confusion, somnolence and tachypnea are common.
  • Irreversible/Terminal Shock: Thready pulse, hypotension, periodic breathing, apnea, anuria, and stupor/coma.

Compensated Shock

  • Thirst, pallor, diminished urine output, reduced perfusion to extremities.

Decompensated Shock

  • Oliguria, cool pale extremities, decreased skin turgor, poor capillary refill

Therapeutic Management

  • Ventilation: Establish airway and intubate; administer oxygen.
  • Fluid Administration: Obtain vascular access (intraosseous in emergency), restore fluid volume.
  • Cardiovascular Support: Administer vasopressors (e.g., epinephrine). Provide continuous ECG monitoring, monitor pulse oximetry. Maintain positioning (flat/legs raised), keep child calm and warm.

Review of the Heart Structures

  • Screening for Critical Congenital Heart Disease: Prenatal ultrasound, physical examination, oximetry screening (right hand and one foot).
  • Congenital Heart Conditions in Children: Information on different congenital heart conditions such as increased/decreased pulmonary blood flow, obstruction of blood flow out of the heart and mixed blood flow.

Congenital Heart Disease (Examples)

  • Patent Ductus Arteriosus (PDA): A defect where a fetal artery connecting the aorta and pulmonary artery does not close. This leads to increased pulmonary blood flow.
  • Tetralogy of Fallot: Four heart anomalies, including pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and overriding aorta. This leads to decreased pulmonary blood flow.

Presentation of PDA

  • Patients may be asymptomatic or show symptoms like heart failure, a machinery-like murmur, widening pulse pressure and bounding pulses.

Management and Treatment of PDA

  • Intravenous administration of prostaglandins; Surgical division or ligation of the parent vessel; Surgical coils to occlude the PDA; Surgical and non-surgical procedures have a 0% mortality rate.

Tetralogy of Fallot

  • Characterized by four heart anomalies (pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and overriding aorta). This leads to decreased pulmonary blood flow.

Side-by-Side Heart Comparison

  • Includes various factors including Preload, Afterload, Cardiac Output, and Contractility

Diagnostic Tests

  • Chest X-ray, electrocardiogram, echocardiography, cardiac catheterization, cardiac MRI.

Signs of Heart Failure

  • Impaired myocardial function; pulmonary congestion; systemic venous congestion

Impaired Myocardial Function

  • Tachycardia, Sweating/inappropriate, decreased urine output, fatigue, weakness, restlessness, Anorexia, Pale/Cool extremities, weak/peripheral pulses, Decreased blood pressure.

Pulmonary Congestion Manifestations

  • Symptoms include increased breathing rate, shortness of breath, retractions, flared nostrils, exercise intolerance, and orthopnea.

Systemic Venous Congestion Manifestations

  • Weight gain, hepatomegaly, peripheral edema (especially periorbital), ascites, neck vein distention

Therapeutic Management

  • Improve cardiac function; Remove accumulated fluid and sodium; Decrease cardiac demands; Improve tissue oxygenation and decrease oxygen consumption.

Medications to Improve Cardiac Function

  • Ace inhibitors, digitalis, beta blockers, diuretics.

Nursing Actions and Interventions

  • Assess the infant/child, administer oxygen, elevate the head of the bed, offer feeds, and encourage family participation.

Treating Hyper Cyanotic Spells

  • Place infant in knees/chest position, provide calm approach, administer oxygen, and potentially give morphine and fluid replacement..

Surgical Interventions

Surgical interventions such as palliative shunts like Blalock-Taussig or complete repair may be necessary.

Care of Child Preoperatively/Postoperatively

  • Preoperative care includes frequent cardiorespiratory assessment, daily weights, and preparing the family; Postoperative care includes monitoring, positioning, oxygenation, nutrition, and fluid status.

Diagnosis and Complications for Tetralogy of Fallot

  • The congenital heart condition might have varied symptoms from healthy to severe; The condition could lead to additional family fears and the loss of normal routines and expectations; Pediatric cardiac inquest.

Recommendations

  • Recommendations on structuring the nursing council; how to report patient concerns related to risks; and potential whistleblower legislation to protect nurses.

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Description

Explore the critical aspects of pediatric care concerning circulatory concerns. This quiz covers the application of family-centered care, holistic assessment, and immediate interventions for children experiencing shock and other circulatory issues. Gain insights into the roles of nurses in managing congenital heart diseases and ethical challenges in pediatric care.

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