Congenital Heart Disease in Maternal and Child Health Nursing
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Questions and Answers

What is the definition of congenital heart disease?

  • A defect in the heart that develops after birth
  • A structural, functional or positional defect of the heart present from birth (correct)
  • A heart condition caused by infections during pregnancy
  • A heart condition that only affects children

    • What is the incidence of congenital heart disease in newborns?

  • 8:1000 births (correct)
  • 20:1000 births
  • 1:1000 births
  • 10:1000 births

    • What is a possible cause of congenital heart disease?

  • Eating a balanced diet during pregnancy
  • Taking vitamins during pregnancy
  • Exercising regularly during pregnancy
  • Using certain medications or drugs during pregnancy (correct)

    • What is the role of the placenta in fetal circulation?

    <p>It accepts the bluest blood from the fetus and oxygenates it</p> Signup and view all the answers

    What is the path of the oxygenated blood in the fetus?

    <p>Umbilical vein to the left atrium and then to the left ventricle</p> Signup and view all the answers

    What is the function of the foramen ovale in fetal circulation?

    <p>It allows blood to flow from the right atrium to the left atrium</p> Signup and view all the answers

    Which of the following genetic conditions is associated with congenital heart disease?

    <p>Both A and B</p> Signup and view all the answers

    Why is fetal circulation more complicated than after birth?

    <p>Because the mother's heart is doing the work of the fetus's lungs</p> Signup and view all the answers

    What is the primary function of the ductus arteriosus in fetal circulation?

    <p>To shunt a major portion of the blood from the pulmonary artery to the descending aorta</p> Signup and view all the answers

    What happens to the ductus arteriosus after birth?

    <p>It withers and closes off, becoming unnecessary for circulation</p> Signup and view all the answers

    What is the primary cause of cyanotic heart defects?

    <p>Obstruction to blood flow from ventricles</p> Signup and view all the answers

    What is the name of the abnormal duct that occurs when the ductus arteriosus fails to close after birth?

    <p>Patent Ductus Arteriosis (PDA)</p> Signup and view all the answers

    Which of the following is a major cyanotic heart defect that causes obstruction to blood flow from ventricles?

    <p>Pulmonic Stenosis (PS)</p> Signup and view all the answers

    What is the sex ratio for Patent Ductus Arteriosis (PDA)?

    <p>Female to male ratio of 2:1</p> Signup and view all the answers

    Which of the following is associated with a higher incidence of Patent Ductus Arteriosis (PDA)?

    <p>Premature birth</p> Signup and view all the answers

    What is the effect of the closure of the foramen ovale on blood circulation?

    <p>Normal circulation of blood through the heart</p> Signup and view all the answers

    What is the typical time frame for the closure of the ductus arteriosus after birth?

    <p>Within the first 10 to 15 hours of life</p> Signup and view all the answers

    What is the characteristic murmur of a patent ductus arteriosus?

    <p>A loud machine like murmur</p> Signup and view all the answers

    What is a potential complication of a patent ductus arteriosus?

    <p>Bacterial endocarditis</p> Signup and view all the answers

    What is the primary cause of left ventricular hypertrophy in coarctation of the aorta?

    <p>Increased work load on the left ventricle</p> Signup and view all the answers

    What is a common symptom of coarctation of the aorta?

    <p>Leg muscle cramps due to tissue anoxia</p> Signup and view all the answers

    What is the goal of surgical management for coarctation of the aorta?

    <p>To remove the stenotic area</p> Signup and view all the answers

    What is the primary characteristic of tetralogy of Fallot?

    <p>Decreased pulmonary blood flow</p> Signup and view all the answers

    What is the primary goal of management for coarctation of the aorta in asymptomatic children?

    <p>To postpone the operation until the descending aorta is at least 50% of the adult size</p> Signup and view all the answers

    What is the primary reason for central cyanosis in tetralogy of Fallot?

    <p>Decreased pulmonic blood flow due to blood flow obstruction from the right ventricular into the pulmonic artery</p> Signup and view all the answers

    What is the purpose of squatting position in infants with tetralogy of Fallot?

    <p>To increase pulmonary blood flow and eventually oxygenated blood in the systemic circulation</p> Signup and view all the answers

    What is the anatomical defect in tetralogy of Fallot that results in overriding of the aorta?

    <p>Ventricular septal defects</p> Signup and view all the answers

    Why are neonates with tetralogy of Fallot not cyanotic at birth?

    <p>Because of the presence of patent ductus arteriosis</p> Signup and view all the answers

    What is the purpose of antibiotic prophylaxis in patients with tetralogy of Fallot?

    <p>To prevent endocarditis during tooth extraction, GIT, or urinary procedure</p> Signup and view all the answers

    What is the defect in transposition of great vessels?

