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Peds Exam 3
Cardiovascular Dysfunction day 1 pt 2
| Question | Answer |
|---|---|
| obstructive defects | Blood exiting heart meets stenosis (narrowing) which obstructs blood flow |
| obstructive defects cause | Blood to back up before obstruction leading to decreased blood flow beyond obstruction which causes increased pressure load on ventricle |
| obstruction on left side of heart causes | decreased blood to body, increased left ventricular afterload- heart failure |
| severe obstruction right side | decreased blood to lungs cyanosis |
| obstructive defects if mild | asymptomatic |
| obstructive defect types | Coarctation of aorta (COA) Aortic Stenosis (AS) Pulmonic Stenosis (PS) |
| Coarctation of the Aorta (COA) is the | localized narrowing of aorta - pre or post ductus arteriosus |
| Coarctation means | narrowing |
| when there is a localized narrowing of aorta, | blood is not able to get beyond it and backs up before it |
| where does COA happen to many kids | before subclavian and builds up in upper body so decreased blood flow to lower body |
| Coarctation of the Aorta (COA) nursing assessment | Upper extremities: bounding pulses, high BP Lower extremities: weak or absent femoral pulse, low BP Systolic murmur |
| Coarctation of the Aorta (COA) critical coarctations are | 50% symptomatic at birth with severe HF |
| for COA, what determines symptoms | degree or narrowing as well as age |
| in addition to pulse and BP differences, COA in infants can cause | Heart failure- poor feeding, lethargy, tachypnea, pallor, diaphoresis Critical coarctation - acidosis, hypotension |
| in addition to pulse and BP differences, COA in older children can cause | Dizziness Headache Fainting Epistaxis Pain in legs with exertion At risk for hypertension, ruptured aorta, aortic aneurysm and stroke Rib notching- from collateral circulation |
| COA management | surgery interventional angiography |
| COA management- critical coarctation | Mechanical ventilation and inotropic support before surgery ProstaglandinE1 (PGE) to keep DA open |
| COA management- surgery | Long segmental stenosis Complex anatomy |
| treatment of choice for COA under 6 months | surgery |
| COA management- interventional angiography | Balloon angioplasty Higher rate of re-coarctation |
| treatment of choice COA over 6 months | interventional angiography |
| when is COA treatment advised | within first 2 years |
| Aortic Stenosis is the | Narrowing at aortic valve - between LV and aorta |
| Aortic Stenosis can cause | decreased blood flow to aorta and body increased resistance, increased workload on LV |
| what does decreased blood flow to aorta and body cause in aortic stenosis | decreased cardiac output |
| what does increased resistance and increased workload on LV cause in aortic stenosis | LV hypertrophy, possible failure Pulmonary congestion |
| why is there pulmonary congestion in aortic stenosis | blood backs up into the lungs |
| Aortic Stenosis Nursing Assessment | systolic murmur signs and symptoms decreased cardiac output progressive |
| Aortic Stenosis Nursing Assessment for mild stenosis | Asymptomatic, except murmur |
| Aortic Stenosis Nursing Assessment for signs and symptoms of decreased cardiac output | Diminished pulses, tachycardia, hypotension, heart failure |
| why is there tachycardia in aortic stenosis with decreased cardiac output | because they're trying to increase CO |
| Aortic Stenosis Nursing Assessment: S/S decreased cardiac output in an infant | poor feeding |
| Aortic Stenosis Nursing Assessment: S/S decreased cardiac output in children | exercise intolerance, chest pain, dizziness |
| Aortic Stenosis Nursing Assessment in newborn | possible critical stenosis |
| since Aortic Stenosis is progressive, | it ALWAYS gets worse and needs treatment |
| Aortic Stenosis Management | Interventional Cardiac Catheterization Surgery Repeat procedure as child grows |
| Interventional Cardiac Catheterization for Aortic Stenosis | Balloon dilation valvuloplasty- first line |
| Surgery for Aortic Stenosis | mechanical valve replacement: take healthy pulmonary valve to replace aortic valve and get mechanical valve for pulmonary valve since kids do better with those replacements |
