Congenital Heart Disease

Ductus arteriosis connects

pulmonary artery & aorta

foramen ovale connects

right and left atrium

Assessing functional capacity: ask

Can the pt walk across a room?

Does the patient become short of breath with routine activity?

Has exercise tolerance changed?

Can the patient complete school, work, feeding, or play activities?

Defects that INCREASE Pulmonary Blood Flow

PDA

ASD

VSD

Defect symptoms are primarily influenced by [2]:

size of opening

volume of blood

PDA cause

ductus arteriosis fails to close after birth

PDA findings

murmur

respiratory or pulmonary congestion

poor oxygenation

poor growth

signs of heart failure

prostaglandins

Prostaglandin treatment

maintains ductal patency

ASD

opening btwn right and left atria

ASD s/s

heart murmur

pulmonary hypertension

atrial arrythmias

RIGHT-SIDED heart failure

ASD “HOLES”

Heart failure + murmurs

Often recurrent lung infections

Low growth rate

Extra heart sounds

Stroke risk

When can a small ASD close?

4 hrs

VSD

opening btwn right & left ventricles

A small VSD may close spontaneously within

6 months of life

VSD s/s

Murmur

Congestive heart failure

Inadequate growth or failure to thrive

Frequent respiratory infections

Poor exercise intolerance

Diaphoresis and fatigue during feeding

Tachypnea, nasal flaring, peripheral edema in infants

Biggest sign of VSD

Diaphoresis and fatigue during feeding

Defects that decrease pulmonary blood flow

Pulmonary stenosis
ToF
Pulmonary atresia

Tricuspid atresia

Pathology of defects that decrease pulmonary blood flow

Defects restrict blood reaching the lungs for oxygenation, leads to reduced pulmonary blood flow

Pulmonary/tricuspid atresia

abnormal or absent valve formation

pulmonary stenosis

pulmonary valve unable to open —> leads to pooling of blood

ToF “RAPS”

Right ventricular hypertrophy

Aortic displacement

Pulmonary stenosis

Septal defect, usually ventricular

ToF s/s

cyanosis

dyspnea

harsh systolic murmur [left 2nd intercostal space]

Tet spells
Squatting in older children

Clubbing of the fingers

Poor growth and fatigue

POOR FEEDING + FAILURE TO THRIVE
RUDDY OR MOTTLED SKIN

EXERCISE INTOLERANCE

Chronic hypoxemia can lead to

polycythemia [thickened blood]

Tet spell

acute spell of worsening cyanosis and hypoxemia

Tet spells are triggered by [5]

crying

feeding

exertion

agitation

stress

Sign of tet spell

older children may instinctively squat

Management interventions of tet

Calm child
Reduce stimulation
position in squatting posture

Provide oxygen

Prescribe propranolol or morphine when indicated

Medications to give in tet [2]

propranolol
morphine

Nursing priorities for congenital defects

Cluster care

preserve rest

avoid scheduling bathing, therapies, feeding, etc… at all once
space activities

provide developmentally appropriate toys

infants need smaller, more frequent feedings

Communication with children

Describe echo as “taking a picture”

Offer favorite object

Describe what child will see

Sibling support

Validate anger and sadness

Explain child’s condition honestly

Maintain routines, peer relationships

Arrange support from relatives

Schedule individual time with siblings and involve them in activities