Pediatric Nursing Reviewer Cardiovascular
Content
Pediatric Nursing Reviewer
Cardiovascular Dysfunction
Fetal circulation:
Placenta - Umbilical vein – Liver (Ductus
Venosus) – Inferior Vena Cava – Right Atrium –
Foramen Ovale – Left Atrium – Mitral valve – left
ventricle – aortic semilunar valve – Aorta –
ascending aorta – head & upper extremities –
superior vena cava – right atrium – tricuspid valve –
right ventricle – pulmonary semilunar valve –
pulmonary artery – Lungs pulmonary vein – ductus
arteriosus – descending aorta – lower part of the
body – umbilical artery – placenta
INCREASE PULMONARY BLOOD FLOW
Atrial Septal Defect
CONGENITAL
INCIDENCE:
5 – 8 in 1000 live birth.
2 – 3 per 1000 birth is with symptoms needs
treatment.
Major cause of death in first year of life (after
prematurity)
Most common anomaly is VSD
In ASD Right Atrium Receives blood both
from the organs and from Left Atrium.
In effect Right Ventricle and Pulmonary
Artery receives more blood than they
usually do.
PULMONARY CONGESTION is common.
Ventricular Septal Defect
Left to right shunting – Acyanotic
Increase Pulmonary blood flow
Congestive heart failure
Right to Left shunting – cyanotic
Decrease Pulmonary blood flow
Hypoxemia
Hemodynamics
1. Pressure Increase pressure in Left Side
Decrease pressure in Right Side
2. Resistance Increase Resistance in Systemic
Circulation Decrease in Pulmonary Circulation
3. Saturation
SVC and IVC –lowest O2 saturation
RA, RV and Pulmonary Artery - equal saturation
Pulmonary Vein – fully saturated
LA and LV – equal saturation
Presence of Hole between the Right
Ventricle and the Left Ventricle.
In VSD Right Ventricle Receives blood both
from Right Atrium and from Left Ventricle.
In effect Pulmonary Artery receives more
blood than they usually do.
PULMONARY CONGESTION is common.
Severe cases:
EISENMENGER SYNDROME – very severe
resistance in pulmonary blood flow
increases
Intervention in ASD and VSD
If not interfere with the ADL – x surgery
If interfere with ADL – need for surgery
Put DACRON PATCH
Open Heart Surgery is perform for ASD
and VSD
Patent Ductus Arteriosus
Balloon – Tipped Catheter - to increase the
diameter of the lumen of the Aorta
Usually done with Cardiac Catheterization.
If not effective – surgery is done by Ligating the
portion of the Aorta with the coarctation and
then END-to-END Anastomosis is performed.
CYANOTIC…
DECREASE PULMONARY BLOOD FLOW
Presence of Artery that connects the Aorta to
the Pulmonary Artery.
Shunting is from the Aorta to Pulmonary Artery.
In effect Pulmonary Artery receives more blood
that it usually does.
Leading to increase Pulmonary Artery Pressure.
PULMONARY CONGESTION
Intervention of PDA
15 mins to 12 hours (normal time it takes for
PDA to Close)
After 12 hours - x surgery yet.
INDOMETHACIN – prostaglandin inhibitor that
causes vasospasm of the Ductus Arteriosus.
Gastric irritant – causes Gastric bleeding.
Manifestaion of ASD & VSD
Presence of Murmur
Manifestaion of PDA
Presence of Murmur (machinery like murmur)
OBSTRUCTIVE DEFECTS
Coarctation of Aorta
Manifestation
The BP on the UPPER EXTREMITY is
GREATER relative to the pressure on the
LOWER EXTREMITY.
Epistaxis
Gum Bleeding
Intracranial Hemorrhage – the most common
cause of death in COA.
Intervention
Manifestation
Clubbing of Fingers
Polycythemia
TET SPELL / blue spell
Intervention
Provide rest and Decrease Energy
expenditure.
Position: Knee Chest
Position, Squatting position.
COMPLETE REPAIR
First yr of life
Closure of VSD & resection of stenosis;
pericardial patch to enlarge RV outflow
Blalock –total repair
ACQUIRED HEART DISEASE
Rheumatic Heart Disease
Inflammatory disease following an
infection by GABHS.
