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Chapter 27

Chapter 27. Caring for the Child with a Cardiovascular Condition . A & P Review. Anatomy Chambers Valves Vessels Normal flow Physiology Cardiac output Stroke volume. Chambers of the Heart. Valves of the Heart. Vessels of the Heart. Normal Blood Flow. Congestive Heart Failure.

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Chapter 27

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  1. Chapter 27 Caring for the Child with a Cardiovascular Condition

  2. A & P Review • Anatomy • Chambers • Valves • Vessels • Normal flow • Physiology • Cardiac output • Stroke volume

  3. Chambers of the Heart

  4. Valves of the Heart

  5. Vessels of the Heart

  6. Normal Blood Flow

  7. Congestive Heart Failure • Signs & Symptoms: • Vary with age fluid congestion • Poor feeding & growth, irritability, shortness of breath, excessive sweating • Nursing Care: • Positive inotropes (digoxin), diuretics (furosemide), vasodilators (captopril) • Fluid restriction not often used (only in the worst cases)

  8. Congenital Heart Disease Cyanotic versus Acyanotic Congenital Heart Defects • Shunting Pattern • Left to right shunting • Acyanotic • Right to left shunting • Cyanotic

  9. Segmental Classification of Congenital Heart Defects (Table 27-2) • Types of Defects • Septum or septae (chamber walls) • Vessels & valve • Conaltruncal defects • Combination defects

  10. Defects in the Septum

  11. Atrial Septal Defect (ASD)

  12. Atrial Septal Defect (ASD) • Signs & Symptoms: • May have a murmur, a heave or a thrill • Right atrial enlargement • Nursing Care: • Closes spontaneously or may need a surgical procedure • Post-operative management

  13. Postoperative Management • Record vital signs frequently • Maintain “lines” • Peripheral IV line • Central venous pressure • Intracardiac lines • Assess & maintain respiratory status • Monitor fluid status • Assess for s/s of infection

  14. Ventricular Septal Defect (VSD)

  15. Ventricular Septal Defect (VSD) • Signs & Symptoms: • Large opening; (SOB, feeding difficulties, poor growth, easy fatigability & recurrent pulmonary infection) • Harsh murmur with a thrill • Nursing Care: • Closes spontaneously or may need a surgical procedure • Post-operative management (see critical nursing action Postoperative management)

  16. Atrioventricular Canal Defect (AVC)

  17. Atrioventricular Canal Defect (AVC) • Signs and Symptoms: • Cardiac failure (SOB, respiratory distress, periorbital edema, FTT, respiratory infections, distended liver) • Nursing care: • Prior to surgery; optimize cardiac output & weight gain • Post-operative management

  18. Defects of the Vessels & Valves

  19. Patent Ductus Arteriosus (PDA)

  20. Patent Ductus Arteriosus (PDA) • Signs & Symptoms: • Murmur • Frequent colds, susceptible to RSV, fatigue, poor feeding & poor growth pattern • Nursing Care: • Closed surgically, or with a transcatheter device • Indomethacin (Indocin) • Postsurgical measures (wound care, monitoring VS, adequate hydration & nutrition)

  21. Pulmonic Stenosis (PS or PVS)

  22. Pulmonic Stenosis • Signs & Symptoms: • Murmur, may have dyspnea • Cyanosis • Nursing Care: • Balloon angioplasty or valvuloplasty • Monitor for restenosis • Reduce stressful situations • Subacute Bacterial Endocarditis prophylaxis (SBE)

  23. Pulmonary Atresia

  24. Pulmonary Atresia • A fatal defect if not corrected or palpitated • Emergency procedure performed to save child’s life • Initial prostaglandin (PGE1) is infused (maintain patency) • Balloon atrial septostomy is performed to create an ASD • Initial surgical repair includes a shunt or conduit • Later, Fontan procedure may be needed

  25. Aortic Stenosis (AS or AVS)

  26. Aortic Stenosis (AS or AVS) • Signs & Symptoms: • Murmer • Click or thrill • Chest pain, fatigue and syncope • Nursing Care: • Angioplasty or valvuloplasty • Repair or replace valve • Medical and/or postoperative management • Life-long monitoring • Subacute Bacterial Endocarditis prophylaxis (SBE)

  27. Coarctation of the Aorta (CoA)

  28. Coarctation of the Aorta (CoA) • Signs & Symptoms: • B/P differences between the arms & legs • Signs of congestive heart failure • Pain in legs or cyanotic lower extremities • Nursing Care: • Surgery • Balloon angioplasty & stent placement • Postoperative management (follow-up; restenosis) • Subacute Bacterial Endocarditis prophylaxis (SBE)

