copyright © 2012 by saunders, an imprint of elsevier, inc. chapter 12 cardiac disorders

Copyright © 2012 by Saunders, an imprint of Elsevier, Inc.

Chapter 12

Cardiac Disorders


Key Terms

• Chemoprophylaxis• Ductus arteriosus• Ductus venosus• Foramen ovale• Hemodynamics• Infective endocarditis

(IE)• Jones criteria

• Multifactorial• Polycythemia• Shunting• Subacute bacterial

endocarditis (SBE)• Squatting position

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Chapter 12

Lesson 12.1

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Learning Objectives

• Describe changes from fetal to neonatal circulation• Summarize the symptoms of a congenital heart

defect with increased pulmonary blood flow• Discuss the corrective interventions for a child with

mixed heart defects• Develop a teaching plan for an older child who is

scheduled for a cardiac catherization• List the symptoms for an infant with CHF• Plan discharge instructions for a postsurgical

cardiac child

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Cardiovascular System

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Cardiovascular System

• Heart fully functioning by 8th week of gestation

• Fetal circulation: placenta is the organ of oxygenation– Ductus venosus

– Ductus arteriosus

– Foramen ovale

• The birthing process begins closure of fetal shunts

• Heart defects are the most common birth defect– Leading cause of birth defect-related deaths

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Congenital Heart Disease

• Description– A defect in the structure of the heart or in one or more of the

large blood vessels that lead to and from the heart– Multifactorial

• Result of genetic-environmental interactions

• Four classifications– Based on defect’s effect on blood flow

• Hemodynamics: study of blood circulation• Shunting: flow of blood through abnormal openings

– Defects with increased pulmonary blood flow– Obstructive defects– Defects with decreased pulmonary blood flow– Mixed defects

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Congenital Heart Disease (CHD)

• Diagnostic tools– Not all testing is necessary for each child

– Lab tests, electrocardiogram, halter monitor, event recorder, chest radiography, echocardiogram, MRI, cardiac catherization

• Cardiac catherization is an invasive procedure• Provides information about anatomy, cardiac

pressure, oxygen saturation, cardiac function

• Sedation is necessary

• Extremity kept straight 4-6 hours after procedure12-9


Congenital Heart Disease (CHD)

• Signs and symptoms– Depend on location and type of heart defect– Child may be small for age, condition may be classified as

a physiologic failure to thrive– Exercise intolerance noticed anywhere from infancy to

toddler age– Clubbing of the fingers– Frequent respiratory infections because of pulmonary

vascular congestion– Squatting position– Polycythemia: Body compensates for hypoxemia by

increasing number of RBCs12-10


Congestive Heart Failure (CHF)

• Early symptoms– Lack of infant weight gain– Infant irritability and

fatigue– Tachycardia/tachypnea– Increased work of

breathing

• Progressive symptoms– Periorbital/facial edema– Vein distention– Hepatomegaly– Splenomegaly– Decreased urine output– Diaphoresis– Mottling– Cyanosis– Pallor

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Defects with Increased Pulmonary Blood Flow

• Patent ductus arteriosus (PDA)– Passageway connecting pulmonary artery to aorta, avoiding fetal

lungs– Failure to close causes oxygenated blood to recycle through the

lungs• Overburdens pulmonary circulation• Makes heart work harder• One of the most common cardiac anomalies

– Symptoms• Machine-like murmur, dyspnea, bounding pulses on exertion, failure to

thrive, frequent respiratory infections

– Treatment• Indomethacin/ibuprofen in premature infants• Amplatzer PDA device• Surgical repair

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• Atrial septal defect (ASD)– Abnormal opening between right and left atria– Common congenital heart anomaly– Symptoms

• Generally asymptomatic• Cyanosis if blood flow is reversed by heart failure• Large openings may cause failure to thrive

– Treatment• Open heart surgery• Percutaneous occluding devices

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• Ventricular septal defect (VSD)– Opening between right and left ventricles– 75% of small VSDs close spontaneously by age 10– Symptoms

• Loud, harsh murmur• Systolic tremor• Moderate/large defects may present CHF symptoms

– Treatment• Percutaneous transcatheter closure• Occluder devices

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Obstructive Defect

• Coarctation (tightening) of the aorta– Symptoms

• Increased pressure proximal to the defect• Decreased pressure distal to the defect• High blood pressure• CHF symptoms

– Treatment• Balloon angioplasty• Surgical intervention; anastomosis• Risk of developing subacute bacterial endocarditis

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Defect with Decreased Pulmonary Blood Flow

