ALTERATIONS OF CARDIAC FUNCTION CONGENITAL HEART DEFECTS VALVULAR
- Slides: 133
ALTERATIONS OF CARDIAC FUNCTION CONGENITAL HEART DEFECTS VALVULAR PROBLEMS ENDOCARDITIS ABDOMINAL AORTIC ANEURYSM 2009
Transition from fetal to pulmonary circulation R How does the circulation during fetal life differ from that of the neonate? R What leads to this transition? R How do the changes of pressures and resistance within the heart effect the foramen ovale, ductus venosus, and ductus arteriosus?
Differences for the child in cardiovascular functioning R Why is the child at greater risk of CHF? R Why does the child’s heart beat faster? R What are the Hct, Hgb and pulse ox concentrations appropriate for age needed for adequate oxygen transport R What does cyanosis indicate? hypoxemia What is polycythemia? R What labs indicate Polycythemia: R What is the danger of Severe Hypoxemia?
BASIC PHYSIOLOGY R WHAT IS THE HEART: R WHAT IS CARDIAC OUTPUT? R How is cardiac output determined? R WHAT IS STROKE VOLUME?
PHYSIOLOGY CONTINUED R WHAT 3 things influence STROKE VOLUME? 1. Define Preload: 2. Define Afterload: 1. Define Contractility:
WHAT KIND OF TESTING IS DONE TO DIAGNOSE? RCardiac Catherization R What is used during the test? R Where are the catheters placed? R What measurements are taken? R What is visualized?
PREOP NURSING CARE CARDIAC CATHERIZATION RWHY NEED Accurate hgt and wgt RWHY IS History of allergies to iodine important? RWHAT HAPPENS IF THE CHILD HAS Severe diaper rash RWHY Mark pulses: dorsalis pedis, posterior tibial RWHY Baseline pulse ox
PREOP CARDIAC CATH RHOW TO Prepare child: schoolage/adolescent RPreop receive what drugs? RWHAT DIET PREOP AND WHY?
POSTOP NURSING CARE CARDIAC CATHERIZATION R What would you expect to find when assessing the pulses? R What is normal and what is abnormal? R R What rhythm and rate change would you expect?
POSTOP NURSING CARE CARDIAC CATHERIZATION R WHY CHECK BP R WHY Check dressing R What assessment would you need to do regarding hydration and why? R What do you do with the effected? R How do you adapt care to a toddler? R What do you do to prevent bleeding?
POSTOP HOME CARDIAC CATH RPressure dressing INSTRUCTIONS RWhat is done to Cover site? RBathing instructions? RWhat observations are made for complications? RWhat activity instructions? RWhat is used for pain?
POSTOP CARDIAC CATH SITUATION R Tommy, a 4 year old with Tetralogy of Fallot returns from catherization laboratory. He has vomited, his mother calls you to the bedside to tell you that he is bleeding. You arrive to find Tommy crying and sitting up in a puddle of blood. The first thing you do is:
ANSWERS TO POSTOP CATH SITUATION R 1. Increase the rate of his IV fluids R 2. Give an antiemetic and keep Tommy NPO R 3. Call the cardiologist R 4. Lie Tommy down, remove the dressing and apply direct pressure above the catherization site
ANSWERS TO SITUATION
GENERAL S & S of CHD in INFANTS AND CHILDREN R R R R R INFANTS: Dyspnea Difficulty feeding Stridor, choking spells Pulse rate over 200 FTT Heart murmurs Frequent URI’s Anoxic attacks CVA R R R R R CHILDREN: Exercise intolerance Increased BP Poor physical development Heart murmurs Cyanosis Recurrent URI Clubbing fingers/toes squatting
CLASSIFICATION OF CHD R 1. 2. eg: Based on how the blood flows: obstructed, delayed, abnormally shunted: Blood flow can be obstructed or delayed which CHD (what anomalies are examples? ) If Blood is abnormally shunted from one side of the heart to the other what happens to pulmonary blood flow with a left to right shunt? right to left shunt What kind of blood is abnormally shunted? What happens to the lungs
REMEMBER THIS ABOUT SHUNTS! RHow does Blood flows occur in the heart? RWhat can you say about the pressure on the RIGHT SIDE of the heart as compared to the pressure on the LEFT SIDE of the heart?
SECONDARY CLASSIFICATION OF CHD R Define happens with ACYANOTIC DEFECTS? R Give examples of Acyanotic defects? R Define what happens with CYANOTIC DEFECTS: R Give examples of Cyanotic defects? R What kind of shunt occurs?
