Infant: CHD, CHF Flashcards
What are some strategies to build attachment?
- Visits
- Holding
- Skin to skin
- Involve in care
- Advocate for policies
- Give information
- Developmental assessments on a regular basis
- Attending to needs in timely manner
○ Changing diaper
○ feeding
What are risk factors to congenital heart disease?
- Exposure to tetragons (alcohol, drugs, smoking)
- Preterm
- Can be associated with syndromes (Ex. Down syndrome -trisomy syndrome)
- Mothers exposed to viral infections (ex. Rubella)
- Older maternal age
- Genetics
- Family history
What are some assessments for a child with a cardiac condition?
- respirations
- pulse characteristics
- blood pressure
- colour
- chest
- heart auscultation
- fluid status
- activity and behaviour
- general (pattern of growth)
As the heart grows, the systolic pressure _____ (inc or dec)
increases
What is usually the first indication of CHD?
heart murmur
What does it mean when a heart murmur is loud?
Loud = blood flowing w/ higher pressure than normal to get through narrowed vessel or valve
blood flows from an area of _____ pressure to ______ pressure
high pressure to low pressure
Resistance increases = blood flow ______ (inc or dec) = ________ workload on heart (inc or dec)
blood flow decreases, increases workload
What happens when there is increased pulmonary blood flow?
Increased pulmonary blood flow = increased pulmonary vascular resistance to reduce blood flow but leads to pulmonary artery hypertension
Right ventricular muscle hypertrophies due to resistance and to pump increased volume of blood to lungs
leads to decreased perfusion to body
what are the early S&S of increase pulmonary blood flow?
- Tachycardia
- Tachypnea
What are the S&S of increased pulmonary blood flow?
- Murmur
- Poor growth and weight gain
- poor feeding due to lack of energy = not enough calories
- Increased pulmonary infections
- Diaphoresis
- Periorbital edema
What are some examples of defects that causes increased pulmonary blood flow?
Patent ductus arteriosus, atrial/ventricular septal defect, AV canal defect
what happens when there is decreased pulmonary blood flow?
Defect or development failure that obstructs flow of blood from right side of heart to lungs = decrease in pulmonary blood flow
= little to no blood reaching lungs to get oxygenated
Increased workload on the right side of the heart = leads to right ventricular hypertrophy → CHF
What are S&S of decreased pulmonary blood flow?
- cyanosis
- Supplemental O2 has little to no effect
- polycythemia
- clubbing on fingers
- poor weight gain
- dyspnea
- loud murmur
Why does supplemental O2 have no effect with decreased pul. blood flow?
Blood is not getting to lungs to be oxygenated, So oxygen is not going to make a difference
Why does polycythemia occur with decreased pul. blood flow?
- compensatory mechanism of kidneys to produce erythropoietin (EPO) hormones to produce more RBC to try and improve oxygen carrying capacity
- Leads to: sluggish blood flow, diminished clotting time (vit K clotting factors impaired), cerebral infarcts
are you at risk for thromboembolism and bleeding with dec. pul. blood flow?
yes due to polycythemia
What are examples of defects that cause dec. pul. blood flow?
Pulmonic stenosis, tetralogy of fallot, pulmonary atresia, tricuspid atresia
What happens with obstructive heart defects?
- Obstruction to blood flow from the left ventricle to the systemic circulation (low cardiac ouput)
- Left ventricular hypertrophy due to extra work on heart, blood eventually backs up into the lungs (pulmonary congestion/edema)
What are S&S of obstructive heart defects? (low cardiac output)
- Poor perfusion: diminished pulses, prolonged cap refill
- Decreased blood flow to kidneys = decreased urine output
- Pale or cyanosis
- Diminished flow gastrointestinal tract = risk for GI issues
- Pulmonary edema (due to backflow)
- CHF
- BP greater in arms than legs
What are some examples of obstructive heart defects?
coarctation of aorta, aortic stenosis, hypoplastic left heart syndrome, mitral stenosis, interrupted aortic arch
What is the tetralogy of fallot?
