Transcript NURSING CARE OF THE CHILD WITH A

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