Cardiology

1. Fetal structure of heart

a. Foramen ovale-systemic blood enters rt atrium- blood bypasses lungs
which are nonfnl
b. Ductus arteriosus- btwn aorta and pulmonary-allows for mixing of blood
2. Acyanotic heart defects: do not cause deoxygenated or low oxygen levels;
mucus membrane=pink
a. Patent Ductus Arteriosus: (PDA)
i. Description: remains open after birth
ii. Etiology: shunts from aorta back to pulmonary artery
iii. Assessment: wt loss, FTT, MACHINERY murmur, wide pulse pressure
iv. Complication: CHF(HR increases with inspiration), pulmonary HTN,
atrial flutter/fibrillation
v. Lab tests: X-ray (note enlargement), Echo,
vi. Interventions: Surgery (close with patch and stitch closures under
cardiopulmonary through atrial approach)
a. Cloracotomy (3 incisions to close PDA)
2. Increase calories in diet, I&O, want child relaxed
3. Med: Digoxin and diuretics,
a. Endometricin prostaglandin that promotes closure
b. Atrial septal defect( ASD):
i. Description: defect btwn atria, blood flow from left atrium to right
atrium
ii. Etiology: opening btwn atria, FORAMEN OVALE fails to close
iii. Assessment: asymptomatic if small defect, dyspnea,
1. soft systolic murmur in pulmonic area
iv. Lab test: Echocardiogram (uses ultrasound), shows rt ventricular
overload and
v. Interventions: surgery/ patch of defect,
c. Ventricular septal defect: (VSD)
i. Description: defect btwn ventricles, left vent to right ventricle
ii. Etiology: Opening in septum btwn vent, cause unknown
iii. Assessment: FTT, loud/harsh murmur (3th-4th intercostal),
tachycardia, dyspnea, poor growth, reduced fluid intake, palpable
thrill, signs of CHF*
iv. Lab tests: ECG- detects large septal defects
v. Complications: CHF
vi. Interventions: surgical patching, prophylactic antibiotics to prevent
endocarditis
vii. Teach: reduce stress on heart, support nutrition, promote rest,
1. Older child needs to cough and deep breath postop and
movement
d. Coarctation of aorta- obstructive defect, NARROWING
i. Description: narrowing of descending aorta, restricts blood flow
leaving hrt
ii. Etiology: often near ductus arteriosus, progressive disorder

iii. Complication: CHF, CVA(secondary HTN in upper circulation)

iv. Assessment: may be asymptomatic, bp difference of 20 mm btwn
upper &lower extremities, brachial and radial pulses fullfemoral
weak
1. Headache, vertigo, and epistaxis
2. Exercise intolerance, dyspnea
3. Left vent hypertrophy, CVA
v. Interventions: therapeutic management, balloon cardiac cath,
surgical resection and patch, prophylaxis for endocarditis when
undergoing surgical/dental procedure
1. Preop- monitor bp in upper and lower extremities
2. Postop-monitor for rebound HTN
e. All interventions:
i. Provide care for family due to stress
1. Assess coping mechanisms, provide info and refer
ii. Risk for impaired growth and development
1. Treat child normal, teach parents to tell/talk to children
open disclosure comforting, promote mental health
development
iii. Risk for infection
1. Limit exposure to individuals with infections, teach good
hygiene- change position, use percussion and postural
drainage
2. Prophylactic antibiotics when undergoing surg/dental
treatments-prevents endocarditis
iv. Imbalanced nutrition
1. Offer small frequent feedings,
2. use soft nipple for infect to ease stress of sucking
3. organize nursing care to allow for rest
v. Impaired gas exchange
1. Promote good pulmonary hygiene, change position q2hrs
2. Monitor I&O, limit fluids as ordered, give diuretics as ordered
3. Cyanotic heart defects: cause blood to contain less oxygen then required,
membranse= pale to blue
a. Tetralogy of Fallot: rt to left shunting
i. Description:4 defects that combine, blood flow bypasses lungs,
enters lft hrt
ii. Etiology: Pulmonic stenosis, rt ventricular hypertrophy, VSD, and
overriding aorta
1. ASD occurs at times
2. Deficient O2 leads to acidosis
iii. Assessment: clubbing of digits, polycythemia, poor growth, exercise
intolerance,
1. Systolic murmur in pulmonic area
2. TET spells (hypoxia/pallor/tachypnea) precip by: crying,
defecation, feeding
a. Older children: assume squatting position to decrease
blood return from lower extremities

iv. Interventions:
1. Place child in knee to chest position during TET spells
a. Give morphine/propranolol and O2 also
2. palliative surgery to increase O2 includes shunting
procedures
3. Medications:
a. Prostaglandin E1: to maintain open ductus arteriosus,
palliative surgery
b. Transposition of the great vessels (TGA):
i. Description: aorta arises from rt ventricle, and pulmonary artery
arises from left ven
ii. Etiology: unknown, pulmonary artery- oxygenated blood, aorta-deox
blood
iii. Complication: CHF
iv. Assessment: progressive cyanosishypoxiaacidosis
1. Tachypnea, poor feeding, failure to grow,
v. Lab tests: echocardiogram- ids misplacement of arteries
vi. Interventions/ Management: prostaglandin E1 (maintain open
ductus arteriosus)
1. Palliative surgical interventions
2. Corrective surgery
3. Prophylactic antibiotic theray to prevent endocarditis
4. Promote nutrition and reduce respiratory congestion
vii. Balloon Atrial Septostomy: surgical treatment
c. Truncus Arteriosus: pulmonary artery and aorta do not separate
i. Description: one main vessel receives blood from the left and rt
ventricles
ii. Etiology: blood mixes in rt and left through large VSD
iii. Complication: cyanosis
iv. Interventions: surgical
d. Interventions Cyanotic heart defects
i. Monitor hemoglogin and hematocrit levels, keep child calm, dont
allow long periods of crying
1. When hypercyanosis occurs, assist child to squattin/knee to
chest position
2. Give O2 and morphine during these (TET) spells
ii. Limit exposure to others with infections, promote good pulmonary
hygiene
1. Position change, percussion, postural drainage
2. Prophylactic antibiotics
iii. Offer small freq feedings, Use soft nipple for infant to ease stress of
sucking
iv. Limit activity, organize care to allow for rest
v. Maintain clear airways, monitor electrolytes
vi. Assess v/s, monitor for signs of CHF, note peripheral edema, weigh
child/day
1. Strick I&Os , give diuretics, O2
2. Palpate liver 4-12 hrs (indicates rt sided failure)

vii. Med
1. Give digoxin as ordered
a. Assess apical pulse- monitor for
bradycardia/arrhythmias
b. Be consistent in measurement of medications and time
of administration
c. Do not repeat dose if child vomits
4. Rheumatic Fever:
a. Description:
b. Etiology:
c. Complications:
d. Risk Factors:
e. Interventions:

5. Kawasaki Disease
a. Description:
b. Etiology:
c. Complications:
d. Risk Factors:
e. Interventions: