3Cardiac Part 2 Flashcards
Defects that decrease pulmonary blood flow
Tetralogy of fallot
Tricuspid atresia
(Right to left shunt)
Hypoxemia
S/s
Polycythemia
Fatigue
Clubbing
Cyanosis
Exertional dyspnea
Polycythemia:
-kidney produce erythropoietin to stimulate bone marrow to produce more RBCs
What is polycythemia:
What we are worried about
Kidneys produce erythropoietin to stimulate bone marrow to produce more RBC’s
Over production—>
causes sluggish blood (thick)—>
Causes thromboembolism (clots)
Tetralogy of fallot (TOF)
Defects included
Pulmonary stenosis
Right ventricular hypertrophy (bc of stenosis)
VSD
Overriding aorta (more centered in middle)
Tetralogy of fallot (TOF)
S/s
Tx
Murmur
Cyanosis
TET spells
Tx:
-palliative repairs (blalock taussig BT shunt): connects subclavian artery to pulmonary artery
-complete repair (fix all defects)
Hypercyanotic episodes (TET spells)
-caused by
Crying
Feeding
Exercise
Straining
Hypercyanotic episodes (TET spells)
S/s 8 DLITTIPS
Diaphoresis
Loss of consciousness
Irritability and crying
Tachycardia
Tachypnea
Increased cyanosis
Poor tissue perfusion
Seizures (if last too long have no O2 to brain)
Hypercyanotic episodes (TET spells)
1st intervention
Tx
1st intervention:
-knee to chest position
(increase systemic pressure forcing blood to go to lungs)
Tx:
-reduce crying/calm child (pacifier, swaddle)
-give oxygen
-administer morphine or propranolol
Tricuspid atresia
What is it
Common to see
Failure of tricuspid valve to develop
Common to see VSD
Tricuspid atresia
S/s
Tx
Cyanosis
Marked cyanosis once PDA closes
Tachypnea
Difficulty feeding
Murmur
Tx:
-PFO
-palliative BT shunt
-several surgeries
Mixed defects
(significant mixing of oxygenated and deoxygenated blood)
Transposition of the Great Arteries/Vessels
Truncus Arteriosus
total anomalous pulmonary venous return (TAPVR)
Hypoplastic left heart syndrome (HLHS)
Transposition of the Great Arteries (TGA)
What is it
What is needed
Pulmonary artery and aorta swapped
-need PDA and PFO to be compatible with life other wise blood would be pumped out to rest of body and never oxygenated.
-RV pushing blood to aorta instead of pulmonary artery
Transposition of the Great Arteries (TGA)
S/s
Tx
Cyanosis
Tachypnea
Worsens as PDA closes
Tx:
Keep PDA open (other wise uncompatible with life)
-administer Prostaglandin E (IV) to keep open
-PFO stretched
-surgical repair 4-7 DOL (days of life)
Truncus Arteriosus
What is it
What may be present
One major artery leaves the heart with one valve
(Aorta and pulmonary artery are one)
VSD may be present (murmur)
Truncus Arteriosus
S/s
Tx
Cyanosis
Tachynea, retractions, crackles
Activity intolerance
Poor feeding/growth
Tx:
-surgical repairs: 1st few weeks of life (cant go home at first)
Total anomalous pulmonary venous return (TAPVR)
What is it
What does that lead to
Is it compatible with life (can it be)
Pulmonary vein should connect to left atrium, instead it connects to right atrium/superior vena cava
Right sided hypertrophy
Pulmonary HTN/edema
Incompatible with life unless: PFO/ASD present
Total anomalous pulmonary venous return (TAPVR)
S/s
Tx
Cyanosis
Murmur
Tachypnea
Hepatomegaly (bc it causes right sided HF if not treated)
Tx:
-surgical repair
Hypoplastic left heart syndrome (HLHS)
What is it
Goal
-Structures on L side underdeveloped
-Mitral/aortic valves closed or very narrow
-LV nonfunctional (minimal CO)
Goal:
-create the R side of heart to do all the pumping
