cardiac peds Flashcards
group A hemolytic strep (GAS) connected to what disease?
connected to rheumatic fever
Rheumatic Fever (RF)- Definition - think rheumatic
- Inflammatory connective tissue disease following -
Group A B-hemolytic streptococcal pharyngitis (GAS) infection - Potentially serious consequences to the heart * Affects: joints, brain, skin tissues
Rheumatic Fever - patho (just antibodies)
Autoimmune response
– Body generates antibodies – to destroy bacteria
– Structural similarity between the bacterial cell wall and heart valve tissue
– Results in damage to the valves from the body’s own immune system
know difference between
rheumatic fever and rheumatic heart disease
Rheumatic Fever - FACTS
Favored by poor living conditions & overcrowding
* Lack of health care * Lack of knowledge
Rheumatic Fever Etiology - when do hallmark signs appear?
(Rhemy is my fav number)
- Major or hallmark signs may occur 1-3 weeks
- After untreated or partially treated group A beta-hemolytic streptococcal infection
5 Major Clinical Manifestations (rheumatic fever is a SPECC on the door)
- Carditis
- Polyarthritis
- Erythema marginatum
- Subcutaneous nodules
- Chorea
Rheumatic Fever - which test for the criteria? (it’s a name)
jones - on test
Rheumatic Fever affects what part of the heart?
heart valves
1st Major Manifestation: Carditis
Inflammation of the heart
* Types:
* Pericarditis: inflammation of the pericardium
* Myocarditis: inflammation of myocardium-heart muscle
* Endocarditis: inflammation of the endocardium
Carditis - symptoms - what kind of heart sounds?
- Chest pain
- Fatigue
- Fever
- Tachycardia
- Pericardial friction rub
- CHF – signs and symptoms
- Cardiomegaly
- Chest x-ray
- Echocardiogram
- Activity restrictions
Carditis - does it cause permanent damage?
Progressive valve damage in time * Involvement of mitral or aortic
* ONLY manifestation
to cause permanent damage
Polyarthritis - RF
Polyarthritis: 2 or More Large Joints
Polyarthritis - what locations in the body?
- Wrists
- Hips
- Elbows
- Shoulders * Knees
- Ankles
- Pain
- Swelling – (edema) * Tenderness
- Heat
- Erythema - Red
- Inflammation
know mitral
aortic valves
5th Major Manifestation: Chorea - RF
(corey is a spaz)
St Vitus Dance
or Sydenham chorea (SD)
* Involuntary, purposeless, jerking movements of arms, legs, and face
* Facial grimacing
* Speech disturbances
* Emotional changes
5th Major Manifestation: Chorea - does it go away? after how long?
(Korea is only 5)
Increased by anxiety & attempts at fine motor
* Will eventually disappear – Can last 5-15 weeks
Antistreptolysis (ALSO) (ASOT)
Antistreptolysis-O (ASLO) titers
measures the concentration of antibodies formed in the blood against Streptolysin-O
* Titers rise 7 days after onset reach maximum levels 4-6 weeks
* (2) rising ASLO evidence recent strep infection
Clinical Management for RF - what meds?
- Penicillin – acute & long term (Intramuscular benzathine Penicillin G)
- Or erythromycin
- Aspirin – fever, arthritis, & arthralgia’s
- Corticosteroids - if significant Carditis
People who have RF or RHD - does it reoccur?
- At risks for recurrent episodes
- Following streptococcal throat infection * IF –they do not receive regular penicillin * Injections or oral
ALSO is
(also the titer)
the titer
Kawasaki Disease (KD) - is there a fever?
- Acute febrile, systemic vascular inflammatory disorder
- Leading cause of acquired heart disease
- Generalized vasculitis of unknown etiology
Who’s at Risk? Kawasaki Disease (KD)
50% occur in children under 2 years old * 80% are younger than 5 Years-old
* Higher incidence in
– Asian and Pacific Island origin
use aspirin instead of tylenol
because of the platelets
Kawasaki Disease (KD) - is it person to person?
