Pediatric Cardiovascular Disorders | Saunders NCLEX-PN Review Chapter 33

Pediatric Cardiovascular Disorders | Saunders NCLEX-PN Review Chapter 33

Saunders NCLEX-PN Review Book Cover

Chapter 33 of Saunders Comprehensive Review for the NCLEX-PN Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri offers a complete overview of pediatric cardiovascular disorders. This chapter helps nursing students master recognition, intervention, and family education for heart failure, congenital heart defects, rheumatic fever, Kawasaki disease, and critical cardiac emergencies.

Watch the full chapter summary and explore more NCLEX-PN content on the Last Minute Lecture YouTube channel:

Heart Failure in Children: Early Signs & Priority Nursing Actions

  • Early warning signs: Tachycardia, tachypnea, scalp sweating, poor feeding, weak pulses, irritability, delayed cap refill.
  • Key interventions: Oxygen therapy, strict I&O, daily weights, diuretics (furosemide), digoxin administration, high-calorie nutrition, minimize energy expenditure, monitor potassium if on diuretics.
  • Digoxin safety: Check apical pulse, hold if bradycardia, watch for toxicity (vomiting, bradycardia, arrhythmia), educate parents on dosing and signs of overdose.

Congenital Heart Defects: Classifications & Clinical Care

  • Increased pulmonary blood flow:
    • Atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA)
    • Symptoms: Murmurs, heart failure, respiratory distress, poor feeding
  • Obstructive defects:
    • Aortic stenosis, pulmonary stenosis, coarctation of the aorta
    • Symptoms: Diminished pulses, hypertension in upper extremities, leg cramps, heart failure
  • Decreased pulmonary blood flow:
    • Tetralogy of Fallot, tricuspid atresia
    • Symptoms: Cyanosis, "tet spells," squatting, clubbing
  • Mixed defects:
    • Transposition of the great arteries, truncus arteriosus, hypoplastic left heart syndrome
    • Symptoms: Profound cyanosis, heart failure, surgical emergencies

Managing Tetralogy of Fallot & Hypercyanotic (Tet) Spells

  • Sudden cyanosis, rapid breathing, limpness—triggered by crying, feeding, or defecation.
  • Priority interventions: Knee-chest position, 100% oxygen, morphine, IV fluids, calm environment, call provider.

Cardiac Catheterization: Nursing Care & Complications

  • Pre-op: Assess for allergies (iodine, shellfish), check pedal pulses, explain procedure to family.
  • Post-op: Monitor for bleeding at insertion site, check distal pulses, keep leg straight, monitor for arrhythmias and infection, discharge teaching about activity and infection signs.

Rheumatic Fever: Recognition & Nursing Interventions

  • Caused by untreated group A strep infection (throat), common in ages 5–15.
  • Jones Criteria: Polyarthritis, carditis, chorea, erythema marginatum, subcutaneous nodules. Minor: fever, arthralgia, prolonged PR interval.
  • Long-term penicillin therapy, monitor cardiac function, manage joint pain, emotional support for involuntary movements (chorea).

Kawasaki Disease: Stages & Cardiac Risks

  • Acute, subacute, and convalescent phases with high fever, red eyes/lips/tongue ("strawberry tongue"), swelling, skin peeling, and risk of coronary artery aneurysms.
  • Treatment: IVIG and high-dose aspirin; monitor for cardiac complications, teach parents about signs of thrombosis and activity restrictions.

Homecare, Parent Teaching, and Postoperative Cardiac Care

  • Incision care, activity limits, infection precautions, signs of sepsis (fever, chills, lethargy), immunizations (no live vaccines for 11 months after IVIG).
  • Parental teaching: Administering digoxin safely, monitoring for adverse effects, keeping up with follow-up care, and when to call the provider.
  • CPR training for caregivers, medication and dietary guidance (potassium, sodium restriction if needed), importance of regular dental care to prevent endocarditis.

Conclusion:
Pediatric cardiovascular disorders are complex and high-risk—demanding prompt recognition, specialized interventions, and robust family support. Mastering these topics ensures NCLEX-PN success and safer, more effective pediatric care.

For more chapter summaries and the complete NCLEX-PN review, visit Last Minute Lecture or watch the full NCLEX-PN playlist: YouTube Playlist

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