PEDIATRIC NURSING

SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

FETAL CIRCULATION

O2 blood from placenta (mother) 📌 via umbilical vein

Liver 📌ductus venosus Inferior vena cava 🪢

Right Atrium 🫀 -> Left Atrium 🫀 📌 via foramen ovale

Left atrium ➡️left ventricle 🫀(pump blood to the rest of the body)

Whole body

Superior vena cava 🪢 Right Ventricle 🫀 Pulmonary artery 🪢

(fetal lungs collapse = pressure very high

Pulmonary ➡️Aorta (distal) 🪢📌 via ductus arteriosus

1️⃣ VEIN
Lower Extremities or back to mom
2️⃣ ARTERIES

CONGESTIVE HEART FAILURE + anatomy aw aw (to follow!!!!)

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 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

INCREASED BLOOD FLOW

DEFINITION ASSESSMENT COMPLICATIONS NURSING IMPLICATIONS MANAGEMENT

● Abnormal opening between the 2 atria ● Crescendo-decrescendo systolic ● Emboli ● Surgical intervention
= blood flow from left atrium ~> right atrium ejection murmur or systolic (females) 1. Assess and evaluate heart sounds (recommended)
○ Portion of arterial septal tissue does murmur over 2nd or 3rd - If no surgery (including murmurs)
not completely form intercostal space ● Hypertrophy ● IF ASD IS:
- Heard best at the upper 2. IF ASD IS: - INCIDENTALLY NOTED
● Oxygenated unoxygenated 🟰 mixture left sternal border w/ - INCIDENTALLY NOTED - <5mm
- (high-pressure sa left to lower pressure echocardiogram - LESS THAN 5MM - NO CLINICAL
sa right) - NO CLINICAL SYMPTOMS SYMPTOMS
● Wide, fixed splitting of 2ND heart 🟰 will not close 🟰 will not close
● Right ventricle - affected = hypertrophy sound (S2 / DUB )
3. Address parents’ knowledge deficit and ● Clinically significant
● Enlarged right side of heart teach them about the normal findings + symptoms
TYPES OF ASD
heart defect complications - Management based
Ostium primum ● 🟩 Opening: lower end of ● Overtime, right heart may dilate on child’s age and
(ASD1) septum (increased volume) 4. Explain all procedures and rationales for size of defects
● Mitral valve treatment to child and parents
abnormalities ● Dyspnea, cough, tachypnea, MEDICAL:
chest retractions, orthopnea, 5. Invite verbalization of fears and ● Diuretics
Ostium ● 🟩 Opening: near center of wheezing, crackles, and rhonchi discussion of concerns of the fam - Allow defect to sponti
secundum septum CLOSE
ATRIAL SEPTAL (ASD2) ● 🛑 Closed in 6. Promote cardiac output for child w ASD
DEFECT catheterization lab ● >5mm w/ shunting after
(device that sits in 7. Prepare child and parent for potential observation
acyanotic defect space) surgical procedure to correct anomaly - Closure to:
congenital heart a.decrease the
defect Sinus venous ● 🟩 Opening: near 8. Observe for jaundice preoperatively from incidence of
defect junctions of superior VC RBC destruction if new valve is placed supraventricular
and Right Atrium dysrhythmias
● Partial anomalous 9. Assess, evaluate treat arrhythmias b. prevent pulmonary
pulmonary venous common post-op secondary to edema vascular disease
connection
● 🛑 Surgical closure 10. Monitor for signs of infection to avoid ● >8mm w/ 📈 pulmo blood
pulmonary complications flow
- Refer for closure
● Small ASD = generally well tolerated
11. Provide post-op instructions immediately
● Maternal Rubella is associated with ASD
- Rubella during pregnancy (1st Tri)
12. Instruct the parents and child for ● Before and after any
discharge planning on potential limitations, congenital heart repair,
awareness, unusual symptoms, children may REQUIRE
medications and side effects prophylactic
administration of
antibiotics (pre and
post)
- to prevent infectious
endocarditis

VENTRICULAR ● Most common congenital cardiac defects ● 4-8 weeks infant demonstrates ● Increased 1. Provide support to family ● Small
SEPTAL DEFECT ● Abnormal opening between 2 ventricles easy fatigue and loud, harsh pan pulmonary = close spontaneously

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 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