  29. Tricuspid Atresia (TA)

  30. Tricuspid Atresia (TA) • Signs & Symptoms: • Severely cyanotic, tachycardiac & dyspneic  • Heart murmur • Nursing Care: • Prostaglandin (PGE1) • Emergent Balloon atrial septostomy • Numerous surgical repairs • Postoperative management

  31. Total Anomalous Pulmonary Venous Return (TAPVR)

  32. Total Anomalous Pulmonary Venous Return (TAPVR) • Signs & Symptoms: • Cyanosis, respiratory distress, lethargy, poor & rapid breathing, poor feeding, frequent respiratory infections & signs heart failure • Nursing Care: • Surgical repair • Routinely followed (every 1-2 years) • Subacute Bacterial Endocarditis prophylaxis (SBE)

  33. Conal Truncal defects

  34. Transposition of the Great Arteries or Vessels (TGA or TGV)

  35. Transposition of the Great Arteries or Vessels (TGA or TGV) • Signs & Symptoms: • Appear at birth • Cyanosis, SOB, poor feeding, clubbing of fingers & toes • Nursing Care: • Surgical repair (arterial switch operation) • Postoperative management • Subacute Bacterial Endocarditis prophylaxis

  36. Truncus Arteriosus

  37. Truncus Arteriosus • Signs & Symptoms: • Cyanosis • Congestive heart failure • Low cardiac output • Nursing Care: • Inotropic medications • Postoperative management • Subacute Bacterial Endocarditis prophylaxis (SBE)

  38. Combination Defects – Tetrology of Fallot (TOF)

  39. Tetrology of Fallot (TOF) • Signs & Symptoms: • Cyanosis with crying or playing • “TET" spells • Nursing Care: • Surgical repair • Postoperative management • Subacute Bacterial Endocarditis prophylaxis (SBE)

  40. Complex or Single Ventricle Type Defects – Hypoplastic Left Heart Syndrome (HPLS)

  41. Hypoplastic Left Heart Syndrome (HLHS) • Signs & Symptoms: • Inadequate cardiac output • Nursing Care: • Artificial shunt or pathway created shortly after birth • Prostaglandin (PGE1) given • Numerous surgical repairs (cardiac transplant) • Palliative care measures

  42. Cardiac Diseases

  43. Subacute Bacterial Endocarditis (SBE) • Signs & Symptoms: • Vague (low-grade fever, malaise, loss of appetitive & muscle aches • Acute (high fever, chills, sweating, stiff joints or back pain) • As the condition worsens symptoms of heart failure occur • Nursing Care: • Antibiotics • Prevention (see Prophylaxis Guidelines) • Valve destruction needs repair or replacement

  44. Kawasaki Disease • Signs & Symptoms: • Vasculitis affecting all organ systems • Fever (5 days or more 104F° [40C°]) • Skin rash • Cervical lymphadenopathy • Edema & erythema of hands & feet (peeling) • Strawberry tongue • Conjunctivitis without exudate • Nursing Care: • IV immunoglobulin (IVIG) • Aspirin (ASA) • Steriods, plasma exchange, • Cytotoxic agents • Clinical alert: aneurysm formation • Frequent follow-up visits • Exercise stress test

  45. Cardiomyopathy (CM) • Signs & Symptoms: • Vague symptoms; (weakness, excessive tiredness, exercise intolerance, SOB, exercise intolerance, heart palpitations, chest pain, poor feeding, slow weight gain, fainting or lightheadedness) • Nursing Care: • Medications (ACE inhibitors) or angiotension receptor blockers • Beta blocker therapy • Nutritional supplementation • Diuretic and inotropic therapy • Followed closely • Activity restrictions • Cardiac transplant

  46. Rheumatic Fever (RF) • Group A-hemolytic streptococcal infection affecting the heart, joints, subcutaneous tissue & nervous system • Cause permanent damage (aortic & mitral valves involved) • Require valve replacement

  47. Additional Cardiac Conditions

  48. Cardiac Trauma • Signs & Symptoms: • Related to the type of cardiac trauma sustained • Nursing Care: • Based on exact type of injury • Bedrest, activity restrictions • Antiarrhythmics & inotropic agents • Pericardiocentesis • Cardiac rehabilitation program

  49. Hypercholesterolemia-Hyperlipidemia • Primary or Secondary Condition: • Primary - hereditary predisposition • Secondary – exogenous • Treatment goals: • Know cholesterol levels in children • Diet modification • Exercise • Medication

  50. Hypertension • Signs& Symptoms: • Depend on underlying cause • Elevated blood pressure (see Table 21-2) • Nursing Care: • Education about the condition, diet, exercise, lifestyle modification • Medication (beta-blockers & angiotensin-converting enzyme (ACE) inhibitors

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