Disease process/ procedure
VITALS
Infant
HR: 88-150 bpm
BP: 70-100/40-70
RR: 28-60
Toddler
HR: 70-110 BPM
BP: 90-100/ 56-64
RR: 20-30
Preschool
HR: 70-110
BP: 90-100
RR: 20-28
Acyanotic defects/ Commonalities
1. PDA
2. ASD
3. VSD
Commonalities:
1. Acyanotic
2. left to right shunting
3. increased pulmonary blood flow
Symptoms:
-Increase RR
-Increase fatigue
-Bounding pulse
-Increase respiratory infections
Tetrology of Fallot (TOF), symptoms, defects
-Mixing of blood
-right to left shunting
-decrease pulmonary blood flow
Defects:
1. VSD
2. Overriding aorta
3. pulmonary stenosis
4. hypertrophy of right ventricle
PDA treatment
1. indomethacin (medically close)
2. if indomethacin doesn't work coil embolization
3. allow 6 weeks to close on its own in full term newborns
Cardiac Catherization PRE-OP
1. Baseline EKG and vitals
2. height and weight to determine catheter size
3. assess and mark pedal pulses
4. NPO 4-6 hours before
5. Assess for infection of diaper rash
6. Allergies to iodine or shellfish
7. Explain procedure
Heart failure secondary to CHD
-Increase blood flow to lungs
-Increase pressure to the lungs
-Impaired contraction
Cyanotic defects
2. Tricupsid artesia
Commonalities:
1. Cyanotic
2. right to left shunting
3. decrease pulmonary blood flow
Tricupsid Artesia, symptoms, defects
-Mixing of blood
-Right to left shunting
-Decrease pulmonary blood flow
Symptoms:
-Newborns: Cyanosis
Adolescence: hypoxemia and clubbing
-respiratory depression, Tachycardia, dyspnea
Defects:
1. VSD
2. PDA
3. ASD
4. Absence of tricupsid valve
5. underdeveloped right ventricle
ASD treatment
-Vortex patch
-Amplatzer/ umbrella device
Cardiac Catherization POST-OP
1. Assess vitals every 15-30 minutes for the first hour
2. Assess pedal pulses for perfusion (if cant feel or hear them, 24 hour IV infusion of heparin)
3. monitor for hemorrhaging ( check under and between legs)
4. lay flat with leg straight for 6 hours
5. Assess temp and color of skin
6. Can begin eating as soon as wake up
7. babies should be on oral fluids with dextrose
Left side HF symptoms
-Cough
-Dyspnea
-Orthopnea
-Rales
-Crackles
-Retractions
-Cyanosis
-gasping/grunting
-Nasal flaring
PDA
failure of closure of ductus arteriosus
-left to right shunting
-increase pulmonary blood flow
symptoms:
-machine like sytolic murmur
-widened pulse pressure
TET spells/Squatting + Treatment
bluish tints of skin during episodes of crying and feeding
Squatting
-instinctively squatting during TET spells to decrease deoxygenated venous return from lungs and increase blood flow to lungs
Treatment:
-Knee to chest position
-flick of morphine
VSD treatment
-pulmonary artery banding (small and one hole)
-open heart surgery (if hole is big and its multiple)
Cardiac catherization: Discharge teaching
-Avoid tub baths, swimming or submerging in water for the first 3 days
-Change dressings every 2 days
-Tylenol for pain (NO ASPIRIN)
-Monitor for S/S of infections
-Can return to school in 24 hours with restrictions
Right side HF symptoms
-Edema
-Heptamology
-Weight gain
-Weak peripheral pulses
-Fatigue
-Cool extremities
-Tachycardia
-Hypotension
-Decreased urine output
ASD
Abnormality between right and left atrium
symptoms:
Hypertrophy of right ventricle
Kawaski disease Treatment
-IVIG within the first 48 hours onset of symptoms
-once a day for up to 5 days
-Aspirin d/t increased platelet
TOF Treatment
Open heart surgery
Open heart surgery: PRE-OP
-Explain procedure
-Explain equipment
-Chest tubes
-Tours: show them someone freshly post-op to prepare them
Kawasaki Disease
systemic vasculitis
widespread inflammation of the blood vessels
VSD
Hole in septal between right and left ventricle
symptoms:
-Begins Acyanotic but can become Cyanotic
Kawasaki disease S/S
Acute phase:
-Elevated ESR/CRP
-Strawberry red tongue
-rash
-lips swelling
-fever
-aching joints
-irritability
Subacute phase: last 4-6 weeks
-Elevated ESR/CRP
-fever and rash going away
-hands and feet peeling
-thrombocytosis (increased platelets)
-irritability
Convalescent phase:
-clinical signs goes away but labs still elevated
-ESR/CRP
-Thrombocytosis
-temporary arthritis
-ends when labs remain normal (weekly labs after discharge)
Tricupsid Artesia Treatment
-Prostaglandin to keep valves open until surgery
-3 surgeries
1. BT shunt at 1-2 months
2. Hemi fontann/Glenn at 6 months
3. Fontann at 1 1/2 to 3 years
Open heart surgery: POST-OP
-Ches tube output: MAX 1 mL/kg/hr
-monitor chest tube drainage amount, color and odor
-Urine output (foley): MIN 1 mL/kg/hr
-Vents, inline suction, percussor
-1:1 Albumin
-Frequent neuro checks
-labs around the clock
-strict I and O
-IV fluid (dextrose for newborns)
-Rest
-Pain
-Psychosocial