NCMA219

LESSON 12: CARDIOVASCULAR DISORDERS OF CHILDREN

WEEK 11 I SECOND YEAR, SECOND SEMESTER - MIDTERMS| A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA
CAMPUS
Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN
Transcribed by: ASHLEY G. IGLESIAS, SN I BSN 2-Y2-6 I OLFU - VAL

● A soft systolic murmur in the pulmonic area (splitting S2).

ALTERATIONS IN OXYGENATION: RESPONSES TO ALTERED ● LABORATORY/DIAGNOSTIC EXAMS:
CARDIAC AND TISSUE PERFUSION ○ 2D ECHO: reveals enlarged right side of the
heart and increased pulmonary circulation.
REVIEW: FETAL AND NEONATAL CIRCULATION
○ CARDIAC CATHETERIZATION: demonstrates
separation of RA and the increased O2
saturation in the RA.
● SURGICAL TREATMENT: PERICARDIAL PATCH OR DACRON
PATCH CLOSURE.
○ Open repair with C-P bypass before school age.
● NON-SURGICAL: MAY BE CLOSED USING DEVICES DURING
CARDIAC CATHETERIZATION (AMPLATZER SEPTAL
OCCLUDER).
● Low-dose aspirin for 6 months.
● NURSING MANAGEMENT:
○ Explain to parents the purpose of tests and
procedures.
○ Teach parents ways to support nutrition, reduce
PLACENTATION & FETAL CIRCULATION stress on the heart, promote rest, and support
growth and development during the
CONGENITAL HEART DEFECTS (CHD)
preoperative period.
● Congenital heart disease is the abnormality of the heart ○ Teach parents signs of congestive heart failure
present from birth. and infection.
● Congenital heart disease usually manifests in childhood ○ Prepare parents and child for surgery by visiting
but may pass unrecognized and not present until adult the intensive care unit, and explaining
life. equipment and sounds.
CLASSIFICATION OF CHD ○ Prepare older child for post-operative
experience, including coughing and deep
breathing, and the need for movement.
○ Teach the need for antibiotic prophylaxis to
prevent subacute bacterial endocarditis.
VENTRICULAR SEPTAL DEFECT (VSD)
● Defect in ventricular septum — error in early fetal
development.
● Abnormal opening between the right and left ventricles.
● Location: membranous (80%) or muscular.
● Pinhole to the absence of septum.
● Spontaneous closure may occur during the first year of
life.
ATRIAL SEPTAL DEFECT (ASD) ● Pressure LV → RV and systemic arterial circulation
● Abnormal opening between atria → Blood from higher resistance → Pulmonary circulation, blood flows through
pressure (LA) to flow into lower pressure (RA). the defect and into the pulmonary artery
● Increase O2 blood into the R side of the heart. ● RV becomes enlarged (hypertrophied), and over time the
● RA & RV enlargement. RA may also become distended.
● Cardiac failure is unusual in uncomplicated ASD. ● SYMPTOMS:
● May be asymptomatic if small defect. ○ Tachypnea, dyspnea
● Dyspnea ○ Poor growth, reduced fluid intake.
● Fatigue and poor growth. ○ Palpable thrills

NCMA219: CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC) LESSON 12: CARDIOVASCULAR DISORDERS OF CHILDREN 1
 NCMA219
LESSON 12: CARDIOVASCULAR DISORDERS OF CHILDREN
WEEK 11 I SECOND YEAR, SECOND SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS
Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN
Transcribed by: ASHLEY G. IGLESIAS, SN I BSN 2-Y2-6 I OLFU - VAL

