 Hello and welcome to Nursing School Explained. Today I'll be going over pediatric cardiac defects. I won't be discussing the particular specific defects, but I'll be discussing the difference between asianotic and cyanotic differences. I find it very helpful if you really think about the structures of the heart and how the blood flows through the heart normally and that if there is any abnormalities with the structure then you can typically discern what kind of signs and symptoms the patient will have. So let's go ahead and start by looking at the normal circulation. I've drawn out some hearts there. I'm not the best artist but you can see this is basically a normal heart. You can see the right atrium, right ventricle, left atrium and left ventricle. In blue behind here there's the pulmonary artery stemming from the right ventricle and going to the lungs. On the left side from the left ventricle we have the aorta coming out pumping blood towards the body and in pediatric circulation or in fetal circulation there are two different structures that allow the blood to bypass the lungs because in utero we don't really need the blood flow to the lungs. So there are these two structures. One of them is the foramen ovale which is an opening between the right atrium and the left atrium that allows the blood to flow from the right atrium over to the left atrium then to the left ventricle and out to the body and again bypassing the lungs. The ductus arteriosus up here is an artificial opening or a normal fetal opening between the pulmonary artery and the aorta which means because not all the blood is going to flow through the foramen ovale from the right atrium to the left there will be some flowing down to the right ventricle and some circulation going out to the lungs and so before it gets to the lungs even if the blood gets into the pulmonary artery it will be going over through the ductus arteriosus into the aorta again bypassing the lungs and then getting pumped over to the body. The foramen ovale and ductus arteriosus both close after birth typically the foramen ovale closes about one to two hours after birth and the ductus arteriosus about 15 to 18 hours after birth so fairly quickly. Now if we think about when these two structures close then we have normal blood flow which is just like an adult or a healthy child where the blood returns from the body to the right atrium flows down to the right ventricle goes out to the lungs gets oxygenized returns back to the left atrium goes out to the left ventricle and then out to the body through the aorta. Now if we look at different heart defects we can see that there is differences so our first example here again has our four heart chambers and the green here I've drawn VSD ventricular septal defect so there's basically a hole right here in the septal wall between the right ventricle and the left ventricle and as you can see here the shunting will happen from the right sorry from the left side to the right side and so typically this opening is not there but since the left ventricle supplies the body with with blood and is generating the cardiac output the pressure on the left side of the heart is generally higher than on the right side so now if I have an opening here an abnormal opening the blood will flow from a higher pressure area to a lower pressure area so basically in ventricular septal defect the blood will come in through the right atrium into the right ventricle will go to the lungs there might be a little bit of flow over to the left ventricle it'll the blood returns from the lungs to the left atrium to the left ventricle and then because we have this abnormal opening here and we have a higher pressure on the left side the blood will flow back into the right ventricle and send it back to the lungs again so the blood will circulate to the lungs multiple times that's why left to right shunting as you can see the arrows here match are asynotic defects because there's no cyanosis the blood actually gets circulated more to the lungs than it would usually now some other examples besides ventricular septal defect that are asynotic is atrial septal defect or ASD and patent doctor's arteriosus that we discussed over here now in an asynotic infant you would think oh that's good because they're not cyanotic they're not turning blue however they are still going to have significant signs and symptoms so I've color coded them here so everything asynotic will be in red and everything cyanotic will turn blue because the baby will be blue so signs and symptoms for asynotic heart defects are all those signs and symptoms of heart failure trust like in adults now in addition here because we have this big abnormal opening we're going to hear a pretty significant murmur in these patients there will be jvd jugular venous distention because the blood is being recirculated and then it can also back up into the periphery causing jugular venous distention going back up to the brain and then also it'll cause peripheral edema because it's backing up into the periphery here in addition because the blood is being circulated to the lungs multiple times there will be crackles because of all this congestion that the patient has now we talked about crackles jvd peripheral edema and then along with the backing up of the blood we also have to think about hepatitis splenomegaly so the blood the organs that are profused before the blood returns to the heart here are the liver on the right and the spleen on the left side so if there's back up just like the fluid would be backing up into the into the jugular vein into the periphery down in the lower extremities and we can have um some edema as assessment findings it'll back up into these two organs causing hepatitis splenomegaly which is pretty typical but it's a pretty significant sign of heart failure and then infants they'll have poor feeding they'll be working so hard to breathe because the lungs are extra congested that there will be poor feeding and they will have low appetite usually um not appropriate weight gain and they will be low um the lowest percentile for their for their age now treatments how do we treat this just like in adults congestive heart failure we're going to give them the doxin which is a cardiac glycoside and it increases the contractility the ability of the heart to pump to create that cardiac output and whatever blood is left in that left ventricle help it um bring the blood flow out to the body now there's diuretics because we have all this fluid that's recirculating and we have all these signs of fluid retention so we're going to want to get rid of some of these fluids by using diuretics as well as ACE inhibitors which are a RAS antagonist so they they prevent the renal angiotentin industrial system from kicking in and upping the blood pressure because this is not what we want in this scenario and eventually patients will need surgery because this big um defect here will have to be surgically be patched and fixed but a lot of times the surgeon will wait until the infant is four to six months old depending on how they're developing how big the defect is to let the child grow gain weight and then be more stable for surgery now nursing considerations on nursing care for children with an acynotic defects are very important so we want to do daily weights