cv disorders[dr.manalkassab2nd sems2012

8/2/2019 CV Disorders[Dr.manalKassab2nd Sems2012

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Care of the Child with a Cardiovascular

Disorder

1

Dr. Manal Kassab


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Normal Hear structure

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History Taking

Must be careful. Some of the symptoms are very subtle and do not

show up right after birth

Typical presentations of infants are tachycardia, tachypnea, and poorfeeding

Older children may present with fatigue and frequent lower respiratory

infections.

Some children may perspire excessively

Edema is a late sign and usually presents first as periorbital edema

May complain of decreased UOP (UOP of 30ml/hour indicates that the child hasadequate cardiac output )

May have headaches, nose bleeds, high blood pressure in upperextremities

It is very common in most of cardiac anomalies to have a delayedphysical growth.


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History Continued

Obtain a detailed prenatal history includingexposure to infections (toxoplamosis, rubella orvaricella), medication usage, drug and alcohol use,

nutrition, exposure to radiation

Determine if there is any family history ofcongenital heart defects or heart disease, cognitive

impairments, renal disease

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Physical Assessment

Compare height and weight to standard growth chart Assess:

5

Capillary refill

Presence of clubbing

Ruddy complexion

Vital signs

Lethargy

Rapid respirations

Point of maximum intensity and theapical impulse (position of the heart).

Tachycardia

Abnormal body posture

cyanosis

Murmur (Innocent vs. organic)

Thrill

Edema

Hepatic & spleenic borders(enlargement)


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Self Reading

Physical Examination

Common nursing diagnoses

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MurmursInnocent murmurs vs. Organic murmurs

An innocent or functional heart murmur(Normal)

Not resulting from heart disease

This is the most common type of heartmurmur

May be caused by fever, anemia, or a thinchest

Organic murmur

Indicates abnormality heart

major artery

May be caused by a narrow valve, a leaking

valve, or a hole in the heart


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Diagnostic procedures to Evaluate theCardiovascular Function

Blood & electrolytes Lab tests - Hgb and Hct (polycythemia), ESR(rheumatic fever, myocarditis), ABG (presence of a right to leftshunt), O2 Sat, clotting times total protein and albumin, (PT, PTT)and platelet count, Na, K, dig level

Radiography; MRI

Treadmill (older children)

ECG

Echocardiogram

Pulse oximetry

Chest x-ray

Phonocardiogram

Fluoroscopy (radioactive dye in injected)

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Cardiac Catheterization Can be diagnostic /interventional

Performed on children of any age - even newborns

Catheter is inserted through a peripheral blood vessel into theheart, to visualize the structures & function

Other purpose

Pressures in the heart can be measured

CO can be evaluated

Blood samples can be obtained and tested (O2 sat) Electrical activity can be studied

Contrast can be injected to study blood flow, vessels

and chambers

Balloon angioplasty can be performed to stretch stenosedareas or blockages in vessels


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Cardiac Catheterization Nursing care; Pre- catheterization education

Explain about catheterization what to expect during and after the test (child will have to lie flat

and will have a bulky dressing over the catheter insertion site)

Post-Procedure lie flat 3-4 hours VS every 15 minutes for the first several hours Check site every 15 minutes for integrity of dressing

Check pulses distal to site & extremity for capillary refill and warmth Avoid dehydration & hypothermia Check for signs of infection Avoid tub baths and strenuous exercise for 2-3 days


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Congenital Heart Disease

Occurs in about 8% of term newborns

Higher in pre-term infants

Can be as high as 10-15% in infants who have a parent withaortic stenosis, ASD, VSD, or pulmonic stenosis

Females - more prone to have PDA and ASD

valvular aortic stenosis

Males more prone coarctation of the aorta

TOF

transposition of the great vessels

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Causes

The usual cause is failure of the heart todevelop beyond an early stage ofembryonic development

Maternal rubella is associated with PDA,stenosis, ASD, VSD

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Left (High pressure)-to-right shuntO2 rich blood re-circulate through lungAway from body


