Alterations in Oxygenation




 Assessment

„ The assessment of heart disease begins

with a thorough history and physical
assessment.
„ More specific diagnostic studies such as
electrocardiography or echocardiography,
are ordered as indicated
V Ristory
* The following must be given emphasis in history
taking:
- infants with heart disease are generally have
tachycardia and tachypnea
- infants frequently stop during feeding or sucking
due to easy fatigability because of ineffective heart
action
- thorough pregnancy history to determine whether
an intrauterine insult may have led to poor fetal
formation; cardiac anomalies can occur as a result of
infection such as rubella
- any intake of medications and exposure to
radiation during pregnancy, as these may contribute to
congenital heart disorders
 - for older children, ask for easy fatigability
and how much activity before the child becomes
tired
- ask what is the child¶s usual resting position,
some infants with congenital heart disease prefer a
knee-chest position and older children often
voluntarily squat.
- assess for cyanosis, indicates that
deoxygenated blood enter the arterial system
- any family history for heart diseases because
some of the congenital heart diseases such as the
atrial septal defect has genetic tendencies.
V hysical Examination
* General Appearance:
- measure the height and weight then compare
with the findings with the standard growth charts
- inspect the toes and fingers (particularly the
thumbs) for clubbing and color
- check for the capillary refill time; a child
with heart problem has a capillary refill time of
more than 5 seconds
- inspect the mucous membranes of the mouth
for cyanosis; cyanosis persisting for over 20
minutes after birth (except for acrocyanosis) may
indicate serious cardiopulmonary dysfunction
 - note if the cyanosis increases with crying,
cardiac dysfunction is suggested; if the cyanosis
decreases with crying, pulmonary dysfunction
is suggested
- inspect the chest, note for prominence of
the left side and an obvious heart movement
* ulse, Blood ressure and Respirations
- note for tachycardia especially if it persists even
during sleep
- auscultate for heart murmurs
Characteristic
Timing Systolic or diastolic
Duration Long
Quality Rarsh, Blowing
Intensity Loud
osition in which heard Reard in all positions
Affected by exercise No
V Diagnostic Tests
* Electrocardiogram (ECG)
- is a written record of the elctrical voltages
generated by the contracting heart. It provides
information about the heart
- it provides information about heart rate,
rhythm, state of myocardium, presence or
absence of hypertrophy (thickening of the heart
walls), ischemia or necrosis due to inadequate
cardiac circulation, and abnormalities of
conduction
 - The electrocardiogram (ECG) is a diagnostic tool that
measures and records the electrical activity of the heart in
detail. Being able to interpret these details allows diagnosis of
a wide range of heart problems
‡ Skin reparation:
- Clean with an alcohol wipe if necessary. If the patients
are very hairy ± shave the electrode areas.

‡ Chest Electrode lacement

V1: Fourth intercostal space to the right of the sternum.
V2: Fourth intercostal space to the Left of the sternum.
V3: Directly between leads V2 and V4.
V4: Fifth intercostal space at midclavicular line.
V5: Level with V4 at left anterior axillary line.
V6: Level with V5 at left midaxillary line. (Directly
under the midpoint of the armpit)
Significant Findings:
- a longer than normal  wave suggets that
the atria are hypertrophied and is taking longer
than usual for electrical conduction to spread
over the atria
- a lengthened R intervals suggests that
there is difficulty in coordination between the
SA and AV nodes (first degree heart block)
- a heightened R wave indicates that
ventricular hyperthrophy is present
 - an R wave that is decreased in height means
that the ventricles cannot contract fully, as it
happens if it is surrounded by fluids
(pericarditis)
- elongation of the T wave occurs in
hyperkalemia
- depression of the T wave is associated with
anoxia
- depression of the ST segment is associated
with abnormal calcium levels
* Radiography
- furnishes an accurate picture of the heart
size; and the contour and size of the heart
chambers
- X-ray findings are usually complemented
by an ECG, a more sensitive and accurate
measure of ventricular enlargement
* Flouroscopy
- provides a permanent motion-picture
record of important information about the size
and configuration of the heart and great
vessels, thoracic cage and diaphragm.
- in radioangiocardiography, a radioactive
substance as ³technetium´ is injected
intravenously into the blood stream; as the
substance circulates through the heart, it may
be traced and recorded on videotape
- it uses a low dose of radiation and may be
used to demonstrate, in particular, septal shunts
* Echocardiography or Ultrasound
Cardiography
- high frequency sound waves directed
toward the heart, are used to locate and study
the movement and dimensions of cardiac
structures such as the size of chambers, and the
thickness, motion, and pressure gradients of the
valves.
- fetal echocardiography can reveal heart
anomalies as early as 18 weeks into pregnancy
Like the heart, never let your dreams
stop beating; dream higher«

Thank You«