Peds Final Review - Cardiovascular Disorders Flashcards
Congenital Heart Disease
Increased pulmonary blood flow
Decreased pulmonary blood flow
Obstruction of blood flow out of the heart
Mixed blood flow
Increased pulmonary blood flow
ASD
VSD
PDA
Decreased pulmonary blood flow
Tetralogy of Fallot
Tricuspid atresia
Transposition of the Great Vessels
Obstruction of blood flow out of the heart
Coarctation of the aorta
Aortic stenosis
Pulmonic stenosis
Mixed blood flow
Transposition of great vessels
Total anomalous pulmonary venous connection
Hypoplastic heart syndrome
Polycythemia is common in children with:
decreased pulmonary blood flow (cyanotic )defects.
- Tetralogy of Fallot
- Tricuspid atresia
- Transposition of the Great Vessels
(Because the body thinks that it needs to make more RBC’s to carry the oxygen)
VSD
Increased pulmonary blood flow defect (Acyanotic)
There is a hole between the ventricles
Oxygenated blood from the left ventricle is shunted to the right ventricle and recirculated to the lungs (Left to right shunt)
Small defects may close spontaneously
Large defects cause Eisenmenger syndrome or congestive heart failure and require surgical closures
ASD
Increased pulmonary blood flow defect (Acyanotic)
There is a hole between the atria
Oxygenated blood from the left atrium is shunted to the right atrium and lungs(Left to right shunt)
Most defects do not compromise children seriously
Surgical closure is recommended before school age. It can lead to significant problems, such as congestive heart failure or atrial dysrhythmias later in life if not corrected
PDA
Increased pulmonary blood flow defect (Acyanotic)
There is an abnormal opening between the aorta and the pulmonary artery.
It usually closes within 72 hours after birth
If it remains patent, oxygenated blood from the aorta returns to the pulmonary artery.
Increased blood flow to the lungs causes pulmonary hypertension
It may require medical intervention with indomethacin (Indocin) administration or surgical closure
COARCTATION OF THE AORTA
Obstructive Blood Flow defect
There is an obstructive narrowing of the aorta
The most common sites are the aortic valve and the aorta near the ductus arteriosus
A common finding is hypertension in the upper extremities and decreased or absent pulses in the lower extremities
It may require surgical correction
AORTIC STENOSIS
Obstructive Blood Flow defect
It is an obstructive narrowing immediately before, at, or after the aortic valve. It is most commonly valvular.
Oxygenated blood flow from the left ventricle into systemic circulation is diminished.
Symptoms are caused by low cardiac output
It may require surgical correction
TETROLOGY OF FALLOT
Cyanotic , or Decreased Blood Flow,
Right- to- left shunt
Tetralogy of Fallot consists of four defects:
Pulmonary stenosis that obstructs right ventricular outflow
VSD
Overriding aorta
Right ventricular hypertrophy.
The severity of the pulmonary stenosis is related to the degree of right ventricular hypertrophy and the extent of shunting
TETROLOGY OF FALLOT
Cyanosis occurs because unoxygenated blood is pumped into the systemic circulation
Decreased pulmonary circulation occurs because of the pulmonic stenosis
The child experiences hypoxic episodes or “tet” spells. They are relieved by the child squatting or the infant being placed in the knee-chest position
Tetralogy of Fallot requires staged surgery for correction.
CARE OF CHILDREN WITH CONGENITAL HEART DISEASE (CHD)
Nursing Assessment:
Manifestations of CHD
**Murmur (present or absent; thrill or rub)
**Cyanosis, clubbing of digits (usually after age 2)
**Poor feeding, poor weight gain, failure to thrive
**Frequent regurgitation
**Frequent respiratory infections
**Activity intolerance, fatigue
The following are assessed:
**Heart rate and rhythm and heart sounds
**Pulses (quality and symmetry)
**Blood pressure (upper and lower extremities)
**History of maternal infection during pregnancy
CARE OF CHILDREN WITH CONGENITAL HEART DISEASE (CHD)
Nursing Diagnosis:
Decreased cardiac output
Activity intolerance
Delayed growth and development
CARE OF CHILDREN WITH CONGENITAL HEART DISEASE (CHD)
Nursing Interventions:
Provide care for the child with cardiovascular dysfunction
Maintain nutritional status; feed small, frequent feedings; provide high calorie formula
Infants may require tube feeding to conserve energy.
