NUR 2310: STUDY GUIDE FOR EXAM 2
Cardiovascular Disorders:
o Transposition of the Great Vessels (TGV)
Pulmonary artery receives blood from the left ventricle, and the aorta received blood from the
right ventricle.
S/S
Tachycardia, tachypnea, difficulty feeding, poor weight gain, pallor, cool and moist.
Newborns w minimal communication defects are cyanotic at birth
Genetic Considerations
Gestational diabetes, genetics, boys more than girls
Diagnostic Tests
CBC and ABG
CXR ECG, MRI, EKG
Pharmacology/Non-Pharmacologic as indicated Nursing Process/Management
Medication- prostaglandin E may be given to maintain patent ductus arteriosus
Mechanical vent
Inverventional cardiac catheter procedure
Balloon atrial septostomy
Surgery: Arterial Switch
Open surgery done within 1-2 weeks of birth
Mustang or Senning Procedure- directs the blood with oxygen to the pumping chamber that
goes to the lungs
Nursing Process/Management
Catheterization Preop
-NPO, baseline o2, assess and mark pulses, explain procedure to child, prepare child and family
Catheterization postop
-check pulse distal to sites, monitor temp and extremity color, vital signs q15min, monitor bp, monitor
dressing for bleeding or hematoma, monitor intake and output, monitor blood glucose levels
o Congestive Heart Failure (CHF)
Decrease in cardiac output necessary to meet the metabolic needs of the body
S/S
Pulmonary venous congestion: tachypnea, labored breathing during feeding, cough, crackles, grunting,
cyanosis,diaphoresis during feeding
Systemic venous congestion: peripheral edema, fluid retention,, ascites, enlarged liver, jvd
Impaired cardiac output: tachycardia, pallor, tiring w play, cool extremities, weak pules, hypotension.
Oliguria, irritability, delayed cap refill
Increased Metabolic demand: Diaphoresis, slow weight gain, , failure to thrive, weight loss
Clinical Manifestations
Depends on affected side
Right sided hf moves unoxygenated blood to the pulmonary circulation
Failure results in the backup of blood in systemic venous systems
Left side of heart moves oxygenated blood from pulmonary circulation to the systemic circulation
Failure causes backup into the lungs
When body compensates- peripheral vasoconstriction=cold/blue hands and feet and tachycardia and
tachypnea
Infants
Early: easily tired, weight gain, diaphoresis, frequent respiratory infection
Late: Tachypnea, tachycardia, parlor or cyanosis, nasal flaring, grunting, or retractions, cough or
crackles, s3 gallop
Older children
Early: Exercise intolderance, dyspnea, addominal pain or distension, peripheral edema, changes in skin
color
Late: Anorexia, wheezing, crackles, fluid, volume excess, jugular vein distension
Complications Laboratory
Diagnostic Tests
Decreased cardiac output, increased fluid volume, risk for impaired skin integrity, imbalanced nutrition,
compromised family copinh
Pharmacology/Non-Pharmacologic as indicated Nursing Process/Management
Loop diuretics are potassium wasting, you need to use potassium sparing like
spironolactone and aldactone
Nursing Process/Management
Assessment of child and family: provide of emotional support, discharge planning and teaching
Promote ocygenation: improve respiration: give oxygen to reduce dyspnea
Cardiovascular function: reduce the work of the heart
Meds:
Digoxin (Lanoxin): Solws hr, increases cardiac filling time, decreases cardiac output, used w increased
pulmonary blood flowAssess apical pulse for 1 minute if brady (lower than 90), monitor for digoxin toxicity- blurred
vision, bradycardia
Furosemide (Lasix): rapid diuresis not potassium sparing, monitor for hypokalemia below 3.9 for infant
3.9 newborn
Teach parents to avoid competitive sports, nutritional guidance to prevent anemia, no vacations to high
altitudes
Give pt family a scale, first indication is sudden weight gain
o Rheumatic heart disease (RF)
Autoimmune disease caused by beta-hemolytic streptococcus infection that causes pharyngitis
Genetic Considerations
Family History of RF
Clinical Manifestations
Symptoms usually develop within a few weeks after strep throat: shortness of breath, irregular heart
beat , chest pain, fever, rash, tiredness, loss of appetite, irritability, poor concentration, and behavioral
problems
Polyartritis, nontender, subcutaneous nodules over bony prominence , chorea (sudden movememts)
Damage to heart valves: carditis, mitral/aortic stenosis, mitral regurgitation, chf, afib
Diagnostic Test
Elevated c reactive proteins (CRP titer)
