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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.
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(+) S/SX of decreased CO:
- -dec peripheral pulses
- -exercise intolerance
- -feeding difficulties
- -hypotension
- -irritability, restlessness, lethargy
- -oliguria
- -pale, cool extremities
- -tachy
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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
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Management: ASD
- *cardiac catheterization
- -to CLOSE defect
- *open repair with cardiopulmonary bypass
- -done before school age.
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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
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Management: VSD
- closure during CC.
- open repair may be done with cardiopulmonary bypass.
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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
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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
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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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