ALTERATIONS OF CARDIAC FUNCTION CONGENITAL HEART DEFECTS VALVULAR PROBLEMS ENDOCARDITIS ABDOMINAL AORTIC ANEURYSM 2009
Transition from fetal to pulmonary circulation • How does the circulation during fetal life differ from that of the neonate? • What leads to this transition? • 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 • Why is the child at greater risk of CHF? • Why does the child’s heart beat faster? • What are the Hct, Hgb and pulse ox concentrations appropriate for age needed for adequate oxygen transport • What does cyanosis indicate? hypoxemia What is polycythemia? • What labs indicate Polycythemia: • What is the danger of Severe Hypoxemia?
BASIC PHYSIOLOGY • WHAT IS THE HEART: • WHAT IS CARDIAC OUTPUT? • How is cardiac output determined? • WHAT IS STROKE VOLUME?
PHYSIOLOGY CONTINUED • WHAT 3 things influence STROKE VOLUME? • Define Preload: • Define Afterload: • Define Contractility:
Cardiac Catherization What is used during the test? Where are the catheters placed? What measurements are taken? What is visualized? WHAT KIND OF TESTING IS DONE TO DIAGNOSE?
PREOP NURSING CARE CARDIAC CATHERIZATION • WHY NEED Accurate hgt and wgt • WHY IS History of allergies to iodine important? • WHAT HAPPENS IF THE CHILD HAS Severe diaper rash • WHY Mark pulses: dorsalis pedis, posterior tibial • WHY Baseline pulse ox
PREOP CARDIAC CATH • HOW TO Prepare child: schoolage/adolescent • Preop receive what drugs? • WHAT DIET PREOP AND WHY?
POSTOP NURSING CARECARDIAC CATHERIZATION • What would you expect to find when assessing the pulses? • What is normal and what is abnormal? • What rhythm and rate change would you expect?
POSTOP NURSING CARECARDIAC CATHERIZATION • WHY CHECK BP • WHY Check dressing • What assessment would you need to do regarding hydration and why? • What do you do with the effected? • How do you adapt care to a toddler? • What do you do to prevent bleeding?
POSTOP HOME CARE CARDIAC CATH • Pressure dressing INSTRUCTIONS • What is done to Cover site? • Bathing instructions? • What observations are made for complications? • What activity instructions? • What is used for pain?
POSTOP CARDIAC CATH SITUATION • 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 • 1. Increase the rate of his IV fluids • 2. Give an antiemetic and keep Tommy NPO • 3. Call the cardiologist • 4. Lie Tommy down, remove the dressing and apply direct pressure above the catherization site
INFANTS: Dyspnea Difficulty feeding Stridor, choking spells Pulse rate over 200 FTT Heart murmurs Frequent URI’s Anoxic attacks CVA CHILDREN: Exercise intolerance Increased BP Poor physical development Heart murmurs Cyanosis Recurrent URI Clubbing fingers/toes squatting GENERAL S & S of CHD in INFANTS AND CHILDREN
CLASSIFICATION OF CHD • 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 eg: what happens to pulmonary blood flow with a left to right shunt? eg: right to left shunt What kind of blood is abnormally shunted? What happens to the lungs
REMEMBER THIS ABOUT SHUNTS! • How does Blood flows occur in the heart? • What 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 • Define happens with ACYANOTIC DEFECTS? • Give examples of Acyanotic defects? • Define what happens with CYANOTIC DEFECTS: • Give examples of Cyanotic defects? • What kind of shunt occurs?
OBSTRUCTIVE DEFECTS • Explain what happens to blood flow with an anatomic narrowing (stenosis)? • Explain what happens to the Pressure in the ventricle and in the great artery before the obstruction? • Where is the the most common Location of narrowing? • Give some EXAMPLES of obstructive defects:
COARCTATION OF AORTA • Where is the narrowing located? • Where is the increased pressure and what does it cause? • Where is decreased pressure and what does it cause?
RESULTS OF COARCTATION • Because of the large volume of blood going to the head the child may experience what? • What is common in infants?
TREATMENT OF COARCTATION OF AORTA Surgical treatment: Involves what correction? • What if the narrowed area is large, what might the surgeon have to do? • Is this open or closed heart surgery? • What is the common age of this surgery?
TREATMENT OF COARCTATION OF AORTA • What is the Nonsurgical treatment called? • Is this method performed everywhere?
