Post on 22-Dec-2015
NURSING CARE OF THE CHILD WITH A
CARDIOVASCULAR DISEASE
ASSESSMENT OF HEART DISORDERS IN CHILDREN
• History
• Physical assessment– general
appearance– pulse, blood
pressure, & respirations
ASSESSMENT OF HEART DISORDERS IN CHILDREN
• Diagnostic tests– Electrocardiogram– Radiography– Echocardiography– Phonocardiography & magnetic resonance
imaging– Exercise testing– Laboratory tests
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
• Defects with increased pulmonary blood flow– Atrial Septal Defect
• Opening between the atria
• S/S– Murmur, second
heart sound splitting
• Management– Surgery
– 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
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
-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
– 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
• 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
• 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
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
• 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
• 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