Term
| most common heart anomaly |
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Definition
| Ventricular septal defect |
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Term
| Extracardiac defects seen in association with heart anomalies |
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Definition
| tracheoesophageal fistula, renal abnormalities, and diaphragmatic hernia |
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Term
| two principal clinical consequences of congenital heart disease |
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Definition
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Term
| defects causing symptoms of CHF |
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Definition
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Term
| Classifications of CHF changes |
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Definition
*Volume overload- RV hypertrophy to compensate for additional blood volume (esp. right-to-left shunts)
*Pressure overload- obstructive lesions such as valvular stenosis or coarctation of the aorta
*Decreased contractility- primarily of the myocardium caused by myopathy or ischemia from severe anemia or asphyxia, heart block, acidemia, low k+, low glucose, low ca+, and low mg+
*High cardiac output demands- body's need exceeds CO even though volume normal such as sepsis, hyperthyroidism, and severe anemmia. |
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Term
| CHF resulting from ostructive lung diseases such as cystic fibrosis or bronchopulmonary dysplasia |
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Definition
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Term
| CHF compensatory mechanisms or "cardiac reserve" |
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Definition
| Hypertrophy and dilation of cardiac muscle and stimulation sympathetic nervous system |
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Term
| Negative effects of symathetic nervous system stimulation |
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Definition
| shortened diastlic period, increase O2 consumption by heart muscle, eliminated resting phase, impaired coronary perfusion, and increase afterload (SVR) |
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Term
| Impaired Myocardial Fx manifestation of CHF in children |
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Definition
Sleeping heart rate >160 in sleeping infants and becomes extremely rapid with slightest exertion, gallop rhythm (S3, S4), diaphoresis, poor exercise tolerance, irritability, cold extermities, weak pulses, slow cap refill, low bp, and mottled skin.
*Extreme pallor or duskiness is an ominous sign |
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Term
| Pulmonary Congestion manifestation of CHF in children |
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Definition
| Tachypnea (>60 breaths/min in infants)d/t decreased lung compliance can lead to hypoxemia. Mild cyanosis, dyspnea, inability to feed, costal retractions that may be accompanied by flaring nares, orthopnea, wheezing, increased secretions and hoarseness. Gross motor developmental delays d/t lack of energy for activities. |
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Term
| Systemic Venous Congestion manifestation of CHF in children |
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Definition
| Hepatomegaly, edema (earliest sign is weight gain), edema of dependent tissue leads to swelling of sacrum, scrotum, and periorbital tissues. Veins of hands that don't collapse when raised above the heart. |
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Term
| Diagnosis of CHF in children |
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Definition
| Based on clinical symptoms, CXR indicates cardiomegaly, ECG indicates ventricular hypertrophy, Echo is performed to determine cause. |
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Term
| Goals of therapeutic management of CHF in children |
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Definition
*Improve cardiac fx (increase contractility and decrease afterload)
*Remove accumulated fluid and Na+ (decrease preload)
*Decrease cardiac demand
*Improve tissue oxygenation and decrease O2 demand
Stabilized with medical tx then referred for surgical repair to treat underlying cause |
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Term
| Medical tx to *improve cardiac fx in children with CHF |
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Definition
Two groups of drugs: *
Digitalis glycosides; increases contractility(positive inotrope), decreases HR and slows conduction through AV node, and enhances diuresis through increased renal perfusion.
