Systemic Bullets
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CARDIO
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
atriumVENTRICULAR 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
pulsein both upper and lower extremities
surgical repair only permanent treatment; usually deferred until 3 yearsof age
PULMONIC VALVE STENOSIS usually do not produce symptoms; typical murmur
AORTIC VALVE STENOSIS mild to moderate asymptomatic; typical murmur
CYANOTIC DISEASES
TETRALOGY OF FALLOT1. VSD2. Overriding of the aorta3. Pulmonary valve stenosis4. 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
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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 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 position2. Administer 100% oxygen by mask3. Administer morphine as ordered4. IVF as prescribed
Assess for signs of CHF Assess peripheral pulses Keep child stress free as possible; allow maximal rest
CARDIAC SURGERYPostoperatively:
monitor for signs of discomfort monitor for signs of sepsis (fever, lethargy, diaphoresis, altered LOC)
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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
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monitor serum electrolytes restrict fluid in acute stages check with physician regarding sodium restriction; infant formulas have
slightlymore 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 andblood 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
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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
GASTROINTESTINAL SYSTEM
Physiology of DIGESTIVE SYSTEM
Mechanical functions of digestion immature at birth
No voluntary control over swallowing until 6 weeks
Stomach capacity decreasedRelaxed sphincter contributes to tendency to regurgitate
Liver functions immature throughout infancy
Gastric acidity low in infants rises until age 10
Digestive processes are mature by toddlerhood
Assessment:
Presenting problem
a. Vomitingb. Abnormal bowel habits: diarrhea, constipation, bleeding
c. Weight loss, failure to thrived. Pain
Nutritional history
Physical Examination:
General appearance:
a. Height and weightb. Measure mid arm circumferencec. Observe color: jaundice
Mouth: dentition
Abdomen
a. Skin integrityb. Abdominal distension; visible peristaltic wavesc. Inspect for herniasd. Auscultate bowel sounds ( every 10-30 seconds)e. Palpate for tendernessf. Liver span (inferior edge palpated 1-2 cm below RCM)g. Spleen (felt on inspiration 1-2 cm below left costal margin)
DISORDERS OF THE TEETH
DENTAL CARIES
erosion of the enamel and dentine of teeth
results from combination of fermenting sugars and starched
and acid forming organisms
Prevention:
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dental hygiene
regular dental hygiene
good nutrition
fluoridation
CLEFT LIP AND CLEFT PALATE
1 in 1000 births
multifactorial
common among children with chromosomal abnormalities
resul