Infants being tube fed need to continue to satisfy sucking needs by a pacifier.
Maintain hydration (polycythemia increases risk for thrombus formation).
Maintain neutral thermal environment
Plan frequent rest periods
Organize activities so as to disturb child only as indicated
Administer digoxin and diuretics as prescribed
Monitor for signs of deteriorating condition or congestive heart failure
Teach family the need for prophylactic antibiotics prior to any dental or invasive procedures due to risk for endocarditis
CARE OF CHILDREN WITH CONGENITAL HEART DISEASE (CHD)
Nursing Interventions:
Assist with diagnostic tests, and support family during diagnosis
ECG
Echocardiography
CARE OF CHILDREN WITH CONGENITAL HEART DISEASE (CHD)
Nursing Interventions:
Prepare family and child for cardiac catheterization (conducted when surgery is probable or as an intervention for certain procedures).
Risks of catheterization are similar to those for a child undergoing cardiac surgery: --Arrhythmias --Bleeding --Perforation --Phlebitis --Arterial obstruction at the entry site
Child requires reassurance and close monitoring
post-catheterization:
- -Vital signs
- -Pulses
- -Incision site
- -Cardiac rhythm
CARE OF CHILDREN WITH CONGENITAL HEART DISEASE (CHD)
Nursing Interventions:
Prepare family and child for surgical intervention is necessary
Prepare child as appropriate for age:
–Show to ICU
–Explain chest tubes, IV lines, monitors, dressings, and ventilator
–Show family and child waiting area for families
–Use a doll or a drawing for explanations
–Provide emotional support
CONGESTIVE HEART FAILURE (CHF)
Condition in which the heart is unable to pump effectively the volume of blood that is presented to it.
CHF is a common complication of congenital heart disease.
It reflects the increased workload of the heart caused by shunts or obstructions.
The two objectives in treating CHF are to reduce the workload of the heart and increase the cardiac output.
CONGESTIVE HEART FAILURE (CHF) Nursing Assessment
Tachypnea, shortness of breath
Tachycardia
Difficulty feeding
Cyanosis
Grunting, wheezing, pulmonary congestion
Edema (face, eyes of infants) , weight gain
Diaphoresis (especially head)
Hepatomegaly
CONGESTIVE HEART FAILURE (CHF) Nursing Diagnosis:
Decreased cardiac output
Impaired gas exchange
CONGESTIVE HEART FAILURE (CHF) Nursing Interventions:
Monitor vital signs frequently, and report signs of increasing distress
Assess respiratory functioning frequently
Elevate head of bed, or use infant seat
Administer oxygen therapy as prescribed
Administer digoxin and diuretics as prescribed
CONGESTIVE HEART FAILURE (CHF) Nursing Interventions:
Weigh frequently (may be every shift for infants)
When frequent weights are required, weigh client on the same scale at the same time of day so that accurate comparisons can be made
Maintain strict input and output, weighing all diapers
Report any unusual weight gains
Provide low sodium diet for formula Gavage feed infants if unable to ge adequate nutrition by mouth
Continue care for infant or child with a congenital defect as indicated
Managing Digoxin
Administration:
Prior to administering digoxin, the nurse MUST take child’s apical pulse for 1 minute to assess for bradycardia.
Hold dose if pulse is below normal heart rate for child’s age
less than 90 beats/min for an infant or young child
older child if pulse below 70 bpm
What is the therapeutic blood levels of Digoxin?
Therapeutic blood levels of digoxin are 0.8 – 2.0 nanograms per milliliter
Families should be taught safe home administration of digoxin:
Administer on a regular basis
Do not skip or make up for missed doses
Give 1 hour before or 2 hours after meals. Do not mix with formula or food
Take child’s pulse prior to administration, and know when to call the caregiver
Keep in safe place – high up and in a locked cabinet
Managing Digoxin
Toxicity:
Nurse must be acutely aware of the signs of digoxin toxicity.
