Chapter 41: Cardiovascular Disorders in Children Nursing Care

The chapter delivers essential information for nurses providing care and health teaching to children diagnosed with cardiovascular disorders, spanning congenital defects that appear at birth and acquired conditions developing later in life. Emphasis is placed on preventative healthcare measures outlined in Healthy People 2030, focusing on risk reduction strategies such as promoting healthy nutrition, physical activity, and reducing obesity to minimize future heart disease risk in adulthood. The nursing process is detailed, covering comprehensive assessment techniques, including physical examinations to identify heart sounds, palpable pulsations (thrills, lifts, heaves), and the significance of various heart murmurs, alongside utilizing diagnostic tools like echocardiography, ECGs, and cardiac catheterization. A major theme addressed is Heart Failure (HF), defined by the heart's inability to meet the body's metabolic demands; management relies on pharmacological agents such as digoxin, ACE inhibitors, and diuretics, coupled with crucial nutritional support often requiring concentrated feeds for infants with increased caloric needs. Congenital Heart Defects (CHD) are grouped by physiological impact: defects causing increased pulmonary blood flow (like Patent Ductus Arteriosus, Atrial Septal Defects, and Ventricular Septal Defects), those decreasing pulmonary flow (notably Tetralogy of Fallot, which can lead to life-threatening hypercyanotic or "tet" spells), obstructive lesions (such as Aortic Stenosis and Coarctation of the Aorta), and complex single-ventricle defects (e.g., Hypoplastic Left Heart Syndrome or HLHS), which require palliative, staged surgical interventions like the Norwood, Glenn, and Fontan procedures. Extensive guidance is provided on pre- and postoperative nursing care for children undergoing heart surgery or cardiac catheterization, focusing on managing pain, monitoring for dysrhythmias (like Supraventricular Tachycardia), maintaining fluid balance, and critical discharge teaching regarding activity limitations and infection avoidance. The discussion also includes acquired heart diseases, such as Kawasaki disease—a vasculitis requiring timely treatment with intravenous immunoglobulin (IVIG) and high-dose aspirin to prevent coronary artery aneurysms—and Rheumatic Fever, an autoimmune sequelae of streptococcal infection necessitating long-term penicillin prophylaxis to prevent progressive heart valve damage.