Lecture 5 Cardiovascular PDF

Nursing care of children with altered cardiovascular function  Objectives ▪ Identify Physiological differences between pediatrics and adults ▪ Identify etiological factors for CHD. ▪ Discuss classifications of CHD. ▪ Define ASD, TOF. ▪ List signs and symptoms for ASD, T...

Nursing care of children with altered cardiovascular function  Objectives ▪ Identify Physiological differences between pediatrics and adults ▪ Identify etiological factors for CHD. ▪ Discuss classifications of CHD. ▪ Define ASD, TOF. ▪ List signs and symptoms for ASD, TOF. ▪ Describe medical/nursing management for ASD, TOF. ▪ Nursing Diagnosis of Family and Child with Congenital Heart Defects. Physiological differences between pediatrics and adults ❑ The normal infant heart rate ranges from 90 to 160 beats per minute (bpm), the toddler's or preschooler's is 80 to 125 bpm, the school-age child's is 70 to 100 bpm, and the adolescent's ranges from 60 to 100 bpm,These findings are related to the change in the size of the heart. ❑ The infant's and child's blood vessels widen and increase in length over time. ❑ The normal infant's blood pressure (BP) is about 80/40 mm Hg, The BP increases over time to the adult level. The toddler or preschooler's BP averages 80 to 100/64 mm Hg, the school-age child's 94 to 112/56 to 60 mm Hg, and the adolescent's 100 to 120/50 to 70 mm Hg Normal BP and Heart rate Definition of Congenital Heart Defects ❑ Its a structural malformation of the heart or great vessels present at birth, but not necessary to detect at that time. ❑ Approximately (8:1000 live birth). ❑ Most common cardiac disease in children. ❑ The etiology of most CHD is unknown. Risk Factors of Congenital Heart Defects ❑ Fetal and maternal infection German measles (rubella in the first trimester) ❑ Drugs and alcohol ❑ Genetic factors ❑ Maternal dietary deficiencies ❑ Maternal age greater than 40 years ❑ Maternal diabetes mellitus ❑ Exposure to radiation ❑ Use of certain medications, including some anti-seizure medications and drugs to treat mood disorders Classifications of Congenital Heart Defects By the presence or absence of cyanosis: 1.A Cyanotic 2.Cyanotic  A cyanotic ❑ Every child is born with an opening between the upper heart chambers. It's a normal fetal opening that allows blood to detour away from the lungs before birth. After birth, the opening is no longer needed and usually closes or becomes very small within several weeks or months. ❑ Blood follow from left to right there is no mixing oxygenated and unoxygenated in systemic circulation.  Arterial septal defect (ASD) Its a simple defect of atria during the fetal development, which is form between the 4th and 8th week of life.  Symptoms of ASD ❑ Child tires easily when playing ❑ Fatigue ❑ Sweating ❑ Rapid breathing ❑ Shortness of breath ❑ Poor growth ❑ Recurrent chest infections  Classification of ASD ASDs are classified by their different location and development: ❑Sinus ASD occurs in the upper part of the atrial septum ❑Secundum ASD occurs in the middle part of the atrial septum. ❑Primum ASD occurs in the lower part of the atrial septum Diagnosis: ASD is confirmed by : ❑Chest x-ray exam ❑Echocardiography ❑Cardiac catheterization  Management ❑ Without treatment, certain type of ASD may closed spontaneously in the first year of life. ❑ Surgical procedure. ❑ Interventional cardiology where a close devise is inserted. The surgeons use patches to close the hole: (septal occluder) ❑ Nursing care focused on postoperative management of the child.  Post-operative management Immediate postoperative in the intensive care unit: ❑Record the vital signs frequently until the child is stable. ❑ Monitor fluid status. Accurately measure the intake and output of all fluids. ❑Assess and maintain respiratory status. ❑Respiratory assessment is done frequently and oxygen is given via mechanical ventilation.  