ATI 20 - Congenital heart Disease - DECR PULMO BF

Question 1

***3 types of decr pulmo BF

Answer 1

1 pulmo stenosis
2 tetralogy of fallot
3 pulmo/tricuspid atresia

Question 2

stenosis

Answer 2

narrowing

• obstructs blood flow
• can be above or below valve

Question 3

PULMONARY STENOSIS

**pathophysiology

Answer 3

obstructs BF into pulmo artery
>incr preload
»leads to RIGHT VENT HYPERTROPHY

Question 4

PULMONARY STENOSIS

**clinical manifestations

Answer 4

• *mild stenosis = asymptomatic**
• dyspnea, fatigue on exertn
• systlc ejectn mrmr
• cyanosis
• cardiomegaly

Question 5

incr in severity of pulmo stenosis

Answer 5

• louder + longer murmur

- cyanosis is worse

Question 6

PULMONARY STENOSIS

**clinical therapy

Answer 6

• *balloon dilatn of valve**

- surgicl valvotomy - when baloon is not indicated

Question 7

PULMONARY STENOSIS

prognosis

Answer 7

newborns w critical PS = mortality rt 10%

• usually doesnt incr in severity
• lifelong infective endocarditis prophylaxis is needed

Question 8

preferred tx for PULMONARY STENOSIS

Answer 8

balloon dilation of valve

-performed during catherization

Question 9

**TETRALOGY OF FALLOT **

4 defects involved

Answer 9

1 stenosis of pulmo outflow tract or valve
2 right ventrcl hypertrophy
3 ventricl septal defect
4 overriding aorta

Question 10

overriding aorta + ventrclr septal defect

Answer 10

allow unoxygenated blood to pass into systemic circulation

Question 11

***How is severity determine din TETRALOGY OF FALLOT

Answer 11

***degree of pulmo stenosis

Question 12

**toddlers w uncorrected TETRALOGY OF FALLOT instinctively…

Answer 12

squat

• assume knee-chest position
• incr systemic vascular resistance
• incr pulmo blood flow

Question 13

TETRALOGY OF FALLOT

clinical manifestations

Answer 13

newbornds: hypoxic + cyanotic as ductus arteriosus closes
older infants/toddlers: tachypnea + cyanosis
-polycythemia, hypoxic spells, metab acidosis, poor growth, clubbing, + exercise intolerance
-systolc murmur heard in pulmonic area
-thrill inpulmo area

Question 14

TETRALOGY OF FALLOT

clinical therapy*

Answer 14

• *most have corrective surgery by 1-2 yr unless a hypercyanotic spell occurs earlier
• symptomatic kids have correctv surgery after 3-4 mo age
• *may need palliative modified BLALOCK-TAUSSIG SHUNT while waiting

Question 15

**priority nursing mgmt if TETRALOGY OF FALLOT is experiencing cyanosis

Answer 15

KNEE CHEST POSITION

• then O2
• calm kid
• give morphine

Question 16

TETRALOGY OF FALLOT

**prognosis

Answer 16

-not all are cured, most have improved quality of life

• *valve replacement 10-20 yr after corrective surgery
• —if pulmo regurg worsens
• *ventricular arrythmias may happen years after surgery and can cause sudden death!!! wtf

Question 17

**atresia

Answer 17

absent or abnormal narrowing

no valve

Question 18

**patent foramen ovale

Answer 18

allows blood flow fr RA to LA

Question 19

**patent ductus arteriosus

Answer 19

allows blood flor to pulmo artery

Question 20

**Pulmonary Atresia

Answer 20

no valve/opening to allow blood to flow from RV to pulmo artery

Question 21

**Tricuspid Atresia

Answer 21

no valve or opening to allow blood to flow fr RA to RV

Question 22

Pulmonary or Tricuspid Atresia

**clinical manifestations

Answer 22

severe cyanosis present at birth

• poor feedng, growth delay
• CHF, pulmo edema, hepatomegaly
• tachypnea, acidosis, hypoxic spells, clubbing
• cont mrmr in pulmo area
• single s2

Question 23

**medication to keep atresia open

Answer 23

prostaglandin E

• given immediately to maintain PDA
• opposite of ibuprofen which is a prostaglandin inhibitor

Question 24

Pulmonary or Tricuspid Atresia

clinical therapy

Answer 24

• PGE (immediately to maintain PDA)
• tx CHF
• balloon atrial septostomy
• surgery in 3 stages

Question 25

Pulmonary or Tricuspid Atresia

**surgery in 3 stages

Answer 25

1 shunt placement
2 glenn procedure
3 fontan procedure

Question 26

**in pulmo/tricuspic atresia, the RV becomes…

Answer 26

hypoplastic