1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 41 Nursing Care of a Family When a Child Has a Cardiovascular Disorder

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Cardiovascular Disorder Assessment Nursing diagnosis Outcome identification, planning Implementation Outcome evaluation

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins The Cardiovascular System Terms –Systole –Diastole –Cardiac output –Preload –Afterload –Contractility

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Heart Disorders History Physical assessment –General appearance –Pulse, blood pressure, respirations –Murmurs

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Heart Disorders (cont’d) Diagnostic tests –Electrocardiogram –X-ray –Echocardiography –Phonocardiography, MRI –Exercise testing –Laboratory tests

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Promotion and Risk Management Congenital heart disease Acquired heart disease

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Care: Cardiac Disorder Provide information Review follow-up care, emergencies

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Care: Cardiac Disorder (cont’d) Cardiac catheterization –Preprocedure –Procedure –Postprocedure

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Care: Cardiac Disorder (cont’d) Cardiac surgery –Preoperative care –Preparing for surgery

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Care: Cardiac Disorder (cont’d) –Postoperative care Central venous pressure monitoring Pulmonary artery pressure monitoring Preventing pooling of lung secretions Complications Post cardiac surgery syndrome Post perfusion syndrome

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Care: Cardiac Disorder (cont’d) Artificial valve replacement Cardiac transplantation Pacemaker

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disorders Classification –Increased pulmonary blood flow –Obstruction of blood flow leaving heart –Mixed blood flow –Decreased pulmonary blood flow

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disorders (cont’d) Increased pulmonary blood flow –Ventricular septal defect –Atrial septal defect –Atrioventricular canal defect –Patent ductus arteriosus

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disorders (cont’d)

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Defects c > Pulmonary Blood Flow VSD= Opening in the septum that allows blood to shunt between L & R ventricle. May be associated with PDA, fetal alcohol syndrome, prematurity, Down’s & renal abnormalities

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment FTT, loud, harsh systolic murmur & palpable thrill, loud widely split pulmonic component of S2, displacement of PMI to L. Prominent anterior chest. Enlarged liver, hear & spleen Diaphoresis, tachycardia, rapid-grunting respirations

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Mgt VS, I&O, pulse ox, elevate HOB Digoxin, diuretics, & antibiotics Oral iron if anemia develops Spontaneous closure may occur by 6 mon Surgical closure

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disorders (cont’d)

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins PDA Lumen of the duct between pulmonary artery & aorta remains open. Right ventricle hypertrophies causing > pressure in pulmonary circulation

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Typical continuous systolic & diastolic “machinery” murmur heard in upper L sternal border or under L clavicle in older children

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Mgt PO or IV indomethacin-lowers PGE level which can lead to ductus closure Diuretics, antibiotics Surgery

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disorders (cont’d) Obstruction of blood flow –Pulmonary stenosis –Aortic stenosis –Coarctation of the aorta

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulmonary Stenosis Assessment Therapeutic Management

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulmonic Stenosis Narrowing of pulmonary valve or artery distal to valve

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Asymptomatic Mild R sided heart failure Cyanosis systolic ejection murmur grade IV or V ECK-R ventricular hypertrophy

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins MGT Balloon Angioplasty

27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Aortic Stenosis Assessment Therapeutic management

28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Aortic Stenosis Stenosis or stricture of valve prevents blood from passing freely from L ventricle into aorta. Increased pressure leads to hypertrophy of L ventricle can lead to > L atrium pressure leading to pulmonary edema Rough systolic murmur in aortic area

29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins MGT Beta or Calcium channel blockers Anticoagulants Antibiotics & Surgery

30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disorders (cont’d)

31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Obstruction to flow-Coarctation of Aorta Narrowing of the lumen of the aorta due to a constricting band. Leading cause of CHF in first few mon. of life

32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment If slight-absence of a palpable femoral pulse may be the only symptom. Obstruction proximal to L subclavian may have absent brachial pulse as well Evaluate femoral pulses on newborns

33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Leg pain secondary to < blood supply Soft or moderately loud systolic murmur- prominent at base of heart & transmitted to L intercapsler area

34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Mgt Surgery Prostaglandin E infusion-re-open or maintain a patent ductus arteriosus Inotropic agents Diuretics Antibiotics

35. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disorders (cont’d) Mixed blood flow –Transposition of great arteries –Total anomalous pulmonary venous return –Truncus arteriosis –Hypoplastic left heart syndrome

36. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Mixed Blood Flow Transposition of Great Arteries Aorta arises from R ventricle instead of L & pulmonary artery arises from L ventricle instead of R

37. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Cyanotic from birth Mgt-surgery

38. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disorders (cont’d)

39. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disorders (cont’d) Decreased pulmonary blood flow –Tricuspid atresia –Tetralogy of Fallot

40. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Congenital Heart Disorders (cont’d)

41. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Decreased Pulmonary Blood Flow Tetalogy of Fallot 4 anomalies present= pulmonary stenosis VSD dextroposition of aorta hypertrophy of R ventricle

42. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Skin develops blue tint Trouble sucking Polycythemia Dyspnea, growth restriction, Clubbing of fingers Squatting or knee chest position Tet spells (fainting & hypoxia)

43. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Mgt Inderal, antibiotics Temporary Surgery Full surgical correction at 1-2 yrs

44. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Heart Disease Congestive heart failure –Assessment –Therapeutic management Rest Oxygen Medications

45. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Heart Disease (cont’d) Persistent pulmonary hypertension Rheumatic fever –Assessment –Therapeutic management

46. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Heart Disease (cont’d) Kawasaki disease –Assessment –Therapeutic management

47. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Acquired Heart Disease (cont’d) Endocarditis Arrhythmias Hypertension Dyslipidemia Cardiomyopathy

48. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cardiopulmonary Arrest Assessment –Circulation –Airway –Breathing

49. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Cardiopulmonary Arrest (cont’d) Secondary measures –IV access –Medications Psychological support

50. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question When planning the care for a child with Kawasaki disease, which of the following would be most important? A.Making sure he performs postural drainage daily B.Observing him for symptoms of bowel obstruction C.Encouraging him to cough and deep-breathe D.Teaching him to live with a chronic illness

51. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Observing him for symptoms of bowel obstruction Rationale: Extreme enlargement of lymph nodes can occur with Kawasaki disease. If abdominal nodes increase in size, they can compress intestines, leading to bowel obstruction.

52. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question An 18-year-old with hypertension attends your ambulatory clinic. She currently takes an oral contraceptive and an over- the-counter vitamin pill daily. What health teaching would you initiate with her? A.Teach her not to take the oral contraceptive in the morning when blood pressure is highest. B.Suggest she discontinue the vitamin tablet to help reduce her blood pressure. C.Suggest she speak to her physician about whether she should remain on the oral contraceptive. D.Nothing. There is no relationship between use of oral contraceptives or vitamins and hypertension.

53. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Suggest she speak to her physician about whether she should remain on the oral contraceptive. Rationale: Adolescents with hypertension are advised not to take oral contraceptives because these elevate blood pressure.

54. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following criteria is used to define childhood hypertension? A.A systolic reading over 70 B.A systolic reading above the 95th percentile for the child’s age C.Sustained increased systolic and diastolic readings of 20 or more after minimal exercise D.An increase in either systolic or diastolic reading after exercise

55. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. A systolic reading above the 95th percentile for the child’s age Rationale: Hypertension in children is defined as a systolic reading above the 95th percentile.