Cardiac disorder in children 3

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Cardiac disorder in children 3
2015-04-25 16:52:41

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  1. disorders with decreased pulmonary blood flow
    • def: involves obstruction of blood flow to the lungs. cyanotic
    • causes: increase pressure in the right side of the heart compared to the left
    • if there is a defectr, +ASD or +VSD, high pressure causes shunting R-> L with resultant. Incre deoxy blood into circulation= low O2 stat and polycythemia (bc the body trying to compensate and build more red blood cells)
    • defect
    • tetralogy of fallot
  2. Tetralogy for Fallot
    • four defects
    • happens in about 10% of children
    • 1. VSD
    • 2. Pulmonic Stenosis
    • 3. overriding aorta- in the wrong place
    • 4. RV hypertrophy
  3. Tetralogy of fallot Assessment
    • murmur: loud and harsh or soft systolic murmur
    • cyanosis with incre activity (bc not enough blood to the lungs)
    • retractions, SOB, noisy breathing (bc they have trouble breathing)
    • children will squat or get knee chest positions when lying down
    • syncope (faint not enough pressure) or hypoxic (tet spell) blue around the mouth
    • polycythemia: incre risk for emobolism, CVA and thrombophlebitis, especially if dehydrate
    • long term finding: severe dyspnea, FTT, clubbing
    • - children can become intellectually challenged with episodes that occur frequently over the long term
  4. tet spells
    • called hypercyanotic event
    • children with this experience bluish skin while crying and feedings
    • parents are taught to do knee to chest
    • blue around the mouth low o2
  5. tetralogy of fallot diagnostic
    • ECG: enlarged right heart
    • Echo: decrease pulmonary artery and decr blood flow to the lungs and enlarged right heart
    • cardiac cath: allows visualization of the defect to determine size of the defects
    • labs: CBC polycythemia incr H&H, decre O2
  6. Tetralogy of Fallot: therapeutic management
    • surgical correction of the heart defects, done at 1-2 yrs of age. needed to fully prepare all defects
    • medications:
    • - morphine sulfate: helps reduce symptoms (can do at home)
    • - propranolol (beta blocker) helps open the pulmonary artery
  7. Tetralogy of fallot: teaching
    • teach parents how to handle hypercyanotic events (tet spells)
    • remain calm, place child into knee chest position. give child oxygen and prescribed medications as advised
    • Post op: monitor for arrhythmias, edema, and conduction problems
    • once fixed the heart will stop working so hard and muscle can relax
  8. Acquired Heart disease
    • Def: cardiac problem that occurs after birth. due to complication of congenital heart disease, response to respiratory infection such as in rheumatic fever, sepsis, htn, or severe anemia
    • topics
    • congestive heart failure
    • Rheumatic fever
    • Kawaski disease
  9. Congestive Heart Failure
    • def: is defined as a decreased cardiac output necessary to meet metabolic needs of the body. Pediatric CHF: occurs most frequently in children < 1yr old
    • Assessment: 1st sign of CHF tachycardia and tachyapnea
    • R heart failure: tachycardia, tachypnea, hepatomegaly, irritable, restlessness, periorbital edema (esp in little children), weight gain, ascites, lower extremity edema (late sign)
    • L Heart failure: dyspnea, crackles, bloody sputum, tachycardia, tachyapnea, fatigue
    • infants: subtle sign; breathlessness, rapid breathing, fatigue, difficulty feeding, diaphoretic (not normal), generalized edema (periorbital)
  10. CHF: therapeutic management
    • goal: reduce workload of the heart
    • medications
    • - digoxin slows and strengthens the heart
    • - incre contraction of the heart muscle, and slows the ventricular beat.
