Nursing care of a child with alteration on oxygenation related to cardiac anomalies (Cyanotic)
|
Occurs when blood is shunted from the venous to the arterial system as a result of abnormal communication bet. the two systems (deoxy to oxy. R to L shunts)
|
|
|
Decreased pulmonary blood flow (Right to left shunt)
|
|
Localized narrowing of the aorta, the most common cardiac malformation responsible for cyanosis in a child over 1 year. 4 major defects:
|
|
|
Pulmonary stenosis
|
Ventricular septal defect
|
|
Aorta overriding VSD
|
Right ventricular hypertrophy
|
|
Pathophysiology
|
|
|
•PS impedes the flow of blood to lungs
|
|
|
•increases pressure in the right ventricle (hypertrophy)
|
|
|
•Forces deoxy blood through the septal defect to the left ventricle
|
|
|
•Overriding aorta receives blood from both right and left ventricles.
|
|
|
Signs & Symptoms
|
|
|
•Clubbing of the fingers, murmur
|
|
|
•Severe dyspnea, hypercyanotic spells & acidosis
|
|
|
•Polycythemia & clot formation
|
|
|
•Failure to thrive and growth retardation.
|
|
|
Treatments
|
|
|
•If O2 level ex low, prostaglandins (IV) to keep PDA open.
|
|
|
•Complete repair when 6 mos. of age.
|
|
|
•Closure of the VSD with dacron patch
|
|
|
•The narrowed pulmonary valve is enlarged
|
|
|
•Coronary arteries will be repaired
|
|
|
•Hypertrophy of right heart should remodel when pressure in right side is reduced.
|
|
|
Streptococcal infections causes damage to the heart muscle and valves. All heart layers are affected.
|
|
|
•Pancarditis (all layers)
|
•Pericarditis
|
|
•Myocarditis
|
•Endocarditis
|
|
Pathogenesis
|
|
|
•An acute attack of streptococcal pharyngitis by group A beta-hemolytic streptococci
|
|
|
•Within 2-4 weeks after this attack anti-streptococcal antibodies are formed and attack the heart and the extra cardiac sites.
|
|
|
Diagnostic test
|
|
|
•Throat swab, blood test, ECG heart test
|
|
|
Tricuspid valve fails to develop causing complete closure of the tricuspid valve that results in mixed blood flow.
|
|
|
Signs & Symptoms
|
|
|
•Cyanosis in NB, Chronic hypoxia, clubbing
|
|
|
•No blood flow form the right A to the right V
|
|
|
•Heart failure, chronic hypoxemia
|
|
|
•Failure to thrive and growth retardation.
|
|
|
Diagnosis
|
|
|
•Listening with a steth for changes in heart sounds
|
|
|
•O2 sat to see how much O2 is getting into blood
|
|
|
•Chest x-ray to see the size & position of the heart
|
|
|
•ECG to check the electrical activity
|
|
|
•Ultrasound scan (echocardiography)
|
|
|
Treatment
|
|
|
•A glenn | Cavopulmonary | HemiFontan shunt
|
|
|
making a passage between the superior vena cava to the right lung (pulmonary) artery
|
|
|
•A fontan | Total Cavo-Pulmonary Connection
|
|
|
This operation joins the inferior vena cava to the pulmonary arteries.
|
|
Nonpruritic, painless erythematous rash on trunk and/or proximal extremities.
|
|
|
•Macular lesions with raised margins & central clearing
|
|
|
•May last from weeks to months
|
|
Minor Manifestations
|
|
|
Clinical: Fever, arthralgia, history of RF
|
|
|
Lab test: Acute phase reactants, ECG changes
|
|
|
Major Manifestations
|
|
|
• Carditis: friction rub, murmur, cardiomegaly, CHF
|
|
|
•Arthritis: migratory polyarthritis, swollen, red, tender
|
|
|
•Chorea, subcutaneous nodules, Erythema marginatum
|
|
A neurologic disorder with muscular weakness, emotional lability and involuntary, uncoordinated, purposeless movement
|
|
|
•Disappear during sleep, lasts 2-4 months
|
|
|
•Mainly occurs in hands, feet and face, sensation intact
|
|
• An autoimmune disease affecting the heart and extra cardiac sites ( joints, brain, skin)
|
|
|
•Occurs 10 days to 6 weeks after pharyngitis
|
|
|
•The disease affects children and young adults (5-15yrs)
|
|
|
•The disease follows upper respi infection (tonsillitis)
|
|
|
Cardiac Manifestations
|
|
|
•Pericardial friction rubs, weak heart sounds
|
|
|
•Tachycardia, arrythmias
|
|
|
•Extracardiac: fever, polyarthritis, arthralgia, skin lesions, chorea
|
|
|
•Pharyngeal culture may be negative
|
|
|
• Anti streptolysin O (ASO) titer will be high
|
|
•May be migratory. last for 2 - 3 weeks
|
|
|
•Warm, swollen, tender joints, inflamed membrane
|
|
|
•Usually involves the knees, ankles, elbows, and wrists
|
|
|
•Eroded cartilage and narrowed joint space
|
|
Usually associated with severe carditis and occur several weeks after
|
|
|
•Firm, painless nodules (up to 2cm) found over bony surfaces and tendons. persist for 1-2 weeks.
|
|
|
•Occur near elbows, knees, wrists, achilles tendon, vertebral joints
|
|
Idiopathic multisystem disease. vasculitis of small & medium blood vessels & arteries. Usually <5 yrs old.
|
|
|
Mucocutaneous Ocular Syndrome (MCOS) the original name of kawasaki disease. The cause is unknown.
|
|
|
Diagnostic Criteria
|
|
|
•Changes in extremities: edema, erythema, desquam.
|
|
|
•Polymorphous exanthem, usually truncal
|
|
|
•Conjunctival injection, fissuring of lips & oral cavity
|
|
|
•Cervical lymphadenopathy
|
|
|
Symptoms
|
|
|
•Red eyes, changes in lips, tongue & mouth
|
|
|
•Redness, cracking on lips, red strawberry tongue
|
|
|
•Hands & feet: red, swollen, hands & soles.
|
|
|
•Body rash : 1st appears w/fever. bumpy to touch
|
|
|
•Swelling of glands in the neck, soft, painless nodes
|
|
|
Phases
|
|
|
Acute: 1-2 weeks from onset, febrile, irritable, oral changes, rash, edema/erythema of feet
|
|
|
•Subacute: 2-8 weeks, desquamation, persistent arthritis or arthralgias, gradual improvement.
|
|
|
• Convalescent (months to years later)
|
|
|
Treatment
|
|
|
•No single medicine can treatment or cure
|
|
|
• Meds : Aspirin and gamma globulin
|
No comments yet.
Cheatography n. The art of mapping complex subjects into clear, instantly navigable reference guides.
