NURSING CARE OF THE CHILD WITH A CARDIOVASCULAR DISEASE

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NURSING CARE OF THE CHILD WITH A CARDIOVASCULAR
DISEASE
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ASSESSMENT OF HEART DISORDERS IN CHILDREN

• History
• Physical assessment
• general appearance
• pulse, blood pressure, respirations

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ASSESSMENT OF HEART DISORDERS IN CHILDREN

• Diagnostic tests
• Electrocardiogram
• Radiography
• Echocardiography
• Phonocardiography magnetic resonance imaging
• Exercise testing
• Laboratory tests

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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 dont
  require open heart surgery

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

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• 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

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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

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• -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

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• 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

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• 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

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• 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

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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

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• 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

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• Kawasaki disease
• S/S (early)
• High fever that doesnt 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