Flashcards in Congeital Heart Defects Deck (55):
Embryonic development of heart is by ______ weeks
Shunts for fetal circulation
Foremen ovale shunts blood from which ____ side to the ______ side
Left to right
Ductus arteriosus shunts blood from the...
Path of fetal circulation
From mother, to fetus via umbilical vein, through fetal circulation...
Returns partially oxygenated and deoxygenated blood to mother via umbilical arteries
Incidence of congenital heart defects
5 to 8 in every 1000 live births
Congenital heart defects have an increased incidence in what kind of babies/births?
Premature, stillborns, low birth weight infants, and spontaneous abortions
Two major groups of heart defects are...
Congenital heart defects and acquired cardiac disorders
Types of congenital heart defects
Congestive heart failure and hypoxemia
Acquired cardiac disorders are from...
Infection, autoimmune responses, environmental factors, familial
Prenatal and maternal factors for congenital heart defects
Rubella, alcohol abuse, older than 40, type 1 diabetes
Genetic factors that put infants at risk for congenital heart defects
Sibling with a defect, parent with CHD, chromosomal problem, born with other noncardiac abnormality
What is pulmonary congestion?
A backup of fluid into lungs
What is a right to left blood shunt and the results of it?
Blood from right side enters left side of heart and causes hypoxemia, cyanosis, and polycythemia
What is polycythemia?
Increased viscosity in the blood because there are more RBCs than needed, prone to strokes
What is a left to right shunt and results of it
Blood flow from the high pressured left side to low pressure right side and causes tachypnea, dyspnea, and pulmonary edema
Symptoms of pediatric pulmonary hypertension
Tachycardia- over 160, tachypnea- over 60, s3 and s4 heart sounds, dyspnea, diaphoresis, easily fatigued,
What are acyanotic defects?
Increased pulmonary blood flow, ASD, VSD, PDA
What are cyanotic defects?
Decreased pulmonary blood flow, tetrology of fallot, transportation of great arteries
What is atrial septal defect (ASD)?
An abnormal opening between the right and left atrium from an incompetent foremen ovale and cause incorrect development of atrial septum
Clinical manifestations of Atrial septal defect
Can be asymptomatic, congestive heart failure symptoms, a murmur, and atrial dysrhythmiasw
Treatment of atrial septal defect (ASD)
Surgical with a Dacron patch or no surgical with cardiac catheterization
Surgical treatment of ASD requires...
Bypass and a 4-6 day stay
What is ventricular septal defect (VSD)?
An abnormal opening between the left and right ventricles
Types of ventricular septal defects
Membranous and muscular
Clinical manifestations of ventricular septal defect
CHF, murmur, bacterial endocarditis, eisenmenger syndrome
Ventricular septal defect treatment
Surgical (palliative or a repair)
Nonsurgical with cardiac cath
What is Patent Ductus Arteriosus (PDA)?
Failure of ductus arteriosus to close after the first weeks of life. Blood flow is altered. Increased workload on left side of heart
Patent Ductus Arteriosus (PDA) blood flow alteration
Left side of heart has increased workload -- increases pulmonary vascular congestion and resistance, potential increase in right ventricular pressure and hypertrophy.
Clinical manifestations of patent ductus arteriosus (PDA)
Asymptomatic, CHF symptoms, machinery like murmur (humming top), widened pulse pressure, bounding pulse
Treatment of patent ductus arteriosus (PDA)
medical- endocin, or surgical is open heart surgery
What is Coarctation of the Aorta (COA)?
Narrowing of the aortic arch near the insertion of the ductus arteriosus with increase pressure near the narrowing and decreased pressure distal to the narrowing-- causes ventricular workoverload
Clinical manifestations of coarctation of the aorta (COA)?
increased BP, bounding pulses, weak/absent femoral pulses
Cool lower extremities, symptoms worsen
dizziness, faintness, headaches, increased BP
Treatment of coarctation of the aorta (COA)?
Surgical or nonsurgical
What is tetrology of fallot (TOF)?
When right ventricle contracts, blood resistance occurs related to pulmonary stenosis. Blood is shunted across ventricular septal defect, into the aorta, and the left ventricle gives persistent arterial unsaturation--- CYANOSIS
Four main defects of tetrology of fallot (TOF)?
Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
Clinical manifestations of tetrology of fallot (TOF)?
Cyanosis, clubbing, systolic murmur, delayed growth and development, hypoxia, tet spells, squatting
Risks associated with tetrology of fallot (TOF)?
Emboli, brain abscesses, seizures, loss of consciousness,
Treatment of Tetrology of fallot (TOF)?
surgical- palliative- Balock-Taussig or Modified Blalock-Taussig Shunt and a complete repair in the 1st year of life
What is Transposition of the Great Areries and Transposition of the Great Vessels (TGA/TGV)?
When the pulmonary artery leaves the left ventricle and the aorta exits the right ventricle with no communication between the systemic and pulmonary circulations- mixed defect
What is basically happening with TGA and TGV?
the aorta and pulmonary artery are switched.
What are symptoms of TGA and TGV?
dependent on type and size of defects
Treatment of TGA/TGV
therapeutic prostaglandin and increased oxygen
Cardiac catheterization- rashkind
surgical- transection and anastomosis
Nursing Care- Patient history
family history of heart disease- sibilings too
contact with teratogens- infections, drugs, alcohol
history of genetic chromosomal abnormality
poor weight gain and appetite
Respiratory infections, heart murmurs, cyanosis
Assessment of clinical manifestations
activity intolerance with/without color changes, rest periods, weight gain/loss, difficulty eating and sucking, unusual position, skin assessment, lab studies, Tets
Physical Assessment of Peds patient
VS, Inspect skin, posture, clubbing, Palpate peripheral pulses and cap refill, Percuss liver size, Auscultate apical pulse, murmurs, lungs
Diagnostic procedures for Ped cardiac defects
Chest Xray, ECG, Echo, TEE, Cath, Stress test, MRI
How to hook up leads
Right side- White side
Left side- black on top, red/green on bottom (smoke over fire)
What is cardiac cauterization?
Diagnostic procedure where radiopaque dye is injected via catheter in a vein and is guided by fluoroscopy into heart chamber
Medication for cardiac cath
digoxin q 12 hrs= check HR
ACE inhibitors- --pril
What is Kawaski disease?
Inflammatory process that causes thickening and scarring of the vascular walls of coronary arteries
Acute stage of Kawaski disease
10-14 days- very sick with fever, conjunctivitis, strawberry tongue, hand edema tachycardia
Subacute stage of kawaski disease
15-25 days, fever gone, irritable, peeling, coronary aneurysms
Convalescent Stage of kawaski disease
26 days until ESR returns to normal and symptoms disappear- beaus lines on nails