This action might not be possible to undo. Are you sure you want to continue?
High risk fo r infectio n 2. Physio lo gica l inte grity a. Decrea sed card iac o utp ut b. Impa ired gas e xc ha nge c. Activity into lera nc e 3. Psyc hoso c ia l inte grity a. Ine ffec tive ind ivid ua l cop ing b. Anxie ty c. Bod y ima ge d isturba nc e 4. Hea lth pro mo tio n/ma inte na nce a. Impa ired adjustme nt b. Hea lth-seek ing be ha viors c. Nonco mp lia nce Ge nera l Nursing P la nning, Imp le me ntatio n, a nd Eva lua tio n Goa l 1 : C lie nt will ma inta in pate nt a irwa y a nd adeq uate o xy natio n. ge Imp le me nta tio n 1. Monitor resp irato ry status (e. g., vita l signs breath so und s, sk in co lor). 2. Red uce a nxiety. 3. Limit or space activities to decrea se O2 need, 4. Turn freq ue ntly if o n bed rest. 5. Pla ce in Fo wler¶s positio n to increase a ir e xc ha nge. 6. Humid ity a ir 7. Ad minister O2 as need ed. 8. Cough a nd deep-breathe freq ue ntly. 9. Avo id seda tive s tha t depress resp ira tio ns a nd co ugh re fle x (e. g., narcotics). 10. Force fluids to liq ue fy bro nc hia l secretio ns. 11. Suctio n as need ed; pro vide hypero xyge natio n be fore a nd a f r suc tio ning to dec rease c ha nc es te of hypo xia. 12. Carry o ut postura l d ra ina ge to pro mote d ra ina ge o f lung a nd b ro nc hi b y gra vity, if needed. a. Give humid ified a ir o r bro nc hod ilato rs 10-15 minutes be fore. b. Do not lo nger tha n 15 minutes a t o ne time c. Clapp ing or vib rating he lp s loose n secre tio ns d. Avo id c lapp ing or vibra ting o ve r sternum, b reast tissue, be low ribs e. Follow with co ughing to be e ffective; do no t a llow c lie nt to co ugh in head -down positio n Eva lua tio n Clie nt is we ll-o xyge nated (PO2 is greate r tha n 80 mm Hg.)
Goal 2 : C lient¶s card iac work load will be decreased. Imp lementatio n 1. Monitor card io vascular status (e. g., vital signs, p ulse deficit, sk in co lor. 2. Limit activity to decrease O 2 need. 3. Pro mote rest. 4. Ad minister O 2 as need ed. 5. Monitor I&O o f fluid s to detect circulato ry o verload. 6. Give d iuretics as ordered to red uce circulating b lood vo lume (see Tab le 3 -15). 7. Prevent co nstipatio n (e. g., use stoo l so fteners). 8. Red uce anxiety. Evaluatio n Client¶s card iac wo rk load is decreased ; p ulse decreases fro m 100 to 84. Goal 3 : C lient will remain free fro m the hazards o f immob ility. Imp lementatio n 1. Turn freq uently. 2. Deep-breathe and co ugh as needed. 3. Provide passive ROM exercises as needed. 4. Teach client ank le flexio n exercises. 5. Give good back care. 6. App ly antiembo lic hose. 7. Give anticoagulants if o rdered (see Tab le 3-10. Evaluatio n Client remains free fro m thro mbop hleb itis, decub itus ulcers, p ulmo nary co nso lidatio n. SELEC TED HEALTH P ROBLEMS RESULTING IN INTERFERENCE WITH C ARDIAC FUNCTION Card iop ulmo nary Arrest General Info rmatio n 1. 2. Definitio n: sudd en cessatio n o f adeq uate card iac and p ulmo nary functio n Classificatio n: med ical emergency
Nursing Process ASSESSMENT 1. Respo nsiveness a. Tap or gently shake victim. b. Sho ut ³Are yo u OK?´ 2. A-airway ± d etermine airway patency 3. B-breathing a. Determine breathlessness in 3-5 second s
a. Place ear o ver mo uth and nose o f victim and listen fo r air escap ing d uring exhalatio n. b. Look for chest to rise and fall. c. Feel for flo w o f air. C-circulatio n a. Determine p ulselessness in 3-10 seco nds. b. Check caro tid p ulse.
