Congenital Heart Defects – Wendy – Flashcards

- opening between R and L atria - closes within the first week of birth

- connects the pulmonary artery and distal aorta - closes within 24 hrs of birth

-closes 3-7 days after birth

- may lead to CHF or hypoxia - may be associated w/ chromosomal abnormalities, syndromes, or congenital defects in other systems

- r/t: infection, autoimmune responses, environmental factors, familial tendencies

- accurate hx/family hx:genetic problems, chromosomal-Down's syndrome (high cardiac risk), plot height and weight on growth chart, prenatal hx, chronic health issues in mom in pregnancy-exposure to infections(rubella, viral inf), drugs/alcohol/smoking, high-birth weight, medications exposure in utero, x-rays. -good pt hx - what is presenting problem, what are they coming in for. - presenting problem: feeding issues? profuse sweating? FTT? tachypnea? respiratory difficulties? color changes? activity intolerance? fatigue, SOB, cyanosis, inability to gain wt. -past med hx- exposure to rheumatic fever?

- heart sounds murmur? Irregular? - murmur? obtain 4-point BPs; loud or subtle? - Height/weight; FTT - Color, paleness, cyanosis (80-85% O2 sat) - Nutrition, FTT, failure to gain weight, undernourished - color of Extremities, mucous membranes - Chest symmetry deformities? barrel, pigeon chest - neck Veins? distended? - Clubbing of the fingers - fluid retardation; edema - cool skin - grunting, nasal flaring, cough, retractions - in infants: arm and thigh BP should be = - over 1 year: SBP in leg is higher by 10-40 mmHg - wide pulse pressure (>50) or narrow pulse pressure (<10) may indicate heart defect**

-cyanosis, pale skin, sweaty clammy skin -tachypnic, tachycardic, retractions for increased work of breathing -fluid retention-edema, decreased urine output -cyanosis- not going to see a change in skin or lip color until you see an o2 stat below 80-85

*cyanotic screening: prior to these diagnostic tests all newborns get a cyanotic congenital heart defect CCHD screening between 24-48 hours of birth. o2 stat on right hand and foot- simultaneously. want 95% or higher, with less than a 4% difference between the hand and foot - EKG: electrical activity; checks for arrhythmia's - echo: 3D image of heart structure; checks for deformities - cardiac cath: heart vessels; measures O2 levels-, anatomical alterations, most invasive. **femoral and antecubital site - chest XR: heart size, contours, pulmonary placement

prepare child based on developmental level: - What they're going to feel/hear/see-play and dolls - NPO for 4-6 hrs before - Baseline labs: coags, H&H, O2 sats, VS, pedal pulses, start IV fluid - Sedation before procedure -r/f clots, bleeding, infection, rough on kidneys, arrhythmia's post-cath: -Check extremity distal to insertion site for color, temperature, pulse, and papillary refill -*Keep extremity extended for 4-6 hours -*Check site for bleeding*** femoral or AC straight -*positioning/bed rest (at least 4 - 6 hours afterwards), -monitor pulses, temp, cap refill, color, etc. -Monitor VS and urine output-strict I&O *make sure they pee out that dye contrast -Continuous cardiac monitoring for dysrrhythmias -Monitor for infection -Watch for hematoma formation -Quiet play for 24 hrs afterwards -Maintain fluid intake -pressure dressing on site for 6 hours **if they have a severe diaper rash- procedure is postponed-infection

-improved cardiac function and energy conservation -remove accumulated fluids -decrease cardiac demands -increase tissue oxygenation -help achieve normal G&D milestones -help education parents to understand parents condition so they know how to take care of them decrease energy expenditure: -minimize stress and anxiety - anticipate their needs - *frequent, adequate rest (cluster care)-decrease cardiac work load, decrease energy expenditure -*small, frequent feedings are key-improve cardiac function and energy conservation - minimize crying - *minimize/prevent cold stress-increases RR, demand for o2, and affect blood sugars - *provide passive stimulation - quiet age-appropriate play - use a soft nipple; NG feedings if necessary; provide adequate nutrition and decrease workload - monitor fluid status: strict I+Os; daily wts. - prevent infections-avoid crowds, hand washing - semi/high fowler's positions, reduce respiratory distress, may need supplemental oxygen as well - knee-chest for Tet spells -*medication depends on the type of defect they have -a lot of them need surgical correction

