Cards disorder in children 2

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Prittyrick
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301474
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Cards disorder in children 2
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2015-04-24 21:17:11
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children heart problems
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  1. cardiac Catheterization
    • Def: medical procedure used to diagnose and treat some heart conditions
    • Uses:
    • 1. diagnostic: congenital heart defects
    • 2. interventional or therapeutic; correct cardiac anatomy, open stenosed vessels or valves, or close abnormal connections
    • 3. other: study conduction pathways, obtain blood samples and O2 levels
    • Procedure: performed under conscious anesthesia sedation. long thin flexible tube catheter is put in a blood vessel in the arm, leg, or neckĀ  and threaded into the heart. the cath is guided by fluoroscopy.
  2. Cardiac cath risk, complication
    • Risk
    • - hemorrhage (heparin in the cath, use of pressure bandage)
    • - loss of pulse in catherized extremity (bc u can get clot, check pedal pulse before to get a baseline)
    • - hematoma
    • - transient dysrhythmias: intervention in heart can cause swelling
    • Complications:
    • - arrhythmias: more dysfunction
    • -perforation: can tear structures of heart
    • - bleeding
    • - thrombophlebitis
  3. Cardiac Cath Pre op
    • NPO 6-8 hrs prior to decrease risk for aspiration and vomiting during procedure
    • recent cxr, ecg, electrolytes, type and cross match,
    • baseline pedal pulses
    • Ht and weight
    • no lab blood draws near potential cath site to prevent infection
  4. Cardiac Cath post op
    • monitor closely for complication
    • - bleeding, arrhythmias, thrombi, infection, hematoma
    • Priority assessments: VS, pedal pulses, pressure dressing
    • - check q 15 mins for the 1st hr and then q 30mins for the next hr, maintain bedrest
    • - assess pressure dressing: maintain extremities in a straight position for 4-6hr. teach children not to bend at the hip or elbow. keep pressure dressing secure to decr risk for hematoma
    • if bleeding should occure at site: apply firm continous pressure 1" above the cath site
    • contact cardiac surgeon who did the procedure immediately
    • always follow hospital policy
  5. Cardiac Cath: post op nursing
    • assess baseline temp immediately after procedure
    • - incre temp d/t mild dehydration from NPO status or the dye used during procedure
    • - hypothermia- keep warm
    • - all stress the heart, can lead to exhausation
    • place infant under a radiant warmer to maintain body heat- no stress
    • keep child flat for 6hr: until completely awake from sedation, helps prevent postural hypotension
    • Monitor for other adverse reactions: apnea, sternal retractions, dyspnea
  6. Cardiac cath teaching post op dressing
    • change pressure dressing on the 1st day after the procedure
    • - apply a dry sterile dressing or adhesive bandage for the next several days according the surgeon
    • - keep dressing dry cover with plastic if there is a chance the dressing can get wet or soiled
    • when changing the dressing:
    • - inspect the insertion site for redness, irritation, swelling, drainage, and bleeding
    • - report any of these to the health care provider
  7. Cardiac cath teaching temp, diet,
    • Check temperature, color, sensation, and pulses on the child's extremities and compare with unaffected extremity CSM
    • resume the child normal diet after the procedure report any N/V
    • check temp once a day for 3 days after procedure. report any temp elevation of 100.4 or greater
    • report any changes or concerns to the health care provider
    • no ibuprofen to babies until 6m
  8. Cardiac Cath teaching more
    • for 3 day post op:
    • - no tub baths use shower
    • - discourage strenous exercise or activities
    • Watch for change in the child's appearance or status:
    • - fever or difficulty breathing, change in skin color, reports of heart fluttering or skipping a beat
    • give acetaminophen or ibuprofen for complaints of pain
