Perfusion Flashcards
Exam 2
What happens during the first breath?
pulmonary alveoli open
pressure in pulmonary tissue decreases
blood from R side of heart rushes to fill alveolar capillaries
decreased R side pressure
increased L side pressure increases
how to check perfusion
cap. refill, skin color/temp, level of consciousness, I&O, HR, O2 sat.,
Congenital heart defects:
in structures of great vessels, persistence of fetal structure, irregular rhythm, heart muscle deterioration
Acquired heart defects:
infection, autoimmune response, environment, familial tendencies
LUB
S1
closure of the mitral and tricuspid valve
DUB
S2
aortic and pulmonic closure
Systole
ventricular contraction
Diastole
ventricular relaxion
S3
occurs right after S2
Ventricular gallop
“Kentucky”
S4
right before S1
atrial gallop
“Tennessee”
Where is the child heart located?
<7 years, heart lies more horizontal, apex is higher in the chest
Below 4th intercostal space
Why are infants at a greater risk for heart failure?
immature heart is more sensitive to Vol. and pressure overload
less Dev. muscle fibers= limited functional capacity
less compliance, reduced stroke vol.
Focused heart assessment means:
Inspect- nutritional state, color, chest deformities, unusual pulsations, skin color changes when crying, sweating?, skin compared in all extremities, periorbital edema?
Palpate- chest, abdomen, peripheral pulses
Auscultation- HR, sounds, rhythm
Hepatosplenomegaly
R side under rib cage-liver
L side under rib- spleen
liver starts to drop down due to fluid buildup
Stop palpation if you feel the spleen
Hwat is the purpose of the Cardiac Catheterization?
information regarding O2 sat and pressure in the chambers, CO and function, vascular resistance, cardiac response to meds. and exercise
WHat is done in the cardiac cetheterization?
radiopaque catheter introduced into heart chambers through femoral vessel in children, radial in adults, umbilical in neonates
observed using fluoroscopy
Nursing care for Pre Cath.
bassline vitals, accurate height and weight, Hx allergies, ANY infection, assess/mark pedal pulses, NPO 4-6 hrs. before
Nursing care post Cath.
Pulse monitor, pressure dressing over cath. site, vitals, assess bleeding, assess neurovascular status of lower extremities, temp, cap refill, color of extremity, I&O, keep in bed for 6-8 hours after
4 categories of congenital heart defects:
increased pulmonary blood flow
decreased pulmonary blood flow
obstructed systemic blood flow
mixed systemic and pulmonary blood flow
Atrial Septal Defect
hole in the atrium
oxygenated blood flows into the R side, too much blood in that side,
L-to-R shunt
S+S Atrial septal defect:
RR up, HR up, resp. infections, diaphoretic, failure to thrive,
Treatment of Atrial Septal Defect:
Amplatzer Septal Occluder
Ventricular Septal Defect
hole in septum between ventricles
increased pulmonary blood flow, blood from R side goes to L side, very common in children, loud murmur,
Patent Ductus Arteriosus
Blood shunts from L aorta to pulmonary artery R, increased pressure in lungs, pressure in aorta pushes back into the pulmonary vein, loud murmur, bounding radial pulse on exertion,
Prostaglandins vs. NSAIDS
P= keep patent ductus arteriosus open
NSAIDS= closes
Tetrology of Fallot
Pulmonary Stenosis, R ventricular hypertrophy, overriding aorta, ventricular septal defect
Right ventricular hypertrophy
muscle gets bigger bc its working harder
Overriding aorta
the vessel is inappropriately positioned, straddles L=R ventricle, deoxygenated blood flows back out into body
Pulmonic Stenosis:
Valve narrows, not enough blood going through
Ventricular Septal Defect
causes deoxygenated blood backflow
When the child is hypoxic due to Tetrology of Fallot, will you give oxygen?
no. Giving O2 to these patients will not solve the problem, not an issue of the lungs, deoxygenated blood flows back out into the body
Obstructive Defect
closed that should be open, narrowing to blood flow
what is coarctation of the aorta
narrowing of aortic arch
What does Coarctation of the Aorta cause?
obstruction of L ventricular blood flow, hypertrophy
S+S Coarctation of the Aorta
high BP in upper extremities, low BP in lower extremities, bounding radial pulses, weak/absent popliteal and femoral pulses, nose bleeds, leg pain, fatigue, CHF
Hypoplastic Left Heart Syndrome
L side of the heart is underdeveloped, hypoplasia of the aorta, keep PDA open
S+S of impaired myocardial function:
Tachycardia, fatigue, weakness, restless, pale, cool extremities, decreased BP, decreased urine O
What is an innocent murmur?
r/t the change in size of the heart to the thoracic cavity
S+S pulmonary congestion:
tachypnea, dyspnea, respiratory distress, exercise, intolerance, cyanosis
S+S systemic venous congestion:
peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distension
What is Rheumatic fever?
systemic inflammatory disease involving the joints, heart, CNS, skin, and subQ tissue.
follows A B-hemolytic streptococcal pharyngitis
antibodies cause lesions to dev. in joints, heart, and connective tissue
What is the most common complication of Rheumatic Fever?
rheumatic heart disease
Rheumatic Heart Disease Focused assessment:
jones criteria, fever, painful, swollen, red joints. Nosebleeds, skin rashes, SOB, chest pain, abnormal rhythm, abdominal pain
Kawasaki Disease
acute systemic vasculitis of unknown cause affecting children <5 yrs
What does Kawasaki Disease affect?
skin, blood vessels, mucous membranes, lymph system
Kawasaki Disease S+S
Moderate to high fever (101-104) lasting at least 5 days unresponsive to antipyretics, Irritable, rash
