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Module 5 Pediatric Cardiac Disorders

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Title: Module 5 Pediatric Cardiac Disorders


1
Module 5 Pediatric Cardiac Disorders
2
Fetal Circulation
  • What is the main route
  • of blood flow
  • through the fetal heart?

3
Fetal Circulation
Why does the blood flow in that route?
4
Fetal Circulation
  • What is the stimulus for the change in
    circulation?

5
Intrauterine to Extrauterine
What Happens after the Umbilical cord is
Clamped?
6
Oxygen Saturation
  • What is oxygen saturation?
  • What is normal oxygen saturation levels?
  • What values indicate hypoxemia?
  • Why is it important for the nurse to know the
    oxygen saturation levels?


  • question 5

7

Congestive Heart Failure
8
Congestive Heart Failure
  • What is wrong with the heart?

9
Congestive heart failure
  • What is the effect on
  • Heart rate
  • Preload
  • Contractitility
  • Afterload

10
Congestive Heart Failure
  • Why does the pump fail?

11
Etiology and Pathophysiology
12
Congestive Heart Failure
  • What does the body do to compensate for this
    congestion and heart failure?

13
Compensatory Mechanisms
  • With a decrease in Cardiac Output
  • Stimulation of the sympathetic nervous system
  • Tachycardia - increases venous return to the
    heart which stretches the myocardial fibers and
    increases preload.

14
Compensatory Mechanisms
  • With a decrease in cardiac output
  • Decrease perfusion to the kidneys and
  • glomerulus
  • Increased renin and ADH secretion
  • Increase in Na and H2O retention to increase
    intravascular volume

15
Early Signs of CHF
  • The earliest signs are often subtle
  • Infant will have mild resting tachypnea
  • Increasing difficulty feeding

A Change in Condition
16
Signs and Symptoms
  • Pulmonary congestion
  • Tires easily during feeding
  • Tachypnea, Dyspnea, orthopnea
  • Signs of respiratory distress
  • Wheezing, rales and rhonchi
  • Easily fatigue
  • Impaired cardiac output
  • Tachycardia
  • Extremities cool, capillary refill gt2 seconds
  • Diaphoretic, sweating, hypotension

17
Signs and Symptoms
  • Systemic venous congestion
  • Hepatomegaly
  • Edema
  • Weight gain
  • High metabolic rate
  • Failure to thrive
  • Slow weight gain

18
Goal of Treatment
19
Treatment of Congestive Heart Failure
  • Medication Therapy
  • Digitalis increases contractility and
    decreases heart rate.
  • ACE-inhibitors - blocks release of
    angiotension-aldosterone arterial vasodilator /
    afterload reducing agent
  • Diuretics - enhance renal secretion of sodium and
    water by reducing circulating blood volume and
    decreasing preload, ? pulmonary congestion.
  • Beta Blocker - increases contractility

20
Nursing Care
How would the nurse recognize digitalis toxicity
in an infant or child?
What are the pulse rate criteria in
administration of digitalis?
21
Digitalis
  • Digitalization
  • Given in divided doses
  • Maintenance
  • Given daily, usually in two divided doses
  • Therapeutic vs. Toxicity
  • Therapeutic range 0.8 to 2.0 ng/ml
  • Toxicity
  • EKG changes arrhythmia
  • Slow pulse- bradycardia
  • Vomiting very rare in infants

22
Digitalis
  • Why are we so concerned with the potassium levels
    when the child is on digitalis therapy?

23
Treatment of Congestive Heart Failure
  • What is the type of Diet most commonly ordered?
  • How would nursing measure are used to decrease
    stress on the heart?

