1

Cardiovascular DysfunctionCardiovascular Dysfunction

Maternal Child Nursing Care Maternal Child Nursing Care Chapter 48, pp. 1553Chapter 48, pp. 1553--16001600

Baptist Health School of NursingBaptist Health School of NursingNSG 3026A: ChildrenNSG 3026A: Children’’s Healths Health

Carole Mackey, Carole Mackey, MNScMNSc, RN, APN, RN, APNDebbie Mercer, BSN, RN, RRTDebbie Mercer, BSN, RN, RRT

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Two Types of Cardiac DefectsTwo Types of Cardiac Defects

CongenitalCongenitalAnatomic>abnormal Anatomic>abnormal functionfunction

AcquiredAcquiredDisease process Disease process

InfectionInfectionAutoimmune responseAutoimmune responseEnvironmental factorsEnvironmental factorsFamilial tendenciesFamilial tendencies

33

Assessment of Cardiac FunctionAssessment of Cardiac Function

Health HistoryHealth HistoryPoor FeedingPoor FeedingTachypneaTachypneaMotherMother’’s s HistoryHistory

2

44

Assessment of Cardiac FunctionAssessment of Cardiac Function

InspectionInspectionFailure to thrive Failure to thrive ColorColorChest DeformitiesChest DeformitiesPulsationsPulsationsRespiratory ExcursionRespiratory ExcursionClubbingClubbingAbdomenAbdomenHeart Rate/RhythmHeart Rate/RhythmHeart SoundsHeart Sounds

55

Character of Heart Sounds: Character of Heart Sounds: MurmursMurmurs

Classification of MurmursClassification of MurmursI I –– Very faint, heard only after listener has "tuned Very faint, heard only after listener has "tuned in"; may not be heard in all positions. in"; may not be heard in all positions. II II -- Quiet, but heard immediately after placing the Quiet, but heard immediately after placing the stethoscope on the chest stethoscope on the chest III III –– Moderately loud. Moderately loud. IV IV -- Loud, with palpable Loud, with palpable thrillthrill. . V V -- Very loud, with thrill. May be heard when Very loud, with thrill. May be heard when stethoscope is partly off the chest stethoscope is partly off the chest VI VI -- Very loud, with thrill. May be heard with Very loud, with thrill. May be heard with stethoscope entirely off the chest. stethoscope entirely off the chest.

66

Diagnostic EvaluationDiagnostic Evaluation

Chest XChest X--rayrayElectrocardiographyElectrocardiographyEchocardiographyEchocardiographyCardiac Cardiac CatherizationCatherizationInterventional Cardiac Interventional Cardiac CatherizationCatherization

3

77

EchocardiographyEchocardiography

TechniquesTechniquesNoninvasiveNoninvasivePainlessPainlessStressfulStressful

88

Interventional Cardiac Catheter Interventional Cardiac Catheter Procedures in ChildrenProcedures in Children

Transposition of Transposition of great vesselsgreat vesselsSome complex Some complex singlesingle--ventricle ventricle defectsdefectsASDASDPulmonary artery Pulmonary artery stenosisstenosis

99

PrePre--procedural Careprocedural Care

Nursing AssessmentNursing AssessmentHeight/WeightHeight/WeightAllergiesAllergiesS/S InfectionS/S InfectionMethods of SedationMethods of Sedation

4

1010

PostPost--procedural Careprocedural Care

Cardiac MonitorCardiac MonitorTemperature and Temperature and Color of extremityColor of extremityVital SignsVital SignsMonitor DressingMonitor DressingDirect pressure if Direct pressure if bleeding occursbleeding occurs

1111

Critical Thinking ExerciseCritical Thinking Exercise

4 year old with 4 year old with tetralogytetralogyof of FallotFallot recovering from recovering from cardiac catheterization cardiac catheterization begins vomiting and begins vomiting and bleeding (p. 1557). bleeding (p. 1557). Priorities of Nursing CarePriorities of Nursing CareNursing InterventionsNursing Interventions

1212

Congenital Heart DiseaseCongenital Heart Disease(CHD)(CHD)

Incidence: 5 to 8 per 1000 live births Incidence: 5 to 8 per 1000 live births About 2 or 3 of these are symptomatic in first About 2 or 3 of these are symptomatic in first year of lifeyear of lifeMajor cause of death in first year of life (after Major cause of death in first year of life (after prematurity)prematurity)Most common anomaly is VSDMost common anomaly is VSD28% of children with CHD have another 28% of children with CHD have another recognized anomaly (trisomy 21, 13, 18, )recognized anomaly (trisomy 21, 13, 18, )

