Cardiological Disorders

● Dysrhythmia
○ Types
■ Bradycardia
■ Tachycardia
■ Supraventricular Tachycardia
■ Asystole
○ Risk Factors
■ Medications
■ Hypoxia
■ Procedures or surgeries
■ Intubation
■ Infections
● Congenital Heart Disease (CHD)
○ What? Anatomic a defect of the fetal heart which prevents normal blood flow to the
pulmonary and/or systemic system.
○ Risk Factors
■ Maternal: alcohol use in pregnancy, diabetes mellitus, infection
■ Genetic: history, down syndrome, other congenital anomalies present
○ Classification: Acyanotic Lesions
■ What? The shunting of blood goes from left to right - oxygenated blood on the
left side shunts back to the right side and reenters the lung.
■ Lesions
● Ventricular Septal Defect (VSD): a hole in the septum between the
right and left ventricle results in increased pulmonary blood flow (left
to right) → a loud murmur can be heard at left sternal border
● Atrial Septal Defect (ASD): a hole in the septum between the right and
left atria that results in increased pulmonary blood flow (left to right)
→ loud murmur heard with a fixed split second heart sound
● Patent Ductus Arteriosus (PDA): a condition in which the normal fetal
circulation between the pulmonary artery and the aorta fails to close
resulting in increased pulmonary flow (left to right) → murmur heard
with wide pulse pressure and bounding pulses
■ S/S: increased pulmonary blood flow (increased HR, RR, and metabolic rate)
■ Complication
● Congestive Heart Failure (CHF): edema in face, weight gain in
general, scalp sweating → can be started on other medications
digoxin, diuretics, ACE inhibitors; HOB up, strict I/O, daily weight,
increased calorie formula, increase calories with additives to
breastmilk, overnight NG feedings
○ Classification: Cyanotic Lesions
■ What? Occurs with a defect that obstructs pulmonary blood flow to the lungs OR
due to a defect that permits no connection of the right sided blood flow to the
lungs.
● If atrial or ventricular septal defects are present, the right sided pressure
exceeds the left, resulting in right to left shunt.
■ Lesions
● Tetralogy of Fallot: four defects that result in mixed blood flow
(pulmonary stenosis, ventricular septal defect, overriding aorta, right
ventricular hypertrophy)
○ Causes: cyanosis at birth, systolic murmur, episodes of acute
cyanosis/hypoxia
■ S/S
● Decreased pulmonary blood flow
● Hypercyanotic “Tet Spells”: occurs with anything that disrupts the
systemic vascular resistance and pulmonary blood flow (walking in the
am, crying, feeding, exercise, warm bath, defecation)
○ S/S
■ Cyanosis
■ Clubbing of the fingers
■ Poor growth / development delay
■ Feeding problems (dyspnea, diaphoresis)
■ Polycythemia (increased RBCs)
○ Tx
■ Digoxin → to improve myocardial contractility
● Pre: HOLD if apical pulse in infant is < 90 bpm, child < 70 bpm
● Normal Blood Levels: 0.8 - 2 ng/mL
● Administration: Q12
● Toxicity S/S: nausea, bradycardia, anorexia, abdominal pain, diarrhea,
fatigue, drowsiness, muscle weakness, hypokalemia can increase digoxin
levels
■ Lasix (loop diuretic) → potassium wasting diuretics rids the body of excess
fluid and sodium
● Encourage high potassium diet to prevent hypokalemia
■ ACE inhibitors (Captopril / Enalapril) → reduces afterload by causing
vasodilation, resulting in decreased pulmonary and systemic vascular
resistance
● Monitor BP before and after administration
○ Nursing Interventions
■ Maintain hydration (especially with polycythemia b/c it can cause clots)
■ HOB up to assist with respiration
 ■ Increased calorie formula (polycose)
■ Increase calories with additives to formula or breastmilk

● Rheumatic Fever
○ What? Inflammatory connective tissue disorder which results from an autoimmune
response to an infection (beta-hemolytic streptococcal)
■ Occurs within 2-6 weeks following an untreated or partially treated upper
respiratory infection (strep throat) with beta hemolytic streptococcal.
○ S/S
■ Fever - Prolonged PR interval
■ Tachycardia - New or changed heart murmur
■ Cardiomegaly - Pericardial friction rub
■ Large joints with painful swelling
■ Pink, nonpruritic macular rash on the trunk and inner surfaces of extremities
○ Labs
■ Elevated ESR
■ Elevated antistreptolysin O titer (ASO)
■ Elevated C reactive
○ Nursing Interventions
■ Bed rest
■ Assist with ambulation
○ Tx
■ Antibiotics (penicillin or erythromycin)
■ Aspirin (anti inflammatory and anticoagulant)
● Kawasaki Disease
○ What? Acute febrile, systemic vascular inflammatory disorder that affects small and
midsize arteries, including coronary arteries.
