Cardio Pediatrics

Source:  Cardio Pediatrics    Tag:  tricuspid atresia life expectancy


CONGENITAL HEART DISEASE

  1. Acyanotic diseases
          Pulmonary circulation and systemic circulation are not connected
          If there is a connection, the pressure is higher in the left side than in the
            right side

PATENT DUCTUS ARTERIOSUS
          Most common congenital heart defect
          Symptoms depend on size of the vessel and age of the child
          May have no symptoms; indication may be a murmur
          Increasing dyspnea, full bounding pulse, wide pulse pressure
          Spontaneous closure after infancy rarely occurs
          Without treatment – life expectancy short

ATRIAL SEPTAL DEFECTS
          10% of all forms of congenital heart disease
          Allows oxygenated blood returning from the lungs to pass into the right
            atrium
VENTRICULAR SEPTAL DEFECT
             constitute 20% of all forms of CHD
             allows systemic venous and oxygenated arterial blood to mix
             may produce no symptoms at all
             require no specific treatment and often close spontaneously

COARCTATION OF THE AORTA
            narrowing of the lumen of the aorta
            may be an isolated defect or associated with other cardiac malformation
            Assessment:  measure BP in both arms and a leg and to assess the pulse
            in both upper and lower extremities
            surgical repair – only permanent treatment; usually deferred until 3 years
            of age

PULMONIC VALVE STENOSIS
            usually do not produce symptoms; typical murmur

AORTIC VALVE STENOSIS
            mild to moderate asymptomatic; typical murmur
CYANOTIC DISEASES

TETRALOGY OF FALLOT
  1. VSD
  2. Overriding of the aorta
  3. Pulmonary valve stenosis
  4. Enlarged right ventricular wall

Assessment:
          Primary sign – cyanosis
          Hypoxic spells – usually initiated by crying
          Fainting – due to cerebral hypoxia
          Stunted growth, clubbed fingers and toes
          Squatting position – characteristic position to relieve dyspnea

Implementation
          Decrease hypoxic spells – do not permit child to cry
          Place in knee chest position
          O2 as needed

TRANSPOSITION OF THE GREAT VESSELS
            aorta arises from the right ventricle
            degree of cyanosis depends on the abnormal connections

Assessment:
            cyanotic at birth
            develop polycythemia à risk for emboli and thromboses
            may develop CHF or pulmonary vascular obstructive

Implementation:
            require emergency medical treatment
            cardiac catheterization
            ballool atrial septostomy

TRICUSPID ATRESIA
            condition in which tricuspid valve did not form
            no opening between the right atrium and right ventricle
            2% of congenital heart defects
            profound cyanosis and dyspnea at birth
            emergency catheterization with balloon atrial septotomy

TOTAL ANOMALOUS VENOUS RETURN
            condition in which all the pulmonary venous blood returns to the heart
            cyanosis and severe respiratory distress
            emergency surgical intervention

TRUNCUS ARTERIOSUS
            single vessel arising from the ventricles just above a large VSD
            retarded growth; enlarged liver and heart
            usually infants die within the first year

CARDIOVASCULAR DEFECTS
            Monitor vital signs closely
            Monitor respiratory status
            Auscultate breath sounds for crackles, ronchi or rales
            if respiratory effort is increased, place child in reverse Trendelenburg
            position
            administer humidified oxygen
            Monitor for hypercyanotic spells:
  1. Place infant in a knee chest position
  2. Administer 100% oxygen by mask
  3. Administer morphine as ordered
  4. IVF as prescribed

          Assess for signs of CHF
          Assess peripheral pulses
          Keep child stress free as possible; allow maximal rest

CARDIAC SURGERY
Postoperatively:
             monitor for signs of discomfort
             monitor for signs of sepsis (fever, lethargy, diaphoresis, altered LOC)
             Monitor lines, tubes or catheters ; remove promptly
             administer pain medications; note effectiveness
             encourage rest periods
              facilitate parent-child contact as soon as possible

