Podcast
Questions and Answers
A child with a known cardiovascular disorder presents with increased fatigue and decreased activity tolerance. Which assessment question is most important for the nurse to ask the parents?
A child with a known cardiovascular disorder presents with increased fatigue and decreased activity tolerance. Which assessment question is most important for the nurse to ask the parents?
- Has the child been exposed to any classmates with respiratory infections?
- Has the child had any recent changes in diet or appetite?
- What new activities has the child begun recently?
- What is the child's usual position when resting or sleeping? (correct)
A newborn is diagnosed with a congenital heart defect. Which pregnancy history finding is most concerning and requires further investigation?
A newborn is diagnosed with a congenital heart defect. Which pregnancy history finding is most concerning and requires further investigation?
- Maternal history of rubella infection during the first trimester. (correct)
- Maternal gestational diabetes managed with diet.
- Maternal report of occasional morning sickness.
- Maternal use of prenatal vitamins throughout the pregnancy.
During a physical assessment of a child, the nurse notes a capillary refill time of greater than 5 seconds. What cardiovascular issue does this finding suggest?
During a physical assessment of a child, the nurse notes a capillary refill time of greater than 5 seconds. What cardiovascular issue does this finding suggest?
- Rapid cardiac compensation.
- Efficient peripheral perfusion.
- Possible cardiac dysfunction. (correct)
- Normal cardiovascular function.
The nurse is preparing a teaching plan for the parents of a child scheduled for cardiac catheterization. Which pre-procedure instruction is most important to emphasize?
The nurse is preparing a teaching plan for the parents of a child scheduled for cardiac catheterization. Which pre-procedure instruction is most important to emphasize?
Following a cardiac catheterization, a child's pedal pulses are weaker on the affected side compared to the baseline assessment. What is the priority nursing intervention?
Following a cardiac catheterization, a child's pedal pulses are weaker on the affected side compared to the baseline assessment. What is the priority nursing intervention?
A child is diagnosed with a ventricular septal defect (VSD). The parents ask the nurse to explain what this means. What is the nurse's best explanation?
A child is diagnosed with a ventricular septal defect (VSD). The parents ask the nurse to explain what this means. What is the nurse's best explanation?
An infant with a large ventricular septal defect (VSD) is at risk for developing which complication?
An infant with a large ventricular septal defect (VSD) is at risk for developing which complication?
A child with an atrial septal defect (ASD) is scheduled for a cardiac catheterization. What finding would indicate the procedure was successful?
A child with an atrial septal defect (ASD) is scheduled for a cardiac catheterization. What finding would indicate the procedure was successful?
The nurse is caring for an infant with patent ductus arteriosus (PDA). Which assessment finding would the nurse expect to observe?
The nurse is caring for an infant with patent ductus arteriosus (PDA). Which assessment finding would the nurse expect to observe?
An infant with a large, untreated patent ductus arteriosus (PDA) is most at risk for developing which long-term complication?
An infant with a large, untreated patent ductus arteriosus (PDA) is most at risk for developing which long-term complication?
When providing care for an infant with increased pulmonary blood flow, what nursing intervention is most important in managing their nutritional needs?
When providing care for an infant with increased pulmonary blood flow, what nursing intervention is most important in managing their nutritional needs?
A child is diagnosed with pulmonary stenosis. The nurse anticipates which physiological change as a result of this condition?
A child is diagnosed with pulmonary stenosis. The nurse anticipates which physiological change as a result of this condition?
A child with aortic stenosis may exhibit which of the following clinical manifestations?
A child with aortic stenosis may exhibit which of the following clinical manifestations?
The nurse is assessing a child with coarctation of the aorta. Which finding is most indicative of this condition?
The nurse is assessing a child with coarctation of the aorta. Which finding is most indicative of this condition?
In a newborn with suspected transposition of the great arteries (TGA), what is the immediate treatment priority?
In a newborn with suspected transposition of the great arteries (TGA), what is the immediate treatment priority?
An infant with total anomalous pulmonary venous return (TAPVR) would likely exhibit which clinical manifestation?
An infant with total anomalous pulmonary venous return (TAPVR) would likely exhibit which clinical manifestation?
A newborn is diagnosed with truncus arteriosus. The nurse knows this condition is often associated with which other congenital heart defect?
A newborn is diagnosed with truncus arteriosus. The nurse knows this condition is often associated with which other congenital heart defect?
A baby with Hypoplastic Left Heart Syndrome (HLHS) is receiving Prostaglandin E1. What is the primary goal of this Prostaglandin E1 administration?
A baby with Hypoplastic Left Heart Syndrome (HLHS) is receiving Prostaglandin E1. What is the primary goal of this Prostaglandin E1 administration?
The long-term management of a child who has undergone the Fontan procedure for hypoplastic left heart syndrome (HLHS) often includes which medication?
The long-term management of a child who has undergone the Fontan procedure for hypoplastic left heart syndrome (HLHS) often includes which medication?
In a newborn with tricuspid atresia, what is the immediate nursing priority?
In a newborn with tricuspid atresia, what is the immediate nursing priority?
A child with Tetralogy of Fallot (TOF) is experiencing a hypercyanotic spell ('tet spell'). What is the priority nursing intervention?
A child with Tetralogy of Fallot (TOF) is experiencing a hypercyanotic spell ('tet spell'). What is the priority nursing intervention?
A toddler with Tetralogy of Fallot (TOF) becomes cyanotic while playing. The nurse educates the parents to use which intervention during these episodes?
A toddler with Tetralogy of Fallot (TOF) becomes cyanotic while playing. The nurse educates the parents to use which intervention during these episodes?
The nurse is evaluating the effectiveness of digoxin therapy in a child with congestive heart failure (CHF). What assessment finding indicates that the medication is having a therapeutic effect?
The nurse is evaluating the effectiveness of digoxin therapy in a child with congestive heart failure (CHF). What assessment finding indicates that the medication is having a therapeutic effect?
A child with congestive heart failure (CHF) is prescribed furosemide (Lasix). The nurse should monitor for which electrolyte imbalance?
A child with congestive heart failure (CHF) is prescribed furosemide (Lasix). The nurse should monitor for which electrolyte imbalance?
Prior to administering digoxin to an infant, the nurse assesses an apical pulse of 90 beats per minute. What is the nurse's most appropriate action?
Prior to administering digoxin to an infant, the nurse assesses an apical pulse of 90 beats per minute. What is the nurse's most appropriate action?
The nurse is teaching parents about the signs and symptoms of digoxin toxicity in their infant. Which manifestation should the nurse emphasize?
The nurse is teaching parents about the signs and symptoms of digoxin toxicity in their infant. Which manifestation should the nurse emphasize?
The nurse is caring for a child with Kawasaki disease. Which assessment finding is most indicative of cardiac involvement?
The nurse is caring for a child with Kawasaki disease. Which assessment finding is most indicative of cardiac involvement?
A child with Kawasaki disease is receiving intravenous immunoglobulin (IVIG). The nurse explains to the parents that the primary purpose of this medication is to:
A child with Kawasaki disease is receiving intravenous immunoglobulin (IVIG). The nurse explains to the parents that the primary purpose of this medication is to:
Following administration of IVIG for Kawasaki disease, what is the nurse's most important instruction to the parents regarding vaccinations?
Following administration of IVIG for Kawasaki disease, what is the nurse's most important instruction to the parents regarding vaccinations?
A child with a history of congenital heart disease is diagnosed with infective endocarditis. What is the most likely cause of this infection?
A child with a history of congenital heart disease is diagnosed with infective endocarditis. What is the most likely cause of this infection?
The nurse is caring for a child with endocarditis. Which assessment finding is most concerning and warrants immediate notification of the physician?
The nurse is caring for a child with endocarditis. Which assessment finding is most concerning and warrants immediate notification of the physician?
The nurse is teaching the parents of a child with a history of endocarditis about preventive measures. Which statement indicates a need for further teaching?
The nurse is teaching the parents of a child with a history of endocarditis about preventive measures. Which statement indicates a need for further teaching?
A child is diagnosed with rheumatic fever. The nurse understands that this condition is a result of a previous infection with which organism?
