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Children - cardiovascular disorder
Terms in this set (76)
The nursing goals significant to the care of children with heart failure are to:
1. reduce the work of the heart.
2. improve respiration.
3. maintain proper nutrition.
4. prevent infection
5. reduce the anxiety of the parent.
6. support growth and development.
Congenital heart defects may be caused by:
1. Genetic factors
2. Maternal factors such as drug use or illness
3. Environmental factors
Acquired heart disease occurs:
After birth as a response to a defect or illness.
Congenital heart defects that result in a recirculation of blood to the lungs:
Do not usually produce cyanosis as a clinical sign
A congenital heart defect can cause:
1. An increase in pulmonary blood flow.
2. A decrease in pulmonary blood flow.
3. An obstruction of blood flow.
A difference in the blood pressure between arms and the legs is a characteristic of:
coarctation of the aorta
The defects in tetralogy of Fallot include:
1. pulmonary artery stenosis
2. Hypertrophy of the right ventricle
3. Dextroposition of the aorta
4. Ventricular septal defect
Hypercyanotic "tet" spells are relieved by:
Placing the child in a knee/chest position
Signs of congestive heart failure in infants include:
2. Fatigue at rest
3. Fatigue during feedings
4. Perspiration around the forehead
What should a nurse do when administering digoxin to an infant/child?
A dose exceeding 0.05 mg should be reconfirmed with the health care provider
young infants should not have a fat-restricted diet
because fat is needed for CNS growth and development.
Signs Related to Suspected Cardiac Pathology
1. Failure to thrive and/or poor weight gain
2. Cyanosis, pallor
3. Visually observed pulsations in the neck veins
4. Tachypnea, dyspnea
5. Irregular pulse rate
6. Clubbing of fingers
7. Fatigue during feeding or activity
8. Excessive perspiration, especially over forehead
Two categories of Congenital Heart Disease:
Pathology of blood flow in congenital heart diseases?
Blood always flows from area of high pressure to an area of low pressure and it always takes the path of least resistance.
Physiologically, defects can be organized into lesions that::
1. Increase pulmonary blood flow
2. Decrease pulmonary blood flow
3. Obstruct blood flow
The flow of blood through an abnormal opening between two vessels of the heart.
pathophysiology of Atrial Septal Defect (ASD)
1. ↑Pulmonary Blood Flow due to Left to Right Shunt
3. Systolic murmur with a fixed split second heart sound.
3. Most patients do not have symptoms.
4. Usually found on routine physical.
5. Best to correct before starting school
6. At risk for dysrhythmias.
Atrial Septal Defect (ASD) symptoms:
1. Possible dysrhythmias - usually due to enlargement of
Surgical treatment of ASD:
Pericardial patch or Dacron Patch. May also require mitral valve replacement.
Non-surgical treatment of ASD:
closure with a device during cardiac catheterization.
Ventricular Septal Defect (VSD)
1. ↑Pulmonary Blood Flow due to left to right shunt
2. Most common heart anomaly
4. Loud, harsh murmur w/ a systolic thrill
5. May have spontaneous closure if small
Clinical manifestations of VSD:
1. Heart failure
2. Murmur heard as the left sternal border.
3. At risk for bacterial endocarditis
4. At risk for pulmonary vascular obstructive disease
Palliative care for VSD:
Artery banding - placement of a band around the main pulmonary artery to decrease pulmonary blood flow.
preferred treatment for VSD:
cardiopulmonary bypass with knitted Dacron patch.
Repair of small VSD?
Nonsurgical treatment for VSD?
Device closure during cardiac catheterization
Patent Ductus Arteriosus (PDA)
1, ↑Pulmonary Blood Flow results in extra blood flow to the lungs.
2. Usually closes shortly after birth.
3. Blood passes from high pressure Aorta to low pressure Pulmonary Artery
4. Symptoms: Dyspnea
5. Machinery-type murmur
clinical manifestations of PDA?
