Download - Transposition of the Great Vessel
-
8/8/2019 Transposition of the Great Vessel
1/30
TRANSPOSITION OF THETRANSPOSITION OF THE
GREAT VESSELGREAT VESSEL
Definition: Is a congenital heart defect in
which the two major vessels that carryblood away from the heart- the aortaand the pulmonary artery are switched.
-
8/8/2019 Transposition of the Great Vessel
2/30
TRANSPOSITION OF THETRANSPOSITION OF THE
GREAT VESSELGREAT VESSEL
-
8/8/2019 Transposition of the Great Vessel
3/30
Cause: Unknown
-
8/8/2019 Transposition of the Great Vessel
4/30
Risk factors:-
- Rubella or other viral illness in themother during pregnancy
- Poor nutrition in the mother during
pregnancy- Alcoholism
- Mothers age over 45
- Diabetes
-
8/8/2019 Transposition of the Great Vessel
5/30
Symptoms:
- Blueness of the skin
- Shortness of breath- Poor feeding
- Clubbing of the fingers
-
8/8/2019 Transposition of the Great Vessel
6/30
DIAGNOSTIC TESTDIAGNOSTIC TEST
TEST DEFINITION PURPOSE1. CHEST X-RAY - makes images of the
heart, lungs, airways,blood vessels and thebones of the spine andchest.
- The two com monpositions areposteroanterior (PA)
and lateral
- to evaluate the lungs,heart, and chest wall
-
8/8/2019 Transposition of the Great Vessel
7/30
-
8/8/2019 Transposition of the Great Vessel
8/30
NURSING RESPONSIBILITYNURSING RESPONSIBILITY Inquire about frequency of recent x-
rays 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 heartand lungs
-
8/8/2019 Transposition of the Great Vessel
9/30
DIAGNOSTIC TESTDIAGNOSTIC TESTTEST DEFINITION PURPOSE
2. CardiacCatheterization
- involve passing a thinflexible tube (catheter)into the right or left side
of the heart, usuallyfrom the groin or arm
to examine the coronary
arteries,because heartattacks, angina,
sudden death,often originate fromdisease in these arteries
-
8/8/2019 Transposition of the Great Vessel
10/30
-
8/8/2019 Transposition of the Great Vessel
11/30
NURSING RESPONSIBILITYNURSING RESPONSIBILITY
Before procedure, obtain a writtenpermission
Withhold food and fluids for 6-8 hrs.before procedure
Inform patient about use of localanesthesia, insertion of catheter, andfeeling of warmth when dye is injecting
and fluttering sensation of heart ascatheter is passed
-
8/8/2019 Transposition of the Great Vessel
12/30
Instruct the patient to cough or take adeep breath when catheter is inserted
After procedure, assess circulation toextremity use for catheter insertion Check peripheral pulses, color and
sensation of extremity every 15 min. for1 hr. and then with decreasingfrequency
Observe puncture site for hematoma
and bleeding
-
8/8/2019 Transposition of the Great Vessel
13/30
DIAGNOSTIC TESTDIAGNOSTIC TEST
TEST DEFINITION PURPOSE3. ECG - it records the electrical
activity of the heart
- for detecting manycardiac problems,including angina
pectoris, stableangina, ischemicheart disease,arrhythmias (irregularheartbeat),
tachycardia (fastheartbeat),bradycardia (slowheartbeat),myocardial infarction
(heart attack), andcertain con enital
-
8/8/2019 Transposition of the Great Vessel
14/30
PURPOSE- is used routinely in
physical examinations andfor monitoring a patient's
condition during and aftersurgery- used in exercisetolerance tests (i.e., stresstests) and is also used toevaluate symptoms suchas chest pain, shortness of
breath, and palpitations.
-
8/8/2019 Transposition of the Great Vessel
15/30
-
8/8/2019 Transposition of the Great Vessel
16/30
NURSING RESPONSIBILITYNURSING RESPONSIBILITY
Prepare skin and apply electrodes andlead
Inform patient that no discomfort isinvolved
Instruct patient to avoid moving todecrease motion artifact
-
8/8/2019 Transposition of the Great Vessel
17/30
DIAGNOSTIC TESTDIAGNOSTIC TESTTEST DEFINITION PURPOSE
4. Echocardiogram - Transducer that emitsand receives ultrasoundwaves is placed in fourposition on the chestabove the heart
to diagnose certaincardiovasculardiseases, and is oneof the most widelyused diagnostic testsfor heart diseasealso used to evaluateheart murmurs(abnormal heart
sounds), determinethe causes ofcongestive heartfailure, assessenlarged hearts or
hearts with septaldefects holes
-
8/8/2019 Transposition of the Great Vessel
18/30
PURPOSES
- and monitor the heart inpatients with diseases that
may affect heart function(e.g., lupus, lung diseases)
-
8/8/2019 Transposition of the Great Vessel
19/30
-
8/8/2019 Transposition of the Great Vessel
20/30
MANAGEMENTMANAGEMENTCLASSIFICATION
ACTION INDICATION GENERIC N. BRAND N.
