Introduction
Congenital vascular lesions are referred to as arteriovenous malformations (AVMs), which can be diagnosed at any age. The overall risk of complications (e.g. hemorrhage) from an untreated AVM is estimated to be between 2 and 4% (El-Ghanem et al., 2016). Although AVMs are rare in kids, they are estimated to count for 3% of AVMs in all age groups (El-Ghanem et al., 2016). These types of AVMs also tend to rupture more frequently than those in adults (El-Ghanem et al., 2016). Therefore, children are more vulnerable and require immediate and well-structured treatment, including multimodality therapies such as open vascular resection, endovascular embolization, and radiosurgery (El-Ghanem et al., 2016). Young patients must achieve full angiographic obliteration of the AVM given the higher risk of rupture, the possible threat of developmental issues, and their longer life expectancy. This paper offers an overview of the disease, its signs and symptoms, possible medications, and the implications of parent education. It also highlights the nuances of nursing interventions during the treatment of AVMs.
Disease Pathophysiology
In the absence of a true capillary bed, a venous drainage system connects to arteries, which results in abnormal blood vessels. AVMs “are lesions that are defined by the presence of arteriovenous (AV) shunting through a nidus of coiled and tortuous vascular connections that connect feeding arteries to draining veins” (El-Ghanem et al., 2016, p. 220). Thus, the direct shunting causes hypertrophy in the arterial and venous components of the AVMs (El-Ghanem et al., 2016). This happens due to the lack of capillaries between the arterial (feeding) and venous (drainage) components of AVMs (El-Ghanem et al., 2016). As for the embryological basis of AVMs, there is a hypothesis that most malformations develop during the third week of embryogenesis (El-Ghanem et al., 2016). According to El-Ghanem et al. (2016), there is possibly a mutation early in embryogenesis, which leads to arteriovenous malformations. It is characterized by the absorption of pial-dural subarachnoid veins, which subsequently leads to dynamic events resulting in growth.
Signs and Symptoms
Symptoms may depend on the size of AVMs and their possible rupture. The most common signs of AVMs in children include seizures, headaches, nausea, speech changes, and sudden loss of consciousness associated with ruptures (El-Ghanem et al., 2016). Other possible symptoms are weak muscles, ataxia (loss of coordination), back pain, dizziness, memory loss, and even hallucinations (El-Ghanem et al., 2016). AVMs in the brain (bAVMs) often imply progressive loss of neurological function. In addition, children and teenagers may have trouble with learning and behavior due to the disease.
Patient/Parent Education
It is crucial to understand the importance of parent education in a pediatric setting. To make informed decisions, parents or legal guardians need to have access to the latest and high-quality insights regarding the treatment options and possible outcomes. Firstly, parents have to know that AVM treatment depends on various factors, including its location, symptoms, and size (Qin, Gia, & Liu, 2016). In some instances, AVMs may not even need treatment, but the condition could change due to the child’s growth and development (Qin et al., 2016). It is important to track the size of an AVM and its effects on the child’s health to identify if malformations have gotten bigger and require treatment.
Nursing Interventions
In the case of AVM treatment, nurses are tasked with monitoring, patient assessment, and acute pain management. Due to hypoxemia and cerebral bleeding being risk factors, nurses monitor ECG (Qin et al., 2016). They also monitor and analyze ICP hourly (Qin et al., 2016). Nursing interventions include initial monitoring of blood pressure and pulse every 20 to 30 minutes (Qin et al., 2016). Nurses also have to CVP and PA pressure as frequently as required. When it comes to patient assessment, nurses note headache severity, stiff neck, disorientation, and neurologic status using the Glasgow coma scale (Qin et al., 2016). They also have to always be alert due to the possible subtle changes, which can occur. To prevent hypoxemia, nurses administer oxygen and implement measures to minimize external stimuli (Qin et al., 2016). They have to anticipate embolization, proton-beam therapy, or feeding vessels ligation.
Medications: Side Effects and Patient/Parent Education, and Effects upon Developmental Milestones
Along with the aforementioned surgical treatment of AVMs, children most commonly receive seizure medications. These medications include carbamazepine, phenytoin, oxcarbazepine, and ethosuximide (for children especially) (Glass et al., 2019). The most common side effects of anti-seizure medications are drowsiness and dizziness due to their direct effect on the central nervous system (Glass et al., 2019). Anti-seizure medications can also lead to reduced sodium levels, increased urination, and serious skin reactions (Glass et al., 2019). Nurses need to inform parents of all the possible side effects and risk factors. As for the effects on developmental milestones, untreated AVMs may lead to learning disorders and speech problems. They can also result in behavioral problems as a neurologic symptom of arteriovenous malfunctions.
Conclusion
Arteriovenous malfunctions in a pediatric setting require immediate and well-structured treatment, which depends on the cooperation of doctors, nurses, and parents. The symptoms of AVMs can be managed using specific medications. However, parents should be informed about the possible side effects. Untreated AVMs can lead to learning disorders and behavioral problems. Successful treatment of the disease, however, minimizes the risk of the child’s slow pace of development.
References
El-Ghanem, M., Kass-Hout, T., Kass-Hout, O., Alderazi, Y. J., Amuluru, K., Al-Mufti, F., … Gandhi, C. D. (2016). Arteriovenous malformations in the pediatric population: Review of the existing literature. Interventional neurology, 5(3-4), 218–225.
Glass, H. C., Soul, J. S., Chu, C. J., Massey, S. L., Wusthoff, C. J., Chang , T., … Shellhaas, R. A. (2019). Response to antiseizure medications in neonates with acute symptomatic seizures. Epilepsia, 60(3), 20-24.
Qin, H. Y., Jia, P., & Liu, H. (2016). Nursing strategies for patients with chronic renal failure undergoing maintenance hemodialysis treatment by arteriovenous fistula. Iranian journal of public health, 45(10), 1270–1275. Web.