Right-to-left shuntPoor O2 blood travel tobody

Sat & Un-satbld mixwithinheart/great

vessle

Re direct O2-rich bloodto lungs instead of body

These defects These defects

allow poor oxygenatedblood to travel body


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A cyanotic Congenital heart disease

a. Pulmonary blood flow

Blood flows from left side heart to R.Tt side heart through anabnormal opening Pulm-Bld-flow Vol R.T Heart

Physyiological effects include:

Pulm-Bld-FlowCardiac workload

Heart defects causes Pulm Bld flow:

Atrial Septal Defect (ASD)

Ventricular Septal Defect (VSD)

Patent Ductus Arteriosis (PDA)

Atrioventricular canal defect (AVC)

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Opening in the septum between the twoventricles

Incidence:Most common congenital heart defect

Classified as

1. Membranous VSD mostcommon and located in theupper section)

1. Muscular VSD (located in thelower section)

Increased pulmonary blood flowVentricular Septal Defect


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Pathophysiology

Results in Pressure pulmonary artery

Hypertrophy R.T ventricular

May not be evident at birth because high

pulmonary resistance from incompleteopening of alveoli keeps the blood fromcoming across to the right ventricle

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Increased pulmonary blood flowVSD


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Symptoms

Age 4 - 8 weeks develops loud, harsh, systolic murmur along the left sternalborder 3rd or 4th ICS, widely transmitted, usually with a thrill

Fast hard breathing

Fatigue

Paleness

Failure to gain weigh

Disinterest in feeding

Pounding heart

Murmurs

Fast heart rate Sweating while feeding

Frequent respiratory infections

May lead to hypertrophy and enlargement of the right atrium

CHF is common



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Diagnosed

ECG or MRI

Treatment

60% close spontaneously - otherwise at risk of infectious endocarditisand cardiac failure

May require a Silastic or Dacron patch to close opening if edges cantbe approximated and sutured

Surgical repair----

Cardiopulmonary bypass

Surgical procedures in which cardiopulmonary

bypass is used

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Abnormal opening between the two atria allowingblood to flow from left atrium to right atrium

Common in children with down syndrome

Classified as`

ASD1 (ostium primum) at the lower end of the septum

ASD2 (ostium secondum) most common

near the center of the septum and may beasymptomatic

Sinus venous defect: opening high in atrial septum,near junction of superior vena cava and R.T atrium.

Increased pulmonary blood flowAtrium Septal Defect


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Pathophysiology

As left atrial pressure slightly exceed right atrialpressure, blood flows from L.F.T to R.T atriumcause increase flow of oxygenated blood into R.Tside of heart.

There is R.T atrial and ventricular enlargement

Pulmonary vascular changes occurs afterdecades if defect unrepaired

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Increased pulmonary blood flowASD


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SymptomsUnless opening is large, children have no symptoms and seemshealthy

If opening is large----permit blood to pass R.T side of heart -----

atrium, ventricle and lung overworked leading to CHF S&S:

Echo----enlarged right side

increased pulmonary circulation

Harsh systolic Murmur (2nd-3rd ICS & Split S2)

Atrial dysrhythmias

Moderate to severe CHF

High risk of developing pulmonary vascular obstructive disease

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ASD2 (Ostium secundum) may close spontaneously

as child grows

Or

Repaired by the time of school age

(prevent lung problem)

Medication:

If needed to help heart work better

DigoxinDuritics (hold dose vomiting or Brady cardia)

Infection control

Dacron patch


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Increased pulmonary blood flowAtrioventricular Canal Defect (AVC)

An incomplete fusion of the endocardial cushion thatlead to having a hole between chambers of heart &problems in valves that regulate blood flow Heart

There is no separation between the chambers of theheart and blood flow between all 4 chambers

Mitral and tricuspid valves are usually distorted.

