1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 40 Nursing Care of the Child With a Cardiovascular Disorder Maternity and Pediatric Nursing

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Variations in Pediatric Anatomy and Physiology Circulatory Changes from Gestation to Birth Structural and Functional Differences

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

4. Common Medical Treatments A variety of medications as well as other medical treatments and surgical procedures are used to treat cardiovascular problems in children (see Common Medical Treatments 40-1 and Drug Guide 40-1). Physician’s order is necessary for most of these treatments when the child is in the hospital.

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Overview for the Child with a Cardiovascular Disorder Assessment –Health History (see Table 40-1) History of Present Illness Past Medical History –Physical Examination Inspection Palpation Auscultation

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Overview (cont’d) Assessment (cont’d) –Laboratory and Diagnostic Testing (see Common Laboratory and Diagnostic Tests 40-1) –Cardiac Catheterization Procedure (right-side, left-side) Nursing Management (before and after procedure; see Teaching Guideline 40-1) Nursing Diagnoses and Related Interventions (see Nursing Care Plan 40-1)

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? For a right-sided catheterization, the catheter is threaded to the right atrium.

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. In a right-sided catheterization, the radiopaque catheter is inserted to the right atrium.

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disease Pathophysiology Categories –Disorders with decreased pulmonary blood flow (tetralogy of Fallot; tricuspid atresia) –Disorders with increased pulmonary blood flow (PDA, ASD, VSD, ACD) –Obstructive disorders (coarctation of aorta, aortic stenosis, pulmonary stenosis) –Mixed disorders (TGV, TAPVR, hypoplastic left heart syndrome) Therapeutic Management (see Table 40-2)

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The nurse would identify which congenital heart disease as involving increased pulmonary blood flow? A.Triscupid atresia B.Patent ductus arteriosus C.Tetralogy of Fallot D.Aortic stenosis

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Patent ductus arteriosus is a congenital heart disease that involves increased pulmonary blood flow. Tricuspid atresia and tetralogy of Fallot are disorders involving decreased pulmonary blood flow. Aortic stenosis is an obstructive disorder.

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders with Decreased Pulmonary Blood Flow Tetralogy of Fallot –Pathophysiology –Nursing Assessment Health History and Physical Examination Laboratory and Diagnostic Tests Tricuspid Atresia (see Figure 40-3) –Pathophysiology –Nursing Assessment Health History and Physical Examination Laboratory and Diagnostic Tests

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders with Increased Pulmonary Flow Atrial Septal Defect (see Figure 40-4) –Pathophysiology –Nursing Assessment Ventricular Septal Defect (see Figure 40-5) –Pathophysiology –Nursing Assessment

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders with Increased Pulmonary Flow (cont’d) Atrrioventricular Canal Defect (see Figure 40-6) –Pathophysiology –Nursing Assessment Patent Ductus Arteriosus (see Figure 40-7) –Pathophysiology –Nursing Assessment

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Obstructive Disorders Coarctation of the Aorta (see Figure 40-8) –Pathophysiology –Nursing Assessment Aortic Stenosis (See Figure 40-9) –Pathophysiology –Nursing Assessment Pulmonary Stenosis (see Figure 40-10) –Pathophysiology –Nursing Assessment

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Mixed Defects Transposition of the Great Vessels (see Figure 40-11) –Pathophysiology –Nursing Assessment Total Anomalous Pulmonary Venous Connection (TAPVC; see figure 40-12) –Pathophysiology –Nursing Assessment Truncus Arteriosus (see Figure 40-13) –Pathophysiology –Nursing Assessment

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Mixed Defects (cont’d) Hypoplastic Left Heart Syndrome (HLHS; see Figure 40-14) –Pathophysiology –Nursing Assessment

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Management of the Child with CHD Improving Oxygenation (see Box 40-1) Promoting Adequate Nutrition Assisting the Child and Family to Cope Preventing Infection Providing Care for the Child Undergoing Cardiac Surgery –Providing Preoperative Care –Providing Postoperative Care (see Box 40-2) Providing Patient and Family Education (see Teaching Guidelines 40-2)

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A child with CHD experiences hypercyanotic spells. The nurse would place the child in which position for relief? A.Supine B.Trendelenburg C.Knee-to-chest D.Prone

20. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. To relieve hypercyanotic spells, the child should be placed in the knee-to-chest position.

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Cardiovascular Disorders Heart failure Infective endocarditis Acute rheumatic fever Cardiomyopathy Hypertension Kawasaki disease Hyperlipidemia

22. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Heart Failure Pathophysiology (see Figure 40-15) Therapeutic Management: supportive; drug therapy (digitalis, diuretics, inotropic agents, vasodilators, antiarrhythmics, and antithrombotics) Nursing Assessment –Health History –Physical Examination –Laboratory and Diagnostic Tests

23. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Heart Failure (cont’d) Nursing Management –Promoting Oxygenation –Supporting Cardiac Function –Providing Adequate Nutrition –Promoting Rest –Educating the Child and Family

24. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Infective Endocarditis Therapeutic Management (antibiotic or antifungal therapy Nursing Assessment –Health History –Physical Examination Nursing Management (see Box 40-3)

25. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Acute Rheumatic Fever Diagnosis using modified Jones’ criteria (see Box 40- 4) Therapeutic Management: managing inflammation and fever, eradicating bacteria, preventing permanent heart damage, preventing recurrences Nursing Assessment Nursing Management –Compliance with therapy –Prophylaxis –Child and family education

26. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? The diagnosis of acute rheumatic fever requires evidence of a positive culture for streptococcus.

27. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. The diagnosis of acute rheumatic fever is based on the modified Jones’ criteria; this requires the presence of either two major criteria or one major plus two minor criteria, none of which is a positive streptococcal culture.

28. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Cardiomyopathy 3 types: restrictive, dilated, hypertrophic Therapeutic Management: improvement of heart function and blood pressure (mechanical ventilation, vasoactive medications, pacemakers, or surgery) Nursing Assessment Nursing Management –Monitoring for complications –Medication administration –Child and family support and education

29. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Hypertension Pathophysiology Nursing Assessment –Health History: risk factors, signs and symptoms –Physical Examination: inspection, auscultation –Laboratory and Diagnostic Testing Nursing Management

30. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Kawasaki Disease Pathophysiology Therapeutic Management Nursing Assessment –Health History and Physical Examination –Laboratory and Diagnostic Testing Nursing Management –Monitoring Cardiac Status –Promoting Comfort –Providing Patient and Family Education

31. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Hyperlipidemia Pathophysiology Therapeutic Management Nursing Assessment –Health History and Physical Examination –Lipid Levels (see Table 40-3) Nursing Management –Diet –Physical Activity –Medications –Education

32. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Heart Transplantation Indications Candidates and Evaluation Surgical Procedure and Postoperative Therapeutic Management Nursing Management –Preoperative care –Postoperative care –Patient and family education

33. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation