Classification According to Size - born after 42 weeks Week 20 - start of surfactant production

● Low-birthweight (LBW) infant and storage

- less than 1500 g (3.3 pounds) - Birth in which the neonate manifests any Week 28-32 - maximal production of
● Extremely low–birth weight (ELBW) heartbeat breathes or displays voluntary surfactant and appears in
- less than 1000 g (2.2 pounds) movement amniotic fluid
● Appropriate-for-gestational-age (AGA) ● Fetal death
Week 34-35 - mature levels of surfactant in
- weight falls between the 10th and 90th - Death fetus after 20 weeks lungs
percentiles - absence of any signs of life before delivery
● Small-for-date (SFD) or small-for- ● Neonatal death Quality amounts produced or released
gestational-age (SGA) - occurs in the first 27 days of life; may be insufficient to meet
postnatal demands because of
- birth weight falls below the 10th percentile - early neonatal death - first week of life immaturity.
● Intrauterine growth restriction (IUGR) - late neonatal death - 7 to 27 days.
- Found in infants whose intrauterine growth ● Perinatal mortality Clinical manifestation
is restricted - Total number of fetal and early neonatal ● Tachypnea
● Symmetric IUGR deaths per 1000 live births ● Nasal flaring
- Growth restriction in which the weight, ● Intercostal, sternal recession
length, and head circumference are all RESPIRATORY DISTRESS SYNDROME (RDS) ● Grunting; closure of glottis during
affected - disease related to developmental delay in expiration.
● Asymmetric IUGR lung maturation. ● Cyanosis
- Growth restriction in which the head - seen almost exclusively in preterm infants. Management of Respiratory Distress
circumference remains within normal - Pneumonia in the neonatal period may ● Monitoring
parameters result in respiratory distress ● Supportive
- birth weight falls below the 10th percentile Symptoms of RDS - IV fluid - Maintain vital signs.
● Large-for-gestational-age (LGA) ● blue-colored lips, fingers, and toes - Oxygen therapy
- above the 90th percentile ● rapid, shallow breathing ● Respiratory support
● flaring nostrils Initial Care
Classification According to Gestational Age ● a grunting sound when breathing ● Maintain warmth
● Preterm (premature) infant Etiology and Pathophysiology - cold stress will mimic other causes of
- born before completion of 37 weeks - Surfactant deficiency distress.
● Full-term infant - Low levels of surfactant cause high surface ● Monitor blood glucose levels
- born beginning 38 weeks and the tension - Assure they are normal.
completion of the 42 weeks - High surface tension makes it hard to ● Provide enough oxygen
● Late-preterm infant expand the alveoli. - to keep the baby pink
- born between 34 and 36 weeks
● Post-term (postmature) infant
MECONIUM ASPIRATION SYNDROME (MAS) ● Amnioinfusion - Continue respiratory care: Oxygen
- Is respiratory distress in a newborn who - relieved umbilical cord compression during saturation ( 90-95%) should be maintained.
has breathed(aspirated) meconium into the labor -> reducing the occurrence of - treated with antibiotics because of the risk
lungs before or around the time of birth. variable fetal heart rate decelerations - of infection
Causes of MAS efficiency not well demonstrated. ● Supportive treatment
● Hypoxia in distressed baby Delivery room management - IV Dextrose to prevent hypoglycemia.
● Meconium Stained Liquor ● Immediate Management - Fluid restriction (60-70 mL/kg/d) to prevent
● Uterine Infections baby is not vigorous: cerebral and pulmonary edema
● Difficulty during the labor process - Suction the trachea immediately after Treatment
● passage of meconium from the fetus into delivery (no longer than 5s) ● Surfactant Therapy
amnion - no meconium is retrieved - do not repeat - Replace displaced or inactivated surfactant
● Vagal Stimulation intubation and suction. and as a detergent to remove meconium
- increased peristalsis and a relaxed anal - meconium is retrieved and no - May decrease respiratory failure with MAS
sphincter. bradycardia is present - reintubate and within 6 hrs of 3 doses.
