Podcast
Questions and Answers
What are the two major groups of cardiovascular disorders in children?
What are the two major groups of cardiovascular disorders in children?
- Genetic heart disease and acquired heart abnormalities
- Inherited heart disease and acquired heart disorders
- Innate heart defects and acquired cardiac disorders
- Congenital heart disease and acquired heart disorders (correct)
What are the clinical consequences of congenital heart defects?
What are the clinical consequences of congenital heart defects?
- Valvular heart disease and endocarditis
- Arrhythmias and myocardial infarction
- Heart failure and hypoxemia (correct)
- Cardiomyopathy and pericarditis
What is an important first step in assessing an infant or child for possible heart disease?
What is an important first step in assessing an infant or child for possible heart disease?
- Monitoring blood pressure trends
- Conducting an MRI scan
- Taking an accurate health history (correct)
- Performing genetic testing
Which factor is mentioned as a cause of acquired cardiac disorders in children?
Which factor is mentioned as a cause of acquired cardiac disorders in children?
What type of electrodes are typically used for bedside cardiac monitoring in pediatric care?
What type of electrodes are typically used for bedside cardiac monitoring in pediatric care?
What is the purpose of alarms in bedside cardiac monitoring?
What is the purpose of alarms in bedside cardiac monitoring?
What is the primary purpose of echocardiography in pediatric care?
What is the primary purpose of echocardiography in pediatric care?
What is the purpose of fetal echocardiography?
What is the purpose of fetal echocardiography?
When is cardiac MRI used in pediatric care?
When is cardiac MRI used in pediatric care?
What is the purpose of cardiac catheterization?
What is the purpose of cardiac catheterization?
What are the types of cardiac catheterizations?
What are the types of cardiac catheterizations?
What are potential complications of cardiac catheterization?
What are potential complications of cardiac catheterization?
What is necessary before cardiac catheterization to minimize complications?
What is necessary before cardiac catheterization to minimize complications?
What are examples of interventional cardiac catheterization procedures?
What are examples of interventional cardiac catheterization procedures?
Which factor increases the risk of congenital heart defects during pregnancy?
Which factor increases the risk of congenital heart defects during pregnancy?
What is an important feature to assess during the physical assessment for suspected cardiac disease?
What is an important feature to assess during the physical assessment for suspected cardiac disease?
Which diagnostic procedure provides information on heart rate, rhythm, abnormal rhythms, and ischemic changes?
Which diagnostic procedure provides information on heart rate, rhythm, abnormal rhythms, and ischemic changes?
What can result in congenital anomalies if contracted early in pregnancy?
What can result in congenital anomalies if contracted early in pregnancy?
Which syndrome is hereditary and associated with congenital heart defects?
Which syndrome is hereditary and associated with congenital heart defects?
What may indicate heart disease in terms of family history?
What may indicate heart disease in terms of family history?
What is an important observation during the physical assessment for suspected cardiac disease?
What is an important observation during the physical assessment for suspected cardiac disease?
Which test helps discern heart size and characteristics associated with heart disease?
Which test helps discern heart size and characteristics associated with heart disease?
What is a noninvasive test for diagnosing heart disease?
What is a noninvasive test for diagnosing heart disease?
What does auscultation involve in terms of heart assessment?
What does auscultation involve in terms of heart assessment?
Which medication is teratogenic to the fetus?
Which medication is teratogenic to the fetus?
What is a risk factor for congenital heart defects in infants?
What is a risk factor for congenital heart defects in infants?
What directs the better-oxygenated blood from the right atrium to the left atrium in a fetus?
What directs the better-oxygenated blood from the right atrium to the left atrium in a fetus?
Where does the major portion of the blood pumped through the pulmonary artery in a fetus go?
Where does the major portion of the blood pumped through the pulmonary artery in a fetus go?
What causes greater pressures in the right side of the heart and the pulmonary arteries before birth?
What causes greater pressures in the right side of the heart and the pulmonary arteries before birth?
Where does the blood carrying oxygen and nutritive materials from the placenta enter the fetal system?
Where does the blood carrying oxygen and nutritive materials from the placenta enter the fetal system?
What is a potential later issue after surgical repair of patent ductus arteriosus (PDA)?
What is a potential later issue after surgical repair of patent ductus arteriosus (PDA)?
What is a potential complication of cardiac catheterization to occlude the PDA?
What is a potential complication of cardiac catheterization to occlude the PDA?
What can result in congenital anomalies if contracted early in pregnancy?
What can result in congenital anomalies if contracted early in pregnancy?
What is the most common technique for surgical repair of PDA in infants?
What is the most common technique for surgical repair of PDA in infants?
What is a potential risk factor that increases surgical risk for PDA closure?
What is a potential risk factor that increases surgical risk for PDA closure?
What is a potential complication of PDA closure in very preterm infants?
What is a potential complication of PDA closure in very preterm infants?
What is a potential consequence of congenital heart defects in infants?
What is a potential consequence of congenital heart defects in infants?
What is a potential palliative treatment for small infants with severe symptoms of PDA?
What is a potential palliative treatment for small infants with severe symptoms of PDA?
What is a potential nonsurgical treatment for PDA closure?
What is a potential nonsurgical treatment for PDA closure?
What is a potential consequence of cardiac output decrease in infants with congenital heart defects?
What is a potential consequence of cardiac output decrease in infants with congenital heart defects?
What is a potential later issue that may require valve replacement after PDA closure?
What is a potential later issue that may require valve replacement after PDA closure?
What is a potential complication of small PDAs in infants?
What is a potential complication of small PDAs in infants?
Which factor can cause anomalies resulting in cyanosis in congenital heart defects?
Which factor can cause anomalies resulting in cyanosis in congenital heart defects?
What is the primary effect of defects causing left-to-right shunts in congenital heart defects?
What is the primary effect of defects causing left-to-right shunts in congenital heart defects?
What is the primary classification system for congenital heart defects based on?
What is the primary classification system for congenital heart defects based on?
What are the patient risk factors for increased morbidity and mortality following surgical treatment of congenital heart defects?
What are the patient risk factors for increased morbidity and mortality following surgical treatment of congenital heart defects?
What has significantly improved surgical outcomes for congenital heart defects?
What has significantly improved surgical outcomes for congenital heart defects?
What is the survival rate of children with congenital heart defects to adulthood due to advances in treatment?
What is the survival rate of children with congenital heart defects to adulthood due to advances in treatment?
What is the primary effect of obstructive defects in congenital heart defects?
What is the primary effect of obstructive defects in congenital heart defects?
What do defects causing left-to-right shunts result in?
What do defects causing left-to-right shunts result in?
What is the primary effect of defects causing obstructive blood flow in congenital heart defects?
What is the primary effect of defects causing obstructive blood flow in congenital heart defects?
What is the primary effect of defects causing right-to-left shunts in congenital heart defects?
What is the primary effect of defects causing right-to-left shunts in congenital heart defects?
What is the primary effect of defects causing mixing of oxygenated and deoxygenated blood in the heart or arteries in congenital heart defects?
What is the primary effect of defects causing mixing of oxygenated and deoxygenated blood in the heart or arteries in congenital heart defects?
What is the primary classification system for congenital heart defects based on?
What is the primary classification system for congenital heart defects based on?
Which defect is associated with the most common cardiac defect in children with Down syndrome?
Which defect is associated with the most common cardiac defect in children with Down syndrome?
What is the primary cause of right ventricular hypertrophy in congenital heart defects?
What is the primary cause of right ventricular hypertrophy in congenital heart defects?
What is the characteristic murmur associated with Patent Ductus Arteriosus (PDA)?
What is the characteristic murmur associated with Patent Ductus Arteriosus (PDA)?
What is the surgical treatment option for PDA closure that involves using a device during cardiac catheterization?
What is the surgical treatment option for PDA closure that involves using a device during cardiac catheterization?
What is the primary consequence of left-to-right shunting in Patent Ductus Arteriosus (PDA)?
