Care of a Child with an Aortic Coarctation

Resources to Support the Child and Family

- <a href="https://kidshealth.org/en/parents/coa.html">KidsHealth: For Parents Coarctation of the Aorta</a> - <a href="https://www.fairview.org/patient-education/89177">When Your Child Has Coarctation of the Aorta (COA)&nbsp;</a> - <a href="https://www.bhf.org.uk/informationsupport/publications/children-and-young-people/understanding-your-childs-heart---coarctation-of-the-aorta">Booklet Understanding your child's heart - Coarctation of the aorta</a> - <a href="https://www.cdc.gov/ncbddd/birthdefects/stories/heart-defects/coa-nicholas.html">Nicholas's Story with Coarctation of the Aorta </a> - <a href="https://www.achaheart.org/media/3199/lifelongbrochure.pdf">When Your Child Has a Heart Defect: Planning Ahead for Lifelong Heart Health</a>

Nursing Diagnosis: Risk for inadequate nutrition due to poor feeding and anxiety related to increased metabolic needs and stress

Expected Outcomes: - Blood work shows appropriate electrolyte levels - Patient weight is in the correct percentile for age - Patients eats without overpowering external factors

Nursing Interventions + Rationale: Weights every morning and daily fluid balance --&gt; Accurate indicator of weight gain/loss Create and follow appropriate diet plan --&gt; Consult with dietician --&gt; Plan around patient's peak appetite --&gt; Minimum caloric intake Encourage eating with patient preferences --&gt; Smaller meals lessen nausea --&gt; Positive environment --&gt; Healthy and desirable options Daily blood work --&gt; Assesses the sodium, potassium, calcium levels --&gt; Imbalanced potassium can affect heart rhythm Maintain daily feeding routine --&gt; Psychological --&gt; Eases the stress/anxiety with mealtime **Nutrition is in an important factor of healing

(Ball et al., 2019)         (Highfield, 2022)

Growing Up with Coarctation of the Aorta 

Children with a coarctation of the aorta can lead a normal, active life once it is corrected from surgery. They will still need visits to their cardiologist (heart doctor) every 1-2 years to ensure that they are healing as expected and that the narrowing of the aorta is not returning. The cardiologist will check for hypertension (high blood pressure) which is a risk with this condition. These appointments are very important to attend to ensure that your child is recovering and able to live their lives to the fullest.

Ensure you practice self care! This means step out for coffee when a nurse has a minute to be with your child, get rest when you can, take a shower, etc. Ask about social work and support groups in the hospitals as most of them have great programs in place to support you on this journey. Ask questions, share your concerns, and voice your suggestions- YOU know your child best and the health care team values your input.

Nursing Diagnosis: Risk for impaired tissue perfusion related to decreased cardiac output and impaired gas exchange

Nursing Interventions + Rationale: Assess vitals (oxygen saturation) --&gt; Indicates perfusion rate Change positions slowly --&gt; Position for breathing easier Assess skin colour and temperature --&gt; Cold/pale/clammy are signs of oxygen desaturation --&gt; Blue toes signals poor perfusion (lower extremities) Check peripheral pulses and capillary refill --&gt; Weak/slow related to poor perfusion **Similar interventions to cardiac output but with higher focus on oxygen and respiratory system (lungs)

Expected Outcomes: - Normal breath sounds - SpO2 above 95% - Signs of adequate tissue perfusion (not pale or blue skin, capillary refill &lt;2 seconds)

Many healthcare institutions such as The Seattle Children's Hospital, the Hospital for SickKids and HealthLink BC have resources explaining more about aortic coarctation.

