Chapter 37 The Child with a Cardiovascular/Hematologic Disorder

The Child with Cardiovascular/Hematologic Disorders Growth and development of the cardiovascular and hematologic systems Usually serious May be chronic or long-term conditions Differences between child’s and adult’s systems

Congestive Heart Failure Clinical manifestations Infants: Tachycardia; easy fatigability (feeding problems); respiratory symptoms; difficulties from lying flat; periorbital edema; rapid weight gain Older children: Failure to gain weight; weakness; fatigue; restlessness; irritability; pallor; tachypnea; dyspnea Diagnosis Treatment: Medications; oxygen administration; limited physical activity

Congestive Heart Failure (cont.) Nursing process for the child with congestive heart failure Assessment Selected nursing diagnoses Outcome identification and planning

Congestive Heart Failure (cont.) Nursing process for the child with congestive heart failure (cont.) Implementation Monitoring vital signs Improving respiratory function Maintaining adequate nutrition Promoting energy conservation Providing family teaching Evaluation: Goals and expected outcomes

Rheumatic Fever Autoimmune reaction to group A beta-hemolytic streptococcal infections Clinical manifestations Carditis: Inflammation of the heart Polyarthritis: Migratory arthritis Chorea: Emotional instability, muscular weakness, purposeless movements Diagnosis: Difficult Treatment: Prevention of residual heart disease Prevention of infection

Rheumatic Fever (cont.) Nursing process for the child with rheumatic fever Assessment Selected nursing diagnoses Outcome identification and planning: Preoperative care Implementation Providing comfort measures, reducing pain Providing diversional activities, sensory stimulation

Rheumatic Fever (cont.) Nursing process for the child with rheumatic fever (cont.) Implementation (cont.) Promoting energy conservation Preventing injury Promoting compliance with drug therapy Providing family teaching Evaluation: Goals and expected outcomes

Question In a child with a diagnosis of congestive heart failure, what would chest radiographs show? a. Pigeon chest b. Enlarged heart c. Lung infiltrates d. Flail chest

Answer b. Enlarged heart Rationale: The clinical symptoms are the primary basis for diagnosis of CHF. Chest radiographs reveal an enlarged heart; electrocardiography may indicate ventricular hypertrophy, and an echocardiogram may be done to note cardiac function.

Kawasaki Disease Immune system alteration Clinical manifestations Fever; irritability; lethargy; dry, red, cracked lips Conjunctival inflammation; red-colored tongue Edema and skin peeling in hands, feet; rash Diagnosis: Symptomology Treatment and nursing care

Iron-Deficiency Anemia Blood cells produce insufficient hemoglobin, are smaller than normal; milk babies Clinical manifestations Less-than-average weight; pale mucous membranes; anorexia; listlessness; slowed growth Diagnosis Treatment and nursing care

Sickle Cell Disease Abnormal hemoglobin production (most common in African Americans), resulting in RBCs assuming sickle shape when inherited from both parents Sickle cell trait: Asymptomatic when inherited from one parent Clinical manifestations: Chronic anemia; sickle cell crisis Diagnosis: Screening Treatment: Prevention of crises

Sickle Cell Disease (cont.) Nursing process for the child with sickle cell disease Assessment Selected nursing diagnoses Outcome identification and planning Implementation Relieving pain; maintaining fluid intake Improving physical mobility Promoting: Energy conservation, skin integrity, family coping Providing family teaching

Thalassemia Inherited mild-to-severe anemias: Abnormal hemoglobin production Clinical manifestations Anemia; fatigue; pallor; irritability; anorexia Bone pain/fractures common; organ involvement Treatment: Transfusions (potential iron overload); medications; side effects Nursing care: Poor prognosis

Hemophilia Mechanics of clot formation Common types of hemophilia Factor VIII deficiency Factor IX deficiency Clinical manifestations: Prolonged bleeding with frequent hemorrhages into skin, joint spaces, intramuscular tissues Diagnosis Treatment

Hemophilia (cont.) Nursing process for the child with hemophilia Assessment Selected nursing diagnoses Outcome identification and planning Implementation Relieving pain Preventing: Joint contractures, injury Providing family teaching; promoting family coping Evaluation: Goals and expected outcomes

Idiopathic Thrombocytopenic Purpura Platelet deficit causing hemorrhages into skin or mucous membranes Clinical manifestations: Acute onset; bruising/rash; hematuria or epistaxis Diagnosis Treatment and nursing care

Acute Leukemia Pathophysiology: Uncontrolled reproduction of deformed WBCs; most common type of childhood cancer Clinical manifestations Surprisingly abrupt with few warning signs Fatigue; pallor; low-grade fever Bone, joint pain; petechiae; purpura Diagnosis Treatment

Acute Leukemia (cont.) Nursing process for the child with leukemia Assessment Selected nursing diagnoses Outcome identification and planning

Acute Leukemia (cont.) Nursing process for the child with leukemia (cont.) Implementation Preventing: Infection, bleeding and injury Reducing pain Promoting energy conservation, relieving anxiety Promoting normal growth and development Promoting a positive body image Promoting family coping Evaluation: Goals and expected outcomes

Question What disease is a sex-linked recessive trait caused by a deficiency of factor IX? a. Hemophilia B b. Hemophilia A c. Factor VIII disease d. Christmas disease

Answer d. Christmas disease Rationale: Christmas disease is a sex-linked recessive trait appearing in male offspring of carrier females, and it is caused by a deficiency of one of the necessary thromboplastin precursors: factor IX, the plasma thromboplastin component.