○ Loud holo-systolic murmur at left lower sternal DEFECTS OF DECREASE PULMONARY BLOOD FLOW
border.
● Obstruction of pulmonary blood flow + anatomic defect
○ May develop HF. (ASD/VSD) between R & L side of heart.
○ At risk for BE and pulmonary vascular
● Difficulty of blood exiting R heart via pulmonary artery →
obstructive disease. increase R side pressure → L side pressure → desaturated
● TREATMENT: blood shunt R to L → desaturated blood in systemic
○ MEDICATIONS: circulation.
■ Furosemide: a diuretic which removes ● Hypoxemia, usually cyanotic.
excess fluid out of the body.
■ Digoxin: helps the heart pump more
forcefully
■ Angiotensin-converting enzyme (ACE)
inhibitor: relaxes blood vessels and
help heart to pump more easily.
○ SURGICAL REPAIR WITH CP BYPASS
(PROCEDURE OF CHOICE): SMALL DEFECTS BY
SUTURE WHILE LARGE DEFECTS BY KNITTED
DACRON PATCH.
○ Pulmonary artery banding (for infants with
multiple muscular VSD).
PATENT DUCTUS ARTERIOSUS (PDA)
● Ductus SHOULD close by about age 15 hours after birth.
● Some shunting of blood may occur up to 24 hours of life.
● DUCTUS closes because increase in arterial oxygen
concentration that follows initiation of pulmonary
function.
● Prostaglandin inhibitors leads to closure of PDA.
● Allows blood to flow from left to right and pulmonry blood TETRALOGY OF FALLOT
flow. ● Involves four heart defects:
● SMALL PDA: asymptomatic ○ Ventricular septal defect
● Bounding peripheral pulses ○ Pulmonary stenosis
● Widened pulse pressure (>25) ○ Right ventricular hypertrophy
● Loud machinery-like murmur at upper left sternal border ○ Overriding aorta
(left intraclavicular area)
● COMPLICATION FOR LARGE PDA: CHF with tachypnea,
dyspnea, and hoarse cry
● DEFINITIVE DIAGNOSIS: ECHO
● MEDICAL:
○ (PREMATURE) INDOMETHACIN to close PDA’;
surgical ligation if meds fail.
○ Prophylactic antibiotics to prevent bacterial
endocarditis.
● SURGICAL: (BETWEEN AGE 1-2 YEARS)
○ Surgical division or ligation via let thoracotomy.
○ Video-assisted thoracoscopic surgery
● NON-SURGICAL:
○ Coiling through cardiac catheterization
(contraindicated in preterm and small infants,
and with large PDAs)

NCMA219: CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC) LESSON 12: CARDIOVASCULAR DISORDERS OF CHILDREN 2
 NCMA219
LESSON 12: CARDIOVASCULAR DISORDERS OF CHILDREN
WEEK 11 I SECOND YEAR, SECOND SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS
Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN
Transcribed by: ASHLEY G. IGLESIAS, SN I BSN 2-Y2-6 I OLFU - VAL

