Cardiac PP Flashcards
what is important to start with in cardiac pt.
health history physical assessment (palpate/auscultate)
what s/s on the physical assessment will we find?
turbulent blood flow (heart murmur) irritable/weak cry cyanosis (during activity) tires/sweats while eating FTT - underweight (high metabolic state, poor feeders, plot at or below 5th percentile)
what are we looking for in the health history for cardiac pt?
family hx: marfan syndrome, digeorge syndrome
siblings
congenital abnormalities
maternal (rubella)
s/s of cardiac problems in the older child
chest pain (verbalized)
decreased activity
syncope (fainting)
FTT
if pt. in a squatting position or knee/chest what do we assume?
tetralogy of fallot
“tet squat”
when is tetralogy of fallot treated
early in infancy
if pt. underwent a “tet” spell what interventions would we do
blow-by oxygen
morphine (iv, sub-q), Inderal
calming
place pt. in knee-chest position
dx tests for cardiac defects
x-ray (cardiomegaly)
holter monitor (24 hr. ekg)
ekg
trans-esophageal echocardiogram (invasive)
some apnea can be expected in peds pt. t or f
true, called periodic breathing
15sec in neonate
20sec in infancy
the best cardiac treatment and dx method
cardiac catheterization
note seafood or iodine allergy (dye)
pre-procedures for cardiac cath
accurate height and weight-determines size of equipment
vitals
h&h (stable)
identify pedal pulses (mark)
NPO - 6 hrs. prior to procedure
iv if child is polycythemic (increased rbc)
post cardiac cath procedures
vitals
monitor for toxicity to dye(itching)
home care instructions for card. cath
keep dressing dry/clean in place (24 hours)
avoid exercise
observe site for infection
what is congestive heart failure
heart is ineffective as a pump
congestive heart failure in children under 1 year of age is due to
congenital anomalies
congestive heart failure in children over 1 year with no congenital anomaly may be r/t
acquired diseases (Kawasaki)
**1 of the earliest signs of CHF
tachycardia
s/s of CHF
fatigue irritability hepatomegaly tachypnea cardiomegaly infant resting pulse of over 160-notify provider
normal HR for an infant
120-140
goals of trt for CHF
improve cardiac contractility (digoxin, diuretics, ace inhibitors (prils)
decrease intravascular fluid volume (lasix) - restrict salt and water
provide soothing environment
preserve energy and decrease metabolic demands
***small frequent feedings (increase calories)
what can we do to increase calories for a child
enteral feedings - supplemental feedings
widen the nipple - not working so hard to feed
interventions for CHF
fluid/sodium restrictions diuretics - be sure to take in potassium bed rest - preserve energy - decrease oxygen demands oxygen - monitor w/sedatives small freq feeds pulse ox cluster care daily weights for water balance loosely attach diapers check temp q4 hrs
VSD s/s
presence of a murmur (turbulent blood flow)
dyspnea on exertion
recurrent resp infections
mgmt of VSD
medications that increase cardiac output (inotropic)
placement of patch to hole so ventricles don’t communicate
nurs dx of VSD
decreased cardiac output activity intolerance ineffective tissue perfusion fluid vol excess risk for injury (cardiac cath) risk for growth and development delay
preop for VSD
prepare child w/age approp. explanations
monitor baseline VS
teach parents what they can expect
post op VSD monitor
hydration status
hemorrhage
encourage fluid intake - eliminates dye
s/s of CHF (tachypnea in left sided HF) - edema, crackles in lungs (fluid is backing up)
trt of CHD w/ increased pulmonary blood flow
limit feedings to 30 minutes
daily weights
cluster care
HOB elevated
what is bacteremia
bacteria in the blood
bacterial endocarditis comes from
bacteremia
what types of bacteria lead to bacterial endocarditis
strep
staph
what is bacterial endocarditis
infection in valves and endocardial surface of the heart
assess for a hx of this with bacterial endocarditis
congestive heart disease
Kawasaki disease
rheumatic fever
prosthetic valves implanted
prevent bacteremia during dental trt/care with?
prophylactic antibiotics
can bacterial endocarditis lead to heart failure
yes - resolve infections, can effect heart and valves
bacterial endocarditis is treated with this
long term antibiotic therapy (2-8 weeks)
requires picc line
do we require repeat blood cultures w/BE
yes - evaluating effect of treatment
is there a surgical approach to BE
yes. scrape heart valve or valve replacement
an ACQUIRED infection that can be the response from a strep throat infection
rheumatic fever
what causes rheumatic fever
a group a b-hemolytic streptococcus
impetigo
rheumatic fever effects..
joints - can lead to arthritis or can effect movements (**chorea/st Vitus dance) - heat/cold trt
skin - subcutaneous nodules over bony prominence’s; aschoff bodies (bolus lesions in connective tissue (heart vessels, brain))
can rheumatic fever lead to CHF
yes - can lead to carditis (inflammation of the heart) which can lead to HF
a s/s of rheumatic fever
Rash of trunk/extremities (erythema marginatum)
ideal trt for rheumatic fever
penicillin
salicylate therapy - reduce fever
corticosteroids
is there dx criteria for rheumatic fever
yes - Jones criteria
serum blood test - anti-streptomycin titer
rheumatic fever serum blood test (aslo) is positive for rheumatic fever when
rising ASO (anti-streptomycin) titers between 2 blood draws
OR
greater than 333 Todd units
most common acquired heart disease in children worldwide
rheumatic heart disease
Kawasaki disease is also known as this
Mucocutaneous lymph node syndrome
In Kawasaki disease what 2 conditions are we concerned with
Vasculitis - Inflammation of vessels leading to aneurysms, which can rupture leading to death
Increased platelet formation - risk for an MI
trt for Kawasaki disease
salicylate therapy - 2 purposes
high dose to reduce inflammation(80-100 mg/kg/day)
afebrile for 48-72hrs -low dose salicylate for anti-platelet effect to avoid MI
IVIG - intravenous immunoglobulin G
3 phases to Kawasaki disease
acute phase - abrupt onset of high fever for 4 days, unresponsive to trt; irritability; conjunctivitis (dry); strawberry tongue; edema of hands/feet
sub-acute phase - resolution of fever but platelet count is high; (periungual desquamation) peeling of fingers/toes; thrombosis may occur
convalescent stage - lasts anywhere from 4-6 weeks, outward signs have disappeared
Labs r/t Kawasaki disease
*elevated ESR (erythrocyte sedimentation rate), WBC count, Platelet counts
s/s of MI in a young child are VAGUE and include:
*abdominal pain vomiting restlessness inconsolable crying pallor
add warfarin to trt for Kawasaki when this is seen
> 8mm aneurysm
should we hold vaccines in children with Kawasaki’s
yes delay MMR and varicella due to IVIG; immunizations are not effective in creating an immune response; up to 1 year
trt ivig like this
a blood transfusion
often times there will be a prn order for benadryl and epineprhine in case of an allergic reaction to the IVIG
