Caring for the Child with a Cardiovascular Condition

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 childs
  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

51
Idiopathic Primary Pulmonary Arterial
Hypertension (IPAH)

• Signs Symptoms
• SOB, chest pain, weakness, fatigue, dizziness,
  leg swelling fainting episodes
• Nursing Care
• Prostacyclin (Flolan) dilates blood vessels
  decreases pulmonary vascular resistance
• Inhaled nitric oxide relaxes pulmonary (not
  systemic) vessels
• Sildenafil (Revatio) decreases pulmonary artery
  pressures
• Bosentan (Tracleer) blocks hormone that causes
  vasoconstriction

52
Neurally Mediated Syncope (NMS)

• Signs Symptoms
• A fainting spells (may experience a seizure)
• Nursing Care
• Increase sodium water intake
• Fludrocortisione (Florinef)
• Beta-blocker
• Monitor (frequency, severity precipitating
  factors)

53
Long Q-T Syndrome

• Signs Symptoms
• fainting, palpitations, seizure or death
• Nursing Care
• Beta-blockers
• Pacemaker-defibrillator insertion
• Left cardiac sympathetic denervation
• Medication compliance

54
Rhythm Disturbances

• The nurse who can determine the baseline rhythm
  and recognize changes will facilitate the best
  outcome for a child with an arrhythmia
• Important questions
• Is the rhythm potentially fatal?
• Will it alter the cardiac output?

55
Invasive Tests

• Cardiac Catheterization
• Determines the pressures in heart radiographic
  picture of heart anatomy
• Interventional catheterization is a corrective
  procedure
• Post Catheterization Monitor - pressure dressing
  in the groin, heart rate, respirations blood
  pressure
• Angiography
• Visualizes the structures function of the
  ventricles, vessels valves size location of
  septal defects directs medical treatment

56

• Biopsy
• Routine biopsies to assess for cardiac transplant
  rejection
• Closure devices
• Close simple intracardiac communications or
  shunts
• Opening devices
• Angioplasty or Valvuloplasty
• Opens narrow vessels or valves
• Balloon atrial septostomy
• Emergent palliative procedure necessary to keep
  the child alive

57
Surgical Interventions

• Complete or palliative repair (Table 27-4)
• Pacemakers
• Used to treat cardiac conditions internal or
  external temporary or permanent
• Postoperative watch for s/s of infection
  ensure incision remains
• Follow-up care requires routine pacemaker testing
  

58
Cardiac Transplantation

• Corrects and prevents the condition from
  progressing
• Nursing Care
• Educate regarding medication compliance
• Communicating to family about frequent follow-up
  visits
• Educate family about post transplant tests
  rejection
• Address emotional psychological issues
• Address alterations in growth development

59
Nursing Care for the Child with a Cardiac
Condition

• Admission to the PICU (highly trained nurses)
• Assessment
• Nutrition
• Hygiene
• Activity
• Psychosocial care
• Vital signs
• Maintaining growth development
• Administering medications
• Performing lab tests
• Interpreting an ECG

60
Transferring the Stable Child to a Surgical or
Medical Unit

• Children have a more stable condition
• Telemetry monitoring
• Take less frequent vital signs
• Consider growth development
• Medications
• Draw blood for laboratory analysis
• ECG monitoring

61
Caring for Children with Cardiac Conditions
Across Care Settings

• Parent knows the child the best
• School
• Automatic external defibrillator
• Personnel should complete a CPR course
• Vital signs medication
• Teach the child family
• Cardiopulmonary Resuscitation (CPR)
• Vital Signs
• Medication
• Disease entity
• Resources