Congenital Heart Defects

Question 1

What do heart defects result in?

Answer 1

Heart failure

Hypoxemia

Question 2

Acquired heart defects

Answer 2

Really anything that alters cardiac muscles

Infection
Autoimmune Response
Environmental factors
Familial Tendencies

Question 3

Types of diagnostic procedures that may be done for the heart?

Answer 3

Chest X Ray for heart size and pulmonary blood flow

EKG which measures electrical activity of the heart

Question 4

What is the echocardiogram for the heart though?

Can this be stressful?

Answer 4

High frequency sound waves bounced off structures to produce image ; sort of like an ultrasound of the heart

Can be very stressful so consider sedation

Question 5

Who is easier to see on echo? Younger or older kids

Answer 5

Younger kids - the smaller the heart the easier it is to see

Question 6

What is a transesophageal echo?

Nursing care?

Answer 6

When you do an echo but put the scope down the throat instead

Nurse needs to maintain the airway, be aware of aspiration, respiratory

Question 7

What is heart catheterization

Answer 7

Measures pressures and oxygen to visualize structures and blood flow to see how well your heart is working

Question 8

Who do you need to provide teaching to before doing the catheterization?

Answer 8

Teach patient and family

Question 9

Can the infant/child eat before cauterization?

Answer 9

No. Must be NPO

Question 10

What to signs and symptoms are you looking for with assessment of the catheterization patient before the procedure?

Answer 10

Signs and symptoms of infection

Question 11

What physical data are you gathering for with assessment of catheterization patient before the procedure?

Tips for assessing the pulses?

Answer 11

Accurate height and weight
Baseline VS for possible bleeding complications
Pulses (location and intensity)
Color and temp of extremities

Mark the spots when you feel the pulses. Femoral pulse is likely but you may find reduced pulses distal to the lower extremity. If you mark it, then there’s no guessing game.

Question 12

Last thing nurse has to do with assessment of the catheterization patient

Answer 12

Document the post procedural comparison

Question 13

What are the most important vitals to accurately monitor after the procedure of catheterization?

What might they look like?

Answer 13

Heart rate and blood pressure

The heart rate/pulse may be weaker distal to site first few hours but this will go away and become normal

Question 14

After the catheterization what do you check for in the extremities?
What position does the extremity need to be kept it?

Answer 14

The temperature and color of the extremity for cyanosis

Straight as to not dislodge a clot

Question 15

How do you help the child clear the dye from the body after catheterization?

Answer 15

Keep the child hydrated so it flushes it out

Question 16

What is a shunt?

Answer 16

A movement of blood across an opening based off pressure

Can go either direction.

Question 17

Preload definition

Answer 17

The amount of stretching done for the volume presented to the ventricle and compliance of the ventricle at the end of relaxation or diastole

The ventricles having to stretch in order to fill up to get ready for the contraction

Question 18

Afterload definition

Answer 18

Ventricular wall tension or stress during systolic ejection

The pressure response when the ventricles have to eject the blood

Question 19

Contractility definition

Answer 19

force of contractions

Question 20

Chronotropic definition

Answer 20

change in rate

Question 21

Inotropic definition

Answer 21

change in contractility

Question 22

Hemodynamic classification is based off…

Answer 22

Based off blow flow patterns within the heart
- so the type of blood flow going in may determine the issue

Increased or decreased pulmonary blood flow
Obstruction of blood flow
Mixed blood flow

Question 23

What is an ASD?

Answer 23

Atrial septal defect is an opening between the two atriums causing shunt that goes left to right.

Question 24

What clinical clues are there that may point to the ASD?

Answer 24

(Opening in septal atriums - ASD)

Murmur
Heart failure signs

Question 25

What is conservative treatment like for ASD? What other treatment are there for ASD?

Answer 25

Very conservative since the ASD may close on its own Aggressive treatments may include surgical path Or transcatheter but depends on size and shape since you want it to be small

Question 26

What is a VSD? What other phenomena might you see with VSD?

Answer 26

Ventricular septal defect is a hole in the 2 ventricles that allows blood to move based off pressure Ventricular hypertrophy due to ventricles working hard Endocarditis due to stasis Murmur HF

Question 27

What is the easier treatment for a VSD? Next treatments for VSD or ventricular septal defect?

Answer 27

Conservative here as well since it might close on its own Pulmonary banding in order to limit amount of blood shunting If larger issue, the hole will be closed surgically with graft patch

Question 28

What is an Atrioventricular Canal Defect?

Answer 28

When you have the ASD and VSD (holes in the heart) as well as valve defects happening together to sort of creating a one chambered heart and so blood goes back and forth

Question 29

Atrioventricular Canal Defect treatment if it is a severe problem?

Answer 29

(when you have asd & vsd holes + valve issues) Pulmonary banding Surgery to patch up the holes and repair the valves

Question 30

What is the fetal connection between the aorta and pulmonary artery that allows circulation to bypass the lungs What is it called when it fails to close

Answer 30

Ductus arteriosus Patent ductus arteriosus

Question 31

What will the heart sound like and what will pulses be like in patent ductus arteriosus?

Answer 31

Machine like murmur Bounding pulses Widened pulse pressure

Question 32

Patent Ductus arteriosus medical treatment Patent Ductus arteriosus surgical treatment

Answer 32

Indomethecin for infants Thoracotomy - Ligate and close off two edges or use clips to create an artificial closing

Question 33

What is Coarctation of the Aorta? What does it affect?

Answer 33

When the aortic segment made a stricture instead of a patent passageway for blood that mostly affects oxygenation of the lower body due to decreased pressure

Question 34

In Coarctation of the Aorta what will pulses be like for upper and lower body?

Answer 34

(stricture of aortic segment) Upper body - bounding Lower body - faint

Question 35

What can Coarctation of the Aorta cause? What if it is severe?

Answer 35

heart failure & its symptoms Severe coarctation may cause Rapid Deterioration w acidosis and hypotension

Question 36

Coarctation of the Aorta symptoms of older kids

Answer 36

Dizziness and fainting | Headaches and epistaxis (nose bleeds) from high BP in upper body

Question 37

Coarctation of the Aorta treatment first? | Second?

Answer 37

Nonsurgical balloon angioplasty to try to balloon the stricture Thoracotomy resection where you anastomosis the stricture segment

Question 38

Main post op considerations for long term care after the Coarctation of Aorta treamtent/surgeries?

Answer 38

Control of hypertension | - the earlier the repair, the less systemic hypertension most likely

Question 39

What is Aortic stenosis What can the stenosis manifest into? Which can lead to what event?

Answer 39

Stricture of the aortic VALVE that is often progressive Left sided Heart failure and thus pulmonary edema can lead to MI or sudden death bc it can catch up with you

Question 40

What is Pulmonary stenosis

Answer 40

Narrowing of the pulmonary opening so valve or artery..

Question 41

Pulmonary stenosis outcome risks?

Answer 41

(narrowing of pulmonary artery) Right sided heart failure Cardiomegaly Endocarditis

Question 42

Pulmonary stenosis manifestations?

Answer 42

Right ventricular hypertrophy | Decreases pulmonary blood flow

Question 43

Treatment options for Pulmonary stenosis What might they give to someone before treatment though to manage pulmonary stenosis?

Answer 43

Balloon angioplasty Surgical valvotomy or valve repair Might give prostaglandin E to keep the artery patent as much as possible