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Pathophysiology of Congenital Heart Defects in Children

- Abnormal heart development: During fetal development, errors in the formation of the heart can result in structural defects.

- Blood flow disturbances: Congenital heart defects can disrupt the normal flow of blood through the heart and blood vessels, leading to various complications.

- Oxygenation issues: Some defects can affect the oxygenation of the blood, resulting in inadequate oxygen supply to the body.
 

Common Childhood Congenital Heart Defects

Symptoms

Characteristic Heart Murmur

Nursing Intervention

Patent ductus arteriosus (PDA)

Poor feeding, weight gain, or growth; fast breathing or breathlessness; easy tiring; sweating with exertion

A continuous “machinery” murmur that is loudest below the left clavicle

Administer diuretics, digoxin, and indomethacin as prescribed; monitor fluid balance and signs of heart failure; prepare for surgical ligation or transcatheter device closure if indicated

Ventricular septal defect (VSD)

May be asymptomatic or have signs of heart failure such as poor feeding, weight gain, or growth; fast breathing or breathlessness; easy tiring; sweating with exertion

A harsh holosystolic murmur that is best heard at the left lower sternal border

Administer diuretics, digoxin, and afterload-reducing agents as prescribed; monitor fluid balance and signs of heart failure; provide small, frequent feedings and supplemental oxygen as needed; prepare for surgical repair or transcatheter device closure if indicated

Atrial septal defect (ASD)

Difficulty breathing (dyspnea); frequent respiratory infections in children; feeling the heart beat (palpitations) in adults; shortness of breath with activity

A systolic ejection murmur that is best heard at the left upper sternal border

Monitor blood pressure and pulses in all extremities; administer antihypertensive medications as prescribed; provide rest and comfort measures; prepare for surgical repair or balloon angioplasty if indicated

Coarctation of the aorta (COA)

May have no symptoms or have high blood pressure in the arms, low blood pressure in the legs, headache, dizziness, fainting, nosebleeds, leg cramps, cold feet, or weak pulses

A systolic ejection murmur that is best heard at the left upper sternal border and radiates to the back

Monitor blood pressure and pulses in all extremities; administer antihypertensive medications as prescribed; provide rest and comfort measures; prepare for surgical repair or balloon angioplasty if indicated

Tetralogy of Fallot (TOF)

Cyanosis that worsens with crying or feeding; clubbing of fingers and toes; poor feeding, weight gain, or growth; polycythemia; hypercyanotic spells (“tet spells”) that cause sudden severe cyanosis, dyspnea, irritability, and loss of consciousness

A harsh systolic ejection murmur that is best heard at the left upper sternal border

Administer oxygen, morphine, propranolol, and fluids as prescribed during tet spells; monitor oxygen saturation and hematocrit levels; provide small, frequent feedings and supplemental oxygen as needed; prepare for surgical repair or palliative shunt placement if indicated

Transposition of the great arteries (TGA)

Severe cyanosis that does not improve with oxygen; poor feeding, weight gain, or growth; signs of heart failure such as tachypnea, tachycardia, hepatomegaly, and edema

A single second heart sound (S2) and a systolic ejection murmur that is best heard at the left upper sternal border

Administer prostaglandin E1 to maintain ductal patency; monitor oxygen saturation and blood gases; provide small, frequent feedings and supplemental oxygen as needed; prepare for balloon atrial septostomy or surgical correction if indicated

Questions on Pathophysiology of Congenital Heart Defects in Children

Correct Answer is B

Explanation

A systolic ejection murmur that radiates to the back is characteristic of aortic regurgitation, which is a different cardiac condition. The characteristic heart murmur in VSD is the result of blood flowing from the left ventricle to the right ventricle through the VSD hole during systole. This causes a harsh holosystolic murmur, which is loudest at the left lower sternal border due to the location of the defect in the ventricular septum. Therefore, choice B is The correct answer.

Correct Answer is ["A","B","C","D"]

Explanation

While paternal health is important for overall fetal development, it is not a well-established risk factor for congenital heart defects. The primary factors are maternal and genetic. Congenital heart defects in children can be influenced by a combination of genetic factors, maternal health, exposure to infections during pregnancy, and chromosomal abnormalities. These factors interact to increase the risk of congenital heart conditions. Therefore, choices A, B, C, and D are all correct answers.

