Pediatrics
Pediatric Cardiovascular Disorders
Overview
Pediatric cardiovascular disorders primarily consist of congenital heart defects present at birth that affect blood flow through the heart. These defects can cause either increased or decreased pulmonary blood flow, or obstruction of systemic flow. Management focuses on optimizing oxygenation, maintaining cardiac output, and ensuring adequate nutrition for growth.
Key nursing concepts
- Congenital heart defects are classified by blood flow patterns.
- Acyanotic defects involve left-to-right shunting (e.g., ASD, VSD).
- Cyanotic defects involve right-to-left shunting (e.g., Tetralogy of Fallot).
- Digoxin increases cardiac contractility but requires strict heart rate monitoring.
- Heart failure in infants often manifests as poor feeding and diaphoresis.
- Obstructive defects like coarctation lead to pressure gradients between extremities.
Important nursing considerations
- Monitor for the 'tet spell' or hypercyanotic episode during crying or feeding.
- Administer prophylactic antibiotics before dental procedures to prevent endocarditis.
- Assess for clubbing of fingers and toes as a sign of chronic hypoxia.
- Limit feeding time to 20-30 minutes to conserve the infant's energy.
- Monitor potassium levels closely if the child is taking digoxin and diuretics.
- Ensure the infant remains in a knee-chest position during cyanotic spells.
Patient teaching
- Teach parents how to accurately measure and administer liquid digoxin.
- Instruct caregivers to provide small, frequent, high-calorie feedings.
- Explain the importance of avoiding illness and keeping up with immunizations.
- Show parents how to perform the knee-chest maneuver for cyanotic episodes.
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