Common in Down syndrome

Risk factors:Link between retinoic acid usage pregnancy & AVC

Maternal age

Requires surgical repair and possible double valvereplacement (earlier surgery ----lung problem)

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Increased pulmonary blood flow: ACD

Symptoms

Baby tires easily

Mild Cyanosis increase with crying Failure to gain weight & grow Frequent pneumonia Lack of appetite

Pale skin (pallor) Rapid breathing Sweating Trouble breathing, especially during feeding


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Increased pulmonary blood flowPatent Ductus Arteriosus (PDA)

The ductus arteriosus is a normal fetalstructure

Ductus arteriosus close in most caseswithin 27 hours 1st week of life

The ductus arteriosus between thepulmonary artery & aorta fails to close atbirth

May not close until 3 months causingblood to be shunted from aorta topulmonary artery

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Increased pulmonary blood flow

PDA

Symptoms:

S & S depend on defect size

While some cases of PDA are symptomatic, if ductus islarge, common symptoms include:

Tachycardia or other arrhythmia

Respiratory problems

Acyanotic

Dyspnea & difficulty breathing after physical activity

Continuous machine-like murmur

Enlarged heart

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Increased pulmonary blood flow

PDATreatment:

Pre-mature---Give indomethacin NSAID (prostaglandin inhibitor) tostimulate closure

If medical management fails

surgical closure indicated through ligation of PDA via left thoracotomy

It is recommended for infants < 6 months if defect large & causing

symptoms such as poor W.T gain and rapid breathing It prevent the return of oxygenated blood to the lungs

Cardiac Cath is also an option

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Congenital heart disease:Obstructive Defects (OD)

Narrowing of a vessel or valve.

Prevents sufficient blood supply fromreaching its intended site

Results in high B/P proximal toobstruction(head & Upperextremities), and lower B/P distal toobstruction(body& lower extremities).

Heart Defects that causes ODPulmonic Stenosis

Aortic Stenosis

Coarctation of aorta

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Obstructive Defects:Pulmonary Stenosis (PS)

Narrowing at the entrance topulmonary artery

Resistance to blood flow causes

RT vent- hypertrophy

Pulmonary blood flow

Pulmonary atrasia is extreme formthat caused by total fusion whichstoped blood flow lung

In severe cases CHF occurs

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Obstructive Defects:Pulmonary Stenosis

Tx & Symptoms depends on severity of stenosis &childs age

Mild cases are asymptomatic

Sever Case: Cyanosis

Murmurs

Cardiomegaly (chest X-ray) At risk bacterial endocarditic

Poor weight gain or FTT in infants

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Obstructive Defects:Pulmonary Stenosis

Tx:Cardiac Cath

Balloon angioplasty may betried to break valve adhesions &

relieve the stenosis

If there is a lesser degree ofstenosis, the child can beallowed to wait until they are 4or 5 years old so that there isless surgical risk

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Ob i D f


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Obstructive Defects:Aortic Stenosis (AS)

Prevents blood from flowing freely fromthe Left Ventricle to Aorta

Can lead to

hypertrophy of the left ventricle

heart failure

pulmonary edema

Types of AS:

1. Valvular stenosis, bicuspid rather thantricuspid valvemost common type

2.Subvalvular stenosis, a stricture causedfibrous ring below normal valve

3. Supravalvular stenosis, infrequent

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Obstructive Defects:Aortic Stenosis

Tx & Symptoms

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Sever defect we may seeS&S of decreased CO

faint pulses,

hypotension,tachycardia,Murmurs poor feedingActivity intolerance

develop chest pain with activity,Dizzinessstanding long time

At risk

endocarditisCoronary insufficiencyVentricular dysfunction

TxBallon dilationValvotomyAortic valve replacementAortic/ pulmonary homograft

Obstructive Defects


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Obstructive DefectsCoarctation of the Aorta (up to here)

A constrictive band causes

narrowing of aorta

Narrowing either betweenInfantile or preductal(Subclavian vein & ductusarteriosus)Postductal (Distal to the ductusarteriosus)

Since BP is greatest in thesubclavian vein, you will seehigher pressures in the upperextremities (at least 20 mmHg)than in the lower extremities.

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Obstructive DefectsCoarctation of the Aorta

The increased BP can cause headaches or nosebleeds.

As child grows older, veins may become visible on the chest.

Child may complain of leg pain on exertion.

Child may or may not have systolic murmur prominent at base of heart

While palpating the brachial, radial and femoral pulses difference in pulseamplitude between the femoral & radial pulses will be noted.