| Repeat procedures as child grows for Aortic Stenosis | Repeat dilation(s) Valve replacement(s) |
| all treatment for aortic stenosis is | palliative |
| Pulmonary Stenosis (PS) | Narrowing at pulmonic valve between RV and PA Obstruction of flow out RV - decreased pulmonary blood flow |
| Pulmonary Stenosis (PS) causes | increased resistance, increased workload on RV RV hypertrophy |
| Severe PS | RV failure causes increased pressure in RA which reopens foramen ovale R to L shunt |
| Pulmonary Atresia (blocked or absent) | most severe form- no blood flow to lungs, RV may be hypoplastic |
| Pulmonary Stenosis (PS) Nursing Assessment for mild to moderate | Asymptomatic except murmur: soft murmur in severe cases |
| Pulmonary Stenosis (PS) Nursing Assessment for severe | Newborn- critical stenosis Cyanosis Heart failure |
| Pulmonary Stenosis (PS) Nursing Assessment in older children | easily fatigues, shortness of breath with exertion |
| Pulmonary Stenosis of Management | monitor Interventional Cardiac Catherization surgical repair |
| Pulmonary Stenosis Management: Interventional Cardiac Catherization | balloon valvuloplasty - treatment of choice |
| Pulmonary Stenosis- Management: surgical repair | partial or complete valvotomy- rare |
| Defects Decreased Pulmonary Blood Flow | obstruction of pulmonary blood flow chronic hypoxia |
| obstruction of pulmonary blood flow | increased resistance and increased pressure R exceeds pressure L Blood shunts R to L through structural defect Deoxygenated blood mixes with oxygenated blood on left side Desaturation blood enters systemic circulation to hypoxemia to usually cyanosis |
| chronic hypoxia | Polycythemia and clubbing - compensation Increased risk of CVA- viscous blood |
| clubbing | increased tissue growth in that area so fingers are fat with weak nail beds |
| why is there polycythemia in defects of decreased pulmonary blood flow | kidneys produce more erythropoietin to compensate for decreased blood flow |
| Defects Decreased Pulmonary Blood Flow | Tetralogy of Fallot (TOF) Tricuspid Atresia |
| 4 defects of tetrology of fallot | pulmonary stenosis RV hypertrophy VSD overriding aorta |
| tetrology of fallot: pulmonary stenosis | blood flow decreased to lungs increase workload on RV, causes RV hypertrophy |
| tetrology of fallot: RV hypertrophy | results from increased resistance |
| tetrology of fallot: VSD | opening between ventricles blood shunts R to L because of resistance out of RV unoxygenated blood mixes with oxygenated blood |
| tetrology of fallot: overriding aorta | sits on top of VSD picks up unoxygenated and oxygenated blood and delivers to body |
| tetrology of fallot | increased R-sided pressures - R to L shunt - unoxygenated blood enters systemic circulation through VSD and overriding aorta |
| it TOF, | there is decreased blood flow to lungs and unoxygenated blood enters circulation |
| Tetralogy of Fallot (TOF): nursing assessment: infant | Severe cyanosis at birth or few days later Mild cyanosis that progresses Murmur- loud harsh Anoxic spells – Tet spells!! |
| Tetralogy of Fallot (TOF): nursing assessment | Clubbing Polycythemia Delayed Growth & Development |
| Tetralogy of Fallot (TOF): management | Corrective "complete repair" in first year of life - close VSD and relieve pulmonary stenosis |
| Closing VSD and relieving pulmonary stenosis in TOF resolves | RV hypertrophy and overriding aorta |
| timing of corrective repair of TOF | varies - stabilize and allow optimal growth Use possible nutritional support |
| TOF possible management | Prostaglandins to maintain PDA Nutritional support Palliative surgery "temporary repair"- increases pulmonary blood flow Blalock-Taussig (BT) Shunt |
| Blalock-Taussig (BT) Shunt for TOF management | Connects subclavian and pulmonary artery No BP or venipunctures on side of shunt |
| TOF spells | Hypercyanotic episodes Severe hypoxemia, leads to anoxia |
| causes of TOF spells | Crying, feeding, defecating causes Increased O2 needs, infundibular spasm at pulmonary trunk which causes decreased pulmonary blood flow, increased R to L shunting |
| TOF spells can cause | Loss of consciousness, sudden death |
| clinical management TOF spells | Knee-to-chest position Supplemental oxygen Morphine |
