Classification According to Size
● Low-birthweight (LBW) infant
- less than 2500 g (5.5 pounds)
● Very low–birth weight (VLBW)
- less than 1500 g (3.3 pounds)
● Extremely low–birth weight (ELBW)
- less than 1000 g (2.2 pounds)
● Appropriate-for-gestational-age (AGA)
- weight falls between the 10th and 90th
percentiles
● Small-for-date (SFD) or small-for-
gestational-age (SGA)
- birth weight falls below the 10th percentile
● Intrauterine growth restriction (IUGR)
- Found in infants whose intrauterine growth
is restricted
● Symmetric IUGR
- Growth restriction in which the weight,
length, and head circumference are all
affected
● Asymmetric IUGR
- Growth restriction in which the head
circumference remains within normal
parameters
- birth weight falls below the 10th percentile Symptoms of RDS
● Large-for-gestational-age (LGA)
- above the 90th percentile
Classification According to Gestational Age
● Preterm (premature) infant
- born before completion of 37 weeks
● Full-term infant
- born beginning 38 weeks and the
completion of the 42 weeks
● Late-preterm infant
- born between 34 and 36 weeks
● Post-term (postmature) infant
- born after 42 weeks Week 20 - start of surfactant production
and storage
Classification According to Mortality - does not reach the lung
● Live birth surface until later.
- Birth in which the neonate manifests any Week 28-32 - maximal production of
heartbeat breathes or displays voluntary surfactant and appears in
movement amniotic fluid
● Fetal death
Week 34-35 - mature levels of surfactant in
- Death fetus after 20 weeks lungs
- absence of any signs of life before delivery
● Neonatal death Quality amounts produced or released
- occurs in the first 27 days of life; may be insufficient to meet
postnatal demands because of
- early neonatal death - first week of life immaturity.
- late neonatal death - 7 to 27 days.
● Perinatal mortality Clinical manifestation
- Total number of fetal and early neonatal ● Tachypnea
deaths per 1000 live births ● Nasal flaring
● Intercostal, sternal recession
RESPIRATORY DISTRESS SYNDROME (RDS) ● Grunting; closure of glottis during
- disease related to developmental delay in expiration.
lung maturation. ● Cyanosis
- seen almost exclusively in preterm infants. Management of Respiratory Distress
- Pneumonia in the neonatal period may ● Monitoring
result in respiratory distress ● Supportive
- IV fluid - Maintain vital signs.
● blue-colored lips, fingers, and toes - Oxygen therapy
● rapid, shallow breathing ● Respiratory support
● flaring nostrils Initial Care
● a grunting sound when breathing ● Maintain warmth
Etiology and Pathophysiology - cold stress will mimic other causes of
- Surfactant deficiency distress.
- Low levels of surfactant cause high surface ● Monitor blood glucose levels
tension - Assure they are normal.
- High surface tension makes it hard to ● Provide enough oxygen
expand the alveoli. - to keep the baby pink
MECONIUM ASPIRATION SYNDROME (MAS)
- Is respiratory distress in a newborn who
has breathed(aspirated) meconium into the
lungs before or around the time of birth.
Causes of MAS
● Hypoxia in distressed baby
● Meconium Stained Liquor
● Uterine Infections
● Difficulty during the labor process
● passage of meconium from the fetus into
amnion
● Vagal Stimulation
- increased peristalsis and a relaxed anal
sphincter.
● Fetal maturation (post-term)
- causes a high motilin level increased
peristalsis
Symptoms include the following:
● Cyanosis
● End-expiratory grunting
● Nasal flaring
● Breathing problems like( difficulty in
breathing, no breathing, and rapid
breathing)
● Intercostal retractions
● Tachypnea
● Barrel chest in the presence of air trapping
● Auscultated rales and rhonchi ( in some
cases).
● Yellow-green staining of fingernails,
umbilical cord, and skin may be observed.
Management of MAS Prenatal:
● Identification of high-risk pregnancies
● Monitoring
- careful observation and fetal monitoring
during labor
● Amnioinfusion
- relieved umbilical cord compression during
labor -> reducing the occurrence of
variable fetal heart rate decelerations -
efficiency not well demonstrated.
