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Pediatrics > Acquired cardiac Disorders > Flashcards

Acquired cardiac Disorders Flashcards

1
Q

Bacterial endocarditis

A

inflam process resulting from infx of valves and inner lining of heart

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2
Q

inc risk of bac endocarditis

A

-inc sus with CHD or acquired heart disease
-inc risk after dental procedures, surgery, intracardiac lines
- common cause–Streptococcus viridans, satph aureus, gram-neg bact, fungus

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3
Q

BE patho

A
  • org enters blood from area of localized infx and grow on endocardium
  • vegetations, fibrin deposits, platelet thrombi form
  • lesions may invade adjacent tissue and break off and embolize elsewhere
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4
Q

BE CM

A
  • low fever
  • anorexia
  • malaise
  • joint pain
    • cultures
  • new heart murmur
  • petechiae of mucus mem
  • janeway spots (painless hemorrhagic areas on palms/soles)
  • osler nodes (painful white spots on pads of fingers and toes)
  • splinter hemorrhages under nails
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5
Q

Therapeutics for BC

A
  • long-term antibiotics for 2-8weeks
  • surgical removal of emboli or valve replacement
  • prevent with prophylactic antibiotics 1h before surg (if at high risk like CHD)
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6
Q

BE NC

A
  • teach prophylactic antibiotic therapy
  • teach fam to give IV antibiox at home
  • sx relief–soak hands, lotion
  • monitor for emboli (SOB, swell)
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7
Q

Rheumatic fever

A

sys inflam following group A beta hemolytic strep infx; autoimmune response to strep antibodies (when strep not treated soon enough)
- Aschoff bodies–infalm hemorrhagic bullous lesions that are formed and cause swelling, fragmentation, alterations in conn tissues
- rheumatic heart disease may dev–fever that causes heart probs

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8
Q

Rheumatic fever diagnosis

A

Jones criteria
- often school age
- URI in weeks prior
- more freq in males, later winter or early spring

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9
Q

RF CM

A
  • polyarthritis
  • carditis
  • chorea (sudden abnormal mvt of extremities)
  • muscle weakness
  • erythema marginatum
  • subcutaneous nodules
  • arthraglia
  • low fever
    -elevated ASO titer; antistreptolysin-O
  • ab pain
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10
Q

RF treatment

A
  • get rid of strep with antibiotics
  • prevent cardiac damage and relieve sx with giving aspirin (salicylates), steroids, bed rest
  • prevention of reccurence and endocarditis (sus for rest of life, esp next 5Y)
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11
Q

Can you give aspirin to kids with RF?

A

Yes if it the benefits may outweigh risk of getting Reye’s syndrome

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12
Q

RF NC

A
  • prevent disease
  • encourage compliance with drugs esp antibiotics
  • facilitate recovery, rest, adequate nutrition, pain management
  • provide emo support
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13
Q

Kawasaki disease (mucocutaneous lymph nose syndrome)

A
  • acute systemic vasculitis of unknown etiology
  • thought to have infectious component
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14
Q

Kawasaki disease

A
  • pre-pubertal kids, esp boys under 2 Y
  • more freq in winter and spring
  • usually self-limit and resolve but 20% get serious cardiac prob
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15
Q

KD CM (acute phase)

A
  • fever non-reponsive to drugs
  • pruritic polymorphic rash
  • cervical lymphadenopathy
  • dry, red lips
  • strawberry tongue
  • bilateral conjunctivits, injection (inflam w/o exudation)
  • erythema and swell of palms and soles
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16
Q

KD subacute phase (10-35 days)

A
  • begin with resolution of fever and lasts until all s/s are gone
  • vasculitis and inc platelets–bad combo
  • desquamous of toes, feet, fingers, palms
  • arthritis
  • thrombocytosis
17
Q

KD convalescent or recovery phase (up to 10 weeks)