| primary treatment for TOF spells | Knee-to-chest position because it makes it harder for blood to move systemically so blood gets pushed to the lungs which is where it is needed, causes increased systemic vascular resistance |
| morphine for TOF spells | prevents infundibular spasms |
| cause of tof spells | infundibular muscle spasm at pulmonary artery causes even less blood flow to lungs |
| supplemental oxygen is a | potent pulmonary vasodilator |
| mixed defects cause | Mixing blood well oxygenated and poorly oxygenated blood Decreased cardiac output |
| Mixing blood well oxygenated and poorly oxygenated blood leads to | hypoxemia |
| Decreased cardiac output leads to | heart failure |
| mixed defects | Transposition of the Great Arteries (TGA) Hypoplastic Left Heart Syndrome (HSLS) Total Anomalous Pulmonary Venous Connection Truncus Arteriosus |
| Transposition of Great Arteries (TGA) | Major arteries are switched (transposed) Aorta arises from RV instead of LV and PA comes from LV instead of RV |
| what happens in Transposition of Great Arteries (TGA) | Oxygenated blood never reaches the systemic circulation |
| Transposition of Great Arteries (TGA) additional defect | Patent foramen ovale - most common VSD- increased risk HF PDA at birth |
| Transposition of the Great Arteries (TGA) Nursing Assessment | Cyanosis within few hours of birth in apparently healthy, full-term infant Heart failure Murmur Cardiomegaly few weeks after birth |
| the only things keeping TGA babies alive the first couple of days is | their open FO so when that closes, they die |
| Transposition of the Great Arteries (TGA): Cyanosis within few hours of birth in apparently healthy, full-term infant occurs with? | With closure of DA Administration of oxygen doesn't help Cyanosis delayed if septal defect |
| Transposition of the Great Arteries (TGA) nursing assessment | Heart failure Murmur Cardiomegaly few weeks after birth |
| TGA Initial Management | First: ProstaglandinE Then: Balloon atrial septostomy |
| ProstaglandinE | need to keep ductus arteriosis open, allows blood to flow from R to L |
| TGA managemen- balloon atrial septostomy | Rashkind procedure - keeps LA open until surgery Goes through pulmonary foramen ovale |
| TGA surgical repair | Arterial switch procedure Reconstruction of coronary circulation |
| when is TGA surgical repair completed | within days to first few weeks of life |
| TGA requires | treatment ASAP |
| Hypoplastic Left Heart Syndrome (HLHS) | Left heart is underdeveloped Right side of heart is normal When PDA closes - cannot pump blood to systemic circulation |
| Hypoplastic Left Heart Syndrome (HLHS): left heart | Mitral & aortic valves closed or hypoplastic (small) First part of aorta is small LV non-functioning |
| Hypoplastic Left Heart Syndrome (HLHS): right heart | Needs to pump blood to both lungs and body Blood from lungs flows to LA through ASD to RA RV pumps blood to lungs and systemic circulation through PDA |
| what happens when ductus arteriosis closes in HLHS | cannot pump blood to systemic circulation Death without intervention in a few hours |
| Hypoplastic Left Heart Syndrome (HLHS) Nursing Assessment | Cyanosis within days Heart murmur Tachypnea & Dyspnea Tachycardia, poor perfusion Circulatory collapse (shock) - requiring emergent resuscitation Poor feeding Tires easily Hypothermia |
| Hypoplastic Left Heart Syndrome (HLHS) Treatment Options | First: ProstaglandinE1 Cardiac transplant Palliative reconstructive surgery - 3 stages |
| what does ProstaglandinE1 do for treatment of HLHS | Maintains ductus arteriosis |
| what do you want oxygen sats to be with HLHS | want to maintain O2 sats at 75-85% when unrepaired bc O2 vasodilates pulmonary artery and if its made easier for blood to get to lungs, it will be less favorable for blood to go to the body |
| defects that increase pulmonary flow | allow for left to right shunt cause heart failure, pulmonary congestion |
| obstructive defects | impedes blood flow out of the ventricles obstruction on left side – heart failure severe obstruction right side- hypoxemia |
| decreased pulmonary flow consequences | hypoxemia |
| mixed blood flow consequences | hypoxemia (with or without cyanosis) and heart failure |
Created by:
leh195