Peds cardiac Flashcards
(31 cards)
Fetal circulation
- Heart develops between 4th& 8thweeks
- Intrauterine circulation
- Foramen ovale: pumps blood from R to L atrium
- Ductus arteriosus: shunts blood from pulmonary artery to descending aorta
- Ductus venosus: shunts most of blood around fetal liver
Transitional and Neonatal Circulation
After birth:
- Pulmonary vessels dilate & dec. pulmonary vascular resistance as lungs expand
- Umbilical cord clamping(?) causes inc. in systemic vascular resistance, causes inc. in pressure in L. side of heart
- Foramen ovaleusually closes shortly after birth
- Ductus arteriosus usually closes by 4th day of life
Congenital Cardiac problems factors
- Present at birth
- Family history
- Down Syndrome
- Trisomy 13 and others
- High risk maternal factors:
- Age > 40 years old
- Diabetes
- ETOH abuse
- Rubella during pregnancy
Acquired cardiac problems factors
- Develops after birth:
- Technically, heart failure
- Cardiomyopathy
- Infection
- Toxins
- Hypertension/ hyperlipidemia
- Kawasaki disease*
4 classifications of congenital defects
Increased pulmonary blood flow
•Abnormal structure pushes more blood to lungs, less blood to body. Heart works harder
Decreased pulmonary blood flow
•Abnormal structure pushes less blood to lungs, deoxygenated blood to body.
- Obstructive –narrowing, stricture, heart works harder
- Mixed
Type of increased blood flow defect
- (Left-to-right shunt)
- Oxygenated blood re-enters pulmonary circulation.
- R. ventricular strain, dilation, hypertrophy
3 Ex. of defects with increased Pulmonary blood flow
- VSD (ventriculoseptal defect): Abnormal opening in the ventricular septum
- ASD (atrioseptal defect): Abnormal opening in the atrial septum
- PDA (patent ductus arteriosus): ductus arteriosus fails to close
- In all of these:
- Blood is recirculated throughlungs
- Less blood available to rest of body
- Heart works harder
- If symptoms not severe, may be “watched”
- May correct themselves
- If not, usually require one surgery with excellent prognosis
- If defect persists, worsens, and/or is not treated:
- Heart Failure
- Pulmonary Hypertension
- VSD is most common congenital heart defect
Obstructive Congenital heart defect ex.
- Coarctationof aorta:
- Narrowing of aorta,
- Dec blood flow below defect
- Inc. pressure above defect
- Femoral pulses weak or absent
- Radial pulses bounding
- Upper extremity hypertension
Defect with decreased pulmonary blood flow
Right-to-left shunts •deoxygenated blood enters systemic circulation = “blue babies” • dec pulmonary blood flow •Tetralogy of Fallot* •Transposition of great arteries •Hypoplastic Left Heart Syndrome
Tx of Defects with decreased pulm. blood flow
Often requires emergency treatment
Surgery in several stages
Prognosis varies with extent of defect
Tetralogy of Fallot
(Most common complex lesion) •4 anomalies 1.VSD 2.Pulmonic valve stenosis 3.Overriding aorta 4.R. ventricular hypertrophy
Medical Mgmt TOF
- keep DA patent: prostaglandins*
- Vasodilator, diuretics, digoxin, ACEI*
- Activity/Rest balance to prevent fatigue
- (All the interventions used to treat heart failure + prostaglandins)
- Surgical management necessary
TOF what will you see?
- Hypercyanotic/blue called ”TET” spells = Specific to TOF
- Choking spells with periods of dyspnea
- Relief from squatting or place infant in knee-chest position to inc. blood flow to lungs
- Clubbing (not specific)
- Polycythemia (not specific)
Screening for defects
- Newborn cardiac screening using pulse ox:
- Pre and post ductal screening (right hand, foot).
- Both should be >95%.
- Baby should be 25-48 hours old*
Ex of cardiac screening tests
Echocardiogram •Electrocardiogram •Chest x-ray •Cardiac MRI •Cardiac Cath •Older kids: stress test
Gen. manifestations of congenital heart disease in newborns
- May be none!
