Nursing Care of the Child with Alterations in the CV System

What is different about the fetal cardiac system?

bypass pulmonary system, placenta does the work, when child takes first breath pulmonary and system pressure decreases, fetal structures start to close

What are the fetal CV structures?

ductus venosus, foramen ovale, ductus arteriosus

What are s/s of infants with defects until their structures begin to close?

poor feeding, poor weight gain, tachypnea, tachycardia, lethargy

What is the screening that newborns with congenital heart defects undergo?

pulse oximetry screening

When infants get pulse oximetry screening where does the pulse ox go?

right hand and right foot

Prior to discharge for infants with a positive pulse oximetry, what should you do?

evaluate

If CHD is the cause of a positive pulse oximetry test what should you do?

get an echo

What condition is characterized by arterial oxygen tension that is less than normal?

hypoxemia

What are the causes of hypoxemia?

hypoxia, cyanosis, polycythemia, clubbing

When do congenital heart defects develop?

embryologic development

What heart test assesses the heart rate and rhythm?

EKG

What heart test is and US to get images of the heart structure and blood flow?

echocardiography

What heart test is used to assess structure?

x-ray

What is used to diagnose a heart condition before birth?

fetal ultrasound

What treatment can be done for some heart defects to allow more normal growth and long-term outcomes?

fetal cardiac intervention

What is the movement of blood through an opening caused by differences in pressure of the heart chambers?

shunting

What side of the heart has higher pressure?

left side

What are the 4 types of cardiac defects?

increased pulmonary blood flow, decreased pulmonary blood flow, obstructive defects, complex (mixed defects)

What type of cardiac defect is when blood flows from the higher-pressure left side to the lower-pressure right side, and causes increased volume on the right increases pulmonary blood flow, causing cyanotic defects?

defects with increased pulmonary blood flow

Which defects increase pulmonary blood flow?

atrial septal defect (ASD), ventricular septal defect (VSD), atrioventricular septal defect (AVSD), patent ductus arteriosus (PDA)

What defect is characterized by an opening in the atrial septum, in a similar location to the foramen ovale but is larger and irregular?

atrial septal defect (ASD)

What is the treatment for ASD?

catheterization to place an occluder

What defect is characterized by an opening in the ventricular septum and is the most common defect?

ventricular septal defect (VSD)

What is the treatment for VSD?

surgical patch

What defect is characterized by having both ASD and VSD present, and having malformed valves?

atrioventricular septal defect (AVSD)

What does AVSD cause?

over-circulation to the pulmonary system

What is the treatment for AVSD?

surgical patch closure and valve repair

What defect is characterized by the failure of the fetal ductus arteriosus to close, causing left-to-right shunting of blood from the aorta to the pulmonary artery?

patent ductus arteriosus (PDA)

What is the treatment for PDA?

catheterization to coil off opening or sometimes kept open

What type of defect is characterized by increased right-side pressure due to the inability of blood to exit the pulmonary artery, causing right-to-left shunting?

cyanotic defects with decreased pulmonary blood flow

What are the cyanotic defects with decreased pulmonary blood flow?

tetralogy of fallot (TOF) and tricuspid atresia

What defect is characterized by having VSD, pulmonary stenosis /obstruction, overriding aorta, right hypertrophy, where a large volume of deoxygenated blood gets out of the body?

Tetralogy of Fallot

What is the treatment for tetralogy of Fallot?

2 patch repaire

What is a hypercapnic episode where there is an increase in pulmonary resistance, causing shunting of deoxygenated blood peripherally?

“tet spell”

What does “tet spell” occur after?

feeding, crying, BM

What is the treatment for a “tet spell”

knees to test, oxygen, morphine

What defect is characterized by the failure of the tricuspid valve to develop, the right ventricle is underdeveloped, and most have an ASD and VSD?

tricuspid atresia

What is the treatment for tricuspid atresia?

staged surgeries

What type of defects are characterized when the blood flow meets resistance from a narrowed area, where the pressure before the defect is increased and the pressure after is decreased, causing acyanotic defects?

obstructive defects

What are the types of obstructive defects?

coarctation of the aorta, aortic stenosis, pulmonic stenosis

What type of defect is characterized by the narrowing of the aortic arch, causing increased pressure before the defect and bounding pulses in the upper extremities, then there is decreased pressure after the defect and decreased pulses in the lower extremities?

coarctation of the aorta

What is the treatment for coarctation of the aorta?

removal of narrowed aorta and end-to-end anastomosis

What defect is characterized by the inability of the aortic valve to open completely, where there are 2 rather than 3 leaflets, and thick leaflets that do not open all the way?

aortic stenosis

What is aortic stenosis caused by?

rheumatic fever or bacterial endocarditis

What is the treatment for aortic stenosis?

valve repair

What type of valve repair in aortic stenosis is done by a cath procedure to open the valve more?

balloon valvotomy

What type of valve repair in aortic stenosis is done by cutting away extra tissue from the aortic valve?

valvectomy

What type of valve repair in aortic stenosis is done by replacing the valve with a mechanical valve?

mechanical valve replacement

What type of valve repair in aortic stenosis is done by replacing the valve with artificial tissue?

artificial valve replacement

What defect is characterized by problems with the valve to prevent complete opening for blood flow because the leaflets are partially fused together, thick leaflets do not open all the way, or narrowing of the area above or below the pulmonary valve?

pulmonary stenosis

What type of defects are characterized by survival in the postnatal period depends upon the mixing of oxygenated and deoxygenated blood flow, causing cyanotic defects?

