Module 4

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Pediatric Nursing Care
Chapter 13
Care of the Child with
Cardiovascular Disorders
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Congenital and Acquired Heart
Disorders
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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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
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
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Assessment of the
Cardiovascular System
 History
– Family history cardiac disease
– Weakness and fatigue upon physical exertion
– Cyanosis, edema, dizziness, poor weight gain
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
COLOR CHANGES
Pale or dusky undertones
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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COLOR CHANGES
Note the pallor of extremities compared to trunk
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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COLOR CHANGES
Mottled Skin
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
COLOR CHANGES
Dusky skin tones
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
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
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.
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
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
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Atrial Septal Defect
 Increased pulmonary blood flow
 Opening in septum between atria
 Between left and right atria
 Foramen ovale
 Results in right ventricular hypertrophy
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
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Atrial Septal Defect
 Manifestations
– Asymptomatic in young child/baby
– Fatigue, delayed growth, congestive heart failure
– Soft, systolic murmur
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Atrial Septal Defect
 Diagnosis
– Echocardiogram
– Chest X-ray
 Treatment
– Perform surgical closure or patch
– Perform cardiac catheterization with septal occluder
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Septal Occluder
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
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Upper Saddle River, New Jersey 07458
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Patent Ductus Arteriosus
 Ductus arteriosus fails to close
 Blood flows from aorta to pulmonary artery
 Increased blood flow to lungs
 Causes right ventricular hypertrophy
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
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Patent Ductus Arteriosus
Manifestations
 Manifestations
– Full, bounding pulse, dyspnea, tachypnea
– Delayed growth patterns
– Continuous systolic murmur
– Pulmonic thrill at LSB, 2nd to 4th ICS
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 antiinflammatory
– Surgical ligation
– Surgical closure with transcatheter, obstructive
device
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
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
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Ventricular Septal Defect
Manifestations
 Manifestations
– May be asymptomatic
– Dyspnea, tachypnea
– Delayed growth patterns, reduced fluid intake
– Congestive heart failure, pulmonary disease
– Systolic murmur
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
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
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 kneechest position) to relieve cyanotic spells. (C) Clubbing of
the fingers is one manifestation of a cyanotic defect in an
older child.
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
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
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
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
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
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
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
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
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
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
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 defects
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
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Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Acquired Heart Diseases:
Congestive Heart Failure
 Circulatory deficits
 Decreased cardiac output
 Cardiogenic shock
 Results from congenital or acquired heart
defects
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
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
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
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
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
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Kawasaki Disease
Convalescent Phase
 Manifestations
– Decreased inflammation
– Permanent heart damage
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Kawasaki Disease
Diagnosis
 Diagnosis
– Erythrocyte sedimentation rate, platelet count
– C-reactive protein, white blood cell count
– Anemia, thrombocytosis, hypoalbuminemia
– Echocardiogram
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
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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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
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
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
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
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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Acute Rheumatic Fever
Diagnosis and Treatment
 Diagnosis
– Clinical manifestations, antistreptolysin O titer
 Treatment
– Administer antibiotics, anti-inflammatories, steroids
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
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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
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
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
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)
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
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
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
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
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
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
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
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
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
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
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 antiinflammatory 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
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
Pediatric Nursing Care
Ellise Adams and Mary Ann Towle
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
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