- Intercostal retractions, difficulty breathing, tachypnea >80/min, crackles, wheezing
- Central cyanosis at rest or on exertion
- Tachycardia (> 160/min)
- Uncontrollable crying, irritability
- Altered LOC, drowsiness
- limp extremities
- seizure, cardiac arrest
Heart failure, what happens?
•Heart does not pump enough blood to meet body’s demand for energy
1.Heart pumps well, but volume is insufficient or structure doesn’t work
OR
2. Weak heart muscle not pumpingenough blood.
Backup of blood and fluid
•Into the lungs:left sided failure
•Into the liver & veins: right sided failure
•Everywhere if both sides of heart are failing
•Backup into lungs is most common in pediatrics
S/S of HF - decreased perfusion
** Heart muscle having to work harder than with healthy kids = decreased perfusion:
•Fatigue; falling asleep when feeding; too tired to eat
•Change in skin temperature and color (pale, cold and clammy, or sweaty, flushed, and warm)
•Jugular venous distention
•Fast breathing during rest or exercise: needing to take frequent breaks when playing (tachypnea)
•Sweatingwhile feeding, playing, or exercising
•Loss of interest in feeding(poor appetite, loss of muscle mass, ↓ weight ), which leads to….
•Failure to gain weight* (as in growth and development)
S/S of HF - Fluid retention (RAAS)
- Edema–FACE!, legs, ankles, eyelids (periorbital), abdomen, flanks
- Pain over liver –hepatomegaly
- Weight gain over a short period of time, even when the appetite is poor (as in EDEMA weight)
- Cough and congestion in the lungs (rales/ crackles)
- *As lungs fill with fluid, short of breath
S/S of HF- Resp sx
Due to •Backup of fluid in lungs
•Trying to keep up with increased workload of heart
•Symptoms already discussed above:
Cough and congestion in the lungs (rales/ crackles)
As lungs fill with fluid, short of breath
Fast breathing during rest or exercise: needing to take frequent breaks when playing
Tachypnea, orthopnea
Clubbing, polycythemia
Tx of HF in children
- Congenital heart defect or rheumatic valve disease surgery or transplant
- Some surgeries can be done less invasively
- Medications* (will address later)
- O2 therapy
- Sometimes fluid restriction
- NGT feedings (can use breastmilk) or hi calorie formula
- (Pacemaker?
- LVADs?)
Nsg Interventions
- Position for comfort & inc. oxygenation
- Medications
- Cluster care to provide rest** –activity as tolerated
- Provide diversion to meet developmental needs (child life)
- Anticipate child’s needs to minimize stress –parents can help!
- Avoid extremes of temperature to avoid stress of hypothermia/hyperthermia
- Breastfeeding ok if tolerated
- Low sodium formula (Lonalac)
- Strict I & O
- Daily weights
- Standard precautions to prevent infection –why?
- Prone to URI’s
- Infections = Increased work for heart
•Teach parents
•Good handwashing
•Limit visitors with infections
Explain diagnostic procedures, blood tests
Review dietary restrictions & medications
Cardiac Meds
- Digoxin(Lanoxin):
- cardiac glycoside to slow & strengthen heart beat
- Potassium:
- electrolyte to replace loss from diuretic
- Furosemide(Lasix):
- diuretic to reduce preload by dec. reabsorption of sodium
- Propranalol(Inderal):
- beta-blocker to reduce cardiac oxygen demands/ decrease pulse –blocks sympathetic stimulation
- Enalapril(Vasotec), Captopril, (Capoten):
- Ace inhibitor to dec. afterload; cause vessel dilation
- Spironolactone (Aldactone)
- Aldosterone antagonist, K+ sparing diuretic
Use of digoxin ***
Forarrhythmias and heart failure.
inc. strength and efficiency of the heart
Controls rate and rhythm of the heartbeat.
Available in tablet, liquid, IV
Give q 12 h: 1 hour before or 2 hours after feeding
Measure the oral liquid medicine with a marked measuring spoon or medicine cup.
Check heart rate for 1 minute
Hold if apical pulse is < than 90-110 in small child, <70 older child
Do not mix with other foods or fluids
If child has teeth, brush them or rinse mouth after giving
If child vomits, do notgive second dose
TWO nurses check dose before admin