Analysis (See p. 131 ) Planning, Imp lementatio n, and Evaluatio n Goal 1 : Unrespo nsive victim will b e reco gnized pro mptly and receive emergency med ical services (EMS ) interventio n as soo n as possib le. Imp lementatio n 1. Determine unrespo nsiveness q uick ly. 2. If unrespo nsive, activate EMS system immed iately, before beginning CPR; i.e., p ho ne 911 or equivalent emergency number. Evaluatio n Unrespo nsive victim receives EMS interventio n within 10 minutes o f co llapse. Goal 2 : Breathless, unrespo nsive victim will have an pen airway and receive adeq uate ventilatio n. Imp lementatio n 1. Place victim in sup ine positio n o n flat, firm surface. 2. Assume rescuer positio n at victim¶s side. 3. Clear airway o f foreign matter if p resent (finger sweep ). 4. Open airway b y head tilt ± chin lift maneuver (lifts to ngue away fro m back o f throat). 5. Watch for b reathing. 6. If spo ntaneo us breathing is ob vio us, ro ll unrespo nsive victim witho ut cervical trauma o nto his/her side (reco very positio n) and maintain open airway. 7. If no breathing, ventilate mo uth-to- mo uth. 8. Take deep b reath and give two initial slow b reaths o f 1 ½ - 2 seco nds each a. Keep airway open with head tilt-chin lift maneuver b. Pinch no se clo sed with thumb and index finger c. Seal lip s aro und victim¶s lips to create airtight seal. 9. If unab le to ventilate a. Repositio n head b. Ventilate 10. If still unab le to ventilate, use Heimlich¶s maneuver (subd iap hragmatic abdo minal thrust) to clear airway o f fo reign bod y. 11. Watch for b reathing.
1. 2. 3.
Continue mo uth-to-mo uth ventilatio n, if no breathing b ut p ulse is p resent, at rate o f 10 -12 breaths/minute. Take a breath after each ventilatio n. If availab le a. Use barrier devices (e. g., latex glo ves) b. Use ventilatory devices c. Ad minister 100% o xygen.
Evaluatio n Vic tim is adeq uately ventilated; i. e., chest rises with each ventilatio n, air escape is heard and felt d uring exhalatio n. Goal 3 : Breathless, p ulseless, unrespo nsive victim will circulate adeq uately o xygenated b lood. Imp lementatio n 1. Check caro tid p ulse. 2. If caro tid p ulse is absent, b egin external chest co mpressio n after initial two breaths. 3. Place victim in horizo ntal, sup ine positio n o n firm flat surface. 4. Assume rescuer positio n at victim¶s side a. Arms straight, elbo ws lo cked b. Sho ulders d irectly o ver hand and victim¶ sternum 5. Locate lo wer half o f victim¶s sternum. 6. Locate proper hand po sitio n a. Place heel o f o ne hand o n lo wer half o f sternum. b. Place other hand o n top o f hand o n sternum so hands are parallel. c. Have lo ng axis o f hand heel o ver lo ng axis o f sternum. d. Have fingers extended or interlocked, b ut o ff chest. 7. Depress sternum app ro ximately 1 ½ - 2 inches at rate o f 80-100/minute. 8. After each co mpressio n, release p ressure co mp letely witho ut lifting hands fro m chest and allo w chest to return to its normal positio n. 9. One rescuer: give 15 co mp ressio ns / 2 ventilatio ns. 10. Two rescuers: give 5 co mp ressio ns/1 ventilatio n 11. Determine if victim has resumed spo ntaneo us breathing and circulatio n b y reassessing breathlessness and p ulselessness at abo ut the end o f first minute and e very few minutes thereafter. 12. Continue CPR until spo ntaneo us resp iratio ns and p ulse return. 13. If availab le a. Monitor ECG. b. Defib rillate as soo n as possib le for ventricular fibrillatio n. Evaluatio n Victim has caro tid p ulsatio n with each co mp ressio n; maintains systo lic arterial b lood pressure o f 60-80 mm/Hg.
