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Pediatric Nursing Ppt Lecture 6 – Cardiovascular Disorders 2

Lecture   6-Cardiovascular Disorders 
DISORDER  PATHOPHYSIOLOGY  INTERVENTIONS 

Congenital     Heart Disease




















































DISORDER

 

·Etiology of congenital     heart disease are unknown 

·Post natal cord clamping     and lung expansion cause flow and pressure changes



Pressure     Changes

Prenatal

·Increased pulmonary     resistance


·Increased R     atrium/ventricle/pulmonary artery pressure


·Decreased L     atrium/ventricle/pulmonary artery pressure



Postnatal

·Decreased pulmonary     resistance


·Decreased R     atrium/ventricle/pulmonary artery pressure


·Increased L     atrium/ventricle/pulmonary artery pressure


·Increased systemic     vascular resistance



Flow     Changes

·Ductus venosus– closes     immediately after birth


·Ductus arteriosus:


–closed functionally by     4th day


–functional closure due to     increased aortic pressure and


decreased pulmonary     resistance


–increased oxygen blood     levels cause wall spasms



·Foramen Ovale


–valve closes functionally     after birth


–functional closure is due     to increased L atrium pressure and


decreased R atrium pressure



Types of Heart Defects

Acyanotic

·Unoxygenated blood     does not flow into the left side of the heart and into     the general body circulation



Cyanotic

·Unoxygenated blood doesflow     into the left side of the heart and into the general body circulation



Clinical Manifestations

·Symptoms are related to     altered hemodynamics


–blood flows from area of     high pressure to low pressure


–pressures on left side of     the heart are higher usually


–shunting of blood can     occur with altered pressures


–shunting of blood     increases workload on affected chambers


–shunting of blood may     increase pulmonary resistance ( more than the lungs can normally handle)


–receiving heart chamber     of shunted blood enlarges due to workload







PATHOPHYSIOLOGY

 

 





















































INTERVENTIONS

 

Congenital Heart Disease     (continued) 



















































DISORDER

 

Congestive     Heart Failure·Symptoms are due to the     heart’s inability to pump efficiently


–Edema is due to systemic     congestion


periorbitaledema in infants


dependent edema in children     that are walking


excessive sweating – due to     sympathetic nervous system


stimulation


·Goal is to improve cardiac     function and remove excess fluid



Symptoms that are specific     to cyanotic heart disease:

Posturing – squatting or     knee chest position- decreases


venous return from lower     extremities so more


oxygen-saturated blood is     shunted to the aorta


Skin/lip cyanosis – due to     circulation of unoxygenatedblood


in the general circulation


Clubbing of fingers – due     to chronic low oxygen levels



Diagnostic Tests

History


Physical examination


–murmurs


–organ enlargement (heart,     liver, spleen)


Radiographics– chest


ECG, Echocardiogram


Cardiac Catheterization


–opaque catheter is     inserted into a peripheral blood vessel and


into the heart


–information on pressures,     cardiac output, oxygen saturation


and defects are obtained




























PATHOPHYSIOLOGY

 

 

















Pre-catheterization

Teach at developmental     level



Post-catheterization

Monitor for complications:


–hemorrhage


–clots- check for pulses,


temperature, color


–infection


–arrhythmias


–dye reactions


–heart perforation


–hypoxia


–phlebitis























INTERVENTIONS

 

Congenital Heart Disease(continued)




















































DISORDER

 

Acyanotic DefectsVentricular Septal Defect (VSD)

·abnormal opening between     ventricles


–shunting – right     ventricle is the receiving chamber


–enlargement of the heart


·loud, harsh murmur


–needs surgical correction



Atrial Septal Defect (ASD)

·abnormal opening between     the atriums


–shunting – right atrium     is the receiving chamber


·Mid ejection murmur


–needs surgical correction



Patent ductus arteriosus     (PDA)

·failure of fetal structure     to close postnatally


–PDA closes because of     changes in oxygen levels/pressure


–frequently found in     preterm infants due to their respiratory difficulties


–blood is shunted from the     aorta to the pulmonary artery


·Machine-like murmur


–medical correction is to     give indomethacin(prostaglandin inhibitor which promotes closure)


–if not effective;     surgical correction



Coarctation of the aorta

·constricted aortic lumen     near the aortic arch


–symptoms depend on the     degree of constriction


–surgical correction;     graft or anastomosis


–in the infant     prostaglandins may be given to keep the PDA open until surgical correction



Newborn

–decreased/absent femoral     pulses


–may develop congestive     heart failure



Older     child

-BP differences between     upper and lower extremities


–headaches



Pulmonic/Aortic     Stenosis

·narrowed entrance at valve


–more serious


–may have activity     restrictions


–surgical correction     cannot create a normal valve











PATHOPHYSIOLOGY

 

 






















































INTERVENTIONS

 

Congenital Heart Disease(continued)




















































DISORDER

 

Cyanotic defectsTetrology of Fallot

·Four defects: ventricular     septal defect, right ventricular hypertrophy, pulmonic stenosis, aorta     overrides VSD