May only have a decreased femoral pulse.

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Coarctation of the Aorta

Treatment

Balloon angioplasty or surgical removal of

narrowed portion.

Usually scheduled around age 2. Has to be done prior to childbearing age in females

Post Op

May have abdominal discomfort for a while

R.T blood flow to lower part of the body.

Will usually still have an elevated BP for a while.

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CyanoticMixed blood flow

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Mixed DefectsTransportation of great arteries/ vessels

TGA/VThe pulmonary arteryleaves theleft ventricle, & the aorta exits fromright ventricle, with no

communication between thesystemic and pulmonary circulation

Deoxygenated blood returns via

misconnected aorta to the body

Oxygenated blood goes back tolungs

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Mixed DefectsTGA/V

Often associated with septal defects PDA, VSD, patent foramen ovale These deformities make it

compatible to lifeCM Severe cyanosis at birth May have signs of CHF Cardiomegaly a few weeks after birth

Treatment give PGE1 to keep the ductus open have balloon passed

Surgical (arterial switch procedure)

Mi d D f t


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Mixed Defects

Total Anamalous Pulmonary Venouse return

Pulmonary veins return to Right Atriumor superior vena cava instead of the Left atrium

Systemic circulation depends on a

patent foramen ovale and/or patent ductus

Often these patients are also without a spleen

The infant is usually mildly cyanotic and tires easily

Will be kept on PGE1 until surgery to keep the ductusarteriosus open

The pulmonary veins are reimplanted into the LA40


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Mixed DefectsTruncus Arteriosus (TA)

Truncus arteriosus is Ch.Ch by a large VSD overwhich a large, single great vessel (truncus) arises

The infant has a single vessel coming off the RV andLV instead of a separate pulmonary artery and aorta.

TA causes severe cyanosis & has a typical VSDmurmur

O2 & deO2 blood mixed inside the heart, some leavesto the lungs others to the systemic circulation

TXThe common trunk is restructured surgically to createan aorta & pulmonary artery

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Mixed DefectsTruncus Arteriosus (TA)

Symptoms

cyanosis

fatigue

sweating

pale skin

cool skin

rapid heavy breathing

rapid heart rate

congested breathing disinterest in feeding or tiring while

feeding

poor weight gain

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Mixed DefectsHypoplastic left heart syndrome (HLHS)

Is a combination ofabnormalities of the heart &great vessels in which most ofstructure on left side of heart aresmall & underdeveloped

Mitral valve, left ventricle, aorticvalve & aorta are involved

The degree of

underdevelopment differs fromchild to child.

The newborn developssymptoms shortly after delivery


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Mixed DefectsHypoplastic left heart syndrome (HLHS)

The RV hypertrophies as it tries to do all of the work

Symptoms

Cyanosis sweating, cool skin

Increased RR & HR, heavy breathing

Treatment

A series of three operations that are done in stages

Best hope is heart transplant44

Cyanotic


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CyanoticDefects with Decreased Pulmonary Blood Flow

Involve an obstruction of

pulmonary blood flow

which increases pressure

in the right side of theheart.

If an ASD & or VSD

also exists, thendeO2 blood

shunts from the right

side to the left side


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Decreased Pulmonary Blood FlowTricuspid Atresia

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Tricuspid valve is completely closed.

Blood cant flow fromRA to RV so goes through Patent foramen ovale or ASD to the L. Atrium.

And through

VSD to the Rt. Ventricle

If the foramen ovale & ductus arteriosus close,the patient becomes profoundlycyanotic,

tachycardicdyspneic.

It is often associated with pulmonic stenosis &

transposition of great arteries.

B


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Decreased Pulmonary Blood FlowTricuspid Atresia

CM

Cyanosis

Tachycardia & dyspnea

Clubbing nail Children with TA at risk for stroke

Treatment

Prostaglandin

Surgery

Subclavian pulmonary artery Shunt


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Decreased Pulmonary Blood FlowTetralogy of Fallot (TOF)

Tetralogy of Fallot makes up about 8%of all cases of congenital heartdisease.