5

1313

Causes of CHDCauses of CHDChromosomal/genetic = 10%Chromosomal/genetic = 10%--12%12%Maternal or environmental = 1%Maternal or environmental = 1%--2%2%

Maternal drug useMaternal drug useFetal alcohol syndrome Fetal alcohol syndrome risk of CHDrisk of CHD

Maternal illnessMaternal illnessRubella in 1st 7 wk of pregnancyRubella in 1st 7 wk of pregnancyCMV, toxoplasmosis, other viral illnesses CMV, toxoplasmosis, other viral illnesses IDMsIDMs = 10% risk of CHD (VSD, cardiomyopathy, = 10% risk of CHD (VSD, cardiomyopathy, TGA most common)TGA most common)

Multifactorial = 85%Multifactorial = 85%

1414

OverviewOverview

Normal Fetal CirculationNormal Fetal CirculationPatent Ductus ArteriosusPatent Ductus ArteriosusForamen OvaleForamen Ovale

PostPost--Natal CirculationNatal CirculationPhysiologic Events:Physiologic Events:

Increase in Systemic Circulation PressuresIncrease in Systemic Circulation PressuresDecrease in Lung ResistanceDecrease in Lung Resistance

1515

6

1616

Fetal Circulation Structures Fetal Circulation Structures

Umbilical vein; umbilical Umbilical vein; umbilical arteriesarteriesForamen ovaleForamen ovaleDuctus arteriosusDuctus arteriosusDuctus venosusDuctus venosus

1717

Heart = PumpHeart = Pump

1818

How the Heart WorksHow the Heart Works

Right SideRight Sideto Lungsto Lungs

Left Side Left Side to Bodyto Body

7

1919

Normally low oxygen Normally low oxygen blood entering the blood entering the right side of the heart right side of the heart stays on the right sidestays on the right sideOxygen rich blood Oxygen rich blood stays on the left side stays on the left side of the heart where it of the heart where it is pumped to the is pumped to the bodybody

2020

Traditional Categories of CHDTraditional Categories of CHD

2121

Congenital Heart DefectsCongenital Heart Defects

AcyanoticAcyanoticAtrial Septal DefectAtrial Septal DefectVentricular Septal Ventricular Septal DefectDefectPatent Ductus Patent Ductus ArteriosusArteriosusCoarctation of the Coarctation of the AortaAortaAortic StenosisAortic StenosisPulmonic StenosisPulmonic Stenosis

Cyanotic Cyanotic TetrologyTetrology of of FallotFallotPulmonary Pulmonary AtresiaAtresiaTransposition of Great Transposition of Great VesselsVesselsHypoplasticHypoplastic left heartleft heart

8

2222

Newer Classification of CHDNewer Classification of CHD

Hemodynamic characteristicsHemodynamic characteristicsIncreased pulmonary blood flowIncreased pulmonary blood flowDecreased pulmonary blood flowDecreased pulmonary blood flowObstruction of blood flow out of the Obstruction of blood flow out of the heartheartMixed blood flowMixed blood flow

2323

Increased Pulmonary Blood Flow Increased Pulmonary Blood Flow DefectsDefects

Abnormal connection between two sides of Abnormal connection between two sides of heart heart -- either the septum or the great vesselseither the septum or the great vesselsIncreased blood volume on right side of heartIncreased blood volume on right side of heartIncreased or decreased pulmonary blood flowIncreased or decreased pulmonary blood flowDefects include:Defects include:

•• AtrialAtrial septalseptal defectdefect•• Ventricular Ventricular septalseptal defectdefect•• Patent Patent ductusductus arteriosusarteriosus

2424

HemodynamicsHemodynamics with Increased with Increased Pulmonary Blood FlowPulmonary Blood Flow

9

2525

Defects with Increased Pulmonary Defects with Increased Pulmonary Blood FlowBlood Flow

AtrialAtrial Septal DefectSeptal DefectVentricular Septal DefectVentricular Septal DefectPatent Ductus ArteriosusPatent Ductus Arteriosus

Patients present with signs and symptoms Patients present with signs and symptoms of Congestive Heart Failureof Congestive Heart Failure

2626

AtrialAtrial SeptalSeptal Defect (ASD)Defect (ASD)

2727

Ventricular Ventricular SeptalSeptal Defect (VSD)Defect (VSD)

