CARDIACDISORDERS

CARDIACDISORDERS - CARDIAC DISORDERS Edgar Garcia, MSN,...

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CARDIAC DISORDERS Edgar Garcia, MSN, ARNP
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Circulatory Changes at Birth When the umbilical cord is clamped, the blood supply from the placenta is cut off, and oxygenation must then take place in the infant’s lungs As the lungs expand with air, the pulmonary artery pressure decreases and circulation to the lungs increases
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Circulatory Changes at Birth Structural Changes Ductus venosus: after the umbilical cord is severed, flow through the ductus venosus decreases and eventually ceases; it constricts within 3-7 days
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Foramen ovale Functional closure of this valve-like opening occurs when pressure in the left atrium exceeds pressure in the right. Closure occurs within the first weeks after birth
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Ductus arteriosus Increase in aortic blood flow increases aortic pressure and decreases right-to left-shunt through the ductus arteriosus. Functional closure occurs when this constriction causes cessation of blood flow, usually 24 hours after birth. Anatomic closure by 1-3 weeks.
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Abnormal Circulatory Patterns After Birth Normal blood flow may be disrupted as a result of abnormal openings between the pulmonary and systemic circulations. Any time there is a defect, blood will go from high to low pressure.
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Shunting Normally pressure is higher in the systemic circulation, so blood will be shunted from systemic to pulmonary Left to right shunt With an obstruction to pulmonary blood flow, as well as an opening between ventricles, the blood flow may be right to left
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Symptoms Feeding problems: fatigue, irritability, tachypnea, profuse sweating, reflux Failure to thrive, poor weight gain Respiratory difficulties: tachypnea, difficulty breathing, frequent respiratory infections, periods of anoxia, nasal flaring, retractions
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Symptoms Activity intolerance: restlessness, lethargy Color changes: pallor, cyanosis, clubbing of digits Hematologic: polycythemia Organ enlargement: liver, spleen, heart
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Figure 43-6 Clubbing Clubbing of the fingers is one manifestation of a cyanotic defect in an older child. London / Ladewig / Ball / Bindler Maternal-Newborn and Child Nursing: Family-Centered Care
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Diagnostics Chest x-ray Cardiac fluoroscopy Echocardiogram Electrocardiogram Hematologic testing Cardiac catheterization
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Cardiac Catheterization Catheter threaded into right side of the heart since septal defects permit entry into the left side. Nursing care – pretest Preparation teaching done on child’s developmental level Administer medications as ordered
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Cardiac Catheterization Nursing care – posttest Check extremity distal to catheterization site for color, temperature, capillary refill Keep extremity distal to the catheterization site extended Check pressure dressing over site for bleeding Monitor heart rate for bradycardia, tachycardia and dysrhythmia
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CARDIACDISORDERS - CARDIAC DISORDERS Edgar Garcia, MSN,...

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