CARE OF CHILD 303 NURSING MISC

CARE OF CHILD 303 LEFT-TO-RIGHT SHUNTING OCCURS WHEN AN ABNORMAL CONNECTION EXISTS BETWEEN THE SYSTEMIC AND PULMONARY CIRCULATIONS. THESE DEFECTS ALLOW BLOOD FLOW FROM THE HIGHER PRESSURE LEFT SIDE OF THE HEART TO THE LOWER PRESSURE RIGHT SIDE OF THE HEART (LEFT-TO-RIGHT SHUNT) RESULTING IN INCREASED PULMONARY BLOOD FLOW. LEFT-TO-RIGHT SHUNTING RESULTS IN VOLUME OVERLOAD IN THE RIGHT SIDE OF THE HEART AND IN THE PULMONARY ARTERY; CARDIAC WORKLOAD INCREASES TO MANAGE THE ADDITIONAL VOLUME (PRESSURE OVERLOAD). THIS ABNORMAL INCREASE IN HIGHLY SATURATED BLOOD COMBINED WITH THE INCREASED FLUID VOLUME IN THE LUNGS RESULTS IN ALTERED GAS EXCHANGE. ONE OF THE MAJOR CONSEQUENCES OF LEFT-TO-RIGHT SHUNTING LESIONS IS HEART FAILURE (HF). THERE ARE MANY DIFFERENT LEFT TO RIGHT HEART DEFECTS THAT REQUIRE CAREFUL ATTENTION AND MANAGEMENT BY NURSES. LEFT TO RIGHT SHUNTING LESIONS THAT INCREASE PULMONARY BLOOD FLOW INCLUDE: PDA, ASD, VSD, AVSD. MANAGEMENT OF LEFT-RIGHT SHUNTING LESIONS PDA PATIENTS WITH PDA WILL REQUIRE MONITORING FOR HEART FAILURE. INTERVENTIONS ADDRESS HEART FAILURE (HF) MEDICATIONS SUCH AS INDOMETHACIN AND IBUPROFEN TO CLOSE PDA IF MEDICATION UNSUCCESSFUL, SURGERY IS NECESSARY INTERVENTIONAL CARDIAC CATHETERIZATION CAN BE USED TO PLACE COIL AND OCCLUDE DUCTUS SURGICAL LIGATION OF DUCTUS VIA LEFT THORACOTOMY MAY BE NECESSARY TO OBLITERATE REMAINING VESSEL THE PATIENT WILL NEED TO BE MONITORED FOR PHYSIOLOGIC RESPONSES TO THE DEFECT SUCH AS THE DEVELOPMENT OF CYANOSIS. FINGER CLUBBING CAN BE A SIGN OF CHRONIC HYPOXIA. ASD CONSERVATIVE; SPONTANEOUS CLOSURE CAN OCCUR IN EARLY CHILDHOOD WITH VERY SMALL DEFECTS ADDRESS HF & DYSRHYTHMIAS IF PRESENT, IF SO WILL NEED TO BE PART OF NURSING MANAGEMENT PLACEMENT OF OCCLUDER DEVICES, SUTURES, OR PROSTHETIC PATCH MONITORING VITALS WILL BE VITAL IN CARING FOR THESE PATIENTS. NURSES WILL ALSO NEED TO WATCH FOR ATRIAL ARRHYTHMIAS AND ENCOURAGE RANGE OF MOTION EXERCISES. COUGH AND DEEP BREATHING CAN BE A SIGN OF PULMONARY CONGESTION. VSD IS ANOTHER DEFECT THAT CAN CAUSE INCREASED PULMONARY BLOOD FLOW. MANY VSD LESIONS CAN CLOSE SPONTANEOUSLY AND CAN BE TREATED WITH DIGOXIN. CONSERVATIVE: 30%-40% CLOSE SPONTANEOUSLY MEDICATIONS TO INCREASE HEART’S CONTRACTIONS SUCH AS DIGOXIN INSERTION OF AN OCCLUDER DEVICE OR SUTURE/PATCH CLOSURE FOR THESE PATIENTS, NURSES WILL NEED TO MONITOR FOR QUALITY AND STRENGTH OF HEART RATE, ASSESS FOR CYANOSIS, AND MONITOR FOR SIGNS OF CHF. ADS THOSE PATIENTS WITH ASD MAY HAVE SPONTANEOUS CLOSURE IN EARLY CHILDHOOD WITH VERY SMALL DEFECTS. SYMPTOMATIC TREATMENT OF HF SURGICAL PARTIAL: IF ASYMPTOMATIC, ASD AND MITRAL VALVE CLEFT REPAIRED COMPLETE: ASD AND VSD CLOSED, CONSTRUCTION OF TWO SEPARATE AV VALVES, POSSIBLE MITRAL VALVE REPLACEMENT THE CARE PLAN FOR THESE PATIENTS WILL INCLUDE OBSERVING FOR DECREASED ENERGY, MONITORING FOR WEIGHT LOSS, AND MAKING SERIOUS EFFORTS TO PROMOTE GROWTH AND DEVELOPMENT. UNLIKE VSDS AND ASDS, AVSDS WILL RARELY CLOSE ON THEIR OWN WITH GROWTH OVERTIME, AND THEREFORE SURGERY WILL USUALLY BE REQUIRED. AVSD IS ANOTHER LESION THAT CAN INCREASE PULMONARY BLOOD FLOW. NURSING MANAGEMENT INCLUDES OBSERVING FOR DECREASED ENERGY AND MONITORING FOR WEIGHT LOSS. PATIENTS WITH DOWN SYNDROME OFTEN HAVE CARDIAC DEFECTS ASSOCIATED WITH THE GENETIC SYNDROME. THE PATIENT MAY HAVE AN ATRIOVENTRICULAR SEPTAL DEFECT (AVSD). AVSD (ATRIOVENTRICULAR SEPTAL DEFECT) IS OFTEN ASSOCIATED WITH GENETIC SYNDROMES SUCH AS DOWN SYNDROME. IN AVSD THERE IS ABNORMAL DEVELOPMENT OF BOTH SEPTA AND AV VALVES. LEFT-TO-RIGHT SHUNTING INCREASES PULMONARY BLOOD FLOW. ...............................................CONTINUED.......................................................