Jones Criteria
Major Criteria:
Subcutenous nodule
Polyarthritis
Erythema marginatum
Carditis
Syndenhamms Chorea or
St. Vitus Dance
Minor Criteria:
Arthralgia
Low Grade Fever
All Lab results
**Increase C- Reactive Protein, ESR and
ASO
Diagnosis
2 MAJOR or
1 MAJOR + 2 MINOR
Management
CBR
Treatment of streptococcal
tonsillitis/pharyngitis
Medications = penicillin; ASA
(tinnitus)
Kawasaki Disease
Mucocutaneuos lymph node
syndrome
Multisystem
disease
associated
with
Splenomegaly
Petichiae
Respi distress, dif, in feeding, tachycardia
Intervention
High-dose antibiotics= penicillin IV (2-8wks)
DOC: Amoxicillin 1 hour before any procedure
*dental prodedure; respi; GI;
Gatrourinary tract
Observe side effects of antibiotics; &
complications (embolism)
Teaching importance of follow up check up
Early dx & tx
Congestive heart failure
Inability of the heart to pump sufficiently to
meet the metabolic needs of the body.
Common cause by congenital heart defect.
inflammation (Vasculitis)
Phases:
Acute Phase
– Fever
– Unresponsive to antibiotics & antipyretics
– Eyes redden, dry w/o drainage
– Strawberry tongue
– Rashes
Subacute Phase
– 10 days after the onset.
– Increase in Platelet count
– Aneurysm
– Most dangerous phase
Convalescent Phase
– 25th – 40 days
– ESR returning to normal
Management
Administration of Acetylsalicylic acid (ASA)
Bacterial Endocarditis
Infective endocarditis
Infection of valve & inner lining of heart that can
damage & destroy heart valves
Usually affect mitral or aortic valve
After birth/ congenital heart defect
Autoimmune; environmental factor; infection
Sequela of bacteremia
Manifestation
Low grade fever, intermittent fever
Headache, malaise, diaphoresis, wt loss
New murmur – damage in valve/perforation
Heart Failure
Right Sided
Jugular vein distention
Ascites
Hepatomegaly
Spleenomegaly
Peripheral edema
Left Sided
Dyspnea
Orthopnea
Crackles / Rales
Moist cough
Blood tinge frothy sputum
(Pulmonary Edema)
Intervention
Digitalis – improves contractility.
3 Major Actions
1. Increase force of contraction
2. Decrease heart rate
3. Enhances diuresis
Angiotensin Converting Enzyme (ACE)
inihbitors – it reduces afterload, thus make
heart easier to pump.
Example:
Captopril (Capoten)
Enalapril (Vasotec)
Diuretics - eliminate water and Salt
Example:
Furosemide (Lasix) & Thiazides
- It can cause K loss
- K supplement
Decrease K = Enhancement of Digoxin that
may lead to Digoxin Toxicity
Increase K = Decrease absorption of
Digoxin that may lead to no effect
Therefore normal K must be monitored
Normal K: 3.3-5.5mmol/L
Nursing Management
1. Administration of Digoxin
Calculating correct dosage.
Digoxin toxicity.
Check . . .
APICAL PULSE
***Not Given if Pulse is:
a. < 90 – 110 beats/min – infant and
young children
b. 70 beats/min – older children
c. 60 beats / min adult
Digoxin Toxicity
Bradycardia
Anoxeria
Nausea and Vomiting
Therapeutic Level: 0.8-2mcg/L
2. BP Monitoring
3. Position in SEMI FOLWERS - for Lung
expansion
4. Maintain Nutritional Needs – small frequent meal
5. Maintain F & Electrolyte Balance
Cardiac catheterization- most invasive
diagnostic procedure
Inserting of catheter into the heart &
surrounding vessels
Obtain info about structure &
performance of the heart valves & circulatory
system; O2 sat.;
pressure changes;
cardiac output & stroke volume
Insertion of Cardiac Catheter
1. Right sided-(most common)
** Femoral vein to right atrium
2. Left sided
**artery to aorta to Right ventricle
Management
Consent
sedation
Assess allergy to dye, seafood, or radiopaque
dyes
No solid food 6-8hours & liquid 4 hrs
Document ht. & wt.