What is the primary consequence of left-to-right shunting in Patent Ductus Arteriosus (PDA)?
What is the potential medical management for Patent Ductus Arteriosus (PDA)?
What is the potential medical management for Patent Ductus Arteriosus (PDA)?
What is the primary risk for patients with untreated congenital heart defects?
What is the primary risk for patients with untreated congenital heart defects?
What determines the prognosis of congenital heart defects?
What determines the prognosis of congenital heart defects?
What is the primary surgical treatment option for Patent Ductus Arteriosus (PDA) closure?
What is the primary surgical treatment option for Patent Ductus Arteriosus (PDA) closure?
What is the primary consequence of Atrioventricular Canal Defect in children with Down syndrome?
What is the primary consequence of Atrioventricular Canal Defect in children with Down syndrome?
What are the potential atrial complications for patients with congenital heart defects?
What are the potential atrial complications for patients with congenital heart defects?
What is the nonsurgical treatment option for Patent Ductus Arteriosus (PDA) closure?
What is the nonsurgical treatment option for Patent Ductus Arteriosus (PDA) closure?
Which type of congenital heart defect involves blood meeting anatomical narrowing, causing pressure changes in the ventricle and great artery?
Which type of congenital heart defect involves blood meeting anatomical narrowing, causing pressure changes in the ventricle and great artery?
Which congenital heart defect leads to hypoxemia and cyanosis in infants and children?
Which congenital heart defect leads to hypoxemia and cyanosis in infants and children?
Which defect involves complex anomalies where survival depends on the mixing of blood from pulmonary and systemic circulations?
Which defect involves complex anomalies where survival depends on the mixing of blood from pulmonary and systemic circulations?
Which congenital heart defect causes blood to flow from the left to the right side of the heart?
Which congenital heart defect causes blood to flow from the left to the right side of the heart?
Which congenital heart defect involves increased right heart blood volume, leading to pulmonary blood flow at the expense of systemic blood flow?
Which congenital heart defect involves increased right heart blood volume, leading to pulmonary blood flow at the expense of systemic blood flow?
Which congenital heart defect involves decreased pulmonary blood flow due to obstruction and anatomical defects between the right and left sides of the heart?
Which congenital heart defect involves decreased pulmonary blood flow due to obstruction and anatomical defects between the right and left sides of the heart?
What is the primary consequence of left-to-right shunting in Patent Ductus Arteriosus (PDA)?
What is the primary consequence of left-to-right shunting in Patent Ductus Arteriosus (PDA)?
What is the primary effect of defects causing mixing of oxygenated and deoxygenated blood in the heart or arteries in congenital heart defects?
What is the primary effect of defects causing mixing of oxygenated and deoxygenated blood in the heart or arteries in congenital heart defects?
What are the two major groups of cardiovascular disorders in children?
What are the two major groups of cardiovascular disorders in children?
What is an important feature to assess during the physical assessment for suspected cardiac disease?
What is an important feature to assess during the physical assessment for suspected cardiac disease?
Which medication is used to improve contractility in heart failure?
Which medication is used to improve contractility in heart failure?
What is the primary purpose of the modified Fontan procedure?
What is the primary purpose of the modified Fontan procedure?
What is the recommended adjunct therapy for infants and children with heart failure, according to the Canadian Cardiovascular Society Guidelines?
What is the recommended adjunct therapy for infants and children with heart failure, according to the Canadian Cardiovascular Society Guidelines?
What is a potential long-term concern after the Fontan operation?
What is a potential long-term concern after the Fontan operation?
What is the primary consequence of defects causing right-to-left shunts in congenital heart defects?
What is the primary consequence of defects causing right-to-left shunts in congenital heart defects?
What is the primary surgical treatment option for Patent Ductus Arteriosus (PDA) closure?
What is the primary surgical treatment option for Patent Ductus Arteriosus (PDA) closure?
What is the primary effect of defects causing left-to-right shunts in congenital heart defects?
What is the primary effect of defects causing left-to-right shunts in congenital heart defects?
What is the primary long-term concern after the Fontan operation?
What is the primary long-term concern after the Fontan operation?
What is the primary classification system for congenital heart defects based on?
What is the primary classification system for congenital heart defects based on?
What is the primary consequence of left-to-right shunting in Patent Ductus Arteriosus (PDA)?
What is the primary consequence of left-to-right shunting in Patent Ductus Arteriosus (PDA)?
What is the primary effect of defects causing mixing of oxygenated and deoxygenated blood in the heart or arteries in congenital heart defects?
What is the primary effect of defects causing mixing of oxygenated and deoxygenated blood in the heart or arteries in congenital heart defects?
What is the potential risk factor that increases surgical risk for PDA closure?
What is the potential risk factor that increases surgical risk for PDA closure?
Which intervention is the primary choice for older infants and children with Coarctation of the Aorta?
Which intervention is the primary choice for older infants and children with Coarctation of the Aorta?
What is the mortality rate in patients with isolated Coarctation of the Aorta?
What is the mortality rate in patients with isolated Coarctation of the Aorta?
What are the clinical manifestations of Aortic Stenosis?
What are the clinical manifestations of Aortic Stenosis?
When is surgical repair the treatment of choice for Aortic Stenosis?
When is surgical repair the treatment of choice for Aortic Stenosis?
What is the mortality from surgical repairs of subvalvular Aortic Stenosis?
What is the mortality from surgical repairs of subvalvular Aortic Stenosis?
What does Pulmonic Stenosis cause?
What does Pulmonic Stenosis cause?
What are the signs of decreased cardiac output and poor feeding in newborns with critical Aortic Stenosis?
What are the signs of decreased cardiac output and poor feeding in newborns with critical Aortic Stenosis?
Why is aortic valvotomy rarely used for Aortic Stenosis?
Why is aortic valvotomy rarely used for Aortic Stenosis?
What is the primary consequence of Coarctation of the Aorta?
What is the primary consequence of Coarctation of the Aorta?
What is the primary consequence of Aortic Stenosis?
What is the primary consequence of Aortic Stenosis?
What causes resistance to ejection of blood from the right ventricle in Pulmonic Stenosis?
What causes resistance to ejection of blood from the right ventricle in Pulmonic Stenosis?
What is the characteristic murmur associated with Aortic Stenosis?
What is the characteristic murmur associated with Aortic Stenosis?
Which condition is the extreme form of Pulmonic Stenosis (PS) resulting in no blood flow to the lungs?
Which condition is the extreme form of Pulmonic Stenosis (PS) resulting in no blood flow to the lungs?
What is the primary aim of therapeutic management for heart failure (HF) in children?
What is the primary aim of therapeutic management for heart failure (HF) in children?
What is the treatment of choice for discrete Pulmonic Stenosis (PS) and can be done safely in newborns?
What is the treatment of choice for discrete Pulmonic Stenosis (PS) and can be done safely in newborns?
What is the most common complication of Pulmonic Stenosis (PS)?
What is the most common complication of Pulmonic Stenosis (PS)?
What is the first intervention for non-surgical treatment of Pulmonic Stenosis (PS)?
What is the first intervention for non-surgical treatment of Pulmonic Stenosis (PS)?
What is the primary cause of heart failure (HF) in children?
What is the primary cause of heart failure (HF) in children?
What is the primary surgical treatment option for Pulmonic Stenosis (PS) closure?
What is the primary surgical treatment option for Pulmonic Stenosis (PS) closure?
What is the primary aim of surgical treatment for Subvalvular Aortic Stenosis?
What is the primary aim of surgical treatment for Subvalvular Aortic Stenosis?
What is the primary aim of surgical repair for infants diagnosed with heart failure (HF) due to congenital heart defects?
What is the primary aim of surgical repair for infants diagnosed with heart failure (HF) due to congenital heart defects?
What is the primary treatment option for discrete Pulmonic Stenosis (PS) in newborns?
What is the primary treatment option for discrete Pulmonic Stenosis (PS) in newborns?
What is the primary aim of diagnostic evaluation for heart failure (HF) in children?
