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Module 5 (Pediatrics) > Cardiac Dysfunction > Flashcards

Cardiac Dysfunction Flashcards

1
Q

Atresia

A

absent or closure of something

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2
Q

Stenosis

A

narrowing

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3
Q

What is the blood flow through the body

A

Superior/Inferior Vena Cava
Right atrium
Tricuspid
R Ventricle
Pulmonary Valve
Pulmonary Artery (only artery with deoxygenated blood)
Lungs
Pulmonary Vein (only veins with oxygenated blood)
L Atrium
Mitral Valve
L Ventricle
Aortic Valve
Aorta
Body

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4
Q

What are the changes in the heart after birth?

A

The foramen ovale shunt in r atrium is closed
Patent ductus arteriosus closes and becomes ligamentum arteriosus

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5
Q

What is different between the fetal circulation than adult circulation?

A

fetal closes off the lungs and shunts all blood away from the lungs to the body

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6
Q

What is the normal cardiac anatomy?

A

4 chambers
superior and inferior vena cava with aorta
Tricuspid, Pulmonary, Mitral, and Aorta values
Left is systemic ha higher pressure in the normal heart due to shunting blood to the entire body
Right is pulmonary pressure is less than the systemic

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7
Q

Cardiac Pressures

A

highest (left, systemic) to lowest (right, pulmonary)

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8
Q

If there is no flow of blood, then

A

no grow due to no O2 and nutrients getting to the body

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9
Q

Congenital Heart Disease

A

abnormalities present at birth

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10
Q

Acquired Heart Disease

A

after birth
- infection
-autoimmune
- environmental
- family tendencies

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11
Q

Congenital Heart Disease results in

A

abnormal cardiac function
- major cause of death in 1st year of life

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12
Q

What is the most common defect of congenital heart defects?

A

Ventricular Septal Defect (VSD

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13
Q

Congenital Heart Disease Causes

A

90% unknown
Maternal (fetal alcohol syndrome, Dilantin (seizure meds), advance maternal age, DM, Lupus, Rubella)
Chromosome abnormality (Down Syndrome)

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14
Q

Congenital Heart Disease Physical Assessment?

A

FFT
Cyanotic or pallor (poor perfusion)
Chest enlarged
Jugular pulses distension (unusual pulsations)
Tachypnea, dyspnea, grunting
Clubbing
Palpate liver on right side failure
Murmur

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15
Q

If you can plapate the liver on assessment with s/s, then what heart failure would it be?

A

Right sided

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16
Q

If suspecting congenital heart disease, what dx procedures would they run?

A

12 LEAD ECG
XRay - cardiomegaly/pulmonary congestion
ECHO- 1-hour
MRI
Cardiac Cath

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17
Q

Cardiomegaly is when the heart size is

A

half the size of the chest

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18
Q

ECHO shows what

A

structures and blood flow patterns
baby or developmental delays need to be still
- possible PICU for sedation

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19
Q

Cardiac Catheterization can be used for

A

Diagnostic
- measure pressure and see blood flow patterns
- before surgery to see
Interventional
- Balloon procedures for narrowed valves and stents
Electrophysiology
- irregular rhythm

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20
Q

Altered Hemodynamics in Congential Heart Disease

A

Higher pressure to lower pressure
- path of least resistance

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21
Q

In Congenital Heart Disease,
higher pressure

A

faster flow

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22
Q

In Congenital Heart Disease,
higher resistance

A

slower flow

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23
Q

Left to Right Shunt means

A

blood flows from area of higher pressure to lower pressure

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24
Q

Left to Right shunt is located

A

allows blood from left ventricle into the right ventricle

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25
Q

Right to Left Shunt

A

blood shunted from the right side to the left

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26
Q

Congenital Heart Defects

A

Left to Right Shunt
Right to Left Shunt

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27
Q

Right to Left Shunt location

A

right ventricle to left ventricle with deoxygenated blood into the rest of the body

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28
Q

Right to Left Shunt can cause what

A

Pulmonary stenosis for right-sided increase
- Cyanosis starts at the mouth due to deoxygenated blood into the body

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29
Q

Congenital Heart Defects
blood flow patterns

A

Increased pulmonary blood flow
Decreased pulmonary blood flow
Obstruction to blood flow out of the heart
Mixed blood flow