    • schedule a follow up with HCP in the time specified
  9. CV dysfunction
    • two major categories
    • 1. congenital heart disease: abnormalities in the heart anatomy, present at birth. develop congestive heart failure, or hypoxia
    • 2. Acquired heart disorder: disease process occurs after birth. could be due to infection, autoimmune disease, environment, genetic, predisposition
  10. Congenital Heart disorders
    • Acyanotic or cyanotic heart disease
    • - acyanotic: L- R shunt, oxy to deoxy (bc blood is mixing)
    • - cyanotic: r-l shunting, deoxy to systemic circulation
    • Four classifications:
    • 1. incre pulmonary blood flow too much blood in lungs
    • 2. obstruction to blood leaving the heart
    • 3. mixed blood flow
    • 4. decre pulmonary blood flow (not enough blood flow in lungs
  11. Congenital heart disorder (the actual disorders)
    • Defects of increased pulmonary blood flow
    • - ventricular septal defect (VSD)
    • - Atrial septal defect (ASD)
    • - patent ductus arteriosus (PDA)
  12. Ventricular Septal Defect (VSD)
    • def: opening or hole in the septum between the R&L ventricles allows blood to shunt from L to R
    • - most common congenital cardiac disorder, 3:1000 live births
    • - acyanotic oxy shunting deoxy
    • Cause unknown: associated with downs syndrome, renal anomalies, prematurity, fetal alcohol syndrome. PDA or coarctation of the aorta
  13. VSD Assessment/ s/s dx
    • Assessment s/s:
    • at 4-8 weeks of age infants develops
    • - fatigue (trouble eating)
    • - loud harsh holosystolic murmur at the left sternal border in 3rd/4th ICS
    • - possible thrill (feel it on the chest)
    • Diagnostic: echo, MRI= RV hypertrophy, pulmonary artery dilation, ECG= RV hypertrophy (getting too small in there)
  14. VSD thera management,
    • therapeutic Management:
    • - most small VSD close spontaneously
    • - moderate size VSD. Interventional cardiac cath
    • - open heart surgery. large VSD > 3mm scheduled prior to 2 yrs of age
    • (closure necessary to prevent pulmonary hypertension-pressure and cardiac failure or endocarditis)
    • Open heart surgery: requires cardiopulmonary bypass and a quiet heart. surgeon sutures defect closed or sutures dacron patch in place to fill hole, over time the septum tissue grow over the patch keeping it firmly in place.
  15. VSD post op
    • monitor for arrhythmias (bc of edema in heart)
    • teach need for prophylactic antibiotics for 6m post procedure to prevent endocarditis.
    • - penicillin, amoxicillin or clinidamycin, erthromycin
    • good prognosis, provide reassurance
  16. Atrial septal defect
    • Def: opening atrial septum, allows bleed to flow between the L & R atria. Shunts L- R acyanotic. more common in girls. r heart hypertrophy due to incr blood volume and pulmonary blood flow.
    • assessment: harsh systolic murmur heard over the pulmonic area at 2nd and 3rd intercostal space, fixed split S2 almost always diagnostic of ASD (lub sh dub dub two sounds)
    • diagnostics: echo- hypertrophied r heart, increase pulmonary circulation, CXR enlarged heart/increased vascularity
    • - cardiac cath rarely needed to dx, would should show separation/hole in the atrial septum
  17. ASD thera management and nursing intervention
    • therapeutic management: elective surgery 1-3yrs of age
    • - closure important: incre risk of endocarditis and eventual heart failure
    • - especially important to repair female defects due to increased risk of emboli during pregnancy.
    • - open heart surgery or interventional cardiac cath to close defect as with VSD
    • Nursing interventions: post op monitor for arrhythmias d/t edema of atrial septum which can cause SA nose dysfunction. prognosis is good with uncomplicated surgery
  18. Patent ductus Arteriosus (PDA)
    • def: accessory fetal structure that connects pulmonary artery to aorta
    • normally closes at birth and completely closes at 3mon
    • when PDA fails to close normally blood shunts from aorta to pulmonary artery (oxy to deoxy)
    • This shunted blood returns to the LA then to LV out to aorta and shunts to the pulmonary artery again causing increase pressure in pulmonary circulation.