● Fetal maturation (post-term) suction. ● Extracorporeal membrane (ECMO)
- causes a high motilin level increased - heart rate is low - administer positive - oxygenation is the last option focused on
peristalsis pressure ventilation, and consider the function of oxygenation and CO2
Symptoms include the following: suctioning again later. removal.
● Cyanosis baby is vigorous: - anesthesia used for longer-term support
● End-expiratory grunting - Do not electively intubate ranging from 3-10 days
● Nasal flaring - Clear secretions and meconium from the - Survival rate 93-100%
● Breathing problems like( difficulty in mouth and nose with a bulb syringe or a
breathing, no breathing, and rapid large- bore suction catheter. NEONATAL SEPSIS (NS)
breathing) - Dry, stimulate, reposition, and administer - defined as a clinical syndrome of
● Intercostal retractions oxygen as necessary. bacteremia with systemic signs and
● Tachypnea - Transfer ill newborns with respiratory symptoms of infection
● Barrel chest in the presence of air trapping distress to NICU - first four weeks of life.
● Auscultated rales and rhonchi ( in some ● General management Etiology
cases). - Continued care in the neonatal ICU (NICU) ● Escherichia coli.
● Yellow-green staining of fingernails, - Maintain an optimal thermal environment ● Group B Streptococci.
umbilical cord, and skin may be observed. - Minimal handling to reduce agitation thus ● Listeria monocytogenes.
pulmonary hypertension and R to L ● Others:
Management of MAS Prenatal: shunting ● Coagulase-negative staphylococci.
● Identification of high-risk pregnancies - Insert the umbilical artery to monitor blood ● Streptococcus pneumoniae.
● Monitoring pH and blood gases without agitating the ● Klebsiella pneumoniae.
- careful observation and fetal monitoring infant. ● Acinetobacter species.
during labor ● Pseudomonas aeruginosa.
 ● Candida. - Decreases, a late sign, and non-specific. - Metabolic: Correct hypo-/hyperglycemia
Classification Cultures: and metabolic acidosis.
● Early-onset sepsis ● Blood Prevention
- (birth to 7 days) - Confirms sepsis. 1. Good antenatal care.
- transplacental, ascending, or intrapartum. ● Urine 2. Maternal infections were diagnosed and treated
● Late-onset sepsis ● CSF early.
- (8 to 28 days - May be useful in clinically ill newborns or 3. Babies should be breastfed early.
- acquired in a hospital, home, or community those with positive blood cultures. 4. Infection control policies applied in the unit.
Clinical Features Radiology:
● Respiratory distress ● Chest X-Ray HYPERBILIRUBINEMIA
- in early-onset NS. - For infants with respiratory symptoms. - refers to an excessive level of accumulated
● Altered feeding behavior ● Renal ultrasound: bilirubin in the blood
- in a well-established feeding newborn - For infants with accompanying UTI. - above 12.9 mg/100mL for formula feed
(aspiration, vomiting, etc.). ● CT scan infants
● Active baby suddenly or gradually - For infants with probable meningitis or - above 15 mg/100 mL for breastfed infants
becomes lethargic, inactive or seizures. and Premature)
unresponsive, and refuses to suckle. Treatment and Management Characteristics of Hyperbilirubinemia
● Temperature instability ● Antibiotics: ● yellowish discoloration of the skin, sclerae,
- Hypo- or hyperthermia. - based on culture & sensitivity and nails.
● Skin - combination of ampicillin and an Pathophysiology
- Poor peripheral perfusion, cyanosis, pallor, aminoglycoside (usually gentamicin) for 10 - RBCs are destroyed, the breakdown
petechiae, rashes, or jaundice. to 14 days is an effective treatment against products are released into the circulation
● Metabolic most organisms responsible for early-onset - Hemoglobin splits into two fractions: heme
- Hypo- or hyperglycemia or metabolic sepsis. and globin.
acidosis. - combination of ampicillin and cefotaxime - body uses the globin (protein) portion
Diagnosis also is proposed as an alternative method - heme portion is converted to unconjugated
Non-specific: of treatment. bilirubin, an insoluble substance bound to
● White blood cell count and differentia - If meningitis is present, the treatment albumin.
