Increasing Pulm Blood flow
Patent Ductus Arteriosus (PDA)
Severity is based off of what 3 things?
S&S?
DX/TX?
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
•CONGENITAL
•ACQUIRED
•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
Interventions?
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
How commmon?
S&S?
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?
S&S?
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?
TX/DX?
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?
S&S?
Dx/TX?
•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
•Strabismus
•altered motor activity
•Seizures
•vomiting
Atrioventricular Septal Defect (AVSD)
What CHD defects are involved?
S&S?
DX/TX?
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?
TX/Mngmgnt?
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
LP
Management of hydrocephalus:
Overproduction:
Obstruction of Flow:
Overproduction of csF:
-Diuretics
-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