• Tetralogy of Fallot– The most common cyanotic heart defect– Four defects

• Stenosis (narrowing of pulmonary artery)• Hypertrophy of the right ventricle• Dextroposition of the aorta• VSD

– Symptoms• Cyanosis/hypoxemia episodes with hyperpnea, irritability• Hypoxia

– Treatment• Open heart surgery

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Mixed Defect

• Transposition of the great arteries (TGA)– Pulmonary artery leaves left ventricle– Aorta leaves the right ventricle– Other defects (septal defects, PDA) must be present to sustain

life– Survival impossible without surgery– Symptoms

• CHF symptoms• Any murmur present is caused by other defects, not TGA

– Treatment• Prostaglandin E1

• Balloon atrial septostomy• Corrective surgery

– Performed within the first 2 weeks of life12-18


Mixed Defect

• Hypoplastic left heart syndrome (HLHS)– Left side of the heart is underdeveloped– Hypoplasia of aorta, left ventricle, mitral valve– Systemic circulation provided by right side of the

heart– Ductus arteriosus and foramen ovale must remain

patent to survive with HLHS– Treatment

• PGE1 is administered to maintain a PDA

• Surgery in several stages– Norwood, Glenn, Fontan

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Question 12.1

Coarctation means:

A. widening.

B. shortening.

C. tightening.

D. lengthening.

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• Treatment and nursing care– Nursing goals in the care of the newborn

infant can be adapted for all children with heart defects

• Reduce the work of the heart• Improve respiration• Maintain proper nutrition• Prevent infection• Reduce the anxiety of the patient• Support and instruct the parents

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• Treatment and nursing care (continued)– Change child’s position frequently to prevent respiratory complications– Threat of cerebral thrombosis– Chest tubes may be used after surgery

• System must be airtight• Drainage containers always kept below the level of the chest

– Avoid unnecessarily disturbing the child

• Common medications– Digoxin (Lanoxin)– Dopamine, dobutamine, epinephrine– Amrinone, milrinone– ACE inhibitors– Angiotensin II receptor blockers– Diuretics

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• Treatment and nursing care (continued)– Infective endocarditis (IE)

• High risk for children with complex cyanotic heart diseases or children who have had heart surgery

• Organisms grow on the endocardium or areas of turbulent blood flow

– Symptoms• Fever, fatigue, headache, nausea, vomiting

– Diagnosis and treatment• Blood cultures determine causative organism• Antibiotics

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• Home care– Family must understand medication administration

– Family must identify symptoms requiring medical attention

– Provide a normal environment within child’s limits

– Avoid allowing the child to gain control of the home• Limit setting

– Integrate the child into family life

– Explain the possible need for frequent hospitalization to parents and child

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Question 12.2

Which of the following is NOT one of the four classifications of congenital heart disease?

A. Defects with increased pulmonary blood flow

B. Congestive heart failure

C. Defects with decreased pulmonary blood flow

D. Mixed defects

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Chapter 12

Lesson 12.2

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Learning Objectives

• List three major and two minor manifestations of acute rheumatic fever as determined by the modified Jones criteria

• Identify the priority nursing care for a child with rheumatic fever

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Acute Rheumatic Fever

• Description– Follows infection with certain strains of Group

A beta-hemolytic streptococci

• Signs and symptoms– Abdominal pain, fever, pallor, fatigue,

anorexia, unexplained nosebleeds– Jones criteria aid in diagnosis of rheumatic

fever– ECG is sometimes a useful diagnostic

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• Treatment and nursing care– Elimination of the initial infection is followed

by long-term chemoprophylaxis (prevention of disease by drugs)

– Intramuscular penicillin G benzathine (Bicillin), given as an intramuscular injection every 28 days

– Anti-inflammatory drugs are used to decrease pain and inflammation

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• Home care– Bed rest during the initial attack is not

necessary but is recommended if carditis is present

– Nurse must verify that parent and child understand activity limitations

• Parents should provide interesting quiet activities

– Long-term chemoprophylaxis

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• Prevention– The nurse is involved in prevention of rheumatic

fever in the community by recognizing signs and symptoms of streptococcal infections, doing screening, and referring for treatment

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Question 12.3

True or false: acute rheumatic fever is a system-specific disease, involving only the respiratory and cardiac systems.

A. True

B. False

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copyright © 2012 by saunders, an imprint of elsevier, inc. chapter 12 cardiac disorders

Documents

imprint of elsevier

mixed heart defects

congenital heart defect

flow of blood

type of heart defect

blood flow hemodynamics

cardiovascular system

postsurgical cardiac