TRANSPOSITION OF THE GREAT VESSEL

Definition:  Is a congenital heart defect in which the two major vessels that carry blood away from the heart- the aorta and the pulmonary artery are switched.
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TRANSPOSITION OF THE GREAT VESSEL

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Cause: Unknown

Risk factors:

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- Rubella or other viral illness in the mother during pregnancy - Poor nutrition in the mother during pregnancy - Alcoholism - Mother’s age over 45 - Diabetes

Symptoms: - Blueness of the skin - Shortness of breath - Poor feeding - Clubbing of the fingers

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DIAGNOSTIC TEST
TEST
1. CHEST X-RAY

DEFINITION
- makes images of the
heart, lungs, airways, blood vessels and the bones of the spine and chest. - The t wo com m on posit ions are post eroant erior (PA) and lat eral

PURPOSE
- to evaluate the lungs, heart, and chest wall

NURSING RESPONSIBILITY

♥ Inquire about frequency of recent xrays and possibility of pregnancy ♥ Provide lead shielding to areas not being viewed ♥ Remove any jewelry or metal objects that may obstruct the view of the heart and lungs

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DIAGNOSTIC TEST
TEST
2. Cardiac Catheterization

DEFINITION
- involve passing a thin flexible tube (catheter) into the right or left side of the heart, usually from the groin or arm

PURPOSE
to examine the coronary arteries, because heart attacks, angina, sudden death, often originate from disease in these arteries

NURSING RESPONSIBILITY
♥ Before procedure, obtain a written permission ♥ Withhold food and fluids for 6-8 hrs. before procedure ♥ Inform patient about use of local anesthesia, insertion of catheter, and feeling of warmth when dye is injecting and fluttering sensation of heart as catheter is passed
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♥ Instruct the patient to cough or take a deep breath when catheter is inserted ♥ After procedure, assess circulation to extremity use for catheter insertion ♥ Check peripheral pulses, color and sensation of extremity every 15 min. for 1 hr. and then with decreasing frequency ♥ Observe puncture site for hematoma and bleeding
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DIAGNOSTIC TEST
TEST
3. ECG

DEFINITION

PURPOSE

- it records the electrical - for detecting many activity of the heart cardiac problems, including angina pectoris, stable angina, ischemic heart disease, arrhythmias (irregular heartbeat), tachycardia (fast heartbeat), bradycardia (slow heartbeat), myocardial infarction (heart attack), and certain congenital

PURPOSE

- is used routinely in physical examinations and for monitoring a patient's condition during and after surgery - used in exercise tolerance tests (i.e., stress tests) and is also used to evaluate symptoms such as chest pain, shortness of breath, and palpitations.

NURSING RESPONSIBILITY

♥ Prepare skin and apply electrodes and lead ♥ Inform patient that no discomfort is involved ♥ Instruct patient to avoid moving to decrease motion artifact

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DIAGNOSTIC TEST
TEST
4. Echocardiogram

DEFINITION
- Transducer that emits
and receives ultrasound waves is placed in four position on the chest above the heart

PURPOSE
to diagnose certain cardiovascular diseases, and is one of the most widely used diagnostic tests for heart disease also used to evaluate heart murmurs (abnormal heart sounds), determine the causes of congestive heart failure, assess enlarged hearts or hearts with septal defects (holes

PURPOSES
- and monitor the heart in patients with diseases that may affect heart function (e.g., lupus, lung diseases)

MANAGEMENT
CLASSIFICATI ACTION ON

INDICATION

GENERIC N.

BRAND N.

Diuretic

Chloro- Each of the - Decrease sodiumreabsorption thiazide transporting of water, cells contains potassium, Na-K-ATPase and sodium pumps in the by the kidney basolateral membrane. These pumps perform two major functions: they return reabsorbed sodium to the

- Diuril

CLASSIFICATI ACTION ON

INDICATION

GENERIC N.

BRAND N.

and they maintain the cell sodium concentration at relatively low levels. The latter effect is particularly important, since it allows filtered sodium to passively enter the cells down a favorable concentration

Management
CLASSIFICATI ACTION ON INDICATION GENERIC N. BRAND N.

2. Cardiac glycosides

- Digoxin - Increase the - Digoxin binds to a site force of and on the decrease the extracellular rate of cardiac aspect of the contraction α-subunit of the Na+/K+ ATPase pump in the membranes of heart cells (myocytes). This causes an increase in the level of sodium ions in

- Lanoxin

CLASSIFICATI ACTION ON

INDICATION

GENERIC N.

BRAND N.

which then leads to a rise in the level of calcium ions. The proposed mechanism is the following: inhibition of the Na+/K+ pump leads to increased Na+ levels, which in turn slows down the extrusion of Ca2+ via the Na+/Ca2+

MANAGEMENT
CLASSIFICATI ACTION ON INDICATION GENERIC N. BRAND N.

3. Antibiotic - Penicillin- - treatment of - Penicillin G - Pfizerpen serious infections Potassium induced inactivation of caused by susceptible aminoglycosid strains of the e. The loss of designated aminoglycosid microorganisms e effect may be due to a physicalchemical reaction between the antibiotics.

SURGICAL PROCEDURE
♥ Arterial Switch Procedure  ► anatomically corrects the defects by placing the pulmonary artery and aorta in their proper anatomic positions
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NURSING DIAGNOSIS

1. Decrease Cardiac Output R/T structural factors of congenital heart defect

► monitor cardiac rhythm continuously ► encourage parents of relaxing environment, using relaxation techniques, soothing music, quiet activities ► encourage to breathe deeply in/out during activities ► promote adequate rest by decreasing stimuli, providing quiet environment

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NURSING OUTCOME: The client will be able to display hemodynamic stability after nursing intervention

2. Ineffective breathing pattern R/T decrease energy and fatigue
► assist with necessary testing ► encourage slower and deeper respiration, use of pursed-lip technique ► assist client in the use of relaxation technique ► encourage adequate rest periods between activities


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NURSING OUTCOME: The client will be able to establish normal respiratory pattern after continuous nursing interventions.

3. Activity Intolerance R/T Imbalance between  oxygen supply and demand

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► assess level of fatigue, ability to perform ADL and other activities in relation to severity of condition ► plan care with rest periods between activities ► avoid allowing infant to cry for long period of time ► provide toys and games for quite and diversion appropriate for age of child, allow to limit own activities as much as possible ► explain to parents need to conserve energy and encourage rest NURSING OUTCOME: The client will be able to tolerate increase activity after 3 days


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PROGNOSIS
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Improvement in symptoms and growth and development is seen after surgical correction of the defect. If corrective surgery is not performed, the life expectancy is shortened.

RESEARCH

A group of 186 propositi with transposition of the great vessels (TGV) and 33 propositi with tricuspid atresia (TA) were studied. Data were obtained from hospital records and complemented by questionnaires and in part by personal interview and clinical examination. The main results were among sibs of propositi with TGV an increased incidence of TGV (0.0135±0.0054) and of congenital heart disease in general (0.0495±0.0103) (K=0, rmin =1). Among 92 sibs of propositi with TA only one with patent ductus arteriosus was found. The sex ratio of the propositi with TGV was 1.95. There was also noted a highly abnormal sex ratio among sibs of parents of patients with TGV in part confirming the findings of KNOX.A male excess was found in paternal and maternal sibships and was also present in sibships of propositi. Data about seasonal distribution were inconclusive as were data about consanguinity of parents. No parental age or birth order effect was found in either group.

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