2. Acquired Heard Diseases MSN.Khitam moh ’ d

3. Outline 1. Congestive Heart Disease 2. Rheumatic fever 3. Kawasaki Disease

4. Congestive Heart Disease CHF … the heart cannot pump & circulate enough blood to supply O2 & nutrient. Result in decrease blood flow to the kidney …stimulate renin angiotensin …cause fluid &Na retention. * Tow Type: 1. Right side HF 2. Lift side HF

5. ASSESSMENT * Right side CHF : 1. Ascites 2.wt gain 3. Hepatomegaly 4. Lower extremity edema. * Lift side CHF : 1.Dyspnea 2. Crackles 3. Tachpnea 4. Tachycardia 5. Fatigue. In infant : 1. Rapid respiration 2. Generalized edema 3. Poor feeding 3. Enlarge liver & heart

6. Nursing Diagnosis 1. Ineffective cardiac output & peripheral tissues perfusion r/t inadequate heart function. 2. Risk for imbalance nutrient less than body requirement 3. Fear r/t child ill appearance & outcome. Nursing intervention 1. provide O2 as necessary 2. Provide rest periods ( semi fowler position ) 3. give time for family to talk about their fear

7. 4. Observe close for doctor visit,and medication dosage. 5. Give medication as order * Diuretics…lasix ( B.W, UOP,ECG change,& elec imbalance ) * Digoxin…calculate the dosage in (ml+mg) -HR = 100 b/min infant and 70 b/m in older child. * Observe for digoxin (Toxicity) WHEN GIVEN AT HOME S&S OF toxicity : 1. Anorexia 2. Dizziness 3.Nausea & Vomiting 4. Diarrhea 5. Headache & arrhythmia.

8. RHEUMATIC FEVER

9. Occurs in group age ( 6 –15 y/d) peak 8y/d ) *Autoimmune disease occurs as a reaction to group A-beta –hemolytic streptococcal infection. - major body joints - mitral valve - female incident more than male - attack of pharyngitis,tonsillitis & scarlet fever. * Assessment : 1. fever 2. systolic murmur 3. Prolong PR & QT interval on ECG.

10. Nursing Care 4. Chorea ( sudden involuntary movement of the limbs ) 5. polyarthritis. 6. Erythema and arthralgia NDX: 1. Risk for non compliance with drug therapy r/t knowledge deficit about importance of long term therapy. 2. Low self-esteem r/t chorea (movement secondary to RF)

11. Nursing intervention 1. Prevent initial attack ( prevent infection URTI & give Anti-B for 10 – 14 day 2. Prevent recurrent attack ( plan for any surgical procedure ) 3. Help them in feeding and DAL. 4. Low activity level sitting games types 5. Bedside rails to prevent any injuries

12. Therapeutic management * Antibiotic for 6 – 8 week (most common used penicillin) * Bed rest (close bedside caring). * V/S until return to normal value. * Aspirin,Ibuprofen & Corticosteriode

13. Kawasaki Disease A mucocutaneous lymph node syndrome

14. Kawasaki Disease * Cause unknown peak child boy less than 4 y of age * Ch.ch by systemic vasculitis & may present itself as febrile illness **Assessment : 1. Fever lasting for more than 5 days not response to antipyretic 2. Lethargic or irritability 3. Bilateral conjunctivitis 4. Chang of lips and oral cavity a. Dry,red,fissured lips b. Strawberry tongue c. Diffuse erythema of mucous membranes

15. Chang of lips and oral cavity a. Dry,red,fissured lips b.Strawberry tongue c. Diffuse erythema of mucous membranes

16. Criteria for diagnosis of KD 5. Changes of peripheral extremities a. Erythema of palms and soles b. Indurative edema of hands and feet c. Membranous desquamation from fingertips 6. Polymorphous rash (primarily on trunk)

17. 7. Acute non purulent swelling of cervical lymph node to more than 1.5cm in diameter 8. Abdomen pain,anorexia, or diarrhea 9. Swollen red joint. 10. WBC,ESR & plat elevated may led to clotting and sudden death

18. Kawasaki Disease Coronary aneurysm

19. Kawasaki disease * Stage 2 of the KD…convalescent phase ( 25 – 40 days) * Stage 3 of the KD…until ESR return to normal * Diagnostic Test : 1. CBC, WBC differ & ESR. 2. Echo *Therapeutic management : 1. Aspirin ( high doses) 2. Immune globulin.

20. Nursing Care diagnosis and intervention * The most common NDx: 1. Pain r/t swelling of lymph node and joint inflammation 2.risk for ineffective peripheral tissue perfusion r/t inflammation of blood vessels. * Nursing Role : 1.Assess S&S of CHF,ECG change 2.blood test for plat count 3. Anti-inflammatory & anti-pyretic

21. Nursing Role 4. Comfortable measure ( position, special games) 5. Hydration to decrease mouth tenderness. 6. Record I&O. 7. Soft food non-irritant 8. In some cases you have to prepare for surgical treatment child with CAD.