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30
Q

Congenital Heart Defects with Increased pulmonary blood flow

A

Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Patent Ductus Arteriosus (PDA)

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31
Q

Increased pulmonary blood flow occurs when a

A

Defects along the septum or abnormal connection between great arteries
- Left-to-right shunting of blood
- Increased blood volume on the Right side of the Heart
- Increased Pulmonary Blood Flow

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32
Q

Atrial Septal Defect is the

A

abnormal opening between atria in the septum (failure to close of the foramen ovale)
-allows blood flow from l. atrium to r.atrium

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33
Q

The ASD, pushes more

A

blood into the lungs

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34
Q

If the ASD is a small defect, then what are the s/s?

A

asymptomatic
- paradoxical embolus

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35
Q

If the ASD is a small defect, then what are the s/s?

A

CHF is unusually possible in older children if untx
-fatigue
-SOB
-respiratory infections

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36
Q

When listening to the heart what sounds to do hear and what are the meanings?

A

LUB - closing of the atrium to ventricles (Tricuspid and Mitral)
DUB - closing of the pulmonary and aortic valves

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37
Q

What heart sound is heard with ASD?

A

LUB DU-UB
- due to the pulmonary valve closing a little later than the aorta valve because of the massive inflow of more blood than the left atria

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38
Q

ASD Tx

A

Spontaneous closure (size and age)
Transcatheter Closure
- Septal occluders - smaller defects
Surgical Closure
- small defect-suture
- large (patch with pericardial or Dacron)

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39
Q

After a septal occluder is placed, what medication should the child be on

A

low-dose aspirin for 6 months

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40
Q

Atrial Septal Defect should be repaired before

A

school age (5)

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41
Q

Ventricular Septal Defect (VSD) IS THE

A

Abnormal Opening between Right & Left Ventricles
- BLOOD FLOWS FROM THE LEFT VENTRICLE TO THE RIGHT VENTRICLE
- pinhole to no septum

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42
Q

VSD Heart sounds when ausculated?

A

In the 3rd location at the r. ventricular spot you will hear
swoosh DUB(faint) swoosh
-polo systolic murmur

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43
Q

Small VSD s/s

A

asymptomatic
o2 levels good
no physical restrictions
reassurance and periodic follow-up with cardiologist

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44
Q

Large VSD s/s

A

CHF

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45
Q

VSD Tx

A

spontaneous closure (20-60%) - size and age
Transcatheter Closure with septal occluders
Small defects - sutures
Large defects - patch pericardial/Dacron

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46
Q

What is another procedure done on VSD as a possible palliative procedure?

A

Pulmonary Artery Banding
goal: decrease pulmonary blood flow

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47
Q

Patent Ductus Arteriosus (PDA) is the

A

Failure of the Fetal Ductus Arteriosus to close within first few weeks of life

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48
Q

PDA blood flow

A

higher(Aorta) to lower (Pulmonary artery)
Left to right shunt

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49
Q

PDA location is the

A

aortic arch into the pulmonary arteries
- oxygenated blood goes into the pulmonary artery into the lungs

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50
Q

PDA small defect s/s

A

asymptomatic

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51
Q

PDA large defect s/s

A

CHF
FTT
“Machine like murmur” - washing machine
frequent respiratory infections

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52
Q

PDA Tx medication closures

A

Indomethacin (Indocin)
Premature infants
Some newborns

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53
Q

How is the ductus arteriorous kept open in the womb?

A

prostaglandin

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54
Q

Indomethacin is what type of medication

A

prostaglandin inhibitor (ductus to close)

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55
Q

PDA Tx transcatheter

A

coils

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56
Q

PDA Tx Surgical

A

Left Thoracotomy Incision for Litigation
- clamp off blood flow through the ductus
- incision is under the shoulder blade

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57
Q

Congenital Heart Defects with DECREASED pulmonary blood flow

A

Tetralogy of Fallot
Tricuspid Atresia

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58
Q

If a mother has Rubella, what defect could the infant have as a result?

