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Questions and Answers
What is the most common type of birth defect?
What is the most common type of birth defect?
Which of the following is NOT a sign of suspected cardiac pathology?
Which of the following is NOT a sign of suspected cardiac pathology?
What percentage of infants with congenital heart disease show signs or symptoms within the first year of life?
What percentage of infants with congenital heart disease show signs or symptoms within the first year of life?
Which type of congenital heart defect leads to an increase in pulmonary blood flow?
Which type of congenital heart defect leads to an increase in pulmonary blood flow?
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What is a shunt in the context of congenital heart disease?
What is a shunt in the context of congenital heart disease?
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What is the main focus of treatment for secondary hypertension?
What is the main focus of treatment for secondary hypertension?
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Which lipoprotein is primarily responsible for carrying cholesterol to the liver for excretion?
Which lipoprotein is primarily responsible for carrying cholesterol to the liver for excretion?
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What is a common manifestation of Kawasaki Disease?
What is a common manifestation of Kawasaki Disease?
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Why should parents postpone active routine immunizations after their child receives immune globulin?
Why should parents postpone active routine immunizations after their child receives immune globulin?
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Which of the following is a characteristic feature of Kawasaki Disease?
Which of the following is a characteristic feature of Kawasaki Disease?
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What is a characteristic feature of congenital heart anomalies that decrease pulmonary blood flow?
What is a characteristic feature of congenital heart anomalies that decrease pulmonary blood flow?
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Which defect is associated with four specific abnormalities, including pulmonary artery stenosis?
Which defect is associated with four specific abnormalities, including pulmonary artery stenosis?
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What is the knee-chest position recommended for during tet spells in children?
What is the knee-chest position recommended for during tet spells in children?
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In hypoplastic left heart syndrome, what is crucial for initial survival of the infant?
In hypoplastic left heart syndrome, what is crucial for initial survival of the infant?
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What is a common manifestation of congestive heart failure in children?
What is a common manifestation of congestive heart failure in children?
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Which age range has a peak incidence of rheumatic fever?
Which age range has a peak incidence of rheumatic fever?
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What is the treatment approach for persistent systemic hypertension in children?
What is the treatment approach for persistent systemic hypertension in children?
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Which major criteria must be present for a positive diagnosis of rheumatic fever?
Which major criteria must be present for a positive diagnosis of rheumatic fever?
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What specific condition is characterized by destruction of connective tissue, scarring the mitral valve?
What specific condition is characterized by destruction of connective tissue, scarring the mitral valve?
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Which nursing care practice is recommended for a patient with congestive heart failure?
Which nursing care practice is recommended for a patient with congestive heart failure?
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What is often a goal in the treatment of a child with congestive heart failure?
What is often a goal in the treatment of a child with congestive heart failure?
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Which physiological change occurs due to coarctation of the aorta?
Which physiological change occurs due to coarctation of the aorta?
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What is advised when caring for children with congenital heart disease, particularly regarding sports?
What is advised when caring for children with congenital heart disease, particularly regarding sports?
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In which condition is a significant narrowing or constriction of blood vessels common?
In which condition is a significant narrowing or constriction of blood vessels common?
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Study Notes
Signs of Suspected Cardiac Pathology
- Failure to thrive/poor weight gain: A possible indicator of cardiac issues.
- Cyanosis/pallor: Bluish discoloration or paleness of the skin, potentially signifying oxygenation problems.
- Neck vein pulsations: Visible pulsations in the neck veins may signal heart problems.
- Tachypnea/dyspnea: Rapid breathing and shortness of breath, respectively, are common cardiac symptoms.
- Irregular pulse rate: An inconsistent heartbeat may be a sign of cardiac dysfunction.
- Finger clubbing: Enlarged fingertips, sometimes indicative of heart conditions.
- Fatigue during feeding/activity: Exhaustion during feeding or physical exertion can point to cardiac difficulties.
- Excessive perspiration, especially on forehead: Excessive sweating, especially on the forehead, can be linked to some heart issues.
Congenital Heart Disease (CHD)
- Frequency: CHD is a prevalent birth defect, occurring in approximately 8 out of every 1000 births.
- Symptoms onset: Fifty percent of infants with CHD exhibit signs/symptoms within their first year of life.
- Causes: CHD can result from genetic, maternal, or environmental factors.
- Fetal stage: CHD is not typically detected during the fetal stage due to fetal-maternal circulation.
- Infancy impact: CHD is a leading cause of death in infants during the first year of life.
- Diagnosis: CHD diagnosis involves a range of studies from noninvasive (ECG) to invasive (angiograms).
- Treatment: Most CHD defects require surgical intervention after diagnosis.
- Classification: CHD is categorized into cyanotic and acyanotic types.
- Physiologic categorization: CHD defects can increase, obstruct, or decrease pulmonary blood flow.
- Shunts: Shunts are abnormal passages of blood between heart vessels.
CHD: Defects Increasing Pulmonary Blood Flow
- Blood flow: Oxygenated blood returns to the right ventricle and recirculates through the lungs, before entering the aorta.
- Examples: Atrial septal defect, ventricular septal defect, and patent ductus arteriosus are examples of defects increasing pulmonary flow.
- Cyanosis: Cyanosis (bluish discoloration) isn't usually seen with these defects.
CHD: Restrictive Defects
- Physiology: These defects typically involve stenosis (narrowing) of a blood vessel, leading to increased pressure proximal (near) to the constriction and decreased pressure distal to it.
- Example: Coarctation of the aorta, a narrowing of the aorta, is an example.
CHD: Defects Decreasing Pulmonary Blood Flow
- Blood flow: Unoxygenated blood bypasses the lungs and enters the aorta, leading to reduced oxygenation of the blood in circulation.