○ S/S
■ Acute Stage (1-2 weeks)
● Irritability, high fever for more than 5 days, conjunctival hyperemia, red
throat, swollen hands and feet, maculopapular rash on trunk/perineal
area, unilateral enlargement of lymph nodes, diarrhea…
■ Subacute Stage (2-4 weeks)
● Cracking lips and fissures, desquamation of the skin on the tips of the
fingers and toes, joint pain, cardiac disease, thrombocytosis…
■ Convalescent Stage (6-8 weeks)
● Child appears normal, with lingering signs of inflammation present
○ Tx
■ IV Gamma Globulin
● Dosage: 2 grams/kg Q8-12
■ Aspirin
● Initial: 80-100 mg/kg/day Q6
● Afebrile: 3-5 mg/kg/day until platelet count returns to normal (6-8 wks)
Hematological Disorders
● Iron Deficiency Anemia
○ What? Decreased levels of hemoglobin (Hgb) resulting from an inadequate dietary
supply of iron or malabsorption disorders.
○ S/S
■ Tachycardia - Brittle, spoon shaped nails
■ Pallor - fatigue, irritability, muscle weakness
■ Systolic heart murmur
○ Labs
■ Mild: Hgb 9.5 -11
■ Moderate: Hgb 8-9.4
■ Severe: Hgb < 8
○ Tx
■ Oral Iron
■ Diet with Iron rich foods (fish, nuts, greens)
○ Nursing Consideration
■ Administer iron on an empty stomach with orange juice for optimal absorption
■ Do not have dairy or antacids with doses of iron
■ Use straw to avoid teeth staining
■ Tarry stool
● Sickle Cell Anemia
○ What? Recessive hereditary disease (prevalence - african ancestry) that causes partial or
complete replacement of normal hemoglobin with abnormal hemoglobin ‘s’ in red blood
cells.
■ Sickled cells obstruct capillary blood flow, leading to tissue ischemia and further
hypoxia, thus causing more sickling.
○ Triggers
■ Hypoxia r/t high altitudes, poorly pressurized airplanes, hypoventilation,
vasoconstriction with cold weather, emotional stress
○ S/S
■ Reports of pain - Cold to touch hands/feet
■ Shortness of breath, fatigue - Dizziness
■ Jaundice - Headache
○ Complications
■ Vaso-occlusive crisis (lasts 4-6 days) → fever, severe abdominal pain, painful
edema of hands/feet, arthralgia
■ Aplastic crisis → extreme anemia as a result of decreased RBC production,
typically triggered by an infection with a virus.
■ Bacterial infections
○ Tx
■ Pain control (opioids) - Prevention and treatment of infection
 ■ Hydration - Possible blood transfusion
■ Oxygenation
○ Education
■ Prevention (avoid strenuous exercise, prevent infection, prophylactic antibiotics,
hydration)
■ Genetic counseling
■ Up to date on immunizations
● Hemophilia
○ What? Hereditary bleeding disorder, which is due to the lack of a factor required for
blood to clot. that is usually exclusively a male disorder with female carriers (X linked
recessive disorder)
○ Classification
■ Mild (greater than 5%, upto 30%-40%) → occurs with surgery or major
trauma
■ Moderate (1%-5%) → after minor trauma
■ Severe (< 1%) → spontaneous
○ S/S
■Prolonged bleeding first noted when: umbilical cord is cut, vitamin K injection,
circumcision
■ Bruising with minor injuries
■ Hemarthrosis (AEB joint pain, stiffness, warmth, welling, redness and loss of
range of motion)
■ Headache, slurred speech and decreased level of consciousness
○ Labs: Prolonged aPTT
○ Tx
■ DDAVP: synthetic form of vasopressin that increases plasma factor (effective for
mild form)
■ Factor VIII: used to prevent and treat hemorrhage
■ Corticosteroids: used to treat hematuria, acute episodes of hemarthrosis and
chronic synovitis
○ Nursing Interventions
■ Administer blood products as ordered
■ Administer injections via SQ
■ Avoid unnecessary punctures
■ Pain management (no aspirin)
● Lead Poisoning
○ Risk Factors
■ Lead paint (pre 1970 homes and older toys)
■ Soil, dust
○ S/S
■ Interferes with developmental processes in the CNS
■ Greater risk of becoming hypertensive as an adult
■ Delayed growth r/t malabsorption of vitamin d and iron
 ○ Tx
■
Find and eliminate the source of lead
■
Optimize nutrition
■
Lead blood levels should decrease past age of 2, and a stable blood lead level
past age 2 is likely to be attributable to ongoing exposure
■ Chelation therapy for children with blood levels of 20-44 micrograms/dL aides in
decreasing blood levels
● Henoch Schonlein Purpura (HSP)
○ What? Vasculitis (inflammation) of the small blood vessels in your skin, joints, intestines
and kidneys which affects children with the mean age of 6 years old.
○ Risk Factors
■ Age → 2-6 years
■ Sex → common in boys than girls
■ Race → white and asian children are more likely than black children
■ Time of year → autumn, winter and spring (rarely in summer)
○ S/S
■ Palpable purpura (typically on the lower legs and buttocks)
■ Joint pain
■ Colicky abdominal pain
■ GI bleed with blood in stool and hematuria
○ Complications
■ Kidney damage
■ Bowel obstruction
○ Tx → goes away on its own within a month