Obstructive Heart (Cardiac) Defects
Included In This Lesson
Study Tools For Obstructive Heart (Cardiac) Defects
Outline
Overview
- Blood leaving the heart is obstructed due to stenosis (narrowing)
- Pressure in the area of the heart just before the stenosis is increased
- Pressure in the area of the heart after the stenosis is decreased
Nursing Points
General
- Coarctation of the Aorta
- Narrowing in the descending aorta after subclavian artery
- Increased blood flow to upper extremities
- Decreased blood flow to lower extremities
- Common with Turner’s Syndrome
- Life threatening if uncorrected
- Narrowing in the descending aorta after subclavian artery
- Aortic Stenosis
- Stenosis of the aortic valve resulting in:
- Decreased cardiac output
- Pulmonary vascular congestion
- Left ventricular hypertrophy
- Pulmonic Stenosis
- Stenosis of the pulmonic valve resulting in:
- Decreased pulmonary blood flow
- Right ventricular Hypertrophy
Assessment
- Coarctation of the Aorta
- Upper extremities
- High BP
- Bounding pulses
- Lower extremities
- Low BP
- Weak or absent femoral pulses
- Cool extremities
- Older children
- Dizziness
- Heachaches
- Fainting
- Epistaxis
- Upper extremities
- Aortic Stenosis
- Murmur
- Systolic ejection murmur
- Signs of decreased CO
- Faint pulses
- Hypotension
- Tachycardia
- Poor feeding
- Older children
- Chest pain
- Activity intolerance
- Dizziness when standing
- Murmur
- Pulmonic Stenosis
- Murmur
- Murmur
- Cardiomegaly
- Right sided hypertrophy
- Cyanosis with severe
- Signs of Heart failure
- Murmur
Therapeutic Management
- Coarctation of the Aorta
- Prostaglandin E1 to keep Ductus Arteriosus open
- Balloon angioplasty
- Restenosis may occur
- Surgical resection
- For patients with hypertension and heart failure
- Aortic and/or Pulmonic Stenosis
- Cardiac catheterization – Balloon valvuloplasty
- Dilate narrow valve
- Valve replacement
- Cardiac catheterization – Balloon valvuloplasty
- Nursing Post-Op Care
- Decrease cardiac workload
- Promote rest
- Monitor Feeding
- Manage pain
- Monitor I’s & O’s
- Monitor for complications
- Hemorrhage
- Stroke
- Pneumothorax
- Pleural effusions
- Decrease cardiac workload
Nursing Concepts
- Perfusion
- Oxygenation
- Gas Exchange
Patient Education
- Frequent rest periods to relieve SOB
- Surgical options and post-op care
ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Obstructive Heart (Cardiac) Defects
Transcript
Hey guys, in this lesson we are going to talk about obstructive heart defects.
Obstruction usually happens because the blood vessel is narrow or stenosed. In the area before the stenosis there will increased pressure and in the area after the stenosis the pressure is decreased. This is important because it will help you think through what signs and symptoms to expect.
The first obstructive heart defect that we’re going to talk about is coarctation of the aorta and this is when there is a narrowing in the descending aorta after the subclavian artery. Because the stenosis happens after the subclavian artery this means that there’s going to be increase blood flow to the upper body and decrease blood flow to the lower body. And this explains the classic symptoms that we see with coarctation of the aorta which are high blood pressure and bound impulses in the upper extremities and low blood pressure and weak or absent pulses in the lower extremities. In older kids this can actually present as dizziness or even nosebleeds from the high blood pressure.
This diagnosis one of the reasons why it’s so important to make sure you always check peripheral pulses and compare them.
The next obstructive defect we going to talk about is Aortic Stenosis and this is when there is a narrowing at the aortic valve that is where the left ventricle meets the aorta. This stenosis is really going to decrease cardiac output and make the left side of the heart work extremely hard to get blood out into systemic circulation. Because blood has a difficult time leaving the left side of the heart it will back up into the pulmonary system causing pulmonary congestion.
