What is the teaching for parents of children receiving Dig?
Hold if BP is less than 90-110 (70 in older kids)
Do not mix med with milk (if baby doesn't finish we have no idea how much was given)
Usually BID (morning does/night dose)
If baby vomits after taking med, do not re-administer
teach S&S of dig toxicity
foods high in K+ (bananas, dark green leafy vegetables??)
What are the S&S of Dig toxicity?
a decreased potassium leads to an increased risk of dig toxicity.
What are the hemodynamic characteristics of the newer classifications of CHD
increased pulmonary blood flow
decreased pulmonary blood flow
Obstruction of blood flow out of the heart
Mixed blood flow
What are the characteristics of the increased pulmonary blood flow defects?
Abnormal connection between the two sides of the heart (either the septum or the great vessels)
increased blood volume in the right side of the heart
increased pulmonary blood flow
decreased systemic blood flow
What are the 3 different defects that occur with increased pulmonary blood flow?
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Describe PDA. Assessments? Nursing interventions?
Def: the non-closing of the ductus arteriosus; can take up to a year to close; severity is determined by gestational age and degree of PVR
Assessments: heart murmur (systolic murmur; sounds like washing machine) some infants may have no murmur
"wet" sounding breath sounds
increased worht of breathing or apnea
poor feeding, poor weight gain and growth pattern
sweating with feeding
excessive weight gain
Decreases O2 sats
prolonged Cap refill
post op care
decrease work of breathing
maintain frequent rest periods
do not cluster care
strict I&O (and fluid restriction), daily weights
monitor for thrombocytopenia
monitor feeding tolerance
What are the Diagnostics/treatments of PDA?
Wide pulse pressures-low diastolic pressure
Increased vascular markings on CXR D/T enlarged heart
Echocardiogram will show increased enlargement of L heart chambers
Describe ASD. Assessments? Nursing Interventions?
Two septal walls fail to form; a left to right mixing or shunting of blood may occur; moor blood flows into the right side of heart from left atrium, and pulmonary blood flow to lungs is increased through hole in atria; may lead to increased pulmonary hypertension& right ventricular hypertrophy; increased risk of stroke
Obstruction of blood flow from L ventricle to Aorta; decreased CO; aoritc regurg; increases workload of myocardium of the L ventricle leading to hypertrophy; scarring of aortic valve occurs from rheumatic fever caused by group A strep.
narrow pulse pressure with decreased systolic pressure
activity intolerance which may lead to sudden death
increased pressure load on left ventricle
Monitor for S&S of CHF
Prepare for emerg measures for A Fib
maint. pain mang.
May need prostaglandin E. drip to provide pattent ductus arteriosus until surgery
What are the Diagnostics/treatments of aortic stenosis?
EKG: thickening of septum; inverted T-waves; abnormal mitral valve
There is a defect in the pulmonary artery or pulmonary valve.
Increased work load of right ventricle
Often assos. with other disorders like Noonan Syndrome or Tetralogy of Fallot
Post Op care
Maintain Calm Environment to decrease O2 requirements
What are the Diagnostics/treatments of pulmonic stenosis?
What are the 2 decreased pulmonary blood flow defects?
Tetralogy of Fallot
Describe Tetrology of Fallot. Assessments? Nursing Interventions?
The 3rd most common lesion. Occurs more in males, Associated with Downs, 22 deletion chromosomes, and DiGeorge. Results in a right to left shunting of blood in the heart, which recirculates venous blood to body without it having gone to the lungs to be oxygenated. "Tetralogy" means four. 4 separate defects in the heart
"tet" spells or hypercyanotic spells
Pink "Tet" spells are due to left to right shunting
increased cyanosis with irritability and crying
Increased irritability due to lack of O2
Clubbing of fingers
Poor growth as a result to lack of O2
Cluster care to improve Oxygenation
prevent inconsolable crying
maintain fluid balance
Provide O2 to reduce vasoconstriction (will not improve O2 sats or reduce cyanosis)
Have on hand vasopressors to increase systemic vascular resistance; Have sedative or morphine to decrease agitation; have Prostaglandin E drip to keep PDA open.
What are the Diagnostics/treatments of TOF?
