Cardiovascular System: 1 Congenital Heart Disease Description: CHD defect in structure of heart in 1 or more of the lg blood vessels that

at lead to & from heart. Associated risk factors: alcoholism, cocaine use, rubella, exposure to Coxsackie virus, DM, ingestion of lithium salts, advanced maternal age. Genetic factors: hx of CHD, pts w/ down syndrome/other chromosomal aberrations (deviations), pts w/ congenital defects contribute to incidence of CHD. Theres a hereditary predisposition Heart defect = most common birth defect & leading cause of birth defect related deaths. Diagnostic Procedures : Jalissas paper Classification: Defects are classified according to effect defect has on movement of circulating blood. Study of blood circulation = hemodynamics Defects can be classified as: - Defects w/ increased pulmonary blood flow - Obstructive defects - Defects w/ decreased pulmonary blood flow - Mixed defects Signs and Symptoms: Infants: Dyspnea, difficulty feeding, stridor(harsh noise)/choking spells, tachycardia, recurrent resp infections, failure to gain wt, heart murmurs, cyanosis, cerebral thrombosis, anoxic (inadequate oxygenation) episodes. Children: Dyspnea, decreased activity tolerance, squatting, tachycardia, recurrent resp infections, delayed physical development, heart murmur and thrills, cyanosis, clubbing of fingers, elevated BP. Hemodynamics and Examples of Congenital Heart Disease: (Classifications of Congenital Heart Disease) Increased Pulmonary Blood Flow - Atrial septal defect - Patent ductus arteriosus - Ventricular septal defect Obstructive Blood Flow - Aortic stenosis - Coarctation of the aorta - Pulmonary stenosis Decreased Pulmonary Blood Flow: - Tetralogy of fallot - Tricuspid atresia Mixed Blood Flow: - Hypoplastic left heart - Total anomalous pulmonary venous return - Transposition of the great vessels - Truncus arteriosus

5 Hypoplastic Left Heart Syndrome (HLHS): Left side of heart is undeveloped. Theres hypoplasia (incomplete development of organ) of aorta and left ventricle and mitral valve involvement. So, systemic circulation is provided by right side of heart. Ductus arteriosus and foramen ovale need to remain open (patent) to provide oxygentated blood to the body. Prostaglandin E1 (PGE1) given to maintain a PDA (patent ductus arteriosus) Tx options: surgical tx and heart transplants. Mortality rates = high. 7 Rapid Respirations: Respirations over 60 breaths per min in newborn infant @ rest = distress Amt of dyspnea varies - acute cases its accompanied by nasal flaring, mouth breathing, & sternal retractions. Baby has trouble breathing when flat then when upright Signs of hunger = irritability, restlessness, and a weak/hoarse cry Rapid Pulse: Aka tachycardia. Pulse rate over 150 bpm = important it occurs b/c heart pumps harder, trying to get enough O2 to all parts of body. Feeding Difficulties: Pts w/ CV pxs tire easily when they are fed. Infant may refuse to suck after few ounces. In crib, infant may cry and appear hungry. May choke/gag during feedings. Pleasure of sucking is spoiled by inability to breathe Poor Weight Gain: Infant may fail to gain wt. Sudden increase in wt = may indicate beginning of heart failure. Edema: Observe for puffiness about eyes, and occasionally in legs, feet, & abd. Urine output should be monitored b/c it may decrease w/ CHF. Exercise Intolerance: Infant may sleep a lot & fall asleep during feedings. As they grow, may not be as active as other children b/c may have delayed motor development. Older children = may also tire easily & be intolerant of exercise. 9 Treatment & Nursing Care Contd. Accurate I&O = essential.

Signs of dehydration thirst, fever, poor skin turgor, apathy, sunken fontanel, dry skin, dry tongue, dry mucous membrane, decrease in urination should be brought to immediate attention of charge nurse. Pneumonia can occur rapidly. S/s = fever irritability, increase in resp distress. Position changed frequently to prevent this. Chest tubes after surgery to remove secretions & air from pleural cavity to allow reexpansion of lungs. This system must be air-tight to prevent collapse of lung. Drainage bottles = kept below lvl of chest. Kelly clamps for emergency clamping of tubes When tubes are removed, petrolatum covered gauze must be available for immediate application = gives airtight seal over site. Parents of child need support & understanding over a long pd of time. Heart = most vital organ so this dx often causes a lot of apprehension/anxiety. If condition permits, infant is usually sent home until preferred age for surgery is reached.