Increasing Pulm Blood flow
Decreasing Pulm Blood Flow

Patent Ductus Arteriosus (PDA)

Severity is based off of what 3 things?



Gestational age, size of ductal opening, degree of pulmonary vascular resistance.

S&S- Asymptomatic to pulmonary overload, failure to thrive, difficulty feeding, poor weight gain

Dx/ Management- Echocardiogram;    NSAID/Prostaglandin Inhibitors, diuretics, Surgery- coil embolization or duct ligation, Cardiac Cath- PDA closure


Tetralogy of Fallot is comprised of what 4 defects?

Pulmonary Stenosis

VSD (usually large)

Overriding Aorta

Right Ventricular Hypertrophy 


What assessment ust a nurse perform for a patient on anti-epileptic medications?

Suicide Risk assessment 

3 Causes of Hydrocephalus and reasons for CSF accumulation 



•REASONS for csf accumulation:

-Overproduction of CSF

-Obstructed  flow to subarachnoid space

-Impaired absorption of CSF


Nursing DX: ALTERED FAMILY PROCESS   R/T parents fears, guilt


Encourage parental involvement and attachment—praise caring, touching, talking..

Provide honest and complete information  to both parents and child (age appropriate)

Teach and demonstrate feeding, meds, infant stimulation balanced with rest, norms for development, discipline, s/s  and Rx for complications—CHF, infection, hypoxia actions:  positioning, calming, ABX before dental care, contact number and backup, CPR

Encourage flexibility—child self adjusting activities, avoid overprotecting, involve siblings

Prepare for tests, procedures and surgery

Ventricular Septal Defect (VSD)

How commmon?


DX& Tx?

Most common defect, severity is based off size of the defect. 

S&S- Asymptomatic to SOB, feeding difficulties, murmur, failure to thrive.. can result in Left Ventricular Hypertrophy

Dx/TX: Echocardiogram; Lasix, VSD closure-patch 


HyperCyanotic Spell (Tet Spells)

When do they occur? 


Nursing Mngmnt?

with crying, feeding, procedures

pO2 in 50’s, sat 80’s temporary

cyanosis: circum-oral, mucous membranes

s/s of respiratory distress

Nursing Mngmnt- Calmly hold in knee chest position, head up, remove cause of distress, distract child

-Oxygen in hospital

-Surgery as early as newborn period


Tonic-Clonic Seizure

Characterized by 3 phases:

(1) The Prodromal Period or Aura Phase, warning that precedes a seizure by hours or days;

(2) The Tonic-Clonic Phase, from first symptoms to the end of seizure activity; and 

(4) the postictal phase, the recovery period after the seizure.


Visible S&S on assessment 

•15% evident at birth or on sonogram

•85% sutures separate, tense/ bulging fontanelles, head circumference increases in  weeks. Scalp veins dilate, shiny scalp, bossing(brow bulges), sunset eyes


4 Causes of Developmental Seizures in Newborns?

•Birth trauma/anoxia,

•Metabolic disorders,

•Neonatal infection

•high dose meds


Atrial Septal Defect (ASD)



S&S- Asymptomatic to SOB, rales, pulmonary congestions, feeding difficulties, poor weight gain, dysrhythmias, tires easily 

DX/TX- Echocardiogram; Diuretics, Cath Lab or Surgical closure  


Coarctation of the Aorta

When do s&s begin?

When do s&s begin when dx at birth?



•Children may be asymptomatic until they grow older > LVH & HTN

When noted within weeks of birth > heart failure > surgery

S&S: Headache, hypertension (SBP higher in right upper extremity than the lower extremities), S&S of HF

DX: Echocardiogram

Management: Medications for HF, Cardiac Cath-balloon angioplasty &/or stent, Surgery


Status Epilepticus

What is it?

Some causes?

Medical Emergency?

seizure activity lasting longer than 30 minutes or more than one  seizure without full recovery of consciousness in between seizures.

Causes: head trauma, hydrocephalus, acute drug or alcohol withdrawal, metabolic disturbances, abrupt withdrawal or missed anticonvulsant medications, infection, high fever

Medical Emergency!

A seizure lasting longer than 5 minutes is a medical emergency, and seizures lasting longer than 30 minutes can cause respiratory failure, brain damage, and death.


S&S of increasing ICP

•AMS (lethargy, irritability)

•pulse & respiratory rate decrease

•BP & temperature increase 

•shrill cry

•hyper-active reflexes


•altered motor activity




Atrioventricular Septal Defect (AVSD)

What CHD defects are involved?



Primum ASD, high VSD, Failure of both the tricuspid and mitral valves development and attachment. 

S&S- CHF, increased pulmonary vascular resistance

DX/TX- Echocardiogram; Diuretics, Digoxin, ACE Inhib, Surgical repair 


Aortic Stenosis

Evidenced by? Can lead to? 

DX? Tx?

Left Ventricular Hypertrophy

Can lead to Pulmonary Edema

Usually associated with Bi-cuspid valve

Dx: Echocardiogram

Management: Beta-blockers, calcium channel blockers, cardiac Cath with balloon dilation, surgery to replace valve


Febrile Seizures-- 

Most common when?

Fever range? 

Toni- Clonic Pattern?


Most common in Pre-school Children (ages 3 up to 7)Seizures associated with high fever 102 to 104 degrees F (38.9 to 40.0 degrees C)

Tonic-clonic pattern lasting 15-20 seconds

Ibuprofen and Acetaminophen,

TSB, no tub baths, no ROH/cold water

Goal < T:101F



Management of hydrocephalus:


Obstruction of Flow: 

Overproduction of csF:


-Ventricular endoscopy - to remove tumor or some choroid plexus

Obstruction of Flow:

-endoscopic laser procedure - to open flow (ventriculostomy) Ventriculo-peritoneal (VP) shunt

-Also used when meningomyelocele present

-Shunt  changed as child grows,  or occlusion


Anomalous Pulmonary Venous Return and Truncus Arteriosus (Rare Defects)

APVR-- What is it?

TA-- What is it?

Tx for both?

APRV- failure of pulmonary venous connections to unite with left atrium in utero

TA- characterized by single arterial vessel that originates from the heart

Both require immediate surgical intervention


Nursing DX: Risk for Nutrition<required, R/T high caloric need and reduced intake ( secondary to fatigue

What are nursing interventions for children based off age.

HGT/WGT WNL for age:   Feed small amt. more frequently (q3h), on awakening, increase calorie density (calorie/ounce or enriched breast milk), head up, vitamin/iron/protein supplements prn

(older-6-8 small meals, snacks-low salt and high- protein & vitamins)


Education for seizure medications and at home management

•Medication regimen

•Medic alert bracelet

•Driving restrictions

•Reports: Mood changes-suicide ideation drowsiness/fatigue, visual changes, anorexia, N/V, rash, cognitive or behavioral changes, tremors, ataxia…


Tx options

Diuretics, Lumbar puncture, Shunt placement, endoscopic third ventriculostomy