Vomiting is a common early sign of toxicity. This symptom is often overlooked because infants commonly “spit up.”
Other GI symptoms include anorexia, diarrhea, and abdominal pain
Neurologic signs include fatigue, muscle weakness, and drowsiness
Hypokalemia can increase digoxin toxicity
RHEUMATIC FEVER
Inflammatory disease
Rheumatic fever is the most common cause of acquired heart disease in children. It usually affects the aortic and mitral valves of the heart.
Rheumatic fever is associated with an antecedent beta-hemolytic streptococcal infection
Rheumatic fever is a collagen disease that injures the heart, blood vessels, joints, and subcutaneous tissue
RHEUMATIC FEVER Nursing Assessment:
Chest pain, shortness of breath (carditis)
Tachycardia, even during sleep
Migratory large-joint pain
Chorea (irregular involuntary movement)
Rash (erythema marginatum)
Subcutaneous nodules over bony prominences
Fever
Lab findings:
- -Elevated erythrocyte sedimentation rate
- -Elevated ASO (antistreptolysin O ) titer
RHEUMATIC FEVER Nursing Diagnosis
Decreased cardiac output
Risk for injury related to……..
RHEUMATIC FEVER Nursing Interventions
Monitor vital signs
Assess for increasing signs of cardiac distress
Encourage bed rest
Assist with ambulation
Reassure child and family that chorea is temporary
RHEUMATIC FEVER Nursing Interventions
Administer prescribed medications
–Penicillin or erythromycin
–Aspirin for anti-inflammatory
and anticoagulant actions
Teach home care
Explain the necessity for prophylactics
Antibiotics taken either orally or IM; oral penicillin BID
IM penicillin G (Bicillin ) each month
Penicillin G is released very slowly over several weeks, giving sustained levels of concentration. Have emergency equipment available wherever medication is administered
Always determine existence of allergies to penicillin and cephalosporins; check chart and record and inquire of client and family
RHEUMATIC FEVER Nursing Interventions
Administer prescribed medications
–Penicillin or erythromycin
–Aspirin for anti-inflammatory
and anticoagulant actions
Teach home care
Explain the necessity for prophylactics
Antibiotics taken either orally or IM; oral penicillin BID
IM penicillin G (Bicillin ) each month
Penicillin G is released very slowly over several weeks, giving sustained levels of concentration. Have emergency equipment available wherever medication is administered
Always determine existence of allergies to penicillin and cephalosporins; check chart and record and inquire of client and family
KAWASAKI DISEASE
Acute systemic vasculitis of unknown cause
Leading cause of acquired heart disease in children in the U.S.
KAWASAKI DISEASE
Clinical manifestations:
Cervical lymphadenopathy
Red, cracked lips
Strawberry tongue
Erythematous palms
Reddened, dry eyes
Hands and feet edematous
Palms and soles erythematous
KAWASAKI DISEASE
Treatment:
High dose IVIG and high dose aspirin
KAWASAKI DISEASE
Nursing Interventions:
Management of risk for fluid imbalance
Assess for signs of heart failure
- -Decreased UOP
- -Gallop rhythm
- -Tachycardia
- -Respiratory distress
Provide quiet, restful environment
Mouth care – lubricating ointment for lips
ROM in bath for arthritis pain
KAWASAKI DISEASE
Nursing Interventions:
Acetaminophen for fever
Clear liquids/soft foods
Cool cloths
Gentle lotions
Monitor for allergic reaction during IVIG infusion
Cardiac monitoring during IVIG administration and any evidence of cardiac involvement
Provide support and respite for parents – very irritable child for a very long time
CPR – INFANT
One rescuer: 30 compressions to 2 breaths
Two rescuer: 15 compressions to 2 breaths
CPR –CHILD
One rescuer: 30 compressions to 2 breaths
Two rescuer: 15 compressions to 2 breaths
