congestive cardiac failure

1. 1

2. 2
By the end of this class, students will be able to:By the end of this class, students will be able to:
 Describe fetal and postnatal circulationDescribe fetal and postnatal circulation
 Identify the structural defects of patentIdentify the structural defects of patent
ductus arteriosus and tetralogy of fallotductus arteriosus and tetralogy of fallot
 Discuss preparation and post-procedureDiscuss preparation and post-procedure
care of the child who is having a cardiaccare of the child who is having a cardiac
catheterizationcatheterization

3. 3
Learning Objectives Continued:Learning Objectives Continued:
 Apply the nursing process in the care of theApply the nursing process in the care of the
child with congenital heart defectschild with congenital heart defects
 Discuss care of the child who is having openDiscuss care of the child who is having open
heart surgeryheart surgery
 Describe the common complications withDescribe the common complications with
congenital heart defects and the nursingcongenital heart defects and the nursing
care that is requiredcare that is required

4. 4

5. 5

6. 6
Post-Natal CirculationPost-Natal Circulation


7. 7
Pressures andPressures and
OxygenOxygen
Saturations inSaturations in
each Hearteach Heart
Chamber andChamber and
Main CardiacMain Cardiac
VesselsVessels
Where would the blood shuntWhere would the blood shunt
to if there was a ventricularto if there was a ventricular
septal defect?septal defect?
Where would the blood shunt
to if there was an atrial septal
defect?

8. 8
Cardiac CatheterizationCardiac Catheterization
 Purpose of Cardiac CatheterizationPurpose of Cardiac Catheterization
 Preparation of the Child and FamilyPreparation of the Child and Family
 Post-procedure Complications and CarePost-procedure Complications and Care

9. 9
Uses for Cardiac CatheterizationUses for Cardiac Catheterization
O2 SatsStructureStructure
PressurePressure
Repair PDARepair PDA Intra-arterialIntra-arterial
BalloonBalloon

10. 10

11. 1111
What Happens During the CardiacWhat Happens During the Cardiac
Catheterization Procedure?Catheterization Procedure?
• EKG leads are placedEKG leads are placed
• Arm and legArm and leg
restraintsrestraints
• Temperature probeTemperature probe
• Cleansing of site with betadineCleansing of site with betadine
• Small incision and threadSmall incision and thread
cathetercatheter
• Dye is insertedDye is inserted
• X-rays areX-rays are
takentaken
• Catheter is removed andCatheter is removed and
pressure bandage appliedpressure bandage applied
How doHow do
youyou
prepareprepare
the child?the child?

12. 1212
Cardiac Catheterization Complications andCardiac Catheterization Complications and
Nursing CareNursing Care
Potential Decreased CardiacPotential Decreased Cardiac
Output: Cardiac DysrhythmiasOutput: Cardiac Dysrhythmias
CardiacCardiac
MonitorMonitor
Check apicalCheck apical
pulse forpulse for
irregularitiesirregularities
Check vital signsCheck vital signs
every 15 minsevery 15 mins
until stable, thenuntil stable, then
hourly for fourhourly for four
hourshours

13. 1313
Potential Altered Tissue PerfusionPotential Altered Tissue Perfusion
Hemorrhage fromHemorrhage from
sitesite
Arterial/venous clotArterial/venous clot
obstructionobstruction
Pressure dressing over site for 24 hoursPressure dressing over site for 24 hours
Keep leg straight & flat for at least 6 hours post-procedureKeep leg straight & flat for at least 6 hours post-procedure
Monitor weak or absent pulses distal to siteMonitor weak or absent pulses distal to site
Monitor for decreased blood flow to extremities (cool, pale,Monitor for decreased blood flow to extremities (cool, pale,
extremity with poor capillary refill)extremity with poor capillary refill)
Monitor for drop in BPMonitor for drop in BP
Monitor Hgb & HctMonitor Hgb & Hct

14. 1414

15. 1515
Patent Ductus ArteriosusPatent Ductus Arteriosus
 Locate the defectLocate the defect
 Where does blood circulate?Where does blood circulate?
 Assessment findingsAssessment findings
 TreatmentTreatment
 Nursing careNursing care

16. 1616
StructuralStructural
Defects andDefects and
CardiacCardiac
Circulation withCirculation with
PDAPDA
Where does theWhere does the
blood shunt to?blood shunt to?
Is the shuntedIs the shunted
bloodblood
oxygenated oroxygenated or
deoxygenated?deoxygenated?
What happensWhat happens
to the bloodto the blood
flow in theflow in the
aorta?aorta?