Delivery room management
● Immediate Management
baby is not vigorous:
- Suction the trachea immediately after
delivery (no longer than 5s)
- no meconium is retrieved - do not repeat
intubation and suction.
- meconium is retrieved and no
bradycardia is present - reintubate and
suction.
- heart rate is low - administer positive
pressure ventilation, and consider
suctioning again later.
baby is vigorous:
- Do not electively intubate
- Clear secretions and meconium from the
mouth and nose with a bulb syringe or a
large- bore suction catheter.
- Dry, stimulate, reposition, and administer
oxygen as necessary.
- Transfer ill newborns with respiratory
distress to NICU
● General management
- Continued care in the neonatal ICU (NICU)
- Maintain an optimal thermal environment
- Minimal handling to reduce agitation thus
pulmonary hypertension and R to L
shunting
- Insert the umbilical artery to monitor blood
pH and blood gases without agitating the
infant.
- Continue respiratory care: Oxygen
saturation ( 90-95%) should be maintained.
- treated with antibiotics because of the risk
of infection
● Supportive treatment
- IV Dextrose to prevent hypoglycemia.
- Fluid restriction (60-70 mL/kg/d) to prevent
cerebral and pulmonary edema
Treatment
● Surfactant Therapy
- Replace displaced or inactivated surfactant
and as a detergent to remove meconium
- May decrease respiratory failure with MAS
within 6 hrs of 3 doses.
● Extracorporeal membrane (ECMO)
- oxygenation is the last option focused on
the function of oxygenation and CO2
removal.
- anesthesia used for longer-term support
ranging from 3-10 days
- Survival rate 93-100%
NEONATAL SEPSIS (NS)
- defined as a clinical syndrome of
bacteremia with systemic signs and
symptoms of infection
- first four weeks of life.
Etiology
● Escherichia coli.
● Group B Streptococci.
● Listeria monocytogenes.
● Others:
● Coagulase-negative staphylococci.
● Streptococcus pneumoniae.
● Klebsiella pneumoniae.
● Acinetobacter species.
● Pseudomonas aeruginosa.
 ● Candida.
Classification
● Early-onset sepsis
- (birth to 7 days)
- transplacental, ascending, or intrapartum.
● Late-onset sepsis
- (8 to 28 days
- acquired in a hospital, home, or community
Clinical Features
● Respiratory distress
- in early-onset NS.
● Altered feeding behavior
- in a well-established feeding newborn
(aspiration, vomiting, etc.).
● Active baby suddenly or gradually
becomes lethargic, inactive or
unresponsive, and refuses to suckle.
● Temperature instability
- Hypo- or hyperthermia.
● Skin
- Poor peripheral perfusion, cyanosis, pallor,
petechiae, rashes, or jaundice.
● Metabolic
- Hypo- or hyperglycemia or metabolic
acidosis.
Diagnosis
Non-specific:
● White blood cell count and differentia
- Neutropenia can be a threatening sign (<
1,800/cm).
- Immature to Total neutrophil (I:T) ratio ≥
0.2 is predictive (Normal: ˂ 0.16).
● Acute phase reactants
- C-Reactive Protein (CRP): rises early.
- ESR rises > 15 mm 1 st hr.
● Platelet count:
- Decreases, a late sign, and non-specific.
Cultures:
● Blood
- Confirms sepsis.
● Urine
● CSF
- May be useful in clinically ill newborns or
those with positive blood cultures.
Radiology:
● Chest X-Ray
- For infants with respiratory symptoms.
● Renal ultrasound:
- For infants with accompanying UTI.
● CT scan
- For infants with probable meningitis or
seizures.
Treatment and Management
● Antibiotics:
- based on culture & sensitivity
- combination of ampicillin and an
aminoglycoside (usually gentamicin) for 10
to 14 days is an effective treatment against
most organisms responsible for early-onset
sepsis.
- combination of ampicillin and cefotaxime
also is proposed as an alternative method
of treatment.
- If meningitis is present, the treatment
should be extended to 21 days or 14 days
after a negative result from a CSF culture.
● Supportive therapy
- Respiratory: Oxygen and ventilation as
necessary.
- Cardiovascular: Support blood pressure
with volume expanders.
- Hematologic: Treat DIC.
- CNS: Treat seizures with phenobarbital.
- Metabolic: Correct hypo-/hyperglycemia
and metabolic acidosis.
Prevention
1. Good antenatal care.
2. Maternal infections were diagnosed and treated
early.
3. Babies should be breastfed early.
4. Infection control policies applied in the unit.
HYPERBILIRUBINEMIA
- refers to an excessive level of accumulated
bilirubin in the blood
- above 12.9 mg/100mL for formula feed
infants
- above 15 mg/100 mL for breastfed infants
and Premature)
Characteristics of Hyperbilirubinemia
● yellowish discoloration of the skin, sclerae,
and nails.
Pathophysiology
- RBCs are destroyed, the breakdown
products are released into the circulation
- Hemoglobin splits into two fractions: heme
and globin.
- body uses the globin (protein) portion
- heme portion is converted to unconjugated
bilirubin, an insoluble substance bound to
albumin.
- In the liver, the bilirubin is detached from
the albumin molecule. In the presence of
the enzyme glucuronyl transferase, it is
conjugated with glucuronic acid to produce
a highly soluble substance, conjugated
bilirubin, then excreted into the bile.
- In the intestine, bacterial action reduces
the conjugated bilirubin to urobilinogen, the
 pigment that gives stool its characteristic
color.
- Most of the reduced bilirubin is excreted
through the feces; a small amount is
eliminated in the urine.
- Normally, the body can balance the
destruction of RBCs and the use or
excretion of byproducts.
- when developmental limitations or a
pathologic process interferes with this
balance, bilirubin accumulates in the
tissues to produce jaundice.
- Anemia caused by this destruction
stimulates RBC production, which provides
increasing numbers of cells for hemolysis.
- Major causes of increased erythrocyte
destruction are isoimmunization (primarily
Rh) and ABO incompatibility.
Possible causes of hyperbilirubinemia in
newborns are:
● Physiologic (developmental) factors
(prematurity)
● An association with breastfeeding or breast
milk
● Excess production of bilirubin
● The disturbed capacity of the liver to
secrete conjugated bilirubin
● Combined overproduction and under
secretion (e.g., sepsis)
● Genetic predisposition to increased
production
Nursing Implementation
● Observe infant for signs of increased
jaundice
● Observe for and prevent acidosis
● Maintain adequate hydration and offer
fluids between feeding as ordered.
● Using a skin temperature probe
● Prevent Infections
● Provide Phototherapy
● Meet the infant's emotional needs
● Reinforce Physician's teaching to parents
and allow parents to express concerns and
feelings
● Monitor Exchange Transfusion.
ERYTHROBLASTOSIS FETALIS
- destruction of Red Blood Cells that results
from an Antigen-Antibody reaction and is
- characterized by Hemolytic Anemia and or
Hyperbilirubinemia
Diagnosis
● Indirect Coombs' test
- If there are antibodies present in your
blood stream that should attach to RBC
● Directs Coombs' test
- Detect antibodies that are stuck in the
surface of RBC
- These antibodies sometimes destroy RBC
and cause anemia
● Spectrophotometric Analysis of
Amniotic fluids
- Scan fluid that increasing wavelengths
Assessment
● Assess anemia
● Assess for Jaundice
● Evaluate edema
Nursing Interventions
● Administer immunization against hemolytic
disease with RhoGAM as ordered
● Monitor exchange transfusion after birth or PEDIATRIC CARDIOLOGY
● Intrauterine transfusion.
● Follow interventions for Hyperbilirubinemia
SUDDEN INFANT DEATH SYNDROME (SIDS)
- sudden unexplained death of a child of
less than one year of age
- also known as cot death or crib death.
- usually occurs during sleep; typically,
- between the hours of 00:00 and 09:00.
- usually no noise or evidence of a struggle.
- tends to occur at a higher-than-usual rate
in infants of adolescent mothers, infants of
closely spaced pregnancies, and
underweight and preterm infants.
