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Alterations of Cardiac Function
Alterations of Cardiac Function
Alterations of Cardiac Function
CARDIAC FUNCTION
CONGENITAL HEART DEFECTS
VALVULAR PROBLEMS
ENDOCARDITIS
ABDOMINAL AORTIC ANEURYSM
2009
Transition from fetal to
pulmonary circulation
How does the circulation during fetal life
differ from that of the neonate?
What leads to this transition?
How do the changes of pressures and
resistance within the heart effect the
foramen ovale, ductus venosus, and
ductus arteriosus?
Differences for the child in
cardiovascular functioning
Why is the child at greater risk of CHF?
Why does the child’s heart beat faster?
What are the Hct, Hgb and pulse ox
concentrations appropriate for age needed for
adequate oxygen transport
What does cyanosis indicate? hypoxemia
What is polycythemia?
What labs indicate Polycythemia:
What is the danger of Severe Hypoxemia?
BASIC PHYSIOLOGY
WHAT IS THE HEART:
2.Define Afterload:
1.Define Contractility:
WHAT KIND OF TESTING
IS DONE TO DIAGNOSE?
Cardiac What is used during the
test?
Catherization Where are the catheters
placed?
What measurements are
taken?
What is visualized?
PREOP NURSING CARE
CARDIAC CATHERIZATION
WHY NEED Accurate hgt and wgt
WHY IS History of allergies to
iodine important?
WHAT HAPPENS IF THE CHILD
HAS Severe diaper rash
WHY Mark pulses: dorsalis pedis,
posterior tibial
WHY Baseline pulse ox
PREOP CARDIAC CATH
HOW TO Prepare child:
schoolage/adolescent
Preop receive what drugs?
WHAT DIET PREOP AND WHY?
POSTOP NURSING CARE
CARDIAC CATHERIZATION
What would you expect to find when assessing
the pulses?
What rhythm and rate change would you
expect?
POSTOP NURSING CARE
CARDIAC CATHERIZATION
WHY CHECK BP
WHY Check dressing
What assessment would you need to do
regarding hydration and why?
What do you do with the effected?
How do you adapt care to a toddler?
What do you do to prevent bleeding?
POSTOP HOME CARE
CARDIAC CATH
Pressure dressing INSTRUCTIONS
What is done to Cover site?
Bathing instructions?
What observations are made for
complications?
What activity instructions?
What is used for pain?
POSTOP CARDIAC CATH
SITUATION
Tommy, a 4 year old with Tetralogy of
Fallot returns from catherization
laboratory. He has vomited, his mother
calls you to the bedside to tell you that
he is bleeding. You arrive to find
Tommy crying and sitting up in a puddle
of blood. The first thing you do is:
ANSWERS TO POSTOP
CATH SITUATION
1. Increase the rate of his IV fluids
2. Give an antiemetic and keep
Tommy NPO
3. Call the cardiologist
4. Lie Tommy down, remove the
dressing and apply direct pressure
above the catherization site
ANSWERS TO SITUATION
GENERAL S & S of CHD in
INFANTS AND CHILDREN
INFANTS: CHILDREN:
Dyspnea Exercise intolerance
Difficulty feeding Increased BP
Stridor, choking spells Poor physical
Pulse rate over 200 development
FTT Heart murmurs
Heart murmurs Cyanosis
Frequent URI’s Recurrent URI
Anoxic attacks Clubbing fingers/toes
CVA squatting
CLASSIFICATION OF CHD
Based on how the blood flows: obstructed,
delayed, abnormally shunted:
1. Blood flow can be obstructed or delayed which
CHD (what anomalies are examples?)
2. If Blood is abnormally shunted from one side of
the heart to the other
eg: what happens to pulmonary blood flow with a
left to right shunt?
eg: right to left shunt What kind of blood is
abnormally shunted? What happens to the lungs
REMEMBER THIS ABOUT
SHUNTS!
How does Blood flows occur in the
heart?
What can you say about the
pressure on the RIGHT SIDE of the
heart as compared to the pressure
on the LEFT SIDE of the heart?
SECONDARY
CLASSIFICATION OF CHD
Define happens with ACYANOTIC
DEFECTS?
Give examples of Acyanotic defects?
Define what happens with CYANOTIC
DEFECTS:
Give examples of Cyanotic defects?
What kind of shunt occurs?
OBSTRUCTIVE DEFECTS
Explain what happens to blood flow with an
anatomic narrowing (stenosis)?
Explain what happens to the Pressure in the
ventricle and in the great artery before the
obstruction?
Where is the the most common Location of
narrowing?
Give some EXAMPLES of obstructive defects:
COARCTATION
Where is the narrowing
OF AORTA
located?
Where is the increased
pressure and what does
it cause?
Where is decreased
pressure and what does
it cause?
RESULTS OF
COARCTATION
Because of the large volume of
blood going to the head the child
may experience what?
What is common in infants?
TREATMENT OF
COARCTATION OF AORTA
Surgical treatment:
Involves what correction?
What if the narrowed area is large,
what might the surgeon have to
do?
Is this open or closed heart
surgery?
What is the common age of this
surgery?
TREATMENT OF
COARCTATION OF AORTA
What is the Nonsurgical treatment
called?
Surgical correction:
What complications?
1.
2.
3.
4.
TETRALOGY
OF FALLOT
FOUR
DEFECTS
SHUNTS IN TETRALOGY
OF FALLOT VARY
If pulmonary vascular resistance is
higher than systemic resistance
WHICH DIRECTION IS THE
SHUNT?
If systemic resistance is higher
than pulmonary vascular
resistance WHICH DIRECTION IS
THE SHUNT?
S&S OF TOF IN INFANTS
ASSESSMENT OF INFANTS WITH TOF?
