Cardiac Case study

Part 1-
Fetal period:
• Blood leaves the ________ and enters the fetus through the ________ After
circulating through the fetus, the blood returns to the placenta through the__________

KEY DIFFERENCE in fetal circulation – is not needed in the lungs except a small
amount to allow

#1. ____________ is the channel between the __________ and _________

● What is the main purpose of this channel? ______________________

#2. ______________– channel between the two ________

● What is the main purpose of this channel ___________________

#3. _____________- channel between the _________& ________ to systemic

circulation.

● What is the main purpose of this channel? Allow ________ to go to the____________

circulation.

● How does only small amount of blood go to lungs? (8-10% of blood goes to lungs for
lung growth)
________________are constricted; most blood goes to an area of ________resistance,
which is the rest of the body. Blood with the _________ O2 concentration goes to the
brain and heart.
Newborn period:

Mother is in labor and is ready to push. After the head is delivered, the doctor suctions
the airway and then…

1. Baby takes his first breath. What happens in the pulmonary circulation immediately?

- Lungs expand; blood vessels expand

- This allows _________ to flow into the lungs.

- Pulmonary vessel resistance now ____________

2. Baby’s lungs are now perfused. What is the pulmonary blood flow like now compared
to fetal circulation?

 ____________ blood returns to heart from _______ = _______ pressure in LA

 With the blood flow and pressure changes, which fetal channel now closes?
- Helps close _________, which is permanently ________- with fibrin deposits

 What would negate this channel from closing?

3. The umbilical cord is cut. This procedure automatically seals off the second fetal
channel, the _________________

 The baby is breathing and is completely on his own for breathing and circulation;
the right atrium pressure falls. It no longer needs to do most of the work now that
the left side of the heart and the lungs are helping out.

**Baby is ready for a normal cardiac cycle involving the heart and lungs; both
sides will now work simultaneously alongside each other.**

4. Since the pulmonary circulation has now kicked in, it causes an ___________ in the
baby’s O2 concentration.

 This O2 concentration makes it no longer necessary for the 3 rd fetal channel to

exist. So, it begins to constrict to become a ligament like the other two channels.
This can happen within 10-15 hrs of birth up to __________ after birth.
**Now baby is ready for a normal cardiac cycle involving the heart and lungs;
both sides will now work simultaneously alongside each other**

Part 2-
Diagnostics

Part of the baby’s diagnostic work-up included a cardiac catheterization.

Explain the post-procedure care for baby after this procedure; include activity (consider
age and developmental needs), assessment, VS & dressing care

 Activity:

 Assessment:

 Vitals:

 Dressing Care:

Complications:

Mark has had a rough time growing and meeting developmental milestones as part of
his unknown cardiac illness. He developed Failure to Thrive (FTT).

 What is FTT?

 Why might an infant with CHF develop FTT?

Describe the nutritional needs of an infant with CHF

 Feed schedule –

 Feeding technique –

 Formula –

Treatment:

Furosemide and digoxin have been ordered; the doctor orders digoxin for the baby to
help increase their cardiac output. The order is digoxin 0.035 mg, at 8 a.m. & 8
p.m./daily
 1. Before the 8 A.M. dose, the nurse takes his apical pulse & it is 75 and regular.

- Explain what the nurse should do?

2. If the nurse gave the digoxin and the baby spit it out, what is the next action?

3. Why was furosemide ordered?

4. Since the baby is receiving both Digoxin & Furosemide, the nurse should be
particularly alert for signs or symptoms of:

A. Hypokalemia.
B. Hyponatremia.
C. Hypoglycemia.
D. Hypocalcemia.

- Why? Is there any concern about giving these two meds?

Surgery:

Prior to surgery, the baby began having hyper-cyanotic (tet spells) episodes.

1. What should the nurse do first?

A. Position him in the knee-chest position.

B. Position him on his side and give him ordered morphine.
C. Ask the parents to leave and start oxygen.
D. Give oxygen and notify the physician.

- Why? Incorporate the patho.

 2. What causes tet or hyper-cyanotic spells?

3. What interventions can the nurse use to prevent tet or hyper-cyanotic spells?

4. The baby’s admission lab data reveals a hematocrit level that is:

A. normal
B. elevated
D. decreased

5. The nurse interprets this as being due to:

A. Chronic infection.
B. Recent dehydration.
C. Increased cardiac output.
D. Chronic oxygen deficiency

- Why? Incorporate the patho.