Factors that place infants at high risk for SIDS:
● prone sleeping position
● soft bedding,
● sleeping in a noninfant bed with an adult or
older child
● environmental exposure to smoking.
Factors that are protective for SIDS
● supine sleep position
● Breastfeeding
● pacifier use at bedtime and naptime,
● updated immunization status.
Nursing Responsibilities
● Educating the family of newborns about the
risks for SIDS
● modeling appropriate behaviors in the
hospital, such as placing the infant in a
supine sleep position
● providing emotional support of the family
who has experienced a SIDS loss.
● Acyanotic = left-to-right
● Cyanotic = right-to-left
NOTE: All left-to-right shunts have the potential to
revert to right-to-left shunts due to increasing
pulmonary congestion (Eisenmenger’s syndrome).
Investigation of suspected heart defect
- diagnosed prenatally @ 16-20 weeks
- Some defects don’t emerge until several
days or weeks have passed since birth due
to transition of circulation → adult levels of
pulmonary vascular resistance
- usually have symptoms within 24 hours
Four Classification of CHD
● Increased Pulmonary Blood Flow (L-R)
- Atrial Septal Defect
- Ventral Septal Defect
- Atrioventricular Canal Defect
- Patent Ductus Arteriousus
● Defect Obstruction to Blood Flow
- Pulmonary Stenosis
- Aortic Stenosis
- Coarctation of the Aorta
● Defects with Mixed Blood Flow (O2 and
UnO2)
- Transposition of Great Arteries
- Total Anomalous Pulmonary Venous
Connection
- Truncus Arteriousus
- Hypoplastic Left Heart Syndrome
● Defects with Decreased Pulmonary
Blood Flow
- Tricuspid Atresia
- Tetralogy of Fallot
VENTRICULAR SEPTAL DEFECT
- most diagnosed CHD
- May be single or multiple
- May be associated with other lesions
Signs and Symptoms
● Holosystolic murmur
● May have thrill or diastolic rumble
● Fatigue
- d/t mixing of unoxygenated and
oxygenated blood
● Failure to thrive
- Slow progress of development)
- d/t poorfeeding
● Dyspnea on exertion (e.g.,
- increased demand for oxygen during
activities but if there is a mixing of blood,
there is insufficient oxygen
- Leading to exercise/activity intolerance
- If during breastfeeding: Brow sweats d/t
too much exertion of effort
Management
● Most will get smaller and disappear on
their own
● Surgical repair indicated for intractable
CHF, failure to Thrive Surgery:
● Palliative
- pulmonary artery banding
● Complete repair
- Knitted Dacron Patch is sutured over the
opening via cardiopulmonary bypass
● Medications
- Digoxin
- Diuretics
Dacron patch
- Implantable consumables in cardiac
surgery
- Tissue: decreased rejection rate
(commonly used)
- Normal microflora → less inflammatory
response → decreased rejection rate
- Obtained in other parts of the body with the
same tissue integrity (usually from the
heart)
- A scintillation camera is inserted for
visualization with a fiber optic scope to
disintegrate/scrape the tissue to be used
- tissue is rejected - surgery is repeated
until compatibility
- Plastic: increased rejection rate
- Only used when the tissue type is not
effective or rejection occurs
- Immunosuppressant therapy - given to
prevent rejection
- no rejection in the dacron patch, s/sx of
septal defect should diminish after a few
weeks
ATRIAL SEPTAL DEFECT
- Acyanotic type
- Most common in girls
3 types of ASD
● Ostrium Primum (ASD1)
- opening is in the lower end of the septum
● Ostrium Secundum (ASD2)
- opening is near the center of the septum
● Sinus Venosus Defect
- opening near junction of the superior vena
cava and right atrium
Signs & symptoms
● asymptomatic unless there are other
defects
● R heart failure
 ● Pulmonary edema
● Increased pulmonary vasculature
● Mid systolic pulmonary flow or ejection
murmur accompanied by a fixed split S2
● Harsh systolic murmur
● Dyspnea
- w/ feeding and frequent respiratory
infections
● Decrease CO
- Tachycardia, cool skin
- Delayed capillary refill
- AV node involvement may result in
arrhythmias
Management
● Refer to pediatric cards for echo
● Small defects in boys
- don’t need closure if RV size is normal.
