Congenital Cardiac Conditions Flashcards
The ______ side of the heart is under higher pressure
Left
The right side of the heart pumps blood to the ______
Lungs
The left side of the heart pumps blood to the ______
Body
Left-to-right shunting (high to low pressure) causes …
Increased pulmonary blood flow
Describe congestive heart failure (CHF)
Inadequate cardiac output for metabolic demands
Describe right-sided heart failure (2)
- Unable to pump blood to lungs
- Blood pooling in body
Right-sided heart failure can lead to ______
Left-sided heart failure
What are the manifestations of right-sided heart failure? (4)
- JVD
- Ascites
- Hepatomegaly
- Dependent edema
Describe left-sided heart failure (2)
- Unable to pump blood to the body
- Blood pooling in lungs
What are the manifestations of left-sided heart failure? (4)
- SOB
- Pulmonary edema
- Blood-tinged cough
- Adventitious lung sounds
What are the manifestations of CHF? (5)
- Tachycardia
- Tachypnea
- Difficulty feeding
- Decreased urinary output
- Sudden weight gain
Why does CHF cause tachycardia?
Compensation for poor cardiac output
What diagnostic tests are used to diagnose CHF? (2)
- Chest x-ray
- Echocardiogram
What are the goals of CHF treatment? (4)
- Improve cardiac function
- Remove fluid accumulation
- Decrease cardiac demands
- Improve tissue oxygenation
What are the pharmacologic methods used to improve cardiac function in CHF? (3)
- digoxin (cardiac glycoside) - improves contractility
- enalapril (ACE inhibitor) - decreases HR
- carvedilol (beta blocker) - decreases BP / causes vasodilation
Describe the nursing interventions associated with digoxin for CHF (3)
- Assess apical pulse for 1 full minute
- Daily weights (weight loss = toxicity risk)
- Monitor potassium (hypokalemia = toxicity risk)
What is the therapeutic dosage of digoxin?
0.8 - 2.0 mcg / L
What are the manifestations of digoxin toxicity? (2)
- Nausea / vomiting *
- Bradycardia
Hold digoxin in infants / young children if HR is ______
< 90
Hold digoxin in older children / adolescents if HR is ______
< 60 - 70
When should digoxin be given for optimal absorption?
1 hour before meals OR 2 hours after meals
If a dose of digoxin is missed, and it has been MORE than 4 hours …
Hold the dose and give the next scheduled dose
If a dose of digoxin is missed, and it has been LESS than 4 hours …
Give the missed dose
If a child vomits after administration of digoxin …
DO NOT give a repeat dose
What method should be used to administer digoxin to a child?
Syringe (most accurate)
What are the pharmacologic methods used to remove fluid accumulation in CHF? (2)
- furosemide (loop diuretic) - drug of choice *
- diuril / spironolactone (thiazide diuretic)
Describe the nursing interventions associated with diuretics for CHF (3)
- Monitor potassium
- I & O (weigh diapers)
- Fluid / sodium restriction
What are the methods used to decrease cardiac demands in CHF? (4)
- Maintain body temperature
- Sedation if irritable
- Small frequent feedings
- Gavage feedings
A ______ can be used to decrease sucking effort for infants during feeding
Soft “preemie” nipple
What are the methods used to improve tissue oxygenation in CHF? (2)
- Humidified O2
- Semi-fowler’s position
How can semi-fowler’s position be accomplished for infants?
Use a car seat in a crib
Which conditions cause increased pulmonary blood flow? (3)
- Atrial septal defect
- Ventricular septal defect
- Patent ductus arteriosus
Which condition causes decreased pulmonary blood flow?
Tetralogy of Fallot
Which condition causes obstruction to blood flow?
Coarctation of aorta
Which condition causes mixed blood flow?
Transposition of great arteries
What is atrial septal defect?
Abnormal connection between the right and left atria
Which type of shunting is present in an atrial septal defect?
Left-to-right shunting - increased blood flow to lungs
What complication is a concern associated with a large atrial septal defect?
Pulmonary hypertension
Describe the diagnosis of atrial septal defect (2)
- Auscultation - systolic murmur
- Chest x-ray - enlarged heart
What is the purpose of an echocardiogram for congenital cardiac conditions?