- Neutropenia can be a threatening sign (< should be extended to 21 days or 14 days - In the liver, the bilirubin is detached from
1,800/cm). after a negative result from a CSF culture. the albumin molecule. In the presence of
- Immature to Total neutrophil (I:T) ratio ≥ ● Supportive therapy the enzyme glucuronyl transferase, it is
- Respiratory: Oxygen and ventilation as conjugated with glucuronic acid to produce
0.2 is predictive (Normal: ˂ 0.16). necessary. a highly soluble substance, conjugated
● Acute phase reactants - Cardiovascular: Support blood pressure bilirubin, then excreted into the bile.
- C-Reactive Protein (CRP): rises early. with volume expanders. - In the intestine, bacterial action reduces
- ESR rises > 15 mm 1 st hr. - Hematologic: Treat DIC. the conjugated bilirubin to urobilinogen, the
● Platelet count: - CNS: Treat seizures with phenobarbital.
 pigment that gives stool its characteristic ● Using a skin temperature probe SUDDEN INFANT DEATH SYNDROME (SIDS)
color. ● Prevent Infections - sudden unexplained death of a child of
- Most of the reduced bilirubin is excreted ● Provide Phototherapy less than one year of age
through the feces; a small amount is ● Meet the infant's emotional needs - also known as cot death or crib death.
eliminated in the urine. ● Reinforce Physician's teaching to parents - usually occurs during sleep; typically,
- Normally, the body can balance the and allow parents to express concerns and - between the hours of 00:00 and 09:00.
destruction of RBCs and the use or feelings - usually no noise or evidence of a struggle.
excretion of byproducts. ● Monitor Exchange Transfusion. - tends to occur at a higher-than-usual rate
- when developmental limitations or a in infants of adolescent mothers, infants of
pathologic process interferes with this ERYTHROBLASTOSIS FETALIS closely spaced pregnancies, and
balance, bilirubin accumulates in the - destruction of Red Blood Cells that results underweight and preterm infants.
tissues to produce jaundice. from an Antigen-Antibody reaction and is Factors that place infants at high risk for SIDS:
- Anemia caused by this destruction - characterized by Hemolytic Anemia and or ● prone sleeping position
stimulates RBC production, which provides Hyperbilirubinemia ● soft bedding,
increasing numbers of cells for hemolysis. Diagnosis ● sleeping in a noninfant bed with an adult or
- Major causes of increased erythrocyte ● Indirect Coombs' test older child
destruction are isoimmunization (primarily - If there are antibodies present in your ● environmental exposure to smoking.
Rh) and ABO incompatibility. blood stream that should attach to RBC
Possible causes of hyperbilirubinemia in ● Directs Coombs' test Factors that are protective for SIDS
newborns are: - Detect antibodies that are stuck in the ● supine sleep position
● Physiologic (developmental) factors surface of RBC ● Breastfeeding
(prematurity) - These antibodies sometimes destroy RBC ● pacifier use at bedtime and naptime,
● An association with breastfeeding or breast and cause anemia ● updated immunization status.
milk ● Spectrophotometric Analysis of
● Excess production of bilirubin Amniotic fluids Nursing Responsibilities
● The disturbed capacity of the liver to - Scan fluid that increasing wavelengths ● Educating the family of newborns about the
secrete conjugated bilirubin Assessment risks for SIDS
● Combined overproduction and under ● Assess anemia ● modeling appropriate behaviors in the
secretion (e.g., sepsis) ● Assess for Jaundice hospital, such as placing the infant in a
● Genetic predisposition to increased ● Evaluate edema supine sleep position
production Nursing Interventions ● providing emotional support of the family
Nursing Implementation ● Administer immunization against hemolytic who has experienced a SIDS loss.
● Observe infant for signs of increased disease with RhoGAM as ordered
jaundice ● Monitor exchange transfusion after birth or PEDIATRIC CARDIOLOGY
● Observe for and prevent acidosis ● Intrauterine transfusion. ● Acyanotic = left-to-right
● Maintain adequate hydration and offer ● Follow interventions for Hyperbilirubinemia ● Cyanotic = right-to-left
fluids between feeding as ordered.
NOTE: All left-to-right shunts have the potential to - most diagnosed CHD - Tissue: decreased rejection rate
revert to right-to-left shunts due to increasing - May be single or multiple (commonly used)
pulmonary congestion (Eisenmenger’s syndrome). - May be associated with other lesions - Normal microflora → less inflammatory
Signs and Symptoms
Investigation of suspected heart defect ● Holosystolic murmur response → decreased rejection rate
- diagnosed prenatally @ 16-20 weeks ● May have thrill or diastolic rumble - Obtained in other parts of the body with the
- Some defects don’t emerge until several ● Fatigue same tissue integrity (usually from the
- d/t mixing of unoxygenated and heart)
days or weeks have passed since birth due oxygenated blood - A scintillation camera is inserted for
to transition of circulation → adult levels of ● Failure to thrive visualization with a fiber optic scope to
- Slow progress of development) disintegrate/scrape the tissue to be used
pulmonary vascular resistance - d/t poorfeeding - tissue is rejected - surgery is repeated
- usually have symptoms within 24 hours ● Dyspnea on exertion (e.g., until compatibility
- increased demand for oxygen during - Plastic: increased rejection rate
Four Classification of CHD activities but if there is a mixing of blood, - Only used when the tissue type is not
● Increased Pulmonary Blood Flow (L-R) there is insufficient oxygen effective or rejection occurs
- Atrial Septal Defect - Leading to exercise/activity intolerance - Immunosuppressant therapy - given to
- Ventral Septal Defect - If during breastfeeding: Brow sweats d/t prevent rejection
- Atrioventricular Canal Defect too much exertion of effort - no rejection in the dacron patch, s/sx of
- Patent Ductus Arteriousus septal defect should diminish after a few
● Defect Obstruction to Blood Flow Management weeks
- Pulmonary Stenosis ● Most will get smaller and disappear on
- Aortic Stenosis their own ATRIAL SEPTAL DEFECT
- Coarctation of the Aorta ● Surgical repair indicated for intractable - Acyanotic type
● Defects with Mixed Blood Flow (O2 and CHF, failure to Thrive Surgery: - Most common in girls
UnO2) ● Palliative 3 types of ASD
- Transposition of Great Arteries - pulmonary artery banding ● Ostrium Primum (ASD1)
- Total Anomalous Pulmonary Venous ● Complete repair - opening is in the lower end of the septum
Connection - Knitted Dacron Patch is sutured over the ● Ostrium Secundum (ASD2)
- Truncus Arteriousus opening via cardiopulmonary bypass - opening is near the center of the septum
- Hypoplastic Left Heart Syndrome ● Medications ● Sinus Venosus Defect
● Defects with Decreased Pulmonary - Digoxin - opening near junction of the superior vena
Blood Flow - Diuretics cava and right atrium
- Tricuspid Atresia Signs & symptoms
- Tetralogy of Fallot Dacron patch ● asymptomatic unless there are other
- Implantable consumables in cardiac defects
VENTRICULAR SEPTAL DEFECT surgery ● R heart failure
 ● Pulmonary edema PATENT DUCTUS ARTERIOSUS (PDA) - Only if not managed by medication
● Increased pulmonary vasculature - Failure of ductus arteriosus to close
● Mid systolic pulmonary flow or ejection - within the first week of life PULMONARY STENOSIS
murmur accompanied by a fixed split S2 - Acyanotic - Narrowing of the pulmonary valve or
● Harsh systolic murmur - lifespan varies on how the size of patency pulmonary artery just distal to the valve
● Dyspnea and the urgency of treatment - occurs due to abnormal development of
- w/ feeding and frequent respiratory Signs and Symptoms the prenatal heart
infections ● Machinery-like murmur - first eight weeks of pregnancy.