    • - take pulse one full minute prior to administration
    • - Hold med if infant < 90, children , 70 adoles < 60
    • - monitor for digixon toxicity
    • Diuretics: eliminate excess fluids to decre heart preload
    • - furosemide and aldactone
    • - monitor K levels closely
    • rest: to decre metabolic rate, and decre heart and body oxy needs
    • - semi fowler, cluster care
    • Oxygen: O2 as necessary by NC, mask, nostril skin care
  11. Rheumatic Fever
    • Def: post infectious immune response to GABHS, results in a diffuse inflammatory process involving multiple organ systems. affects connective tissue: heart, joints, brain, blood vessels, and subcutaneous tissue. leads to fibrin deposits on heart valves
    • can cause lifelong damage to heart valves. aortic and mitral valve most often involved
    • begins as a URI with Strep infection
    • without treatment, pt appears to get well. then 1-3 weeks later they have RF symptoms. usually in children 5-15
  12. RF assessment
    • jones criteria to determine if this is RF
    • s/s
    • fever
    • carditis
    • nodules on wrist
    • pain in joints chorea- weird jerky movements cant control
    • can have two major s/s and a major and minor
  13. RF: jones criteria major
    • JONES
    • J- joints migratory polyathritis inflammation of the joints
    • O- heart carditis SOB new heart murmur
    • N- nodules wrist, knee
    • E- Erythymia long lasting rash
    • S- Sydebham- chorea jerky movements
  14. RF Jones criteria minor
    • fever
    • Arthralgia: joint pain without swollen
    • lab abnormalities: incre ESR, incr CRP, leukocytosis
    • ECG abnormal prolonged PR interval
    • Evidence of Group a step positive culture
  15. RF Thera management
    • RF last 6-8 weeks
    • Goal: prevent permanent damage to the heart
    • medication:
    • antibiotics: penicillin= drug of choice given for 10 days or IM injection of penicillin
    • PCN allergy erthymycin
    • corticorsteriods and ibuprofen: for inflammation and joint pain
    • neuroleptic agent: to treat chorea
    • digixin and diuretics: cardiac support
    • possible valve replacement acute phase bedrest, analgesics and antipyretics
  16. RF prevention teaching
    • Prevent reoccurance
    • - pt with reheumatic carditis: for 5 yrs or until they are 21
    • - pt will previous hx of reheumatic carditis but will not residual cardiac disease
    • --prophalytic antibiotics for at least 10 yrs and will into adulthood
    • pt with rheumatic heart disease should have prophylactic antibiotics for at least 10 yrs and at least until 40 yrs old
  17. kawasaki disease
    • def: multisystem disease of young children, characterized by vasculitis of the small and medium sized blood vessels (vessels in body all inflammed becomes weaks and it could collapse and you have aneurism) have aneurism if not treated. self limited syndrome
    • vasculitis: inflammation of blood vessels
    • leading cause of acquired heart disease in children
    • < 5yrs in children 80% < 4yrs old
    • winter and spring
    • cause: unkwown but suggestive of infectious process maybe autoimmune but not contagious
  18. kawasaki disease s/s
    • fever greater than 5 days and 4/5 days you will see:
    • - skin rash non vesicular
    • - cervical lymphadenopathy >1.5mm
    • - edema and erythema of hands and feet with eventual peeling of skin
    • - irritation and inflammation of the mouth with strawberry tongue, erythema and cracking lipis
    • - conjunctivitis without exudate
    • - big thing we worry about is aneurism
  19. Kawasaki disease: additional information
    • children with fever and fewer than four signs but have vessel aneurysm= atypical kawaski disease
    • complication: aneurysm of arterial vessels at 12-28 days after onset of disease, may thrombose leading to myocardial infartion and death
  20. Kawasaki disease nursing care
    • Administer meds:
    • IV immunoglobin: high dose 2g/kg
    • aspirin: high dose 80-100 mg/kg/day
    • corticosteriods: methylprednisolone
    • monitor cardiac status for CHF
    • - po and IVF strict I&O
    • Promote comfort: fever manage, cluster care, mouth care, cool liquids, ice chips, positioning
    • ongoing communication/education of family
    • - chorea and continued arthritis will resolved eventually
    • avoid measles and varicella immunization for 11 months after high dose IV
    • on going monitoring CPR training
  21. Cardiac surgery
    • open heart surgery is the chief cure for congenital heart disease
    • 1. Cardiopulmonary bypass: diverts blood from the right atrium to heart-lung machine, then blood is returned to the body bypassing the heart
    • 2. maintained in hypothermia state
    • 3. Major nursing responsibility
    • - monitor body temp
    • - rewarm after surgery
  22. Cardiac surgery pre op nursing
    • Vital Sign baseline count 1 full minute
    • - important: for bp have child rest for 15 minutes and take bp with child laying down
    • height weight: estimation of blood volume and medication dosing
    • hold digoxin 24 hr prior to surgery
    • Surgical site preparation: scrub with antiseptic to prevent infection
    • Prepare child and family for surgery:
    • - about surgery
    • - amount of equipment that is necessary to care for child post operative
  23. Cardiac surgery post op nursing
    • incentive spirometer: encourage incentive spirometer, and deep breathing and cough to help lungs expand
    • chest tubes: educate about the neeed for thoracotomy chest tubes after surgery
    • - necessary to help re-expand the lungs
    • - drain excessive fluid to decrease the risk of infection
    • - chest tube are connected to a water seal drainage system (pleur-evac)
  24. Dislodged Thoracotomy chest tubes
    • Emergency situation:
    • Air rushing into the chest cavity causing pneumothorax, with dyspnea, tachycardia, cyanosis, sharp chest pain
    • clamp tube closest to the chest with large clamp, prevents more air for entering into the chest cavity
    • If completely dislodge: cover immediately with petrolatum gauze or place a gloved hand directly over the punctured wound and hold tightly until help arrives
    • provide emergent O2
    • remain calm
  25. Blood pressure children
    • Htn in children and adolescents is defined:
    • - systolic BP and/or diastolic BP that is at or above the 95th percentile, on repeated measurement
    • - BP between the 90th-95th normal high or prehtn- lifestyle modification
  26. taking blood pressure in children
    • all children >3 yrs old should their bp measure
    • - manual auscultation
    • - approriate size cuff
    • - confirm elevated bp on repeated visit to HCP before characterizing a child as htn
  27. Classification for Htn
    • Normal BP less than 90th percentile
    • prehyn: 90th and 95th percentile
    • - greater than or equal to 120-80
    • Htn greater than 95th percentile