Module 5 pediatric cardiac disorders
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Module 5 – Pediatric Cardiac Disorders. Revised, Summer 2008. Fetal Circulation. Changes in Circulation. Umbilical cord clamped Pulmonary Pressure Pulmonary resistance. Critical thinking:. When are most cardiac anomalies discovered?

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Changes in circulation
Changes in Circulation

  • Umbilical cord clamped

  • Pulmonary

  • Pressure

  • Pulmonary resistance


Critical thinking
Critical thinking:

  • When are most cardiac anomalies discovered?

  • What is included in the initial cardiac assessment of a newborn?

  • Why?


Assessment
Assessment

  • History

  • Physical

  • Diagnostic


Importance of the nurse knowing normal value for o2 saturations
Importance of the Nurse Knowing Normal Value for O2 Saturations

  • Children respond to severe hypoxemia with BRADYCARDIA

  • Cardiac arrest in children generally r/t prolonged hypoxemia

  • Hypoxemia is r/t to respiratory failure or shock

  • BRADYCARDIA is a significant warning sign of cardiac arrest



Clinical manifestations
Clinical Manifestations Saturations

  • Pump Fails – cannot meet the demands of the body = CHF

    How do you know when something is wrong?

  • Tires easily during feeding

  • Periorbital edema, weight gain

  • Rales and rhonchi

  • Dyspnea, orthopnea, tachypnea

  • Diaphoretic / sweating

  • Tachycardia

  • Weight


Goal of treatment
Goal of Treatment: Saturations

  • Improve cardiac function

  • Remove accumulated fluid and Na+

  • Decrease cardiac demands

  • Decrease O2 consumption


Medications
Medications: Saturations

  • Digoxin –what do we assess prior to administration?

    • Which VS? Weigh diapers for strict I & O

    • Double check

    • Digoxin levels

    • Parent teaching

    • Digitalis toxicity

  • ACE inhibitors

    • Capoten (Captoril)

    • Vasotec


Medications continued
Medications continued… Saturations

  • Furosemide (Lasix)

  • Chlorothiazide (Diuril)

  • Zarozolyn (Thiazide type)

  • Spironolactone (Aldactone)


Nursing care
Nursing care Saturations

  • Reduce metabolic needs

  • Diet therapy

  • Decrease Cardiac Demands

  • Improve tissue oxygenation



Classifying congenital heart defects
Classifying congenital heart defects Saturations

  • By defects that increase pulmonary blood flow

    • Patent ductus arteriosus

    • Atrial septal defect

    • Ventricular septal defect

  • By defects that decrease blood flow and mixed defects

    • Pulmonic stenosis

    • Tetralogy of Fallot

    • Tricuspid atresia

    • Transposition of the great arteries

    • Truncus arteriosus


Signs symptoms
Signs & Symptoms Saturations

What is most common indication of a congenital heart defect?


Cardiac catheterizations
Cardiac catheterizations Saturations

  • Used to determine anomalies

  • Measures O2 sats in cardiac chambers and great arteries

  • Evaluates cardiac output

  • Identify detailed images of blood flow patterns

  • May allow for corrective or palliative measures


Nursing interventions pre and post cardiac catheterization
Nursing interventions pre and post cardiac catheterization Saturations

  • Assessment pre-op for baselines

  • Assessment post-op:

    • Vital signs (which ones are priority?)

    • Extremities

    • Activity

    • Hydration

    • Medications

    • Comfort measures


Teaching after cardiac catheterization
Teaching after cardiac catheterization Saturations

  • Parental teaching

    • Watch for s/s of bleeding, bruising at site

    • Foot temp on side of cath cooler

    • Loss of sensation in foot on side of cath

  • When to call the physician

    • If any of above s/s noted within 1st 24 hrs


Patent ductus arteriosus

Blood shunts from aorta (left) to the pulmonary artery (right)

Returns to the lungs causing increase pressure in the lung

Congestive heart failure

Patent Ductus Arteriosus


Treatment
Treatment (right)

  • Medical Management

    • Medication

      • Indomethacin

  • Surgical

  • ____Ligate the ductus arteriosus


Nursing care1
Nursing Care: (right)

  • Pre-op

    • Patient/parent teaching

    • Assess for infection

  • Obtain lab values for chart

  • Post-op

    • ABCs

    • Rest

    • Hydration/nutrition

    • Prevent complications

    • Discharge teaching


Atrial septal defect
Atrial Septal Defect (right)

  • Oxygenated blood is shunted from left to right side of the heart via defect

  • A larger volume of blood than normal must be handled by the right side of the heart hypertrophy

  • Extra blood then passes through the pulmonary artery into the lungs, causing higher pressure than normal in the blood vessels in the lungs  congestive heart failure


Treatment1
Treatment (right)

  • Medical Management

    • Medications – digoxin

  • Surgical repair

    • Suture or simple patch


Treatment2
Treatment (right)

  • Device Closure – Amplatzer septal occluder

During cardiac catheterization the occluder is placed in the

Defect


Ventricle septal defect
Ventricle Septal Defect (right)

  • Oxygenated blood is shunted from left to right side of the heart via defect

  • A larger volume of blood than normal must be handled by the right side of the heart hypertrophy

  • Extra blood then passes through the pulmonary artery into the lungs, causing higher pressure than normal in the blood vessels in the lungs  congestive heart failure


Treatment3
Treatment (right)

Surgical repair with a patch inserted



Pulmonic or aortic stenosis
Pulmonic or Aortic Stenosis (right)

  • Narrowing of entrance that

    decreases blood flow

  • Treatment:

    • Medications – Prostaglandins to keep the PDA open

    • Cardiac Catheterization

      • Balloon Valvuloplasty

    • Surgery

      • Valvotomy


Coarctation of the aorta
Coarctation of the Aorta (right)

  • Narrowing of Aorta causing obstruction of left ventricular blood flow

  • Left ventricular hypertrophy

  • Signs and Symptoms

  •  B/P in upper extremities

  • B/P in lower extremities

  • Radial pulses full/bounding and femoral or popliteal pulses weak or absent

  • Leg pains, fatigue

  • Nose bleeds


Treatment4
Treatment (right)

  • Goals of management are to improve ventricular function and restore blood flow to the lower body.