Goal 4: Breathless, pulseless, unresponsive victim will receive appropriate emergency drugs. Implementation 1. Start IV for drug administration. 2. Administer emergency drugs as ordered (see Table 3-7). Evaluation Victim receives appropriate doses of ordered drugs; victim¶s heart resumes normal sinus rhythm. Shock General Information 1. Definition: state in which tissue perfusion is in-adequate to sustain life. 2. Etiological classificat ion a. Hypovolemic (decreased volume) b. Cardiogenic (inadequate pump) c. Vasogenic (pooling due to vasodilation) 1. neurogenic 2. septic 3. anaphylactic 3. Precipitating factors a. Hemorrhage b. GI loss of fluid and electrolytes c. Burns d. Myocardial infarction e. Dysrhythmias f. Spinal cord trauma g. Spinal anesthesia h. Infections, particularly gram- negative bacteria i. Allergic reactions 4. Body¶s response to shock a. Stimulation of the adrenal medulla by the sympathetic nervous system 1. Tachycardia 2. tachypnea 3. vasoconstriction 4. redistrib ution of blood 5. cool, clammy skin; oliguria; decreased bowel sounds b. Stimulation of rennin-angiotyensin-aldosterone system and antidiuretic hormone (ADH) 1. thirst 2. decreased urine volume 3. increased concentration of urine c. Stimulation of cortisol and growth hormone secretion 1. increased glucose metabolism 2. increased fat mobilization
Nursing Process ASSESSMENT 1. 2. 3. 4. Identify high-risk client Vital signs: tachycard ia, tachyp nea; early BP may be normal because o f co mpensatory mechanisms b ut will decrease later Mental status: restless, early increased alertness; as hypo xia occurs, alertness decreases, lethargy and co ma fo llo w Skin changes a. Pale, coo l, clammy sk in (hypo vo lemic and card io genic shock ) b. Flushed, coo l if vasod ilatio n p resent (vaso genic shock ) Fluid status: check sk in turgor, I&O urine specific gravity, central veno us pressure (CVP) a. CVP increased in card io genic shock b. CVP decreased in hypo vo lemic and vaso genic shock
ANALYSIS (S EE P. 131) PLANNING, IMP LEMENTATION, AND EVALUATION Goal 1 : High-risk client will remain free fro m undetected change in cellu lar perfusio n. Imp lementatio n (high risk client) 1. Assess vital signs q4 h, mo re freq uently if unstab le. 2. Measure I&O at least q8 h, q h if unstab le. 3. Note sk in turgor, temperature, and co lor q8 h. 4. Monitor ECG if d ysrhythmias are present. 5. Obtain b lood work as app ropriate (C BC, electro lytes, b lood urea nitro gen (BUN), creatinine, b lood gases). Evaluatio n Client maintains stab le vital signs, fluid balance; has no signs o f impend ing shock. Goal 2 : C lient will have adeq uate perfusio n. Imp lementatio n 1. Monitor b lood pressure (mean sho uld be at least 80), p ulse, and resp iratio n. 2. Note and report d ysrhythmias. 3. Monitor C VP (normal = 4-10 cm H2 O); measure the same way each time. 4. Maintain urine o utp ut o f at least 30 ml/hr and eq ual to intake. 5. Monitor mental status. 6. Monitor GI functio n. 7. Ad minister fluids as ordered : b lood, co llo id fluid s, or electro lyte so lutio ns as necessary (until CVP=6-10 cm H2 O).
Administer drugs only after circulating volume has returned to normal (see Table 3-7). a. Adrenergic, stimulants, (epinephrine, dopamine, dobutamine, norepinephrine (Levophed), isoproterenol (Isuprel) cause increase in contractility and heart rate to increase cardiac output; some may also cause vasoconstriction. 1. administer with a controlled-volume regulator. 2. monitor BP q15min continually. 3. wean off drugs as soon as possible. 4. know that some of these drugs cause severe vasoconstriction and can worsen organ damage (renal, failure, hepatic failure) 5. watch for extravasation of vasopressors (if norepinephrine or dopamine extravasates, infiltrate around area with phentolamine (Regitine). 6. titrate drug infusion to keep BP at a mean of 80, or as ordered. b. Vasolidators (nitroprusside, hydralazine) may be used to decrease cardiac work in cardiogenic shock load c. When using adrenergic stimulants and vasolidators together 1. if BP drops, decrease vasolidator first; then increase adrenergic stimulant. 2. if BP increases, decrease adrenergic stimulant and then increase vasolidator. d. Administer other drugs as ordered (e.h., cardiac glycosides to enhance cardiac contractility); see Table 3-14. Place in modified Trendelenburg¶s position (feet up 450 and head flat).
