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Chapter 32 Disorder of the Cardiovascular Function


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Zeltcha Salut


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[Front]


What is Congenital Heart Disorder (CHD)
[Back]


An abnormality or anomaly of the heart is present at birth.

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What is Congenital Heart Disorder (CHD)
An abnormality or anomaly of the heart is present at birth.
What are the cardiovascular disorder?
Acquired Heart Disorder, compromises abnormalities occurring after birth that compromises the hearts function.
Children with suspected cardiac dysfunction may exhibit what?
Cyanosis, pallor, cardiomegaly, pericardial rubs, murmurs and additional heart sound S3 n S4,
Environmental factor for CHD includes what?
Intrauterine rubella exposure exposure, maternal alcoholism, DM, advance maternal age and maternal drug ingestion.
Genetics risk factor for CHD are.
Presence of sibling or parent w/ CHD, chromosomal anomalies, (trisomy G{ trisomy 21, Down Syndrome} Trisomy D { trisomies 13, patau syndrome 14: 15} and monosomy X { turner syndrome}
What are the two types of defects?
CHD - disorder related to symptoms of color ( cyanotic or acyanotic. Disorders related to the direction of blood flow ( left to right shunt or right to left shunt.)
What re the four physiologic characteristics most current CHD categories ?
Increased pulmonary blood flow decrease pulmonary blood flow obstruction to systemic blood flow and mixed blood flow
(Patent ductus arteriosus) children with larger defects often exhibits S/S of HF including what?
Poor eating, poor growth patterns and fatigue other S/S typical machine like murmur, widened pulse pressure and bounding pulses
Tetralogy of fallot involves a combination of four defects.
Pulmonary stenosis VSD right ventricular hypertrophy overriding aorta
Fallot sometimes exhibits what?
Systolic ejection murmur, clubbing of the nails beds, dyspnea, squatting, poor growth, mental slowness. syncope and stroke
What is anemia?
Defines as decrease in red blood cell volume a decrease in hemoglobin or both
What is the clinical S/S of mild to moderate anemia?
Hemoglobin values is 6 to 10 g/dl irritability weakness decreased play activity and fatigue
If the hemoglobin falls down below 5 g/dl child has
Anorexia, skin pallor, pale mucous membranes, glossitis, concave or spoon fingernails etc
Children w/ chronic long term anemia often exhibit what?
Growth retardation and developmental delays
Pack RBCs are given only to who?
Severely anemic children.
What is sickle anemia?
Genetic disorder characterized by the abnormal form of hemoglobin within erythrocyte
Sickle anemia is classified as what?
Sickle trait or Active sickle cell disease
Sickling is an intermittent phenomenon the usual precipitating factors are?
Infection fever hypoxemia dehydration high altitudes, cold and emotional stress
Children with Sickle cell disease tend to fist experiences what?
Pallor irritability fatigue jaundice growth impairment
Severe sickling leads to what?
Recurrent sickle cell crisis
The only potential cure for sickle cell disease is what?
Bone marrow or Stem cell transplantation
What is Patent ductus arteriosus?
Failure of the ductus arteriosus to close within the first weeks of life allows oxygenated blood to shunt from the high-pressure aorta to the low-pressure pulmonary artery, which causes the blood to become deoxygenated
What is Atrial septal defect?
Abnormal opening in the atrial septum that enables oxygenated blood to flow from the higher pressure left atrium to the lower pressure right atrium, which causes the blood to become deoxygenated
What are the S/S to Atrial Septal Defect?
Respiratory infections and difficulty breathing. A characteristic harsh systolic murmur may be heard during auscultation over the third intercostal space.
What is VSD?
A ventricular septal defect (VSD) is an abnormal opening in the interventricular septum, resulting in the flow of oxygenated blood from the higher pressure left ventricle to the lower pressure right ventricle, which causes the blood to become deoxygenated.
S/S of VSD
Such defects may be asymptomatic, but signs of heart failure eventually manifest. Other clinical manifestations include a loud, harsh systolic murmur and a palpable thrill.
What happens in transposition of the great vessels?
The pulmonary artery arises from the left ventricle and the aorta arises from the right ventricle, Some affected infants are born with associated defects that allow for communication between the two circulations
(A) those who born with associated defect such as patent ductus arteriosus, atrial septal defect, or VSD are sometimes what?
Have less cyanosis and experience manifestations of heart failure. Cardiomegaly is usually apparent on x-ray study.
(A) what happens in Coarctation of the Aorta?
Narrowing of the lumen of the aorta (usually at the site of the ductus arteriosus), resulting in increased pressure proximal to the defect (head and upper extremities) and decreased pressure distal to the defect (body and lower extremities.
(A) Clinical Manifestation of Coarctation of the Aorta?
