LP 10 Cardiovascular & Respiratory Disorders Learning Objectives (OB Exam #3)

Card Set Information

Author:
robertkonkright
ID:
216097
Filename:
LP 10 Cardiovascular & Respiratory Disorders Learning Objectives (OB Exam #3)
Updated:
2013-04-28 16:54:56
Tags:
Pediatric Nursing
Folders:

Description:
LP 10 Learning Objectives for NURS 155 OB Exam #3
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user robertkonkright on FreezingBlue Flashcards. What would you like to do?


  1. Circulation Of the Heart:
    FETAL
    • Blood leaves the placenta
    • ↳Enters the fetus through the umbilical vein.
    • ↳Blood Circulates Through The Fetus
    • ↳Blood Returns To The Placenta Through The Umbilical Arteries

    The 3 fetal heart shunts allow the blood to bypass the fetal liver and the lungs.

    Placenta does not offer resistance to the blood flow (So no pressure change is needed)
  2. 3 Shunts of Fetal Circulation
    • 3 Shunts in Fetal Circulation:
    • DUCTUS ARTERIOSUS: between the pulmonary artery & the Aorta. Its Purpose Is to Shunt the blood beyond the lungs.

    • FORAMEN OVALE:
    • Between the Left and Right Atrium. Its Purpose is to bypass the lungs with the large portions of the blood that comes into the RIGHT ATRIUM.

    • DUCTUS VENOSUS:
    • Joins the umbilical cord with the INFERIOR VENA CAVA. Once the cord is severed After birth, the ductus venous becomes non-functional.
  3. Circulation Of the Heart: INFANT Vs. NEONATAL
  4. Sequence Pathophysiology Of: SHUNT CLOSURES
    • Infant Takes First Breath Of Life
    • ↳Expansion of the aveoli and decrease in Pulmonary Vascular Resistance
    • ↳Increase Blood Flow To The Lungs
    • ↳Increased Blood Volume to The LEFT ATRIUM and an INCREASING PERIPHERAL VASCULAR RESISTANCE in the body (Due to severance of the cord)
    • ↳Increase distention & Pressure Of the LEFT ATRIUM
    • ↳Closure of the FORAMEN OVALE between the Two Atria

    A left to Right shunt through the DUCTUS ARTERIOUSUS may persist for 10-20 hours to several days. The oxygen Tension (PaO2) in the newborns arterial blood from increased Pulmonary blood flow & Oxygenation in the lungs initiates constriction of the DUCTUS ARTERIOSUS
  5. Diagnostic Procedures For: CONGENITAL HEART DISEASE
    • ECHOCARDIOGRAMS & ULTRASOUND will show some of the blood flow to the heart so a Doctor will most likely order these tests before electing for Open Heart Surgery.
    • CARDIAC CATH: To determine what the pressures are in the chambers, what the chambers look like, what the defects look like. This is essentially a Pre-Test for Open Heart Surgery.
  6. Open Heart Surgery: Infant Vs. Adult
    ADULTS: Blood Flow bypasses the heart and Lungs through a Cardiopulmonary Machine.

    • INFANTS: Heart is too small to use bypasses & Surgery at the same time. 
    • ♥Child placed on Cardiopulmonary machine prior to surgery and given Heparin so that their blood will not clot. Removed from the machine prior to surgery.
    • ♥Body is cooled down to 17 degrees C (The low Temp will require less oxygen for the brain. Low temp can be sustained for up to 1 hour without brain damage.
    • ♥The child will be clinically dead during the procedure, assure that the parents understand.
    • ♥Upon completion the child goes back on the machine, temperature is raised, and they will be administered a shock to go back into a sinus rhythm.
    • ♥Vitamin K is administered to reverse effects of Heparin
  7. Congenital Heart Defects
    • Determined by a comparison of BP between upper and lower extremities.
    • ♥Blood Pressure between upper and lower extremities should be within 10mmHg
    • ♥A difference greater that 20mmHg is likely caused by some sort of obstructed outflow of blood from the heart.
    • ♥Cardiac Catheter may be ordered as a further testing
  8. Impact of CONGENITAL HEART DEFECTS On The Infant & Family
  9. Heart Defect Classifications
    • Cyanotic Heart Defects: (↓Blood Flow)
    • ♥Pulmonary Stenosis (PS)
    • ♥Tetralogy Of Fallot (TOF)
    • (M)♥Transposition Of The Great Arteries
    • (M)♥Atrial Stenosis
    • (M)♥Coarctication Of The Aorta

    • Acyanotic Heart Defects:(↑Blood Flow)
    • ♥Patent Ductus Arteriosus (PDA)
    • ♥Atrial Septal Defect (ASD)
    • ♥Ventricular Septal Defect (VSD)

