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Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Chapter 27
Caring for the Child with a
Cardiovascular Condition
Susan Ward
Shelton Hisley
A & P Review
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Anatomy
Chambers
Valves
Vessels
Normal flow
Physiology
Cardiac output
Stroke volume
Chambers of the Heart
Valves of the Heart
Vessels of the Heart
Normal Blood Flow
Congestive Heart Failure
 Signs & Symptoms:
 Vary with age fluid congestion
 Poor feeding & growth, irritability, shortness of breath,
excessive sweating
 Nursing Care:
 Positive inotropes (digoxin), diuretics (furosemide),
vasodilators (captopril)
 Fluid restriction not often used (only in the worst
cases)
Congenital Heart Disease
Cyanotic versus Acyanotic Congenital Heart
Defects
 Shunting Pattern
 Left to right shunting
 Acyanotic
 Right to left shunting
 Cyanotic
Segmental Classification of
Congenital Heart Defects (Table 27-2)
 Types of Defects
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Septum or septae (chamber walls)
Vessels & valve
Conaltruncal defects
Combination defects
Defects in the Septum
Atrial Septal Defect (ASD)
Atrial Septal Defect (ASD)
 Signs & Symptoms:
 May have a murmur, a heave or a thrill
 Right atrial enlargement
 Nursing Care:
 Closes spontaneously or may need a surgical
procedure
 Post-operative management
Postoperative Management
 Record vital signs frequently
 Maintain “lines”
 Peripheral IV line
 Central venous pressure
 Intracardiac lines
 Assess & maintain respiratory status
 Monitor fluid status
 Assess for s/s of infection
Ventricular Septal Defect (VSD)
Ventricular Septal Defect (VSD)
 Signs & Symptoms:
 Large opening; (SOB, feeding difficulties, poor
growth, easy fatigability & recurrent pulmonary
infection)
 Harsh murmur with a thrill
 Nursing Care:
 Closes spontaneously or may need a surgical
procedure
 Post-operative management (see critical nursing action
Postoperative management)
Atrioventricular Canal
Defect (AVC)
Atrioventricular Canal
Defect (AVC)
 Signs and Symptoms:
 Cardiac failure (SOB, respiratory distress, periorbital
edema, FTT, respiratory infections, distended liver)
 Nursing care:
 Prior to surgery; optimize cardiac output & weight
gain
 Post-operative management
Defects of the Vessels &
Valves
Patent Ductus Arteriosus (PDA)
Patent Ductus Arteriosus (PDA)
 Signs & Symptoms:
 Murmur
 Frequent colds, susceptible to RSV, fatigue, poor
feeding & poor growth pattern
 Nursing Care:
 Closed surgically, or with a transcatheter device
 Indomethacin (Indocin)
 Postsurgical measures (wound care, monitoring VS,
adequate hydration & nutrition)
Pulmonic Stenosis (PS or PVS)
Pulmonic Stenosis
 Signs & Symptoms:
 Murmur, may have dyspnea
 Cyanosis
 Nursing Care:
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Balloon angioplasty or valvuloplasty
Monitor for restenosis
Reduce stressful situations
Subacute Bacterial Endocarditis prophylaxis (SBE)
Pulmonary Atresia
Pulmonary Atresia
 A fatal defect if not corrected or palpitated
 Emergency procedure performed to save child’s
life
 Initial prostaglandin (PGE1) is infused (maintain
patency)
 Balloon atrial septostomy is performed to create
an ASD
 Initial surgical repair includes a shunt or conduit
 Later, Fontan procedure may be needed
Aortic Stenosis (AS or AVS)
Aortic Stenosis (AS or AVS)
 Signs & Symptoms:
 Murmer
 Click or thrill
 Chest pain, fatigue and syncope
 Nursing Care:
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Angioplasty or valvuloplasty
Repair or replace valve
Medical and/or postoperative management
Life-long monitoring
 Subacute Bacterial Endocarditis prophylaxis (SBE)
Coarctation of the Aorta (CoA)
Coarctation of the Aorta (CoA)
 Signs & Symptoms:
 B/P differences between the arms & legs
 Signs of congestive heart failure
 Pain in legs or cyanotic lower extremities
 Nursing Care:
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Surgery
