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Nursing 271 > Chapter 26: Congenital Heart Disease (Children) > Flashcards

Chapter 26: Congenital Heart Disease (Children) Flashcards

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1
Q

Congenital Heart Disease

A

a defect in the heart, great vessels, or a noted disease pattern after birth

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2
Q

How can the nurse recognize a congenital heart defect?

A

recognizing the shunting pattern and recognizing cyanotic versus acyanotic congenital heart defects

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3
Q

What are the Signs and Symptoms Related To?

A
  • the oxygenation status of the defect

- the contractility state or if the patient is in heart failure

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4
Q

Cyanotic Defects

A

right to left shunting

  • the deoxygenated or venous blood from the right side of the heart is forced into the left side of the heart
  • the overall oxygen saturation of the blood will drop; range may vary from normal (96-100%) to as low as 70%
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5
Q

Acyanotic Defects

A

left to right shunting

  • the oxygenated blood shunts from the left to the right
  • this type of mixing will not affect the overall oxygenation status
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6
Q

In the presence of normal hemoglobin, a decrease in the oxygenation saturation to 85% will cause what?

A

an outward sign of cyanosis (bluish coloration) that appears around the lips, nose, and mouth of babies and toddlers and in the nailbeds of older children
-if the decreased oxygen state is chronic, the child will eventually develop clubbing of the fingernails; the longer and lower the oxygen saturation, the more evident the clubbing (explanation: the capillaries enlarge (dilate) to accommodate the low saturation in an attempt to deliver more blood to the periphery)

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7
Q

Polycythemia

A

long-term effect of low oxygenation
-is the increase in red blood cell production in response to the low oxygen output
-has hemoglobin levels greater than 15 g/dL
-condition causes thickening of the blood and predisposes the child to thrombi and stroke
>low oxygenation and thickened blood will often cause the heart muscle to work harder in an effort to circulate more oxygen; this leads to muscular hypertrophy and eventually pump failure

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8
Q

Diagnosis

A

diagnosis of a heart murmur usually starts with a referral after a murmur is detected
-symptoms can be present: SOB, or high blood pressure in children

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9
Q

Diagnostic Screenings

A

-chest x-ray
-electrocardiogram (ECG)
>most confirmed by echocardiography or cardiac catheterization
-echocardiogram gives information such as location and size of the defect and can give indirect measurement of pressure
-cardiac cath will give direct measurements of the pressure in the chambers and vessels and gradients (difference of pressure) across the valves

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10
Q

Nursing Care

A
  • monitoring and maintaining the child’s oxygen and nutritional status
  • educate family about importance of rest periods and managing the child’s fatigue
  • emotional care; this condition may involve many types of surgeries and many hospitalizations; provide emotional support by listening and suppling the family with resources for understanding the disease, prognosis, and treatment plan
  • help fulfill spiritual needs when family is interested
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11
Q

Medical Care

A

focuses on treating the CHF that may develop b/c of the specific defect and includes preload-reducing agents (furosemide (Lasix)), positive inotropes (digoxin (Lanoxin)), and contractile function agents (carvedilol (Coreg))

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12
Q

Surgical Care: Preoperative Care

A
  • thorough history and physical to identify recent changes in the past medical history
  • preop checklist
  • nurse can provide and support the education given to the family regarding the type of surgery and the process of the surgery (e.g. surgery time, recovery times, and expectations)
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13
Q

Surgical Care: Postoperative Care

A
  • sometimes includes admission to the intensive care unit

- care is complex

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14
Q

Nonpharmacological Approaches to Congenital Heart Defects

A
  • exercise

- stress reduction

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15
Q

Only method to “cure” a defect

A

-surgery

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16
Q

Safety Measures when Caring for a Patient with CHD

A

placing child on a pulse oximeter and cardiac monitor

-these children are at risk for deoxygenation and dysrhythmic episodes

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17
Q

Education/ Discharge

A
  • monitoring vital signs and how to recognize signs and symptoms of cardiac failure
  • parents should learn CPR
  • if discharged to home with oxygen, parents will have pulse oximeter in the home
  • taught subtle signs of CHF (SOB, decreased appetite, irritability, swelling, weight gain)
  • medication use, effects, side effects
  • postop teaching points will answer questions about diet. exercise, activity, and return to school
  • care of surgical wound if post op
18
Q

