alterations of cardiac function congenital heart defects valvular problems endocarditis abdominal...
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ALTERATIONS OF CARDIAC FUNCTION
ALTERATIONS OF CARDIAC FUNCTION
CONGENITAL HEART DEFECTSVALVULAR PROBLEMS
ENDOCARDITISABDOMINAL AORTIC ANEURYSM
2009
CONGENITAL HEART DEFECTSVALVULAR PROBLEMS
ENDOCARDITISABDOMINAL AORTIC ANEURYSM
2009
Transition from fetal to pulmonary circulationTransition 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?
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 functioningDifferences 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?
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 PHYSIOLOGYBASIC PHYSIOLOGY
WHAT IS THE HEART:
WHAT IS CARDIAC OUTPUT?
How is cardiac output determined?
WHAT IS STROKE VOLUME?
WHAT IS THE HEART:
WHAT IS CARDIAC OUTPUT?
How is cardiac output determined?
WHAT IS STROKE VOLUME?
PHYSIOLOGY CONTINUEDPHYSIOLOGY CONTINUED
WHAT 3 things influence STROKE VOLUME?1.Define Preload:
2.Define Afterload:
1.Define Contractility:
WHAT 3 things influence STROKE VOLUME?1.Define Preload:
2.Define Afterload:
1.Define Contractility:
WHAT KIND OF TESTING IS DONE TO DIAGNOSE?
WHAT KIND OF TESTING IS DONE TO DIAGNOSE?
Cardiac Catherization
Cardiac Catherization
What is used during the test?
Where are the catheters placed?
What measurements are taken?
What is visualized?
What is used during the test?
Where are the catheters placed?
What measurements are taken?
What is visualized?
PREOP NURSING CARE CARDIAC CATHERIZATION
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 rashWHY Mark pulses: dorsalis pedis,
posterior tibialWHY Baseline pulse ox
WHY NEED Accurate hgt and wgt WHY IS History of allergies to
iodine important?WHAT HAPPENS IF THE CHILD HAS
Severe diaper rashWHY Mark pulses: dorsalis pedis,
posterior tibialWHY Baseline pulse ox
PREOP CARDIAC CATHPREOP CARDIAC CATH
HOW TO Prepare child: schoolage/adolescent
Preop receive what drugs? WHAT DIET PREOP AND WHY?
HOW TO Prepare child: schoolage/adolescent
Preop receive what drugs? WHAT DIET PREOP AND WHY?
POSTOP NURSING CARECARDIAC CATHERIZATIONPOSTOP NURSING CARE
CARDIAC CATHERIZATION What would you expect to find when assessing
the pulses?
What is normal and what is abnormal?
What rhythm and rate change would you
expect?
What would you expect to find when assessing the pulses?
What is normal and what is abnormal?
What rhythm and rate change would you
expect?
POSTOP NURSING CARECARDIAC CATHERIZATIONPOSTOP NURSING CARE
CARDIAC CATHERIZATIONWHY CHECK BPWHY Check dressingWhat 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?
WHY CHECK BPWHY Check dressingWhat 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
POSTOP HOME CARE CARDIAC CATH
Pressure dressing INSTRUCTIONSWhat is done to Cover site? Bathing instructions?What observations are made for
complications?What activity instructions?What is used for pain?
