Jenna Cohen Exam 2 Study Guide Notify CI if 97 or 100 4F Cardiovascular Dysfunction Physiology Fetal circulation bypasses lungs babies don t breathe to get their oxygen they get it from their mother then they don t need any structure once breathing in outside air when in mom not breathing in outside air so their structures change afterwards The following structures in place o Foramen ovale between atria connects the two atria o Ductus arteriosus between PA and aorta pulmonary artery o Ductus venosus between liver and infVC inferior vena cava Circulatory changes at birth o At birth umbilical cord is clamped and they take a 1st breath lungs expand increased O2 prevents bleeding and important for o2 and perfusion to be recognizes for the baby vasodilation the effect o2 has on the vessels is vasodilation o Pulmonary pressure decreases as systemic pressure increases foramen ovale closes as L atrial pressure is increased than R atrium Ductus arteriosus begins closing with O2 exposure use vasodilation to our advantage but will limit it after if increased intracranial pressure then the blood pressure is increased we don t want to cause massive vasodilation because it will increase pressure Changes at Birth Ductus venousus connect liver to infvc then after birth it becomes a piece of ligament the other connection is ductus arteriosus and the connection at birth is closed off after birth and also becomes a ligament foramen ovale connects the two atria it closes later and becomes a ligament foramen ovale Consider Adult Blood Flow normal heart flow need to know normal flow of the blood through the heart Right atrium tricuspid valve Right ventricle Pulmonary Artery PA LUNGS Pulmonary Veins Left atrium mitral valve Left ventricle aorta system Under normal conditions which side of the heart has HIGHER pressure Left has higher pressure Expected circulatory cardiac findings in Pediatric clients 4 P s Pulse Heart rate adults have a slower heart rate children have a faster heart rate smaller the child the faster the heart rate bigger person takes longer for it to get around Pressure Blood pressure in children bp will be lower doesn t take as much pressure to move through a smaller child we can take bp on the legs or arms because the numbers should be basically the same if they re healthy if we do notice a difference that is something we should pay attention to Perfusion children show signs of poor perfusion quickly expect high oxygen sats in pediatric because systems should be good not a lot of reason for there to be damage if a lowered we have to play cose attention and what other s sx do we see in that less than 96 wouldn t make sense assess them first then to make sure it s being read properly Peripheral pulses should be pretty much the same both in the feet and everywhere else in adult may have weaker in the feet bc of disease but no differences in normal children Murmurs in Children Physiology Murmur due to difference in flow of blood within heart Systolic Diastolic or Continuous can be not terribly concerning or could be just a sign so could go either way have a grading system can you hear it w o a stethoscope different types systolic diastolic continuous continuous means systolic and diastolic murmur o Can reflect heart or vessel abnormality OR o Occur in normal heart during stress anemia fever rapid growth anemia considered hgb less than 11 we would hear murmur with this because it makes the blood thinner not as thick as a regular patient fever thinner blood will slosh around and make more sounds the heat can warm up the blood and make it thinner ihop rapid growth blood volume not keeping up with rapid growth or in adults and sometimes adolescent girls pregnancy o if new and not continuous reeval after acute issue resolves Higher level of concern need for further assessment and testing if o Signs of cardiac compromise o A new unexplained murmur if it is a new murmur talk to the parent make sure you mention the positive signs find out if they ve ever been told they have a murmur before hgb was less than 7 and had a murmur and then once a transfusion and it was gone if really thin missing cushion pad that people would have in the chest so the heartbeat is rubbing against that first tissue not necessarily bad or wrong just don t have that extra tissue layer Lab Procedures BMP important for electrolytes same in adults and children BNP elevated worsened CHF brain natriuterit peptide produced by cardiac muscle if elevated chf and means brain communicating with heart muscle that s something wrong with the body sending a signal the higher the brain natriuretic peptide the worse the CHF CBC hgb important with anemia wbc bc at greater risk for infection Albumin and pre albumin for nutrition Diagnostic Tests ECG monitoring electrical discharge Echocardiography how the blood is flowing through the heart Radiography chest xray dextracardia heart was turned around it s not terribly bad but Cardiac catheterization if a defect found if you have one abnormality you think about if you have to assess it further there are others System Specific Etiology Risk Factors for Cardiac Defects Prenatal hx preterm birth IUGR Mom with alcohol illicit drug Dilantin use or Rubella exposure vaccine iugr intrauterine growth restriction smaller than expected side for age illicit drugs especially heroin and methylamphetamine coke if taking Dilantin important to take to prevent seizures but you have to taper off if you want to get pregnant but if not planned pregnancy you have to figure out what to do bc you cant just stop immediately or else mom will have a seizure rubella vaccine cant be pregnant Family hx of o Cardiac defects especially parent or sibling o Sudden death in adults 30 50 yo due to cardiac dysfunction defects have to look into the hx o SIDS sudden infant death syndrome older sids not positive always o Genetic syndromes Turner s Down s if you have one of these then it would give attention for the child to have a cardiac defect System Specific Assessment Due to Impaired Myocardial Function H heart rate increased increased heart size has poor feeding poor weight gain child had daily caloric needs and trying to cope with this problem children are also trying to grow and develop on top of this baby is trying to keep up with breathing and eating at the same time issue with energy and calorie E edema evaluation decreased in peripheral pulses BP extremities cool edema with chf A activity intolerance anorexia might