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ALTERATIONS OF CARDIAC FUNCTION CONGENITAL HEART DEFECTS VALVULAR PROBLEMS ENDOCARDITIS ABDOMINAL AORTIC ANEURYSM 2009 CONGENITAL HEART DEFECTS VALVULAR.

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Presentation on theme: "ALTERATIONS OF CARDIAC FUNCTION CONGENITAL HEART DEFECTS VALVULAR PROBLEMS ENDOCARDITIS ABDOMINAL AORTIC ANEURYSM 2009 CONGENITAL HEART DEFECTS VALVULAR."— Presentation transcript:

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2 ALTERATIONS OF CARDIAC FUNCTION CONGENITAL HEART DEFECTS VALVULAR PROBLEMS ENDOCARDITIS ABDOMINAL AORTIC ANEURYSM 2009 CONGENITAL HEART DEFECTS VALVULAR PROBLEMS ENDOCARDITIS ABDOMINAL AORTIC ANEURYSM 2009

3 Transition from fetal to pulmonary circulation RHow does the circulation during fetal life differ from that of the neonate? RWhat leads to this transition? RHow do the changes of pressures and resistance within the heart effect the foramen ovale, ductus venosus, and ductus arteriosus? RHow does the circulation during fetal life differ from that of the neonate? RWhat leads to this transition? RHow do the changes of pressures and resistance within the heart effect the foramen ovale, ductus venosus, and ductus arteriosus?

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5 Differences for the child in cardiovascular functioning RWhy is the child at greater risk of CHF? RWhy does the child’s heart beat faster? RWhat are the Hct, Hgb and pulse ox concentrations appropriate for age needed for adequate oxygen transport RWhat does cyanosis indicate? hypoxemia What is polycythemia? RWhat labs indicate Polycythemia: RWhat is the danger of Severe Hypoxemia? RWhy is the child at greater risk of CHF? RWhy does the child’s heart beat faster? RWhat are the Hct, Hgb and pulse ox concentrations appropriate for age needed for adequate oxygen transport RWhat does cyanosis indicate? hypoxemia What is polycythemia? RWhat labs indicate Polycythemia: RWhat is the danger of Severe Hypoxemia?

6 BASIC PHYSIOLOGY RWHAT IS THE HEART: RWHAT IS CARDIAC OUTPUT? RHow is cardiac output determined? RWHAT IS STROKE VOLUME? RWHAT IS THE HEART: RWHAT IS CARDIAC OUTPUT? RHow is cardiac output determined? RWHAT IS STROKE VOLUME?

7 PHYSIOLOGY CONTINUED RWHAT 3 things influence STROKE VOLUME? 1.Define Preload: 2.Define Afterload: 1.Define Contractility: RWHAT 3 things influence STROKE VOLUME? 1.Define Preload: 2.Define Afterload: 1.Define Contractility:

8 WHAT KIND OF TESTING IS DONE TO DIAGNOSE? RCardiac Catherization RWhat is used during the test? RWhere are the catheters placed? RWhat measurements are taken? RWhat is visualized? RWhat is used during the test? RWhere are the catheters placed? RWhat measurements are taken? RWhat is visualized?

9 PREOP NURSING CARE CARDIAC CATHERIZATION RWHY NEED Accurate hgt and wgt RWHY IS History of allergies to iodine important? RWHAT HAPPENS IF THE CHILD HAS Severe diaper rash RWHY Mark pulses: dorsalis pedis, posterior tibial RWHY Baseline pulse ox RWHY NEED Accurate hgt and wgt RWHY IS History of allergies to iodine important? RWHAT HAPPENS IF THE CHILD HAS Severe diaper rash RWHY Mark pulses: dorsalis pedis, posterior tibial RWHY Baseline pulse ox

10 PREOP CARDIAC CATH RHOW TO Prepare child: schoolage/adolescent RPreop receive what drugs? RWHAT DIET PREOP AND WHY? RHOW TO Prepare child: schoolage/adolescent RPreop receive what drugs? RWHAT DIET PREOP AND WHY?