The classic form includes fourstructural defects:

1. Ventricular septal defect

2. Pulmonic stenosis

3. Overriding aorta: the aorta

is shifted towards the rightside of the heart so that itsits over theventricularseptal defect

4. Right ventricular

hypertrophy


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blue baby syndrome
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blue baby syndrome

D d P l Bl d Fl
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Decreased Pulmonary Blood FlowTetralogy of Fallot (TOF)

Symptoms:

poor physical growth, clubbing,

systolic murmur at left sternal border hypoxic spells,(Acute episodes of cyanosis and hypoxia) Severe dyspnea Polycythemia (elevated red blood cell count ) Fatigue & activity intolerance

Squatting (a kneechest position) Tachycardia
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Treatment of the Child with TOF

If having hypoxic episode, place infant in knee-tochest position.

Decrease cardiac workload/demands

Prevention of intercurrent infection Prevention of hemoconcentration (Lab values

show increased RBCs and reduced O2 sat)

Care During a Hypercyanotic Spell

Maintain Nutrition Administration of Cardiac Medications

Decrease Respiratory Distress

Surgical repair(1 or 2 years)52
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Acquired Heart Disease/ Disorders

Rheumatic Fever

Rheumatic Fever---Rheumatic HeartDisease (RHD)

Congestive Heart Failure (CHF)

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Rheumatic Fever Rhe-Heart_diesease--permanent damage to heart valves caused by RF

An autoimmune disease, self-limited non contagious.

It develops after an infection of the upper RTI with group A -hemolytic streptococci

The antigens of group A Streptococci bind to receptors in the heart,muscle, brain & synovial joints, blood vessels, subcut.- tissue andCNS causing an autoimmune response

The antigens produced by Streptococci are similar to the bodys own

antigens thus antibodies may attack healthy body cells

RHD forms inflammatory lesions that causes swelling and alterationsin the connective tissue (Aschoff bodies)hemorrhagic bulbous lesion

A i d H t Di / Di d
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Acquired Heart Disease/ DisordersRheumatic Fever

EpidemiologyAges 5-15 yrs are most susceptible

Rare boys

Common in 3rd world countries

Incidence more during fall ,winter & early spring

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Precipitating factor for RF

Any systematic inflammatory disease that affectsprimarily the heart, joints, brain and skin.

Environmental factors---Lower socioeconomic,crowded and cold humid areas

Recurrent sore-throat infections with

streptococcal

Not treating streptococcal throat infections with a

full course of antibiotic56

A i d H t Di / Di d
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Four Major cardiac manifestation

Rheumatic Carditis Polyarthritis

Erythema marginatum

Subcutaneous nodules Chorea

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Rheumatic Carditis Carditis is the only manifestation of rheumatic fever thatleaves a sequelae & permanent damage to the organ

Treatment - antibiotics (PCN, Ampicillin, Gentamycin)for 2 to 8 weeks.

Involves endocardium, pericardium & myocardium

CM: valvulitis Myocardities Pericarditis Murmur (reflecting mitral regurgitation) Tachycardia especially during sleep

Migratory Polyarthritis/ Arthritis Joints such as knees, elbows, hips, shoulders & wrists Joints are swollen, hot, red & painful Arthritis do not progress to chronic disease (reversible &

migratory)

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Erythema marginatum

Erythematous macule mostly found on the

trunk & extremities

Subcutaneous nodules Painless,pea-sized,palpable nodules

Found on the bony prominences areas (feet,

hands vertebrae)

Always associated with carditis

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Sydenham Chorea ST-----(CNS involved)

Sudden & aimless irregular movements of the extremities(Vitus dance)

Involuntary facial, grimaces

deterioration of handwriting, speech, Emotional liability (uncontrolled)

Muscle weakness

Important Nursing Care to maintain pats safety

Keep side in safe position especially during sleeping by making railsraised.

Assist the child with all activities of daily living.

