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TRANSPOSITION OF THETRANSPOSITION OF THE

GREAT VESSELGREAT VESSEL

Definition: Is a congenital heart defect in

which the two major vessels that carryblood away from the heart- the aortaand the pulmonary artery are switched.

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TRANSPOSITION OF THETRANSPOSITION OF THE

GREAT VESSELGREAT VESSEL

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Cause: Unknown

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Risk factors:-

- Rubella or other viral illness in themother during pregnancy

- Poor nutrition in the mother during

pregnancy- Alcoholism

- Mothers age over 45

- Diabetes

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Symptoms:

- Blueness of the skin

- Shortness of breath- Poor feeding

- Clubbing of the fingers

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DIAGNOSTIC TESTDIAGNOSTIC TEST

TEST DEFINITION PURPOSE1. CHEST X-RAY - makes images of the

heart, lungs, airways,blood vessels and thebones of the spine andchest.

- The two com monpositions areposteroanterior (PA)

and lateral

- to evaluate the lungs,heart, and chest wall

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NURSING RESPONSIBILITYNURSING RESPONSIBILITY Inquire about frequency of recent x-

rays and possibility of pregnancy

Provide lead shielding to areas not

being viewed

Remove any jewelry or metal objects

that may obstruct the view of the heartand lungs

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DIAGNOSTIC TESTDIAGNOSTIC TESTTEST DEFINITION PURPOSE

2. CardiacCatheterization

- involve passing a thinflexible tube (catheter)into the right or left side

of the heart, usuallyfrom the groin or arm

to examine the coronary

arteries,because heartattacks, angina,

sudden death,often originate fromdisease in these arteries

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NURSING RESPONSIBILITYNURSING RESPONSIBILITY

Before procedure, obtain a writtenpermission

Withhold food and fluids for 6-8 hrs.before procedure

Inform patient about use of localanesthesia, insertion of catheter, andfeeling of warmth when dye is injecting

and fluttering sensation of heart ascatheter is passed

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Instruct the patient to cough or take adeep breath when catheter is inserted

After procedure, assess circulation toextremity use for catheter insertion Check peripheral pulses, color and

sensation of extremity every 15 min. for1 hr. and then with decreasingfrequency

Observe puncture site for hematoma

and bleeding

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DIAGNOSTIC TESTDIAGNOSTIC TEST

TEST DEFINITION PURPOSE3. ECG - it records the electrical

activity of the heart

- for detecting manycardiac problems,including angina

pectoris, stableangina, ischemicheart disease,arrhythmias (irregularheartbeat),

tachycardia (fastheartbeat),bradycardia (slowheartbeat),myocardial infarction

(heart attack), andcertain con enital

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PURPOSE- is used routinely in

physical examinations andfor monitoring a patient's

condition during and aftersurgery- used in exercisetolerance tests (i.e., stresstests) and is also used toevaluate symptoms suchas chest pain, shortness of

breath, and palpitations.

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NURSING RESPONSIBILITYNURSING RESPONSIBILITY

Prepare skin and apply electrodes andlead

Inform patient that no discomfort isinvolved

Instruct patient to avoid moving todecrease motion artifact

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DIAGNOSTIC TESTDIAGNOSTIC TESTTEST DEFINITION PURPOSE

4. Echocardiogram - Transducer that emitsand receives ultrasoundwaves is placed in fourposition on the chestabove the heart

to diagnose certaincardiovasculardiseases, and is oneof the most widelyused diagnostic testsfor heart diseasealso used to evaluateheart murmurs(abnormal heart

sounds), determinethe causes ofcongestive heartfailure, assessenlarged hearts or

hearts with septaldefects holes

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PURPOSES

- and monitor the heart inpatients with diseases that

may affect heart function(e.g., lupus, lung diseases)

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MANAGEMENTMANAGEMENTCLASSIFICATION

ACTION INDICATION GENERIC N. BRAND N.

