Cardiovascular Disorders Flashcards
Incidence: about 1 out of every 100 live births
About 2 or 3 of these cases are symptomatic in first year of life
25% require surgery within the first year
90% live into adulthood
Common
Major cause of death in first year of life (after prematurity)
Can be associated with prenatal factors (ex. Alcohol use, gestational diabetes)
Most common anomaly is ventricular septal defect
Often associated with other anomalies (trisomies 21, 13, 18)
Often not have do intervention - some cardiac defects not know have until in 40s - sometimes major - require surgery immediately
20 week US - hearts and pieces - see lot defects
PDA and PFO closes
Things to note:
History
Inspection
Not present at birth or present at birth
Gradual - can compensate - work harder to get O2 to blood to body
CHD
Poor feeding = due to activity intolerance; body having work extra hard to get blood out to be oxygenated - tire out quickly when feeding - not finish feedings - hard to wake up and tired; also have poor growth
Poor growth (FTT)
Activity intolerance
Developmental delays
Positive prenatal history = Uncontrolled diabetic; certain drugs - prescription or not - fam hx
Family history of cardiac disease
History
Color - Pale
Chest deformities - Phys deformities
Tachypnea
Tachycardia
Mummer - Murmur heard - normal after birth - PDA open to close first 24-48 hours
Unusual pulsations
Clubbing of fingers = later sign
Head bobbing
Sweat - not typ
Use at ECG - see structure of heart since structural issue - diagnosing want an echo
Respiratory excursion
Inspection
Acyanotic
Cyanotic
Classification of defects
Getting blood to lungs
Oxygenate to blood
Increased pulmonary blood flow
Obstruction to blood flow from ventricles
Acyanotic
Lot blood flow to lungs
Left to right shunting to lungs
Blood going to lungs still
Shunt = blood going between them in incorrect fashion; moving in way should not; heart deals with pressure; most pressure - LV - send out to body
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Increased pulmonary blood flow - Acyanotic
Something there preventing on how blood should flow
Worry about hypertrophy - bigger to pushcoarcation of aorta
Aortic stenosis
Pulmonic stenosis
Obstruction to blood flow from ventricles - Acyanotic
Not much or any blood to lungs
Decreased pulmonary blood flow
Cyanotic
Tetralogy of Fallot
Decreased pulmonary blood flow - Cyanotic
Transposition of great arteries
Mixed blood flow - Cyanotic
Common -
DA - fetal blood flow - diverts blood from going to lungs - not need blood going to lungs
Attaches pulm artery to aorta - open - mixing blood
Usually not big deal - sick and not getting better
Treat: med - close the DA; dehydrated; surgery to close it if very sick
Not Sick - not worried because no issues
Patent ductus arteriosus (acyanotic)
Hole in wall
Mixing blood - blood going to lungs
Small - majority life not noticing have this
Symptomatic - extra hard because mixing some blood going out - activity intolerance, hear murmur - do surgery and patch - try and give meds first so do surgery when older
Hole in heart
ventricular/atrial Septal defect (acyanotic)
Oxygenating blood
Work harder to get past stenotic area
Angioplasty - meds to make heart pump stronger
Do worry about hypertrophy
pulmonary/aortic Stenosis (acyanotic)
Narrowing usually begins after the left subclavian artery but before the PDA.
