Chapter 27 Christine Limann Dyer, RN, MSN CPN.
-
Upload
della-small -
Category
Documents
-
view
217 -
download
0
Transcript of Chapter 27 Christine Limann Dyer, RN, MSN CPN.
Umbilical vein, umbilical arteries
Foramen ovale Ductus
arteriosus Ductus venosus
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6
Poor feeding Tachypnea/tachycardia Failure to thrive/poor weight
gain/activity intolerance Developmental delays Prenatal history Family history of cardiac disease
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8
Murmurs = heart sounds that reflect flow of blood within the heartMay occur in systole or diastole, or bothCan occur in a normal heart in periods of
stress: anemia, fever, or rapid growthCan reflect abnormalities in heart or vessels
“Innocent murmurs” = normal cardiac anatomy and cardiac functionOccur in up to 50% of all kids at some time
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9
http://depts.washington.edu/physdx/heart/demo.html
Chest x-ray ECG Echocardiography Cardiac
catheterizationNursing
Responsibilities Post Catheterization: Monitor -
pressure dressing in the groin, heart rate, respirations & blood pressure
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 11
Signs & Symptoms: Inadequate cardiac output
Nursing Care:Artificial shunt or pathway created shortly after
birth Prostaglandin (PGE1) givenNumerous surgical repairs (cardiac transplant)Palliative care measures
Transposition of great vessels
Some complex single-ventricle defects
ASD Pulmonary
artery stenosis
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 14
DIAGNOSISDIAGNOSIS INTERVENTIONINTERVENTION
Valvular pulmonic stenosisValvular pulmonic stenosis Balloon dilationBalloon dilation
Recurrent coarctation of aortaRecurrent coarctation of aorta Balloon dilationBalloon dilation
Congenital mitral stenosisCongenital mitral stenosis Balloon dilationBalloon dilation
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15
CongenitalAnatomic → abnormal function
AcquiredDisease process
Infection Autoimmune response Environmental factors Familial tendencies
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 17
Maternal or environmental = 1% to 2%Maternal drug use
Fetal alcohol syndrome—50% have CHDMaternal illness
Rubella in first 7 weeks of pregnancy → 50% risk of defects including PDA and pulmonary branch stenosis
CMV, toxoplasmosis, other viral illnesses → cardiac defects
IDMs (infant of diabetic mother) = 10% risk of CHD (VSD, cardiomyopathy, TGA most common)
Chromosomal/genetic = 10% to 12% Multifactorial = 85%
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 18
Incidence: 5 to 8 per 1000 live births About 2 or 3 of these are symptomatic in
first year of lifeMajor cause of death in first year of life
(after prematurity)Most common anomaly is VSD28% of kids with CHD have another
recognized anomaly (trisomy 21, 13, 18, + + + )
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 19
AcyanoticMay become
cyanotic Cyanotic
May be pinkMay develop CHF
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 20
Hemodynamic characteristics Increased pulmonary blood flowDecreased pulmonary blood flowObstruction of blood flow out of the heartMixed blood flow
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 21
Abnormal connection between two sides of heartEither the septum or the great vessels
Increased blood volume on right side of heart
Increased pulmonary blood flow Decreased systemic blood flow
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 24
Atrial septal defect Ventricular septal defect Patent ductus arteriosus
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 26
Coarctation of the aorta Aortic stenosis Pulmonic stenosis
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 30
Tetralogy of Fallot(T.O.F.) Tricuspid atresia
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 34
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 36
Place in thisPosition
During Tet spell
Transposition of great vessels Total anomalous pulmonary venous
connection Hypoplastic heart syndrome
RightLeft
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 39
Impaired myocardial functionTachycardia; fatigue; weakness; restless,
pale, cool extremities; decreased BP; decreased urine output
Pulmonary congestion Tachypnea, dyspnea, respiratory
distress, exercise intolerance, cyanosis Systemic venous congestion
Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 43
Signs & Symptoms: Vary with age fluid congestionPoor feeding & growth, irritability, shortness of
breath, excessive sweating Nursing Care:
Positive inotropes (digoxin), diuretics (furosemide), vasodilators (captopril)
Fluid restriction not often used (only in the worst cases)
Help family adjust to the disorder
Educate family Help family cope
with effects of the disorder
Prepare child and family for surgery