11 POSTOP NURSING CARE CARDIAC CATHERIZATION RWhat would you expect to find when assessing the pulses? RWhat is normal and what is abnormal? R RWhat rhythm and rate change would you expect? RWhat would you expect to find when assessing the pulses? RWhat is normal and what is abnormal? R RWhat rhythm and rate change would you expect?

12 POSTOP NURSING CARE CARDIAC CATHERIZATION RWHY CHECK BP RWHY Check dressing RWhat assessment would you need to do regarding hydration and why? RWhat do you do with the effected? RHow do you adapt care to a toddler? RWhat do you do to prevent bleeding? RWHY CHECK BP RWHY Check dressing RWhat assessment would you need to do regarding hydration and why? RWhat do you do with the effected? RHow do you adapt care to a toddler? RWhat do you do to prevent bleeding?

13 POSTOP HOME CARE CARDIAC CATH RPressure dressing INSTRUCTIONS RWhat is done to Cover site? RBathing instructions? RWhat observations are made for complications? RWhat activity instructions? RWhat is used for pain? RPressure dressing INSTRUCTIONS RWhat is done to Cover site? RBathing instructions? RWhat observations are made for complications? RWhat activity instructions? RWhat is used for pain?

14 POSTOP CARDIAC CATH SITUATION RTommy, a 4 year old with Tetralogy of Fallot returns from catherization laboratory. He has vomited, his mother calls you to the bedside to tell you that he is bleeding. You arrive to find Tommy crying and sitting up in a puddle of blood. The first thing you do is:

15 ANSWERS TO POSTOP CATH SITUATION R1. Increase the rate of his IV fluids R2. Give an antiemetic and keep Tommy NPO R3. Call the cardiologist R4. Lie Tommy down, remove the dressing and apply direct pressure above the catherization site R1. Increase the rate of his IV fluids R2. Give an antiemetic and keep Tommy NPO R3. Call the cardiologist R4. Lie Tommy down, remove the dressing and apply direct pressure above the catherization site

16 ANSWERS TO SITUATION

17 GENERAL S & S of CHD in INFANTS AND CHILDREN RINFANTS: RDyspnea RDifficulty feeding RStridor, choking spells RPulse rate over 200 RFTT RHeart murmurs RFrequent URI’s RAnoxic attacks RCVA RINFANTS: RDyspnea RDifficulty feeding RStridor, choking spells RPulse rate over 200 RFTT RHeart murmurs RFrequent URI’s RAnoxic attacks RCVA RCHILDREN: RExercise intolerance RIncreased BP RPoor physical development RHeart murmurs RCyanosis RRecurrent URI RClubbing fingers/toes Rsquatting RCHILDREN: RExercise intolerance RIncreased BP RPoor physical development RHeart murmurs RCyanosis RRecurrent URI RClubbing fingers/toes Rsquatting

18 CLASSIFICATION OF CHD RBased on how the blood flows: obstructed, delayed, abnormally shunted: 1.Blood flow can be obstructed or delayed which CHD (what anomalies are examples?) 2.If Blood is abnormally shunted from one side of the heart to the other eg: what happens to pulmonary blood flow with a left to right shunt? eg: right to left shunt What kind of blood is abnormally shunted? What happens to the lungs RBased on how the blood flows: obstructed, delayed, abnormally shunted: 1.Blood flow can be obstructed or delayed which CHD (what anomalies are examples?) 2.If Blood is abnormally shunted from one side of the heart to the other eg: what happens to pulmonary blood flow with a left to right shunt? eg: right to left shunt What kind of blood is abnormally shunted? What happens to the lungs

19 REMEMBER THIS ABOUT SHUNTS! RHow does Blood flows occur in the heart? RWhat can you say about the pressure on the RIGHT SIDE of the heart as compared to the pressure on the LEFT SIDE of the heart? RHow does Blood flows occur in the heart? RWhat can you say about the pressure on the RIGHT SIDE of the heart as compared to the pressure on the LEFT SIDE of the heart?