systolic murmur evident along vascular 2. Promote growth & development

● Oxygenated (LV) unoxygenated (RV) 🟰 the left sternal border at the 3rd resistance ● Moderate
mixture or the amount of oxygenated blood or 4th intercostal space 3. Instruct family regarding clinical = cardiac
is diminished ● Increased manifestations of congestive heart failure catheterization
● Thrill may be palpable pressure in RV
● Classified according to location: (left to right 4. Instruct the family on measures to ● Large >3mm
○ Membranous (80%) ● Congestive heart failure is shunting) = decrease the cardiac workload of the child = open heart surgery
○ Muscular common attempt to done before 2 y/o to
● May vary in size: overcome 5. Instruct the family on the administration of prevent pulmonary
○ Small pinhole ● Risk for bacterial endocarditis resistance = drugs (digoxin, diuretics, ace inhibitors and artery hypertension
○ Absence of septum hypertrophy oxygen) if surgery is to be performed
● Frequently associated with other defects ● Bradycardia MEDICAL MANAGEMENT:
- Pulmonary stenosis ● post -op: 6. Instruct the family about the necessity of ● Surgical
- Transposition of great vessels ● Stunted growth - Residual VSD prophylactic antibiotics for the prevention ○ Palliative
- Patent ductus arteriosus - Conduction of endocarditis - pulmonary artery
- Atrial defects ● Pulmonary vascular obstructive disturbances bonding placing a band
- Coarctation of the aorta disease around the main
● 20% - 60% close spontaneously during the PROGNOSIS: (RISK) pulmonary to decrease
first year of life in children having small or DIAGNOSTIC TESTS: 1. Location pulmonary blood flow
moderate defects ★ Chest x-ray 2. Number of defects (common in the past)
- Cardiomegaly, pulmonary 3. Other associated - improvements in
vascular changes cardiac defects surgical techniques
2 TYPES OF VSD
★ Electrocardiogram
- Small defect - Normal = small VSD ● Single membranous ○ Complete repair
- ✅ MAY - Ventricular hypertrophy defects - small defects are
Low Septum Spontaneously - Left atrial enlargement with mortality rate repaired with purse-
close larger lesions (>5%) string approach
- No treatment ★ Echocardiogram ● Multiple defects - large defects require a
- Dimensions and position of mortality rate knitted decron patch
- Larger defect VSD (20%) sewed over the opening
- ❌ NOT close - Size of heart - both procedures are
spontaneously - Estimate of internal pressure performed via cardio-pulmonary
High Septum - Plastic patch to ★ Cardiac Catheterization by-pass (right atrium and
close defect to - hemodynamics tricuspid valve)
prevent pulmonary
hypertension ● Non-surgical
- Cardiac
catheterization is
under clinical trials
(high operative risks)

ATRIO- ● Endocardial septal defect ● Moderate to severe CHF ● Pulmonary artery banding
VENTRICULAR - Palliative in infants

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 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

● Incomplete fusion of the endocardial ● Murmur (severe)

cushion or in the septum in the heart at the
junction of the atria and the ventricles ● Mild cyanosis when crying (risk ● Patch closure
- Low ASD continous with a high VSD for pulmonary vascular
and distortion of the mitral and obstructive diseases) ● Surgery
tricuspid valves - Final repair (too large
● Respiratory infections to close
● Blood may flow between all 4 heart spontaneously)
chambers (butas sa atrial and ventricular) ● Poor weight gain ● Reconstruction of AV
valves/ Valve
● Trisomy 21 (down syndrome) DIAGNOSTIC TESTS: replacement
★ Chest X-ray (structure) - Valve and septal
- Cardiomegaly repair; mitral &
- All 4 chambers pulmonary tricuspid
vascular changes, insufficiency
SEPTAL DEFECT
enlarged pulmonary artery from poor valve
★ Electrocardiogram (function) function may
- Left axis deviation, right occur
ventricular hypertrophy, ● Post-op: observe for
abnormal conduction - jaundice
1st-degree heart block/ = RBC destruction from
bundle branch block newly constructed
★ Echocardiogram (valve leak) valves
- Exact nature of the defect ● Prophylactic
- Visualization of the anticoagulant and
chambers and antibiotic therapy post-
involvement of valves op
★ Cardiac Catheterization
- Confirms septal defects +
degree of shunting

PATENT ● Acyanotic congenital heart defect ● Asymptomatic or CHF PROGNOSIS 1. Assess and evaluate heart sounds SURGICAL
DUCTUS ● Failure to close soon after birth ● Machinery like murmur ● Shortened life including murmurs in all children. ● Surgical division or
ARTERIOSUS ● Normal closure: birth ~ 3 MONTHS - Left intraaventricular area expectancy ligation of patent vessel
● nOT CLOSED = BLOOD FLOW FROM AORTA - Bacterial 2. Address parents’ knowledge deficit and - Thoracotomy
(high pressure) TO PDA and into ● 2nd intercostal space, upper left endocard teach them about the normal physiology of incision
PULMONARY ARTERY (low pressure) sternal border itis the heart and the pathophysiology of the - ❌ pulmonary
● Mothers with rubella - Under the left clavicle congenital heart defect with resultant bypass
● Stunted growth complications.
● Prominent radial pulse since ● Visual assisted
radial pulse is not palpable in ● Frequent 3. Explain all treatment procedures and thorascopic surgery
newborn fainting rationales to the child and parents. - 3 small incisions

● Thrill ● Fatigue 4. Invite verbalization of fears and ● Rashkind umbrella

discussions of concerns from family. procedure
● Limited growth and physical
activity 5. Support the parents and child throughout NON-SURGICAL
the hosp. ● Coils occlude PDA in the
● Widened pulse pressure and Cath Lab
bounding pulses (runoff of blood 6. Promote cardiac output for the child w/ MEDICAL
from aorta to pulmonary artery) PDA. Monitor for and reduce respiratory ● Indomethacin
distress and pulmonary congestion. - Prostaglandin
● Left ventricular hypertrophy inhibitor
7. Administer oral or intravenous - Preemie and

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PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

indomethacin, a prostaglandin inhibitor newborns

and monitor side effect. - 3 doses
● Increased blood flow
8. Prepare the child and parents for surgical - Diuretic
experience and postoperative furosemide or
management. lasix
- BP first
9. Assess, evaluate and treat arrhythmias ● Caloric concentration
common postoperatively secondary to weight gain
edema

10. Monitor carefully for signs of infection and

administer antibiotics as necessary.

