Pediatric Nursing: Chapter 23 - Congenital Heart Defects, Cardiac Conditions, and Shock

Vocabulary review flashcards covering congenital heart disease classifications, pathophysiology, medications, post-procedural nursing care, rheumatic fever, and pediatric shock from Miami University Nursing Pediatric Cardiac lecture notes.

Congenital Heart Defect (CHD)

The #1 birth defect, affecting $1\text{ in }100$ newborns and serving as the #1 cause of birth defect-related deaths, for which there is currently no cure.

Ventricular Septal Defect (VSD) - Prevalence

The most common congenital heart anomaly, occurring in $1\text{ in }240$ babies born in the United States.

Fetal Alcohol Syndrome (FAS) - Cardiac Association

A condition resulting from maternal alcohol use where $50\%$ of affected infants develop congenital heart disease.

Maternal Rubella Infection

A maternal infection occurring in the first $7$ weeks of pregnancy that is associated with a $50\%$ risk of cardiac defects, specifically patent ductus arteriosus (PDA) and pulmonary branch stenosis.

Infants of Diabetic Mothers (IDMs) - Cardiac Risk

Infants carrying a $10\%$ risk of congenital heart disease, most commonly ventricular septal defect, cardiomyopathy, and transposition of the great arteries.

Ductus Arteriosus Closure Timeline

The normal physiological closure of the fetal vessel occurring around $2\text{--}3\,\text{days}$ of life, at which point congenital heart defect symptoms most commonly manifest.

Oxygen Administration Precaution in CHD

Oxygen acts as a potent vasodilator that can dramatically increase pulmonary blood flow; therefore, it must be administered with caution in certain congenital heart defects.

Increased Pulmonary Blood Flow Defects

A group of defects (ASD, VSD, PDA) where intracardiac communications along the septum or between great arteries allow oxygenated blood to flow from the high-pressure left side of the heart to the low-pressure right side.

Endocarditis Risk in Acyanotic Shunts

An infection risk increased because higher pressure within the heart chambers damages the inner endothelial lining, making it easier for circulating bacteria to adhere.

Atrial Septal Defect (ASD)

A defect characterized by a hole in the atrial septum or failure of the foramen ovale to close (PFO), resulting in left-to-right shunting and an increased risk of stroke.

Patent Ductus Arteriosus (PDA)

Failure of the fetal connection between the pulmonary artery and the descending aorta to close after birth, leading to increased pulmonary blood flow.

Indomethacin

A prostaglandin inhibitor medication administered to premature infants to pharmacologically stimulate the closure of a patent ductus arteriosus.

Obstructive Heart Defects

Congenital anomalies (e.g., coarctation of the aorta, aortic stenosis) where blood exiting the heart encounters an area of anatomic narrowing (stenosis), obstructing blood flow.

Coarctation of the Aorta

A localized narrowing of a section of the aorta that causes high blood pressure and bounding pulses in the upper extremities, along with absent/diminished femoral pulses and cooler, hypotensive lower extremities.

Alprostadil (Prostaglandin E)

A medication infused to maintain patency of the ductus arteriosus in severe ductal-dependent defects, such as coarctation of the aorta, Tetralogy of Fallot, and transposition of the great arteries.

Aortic Stenosis

A narrowing or tight aortic valve that obstructs left ventricular outflow, resulting in decreased cardiac output, pulmonary congestion, and left ventricular hypertrophy.

SAD Triad

A clinical mnemonic for the hallmark exertional symptoms of aortic stenosis: Syncope, Angina, and Dyspnea.

Decreased Pulmonary Blood Flow Defects

Defects in which right-sided heart pressure exceeds left-sided pressure, allowing desaturated venous blood to shunt right to left directly into the systemic arterial circulation.

Tetralogy of Fallot (TOF) - RAPS Features

A cyanotic heart defect characterized by four anatomic anomalies: Right ventricular hypertrophy, Aortic displacement (overriding aorta), Pulmonary stenosis, and Septal defect (ventricular septal defect).

