ch 27 cardiovascular dysfunction Flashcards
fetal circulation differences than child
-1 umbilical vein
-2 umbilical arteries
-ductus venosus and arteriorus
-foramen ovale
changes in CV system after birth
-lungs begin oxygenation
-shunts close
-rise systemic vascular resistance
-L heart pressure increase
-R heart pressure decrease
how long does transition from high pressure systemic circulation and low pressure pulmonary circulation take after birth
6-8 wks
located within the RA wall near the opening of the SVC, Pacemaker of the
heart
SA node
also located within the RA but near the lower end of the septum, major
pathway for impulses to get to the ventricles
AV node
which extends from the AV node along each side of the interventricular
septum and then divides into right and left bundle branches
AV bundle (bundle of His)
what can influence preload
hydration status
how to calculate cardiac output
heart rate x stroke volume
3 things that influence stroke volume
-preload
-afterload
-contractility
circulating blood volume, measured using CVP
preload
ventricular ejection - measured using arterial BP (resistance against ventricles)
afterload
ability of cardiac muscle to act as an efficient pump - peripheral tissue perfusion (pulses, warmth of extremities, cap refill)
contractility
what can influence afterload
high BP
what can influence contractility
electrolyte imbalances
MI
how to treat decreased cardiac output due to low preload
volume: IV fluids or blood product
how to treat decreased cardiac output due to high afterload
vasodilators
-pril
how to treat decreased cardiac output due to low contractility
inotropes (helps muscles contract)
-digoxin
-dopamine
-dalbutamine
tests of cardiac function
chest xray
ECG
echo
cardiac cath
*review vasodilators and inotrope meds
pediatric S+S cardiac dysfunction
-poor feeding
-tachycardia/tachypnea
-failure to thrive/poor weight gain/activity intolerance
-developmental delays
when might murmurs occur in a normal heart (periods of stress)
-anemia
-fever
-rapid growth
grading of murmurs
(above grade 3 = pathological)
grade 1: barely audible
grade 2: slightly louder
grade 3: moderately loud, no thrill
grade 4: loud and palpable thrill
grade 5: thrill, murmur heart with steth partially off chest
grade 6: audible w/o steth
postop cardiac cath nursing considerations
-monitor pulses
-vital signs q15mins
-dressing for bleeding
-I&O
-hypoglycemia
-keep extremity straight, sandbag on it
what do you need to document preop cardiac cath
-pulses (esp the one below the op site)
-HR
-BP
maternal causes congenital heart disease
-maternal drug use (fetal alcohol syndrome)
-rubella in first 7 wks of pregnancy
-CMV, toxoplasmosis, other viral illnesses
-infants of diabetic mothers
-chromosomal/genetic
most common anomaly
VSD (ventricular septal defect)
consequences CHD
-congested heart failure
-hypoxemia
S+S congested heart failure
-SOB
-edema
-crackles/rales, fluid in lungs
which sided heart failure is associated with:
-systemic symptoms
-lung symptoms
systemic: right
lungs: left
S+S impaired myocardial function in CHF
-tachycardia
-inappropriate sweating
-fatigue
-weakness
-restlessness
-pale
-cool extremities
-decreased BP
-decreased urine output
-weak peripheral pulses
-cardiomegaly, gallop
S+S pulmonary congestion in CHF
-tachypnea
-dyspnea
-exercise intolerance
-cyanosis
-wheezing
-grunting
-resp distress
S+S systemic venous congestion in CHF
-peripheral and periorbital edema
-weight gain
-ascites
-hepatomegaly
-JVD
nursing considerations with digoxin admin
-check HR before (hold if HR <70 in children, HR<90 in infants)
-max: 50 mcg/dose
-fast onset, short half life
-watch for potassium imbalance (hypoK = increases dig effects, hyperK = decreases dig effects)
S+S digoxin toxicity
vomiting
blurred vision
bradycardia
normal digoxin level
0.8-2.0
how to decrease preload
diuretic (lasix/furosemide)
classifications of CHD
acyanotic:
-increased pulmonary blood flow
-obstruction of blood flow out of heart
cyanotic:
-decreased pulmonary blood flow
-mixed blood flow
increased pulmonary blood flow defects (3)
atrial septal defect (ASD)
ventricular septal defect (VSD) -most common
patent ductus arteriosus (PDA)
which side of heart has higher pressure
left
meds that can help close PDA
ibuprofen
indomethacin (prostaglandin inhibitor)
3 severe obstructive defects
-coarction of aorta (COA)
-aortic stenosis (AS)
-pulmonic stenosis (PS)
S+S coarction of aorta (COA)
-poor perfusion of lower extremities
-BP difference upper and lower extremities
S+S aortic stenosis (AS)
-faint pulses, poor perfusion
-decreased cardiac output
-tachycardia, hypoTN
-poor feeding (infants)
-exercise intolerance
-chest pain
-dizziness
risk with aortic stenosis
infective endocarditis
*premedicated before dentist
Tx aortic stenosis
balloon
replacement/repair valve
S+S pulmonic stenosis (PS)
-decreased oxygenation
-R hypertrophy (cardiomegaly)
-if patent PDA, may not see symptoms
-mild cyanosis
-CHF
Tx pulmonic stenosis
-balloon
-replace/repair valve