    • Mixed Blood Defects:
    • ♥Transposition Of The Great Arteries (TGA)
    • ♥Atrial Stenosis (AS)
    • ♥Coarctication Of The Aorta (COA)
  10. CYANOTIC Heart Defects
    • ♥PS, TOF
    • ♥RIGHT TO LEFT SHUNT
    • ♥Cyanosis Will Occur
  11. ACYANOTIC Heart Defects
    • ♥PDA, ASD, VSD
    • ♥LEFT TO RIGHT SHUNT
    • ♥No Cyanosis
    • ♥The pressures are greater in the Aorta then they are in the pulmonary Artery
    • Clinical Manifestations:
    • ♥Pulmonary Edema (Crackles In Lungs)
    • ♥INCREASE In BP (Lungs & Body)
    • ♥Dysrhythmias
    • Treatments:
    • ♥Indomethacin
    • ♥Invasive Surgery(Plug Insertion)
    • ♥Laproscopy (Ligate the shunt closed)
  12. Care Plan: TETRALOGY OF FALLOT (TOF)
    • Description:

    • Signs & Symptoms:

    • Diagnostic Tests:

    • Treatment:

    • Patient Teaching:
  13. Care Plan: PATENT DUCTUS ARTERIOSUS (PDA)
    • Description:
  14. Care Plan: AORTIC STENOSIS (AS)
  15. Care Plan: TRANSPOSITION OF THE GREAT ARTERIES (TGA)
  16. Care Plan: ARTERIAL SEPTAL DEFECT (ASD)
  17. Care Plan: VENTRICULAR SEPTAL DEFECT (VSD)
  18. Care Plan: COARCTICATION OF THE AORTA (COA)
  19. Care Plan: PULMONARY STENOSIS (PS)
  20. Assessment & Management of: CYANOTIC HEART DEFECTS
    • Assessment:
    • ♥Cyanosis
    • ♥↑ BP
    • ♥Pulmonary Edema (Crackles In Lungs)
    • ♥Dysrrhythmias

    • Treatments:
    • ♥Indomethacin
    • ♥Invasive Surgery(Plug Insertion)
    • ♥Laproscopy (Ligate the shunt closed)

    ♥May Lead To CHF♥
  21. Care Plan: RHEUMATIC FEVER
    • Caused by a recent STREP Infection
    • Signs & Symptoms:
    • ☤A Sore Throat with Strep persists passed the occasional temporary sore throat associated with a common cold(Cold Liquids don't make it go away either)
    • ☤Low Grade Fever (↓102oF)
    • ☤Have a Specific Odor of their Breath
    • ☤Salty Tasting Kiss
    • ☤Child may talk like they have hot food in their mouth (Tongue movement causes pain)
    • Diagnostic Test:
    • ☤ASO TITER= Positive Result means there has been a recent Strep Infection
    • Treatment:
    • PENICILLIN-Drug Of Choice
    • ERYTHROMYCIN- Drug Of Choice if Allergic to Penicillin
    • Prophylactic Antibiotic Therapy until 18 y/o (Some doctors shorten antibiotic therapy to 5 years due to Antibiotic Resistant Infections)
    • Patient Teaching:
    • ALWAYS Treat Patient for Strep Throat!
    • ☤If left untreated, the infection can spread to the Heart and or Kidneys
    • ☤Notify provider prior to any invasive procedure due to increased risk of infection
  22. Care Plan: KAWASAKI DISEASE
    ☤High Dose APIRIN If Temp Over 102oF (Aspirin is ok to use due to the infection being bacterial, wont cause Reyes Syndrome)
    • Description:

    • Signs & Symptoms:

    • Diagnostic Tests:

    • Treatment:

    • Patient Teaching:
  23. Adult Vs. Child: RESPIRATORY SYSTEM
    • Size of the Airway (Primary Difference)
    • Easier to compromise child's Airway due to small size
    • Less Alveoli Than An Adult
    • Airway Closes Quicker
    • Children Are Obligatory Nose Breathers
  24. Respiratory Syncytial Virus (RSV)
    • Can Cause Bronchitis
    • Produces a lot of Secretions
    • Most Children Under 2 require Hospitalization due to the Respiratory Distress
    • Small Children are Obligatory Nose Breathers, so when airway is filled with secretions, their O2 Saturation drops
    • Nursing Interventions:
    • Normal Saline Rinse (NettiPot)
    • Suctioning
    • Supplemental Oxygen
    • Be Prepared for Emergency Intubation due to rapid airway closure for children
  25. Signs & Symptoms of ACUTE RESPIRATORY DISTRESS:
    • Cyanosis/Pallor
    • Increased Respiratory Rate (Or Obstruction)
    • Retractions (The More Areas of Retractions, the more severe the distress)
    • Grunting, Adventitious Lung Sounds
    • Nasal Flaring, Coughing
    • Loss Of Appetite
    • Changes in LOC
    • Positioning/Posturing (Tripod Position Indian Style, Neck Extended. Making an attempt to open Thoracic Airway)