20 SECONDARY CLASSIFICATION OF CHD RDefine happens with ACYANOTIC DEFECTS? RGive examples of Acyanotic defects? RDefine what happens with CYANOTIC DEFECTS: RGive examples of Cyanotic defects? RWhat kind of shunt occurs? RDefine happens with ACYANOTIC DEFECTS? RGive examples of Acyanotic defects? RDefine what happens with CYANOTIC DEFECTS: RGive examples of Cyanotic defects? RWhat kind of shunt occurs?

21 OBSTRUCTIVE DEFECTS RExplain what happens to blood flow with an anatomic narrowing (stenosis)? RExplain what happens to the Pressure in the ventricle and in the great artery before the obstruction? RWhere is the the most common Location of narrowing? RGive some EXAMPLES of obstructive defects: RExplain what happens to blood flow with an anatomic narrowing (stenosis)? RExplain what happens to the Pressure in the ventricle and in the great artery before the obstruction? RWhere is the the most common Location of narrowing? RGive some EXAMPLES of obstructive defects:

22 COARCTATION OF AORTA RWhere is the narrowing located? RWhere is the increased pressure and what does it cause? RWhere is decreased pressure and what does it cause? RWhere is the narrowing located? RWhere is the increased pressure and what does it cause? RWhere is decreased pressure and what does it cause?

23 RESULTS OF COARCTATION RBecause of the large volume of blood going to the head the child may experience what? RWhat is common in infants? RBecause of the large volume of blood going to the head the child may experience what? RWhat is common in infants?

24 TREATMENT OF COARCTATION OF AORTA Surgical treatment: Involves what correction? zWhat if the narrowed area is large, what might the surgeon have to do? zIs this open or closed heart surgery? zWhat is the common age of this surgery? Surgical treatment: Involves what correction? zWhat if the narrowed area is large, what might the surgeon have to do? zIs this open or closed heart surgery? zWhat is the common age of this surgery?

25 TREATMENT OF COARCTATION OF AORTA RWhat is the Nonsurgical treatment called? RIs this method performed everywhere? RWhat is the Nonsurgical treatment called? RIs this method performed everywhere?

26 POSTOP COARCTATION SYNDROME RPostop pts develop abdominal pain for what reason? RSURVIVAL POSTOP: 95% RPostop pts develop abdominal pain for what reason? RSURVIVAL POSTOP: 95%

27 PULMONIC STENOSIS RStenosis means what and where? RRV hypertrophy occurs as a result of what RWhat happens to the volume of blood flow to the lungs? RS&S: RStenosis means what and where? RRV hypertrophy occurs as a result of what RWhat happens to the volume of blood flow to the lungs? RS&S:

28 TX OF PULMONIC STENOSIS RSURGICAL TX: 1.Infants: closed heart surgery transventricular valvotomy 2.Children: open heart surgery pulmonary valvotomy RNONSURGICAL TX: balloon angioplasty in cardiac cath lab to dilate valve (TREATMENT OF CHOICE) RSURVIVAL RATE BOTH PROCEDURES: 98% RSURGICAL TX: 1.Infants: closed heart surgery transventricular valvotomy 2.Children: open heart surgery pulmonary valvotomy RNONSURGICAL TX: balloon angioplasty in cardiac cath lab to dilate valve (TREATMENT OF CHOICE) RSURVIVAL RATE BOTH PROCEDURES: 98%

29 NEXT GROUP OF CHD: INCREASED PULMONARY BLOOD FLOW RHow would you describe the blood flow in relationship to the pressures in this type of defect? RWhat happens to blood volume and where? RWITH THIS TYPE WHAT COMMONALITY WOULD YOU SEE IN TERMS OF S&S? RWHAT TYPE OF DEFECTS: RHow would you describe the blood flow in relationship to the pressures in this type of defect? RWhat happens to blood volume and where? RWITH THIS TYPE WHAT COMMONALITY WOULD YOU SEE IN TERMS OF S&S? RWHAT TYPE OF DEFECTS:

30 ATRIAL SEPTAL DEFECT RWHERE IS THE Abnormal opening? RWHERE DOES THE Blood FLOW from & to? RWhat enlarges? RWHERE IS THE Abnormal opening? RWHERE DOES THE Blood FLOW from & to? RWhat enlarges?