● Hemodynamics vary widely ● CLINICAL MANIFESTATION

○ Depends on extent of pulmonic valve stenosis & ○ Insidious onset, unexplained fever (low grade,
size of VSD. intermittent).
○ If VSD is large, pressures are equal in R and L ○ Anorexia, malaise, weight loss.
ventricles. Blood is shunted in the direction of ○ Extracardiac emboli.
the least resistance (pulmonary or systemic ○ Splinter hemorrhage–thin black lines under
vascular resistance). nails.
● PVR is > than systemic vascular resistance, shunt will be R ○ Osler nodes - red, painful, intradermal nodes on
to L. pads of phalanges.
● Clinical Manifestations: ○ Laneway lesions - painless hemorrhage on
○ “TET SPELLS” or “blue spells” with acute panes and soles.
episodes of cyanosis and hypoxia. ○ Petechiae on oral mucous membrane.
○ Anoxic after feeding or with crying. RISK of ○ May be present: CHF, dysrhythmia, new murmur.
emboli, LOC, sudden death, seizures. ● THERAPEUTIC MANAGEMENT
● Repairs: usually indicated when Tet spells and ○ High-dose antibiotics: penicillin, ampicillin,
hypercyanotic spells increase methicillin, cloxacillin, streptomycin, or
○ Stage 1: Blalock or modified Blalock shunt >> gentamycin.
blood to pulmonary arteries from L to R ○ IV/IM x 4 weeks at least.
subclavian artery. ○ Amphotericin or flucytosine for fungal
○ Complete repair: usually in 1st year of life. infections.
Repair of VSD, resect stenosed area, and patch R ○ Treat 2-8 weeks. If antibiotics is unsuccessful >>
ventricular outflow. CHF develops, vulvular damage.
DISTURBANCES IN CIRCULATION ○ Should be instituted immediately.
○ Blood c/s periodically to evaluate response to
ACQUIRED CARDIOVASCULAR DISORDERS
antibiotics.
ENDOCARDITIS (BACTERIAL INFECTIVE ENDOCARDITIS) ○ Prophylaxis before dental procedures,
● BE, IE or subacute bacterial endocarditis (SBE). bronchoscopy, T&A, surgeries, childbirth.
● Infection in valves and endocardium. ○ Prophylaxis: 1 hour before procedures (IV) or
● Sequelae of sepsis in child with cardiac disease of may use PO in some cases.
congenital anomaly. ○ Family dentist should be advised of existing
● Affects children with valvular abnormalities, prosthetic heart problems.
valves, recent heart surgery with invasive lines and RHD RHEUMATIC HEART DISEASE
with valve involvement, and drug abuse. ● Inflammatory disease occurs after Group A
● INFECTIVE ENDOCARDITIS Beta-haemolytic streptococcal throat infection.
○ Staph aureus, strep viridians (most common), ● Self-limiting
candida albicans, gram negative bacteria. ○ Affects joints, skin, brain, serious surfaces, and
○ Enter blood system thru: dental (most common), heart.
UTI, cardiac catheterization, surgery, etc. ● Risk factors:
○ Organism in endocardium → vegetations ○ Age and sex: (5-15 years old) female.
(verrucae) → fibrin deposits → Platelet thrombi ○ Housing and socioeconomic status.
→ invade adjacent tissues (mitral/aortic valves) ○ Season: rainy season.
→ breaks off and embolize elsewhere (spleen, ○ Genetic predisposition.
kidney, CNS) → death. ● CLINICAL MANIFESTATIONS
● DIAGNOSTICS ○ Acute febrile-like illness (2-3 weeks after
○ Based on clinical manifestations. streptococcal throat infection).
○ Blood c/s: definitive diagnosis. ○ Non-specific
○ ECG/CXR (cardiomegaly). ■ Fever
○ Increased ESR, increased WBC, anemia, ■ Joint pain
microscopic hematuria. ■ Loss of appetite
○ 2D-echo-vegetations, valve function. ■ Muscle ache

NCMA219: CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC) LESSON 12: CARDIOVASCULAR DISORDERS OF CHILDREN 3
 NCMA219
LESSON 12: CARDIOVASCULAR DISORDERS OF CHILDREN
WEEK 11 I SECOND YEAR, SECOND SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS
Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN
Transcribed by: ASHLEY G. IGLESIAS, SN I BSN 2-Y2-6 I OLFU - VAL