- Characteristic sign: Cyanosis is a hallmark symptom.
- Example: Tetralogy of Fallot is a complex CHD involving four defects. Its defining feature is the narrowing of the pulmonary artery, which reduces blood flow to the lungs.
Paroxysmal Hypercyanotic Episodes (Tet Spells)
- Occurrence: These episodes typically happen during the first two years of life.
- Symptoms: Signs include spontaneous cyanosis, respiratory distress, lethargy, weakness, and potentially syncope.
- Duration: Spells can last for several hours.
- Positioning: Place the child in a knee-chest position during a tet spell.
Defects Causing Mixed Pathology (Hypoplastic Left Heart Syndrome)
- Description: Underdevelopment of the left side of the heart, often resulting in a nonfunctional or absent left ventricle.
- Diagnosis: Can often be diagnosed prenatally.
- Prognosis: Early placement on a heart transplant list is often necessary.
- Initial survival factors: A patent foramen ovale and ductus arteriosus are crucial for initial survival pathways.
- Symptoms: Manifestations include a grayish-blue coloration and signs of CHF (congestive heart failure), dyspnea, weak pulses, and cardiac murmurs
General Treatment/Nursing Care of CHD
- Treatments: Assorted medical and surgical treatments are available.
- Post-procedure nursing care: Post-operative care involves monitoring vital signs, checking for blood clots, examining limbs for circulation, and providing emotional support to the child and family.
- Parent guidance: Counsel parents to avoid competitive sports so the child can stop activity when symptoms arise; include nutritional guidance, avoiding high altitudes or extreme cold.
Acquired Heart Disease
- Definition: Occurring after birth, acquired heart disease may complicate congenital heart conditions or stem from respiratory infections, sepsis, hypertension, or severe anemia.
- Heart Failure (CHF): A decrease in cardiac output unable to meet metabolic demands of the body.
- Right-side CHF: Backup of blood in the systemic venous system.
- Left-side CHF: Backup of blood into the lungs.
CHF Treatment Goals
- Reduction of heart workload: A primary treatment goal.
- Improvement in respiration: Addressing respiratory problems is crucial.
- Maintenance of proper nutrition: Ensuring adequate nutrition.
- Prevention of infection: Maintaining a healthy immune system.
- Anxiety reduction: Managing the child's anxiety.
- Parental support and education: Supporting parents through the process.
CHF Nursing Care
- Minimizing disturbance: Organize care to minimize disruptions.
- Feeding schedule: Provide frequent, small feedings. Adjust feedings based on the child's condition (early if crying, delayed if sleeping).
- Oxygen: Administer oxygen as needed to alleviate shortness of breath.
- Medication: Administer medications correctly and safely, checking dosages.
- I&O: Keep accurate records of fluid intake and output.
Rheumatic Fever (RF)
- Description: A systemic disease affecting joints, heart, CNS, skin, and subcutaneous tissues; part of the collagen disease family.
- Mechanism: Connective tissue destruction is a characteristic.
- Impact on the Heart: Scarring of the mitral valve is common.
- Age prevalence: Most common in 5-15 year olds.
- Seasonal occurrence: More prevalent during winter/spring.
- Cause: An autoimmune disease resulting from untreated group A streptococcal infection.
- Diagnosis (Modified Jones Criteria): Requires at least one major criterion AND two minor criteria plus a history of strep infection. Major criteria include carditis, polyarthritis, erythema marginatum, and chorea; Minor criteria include fever, arthralgia, past history of RF, ESR, leukocytosis, ECG changes, CRP.
RF Nursing Care
- **Minimizing disruptions:**Organize care to prevent fatigue.
- Hygiene: Providing good skin and back care, oral hygiene and small, frequent feedings are important.
- Dental procedures: Prophylactic antimicrobial treatment before dental procedures is necessary..
Systemic Hypertension (HTN)
- Prevalence: HTN is often observed in children and teens.
- Diagnosis: Considered significant when readings consistently meet or exceed the 95th percentile for age and sex.
- Types: Essential/primary HTN has no identified cause; secondary HTN results from another condition.
- Potential causes (secondary): Renal, congenital, vascular, or endocrine disorders.
HTN Treatment and Nursing Care
- Lifestyle modifications: Nutritional counseling, weight management, and age-appropriate aerobic exercise are essential.
- Adolescent counseling: Discuss the effects of drugs, alcohol, smoking on blood pressure.
- Secondary HTN focus: Treatment focuses on addressing the underlying cause of the elevated blood pressure.
Hyperlipidemia
- Definition: Excessive lipids (fats and fatlike substances) in the blood.
-
Lipoproteins: Lipids and proteins combine to form lipoproteins.
- LDL: Low-density lipoproteins have low triglycerides, high cholesterol, and protein. They carry cholesterol to cells for metabolism and hormone production.
- HDL: High-density lipoproteins have low triglycerides, little cholesterol, and high protein. They transport cholesterol to the liver for removal.
Kawasaki Disease (KD)
- Symptoms: Abrupt onset with high fever (104°F/40°C) that lasts over 5 days. Fever isn't responsive to usual fever reducers or antimicrobials; additional symptoms include conjunctivitis without discharge, fissured lips, strawberry tongue; inflamed mouth and throat, and swollen lymph nodes.
- Treatment: Symptomatic and supportive care; long-term low-dose aspirin therapy may be needed. Delay of routine vaccinations for a few months after immune globulin treatment.
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Description
This quiz explores the key signs and symptoms associated with congenital heart disease (CHD). Understanding these indicators, such as cyanosis, irregular pulse rate, and fatigue, can help in early diagnosis and management of cardiac issues in infants. Test your knowledge on the clinical presentations linked to CHD.
