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Flashcards in Peds Final Review - Cardiovascular Disorders Deck (42)
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1

Congenital Heart Disease

Increased pulmonary blood flow

Decreased pulmonary blood flow

Obstruction of blood flow out of the heart

Mixed blood flow

2

Increased pulmonary blood flow

ASD
VSD
PDA

3

Decreased pulmonary blood flow

Tetralogy of Fallot

Tricuspid atresia

Transposition of the Great Vessels

4

Obstruction of blood flow out of the heart

Coarctation of the aorta

Aortic stenosis

Pulmonic stenosis

5

Mixed blood flow

Transposition of great vessels

Total anomalous pulmonary venous connection

Hypoplastic heart syndrome

6

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)

7

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

8

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

9

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

10

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

11

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

12


TETROLOGY OF FALLOT

Cyanotic , or Decreased Blood Flow,

Right- to- left shunt

13

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

14

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.

15

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

16

CARE OF CHILDREN WITH CONGENITAL HEART DISEASE (CHD)

Nursing Diagnosis:

Decreased cardiac output

Activity intolerance

Delayed growth and development

17

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

18

CARE OF CHILDREN WITH CONGENITAL HEART DISEASE (CHD)

Nursing Interventions:

Assist with diagnostic tests, and support family during diagnosis

ECG
Echocardiography

19

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

20

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

21

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.

22

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

23

CONGESTIVE HEART FAILURE (CHF) Nursing Diagnosis:

Decreased cardiac output

Impaired gas exchange

24

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

25

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

26

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

27

What is the therapeutic blood levels of Digoxin?

Therapeutic blood levels of digoxin are 0.8 – 2.0 nanograms per milliliter

28

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

29

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

30

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