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