NURSING CARE OF A FAMILY WHEN A CHILD HAS ■ Patent Ductus Arteriosus

○ Disorders with Obstruction to Blood Flow

A CARDIOVASCULAR DISORDER
Krizle Adaza ■ Pulmonary Stenosis
■ Aortic Stenosis
OVERVIEW: ■ Coarctation of the Aorta
● The Cardiovascular System ○ Disorders with Mixed Blood Flow
○ 2020 National Health Goals ■ Transposition of the Great Arteries
○ Nursing Process Overview ■ Total Anomalous Pulmonary Venous Return
● Assessment of Heart Disorders in Children ■ Truncus Arteriosus
○ History ■ Hypoplastic Left Heart Syndrome
○ Physical Assessment ○ Disorders with Decreased Pulmonary Blood Flow
○ General Appearance ■ Tricuspid Atresia
○ Pulse, Blood Pressure, and Respirations ■ Tetralogy of Fallot
○ Diagnostic Tests ● Acquired Heart Disease
■ Electrocardiogram ○ Congestive Heart Failure
■ X-Ray Studies ○ Persistent Pulmonary Hypertension
■ Echocardiography ○ Rheumatic Fever
■ Phonocardiography and Magnetic Resonance Imaging ○ Kawasaki Syndrome
■ Exercise Testing ○ Infectious Endocarditis
■ Laboratory Tests ○ Arrhythmias
● Health Promotion and Risk Management ○ Hypertension
○ Risk Management for Congenital Heart Disease ○ Dyslipidemia
○ Risk Management for Acquired Heart Disease ○ Cardiomyopathy
● Nursing Care of the Child with a Cardiac Disorder ● Cardiopulmonary Arrest
○ The Child having a Cardiac Catheterization ○ Chest Compressions
○ The Child Scheduled for Cardiac Surgery ○ Airway
■ Preoperative Care ○ Breathing
■ Complications of Cardiac Surgery ○ Secondary Measures
○ The Child with an Artificial Valve Replacement
○ The Child Undergoing Cardiac Transplantation
■ Ventricular Assist Devices
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○ Psychological Support

■ Cardiac Transplant
○ The Child with a Pacemaker
● Congenital Heart Disorders
○ Classifications
■ Acyanotic Heart Disease
■ Cyanotic Heart Disease
○ Disorders with Increased Pulmonary Blood Flow
■ Ventricular Septal Defect
■ Atrial Septal Defect
■ Atrioventricular Canal Defect
CARDIOVASCULAR SYSTEM ASSESSMENT OF HEART DISORDERS IN CHILDREN
● 2020 National Health Goals ● History , Physical Assessment, and General Appearance
○ Cardiovascular illness is a major health problem in adults
○ Increase the proportion of adolescents who meet current federal
physical activity guidelines for aerobic physical activity (7
days/week) and for muscle strengthening activity (≥3 days/week)
○ Reduce the proportion of children age 2 to 19 years who are
considered obese
○ Reduce consumption of calories from solid fats in the population
aged 2 years and older .
○ Reduce consumption of calories from added sugars
○ Reduce the proportion of children and adolescents (ages 8 to 17
years old)
● Nursing Process Overview
○ Assessment
■ Includes history taking and physical examinations
■ Diagnostic studies include: echocardiography,
electrocardiography, or cardiac catheterization
○ Nursing Diagnosis
■ Addresses the effect of poor circulation to body tissues or
can be an effect of a serious disorder
○ Outcome Identification and Planning
■ Additional teaching is necessary to prepare parents and
children for procedures or surgery and recovery at home
○ Implementation
■ Includes:
● Health teaching
● Providing an opportunity for children and their
families to express fears about a child’s illness ● Pulse, Blood Pressure, and Respirations
● Treatment plan ○ innocent heart murmur/functional/insignificant
● Providing physiologic and psychological support ■ Murmurs of no significance or of no consequence
such as comfort measures after surgery ○ Organic heart murmur/
● Promoting a home environment free from smoke ■ If a murmur occurs as a result of heart disease or
● Encouraging a healthy lifestyle through exercise, a congenital defect
maintaining an appropriate weight, and eating a
low-fat diet
○ Outcome Evaluation
■ Include both immediate and future outcomes
 ■ presence or absence of hypertrophy (thickening of
the heart walls),
■ ischemia or necrosis
■ abnormalities of conduction
■ effect of various drugs and electrolyte imbalances
on the heart
○ X-Ray Studies
■ Provides understanding of:
● heart’s size and orientation
● pulmonary blood flow
● associated lung disorders
■ Fluoroscopy: provides a motion picture record of
the size and configuration of the heart, great
vessels, lungs, thoracic cage, and diaphragm
○ Echocardiography
■ Or Ultrasound cardiography
■ Primary diagnostic test for congenital heart
diseases
■ Used to locate and study the movements and
dimensions of cardiac structures
■ Used during pregnancy as early as 18 weeks to
reveal anomalies
■ M-Mode: reveal chamber contractility
■ 2-dimensional: reveal chamber and vessel size
■ Doppler Technique: reveals velocity and blood
flow
■ This test can be repeated since it does not have
risk for radiation
○ Phonocardiography and Magnetic Resonance Imaging
■ Diagram of heart sounds translated into electrical
energy
■ Measure if heart sounds occur too quickly or if it
has a high or low frequency
● Diagnostic Tests ■ MRIcan be repeated since it does not have risk
○ Electrocardiogram for radiation
■ Record of the electrical activity ○ Exercise Testing
■ Provides information about: ■ Uses treadmill walking to demonstrate the
■ heart rate pulmonary circulation is able to meet the
■ Rhythm respiratory demands of exercise
■ state of the myocardium ■ Difficult to perform successfully with children
because they require the child’s cooperation
 ○ Laboratory Tests ● School nurses can monitoring the foods served
■ Blood test: support the diagnosis of heart disease daily in school cafeterias and advocating for more
or to rule out anemia or clotting disorders nutritious menus
■ Blood gas level: shunt directing deoxygenated ○ Hyperlipidemia
blood into oxygenated blood can be suspected ■ Inherited
■ Oxygen saturation levels: children with a ■ From a diet high in saturated fat
deoxygenated to oxygenated shunt will have a ■ Management:
lower than normal oxygen saturation level in ● Fat intake not be restricted in infants and toddlers:
arterial blood. fat is for brain development.
