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CHILD WITH CARDIOVASCULAR DYSFUNCTION

This document provides an overview of congenital heart defects (CHD) affecting 1-2% of live births, with increased incidence in families with a history of CHD. It discusses various types of defects classified by shunting lesions, obstructive lesions, and admixture lesions, as well as their causes, diagnostic evaluations, and clinical manifestations. Nursing care focuses on identifying early signs of congestive heart failure (CHF), improving cardiac function, promoting fluid loss, and supporting the child and family emotionally and nutritionally.

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CHILD WITH CARDIOVASCULAR DYSFUNCTION

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  1. CHILD WITH CARDIOVASCULAR DYSFUNCTION KAREN E. MILES FLORIDA GULF COAST UNIVERSITY DEPARTMENT OF NURSING

  2. CONGENITAL HEART DEFECTS

  3. 1-2% of all live births Increases to 3% if have another child with CHD 4-10 in 1000 live births INCIDENCE

  4. Multifactorial Inheritance Others Maternal Rubella Maternal Alcoholism Maternal Diabetes Mellitus Down Syndrome Trisomy #13 & #18 Turner’s Syndrome Marfan’s Syndrome Di George Syndrome ETIOLOGY

  5. CLASSIFICATION OF CHD

  6. LEFT-TO-RIGHT SHUNTING LESIONS • Ventricular Septal Defect (VSD) • Atrial Septal Defect (ASD) • Patent Ductus Arteriosus (PDA) • AV Canal or Endocardial Cushion Defect

  7. OBSTRUCTIVE LESIONS • Pulmonary Stenosis (PS) • Aortic Stenosis (AS) • Coarctation of Aorta (COA)

  8. ADMIXTURE LESIONS • Transposition of Great Vessels (TGV) • Total Anomalous Venous Connection (TAPVC) • Truncus Arteriosus

  9. RIGHT-SIDED OBSTRUCTIVE LESIONS • Tetralogy of Fallot (TOF) • Tricuspid Atresia • Pulmonary Atresia

  10. PULMONARY VENOUS OBSTRUCTIVE LESIONS • Mitral/Aortic Atresia • Cardiomyopathy OTHER • Hypoplastic Left Heart Syndrome

  11. NURSING CARE OF CHILD WITH CHD

  12. A. Understand the causes, pathophys., clinical manif., diag. evaluation, and therapeutic management of CHF Causes: • Volume overload • Pressure overload • Decreased contractility • High cardiac output demands

  13. Clinical Manifestations • Tachycardia - resting rate greater than 160 beats/min in infants • Diaphoresis • Easily fatigued • Poor exercise tolerance • Poor perfusion - cold extremities, weak pulses, low BP, mottled skin

  14. Tachypnea - greater than 60 breaths/min in infants • Mild cyanosis • Dyspnea • Retractions • Orthopnea • Wheezing cough

  15. Hepatomegaly • Weight gain • Edema • Distended neck & peripheral veins

  16. DIAGNOSTIC EVALUATION • Chest X-Ray • ECG • Echo-cardiogram

  17. B. PROVIDE SAFE & THERAPEUTIC NURSING CARE Identify Early Signs of CHF • Tachycardia • Tachypnea • Profuse scalp sweating • Fatigue and irritability • Sudden weight gain • Respiratory distress

  18. IMPROVE CARDIAC FUNCTION • Administer Digoxin (Lanoxin) check apical pulse observe for signs of toxicity PROMOTE FLUID LOSS • Administer Diuretics (Lasix, Diuril, Aldactone) • Possible fluid restrictions • Possible sodium restrictions • Monitor intake and output

  19. DECREASE CARDIAC DEMANDS • Prevent cold stress in infants • Treat any infection • Rest and conservation of energy • Minimize unnecessary stress

  20. REDUCE RESPIRATORY DISTRESS • Position with HOB elevated • Administer Oxygen • Monitor Respiratory Rate and Effort MAINTAIN NUTRITIONAL STATUS • Increase Calories • Positioning • Alternate Feeding Techniques

  21. SUPPORT CHILD AND FAMILY • Foster Parent-To-Infant Attachment • Encourage Parents to Stay • Give Clear Explanations • Keep Informed • Provide Emotional Support

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