Balloon angioplasty & stent placement
Postoperative management (follow-up; restenosis)
Subacute Bacterial Endocarditis prophylaxis (SBE)
Tricuspid Atresia (TA)
Tricuspid Atresia (TA)
 Signs & Symptoms:
 Severely cyanotic, tachycardiac & dyspneic
 Heart murmur
 Nursing Care:
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Prostaglandin (PGE1)
Emergent Balloon atrial septostomy
Numerous surgical repairs
Postoperative management
Total Anomalous
Pulmonary Venous Return
(TAPVR)
Total Anomalous
Pulmonary Venous Return (TAPVR)
 Signs & Symptoms:
 Cyanosis, respiratory distress, lethargy, poor & rapid
breathing, poor feeding, frequent respiratory
infections & signs heart failure
 Nursing Care:
 Surgical repair
 Routinely followed (every 1-2 years)
 Subacute Bacterial Endocarditis prophylaxis (SBE)
Conal Truncal defects
Transposition of the
Great Arteries or Vessels (TGA
or TGV)
Transposition of the
Great Arteries or Vessels (TGA or
TGV)
 Signs & Symptoms:
 Appear at birth
 Cyanosis, SOB, poor feeding, clubbing of fingers &
toes
 Nursing Care:
 Surgical repair (arterial switch operation)
 Postoperative management
 Subacute Bacterial Endocarditis prophylaxis
Truncus Arteriosus
Truncus Arteriosus
 Signs & Symptoms:
 Cyanosis
 Congestive heart failure
 Low cardiac output
 Nursing Care:
 Inotropic medications
 Postoperative management
 Subacute Bacterial Endocarditis prophylaxis (SBE)
Combination Defects –
Tetrology of Fallot (TOF)
Tetrology of Fallot (TOF)
 Signs & Symptoms:
 Cyanosis with crying or playing
 “TET" spells
 Nursing Care:
 Surgical repair
 Postoperative management
 Subacute Bacterial Endocarditis prophylaxis
(SBE)
Complex or Single
Ventricle Type Defects –
Hypoplastic Left Heart Syndrome
(HPLS)
Hypoplastic Left Heart
Syndrome (HLHS)
 Signs & Symptoms:
 Inadequate cardiac output
 Nursing Care:
 Artificial shunt or pathway created shortly after birth
 Prostaglandin (PGE1) given
 Numerous surgical repairs (cardiac transplant)
 Palliative care measures
Cardiac Diseases
Subacute Bacterial Endocarditis (SBE)
 Signs & Symptoms:
 Vague (low-grade fever, malaise, loss of appetitive & muscle
aches
 Acute (high fever, chills, sweating, stiff joints or back pain)
 As the condition worsens symptoms of heart failure occur
 Nursing Care:
 Antibiotics
 Prevention (see Prophylaxis Guidelines)
 Valve destruction needs repair or replacement
Kawasaki Disease
 Signs & Symptoms:
 Vasculitis affecting all organ
systems
 Fever (5 days or more 104F°
[40C°])
 Skin rash
 Cervical lymphadenopathy
 Edema & erythema of hands &
feet (peeling)
 Strawberry tongue
 Conjunctivitis without exudate
 Nursing Care:
 IV immunoglobulin (IVIG)
 Aspirin (ASA)
 Steriods, plasma
exchange,
 Cytotoxic agents
 Clinical alert: aneurysm
formation
 Frequent follow-up visits
 Exercise stress test
Cardiomyopathy (CM)
 Signs & Symptoms:
 Vague symptoms;
(weakness, excessive
tiredness, exercise
intolerance, SOB, exercise
intolerance, heart
palpitations, chest pain,
poor feeding, slow weight
gain, fainting or
lightheadedness)
 Nursing Care:
 Medications (ACE
inhibitors) or angiotension
receptor blockers
 Beta blocker therapy
 Nutritional supplementation
 Diuretic and inotropic
therapy
 Followed closely
 Activity restrictions
 Cardiac transplant
Rheumatic Fever (RF)
 Group A-hemolytic streptococcal infection
affecting the heart, joints, subcutaneous
tissue & nervous system
 Cause permanent damage (aortic & mitral
valves involved)
 Require valve replacement
Additional Cardiac Conditions
Cardiac Trauma
 Signs & Symptoms:
 Related to the type of cardiac trauma sustained
 Nursing Care:
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Based on exact type of injury
Bedrest, activity restrictions
Antiarrhythmics & inotropic agents
Pericardiocentesis
Cardiac rehabilitation program
Hypercholesterolemia-Hyperlipidemia
 Primary or Secondary Condition:
 Primary - hereditary predisposition
 Secondary – exogenous
 Treatment goals:
