Evolve Question CHs. 29 - cancer, 31 - endocrine, 5 - pain, 27 -cardiac, 28- hematologic
Pediatric Cardiac Disease (13): ATI CH. 20 pg. 111
● Acyanotic HD: Increased pulmonary blood flow
■ Atrial septal defect (ASD)
■ Ventricular septal defect (VSD)
■ Patent ductus arteriosus (PDA)
● Cyanotic HD: Decreased pulmonary blood flow
■ Tetralogy of Fallot
● Mixed blood flow: Saturated and desaturated
○ Transposition of the great arteries
● Obstruction of blood flow:
○ Coarctation of the aorta
● Nursing care of child & family with CHD:
○ Begins as soon as diagnosis is suspected
○ Parents experience shock & anxiety
■ Need a period of grief before they can assimilate the meaning of the defect
○ Nurses’ role with parents:
○ Support
○ Assess level of understanding
○ Supply needed information
○ Help other health team members understand the parents’ reactions
○ Family-Centered Care:
○ Give some examples of how this diagnosis impacts the entire family
○ Educate the family about the disorder
○ How would you adapt education for the developmental stage of the child?
■ Preschool
■ School-age
■ Adolescent
○ Help the family manage the illness @ home
○ Prepare the child & family for invasive procedures
● Pre-Op care:
○ Vital signs
■ Indirect & arterial BP
■ CVP
■ Intracardiac monitoring lines (RA, LA, pulmonary artery)
○ Respiratory status
■ May be intubated
■ Suctioning only as needed
■ Chest tubes—pleural and/or mediastinal
○ Provide maximum rest
○ Comfort
■ Atraumatic care
○ Monitor fluids
■ Accurate I & O
■ Risk for kidney failure
○ Progressive activity
● Post-Op complications:
■ Cardiac changes
■ Heart failure
■ Hypoxia
■ Low cardiac output
■ Dysrhythmias
● May have epicardial pacing wires in place
■ Tamponade
○ Pulmonary changes
■ Pneumothorax
■ Pulmonary edema
■ Pleural effusion
○ Neurologic changes
■ Seizures (most common)
■ Stroke
■ Cerebral edema
■ Hypoxic or ischemic brain injury
○ Infection
○ Hematologic Changes
○ Postpericardiotomy Syndrome
■ Fever, leukocytosis, pericardial friction rub, pericardial & pleural effusion
● Self-limiting, treated with rest, salicylates, NSAIDs, sometimes steroids, pericardial or
pleurocentesis
● Digoxin:
○ Mechanisms of action
■ Increases force of cardiac contraction (positive inotropic)
■ Decreases the heart rate (negative chronotropic)
, ■ Cerebral edema
■ Hypoxic or ischemic brain injury
○ Infection
○ Hematologic Changes
○ Postpericardiotomy Syndrome
■ Fever, leukocytosis, pericardial friction rub, pericardial & pleural effusion
● Self-limiting, treated with rest, salicylates, NSAIDs, sometimes steroids, pericardial or
pleurocentesis
● Digoxin:
○ Mechanisms of action
■ Increases force of cardiac contraction (positive inotropic)
■ Decreases the heart rate (negative chronotropic)
■ Slows conduction of impulses through AV node (negative dromotropic)
■ Increases renal perfusion ➔ diuresis
○ Loading dose given IV to bring serum Digoxin level to therapeutic range
■ Very narrow margin of safety; frequent Digoxin levels, especially if symptoms of overdose
occur
■ Premature infants very sensitive; require smaller doses
○ Give @ regular intervals, usually 12 hours apart i.e. 8 am & 8 pm
○ Do not mix with foods or other fluids
○ Do not give if HR low (HR< 60)—primary care provider will give order specific to the child
○ Signs of dig toxicity: vision changes - blurred vision, seeing spots, bradycardia, N/V/D, irregular pulse
, GA
● The Green is important things from questions I answered on Nurselabs.com
Pathophysiology/ Clinical Treatment
(Right to Left/Left to Right Shunt)/ Manifestations/
Cyanotic vs Acyantotic (Congenital vs Acquired)
ASD Hole in septum between R. and -results in right atrial and ventricular -surgical patch closure
(arterial L. atria that results in increased enlargement -closure with a device during
septal pulmonary blood flow -characteristics of murmur (loud, cardiac catheterization
defect) harsh; with a fixed split second heart -cardiopulmonary bypass
sound)
-Risk for atrial dysrhythmias
-acyanotic HD -May be asymptomatic
-L-to R
shunting
-Congenital
VSD Hole in septum between R. and -characteristic murur (loud, harsh; -may close spontaneously in first
(ventricular L. ventricle that results in heard over L. sternal border) year of life
septal increased pulmonary blood flow; -SOB -surgical patch closure
defect) classified according to location and -fast or heavy breathing -closure with a device during
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