Alterations in Oxygenation

Assessment

Assessment

The assessment of heart disease begins with a thorough history and physical assessment.

More specific diagnostic studies such as electrocardiography or echocardiography, are ordered as indicated

History* The following must be given emphasis in history taking:

- infants with heart disease are generally have tachycardia and tachypnea

- infants frequently stop during feeding or sucking due to easy fatigability because of ineffective heart action

- thorough pregnancy history to determine whether an intrauterine insult may have led to poor fetal formation; cardiac anomalies can occur as a result of infection such as rubella

- any intake of medications and exposure to radiation during pregnancy, as these may contribute to congenital heart disorders

- for older children, ask for easy fatigability and how much activity before the child becomes tired

- ask what is the child’s usual resting position, some infants with congenital heart disease prefer a knee-chest position and older children often voluntarily squat.

- assess for cyanosis, indicates that deoxygenated blood enter the arterial system

- any family history for heart diseases because some of the congenital heart diseases such as the atrial septal defect has genetic tendencies.

Physical Examination* General Appearance:

- measure the height and weight then compare with the findings with the standard growth charts

- inspect the toes and fingers (particularly the thumbs) for clubbing and color

- check for the capillary refill time; a child with heart problem has a capillary refill time of more than 5 seconds

- inspect the mucous membranes of the mouth for cyanosis; cyanosis persisting for over 20 minutes after birth (except for acrocyanosis) may indicate serious cardiopulmonary dysfunction

- note if the cyanosis increases with crying, cardiac dysfunction is suggested; if the cyanosis decreases with crying, pulmonary dysfunction is suggested

- inspect the chest, note for prominence of the left side and an obvious heart movement

* Pulse, Blood Pressure and Respirations

- note for tachycardia especially if it persists even during sleep

- auscultate for heart murmurs

Characteristic

Timing Systolic or diastolic

Duration Long

Quality Harsh, Blowing

Intensity Loud

Position in which heard Heard in all positions

Affected by exercise No

Diagnostic Tests

* Electrocardiogram (ECG)

- is a written record of the elctrical voltages generated by the contracting heart. It provides information about the heart

- it provides information about heart rate, rhythm, state of myocardium, presence or absence of hypertrophy (thickening of the heart walls), ischemia or necrosis due to inadequate cardiac circulation, and abnormalities of conduction

- The electrocardiogram (ECG) is a diagnostic tool that measures and records the electrical activity of the heart in detail. Being able to interpret these details allows diagnosis of a wide range of heart problems

• Skin Preparation:- Clean with an alcohol wipe if necessary. If the patients

are very hairy – shave the electrode areas.

• Chest Electrode PlacementV1: Fourth intercostal space to the right of the sternum.V2: Fourth intercostal space to the Left of the sternum.V3: Directly between leads V2 and V4.V4: Fifth intercostal space at midclavicular line.V5: Level with V4 at left anterior axillary line.V6: Level with V5 at left midaxillary line. (Directly

under the midpoint of the armpit)

Significant Findings:

- a longer than normal P wave suggets that the atria are hypertrophied and is taking longer than usual for electrical conduction to spread over the atria

- a lengthened PR intervals suggests that there is difficulty in coordination between the SA and AV nodes (first degree heart block)

- a heightened R wave indicates that ventricular hyperthrophy is present

- an R wave that is decreased in height means that the ventricles cannot contract fully, as it happens if it is surrounded by fluids (pericarditis)

- elongation of the T wave occurs in hyperkalemia

- depression of the T wave is associated with anoxia

- depression of the ST segment is associated with abnormal calcium levels

* Radiography

- furnishes an accurate picture of the heart size; and the contour and size of the heart chambers

- X-ray findings are usually complemented by an ECG, a more sensitive and accurate measure of ventricular enlargement

* Flouroscopy- provides a permanent motion-picture

record of important information about the size and configuration of the heart and great vessels, thoracic cage and diaphragm.

- in radioangiocardiography, a radioactive substance as “technetium” is injected intravenously into the blood stream; as the substance circulates through the heart, it may be traced and recorded on videotape

- it uses a low dose of radiation and may be used to demonstrate, in particular, septal shunts

* Echocardiography or Ultrasound Cardiography

- high frequency sound waves directed toward the heart, are used to locate and study the movement and dimensions of cardiac structures such as the size of chambers, and the thickness, motion, and pressure gradients of the valves.

- fetal echocardiography can reveal heart anomalies as early as 18 weeks into pregnancy

Like the heart, never let your dreams stop beating; dream higher…

Thank You…