Pediatric Nursing Reviewer

Cardiovascular Dysfunction
Fetal circulation:
Placenta - Umbilical vein – Liver (Ductus Venosus)
– Inferior Vena Cava – Right Atrium – Foramen
Ovale – Left Atrium – Mitral valve – left ventricle –
aortic semilunar valve – Aorta – ascending aorta –
head & upper extremities – superior vena cava –
right atrium – tricuspid valve – right ventricle –
pulmonary semilunar valve – pulmonary artery –
Lungs pulmonary vein – ductus arteriosus –
descending aorta – lower part of the body –
umbilical artery – placenta

INCREASE PULMONARY BLOOD FLOW

Atrial Septal Defect

CONGENITAL  In ASD Right Atrium Receives blood

INCIDENCE: both from the organs and from Left Atrium.
 5 – 8 in 1000 live birth.  In effect Right Ventricle and
 2 – 3 per 1000 birth is with Pulmonary Artery receives more blood than
symptoms needs treatment. they usually do.
 Major cause of death in first year of  PULMONARY CONGESTION is
life (after prematurity) common.
 Most common anomaly is VSD
Ventricular Septal Defect
Left to right shunting – Acyanotic

Increase Pulmonary blood flow

Congestive heart failure

Right to Left shunting – cyanotic

Decrease Pulmonary blood flow

 Presence of Hole between the Right
Hypoxemia Ventricle and the Left Ventricle.
 In VSD Right Ventricle Receives
Hemodynamics blood both from Right Atrium and from
1. Pressure Increase pressure in Left Side Left Ventricle.
Decrease pressure in Right Side  In effect Pulmonary Artery receives
2. Resistance Increase Resistance in Systemic more blood than they usually do.
Circulation Decrease in Pulmonary Circulation PULMONARY CONGESTION is common.
3. Saturation Severe cases:
SVC and IVC –lowest O2 saturation EISENMENGER SYNDROME – very severe
RA, RV and Pulmonary Artery - equal saturation resistance in pulmonary blood flow
Pulmonary Vein – fully saturated increases
LA and LV – equal saturation
Intervention in ASD and VSD
  If not interfere with the ADL – x
surgery
 If interfere with ADL – need for
surgery
 Put DACRON PATCH
 Open Heart Surgery is perform for
ASD and VSD

Patent Ductus Arteriosus

Manifestation
 The BP on the UPPER EXTREMITY is
GREATER relative to the pressure on the
LOWER EXTREMITY.
 Epistaxis
 Gum Bleeding
 Intracranial Hemorrhage – the most
common cause of death in COA.
Intervention
 Balloon – Tipped Catheter - to increase the
diameter of the lumen of the Aorta
 Presence of Artery that connects the  Usually done with Cardiac Catheterization.
Aorta to the Pulmonary Artery.
 If not effective – surgery is done by Ligating
 Shunting is from the Aorta to the portion of the Aorta with the coarctation and
Pulmonary Artery. then END-to-END Anastomosis is performed.
 In effect Pulmonary Artery receives
more blood that it usually does. CYANOTIC…
 Leading to increase Pulmonary DECREASE PULMONARY BLOOD FLOW
Artery Pressure.
 PULMONARY CONGESTION
Intervention of PDA
 15 mins to 12 hours (normal time it
takes for PDA to Close)
 After 12 hours - x surgery yet.
 INDOMETHACIN – prostaglandin
inhibitor that causes vasospasm of the Ductus
Arteriosus.
 Gastric irritant – causes Gastric
bleeding. Manifestation
Manifestaion of ASD & VSD  Clubbing of Fingers
 Presence of Murmur  Polycythemia
Manifestaion of PDA  TET SPELL / blue spell
 Presence of Murmur (machinery like Intervention
murmur)  Provide rest and Decrease Energy
expenditure.
OBSTRUCTIVE DEFECTS
 Position: Knee Chest
Coarctation of Aorta
Position, Squatting position.
COMPLETE REPAIR
 First yr of life
 Closure of VSD & resection of
stenosis; pericardial patch to enlarge RV
outflow
 Blalock –total repair