11. Provide essential postoperative

instruction to avoid pulmonary
complications.

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 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

OBSTRUCTION OF BLOOD FLOW - which blood leaving the

ventricular chambers meets with resistance to flow.

Pulmonary ● Constriction/stenosis at the PV causing obstruction ● May be asymptomatic ● Monitor vitals for medication NON-SURGICAL TREATMENT
stenosis and increased pressure in the R ventricle (R ● BALLOON ANGIOPLASTY for
ventricular hypertrophy) and decreased pulmonary ● Mild-to severe cyanosis ● Assess for venous engorgement dilatation of the pulmonic
blood flow valve
● R ventricular hypertrophy = R ● Health teaching to the patient and parents → Catheter with small
ventricular failure = CHF balloon on its tip is inflated
at the blockage site
● Headaches, dizziness, fainting and → Also called
epistaxis resulting from PERCUTANEOUS
hypertension TRANSLUMINAL
CORONARY ANGIOPLASTY
● Distinctive murmur
SURGICAL TREATMENT
● In severe cases, ● Resection of the coarcted
portion with end-to end
→ Blood backs up into the R
anastomosis of the aorta
atrium, increasing atrial pressure
and causing an increased
likelihood of right-to-left shunt ● Enlargement of the
through an opened or reopened constricted section using a
foramen ovale, which leads to graft of prosthetic material or
systemic cyanosis a portion of the left
subclavian artery
DIAGNOSTIC TESTS → For both procedures,
★Chest X-ray - enlarged pulmonary mechanical ventilation is
artery required prior but
cardiopulmonary bypass is
★Echocardiogram - right ventricular
not
hypertrophy
★ECG - right axis deviation
★Cardiac catheterization - increased
pressures on the right side

Pulmonary ● Constriction/stenosis at the PA causing obstruction ● May be asymptomatic NON-SURGICAL TREATMENT

Valve Stenosis and increased pressure in the R ventricle (R ● Mild cyanosis ● Balloon angioplasty
ventricular hypertrophy) and decreased pulmonary ● Murmurs
blood flow SURGICAL TREATMENT
● Cardiomegaly - at risk for bacterial
● PULMONARY ATRESIA endocarditis ● For infants, trans-ventricular
→ Extreme form; no blood flows to the lungs (closed) valvotomy procedure
● In severe cases of PS = CHF
● For children, pulmonary
valvotomy with
cardiopulmonary bypass

Aortic Stenosis ● Constriction/stenosis at the AV causing resistance ● May be asymptomatic ● Monitor vital signs, continuous heart monitor if NON-SURGICAL TREATMENT
to blood flow in the L ventricle (L ventricular ● Murmurs ordered ● Balloon angioplasty
hypertrophy), decreased cardiac output, and → Second intercostal space → Complications may be

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 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

pulmonary vascular congestion or edema ● If severe, chest pain with exercise ● Assess feeling patterns and fatigue valvular regurgitation,
● Decreased cardiac output with faint ● Health teaching to the patient and parents rearing of the valve
● VALVAR AORTIC STENOSIS pulses, hypotension, tachycardia,
→ Most common; fusion of the cusps (bicuspid and poor feeding SURGICAL TREATMENT
rather than a tricuspid valve) ● Aortic valvotomy under inflow
● Exercise intolerance, chest pain, occlusion (palliative); a valve
and dizziness when standing for replacement may be required
long periods of time at a second procedure
→ Complications may be
● Aortic regurgitation valve incompliance,
dysrhythmias, aortic
insufficiency
● L ventricular hypertrophy = L
ventricular failure = CHF

DIAGNOSTIC TEST
★Chest X-ray - enlarged and dilated of
the ascending aorta
★Echocardiogram - exact nature of
constriction
★ECG - generally normal