Abnormal pathway Abnormal pathway b/tb/t right and left right and left ventricles causing shunting and fluid ventricles causing shunting and fluid excess (volume overload)excess (volume overload)Can result in CHF Can result in CHF Loud Loud holosystolicholosystolic murmurmurmurTypically Typically asymtomaticasymtomaticuntil CHF developsuntil CHF develops

Risk for Risk for endocarditisendocarditis and PV obstructionand PV obstruction

10

2828

VSDVSD

2929

Patent Patent DuctusDuctus ArteriosusArteriosus (PDA)(PDA)

Failure of the fetal artery Failure of the fetal artery connecting the aorta and connecting the aorta and pulmonary artery to close pulmonary artery to close within the first few weeks within the first few weeks of lifeof lifeAllows blood to flow from Allows blood to flow from the higherthe higher--pressure aorta pressure aorta to the lower pressure to the lower pressure pulmonary artery, pulmonary artery, causing leftcausing left--toto--right right shuntingshunting

3030

PDAPDA

11

3131

PDA cont.PDA cont.

The amount of leftThe amount of left--toto--right shunting right shunting depends upon the size of the PDA and the depends upon the size of the PDA and the relative resistances of the systemic and relative resistances of the systemic and pulmonary circulationspulmonary circulationsResults in increased pulmonary artery Results in increased pulmonary artery blood flow as well as left blood flow as well as left atrialatrial and left and left ventricular overloadventricular overloadA large PDA can result in systemic organ A large PDA can result in systemic organ hypoperfusionhypoperfusion

3232

AtrioventricularAtrioventricular Canal Defect (AVC)Canal Defect (AVC)

3333

Obstructive DefectsObstructive Defects

Anatomic Narrowing Anatomic Narrowing ((StenosisStenosis))

ValvularValvular

SubvalvularSubvalvular

SupravalvularSupravalvular

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3434

Obstructive DefectsObstructive Defects

CoarctationCoarctation of the aortaof the aortaAortic stenosisAortic stenosisPulmonic stenosisPulmonic stenosis

3535

COACOA

3636

Aorta Aorta -- Largest artery Largest artery

13

3737

CoarctationCoarctation of the aortaof the aorta

Increased pressure Increased pressure proximal to the defect proximal to the defect (head and upper (head and upper extremities) extremities) Decreased pressure Decreased pressure distal to the distal to the obstruction (body and obstruction (body and lower extremities)lower extremities)

3838

CoarctationCoarctation RepairRepair

Normal Normal CoarctationCoarctation

Repair Step #1Repair Step #1 Completed RepairCompleted Repair

3939

Aortic StenosisAortic Stenosis

14

4040

Pulmonic Stenosis Pulmonic Stenosis

4141

Decreased Pulmonary Decreased Pulmonary Blood Flow DefectsBlood Flow Defects

Obstruction of pulmonary Obstruction of pulmonary flow + Anatomic Defectflow + Anatomic DefectASD or VSDASD or VSDHypoxicHypoxicCyanoticCyanotic

4242

HemodynamicsHemodynamics with Decreased with Decreased Pulmonary Blood Flow DefectsPulmonary Blood Flow Defects

15

4343

Most Common Decreased Most Common Decreased Pulmonary Pulmonary

Blood Flow DefectsBlood Flow Defects

Tetralogy of FallotTetralogy of FallotTricuspid atresiaTricuspid atresia

4444

Tetralogy of FallotTetralogy of Fallot

4545

TetralogyTetralogy of of FallotFallot

Includes 4 defects: Includes 4 defects: ventricular ventricular septalseptal defect, defect, pulmonic pulmonic stenosisstenosis, , overriding aorta, and overriding aorta, and right ventricular right ventricular hypertrophyhypertrophyAs the severity of right As the severity of right ventricular outflow tract ventricular outflow tract obstruction increases, obstruction increases, right to left shunting of right to left shunting of blood occurs through the blood occurs through the VSD resulting in cyanosisVSD resulting in cyanosis

16

4646

TetrologyTetrology of of FallotFallot (TOF)(TOF)

Four separate yet intertwined problemsFour separate yet intertwined problemsPulmonary Pulmonary StenosisStenosisVentricular Ventricular septalseptal defect (VSD)defect (VSD)Overriding aortaOverriding aortaRight ventricular hypertrophy Right ventricular hypertrophy This is a CYANOTIC CHDThis is a CYANOTIC CHDTypically seen with Downs childrenTypically seen with Downs childrenASD can also occur (must have the ASD to encourage ASD can also occur (must have the ASD to encourage circulation and oxygenation)circulation and oxygenation)

4747

TetralogyTetralogy cont.cont.

