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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