complex (mixed) defects

What are the types of complex (mixed) defects?

transposition of the great arteries (TGA), truncus arteriosus, total anomalous pulmonary venous return (TAPVR), hypoplastic left heart syndrome (HLHS)

What defect is characterized by the pulmonary artery and the aorta being transposed, causing little communication between systems?

transposition of the great arteries (TGA)

What is the treatment for TGA?

surgical switch of the coronary arteries

What is a smooth muscle relaxant and vasodilator that is given through a drip in the central line that prevents closure of openings necessary for survival at that time but is used in TGA and HLHS?

prostaglandin E1

What defect is characterized by a single blood vessel coming out of the right and left ventricles instead of 2 normal vessels, causing the mixing of oxygenated and deoxygenated blood?

truncus arteriosus

What is the treatment for truncus arteriosus?

surgical creation of new pulmonary artery and closure of VSD

What defect is characterized by the pulmonary veins not connecting to the left atrium, leading to the mixing of blood, causing desaturation?

total anomalous pulmonary venous return (TAPVR)

What is the treatment of TAPVR?

surgical attaching of the pulmonary veins to the left atrium

What defect is characterized by the underdevelopment of the left-sided heart structure, where the ventricle is too small to support systemic circulation, the aorta is underdeveloped, and many have an ASD?

hypoplastic left heart syndrome (HLHS)

What is the treatment for HLHS?

staged surgeries

When is the first HLHS surgery done?

1st week of life

When is the second HLHS surgery done?

6 months old

When is the 3rd HLHS surgery done?

2 years old

What is teh intervention when there is a catheter passed through the femoral artery to evaluate function, assess pressures, obtain biopsy, and provide intervention?

cardiac catheterization

What are possible complications of cardiac cath?

hemorrhage, clot or hematoma, anesthesia reaction, risk for falls, risk for infection

What should the RN do if the patient starts to hemorrhage after cardiac cath?

bed rest flat for 6 hours, if bleeding holy pressure 1 in above incision for 20 minutes

What post op meds are need?

pain meds, diuretics, anti-inflammatories, anti-coagulation

What respiratory interventions are needed post op?

chest tubes, ambulation, IS, strict I and O’s, caution with oxygen

What care is needed for a baby with mediastinal incision?

do not lift under arms, and incision care

What nutritional support is needed for kids post op?

concentrated formula to increase calories, need strict feeding schedule

What can happen to babies if the are not meeting nutrition goals post op?

failure to thrive (FTT)

What is right ventricular dysfunction, where blood is not pumping out of lung appropriately, and it backs up into the lungs?

right-sided heart failure

What is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressure to meet the body’s metabolic demands, most often due to congenital heart defects?

left-sided heart failure

What are the symptoms of LHF?

tachypnea, dyspnea, retractions, tachycardia, poor perfusion, pale/cyanosis, poor feeding

What are symptoms of RHF?

weight gain, hepatosplenomegaly, edema, ascites

What HF medication increases contractility and decreases workload?

digoxin

What HF medication is an angiotensin-converting enzyme inhibitor, causing decreased workload?

enalapril

What HF medication decreases circulating blood volume?

lasix

What nursing care is needed for HF?

strict feeding schedule, cluster care, avoid overexertion, strict I and O’s

What is the enlargement of the heart leading to HF?

dilated cardiomyopathy

What may cause dilated cardiomyopathy?

bacterial/viral etiology, muscular dystrophy, chemotherapy, congenital

What is needed for a patient with ineffective heart function, and we have exhausted any medication treatment and surgical intervention?

heart transplant

What determines how patients are placed on the transplant list?

structure and patient need

What is a mechanical pump that is placed into a poorly functioning heart to improve the circulation of the blood through the body to help organs get better and to improve heart failure symptoms?

ventricular assist device (VAD)

What are 2 reasons for a VAD?

bridge to transplant and extending life in end-stage HF pt

What needs to be observed after heart transplant?

assess function and signs if rejection, schedule biospies, and echos

What infection control is needed post-heart transplant?

handwashing, bottled water, restrict sick visitors, avoid crowds, masks in public, no live vaccines for 6 months, no fresh flowers

What cardiac monitoring is needed post heart transplant?

arrhythmia management and BP control

What is the inflammation of small blood vessels around the ages 2-5 years old?

kawasaki disease

What is the diagnostic criteria for kawasaki disease?

5 or more days of fever up to 104 degrees, erythema, swelling, peeling of skin, generalized rash, changes in lips/mouth, strawberry tongue, cervical lymphadenopathy

What treatment is needed for Kawasaki disease?

aspirin (high dose for 48hrs and low dose for 6-8 weeks), IVIG

What can happen if Kawasaki disease is left untreated?

heart problems

What is an inflammatory disease following a group A strep infection, most common in school-aged children and adolescents?

rheumatic fever

What treatment is needed for rheumatic fever?

penicillins and anti-inflammatory meds

What is needed to assess cardiac damage in Rheumatic fever?

echo

What is an increase in pressure in the pulmonary system that is eventually fatal?

pulmonary hypertension

What causes pulmonary hypertension?

congenital, short term after surgery, result of pulmonary overcirculation

What is the treatment for pulmonary hypertension?

oxygen and vasodilators

What is it called when the HR is 140-280bpm, where the impulses are not coming from the SA node, but from tissue near the AV node, causing the tissue to not be perfused accurately?

superventricular tachycardia (SVT)