Coarctation of ● Infants - can present in cardiogenic shock with poor ● Bounding pulses and high BP in the ● Mild or absent ● Monitor BP of upper and lower extremities ● PROSTAGLANDIN E1 - blood
Aorta perfusion upper extremities brachial & femoral from pulmonary arteries to go
● Adults - with unexplained hypertension pulses - ● Health teaching to the patient and parents to descending aorta
● Weak or absent pulses in the lower pathognomonic sign ● BETA BLOCKER - upper
● Narrowing of the aorta causing increased pressure extremities cool to touch ● Observe signs of HF (fluid retention, dyspnea, extremity hypertension
in the upper body and decreased pressure in the ● Headache, vertigo, activity intolerance, tachycardia, & increased
lower body ● Hypertension (headache, dizziness dizziness, fainting due respiratory effort) SURGICAL TREATMENT
and epistaxis) high BP ● RESECTION AND
● AORTIC STENOSIS, PULMONIC STENOSIS and ● Dyspnea and exercise intolerance ● Digoxin and ACE inhibitors as ordered to ANASTOMOSIS
TURNER’S SYNDROME ● Leg cramps, fatigue, improve cardiac function → cardiopulmonary bypass
→ Typical defects; 4-6%; common in males than ● Rapid progression to HF and epistaxis → Antidote for digoxin - DIGIBAND (DIGIFAB) is not required
female acidosis is at risk once ductus → thoracotomy incision is
arteriosus has closed ● Hypertension ● Oxygen as ordered to improve oxygenation used
● Located at the level of ductus arteriosus → If systolic
→ Occurs when tissue from the ductus arteriosus ● Not diagnosed until they grow and pressure reading in ● To decrease cardiac demand, ● POSTOPERATIVE
grows into the wall of the fetal aorta, narrowing noted to be hypertensive the right upper HYPERTENSION (>160
→ Restful, quiet environment
the passage ● The narrowed area is most extremity is 10 mmHg)
mmHg higher than → Restrict fluids and administer diuretics as
frequently distal to the right ordered → treated with IV sodium
subclavian artery so pressures that in the lower nitroprusside or Amrinone
● narrowing in the aorta (CoA),
before the area increase extremity = lower
→ Decreased oxygenated blood flow to the body → followed by oral
extremities cool & NURSING IMPLICATION
→ Obstructed pulmonary blood flow and medications, such as
DIAGNOSTIC TESTS lower BP = potential ● Check femoral pulses in all newborns
anatomic defects like ASD captopril, hydralazine, & or
CoA ● Monitor oxygenation & pulmonary status
★BP in all 4 extremities = high BP in propranolol
→ Pressure builds up on the right side of the heart → Normally, BP in ● Health teaching to the patient and parents
upper extremities
(right-to-left shunt) the legs is higher
★Chest X-ray - rib notching ● To prevent both hypertension
→ This narrowing increases pressure before the 20-40 mmHg higher
★ECG - left ventricular hypertrophy at rest and exercises,
defect and decreases it afterward than the arms
because of → Elective surgery for COA
is advised within the first 2

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PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

peripheral vascular years of life

resistance
● Impaired circulation NON-SURGICAL TREATMENT
PREDUCTAL Constriction is above
in the lower ● Balloon Angioplasty/Stent
− Lower body gets
extremities → Stent - tiny tube placed
blood from the right
ventricle via the → Leg pains on into a hollow structure to
ductus arteriosus exertion hold it open
→ Cold feet or cool ▪ It is placed to keep artery
EXTENSIVE PREDUCTAL Long constriction pale extremities open after balloon is
→ Muscle spasm deflated and removed
POSTDUCTAL Narrowing is below ● Use of prosthesis or graft
− Collateral circulation ● Myocardial
develops to maintain hypertrophy PROGNOSIS
blood flow to the ● Less than 5% mortality in
→ usual response
lower body. patients with isolated
of the heart when it
pumps harder than coarctation
usual because of an ● Increased risk in infants with
obstruction other complex cardiac defects

● Systolic murmur
→ Left sternal
border
→ Left midscapular
area

● For infancy, more

critical & can produce
HF
→ Require
immediate surgical
intervention
→ Observe signs of
CHF

● Aortic aneurysm or
stroke

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 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

MIXED BLOOD FLOW - fully saturated systemic blood flow mixes with desaturated blood flow

DEFINITION ASSESSMENT COMPLICATIONS NURSING IMPLICATIONS MANAGEMENT

● Rare, uncommon ● Oxygenated and deoxygenated SURGICAL TREATMENT

blood mix in the Right atrium, ● CORRECTIVE REPAIR
● Result of failure of pulmonary venous shunting through the ASD - PV is anastomosed to the
connection to unite with left atrium in utero Left atrium
- PV returns o2 in left atrium BUT APV ● Right heart hypertrophy (left - ASD is closed
return o2 to SVC by an abnormal heart small) - Anomalous pulmonary
connecting vein or another vessel venous connection is ligated
● CHF
● Connects with:
- Left innominate portal, coronary ● Cyanosis worsens with PV
sinus vein obstruction
ANOMALOUS - Directly to Right Atrium
PULMONARY
VENOUS RETURN ● Oxygenated pulmonary blood return to the
right side of the heart
- Pulmonary veins return oxygenated
blood to the SVC by an anomalous
connection vein

