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Cardiovascular

Disorders
Fetal Circulation

• placenta provides the


exchange of gas and
nutrient

• four shunts in fetal


circulation:
– Placenta
– Ductus venosus
– Foramen Ovale
– Ductus arteriosus
CONGENITAL HEART
DEFECTS
• CHD are structural defects of the heart,
great vessels, or both that are present at
birth.

• Children with CHD are more likely to have


associated defects such as
tracheoesophageal fistula (TEF)

• CHD is second only to prematurity as a cause


of death in the first year of life.
CONGENITAL HEART
DEFECTS
1.Acyanotic Heart Disease
L R shunt
high pressure to low pressure
oxygenated to unoxygenated
blood

2. Cyanotic Heart Disease


R L shunt
low pressure to high pressure

3. Obstructive Defects
ACYANOTIC HEART DISEASE
1. Atrial Septal Defect
• Opening between atria
• late childhood/early
adulthood
• S/sx: cyanosis(CHF),
dyspnea, fatigue, failure
to thrive, split S2
• Mx: Abx, surgery 1-3 yo
• Cx: endocarditis, heart
failure
• Postop: monitor arrhythmia,
administer antibiotics
ACYANOTIC HEART DISEASE
2. Ventricular Septal Defect

• Opening in ventricular
septum
• Most common
• S/sx: respi infections,
failure to thrive, dyspnea,
fatigue, pansystolic murmur
• Mx: close spontaneously
otherwise surgery <2 yo
• Cx: pulmonary HPN,
endocarditis, heart failure
• Postop: monitor arrhythmia,
administer antibiotics
ACYANOTIC HEART DISEASE
3. Patent Ductus Arteriosus

• Aorta to pulmonary
artery
• Common in prematurity,
high altitude, maternal
rubella
• females
• S/sx:clubbing, dyspnea,
“machinery murmur”
(2nd-3rd ICS)
• Cx: heart failure,
endocarditis, pulmonary
artery stasis/HPN
• Mx: Indomethacin,
surgery
CYANOTIC HEART DISEASE
1. Tetralogy of Fallot (TOF)

• S/sx: cyanosis, clubbing,


dyspnea, fatigue, squatting,
“Tet spells”, failure to thrive,
systolic murmur,
polycythemia
• Cx: thromboembolism, CVA
• Mx: O2, knee-chest position,
surgery 1-2 yo
• Postop: monitor for
arrhythmia
Blalock Taussig: anastomose
SC and pulmo art.
- avoid BP and venipuncture
in right arm
CLUBBING IN TETRALOGY OF
FALLOT
CLUBBING OF THE FINGERS
CYANOTIC HEART DISEASE
2. Transposition of the Great Vessels

• Aorta from R
ventricle
• Pulmonary a. from L
ventricle
• Males
• S/sx:cyanosis,
murmurs
• Mx: PGE for PDA,
Balloon catheter to
create ASD, definitive
surgery 1 wk-3 mos
CYANOTIC HEART DISEASE
3. Total Anomalous Pulmonary
Venous Return

• Pulmonary vein
drain to SVC or R
atrium
• PDA or foramen
ovale essential
• S/sx: cyanosis,
fatigue
• CX: R heart
failure
• Mx: PGE, surgery
OBSTRUCTIVE DEFECT
Coarctation of the Aorta

• Constriction of aorta
• S/sx: asymptomatic
HPN, irritability,
headache, epistaxis,
dyspnea, claudication,
higher BP in upper
extremities, dec
femoral and distal
pulses,systolic
murmur
• Cx:chronic HPN
• Mx:surgery 2 yo
• Postop: monitor
abdominal pain,
antihypertensives
COARCTATION OF THE
AORTA
Ndx:
Ineffective cardiopulmonary and peripheral
tissue perfusion related to impaired
cardiac function
• Proper positioning to maintain
respiration
• Conserve energy to promote rest
• Quiet activities and stimulation
• Anticipate needs
• Administer prescribed drugs
COARCTATION OF THE AORTA

Activity intolerance r/t effects of


congenital heart defect and
dyspnea

• Rest periods
• Adequate nutrition
small frequent feedings
iron supplementation
Obstructive Defect
2. PULMONIC STENOSIS
Obstruction of blood flow from the right ventricle to
the pulmonary artery
PULMONIC VALVE
Backflow of blood towards the right ventricle

Right Ventricle has to PUMP HARDER to push the blood


to the pulmonary artery for Oxygenation

RIGHT VENTRICULAR ENLARGEMENT

RIGHT-SIDED CONGESTIVE HEART FAILURE


Obstructive Defect
3. AORTIC STENOSIS
• Involves an obstruction of the ventricular
outflow of the blood
• S/SX: faint pulse, hypotension, tachycardia,
poor feeding, exercise intolerance, chest pains
• DX; ECG, Echocardiography reveals left
ventricular hypertrophy.
• MX:
• Surgical aortic valvulotomy or prosthetic valve
replacement.
• - Balloon Angioplasty to dilate the narrow
valve.
Obstructive Defect
3. AORTIC STENOSIS
Obstruction of flow to the AORTA
• AORTIC VALVE
Backflow of blood towards the LEFT VENTRICLE