VS; local anesthesia;
Check peripheral pulse
+ fluttery feeling in insertion ; flushed; warm
feeling when dye is injected; desired to cough;
palpitation = heart irritability
Shaving & cleaning the site
IV Line
Cardiovascular Dysfunction
Fetal circulation:
Placenta - Umbilical vein – Liver (Ductus
Venosus) – Inferior Vena Cava – Right Atrium –
Foramen Ovale – Left Atrium – Mitral valve – left
ventricle – aortic semilunar valve – Aorta –
ascending aorta – head & upper extremities –
superior vena cava – right atrium – tricuspid valve –
right ventricle – pulmonary semilunar valve –
pulmonary artery – Lungs pulmonary vein – ductus
arteriosus – descending aorta – lower part of the
body – umbilical artery – placenta
INCREASE PULMONARY BLOOD FLOW
Atrial Septal Defect
CONGENITAL
INCIDENCE:
5 – 8 in 1000 live birth.
2 – 3 per 1000 birth is with symptoms needs
treatment.
Major cause of death in first year of life (after
prematurity)
Most common anomaly is VSD
In ASD Right Atrium Receives blood both
from the organs and from Left Atrium.
In effect Right Ventricle and Pulmonary
Artery receives more blood than they
usually do.
PULMONARY CONGESTION is common.
Ventricular Septal Defect
Left to right shunting – Acyanotic
Increase Pulmonary blood flow
Congestive heart failure
Right to Left shunting – cyanotic
Decrease Pulmonary blood flow
Hypoxemia
Hemodynamics
1. Pressure Increase pressure in Left Side
Decrease pressure in Right Side
2. Resistance Increase Resistance in Systemic
Circulation Decrease in Pulmonary Circulation
3. Saturation
SVC and IVC –lowest O2 saturation
RA, RV and Pulmonary Artery - equal saturation
Pulmonary Vein – fully saturated
LA and LV – equal saturation
Presence of Hole between the Right
Ventricle and the Left Ventricle.
In VSD Right Ventricle Receives blood both
from Right Atrium and from Left Ventricle.
In effect Pulmonary Artery receives more
blood than they usually do.
PULMONARY CONGESTION is common.
Severe cases:
EISENMENGER SYNDROME – very severe
resistance in pulmonary blood flow
increases
Intervention in ASD and VSD
If not interfere with the ADL – x surgery
If interfere with ADL – need for surgery
Put DACRON PATCH
Open Heart Surgery is perform for ASD
and VSD
Patent Ductus Arteriosus
Balloon – Tipped Catheter - to increase the
diameter of the lumen of the Aorta
Usually done with Cardiac Catheterization.
If not effective – surgery is done by Ligating the
portion of the Aorta with the coarctation and
then END-to-END Anastomosis is performed.
CYANOTIC…
DECREASE PULMONARY BLOOD FLOW
Presence of Artery that connects the Aorta to
the Pulmonary Artery.
Shunting is from the Aorta to Pulmonary Artery.
In effect Pulmonary Artery receives more blood
that it usually does.
Leading to increase Pulmonary Artery Pressure.
PULMONARY CONGESTION
Intervention of PDA
15 mins to 12 hours (normal time it takes for
PDA to Close)
After 12 hours - x surgery yet.
INDOMETHACIN – prostaglandin inhibitor that
causes vasospasm of the Ductus Arteriosus.
Gastric irritant – causes Gastric bleeding.
Manifestaion of ASD & VSD
Presence of Murmur
Manifestaion of PDA
Presence of Murmur (machinery like murmur)
OBSTRUCTIVE DEFECTS
Coarctation of Aorta
Manifestation
The BP on the UPPER EXTREMITY is
GREATER relative to the pressure on the
LOWER EXTREMITY.
Epistaxis
Gum Bleeding
Intracranial Hemorrhage – the most common
cause of death in COA.
Intervention
Manifestation
Clubbing of Fingers
Polycythemia
TET SPELL / blue spell
Intervention
Provide rest and Decrease Energy
expenditure.
Position: Knee Chest
Position, Squatting position.
COMPLETE REPAIR
First yr of life
Closure of VSD & resection of stenosis;
pericardial patch to enlarge RV outflow
Blalock –total repair
ACQUIRED HEART DISEASE
Rheumatic Heart Disease
Inflammatory disease following an
infection by GABHS.