    • Nursing Implications:
    • Children crash quickly, but can also come back quickly
    • Respiratory Distress usually comes before Cardiac Arrest in Children, so maintaining Oxygen Status can decrease change of Cardiac Arrest
    • Respiration & Heart Rates are often directly Correlated. If RR/HR goes from 40/100 to 20/80, the child is likely going into respiratory failure.
    • Respiratory Failure will lead to Cardiac Arrest and death.
    • Children often present with a lot of noise of the nose and throat.
    • If no adventitious lung sounds are heard upon auscultation of the lungs but are heard in nose and throat, chart that the lung sounds were clear but nose and throat(Neck) were not.
  26. Types Of Cough/Drainage
    • A productive cough is usually a sign that mucous is breaking up in the lungs either by an antibiotic, expectorant, or your own WBC defense. Colored drainage may be an indication of getting ahead of the cold due to infection sticking to mucous like flypaper.
    • Barking Cough:
    • Endotracheal Bronchitis
    • Croup Syndrome (E&LTB)
    • Dry Cough (Non-Productive):
    • Most Pneumonia Starts out with a dry cough
    • Asthma
    • Respiratory Irritants
    • Croup (Barking)
    • Wet Cough (Productive):
    • Smokers Cough
    • Cystic Fibrosis
    • Later Pnuemonia
    • Drainage/Mucous Colors:
    • White/Clear: Normal Color, Allergies, Hay Fever, Congestion
    • Yellow: Upper Respiratory Viral Infections
    • Dark Yellow: Lower Respiratory Infections
    • Green: Bacterial Infections, Allergies, Dead WBCs
    • Brown/Red: Asthma, Bronchitis, Smokers, Airway Polutants, TB, Lung Cancer, Trauma
  27. ADVENTITIOUS LUNG SOUNDS
    • Rails/Rhonchi: Pleural Rub, fluid build up, usually better after cough
    • Crackles (Early): Bronchitis, Emphasema, Asthma
    • Crackles (Late): Pulmonary Fibrosis, Pneumonia, Pulmonary Edema, L♥ Failure
    • Stridor: Croup, Obstruction
    • Wheezing: Asthma, COPD, Allergies

    • Lower Lobes: O2 Exchange Affected, Pneumonia 
    • Upper Airway: Obstructions, Inflamation
  28. Compare/Contrast Of LTB & EPIGLOTTITIS:
    • Similar:
    • Same Initial Clinical Manifestations
    • Acute Respiratory Distress
    • Stridor Scoring Scale Used
    • Barking Cough
    • Fever
    • X-Ray of Lateral Neck (Narrowing for LTB, Bulging for EPI)