31 ATRIAL SEPTAL DEFECT RS&S: RSurgical correction: R99% survival rate postop RS&S: RSurgical correction: R99% survival rate postop

32 VENTRICULAR SEPTAL DEFECT (VSD) RAbnormal opening between? RWhat can happen at birth? RDescribe the effects of the shunt? And where the blood flows? RS&S: RComplications? RCorrective Surgery: RAbnormal opening between? RWhat can happen at birth? RDescribe the effects of the shunt? And where the blood flows? RS&S: RComplications? RCorrective Surgery:

33 PATENT DUCTUS ARTERIOSUS RFailure of what to close at birth? RHow does Blood flow? Rcausing what kind of shunt? RFailure of what to close at birth? RHow does Blood flow? Rcausing what kind of shunt?

34 Patent Ductus Arteriosus RS&S: RWhat complications? RWhat long term effects? RWhat changes in heart muscle? RS&S: RWhat complications? RWhat long term effects? RWhat changes in heart muscle?

35 PDA CONTINUED RWhat might be administered by the nurse to newborns/premies to close the shunt? RWhat Surgical Tx is used to correct problem? RSurvival Rate postop: 99% RWhat might be administered by the nurse to newborns/premies to close the shunt? RWhat Surgical Tx is used to correct problem? RSurvival Rate postop: 99%

36 NEXT GROUP OF CHD: DECREASED PULMONARY BLOOD FLOW RObstruction of pulmonary blood flow caused by what type of anatomical defect? RHow does the defect cause problems with blood flow? RWhat effect does it have on desaturated blood? RWhere does the desaturated blood flow go? RObstruction of pulmonary blood flow caused by what type of anatomical defect? RHow does the defect cause problems with blood flow? RWhat effect does it have on desaturated blood? RWhere does the desaturated blood flow go?

37 TETRALOGY OF FALLOT RFOUR DEFECTS IDENTIFIED 1. 2. 3. 4. RFOUR DEFECTS IDENTIFIED 1. 2. 3. 4.

38 TETRALOGY OF FALLOT RFOUR DEFECTS

39 SHUNTS IN TETRALOGY OF FALLOT VARY RIf pulmonary vascular resistance is higher than systemic resistance WHICH DIRECTION IS THE SHUNT? RIf systemic resistance is higher than pulmonary vascular resistance WHICH DIRECTION IS THE SHUNT? RIf pulmonary vascular resistance is higher than systemic resistance WHICH DIRECTION IS THE SHUNT? RIf systemic resistance is higher than pulmonary vascular resistance WHICH DIRECTION IS THE SHUNT?

40 S&S OF TOF IN INFANTS RASSESSMENT OF INFANTS WITH TOF? RWHAT IS A BLUE SPELL, HYPERCYANOTIC SPELL OR TET SPELL: RWHAT NORMAL INFANT SITUATIONS LEAD TO A SPELL? RCAUSE of TET SPELL? RWHAT IMPACT DOES THIS SPELL HAVE ON PULMONARY BLOOD FLOW? RHOW DOES IT EFFECT THE SHUNTING? RASSESSMENT OF INFANTS WITH TOF? RWHAT IS A BLUE SPELL, HYPERCYANOTIC SPELL OR TET SPELL: RWHAT NORMAL INFANT SITUATIONS LEAD TO A SPELL? RCAUSE of TET SPELL? RWHAT IMPACT DOES THIS SPELL HAVE ON PULMONARY BLOOD FLOW? RHOW DOES IT EFFECT THE SHUNTING?

