Transposition
of the great arteries occurs when the aorta and the pulmonary
artery are reversed (or transposed). In transposition,
deoxygenated blood returns to the body through the right atrium,
enters the right ventricle, and goes to the body via the aorta,
bypassing the lungs. Oxygenated blood is pumped back into the
lungs via the pulmonary artery without circulating through the
body. As a result, these infants will be cyanotic. In transposition of
the great arteries, a patent foramen ovale or atrial septal defect
needs to be present so that there is a connection between the
right and left sides of the heart, allowing oxygenated blood to
reach the body. To establish normal blood flow, surgery is required
in the first few weeks of life to switch the aorta and pulmonary
artery to their correct anatomical position.
Truncus Arteriosus
refers to the failure of the common great vessel to divide into the
pulmonary artery and aorta, resulting in one major vessel (or
“trunk”) arising from the left and right ventricles. A ventricular
septal defect allows blood to mix before entering the common
trunk. The mixed blood then goes to the body via the aorta and
to the lungs via the pulmonary artery. As the infant grows, the
blood pressure will drop, with too much blood to go to the lungs,
causing congestive heart failure. Surgery is needed to separate
the pulmonary artery from the aorta to restore normal blood
circulation.
Hypoplastic Left Heart Syndrome
refers to the underdevelopment of the left side of the heart. The
mitral valve is also underdeveloped, either severely narrowed or
missing. The abnormal (or absent) mitral valve prevents blood
from entering the left ventricle. Blood flow is diverted through the
atrial septal defect into the right atrium where it combines with
blood from the lungs and flows into the right ventricle. The right
ventricle then pumps blood to both the lungs and the body. For
this reason, this defect is sometimes referred to as a single
ventricle defect.
, Congenital Heart Defects: Nursing
Care
Children with congenital heart defects (CHD) tire easily due to
oxygenation problems and poor nutrition. For this reason, priority
nursing care focuses on hydration, oxygenation, and pain
management.
A great mnemonic for this is HOP (hydrate, oxygenate, pain management).
Hydrate
• Keep the child well hydrated.
• Maintain fluid and electrolyte
balance. Oxygenate
• Provide cool, humidified oxygen via oxygen hood (or
tent), mask, or nasal canula.
• Suction the airway as needed.
• Monitor oxygen saturation frequently or every 2-4
hours. Pain Management
• Administer pain medication as needed.
• morphine sulfate is used for pain and to
decrease agitation especially during
hypercyanotic ‘tet’ spells
• vasopressors to increase systematic vascular
resistance seen in children with Tetralogy of Fallot
Nutrition
• It can be very unpleasant and tiring to eat because
these children have such a difficult time breathing.
• Small, frequent, high-calorie meals offer children the
nutrients they need without tiring them out.
of the great arteries occurs when the aorta and the pulmonary
artery are reversed (or transposed). In transposition,
deoxygenated blood returns to the body through the right atrium,
enters the right ventricle, and goes to the body via the aorta,
bypassing the lungs. Oxygenated blood is pumped back into the
lungs via the pulmonary artery without circulating through the
body. As a result, these infants will be cyanotic. In transposition of
the great arteries, a patent foramen ovale or atrial septal defect
needs to be present so that there is a connection between the
right and left sides of the heart, allowing oxygenated blood to
reach the body. To establish normal blood flow, surgery is required
in the first few weeks of life to switch the aorta and pulmonary
artery to their correct anatomical position.
Truncus Arteriosus
refers to the failure of the common great vessel to divide into the
pulmonary artery and aorta, resulting in one major vessel (or
“trunk”) arising from the left and right ventricles. A ventricular
septal defect allows blood to mix before entering the common
trunk. The mixed blood then goes to the body via the aorta and
to the lungs via the pulmonary artery. As the infant grows, the
blood pressure will drop, with too much blood to go to the lungs,
causing congestive heart failure. Surgery is needed to separate
the pulmonary artery from the aorta to restore normal blood
circulation.
Hypoplastic Left Heart Syndrome
refers to the underdevelopment of the left side of the heart. The
mitral valve is also underdeveloped, either severely narrowed or
missing. The abnormal (or absent) mitral valve prevents blood
from entering the left ventricle. Blood flow is diverted through the
atrial septal defect into the right atrium where it combines with
blood from the lungs and flows into the right ventricle. The right
ventricle then pumps blood to both the lungs and the body. For
this reason, this defect is sometimes referred to as a single
ventricle defect.
, Congenital Heart Defects: Nursing
Care
Children with congenital heart defects (CHD) tire easily due to
oxygenation problems and poor nutrition. For this reason, priority
nursing care focuses on hydration, oxygenation, and pain
management.
A great mnemonic for this is HOP (hydrate, oxygenate, pain management).
Hydrate
• Keep the child well hydrated.
• Maintain fluid and electrolyte
balance. Oxygenate
• Provide cool, humidified oxygen via oxygen hood (or
tent), mask, or nasal canula.
• Suction the airway as needed.
• Monitor oxygen saturation frequently or every 2-4
hours. Pain Management
• Administer pain medication as needed.
• morphine sulfate is used for pain and to
decrease agitation especially during
hypercyanotic ‘tet’ spells
• vasopressors to increase systematic vascular
resistance seen in children with Tetralogy of Fallot
Nutrition
• It can be very unpleasant and tiring to eat because
these children have such a difficult time breathing.
• Small, frequent, high-calorie meals offer children the
nutrients they need without tiring them out.
