Nursing Care of a Family When a Child Has a Cardiovascular Disorder

Right side of the heart

Pumps blood to the lungs where it will be oxygenated. (Pulmonary Circulation)

Left side of the heart

Pumps oxygenated blood to the peripheral tissues (Systemic Circulation)

Systole

Contraction of the heart chambers

Diastole

Relaxation of the heart chambers

Cardiac output

Volume of blood pumped by the ventricles each minute

Preload, contractility, afterload

Cardiac output is affected by three main factors

Preload

The volume of blood in the ventricles at the end of diastole or the point just before contraction

Contractility

The ability of the ventricles to stretch

afterload

The resistance against which the ventricles must pump

• Right Atrium

• Right Ventricle

• Left Atrium

• Left Ventricle

4 chambers of the heart

Superior vena cava and Inferior vena cava

The two vessels that connect to the Right Atrium

Knee-chest position or squatting

These positions trap blood in the lower extremities because of the sharp bend at the knee and hip, allowing the child to oxygenate the blood remaining in the upper body more fully and easily.

Cyanosis

occurs if a shunt is allowing deoxygenated blood to enter the arterial system.

Adult heart flow

• Foramen ovale

• Ductus arteriosus

• Ductus venosus

Three fetal shunts

Fetal Heart Circulation

Highly oxygenated blood from the placenta returns via the umbilical vein, bypassing the liver through the ductus venosus and entering the IVC.

40%

About __ of this blood is shunted through the foramen ovale from the right atrium to the left atrium, then to the left ventricle and aorta, supplying the brain and upper body.

90%

Due to high pulmonary pressure, roughly __ of this blood bypasses the lungs via ductus arteriosus, flowing directly into the aorta.

• Aortic

• Pulmonic

• Erb’s Point

• Tricuspid

• Mitral

Points of Maximal Impulse of the Heart

Apical impulse, thrills, lifts or heaves

In a physical examination, your place a hand on the left side of the chest to evaluate for?

Right 2nd intercoastal space

The Point of Maximal Impulse (PMI) of the heart for aortic is located?

Left 2nd intercoastal space

The Point of Maximal Impulse (PMI) of the heart for pulmonic is located?

(S1, S2) Left 3rd intercostal space

The Point of Maximal Impulse (PMI) of the heart for Erb’s point is located?

Lower left sternal border 4th intercoastal space

The Point of Maximal Impulse (PMI) of the heart for tricuspid is located?

Left 5th intercoastal, medial to midclavicular line

The Point of Maximal Impulse (PMI) of the heart for mitral is located?

Thrills, Lifts, Heaves

These are three abnormal sounds we can hear upon auscultation

Thrills

A vibration felt secondary to significant cardiac murmurs

Lifts

Forceful cardiac contraction that causes the hand to move up

Heaves

Forceful cardiac contraction that actually causes the hand to move up and laterally

S1

Produced by the closing of mitral and tricuspid valve.

Blood fills the ventricles, and as ventricular pressure exceeds atrial pressure due to the volume within, the mitral and tricuspid valve areas are forced to close.

What happens during the S1- First Heart Sound?

Systole

Aortic and pulmonic valves are forced open and the ventricles contract ejecting blood out of the aorta and pulmonary artery.

“Lub”

During the first heart sound, the contraction of the heart produces this sound.

S2

Produced by the closure of the aortic and pulmonic valves.

Diastole

The ventricles contract and empty, the aortic and pulmonic valves closure during the ventricular relaxation.

“Dub”

During the second heart sound, due to the ventricular relaxation it produces this sound

S3

Produced from the rapid filling of the ventricles in early diastole and is best heard with the bell of the stethoscope.

“Lub-Lub-Dub”

In the third heart sound, due to the extra contraction in the ventricles it produces this sound. Aka the ventricular gallop.

S4

Produced by atrial contraction in late diastole and is always pathologic. It is best heard with the bell of the stethoscope and produces a gallop rhythm.

