Cardiovascular Disorders - PEDS

Defects That Increase Pulmonary Blood Flow (Red Baby) (3)

• These defects allow blood to shift from high pressure (left side) to low pressure (right side)

• Leads to increased pulmonary blood volume on the R side of the heart that increases pulmonary blood flow

• Defects include manifestations & findings of heart failure

Defects - Red Baby (3)

• Ventricular Septal Defect (VSD)

• Atrial Septal Defect (ASD)

• Patent Ductus Arteriosus (PDA)

Ventricular Septal Defect (VSD)

Hole in septum between R & L ventricle that results in increased pulmonary blod flow (L to R shunt)

VSD Findings (3)

• Loud, harsh murmur auscultated at left sternal border

• Heart failure

• Many close spontaneously early in life

Atrial Septal Defects (ASD)

Hole in septum between R & L atria that results in increased pulmonary blood flow (L to R shunt)

ASD Findings (3)

• Systolic murmur & a fixed split second heart sound may be present

• Heart failure

• Asymptomatic (possibly)

Patent Ductus Arteriosus (PDA) (2)

• A condition in which the a connection between the pulmonary artery & aorta fails to close

• Results in increased pulmonary blood flow (left-to-right shunt)

PDA - Findings (6)

1. Systolic murmur (machine hum)

2. Wide pulse pressure

3. Bounding pulses

4. Asymptomatic (possibly)

5. Heart failure

6. Rales

Define Obstructive Defects (4)

• Defects where blood flow exiting the heart meet an area of narrowing (stenosis) which obstructs blood flow

• Pressure before defect increased (ventricle) & pressure after defect decreased

• Results in decreased CO

• Manifestations of heart failure

Obstructive Defects (3)

Pulmonary stenosis

Aortic Stenosis

Coarctation of aorta

Aortic Stenosis

Narrowing of aortic valve

Aortic Stenosis Findings - Infants (3)

• Faint pulses

• Hypotension & Tachycardia

• Poor feeding tolerance

Aortic Stenosis Findings - Children (4)

• Intolerance to exercise

• Dizziness

• Chest pain

• Possible ejection murmur

Procedures - Aortic Stenosis (2)

• Balloon dilation with cardiac catheterization (Cath labs)

• Digoxin

Defects That Decrease Pulmonary Blood Flow - Blue Babies (3)

• Have an obstruction of pulmonary blood flow & an anatomic defect (ASD or VSD) between R & L sides of heart

• R to L shift allowing deoxygenated blood to enter systemic circulation

• Hypercyanotic spells

Hypercyanotic Spells (Tet Spells)

Manifest as acute cyanosis & hyperpnea

Defects - Blue Babies (4)

• Tricuspid Atresia

• Truncus Arteriosus

• Transposition of Great Arteries

• Tetralogy of Fallot

Tetralogy of Fallot (5) PROV

• Four defects that result in mixed blood flow

• Pulmonary stenosis

• Ventricular septal defect

• Overriding aorta

• Right ventricular hypertrophy

Tetralogy of Fallot - Findings (4)

• Cyanosis at birth - Progressive cyanosis over the 1st year of life

• Systolic murmur

• Episodes of acute cyanosis & hypoxia (“Tet” spells)

• Squatting or tripod position relieves tet spells

Mixed Defects (3)

• Transposition of the great arteries

• Truncus arteriosus

• Hypoplastic left heart syndrome

Transposition of the Great Arteries (2)

• Aorta connected to the R ventricle instead of the L, & pulmonary artery is connected to L ventricle instead of R.

• A septal defect or PDA must exist in order to oxygenate the blood.

Transposition - Findings (4)

• Murmur depending on presence of associated defects

• Severe to less cyanosis depending on size of associated defect

• Cardiomegaly

• Heart failure

Define Rheumatic Fever

Inflammatory disease that occurs as a reaction to Group A beta-hemolytic streptococcus (GABHS) infection of the throat.

Risk Factors - Rheumatic Fever

Usually occurs within 2-6 weeks following an untreated or partially treated upper respiratory infection (strep throat) with GABHS.

