Peds - Exam 2 - Cardiac - What To Know Flashcards
(27 cards)
Chest X-ray
- Most frequently ordered
- Shows information about shape and size of heart, pattern of blood flow especially through pulmonary vessels
Cardiac catheterization
- Invasive - thread cath through peripheral vessel (usually femoral)
- Complications: bleeding, hematomas, infection, blood clots
- Mark pedal pulses before site so they are palpated again in same position
Post procedure:
- It is NORMAL for pulse site to be weaker for a few hours after procedure
- Vital signs - count HR for full minute
- Check for drainage of blood - if dressing saturated, apply pressure just above the site (1 in above), call physician or have someone call for you.
- Pt should lay with extremity straight for 4-6 hours
- Dressing needs to stay clean dry intact for 24 hours after (no bathing etc)
- No tub baths 3 days (older children can shower day after cath)
- Avoid strenuous activity for several days but may attend school
- Can resume regular diet without restrictions
- Acetaminophen or ibuprofen for pain
Echocardiography
- Non-invasive, nonpainful
- Can be stressful b/c child has to lay still - may need mild sedative
CHF
- Inability of heart to pump adequate amount of blood to meet body’s demands
- Earliest signs in infant - tachycardia (sleeping HR of > 160)
o Impaired myocardial function
- Tachycardia; fatigue; weakness; restlessness; S3/S4; diaphoresis; irritability
- Decreased perfusion – pale, cool extremities; decreased BP, decreased urine output; slow cap refill
o Pulmonary congestion
- Tachypnea, dyspnea, respiratory distress, cyanosis, exercise intolerance
o Systemic venous congestion
- Peripheral and periorbital edema, weight gain, ascites, hepatomegaly (may be able to palpate liver), neck vein distention
Congenital vs acquired heart defect
Congenital:
- Anatomic –> abnormal function
- Seen most commonly
- Causes: maternal or environmental (fetal alcohol syndrome, maternal illness - rubella, infants of diabetic mothers, cytomaglovirus, toxoplasmosis, etc); genetic; mostly multifactorial
Acquired
- Disease process - infection, autoimmune response, environmental factors, familial tendencies
Increased pulmonary blood flow - caused by which defects?
- Atrial septal defect
- Ventricular septal defect
- Patent ductus arteriosus
- Atrioventricular canal
Obstruction to blood flow from ventricles - caused by which defects?
- Coarctation of aorta
- Aortic stenosis
- Pulmonic stenosis
Decreased pulmonary blood flow - caused by which defects?
- Tetralogy of Fallot
- Tricuspid astresia
Mixed blood flow - caused by which defects?
- Transposition of great arteries
- Total anomalous pulmonary venous return
- Truncus arteriosus
- Hypoplastic left heart syndrome
ASD (Atrial Septal Defect)
- It is an opening between the atria
- Blood is going to flow from L to R – then causes increased blood flow to lungs
- Child often presents well, not always caught early on because they are asymptomatic
- Tx: know in general, usually do cardiac cath procedure (if small enough) or surgical repair procedure with patch
VSD (Ventricular Septal Defect)
- Most common congenital heart defect we see
- Defect in the ventricular septum
- Manifestations, severity, prognosis – all depends on size –> Will affect treatment, how badly they present
- Will hear murmur
- Tx is surgical
- Prognosis depends on size
PDA (Patent Ductus Arteriosus)
- Ductus SHOULD close by ~15 hours after birth
- Can treat that by administering indomethacin in preemies and newborns to close that – otherwise will do surgical intervention or cath lab to close it
- Prognosis overall good – in preemies, can be worse prognosis because there can be other medical issues
COA (Coarctation of Aorta)
- Coarctation – narrowing of aorta – typically near insertion of ductus arteriosus
- Causes increased pressure proximal to defect
- Causes bounding pulses in arms
- Decreased perfusion to lower extremities (cool cyanotic)
- Infants – signs of CHF in infants
- Condition can deteriorate rapidly – how large of an area is narrowed?
