Exam 3: Perfusion Flashcards
Murmur
Most common reason for consulting cardiology, not the most urgent indication of CHD in newborns
Cyanosis
Diminished femoral pulses or shock in a newborn should be considered critical CHD unless proven otherwise
Newborn screening for CHD
Right wrist, left foot
Preductal and post ductal needs to be within 3% or refer to cardiologist
Older child presentation with CHD
Chest pain
Decreased activity level
Syncope
Thin, not very tall
Does not look strong
Underweight
Ventricular Septal Defect (VSD)
Oxygenated blood leaks from left ventricle to right ventricle (left to right shunt) instead of flowing into the aorta
Can lead to heart failure, pulmonary hypertension (pulmonary artery banding)
Symptoms: Signs of heart failure (4-8 weeks), harsh, holosystolic murmur at LLSB, disinterest in feeding, tiring while feeding, poor weight gain, fatigue, color change, sweating with breast feeding, tachypnea, SOB, pulmonary edema. Palpation: Thrill on chest
Treatment for VSD
Spontaneous closure of small VSDs occurs in about half of children by 2 years
Repair of larger defects by 2 years to prevent development of pulmonary vascular disease
Good long-term outcomes for surgically repaired VSDs
Nursing care and treatments for VSD
Promote adequate nutrition, daily weights, more frequent feedings with rest periods
Infection control
Surgical repair
Surgical closure
Interventional cardiac catheterization
Tetralogy of Fallot (TOF)
Syndrome represented by four defects (RAPS)
Right ventricle hypertrophy
Aorta displacement
Pulmonary stenosis
Septal defect, ventricular (VSD)
R –> L
Surgical intervention required in first year of life, excellent long-term survival
Signs and symptoms of TOF
Cyanosis (profound)
Tachypnea
Hypercyanotic spells TET spells
Murmur
Edema
Clubbing of fingernails over time
Polycythemia overproduction of RBCs in response to being cyanotic
TET spell
Put knees to chest FIRST, decreases pulmonary systemic vascular resistance and increases systemic vascular resistance. Shunts more blood to body
Give supplemental O2
Soothing approach to child
Propranolol and morphine sulfate
Complications of VSD and TOF in children
May develop heart failure symptoms and require pharmacologic treatment
Digoxin
Helps strengthens the heart muscle enabling it to pump more effectively, not used in isolated VSD alone
Give at regular intervals every 12 hours, 1 hour before or 2 hours after a feeding
ACE inhibitors
Lower BP in the body, makes it easier for blood to be pumped from Left ventricle to body
Not used in TOF (Increases TET spells)
Digoxin toxicity
Bradycardia
Arrythmia
n/v/d
Lethargy
Infuse drug slowly over at least 5 minutes or longer