Nursing Diagnosis: Risk for changes to cardiac output (CO) due to structural defects related to the narrowed aorta

Nursing Interventions + Rationale: Assess heart rate and blood pressure --&gt; Tachycardia (fast heart rate) and Hypertension (high blood pressure) present with high CO Assess skin colour and temperature --&gt; Cold/pale/clammy are signs of oxygen desaturation Monitor electrocardiogram for rate and rhythm --&gt; Changes in ECG can impact CO more Check peripheral pulses and capillary refill --&gt; Weak/slow due to insufficient stroke volume and CO Record fluid balance and weight changes --&gt; Fluid retention can cause swelling (edema)

Expected Outcomes: - Ability to maintain adequate cardiac perfusion to body - Normal parameters for heart rate, blood pressure, and cardiac rhythm - Ability to tolerate activity without pain or distress

COA stands for coarctation of the aorta. The aorta is a blood vessel that carries oxygen rich blood from the heart to the rest of the body. Coarctation of the aorta means that a section of the aorta is narrowed, making it harder for the heart to pump blood out to the body.

COA can cause the blood to back up into the left ventricle, which is the section of the heart that connects to and pumps blood through the aorta. This increases the pressure in the left ventricle, causing the heart muscles to have to work harder to pump blood effectively. Coarctation usually affects the part of the aorta that brings blood to the lower body. This means that it can be difficult for enough blood to reach the lower body. If the narrowing is severe enough and is not diagnosed, it can lead to thickening and weakening of the heart muscle, and eventually heart failure.

Coarctation of the Aorta

Nursing Diagnosis: Risk for patient and family unable to cope related to new diagnosis and hospitalization

Nursing Interventions + Rationale: Assess source of anxiety --&gt; Treat the issue (new environment, hospital tour) Involve patient and family in care decisions --&gt; Feeling empowered and confident Discuss appropriate coping methods --&gt; Individual and group ability to handle the situation Observe for changes in behaviours --&gt; Indicator for increased anxiety Encourage expression of feeling --&gt; Open communication to ease stress of miscommunication

Expected Outcomes: - Child and family experience reduced anxiety (no symptoms) - Able to cope with care plan, restrictions, and prognosis - Diagnosis does not take over their life (less worrying)

About 5-8% of individuals who have a heart defect have a coarctation of the aorta. This means that about 16,000 people in Canada have a coarctation of the heart. It is one of the most common congenital heart defects. 

DIAGNOSTICS - How do I know that my child has COA?

COA usually presents itself soon after birth, but is not seen at birth. Symptoms may develop within the first week after delivery. Your child may experience: - Pale, Blue-Tinged Skin - Irritability or Grouchiness - Poor Feeding, Decreased Food Intake In addition to the following clinical presentations: - High Blood Pressure - Blood Pressure Differences between Arms and Legs - Fast Heart Rate - Fast Respiratory Rate - Poor Capillary Refill - Poor or Absent Pulses in Legs

