Chapter 23: Cardiovascular Dysfunction in Children

Cardiovascular Dysfunction in Children begins by outlining the essential components of a pediatric cardiac assessment, including history taking and physical examination techniques to detect murmurs, cyanosis, and other signs of cardiac compromise. Diagnostic procedures are detailed with a specific focus on the nursing management of children undergoing cardiac catheterization, emphasizing pre-procedural preparation and critical post-procedural monitoring for hemorrhage and vascular integrity. The text delves deeply into the hemodynamic classification of congenital heart defects, categorizing them into lesions with increased pulmonary blood flow such as atrial septal defects (ASD), ventricular septal defects (VSD), and patent ductus arteriosus (PDA); obstructive defects like coarctation of the aorta and aortic stenosis; defects with decreased pulmonary blood flow including Tetralogy of Fallot and tricuspid atresia; and mixed defects such as transposition of the great arteries and hypoplastic left heart syndrome. Significant attention is given to the clinical consequences of these defects, specifically congestive heart failure (HF) and hypoxemia. Management strategies for HF are thoroughly explored, covering pharmacological interventions with digoxin, ACE inhibitors, and diuretics, alongside nursing measures to decrease cardiac demands and maintain nutritional status. The chapter also addresses the management of hypoxemia, describing the physiology of cyanosis, polycythemia, and the emergency treatment of hypercyanotic or Tet spells. Beyond congenital anomalies, the discussion extends to acquired cardiovascular disorders, including the pathophysiology and prevention of infective endocarditis and the inflammatory progression of acute rheumatic fever following streptococcal infections. A major section is dedicated to Kawasaki disease, detailing its diagnostic criteria, the risk of coronary artery aneurysms, and therapeutic management with intravenous immunoglobulin (IVIG) and aspirin. Additional topics include the management of cardiac dysrhythmias like supraventricular tachycardia (SVT), pediatric hypertension screening and management, pulmonary hypertension, and cardiomyopathies. The chapter concludes with a critical examination of circulatory failure, defining the stages of shock (compensated and hypotensive), septic shock, and anaphylaxis, while outlining emergency resuscitative measures to restore oxygenation and perfusion.