    <p>Aorta arises from the right ventricle and pulmonary artery arises from the left ventricle</p> Signup and view all the answers

    What is the characteristic of long-standing cases of tetralogy of Fallot?

    <p>Clubbing of the fingers and toes</p> Signup and view all the answers

    What is the treatment for cyanotic spells in patients with tetralogy of Fallot?

    <p>All of the above</p> Signup and view all the answers

    Study Notes

    Congenital Heart Disease (CHD)

    • Definition: A structural, functional, or positional defect of the heart present from birth, which may manifest at any time after birth or may not manifest at all.

    Incidence

    • 8:1000 births

    Causes of Congenital Heart Defects

    • Unknown etiology in most cases
    • Factors associated with a higher incidence:
      • Infections during pregnancy (e.g., rubella)
      • Certain medications or drugs (e.g., alcohol or tobacco) during pregnancy
      • Poor nutritional status or obesity in the mother
      • Genetic conditions (e.g., Down syndrome, Turner syndrome, Marfan syndrome)

    Fetal Circulation

    • Fetal blood flow is more complicated than after birth
    • The placenta accepts deoxygenated blood from the fetus through the umbilical arteries
    • Oxygenated blood returns to the fetus through the umbilical vein
    • Blood enters the right side of the heart, then the left side, and finally the aorta

    Changes at Birth

    • With the first breaths of air, the fetal circulation changes
    • The ductus arteriosus closes over the first few days of life
    • The foramen ovale closes due to increased pressure in the left atrium
    • Blood circulates in a normal way

    Classification of Congenital Heart Disease

    A. Acyanotic Heart Defects

    Patent Ductus Arteriosis (PDA)

    • Definition: Abnormal duct between the aortic and pulmonary circulation that occurs when the ductus arteriosus fails to close after birth
    • Incidence: More common in females than males (2:1), higher in premature babies, and associated with maternal rubella
    • Pathophysiology: Failure of the ductus arteriosus to close after birth
    • Clinical manifestations:
      • Loud machinery-like murmur
      • Dyspnea
      • Underweight child
      • Frequent respiratory tract infections
      • CHF with poor feeding, fatigue, hepatosplenomegaly, and tachypnea
      • Pounding pulse rate
    • Therapeutic Management:
      • Supportive: fluid restriction with diuretics and digitalization for CHF
      • Surgical: surgery can be performed at any time, preferably at 6 months of age
    • Complications:
      • Bacterial endocarditis
      • Congestive heart failure
      • Pulmonary hypertension

    Coarctation of the Aorta

    • Definition: Narrowing of the aorta at the level of the ductus arteriosus
    • Pathophysiology:
      • Left ventricular hypertrophy occurs due to increased workload
      • Pulmonary edema occurs due to left ventricular failure and increased left arterial pressure
    • Assessment Findings:
      • Child may be asymptomatic
      • Blood pressure is higher, resulting in headache, dizziness, fainting, difference in pulse pressure, and pulse between the upper and lower extremities
      • Leg muscle cramps due to tissue anoxia
      • The legs may be cooler than the arms
    • Management:
      • Surgical removal of the stenotic area or nonsurgical by balloon angioplasty
      • If blood pressure is not elevated and heart failure is not a problem, it is wise to postpone the operation until the descending aorta is at least 50% of the adult size (age 3 to 6 years)

    B. Cyanotic Heart Defects

    Tetralogy of Fallot

    • Definition: A combination of four anomalies:
      • Ventricular septal defect
      • Overriding of the aorta
      • Pulmonic valve stenosis
      • Right ventricular hypertrophy
    • Pathophysiology:
      • Defects result in decreased pulmonic blood flow and right ventricular hypertrophy with shunting of blood from the right to the left side of the heart
      • Central cyanosis occurs, depending on the severity of blood flow obstruction from the right ventricle into the pulmonary artery
    • Assessment:
      • The neonates who have tetralogy of Fallot are not cyanotic since birth due to the presence of the patent ductus arteriosis
      • Clubbing of the fingers and toes in long-standing cases
      • Stunted growth
      • Infant and toddler assume the squatting position to relieve dyspnea
    • Management:
      • Medical:
        • Antibiotic prophylaxis before tooth extraction, GIT, or urinary procedure
        • Treatment of cyanotic spells by O2 therapy, knee-chest position, morphine sulfate, I.V beta-adrenergic blockers, and I.V sodium bicarbonate if acidosis is present
      • Surgical:
        • Palliative and total corrective surgery is being done on infants and children of all ages

    Transposition of Great Arteries

    • Definition: The aorta arises from the right ventricle instead of the left ventricle, and the pulmonary artery arises from the left ventricle.

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    Description

    This quiz covers congenital heart disease, including definition, incidence, and cyanotic heart diseases, in the context of maternal and child health nursing.

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