*ACE inhibitors; reduce afterload by inhibiting the RAS system resulting in vasodilation, prevention of volume expansion, and enhanced diuresis. |
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Term
| medical tx to remove accumulated fluid and sodium in children with CHF |
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Definition
| Diuretics, possible fluid restriction (because feeding is difficult is rarely needed), and possible sodium restriction (usually focus is avoiding highly salted foods and added table salt) |
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Term
| medical tx to decrease cardiac demands in children with CHF |
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Definition
| *provide neutral thermal environment to prevent cold stress, *treat existing infections, *reduce effort of breathing (semi-fowlers), *medication to sedate irritable child, *provide rest and decrease environmental stimuli |
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Term
| medical tx to improve tissue oxygenation in children with CHF |
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Definition
| oxygen hood, face tent, or nasal cannula (cool humidification counteracts drying effect of O2- carefully regulated to prevent chilling) |
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Term
| medical tx to improve tissue oxygenation in children with CHF |
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Definition
| oxygen hood, face tent, or nasal cannula (cool humidification counteracts drying effect of O2- carefully regulated to prevent chilling) |
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Term
| Nursing measures to improve cardiac function in children with CHF |
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Definition
| calculate and administer correct dose of digoxin, observe for signs of toxicity (bradycardia, anorexia, n/v unrelated to feedings), and teaching parents at home administration *Apical pulse assessed for 1 full min prior to admin and HR parameters verified |
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Term
| Nursing measures to in reducing afterload in children with CHF |
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Definition
| carefully monitor BP before and after admin of ACE inhibitor, monitor K+ because ACEI also block aldosterone |
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Term
| Nursing measures to decrease cardiac demand in children with CHF |
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Definition
| In an effort to conserve energy for feeding: organize nursing activities to allow for uninterrupted sleep, small freq feedings or gavage feedings to prevent crying r/t hunger, sedation during acute phase, monitor temp, and prevent skin breakdown |
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Term
| Nursing measures to reduce respiratory distress in children with CHF |
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Definition
*positioning (sit in infant seat or be held at 45 degree angle)
*O2 admin (humidified) |
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Term
| Nursing measures to maintain nutritional status of children with CHF |
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Definition
| Child well rested prior to feeding, soft nipple or one with enlarged opening, gavage feeding through NG, and calorie dense formulas either alone or alternated with breast feeding |
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Term
| Nursing measures to promote fluid loss in children with CHF |
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Definition
| Admin diuretics early in the day, record I+O and body weight at same time daily |
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Term
| Nursing measures to support child and family with CHF |
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Definition
| Reduce anxiety through anticipatory preparation and freq communication with parents, teach about medications, s/s of worsening HF, and make compliance as simple as possible with charts and visual aids. |
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Term
| Acyanotic heart defects r/t increased pulmonary blood flow |
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Definition
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Atrioventricular canal |
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Term
| Acyanotic heart defects r/t obstruction of blood flow from ventricles |
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Definition
Coarctation of aorta
Aortic stenosis
Pulmonic stenosis |
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Term
| Cyanotic heart defects r/t decreased pulmonary blood flow |
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Definition
Tetralogy of Fallot
Tricuspid atresia |
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Term
| Cyanotic heart defects r/t mixed blood flow |
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Definition
Transposition of great arteries
Total anomalouspulmonary venous return
Truncus arteriosus
Hypoplastic left heart syndrome |
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Term
| Pathophys of an Atrial Septal Defect |
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Definition
L to R shunt (acyanotic)
Higher pressure of left atrium creates flow into lower pressure right atrium leading to increased flow of oxygenated blood to R side of heart |
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Term
| Atrial Septal Defect characteristics |
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Definition
-Cardiac failure unusual
-May be asymptomatic
-Characteristic murmur
-Atrial dysrhythmias
Tx: surgical patch |
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Term
| Pathophys of Ventricular Septal Defect |
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Definition
Acyanotic (L to R shunt)
-Associated with other defects
-many close spontaneously
Blood shunted to R ventricle d/t higher pressure from L ventricle. Because SVR is greater than pulmonary vascular resistance the lungs recieve greater blood flow eventually leading to pulmonary HTN. R ventricular hypertrophy may lead to enlarged R atrium. |
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Term
| Ventricular Septal Defect Characteristics |
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Definition
-CHF
-Murmur
-R/O Bacterial Endocarditis
Tx: Surgical- patch or sutures
non-Surgical- device closure |
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Term
| Pathophys of Atrioventricular Canal Defect |
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Definition
Acyanotic (generally L to R shunt)
Defect allows blood to flow between all four chambers of the heart. Most common with Down Syndrome. Leads to pulmonary vascular engorgement and predisposes CHF |
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Term
| Characteristics of Atrioventricular Canal Defect |
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Definition
-CHF
-Murmur
-Mild cyanosis worsens with crying
-Increases risk for pulmonary vascular obstructive disease
Tx: Surgical closure and AV valve reconstruction |
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Term
| Pathophys of Patent Ductus Arteriosus |
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Definition
Acyanotic (L to R shunt)
Failure of fetal ductus to close leads to blood flow from high pressure aorta to lower pressure pulmonary artery. At birth pressure is almost equal but as SVR increases, blood is shunted and recirculated to lungs which leads to increased work of L side of heart, increased pulmonary congestion that can lead to R ventricular hypertrohy |
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Term
| Characteristics of Patent Ductus Arteriosus |
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Definition
-Asymp or CHF
-Machinery-like murmur
-Widened pulse pressure
-Bounding pulses
-R/F Bacterial Endocarditis
-Pulmonary congestion
Tx: Admin prostaglandin inhibitor (Indomethacin) to close ductus arteriosus, surgery, coils |
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Term
| Pathophys of Coarctation of the Aorta |
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Definition
Acyanotic
Narrowing in the aorta leading to increased pressure in upper extermities and decreased pressure in lower extremities. |
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Term
| Characteristics of Coarctation of the Aorta |
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Definition
High bp and bounding pulses in upper extremities and cool lower extremities with low bp. Signs of CHF. Rapidly deteriorating condition leading to severe acidosis and hypotension. Older children may experience dizziness, HA, fainting, and epitaxis. Patients at risk for HTN, ruptured aorta,aortic aneurysm, and stroke.