41 TET SPELLS RISKS 1. 2. 3. 4. 1. 2. 3. 4.

42 TREATING TET SPELLS OR HYPERCYANOTIC SPELLS RWHAT position helps the infant? RWhat approach needs to be used by caregiver? RWhat treatment needs to be instituted immediately? RWhat drug is given and why? RWhy does the infant need IV fluid replacement and volume expanders? RWhat can be repeated if needed? RWHAT position helps the infant? RWhat approach needs to be used by caregiver? RWhat treatment needs to be instituted immediately? RWhat drug is given and why? RWhy does the infant need IV fluid replacement and volume expanders? RWhat can be repeated if needed?

43 S&S OF TOF IN CHILDREN RWith long term cyanosis what develops in the fingers RWhat position do children assume when in Tet spell? RHow does TOF effect growth? RWhat life threatening risks of TOF in children? RWith long term cyanosis what develops in the fingers RWhat position do children assume when in Tet spell? RHow does TOF effect growth? RWhat life threatening risks of TOF in children?

44 SURGICAL TX OF TOF RPALLIATIVE: RCOMPLETE REPAIR: RPostop risks? RSURVIVAL: 95% RPALLIATIVE: RCOMPLETE REPAIR: RPostop risks? RSURVIVAL: 95%

45 TRICUSPID ATRESIA RWhat fails to develop? RWhat does this failure prevent between RA and RV? RBlood flows through another defect where? RWhen would the child die with this defect? RWhat keeps the child alive? RWhat fails to develop? RWhat does this failure prevent between RA and RV? RBlood flows through another defect where? RWhen would the child die with this defect? RWhat keeps the child alive?

46 TRICUSPID ATRESIA RS&S: RPalliative surgery: RCorrective surgery: RSurvival: 80-90%; many postop complications RS&S: RPalliative surgery: RCorrective surgery: RSurvival: 80-90%; many postop complications

47 MIXED DEFECT EXAMPLES RTRANSPOSITION OF THE GREAT VESSELS (TGV) OR TRANSPOSITION OF THE GREAT ARTERIES (TGA) RTRUNCUS ARTERIOSUS (TA) RTRANSPOSITION OF THE GREAT VESSELS (TGV) OR TRANSPOSITION OF THE GREAT ARTERIES (TGA) RTRUNCUS ARTERIOSUS (TA)

48 TRANSPOSITION OF THE GREAT VESSELS RPA leaves the LV taking what blood back to the lungs RAorta exits from where? RNo communication between what? RWhat other defect allows child to live at birth? RPA leaves the LV taking what blood back to the lungs RAorta exits from where? RNo communication between what? RWhat other defect allows child to live at birth?

49 TRANSPOSITION OF THE GREAT VESSELS RWhat assessment and complications seen at birth? RSurgical Tx: RSurvival: 80% RWhat assessment and complications seen at birth? RSurgical Tx: RSurvival: 80%

50 TRUNCUS ARTERIOSUS RWhat does this look like? RWhat other defects? RS&S RSurgical repair: RSurvival of surgery: 80%. Other surgeries required RWhat does this look like? RWhat other defects? RS&S RSurgical repair: RSurvival of surgery: 80%. Other surgeries required

51 CONGESTIVE HEART FAILURE IN CHILDREN RWhat happens to the heart? RIs it able to meet the body’s demands? RWhat situations would lead to CHF? RWhat happens to the heart? RIs it able to meet the body’s demands? RWhat situations would lead to CHF?

52 SUBTLE S & S OF CHF in CHILDREN RHow does it effect feeding? RHow does it effect energy? RWhat happens during feeding? RHow does it effect feeding? RHow does it effect energy? RWhat happens during feeding?

53 CONGESTIVE HEART FAILURE IN CHILDREN RImpaired myocardial function RHow does it effect ? RImpaired myocardial function RHow does it effect ? RVS? REnergy? Rappetite RTemperature of skin? RHeart muscle? RUrinary elimination? RVS? REnergy? Rappetite RTemperature of skin? RHeart muscle? RUrinary elimination?

