Nurs 3548 Exam 2 review notes

Peds Exam 2 Review

CARDIAC
Congenital Cardiac Defects
 Increased pulmonary blood flow - Acyanotic
o Ventricular Septal Defect (VSD)
o Atrial Septal Defect (ASD)
o Patent Ductus Arteriosus (PDA)
 Obstruction of blood flow out of the heart - Acyanotic
o Coarctation of Aorta
o Aortic Stenosis
o Pulmonic Stenosis
 Decreased pulmonary blood flow - Cyanotic
o Tetralogy of Fallot
o Transposition of Great Vessels
 Mixed blood flow within the heart or great arteries

ACYANOTIC: defect with INCREASED pulmonary blood flow = heart conditions that do NOT
cause deoxygenation or low oxygen levels; skin and mucous membrane color is usually
NORMAL PINK; infant usually shows s/s of heart failure

CYANOTIC: defect with DECREASED pulmonary blood flow = heart conditions that cause blood
to contain LESS OXYGEN THAN REQUIRED; skin and mucous membrane color is usually PALE to
BLUE; typically hypoxemia and cyanosis appear

Increased Pulmonary blood flow
 Ventricular Septal Defect (VSD)
o PATHO: Opening between right and left VENTRICLE in the septum. Blood flows
from LV to RV (Left to Right shunt)
o S/S: Systolic murmur at left lower sternal border, S/S of right-sided heart failure
are commonly present. Underweight for age, tires before feeding.
o DX: X-ray  cardiomegaly of the L-side
o TREATMENT:
 Many close spontaneously during first year of life.
 Digoxin
 Assess HR for 1 min before administering
 Hold if: Infant/Young children HR <90-100/min, Older Children:
HR <70/min.
 Dig toxicity: level 2mg/mL will have N/V, Brady, dysrhythmias,
yellow halos (Normal Dig level is 0.5-2)
 ANTIDOTE: Digibind
 KNOW THE K LEVEL
 Atrial Septal Defect (ASD)

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, o PATHO: Opening between right and left ATRIA. Blood flows from LA to RA (Left to
Right shunt)
o S/S: May be asymptomatic. increased pulmonary blood flow, dyspnea, fatigue,
poor growth, soft systolic murmur in pulmonic area, ECG shows right ventricular
overload and shunt size. Atrias are stretched out affects electrical component
of the heart atrial arrhythmias.
o TREATMENT: Possibly cardiac cath or cardiopulmonary bypass before school-age
 Patent Ductus Arteriosus
o PATHO: Fetal ductus arteriosus FAILS to CLOSE. Blood flows from the high
pressure aorta into the low pressure pulmonary artery and into pulmonary
circulation.Traffic jam of blood in the aorta because blood is confused about
whether to go straight to the body or go through the ductus arteriosus. Increased
workload on left side of heart = LSHF
o S/S: May be asymptomatic. Machinery-like murmur heard just below the left
clavicle. Widened pulse pressure and bounding pulses. Decreased peripheral
pulses, exercise intolerance, feeding difficulties, hypotension, irritability,
restlessness, lethargy, oliguria, pale/cool extremities, tachycardia
o TREATMENT: Indomethacin (Indocin): prostaglandin inhibitor. Administered to
close PDA - Not effective in full term infants (will need surgery)

Obstruction of Blood Flow
 Coarctation of Aorta
o PATHO: Narrowing in the aorta
o S/S: Causes high BP and bounding pulses in arms, weak or absent femoral
pulses, decreased CO, fainting, HF, epistaxis from HTN, cool lower extremities.
Increased workload for Left side of heart Left sided heart failure
o TREATMENT: Balloon Angioplasty
**PT is at RISK for ruptured aorta, aortic aneurysm, or stroke
 Pulmonic Stenosis
o PATHO: Narrowing at the entrance of the pulmonary artery. Right ventricle has
to work hard to pump blood through a very small opening  may develop right
sided heart failure
o S/S: characteristic murmur, asymptomatic, NB w/severe narrowing are cyanotic,
if severe  HF occurs decreased CO
o TREATMENT: Cardiac cath or transventricular (closed) valvotomy procedure.
Children pulmonary valvotomy with cardiopulmonary bypass
 Aortic Stenosis
o PATHO: Narrowing/hardening of the aortic valve. LV has to pump blood through
the small opening in the aorta increased workload on LV at risk for left sided
heart failure
o S/S: Infants with severe defects will demonstrate signs of decreased CO. Faint
pulses, hypotension, poor feeding, tachycardia, have a murmur, exercise


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, intolerance, chest pain and dizziness w/standing. Will have decreased CO
because aorta pumps blood to the body
o TX: Balloon angioplasty to dilate the valve. Konnon procedure [valve
replacement] May require repeat procedures.
Decreased Pulmonary Blood Flow
 Tetralogy of Fallot (TOF)
o PATHO: 1. Ventricular Septal Defect, 2. Pulmonic Stenosis, 3. Overriding Aorta, 4.
Right ventricular hypertrophy. This is a DECREASE in pulmonary blood flow =
Heart is pumping Deoxygenated blood to the body  Deficient oxygen in the
tissues leads to acidosis
o S/S: Hypercyanosis (TET) spells, Clubbing of digits, Polycythemia, Metabolic
Acidosis, Poor growth, exercise intolerance, Systolic murmur in pulmonic area,
Right ventricular hypertrophy
o Dx: Chest X-ray= Boot-shaped heart, Pulmonary Artery Cath (Swan Ganz),
Echocardiogram
o TREATMENT: Prostaglandin E1 to maintain an open patent ductus arteriosus,
Palliative shunt, Complete repair, will often be in knee-chest position to
compensate.

HYPERCYANOSIS SPELLS: Occur when O2 requirements exceed blood supply during periods of
crying, feeding, or defecating due to the stress on the body needing more O2 than it is getting.
 Treatment:
1. Place in a knee-chest position
2. Administer 100% O2
3. Administer morphine sulfate
4. Administer IV fluids

Kawasaki Disease
 PATHO: Multisystem vasculitis  damage to blood vessels
 DX: High fever, Conjunctivitis (redness), strawberry tongue, erythematous rash on
palms and soles.
 S&S:
o Acute: Fever more than 5 days, Conjunctiva, Red throat, erythema, swollen
hands/feet
o Sub-acute: Desquamation of skin (toes & fingers), NO Fever
o Convalescent: Appears normal w/ possible signs of inflammation
 Interventions:
o IV Immunoglobulin (IVIG)
o Admin same as Blood Product
o RASH, FEVER, Shaking, Chills, DISCONTINUE NOTIFY HCP
o Aspirin (salicylate therapy)
o MAY CAUSE REYES SYNDROME
o TOXICITY: Tinnitus, HA, Vertigo, Bruising

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