Diuretic - Each of thesodium-transportingcells contains

Na-K-ATPasepumps in thebasolateralmembrane.These pumps

perform twomajorfunctions:they returnreabsorbedsodium to the

- Decreasereabsorptionof water,

potassium,

and sodiumby the kidney

Chloro-thiazide

- Diuril

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CLASSIFICATION

ACTION INDICATION GENERIC N. BRAND N.

and they

maintain thecell sodiumconcentrationat relativelylow levels.

The lattereffect is

particularlyimportant,

since it allowsfilteredsodium to

passively enterthe cells down

a favorableconcentration

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ManagementManagementCLASSIFICATION

ACTION INDICATION GENERIC N. BRAND N.

2. Cardiacglycosides

- Digoxinbinds to a siteon theextracellularaspect of the

-subunit ofthe Na+/K+ATPase pumpin themembranes ofheart cells(myocytes).This causes anincrease in the

level ofsodium ions in

- Increase theforce of anddecrease therate of cardiaccontraction

- Digoxin - Lanoxin

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CLASSIFICATION

ACTION INDICATION GENERIC N. BRAND N.

which thenleads to a risein the level ofcalciumions. The

proposedmechanism is

the following:inhibition ofthe Na+/K+

pump leads toincreased Na+

levels, whichin turn slowsdown theextrusion ofCa2+ via the

Na+/Ca2+

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MANAGEMENTMANAGEMENTCLASSIFICATI

ON

ACTION INDICATION GENERIC N. BRAND N.

3. Antibiotic - Penicillin-inducedinactivation ofaminoglycosid

e. The loss ofaminoglycoside effect may

be due to aphysical-

chemicalreaction

between theantibiotics.

- treatment ofserious infectionscaused bysusceptiblestrains of the

designatedmicroorganisms

- Penicillin GPotassium

- Pfizerpen

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SURGICAL PROCEDURESURGICAL PROCEDURE Arterial Switch Procedure anatomically corrects the defects by placing the

pulmonary artery and aorta in their proper anatomicpositions

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NURSING DIAGNOSISNURSING DIAGNOSIS

1. Decrease Cardiac Output R/T structural factorsof congenital heart defect monitor cardiac rhythm continuously encourage parents of relaxing environment, using

relaxation techniques, soothing music, quiet activities

encourage to breathe deeply in/out duringactivities promote adequate rest by decreasing stimuli,

providing quiet environment

NURSING OUTCOME: The client will be able todisplay

hemodynamic stability after nursing intervention

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2. Ineffective breathing pattern R/T decreaseenergy and fatigue

assist with necessary testing

encourage slower and deeper respiration, use of pursed-lip technique assist client in the use of relaxation technique encourage adequate rest periods between activities

NURSING OUTCOME: The client will be able to establish normal respiratory pattern after continuous nursing interventions.

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3. Activity Intolerance R/T Imbalance between

oxygen supply and demand assess level of fatigue, ability to perform ADL and

other activities in relation to severity of condition plan care with rest periods between activities avoid allowing infant to cry for long period of time

provide toys and games for quite and diversionappropriate for age of child, allow to limit ownactivities as much as possible

explain to parents need to conserve energy andencourage rest

NURSING OUTCOME: The client will be able totolerate

increase activity after 3 days

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PROGNOSISPROGNOSIS

Improvement in symptoms and growth

and development is seen after surgicalcorrection of the defect. If corrective

surgery is not performed, the lifeexpectancy is shortened.

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RESEARCHRESEARCHA group of 186 propositi with transposition of the great

vessels (TGV) and 33 propositi with tricuspid atresia (TA)were studied. Data were obtained from hospital recordsand complemented by questionnaires and in part bypersonal interview and clinical examination. The mainresults were among sibs of propositi with TGV anincreased incidence of TGV (0.01350.0054) and of

congenital heart disease in general (0.04950.0103)(K=0, rmin =1). Among 92 sibs of propositi with TA onlyone with patent ductus arteriosus was found. The sexratio of the propositi with TGV was 1.95. There was alsonoted a highly abnormal sex ratio among sibs of parentsof patients with TGV in part confirming the findings ofKNOX.A male excess was found in paternal and maternalsibships and was also present in sibships of propositi.Data about seasonal distribution were inconclusive aswere data about consanguinity of parents. No parentalage or birth order effect was found in either group.