OBSTRUCTIVE DEFECTS R Explain what happens to blood flow with an anatomic narrowing (stenosis)? R Explain what happens to the Pressure in the ventricle and in the great artery before the obstruction? R Where is the most common Location of narrowing? R Give some EXAMPLES of obstructive defects:
COARCTATION OF AORTA R Where is the narrowing located? R Where is the increased pressure and what does it cause? R Where is decreased pressure and what does it cause?
RESULTS OF COARCTATION RBecause of the large volume of blood going to the head the child may experience what? RWhat is common in infants?
TREATMENT OF COARCTATION OF AORTA Surgical treatment: Involves what correction? z What if the narrowed area is large, what might the surgeon have to do? z Is this open or closed heart surgery? z What is the common age of this surgery?
TREATMENT OF COARCTATION OF AORTA RWhat is the Nonsurgical treatment called? RIs this method performed everywhere?
POSTOP COARCTATION SYNDROME RPostop pts develop abdominal pain for what reason? RSURVIVAL POSTOP: 95%
PULMONIC STENOSIS R Stenosis means what and where? R RV hypertrophy occurs as a result of what R What happens to the volume of blood flow to the lungs? R S&S:
TX OF PULMONIC STENOSIS R SURGICAL TX: 1. Infants: closed heart surgery transventricular valvotomy 2. Children: open heart surgery pulmonary valvotomy R NONSURGICAL TX: balloon angioplasty in cardiac cath lab to dilate valve (TREATMENT OF CHOICE) R SURVIVAL RATE BOTH PROCEDURES: 98%
NEXT GROUP OF CHD: INCREASED PULMONARY BLOOD FLOW R How would you describe the blood flow in relationship to the pressures in this type of defect? R What happens to blood volume and where? R WITH THIS TYPE WHAT COMMONALITY WOULD YOU SEE IN TERMS OF S&S? R WHAT TYPE OF DEFECTS:
ATRIAL SEPTAL DEFECT R WHERE IS THE Abnormal opening? R WHERE DOES THE Blood FLOW from & to? R What enlarges?
ATRIAL SEPTAL DEFECT RS&S: RSurgical correction: R 99% survival rate postop
VENTRICULAR SEPTAL DEFECT (VSD) R Abnormal opening between? R What can happen at birth? R Describe the effects of the shunt? And where the blood flows? R S&S: R Complications? R Corrective Surgery:
PATENT DUCTUS ARTERIOSUS R Failure of what to close at birth? R How does Blood flow? R causing what kind of shunt?
Patent Ductus Arteriosus R S&S: R What complications? R What long term effects? R What changes in heart muscle?
PDA CONTINUED R What might be administered by the nurse to newborns/premies to close the shunt? R What Surgical Tx is used to correct problem? R Survival Rate postop: 99%
NEXT GROUP OF CHD: DECREASED PULMONARY BLOOD FLOW R Obstruction of pulmonary blood flow caused by what type of anatomical defect? R How does the defect cause problems with blood flow? R What effect does it have on desaturated blood? R Where does the desaturated blood flow go?
TETRALOGY OF FALLOT R FOUR DEFECTS IDENTIFIED 1. 2. 3. 4.
TETRALOGY OF FALLOT R FOUR DEFECTS
SHUNTS IN TETRALOGY OF FALLOT VARY RIf pulmonary vascular resistance is higher than systemic resistance WHICH DIRECTION IS THE SHUNT? RIf systemic resistance is higher than pulmonary vascular resistance WHICH DIRECTION IS THE SHUNT?
S&S OF TOF IN INFANTS R ASSESSMENT OF INFANTS WITH TOF? R WHAT IS A BLUE SPELL, HYPERCYANOTIC SPELL OR TET SPELL: R WHAT NORMAL INFANT SITUATIONS LEAD TO A SPELL? R CAUSE of TET SPELL? R WHAT IMPACT DOES THIS SPELL HAVE ON PULMONARY BLOOD FLOW? R HOW DOES IT EFFECT THE SHUNTING?
TET SPELLS RISKS 1. 2. 3. 4.
TREATING TET SPELLS OR HYPERCYANOTIC SPELLS R WHAT position helps the infant? R What approach needs to be used by caregiver? R What treatment needs to be instituted immediately? R What drug is given and why? R Why does the infant need IV fluid replacement and volume expanders? R What can be repeated if needed?
S&S OF TOF IN CHILDREN RWith long term cyanosis what develops in the fingers RWhat position do children assume when in Tet spell? RHow does TOF effect growth? RWhat life threatening risks of TOF in children?