What is the primary aim of diagnostic evaluation for heart failure (HF) in children?
What is the primary aim of aortic valve replacement in Pulmonic Stenosis (PS)?
What is the primary aim of aortic valve replacement in Pulmonic Stenosis (PS)?
Which of the following is a surgical treatment option for Tetralogy of Fallot?
Which of the following is a surgical treatment option for Tetralogy of Fallot?
What is the most common cyanotic lesion among congenital heart diseases?
What is the most common cyanotic lesion among congenital heart diseases?
What is the primary consequence of Tricuspid Atresia?
What is the primary consequence of Tricuspid Atresia?
What is the characteristic acute condition experienced by infants with Tetralogy of Fallot?
What is the characteristic acute condition experienced by infants with Tetralogy of Fallot?
What is the operative mortality for total correction of Tetralogy of Fallot during the first 2 years of life?
What is the operative mortality for total correction of Tetralogy of Fallot during the first 2 years of life?
What is the palliative treatment for Tricuspid Atresia?
What is the palliative treatment for Tricuspid Atresia?
What may indicate Tricuspid Atresia in the newborn period?
What may indicate Tricuspid Atresia in the newborn period?
What is the primary therapeutic management for Tricuspid Atresia in newborns?
What is the primary therapeutic management for Tricuspid Atresia in newborns?
What is required for blood flow across the septum into the left atrium at birth?
What is required for blood flow across the septum into the left atrium at birth?
What allows blood flow to the pulmonary artery into the lungs for oxygenation?
What allows blood flow to the pulmonary artery into the lungs for oxygenation?
What is the primary nonsurgical treatment option for Tricuspid Atresia closure?
What is the primary nonsurgical treatment option for Tricuspid Atresia closure?
What is the primary classification of congenital heart defects based on the provided information?
What is the primary classification of congenital heart defects based on the provided information?
Which defect is associated with transposition of the great arteries (TGA)?
Which defect is associated with transposition of the great arteries (TGA)?
What is the consequence of a ventricular septal defect (VSD) in congenital heart defects?
What is the consequence of a ventricular septal defect (VSD) in congenital heart defects?
In which defect do the pulmonary veins fail to join the left atrium?
In which defect do the pulmonary veins fail to join the left atrium?
What is the most common defect associated with the mixing of saturated and desaturated blood?
What is the most common defect associated with the mixing of saturated and desaturated blood?
Which congenital heart defect involves underdevelopment of the left side of the heart?
Which congenital heart defect involves underdevelopment of the left side of the heart?
What is the primary surgical treatment option for Patent Ductus Arteriosus (PDA) closure?
What is the primary surgical treatment option for Patent Ductus Arteriosus (PDA) closure?
What is the mortality rate for truncus arteriosus?
What is the mortality rate for truncus arteriosus?
What is a potential long-term issue with repair for hypoplastic left heart syndrome?
What is a potential long-term issue with repair for hypoplastic left heart syndrome?
What is the first stage of the surgical treatment for truncus arteriosus?
What is the first stage of the surgical treatment for truncus arteriosus?
What is a potential risk of heart transplantation in the newborn period for infants with hypoplastic left heart syndrome?
What is a potential risk of heart transplantation in the newborn period for infants with hypoplastic left heart syndrome?
What determines the amount of blood flow to pulmonary and systemic circulations in truncus arteriosus?
What determines the amount of blood flow to pulmonary and systemic circulations in truncus arteriosus?
What is a potential postoperative complication for truncus arteriosus?
What is a potential postoperative complication for truncus arteriosus?
What is the final repair stage in the surgical treatment for hypoplastic left heart syndrome?
What is the final repair stage in the surgical treatment for hypoplastic left heart syndrome?
What is a potential consequence of truncus arteriosus?
What is a potential consequence of truncus arteriosus?
What is a potential complication of surgical repair for truncus arteriosus?
What is a potential complication of surgical repair for truncus arteriosus?
What is the primary consequence of hypoplastic left heart syndrome?
What is the primary consequence of hypoplastic left heart syndrome?
Which surgical procedure involves closure of the VSD with a baffle and placement of a conduit?
Which surgical procedure involves closure of the VSD with a baffle and placement of a conduit?
What is the primary aim of the arterial switch procedure?
What is the primary aim of the arterial switch procedure?
What is the potential complication of the arterial switch procedure?
What is the potential complication of the arterial switch procedure?
What is the characteristic feature of infradiaphragmatic TAPVC?
What is the characteristic feature of infradiaphragmatic TAPVC?
What is the primary surgical treatment for mixed defects?
What is the primary surgical treatment for mixed defects?
What is the potential postoperative complication of surgical treatment for mixed defects?
What is the potential postoperative complication of surgical treatment for mixed defects?
What is the characteristic symptom of infants with mixed defects?
What is the characteristic symptom of infants with mixed defects?
What is the primary therapeutic management for infants with mixed defects?
What is the primary therapeutic management for infants with mixed defects?
What is the characteristic of the arterial switch procedure?
What is the characteristic of the arterial switch procedure?
What is the surgical treatment option for total anomalous pulmonary venous connection (TAPVC)?
What is the surgical treatment option for total anomalous pulmonary venous connection (TAPVC)?
What is the characteristic of infants with infradiaphragmatic TAPVC?
What is the characteristic of infants with infradiaphragmatic TAPVC?
What is the characteristic of the Rastelli procedure?
What is the characteristic of the Rastelli procedure?
Which medication is used to reduce aldosterone secretion in pediatric heart failure?
Which medication is used to reduce aldosterone secretion in pediatric heart failure?
What type of therapy using biventricular pacing is being applied to pediatric patients with heart failure?
What type of therapy using biventricular pacing is being applied to pediatric patients with heart failure?
Which measure is used to remove excess fluid and sodium in pediatric heart failure treatment?
Which measure is used to remove excess fluid and sodium in pediatric heart failure treatment?
What should be monitored carefully due to its effect on digoxin toxicity in pediatric heart failure?
What should be monitored carefully due to its effect on digoxin toxicity in pediatric heart failure?
Which measure may be necessary in acute heart failure stages, especially in cyanotic CHD and polycythemia cases?
Which measure may be necessary in acute heart failure stages, especially in cyanotic CHD and polycythemia cases?
What is the primary aim of providing a neutral thermal environment in pediatric heart failure management?
What is the primary aim of providing a neutral thermal environment in pediatric heart failure management?
What is the primary aim of measures to improve tissue oxygenation in pediatric heart failure management?
What is the primary aim of measures to improve tissue oxygenation in pediatric heart failure management?
What is crucial in reducing cardiac demands, providing emotional support, and assisting in measures to improve cardiac function in pediatric heart failure management?
What is crucial in reducing cardiac demands, providing emotional support, and assisting in measures to improve cardiac function in pediatric heart failure management?
What are the clinical manifestations of heart failure in pediatric patients?
What are the clinical manifestations of heart failure in pediatric patients?
Which medication is used to decrease cardiac demands in some children with chronic heart failure?
Which medication is used to decrease cardiac demands in some children with chronic heart failure?
What is used to improve tissue oxygenation in pediatric heart failure management?
What is used to improve tissue oxygenation in pediatric heart failure management?
Which medication is used to reduce aldosterone secretion in pediatric heart failure?
Which medication is used to reduce aldosterone secretion in pediatric heart failure?
Which medication for afterload reduction requires close monitoring of blood pressure and symptoms of hypotension in pediatric heart failure management?
Which medication for afterload reduction requires close monitoring of blood pressure and symptoms of hypotension in pediatric heart failure management?
What is the primary purpose of ECG monitoring in pediatric heart failure management?
What is the primary purpose of ECG monitoring in pediatric heart failure management?
What is the primary reason for educating parents about signs of digoxin toxicity in pediatric heart failure management?
What is the primary reason for educating parents about signs of digoxin toxicity in pediatric heart failure management?
What is the primary purpose of careful assessment of serum electrolytes and renal function in children taking multiple diuretics and an ACE inhibitor?
