Cardiac (Peds)

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Cardiac (Peds)
2012-04-02 21:09:07
Cardiac Peds

Cardiac (Peds)
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  1. Normal Heart Hemodynamics
    • Greater pressure on left side of heart (less pressure to lungs)
    • Less resistance in pulmonary circulation than systemic circulation
    • O2 rich blood returning from the lungs to the heart
    • Saturated blood circulated separately from desaturated blood
  2. Cardiac Output (CO) = ...
    HR * Stroke volume (preload, afterload contractibility)
  3. 3 Essential Components of Heart Hemodynamics
    Pressure, Flow and Resistance
  4. Fetal development of heart occurs...
    between 4-8 weeks
  5. 3 Shunts that redirect blood w/ growth and make the lungs non-functional
    • Ductus Arterious
    • Ductus Venosus
    • Foramen Ovalea
  6. Ductus Arterious
    Pulmonary artery to aorta
  7. Ductus Venosus
    umbilical cord to vena cavae (to bypass the liver)
  8. Foramen Ovalea
    atriums bypass blood to one another
  9. Oxygen concentration in blood increases the pressure change which...
    Closes the shunts in fetus'
  10. Changes @ Birth
    • Lungs Expand-O2 dilates pulmonary vessels-decreasing pulmonary vascular resistance
    • Increased pulmonary blood flow (decreases pressure to right side of heart)
    • Increased resistance from systemic vascular system with increase volume of blood with placenta clamping
  11. Congenital Heart Defects occur...
    4-10 per 1000 births

    usually secondary in children with heart defects
  12. What is a major cause of death in first year other than prematurity
    congenital heart defects
  13. Clinical Manifestation of Congenital Heart Defects
    • Murmurs
    • Arrhythmias
    • Hypoxia
    • Cyanosis
    • Other factors to consider: age of presentation, perfusion, temp, respiratory status, response to oxygen therapy
  14. Clinical Manifestation of Congenital Heart Defect: Mumurs
    • 50% of population have innocent murmurs
    • Sound comes from blood going back and forth in heart structure
    • Swishing sound
    • Gallop
  15. Clinical Manifestation of Congenital Heart Defect: Arryhthmias
    • Rate of infants already fast and make it difficult to heart
    • Children can change rate with breathing pattern
  16. Clinical Manifestation of Congenital Heart Defect: Hypoxia
    reduction in arterial tissue oxygenation which causes impaired cellular process function
  17. Clinical Manifestation of Congenital Heart Defect: Cyanosis
    • blue discoloration with reduced O2 saturation from deoxygenated hemoglobin
    • cyanosis SaO2 will occur with 85% of lower levels
  18. Congested Heart Failure Manifestations
    • Impaired Myocardial Function
    • Pulmonary Congestion
    • Systemic Venous Congestion

    SHOCK usually occurs with CHF
  19. Clinical Manifestation of Congested Heart Failure: Impaired Myocardial Function
    • Tachycardia (>160 in sleeping infants)
    • Diaphoresis
    • Poor Perfusion (decreased UO)
  20. Clinical Manifestation of Congested Heart Failure: Pulmonary Congestion
    • Tachypnea (>60 in infants)
    • Poor feeding (dysfunctional breathing/sucking)
    • Retractions
    • Orthopnea
    • Cyanosis
  21. Clincial Manifestation of Congested Heart Failure: Systemic Venous Congestion
    • Hepatomegaly (englarged liver)
    • Edema and weight gain
  22. Cardio-Defect Groups
    • Increased Pulmonary Artery Blood Flow (too much blood in R ventricle)
    • Decreased Pulmonary Artery Blood Flow (stenosis)
    • Obstructive Defect (valve problems)
    • Mixed Blood Flow Defect (septal problem)
  23. Long-Term Effects of Congested Heart Failure
    • Polycythemia (increased number of RBC)
    • Clubbing (thickening of finger and toes)
    • Hypercyanotic spells (esp. associated w/ tet spells) (increased risk of infections)
    • Learning disabilities
    • Failure to Thrive
    • Increased risk of infections
  24. Dx Tools of Congested Heart Failure
    • EKG
    • Lab work
    • Echocardiogram
    • MRI
    • CT
    • X-ray
    • Blood Gases
    • Cardio Cath
  25. Nursing Actions for CHF
    • Feeding (limit time - 20 minutes)
    • Positioning (upright position)
    • Medicationis (lorenapril -ace inhibitor-dilates blood vessels; easier for heart to pump out blood)
    • Accurate I & O
    • Daily Weights
    • Decrease Cardiac Demands (keep warm/avoid prolonged crying)
    • Promote optimal growth and development
  26. Nursing Interventions w/ Cardiac Children
    • Maintain Respiratory Status
    • Maximize Energy
    • Monitor Fluids
    • Pain Relief
    • Long Term Care
  27. Characteristics of Decreased O2
    • Body compensates (increased HCT and increased HGB)
    • Worry about clots
    • Clubbing
    • Tet Spells (2 steps and would have to squat to get blood circulating)
    • Learning disabilities (decreased O2 to brain)

    Dx w/ these problems: Decreased pulmonary artery blood flow b/c not enough O2