Home Care
            omit activities in which child could fall for 2-4 weeks
            avoid crowds for 2 weeks after discharge
            no added salt diet
            do not put creams, lotions or powders on the incision site
            child may return to school 3rd week after discharge
            no physical education for 2 months
            follow up after 2 weeks
            avoid immunizations, invasive procedure and dental visits for 2 months
            advise parents regarding importance of dental visit every 6 months
            inform dentist of cardiac problem
            instruct parents to call MD if with coughing, tachypnea, cyanosis, diarrhea

CONGESTIVE HEART FAILURE
            inability of the heart to pump sufficiently to meet the metabolic demands
            of the body
            infants – most commonly caused by congenital heart defects
            combination of both left sided and right sided heart failure
            goal of treatment: to improve cardiac function, remove accumulated fluid
            and sodium, decrease cardiac demands, improve tissue oxygenation

Assessment:
            tachycardia
            tachypnea
            profuse scalp sweating especially in infants
            fatigue and irritability
            sudden weight gain
            respiratory distress
Implementation:
            monitor vital signs closely and for early signs of CHF
            monitor for respiratory distress
            monitor I and O; weigh diapers
            Monitor daily weight to assess for fluid retention; weight gain of 0.5 kg
            ( 1 lb /day)
            monitor for facial or peripheral edema , auscultate lung sounds
            elevate HOB
            maintain neutral thermal environment to prevent cold stress in infants
            administer cool, humidified oxygen
            organize nursing activities to allow  uninterrupted sleep
            maintain adequate nutritional status
            provide rest; decrease environmental stimuli
            feed when hungry and soon after awakening
            infant should be well rested before feeding
            provide small, frequent feedings
            administer sedation
            administer digoxin
            check with physician parameters for witholding digoxin
          Note that infants rarely receive more than 1 mL (50 ug or 0.05 mg) of digoxin
            Administer diuretics;  monitor for hypokalemia
            administer potassium supplements
            monitor serum electrolytes
            restrict fluid in acute stages
            check with physician regarding sodium restriction;  infant formulas have slightly
            more sodium than does breast milk

Home care Instructions for Administering Digoxin
            administer 1 hr before or 2 hrs after feeding
            do not mix medication with food or drink
            if the child vomits, do not administer a second dose
            if more than 2 consecutive doses have been missed, notify MD; do not
            increase or double the dose for missed doses
            keep the medication in a locked cabinet
            if the child becomes ill, notify MD

RHEUMATIC FEVER
            an inflammatory autoimmune disease
            affects connective tissue of the heart, joints, subcutaneous tissues and
            blood vessels of the CNS
            most serious complication – RHD affecting the cardiac valves
            presents 2-6 weeks following an untreated Group A beta hemolytic strep
            Jones criteria

Asssessment:
            signs of carditis:  SOB, edema of the face, abdomen or ankles, precordial  pain
            signs of polyarthritis:  edema, inflammation of the large joints, joint pain
            erythema marginatum: macular rash on trunk and extremities
            subcutaneous nodules
            fever
            elevated ASO
            elevated ESR
            elevated CRP 

Implementation:
            Assess vital signs
            Control joint pain and inflammation with massage
            Febrile phase – provide bed rest
            limit physical exercise in child with carditis
            Administer antibiotics (penicillin) as prescribed
            administer salicylates and anti-inflammatory agents
            Instruct parents about the importance of follow up and need for
            antibiotic prophylaxis for dental work, infection, invasive procedures
            advise child to inform the parents if anyone in school develops a
            strep throat infection

KAWASAKI DISEASE
            known as mucocutaneous lymph node syndrome
            acute systemic inflammatory illness
            unknown cause
            cardiac involvement – most serious complication

Assessment:
            fever
            conjunctival injection
            red throat
            Swollen hands, rash, enlargement of the cervical lymph nodes

Implementation:
            monitor temperature frequently
            assess heart sounds and rhythm
            assess extremities for edema, redness, desquamation
            monitor mucus membrane for inflammation
            weigh daily
            administer IV immune globulin
            instruct parents in the administration of prescribed meds
                  aspirin – need to monitor bleeding