● Surgery
- done bet 2 and 3 years of age,
- Dacron or Silastic patch is sutured into
place for occlusion
● Non-Surgical
- cardiac catheterization
ATRIOVENTRICULAR CANAL DEFECT
- Also called as endocardial cushion
defect
- Incomplete fusion of endocardial cushions
- Associated with Down’s Syndrome
Management:
● Palliative
- Pulmonary artery banding
● Surgery
- Patch closure of the septal defects
- Reconstruction of the AV valve / valve
replacement
PATENT DUCTUS ARTERIOSUS (PDA)
- Failure of ductus arteriosus to close
- within the first week of life
- Acyanotic
- lifespan varies on how the size of patency
and the urgency of treatment
Signs and Symptoms
● Machinery-like murmur
- (pathognomonic sign/ hallmark
manifestation)
- distinguishing characteristic
● Signs and symptoms of heart failure
- especially if not managed
● Poor feeding
- Mode of feeding is sucking
- they need an enormous amount of oxygen
but there is a mixing of blood resulting in
insufficient oxygenation
- PDA has decrease in O2 → poor sucking →
poor feeding → poor weight gain
● Fatigue
- Poor feeding d/t easy fatigability
- Easily fatigued during crying
● Poor weight gain
- d/t poor feeding
- Weight - primary indicator of health in
newborn
- Ideal birth weight ; 6 months: double birth
weight ; 1-year-old: triple birth weight
Management
● Indomethacin
- facilitate closure of PDA (DOC)
● HOBE
- promote lung expansion
● Surgery
- (bypass) is rare
- Only if not managed by medication
PULMONARY STENOSIS
- Narrowing of the pulmonary valve or
pulmonary artery just distal to the valve
- occurs due to abnormal development of
the prenatal heart
- first eight weeks of pregnancy.
- component of half of all complex congenital
heart defects.
Symptoms of pulmonary stenosis
● symptoms are mild
- pulmonary stenosis may never require any
treatment.
- may have few or no symptoms, or perhaps
none until later in adulthood.
● severe pulmonary stenosis
- will need a procedure to fix the pulmonary
valve so blood can flow properly through
the body.
- could be quite ill, with major symptoms
noted early in life.
Pathophysiology
- problems with the pulmonary valve make it
harder for the leaflets to open and permit
blood to flow forward from the right
ventricle to the lungs in a normal fashion.
- A valve that has leaflets that are partially
fused together.
- A valve that has thick leaflets that do not
open all the way.
- The area above or below the pulmonary
valve is narrowed.
Types of Pulmonary Stenosis:
● Valvar pulmonary stenosis
 - valve leaflets are thickened and/or - Obstructive Narrowing of the aorta once in place, the balloon is inflated to
narrowed (descending aorta)
● expand the stent and dilate the aorta→
Supravalvar pulmonary stenosis. - Narrowing aorta → increase pressure →
- The pulmonary artery just above the once expanded, the balloon is deflated for
pulmonary valve is narrowed decrease in output
● Subvalvar (infundibular) pulmonary Signs and Symptoms withdrawal while the stent stays in place
stenosis ● Different vital signs in the upper extremities - stent prevents the aorta from narrowing
- The muscle under the valve area is and lower extremities again because it acts as a support
thickened, narrowing the outflow tract from - upper extremities are proximal to the heart - Has low probability for rejection; made of
the right ventricle - increased pressure, synthetic plastic or wire
● Branch peripheral pulmonic stenosis - lower extremities are distal to the heart - Only replaced if damaged or dislodged
- The right or left pulmonary artery is where the output is decreased ● Before surgery
narrowed, or both may be narrowed - stable VS
UPPER LOWER - no underlying conditions
AORTIC STENOSIS EXTREMITIES EXTREMITIE
- Narrowing or stricture of the aortic valve S
TRANSPOSITION OF THE GREAT ARTERIES
Clinical Manifestations: BP Increased Decreased (TGA)
● Infants - Cyanotic
PULSE Bounding Weak/absent
- Decrease CO w/ faint pulses - Aorta and pulmonary trunk are switched
- Hypotension, tachycardia ● Rib notching - deoxygenated blood gets pumped through