Evaluation Client¶s BP is maintained at a mean of 80 mm Hg. Goal 3: C lient will have adequate O2 and CO2 levels. Implementation 1. See General Nursing Goals 1 and 2, p. 131. 2. Provide comfort measures (NOTE: If giving pain medications, do not use IM or subcutaneous route since medications may accumulate and not be absorbed; when perfusion improves, client may get overdose). 3. Keep client warm, not hot or cold (heat causes sweating; cold causes shivering). Evaluation Client is well oxygenated (PO2 is greater than 80 mm Hg; no air hunger or cyanosis). Goal 4: C lient will be protected from injury and complications. Implementation 1. Keep bed¶s side rails up; if client I confused, watch carefully and avoid restraints. 2. Apply antiembolic stocking to prevent venous stasis. 3. Turn frequently to prevent decubitus ulcers, pulmonary problems.
Use sterile techniq ue with all proced ures (e. g., changing IVs) since client has decreased resistance to infectio n.
Evaluatio n Client is free fro m preventab le co mp licatio ns (e. g., falls, infectio ns). Ang ina Pectoris General Info rmatio n 1. Definitio n a. Athero sclerosis: fatty p laq ue deposits in the intima o f the artery b. Arteriosclero sis: calcium d eposits in the med ia o f the artery c. Angina pectoris: chest pain caused b y tempo rary ischemia o f the myocard ium; usually caused b y atherosclerosis, arterio sclerosis, thro mb us, or coro nary artery spasm. 2. Coronary artery d isease (C AD) risk facto rs a. Mod ifiab le 1. hypertensio n 2. hyperlip idemia 3. smok ing 4. obesity 5. diabetes 6. stress 7. sedentary life-style b. Nonmod ifiab le 1. age 2. sex: male 3. family history 3. Precip itating factors (immed iate) a. Five ³E´s 1. exercise 2. exertio n: arteries ab le to pro vide b lood to myo card ium at rest, b ut increased d emand o n coronary circulatio n cannot be met temporarily 3. emotio ns: stimulatio n o f sympathetic nervo us system leads to increased demand o n heart 4. eating a heavy meal: increased p erfusio n o f the gastro intestinal tract fo r d igestio n; pressure fro m full sto mach against d iap hragm 5. exposure to co ld b. Smok ing Nursing Process ASSESSMENT 1. Precip itating factor(s) 2. Pain a. Pattern varies with each ind ivid ual, b ut is usually the same fo r a specific pero n b. Usually retrosternal
a. Tends to radiate into neck, jaw, shoulder, and down inner aspect of left arm (see F ig. 3 -6). b. Short duration (1-3 minutes) c. Usually relieved by rest and nitroglycerin EC changes 9if any0 are not permanent
oal 1: C lient will have improved perfusion of the myocardium.
Implementation 1. ive antianginal drugs as ordered (see Table 3-8). 2. Know action and side effects of these drugs. Evaluation Client performs daily activities without pain by spacing activities or by taking a nitroglycerin tablet before bathing, eating, or taking daily walks.
oal 2: C lient will learn methods to prevent attacks.
Implementation 1. Teach client a. To recognize symptoms. b. To take medications and cope with any side effects. c. When to take medications (e.g., before activity) d. To avoid precipitating factors if possible. e. To decrease risk factors (e.g., quit smoking, control hypertension) f. To reduce dietary cholesterol, fat, and saturated fat to prevent further atheroslerosis (see Table 3-12) efine activity level space activities, eliminate those that might precipitate angina (e.g., 2. mowing grass, shoveling snow). Evaluation Client is able to explain correctly medications, dosage, time schedule, side effects, has a balanced schedule of rest and activities.
oal 3: C lient will be able to state what to do if symptoms change.
Implementation 1. Teach client to identify own pain pattern and to recognize change in pain. 2. Instruct client to notify physician of change. Evaluation Client correctly explains ways of dealing with a change in anginal pain.