Partial APVR 1, 2, or 3 pulmonary veins

draining abnormally

Total APVR All 4 pulmonary veins

draining abnormally

● Rare, uncommon ● Murmur ● HF ● Health teaching MEDICATION

TRUNCUS - Ejection of systolic ● Prophylactic Antibiotic
ARTERIOSUS ● Failure of normal septation + division of the murmur ● Dysrhythmias ● Monitor arrhythmias - Prevent bacterial
embryonic bulbar trunk - Esp. during post-op endocarditis
- Pulmonary artery and aorta fail to ● Symptomatic with moderate- ● Residual septal
divide = single vessel due to the severe CHF defect ● Monitor I&O, nutrition, lung sounds, ● Digoxin (0.5-2 mg/ml)
overriding of one over the other. and O2 sat. - Help heart function
● Cyanosis with poor growth ● Bleeding ○ Digoxin toxicity: nausea
● Results in, - Inadequate O2 and low ● Surgery is done on first 2 weeks of ○ Antidote: Digifab or
cardiac output ● Pulmonary life Digibind
- Single arterial vessel overriding - Activity intolerance, cold, artery - Prophylactic antibiotic
both ventricles, supplying systemic, clammy, sweating, edema hypertension - Oral medication (Lasix) - to ● Furosemide (diuretic)
coronary, and pulmonary blood flow remove fluid, lower BP - Remove fluid
● Fatigue, lethargy, and poor - Lower BP
● Blood from both ventricles mixes in the feeding
common great artery, causing desaturation - Mixing of blood ● Captropil (ace inhibitor)
and hypoxemia - Reduce afterload and
- Branch pulmonary arteries arise at
● VSD decrease effort o the
heart to pump blood
some point along the large vessel
- 4 classifications depending on ● Prostaglandin E1 (edema)

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 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

where the pulmonary arteries arise DIAGNOSTIC TEST SURGICAL TREATMENT

from the truncal vessel ★Chest X-ray - cardiomegaly and ● Surgical closure of VSD
ventricular hypertrophy - With patch and valve
★ECG - biventricular hypertrophy conduit placement
★Echocardiogram - defect positions
● Homograft conduit
and blood flow directions, valvular
- Require replacement
incompetence
as the child grows
★Heart ultrasound
★Cardiac catheterization - saturation ● Repair is recommended in
levels, pressure, and defects first months
visualization

TRANSPOSITION ● Second most common (reversal of great ● Severe cyanosis and depression ● Dysrhythmias, ● Health teaching NON- SURGICAL MANAGEMENT
OF THE GREAT arteries) at birth w/ poor apgar ventricular ● Prostaglandin E1 (PGE1)
ARTERIES OR failure, coronary ● Provide small, frequent nutritive - Infusion immediately
VESSELS ● Pulmonary artery and the aorta switch ● Large septal defects or PDA artery meals after birth
positions - Less severe cyanosis, insufficiency, - Help maintain ductus
- Aorta arises from the R ventricle tachypnea and murmurs contraction or ● Provide procedural any sensory arteriosus patency,
- Pulmonary artery originates from but could present narrowing at the teaching regarding unit and routines promoting pulmonary
the L ventricle symptoms of CHF anastomosis & nursing care blood low and left-to-
sites right intercirculatory
● Results in: ● Heart sounds vary based on NURSING CARE BEFORE SURGERY mixing in the arterial
- Two separate circulation associated defects ● Palliative ● O2 sat remains 75-85% level
- Oxygenated blood returns from surgical ● Monitor signs of increased blood flow - Side effects: apnea
the lungs to the L atrium, L ● Poor feeding, failure to thrive, and procedures are ● Support family and hypotension (esp.
ventricle, pulmonary artery, and increased respi intake performed if In infants weighing
back to the lungs necessary >2kg)
- Deoxygenated blood returns from ● Heart murmur - ejection o
the body to the R atrium, R systolic murmur SURGICAL MANAGEMENT
ventricle, aorta, supplying ● Balloon atrial Septostomy
deoxygenated blood to systemic DIAGNOSTIC TEST - Catheter is inserted
circulation ★Chest X-ray - egg-shaped heart and through the IVC > R
cardiomegaly several weeks atrium > foramen
postnatally ovale > L atrium =
★ECG - right axis deviation inflated balloon =
enlarging the ASD
★Echocardiogram - confirm/corroborate
- May be performed
the diagnosis and locating the defect
during cardiac
★Cardiac catheterization - saturation catheterization
levels, pressures, and assesses
anatomical landmarks ● Arterial Switching operation
(Jatene position)
- Surgery within the first
14 days of life
- Pulmonary artery and
aorta are dissected
above their valves and
switched to their
correct locations
- Coronary arteries are
repositioned,
establishing a new

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 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

aorta

● Final moving of the arteries

- Coronary arteries are
removed from the
original aorta and
placed on the new
aortic root,
necessitating
cardiopulmonary
bypass

● Rastelli procedure (by:

Giancarlo Rastelli)
- Involves closure of
VSD, pulmonic valve,
and placement of a
conduit from the R
ventricle to the
pulmonary artery
- Requires multiple
conduit replacements
as the child grows