A

PDA

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59
Q

Decreased Pulmonary blood flow is caused by

A

obstruction of pulmonary blood flow + anatomic defect between side of the heart **ASD/VSD

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60
Q

With low pulmonary blood flow, the pressures do what

A

right side pressures increases and exceeds left-sided pressure

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61
Q

The increase of right sided pressure leads to

A

desat blood shunted right to left and to systemic circulation
Hypoxemia and cyanosis

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62
Q

Tetralogy of Fallot (TOF) has what 4 cardiac defects?

A
  • VSD
  • Pulmonary stenosis
  • Overriding Aorta
  • R. Ventricular Hypertrophy
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63
Q

TOF blood flows from

A

right to left

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64
Q

TOF s/s

A

chronic cyanosis
tachypnea - compensate
Acute epi. of cyanosis and hypoxia
Clubbing
Impaired growth

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65
Q

TOF - Hypercyanotic Spells preceded by

A

feeding, crying, defecation, or stressful procedures

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66
Q

Hypercyanotic spells

A

infundibular spasm decrease pulmonary blood flow
Increase Right to Left shunt
- desat blood flows to the systemic circulation
- acute cyanosis and hypoxia

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67
Q

Infundibular

A

funnel-shaped

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68
Q

What can cause a decrease of BP?

A

hypovolemia
**vasodilation (meds, heat,exercise, fever)

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69
Q

Hypercyanotic spells aka

A

blue or tet spells

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70
Q

Hypercyanotic spells are frequent in

A

1st year of life with TOF
- rare less than 2 months

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71
Q

Hypercyanotic spells happen usually in the

A

morning

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72
Q

Hypercyanotic speels in the morning require

A

immediate recognition and intervention
- increase risk of emboli, seizures, LOC, death

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73
Q

What nursing interventions would you use for a hypercyanotic spell? SATA

  • Knee-Chest Position “Squatting”
  • Calm
  • Blow-by 100% O2
  • Give Morphine and repeat
  • IV Fluid replacement PRN
A
  • Knee-Chest Position “Squatting”
  • Calm
  • Blow-by 100% O2
  • Give Morphine and repeat
  • IV Fluid replacement PRN
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74
Q

What does the knee-chest squat do for a baby in hyper cyanotic spells?

A

kinks the femoral arteries and puts more blood to travel to the pulmonary system and increases left-sided pressure

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75
Q

TOF Tx

A

educate family on recognition/intervention of hypercyanotic spells
-hydration (IVF)
prevent infections (fevers to HCP)
Anemia Tx (less O2 with RBCs)

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76
Q

If the TOF is severe, what tx will be required?

A

surgical correction WITHIN 1ST year of life
- palliative shunt
-complete repair

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77
Q

TOF is Dx by

A

ECHO

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78
Q

Obstructive Congenital Heart Defects

A

Coarctation of the Aorta
Aortic Stenosis
Pulmonic Stenosis

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79
Q

Obstructive Defects are when the blood

A

exits the heart and meets anatomic narrowing (stenosis)
- obstruction to blood flow

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80
Q

Obstructive Defects increase the pressure of

A

ventricles and vessel behind obstruction

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81
Q

Obstructive Defects decrease the pressure of

A

after the obstruction

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82
Q

Coarctation of the Aorta is the

A

Narrowing of the Aorta near the insertion of the Ductus Arteriosus

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83
Q

COA increases pressure

A

proximal to the defect (near defect)
- head and upper extremities

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84
Q

COA decreases pressure

A

distal to the obstruction (away)
- body and lower extremities

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85
Q

COA S/S

A
  • Arms: elevated BP and bounding pulses
  • LEGS: low BP, weak/absent femoral pulses and in lower extremities
    CHF
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86
Q

COA Tx

A

Cath Lab through femoral
- Older infants and children: balloon angioplasty
- Adolescents: stents
Surgical Repair (< 6mn.)

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87
Q

What is the Tx of choice for an infant < 6 months with COA AND LONG-STEM STENOSIS/COMPLEX ANATOMY?

A

Surgical Repair

88
Q

Surgical Repair of COA POST-OP

A

HTN is common
- antiHTN after and wean off as the body adjusts down

89
Q

Why is a follow-up after the COA surgical repair important?

