Chapter 37

The Child with a

Cardiovascular/Hematologic
Disorder

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 The Child with
Cardiovascular/Hematologic Disorders
• Growth and development of the cardiovascular and
hematologic systems
– Usually serious
– May be chronic or long-term conditions
• Differences between child’s and adult’s systems

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 Congestive Heart Failure

• Clinical manifestations
– Infants: Tachycardia; easy fatigability (feeding
problems); respiratory symptoms; difficulties from
lying flat; periorbital edema; rapid weight gain
– Older children: Failure to gain weight; weakness;
fatigue; restlessness; irritability; pallor; tachypnea;
dyspnea
• Diagnosis
• Treatment: Medications; oxygen administration; limited
physical activity

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 Congestive Heart Failure (cont.)

• Nursing process for the child with congestive heart failure

– Assessment
– Selected nursing diagnoses
– Outcome identification and planning

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 Congestive Heart Failure (cont.)

• Nursing process for the child with congestive heart failure

(cont.)
– Implementation
• Monitoring vital signs
• Improving respiratory function
• Maintaining adequate nutrition
• Promoting energy conservation
• Providing family teaching
– Evaluation: Goals and expected outcomes
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 Rheumatic Fever
• Autoimmune reaction to group A beta-hemolytic
streptococcal infections
• Clinical manifestations
– Carditis: Inflammation of the heart
– Polyarthritis: Migratory arthritis
– Chorea: Emotional instability, muscular weakness,
purposeless movements
• Diagnosis: Difficult
• Treatment: Prevention of residual heart disease
• Prevention of infection
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 Rheumatic Fever (cont.)
• Nursing process for the child with rheumatic fever
– Assessment
– Selected nursing diagnoses
– Outcome identification and planning: Preoperative
care
– Implementation
• Providing comfort measures, reducing pain
• Providing diversional activities, sensory stimulation

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 Rheumatic Fever (cont.)

• Nursing process for the child with rheumatic fever (cont.)

– Implementation (cont.)
• Promoting energy conservation
• Preventing injury
• Promoting compliance with drug therapy
• Providing family teaching
– Evaluation: Goals and expected outcomes

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 Question
In a child with a diagnosis of congestive heart failure, what
would chest radiographs show?

a. Pigeon chest
b. Enlarged heart
c. Lung infiltrates
d. Flail chest

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 Answer
b. Enlarged heart

Rationale: The clinical symptoms are the primary basis for

diagnosis of CHF. Chest radiographs reveal an enlarged
heart; electrocardiography may indicate ventricular
hypertrophy, and an echocardiogram may be done to
note cardiac function.

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 Kawasaki Disease
• Immune system alteration
• Clinical manifestations
– Fever; irritability; lethargy; dry, red, cracked lips
– Conjunctival inflammation; red-colored tongue
– Edema and skin peeling in hands, feet; rash
• Diagnosis: Symptomology
• Treatment and nursing care

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 Iron-Deficiency Anemia

• Blood cells produce insufficient hemoglobin, are smaller

than normal; milk babies
• Clinical manifestations
– Less-than-average weight; pale mucous membranes;
anorexia; listlessness; slowed growth
• Diagnosis
• Treatment and nursing care

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 Sickle Cell Disease

• Abnormal hemoglobin production (most common in

African Americans), resulting in RBCs assuming sickle
shape when inherited from both parents
– Sickle cell trait: Asymptomatic when inherited from
one parent
• Clinical manifestations: Chronic anemia; sickle cell crisis
• Diagnosis: Screening
• Treatment: Prevention of crises

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 Sickle Cell Disease (cont.)
• Nursing process for the child with sickle cell disease
– Assessment
– Selected nursing diagnoses
– Outcome identification and planning
– Implementation
• Relieving pain; maintaining fluid intake
• Improving physical mobility
• Promoting: Energy conservation, skin integrity,
family coping
• Providing family teaching
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 Thalassemia

• Inherited mild-to-severe anemias: Abnormal hemoglobin

production
• Clinical manifestations
– Anemia; fatigue; pallor; irritability; anorexia
– Bone pain/fractures common; organ involvement
• Treatment: Transfusions (potential iron overload);
medications; side effects
• Nursing care: Poor prognosis

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 Hemophilia

• Mechanics of clot formation

• Common types of hemophilia
– Factor VIII deficiency
– Factor IX deficiency
• Clinical manifestations: Prolonged bleeding with frequent
hemorrhages into skin, joint spaces, intramuscular tissues
• Diagnosis
• Treatment

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 Hemophilia (cont.)
• Nursing process for the child with hemophilia
– Assessment
– Selected nursing diagnoses
– Outcome identification and planning
– Implementation
• Relieving pain
• Preventing: Joint contractures, injury
• Providing family teaching; promoting family coping
– Evaluation: Goals and expected outcomes
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 Idiopathic Thrombocytopenic Purpura

• Platelet deficit causing hemorrhages into skin or mucous

membranes
• Clinical manifestations: Acute onset; bruising/rash;
hematuria or epistaxis
• Diagnosis
• Treatment and nursing care

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 Acute Leukemia

• Pathophysiology: Uncontrolled reproduction of deformed

WBCs; most common type of childhood cancer
• Clinical manifestations
– Surprisingly abrupt with few warning signs
– Fatigue; pallor; low-grade fever
– Bone, joint pain; petechiae; purpura
• Diagnosis
• Treatment

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 Acute Leukemia (cont.)

• Nursing process for the child with leukemia

– Assessment
– Selected nursing diagnoses
– Outcome identification and planning

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 Acute Leukemia (cont.)
• Nursing process for the child with leukemia (cont.)
– Implementation
• Preventing: Infection, bleeding and injury
• Reducing pain
• Promoting energy conservation, relieving anxiety
• Promoting normal growth and development
• Promoting a positive body image
• Promoting family coping
– Evaluation: Goals and expected outcomes

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 Question
What disease is a sex-linked recessive trait caused by a
deficiency of factor IX?

a. Hemophilia B
b. Hemophilia A
c. Factor VIII disease
d. Christmas disease

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 Answer
d. Christmas disease

Rationale: Christmas disease is a sex-linked recessive trait

appearing in male offspring of carrier females, and it is
caused by a deficiency of one of the necessary
thromboplastin precursors: factor IX, the plasma
thromboplastin component.

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