A child is diagnosed with rheumatic fever. The nurse understands that this condition is a result of a previous infection with which organism?
A child with suspected rheumatic fever is being assessed. Which clinical manifestation is considered a major Jones criterion?
A child with suspected rheumatic fever is being assessed. Which clinical manifestation is considered a major Jones criterion?
Parents of a child diagnosed with rheumatic fever ask the nurse about long-term management. What is the most important aspect of long-term care the nurse should emphasize?
Parents of a child diagnosed with rheumatic fever ask the nurse about long-term management. What is the most important aspect of long-term care the nurse should emphasize?
A nurse assesses a child with a history of rheumatic fever. Which finding suggests the child is experiencing chorea?
A nurse assesses a child with a history of rheumatic fever. Which finding suggests the child is experiencing chorea?
Flashcards
Cardiovascular System
Cardiovascular System
The heart, blood, and blood vessels working together to transport oxygen and nutrients throughout the body.
History Taking (Cardiac)
History Taking (Cardiac)
Family history, pregnancy history (intrauterine insults, infections, meds), and child's history (respiratory infections, edema)
Physical Assessment Signs (Cardiac)
Physical Assessment Signs (Cardiac)
Clubbing of toes, capillary refill >5 seconds, cyanosis, ruddy complexion, lethargy, rapid respiration, chest prominence.
Normal Pulse Rate (Age)
Normal Pulse Rate (Age)
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Water Hammer Pulse
Water Hammer Pulse
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Pulsus Alternans
Pulsus Alternans
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Dicrotic Pulse
Dicrotic Pulse
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Thready Pulse
Thready Pulse
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Cardiac Diagnostic Tests
Cardiac Diagnostic Tests
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Cardiac Catheterization
Cardiac Catheterization
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Dye Toxicity Signs (Cardiac Cath)
Dye Toxicity Signs (Cardiac Cath)
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Pre-Cardiac Cath Preparation
Pre-Cardiac Cath Preparation
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Post-Cardiac Cath Care
Post-Cardiac Cath Care
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Post-Cardiac Cath Home Care
Post-Cardiac Cath Home Care
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Congenital Heart Disorder
Congenital Heart Disorder
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Left-to-Right Shut
Left-to-Right Shut
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Manifestations of L-R Shunts
Manifestations of L-R Shunts
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Right-to-Left Shunts
Right-to-Left Shunts
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Manifestations of R-L Shunts
Manifestations of R-L Shunts
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Increased Pulmonary Blood Flow
Increased Pulmonary Blood Flow
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Ventricular Septal Defect (VSD)
Ventricular Septal Defect (VSD)
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VSD Assessment
VSD Assessment
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VSD Management
VSD Management
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Atrial Septal Defect (ASD)
Atrial Septal Defect (ASD)
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ASD Risk Factors
ASD Risk Factors
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Assessment of ASD
Assessment of ASD
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ASD Management
ASD Management
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ASD Complications
ASD Complications
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Patent Ductus Arteriosus (PDA)
Patent Ductus Arteriosus (PDA)
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PDA Signs and Symptoms
PDA Signs and Symptoms
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PDA Treatments
PDA Treatments
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PDA Complications
PDA Complications
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Pulmonary Stenosis
Pulmonary Stenosis
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Pulmonary Stenosis Signs
Pulmonary Stenosis Signs
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Pulmonary Stenosis Treatment
Pulmonary Stenosis Treatment
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Aortic Stenosis
Aortic Stenosis
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Aortic Stenosis Signs
Aortic Stenosis Signs
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Aortic Stenosis Management
Aortic Stenosis Management
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Coarctation of Aorta (CoA)
Coarctation of Aorta (CoA)
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CoA Signs and Symptoms
CoA Signs and Symptoms
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Study Notes
- The cardiovascular system consists of the heart (the pump), blood (transport fluid), and blood vessels (transport routes).
- Conditions of the cardiovascular system can be congenital or acquired.
Assessment of Cardiovascular Disorders
- Obtain a family history to identify hereditary factors.
- Check pregnancy history for intrauterine infections (toxoplasmosis, rubella), medication intake, and radiation exposure.