A

recoarctation
- narrow again in the future
- cardiologist for life

90
Q

Aortic Stenosis is the

A

narrowing of the aortic valve

91
Q

Aortic Stenosis can cause what

A

decrease cardiac output
left ventricular hypertrophy
pulmonary vascular congestion

92
Q

Aortic Stenosis S/S in Newborns

A

low cardiac output
faint pulses
Hypotension
tachycardia
poor feedings

93
Q

Aortic Stenosis S/S in Children

A

exercise intolerance (sudden death of children in sports)
dizzy
chest pain

94
Q

A child will develop ________ in the 1st few days of Aortic Stenosis

A

Heart failure

95
Q

If the child has mild Aortic Stenosis, they can

A

participate in most sports

96
Q

If the child has moderate to severe Aortic Stenosis, they can

A

not do competitive sports
- no sustained strenuous activities

97
Q

Aortic Stenosis Tx

A

Transcath - Balloon Valvuloplasty
Surgical = valvotomy or valve replacement

98
Q

Pulmonic Stenosis

A

narrowing of the pulmonary valve

99
Q

Pulmonic Stenosis can cause what

A

decreased pulmonary blood flow
- Right ventricular hypertrophy

100
Q

Mild Pulmonary stenosis s/s

A

asymptomatic
mild cyanosis

101
Q

Moderate - severe Pulmonary stenosis s/s

A

CHF
Cardiomegaly

102
Q

Pulmonary stenosis Tx

A

Transcatheter (Balloon valvuloplasty
- works well with this valve
Rare - surgical
Valvotomy
Valve replacement

103
Q

What are the Mixed Congenital Heart Defects?

A

Hypoplastic Left Heart Syndrome (HLHS)

104
Q

Mixed Defects are complex heart anomalies in which survival after birth depends on

A

mixing of blood from pulmonary and systemic circulations within heart chambers

105
Q

Hypoplastic Left Heart Syndrome (HLHS) is the

A

underdevelopment of the left side of the heart

106
Q

HLHS has what being the heart is underdeveloped

A

Hypoplastic left ventricle
Aortic stenosis

107
Q

Oxygenation of the body depends on what in HLHS

A

ASD (Atrial Septal Defect) or PFO (Patent Foramen Ovale

108
Q

Systemic blood flow is dependent on what in HLHS?

A

PDA (Patent Ductus Arteriosus)

109
Q

HLHS S/S

A

Mild cyanosis (Sat 75-80%)
Heart failure*
Lethargy
Cold hands and feet

110
Q

Inotropic support means

A

increase contractibility

111
Q

When the PDA closes in HLHS, the cyanosis

A

progresses an decreased cardiac output leads to cardiac collapse

112
Q

HLHS Tx

A

Stabilize with vent and inotropic support
Prostaglandin infusion to keep PDA open
Staged Reconstruction (3 operations)
- 1st week, 3-6 mn. and 2-5 y/o
Heart Transplant
- immunosuppressant and risk of rejection

113
Q

HLHS staged reconstruction does not

A

fix the issue but they can live with it

114
Q

What are the complications of Congenital Heart Defects?

A

CHF
Hypoxemia (cyanosis)

115
Q

CHF defined as

A

heart can not pump enough blood to meet the body’s demand for energy

116
Q

CHD are the clinical consequences of CHD

A

Congestive HF
Hypoxemia and Cyanosis

117
Q

CHF Causes

A

structural
- increase blood vol/pressure within the heart
Myocardial insufficiency/failure
- impaired contractibility/relax of ventricle
Excess demand
- sepsis, severe anemia

118
Q

Right-sided Heart Failure defined as

A

Right Ventricle unable to pump blood effectively into the Pulmonary Artery

119
Q

Right-sided Heart Failure increases pressure in

A

right atrium and systemic venous circulation

120
Q

Right-sided Heart Failure causes what to the other tissues

A

Hepatosplenomegaly (blood pools in the liver)
Peripheral Edema

121
Q

Left-Sided Failure
defined as

A

Left Ventricle unable to pump blood effectively into Systemic Circulation

122
Q

Left-sided Heart Failure increases pressure in

A

Left Atrium and Pulmonary Veins

123
Q

Left-sided Heart Failure causes what to the other tissues

A

elevated pulmonary pressures
pulmonary edema

124
Q

In one sided heart failures, the blood is causing problems in

A

other area and pumps backward

125
Q

Children get what type of heart failure

A

Both

126
Q

CHF Dx

A

based on s/s - tachypnea and cardia
- low tolerance feeds
- poor growth
CXR
ECG
ECHO
Cardiac Cath