HYPOPLASTIC ● Left side (L ventricle and ascending aorta) are ● Prostaglandin E1 as ordered SURGICAL TREATMENT
LEFT HEART underdeveloped ● Norwood Procedure
Open Mild cyanosis
SYNDROME ● Health teachings - Attach main
ductus HF symptoms, labored
● Results in, pulmonary artery to
arteriosus breathing, tachypnea,
● Instruct to minimize care on cardiac the hypoplastic
→ Aortic atresia - no blood flow from the L dyspnea, decreased
workload ascending aorta
atrium to the L ventricle and aorta peripheral pulses
- Systemic blood flow
→ Mitral and aortic valves may be absent or PROCEDURES PERFORMED ● Shunt placement (BT or Sano)
stenosed Closed Severe cyanosis
ductus Decreased cardiac - Ensure stable blood
→ Right ventricular hypertrophy - oxygenated A. LIGATION low to the lungs
arteriosus output, rapid
blood from the L atrium flows to the R atrium ● Ligation of the previously placed
decompensation, arrest
through the foramen ovale BT or Sano shunt ● PDA ligation
- Post op
● Systemic circulation relies on blood flow ● Mechanical ventilation B. DISSECTION ● Widely patent arterial septum
through the PDA from the pulmonary artery to ● Prostaglandin E1 - Proper circulation
● Dissection of the SVC at its
the aorta insertion to the R atrium
DIAGNOSTIC TEST ● Glenn shunt and bidirectional
● Attachment of the SVC directly to
● Oxygenated blood mixes across the PFO with ★Chest X-ray - absence of normal L the branch pulmonary artery
Glenn Shunt
deoxygenated blood = approximately 75% ventricle, pulmonary vascular changes - Antiviral therapy
= Deoxygenated blood from the prophylaxis against
oxygen saturation ★ECG - left axis alteration
head & upper body flows (RSV)
★Echocardiogram - L ventricle directly but passively to the
● Ductal dependency requires ductus to remain dimensions and associated - 4~6 mos to relieve
lungs to get oxygenated volume load on the R
patent until surgery anatomical defects (Normal saturation after
→ PGE1 infusion ★Cardiac catheterization - saturation ventricle
surgery 85%)
levels, pressures, and assesses ● Several-staged approach
anatomical landmarks
= New aorta and a large atrial
septal defect followed by a
bidirectional Glenn shunt

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PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

= Final repair is a modified

Fontan repair

C. FONTAN PROCEDURE
● 15 kg or is 3 years old
● IVC is dissected from the R atrium,
& flow from there is directed
through an artificial conduit
directly to the branch pulmonary
artery
= Deoxygenated blood (except
for coronary sinus return) flows
directly but passively to the
lungs
= Blood returning to the L atrium
flows across the ASD, to the R
atrium, R ventricle, & out the
augmented aorta to the body
(Normal saturation after
surgery 90%)

D. CARDIAC TRANSPLANTATION
● Alternative form of therapy
= Only if may magdodonate

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 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

DECREASED BLOOD FLOW - hypoxemia and cyanosis

DEFINITION ASSESSMENT COMPLICATIONS NURSING IMPLICATIONS MANAGEMENT

● TAF fail to develop + no communication ● Cyanosis, tachycardia, dyspnea ● Advise on nutritional support and provide SURGICAL TREATMENT
between Right Atria and Right Ventricle small frequent feedings ● Prostaglandin E
● Signs of chronic hypoxemia with - Maintain
● Associated with: clubbing and polycythemia ● Health teaching openness
- Pulmonic Stenosis
- Transposition of the great arteries ● Failure to thrive, growth ● Reduce cardiac workload ● Placement of shunt
retardation (pulmonary-to-systemic
● Results in arteria anastomosis)
- Systemic desaturation, lung ● Murmur depends on size and - ASD small, =
obstruction, and reduced blood flow figuration on defect arterial
to the lungs septostomy is
DIAGNOSTIC TEST performed
● Older children: chronic hypoxemia and ★Chest X-ray - normal or minimally during cardiac
clubbing enlarged heart catheterization
★ECG - hypertrophy of both atria and the
left ventricle ● Pulmonary artery
banding
★Echocardiogram - location of
TRICUSPID - reduce volume
associated defects; left-to-right
ATRESIA of blood flowing
shunting
to lungs
★Cardiac catheterization - pressures
and direction of blood flow ● Bidirectional Glenn
Shunt (Cavopulmonary
anastomosis)
- 6-9mos @ 2nd
stage
● Modified fontan
procedure
- Direct systemic
venous return to
the lungs,
separating
oxygenated and
unoxygenated
blood in the
heart

TETRALOGY OF ● Includes four defects: ● Cyanosis, clubbing, murmurs, chest INFANTS WITH PULMONIC STENOSIS ● Prostaglandin E1
FALLOT ○ Pulmonary artery stenosis deformities, syncope, tet spells, ● Propranolol
○ Overriding aorta feeding difficulties, retarded growth ● Acutely cyanotic at birth or may have mild ● Phenylephrine
○ Right ventricular hypertrophy → Murmurs at second to fourth ICS cyanosis that progresses over the first year of - Vasoconstriction
○ Ventricular septal defect to clavicular area life as the pulmonic stenosis worsens and more flow
out the urinary
▪ Squatting - enhances systemic
● Etiology is unclear but may be due to, ● Murmur artery
resistance, decreases venous
○ Increased infundibular contractility
return, and relieves heart stress by
○ Peripheral vasodilatation
trapping blood in the lower ● Hypercyanotic spells (blue spells/tet spells)
○ Hyperventilation
extremities occur when the infant's oxygen requirements
○ Stimulation of right ventricular SURGICAL TREATMENT
exceed the blood supply (usually during crying
mechanoreceptors ● Palliative shunt