    • Differences (Epiglottitis Only):
    • Fever Greater Than 102oF
    • The 4 D's
    • May Sit in Tripod Position
    • NOTHING IN OR NEAR THEIR MOUTH!
    • Emergency Intubation may be needed
    • May Require Tracheotomy
    • Requires Clear Communication throughout healthcare team if EPIGLOTTITIS is suspected
    • Don't Move their Jaw!
    • Throat Culture Can only be preformed after Intubation is complete
    • X-Ray of lateral Neck will show shadowy spot near the top of the trachea (Bulging).
    • Not Seen as often anymore (Hurd Effect) due to Haemophilus Influenza (Hib) Immunizations
  29. Signs & Symptoms of ACUTE RESPIRATORY DISTRESS: LARYNGOTRACHEOBRONCHITIS (LTB)
  30. Signs & Symptoms of ACUTE RESPIRATORY DISTRESS: EPIGLOTTITIS
  31. Diagnostic Tests For Acute Respiratory Distress: CROUP SYNDROME (LTB & EPIGLOTTITIS)
  32. Therapeutic Techniques For: RESPIRATORY ILLNESSES
    • Cruepet AKA Oxygen Tent (Oxygen Concentration increases 2-3% for each liter of Supplemental Oxygen in tent Example: 3 liters of Oxygen increases Oxygen Concentration to 27-30% from room air)
    • Humidified Air (To Loosen Mucus)
    • Cough & Deep Breathing
    • Percussion & Postural Drainage
    • Suctioning
    • Supplemental Oxygen (Doctor may write an order to keep O2 at 95-100%, Room Air is 21% Oxygen)
    • Cold Air Therapy (For Croup & Other Inflammatory Disorders)
    • Avoid the use of cotton sheets or Pillow Cases (Cotton Bedding becomes wet and can lead to hypothermia)
    • Change Bath Blanket Every Hour (As it becomes saturated)
    • Encourage Parental Presence to reduce patient anxiety
    • Anxiety will cause the child to need more Oxygen because O2 consumption increases with Anxiety
    • Breathing Treatments:
    • Bronchodialators (Opens Airway)
    • Mucolytics (Breaks Up Mucus)
    • Steroids (Reduce Swelling)
    • Percussion (Moves secretions up and out of the lungs.
    • Other Respiratory Meds
  33. Care Plan: UPPER RESPIRATORY INFECTIONS
    • Signs & Symptoms:
    • Adventitious Lung Sounds Heard At the START of INSPIRATION & END of EXPIRATION (First in, Last Out)
  34. Care Plan: LOWER RESPIRATORY INFECTIONS
    • Signs & Symptoms:
    • Adventitious Lung Sounds Heard At the END of INSPIRATION & START of EXPIRATION (Lower Lobes, Aveoli)
    • Cyanosis
    • Low Oxygen Saturation
  35. Common Medications For: CARDIOVASCULAR DISORDERS
    (Actions, Side Effects, & Nursing Implications)
  36. Common Medications For: RESPIRATORY DISORDERS
    (Actions, Side Effects, & Nursing Implications)
    • Bronchodialators (Opens Airway) 1st, wait 5 minutes between meds
    • Racemic Epinephrine (Opens Airway)
    • Mucolytics (Breaks Up Mucus) 2nd
    • Steroids (Reduce Swelling) 3rd, Stress Importance of rinsing mouth and maintaining good Oral Hygeine
    • Duretics Such As LASIX- Removes Excess Fluid from the Lungs
    • Antibiotics- To Prevent Further Infections
    • Antivirals
    • Ribavirin- Specifically for RSV treatment reserved for severe respiratory compromise, sometimes coupled with Congenital Heart Disease or Immunocompromised. It is Expensive, with marginal benifits. NO CAREGIVERS WITHIN CHILD BEARING AGE.
    • Pancreatic Enzymes- Helps digest & Absorb Nutrients. The more fat in the diet, the more enzymes they will need. Fat soluble Vitamins are given in water soluble form
  37. Care Plan: CYSTIC FIBROSIS
    (Several Exam Questions)
    • Definition: Thick Sticky Mucous within the lungs blocks ducts
    • Signs & Symptoms:
    • Clubbing Of Fingers/Thumbs(Lack Of O2)
    • Salty Kiss
    • Poop That Floats (Poor Fat Breakdown)
    • Diagnostic Test: Sweat Test
    • Treatment:
    • Requires Lots Of Medications
    • Percussion & Postural Drainage (Up to an Hour Each Session, 4 Times a Day)
    • Pulmonary Cleansing (Once a Year)
    • Client Teaching:
    • Exocrine Disorder
    • Autosomal Recessive

    • May Lead To:
    • Excessive Fluid In The Lungs/Other Resp Problems
    • Clubbing Of Fingers/Thumbs(Lack Of O2)
    • Gastrointestinal Disorders
    • Diabetes
    • FFT: Fetal Failure To Thrive
  38. The 4 D's Of EPIGLOTTITIS
    • D-Dysphasia (Difficulty Swallowing)
    • D-Drooling (Due To Difficulty Swallowing)
    • D-Dysphonia (Difficulty Speaking due to swollen vocal cords)
    • D-Dyspnea (Difficulty Breathing)
  39. Fever: LOW Vs. HIGH FEVER
    • Low Grade Fever: 102oF or Less
    • High Fever: Over 102oF
  40. BRONCHOPULMONARY DYSPLASIA
    • A newborn presenting with Signs & Symptoms of COPD
    • Premature Babies are at Higher Risk
  41. ASTHMA (Peak Flow Meter 1345)
    • Children at Higher Risk Due to Smaller Airway
    • PEAK FLOW METER: A device to measure Oxygen need. Color indicated whether the child should use their inhaler before sporting events.
    • Red- Great Ihalor Need
    • Yellow- Moderate Inhalor Need
    • Green- Low Inhalor Need
  42. ENDOCRINE Vs. EXOCRINE Disorders
    • ENDOCRINE: 
    • EXOCRINE: (Example: Cystic Fibrosis)

What would you like to do?

Home > Flashcards > Print Preview