Proper Diet for a Cardiac Patient

A

includes balanced, healthy food choices for good bone healing

  • avoidance of junk food and empty calories
  • fluid restriction may be used in adults, practice avoided in children since infants and younger children can dehydrate much easier
19
Q

Care of the Surgical Wound

A
  • area to be kept clean and dry
  • steri-strips often kept in place until they fall off
  • parents taught how to watch for wound healing and signs of infection (redness at the site or fever)
20
Q

Post-Op: When a Sternal Approach is Used in Surgery

A

the bone must be allowed to heal for 6 weeks

  • infant or baby must be cradled when picked up or carried (i.e. avoid lifting the child from under arms)
  • older children should not use backpacks
21
Q

Exercise Guidelines

A

specific for each condition and based on protection of the surgical site and bone healing time
-older children: no contact sports are allowed in the first 6 weeks to 6 months after surgery until the bone is healed
>a child may be fitted with a protective vest to prevent injury to the chest when returning to sports
-good exercise plan might help to make the heart muscle stronger and help to prevent CHF
-parents taught that the child with a cardiac condition may be incapable of doing certain strenuous exercises and may need to modify or avoid physical activity; there may be a fine line between encouraging the child to engage in physical activity for the benefits and inhibiting the child from doing physical exercise for fear of getting sicker
>nurse helps balance the decision for the types and amounts of exercise

22
Q

When can a Child Return to School After Surgery

A
  • when the bone is healed

- nurse provides parents with community based resources to set up home-bound schooling

23
Q

ATI: Congenital Heart Disease

A

anatomic defects of the heart prevent normal blood flow to the pulmonary and/or systemic system

  • Increased pulmonary blood flow: ASD, VSD, PDA
  • Decreased pulmonary blood flow: Tetralogy of Fallot
  • Obstruction of blood flow: Coarctation of the Aorta
  • Mixed Blood Flow: Transposition of the great arteries
24
Q

ATI: Defects that increase pulmonary blood flow

A

allow blood to shift from the high pressure (Left side) to the lower pressure (right side) of the heart
-increased pulmonary blood volume on the right side of the heart increases pulmonary blood flow
>Ventricular Septal Defect (VSD)
>Atrial Septal Defect (ASD)
>Patent Ductus Arteriosus (PDA)

25
Q

ATI: Ventricular Septal Defect (VAD)

A

a hole in the septum between the right and left ventricle that results in increased pulmonary blood flow; increased flow to the lungs
(left-to-right shunting)
-loud, harsh murmur auscultated at the left sternal border
-heart failure
-many can close spontaneously early in life

26
Q

ATI: Atrial Septal Defect (ASD)

A

a hole in the septum between the right and left atria that results in increased pulmonary blood flow; increased blood flow to the lungs
(left-to-right shunting)
-loud, harsh murmur with a fixed split second heart sound
-heart failure
-asymptomatic

27
Q

ATI: Patent Ductus Arteriosus (PDA)

A 
condition in which the normal fetal circulation conduit between the pulmonary artery and the aorta fails to close and results in increased pulmonary blood flow
(left-to-right shunting)
-systolic murmur (machine hum)
-wide pulse pressure
-bounding pulses
-asymptomatic
-heart failure
-rales
28
Q

ATI: Obstructive Defects

A

include those where blood flow exiting the heart meets an area of narrowing (stenosis), which causes obstruction of blood flow
-the pressure that occurs before the defect is increased (ventricle) and the pressure that occurs after the defect is decreased; results in decreased cardiac output
>Coarctation of the Aorta

29
Q

ATI: Coarctation of the Aorta

A

a narrowing of the lumen of the aorta, usually at or near the ductus arteriosus, that results in obstruction of blood flow from the ventricle