- helps strengthen heart mms., enabling it to pump more effectively; increases (force) contractility/decreases after load (HR), indirectly enhanced diuresis. - *check apical pulse for 1 FULL MIN* - *withhold dose if HR (pulse rate) is <90-110 in infants or <70 in older kids*** - watch for digoxin toxicity: n+v, anorexia, bradycardia, dysrhythmias, monitor K+ levels - *give water after med to prevent tooth decay** - give 1 hr before food or 2 hrs post-food - if child vomits DONT re-administer

- body's water balance can be affected when the heart isn't working effectively; help the kidney remove excess fluid from the body; remove fluid/sodium - high K+ diet (bran cereal, potatoes, tomatoes, bananas, melons, oranges, green veggies, orange juice), - monitor I+Os, daily wts., monitor for adverse SE such as hypoK+, n+v and dizziness - mix w/ juice to disguise bitter taste*

- dilate the blood vessels, making it easier for the heart to pump blood forward into the body; reduce afterload; result in decreased pulmonary and systemic vascular resistance; increased contractility - watch for hyperK+, monitor BP before and after administration - teach pt. to monitor BP frequently

- decrease HR and BP and promote vasodilation - monitor BP and HR before administering - SE: dizziness, hypotension, headache*

-abnormal opening between pulmonic and systemic circulation disrupt normal blood flow - blood will ALWAYS go from high to low pressure = the path of least resistance

- 1. *decreased pulmonary blood flow cause (cyanosis) - 2. right to left shunting of blood cause (symptoms of HF): obstructed pulmonary blood flow leads to higher pressure on RIGHT side of the heart - doesn't pick up O2 in the lungs 3. CAN OCCUR ALONE OR TOGETHER - both oxygenated and deoxygenated blood circulate to the body - cyanosis + hypoxemia

- cyanotic congenital heart defect that involves 4 abnormalities; most common cause of cyanotic congenital heart defect - will automatically go into natural squat position: changes pulmonary/vascular resistance-will increase pulmonary blood flow. SELF CORRECT THEMSELVES *always have all 4-lack of blood flow to heart - 1. ventricular septal defect: a hole between the ventricles - 2. pulmonary stenosis: narrowing of pulmonary valve - 3. right ventricle hypertrophy: right ventricle develops a thickened mms. - 4. overriding aorta: aortic valve is connected to both the left and right ventricle *-acute spells of cyanosis, syncope. O2 IS NOT EFFECTIVE IN TREATING THIS. not due to lack of oxygenated blood, its lack of blood flow to the heart -s/s episodes of acute cyanosis and hypoxia, systolic murmur *does require SURGERY TO CORRECT

- *oxygenated and deoxygenated blood mixes in the heart - increased pulmonary blood flow due to defect - severe hypoxemia and cyanosis* - risk for poor CO and r/f CHF

- pulmonary artery and aorta are reversed - oxygenated blood not entering systemic circulation - have 2 separate circulatory systems - will only survive if the PDA is kept open (usually closes within 24 hours)-as soon as notice s/s the better - PDA-patent ductus arteriosus you want to remain open in order them them to get some oxygenation and stay alive, -will only stay alive if they have a patent ductus, ventral septum defect or aorta septum defect. -long term outlooks depends on severity of defect and how quickly they get surgery -keep it open through the prostaglandin E medication -r/f endocarditis -any surgery or dental surgery will need antibiotics and good dental hygiene is key in the long run -usually present with murmur, and cyanosis

- only one artery originates from the heart and forms both the aorta and pulmonary artery - the trunks arises above a large VSD (ventricular septal defect) that is almost always associated with this defect - the truncus receives low O2 blood from the right ventricle and O2 rich blood from the left ventricle - this mix of high and low O2 blood is sent out to the body and to the lungs - open heart surgery in infancy is needed to correct -s+s: HF, cool skin, murmur, variable cyanosis, increased HR

