1. Pediatric Nursing Care Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Chapter 13 Care of the Child with Cardiovascular Disorders

2. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congenital and Acquired Heart Disorders

3. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Anatomy and Physiology of the Pediatric Cardiovascular System  Fetus –Blood oxygenated in the placenta –Decreased blood flow to lungs –Foramen ovale connects atria –Ductus arteriosus connects pulmonary artery to aortic arch

4. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Anatomy and Physiology of the Pediatric Cardiovascular System  Infant –Foramen ovale and ductus arteriosus close –Left side pressure higher than right side –Heart muscle fibers immature –Ventricles less compliant to stroke volume –Preload, afterload, contractility affect cardiac output

5. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Assessment of the Cardiovascular System  History –Family history cardiac disease –Weakness and fatigue upon physical exertion –Cyanosis, edema, dizziness, poor weight gain

6. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pale or dusky undertones COLOR CHANGES

7. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Note the pallor of extremities compared to trunk COLOR CHANGES

8. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Mottled Skin COLOR CHANGES

9. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Dusky skin tones COLOR CHANGES

10. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Assessment of the Cardiovascular System  Physical –Observe child’s posture –Observe for respiratory difficulty, dehydration –Inspect nail beds, sclera, skin tone –Monitor vital signs, palpate pulses –Auscultate heart and breath sounds

11. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Types of Congenital Heart Anomalies and Defects  Increased pulmonary blood flow –Atrial septal defect (ASD) –Patent Ductus Arteriosus (PDA) –Ventricular septal defect (VSD)  Decreased pulmonary blood flow –Tetralogy of Fallot  Obstruct systemic blood flow –Coarctation of the aorta –Mixed defects  Transposition of the great arteries

12. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 13.4 (A) Atrial septal defect. Note that the defect is an opening between the right and the left sides of the heart. (B) Patent ductus arteriosus. Note that the connecting duct between the pulmonary artery and the aortic arch is still open. (C) Ventricular septal defect. Note the opening between the right and left ventricles.

13. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Acquired Heart Diseases  Congestive heart failure (CHF)  Systemic hypertension  Hyperlipidemia  Kawasaki’s syndrome  Acute Rheumatic Fever

14. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congenital Heart Anomalies and Defects  Congenital heart anomalies or defects –Often identified at birth or within first weeks of life –Some repaired surgically immediately after birth, others corrected later. Complete correction may take years –More common when fetus exposed to rubella, alcohol, or drugs intrauterine –Other risk factors include other defects, maternal age or disorders such as lupus and diabetes, siblings or parents with congenital defects

15. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Atrial Septal Defect  Increased pulmonary blood flow  Opening in septum between atria  Between left and right atria  Foramen ovale  Results in right ventricular hypertrophy

16. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Atrial Septal Defect

17. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Atrial Septal Defect  Manifestations –Asymptomatic in young child/baby –Fatigue, delayed growth, congestive heart failure –Soft, systolic murmur

18. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Atrial Septal Defect  Diagnosis –Echocardiogram –Chest X-ray  Treatment –Perform surgical closure or patch –Perform cardiac catheterization with septal occluder

19. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Septal Occluder

20. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patent Ductus Arteriosus  Ductus arteriosus fails to close  Blood flows from aorta to pulmonary artery  Increased blood flow to lungs  Causes right ventricular hypertrophy

21. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. PDA

22. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patent Ductus Arteriosus Manifestations  Manifestations –Full, bounding pulse, dyspnea, tachypnea –Delayed growth patterns –Continuous systolic murmur –Pulmonic thrill at LSB, 2nd to 4th ICS

23. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patent Ductus Arteriosus Diagnosis and Treatment  Diagnosis –Chest X-ray, ECG, echocardiogram  Treatment –Administer indomethacin or nonsteroidal anti- inflammatory –Surgical ligation –Surgical closure with transcatheter, obstructive device

24. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Ventricular Septal Defect VSD  Defects with increased pulmonary blood flow –Ventricular Septal Defect  Opening in septum between ventricles  Blood flows left to right

25. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. VSD

26. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Ventricular Septal Defect Manifestations  Manifestations –May be asymptomatic –Dyspnea, tachypnea –Delayed growth patterns, reduced fluid intake –Congestive heart failure, pulmonary disease –Systolic murmur

27. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Ventricular Septal Defect Diagnosis and Treatment  Diagnosis –Chest X-ray, ECG, echocardiogram  Treatment –May close spontaneously –Perform Rashkind procedure, permanent closure –Administer antibiotics

28. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Tetralogy of Fallot  Decreased Pulmonary Blood Flow  Pulmonary stenosis, narrowing of pulmonary valve  Ventricular septal defect also found  Right ventricular hypertrophy  Overriding aorta

29. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 13.7 (A) Tetralogy of Fallot involves four distinct problems: pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy, and an overriding aorta. (B) A child with cyanotic heart defect squats (assumes a knee- chest position) to relieve cyanotic spells. (C) Clubbing of the fingers is one manifestation of a cyanotic defect in an older child.

30. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Tetralogy of Fallot Manifestations  Manifestations –Cyanosis, hypoxia –Delayed growth, polycythemia, metabolic acidosis –Exercise intolerance, clubbing of fingers –Systolic murmur

31. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Tetralogy of Fallot Diagnosis and Treatment  Diagnosis –Chest X-ray, ECG, echocardiogram –Cardiac catheterization  Treatment –Perform surgical correction of all defects

32. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Coarctation of the Aorta  Obstructs systemic blood flow  Narrowing of the aorta  Most common site is arch of aorta  Leads to congestive heart failure

33. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Coarctation of the Aorta

34. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Coarctation of the Aorta Manifestations  Manifestations –May be asymptomatic, growth patterns unaffected –Blood pressure higher in arms than legs –Weak pulses in legs –Bounding pulses in arms, neck, head –Weakness and pain in legs with exercise

35. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Coarctation of the Aorta Diagnosis and Treatment  Diagnosis –Chest X-ray, SCG, MRI  Treatment –Perform balloon dilation, anastomosis –Perform surgical resection –Teach parents signs and symptoms, may recur

36. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Mixed Defect: Transposition of the Great Arteries  Reversed positions of aorta and pulmonary artery  Unoxygenated blood moves in and out of heart  Oxygenated blood moves through heart and lungs

37. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Transposition of the Great Arteries

38. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Transposition of the Great Arteries Manifestations  Manifestations –Cyanosis – no improvement with oxygen administration –Hypoxia, acidosis, tachypnea, delayed growth –CHF, fatigue

39. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Transposition of the Great Arteries Diagnosis & Treatment  Diagnosis –Chest X-ray, echocardiogram  Treatment –Administer Prostaglandin E1 intravenously –Perform surgical intervention – arterial switch –Balloon atrial septostomy

40. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congenital Heart Defects Animation Click here to view an animation on congenital heart defectshere Back to Directory

41. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Acquired Heart Diseases: Congestive Heart Failure  Circulatory deficits  Decreased cardiac output  Cardiogenic shock  Results from congenital or acquired heart defects

42. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congestive Heart Failure Manifestations  Manifestations –Cardiac symptoms  Tachycardia, poor capillary refill, peripheral edema  Fatigue, restlessness, cardiomegaly –Pulmonary symptoms  Dyspnea, tachypnea, cyanosis, feeding difficulties  Crackles, wheezing on auscultation –Metabolic symptoms  Slow weight gain, perspiration

43. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Congestive Heart Failure Diagnosis and Treatment  Diagnosis –Heart X-ray, symptoms  Treatment –Administer diuretics, potassium supplements, inotropic medications –Perform heart transplantation

44. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Acquired Heart Diseases: Kawasaki Disease  Acute systemic inflammatory illness  Mucocutaneous lymph node syndrome  More common in Asian and male children

45. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Kawasaki Disease Acute Phase  Manifestations –Fever, conjunctival hyperemia, red throat –Swollen hands and feet, rash –Enlarged cervical lymph nodes

46. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Kawasaki Disease Subacute Phase  Manifestations –Skin on lips, hands, feet slough off –Joint pain, thrombosis of heart –Large aneurysms of coronary arteries –Myocardial infarction

47. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Kawasaki Disease Convalescent Phase  Manifestations –Decreased inflammation –Permanent heart damage

48. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Kawasaki Disease Diagnosis  Diagnosis –Erythrocyte sedimentation rate, platelet count –C-reactive protein, white blood cell count –Anemia, thrombocytosis, hypoalbuminemia –Echocardiogram

49. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Kawasaki Disease Treatment  Treatment –Admit to hospital –Administer intravenous immunoglobulin, oral aspirin

50. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Kawasaki Disease Nursing Considerations  Nursing interventions –Take temperature every four hours –Administer large doses of aspirin –Assess for bleeding –Monitor conjunctiva, oral mucosa, skin –Assess for dehydration, malnutrition

51. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Kawasaki Disease Nursing Considerations  Nursing interventions –Auscultate heart every four hours –Provide oral and bath care gently –Administer intravenous fluids, soft foods –Maintain bed rest with repositioning and exercises –Teach parents home care

52. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Acquired Heart Diseases: Acute Rheumatic Fever  Inflammatory disorder  Follows a beta-hemolytic Streptococcus infection  Autoimmune response damages heart, joints, CNS, skin  May recur with further heart damage

53. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Acute Rheumatic Fever Manifestations  Enlarged, painful, inflamed joints (polyarthritis)  Fever, tachycardia, red rash (erythema marginatum)  Abnormal heart sounds, irregular heart rhythm  Sydenham’s chorea

54. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Acute Rheumatic Fever Diagnosis and Treatment  Diagnosis –Clinical manifestations, antistreptolysin O titer  Treatment –Administer antibiotics, anti-inflammatories, steroids

55. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Acute Rheumatic Fever Nursing Considerations  Nursing interventions –Assessment of symptoms –Acute phase  Assess temperature, heart every 4 hours  Administer intravenous fluids, prevent overload  Administer antibiotics, aspirin  Provide quiet activities, prevent fatigue

56. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Acute Rheumatic Fever Nursing Considerations  Nursing interventions –Recovery phase  Teach parents home care  Provide limited activities  Administer long-term antibiotic therapy  Teach clients and family they must inform all healthcare providers of history of rheumatic fever so prophylactic antibiotics can be prescribed for all invasive procedures

57. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Care: Priorities in Nursing Care  Priority aspects of care –Assess oxygen status –Promote oxygenation –Correct administration of oxygen –Positioning of child to facilitate breathing  Energy conservation  Assess respiratory, cardiac, hydration, and electrolyte status

58. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Care: Assessing  May display symptoms of CHF  Nurse should monitor for: –Altered vital signs –Heart murmur –Cyanosis (circumoral or generalized) –Clubbing of fingers –Respiratory distress (tachypnea, orthopnea, grunting, nasal flaring, retractions)

59. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Care: Assessing  May display symptoms of CHF  Nurse should monitor for: –Fluid retention (bulging fontanels, fewer than six wet diapers per day, moist lung sounds, edema) –Restlessness, crying, and lethargy may be signs of intracranial edema –Activity intolerance displayed by increased respiratory effort, resting frequently, or squatting at play

60. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Care Diagnoses  Activity intolerance related to impaired circulation  Risk for infection related to inadequate defense mechanisms  Imbalanced nutrition: More than body requirements related to excess intake of sodium or fat containing food  Impaired skin integrity related to hypothermia or peripheral edema  Risk for imbalanced fluid volume related to impaired circulation

61. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Care Postoperative Diagnoses  Ineffective breathing pattern related to pulmonary edema, increased work of breathing, or poor respiratory effort  Decreased cardiac output related to mechanical defects  Acute pain related to operative site

62. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Care Goals  Tolerance of activity will be achieved by balancing rest and activity  Freedom from signs and symptoms of infection  Improved diet based on prescribed regime  Skin will be lesion free  Fluid and electrolyte balance will be maintained  Breathing will improve and the need for oxygen will be reduced  Parents report child appears more comfortable  Ability to take food orally

63. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Care Interventions  Nursing interventions and supportive measures for the child and family –Group activities and alternate with rest –Encourage a balanced diet –Establish routine of skin care  Assessing daily  Frequent position change  Keeping diaper area clean  Changing bed linens frequently  Mouth care prn

64. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Care Nursing Interventions  Instruct on importance of hand hygiene  Encourage maintaining immunizations  Monitor I&O  Weigh daily  Monitor lab values  Position to assist respirations  Encourage use of slow, deep breathing during times of respiratory distress

65. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Nursing Care Nursing Interventions  Monitor oxygen saturation  Teach the hazards of smoking  Administer medications and procedures in timely manner  Provide emotional support  Reinforce teaching about condition  Help child maintain some control

66. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Key Points  Infant sensitive to volume and pressure overload because heart muscle fibers not fully developed and not as compliant  Volume and pressure overloads cause CHF in infants  CHF characterized in children by type of heart defect. –Left sided – cyanosis, dyspnea, respiratory rales, orthopnea, tachycardia, fatigue, and restlessness –Right sided – distended neck veins, tachycardia, liver enlargement, weight gain, and edema

67. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Key Points  Congenital heart defects may arise when the fetus is exposed to infections and chemicals such as rubella, alcohol, or drugs in utero  Four classifications of congenital heart defects include defects that: –Increased pulmonary blood flow –Decreased pulmonary blood flow –Obstruct systemic blood flow –Mixed defects

68. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Key Points  Elevated blood pressure in children is often secondary to kidney disease, coarctation of the aorta, hyperthyroidism, increased ICP, and side effects of medication  Important accurate blood pressures obtained with appropriate sized cuff  Nursing care should include assessing oxygen status, promoting oxygenation, energy conservation, and fluid and electrolyte balance

69. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Key Points  Educate parents on symptoms of strep throat infection and encourage them to have child seen by provider to prevent rheumatic fever  Polyarthritis of ARF responds better to anti- inflammatory effects of aspirin than ibuprofen. Aspirin must be administered under supervision of physician and teach them symptoms of Reye’s syndrome to report to physician

70. Pediatric Nursing Care Ellise Adams and Mary Ann Towle Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Cardiac Medications  Know what they are for in relation to cardiac disorders –Digoxin –Antibiotics –Diuretics –Potassium