CHILD WITH CHILD WITH CARDIOVASCULAR CARDIOVASCULAR

DYSFUNCTIONDYSFUNCTION

KAREN E. MILESKAREN E. MILESFLORIDA GULF COAST FLORIDA GULF COAST

UNIVERSITYUNIVERSITYDEPARTMENT OF NURSINGDEPARTMENT OF NURSING

CONGENITAL HEART CONGENITAL HEART DEFECTSDEFECTS

INCIDENCEINCIDENCE

1-2% of all live 1-2% of all live birthsbirths

Increases to 3% if Increases to 3% if have another child have another child with CHDwith CHD

4-10 in 1000 live 4-10 in 1000 live birthsbirths

ETIOLOGYETIOLOGY

Multifactorial Multifactorial InheritanceInheritance

OthersOthers

Maternal RubellaMaternal RubellaMaternal AlcoholismMaternal AlcoholismMaternal Diabetes Maternal Diabetes MellitusMellitus

Down SyndromeDown SyndromeTrisomy #13 & #18Trisomy #13 & #18Turner’s SyndromeTurner’s Syndrome Marfan’s SyndromeMarfan’s SyndromeDi George SyndromeDi George Syndrome

CLASSIFICATION OF CHDCLASSIFICATION OF CHD

LEFT-TO-RIGHT SHUNTING LEFT-TO-RIGHT SHUNTING LESIONSLESIONS

Ventricular Septal Defect (VSD)Ventricular Septal Defect (VSD) Atrial Septal Defect (ASD)Atrial Septal Defect (ASD) Patent Ductus Arteriosus (PDA)Patent Ductus Arteriosus (PDA) AV Canal or Endocardial Cushion DefectAV Canal or Endocardial Cushion Defect

OBSTRUCTIVE LESIONSOBSTRUCTIVE LESIONS

Pulmonary Stenosis (PS)Pulmonary Stenosis (PS) Aortic Stenosis (AS)Aortic Stenosis (AS) Coarctation of Aorta (COA)Coarctation of Aorta (COA)

ADMIXTURE LESIONSADMIXTURE LESIONS

Transposition of Great Vessels (TGV)Transposition of Great Vessels (TGV) Total Anomalous Venous Connection Total Anomalous Venous Connection

(TAPVC)(TAPVC) Truncus ArteriosusTruncus Arteriosus

RIGHT-SIDED OBSTRUCTIVE RIGHT-SIDED OBSTRUCTIVE LESIONSLESIONS

Tetralogy of Fallot (TOF)Tetralogy of Fallot (TOF) Tricuspid AtresiaTricuspid Atresia Pulmonary AtresiaPulmonary Atresia

PULMONARY VENOUS PULMONARY VENOUS OBSTRUCTIVE LESIONSOBSTRUCTIVE LESIONS

Mitral/Aortic AtresiaMitral/Aortic Atresia CardiomyopathyCardiomyopathy

OTHEROTHER Hypoplastic Left Heart SyndromeHypoplastic Left Heart Syndrome

NURSING CARE OF NURSING CARE OF CHILD WITH CHDCHILD WITH CHD

A. A. Understand the causes, Understand the causes, pathophys., pathophys., clinical manif., clinical manif., diag. evaluation, and diag. evaluation, and therapeutic management of CHFtherapeutic management of CHF

Causes:Causes: Volume overloadVolume overload Pressure overloadPressure overload Decreased contractilityDecreased contractility High cardiac output demandsHigh cardiac output demands

Clinical ManifestationsClinical Manifestations Tachycardia - resting rate greater than Tachycardia - resting rate greater than

160 beats/min in infants160 beats/min in infants DiaphoresisDiaphoresis Easily fatiguedEasily fatigued Poor exercise tolerancePoor exercise tolerance Poor perfusion - cold extremities, weak Poor perfusion - cold extremities, weak

pulses, low BP, mottled skinpulses, low BP, mottled skin

Tachypnea - greater than 60 Tachypnea - greater than 60 breaths/min in infantsbreaths/min in infants

Mild cyanosisMild cyanosis DyspneaDyspnea RetractionsRetractions OrthopneaOrthopnea Wheezing coughWheezing cough

HepatomegalyHepatomegaly Weight gainWeight gain EdemaEdema Distended neck & peripheral veinsDistended neck & peripheral veins

DIAGNOSTIC EVALUATIONDIAGNOSTIC EVALUATION Chest X-RayChest X-Ray ECGECG Echo-cardiogramEcho-cardiogram

B.B. PROVIDE SAFE & PROVIDE SAFE & THERAPEUTICTHERAPEUTIC NURSING NURSING CARECAREIdentify Early Signs of CHFIdentify Early Signs of CHF TachycardiaTachycardia TachypneaTachypnea Profuse scalp sweatingProfuse scalp sweating Fatigue and irritabilityFatigue and irritability Sudden weight gainSudden weight gain Respiratory distress Respiratory distress

IMPROVE CARDIAC FUNCTIONIMPROVE CARDIAC FUNCTION Administer Digoxin (Lanoxin) Administer Digoxin (Lanoxin)

check apical pulsecheck apical pulse observe for signs of toxicityobserve for signs of toxicityPROMOTE FLUID LOSSPROMOTE FLUID LOSS Administer Diuretics (Lasix, Diuril, Aldactone)Administer Diuretics (Lasix, Diuril, Aldactone) Possible fluid restrictionsPossible fluid restrictions Possible sodium restrictionsPossible sodium restrictions Monitor intake and outputMonitor intake and output

DECREASE CARDIAC DEMANDSDECREASE CARDIAC DEMANDS Prevent cold stress in infantsPrevent cold stress in infants Treat any infectionTreat any infection Rest and conservation of energyRest and conservation of energy Minimize unnecessary stressMinimize unnecessary stress

REDUCE RESPIRATORY DISTRESSREDUCE RESPIRATORY DISTRESS Position with HOB elevatedPosition with HOB elevated Administer OxygenAdminister Oxygen Monitor Respiratory Rate and EffortMonitor Respiratory Rate and Effort

MAINTAIN NUTRITIONAL STATUSMAINTAIN NUTRITIONAL STATUS Increase CaloriesIncrease Calories PositioningPositioning Alternate Feeding TechniquesAlternate Feeding Techniques

SUPPORT CHILD AND FAMILYSUPPORT CHILD AND FAMILY Foster Parent-To-Infant AttachmentFoster Parent-To-Infant Attachment Encourage Parents to StayEncourage Parents to Stay Give Clear ExplanationsGive Clear Explanations Keep InformedKeep Informed Provide Emotional SupportProvide Emotional Support