Adult Congenital Heart Association. (n.d.). When Your Child Has a Heart Defect: Planning Ahead for Lifelong Heart Health. Retrieved February 13, 2022, from <a href="https://www.achaheart.org/">https://www.achaheart.org/</a> Amy. (2021, October 8). Living with Coarctation of the Aorta, Nicholas. Centers for Disease Control and Prevention. Retrieved February 13, 2022, from <a href="https://www.cdc.gov/ncbddd/birthdefects/stories/heart-defects/coa-nicholas.html">https://www.cdc.gov/ncbddd/birthdefects/stories/heart-defects/coa-nicholas.html</a> Ball, J., Bindler, R., &amp; Cowen, K. (2019). Child health nursing: Partnering with children and&nbsp;families (3rd ed.). Boston: Pearson. Bhatt, A., &amp; Defaria Yeh, D. (2015). Long-term outcomes in coarctation of the aorta: an evolving story of success and new challenges. Heart (British Cardiac Society), 101(15), 1173–1175. <a href="https://doi.org/10.1136/heartjnl-2015-307641">https://doi.org/10.1136/heartjnl-2015-307641</a> British Heart Foundation. (2019, September 19). Understanding your child's heart - coarctation of the aorta. <a href="https://www.bhf.org.uk/informationsupport/publications/children-and-young-people/understanding-your-childs-heart---coarctation-of-the-aorta">https://www.bhf.org.uk/informationsupport/publications/children-and-young -people/understanding-your-childs-heart---coarctation-of-the-aorta</a> Children's Heart Surgery Fund. (2021, May 13). Coarctation of the aorta. Youtube. Retrieved&nbsp;February 13, 2022, from <a href="https://www.youtube.com/watch?v=oQAVDw2o2uA&amp;t=1s">https://www.youtube.com/watch?v=oQAVDw2o2uA&amp;t=1s</a> Canadian Congenital Heart Alliance. (n.d.). Q and A: Coarctation of the Aorta. Retrieved&nbsp;February 12, 2022, from&nbsp;<a href="https://www.cchaforlife.org/sites/default/files/Coarctation_Q&amp;A.pdf">https://www.cchaforlife.org/sites/default/files/Coarctation_Q&amp;A.pdf</a> Fairview Health Services. (2019). When Your Child Has Coarctation of the Aorta (COA). Retrieved February 13, 2022, from <a href="https://www.fairview.org/patient-education/89177">https://www.fairview.org/patient-education/89177</a> Healthwise Staff. (2020, September 23). Support Groups and Social Support. HealthLink BC. Retrieved February 13, 2022, from <a href="https://www.healthlinkbc.ca/health-topics/support-groups-and-social-support">https://www.healthlinkbc.ca/health-topics/support-groups-and-social-support</a> Heart Structure. BioNinja. (n.d.). [Infographic]. Retrieved February 12, 2022 from&nbsp;<a href="https://ib.bioninja.com.au/standard-level/topic-6-human-physiology/62-the-blood-system/">https://ib.bioninja.com.au/standard-level/topic-6-human-physiology/62-the-blood-system/</a>heart-structure.html Highfield, M. (2022, January 24). Week 3: Care of the Infant to Toddler [Lecture notes]. OWL.<a href="https://owl.uwo.ca/portal/directtool/bc7e8906-88ab-44e9-b7ff-d94335eeda37/"> https://owl.uwo.ca/portal/directtool/bc7e8906-88ab-44e9-b7ff-d94335eeda37/</a> Martin, P. (2019a). 5 congenital heart disease nursing care plans. Nurseslabs. <a href="https://nurseslabs.com/5-congenital-heart-disease-nursing-care-plans/">https://nurseslabs.com/5-congenital-heart-disease-nursing-care-plans/</a> Martin, P. (2019b). 5 hospitalized child nursing care plans. Nurseslabs. <a href="https://nurseslabs.com/5-hospitalized-child-nursing-care-plans/">https://nurseslabs.com/5-hospitalized-child-nursing-care-plans/</a> Mhanna, C., &amp; Weinberger, S. M. (Eds.). (2021, November). Coarctation of the aorta (for parents). KidsHealth. Retrieved February 13, 2022, from <a href="https://kidshealth.org/en/parents/coa.html">https://kidshealth.org/en/parents/coa.html</a> Seattle Children's Hospital. (n.d.). Coarctation of the aorta. Retrieved February 13, 2022, from <a href="https://www.seattlechildrens.org/conditions/coarctation-of-the-aorta/">https://www.seattlechildrens.org/conditions/coarctation-of-the-aorta/</a> U.S. Department of Health &amp; Human Services. (2022, January 24). Coarctation of the Aorta. Centers for Disease Control and Prevention. Retrieved February 11, 2022 from <a href="https://www.cdc.gov/ncbddd/heartdefects/coarctationofaorta.html">https://www.cdc.gov/ncbddd/heartdefects/coarctationofaorta.html</a> U.S. Department of Health &amp; Human Services. (2022, January 24). Coarctation of the Aorta. Centers for Disease Control and Prevention. [Infographic]. Retrieved February 11, 2022 from <a href="https://www.cdc.gov/ncbddd/heartdefects/coarctationofaorta.html">https://www.cdc.gov/ncbddd/heartdefects/coarctationofaorta.html</a>

STRESSORS- How COA May Affect your Child

Being hospitalized as an infant can create feelings of separation anxiety as the child might be away from their parents/caregivers. They may feel anxious being around strangers such as the nurses, doctors, and other health care team members. Your child may also experience sleep deprivation from frequent check-ups in the night and during their resting periods.

