Cardiac 3 Flashcards
what is important to remember when administering digoxin
-count apical pulse for full min and hold dose if <90-110 in infants or <70-85 in children
what should you observe for if administering digoxin
- observe for toxicity (arrhythmias are a sign)
- obtain serum dig level at least 6 hrs after daily dose
how is digoxin given
IV or by mouth
must maintain a therapeutic level**
describe rheumatic fever
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
what is the acute phase of rheumatic fever
2-3 wks (lasts < 3 months)
meds for strep
amoxicillin (in high doses)
azithromycin
*important to take all meds
major criteria for rheumatic fever
- joint inflammation
- carditis (new murmur, tachy)
- chorea (involuntary limb movement, slurred)
- ***erythema marginatum (rash on trunk and proximal limbs)
- subcutaneous nontender nodules
what is erythema marginatum
scarlet rash
rash is rough like sandpaper
minor criteria for rheumatic fever
- fever is spiked
- arthralgia
- elevated erythrocyte sedimentation rate
- prolonged PR interval
how to determine if fits critera
-2 major or 1 mjor and 2 minor to diagnose
nursing diagnoses for rheumatic fever
- high risk for injury (carditis)
- pain
- high risk for diversional activity deficit
treatment for rheumatic fever
- 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
what analgesic is used for rheumatic fever
aspirin is only used in this instance (usually not used for any kids)
ibuprofen typcially given if >6 mos
describe steptoccal prophylaxis with rheumatic
- 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
describe kawasaki’s
- cause is unkown
- children <2
- multisystem vasculitis (inflammation in multiple systems)
how do you treat kawasaki’s
- 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)
acute phase of kawasaki’s
(1-2 wks)
- high fever >5 days
- conjunctivitis
- red throat
- swollen hands and feet
- rash
- lymphadenopathy
subacute phase of kawasaki’s
(2-4 wks)
- crackling lips/fissures
- desquamation of skin
- joint pain
- cardiac disease
- thrombocytosis
covalescent phase of kawasaki’s
(6-8 wks)
- child appears normal
- lingering signs of inflammation
nursing care for kawasaki’s
- 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
diagnostic criteria of kawasaki’s
- 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
20% of children with kawasaki’s develop this
cardiac sequele
what is the most serious complication of kawasaki’s
-myocardial infarction d/t thrombotic occlusion of a coronary aneurysm
s/s of MI in children
- abdominal pain
- V
- restlessness
- inconsolable
- crying
- pallor
- shock
