Study Notes: Nursing Care of the Child with Cardiovascular Disorders

Chapter 41: Nursing Care of the Child with an Alteration in Perfusion/Cardiovascular DisorderCopyright InformationCopyright © 2025 Wolters Kluwer. All rights reserved.Cardiovascular System DevelopmentFetal DevelopmentFetal Heart Rate: Present around postconceptual day 17.Formation of Heart Chambers and Arteries: Occurs during gestational weeks 2 through 8.Oxygenation of the Fetus:Occurs via the placenta.Lungs are perfused but do not perform oxygenation and ventilation.Foramen Ovale: Opening between the atria that allows blood flow from the right atrium to the left atrium.Ductus Arteriosus: Allows blood flow between the pulmonary artery and the aorta, shunting blood away from pulmonary circulation.Changes from Fetal to Neonatal CirculationDiagram Representation (with structure labeled):Foramen ovaleDuctus arteriosus transitioning to ligamentum arteriosus post-birthBlood flow differentiation between pulmonary arteries and the aortaPediatric DifferencesDevelopmental Stage: 3-8 weeks gestationAnatomical Features:Chest wall thinnerMyocardial muscle less efficient, resulting in a less effective heart.Blood Pressure: Late indicator of heart function.Heart Disease Classification:Congenital heart disease vs. acquired heart diseaseCardiovascular Changes in ChildhoodHeart Rate (HR):Typically faster in infancy (90–160 BPM), decreases as the child ages.Blood Pressure (BP):Normal ranges lower in infancy (~80–55 mmHg), increases as the child ages.Both HR and BP reach adult levels by adolescence.Risk Factors for Cardiovascular Disorders in ChildhoodCongenital Risk FactorsIntrauterine rubella exposureMaternal alcoholismDiabetes mellitus (Type 1) of motherAdvanced maternal ageMaternal drug ingestionSibling or parent history of congenital heart disease (CHD)Chromosomal abnormalities (e.g., Down syndrome, Trisomy, Turner syndrome)Acquired Risk FactorsInfections:Rheumatic feverKawasaki diseaseEndocarditisLifestyle and Health Factors:ObesityDiabetesDrug or alcohol exposureHypertensionChemotherapyOther diseases (connective tissue disorders, autoimmune or endocrine diseases)Organ transplant historyHyperlipidemiaNormal Anatomy of the Cardiovascular SystemFundamental Principle: Blood flows from higher pressure to lower pressure and takes the path of least resistance.Pulmonary Vascular Bed: Internally a low-pressure system after birth.Great Vessels: Consists of the aorta and pulmonary artery.Assessment: Cardiovascular EvaluationComponents of Assessment:Prenatal and postnatal historyGrowth: height and weight measurementsFamily history (genetic predisposition)Physical examinationDiagnostic testsDiagnostic Tests for Cardiovascular DisordersKey Tests Include:Pulse oximetryElectrocardiogram (ECG) and Holter monitoringEchocardiogramChest radiographExercise stress testingLaboratory tests such as:Complete Blood Count (CBC)Basic Metabolic Panel (BMP)C-Reactive Protein (CRP)Erythrocyte Sedimentation Rate (ESR)Arteriogram and cardiac catheterizationSigns Related to Suspected Cardiac PathologyCommon Indicators Include:Failure to thrive or poor weight gainCyanosis or pallorObserved pulsations in the neckTachypnea, dyspneaIrregular pulse rateFatigue during feeding or activityExcessive perspiration, especially on the foreheadClubbing of fingersFrequent respiratory problemsCongestive Heart FailureDefinition:Severe circulatory congestion due to decreased myocardial contractility, leading to the heart's inability to pump sufficient blood to meet bodily needs.Consequences:Impaired myocardial functionPulmonary congestionSystemic venous congestionSymptoms of Congenital Heart DiseaseClinical Presentation:Varying severity based on the conditionTypical presentations:Poor growth/gaining weightRapid breathing or difficulty breathingTiredness during feedsMild or no symptoms in cases of mild congenital heart diseaseExcessive sweating, fatigue, rapid heartbeatCyanosis, reflected as bluish skin, lips, or fingernailsManagement Goals in Congestive Heart FailurePrimary Goals:Improve cardiac functionRemove excess fluid and sodiumDecrease cardiac demandsImprove tissue oxygenation/perfusion and decrease oxygen consumptionNursing InterventionsHome Care Recommendations:Monitor Intake/Output (I/O) and daily weightLimit feeding time to 30 minutes if the child becomes fatiguedImplement small, frequent feeding