These 4 defects lead to a reduced blood These 4 defects lead to a reduced blood flow to the lungs and the mixing of flow to the lungs and the mixing of oxygenoxygen--rich and oxygenrich and oxygen--poor blood in the poor blood in the heart. This causes the babies to appear heart. This causes the babies to appear cyanotic, especially during exertion cyanotic, especially during exertion (feeding)(feeding)If left untreated will usually cause death If left untreated will usually cause death by age 20by age 20Must be repaired surgically, usually in 2 Must be repaired surgically, usually in 2 stages, when the child is very youngstages, when the child is very young

4848

Nursing and medical management Nursing and medical management (TOF)(TOF)

Diagnosis: CXR shows boot shaped heart (RV Diagnosis: CXR shows boot shaped heart (RV large), EKG shows RVH, ECHO large), EKG shows RVH, ECHO If If DuctusDuctus arteriosisarteriosis closes cyanosis develops IV closes cyanosis develops IV Prostaglandin in infancy (keep Prostaglandin in infancy (keep ductusductus open)open)Monitor labs CBC (blood can thicken)Monitor labs CBC (blood can thicken)Initial surgery in infancy then progressive Initial surgery in infancy then progressive surgeries depending on hypoxic eventssurgeries depending on hypoxic eventsCan have Can have hypercyanotichypercyanotic spellsspells

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4949

Tricuspid AtresiaTricuspid Atresia

5050

Palliative Tricuspid Palliative Tricuspid AtresiaAtresia RepairRepair

5151

Mixed DefectsMixed Defects

Transposition of great vesselsTransposition of great vesselsTotal anomalous pulmonary venous Total anomalous pulmonary venous connectionconnectionHypoplastic heart syndrome Hypoplastic heart syndrome

RightRightLeftLeft

18

5252

Transposition of Great VesselsTransposition of Great Vessels

5353

Total Anomalous Pulmonary Venous Total Anomalous Pulmonary Venous ConnectionConnection

5454

TruncusTruncus ArteriosusArteriosus (TA)(TA)

19

5555

Hypoplastic Left HeartHypoplastic Left Heart

5656

Congestive Heart FailureCongestive Heart FailureDefinition: Congestive heart failure Definition: Congestive heart failure (CHF) is a condition in which the heart (CHF) is a condition in which the heart cannot pump enough oxygenated blood cannot pump enough oxygenated blood to meet the needs of the body's other to meet the needs of the body's other organs organs

5757

Congestive Heart FailureCongestive Heart Failure

Pathophysiology of CHFPathophysiology of CHFRightRight--Sided FailureSided FailureLeftLeft--Sided FailureSided Failure

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Congestive Heart FailureCongestive Heart Failure

Therapeutic GoalsTherapeutic GoalsImprove Cardiac FunctionImprove Cardiac FunctionRemove Excess FluidsRemove Excess FluidsDecrease Cardiac DemandsDecrease Cardiac DemandsImprove OxygenationImprove Oxygenation

5959

Improve Cardiac FunctionImprove Cardiac Function

Increase Increase contractility contractility Decrease Decrease AfterloadAfterloadDigitalis GlycosidesDigitalis Glycosides

6060

Remove Excess FluidRemove Excess Fluid

DiureticsDiureticsFluid RestrictionFluid RestrictionSodium Sodium RestrictionRestrictionPotassium Potassium SupplementsSupplements

21

6161

Decrease Cardiac DemandsDecrease Cardiac Demands

Bed RestBed RestReduce Effort of Reduce Effort of BreathingBreathingSedationSedationTreat InfectionsTreat Infections

6262

Improve Tissue OxygenationImprove Tissue Oxygenation

Humidified Humidified OxygenOxygenOxygen HoodOxygen HoodNasal Nasal CannulaCannula

6363

Nursing Care Management of CHFNursing Care Management of CHF

Nursing Care Plan Nursing Care Plan (p. 1576)(p. 1576)Goals (p. 1571)Goals (p. 1571)

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Improve Cardiac Function: Improve Cardiac Function: DigoxinDigoxinAdministrationAdministration