17. 1717
Assessment FindingsAssessment Findings
with PDAwith PDA
 Signs and Symptoms depend on defect sizeSigns and Symptoms depend on defect size
 Signs and Symptoms Include:Signs and Symptoms Include:
 Dyspnea on exertionDyspnea on exertion
 Forceful pulseForceful pulse
 Murmur over pulmonary arteryMurmur over pulmonary artery

18. 1818
Low diastolic BPLow diastolic BP
 Feeding difficulties and slowFeeding difficulties and slow
weight gainweight gain
 Pale, feeble appearancePale, feeble appearance
 Possible heart enlargementPossible heart enlargement
and left sided heart failureand left sided heart failure
Symptoms of PDA (Cont’d)Symptoms of PDA (Cont’d)

19. 1919
Treatment and Nursing Care of the ChildTreatment and Nursing Care of the Child
with Patent Ductus Arteriosuswith Patent Ductus Arteriosus
 May close spontaneously during the first yearMay close spontaneously during the first year
 Indomethacin AdministrationIndomethacin Administration
 Surgical RepairSurgical Repair
 Prophylactic AntiobioticsProphylactic Antiobiotics
 Prevent Congestive Heart FailurePrevent Congestive Heart Failure

20. 2020
Tetralogy of FallotTetralogy of Fallot
 Structural DefectsStructural Defects
 Assessment DataAssessment Data
 TreatmentTreatment
 Nursing CareNursing Care

21. 2121
FourFour
StructuralStructural
Defects ofDefects of
Tetralogy ofTetralogy of
FallotFallot
Why is thereWhy is there
rightright
ventricularventricular
hypertrophy?hypertrophy?
Which wayWhich way
does the blooddoes the blood
shunt?shunt?

22. 2222
Assessment Findings withAssessment Findings with
Tetralogy of FallotTetralogy of Fallot
 Symptoms are variable depending of degree ofSymptoms are variable depending of degree of
obstructionobstruction
 Symptoms include:Symptoms include:
CyanosisCyanosis
TachycardiaTachycardia
Systolic murmur at left sternal borderSystolic murmur at left sternal border
Retarded growth and developmentRetarded growth and development
Severe dyspnea on exertionSevere dyspnea on exertion

23. 2323
Assessment Findings with TetralogyAssessment Findings with Tetralogy
of Fallot (cont.. )of Fallot (cont.. )
Severe dyspnea on exertionSevere dyspnea on exertion
Paroxymal dyspneaParoxymal dyspnea
Blue spellsBlue spells
SquattingSquatting
ClubbingClubbing
Mental retardationMental retardation

24. 2424
Treatment of the Child with TOFTreatment of the Child with TOF
 Decrease cardiac workloadDecrease cardiac workload
 Prevention of intercurrent infectionPrevention of intercurrent infection
 Prevention of hemoconcentrationPrevention of hemoconcentration
 Surgical repairSurgical repair

25. 2525
Nursing Care of the Child withNursing Care of the Child with
Tetralogy of FallotTetralogy of Fallot
 Care During a Hypercyanotic SpellCare During a Hypercyanotic Spell
 Decrease Cardiac WorkloadDecrease Cardiac Workload
 Maintain NutritionMaintain Nutrition
 Administration of Cardiac MedicationsAdministration of Cardiac Medications
 Decrease Respiratory DistressDecrease Respiratory Distress

26. 26

27. 2727
Hypercyanotic Spells/Blue Spells/Tet SpellsHypercyanotic Spells/Blue Spells/Tet Spells
Clinical ManifestationsClinical Manifestations
‫٭‬‫٭‬ Most often occurs in morningMost often occurs in morning
after feedings, defecation, or cryingafter feedings, defecation, or crying
‫٭‬‫٭‬ Acute cyanosisAcute cyanosis
‫٭‬‫٭‬ HyperpeniaHyperpenia
‫٭‬‫٭‬ Inconsolable cryingInconsolable crying
‫٭‬‫٭‬ Hypoxia which leads to acidosisHypoxia which leads to acidosis

28. 28
Place Infant in Knee Chest Position
Administer 100% Oxygen
Administer Morphine
Use a Calm Approach
IV Fluid Replacement for
Blood Volume Expansion

