10 Questions
What are the two major groups of cardiac disorders in pediatrics?
Congenital and Acquired
What is the characteristic of cardiac disorders with increased pulmonary blood flow?
Pulmonary edema
What is the purpose of cardiac catheterization?
To assess the heart's function and hemodynamic values
What is a crucial aspect of nursing interventions for cardiac catheterization?
Providing age-appropriate teaching and preparation to the child and parents
What should the nurse monitor for after cardiac catheterization?
Bleeding at the site of insertion of the catheter
What is the primary reason for keeping the leg immobilized after cardiac catheterization?
To prevent bleeding at the entry site
What is a common symptom of Congestive Heart Failure (CHF) in children?
Tachycardia
What is the primary treatment for Patent Ductus Arteriosus (PDA) in preemies?
Indomethacin
What is the defect in Ventricular Septal Defect (VSD)?
Hole between the two ventricles
What is associated with Atrioventricular Canal (AVC) defect?
Down syndrome
Study Notes
Cardiac Disorders in Pediatrics
- Two major groups of disorders: Congenital (aka "born with", most structural defects) and Acquired (develop later in life, e.g. bacterial endocarditis, rheumatic fever, Kawasaki disease, systemic HTN)
Classifications of Congenital Heart Diseases (CHD)
- Hemodynamic characteristics:
- Increased pulmonary blood flow (too much to lungs, "pink", pulmonary edema)
- Decreased pulmonary blood flow (too little to lungs, "blue", cyanotic)
- Obstruction of blood flow out of the heart (can't get to lungs or body)
- Mixed blood flow (most common)
Fetal Circulation
- Fetal circulation characteristics:
- Two fetal circulatory pathways: right-to-left shunt through foramen ovale and ductus arteriosus
- Fetal circulation changes after birth: ductus arteriosus closes, foramen ovale closes
Tests of Cardiac Function
- Prenatal ultrasound
- Chest x-ray
- Electrocardiogram (ECG)
- Echocardiogram
- Cardiac catheterization
- Stress test (dobutamine or exercise)
- Cardiac MRI
Cardiac Catheterization
- Invasive diagnostic procedure benefits: better visualization, actual pressures, sats, hemodynamic values
- Risks: hemorrhage, fever, N/V, loss of pulse, transient dysrhythmias
- Pre-procedure: complete hx & physical exam, check for allergies, age-appropriate teaching & preparation, NPO 4-6 hrs before
- Post-procedure: monitor for bleeding, pulses, VS, heart rate, potential complications (nausea, fever, loss of pulse)
Cardiac Catheterization Complications
- Nausea and/or vomiting
- Low-grade fever
- Loss of pulse in catheterized extremity
- Transient dysrhythmias
- Acute hemorrhage from entry site
Symptoms of CHF
- Increased work of breathing
- Tachycardia
- Decreased pulses
- Decreased urinary output
- Poor weight gain
- Diaphoresis with activity
- Hepatomegaly
- Cold, cool extremities, especially with stress or activity
- JVD (jugular venous distention)
- Decreased BP (late sign)
Patent Ductus Arteriosus
- Ductus doesn't close
- Common in preemies
- "Machinery" murmur
- Treatment: indomethacin, cath lab, ligation
Atrial Septal Defect (ASD)
- Hole between two atria of heart
- Usually asymptomatic
- If not treated, increased risk of atrial dysrhythmia or stroke
- Usually close on own
Ventricular Septal Defect (VSD)
- Hole between two ventricles of heart
- Symptoms related to size and location of VSD and amount of pulmonary blood flow
- Fix by patching with Goretex
Atrioventricular Canal (AVC)
- ASD, VSD, and affected mitral & tricuspid valves
- Associated with Down syndrome
- Symptoms related to size of holes, degree of valvular involvement, and size of ventricles
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