ventricular septal defect- gihs

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venticular defect, septal defect, child health nursing,pediatric nursing

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VENTRICULAR SEPTAL DEFECT

Presented by :

Presented by RAMALAKSHMI.R M.SC(NURSING) LECTURER, GANGA INSTITUTE OF HEALTH SCIENCES, COIMBATORE .

OUT LINE…….:

OUT LINE ……. Development Of The Heart A Review of Anatomy and Physiology Definition Etiology Risk Factors Types of VSD Phathophysiology Clinical manifestation Diagnostic Evaluation Management-Medical ,surgical, Non Surgical, Nursing Management Complication Prognosis

DEVELOPMENT OF THE HEART:

DEVELOPMENT OF THE HEART

DEVELOPMENT OF THE HEART:

DEVELOPMENT OF THE HEART

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A Review of Anatomy and physiology

DEFINITION :

DEFINITION

ETIOLOGY :

ETIOLOGY The ventricular septum form before 8 th ` week of fetal life and require downward growth from endocardial cushion and the bulbar ridge separating PA &Aorta. Failure of these structures to grow correctly will result VSD.

RISK FACTORS:

RISK FACTORS Genetic Factors Radiation Exposure Drugs Like Teratogens Antenatal Effects Chromosomal Disorders

TYPES OF VSD:

TYPES OF VSD PER MEMBRANOUS VSD : These are the most common type of ventricular septal defects. They involve the membranous part of ventricular septum which lies in the outflow tract of the left ventricle immediately beneath the aortic valve. They usually extend into muscular, inlet or outlet portion of ventricular septum. B. Inlet VSD : These VSD account for 5 to 8 % of all the VSD's. They are located posteriorly and inferior to perimembranous portion of ventricular septum. C. Subarterial VSD or Doubly committed VSD or Subpulmonary VSD : These VSD account for 5 to 7 % of all the VSD’s. They are located just beneath the pulmonary valve.

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D. Muscular VSD : These VSD account for 5 to 20 % of all the VSD’s and are further sub classified depending on their location in the muscular septum. i ) Central : Located in the mid-muscular part of the ventricular septum with multiple apparent channels on right ventricular side and single defect on the left ventricular side. ii) Apical : Located in the apical part of the ventricular septum with multiple apparent channels on right ventricular side and single defect on the left ventricular side. iii) Swiss Cheese : Multiple muscular defects in the ventricular septum.

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Pathophysiology Pressure in the left ventricle is higher than the right ventricle Blood Flow through abnormal opening from left ventricle to right ventricle

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Mixing up of blood in the right ventricle and it is enters into the pulmonary artery Pulmonary hypertension Regurgitation of blood into right atrium

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Hypertrophy of right side of the heart Increased Pulmonary vascular Resistance Left to right shunt reduced and right to left shunt started

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Decreased amount of blood for purification Unoxygenated blood is supplied by aorta to the body Cyanosis , Eisenmenger syndrome

CLINICAL MANIFESTATION:

CLINICAL MANIFESTATION Small VSD may be asymptomatic Pan systolic murmur Moderate breathing difficulty -slow to gain weight Respiratory infection Sign of LV failure Mid systolic murmur Large VSD Hepatomegaly & oliguria Systolic murmur with thrill Failure to thrive Biventricular hypertrophy and CCF

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CLINICAL MANIFESTATIONS: Feeding difficulty Poor Weight Gain Failure to cry Increased sweating Palpitation Dyspnoea Cyanosis

DIAGNOSTIC EVALUATION :

DIAGNOSTIC EVALUATION History of illness Physical Examination Chest x-ray( cardiomegaly , enlarged LA& LV, PA, increased Pulmonary vascular marking, Pulmonary Edema) ECG(Extreme left axis is characteristics, biventricular hypertrophy) ECO(Chamber size and pressures) Two dimensional echo cardiogram with Doppler study Cardiac catheter o2 content, PA pressure, size and no of defects.

