Defects of Increased Pulmonary Blood Flow
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Included In This Lesson
Study Tools For Defects of Increased Pulmonary Blood Flow
Patent Ductus Arteriosus (Image)
Atrial Septal Defect (Image)
Ventricular Septal Defect (Image)
Congenital Heart Defects Cheatsheet (Cheatsheet)
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Outline
Overview
- Pressure in the heart is higher in the left side than the right side
- Septal defects (openings between the chambers) allow oxygen rich blood to flow back from the left side (higher pressure) → to the right side (lower pressure)
- Blood leaving the heart is oxygenated
- Lt to Rt Shunt causes increased pulmonary blood flow
- Makes the Rt side of the heart work harder
- Can lead to heart failure
Nursing Points
General
- Atrial Septal Defect (ASD)
- Hole in the septum separating the right and left atria.
- Oxygen rich blood from the left side of the heart flows into the right side
- Ventricular Septal Defect (VSD)
- Hole in the septum separating the right and left ventricles.
- Oxygen rich blood from the left side of the heart flows into the right side
- Many close within first year of life
- Atrioventricular Canal Defect
- Large opening in atrioventricular septum connecting all four chambers
- Blood from all chambers of the heart mixing (still Lt → Rt)
- Common in Down Syndrome
- Patent Ductus Arteriosus (PDA)
- Shunt (ductus arteriosus) connecting the aorta and pulmonary artery fails to close within a few days of birth.
- Opening allows oxygenated blood from aorta (higher pressure) to flow into pulmonary artery (lower pressure)
Assessment
- General Symptoms
- Increased pulmonary blood flow
- Dyspnea
- SOB
- Tachypnea
- Respiratory infections
- Feeding Difficulty
- Failure to Thrive
- Heart Failure
- Edema
- Fatigue
- Sweating
- Increased pulmonary blood flow
- Atrial Septal Defect (ASD)
- Often asymptomatic until adulthood
- Murmur
- Atrial dysrhythmias
- Increased risk for:
- Emboli
- HF
- Ventricular Septal Defect (VSD)
- Symptoms vary with size of defect
- Characteristic loud murmur
- Patent Ductus Arteriosus (PDA)
- Continuous “machine-like” murmur
- Heart failure is rare in kids
- Atrioventricular Canal Defect
- Cyanosis
- Moderate heart failure can develop
Therapeutic Management
- Atrial Septal Defect (ASD)
- Repair via cardiac catheterization
- Ventricular Septal Defect (VSD)
- Many close within the first year of life
- Repair via cardiac catheterization
- Usually in first year of life
- Atrioventricular Canal Defect
- Surgical
- Patch closure of all defects
- Reconstruction of AV valve
- Surgical
- Patent Ductus Arteriosus (PDA)
- Watchful waiting
- Symptomatic PDA management with surgical and nonsurgical therapies
- Medications → NSAIDS (indomethacin, ibuprofen)
- May close PDA in premature infants
- Prostaglandins are responsible for maintaining an open DA
- NSAIDS inhibit prostaglandin synthesis and can initiate closure
- Kept open on purpose (with prostaglandins) to ensure circulation of oxygenated blood in patients with Transposition of the Great Arteries and Pulmonary atresia.
Nursing Concepts
- Perfusion
- Oxygenation
- Gas Exchange
Patient Education
- s/s to report to provider
- Surgical options and post-op plan of care
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Related Nursing Process (ADPIE) Lessons for Defects of Increased Pulmonary Blood Flow
Transcript
Hey guys, in this lesson we are going to go over heart defects that cause an increase in pulmonary blood flow. This information will build on what is discussed in the congenital heart defects lesson so check that one out if you haven’t already!
The defects that cause an increase in pulmonary blood flow are Atrial Septal Defect, Ventricular Septal Defect, Atrioventricular Canal Defect and Patent Ductus Arteriosus. These are all abnormal openings in the heart, we’ll talk more specifically about their locations in just a second. Remember that pressure on the left side of the heart is greater than on the right side of the heart, so these openings allow blood that has already been oxygenated to flow back to the right side of the heart. This is called a left to right shunt. Blood is being circulated through the lungs again, increasing pulmonary blood flow and the right side of the heart is having to work extra hard.
The blood leaving the heart is going to be oxygenated so for the most part these patients will not be cyanotic at first.
We are going to talk through each defect and highlight the things that are unique to each one.
Atrial Septal Defect or ASD is a hole in the septum connecting the right and left atria. Oxygenated blood shunts from the left back to the right and is recirculated. A lot of times patients with ASD are asymptomatic for a long time. Some even present well into adulthood with heart palpitations and shortness of breath.
For our peds patients they may have a murmur and they may present with dyspnea and frequent respiratory infections.
When they go undiagnosed patients are at risk for atrial dysrhythmias, clot formation and stroke.
Ventricular Septal Defect is a hole between the right ventricle and the left ventricle. Again, the blood is shunted from left to right recirculated the oxygenated blood.
How symptomatic the kid is will depend on large the defect is. If it’s small they may be asymptomatic, but larger defects will often present in the first few months of life. Usually it presents as feeding difficulties so babies struggle to eat, sweating while feeding and tiring easily and they may not meet growth milestones.