■ Blood clotting: before cardiac catheterization or
surgery NURSING CARE OF THE CHILD WITH A CARDIAC DISORDER
■ Serum sodium level: ensure that an increased ● The Child having a Cardiac Catheterization
sodium level is not causing edema ○ 2 types:
■ Diagnostic Cardiac Catheterization: Diagnose specific
HEALTH PROMOTION AND RISK MANAGEMENT heart disorder
● Risk Management for Congenital Heart Disease ■ Interventional Cardiac Catheterization: Correct an
○ Women need to enter pregnancy fully immunized: prevent abnormality
infection during pregnancy ○ This procedure is invasive; catheters are inserted through a large
○ Family member born with heart disorder need to be aware that vein and artery and floated into the heart
other children born to them need to be carefully screened: ○ uses fluoroscopy, which is a form of imaging that uses radiation
familial patterns of inheritance. to generate real-time moving images of structures
● Risk Management for Acquired Heart Disease ● The Child Scheduled for Cardiac Surgery
○ Risk factors for children to have an acquired heart diseases ○ Preoperative Care
includes: ■ Obtain vital signs: to establish baselines
■ Rheumatic fever ■ Count pulse and respiratory Blood pressure: take when
■ Hypertension lying down so it mimics what the child’s position will be
■ Hyperlipidemia following surgery
○ Rheumatic fever ■ Record height and weight: necessary for estimation of
■ Autoimmune response that follows a group A ß-hemolytic blood volume of heart, medication dosages, estimate
streptococcal infection. blood loss and edema
■ Management: ■ Note: Digoxin is withheld 24 hrs before surgery to prevent
● Receive adequate antibiotic therapy arrhythmias
○ Hypertension ○ Complications of Cardiac Surgery
■ Elevated blood pressure ■ Hemorrhage
■ A genetic predisposition ● Occur because of heparin. Heparin is needed
■ High intake of sodium, lack of exercise, and obesity during surgery despite its risk because it prevents
increases child susceptibility blood coagulation
■ Management: ● Protamine Sulfate is the antidote for heparin
● Urging families to reduce intake of processed ■ Shock
foods and snacks: reduce salt intake in children ● Revealed by hypotension, oliguria, acidosis and
cyanosis
 ● Results from hypovolemia or cardiac tamponade ○ Cardiac Transplant
(bleeding in heart muscles interfering with hearts ■ remains an i​mportant treatment option in the care of
contractility) children ​with end-stage heart disease, whether it is
■ Heart Block or Arrhythmias secondary to cardiomyopathy or congenital heart disease
● Result of edema or trauma (CHD
■ Neurologic Disorders ● The Child with a Pacemaker
● Result when a child develops hypoxia during ○ A pacemaker is a small device that uses electrical impulses to
surgery control the speed and rhythm of child's heartbeat.
■ Post Cardiac Surgery Syndrome ○ Your child should avoid strong electric and magnetic fields, as
● Occur at the end of postoperative weeks these can interfere with pacemaker function.
● A febrile illness with pericarditis and pleurisy (fluid ○ Your child should not play sports where there is a risk of
in the pleural space) repetitive blows to the pacemaker area.
● Inflammatory response to the procedure ○ Regular follow-up appointments with both the cardiologist and
■ Postperfusion Syndrome the pacemaker clinic are important.
● Occur 3-12 weeks after surgery ○ If you are concerned about your child, please seek medical
● Results from a cardiopulmonary bypass during attention. If you have questions about the pacemaker, please
surgery call the pacemaker clinic staff.