29. 2929
ConsolidateConsolidate
CareCare
ProvideProvide
RestRest
PeriodsPeriods
Respond to CryingRespond to Crying
Monitor tolerance toMonitor tolerance to
feedingsfeedings
DecreaseDecrease
CardiacCardiac
WorkloadWorkload

30. 3030
Give small frequent high calorieGive small frequent high calorie
formulasformulas
Use a large holed nippleUse a large holed nipple
Monitor Cardiac ToleranceMonitor Cardiac Tolerance
• TachycardiaTachycardia
• TachypneaTachypnea
• DesaturationDesaturation
Gavage FeedingsGavage Feedings
PRNPRN

31. 3131
Preparing the Child forPreparing the Child for
Open Heart SurgeryOpen Heart Surgery

32. 3232
Balloon DilatationBalloon Dilatation
of Pulmonic Valveof Pulmonic Valve

33. 3333
Post-op Care for the Child who had Open HeartPost-op Care for the Child who had Open Heart
SurgerySurgery
Airway: Endotrachial tube and ventilatoryAirway: Endotrachial tube and ventilatory
supportsupport
Bleeding: Cardiac Tamponade and HemorrhageBleeding: Cardiac Tamponade and Hemorrhage
Circulation: CHF, Decreased Cardiac Output,Circulation: CHF, Decreased Cardiac Output,
Hemolysis (due to heart-lung machine)Hemolysis (due to heart-lung machine)

34. 3434
CardiacCardiac
TamponadeTamponade
As theAs the
pericardium fillspericardium fills
with blood, thewith blood, the
heart has lessheart has less
room toroom to
contract andcontract and
move.move.
VentricularVentricular
fibrillation andfibrillation and
tachycardiatachycardia
occur followedoccur followed
by cardiacby cardiac
arrest.arrest.

35. 35

36. 36

37. 3737

38. 38

39. 39

40. 40

41. 41

42. 42

43. 43

44. 44

45. 45

46. 46

47. 4747
Clinical Manifestions of CardiacClinical Manifestions of Cardiac
TamponadeTamponade
 Paradoxic pulse pressureParadoxic pulse pressure
 Rising venous pressureRising venous pressure
 Falling arterial pressureFalling arterial pressure
 Narrowing pulse pressureNarrowing pulse pressure
 Increased heart rateIncreased heart rate
 Dyspnea, apprehension, cyanosisDyspnea, apprehension, cyanosis

48. 4848
Nursing Care for Cardiac TamponadeNursing Care for Cardiac Tamponade
Call the MD immediately if there are s/s of cardiacCall the MD immediately if there are s/s of cardiac
tamponadetamponade
Contiue to assess cardiac statusContiue to assess cardiac status
Monitor chest tubes for wound drainageMonitor chest tubes for wound drainage
Prepare patient to return to the OR to stop bleeding inPrepare patient to return to the OR to stop bleeding in
pericardial sacpericardial sac
Be prepared to call a CODEBe prepared to call a CODE

49. 4949
Complications and Preventive Nursing Care after SurgeryComplications and Preventive Nursing Care after Surgery
AtelectasisAtelectasis InfectionInfection PainPain
AssessAssess
lungs q hrlungs q hr
IncentiveIncentive
SpirometerSpirometer
Chest tubeChest tube
to reinflateto reinflate
MonitorMonitor
temp, WBC,temp, WBC,
surgical sitesurgical site
ProphylactiProphylacti
c antibioticsc antibiotics
SterileSterile
dressingsdressings
PreventPrevent
EndocarditiEndocarditi
ss
MorphineMorphine
OralOral
analgesicsanalgesics
whenwhen
tubes aretubes are
removedremoved

50. 5050
TemperatureTemperature
ChangesChanges
HypothermiaHypothermia
TissueTissue
InflammationInflammation
InfectionInfection
Renal Failure r/tRenal Failure r/t
Transient Period ofTransient Period of
Low Cardiac OutputLow Cardiac Output
Monitor I & OMonitor I & O
IV fluids andIV fluids and
NPO tillNPO till
extubatedextubated
S/S renalS/S renal
failurefailure
Monitor forMonitor for
fluid retentionfluid retention
NeurologicNeurologic
ChangesChanges
Risk for:Risk for:
Air EmboliAir Emboli
DecreasedDecreased
cerebralcerebral
blood flow,blood flow,
cerebralcerebral
edema,edema,
damagedamage

51. 5151
Left CHF/PulmonaryLeft CHF/Pulmonary
CongestionCongestion

52. 52