What is the primary purpose of careful assessment of serum electrolytes and renal function in children taking multiple diuretics and an ACE inhibitor?
What is the primary purpose of encouraging parents to provide comforting activities for infants with heart failure?
What is the primary purpose of encouraging parents to provide comforting activities for infants with heart failure?
What is the primary reason for planning feeding based on the infant's hunger signs in pediatric heart failure management?
What is the primary reason for planning feeding based on the infant's hunger signs in pediatric heart failure management?
What is the primary purpose of explaining the illness and treatments to older children in pediatric heart failure management?
What is the primary purpose of explaining the illness and treatments to older children in pediatric heart failure management?
What is the primary reason for carefully monitoring body temperature in children receiving cool, humidified oxygen in pediatric heart failure management?
What is the primary reason for carefully monitoring body temperature in children receiving cool, humidified oxygen in pediatric heart failure management?
What is the primary reason for preventing skin breakdown from edema in pediatric heart failure management?
What is the primary reason for preventing skin breakdown from edema in pediatric heart failure management?
What is the primary reason for reducing respiratory distress through careful assessment, positioning, and oxygen administration in pediatric heart failure management?
What is the primary reason for reducing respiratory distress through careful assessment, positioning, and oxygen administration in pediatric heart failure management?
What is the primary reason for requiring rest and energy conservation for feeding in infants with heart failure?
What is the primary reason for requiring rest and energy conservation for feeding in infants with heart failure?
What is the primary reason for carefully calculating and measuring digoxin dosage in pediatric heart failure management?
What is the primary reason for carefully calculating and measuring digoxin dosage in pediatric heart failure management?
What is the recommended feeding schedule for many infants with serious CHD?
What is the recommended feeding schedule for many infants with serious CHD?
What is the recommended feeding goal for newborns with significant heart disease in terms of caloric intake?
What is the recommended feeding goal for newborns with significant heart disease in terms of caloric intake?
What is the purpose of using a soft preemie nipple or a slit in a regular nipple for infants with serious CHD?
What is the purpose of using a soft preemie nipple or a slit in a regular nipple for infants with serious CHD?
What is the reason for feeding the infant soon after awakening in pediatric heart failure management?
What is the reason for feeding the infant soon after awakening in pediatric heart failure management?
What is the recommended approach for discussing information about congenital heart defects with preschoolers?
What is the recommended approach for discussing information about congenital heart defects with preschoolers?
What is the recommended level of information for school-age children regarding their heart defect?
What is the recommended level of information for school-age children regarding their heart defect?
What is the recommended approach for discussing information about congenital heart defects with preadolescents and adolescents?
What is the recommended approach for discussing information about congenital heart defects with preadolescents and adolescents?
Which factor can indicate the presence of hypercyanotic spells in infants?
Which factor can indicate the presence of hypercyanotic spells in infants?
What is the primary purpose of placing the infant in the knee–chest position during a hypercyanotic spell?
What is the primary purpose of placing the infant in the knee–chest position during a hypercyanotic spell?
What is the proposed mechanism in tetralogy of Fallot leading to hypercyanotic spells?
What is the proposed mechanism in tetralogy of Fallot leading to hypercyanotic spells?
What is the diagnostic significance of a PaO2 lower than 100 mm Hg during a hyperoxia test?
What is the diagnostic significance of a PaO2 lower than 100 mm Hg during a hyperoxia test?
What is the primary purpose of administering Prostaglandin E1 to newborns with ductus-dependent cardiac defects?
What is the primary purpose of administering Prostaglandin E1 to newborns with ductus-dependent cardiac defects?
What is the primary purpose of using the knee–chest position during a hypercyanotic spell?
What is the primary purpose of using the knee–chest position during a hypercyanotic spell?
What is the primary purpose of administering morphine during a hypercyanotic spell?
What is the primary purpose of administering morphine during a hypercyanotic spell?
What is the primary purpose of administering IV fluid replacement and volume expansion during a hypercyanotic spell?
What is the primary purpose of administering IV fluid replacement and volume expansion during a hypercyanotic spell?
What is the primary purpose of administering iron supplementation and blood transfusion to cyanotic infants?
What is the primary purpose of administering iron supplementation and blood transfusion to cyanotic infants?
What is the primary purpose of aggressive pulmonary hygiene and chest physiotherapy in cyanotic children?
What is the primary purpose of aggressive pulmonary hygiene and chest physiotherapy in cyanotic children?
What is the primary purpose of administering antibiotics to cyanotic children?
What is the primary purpose of administering antibiotics to cyanotic children?
What is the primary purpose of administering IV fluids and volume expansion during a hypercyanotic spell?
What is the primary purpose of administering IV fluids and volume expansion during a hypercyanotic spell?
What is the recommended position for feeding infants with heart failure?
What is the recommended position for feeding infants with heart failure?
What may be needed for adequate nutrition in some infants with severe heart failure and neurological deficits?
What may be needed for adequate nutrition in some infants with severe heart failure and neurological deficits?
How is formulas' caloric density frequently increased to enhance calorie intake?
How is formulas' caloric density frequently increased to enhance calorie intake?
What can breastfeeding parents do to increase caloric intake for infants with heart failure?
What can breastfeeding parents do to increase caloric intake for infants with heart failure?
Who should calculate and prescribe a diet plan specific to the individual infant’s needs?
Who should calculate and prescribe a diet plan specific to the individual infant’s needs?
What should be monitored and evaluated daily in infants taking diuretics?
What should be monitored and evaluated daily in infants taking diuretics?
What does hypoxemia refer to in the context of pediatric heart failure?
What does hypoxemia refer to in the context of pediatric heart failure?
When is fluid restriction rarely necessary in infants with heart failure?
When is fluid restriction rarely necessary in infants with heart failure?
What occurs when arterial oxygen saturations are below 80 to 85% in infants with heart failure?
What occurs when arterial oxygen saturations are below 80 to 85% in infants with heart failure?
What physiological changes can chronic hypoxemia lead to over time in infants with heart failure?
What physiological changes can chronic hypoxemia lead to over time in infants with heart failure?
What may result from defects causing hypoxemia and cyanosis in infants with heart failure?
What may result from defects causing hypoxemia and cyanosis in infants with heart failure?
What is the primary aim of providing a half-hour feeding time for infants with heart failure?
What is the primary aim of providing a half-hour feeding time for infants with heart failure?
What is the primary purpose of the Bidirectional Glenn shunt?
What is the primary purpose of the Bidirectional Glenn shunt?
What is the unique concern for infants and children with significant cyanosis?
What is the unique concern for infants and children with significant cyanosis?
What is the primary route for the Central shunt?
What is the primary route for the Central shunt?
What is the potential consequence of intracardiac shunting of blood and air embolism risks?
What is the potential consequence of intracardiac shunting of blood and air embolism risks?
What is the primary concern for infants with compromised pulmonary function?
What is the primary concern for infants with compromised pulmonary function?
What is the potential consequence of excessive shunt flow and thrombosis in Modified Blalock-Taussig shunt?
What is the potential consequence of excessive shunt flow and thrombosis in Modified Blalock-Taussig shunt?
What is the primary consideration for parents in preventing dehydration in hypoxemic children?
What is the primary consideration for parents in preventing dehydration in hypoxemic children?
What is the primary purpose of the Sano modification in the Norwood procedure?
What is the primary purpose of the Sano modification in the Norwood procedure?
What is the primary aim of monitoring fluid status in hypoxemic children?
What is the primary aim of monitoring fluid status in hypoxemic children?
What is the potential consequence of a shunt procedure that is easy to ligate at time of definitive correction?
What is the potential consequence of a shunt procedure that is easy to ligate at time of definitive correction?
What is the primary concern for children with significant cyanosis and parental fears?
What is the primary concern for children with significant cyanosis and parental fears?
What is the potential consequence of a Central shunt being uncommon and used when Modified Blalock-Taussig shunt cannot be used?