Correct DosageCorrect DosageApical PulseApical PulseInfants (>90Infants (>90--110 110 bpmbpm))Young Children (>70 Young Children (>70 bpmbpm))Older Children (>60 Older Children (>60 bpmbpm))Signs of ToxicitySigns of ToxicityParental TeachingParental Teaching

6565

AfterloadAfterload Reduction: ACE Inhibitors Reduction: ACE Inhibitors

Monitor Blood Monitor Blood PressurePressureSerum Serum Electrolytes Electrolytes Renal FunctionRenal Function

6666

Decrease Cardiac Demands Decrease Cardiac Demands

RestRestFeedingFeedingMinimize StressMinimize Stress

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6767

Reduce Respiratory Distress Reduce Respiratory Distress

AssessmentAssessmentPositioningPositioningOxygen Oxygen AdministrationAdministration

6868

Maintain Nutritional Status Maintain Nutritional Status

Caloric NeedsCaloric NeedsFatigue with Fatigue with FeedingFeedingGavageGavage FeedingFeedingAdded CaloriesAdded Calories

6969

Promote Fluid Loss Promote Fluid Loss

Record I & ORecord I & O’’ssWeightsWeightsSerum Potassium Serum Potassium LevelsLevelsFluid RestrictionFluid RestrictionSodium RestrictionSodium Restriction

24

7070

Support Child and Family Support Child and Family

Reduce AnxietyReduce AnxietyFrequent Frequent CommunicationCommunicationReassuranceReassuranceFamily TeachingFamily TeachingEnd Stage CHFEnd Stage CHF

7171

CHF: Evaluate Interventions CHF: Evaluate Interventions

Monitor Heart Monitor Heart RateRateMonitor NutritionMonitor NutritionMonitor I/OMonitor I/OMonitor WeightMonitor WeightFamily ConcernsFamily Concerns

7272

Hypoxemia Hypoxemia HypoxemiaHypoxemiaHypoxia Hypoxia CyanosisCyanosisEisenmengerEisenmengerComplex Complex (syndrome)(syndrome)

25

7373

Hypoxemia: Therapeutic Hypoxemia: Therapeutic Management Management

PolycythemiaPolycythemiaClubbingClubbingSquattingSquattingHypercyanoticHypercyanoticSpellsSpellsNeurologicNeurologicComplicationsComplications

7474

Hypoxemia: Nursing Care Hypoxemia: Nursing Care Management Management

Treatment of Treatment of HypercyanoticHypercyanotic SpellsSpells

OxygenOxygenMorphineMorphineHydrationHydrationNurse AssessmentNurse Assessment

7575

Care of Family and Child with Care of Family and Child with CHDCHD

Care before RepairCare before RepairCare after RepairCare after RepairFamily AdjustmentFamily AdjustmentEducate FamilyEducate FamilyFamily CopingFamily CopingPrepare for SurgeryPrepare for Surgery

26

7676

Preparations for SurgeryPreparations for Surgery

EnvironmentEnvironmentProceduresProceduresPostoperative Postoperative CareCare

7777

Postoperative CarePostoperative Care

Observe Vital SignsObserve Vital SignsMaintain Maintain Respiratory StatusRespiratory StatusMonitor FluidsMonitor FluidsRest and ActivityRest and ActivityComfort and Comfort and Emotional SupportEmotional Support

Acquired CardiovascularAcquired CardiovascularDisordersDisorders

Infectious and Inflammatory Infectious and Inflammatory Cardiac DisordersCardiac Disorders

27

7979

Bacterial (Bacterial (Infective)EndocarditisInfective)Endocarditis

PathophysiologyPathophysiologyDiagnostic EvaluationDiagnostic EvaluationTherapeutic ManagementTherapeutic ManagementNursing Care Nursing Care ManagementManagement

8080

Rheumatic FeverRheumatic Fever

RFRFInflammatory disease occurs after Group A Inflammatory disease occurs after Group A ßß--hemolytic streptococcal pharyngitishemolytic streptococcal pharyngitisInfrequently seen in U.S.; big problem in Third Infrequently seen in U.S.; big problem in Third World World SelfSelf--limitinglimiting

Affects joints, skin, brain, serous surfaces, and Affects joints, skin, brain, serous surfaces, and heartheart

Rheumatic heart diseaseRheumatic heart diseaseMost common complication of RFMost common complication of RFDamage to valves as result of RFDamage to valves as result of RF

8181

Clinical Manifestations of RFClinical Manifestations of RF

CarditisCarditisPolyarthritisPolyarthritisErythema marginatumErythema marginatumSubcutaneous nodulesSubcutaneous nodules