    • leads to right ventricular hypertrophy
    • accounts from 10% of all congenital heart abnormalities
    • twice as common in girls
  19. PDA assessment dx
    • assessment:
    • - bounding peripheral pulses bc of extra pressure in systemic circulation
    • - wide pulse pressure, difference between the systolic and diastolic pressures wife => 50. diastolic pressure low due to shunt
    • - harsh continous machinery murmur at upper left clavicle in older children
    • - ausculate heart and lungs, rales/crackles in heart failure too much flow to the lungs
    • dx:
    • ecg, normal, echo will visualize a patent ductus, cardiac cath not normall necessary
  20. PDA therapeutic
    • Therapeutic management: goal inhibit prostagladins bc prostagladins will keep it open
    • - NSAID's
    • -- indometocin IV many side effects ie decr GFR, decre platelet activity, dece cerebral and GI blood flow
    • -- Ibuprofen: becoming the drug of choice d/t less side effect. used prophalectically in some preterm
    • interventional cath can be performed 6m to 1yr
    • when PDS remains open child is at risk for heart failure (crackles in lungs), infectious endocarditis, potential statis in the pulmonary artery
  21. Congential Heart disease
    • Disorders of obstruction of blood flow:
    • - coarctation of the aorta- acyanotic
    • - aortic stenosis, pulmonic stenosis
    • Disorders with mixed blood flow
    • - transposition of the great arteries- cyanotic
    • Disorders with decreased pulmonary blood flow
    • - tetralogy of fallot- cyanotic
    • Acquired heart disease
    • - congestive heart failure
    • - rheumatic fever
    • Cardiac Surgery
  22. Disorders with Obstruction to blood flow
    • def: blood exiting the heart meets an area of anatomic narrowing, which causes obstruction to blood flow
    • - Pulmonary stenosis: narrowing of the pulmonary valve or artery distal valve- decre blood flow to the lungs
    • - Aortic Stenosis: stenosis or stricture of the aortic valve, prevents blood flow out the aorta to systemic circulation.
    • - coarctation of the aorta: narrowing of the aorta due to a constricting band, leading cause of CHF in the first few months of life
    • too little blood going thru the structure
    • -
  23. Coarctation of the aorta-acyanotic
    • def: narrowing of the aorta due to constricting band, results in an hour glass segment in aorta
    • - leading cause of congestive heart failure in first months of life
    • Characteristic symptoms: significant difference in blood pressure and pulses of upper and lower extremities
    • - assess brachial and femoral pulse
    • - too much pressure in the upper body
    • - at least 20mm hg hight in arms than legs
    • - slight coarctation: absent femoral pulses. always check femoral pulses in the newborn
    • - < 3yrs irritability
    • - older children- leg pain with activity, nodules on ribs, occasional systolic murmur
  24. coarcatation of the aorta
    • diagnostics: echo, ecg, mri, cxr
    • - L ventricular hypertrophy, notching of ribs due to enlarged collateral vessels
    • Therapeutic management:
    • - interventional angiography by balloon cath (widen structure)
    • - surgery: removed narrowed piece of aorta. surgery usually perform by two yrs of age
    • medications:
    • - digoxin and duiretics used for infants awaiting surgery. helps reduce congestive heart failure. successful surgery good prognosis for normal life
    • complications:
    • - transient abdominal pain
    • - continued hypertension in upper body (meds to help manage this)
  25. Disorders with mixed blood flow
    • def mixing of blood from pulmonary and systemic circulation in the heart chambers
    • results in deoxy
    • results deoxy in to systemic blood flow
    • Mixed defects:
    • - transposition of the great arteries
    • -
  26. transposition of the great vessels TGV
    • def: congenital heart defect where great arteries are reversed
    • cause: abnormal embryoogenesis
    • - aorta arises from right ventricle
    • - pulmonary artery from left ventricle
    • - so everything is reverse
    • - produces two non communicating circulatory systems
    • - often seen with other congenital anomalies
    • - affects boys 2-3 times more than girls
    • deoxy goes to the body and oxy never gets to the body
    • decrease O2 stat like 70's but person doing okay
  27. TGV nursing assessment
    • Assessment
    • usually significant cyanosis from birth but cyanosis may not develop for several days
    • no murmur or various murmurs
    • echocardiogram: enlarged heart ecg is normal
    • cardiac cath: low oxygen stat in the heart chambers because of the mixing of blood
    • u want some of those defects so mixing can happen or we can make one
  28. TGV thera management
    • for no communication between the circulatory systems or if associated defects are to small to allow adequate mixing of blood
    • administer prostaglins: keep PDA open
    • surgical correction:
    • - switch operation at 1 w to 3 m of age. vessels switched back to correct position
    • - allows proper oxygenation and circulation of the blood
    • - survical rate with surgery 95%

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