Cardiac Dysfunction Flashcards
Inspection of a child with cardiac problems
nutritional state color chest deformities unusual pulsations respiratory excursion digital clubbing
is FTT associated with heart problems?
yes
historical assessment of a child with cardiac problems
parental concerns
mothers health and pregnancy (DM, ETOH, Drugs?)
family history
what is a late sign of something going on cardiac in infants?
cyanosis
what is a cardinal sign of something going on cardiac in infants?
poor weight
tachycardia
assessment of a child with possible cardiac disorders
palpation and percussion
auscultation
what do you look for on a cxr for cardiac?
any abnormalities
increased heart size
what do you look for on an abdominal assessment for cardiac?
hepatomegaly
enlarged spleen
what do you look for in peripheral pulses for cardiac?
are they even?
bounding?
faint?
unilateral?
what diagnostic tests do you use for cardiac evaluation?
chest xray - do 1st ECG- 15 lead CBC- check for polycythemia echo- can be done fetally if needed ABG cardiac cath- to visualize heart structure
cardiac catheterization
can do diagnostically or interventional (know what is wrong and fix it)
electrophysiology (check impulse of heart, irritate specific part of heart)
which side of the heart is commonly used in peds for cardiac catheterization?
Right side
it is safer and structural defects allow access to left side of heart
pre procedural care of cardiac catheterization
assess skin ( diaper rash, any skin breaks)
NPO 4-6 hours, clarify AM needs
IV fluids if indicated (polycythemia start fluids to prevent dehydration)
developmentally appropriate psychological prep (let them know what to expect)
sedation?
mark pulses in both feet
post procedural care of cardiac catherterization
observe for skin color LOC VS respiratory status pulses dressings fluid intake, IV and PO hypoglycemia
what is important to know about distal pulses following a cardiac cath?
distal pulses to the site can be weaker for the first few hours post procedure
how long must a child maintain a flat lying position with legs not bent following a cardiac cath?
Venous 4-6 hours
Arterial 6-8 hours
if you suspect bleeding following a cardiac cath what do you do?
circle drainage, time and date
if you suspect a bleed occlude the area 1 inch above insertion site.
CALL FOR HELP, do not leave patient.
discharge planning following cardiac catheterization
pressure dressing x 24 hours
no tub baths for 48 hours
rest that night but resume normal activities afterwards
teach for s/s of infection
can infants hearts pump harder? why
no, they can only pump faster
because in infancy muscle fibers of the heart are less developed and less organized resulting in limited functional capacity
anatomy developmental considerations
heart size- ventricles are equal size at birth
normal O2- 95-100%
infants and small children have thin chest walls with little to no sub-q fat and muscle
ductus venosus
helps blood bypass lungs
blood bypasses liver
ductus arteriosis
blood escapes through here to avoid lungs, blood is shunted to descending aorta
blood bypasses lung
this closes in presence of increased oxygen concentration in blood
fetal blood flow
O2 rich blood enters fetal body through umbilical vein to liver where it divides 1/2 to liver, 1/2 to inferior vena cava via ductus venosus (1st fetal opening) after birth it closes, then to RT atrium to LT atrium through foramen ovale (2nd opening), then LT ventricle, then aorta to head and extremities, then returned to placenta via descending aorta through umbilical arteries
foramen ovale
between RT atrium
since lungs are not working blood bypasses the lungs
when does foramen ovale close?
when infant takes 1st breath and air fills lungs causing pulmonary vasodilation allows for vascular resistance to decrease.
fetal shunts
all close at birth or shortly after
why do fetal shunts close?
decreased maternal hormone prostaglandin E
increased O2 saturations
pressure changes within the heart
general clinical findings for cardiac defects
dyspnea on exertion feeding difficulty - FTT HR over 200, RR about 60 in infants recurrent respiratory infections cyanosis and clubbing fingers squatting/ knee to chest position heart murmurs excessive sweating signs of HF
types of cardiovascular disorders in children
congenital heart defects (CHF)
acquired cardiac disorders
if there is a hole in the LT side of heart how does blood flow?