What is the potential consequence of a Central shunt being uncommon and used when Modified Blalock-Taussig shunt cannot be used?
What is a potential consequence of overdependency of a child with congenital heart defects on their parents?
What is a potential consequence of overdependency of a child with congenital heart defects on their parents?
What is a crucial factor for parents to consider when seeking information about heart disease in children?
What is a crucial factor for parents to consider when seeking information about heart disease in children?
What is a potential consequence of neglect and resentment in fathers and siblings of a child with a serious heart defect?
What is a potential consequence of neglect and resentment in fathers and siblings of a child with a serious heart defect?
What is a recommended approach for parents to help their child with congenital heart defects adjust to daily stresses?
What is a recommended approach for parents to help their child with congenital heart defects adjust to daily stresses?
What is the primary consequence of parental fear of the child's mortality in the context of congenital heart defects?
What is the primary consequence of parental fear of the child's mortality in the context of congenital heart defects?
What is a potential consequence of leaving the child in another's care for parents of a child with congenital heart defects?
What is a potential consequence of leaving the child in another's care for parents of a child with congenital heart defects?
What is the impact of a child with a serious heart defect on all family members, according to the text?
What is the impact of a child with a serious heart defect on all family members, according to the text?
What is the recommended way for health care providers to support parental understanding of the condition of their child with congenital heart defects?
What is the recommended way for health care providers to support parental understanding of the condition of their child with congenital heart defects?
What is the primary aim of introducing families to others with similarly affected children?
What is the primary aim of introducing families to others with similarly affected children?
What is a potential consequence of the unremitting stresses of care for a child with congenital heart defects?
What is a potential consequence of the unremitting stresses of care for a child with congenital heart defects?
What is a crucial factor for parents to realize when seeking information about congenital heart defects?
What is a crucial factor for parents to realize when seeking information about congenital heart defects?
What is the primary focus of parents managing their child's illness at home?
What is the primary focus of parents managing their child's illness at home?
What is essential for successful relationships between parents and caregivers in managing a child's illness?
What is essential for successful relationships between parents and caregivers in managing a child's illness?
As children reach adolescence, what role do they begin to take in managing their illness?
As children reach adolescence, what role do they begin to take in managing their illness?
What should parents of children who may develop heart failure be familiar with?
What should parents of children who may develop heart failure be familiar with?
What is the recommended timing to reinitiate enteral fluids after extubation for children post-heart surgery?
What is the recommended timing to reinitiate enteral fluids after extubation for children post-heart surgery?
What is the primary purpose of daily weight monitoring for children post-heart surgery?
What is the primary purpose of daily weight monitoring for children post-heart surgery?
What is the primary concern for pain management in children post-heart surgery with different incisions?
What is the primary concern for pain management in children post-heart surgery with different incisions?
What is the primary aim of using nonpharmacological measures for pain management in children post-heart surgery?
What is the primary aim of using nonpharmacological measures for pain management in children post-heart surgery?
What is a potential emotional effect on children after heart surgery?
What is a potential emotional effect on children after heart surgery?
What is the primary role of nurses in supporting parents of children post-heart surgery?
What is the primary role of nurses in supporting parents of children post-heart surgery?
What is the primary reason for the presence of parents being crucial in post-heart surgery care for children?
What is the primary reason for the presence of parents being crucial in post-heart surgery care for children?
What is the primary purpose of progressive ambulation and activity schedules for children post-heart surgery?
What is the primary purpose of progressive ambulation and activity schedules for children post-heart surgery?
What is the primary reason for restricting fluids postoperatively for children after heart surgery?
What is the primary reason for restricting fluids postoperatively for children after heart surgery?
What is the primary purpose of rest post-heart surgery for children?
What is the primary purpose of rest post-heart surgery for children?
What is the primary concern for children post-heart surgery in terms of emotional support and pain management?
What is the primary concern for children post-heart surgery in terms of emotional support and pain management?
What is the recommended approach to pain management for children post-heart surgery with different incisions?
What is the recommended approach to pain management for children post-heart surgery with different incisions?
Which of the following is a recommended coping strategy for young children undergoing medical procedures?
Which of the following is a recommended coping strategy for young children undergoing medical procedures?
What is the primary purpose of including parents in the preparation session for a child's medical procedure?
What is the primary purpose of including parents in the preparation session for a child's medical procedure?
When is preoperative preparation most beneficial for young children?
When is preoperative preparation most beneficial for young children?
What should be explained to children regarding sensory experiences in the CCU or catheterization laboratory?
What should be explained to children regarding sensory experiences in the CCU or catheterization laboratory?
What is essential for post-catheterization recovery topics?
What is essential for post-catheterization recovery topics?
What is the primary purpose of specific information tailored to the planned procedure for each patient?
What is the primary purpose of specific information tailored to the planned procedure for each patient?
What is the recommended coping strategy for older children undergoing medical procedures?
What is the recommended coping strategy for older children undergoing medical procedures?
When may patients being sedated during catheterization or receiving opioid pain relievers not need detailed information about equipment or procedures?
When may patients being sedated during catheterization or receiving opioid pain relievers not need detailed information about equipment or procedures?
What should be emphasized when describing familiar and new equipment in the environment to children?
What should be emphasized when describing familiar and new equipment in the environment to children?
What is the primary aim of simple coping strategies for painful procedures?
What is the primary aim of simple coping strategies for painful procedures?
What should children and their families have a choice about in relation to the CCU environment?
What should children and their families have a choice about in relation to the CCU environment?
What should be prevented in relation to the child's experience in the unit?
What should be prevented in relation to the child's experience in the unit?
What is the primary purpose of chest tube insertion in pediatric cardiac surgery patients?
What is the primary purpose of chest tube insertion in pediatric cardiac surgery patients?
What is the potential risk factor for renal failure in pediatric cardiac surgery patients?
What is the potential risk factor for renal failure in pediatric cardiac surgery patients?
What is the recommended frequency for checking drainage from chest tubes in pediatric cardiac surgery patients?
What is the recommended frequency for checking drainage from chest tubes in pediatric cardiac surgery patients?
What is the primary aim of assessing specific gravity of urine in pediatric cardiac surgery patients?
What is the primary aim of assessing specific gravity of urine in pediatric cardiac surgery patients?
What is the potential consequence of excessive drainage from chest tubes in pediatric cardiac surgery patients?
What is the potential consequence of excessive drainage from chest tubes in pediatric cardiac surgery patients?
What is the primary purpose of administering supplemental oxygen before and after suctioning in pediatric cardiac surgery patients?
What is the primary purpose of administering supplemental oxygen before and after suctioning in pediatric cardiac surgery patients?
What is the potential risk associated with vagal stimulation during suctioning in pediatric cardiac surgery patients?
What is the potential risk associated with vagal stimulation during suctioning in pediatric cardiac surgery patients?
What is the primary role of intracardiac monitoring lines in pediatric cardiac surgery patients?
What is the primary role of intracardiac monitoring lines in pediatric cardiac surgery patients?
What is the potential complication associated with leaving chest tubes in place for an extended period in pediatric cardiac surgery patients?
What is the potential complication associated with leaving chest tubes in place for an extended period in pediatric cardiac surgery patients?
What is the primary purpose of assessing intake and output of fluids in pediatric cardiac surgery patients?
What is the primary purpose of assessing intake and output of fluids in pediatric cardiac surgery patients?
What is the potential consequence of excessive drainage from chest tubes in pediatric cardiac surgery patients?
What is the potential consequence of excessive drainage from chest tubes in pediatric cardiac surgery patients?
What is the primary purpose of assessing for signs of renal failure in pediatric cardiac surgery patients?
What is the primary purpose of assessing for signs of renal failure in pediatric cardiac surgery patients?
What is a critical role of medications in managing cardiac conditions such as dysrhythmias and severe heart failure?
What is a critical role of medications in managing cardiac conditions such as dysrhythmias and severe heart failure?
What is the primary consideration for physical activity in children with congenital heart disease (CHD)?