AYLM ♡ | 13
PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

DIAGNOSTIC TEST or after feeding) - pulmonary blood

★Chest X-ray - Boot-shaped heart → Relieved by knee-to-chest position, flow and O2 sat
★ECG - Right ventricular heart failure increasing systemic vascular resistance or in infants who
Pulmonary Vascular Shunt (right to
the left side of the heart cannot undergo
Resistance left) ★Echocardiogram - Nature and position
repair
of all defects
Systemic resisitance Shunt (left to ★Cardiac catheterization - pressures ● If child is distressed and irritable,
right) ● Blalock-Taussig or
beyond the pulmonic valve → Knee-to-chest positioning and blow-by
modified
★Laboratory - Polycythemia and oxygen to boost oxygenation and possibly
- Provide blood
decreased O2 saturation dilate the distal pulmonary bed
flow in the
→ Surgery referral if weight gain is difficult or pulmonary
hypercyanotic spells occur, usually around 3-6 arteries from left
months of age or right
subclavian artery
● Small frequent feedings
● Complete repair in first
● Knee-chest during hypoxic spells year of life
- Closure of VSD
● Prophylactic antibiotic - Resection of
- To prevent endocarditis stenosis (w/
pericardial patch
to enlarge
ventricular
outflow tract)
- Requires median
sternotomy and
cardiopulmonary
bypass

AYLM ♡ | 14
 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

ACQUIRED HEART DISEASES

- Penicillin: main drug
DEFINITION ASSESSMENT COMPLICATIONS NURSING IMPLICATIONS MANAGEMENT
RHEUMATIC ● Autoimmune disease that occurs as a MAJOR 5 SIGNS ● Penicillin
FEVER reaction to - Oil-based (slow
- Group A Beta-Hemolytic w/ systolic murmur ● Bed rest during acute phase absorption)
Streptococcus infection & prolonged P-R & - Treats infection
Carditis
QT intervals on ● Be alert for petechiae - IM erythromycin
● Tonsillitis (recurring = tonsillectomy kasi Electrodiagram - (tiny spots of bleeding under skin) (if sensitive to
may risk for rheumatic fever) (Involuntary limb - if the aspirin dosage interferes with Penicillin)
movement) prothrombin synthesis. - Z-track
● Occurs most often in children 6~15 years Dysfunctional - Since aspirin is anticoagulant technique
with a peak incidence at 8 years Chorea speech, weak or - Toxic effect is bleeding - (painful)
spasmodic hand monitoring is necessary
● Course: 6 ~ 8 weeks grasp & axial ● Oral Salicylates
expression changes ● If Chorea is present, provide toys and - Reduce
● Inflammation from immune response = Subcutaneous By the joints games that do not require coordination to inflammation
fibrin deposits on the endocardium and Nodules minimize frustrations and pain
valves: Swollen and tender - Toxicity:
Polyarthritis
- Mitral valve joints ● To continue the course of therapy for the Tinnitus, nausea,
- Major body joints Erythema Macular rash full 10 to 14 days as prescribed. vomiting,
Marginatum primarily on trunk headache,
● Follows URT infections ● Need to maintain prophylactic antibiotics blurred vision
- Follows an attack of pharyngitis, ● Fever therapy for at least 5 years after the initial
tonsillitis, scarlet fever, strep throat ● Arthalgia attack, or until the child is 18 years old or ● Corticosteroids
or impetigo (same organisms) ● History of prev Rheumatic Fever if the physician may prescribe. - If not responding
● Elevated sedimentation rates to salicylate
● Can recur (strep infections recur) (ESR) and C-reactive protein ● NO DENTAL SURGERY: An open incision therapy
levels in the mouth increases the risk of - Side effects:
● Socioeconomically depressed areas streptococcal invasion into the Moon face 🌚,
bloodstream. Weight gain (bc
of edema)

● Phenobarbital
- Reduce
purposeless
movement of
chorea

NURSING IMPLICATIONS
● Salicylic acid (aspirin)
- Decrease
inflammation
and block
platelet
agglutination

● Sequential
echocardiograms
- Monitor
● The child must manifest fever &
aneurisms
four of the typical symptoms
● CBC
listed below:
- Leukocytosis &

AYLM ♡ | 15
 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

1. Fever of 5 or more days (38.9 tcells

to 41.4C) that does not
respond to antipyretics. ● Dipryradimole
- Increase
2. Bilateral congestion of ocular coronary
conjunctiva vasodilation and
decrease
3. Changes of the mucous platelet
membrane of the upper accumulation
respiratory tract, such as
reddened Pharynx; red, dry, ● IV gamma globulin
fissured lips; or protuberance - Reduce antigen-
of tongue papillae ( strawberry antibody
tongue) reaction and
possibility of
4. Changes of the peripheral coronary artery
extremities, such as peripheral disease
edema, desquamation of the
palms & soles. ● Warfarin (Coumadin) or
Heparin or fibrinolytic
5. Rashes, primarily truncal & therapy
polymorphous
→ rashes na parang bungang
araw (prickly heat)