A
  • sx free
  • phase complete when all blood values have returned to normal
    most dangerous phase–no sx or pain in chest and back but highest risk of myocardial infarction here
18
Q

s/s myocardial infarction in kids

A
  • ab pain
  • vom
  • restless
    -inconsolable cry
    -pallor
    -shock
19
Q

Therapeutic management of KD

A
  • salicylates for anti-inflam and anti-plt effect–high dose ASA is begun and continue until child has been afebrile for 48-72h; start on low dose ASA and may be on forever
  • high dose IV gamma globulin has to start w/i 10 days of fever
20
Q

NC for KD

A
  • monitor cardiac status carefully (O2 and resp monitoring very imp, I&O, V/S q1-2, DW, admin fluids with care, watch for signs of MI
  • safely admin gamma globulin–blood product with usual precautions, immunizations, possibility of MI
  • symptomatic relief incl skin discomfort, mouth care, clear liquids and soft foods, irritability
  • D/C teaching–accurate info regarding progression, immunizations, possibility of MI
21
Q

Hypertension in kids

A
  • consistent elevation of BP beyond the upper limits of normal
  • major categories–essential or primary, no identifiable cause; secondary–subsequent to an identifiable cause; mild, significant or severe hypertension
22
Q

Hypertension in kids is based on…

A

age, wt, ht

23
Q

Primary hypertension prevalence

A

rare in kids

24
Q

Secondary hypertension causes

A
  • renal disease
  • coarctation of the aorta
  • oral contraception
  • steroids
  • obesity
  • adrenal disorders
25
Q

CM of hypertension in kids

A
  • high BP
  • headache
  • dizzy
26
Q

Hypertension tx

A
  • ID and treat underlying cause
  • monitor if mild
  • combo of nonpharm and pharm therapy
27
Q

Hypertension NC

A
  • detection–calm child and use proper cuff
  • teach–how to monitor child’s BP, diet and exercise, precautions with antihypertensive drugs, avoid alc and stay on prescribed diet, no oral contraceptives
28
Q

HLD in kids

A
  • presymptomatic phase of atherosclerosis
  • AAP recommends selective screening
  • total chol over 170
  • fat intake never limited in kids from birth-2Y
29
Q

HLD tx

A
  • dietary; step diet
  • pharm, cholestyramine or Colestipol- nursing, screening, edu, support
30
Q

Dysrhythmias in kids

A
  • Diagnosis–24h Holter monitor, ECG, transesophageal recording
  • Bradyarrhythmia (sinus brady (slower) or complete AV block)
  • Tachyarrhythmias (sinus tachy from fever or anxiety, pain, dehydration) or supraventricular tachy
31
Q

Supraventricular tachy

A
  • rapid, regular HR 200-300
  • tx–vagal maneuver like ice on face, bare down, carotid massage–do NOT do these at home
  • adenosine impairs AV conduction, rapid IV push as fast as you can and flush as fast as can
  • radio-freq ablation, digoxin
  • often self-limiting
  • can be caused by caffeine
  • education
32
Q

Sinus arrhythmia

A
  • regular irregularity
  • normal in school age child
  • have child hold breath and it should regulate
33
Q

Cardiomyopathy

A

Cardiac muscles can’t contract as should
- dilated ventricular dilation with greatly inc contractility leading to CHF
- restrictive ventricular filling cause by disease (vent not filling as should)
- hypertropic heart

34
Q

Cardiomyopathy in kids

A
  • rare
  • genetic cause, infection, deficiency, metabolic abnormalities, collagen vasc disease
  • most are idiopathic
35
Q

Cardiomyopathy tx

A
  • Digoxin
  • diuretics
  • beta blockers
  • anticoags
  • calcium channel blockers
  • transplant
36
Q

NC for cardiomyopathy

A
  • getting kids to adjust to failing health–can’t play soccer and run around like others
  • include kids in discussion and decisions about transplant etc
  • teach psych prep and postop care

Pediatrics (26 decks)

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