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CCC Nurs 235 - Pediatric & Maternity NursingFinal Study Guide

CCC Nurs 235 - Pediatric & Maternity NursingFinal Study Guide

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Published by Heidi Heffelfinger
Information for the final of Nurs 235 at Contra Costa College
Information for the final of Nurs 235 at Contra Costa College

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Published by: Heidi Heffelfinger on May 23, 2011
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02/11/2013

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EXAM6NOTES
Child withCardiovascular Dysfunction
-Kawasaki Disease= acute systemic vasculitis of unknown cause(widespread inflammation)Untx'ed= 20-25% develop cardiac sequelae (damage to coronary blood vessels and heartmuscle, scarring, cardiac calcification).S/S=↑ ESR & C-reactive protein (shows inflammation), Fever (unresponsive to antibx, at least5 days), red & dry conjunctivae, inflamed oral mucosa (dry cracked lips, strawberrytongue), Edema (hands & feet, erythematous)Cardiac= coronary aneurysm (leading to MI), inflammation, ECG changes, ↓LV fxn, mitralregurgitation TX= ↑dose IVIG w salicylate therapy, ASA-Cardiac Catheritization= catheter inserted into peripheral blood vessel (angiography= w contrast) Two kinds:R sides venous= into RAL sided arterial= into aorta & LV Yields info on:O2 sat in chambers of heart, pressure changesCO or SV (amt of blood pumped out LV to aorta w each contractionAnatomic abnormalities (obstruction)RN Care:Mark/check pedal pulses, Temp, v/s (q15), dressing (bleeding), fluids for hydrationContraindication= diaper rashBleeding @ site= direct continuous pressure 2.5 cm above vessel puncture ←BLACK BOX WARNING
-Fetal Circulation
BF (blood flow)= Oxygenated blood in thru placenta→ umbilical vein→ liver (some to portal/hepaticcirculation)→ inferior vena cava→ RA→ Foramen Oval (or pulm art out duct art)→ LA→LV→ aorta.-Small amount goes to lungs (some of that blood diverted by ductus arteriosis)-Post natal= clamping of cord ↑ systemic circulation, ↑ pressure closes foramen ovale. Duct art closesabout 4th day (fibrin deposits.... murmur heard until it closes)
-Cardiac Pressures
 
-RA= 70±5%, 3-7 mmhg. Not oxygenated, low pressure-RV= 70±5%, 25/0 mmhg. Not oxygenated (no change from RA), ↑ in pressure since RV is a pump-PA= 70±5%, 25/10 mmhg. Still not oxygenated, no big pressure change.-LA= 97±3%, 5-10 mmhg. Oxygenated (blood has been to lungs), pressure ↑er than R side of heartbut lower than ventricle pressure-LV= 97±3%, (O2 same, oxygenated) pressure 4x greater than RV50-60 Preterm baby65-80 Full term baby100/10 Normal child-Ao= 97±3%, 100/70. O2 same, pressure still high (sent out to perfuse body)
-Shunts/defects
Shunt= blood flow takes abnormal pathway (∆ in pressure in heart, blood takes path of leastresistance)
Cyanotic
= (More Severe) Unoxygenated blood (hasn't been to lungs) gets out into systemcirculation.
↓pulm flow
 Acyanotic
= oxygenated blood not getting out of heart/pulm into systemic circulation.
↑ pulmflow
(= enlargement)
-Ventricular Septal Defect (VSD
)
 Acyanotic
 
-BF= RA→RV→pulm art→lungs→pulm vein→LA→LVAbnormal opening in septum btwn LV & RV. ↑er pressure in LV so blood flows path of leastresistance into RV (instead of out aorta into systemic circulation). Size of hole varies (50%of small ones close of own)Causes ↑ pressure in pulm art (due to excess blood vol.) and RV( poss hypertrophy) and ↑O2sat in RV TX=Small hole left to close on own.Large hole= Suture or patch (will collect firbrin/clots an eventually close)Huge hole= PAB (Pulm Artery banding). ↓ amt of blood able to exit through pulm art(since extra blood is being shunted there)Goal of tx is to ↓ amt of blood going to pulmart.Surgery 3-4 yrs.S/s= recurrent resp infections (warning sign!!!) fatigue, dyspnea, murmur, HF later in life if unDX
-Atrial Septum Defect (ASD)
 Acyanotic
-BF= RA→RV→pulm art→ lungs→ pulm vein→ LAAbnormal opening btwn LA & RV. ↑er pressure in LA so oxygenated blood follows path of leastresistance into RA.Causes= ↑ pressure in R side of heart (due to excess blood volume) and ↑ O2 sat in RA (70)due to mixing of blood.S/S= growth retardation/small for age, fatigue, dyspnea, murmur, HF (later in life if unDX) Tx=requires surgery for larger holes/ severe s/s ( holes will not close on own). Survival wsurgery (2-4 yrs) @99%
-Patent Ductus Arteriosis (PDA)
 Acyanotic

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