congenital Cardiac Flashcards
congestive heart failure
Inability of heart to pump enough blood to meet bodies demands
sx of pulmonary venous congestion
Increased respiratory rate
Nasal flare
Wheezing , crackles
Grunting
Retractions
sx systemic congestion
Hepatomegaly
Ascites
Edema
Weight gain
JVD
impaired myocardial function sx
increased heart rate, weak pulses
Decreased blood pressure
Cool extremities
gallop murmur
increased metabolic rate sx
FTT
Slow weight gain
Sweating
Medications to treat CHF
Furosemide – decrease fluid
Ace inhibitors – decrease BP, afterload
Digoxin – increase contractility, decrease heart rate, increase BP
what is the only oral ionotropic medication?
Digoxin
when to hold digoxin
Infants-heart rate, less than 90 to 110
Older kids – heart rate less than 70
Vomiting
Low potassium level <3.5
other digoxin rules
Give at regular intervals
Give one hour before or two hours after eating
Check apical rate one minute before
Don’t mix with food or water
Brush after – stains
What to do if missing a dose of digoxin
less than four hours, give
Greater than four hours skip
Two doses - call HCP
Signs of digoxin toxicity
nausea/vomiting
Bradycardia
Anorexia
Vision disturbances
Elevated potassium
what is the antidote for digoxin toxicity?
Digibind
nursing care for CHF patient
Prevent crying
Anticipate needs
Promote rest
Group activities together
Neutral thermal environment
Avoid construction , crowded places
Nutrition for CHF patients
small, frequent meals
Feed less than 30 minutes at a time, remaining NG tube
Calm environment
Semi erect position
Burp before during and after
Increase calories per ounce with formula
Soft premie nipple with large volume
arterial septal defect (ASD)
Hole between atrias
Left to right shunting
More blood to the lungs
ventricular septal defect (VSD)
hole between ventricles
Left to right shunting
More blood to the lungs
T/F it is important to stay up-to-date on vaccines with CHF patients
True, most are eligible for high up vaccines
patent ductus arteriosus (PDA)
Fetal structure fails to close
Blood is shunted from aorta to pulmonary artery
treatment for PDA
Indomethacin – anti-prostaglandin E promotes closure of PDA
Ibuprofen
coarctation of aorta
Narrowing of aorta distal to ductus arteriosus
what are the pressure changes with COA?
Increased pressure, proximal to defect
Decreased pressure distal to defect
s/sx COA
Headache
Nosebleed
Increased blood pressure in upper extremities
Weak/absent lower extremity pulses
bounding upper extremity pulses
Cool legs
Treatment of COA
Prostaglandin E
Aortic stenosis
narrowing fusion of aortic valves
Blood backs up into the right side of the heart and enlarges
Hypertrophy of left ventricle
s/sx aortic stenosis
Exercise intolerance
Poor feeding
Faint pulse, increased HR
Chest pain
what is the level of activity patients with aortic stenosis should be doing?
Limited activity, but not bedrest
Example – elevator versus stairs
Pulmonic stenosis
Narrowing of valves of pulmonary artery
Small left ventricle
Atresia
Total fusion
no blood flow to the lungs
polycythemia
thick blood
More RBCs
More at risk of clots in stroke
Prevented by hydration
tetralogy of fallot
right ventricle hypertrophy
VSD
Pulmonic stenosis
Overriding aorta
hyper cyanosis
Hyper contractility
Tet spell
Hypoxic squat
increases vascular resistance
Decreases venous return of deoxygenated blood
Diverts more blood to the pulmonary artery
TET spell guidelines
1- knee to chest position
2- oxygen
3- morphine
what is the role of morphine?
Relaxes infundibular muscle
Allows more blood to leave right ventricle
tricuspid atresia
Failure of tricuspid valve to develop
treatment of tricuspid atresia
Prostaglandin E
Digoxin
Diuretics
Surgery
transposition of the great arteries
Pulmonary artery connects to the left ventricle
Aorta connects to the right ventricle
treatment for transposition of great arteries
Arterial switch procedure within the first few weeks of life
IV. Prostaglandin E
Surgery
Truncus arteriosus
Pulmonary artery an aorta fail to divide
One single, large vessel, empties both ventricles
Hypoplasia left heart syndrome (HLHS)
small/absent left ventricle-severe hypoplasia
Mixed blood to the lungs
treatment for HLHS
Prostaglandin E
Transplant
discharge planning for heart surgery
Wound care – sternal incision
Prophylaxis antibiotics for bacterial endocarditis
When to call HCP
Self limit activities
Med. Teaching.
how should a child be picked up after open heart surgery?
Scooped under their bottom and back
Do not pick up under arms for at least two weeks
what is the role of prostaglandin E
Keeps PDA open
