Cong Cardia (Cyanotic Defects) (Exam 2) Flashcards
(23 cards)
Cyanotic Heart Defects: Decreased Pulmonary Blood Flow
Tetrology of fallot
Tricuspid atresia
Cyanotic Heart Defects: Mixed Blood Flow
Transposition of the Great Vessles
Hyoplastic left heart
Truncus arteiros
Cyanotic Heart Defects
Pressure is greater on the pulmonic side so blood shunts from right to left
Mixed oxygenated and deoxygenated blood flow to systemic circulation leading to hypoxia
Cyanotic Heart Defects General Symptoms
Cyanosis
Polycythemia (keep them hydrated)
(body trying to make more RBC making blood thick)
Digital clubbing
Altered ABGS
General Intervention for Cyanotic Heart Defects
Provide good skin care
Hydration to prevent blood clots because of polycythemia
Supplemental O2 but we do not want to give to much oxygen
Monitor for and prevent dehydration
Developmentally appropriate preparation for tests and procedures
Watch CBC for high red blood count
Tetralogy of Fallot: Combination of 4 defects
- VSD
- Overriding aorta
- Pulmonic stenosis
- Right ventricular hypertrophy
Tetralogy of Fallot: Clinical Manifestations
Heart murmur with a thrill
Polycythemia
Hypoxic episodes (Tet spells) (Squatting position)
Poor growth
Clubbing
Exercise intolerance
What position do we usually see children in who have tetralogy of fallot?
Squatting position to re-route the blood
Blood can not flow through hips and knees / shunts blood to important organs
Guidelines for Hypercyanotic Spells (O2 Down) (Cyanosis Up)
- Employ calm, comforting approach
- Knee-chest position (mimic squating)
- 100% oxygen by face mask
- Give morphine (relaxed muscle of the heart)
- IV fluid replacement and volume expansion if needed
- Repeat morphine if needed
When do hypercyanotic spells typically happen in children?
When crying or straining
Tricuspid Atresia
Failure of tricupid valve to develop resulting in no communication between right atrium and ventricle resulting in severe right hypoplasia or absence of right ventricle
Have to have patent ductuc arteriosis or patent forman ovale
Tricuspid Atresia: Clinical Manifestations
Cyanosis
Tachypnea
SOB
Tricuspid Atresia: Treatment
Prostaglandin E to maintain ductus arteriosus (need open for mixing of blood, will result in death if not)
Digoxin and diuretics
Palliative surgical repair to increase pulmonary blood flow
Transposition of the Great Arteries
Pulmonary artery arises from left ventricle and the aorta arises from the right ventricle
No communication between systemic and pulmonary circulation
Kids cannot survive if there is not another disorder (Foramen Ovale / Ductus arteriosus)
Transposition of Great Vessel: S/S
Increasing cyanosis as foramen ovale closes and ductus arterioses closes
Transposition of Great Vessel: Treatment
IV prostaglandin E to patent ductus arteriosis open
Arterial switch procedure in the first few weeks of life
Truncus Arteriosus
Pulmonary artery and aorta fail to divide during development
Pulmonary artery is attached to aorta
One single large vessel empties both ventricles
Truncus Arteriosus: Clinical manifestations
Cyanosis
CHF
Heart murmur
Truncous arteriosus: Treatment
Digoxin and Diuretics until surgery
Surgical repair during the first few months of life
Hypoplastic Left Heart Syndrome
Small or absent left ventricle, small ascending aorta and aortic arch
Underdeveloped left side of the heart
Descending Aorta receives blood via the Patent Ductus Arteriosus
These kids heart transplant
Hypoplastic Left Heart Syndrome: Management
Prostaglandin E to keep PDA open
Heart Transplant
Complications of Heart Surgery
CHF
Dysrhythmias
Cardiac Tamponade
-decrease BP
-decrease pulse pressure
Atelectasis - pneumothorax - pulmonary edema
Cerebral edema and brain damage
Hemorrhage / anemia
Discharge Planning
Wound care (sternal incision)
Medication teaching
Bacterial endocarditis prophylaxis (anytime after open heart surgery)
No strain on the incision (do not pick up underneath the arms)
No rough housing (limit activity)
