Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 40 Nursing Care of the Child with a Cardiovascular Disorder

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Variations in Pediatric Anatomy and Physiology Circulatory changes from gestation to birth Structural and functional differences

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Common Medical Treatments and Drugs 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 –Most of these treatments will require a physician’s order when the child is in the hospital Multiple drugs are used to treat cardiovascular disease See Drug Guide 40.1

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Overview for the Child With a Cardiovascular Disorder Assessment –Health history – see Table 40.1 for assessment questions History of present illness Past medical history

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Overview for the Child With a Cardiovascular Disorder (cont.) Physical examination –Inspection –Palpation –Auscultation Location Relation to the heart cycle and duration Intensity Quality Variation with position

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A nurse is auscultating a child’s heart and notes that there are audible “clicks.” This assessment finding is suggestive of what type of problem? A.Valve dysfunction B.A defect in the heart wall C.Impaired oxygenation D.Electrical dysfunction

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A – Valve dysfunction Rationale: Ejection clicks, which are high-pitched, are related to problems with dilated vessels and/or valve abnormalities.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Overview for the Child With a Cardiovascular Disorder (cont.) Assessment –Laboratory and diagnostic testing – see Common Laboratory and Diagnostic Tests 40.1 –Cardiac catheterization Performing cardiac catheterization Preprocedure nursing management Postprocedure nursing management Nursing diagnoses and related interventions

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disease Pathophysiology Therapeutic management Disorders with decreased pulmonary blood flow Tetralogy of Fallot –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Question Is the following statement true or false? The cyanosis associated with tetralogy of Fallot primarily results from the mixing of oxygenated and poorly oxygenated blood.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: When shunting occurs in the child with tetralogy of Fallot, a mixing of oxygenated and poorly oxygenated blood occurs, with this blood ultimately being pumped into the systemic circulation. The oxygen saturation of the blood in the systemic circulation is reduced, leading to cyanosis.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disease (cont.) Disorders with decreased pulmonary blood flow (cont.) Tricuspid atresia –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic testing

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Congenital Heart Disease (cont.) Disorders with increased pulmonary flow Atrial septal defect –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Congenital Heart Disease (cont.) Disorders with increased pulmonary flow (cont.) Ventricular septal defect –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Congenital Heart Disease (cont.) Disorders with increased pulmonary flow (cont.) Atrioventricular septal defect (AVSD) –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Congenital Heart Disease (cont.) Disorders with increased pulmonary flow (cont.) Patent ductus arteriosus (PDA) –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Question Is the following statement true or false? Failure of the ductus arteriosus to close leads to continued blood flow from the pulmonary artery to the aorta.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Failure of the ductus arteriosus to close leads to inappropriate blood flow from the aorta to the pulmonary artery.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disease (cont.) Obstructive disorders Coarctation of the aorta –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Congenital Heart Disease (cont.) Obstructive disorders (cont.) Aortic stenosis –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Congenital Heart Disease (cont.) Obstructive disorders (cont.) Pulmonary stenosis –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Question A child is most likely to be asymptomatic if he or she has a diagnosis of: A.Tetralogy of Fallot B.Aortic stenosis C.AVSD

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B – Aortic stenosis Rationale: Typically, the child with aortic stenosis is asymptomatic. This is not the case in children who have AVSD or tetralogy of Fallot.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disease (cont.) Mixed defects Transposition of the great vessels (arteries) –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Congenital Heart Disease (cont.) Mixed defects (cont.) Total anomalous pulmonary venous return (TAPVR) –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Congenital Heart Disease (cont.) Mixed defects (cont.) Truncus arteriosus –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Congenital Heart Disease (cont.) Mixed defects (cont.) Hypoplastic left heart syndrome (HLHS) –Pathophysiology –Nursing assessment Health history and physical examination Laboratory and diagnostic tests

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Congenital Heart Disease (cont.) Nursing management of the child with CHD Improving oxygenation Promoting adequate nutrition Assisting the child and family to cope Preventing infection

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disease (cont.) Nursing management of the child with CHD (cont.) –Providing care for the child undergoing cardiac surgery –Providing preoperative care –Providing postoperative care –Providing patient and family education

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Cardiovascular Disorders Heart failure Pathophysiology Therapeutic management Nursing assessment –Health history and physical examination –Laboratory and diagnostic tests

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Acquired Cardiovascular Disorders (cont.) Heart failure (cont.) Nursing management –Promoting oxygenation –Supporting cardiac function –Providing adequate nutrition –Promoting rest Patient and family education

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The child with a diagnosis of heart failure should be positioned supine in order to promote oxygenation and circulation.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: The nurse should position the infant or child with HF in a semi-upright position to decrease work of breathing and lessen pulmonary congestion.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Cardiovascular Disorders (cont.) Infective endocarditis Nursing assessment –Health history and physical examination Nursing management Patient and family education

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Cardiovascular Disorders (cont.) Acute rheumatic fever Nursing assessment Nursing management Patient and family education

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Cardiovascular Disorders (cont.) Cardiomyopathy Nursing assessment Nursing management Patient and family education

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Cardiovascular Disorders (cont.) Hypertension Pathophysiology Nursing assessment –Physical examination –Laboratory and diagnostic testing Nursing management Patient and family education

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Cardiovascular Disorders (cont.) Kawasaki disease Pathophysiology Nursing assessment –Health history and physical examination –Laboratory and diagnostic testing

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Cardiovascular Disorders (cont.) Kawasaki disease (cont.) Nursing management –Monitoring cardiac status –Promoting comfort –Providing patient and family education

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Cardiovascular Disorders (cont.) Hyperlipidemia Pathophysiology Therapeutic management Nursing assessment Nursing management Patient and family education

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Cardiovascular Disorders (cont.) Heart transplantation Surgical procedure and postoperative therapeutic management Nursing management Patient and family education