Congestive Heart Disease in Children

1. CHILD HEALTH NURSING
CONGESTIVE HEART DISEASE
PRESENTATION BY:
MR.SHRISHAIL.B .TAMBAKAD
Principal
School of Nursing
Bagalkot

2. CONGESTIVE HEART FAILURE
Introduction: Congestive cardiac failure (CCF) is a common
pediatric emergency. It is also termed as congestive heart
failure(CHF). It indicatesinadequatecardiac output.
Definition: CCF is defined as “ inability of the heart to
maintain an output at rest or during stress, necessary for the
metabolic needs of the body(systolic failure) and inability to
receive blood into the ventricular cavities at low pressure
during diastole(diastolic failure)”.

3.  CCF may result due to
congenital heart disease and
also due to acquired heart
diseases like:
Rheumatic heart disease
Myocarditis
Hypertension
Mitral or tricuspid stenosis
Mycardial ischaemia
Cardiomyopathy.
ETIOLOGY

4. Non-cardiovasculardiseases
like
Chronic pulmonary disease
Respiratory infections
Anemia
Nephrotic syndrome.
ETIOLOG
Y

5. PATHOPHYSIOLOGYPATHOPHYSIOLOGY
Due to etiological factors
Decreased cardiac output
Leads to inadequate supply of O2 and
nutrition to tissue
Increased systemic vascular resistance to
maintain B.P
Reduced blood flow to kidneys decreases
GFR & tubular reabsorption increases

6. Sodium & water retention
Edema & decreased urine output
Results in further decreased cardiac
output
Finally myocardial failure…
Conti… Pathophysiology

7. CLINICAL MANIFESTATIONS OF CONGESTIVE CARDIACCLINICAL MANIFESTATIONS OF CONGESTIVE CARDIAC
FAILUREFAILURE
Impaired
Myocardial
Function
Pulmonary
Congestion
Systemic Venous
Congestion
Tachycardia Tachypnea Hepatomegaly
Sweating dyspnea Periorbital edema
Decreased
urinary output
Cyanosis Peripheral edema
weakness Retractions Neck vein distension
Anorexia Nasal flaring Ascites
Gallop rhythm (S3) Cough Water weight gain
Cardiac
enlargement
Wheezing Oliguria
Weak peripheral Grunting Feeding difficulties

8. 1)History collection
2) Physical examination:
 Palpation of weak peripheral
pulses with cold extremities.
 Poor capillary refill
 Palpable liver
 Auscultation of heart reveals
gallop rhythm, tachycardia
 Auscultation of lungs reveals
wheezing sound.
3) Chest x-ray shows cardiac
enlargement and pulmonary
congestion.
DIAGNOSTIC EVALUATION:

9. 1) Failure to thrive
2) Metabolic
acidosis
3) Growth
retardation
COMPLICATIONS OF CCF

10. Bed rest in propped up position
(45%) and restrict the activities.
Oxygen therapy
Digitalis improves the cardiac
output
Ex: digoxin ( lanoxin)
Vasodilators like hydralazine,
Nitroglycerine ,
ACE inhibitors ( B.P) Like
Captopril,enalapril,
Diuretics like furosemide
Fluid restriction
Sedatives
Low salt diet.
Iron supplements.
MANAGEMEN
T

11. STEPWISE-TREATMENT OF PAEDIATRIC CCFSTEPWISE-TREATMENT OF PAEDIATRIC CCF
STEP-1: Diuretics (Frusemide) which improves
the cardiac performance.
STEP-2: Digoxin which improves cardiac
contractility
STEP-3: ACE inhibitors (captopril, enalapril)
STEP-4: Vasodilators eg: Nitroglycerine
STEP-5: Intermittent I.V dopamine
STEP-6: Beta- blockers if active myocarditis
present
STEP-7: Heart transplantation.

12. NURSING MANAGEMENT OF CHILDNURSING MANAGEMENT OF CHILD
WITHCCFWITHCCF
 Assess the condition of child
 Monitor the vital signs
 Administer the medications according to
doctor’s order.
 Prevention of infections
 Maintain fluid and electrolyte balance
 Encourage diet rich in potassium
 Maintain intake and output chart
 Emotional support to parents
 Health teaching to parents regarding care
of their child