The symptoms you are going to see with this are a murmur and then patients are show signs of having poor cardiac output, like weak pulses, low blood pressure and tachycardia because the heart is working extra hard. And as we’ve seen with all of these cardiac defects kids are going to have a difficult time feeding which can lead to failure to thrive.
Pulmonic stenosis is when there is a narrowing of the pulmonary valve. So thinking about the anatomy of the heart, this means pressure is going to be increased on the right side and decrease on the left.
The right side of the heart is going to have to work extra hard and you can end up systemic congestion and signs like peripheral edema.
These patients will have a murmur and they can be cyanotic if the stenosis is severe.
For therapeutic management one of the first things that we can do is administer prostaglandin E1. WE usually give this via IV infusion and what it does is it helps to keep that Ductus Arteriosus open which can help improve oxygenated blood flow while waiting for catheterization or surgery. This is usually done for patients with Coarctation of the Aorta.
Treatment for these obstructions is usually cardiac catheterization and surgery. With catheterization they may try a balloon angioplasty or valvuloplasty. If surgery is required they can perform a valve replacement or resection to remove the stenosed area.
Nursing care for a paediatric patient after cardiac surgery is all about decreasing that cardiac workload the heart can heal. So we really want to encourage rest and make sure the patient is not overworking with their feeds.
We also have to manage their pain and watch out for complications like hemorrhage, stroke and pneumothorax.
Your priority nursing concepts for a pediatric patient with an obstructive congenital heart defect are perfusion, oxygenation, and gas exchange.
Okay so let’s go over your key points for this lesson. We went over the obstructive heart effects. Obstruction means that there is a stenosed area which is blocking blood flow. Most of the time this happens at a valve and what it causes pressure changes in the heart. The pressure before the narrowing is increased and the pressure after is narrowing is decreased.
Coarctation of the Aorta is where there is a narrowing in the aorta after the subclavian artery. This causes increased pressure on the upper extremities and decrease pressure in the lower extremities. Always make sure to check femoral pulses so you can identify this problem.
Aortic Stenosis causes decreased cardiac output and increased work for the left ventricle.
Pulmonic stenosis causes decreased pulmonary blood flow and increased work for the right side of the heart which causes systemic congestion.
These defects are all going to require surgery to open up the stenosed area and restore blood flow!
That’s it for our lesson on Obstructive Heart Defects. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
Tiona RN
Concepts Covered:
- Studying
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Intraoperative Nursing
- Microbiology
- Cardiac Disorders
- Vascular Disorders
- Nervous System
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Immunological Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Hematologic Disorders
- Newborn Care
- Adulthood Growth and Development
- Disorders of Pancreas
- Postoperative Nursing
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Noninfectious Respiratory Disorder
- Peripheral Nervous System Disorders
- Learning Pharmacology
- Prenatal Concepts
- Tissues and Glands
- Developmental Considerations
- Factors Influencing Community Health
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Developmental Theories
- Basic
- Neonatal
- Pediatric
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Communication
- Basics of Mathematics
- Statistics
- Basics of Sociology
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Oncology Disorders
- Female Reproductive Disorders
- Musculoskeletal Trauma
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Musculoskeletal Disorders
- EENT Disorders
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Urinary System
- Emergency Care of the Neurological Patient
- Central Nervous System Disorders – Spinal Cord
- Respiratory System
- Emergency Care of the Respiratory Patient
- Cognitive Disorders
- Anxiety Disorders
- Depressive Disorders
- Trauma-Stress Disorders
- Substance Abuse Disorders
- Bipolar Disorders
- Psychotic Disorders
- Concepts of Mental Health
- Eating Disorders
- Personality Disorders
- Health & Stress
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Community Health Overview
- Gastrointestinal Disorders
- Integumentary Disorders
- Respiratory Disorders
- Neurologic and Cognitive Disorders
- Renal and Urinary Disorders
- Infectious Disease Disorders
- EENT Disorders
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Oncologic Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Note Taking
- Concepts of Population Health
- Basics of Human Biology