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Chapter 41
Nursing Care of a Family When a
Child Has a Cardiovascular Disorder
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Cardiovascular Disorder
• Assessment
• Nursing diagnosis
• Outcome identification, planning
• Implementation
• Outcome evaluation
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The Cardiovascular System
• Terms
– Systole
– Diastole
– Cardiac output
– Preload
– Afterload
– Contractility
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Assessment of Heart Disorders
• History
• Physical assessment
– General appearance
– Pulse, blood pressure, respirations
– Murmurs
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Assessment of Heart Disorders (cont’d)
• Diagnostic tests
– Electrocardiogram
– X-ray
– Echocardiography
– Phonocardiography, MRI
– Exercise testing
– Laboratory tests
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Health Promotion and Risk Management
• Congenital heart disease
• Acquired heart disease
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Nursing Care: Cardiac Disorder
• Provide information
• Review follow-up care, emergencies
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Nursing Care: Cardiac Disorder (cont’d)
• Cardiac catheterization
– Preprocedure
– Procedure
– Postprocedure
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Nursing Care: Cardiac Disorder (cont’d)
• Cardiac surgery
– Preoperative care
– Preparing for surgery
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Nursing Care: Cardiac Disorder (cont’d)
– Postoperative care
• Central venous pressure monitoring
• Pulmonary artery pressure monitoring
• Preventing pooling of lung secretions
• Complications
• Post cardiac surgery syndrome
• Post perfusion syndrome
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Nursing Care: Cardiac Disorder (cont’d)
• Artificial valve replacement
• Cardiac transplantation
• Pacemaker
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Congenital Heart Disorders
• Classification
– Increased pulmonary blood flow
– Obstruction of blood flow leaving heart
– Mixed blood flow
– Decreased pulmonary blood flow
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Congenital Heart Disorders (cont’d)
• Increased pulmonary blood flow
– Ventricular septal defect
– Atrial septal defect
– Atrioventricular canal defect
– Patent ductus arteriosus
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Congenital Heart Disorders (cont’d)
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Defects c > Pulmonary Blood Flow
• VSD=
• Opening in the septum that allows blood to
shunt between L & R ventricle. May be
associated with PDA, fetal alcohol syndrome,
prematurity, Down’s & renal abnormalities
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Assessment
• FTT, loud, harsh systolic murmur & palpable
thrill, loud widely split pulmonic component
of S2, displacement of PMI to L. Prominent
anterior chest. Enlarged liver, hear & spleen
Diaphoresis, tachycardia, rapid-grunting
respirations
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Mgt
• VS, I&O, pulse ox, elevate HOB
• Digoxin, diuretics, & antibiotics
• Oral iron if anemia develops
• Spontaneous closure may occur by 6 mon
• Surgical closure
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Congenital Heart Disorders (cont’d)
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PDA
• Lumen of the duct between pulmonary
artery & aorta remains open. Right ventricle
hypertrophies causing > pressure in
pulmonary circulation
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Assessment
• Typical continuous systolic & diastolic
“machinery” murmur heard in upper L
sternal border or under L clavicle in older
children
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Mgt
• PO or IV indomethacin-lowers PGE level
which can lead to ductus closure
• Diuretics, antibiotics
• Surgery
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Congenital Heart Disorders (cont’d)
• Obstruction of blood flow
– Pulmonary stenosis
– Aortic stenosis
– Coarctation of the aorta
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Pulmonary Stenosis
• Assessment
• Therapeutic Management
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Pulmonic Stenosis
• Narrowing of pulmonary valve or artery
distal to valve
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Assessment
• Asymptomatic
• Mild R sided heart failure
• Cyanosis systolic ejection murmur grade IV
or V
• ECK-R ventricular hypertrophy
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MGT
• Balloon Angioplasty
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Aortic Stenosis
• Assessment
• Therapeutic management
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Aortic Stenosis
• Stenosis or stricture of valve prevents blood
from passing freely from L ventricle into
aorta.
• Increased pressure leads to hypertrophy of L
ventricle can lead to > L atrium pressure
leading to pulmonary edema
• Rough systolic murmur in aortic area
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MGT
• Beta or Calcium channel blockers
Anticoagulants Antibiotics & Surgery
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Congenital Heart Disorders (cont’d)
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Obstruction to flow-Coarctation of Aorta
• Narrowing of the lumen of the aorta due to a
constricting band. Leading cause of CHF in
first few mon. of life
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Assessment
• If slight-absence of a palpable femoral pulse
may be the only symptom.