Hypercyanotic Spell (TET Spell)

An acute, paroxysmal hypoxemic episode occurring in children with Tetralogy of Fallot, typically triggered by exertion, agitation, or feeding, marked by acute cyanosis, shortness of breath, and fatigue.

Knee-Chest Position

A therapeutic, compensatory posture that increases systemic vascular resistance and reduces right-to-left shunting during an acute hypercyanotic 'TET spell'.

Transposition of the Great Arteries (TGA)

A congenital condition where the pulmonary artery leaves the left ventricle and the aorta exits the right ventricle, producing two separate parallel circuits and severe neonatal cyanosis.

Balloon Atrial Septostomy

An interventional cardiac catheterization procedure performed to create or enlarge an atrial septal defect, allowing necessary blood mixing in infants with transposition of the great arteries.

Digoxin (Pediatric Nursing Considerations)

An inotropic agent that enhances myocardial contractility and slows heart rate; must be held if apical heart rate is $< 90\text{--}110\,\text{bpm}$ in infants or $< 70\,\text{bpm}$ in children, and closely monitored because hypokalemia potentiates toxicity.

Furosemide (Lasix)

A diuretic used to eliminate excess fluid volume and reduce cardiac workload, requiring continuous serum potassium ($\text{K}^+$) monitoring due to the risk of hypokalemia.

Captopril

An ACE inhibitor that lowers systemic blood pressure, thereby decreasing left ventricular pressure and minimizing left-to-right shunting in congenital heart defects.

Pediatric Post-Cardiac Catheterization Nursing Care

Essential post-procedure management requiring keeping the affected leg straight, checking pulses distal to the insertion site, taking vital signs every $15\,\text{minutes}$, and never removing the dressing in the event of bleeding or hematoma.

Rheumatic Fever (RF)

A self-limiting inflammatory disease of connective tissues occurring as a delayed complication after group A beta-hemolytic streptococcal (GABHS) pharyngitis, affecting the joints, skin, brain, serous surfaces, and heart.

Rheumatic Heart Disease (RHD)

The most common and significant chronic complication of rheumatic fever, characterized by permanent scarring and damage to the heart valves.

Jones Criteria (Major Manifestations)

Diagnostic criteria for acute rheumatic fever, requiring two major signs (or one major and two minor): Carditis, Polyarthritis, Erythema marginatum, Subcutaneous nodules, and Chorea.

Shock

A complex clinical syndrome characterized by inadequate systemic tissue perfusion to meet cellular metabolic demands, leading to cellular dysfunction and eventual organ failure.

Compensated Shock

The initial stage of shock wherein vital organ perfusion and function are maintained, with blood flow remaining normal or elevated but unevenly distributed.

Decompensated Shock

A progressive stage of shock characterized by diminished cardiac output, tissue hypoxia, worsening metabolic acidosis, and emerging organ dysfunction.

Irreversible Shock

The terminal phase of shock during which damage to vital organs is of such extensive severity that death is imminent regardless of therapeutic interventions.

Hypovolemic Shock

The most common form of pediatric shock, caused by acute blood loss (trauma, hemorrhage), plasma loss (burns), or fluid loss (vomiting, diarrhea), presenting with falling blood pressure, delayed capillary refill, and low central venous pressure (CVP).

Distributive Shock

A category of shock characterized by an abnormal decrease in peripheral vascular resistance, maldistribution of blood flow, and inadequate tissue perfusion, seen in anaphylaxis, sepsis, and ingestions.

Pediatric Fluid Resuscitation Bolus

The emergency administration of a rapid $20\,\text{ml/kg}$ intravenous bolus of normal saline (NS), which can be repeated up to $3\times$ for hypovolemic shock resuscitation.

Anaphylactic Shock

A life-threatening, IgE-mediated systemic reaction occurring in response to allergens (e.g., insect stings, foods, medications), where the primary priority is prompt recognition and immediate administration of epinephrine.