- Etiology unknown
- Not spread person-person
- Geographic & seasonal outbreaks * Late winter and early spring
- Pediatric illness which suggests (?) passive immunity
Etiology and Pathophysiology - Kawasaki Disease (KD) - what part of the heart is affected?
- Infectious or possibly toxic trigger initiates immune response
- Multisystem inflammatory disease
- Affects small, midsize, & coronary arteries * Can cause aneurysms
Pathophysiology - kawaski
- Infiltration causes edema and inflammation
- Weakened vascular walls
- Leading to aneurysms
- Fibrous connective tissue forms
- Thickening and scarring the vascular walls
Pathophysiology - kawasaki
Vascular changes can cause:
– Thrombus formation
– Myocardial infarction – Death in some children
Other complications:
* Myocarditis
* Impaired left ventricular
function
* Valve regurgitation * Arrhythmia
* Pericardial effusion
Clinical Manifestations - 3 stages of kawasaki
- Acute
- Subacute
- Convalescent
Acute Stage - kawasaki - lasts how long?
(a cutie only lasts for 1-2 weeks)
- Lasting 1-2 weeks
- Extreme irritability & inconsolable
- Unresponsive to antibiotics & antipyretics
Acute Stage – clinical signs
- kawaski - eyes?
(bloodshot kawaski)
- Extremely bloodshot eyes/red eyes (without pus or drainage)
- Inflammation of pharynx & oral mucosa
kawasaki - Acute Stage - tongue?
(a cutie has a strawberry tongue)
Acute Stage - Strawberry Tongue red tongue with prominent papillae
Acute Stage- kawasaki - what about palms?
(a cute kawaski makes me red)
- Red palms of hands and soles of feet
- Edematous – hands & feet, palms & soles erythematous
Acute Stage - kawasaki - lymph nodes - one side or both?
- Unilateral swollen cervical lymph nodes 1.5 cm/larger
Subacute Stage - kawasaki - skin?
(peeling submarine)
- Peeling of skin in the genital area, hands and feet (esp. around nails, palm, and soles)
Subacute Stage - kawasaki - what is the skin like?
Bright red, chapped, or cracked lips
* Peeling under fingertips & toes of hands and feet
* Joint pain
* Cardiac disease
Convalescent Stage 6-8 weeks - kawasaki - what might be present?
Child appears normal
* Lingering signs of inflammation
* Thrombocytosis (high platelet count) may be present
* Arthritis may continue
* Cardiac complications still a concern
Diagnostic Criteria cont - kawasaki - how many symptoms do you need?
(4 kawasaki motorcycles)
4 of 5 principal features present
* Not explained by other disease process
Less than 4 criteria present
* Echocardiography or angiography – reveal coronary artery abnormalities
what tests for kawasaki - is there anemia?
- WBC - elevated
- Anemia
- Erythrocyte
sedimentation rate (ESR) - C-Reactive protein
- Platelet counts
- Urinalysis – may show pus
- Elevated liver enzymes
- Chest-x-ray
- Echocardiogram/angi
ogram * ECG
Clinical Management - kawasaki - what meds?
(IV for kawasaki)
- Preventing or reducing coronary artery damage
- High dose IV immune globulin (IVIG) * Salicylate therapy (ASPIRIN)
Clinical Management - kawasaki - IVIG
(I’ve got kawasaki)
IVIG - * Reduces duration of fever & inflammation
* Reduces incidence of coronary artery abnormalities & aneurysms
Clinical Management - kawasaki - Aspirin Therapy
- Control fever and promote comfort
- 80-100 mg/kg/day in 4 divided doses (every 6 hours)
- Afebrile 2-3 days
- 2 – 5 mg/kg/day
- Low-dose continues if…
– Platelet count returns to normal (6-8 weeks)
– Coronary abnormalities develop
NURSING ALERT - kawasaki
ADMINISTRATION OF IVIG
* Follow hospital guidelines for blood products
* IV Diphenhydramine
* Monitoring of vital signs
If adverse reaction
* Rash, fever, shaking, facial flushing, chest tightness, or chills
– DC infusion immediately & notify provider
Nursing Tip - kawasaki
- ADMINISTRATION OF ASPIRIN
- Give with meals, with milk or an antacid to prevent GI upset.
