ATI 20 - Congenital Heart Disease - INCR PULMO BF Flashcards
Congenital Heart Disease
occurrence
8-12 per 1,000 live birth
Congenital Heart Disease
genetic + environmental causes
- drug exposure
- maternl viral infectn
- maternl metab disorder
- incr maternl age
- multifactorial genetc pattern
- chrmsml abnorm
Congenital Heart Disease
etiology
inadequate CO
-hypertrophy followed by failure
Congenital Heart Condition
nursing care
- limit feeding to 30min unless instructed otherwise
- careful w fluid + O2
- breastmilk preferred (possibly pumped, fortifd, or supplmtd)
- infectn prevention
- maybe transpyloric, nasogastric, gastronomy tube
___ is required before cardiac catheterization
baseline assessment
-make sure no allergies to iodine or shellfish bc contrast
cardiac catheterization
post op care
- continuous cardiac + pulse ox
- assess pulse for symmetry
- assess skin
- assess insertion site for bleed/hematoma
- prevent bleeding by keeping extremity in straight position
cool extremity that blanches after cardiac catheterization can indicate
arterial obstruction
sudden sustained incr in pulse/resp + decr in perfusn may indicate…
early hemorrhage
INCREASED pulmonary BF
clinical manifestations
- tachypnea
- tachycardia
- murmur
- *CHF**
- poor wt gain
- diaphoresis
- periorbital edema
- freq resp infection
DECREASED pulmonary BF
clinical manifestations
- *cyanosis**
- hypoxic spells
- poor wt gain
- polycythemia
OBSTRUCTION to systemic BF
clinical manifestation
- *CHF w pulmo edema**
- diminished pulse
- poor color
- delayed cap refill time
- decr UO
MIXED Defects
clinical manifestations
- *cyanosis**
- *CHF can occur w incr shunting**
- poor wt gain
- pulmo congestn
Patent Ductus Arteriosus
occurrence
common
-5-10% of all infants w congenital heart disease
normal ductus arteriosus
blood goes fr pulmo artery to aorta
- closes 10-15 hr after birth
- complete seal after 10-21 days after birth
normal closure of ductus arteriosus is triggered by…
high O2 saturation
Patent Ductus Arteriosus
pathophysiology
at birth, SVR incr + PVR decr
|»_space;reverses flow across ductus arteriosus
Patent Ductus Arteriosus
is common in…
preterm infants w resp distress syndrome or hypoxemia
Patent Ductus Arteriosus
clinical manifestations
- *continuous machinery murmur during sys + dias**
- *thrill in pulmonic area**
- full, bounding pulse
- widened pulse pressure
- if CO is low, hypotension
- CHF
Patent Ductus Arteriosus are at a high risk for…
freq rsp infectn
PNA
Patent Ductus Arteriosus
therapy fr least to most invasive
- wait + monitor
- medication
- cardiac catheter to insert coils + occlude PDA
- thoracoscopic repair (ligate vessels)
Patent Ductus Arteriosus
medications
-prostaglandin inhibitor
-ibuprofen
-indomethacin
(helps w closure)
Normal foramen ovale
blood moves fr RT atrium to LFT atrium
Atrial Septal Defect
opening bw atrium septum remain open
|»_space;allows left-to-right shunting
small vs large Atrial Septal Defect
small: patent foramel ovale
large: completely absent septum
small - mod Atrial Septal Defect in infants + young children
clinical manifestations
usually asymptomatic
LARGE Atrial Septal Defect
clinical manifestations
- may cause CHF
- easily tired + poor growth
- loud harsh murmur w dixed split second heart sound
adults w uncorrected small to mod Atrial Septal Defect are at an incr risk for..
stroke
ATRIAL SEPTAL DEFECT
therapy fr least to most invasive
- wait + monitor
- cardiac catheter, septal occluder
- patch closure if CHF is present
cardiac catheter, septal occluder
post care
aspirin at 81mg/day for 6 months
VENTRICULAR SEPTAL DEFECT
pathophysiology
opening in ventricular septum
»incr pulmo blood flow
»blood is shunted fr LFT.VNTRCL to RT.VNTRCL to PULMO ARTERY
most common congenital heart defect
VENTRICULAR SEPTAL DEFECT
SMALL VENTRICULAR SEPTAL DEFECT
clinical manifestations
may have no symptoms
-may close spontaneously early in life
MOD - LARGE VENTRICULAR SEPTAL DEFECT
clinical manifestations
- may be assoc w CHF, poor growth, + decr exercise tolerance
- loud harsh murmur at left sternal border
- thrill may be present
VENTRICULAR SEPTAL DEFECT
least to most invasive therapy
- wait + monitor
- cardiac catheter closure
- surgery after 1yo
surgery for VENTRICULAR SEPTAL DEFECT
teaching re age
best after 1yo
- if CHF s/s cannot be medically managed, then w/in first 6 mo
- highest risk in first 2 mo
- good prognosis post op
ATRIOVENTRICULAR CANAL DEFECT
pathophysiology
-one AV valve + large septal defect bw both ATRIA + VENTRICLES
*ATRIOVENTRICULAR CANAL DEFECT
etiology
occurs in 2% of congenital heart defect cases
70% of these kids have DOWN SYNDROME
ATRIOVENTRICULAR CANAL DEFECT
clinical manifestation
-infants often develop CHF, tachypnea, avoidant/restrictv food intake disorder (failure to thrive), recurrent respiratory, infections, and repeated resp failure
S1 accentuated, S2 split
-holosystolic murmur
-thrill
ATRIOVENTRICULAR CANAL DEFECT
holosystolic murmur can be heard at…
left lower sternal border
-may be transmitted to left axilla when mitral regurg is present
ATRIOVENTRICULAR CANAL DEFECT
clinical therapy
- *CHF is treated
- *surgery bw 2-4mo to prevent pulmo vasc disease
- patch septal defect
- mitral valve replacemt
- infective endocarditis prophylaxis for 6 mo
