Cardiac Disorders Lecture Notes PDF

Cardiac Disorders County College of Morris NUR 213 Dr. Feichtl Unit Objectives – Cardiac Disorders Describe the difference between congenital defect etiologies: increased and decreased pulmonary flow disorders Describe general nursing assessments, interventions, medicatio...

Cardiac Disorders County College of Morris NUR 213 Dr. Feichtl Unit Objectives – Cardiac Disorders Describe the difference between congenital defect etiologies: increased and decreased pulmonary flow disorders Describe general nursing assessments, interventions, medications, and treatments for children with cardiac disorders Describe heart failure (assessments, treatments, medications, and general nursing interventions) Describe Kawasaki disease (assessments, treatments, medications, and general nursing interventions) Unit Objectives – Cardiac Disorders Synthesize a plan of care for the family with a child suffering from a heart defect Describe symptoms or situations that would require the nurses' immediate attention in children with cardiac defects Describe diagnostic procedures related to cardiac disorders and associated nursing implications (chest x-ray, ECG, echocardiogram, cardiac catheterization, CT scan, MRI, CBC, ABGs, serum drug levels of digoxin) Unit Objectives – Cardiac Disorders Describe the general actions, indications, and nursing implications for the following medications: o Beta blockers o Ace inhibitors o Diuretics o Morphine o Digoxin Topics Focused Assessment Congenital Heart Disease: Most Common Pulmonary Blood Flow Disorders Increased Decreased Heart Failure Kawasaki Disease Most cardiac defects form during the first 8 weeks of gestation Cardiac General Assessment Peripheral Cardiopulmonary Vascular Assessment Assessment Skin color Vital signs Capillary refill Heart sounds Activity Respiratory Fluid status Heart Rhythm Clubbing Pulse oximetry Cardiac Assessment Heart rate – high or low? Heart rhythm – regular or irregular? Respiratory rate – fast or slow, labored? Breath sounds – abnormal/adventitious, crackles, wheezing? Heart sounds – extra sounds? Breathing effort – easy and unlabored, labored? Symmetry of chest – use of accessory muscles? Other assessments: LOC, irritability, difficulty feeding, failure to thrive, labs, limp extremities, seizure activity? General Diagnostics Newborn cardiac screening Bloodwork Heart markers Echocardiogram BNP (b-type EKG natriuretic peptide Chest x-ray –marker for heart failure)/Troponin Cardiac MRI CBC Cardiac Cath Chemistry Older kids: stress test ABG Pulse oximetry Kidney profile Halter monitor (usually 24- Lipids 48hrs) Liver profile Dig level  Congenital Heart Defects (4 Types) Increased pulmonary blood flow (acyanotic) Decreased pulmonary blood flow (cyanotic) (Obstruction to systemic blood flow and Mixed flow defects) Figure 22.7 (page 379)  Increased Pulmonary Blood Flow (Acyanotic) Left -Ventricular Septal Defect (VSD) - Right shunt MOST COMMON -Patent Ductus Arteriosus (PDA) Increased Pulmonary Blood Flow (Acyanotic) Left – to – right shunt (high to low pressure) Defects with a connection between the right and left sides of the heart shunt blood from the area of higher pressure (left side) to the area of lower pressure (right side) which results in increased blood flow to the right side of the heart and to the lungs Heart failure and pulmonary overcirculation can result Increased Pulmonary Blood Flow (Acyanotic) Congenital heart defects that lead to increased pulmonary blood flow include the following: patent ductus arteriosus (PDA), atrial septal defect (ASD), ventricular septal defect (VSD), and atrioventricular canal (AV) Acyanotic: Left-to-right shunts = no cyanosis VSD is the most common congenital heart defect Decreased Pulmonary Blood Flow (cyanotic) "blue" babies Right Left Shunt -Tetralogy of Fallot – Most Common -Pulmonic stenosis -Pulmonary atresia Decreased Pulmonary Blood Flow Defects involving decreased pulmonary blood flow occur as a result of an obstruction of blood flow to the lungs Obstruction to pulmonary blood flow may cause increased right-sided pressures, and if there is a septal defect, right to left shunting of blood, causing cyanosis. Decreased Pulmonary Blood Flow The lack of oxygenation in the lungs leads to an increased concentration of arterial deoxygenated hemoglobin, decreasing blood oxygen overall and causing cyanosis, a sign of hypoxemia Congenital heart defects that result in decreased pulmonary blood flow include pulmonic stenosis, pulmonary atresia, tricuspid atresia, and tetralogy of Fallot General Treatment: Congenital Heart Disease Rest and positioning Oxygen Fluid resuscitation Medications Calm environment Nutritional support Surgery (if indicated) Medications and Surgical Repair Morphine Furosemide Digoxin Vasodilators ACEI Beta Blocker Enalapril Surgery Captopril Nursing Interventions Cardiovascular focused assessment Oxygenation Hydration and nutrition Promotion of growth and development Emotional and psychosocial support Referrals: Dietician PT/OT Social services Nursing Interventions Provide appropriate pain interventions, especially post-operatively Cardiovascular focused assessment oMonitor vital signs, skin color, feeding tolerance oMonitor lab values, medications, test results Nursing Interventions Adequate oxygenation o Decreased cardiac output leads to inadequate oxygenation o Administer supplemental oxygen and monitor saturation o Hydration and Nutrition o Monitor intake and outputs, daily weights, monitor labs (electrolytes); salt and/or