- Ask about the child's activity level and positions they assume when tired (knee-chest for infants, squatting for older children).
- Note any history of lower respiratory infections, voiding capacity, and edema.
Physical Assessment
- Check toes for clubbing.
- Assess capillary refill (normal is less than 5 seconds).
- Examine the buccal membrane and lips for cyanosis.
- Cyanosis persisting >20 minutes after birth suggests cardiovascular dysfunction.
- A ruddy complexion may indicate polycythemia.
- Observe for lethargy and rapid respiration.
- Inspect the chest for prominence on the left side or visible heart movement.
Pulse, Blood Pressure, and Respirations
Pulse
- Normal infant pulse is 100-150 bpm.
- Assess for tachycardia and abnormal pulse patterns.
- Water Hammer pulse: Forceful, bounding, suggests cardiac insufficiency.
- Pulsus Alternans: Strong and weak beats, indicates myocardial weakness.
- Dicrotic pulse: Double radial pulse for every apical beat, symptomatic of aortic stenosis.
- Thready pulse: Weak, rapid, suggests ineffective heart action.
Diagnostics
- Electrocardiogram (ECG) monitors the heart's electrical activity.
- Chest radiography assesses heart size and lung condition.
- Echocardiography uses ultrasound to visualize heart structures.
- Exercise testing evaluates heart function under stress.
- Cardiac catheterization involves inserting a catheter into the heart for blood samples or dye injection.
- Lab tests include CBC (Hg & Hct), arterial blood gas, oxygen saturation, prothrombin and partial thromboplastin times, and electrolytes (Na).
Cardiac Catheterization
- Involves inserting a radiopaque catheter through a major vein into the heart.
- Used for diagnostic (securing blood samples) and interventional purposes (dye injection).
Pre-Cardiac Catheterization Preparation
- Check for dye toxicity signs: increased temperature, urticaria, wheezing, edema, dyspnea, headache.
- Procedure is usually ambulatory; conscious sedation is used.
- Ensure recent chest radiograph, ECG, electrolyte levels, and blood typing/cross-matching are done.
- Digoxin is typically held before the procedure.
- Take and record baseline pedal pulses; measure and record height and weight.
- Avoid drawing blood specimens from the projected catheterization site.
- Patient is kept NPO for 2-4 hours before procedure.
Post-Cardiac Catheterization Care
- Monitor vital signs with apical pulse and BP every 15 minutes for the first hour.
- Check apical pulse for 1 minute for bradycardia or dysrhythmias.
- Assess pulses below the catheterization site.
- Record pulse quality and symmetry.
- Assess temperature and color of the affected extremity.
- Check dressing for bleeding or hematoma formation.
Post-Cardiac Catheterization Home Care
- Keep dressing in place for 24 hours, keep the site dry and clean.
- Observe the site for redness, swelling, drainage, or bleeding.
- Check temperature.
- Avoid strenuous exercise.
- Acetaminophen is for pain.
- Maintain the follow-up appointment.
Congenital Heart Disorder (CHD)
- Heart disease with cardiovascular structure abnormalities occurring before birth.
- Affects about 1 in 100 children.
- Symptoms may occur at birth, during childhood, or in adulthood.
- Classified as left-to-right or right-to-left shunts.
Left-to-Right Shunts
- Acyanotic heart disease with blood shunting from arterial to venous system.
- Oxygenated blood to oxygenated blood.
- Higher pressure on the left side of the heart causes blood to shunt to the right.
Clinical Manifestations
- Typically acyanotic.
- Tachycardia occurs due to increased blood volume.
- Cardiomegaly develops from the heart's increased workload.
- Dyspnea and pulmonary edema result from high-pressure blood flow to the lungs.
- Increased respiratory infections occur due to blood pooling in the lungs.
Right-to-Left Shunts
- Cyanotic heart disease with blood shunting from the venous to the arterial system.
- Deoxygenated blood mixes with oxygenated blood.
Clinical Manifestations
- Hypoxemia results in decreased tissue oxygenation.
- Polycythemia is increased red blood cell production to compensate for hypoxemia.
- Increased blood viscosity causes the heart to pump harder.