Decreased ventricular compliance or Structural defects that cause obstruction to ventricular flow.

In the S4- Fourth Heart Sound an atrial gallop occurs, with this sound the following conditions are noted:

“Lub-Dub-Dub”

In the fourth heart sound, due to the atrial contraction in the late diastole, it produces this sound. Aka the atrial gallop.

Heart Murmurs

Turbulent flow through an abnormal valve, vessel, or chamber.

Innocent Murmurs

This type of heart murmurs are not associated with any intracardiac disease.

Increased metabolic states that occur with anemia, fever, pregnancy, or anxiety

The following can alter characteristics of an innocent murmur:

Pathologic murmurs

This type of heart murmurs are always associated with cardiac anomaly or altered cardiac function

• Position in the cardiac cycle

• Duration

• Quality

• Pitch

• Intensity

• Location

• Presence of a thrill

• Response of the murmur to exercise or change of position

(mnemonic na medyo bastos Please Don’t Quit Penetrating In Lusty Positions Roughly)

What to asses and document when noting a murmur?

Levine Grading Scale

What grading scale do you use for systolic murmurs?

Grade I

The characteristic of this murmur grade is at its lowest intensity and difficult to hear.

Grade II

The characteristic of this murmur grade is immediately audible but has lower intensity.

Grade III

The characteristic of this murmur grade is audible and louder than grade II.

Grade IV

The characteristic of this murmur grade is readily noted; has an associated palpable thrill.

Grade V

The characteristic of this murmur grade has a palpable thrill; murmur can be heard with stethoscope partially lifted off the chest.

Grade VI

The characteristic of this murmur grade has a palpable thrill; loudest intensity; murmur can be heard with stethoscope raised above the chest.

Systolic

The timing of an innocent heart murmur is?

Systolic or Diastolic

The timing of a pathologic heart murmur is?

Short

The duration of an innocent heart murmur is?

Longer

The duration of a pathologic heart murmur is?

Soft, musical, twangy

The quality of an innocent heart murmur is?

Harsh, blowing, to and fro

The quality of a pathologic heart murmur is?

Soft

The intensity of an innocent heart murmur is?

Loud

The intensity of a pathologic heart murmur is?

Supine position

The position in which innocent heart murmurs is heard?

All positions

The position in which pathologic heart murmurs is heard?

SA node

The heart’s electrical activity starts in the?

Right atrial wall near the entrance of the superior vena cava

SA node is found in the?

Bundle of His, Purkinje fibers

Fill in the blanks:

SA node >AV node >____________ >_____________> walls and septum of the ventricles

Asystole

Complete absence of electrical and mechanical activity in the heart, indicating no heartbeat.

Electrocardiogram

Is a written record of the electrical voltages generated by the contracting heart

P-wave

Represents atrial depolarization or atrial contraction

QRS complex

ventricular depolarization or contraction

T-wave

ventricular depolarization or relaxation

U-wave

An additional slow wave

PR interval

time it takes for an electrical impulse to travel from atria to ventricles, its normal time is 0.12 to 0.20 sec.

QRS interval

The time it takes for the ventricle to depolarize, which typically takes between 0.08 to 0.10 seconds.

ST segment

80 to 120 milliseconds

QT interval

the time it takes for the ventricles to depolarize and repolarize, and typically lasts 0.45 to 0.46

• Acrocyanotic Heart Disease

• Cyanotic Heart Disease

Classifications of Congenital Heart Diseases

Acrocyanotic Heart Disease

Involve heart or circulatory anomalies, either a stricture to the flow of blood or shunt that moves blood from arterial to the venous system (left to right shunts)

Cyanotic Heart Disease

Blood is shunted from the venous to the arterial system as a result of abnormal communication between two systems (right to left shunts)

• Increased pulmonary blood flow

• Obstruction to blood flow leaving the heart

• Mixed blood flow (oxygenated and deoxygenated blood mixing in the heart or great vessels)

• Decreased pulmonary blood flow

Second Classification System