TRANSPOSITION OF THE

GREAT VESSEL
 Definition:
 Is a congenital heart defect in
which the two major vessels that carry
blood away from the heart- the aorta
and the pulmonary artery are switched.



TRANSPOSITION OF THE
GREAT VESSEL


 Cause: Unknown

 Risk factors:
-
- Rubella or other viral illness in the
mother during pregnancy
- Poor nutrition in the mother during
pregnancy
- Alcoholism
- Mother’s age over 45
- Diabetes


 Symptoms:
- Blueness of the skin
- Shortness of breath
- Poor feeding
- Clubbing of the fingers



 DIAGNOSTIC TEST
TEST DEFINITION PURPOSE
1. CHEST X-RAY - makes images of the - to evaluate the lungs,
heart, lungs, airways, heart, and chest wall
blood vessels and the
bones of the spine and
chest.

- The t wo com m on
posit ions are
post eroant erior (PA)
and lat eral
 NURSING 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 heart
and lungs

 DIAGNOSTIC TEST
TEST DEFINITION PURPOSE

2. Cardiac - involve passing a thin to examine the coronary



Catheterization flexible tube (catheter) arteries, because heart

into the right or left side attacks, angina,
of the heart, usually sudden death,
from the groin or arm often originate from
disease in these arteries
 NURSING RESPONSIBILITY
♥ Before procedure, obtain a written
permission
♥ Withhold food and fluids for 6-8 hrs.

before procedure
♥ Inform patient about use of local

anesthesia, insertion of catheter, and

feeling of warmth when dye is injecting
and fluttering sensation of heart as
catheter is passed



♥ Instruct the patient to cough or take a
deep breath when catheter is inserted
♥ After procedure, assess circulation to

extremity use for catheter insertion

♥ Check peripheral pulses, color and

sensation of extremity every 15 min. for

1 hr. and then with decreasing
frequency
♥ Observe puncture site for hematoma

and bleeding

 DIAGNOSTIC TEST
TEST DEFINITION PURPOSE
3. ECG - it records the electrical - for detecting many
activity of the heart cardiac problems,
including angina
pectoris, stable
angina, ischemic
heart disease,
arrhythmias (irregular
heartbeat),
tachycardia (fast
heartbeat),
bradycardia (slow
heartbeat),
myocardial infarction
(heart attack), and
certain congenital
PURPOSE
- is used routinely in
physical examinations and
for monitoring a patient's
condition during and after
surgery
- used in exercise
tolerance tests (i.e., stress
tests) and is also used to
evaluate symptoms such
as chest pain, shortness of
breath, and palpitations.
 NURSING RESPONSIBILITY
 ♥ Prepare skin and apply electrodes and
lead


 ♥ Inform patient that no discomfort is

involved


 ♥ Instruct patient to avoid moving to

decrease motion artifact



 DIAGNOSTIC TEST
TEST DEFINITION PURPOSE
4. Echocardiogram - Transducer that emits to diagnose certain
and receives ultrasound cardiovascular
waves is placed in four
position on the chest diseases, and is one
above the heart of the most widely
used diagnostic tests
for heart disease
also used to evaluate

heart murmurs
(abnormal heart
sounds), determine
the causes of
congestive heart
failure, assess
enlarged hearts or
hearts with septal
defects (holes
PURPOSES
- and monitor the heart in
patients with diseases that
may affect heart function
(e.g., lupus, lung diseases)
 MANAGEMENT
CLASSIFICATI ACTION INDICATION GENERIC N. BRAND N.
ON
Diuretic
 - Each of the - Decrease Chloro- - Diuril
sodium- reabsorption thiazide
transporting of water,
cells contains potassium,
Na-K-ATPase and sodium
pumps in the by the kidney
basolateral
membrane.
These pumps
perform two
major
functions:
they return
reabsorbed
sodium to the
CLASSIFICATI ACTION INDICATION GENERIC N. BRAND N.
ON
and they
maintain the
cell sodium
concentration
at relatively
low levels.
The latter
effect is
particularly
important,
since it allows
filtered
sodium to
passively enter
the cells down
a favorable
concentration
 Management
CLASSIFICATI ACTION INDICATION GENERIC N. BRAND N.
ON
2. Cardiac - Digoxin - Increase the - Digoxin - Lanoxin
glycosides binds to a site force of and
on the decrease the
extracellular rate of cardiac
aspect of the contraction
α-subunit of
the Na+/K+
ATPase pump
in the
membranes of
heart cells
(myocytes).
This causes an
increase in the
level of
sodium ions in
CLASSIFICATI ACTION INDICATION GENERIC N. BRAND N.
ON
which then
leads to a rise
in the level of
calcium
ions. The
proposed
mechanism is
the following:
inhibition of
the Na+/K+
pump leads to
increased Na+
levels, which
in turn slows
down the
extrusion of
Ca2+ via the
Na+/Ca2+
 MANAGEMENT
CLASSIFICATI ACTION INDICATION GENERIC N. BRAND N.
ON
3. Antibiotic - Penicillin- - treatment of - Penicillin G - Pfizerpen
induced serious infections Potassium
inactivation of caused by
susceptible
aminoglycosid strains of the
e. The loss of designated
aminoglycosid microorganisms
e effect may
be due to a
physical-
chemical
reaction
between the
antibiotics.
 SURGICAL PROCEDURE
 ♥ Arterial Switch Procedure
 ► anatomically corrects the defects by placing the
pulmonary artery and aorta in their proper anatomic
positions

 NURSING DIAGNOSIS
1. Decrease Cardiac Output R/T structural factors


of 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 during
activities
 ► promote adequate rest by decreasing stimuli,
providing quiet environment


 NURSING OUTCOME: The client will be able to

display
 hemodynamic stability after
 nursing intervention

 2. Ineffective breathing pattern R/T decrease
energy 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.



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 diversion
appropriate for age of child, allow to limit own
activities as much as possible
 ► explain to parents need to conserve energy and
encourage rest


 NURSING OUTCOME: The client will be able to

tolerate
 increase activity after 3 days



 PROGNOSIS


 Improvement in symptoms and growth

and development is seen after surgical
correction of the defect. If corrective
surgery is not performed, the life
expectancy is shortened.
 RESEARCH
 A 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 records
and complemented by questionnaires and in part by
personal interview and clinical examination. The main
results were among sibs of propositi with TGV an
increased incidence of TGV (0.0135±0.0054) and of
congenital heart disease in general (0.0495±0.0103)
(K=0, rmin =1). Among 92 sibs of propositi with TA only
one with patent ductus arteriosus was found. The sex
ratio of the propositi with TGV was 1.95. There was also
noted a highly abnormal sex ratio among sibs of parents
of patients with TGV in part confirming the findings of
KNOX.A male excess was found in paternal and maternal
sibships and was also present in sibships of propositi.
Data about seasonal distribution were inconclusive as
were data about consanguinity of parents. No parental
age or birth order effect was found in either group.