Pressure dressing INSTRUCTIONSWhat 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
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:
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
ANSWERS TO POSTOP CATH SITUATION
1. Increase the rate of his IV fluids2. Give an antiemetic and keep
Tommy NPO3. Call the cardiologist4. Lie Tommy down, remove the
dressing and apply direct pressure above the catherization site
1. Increase the rate of his IV fluids2. Give an antiemetic and keep
Tommy NPO3. Call the cardiologist4. Lie Tommy down, remove the
dressing and apply direct pressure above the catherization site
ANSWERS TO SITUATIONANSWERS TO SITUATION
GENERAL S & S of CHD in INFANTS AND CHILDRENGENERAL S & S of CHD in INFANTS AND CHILDREN
INFANTS: Dyspnea Difficulty feeding Stridor, choking spells Pulse rate over 200 FTT Heart murmurs Frequent URI’s Anoxic attacks CVA
INFANTS: Dyspnea Difficulty feeding Stridor, choking spells Pulse rate over 200 FTT Heart murmurs Frequent URI’s Anoxic attacks CVA
CHILDREN: Exercise intolerance Increased BP Poor physical
development Heart murmurs Cyanosis Recurrent URI Clubbing fingers/toes squatting
CHILDREN: Exercise intolerance Increased BP Poor physical
development Heart murmurs Cyanosis Recurrent URI Clubbing fingers/toes squatting
CLASSIFICATION OF CHDCLASSIFICATION 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
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!
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?
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
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?
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 DEFECTSOBSTRUCTIVE 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:
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 OF AORTACOARCTATION OF AORTA Where is the narrowing
located? Where is the increased
pressure and what does it cause?
Where is decreased pressure and what does it cause?
Where is the narrowing located?
Where is the increased pressure and what does it cause?
Where is decreased pressure and what does it cause?
RESULTS OF COARCTATIONRESULTS OF COARCTATION
Because of the large volume of blood going to the head the child may experience what?
What is common in infants?
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
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?
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
TREATMENT OF COARCTATION OF AORTA
What is the Nonsurgical treatment called?
Is this method performed everywhere?
What is the Nonsurgical treatment called?
Is this method performed everywhere?
POSTOP COARCTATION SYNDROME
POSTOP COARCTATION SYNDROME
Postop pts develop abdominal pain for what reason?
SURVIVAL POSTOP: 95%
Postop pts develop abdominal pain for what reason?
SURVIVAL POSTOP: 95%
PULMONIC STENOSISPULMONIC STENOSIS
Stenosis means what and where?
RV hypertrophy occurs as a result of what
What happens to the volume of blood flow to the lungs?
S&S:
Stenosis means what and where?
RV hypertrophy occurs as a result of what
What happens to the volume of blood flow to the lungs?
S&S:
TX OF PULMONIC STENOSIS
TX OF PULMONIC STENOSIS
SURGICAL TX:1. Infants: closed heart surgery transventricular
valvotomy2. Children: open heart surgery pulmonary
valvotomy NONSURGICAL TX: balloon angioplasty in
cardiac cath lab to dilate valve (TREATMENT OF CHOICE)
SURVIVAL RATE BOTH PROCEDURES: 98%
SURGICAL TX:1. Infants: closed heart surgery transventricular
valvotomy2. Children: open heart surgery pulmonary
valvotomy NONSURGICAL TX: balloon angioplasty in
cardiac cath lab to dilate valve (TREATMENT OF CHOICE)
SURVIVAL RATE BOTH PROCEDURES: 98%
NEXT GROUP OF CHD: INCREASED PULMONARY BLOOD FLOW
NEXT GROUP OF CHD: INCREASED PULMONARY BLOOD FLOW
How would you describe the blood flow in relationship to the pressures in this type of defect?
What happens to blood volume and where?
WITH THIS TYPE WHAT COMMONALITY WOULD YOU SEE IN TERMS OF S&S?
WHAT TYPE OF DEFECTS:
How would you describe the blood flow in relationship to the pressures in this type of defect?
What happens to blood volume and where?
WITH THIS TYPE WHAT COMMONALITY WOULD YOU SEE IN TERMS OF S&S?
WHAT TYPE OF DEFECTS:
ATRIAL SEPTAL DEFECTATRIAL SEPTAL DEFECT
WHERE IS THE Abnormal opening?
WHERE DOES THE Blood FLOW from & to?
What enlarges?
WHERE IS THE Abnormal opening?
WHERE DOES THE Blood FLOW from & to?
What enlarges?