Congenital Heart Disorder Classifications
- Disorders with increased pulmonary blood flow.
- Obstruction to blood flow leaving the heart.
- Mixed blood flow (oxygenated and deoxygenated blood mixing).
- Decreased pulmonary blood flow.
Disorders in Increased Pulmonary Blood Flow
- Blood flows from the high-pressure left side to the low-pressure right side through abnormal openings.
- Includes ventricular septal defect (VSD), atrial septal defect (ASD), atrioventricular canal (AVC) defect, and patent ductus arteriosus (PDA).
Ventricular Septal Defect (VSD)
- The most common congenital cardiac disorder.
- An opening exists in the septum between the two ventricles.
- Acyanotic disorder.
- Blood shunts from the left ventricle to the right, leading to right ventricular hypertrophy and pulmonary artery hypertension.
- Small holes are generally asymptomatic.
- Larger defects can lead to CHF (congestive heart failure).
Assessment
- Heart murmur: Harsh pansystolic murmur along the left sternal border.
- Echocardiography/MRI reveals right ventricular hypertrophy and pulmonary artery dilatation.
- ECG may reveal right ventricular hypertrophy.
- Chest X-ray can show the size of the heart.
Management
- Small VSDs may close spontaneously.
- Moderate defects may be closed during cardiac catheterization.
- Large VSDs (>3 mm) require open-heart surgery before age 2 to prevent pulmonary artery hypertension.
- Treatment includes surgery and management of CHF.
- Postoperatively: Monitor for arrhythmias due to edema in the septum, prophylactic antibiotics given for 6 months to prevent bacterial endocarditis, and normal activity can be resumed after repair.
Atrial Septal Defect (ASD)
- Abnormal communication between the two atria, allowing blood to shift from left to right.
- Acyanotic defect.
- Leads to increased volume in the right side of the heart, ventricular hypertrophy, and increased pulmonary artery blood flow.
Risk Factors
- Rubella infection during pregnancy.
- Drug, tobacco, or alcohol use during pregnancy, or exposure to certain substances.
- Maternal diabetes or lupus.
- Obesity.
- Phenylketonuria (PKU).
Assessment
- Auscultation: Systolic murmur over the pulmonic area, fixed S2 splitting.
- Echocardiography: Enlarged right side of the heart and increased pulmonary circulation.
- Cardiac catheterization: Reveals separation in the atrial septum and increased oxygen saturation in the right atrium.
Signs and Symptoms
- Shortness of breath, especially during exercise.
- Fatigue.
- Swelling of legs, feet, or abdomen.
- Heart palpitations or skipped beats.
- Heart murmur.
Management
- Treatment depends on the size of the hole; medications (beta-blockers, anticoagulants) manage symptoms.
- Some ASDs close spontaneously; surgery is done electively between 1 and 3 years of age.
- Procedures include catheter-based repair or open-heart surgery with patch closure.
Complications
- Right-sided heart failure.
- Arrhythmias.
- Increased risk of stroke.
- Shortened lifespan.
- Eisenmenger syndrome (pulmonary hypertension).
Patent Ductus Arteriosus (PDA)
- Before Birth: ductus arteriosus essential to systemic perfusion
- After Birth: closure begins with first breath
- Anatomic closure occurs over 7-14 days
Signs and Symptoms
- Larger PDAs may cause wide pulse pressure, rapid breathing, shortness of breath, sweating during feedings, fatigue, feeding problems, poor weight gain, fast pulse, heart murmur, heart palpitations, and pulmonary hypertension.
Diagnostics
- Chest X-ray and Echocardiogram (key diagnostic tool).
- Electrocardiogram (EKG).
Treatment
- Indomethacin: constricts muscle in PDA wall for closure.
- Cardiac Catheterization: coil placement to plug the duct.
- Closed-heart surgery: ligation (tying) and cutting the PDA.
- Antibiotics after the procedure.
Complications
- Pulmonary Hypertension.
- Infectious endocarditis.
- Congestive Heart Failure (CHF).
- Failure to Thrive (FTT).
- Atrial or Ventricular Arrhythmias.
