NURSING CARE OF THE CHILD WITH A CARDIOVASCULAR DISEASE Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture 9

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 –Magnetic resonance imaging –Exercise testing –Laboratory tests

CLASIFICATION OF CHD A Cyanotic Heart Defect Move blood from arterial …to…venous system A Cyanotic Increased in pulmonary blood flow 1. ASD 2. VSD 3. AVC 4. PDA Obstruction of blood flow from ventricle 1.Pulmonary stenosis 2.Aortic stenosis 3.Coarctation of the Aorta 5

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 (small ones). Other larger VSDs may require open heart surgery

Defects with increased pulmonary blood flow –Atrial Septal Defect Opening between the atria S/S –Murmur Management –Surgery

A trial Sepal Defect (ASD)

**Obstruction of blood flow from ventricle 1.Pulmonary stenosis 2.Aortic stenosis 3.Coarctation of the Aorta 10

–Pulmonic Stenosis Narrowing of the pulmonary valve or artery causing the right ventricle to hypertrophy S/S –Mild right sided heart failure 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, leg pain Therapeutic Management –Surgery or angiography

Coarctation of the Aorta 14

Cyanotic Heart Defect Cyanotic Decreased pulmonary blood flow Mixed blood flow 16

**Defect with Decreased pulmonary blood flow 1.Tricuspid Artesia 2. Tetrology of Fallot 17

–Tricuspid Atresia The tricuspid valve is completely closed, allowing no blood to flow from the right atrium to the right ventricle. When these structures close, cyanosis, tachycardia, and dyspnea occur. Treatment consists of an IV infusion of PGE (prostaglandin) to keep the ductus open until surgery can be performed.

Tetrology of Fallot (TOF) 20

–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