Peds Cardiac Ppt - Student - Tagged

The Child with Cardiovascular Dysfunction

Overview

• Presentation by: Jessie Seeck, STLCC Wildwood

Types of Cardiovascular Disorders

• Major Groups:

  • Congenital Heart Disease: Defects present at birth.

  • Acquired Cardiac Disorders: Develop during or after birth.

• Impact: Both types can cause varying degrees of heart failure.

Patient Assessment

History and Physical Examination

• History Collection:

  • Maternal health history (diabetes, lupus, substance use, infections like rubella, teratogenic drugs- DILANTIN).

  • Family health history.

• Physical Assessment Techniques:

  • Inspection

  • Palpation

  • Percussion

  • Auscultation

• Physical Exam of Child with cardio dysfunction

  • Failure to thrive

  • Cyanosis

  • Respiratory excursions

  • Clubbing of fingers

  • Abdomen: Hepatomegaly or splenomegaly may be present.

  • Peripheral pulses: rates regularity and amplitude may reveal discrepancies.

  • Auscultation of heart: tachy, brady, irregular rhythm, murmurs.

• Additional Evaluations:

  • Diagnostic evaluations like EKG, echocardiogram, chest X-ray, MRI, CBC, ABGs, hyperoxia test.

  • Heart catheterizations for diagnostics and treatment.

  • PRE/POST OP

Nursing Care Management

• Preprocedural Care:

  • Complete nursing assessment including allergies, signs of infection, and vital signs.

• Postprocedural Care:

  • Monitor for complications, including vital signs, extremities checks at access point, bleeding from dressings, and fluid intake.

Circulatory Changes at Birth

• Closure of Fetal Shunts:

  • Umbilical Cord Clamping: Triggers functional closure of the umbilical vein and arteries, and foramen ovale.

  • Foramen Ovale: Closes as left atrial pressure exceeds right atrial pressure.

  • Ductus Arteriosus: Begins to close when oxygen levels increase.

Normal Fetal and Newborn Heart Anatomy

• Important structures include:

  • Superior vena cava, inferior vena cava, pulmonary artery, aorta, and valves.

Diagnostic Tools for Cardiovascular Dysfunction

• Tools Used:

  • EKG

  • Holter Monitor

  • Echocardiogram

  • Chest X-ray

  • MRI

  • CBC and ABGs

  • Hyperoxia test

  • Heart catheterizations

Nursing Care for Heart Catheterization

• Pre-Procedure:

  • Assess and mark pulses, baseline O2 saturation, explain procedures to parents and children.

  • NPO for 6-8 hours before the procedure.

• Post-Procedure Monitoring:

  • Monitor heart rhythm with heart monitor, oxygen saturation, and check for signs of bleeding or infection.

    • pulse, temp, check extremitiesand assess capillary refill to ensure adequate circulation and recovery.

    • FULL 1 MIN PULSE COUNT

    • BP- monitor for hypotension = BLEEDING

    • Dressing- check for bleeding.

    • Fluid intake- at risk for hypovolemia/dehydration

    • Blood glucose- infants are at risk for HYPOGYLCEMIA= IV FLUID DEXTROSE

  • Strict bed rest, particularly for diaper-wearing patients to prevent infection.

Family-Centered Care Post-Catheterization

• Teaching and Guidance:

  • Daily bandage changes for two days, keeping the site clean and dry.

  • Avoid baths and swimming for one week; sponge baths are acceptable.

  • Regular diet intake, use of acetaminophen for pain.

  • Discuss return to activities with the healthcare provider.\

  • Keep follow up visits.

Congenital Heart Defects

• Educate the patient and family about signs of complications, such as increased fatigue or difficulty breathing.

  • If you apply 02 to a baby with an acyanotic defect it will do NOTHING.

• Categories:

  • Increased Pulmonary Blood Flow: blood shifts from the left to right side of heart through a hold. Acyanotic defects, e.g.,

    • Ventricular Septal Defect (VSD)- can close spontaneously, loud harsh murmur, S/S of heart failure.

    • Atrial Septal Defect (ASD)- can be asymptomatic, loud murmur, s/s of heart failure (fluid overload,dyspnea, edema)

    • Patent Ductus Arteriosus (PDA).

  • Obstruction to Blood Flow: Obstructive defects like pulmonary and aortic stenosis.

  • Decreased Pulmonary Blood Flow: Right to left shunts, e.g., Tetralogy of Fallot, Tricuspid Atresia.

  • Mixed Blood Flow: Transposition of Great Vessels, Truncus Arteriosus, Hypoplastic Left Heart Syndrome.

Increased Pulmonary Blood Flow Details

• Ventricular Septal Defect:

  • Characteristics: loud murmur, possible asymptomatic, signs of heart failure.

  • Treatment: device closure, surgical repair depending on the size.

Obstructive Defects Overview

• Pulmonary Stenosis:

  • Diagnosis and management through catheterization or surgical procedures based on age and severity.

• Aortic Stenosis:

  • Requires careful monitoring of vital signs and potential interventions for severe cases.

Decreased Pulmonary Blood Flow Defects

• General Characteristics:

  • Present simultaneously with other issues like ASD or VSD, leading to cyanosis and signs of hypoxia.

• Tetralogy of Fallot:

  • Significant nursing considerations include high calorie nutrition and preparing for hypercyanotic episodes.

Nursing Care for Heart Failure in Children

1. Goals of Treatment:

   • Improve cardiac function, remove excess fluid and sodium, decrease cardiac demands, and improve tissue oxygenation.

2. Medications:

   • Digoxin for contractility, ACE inhibitors, and diuretics for fluid management.

   • Monitor for side effects and adjust care based on patient's needs.

Kawasaki Disease Overview

• Clinical Manifestations: High fever, edema, erythema, peeling skin, strawberry tongue, rash, lymphadenopathy.

• Nursing Management: IVIG, aspirin treatment, monitoring heart function and providing symptomatic support.

Pediatric Vitals Summary

• Blood Pressure: Infant SBP 70+; Age 10+ SBP 90+

• Pulse Rates and Respirations varied across age groups, with detailed ranges provided for newborns to adolescents.

Final Review Questions

• What to do in case of a hypercyanotic spell?

• Signs and symptoms of digoxin toxicity in children?

• Key manifestations and treatment options for Kawasaki Disease?