NURSING CARE OF THE CHILD WITH A CARDIOVASCULAR DISEASE

1. NURSING CARE OF THE CHILD WITH A CARDIOVASCULAR DISEASE

2. ASSESSMENT OF HEART DISORDERS IN CHILDREN • History • Physical assessment • general appearance • pulse, blood pressure, & respirations

3. ASSESSMENT OF HEART DISORDERS IN CHILDREN • Diagnostic tests • Electrocardiogram • Radiography • Echocardiography • Phonocardiography & magnetic resonance imaging • Exercise testing • Laboratory tests

4. CONGENITAL HEART DISEASE • Defects with increased pulmonary blood flow • Ventricular Septal Defect • Opening between ventricles • S/S • 4-8 weeks, fatigue and harsh murmur • Therapeutic management • Most close spontaneously, those that don’t require open heart surgery

5. Defects with increased pulmonary blood flow • Atrial Septal Defect • Opening between the atria • S/S • Murmur, second heart sound splitting • Management • Surgery

6. Patent Ductus Arteriosus • Fetal structure that should begin closing with the first breath and should complete by 3 months • S/S • Wide pulse pressure and continuous murmur • Management • Administration of indomethacin • Cardiac Catheterization • Surgery

7. NURSING CARE OF THE CHILD WITH A HEART DISORDER • Obstructive defects • Pulmonic Stenosis • Narrowing of the pulmonary valve or artery causing the right ventricle to hypertrophy • S/S • Mild right sided heart failure • Cyanosis • SEM • Therapeutic Management • Balloon angioplasty to relieve the stenosis

8. -Aortic Stenosis • Stenosis of the aortic valve prevents blood from passing from the left ventricle into the aorta, leading to hypertrophy of the left ventricle • S/S • Usually asymptomatic but with murmur • May have chest pain and even sudden death • Therapeutic Management • Stabilization with a Beta Blocker or Calcium Channel Blocker • Balloon valvuloplasty • Valve replacement

9. Coarctation of the Aorta • Narrowing of the lumen of the aorta • S/S • Absence of palpable femoral &/or brachial pulses; headache, vertigo, nosebleeds, CVA; leg pain • Therapeutic Management • Surgery or angiography

10. Defects with decreased pulmonary blood flow • Tricuspid Atresia • The tricuspid valve is closed, blood flows through the patent foramen ovale into the left atrium, bypassing the lungs. Then it is shunted back through a PDA into the lungs. When these structures close, cyanosis, tachycardia, and dyspnea occur. Surgery must correct. • Treatment: IV infusion of PGE until surgery

11. Defects with decreased pulmonary blood flow • Tetralogy of Fallot • Four anomalies • Pulmonary stenosis • VSD • Dextroposition of the aorta • Hypertrophy of right ventricle • S/S • Cyanosis • Polycythemia (increase in number of RBC) • Dyspnea, growth restriction, clubbing of fingers • Therapeutic Management • Surgery

12. ACQUIRED HEART DISEASE • Congestive Heart Failure • S/S • Tachycardia, tachypnea • Right sided: increased venous pressure, hepatomegaly • Left sided: dyspnea, crackles (rales), cyanosis, and, eventually, ride sided failure • Therapeutic management • Reduce workload of the heart using diuretics, inotropics, and vasodilators

13. Rheumatic fever • S/S • Systolic murmur • Chorea (sudden involuntary movement of the limbs) • Macular rash on the trunk • Swollen and tender joints, SQ nodules on tendon sheaths • Positive ASO titer and increased ESR and C-reactive protein • Therapeutic management • Bedrest • Antibiotics to eliminate Group A Beta hemolytic Strept • Prognosis depends on how much heart involvement

14. Kawasaki disease • S/S (early) • High fever that doesn’t respond to therapy • Swollen hands and feet, enlarged joints • Strawberry tongue, red lips, conjunctiva • Enlarged cervical lymph nodes • S/S (late) • Skin desquamation • Platelet count increases • aneurysms • Therapeutic management • Administration of Ibuprofen for inflammation and platelet aggregation • IV immunoglobulin to decrease immune response • Most children recover fully but some will need heart surgery to repair damage