ATRIAL SEPTAL DEFECTATRIAL SEPTAL DEFECT
S&S:
Surgical correction:
99% survival rate postop
S&S:
Surgical correction:
99% survival rate postop
VENTRICULAR SEPTAL DEFECT (VSD)
VENTRICULAR SEPTAL DEFECT (VSD)
Abnormal opening between? What can happen at birth?Describe the effects of the shunt? And
where the blood flows? S&S:Complications? Corrective Surgery:
Abnormal opening between? What can happen at birth?Describe the effects of the shunt? And
where the blood flows? S&S:Complications? Corrective Surgery:
PATENT DUCTUS ARTERIOSUSPATENT DUCTUS ARTERIOSUSFailure of what to
close at birth?How does Blood
flow? causing what kind of
shunt?
Failure of what to close at birth?
How does Blood flow?
causing what kind of shunt?
Patent Ductus ArteriosusPatent Ductus Arteriosus
S&S:
What complications?
What long term effects? What changes in heart muscle?
S&S:
What complications?
What long term effects? What changes in heart muscle?
PDA CONTINUEDPDA CONTINUED
What might be administered by the nurse to newborns/premies to close the shunt?
What Surgical Tx is used to correct problem?
Survival Rate postop: 99%
What might be administered by the nurse to newborns/premies to close the shunt?
What Surgical Tx is used to correct problem?
Survival Rate postop: 99%
NEXT GROUP OF CHD: DECREASED PULMONARY BLOOD FLOW
NEXT GROUP OF CHD: DECREASED PULMONARY BLOOD FLOW
Obstruction of pulmonary blood flow caused by what type of anatomical defect?
How does the defect cause problems with
blood flow?
What effect does it have on desaturated blood?
Where does the desaturated blood flow go?
Obstruction of pulmonary blood flow caused by what type of anatomical defect?
How does the defect cause problems with
blood flow?
What effect does it have on desaturated blood?
Where does the desaturated blood flow go?
TETRALOGY OF FALLOTTETRALOGY OF FALLOT
FOUR DEFECTS IDENTIFIED
1.2.3.4.
FOUR DEFECTS IDENTIFIED
1.2.3.4.
TETRALOGYOF FALLOTTETRALOGYOF FALLOTFOUR
DEFECTSFOUR
DEFECTS
SHUNTS IN TETRALOGY OF FALLOT VARY
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?
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 INFANTSS&S OF TOF IN INFANTS
ASSESSMENT OF INFANTS WITH TOF?
WHAT IS A BLUE SPELL, HYPERCYANOTIC SPELL OR TET SPELL:
WHAT NORMAL INFANT SITUATIONS LEAD TO A SPELL? CAUSE of TET SPELL?
WHAT IMPACT DOES THIS SPELL HAVE ON PULMONARY BLOOD FLOW?
HOW DOES IT EFFECT THE SHUNTING?
ASSESSMENT OF INFANTS WITH TOF?
WHAT IS A BLUE SPELL, HYPERCYANOTIC SPELL OR TET SPELL:
WHAT NORMAL INFANT SITUATIONS LEAD TO A SPELL? CAUSE of TET SPELL?
WHAT IMPACT DOES THIS SPELL HAVE ON PULMONARY BLOOD FLOW?
HOW DOES IT EFFECT THE SHUNTING?
TET SPELLS RISKSTET SPELLS RISKS
1.2.3.4.
1.2.3.4.
TREATING TET SPELLS OR HYPERCYANOTIC SPELLS
TREATING TET SPELLS OR HYPERCYANOTIC SPELLS
WHAT position helps the infant? What approach needs to be used by
caregiver? What treatment needs to be instituted
immediately?What drug is given and why? Why does the infant need IV fluid
replacement and volume expanders? What can be repeated if needed?
WHAT position helps the infant? What approach needs to be used by
caregiver? What treatment needs to be instituted
immediately?What drug is given and why? Why does the infant need IV fluid
replacement and volume expanders? What can be repeated if needed?