● DIAGNOSTIC APPROACH: MODIFIED JONES CRITERIA lability and muscle

○ 2 major or 1 major + 2 minor manifestations + weakness.
strep infection. ● Worse with anxiety and
○ MAJOR relieved by rest.
■ CARDITIS - tachycardia out of ○ MINOR
proportion to degree of fever. ■ Arthralgia
● Cardiomegaly, murmur, ■ Fever
muffled heart sounds. ● WHAT IS ARTHRALGIA?
● Pericardial friction rub, ○ Arthralgia is
pericardial pain, changes in basically a medical
ECG. term for joint pain.
● Involves endocardium, It can affect any
pericardium, and joint in a person’s
myocardium. body, including the
○ Most commonly hips, shoulders,
the mitral valve. elbows, wrists,
■ POLYARTHRITIS hands, knees,
● Arthritis is reversible and ankles, and fever.
migrates, especially in large ● LABORATORY
joints (knees, elbow, hips, ○ Increased ESR, CRP
shoulders, wrists). ■ Supporti
● Swollen, hot, red, painful ng
joints, after 1-2 days → evidence
affects different joints. of
■ ERYTHEMA MARGINATUM antecede
● Rash nt group
● Transitory, proximal position A Strep
of extremities. infection.
● Red macule with clear center ○ Throat c/s, rapid
wavy, well-dermacated Ag test.
border. ○ ASO titer (most
■ SUBCUTANEOUS NODULES reliable - 80%
● Small nontender nodules. children)
● Bony prominences - hands, ○ antiDNAse, ESR,
feet, elbows, scalp, scapulae, CRIP
vertebrae ○ ECG, CXR –
● Persistent indefinitely after evidence of heart
onset of the disease and involvement.
resolve with no resulting ■ TREATMENT
damage. ● STEP 1 — PRIMARY
■ ST. VITUS DANCE - THE FIFTH PREVENTION OF RHD
MANIFESTATION (SYDENHAM’S ○ Eradication of
CHOREA) streptococci.
● St. Vitus Dance (aka, chorea) ○ Treatment of
reflects CNS involvement. streptococcal
● Definition: chorea refers to tonsillitis/pharyngi
sudden, aimless movements tis.
of extremities, involuntary ■ Penicillin
facial grimaces, speech G
disturbances, emotional (parenter

NCMA219: CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC) LESSON 12: CARDIOVASCULAR DISORDERS OF CHILDREN 4
 NCMA219
LESSON 12: CARDIOVASCULAR DISORDERS OF CHILDREN
WEEK 11 I SECOND YEAR, SECOND SEMESTER - MIDTERMS | A.Y. 2023-2024 I COLLEGE OF NURSING - VALENZUELA CAMPUS
Discussed by: DR. CARMENCITA R. PACIS, PhD, MAN, RN
Transcribed by: ASHLEY G. IGLESIAS, SN I BSN 2-Y2-6 I OLFU - VAL

al) — IM KAWASAKI DISEASE

x1
● Mucocutaneous LN syndrome.
■ Penicillin ● Acute systemic vasculitis.
V (oral)
● < 5y/o (peak: toddlers).
— oral x
● Self limiting but 20% children without treatment develop
10 days. cardiac disease.
■ Erythrom ● Etiology: unknown.
ycin (if
allergic
to
above)
— oral x
10 days.
● STEP 2 –
● Area involved: CVS
ANTI-INFLAMMATORY
○ Initially: inflammation arterioles, venules,
TREATMENT
capillaries → formation coronary artery
○ Salicylates (ASA) -
aneurysm.
control
○ Death: result of coronary thrombosis or severe
inflammatory
scar formation & stenosis of main coronary
process esp. Joints,
artery.
dec fever and
○ Myocardial infarction from thrombosis.
discomfort.
● No specific diagnostic test.
● STEP 3 – SUPPORTIVE
○ IRRITABILITY – hallmark of kawasaki disease.
MANAGEMENT
○ Persists in 2 weeks.
○ Bed rest - during
● TREATMENT
febrile phase but
○ Intravenous immune globulin (IVIG) infusion –
need not be strict.
10-12 hours (7-10 days from onset)
● STEP 4 – PREVENTION OF
○ Diphenhydramine — reduce risk for allergic
RECURRENT ATTACKS
reaction to IVIG.
○ Treatment of
○ Aspirin.
recurrent RF.
● Help family adjust to the disorder.
○ Should be followed
● Educate family.
medically x5 years
● Help family cope with effects of the disorder.
at least.
● Prepare child and family for surgery.
● Most common complication of RF.
● Damage to valves leading to stenosis or regurgitation with
resultant hemodynamic disturbance.

NCMA219: CARE OF MOTHER AND CHILD AT RISK (ACUTE AND CHRONIC) LESSON 12: CARDIOVASCULAR DISORDERS OF CHILDREN 5