Correct Answer is A

Explanation

Frequent respiratory infections are not a characteristic symptom of TOF. The symptoms associated with TOF are primarily related to cardiac function, such as cyanosis, and do not directly cause respiratory infections.

Correct Answer is B

Explanation

"I have been having severe chest pain and palpitations.”. This response does not align with the typical symptoms of VSD. While palpitations can be associated with heart issues, chest pain is not a common symptom of VSD.

Correct Answer is ["A","B","D","E"]

Explanation

Educate the client about lifestyle modifications. Educating the client about lifestyle modifications is essential. Clients with ASD may benefit from lifestyle changes such as a heart-healthy diet, regular exercise within their limits, and smoking cessation if applicable. These modifications can help manage symptoms and improve overall cardiovascular health.

Correct Answer is B

Explanation

Administer prescribed medication. Administering prescribed medication may be part of the overall management of a patient with TOF, but it is not the immediate response during a hypercyanotic spell. Medications can help manage symptoms and stabilize the patient, but the definitive treatment for TOF is surgical correction.

Correct Answer is A

Explanation

"This murmur is a sign of a heart defect called tetralogy of Fallot (TOF).”. Tetralogy of Fallot (TOF) is characterized by a different set of heart defects, including a ventricular septal defect (VSD), overriding aorta, right ventricular outflow tract obstruction, and right ventricular hypertrophy. The murmur described in the question is not specific to TOF and is more indicative of coarctation of the aorta (COA) due to its location and characteristics.

Correct Answer is A

Explanation

"I can hear abnormal heart sounds during the check-up" is not a symptom but rather a sign of a ventricular septal defect. Abnormal heart sounds, like a loud holosystolic murmur, may be heard on auscultation.

Correct Answer is C

Explanation

"The doctor mentioned hearing unusual heart sounds during the examination" is not a symptom but rather a sign of an atrial septal defect. Unusual heart sounds, like a fixed split second heart sound, may be heard on auscultation.

Correct Answer is ["A","B","C","D"]

Explanation

Frequent respiratory infections are not typically associated with CCHD. While children with CCHD may be more susceptible to infections due to their compromised oxygenation, it is not a direct symptom of the condition.

Cardiac catheterization Cardiac catheterization is an invasive procedure that involves threading a thin tube (catheter) through blood vessels into the heart. It is primarily used to obtain detailed hemodynamic information and to perform interventions such as closing defects or dilating narrowed bloo

Measuring the level of oxygen in the blood does not measure the child's weight and developmental milestones. This response is unrelated to the purpose of monitoring oxygen levels in the blood.

Genetic testing is not typically a part of the routine nursing assessment for a child with a congenital heart defect. While some heart defects may have a genetic component, this is not a standard part of the assessment process.

Painkillers may be prescribed for pain relief, but they are not specific to congenital heart defects. Their use would depend on the individual circumstances and whether the child is experiencing pain.

Providing information on the child's condition is essential, but it does not directly address the question about optimizing respiratory function. While education is crucial, the primary focus should be on practical measures to improve the child's respiratory function, such as proper positioning and

Monitoring the child's growth based on height alone is not a comprehensive assessment for a child with a congenital heart defect. Monitoring growth should include various parameters, such as weight, head circumference, and developmental milestones. Relying solely on height may not provide a complete

The statement, "I should keep a record of all the medications my child is taking," is a responsible and proactive approach to medication management. Keeping a record helps ensure that the child is receiving The correct medications and doses and can be helpful in case of any emergencies. It indicates

Providing resources for support groups and counseling for the parents is an excellent nursing intervention. Having a child with a congenital heart defect can be emotionally challenging for parents. Support groups and counseling can offer them emotional support, guidance, and a safe space to share th

Assessing for signs of infection or bleeding at the surgical site is a key nursing intervention during the post-operative period. Infection and bleeding are immediate post-operative complications that can have serious consequences. Early detection and prompt intervention are crucial to ensure the ch

Claiming, "Balloon valvuloplasty will be the primary treatment for long-term management," is not a universally applicable statement. The choice of treatment for long-term management of a congenital heart defect depends on the specific diagnosis and clinical circumstances. While balloon valvuloplasty
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