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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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Module 5 – Pediatric Cardiac Disorders

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Module 5 pediatric cardiac disorders

Module 5 – Pediatric Cardiac Disorders

Revised, Summer 2008

Fetal circulation

Fetal Circulation

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?



  • 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

Congestive heart failure

Congestive Heart Failure

Clinical manifestations

Clinical Manifestations

  • 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:

  • Improve cardiac function

  • Remove accumulated fluid and Na+

  • Decrease cardiac demands

  • Decrease O2 consumption



  • 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…

  • Furosemide (Lasix)

  • Chlorothiazide (Diuril)

  • Zarozolyn (Thiazide type)

  • Spironolactone (Aldactone)

Nursing care

Nursing care

  • Reduce metabolic needs

  • Diet therapy

  • Decrease Cardiac Demands

  • Improve tissue oxygenation

Congenital cardiac anomalies

Congenital Cardiac Anomalies

Classifying congenital heart defects

Classifying congenital heart defects

  • 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

What is most common indication of a congenital heart defect?

Cardiac catheterizations

Cardiac catheterizations

  • 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

  • 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

  • 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



  • Medical Management

    • Medication

      • Indomethacin

  • Surgical

  • ____Ligate the ductus arteriosus

Nursing care1

Nursing Care:

  • 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

  • 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



  • Medical Management

    • Medications – digoxin

  • Surgical repair

    • Suture or simple patch



  • Device Closure – Amplatzer septal occluder

During cardiac catheterization the occluder is placed in the


Ventricle septal defect

Ventricle Septal Defect

  • 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



Surgical repair with a patch inserted

Obstructive or stenotic defects

Obstructive or Stenotic Defects

Pulmonic or aortic stenosis

Pulmonic or Aortic Stenosis

  • 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

  • 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



  • 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



Cyanotic disorders

Cyanotic Disorders

Tetralogy of fallot

Tetralogy of Fallot

  • 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







  • Surgical interventions

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

    • Open heart surgery

Ask yourself

Ask Yourself ?

  • 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

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

  • 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

  • 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


Nursing diagnosis goals

Nursing Diagnosis & Goals:

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

Goal: Child will maintain adequate cardiac output AEB:

Nursing care2

Nursing Care:

  • Monitor VS

  • I&O

  • Medications

  • Position

  • Metabolic rest

  • Assess and document child/family interactions

  • Parent teaching

Acquired cardiac diseases

Acquired Cardiac Diseases

Kawasaki disease

Kawasaki Disease

Mucocutaneous lymph node syndrome

  • Not contagious

  • Preceded by upper respiratory tract infection

  • Cause unknown

Clinical manifestations1

Clinical Manifestations:

  • Acute Phase-10-14 days

  • Subacute Phase 10-25 days

  • Convalescent Phase 25-60 days



  • ECG

  • CBC, WBC

  • PT

  • ESR


  • IgA, IgG and IgM

Nursing care3

Nursing Care:

  • Medication Therapy

    • Aspirin

    • Gamma Globulin

  • Nursing Interventions

    • Assess/monitor

    • Decrease stimulation

    • Comfort measures

    • Discharge teaching

Rheumatic fever

Rheumatic Fever

  • Systemic inflammatory disease

  • Follows group A beta-hemolytic

    streptococcus infection

  • Causes changes in the entire heart especially the valves

Clinical manifestations2

Clinical Manifestations

  • Jones Criteria

  • Major

  • Minor

  • Supporting Evidence

Therapeutic intervention

Therapeutic Intervention

  • Medication

    • long term

    • prophylaxis

  • Nursing

    • Prevention

    • Parent teaching (ANTIBIOTICS)

Subacute bacterial endocarditis

Subacute Bacterial Endocarditis

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:

  • Onset insidious

    • Fever

    • Lethargy/general malaise

    • Anorexia

    • Splenomegaly

    • Retinal hemorrhages

    • Heart murmur –90%

    • Diagnosis- positive blood cultures

Nursing care4

Nursing Care

  • 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:

  • 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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