Cardiovascular Care Changes in Circulation After Birth First breath after birth changes pressures- foramen ovale closes, pressure drops from lungs, w/in 48 hours ductus arteriosis closes o Young GA – it will stay open longer Placenta provides oxygenated blood Ductus venosus – (from placenta to inferior vena cava) closed Ductus arteriosus- (between pulmonary artery and descending aorta) closed o Allows blood going throu pulm Artery to shunt out to aorta – allows more blood to shunt to body & not lungs Foramen ovale – (between atria) closed (allows blood to shunt LA – bypass lungs)
Respiratory or Cardiac problems? Medical Interventions and Complications Medications used with CV disorders IVIg – blood product, gloves, high reactions o Give slowly o Use a lot with kids Autoimmune dz – reboots immune system Digoxin (Lanoxin) o Helps with cardiac output ACE inhibitors o captopril ASA – aspirin (don’t usually give to kids cause can cause reyes syndrome NSAIDs Lasix o Monitor potassium o Hydrochlorothiazide – still watch potassium Spironolactone (Aldactone) o Potassium sparing Antibiotics o Endocarditis – surgery or making scar tissue on heart – higher likelihood of bacteria on tissue o Prophylaxis before dental work Endotropes – epi Indomethacin – closes PDE Ibuprophen – under mo Ø o No NSAIDs under 6mo – kidneys small & aren’t fully developed o Block/Decreases prostaglandin release o Kidneys don’t have natural protection (prostaglandins help vasodilate kidneys during times when BP is going down)
Prostaglandin E – keeps PDE open – give NSAIDS to close Surgical Interventions Closed heart procedures – cardiac cath, mid ax incision Open heart procedures – ECMO needed commonly Staged procedures Prepare child and family for procedures – wait until 5kg to fix heart Systems affected by cardiac surgery: cardiac, pulmonary, neuro, hematologic, infection risk o Best outcome with 2-3 days of support (off vent) in short period of time o Shorter support better the outcome Pre-Cardiac Cath Education – pt and parents Mark peripheral pulses in legs/feet Activity Level after cath o Cant move for 4-6 hours, totally flat! Not ↑ HOB o Sedate for 4-6 hours Dye allergies? Explain to them that the injection of the medicine may make them feel warm Ensure that patient has been NPO o Breast milk is a clear liquid Administer sedative as ordered Interventions – balloons, stents, patches on holes, dx interventions – measure pressures, visualize circulations, look at conduction pathways in heart Post Cardiac Cath Arrhythmias -#1 problem they will have Child will need to remain in bed with affected leg straight for 4-6 hours Check color, temperature and dorsalis pedis and posterior tibialis o Q15min after procedure o Q30 nect 4 hr o Q1hour o ???????
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- Spring '17