• Obstruction proximal to L subclavian may
have absent brachial pulse as well
• Evaluate femoral pulses on newborns
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• Leg pain secondary to < blood supply
• Soft or moderately loud systolic murmurprominent at base of heart & transmitted to
L intercapsler area
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Mgt
• Surgery
• Prostaglandin E infusion-re-open or maintain
a patent ductus arteriosus
• Inotropic agents
• Diuretics
• Antibiotics
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Congenital Heart Disorders (cont’d)
• Mixed blood flow
– Transposition of great arteries
– Total anomalous pulmonary venous return
– Truncus arteriosis
– Hypoplastic left heart syndrome
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Mixed Blood Flow
Transposition of Great Arteries
• Aorta arises from R ventricle instead of L &
pulmonary artery arises from L ventricle
instead of R
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Assessment
• Cyanotic from birth
• Mgt-surgery
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Congenital Heart Disorders (cont’d)
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Congenital Heart Disorders (cont’d)
• Decreased pulmonary blood flow
– Tricuspid atresia
– Tetralogy of Fallot
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Congenital Heart Disorders (cont’d)
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Decreased Pulmonary Blood Flow
• Tetalogy of Fallot
• 4 anomalies present=
•
pulmonary stenosis
•
VSD
•
•
dextroposition of aorta
hypertrophy of R ventricle
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Assessment
• Skin develops blue tint
• Trouble sucking
• Polycythemia
• Dyspnea , growth restriction,
• Clubbing of fingers
• Squatting or knee chest position
• Tet spells (fainting & hypoxia)
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Mgt
• Inderal, antibiotics
• Temporary Surgery
• Full surgical correction at 1-2 yrs
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Acquired Heart Disease
• Congestive heart failure
– Assessment
– Therapeutic management
• Rest
• Oxygen
• Medications
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Acquired Heart Disease (cont’d)
• Persistent pulmonary hypertension
• Rheumatic fever
– Assessment
– Therapeutic management
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Acquired Heart Disease (cont’d)
• Kawasaki disease
– Assessment
– Therapeutic management
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Acquired Heart Disease (cont’d)
• Endocarditis
• Arrhythmias
• Hypertension
• Dyslipidemia
• Cardiomyopathy
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Cardiopulmonary Arrest
• Assessment
– Circulation
– Airway
– Breathing
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Cardiopulmonary Arrest (cont’d)
• Secondary measures
– IV access
– Medications
• Psychological support
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Question
• When planning the care for a child with
Kawasaki disease, which of the following
would be most important?
A. Making sure he performs postural drainage daily
B. Observing him for symptoms of bowel obstruction
C. Encouraging him to cough and deep-breathe
D. Teaching him to live with a chronic illness
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Answer
• B. Observing him for symptoms of bowel
obstruction
• Rationale: Extreme enlargement of lymph
nodes can occur with Kawasaki disease. If
abdominal nodes increase in size, they can
compress intestines, leading to bowel
obstruction.
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Question
• An 18-year-old with hypertension attends your ambulatory
clinic. She currently takes an oral contraceptive and an overthe-counter vitamin pill daily. What health teaching would you
initiate with her?
A. Teach her not to take the oral contraceptive in the morning
when blood pressure is highest.
B. Suggest she discontinue the vitamin tablet to help reduce her
blood pressure.
C. Suggest she speak to her physician about whether she
should remain on the oral contraceptive.
D. Nothing. There is no relationship between use of oral
contraceptives or vitamins and hypertension.
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Answer
• C. Suggest she speak to her physician about
whether she should remain on the oral
contraceptive.
• Rationale: Adolescents with hypertension are
advised not to take oral contraceptives
because these elevate blood pressure.
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Question
• Which of the following criteria is used to
define childhood hypertension?
A. A systolic reading over 70
B. A systolic reading above the 95th percentile for the
child’s age
C. Sustained increased systolic and diastolic readings
of 20 or more after minimal exercise
D. An increase in either systolic or diastolic reading
after exercise
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Answer
• B. A systolic reading above the 95th
percentile for the child’s age
• Rationale: Hypertension in children is
defined as a systolic reading above the 95th
percentile.
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