Congenital Heart Defects

Question 1

CHD Manifestations - History

Answer 1

• Poor feeding
• Poor growth (FTT)
  > baby can’t keep up bc body is working hard to deliver oxygen, baby is too exhausted to feed, burning lots of calories; not gaining weight
• Activity intolerance
  > their activity/job is to eat
• Positive prenatal hx
  > uncontrolled DM
• Fam hx of cardiac disease

Question 2

CHD Manifestations - Inspection

Answer 2

• Color
  > concerned abt central cyanosis
• Chest deformities
• Tachypnea
  > use pulse ox
• Tachycardia
• Murmur
• Unusual pulsations
• Clubbing of fingers
  > late sign
• Respiratory excursion

Question 3

Acyanotic

Answer 3

• Incrd pulmonary blood flow
  > L > R Shunt: arterial septal defect, ventricular septal defect, patent ductus arteriosus
• Obstruction to blood flow from ventricles
  > coarctation of aorta, aortic stenosis, pulmonic stenosis
• child may be sent home with these because they are asymptomatic

Question 4

Cyanotic

Answer 4

• Dcrd pulmonary blood flow
  > tetralogy of fallot
• Mixed blood flow
  > transposition of great arteries

Question 5

Coarctation - Acyanotic

Answer 5

• Narrowing usually begins after left subclavian artery but before PDA
• UEs & brain well oxygenated
• LE cyanotic
• 4 point BPs

Question 6

Tetralogy of Fallot - Cyanotic

Answer 6

• 4 anomalies
  > RV hypertrophy
  > VSD
  > RV outflow obstruction (pulm stenosis)
  > Aorta “overrides” VSD

Question 7

Tet Spells

hypercyanotic episode

Answer 7

• When infant’s oxygen requirements exceed blood supply
• Common during episodes of crying, feeding, overworked/overwhelmed
• Lay on stomach w/ knees to chest
  > O2
  > meds to calm down

Question 8

Pink to Blue

Answer 8

Cardiac issue

Question 9

Blue to Pink

Answer 9

Respiratory issue

Question 10

Transposition of Great Vessels - Cyanotic

Answer 10

• Aorta connected to RV (instead of LV)
• Pulmonary artery connected to LV (instead of RV)
• PDA or septal defect
• Want to keep PDA open to allow for oxygenated blood still

Question 11

CHD - Nursing Interventions

Answer 11

• Prevent infection
• Rest
• Education
• Oxygenation
• Feeding plans
  > timing (restrict)
  > incr caloric intake (fortify)
  > better to bottle feed
• I&Os, daily weights

Question 12

CHD - Education

Answer 12

• Home care
• S/S heart failure
• Sick child
• Med admin

Question 13

CHD - Medications

Answer 13

• IV Prostaglandin E
  > keep ducts open
• Digoxin
  > improves myocardial contractility
• Diuretics
  > potassium-sparing: rid excess fluid & sodium
• ACE inhibitors
  > reduce afterload; dcrs pulm & systemic resistance
  > captopril, enalapril
• Beta-blockers
  > dcr HR & BP, promot vasodilation
  > metoprolol, carvedilol

Question 14

CHD - Surgery

Answer 14

• Cardiac catheterization
• Patching
• Balloon angioplasty
• Stents

Question 15

Heart Failure

Answer 15

The inability of the heart to adequately supply blood to meet body’s needs

Question 16

Heart Failure - Left Sided

Answer 16

• Tachypnea
• Dyspnea
• Nasal flaring/retractions
• Wheezing

Question 17

Heart Failure - Right Sided

Answer 17

• Systemic congestion
• Peripheral edema
• Ascites
• Hepatomegaly
• Jugular vein distension

Question 18

Hypoxemia

Answer 18

• Inadequate oxygenation of blood
• Common in kids w/ CHD
  > and resp disorders & anemia

Question 19

Hypoxemia - S/S

Answer 19

• Cyanosis
• Tachypnea
• Dyspnea
• Clubbing
• Polycythemia

Question 20

Kawasaki Disease - Etiology

mucocutaneous lymph node syndrome

Answer 20

• unknown
• Acute systemic inflammatory illness
• Usually resolves w/in 8wks

Question 21

Kawasaki Disease - CMs: Acute Phase

mucocutaneous lymph node syndorme

Answer 21

• High fever
• Red eyes
• Bright red/chapped lips
• Strawberry tongue
• Oral mucosa irritation
• Rash
• Joint pain
• Cardiac Manifs:
  > myocarditis
  > dcrd LV function
  > percardial effusion
  > mitral regurgitation

Question 22

Kawasaki Disease - CMs: Subacute Phase

Answer 22

• Resolution of fever
• Irritable
• Peeling skin
• Temporary arthritis

Question 23

Kawasaki Disease - CMs: Convalescent

Answer 23

• No manifs
• Labs usually abnormal

Question 24

Kawasaki Disease - Therapeutic Management

Answer 24

• Gamma globulin
• Aspirin
• I&Os
• Monitor heart function
• Promote comfort

Question 25

Kawasaki Disease - CRASH & BURN

Answer 25

• C: conjuctivitis
• R: rash
• A: adinopathy
• S: strawberry tongue
• H: hands & feet = swollen & red
• BURN: high fever
• treated w/ high doses of Aspirin
• recovery = 8 wks

Question 26

Rheumatic Fever

Answer 26

Inflammatory disease that occurs as a reaction to a Group A beta-hemolytic streptococcus infection (GABHS)
> untreated strep throat

Question 27

Rheumatic Fever - Diagnosed

Answer 27

• Based on Jones critieria
• Major
  > carditis
  > subcutaneous nodules
  > polyarthritis
  > rash
  > chorea
• Minor
  > fever
  > arthralgia
• 2 major or 1 major & 2 minor w/ evidence of recent froup A strep infection

Question 28

Critical Congenital Heart Defect (CCHD) Screening

Answer 28

• Hypoplastic left heart syndrome
• Pulmonary atresia w/ intact ventricular septum
• Transposition oof great arteries
• Truncus arteriosus
• Tricuspid atresia
• Tetralogy of Fallot
• Total anomalous pulmonary venous return
• 24-48hrs after baby is born