In addition, certain medical procedures can be painful and invasive for your child. These will be minimized as much as possible through pain medications and distraction strategies. It can help for the child to be held by their caregiver during these interventions.

At this age, caregivers can coo and speak to their infant to ease some of these stressors. Also, providing black and white geometric shapes and images to look at is appropriate for this stage of life. 

Staying at the hospital and attending appointments can mean missed time at work, travelling to and from, and finding arrangements for siblings

Families may feel anxious around check-ups fearing that there has been changes to their child's health. Furthermore, having a child diagnosed with COA, the rapid treatment and surgery can lead to trauma from those moments in the hospital. 

It is also common for caregivers to feel a sense of guilt and/or hopelessness as their child navigates having a congenital birth defect such as COA.

Siblings may not understand why their brother or sister is in the hospital, they may feel that their parents spend more time with their sibling, and sense the heightened emotions of their family.

If aortic coarctation is identified early and resolved with surgery in infancy, they can be expected to experience a normal life expectancy.

Children must attend their scheduled follow up appointments with their cardiologist to ensure that if any changes to their condition occur, they are addressed promptly.

Good cardiac health is essential as this condition can increase the risk for other cardiac conditions such as hypertension, heart rhythm disturbances, and obstruction. This means minimizing risk through controlling diabetes, abstaining from smoking, controlling hypertension, eating healthy, and staying active.

Endocarditis, also known as, infection of the heart is a risk for your child so your child may require antibiotics for other surgeries and procedures such as dental work, but your cardiologist will address this as needed. 

COA is treated with surgery or cardiac catheterization.

Oftentimes, the narrowing will be fixed using a stent. The aorta is widened using a balloon and is held open by a stent to allow proper blood flow&nbsp; - Surgery/catheterization can be performed at any age but is more effective before the age of 5&nbsp; - Recatheterization may be completed if the aorta becomes narrow again later in life&nbsp; - Usually, a medication to control blood pressure is prescribed - Routine checks and continuous monitoring over life are necessary to prevent complications

The ductus arteriosus is a blood vessel normally present in fetuses. It connects the aorta and another blood vessel, the pulmonary artery. It normally closes a few days after birth, and has special tissue that allows it to do so. Narrowing of the aorta usually happens near this blood vessel. One theory is that some of the tissue from the ductus arteriosus may extend into the aorta, and when this tissue tightens and causes the ductus arteriosus to close, it may also pinch or narrow the aorta, causing coarctation. This can be caused by a combination of genetic and environmental factors, such as family history, or things in the environment the mother was exposed to during pregnancy.

Helix border

Your Child's Journey with an Aortic Coarctation

1. Maintain Adequate Nutrition 2. Monitor Cardiac Output 3. Impaired Tissue Perfusion 4. Coping with Anxiety

DIAGNOSTICS - How do I know that my child has COA?

Along with the signs and symptoms, a Paediatric Cardiologist will be able to diagnose COA by using various imaging technology.

X-Ray - A picture of the heart that can show enlarged heart muscle from an overworked heart Electrocardiogram (ECG) - Views changes in electrical impulses conducted by the heart Echocardiogram - A detailed picture/movie of the heart that can illustrate problems in blood flow CT Scan and MRI - Another set of scans that can show the potential structural changes of the heart Catheterization - Using dye to detect narrowing of vessels or other structural changes