HEART

PHYSIOLOGIC CONSEQUENCE OF CHD Heart FAilure Assessment

Impaired Myocardial function Pulmonary Congestion Systemic Venous Congestion:

A 5-month-old has been diagnosed with an ASD. The flow of blood through the atrial septal defect

Left to right 3. The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood.

Nursing Implications

Prepare child & family for possible tests such as catheterization, and for surgery if indicated

TET spell

Sometimes, babies who have tetralogy of Fallot will suddenly develop deep blue skin, nails and lips after crying or feeding, or when agitated. These episodes are called tet spells and are caused by a rapid drop in the amount of oxygen in the blood.

Managment of TOF

Staged Surgery

Polycethemia Disorders

TOF Tricuspid atresia

Digoxin

apical pulse must be taken hold if infant pulse < 90-110 hold if child pulse < 70 therapeutic level 0.8-2.0ng/ml (nanogram)

A nurse is reviewing blood work on a patient with a cyanotic heart defect. Which of the following results would most likely be seen in a patient experiencing polycythemia?

Increased RBC

Janeway lesions, Black lines, and Osler's nodes are associated with

Infective endocartitis

A child is diagnosed with acute rheumatic fever. Which of the following would the nurse expect to find?

Jerky facial and upper extremity movements Sydenham chorea is a movement disorder of the face and upper extremities associated with acute rheumatic fever. It is considered a major criterion of the modified Jones criteria.

When caring for a child with Kawasaki Disease, the nurse would know which of the following? a) Joint pain is a permanent problem. b) Management includes administration of aspirin and IVIG. c) Steroid creams are used for the hand peeling. d) Antibiotics should be administered exactly every 8 hours by IV.

Management includes administration of aspirin and IVIG. IMMUNOGLOBIN LONG TERM ASA for FEVER

Digoxin Toxicity

NAUSEA* bradycardia,* anorexia, nausea, visual or neuro changes, dysrhythmias

A nurse is caring for a child with Kawasaki disease. Which assessment finding would the nurse expect to see?

Peeling hands and feet and fever

When reviewing the record of a child with tetralogy of Fallot, which of the following would you expect to discover?

Polycethmia

While looking through the chart of an infant with a CHD of decreased pulmonary blood flow, the nurse would expect what laboratory finding?

Polycythemia is the result of the body attempting to increase the oxygen supply in the presence of hypoxia by increasing the total number of red blood cells to carry the oxygen.

Result of TOF

The result is that the aorta receives some blood from the right ventricle, which reduces the amount of oxygen in the blood. unoxygenated blood is pumped into systemic circulation deoxgenated blood mixes with oxygenated blood on the left side of the heart which is low in oxygen and pumped to the system circulation

A child with a congenital heart defect is getting an echocardiogram. How would the nurse describe this test to the parent?

This is a test that will check how blood is flowing through the heart.

Knee Chest Position

WIth tetralogy of fallot, Bring the child's knees up tight against his or her chest (this is called the knee-chest position) or have your child squat down. This will increase blood flow to the lungs.

First indicators of heart failure

Weight loss/gain Tachycardia* Tachypnea*

Nursing interventions for CHD:

-*Improve_oxygenation_, conserve_energy_, daily _weights_ , monitor * _nutrition/hydration_ status using calorie count, monitor vital_ signs, & __lab__ values, -administer meds_ to improve cardiac function

What two physiological changes occur as a result of hypoxemia in CHF?

. Polycythemia and clubbing.

Tet of Fallot composed of four heart defects.

1. Pulmonary stenosis: Narrowing of the pulmonary valve and outflow tract, creating an obstruction of blood flow from the RIGHT ventricle to the the pulmonary artery (LUNGS) worst one(DECREASE IN PULMONARY BF) 2. Ventricular septal defect: over the left ventricle 3.Overriding Aorta: enlargment of the aortic valve , appears to arise from the right and left ventricle instead of just the left. 4. RIght ventricular Hypertrophy : the muscle walls of the right ventricle increase in size due to continued overuse as the right ventricle attempts to overcome high pressure

An infant has been diagnosed with an ASD, or AVC defect. The flow of blood through the heart with this type of defect is: 1. Right to left. 2. Equal between the two chambers. 3. Bypassing the defect. 4. In either direction.