● Decrease CO - (pathognomonic sign/ hallmark - component of half of all complex congenital
- Tachycardia, cool skin manifestation) heart defects.
- Delayed capillary refill - distinguishing characteristic
- AV node involvement may result in ● Signs and symptoms of heart failure Symptoms of pulmonary stenosis
arrhythmias - especially if not managed ● symptoms are mild
Management ● Poor feeding - pulmonary stenosis may never require any
● Refer to pediatric cards for echo - Mode of feeding is sucking treatment.
● Small defects in boys - they need an enormous amount of oxygen - may have few or no symptoms, or perhaps
- don’t need closure if RV size is normal. but there is a mixing of blood resulting in none until later in adulthood.
● Surgery insufficient oxygenation ● severe pulmonary stenosis
- done bet 2 and 3 years of age, - PDA has decrease in O2 → poor sucking → - will need a procedure to fix the pulmonary
- Dacron or Silastic patch is sutured into valve so blood can flow properly through
place for occlusion poor feeding → poor weight gain the body.
● Non-Surgical ● Fatigue - could be quite ill, with major symptoms
- cardiac catheterization - Poor feeding d/t easy fatigability noted early in life.
- Easily fatigued during crying Pathophysiology
ATRIOVENTRICULAR CANAL DEFECT ● Poor weight gain - problems with the pulmonary valve make it
- Also called as endocardial cushion - d/t poor feeding harder for the leaflets to open and permit
defect - Weight - primary indicator of health in blood to flow forward from the right
- Incomplete fusion of endocardial cushions newborn ventricle to the lungs in a normal fashion.
- Associated with Down’s Syndrome - Ideal birth weight ; 6 months: double birth - A valve that has leaflets that are partially
Management: weight ; 1-year-old: triple birth weight fused together.
● Palliative Management - A valve that has thick leaflets that do not
- Pulmonary artery banding ● Indomethacin open all the way.
● Surgery - facilitate closure of PDA (DOC) - The area above or below the pulmonary
- Patch closure of the septal defects ● HOBE valve is narrowed.
- Reconstruction of the AV valve / valve - promote lung expansion
replacement ● Surgery Types of Pulmonary Stenosis:
- (bypass) is rare ● Valvar pulmonary stenosis
 - valve leaflets are thickened and/or - Obstructive Narrowing of the aorta once in place, the balloon is inflated to
narrowed (descending aorta)
● expand the stent and dilate the aorta→
Supravalvar pulmonary stenosis. - Narrowing aorta → increase pressure →
- The pulmonary artery just above the once expanded, the balloon is deflated for
pulmonary valve is narrowed decrease in output
● Subvalvar (infundibular) pulmonary Signs and Symptoms withdrawal while the stent stays in place
stenosis ● Different vital signs in the upper extremities - stent prevents the aorta from narrowing
- The muscle under the valve area is and lower extremities again because it acts as a support
thickened, narrowing the outflow tract from - upper extremities are proximal to the heart - Has low probability for rejection; made of
the right ventricle - increased pressure, synthetic plastic or wire
● Branch peripheral pulmonic stenosis - lower extremities are distal to the heart - Only replaced if damaged or dislodged
- The right or left pulmonary artery is where the output is decreased ● Before surgery
narrowed, or both may be narrowed - stable VS
UPPER LOWER - no underlying conditions
AORTIC STENOSIS EXTREMITIES EXTREMITIE
- Narrowing or stricture of the aortic valve S
TRANSPOSITION OF THE GREAT ARTERIES
Clinical Manifestations: BP Increased Decreased (TGA)
● Infants - Cyanotic
PULSE Bounding Weak/absent
- Decrease CO w/ faint pulses - Aorta and pulmonary trunk are switched
- Hypotension, tachycardia ● Rib notching - deoxygenated blood gets pumped through
- Poor feeding - heartbeat can be seen in the rib cage area the aorta to systemic circulation
● Children - d/t the narrowed aorta which causes the - oxygenated blood gets pumped through
