Perfusion exam 3 Flashcards
foramen ovale
allows oxygenated blood to travel from RA to LA
ductus arteriosus
allows fetal blood to bypass the lungs
patent
remain open
congenital heart disease
missing or poorly formed parts of the heart
shunt
refers to the flow of blood through an abnormal opening between two vessel of the heart
diagnosis
- screening- CCHD for all newborns at 24hr age
electrocardiography
echocardiography
MRI
cardiac catheterization
assessment
positive fam hist of cardiac disease
- poor feeding
- tachypnea/tachycardia
- arrhythmia/murmur
- failure to thrive/ poor weight gain
- activity intolerance
- developmental delays
- abnormal color-cyanosis and pallor
- clubbing of fingers
- chest deformities
acyanotic shunts
do not impair blood flow to the lungs, and the oxygenation process is intact. These shunts cause increased pulmonary blood flow
cyanotic shunts
impair oxygenation of blood by the pulmonary system and result in cyanosis. These defects cause decreased pulmonary blood flow
ASD
abnormal hole in the septum that divides the atria of the heart
ASD pathophysiology
- acyanotic defect- increase pulmonary bd flow
- left to the right shunt- blood leaks from the left atrium to the right atrium delivering extra oxygenated blood back to the lungs
- a large ASD over a period of time, can cause damage to the heart and the lungs
ASD symptoms
- fatigue
- feeding intolerance
- shortness of breath especially during any physical activity
- swelling in abdomen, legs
- murmur on auscultation
- may not have any symptoms
ASD treatment
- may close on its own
- some defects may not close, and may need treatment
- surgical correction done via cardiac cath or open heart surgery
VSD
a hole in the septum of heart ventricles
VSD pathophysiology
-acyanotic defect- increase pulmonary bd flow
- left to right shunt- blood leaks from the left ventricle to the right ventricle delivering extra oxgenated blood back to the lungs
- large VSD over a period of time can cause damage to the heart and the lungs
VSD symptoms
- fatigue
- feeding intolerance
- shortness of breath especially during any physical activity
- swelling in abdomen or legs
murmur on auscultation
may not have any symptoms
VSD treatment
- may close on its own
- some defects may not close and may need treatment
- surgical correction done via open heart surgery
coarctation of aorta
a constriction or narrowing of the aortic arch or of the descending aorta
coarctation of aorta pathophysiology
- acyanotic defect
- restricts blood flow to the body due to stenosis of aorta
- L ventricle hypertrophy over time (working harder to pump through narrow aorta
Coarctation of aorta symptoms
- may not develop symptoms until adulthood
- pulses and BP will differ between upper and lower extremities
- fatigue
- feeding intolerance
- shortness of breath especially during any physical activity
- heavy sweating
- irritability
- pale skin
coarctation of aorta treatment
- balloon angioplasty with stent placement
- surgical repair
- if untreated, leads to HTN, heart failure, and endocarditis
Tetralogy of fallot
it’s a combination of four heart defects that change the way blood flows through the heart and to the lungs
TF pathophysiology
- cyanotic defect (decrease pulmonary bd flow)
- Righ ventricular hypertrophy- thickening of muscle in right ventricleaorta displacement- opening to aorta collection from both ventricles
- pulmonary stenosis- narrowing of the pulmonic valve
- ## ventricular septal defects- hole between ventricles
TF symptoms
- low SpO2- blue skin, lips, and fingernails
- TET spells
- fatigue
- feeding intolerance
- shortness of breath especially during any physical activity
- murmur on auscultation
TF treatment
- tet spell- knee to chest
- surgery
temporary shunt (increase pulmonary blood flow and relieve hypoxia
surgical correction via open heart surgery soon after birth, or after baby gets stronger
heart failure
the inability of the heart to pump an adequate amount of blood into the systemic circulation
Heart failure clinical cues
- impaired myocardial function- tachycardia at rest, feeding intolerance, weight gain
- pulmonary congestion- tachypnea, dyspnea
- system venous congestion- hepatomegaly
HF diagnostic evaluation
- made on the basis of clinical symptoms
- echocardiography and other diagnostic imaging
defects that have potential to lead to heart failure
- in children, occurs as result of structural abnormalities
- heart muscle may become damaged if left untreated
- right- or- left sided failure
Managing heart failure steps
1 improve cardiac function
#2 remove accumulated fluid and sodium
#3 decrease cardiac demands
digitalis glycosides
improves contractility; slows HR
- monitor K+; check HR (hold <90 infant; <70 older child)
- adverse effects: N/V, visual disturbances, anorexia, bradycardia, or dysrhythmia
ACE inhibitors
prevents compensatory vasocontriction
- monitor for cough, edema, hyperkalemia, hypotension
beta blockers
decreased HR and BP, vasodilation
- monitor for bradycardia, hypotension, fatigue
nursing considerations diuretics
- strict intake and output
- fluid assessments
- watch for hyponatremia, hypotension, and monitor for dehydration
-monitor potassium
remove accumulated fluid and sodium
- loop diuretic- furosemide
- thiazide diuretics- chlorothiazide
- potassium-sparing diuretic- spironolactone
decrease cardiac demands
- limit activity
- preserve body temp
- treat infections
- reduce effort of breathing
- improve tissue oxygenation, reduce respiratory distress
- maintain nutritional status
heart failure nursing considerations
Monitor fluid status (I/O, daily weight)
Decrease energy expenditure/promote rest
Freq rest, small/frequent feeds, minimize crying, prevent cold stress
Prevent infections
Reduce respiratory distress
Upright or knee-chest (squatting) for cyanotic heart disease
Provide adequate nutrition
Promote growth and development
Establish daily caloric requirements
Consider gavage feedings
Consider nipple type
Family-centered care
Help the family adjust to the disorder and the new life at home (Discharge and homecare)
Educate the family about the disease
Prepare child and family for invasive procedures
