peds exam 2: cardiovascular part 1

which 2 valves are known as the atrioventricular valves (and locations)

tricuspid (right) and bicuspid/mitral (left)

which 2 valves are known as the semilunar valves (and locations)

pulmonic (between RV and pulmonary artery)

aortic (between LV and aorta)

what is the sinoatrial (SA) node

pacemaker of the heart; initiate electrical impulses

what is the electrical condition pathway of the heart

SA node -> AV node -> Bundle of His -> right and left bundle branches -> Perkinje fibers

what is the p-wave

atrial depolarization

what is the P-R interval

time from beginning of atrial depolarization to beginning of ventricular depolarization

what is the QRS complex

ventricular depolarization

what is the T wave

ventricular repolarization

what is the ST segment

period between ventricular depolarization and repolarization

where is the point of maximal impulse:

-up to age 7

-over age 7

up to age 7: 4th intercostal space medial to MCL

over age 7: 5th intercostal space left MCL

what is cardiac output

volume of blood ejected from the left ventricle each minute

cardiac output depends on what until age 5

depends on heart rate until heart muscle is fully developed at age 5

what is S1

first heart sound

-closure of the tricuspid and mitral valves

what is S2

second heart sound

-closure of the aortic and pulmonic valves

neonate heart rate

-awake

-sleeping

awake: 100-205

sleeping: 90-160

infant heart rate

-awake

-sleeping

awake: 100-180

sleeping: 90-160

toddler heart rate

-awake

-sleeping

awake: 98-140

sleeping: 80-120

preschooler heart rate

-awake

-sleeping

awake: 80-120

sleeping: 65-100

school age heart rate

-awake

-sleeping

awake: 75-118

sleeping: 58-90

adolescent heart rate

-awake

-sleeping

awake: 60-100

sleeping: 50-90

what is the calculation for the 5th percentile systolic BP in a 1-10 year old

70 + (age in years x 2)

example: 3 year old would be 76

what is a heart murmur

turbulent blood flow; blood forced through a narrow passageway

what are the muscle fibers in the interventricular septum called

bundle of his

a cardiovascular peripheral assessment would include what

color, temperature, capillary refill, pulses and edema

how does fetal circulation happen (oxygenation takes place where)

the lungs are nonfunctional so the oxygenation takes place at the placenta

what is the ductus arteriosus

vascular channel between the pulmonary artery and the descending aorta

what is the foramen ovale

opening in atrial septum

when does the foramen ovale close and why

increased pressure in the left atrium stimulates the closure shortly after birth

when does the ductus ateriosus close and when is it permanently closed

-closes within 10-15 hours after birth

-permanently closed in 10-21 days after birth

what are some possible causes of fetal congenital heart defects

-fetal exposure to drugs/alcohol

-maternal viral infections

-genetics

-increased maternal age

-chromosomal abnormalities

-maternal metabolic disorders

what is cardiac catheterization

catheter inserted through a peripheral blood vessel into the heart, then contrast media is injected for drs to see a congenital defect

nursing management for post cardiac cath procedure

-if site bleeds, apply pressure 1 inch above site

-bedrest for 4-6 hours with leg straight

-assess peripheral perfusion

-assess I&O (contrast media clearance)

-pain medication (acetaminophen)

what constitutes congestive heart failure

cardiac output is inadequate to support the body's circulatory and metabolic needs

CHF clinical manifestations: infants

*develop subtly*

-tires easily

-weight loss

-diaphoresis, especially w/ feeds

-frequent respiratory infections

CHF clinical manifestations: toddlers and older children

-exercise intolerance

-dyspnea

-abd pain or distention

-peripheral edema

pulmonary venous congestion is what sided heart failure

left-sided heart failure

clinical manifestations of pulmonary venous congestion (left-sided heart failure)

-tachypnea/tachycardia

-wheezing/crackles

-retractions + nasal flaring

-cyanosis

-frequent respiratory infections

systemic venous congestion is what sided heart failure

right-sided heart failure

clinical manifestations of systemic venous congestion (right sided heart failure)

-hepatomegaly + ascites

-edema (periorbital + peripheral)

-weight gain + fluid retention

-neck vein distention

clinical manifestations of impaired CO (cardiac output)

-weak, thready pulses

-hypotension

-longer cap refill time

-cool extremities + pallor

-enlarged heart w/ S3

what 3 tests diagnose CHF and what do they show

CXR: cardiac enlargement and venous congestion

Echocardiogram: cardiac defects or dysfunction

electrocardiogram: identifies arrhythmias

what is the goal of CHF treatment

treat the cause and make the heart work more efficiently and remove excess fluid

what drugs might we give a CHF patient as treatment

diuretics, ACE I's, beta blockers, digoxin

what is the drug of choice in infants and children for CHF

digoxin

what is the action of digoxin

slows HR, increases CO and contractility

what is a digitalizing dose for digoxin

-what is the purpose

loading dose followed by maintenance dose

-accelerates response to the drug to achieve therapeutic blood levels more quickly

what must be done before administering digoxin in children

-hold when

check apical HR for a *full minute* prior to dose

-hold for HR

s/sx of digoxin toxicity

nausea, vomiting, bradycardia, arrythmia

what meds increase the risk of digoxin toxicity

low potassium and antibiotics

fetal circulation includes which of the following

A. ductus arteriosus

B. foramen ovale

C. pulmonary artery

D. pulmonary vein

A. ductus arteriosus

B. foramen ovale

diagnosis for congenital heart disease would include which tests?

EKG, CXR, echo, cardiac cath

true or false. cardiac catheterization puts the child at risk for arrhythmias

true

early clinical manifestations of CHF would include which of the following?

A. increased weight gain

B. eager eater

C. emesis

D. poor weight gain

E. bottle feeding taking >30 minutes

D. poor weight gain

E. bottle feeding taking >30 minutes