Congenital Heart Congenital Heart Disease in ChildrenDisease in Children

Dr. Sara Mitchell January 31. 2007

Changes in circulation at birth Foramen ovale

________ Ductus arteriosis

________ Ductus venous

________ Umbilical vein & artery

_________

Differences in the pediatric heart

Heart rate ______& stroke volume ______ than in adults

______ _______ are normal findings in infants

the ______’s thorax is _____-______ the ______'s thorax is ________ by age __ years, the AP:transverse thorax

has mature proportions

Differences in the pediatric heart(continued)

The PMI is located at the __th intercostal space in the child younger than __ years of age

The apical pulse may be visible

Congenital heart diseasewhat's the incidence?

~ 40,000 babies are born each year in the Untied States with congenital heart disease

Congenital heart diseasewhat’s the cause?

~90% of congenital heart disease is thought to be due to ___________ ____________

Congenital heart diseaseWhen in gestation does it occur?

Development of the heart and great vessels occurs between the 2nd & 9th week of gestation

Congenital heart disease:name the types Lesions with increased pulmonary

blood flow Lesions with decreased pulmonary

blood flow Mixed circulation defects Obstructive lesions

Lesions with ________ pulmonary blood flow: What are they?

______ septal defect (ASD) ______ ductus arterious (PDA) _________ septal defect (VSD) AV canal defect

Ventricular Septal Defect

Lesions with decreased pulmonary blood flow

_________ of _____ ________ atresia _________ atresia Epstein anomaly

Tetralogy of Fallot

Tricuspid Atresia

TET spells – what are they?

_____________ spells May occur in any child whose heart

defect includes ________ to ________ blood flow and communication between the ventricles

TET spells - what do they look like

The infant becomes acutely cyanotic because of sudden ________ in pulmonary blood flow and _______ in _______-to-____ shunting.

Spells occur more often in the _______ May be preceded by feeding, crying,

or defecation.

TET spells need to be treated ASAP to prevent _______ ______ with resulting brain damage and possible _______

TET spells – what is the management? Place infant in ____-_____

position Employ calm, comforting

approach Administer _____% O2 by

face mask Give ________ SQ or IV Begin IV fluid

replacement and volume expansion if needed

Mixed Circulation defects What are they?

___________ of the great arteries Total anomalous _________ venous

connection Trucus Arterious Hypoplastic ______ Heart Syndrome

Transposition of the great arteries

Truncus Arterious

Obstructive cardiac lesions:What are they? _________ stenosis

Aortic stenosis

__________ of the Aorta

Coarctation of the aorta

Pulmonic Stenosis

Cardiac Catherization

Pre-Op assessment accurate ________ assess & mark _____ _______. baseline ___ explain procedure to child & family

Cardiac catheterization (continued)

Post-Op assessment be aware of most common complications check pulses ______ cath site check color and temperature of affected

extremity check vital signs every 15 minutes (per facility

policy). * Be sure to check heart rate for a full 60 seconds

**___________________________________________________________________________

Congestive heart failure

Causes of CHF can be classified according to the following changes:Volume overload*Pressure overload*Decreased contractilityHigh cardiac output demands * = most common in children in which structural

abnormalities result in an increased volume load or

increased pressure load on the ventricles.

Therapeutic management of Therapeutic management of congestive heart failurecongestive heart failure Two groups of drugs are used to

enhance myocardial function in CHF:Digatalis - improves contractility

ACE inhibitors - reduce the afterload on the heart making it easier for the heart to pump

Diuretics - remove excess fluid

Things to know about giving Things to know about giving digoxin to infants & childrendigoxin to infants & children Always check the dosage with a

_______ _______ before giving. Count the ______ pulse Monitor for signs & symptoms of

toxicity Know what to do if a dose is missed

Nursing care plan for a child with congenital heart disease

Problem Goal/Outcome Intervention

1. ________ cardiac output R/T structural defect, myocardial dysfunction.

2. Ineffective breathing pattern R/T _________ _______.

3. Fluid volume excess R/T _____ ________

4.Activity intolerance R/T___________.

5. Risk for infection R/T reduced body______________.

6. Altered family processes R/T a child with life-threatening illness

The child will exhibit

1. Improved _________

2. Improved respiratory function

3. No evidence of fluid excess

4. The child will experience decreased cardiac demands.

5. The child will maintain adequate nutritional status

6. The child/family will receive adequate support & education

Rationale