S&S OF TOF IN CHILDRENS&S OF TOF IN CHILDREN
With long term cyanosis what develops in the fingers
What position do children assume when in Tet spell?
How does TOF effect growth?What life threatening risks of TOF
in children?
With long term cyanosis what develops in the fingers
What position do children assume when in Tet spell?
How does TOF effect growth?What life threatening risks of TOF
in children?
SURGICAL TX OF TOFSURGICAL TX OF TOF
PALLIATIVE:
COMPLETE REPAIR:
Postop risks? SURVIVAL: 95%
PALLIATIVE:
COMPLETE REPAIR:
Postop risks? SURVIVAL: 95%
TRICUSPID ATRESIATRICUSPID 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?
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 ATRESIATRICUSPID ATRESIA
S&S:
Palliative surgery:Corrective surgery:
Survival: 80-90%; many postop complications
S&S:
Palliative surgery:Corrective surgery:
Survival: 80-90%; many postop complications
MIXED DEFECT EXAMPLESMIXED DEFECT EXAMPLES
TRANSPOSITION OF THE GREAT VESSELS (TGV) OR TRANSPOSITION OF THE GREAT ARTERIES (TGA)
TRUNCUS ARTERIOSUS (TA)
TRANSPOSITION OF THE GREAT VESSELS (TGV) OR TRANSPOSITION OF THE GREAT ARTERIES (TGA)
TRUNCUS ARTERIOSUS (TA)
TRANSPOSITION OF THE GREAT VESSELS
TRANSPOSITION OF THE GREAT VESSELS
PA leaves the LV taking what blood back to the lungs
Aorta exits from where?
No communication between what?
What other defect allows child to live at birth?
PA leaves the LV taking what blood back to the lungs
Aorta exits from where?
No communication between what?
What other defect allows child to live at birth?
TRANSPOSITION OF THE GREAT VESSELS
TRANSPOSITION OF THE GREAT VESSELS
What assessment and complications seen at birth?
Surgical Tx:
Survival: 80%
What assessment and complications seen at birth?
Surgical Tx:
Survival: 80%
TRUNCUS ARTERIOSUSTRUNCUS ARTERIOSUS
What does this look like?What other defects? S&S
Surgical repair:
Survival of surgery: 80%. Other surgeries required
What does this look like?What other defects? S&S
Surgical repair:
Survival of surgery: 80%. Other surgeries required
CONGESTIVE HEART FAILURE IN CHILDREN
CONGESTIVE HEART FAILURE IN CHILDREN
What happens to the heart? Is it able to meet the body’s
demands?
What situations would lead to CHF?
What happens to the heart? Is it able to meet the body’s
demands?
What situations would lead to CHF?
SUBTLE S & S OF CHF in CHILDREN
SUBTLE S & S OF CHF in CHILDREN
How does it effect feeding?
How does it effect energy?
What happens during feeding?
How does it effect feeding?
How does it effect energy?
What happens during feeding?
CONGESTIVE HEART FAILURE IN CHILDRENCONGESTIVE HEART
FAILURE IN CHILDREN Impaired
myocardial function
How does it effect ?
Impaired myocardial function
How does it effect ?
VS? Energy? appetite Temperature of
skin? Heart muscle? Urinary
elimination?
VS? Energy? appetite Temperature of
skin? Heart muscle? Urinary
elimination?
CHF IN CHILDRENCHF IN CHILDREN
Systemic venous congestion
How does it effect?
Systemic venous congestion
How does it effect?
Weight? Liver? Fluid accumulation?
Neck vein?
Respiratory assessment?
Weight? Liver? Fluid accumulation?
Neck vein?
Respiratory assessment?
THERAPEUTIC MANAGEMENT GOALS
THERAPEUTIC MANAGEMENT GOALS
Improve cardiac function by?
Remove accumulated fluid and sodium leading to what effect on the heart?
What on cardiac demands? What effect on oxygenation?
Improve cardiac function by?
Remove accumulated fluid and sodium leading to what effect on the heart?