Tx: Surgical repair advised within first 2 years of life. Non-surgical: balloon angioplasty and stents |
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Term
| Pathophys of Aortic Stenosis |
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Definition
Acyanotic
Stricture in aortic outflow causes resistance to ejection of blood from L ventricle. L ventricle failure can lead to increased pressure in the L atria and pulmonary congestion |
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Term
| Characteristics of Aortic Stenosis |
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Definition
-Signs of decreased CO
-faint pulses, hypotension, tachycardia, and poor feeding
-Exercise intolerance, chest pain, and dizziness
-Characteristic murmur
-R/F bacterial endocarditis, coronary insuff,and ventricular dysfx
Tx: surgical Aortic valvotomy, non-surgical balloon angioplasty |
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Term
| Pathophys of Pulmonic Stenosis |
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Definition
Acyanotic to cyanotic
Resistance to blood flow cause R ventricular hypertrophy, may lead to increased R atrial pressure that can result in the reopening of the foramen ovale and the shunting of unoxygenated blood into the L atrium and systemic cyanosis
*An associated defect such as patent ductus arteriosus partially compensates for obstruction by shunting blood from aorta to pulmonary artery and the lungs. |
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Term
| Characteristics of Pulmonic stenosis |
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Definition
-Asymptomatic to mild cyanosis, or CHF
-Progressive narrowing causes increased symptoms
-Characteristic murmur
-Cardiomegaly on CXR
-R/F Bacterial Endocarditis
Tx: surgical; Transventricular valvotomy
non-surgical: balloon angioplasty (tx of choice) |
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Term
| Pathophys of Tetralogy of Fallot |
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Definition
| Alteration varies depending on the degree of pulmonic stenosis and size of VSD. Because the VSD is usually large, pressures may be equal in R and L ventricles. If pulmonary vascular resistance is > than SVR, the shunt is from L to R. Pulmonic stenosis results in reduced amount of oxygenated blood reaching the L side of heart. Depending on position of aorta, blood from both ventricles may be distributed systemically. |
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Term
| Characteristics of Tetralogy of Fallot |
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Definition
-May be acutely cyanotic at birth
-May have mild cyanosis that progresses
-Characteristic murmur
-May have blue spells or tet spells (usually after crying or feeding)
-R/F emboli, seizures, and loss of consciousness or sudden death
Tx: surgical; *palliative shunt from R subclavian artery to pulmonary arteries, *complete repair; closure of VSD and resection of infundibular stenosis with pericardial patch within 1st year of life |
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Term
| Pathophy Tricuspid Atresia |
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Definition
| No opening between R atria and R ventricle. Patent foramen ovale required to permit blood flow to L side of heart, blood flows through VSD to R ventricle and out to lungs, and a patent ductus arteriosus allows blood flow into the lungs. Mixing of saturated and unsaturated blood in L ventricle results in systemic desaturation |
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Term
| Characteristics of Tricuspid Atresia |
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Definition
-Cyanosis in newborn period
-May be tachycardia and dyspnea
-Older children may display chronic hypoxemia with clubbing
Tx: shunt to increase blood flow to lungs or the modified Fontan procedure |
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Term
| Transposition of the great arteries |
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Definition
Mixed defect
Pulmonary artery leaves the L ventricle and the aorta exits from the R ventricle with no communication between the systemic and pulmonary circulations. Associated defects must be present to permit blood to mix before going systemic. Most common defect is a patent foramen ovale. |
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Term
| Characteristics of Transposition of the great arteries |
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Definition
-depend on type and size of associated defects
-newborns with minimum communication are severly cyanotic with depressed fx
-lrg septal defects or patent ductus arteriosus may be less cyanotic but have symptoms of CHF
-Cardiomegaly present in first weeks of life
Tx: Prostaglandin E to keep ductus arteriosus open. Surgical: srterial switch procedure to reestablish normal circulation |
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Term
| Total anomalous pulmonary venous connection |
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Definition
Mixed defect
Failure of pulmonary veins to join L atrium. The R atrium receives all the blood and hypertrophies. An associated defect allows blood to shunt from higher pressure R side to L side of heart. As a result the O2 saturation is equal on both sides of heart. Pulmonary blood flow is large with obstructed drainage. |
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Term
| Total anomalous pulmonary venous connection |
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Definition
Mixed defect
Failure of pulmonary veins to join L atrium. The R atrium receives all the blood and hypertrophies. An associated defect allows blood to shunt from higher pressure R side to L side of heart. As a result the O2 saturation is equal on both sides of heart. Pulmonary blood flow is large with obstructed drainage. |
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Term
| Characteristics of Total anomalous pulmonary venous connection |
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Definition
-cyanosis inversely r/t amount of amount of pulmonary blood flow
-signs of CHF
Tx: Surgical repair early in infancy
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Term
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Definition
