CARDIO: Defects with increased pulmonary BF (ASD & VSD)

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japanice27
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306965
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CARDIO: Defects with increased pulmonary BF (ASD & VSD)
Updated:
2015-08-28 01:00:21
Tags:
atrialseptaldefect ventricularseptaldefect
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pedia
Description:
review about defects in the heart with increased pulmonary blood flow.
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  1. ATRIAL SEPTAL DEFECT (ASD)
    • an abnormal opening bet the atria that causes an increased flow of oxygenated blood in the RIGHT side of the heart.
    • (+)right atrial and ventricular enlargement occurs.
    • infants: may be asymptomatic or may have HF.
    • (+)s/sx of dec CO may be present.

  2. (+) S/SX of decreased CO:
    • -dec peripheral pulses
    • -exercise intolerance 
    • -feeding difficulties
    • -hypotension
    • -irritability, restlessness, lethargy
    • -oliguria
    • -pale, cool extremities
    • -tachy
  3. TYPES: ASD
    • 1. ASD 1: ostium primum
    • -opening is at the lower end of the septum

    • 2. ASD 2: ostrium secundum
    • -opening is at the center of the septum

    • 3. ASD 3: sinus venous defect
    • -opening is at the near junction of the superior vena cava and the right atrium
  4. Management: ASD
    • *cardiac catheterization
    • -to CLOSE defect
    • *open repair with cardiopulmonary bypass
    • -done before school age.
  5. VENTRICULAR SEPTAL DEFECT:
    • abn opening the bet the right and left ventricles.
    • many VSDs close spontaneously during the first year of life (small or moderate defect)
    • (+)characteristic murmur
    • (+)s/sx of HF and dec CO

  6. Management: VSD
    • closure during CC.
    • open repair may be done with cardiopulmonary bypass.
  7. S/SX of HF:
    • tachy (esp when at rest and on slight exertion)
    • tachypnea (rapid breathing)
    • profuse scalp diaphoresis, esp infants
    • fatigue and irritability
    • sudden weigh gain
    • resp distress

    • LEFT-SIDED HF:
    • -crackles and wheezes
    • -cough
    • -dyspnea
    • -grunting (infants)
    • -head bobbing (infants)
    • -nasal flaring
    • -orthopnea
    • -periods of cyanosis
    • -retractions
    • -tachypnea

    • RIGHT-SIDED HF:
    • -ascites
    • -hepatosplenomegaly
    • -jugular vein distention
    • -oliguria
    • -peripheral edema, esp dependent edema and periorbital edema
    • -weight gain
  8. INT: HF
    • monitor VS: early signs, resp distress, apical pulse and dysrhythmias
    • strict I&O (weigh diapers)
    • weigh pt daily to assess fluid retention (0.5kg or 1lb in one day is caused by accumulation of fluid).
    • monitor: facial or peripheral dependent edema, auscultate lung sound and report abnormalities.
    • elevate HOB (semi-fowlers)
    • maintain a neutral thermal environment to px cold stress in infants
    • give cool humidified O2: O2 hood for young infants and a nasal canula or face mask for older infants and children.
    • don't interrupt on sleep
    • feed when hungry and soon after awakening
    • small frequent feedings to conserve energy and O2 supply
    • acute stage: sedatives as prescribed (promote rest)
    • *GIVE DIGOXIN:
    • a. before giving: assess APICAL PULSE for 1 full minute
    • b. withhold if apical pulse is LESS than 90-110 beats/min (infants); less than 70bpm in older children
    • c. CAUTION: infants RARELY receive more than 1mL (50mcg or 0.05mg) of digoxin in  one dose.
    • monitor digoxin levels and for signs of DIGOXIN TOXICITY: anorexia, poor feeding, n&v, bradycardia and dysrhythmias.
    • *NORMAL DIGOXIN LEVELS: 0.5-2ng/mL
    • *DIGOXIN TOXICITY: >2ng/mL

    • *GIVE ACE inhibitors:
    • monitor: hypotension, renal dysfxn, and cough
    • assess: BP, serum protein, albumin, BUN and CREA; WBC count, UO, USG, urinary protein level. 

    • *GIVE DIURETICS (ferosemide):
    • monitor s/sx of hypokalemia (<3.5meq/L); muscle weakness and cramping, confusion, irritability; restlessness, and inverted T waves or prominent U waves on ECG.
    • (+)hypokalemia+digoxin therapy: WOF digoxin toxicity bec digoxin potentiates DT.

    • *K supplements and K rich foods:
    • give only if indicated by K levels and if adequate renal fxn is evident
    • necessary when giving K-losing diuretic such as FUROSEMIDE (Lasix)
    • K rich foods: bananas, baked potatoes, skin and peanut butter
    • N K levels: 3.5-5meg/L
    • limit fluid intake 
    • monitor signs of dehydration: sunken fontanel (infant), nonelastic skin turgor, dry mucus membrane, decreased tear production, and concentrated urine

    • *monitor Na levels:
    • N: 135-145meq/L
  9. Home care instructions on giving DIGOXIN:
    • -give 1 or 2 hrs before feeding
    • -calendar: mark off the dose administered
    • -DO NOT MIX meds with foods or fluids
    • -MIXED DOSE: if more than 4 hrs has elapsed, withhold dose and give the next scheduled dose; if less than 4 hrs has elapsed, give missed dose.
    • -if child vomits, DO NOT GIVE SECOND DOSE.
    • -if more than 2 consecutive dose is missed, do not increase or double dose for missed doses.
    • -(+)teeth: give dose with water or brush teeth after giving the dose to px tooth decay.
    • -WOF signs of toxicity
    • -if child becomes ill, !HCP
    • -accidental overdose: CALL POISON CONTROL CENTER
    • -keep meds in a locked cabinet.

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