increased pressure between atrium and ventricles, blood flows from high pressure to low pressure causing a LT to RT sided shunt
blood flow of heart
RT atrium tricuspid valve RT ventricle pulmonic valve to lungs, blood becomes oxygenated enters LT atrium mitral (bicuspid) valve LT Ventricle Aortic valve Aorta
2 classifications of heart defects
acyanotic and cyanotic
the severity of congenital heart defects depends on the severity of these two principle consequences
defects that result in LT to RT shunting of blood
Defects that result in decreased pulmonary blood flow
acynotic heart defects with increased pulmonary blood flow can indiate
atrial septal defect
ventricular septal defect
patent ductus arteriosis
acyanotic heart defects with obstructive lesions, decreased blood flow to areas of the body can indicate
coarctation of aorta
aortic stenosis
pulmonic stenosis
cyanotic heart defects with decreased pulmonary blood flow can indicate
tetralogy of Fallot
tricuspid atresia
cyanotic heart defects with mixed blood flow
transposition of the great vessels
hypoplastic left heart
truncus arteriosus
clinical consequences of defects with increased pulmonary blood flow
left to right shunting occurs
increased blood volume on the right side of heart increases pulmonary blood flow at the expense of systemic blood flow
*blood that should be returning to the lungs is going back to the heart
clinical signs and symptoms of increased pulmonary blood flow
s/s of HF
what is CHF?
inability of the heart to pump enough blood enough blood to meet the bodies demand
CHF can be caused by
volume overload
pressure overload
decreased contractility (cardiomyopathy)
high cardiac output demands
clinical manifestations of pulmonary venous congestion
tachypnea wheezing crackles retractions cough dyspnea on exertion feeding difficulties irritability fatigue with play
clinical manifestations of systemic venous congestion
hepatomegaly ascites edema weight gain neck vein distention
clinical manifestations of impaired myocardial function (cardiac output)
tachycardia weak peripheral pulses hypotension gallop rhythm longer capillary refills pallor cool extremities oliguira fatigue restlessness enlarged heart sweating
clinical manifestations of high metabolic rate
FTT or slow weight gain, perspiration
therapeutic management of CHF
improve cardiac function
remove accumulated fluid and sodium
decrease cardiac demands
improve tissue oxygenation and decrease oxygen consumption
medications for CHF
Lasix (furosemide)- monitor K+
Ace inhibitors ( PRILS) stops vasoconstriction and decreases afterload, decreased BP
Digitalis (digoxin)- only oral inotropic agent works very rapid, causes heart to pump harder, increased contractility
rules for administering digitalis
regular intervals
1 hour before eating or 2 hours after
apical heart rate for 1 min(hold if <90-110 for infants/children, <70 older kids)
do not mix with food/liquids
give behind teeth or brush after administering (stains teeth)
if a child misses a dose of digitalis what do you do?
if <4 hours give the missed dose
>4 hours withhold med
if 2 doses are missed contact provider
if the child vomits after administering digitalis what do you do?
do not repeat dose
if the child is hospitalized and receiving digitalis what do you monitor?
potassium levels prior to giving digitalis
digitalis levels
when do you hold digitalis?
if potassium levels are low
s/s of digitalis toxicity
nausea vomiting bradycardia anorexia neurologic and visual disturbances *monitor child closely for dysrhythmias b/c digoxin toxicity can cause hyperkalemia
what is the antidote for digitalis toxicity?
digibind (digoxin immune fab fragments)
* monitor for rapidly falling potassium levels
nursing considerations for activity intolerance r/t CHF
promote adequate rest prevent crying small frequent feedings (don't want to exhaust from eating) short intervals of play prevent shivering supplemental oxygen if needed
nursing considerations for altered nutrition r/t CHF
anticipate hunger (small, frequent meals)
feed no longer than 30 min at a time and give rest through NG
non-stimulating environment
semi-erect position for feeding
burp before starting and frequently
formula with increased calories per ounce
soft preemie nipple with moderately large opening
encourage mom to pump and feed through bottle
nursing considerations for ineffective breathing pattern
assess RR, effort and O2 sats
position to encourage maximum chest expansion
avoid constriction
humidified supplemental oxygen during stressful periods such as bouts of crying or invasive procedures
1 oz of weight gain = how many grams
28.35 grams
weight gain of how many grams can indicate fluid overload?
50 grams
nursing considerations for fluid volume excess of CHF
accurate I and O daily weight (same time and clothes) assess for edema maintain fluid restriction if ordered good skin care change positions frequently
