Cardiac 2 Flashcards
describe pulmonary/pulmonic stenosis
- narrowing at the entrance to pulmonary artery
- causes increased workload on R side of heart
- congestive heart failure occurs when severe
s/s of pulmonary/pulmonic stenosis
-loud systolic injection heart murmur
thrill in pulmonic area may be present
treatment of pulmonary/pulmonic stenosis
balloon angioplasty or OHS
4 defects of tetrology of fallot (TOF)
1) pulmonic stenosis
2) R ventricular hypertrophy
3) overriding aorta
4) ventricular septal defect
s/s of tetrology of fallot (TOF)
- digital clubbing
- poor growth
- exercise intolerance
- murmur
- thrill
- hypoxemia
what happens during tetrology of fallot (TOF)
decreased pulmonary BF (unoxygenated blood enter circulation)
treatment of tetrology of fallot (TOF)
- prostaglandin E1 to maintain open ductus arteriosus
- palliative surgery to improve oxygenation (ie/ patch on VSD)
describe transposition of great vessel
- aorta arises form RV and pulmonary artery from LV
- survival depends on foramen ovale reaminaing open to mix blood
s/s of transposition of great vessel
- tachypnea, poor feeding, failure to grow,
- progressive cyanosis to hypoxia to acidosis (CHF)
treatment of transposition of great vessel
- prostaglandin E1 to maintain openings
- prophylatic antibiotics to prevent endocarditis
- palliative and corrective surgery (aggressive)
malformation and narrowing of aorta
aortic stenosis
what happens in aortic stenosis
increased workload on LV, leads to hypertrophy and HF
s/s of aortic stenosis
audible murmur, ejection click, and thrill
treatment of aortic stenosis
angioplasty or surgicla intervention to repair or replace valve
describe hypercyanosis spells (TET)
- acute episodes of cyanosis and hypoxia
- aka blue spells
how are hypercyanosis spells (TET) relieved
squatting and drawing up the legs
*assume squatting to decrease blood return from extremities
when do hypercyanosis spells (TET) occur
when infants O2 requirements exceed the blood supply (ie/ after feeding or play)
s/s of hypercyanosis spells (TET)
hypoxia
pallor
cyanosis
tachypnea
treatment of hypercyanosis spells (TET)
place child in knee chest position, calm, supplemental O2, administer morphine and propanolo IV and IV fluids
this is the narrowing and descending of aorta
this restricts blood flow from the heart
coarctation of aorta (COA)
describe COA
- left ventricular hypertrophy
- blood pressure difference between upper and lower extremities
- femoral pulses are weak
- murmur and thrill
- CVA from HTN
- can lead to CHF
treatment of COA
- prophylatic antibiotics to prevent endocarditis
- surgical resection of balloon dilation
nutrition with heart disease
- feeding can be difficult and tiring
- feed in relaxed ennvironment
- frequent small feedings
- if cannot eat during 30 min every 3 hrs, will need NG tube
describe innocent murmurs (functional)
- do not cause bad effects
- investigate, see cardiologist with any murmur to be safe
- *does NOT affect growth and development but harmful murmurs will
what is important to remember about children in the hospital
- children need adequate rest
- do everything at once
- do not continuously go in to disturb them
describe congestive heart failure
- disorder of circulation
- occurs when cardiac output is inadequate to support body’s circulation and metabolic needs
what can CHF result from
- congential heart defect
- heart contractility
- acquired heart disease (Kawasaki)
early signs of CHF
- fatigue
- irritability
- change in play behavior
- wt loss and lack of normal wt gaint
- sweating during feeding
s/s as CHF progresses
- tachycardia
- pallor/cyanosis
- tachypnea
- resp distress
treatment of CHF
- give oxygen
- Digoxin (Lanoxin)
- ACE inhibitors
- diuretics (lasix, aldactone)
management goals of CHF
- remove accumulated fluid and sodium
- decrease cardiac demands
- improve tissue oxygenation
- decrease consuption
