PEDS NAPediatrics Exam 2 Study Guide
PEDS NAPediatrics
Exam 2 Study Guide
Pediatrics Exam 2 Study Guide
CHAPTER 25: The Child with Cardiovascular Dysfunction
❖ Cardiac Assessment in Peds
• How do you perform a cardiac assessment in Pediatrics? – least invasive to most invasive
• Inspection – look at color, work of breathing, LOC, chest movement, activity tolerance (position)
• Auscultation – heart sounds
• Palpation – capillary refill, pulses (radial, pedal), palpate liver (congestion of blood flow through inferior vena
cava causes liver to engorge)
❖ Congenital Heart Disease (CHD)
• What is the incidence of CHD in the Pediatric population?
• Incidence is 5 to 8 per 1000 live births
▪ Approximately 1 in every 115 live births (only 2 to 3 children are symptomatic)
▪ CHD is the major cause of death in the first year of life (after maturity)
▪ In 28% of kids with CHD, another recognized anomaly is also present
• Causes of CHD
▪ What causes CHD?
▪ Chromosomal or genetic disorders linked to higher incidence (Down’s syndrome, Type I Diabetes)
▪ Maternal or environmental cause in 1 to 2% (smoking, drugs, alcohol) (Lupus, Rubella, CMV)
▪ Multifactorial in 85%
❖ Physical Indicators of Cardiac Dysfunction
• Poor feeding, tachypnea, tachycardia, diaphoresis, crackles (pulmonary congestion), hepatomegaly, cyanosis,
murmur, sternal lift, not gaining weight
❖ Two Types of Cardiac Defects
• Congenital – anatomic defects
• Acquired – an illness or an infection, medication, environment, familial tendencies (cardiomyopathy,
spontaneous death before age 40)
❖ Fetal Circulation
,PEDS NAPediatrics Exam 2 Study Guide
❖ Changes at Birth
• Foramen ovale and patent ductus arteriosus close at birth due to increased pressure on the left compared to the
right forcing foramen ovale to close. PDA closes due to presence of increased oxygen.
• Positive pressure through the normal birth expands the lungs and closes the openings
, PEDS NAPediatrics Exam 2 Study Guide
• Children born via caesarean section, 40% have pneumothorax
❖ Old/New Classification of CHD
• Old – Acyanotic and Cyanotic
• Acyanotic – not blue
• Cyanotic – blue
• New – Left-to-Right shunting,
obstruction…, decreased
pulmonary…, mixed blood flow
• Left-to-Right Shunting – stuff
from the left moves to the right
• Obstruction of blood flow from
ventricles
• Stenosis – narrowing, may
sometimes be completely closed
off
• Decreased pulmonary blood
flow – pulmonary arteries and
pulmonary veins
• Mixed blood flow – complex
series of events to repair heart
flow
❖ Increased Pulmonary Blood Flow Defects
• Atrial septal defect
• Ventricular septal defect
• Atrioventricular (AV) Canal
• Patent ductus arteriosus
❖ Atrial Septal Defect
• ASD – foramen ovale doesn’t close
• Watchful waiting is recommended,
foramen ovale closes by itself (see if
impacting growth & development,
socializing; take measures)
• If foramen ovale doesn’t close, much
more functional operation when
surgery is done on an adolescent
compared to an infant (if becoming
symptomatic)
❖ Ventricular Septal Defect
PEDS NAPediatrics
Exam 2 Study Guide
Pediatrics Exam 2 Study Guide
CHAPTER 25: The Child with Cardiovascular Dysfunction
❖ Cardiac Assessment in Peds
• How do you perform a cardiac assessment in Pediatrics? – least invasive to most invasive
• Inspection – look at color, work of breathing, LOC, chest movement, activity tolerance (position)
• Auscultation – heart sounds
• Palpation – capillary refill, pulses (radial, pedal), palpate liver (congestion of blood flow through inferior vena
cava causes liver to engorge)
❖ Congenital Heart Disease (CHD)
• What is the incidence of CHD in the Pediatric population?
• Incidence is 5 to 8 per 1000 live births
▪ Approximately 1 in every 115 live births (only 2 to 3 children are symptomatic)
▪ CHD is the major cause of death in the first year of life (after maturity)
▪ In 28% of kids with CHD, another recognized anomaly is also present
• Causes of CHD
▪ What causes CHD?
▪ Chromosomal or genetic disorders linked to higher incidence (Down’s syndrome, Type I Diabetes)
▪ Maternal or environmental cause in 1 to 2% (smoking, drugs, alcohol) (Lupus, Rubella, CMV)
▪ Multifactorial in 85%
❖ Physical Indicators of Cardiac Dysfunction
• Poor feeding, tachypnea, tachycardia, diaphoresis, crackles (pulmonary congestion), hepatomegaly, cyanosis,
murmur, sternal lift, not gaining weight
❖ Two Types of Cardiac Defects
• Congenital – anatomic defects
• Acquired – an illness or an infection, medication, environment, familial tendencies (cardiomyopathy,
spontaneous death before age 40)
❖ Fetal Circulation
,PEDS NAPediatrics Exam 2 Study Guide
❖ Changes at Birth
• Foramen ovale and patent ductus arteriosus close at birth due to increased pressure on the left compared to the
right forcing foramen ovale to close. PDA closes due to presence of increased oxygen.
• Positive pressure through the normal birth expands the lungs and closes the openings
, PEDS NAPediatrics Exam 2 Study Guide
• Children born via caesarean section, 40% have pneumothorax
❖ Old/New Classification of CHD
• Old – Acyanotic and Cyanotic
• Acyanotic – not blue
• Cyanotic – blue
• New – Left-to-Right shunting,
obstruction…, decreased
pulmonary…, mixed blood flow
• Left-to-Right Shunting – stuff
from the left moves to the right
• Obstruction of blood flow from
ventricles
• Stenosis – narrowing, may
sometimes be completely closed
off
• Decreased pulmonary blood
flow – pulmonary arteries and
pulmonary veins
• Mixed blood flow – complex
series of events to repair heart
flow
❖ Increased Pulmonary Blood Flow Defects
• Atrial septal defect
• Ventricular septal defect
• Atrioventricular (AV) Canal
• Patent ductus arteriosus
❖ Atrial Septal Defect
• ASD – foramen ovale doesn’t close
• Watchful waiting is recommended,
foramen ovale closes by itself (see if
impacting growth & development,
socializing; take measures)
• If foramen ovale doesn’t close, much
more functional operation when
surgery is done on an adolescent
compared to an infant (if becoming
symptomatic)
❖ Ventricular Septal Defect