Combination of 4 defects:
- Pulmonary stenosis
- right ventricular hypertrophy
- VSD
- Misplaced aorta
What are S&S for tetralogy of fallot?
- Poor systemic perfusion
- Cyanosis
- Tet spells: immediate and profound decrease in systemic venous return of deoxygenated blood
What is congestive heart failure (CHF)?
disorder in which heart function is impaired and cardiac output is inadequate to support the body’s circulatory and metabolic needs
What are the signs of CHF?
- Impaired Myocardial Function
- Pulmonary Congestion
- Systemic Venous Congestion
What are the early signs of impaired myocardial function?
- Tachycardia
- Sweating (diaphoresis)
- Fatigue, lethargy, tires easily (poor feeding)
What are the signs of impaired myocardial function?
- Early signs:
○ Tachycardia
○ Sweating (diaphoresis)
○ Fatigue, lethargy, tires easily (poor feeding)
-Decreased urine output
-Pale, cool extremities
- Weak peripheral pulses
-Decreased BP
- cardiomegaly
What is an early sign of pulmonary congestion?
tachypnea
What are the signs of pulmonary congestion?
Early sign:Tachypnea
-Dyspnea
- Retractions - infants
- Nasal flaring - infants
- Grunting - infants
- Head bobbing - infants
-Wheezing, crackles (due to pulmonary edema)
-Pulmonary edema
- Cough
What are the signs of systemic venous congestion?
- Weight gain
- Hepatomegaly
- Peripheral edema: Where in Infants -periorbital (eyes), sacral (where they lie on back, in males in scrotum
- Ascites c/o abdominal pain - children
- Jugular vein distention - children
What are the 6 goals for CHF management?
- improve cardiac function
- remove fluid volume excess
- decrease cardiac demands
- improve tissue oxygenation & decrease O2 consumption
- maintain nutritional status
- support for family
How do you improve cardiac function? (CHF goals)
- Medication to strengthen cardiac contractility (Digoxin): slows heart rate and Increases cardiac filling time and myocardial contractility to improve systemic circulation
- Medication to decrease peripheral vascular resistance (decrease afterload) (CAPTOPRIL, ENALAPRIL, Carvedilol : angiotensin-converting enzyme (ACE) inhibitors): Lower BP and vasodilate peripheral vasculature (vascular relaxation)
What are the key nursing considerations & priorities when caring for a child on digoxin?
- Monitor serum levels for therapeutic digoxin
- Apical pulse for 1 whole min
How do you remove fluid volume excess? (CHF goal)
- Medication (diuretics) to remove accumulated fluid & sodium (eg:Lasix)
- Monitor levels due to related excretion of potassium
- May need potassium supplement (if on potassium depleting diuretic)
- Strict intake & output
-Daily body weights (same scale)
-Watch for skin breakdown in edematous areas: Note in infants eyes, back, scrotum
How do you decrease cardiac demands? (CHF goals)
- Organize nursing care so as not to tire the infant, and to maintain periods of rest
- Decrease stress (parent participation and proximity)
- Maintain normothermia: Hyperthermia or hypothermia puts extra stress on body
- Careful intake/output balance – Fluid overload can cause cardiac demands
-May be on lower than maintenance fluids such as 80%
How do you improve tissue oxygenation & decrease O2 consumption? (CHF goals)
- Give supplemental humidified O2 as ordered
- Increase the head of the bed (HOB)
- Pulse oximetry
- Careful and frequent resp assessments
- Clinical tip: ways to decrease the work of feeding - More oxygen during feeding
How do you maintain nutritional status? (CHF goals)
- Small frequent feedings or meals
- Bottle feeding ½ hr. feeding time is appropriate
- May require NG or G-tube feedings
- higher calorie: meet metabolic needs without excess fluid
- Gastroesophageal Reflux is common
how do you support the family? (CHF goals)
- Education: Medications, Understanding defects, Surgery, Care of child
- Support
- Specialist support
-Parent to parent support “Heart Beats”
