 Decreased pulmonary blood flow (tricuspid atresia, TOF)

NURSING CARE OF THE CHILD

BORN WITH CARDIOVASCULAR VENTRICULAR SEPTAL DEFECT

o There’s a fistula in the septum between two

ILLNESSES ventricles.
Learning Outcomes o Great pressure on left ventricle = left to right shunt
o Acyanotic disorder
1 Describe congenital heart disorders that occur in o Onset of symptoms: 4-8wks
pediatrics. o Easy fatigue
2 Assess an infant who is born with congenital heart o Loud, harsh parasystolic murmur (3rd-4th
disorders. intespace)
3 Utilize knowledge of congenital heart disorders to o Palpable thrill
promote quality maternal and child health nursing o Dx: dopple/MRI and ECG
care. o Findings: Right ventricular hypertrophy and
pulmonary artery dilatation
Course Outline

CONGENITAL HEART DISORDERS

□ Ventricular Septal Defect
□ Atrial Septal Defect
□ Patent Ductus Arteriosus
□ Pulmonary Stenosis
□ Aortic Stenosis
□ Coarction of the Aorta
□ Transposition of the Great Arteries
□ Truncus Arteriosus Management
□ Tricuspid Atresia
 85% expectant management
□ Tetralogy of Fallot  Open-heart surgery before 2y/o

CONGENITAL HEART DISORDERS ATRIAL SEPTAL DEFECT

Classification according to physical sign of cyanosis:
(a) Acyanotic Heart Disease (b) Cyanotic Heart Disease
ACYANOTIC HEART DISEASE
o Heart/circulatory anomalies that moves blood from
arterial to venous system.
o Oxygenated – deoxygenated blood
o Left-to-right shunts
CYANOTIC HEART DISEASE
o Fistula in the septum between left and right atria.
o Abnormal communication between two upper
chambers.
o Left to right shunt
o Acyanotic defect
o Dx: doppler
Harsh systolic murmur can be heard at the 2nd – 3rd interspace
and the second heart sound auscultated as “split”. The right
side of the hear is enlarged and there is an increased
pulmonary circulation.

o Blood is shunt from venous to arterial.

o Altered communication between two systems.
o Deoxygenated to oxygenated.
o Right-to-left shunts.

Four Classification according to Anomalies

 Increased pulmonary blood flow (VSD, ASD, PDA)

 Obstruction to blood flow leaving the heart (pulmonary
stenosis, aortic stenosis, COA)
 Mixed blood flow (TGA, truncus arteriosus)
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PATENT DUCTUS ARTERI OSUS
Usually, ductus arteriosus will begin to close after first breath
and takes 7-14 days to complete closure. Full closure may be
up to 3 months.
Ductus arteriosus is a stricture that connects pulmonary
artery to the aorta.
Blood shunts from aorta to the pulmonary artery then returns
to left atrium to left ventricle back again to the aorta then
pulmonary artery.
o Increased pressure sa pulmonary circulation = right
ventricle hypertrophy + ineffective heart action
o Common in girls
o Wide pulse pressure
o Continuous machinery murmur at the UL sternal
border (under left clavicle)
o Dx: Echocardiography to visualize
o IV indomethacin, ipubrofen, prostaglandin inhibitors
o Cardiac catheterization
o Ductal ligation via thoracotomy
COARCTATION OF THE A ORTA
PULMONARY STENOSIS
o Pulmonary artery or pulmonary valve narrowing
o 10% of congenital heart anomalies
o Narrowing = obstruction > unable to empty RV >
hypertrophy
o Signs of R-sided heart failure
o Cyanotic
o Systolic ejection murmur
o Dx: Echocardiograpy
o Balloon angioplasty via cardiac catheterization
o Prognosis after surgery: residual heart murmur
AORTIC STENOSIS
o Narrowing of aortic valve
o Prevents blood flow to left ventricle to aorta
o Increase pressure= L ventricle hypertrophy
o Increased pressure in L atrium = backpressure in
pulmo veins = pulmonary edema
o 2nd interspace: Typical mumur
o Suprasternal notch: thrill
o Decreased CO: faint pulse, hypotension, tachycardia,
inability to suck.
o Active = chestpain
o Dx: Echocardiography [left ventricular hypertrophy]
o Beta blocker/ Ca Channel blocker
o Balloon valvuloplasty
o Severe: dividing stenotic valve/ dilate constricting
aortic ring or valve replacement
o Presence of constricting band that narrows the
lumen of the aorta.
o RF: boys
o Increased BP in heart and upper body and decreased
BP in lower body.
o BP Arms: 20mmHg higher
o Mild: (-) palpable femoral pulses
o Prognosis: leg pain on exertion
o Dx: echocardiography, MRI, X-Ray
o Findings: L-Sided heart enlargement
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 TRICUSPID ATRESIA

o Closed tricuspid valve.

o Blood flow from RA to RV is impossible.
o Patent foramen ovale into LA = bypasses lungs
(oxygenation)
o Oxygenation by shunt via PDA
Pharmacological [Pre-Op]: digoxin, diuretics o Patent foramen ovale & ductus arteriosus =
adequate oxygenation.
TRANSPOSITION OF THE GREAT ARTERIES o Fontan Procedure/ Glenn Shunt baffle: construct of
vena cava to pulmonary shunt
o Aorta arises from the right ventricle.
o Pulmonary artery arises from left ventricle.
o 2 closed circulatory system.
o Incompatible with life.
o May occur along with ASD/VSD and much occur in
macrosomia.

TETRALOGY OF FLLOT

o Composed of four anomalies (pulmonary stenosis,

VSD, dextroposition of aorta, RV hypertrophy)
o Chromosomal aberration: Deletion abnormality of
chromosome 22.
o Cyanotic
o May have typical VSD murmur
o Dx: Echocardiography = heart hypertrophy
o Cardiac catheterization = low O2 saturation
o No septal defect: PGE1
o Balloon atrial septal pull-through
o Surgery: 1wk to 3mos of age
o Arterial Switch Procedure

TRUNCUS ARTERIOSUS

o One major artery or trunk arises from left or right

ventricle. o Minimal or no cyanosis to cyanotic, polycythemia
o Usually with VSD. o Prognosis if not treated: severe dyspnea, growth
o Cyanotic & typical VSD murmur restriction, clubbing of fingers, squatting or knee-
o Restructure common trunk to separate vessels. chest position
o Loud harsh or soft, scratchy systolic murmur in L 2nd,
3rd, 4th parasternal insterspace.
o Echocardiography, ECH shows R side heart
hypertrophy, decreased size of pulmonary artery,
and decreased perfusion to the lungs,
o Cardiac catheterization & angiography
o CBC inc. Hgb, Hct, dec O2 sat
o Surgery: 1 to 2 y/o
o 02 administration, prevent hypercyanotic episodes
o Knee chest position alleviates pain
o MS04 & Beta blockers
o Blalock-Taussig procedure and Brock Procedure
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