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Know cholesterol levels in children
Diet modification
Exercise
Medication
Hypertension
 Signs& Symptoms:
 Depend on underlying cause
 Elevated blood pressure (see Table 21-2)
 Nursing Care:
 Education about the condition, diet, exercise, lifestyle
modification
 Medication (beta-blockers & angiotensin-converting
enzyme (ACE) inhibitors
Idiopathic Primary Pulmonary Arterial
Hypertension (IPAH)
 Signs & Symptoms:
 SOB, chest pain, weakness, fatigue, dizziness, leg swelling & fainting
episodes
 Nursing Care:
 Prostacyclin (Flolan) dilates blood vessels & decreases pulmonary
vascular resistance
 Inhaled nitric oxide relaxes pulmonary (not systemic) vessels
 Sildenafil (Revatio) decreases pulmonary artery pressures
 Bosentan (Tracleer) blocks hormone that causes vasoconstriction
Neurally Mediated Syncope (NMS)
Signs & Symptoms:
 A fainting spells (may experience a seizure)
Nursing Care:
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Increase sodium & water intake
Fludrocortisione (Florinef)
Beta-blocker
Monitor (frequency, severity & precipitating factors)
Long Q-T Syndrome
 Signs & Symptoms:
 fainting, palpitations, seizure or death
 Nursing Care:
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Beta-blockers
Pacemaker-defibrillator insertion
Left cardiac sympathetic denervation
Medication compliance
Rhythm Disturbances
 The nurse who can determine the baseline
rhythm and recognize changes will facilitate the
best outcome for a child with an arrhythmia
 Important questions:
 Is the rhythm potentially fatal?
 Will it alter the cardiac output?
Invasive Tests
 Cardiac Catheterization:
 Determines the pressures in heart & radiographic picture
of heart anatomy
 Interventional catheterization is a corrective procedure
 Post Catheterization: Monitor - pressure dressing in the
groin, heart rate, respirations & blood pressure
 Angiography:
 Visualizes the structures & function of the ventricles,
vessels & valves; size & location of septal defects; directs
medical treatment
 Biopsy:
 Routine biopsies to assess for cardiac transplant
rejection
 Closure devices:
 Close simple intracardiac communications or shunts
 Opening devices:
 Angioplasty or Valvuloplasty
 Opens narrow vessels or valves
 Balloon atrial septostomy:
 Emergent palliative procedure necessary to keep the
child alive
Surgical Interventions
 Complete or palliative repair (Table 27-4)
 Pacemakers
 Used to treat cardiac conditions; internal or
external; temporary or permanent
 Postoperative; watch for s/s of infection &
ensure incision remains
 Follow-up care requires routine pacemaker
testing
Cardiac Transplantation
 Corrects and prevents the condition from
progressing
 Nursing Care:
 Educate regarding medication compliance
 Communicating to family about frequent follow-up
visits
 Educate family about post transplant tests & rejection
 Address emotional & psychological issues
 Address alterations in growth & development
Nursing Care for the
Child with a Cardiac Condition
 Admission to the PICU (highly trained nurses)
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Assessment
Nutrition
Hygiene
Activity
Psychosocial care
Vital signs
Maintaining growth & development
Administering medications
Performing lab tests
Interpreting an ECG
Transferring the Stable
Child to a Surgical or Medical Unit
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Children have a more stable condition
Telemetry monitoring
Take less frequent vital signs
Consider growth & development
Medications
Draw blood for laboratory analysis
ECG monitoring
Caring for Children with Cardiac
Conditions Across Care Settings
 Parent knows the child the best
 School
 Automatic external defibrillator
 Personnel should complete a CPR course
 Vital signs & medication
 Teach the child & family
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Cardiopulmonary Resuscitation (CPR)
Vital Signs
Medication
Disease entity
Resources