What is the primary consideration for physical activity in children with congenital heart disease (CHD)?
What is an important intervention for infants with heart disease in terms of nutrition?
What is an important intervention for infants with heart disease in terms of nutrition?
What is a potential risk factor for developmental delays in infants and children with serious heart disease?
What is a potential risk factor for developmental delays in infants and children with serious heart disease?
What should be monitored in patients who have undergone surgery entailing cardiopulmonary bypass, especially in the newborn period?
What should be monitored in patients who have undergone surgery entailing cardiopulmonary bypass, especially in the newborn period?
What may improve outcomes in the future for infant surgery involving deep hypothermic circulatory arrest?
What may improve outcomes in the future for infant surgery involving deep hypothermic circulatory arrest?
What is an important factor to consider in planning preparation strategies for invasive procedures in children?
What is an important factor to consider in planning preparation strategies for invasive procedures in children?
What is a common practice for preoperative workups for most elective procedures in children with congenital heart disease?
What is a common practice for preoperative workups for most elective procedures in children with congenital heart disease?
What is a primary goal of preparing children for invasive procedures?
What is a primary goal of preparing children for invasive procedures?
What is an important consideration for outpatient preoperative workups for children with congenital heart disease?
What is an important consideration for outpatient preoperative workups for children with congenital heart disease?
What is the primary goal of Pediatric Early Warning Signs (PEWS)?
What is the primary goal of Pediatric Early Warning Signs (PEWS)?
Who developed the first PEWS based on MEWS, interviews with pediatric nurses, and observation of pediatric patients?
Who developed the first PEWS based on MEWS, interviews with pediatric nurses, and observation of pediatric patients?
What is the main purpose of the Pediatric Intensive Care Unit (PICU)?
What is the main purpose of the Pediatric Intensive Care Unit (PICU)?
What is the significance of PEWS in pediatric patient care?
What is the significance of PEWS in pediatric patient care?
Which is the most accurate method for measuring heart rate in children?
Which is the most accurate method for measuring heart rate in children?
What is the preferred method for measuring a child’s respiratory rate?
What is the preferred method for measuring a child’s respiratory rate?
How is the size of the blood pressure cuff determined for a child?
How is the size of the blood pressure cuff determined for a child?
At what temperature is a fever considered for a child from birth until adolescence?
At what temperature is a fever considered for a child from birth until adolescence?
At what temperature is a fever considered for a child if taken rectally?
At what temperature is a fever considered for a child if taken rectally?
What temperature range is considered a mild fever for a child?
What temperature range is considered a mild fever for a child?
When is a fever in a 3-month-old infant considered significant?
When is a fever in a 3-month-old infant considered significant?
What is the most accurate method for measuring a child's temperature?
What is the most accurate method for measuring a child's temperature?
What was the primary purpose of the Modified Early Warning System (MEWS) in pediatric critical care?
What was the primary purpose of the Modified Early Warning System (MEWS) in pediatric critical care?
What is the primary purpose of the pediatric early warning score (PEWS) in pediatric care?
What is the primary purpose of the pediatric early warning score (PEWS) in pediatric care?
Why should temperature be taken via rectum for children under the age of three?
Why should temperature be taken via rectum for children under the age of three?
In what order should vital signs be taken in infants for best results?
In what order should vital signs be taken in infants for best results?
What has PEWS shown to decrease and improve in pediatric care?
What has PEWS shown to decrease and improve in pediatric care?
Why can adult parameters not be directly applied to pediatric patients?
Why can adult parameters not be directly applied to pediatric patients?
What was the primary cause of pediatric cardiac arrests according to the provided information?
What was the primary cause of pediatric cardiac arrests according to the provided information?
What is the primary aim of the development of pediatric critical care and the early warning system?
What is the primary aim of the development of pediatric critical care and the early warning system?
Why do vital parameters in pediatric patients vary by age group?
Why do vital parameters in pediatric patients vary by age group?
What has PEWS shown to improve in pediatric care?
What has PEWS shown to improve in pediatric care?
What is the consequence of excessive drainage from chest tubes in pediatric cardiac surgery patients?
What is the consequence of excessive drainage from chest tubes in pediatric cardiac surgery patients?
What should be the primary focus when taking vital signs in infants?
What should be the primary focus when taking vital signs in infants?
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Study Notes
Congenital Heart Defects and Diagnostic Evaluation
- Some medications like phenytoin are teratogenic to the fetus, while alcohol and illicit drug use during pregnancy increase the risk of congenital heart defects.
- Infections like rubella early in pregnancy can result in congenital anomalies, while low birth weight and high birth weight infants are more likely to have heart disease.
- Detailed family history is important as there is an increased incidence of congenital cardiac defects with a family history of heart defects or certain diseases.
- Syndromes like Marfan and cardiomyopathies are hereditary, and a family history of fetal loss or sudden death may indicate heart disease.
- Many syndromes like Down and Turner syndromes are associated with congenital heart defects.
- Physical assessment for suspected cardiac disease starts with general observation and proceeds with specific observations.
- Nutritional state, color, chest deformities, unusual pulsations, respiratory excursion, and finger clubbing are important features to assess.
- Palpation and percussion help discern heart size and characteristics associated with heart disease, and may reveal hepatomegaly or splenomegaly.
- Auscultation involves listening for heart rate and rhythm, character of heart sounds, murmurs, and additional heart sounds.
- Diagnostic evaluation for heart disease includes invasive and noninvasive tests such as chest radiograph, electrocardiography, echocardiography, and cardiac catheterization.
- Other diagnostic procedures include hemodynamics, angiography, biopsy, electrophysiology, exercise stress test, and cardiac magnetic resonance imaging.
- Electrocardiography measures electrical activity of the heart, providing information on heart rate, rhythm, abnormal rhythms, ischemic changes, and other details, and takes about 15 minutes to perform.
Congenital Heart Defects and Hemodynamics
- At birth, the fetal vascular system undergoes significant changes due to the cessation of placental blood flow and lung expansion.
- The physiology of heart defects is affected by pressure gradients, flow, and resistance within the circulation.
- Abnormal connections between heart chambers can cause left-to-right shunts, leading to blood flow from higher to lower pressure areas.
- Anomalies resulting in cyanosis can occur due to a change in pressure, causing right-to-left shunts or mixing of oxygenated and deoxygenated blood in the heart or arteries.
- There are two classification systems for congenital heart defects: based on cyanosis and hemodynamic characteristics.
- The hemodynamic classification system categorizes defects based on blood flow patterns within the heart, leading to more uniform and predictable clinical manifestations.
- Defects causing left-to-right shunts result in increased pulmonary blood flow and heart failure, while obstructive defects can cause cyanosis or heart failure.
- The text provides a list of specific congenital heart defects, including atrial septal defect, ventricular septal defect, and others, outlining their effects on blood flow and clinical presentation.
- Patient risk factors for increased morbidity and mortality following surgical treatment of congenital heart defects include prematurity, low birth weight, genetic syndromes, and age at the time of surgery.
- Surgical outcomes for congenital heart defects have steadily improved, with mortality rates for severe defects below 10%, and decreased incidence of complications and hospital stays.
- Advances in treatment have significantly improved survival rates, with 9 out of 10 children with congenital heart defects surviving to adulthood.
- Specific defects with increased pulmonary blood flow are outlined, along with their clinical presentation and management.
