CHILD WITH CARDIOVASCULAR
DYSFUNCTION
KAREN E. MILES
FLORIDA GULF COAST UNIVERSITY
DEPARTMENT OF NURSING
CONGENITAL HEART DEFECTS
INCIDENCE
1-2% of all live births
 Increases to 3% if
have another child
with CHD
 4-10 in 1000 live births

ETIOLOGY


Multifactorial Inheritance
Others
Maternal Rubella
Maternal Alcoholism
Maternal Diabetes
Mellitus
Down Syndrome
Trisomy #13 & #18
Turner’s Syndrome
Marfan’s Syndrome
Di George Syndrome
CLASSIFICATION OF CHD
LEFT-TO-RIGHT SHUNTING LESIONS
Ventricular Septal Defect (VSD)
 Atrial Septal Defect (ASD)
 Patent Ductus Arteriosus (PDA)
 AV Canal or Endocardial Cushion Defect

OBSTRUCTIVE LESIONS
Pulmonary Stenosis (PS)
 Aortic Stenosis (AS)
 Coarctation of Aorta (COA)

ADMIXTURE LESIONS
Transposition of Great Vessels (TGV)
 Total Anomalous Venous Connection (TAPVC)
 Truncus Arteriosus

RIGHT-SIDED OBSTRUCTIVE LESIONS



Tetralogy of Fallot (TOF)
Tricuspid Atresia
Pulmonary Atresia
PULMONARY VENOUS OBSTRUCTIVE
LESIONS
Mitral/Aortic Atresia
 Cardiomyopathy

OTHER
 Hypoplastic Left Heart Syndrome
NURSING CARE OF
CHILD WITH CHD
A.
Understand the causes, pathophys.,
clinical manif., diag. evaluation, and
therapeutic management of CHF
Causes:




Volume overload
Pressure overload
Decreased contractility
High cardiac output demands
Clinical Manifestations
Tachycardia - resting rate greater than 160
beats/min in infants
 Diaphoresis
 Easily fatigued
 Poor exercise tolerance
 Poor perfusion - cold extremities, weak pulses,
low BP, mottled skin

Tachypnea - greater than 60 breaths/min in
infants
 Mild cyanosis
 Dyspnea
 Retractions
 Orthopnea
 Wheezing cough

Hepatomegaly
 Weight gain
 Edema
 Distended neck & peripheral veins

DIAGNOSTIC EVALUATION
Chest X-Ray
 ECG
 Echo-cardiogram

B. PROVIDE SAFE & THERAPEUTIC
NURSING CARE
Identify Early Signs of CHF
 Tachycardia
 Tachypnea
 Profuse scalp sweating
 Fatigue and irritability
 Sudden weight gain
 Respiratory distress
IMPROVE CARDIAC FUNCTION

Administer Digoxin (Lanoxin)
check apical pulse
observe for signs of toxicity
PROMOTE FLUID LOSS
Administer Diuretics (Lasix, Diuril, Aldactone)
 Possible fluid restrictions
 Possible sodium restrictions
 Monitor intake and output

DECREASE CARDIAC DEMANDS
Prevent cold stress in infants
 Treat any infection
 Rest and conservation of energy
 Minimize unnecessary stress

REDUCE RESPIRATORY DISTRESS
Position with HOB elevated
 Administer Oxygen
 Monitor Respiratory Rate and Effort

MAINTAIN NUTRITIONAL STATUS
 Increase Calories
Positioning
 Alternate Feeding Techniques

SUPPORT CHILD AND FAMILY
Foster Parent-To-Infant Attachment
 Encourage Parents to Stay
 Give Clear Explanations
 Keep Informed
 Provide Emotional Support
