What do all of these pediatric cardiac conditions generally have in common?
- atrial septal defect
- atrioventricular canal defect
- patent ductus arteriosus
- ventricular septal defect
- aortic stenosis
- coarctation of the aorta
- pulmonary stenosis
In general, these are all cardiac defects that occur at birth that can cause low oxygen and the infant to become hypercyanotic.
What are the steps if an infant is hypercyanotic due to a heart defect?
(Immediate complication)
- place infant in knee-chest position
- give 100% oxygen
- give morphine sulfate to ease breathing
- start IV fluids
- document
How are cardiac defects treated?
Surgery to repair the vessels or cardiac tissue.
Describe:
Tetralogy of Fallot
Includes 4 heart defects.
VORP:
1. Ventricular septal defect
2. Overriding aorta
3. Right ventricular hypertrophy
4. Pulmonic stenosis
What are the characteristic signs and symptoms of Tetralogy of Fallot and most other cardiac defects?
(Immediate complication)
- cyanosis called blue spells or tet spells
- hypoxia
- tachycardia
- diaphoresis
- fatigue
- irritability
When is digoxin given to an infant?
1 hour before or 2 hours after feedings.
Needs to be given on an empty stomach for absorption.
What is the intervention if the digoxin dose for a child has been missed?
Skip the dose.
If it’s less than 4 hours, give the dose.
After how many missed doses of digoxin should the parent notify the HCP?
After 2 missed doses.
Can medications be added to baby formula?
Never mix medications with formula. It makes the formula taste bad and the baby is likely not to drink it all.
What is the diet for a child after cardiac surgery?
- no added-salt diet
- do not introduce new foods in case of allergy (allergy may be mistaken as a complication)
What is the activity for a child after cardiac surgery?
- do not play outside for 2 weeks due to injuries and possible infections
- avoid activities that could cause injuries for 2 - 4 weeks such as bike riding
- do not attend physical education class for at least 2 months
- no crowded places for 2 weeks
When can a child go back to school after cardiac surgery?
On the 3rd week starting with half days.
What medical procedures are avoided for 2 months following cardiac surgery for a child?
- immunizations
- dental visits
- invasive procedures
All increase risk of infection.
Describe:
Rheumatic fever
An inflammatory autoimmune disorder that affects all parts of the body, especially the heart, joints, skin, and brain.
It is caused by an untreated strep infection.
What is the most serious complication of rheumatic fever?
Rheumatic heart disease which affects the heart valves.
How long after a strep infection can rheumatic fever begin?
Can start 2 to 6 weeks after a strep infection.
Diagnostic tests:
Rheumatic fever
- ↑ anti-streptolysin O titer
- ↑ ESR (erythrocyte sedimentation rate)
- ↑ C-reactive protein
- Aschoff bodies (lesions): found in the body
Interventions:
Rheumatic fever and rheumatic heart disease
- anti-inflammatory meds such as NSAIDs
- seizure precautions if brain is affected
- antibiotics to treat any infections
What is the teaching to the parents if the heart valves have been affected by rheumatic heart disease?
Antibiotic prophylaxis for dental work and invasive procedures.
How is joint pain managed with rheumatic fever?
Massage and alternating hot/cold therapy.
Describe:
Kawasaki Disease (mucocutaneous lymph node syndrome)
An acute systemic inflammation that can cause serious cardiac complications such as aneurysms.
The cause is unknown.
Medications:
Kawasaki disease
- aspirin to prevent blood clots
- immunoglobulin IV to boost immune system
- steroids
- antipyretics
Do not give aspirin to children < 18 years old unless prescribed by the HCP.
Interventions:
Kawasaki disease
- EKG monitoring
- address chapped lips / dry skin
Do not give aspirin to children < 18 years old unless prescribed by the HCP.