Types of Congenital Heart Defects and their Hemodynamic and Clinical Manifestations
- Intracardiac communications or abnormal connections between great arteries cause blood to flow from left to right side of the heart
- Increased right heart blood volume increases pulmonary blood flow at the expense of systemic blood flow
- Patients exhibit signs and symptoms of heart failure
- Atrial septal defect (ASD), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) are typical anomalies in this group
- Obstructive defects involve blood meeting anatomical narrowing, causing pressure changes in the ventricle and great artery
- Valvular, subvalvular, and supravalvular obstructions are common in this group
- Coarctation of the aorta, aortic stenosis, and pulmonic stenosis are typical defects in this group
- Infants and children exhibit signs of heart failure due to pressure load on the ventricle and decreased cardiac output
- Defects with decreased pulmonary blood flow involve obstruction and anatomical defects between right and left sides of the heart
- Tetralogy of Fallot and tricuspid atresia are common defects in this group, leading to hypoxemia and cyanosis
- Mixed defects involve complex anomalies where survival depends on the mixing of blood from pulmonary and systemic circulations
- Fully saturated systemic blood flow mixes with desaturated pulmonary blood flow, causing relative desaturation and pulmonary congestion
Pediatric Pulmonic Stenosis and Heart Failure
- Pulmonic stenosis (PS) causes resistance to blood flow leading to right ventricular hypertrophy and decreased pulmonary blood flow
- Pulmonary atresia is the extreme form of PS where no blood flows to the lungs
- Aortic valve replacement is a good treatment option for PS, with approximately 25% of patients requiring additional surgery within 10 years for recurrent stenosis
- Complications of PS include aortic insufficiency, tearing of valve leaflets, and systemic cyanosis
- Non-surgical treatment includes balloon angioplasty, usually the first intervention, while surgical treatment may involve incising a membrane or cutting the fibromuscular ring
- Subvalvular aortic stenosis may be treated surgically by incising a membrane or cutting the fibromuscular ring, and may require a patch to enlarge the left ventricular outflow tract and annulus
- Balloon angioplasty is the treatment of choice for discrete PS and can be done safely in newborns
- Heart failure (HF) in children can be caused by congenital heart defects (CHD) and may present with impaired myocardial function, pulmonary congestion, and systemic venous congestion
- Diagnostic evaluation for HF includes clinical symptoms, chest X-ray, ECG, and echocardiogram
- Therapeutic management for HF aims to improve cardiac function, remove accumulated fluid and sodium, decrease cardiac demands, and improve tissue oxygenation
- Infants diagnosed with HF due to CHD are stabilized on medical therapy and referred for surgical repair
- Many children are surgically repaired in the newborn and early infancy stages before the onset of HF symptoms, while others may develop HF due to worsening ventricular function after a previous cardiac repair, cardiomyopathy, or dysrhythmia
Congenital Heart Defects: Tetralogy of Fallot and Tricuspid Atresia
- Tetralogy of Fallot is a congenital heart defect with four defects: ventricular septal defect (VSD), pulmonic stenosis (PS), overriding aorta, and right ventricular hypertrophy
- It occurs in 5 to 10% of all congenital heart diseases and is the most common cyanotic lesion
- Surgical treatment options for Tetralogy of Fallot include palliative shunt and complete repair involving closure of the VSD and resection of the infundibular stenosis
- Infants with Tetralogy of Fallot may experience acute cyanosis and hypoxia called "blue spells" or "tet spells"
- The operative mortality for total correction of Tetralogy of Fallot is less than 2 to 3% during the first 2 years of life
- Tricuspid atresia is a condition where the tricuspid valve fails to develop, leading to no communication from the right atrium to the right ventricle
- Tricuspid atresia is often associated with pulmonary stenosis and transposition of the great arteries
- Palliative treatment for tricuspid atresia involves the placement of a shunt to increase blood flow to the lungs
- Modified Fontan procedure may be performed for tricuspid atresia, where systemic venous return is directed to the lungs without a ventricular pump
- Tricuspid atresia may present with cyanosis in the newborn period and signs of chronic hypoxemia with clubbing in older children
- Therapeutic management for tricuspid atresia includes continuous infusion of prostaglandin E1 for newborns and pulmonary artery banding for some children with increased pulmonary blood flow
- The presence of a patent foramen ovale at birth is required for blood flow across the septum into the left atrium; the patent ductus arteriosus allows blood flow to the pulmonary artery into the lungs for oxygenation
Pediatric Heart Failure Management
- Common medications for pediatric heart failure include captopril, enalapril, and lisinopril
- ACE inhibitors reduce aldosterone secretion, preventing fluid retention and hypokalemia
- Beta blockers like carvedilol are used in some children with chronic heart failure
- Cardiac resynchronization therapy (CRT) using biventricular pacing is being applied to pediatric patients
- Diuretics, fluid and sodium restriction, potassium supplements, and rich sources of potassium are used to remove excess fluid and sodium in heart failure treatment
- Serum potassium levels should be monitored carefully due to its effect on digoxin toxicity
- Fluid restriction may be necessary in acute heart failure stages, especially in cyanotic CHD and polycythemia cases
- Sodium-restricted diets are used less often in children due to potential negative effects on appetite and growth
- Measures to decrease cardiac demands include providing a neutral thermal environment, treating infections, reducing breathing effort, sedation, rest, and minimizing environmental stimuli
- Measures to improve tissue oxygenation include improving myocardial function and administering supplemental cool, humidified oxygen
- Nursing care is crucial in reducing cardiac demands, providing emotional support, and assisting in measures to improve cardiac function
- Clinical manifestations of heart failure include impaired myocardial function and systemic venous congestion, with associated signs and symptoms for each category
Pediatric Heart Failure Management
- ECG monitoring is used to analyze rate and rhythm, detecting abnormalities like PR interval lengthening and dysrhythmias.
- Digoxin has a narrow therapeutic safety margin, and its toxicity can mimic its therapeutic effects.
- Careful dosage calculation and measurement are crucial to prevent accidental overdose of digoxin.
- Parents are educated about signs of digoxin toxicity and may be taught to take the child's pulse before medication administration.
- ACE inhibitors for afterload reduction require close monitoring of blood pressure and symptoms of hypotension.
- Children taking multiple diuretics and an ACE inhibitor need careful assessment of serum electrolytes and renal function.
- Infants with heart failure require rest and energy conservation for feeding, and parents are encouraged to provide comforting activities.
- Feeding should be planned based on the infant's hunger signs to avoid exhausting their limited energy supply.
- Older children need explanations about their illness and treatments to decrease anxiety.
- Careful monitoring of body temperature is essential, especially for children receiving cool, humidified oxygen.
- Skin breakdown from edema is prevented by regularly changing the child's position and using pressure-relieving measures.
- Respiratory distress is reduced through careful assessment, positioning, and oxygen administration, with attention to preventing respiratory tract infections.
Shunt Procedures for Children with Cardiac Defects and Nursing Care Considerations
- Modified Blalock-Taussig shunt: Subclavian artery to pulmonary artery, potential for excessive shunt flow and thrombosis, easy to ligate at time of definitive correction, fixed shunt size
- Sano modification: Right ventricular to pulmonary artery conduit using Gore-Tex graft, prevents diastolic runoff of systemic blood, used in place of modified Blalock-Taussig shunt in Norwood procedure
- Central shunt: Ascending aorta to main pulmonary artery using Gore-Tex, restricts blood flow, easy to insert and remove at time of repair, uncommon and used when modified Blalock-Taussig shunt cannot be used
- Bidirectional Glenn shunt: Superior vena cava to side of right pulmonary artery, used as a staging step to a Fontan procedure, relieves severe cyanosis and decreases volume overload on ventricle
- Importance of teaching parents about treatment for hypercyanotic spells and prevention of dehydration in hypoxemic children
- Monitoring fluid status with accurate intake and output and daily weight measurements, availability of oral electrolyte solution at home
- Need for prompt treatment of fever, vomiting, and diarrhea to prevent dehydration
- Unique concerns for infants and children with significant cyanosis, including body image issues and parental fears
- Importance of preventive measures and accurate assessment of respiratory infection for children with cyanosis
- Nursing care considerations for infants with compromised pulmonary function, including thorough hand hygiene and protection from respiratory infections
- Alert on intracardiac shunting of blood and air embolism risks, emphasizing the need for IV line filters, secure taping of connections, and air removal
- Family adjustment to the disorder, including initial shock, anxiety, fear of child's death, and the need for time to grieve before assimilating the meaning of the defect
Challenges Faced by Families of Children with Congenital Heart Defects
- Parents of severely ill newborns are often required to give immediate informed consent for diagnostic-therapeutic procedures due to the demands for medical treatment.
