Cardiac Template - Week 3 cardiology notes PDF

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Summary

Cardiology notes for different congenital heart defects, pediatric notes...

Description

WEEK 3 TOPICS Book: 21 ATI: 20 Anatomic Defects prevent normal blood flow TO THE PULMONARY AND/OR Systemic System.

1. Defect Name

ASD ARTERIAL SEPTAL DEFECT

VSD VENTRICUL AR SEPTAL DEFECT

Description

Increased Pulmonary Blood flow:

Blood Flow Direction

Assessment

A hole in the septum between right and left atria that results in increased pulmonary blood flow (LEFT-TORIGHT SHUNT)

Defects with increased pulmonary blood flow allow the blood to shift from the high pressure left side of the heart to the right, lower pressure side of the heart.

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A hole in the septum between the right and left ventricle that results in increased pulmonary blood flow (LEFT-TO-RIGHT SHUNT)

Defects with increased pulmonary blood flow allow the blood to shift from the high pressure left side of the heart to the right, lower pressure side of the heart.

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Nonsurgical/Surgical Repair

Loud, harsh murmur with a fixed splitsecond heart sound Heart failure Asymptomatic (possibly)

NONSURGICAL: closure during cardiac catheterization. Diuretics. Low dose aspirin 6 months after procedure. SURGICAL: patch closure, cardiopulmonary bypass.

Loud, harsh murmur auscultated at the sternal left border Heart failure Many VSDs close spontaneously early in life

NONSURGICAL: closure during cardiac catheterization. Careful observations for spontaneous closure. Diuretics. SURGICAL: pulmonary artery banding. Complete repair with patch (increased risk for heart block)

PDA PATENT DUCTUS ARTERIOSU S

A condition in which the normal fetal circulation conduit between the pulmonary artery and the aorta fails to close and results in increased pulmonary blood flow (LEFT-TORIGHT-SHUNT)

Defects with increased pulmonary blood flow allow the blood to shift from the high pressure left side of the heart to the right, lower pressure side of the heart.

Systolic murmur (machine hum) Wide pulse pressure Bounding pulses Asymptomatic (possibly) Heart failure Rales

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NONSURGICAL: administration of indomethacin (to allow for closure), insertion of coils to occlude PDA during cardiac catheterization, administration of diuretics (furosemide), provide extra calories for infants. SURGICAL: thoracoscopic repair (ligate vessels)

2. Decrease Pulmonary Blood Flow: Defect Name

Tetralogy of Fallot

Description

Blood Flow Direction

Right to left shift Four defects that result I mixed blood flow: Pulmonary allowing deoxygenated blood to enter the stenosis, ventricular septal defect, overriding aorta, right systemic circulation. ventricular hypertrophy

Assessment

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Cyanosis at birth: progressive cyanosis over the first year of life Systolic murmur Episodes of acute cyanosis and hypoxia (blue or “Tet” spells)

NonSurgical/Surgical Repair SURGICAL: shunt placement until able to undergo primary repair. Complete repair within the first year of life.

Tricuspid Atresia

A complete closure of the tricuspid valve that results in mixed blood flow. An atrial septal opening needs to be present to allow blood to enter the left atrium.

Right to left shift allowing deoxygenated blood to enter the systemic circulation.

3. Defect Name

Coarctation of the aorta

Description

A narrowing of the lumen of the aorta, usually at or near the ductus arteriosus, that results in obstruction of blood flow from the ventricle.

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Infants: cyanosis, dyspnea, tachycardia Older children: hypoxemia, clubbing of the fingers

SURGICAL: surgery in 3 stages: shunt placement, Glenn procedure, modified Fontan procedure

Obstructive to blood flow:

Blood Flow Direction

Blood flow exiting the heart meets an area of narrowing (stenosis), which causes obstruction of blood flow

Assessment

Nonsurgical/Surgical Repair

Elevated blood pressure in the arms Bounding pulses in the upper extremities Decreased blood pressure in the upper extremities Cool skin

NONSURGICAL: infants & children-balloon angioplasty. Adolescents: placement of stents. SURGICAL: repair of defect recommended for infants less than 6 months of age.

