1. NURSING CARE OF THE CHILD WITH A CARDIOVASCULAR DISEASE
Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture 8
NURSING CARE OF THE CHILD WITH A CARDIOVASCULAR DISEASE

2. ASSESSMENT OF HEART DISORDERS IN CHILDREN
History
Physical assessment
general appearance
pulse, blood pressure, & respirations

3. ASSESSMENT OF HEART DISORDERS IN CHILDREN
Diagnostic tests
Electrocardiogram
Radiography
Echocardiography
Magnetic resonance imaging
Exercise testing
Laboratory tests

5. CLASIFICATION OF CHD A Cyanotic Heart Defect Move blood from arterial …to…venous system
Increased in pulmonary
blood flow
1. VSD
2. ASD
Obstruction of blood flow from
ventricle
Pulmonary stenosis
Aortic stenosis
3.Coarctation of the Aorta

6. CONGENITAL HEART DISEASE
Defects with increased pulmonary blood flow
Ventricular Septal Defect
Opening between ventricles
S/S
4-8 weeks, fatigue and harsh murmur
Therapeutic management
Most close spontaneously (small ones). Other larger VSDs may require open heart surgery

8. Defects with increased pulmonary blood flow
Atrial Septal Defect
Opening between the atria
S/S
Murmur
Management
Surgery

9. A trial Sepal Defect (ASD)

10. **Obstruction of blood flow from ventricle
1.Pulmonary stenosis 2.Aortic stenosis 3.Coarctation of the Aorta

11. Pulmonic Stenosis
Narrowing of the pulmonary valve or artery causing the right ventricle to hypertrophy
S/S
Mild right sided heart failure
Therapeutic Management
Balloon angioplasty to relieve the stenosis

12. -Aortic Stenosis
Stenosis of the aortic valve prevents blood from passing from the left ventricle into the aorta, leading to hypertrophy of the left ventricle
S/S
Usually asymptomatic but with murmur
May have chest pain and even sudden death
Therapeutic Management
Stabilization with a Beta Blocker or Calcium Channel Blocker
Balloon valvuloplasty
Valve replacement

13. Coarctation of the Aorta
Narrowing of the lumen of the aorta
S/S
Absence of palpable femoral &/or brachial pulses; headache, vertigo, nosebleeds, leg pain
Therapeutic Management
Surgery or angiography

14. Coarctation of the Aorta

16. Cyanotic Heart Defect Cyanotic Decreased pulmonary Mixed blood flow

17. **Defect with Decreased pulmonary blood flow
Tricuspid Atresia
2. Tetrology of Fallot

19. Tricuspid Atresia
The tricuspid valve is completely closed, allowing no blood to flow from the right atrium to the right ventricle.
When these structures close, cyanosis, tachycardia, and dyspnea occur.
Treatment consists of an IV infusion of PGE (prostaglandin) to keep the ductus open until surgery can be performed.

20. Tetrology of Fallot (TOF)

21. Tetralogy of Fallot
Four anomalies
Pulmonary stenosis
VSD
Dextroposition of the aorta
Hypertrophy of right ventricle
S/S
Cyanosis
Polycythemia (increase in number of RBC)
Dyspnea, growth restriction, clubbing of fingers
Therapeutic Management
Surgery

22. Nursing Care of the Child with GI anomalies
Lecture 9

23. Gastrointestinal System
Many GI issues require surgical intervention
Nursing interventions will often include general pre and post-op care
Assess stools
Assess hydration status

24. Gastrointestinal System Pediatric Variances
Mechanical functions of digestion are immature at birth
Infants have decreased saliva
Peristalsis is faster in infants
Digestive processes are mature as a toddler
Gastric acidity is low at birth

25. The Gastrointestinal System
8 Altered Connections
3 Esophageal Atresia/Tracheoesophageal Fistula
3 Cleft Lip and Palate
8 Gastrointestinal Disorders
3 Gastroesophageal Reflux
3 Pyloric Stenosis
8 Acquired Gastrointestinal Disorders
3 Appendicitis

26. ESOPHAGEAL ATRESIA & TRACHEOESOPHAGEAL FISTULA
Congenital defects of esophagus
EA is an incomplete formation of esophagus
TEF is a fistula between the trachea and esophagus
Classic 3 “C’s” - coughing, choking, cyanosis

27. ESOPHAGEAL ATRESIA & TRACHEOESOPHAGEAL FISTULA
TREATMENT
Surgery: either a one- or two-stage repair
Pre-op care focuses on preventing aspiration and hydration
Post-op care focus is a patent airway, prevent incisional trauma

28. Cleft Lip/Palate May present as single defect or combined
Non-union of tissue and bone of upper lip and hard/soft palate during fetal development
Cleft interferes with normal anatomic structure of lips, nose, palate, muscles – depending on severity and placement
Open communication between mouth and nose with cleft palate
Nutrition is a challenge in infancy
Risk for aspiration
Respiratory distress

29. Cleft Lip/Palate Monitor for infection Operative Care Pain Management
Clean Cleft Lip incision
Pain Management

30. GASTROESOPHAGEAL REFLUX
Regurgitation of gastric contents back into esophagus
GER may predispose patient to aspiration and pneumonia
Apnea has been associated with GER
 chance of GER after months old related to growth due to elongation of esophagus

31. GASTROESOPHAGEAL REFLUX
SIGNS/SYMPTOMS
Vomiting
Gagging during feedings
Irritability
Anemia
Bloody stools
DIAGNOSTIC EVAL
History of feedings/Physical Exam
Upper GI endoscopy to visualize esophageal mucosa

32. GASTROESOPHAGEAL REFLUX: Therapeutic Management
Medications
Prokinetic agents
Histamine H-2
Proton Pump Inhibitors
Mucosal Protectants
Surgery: fundoplication
Positioning
Prone HOB  30°
Right side
Dietary modifications
Small, frequent feedings
Possibly thicken formula
Avoid fatty, spicy foods caffeine, & citrus
Teach
Fundoplication (anti-reflux surgery): A surgical technique that strengthens the barrier to acid reflux when the lower esophageal sphincter does not work normally and there is gastro-esophageal reflux.

