1301 TETRALOGY FALLOT Congenital Heart Defects

7/30/2019 1301 TETRALOGY FALLOT Congenital Heart Defects

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By the end of this class, students will be able to:

Describe fetal and postnatal circulation

Identify the structural defects of patent ductusarteriosus and tetralogy of fallot

Discuss preparation and post-procedure care ofthe child who is having a cardiac catheterization


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Learning Objectives Continued:

Apply the nursing process in the care of the

child with congenital heart defects

Discuss care of the child who is having openheart surgery

Describe the common complications with

congenital heart defects and the nursing care

that is required


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Post-Natal Circulation


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Pressures and

Oxygen

Saturations ineach Heart

Chamber and

Main Cardiac

Vessels

Where would the blood shunt

to if there was a ventricular

septal defect?

Where would the blood shunt to

if there was an atrial septal

defect?


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Cardiac Catheterization

Purpose of Cardiac Catheterization

Preparation of the Child and Family

Post-procedure Complications and Care


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Uses for Cardiac Catheterization

O2 SatsStructure

Pressure

Repair PDA Intra-arterial

Balloon


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Preparation of the Child and Family for

Cardiac Catheterization

Why is the child NPO?NPO for 4 to 6 hours to

prevent nausea, vomiting, and

aspiration

What premedication is

given prior to this test?

Sedatives are given to

decrease anxiety.


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What Happens During the Cardiac

Catheterization Procedure?

EKG leads are placed

Arm and leg restraints

Temperature probe Cleansing of site with betadine

Small incision and thread catheter

Dye is inserted

X-rays are taken

Catheter is removed and

pressure bandage applied

How do

you

prepare the

child?


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Cardiac Catheterization Complications and Nursing Care

Potential Decreased Cardiac

Output: Cardiac Dysrhythmias

Cardiac

MonitorCheck apical

pulse for

irregularities

Check vital signs

every 15 mins until

stable, then hourly

for four hours


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Potential Altered Tissue Perfusion

Hemorrhage from

siteArterial/venous clot

obstruction

Pressure dressing over site for 24 hours

Keep leg straight & flat for at least 6 hours post-procedure

Monitor weak or absent pulses distal to site

Monitor for decreased blood flow to extremities (cool, pale,

extremity with poor capillary refill)

Monitor for drop in BP

Monitor Hgb & Hct


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Patent Ductus Arteriosus

Locate the defect

Where does blood circulate?

Assessment findings Treatment

Nursing care


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Structural

Defects and

Cardiac

Circulation

with PDA

Where does the

blood shunt to?

Is the shunted

blood

oxygenated or

deoxygenated?

What happens

to the blood

flow in the

aorta?


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Assessment Findingswith PDA

Signs and Symptoms depend on defect size

Signs and Symptoms Include: Dyspnea on exertion

Forceful pulse

Murmur over pulmonary artery


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Low diastolic BP

Feeding difficulties and slow

weight gain

Pale, feeble appearance

Possible heart enlargement

and left sided heart failure

Symptoms of PDA (Cont)


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Treatment and Nursing Care of the Childwith Patent Ductus Arteriosus

May close spontaneously during the first year

Indomethacin Administration

Surgical Repair Prophylactic Antiobiotics

Prevent Congestive Heart Failure


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Tetralogy of Fallot

Structural Defects

Assessment Data

Treatment Nursing Care


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Four

Structural

Defects ofTetralogy of

Fallot

Why is thereright ventricular

hypertrophy?

Which way

does the blood

shunt?


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Assessment Findingswith Tetralogy of Fallot

Symptoms are variable depending of degree of obstruction

Symptoms include:

Cyanosis

Tachycardia

Systolic murmur at left sternal border

Retarded growth and development

Severe dyspnea on exertion


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Assessment Findingswith Tetralogy of Fallot

(cont.. )

Severe dyspnea on exertion

Paroxymal dyspneaBlue spells

Squatting

ClubbingMental retardation


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Treatment of the Child with TOF

Decrease cardiac workload

Prevention of intercurrent infection

Prevention of hemoconcentration

Surgical repair


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Nursing Care of the Child withTetralogy of Fallot

Care During a Hypercyanotic Spell

Decrease Cardiac Workload

Maintain Nutrition Administration of Cardiac Medications

Decrease Respiratory Distress


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Hypercyanotic Spells/Blue Spells/Tet Spells

Clinical Manifestations

Most often occurs in morning

after feedings, defecation, or crying

Acute cyanosis

Hyperpenia

Inconsolable crying

Hypoxia which leads to acidosis


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Place Infant in Knee Chest Position

Administer 100% Oxygen

Administer Morphine

Use a Calm Approach

IV Fluid Replacement for

Blood Volume Expansion


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Consolidate

Care

Provide

Rest Periods

Respond to Crying

Monitor tolerance to feedings

DecreaseCardiac

Workload


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Give small frequent high calorie formulas

Use a large holed nipple

Monitor Cardiac Tolerance

Tachycardia

Tachypnea

Desaturation

Gavage Feedings PRN


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Preparing the Child for

Open Heart Surgery


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Balloon Dilatation

of Pulmonic Valve


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Post-op Care for the Child who had Open Heart Surgery

Airway: Endotrachial tube and ventilatory support

Bleeding: Cardiac Tamponade and Hemorrhage

Circulation: CHF, Decreased Cardiac Output,

Hemolysis (due to heart-lung machine)


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Cardiac

Tamponade

As thepericardium fills

with blood, the

heart has less

room to contract

and move.

Ventricular

fibrillation and

tachycardia occurfollowed by

cardiac arrest.


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Clinical Manifestions of Cardiac Tamponade

Paradoxic pulse pressure

Rising venous pressure

Falling arterial pressure

Narrowing pulse pressure

Increased heart rate

Dyspnea, apprehension, cyanosis


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Nursing Care for Cardiac Tamponade

Call the MD immediately if there are s/s of

cardiac tamponade

Contiue to assess cardiac status

Monitor chest tubes for wound drainage

Prepare patient to return to the OR to stop

bleeding in pericardial sacBe prepared to call a CODE


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Complications and Preventive Nursing Care after Surgery

Atelectasis Infection Pain

Assess

lungs q hr

Incentive

Spirometer

Chest tubeto reinflate

Monitor

temp, WBC,

surgical site

Prophylactic

antibiotics

Steriledressings

Prevent

Endocarditis

Morphine

Oral

analgesics

when tubes

are

removed


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Temperature

ChangesTemperature

Changes

Hypothermia

Tissue

Inflammation

Infection

Renal Failure r/t

Transient Period of

Low Cardiac Output

Monitor I & O

IV fluids andNPO till

extubated

S/S renal failure

Monitor for fluid

retention

Neurologic

Changes

Risk for:

Air Emboli

Decreased

cerebral

blood flow,

cerebral

edema,

damage

L ft CHF/P l C ti


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Left CHF/Pulmonary Congestion


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Documents

1301 TETRALOGY FALLOT Congenital Heart Defects