ANALYSIS (S EE P. 131) PLANNI , IMP LEMEN TATION, AN
Tab le 3-8 Antia ngina l d rugs Name Actio n NITRATES Nitro glyce rin (Nitrostat) Rap id ge ne ra lized vasod ila tio n Oxyge n consumptio n a nd de ma nd onmycard ium are decreased Nitro glyce rin ointme nt (N itroBid) Nitro glyce rin d isc (Tra nsderm-N itro, Nitro-Dur) Slo wly ab sorbed thro ugh sk in; lo ngacting vaso lida tio n
Side Effec ts Pound ing he adac he, flushing, tac hycard ia, dizziness, orthostatis hypote nsio n
Same as nitro glycerin
Erythrityl Lo ng-acting tetra nitrate vaso lida tio n (Card ila te) Isosorb ide d initra te (Isord il, Sorb itrate ) Pentaerythrito l Possib le lo ng-acting tetra nitrate vasod ila tio n (Peritrate) CALCIUM CHANNEL BLOCKERS Nifed ip ine Coronary arte ry (Procard ia) spasm is inhib ited Diltia ze m Oxyge n (Card ia ze m) consumptio n o f Verapa mil (Ca la n) myo card ium is decreased BETA-ADREERGIC BLOCKERS Propra no lo l Heart rate, card iac (Indera l) contrac tility, c ard ia c outp ut, a nd BP are reduced; o xyge n consumptio n o f myo card ium is decreased
Same as nitro glycerin; ca n cause gastric irrita tio n, na use a, vo miting Same as nitro glycerin
Nursing imp licatio ns Usua lly take n sub lingua lly. Take a t pa in o nse t; repeat in 5 min x 2 ; if no pa in re lie f, go to ER. Also take n prophylactica lly befo re pa in o nset. Top ica l; d isc app lied to intact, ha irle ss sk in. Rota te sites. Use derma l pa tc hes intermitte ntly (to le ra nce de ve lops with use). Sub lingua l o r ora l
Take o n e mpty sto mac h
Fatigue, headac he, tra nsie nt hypote nsio n, na use a, co nstipatio n
Fatigue, bradycard ia, postura l hypote nsio n, na use a, vo miting, diarrhea, bronc ho spasm
Heart rate must be 50 or more be fore the drug is ad ministe red.
MYOCARDIAL INFARCTION General Information 1. Definition: occlusion of one or more coronary arteries causing an area of necrosis in the myocardium (infarct); see F igs. 3-7 and 3-8 2. Incidence a. Leading cause of death in the United States b. More common in men; rate in women rises a fter menopause 3. Risk factors 9see coronary artery disease risk factors, p. 135) Nursing Process Assessment 1. Chest pain a. Intense, crushing, substernal b. Not relieved by rest or nitroglycerin 2. ECG changes: S T elevation or depression; T wave inversion; pathological Q waves 3. Series serum enzymes (See Table 3-9) ANALYSIS (S EE P. 131) PLANNING, IMP LEMENTAION, AND EVALUATION Goal 1: C lient¶s chest pain will be controlled. Implementation 1. Gives analgesics (e.g., morphine sulfate IV) until pain is relieved. 2. Administer O 2 (4-6L/min) per nasal cannula. 3. Give sedatives prn to promote rest. Evaluation Client states pain is relieved. Goal 2: C lient¶s coronary blood flow will be increased or reestablished. Implementation 1. Administer thrombolytic drugs as ordered 9see Table 3-10) 2. Monitor cardiac rhythm for reperfusion dysrhythmias. 3. Provide postproceduer care after percutaneous transluminal coronary angioplasty. a. Monitor arterial puncture site. b. Keep head of bed elevated less than 30 0 for 12 hours. c. Monitor pulses distal to puncture site. Evaluation Following angioplasty, client reports decreased chest pain; is free from dysrhythmias.