Throat culture: GABHS serum antistreptolysin-O (ASO titer) - most definitive
Radiology, EKG, ECG
Therapeutic Management
Antibiotics: Penicillin G, V, Sulfidiazine, or erythromycin if allergic to others
Antipyretics/analgesic
Antiinflammatory joint disease- Aspirin
Steroids-Prednisone- for severe cardiac symptoms
Anticonvulsant:severe symptoms of chorea
Treatment of recurrent RF
Prophylaxtic antibiotivs
Salicyliates control imfalmmatory
Nursing Process/Management
Reassure joint damage
Prevent GABhs, PROPER TREATMENT OF STREP
o Kawasaki Disease (KD)
Mucotaneous lymph node syndrome leading cause of acquired heart disease in children, weakens
the walls of the vesssels, often results in aneurysms
Categories and stages
Acute: sudden high fever unresponsive to antipyretics and antibiotics
Subacute: Lasts from the end of fever through clinical signs
Convalescent: clinical signs have resolved but labs are not normal, end when labs are normal at 6-8
weeks
S/S
Acute:
Irritability, Hyperemic conjunctivae, fever over 102.2 that lasts for 5 days, inflamed mouth, red
toungue, red hands and feer, nvd, pain in abdomen
Subacute: lasting 2 or more weeks
No fever, cracked lips and fissures, swollen and peelings hands and feet, swollen painful joints,
cardiac disease, thrombocytosis
Convalescent:6-8 weeks after onset
Symptoms slowly decrease, lingering signs of inflammation, lines on nails
Diagnostic Tests
Leukocytosis shift to left
ESR
C-reactive protein
EKG
ECG
XRAY
Therapeutic Management
No live vaccines w blood products
High dose IV immunoglobin G 7-10 days
Salicyliate: 6 weeks or longer
Anticoagulant therapy: warfarin
Coronary aneurysms
Nursing Process/Management
Avoid MMR and Varicella
80-100 mg/kg for antiinflammatory
o Tetralogy of Fallot (ToF)
4 defects
 Pulmonary stenosis
 Hypertrophy of the right ventricle
 Overriding aorta
 Ventral Septal Defect
Squatting, or knee to chest for infant
Boot shaped heart, surgery if not squatting
S/S
Genetic Considerations
Pathophysiological Changes
Clinical Manifestations
Complications Laboratory
Diagnostic Tests
Therapeutic Management
Pharmacology/Non-Pharmacologic as indicated Nursing Process/Management
Nursing Process/Management
o Atrial Septal Defect (ASD)
Categories and stages
S/S
Genetic Considerations
Pathophysiological Changes
Clinical Manifestations
Complications Laboratory
Diagnostic Tests
Therapeutic Management
Pharmacology/Non-Pharmacologic as indicated Nursing Process/Management
Nursing Process/Management
o Ventricular Septal Defect (VSD)
Categories and stages
S/S
Genetic Considerations
Pathophysiological Changes
Clinical Manifestations
Complications Laboratory
Diagnostic Tests
Therapeutic Management
Pharmacology/Non-Pharmacologic as indicated Nursing Process/Management
Nursing Process/Management
o Patent Ductus Arteriosus (PDA)
Categories and stages
S/S
Genetic Considerations
Pathophysiological Changes
Clinical Manifestations
Complications Laboratory
Diagnostic Tests
Therapeutic Management
Pharmacology/Non-Pharmacologic as indicated Nursing Process/Management
Nursing Process/Management
o Coarctation of the Aorta (CoA)
Categories and stages
S/S
Genetic Considerations
Pathophysiological Changes
Clinical Manifestations
Complications Laboratory
Diagnostic Tests
Therapeutic Management
Pharmacology/Non-Pharmacologic as indicated Nursing Process/Management
Nursing Process/Management
o Hypoxemia
Categories and stages
S/S
Genetic Considerations
Pathophysiological Changes
Clinical Manifestations
Complications Laboratory
Diagnostic Tests
Therapeutic Management
Pharmacology/Non-Pharmacologic as indicated Nursing Process/Management
Nursing Process/Management
Musculoskeletal Disorders
o Scoliosis
o Hip Dysplasia
o Club Foot
Hematological Disorders
o Leukemia (ALL)
Malignant diseases of the bone marrow and lymphatic system
MOST COMMON FORM OF CHILDHOOD CANCER
LEADING CAUSE OF DEATH FROM DISEASE IN CHILDREN PAST INFANCY
Categories and stages
2 forms (ALL & AML)
4 phases of therapy
Intro therapy- 4-6 week
CNS prophylactic therapy: intrathecal chemo
Intensification therapy
Eradicate residual leukemic cells, prevent resistant leukemic clones
Maintenance therapy, preserve remission
S/S
Assess for hypoxia, fatigue, anemia, pain, cachexia (wasting syndrome, muscle loss), Testicular exam
Lethargy= decrease Hgb
Decrease amount of oxygen to the brain
Pallor-anemia
Petechia and brusing- thrombocytopenia, lymphadenopathy, hepatosplenectomy
Changes on mental status (CNS)-papilledema, nuchal rigidity (Stiff neck), cranial nerve palsy
