PEDS CARDIAC [SimpleNursing]
Congenital Heart Defects
Occurs before birth  One or more problems within the heart structures changes the way the blood pumps
through the heart and into the body
- Decreased cardiac output meaning
o Less oxygen rich blood goes OUT to the body
Risk Factors of CHD:
- Genetics:
o Family hx of heart disease
o Down syndrome
- During pregnancy:
o Mom develops infection (rubella)
o Mom abuses drugs/alcohol
o Diabetes
Complications of CHD:
- Hypoxia  RIGHT to left blood flow: TOF, TGA
o T – TROUBLE!!
o T – TETRALOGY OF FALLOT [TOF]
o T – TRANSPOSITION OF THE GREAT VESSELS [TGA]
o T – TRUNCUS ARTERIOSUS
o T – TRICUSPID ATRESIA
- S/S of Hypoxia:
o Cyanosis
o Poor feeding & poor weight gain
o Clubbing fingers
o Dyspnea
o Tachypnea
o Polycythemia  increase in red blood cells
 BLOOD CLOT RISK
 Report Hgb level over 22
 Maintain adequate hydration* to reduce CVA
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CHF [Congestive Heart Failure]  LEFT to right: ASD, VSD, PDA, AVSD
o Holes in the heart septum that push blood from the LEFT side to the RIGHT side of the heart into
the lungs, overloading lungs with TOO much blood flow
o HF – heavy fluid
o HF – heart failure
S/S of CHF:
o Weight gain  bc of water gain
 Pale, cool extremities
 Periorbital Edema  Puffiness around the eyes
 Reduction of number in wet diapers
o Diaphoresis
o Grunting during feedings
 Increased efforts on the heart during feeding
o Dyspnea
o Tachypnea + tachycardia
o Poor weight gain [developmentally]
Obstructive Defects  Right to Left
o TROUBLE!!, T+T+T
Tetralogy of Fallot
o P – Pulmonary Stenosis
o R – Right Ventricular Hypertrophy
o O – Overriding Aorta
o V – VSD [Ventricular Septal Defect]
- S/S of TOF:
o “TET Spells”  hypercyanotic spells
*During a TET spell episode:
1. Infants: Knee to chest
Older children: Squatting position
Prevention of TET spell:
2. DO NOT interrupt sleep ; provide a calm quiet environment upon waking up
3. offer a pacifier during crying
4. small + frequent feedings
5 heart failure signs to report:
5. swaddle or hold the infant during procedures
1.
Weight gain
o Cyanosis
2. Periorbital edema
o Hypoxemia
3. Pale, cool extremities
o Clubbing fingernails
4. Reduction in # of wet diapers
o Polycythemia = blood clot risk  report to HCP if Hgb
levels >22
- Treatment of TOF:
o Surgical repair
Transposition of the Great Vessels
o Reversal of the 2 main arteries leaving the heart [pulmonary + aorta]
- Treatment of TGA:
o Surgical Repair
Tricuspid Atresia
o Closure of the Tricuspid valve
 ASD  Atrial Septal Defect
 VSD  Ventricular Septal Defect
 Blood from the RIGHT atrium can’t enter the RIGHT ventricle since tricuspid valve is closed;
blood must flow through the hole connecting both atria and then get to the RIGHT ventricle
through the VSD
Truncus Arteriosus
o Connection between the aorta + pulmonary artery + VSD
 Results in mixing of oxygen rich blood and oxygen poor blood
Obstructive Defects  Left to Right
Blood is pushed from the LEFT side of the heart where its already oxygenated back to the RIGHT side of
the heart [AKA Cardiac Shunt]
Atrial Septal Defect
KEY SIGNS of L to R Cardiac Shunts:
*Hole between the Atria
1. Diaphoresis
- S/S of ASD:
2. Heart murmur
o Murmur
3. Poor weight gain
 This is normal and to be expected
4. Increased risk for HF + pulmonary HTN
- Treatment of ASD:
o Closes naturally, on its own
o If it DOESN’T, then, surgical repair
Ventricular Septal Defect
*Hole between the Ventricles
- S/S of VSD:
o Grunting during feeding
o Systolic heart murmur
- Treatment of VSD:
o Closes naturally
o If it DOESN’T, then, surgical repair
Patent Ductus Arteriosus
*Opening that connects the Aorta to the Pulmonary Artery
- S/S of PDA:
o Loud machine-like murmur
 Sounds like a duck “DUCKtus”
- Treatment of PDA:
o Will close on its own within 48hrs of birth
o For PREMATURE BABY:
 Indomethacin [NSAID] is given to close hole
 Surgical ligation
AtrialVentricular Septal Defect AVSD
*this is both ASD+VSD; 2 holes: Atria + Ventricles
Typically seen in babies with DOWN SYNDROME
Stenosis  Stiff valve  Stiff + Narrow
Pulmonic Stenosis
*Pulmonary valve is stiff, small, & narrow
*Causes increased pressure and straining on the RIGHT side of the heart
*Right ventricle tries to push blood through this tiny opening causing RIGHT ventricular hypertrophy  a big
hyperinflated heart muscle.