Offer the child a spoon only for meals, no fork or knife to preventsudden accident 60

Acquired Heart Disease/ DisordersRh i F
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Rheumatic Fever

Other Signs and Symptoms

Minor fever

fatigue

Arthralgia (joint tenderness) elevated ESR & C reactive protein

Anorexia, Loss of weight

2 minor 1 major Or 2 major= confirm dx

61



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Rheumatic Fever

Treatment In the acute stage of rheumatic fever, it is important to keep

child quiet.

Bedrest until ESR decreases

Antibiotics (penicillin, erythromycin) x 10 days

Reduce inflammation (aspirin - watch for toxicity such astinnitus, nausea, vomiting, headache, blurred vision)

Corticosteroids (if not responding to aspirin alone)

Phenobarbital for chorea

Treatment of heart failure

Kept on prophylactic antibiotics for 5 years or until 18 toprevent recurrence after RF



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Complications of RHD

Sever damage mitral valve

Congestive heart failure Hypoxemia


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Acquired Cardiovascular Disorders :CHF

CHF: is a condition in which the heart cannot pump enoughoxygenated blood to meet the need of the body organs

CHF often occurs in children with congenital heart defects

Medical problems that may lead to CHF are Rheumatic fever Endocarditis or valuvlitis Cardiac arrhythmias Cardiomyopathy

Chronic lung disease Hypertension hemorrhage
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Acquired Cardiovascular Disorders :CHF

Causes of CHF

Volume overload (lt to rt shunt=rt vent. Hypertrophy)

Pressure overload which is caused by obstructive

lesion, stenosis or coarctation of the aorta Decreased contractility which may be caused by

1. myocardial ischemia due to Severe anemia

Asphyxia

Acidemia

Low level of K, glucose, Ca , Mg

2. High cardiac output (such in sepsis,hyperthyroidism or severe anemia)
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Acquired Cardiovascular Disorders :CHFSymptoms depend on whether there is right- or left sided

heart failure

Right side failure (sys cong) Right side is unable to pump blood to the lungs Due to the congestion in the right side of the heart the

blood flow begins to back up into the veins which causingfluid retention CM----Edema can be seen in the feet, ankles, eyelids

Left side failure (pul cong) Left side is unable to pump much blood to the body Blood begins to back up into thevessels in the lungs, thus

lungs become stressed (increased RR and laboredbreathing)

CM-----Fatigue and poor growth
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Symptoms of CHF

ImpairedMyocardialFunction

Tachycardia

Dec. urine output

Fatigue & weakness

Sweatingrestlessness

AnorexiaPale & coolextremities

Weak peripheralpulses

Decreased BP

Gallop rhythm

cardiomegaly

PulmonaryCongestion

Tachypnea

Retractions

Flaring nares

Exercise intolerance

Orthopnea(breathlessness)

Cough, hoarseness

Cyanosis

Wheezing

Grunting

Systemic VenousCongestion

Weight gain

Hepatomegaly

Edema (is a late signin children and it

shows up asperiorbital edema)other sites includesfeet, ankles, face andabdomen)

Ascites

Neck vein distension
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Therapeutic Management of CHF

Digitalis (digoxin) Angiotensin- converting enzyme

(ACE)

Improvecardiacfunction

Diuretics

Removeaccumulated

fluid & sodium

Neutral thermal environment Treat existing infections

Reducing the effort of breathing Sedation & rest

Decrease

cardiacdemands

Improving myocardial function

Oxygen supplement

Improve tissueoxygenation &

decrease oxygenconsumption
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Improve cardiac function Digitalis glycosides have three actions

Increase the force of contraction (increase cardiac output & decreasevenous pressure)

Decrease the HR & slow the conduction of the impulses through the AVnode

Increase renal perfusion (enhance diuresis)

Digoxin (Lanoxin) is used for children because of rapid onset anddecreased risk of toxicity

Digoxin level 0.8 2.0 u/L S&S of Toxicity includes nausea, vomiting, anorexia, slow HR

(bradycardia) Thus taking vital sign regularly is priority intervention

Hold digoxin dose If HR less than 100 for infant If HR less than 80 for older children If HR less than 60 for adolescents
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Remove accumulated fluid & sodium (decreasepreload)

