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Free online NCLEX Review for the Complete Idiot. LVN/LPN. Peds: Cardiac Dysfunction in Peds Patients #2: Foramen ovale, ductus arteriosus, shunting, holes, defects, openings, blood flowing, atrial septal defects, pulmonary stenosis.

(Not for a Beginner). Foramen ovale, Ductus arteriosus, shunting, holes, defects, openings, blood flowing, atrial septal defects, pulmonary stenosis. LVN LPN NCLEX. Nursing.
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Foramen ovale
This is an opening between the two atria. In the fetus, it allows blood to flow from the RA to the LA to the body:
Ductus arteriosus
This is the opening between the pulmonary artery and the aorta. In the fetus it shunts blood away from the pulmonary circulation (bypasses the lungs):
Left to right shunt
This is a hole or a defect. It causes extra blood to be pumped into lungs in turn causing CHF:
Right to left shunt
This causes decreased pulmonary blood flow resulting in cyanosis. This is caused by increased pulmonary vascular resistance or by obstruction of the pulmonary vein or artery:
Left sided heart failure.
This condition results in less blood being in the systemic circulation; more pressure in the left atria, and more pulmonary pressure (causing pulmonary symptoms):
Right sided heart failure
In this condition there is less blood pumped into the pulmonary artery; more pressure in the right atria and the systemic circulation. All this leads to systemic edema:
This occurs with Increased pulmonary blood flow defects:
There is increased blood volume on the right side of the heart which leads to rights sided hypertrophy. There is a decrease in systemic blood flow.
This is a list of 'Increased pulmonary blood flow' defects:
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
This is a list of 'Obstructive' defects:
Coarctation of aorta
Aortic stenosis
Pulmonic stenosis
This is a decreased pulmonary blood flow defect:
'Tetrology of Fallot'
Patent Ductus Arteriosis
In this condition, oxygenated blood flows from the aorta to the pulmonary artery and lungs, causes an increased LV workload and increased pulmonary vascular congestion:
PDA complications/CMs
may have no sx, or CHF sx; widened pulse pressure, bounding pulse, machine-like murmur
Atrial Septal Defect
This is the failure of the foramen ovale to close or there is a structural weakness. Blood shunts from L to R side of heart. The RV and the pulmonary artery enlarge d/t inc blood volume.
These are s/s & complications of an Atrial Septal Defect:
The Pt may have none, fatigue, DOE, FTT, or a murmur.
These are s/s & complications of a Ventricular Septal Defect:
The Pt may have an abnormal opening; increased pulm vasc resistance, enlarged RV, more blood in lungs, or less in systemic circ.
This is a list of mixed defects:
Transposition of the great vessels
Total anomalous pulmonary venous connection
Hypoplastic heart syndrome (R&L)
This is what is occurring during an 'Obstructive' defect:
The blood exiting the heart meets an area of anatomical narrowing, causing resistance, LV hypertrophy occurs, and there are s/s of CHF.
This is what is occurring during decreased PULMONARY blood flow defects:
There is obstruction of pulmonary blood flow. This causes desaturated blood to enter systemic circ. Pts are cyanotic.
This is what occurs in 'Mixed' defects:
Fully saturated blood mixes with the desaturated pulmonary blood flow causing relative desaturation, pulmonary congestion occurs, and cardiac output decreases.
These are s/s of 'Coarctation of the Aorta':
There is a narrowing of an area of the aorta. Classic SS is a difference in pulse quality and BP between the upper (inc) and lower (dec) extremities.
These are 'Coarctation of the Aorta' complications/CMs
No sx, epistaxis, headache, syncope, lower leg muscle cramps, weak/absent leg pulses, CHF, HTN,
pulmonic stenosis
obstruction of blood flow from the RV to the PA, blood backs up into the RV, causing hypertrophy and RVHF
pulmonic stenosis complications/CMs
no sx, cyanosis, HF, dyspnea, precordial pain, murmur, systemic edema
This is what 'Tetrology of Fallot (TOF)' is:
There are 4 major anomalies: VSD, RV hypertrophy, pulmonic stenosis, overriding aorta
These are complications/CMs of 'Tetralogy of Fallot':
R-L shunt, cyanosis, tet spells, squatting, clubbing
Aortic stenosis
Narrowing of the aortic valve obstructs LV outflow
aortic stenosis complications/CMs
inc risk of endocarditis, dec CO, LV hypertrophy, pulm edema, LV failure, hypotension, tachycardia, dizziness, chest pain
hypoplastic left heart syndrome (HLHS)
underdeveloped left heart and various left sided defects. LV, aortic valve, mitral valve, ascending aorta are usually small
HLHS complications/CMs
HF, pulmonary edema, single 2nd heart sound, O2 sats in 70s
SS of Digoxin toxicity
bradycardia, arrhythmia, NVA, dizziness, HA, weakness, fatigue
These are causes of RHF:
Systemic back-up (edema, ascites, etc)
These are causes of LHF:
Pulmonary back-up (dyspnea, cyanosis, etc)
These are meds used in pediatric CHF:
Digoxin, ACE inhibs, ASA, Lasix, Spironolactone
ACE inhibitors cause this:
Vasodilation
This is when to hold Digoxin:
HR <100 bpm for infant/toddler
HR <80 bpm for school-age
HR <60 bpm for adolescent
Hypokalemia has this effect on digoxin therapy:
It enhances the effect.
These are SS of CHF in a infant:
Poor feeding, FTT, tachypnea, diaphoresis, "dusky" appearance