congenital heart diseases

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Slide 1:

PRESENTED BY: KIRAN RANDHAWA ARMY COLLEGE OF NURSING CONGENITAL HEART DISEASES

INTRODUCTION:

INTRODUCTION DEFECTS PRESENT FROM BIRTH EFFECT LESS THEN 1% OF ALL CHILDREN. AMPLE OPPERTUNITIES FOR SOMETHING TO GO WRONG DURING FORMATION OF COMPLICATID STRUCTURE--- THE HEART

DEFINITION:

DEFINITION HEART DISEASES IN THE NEW BORN , INCLUDES STRUCTURAL DEFECTS , CONGENITAL ARRYTHMIAS , AND CARDIOMYOPATHIES IN WHICH HEART DOES NOT PUMP OR THE BLOOD FLOW OBSTRUCTION CAUSING AN ABNORMAL FLOW OF BLOOD THROUGH HEART, INSUFFICIENT TO FULL FILL BODY DEMANDS.

EPIDEMIOLOGY:

EPIDEMIOLOGY CHD AFFECTS 8-12 OF EVERY 1000 NEONATES.(IN WORLD) 85% OF INFANTS BORN WITH CARDIO VASCULAR ANOMALIES CAN EXPECT TO REACH ADULTHOOD. 750,000 ADULT SURVIVORS OF CHD BETWEEN 21---40 YRS.

CAUSES:

CAUSES IDEOPATHIC. FETAL OR MATERNAL INFECTION . CHROMOSOMAL ABNORMALITIES. MATERNAL INSULIN—DEPENDENT DIABETES. TERATOGENIC EFFECTS OF DRUGS AND ALCOHOL. WOMEN WITH SLE AND PHENYLKETONEURIA. SYNDROMES: MARFAN’S SYNDROME TURNER’S “ DOWN SYNDROME

CLASSIFICATION:

CLASSIFICATION ACYANOTIC CYNOTIC

ACYNOTIC:

ACYNOTIC NORMAL PULMONARY INCREASED PULMO BLOOD FLOW NARY BLOOD FLOW AORTIC STENOSIS ASD COARCTATION OF VSD AORTA PDA PULMONIC VALVE ATRIOVENTRICULAR STENOSIS CANAL

CYANOTIC:

CYANOTIC DECREASED INCREASED PULMONARY PULMONRY BLOOD FLOW BLOOD FLOW TOF TGA WITH ASD EBSTEIN’SANOMALY TRUNCUS ATERI WITH ASD OSUS TRICUSPID ATRESIA UNIVENTRICULAR PULMONARY ATRESIA COMMON ATRIUM

DIAGNOSTIC EVALUATION:

DIAGNOSTIC EVALUATION ASCULTATION CHEST X-RAYS ECG DOPPLER STUDIES CARDIAC CATHETERIZATION CARDIAC MAGNATIC RESONANCE IMAGING.

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AORTIC STENOSIS: -- 3%-6% OF ALL CASES OF CHD. -- MORE IN MALES. -- THICKENING AND RIGIDITY OF VALVE,COMMISSURE FUSION BLOOD FLOW IS INCREASED ACROSS OBSTRUCTIVE VALVE DURING SYSTOLE FURTHER IN Lt. VENTRICLE PRESSURE DILATION AND HYPERTROPHY PRESSURE IN Lt. ATRIUM & PUL. VEINS

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Fig. Of AS

Slide 12:

CLINICAL MANIFESTAIONS CHEST PAIN DYSPNEA FATIGUE SYNCOPE LIGHT HEADEDNESS PALPITATION CHF SUDDEN DEATH

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MANAGEMENT PALLIATIVE MEDICAL MANAGEMENT SURGICAL MANAGEMENT BALLOON VALVULOPLASTY VALVULOTOMY VALVE REPLACEMENT

COARCTATION OF AORTA:

COARCTATION OF AORTA DEFORMITY OF THE AORTIC ISTHMUS . NARROWING EITHER PROXIMAL OR DISTAL TO THE LEFT SUBCLAVIAN ARTERY WHERE THE DUCTUS ARTERIOSIS JOINS THE DESCENDING AORTA . 8-12% OF ALL CHD. STRONGLY ASSOCIATED WITH BICUSPID AORTIC VALVE , VSD , PDA .