  • Medical management with Medication

    • A continuous intravenous medication, prostaglandin (PGE-1), is used to open the ductus arteriosus (and maintain it in an open state) allowing blood flow to areas beyond the coarctation.

  • Balloon dilation

  • Surgery

Resect narrow

area

Anastomosis



Tetralogy of fallot
Tetralogy of Fallot (right)

  • 1. Four defects with right to left shunting

  • Signs and Symptoms

  • Failure to thrive

  • Lack of energy

  • Infections

  • Polycythemia

  • Clubbing of fingers

  • Squatting

  • Cerebral absess

  • Cardiomegaly

  • Cyanosis

2

1.

3

4


Treatment5
Treatment (right)

  • Surgical interventions

    • Blalock – Taussig or Potts procedure – increases blood flow to the lungs.

    • Open heart surgery


Ask yourself
Ask Yourself ? (right)

  • Laboratory analysis on a child with Tetralogy of Fallot indicates a high RBC count. The polycythemia is a compensatory mechanism for:

    a. Tissue oxygen need

    b. Low iron level

    C. Low blood pressure

    d. Cardiomegaly


Mixed blood flow
Mixed blood flow (right)

Survival depends upon mixing of blood from pulmonic and systemic circulation

Cyanotic Disorders:

  • Truncus arteriosus

  • Hypoplastic left heart

  • Transposition of the great arteries


Truncus arteriosus
Truncus arteriosus (right)

  • A single arterial trunk arises from both ventricles that supplies the systemic, pulmonary, and coronary circulations. A vsd and a single, defective, valve also exist.

  • Entire systemic circulation supplied from common trunk.


Hypoplastic heart
Hypoplastic heart (right)

  • May have various left-sided defects, including coarctation of the aorta, aortic valve & mitral valve stenosis or artresia


Transposition of great vessels

Aorta arises from the right ventricle, and the pulmonary artery arises from the left ventricle –

not compatible with survival unless there is a large defect present in ventricular or atrial septum.

Transposition of Great Vessels

aorta


Nursing diagnosis goals
Nursing Diagnosis & Goals: artery arises from the left ventricle –

DX: Alteration in cardiac output: decrease R/T heart malformation

Goal: Child will maintain adequate cardiac output AEB:


Nursing care2
Nursing Care: artery arises from the left ventricle –

  • Monitor VS

  • I&O

  • Medications

  • Position

  • Metabolic rest

  • Assess and document child/family interactions

  • Parent teaching


Acquired cardiac diseases

Acquired Cardiac Diseases artery arises from the left ventricle –


Kawasaki disease
Kawasaki Disease artery arises from the left ventricle –

Mucocutaneous lymph node syndrome

  • Not contagious

  • Preceded by upper respiratory tract infection

  • Cause unknown


Clinical manifestations1
Clinical Manifestations: artery arises from the left ventricle –

  • Acute Phase- 10-14 days

  • Subacute Phase 10-25 days

  • Convalescent Phase 25-60 days


Diagnosis
Diagnosis: artery arises from the left ventricle –

  • ECG

  • CBC, WBC

  • PT

  • ESR

  • SGOT, SGPT

  • IgA, IgG and IgM


Nursing care3
Nursing Care: artery arises from the left ventricle –

  • Medication Therapy

    • Aspirin

    • Gamma Globulin

  • Nursing Interventions

    • Assess/monitor

    • Decrease stimulation

    • Comfort measures

    • Discharge teaching


Rheumatic fever
Rheumatic Fever artery arises from the left ventricle –

  • Systemic inflammatory disease

  • Follows group A beta-hemolytic

    streptococcus infection

  • Causes changes in the entire heart especially the valves


Clinical manifestations2
Clinical Manifestations artery arises from the left ventricle –

  • Jones Criteria

  • Major

  • Minor

  • Supporting Evidence


Therapeutic intervention
Therapeutic Intervention artery arises from the left ventricle –

  • Medication

    • long term

    • prophylaxis

  • Nursing

    • Prevention

    • Parent teaching (ANTIBIOTICS)


Subacute bacterial endocarditis
Subacute Bacterial Endocarditis artery arises from the left ventricle –

Infectious disease involving abnormal cardiac tissue:

  • Usually rheumatic lesions or congenital defects

  • Infection may invade adjacent tissues- aortic and mitral valves


Clinical manifestations3
Clinical Manifestations: artery arises from the left ventricle –

  • Onset insidious

    • Fever

    • Lethargy/general malaise

    • Anorexia

    • Splenomegaly

    • Retinal hemorrhages

    • Heart murmur –90%

    • Diagnosis- positive blood cultures


Nursing care4
Nursing Care artery arises from the left ventricle –

  • Medication-large doses antibiotic

  • Bed rest

  • Teach to notify dentist prior to dental work


Principles that apply to all cardiac conditions
Principles that apply to all cardiac conditions: artery arises from the left ventricle –

  • Encourage normal growth and development

  • Counsel parents to avoid overprotection

  • Address parents’ concerns and anxieties

  • Educate parents about conditions, tests, planned treatments, medications

  • Assist parents in developing ability to assess child’s physical status


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