Shows size / location of defect
Describe the treatment of atrial septal defect (2)
- Dacron patch
- Transcatheter closure
Describe transcatheter closure
Catheter through femoral artery with insertion of closure device (quicker recovery)
Small septal defects are typically …
Monitored over time for spontaneous closure during growth
What is ventricular septal defect?
Abnormal connection between the right and left ventricles
Which type of shunting is present in a ventricular septal defect?
Left-to-right shunting - increased blood flow to lungs
What complication is a concern associated with a large ventricular septal defect?
CHF
What are the manifestations of ventricular septal defect? (2)
- Loud murmur
- Cyanotic nail beds
Why might a murmur get louder if an infant grips their hands?
Increased interthoracic pressure
Describe the diagnosis of ventricular septal defect (2)
- Auscultation - murmur at left lower sternal border
- Chest x-ray - enlarged heart
Describe the treatment of ventricular septal defect (3)
- Dacron patch
- Transcatheter closure
- digoxin / diuretics to relieve symptoms of CHF
What is patent ductus arteriosus?
Failure of the ductus arteriosus to close
Which type of shunting is present in patent ductus arteriosus?
Left-to-right shunting - increased blood flow to lungs
Patent ductus arteriosus is most common in ______
Premature infants
What complication is a concern associated with a large patent ductus arteriosus?
CHF
What are the manifestations of patent ductus arteriosus? (2)
- Machine-like, turbulent murmur
- Bounding pulses
Describe the diagnosis of patent ductus arteriosus
Auscultation - murmur below left clavicle
Describe the treatment of patent ductus arteriosus (3)
- Dacron patch
- Transcatheter closure
- indomethacin / ibuprofen (prostaglandin inhibitors)
A large patent ductus arteriosus may require ______ in addition to surgical closure
Clips
Which type of shunting is present in tetralogy of fallot?
Right-to-left shunting - decreased blood flow to lungs
What is tetralogy of fallot?
Pulmonary stenosis
The degree of pulmonary stenosis determines …
Amount of cyanosis
What term is used to describe children with tetralogy of fallot who have minimal obstruction / cyanosis?
“Pink tet”
Describe the pathophysiology of tetralogy of fallot
Ventricular septal defect equalizes pressure in ventricles
What are the manifestations of tetralogy of fallot? (3)
- Squatting
- Cyanosis
- ‘Tet spells’
What are ‘tet spells’?
Episodes of cyanosis - triggered by exertion (crying, feeding, straining)
‘Tet spells’ can lead to ______
Strokes - due to clotting
Describe the primary nursing intervention for a ‘tet spell’ in an infant
Place the child on their back and bring the knees as close to the chest as possible
What is the purpose of the knee-to-chest position?
Reduces right-to-left shunting (increases blood flow to lungs)
What alternative for the knee-to-chest position is used for an older child?
Squatting
What is the primary late sign of tetralogy of fallot?
Clubbing of fingers / toes
What possible complications are associated with tetralogy of fallot? (4)
- Emboli
- Stroke
- Seizure
- Sudden death
Describe the diagnosis of tetralogy of fallot (2)
- Auscultation - systolic murmur
- Chest x-ray - boot-shaped heart
When can surgical intervention take place for tetralogy of fallot?
After 12 months old
When blood flow is obstructed, children exhibit signs of ______
CHF
What is coarctation of the aorta?
Aortic stenosis
Describe the pathophysiology of coarctation of the aorta (2)
- Increased pressure to head / upper extremities
- Decreased pressure to body / lower extremities
What possible complications are associated with coarctation of the aorta? (3)
- Acidosis
- Shock
- Sudden death
What are the manifestations of coarctation of the aorta? (5)
- Headache
- Epistaxis
- Bounding pulses in upper extremities
- Weak / absent pulses in lower extremities
- Cool lower extremities
Describe BP findings associated with coarctation of the aorta
Difference of 20 mmHg between upper / lower extremities
Describe the diagnosis of coarctation of the aorta
Chest x-ray - enlarged heart
Describe the treatment of coarctation of the aorta (2)
- Balloon angioplasty / stent
- Anastomosis of aorta segments
What is the primary nursing intervention post-op surgical repair of coarctation of the aorta?
Control hypertension to prevent pressure in aorta
What is transposition of great arteries?
Aorta and pulmonary artery are switched
What are the manifestations of transposition of great arteries? (2)
- Cyanosis within first few hours of life
- CHF
Describe treatment of transposition of great arteries
Surgery - arterial switch (within first week of life)