MANAGEMENT:

MANAGEMENT MEDICAL MANAGEMENT Management of heart failure Digoxin (5-10 µg/kg/d) - This may be indicated if diuresis and afterload reduction do not relieve adequately symptoms Diuretics ( eg , furosemide ) to relieve pulmonary congestion - Furosemide is usually given in a dosage of 1-3 mg/kg/d divided in 2 or 3 doses; .

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ANTIBIOTICS Inj.Cefazolin 25 mg/kg (max 1 gm; if greater than 80 kg, use 2 gm) OR Inj.Vancomycin 15 mg/kg (1 gm if > 50 kg) Oxygen - should be used judiciously to reduce hypoxemia as excessive oxygenation can rather increase the left to right shunt by reducing the pulmonary vascular resistance

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SURGICAL MANAGEMENT PALLIATIVE Pulmonary artery banding Placement of band around the main pulmonary artery to decrease pulmonary blood flow) may be done in infants with multiple muscular VSD COMPLETE REPAIR Small defects – Purse string sutures. Large defects - Knilled Dacron patch be sewn over the opening. Cardio Pulmonary Bypass is used for both procedures

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Non surgical Management Device closure during cardiac catheterisation is being performed in some centres under some investigation protocols.

NURSING MANAGEMENT:

NURSING MANAGEMENT

Preoperative care:

Preoperative care To avoid possible complications, should be prepared to clotting mechanism, cross-matching of blood, blood, liver and kidney function tests. Gather emergency medicine, such as cardiac drugs, vasopressors, thrombolytic drugs, etc. prepare temporary pacemaker, monitor, defibrillator and a variety of contingency plans prepared. Of preoperative patients and their families guidance and health education. Guide patients to master the various stages of surgical care with the points, and enhance the confidence of transcatheter therapy, active with the treatment, avoid stress, anxiety, and with the poor.

Intraoperative care:

Intraoperative care Supine patient, connected monitor cable, the establishment of intravenous access, close monitoring of intraoperative heart rate, heart rate, blood pressure changes. Prepare rescue medicines, doctors immediately report any abnormal situation, symptomatic treatment. patients had frequent ventricular contraction, and cardiac catheterization room operation caused a transient stimulus-related, suspend operation and adjust the catheter location go away. Caring, children, especially after the children leave their parents have a strong sense of fear, they should be caring, to eliminate their fear, if necessary, to the sedatives. Prescribed for management of arrhythmias, transient hypotension.

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Postoperative Care

Postoperative Care:

Postoperative Care Assess the child. Monitor blood pressure ,CVP,O2 saturation. Close observation of body temperature, heart rate, blood pressure changes and puncture, local availability of bleeding, hematoma; Observe distal lower extremity skin color,dorsalis pedis arterial pulse conditions to determine limb blood circulation . Attention to changes in cardiac auscultation noise, to observe the urine color and volume changes. Postoperative angiography because of the line should be adequate water several times to promote the contrast agent from the kidneys.

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Impaired gas exchange related to altered Pulmonary blood flow Impaired gas exchange related to altered Pulmonary blood flow Activity intolerance related to hypoxia Imbalanced nutritional status less than body requirement related to excess energy demand required by increased cardiac workload Risk for infection related to chronic illness Parental anxiety related to disease condition NURSING DIAGNOSIS

PROGNOSIS:

PROGNOSIS Risk depends on the location of the defect , the number of defects, and the presence of other associated cardiac defects. Single membranous defects are associated with low mortality (<2%) multiple muscular defects can occur a higher risk.

COMPLICATIONS :

COMPLICATIONS Arrhythmias Right ventricular failure Pulmonary complication-pneumonia, enlarged LA, left lobe collapsed Residual VSD Pulmonary hypertension Pulmonary stenosis Failure to thrive

THANK YOU:

THANK YOU

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