–aorta receives blood from     both ventricles


·pansystolicmurmur


–infants may not have     cyanosis due to PDA shunting


–surgical correction



Transposition of the Great Vessels

·pulmonary artery exits     left ventricle and aorta exits right ventricle


–need a VSD or ASD defect     in order to survive; otherwise there would be no communication between the     pulmonary and systemic circulations










































PATHOPHYSIOLOGY

 

Interventions related to     congenital heart disease disorders:·Detection


–regular well child exams



·Parental Support


–supply information


–assess level of     understanding


–refer to support groups


–need CPR and emergency plan



·Nutrition


–small frequent feedings


–position for increased     energy (semi-Fowler’s)


–use soft, large hole     nipple


–allow child to rest     during feeding


–may need increased     caloric formula



·Cyanotic “tet” spells


–rest


–position of comfort


–keep warm


–stay calm



·Digoxin (lanoxin)


-has narrow safety range


–parents must understand     specific instructions for administration


–dose checked with another     nurse before administration


–give at regular intervals     for steady blood levels


–do not give with feedings


–Monitor for toxicity


·bradycardia:


infant’s heart rate less     than 90


child’s heart rate less     than 70


·vomiting


·arrhythmia



INTERVENTIONS

 

Congenital Heart Disease(continued)




















































DISORDER

 

 













































PATHOPHYSIOLOGY

 

·Discipline 

–child may become     manipulative


–discipline as other     children



·Needs social opportunities


–may have an infection     risk


–may be limited to close     family members



·Surgical correction


–may be open heart or     chest



Pre-operative Care

–teaching important



Post-operative Care

–in ICU initially


-progress with activity


–monitor for complications


·anemia


·thrombosis


·bleeding (anticoagulants)


·signs of heart failure


·arrhythmias (potassium     level)


·respiratory complications


·neurological complications



·Discharge


–needs referrals


–increased responsibility     and independence















INTERVENTIONS

 

Kawasaki Disease 


































Rheumatic Fever


















DISORDER

 

·an     acute systemic inflammatory disease 

–commonly found in     Japanese children, it is seen in all races


·In US most common cause of     acquired heart disease in children


·etiology unknown


–may be caused by infective     organism or toxin


–not spread by person to     person contact


–increased incidence in     earl spring and late summer



Pathophysiology

·Three stages of the     disease:


acute

–fever


–conjunctivalhyperemia


–red throat


–swollen hands and feet


–rash


–enlargement of cervical     lymph nodes


subacute

–cracking lips and     fissures


–desquamation of tips of     fingers and toes


–joint pain


–cardiac disease


–thrombocytosis


convalescent

—-child appears normal


–lingering signs of     inflammation may be present



Diagnosis

·Clinical signs based on     criteria (5 out of 6)


·Blood studies – increased     sed rate, WBC’s, increased platelets, elevated C-reactive protein


·Echocardiogram





·Systemic inflammatory     disease that involves the heart and joints; CNS and connective tissue     involvement may also occur


·Occurs 2-6 weeks secondary     after an infection by group A beta-hemolytic streptococcus



Pathophysiology

·Autoimmune reaction     against beta-hemolytic streptococcus


·Acute phase lasts 2-3     weeks


–characterized by inflammation     of connective tissue in the hearts, joints and skin


·Proliferative phase     affects primarily the heart with Aschoffbodies developing on the heart     valves


–cardiac leaflets scar and     lead to valvular stenosisand regurgitation


·Episode of rheumatic fever     lasts up to 3 months and is self-limiting



PATHOPHYSIOLOGY

 

·Monitor for signs of     cardiac disease 


·Medications


–high dose aspirin while     fever high (80-100 mg/kg/day)


–immune globulin early in     disease reduces incidence of cardiac disease



·Promote comfort


–keep skin clean and dry


–assess extremities for     edema, redness and desquamation


–observe for     conjunctivitis


–passive ROM


–small, frequent feedings



·Discharge


–teach parents to     administer aspirin


–avoid contact sports


–postpone any     immunizations for 5 months after immune globulin







·Bed rest until ESR normal     (may be prolonged)



·Aspirin and prednisone to     reduce inflammation and pain of arthralgia



·Reduce cardiac workload


–promote rest


–diversionalactivities



·Penicillin


–reduces risk of     reoccurrence of strep infection




INTERVENTIONS

 

Rheumatic Fever (cont) Diagnosis·History of Strep infection


·Positive     anti-streptolysin-O (ASO) titer


·Jones Criteria


–diagnosis is based on the     presence of two major or one major and two minor criteria



Major     criteria

–multiple inflamed joints


–carditis


–chorea (St. VitusDance)


–erythema marginatumover     trunk and limbs


–subcutaneous nodules over     joints and vertebrae



Minor     criteria

–fever: spiking     temperature


–arthralgia


–elevated ESR, C-reactive     protein and decreased RBC count


–prolonged P-R and/or Q-T     interval on ECG


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