Post on 13-Jan-2016
‘ The Pedi-Cardiac Lecture ’ Part 3
Pediatric Cardiovascular DisordersJerry Carley MSN, MA, RN, CNE
Concept Map: Pediatric Cardiac Conditions
AS
Aortic Stenosis
6% of CHD defects Aortic valve: has two rather than three
leaflets. Leaflets are thickened or fused. Obstruction of blood flow from left ventricle Mild symptoms: dizziness, syncope, angina,
fatigue 30% incidence of sudden death
Pathophysiology Partially fusedAortic Valve Leaflets
Frequently found inAssociation with:
Mitral valveStenosis
Effects / Symptoms
DecreasedExerciseTolerance
PossiblyAsymptomatic
Heart FailureTreatments
Surgery Heart Catheterization
Nursing Care
Closed HeartSurgery
Coarctation of The Aorta
Possible (L)VentricularHypertrophy
BalloonDilation
Stenting
Aortic Stenosis
Causes obstruction to blood flow between the left ventricle and aorta.
Most common form is obstruction of the valve itself
When the aortic valve does not open properly the left ventricle must work harder to eject blood into the aorta.
Left ventricular muscle becomes hypertrophied.
Diagnosis
Heart murmur or AS is a turbulent noise caused by ejection of blood through the obstructed valve.
Electrocardiogram is usually normal Echocardiogram will show the obstruction
and rule out other heart anomalies Exercise stress test – provides information on
impact of the stenosis on heart function
Treatment
Cardiac catheterization – balloon dilation of the narrowed valve.
Surgical valvotomy if the closed procedure does not work – often done when patient is older when severe calcium deposits further obstruct the valve.
Recurrent valve obstruction is a complication and if valve replacement is done too early the child may outgrow the valve.
Antibiotic prophylaxis especially if valve replacement
HLH
Hypoplastic Left Heart (HLH) One of the most complex defects seen in the
newborn and the most challenging of all the congenital defects
All the structures on the left side of the heart are severely underdeveloped.
Mitral and aortic valves are either completely closed or are very small – left ventricle is tiny – aorta is small and often only a few millimeters in diameter
(HLH)
HLH
Life threatening shock develops when the ductus arteriosis closes
Low oxygen saturations – will not increase with oxygen administration
Pulses will be weak in all extremities Plan to deliver infant in a hospital capable of
providing the aggressive treatment needed
Treatment HLH
Three staged procedure to reconfigure the cardiovascular system Norwood Procedure – right ventricle becomes the
systemic ventricle pumping blood to the body Glenn Procedure-- done at 3-6 months Fontan Procedure-- done at 2 -3 years of age
Long Term Complications
Easily tiring when participating in sports or other exercises
Formation of blood clots – heparin or Coumadin use
Heart arrhythmias – pace maker Cardiac failure
Concept Map: Pediatric Cardiac Conditions ( Acquired )
‘Acquired’ Pediatric Cardiac Conditions
Frequent CHD Complication:
Bacterial Endocarditis Infection of endocardial surface of the heart History of CHD, Kawasaki Disease,
Rheumatic Fever, or prosthetic valves are more susceptible to infection
Prophylactic antibiotics with dental care, throat, intestinal, urinary or vaginal infections or surgery.
●● an inflammatory disease that occurs as a reaction to Group Aβ-hemolytic streptococcus (GABHS) infection of the throat.
Assessment●● Risk Factors◯◯ usually occurs within 2 to 6 weeks following an untreated or partiallytreated upper respiratory infection (strep throat) with GABHS.
●● Subjective and Objective Data◯◯ History of recent upper respiratory infection◯◯ Fever◯◯ Fatigue◯◯ Sore throat
Rheumatic Fever
◯◯ Activity intolerance
◯◯ Poor appetite
◯◯ Tachycardia, cardiomegaly, prolonged PR interval, new or changed heart murmur, muffled heart sounds, pericardial friction rub, and reports of chest pain, which may indicate carditis
◯◯ Nontender, subcutaneous nodules over bony prominence
◯◯ Large joints (knees, elbows, ankles, wrists, shoulders) that have painful swelling indicating polyarthritis
■■ Symptoms last a few days and then disappear without treatment, frequently returning in another joint.
Rheumatic Fever…S/S Continued
◯◯ Pink, nonpruritic macular rash on the trunk and inner surfaces of extremities that appears and disappears rapidly, indicating erythema marginatum.
◯◯ CNS involvement (chorea) including involuntary, purposeless muscle movements; muscle weakness; involuntary facial movements; difficulty performing fine motor activities; labile emotions; and random, uncoordinated movements of the extremities
◯◯ Irritability, poor concentration, and behavioral problems
Rheumatic Fever……
Kawasaki Disease
Acute-self limiting disease Generalized vasculitis Peak incidence 6 months to 2 years More common in males and Japanese
http://www.aafp.org/afp/990600ap/3093.html
Clinical Manifestations
High fever Conjunctivitis – no drainage Strawberry tongue Edema of hands and feed Reddening of palms and soles Lymph node swelling
Child with Kawasaki Disease:
Red eyes, dry cracked lips, beefy red tongue
Edema – Hands and Feet
Peeling Finger Tips
Blood Values
Elevated WBC
Elevated ESR
Elevated platelets
Interdisciplinary Interventions
Intravenous gamma globulin High dose of ASA while in hospital Low dose ASA upon discharge Base-line echocardiogram to assess
coronary artery status
Pye, S. & Green, A. (2011) Parent Education After Newborn Congenital Heart Surgery. Retrieved from http://www.medscape.com/viewarticle/458206
Cyanosis Prior to Surgery…
18HoursPost-op
TOF: The Tatoo !
Cardiac
24 Hours Post-Op
http://www.youtube.com/watch?v=KFfCKy0nKr0