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Mgmt PEDS > Cardiac PP > Flashcards

Cardiac PP Flashcards

1
Q

what is important to start with in cardiac pt.

A 
health history 
physical assessment (palpate/auscultate)
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2
Q

what s/s on the physical assessment will we find?

A 
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)
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3
Q

what are we looking for in the health history for cardiac pt?

A

family hx: marfan syndrome, digeorge syndrome
siblings
congenital abnormalities
maternal (rubella)

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4
Q

s/s of cardiac problems in the older child

A

chest pain (verbalized)
decreased activity
syncope (fainting)
FTT

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5
Q

if pt. in a squatting position or knee/chest what do we assume?

A

tetralogy of fallot

“tet squat”

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6
Q

when is tetralogy of fallot treated

A

early in infancy

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7
Q

if pt. underwent a “tet” spell what interventions would we do

A

blow-by oxygen
morphine (iv, sub-q), Inderal
calming
place pt. in knee-chest position

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8
Q

dx tests for cardiac defects

A

x-ray (cardiomegaly)
holter monitor (24 hr. ekg)
ekg
trans-esophageal echocardiogram (invasive)

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9
Q

some apnea can be expected in peds pt. t or f

A

true, called periodic breathing
15sec in neonate
20sec in infancy

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10
Q

the best cardiac treatment and dx method

A

cardiac catheterization

note seafood or iodine allergy (dye)

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11
Q

pre-procedures for cardiac cath

A

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)

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12
Q

post cardiac cath procedures

A

vitals

monitor for toxicity to dye(itching)

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13
Q

home care instructions for card. cath

A

keep dressing dry/clean in place (24 hours)
avoid exercise
observe site for infection

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14
Q

what is congestive heart failure

A

heart is ineffective as a pump

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15
Q

congestive heart failure in children under 1 year of age is due to

A

congenital anomalies

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16
Q

congestive heart failure in children over 1 year with no congenital anomaly may be r/t

A

acquired diseases (Kawasaki)

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17
Q

**1 of the earliest signs of CHF

A

tachycardia

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18
Q

s/s of CHF

A 
fatigue
irritability
hepatomegaly
tachypnea
cardiomegaly
infant resting pulse of over 160-notify provider
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19
Q

normal HR for an infant

A

120-140

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20
Q

goals of trt for CHF

A

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)

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21
Q

what can we do to increase calories for a child

A

enteral feedings - supplemental feedings

widen the nipple - not working so hard to feed

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22
Q

interventions for CHF

A 
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
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23
Q

VSD s/s

A

presence of a murmur (turbulent blood flow)
dyspnea on exertion
recurrent resp infections

24
Q

mgmt of VSD

A

medications that increase cardiac output (inotropic)

placement of patch to hole so ventricles don’t communicate

25
Q

nurs dx of VSD

A 
decreased cardiac output
activity intolerance
ineffective tissue perfusion
fluid vol excess
risk for injury (cardiac cath)
risk for growth and development delay
26
Q

preop for VSD

A

prepare child w/age approp. explanations
monitor baseline VS
teach parents what they can expect

27
Q

post op VSD monitor

A

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)

28
Q

trt of CHD w/ increased pulmonary blood flow

A

limit feedings to 30 minutes
daily weights
cluster care
HOB elevated

29
Q

what is bacteremia

A

bacteria in the blood

30
Q

bacterial endocarditis comes from

A

bacteremia

31
Q

what types of bacteria lead to bacterial endocarditis

A

strep

staph

32
Q

what is bacterial endocarditis

A

infection in valves and endocardial surface of the heart

33
Q

assess for a hx of this with bacterial endocarditis

A

congestive heart disease
Kawasaki disease
rheumatic fever
prosthetic valves implanted

34
Q

prevent bacteremia during dental trt/care with?

A

prophylactic antibiotics

35
Q

can bacterial endocarditis lead to heart failure

A

yes - resolve infections, can effect heart and valves

36
Q

bacterial endocarditis is treated with this

A

long term antibiotic therapy (2-8 weeks)

requires picc line

37
Q

do we require repeat blood cultures w/BE

A

yes - evaluating effect of treatment

38
Q

is there a surgical approach to BE

A

yes. scrape heart valve or valve replacement

39
Q

an ACQUIRED infection that can be the response from a strep throat infection

A

rheumatic fever

40
Q

what causes rheumatic fever

A

a group a b-hemolytic streptococcus

impetigo

41
Q

rheumatic fever effects..

A

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))

42
Q

can rheumatic fever lead to CHF

A

yes - can lead to carditis (inflammation of the heart) which can lead to HF

43
Q

a s/s of rheumatic fever

A

Rash of trunk/extremities (erythema marginatum)

44
Q

ideal trt for rheumatic fever

A

penicillin
salicylate therapy - reduce fever
corticosteroids

45
Q

is there dx criteria for rheumatic fever

A

yes - Jones criteria

serum blood test - anti-streptomycin titer

46
Q

rheumatic fever serum blood test (aslo) is positive for rheumatic fever when

A

rising ASO (anti-streptomycin) titers between 2 blood draws
OR
greater than 333 Todd units

47
Q

most common acquired heart disease in children worldwide

A

rheumatic heart disease

48
Q

Kawasaki disease is also known as this

A

Mucocutaneous lymph node syndrome

49
Q

In Kawasaki disease what 2 conditions are we concerned with

A

Vasculitis - Inflammation of vessels leading to aneurysms, which can rupture leading to death
Increased platelet formation - risk for an MI

50
Q

trt for Kawasaki disease

A

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

51
Q

3 phases to Kawasaki disease

A

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

52
Q

Labs r/t Kawasaki disease

A

*elevated ESR (erythrocyte sedimentation rate), WBC count, Platelet counts

53
Q

s/s of MI in a young child are VAGUE and include:

A 
*abdominal pain
vomiting
restlessness
inconsolable crying
pallor
54
Q

add warfarin to trt for Kawasaki when this is seen

A

> 8mm aneurysm

55
Q

should we hold vaccines in children with Kawasaki’s

A

yes delay MMR and varicella due to IVIG; immunizations are not effective in creating an immune response; up to 1 year

56
Q

trt ivig like this

A

a blood transfusion

often times there will be a prn order for benadryl and epineprhine in case of an allergic reaction to the IVIG

Mgmt PEDS (21 decks)

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