POSTOP COARCTATION SYNDROME • Postop pts develop abdominal pain for what reason? • SURVIVAL POSTOP: 95%
PULMONIC STENOSIS • Stenosis means what and where? • RV hypertrophy occurs as a result of what • What happens to the volume of blood flow to the lungs? • S&S:
TX OF PULMONIC STENOSIS • SURGICAL TX: • Infants: closed heart surgery transventricular valvotomy • Children: open heart surgery pulmonary valvotomy • NONSURGICAL TX: balloon angioplasty in cardiac cath lab to dilate valve (TREATMENT OF CHOICE) • SURVIVAL RATE BOTH PROCEDURES: 98%
NEXT GROUP OF CHD: INCREASED PULMONARY BLOOD FLOW • How would you describe the blood flow in relationship to the pressures in this type of defect? • What happens to blood volume and where? • WITH THIS TYPE WHAT COMMONALITY WOULD YOU SEE IN TERMS OF S&S? • WHAT TYPE OF DEFECTS:
ATRIAL SEPTAL DEFECT • WHERE IS THE Abnormal opening? • WHERE DOES THE Blood FLOW from & to? • What enlarges?
ATRIAL SEPTAL DEFECT • S&S: • Surgical correction: • 99% survival rate postop
VENTRICULAR SEPTAL DEFECT (VSD) • Abnormal opening between? • What can happen at birth? • Describe the effects of the shunt? And where the blood flows? • S&S: • Complications? • Corrective Surgery:
PATENT DUCTUS ARTERIOSUS • Failure of what to close at birth? • How does Blood flow? • causing what kind of shunt?
Patent Ductus Arteriosus • S&S: • What complications? • What long term effects? • What changes in heart muscle?
PDA CONTINUED • What might be administered by the nurse to newborns/premies to close the shunt? • What Surgical Tx is used to correct problem? • Survival Rate postop: 99%
NEXT GROUP OF CHD: DECREASED PULMONARY BLOOD FLOW • Obstruction of pulmonary blood flow caused by what type of anatomical defect? • How does the defect cause problems with blood flow? • What effect does it have on desaturated blood? • Where does the desaturated blood flow go?
TETRALOGY OF FALLOT • FOUR DEFECTS IDENTIFIED 1. 2. 3. 4.
TETRALOGYOF FALLOT • FOUR DEFECTS
SHUNTS IN TETRALOGY OF FALLOT VARY • If pulmonary vascular resistance is higher than systemic resistance WHICH DIRECTION IS THE SHUNT? • If systemic resistance is higher than pulmonary vascular resistance WHICH DIRECTION IS THE SHUNT?
S&S OF TOF IN INFANTS • ASSESSMENT OF INFANTS WITH TOF? • WHAT IS A BLUE SPELL, HYPERCYANOTIC SPELL OR TET SPELL: • WHAT NORMAL INFANT SITUATIONS LEAD TO A SPELL? • CAUSE of TET SPELL? • WHAT IMPACT DOES THIS SPELL HAVE ON PULMONARY BLOOD FLOW? • HOW DOES IT EFFECT THE SHUNTING?
TET SPELLS RISKS 1. 2. 3. 4.
TREATING TET SPELLS OR HYPERCYANOTIC SPELLS • WHAT position helps the infant? • What approach needs to be used by caregiver? • What treatment needs to be instituted immediately? • What drug is given and why? • Why does the infant need IV fluid replacement and volume expanders? • What can be repeated if needed?
S&S OF TOF IN CHILDREN • With long term cyanosis what develops in the fingers • What position do children assume when in Tet spell? • How does TOF effect growth? • What life threatening risks of TOF in children?
SURGICAL TX OF TOF • PALLIATIVE: • COMPLETE REPAIR: • Postop risks? • SURVIVAL: 95%
TRICUSPID ATRESIA • What fails to develop? • What does this failure prevent between RA and RV? • Blood flows through another defect where? • When would the child die with this defect? • What keeps the child alive?
TRICUSPID ATRESIA • S&S: • Palliative surgery: • Corrective surgery: • Survival: 80-90%; many postop complications
MIXED DEFECT EXAMPLES • TRANSPOSITION OF THE GREAT VESSELS (TGV) OR TRANSPOSITION OF THE GREAT ARTERIES (TGA) • TRUNCUS ARTERIOSUS (TA)
TRANSPOSITION OF THE GREAT VESSELS • PA leaves the LV taking what blood back to the lungs • Aorta exits from where? • No communication between what? • What other defect allows child to live at birth?
TRANSPOSITION OF THE GREAT VESSELS • What assessment and complications seen at birth? • Surgical Tx: • Survival: 80%
TRUNCUS ARTERIOSUS • What does this look like? • What other defects? • S&S • Surgical repair: • Survival of surgery: 80%. Other surgeries required
CONGESTIVE HEART FAILURE IN CHILDREN • What happens to the heart? • Is it able to meet the body’s demands? • What situations would lead to CHF?