CHD Flashcards
What is the most common pediatric anomaly?
VSD
Hx and physical exam: Risk factors (3)
- Maternal health, environment and genetics
- drug use or medication use
- Rubella exposure
What to assess for in maternal, environmental and genetics hx? -3
- CMV, toxoplasmosis
- IDMs
Drug use or medication use in history -2
- FAS
- Dilantin
How to assess for cyanosis in an infant
Blanch nose or may notice it on lips
In children, where is edema first and last seen
-periorbital —> sacral
What to look for in the chest
Precordial chest wall
Which peripheral pulses to check in children
Brachial and femoral
For a right-sided cardiac cath where is the catheter threaded?
Threaded to the right atrium via the femoral vein
For a left-sided cardiac cath, where is the catheter threaded?
Threaded to the aorta via an artery
Nursing management before cardiac cath (3)
- assess allergy to iodine or shellfish
- pay attention to pulses
- inform about possible complications
Complications of cardiac cath- 5
- bleeding
- arhthymias
- hematoma
- thrombus formation
- infection
Nursing management after cardiac cath- 6
- monitor complications
- evaluate vital signs
- neuro status
- check pressure over cath site
- assess pulses
- encourage feeding
Checking vital signs after cardiac cath
Every 15 minutes for the first hour then every 30 min for the next hour then every hour then routine
WHere to check for bleeding in a post cardiac cath pt
Under pt —> check sheets, back, butt
What will the pulses be like after cardiac cath
-slightly less on the side that was catheterized
What does the child have to do with the affected extremity after cardiac cath
Keep it straight for 4-8 hours
Patho for increased pulmonary blood floe heart defects
Left side of the heart is at higher pressure than right which means defects that cause a connection between the two sides makes to blood flow from left to right causing more blood to the lungs and overwhelms the lungs ability to move blood to the left side of the heart
Wet lungs make gas exchange more difficult —> child compensates with tachycardia and tachypnea
Risks of increased pulmonary blood flow heart defects -3
- risk of infections (PNA)
- decreased blood to cellular level (thin, low weight, failure to thrive)
- pulmonary HTN
S/s increased pulmonary pressure cardiac defect (7)
- loud, mechanical murmur
- tachypnea, tachycardia
- poor feeding
- diaphoresis with feeding
- thin, small child
- periorbital edema
- frequent PNA
Can a child with increased pulmonary pressure heart defects receive O2? Why?
No it will cause more issues due to O2 causing pulmonary vasodilation = more pulmonary blood flow = more symptoms
Heart defects of increased pulmonary pressure (3)
- ASD
- VSD
- patent ductus arteriosis (PDA)
What is ASD?
-opening between R and L atria —> blood flow from L to R —> R atria becomes distended —> blood backs up into pulmonary vessels causing R Ventricle to become distended
Hx and PE ASD (3)
- poor feeding
- hyper dynamic pericardium
- fixed split heart sound and systolic ejection murmur
TX ASD
Closed in cardiac cath procedure —> surgical repair with patch before age 6
Complications ASD closure
- atrial arrhythmias
- with Gore Helix decide strenuous activity should be avoided for 2 weeks post procedure
Patho VSD
-opening between ventricles —> blood flows from L to R ventricle to pulmonary artery —> R ventricle hypertrophy
SYmptoms VSD-5
Risk of - 2
-characteristic holosystolic harsh murmur along left eternal border (loud and harsh), CHF, frequent pulmonary infections, SOB, color change with feeding, risk of bacterial endocarditis, risk of pulmonary vascular obstructive disease
-
What can happen in severe cases of VSD?
Eisenmenger syndrome —> resistance in pulmonary blood flow is greater than systemic circulation causing reversal of blood flow through the ventricle
What disease increases risk of VSD
Down syndrome
Medications that can be used for VSD
- dopamine + inotropic
- Isuprel
Complications of VSD repair
-ventricular arrhythmia or AV block
What is the surgery for repairing VSD
Dacron patch
What is PDA?
The ductus arteriosis does not close after birth (should close within 15 hours) —> shunting of blood from aorta to pulmonary artery
Manifestations of a small PDA
ASymptomatic
Manifestations of large PDA
-CHF with tachypnea, dyspnea, and hoarse cry
Symptoms of PDA
- bounding peripheral pulses
- widened pulse pressure (> 25)
- machinery murmur
- murmur audible throughout cardiac cycle
What drug can be used to close PDA
Indomethacin
What is indomethacin and what does it do?
NSAID
Blocks prostaglandin synthesis closing the vessel
How is PDA repaired?
Stitch closure
Complications of PDA closure (2)
- bleeding
- laryngeal nerve damage
What happens in decreased pulmonary flow heart defects?
-less or no blood reaches lungs (failure to oxygenate)
How does the body compensate for decreased pulmonary flow?
Kidneys stimulate bone marrow producing more RBCs causing polycythemia
Issues of polycythemia
-diminished clotting ability, sluggish blood flow —> cerebral infarcts
Decreased pulmonary blood flow cardiac issues (4)
- tetralogy of fallout
- tricuspid artesia
- pulmonary stenosis
- pulmonary atresia
Clinical picture of decreased pulmonary blood flow (6)
- significant cyanosis
- murmur
- need palliative surgery soon after birth
- need PDA to survive —> keep open with prostaglandin
- complete repair around 1st bday
- O2 has no effect
What is pulmonary stenosis?
Pulmonary valve is stenosis —> narrowed entrance to pulmonary artery —> R ventricular hypertrophy —> decreased pulmonary blood flow
What is the extreme form of pulmonary stenosis?
Pulmonary atresia —> total fusion causing no blood flow to lungs
Patho Pulmonary stenosis
PS —> R ventricular hypertrophy —> right ventricular failure —> R arterial pressure increases and may reopen foremen ovale —> unoxygenated blood to L atrium —> systemic cyanosis
What will be seen on CXR for pt with pulmonary stenosis?
Cardiomegaly
TX of pulmonary stenosis
- balloon angioplasty
- Brock procedure
4 defects of TOF
- VSD
- overriding aorta
- pulmonary stenosis
- R Ventricular hypertrophy
Clinical manifestations of TOF
- Tet spells
- anoxic after feeding or crying
- clubbing (after 1 year old)
- squatting or knee chest position
Risks of TOF
- emboli
- LOC
- sudden death
- seizures
When are repairs of TOF indicated?
When tet spells and hypercyanotic spells increase
STage one of TOF tx
Blalock or modified blalock shunt —> blood to pulmonary arteries from L or R subclavian artery
patho TOF
Decreased blood flow to lungs as well as mixing of the blood from each side of the heart
Reasoning behind knee-chest position in TOF
Comfort position to increase vascular resistance and flow back to the heart
Drug used to keep PDA open in TOF
Alprostadil
Obstructive defects of heart (2)
- coarction of aorta
- aortic stenosis
Coarctation of the aorta clinical picture 7
- hypertension
- murmur
- decreased peripheral pulses
- pallor
- irritability
- heavy sweating
- difficulty breathing
In coarctation of the aorta, where should pulses and BP be taken? Expectations?
- all four extremities
- bounding pulses and increased BP in upper extremities
Definitive DX PDA
Echo