Mixed defect
Single vessel overrides both ventricles which leads to mixing of saturated and unsaturated blood. Lower pressure pulmonary arteries leads to increased blood flow to lungs, systemic blood flow reduced. |
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Term
| Characteristics of Truncus Arteriosus |
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Definition
-symptomatic with moderate to severe CHF
-variable cyanosis
-poor growth
-activity intolerance
-characteristic murmur
Tx: surgical repair in first month of life |
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Term
| Hypoplastic left heart syndrome |
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Definition
| Underdeveloped L side of heart, resulting in a hypoplastic L ventricle and aortic atresia. Saturated blood from L atrium flows through patent foramen ovale to R side of heart. Mixed blood flows from R side of heart to lungs and through ductus arteriosus to systemic circulation. |
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Term
| Characteristics of Hypoplastic left heart syndrome |
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Definition
-mild cyanosis and signc of CHF until patent ductus arteriosus closes then progresses to cyanosis and decresed CO leading to cardiovascular collapse
-fatal in first few months if not treated
Tx: Mechanical ventilation, inotropic support, and prostaglandin E preoperatively then multiple stage surgery or heart transplant |
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Term
| Help family adjust to child's cardiovascular disorder |
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Definition
-allow period of grief
-assess level of parents understanding
-supply information as needed
-encourage parent-infant attachment
-help parents with behavioral modification techniques before child learns to control the family
-introduce family to other families experiencing similar situation |
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Term
| How to educate family about cardiovascular disorder |
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Definition
-clear explanation based on level of understanding
-use simple diagram, picture, or model of heart (professionals should use same pictures etc. to create consistency)
-encourage communication between MD and family regarding info found on internet
-Give age appropriate info to child as he matures |
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Term
| How to help the family manage cardiovascular illness at home |
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Definition
-educate s/s of worsening clinical status
-know how to contact child's cardiologist at all times
-informed about fluid management and hypercyanotic spells
-information sheet available with child's dx, txs, allergies, medications, and phone numbers of caregivers
-correct procedure for giving meds and keeping them in safe place
-advise parents of maladaptive parenting patterns surrounding crying and feeding
-maitaining immunization schedule
-prepare family for developmental delays |
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Term
| Postoperative observation of vital signs |
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Definition
-HR and RR counted for 1 full min and compared against ECG
-Lungs auscultated hourly
-Hypothermia expected immediately after surgery
-temp may rise in 24-48hrs d/t inflammatory response
-after 48hrs elevated temp likely r/t infection |
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Term
| Postoperative maintenance of respiratory status |
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Definition
-when extubation complete, humidified O2 delivered
-turn and deep breathe hourly
-splinting and pain meds encouraged
-PRN suctioning for NO MORE than 5 secs
-monitor for bradycardia after suctioning
-check for chest tube patency and check drainage hourly for color and quantity |
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Term
| Postoperative pain management |
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Definition
-continuous IV infusion of opioids
-NSAIDS for moderate pain
-IV analgesics for 24-48 hours
-after 48 hours, Round-the-clock use of oral NSAIDS to augment oral narcotics |
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Term
| Postoperative fluid monitoring |
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Definition
-I&O accurately calculated
-track saline flushes and NS used to dilute medications
-hourly recording of output from Foley, CT, NG, and blood draw
*signs of renal failure UO <1ml/kg/hr and elevated BUN and creatinine
-Fluid restriction first postoperative day because pts returning from OR in fluid overload
-NPO first 24 hours
-Clear liquids when bowel sounds heard |
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Term
| Postoperative cardiac problems |
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Definition
-hypoxia
-low CO
-dysrhythmias
-tamponade |
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Term
| Low cardiac output syndrome |
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Definition
-affects up to 25% children after cadiac surgery
-decreased CO and peripheral perfusion can occur from hypothermia or poor LV fx
-decreased bp
-decreased pulse pressure
-cool extermities
-metabolic acidosis
-oliguria
Tx: IV inotropes |
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Term
| Pulmonary complications of cardiac surgery |
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Definition
-atelectasis
-pneumothorax
-pulmonary edema
-pleural effusion
Dx: CXR |
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Term
| neurological complications r/t heart surgery |
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Definition
-uncommon but can be devastating
-seizures
-strokes
-cerebral edema
-ischemic brain injury |
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Term
| hematologic changes r/t heart surgery |
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Definition
-mechanical trauma leads to RBC hemolysis and potential renal tubular necrosis
-hemolysis leads to blood loss and anemia
-heparinization can lead to decreased thrombin, platelets, and altered platelet aggregation |
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