Chapter 40
Nursing Care of the Child
with a Cardiovascular
Disorder
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Variations in Pediatric Anatomy
and Physiology
• Circulatory changes from gestation to birth
• Structural and functional differences
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Common Medical Treatments and Drugs
• A variety of medications as well as other medical
treatments and surgical procedures are used to treat
cardiovascular problems in children
– See Common Medical Treatments 40.1
– Most of these treatments will require a physician’s
order when the child is in the hospital
• Multiple drugs are used to treat cardiovascular disease
• See Drug Guide 40.1
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process Overview for the Child
With a Cardiovascular Disorder
• Assessment
– Health history – see Table 40.1 for assessment
questions
• History of present illness
• Past medical history
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process Overview for the Child
With a Cardiovascular Disorder (cont.)
• Physical examination
– Inspection
– Palpation
– Auscultation
• Location
• Relation to the heart cycle and duration
• Intensity
• Quality
• Variation with position
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• A nurse is auscultating a child’s heart and notes that
there are audible “clicks.” This assessment finding is
suggestive of what type of problem?
A. Valve dysfunction
B. A defect in the heart wall
C. Impaired oxygenation
D. Electrical dysfunction
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• A – Valve dysfunction
• Rationale: Ejection clicks, which are high-pitched, are
related to problems with dilated vessels and/or valve
abnormalities.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process Overview for the Child
With a Cardiovascular Disorder (cont.)
• Assessment
– Laboratory and diagnostic testing – see Common
Laboratory and Diagnostic Tests 40.1
– Cardiac catheterization
• Performing cardiac catheterization
• Preprocedure nursing management
• Postprocedure nursing management
• Nursing diagnoses and related interventions
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease
• Pathophysiology
• Therapeutic management
Disorders with decreased pulmonary blood flow
• Tetralogy of Fallot
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
• The cyanosis associated with tetralogy of Fallot primarily
results from the mixing of oxygenated and poorly
oxygenated blood.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• True
• Rationale: When shunting occurs in the child with
tetralogy of Fallot, a mixing of oxygenated and poorly
oxygenated blood occurs, with this blood ultimately being
pumped into the systemic circulation. The oxygen
saturation of the blood in the systemic circulation is
reduced, leading to cyanosis.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Disorders with decreased pulmonary blood flow
(cont.)
• Tricuspid atresia
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic testing
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Disorders with increased pulmonary flow
• Atrial septal defect
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Disorders with increased pulmonary flow (cont.)
• Ventricular septal defect
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Disorders with increased pulmonary flow (cont.)
• Atrioventricular septal defect (AVSD)
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Disorders with increased pulmonary flow (cont.)
• Patent ductus arteriosus (PDA)
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
• Failure of the ductus arteriosus to close leads to
continued blood flow from the pulmonary artery to the
aorta.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• False
• Rationale: Failure of the ductus arteriosus to close leads
to inappropriate blood flow from the aorta to the
pulmonary artery.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Obstructive disorders
• Coarctation of the aorta
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Obstructive disorders (cont.)
• Aortic stenosis
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Obstructive disorders (cont.)
• Pulmonary stenosis
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• A child is most likely to be asymptomatic if he or she has
a diagnosis of:
A. Tetralogy of Fallot
B. Aortic stenosis
C. AVSD
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• B – Aortic stenosis
• Rationale: Typically, the child with aortic stenosis is
asymptomatic. This is not the case in children who have
AVSD or tetralogy of Fallot.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Mixed defects
• Transposition of the great vessels (arteries)
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Mixed defects (cont.)
• Total anomalous pulmonary venous return (TAPVR)
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Mixed defects (cont.)
• Truncus arteriosus
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Mixed defects (cont.)
• Hypoplastic left heart syndrome (HLHS)
– Pathophysiology
– Nursing assessment
• Health history and physical examination
• Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
Nursing management of the child with CHD
• Improving oxygenation
• Promoting adequate nutrition
• Assisting the child and family to cope
• Preventing infection
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Congenital Heart Disease (cont.)
• Nursing management of the child with CHD (cont.)
– Providing care for the child undergoing cardiac
surgery
– Providing preoperative care
– Providing postoperative care
– Providing patient and family education
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acquired Cardiovascular Disorders
Heart failure
• Pathophysiology
• Therapeutic management
• Nursing assessment
– Health history and physical examination
– Laboratory and diagnostic tests
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acquired Cardiovascular Disorders (cont.)
Heart failure (cont.)
• Nursing management
– Promoting oxygenation
– Supporting cardiac function
– Providing adequate nutrition
– Promoting rest
• Patient and family education
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Is the following statement true or false?
• The child with a diagnosis of heart failure should be
positioned supine in order to promote oxygenation and
circulation.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• False
• Rationale: The nurse should position the infant or child
with HF in a semi-upright position to decrease work of
breathing and lessen pulmonary congestion.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acquired Cardiovascular Disorders (cont.)
Infective endocarditis
• Nursing assessment
– Health history and physical examination
• Nursing management
• Patient and family education
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acquired Cardiovascular Disorders (cont.)
Acute rheumatic fever
• Nursing assessment
• Nursing management
• Patient and family education
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acquired Cardiovascular Disorders (cont.)
Cardiomyopathy
• Nursing assessment
• Nursing management
• Patient and family education
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acquired Cardiovascular Disorders (cont.)
Hypertension
• Pathophysiology
• Nursing assessment
– Physical examination
– Laboratory and diagnostic testing
• Nursing management
• Patient and family education
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acquired Cardiovascular Disorders (cont.)
Kawasaki disease
• Pathophysiology
• Nursing assessment
– Health history and physical examination
– Laboratory and diagnostic testing
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acquired Cardiovascular Disorders (cont.)
Kawasaki disease (cont.)
• Nursing management
– Monitoring cardiac status
– Promoting comfort
– Providing patient and family education
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acquired Cardiovascular Disorders (cont.)
Hyperlipidemia
• Pathophysiology
• Therapeutic management
• Nursing assessment
• Nursing management
• Patient and family education
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Acquired Cardiovascular Disorders (cont.)
Heart transplantation
• Surgical procedure and postoperative therapeutic
management
• Nursing management
• Patient and family education
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins