Cardiovascular disease pediatric sept 13

Cardiovascular disease : pediatrics

Professor Alice SantiagoReference : Saunders NCLEX-RN

review (2011)

Integrating concepts

• Chronic disease • Genetic condition • Hospital associated infection

Cardiovascular disease

• Congenital• Defects with increased

pulmonary blood flow• Obstructive defects• Defects with decreased

blood flow• Mixed defects

• Acquired – Rheumatic fever– Kawasaki disease

Defects with increased pulmonary blood flow

1. Atrial septal defect 2. Atrioventricular canal

defect3. Patent ductus arteriosus4. Ventricular septal defect

Defects with decreased pulmonary blood flow

1. Tetralogy of Fallot2. Tricuspid atresia

Obstructive defects

1. Aortic stenosis2. Coarctation of the aorta3. Pulmonary stenosis

Mixed defects

1. Hypoplastic left heart syndrome

2. Transportation of the great arteries

3. Total anomalous pulmonary venous connection

4. Truncus arteriosus

Defects with increased pulmonary blood flow (4)

• 1. Atrial septal defect• Abnormal opening between atria that causes an

increased flow of oxygenated blood into the right side of the heart (allows blood to flow from the high pressure left side of the heart to the low pressure right side of the heart)

• Three types according to location of opening• Management– May be closed during cardiac catherization– Open repair with cardiopulmonary bypass- before

school age

Defects with increased pulmonary blood flow (4)

• 2. Atrioventricular canal defects• Incomplete fusion of the endocardial cushions• Most common- Down syndrome• Cyanosis increases with crying• Management– Pulmonary banding infants severe symptoms

(palliative)– Complete repair via cardiopulmonary bypass

Defects with increased pulmonary blood flow (4)

3. patent ductus arteriosus• Failure of fetal ductus arteriosus (artery

connecting the aorta and the pulmonary artery) to close within the first weeks fo life.

• Management – Indomethacin (Indocin), a prostaglandin inhibitor,

administered to close a patent ductus in premature infants and some newborns.

– Closed during cardiac catherization, or may requires surgery

Defects with increased pulmonary blood flow (4)

4. ventricular septal defect (VSD)o Abnormal opening between the right and left

ventricleso Many VSDs (small or moderate) close

spontaneously first years of lifeo Management

o Closed during cardiac catherizationo Open repair cardiopulmonary bypass

Defects with decreased pulmonary blood flow (2)

1. Tetralogy of FallotIncludes four defects: 1. VSD, 2. pulmonary

stenosis, 3. overriding aorta, 4. right ventricular hypertrophy

If PVR is higher than systemic resistance , shunt from right to left, if SVR is higher than PVR, the shunt is from left to right.

Acute episodes of cyanosis and hypoxia (hypercyanotic spells, called blue spells or tet spells-occurs during crying, feeding, or defecating

Continue-Tetralogy of Fallot• Management– Surgical management: palliative shunt• Increases pulmonary blood flow & increase oxygen

saturation in infants who cannot undergo primary surgery• Provides blood flow to the pulmonary arteries from the

left or right subclavian arteries

– Surgical management : complete repair• Performed first year of life

– Requires median sternotomy and cardiopulmonary bypass

Defects with decreased pulmonary blood flow (2)

2. Tricuspid atresiao Failure of the tricuspid valve to developo No communication exist between the right

atrium and right ventricleo Blood flows through an ASD or a patent

foramen ovale to left side of the heart and through a VSD to the right ventricle and out to the lungs

o Associated with pulmonic stenosis and transposition of the great vessels

Continue:2. tricuspid atresia

• Results in complete mixing of unoxygenated and oxygenated blood in the left side of the heart

• Cyanosis, tachycardia, and dyspnea are seen in the newborn

• Management– If ASD is small, closed during cardiac catherization,

otherwise surgery

Obstructive defects (3)

• 1. aortic stenosis

Practice Questions , p.463

• 1. (397) A nurse is caring for an infant with congenital heart disease is monitoring the infant closely for signs of CHF. The nurse assesses the infant for which early sign of CHF?A. PallorB. CoughC. TachycardiaD. Slow and shallow breathing

• 1. (397) A nurse is caring for an infant with congenital heart disease is monitoring the infant closely for signs of CHF. The nurse assesses the infant for which early sign of CHF?A. PallorB. CoughC. TachycardiaD. Slow and shallow breathing

• 2. (401). A physician has prescribed oxygen as needed for an infant CHF. In which situation should the nurse administer the oxygen to the infant?

A.During sleepB.When changing the infant’s diaperC.When the mother is holding the infantD.When drawing blood for electrolyte level

testing

• 2. (401). A physician has prescribed oxygen as needed for an infant CHF. In which situation should the nurse administer the oxygen to the infant?

A.During sleepB.When changing the infant’s diaperC.When the mother is holding the infantD.When drawing blood for electrolyte level

testing

• 3. (402). An infant with CHF is receiving diuretic therapy and a nurse is closely monitoring the intake and output. The nurse uses which appropriate method to assess the urine output?A. Weighting the diaperB. Inserting a Foley catheterC. Comparing intake and outputD. Measuring the amount of water added to

formula

• 3. (402). An infant with CHF is receiving diuretic therapy and a nurse is closely monitoring the intake and output. The nurse uses which appropriate method to assess the urine output?A. Weighting the diaperB. Inserting a Foley catheterC. Comparing intake and outputD. Measuring the amount of water added to

formula

• 4. (403). A clinic nurse reviews the record of a child just seen by a physician and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?

A.PallorB.HyperactivityC.Exercise intoleranceD.Gastrointestinal disturbances

• 4. (403). A clinic nurse reviews the record of a child just seen by a physician and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?

A.PallorB.HyperactivityC.Exercise intoleranceD.Gastrointestinal disturbances

• 5. (404). A nurse provided home care instructions to the mother of a child who is being discharged after cardiac surgery. Which statement made by the mother indicates a need for further instructions?

A.“A balance of rest and exercise is important.”B.“I can apply lotion or powder to the incision if it

itchy.”C. “Activities in which my child could fall need to be

avoided for 2 to 4 weeks.”D.“Large crowds of people need to be avoided for

at least 2 weeks after surgery.”

• 5. (404). A nurse provided home care instructions to the mother of a child who is being discharged after cardiac surgery. Which statement made by the mother indicates a need for further instructions?

A.“A balance of rest and exercise is important.”B.“I can apply lotion or powder to the incision if it

itchy.”C. “Activities in which my child could fall need to be

avoided for 2 to 4 weeks.”D.“Large crowds of people need to be avoided for

at least 2 weeks after surgery.”

• 6. (406). Alternate Format: Figure /IllustrationAssessment findings of an infant admitted to the

hospital reveal a machinery-like murmur on auscultation of the heart and signs of CHF. The nurse reviews congenital cardiac anomalies and identifies the infant’s condition as which of the following? Refer to the circled area in the figure to determine the condition.

A.Aortic stenosisB.Atrial septal defectC. Patent ductus arteriosusD.Ventricular septal defect

• 6. (406). Alternate Format: Figure /IllustrationAssessment findings of an infant admitted to the

hospital reveal a machinery-like murmur on auscultation of the heart and signs of CHF. The nurse reviews congenital cardiac anomalies and identifies the infant’s condition as which of the following? Refer to the circled area in the figure to determine the condition.

A.Aortic stenosisB.Atrial septal defectC. Patent ductus arteriosusD.Ventricular septal defect

Review/ QUESTIONS???