Diuretic - Each of thesodium-transportingcells contains
Na-K-ATPasepumps in thebasolateralmembrane.These pumps
perform twomajorfunctions:they returnreabsorbedsodium to the
- Decreasereabsorptionof water,
potassium,
and sodiumby the kidney
Chloro-thiazide
- Diuril
-
8/8/2019 Transposition of the Great Vessel
21/30
CLASSIFICATION
ACTION INDICATION GENERIC N. BRAND N.
and they
maintain thecell sodiumconcentrationat relativelylow levels.
The lattereffect is
particularlyimportant,
since it allowsfilteredsodium to
passively enterthe cells down
a favorableconcentration
-
8/8/2019 Transposition of the Great Vessel
22/30
ManagementManagementCLASSIFICATION
ACTION INDICATION GENERIC N. BRAND N.
2. Cardiacglycosides
- Digoxinbinds to a siteon theextracellularaspect of the
-subunit ofthe Na+/K+ATPase pumpin themembranes ofheart cells(myocytes).This causes anincrease in the
level ofsodium ions in
- Increase theforce of anddecrease therate of cardiaccontraction
- Digoxin - Lanoxin
-
8/8/2019 Transposition of the Great Vessel
23/30
CLASSIFICATION
ACTION INDICATION GENERIC N. BRAND N.
which thenleads to a risein the level ofcalciumions. The
proposedmechanism is
the following:inhibition ofthe Na+/K+
pump leads toincreased Na+
levels, whichin turn slowsdown theextrusion ofCa2+ via the
Na+/Ca2+
-
8/8/2019 Transposition of the Great Vessel
24/30
MANAGEMENTMANAGEMENTCLASSIFICATI
ON
ACTION INDICATION GENERIC N. BRAND N.
3. Antibiotic - Penicillin-inducedinactivation ofaminoglycosid
e. The loss ofaminoglycoside effect may
be due to aphysical-
chemicalreaction
between theantibiotics.
- treatment ofserious infectionscaused bysusceptiblestrains of the
designatedmicroorganisms
- Penicillin GPotassium
- Pfizerpen
-
8/8/2019 Transposition of the Great Vessel
25/30
SURGICAL PROCEDURESURGICAL PROCEDURE Arterial Switch Procedure anatomically corrects the defects by placing the
pulmonary artery and aorta in their proper anatomicpositions
-
8/8/2019 Transposition of the Great Vessel
26/30
NURSING DIAGNOSISNURSING DIAGNOSIS
1. Decrease Cardiac Output R/T structural factorsof 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 duringactivities promote adequate rest by decreasing stimuli,
providing quiet environment
NURSING OUTCOME: The client will be able todisplay
hemodynamic stability after nursing intervention
-
8/8/2019 Transposition of the Great Vessel
27/30
2. Ineffective breathing pattern R/T decreaseenergy 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
NURSING OUTCOME: The client will be able to establish normal respiratory pattern after continuous nursing interventions.
-
8/8/2019 Transposition of the Great Vessel
28/30
3. Activity Intolerance R/T Imbalance between
oxygen supply and demand 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 diversionappropriate for age of child, allow to limit ownactivities as much as possible
explain to parents need to conserve energy andencourage rest
NURSING OUTCOME: The client will be able totolerate
increase activity after 3 days
-
8/8/2019 Transposition of the Great Vessel
29/30
PROGNOSISPROGNOSIS
Improvement in symptoms and growth
and development is seen after surgicalcorrection of the defect. If corrective
surgery is not performed, the lifeexpectancy is shortened.
-
8/8/2019 Transposition of the Great Vessel
30/30
RESEARCHRESEARCHA 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 recordsand complemented by questionnaires and in part bypersonal interview and clinical examination. The mainresults were among sibs of propositi with TGV anincreased incidence of TGV (0.01350.0054) and of
congenital heart disease in general (0.04950.0103)(K=0, rmin =1). Among 92 sibs of propositi with TA onlyone with patent ductus arteriosus was found. The sexratio of the propositi with TGV was 1.95. There was alsonoted a highly abnormal sex ratio among sibs of parentsof patients with TGV in part confirming the findings ofKNOX.A male excess was found in paternal and maternalsibships and was also present in sibships of propositi.Data about seasonal distribution were inconclusive aswere data about consanguinity of parents. No parentalage or birth order effect was found in either group.