Dx: see in US; notice: discrepancy in vital - descending aorta - having issues - how much oxygen in it - completely constricted - getting blood if PDA open - having PDA open good - oxygenated blood in it - typ usually open - bounding upper pulses
Weak lower pulses
4 point BP - upper and lower extremities - high in UE and low in LE - may be blue in LE if severe
Coarctation (acyanotic)
“Tet” spells
When the infant’s oxygen requirements exceed the blood supply
Common during episodes of crying and feeding
Mix 4 diff heart heart defects
Ventricular Septal defect
RV Hypertrophy
RV Outflow obstruction
Aorta sitting over wrong place
Want open PDA - want mixed blood flow - meds to keep open until surgery - need right away is necessary
VSD - help get oxygenated and deoxy blood mixing - some oxy blood out
Anytime overworked, overwhelmed, upset unable to oxygenate body - Knee-chest position
100% O2
Morphine to relax them - quiet, calm environment
Older kids - Tet spells - cannot compensate - Cannot keep up go into tripod position
Tetralogy of Fallot (cyanotic)
Not crying, blue - stimulate - then pink up
Resp issue - when cry - pink up
Cardiac issue - cry - lose color - more cyanotic; needing more O2 - O2 requirement going through quicker and body cannot keep up
Determine if resp/cardiac
Aorta is connected to the right ventricle (instead of left)
Pulmonary artery connected to the left ventricle (instead of the right)
PDA or Septal defect
Is a cycle - 2 sep sys working: extremities not getting O2 blood
Surgery ASAP
Keep PDA open - prostaglandins given - IV going - umbilical lines - central lines in umbilical cord - keep PDA open
If closes SOL
PDA allow deoxy and oxy to mix
Transposition of the great vessels (cyanotic)
Caring for child with CHD
Nursing Interventions
Education
Medications
Surgery
Interventions are based on heart defect and the individual patients plan of care***
N. care
Prevent infection
Rest
Education
Oxygen needs
Feeding plans
I/O, daily weights
Nursing Interventions
Prevent from getting sick - harder - in overdrive already - not do daycare - prevent from getting sick - call pediatrician if get sick
Prevent infection
Lot edu for parents
How read O2 sat probs
Education
Timing
Caloric needs
Feeding - tire out easily - not want cardiac kids breastfeeding - work harder - get breastmilk via bottle - wider nipples - easier; increase calories of milk - add more powder to it
Feeding plans
Hospital - monitor I/O - weigh diapers
I/O, daily weights
Home care
s/s heart failure
recognize it and know something off
Sick child
Medication administration
Education
Med administration - how count HR adequately
Meds - push off surgery
Prostaglandins - keep PDA open; hospital only
Digoxin
Diuretics
ACE inhibitors
Beta-Blockers
Medications
Cardiac catheterization
Patching
Balloon angioplasty
Stents
Surgery
Heart Failure
Hypoxemia
Comps
The inability of the heart to adequately supply blood to meet the body’s needs.
Left sided
Right sided
Heart Failure
Tachypnea
Dyspnea
Nasal flaring/retractions
Wheezing
Left sided
systemic congestion
peripheral edema
Ascites
Hepatomegaly
jugular vein distension
Right sided
Inadequate oxygenation of the blood
Common in our kids with congenital heart defects (also seen in kids with resp disorders and anemia)
Signs and symptoms
Cyanosis
Tachypnea
Dyspnea
Clubbing
Polycythemia
Hypoxemia
Etiology- unknown
Clinical manifestations
Therapeutic management
Kawasaki Disease
Acute systemic inflammatory illness
Usually resolves within 8 weeks
Etiology- unknown
Acute phase
High fever, red eyes, bright red/chapped lips, strawberry tongue, oral mucosa irritation, rash, join pain
Cardiac manifestation: myocarditis, decreased left ventricular function, pericardial effusion, mitral regurgitation
Strawberry tongue
Rash hands and feet
Cardiac manifestations - myocarditis, LV - muscle not work as well, may need valve replaced
Subacute phase
Resolution of fever. Irritable, peeling skin, temporary arthritis
Convalescent
No manifestations; however, labs usually still abnormal
Clinical manifestations
Gamma globulin
Aspirin
Monitor I & O
Monitor heart function
Promote comfort
IVIG, aspirin (one time give kids aspirin and is high dose - not typ give because Reye’s syndrome - in hospital)
Therapeutic management
Inflammatory disease that occurs as a reaction to a Group A beta-hemolytic streptococcus infection (GABHS)
Diagnosed based on Jones criteria:
Major
Minor
Predisposed by strep throat
2-6 weeks after strep
Inflammatory disease
2 majors or 1 major and 2 minor
Cardiac valve issues - have be replaced
Rheumatic fever
Carditis
Subcutaneous nodules
Polyarthritis
Rash
Chorea
Major
Fever
Arthralgia
Minor
Do on every single baby
See if have heart defect not know
Highlight if at risk
Not diagnostic - tells that might have something going on - get echo - that will diagnosis it
Sat prob on right hand - preductal - one on either foot - postductal - nothing greater than 3% in O2 - rescreen before order echo; between 95-100%; 24-48 hrs of life - cheap and noninvasive way; not check for all of them
Below 95% fail; greater difference than 3% between hand and foot fail
CCHD screening