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CLINICAL MANIFESTATIONS ASYMPTOMATIC(DUE TO PDA) POOR LOWER PERFUSION TACHYPNEA ACIDOSIS PROGRESSIVE CIRCULATERY SHOCK WEAK FEMORAL PULSES EPISTAXIS,HEADACHE, LEG CRAMPS

MANAGEMENT:

MANAGEMENT PALLIATIVE MANAGEMENT SURGICAL MANAGEMENT SUBCLAVIAN FLAP REPAIR ( WALDHAUSEN PROCEDURE) END-TO-END ANASTOMOSIS DACRON PATCH REPAIR BALLOON ANGIOPLASTY STENTING

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PATENT DUCTUS ARTERIOSUS VASCULAR CONNECTION BETWEEN PULMONARY ARTERY AORTA,BYPASSING LUNGS. NORMALLY CLOSE WITHIN 24Hrs. OF BIRTH. 10% OF ALL CHD.(MORE IN FEMALES)

CLINICAL MANIFESTATIONS::

CLINICAL MANIFESTATIONS : ASYMPTOMATIC TACHYPNEA RESPIRATRY TRACT INFECTION BOUNDING PULSE WIDEN PULSE PRESSURE POOR Wt.GAIN FAILURE TO THRIVE FEEEDING DIFFICULTIES

MANAGEMENT::

MANAGEMENT: INDOMITHACIN (I.V.) DIURETICS SURGICAL PROCEDURE SURGICAL LIGATION PERCUTANEOUS CLOSURE DEVICES

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PULMONIC VALVE STENOSIS: VALVULAR, SUBVALVUAR OR SUPRAVALVULAR. INDEPENDENT OF ASD ,VSD. 14% OF ALL CHD. MALE=FEMALE.

CLINICAL MANIFESTATION:

CLINICAL MANIFESTATION ASYMPTOMATIC HYPOXIA CHEST PAIN TACHYPNEA DECREASED EXERCISE TOLERANCE RV FAILURE

MANAGEMENTS::

MANAGEMENTS: MEDICAL MANAGEMENT SURGICAL MANAGEMENT: BALLOON PULMONARY VALVOPLASTY BLALOCK-TAUSSING SHUNT

ATRIAL SEPTAL DEFECTS:

ATRIAL SEPTAL DEFECTS ABNORMAL COMMUNICATION BETWEEN LEFT ATRIUM RIGHT ATRIUM 9% OF ALL CHD. THREE TYPES: OSTIUM SECUNDUM ASD “ PRIMUM ASD SINUS VENOUS ASD

CLINICAL MANIFESTATIONS: :

CLINICAL MANIFESTATIONS: ASYMPTOMATIC + PDA MILD SYSTOLIC PULMONIC EJECTION MURMUR. UPPER RESPITARY TRACT INFECTION POOR WEIGHT GAIN DECREASED EXERCISES TOLERANCE

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MANAGEMENTS: ANTICONGESTIVE THERAPY SURGICAL MANAGEMENT: ATRIAL OCCLUSION DEVICES SUTURE CLOSING PATCH REPAIRE

VENTRICULAR SEPTAL DEFECT:

VENTRICULAR SEPTAL DEFECT ABNORMAL COMMUNICATION BETWEEN RIGHT VENTRICAL LEFT VENTRICAL 25% OF ALL CHD. TYPES: PERIMEMBRANOUS APICAL VARIABLE IN SIZES

CLINICAL MANIFESTATIONS :

CLINICAL MANIFESTATIONS ASYMPTOMATIC TACHYCARDIA TACHYPNEA DIAPHORESIS FAILURE TO THRIVE HEPATOMEGALLY UPPER RESPIRATORY TRACT INFECTION

MANAGEMENT:

MANAGEMENT VENTRICULAR OCCLUSION DEVICES PATCH CLOSURE TWO STAGE APPROACH

TETRALOGY OF FALLOT:

TETRALOGY OF FALLOT 10% OF ALL CHD COMPLEX MALE=FEMALE TETRAD INCLUDE: NON RESTRICTIVE VSD AORTIC OVERRIDE PULMONARY STENOSIS RIGHT VENTRICAL HYPERTROPHY

CLINICAL MANIFESTATIONS ::

CLINICAL MANIFESTATIONS : CYNOSIS CLUBBING HYPOXIC SPELLS UNDERDEVELOPED BODY GROWTH

MANAGEMENT::

MANAGEMENT: PALLIATIVE MANAGEMENTS SURGICAL MANAGEMENT : BALLOON PULMONARY ANGIOPLASTY MODIFIED BLALOCK- TAUSSING SHUNT PATCH CLOSURE OF VSD

EBSTEIN ANOMALY:

EBSTEIN ANOMALY 1% OF ALL CHD DOWNWARD DISPLACEMENT OF PORTION OF THE TRICUSPID VALVE INTO THE RIGHT VENTRICLE. THE PORTION OF RV BECOME THE PORTION OF RA . MALE = FEMALE NORMALLY PATIENT MAY LIVE BEYOND AGE OF 50 Yrs.