6. Cervical lymph node swelling

KAWASAKI ● Acute, systemic vasculitis CRASH & BURN ● Coronary artery ● Echocardiogram
DISEASE - principal and life-threatening; leads ● C - Conjunctivitis (bilateral, aneurysm - - (coronary aneurysm,
to aneurysm and myocardial nonpurulent) most dilatation,
infarction (cut in blood supply ● R - Rash (polymorphic, trunk, concerning pericardial effusion,
extremities, groin) complication valvular regurgitatio,
● AKA mucotaneous lymph node syndrome ● A - Strawberry tongue (prominent - occurs in 25% decrease LV
papillae, erythema of mucosa untreated function)
● Children 5+ years and lips) patient; with
- Occurs in children before puberty ● H - Hands and Feet erythema timely ● Lab test
- Peak at boys under 4 years (swelling, erythema, periungual treatment - I diagnosis is not
of age desquamation 2 weeks after fewer 5% certain
fever onset) develop
- Asian Pacific children at
● B - burn aneurysm MAIN TREATMENT
highest risk
● IVIG (IV
—----------------------------------------------- immunoglobulin)
● Cause: unknown
- Given one-time dose
- Believed to develop in genetically
● Irritable and difficult to consult within 1st 10 days to
predisposed individuals, triggered by
decrease aneurysm
exposure to an unidentified
● Involvement of musculoskeletal, & lower ever
infectious agent
GI, GU, respiratory, nervous, and ● Aspirin
cardiovascular systems - moderate to high
● Affects coronary arteries by vascular
dose is given to
infiltration
afebrile patients for 48-
● Febrile, multisystem disorder
72 hours then low
- *Believed to develop in
dose for 4-6 until
immunocompromized indivs,
aneurysm resolve
triggered by exposure to an
- If develops fever
unidentified infectious agent
after 36 hrs post

AYLM ♡ | 16
 PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

IVIG without any

● Cases weakening and dilation of vessel explanation =
calles Refractory
Kawasaki Disease
or re-treated with
2nd IVIG

● For uncomplicated
Kawasaki disease:
follow-up
echocardiography at 1-2
weeks, 4-6 weeks

● For coronary artery

patients: cardiology
follow-up

BACTERIAL ● Inflammation and infection of the endocardium ● Pallor, anorexia, and weight loss ● Health history and physical assessment ● IV Penicillin
ENDOCARDITIS or valves of the heart due to bacterial invasion - Treat strep
● Arthralgia - joint pain ● Prophylactic use of antibiotics before invasive infection
● More common as a complication of congenital procedures including dental work
heart disease such as TOF, VSD, or CoA ● Diuretics
● Malaise - generalized feeling of
- Pag may serious
discomfort or unease ● Discover and appropriately treat the invading
CHF
● Streptococcal, staphylococcal, or fungal in organism
origin ● Chills - often associated with fever ● Bed rest
→ Streptococcal infection can occur with ● IV PENICILLIN to treat streptococcal infection - Acute stages
dental work or UTI ● Heart murmurs - due to turbulent
▪ e.g. Tooth extraction - thus, wearing of blood flow due to valvular involvement ● Monitor for serious CHF and administer
gloves is needed DIURETICS as prescribed
● CHF → Helping your kidneys produce more urine >
● Progression leads to VALVULAR VEGETATION more excess salt and water you flush out of
→ Bacterial colonization > growths > toxins > ● Petechiae of the conjunctiva or oral your body > easier for your heart to pump
bacteria breaking down heart tissues or mucosa - microhemorrhages ● Bed rest during the acute stages to help rest
muscles > holes in the heart > obstructs blood the heart if there is increase in laboratory
flow ● Hemorrhages of the fingernails or workups
toenails - small blood vessel damage
● Onset is typically insidious (gradual but harmful) ● Provide and prepare
● Left upper quadrant pain secondary → Long-term follow-up care to certain that
● Treatment involves identification of organism to spleen infarction the invading organism has been eliminated &
and treatment with appropriate antibiotics with disease halted
supportive measures to reduce congestive heart ● Splenomegaly - enlargement of the → Continued follow-up care, monitoring the
failure spleen heart muscle
→ Continued medical & possible surgical
● Proteinuria - protein in urine interventions depending on the severity

● Hematuria - blood in urine ● Health teaching to the patient and parents

● Leukocytosis - high count of WBC

● Increased ESR - RBC falls faster to the

bottom of the test tube, meaning there

AYLM ♡ | 17
PEDIATRIC NURSING
SY 2023-2024 | SECOND SEMESTER | MIDTERMS | FEU - NRMF PROF. UBANA | BY: AYABELLZ ♡

is a visible sign of inflammation inside

your body

● Positive blood culture of invading

organism

● Echocardiogram revealing vegetative

growth on the heart valves

FROM JANE
→ F - fever → J - janeway lesions
→ R - roth spots → A - anemia
→ O - osler nodes → N - nail-bed hemorrhages
→ M - murmur → E - emboli

AYLM ♡ | 18