Over time, if untreated the right side of the heart will hypertrophy and heart failure can occur.
Atrioventricular Canal Defect is an opening between all four chambers. This is a much larger defect than the previous two. Again, blood moves left to right, increasing pulmonary blood flow. This is the most common heart defect seen in patients with Down Syndrome.
This defect usually presents in the first few months of life and if severe enough the patient can be cyanosed. Most of the time though, and you’ll be seeing a pattern by now, it presents as respiratory distress, frequent infections and feeding difficulty. They may also have a murmur and again, if untreated it can lead to moderate to severe heart failure.
Patent Ductus Arteriosus is a little different than the other three we’ve talked about. It’s not located in the septum. It’s an opening between the aorta and the pulmonary artery. This opening is called the ductus arteriosus and in a fetus it’s totally normal, but it should close after the baby is born. If it doesn’t it’s called Patent Ductus Arteriosus.
Blood still moves from the higher pressure (aorta) to the lower pressure (pulmonary artery) so there is still going to be increased pulmonary pulmonary blood flow.
Probably the most classic symptom of a PDA is a machine-like murmur. As with the others symptoms it will be worse with larger holes. And you’ve probably guessed it, presentation is often respiratory distress, frequent respiratory infections and feeding difficulties. Over time, heart failure can occur but is rare in childhood.
Management of these vary but sometimes watchful waiting is appropriate. VSD and PDA will sometimes close on their own, so we keep an eye on the kid and wait to see if this happens.
Cardiac catheterization can be used to repair ASD and VSD.
Surgery is needed to repair the atrioventricular defect because it is much larger and has to be patched rather than just closed.
Medications can be used to close the PDA. If it doesn’t close on it’s own NSAIDS will actually close it. Prostaglandins keep the PDA open and NSAIDS inhibit prostaglandin synthesis so this can cause it to close. This is why pregnant women shouldn’t take NSAIDS. We need the DA to stay open!
Your priority nursing concepts for a peds patient with a congenital heart defect that causes increased pulmonary blood flow are perfusion, oxygenation, and gas exchange.
Okay, let’s recap the key points for this lesson. We talked through, Atrial Septal Defects, Ventricular Septal Defects, Atrioventricular Canal Defects and Patent Ductus arteriosus. These are all abnormal openings in the heart. They cause oxygenated blood to shunt from the left side back into the right side to be recirculated through the lungs. This results in increased pulmonary blood flow that can cause pulmonary congestion and makes the right side of the heart work harder.
Because these don’t immediately cause cyanosis a lot of babies are asymptomatic for a while and presentation is usually respiratory distress and feeding difficulty.
Treatment varies and can be watchful waiting, Cardiac Catheterization and Surgery. NSAIDS can be used to help trigger the close of the PDA.
That’s it for our lesson on heart defects that cause an increase in pulmonary blood flow.
Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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Sterile Gloves
Stoma Care (Colostomy bag)
Stomach Cancer (Gastric Cancer)
Stress and Crisis
Stroke (CVA) Management in the ER
Stroke Concept Map
Stroke Nursing Care (CVA)
Subinvolution
SubQ Injections
Sudden Infant Death Syndrome (SIDS)
Suicidal Behavior
Surgical Incisions & Drain Sites
Surgical Prep
Surgical Wound Classification Documentation for Certified Perioperative Nurse (CNOR)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Systemic Lupus Erythematosus (SLE)
Tenet 2 Linchpins & Connections
Tenet 3 Why Behind the What
Tenet 4 Learner-Centered Talkabouts
Tension and Cluster Headaches
Testicular Cancer
The 5-Minute Assessment (Physical assessment)
The EKG (ECG) Graph
The Medical Team
Thinking Like a Nurse
Thoracentesis
Thorax and Lungs Assessment
Threatened/Spontaneous Abortion for Certified Emergency Nursing (CEN)
Thrombocytopenia
Thyroid Cancer
Time Management
Tocolytics
Tocolytics
Tonsillitis
Topical Medications
Total Bilirubin (T. Billi) Lab Values
Trach Care
Trach Suctioning
Transient Tachypnea of Newborn
Transition To Practice
Transition to Practice Course Introduction
Trauma Survey
Triage in the ER
Troponin I (cTNL) Lab Values
Types of Exercise
Types of Schizophrenia
Umbilical Hernia
Urinary Elimination
Using Aseptic Technique
Uterine Stimulants (Oxytocin, Pitocin)
Uterine Stimulants (Oxytocin, Pitocin) Nursing Considerations
Varicella – Chickenpox
Varicocele
Venous Disorders (Chronic venous insufficiency, Deep venous thrombosis/DVT)
Vent Alarms
Vitals (VS) and Assessment
Vomiting
What Guides Nurses Practice
What is CCMM?
White Blood Cell (WBC) Lab Values
Working night shift
Working with a Preceptor
Wound Care – Assessment
Wound Care – Dressing Change
Wound Care – Selecting a Dressing
Wound Care – Wound Drains