24
Feeding the child with CHF
  • Feed the infant or child in a relaxed
    environment frequent, small feedings may be less
    tiring
  • Hold infant in upright position may provide less
    stomach compression and improve respiratory
    effort
  • If child unable to consume appropriate amount
    during 30-minute feeding q 3 h, consider
    nasogastric feeding
  • Monitor for increased tachypnea, diaphoresis, or
    feeding intolerance (vomiting)
  • Concentrating formula to 27 kcal/oz may increase
    caloric intake without increasing infants work

25
Cardiac Catheterization
  • Measure oxygen saturations and pressure in the
    cardiac chambers and great arteries
  • Evaluate cardiac output

26
Cardiac Catheterization
  • This process involves passing a catheter through
    the femoral vein or artery into the heart.
  • Performed to evaluate heart valves, heart
    function and blood supply, or heart abnormalities
    in newborns.

27
Cardiac Catheterization
  • Pre-care
  • History and Physical
  • Lab work EKG, ECHO cardiogram, CBC
  • NPO
  • Vital signs
  • Preprocedural teaching

28
Best Nursing Action
  • During post procedure assessment, the nurse notes
    bleeding at the insertion site.
  • What should the nurse do first?
  • What additional interventions are implemented?

29
Post Cardiac Catheterization Care
What is Wrong with this picture?
30
Post Cardiac Catheterization Care
Mother Reading to child
31
Congenital Cardiac Anomalies
32
Ask Yourself?
  • What is the most common assessment finding
    indicating a cardiac anomaly?
  • Answer an audible heart murmur

33
Left-to-Right Shunting Defects
  • Patent Ductus Arterious
  • Atrial septal defects
  • Ventricle septal defects

34
Atrial Septal Defect
  1. Oxygenated blood is shunted from left to right
    side of the heart via defect
  2. A larger volume of blood than normal must be
    handled by the right side of the heart
    ?hypertrophy
  3. Extra blood then passes through the pulmonary
    artery into the lungs, causing higher pressure
    than normal in the blood vessels in the lungs ?
    congestive heart failure

35
Treatment
  • Medical Management
  • Medications digoxin
  • Cardiac Catheterizaton -
  • Amplatzer septal occluder
  • Open-heart Surgery

36
Treatment
  • Device Closure Amplatzer septal occluder

During cardiac catheterization the occluder is
placed in the Defect
37
Ventricle Septal Defect
  • Oxygenated blood is shunted from left to right
    side of the heart via defect
  • A larger volume of blood than normal must be
    handled by the right side of the heart
    ?hypertrophy
  • Extra blood then passes through the pulmonary
    artery into the lungs, causing higher pressure
    than normal in the blood vessels in the lungs ?
    congestive heart failure

38
Treatment
Surgical repair with a patch inserted
39
Patent Ductus Arteriosus
  1. Blood shunts from aorta (left) to the pulmonary
    artery (right)
  2. Returns to the lungs causing increase pressure in
    the lung
  3. Congestive heart failure

40
Treatment for PDA
  • Medical Management
  • Medication
  • Indomethacin - inhibits prostaglandin's .
  • (When levels of prostaglandins are decreased,
    the ductus closes)
  • Surgery

Ligate the ductus arteriosus
41
Treatment for PDA
  • Cardiac Catheterization
  • Insert coil tiny fibers occlude the ductus
    arteriosus when a thrombus forms in the mass
    of fabric and wire

42
Cardiac Anomalies - Treatment
When is surgery Performed? Why?
43
Obstructive or Stenotic Lesions
  • Pulmonic stenosis
  • coarctation of aorta

44
Pulmonic Stenosis
  • Narrowing of entrance that decreases blood
    flow
  • Increases preload causes right ventricular
    hypertrophy

45
Obstructive or Stenotic Lesions
  • Treatment
  • Medications Prostaglandins to keep the PDA open
  • Cardiac Catheterization
  • Baloon Valvuloplasty
  • Surgery
  • Valvotomy

46
Aortic Stenosis
  • The aortic valve is thickened and rigid
  • Stenosis creates left ventricular hypertrophy
  • Left ventricle may not be large enough to eject a
    normal cardiac output.

