congenital heart disease in children dr. sara mitchell january 31. 2007
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Congenital Heart Congenital Heart Disease in ChildrenDisease in Children
Dr. Sara Mitchell January 31. 2007
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Changes in circulation at birth Foramen ovale
________ Ductus arteriosis
________ Ductus venous
________ Umbilical vein & artery
_________
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Differences in the pediatric heart
Heart rate ______& stroke volume ______ than in adults
______ _______ are normal findings in infants
the ______’s thorax is _____-______ the ______'s thorax is ________ by age __ years, the AP:transverse thorax
has mature proportions
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Differences in the pediatric heart(continued)
The PMI is located at the __th intercostal space in the child younger than __ years of age
The apical pulse may be visible
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Congenital heart diseasewhat's the incidence?
~ 40,000 babies are born each year in the Untied States with congenital heart disease
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Congenital heart diseasewhat’s the cause?
~90% of congenital heart disease is thought to be due to ___________ ____________
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Congenital heart diseaseWhen in gestation does it occur?
Development of the heart and great vessels occurs between the 2nd & 9th week of gestation
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Congenital heart disease:name the types Lesions with increased pulmonary
blood flow Lesions with decreased pulmonary
blood flow Mixed circulation defects Obstructive lesions
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Lesions with ________ pulmonary blood flow: What are they?
______ septal defect (ASD) ______ ductus arterious (PDA) _________ septal defect (VSD) AV canal defect
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Ventricular Septal Defect
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Lesions with decreased pulmonary blood flow
_________ of _____ ________ atresia _________ atresia Epstein anomaly
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Tetralogy of Fallot
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Tricuspid Atresia
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TET spells – what are they?
_____________ spells May occur in any child whose heart
defect includes ________ to ________ blood flow and communication between the ventricles
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TET spells - what do they look like
The infant becomes acutely cyanotic because of sudden ________ in pulmonary blood flow and _______ in _______-to-____ shunting.
Spells occur more often in the _______ May be preceded by feeding, crying,
or defecation.
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TET spells need to be treated ASAP to prevent _______ ______ with resulting brain damage and possible _______
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TET spells – what is the management? Place infant in ____-_____
position Employ calm, comforting
approach Administer _____% O2 by
face mask Give ________ SQ or IV Begin IV fluid
replacement and volume expansion if needed
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Mixed Circulation defects What are they?
___________ of the great arteries Total anomalous _________ venous
connection Trucus Arterious Hypoplastic ______ Heart Syndrome
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Transposition of the great arteries
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Truncus Arterious
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Obstructive cardiac lesions:What are they? _________ stenosis
Aortic stenosis
__________ of the Aorta
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Coarctation of the aorta
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Pulmonic Stenosis
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Cardiac Catherization
Pre-Op assessment accurate ________ assess & mark _____ _______. baseline ___ explain procedure to child & family
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Cardiac catheterization (continued)
Post-Op assessment be aware of most common complications check pulses ______ cath site check color and temperature of affected
extremity check vital signs every 15 minutes (per facility
policy). * Be sure to check heart rate for a full 60 seconds
**___________________________________________________________________________
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Congestive heart failure
Causes of CHF can be classified according to the following changes:Volume overload*Pressure overload*Decreased contractilityHigh cardiac output demands * = most common in children in which structural
abnormalities result in an increased volume load or
increased pressure load on the ventricles.
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Therapeutic management of Therapeutic management of congestive heart failurecongestive heart failure Two groups of drugs are used to
enhance myocardial function in CHF:Digatalis - improves contractility
ACE inhibitors - reduce the afterload on the heart making it easier for the heart to pump
Diuretics - remove excess fluid
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Things to know about giving Things to know about giving digoxin to infants & childrendigoxin to infants & children Always check the dosage with a
_______ _______ before giving. Count the ______ pulse Monitor for signs & symptoms of
toxicity Know what to do if a dose is missed
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Nursing care plan for a child with congenital heart disease
Problem Goal/Outcome Intervention
1. ________ cardiac output R/T structural defect, myocardial dysfunction.
2. Ineffective breathing pattern R/T _________ _______.
3. Fluid volume excess R/T _____ ________
4.Activity intolerance R/T___________.
5. Risk for infection R/T reduced body______________.
6. Altered family processes R/T a child with life-threatening illness
The child will exhibit
1. Improved _________
2. Improved respiratory function
3. No evidence of fluid excess
4. The child will experience decreased cardiac demands.
5. The child will maintain adequate nutritional status
6. The child/family will receive adequate support & education
Rationale