Nursing Management of Disorders with Increased Pulmonary Blood Flow
Assessment
- Monitor respiratory status for tachypnea, dyspnea, retractions, nasal flaring, or crackles.
- Observe for signs of heart failure: tachycardia, sweating, poor feeding, fluid retention weight gain.
- Assess oxygen saturation and provide supplemental oxygen as needed.
- Monitor for growth and development delays.
Interventions
- Provide respiratory support by maintaining a neutral thermal environment and positioning in a semi-Fowler’s or Fowler’s position.
- Optimize nutrition with small, frequent meals and high-calorie formulas, consider NG tube feeding.
- Monitor fluid balance and administer diuretics.
- Administer medications as ordered (diuretics, ACE inhibitors, digoxin).
- Prevent infection through hand hygiene and vaccinations, and prophylactic antibiotics.
Disorders with Obstruction to Blood Flow
- Includes pulmonary stenosis, aortic stenosis, and contraction of the aorta.
Pulmonary Stenosis
- Narrowing of the pulmonary valve or artery.
- Right ventricular hypertrophy results from the inability to evacuate blood.
Signs and Symptoms
- Asymptomatic in mild cases, cyanosis, heart murmur, chest pain, shortness of breath.
Treatment
- Balloon dilation or valvuloplasty.
- Valvotomy.
- Valvectomy.
- Pulmonary valve replacement.
Aortic Stenosis
- Narrowing of the aortic valve opening.
- Restricts blood flow from the left ventricle to the aorta.
Signs and Symptoms
- A rough systolic murmur heard loudest in the aortic space.
- Faint pulses, hypotension, tachycardia, inability to suck for long periods, chest pain.
Causes
- Congenital heart defect (bicuspid aortic valve).
- Calcium buildup on the valve.
- Rheumatic fever.
Diagnostics
- Chest X-ray.
- Echocardiogram.
- Electrocardiogram (EKG).
Management
- Beta-blockers or calcium channel blockers.
- Balloon valvuloplasty.
- Valvotomy.
- Aortic valve replacement (tissue or mechanical valves require lifelong anticoagulation if mechanical).
- Pulmonary autograft (Ross procedure).
- Aortic homograft.
Contraction of the Aorta
- Narrowing of the aorta, forcing the heart to pump harder.
- Leading cause of CHF in the first few months of life.
- Often occurs with other congenital heart defects.
Signs and Symptoms
- Absence of palpable femoral pulses.
- Absent brachial pulses (obstruction of subclavian artery).
- Leg cramps.
- Higher blood pressure in arms than legs (>20mmHg).
- Nosebleeds.
- Irritability.
Treatment
- Balloon dilation (angioplasty).
- Surgery (aortic anastomosis).
- Pre-op: Digoxin and diuretics.
Complications
- Hypertension.
- Heart Failure
- Poor Peripheral Perfusion
- Left Ventricular Hypertrophy (LVH)
- Aneurysm or Aortic Rupture
Nursing Management for Disorders with Obstruction to Blood Flow
Interventions
- Monitor respiratory status (tachypnea, dyspnea, cyanosis) administer oxygen cautiously if ductal-dependent.
- Monitor cardiac function (HR, BP in all extremities, pulses), assess for heart failure, and administer medications (Prostaglandin E1, diuretics, beta-blockers, ACE inhibitors).
- Manage fluid balance (I&O, daily weights) and restrict fluids and sodium if prescribed.
- Optimize nutrition with small, frequent, high-calorie feedings, consider NG tube if needed.
- Prevent & manage complications (monitor for hypertension, decreased perfusion).
- Pre- and postoperative care.
Disorders with Mixed Blood Flow
- Oxygenated and deoxygenated blood mix in the heart or great vessels.
Transposition of the Great Arteries (TGA)
- The main pulmonary artery and aorta are switched.
- Often occurs with ventricular and atrial septal defects.
Signs and Symptoms
- Cyanosis, breathing problems, pounding heart, weak pulse, poor feeding.
Management
- Arterial Switch Operation: restores normal blood flow.
Total Anomalous Pulmonary Venous Return (TAPVR)
- Pulmonary veins return to the right atrium or superior vena cava instead of the left atrium.