SURGICAL TX OF TOF R PALLIATIVE: R COMPLETE REPAIR: R Postop risks? R SURVIVAL: 95%
TRICUSPID ATRESIA R What fails to develop? R What does this failure prevent between RA and RV? R Blood flows through another defect where? R When would the child die with this defect? R What keeps the child alive?
TRICUSPID ATRESIA R S&S: R Palliative surgery: R Corrective surgery: R Survival: 80 -90%; many postop complications
MIXED DEFECT EXAMPLES RTRANSPOSITION OF THE GREAT VESSELS (TGV) OR TRANSPOSITION OF THE GREAT ARTERIES (TGA) RTRUNCUS ARTERIOSUS (TA)
TRANSPOSITION OF THE GREAT VESSELS R PA leaves the LV taking what blood back to the lungs R Aorta exits from where? R No communication between what? R What other defect allows child to live at birth?
TRANSPOSITION OF THE GREAT VESSELS RWhat assessment and complications seen at birth? RSurgical Tx: RSurvival: 80%
TRUNCUS ARTERIOSUS R What does this look like? R What other defects? R S&S R Surgical repair: R Survival of surgery: 80%. Other surgeries required
CONGESTIVE HEART FAILURE IN CHILDREN RWhat happens to the heart? RIs it able to meet the body’s demands? RWhat situations would lead to CHF?
SUBTLE S & S OF CHF in CHILDREN RHow does it effect feeding? RHow does it effect energy? RWhat happens during feeding?
CONGESTIVE HEART FAILURE IN CHILDREN R Impaired myocardial function R How does it effect ? R VS? R Energy? R appetite R Temperature of skin? R Heart muscle? R Urinary elimination?
CHF IN CHILDREN R Systemic venous congestion R Weight? R Liver? R Fluid accumulation? R How does it effect? R Neck vein? R Respiratory assessment?
THERAPEUTIC MANAGEMENT GOALS RImprove cardiac function by? RRemove accumulated fluid and sodium leading to what effect on the heart? RWhat on cardiac demands? RWhat effect on oxygenation?
IMPROVE CARDIAC FUNCTION RDigitalis RWhich class of drug? RUsed to?
MAJOR ACTIONS OF DIGITALIS R positive inotropic: means what? R negative chronotropic: means what? R negative dromotropic: means what? R Indirectly enhances what?
DIGOXIN (Lanoxin) IN PEDS R Elixir (50 ug/ml) po R IV (O. 1 mg/ml) R Dose calculated in micrograms (1000 ug=1 mg R Give Digitalizing dose to bring serum dig level into therapeutic range R Maintenance dose = 1/8 of digitalizing dose
THERAPEUTIC SERUM DIGOXIN RANGE RRange from 0. 8 to 2 ug/l
Digoxin administration guide RApical pulse checked RDrug not given if pulse below 90110/min in infants and young children or below 70/min in older children RDo one full minute
DIGOXIN Toxicity: REffect on heart rate? REffect on appetite and feeding?
MEDS CONTINUED RAngiotensin converting enzyme inhibitors (ACE): Vasotec, Capoten RUsed to
OTHER MEDICATIONS R For severe CHF, other IV inotropic drugs used in the ICU: 1. Dopamine 2. Dobutamine 3. Amrinone Used to
GOALS OF TREATMENT CONTINUED RRemove accumulated fluid and sodium with which group of drugs? RGive examples? RCAUTION:
GOALS OF TREATMENT CONTINUED: R Decrease cardiac demands: R GIVE EXAMPLES OF NURSING ACTIONS:
GOALS OF TREATMENT CONTINUTED: R Improve tissue oxygenation NURSING ACTIONS:
NRSG DX FOR ACYANOTIC HEART DEFECTS
NRSG DX FOR CYANOTIC HEART DEFECTS
NURSING CARE IN ICU POST -OP CARDIAC SURGERY R What is done to keep child calm? R How is the infant’s temp regulated R How often VS? R How is the heart monitored? R What measures Cardiac output? R Why does the child have Pacemaker leads in place?
POSTOP NURSING CARE CONTINUED R What is used to monitor BP? R What is used to provide oxygen? R How are increased secretions managed R How is oxygenation measured? R Why is an NGT used? R Dressing over chest incision checked q 15 minutes for 24 hr for what?