28

8282

Prevention of RHD Prevention of RHD Treatment of streptococcal Treatment of streptococcal tonsillitis/pharyngitistonsillitis/pharyngitis

Penicillin GPenicillin G——IM x 1IM x 1Penicillin VPenicillin V——oral x 10 daysoral x 10 daysSulfaSulfa——oral x 10 daysoral x 10 daysErythromycin (if allergic to above)Erythromycin (if allergic to above)——oral x 10 oral x 10 daysdays

Treatment of recurrent RFTreatment of recurrent RFSame as aboveSame as above

8383

HyperlipidemiaHyperlipidemia

Identify kids at risk and treat Identify kids at risk and treat earlyearlyTreatment: dietaryTreatment: dietary

Restrict intake of cholesterol and Restrict intake of cholesterol and fatsfats

If no response to dietIf no response to diet→→RxRxColestipol (Colestid)Colestipol (Colestid)Cholestyramine (Questran)Cholestyramine (Questran)

8484

Cardiac Cardiac DysrythmiasDysrythmias

Variable heart rateVariable heart rateDiagnostic Diagnostic EvaluationEvaluationBradycardiaBradycardiaTachycardiaTachycardiaConduction Conduction disturbancesdisturbances

29

8585

Pulmonary Artery HypertensionPulmonary Artery Hypertension

PAD definedPAD definedSupportive CareSupportive CareCausesCausesClinical Clinical ManifestationsManifestationsTherapeutic Therapeutic ManagementManagement

8686

CardiomopathyCardiomopathy

EtiologyEtiologyDilated Dilated HypertrophicHypertrophicRestrictive Restrictive ManagementManagement

8787

Heart TransplantationHeart Transplantation

Orthotopic transplantOrthotopic transplantHeterotopic transplant (piggyback)Heterotopic transplant (piggyback)Organ donation issuesOrgan donation issuesNursing ManagementNursing Management

30

8888

Hypertension in childrenHypertension in children

Essential Essential HypertensionHypertensionSecondary Secondary HypertensionHypertensionEtiologyEtiologyClinical Clinical ManifestationsManifestations

8989

Hypertension in ChildrenHypertension in Children

DiagnosisDiagnosisTherapeutic Therapeutic ManagementManagementDiagnostic Diagnostic ManagementManagement

9090

Kawasaki diseaseKawasaki disease

DefinitionDefinitionEtiologyEtiologyPathphysiologyPathphysiology

31

9191

Kawasaki Clinical ManifestationsKawasaki Clinical Manifestations

Diagnostic Diagnostic Criteria (Box 48Criteria (Box 48--11, p. 1593)11, p. 1593)Acute PhaseAcute PhaseSubacuteSubacute PhasePhaseConvalescent Convalescent PhasePhase

9292

Kawasaki: Cardiac InvolvementKawasaki: Cardiac Involvement

ComplicationsComplicationsTherapeutic Therapeutic ManagementManagementPrognosisPrognosisNursing CareNursing Care

9393

Kawasaki Disease TreatmentKawasaki Disease Treatment

Then 3Then 3--5 mg/kg/day5 mg/kg/day——antiplateletantiplatelet

IVIGIVIG ASA 80ASA 80--100 mg/kg/day100 mg/kg/day——feverfever

32

9494

ShockShock

HypovolemicHypovolemicDistributiveDistributiveCardiogenicCardiogenicClinical Clinical manifestationsmanifestationsTherapeutic Therapeutic ManagementManagementNursing Nursing ManagementManagement

9595

Emergency Treatment: ShockEmergency Treatment: Shock

VentilationVentilationFluid Fluid AdministrationAdministrationCardiovascular Cardiovascular SupportSupportGeneral General SupportSupport

9696

AnaphylaxisAnaphylaxis

DefinitionDefinitionClinical Clinical manifestationsmanifestationsTherapeutic Therapeutic ManagementManagementNursing Nursing ManagementManagement

33

9797

Toxic Shock Syndrome (TSS)Toxic Shock Syndrome (TSS)

Diagnostic evaluationDiagnostic evaluationCriteria (Box 48Criteria (Box 48--14, p. 14, p. 1598)1598)

9898

Toxic Shock Syndrome (TSS)Toxic Shock Syndrome (TSS)

Diagnostic evaluationDiagnostic evaluationTherapeutic managementTherapeutic managementNursing considerationsNursing considerationsCriteria for definition of TSSCriteria for definition of TSS