Slide-by-Slide Summary: Chapter 27 – Cardiovascular Dysfunction
Slide 1–2: Introduction to PICU Nursing
● Focus: Pediatric ICU nurses must be skilled in critical care, family-centered
communication, and managing life-threatening conditions.
● Real-Life Example:
○ A nurse uses therapeutic communication with parents whose child is post-op for
heart repair.
○ Another nurse sets up IV meds while educating the sibling on monitors to reduce
fear.
Slide 3–5: Why Does the Heart Fail? + CHF Etiology
● Etiology:
○ Left-sided obstructive disease
○ Prolonged HTN
○ Maternal drug use (cocaine, amphetamines)
● Real-Life Example:
○ A newborn with coarctation of the aorta (left-sided obstructive lesion) develops
CHF.
○ An infant with Fetal Alcohol Syndrome presents with PDA and pulmonary
stenosis.
Slide 6–8: CHF Risk Factors & Clinical Findings
● Maternal/environmental:
○ Rubella in 1st trimester → 50% risk of CHD
○ CMV, toxoplasmosis → cardiac anomalies
, ● Assessment:
○ Impaired myocardial function: tachycardia, fatigue, cool extremities
○ Pulmonary congestion: tachypnea, dyspnea, cyanosis
○ Systemic venous congestion: edema, hepatomegaly, weight gain
● Example:
○ Infant with tachycardia and dyspnea → CHF diagnosis.
○ Child with hepatomegaly, poor feeding → evaluated for systemic
congestion.
Slide 9: CHF in Infants
● Signs: Poor feeding (due to fatigue), tachypnea, FTT, developmental delays
● Nursing:
○ Small, frequent feeds
○ Monitor weight trends
○ Conserve energy
Slide 10–11: CHF Diagnostics & Nursing Interventions
● Diagnostics: CXR, ECG, Echo, BNP
● Nursing Priorities:
○ Conserve energy, cluster care
○ Monitor VS, I&O, weight
○ Elevate HOB
○ Provide emotional support to family
,Slide 12: Feeding Interventions
● Feeding Tips:
○ Feed after rest
○ Use high-calorie formula
○ Use special nipples or gavage after 30 mins
○ Semi-upright position
Slide 13–15: Medications
Medication Purpose Key Considerations Monitor
Digoxin ↑ Hold if HR < 90–110 (infant), < 70 Apical HR, K+
Contractility (child); signs of toxicity: N/V,
bradycardia
ACE Inhibitors ↓ Afterload Causes hypotension; watch for BP, renal
(e.g., captopril) cough function, K+
Furosemide Diuretic to ↓ Risk of hypokalemia Electrolytes,
(Lasix) preload I&O
●
Example:
○ Child with CHF started on Digoxin; nurse holds dose due to bradycardia.
○ Child on Lasix shows hypokalemia → bananas added to diet.
Slide 16–18: Acquired Heart Diseases
1. Endocarditis
○ Bacterial infection of valves
○ Risk: structural heart defects
○ Treatment: IV antibiotics x 4–6 weeks
, ○ Prophylaxis: dental procedures
2. Rheumatic Fever
○ Post-GABHS; 5–15 yrs
○ S/S: fever, sore throat, joint pain, murmur
○ Labs: ↑ ESR, CRP, ASO titer
○ Treatment: Penicillin
3. Kawasaki Disease
○ Vasculitis in toddlers
○ S/S: strawberry tongue, high fever, rash, edema
○ Treatment: IVIG, Aspirin, supportive care
Slide 19–25: Congenital Heart Defects (CHDs)
Defect Type Key Features Treatment
VSD L→R Murmur, CHF, FTT Surgical patch
ASD L→R Murmur, mild HF Observation/Surgery
PDA L→R “Machine-hum” murmur, Indomethacin, coil
bounding pulses
Pulmonic Stenosis Obstruction Cyanosis, murmur Balloon valvuloplasty
Aortic Stenosis Obstruction Murmur, weak pulses, syncope Balloon valvuloplasty
Coarctation of Aorta Obstruction ↑ BP upper, ↓ BP lower, leg Balloon angioplasty
pain
Tetralogy of Fallot Mixed Cyanosis, clubbing, tet spells Surgical repair
(TOF)
Slide 26: TOF & Tet Spells
Slide 1–2: Introduction to PICU Nursing
● Focus: Pediatric ICU nurses must be skilled in critical care, family-centered
communication, and managing life-threatening conditions.