Post-operative management ❑ Anticoagulant to keep blood clots from forming on the device ❑ Maintain lines (there may be several): ⮚ A peripheral IV line is used to administer fluid and medications. ⮚ A central venous pressure (CVP) line is inserted in a large vessels in the neck and is used to measure central venous pressure. ❑ Assess for signs and symptoms of infection.  Cyanotic ❑ In this case unoxygenated blood from the right of the heart mixes with oxygenated blood in the left side of the heart which lead to unoxygenated circulation and overall oxygen saturation ranges from normal (96-100%) to as low as 70% Tetralogy of fallot Its a condition always seen in combination with 4 defects. 1. Ventricular septal defect (VSD) 2. Pulmonary stenosis 3. Right ventricular hypertrophy 4. Over riding of aorta (deviation of the aortic origin to the right)  Signs and Symptoms Symptoms are variable depending of degree of obstruction ❑Cyanosis ❑ Tachycardia ❑Murmur at left sternal border ❑Retarded growth and development ❑ Severe dyspnea on exertion ❑Right ventricle hypertrophy ⮚ Blue spells ⮚ Clubbing of the fingers and toes 16  Diagnosis TOF ❑ Signs and symptoms such as cyanosis and breathing difficulties. ❑ Chest x-ray ❑ Echocardiogram ❑ ECG ❑ Cardiac catheterization  Treatment ❑ Surgical repair ❑ Prevention of inter-current infection Nursing care: Focus on: ❑ Preoperative involves preventing or minimizing symptoms such as blue spells. ❑ Post operative care.  Hyper- cyanotic Spells/Blue Spells It's a cute cyanosis with crying or playing, feedings and defecation which is relieve with squatting position or drawing up the legs. Most often occurs in morning. Characterized by: ❑ Sudden increase in cyanosis ❑ Syncope ❑ Chest pain ❑ Arrhythmias ❑ Anxiety ❑ Hyperventilation ❑ Congestive heart failure  Nursing care for blue spells ❑ Place Infant in Knee Chest Position (squatting) ❑ Administer 100% Oxygen ❑ Administer Morphine: enhanced cardio protection against ischemia injury in children undergoing corrections of TOF ❑ Use a Calm Approach ❑ IV Fluid Replacement for Blood Volume Expansion ❑ Decrease Cardiac Workload Decrease Cardiac Workload ❑Provide Rest Periods ❑Consolidate Care ❑Respond to Crying ❑Monitor tolerance to feedings Nutritional Management ❑Give small frequent high calorie formulas ❑Use a large holed nipple ❑Gavage Feedings ❑Monitor Cardiac Tolerance ⮚ Tachycardia ⮚ Tachypnea ⮚ Desaturation Knee Chest Position(squatting) Knee Chest Position(squatting) Nursing Diagnosis 1-Decreased cardiac output related to structural defect Intervention: ❑Administer digoxin as ordered. ❑The child's apical pulse is always checked before administrating digoxin (as general rule the drug is not given if the pulse is below 90-100 b/m in infants and young children or below 70 b/m in older children). 2-Activity intolerance related to imbalance between oxygen supply and demand. Intervention: ❑Allow for frequent of rest. ❑Encourage quite games and activities. ❑Help child to select activities appropriate to age, condition and capabilities. ❑Avoid extremes of environmental temperature. 3-Altered growth and development related to inadequate oxygen, nutrients to tissue and social isolation. Intervention: ❑Provide well balanced highly nutrition diet. ❑Administer iron preparation as prescribed. ❑ Encourage iron rich foods in diet. ❑Encourage age appropriate activities. 4-High risk for infection related to debilitated physical status. Intervention: ▪ Avoid contact with infected persons. ▪ Provide for adequate rest. ▪ Provide optimum nutrition. 