1301 tetralogy fallot congenital heart defects
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By the end of this class, students will be able to:
Describe fetal and postnatal circulation
Identify the structural defects of patent ductusarteriosus and tetralogy of fallot
Discuss preparation and post-procedure care ofthe child who is having a cardiac catheterization
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Learning Objectives Continued:
Apply the nursing process in the care of the
child with congenital heart defects
Discuss care of the child who is having openheart surgery
Describe the common complications with
congenital heart defects and the nursing care
that is required
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Post-Natal Circulation
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Pressures and
Oxygen
Saturations ineach Heart
Chamber and
Main Cardiac
Vessels
Where would the blood shunt
to if there was a ventricular
septal defect?
Where would the blood shunt to
if there was an atrial septal
defect?
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Cardiac Catheterization
Purpose of Cardiac Catheterization
Preparation of the Child and Family
Post-procedure Complications and Care
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Uses for Cardiac Catheterization
O2 SatsStructure
Pressure
Repair PDA Intra-arterial
Balloon
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Preparation of the Child and Family for
Cardiac Catheterization
Why is the child NPO?NPO for 4 to 6 hours to
prevent nausea, vomiting, and
aspiration
What premedication is
given prior to this test?
Sedatives are given to
decrease anxiety.
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What Happens During the Cardiac
Catheterization Procedure?
EKG leads are placed
Arm and leg restraints
Temperature probe Cleansing of site with betadine
Small incision and thread catheter
Dye is inserted
X-rays are taken
Catheter is removed and
pressure bandage applied
How do
you
prepare the
child?
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Cardiac Catheterization Complications and Nursing Care
Potential Decreased Cardiac
Output: Cardiac Dysrhythmias
Cardiac
MonitorCheck apical
pulse for
irregularities
Check vital signs
every 15 mins until
stable, then hourly
for four hours
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Potential Altered Tissue Perfusion
Hemorrhage from
siteArterial/venous clot
obstruction
Pressure dressing over site for 24 hours
Keep leg straight & flat for at least 6 hours post-procedure
Monitor weak or absent pulses distal to site
Monitor for decreased blood flow to extremities (cool, pale,
extremity with poor capillary refill)
Monitor for drop in BP
Monitor Hgb & Hct
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Patent Ductus Arteriosus
Locate the defect
Where does blood circulate?
Assessment findings Treatment
Nursing care
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Structural
Defects and
Cardiac
Circulation
with PDA
Where does the
blood shunt to?
Is the shunted
blood
oxygenated or
deoxygenated?
What happens
to the blood
flow in the
aorta?
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Assessment Findingswith PDA
Signs and Symptoms depend on defect size
Signs and Symptoms Include: Dyspnea on exertion
Forceful pulse
Murmur over pulmonary artery
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Low diastolic BP
Feeding difficulties and slow
weight gain
Pale, feeble appearance
Possible heart enlargement
and left sided heart failure
Symptoms of PDA (Cont)
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Treatment and Nursing Care of the Childwith Patent Ductus Arteriosus
May close spontaneously during the first year
Indomethacin Administration
Surgical Repair Prophylactic Antiobiotics
Prevent Congestive Heart Failure
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Tetralogy of Fallot
Structural Defects
Assessment Data
Treatment Nursing Care
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Four
Structural
Defects ofTetralogy of
Fallot
Why is thereright ventricular
hypertrophy?
Which way
does the blood
shunt?
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Assessment Findingswith Tetralogy of Fallot
Symptoms are variable depending of degree of obstruction
Symptoms include:
Cyanosis
Tachycardia
Systolic murmur at left sternal border
Retarded growth and development
Severe dyspnea on exertion
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Assessment Findingswith Tetralogy of Fallot
(cont.. )
Severe dyspnea on exertion
Paroxymal dyspneaBlue spells
Squatting
ClubbingMental retardation
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Treatment of the Child with TOF
Decrease cardiac workload
Prevention of intercurrent infection
Prevention of hemoconcentration
Surgical repair
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Nursing Care of the Child withTetralogy of Fallot
Care During a Hypercyanotic Spell
Decrease Cardiac Workload
Maintain Nutrition Administration of Cardiac Medications
Decrease Respiratory Distress
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Hypercyanotic Spells/Blue Spells/Tet Spells
Clinical Manifestations
Most often occurs in morning
after feedings, defecation, or crying
Acute cyanosis
Hyperpenia
Inconsolable crying
Hypoxia which leads to acidosis
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Place Infant in Knee Chest Position
Administer 100% Oxygen
Administer Morphine
Use a Calm Approach
IV Fluid Replacement for
Blood Volume Expansion
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Consolidate
Care
Provide
Rest Periods
Respond to Crying
Monitor tolerance to feedings
DecreaseCardiac
Workload
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Give small frequent high calorie formulas
Use a large holed nipple
Monitor Cardiac Tolerance
Tachycardia
Tachypnea
Desaturation
Gavage Feedings PRN
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Preparing the Child for
Open Heart Surgery
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Balloon Dilatation
of Pulmonic Valve
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Post-op Care for the Child who had Open Heart Surgery
Airway: Endotrachial tube and ventilatory support
Bleeding: Cardiac Tamponade and Hemorrhage
Circulation: CHF, Decreased Cardiac Output,
Hemolysis (due to heart-lung machine)
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Cardiac
Tamponade
As thepericardium fills
with blood, the
heart has less
room to contract
and move.
Ventricular
fibrillation and
tachycardia occurfollowed by
cardiac arrest.
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Clinical Manifestions of Cardiac Tamponade
Paradoxic pulse pressure
Rising venous pressure
Falling arterial pressure
Narrowing pulse pressure
Increased heart rate
Dyspnea, apprehension, cyanosis
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Nursing Care for Cardiac Tamponade
Call the MD immediately if there are s/s of
cardiac tamponade
Contiue to assess cardiac status
Monitor chest tubes for wound drainage
Prepare patient to return to the OR to stop
bleeding in pericardial sacBe prepared to call a CODE
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Complications and Preventive Nursing Care after Surgery
Atelectasis Infection Pain
Assess
lungs q hr
Incentive
Spirometer
Chest tubeto reinflate
Monitor
temp, WBC,
surgical site
Prophylactic
antibiotics
Steriledressings
Prevent
Endocarditis
Morphine
Oral
analgesics
when tubes
are
removed
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Temperature
ChangesTemperature
Changes
Hypothermia
Tissue
Inflammation
Infection
Renal Failure r/t
Transient Period of
Low Cardiac Output
Monitor I & O
IV fluids andNPO till
extubated
S/S renal failure
Monitor for fluid
retention
Neurologic
Changes
Risk for:
Air Emboli
Decreased
cerebral
blood flow,
cerebral
edema,
damage
L ft CHF/P l C ti
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Left CHF/Pulmonary Congestion
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