- left side of the heart is underdeveloped - small left ventricle cannot provide enough blood flow to meet the body's needs - usually ok until PDA closes, then s/s worse and go into a cardiac collapse - surgical intervention: 3 stages = surgery shortly after birth, second at about 6 mos, & last at 18 mos. most of time need heart transplant.. wont live long without surgery - s+s: cyanosis, pale skin, sweaty or clammy skin, cool skin, heavy/rapid breathing, tachycardia

- underdevelopment of the right sided structures of the heart - inadequate blood flow to lungs = cyanosis (blue) - want PDA to remain open - surgical shunt needed to send blood to lungs for O2

- *defects associated with increased pulmonary blood flow - left-to-right shunting of blood across a septal defect of blood vessel: higher pressure on the LEFT side of the heart - pulmonary over-circulation and increased workload of ventricle (too much blood passing through the lungs) - risk for HF - s+s: blood recirculates to the heart, lethargy, FTT, murmur, fatigue, good O2 sats*(do not cause low oxygen levels) skin and mucus membranes are usually pink. - tx.: surgical

- acyanotic congenital heart disease - hole between ventricles - inefficient O2 use - enlarged heart from added workload - pulmonary HTN d/t increased volume - murmurs? LOUD harsh - small VSD: may close itself - large VSD: surgery repair by age 2 - patch the hole -s/s-SOB, fatigue, edema -good long term outlook

- hole between atrium - inefficient O2 - murmur heard? LOUD harsh murmur** - may be surgically repaired w/ patch -may be asymptomatic and then develop pulmonary HTN: if large ASD not treated in childhood *HF or increased blood pressure if undetected in adulthood shortened lifespan

- when normal ductus arteriosus doesn't close - creates abnormal circulation between pulmonary artery and aorta. doesnt get nourished by lungs - opening allows blood to flow from the aorta into pulmonary artery: strain on the heart, pulmonary HTN - s+s: bounding pulses, wide pulses, murmur, can be asymptomatic -If large PDA child may tire quickly, grow slowly, more prone to infection (pneumonia), rapid breathing. *common in premies *go in and tie is off surgically -sometimes small will go undetected *to get it to close through medication -NSAIDs ibuprophen or indomethacin to get it to close, instead of surgery for small ones

- *(obstructed) (stenosis)-narrowing of outflow from the heart to the blood vessels - increased workload to the heart as it strains to push blood out. causes little blood to travel to the body - risk for CHF, poor cardiac output

- narrowing of aorta between the upper-body artery branches and the branches to the lower body - can increase blood pressure in arms and head, reduce pressure in legs, seriously straining the heart** -left ventricle has to work harder to move the blood, will end up not being able to handle the extra workload and go into CHF - s+s: bounding pulses ,(absent/weak pedal pulses), cool skin, dizziness, headaches, fainting, and nosebleeds. BP higher in upper extremities, and decreased in the lower

- congenital narrowing of pulmonary artery opening (valve) - increases resistance to blood flow from the right ventricle to the pulmonary artery - right side of the heart pump harder - becomes enlarged - possible right sided HF - produces a LOUD heart murmur: systolic ejection murmur -if severe you will see cyanosis, CP, fainting, SOB -if minor can be asymptomatic - tx.: surgery/valvuloplasty

- aortic valve forms improperly-stenosis - tx. depends severity: surgery to expand or replace valve -may be asymptomatic if minor; - s+s: severe-chest pain, tiring, dizziness, faint pulses, hypotension, tachycardia, poor feeding

b rationale: time is the best tx. the kidneys excrete the metabolites and symptomatic tx. alleviates the rhythm disturbances or nausea caused by the toxicity. a: only effective if the client has taken an overdose of cardiac glycoside and large amount of unabsorbed drug remains in the GI tract before the serum level increases. c: this is for clients who are extremely unstable despite symptomatic tx. or whose renal function isn't sufficient to exert the drug. d: used for bradycardia, but wouldn't necessarily use atropine to tx. the toxicity itself.

b rationale: sign of worsening HF. a, c & d: all adverse effects, but don't indicate that therapy is ineffective

b rationale: a: murmur in aortic insufficiency c: mitral stenonis d: mitral insufficiency