Professional Documents
Culture Documents
Epicardium thin
covering(mesothelium), covers the outer
surface of the heart
Papillary Muscle
Arise from the endocardial & myocardial surface of the
ventricles & attach to the chordae tendinae
Chordae Tendinae
Attach to the tricuspid & mitral valves & prevent
eversion during systole
PEDIATRIC NURSING
Congenital Heart Diseases
Lecturer: Mark Fredderick R. Abejo RN, MAN
________________________________________________
HEART
Ventricles
2 thick-walled chambers; major
responsibility for forcing blood out of the
heart; lie below the atria
Lower Chamber (contracting or pumping)
Right Ventricle: contracts & propels
deoxygenated blood into pulmonary
circulation via the aorta during ventricular
systole; Right atrium has decreased pressure
which is 60 80 mmHg
Left Ventricle: propels blood into the
systemic circulation via aortaduring
ventricular systole; Left ventricle has
increased pressure which is 120 180 mmHg
in order to propel blood to the systemic
circulation
Pediatric Nursing
Heart Valves
Tricuspid
Pulmonic
Mitral
Aortic
Abejo
Heart Circulation
Pediatric Nursing
Abejo
Direction of Shunts
Since pressures in the left side of the heart are usually
higher than the right side, in shunts the blood flows from
left to right. However right to left shunts occur when the
following conditions are present:
Severe pulmonary hypertension
Right ventricular outflow obstruction
as in
Tetralogy of
Fallot
Obstruction to the inflow of blood as in tricuspid
atresia
Pulmonary arteriovenous fistula
Anomalous origin of the major arteries
Birth changes
History
History of heart disease in the family
Contact with known teratogens, such as rubella
during pregnancy
Presence of chromosomal abnormalities
(Downs)
Poor weight gain and/or feeding behavior
Exercise intolerance and/or fatigue during feeds
Sweating during feeding
Frequent respiratory infections
Respiratory difficulties, such as tachypnea,
dyspnea, and shortness of breath.
Recent streptococcal infection (may lead to
valve damage)
Palpation
Quality and symmetry of pulses
Auscultation
Heart rate and rhythm
Presence of murmurs
Height and weight
Position of comfort
Remember, squatting/fetal positions are
often comfortable for a child with a
CHD.
Physical exam
Begins with observation of general appearance,
then the specifics
Use general assessment techniques but look
specifically for the following:
Inspection:
Nutritional state: failure to thrive or poor
weight gain
Skin color: cyanosis and pallor
Chest deformities- enlarged heart
Unusual pulsations of neck veins seen in
some patients
Respiratory pattern- tachypnea, dyspnea,
presense of expiratory grunt
Clubbing of fingers (now rarely seen in
children d/t advances in surgical
techniques)
Pediatric Nursing
Abejo
A.
B.
Management
open heart surgery
long term antibiotic to prevent
subacute bacterial endocarditis
B.
Diagnostics in PDA
C.
A.
B.
Therapy of PDA
Prostaglandin
Transcatheter closure of the PDA
Surgical ligation of the PDA
Management
open heart surgery
long term antibiotic to prevent
subacute bacterial endocarditis
Pediatric Nursing
Abejo
V.
A.
B.
Management
Surgery
Balloon Septostomy, is the widening of
a foramen ovale, patent foramen ovale
(PFO), or atrial septal defect (ASD) via
cardiac catheterization (heart cath)
using a balloon catheter. This procedure
allows a greater amount of oxygenated
blood to enter the systemic circulation
in some cases of cyanotic congenital
heart defect (CHD).
B.
C.
D.
E.
Complications
CHF
Aortic rupture
Bacterial endocarditis
CVA due to rupture of Berry aneurysm
F.
Therapy
Antihypertensive therapy
Treatment of CHF
Balloon dilation
Surgery
C.
D.
Management
Surgery
Balloon Septostomy
Pediatric Nursing
Abejo
A.
B.
Management
Surgery
A.
B.
Management
Pediatric Nursing
O2
no valsalva maneuver , fiber diet
laxative
morphine hypoxia
propranolol decrease heart spasms
BLT blalock taussig procedure palliative repair
Brock procedure complete procedure
Abejo