54 CHF IN CHILDREN RSystemic venous congestion RHow does it effect? RSystemic venous congestion RHow does it effect? RWeight? RLiver? RFluid accumulation? RNeck vein? RRespiratory assessment? RWeight? RLiver? RFluid accumulation? RNeck vein? RRespiratory assessment?

55 THERAPEUTIC MANAGEMENT GOALS RImprove cardiac function by? RRemove accumulated fluid and sodium leading to what effect on the heart? RWhat on cardiac demands? RWhat effect on oxygenation? RImprove cardiac function by? RRemove accumulated fluid and sodium leading to what effect on the heart? RWhat on cardiac demands? RWhat effect on oxygenation?

56 IMPROVE CARDIAC FUNCTION RDigitalis RWhich class of drug? RUsed to? RDigitalis RWhich class of drug? RUsed to?

57 MAJOR ACTIONS OF DIGITALIS Rpositive inotropic: means what? Rnegative chronotropic: means what? Rnegative dromotropic: means what? RIndirectly enhances what? Rpositive inotropic: means what? Rnegative chronotropic: means what? Rnegative dromotropic: means what? RIndirectly enhances what?

58 DIGOXIN (Lanoxin) IN PEDS RElixir (50 ug/ml) po RIV (O.1mg/ml) RDose calculated in micrograms (1000 ug=1mg RGive Digitalizing dose to bring serum dig level into therapeutic range RMaintenance dose = 1/8 of digitalizing dose RElixir (50 ug/ml) po RIV (O.1mg/ml) RDose calculated in micrograms (1000 ug=1mg RGive Digitalizing dose to bring serum dig level into therapeutic range RMaintenance dose = 1/8 of digitalizing dose

59 THERAPEUTIC SERUM DIGOXIN RANGE RRange from 0.8 to 2 ug/l

60 Digoxin administration guide RApical pulse checked RDrug not given if pulse below 90- 110/min in infants and young children or below 70/min in older children RDo one full minute RApical pulse checked RDrug not given if pulse below 90- 110/min in infants and young children or below 70/min in older children RDo one full minute

61 DIGOXIN Toxicity: REffect on heart rate? REffect on appetite and feeding? REffect on heart rate? REffect on appetite and feeding?

62 MEDS CONTINUED RAngiotensin converting enzyme inhibitors (ACE): Vasotec, Capoten RUsed to RAngiotensin converting enzyme inhibitors (ACE): Vasotec, Capoten RUsed to

63 OTHER MEDICATIONS RFor severe CHF, other IV inotropic drugs used in the ICU: 1.Dopamine 2.Dobutamine 3.Amrinone Used to RFor severe CHF, other IV inotropic drugs used in the ICU: 1.Dopamine 2.Dobutamine 3.Amrinone Used to

64 GOALS OF TREATMENT CONTINUED RRemove accumulated fluid and sodium with which group of drugs? RGive examples? RCAUTION: RRemove accumulated fluid and sodium with which group of drugs? RGive examples? RCAUTION:

65 GOALS OF TREATMENT CONTINUED: RDecrease cardiac demands: RGIVE EXAMPLES OF NURSING ACTIONS: RDecrease cardiac demands: RGIVE EXAMPLES OF NURSING ACTIONS:

66 GOALS OF TREATMENT CONTINUTED: RImprove tissue oxygenation NURSING ACTIONS: RImprove tissue oxygenation NURSING ACTIONS:

67 NRSG DX FOR ACYANOTIC HEART DEFECTS

68 NRSG DX FOR CYANOTIC HEART DEFECTS

69 NURSING CARE IN ICU POST-OP CARDIAC SURGERY RWhat is done to keep child calm? RHow is the infant’s temp regulated RHow often VS? RHow is the heart monitored? RWhat measures Cardiac output? RWhy does the child have Pacemaker leads in place? RWhat is done to keep child calm? RHow is the infant’s temp regulated RHow often VS? RHow is the heart monitored? RWhat measures Cardiac output? RWhy does the child have Pacemaker leads in place?

