Care of the client with cardiovascular disorders II

Cardiac Tamponade

Main Problem: Fluid accumulation in the pericardial sac

Clinical manifestation:
Hypotension
Muffled heart sounds is a common sign
Diagnostic test: electrocardiogram (ECG)
Nursing diagnosis:
Altered cardiac output
Nursing Interventions:
Prepare the patient for pericardiocentesis, this involves aspirating the fluid or air from the
pericardial sac
Assess for complications
Complete Heart Block

Main Problem: Altered transmission of wave impulses from the sinoatrial (SA )node (it is one of
the elements in the cardiac conduction system that controls the heart rate) to the atrioventricular
node (AV) node (it is part of the electrical control system of the heart that coordinates the top of
the heart)
Clinical manifestation:
Bradycardia
Diagnostic test: electrocardiogram (ECG)
Nursing diagnosis:
Altered tissue perfusion
Nursing Interventions:
Monitor patients’ ECG
Prepare patient for pacemaker insertion
A common sign of pacemaker failure is hiccups
Atropine sulfate is given as a vagolytic
Congenital Heart Disease

1.Defects with increased pulmonary blood flow

Pulmonary circulation (carries deoxygenated blood away from the heart, to the lungs, and
returns oxygenated blood back to the heart) and sytemic circulation are not connected (it
carries oxygen and nutrients to the cells and picks up carbon dioxide and waste products,
carries oxygenated blood from the left ventricle through the arteries, to the capillaries in the
tissues of the body) are not connected
If there is a connection, the pressure is higher in the left side than in the right side
Patent Ductus Arteriosus
Most common congenital heart defect
Symptoms depend on size of the vessel and age of the child
May have no symptoms; indication may be a machine like murmur
Increasing dyspnea, full bounding pulse, wide pulse pressure
Spontaneous closure after infancy rarely occurs
Without treatment - life expectancy short
If neonate is critically ill where surgery is improbable, prostaglandin inhibitor (indomethacin)
indicated
Atrial Septal Defects
10% of all forms of congenital heart disease
Allows oxygenated blood returning from the lungs to pass into the right atrium

Ventricular Septal Defect

Constitute 20% of all forms of CHD
Allows systemic venous and oxygenated arterial blood to mix
May produce no symptoms at all
Require no specific treatment and often close spontaneously, if not Dacron/Silastic Patch is
done surgically
2.Obstructive Defects
Coarctation of the aorta
Narrowing of the lumen of the aorta
May be an isolated defect or associated with other cardiac malformation
Assessment: measure BP in both arms and a leg and to assess the pulse in both upper and
lower extremities
Surgical repair - only permanent treatment; usually deferred until 3 years of age

Pulmonic Valve Stenosis

Usually do not produce symptoms; typical murmur

Aortic Valve Stenosis

Mild to moderate asymptomatic: typical murmur
3.Defects with Decreased Pulmonary Blood Flow
Tetralogy of Fallot
1.Ventral septic defect
2.Dextraposition of the aorta (when the aorta overrides the interventricular septum to the right
ventricular side)
3.Pulmonary Valve stenosis
4.Enlarge right ventricular wall
Assessment
Primary sign - cyanosis
Hypoxic spells - usually initiated by crying
Fainting - due to cerebral hypoxia
Stunted growth, clubbed fingers and toes
Squatting position (knee-chest) - characteristic position to relieve dyspnea
Implementation
Decrease hypoxic spells - do not permit child to cry
Place in knee chest position
O2 as needed
Surgical repair - blalock taussig shunt

Triscuspid Atresia
Condition in which tricuspid valve did not form
No opening between the right atrium and right ventricle
2% of congenital heart defects
Profound cyanosis and dyspnea at birth
Emergency catheterization with atrial septostomy
Total Anomalous Venous Return
Condition in which all the pulmonary venous blood returns to the heart
Cyanosis and severe respiratory distress
Emergency surgical intervention

Truncus Arteriosus
Single vessel arising from the ventricles just above a ventrical septic defect (VSD)
Retarded growth; enlarged liver and heart
Usually infants die within the first year
Cardiovascular defects management:
Monitor VS closely
Monitor respiratory status
Auscultate breath sounds for crackles, ronchi or rales
If respiration effort is increased, place child in reverse trendelenburg position
Administer humidified oxygen
Monitor for hypercyanotic spells
1.Place infant in a knee chest position
2.Administer 100% oxygen by mask
3.Administer morphine as ordered
4.IVF as prescribed

Assess for signs of Congestive Heart Failure
Assess peripheral pulses
Keep child stress free as possible; allow maximal rest