● The Child with an Artificial Valve Replacement
○ Used for aortic stenosis, rheumatic fever, and Kawasaki
CONGENITAL HEART DISORDERS
syndrome
● Former Classification
○ Artificial valves are made of synthetic material (prosthetic) or
○ Acyanotic Heart Disease
obtained from human donors (homografts)
■ “Left-right” shunt
○ If a child develops a bacterial infection with an artificial valve in
■ Oxygenated blood from the left side mixes with blood in
place may develop endocarditis
the right side of the heart and goes back to the lungs
■ Prescribe with prophylactic antibiotic therapy or additional
again
amoxicillin if the child is due for another invasive
○ Cyanotic Heart Disease
procedure
■ “Right-to-left” shunt
○ Adolescent girls need counseling about avoiding pregnancy:
■ Venous blood from the right side of the heart mixes with
artificial valve may be unable to accommodate both the
blood on the left side that delivers deoxygenated blood to
increased blood volume associated with pregnancy and
the body
adolescent growth spurt
● Second Classification
○ Hemolytic anemia may occur from artificial valve replacement
○ Increased pulmonary blood flow
thus periodic blood replacement is necessary for hemolytic
○ Obstruction to blood flow leaving the heart
process to persists
○ Mixed blood flow (oxygenated and deoxygenated blood mixing in
● The Child Undergoing Cardiac Transplantation
the heart or great vessels)
○ Ventricular Assist Devices
○ Decreased pulmonary blood flow
■ Used to support the heart as a patient recovers from
surgery, as a bridge to support the child's heart while
CONGENITAL HEART DISORDERS​ ​(Refer to table)
they wait for a heart transplant, or as a long-term support
ACQUIRED HEART DISEASE​ ​(Refer to table)
for patients for whom heart transplantation is not the right
option
CARDIOPULMONARY ARREST ■ Better than peripheral pulse used for older children
● Assessment ■ easiest to assess
○ Frequent cause: respiratory failure ○ If you feel no pulse, begin chest compressions
○ no audible heart sounds or pulses can be obtained. ○ Chest compression in Newborn: midsternum about a
○ No blood pressure can be recorded (do not waste time trying to fingerbreadth below the nippleline to a depth of 1/4 to 1 inch
obtain one) ○ Infants: administer two breaths, then compress the chest 30
○ The steps for resuscitation can be remembered as times (2:30)
○ “ABCs” (airway, breathing, and circulation) ○ Older Children/Adults: 2:15
● Airway
○ Shake the child
○ Call the child’s name: verify that a child is not just sound asleep
○ Call for help
○ Turn child unto back
○ Open mouth
○ Tip head backward, hyperextend slightly "sniffing position": clear
airway
● Breathing
○ Ambu-bag:Emergency equipment (so that mouth-to mouth
resuscitation is not necessary)
○ If Ambu-bag or breathing bag is not available, use a one-way
valve mask to protect yourself from body secretions
○ small infants: bag mask over the infant’s mouth and nose,
creating a seal
○ larger infants and children: make a bag-to-mouth seal, pinching
the child’s nose tightly with the thumb and forefinger
○ two slow breaths (1 to 1.5 seconds per breath).
○ Head tilt: should not be done if neck or spine trauma is
suspected
○ If oxygen is available: attach it to the resuscitation bag (4 L/min.)
○ Observe the child’s chest with each breath you administer: to
see if it rises
○ If it does not, the airway is obstructed
○ Do not lift your fingers or hands off the chest:requires time spent
○ Infant: perform back blows and chest thrusts help relieve
to properly reposition them
obstruction
○ Make sure to maintain a patent airway by using the head-tilt chin
○ Older child: subdiaphragmatic abdominal thrusts help relieve
lift
obstruction
○ If the resuscitation attempt is successful: child’s color will
○ 20 breaths/min in both infants and older children
improve
● Circulation
○ With shock, the peripheral pulses may be absent while the heart
is still beating
○ Carotid Pulse
SECONDARY MEASURES
● Drugs administered through an intraosseous route reach the circulation
as rapidly as IV administration because of the rich blood supply in the
bone
● Common drugs in resuscitation procedures that should be available on
a pediatric emergency cart:
○ Atropine
■ Reduces bronchial secretions, keeping the airway clear
during resuscitation
■ Relieves bradycardia
○ Calcium chloride
■ Increases heart contractility.
○ Epinephrine
■ Strengthens or initiates cardiac contractions
■ bronchodilates
○ Adenosine
■ Relieves arrhythmias
○ Lidocaine & Bretylium tosylate
■ Counteracts ventricular arrhythmias
○ Amiodarone (Cordarone)
■ An antidysrhythmic
○ Dopamine
■ Increases cardiac output
■ Alphareceptors: cause vasoconstriction.
○ Dobutamine
■ direct-acting beta-agonist that increases contractility and
heart rate

PHYSIOLOGICAL SUPPORT
● Assure the child that everyone is there to help
● Assist, inform, and comfort parents and child
● Provide specific information on the child’s condition as soon as it is
available
● Be certain parents know follow-up procedures: ECG monitoring or
blood-gas measurements to prevent another emergency
● Offer support to help them begin grieving if the child does not survive