4. The blood flow can be in any direction but generally is left to right.

IF on diuretics monitor 4 things

I & O Daily weight Postassium levels Dig levels

Congential Heart Deffect

Anomalies that develop in utero and manifest at birth or soon after

CHD Catherization

Assess bleeding, arrhythmias, clots and circulation by: pulses, color, motion, sensation if bleeding apply pressure 1 inch abouve Keep leg straight for 4-6 hours, bed rest

*****Physiologic Consequences of Congenital Heart Disease****

Chronic Hypoxemia (varying degrees) Heart failure caused by ↓ cardiac output

Tetralogy of Fallot

Congenital heart defect Decrease in pulmonary blood flow

Signs & symptoms of chronic hypoxemia r/t CHD

Cyanosis, **clubbing_ of fingers, polycythemia_, squatting, **tet spells

Digoxin Hold if infant pulse is Hold if Child pulse is Theurputic Range Check what pulse prior Always check....

hold if infant pulse < 90-110 hold if child pulse < 70 therapeutic level 0.8-2.0ng/ml (nanogram) Apical pulse prior to giving Always check with another nurse

Digoxin Action

improves cardiac output by increasing contractility and SLOWING DOWN heart rate

Digoxin Toxicity:

monitor HR, N&V Neuro and visual changes bradycardia, anorexia, nausea, visual or neuro changes, dysrhythmias

Rheumatic fever Interventions 5

monitor VS bed rest, assist w/ ambulation Long-term antibiotics (PCN Parenteral or PO) ASA for anti-inflammatory & anticoagulant effects Home Care: long-term antibiotics

Chronic Hypoxemia

not enough oxygen in blood Polycythemia-abnormally increased concentration of hemoglobin in the blood More RBCs=thick, sticky blood Risk for BLOOD CLOTS, STROKES *Clubbing *Tet Spells=extreme hypoxia Knee/chest or Squat

How do we treat the above spells

position knee to chest (squat), Morphine, oxygen

A 3-month-old has been diagnosed with a VSD. The flow of blood through the heart ventricular septal defect

right to left The pressures in the left side of the heart are greater, causing the flow of blood to be from an area of higher pressure to lower pressure, or left to right, increasing the pulmonary blood flow with the extra blood.

Anomalies resulting from a change in pressure such as ↑ pulmonary resistance or obstruction of blood flow through Pulmonic Valve & PA(PULMONARY ATRESIA) will shunt blood from

right to left These anomalies usually result in cyanosis

Impaired Myocardial function

tachycardia, diaphoresis, ↓ urine output, ↓ BP, Gallop rhyme. also fatigue, anorexia, FTT, weak peripheral pulses, pallor, cool extremities, gallop rhythm, cardiomegaly

Pulmonary Congestion

tachypnea, *crackles*, SOB, retractions, nasal flaring, cyanosis, activity intolerance, cough, frequent respiratory infections

Systemic Venous Congestion:

Hepatomegaly, splenomegaly, peripheral edema, ascites, ? distended neck veins

3. The parent of an infant newly diagnosed with TOF is asking the nurse which defects are involved. Select all that apply. 1. VSD. 2. Right ventricular hypertrophy. 3. Left ventricular hypertrophy. 4. PS. 5. Pulmonic atresia. 6. Overriding aorta. 7. PDA.

3. 1, 2, 4, 6. 1. TOF is a congenital defect with ventric ular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 2. TOF is a congenital defect with ventric ular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 3. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 4. TOF is a congenital defect with ventric ular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 5. TOF is a congenital defect with ventricular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 6. TOF is a congenital defect with ventric ular septal defect, right ventricular hypertrophy, pulmonary valve stenosis, and overriding aorta. 7. PDA is not one of the defects in tetralogy of Fallot.

Medication For CHD

Digoxin: monitor HR, N&V Neuro and visual changes Captopril: monitor BP. K+ Diuretics: monitor I&O, weight, K

After completing the physical examination on a child, the nurse suspects Kawasaki disease based on evidence of which of the following?

Dry fissured lips and a strawberry tongue are common findings with Kawasaki disease. As well as Red eyes, lymph , joint pain, fever lasting 5days MUST HAVE FIVE SYMPTOMS to diagnose

TET SPELLS

Extreme Hypoxia -Deep blue skin, nails and lips after crying or feeding, or when agitated caused by a rapid drop in the amount of oxygen in the blood.

Complicatios of CHD

HF Hypoxemia Growth Development Pulmonary Vascular Disease FTT