Imp le me nta tio n 1. See Ge nera l Nursing Goa l 2, p. 13 1. 2. Teac h C lie nt to a vo id Va lsa lva ¶s ma ne uver (increa ses intra thorac ic pressure a nd ca use sudde n te mpo rary increase in work load ) Eva lua tio n Clie nt¶s resting hea rt rate is decreased fro m 88 to 72. Goa l 4 : C lie nt will re ma in free fro m ne w b lood ve sse l oc c lusio ns. Imp le me nta tio ns 1. Ad minister a nticoa gula nts as orde red (see Tab le 3-10) 2. Know ac tio n, side e ffects, a nd a ntidote s o f a nticoa ngula nts. 3. App ly a ntie mbo lic hose. 4. Teac h c lie nt a nk le fle xio n e xerc ises. Eva lua tio n Clie nt¶s co nd itio n re ma ins stab le ; has no signs o f furthe r occ lusio ns. Goa l 5 : C lie nt will re ma in free fro m co mp licatio ns. Imp le me nta tio n 1. Monitor 2. Monitor 3. Monitor 4. Monitor 5. Monitor
Eva lua tio n Clie nt grad ua lly imp ro ves witho ut co mp licatio ns. Goa l 6 : C lie nt a nd significa nt o thers will b e ab le to e xp la in care d uring ac ute a nd reco very p hase, and ca re tha t will fo llow d isc ha rge. Imp le me nta tio n 1. Teac h a. Le ve l o f activity b. Die t 1. ca lories red uced if c lie nts is obese 2. sod ium restric ted (see Tab le 3-11) 3. cho leste ro l, fat, a nd satura ted fa t re stricted (see Tab le 3 -12) 4. potassium inc reased if nece ssary (see Tab le 3_16) c. Med icatio ns
¨ §¦ ¥¤ £ ¢
: li t
a rd iac work load will be decreased
ECG for d ysrhythmias. lab repo rts (e nzymes a nd e lectro lyte s) see Tab les 3-9 a nd 3-39. for sympto ms o f c ard io ge nic shock (see p. 134) for sympto ms o f co ngestive heart fa ilure (see p. 141 ). for sympto ms o f thro mbop hleb itis (see F ig. 3-10)
a. E aluation
1. admi i t ati . schedule 3. side effects Sexual acti it : may resume sexual i tercourse i 6 -8 weeks followi uncomplicated M
Client explains own acti ity; plans menu for a so dium-restricted diet; knows what symptoms to report to physician immediately. SELEC TE HE LTH P FUNCTIONING Congenital Heart Disease LEMS RESULTING IN AN INTERFERENCE WITH CARDIAC
General Information 1. Hemodynamics: related to three principles a. Pressure gradients: blood flows from higher pressure to lower; normally left side of heart is higher pressure. b. Resistance: the higher the resistance the less the flow; normally the systemic circulation has higher resistance than pulmonary circulation, larger vessels have less resistance than smaller, narrow ones c. Quality of pumping action of heart affects the flow 2. Physical consequences of cardiac problems a. Increased work load of the heart (causes changes in systolic and diastolic pressures) b. Pulmonary hypertension (from increased pulmonary resistance) c. Inadequate systemic output from recirculated bleod flow d. Cyanotic defects: no pure oxygenated blood in body, tissue hypoxia and hypoxemia, stimulates erythropoiesis, resulting in polycythemia. 3. Cause: not known e xactly; predisposing factors include a. Certain chromosome disorders (e. g., Down syndrome) b. Maternal and fetal infections (e. g., rubella in first trimester) c. Maternal alcoholism, undernutrition, diabetes, age over 40 years 4. Classification of defects: two different classification system based on: a. Physical characteristic of cyanosis: traditional classification that can be confusing and misleading 1. Acyanotic defects: blood flows from the arterial (left, oxygenated) side of the heart to the venous (right, unoxyge nated) side; left-to-right shunt; there is no mixing of oxygenated and unoxygenated blood in systemic circulation; less se4rious defects 2. Cyanotic defects: those in which unoxygenated blood from the right side of the heart mixes with oxygenated blood on the left side, causing unoxygenated blood to be circulated throughout the body; right-to-left shunt; can result in cyanosis; sever defects