Jones Criteria
Major Criteria:
Subcutenous nodule
Polyarthritis
Erythema marginatum
Carditis
Syndenhamms Chorea or
St. Vitus Dance
Minor Criteria:
Arthralgia
Low Grade Fever
All Lab results
**Increase C- Reactive Protein, ESR and
ASO
Diagnosis
2 MAJOR or
1 MAJOR + 2 MINOR
Management
CBR
Treatment of streptococcal
tonsillitis/pharyngitis
Medications = penicillin; ASA
(tinnitus)
Kawasaki Disease
Mucocutaneuos lymph node
syndrome
Multisystem
disease
associated
with
Splenomegaly
Petichiae
Respi distress, dif, in feeding, tachycardia
Intervention
High-dose antibiotics= penicillin IV (2-8wks)
DOC: Amoxicillin 1 hour before any procedure
*dental prodedure; respi; GI;
Gatrourinary tract
Observe side effects of antibiotics; &
complications (embolism)
Teaching importance of follow up check up
Early dx & tx
Congestive heart failure
Inability of the heart to pump sufficiently to
meet the metabolic needs of the body.
Common cause by congenital heart defect.
inflammation (Vasculitis)
Phases:
Acute Phase
– Fever
– Unresponsive to antibiotics & antipyretics
– Eyes redden, dry w/o drainage
– Strawberry tongue
– Rashes
Subacute Phase
– 10 days after the onset.
– Increase in Platelet count
– Aneurysm
– Most dangerous phase
Convalescent Phase
– 25th – 40 days
– ESR returning to normal
Management
Administration of Acetylsalicylic acid (ASA)
Bacterial Endocarditis
Infective endocarditis
Infection of valve & inner lining of heart that can
damage & destroy heart valves
Usually affect mitral or aortic valve
After birth/ congenital heart defect
Autoimmune; environmental factor; infection
Sequela of bacteremia
Manifestation
Low grade fever, intermittent fever
Headache, malaise, diaphoresis, wt loss
New murmur – damage in valve/perforation
Heart Failure
Right Sided
Jugular vein distention
Ascites
Hepatomegaly
Spleenomegaly
Peripheral edema
Left Sided
Dyspnea
Orthopnea
Crackles / Rales
Moist cough
Blood tinge frothy sputum
(Pulmonary Edema)
Intervention
Digitalis – improves contractility.
3 Major Actions
1. Increase force of contraction
2. Decrease heart rate
3. Enhances diuresis
Angiotensin Converting Enzyme (ACE)
inihbitors – it reduces afterload, thus make
heart easier to pump.
Example:
Captopril (Capoten)
Enalapril (Vasotec)
Diuretics - eliminate water and Salt
Example:
Furosemide (Lasix) & Thiazides
- It can cause K loss
- K supplement
Decrease K = Enhancement of Digoxin that
may lead to Digoxin Toxicity
Increase K = Decrease absorption of
Digoxin that may lead to no effect
Therefore normal K must be monitored
Normal K: 3.3-5.5mmol/L
Nursing Management
1. Administration of Digoxin
Calculating correct dosage.
Digoxin toxicity.
Check . . .
APICAL PULSE
***Not Given if Pulse is:
a. < 90 – 110 beats/min – infant and
young children
b. 70 beats/min – older children
c. 60 beats / min adult
Digoxin Toxicity
Bradycardia
Anoxeria
Nausea and Vomiting
Therapeutic Level: 0.8-2mcg/L
2. BP Monitoring
3. Position in SEMI FOLWERS - for Lung
expansion
4. Maintain Nutritional Needs – small frequent meal
5. Maintain F & Electrolyte Balance
Cardiac catheterization- most invasive
diagnostic procedure
Inserting of catheter into the heart &
surrounding vessels
Obtain info about structure &
performance of the heart valves & circulatory
system; O2 sat.;
pressure changes;
cardiac output & stroke volume
Insertion of Cardiac Catheter
1. Right sided-(most common)
** Femoral vein to right atrium
2. Left sided
**artery to aorta to Right ventricle
Management
Consent
sedation
Assess allergy to dye, seafood, or radiopaque
dyes
No solid food 6-8hours & liquid 4 hrs
Document ht. & wt.
VS; local anesthesia;
Check peripheral pulse
+ fluttery feeling in insertion ; flushed; warm
feeling when dye is injected; desired to cough;
palpitation = heart irritability
Shaving & cleaning the site
IV Line