fluid restrictions is applicable Nursing Interventions Promote growth and development oUse occupational therapy and physical therapy to meet motor milestones oEncourage play and socialization with peers to promote psychological development Provide emotional and psychological support, using support groups and social workers as needed Nursing – Teach Parents/Caregivers Watch for: FEAR How to Manage: F – Feeding poorly F – Family coping E – Energy is low E – Educate parents A – Activity A – Always fussy guidelines R – Rapid R – Reinforce Respirations adherence  Heart Failure (HF) A complex clinical and pathological syndrome resulting from structural or functional impairment of the heart ventricle In children, HF is most commonly attributed to congenital heart disease Left-sided (most common in PEDS) Heart muscle is working harder than those of healthy kids, causing decreased perfusion Heart Failure HF is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body's organs Three categories: (pathophysiological) o Ventricular dysfunction o Volume overload with normal ventricular contractility o Pressure overload with normal ventricular contractility Regardless of etiology, decreased cardiac output develops in heart failure which puts the body's organs at risk for impaired perfusion and inadequate oxygenation of tissues Signs and Symptoms Cardiopulmonary Grunting, SOB, cyanosis, tachypnea Decreased cap refill, cool extremities Edema and oliguria Kidney abnormalities Feeding difficulties Diaphoresis, labored breathing, decreased intake, failure to thrive Fatigue and irritability Poor growth Diagnostic abnormalities Signs and symptoms Pulmonary venous congestion oEarly: mild tachypnea, respiratory infections, labored breathing during feeding, cough oProgressive: increased tachypnea at rest, wheezing, crackles, grunting, cyanosis, increased diaphoresis and tachypnea during feedings Signs and symptoms Systemic venous congestion oEarly: peripheral edema, periorbital edema, weight gain associated with fluid retention oProgressive: enlarged liver, ascites, abdominal distention, jugular venous distention Signs and symptoms Impaired cardiac output o Early: tachycardia, pallor, tiring with play, cool extremities o Progressive: weak pulses, hypotension, delayed capillary refill, oliguria, irritability Increased metabolic demand o Diaphoresis, slow weight gain or weight loss, failure to thrive Signs and symptoms Congestive heart failure can result in poor growth: o Babies with CHF use a significant amount of energy as the heart works harder to do its job o As the lungs fill with fluid, it becomes more difficult for babies to breathe, and they use muscles of their chest and belly to compensate (accessory muscles) o Babies have a harder time eating and may not eat as fast or as well as other babies – they become diaphoretic with feedings because of the extra work needed to eat Signs and symptoms o Babies work so hard they wear themselves out and sleep more or have less energy than babies without heart problems o Appetite may be poor when HF is severe; weight loss or lack of weight gain may be seen o Children with HF who retain fluid and gain weight may appear puffy Treatment Oxygen therapy Fluid restriction if needed I/O's NGT feedings/Nutritional support Pacemaker Medications Surgery Treatment Surgery or transplant may be needed depending on the issue Some surgeries can be done less invasively Medication therapy Oxygen: supplemental Fluid restrictions – depends on patient fluid status NGT feedings (can use breastmilk) or high calorie formula to meet nutritional requirements Medications Cardiac glycosides Loop Diuretics (inotropes) Furosemide Digoxin Potassium sparing ACEIs diuretics Enalapril Spironolactone Captopril Beta Blockers Potassium propranolol supplement Medications Cardiac glycosides (Digoxin) o Increases force of myocardial contractions and decreases heart rate o Controls rate and rhythm of the heartbeat – helps slow and strengthen the heart muscle, enabling it to pump more efficiently o Increases renal perfusion o Needs lab work for level checks o Monitor apical pulse for 1 minute before administration Medications ACE inhibitors o Decreases peripheral resistance, afterload, preload, and heart size o Blocks the conversion of angiotensin I to II which decreases BP o May cause cough (side effect) o Monitor blood pressure for hypotension Medications Loop diuretics (furosemide) o Helps kidneys remove the extra fluids (inhibits reabsorption of sodium and chloride) o Sodium-rich diuresis o Monitor urine output o Monitor potassium levels (may need replacement therapy) o Daily weights Medications Potassium-sparing diuretic (spironolactone) o Helps the body retain potassium which is often lost when taking diuretics Beta blockers o Blocks beta-adrenergic receptors; decreases the excitability of the heart o Check apical pulse and blood pressure before administering o Decreases the heart rate and blood pressure and improves heart function Medications – Quick Overview Medication treatment of heart failure: o Digoxin: helps strengthen the heart muscle, enabling it to pump more efficiently o Diuretics: helps kidneys remove excess fluid from the body o Potassium-sparing Diuretics: helps the body retain potassium, often lost when taking diuretics o Potassium supplements: replaces potassium lost when taking diuretics Digoxin – Special Considerations IV/liquid/tablet Assess heart rate before Care measurement with liquid forms administering 2 Nurses - independent check Hold apical rate with IV form