Hemod ynamic characteristics: more descrip tive, p ractical, and freq uently caused classificatio n 1. Increased p ulmo nary b lood flow: defects that allo w left-to-right shunting resulting in increased b lood flow to the lungs and co ngestive heart failure 2. Obstructive defects: those that impede b lood flow o ut o f the ventricle 3. Decreased p ulmo nary b lood flo w: defects that cause right-to- let shunting or impede blood flo w to the lungs. 4. Mixed b lood flo w: o xygenated and uno xygenatd b lood is allowed to mix within the heart or great arteries Specific d efects (See F ig. 5-2) a. atrial sep tal defect (AS D): acyanotic; increased p ulmo nary b lood flo w 1. flow o f b lood is fro m left atrium to right atrium (normal flo w resistance0 2. increased b lood flow to right side o f heart 3. treatment: surgical closure or patch graft o f defect; 99% survival rate b. ventricular septal defect (VSD): acyano tic: increased p ulmo nary b lood flow. 1. mo st co mmo n card iac defect 2. flow o f b lood is fro m left ventricle (higher pressure) to right ventricle where o xygenated blood mixes with veno us b lood 3. may cause right- ventricular hypertrop hy and increased p ulmo nary-vascular resistance 4. 50% close spo ntaneo usly within 1-3 years o f age 5. often asso ciated with o ther card iac defects (tetralo gy o f Fallot, transpositio n o f great vessels, patent d uctus arterio usus (PDA), p ulmo nic steno sis) 6. infants with severe VS D may develop co ngestive heart failure 7. treatment: surgical closure or patch graft o f defect 8. co mp licatio ns include co nd uctio n d isturbances, CHF, o r endocard itis c. patent d uctus arteriosus (P DA): acyanotic; increased p ulmo nary b lood flo w 1. ductus arteriosus (no rmally open in fetus) fails to close: so me b lood is shunted b y higher pressure in aorta to p ulmo nary artery 2. leads to recirculatio n thro ugh lungs and return to left atrium and ventricle; effect is increased work load o n left side o f heart and increased p ulmo nary co ngestio n 3. pulse pressure is wide; left-ventricular hypertrop hy and co ngestive heart failure may develop 4. characteristic machinery- like murmur 5. treatment: surgical ligatio n (clo sed-heart surgery) before 2 eyars o f age; 99% survival rate 6. in very ill newborns, med ical closure o f the d uctus with the pro stagland in inhib itor indo methacin may be tried d. coarctatio n o f the aorta: acyanotic; obstructive 1. a narrowing o f the aorta. 2. blood p ressure is higher in upper extremities 3. bound ing upp er-extremely p ulses, weak or absent femo ral and p op liteal p ulses 4. lo wer extremities may be coo l, pale 5. cramps (claud icatio n) 6. headaches, d izziness, ep istaxis
1. treatment: surgical resection and end-to-end anastomosis within first 2 years of life pulmonic / aortic stenosis: acyanotic; obstructive 1. pulmonic stenosis interferes with flow of blood from right ventricle to pulmonary artery 2. aortic stenosis interferes with blood flow from left ventricle to aorta 3. both pulmonic and aortic stenosis a. may be asymptomatic b. are usually of the valves c. increased resistance can cause right ventricular hypertrophy with pulmonary stenosis, left ventricular hypertrophy with aortic stenosis d. aortic stenosis may result in sudden death after strenuous exercise or activity because of increased sudden oxygen demand and resultant myocardial ischemia 4. treatment: valvotomy or valve replacement b. tetralogy of Fallot: cyanotic; decreased pulmonary blood flow 1. most common cyanotic heart defect in children 2. 4 (tetra) defects a. severe VD b. severe pulmonic stenosis: right-to-let shunting of blood through ventricular septal defect because of pulmonic tenosis and increased pulmonary resistance; result in desaturated blood entering systemic circulation c. right ventricular hypertrophy d. overriding aorta: because the aorta overrides the septal defect, much of the systemic flow is venous and therefore unoxygenated 3. treatment a. palliative surgical correction in infancy to increase pulmonary blood flow (Blalock Taussig anastomosis of right or left subclavian artery and corresponding pulmonary artery) b. corrective surgical repair; closure of VSD (corrects overriding aorta) and pulmonary valvotomy or valve replacement c. transposition of the great vessels: cyanotic; mixed blood flow a.
Fig. 5-2 Normal and abnormal hearts. A, Superior vena cava; b, inferior vena cava; c, right atrium; d, right ventricle; e, pulmonary artery; f, pulmonary vein; g, left atrium; h, left ventricle; and I, aorta. (From N ursing Inservice Aid #2, Congenital Heart Abnormalities Aid. Columbus, OH: Ross Laboratories. Used with permission.)
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.