5- Altered family process related to having a child with a heart condition. Intervention: ❑Discuss with parents their fears regarding child symptoms. ❑Encourage family to participate in care of child while hospitalized. ❑ Encourage family to include others in child's care to prevent their own exhaustion. ❑Assist family in determining appropriate physical activity. ❑Teach skills for home care. ⮚ Administration of medications. ⮚ Feeding techniques, ⮚ Signs that indicate complications. ⮚ Where and whom to contact for help and guidance. 6-High risk for injury (complications) related to cardiac condition and therapies. Intervention: ❑Teach family to intervene during hyper cyanotic spells, place child in knee chest position with head and chest elevated. ❑Teach family to recognize signs of complications such as: ⮚ Digoxin toxicity (vomiting, bradycardia, dysrhythmias). ⮚ Increased respiratory effort (tachypnea, retraction, grunting, cough, cyanosis). ⮚ Hypoxemia (cyanosis, restlessness, tachycardia). ⮚ Cerebral thrombosis (compensatory polycythemia is particularly hazardous when child is dehydrated). - Cardiovascular collapse (pallor, cyanosis and hypotonia). Acquired cardiac disorders HEART FAILURE ⚫Pathophysiology : -Right-sided failure, the right ventricle is unable to pump blood effectively into the pulmonary artery, resulting in increased pressure in the right atrium and systemic venous circulation. - In left-sided failure, the left ventricle is unable to pump blood into the systemic circulation, resulting in increased pressure in the left atrium and pulmonary veins. ⚫(1) impaired myocardial function ⚫Tachycardia ⚫ Decreased urinary output ⚫cool extremities ⚫ Weak peripheral pulses Decreased blood pressure (2) pulmonary congestion ⚫Tachypnea ⚫ Dyspnea ⚫ Retractions (infants) ⚫ Flaring nares ⚫ Cyanosis ⚫ Grunting  - 3) systemic venous congestion Weight gain Hepatomegaly Peripheral edema, especially periorbital Ascites Neck vein distention (children) Diagnostic Evaluation 1. Chest radiography Ventricular hypertrophy appears on the 2. ECG. 3. An echocardiogram is done to determine the cause of HF such as a congenital heart defect or poor ventricular function. Nursing Care Management 1. Reduce Respiratory Distress 2. Maintain Nutritional Status 3. Assist in Measures to Promote Fluid Loss 4. Support Child and Famiy 5.Keep head of bed elevated at a 30- to 45 degree angle to promote maximum chest expansion 6.Assess and record oxygen saturation every 2 to 4 hours RHEUMATIC FEVER ▪ Rheumatic fever is an inflammatory disease of connective tissues involving mainly joints & heart (licks the joints but bites the heart). It has a marked tendency to recur. Incidence ▪ The incidence of ARF is still high, peaks between the school age children i.e. between 5-10y, boys & girls are equally affected, and with the incidence is still high in the developing countries due to: Overcrowded living conditions. Poor socioeconomic and educational level. Nursing care Management Home Care ⚫Family complies with the medical regimen and follow up care ⚫Instruct parents on the needs for prophylactic. ⚫antibiotic therapy before dental, upper respiratory, and urologic procedure. ⚫Have parents return demonstrate the proper demonstration of antibiotic. ⚫Family demonstrates preventive measure to avoid recurrence of disease.  Test your self Baby boy Ali is a newborn who is experiences hypoxia and cyanosis. And he always takes the knee-chest position to feel more comfort and to relieve dyspnea due to physical exertion. The most likely diagnosis is a congenital heart defect which called; A. VSD B. ASD C. PDA D. TOF One of the following is a diffuse inflammatory disease of connective tissue, involving mainly the heart and the joints. A. Measles B. Mumps C. Diabetes mellitus D. Rheumatic fever Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation? A. Aortic stenosis (AS) B. Coarctation of aorta C. Patent ductus arteriosus (PDA) D. Tetralogy of Fallot Dr.Samar M EL-ziady 23/1445 H