The Child with Cardiovascular Dysfunction

Cardiovascular disorders in children are divided into two major groups:

1. Congenital heart disease (CHD)
Include primarily anatomic abnormalities present at birth that result
in abnormal cardiac function
Clinical consequences fall into two broad categories: heart failure and
hypoxemia
2. Acquired cardiac disorders
Disease processes or abnormalities that occur after birth and can be
seen in the normal heart of in the presence of congenital heart defects
Result from various factors, including infection, auto immune
responses, environmental factors, and familial tendencies

History & Physical Exam
1. History
Ask details of mothers health history, pregnancy, and birth history is important
in assessing infants
o Mothers with chronic health conditions, such as diabetes or lupus,
more likely to have infants with heart disease
o Some meds teratogenic to fetuses (Phenytoin- Dilantin)
o Maternal alcohol and illicit drug use
o Exposure to infection (such as rubella, early to pregnancy, may result
in congenital anomalies)
o Infants with LBW resulting from IUGR are more likely to have CHA
o HBW infants have increased incidence of heart disease
Detailed family history
o Some diseases hereditary
o Increased incidence if either parent or a sibling has a heart defect
o Frequent fetal loss, sudden infant death, and sudden death in adults
may indicate
o Congenital heart defects often seen in many syndromes such as Down
and Turner syndromes
2. Physical Exam
Begins with observation of general appearance and then proceeds with more
specific observations
Inspection:
o Nutritional state
o Color
o Chest deformities
o Unusual pulsations
o Respiratory excursion
o Clubbing of fingers
Palpation and Percussion
o Chest
o Abdomen
o Peripheral pulses


Chest radiography (x-ray)






ECG






Holter monitor






Echocardiography







Transthoracic





M-mode






Two-dimensional


Doppler




Fetal





TEE





Hemodynamics




Angiography




Biopsy




EPS




Exercise stress test






Cardiac MRI

Cardiac catheterization





Diagnostic catheterizations:




Interventional catheterizations:




Electrophysiology studies:




Nursing Care Management
Possible complications include acute hemorrhage from the entry site, low-grade
fever, nausea, vomiting, loss of pulse in catherized extremity, and transient
dysrhythmias.
Rare risks: stroke, seizure, tamponade, death

Preprocedural care
Accurate height (essential for correct catheter selection) and weight
Allergies (iodine based)
S/S infection
Severe diaper rash may be a reason to cancel if femoral access required
Because assessment of pedal pulses important after catheterization, nurse
should assess and park the pulses (dorsalis pedis, posterior tibial) before child
goes into room
o Presense and quality of pulses in both feet clearly documented
Baseline ox sat using puls eox in children with cyanosis also recorded
School age children and adolescents- benefit from description of cath lab and a
chronologic explanation of procedure, emphasizing what they will see, feel, and
hear.
Older children may being ear phones to listen too during procedure.
Prep geared toward childs developmental level
Outline expected length, description of appearance after catheterization, and
usual postprocedural care
Methods of sedation
o Oral or IV meds
o Childs age, heart defect, clinical status, and type of catheterization
procedures planned are considered when determining sedation
o General anesthesia for some procedures
THEREFORE, NPO for 4-6 HOURS OR MORE BEFORE
PROCEDURE ACCORDING TO INSTITUTIONAL GUIDELINES
o Infants with polycythemia may need IV fluids to prevent dehydration
and hypoglycemia
Post Procedural Care
Patients placed on cardiac monitor and puls ox for the first few hours of
recovery
Depending on policy, child may be kept in bed with affected extremity
maintained straight for 4-6 hours after venous catheterization and 6-8 after
arterial catheterization to facilitate healing of the cannulated vessel
Young children can sit on lap of parent
Usual diet can be resumed as soon as tolerated, beginning with clear sips of
liquids and advancing as allowed
Encourage to void to clear contrast from blood
Generally only slight discomfort from percutaneous site
To prevent infection, cath area is protected from contamination
o If child wears diapers, keep dressing dry by covering it with a piece of
plastic film and sealing the edges of the film to the skin with tape
o Continue to observe for bleeding
Most important nursing responsibility is observing for the following signs
complications:
o Pulses


o Temperature and color of affected extremity


o Vital signs


o Blood pressure (BP)


o Dressing


o Fluid intake


o Blood glucose levels



Current interventional cardiac catheterization procedures in children:
Intervention Diagnosis
Balloon atrioseptostomy




Balloon dilation






Coil occlusion



Transcatheter device closure



Amplatzer septal occluder



VSD devices



Stent placement




RF ablation