ACQUIRED HEART DISEASE

 Rheumatic Heart Disease  Administration of Acetylsalicylic acid
 Inflammatory disease following an (ASA)
infection by GABHS.
Jones Criteria Bacterial Endocarditis
Major Criteria:  Infective endocarditis
 Subcutenous nodule  Infection of valve & inner lining of
 Polyarthritis heart that can damage & destroy heart valves
 Erythema marginatum  Usually affect mitral or aortic
 Carditis valve
 Syndenhamms Chorea or  After birth/ congenital heart defect
 St. Vitus Dance  Autoimmune; environmental factor;
Minor Criteria: infection
 Arthralgia  Sequela of bacteremia
 Low Grade Fever Manifestation
 All Lab results  Low grade fever, intermittent fever
**Increase C- Reactive Protein, ESR and  Headache, malaise, diaphoresis, wt
ASO loss
Diagnosis  New murmur – damage in
 2 MAJOR or valve/perforation
 1 MAJOR + 2 MINOR  Splenomegaly
Management  Petichiae
 CBR  Respi distress, dif, in feeding,
 Treatment of streptococcal tachycardia
tonsillitis/pharyngitis Intervention
 Medications = penicillin; ASA  High-dose antibiotics= penicillin IV
(tinnitus) (2-8wks)
Kawasaki Disease  DOC: Amoxicillin 1 hour before any
 Mucocutaneuos lymph node procedure
syndrome *dental prodedure; respi; GI; Gatrourinary
 Multisystem tract
disease associated with  Observe side effects of antibiotics; &
inflammation complications (embolism)
(Vasculitis)  Teaching importance of follow up
check up
Phases:  Early dx & tx
Acute Phase
- Fever Congestive heart failure
- Unresponsive to  Inability of the heart to pump
antibiotics & sufficiently to meet the metabolic needs of the
antipyretics body.
- Eyes redden, dry Common cause by congenital heart defect.
w/o drainage
- Strawberry
tongue Heart Failure
- Rashes Right Sided
Subacute Phase  Jugular vein distention
- 10 days after the onset.  Ascites
- Increase in Platelet count  Hepatomegaly
- Aneurysm
 Spleenomegaly
- Most dangerous phase
Convalescent Phase  Peripheral edema
th
- 25 – 40 days Left Sided
- ESR returning to normal  Dyspnea
Management  Orthopnea
 Crackles / Rales
  Moist cough  cardiac output & stroke volume
 Blood tinge frothy sputum Insertion of Cardiac Catheter
(Pulmonary Edema) 1. Right sided-(most common)
Intervention ** Femoral vein to right atrium
Digitalis – improves contractility. 2. Left sided
3 Major Actions **artery to aorta to Right ventricle
1. Increase force of contraction Management
2. Decrease heart rate  Consent
3. Enhances diuresis  sedation
Angiotensin Converting Enzyme (ACE)  Assess allergy to dye, seafood, or
inihbitors – it reduces afterload, thus make radiopaque dyes
heart easier to pump.  No solid food 6-8hours & liquid 4 hrs
Example:  Document ht. & wt.
Captopril (Capoten)
 VS; local anesthesia;
Enalapril (Vasotec)
 Check peripheral pulse
Diuretics - eliminate water and Salt
Example:  + fluttery feeling in insertion ; flushed;
Furosemide (Lasix) & Thiazides warm feeling when dye is injected; desired to
- It can cause K loss cough; palpitation = heart irritability
- K supplement  Shaving & cleaning the site
Decrease K = Enhancement of Digoxin that  IV Line
may lead to Digoxin Toxicity
Increase K = Decrease absorption of
Digoxin that may lead to no effect
Therefore normal K must be monitored
Normal K: 3.3-5.5mmol/L
Nursing Management
1. Administration of Digoxin
 Calculating correct dosage.
 Digoxin toxicity.
 Check . . .
APICAL PULSE
***Not Given if Pulse is:
a. < 90 – 110 beats/min – infant and
young children
b. 70 beats/min – older children
c. 60 beats / min adult
Digoxin Toxicity
 Bradycardia
 Anoxeria
 Nausea and Vomiting
Therapeutic Level: 0.8-2mcg/L
2. BP Monitoring
3. Position in SEMI FOLWERS - for Lung
expansion
4. Maintain Nutritional Needs – small frequent meal
5. Maintain F & Electrolyte Balance

Cardiac catheterization- most invasive

diagnostic procedure
 Inserting of catheter into the heart &
surrounding vessels
 Obtain info about structure &
 performance of the heart valves &
circulatory system; O2 sat.;
 pressure changes;