CHILD WITH CARDIOVASCULAR DYSFUNCTION
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Transcript of CHILD WITH CARDIOVASCULAR DYSFUNCTION
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CHILD WITH CHILD WITH CARDIOVASCULAR CARDIOVASCULAR
DYSFUNCTIONDYSFUNCTION
KAREN E. MILESKAREN E. MILESFLORIDA GULF COAST FLORIDA GULF COAST
UNIVERSITYUNIVERSITYDEPARTMENT OF NURSINGDEPARTMENT OF NURSING
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CONGENITAL HEART CONGENITAL HEART DEFECTSDEFECTS
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INCIDENCEINCIDENCE
1-2% of all live 1-2% of all live birthsbirths
Increases to 3% if Increases to 3% if have another child have another child with CHDwith CHD
4-10 in 1000 live 4-10 in 1000 live birthsbirths
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ETIOLOGYETIOLOGY
Multifactorial Multifactorial InheritanceInheritance
OthersOthers
Maternal RubellaMaternal RubellaMaternal AlcoholismMaternal AlcoholismMaternal Diabetes Maternal Diabetes MellitusMellitus
Down SyndromeDown SyndromeTrisomy #13 & #18Trisomy #13 & #18Turner’s SyndromeTurner’s Syndrome Marfan’s SyndromeMarfan’s SyndromeDi George SyndromeDi George Syndrome
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CLASSIFICATION OF CHDCLASSIFICATION OF CHD
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LEFT-TO-RIGHT SHUNTING LEFT-TO-RIGHT SHUNTING LESIONSLESIONS
Ventricular Septal Defect (VSD)Ventricular Septal Defect (VSD) Atrial Septal Defect (ASD)Atrial Septal Defect (ASD) Patent Ductus Arteriosus (PDA)Patent Ductus Arteriosus (PDA) AV Canal or Endocardial Cushion DefectAV Canal or Endocardial Cushion Defect
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OBSTRUCTIVE LESIONSOBSTRUCTIVE LESIONS
Pulmonary Stenosis (PS)Pulmonary Stenosis (PS) Aortic Stenosis (AS)Aortic Stenosis (AS) Coarctation of Aorta (COA)Coarctation of Aorta (COA)
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ADMIXTURE LESIONSADMIXTURE LESIONS
Transposition of Great Vessels (TGV)Transposition of Great Vessels (TGV) Total Anomalous Venous Connection Total Anomalous Venous Connection
(TAPVC)(TAPVC) Truncus ArteriosusTruncus Arteriosus
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RIGHT-SIDED OBSTRUCTIVE RIGHT-SIDED OBSTRUCTIVE LESIONSLESIONS
Tetralogy of Fallot (TOF)Tetralogy of Fallot (TOF) Tricuspid AtresiaTricuspid Atresia Pulmonary AtresiaPulmonary Atresia
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PULMONARY VENOUS PULMONARY VENOUS OBSTRUCTIVE LESIONSOBSTRUCTIVE LESIONS
Mitral/Aortic AtresiaMitral/Aortic Atresia CardiomyopathyCardiomyopathy
OTHEROTHER Hypoplastic Left Heart SyndromeHypoplastic Left Heart Syndrome
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NURSING CARE OF NURSING CARE OF CHILD WITH CHDCHILD WITH CHD
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A. A. Understand the causes, Understand the causes, pathophys., pathophys., clinical manif., clinical manif., diag. evaluation, and diag. evaluation, and therapeutic management of CHFtherapeutic management of CHF
Causes:Causes: Volume overloadVolume overload Pressure overloadPressure overload Decreased contractilityDecreased contractility High cardiac output demandsHigh cardiac output demands
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Clinical ManifestationsClinical Manifestations Tachycardia - resting rate greater than Tachycardia - resting rate greater than
160 beats/min in infants160 beats/min in infants DiaphoresisDiaphoresis Easily fatiguedEasily fatigued Poor exercise tolerancePoor exercise tolerance Poor perfusion - cold extremities, weak Poor perfusion - cold extremities, weak
pulses, low BP, mottled skinpulses, low BP, mottled skin
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Tachypnea - greater than 60 Tachypnea - greater than 60 breaths/min in infantsbreaths/min in infants
Mild cyanosisMild cyanosis DyspneaDyspnea RetractionsRetractions OrthopneaOrthopnea Wheezing coughWheezing cough
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HepatomegalyHepatomegaly Weight gainWeight gain EdemaEdema Distended neck & peripheral veinsDistended neck & peripheral veins
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DIAGNOSTIC EVALUATIONDIAGNOSTIC EVALUATION Chest X-RayChest X-Ray ECGECG Echo-cardiogramEcho-cardiogram
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B.B. PROVIDE SAFE & PROVIDE SAFE & THERAPEUTICTHERAPEUTIC NURSING NURSING CARECAREIdentify Early Signs of CHFIdentify Early Signs of CHF TachycardiaTachycardia TachypneaTachypnea Profuse scalp sweatingProfuse scalp sweating Fatigue and irritabilityFatigue and irritability Sudden weight gainSudden weight gain Respiratory distress Respiratory distress
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IMPROVE CARDIAC FUNCTIONIMPROVE CARDIAC FUNCTION Administer Digoxin (Lanoxin) Administer Digoxin (Lanoxin)
check apical pulsecheck apical pulse observe for signs of toxicityobserve for signs of toxicityPROMOTE FLUID LOSSPROMOTE FLUID LOSS Administer Diuretics (Lasix, Diuril, Aldactone)Administer Diuretics (Lasix, Diuril, Aldactone) Possible fluid restrictionsPossible fluid restrictions Possible sodium restrictionsPossible sodium restrictions Monitor intake and outputMonitor intake and output
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DECREASE CARDIAC DEMANDSDECREASE CARDIAC DEMANDS Prevent cold stress in infantsPrevent cold stress in infants Treat any infectionTreat any infection Rest and conservation of energyRest and conservation of energy Minimize unnecessary stressMinimize unnecessary stress
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REDUCE RESPIRATORY DISTRESSREDUCE RESPIRATORY DISTRESS Position with HOB elevatedPosition with HOB elevated Administer OxygenAdminister Oxygen Monitor Respiratory Rate and EffortMonitor Respiratory Rate and Effort
MAINTAIN NUTRITIONAL STATUSMAINTAIN NUTRITIONAL STATUS Increase CaloriesIncrease Calories PositioningPositioning Alternate Feeding TechniquesAlternate Feeding Techniques
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SUPPORT CHILD AND FAMILYSUPPORT CHILD AND FAMILY Foster Parent-To-Infant AttachmentFoster Parent-To-Infant Attachment Encourage Parents to StayEncourage Parents to Stay Give Clear ExplanationsGive Clear Explanations Keep InformedKeep Informed Provide Emotional SupportProvide Emotional Support