Pediatric Cardiology Flashcards
increased pulmonary blood flow
- patent ductus arteriosus
- Ventricular Septal Defect
- Atrial septal defect
- Atrioventricular Canal Defect
increased pulmonary blood flow is shunted…
from HIGH pressure (left) to LOW pressure (right)
-large amount of blood moved to lungs
decreased pulmonary blood flow
- pulmonary stenosis
- tetralogy of fallot
- tricuspid atresia
- R ventricular Hypertrophy
- overriding aorta
decreased pulmonary blood flow is shunted….
from HIGH pressure (right) to LOW pressure (left)
-blood moves through structural defect, deoxygenated blood enters blood system
mixed blood flow
- transposition of Great Arteries
- Truncus Arteriosus
- Hypoplastic L heart Syndrome
mixed blood flow contains…
lower O2 concentration and decreased cardiac output
obstructed blood flow
- coarctation of the aorta
- aortic stenosis
- pulmonary atresia
obstructed blood flow contains…
narrowing blood vessels interfering with free blood flow
congenital heart defect consequences
- increased flow –> HF
- obstructive flow –> L side = HF and R obstruction = cyanosis
- decreased flow –> BLUE BABIES , cyanosis
- mixed flow –> hypoxemia w/o or with cyanosis and HF
ventricular septal defect (VSD)
most common, 75% fix themselves
-cause stiffening of lungs and decreased ventilation
VSD s/s
-asymptomatic (small)
-easily tired (lethargy)
-poor feeding
-frequent pulmonary infection
-SOB
-tachypnea
-LOUD HARSH MURMUR
VSD risks
at risk for..
aortic valve regurgitation
infective endocarditis
VSD diagnosis
CXR
echo
MRI
VSD surgical tx
cardiac cath
open heart surgery
VSD cath lab
use septal occluding device, blocking the defect
VSD open heart surgery
pericardial patch or suturing
**MUST BE 6-12 months and 2,000 grams
VSD nonsurgical
digoxin and furosemide
digoxin consideration
HOLD MED when < 90 bpm
**toxicity = dysrhythmias and vomiting
post cardiac cath
-vitals –> manual pulse check
-apply pressure when needed
-keep extremity straight for 4-6 hours
-bath –> not for several days , shower sooner
-after 24 hours change to DRY dressing
-infection risk
what dressing is used 24 hours after cath
dry dressing
are there dietary considerations after a cath?
NO just keep strict I / O
tetralogy of fallot
-cyanosis with feeding and crying
-clubbing
-irritable
-tet spells
tet spells
acute episode of cyanosis and hypoxia
-occurs when O2 requirements exceed blood supply
tetralogy of fallot management
KNEES TO CHEST / bending to squat
-cluster care to decrease irritability
tetralogy of fallot meds
morphine and O2
tetralogy of fallot palliative shunt
used until complete repair, infant cannot undergo primary surgery needed
-blalock taussig shunt = provides blood flow to arteries
tetralogy of fallot complete repair
usually done within first year of life
-complete closure of VSD
-patch is placed enlarging pulmonary artery
coarctation of the aorta
narrowing of the aorta , blood flow is impeded causing increase pressure proximally and decreased distally
coarctation of the aorta s/s
asymptomatic
BP higher in upper extremities : EXTREME
weak / absent femoral pulse
coarctation of the aorta dx
CXR
echo
cardiac cath : E sign
coarctation of the aorta surgical
resect portion of the aorta
coarctation of aorta nonsurgical
balloon angioplasty or stent
aortic stenosis s/s
chest pain
fatigue
SOB
syncope
systolic ejection murmur
aortic stenosis dx
echo : cardiomegaly , enlarged L ventricle
CXR
EKG : inverted T waves
aortic stenosis tx
balloon valvuloplasty : cardiac cath
valve replacement : open heart
pulmonary atresia s/s
cyanosis at birth
tachypnea
poor feeding
**normally also have VSD
**must have PDA or PFO to survive!!
pulmonary atresia dx
echo , normally dx prior to delivery
pulmonary atresia tx
surgical repair : valve opening –> replacement
-most fatal , need to treat quickly
-Fontan Surgery
PGE
needed with pulmonary atresia BEFORE SURGERY
-prostaglandin E1 holds PDA / PFO open
TGA
cardiac emergency!!! if not tx will lead to HF
-also needs PGE
TGA hyperoxia test
if babies get 100% O2 and still have no change
TGA tx
balloon atrial septostomy
atrial switch operation : done within first weeks of life
hypoplastic L heart syndrome
asymptomatic at birth
grayish skin color
difficulty breathing
poor feeding
cold hands / feet
lethargy
O2 in 75-80 %
hypoplastic L heart syndrome can have…
murmur if a PDA is present
-once PDA closes = deterioration with cyanosis and decreased CO –> cardiovascular collapse
cyanotic hypoplastic L heart syndrome
no PDA , ASD, PFO
acyanotic hypoplastic L heart syndrome
free mixing at atrial level (ASD)
hypoplastic L heart syndrome CHF….
presents within 48 hours of life , must be corrected within first year of life
hypoplastic L heart syndrome dx
echo
hypoplastic L heart syndrome tx
therapeutic meds : prostaglandin
surgery : 3 stages
3 stage surgery
- Norwood procedure
- Glenn procedure
- Fontan procedure
Norwood procedure
done within first week of life , R ventricle pumps to lungs
-shunt placed
Glenn procedure
done 4-6 months of life , reduce R ventricle workload
-place patch
Fontan procedure
done at 18 months –> 2 years
-patch removed
-NOW LESS BLUE!!!
nursing considerations
- maintain O2
- prevent infection
- ensure adequate tests
- promote nutrition
- vitals
- I / O assessment : no fluid overload
cardiac health maintenance
promote normal growth / development
nutrition
prevent infection
prevent complications of CHF
promote adequate CO
minimize metabolic demands
post op care
incision heals in 6 weeks
immunization schedule remains the same
bath cant be too long
infant post op
keep child from crying too long : 3-4 weeks
LIFT USING SCOOP METHOD : 4-6 weeks
no physical activity causing blow to chest
no lifting arms over head : 4-6 weeks
no living heavier than 5 lbs
CHF in peds
pump failure
over circulation failure
compensation
septal occluding device
not recommended for pts with coagulation concerns or active bacterial infections
infants CHF
growth failure
persistent tachypnea
hepatomegaly
respiratory distress
toddlers CHF
respiratory distress
poor appetite
decreased activity
hepatomegaly
school age CHF
fatigue
exercise intolerance
poor appetite
hepatomegaly
orthopnea
adolescent CHF
chest pain
dyspnea
abd pain , nausea / vomiting
hepatomegaly
orthopnea
ascites
dependent edema
CHF tx goal
improve function : increase contractility , decrease afterload
decrease sodium
decrease cardiac demand
decrease excess fluid
heart transplant rejection
fever
low urine output
tachycardia
tachypnea
weight gain
fatigue
irritability
poor appetite
palpitations
anxiety
lightheadedness
transplant mortality…
remains high , smallest children normally last
immediately post transplant….
children can go back to new activities
transplant education
med regimen
prep family
transplant is not a cure
chronic immunosuppression
-extensive criteria to meet