again just like in adults with congestive heart failure because we want to see how much weight are they gaining how much fluid are they retaining and i wrote this on here same time same scale same clothing that is very important because infants their overall body weight is not very much so the difference of five grams six grams ten grams may make a huge difference in determining how their fluid status and the heart overall is doing so same time same scale same clothing every single day for those weights we're going to be keeping strict eyes and nose we're going to be administering the medications we talked about definitely infection control is a big issue because they're going to be more prone or not able to fight infections as a normal healthy infant because of this underlying issue and then certainly we want to elevate the head of the bed to help alleviate their respiratory discomfort and the congestion and they might be on the fluid restriction now another important consideration here is to clustering care to allowing the infant to rest because they're going to be very tired most of their energy goes into breathing into supplying blood flow to their bodies so they're going to be tiring out fairly easy and we don't want to overwhelm them with caring for them multiple times an hour but rather once an hour go in when we're taking care of these infants at the hospital and doing everything that we need to do and then letting them rest letting them settle down and allowing them to breathe easily now we'll move on to cyanotic defects so for cyanotic defects there are a variety of different defects again that would lead the patient to become cyanotic the one that i've drawn out here is tetralogy or fallow to f written here tetralogy or fallow and tetra means four so that means there's four different things going on in this patient's heart so number one is again a ventricular septal defect so that abnormal opening between the two ventricles then we also have pulmonary artery stenosis you can see i drew the narrowing of that pulmonary artery here so now what's going to happen is there's extra pressure going to be required from that right ventricle to be pumping the blood to the lungs where it's supposed to go but because that artery is so narrow we can't the the the right ventricle is up against this small opening and it's trying really hard to pump the blood out which makes that right ventricle hypertrophy so right ventricular hypertrophy because again that muscle is working so hard to pump in that blood to the lungs through this stenose pulmonary artery and then the fourth defect in tetralogy or fallow is an overriding aorta and what that means is that the order is abnormally originating not from the left ventricle but actually overriding over that ventricular septal defect to where now it's collecting blood from both the right and the left ventricle pumping that out to the body now this because there is this pulmonary artery stenosis and this right ventricles hypertrophy now we have the opposite from over here the pressure on the right side of the heart is going to be a lot higher than on the left so now we have the blood flow from left from right to left as you can see the arrows again match here and what that means is now the blood comes in through the right atrium down to the right ventricle and it's flowing directly out to the left ventricle and then being pumped to the body basically bypassing the lungs as well as the left atrium so now these infants are going to be cyanotic because the blood shifts from the right to the left side inside the heart and bypasses the lungs hence there will be no oxygenation and then the patients will be cyanotic some examples besides tetralogy or fallow is pulmonary atresia so this is basically a severe degree of the pulmonary artery stenosis where it can be so narrow that it almost no blood can get through and so there's basically no blood flow to the lungs at all or transposition of the great arteries where the pulmonary artery and the order the implantation of those in the ventricles is reversed and certainly those two are more of an immediate surgical emergency because otherwise we just are not able to perfuse the patient because there's no blood flow going to the lungs so clearly with cyanotic defects signs and symptoms that go into blue include cyanosis if the patient has tetralogy or fallow or any of these other cyanotic defects they're going to be very fatigued they're going to be very working very hard to breathe and to oxygenate their bodies there's going to be hypoxemia they're going to be in respiratory distress all varying degrees of respiratory distress they're going to be tachycardic again they're going to have a murmur because we have this abnormal opening here they might be restless but then later on they might become lethargic which is actually worse than being restless now for treatment for cyanotic defects this is usually something that the parents will know ahead of time through the great prenatal screening and ultrasound testing that we have available nowadays so they'll be monitoring this patient very carefully and as soon as the baby is delivered they'll assess them and see what's what's needed but certainly they're going to need oxygen because they are cyanotic and we want to boost their oxygen level and help them with their oxygen carrying capacity then they might need to be intubated and then they will require surgery so these are the cases depending on the the degree and the actual defect the surgery might be done a lot sooner than in some of those BSD cases where they can wait four to six months now nursing care for cyanotic defects includes again daily weight because we want to make sure these kids don't really retain fluid but they might have very poor weight gain because they are so restless and all their energy goes into breathing so we need to monitor that but again they could also go into heart failure because of all these different structural defects that we have going on so daily weight is a is a must on any of these children with cardiac defects again same time same scale same clothing strict eyes and nose for fluid retention purposes medications that they might need in addition to intubation and oxygen certainly again infection control like we discussed for a cyanotic defects maintaining the airway absolutely a necessity and then again clustering care and allowing for periods of rest so in summary don't try to memorize all the different cardiac defects that there are because there's just too many just really think about how is the fetal circulation and how do these two structures close or they're supposed to close to allow for normal circulation through the heart and then when I have an abnormality here in an artificial opening or whatever the abnormality may be how does that affect the blood flow through the heart and then decide between left to right or right to left shunting and then you know that the lungs are supposed to be receiving blood after the right side of the heart so the lungs are bypassed patients are going to be cyanotic I hope this video has helped to get a better understanding of the pediatric cardiac defects please leave me any comments down below and I'll be happy to address those thank you for watching nursing soon explained and I will see you next time