Blood pressure in the arms is 20 mm Hg higher than that in the legs (reversal of normal pattern). bounding pulses in the lower extremities, heart failure, leg cramping on exertion in older affected children, and epistaxis.
What are the patient education for a child with Hemophilia?
RICE method: Rest, Ice, Compression, and Elevation. avoid injury and control bleeding
What medication administer for JIA (Juvenile Idiopathic Arthritis)
Nonsteroidal anti-inflammatory drugs (NSAIDs), which include naproxen (Naprosyn) and ibuprofen (Motrin)
S/S in JIA?
Joints may be stiff and warm to the touch, fever and rash, may reveal swelling in the spleen, liver, and lymph nodes. Changes in vision include red eyes and photosensitivity.
How does the infant or child get affected of HIV?
By their mother while in utero, during delivery, or through breastfeeding.
The greatest threat to an HIV-infected infant younger than 1 year is what?
Pneumocystis jiroveci (formerly Pneumocystis carinii) Pneumonia
What is RDS?
Respiratory distress syndrome severe lung disorder that is the major cause of morbidity and mortality in the neonatal period.
RDS is caused by what?
Deficiency of surfactant and occurs almost exclusively in preterm infants of low birth weight.
What does the surfactant do?
Reduces the surface tension of fluids that line the alveoli.
What happens when the production of surfactant is not sufficient?
Infant is unable to keep the lungs inflated and the alveoli collapse at the end of expiration, resulting in hypoxia, atelectasis, and respiratory acidosis.
What are the S/S of RDS?
Nasal flaring; expiratory grunting; intercostal, subcostal, or substernal retractions; dusky color involving the skin, nail beds, and mucous membranes; tachypnea (up to 80 to 120 breaths/minute) initially and dyspnea; and low body temperature. apnea, flaccidity, absence of spontaneous movement, unresponsiveness, and mottling.
In severe cases of RDS what happens to the infant?
Die within hours of the onset of signs and symptoms
Pneumonia is classified according to what causative agents?
Bacterial Viral mycoplasmal or Foreign body aspiration
What is the difference between bacterial and viral pneumonia?
Viral pneumonias are more common than bacterial pneumonias. Respiratory syncytial virus (RSV) accounts for the largest percentage of infections in infants and young children. Bacterial pneumonias most common in infants and children are caused by streptococci, staphylococci.
S/S Pneumonia in Children are?
Abdominal pain anorexia chest pain cough fever
Diagnostic for pneumonia are?
Radiographic examination Peripheral blood tests culture and Gram stain of respiratory secretions and the blood
What diagnostic tests for leukemia?
Physical examination CBC Lumbar puncture
How to assist the parents post SIDS death for infant?
Ensure that the parents last moments with their infant are quite and peace.
How to care the infant after death?
Clean the infant, wrap the infant in a sheet or blanket and tidy the room where the family able to spend time with the infant.
Patient teaching for patient had tonsillectomy.
Avoid food that are irritating or highly seasoned avoid the use of gargle or vigorous brushing of the teeth. try avoid coughing and clearing throat do not use aspirin use ice collar for pain
What is LTB?
Laryngotracheobronchitis is the most common for of croup
Immediate treatment for child with Acute epiglottis?
Establishing artificial airway humidification gentle oral suctioning and constant observation
What is Acute epiglottis?
Is a severe, potentially life-threatening bacterial infection of the epiglottis in older children and is usually caused by H. influenzae type B.
What can happen suddenly in acute epiglottis?
Inflamed epiglottis becomes cherry-red and edematous, which has the potential to lead to total airway obstruction.
S/S of having LTB?
Hoarseness; inspiratory stridor; tachypnea; nasal flaring; suprasternal, substernal, and intercostal retractions; and characteristic barking cough
S/S of having Acute epiglottis?
Cutely ill with high fever, muffled voice, drooling, progressive respiratory distress, anxiety, and fear.
Is acute epiglottis life threatening?
YES its potentially life-threatening
What is the most common involves with CHD
Increased pulmonary blood flow
What is cystic fibrosis?
Genetic disorder that a child inherits from both parents
What is cystic fibrosis?
Disorder of the exocrine (mucus-producing) glands, with the characteristic presence of excessive thick mucus that obstructs the lungs and the gastrointestinal (GI) system.
S/S of Cystic Fibrosis
Steatorrhea (bulky, foul-smelling, fatty stools), growth failure, protuberant abdomen, and thin, wasted extremities.
Nursing intervention for post cleft palate surgery?
Kept on NPO status until the effects of the anesthesia have disappeared, avoiding contact with the suture line Breastfeeding is usually contraindicated immediately after surgery.
S/S of congenital hypothyroidism
Cool, mottled skin dyspnea hypothermia lethargy poor appetite poor sucking reflex prolonged jaundice
S/S o acquired hypothyroidism
Constipation dry skin growth delay lethargy mental slowness puffy eyes
S/S of hyperthyroidism
Accelerated growth advance bone age excessive appetite hypertension hyperactivity