schedules with increased calorie intakeElevate head of the bed (HOB) to 30 degreesEducate parents on proper medication dosage and administrationMedications for Congestive Heart FailureTypes of Medications:Digoxin: Improves myocardial contractility, leading to more efficient heart pumpingDiuretics: Aid kidneys in removing excess fluid and sodiumAnticoagulants: To prevent blood clottingACE Inhibitors: Reduce blood pressure and manage heart failureBeta Blockers: Slow heart rate and lower blood pressureCalcium Channel Blockers: Help dilate blood vesselsCardiac Catheterization in ChildrenRisks Include:Risk for arrhythmiasBleedingHematoma formationRisk of thrombosisInfectionNursing Actions:Pre-procedure assessmentPost-procedure monitoring for complicationsTypes of Congenital Heart DiseaseSpecific Conditions Include:Patent Ductus Arteriosus (PDA)Ventricular Septal Defect (VSD)Coarctation of the Aorta (COA)Aortic Stenosis (AS)Pulmonic Stenosis (PS)Tetralogy of Fallot (Tet or TEF)Transposition of the Great Vessels (TGV)Patent Ductus Arteriosus (PDA)Definition:Condition where the fetal ductus arteriosus fails to close completely after birth.Physiological Impact:Causes blood from the aorta to flow into the pulmonary artery, leading to lung overload and associated heart failure.Medical Management:Includes Indomethacin and/or surgical closure of the PDAVentricular Septal Defect (VSD)Definition:An abnormal opening between the left and right ventricles, ranging from pinhole to absence of septum.Symptoms:Loud holosystolic murmurPoor feeding and failure to thriveSymptoms may lead to heart failureDiagnosis:Chest X-ray (CXR) and echocardiogram (ECHO) can confirm diagnosisTreatment:Dependent on size and symptoms; typically includes digoxin and LASIX before surgeryCoarctation of the Aorta (COA)Definition:Improper development of the aorta leads to a narrowing that obstructs left ventricular output, which can be observed as a kink in the aorta.Physiological Effects:Causes decreased perfusion below the point of coarctation, resulting in upper body hypertension and lower body hypotension.Surgical Repair:Involves surgical intervention for correctionAortic Stenosis (AS)Definition:An obstruction at the left ventricular outflow tract due to stenosis of the aortic valve.Symptoms:Children may be asymptomatic or might present with left ventricular hypertrophy in more severe cases.Management:Monitoring and possible surgical intervention depending upon severity.Tetralogy of Fallot (TEF)Definition:A congenital heart anomaly consisting of four defects: VSD, right ventricular hypertrophy, pulmonic stenosis, and an overriding aorta.Clinical Manifestations:Children may exhibit cyanosis during physical strain, termed "Tet spells."Management Strategies:Calming techniques, positioning (knee-to-chest), oxygen administration, and possible surgical correction at one year of age.Transposition of the Great Vessels (TGV)Definition:The arterial switch where the pulmonary artery exits the left ventricle and the aorta exits the right.Clinical Manifestation:Leads to systemic oxygen deprivation; immediate correction is required.Acquired Heart DiseaseCongestive Heart FailureExplanation:Involves chronic circulatory system failure and can manifest as fluid overload, fatigue on exertion, and tachycardia.Rheumatic FeverDefinition:A systemic inflammatory disease post group A streptococcal infection.Diagnosis:Modified Jones Criteria; requires either two major or one major plus two minor criteria.Kawasaki DiseaseDescription:An acute systemic vasculitis leading cause of acquired heart disease in children, with features including fever, rash, and swollen lymph nodes.Diagnosis:Requires specific clinical signs and symptoms including persistent fever and conjunctival injection.Treatment:Includes high-dose aspirin and intravenous immunoglobulin.HypertensionDefinition:Blood pressure readings above 95th percentile for age, with diagnosis made by two readings.HyperlipidemiaDefinition:High cholesterol levels influenced by genetics and lifestyle.Screening Recommendations:Children with risk factors should be screened every two years.ConclusionConsiderations for the nursing management and care of children with cardiovascular alterations must integrate comprehensive assessments, vigilant monitoring, and evidence-based interventions to improve outcomes in this population with unique needs.