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Pediatric Cardiac Disorders

Pediatric Cardiac Disorders

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Published by Jerome Daz

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Published by: Jerome Daz on Jul 16, 2012
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01/26/2014

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 PEDIATRIC CARDIAC DISORDERS
 
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Tachycardia
 - an abnormal rapidity of heart action that usually is defined as a heart rate more than 100 beatsper minute (bpm) in adults. In children, the normal heart rate is age dependent, and the definitionof tachycardia variesClassification:- - Atrial Tachycardia- - Atrial Ectopic Tachycardia- - Ventricular Tachycardia- - Supraventricular TachycardiaPathophysiology:The heart is innervated primarily by the vagus nerve and the sympathetic ganglion.Pain sensation travels through afferent fibers associated with the sympathetic ganglia. In mostpatients, the sensation of a normal heartbeat is not felt. Some children may complain of palpitations or rushing or pounding in the ears.Treatment:- - Start intravenous (IV) fluids when indicated- - Administration of prescribed medications (Antiarrhythmic agents)- - Administer oxygenNursing Intervention:- - Assess and stabilize airway, breathing, and circulation- - Place a cardiorespiratory monitor- - Monitor VS- - Monitor the patient- - Monitor medication doses and adverse effects
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Congenital Heart Disease
 - - a defect of the heart that has developed within the womb. It can range in severity from aminor opening within the walls of the heart itself to a missing portion of the organPathophysiology:The reason why some children are born with congenital heart disease is still unknown,there are factors that can play a role in their development. Of all the causes of heart defects,genetics is one of the main culprits. This is largely because many cases of pediatric congenitalheart disease not only run in families, but are also linked to certain disorders, such as Downsyndrome, Noonan syndrome and Marfan syndrome.Treatment:- - Administration of prescribed medications- - Surgery (Heart Transplant)
 
 Nursing Intervention:- - Monitor VS- - Monitor the patient- - Monitor medication doses and adverse effects- - Assess and stabilize airway, breathing, and circulation- - Place a cardiorespiratory monitor
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Prolonged QT Syndrome
 - - is a genetically transmitted cardiac arrhythmia caused by ion channel proteinabnormalities. It is characterized by electrocardiographic abnormalities and a high incidence of syncope and sudden cardiac deathClassification:- - Jervell and Lang-Nielsen (JLN) syndrome
 – 
autosomal recessive form- - Romano-Ward syndrome (RWS)
 – 
dominant formPathophysiology:This syndrome, once diagnosed by clinical profile, has been more clearly defined byspecific genetic defects that cause ion channel abnormalities, resulting in a syndrome thatpredisposes to lethal cardiac arrhythmias. Initial studies using monophasic action potentials haveshown evidence of early after depolarizations (EADs) in congenital and acquired long QTsyndrome. Excessive prolongation of action potential results in reactivation of certain L-typecalcium channels, leading to after depolarizations.Treatment:(Short-term treatment)- - intravenous (IV) magnesium and potassium administration- - temporary cardiac pacing- - withdrawal of the offending agent- - correction of electrolyte imbalance- - IV isoproterenol administration(Long
 – 
term treatment)- - Beta-Adrenergic Blocking AgentsNursing Intervention:- - Monitor VS- - Monitor the patient- - Monitor medication doses and adverse effects- - Monitor ECG
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Congestive Heart Failure
 - - occurs when the heart can no longer meet the metabolic demands of the body at normalphysiologic venous pressuresClassification:- - Acute Heart Failure
 
- - Chronic Heart FailurePathophysiology:The first manifestation of congestive heart failure is usually tachycardia. An obviousexception to this finding occurs in congestive heart failure due to a primary bradyarrhythmia orcomplete heart block. As the severity of congestive heart failure increases, signs of venouscongestion usually ensue. Left-sided heart failure is generally associated with signs of pulmonaryvenous congestion, whereas right-sided heart failure is associated with signs of systemic venouscongestion. Marked failure of either ventricle, however, can affect the function of the other,leading to systemic and pulmonary venous congestion. Later stages of congestive heart failureare characterized by signs and symptoms of low cardiac output. Generally, congestive heartfailure with normal cardiac output is called compensated congestive heart failure, and congestiveheart failure with inadequate cardiac output is considered decompensated.Treatment:- - Administration of prescribed medications (ACE Inhibitors, Inotropic Agents)- - Reducing the preload- - Enhancing cardiac contractility- - Reducing the afterload- - Improving oxygen delivery- - Enhancing nutritionNursing Intervention:- - Monitor VS- - Monitor the patient- - Monitor medication doses and adverse effects- - Assess and stabilize airway, breathing, and circulation- - Place a cardiorespiratory monitor
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Pericarditis
 - - an inflammation of the pericardiumClassification:- - Infective Pericarditis (Fungal, Viral, Bacterial Pericarditis)- - Constrictive PericarditisPathophysiology:Inflammation of the pericardium secondary to an infection leads to an increase inpermeability to proteins and inflammatory cells, and fluid accumulates between the visceral andparietal layers (pericardial effusion). Because the pericardium has a limited ability to stretchacutely, rapid accumulation of fluid leads to increased intrapericardial pressure andhemodynamic compromise. The capacity of the pericardial space is influenced by its naturalstiffness, and infection is known to increase this stiffness, contributing to the symptomatology.Treatment:- - Administration of prescribed medications (non-steroidal Anti-inflammatory drugs)

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