Cardiac Flashcards
stenosis
narrowing causing obstruction to blood flow
Atresia
Complete blockage of blood flow
heart murmurs
abnormal struture of the heart, making blood travel in an abnormal fashion resulting in noise
Physical indicators of cardiac dysfunction
Tachypnea, tachycardia, diaphoresis, crackles, edema, cyanosis, murmur, sternal lift, clubbing of the fingers
Normal heart rate:
- Newborn
- 3 Years
- 10 years
- 16 years
- 120-160
- 80-125
- 70-120
- 55-90
Cardiac catherization
Invasive routine and diagnostic procedure using radiopaque catheters placed in peripheral blood vessel and then guided into heart with aid of fluoroscopy
Biggest risks of cardiac cath
BLEEDING
Cardiac cath post op care includes:
Check pulses
Monitor coolness, blanching
Vitals taken every 15 minutes, HR for full 60 seconds
Hypotension could indicate hemorrhage
Fluid intake, blood glucose levels
What do you do if bleeding occurs after a cardiac cath?
Direct continuous pressure is applied 1 inch above the site to localized pressure of the vessel puncture
What do you do before giving digoxin?
Check apical pulse for a full 60 seconds prior to administration
What pulse would indicate not to give digoxin?
- Infants?
- Older children
90 -110 bpm in infants
70 beats/min in older children
Signs of toxicity in digoxin
N/V
Anorexia
Bradycardia
Dysrhythmias
Prostaglandins - IMPORTANT TO KNOW!
Metabbolizes rapidly - infusion must be continuous and have it’s own IV line
Side effects of prostaglandins
Reduced glomerular filtration
Impaired Plt function
Decreased GI blood flow
What is the major cause of death in the first year of life?
Congenital Heart Disease
Left to Right Shunting
Involves blood flow from the left side(blood that goes to the body) of heart to the right side(blood that goes to the lungs) resulting in increased pulmonary blood flow
Ventricular septal defect(VSD)
MOST COMMON
- Abnormal opening is present in the septum between the two ventricles
Allows blood to shunt L-R
Blood that should go to aorta and out of the body shunts back into pulmonary circulation
VSD assessment upon child
occurs when 4-8 years old
Fatigue, loud and harsh murmur
- SOB, crackles, feeding difficulty, murmur, FTT. respiratory infections, cardiomegaly
- Fatigue, Harsh murmur(at 4-8 weeks of life) is when shunting starts
Treatment of VSD
Most close spontaneously by age of 1
Cardiac cath: moderate size
Prophylatic abx 6 mos - prevents endo carditis and other infections before/after surgery
When would you perform open heart surgery for a patient with VSD?
Over 3mm
-age of 2
Nursing interventions of VSD:
Monitor feeding - give breaks during
S/S CHF
Monitor WOB
Medication for VSD
-Diuretic or digoxin - prevent fluid accumulation in lungs
Atrial Septal Defect(ASD)
- abnormal opening between the atria that causes an increased flow of oygenated blood into the right side of the heart
- Blood shifts L to R
- Most common in girls
How will a patient present with ASD?
Asymptomatic until infection from recirculating blood occurs
Treatment for ASD
- Surgery between 1-3 years old
What happens if ASD is not repaired?
Emboli formation later in life
Infection - endo carditis, HF
S/S of ASD
Asymptomatic
- Harsha systolic murmur over pulmonic area
- Increased blood volume right side of heart
- Split second heart sound(lub-dud-dud)
- Most close spontaneously
Patent Ductus Arteriosus(PDDA)
Failure of the fetal ductus arteriosus(sjunt connecting the aorta and the oulmonary artery) to close within first weeks of life
What would you see in PDA?
- Continuous murmur
- Shunting blood from aorta to pulmonary artery d/t higher pressure in aorta
- Same s/s as ASD - wide pulse pressure, murmur, wet bs, tachypnea, poor feeding, sweating w/ feedings
Treatment of PDA
- Iv Indomethacin or ibuprofen - PGE inhibitors
- Cardiac cath - 6mos -1 year
Ductal ligation
When should PDA close on its own?
Should close hours to days after birth, may take up to 3 months
Nursing Interventions for PDA
Risk for CHF/endocarditis
- Decrease WOB, Give rest periods, I&O, Diueretics, Dopamine, Digoxin, Daily weight
Pulmonic Stenosis
narrowing at the entrance of the pulmonary artery
S/S of pulmonic stenosis
- Mild right sided CHF
- Cyanosis
- Loud murmur
- SOB, RV hypertrophy
- Cardiomegaly
Nursing interventions for pulmonic stenosis
- Calm envirnment
- Monitor BP/O2 sat
-If atresia - Give PGE keep PDA open, IV own line, continuous infusion
Treatment for pulmonic stenosis
- Cardiac cath - Balloon angioplasty
- Normal life span
- Restenosis may occur
Aortic Stenosis
narrowing or stricture of the aortic valve, causing resistance to blood flow from the left ventricle into the aorta, causing a decreased cardiac output
Symptoms of aortic stenosis
- Murmur(may or may not be present)
- Faint pulses
- Hypotension
- Tachycardia
- Poor feeding
- Chest pain
- Exercise tolerance
Treatment of Aortic stenosis
- Stabilization with beta blocker or CCB
- Balloon valvuloplasty
- May need valve repalcement
- Anticoagulation
- Antiplts
- Abx
- Exercise test before competitive sports
Coarctation of the aorta
- Localized narrowing near the insertion of the ductus arteriosus
- Aorta brings blood to the rest of the body
What is the only mild symptom that you would see in COA?
- Dec/Absent femoral pulse
-Cardiomegaly - R sided heart failure
- HTN(headache)
- SOB, Poor feeding
Chest xray
Nursing interventions for COA
Medication - digozin/lasix
- Mild( wait ti repair) at age 2
- Cardiac cath dilation(baloon angioplasty)
- Stent placed
What would be done if severe COA?
Baloon cath then surgery
Decreased pulmonary blood flow:
Blood is having a difficult time leaving the right side of the heart via the pulmonary artery