Pulmonary stenosis

A narrowing of the pulmonary artery that results in obstruction of blood flow from the ventricles

Blood flow exiting the heart meets an area of narrowing (stenosis), which causes obstruction of blood flow

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Aortic stenosis

A narrowing of the aortic valves

Blood flow exiting the heart meets an area of narrowing (stenosis), which causes obstruction of blood flow

4. Defect Name

Description

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Systolic ejection murmur Asymptomatic (possibly) Cyanosis varies with defect, worse with severe narrowing Cardiomegaly Heart failure

NONSURGICAL: Balloon angioplasty with cardiac cath. SURGICAL: Infants-brock procedure. Children-pulmonary valvotomy.

Infants: faint pulses, hypotension, tachycardia, poor feeding tolerance Children: intolerance to exercise, dizziness, chest pain, possible ejection murmur

NONSURGICAL: Balloon dilation with cardiac catheterization. SURGICAL: Norwood procedure, aortic valvotomy

Mixed blood flow:

Blood Flow Direction

Assessment

Nonsurgical/Surgical Repair

Transportatio A condition in which the aorta is connected to the right ventricle n of instead of the left, and the the Great pulmonary artery is connected to Arteries

SURGICAL: Surgery to switch the arteries within the first 2 weeks of life. IV prostaglandin E (keeps ducts open)

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Murmur depending on the presence of associated defects Severe to less cyanosis depending on the size of the associated defect Cardiology Heart failure

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the left ventricle instead of the right. A septal or a PDA must exist in order to oxygenate the blood.

Truncus Arteriosus

Failure of septum formation, resulting in a single vessel that comes off of the ventricles

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Heart failure Murmur Variable cyanosis Delayed growth Lethargy Fatigue Poor feeding habits

SURGICAL: surgical repair within the first month of life.

Hypoplastic Left Heart Syndrome

Left side of the heart is underdeveloped. An ASD or patent foramen ovale allows for oxygenation of the blood.

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Mild cyanosis Heart failure Lethargy Cold hands and feet Once PDA closes, progression of cyanosis and decreased cardiac output result in eventual cardiac collapse

SURGICAL: surgery in three stages starting shortly after birth: Norwood procedure, Glenn shunt, and Fontan procedure.

Diagnosis

Risk Factors

Findings/Assess ments

Diagnostic/Test s

Medication

Nursing Care

Pulmonary Artery Hypertension PAH is high blood pressure in the arteries of the lungs that is a progressive and eventually fatal disease, there is no cure for pulmonary hypertension.

Genetic link in children who have family who have PAH.

Dyspnea with exercise Chest pain Syncope

Radiography (chest x-ray) Electrocardiogra m Echocardiography Cardiac catheterization

PROSTACYCLIN infusion cannot be interrupted for any reason.

Cardiomyopathy Abnormalities of the myocardium which interfere with its ability to contract effectively. Can lead to heart failure. DILATED (DCM): Most common HYPERTROPHIC (HCM): Autosomal genetic increase in heart muscle mass leads to abnormal diastolic function. RESTRICTIVE: rare; prevents filling of the ventricles and causes a decrease in diastolic volume. Shock CARDIOGENIC: impaired cardiac function that leads to a decrease in cardiac output. ANAPHYLACTIC: hypersensitivity to a foreign substance that leads to massive vasodilation and capillary leak and can occur in response to an ALLERGY TO LATEX OR DURGS, INSECT STINGS, OR BLOOD TRANSFUSIONS.

