alterations of cardiac function congenital heart defects valvular problems endocarditis abdominal...

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