CLINICAL MANIFESTATION::

CLINICAL MANIFESTATION : EFFORT INTOLERANCE DYSPNEA FATIGABILITY PROGRESSIVE --- CYNOSIS & HYPOXEMIA JUGULAR PULSATION S 3 & S 4 SOUND PRESENT

MANAGEMENT::

MANAGEMENT: PALLIATIVE MANAGEMENT SURGICAL MANAGEMENT: REPAIRE OF TRICUSPID VALVE CLOSURE OF ASD

TRICUSPID ATRESIA:

TRICUSPID ATRESIA 1% - 2% OF ALL CHD ABSENCE OF THE TRICUSPID VALVE + HYPOPLASIA OF THE RIGHT VENTRICAL . MALE = FEMALE.

CLINICAL MANIFESTATION:

CLINICAL MANIFESTATION CYNOSIS TACHYPNEA FEEDING DIFFICULTIVES CLUBBING HOLOSYSTOLIC MURMUR

MANAGEMENT::

MANAGEMENT: FIRST SURGERY BT – SHUNT PULMONARY BAND NO TREATMENT SECOND SURGERY ( 6 – 9 MONTHS ) BIDIRECTIONAL GLENN SHUNT THIRD SURGERY FONTAN COMPLETION

TRANSPOSITION OF THE GREAT ARTERIES:

TRANSPOSITION OF THE GREAT ARTERIES 5%-10% OF ALL CHD THE PA ARISES OFF THE LV & THE AORTA ARIESES OFF THE RV . ASSOCIATED WITH VSD ,ASD , PDA , PULMONARY STENOSIS & COARCTATION. TWO TYPES : COMPLETE TRASPOSITION OF THE GREAT ARTERIES ( D –TRASPOSITION ) CONGENITALLY CORRECTED TRANSPOSITION (L-TRANSPOSITION)

CLINICALLY MANIFESTATIONS::

CLINICALLY MANIFESTATIONS: CYANOSIS TACHYPNEA METABOLIC ACIDOSIS CHF FEEDING DIFFICULTIES

MANAGEMENT ::

MANAGEMENT : STABILIZING MANAGEMENT CARDIAC CATHETERIZATION: BALLOON ATERIAL SEPTOPLASTY SURGICAL MANAGEMENT: ARTERIAL SWITCH OPER. RASTELLI OPERATION ATERIAL SWITCH OPFR. (MUSTARD/SENNING PROCEDURE)

Slide 49:

RASTELLI OPERATION

TRUNCUS ARTERIOSUS::

TRUNCUS ARTERIOSUS : <1% OF ALL CHD. THERE IS SINGLE GREAT VESSEL EMERGES FROM THE BASE OF THE HEART THROUGH A SINGLE SEMILUNAR VALVE , STRADDLING BOTH VENTRICLFS OVER A LARGE VSD. SECOND SEMILUNAR VALVE IS ABSENT. SURVIVAL IS EXCEPTIONAL.

CLINICAL MANIFESTATIONS ::

CLINICAL MANIFESTATIONS : CYNOSIS RV PRESSURE=SYSTOLIC PRESSURE LOUD SYSTOLIC MURMUR.

MANAGEMENT ::

MANAGEMENT : PALLIATIVE MANAGEMENT BILATERAL PULMONARY ARTERY BENDING. PRIMARY SURGICAL REPAIR VSD CLOSER HOMOGRAFTING

Slide 53:

NURSING PROCESS

NURSING ASSESSMENT::

NURSING ASSESSMENT : HISTORY RECORD OF HIEGHT & WIEGHT. MONITOR VIYAL SIGNS & OXYGEN SATURATION ASSESS– SKIN COLOUR, MUCOUS MEMBRANES, EXTERMITIES, CLUBBING, CHEST WALL , RESPIRATORY STATUS, HEART SOUND,FLUID STATUS,LEVEL OF ACTIVITY.