COMPLETE REPAIR:
Postop risks?
SURVIVAL: 95%
TRICUSPID ATRESIA
What fails to develop?
What does this failure
prevent between RA
and RV?
Blood flows through
another defect where?
When would the child
die with this defect?
What keeps the child
alive?
TRICUSPID ATRESIA
S&S:
Palliative surgery:
Corrective surgery:
Survival: 80%
TRUNCUS ARTERIOSUS
What does this look like?
What other defects?
S&S
Surgical repair:
Give examples?
CAUTION:
GOALS OF TREATMENT
CONTINUED:
Decrease cardiac demands:
GIVE EXAMPLES OF NURSING
ACTIONS:
GOALS OF TREATMENT
CONTINUTED:
Improve tissue oxygenation
NURSING ACTIONS:
NRSG DX FOR ACYANOTIC
HEART DEFECTS
NRSG DX FOR CYANOTIC
HEART DEFECTS
NURSING CARE IN ICU
POST-OP CARDIAC SURGERY
What is done to keep child calm?
How is the infant’s temp regulated
How often VS?
How is the heart monitored?
What measures Cardiac output?
Why does the child have Pacemaker
leads in place?
POSTOP NURSING CARE
CONTINUED
What is used to monitor BP?
What is used to provide oxygen?
How are increased secretions managed
How is oxygenation measured?
Why is an NGT used?
Dressing over chest incision checked q 15
minutes for 24 hr for what?
POSTOP NURSING CARE
CONTINUED POSTOP NU
2-3 chest tubes draining what from thoracic
cavity which entered during surgery
Foley checked how often?
What urinary output would you expect for an
infant? And a child? If Less than that normal
what does this indicate?
Accurate I & O hourly including what
drainage?
IV solutions and blood replacement
POSTOP NURSING CARE
CONTINUED
What class of meds for pain?
What used to prevent infection?
What diet?
What needs to be done for the
mouth?
How to Support parents?
POTENTIAL COMPLICATIONS
HEMORRHAGE
*****ARRHYTHMIAS
CHF
PNEUMONIA
RENAL FAILURE
CVA
PULMONARY EMBOLISM
DEATH
NURSING ASSESSMENTS
Parents
child
ENDOCARDITIS
CAUSATIVE ORGANISMS
Streptococcus
Staphylococcus aureus,
enterococci
PREDISPOSING FACTORS
Who would get endocarditis?
PATHOPHYSIOLOGY
Where does the Infective organisms
travel?
Where is it deposited on the heart?
What aggregation is triggered?
What forms on valves and
endocardium?
EMBOLIZATION
What happens to the Fragments of
friable vegetative lesions?
Where do they go?
What assessments would the nurse
look for with regard to
embolization?
Clinical manifestations
INITIAL SYMPTOMS SEEM LIKE FLU:
FEVER:
VASCULAR MANIFESTATIONS:
Splinter hemorrhages
Petechiae
Roth’s spots:
Clinical manifestations
PERIPHERAL MANIFESTATIONS:
Osler’s Nodes:
Janeway lesions:
Clinical manifestations
CARDIAC:
Heart murmur: indicates?
What happens to the size of the
heart?
What other complication?
Clinical manifestations
CEREBRAL EMBOLIZATION:
What assessments?
Clinical manifestations
PULMONARY EMBOLIZATION:
What assessments?
Clinical manifestations
CORONARY ARTERY
EMBOLIZATION:
What assessments?
Clinical manifestations
SPLENIC EMBOLIZATION:
What assessments?
Clinical manifestations
EMBOLIZATION OF THE RENAL
ARTERY:
What assessments?
Clinical manifestations
CENTRAL NERVOUS SYSTEM:
What assessments?
LABORATORY FINDINGS
Nursing care
What medications are used to treat the
infection? What route?
What activity is best for the client?
What drug is used for the fever?
What drug is used for comfort
What labs indicate the infection status?
Observe for what complication?
What should be done prophylactically?
NURSING DIAGNOSIS
EXPECTED OUTCOMES
ABDOMINAL AORTIC
ANEURYSM
ANEURYSM
Defined
SIGNS AND SYMPTOMS
EXPANDING ANEURYSM
ASSESSMENT
RUPTURED ANEURYSM
ASSESSMENT
TREATMENT: SURGICAL
REPAIR
BEFORE SURGERY
ASSESSMENT
COMPLICATIONS DURING
SURGERY
MYOCARDIAL INFARCTION
How would you know?
GRAFT OCCLUSION OR
RUPTURE
HYPOVOLEMIA &
RENAL FAILURE
RESPIRATORY DISTRESS
PARALYTIC ILEUS
POSTOPERATIVE NURSING
CARE
POST-OP ASSESSMENTS for
ISCHEMIA
POST-OP ASSESSMENTS for:
ARTERIAL OCCLUSION
DISCHARGE PLANNING
Valvular Heart Disease
GENERAL CONCEPTS
VALVULAR DISEASE INVOLVES THE
4 VALVES OF THE HEART
PRESSURES:
PRESSURE ALTERATIONS
DUE TO STENOTIC VALVE
VALVULAR DISEASE
DEFINED:
Stenosis:
Regurgitation:
STENOSIS &
REGURGITATION
STENOSIS:
REGURGITATION:
MITRAL VALVE STENOSIS
ASSESSMENT
MITRAL VALVE
REGURGITATION
ASSESSMENT
MITRAL VALVE PROLAPSE
ASSESSMENT
AORTIC VALVE STENOSIS
ASSESSMENT
AORTIC VALVE
REGURGITATION
ACUTE AORTIC VALVE
REGURGITATION
CAUSES
ASSESSMENT
• ACUTE:
• CHRONIC:
TRICUSPID AND PULMONIC
VALVE DISEASE
RESULTS: