29 terms

Pediatric Nursing-Cardiovascular and Hematology

Cardiovascular and hematological disease in children
Sickle Cell Anemia Etiology
An autosomal recessive disorder which inserts an abnormal amino acid into hemoglobin and causes a gel like hgB which sickles in shape and decreases the O2 carrying capacity of RBCs.
Vaso-occlusive crisis
Painful episode- most common non-life-threating crisis. Characterized by ischemia causing mild to severe pain that may last mins. to days. Localized or general pain, migratory pain w/ presence of low-grade fever w/out an exacerbation of anemia. Result in variety of skeletal problems, like hand foot syndrome.
What factors contribute to increased sickling in Sickle Cell Anemia?
Hypoxemia, Extreme temperatures, decreased pH, increased plasma solutes and decreased plasma volume.
Symptoms of sickle cell anemia
Present after 6 months of age, pallor, irritable, jaundice, growth delay, Pain r/t occlusion, stroke, hand-foot syndrome
Treatment for sickle cell anemia
Activity regulation, O2 administration, monitor intake and output to assure adequate hydration, fluid/electrolytes, NSAIDs to Opioids for pain, heat compresses, Infection prevention (B19 parvovirus)
Labs for sickle cell anemia
RBC, hct, hgb, liver function
Differences between child and adult hematology
Infants produce RBC in liver and spleen whereas adults produce in the bone marrow, infants store catabolized iron in liver and marrow which prevents anemia, infant's have higher WBC counts than adults, and RBCs are higher in infancy.
Preop cardiovascular surgery nursing cares
History and physical exam, educate on procedure, assess allergies (iodine), Mark lower extremity pulses, NPO 4-6 hours prior to Tx, VS and O2 baseline, Pre-sedate as needed.
Post op cardiovascular nursing cares
Include caregivers in cares to assure competency by d/c, monitor cardiac function and O2 sats, Skin color/temp, insertion sites for bleeding, Dressing care, Intake and output, monitor for hypoglycemia, clear oral intake and assist to void, straight positioning of affected extremity 4-8 hours post procedure, educate on fatigue, nutrition, wound care and meds.
Congenital Heart defects
Anomalies present at birth, may spontaneously resolve or require surgery, often accompanied by other anomalies.
Acquired hear disease
Develops after birth secondary to infection or trauma, and requires treatment for resolution.
Hypo-plastic left heart syndrome etiology
Atresia of the mitral or aortic valve causes a dysfunctional/small left heart which blocks left outflow. Patent ductus arteriosis is needed for circulation.
Hypo-plastic Left Heart symptoms
Present within hours of birth up to 1 week after, cardiac failure, hypotension, tachycardia, and tachypnea.
Hypo-plastic Left Heart Treatment
Transplant or staged surgeries, PDA maintained with PGE1 and O2<75% until fixed
Hypo-plastic Left Heart Surgery: Norwood Procedure
1st surgery to repair hypoplastic left heart, The aorta is replaced with pulmonary artery, a BT shunt or Sano shunt is placed, and the atrial septum is destroyed.
Hypo-plastic Left Heart Surgery: Glenn procedure
The superior vena cava is attached to pulmonary inlet at 4-6 months of age
Hypo-plastic Left Heart Surgery: Fontan procedure
The inferior vena cava is attached to pulmonary inlet at 2-3 years of age.
Tetralogy of Fallot etiology
VSD, pulmonary stenosis, Right ventricular hypertrophy and overriding aorta decrease pulmonary blood flow.
Tetralogy of Fallot Symptoms
Moderate systolic murmur, tet (cyanotic) spells, hyperpnea, acidosis, clubbed digits, growth delays, exertional dyspnea, polycythemia causes clotting.
Tetralogy of Fallot Nursing care
Knee chest position for tet spells, morphine sulfate to decrease agitation r/t tet spells, blood volume resuscitation to prevent clots, O2 admin, IV phenylephrine to increase systemic vascular resistance, BT shunt placed until surgery at 3-12 months of age.
Coarctation of the Aorta etiology
A narrowed area of the aorta (normally by the PDA), causes blood back up into the left ventricle. Affects 5xs more boys than girls. Increased pulmonary blood flow.
Coarctation of the Aorta Symptoms
Symptoms present when the ductus arteriosus closes and are classic CHF, Pulsus paradoxus (greater than 20 mm Hg difference between upper and lower), headache, nosebleeds, leg pain, left ventricle hypertrophy.
Coarctation of the Aorta Treatment
balloon dilation in cath lab or anastamosis between the ages of 3-5 to prevent recurrence associated with infancy anastomosis. HTN meds given post surgery to prevent bleeds and residual HTN.
Increased Pulmonary Blood Flow etiology
Left to right blood shunting, Classic CHF symptoms including tachypnea, tachycardia, diminished pulses, decreased urine output, exertional respiratory distress, hepatomegaly, murmurs, ACYANOTIC
Decreased Pulmonary Blood Flow etiology
Right to Left blood shunting, hypoxia, dyspnea, Polycythemia r/t increased RBC production, hct >65%, murmurs, CYANOTIC
Why do pulmonary blood flow defects occur?
Abnormal connections between the left and right sides of heart.
Ventricular Septal Defect Etiology
Ventricles are connected and cause left to right shunting leading to pulmonary congestion.
Ventricular Septal Defect Symptoms
Classic CHF sx, holosystolic murmur, left heart hypertrophy. Diagnosed with ECHO
Ventricular Septal Defect Treatment
Before surgery, treat CHF sx with digoxin, ACE inhibitors, and diuretics (monitor for dig toxicity and potassium decreases), assure nutrition with small meals and tube feedings as needed.