1. May be asymptomatic.
2. Heart failure
3. widened pulse pressure
4. Bounding pulse
5. bacterial endocarditis
6. pulmonary vascular obstructive disease
How is indomethacin used to treat PDA?
To close PDA in preterm infants and some newborns.
What is indomethacin?
A prostaglandin inhibitor (Prostaglandin is a hormone-like substances that participate in a wide range of body functions such as the contraction and relaxation of smooth muscle, the dilation and constriction of blood vessels, control of blood pressure, and modulation of inflammation)
1. Are usually from some form of stenosis of the vessel
˃ Coarctation of the aorta
+Narrowing or constriction of the aortic arch or of the descending aorta
+Hemodynamically, increased pressure proximal to the defect and decreased pressure distally
Surgical treatment of PDA?
1. Left thoractomy.
2. video-assisted thoracoscopic surgery
Non-surgical treatment of PDA?
Coils inserted in the cardiac catheterization lab.
Coarctation of the Aorta
Narrowing or constriction of the aortic arch or of the descending aorta, which hemodynamically, increases pressure proximal to the defect and decreased pressure distally.
Characteristics of Coarctation of the Aorta
1. Marked difference in the blood pressure and pulses of the upper and lower extremities.
2. May not develop symptoms until late childhood.
3. Treatment is dependent upon type and severity of the defect.
4. Best time for surgical intervention is between 2 and 4 years of age
Health issues possibly caused by Coarctation of the Aorta
1. Hypertension upper extremitites
2. Poor vascularization of lower extremities
2. Heart failure
3. Infective endocarditis
4. Dizziness, headaches, fainting, epitaxis
5. ruptured aorta, aortic aneurysm
Treatment for Coarctation of the Aorta
1. Antihypertensive drugs - ACE inhibitors, Beta-Blockers
3. NG tube for decompression of the stomach
4. Mechanical ventilation
5. Inotropics (Digoxin)
Surgical treatment of Coarctation of the Aorta:
1. Surgical repair with thoractomy incision used.
Non-surgical treatment of Coarctation of the Aorta:
1. Percutaneous Balloon angioplasty
2. adolescents may need stent placement.
Post Operations care for Coarctation of the Aorta:
1. Treat HTN with IV nitroprusside.
2. Oral medications possible: ACE inhibitors, beta blockers.
Decreased Pulmonary blood flow causes:
A congenital heart anomaly that allows blood that has not passed through the lungs, causing deoxygenated blood to enter the aorta and systemic circulation.
Classic sign of deoxygenated blood:
Four defects of Tetralogy of Fallot:
1. Pulmonary stenosis
2. Right ventricular hypertrophy
3. Dextroposition (overriding) of aorta
4. Ventral septal defect (VSD)
Clinical manifestations of Tetralogy of Fallot:
1. Cyanosis that increases with age
2. Clubbing of fingers and toes
3. "squatting" position to breathe
4. Emboli formation
7. Sudden death
Paroxysmal Hypercyanotic Episode that occur during the first 2 years of life. Spontaneous cyanosis, respiratory distress, weakness, and syncope occur.
What should be done for an infant suffering a Tet spell?
Place child in knee-chest position to constrict lower extremity vascularization.
Diagnosis of Tetralogy of Fallot?
1. Chest X-ray that shows a typical boot-shaped heart
3. 3-D echocardiography
4. Cardiac catheterization
Palliative treatment of Tetralogy of Fallot?
Palliative Shunt - which increases the pulmonary blod flow and increases oxygen saturation.
Surgical repair(s) of Tetralogy of Fallot?
1. Closure of VSD.
2. resection of stenosis(s)
3. Pericardial patch placement to enlarge Right ventricular outflow tract.
Requires median sternotomy and cardiopulmonary bypass.
Narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle causing decreased cardiac output, left ventricular hypertrophy and pulmonary vascular congestion.
physiology of Aortic Stenosis:
1. Hypertrophy of left ventricle
2. Possible left ventricle failure, which may cause:
3. Left atrium pressure to increase.
4. Causing congestion in the pulmonary vein causing:
5. pulmonary edema.
