Circulatory Part 2 Flashcards
What Tetralogy of Fallot?
A combination of 4 defects
- VSD or hole in the heart
- Pulmonic stenosis (first major valve)
- Overriding aorta (bc the hole in the heart)
- Right ventricular hypertrophy (due to trying to work against the stenosis)
Tetralogy of Fallot
Because of the hole, the stenosis, the overriding, and the hypertrophy – what happens?
Tetralogy of Fallot
Murmurs due to turbulence
Cyanosis due to no blood going to lungs to be oxygenated
Tetrad Spells!!
- episodes of spasm due to hypoxia and cyanosis
Treatment for Tetralogy of Fallot
Two options :
Modified BT shunt for infants that are too young
Complete repair of the VSD (hole in heart) & opening that pulmonary valve (due to the stenosis)
How do tetrad spells make things worse in Tetralogy of Fallot cases?
The spasm is due to hypoxia but when the spasm happens, the blood gets shunted from right to left
What types of activities are strenuous and therefore can trigger Tetrad spells in an infant
Crying
Feeding
Pooping
Tetralogy of Fallot
What position can you put infant in to help with a Tetrad spell ?
What else can you do to calm baby?
Tetralogy of Fallot
Infant can be in knee chest position
- helps decrease metabolic needs of heart & returns blood flow to core
- calms them
Give them O2
IV morphine
Sedative
- all in an effort to get them calm and reestablish blood flow
Type of shunt they will do for Tetrology of Fallot’s tetrad spells?
Explain the shunt
Modified Blalock-Taussig Shunt
- BT shunt
Use subclavian artery to wrap around to the pulmonary artery to the lungs so more oxygenated blood can be made in the lungs
- will still have mixing of the blood and all bc the VSD is still open, but at least now half the blood has oxygen
BT shunt concerns/complications of Tetralogy of Fallot’s tetrad spells
Is a BT shunt a cure
Will the body adjust to the amount of blood flow it is receiving?
- can wrap band around the vessel to try to get less blow flow
Will it affect and distort the artery?
Will clots form from scarring?
No - the BT shunt wont stop spells from happening. But it is better than nothing. If you want a cure , gonna have to wait till infant is older for surgery of the actual pulmonic valve and closing the vsd.
What is Tricupsid Atresia?
Where is the valve supposed to be?
Tricuspid Atresia is when the Tricuspid valve fails to develop
Tricupsid valve is supposed to be in between Right atrium and ventricle.
So what four ways are the only ways really for the blood to flow in a Tricuspid Atresia?
- Initial way is with the patent foramen ovale that you have as a fetus/newborn. But that eventually closes.
- Second way is by making an ASD or atrial septal defect on purpose between the right atrium and right ventricle (where it should’ve been)
- Third way is VSD from L to R side of heart
- Fourth way is the PDA or patent ductus arteriosus from birth as well
Symptoms of Tricuspid Atresia that are most concerning
Older kids?
Cyanosis
Tachycardia
Dyspnea
Older kids have hypoxemia with clubbing
What is TGA or Transposition of Great arteries or vessels?
Pulmonary artery and Aorta are switched causing un-oxygenated blood to go to tissues (the blood that is oxygenated just goes on a repeat loop to lungs)
With a TGA, how would you get oxygen?
PTO or patent foramen ovale
ASD
VSD
What is the first form of treatment options done for TGA?
What is the main surgery? Complications?
Septal defect catheter to make an opening first. This way they don’t have to do surgery quite yet.
Main surgery you go in and switch the vessels & coronary arteries.
Complications are that scarring can occur. and clots forming.
- can use balloon to keep this from happening
- complications from tga surgery tend to happen as they get older
Pre-op management before any heart surgery
How much o2?
RBC?
Nutrition
Education
Limit?
Keep them oxygenated as much as possible
Periodic Pheresis or take off rbcs and give back plasma to reduce polycythemia
Nutrition such as small frequent meals at 30 minutes tops
- breast feeding moms may pump and use bottle to add nutrients
tetrad education on oxygen
Limit squatting
In post op, the patient will have lots of tubing for drainage of pericardial sac. What should you as the nurse do?
Assess the tube to see how much drainage there is and what color it is
- if it is bright red, then you should call the surgeon.
What happens if in post op care, there is a clot in the tubing?
Blood can get trapped which makes it hard for the heart to contract or a tamponade. This is an emergent situation if it gets to that point.
- will need to do drainage of the heart or pericardialcentesis.
In post op care you notice a dysrhythmia. is this normal?
What do you monitor?
It is abnormal since most children don’t have these.
- monitor the ekg and QRST wave
How is cardiac output monitored in post op care of heart surgeries?
What meds can be given to increase cardiac output?
There will be lines to assess and monitor cardiac output and how the body is perfusing.
Inotropic agents to increase contractility such as noriepi
- nurse can adjust the rates