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S/S of Pulmonary Stenosis:
o Right ventricular hypertrophy
o Loud “systolic ejection”  heart murmur
Treatment of Pulmonary Stenosis:
o Balloon Angioplasty
 Balloon is inflated in the valve to open the narrowing
o Surgical repair  valvotomy
Aortic Stenosis
*Aortic valve has narrowing, which, reduces blood flow to the body
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S/S of Aortic Stenosis:
o Decreased cardiac OUTput
 Means: decreased o2 blood OUT to the body
o Activity intolerance
o VS:
 Low BP
 Tachycardia
o Left ventricular hypertrophy
 Blood backs up into the LEFT ventricle, making heart work harder, forcing the LEFT ventricle
to “beef up” and become thick
o Pulmonary congestion
 Blood flow backs up even further, going up into the LEFT atrium and even the lungs, causing
congestion inside the lungs
Treatment of Aortic Stenosis:
o Balloon Angioplasty
 Balloon is inflated in the valve to open the narrowing
o Surgical repair  valvotomy
Coarctation of the Aorta
*Narrowed Aorta  decreased cardiac OUTput specifically in the lower extremities
*Increased blood flow supplied to upper extremities
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S/S of COA:
o Upper extremities:
 High BP
 Bounding pulses
o Lower extremities:
 Cool temp
 Low BP
 Diminished pulses
Treatment of COA:
o Balloon Angioplasty
 Balloon is inflated in the valve to open the narrowing
o Stents
General Treatments for Congenital Heart Defects:
Cardiac catheterization:
Inserting a catheter through the femoral artery [near the groin] and up to the Aorta into the heart
o BEFORE Cardiac Cath:
 Assess if allergic to iodine
 Children must be NPO 4-6 hours
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Infants must be NPO for shorter than 4-6 hours
Report SEVERE diaper rash to HCP
 Rash can introduce bacteria into the bloodstream
o AFTER Cardiac Cath:
*PRIORITY ASSESSMENTS:
1. Check pulses  start most distal up to cath site
a. Normal: weak pulses
b. NOT normal: cool, cold, pale extremity
2. Straighten leg for 4-8 hours after procedure
3. Assess incision site for bleeding and infection
a. Teach parent  NO BATHS to prevent infection
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Chest Tube Monitoring  during cardiac cath
o Placed during cardiac cath surgery to help drain excess fluid and air for lung expansion
 Remains in place AFTER surgery to help drain excess blood
o PRIORITY to report to HCP:
 1hr AFTER sx  more than 5-10mL/kg of blood
 3hr AFTER sx  more than 3mL/kg/hr
 Indicates severe bleeding & cardiac tamponade  deadly condition where sac
around the heart fills with blood, squeezing the heart to death
 Can develop QUICKLY in peds
 EXAMPLE of Cardiac Tamponade:
 Child weighs 6kg
 1hr: 30 – 60mL/kg
 3hrs: 6kg x 3mL = 18mL/hr
o Total of 54mL in 3hrs
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Post-Op Care + Teaching  Cardiac Cath
o Nurse should elevate HOB to reduce respiratory effort AFTER surgery
o Report any fever, warm surgical site, smelly purulent drainage
o No heavy lifting of strenuous activity for the first 3-4 weeks
Rheumatic Fever
~ occurs when strep throat or scarlet fever are not treated correctly  not finishing antibiotics or not treating
the infection.
~ untreated infection causes total body inflammation  affects blood vessels, joint, skin, brain, and heart,
damaging the heart valves
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S/S of Rheumatic Fever:
o Sore throat
o Fever
o Joint pain
LABS:
o Elevated CRP & ESR
o Total body inflammation
o Hemolytic strep
o Shows active strep infection
o Antistreptolysin O titer
o Shows antibodies from past/previous strep infection
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Treatment of Rheumatic Fever:
~ Goal  to stop infection and reduce inflammation
o Antibiotics
o Penicillin
o NSAIDS
o To reduce inflammation
**NEVER GIVE ASPIRIN**
Kawasaki Disease
*Memory Trick*  K-Kawasaki // K-Krazy inflammation
~ inflammation within the blood vessels  particularly the coronary arteries, the blood vessels that feed the
blood O2.
~ affects lymph nodes, skin, and mucous membranes (inside mouth); aneurysm can develop
~ affects infants, young children, and sometimes teens
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S/S of Kawasaki Disease:
o Fever  for 3-5 days and unresolved with antipyretics
o GALLOP HEART RHYTHM*
Interventions for Kawasaki Disease:
o Decreased urinary output
- Monitor for gallop heart rhythm
o Red strawberry tongue*
- Monitor for decreased urinary output
o Red eyes, lips, hands, and feet
- Check temperature regularly
o Skin peeling
o Joint pain
Discharge instructions
- Monitor temp at least q6hr for first 48hrs
Treatment for Kawasaki Disease:
- Report to HCP if fever
o IV immunoglobulin [IVIG]
 To boost antibodies
 No live vaccines for 11 months after IVIG
 MMR, Varicella, Influenza
o Aspirin
 To treat inflammation // also an anti-platelet
*BE CAUTIONS WITH REYES SYNDROME*