Transcript Module 5 – Pediatric Cardiac Disorders

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?
What is included in the initial cardiac assessment of a
newborn?
Why?
Assessment

History

Physical

Diagnostic
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
Clinical Manifestations

1.
2.
3.
4.
5.
6.
7.
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:

Improve cardiac function

Remove accumulated fluid and Na+

Decrease cardiac demands

Decrease O2 consumption
Medications:


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…




Furosemide (Lasix)
Chlorothiazide (Diuril)
Zarozolyn (Thiazide type)
Spironolactone (Aldactone)
Nursing care

Reduce metabolic needs

Diet therapy

Decrease Cardiac Demands

Improve tissue oxygenation
Congenital Cardiac Anomalies
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
What is most common
indication of a
congenital heart defect?
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


Assessment pre-op for baselines
Assessment post-op:
 Vital signs (which ones are priority?)
 Extremities
 Activity
 Hydration
 Medications
 Comfort measures
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
st
 If any of above s/s noted within 1 24 hrs
Patent Ductus Arteriosus
1. Blood shunts from aorta
(left) to the pulmonary
artery (right)
2. Returns to the lungs
causing increase
pressure in the lung
3. Congestive heart failure
Treatment

Medical Management
 Medication
 Indomethacin

Surgical
____Ligate the ductus arteriosus
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
1. Oxygenated blood is shunted
from left to right side of the
heart via defect
2. A larger volume of blood
than normal must be
handled by the right side of
the heart hypertrophy
3. 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
Treatment

Medical Management


Medications – digoxin
Surgical repair

Suture or simple patch
Treatment

Device Closure – Amplatzer septal occluder
During cardiac catheterization the occluder is placed in the
Defect
Ventricle Septal Defect
1. Oxygenated blood is shunted
from left to right side of the
heart via defect
2. A larger volume of blood
than normal must be
handled by the right side of
the heart hypertrophy
3. 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
Treatment
Surgical repair with a patch inserted
Obstructive or Stenotic Defects
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
1. Narrowing of Aorta causing
obstruction of left ventricular
blood flow
2. Left ventricular hypertrophy
Signs and Symptoms
1.  B/P in upper extremities
2. B/P in lower extremities
3. Radial pulses full/bounding
and femoral or popliteal
pulses weak or absent
4. Leg pains, fatigue
5. Nose bleeds
Treatment




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
Cyanotic Disorders
Tetralogy of Fallot
1. Four defects with right to
left shunting
Signs and Symptoms
1. Failure to thrive
2. Lack of energy
2
1
.
3. Infections
4. Polycythemia
5. Clubbing of fingers
3
6. Squatting
7. Cerebral absess
8. Cardiomegaly
9. Cyanosis
4
Treatment

Surgical interventions
 Blalock – Taussig or Potts procedure – increases
blood flow to the lungs.

Open heart surgery
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
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
 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
 May have various leftsided 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.
aorta
Nursing Diagnosis & Goals:
DX: Alteration in cardiac output:
decrease R/T heart malformation
Goal: Child will maintain adequate
cardiac output AEB:
Nursing Care:







Monitor VS
I&O
Medications
Position
Metabolic rest
Assess and document child/family
interactions
Parent teaching
Acquired Cardiac Diseases
Kawasaki Disease
Mucocutaneous lymph node syndrome



Not contagious
Preceded by upper respiratory tract
infection
Cause unknown
Clinical Manifestations:

Acute Phase-

Subacute Phase

Convalescent Phase
10-14 days
10-25 days
25-60 days
Diagnosis:






ECG
CBC, WBC
PT
ESR
SGOT, SGPT
IgA, IgG and IgM
Nursing Care:

Medication Therapy



Aspirin
Gamma Globulin
Nursing Interventions




Assess/monitor
Decrease stimulation
Comfort measures
Discharge teaching
Rheumatic Fever



Systemic inflammatory disease
Follows group A beta-hemolytic
streptococcus infection
Causes changes in the entire heart
especially the valves
Clinical Manifestations

Jones Criteria

Major

Minor

Supporting Evidence
Therapeutic Intervention

Medication
long term
 prophylaxis


Nursing
 Prevention
 Parent teaching (ANTIBIOTICS)
Subacute Bacterial Endocarditis
Infectious disease involving abnormal
cardiac tissue:


Usually rheumatic lesions or congenital
defects
Infection may invade adjacent tissuesaortic and mitral valves
Clinical Manifestations:

Onset insidious
 Fever
 Lethargy/general malaise
 Anorexia
 Splenomegaly
 Retinal hemorrhages
 Heart murmur –90%

Diagnosis- positive blood cultures
Nursing Care

Medication-large doses antibiotic

Bed rest

Teach to notify dentist prior to dental work
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