Hypoplastic left heart syndrome (HLHS)
S/s
Tx
-Tachycardia, low BP (only using R side of heart)
-Pallor, progressive cyanosis
Tx:
-KEEP PDA OPEN (has to be open to be compatible)
-palliative care/surgery
-heart transplant
Cath procedures nursing management
Pre-procedure
Assessments (physiologic/psychosocial)
VS, H&H, capillary refills
baseline temp/color
Baseline pedal and popliteal pulses
Parents psychosocial needs
Cath procedures nursing management
Post procedures
Bed rest 4-6 hours (lay flat)
Prevent flexion of the hip (if they used the leg)
Quiet activities
Monitor perfusion
Surgery nursing management
Presurgery
Prepare for surgery
Presx:
-prostaglandin E therapy (keep PDA open)
-infective endocarditic prophylaxis (IV ABX)
Monitor for development of CHF/growth/hydration
Prepare for sx:
-education for child and parents
-tour the units
Surgery nursing management
Post-sx
General nursing unit
Post-sx:
-ICU intitally (hemodynamics/labs/assessment)
-monitor CO/strict I/O (DW tell us fluid retention)
-infective endocarditic prohpylaxis (IV ABX)
General nursing unit:
-monitor for s/s of sx complications:
—bleeding, infection
—arrhythmias
—low cardiac output
Post op goals
Critical care unit
Pain management
Critical care unit:
-ventilator management
-nutrition
-electrolyte balance (K,Mg)
Pain management:
-around the clock analgesics
-transition to oral
-early mobility
Post op goals
Resp function
Fluids and nutrition
Resp function:
-cough and deep breath (incentive spirometer)
-splinting the chest
Fluid and nutrition:
-strict I/O
-promote oral fluids
-encourage favorite foods
-encourage bowel elimination
Acquired heart conditions
Infective Endocarditis
Kawasaki disease
Rheumatic fever
Infective endocarditis
What is it
What causes it
Infection of inner lining of the heart and valves
Endocardium injury from turbulent blood flow—>
Tigger deposition of plts and fibrin—>
Vegetation on leaflets causing regurgitation and HF—>bacteria/fungi attach to injured site (vegetation) and colonize
Infective endocarditis
risk factors
-congenital heart disease (CHD) or acquired heart disease
-valvular disorders
-indwelling catheters
Infective endocarditis
S/s
Complications
FEVER
Flu-like symptoms (fatigue/myalgias/arthralgias)
-new murmur
-tachycardia
LATE SIGN: CHF—>hepatosplenomegaly
Complications:
CHF/MI/Embolism
Infective endocarditis
Diagnosis
Blood culture: bacteria or fungus
CBC: leukocytosis (too many WBCs)
CRP/ESR
ECHO/EKG (cardiomegaly, abnormal valve function, area of vegetation)
Infective endocarditis
Tx
Prevention with prophylactic oral ABX for high risk kids before procedures:
-Amoxicillin
IV ABX preferred tx (several weeks)
-Ampicillin, Gentamycin, Vancomycin
might need PICC line if going home in ABX
Kawasaki Disease
More common in who
What is it (age)
What vessels affected
Most common in boys and pacific islanders
Acute febrile, systemic vascular inflammation
(Usually under 5y/o)
Small and midsized arteries affected:
-coronary artery dilation (vessel gets larger and has weak spots leading to ANEURYSMS)
Kawasaki Disease
Acute Phase: what vessesl affected
How long acute phase last
S/s (11) AIRRPPSSBCD
Risk (2)
small capillaries become inflamed (1-2weeks)
-Abrupt fever (last 5 days) -high fever w/ no response to meds
-irritability
-Red eyes
-Red cracked lipa
-puffy hands and feet
-palms and soles of feet become red
-strawberry tongue
-signs of myocarditis/CHF
-bilateral joint pain
