Clinical Aspect of Maternal and Child Nursing

NUR 363
Lecture 9

NURSING CARE OF THE CHILD WITH A

CARDIOVASCULAR DISEASE
 ASSESSMENT OF HEART
DISORDERS IN CHILDREN
• History
• Physical
assessment
– general
appearance
– pulse, blood
pressure, &
respirations
 ASSESSMENT OF HEART
DISORDERS IN CHILDREN
• Diagnostic tests
– Electrocardiogram
– Radiography
– Echocardiography
– Magnetic resonance imaging
– Exercise testing
– Laboratory tests
 CLASIFICATION OF CHD
A Cyanotic Heart Defect
Move blood from arterial …to…venous system

A Cyanotic

Increased in pulmonary
Obstruction of blood flow from
blood flow
ventricle
1. ASD
1. Pulmonary stenosis
2. VSD
2. Aortic stenosis
3. AVC
3.Coarctation of the Aorta
4. PDA

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 CONGENITAL HEART
DISEASE
• Defects with increased
pulmonary blood flow
– Ventricular Septal
Defect
• Opening between
ventricles
• S/S
– 4-8 weeks, fatigue and
harsh murmur
• Therapeutic management
– Most close spontaneously
(small ones). Other larger
VSDs may require open
heart surgery
• Defects with
increased
pulmonary blood
flow
– Atrial Septal Defect
• Opening between
the atria
• S/S
– Murmur

• Management
– Surgery
A trial Sepal Defect (ASD)
 **Obstruction of blood flow from
ventricle

1.Pulmonary stenosis

2.Aortic stenosis

3.Coarctation of the Aorta

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– Pulmonic Stenosis
• Narrowing of the
pulmonary valve or
artery causing the right
ventricle to hypertrophy

• S/S
– Mild right sided
heart failure

• Therapeutic
Management
– Balloon angioplasty
to relieve the stenosis
-Aortic Stenosis
• Stenosis of the aortic
valve prevents blood
from passing from the
left ventricle into the
aorta, leading to
hypertrophy of the left
ventricle
• S/S
– Usually asymptomatic but
with murmur
– May have chest pain and
even sudden death
• Therapeutic
Management
– Stabilization with a Beta
Blocker or Calcium
Channel Blocker
– Balloon valvuloplasty
– Valve replacement
– Coarctation of
the Aorta
• Narrowing of the
lumen of the
aorta
• S/S
– Absence of
palpable femoral
&/or brachial
pulses;
headache,
vertigo,
nosebleeds, leg
pain
• Therapeutic
Management
– Surgery or
angiography
Coarctation of the Aorta

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 Cyanotic Heart Defect

Cyanotic

Decreased pulmonary
Mixed blood flow
blood flow

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**Defect with Decreased pulmonary blood flow

1. Tricuspid Artesia

2. Tetrology of Fallot

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– Tricuspid Atresia
• The tricuspid valve is
completely closed,
allowing no blood to
flow from the right
atrium to the right
ventricle.

• When these structures

close, cyanosis,
tachycardia, and
dyspnea occur.

• Treatment consists of an
IV infusion of PGE
(prostaglandin) to keep
the ductus open until
surgery can be
performed.
Tetrology of Fallot (TOF)

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– Tetralogy of Fallot
• Four anomalies
– Pulmonary stenosis
– VSD
– Dextroposition of the
aorta
– Hypertrophy of right
ventricle
• S/S
– Cyanosis
– Polycythemia (increase
in number of RBC)
– Dyspnea, growth
restriction, clubbing of
fingers
• Therapeutic Management
– Surgery