What on cardiac demands? What effect on oxygenation?
IMPROVE CARDIAC FUNCTION
IMPROVE CARDIAC FUNCTION
DigitalisWhich class of drug? Used to?
DigitalisWhich class of drug? Used to?
MAJOR ACTIONS OF DIGITALIS
MAJOR ACTIONS OF DIGITALIS
positive inotropic: means what? negative chronotropic: means what?
negative dromotropic: means what?
Indirectly enhances what?
positive inotropic: means what? negative chronotropic: means what?
negative dromotropic: means what?
Indirectly enhances what?
DIGOXIN (Lanoxin) IN PEDS
DIGOXIN (Lanoxin) IN PEDS
Elixir (50 ug/ml) poIV (O.1mg/ml)Dose calculated in micrograms (1000
ug=1mgGive Digitalizing dose to bring serum
dig level into therapeutic rangeMaintenance dose = 1/8 of digitalizing
dose
Elixir (50 ug/ml) poIV (O.1mg/ml)Dose calculated in micrograms (1000
ug=1mgGive Digitalizing dose to bring serum
dig level into therapeutic rangeMaintenance dose = 1/8 of digitalizing
dose
THERAPEUTIC SERUM DIGOXIN RANGE
THERAPEUTIC SERUM DIGOXIN RANGE
Range from 0.8 to 2 ug/lRange from 0.8 to 2 ug/l
Digoxin administration guide
Digoxin administration guide
Apical pulse checkedDrug not given if pulse below 90-
110/min in infants and young children or below 70/min in older children
Do one full minute
Apical pulse checkedDrug not given if pulse below 90-
110/min in infants and young children or below 70/min in older children
Do one full minute
DIGOXIN Toxicity:DIGOXIN Toxicity:
Effect on heart rate?
Effect on appetite and feeding?
Effect on heart rate?
Effect on appetite and feeding?
MEDS CONTINUEDMEDS CONTINUED
Angiotensin converting enzyme inhibitors (ACE): Vasotec, Capoten
Used to
Angiotensin converting enzyme inhibitors (ACE): Vasotec, Capoten
Used to
OTHER MEDICATIONSOTHER MEDICATIONS
For severe CHF, other IV inotropic drugs used in the ICU:
1. Dopamine2. Dobutamine3. AmrinoneUsed to
For severe CHF, other IV inotropic drugs used in the ICU:
1. Dopamine2. Dobutamine3. AmrinoneUsed to
GOALS OF TREATMENT CONTINUED
GOALS OF TREATMENT CONTINUED
Remove accumulated fluid and sodium with which group of drugs?
Give examples?
CAUTION:
Remove accumulated fluid and sodium with which group of drugs?
Give examples?
CAUTION:
GOALS OF TREATMENT CONTINUED:
GOALS OF TREATMENT CONTINUED:
Decrease cardiac demands: GIVE EXAMPLES OF NURSING
ACTIONS:
Decrease cardiac demands: GIVE EXAMPLES OF NURSING
ACTIONS:
GOALS OF TREATMENT CONTINUTED:
GOALS OF TREATMENT CONTINUTED:
Improve tissue oxygenationNURSING ACTIONS:
Improve tissue oxygenationNURSING ACTIONS:
NRSG DX FOR ACYANOTIC HEART DEFECTS
NRSG DX FOR ACYANOTIC HEART DEFECTS
NRSG DX FOR CYANOTIC HEART DEFECTS
NRSG DX FOR CYANOTIC HEART DEFECTS
NURSING CARE IN ICU POST-OP CARDIAC SURGERY
NURSING CARE IN ICU POST-OP CARDIAC SURGERY
What is done to keep child calm?How is the infant’s temp regulatedHow often VS?How is the heart monitored?What measures Cardiac output?Why does the child have Pacemaker
leads in place?
What is done to keep child calm?How is the infant’s temp regulatedHow often VS?How is the heart monitored?What measures Cardiac output?Why does the child have Pacemaker
leads in place?
