1. Chapter 37 The Child with a Cardiovascular/Hematologic Disorder

2. The Child with Cardiovascular/Hematologic Disorders
Growth and development of the cardiovascular and hematologic systems
Usually serious
May be chronic or long-term conditions
Differences between child’s and adult’s systems

3. Congestive Heart Failure
Clinical manifestations
Infants: Tachycardia; easy fatigability (feeding problems); respiratory symptoms; difficulties from lying flat; periorbital edema; rapid weight gain
Older children: Failure to gain weight; weakness; fatigue; restlessness; irritability; pallor; tachypnea; dyspnea
Diagnosis
Treatment: Medications; oxygen administration; limited physical activity

4. Congestive Heart Failure (cont.)
Nursing process for the child with congestive heart failure
Assessment
Selected nursing diagnoses
Outcome identification and planning

5. Congestive Heart Failure (cont.)
Nursing process for the child with congestive heart failure (cont.)
Implementation
Monitoring vital signs
Improving respiratory function
Maintaining adequate nutrition
Promoting energy conservation
Providing family teaching
Evaluation: Goals and expected outcomes

6. Rheumatic Fever
Autoimmune reaction to group A beta-hemolytic streptococcal infections
Clinical manifestations
Carditis: Inflammation of the heart
Polyarthritis: Migratory arthritis
Chorea: Emotional instability, muscular weakness, purposeless movements
Diagnosis: Difficult
Treatment: Prevention of residual heart disease
Prevention of infection

7. Rheumatic Fever (cont.)
Nursing process for the child with rheumatic fever
Assessment
Selected nursing diagnoses
Outcome identification and planning: Preoperative care
Implementation
Providing comfort measures, reducing pain
Providing diversional activities, sensory stimulation

8. Rheumatic Fever (cont.)
Nursing process for the child with rheumatic fever (cont.)
Implementation (cont.)
Promoting energy conservation
Preventing injury
Promoting compliance with drug therapy
Providing family teaching
Evaluation: Goals and expected outcomes

9. Question
In a child with a diagnosis of congestive heart failure, what would chest radiographs show? a. Pigeon chest b. Enlarged heart c. Lung infiltrates d. Flail chest

10. Answer b. Enlarged heart
Rationale: The clinical symptoms are the primary basis for diagnosis of CHF. Chest radiographs reveal an enlarged heart; electrocardiography may indicate ventricular hypertrophy, and an echocardiogram may be done to note cardiac function.

11. Kawasaki Disease Immune system alteration Clinical manifestations
Fever; irritability; lethargy; dry, red, cracked lips
Conjunctival inflammation; red-colored tongue
Edema and skin peeling in hands, feet; rash
Diagnosis: Symptomology
Treatment and nursing care

12. Iron-Deficiency Anemia
Blood cells produce insufficient hemoglobin, are smaller than normal; milk babies
Clinical manifestations
Less-than-average weight; pale mucous membranes; anorexia; listlessness; slowed growth
Diagnosis
Treatment and nursing care

13. Sickle Cell Disease
Abnormal hemoglobin production (most common in African Americans), resulting in RBCs assuming sickle shape when inherited from both parents
Sickle cell trait: Asymptomatic when inherited from one parent
Clinical manifestations: Chronic anemia; sickle cell crisis
Diagnosis: Screening
Treatment: Prevention of crises

14. Sickle Cell Disease (cont.)
Nursing process for the child with sickle cell disease
Assessment
Selected nursing diagnoses
Outcome identification and planning
Implementation
Relieving pain; maintaining fluid intake
Improving physical mobility
Promoting: Energy conservation, skin integrity, family coping
Providing family teaching

15. Thalassemia
Inherited mild-to-severe anemias: Abnormal hemoglobin production
Clinical manifestations
Anemia; fatigue; pallor; irritability; anorexia
Bone pain/fractures common; organ involvement
Treatment: Transfusions (potential iron overload); medications; side effects
Nursing care: Poor prognosis

16. Hemophilia Mechanics of clot formation Common types of hemophilia
Factor VIII deficiency
Factor IX deficiency
Clinical manifestations: Prolonged bleeding with frequent hemorrhages into skin, joint spaces, intramuscular tissues
Diagnosis
Treatment

17. Hemophilia (cont.) Nursing process for the child with hemophilia
Assessment
Selected nursing diagnoses
Outcome identification and planning
Implementation
Relieving pain
Preventing: Joint contractures, injury
Providing family teaching; promoting family coping
Evaluation: Goals and expected outcomes

18. Idiopathic Thrombocytopenic Purpura
Platelet deficit causing hemorrhages into skin or mucous membranes
Clinical manifestations: Acute onset; bruising/rash; hematuria or epistaxis
Diagnosis
Treatment and nursing care

19. Acute Leukemia
Pathophysiology: Uncontrolled reproduction of deformed WBCs; most common type of childhood cancer
Clinical manifestations
Surprisingly abrupt with few warning signs
Fatigue; pallor; low-grade fever
Bone, joint pain; petechiae; purpura
Diagnosis
Treatment

20. Acute Leukemia (cont.) Nursing process for the child with leukemia
Assessment
Selected nursing diagnoses
Outcome identification and planning

21. Acute Leukemia (cont.)
Nursing process for the child with leukemia (cont.)
Implementation
Preventing: Infection, bleeding and injury
Reducing pain
Promoting energy conservation, relieving anxiety
Promoting normal growth and development
Promoting a positive body image
Promoting family coping
Evaluation: Goals and expected outcomes

22. Question
What disease is a sex-linked recessive trait caused by a deficiency of factor IX? a. Hemophilia B b. Hemophilia A c. Factor VIII disease d. Christmas disease

23. Answer
d. Christmas disease Rationale: Christmas disease is a sex-linked recessive trait appearing in male offspring of carrier females, and it is caused by a deficiency of one of the necessary thromboplastin precursors: factor IX, the plasma thromboplastin component.