Acquired cardiac Disorders Flashcards
Bacterial endocarditis
inflam process resulting from infx of valves and inner lining of heart
inc risk of bac endocarditis
-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
BE patho
- 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
BE CM
- 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
Therapeutics for BC
- 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)
BE NC
- teach prophylactic antibiotic therapy
- teach fam to give IV antibiox at home
- sx relief–soak hands, lotion
- monitor for emboli (SOB, swell)
Rheumatic fever
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
Rheumatic fever diagnosis
Jones criteria
- often school age
- URI in weeks prior
- more freq in males, later winter or early spring
RF CM
- polyarthritis
- carditis
- chorea (sudden abnormal mvt of extremities)
- muscle weakness
- erythema marginatum
- subcutaneous nodules
- arthraglia
- low fever
-elevated ASO titer; antistreptolysin-O - ab pain
RF treatment
- 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)
Can you give aspirin to kids with RF?
Yes if it the benefits may outweigh risk of getting Reye’s syndrome
RF NC
- prevent disease
- encourage compliance with drugs esp antibiotics
- facilitate recovery, rest, adequate nutrition, pain management
- provide emo support
Kawasaki disease (mucocutaneous lymph nose syndrome)
- acute systemic vasculitis of unknown etiology
- thought to have infectious component
Kawasaki disease
- 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
KD CM (acute phase)
- 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
KD subacute phase (10-35 days)
- 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
KD convalescent or recovery phase (up to 10 weeks)
- 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
s/s myocardial infarction in kids
- ab pain
- vom
- restless
-inconsolable cry
-pallor
-shock
Therapeutic management of KD
- 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
NC for KD
- 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
Hypertension in kids
- 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
Hypertension in kids is based on…
age, wt, ht
Primary hypertension prevalence
rare in kids
Secondary hypertension causes
- renal disease
- coarctation of the aorta
- oral contraception
- steroids
- obesity
- adrenal disorders
CM of hypertension in kids
- high BP
- headache
- dizzy
Hypertension tx
- ID and treat underlying cause
- monitor if mild
- combo of nonpharm and pharm therapy
Hypertension NC
- 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
HLD in kids
- presymptomatic phase of atherosclerosis
- AAP recommends selective screening
- total chol over 170
- fat intake never limited in kids from birth-2Y
HLD tx
- dietary; step diet
- pharm, cholestyramine or Colestipol- nursing, screening, edu, support
Dysrhythmias in kids
- 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
Supraventricular tachy
- 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
Sinus arrhythmia
- regular irregularity
- normal in school age child
- have child hold breath and it should regulate
Cardiomyopathy
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
Cardiomyopathy in kids
- rare
- genetic cause, infection, deficiency, metabolic abnormalities, collagen vasc disease
- most are idiopathic
Cardiomyopathy tx
- Digoxin
- diuretics
- beta blockers
- anticoags
- calcium channel blockers
- transplant
NC for cardiomyopathy
- 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