POSTOP NURSING CARE CONTINUED
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?
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 NUPOSTOP 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
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
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?
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 COMPLICATIONSPOTENTIAL COMPLICATIONS
HEMORRHAGE *****ARRHYTHMIAS CHF PNEUMONIA RENAL FAILURE CVA PULMONARY EMBOLISM DEATH
HEMORRHAGE *****ARRHYTHMIAS CHF PNEUMONIA RENAL FAILURE CVA PULMONARY EMBOLISM DEATH
NURSING ASSESSMENTSNURSING ASSESSMENTS
Parentschild
Parentschild
ENDOCARDITISENDOCARDITIS
CAUSATIVE ORGANISMSCAUSATIVE ORGANISMS
StreptococcusStaphylococcus aureus,
enterococci
StreptococcusStaphylococcus aureus,
enterococci
PREDISPOSING FACTORSPREDISPOSING FACTORS
Who would get endocarditis? Who would get endocarditis?
PATHOPHYSIOLOGYPATHOPHYSIOLOGY
Where does the Infective organisms travel?
Where is it deposited on the heart?What aggregation is triggered?What forms on valves and
endocardium?
Where does the Infective organisms travel?
Where is it deposited on the heart?What aggregation is triggered?What forms on valves and
endocardium?
EMBOLIZATIONEMBOLIZATION
What happens to the Fragments of friable vegetative lesions?
Where do they go? What assessments would the nurse
look for with regard to 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 manifestationsClinical manifestations
INITIAL SYMPTOMS SEEM LIKE FLU:
FEVER:VASCULAR MANIFESTATIONS: Splinter hemorrhages
Petechiae
Roth’s spots:
INITIAL SYMPTOMS SEEM LIKE FLU:
FEVER:VASCULAR MANIFESTATIONS: Splinter hemorrhages
Petechiae
Roth’s spots:
Clinical manifestationsClinical manifestations
PERIPHERAL MANIFESTATIONS:
Osler’s Nodes:
Janeway lesions:
PERIPHERAL MANIFESTATIONS:
Osler’s Nodes:
Janeway lesions:
Clinical manifestationsClinical manifestations
CARDIAC:Heart murmur: indicates? What happens to the size of the
heart? What other complication?
CARDIAC:Heart murmur: indicates? What happens to the size of the
heart? What other complication?
Clinical manifestationsClinical manifestations
CEREBRAL EMBOLIZATION:What assessments?
CEREBRAL EMBOLIZATION:What assessments?
Clinical manifestationsClinical manifestations
PULMONARY EMBOLIZATION:What assessments?
PULMONARY EMBOLIZATION:What assessments?
Clinical manifestationsClinical manifestations
CORONARY ARTERY EMBOLIZATION:What assessments?
CORONARY ARTERY EMBOLIZATION:What assessments?
Clinical manifestationsClinical manifestations
SPLENIC EMBOLIZATION:What assessments?
SPLENIC EMBOLIZATION:What assessments?
Clinical manifestationsClinical manifestations
EMBOLIZATION OF THE RENAL ARTERY:
What assessments?
EMBOLIZATION OF THE RENAL ARTERY:
What assessments?
Clinical manifestationsClinical manifestations
CENTRAL NERVOUS SYSTEM:What assessments?
CENTRAL NERVOUS SYSTEM:What assessments?
LABORATORY FINDINGSLABORATORY FINDINGS
Nursing careNursing 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?
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 DIAGNOSISEXPECTED OUTCOMESNURSING DIAGNOSIS
EXPECTED OUTCOMES
ABDOMINAL AORTIC ANEURYSM
ABDOMINAL AORTIC ANEURYSM
ANEURYSMANEURYSM
DefinedDefined
SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS
EXPANDING ANEURYSMEXPANDING ANEURYSM
ASSESSMENTASSESSMENT
RUPTURED ANEURYSMRUPTURED ANEURYSM
ASSESSMENTASSESSMENT
TREATMENT: SURGICAL REPAIR
TREATMENT: SURGICAL REPAIR
BEFORE SURGERY ASSESSMENT
BEFORE SURGERY ASSESSMENT
COMPLICATIONS DURING SURGERY
COMPLICATIONS DURING SURGERY
MYOCARDIAL INFARCTIONMYOCARDIAL INFARCTION
How would you know?How would you know?
