Drop of blood through the heart: Right side of the heart to the lungs and the left side of the heart to the body.
- Valve: Tricuspid valve
- Right atrium
- right ventricles
- Pulmonic valve
- pulmonary artery-arteries leave the heart; veins lead to the heart
- lungs-gas exchange
- pulmonary vein
- left atrium
- Mitral valve
- Left ventricle
- Aortic valve
- aorta
Listen for heart sounds in same place as adult, but in a smaller area. Don’t use Erb’s point.
Murmurs in kids are caused by congenital problems. Holes in the heart.
Cyanotic and Acyanotic-page 1558
Acyanotic-caused by increase in pulmonary blood flow. Will not cause cyanosis: Atrial septal defect, ventricular septal defect, patent ductus arterious, obstruction to blood flow from ventricles: coarctation of aorta, pulmonary stenosis, aortic stenosis.
Cyanotic-decreased blood flow to lungs or mixed blood. Tetralogy of Fallot, Tricuspid atresia, Mixed flow: transposition of great vessels, tuncus arterious, hypoplastic left heart syndrome
A problem that you have with this is: Sometimes Acyanotic can turn into cyanotic
90% of kids born with a congenital heart defect will, during the first year of life, develop CHF.
Ventricular septal defect-opening between ventricles (Box page 1560-1565)
Cure:
Time-50% will close over time by themselves
Surgery-louder the murmur larger the hole
The right ventricle will work harder to pump secondary to the excess flow from the left ventricle. Right heart failure and right ventricular hypertrophy.
This can be seen on x-ray and EKG. Once corrected the right heart will usually return to normal
Atrial septal defect-hole in septum of atria: Same thing as ventricles, excess flow and mixing of blood. Not as common, same kinds of problems, same kinds of treatment.
Normal in fetus:
- Normal opening between right and left atrium called foramen ovale. Normally closes after birth when baby takes first breath.
- Ductus venosis: arteries go to liver. When cord cut goes away.
- Ductus arteriosis: bypassing the lungs, closes at birth if O2 sats are high enough. Premies have problems with O2 sat levels. Can be closed with Indocin and surgery. There are times when needs to be kept open (transposition of vessels)
Acyanotic: Coarctation of aorta: area of aorta that is much smaller. Surgery to cut out. Can go undiagnosed to school age. Blood pressure is high in arms, and low in legs (20 points lower)
Aortic stenosis: narrowing of aorta. Increases pressure in left ventricle
Can have pulmonary stenosis too. Increase pressure right ventricle, causes right ventricular failue.
Treated with balloon on and sometimes stents
Tetrology of Fallot:
- Ventral septal defect
- pulmonary stenosis-will increase R ventricular pressure, cause R ventricular hypertrophy
- Overriding aorta or dextra: straddles the middle of the heart. Looks Acyanotic
- right ventricular hypertrophy
Muscles in lungs spasm (Tet spell): crying, valsalva:
Baby turns purple.-need time and oxygen
Place in knee chest position because it decreases the amount of blood that needs to be circulating
Toddlers automatically squat when they get a Tet spell. Do not have to be taught.
Are usually caught early and can be surgically repaired.
All heart defects can be life threatening because they can turn into heart failure.
Momentary episodes, how big are the defects
Life threatening over time, but not immediately at birth.
CYANOTIC
Transposition of great vessels:
Aorta off of right ventricle and pulmonary artery off of left ventricle.
Need to keep patent ductus arterious open to provide some oxygen to the baby, without that-death.
Need immediate surgery. Major surgery
Truncus arteriosis:
Both the pulmonary artery and aorta are one big trunk that straddles the heart.
Hypoplastic left ventricle:
Very small left ventricle. Correction for this is heart transplant. Can last to teen years, very tired and not active. Aorta small too.
Most not common, memorable when happen. Very pronounced. Surgical procedures are in are book and if, in hospital, need to explain to parents/family would look up first. Won’t be on test.
Congestive heart failure
Patient can’t tell you how they feel. Need to be able to recognized problems. Can see on x-ray. Can have heart gallop. Sounds like horse galloping; third sound (S4 prebeat)
Tachycardia
Pallor-low hemoglobin
Diaphoresis
Fluid retention
How see fluid retention
Sacral
Mostly peri-orbital
Change in lung sounds.
Little people can’t take as much fluid retention as adults.
Meds:
Diuretics-Lasix. How do you know it is working? Daily weight. Check wet diapers. Should change diaper when give Lasix to have a post admin measure
Digoxin-hold dig when apical is less than 100 in kids (not 60 like in adults) Will go on the child, the age, the norm. Is not hard and fast.
Why take for full minute apical pulse? --- Arrhythmia-irregular
Potassium chloride-how does low KCl affect dig-makes more toxic. Need to know dig level. Who is responsible for making sure that the doctor orders all the right meds to go home-Nurse
How know dig toxicity?
Halo-kids won’t be able to tell you. Will not be able to report eye changes at all.
Emesis
Dig levels-if patient is getting higher levels than Harriet Lane says, check lab values.
If have none-get them. Tell MD need to order.
When can pick up heart problems/congenital stuff in kids: Now have fetal echocardiography; must have prenatal care to have this.
Cardiac Cath:
What can it tell you?
Pressures in heart----If you have higher in one area than another; can tell you that blood is backing up.
Nursing care and assessment:
What does nurse need to know before they go to cath? Pedal pulses and mark them. Blood pressure. Color, cap refill, warm/cool,
Post cath: Notice bleeding. Pressure above the site.
Position: flat. How do you keep toddler down? Parents need to assist or one on one with RN.
Urination: Can put something under them, turn to side and teach to use urinal.
Cardiac complications post cath: arrhythmias, bleeding, and infection.
Keep them quiet!
Rhumatic fever:
Used to be #1 acquired heart defect in children, usually follows strep infection. Inflammatory disease- usually follows beta hemolytic strep infection can cause lesions in heart, blood vessels, joints and sub-q tissues. Called rheumatic heart but affects other areas too, sub-q nodules under skin, rash, fever, sore throat and cardiac things: chest pain (may be sign of carditis), SOB (may indicate heart involvement), may have tachycardia esp. during rest, low grade fever that spikes in afternoon and arthritis.
Can affect heart; usually valves. Can recover completely or have problems all their life. Antibiotics before invasive procedures. Bed rest is usually during the sick phase, want to rest heart. Then gradual increase in activity level, good diet, antibiotic (if post strep). School age kids number on target of rheumatic fever.
Kidney: glomerulonephritis
Bone: osteomelytis.
Kawasaki’s disease (now #1 acquired)
Form of vasculitis-affects vasculature at all levels of the body
Primarily affects children 5 and under, mainly in toddler age, 1year old and below, serious risk of heart disease; can be seen in adults but seldom
Self limiting, w/o treatment 20% of children develop cardiac problems. Not spread person to person. Cause not known.
Inflammation of many tissues of the body.
Peeling tissues on feet and hands-bright red.
Eyes are red.
Peeling, red lips and mouth
High fever, swollen lymph nodes
Inflammation in uncomfortable but will resolve in time.
Main threat is to heart and blood vessels. Heart, coronary arteries: 20% affected.
Occurs most often in Japan. In US most commonly affected are Asian and Asian-American heritage, but can happen to anyone.
Twice as common in boys as girls, average age is under 2 years old up to 5 years old.
Don’t know what causes-possibly viral.
Five symptoms that must be present to diagnosis:
- Fever for five days (102 and above)
- Swelling lymph nodes
- Red mouth and lips
- Bright red peeling hands.
- Purpura on arms
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