- Sign of exercise Intolerance heart to compensate by increasing its the pulmonary artery back through the
- Chest pain, dizziness when standing for a workload lungs
long period of time - Mas malakas na rib notching, mas - Aorta arises from the R ventricle instead of
- Murmur narrowed ang aorta the left
MANAGEMENT Management - pulmonary artery arises from the L instead
● Beta blocker or calcium channel blocker ● Balloon angioplasty with coronary of the right
- to reduce hypertrophy before correction stenting - Detected with a low APGAR score and 2D
● Balloon valvuloplasty - “Repair of aorta using balloon” echo
- surgery of choice - Stent: scaffold/ support; made up of mesh Mechanism:
(superfine screen) - right ventricle is connected to the aorta
COARCTATION OF THE AORTA - Balloon angioplasty: repair of an artery - left ventricle is connected to the
- Narrowing of the descending aorta, usually using a balloon pulmonary artery
just below the aortic arc - The balloon is deflated while inserting it to - PDA is kept open to allow the mixture of
- Usually have other congenital lesions blood PDA keeps the patient alive
(Bicuspid Aortic Valve and VSD) the narrowed aorta together with the stent→
 - Unoxygenated blood is deposited into the - One major artery or trunk arises from the blood to the heart → giving sufficient time
body left and right ventricles in place of a
Signs and Symptoms separate aorta and pulmonary artery for the heart to relax
● Severe respiratory depression - usually accompanied by VSD - There will be difficult venous return from
● Cyanosis the lower extremities d/t hip flexion
- A sign of ineffective tissue perfusion HYPOPLASTIC LEFT HEART SYNDROME - The O2ed blood should be concentrated in
● Failure to thrive - Underdeveloped left side of the heart the upper body because the vital organs
● Easy fatigability - lacks adequate strength to pump blood into are there– lungs, brain, and heart
● No murmur even if there is PDA the systemic circulation, - Squatting is a compensatory mechanism
- d/t incomplete pressure of the heart - causing R ventricle to hypertrophy - Tripod position - sitting on a chair and
because of transposition of the two major - Increased pressure on the R side of the leaning on a table
blood vessels (no compression) heart, UnO2 blood is shunted to the left - Squatting - knee chest position
Management side through the foramen ovale - not done throughput the day; only when
● Prostaglandin E there's difficulty of breathing
- maintains/keeps PDA open TRICUSPID ATRESIA ● infants, position
● Surgery: Arterial switch - completely closed, allowing no blood flow - Lying down with head slightly elevated
- (the connection is corrected to achieve the from the R atrium to the R ventricle - To promote lung expansion
normal structure of the heart) - instead blood crosses through the patent ● Tet spells
- Done during the first week of life foramen ovale into the left atrium - Group of signs and symptoms that depicts
(performed in a live client) bypassing the lungs and the step of lack of oxygenation
● Supportive management oxygenation ● Pathognomonic sign/ hallmark
- Oxygen therapy manifestation of TOF
- Vitals signs monitoring TETRALOGY OF FALLOT - Irritability
- WOF signs and symptoms of heart failure - most common cyanotic heart defect - Pallor
- Notify the physician if difficulty of breathing Manifestations - Blackouts (fainting spells)
● Cyanosis (blue babies) - Convulsions (d/t lack O2 in the brain) →
TOTAL ANOMALOUS PULMONARY VENOUS - (+) cyanosis of the lower extremities
CONNECTION - Higher unO2ed blood than O2ed blood cerebral hypoxia
- Very rare defect ● Squatting ● Cardiomegaly
- Failure of pulmonary vein to join left atrium, - Decreases venous return to the heart→ - d/t overworking
instead, connected to right atrium or ● Clubbing
superior vena cava relax the heartConserves oxygenated - One of the main symptoms
- Absent spleen is often associated with this blood in the upper body area - Spoon-shaped fingernails d/t