GRAFT OCCLUSION OR RUPTURE
GRAFT OCCLUSION OR RUPTURE
HYPOVOLEMIA & RENAL FAILURE
HYPOVOLEMIA & RENAL FAILURE
RESPIRATORY DISTRESSRESPIRATORY DISTRESS
PARALYTIC ILEUSPARALYTIC ILEUS
POSTOPERATIVE NURSING CARE
POSTOPERATIVE NURSING CARE
POST-OP ASSESSMENTS for ISCHEMIA
POST-OP ASSESSMENTS for ISCHEMIA
POST-OP ASSESSMENTS for:ARTERIAL OCCLUSION
POST-OP ASSESSMENTS for:ARTERIAL OCCLUSION
DISCHARGE PLANNINGDISCHARGE PLANNING
Valvular Heart DiseaseValvular Heart Disease
GENERAL CONCEPTSGENERAL CONCEPTS
VALVULAR DISEASE INVOLVES THE 4 VALVES OF THE HEART
PRESSURES:
VALVULAR DISEASE INVOLVES THE 4 VALVES OF THE HEART
PRESSURES:
PRESSURE ALTERATIONS DUE TO STENOTIC VALVE
PRESSURE ALTERATIONS DUE TO STENOTIC VALVE
VALVULAR DISEASE DEFINED: VALVULAR DISEASE DEFINED:
VALVULAR DISEASE DEFINED:
Stenosis:
Regurgitation:
VALVULAR DISEASE DEFINED:
Stenosis:
Regurgitation:
STENOSIS & REGURGITATION
STENOSIS & REGURGITATION
STENOSIS:
REGURGITATION:
STENOSIS:
REGURGITATION:
MITRAL VALVE STENOSISMITRAL VALVE STENOSIS
ASSESSMENTASSESSMENT
MITRAL VALVE REGURGITATIONMITRAL VALVE
REGURGITATION
ASSESSMENTASSESSMENT
MITRAL VALVE PROLAPSEMITRAL VALVE PROLAPSE
ASSESSMENTASSESSMENT
AORTIC VALVE STENOSISAORTIC VALVE STENOSIS
ASSESSMENTASSESSMENT
AORTIC VALVE REGURGITATIONAORTIC VALVE
REGURGITATIONACUTE AORTIC VALVE
REGURGITATION
CAUSES
ACUTE AORTIC VALVE REGURGITATION
CAUSES
ASSESSMENTASSESSMENT
• ACUTE:
• CHRONIC:
• ACUTE:
• CHRONIC:
TRICUSPID AND PULMONIC VALVE DISEASE
TRICUSPID AND PULMONIC VALVE DISEASE
RESULTS:
TRICUSPID STENOSIS RESULTS in
PULMONIC STENOSIS: results in
RESULTS:
TRICUSPID STENOSIS RESULTS in
PULMONIC STENOSIS: results in
DIAGNOSTIC STUDIES FOR VALVULAR HEART DISEASEDIAGNOSTIC STUDIES FOR VALVULAR HEART DISEASE
TREATMENTTREATMENT
DEPENDS UPON SYMPTOMS: DEPENDS UPON SYMPTOMS:
TEACHINGTEACHING
Describe disease and complicationsDiscuss ways to prevent
complications: prophylactic antibiotics prior to invasive procedures
Wear Medic AlertTeach about anticoagulants if
prescribed
Describe disease and complicationsDiscuss ways to prevent
complications: prophylactic antibiotics prior to invasive procedures
Wear Medic AlertTeach about anticoagulants if
prescribed