Clinical manifestations of Aortic Stenosis:
1. Decreased cardiac output.
2. Faint pulses
5. Poor feeding
6. Exercise intolerance
7. Chest pain
9. Possible systolic ejection murmur
What does aortic stenosis put patients at risk of?
1. Bacterial endocarditis
2. coronary insufficiency
3. ventricular dysfunction
Surgical Treatment of aortic stenosis?
1. Aortic valvotomy
Nonsurgical treatment of aortic stenosis?
Dilated using balloon angioplasty in the cath lab.
Narrowing at the entrance to the pulmonary artery causing constriction of blood flow that causes ventricular hypertrophy & decreased pulmonary blood flow.
Physiology of pulmonic stenosis
1. Right ventricular hypertrophy
2. Possible right ventricular failure
3. Possible right atrium overload - opening up foramen ovale creating:
4. Shunting of unoxygenated blood into left atrium
5. causing systemic cyanosis
Manifestations of pulmonic stenosis:
1. may be asymptomatic
2. Mild Heart Failure or cyanosis
3. Lous systolic ejection murmur at the upper left sternal border.
4. In very compromised patient, murmur may be muffled secondary to decreased cardiac output.
6. Risk of Bacterial Endocarditis.
Surgical treatment of Pulmonic Stenosis
1. transventricular valvotomy (infant)
2. pulmonary valvotomy with Cardiopulmonary bypass
Non-surgical treatment of pulmonic stenosis
Balloon angioplasty in cath lab.
Tricuspid valve fails to develop, consequently there is no communication from the right atrium to the right ventricle, resulting in complete mixing of unoxygenated & oxygenated blood in left side of heart.
physiology of of Tricuspid atresia
1. A patent foramen ovalle is required to shunt blood.
2. PDA allows blood flow to pulmonary artery.
3. VSD allows a modest amount of blood to enter right ventricle.
4. Pulmonary blood flow is diminished.
Clinical manifestations of Tricuspid atresia
1. Symptomatic with moderate to severe heart failure.
3. poor growth
4. activity intolerance
5. Holosystolic murmur at left sternal
6. diastolic murmur if regurgitation is present.
Surgical treatment of Tricuspid atresia
Early repair is performed in the 1st month of life.
1. Closing of VSD.
Possible complications postoperatively
persistent heart failure
pulmonary artery hypertension
1 or more conduit replacements will be needed in childhood.
Hypoplastic Left Heart Syndrome
Underdevelopment of the left side of the heart, that usually results in an absent or nonfunctional left ventricle and hypoplasia of the ascending aorta.
Manifestations of Hypoplastic Left Heart Syndrome?
2. Heart failure
4. Weak pulses
5. Cardiac murmur
General nursing treatment post op?
1. Vital signs
2. Observe for thrombosis formation
3. Neuro-vascular checks of the limb
4. Emotional support to child and family
Acquired Heart Disease
» Occurs after birth
» May be a complication of a congenital heart disease or a response to respiratory infection,
sepsis, hypertension, or severe anemia
» Heart failure is a decrease in cardiac output necessary to meet the metabolic needs of the
Early signs of Heart Failure in infants that should be reported:
1. Tachycardia at rest
2. Fatigue during feedings
3. Sweating around scalp and forehead
5. Sudden weight gain
Heart Failure Nursing Care
1. Smal, Frequent feedings.
2. Oxygen to relieve dyspnea
3. Medications are given as prescribed, after dosages are checked for safety.
4. Accurate recording of intake and output
Used to reduce need for oxygen during heart surgery
Study of blood circulation
Prevent anemia, maintain hydration, promote growth and development
Describe the diet for the child with this.
Congestive heart failure (CHF)
Small frequent feedings with high-calorie formula
THIS SET IS OFTEN IN FOLDERS WITH...
Chapter 38 - Vascular Disorders (Lewis)
Congenital Heart Defects
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