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 45
Open heart Closed heart
procedures Staged
procedures Prepare child
and family for procedures
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 46
Monitor vital signs and A/V pressures
Intra-arterial monitoring of BP
Intracardiac monitoring Respiratory needs Rest, comfort, and pain
management Fluid management Progression of activity
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 47
CHF Dysrhythmias Decreased cardiac output syndrome Decreased peripheral perfusion Pulmonary changes Neurologic changes
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 48
Symptoms: fever, WBCs, pericardial friction rub, pericardial and pleural effusion
Occurs in immediate postoperative period Also can occur later (days 7 to 21 postop) Etiology unknown Theories of etiology
Viral infection, autoimmune response, reaction to blood in pericardium
May require pericardiocentesis or pleurocentesis
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 49
Infectious and inflammatory cardiac disorders
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 50
BE, IE, or SBE Streptococci Staphylococci Fungal infections Prophylaxis: 1
hour before procedures (IV) or may use PO in some cases
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 51
RF Inflammatory disease occurs after
group A β-hemolytic streptococcal pharyngitis
Infrequently seen in U.S.; big problem in Third World
Self-limiting Affects joints, skin, brain, serous surfaces,
and heart Carditis Polyarthritis Erythema marginatum Subcutaneous nodules
Rheumatic heart disease Most common complication of RF Damage to valves as result of RFMosby items and derived items © 2007, 2003 by Mosby, Inc., an
affiliate of Elsevier Inc.Slide
52
St. Vitus dance (aka, chorea) reflects CNS involvement
Definition: Chorea refers to sudden, aimless movements of extremities, involuntary facial grimaces, speech disturbances, emotional lability and muscle weaknessWorse with anxiety and
relieved by restMosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 53
http://www.youtube.com/watch?v=RnxqqW_nH0k
Treatment of streptococcal tonsillitis/pharyngitis Penicillin G—IM x 1Penicillin V—oral x 10 daysSulfa—oral x 10 daysErythromycin (if allergic to above)—oral x
10 days Treatment of recurrent RF
Same as above
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 54
IV IgG ASA 80-100
mg/kg/day—fever
Then 3-5 mg/kg/day—antiplatelet
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 55
Primary = no known cause Secondary = identifiable cause Pediatrics: HTN generally secondary to
structural abnormality or underlying pathologyRenal diseaseCV diseaseEndocrine or neurologic disorders
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 56
Identify kids at risk and treat early Treatment = dietary
Restrict intake of cholesterol and fats If no response to diet → Rx
Colestipol (Colestid)Cholestyramine (Questran)
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 57
Contractibility of myocardium is impaired
Secondary cardiomyopathy
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Treatment Correct underlying
cause if possible Often treatment is
aimed at managing CHF and dysrhythmias
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 58
Digoxin Diuretics Beta blockers, calcium channel blockers Dobutamine Nitroprusside Amrinone
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 59
IV IgG Digoxin (Lanoxin) ACE inhibitors ASA, NSAIDs Lasix Spironolactone (Aldactone)
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 60
Diagnostic evaluationECGHolter monitoringElectrophysiologic cardiac catheterTransesophageal recording
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 61
Signs & Symptoms: SOB, chest pain, weakness, fatigue, dizziness, leg swelling &
fainting episodes
Nursing Care: Prostacyclin (Flolan) dilates blood vessels & decreases
pulmonary vascular resistance Inhaled nitric oxide relaxes pulmonary (not systemic) vessels Sildenafil (Revatio) decreases pulmonary artery pressures Bosentan (Tracleer) blocks hormone that causes vasoconstriction
Signs & Symptoms: A fainting spells (may experience a seizure)
Nursing Care: Increase sodium & water intakeFludrocortisione (Florinef)Beta-blockerMonitor (frequency, severity & precipitating
factors)
Signs & Symptoms: fainting, palpitations, seizure or death
Nursing Care:Beta-blockersPacemaker-defibrillator insertionLeft cardiac sympathetic denervationMedication compliance
The nurse who can determine the baseline rhythm and recognize changes will facilitate the best outcome for a child with an arrhythmia
Important questions: Is the rhythm potentially fatal?Will it alter the cardiac output?
BradydysrhythmiasAV blockMay use pacemaker
TachydysrhythmiasSVT most common tachydysrhythmiaTreatments
Mosby items and derived items © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 66