Cardiovascular Dysfunction

Cardiovascular Dysfunction Two causes of cardiac defect: congenital (acyanonic and cyonotic) and acquired: infection, an autoimmune disorder, and familial tendencies. VSD: Left to right because pressure is greater in the left ventricle. So the oxygenated blood will mix with the unoxygenated blood and go back into the lungs. - Symptoms: Murmur, pulmonary congestion, heart will work harder. Cardiovascular Dysfunction History and Physical examination: - - - Poor feeding, tachypnea/tachycardia, failure to thrive/poor weight gain, activity intolerance, developmental delays, positive prenatal history, positive family history of cardiac disease. Fatigue, long term cyanosis, SOB Dyspnea, bounding pulses, changes in capillary refill. Listen to apical heart rate, listen to S1 and S2, and are there any extra heart sounds, is the rate regular Diagnositc Testing: - Echocardiogram, Electrocardiography (PQRST), MRI and cardiac catherization (diagnostic, interventional and electrophysiology studies) Pre-Procedure: tour them in the cardiac cath Post cardiac cath: Monitor the sites (pressure dressing), keep their leg straight for 4-6 hours, check pulses, change the dressing. Direct pressure above the site (about 1 inch) - Slightly diminished pulse on the surgical side. Should return over next few hours. Neurovascular checks of their extremities. Vital signs, every fifteen minutes fir the first hour. Heart rate for a full minute to monitor dysrthmias. Lower blood pressure would be bad, they could be bleeding. Discharge Teaching - Change bandage daily for 2 days and keep site clean and dry. Avoid getting it wet, sponge baths are appropriate. Look for signs of infections: redness, bleeding, fever Quiet activities - Tylenol usually enough for pain. Classification of defects - Blood flows from an area of high pressure to one of lower pressure. Blood takes the path of least resistance o Left to right or right to left shunt Patent Ductus Arteriosus - Open at birth and closes pretty quickly if it doesn’t close, you can give endomenthysin or NSAIDS. Obstructive Defects - Coarctation of the aorta Aortic stenosis Pulmonic stenosis Anatomic narrowing of blood vessels exiting the heart. Coarctation of the aorta Bounding pulses in the upper extremities, and high BP compared to lower extremities with low BP and no palpable pulses - Balloon of angioplasty A) Post-Op Care a. Education for the patient about what they should expect. b. Reduce cardiac demand of the heart. c. Perfusion, oxygenation and gas exchange. - Tetralogy of Fallot 1. 2. 3. 4. - Pulmonic stenosis Right ventricular hypertrophy Overriding aorta VSD (ventricular septum defect) Knee to chest to feel better in toddlers Young infant bring knees to chest. Important for patient teaching. - Provide oxygen to the patient Treatment: Morphine can cause apnea if pushed too fast. Protaglandin and decrease the workload fo the heart for transportation of great artiers, and do strict I’s and O’s. ASD, VSD, PDA, Coarcatation of aorta, Tetraogy of Fallot and Transposition of the great arteries. Left Sided Heart Failure Disease Process: Left sides heart failure is the inability of the left ventricle to pump ou Clinical Manifestation: Paroxysmal Nocturnal Dyspnea, cough, crackles, wheezes blood tinged sputum, tachypnea, cyanosis, fatigue, babies fall asleep when they are sleeping and have a lack of appetite Diagnostic Test: cardiac catherization, chest x-ray Therapeutic information - Digoxin for a child using digoxin, monitor apical heart rate for a full minute, therapeutic 0.8-2.0 question dose above 1 ml , assess apical pulse for 1 minute for bradycardia Education do not skip or make up doses, give 1 hour before or 2 hours after meal, do not repeat doses if a child vomits, do not mix with foods or liquids. Toxicity: early signs is vomiting, hypokalemia may increase toxicity, diarrhea, fatigue, weakness. Antidote: Digibind Diuretics help the kidneys to remove excess fluid Potassium sparing diuretics potassium sparing diuretics help the body to retain potassium may be lost when taking diuretics Ace inhibitors help to dilute blood vessels to improve blood flow, decrease the workload of the heart, Beta blocker decrease heart rate and blood pressure, allowing the heart to pump more efficiently. Check sodium, heart rte and blood pressure. Right Sided Heart Failure Right sided HF means that the right side of the heart is not pumping blood to the lungsa s well as normal. Clinical manifestations influce: fatigue, may be secondary to chronic pulmonary problems, peripheroul venous pressure, ascities, enlarged liver and spleen, anorexia and complaints of GI distress, weight gain, dependent Edema Dx test - ECG Blood test to measure substance in the blood Sleep study CT to see the heart MRI Coronary angiography Chest Xray to see if heart is big or congested. Pharm: beta blockers, vasodilators, digoxin, pulmonary vasodilatores Nonpharm: restrict sodium, depending on severity, may have the restrict fluid intake, physical acticcity as tolerated as advised by HCP , cessation of smoking, track weight gain to monitor fluid retention. Rheumatic Fever