More Congenital Defects

Question 1

Transposition of Great Arteries

Answer 1

Aorta emerges from right ventricle and Pulm artery emerges from left—Foramen OVale and Ductus Arterious allow enough mixing to keep infant alive initially

Question 2

Post of Complications of TGA repair

Answer 2

1. low cardiac output
2. left ventircle dysfunction (not sure to pumping such high pressures)
3. myocaridal ischemia
   (high risk for pulm HTN)

Question 3

Something to monitor post op TGA

Answer 3

ST segment–depression shows myocardium not getting enough o2–eleved ST means injury

Question 4

Post op tx TGA

Answer 4

1. DO NOT BOLUS FLUID
2. MIght need nitroglycerin
3. Aggressvie afterload reducing agents
4. often open chest

Question 5

HLHS

Answer 5

ductal dependent for systemtic blood flow
PVR increases systemic circluation
sats 75-85
3 step repair –norwood, glenn, fontan

Question 6

A nurse caring for a pt with HLHS can expect

Answer 6

metabolic acidosis

Question 7

what med is key for ductal dependent lesions

Answer 7

PGE1 (prostaglandin)

Question 8

potential side effects of PGE1

Answer 8

Respiratory depression, seizure, Hypotension—its a vasodialator

Question 9

Decreasing pulm blood flow can be achieved by

Answer 9

maintain fi02 at 21%—high fi02 will dialate pulm vascular bed and increase blood flow

Question 10

Norwood procedure

Answer 10

1. Create ASD

2. BT shunt–Subclavaian artery (aorta) to PA or sano (right ventrical to PA shunt)

Question 11

Post op considerations for Norwood

Answer 11

1. preload dependent, low CO, RV dysunction, AV valve reguritation/obstrucntions, risk for NEC
2. should sat 75-85

Question 12

sudden drop in sats after norwood probably means

Answer 12

clot in shunt–increases SVR and give heparin

Question 13

Pulm blood flow after norwood could be

Answer 13

excessive–will see signs of CHF (high sats, tachy)

Need to decrease your SVR and increase your PVR (PEEP)–give diuretics

Question 14

Gleen procedure

Answer 14

Superior Vena Cava to pulm artery
–around 4-12 months
–Goal reduce load on systmeic pumping ventricle
Sat should be 85

Question 15

Glenn postop conisiderations

Answer 15

extubate quickly

Glenn hedache from intracranial HTN, HOB up, morphine, keep PVR low and avoid hypovolemia

Question 16

After glenn if see edema of face and neck, an enlarged liver, WHY?

Answer 16

back flow of blood into SVC

Question 17

Fontan

Answer 17

IVC to pulm arter
after 2 years
diverts blood from right ventricle
preload dependent

Question 18

post op considerations for glenn

Answer 18

pleural effusion, chylothorax, JET, AV dssycrony, thormbosis,
protein losing enteropathy