Peds Cardiology Flashcards
Fetal circulation
- Foramen ovale between RA and LA.
- Ductus Arteriosus between pulmonary artery and aorta.
- Ductus Venosus usually closes first and does not persist. Connects to IVC
Special pediatric considerations
- HR influenced by ANS.
- Sympathetic will increase HR,
- Heart can’t improve contractility yet.
- Parasympathetic- through vagus nerve, decrease HR.
- Increase heart rate–> increase CO
- Really fast HR leads to decrease in diastole(filling time).
Cardiac Output (CO) Equation
HR x Stroke volume (SV)
Preload
(Right side of the heart)
- Volume of blood returning to heart.
- Evaluate daily with wt + I&Os
Afterload
Resistance the heart has to pump against to get blood out
-A high BP=increased after load
Contractility
Efficiency of the cardiac muscle as a pump.
To evaluate, look at cap refill, skin temp, perfusion, urine output.
Cardiac Assessment
- Vital signs (can be influenced by pain, temp, hydration, age)
- Heart Sounds
- Perfusion (central to peripheral temps)
- Neurological (may indicate increase hypoxia, as a result of decrease CO)
- Respiratory (Distress? Crackles?)
- Renal (I/O, UO)
Chest X-ray
- Looks at heart size/silhouette
- Small heart=flow obstruction
- Large Heart=myopathy
- Child has to lay still, hold breath
EKG
- Looks at electrical activity of the heart
- Need list of meds (digoxin), continuous monitoring?
ECHO
- Uses sound waves to produce image of heart structures
- May require conscious sedation
Cardiac Catheterization
- uses fluoroscopy & radiopaque dye
- done as a pre-op evaluation to measure O2 saturations to identify the exact anatomy & physiology of congenital heart defect
- Placing stent, or balloon to open a valve
Cardiac Cath pre procedural considerations
- NPO
- Check for allergies
- Document VS & O2 sats
- Ht & Wt
- Peripheral pulses
- Need to stop anticoagulant
- Prepare child
- Done with sedation/general anesthesia
Post cath considerations
- Lying flat, leg straight (4-8hr)
- check dressings for bleeding
- Pulse/CRT/temp checks, q15
- VS, full minute for HR
Overall nursing goals
- Assist in measures to improve cardiac function.
- Reduce afterload.
- Decrease cardiac demands.
- Reduce respiratory distress.
- Maintain Nutritional Status.
- Assist in measures to promote fluid loss.
- Support the child and family.
- Assess hypoxemia.
Digoxin
- Improve contractility, lower HR
- Narrow margin for safety between therapeutic, toxic, and lethal doses
- hold drug for infant/young child with (90-110 HR)
- hold drug for older child (70)
Increased pulmonary blood flow
- Ventricular septal defect
- Acyanotic
Obstruction to systemic flow
- Coarctation of the Aorta
- Acyantic
Decreased pulmonary blood flow
- Tetralogy of Fallot
- Cyanotic
Mixed blood flow
-Transposition of the Great Arteries