- Poor feeding - heartbeat can be seen in the rib cage area the aorta to systemic circulation
● Children - d/t the narrowed aorta which causes the - oxygenated blood gets pumped through
- Sign of exercise Intolerance heart to compensate by increasing its the pulmonary artery back through the
- Chest pain, dizziness when standing for a workload lungs
long period of time - Mas malakas na rib notching, mas - Aorta arises from the R ventricle instead of
- Murmur narrowed ang aorta the left
MANAGEMENT Management - pulmonary artery arises from the L instead
● Beta blocker or calcium channel blocker ● Balloon angioplasty with coronary of the right
- to reduce hypertrophy before correction stenting - Detected with a low APGAR score and 2D
● Balloon valvuloplasty - “Repair of aorta using balloon” echo
- surgery of choice - Stent: scaffold/ support; made up of mesh Mechanism:
(superfine screen) - right ventricle is connected to the aorta
COARCTATION OF THE AORTA - Balloon angioplasty: repair of an artery - left ventricle is connected to the
- Narrowing of the descending aorta, usually using a balloon pulmonary artery
just below the aortic arc - The balloon is deflated while inserting it to - PDA is kept open to allow the mixture of
- Usually have other congenital lesions blood PDA keeps the patient alive
(Bicuspid Aortic Valve and VSD) the narrowed aorta together with the stent→
 - Unoxygenated blood is deposited into the
body
Signs and Symptoms
● Severe respiratory depression
● Cyanosis
- A sign of ineffective tissue perfusion
● Failure to thrive
● Easy fatigability
● No murmur even if there is PDA
- d/t incomplete pressure of the heart
because of transposition of the two major
blood vessels (no compression)
Management
● Prostaglandin E
- maintains/keeps PDA open
● Surgery: Arterial switch
- (the connection is corrected to achieve the
normal structure of the heart)
- Done during the first week of life
(performed in a live client)
● Supportive management
- Oxygen therapy
- Vitals signs monitoring
- WOF signs and symptoms of heart failure
- Notify the physician if difficulty of breathing
TOTAL ANOMALOUS PULMONARY VENOUS
CONNECTION
- Very rare defect
- Failure of pulmonary vein to join left atrium,
instead, connected to right atrium or
superior vena cava
- Absent spleen is often associated with this
disorder
TRUNCUS ARTERIOSUS
- Rare defect
- One major artery or trunk arises from the
left and right ventricles in place of a
separate aorta and pulmonary artery
- usually accompanied by VSD
HYPOPLASTIC LEFT HEART SYNDROME
- Underdeveloped left side of the heart
- lacks adequate strength to pump blood into
the systemic circulation,
- causing R ventricle to hypertrophy
- Increased pressure on the R side of the
heart, UnO2 blood is shunted to the left
side through the foramen ovale
TRICUSPID ATRESIA
- completely closed, allowing no blood flow
from the R atrium to the R ventricle
- instead blood crosses through the patent
foramen ovale into the left atrium
bypassing the lungs and the step of
oxygenation
TETRALOGY OF FALLOT
- most common cyanotic heart defect
Manifestations
● Cyanosis (blue babies)
- (+) cyanosis of the lower extremities
- Higher unO2ed blood than O2ed blood
● Squatting
- Decreases venous return to the heart→
relax the heartConserves oxygenated
blood in the upper body area
- Cutting the circulation in the lower
extremities → decreasing the return flow of
blood to the heart → giving sufficient time
for the heart to relax
- There will be difficult venous return from
the lower extremities d/t hip flexion
- The O2ed blood should be concentrated in
the upper body because the vital organs
are there– lungs, brain, and heart
- Squatting is a compensatory mechanism
- Tripod position - sitting on a chair and
leaning on a table
- Squatting - knee chest position
- not done throughput the day; only when
there's difficulty of breathing
● infants, position
- Lying down with head slightly elevated
- To promote lung expansion
● Tet spells
- Group of signs and symptoms that depicts
lack of oxygenation
● Pathognomonic sign/ hallmark
manifestation of TOF
- Irritability
- Pallor
- Blackouts (fainting spells)
- Convulsions (d/t lack O2 in the brain) →
cerebral hypoxia
● Cardiomegaly
- d/t overworking
● Clubbing
- One of the main symptoms
- Spoon-shaped fingernails d/t
compensation of capillaries (enlargement)
- Represents chronic hypoxia
 - Also seen in IDA d/t lack of iron → RBC
have no enough O2 → hypoxia
● Pansystolic murmur
- Every contraction of the heart (+) murmur
because of numerous holes in the heart
(VSD)
Diagnostics
● 2D echo
- boot-shaped heart will be seen
Medical Management
Surgery
● Palliative surgery (Blalock-Tausig
shunt)
- Relieve signs and symptoms
- goal is to increase oxygenated blood than
oxygenated blood
- Anastomosis of the pulmonary artery and
the aorta using the subclavian artery
- The subclavian is part of the aorta, it will
not be harvested it will only be rerouted
and connected
- Blood that passes through the VSD may
be allowed to pass through the aorta→
subclavian artery connected to the aorta→
lungs
● Curative surgery (Intracardiac surgery/
Brock’s procedure)
- Treats the disease condition
- Balloon angioplasty (to widen the
pulmonary stenosis) - This will also resolve
the RVH d/t ↓workload VSD will no longer
be needed to relieve the pressure
- Insertion of Dacron patch (closing of the - The pressure in the right side of the heart
VSD) - This will also resolve the overriding
aorta is increased → backflow in the jugular vein
→ bulging
HEART FAILURE
● Hepatomegaly
- A condition where the heart fails to contract
- liver is sensitive to changes in
to pump blood out of the heart
oxygenation)
- Insufficient ↓CO to oxygenate the different
- ↑pressure in the liver→ portal HTN→
organs
destruction of the liver
Types of HF
● Ascites
● RSHF
- Fluid accumulation in the abdominal area
- manifestations is systemic
- d/t fluid retention and portal HTN
- Damaged right ventricle → right atrium → ● Body weakness & Anorexia
goes back to system → systemic - Nausea d/t bloating→ ↓appetite to eat
manifestations (RSHF) Signs and Symptoms ( RSHF )
● Dyspnea on exertion
● LSHF
- Difficulty of breathing especially during
- manifestations are pulmonary
activity
- Damaged left ventricle → blood goes back ● Orthopnea
to the left atrium → lungs → lung - Difficulty of breathing especially in a lying
manifestations (LSHF) position→ when lying down, lung expansion
Signs and Symptoms ( RSHF ) is not maximal
● peripheral edema/ dependent/ pitting
- Should be placed on a semi-fowler’s
edema (+) indentation
position
- D/t fluid retention, blood is not circulating ● Crackles or rales
well→ fluids are also not properly - d/t fluid retention
- Fluid located inside the lungs are heard
circulated→ extravasation→ edema - Gurgling sounds
● Weight gain ● Cough reflex
- d/t fluid retention - Fluids in the lungs will trigger the cough
● Distended neck veins (JVD) reflex
● Tachycardia
 - early stages - attempt to compensate for - V- visual disturbances (halos) and vomiting Major Manifestations (Jones Criteria)
the lung failure and decrease of - D- diarrhea ● Carditis
oxygenation - A- abdominal cramps - Inflammation of the walls of the heart
- long term - bradycardia will occur d/t - If one or two appear, stop administration, - d/t the presence of a bacteria
fatigue and will stop - digibind (digoxin immune fab) will be given ● Erythema marginatum
Diagnostics as an antidote to digoxin toxicity - Rashes of the trunk
● Chest x-ray ● U- urine I/O monitoring ● Subcutaneous nodules
- (+) cardiomegaly d/t overworking - D/t fluid retention - over bony prominences
● 2D echo ● R- record daily weight ● Chorea
- hypokinetic heart (slow contraction of the - determine if edema worsens - sudden involuntary movements
heart that will present in the latter stages) - Same time, clothes, weighing scale, and ● Polyarthritis
● Pulse oximetry patient - inflammation of more than one joint
- decreased O2 saturation - Done early in the morning Management
- d/t decrease in tissue perfusion ● E- edminister diuretics ● penicillin
