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PEDS > Cardiac 3 > Flashcards

Cardiac 3 Flashcards

1
Q

what is important to remember when administering digoxin

A

-count apical pulse for full min and hold dose if <90-110 in infants or <70-85 in children

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2
Q

what should you observe for if administering digoxin

A
  • observe for toxicity (arrhythmias are a sign)

- obtain serum dig level at least 6 hrs after daily dose

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3
Q

how is digoxin given

A

IV or by mouth

must maintain a therapeutic level**

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4
Q

describe rheumatic fever

A

aka scarlet fever
occurs 1-3 wks after untreated strep (secondary to strep)
**important to culture for strep to treat and prevent this
systemic inflammatory disease involving heart (vulvular damage), joints and CNS

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5
Q

what is the acute phase of rheumatic fever

A

2-3 wks (lasts < 3 months)

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6
Q

meds for strep

A

amoxicillin (in high doses)
azithromycin
*important to take all meds

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7
Q

major criteria for rheumatic fever

A
  • joint inflammation
  • carditis (new murmur, tachy)
  • chorea (involuntary limb movement, slurred)
  • ***erythema marginatum (rash on trunk and proximal limbs)
  • subcutaneous nontender nodules
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8
Q

what is erythema marginatum

A

scarlet rash

rash is rough like sandpaper

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9
Q

minor criteria for rheumatic fever

A
  • fever is spiked
  • arthralgia
  • elevated erythrocyte sedimentation rate
  • prolonged PR interval
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10
Q

how to determine if fits critera

A

-2 major or 1 mjor and 2 minor to diagnose

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11
Q

nursing diagnoses for rheumatic fever

A
  • high risk for injury (carditis)
  • pain
  • high risk for diversional activity deficit
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12
Q

treatment for rheumatic fever

A
  • bedrest until normal ESR (sed rate)
  • antiinflammatory (corticosteroids to decrease inflammation and ASPIRIN to reduce pain/fever)
  • penicillin or erythromycin to reduce risk of reccurrance
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13
Q

what analgesic is used for rheumatic fever

A

aspirin is only used in this instance (usually not used for any kids)
ibuprofen typcially given if >6 mos

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14
Q

describe steptoccal prophylaxis with rheumatic

A
  • damaged valves can sustain more damage with repeated infections
  • strep prophylaxis continues for 5 yrs through adolescence
  • *IM penicillin administered monthly
  • alternative is oral penicillin 2x daily or sulfadiazine 1x daily
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15
Q

describe kawasaki’s

A
  • cause is unkown
  • children <2
  • multisystem vasculitis (inflammation in multiple systems)
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16
Q

how do you treat kawasaki’s

A
  • ASPIRIN (start on high dose then decrease dose: 80-100 mg/kg/day in four divided doses to start)
  • IV immunoglobulin (IVIG) 2kg/kg given in single infusion to prevent cardiovascular events from happening (give quickly)
17
Q

acute phase of kawasaki’s

A

(1-2 wks)

  • high fever >5 days
  • conjunctivitis
  • red throat
  • swollen hands and feet
  • rash
  • lymphadenopathy
18
Q

subacute phase of kawasaki’s

A

(2-4 wks)

  • crackling lips/fissures
  • desquamation of skin
  • joint pain
  • cardiac disease
  • thrombocytosis
19
Q

covalescent phase of kawasaki’s

A

(6-8 wks)

  • child appears normal
  • lingering signs of inflammation
20
Q

nursing care for kawasaki’s

A
  • administer aspirin and IVIG
  • monitor for side effects (ie/ bleeding and GI upset)
  • IVIG is a blood product*** (reaction??)
  • keep skin clean and dry
  • lubricate lips
  • passive range of motion exercises to facilitate joint movement
21
Q

diagnostic criteria of kawasaki’s

A
  • need 5/6
  • fever >5 days
  • bilateral conjunctivitis w/out exudate
  • strawberry tongue, red oropharynx, dryness, erythema, fissuring of lips
  • peripheral edema, erethyma of palms or soles, peeling of feet
  • polymorphous rash
  • cervical lyphadenopathy
22
Q

20% of children with kawasaki’s develop this

A

cardiac sequele

23
Q

what is the most serious complication of kawasaki’s

A

-myocardial infarction d/t thrombotic occlusion of a coronary aneurysm

24
Q

s/s of MI in children

A
  • abdominal pain
  • V
  • restlessness
  • inconsolable
  • crying
  • pallor
  • shock
25
Q

describe dyslipidemia

A

one or more lipids with abnormal level in blood

total cholesterol, low density lipoproteins, triglycerides, high density lipoproteins

26
Q

describe hyperlipidemia

A

excessive fat and fat like substance in blood

27
Q

describe hypercholesterolemia

A

excessive cholesterol in the blood

28
Q

hyperlipidemia and hypercholesterolemia play a role in what

A

producing atherosclerosis which leads to CAD

*predispose to cardiovascular disease early

29
Q

what can help prevent CAD

A

exercise and proper diet

30
Q

presymptomatic phase of athersclerosis begins when

A

in childhood

31
Q

what is the goal of dyslipidemia

A

identify children at risk and intervene EARLY

  • screening and managing lipid levels in childhood
  • screen anyone who appears to be overweight at 4 y/r visit and has a family hx of it
32
Q

treatment of dyslipidemia

A

dietary modifications and exercise

in severe cases drug therapy (do not start with giving drugs d/t potential SE)

33
Q

describe HTN

A
  • BP persistently between 90-95% on 3 occasions
  • primary (has no identifiable cause)
  • secondary (attributable to structural abnormality or to an underlying disease)
34
Q

factors contributing to HTN

A

diet, contraceptive use, family hx, obesity, lack of adequate exercise

35
Q

treatment of HTN

A
  • focus on diet and exercise (rare to use drugs)
  • diet modification: decrease sodium and saturated fat intake, 3-5 servings fruit/day, adequate calcium and dietary fiber)
  • nonpharmalogical: decrease wt, increase exercise (30-60 min a day)
36
Q

what is important in young athletes

A

prevent cardiac death
EKG for sports physical
family hx of heart disease
*important for thorough exam for sports physicals

37
Q

describe sudden cardiac death

A
  • blunt nonpenatratory force to heart wall will cause trauma
  • abrupt ventricular fib: acquired or underlying congenital disease
  • cardiac arrest
38
Q

what are some s/s to watch for during exercise in children

A
  • chest pain
  • SOB
  • syncope
  • palpitations
  • *if any of these document and follow up with cardio eval

PEDS (24 decks)

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