Nursing Care of the Child with Cardiovascular Disease

Blood Flow in the Heart

Upper extremities, chest and head – superior vena cava- lower extremities, trunk-
inferior vena cava- right atrium- tricuspid valve- right ventricle- pulmonary valve- left an right
pulmonary artery- gas exchange in lungs (alveoli)- pulmonary vein- left atrium- mitral/bicuspid
valve- left ventricle- aortic semilunar valve- (aortic arch)- body

- heart disease in newborn may not be detected agad-agad

3 scrub nurse
3 circulating nurse
3 NB care
(must have: Date, case #)

- usually tachycardic and tachypneic

normal PR: 120-160 bpm
normal RR: 30-60 bpm
- Usually appears with poor feeding in children.
- Common Qs:
1. What is feeding pattern?
2. Any difficulty in feeding
3. Hx of mother (If there is infection, medication used during pregnancy or radiation
exposure during pregnancy) (hx of heart disease in the family because it is genetically
transmissible)
- In older children:
1. What is usual position after playing around or taking rest? (If they have heart disease,
they do knee chest position/ squatting position; sign of difficulty of breathing; that
position traps the blood in lower extremities allowing the child to oxygenate in the
upper part of the body effectively)

Diagnostic Test
1. Electrocardiogram (ECG)
2. Radiography (chest xray)
3. Echocardiography (sound waves for imaging test for heart)
4. MRI (most visible hehe)
5. Exercise Testing (literal exercise ie. Treadmill test)
6. Laboratory Tests (u read on that look for specific example for heart; CBC, urinalysis,
blood chem, protein test, SGPT Test)
 Ventricular Septal Defect
- there is a problem in the septum (opening between ventricles)
- there is an excess in hole in right ventricle causing the blood to go back to lungs
- increase pulmonary blood flow. Increased in size (hypertrophy) to accommodate the blood
flow.
- Close on its own, but when it lasts for 2 years, candidate for open heart surgery.
- Endocarditis
- Prophylactic- preventive
Atrial Septal Defect
- Left to right ventricle; still the right ventricle has the problem.
- There is heart systolic murmur.
- Dx: echocardiogram, cardiac catheterization (tube inserted to widen, where the blood
flows to repair the defect)
Patent Ductus Arteriosus
- Not closing anymore. (In 3 months, the ductus arteriosus should be closed.)
- When it remains open, the blood returns from the aorta to the pulmonary artery.
- The back flow of the blood returns to the left atrium passes to the left ventricle exit to
the aorta. Still the right ventricle has the problem.
- Wide pulse pressure (pulse pressure= diastolic- systolic) (normal pulse pressure: 30-40)
- Dx: echocardiogram
- Management: If it fails to close, administer indomethacin (3 times in 12-24 hrs) to help
close the valve.
Pulmonic Stenosis
- Obstructive defect
- RV is unable to evacuate blood in the way of pulmonary artery
- RV hypertrophy
- SEM (Systolic Ejection Murmur) left sternal border under the clavicle.
- Management: cardiac catheter insertion
Aortic Stenosis
- There is obstruction in the aorta.
- LV hypertrophy
- Most children are asymptomatic.
- Beta blocker (-olol) and calcium channel blocker (-dipine; amlodipine)
- Calcium- helps in contractility of the heart
- Balloon valvuloplasty (tx of choice) (insert catheter then balloon to widen narrowing)
Coarctation of the Aorta
- Increase pressure in the heart and upper portion of the body. (The blood in the upper
body drains in superior vena cava)
- Cerebrovascular Accident or stroke

Defects with Decreased Pulmonary Blood Flow

Tricuspid Atresia
- atresia means patent; valve’s not completely closed)
- There’s no blood flow in RA to RV
- Passes through PDA instead of lungs to oxygenate the blood.
- DOB is present.
- PGE (prostaglandin) until open heart surgery
Tetralogy of Fallot
- Combination of the four anomalies
- Squatting position is present.