-cervical lymphadenopathy
-desquamation of perineum
Risk: aneurysm/ coronary thrombosis
Kawasaki disease
Subacute phase: what is it
S/s (2 new thing, 3 continues from acute phase)
Inflammation spreads to large vessels
New:
-fever resolves
-peeling hands and feet
Continues:
-irritability
-arthritis
Risk of aneurysm and coronary thrombosis
Kawasaki disease
Lab and diagnostics
No specific diagnostic test : based on symptoms
Things we can do:
-CBC (elevated wbc, thrombocytosis)
-elevated CRP/ESR
-EXHO/EKG (want baseline as we follow them in life)
Kawasaki disease
Nursing management
Diet
Promoting comfort
Vs, cardiac monitor
Assess for HF (I/O, DW)
Offer liquids and soft, non-acidic/bland foods
(mash potatoes, apple sauce, pudding)
Promote comfort:
-oral hygiene, lip balm
-cool cloths to skin/lotion
Kawasaki disease
Meds
IV immune globulin (IVIG)
- given early in illness
-repeat if client still febrile
-monitor for allergic reaction
Oral ASA: only time we give ASA to peds
—80-100 mg/kg/day during fever devided every 6 hours
—3-5 mg/day once afebrile
IV immun globulin is treated like what
-what we do
ASA:
Why we give it
IVIG: treated like a blood product
-consent
-allergic reaction
-specific intructions from pharmacy
ASA:
-thrombocytosis (prevent clots)
Kawasaki disease
Discharge planning
-cant leave until
-educate parents
-follow up care needed
Cannot leave until afebrile/taking oral fluids
Educate parents:
-irritability likely to persist 2 months
-arthritis/skin conditions persist several weeks
-healthy heart diet
-administration of ASA
-notify if fever returns
F/u care:
-monitor for heart disease as child ages
—ECHO/EKG, BP, Blood Cholesterol
Rheumatic Fever
What is it
Occurs when
Age
Autoimmune response to Group A beta-hemolytic steptococcus
Occurs 2-4wks following untreated/partially treated strep throat
5-15y/o usually
Rheumatic Fever
Normal s/s
-other things affected
Hx of URI/strep throat
Fever
Other things:
-carditis
-arthritis
-rash
-CNS involvement
Rheumatic Fever
Carditis
FSET
PC
What were most worried about
Inflammation of heart muscle and heart tissue (cardiomegaly)
-fatigue, SOB, exercise intolerance, tachycardia,
-pericardial friction rub, CP
Rheumatic Fever
Arthritis
Swelling
Reddness and pain in the joints
Mainly:
-knees
-ankles
-elbows
-wrists
Rheumatic Fever
Rash
Erythema marginatum on trunk and extremities
-pink
-nonpruritic
Appears and disappears rapidly
Nontender subcutaneous nodules over bony prominences
Rheumatic Fever
CNS involvement
Chorea: involuntary purposeless muscle movements
-muscle weakness
-difficulty performing fine motor activities
-irritable, labile emotions
Rheumatic Fever
Labs & diagnostics 5
Throat culture
Blood antistreptolysin O titer: elevated
CBC, CRP, ESR
CXR (cardiomegaly)
ECHO/EKG: monitor dyrhythmias, change in heart function
Rheumatic Fever
Modified Jones criteria
Used to diagnose Rheumatic Fever
Either:
2 major criteria
1major criteria plus 2 minor
Rheumatic Fever
Nursing management (what are we trying to manage 5)
Manage:
-acute strep infection
-fever
-inflammation
-preventing cardiac damage
-preventing reoccurance
Rheumatic Fever
Meds
ABX: used for acute step infection
(10 days of penicillin)
Corticosteroids/NSAIDS
Infectious Endocarditis prophylaxis (3 choices)
Rheumatic fever tx
Infectious Endocarditis prophylaxis (one of these 3)
-2 daily doses of oral penicillin V
-monthly IM injection of penicillin G
-daily oral dose of sulfadiazin