Genetic factors, infection, deficiency states, metabolic conditions, collagen diseases, drug toxicity, dysrhythmias

Tachycardia and dysrhythmias Dyspnea Hepatosplenome galy Fatigue and poor growth DCM: palpitations, syncope, infant poor feeding-resp distress HCM: chest pain, syncope, dyspnea

Radiography (chest x-ray) ECG Echocardiogram Cardiac catheterization

Beta blockers, COMPLICATIONS: infection, calcium channel embolic complications (restrictive) blockers, ACE inhibitors, anticoagulants Heart transplant

CARDIOGENIC: children following cardiac surgery and with acute dysrhythmias, CHF, trauma, or cardiomyopathy. ANAPHYLAXIS: allergies, asthma, or fam history of ANP.

Dyspnea, breath sounds with crackles, grunting, hypotension, tachycardia, weak peripheral pulses. IMPAIRED MYOCARDIAL FUNCTION: sweating, tach, fatigue, pallor, cool extremes with weak pulses,

Prepare them for possible lung transplant. Avoid high altitude areas because of hypoxia. Supplemental oxygen therapy. Adhere to medication schedule.

hypotension, gallop, cardiomegaly. PULMONARY CONGESTION: tachypnea, dyspnea, retractions, nasal flaring, grunting, wheezing, cyanosis, cough, orthopnea, exercise intolerance. SYSTEMIC

Infective (Bacterial Endocarditis) An infection of the inner lining of the heart and the valves that can enter the bloodstream. Causative organisms include strep viridans, candida albicans, and staph aureus.

Congenital or acquired heart disease Indwelling catheters

Fever, malaise, new murmur, myalgias, arthralgias, diaphoresis, weight loss, splinter hemorrhages under fingernails. NEONATES: feeding problems, respiratory distress, tachy, heart failure, septicemia.

CBC ESR Urinalysis Blood cultures (positive for diagnosis)

High-dose anti- Administer antibiotics parenterally for infectives are extended time 2 to 8 weeks via given for 2 to 8 peripherally inserted central catheter. weeks IV Maintain high level of oral care. Advise dentist of existing cardiac problems in high-risk children to ensure preventative treatment.

Electrocardiogra m (ECG; vegetations present) Echocardiogram

High risk kids need prophylactic antibiotics prior to dental and surgical procedures. Observe for manifestations of infection. Schedule follow-up appts. High risk group: ineffective endocarditis, unrepaired cyanotic congenital heart disease, repaired congenital heart disease using prosthetic material or device during first 6 months, residual defects after congenital heart disease repair. Observe for manifestations of endocarditis (low-grade fever, malaise, decreased appetite with weight loss).

COMPLICATION S Heart failure Myocardial infarction Embolism

Diagnosis

Risk Factors

Findings Assessment

Diagnostic/Test s

Medication

Nursing Care

Rheumatic Fever

Dyslipidemia

Kawasaki Disease

Population: Infants, formula and breastfed From 0 to 6 months, an infant has the fastest synthesis of new tissues. The infants grow at a very rapid rate. This is due to proper nutritional intake, which can be either formula or breastmilk. Breastmilk is an infant's main source of energy, protein, carbs, lipids, and vitamins. Micronutrients in breastmilk include, calcium, phosphorous, and E. Amongst the different macronutrients found in milk, lipids is one of them. Lipids help the body absorb fat soluble vitamins. Lipids also aid in the healthy development of the infant's brain growth and development. If there was a deficiency of lipids in the milk that infants are drinking, this would in fact, alter the way their brain develops, which could lead to more severe problems down the road. Calcium is an extremely important micronutrient that is given to the infant through milk. Calcium is essential in the infant's growth, specifically bone growth. Deficiency of calcium can cause rickets once they are older.

An adolescent mother or a mother with poor financial status can affect the amount of nutritional intake an infant has. An adolescent mother may not be aware, or she may not see the importance in the proper feeding of the new baby. A mother who finds herself with low finances and very little help, may not be able to afford proper nutrition for herself, which would affect the quality of the breastmilk she produces. Savarino, G., Corsello, A., & Corsello, G. (2021). Macronutrient balance and micronutrient amounts through growth and development. Italian Journal of Pediatrics, 47(1). https://doi.org/10.1186/s13052-021-01061-0...