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Congenital Heart Diseases

Congenital Heart Diseases

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Published by theglobalnursing

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Published by: theglobalnursing on Aug 18, 2012
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02/20/2014

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 Congenital Heart Disease(CHD)
 
Caused by improper development of the structure of the heart and great vessels
 
Happened during the 1st-8th weeks of fetal development
 
Idiopathic(No known cause)
Risk Factors
 
Maternal Infection(Rubella)
 
Drugs and alcohol intake
 
Family History of CHD
 
Genetic/Chromosomal Disorders
Major Classifications
1.
 
Acyanotic Heart Defect(L-R Shunting)2.
 
Cyanotic Heart Defect(R-L Shunting)
I.
 
ACYANOTIC HEART DEFECT(L-R)
1.
 
DISORDERS WITH INCREASED PULMONARY BLOOD FLOW-abnormal connection between the great arteries that allows blood to flow from the high pressure leftside or the heart to the low pressure right side of the heart.a.
 
VSD-Ventricular Septal Defectb.
 
ASD- Atrial Septal Defectc.
 
PDA- Patent Ductus Arteriosusd.
 
AVC- Atrioventricular Canal Defect2.
 
DISORDERS WITH THE OBSTRUCTION OF BLOOD FLOW-blood leaving the heart meets an area of anatomic narrowing(stenosis), causing obstruction to bloodflow.
 
 a.
 
CoA-Coarctation of the Aortab.
 
AoS- Aortic Stenosisc.
 
PS- Pulmonic Stenosis
ACYANOTIC HEART DEFECT DISORDERS WITH INCREASED PULMONARY BLOOD FLOW
VENTRICULAR SEPTAL DEFECT
-abnormal opening in the wall between the two ventricles
Assessment
 
Easy fatigue
 
Loud harsh murmur at the Left Sternal Border at the 3rd or 4th ICS.
 
Thrill(vibration) may be palpate
 
ECG reveals right ventricular hypertrophy
 
Cardiac catheterization reveals increased O2 saturation at Right side of the heart
Therapeutic Management
 
85% of VSD are small and close spontaneously
 
Moderate in size VSD may be closed by cardiac catheterization
 
Larger size VSD over 3mm require open heart surgery
 
Exceptionally large requires Silastic or Dacron Patch
Nursing Management
 
Cardiac catheterization site at Right Femoral Vein
 
NPO 6 hours before the procedure
 
Protect site of catheterization. Avoid flexion of joints proximal to site
 
Asses for complications:infection, thrombus formation-check for pedal pulse
ATRIAL SEPTAL DEFECT
-
 
Abnormal communication between leftand right atrium due to failure of theforamen ovale to close-
 
More common in girls
Assessment
 
S2 harsh murmur sound at the 2
nd
or 3
rd
 ICS
 
ECG reveals right ventricular hypertrophy
 
Easy fatigue
 
Cardiac catheterization reveals increasedO2 saturation in the right atrium
 
 
Therapeutic Management
 
Interventional Cardiac Catheterization
 
Open heart surgery between 1 and 3 years of age(w/o repair puts child at risk for infectiousendocarditis and emboli during pregnancy)
 
Silastic or Dacron Patch for large defect
PATENT DUCTUS ARTERIOUSUS
-failure of the artery(ductus arteriosus)connecting theaorta and the pulmonary artery to close within 1-3months
Assessment
 
Machinery Murmur
at upper left sternal border
 
Wide Pulse Pressure
 
Bounding femoral pulses
 
ECG reveals ventricular hypertrophy
Therapeutic Management
 
Indomethacin or Ibuprofen(NSAID, ProstaglandinInhibitors-facilitates closing)
 
Ligatation of PDA by 3-4 y/o via thoracotomyprocedure
 
If Indomethacin is given assess for side effects:
o
 
Decrease glomerular filtration
o
 
Impaired platelet aggregation
o
 
Decrease GI and cerebral blood flow
 
Ibuprofen
- drug of choice due to fewer side effects and used as prophylasxis in preterm infants
ATRIOVENTRICULAR CANAL DEFECT
 
also called
ENDOCARDIAL CUSHION
 
 
results from the incomplete fusion of endocardialcushion which is the septum of the heart at the junction of the atria and ventricles
 
Assessment
is the same with Ventricular SeptalDefect
 
most common cardia defect in
DOWN SYNDROME
 
Infant usually has mild to moderate CHF
 
Surgical Treatment:
either pulmonary arterybanding or repair via cardiopulmonary bypass

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