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T. McDonald
Nur2310
PDA: Anatomy
Manifestations
Shunt
Left-to-right can be visualized on
echocardiogram
Increase in pulmonary blood flow
ASD animation
http://www.youtube.com/watch?v=e46
jtin-H50&feature=related
ASD: Anatomy
Manifestations
Usually no symptoms in infants and
young children
With a large ASD, easy tiring, and poor
growth occur
Shunt
Left-to-right resulting in increased pulmonary
blood flow
VSD: Anatomy
VSD: Pathophysiology,
Manifestations and Clinical
Therapy
Pathophysiology
Manifestations
Only 15% are large enough to cause
CHF or pulmonary hypertension, or
pulmonary infections
Systolic murmur at third [Erbs point] or
fourth left [tricuspid vavlve] intercostal
space
Shunt
Left-to-right directly across septum into
pulmonary artery
Increased pulmonary blood flow
TOF animation
http://www.youtube.com/watch?v=ye
PivAlbR4A&feature=relmfu
https://www.youtube.com/watch?
v=DrgUSGvL_4Q
TOF: Anatomy
TOF: Pathophysiology
Pathophysiology
Four defects
Pulmonic Stenosis
page 1371
Right Ventricular
Hypertrophy
VSD
Overriding Aorta
Some kids have a fifth
defect: ASD
TOF: Manifestations
Infant becomes hypoxic
and cyanotic as the
ductus arteriosus closes
[b/c it cuts off the mixing
of the blood which the
child needs b/c it carries
some oxygen]
The degree of the
pulmonary stenosis
determines the severity
of the symptoms
Systolic murmur in the
pulmonic area and
transmitted to
suprasternal notch
Polycythemia [make
more RBCs to
compensate for lack of
oxygen], hypercyanotic
spell (tet spells),
metabolic acidosis, poor
growth, clubbing [ET
fingers], and exercise
intolerance
Knee chest squat of
toddlers to decrease the
return of systemic
venous blood to the
heart
TOF: Pathophysiology,
Manifestations, and Clinical
Therapy
Therapy
Diagnostic Tests
X-ray shows boot shaped
heart due to large right
ventricle, prominent aorta
Treatment
Calm, give oxygen, and
morphine [for pain] and
propanolol [beta blocker] to
decrease pulmonary vascular
resistance
Modified BT shunt to delay
total correction surgery
Shunt
Right-to-left secondary to
elevated pressures on the right
side of the heart
BT shunt
Mixed defects
TGA- Transposition
of the Great
Arteries
TGA animation
http://www.youtube.com/watch?
v=O83cYwKOKtI&feature=relmfu
https://www.youtube.com/watch?
v=ZY11g3VZGVI&list=PL3D6CB3CBA
CEB653B&index=1
TGA: Anatomy
TGA: Pathophysiology
PathophysiologyParallel circulation
Pulmonary Artery is the
outflow tract for the left
ventricle
The Aorta is the outflow
tract for the right ventricle
Life threatening at birth,
survival initially depends
on an open ductus
arteriosus and foramen
ovale
TGA: Manifestations
Cyanosis apparent soon
after birth [have
deoxygenated blood is
being circulated
throughout the body]
Which does not
improve with oxygen
administration
May be less
apparent if VSD is
present
Tachypnea without
retractions or other
signs of dyspnea [the
lungs are still getting
oxygen]
Systolic murmur if VSD
present; otherwise none;
S2 is loud
TGA: Manifestations
Manifestations
CHF may develop
immediately, over
days or weeks
Long time to feed and
need frequent rest
periods b/c of rapid
respiratory rate and
fatigue;
growth failure may be
seen as early as 2wks
if not corrected
Treatment
Prostaglandin E1 is ordered to maintain a patent
ductus arteriosus until a palliative surgery can be
performed
Arterial switch performed before 1 week of life
Balloon atrial septostomy can be performed to allow
mixing until surgery can be performed
Manifestations
Treatment
In symptomatic newborns, PGE1 is given to
reopen the ductus arteriosus and promote blood
flow to the lower extremities
Treatment to prevent CHF may include diuretics,
inotropic medications and oxygen
Surgical correction is preferred
CHF: Pathophysiology
Pathophysiology
Left-to-right shunts
result in increased blood
to the pulmonary
system and can result in
pulmonary hypertension
Obstructive defects
restrict the flow of blood
so the heart muscle
hypertrophies to work
harder to force blood
through the structures
CHF: Manifestations in
Infants
Initial Manifestations
Tiring easily, especially
during feedings [small
frequent feeding, high cal]
Weight loss or lack of
normal weight gain
Diaphoresis [babies dont
really sweat unless under
abnormal defects]
Irritability
Frequent Respiratory
infections [lungs are
flooded prone to bacteria]
Later
Manifestations
Tachypnea
Tachycardia
Pallor
Cyanosis
Nasal Flaring
Grunting
Retractions
Cough or crackles
Third heart sound
Later Manifestations
Generalized fluid volume
overload
Jugular vein distention
CHF: therapy
Medications
Lasix [loop diuretic, monitor I&O
before and after, BP, potassium ]
Digoxin [positive inotropic, anything
less than a HR of 100 hold,
arrhythmias and N&V are the typical
signs of dig. Toxicity (0.5-1.5)]
Evaluation
Kawasaki Disease
Acute febrile, systemic
vascular inflammatory
disorder that affects the
small and midsize arteries,
including the coronary
arteries
Leading cause of acquired
heart disease in children in
the US
Etiology unknown, thought
to be caused by an
unidentified infectious agent
http://www.youtube.com/wat
ch?v=L9FmxwNC5S0
Kawasaki Disease:
Manifestations and Clinical
Manifestations
Therapy
Acute 1-2 weeks
Clinical Therapy
Intravenous Immunoglobulin [gamma globulin]
High does of aspirin for fever [and to thin out the blood clots]
Hospitalization
Medication
Aspirin administration
Monitor for side
effects(bleeding, GI
upset)
Immune Globulin
Treat and administer
like a blood product
[monitor VS]
Comfort
Skin clean and dry
Cool compresses, tepid
baths
Small frequent feeding
Exercise
Passive ROM
Discharge planning
Teaching on aspirin therapy
Postpone live virus vaccines
(measles, mumps, rubella,
and varicella) for 11 months
after immune globulin
administration, others may
be given on schedule
Hallmark signs
Hospitalization
Children with rheumatic
fever should be
hospitalized
Bed rest for monitoring
carditis
4weeks bed rest if carditis
develops
Medications
Antibiotics [for the strep
infection] and aspirin
Discharge Planning
Recovery phase occurs at
home
Activity limitations
Antibiotic prescribed
Teaching
Reoccurrence of sore
throat need for culture
Follow up care to
monitor heart function