disorder compensation of capillaries (enlargement)
- Cutting the circulation in the lower - Represents chronic hypoxia
TRUNCUS ARTERIOSUS extremities → decreasing the return flow of
- Rare defect
 - Also seen in IDA d/t lack of iron → RBC - Insertion of Dacron patch (closing of the - The pressure in the right side of the heart
VSD) - This will also resolve the overriding
have no enough O2 → hypoxia aorta is increased → backflow in the jugular vein
● Pansystolic murmur → bulging
- Every contraction of the heart (+) murmur HEART FAILURE
● Hepatomegaly
because of numerous holes in the heart - A condition where the heart fails to contract
- liver is sensitive to changes in
(VSD) to pump blood out of the heart
oxygenation)
Diagnostics - Insufficient ↓CO to oxygenate the different
● 2D echo - ↑pressure in the liver→ portal HTN→
- boot-shaped heart will be seen organs
destruction of the liver
Medical Management Types of HF
● Ascites
Surgery ● RSHF
- Fluid accumulation in the abdominal area
● Palliative surgery (Blalock-Tausig - manifestations is systemic
- d/t fluid retention and portal HTN
shunt) - Damaged right ventricle → right atrium → ● Body weakness & Anorexia
- Relieve signs and symptoms
- goal is to increase oxygenated blood than goes back to system → systemic - Nausea d/t bloating→ ↓appetite to eat
oxygenated blood manifestations (RSHF) Signs and Symptoms ( RSHF )
- Anastomosis of the pulmonary artery and ● Dyspnea on exertion
● LSHF
the aorta using the subclavian artery - Difficulty of breathing especially during
- manifestations are pulmonary
- The subclavian is part of the aorta, it will activity
not be harvested it will only be rerouted - Damaged left ventricle → blood goes back ● Orthopnea
and connected to the left atrium → lungs → lung - Difficulty of breathing especially in a lying
- Blood that passes through the VSD may
manifestations (LSHF) position→ when lying down, lung expansion
be allowed to pass through the aorta→ Signs and Symptoms ( RSHF ) is not maximal
subclavian artery connected to the aorta→ ● peripheral edema/ dependent/ pitting
- Should be placed on a semi-fowler’s
edema (+) indentation
lungs position
- D/t fluid retention, blood is not circulating ● Crackles or rales
● Curative surgery (Intracardiac surgery/
Brock’s procedure) well→ fluids are also not properly - d/t fluid retention
- Fluid located inside the lungs are heard
- Treats the disease condition circulated→ extravasation→ edema - Gurgling sounds
- Balloon angioplasty (to widen the ● Weight gain ● Cough reflex
pulmonary stenosis) - This will also resolve - d/t fluid retention - Fluids in the lungs will trigger the cough
● Distended neck veins (JVD) reflex
the RVH d/t ↓workload VSD will no longer ● Tachycardia
be needed to relieve the pressure
 - early stages - attempt to compensate for - V- visual disturbances (halos) and vomiting Major Manifestations (Jones Criteria)
the lung failure and decrease of - D- diarrhea ● Carditis
oxygenation - A- abdominal cramps - Inflammation of the walls of the heart
- long term - bradycardia will occur d/t - If one or two appear, stop administration, - d/t the presence of a bacteria
fatigue and will stop - digibind (digoxin immune fab) will be given ● Erythema marginatum
Diagnostics as an antidote to digoxin toxicity - Rashes of the trunk
● Chest x-ray ● U- urine I/O monitoring ● Subcutaneous nodules
- (+) cardiomegaly d/t overworking - D/t fluid retention - over bony prominences
● 2D echo ● R- record daily weight ● Chorea
- hypokinetic heart (slow contraction of the - determine if edema worsens - sudden involuntary movements
heart that will present in the latter stages) - Same time, clothes, weighing scale, and ● Polyarthritis
● Pulse oximetry patient - inflammation of more than one joint
- decreased O2 saturation - Done early in the morning Management
- d/t decrease in tissue perfusion ● E- edminister diuretics ● penicillin