Use of diuretics; lasix , diuril aldactone, Bumex,Zaroxolyn

Potassium supplements when Lasix is used

Low level of K enhances the effect of digoxin thus

increases the risk of digoxin toxicity

High level of K diminishes the effect of digoxin

Fluid & sodium restriction
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Decrease Cardiac Demands (lessen heart workload)

neutral thermal environment

Treating any existing infections

Reducing the effort of breathing (semi-fowlerposition)

Sedation if necessary

Rest

Improve tissue oxygenation and decrease oxygenconsumption

In addition to the previous management Oxygensupplement
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Therapeutic Management

Valve replacement

Cardiac catheterization

Cardiac surgery

Cardiac transplantation


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Cardiac Surgery

Cardiac Surgery Pro-op

Baseline V/S

Measure Ht and Wt

Enema Pt and family teaching

Post-op V/S Q 15 minutes then Q one hr

May need warming

Fluid status, ABGs , PT, PTT, electrolytes Observe chest tube and drainage

Observe for S&S of infection

Pain management

Cough and deep breathing
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Cardiac Surgery

Complications

bleeding, shock, heart block or arrhythmias, heartfailure, neuro changes

postcardiac surgery syndrome (one week post-op)

febrile illness with pericarditis

postperfusion syndrome (3-12 weeks post-op)

fever, splenomegaly, hepatomegaly, elevatedWBC, malaise


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Valve Replacement

In valve replacement surgery

anticoagulation (Coumadin) or antiplatelet (aspirin,dipyridamole) are required therapy

young girls should avoid accidental pregnancy, should notuse an estrogen-based OCD nor an IUD

women desiring to become pregnant need to switch toHeparin therapy

Good oral hygiene

prophylactic antibiotics need to be taken before dentalwork or oral surgery

may develop hemolytic anemia requiring bloodtransfusions


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Cardiac Surgery Contd

Pacemaker - if difficulty with conduction system

Consists of a battery pack and lead wires

Leads are usually epicardial as opposed to endocardial

in children Parents and patient must be taught how to take the

patients pulse

Batteries can last up to 15 years and they lose powerslowly rather than stopping abruptly

If patient has hiccuping, lead wire may need to berepositioned

Magnets should be avoided

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Important Points about Care of the Child with a


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Important Points about Care of the Child with aHeart Defect

Parents taking a child with a heart defect home shouldhave discharge planning which includes, emergencynumbers, instruction in what to do if child becomescyanotic, CPR training,

Should not allow a child with a cyanotic heart defect orsevere aortic stenosis to cry for extended periods oftime

Dont usually have to restrict sodium intake (regulateswater balance)

Need vitamin supplements and maybe an iron

supplement77

C f hild i h CHD


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Care of a child with CHD

Children usually limit their own activities, but parentsshould watch for respiratory distress when newactivities are introduced

Children should receive their immunizations timely

Even minor illnesses should be treated promptly

Avoid dehydration

Receive prophylactic antibiotics prior to dental visits ororal surgery (Penicillin or Erythromycin)

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Give small frequent high calorie formulas every 3-4 hrs (6-8

meals)

Use a large holed nipple (easy to suck) / Tube feeding

Increase frequency & decrease amount

Monitor Cardiac Tolerance

Tachycardia

Tachypnea

Desaturation

GavageFeedings PRN

Decreased cardiac output related to congenital
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p gstructural defect

Goal : pt will exhibit improved cardiac output

Interventions

Administer digoxin Prevent digoxin toxicity

Ascertain accurate rout and dose

Check the pulse before administering drugs

Withhold digoxin if pulse is less then 90-110 (infants),70-85 (older children)

Decreased cardiac output related to congenital
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p gstructural defect

Goal : pt will exhibit improved cardiac output

Interventions

Recognise digoxin toxicity

Nausea, vomiting, anorexia, Bradycardia anddyshrythmia, therforeV/S should be taken regularly.

Ensure adequate K intake

Observe signs of hypokalemia/hyperkalemia

Monitor electrolytes level Check BP

Expected outcomes: heartbeat is strong, regular & withinnormal ranges

Activity Intolerance Related to Imbalance
http://upload.

cv disorders[dr.manalkassab2nd sems2012

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