127
Q

ECG shows what

A

heart working harder

128
Q

ECHO shows

A

function and defects

129
Q

Cardiac Cath shows

A

structural abnormality to cause the failure

130
Q

CHF S/S

A

Difficulty feeding → Failure to Thrive (FTT)
Tachypnea/tachycardia at rest
Dyspnea
Retractions
Activity Intolerance
Weight Gain r/t fluid retention
Hepatomegaly
Peripheral edema – periorbital and face

131
Q

CHF Goals

A

Improve Cardiac Function
Remove accumulated fluid & sodium
Decrease cardiac demands
Improve oxygenation/decrease oxygen consumption
Support Family

132
Q

CHF Tx medication to Improve Cardiac Function

A

Digitalis Glycoside
- Digoxin (Lanoxin)
ACE inhibitors
- Captopril (Capoten)
- Enalapril (Vasotec)
- Lisinopril
Beta-blockers (chronic)
- Carvedilol (Coreg)

133
Q

ACE inhibiors end in

A

-pril

134
Q

Digitalis Glycosides - Digoxin have what effect on the heart

A

Chronotropic effect (effects rate of the heart)
Inotropic effect (effects contractibility of the heart)

135
Q

What does Digoxin do to the body to contract of the heart?

A

increased cardiac output
decrease heart size and venous pressure
edema relief

136
Q

Digoxin signs of toxicity

A
137
Q

When do you withhold digoxin for infants and young children?

A

Apical pulse is < 90-110

138
Q

When do you withhold digoxin for older children?

A

<70 apical pulse

139
Q

When do you withhold digoxin for adults?

A

<60

140
Q

S/S of Digoxin Toxicity

A

Nausea, Vomiting, Anorexia, Bradycardia, Dysrhythmias

141
Q

Do not mix digoxin with

A

food or fluids

142
Q

If you miss a digoxin dose, then

A

DO NOT give extra/2nd dose

143
Q

If your child vomits the digoxin dose, then

A

DO NOT give extra/2nd dose

144
Q

Digoxin should be

A

locked up and call poison control if accidental overdose

145
Q

Before the parents leave with their child on Digoxin, the nurse should ensure

A

return demonstration with parents
- draw up the correct dose
and written instructions

146
Q

K and Digoxin have wat type of relationship

A

inverse

147
Q

ACE Inhibitors do what

A

inhibit normal function of the RAAS by **blocking Angiotensin 1 to Angiotensin 2

148
Q

ACE inhibitors result in what?
vasoconstriction
vaso-occlusion
vasorupture
vasodilation

A

vasodilation

149
Q

ACE’s vasodilation cause what to decrease

A

pulmonary/systemic vascular resistance
decreased BP
afterload reduction
reduces aldosterone secretion = lower preload
- no vol expansion from fluid retention
- decrease risk of low K

150
Q

Aldosterone retains _____ and excretes ____

A

Na; K

151
Q

Nursing Alert! ACE inhibitors block the action of aldosterone, so what also needs to be added to the drug regimen of patients with diuretics?
It could cause?

A

K supplements/spironolactone
- could cause HIGH K

152
Q

ACE inhibitor’s side effects

A

Hypotension
Dry Cough
Renal Dysfunction

153
Q

Beta Blockers are used in

A

chronic HF

154
Q

Carvedilol (Coreg)
BLOCK

A

alpha and beta-adrenergic receptors

155
Q

Beta Blockers do what

A

lower HR, BP and vasodilate

156
Q

Beta Blockers side effects

A

dizzy
HA
low BP

157
Q

CHF Tx for removing too much fluid and Na

A

Diuretics
Restriction of Fluid and Na

158
Q

What diuretics arr used in CHF tx

A

Furosemide (Lasix)
Chlorothiazide (Diuril)
Spironolactone (Aldactone)

159
Q

What needs to be monitored while on diuretics

A

I&Os and daily weights
S/S of Dehydration
Serum Electrolytes
S/S of Adverse Reactions

160
Q

What should the patient eat in response to having K-losing diuretics?