Left Ventricle has to PUMP HARDER to push the blood to


the AORTA for distribution of oxygenated blood

LEFT VENTRICULAR HYPERTROPHY with Regurgitation of


oxygenated blood back to the LUNGS

LEFT-SIDED CONGESTIVE HEART FAILURE (Respiratory


Signs)
Kawasaki Disease/
Mucocutaneous Lymph Node
Syndrome

• Before puberty, peaks 4 yo

• S/sx:spiking fever x 5 days, bilateral


conjunctivitis, reddened pharynx, dry
lips, strawberry tongue, cervical
lymphadenopathy, peripheral edema,
erythema and desquammation, truncal
rash, arthritis

• Patho: Respi infection immune complex


systemic vasculitis aneurysm and MI

• Dx: clinical
Mx: Salicylates and Immunoglobulins
KAWASAKI DISEASE
KAWASAKI
• Risk for ineffective peripheral tissue
perfusion related to inflammation of
blood vessels
- Observe for chest pain, color
changes, vomiting

• Pain r/t swelling of lymph nodes and


inflammation of joints
- Comfort measures, administer pain
medications
KAWASAKI
Other Measures:
Protect edematous areas
Record intake and output
Offer soft food
Administer prescribed
medication
Rheumatic
Fever J. N. E. S.
• Autoimmune
• Grp A Beta hemolytic strep
• 6-15 yo, peaks 8 yo
• 1-3 wks after untreated
infection
• Dx: 5 major criteria –
polyarthritis, carditis,
subcutaneous nodules,
erytHema marginatum,
sydenham’s chorea
minor – fever,
polyarthralgia, hx of RF, inc
ESR, antecedent strep
infection
• To diagnose, either 2 major or
1 major and 2 minor
present
• Cx:mitral valve insufficiency
and myocarditis
RHEUMATIC FEVER
Mgmt: salicylate, penicillin
Ndx:
Risk for noncompliance r/t knowledge deficit
about importance of long term therapy
- prevent initial and recurrent attacks
Decreased cardiac output r/t disease process
- bed rest, comfort and appropriate activities
RHEUMATIC FEVER

Nursing Care
• Monitor vital signs
• Provide adequate nutrition
• Promote safety to prevent
chorea related injuries
Genitourinary
Disorders
Urinary Tract Infection
• Females
• E coli
• Ascending infection
• S/Sx:infants – mimic GI d/o; dysuria,
frequency, hematuria, low grade fever,
abdominal pain and bedwetting
• Dx: urine culture
suprapubic any amount
clean catch > 100,000/ml
• Mx: antibiotic
hydration
Acute Glomerulonephritis
• Inflammation of glomeruli or
kidney
• Follows infection with strep10-14
days
• 5-10 yo
• Males
S/sx:sudden onset of edema and
hematuria, proteinuria,
hypertension

Dx: urinalysis and 24 hour urine


hypoalbuminemia
inc ESR, BUN, Crea,
antistreptolysin O
Mx: semi fowlers
diuretics, antibiotics
O2
antihypertensives

Nsg Care:
quiet play activities
diet – normal CHON, mod salt
restriction, fluid restriction
daily weight and output
Nephrotic Syndrome
• Altered glomerular
permeability(autoimmune);
inc permeability to albumin
• 3 yo
• Males
• Minimal change syndrome
• S/sx: proteinuria, edema-
periorbital area,
hypoalbuminemia,
hyperlipidemia
• Dx: urinalysis and 24 hr
CHON, inc ESR
Mx:steroids, immunosupressant

NDx: Risk for decreased fluid volume r/t


CHON and fluid loss
Imbalanced nutrition: less than BR r/t CHON
and fluid loss

Nsg care:
Adequate nutrition, proper diet – decrease
salt
Weigh daily, monitor I and O
Protect edematous areas
Administer prescribed drugs
Health teaching
Wilm’s Tumor
• Malignant tumor of the kidney
• Associated with other anomalies
• 6 mos-5 yo, peaks 3-4 yo
• Good prognosis
• S/sx: abdominal mass, hematuria, low
grade fever, anemia, wt loss
• Dx: CT scan
• Mx: Nephrectomy, radiotherapy
avoid abdominal palpation
Hypospadia/Epispadi
a

A. Hypospadia B. Epispadia

C. Hypospadia w/ chordee
UROGENITAL DEFECTS
Hypospadia - common
- chordee - fibrous band

Mx: surgery

Nsg care:
Post op – pain relief
assist parents in coping
Cryptorchidism
(Undescended Testis)
• Failure of one or both testes to descend
• Descend up to 6 weeks at birth
• May be d/t dec testosterone

S/sx: right testis more common

Mx: chorionic gonadotrophin hormone


Orchiopexy 1 yo