70 POSTOP NURSING CARE CONTINUED RWhat is used to monitor BP? RWhat is used to provide oxygen? RHow are increased secretions managed RHow is oxygenation measured? RWhy is an NGT used? RDressing over chest incision checked q 15 minutes for 24 hr for what? RWhat is used to monitor BP? RWhat is used to provide oxygen? RHow are increased secretions managed RHow is oxygenation measured? RWhy is an NGT used? RDressing over chest incision checked q 15 minutes for 24 hr for what?

71 POSTOP NURSING CARE CONTINUED POSTOP NU R2-3 chest tubes draining what from thoracic cavity which entered during surgery RFoley checked how often? RWhat urinary output would you expect for an infant? And a child? If Less than that normal what does this indicate? RAccurate I & O hourly including what drainage? RIV solutions and blood replacement R2-3 chest tubes draining what from thoracic cavity which entered during surgery RFoley checked how often? RWhat urinary output would you expect for an infant? And a child? If Less than that normal what does this indicate? RAccurate I & O hourly including what drainage? RIV solutions and blood replacement

72 POSTOP NURSING CARE CONTINUED RWhat class of meds for pain? RWhat used to prevent infection? RWhat diet? RWhat needs to be done for the mouth? RHow to Support parents? RWhat class of meds for pain? RWhat used to prevent infection? RWhat diet? RWhat needs to be done for the mouth? RHow to Support parents?

73 POTENTIAL COMPLICATIONS RHEMORRHAGE R*****ARRHYTHMIAS RCHF RPNEUMONIA RRENAL FAILURE RCVA RPULMONARY EMBOLISM RDEATH RHEMORRHAGE R*****ARRHYTHMIAS RCHF RPNEUMONIA RRENAL FAILURE RCVA RPULMONARY EMBOLISM RDEATH

74 NURSING ASSESSMENTS RParents Rchild RParents Rchild

75 ENDOCARDITIS

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77 CAUSATIVE ORGANISMS RStreptococcus RStaphylococcus aureus, enterococci RStreptococcus RStaphylococcus aureus, enterococci

78 PREDISPOSING FACTORS RWho would get endocarditis?

79 PATHOPHYSIOLOGY RWhere does the Infective organisms travel? RWhere is it deposited on the heart? RWhat aggregation is triggered? RWhat forms on valves and endocardium? RWhere does the Infective organisms travel? RWhere is it deposited on the heart? RWhat aggregation is triggered? RWhat forms on valves and endocardium?

80 EMBOLIZATION RWhat happens to the Fragments of friable vegetative lesions? RWhere do they go? RWhat assessments would the nurse look for with regard to embolization? RWhat happens to the Fragments of friable vegetative lesions? RWhere do they go? RWhat assessments would the nurse look for with regard to embolization?

81 Clinical manifestations INITIAL SYMPTOMS SEEM LIKE FLU: FEVER: VASCULAR MANIFESTATIONS: RSplinter hemorrhages RPetechiae RRoth’s spots: INITIAL SYMPTOMS SEEM LIKE FLU: FEVER: VASCULAR MANIFESTATIONS: RSplinter hemorrhages RPetechiae RRoth’s spots:

82 Clinical manifestations PERIPHERAL MANIFESTATIONS: ROsler’s Nodes: RJaneway lesions: PERIPHERAL MANIFESTATIONS: ROsler’s Nodes: RJaneway lesions:

83 Clinical manifestations CARDIAC: RHeart murmur: indicates? RWhat happens to the size of the heart? RWhat other complication? CARDIAC: RHeart murmur: indicates? RWhat happens to the size of the heart? RWhat other complication?

84 Clinical manifestations CEREBRAL EMBOLIZATION: RWhat assessments? CEREBRAL EMBOLIZATION: RWhat assessments?

85 Clinical manifestations PULMONARY EMBOLIZATION: RWhat assessments? PULMONARY EMBOLIZATION: RWhat assessments?

86 Clinical manifestations CORONARY ARTERY EMBOLIZATION: RWhat assessments? CORONARY ARTERY EMBOLIZATION: RWhat assessments?