Signs and Symptoms
- Severely cyanotic, rapid breathing, grunting, retractions, poor feeding, extreme sleepiness.
Diagnosis
- Pulse oximetry.
- Chest X-ray: Enlargement of the right side, pulmonary edema.
- Echocardiogram.
Management
- Surgery: involves reimplanting pulmonary veins into the left atrium.
- Balloon atrial septal pull-through procedure (enlarge foramen ovale).
- Continuous IV infusion of PGE1 (keep ductus arteriosus open).
Truncus Arteriosus
- One major artery arises from both ventricles instead of separate aorta and pulmonary artery vessels.
- Usually with a VSD.
Signs and Symptoms
- Cyanosis and a VSD murmur.
Management
- Open-heart surgery: Repair of VSD, Rastelli Operation.
Hypoplastic Left Heart Syndrome (HLHS)
- The left side of the heart does not form correctly, and the left ventricle is nonfunctional.
Management
- Prostaglandin therapy to maintain PDA.
- Hole between atria to allow oxygen-rich blood flow.
- Three-stage surgical procedure: Norwood, Glenn, and Fontan.
Stages of Surgery
- Norwood Stage: Creates a pathway for blood flow to the body.
- Glenn Stage: Connects the superior vena cava to the pulmonary artery.
- Fontan Stage: Connects the inferior vena cava to the lung circulation.
Complications
- Easily tiring with exercise, blood clots, heart arrhythmias, cardiac failure.
Disorders with Decreased Pulmonary Blood Flow
- Obstruction to blood flow in the pulmonary artery.
- Pressure increases in the right side of the heart.
- Includes tricuspid atresia and Tetralogy of Fallot.
Tricuspid Atresia
- The tricuspid valve is completely closed, preventing blood flow from the right atrium to the right ventricle.
- Usually has a VSD.
Signs and Symptoms
- Extreme cyanosis, tachycardia, dyspnea, clubbing.
Management
- IV infusion of PGE1.
- Oxygenation.
- Mechanical ventilation.
- Surgery: Blalock-Taussig shunt, Hemi-Fontan/Glenn, Fontan.
Tetralogy of Fallot (TOF)
Signs and Symptoms
- High Degree of Cyanosis
- Polycythemia
- Severe Dyspnea, growth restriction
- Clubbing of the fingers
- Assuming a squatting or knee–chest position
Management
- Oxygen during cyanosis.
- Small frequent meals.
- Knee-chest position during "tet spells".
- Limit strenuous activities.
Surgical Management
-
Early corrective surgery to prevent growth and development Restriction
-
Temporary
- Blalock-Taussig Shunt
- Waterston Shunt
-
PERMANENT: Patch of VSD
Nursing Management
Assess and Monitor
- Respiratory status
- Oxygen saturation
- Heart rate, murmurs, and signs of heart failure
- Tet Spells (Hypercyanotic Episodes)
Intervene to Improve Oxygenation
- Positioning: Place the child in a knee-chest position during Tet spells
- Administer medications
Medications
- Prostaglandin E1 (PGE1)
- Beta-blockers
- Diuretics as needed
- Preventive nutritional support
Acquired Heart Diseases
Congestive Heart Failure (CHF)
- Inability of the heart to pump blood commensurate with the body's metabolic needs.
- Under 1 year old may result from a congenital disorder.
- A combination of inability to dispose of systemic or pulmonary venous return adequately.
- It means the heart can't maintain enough cardiac output.
Clinical Manifestations
- Systemic Venous Congestion: Weight gain, hepatomegaly, edema, jugular vein distension.
- Pulmonary Venous Congestion: Tachypnea, dyspnea, cough, wheezes.
- Compensatory Response: Tachycardia, cardiomegaly, diaphoresis, fatigue, failure to grow.
Assessment
- Clinical History NEONATES & INFANTS: Poor feeding, tachypnea during feeding, cold sweat on forehead, poor weight gain.
- Older Children: Fatigue, exercise intolerance, dyspnea, puffy eyes & pedal edema, growth failure.
Diagnostics
- Chest x-ray: cardiomegaly, pulmonary edema.
- ECG: Arrhythmias.