A

HIGH IN K
- bananas
- avocados
- apricots
- green leafy veggies

161
Q

Fluid restriction in what stage of CHF

A

ACUTE
with Strict I&Os

162
Q

Na Restriction in children is usually

A

less due to negative effects on appetite and growth
- Avoid additional table salt/highly salted foods

163
Q

Infants are not normally on fluid restriction. What are other ways to fluidly “restrict” them?

A

increase calorie density of the formula
increase slowly

164
Q

CHF Tx Mgmt of decrease cardiac demands

A

Minimize metabolic need with
maintain body temp, (thermoregulation)
tx infection quickly,
reduce breath effort (Semi-Fowler)
sedate if irritable
sound sleeping
cluster care
Feed when hungry

165
Q

Maintain body temperature with

A

thermoregulation
antipyretics
warm blankets if cold

166
Q

How do you reduce the effort of breathing in CHF patients?

A

semi-Fowler position
- HOB
-in carriers

167
Q

What would you do when the CHF patient is hungry?

A

every 3 hours soon after awakening
- soft nipple
semi-upright
ONLY for 30 MIN then gavage
increase calorie density (SIM-Advance)

168
Q

Why is feeding a baby only 30 minutes?

A

after 30 minutes, you are burning more calories than taking in

169
Q

How do you improve the O2 of a CHF patient?

A

RR counting for 1 minute
HOB elevated for chest expansion
Supplemental O2 and monitor response

170
Q

What can the nurse do to support the family of a patient with CHF?

A

Anticipatory prep
econmic status
commnunicate
constant reassurance
written instruction
support groups

171
Q

Hypoxemia and Cyanosis occur due to

A

Heart Defects that cause/allow Desaturated Venous Blood to enter Systemic Circulation without passing through Lungs

172
Q

Chronic Hypoxemia S/S

A

Polycythemia
Clubbing (frog)

173
Q

Polycythemia is the

A

increase of RBCs to compensate for low O2
- increase blood thickness
- crowds clotting

174
Q

Clubbing can cause

A

Chronic tissue hypoxemia
Polycythemia

175
Q

Acquired CV Disorders occur

A

after birth
- normal hearts or with Congenital defects

176
Q

Acquired Heart Defects result from various factors which are: SATA.
Infection
Autoimmune
In Utero
Environmental
Family Tendencies

A

Infection
Autoimmune
Environmental
Family Tendencies

177
Q

Acquired Heart Defects

A

Rheumatic Fever
Infective Endocarditis
Kawasaki Disease
Multisystem Inflammatory Syndrom in Children

178
Q

Rheumatic Fever is what type of disease

A

inflammatory

179
Q

Rheumatic Fever occurs as a reaction to

A

Group A Beta-Hemolytic Streptococcal (GABHS) Pharyngitis
within 2-6 weeks after untreated

180
Q

Rheumatic Fever occurs most commonly in

A

5-15 y/o

181
Q

Risk Factors of Rheumatic Fever

A

History of Group A Strep infection

Family history

Environmental factors
- underdeveloped countries

182
Q

Rheumatic Fever follows a

A

recent hx of strep throat infection
elevated or rising ASO Titer

183
Q

Complications of Rheumatic Fever

A

Inflammation in joints, skin, brain, and heart
Inflammation causes permanent cardiac valve damage (Rheumatic Heart Disease)
Most common – Mitral Valve Damage

184
Q

Major S/S of Rheumatic Fever

A
  • Polyarthritis, carditis, erythema marginatum, chorea, subcutaneous nodules
185
Q

Chorea

A

little jerky mvmts

186
Q

Minor S/S/Labs of Rheumatic Fever

A

Arthralgia (no arthritis)
Fever
Lab findings consistent with inflammation
Elevated Erythrocyte Sedimentation Rate (ESR)
Elevated C-Reactive Protein (CRP)

187
Q

The Dx criteria for RF is

A

2 Major Manifestations
OR
1 Major and 2 Minor S/S
= HIGH PROBABILITY OF RF

188
Q

TX for RF

A

Penicillin for 10 days with daily antibiotics FOR 10 years
Aspirin/Prednisone
- reduce fever/discomfort and inflammation
Bedrest

189
Q

Prevention of RF

A

treat strep/scarlet fever completely

190
Q

Infective Endocarditis

A

Infection of the valves and inner lining of the heart caused by bacteria enters the bloodstream and settles in the heart lining, heart valve, or blood vessel