PDA causes increased blood flow to lungs
Boot shaped heart
R ventr. hypertrophy
small pulmonary artery
(child remains pink with a low degree of mixing known as "pink tet")
What does Prostaglandin E do? Why do we use it for some CHDs? What are the nursing responsibility for this med? Contraindications?
is a potent smooth muscle dilator; keeps foramen ovale and the ductus arteriosus open; works in just a few minutes and the result is improved pulmonary and systemic blood flow
watch for resp depression or apnea, flushing bradycardia, hypotension, pulm over-circulation, seizures, irritability and diarrhea.
monitor for bleeding. Is administered by cont. infusion and needs separate line
What are the four separate heart defects that occur together to make the "Tetrology" of Fallot?
VSD: between right and left ventricles
Obstructive right ventricular outflow: (pulmonary stenosis or obstruction)
Overriding aorta: lies directly over VSD and takes blood from the R and L ventricles; allows oxygenated blood to rest of body.
Secondary thickening of right ventricle: (right ventricular hypertrophy) due to restrictive outflow
Rare. increased risk for stroke. The tricuspid valve never opened (or is abnormal/missing) blocks blood flow from R atrium to R ventricle which leads to decreased blood flow to lungs; If there is no VSD with it, a PDA must be opened for child to survive.
Delayed growth & poor weight gain
Murmur (usually due to ASD if present)
Often associated with pulm stenosis
Clubbing (in older kids)
Family Care (transplant often required)
Maintain Prostaglandin E drip to maintain blood flow to lungs
What are the Diagnostics/treatments of tricuspid atresia?
What are the 3 Mixed defects?
Transposition of great vessels
Total anomalous pulmonary venous connection
Hypoplastic Heart syndrome (right and left sided)
Describe Transposition of the great vessels. Assessments? Nursing interventions?
The two great vessels of the aorta and the pulmonary artery are reversed (heart may be on the R side); cyanotic blood flow to brain causes damage; TWO separate circulations that do not mix.
Upper extremity with a decreased O2sat vs. lower extremity (espec. on right side)
profound cyanosis, esp. with crying
VSD and PDA allow blood to mix
tachypnea or quiet tachypnea
S&S of CHF
maintain O2 sats in R arm > 75% to decrease PVR
Have on hand: CHF meds. prost E drip,
Monitor children on ("pril" drugs)
Post op care
What are the Diagnostics/treatments of transposition of the great vessels?
Negetive hyperO2 test
CXR- "egg on string" visualization (may be absent in neonate)
Describe Total anomalous pulmonary veous return (TAPVR)
All pulmonary veins with oxygen rich blood follow an abnormal route back to R atrium instead of L atrium. TAPVR is difficult to distinguish from ASDs. Its both non obstructive and obstructive; there are 3 types. DiGeorge syndrome
Assessment:While PDA is open, few symptoms
If PDA closes: profound cyanosis, severe shock, and CHF occurs
Interventions: Maintain airway management
monitor blood gases
Post Op care (valvular repair)
What are the Diagnostics/treatments of TAPVR?
Snowman sign on CXR
Normal or small heart
Describe Hypoplastic left heart. Assessments? Nursing Interventions?
Second most CHD. Underdeveloped L side of the heart, aorta, aoritc valve, L ventricle and mitral valve leads to pulmonary venous congestion and edema. Often associated with no corpus collasum.
Asymptomatic unless PDA closes
Ashen skin color
usually fatal if not treated
prepare for possible heart transplant
What are the Diagnostics/treatments of Hypoplastic left heart?
As PDA closes baby will be ashen and dusky
Singke S2 gallop
What are the three types of TAPVRs?
occurs beyond left subclavian artery
occurs between left carotid artery and left subclavian artery
occurs between innominate artery and left carotid artery
IN CHF what assessment finding will you find that occur due to the impaired myocardial function?
In CHF what assessments do you find that occur due to pulmonary congestion?
In CHF what assessment do you find that occur do to systemic venous congestion
Edema (peripheral and periorbital)
Cardiac Catheterization can be done for which CHD?
Transposition of the great vessels
Pulmonary artery stenosis
some complex single ventricle defects
Baloon Dilation can be used as an intervention for which Cardiac anomalies?
Valvular pulmonic stenosis
Recurrent Coarctation of the aorta
Congenital mitral stenosis
Check pulse, distal to site
Monitor temp and color of extremity
Take vitals q 15 mins
Monitor dressing for bleeding
Monitor BG levels
Keep legs straight for 4-6 hours
Child life specialist to explain procedure at developmental level