Cardiac Flashcards
Adult heart
Anatomy:
- 2 atrias and ventricles
- 4 valves - pulmonic, aortic, tricupsid, mitral
- aorta and vena cava
- pulmonary artery and veins
Conduction:
- SA, AV, bundle of his, perkinje fibers, cardiac muscle
Oxygenation:
- wants O2 >95%
- hypoxemia
- Cyanosis = O2 <85%
- anemia can alter oxygenation
- polycythemia from chronic hypoxemia (too many cells in the blood )
Pediatric Differences
- Blood pressure
- 70 + 2(age)= min
- 90 + 2(age)= average
- Muscle fibers increases in size as child grows
- Heart rate faster = increased metabolic rate and oxygen demands
- Less compliance - hear rate needs to increase in order to increase output
- infants are at greater risk for heart failure
Congenital Heart Disease
- Defect in the heart structure or great vessels
- Account for 25% of infant deaths related to a birth defect within the 12 months of life
- Can have increased / decreased pulmonary blood flow
- Obstructed systemic blood flow
- Mixed defects
- Will hear murmur ( NOT NORMAL INVENSTIGATE )
Cardiovascular Dysfunction
- Check for history: failure to thrive, poor weight gain
S/sx: feeding and activity intolerance, MURMUR, tachypnea, tachycardia, diaphoresis when eating, crackles (lungs), clubbing (fingers), cyanosis, pallor
Dx: CBC, BMP, CXR (anemia, polycythemia), EKG (electrical), Echocardiography (structural), newborn pulse ox screening (>94% @24 hours old (+) means babys at risk - do it again ), cardiac cath
Cardiac Catheterization: Pre procedure
- Allergies: iodine, shellfish
- Assess skin: rashes, infection
- Assess and mark pulses
- Respiratory and cardiac status
- Baseline O2 + VS
- NPO
- Education
Cardiac Catheterization: Post procedure
- Check distal pulses, perfusion (even on each side)
- Monitor VS- apical for full minute
- Monitor telemetry, incision, I/O (dye is toxic to kidney )
- Must lay flat
Heart Failure (systems affected, patho, s/sx, dx, tx, nursing)
Systems affected: heart, kidneys, lungs, liver
Patho: heart function is impaired -> decreased cardiac output
S/Sx: tires/perspires during feedings, tachycardia, tachypnea, decreased BP, pale/cyanic/mottling, dyspnea, resp. distress, crackles. generalized edema
Dx: BMP, CXR, ECG or echocardiogram to determine the cause
TX: ace inhibitors (decreases afterload) , furosemide( decreases preload) , digoxin ( increases contractility), and surgery to correct defect.
Nursing: strict I/O, daily wt, VS, feeding, skin assessment, growth
Priority nursing dx: fluid volume excess
Patent Ductas Arteriosis (PDA) (systems affected, patho, s/sx, dx, tx, nursing)
Patho: open channel between aorta and pulmonary artery (should close by 24-72 hours old) [ increases pulmonary blood flow]
S/Sx: MACHINERY LIKE MURMUR, and S/sx of CHF ( tachycardia, tachypnea, dyspnea, hypotension, bounding pulses, edema, weight gain, pallor/cyanosis/mottling)
DX: echocardiogram
Tx: surgery, Iv Ibruprofen (can close PDA - prostaglandins)
Nursing: Ineffective feeding pattern, fluid volume excess, not treated –> pulmonary HTN
Priority nursing dx: fluid volume excess, ineffective feeding pattern
Atrial Septal Defect (ASD or PFO)
Patho: hole between right atria and left atria ( increases pulmonary blood flow)
S/Sx: MURMUR, fatigue, poor growth, CHF ( tachycardia, tachypnea, dyspnea, hypotension, bounding pulses, edema, weight gain, pallor/cyanosis/mottling)
Dx: echocardiogram
TX: surgical repair, spontaneous closure by age 4 if small (<8mm)
Nursing: if not fixed can lead to stroke
Priority nursing dx: activity intolerance
Ventricular Septal Defect (VSD)
Patho: hole between right and left ventricle (increases pulmonary blood flow)
S/Sx: MURMUR, poor growth, cardiomegaly, CHF ( tachycardia, tachypnea, dyspnea, hypotension, bounding pulses, edema, weight gain, pallor/cyanosis/mottling)
Dx: echocardiogram, CXR (look at lung involvement
Tx: surgery or will wait 6 months to see if it closes on its own
Nursing: risk
- conduction issues (b/c AV nose is really close)
- pulmonary HTN, infection
- cardiomegaly
- DYSRHYTHMIAS
AV Canal Defect
Patho: septum of the heart is missing, whole middle of the heart is affected (increases pulmonary blood flow)
S/Sx: SYSTOLIC MURMUR (really loud), poor growth, resp. infections/ failures, cardiomegaly, S/sx of CHF
Dx: Echocardiogram
Tx: surgery (2-4 months old)
Nursing: risk- cardiomegaly, CHF, dysrhythmia
Pulmonic Stenosis
Patho: pulmonic valve stenosis (located in the right ventricle), blood cant get to the lungs. [ decreases pulmonary blood flow]
S/Sx: MURMUR, SOB, chest pain, weakpulses, fainting during exercises
Dx: Echocardiogram, cardiac cath
Tx: surgery (valve replacement), balloon dilation, IV protaglandins (keeps PDA open - some blood is better than nothing )
Nursing: risk- heart failure, life threatening
Tetralogy of Fallout (TOF)
Patho: 4 defects combined (decrease pulmonary blood flow)
1. Pulmonic stenosis
2. Right ventricle hypertrophy
3. Ventricle septal defect
4. Overriding aorta
S/Sx: MURMUR, HYPERCYANOTIC EPISODES (tet spells), Squat ( knees to chest help push blood back up to heart ), cyanosis, hypoxia, poor growth, activity intolerance
Dx: echocardiogram, CXR, CBC (polycythemia - lack of O2 –> liver makes more RBC )
TX: Multiple surgeries, morphine ( helps relaxation)
Nursing: dysrthythmia
Aortic Stenosis
Patho: aortic valve stenosis (located in left ventricles) , left ventricles is affected –> enlargement –> floppy, blood cant get to the body (obstructed systemic blood flow)
S/SX: chest pain, weak pulses, exercise intolerance, fainting/ dizzy
Dx: echocardiogram, exercise test
Tx: IV prostaglandins (to keep PDA open until surgery) , balloon dilation, surgery (valve replacement)
Nursing: risk- cardiomegaly, heart failure
Coarctation of Aorta (COA)
Stricter of the aorta (rubber band), usually on the lower end of the aorta (obstructed systemic blood flow)
S/Sx: decrease BP in legs, weak pedal pulses, cyanosis to legs, poor feeding, shock, renal failure, cardiomeagaly.
Dx: echocardiogram, X-Ray
Tx: surgery (cut off bad part), IV prostaglandins (will keep PDA open)
Nursing: heart failure, shock, renal failure