- Parent-newborn attachment is supported by encouraging parents to hold, touch, and look at their child, and providing private time for the parents to bond with their newborn.
- The impact of a child with a serious heart defect on the family is complex and affects all family members, including feelings of inadequacy in mothers, exhaustion, neglect, and resentment in fathers and siblings.
- Parents often feel inadequate in their mothering ability due to the complex care required by infants with congenital heart defects.
- Parents may struggle with leaving the child in another's care and feel the need to maintain discipline and set consistent limits, which can be challenging.
- Overdependency of the child is often a result of parental fear of the child's mortality and may hinder the child's optimum development.
- Children with congenital heart defects need opportunities for social interaction with peers and do not necessarily need to be prevented from playing with other children due to concerns about overexertion.
- The unremitting stresses of care for a child with congenital heart defects, including physical exhaustion, financial costs, emotional upset, and fear of death, are often not fully appreciated by those caring for the family.
- Introducing families to others with similarly affected children can help them adjust to the daily stresses of caring for a child with congenital heart defects.
- After the initial diagnosis of congenital heart defects, parents require a clear explanation based on their level of understanding, including a review of the basic structure and function of the heart, a simple diagram or model, written information about the specific condition, and information about prognosis and treatment options.
- Health care providers should assess parental understanding of the condition and clarify information as needed, as families increasingly seek information about heart disease in children through the Internet and support from other parents and parent groups.
- It is crucial for parents to realize that not all online information is medically accurate, and information from other parents may not be applicable to their child, especially if the child has a rare, complex heart defect requiring individualized treatment plans.
Preparing Children for Medical Procedures and Postoperative Care
- Preparation close to the event is beneficial for young children, while older children and adolescents may benefit from teaching several weeks in advance.
- Parents should be included in the preparation session to support their child and learn about upcoming events.
- Preoperative preparation should include information on the environment, equipment, and procedures the child will encounter during and after the procedure.
- Sensory experiences such as sights, sounds, and sensations in the CCU or catheterization laboratory should be explained.
- Familiar and new equipment in the environment should be described, and comforting aspects should be emphasized.
- Patients being sedated during catheterization or receiving opioid pain relievers may have minimal recall and may not need detailed information about equipment or procedures.
- Specific information tailored to the planned procedure for each patient is essential.
- Coping strategies, such as bringing a familiar stuffed animal or comfort object for young children, and bringing headphones and favorite music for older children, should be discussed.
- Post-catheterization recovery topics include lying still to prevent bleeding, advancing diet, controlling pain, and monitoring.
- Simple coping strategies for painful procedures, such as distraction techniques, should be reviewed.
- Children and their families should have a choice about taking a CCU tour, as exposure to the environment can increase anxiety in some children.
- The child should be protected from frightening sights in the unit, and undue fantasizing about the experience should be prevented.
Title: Postoperative Care for Children
Postoperative Care for Pediatric Cardiac Surgery Patients
- Intracardiac monitoring lines are placed intraoperatively in the right atrium, left atrium, or pulmonary artery to assess pressures inside the cardiac chambers and provide vital information about volume status and ventricular function.
- Strict aseptic technique is essential for caring for intracardiac lines, and patients must be carefully assessed for bleeding at the time of line removal.
- Infants usually require mechanical ventilation in the immediate postoperative period, while early extubation in the operating room or early postoperative period is becoming more common.
- Suctioning is performed only as needed and carefully to avoid vagal stimulation and laryngospasm, especially in infants, and supplemental oxygen is administered before and after the procedure to prevent hypoxia.
- Chest tubes are inserted to remove secretions and air, with drainage checked hourly for color and quantity; excessive drainage may indicate postoperative hemorrhage.
- Chest tubes are usually removed on the first to third postoperative day, and analgesics are given before the procedure.
- After chest tube removal, breath sounds need to be checked to assess for a pneumothorax, and a chest X-ray is usually obtained to evaluate for possible complications.
- Intake and output of all fluids must be accurately calculated, including IV fluids, fluid used to flush the arterial and CVP lines, and urine, drainage, and blood drawn for analysis.
- Urine should be analyzed for specific gravity to assess the kidneys' concentrating ability and the body's approximate degree of hydration.
- Renal failure is a potential risk from a transient period of low cardiac output, and signs of renal failure include decreased urinary output and elevated levels of blood urea nitrogen and serum creatinine.
- Infants and children may require diuretics, iron supplementation, transfusion, and repeat surgery to locate and ligate the source of bleeding for various postoperative complications.
- Assessment and treatment approaches for complications after cardiac surgery include medications, possible pacing, antibiotics, pericardiocentesis, chest physiotherapy, and ambulation.
Supporting Children with Congenital Heart Disease
- Parents should have an information sheet with their child’s diagnosis, significant treatments, allergies, medications, and healthcare providers’ contact numbers for emergencies and to share with caregivers.
- Parents need to be knowledgeable about the therapeutic management of the disorder, including the roles of surgery, procedures, medications, and a healthy lifestyle in maintaining good health.
- Medications play a critical role in managing cardiac conditions such as dysrhythmias and severe heart failure.
- Physical activity for children with congenital heart disease (CHD) should generally not be restricted, except for strenuous recreational and competitive sports, which should be discussed with the child’s cardiologist.
- Infants and children with CHD require good nutrition, and feeding methods that decrease the infant’s work and provide high-calorie formula are important interventions.
- Infants with heart disease should be immunized according to current guidelines, with possible modifications around times of acute illness or surgical procedures.
- Infants and children with serious heart disease are at risk for developmental delays due to various factors, including genetic and pre-/post-operative factors.
- Patients who have undergone surgery entailing cardiopulmonary bypass, especially in the newborn period, should be watched carefully during their early school years for signs of mild to moderate learning disabilities or attention deficit disorders.
- Efforts to limit the time of deep hypothermic circulatory arrest and provide better neuroprotection during infant surgery may improve outcomes in the future.
- Preparing children for invasive procedures involves reducing anxiety, improving their ability to assist with procedures, enhancing recovery, developing trust with caregivers, and improving long-term emotional and behavioral adjustments after procedures.
- Important factors to consider in planning preparation strategies include the child’s cognitive development, previous hospital experiences, the child’s temperament and coping style, timing of preparation, and involvement of the parents.
- Outpatient preoperative and precatheterization workups are common for most elective procedures, with preprocedure teaching often done in the clinic setting or at home and tailored to children of different ages and developmental levels.
Development of Pediatric Critical Care and Early Warning System
- Pediatric critical care has developed as a sub-specialty of medicine over the past two decades, in response to the need for complex pediatric care and advancements in medical and surgical sub-specialties.
- The first pediatric intensive care unit (PICU) was opened in Europe in 1955, and by 1990, there were multiple training programs and certifications available for pediatric critical care.
- Pediatric critical care is a multidisciplinary field that includes a team of various medical professionals and specialists.
- The Modified Early Warning System (MEWS) was developed as a tool for nurses to monitor patients and improve the speed of care in rapidly deteriorating patients.
- Pediatric patients have unique clinical parameters and characteristics, and adult parameters cannot be directly applied to them.
- Children have greater compensatory mechanisms than adults and can maintain a normal blood pressure despite significant fluid loss.
- Sixty-one percent of pediatric cardiac arrests were caused by respiratory failure and twenty-nine percent by shock, both preventable causes.
- A pediatric early warning score (PEWS) was developed to objectively assess pediatric patients and improve mortality rates by identifying children who need a higher level of care and improving staff communication.
- PEWS has shown to decrease code blue incidents, improve staff communication, and patient safety.
- Vital parameters in pediatric patients vary by age group, and temperature should be taken via rectum for children under the age of three for greatest accuracy.
- When taking vital signs in infants, respirations are counted first, pulse next, temperature, and blood pressure last for best results.
- The development of pediatric critical care and the early warning system has significantly improved patient care times and outcomes.
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