  • elevated blood pressure in the arms
  • bounding pulses in the upper extremities
  • decreased blood pressure in the lower extremities
  • cool skin of lower extremities
  • weak or absent femoral pulses
  • heart failure in infants
  • dizziness, headache, fainting, or nosebleeds in older children
30
Q

ATI: Defects that Decrease Pulmonary Blood Flow

A

have an obstruction of pulmonary blood flow and an anatomic defect (ASD or VSD) between the right and left sides of the heart
-right to left shunting of blood allowing deoxygenated blood to enter the systemic circulation
-hypercyanotic spells (blue, or “Tet” spells) manifest as acute cyanosis and hyperpnea
>Tetralogy of Fallot

31
Q

ATI: Tetralogy of Fallot

A

four defects that result in mixed blood flow
-pulmonary stenosis
-ventricular septal defect
-overriding aorta
-right ventricular hypertrophy
>cyanosis at birth: progressive cyanosis over the first year of life
>systolic murmur
>episodes of acute cyanosis and hypoxia (blue or “Tet” spells)

32
Q

ATI: Mixed Defects

A

Transposition of the great arteries
>a condition in which the aorta is connected to the right ventricle instead of the left, and the pulmonary artery is connected to the left ventricle instead of the right
-murmur depending on presence of associated defects
-severe to less cyanosis depending on the size of the associated defect
-cardiomegaly
-heart failure

33
Q

ATI: Therapeutic Procedures for Ventricular Septal Defect

A

> Non-surgical:

  • closure during cardiac catheterization
  • careful observation for spontaneous closure
  • diuretics

> Surgical:

  • pulmonary artery banding
  • complete repair with patch
34
Q

ATI: Therapeutic Procedures for Atrial Septal Defect

A

> Non-surgical:

  • closure during cardiac catheterization
  • diuretics
  • low dose aspirin 6 months after procedure

> Surgical:

  • patch closure
  • cardiopulmonary bypass
35
Q

ATI: Therapeutic Procedures for Patent Ductus Arteriosus

A

> Non-surgical:

  • administration of indomethacin (to allow for closure)
  • insertion of coils to occlude PDA during cardiac catheterization
  • administer of diuretics (furosemide)
  • provide extra calories for infants

> Surgical:
-Thoracoscopic repair (ligate vessels)

36
Q

ATI: Therapeutic Procedures for Coarctation of the Aorta

A

> Non-surgical:

  • infants and children: balloon angioplasty
  • adolescents: placement of stents

> Surgical:
-repair of defect recommended for infants less than 6 months of age

37
Q

ATI: Therapeutic Procedures for Tetralogy of Fallot

A

> surgical

  • shunt placement until able to undergo primary repair
  • complete repair within the first year of life
38
Q

ATI: Therapeutic Procedures for Transposition of the Great Arteries

A

> Surgical

  • surgery to switch the arteries within the first 2 weeks of life
  • IV prostaglandin E (keeps ducts open)
39
Q

ATI: Digoxin

A

improves myocardial contractility
>Nursing Actions:
-monitor pulse and withhold as prescribed; if pulse less than 90/min in infant withhold; if less than 70/min in children withhold
-monitor for toxicity (bradycardia, dysrhythmias, nausea, vomiting, anorexia); administer Digoxin Immune Fag as antidote

40
Q

ATI: Captopril or Enalapril

A

angiotensin-converting enzyme (ACE) inhibitors reduce afterload by causing vasodilation, resulting in decreased pulmonary and systemic vascular resistance
>Nursing:
-monitor blood pressure before and after
-monitor for hyperkalemia

41
Q

ATI: Metoprolol or carvedilol

A

beta-blockers decrease HR and BP, and promote vasodilation

  • monitor blood pressure and pulse prior to administration
  • monitor for adverse effects (dizziness, hypotension, and headache)
42
Q

ATI: Furosemide or chlorothiazide

A

potassium-wasting diuretics rid the body of excess fluid and sodium

  • encourage high-potassium diet
  • monitor I & O
  • monitor for adverse effects (hypokalemia, nausea, vomiting, and dizziness)
  • monitor weight daily

Nursing 271 (208 decks)

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