Ball Ch26 Lecture

5/19/2018 Ball Ch26 Lecture

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CHILD HEALTH NURSINGPartnering with Children and Families

CHAPTER

THIRD EDITION

Copyright 2014, 2010, 2006 by Pearson Education, Inc.All Rights Reserved

Alterations inCardiovascularFunction

26


2/63Child Health Nursing: Partnering with Familes and Children, Third EditionJane W. Ball | Ruth C. Bindler | Kay J. Cowen

LEARNING OUTCOME 1

Explain the transition from fetal topulmonary circulation.



Hemodynamics of Heart(Circulatory System)

Heart pumps blood

Pulmonary system

Receives oxygen

Return to heart

To systemic system

Provides oxygen to organs and tissues

Depletes oxygen stores

Return to heart



Transition from Fetal toPulmonary Circulation

Occurs within few hours after birth

Completes at approximately days 10 to21 with permanent closure of ductus

arteriosus


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Child Health Nursing: Partnering with Familes and Children, Third EditionJane W. Ball | Ruth C. Bindler | Kay J. Cowen

TABLE 262 Comparison of Fetal and NeonatalCirculation


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Hemodynamics change

Increased pulmonary blood flow

Decreased pulmonary vascular

resistance

Left atrium increased blood flow

From lungs through pulmonary veins


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FIGURE 264 The arrows indicate the flow of blood through the heart while the color indicates the level ofoxygen saturation in the blood.A, Fetal (prenatal) circulation. B, Pulmonary (postnatal) circulation. LA, leftatrium; LV, left ventricle; RA, right atrium; RV, right ventricle.


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Hemodynamics change

Right atrial pressure falls

Increased pressure in left atrium

Stimulates closure of foramen ovale

Higher oxygen saturation than fetalcirculation

Stimulates closure of ductus arteriosus


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LEARNING OUTCOME 2

Describe the anatomy and physiologyof the cardiovascular system, focusing

on the flow of blood and action of theheart valves.


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Anatomy of Heart

Atria

Ventricles

Vena cava

Pulmonary artery and vein


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Normal Hemodynamics of Heart

Cardiac function

Pressure gradients


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FIGURE 261 Anatomy of the heart, direction of blood flow, and normal pressure gradients and oxygensaturation levels in the heart chambers and great arteries. The right ventricle has a lower pressure during systolethan the left ventricle because less pressure is needed to pump blood to the lungs through the rest of the body.


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TABLE 261 Hemodynamics of the Normal Heart


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Heart Size

Proportionately larger in children


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Cardiovascular System Growth

Continues until puberty


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LEARNING OUTCOME 3

Contrast the pathophysiologyassociated with congenital heart

defects having increased pulmonary

circulation, decreased pulmonarycirculation, and obstructed systemic

blood flow.


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Increased Pulmonary Blood Flow

Defects that cause increased blood flow


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TABLE 267 Pathophysiology, ClinicalManifestations, and Clinical Therapy for Heart Defects

That Increase Pulmonary Blood Flow


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TABLE 267 (continued) Pathophysiology, ClinicalManifestations, and Clinical Therapy for Heart Defects



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Increased Pulmonary Blood Flow

Common manifestations

Tachypnea

Tachycardia

Congestive heart failure


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Decreased Pulmonary Blood Flow

Defects that cause decreased bloodflow


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with Decreased Pulmonary Blood Flow


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Decreased Pulmonary Blood Flow


Cyanosis (often sat is in 70s)

Hypercyanotic spells (ER morphine,

given something to increase pressure)

Poor weight gain

Polycythemia (too many RBC) could

occulde vesselsTricuspid atresia


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Obstructed Systemic Blood Flow

Defects that cause obstructed bloodflow left side

Not eating, tachpnea, fussy


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That Obstruct the Systemic Blood Flow


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Obstructed Systemic Blood Flow


Diminished pulses

Pale color

Delayed capillary refill

Decreased urinary output

Signs of congestive heart failure


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LEARNING OUTCOME 4

Create a nursing care plan for the childwith a congenital heart defect cared

for at home prior to corrective surgery.

N i A t P i t


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Nursing Assessment Prior toSurgery

Physiologic assessment

Psychosocial assessment


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Education of Family

Family-centered plan

Home care and planning

Assessment for complications

Assessment for worsening condition

Oxygenation requirements

Metabolic and nutritional needs

Fluid-volume balance


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Education of Family

Skin integrity

Management of illness

Medications

Other therapeutic interventions

Prevention of complications

Family interactions

Family adjustment and issues


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LEARNING OUTCOME 5

Plan the nursing care for the childundergoing open heart surgery.