● PCWP (pulmonary capillary wedge - decrease retained excess fluids in the body - A broad-spectrum antibiotic that can kill
pressure) - relieve pulmonary edema both gram-negative and gram-positive
- Measures the pressure in the left side of bacteria
the heart RHEUMATIC HEART DISEASE - Given 5-10 days and duration should be
- Determines LSHF - Tachycardia – 1st sign, attempts to beat finished,
● CVP (central venous pressure) faster, to move blood forward - Administered via IV
- Connected to the RA, therefore, measures - Apical heart beat displaced laterally and - If (+) allergy to penicillin, erythromycin, or
pressure in the right side of the heart downwards clindamycin may be given
- Determines RSHF - Lower extremity edema – late sign in - If (+) exacerbation and remission
Management (FAILURE) children (manifestations become more severe)
● F- fowler’s position - An infectious heart disease ● Salicylates (ASA- acetylsalicylic acid)
- To allow maximizing lung expansion that - Caused by GABHS (group-A beta- - Aspirin
will enhance circulation and oxygenation hemolytic streptococcus) Four As of aspirin
● A- administer high O2 - Causes sore throat and AGN (acute - Antiplatelet aggregate
- Using venturi mask that delivers precise glomerulonephritis) - Antipyretic
and accurate oxygen delivery Minor Manifestations - Analgesic
● I- inotropic drugs ● Prolonged PR interval - Anti-inflammatory
- Strengthens the heart’s contraction to ● History of rheumatic fever - Given for pain and swelling
increase the cardiac output ● Fever Side Effect
● L-Lanoxin or digoxin ● Elevated ESR - WOF: s/sx of bleeding
- Digoxin toxicity ● Leukocytosis ● Corticosteroids
- N- nausea ● Arthralgia - relieve carditis (inflammation)
- A- anorexia - severe joint pain
KAWASAKI DISEASE - Only localized in the palms
- Very common in children especially in the - Shedding of skin on the palms Management
newborn - blood vessels in the hands are small, ● Prophylactic antibiotic
- Acute febrile illness of unknown cause inflammation will decrease circulation in - for children w/ CHD
which may result in obstruction, stenosis or the hands causing the death of cells in the ● Antibiotic and therapy
aneurysm formation of the arteries. hand leading to shedding - for underlying infection
- Common in children of Asian decent. Management ● Long-time follow up care
Involves two disease conditions: ● Immunoglobulins - to prevent recurrence
● Mucocutaneous lymph node syndrome - to enhance and activate the immune
- affectation of the immune system response
● Multisystemic vasculitis - Children with Kawasaki disease have weak
- inflammation of the blood vessels immune systems
specifically affecting the cardiovascular ● Aspirin
system - Low dose only
Manifestations - To address high spiking fever,
● High spiking fever inflammation, and serves as an analgesic
- d/t affectation of the lymph nodes that ● Clear liquid diet
alters the immune system (erratic) - allow monitoring bleeding in the stools
- sharp increase in temperature - Avoid dark-colored foods
- hypothalamus is having difficulties in - Clear liquids do not contain milk and are
regulating the temperature determined according to opacity to light
● Strawberry red tongue (pathognomonic - If light passes through it, it is considered a
sign) clear liquid
- D/t multisystemic vasculitis ● CPR
- tongue is rich in blood vessels - Children tend to develop coronary artery
● Photophobia/ photosensitivity
- retina is composed of the minute blood diseases→ at risk for cardiac arrest
vessels
- Dark-colored glasses are advised to be ENDOCARDITIS
worn - Inflammation and infection of the
- Large-brimmed hats endocardium or valves of the heart.
- Sun visors - Common complication of congenital heart
● Polymorphous rash diseases (TOF, VSD, COA)
- Rashes of different shapes - Caused by streptococcal infections that
- d/t inflamed vessels that can rupture and invade the body at the time of oral surgery,
extravasate in the skin urinary infection, or skin infection
● Palmar desquamation (impetigo)