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CHILD WITH CARDIOVASCULAR DYSFUNCTION

CHILD WITH CARDIOVASCULAR DYSFUNCTION. KAREN E. MILES FLORIDA GULF COAST UNIVERSITY DEPARTMENT OF NURSING. CONGENITAL HEART DEFECTS. 1-2% of all live births Increases to 3% if have another child with CHD 4-10 in 1000 live births. INCIDENCE. Multifactorial Inheritance Others

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CHILD WITH CARDIOVASCULAR DYSFUNCTION

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  1. CHILD WITH CARDIOVASCULAR DYSFUNCTION KAREN E. MILES FLORIDA GULF COAST UNIVERSITY DEPARTMENT OF NURSING

  2. CONGENITAL HEART DEFECTS

  3. 1-2% of all live births Increases to 3% if have another child with CHD 4-10 in 1000 live births INCIDENCE

  4. Multifactorial Inheritance Others Maternal Rubella Maternal Alcoholism Maternal Diabetes Mellitus Down Syndrome Trisomy #13 & #18 Turner’s Syndrome Marfan’s Syndrome Di George Syndrome ETIOLOGY

  5. CLASSIFICATION OF CHD

  6. LEFT-TO-RIGHT SHUNTING LESIONS • Ventricular Septal Defect (VSD) • Atrial Septal Defect (ASD) • Patent Ductus Arteriosus (PDA) • AV Canal or Endocardial Cushion Defect

  7. OBSTRUCTIVE LESIONS • Pulmonary Stenosis (PS) • Aortic Stenosis (AS) • Coarctation of Aorta (COA)

  8. ADMIXTURE LESIONS • Transposition of Great Vessels (TGV) • Total Anomalous Venous Connection (TAPVC) • Truncus Arteriosus

  9. RIGHT-SIDED OBSTRUCTIVE LESIONS • Tetralogy of Fallot (TOF) • Tricuspid Atresia • Pulmonary Atresia

  10. PULMONARY VENOUS OBSTRUCTIVE LESIONS • Mitral/Aortic Atresia • Cardiomyopathy OTHER • Hypoplastic Left Heart Syndrome

  11. NURSING CARE OF CHILD WITH CHD

  12. A. Understand the causes, pathophys., clinical manif., diag. evaluation, and therapeutic management of CHF Causes: • Volume overload • Pressure overload • Decreased contractility • High cardiac output demands

  13. Clinical Manifestations • Tachycardia - resting rate greater than 160 beats/min in infants • Diaphoresis • Easily fatigued • Poor exercise tolerance • Poor perfusion - cold extremities, weak pulses, low BP, mottled skin

  14. Tachypnea - greater than 60 breaths/min in infants • Mild cyanosis • Dyspnea • Retractions • Orthopnea • Wheezing cough

  15. Hepatomegaly • Weight gain • Edema • Distended neck & peripheral veins

  16. DIAGNOSTIC EVALUATION • Chest X-Ray • ECG • Echo-cardiogram

  17. B. PROVIDE SAFE & THERAPEUTIC NURSING CARE Identify Early Signs of CHF • Tachycardia • Tachypnea • Profuse scalp sweating • Fatigue and irritability • Sudden weight gain • Respiratory distress

  18. IMPROVE CARDIAC FUNCTION • Administer Digoxin (Lanoxin) check apical pulse observe for signs of toxicity PROMOTE FLUID LOSS • Administer Diuretics (Lasix, Diuril, Aldactone) • Possible fluid restrictions • Possible sodium restrictions • Monitor intake and output

  19. DECREASE CARDIAC DEMANDS • Prevent cold stress in infants • Treat any infection • Rest and conservation of energy • Minimize unnecessary stress

  20. REDUCE RESPIRATORY DISTRESS • Position with HOB elevated • Administer Oxygen • Monitor Respiratory Rate and Effort MAINTAIN NUTRITIONAL STATUS • Increase Calories • Positioning • Alternate Feeding Techniques

  21. SUPPORT CHILD AND FAMILY • Foster Parent-To-Infant Attachment • Encourage Parents to Stay • Give Clear Explanations • Keep Informed • Provide Emotional Support

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