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Pedia Dso Handout

Pedia Dso Handout

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Published by: api-3842758 on Oct 18, 2008
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03/18/2014

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CARDIO
CONGENITAL HEART DISEASE
1. Acyanotic diseases
\u2022Pulmonary circulation and systemic circulation are not connected
\u2022If there is a connection, the pressure is higher in the left side than in the
right side
PATENT DUCTUS ARTERIOSUS

\u2022Most common congenital heart defect
\u2022Symptoms depend on size of the vessel and age of the child
\u2022May have no symptoms; indication may be a murmur
\u2022Increasing dyspnea, full bounding pulse, wide pulse pressure
\u2022Spontaneous closure after infancy rarely occurs
\u2022Without treatment \u2013 life expectancy short

ATRIAL SEPTAL DEFECTS
\u202210% of all forms of congenital heart disease
\u2022Allows oxygenated blood returning from the lungs to pass into the right
atrium
VENTRICULAR SEPTAL DEFECT
\u2022
constitute 20% of all forms of CHD
\u2022
allows systemic venous and oxygenated arterial blood to mix
\u2022
may produce no symptoms at all
\u2022
require no specific treatment and often close spontaneously
COARCTATION OF THE AORTA
\u2022
narrowing of the lumen of the aorta
\u2022
may be an isolated defect or associated with other cardiac malformation
\u2022

Assessment: measure BP in both arms and a leg and to assess the
pulse
in both upper and lower extremities

\u2022
surgical repair \u2013 only permanent treatment; usually deferred until 3 years
of age
PULMONIC VALVE STENOSIS
\u2022
usually do not produce symptoms; typical murmur
AORTIC VALVE STENOSIS
\u2022
mild to moderate asymptomatic; typical murmur
CYANOTIC DISEASES
TETRALOGY OF FALLOT
1. VSD

2. Overriding of the aorta
3. Pulmonary valve stenosis
4. Enlarged right ventricular wall

Assessment:

\u2022Primary sign \u2013 cyanosis
\u2022Hypoxic spells \u2013 usually initiated by crying
\u2022Fainting \u2013 due to cerebral hypoxia
\u2022Stunted growth, clubbed fingers and toes
\u2022Squatting position \u2013 characteristic position to relieve dyspnea

Implementation

\u2022Decrease hypoxic spells \u2013 do not permit child to cry
\u2022Place in knee chest position
\u2022O2 as needed

TRANSPOSITION OF THE GREAT VESSELS
\u2022
aorta arises from the right ventricle
\u2022
degree of cyanosis depends on the abnormal connections
Assessment:
\u2022
cyanotic at birth
\u2022
develop polycythemia\u00e0 risk for emboli and thromboses
\u2022
may develop CHF or pulmonary vascular obstructive
Implementation:
\u2022
require emergency medical treatment
\u2022
cardiac catheterization
\u2022
ballool atrial septostomy
TRICUSPID ATRESIA
\u2022
condition in which tricuspid valve did not form
\u2022
no opening between the right atrium and right ventricle
\u2022
2% of congenital heart defects
\u2022
profound cyanosis and dyspnea at birth
\u2022
emergency catheterization with balloon atrial septotomy
TOTAL ANOMALOUS VENOUS RETURN
\u2022
condition in which all the pulmonary venous blood returns to the heart
\u2022
cyanosis and severe respiratory distress
\u2022
emergency surgical intervention
TRUNCUS ARTERIOSUS
\u2022
single vessel arising from the ventricles just above a large VSD
\u2022
retarded growth; enlarged liver and heart
\u2022
usually infants die within the first year
CARDIOVASCULAR DEFECTS
\u2022
Monitor vital signs closely
\u2022
Monitor respiratory status
\u2022
Auscultate breath sounds for crackles, ronchi or rales
\u2022
if respiratory effort is increased, place child in reverse Trendelenburg
position
\u2022
administer humidified oxygen
\u2022

Monitor for hypercyanotic spells:
1. Place infant in a knee chest position
2. Administer 100% oxygen by mask
3. Administer morphine as ordered
4. IVF as prescribed

\u2022Assess for signs of CHF
\u2022Assess peripheral pulses
\u2022Keep child stress free as possible; allow maximal rest

CARDIAC SURGERY
Postoperatively:
\u2022
monitor for signs of discomfort
\u2022
monitor for signs of sepsis (fever, lethargy, diaphoresis, altered LOC)
\u2022
Monitor lines, tubes or catheters ; remove promptly
\u2022
administer pain medications; note effectiveness
\u2022
encourage rest periods
\u2022
facilitate parent-child contact as soon as possible
Home Care
\u2022
omit activities in which child could fall for 2-4 weeks
\u2022
avoid crowds for 2 weeks after discharge
\u2022
no added salt diet
\u2022
do not put creams, lotions or powders on the incision site
\u2022
child may return to school 3rd week after discharge
\u2022
no physical education for 2 months
\u2022
follow up after 2 weeks
\u2022
avoid immunizations, invasive procedure and dental visits for 2 months
\u2022
advise parents regarding importance of dental visit every 6 months
\u2022
inform dentist of cardiac problem
\u2022
instruct parents to call MD if with coughing, tachypnea, cyanosis,
diarrhea
CONGESTIVE HEART FAILURE
\u2022
inability of the heart to pump sufficiently to meet the metabolic demands
of the body
\u2022
infants \u2013 most commonly caused by congenital heart defects
\u2022
combination of both left sided and right sided heart failure
\u2022
goal of treatment: to improve cardiac function, remove accumulated fluid
and sodium, decrease cardiac demands, improve tissue oxygenation
Assessment:
\u2022
tachycardia
\u2022
tachypnea
\u2022
profuse scalp sweating especially in infants
\u2022
fatigue and irritability
\u2022
sudden weight gain
\u2022
respiratory distress
Implementation:
\u2022
monitor vital signs closely and for early signs of CHF
\u2022
monitor for respiratory distress
\u2022
monitor I and O; weigh diapers
\u2022
Monitor daily weight to assess for fluid retention; weight gain of 0.5 kg
( 1 lb /day)
\u2022
monitor for facial or peripheral edema , auscultate lung sounds
\u2022
elevate HOB
\u2022
maintain neutral thermal environment to prevent cold stress in infants
\u2022
administer cool, humidified oxygen
\u2022
organize nursing activities to allow uninterrupted sleep
\u2022
maintain adequate nutritional status
\u2022
provide rest; decrease environmental stimuli
\u2022
feed when hungry and soon after awakening
\u2022
infant should be well rested before feeding
\u2022
provide small, frequent feedings
\u2022
administer sedation
\u2022
administer digoxin
\u2022
check with physician parameters for witholding digoxin
\u2022Note that infants rarely receive more than 1 mL (50 ug or 0.05 mg) of
digoxin
\u2022
Administer diuretics; monitor for hypokalemia
\u2022
administer potassium supplements

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