- Echocardiogram: Assesses heart chamber sizes, myocardial function, and diagnoses congenital heart defects.
Treatment
- Correct the underlying causes and focus on; diet, digitalis, diuretics & dialators.
- General care (rest, oxygenation, and small frequent meals.
- Sodium and fluid restriction.
Medications
- Diuretics: Furosemide, Spironolactone/Aldactone.
- Digitalis: Digoxin.
- Dilators: ACE inhibitors (Captopril).
Digoxin Therapy
- Increases myocardial contraction force.
- Check apical pulse for a full minute before each dose.
- Hold if; < 100 bpm for infant/toddler, < 80 bpm in older child, < 60 bpm in adolescent.
Digoxin Toxicity Signs
- Bradycardia, arrhythmia, nausea, vomiting, dizziness, headache, weakness, and fatigue.
Nursing Interventions
- Monitor respiratory distress and provide pulmonary hygiene.
- Monitor altered cardiac output and fluid status.
- Strict I&O, daily weights, assess for edema and severe diaphoresis, monitor electrolytes.
- Administer prescribed medication and prevent infection.
- Provide adequate nutrition, high-calorie and low-sodium as prescribed.
Kawasaki Disease
- Acute febrile, multisystem disorder in children before puberty.
- Leading cause of acquired heart disease in children.
- Peak incidence is in boys under 4 years.
- Unknown cause; Non-contagious.
- can lead to damage of the blood vessel walls creating Aneurysms
Phases
- Acute Phase: High fever, lethargy, irritability, reddened/swollen hands and feet, conjunctivitis, strawberry tongue, cracked lips, enlarged lymph nodes, abdominal pain.
- Subacute Phase: Skin desquamation palms/soles, thrombocytosis, highest risk of sudden death if aneurysms develop.
- Convalescent Phase: Clinical signs disappear around day 25, lasting until day 40.
Management
- Acute Stage: IVIG and Aspirin until the patient is afebrile for at least 48 hrs.
- Convalescent Stage: Aspirin once daily orally until 6-8 wk after illness onset if normal coronary findings throughout course
- Monitor pain and cardiac monitoring.
- Monitor I&O hydration status.
- Plan for rest and activities.
- Oral care with cool liquids and soft, bland foods.
Endocarditis
- Inflammation and infection of the endocardium or heart valves.
- Caused by streptococci.
Diagnosis
- Echocardiogram (ECHO).
- Blood cultures.
- ESR and C-reactive protein can be increased in inflammatory states.
Major Criteria
- Typical microorganism from two blood cultures
- Evidence of vegetation
Minor Criteria
- Have predisposing condition
- Fever >38
- Vascular phenomena
- Immunological phenomena
- Microbiologic evidence
Management
- Goal to minimize complications and Systemic embolization
- Antibiotic Therapy:
- Surgery (Repair or replacement of a heart valve).
Complications:
- Heart failure, abscess in the heart/brain, stroke, heart rhythm problems.
Nursing Management
- Assess Heart Sounds
- Assess and address Oral Hygiene
- Administer IV Antibiotics
- Administer and Monitor Anticoagulant Therapy
- Educate patient on s/s infection
Rheumatic Fever
- An autoimmune reaction to a group A beta-hemolytic streptococcal infection.
- Heart valve damage as a complication years after illness.
- Mostly in children 6-15 years.
Diagnostics
- Throat swabs to test for Group A streptococcus bacteria
- Blood tests for inflammation markers
- Electrocardiogram (ECG)
- Chest x-rays
Clinical Features
- Follow the Jones criteria
JONES CRITERIA
- Polyarthritis, Carditis, Chorea (Sydenham Disease), Erythema marginatum, Subcutaneous nodules
Treatment
- Elimination of streptococcal infection
- Reducing inflammation and symptoms
- Preventing future infections
Interventions
- Hospital admission & antibiotics
- Course of aspirin & Corticosteroids
- Long-term antibiotic treatment
Nursing Management
- Administer prescribed antibiotics
- Provide analgesics and anti-inflammatory medications
- Implement continuous cardiac monitoring
- Educate the patient and their family of antibiotic treatments
- Collaborate with physical therapists to care
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