Cardiovascular Conditions (5-7 ques)

Question 1

cyanotic conditions

Answer 1

Tetrology of Fallot
transposition of great vessels
pulmonary atresia
truncus areteriosus

kids sit at 87%

Question 2

acyanotic conditions

Answer 2

VSD
ASD
Patent ductus arteriosus
pulmonic stenosis
aortic stenosis
coarctation of aorta

desat w/exertion
activity intolerance

Question 3

Tetrology of Fallot - intervention

Answer 3

• cyanotic condition
• decrease O2 demands (time-limited feedings)
• support during “Tet spells” - knee to chest positioning
• Oxygen

Prep family for surgical repair ~ 12 mos of age

Question 4

Ventricular Septal Defect (VSD)

Answer 4

• acyanotic condition
• s/s: tachy, diaphoresis, tachypnea, fatigue
• evaluate exercise/activity intolerance
• monitor for recurrent respiratory infections

Question 5

Ventricular Septal Defect (VSD) - treatments

Answer 5

1. Digoxin - decreases pulse rate and strengthens cardiac contractions
   - - monitor for toxicity: bradycardia, dysrhythmias, anorexia, N/V
2. monitor fluid status: strict I/O
3. diuretics: monitor K+ loss
4. High calorie foods
5. Prep for surgical correction - small ones usually close on own; larger ones need surgery

Question 6

Coarctation of Aorta

Answer 6

obstructive condition - decreases blood flow to trunk and lower extremities; increases flow to head and arms
- risk for stroke

Assessment: full, bounding pulses in arms w/weak/absent pulses in legs

• increased BP on arms
• decreased BP in legs
• warm upper body; cool lower body

Cardiac catheterization usually during school age years

Question 7

Rheumatic Fever - s/s

Answer 7

• preventable
• occurs 1-6 weeks after group A beta-hemolytic strep infection

s/s - fever, fatigue, joint pain w/swelling, redness and warmth

• chorea - sudden involuntary movement of extremities
• temp, disk-shaped red macules that are non-pruitic and faded in center (erythema marginatum)

Question 8

Rheumatic Fever - Intervention

Answer 8

Prevention is key - administer penicillin w/strep throat infections

Promote bed rest until ESR normalizes (~5 weeks)
Meds: anti-inflammatory, penicillin prophylaxis to preven future attacks (take for 10 years or until 21 yo)

Question 9

Kawasaki Disease - what is it?

Answer 9

acute vasculitis, lastig 6-8 weeks, coronary arteries most at risk
– w/o treatment, permanent cardiac damage

Complications - myocardial infarction caused by occlusion of a coronary artery
- fluid overload and CHF

Question 10

Kawasaki - acute phase

Answer 10

High, persistent fever – antipyretics don’t work
Swelling of conjunctive w/o drainage
Inflammation of tongue, mouth, lips (STRAWBERRY TONGUE)
Rash
Swollen, red hands and feet
Cervical lymphadenopathy

Question 11

Kawasaki - subacute phase

Answer 11

Begins w/resolution of fever; ends when all outward symptoms are gone
Feet and hands peel during this phase
Irritability persists

Question 12

Kawasaki - convalescent phase

Answer 12

Begins when all clinical signs of KD resolve and ends when all blood values (ESR, C-Reactive Protein) return to normal

If ESR and C-Reactive protein remain elevated,

• thrombocytosis is still present
• Arthritis still present

Question 13

Kawasaki interventions

Answer 13

IVIG - reduces effect on heart if given w/in 10 days of symptoms)
Aspirin - high doses initially(80-100mg/kg/day / Q6H)
- maintenance - low, antiplatelet dose (3-5 mg/kg/day)
– w/normal EKG: cont for 6-8 wks until plt count has returned to normal
– w/abnormal EKG - continue indefinitely

Cardiac monitoring - assess for fluid overload and CHF

Symptom Relief – minimize skin discomfort (mouth care, cool cloths, lukewarm baths

Pt/family education – offer breaks from irritability

Question 14

Cardiac Catheterization

Answer 14

• contrast dye injected
• immobilize affected extremity to prevent hemorrhage
• ensure adequate hydration (due to blood loss during procedure