47
Aortic Stenosis
  • Symptoms
  • Poor peripheral perfusion, feeding difficulties,
    CHF
  • Treatment
  • Balloon valvoplasty
  • Surgery

48
Coarctation of the Aorta
  • Narrowing of Aorta causing obstruction of left
    ventricular blood flow
  • Left ventricular hypertrophy

49
Signs and Symptoms
  • What are B/P findings support the diagnosis?
  • What is different in the pulses?
  • Why would the patient C/O leg pains?
  • What causes nose bleeds?

50
Treatment
  • Goals of management are to improve ventricular
    function and restore blood flow to the lower
    body.
  • Medical management with Medication
  • A continuous intravenous medication,
    prostaglandin (PGE-1), is used to open the ductus
    arteriosus allowing blood flow to areas beyond
    the coarctation.
  • Baloon Valvoplasty

51
Surgery for Coarctation of Aorta
1. Resect narrow area
2. Anastomosis
52
Cyanotic Lesions With Decreased Pulmonary Flow
  • Tetralogy of fallot

53
Tetralogy of Fallot
Four defects are
1.
2.
3.
4.
54
Signs and Symptoms
  • Failure to thrive
  • Squatting
  • Lack of energy
  • Infections
  • Polycythemia
  • Clubbing of fingers
  • Cerebral abscess
  • Cardiomegaly

55
Ask Yourself?
  • Why does Polycythemia occur in a child with a
    cardiac disorder?
  • What nursing interventions should be included
    when planning care for this child?
  • What lab test will be abnormal and assist in
    confirming the polycythemia?

56
Ask Yourself ?
  • Laboratory analysis on a child with Tetralogy of
    Fallot indicates a high RBC count. The
    polycythemia is a compensatory mechanism for
  • a. Tissue oxygen need
  • b. Low iron level
  • C. Low blood pressure
  • d. Cardiomegaly

57
Hypercyanotic Episode / tet spells
  • Cyanosis suddenly worsens in response to
    activity, such as crying, feeding, or having a
    bowel movement.
  • Signs - The infant becomes very short of breath
    with tachypnea and hyperpnea, and may lose
    consciousness.
  • Treatment calming, knee-chest position, oxygen,
    morphine , and beta-blockers

58
Treatment
  • Open-heart Surgical interventions
  • Blalock Taussig or Potts procedure increases
    blood flow to the lungs.

59
Something the Lord Made
  • View the Movie Trailer
  • About Blalock procedure to treat
  • Tetralogy of fallot

60

Cyanotic Lesions With Increased Pulmonary Flow
  • Truncus Arteriosus
  • Transportation of Great Vessels

These present the greatest risk to survival
61
Truncus arteriosus
  • A single arterial trunk arises from both
    ventricles that supplies the systemic, pulmonary,
    and coronary circulations. A vsd and a single,
    defective, valve also exist.
  • Entire systemic circulation supplied from common
    trunk.

62
Transposition of Great Vessels
  • Aorta arises from the right ventricle, and the
    pulmonary artery arises from the left ventricle -
    which is not
  • compatible with survival unless there is a
    large defect present in ventricular or atrial
    septum.

artery
aorta
63
Acquired Heart Disease
64
Infective Endocarditis
  • Microorganisms grow on the endocardium, forming
    vegetations, deposits of fibrin, and platelet
    thrombi. The lesion may invade adjacent tissues
    such as aortic and mitral valves.

65
Subacute Bacterial Endocarditis / Infective
Endocarditis
  • Assessment
  • Fever
  • Fatigue
  • Muscle and joint pain
  • Headache
  • Nausea and vomiting
  • CHF
  • Spleenomegaly
  • Diagnosis
  • Blood cultures
  • Echocardiogram

66
Infective Endocarditis
  • Diagnosis
  • Blood cultures
  • Echocardiogram
  • Show the vegetation

Who is more susceptible to develop infective
endocarditis?
67
Prevention
  • What is the most therapeutic intervention for
    preventing infective endocarditis?

68
Antibiotic Prophylaxis for Children at Risk for
Infective Endocarditis
  • Dental procedures, including cleaning, that may
    induce gingival or mucosal bleeding
  • Tonsillectomy and/or adenoidectomy
  • Surgery and/or biopsy involving respiratory or
    intestinal mucosa
  • Incision and drainage of infected tissue
  • Invasive GU and GI procedures

69
Ineffective Endocarditis
  • Treatment
  • Monitor temperature
  • Antibiotics 2-8 weeks
  • Patient teaching
  • Good oral hygiene
  • take antibiotics prior to surgery, dental work,
    or any invasive procedure, etc.
  • discouraged from body piercing and tattoos as
    endocarditis may occur even with prophylaxis.

70
Rheumatic Heart Disease
  • A systemic inflammatory (collagen) disease of
    connective tissue that usually follows a group A
    beta-hemolytic streptococcus infection.
  • This disorder causes changes in the entire heart
    (especially the valves), joints, brain, and skin
    tissues.

71
Rheumatic Fever - Assessment
  • Minor
  • Arthralgia
  • Fever
  • Laboratory Findings
  • Erythrocyte sedimentation rate
  • C-reactive protein
  • Prolonged PR interval
  • Major
  • Carditis
  • Polyarthritis
  • Chorea
  • Erythema marginatum
  • Subcutaneous nodules

Jones Criteria
72
What additional laboratory test helps to confirm
the diagnosis of Rheumatic Fever ?
73
Rheumatic Fever
  • Treatment
  • Antibiotic Therapy
  • Antipyretics - aspirin
  • Anti-inflammatory agents steroids
  • Rest
  • Heat and cold to joints
  • Discharge Teaching
  • Antibiotic therapy - be sure to complete all
    medication.

74
Streptococcal Prophylaxis for the Child with
Rheumatic Fever
  • Damaged valves can become further damaged with
    repeated infections
  • Streptococcal prophylaxis is lifelong if there is
    actual valve involvement
  • Intramuscular penicillin, administered monthly,
    is the drug of choice
  • Alternatives include oral penicillin twice daily
    or oral sulfadiazine once a day

75
Kawasaki Disease
  • Multisystem vasculitis inflammation of blood
    vessels in the body especially the coronary
    arteries with antigen-antibody complexes.

76
Kawasaki Disease Signs and Symptoms / Treatment
  • Three Phases of clinical manifestations
  • Acute
  • Subacute
  • Convalesant
  • One of the most common symptoms used to diagnose
    Kawasaki disease is a high spiking fever over
    1020 for 5 days.

77
Acute Phase 10-14 days
  • Fever, which often is higher than 101.3 F, and
    lasts one to two weeks
  • Extremely red eyes (conjunctivitis)
  • without thick discharge
  • Red, dry, cracked lips and an extremely red,
    swollen tongue ("strawberry" tongue)
  • A rash on the main part of the body (trunk)
  • and in the genital area
  • Swollen, erythema on the palms of the hands and
    the soles of the feet
  • Swollen cervical lymph nodes

78
Subacute Phase 15-25 days
  • Irritability
  • Anorexia
  • Desquamation of the skin on the hands and feet,
    especially the tips of the fingers and toes,
    often in large sheets
  • Arthritis and Arthralgia
  • Arrhythmias
  • Coronary aneurysms

79
Convalescent Phase
  • From day 26 until the erythrocyte
    sedimentation rate returns to normal

80
Nursing Care
  • Give Medications
  • Aspirin
  • Intravenous Immunoglobulin
  • Promote comfort
  • Lubricate the lips
  • Cool compresses
  • Keep skin cool and dry
  • Small feedings of soft foods and liquids that are
    not too hot or too cold.
  • Facilitate joint movement
  • Passive Range of Motion exercises

81
Kawasaki Disease
  • Which phase of Kawasaki is this child exhibiting?

Inflamed, Cracked, Peeling Lips
Strawberry tongue
82
Kawasaki Disease
What are major Complications Of Kawasaki?
83
The End!
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