Care of the child with a cardiovascular disorder - Part 2 - Unit 4

Question 1

What is an atrial septal defect?

Answer 1

Failure of the SEPTUM between the atriums to completely form - can also occur from a patent foramen ovale. Some blood shifts back.

Question 2

What is a VSD?

Answer 2

Ventricular septal defect - most common!
Failure of the septum between the ventricles to completely form, so it floods the lungs! Possibly closed with cath or sternotomy.

Question 3

AV canal - what is it? two types? what type of lung flooding?

Answer 3

Openings between atria and ventricles – also cause valve abnormalities. AKA endocardial cushion defect.

Incomplete - separate AV valves.
Complete - common AV valve

EXCESSIVE lung flooding.

Question 4

what is a PDA? When does it usually close?

Answer 4

Patent ductus arteriosis - allows blood to flow to the aorta while being diverted from the lungs. Usually closes during first 12-24 hours (by rise in PO2 and decrease in PGE) - causes a left to right shunt when not closed, so increased blood flow to lungs.

Question 5

what is indomethacin?

Answer 5

NSAID - inhibits the synthesis of porstaglandins - 3 IV doses given at 12 to 24 hour intervals, with careful attention to urinary output.

Question 6

What are the obstructive defects?

Answer 6

Coarctation of the aorta, aortic stenosis, and pulmonary stenosis

Question 7

what is coarctation of the aorta?

Answer 7

Narrowing of the aorta - BP increased in upper extremities/decreased in lower extremities. Management with PGE, balloon angioplasty, surgical repair. risk of aneurysm present, etc.

Question 8

What is aortic stenosis? Management?

Answer 8

narrowing of aortic valve, chest pain with activity/intolerance, increased afterload, syncope present, sudden death, etc.

Managed with balloon valvuloplasty/surgical repair.

Question 9

What is pulmonary stenosis? Management? symptoms?

Answer 9

Narrowing of the pulmonary artery, right ventricular hypertrophy due to increased workload of right ventricle. DECREASED pulmonary blood flow. Manifested as loud murmur, dyspnea, syncope, angina. etc. Managed by balloon valvuloplasty & surgical repair.

Question 10

what are the defects that cause decreased pulmonary blood flow?

Answer 10

Tetrology of fallot/tricuspid atresia.

Question 11

what is tetrology of fallot? which side is stronger?

Answer 11

Pulmonary stenosis, hypertrophy of the right ventricle, overriding aorta, VSD

Increased right side pressure.

Question 12

what’s the #1 intervention for tetrology of fallot?

Answer 12

bring knees to chest! then do O2..but not o2 right away.

Question 13

What is the blalock taussig shunt?

Answer 13

Bides time with t of f - branch of artery to pulmonary artery - increases blood flow to lungs.

Question 14

what is tricuspid atresia?

Answer 14

lack of tricuspid valve between right atrium and ventricle. Underdeveloped right ventricle! ASD or PFO present, VSD present, mixing of blood occurs, increasing cyanosis, etc.

Question 15

Tricuspid atresia - they need a VSD. T/F?

Answer 15

TRUE

Question 16

what’s a fontan?

Answer 16

Systemic venous return is directed to pulmonary artery - baffle inside right atrium to direct blood from the IVC to the pulmonary artery.

Question 17

What are the mixed defects?

Answer 17

Transposition of the great vessels, total anomalous pulmonary venous connection, hypoplastic left heart

Question 18

what is transposition of the great vessels ?

Answer 18

Aorta is connected to R ventricle - pulmonary artery is connected to L ventricle - MUST have ASD/VSD, or PDA., cyanosis usually noted in 1st hour….

Question 19

What is the atrial switch?

Answer 19

Aorta and the pulmonary artery are transected above the valves, moved to the correct position! Coronary arteries have to be moved as well…

Once moved, ASD/VSD/PDA are closed.

Question 20

What is total anomalous pulmonary venous connection?

Answer 20

The 4 pulmonary veins are connected ELSEWHERE! need other defects to deliver oxygenated blood to the body. Surgical correction!

Question 21

what is hypoplastic left heart? symptoms? management?

Answer 21

underdevelopment of the left ventricle, aortic atresia, manifested with extreme cyanosis/decreased CO, management = transplant, norwood, glenn, fontan

Question 22

hypoplastic left heart - 100% mortality until surgically corrected - so they remove what?

Answer 22

Remove septum and just let it flow!

Question 23

what are some complications of CHD?

Answer 23

failure to thrive, cardiogenic shock, thromboembolism, infection, respiratory compromise, cardiac dysrhythmia

Question 24

What are some therapeutic nursing things for CHD?

Answer 24

avoid situations that increase cardiac demand (exercise, feeding, running, playing), monitor weight, small frequent feed, O2, medication, I&O, protect from infection..so DO NOT let kids cry - even though they’ll be brats, DO NOT LET THEM CRY - too much energy!

Question 25

what does prostaglandin E1 do ?

Answer 25

Causes vasodilation and smooth muscle relaxation, given IV to reestablish blood flow, allow infants to be stabilized until further treatment.