Cardiovascular Disorder Flashcards
When are the four chambers of the heart and arteries formed during gestation?
Weeks 2-8
Digoxin
Antiarrhythmic agent, cardiac glycoside
-increases contractility of the heart muscle by decreasing conduction and increasing force
What is Digoxin used for?
- heart failure
- atrial fibrillation
- atrial flutter
- supraventricular tachycardia
What must be done prior to administering Digoxin?
Count apical pulse for 1 full minute
Hold for adolescent if pulse is < 60
Hold for infant if pulse is < 90
Administering Digoxin
- monitor serum levels
- note signs of toxicity
- avoid rapid IV administration
S/S of Toxicity w/ Digoxin
- n/v
- diarrhea
- lethargy
- bradycardia
Heparin
- anticoagulant
- interferes w/ conversion of prothrombin to thrombin
- prevents clot formation
- administer SQ
What should be done when administering Heparin?
- Dose may need adjusted according to coagulation test results
- monitor for bleeding
- monitor platelet count
- ensure antidote is available
What is the antidote for Heparin?
Protamine Sulfate
What is characteristic of ventricular heart failure in older children?
Edema in the lower extremities
Where does peripheral edema develop first in the infants?
Face
S/S of Cardiac Disorder
- cyanosis
- edema
- clubbing
- fever
- retractions
- prominence of precordial chest wall
- visible engorged or abnormal pulsations
- abdominal distention
Cardiac Catherization
- definitive study of the heart
- routine diagnostic procedure
- may be outpatient procedure
What should be done before Cardiac Catherization
- ask about allergies to iodine and shellfish
- review meds; may need to withhold anticoagulants
- pay particular attention to pedal pulses
- NPO 4-6 hrs prior
- get consent
What to do AFTER Cardiac Catherization
- vitals
- neurovascular checks of lower extremities
- check pressure dressing q 15 mins for first hour the q 30 mins for 1 hour
- don’t change dressing until day after
- must remain in straight position 4-8 hours
- no strenuous activity for 3 days
- no tub baths
What to do if bleeding occurs after Cardiac Catherization
Apply pressure 1 inch above the site to create pressure over vessel and reduce blood flow
Congenital Heart Disease
- structural anomalies that are present at birth
- CHD accounts for the largest percentage of all birth defects
Acquired Heart Disease
- occur after birth
- develops from wide range of causes or can occur as complication or long term effect of CHD
Disorders w/ DECREASED Pulmonary Blood Flow
- tetralogy of fallot
- tricuspid atresia
Disorders w/ INCREASED Pulmonary Blood Flow
- patent ductus arteriosus (PDA)
- atrial septal defect
- ventricular septal defect
Obstructive Disorders
- Coarctation of the Aorta
- Aortic stenosis
- Pulmonary stenosis
Mixed disorders
- Transposition of the Great Vessels
- Total Anomalous pulmonary venous return
- Truncus arteriosus
- Hypoplastic Left Heart Syndrome
Tetralogy of Fallot
mixing of oxygenated and poorly oxygenated blood and then pumped to systemic circulation
- child will look cyanotic
- surgical intervention w/in first year
Why is Tetralogy of Fallot usually diagnosed early?
B/c infant has a LOUD HARSH murmur and is cyanotic
S/S of Tetralogy of Fallot
- Hypercyanotic spells
- Infant will get in fetal position
- Toddlers will squat
- Infants may become unresponsive
AFTER Blalock-Taussig Surgery for Tetralogy of Fallot
- no BP in affected arm
- pulse is not palpable in arm b/c subclavian artery has been used for shunt
What are the 4 heart defects that come w/ Tetralogy of Fallot?
- pulmonary stenosis
- VSD
- overriding aorta
- right ventricular hypertrophy
Atrial Septal Defect
- a hole in the wall (septum) that divides the RA from the LA
- will spontaneously close w/in first 18 months
- most asymptomatic
- fixed split second heart sound
- systolic ejection murmur best heard in pulmonic valve area
If Atrial Septal Defect does not close by age 3 what happens?
surgery
Ventricular Septal Defect
- opening b/t the RV and LV
- can spontaneously close by age 2
- Holosystolic HARSH murmur along the left sternal border
Moderate VSD can result in what?
- Heart failure by 4-8 weeks
- infant tires easily
- does not eat well
Atrioventricular Canal Defect
- endocardial cushion fails to fuse
- necessary to separate the central parts of the heart near the tricuspid and mitral valves
- creates large left to right shunt
- 45% of children w/ Down Syndrome
Patent Ductus Arteriosus
- failure of the ductus arteriosus to close w/in first few weeks of life
- causes a connection b/t aorta and pulmonary artery
- increases workload of left side of heart
- most frequent in premies
What type of murmur is heard with Ductus Arteriosus?
Harsh continuous machine like murmur under left clavicle at the 1st and 2nd intercostal space
What would a chest x-ray show for Ductus Arteriosus?
Cardiomegaly-large heart
Hypoplastic Left Heart Syndrome
- structures on left side of the heart are severely underdeveloped
- left side is unable to supply blood to systemic circulation
Treatment for Hypoplastic Left Heart Syndrome
- palliative care
- cardiac transplant
- palliative reconstructive surgery in 3 stages
S/S of Hypoplastic Left Heart Syndrome
- may be asymptomatic until ductus arteriosus closes and then newborn becomes cyanotic
- gallop rhythm single heart sounds, soft systolic, ejection, holosystolic murmur
What are the focuses of Nursing Care for a child w/ Cardiac Disorder?
- improving oxygenation
- promoting adequate nutrition
- assist child and fam w/ coping/education
- providing post op care
- preventing infection
What position can the patient be put in for relieving hypercyanotic spells and provide supplemental oxygen?
knee-to-chest
Preop Assessments during Cardiac Surgery
- temperature and weight measurements
- exam of extremities for peripheral edema, clubbing, and evaluation of peripheral pulses
- auscultation of heart
- respiratory assessment
What is the most common reason for admission to hospitals for kids w/ CHD?
Congestive Heart Failure
CHF occurs most often in who?
Children w/ congenital heart defects
