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Kaiser Ann Pajulas, USRN

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Obstructive Heart (Cardiac) Defects

Obstructive Heart (Cardiac) Defects

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5 Obstructive Heart (Cardiac) Defects NCLEX Questions

Question 1 of 5

The nurse caring for a child diagnosed with coarctation of the aorta is demonstrating signs of respiratory distress. The nurse suspects this is a sign of which of the following?

Pulmonary congestion

Aspiration pneumonia

Systemic congestion

Digoxin toxicity

Question 2 of 5

The parents of a 6-year-old are seeking treatment for the child’s cardiac condition. The child will need surgery to correct coarctation of the aorta. During the history and physical, the parents tell the nurse that the child was adopted from another country last year. The parents are planning to sign informed consent for the procedure. Which of the following responses from the nurse is most appropriate?

I will need a copy of your legal adoption paperwork before we can sign this consent

I will get the paperwork for you to sign as the parent

I'm sorry, I must have the parent or legal guardian sign the consent form

You do not have authority to sign paperwork until the child has been legally adopted

Question 3 of 5

The nurse providing care to an infant diagnosed with aortic stenosis knows to expect which of the following symptoms? Select all that apply.

Poor feeding

Faint pulses

Exercise intolerance

Hypotension

Hypertension

Question 4 of 5

The nurse caring for an infant diagnosed with coarctation of the aorta knows to expect which of the following on assessment.

Bounding peripheral pulses and weak or absent central pulses

Bounding pulses in the upper extremities and weak or absent pulses in the lower extremities

Bounding pulses in the lower extremities and weak or absent pulses in the upper extremities

Bounding central pulses and weak or absent peripheral pulses

Question 5 of 5

A 2-week-old infant was admitted with difficulty feeding and weight loss. During the assessment, the nurse assesses absent femoral pulses and knows this is a sign of which of the following congenital heart defects?

Ventricular septal defect

Coarctation of the aorta

Tricuspid atresia

Tetralogy of fallot

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Additional Lessons

Study Tools For Obstructive Heart (Cardiac) Defects

Coarctation Of The Aorta (Image)

Pulmonic Valve Stenosis (Image)

Aortic Stenosis (Image)

Congenital Heart Defects Cheatsheet (Cheatsheet)

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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
1. Narrowing in the descending aorta after subclavian artery
  1. Increased blood flow to upper extremities
  2. Decreased blood flow to lower extremities
2. Common with Turner’s Syndrome
3. Life threatening if uncorrected
Aortic Stenosis
1. Stenosis of the aortic valve resulting in:
2. Decreased cardiac output
3. Pulmonary vascular congestion
4. Left ventricular hypertrophy
Pulmonic Stenosis
1. Stenosis of the pulmonic valve resulting in:
2. Decreased pulmonary blood flow
3. Right ventricular Hypertrophy

Assessment

Coarctation of the Aorta
1. Upper extremities
  1. High BP
  2. Bounding pulses
2. Lower extremities
  1. Low BP
  2. Weak or absent femoral pulses
  3. Cool extremities
3. Older children
  1. Dizziness
  2. Heachaches
  3. Fainting
  4. Epistaxis
Aortic Stenosis
1. Murmur
  1. Systolic ejection murmur
2. Signs of decreased CO
  1. Faint pulses
  2. Hypotension
  3. Tachycardia
  4. Poor feeding
  5. Older children
    1. Chest pain
    2. Activity intolerance
    3. Dizziness when standing
Pulmonic Stenosis
1. Murmur
  1. Murmur
  2. Cardiomegaly
  3. Right sided hypertrophy
  4. Cyanosis with severe
  5. Signs of Heart failure

Therapeutic Management

Coarctation of the Aorta
1. Prostaglandin E1 to keep Ductus Arteriosus open
2. Balloon angioplasty
3. Restenosis may occur
4. Surgical resection
  1. For patients with hypertension and heart failure
Aortic and/or Pulmonic Stenosis
1. Cardiac catheterization – Balloon valvuloplasty
  1. Dilate narrow valve
2. Valve replacement
Nursing Post-Op Care
1. Decrease cardiac workload
  1. Promote rest
  2. Monitor Feeding
2. Manage pain
3. Monitor I’s & O’s
4. Monitor for complications
  1. Hemorrhage
  2. Stroke
  3. Pneumothorax
  4. Pleural effusions

Nursing Concepts

Perfusion
Oxygenation
Gas Exchange

Patient Education

Frequent rest periods to relieve SOB
Surgical options and post-op care

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ADPIE Related Lessons

Related Nursing Process (ADPIE) Lessons for Obstructive Heart (Cardiac) Defects

Preload and Afterload

Heart (Cardiac) and Great Vessels Assessment

Thorax and Lungs Assessment

Peripheral Vascular Assessment

Care of the Pediatric Patient

Vitals (VS) and Assessment

Diagnose Lessons

Echocardiogram (Cardiac Echo)

Nursing Care Plan (NCP) for Congenital Heart 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!

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Normal Sinus Rhythm
EKG Waveforms
Respiratory Acidosis
Heart Sounds
Lung Sounds

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