POSTOP NURSING CARE CONTINUED POSTOP NU R 2 -3 chest tubes draining what from thoracic cavity which entered during surgery R Foley checked how often? R What urinary output would you expect for an infant? And a child? If Less than that normal what does this indicate? R Accurate I & O hourly including what drainage? R IV solutions and blood replacement
POSTOP NURSING CARE CONTINUED RWhat class of meds for pain? RWhat used to prevent infection? RWhat diet? RWhat needs to be done for the mouth? RHow to Support parents?
POTENTIAL COMPLICATIONS R HEMORRHAGE R *****ARRHYTHMIAS R CHF R PNEUMONIA R RENAL FAILURE R CVA R PULMONARY EMBOLISM R DEATH
NURSING ASSESSMENTS RParents Rchild
ENDOCARDITIS
CAUSATIVE ORGANISMS RStreptococcus RStaphylococcus aureus, enterococci
PREDISPOSING FACTORS R Who would get endocarditis?
PATHOPHYSIOLOGY R Where does the Infective organisms travel? R Where is it deposited on the heart? R What aggregation is triggered? R What forms on valves and endocardium?
EMBOLIZATION RWhat happens to the Fragments of friable vegetative lesions? RWhere do they go? RWhat assessments would the nurse look for with regard to embolization?
Clinical manifestations INITIAL SYMPTOMS SEEM LIKE FLU: FEVER: VASCULAR MANIFESTATIONS: R Splinter hemorrhages R Petechiae R Roth’s spots:
Clinical manifestations PERIPHERAL MANIFESTATIONS: R Osler’s Nodes: R Janeway lesions:
Clinical manifestations CARDIAC: RHeart murmur: indicates? RWhat happens to the size of the heart? RWhat other complication?
Clinical manifestations CEREBRAL EMBOLIZATION: RWhat assessments?
Clinical manifestations PULMONARY EMBOLIZATION: RWhat assessments?
Clinical manifestations CORONARY ARTERY EMBOLIZATION: RWhat assessments?
Clinical manifestations SPLENIC EMBOLIZATION: What assessments?
Clinical manifestations EMBOLIZATION OF THE RENAL ARTERY: RWhat assessments?
Clinical manifestations CENTRAL NERVOUS SYSTEM: RWhat assessments?
LABORATORY FINDINGS
Nursing care R What medications are used to treat the infection? What route? R What activity is best for the client? R What drug is used for the fever? R What drug is used for comfort R What labs indicate the infection status? R Observe for what complication? R What should be done prophylactically?
NURSING DIAGNOSIS EXPECTED OUTCOMES
ABDOMINAL AORTIC ANEURYSM
ANEURYSM RDefined
SIGNS AND SYMPTOMS
EXPANDING ANEURYSM ASSESSMENT
RUPTURED ANEURYSM R ASSESSMENT
TREATMENT: SURGICAL REPAIR
BEFORE SURGERY ASSESSMENT
COMPLICATIONS DURING SURGERY
MYOCARDIAL INFARCTION RHow would you know?
GRAFT OCCLUSION OR RUPTURE
HYPOVOLEMIA & RENAL FAILURE
RESPIRATORY DISTRESS
PARALYTIC ILEUS
POSTOPERATIVE NURSING CARE
POST-OP ASSESSMENTS for ISCHEMIA
POST-OP ASSESSMENTS for: ARTERIAL OCCLUSION
DISCHARGE PLANNING
Valvular Heart Disease
GENERAL CONCEPTS VALVULAR DISEASE INVOLVES THE 4 VALVES OF THE HEART PRESSURES:
PRESSURE ALTERATIONS DUE TO STENOTIC VALVE
VALVULAR DISEASE DEFINED: RStenosis: RRegurgitation:
STENOSIS & REGURGITATION RSTENOSIS: RREGURGITATION:
MITRAL VALVE STENOSIS
ASSESSMENT
MITRAL VALVE REGURGITATION
ASSESSMENT
MITRAL VALVE PROLAPSE
ASSESSMENT
AORTIC VALVE STENOSIS
ASSESSMENT
AORTIC VALVE REGURGITATION RACUTE AORTIC VALVE REGURGITATION RCAUSES
ASSESSMENT • ACUTE: • CHRONIC:
TRICUSPID AND PULMONIC VALVE DISEASE RRESULTS: RTRICUSPID STENOSIS RESULTS in RPULMONIC STENOSIS: results in
DIAGNOSTIC STUDIES FOR VALVULAR HEART DISEASE
TREATMENT DEPENDS UPON SYMPTOMS:
TEACHING RDescribe disease and complications RDiscuss ways to prevent complications: prophylactic antibiotics prior to invasive procedures RWear Medic Alert RTeach about anticoagulants if prescribed
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