- Monitor for side effects - bleeding
- If flu or chickenpox is suspected – discontinue and notify provider
Discharge Teaching - kawasaki - what about temp?
- Information about KD
- Importance of follow- up
- Passive ROM, antiarthritic agents
- Take temperature for 2 weeks – keep log
- CallifTempabove- 38.3 C (101F)
Discharge teaching - kawasaki
- How to administer ASA
- Watch for side effects
- Stop ASA if exposed to chicken pox or influenza (Reye syndrome)
- Follow-up care to monitor cardiac complications
- CPR
Discharge Teaching - kawasaki - how long for antiplatelet therapy?
Coronary Abnormalities
* Indefinite antiplatelet therapy
* Avoid contact sports – bleeding
* Limit strenuous activity
Stay Healthy
* Yearly influenza vaccine * MMR/Varicella delayed
for 11 months after IVIG – Body may not produce appropriate amount of
antibodies * Nutrition
Nursing Considerations - kawasaki
- Challenging
- Symptomatic relief
- Emotional support
- Diagnostic assistance
- Medication administration
- Education of child and family
know which direction
heart shunts
know the defects
PDA, ASV, and VSD
shunts - know these
4th Major Manifestation: Subcutaneous Nodule on Elbow - RF - are they painful?
Non-tender,0.5-1cm, persist indefinitely, gradually resolve, rare, may be found in crops; feet, hands, elbows, scalp, scapulae & vertebrae.
Jones criteria for diagnosing acute rheumatic fever:
(Jones is major)
major, minor and evidence of strep
Diagnosis requires 2 major, or 1 major and 2 minor, criteria and evidence of streptococcal infection or chorea alone
jones - major criteria - just the 5 you memorized - by the door
Major criteria
* Carditis-tissue inflammation or new changing murmur
* Polyarthritis-migratory pain in limb joints
* Chorea-abrupt, purposeless movements
with or without emotional changes
* Erythema marginatum-nonpruritic rash,
spares face
* Subcutaneous nodules-painless, firm, on
bones or tendons
jones - minor criteria
- Fever
- Arthralgia
- Previous acute RF or RHD
- Acute-phrase reactants-
erythrocyte sedimentation rate, C-
reactive protein, leukocytosis - Electrocardiogram-prolonged PR
level
jones - evidence of strep
- *
Positive throat culture/Positive rapid strep antigen detection tests
Elevated antistreptolysin 0 titer (ASOT)
Scarlet fever
polyarthritis - how long is it painful for?
(poly can only last a day)
- Painful for 1-2 days after which another joint is affected
kawaski disease - inflammation of what?
- Involves inflammation of small & medium sized arteries
- Including coronary arteries - most susceptible
kawaski - what’s the rash like?
- Skin rashes on the trunk & perineum, NOT blister-like - may desquamate
acute stage - kawaski - stomach pain?
- Diarrhea – abdominal pain * Hepatic dysfunction
kawaski - subacute stage - how long does it last?
(24 is below a cutie)
Lasting 2-4
weeks
kawaski - subacute stage - what about the heart? at risk for what?
(kawaski throbs)
Cardio vascular manifestations Heart failure Arrhythmias
Thrombocytosis - High risk
kawaski - convalscent stage - what about blood values?
- Phase complete – all blood values normal (6-8 weeks)
- Normal temperament, energy, & appetite
when to give IVIG for Kawasaki?
(one week for IV)
- When given within 7-10 days
- Single large infusion 2 g/kg over 10
-12 hours - Start - 0.5 ml/kg/hour for 30
minutes - Gradually increase to 2 ml/kg/hour
PDA shunt
left to right
ASD shunt - shunt which direction?
left to right
VSD - which way is the shunt?
(vent to the left)
left to right
kawaski acute stage - how long does the fever last?
(kawasaki is hot for more than 5 days)
- High fever (longer than 5 days)
