Cardiovascular system Flashcards
(31 cards)
What is Congestive Cardiac Failure (Heart failure)
The inability of the heart to pump an adequate amount of blood to the systemic circulation to meet the metabolic and oxygen needs of the body.
Right sided heart failure
Right ventricle is unable to pump blood effectively into the pulmonary artery resulting in increased pressure in the right atrium and systemic venous circulation.
Left sided heart failure
The left ventricle is unable to pump blood into the systemic circulation resulting in increased pressure int the left atrium and pulmonary veins
Clinical manifestations of impaired cardiac function
- Tachycardia
- Sweating
- Decreased urinary output
- Fatigue
- Pale, cool extremities
- Weak peripheral pulses
- Decreased blood pressure
- Cardiomegaly
Clinical manifestations of pulmonary congestion
- Tachypnea
- Dyspnea
- Retractions
- Nasal flaring
- Cyanosis
- Wheezing
- Cough, hoarseness
- Exercise intolerance
Clinical manifestations of systemic venous congestion
- Weight gain
- Hepatomegaly
- Ascites
- Neck vein distension
- Peripheral edema especially periorbital
Therapeutic management
- Improve cardiac function (contractility and decrease afterload)
- Remove accumulated fluid and sodium
- Decrease cardiac demands
- Improve tissue oxygenation and decrease consumption
Interventions to improve cardiac function
1) Administer digoxin (digitalis glycosides) to improve contractility, looking for prolonged PRZ interval and reduced ventricular rate
2) Administer angiotensin-converting enzyme inhibitors to reduce after on the heart, making it easier to pump. It acts by inhibits renin/angiotensin II system.
3) Administer beta blockers which causes decreased heart rate, decreased blood pressure and vasodilation. It acts by blocking beta- and alpha-adrenergic receptors.
Side effect of ACE inhibitors
Cough
Interventions for accumulated fluid and sodium
1) Administer diuretics
2) Strict fluid restrictions - monitor for dehydration
3) Monitor strict intake and output
4) Sodium restrictions - less often in children because of negative effects on child’s appetite and ultimate growth
Interventions to decrease cardiac demands
1) Provide a neutral thermal environment to prevent cold stress in infants
2) Treat any existing infections
3) Place in semi-fowler position to reduce effort of breathing
4) Use sedative for irritable child
Before giving digoxin, you should
Check child’s apical pulse. Digoxin is not given if pulse is below 90 - 110 beats/min in infants and young children or below 70 beats/min in older children.
Signs of digoxin toxicity
- Nausea
- Vomiting
- Anorexia
- Bradycardia
- Dysrhythmias
Ductus venous
Shunts oxygenated blood away from the liver into the inferior vena cava
Foremen ovale
Allows oxygenated blood to enter the left atrium and ventricle to be pumped through the aorta to the head and upper extremities
Ductus arteriosus
Shunts blood pumped to the pulmonary artery away from the lungs to the descending aorta
What is atrial septal defect?
Abnormal opening between the atria that causes an increased flow of oxygenated blood into the right side of the heart leading to increased pulmonary blood flow.
Treated during cardiac catheterization and open repair with cardiopulmonary bypass
What is ventricular septal defect?
The abnormal opening between the right and left ventricle. A characteristic murmur is present leading to increased pulmonary flow.
Treatment is during cardiac catheterization and open repair may be done with cardiopulmonary bypass.
Patent ductus arteriosus
The failure of the fetal ductus arteriosus to close within the first weeks of life leading to increased pulmonary blood flow.
Treatment includes administration of indomethacin, prostaglandin inhibitor to close the patent ductus. Defect may also be closed during cardiac catheterization or surgical management.
What is coarctation of the aorta?
Localized narrowing near the insertion of the ductus arteriosus.
Blood pressure is higher in the upper extremities than the lower extremities; bounding pulse in the arms, weak or absent femoral pulses and cool lower extremities may be present.
Management includes balloon angioplasty or surgical management consisting of resection of coarcted portion
Tetralogy of Fallot
A combination of four defects:
* Ventricular septal defect
* Pulmonary stenosis
* Overriding aorta
* Right ventricular hypertrophy
What is hypercyanotic spells?
Acute episodes of cyanosis and hypoxia (hypercyanotic spells), called blue spells or tet spells, occur when the infant’s oxygen requirementsexceed the blood supply, such as during periods of crying, feeding, or defecating
Nursing management of Tet spells
- Place infant in knee-chest position
- Use a calm, comfort approach
- Administer morphine subcutaneously or through an existing IV line
- Administration of IV fluid replacement and volume expansion if needed.
- Administration of prostaglandin E1 to reestablish pulmonary blood flow.
What is infective endocarditis?
Infection of the inner lining of the heart (endocardium) generally involving the valves
Therapeutic management includes administration of prophylactic antibiotic therapy to high-risk patients before dental procedures. Drugs of choice include amoxicillin in penicillin allergic patients administered 1 hour before the procedure.
