Downloaded from http://ccn.aacnjournals.

org/ by guest on July 1, 2014

Viral Myocarditis in Children
ammy !. "hl
Crit Care Nurse 200#, 2#:42$%&.
' 200# (mer)can (ssoc)at)on of *r)t)cal$*are +urses
,ubl)shed onl)ne http://www.cconl)ne.org
Subscription Information
http://ccn.aacnjournals.org/subscr)pt)ons
Information for authors
http://ccn.aacnjournals.org/m)sc/)fora.-html
Submit Manuscript
www.ed)tor)almanager.com/ccn
E-mail alerts
http://ccn.aacnjournals.org/subscr)pt)ons/etoc.-html
*r)t)cal *are +urse )s the off)c)al peer$re.)ewed cl)n)cal journal of the
(mer)can (ssoc)at)on of*r)t)cal$*are +urses, publ)shed b)$monthly by
he /nno0)s)on 1roup 101 *olumb)a, (l)so 0)ejo, *( 22%3%.
elephone: 4#005 #22$1612, 42425 &%2$2030, e-t. 3&2. 7a-: 42425
&%2$2042. *opyr)ght ' 2011 by ((*+. (ll r)ghts reser.ed.
M
Downloaded from http://ccn.aacnjournals.org/ by guest on July 1, 2014
PediatricCare
0)ral
8yocard)t)s
)n *h)ldren
Tammy L. Uhl, RN,
MSN, CCRN, CCNS
h)s art)cle has been des)gnated for *9 cred)t.
( closed$boo:, mult)ple$cho)ce e-am)nat)on
follows th)s art)cle, wh)ch tests your :nowledge
of the follow)ng object).es:
1. /dent)fy wh)ch populat)on )s at most r)s: of
death as the result of myocard)t)s
2. /dent)fy the mechan)sm that results )n
morb)d)ty and mortal)ty )n ch)ldren
w)th myocard)t)s
&. D)scuss the s)gns and symptoms
of myocard)t)ts )n ch)ldren
4. Descr)be the treatment of pat)ents w)th
myocard)t)s
yocard)t)s )s def)ned as
)nflammat)on of the myocard)um
followed by necros)s and/or degen$
erat)on of myocytes.
1$&
he )nflam$
mat)on can be d)ffuse or focal and
)s usually due to an )nfect)on.
(lthough myocard)t)s se.ere enough
to be recogn);ed )s rare, )t )s the
most common cause of heart fa)lure
)n otherw)se healthy ch)ldren.
4
/n
both ch)ldren and adults, most cases
are subcl)n)cal< thus, the true )nc)$
dence of myocard)t)s )n ch)ldren )s
un:nown.
2,3$6
"nfortunately, the cl)n)$
cal features of myocard)t)s can .ary
w)dely, and often no card)ac s)gns
or symptoms occur, compl)cat)ng
recogn)t)on. 7or ch)ldren )n whom
the d)agnos)s )s suspected or card)o$
.ascular comprom)se )s se.ere enough
to re=u)re adm)ss)on to the ped)$
atr)c )ntens).e care un)t 4,/*"5, cr)t$
)cal care nurses are an essent)al
component )n determ)n)ng manage$
ment, care, and outcomes. /n th)s
art)cle, / descr)be the et)ology of .)ral
myocard)t)s )n ch)ldren, potent)al
)ns)d)ous cl)n)cal features, patho$
phys)ology of the d)sease, and cr)t)cal
care management.
Case 1
(.J., a pre.)ously healthy &$year$
old boy, was brought to the emer$
gency department because h)s
body temperature was 40.3>*.
Dur)ng the pre.)ous wee:, he had
had some nasal d)scharge and a
m)ld, nonpro$ duct).e cough. ?e
had no h)story of )ncreased wor:
of breath)ng, rashes,
or d)arrhea. @ne day before the
.)s)t to the emergency department,
he had been .om)t)ng and had
been unable to tolerate anyth)ng by
mouth.
@n arr).al )n the emergency
department, (.J. appeared )ll but
was alert and )n no mar:ed d)stress.
0)tal s)gns were heart rate, 1%2/m)n<
resp)rat)ons, 2%/m)n< and o-ygen
saturat)on, determ)ned by pulse
o-)metry, 22A on room a)r. +o
murmur or gallop was noted< cap)l$
lary ref)ll was br)s: w)th 2B per)ph$
eral pulses and warm e-trem)t)es.
Creath sounds were clear b)later$
ally. ?e appeared m)ldly dehy$
drated w)th tachycard)a, m)ldly
sun:en eyes, and tac:y mucous
membranes.
Dout)ne blood tests were done.
9lectrolyte le.els were normal
e-cept for a carbon d)o-)de le.el of
1# m9=/!, an an)on gap of 2& m9=/!,
and a serum urea n)trogen le.el of
21 mg/d! 4to con.ert to m)ll)moles
per l)ter, mult)ply by 0.&365, cons)s$
tent w)th dehydrat)on. ( complete
blood cell count re.ealed a wh)te
blood cell count of 2% 200/E!, a
hemoglob)n le.el of 12 g/d!, a
hematocr)t of &3.2A, and a platelet
count of &21 000/E!. ( d)fferent)al
count was not completed.
(ppro-)mately 13 m)nutes after
h)s )n)t)al e-am)nat)on, (.J. rece).ed
two 20 m!/:g )ntra.enous boluses
Author
Tammy L. Uhl is a pediatric critical care clinical nurse specialist at Brenner Childrens
Hospital, Wake Forest University Baptist edical Center, Winston!"alem, North
Carolina.
Correspondin# author$ Tammy L. Uhl, %N, "N, CC%N, CCN", Brenner Childrens Hospital, Wake Forest University
Baptist edical Center, edical Center Blvd, Winston!"alem, NC &'()' *e!mail$ tuhl+,-u.mc.edu/.
To purchase electronic or print reprints, contact The 0nno1ision 2roup, (3( Colum.ia, 4liso 1ie5o, C4 6&7)7.
8hone, *933/ 966!('(& or *6:6/ ;7&!&3)3 *e<t );&/= -a<, *6:6/ ;7&!&3:6= e!mail, reprints+aacn.or#.
of normal sal)ne and was g).en
some$ th)ng to eat, wh)ch he
tolerated well. Cecause h)s parents
were comfort$ able w)th obser.)ng
the ch)ld at home and e-pressed
full under$ stand)ng of the s)gns of
dehydrat)on,
(.J. was read)ed for d)scharge.
Downloaded from http://ccn.aacnjournals.org/ by guest on July 1, 2014
42 CRITICALCARENURSE 0ol 2#, +o. 1, 79CD"(DF 200# http://ccn.aacnjournals.org