N303 - Ch 34

Front 1

What are the two major groups of cardiovascular disorders in children?

Back 1

1. Congenital cardiac defects
2. Acquired heart disorders

Front 2

What are the consequences of congenital heart defects?

Back 2

1. Congestive heart failure
2. Hypoxemia

Front 3

What are acquired cardiac disorders?

Back 3

Disease processes or abnormalities that occur after birth and can be seen in the normal heart or in the presence of congenital heart defects

Front 4

What causes acquired cardiac disorders?

Back 4

1. Infection
2. Autoimmune response
3. Environmental factors
4. Familial tendencies

Front 5

What type of circulation does the fetus require?

Back 5

The fetal brain requires the highest concentration of oxygen. The lungs are essentially nonfunctional. The liver is only partly functional. Therefore, less blood is needed in these organs in fetal life.

Front 6

What is the most common heart anomaly?

Back 6

Ventricular septal defect

Front 7

What maternal risk factors are associated with increased incidence of congenital heart defects?

Back 7

1. Chronic illnesses such as diabetes or poorly controlled phenylketonuria
2. Alcohol consumption
3. Exposure to environmental toxins
4. Infections
5. Maternal rubella
6. Poor nutrition
7. Maternal age >40y
8. Sibling with CHD
9. Chromosomal defects
10. Maternal use of meds/drugs during pregnancy

Front 8

What are the pediatric variations in the heart?

Back 8

1. Embryology: 3rd – 8th week gestation. Heart beats by 28th day.

2. Increased Resting HR (↓ as ↑ age). Unable to raise stroke volume to increase cardiac output.

3. Postnatal: Right side pressure ↓and L side ↑; systemic pressure > pulmonary pressure

4. Thin chest wall

5. Innocent murmurs

6. Hypotension is a late sign of shock

7. Continued patent ductus arteriosus functioning may mask CHD for 2-3 days

8. PMI - 4th intercostal infants; 5th intercostal by 7 years

Front 9

Pediatric Heart Rate

Back 9

1. Controlled by autonomic nervous system: Sympathetic – Increase; Parasympathetic - Decrease

2. Adjusts Cardiac Output - Needed to provide adequate systemic perfusion; In general ↑ HR will ↑ CO, however very fast rate will ↓ myocardial perfusion

Front 10

Early indications of CHD

Back 10

1. Poor feeding (anorexia, poor suck, slow feeding with pauses, unable to feed from nipple, difficulty coordinating)

2. Breathing difficulties

3. Growth pattern, developmental milestones, exercise intolerance, recurrent URI, chest pains, fainting, dizziness

Front 11

Physical exam of child with CHD

Back 11

1. Cry (muffled, weak, breathless)
2. Color (clubbing, cap refill, cyanosis at 85% O2 sat)
3. Skin (temp, diaphoresis)
4. Respirations (rate, GFR, dyspnea, cough)
5. Heart (rate, murmur, arrhythmias, femoral pulses)
6. B/P (all 4 extremities, remember cuff size)
7. Pulses (central vs distal, all 4 extremities)
8. Chest (note PMI, precordial activity, thrills)
9. Muscle tone
10. Activity level (restless, lethargic, intolerance)
11. Hepatosplenomegaly

Front 12

What are the diagnostic tests of CHD?

Back 12

1. CXR = Cardiomegaly; increased pulmonary markings
2. EKG Changes = ventricular hypertrophy
3. Echocardiogram
4. Catheterization

Front 13

What is congestive heart failure (CHF)?

Back 13

Inability of the heart to meet metabolic demands of body

Front 14

What causes CHF?

Back 14

CHD or acquired heart disease

Front 15

What occurs with CHF?

Back 15

1. Stimulation of sympathetic and renin-aldosterone systems by reduced CO; initially compensates but will progress to failure if no treatment; heart remodels.

2. SNS - Tachycardia (increased O2 consumption; enlarged heart; gallops; arrhythmias)

3. Peripheral vasoconstriction (cool skin; diaphoresis; mottling; weak pulses; pallor; decreased cap refill)

4. Renin-aldosterone - Reabsorbs H2O; Na to increase volume (decreased urinary output; edematous)

5. Ventricles boggy, pulmonary edema, backs into liver & spleen (increased work of breathing; HSM)

6. NET: Pulmonary and systemic congestion

7. Child becomes irritable, FTT

Front 16

What are the symptoms of CHF?

Back 16

Poor feed, diaphoresis, tachypnea, tachycardia

Front 17

What is the medical management of CHF?

Back 17

1. Digitalis = improves cardiac function; know SE, levels

2. Diuretics

3. Lasix, Diuril, Aldactone = follow serum electrolytes

4. ACE inhibitors = relax vascular musculature (e.g. Captopril and Enalapril)

5. Decrease cardiac demands

6. Improve ventilation and O2 supply

Front 18

Nursing Care of CHF?

Back 18

1. Assess level of compromise = VS, WOB, Activity, Fluid status, lung sounds, I/O [restrict?], heart sounds, daily wts; monitor elect; edema

2. Decrease workload = Rest, combine nsg activities, meds, feed small, frequent/soft nipple/gavage [consider higher calorie/oz], quickly to cries

3. O2 = Color, O2 as needed, sats, elevate HOB

4. Maintain normal G & D

Front 19

Consequences on body of Congenital Heart Disease (CHD)

Back 19

1. Increased cardiac workload = tachycardia, cardiomegaly

2. Pulmonary hypertension = dyspnea, tachypnea, recurrent URI

3. Decreased Cardiac Output = exercise intolerance, growth failure

4. Decreased arterial O2 sat = polycythemia, cyanosis, cerebral changes, clubbing, stroke, metabolic acidosis

Front 20

Classification of CHD – based on hemodynamics

Back 20

1. ↑ Pulmonary Flow (VSD; PDA) = L to R shunting

2. Obstruction of blood flow (Coarction) = L ventricle outflow impeded

3. ↓ Pulmonary Flow (Tetrology of Fallot) = Cyanosis

4. Mixed Blood Flow = Variable expression depending on degree of hypoxemia

Front 21

What is ventricular septal defect?

Back 21

Abnormal opening in the wall between the two ventricles

Front 22

What is Tetralogy of Fallot?

Back 22

Four abnormalities that results in insufficiently oxygenated blood pumped to the body

Front 23

Rheumatic disease

Back 23

1. Autoimmune Disease of Group A hemolytic streptococcus

2. Involves joints, skin, brain, heart

3. Antibiotics can prevent

Front 24

Kawasaki’s Disease

Back 24

1. Etiology unknown - generalized vasculitis

2. Fever >5d, conjunctivitis, rash, inc nodes, mouth, hands, feet, desquamation, anorexia

3. 20% develop cardiac damage

4. Treatment: gamma immunoglobin (IVIG), ASA, Assess for cardiac damage

5. Other cardiac issues: Cholesterol and lipid screening

Front 25

Dysrhythmias

Back 25

1. Too Slow = Begin CPR at 60 BPM

2. Too Fast = Sinus tachycardia; Dehydration, fever, pain

3. Too Fast = SVT; 200-300 BPM
Poor feeds, pallor, irritable; Treatment depends on level of compromise (vagal maneuvers; Adenosine; cardioversion)