Expected Findings - Rheumatic Fever (6)

• History of recent upper respiratory infection

• Fever

• Tachycardia

• Cardiomegaly

• New or changed heart murmur

• Muffled heart sounds,, pericardial friction rub & report of chest pain (can indicate carditis)

Labs - Rheumatic Fever (2)

• Throat Culture for GABHS

• Blood Antistreptolysin O Titer - Tests for immunity or prior infection, NOT current infection

Jones Criteria - Rheumatic Fever

Diagnosis made with jones criteria

Child must demonstrate 2 major criteria or 1 major & 2 minor criteria following a GABHS infection for diagnosis

Major Jones Criteria - Rheumatic Fever (5) CRP CS

• Carditis - Heart inflammation; New/changed heart murmur, muffled heart sounds, friction rub, chest pain

• Rash (erythema marginatum) - Rash nonitchy that appears & dissapears

• Polyarthritis - Painful swelling or large joints that can move

• Chorea - Involuntary movements with muscle weakness & uncoordination

• Subcutaneous nodules - Nontender nodules over bony prominences

Minor Jones Criteria - Rheumatic Fever (2)

• Fever

• Arthralgia - Joint pain

Medications - Rheumatic Fever (3)

2 daily PO doses of pencillin V

Daily PO dose of sulfadiazine

Assess for allergic response & encourage compliance

Define Kawasaki Disease (2)

• Acute systemic vasculitis, resolves in less than 8 weeks

• Also known as “mucocutaneous lymph node syndrome.”

Expected Findings (Acute Phase) - Kawasaki Disease (11)

1. Onset of high fever, lasting 5 days-2 weeks, unresponsive to antipyretics

2. Irritability

3. Red eyes w/o drainage

4. Bright red chapped lips

5. Strawberry tongue with white coating or red bumps

6. Red oral mucous membranes with inflammation

7. Swelling of hands & feet with red palms & soles

8. Nonblistering rash

9. Joint pain & enlarged lymph nodes

10. Desquamation of perineum

11. Cardiac manifestations - Myocarditis, decreased left ventricular function, pericardial effusion, & mitral regurgitation

Expected Findings (Subacute Phase) - Kawasaki Disease (3)

• Resolution of fever

• Peeling skin around nails, palms & soles

• Temporary arthritis

Labs - Kawasaki Disease

CBC - CRP, ESR

Blood albumin

Elevated liver enzymes

Lumbar puncture to assess for aseptic meningitis & inflammation

Nursing Care - Kawasaki Disease (4)

• Monitor vitals & cardiac status. Maintain cardiac monitoring.

• Assess for heart failure (decreased urine output, gallop heart rhythm, tachycardia, respiratory distress

• I&O & daily weight

• IV Gamma globulin & aspirin

Medications - Kawasaki Disease (3)

• Gamma globulin IV

• High dose - 2g/kg over 8-12 hrs

• Aspirin - high dose (80-100 mg/kg/day) continue if coronary abnormalities develop indefinitely

Define Heart Failure

Occurs when heart is unable to meet the metabolic & physical demands of the body due to inadequate blood flow.

Left Sided HF (Pulmonary Congestion) - Findings (5)

• Tachypnea, dyspnea, orthopnea

• Retractions, nasal flaring, grunting

• Wheezing & cough

• Cyanosis

• Exercise intolerance

Right-Sided HF (Systemic Congestion) - Findings (5)

• Hepatomegaly

• Peripheral edema & weight gain

• Ascites

• Neck vein distention

• Periorbital edema

Heart Failure - Nursing Actions (3)

• Nutrition is important, feed every 3 hours

• Avoid stress

• Wake child up gently

Define Balloon Angioplasty (3)

• Intervention

• Balloon-tipped catheter is used to inflate & widen narrowed or blocked coronary arteries

• Often followed by placing a stent.

Define Cardiac Catheterization (3)

• Invasive test used for diagnosing, repairing defects, & evaluating dysrhythmias.

• A catheter is peripherally inserted & threaded into the heart with the use of fluoroscopy.

• A contrast (iodine-based) is injected, & images of the blood vessels & heart are taken

Preprocedure - Cardiac Cath (4)

• Check for allergies to iodine & shellfish (contrast)

• NPO 4-6 hrs prior

• Baseline vitals & document quality of pedal pulse

• Sedate prior

Postprocedure - Cardiac Cath

Continuous cardiac & SpO2 monitoring

• Assess insertion site (femoral or antecubital area) for bleeding or hematoma.

• Assess pulses, HR, RR, skin color & temp

• Straight position 4-8 hrs

• Encourage oral fluid intake & voiding

• Mild analgesics for pain (tylenol & motrin)

Digoxin - Use

Improves myocardial contractility & cardiac output

Digoxin Nursing Actions (7)

• Check pulse prior to administration & give every 12 hours

• Hold if < 110 (infants)

• Hold if < 90 (young child)

• Hold if < 70 (older child)

• Give water after to prevent tooth decay

• Skipped/vomited doses - Do not repeat or give extra dose

• Observe for toxicity - Decreased HR, appetitie, N&V)