191
Q

Causes of IE

A

ORGANISMS ENTER BLOOD STREAM FROM ANY SITE OF LOCALIZED INFECTION
- grow on the endocardium form vegetations

192
Q

IE Risk factors

A

children with acquired or congenital heart anomalies
- SURGICAL REPAIR AND PALLIATIVE SURGERY
Mixed, valve abnormal, shunts, ASD, PDA, TOF

193
Q

Most common organisms in IE

A

Strep Viridans
Staph Aureus

194
Q

Infective Endocarditis S/S

A

History of dental procedure, Tonsillectomy & Adenoidectomy, Urinary or Intestinal Tract procedure
Unexplained fever
Weight loss
Lethargy
Malaise
Anorexia
New murmur or change in previously existing one
Blood culture

195
Q

Infective Endocarditis Complications

A

Stroke & organ damage
Forms vegetation and breaks off to other parts of the body
Infections/Abscesses
Heart Failure

196
Q

Infective Endocarditis Tx

A

Cultures
Antibiotics (IV High dose for 2-8 weeks)
ECHO daily to monitor infection site

197
Q

Prevention of Infective Endocarditis

A

Oral Hygiene
Antibiotics for higher risk
- Amoxicillin 1 hour before dental procedure

198
Q

Kawasaki Disease

A

Acute Systemic Vasculitis
- Small and medium-sized blood vessels
Unknown Etiology

199
Q

What is normally the area of involvement for Kawalsaki Disease?

A

coronary artery aneurysms

200
Q

Kawasaki Disease is TX

A

self-limiting
resolves in 6-8 weeks

201
Q

Risk Fcators for Kawalaski

A

under 5
male
asian

202
Q

Dx of Kawalaski Disease

A

no specific test
CRP, ESR, Platelets

203
Q

Kawasaki Disease Acute Phase (1ST 10 DAYS) S/S

A

Very Irritable
Fever for 5+ days
Erythema/Edema of Hands & Feet
Bilateral CONJUCTIVITIS
Strawberry tongue/Diffuse redness of oral cavity
Polymorphous Rash
Cervical Lymphadenopathy

204
Q

Polymorphous Rash

A

Irregular rash along with palms and sole of the feet

205
Q

Kawasaki Disease (KD) Subacute Phase S/S

A

Begins when Rash/Fever/Lymphadenitis resolved
Desquamation of Fingers/Toes – peeling
Continued irritability
Cardiovascular changes may occur
May experience thrombocytosis
(Platelet count > 600,000 – 800,000)

206
Q

What is the platelet count in Kawasaki Disease sub acute phase?

A

600,000-800,000

207
Q

How long is the Kawasaki Disease (KD) Subacute Phase

A

11-25 days

208
Q

KD Convalescent Phase begins when

A

ALL s/s resolved
blood back to normal
Beau’s line on finger and toe nails

209
Q

Tx of KD

A

IV Gamma Globulin (IVGG) – High doses
Aspirin (fever and inflammation in acute then antiplatelet after fever)

210
Q

IV Gamma Globulin (IVGG) – High doses
does what in Tx of KD

A

reduces the incidence of coronary artery abnormalities

211
Q

KD Nursing Interventions

A

VS, I&O, daily weights
- clear liquids and soft food with acute phase
Rest and calm environment
cool cloths, normal lotions, loose clothing
mouth care nd chap stick

212
Q

Multisystem Inflammatory Syndrome in Children (MIS-C) is associated with

A

COVID-19
affecting
Heart
Lungs
Kidneys
Brain
Skin
Eyes
GI

213
Q

MIS-C Patho

A

Possibly immune-mediated, triggered by COVID-19

214
Q

MIS-C S/S

A

Temp ≥ 38° C for ≥ 24 hrs
Labs r/t inflammation (CRP, ESR, Procalcitonin, etc.)
Need for hospitalization r/t multisystem (≥2) organ involvement
No alternative plausible diagnosis
Positive for COVID-19 (current or recent) or exposure within 4 weeks of symptoms

215
Q

Tx of MIS-C

A

Similar to Kawasaki
IVIG
Systemic glucocorticoids
Antivirals (during acute illness)
Mechanical ventilation
ECMO

Module 5 (Pediatrics) (27 decks)

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