Cardiovascular Dysfunction Chapter 42 Cardiovascular Dysfunction All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Types of Cardiac Defects Congenital Anatomic: abnormal function present at birth Acquired Disease process Infection Autoimmune response Environmental factors Familial tendencies All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Types of Cardiac Defects (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Cardiovascular Dysfunction History and physical examination Poor feeding Tachypnea/tachycardia Failure to thrive/poor weight gain Activity intolerance Developmental delays Positive prenatal history Positive family history of cardiac disease All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Cardiovascular Dysfunction (Cont.) Inspection Nutritional status Color Chest deformities Unusual pulsations Respiratory excursion Clubbing of fingers All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Cardiovascular Dysfunction (Cont.) Palpation and percussion Chest Abdomen Peripheral pulses Heart rate and rhythm Character of heart sounds All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Cardiovascular Dysfunction (Cont.) Diagnostic evaluation Electrocardiography Echocardiography Cardiac catheterization Diagnostic Interventional Electrophysiology studies All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Cardiovascular Dysfunction (Cont.) Nursing care: cardiac catheterization Preprocedural care Postprocedural care Vital signs Dressings Fluid intake Blood glucose levels All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Congenital Heart Disease (CHD) Incidence: 5-8 per 1000 live births About 2 or 3 of these cases are symptomatic in first year of life Major cause of death in first year of life (after prematurity) Most common anomaly is ventricular septal defect Often associated with other anomalies (trisomies 21, 13, 18) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Congenital Heart Disease (Cont.) Altered hemodynamics Acyanotic Cyanotic Classification of defects Blood flows from an area of high pressure to one of lower pressure Blood takes the path of least resistance Left-to-right shunt Right-to-left shunt All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Classification of Defects Increased pulmonary blood flow Decreased pulmonary blood flow Obstruction to blood flow out of the heart Valvular Subvalvular Supravalvular Mixed blood flow All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Classification of Defects (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Defects with Increased Pulmonary Blood Flow Abnormal connection between two sides of heart Increased blood volume on right side of heart Increased pulmonary blood flow Decreased systemic blood flow All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Defects with Increased Pulmonary Blood Flow (Cont.) Atrial septal defect Ventricular septal defect Patent ductus arteriosus All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Defects with Increased Pulmonary Blood Flow (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Obstructive Defects Anatomic narrowing of blood vessel exiting the heart Coarctation of the aorta Aortic stenosis Pulmonic stenosis All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Obstructive Defects (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Defects Causing Decreased Pulmonary Blood Flow Obstruction of pulmonary blood flow and an anatomic defect Tetralogy of Fallot Tricuspid atresia All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Defects Causing Decreased Pulmonary Blood Flow (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Mixed Defects Many complex cardiac anomalies Transposition of great arteries or vessels Total anomalous pulmonary venous connection Truncus arteriosis Hypoplastic left heart syndrome All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Congestive Heart Failure The inability of the heart to pump an adequate amount of blood into the systemic circulation In children, occurs as result of structural abnormalities Heart muscle: may become damaged if left untreated Right- or left-sided failure All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Congestive Heart Failure (Cont.) Clinical manifestations Impaired myocardial function Pulmonary congestion Systemic venous congestion Diagnostic evaluation Made on the basis of clinical symptoms All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Congestive Heart Failure (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Therapeutic Management of Congestive Heart Failure Improve cardiac function Remove accumulated fluid and sodium Decrease cardiac demands Improve tissue oxygenation All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Nursing Care Assist in measures to improve cardiac function Monitor afterload reduction Decrease cardiac demands Reduce respiratory distress Maintain nutritional status Assist in measures to promote fluid loss Support child and family All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Hypoxemia Condition in which arterial oxygen tension is less than normal Identified by a decreased arterial O2 saturation Hypoxia Cyanosis Polycythemia Clubbing All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Hypoxemia (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Hypoxemia (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Care of the Family and Child Help the family adjust to the disorder Educate the family about the disease Help families manage the illness at home Prepare child and family for invasive procedures Provide postoperative care Plan for discharge and home care All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Care of the Family and Child (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Bacterial (Infective) Endocarditis An infection of the inner lining of the endocardium Streptococcus Staphylococcus Fungal infections Prophylaxis: 1 hour before procedures All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Rheumatic Fever and Rheumatic Heart Disease Inflammatory disease occurs after group A β-hemolytic streptococcal pharyngitis Infrequent in United States; devastating problem in developing countries Affects joints, skin, brain, serous surfaces, and heart Rheumatic heart disease Permanent valve damage All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Hyperlipidemia (Hypercholesterolemia) Excessive lipids (fat and fatlike substances) Children at risk: identify and treat early Care management Compliance with drug regimen Facilitating recovery from illness Dietary prevention of disease All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Cardiac Dysrhythmias Can occur in children with normal hearts Bradydysrhythmias Abnormally slow rate Tachydysrhythmias Abnormally rapid rate Conduction disturbances Irregular heart rate All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Pulmonary Artery Hypertension A group of rare disorders that result in an elevation of pulmonary artery pressure Clinical manifestations Dyspnea with exercise Chest pain Syncope All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Cardiomyopathy Abnormalities of the myocardium in which the ability of the muscle to contract is impaired Familial or genetic cause Infection Deficiency states Metabolic abnormalities Collagen vascular disease All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Heart Transplantation Orthotopic transplantation Heterotopic transplantation (piggyback) Organ donation evaluation Ventricular assist devices Rejection Potential long-term problems All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Systemic Hypertension Essential: no known cause Secondary: identifiable cause Pediatrics: hypertension generally secondary to structural abnormality or underlying pathology Renal disease Cardiovascular disease Endocrine or neurologic disorders All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Kawasaki Disease Monocutaneous lymph node syndrome Acute systemic vasculitis of unknown cause 75% of cases: in children younger than 5 years Self-limiting Increased risk of formation of coronary artery aneurysm All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Shock Compensated shock Decompensated shock Irreversible or terminal shock Anaphylaxis Septic shock All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Question Surgical closure of the ductus arteriosus would A. Stop the loss of unoxygenated blood to the systemic circulation B. Decrease the edema in the legs and feet C. Increase the oxygenation of blood D. Prevent the return of oxygenated blood to the lungs All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.