- Older children – dizziness, headache, fainting
- Going to treat typically with balloon angioplasty (older than 6 mos old) if not too large
AS (Aortic Stenosis)
- Kids should NOT be in strenuous exercise
- Serious defect because it tends to be progressive
- Sudden periods of ischemia and decreased CO – can lead to death (which is why it can be so dangerous)
- Narrowing of aortic valve
- Clinical – infants with severe defects – decreased CO – faint pulses, low BP, poor feeding
- Older kids – exercise intolerance, dizziness, chest pain
PS (Pulmonic Stenosis)
- Pulmonic stenosis – pulmonic valve narrowed – in extreme form, can be completely closed off (resulting in no blood to lungs) which would be very serious
- Decreased blood flow to lungs and R ventricular hypertrophy
- Foramen ovale can reopen which allows some shunting – some pts have PDA to help compensate
- Chest xray shows cardiomegaly
- Balloon angioplasty – very successful, what is typically done
Tetralogy of Fallot
4 defects involved in complete defect
- VSD (ventricular septal defect)
- Pulmonic stenosis
- Overriding aorta
- Right ventricular hypretrophy
S/S characteristic “tet spells” (blue spells) – acute episodes of cyanosis and hypoxia typically occurring after feeding or crying (baby turns blue when cries, or blue around lips after feeding, etc)
Surgery – multi-stage procedure
Risk of emboli, LOC, sudden death, seizures
One way we can prevent seizures is to keep child hydrated (prevent dehydration)
Tricuspid Atresia
- Failure of tricuspid valve to develop
- Tx is going to be giving the prostaglandin E to keep open the foramen ovale so blood can continue to shunt – otherwise no blood flow to lungs
- High surgical mortality rate
- Surgery is multistep procedure
Transposition of Great Vessels
- No communication between systemic and pulmonary circulation
- Symptoms depend on type and size of associated defects – the bigger the septal defects, the less cyanotic the newborn will appear (but will still see signs of CHF)
Total Anomalous Pulmonary Venous Connection
- Very very rare defect
- Instead of pulm veins going to L atrium, Pulm veins go to systemic circulation via right atrium, shunted via ASD (atrial septal defect)
- Clinical manifestations - usually cyanotic early
Hypoplastic left heart
- Primary defect - hypoplastic L ventricle – L vent so small, not functioning
- R side compensates with PDA and foramen ovale
- Most of the blood can flow across foramen ovale, so that some of that oxygenated blood can go back into the r atrium then into r ventricle – pumped out to lungs
- Because of PDA patent ductus arteriosus – some goes into systemic circulation
- Tx for this – need to keep shunts open using prostaglandin E infusion
- Tx is ultimately going to be surgery – multiple surgeries into correcting this, and the mortality is pretty HIGH
Postop cardiac surgery
It is normal to have temp up to 100 F post-op, but any higher need to notify MD. Worry about post op infection
If on bypass during sx, will come back intubated on vent
VERY CAREFUL suctioning! No more than 5 secs, GIVE O2 before and after sxn. 2 person job
Chest Tubes After Cardiac Surgery
Monitor chest tube drainage q hour for COLOR
- Immediate postop may be bright red, but changing to serous
Monitor chest tube drainage for quantity
*** Notify surgeon if chest tube drainage >3 ml/kg/hr ×3 consecutive hours OR 5-10 ml/kg in any 1 hour (possible hemorrhage)
Be alert for cardiac tamponade (rapid onset; life-threatening)
Bacterial Endocarditis
Bacterial endocarditis or BE, or IE (infective endocarditis), or SBE (subacute bacterial endocarditis)
Infection in valves and endocardium
Usually sequelae of sepsis in child w/ cardiac disease or congenital anomaly
Staph, Strep, Candida, gram-negative bacteria
High-dose ANTBX: Penicillin, amipicillin, methicillin, cloxacillin, streptomycin, or gentamicin
Amphotericin or flucytosine for fungal infections
Treat 2-8 weeks. If antbx unsuccessful»CHF develops, valvular damage
Prophylax before dental procedures, bronchoscopy, T&A, SURGERIES
Prevention of IE (infective endocarditis)
Prophylactic antibiotics ONLY for highest-risk CHD patients
Recent changes in prophylaxis guidelines
Prophylaxis before dental work, invasive respiratory treatment, or procedures on soft tissue infections
No prophylaxis for GI/GU procedures
Administer prophylaxis 1 hour before procedure
Meticulous dental hygiene
NEED GOOD TEACHING FOR PARENTS OF HIGH-RISK PTS. These parent should not wait to bring their kids in…even if suspect just a cold, need to be evaluated