33. PYLORIC STENOSIS
Hypertrophy of pyloric sphincter, causing a narrowing/ obstruction
Infant presents “always hungry”
Weight loss

34. PYLORIC STENOSIS DIAGNOSTIC EVAL TREATMENT INTERVENTIONS
History/Physical Exam
Abdominal Ultrasound
TREATMENT
Surgical Intervention: Pyloromyotomy
INTERVENTIONS
Pre-op: NPO, NGT to hydration, I/O, monitor electrolytes
Post-op: Start feedings in 4-6 hrs. Progressive feeding schedule

35. APPENDICITIS
Inflammation and infection of vermiform appendix, usually related to an obstruction
Cause may be bacteria, virus, trauma
S/S: periumbilical pain, fever, vomiting, diarrhea, irritability,  WBC’s
Surgery is necessary
Pre-op Care: NPO, pain management, hydration, consent
Post-op Care: routine post-op care, IVF/antibiotics, NPO ambulation, positioning, pain management, wound care, possible drains.

36. Nursing Care of the Child with Respiratory Disorders
Lecture 10+11

37. Respiratory System Pediatric Variances
The airway is smaller.
The larynx is more flexible and more susceptible to spasm.
The tongue is large.
Chest muscles are not well developed
Irregular breathing pattern and brief periods of apnea (10 -
15 secs) are common
Abdominal muscles are used for inhalation until age 5-6 yrs.
Respiratory rate is higher

38. The Respiratory System
Upper Airway Disorders
Tonsillitis
Croup/Epiglottis
Foreign Body Aspiration
Lower Airway Disorders
Bronchiolitis
Asthma
Otitis Media

39. Tonsillitis CLINICAL MANIFESTATIONS Sore throat Mouth breathing
Sleep Apnea
Difficulty swallowing
Fever
IMPLEMENTATIONS
Provide Comfort
Warm saline gargles
Reduce Fever
Promote Hydration
Administer Antibiotics
Provide Rest
Patient Teaching
Tonsillectomy may be
necessary

40. Tonsillectomy Pre-operative Nursing Care Post-operative Nursing Care
Monitor Labs (CBC, PT, PTT)
Age-appropriate Preparation/Teaching
Surgical Consent
Post-operative Nursing Care
Frequent site assessment
Monitor for S/S of Complications
Pain Management
Diet
Patient Teaching

41. Croup/Epiglottitis
Infection and swelling of larynx, trachea, epiglottis, bronchi
Causative agent: Viral
Characterized by hoarseness, barky cough, inspiratory stridor, and respiratory distress
LIFE-THREATENING EMERGENCY
Often the child is intubated

42. Croup/Epiglottitis Nursing Interventions Nursing Interventions
Maintain Patent Airway
Assess and Monitor
Promote Hydration
Reduce Fever
Calm Environment
Promote Rest
Nursing Interventions
Administer Meds
Corticosteroids
Nebulizer treatment
Antibiotic for epiglottitis

43. Foreign Body Aspiration
Occurs most often in small children
Choking, coughing, wheezing, respiratory difficulty
Often it is round food, such as grapes, nuts, popcorn
Bronchoscopy often needed for removal
Prevention and parent education is very important

44. Bronchiolitis
Acute viral infection of the bronchioles causing an inflammatory/obstructive process to occur
CXR shows hyperinflation and consolidation if atelectasis present
Primarily seen in children under 2 years of age

45. CLINICAL MANIFESTATIONS
Bronchiolitis
CLINICAL MANIFESTATIONS
Nasal Congestion
Cough
Crackles, Wheezes
Increased RR & SOB
Respiratory Distress
Fever
Poor Feeding
IMPLEMENTATIONS
Suction – priority
Bronchodilator
CPT
Promote fluids
Monitor VS , SaO2, lung
sounds & respiratory effort
Supplemental oxygen
Reduce fever
Promote rest

46. Asthma Asthma is a common chronic inflammatory disease of the airways
CLINICAL MANIFESTATIONS
Tachypnea
SaO2 below 95%
Wheezes, crackles
Non-productive cough
Restlessness, fatigue
Abdominal pain

47. Asthma Monitor VS (HR, RR) Monitor SaO2 Auscultate lung sounds
INTERVENTIONS
Monitor VS (HR, RR)
Monitor SaO2
Auscultate lung sounds
Monitor respiratory effort
Humified oxygen
Calm environment
Promote hydration
Promote rest
Monitor labs/x-rays
Patient teaching
Administer Medications
Bronchodilator
Corticosteroid IV or PO
Antibiotic if precipitated from a respiratory infection

48. Otitis Media Most common childhood illness Inflammation of middle ear
Acute otitis media (AOM)
S/S: pain, fever, irritability, vomiting, diarrhea, ear drainage, full/bulging tympanic membrane
Otitis media with effusion (OME)
Inflammation of middle ear with fluid behind tympanic membrane-no infection
Chronic otitis media
Can lead to hearing loss/delayed speech

49. Otitis Media TREATMENT Antibiotics INTERVENTIONS Teaching
Feeding techniques
Medication regimen
PAIN MANAGEMENT
Fever management
Surgery prep if needed