Nursing Assessment at the Time of


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Nursing Assessment at the Time ofSurgery

Presence or risk of acute illness

Behavioral patterns

Cardiac function

Respiratory function

Weight

Fluid status

Postoperative Care of Heart


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Postoperative Care of HeartSurgery

Immediate care

Intensive care unit until stable

One or more days


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Immediate Postoperative Care

Monitoring and assessment via labvalues and physical examination

Cardiac function

Respiratory function

Fluid intake and output

Chest or mediastinal tube drainage

Pain

Care Following Transfer to General


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Care Following Transfer to GeneralNursing Unit

Assessment focuses on signs ofcomplications

Cardiac and respiratory monitoring

Return to oral fluids and nutrition aspermitted

Gradual activity increase

Family education

Discharge planning


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LEARNING OUTCOME 6

Recognize the signs and symptoms ofcongestive heart failure in an infant

and a child.


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Congestive Heart Failure (CHF)

Etiology


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Assessment of CHF

Respiratory

Pulse

Blood pressure

Color

Heart


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Assessment of CHF

Fluid status

Activity

Behavior

General

Clinical Manifestations Initial


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Clinical ManifestationsInitialSigns

Subtle, may not be immediatelyrecognized

Infants

Tire easily, irritability

Weight loss or lack of weight gain

Diaphoresis

Frequent respiratory infections

Clinical Manifestations Initial


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Clinical ManifestationsInitialSigns

Older children

Exercise intolerance

Dyspnea

Abdominal pain or distention

Peripheral edema

Changes in skin color

Clinical Manifestations Later


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Clinical ManifestationsLaterSigns

Infants

Tachypnea, tachycardia

Pallor or cyanosis

Nasal flaring, grunting, retractions

Cough or crackles

S3gallop

Clinical ManifestationsLater


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Clinical ManifestationsLaterSigns

Older children

Anorexia

Cough, wheezing, crackles

Fluid volume excess

Jugular vein distention


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Nursing Management of CHF

Assessment of child and family

Promote oxygenation

Cardiovascular function

Administration of medications

Growth and development

Family planning

Family education for home care


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LEARNING OUTCOME 7

Differentiate between heart diseasesthat are acquired during childhood and

congenital heart defects.


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Congenital Heart Disease

Definitionborn with defect


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Acquired Heart Disease

Definitiondefect related to illness

Infective endocarditis

Rheumatic fever

Kawasaki disease


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FIGURE 2614 This child has returned for one of her frequent follow-up visits to assess her cardiac statusafter treatment for Kawasaki syndrome. Notice the lips that show the inflammation and cracking.


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LEARNING OUTCOME 8

Distinguish between thepathophysiology of hypvolemic shock,

distributive shock, and cardiogenicshock.


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Hypovolemic Shock

Definitionacute complex state ofcirculatory dysfunction

Results in failure to deliver sufficient

oxygen to meet demands

FIGURE 2615 If hemorrhage reduces the circulating blood volume sufficiently then the compensatory


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mechanisms support blood circulation by increasing the heart rate and constricting the peripheral blood vessels.This response shifts the remaining blood to larger blood vessels so that the vital organs continue to be perfused.When the blood loss exceeds 20% to 25%, the child's body can no longer compensate; blood pressure falls andcirculatory collapse is imminent.


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Hypovolemic ShockEtiology

Hemorrhage following significant injuryor surgery

Plasma loss due to burns, nephrotic

syndrome, or sepsis Fluid and electrolyte loss associated

with dehydration, diabetic ketoacidosis,

diabetes insipidus


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Distributive Shock

Abnormal distribution of blood volume

Usually results from decrease insystemic vascular resistance and

maldistribution of blood flow toextremities

Child attempts to compensate by

increasing cardiac output to maintainblood pressure

b h k l


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Distributive ShockEtiology

Neurogenicvasodilation occurs withloss of vasomotor tone

Spinal cord injury, various medications

Anaphylaxis with vasodilation

Sepsis resulting from one of variousorganisms

d h k


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Cardiogenic Shock

Impairment of myocardial function thatinterferes with the heart's ability tomaintain adequate cardiac output and

tissue perfusion

C di i Sh k E i l


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Cardiogenic ShockEtiology

Severe obstructive congenital heartdisease such as hypoplastic left heartsyndrome

Cardiomyopathy Myocarditis

Severe electrolyte or acidbase

imbalance

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