Bone Pain-arthritis
Testicular check- unilateral painless testicle enlargement
Infection- fever (low or high); neutropenia, panocytopenia (all cells are reduced)
Palpable mass
Genetic Considerations
Trisomy 1- down syndrome= BIG RISK 20 times greater
Children w 50 chromosomes- best prognosis
(No environmental factors)
Complications Laboratory
CBC, Peripheral blood smear, serum chemistry- potassium, phosphorus, calcium, uric level
acid, LDH, Coagulation studied- pt,aPTT, fibrinogen, d-dimer
Diagnostic Tests
Bone marrow aspiration=best dx
Lumbar Puncture
Pathological Evaluation
Immunophenotyping
Cytogenic studies
Molecular studied (FISH, RT-PCR, Southern blot)
Therapeutic Management
Collaborative approach, decision w fam and child
Surgery, Chemo, Radiation, Biotherapy, HSCT, Complimentary Therapies, End of Life
Pharmacology/Non-Pharmacologic as indicated Nursing Process/Management
Antineoplastics- vincristine, MTX, imatinib
Corticosteroids- prednisone and dexamethasone
Antimicrobials- TMX/SMP and pentamidine
Antifungals- fluconazole
Non pharm
IV fluids
Cranial irradiation: prevents overt CNS relapse
Allogeneic HSCT
Surgical options
Placement of central venous catheter
Chemo, blood products, antibiotics, blood sample
Nursing Process/Management
Assess for bleeding and infection q8h
Monitor for toxic side effects of chemo or tumor cell lysis
Check renal function for children on cyclophosphamide
Educate fam- handwashing, preventing infection, oral care
For bone marrow suppression- isolation and transmission precautions
o Hemophilia
Bleeding disorder as a result of a defiencies of coagulation factors
Categories and stages
Hemophilia A (Factor XIII deficient) – MOST COMMON= X LINKED RECESSIVE
Von Willebrand disease- bleeding disorder caused by low levels of clotting protein (fibrinogen)
Hemophilia B (Christmas disease, factor IX deficiency-hereditary)
Hemophilia C (factor XI deficiency)
Genetic Considerations
X link inheritance. Mom is carrier, son gets it
Risk: family history, males
Pathophysiological Changes
Clinical Manifestations
Prolonged bleeding from minor trauma
Hematoarthritis: bleeding into joints that will need to be drained if severe
Spontaneous or traumatic bleeding
HEMATOMA- HEAD INJURY SUPER BAD
Petechiae isn’t common bc platelette count is normal 150k-450k
Diagnostic Tests
Bleeding episodes, ptt bleeding time, identification of defencient factor (factor assay)
Therapeutic Management
IV administration of the deficient clotting factor- monitor for allergic or anaphylaxis
Prophylactically or on demand, dose varies by injury
Synthetic vasopressin
Pharmacology/Non-Pharmacologic
Desmopressin- reduce intercranial pressure, mild cases ONLY, IV or intranasal
Aminoproic Acid and tranexamic acid- prevent recurrent bleeds NOT ongoing bleedings
Nursing Process/Management
NO NSAID, good dental hygene
Monitor clothing times and coagulation studies, factor replacement
RICE, monitor for internal bleeding, esp: intercranial
o Idiopathic Thrombocytopenia Purpura (ITP)
Most frequent hemmoragic in children, more common in girls 3:1, autoimmune disorder, after viral
infection
Categories and stages
S/S
Genetic Considerations
Pathophysiological Changes
Clinical Manifestations
Complications Laboratory
Diagnostic Tests
Therapeutic Management
Pharmacology/Non-Pharmacologic as indicated Nursing Process/Management
Nursing Process/Management
o Sickle Cell Anemia (SCA)
Categories and stages
S/S
Genetic Considerations
Pathophysiological Changes
Clinical Manifestations
Complications Laboratory
Diagnostic Tests
Therapeutic Management
Pharmacology/Non-Pharmacologic as indicated Nursing Process/Management
Nursing Process/Management
o Iron Deficiency Anemia (IDA)
Most common hematologic disorder, decreased RBC and/or hemoglobin, loss or destruction of
existing RBC
S/S
Pallor, glossitis (soft tongue), cheilitis (mouth cracking at corners), decreased peripheral
resistance, hemodilution, may have murmur, fatigue, PICA, growth retardation
Diagnostic Tests
CBC-Decreased RBC, decreased hemoglobin and hematocrit, hemoglobin is usually less than
10-11
CBC w differential
Energy level and activity
Therapeutic Management 1. Nutrition, 2, Supplement, 3. Transfusion
Treat underlying cause=transfuse hemmorhage, nutrition if diet
Supportive care-IV, oxygen, bed rest, diet, family education
Supplemental iron: NEEDED FOR 6 MONTHS, supplemental folic acid-ferroud sulfate
prophylaxis- 1-2mg/kg, mild-moderate- 3 mg/kg, severe 4-6mg/kg