S+S tetrology of fallot
-cyanosis “tet spells”
-poor weight gain
-irritable
-heart murmur
-tire easily
-nail clubbing
Tx “tet spells”
infant: knee chest position
older children:
-100% O2
-morphine
decreased pulmonary blood flow defects (2)
-tetrology of fallot (tet)
-tricuspid atresia
S+S tetrology of fallot
“boot shaped heart”
S+S transposition of great vessels
Tx
S+S:
-cyanotic at birth
Tx:
-give prostaglandins to keep PDA open
-intubate (prostaglandins can stop breathing)
mixed defects (3)
-hypoplastic heart syndrome (L or R)
-transposition of great vessels
-total anomalous pulmonary venous connection (TAPVR)
Tx hypoplastic heart syndrome
-norwood shunt at birth
-another procedure at 4 mo
-fontan procedure (2-4 yo)
S+S hypoplastic heart syndrome
-developmental delay
-low oxygen saturation
S+S TAPVR
-rapid breathing
-grunting
-emergency surgery needed
side effects calcium channel blockers (CCB)
-constipation
-dizziness
-palpations
-fatigue
-flushing
-headache
-nausea
-lower extremity edema
CCB meds
verapamil
nifedipine
what can’t you eat with CCB meds
grapefruit
side effects ACE inhibitor meds
-persistent dry cough
-dizziness
-fatigue
-weakness
-loss of taste
-headache
-angioedema
who can’t take ACE inhibitors
pregnant mothers
anyone who has had anaphylactic reactions
ACE inhibitor meds
-pril
side effects digoxin
vomiting
headaches
dizziness
hallucinations
diarrhea
blurred vision
side effects lasix/furosemide
dizziness
headache
blurred vision
muscle cramping (hypoK)
chest tube considerations post heart surgery
+ when to notify surgeon
-monitor drainage color every hour (immediate postop bright red, changes to serous)
-monitor drainage quantity (mark mL every hr)
**(notify if drainage >3 mL/kg/hr for 3 consec hours, or 5-10 mL/kg in one hour)
-be alert for cardiac tamponade
-pain meds after
what urinary output indicates possible renal failure
<1 mL/kg/hr
postop heart surgery complications
-CHF
-dysrhythmias
-decreased cardiac output syndrome
-decreased peripheral perfusion
-pulmonary changes
-neurologic changes
S+S postpericardiotomy syndrome
-fever
-high WBC
-pericardial friction rub
-pericardial and pleural effusion
-immediate postop or up to 21 days postop
causes endocarditis
-strep
-staph (higher mortality rate)
-fungal infections
S+S infectious endocarditis
-osler nodes (fingers)
-janeway lesion (spots on hand)
-malaise
-low grade fever
-sudden murmur
-splenomegaly
Dx infectious endocarditis
duke criteria
(major criteria:
-blood cultures
-echo findings)
Tx infectious endocarditis
-IV Abx 2-8 wks
-serial echos
-possible surgical valve repair/replacement
-prophylactic Abx for high risk pts before procedures (including dental)
-Abx: amoxicillin, ampicillin, clindamycin
high risk pts for developing infectious endocarditis
-artificial heart valve
-h/o infective endocarditis
-CHD
-h/o heart transplant
complications infective endocarditis
CHF
embolism
cause rheumatic fever
possible consequence RF
group a b-hemolytic strep
rheumatic heart disease
S+S rheumatic fever
-carditis
-polyarthritis
-erythema marginatum (red spots)
-subq nodules
prevention rheumatic heart disease
treat strep tonsillitis/pharyngitis:
-PenicillinG IM 1x
-penicillin oral 10 days
(sulfa if allergic to penicillin)
S+S kawasaki disease
-duration 6-8 wks
-high fever
-*strawberry tongue
-edema in hands and feet
-extreme irritability
-arthritis
-skin peeling bw fingers/toes
-bilateral conjunctival injection (red eyes)
-cardiac complications w/o Tx
-peak incidence in toddlers
Tx kawasaki disease
-IV IG high dose within 7-10 days onset
-aspirin (fever dose: 80 mg/kg/day, then antiplatelet dose: 3-5 mg/kg/day)
-remicade and steroids (if IV IG fails, sign: breakthrough fever within 24 hrs after IV IG)
causes secondary HTN in peds
-renal disease
-CV disease
-endocrine/neurologic disorders
Tx systemic HTN
-ACE inhibitors
-ARBs
-DASH diet
-lifestyle changes if obese
*BOX 27.13 -review of antiHTN meds
what kids would receive first line therapy of ACE inhibitor or ARB for HTN
-CKD
-protienuria
-diabetes
Tx hyperlipidemia
-diet: restrict intake cholesterol and fats
meds if diet doesn’t work:
-colestipol
-cholestyramine
brady dysrhythmias (2)
-sinus brady
-AV block
tachy dysrhythmias (1)
SVT (superventricular tachy)
possible causes sinus tachy (not structural)
-fever
-anxiety
-pain
-dehydration
-anemia
what HR to start CPR on kid
<60 bpm
what bpm is SVT
200-300 bpm
narrow complex
Tx SVT
-vagal maneuver (ice on face, unilateral carotid artery massage, valsalva)
-adenosine rapid IV push
-synchronized cardioversion
medical management tachycardia
-beta blocker (propranolol for infants, atenolol for children)
-digoxin (not in kids with WPW syndrome)
-radiofrequency ablation
Tx pulmonary artery HTN
-sildenafil (viagra)
-CCB
3 types cardiomyopathy
-dilated (most common)
-hypertrophic
-restrictive
Tx cardiomyopathy
-treat underlying cause
-digoxin
-diuretics
-b blocker,CCB
-dobutamine
-nitroprusside
-amrinone
S+S cardiac tamponade
triad:
-JVD
-narrowing pulse pressure, low bp
-muffled heart tones
