NUR 315 Pediatric Exam 3 Study Guide – Cardiology, GI, Hematology, Oncology

NUR 315 Pediatrics Exam 3: Cardiology; Gastrointestinal; Hematology; Cancer / Tumors


NUR 315 Exam 3

Congenital Heart Disease and Pediatric Cardiology

Congenital Heart Defects: clinical findings, potential complications, and necessary nursing
interventions
 Anatomic abnormalities present at birth can lead to CHD  result in heart failure and
hypoxia
 Cardiovascular Disorders: heart disease can be 2 types
o Congenital = anatomic  resulting in abnormal function
o Acquired = disease process  infection, autoimmune response, environmental factors,
familial tendencies
 CHD:
o Anatomic defects of the heart prevent normal blood flow to the pulmonary &/or
systemic system
o Incidence: 5-8 per 1000 live births
 About 2-3 of these are symptomatic in first year of life
 Major cause of death in first year of life (after prematurity)
 Most common anomaly is ventricular septal defect
 28% of kids with CHD have another recognized anomaly
o Risk Factors:
 Maternal = infection, alcohol/substance abuse, DM
 Genetic = hx of congenital heart disease in family, down syndrome, presence
of other congenital anomalies or chromosomal abnormalities
o older classifications of CHD:
 Acyanotic: May become cyanotic
 Cyanotic: May be pink or develop congestive heart failure (CHF)
 Obstructive
o Newer classification of CHD:
 Hemodynamic characteristics:
 Increased pulmonary blood flow
 Decreased pulmonary blood flow
 Obstruction of blood flow out of the heart
 Mixed blood flow
o Causes of CHD:
 Chromosomal-genetic = 10-12%
 Maternal or environmental = 1-2%
 Maternal drug use  FAS: 50% have CHD
 Maternal illness:

,NUR 315 Pediatrics Exam 3: Cardiology; Gastrointestinal; Hematology; Cancer / Tumors


o Rubella in first 7 weeks of pregnancy – 50% risk of defects,
including patent ductus arteriosus (PDA) & pulmonary branch
stenosis
o Cytomegalovirus, toxoplasmosis, other viral illnesses lead to
cardiac defects
o IDMs (Infant of a diabetic mother) = 10% risk of CHD (VSD,
cardiomyopathy, TGA most common)
 Multifactorial = 85%
o Pediatric Indicators of Cardiac Dysfunction:
 Poor feeding
 Tachypnea, tachycardia
 Failure to thrive, poor weight gain, activity intolerance
 Developmental delays
 Positive prenatal history
 Positive family hx of cardiac disease

Increased Pulmonary Blood Flow Defects:
 LEFT  RIGHT SHUNTING
o Defects allow blood to shift from the high pressure left side of heart to the right,
lower pressure side
 Abnormal connection between two sides of heart
o Either the septum or the great vessels
 Increased blood volume on right side of heart
 Increased pulmonary blood flow
 Decreased systemic blood flow

 Atrial Septal Defect:
o Hole in the septum between R & L atria
o Blood flows from higher pressure to lower pressure
o Usually ASYMPTOMATIC unless associated with other defects
o Increase in pulmonary blood flow
o Murmur-pulmonic area (LUSB): loud, harsh with a fixed split second heart sound
o Heart failure
o Treatment:
 Nonsurgical = Closed with catheter
 Surgical = patch closure
 Ventricular Septal Defect:
o Hole in septum between R & L ventricle increased pulmonary blood flow and right
sided volume overload
o CHF-if defect is large

,NUR 315 Pediatrics Exam 3: Cardiology; Gastrointestinal; Hematology; Cancer / Tumors


o Holosystolic Murmur present-LLSB (loud and harsh)
 heard @ left sternal border
o Many VSD’s CLOSE SPONTANEOUSLY
o Treatment:
 Nonsurgical = closure during cardiac catheterization
 Surgical = pulmonary artery banding and complete repair with patch
 Patent Ductus Arteriosus:
o The normal fetal circulation conduit between the pulmonary artery and the aorta fails to
close and results in increased pulmonary blood flow
o Closes usually after birth due to increased oxygen tension and changes in prostaglandin
levels
o Blood flows from aorta to pulmonary arteryàincrease in pulmonary blood flow
o Clinical findings:
 Murmur is a machine-hum
 Wide pulse pressure
 Bounding pulses
 Possibly asymptomatic
 Heart failure
o Treatment:
 Nonsurgical = INDOMETHACIN
 cardiac catheterization with coil placement
 Surgical = thorascopic repair
 Atrioventricular Canal Defect

Obstructive Defects:
 Where blood flow exiting the heart meets an area of narrowing (stenosis) which causes
obstruction of blood flow & decreased CO
o Pressure occurring before defect is INCREASED
o Pressure occurring after defect is DECREASED
 Coarctation of the Aorta:
o Obstruction of systemic blood flow from left ventricle
o Narrowing of the lumen of the aorta at or near the PDA (keep PDA open)
 Usually @ or near the ductus arteriosus
o Increased BP in upper extremities (arms)
o Decreased BP in lower extremities
o Bounding pulses in upper extremities
o Lower extremities cool
o Absent/weak femoral pulses
o Heart failure in infants

, NUR 315 Pediatrics Exam 3: Cardiology; Gastrointestinal; Hematology; Cancer / Tumors


o Clinical findings:
 Dizziness
 Headaches
 Fainting
 Nosebleeds in older children
o Treatment:
 Children = balloon angioplasty w/cardiac cath
 Adolescents = placement of stents
 Surgical repair recommended for infants less than 6 months
 Aortic Stenosis:
o Narrowing of aortic valve between left ventricle and aorta
o Left ventricular enlargement
o Hypotension
o Infants:
 faint pulses
 hypotension / tachycardia
 poor feeding tolerance
o Children:
 intolerance to exercise
 dizziness
 chest pain
 possible ejection murmur
o treatments:
 nonsurgical = balloon dilation with cardiac catheterization
 surgical = Norwood procedure OR aortic valvotomy
 Pulmonic Stenosis:
o Narrowing of the pulmonary artery or the pulmonary valve
o Systolic ejection murmur
o Possibly asymptomatic
o Right ventricle becomes hypertrophied
o Exercise intolerance
o Cyanosis if severe
o Cardiomegaly
o Heart failure
o Treatment:
 Nonsurgical = Balloon angioplasty with cardiac catheterization
 Surgical:
 Infants = Brock procedure
 Children = pulmonary valvotomy