87 Clinical manifestations SPLENIC EMBOLIZATION: What assessments? SPLENIC EMBOLIZATION: What assessments?

88 Clinical manifestations EMBOLIZATION OF THE RENAL ARTERY: RWhat assessments? EMBOLIZATION OF THE RENAL ARTERY: RWhat assessments?

89 Clinical manifestations CENTRAL NERVOUS SYSTEM: RWhat assessments? CENTRAL NERVOUS SYSTEM: RWhat assessments?

90 LABORATORY FINDINGS

91 Nursing care RWhat medications are used to treat the infection? What route? RWhat activity is best for the client? RWhat drug is used for the fever? RWhat drug is used for comfort RWhat labs indicate the infection status? RObserve for what complication? RWhat should be done prophylactically? RWhat medications are used to treat the infection? What route? RWhat activity is best for the client? RWhat drug is used for the fever? RWhat drug is used for comfort RWhat labs indicate the infection status? RObserve for what complication? RWhat should be done prophylactically?

92 NURSING DIAGNOSIS EXPECTED OUTCOMES

93 ABDOMINAL AORTIC ANEURYSM

94 ANEURYSM RDefined

95 SIGNS AND SYMPTOMS

96 EXPANDING ANEURYSM ASSESSMENT

97 RUPTURED ANEURYSM RASSESSMENT

98 TREATMENT: SURGICAL REPAIR

99 BEFORE SURGERY ASSESSMENT

100 COMPLICATIONS DURING SURGERY

101 MYOCARDIAL INFARCTION RHow would you know?

102 GRAFT OCCLUSION OR RUPTURE

103 HYPOVOLEMIA & RENAL FAILURE

104 RESPIRATORY DISTRESS

105 PARALYTIC ILEUS

106 POSTOPERATIVE NURSING CARE

107 POST-OP ASSESSMENTS for ISCHEMIA

108 POST-OP ASSESSMENTS for: ARTERIAL OCCLUSION

109 DISCHARGE PLANNING

110 Valvular Heart Disease

111 GENERAL CONCEPTS VALVULAR DISEASE INVOLVES THE 4 VALVES OF THE HEART PRESSURES: VALVULAR DISEASE INVOLVES THE 4 VALVES OF THE HEART PRESSURES:

112 PRESSURE ALTERATIONS DUE TO STENOTIC VALVE

113 VALVULAR DISEASE DEFINED: RStenosis: RRegurgitation: VALVULAR DISEASE DEFINED: RStenosis: RRegurgitation:

114 STENOSIS & REGURGITATION RSTENOSIS: RREGURGITATION: RSTENOSIS: RREGURGITATION:

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116 MITRAL VALVE STENOSIS

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119 ASSESSMENT

120 MITRAL VALVE REGURGITATION

121 ASSESSMENT

122 MITRAL VALVE PROLAPSE

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124 ASSESSMENT

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126 AORTIC VALVE STENOSIS

127 ASSESSMENT

128 AORTIC VALVE REGURGITATION RACUTE AORTIC VALVE REGURGITATION RCAUSES RACUTE AORTIC VALVE REGURGITATION RCAUSES

129 ASSESSMENT ACUTE: CHRONIC: ACUTE: CHRONIC:

130 TRICUSPID AND PULMONIC VALVE DISEASE RRESULTS: RTRICUSPID STENOSIS RESULTS in RPULMONIC STENOSIS: results in RRESULTS: RTRICUSPID STENOSIS RESULTS in RPULMONIC STENOSIS: results in

131 DIAGNOSTIC STUDIES FOR VALVULAR HEART DISEASE

132 TREATMENT DEPENDS UPON SYMPTOMS:

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134 TEACHING RDescribe disease and complications RDiscuss ways to prevent complications: prophylactic antibiotics prior to invasive procedures RWear Medic Alert RTeach about anticoagulants if prescribed RDescribe disease and complications RDiscuss ways to prevent complications: prophylactic antibiotics prior to invasive procedures RWear Medic Alert RTeach about anticoagulants if prescribed


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