1. Pediatric Cardiovascular (illustration 1  illustration 2  illustration 3)

Congenital Heart Defects

1. Congenital heart defects in general
1. Etiology: usually not known - associated with maternal factors:
1. infection
2. alcoholism
3. age over 40 years
4. diabetes mellitus, type one
5. genetics, chromosomal changes
2. General findings of congenital heart defects
1. child small for age
2. physiological failure to thrive
3. exercise intolerance
4. dyspnea while feeding
5. squatting position
6. clubbing of fingers
3. Physical consequences of cardiac problems
1. increased workload; pulmonary hypertension; decreased systemic output; cyanotic defects
2. can lead to hypoxemia and polycythemia
3. concern: formation of thrombus with embolus
   
2. Acyanotic defect - infant/child is "pink"
1. Pathology: hole in the heart's internal wall
1. blood flows from heart's arterial (left) to venous (right) side or a "left to right shunt", not systemically, but only within heart itself
2. size of defect will determine severity of condition
2. Four common types: all with increased pulmonary blood flow
   
3. Cyanotic defect: infant/child is "blue"
1. Pathology
1. unoxygenated blood mixes with oxygenated, via a "right to left shunt"
2. decreases oxygenation to the entire system
3. results far more severe than acyanotic
4. thrombus formation is always a concern   
   
4. Nursing care of the child with a congenital heart defect
1. Emotional, physiological, and psychological interventions
2. Assisting the child and family to adjust to special needs
3. Goals of treatment
1. child will maintain adequate oxygenation and physiological stability
2. family will understand signs and symptoms of the condition, and how to manage each of them
3. child will attain milestones of normal growth and development
4. when child has surgery, child and family will be prepared, know prognosis, and know how to give home care afterward
4. Nursing interventions
1. recognize CHF 
2. monitor height, weight, vital signs, pulses, pulse oximeter, intake and output
3. give medications: digoxin (Lanoxin), furosemide (Lasix) or chlorothiazide (Diuril); monitor for desired outcomes and side effects
4. recognize and treat pain appropriately: pharmacological and nonpharmacological interventions
5. maintain a safe environment
6. conserve energy
7. maintain proper nutrition, with small, frequent feedings
8. support and discuss treatment with parents
9. place in proper position - slanting position with head elevated, older babies in infant seats, occasional knee-chest

Acquired Cardiovascular Disorders

5. Hyperlipidemia: excessive lipids
1. Etiology: dietary, heredity
2. Pathophysiology
1. increased lipids and cholesterol
2. causes atherosclerosis, leading to coronary heart disease
3. Diagnosis: lab tests: increased LDL, lipids and cholesterol; decreased HDL
4. Management
1. diet: ADA diet in two steps:
1. < 30 kcal from fat; < ten from saturated fat; < 300 mg/L cholesterol
2. < 30 kcal from fat, < seven from saturated fat; < 200 mg/L cholesterol
2. medications: colestipol (Colestid), niacin (Nicor), cholestyramine (Questran)
   
1. Pediatric Respiratory