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NURSING DIGNOSIS: IMPAIRED GAS EXCHANGE R/T ALTERED PULMONARY CONGESTION EXPECTED OUTCOME: IMROVED OXYGENATION EVIDENCED BY EASY COMFORTABLE RESPIRATION. INTERVENTIONS: POSITION SUCTIONING OXYGENATION ADMINISTRATION DIURETICS , BRONCHODILATERS NASOGASTRIC FEEDING

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2.DECREASED CARDIAC OUTPUT R/T DECREASED MYOCARDIAL FUNCTION EXPECTED OUTCOME : IMPROVED CARDIAC OUTPUT DEMONSTRATED BY STABLE SIGNS, ADEQUATE PERIPHERAL PERFUSION. INTERVENTIONS: MINIMAL EXERTIONAL ACTIVITIES. MAINTAIN NORMOTHERMIA. MONITER CVP, PCWP,IABP. ADMINISTER—DIURETICS,DIGOXIN,CAPTOPRIL.

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ACTIVITY INTOLERANCE R/T HYPOXIA , DECREASED MYOCARDIAL FUNCTION. EXPECTED OUTCOME : INCREASED ACTIVITY LEVEL. INTERVENTIONS: PULSE OXIMETERY. OXYGEN ADMINISTRATION. ASSESS RESPOSE TO OXYGEN. PROVIDE ASSISTANCE.

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4.ALTERED NUTRITION:LESS THEN BODY REQUIREMENT R/T EXCESSIVE ENERGY DEMANDS REQUIRED BY INCREASED CARDIAC WORKLOAD EXPECTED OUTCOME : NORMAL WEIGHT &GROWTH INTERVENTIONS: FOR INFANTS SMALL, FREQUENT MEAL. BREAST MILK. LIMIT ORAL FEEDING. NASO GASTRIC FEEDING.

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FOR ADULT SMALL, FREQUENT MEALS. HIGH CALORIE, NUTRITIONAL SUPPLEMENTS. ASK LIKES & DISLIKES . REPORT FEEDING INTOLERANCE. DAILY WEIGHT. INTAKE – OUTPUT CHART. ASSESS FOR FLUID RESTRICTION

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RISK OF INFECTION R/T CHRONIC ILLNESS EXPECTED OUTCOME : NO SIGNS & SYMPTOMS OF INFECTION. INTERVENTIONS: CHILDHOOD IMMUNIZATION SCHEDULE. ADMINISTER YEARLY INFLUENZA VACCINE. RSV IMMUNIZATION. PREVENTION. HANDWASHING. REPORT ANY SUSPECTATION.

NURSING MANAGEMENT IN SURGICAL PROCEDURES::

NURSING MANAGEMENT IN SURGICAL PROCEDURES: ROUTINE PREPARATION INTRA OPERATIVE MANAGEMENT POST OPERATIVE MANAGEMENT:

CONTD…. :

CONTD…. VITAL SIGNS MAINTAIN RESPIRATORY STATUS COMMUNICATION PAIN MANAGEMENT MONITOR FLUIDS & OUTPUT PROVIDE REST

CONTD.. :

CONTD.. CARDIAC MONITORING RESPIRATORY MONITORING NEUROLOGICAL MONITORING INFECTION HEMATOLOGICAL NURSING ALERTS

BIBLIOGRAPHY ::

BIBLIOGRAPHY : WILLIAMS & WILKINS, “MANUAL OF NURSING PRACTICE” 8 th ED. VOLUME –1 JAYPEE BROTHER PUBLISHERS, PAGE:1436-1438. WOODS L. SUSAN ,ADANS SANDRA “CARDIAC NURSING” 5 th ED, VOL.3 FOREIGN PUBLISHER PAGE:794-802. BRUNNER & SUDDARTH “TEXTBOOK OF MEDICAL SURGICAL NURSING” 7 th ED,VOL.2, ELESVIER PUBLICATIONS,PAGE:445-449.

CONTD.. :

CONTD.. Sr.NANCY “TEXTBOOK OF NURSING PRACTICE OF NURSING”VOL.2,PUBLISHED BY KOTTAYAM ,PAGE: 112-114. WWW.GOOGLE.COM

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THANKS

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