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This is how the blood flow should be


Blood flows from an area of high pressure (left) to one of low pressure (right) and
takes the path of least resistance (pulmonary). Higher the gradient, higher the flow
& vice versa

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Poor feeding, tachypnea,
tachycardia, FTT occur as infant
Activity intolerance maybe seen in
the school age child
Mothers with medical issues, on
certain medications, or ETOH/drugs
are more likely to have babies with
heart disease

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Is the baby gaining weight? Is the baby eating?
Cyanosis is a common feature of congenital heart disease, pallor is associated with
poor perfusion
An enlarged heart can distort the chest configuration
visible pulsation of the neck veins are seen in some patients
Tachypnea, dyspnea, expiratory grunt may occur

Palpation and percussion can help discern the size of some organs. Pulses can
vary in strength, rate, and regularity. Want to auscultate for a fast or slow heart rate
and irregularity, murmurs.

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Sometimes children with acyanotic defects may develop cyanosis, and with cyanotic
defects appear pink and have more s/s of HF. Blood flow patterns are a better way
to classify

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Pressure in the ventricle and in the great artery before the obstruction is increased
and pressure in area beyond the obstruction is decreased
(Severe coarc can be life threatening). Narrowing of the aorta which may not
produce enough blood flow to the rest of the body. Making the LV work harder to
push blood through. At times LV can be weak, depending on severity of coarctation.
Surgical repair is choice for infant younger than 6 months.

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Decreased pulmonary blood flow
Ventricular septal defect, pulmonary stenosis, overriding aorta of the VSD
and ventricular hypertrophy.

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Mixing of saturated and desaturated blood. Pulmonary congestion occurs,
decrease cardiac output.

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Variable picture in patients

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s/s: such tachypnea, tachycardia at rest, dyspnea, retractions, activity tolerance,
fluid retention causing wt gain.
Bedside monitoring of ECG
Diagnostic tests can be stressful for children
Cardiac cath is fairly routine.
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Medical therapy then referred for surgical repair
Medications: digoxin & ACE, beta blockers, internal device
Fluid restriction and sodium restriction, diuretics
Provide thermal regulation, sedation if necessary, semi fowler, decrease stimuli
Medicaiton administration, assessment, monitor VS, organize nursing interventions,
encourage parents to sooth child, smaller feedings and feed before crying,
positioning, monitor caloric needs, and well rested before or NG feed, administer
diuretics and monitor I/O, monitor for dehydration and electrolyte imbalance

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Educate, child can still play, emotional support, teach to use behavior modifications
and set limits, child overdependency, teach physical limitations,

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