● PCWP (pulmonary capillary wedge - decrease retained excess fluids in the body - A broad-spectrum antibiotic that can kill
pressure) - relieve pulmonary edema both gram-negative and gram-positive
- Measures the pressure in the left side of bacteria
the heart RHEUMATIC HEART DISEASE - Given 5-10 days and duration should be
- Determines LSHF - Tachycardia – 1st sign, attempts to beat finished,
● CVP (central venous pressure) faster, to move blood forward - Administered via IV
- Connected to the RA, therefore, measures - Apical heart beat displaced laterally and - If (+) allergy to penicillin, erythromycin, or
pressure in the right side of the heart downwards clindamycin may be given
- Determines RSHF - Lower extremity edema – late sign in - If (+) exacerbation and remission
Management (FAILURE) children (manifestations become more severe)
● F- fowler’s position - An infectious heart disease ● Salicylates (ASA- acetylsalicylic acid)
- To allow maximizing lung expansion that - Caused by GABHS (group-A beta- - Aspirin
will enhance circulation and oxygenation hemolytic streptococcus) Four As of aspirin
● A- administer high O2 - Causes sore throat and AGN (acute - Antiplatelet aggregate
- Using venturi mask that delivers precise glomerulonephritis) - Antipyretic
and accurate oxygen delivery Minor Manifestations - Analgesic
● I- inotropic drugs ● Prolonged PR interval - Anti-inflammatory
- Strengthens the heart’s contraction to ● History of rheumatic fever - Given for pain and swelling
increase the cardiac output ● Fever Side Effect
● L-Lanoxin or digoxin ● Elevated ESR - WOF: s/sx of bleeding
- Digoxin toxicity ● Leukocytosis ● Corticosteroids
- N- nausea ● Arthralgia - relieve carditis (inflammation)
- A- anorexia - severe joint pain
KAWASAKI DISEASE
- Very common in children especially in the
newborn
- Acute febrile illness of unknown cause
which may result in obstruction, stenosis or
aneurysm formation of the arteries.
- Common in children of Asian decent.
Involves two disease conditions:
● Mucocutaneous lymph node syndrome
- affectation of the immune system
● Multisystemic vasculitis
- inflammation of the blood vessels
specifically affecting the cardiovascular
system
Manifestations
● High spiking fever
- d/t affectation of the lymph nodes that
alters the immune system (erratic)
- sharp increase in temperature
- hypothalamus is having difficulties in
regulating the temperature
● Strawberry red tongue (pathognomonic
sign)
- D/t multisystemic vasculitis
- tongue is rich in blood vessels
● Photophobia/ photosensitivity
- retina is composed of the minute blood
vessels
- Dark-colored glasses are advised to be
worn
- Large-brimmed hats
- Sun visors
● Polymorphous rash
- Rashes of different shapes
- d/t inflamed vessels that can rupture and
extravasate in the skin
● Palmar desquamation
- Only localized in the palms
- Shedding of skin on the palms Management
- blood vessels in the hands are small, ● Prophylactic antibiotic
inflammation will decrease circulation in - for children w/ CHD
the hands causing the death of cells in the ● Antibiotic and therapy
hand leading to shedding - for underlying infection
Management ● Long-time follow up care
● Immunoglobulins - to prevent recurrence
- to enhance and activate the immune
response
- Children with Kawasaki disease have weak
immune systems
● Aspirin
- Low dose only
- To address high spiking fever,
inflammation, and serves as an analgesic
● Clear liquid diet
- allow monitoring bleeding in the stools
- Avoid dark-colored foods
- Clear liquids do not contain milk and are
determined according to opacity to light
- If light passes through it, it is considered a
clear liquid
● CPR
- Children tend to develop coronary artery
diseases→ at risk for cardiac arrest
ENDOCARDITIS
- Inflammation and infection of the
endocardium or valves of the heart.
- Common complication of congenital heart
diseases (TOF, VSD, COA)
- Caused by streptococcal infections that
invade the body at the time of oral surgery,
urinary infection, or skin infection
(impetigo)