Nursing Care of the Child with a cardiovascular disorder

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Prittyrick
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301473
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Nursing Care of the Child with a cardiovascular disorder
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2015-04-24 18:12:48
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heart stuff
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  1. Cardiovascular Overview: pediatrics
    • CV disease: significant cause of chronic illness and death in children
    • CV disorders: two categories
    • - congenital heart disease (CHD)
    • - acquired heart disease (happens after birth) associated with Downs syndrome, willimas, duchene's, fetal alcohol syndrome
    • CHD often associated with chromosomal abnormalities, syndromes
    • Many congenital heart defects result in:
    • - heart failure (bc heart works so hard)
    • - chronic cyanosis
    • frighten for parents and children provide reassurance and support
    • Innocent and functional murmur and physiological splitting of heart sounds may be heard. normal variation
    • - organic- heart disease
    • - innocent- people live with them and they would be fine
  2. Normal Values
    • Heart Rate:
    • - NB rest/awake: 100-180, asleep 80-160, exercise/fever 220
    • - infant: 120-130
    • - toddler/preschooler:80-105 (2-5y)
    • - school age: 6-12y 70-80
    • - Adolescent: 60-68
    • - adult 60-100

    • Blood Pressure
    • NB varies: approx: 70/42
    • infant: 80-40
    • toddler/preschool: 80-100/64
    • school: 94-112/56-60
    • Adolescent: 100-120/50-70
    • Adult: 120/70
  3. Terms associated with the cardiovascular system
    • Systole: heart is contracting (both ventricle) pumps blood to lungs and systemic
    • disatole: heart resting/relaxation
    • cardiac output: SV x HR how much blood going out into systemic circulation
    • Stroke volume:
    • Cardiac output is affected by:
    • 1. preload: how much blood sitting in heart before it contracts
    • 2. afterload: something wrong out in systemic circulation. It stops circulation from running and everything gets backed up
    • 3. contractability: muscle contractions when contracts the muscle tightens and it pumps out the blood.
    • Arrythythmia or dysrhythmia: abnormal change in heart rhythm
  4. The Cards system A&P
    go over how it works
  5. Assessment of heart disorder
    • Collect Hx: ask questions
    • Pregnancy hx:
    • - intrauterine infection
    • - medications use
    • - nutrition
    • - radiation exposure
    • Information about children
    • - feeding hx
    • - fatigue
    • - positioning at rest: are they squatting means they have oxygenating their upper body
    • - frequency of infections
    • CV dysfunction: have more infection
  6. Assessment of heart disorder
    • Hx:
    • - perspiration: increase in children with heart disorder- diaphoretic not normal for child
    • - elimination urine output maybe decrease: dont prefuse kidneys 1ml/kg per hr
    • - edema: late sign
    • - cyanosis: bluish color (hypoxic children)
    • - mucous membranes are the best place to check for cyanosis. always the buccal membranes and lips
    • failure to thrive: 2 Standard Deviation below normal when plotted on standardized growth chart; thin children, little
    • Nosebleeds (high pressure), headache, growing pains, leg pain (low pressure)
  7. Assessment Physical assessment, general appearance, pulse, BP
    • PA: Head to toe; height and weight
    • General apprearance: how does the child look across the room, skin color, cyanosis, complexion, sitting position, clubbing, cap refill, mucus/buccal membrance, lethargy, Incr RR, inspect chest symmetry, heart movement. are they acting their age
    • Pulse: tachycardia (infants > 160 3+> 100), investigate further. concern if persist during sleep. abnormal patterns seen in children with heart disorders
    • Blood pressure varies with age
  8. Murmurs: Innocent or Organic
    • Murmurs: abnormal heart sounds produced by turbulent blood flow or by tissue vibrating in heart
    • murmurs can be dangerous ,organic cause or be innocent
    • cause: narrow leaky valves, abnormal passageways or harmless flow characteristics
    • report all murmurs: need for further work up
    • Types:
    • Innocent or functional: normal variation, vibrations within the heart or pulmonary vessel
    • - systolic: between S1 and S2, associated with ventricular ejection
    • - soft musical quality, heard while sitting, no restriction provide reassurance
    • Organic: heart disease, systolic or diastylic, longer in duration heard in all position (shh lub dub, Lub dub shh)
    • - diastolic: between S2 and S1, associated with ventricular relaxation and filling. Almost always organic
    • - harsh blowing sounds, loud. heard in all position
  9. Diagnostic tests
    • Electrocardiogram (ECG)
    • - checking for electrical activity of the heart
    • - identify abnormal rhythms
    • Chest X-ray
    • - check to see heart size, contour, chambers, fluid collection in lungs or pulmonary arteries, also confirms placement of pacemaker leads
    • floroscopy: permanent motion picture recording about size and configuration of heart, great vessels, lungs, thoracic cage, and diaphragm
    • protect child/healthcare worker from radiation exposure.
    • risk of death related to dye, arrthythmias, pulmonary edema
    • make sure no allergy to dye or shellfish
  10. Dx test echo, mri, stress test
    • Echo: US cardiography
    • - diagnostic test for heart disease
    • - no radiation exposure
    • - fetal echocardiography detects heart anamolies as early as 18 weeks gestation
    • MRI: evaluates heart structure, heart size or blood flow
    • Exercise/stress test- treadmill walking
    • - used to determine if pulmonary circulation can increase to meet the respiratory demands of exercise. require cooperation not for children under 5
  11. Diagnostic test: labs
    • ESR (erthyrocyte sedimentation rate): marker of inflammation
    • useful to help identify Kawasaki disease and other inflammatory disorder
    • ABG's: useful to identify shunting of the heart.
    • - Hypoxia testing: children is given 100% oxygen for 15 minutes, when consistenly low PO2 this determines there is R to L shunting (blood is mixing deoxy and oxy)
    • O2 stat helps to determine levels of oxygen in circulation
  12. Other Diagnostic test
    • Hgb Hct: to check for polycythemia- which can cause clotting
    • Pt and PTT and platelet:
    • - assess blood clotting capabilities
    • - abnormal results must be corrected before surgery to prevent hemorrahage or clot
    • Sodium: increase levels may cause edema of heart with surgery
    • K:
    • - low K cause cardiac arrthythima
    • - low k can increase dixogen level too much toxicity
    • - high cardiac arrthythimas (check these before surgery)
    • Digoxin level
    • - normal level 0.5-2
    • - use to slow and strengthen heartbeat
    • Toxic level of digoxin care the following s/sx
    • - infants/small children: first sign cardiac arrthythimas
    • - adults/older children: abdominal pain, anorexia, NV, visual disturbances, bradycardia, and other arrhythimas
    • - hold med and notify provider immediately

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