Peds Ch 46 Cardiovascular Disorders

8/3/2019 Peds Ch 46 Cardiovascular Disorders

1/14

NURSING CARE OF THE

CHILD WITH A

CARDIOVASCULARDISEASE


2/14

ASSESSMENT OF HEART

DISORDERS IN CHILDREN

History

Physicalassessment

general

appearance

pulse, bloodpressure, &

respirations


3/14

ASSESSMENT OF HEART

DISORDERS IN CHILDREN

Diagnostic tests

Electrocardiogram

Radiography

Echocardiography

Phonocardiography & magnetic resonance

imagingExercise testing

Laboratory tests


4/14

CONGENITAL HEART

DISEASE Defects with increased

pulmonary blood flow

Ventricular SeptalDefect

Opening betweenventricles

S/S

4-8 weeks, fatigue andharsh murmur

Therapeutic management Most close spontaneously,

those that dont require

open heart surgery


5/14

Defects with

increasedpulmonary blood

flow

Atrial Septal Defect

Opening between

the atria

S/S

Murmur, second

heart soundsplitting

Management

Surgery


6/14

Patent DuctusArteriosus

Fetal structure thatshould begin closingwith the first breathand should completeby 3 months

S/S Wide pulse pressure

and continuousmurmur

Management

Administration ofindomethacin

CardiacCatheterization

Surgery


7/14

NURSING CARE OF THE CHILD

WITH A HEART DISORDER

Obstructive defectsPulmonic Stenosis

Narrowing of thepulmonary valve or

artery causing the rightventricle to hypertrophy

S/S Mild right sided heart

failure

Cyanosis SEM

TherapeuticManagement

Balloon angioplasty to

relieve the stenosis


8/14

-Aortic Stenosis Stenosis of the aortic

valve prevents blood

from passing from theleft ventricle into theaorta, leading tohypertrophy of the leftventricle

S/S Usually asymptomatic but

with murmur

May have chest pain andeven sudden death

TherapeuticManagement

Stabilization with a BetaBlocker or CalciumChannel Blocker

Balloon valvuloplasty

Valve replacement


9/14

Coarctation ofthe Aorta

Narrowing of thelumen of theaorta

S/S

Absence of

palpable femoral&/or brachialpulses;headache,vertigo,nosebleeds,

CVA; leg pain Therapeutic

Management

Surgery orangiography


10/14

Defects with decreasedpulmonary blood flow

Tricuspid Atresia

The tricuspid valve isclosed, blood flowsthrough the patentforamen ovale into theleft atrium, bypassing

the lungs. Then it isshunted back through aPDA into the lungs.When these structuresclose, cyanosis,tachycardia, anddyspnea occur.Surgery must correct.

Treatment: IV infusionof PGE until surgery


11/14

Defects with decreased

pulmonary blood flow

Tetralogy of Fallot Four anomalies

Pulmonary stenosis

VSD

Dextroposition of the aorta

Hypertrophy of right

ventricle

S/S

Cyanosis

Polycythemia (increase in

number of RBC) Dyspnea, growth

restriction, clubbing of

fingers

Therapeutic Management

Surgery


12/14

ACQUIRED HEART DISEASE

Congestive Heart Failure S/S

Tachycardia, tachypnea

Right sided: increased venous

pressure, hepatomegaly Left sided: dyspnea, crackles

(rales), cyanosis, and,

eventually, ride sided failure

Therapeutic management

Reduce workload of the heartusing diuretics, inotropics, and

vasodilators


13/14

Rheumatic fever

S/S

Systolic murmur Chorea (sudden involuntary

movement of the limbs)

Macular rash on the trunk

Swollen and tender joints, SQ

nodules on tendon sheaths

Positive ASO titer and increased

ESR and C-reactive protein


Bedrest

Antibiotics to eliminate Group A

Beta hemolytic Strept

Prognosis depends on how much

heart involvement


14/14

Kawasaki disease S/S (early)

High fever that doesnt respond totherapy

Swollen hands and feet, enlargedjoints

Strawberry tongue, red lips,conjunctiva

Enlarged cervical lymph nodes

S/S (late)

Skin desquamation

Platelet count increases

aneurysms


Administration of Ibuprofen forinflammation and plateletaggregation

IV immunoglobulin to decreaseimmune response

Most children recover fully but

some will need heart surgery torepair damage

Documents

Peds Ch 46 Cardiovascular Disorders