Peds Hour 10 PDF - Cardiac Defects

CardiacDefect Gget a f can occur alone or with a congenitalsyndrome ex down syndrome classified on blood flow not the patient's symptoms NEEG.IE Id t in the atrium...

CardiacDefect Gget a f can occur alone or with a congenitalsyndrome ex down syndrome classified on blood flow not the patient's symptoms NEEG.IE Id t in the atrium eart right the blood is pumpedthrough the tricuspid valve into the right ventricle the blood then goes through the pulmonary artery into the lungs blood is oxygenated and returns to the heart through the pulmonary veins into the left atrium oxygenated blood travels through the bicuspid valve into the left ventricle then out of  the heart through the aorta and throughout the body Common Pediatric Heart atrials atrioventricular canal defect coarctation of the aorta COA Ebstein anomaly hypoplastic left heart syndrome HHS patent ductus arteriosus PDA pulmonary artesia pulmonary valve stenosis tetralogy of fallot total anomalous pulmonary venous return TAPUR transposition of the great arteries TGA tricuspid artesia truncus arteriosus ventricular septal defect VSD  atonofDef G left to shunt right blood flow increased to the lungs ASD USD PDA coarctation of aorta Cyanotic left shunt rightto blood flow decreased to the lungs transportation of the greatarteries vessels tetralogy of the fallot AE bata.at ovale to close at birth ttlt repair at 5 6 years old often spontaneous closure before that the closure method depends on the size of  the defect 6 months of ASA afterwards can cause more damage to septal wall deoxygenated blood is circling through once fixed can give child aspirin feed wire through femoral artery putthrough defect trigger closure patching up septal wall defect don't need heart surgery LeularseptalDefect opening bewe iies often seen with other congenital heart defects 30 50 close spontaneously by 3 years of age 3 4 heart yrs of age patch graft or open surgery CHF regime need heart  g ge massive effect patch notappropriate can only fix certain size defects Patent BygtoArtenosu.an openingbetween the pulmonary artery and the aorta normal in vitro failure of the fetal ductus arteriosus to close common in preemies usually closes at 72 hrs of life but can be up to 2 3 weeks normally decreased maternal prostaglandins cause closure in full term newborns machine him murmur bounding pulses wide pulse pressure echocardiogram Closure via cardiac catheterization or surgery to Clip close the patent vessel trans catheter closure doctors can insert a soft wire mesh PDA closure device a  g catheter a long narrow tube to stop blood flow through a PDA this non surgical approach is performed in the catheterization lab under fluoroscope if this does not work open heart surgery is the next step L ftheAorta narrowing of the aorta beyond the aortic arch causes obstructed flow from ventricles symptoms flow upper extremities increased BP blood nose bleeds headaches bounding carotids lower extremities decreased BP blood flow weak pulses Cool weak muscle tone  leg cramps CHF regime fluids OSA BP excerise restrictions until repaired transportation of great arteries vessels aorta switch position pulmonary artery and function changes no communication between pulmonary circulation and systemic circulation treatment immediately after birth keep as many prenatal structures open as possible prostaglandin to keep ductus open create VSD to mix ventricular blood keep or create ASD to mix arterial blood surgical correction arterial switch surgery major arteries are switched I 1gyoffal 1 USD  2 pulmonic stenosis 3 overriding aorta 4 right ventricular hypertrophy Signs and symptoms cyanosis systolic murmur JET spells blue spells hyper cyanotic spells TET Spells at birthinfants may not show cyanosis signs but may develop bluish skin episodes from crying or feeding Treatment place in knee chest position 1 administer 100 02 blow by morphine IV SQ or IV fluid replacement for expansion Repair usually done in the first year of life as cyanosis and hyper cyanotic spells increase done I at a time may continue to need CHFregimen postoperatively CHF assessments impaired myocardial function tachycardia diaphoresis decreased urinary output fatigue pale and cool extremities weak peripheral pulses FTT anorexia pulmonary congestion tachypnea dyspnea retractions and nasal flaring excessive intolerance stridor or grunting recurrent respiratory infections systemic vascular congestion peripheral edema ascites neck vein distention  signs and symptoms of hypoxemia cyanosis term clubbing long polycythemia TET spells CHF Nursing Interventions rest HOB 30 or hip nap angle cluster care with feedings to allow good rest periods feed only if alert and sucking finish feeds by GT or 06 if tired sedation morphine to decrease RR if tachypheic ICO 02 PRN watch 02 saturations digoxin know when to hold digoxin 4110 in infant  90 in 1 64 0 270 in 7 15 4 0 cardiac monitor wait until HR lasix diuretic dependent check med doses with weight are IV drugs in tenths of mL many low Na formula diet as they grow asepsis decrease immune reserves no energy reserves to fight infection hydration increase risk of fluid volume overload or deficit loose diaper abdominal breathers Diagnostic tests Chest X ray see if anything is on there EKG echocardiogram of the heart  cardiac catheterization lie flat minimum 4 6 hrs post procedure risks thrombosis embolism formation puncture of vessel or heart bleeding decrease circulation to lower extremitie groin difficulty in keeping child flat and still check pressure dressingfrequenth Surgery expectations depending on the type of surgery Post op ICU ET tube not removed unless child is oxygen breathingindependently multiple IV lines chest tubes foley No tube hypothermia in OR warm slowly cold in OR temp of room risk of SS sedation pain meds  EYEEL.IE Widespread inflammation of the small and medium sized blood vessels coronary arteries are most susceptible to damage aneurysm 80 of children are less than 5 years old cause unknown seen late winter early spring not communicable symptoms mimics strep throat strep test comes back negative erythema of palms and soles of feet strawberry tongue cracked lips then the effects of the cardiovascular system diagnosis no specific test  diagnosis is based on symptoms Acute phase abrupt onset of fever not resolved with antipyretics irritable edema erythema of palms and soles Subacute phase begins with the resolution of fever until all symptoms resolve highest risk for coronary artery aneurysms baseline EKG's echo continuously monitor no rhythm changes in Convalescent phase symptoms resolve but lab work is not back to baseline Treatment culture negative for strep health teaching and monitoring unresolved strep no response for antibiotics if strep and Kawasaki disease t negative treat with IVI G intravenous immunoglobulin and  ASA therapy might get ABX depending on what is occurring