Ball Ch26 Lecture

CHILD HEALTH NURSING
Partnering with Children and Families

CHAPTER
THIRD EDITION
Copyright 2014, 2010, 2006 by Pearson Education, Inc.
All Rights Reserved
Alterations in
Cardiovascular
Function
26
Child Health Nursing: Partnering with Familes and Children, Third Edition
Jane W. Ball | Ruth C. Bindler | Kay J. Cowen
LEARNING OUTCOME 1
Explain the transition from fetal to
pulmonary 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 to
Pulmonary Circulation
Occurs within few hours after birth
Completes at approximately days 10 to
21 with permanent closure of ductus
arteriosus
TABLE 262 Comparison of Fetal and Neonatal
Circulation
Hemodynamics change
Increased pulmonary blood flow
Decreased pulmonary vascular
resistance
Left atrium increased blood flow
From lungs through pulmonary veins
FIGURE 264 The arrows indicate the flow of blood through the heart while the color indicates the level of
oxygen saturation in the blood. A, Fetal (prenatal) circulation. B, Pulmonary (postnatal) circulation. LA, left
atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
Hemodynamics change
Right atrial pressure falls
Increased pressure in left atrium
Stimulates closure of foramen ovale
Higher oxygen saturation than fetal
circulation
Stimulates closure of ductus arteriosus
LEARNING OUTCOME 2
Describe the anatomy and physiology
of the cardiovascular system, focusing
on the flow of blood and action of the
heart valves.
Anatomy of Heart
Atria
Ventricles
Vena cava
Pulmonary artery and vein
Normal Hemodynamics of Heart
Cardiac function
Pressure gradients
FIGURE 261 Anatomy of the heart, direction of blood flow, and normal pressure gradients and oxygen
saturation levels in the heart chambers and great arteries. The right ventricle has a lower pressure during systole
than the left ventricle because less pressure is needed to pump blood to the lungs through the rest of the body.
TABLE 261 Hemodynamics of the Normal Heart
Heart Size
Proportionately larger in children
Cardiovascular System Growth
Continues until puberty
LEARNING OUTCOME 3
Contrast the pathophysiology
associated with congenital heart
defects having increased pulmonary
circulation, decreased pulmonary
circulation, and obstructed systemic
blood flow.
Increased Pulmonary Blood Flow
Defects that cause increased blood flow
TABLE 267 Pathophysiology, Clinical
Manifestations, and Clinical Therapy for Heart Defects
That Increase Pulmonary Blood Flow
TABLE 267 (continued) Pathophysiology, Clinical
Increased Pulmonary Blood Flow
Common manifestations
Tachypnea
Tachycardia
Congestive heart failure
Decreased Pulmonary Blood Flow
Defects that cause decreased blood
flow
with Decreased Pulmonary Blood Flow
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 vessels
Tricuspid atresia
Obstructed Systemic Blood Flow
Defects that cause obstructed blood
flow left side
Not eating, tachpnea, fussy
That Obstruct the Systemic Blood Flow
Obstructed Systemic Blood Flow
Diminished pulses
Pale color
Delayed capillary refill
Decreased urinary output
Signs of congestive heart failure
LEARNING OUTCOME 4
Create a nursing care plan for the child
with a congenital heart defect cared
for at home prior to corrective surgery.
Nursing Assessment Prior to
Surgery
Physiologic assessment
Psychosocial assessment
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
Education of Family
Skin integrity
Management of illness
Medications
Other therapeutic interventions
Prevention of complications
Family interactions
Family adjustment and issues
LEARNING OUTCOME 5
Plan the nursing care for the child
undergoing open heart surgery.
Nursing Assessment at the Time of
Surgery
Presence or risk of acute illness
Behavioral patterns
Cardiac function
Respiratory function
Weight
Fluid status
Postoperative Care of Heart
Surgery
Immediate care
Intensive care unit until stable
One or more days
Immediate Postoperative Care
Monitoring and assessment via lab
values and physical examination
Cardiac function
Respiratory function
Fluid intake and output
Chest or mediastinal tube drainage
Pain
Care Following Transfer to General
Nursing Unit
Assessment focuses on signs of
complications
Cardiac and respiratory monitoring
Return to oral fluids and nutrition as
permitted
Gradual activity increase
Family education
Discharge planning
LEARNING OUTCOME 6
Recognize the signs and symptoms of
congestive heart failure in an infant
and a child.
Congestive Heart Failure (CHF)
Etiology
Assessment of CHF
Respiratory
Pulse
Blood pressure
Color
Heart
Assessment of CHF
Fluid status
Activity
Behavior
General
Clinical ManifestationsInitial
Signs
Subtle, may not be immediately
recognized
Infants
Tire easily, irritability
Weight loss or lack of weight gain
Diaphoresis
Frequent respiratory infections
Clinical ManifestationsInitial
Signs
Older children
Exercise intolerance
Dyspnea
Abdominal pain or distention
Peripheral edema
Changes in skin color
Clinical ManifestationsLater
Signs
Infants
Tachypnea, tachycardia
Pallor or cyanosis
Nasal flaring, grunting, retractions
Cough or crackles
S
3
gallop
Clinical ManifestationsLater
Signs
Older children
Anorexia
Cough, wheezing, crackles
Fluid volume excess
Jugular vein distention
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
LEARNING OUTCOME 7
Differentiate between heart diseases
that are acquired during childhood and
congenital heart defects.
Congenital Heart Disease
Definitionborn with defect
Acquired Heart Disease
Definitiondefect related to illness
Infective endocarditis
Rheumatic fever
Kawasaki disease
FIGURE 2614 This child has returned for one of her frequent follow-up visits to assess her cardiac status
after treatment for Kawasaki syndrome. Notice the lips that show the inflammation and cracking.
LEARNING OUTCOME 8
Distinguish between the
pathophysiology of hypvolemic shock,
distributive shock, and cardiogenic
shock.
Hypovolemic Shock
Definitionacute complex state of
circulatory dysfunction
Results in failure to deliver sufficient
oxygen to meet demands
FIGURE 2615 If hemorrhage reduces the circulating blood volume sufficiently then the compensatory
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 and
circulatory collapse is imminent.
Hypovolemic ShockEtiology
Hemorrhage following significant injury
or surgery
Plasma loss due to burns, nephrotic
syndrome, or sepsis
Fluid and electrolyte loss associated
with dehydration, diabetic ketoacidosis,
diabetes insipidus
Distributive Shock
Abnormal distribution of blood volume
Usually results from decrease in
systemic vascular resistance and
maldistribution of blood flow to
extremities
Child attempts to compensate by
increasing cardiac output to maintain
blood pressure
Distributive ShockEtiology
Neurogenicvasodilation occurs with
loss of vasomotor tone
Spinal cord injury, various medications
Anaphylaxis with vasodilation
Sepsis resulting from one of various
organisms
Cardiogenic Shock
Impairment of myocardial function that
interferes with the heart's ability to
maintain adequate cardiac output and
tissue perfusion
Cardiogenic ShockEtiology
Severe obstructive congenital heart
disease such as hypoplastic left heart
syndrome
Cardiomyopathy
Myocarditis
Severe electrolyte or acidbase
imbalance

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CHILD HEALTH NURSING

Partnering with Children and Families

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