● Real-Life Example:
○ A nurse uses therapeutic communication with parents whose child is post-op for
heart repair.
○ Another nurse sets up IV meds while educating the sibling on monitors to reduce
fear.
Slide 3–5: Why Does the Heart Fail? + CHF Etiology
● Etiology:
○ Left-sided obstructive disease
○ Prolonged HTN
○ Maternal drug use (cocaine, amphetamines)
● Real-Life Example:
○ A newborn with coarctation of the aorta (left-sided obstructive lesion) develops
CHF.
○ An infant with Fetal Alcohol Syndrome presents with PDA and pulmonary
stenosis.
Slide 6–8: CHF Risk Factors & Clinical Findings
● Maternal/environmental:
○ Rubella in 1st trimester → 50% risk of CHD
○ CMV, toxoplasmosis → cardiac anomalies
, ● Assessment:
○ Impaired myocardial function: tachycardia, fatigue, cool extremities
○ Pulmonary congestion: tachypnea, dyspnea, cyanosis
○ Systemic venous congestion: edema, hepatomegaly, weight gain
● Example:
○ Infant with tachycardia and dyspnea → CHF diagnosis.
○ Child with hepatomegaly, poor feeding → evaluated for systemic
congestion.
Slide 9: CHF in Infants
● Signs: Poor feeding (due to fatigue), tachypnea, FTT, developmental delays
● Nursing:
○ Small, frequent feeds
○ Monitor weight trends
○ Conserve energy
Slide 10–11: CHF Diagnostics & Nursing Interventions
● Diagnostics: CXR, ECG, Echo, BNP
● Nursing Priorities:
○ Conserve energy, cluster care
○ Monitor VS, I&O, weight
○ Elevate HOB
○ Provide emotional support to family
,Slide 12: Feeding Interventions
● Feeding Tips:
○ Feed after rest
○ Use high-calorie formula
○ Use special nipples or gavage after 30 mins
○ Semi-upright position
Slide 13–15: Medications
Medication Purpose Key Considerations Monitor
Digoxin ↑ Hold if HR < 90–110 (infant), < 70 Apical HR, K+
Contractility (child); signs of toxicity: N/V,
bradycardia
ACE Inhibitors ↓ Afterload Causes hypotension; watch for BP, renal
(e.g., captopril) cough function, K+
Furosemide Diuretic to ↓ Risk of hypokalemia Electrolytes,
(Lasix) preload I&O
●
Example:
○ Child with CHF started on Digoxin; nurse holds dose due to bradycardia.
○ Child on Lasix shows hypokalemia → bananas added to diet.
Slide 16–18: Acquired Heart Diseases
1. Endocarditis
○ Bacterial infection of valves
○ Risk: structural heart defects
○ Treatment: IV antibiotics x 4–6 weeks
, ○ Prophylaxis: dental procedures
2. Rheumatic Fever
○ Post-GABHS; 5–15 yrs
○ S/S: fever, sore throat, joint pain, murmur
○ Labs: ↑ ESR, CRP, ASO titer
○ Treatment: Penicillin
3. Kawasaki Disease
○ Vasculitis in toddlers
○ S/S: strawberry tongue, high fever, rash, edema
○ Treatment: IVIG, Aspirin, supportive care
Slide 19–25: Congenital Heart Defects (CHDs)
Defect Type Key Features Treatment
VSD L→R Murmur, CHF, FTT Surgical patch
ASD L→R Murmur, mild HF Observation/Surgery
PDA L→R “Machine-hum” murmur, Indomethacin, coil
bounding pulses
Pulmonic Stenosis Obstruction Cyanosis, murmur Balloon valvuloplasty
Aortic Stenosis Obstruction Murmur, weak pulses, syncope Balloon valvuloplasty
Coarctation of Aorta Obstruction ↑ BP upper, ↓ BP lower, leg Balloon angioplasty
pain
Tetralogy of Fallot Mixed Cyanosis, clubbing, tet spells Surgical repair
(TOF)
Slide 26: TOF & Tet Spells
