Cardiovascular Dysfunction In Children

Question 1

What drugs taken while a mother is pregnant that can contribute to Chronic heart disease or heart issue?

Answer 1

Medication such as phenytoin Dilantin
Illegal drugs
Alcohol which leads to fetal alcohol syndrome

Question 2

For atrial septal defect a trans catheter closure will be done on a smaller defect that will not close on it’s own. It is a septal occluders that gets placed in defect that tissue eventually grows over. What medication is ordered for the child after the surgery and how long are they ordered to take it?

Answer 2

Low dose aspirin for 6 mo after to prevent clot formation on the device

Question 3

If mom has diabetes or lupus or even rubella what can these lead to

Answer 3

chronic heart disease

Question 4

What is taken to help close patent dictums arteriosus (PDA)

Answer 4

Indomethacin (indocin)
Prostaglandin inhibitor (for premature infants and some new borns)

Question 5

Tetralogy of fallout hyper cyanotic spells treatment

Answer 5

Knee to chest
Calm environment
Blow by o2 to oxygenate blood
Off re[;ace,emt of needed
Repeat morphine to help with spasms

Question 6

What is important to monitor for hyper cyanotic spells

Answer 6

Anemia RBCs carry o2 pt may need more RBCs

Question 7

Hypoplastic left heart treatment

Answer 7

Prostaglandin infusion helps keep PDA open

Question 8

Staged reconstruction for hypoplastic left heart

Answer 8

Series of 3 operations
During first wk after born
2nd at 3-6mo of age
3rd is 2-5 yrs old

Question 9

Increase pulmonary blood flow (left to right shunt)

Answer 9

ASD
VSD
PDA

Question 10

Decrease pulmonary blood flow right to left shunt

Answer 10

Tetralogy of fallot

Question 11

Obstructive defects

Answer 11

COA
AS
PS

Question 12

Mixed blood flow defects

Answer 12

Hypoplastic left heart

Question 13

Digoxin (lanoxin)

Answer 13

Effects HR
Effects contractions- slower stronger heart beat

Question 14

Ace inhibitors meds

Answer 14

Captopril (capoten)
Enalapril(vasotec)
Lisinopril

Question 15

Beta blockers

Answer 15

Carvedilol (Coreg)
Most common
In children w chronic heart failure

Decreases hr , decrease bp , vasodilation

Question 16

Beneficial effects of digoxin

Answer 16

Increase cardiac output
Decrease heart size
Decrease venous pressure
Relief edem

Question 17

Digoxin admin

Answer 17

Calculate the correct dose and admin the correct dose
Med come in mg but we write in mcg so we have to convert
Narrow margin between therapeutic toxic and lethal

Question 18

When do we hold digoxin in infant to young children

Answer 18

Hold for HR 90-110 bpm
Depending on age and normal HR doc will specify

Question 19

When do we hold digoxin in an older child

Answer 19

Hold for HR less than 70 BPM

Question 20

S/s of digoxin toxicity

Answer 20

N&v
Anorexia
Bradycardia
Dysrhythmias

So teach pars to check apical puls

Question 21

What is significant about digoxin and potassium

Answer 21

Adverse relationship w potassium so increase k = will diminish digoxin
Low k+= will enhance digoxin effects
So keep a balance

Question 22

Ace inhibitors

Answer 22

Reduces secretion of aldosterone= excrete NA and increase k+ now
Prevents volume expansion from fluid retention and decreases risk for hypokalemia

Question 23

Nursing alert with ace inhibitors

Answer 23

Since it blocks the action of aldosterone the addition of k+ supplement or spironolactone to the drug regiment may cause hyperkalemia

Question 24

Side effects of ace inhibitors

Answer 24

Hypotension
Dry cough
Renal dysfunction

Question 25

Beta blockers side effects

Answer 25

Dizziness
Headache
Hypotension

Question 26

Major clinical findings in rheumatic fever

Answer 26

Carditis
Poly arthritis ( knees ankles, elbows wrist - larger joints)
Erythema marginatum - distinct rash
Chorea - jerky movements irregular and facial grimace
Subq nodules

Question 27

Minor manifestations of RF

Answer 27

Arthralgia ( no arthritis, joint pain)
Fever
Lab findings consistent w inflammation
(Ear , crp)

Question 28

What permanent damages does RF cause a

Answer 28

Mitral valve issues and carditis

Question 29

RF treatment

Answer 29

Penicillin 10 day course
Followed by prophylactic treatment (daily PO or monthly IM) for at least 10 years after or indefinitely

Question 30

Aspirin and prednisone in RF

Answer 30

Aspirin is preferably helps w fever and inflammation

Prednisone helps only with inflammation

Question 31

What is recommended for carditis in RF

Answer 31

BED. Rest during acute illness

Question 32

Ineffective endocarditis treatment

Answer 32

Blood cultures- find organism
Antibiotics- high doses , IV , 2-8 wks
Echo cardiac monitoring to watch vegetation and to make sure nothing hasn’t broken off
(Can cause stroke or organ damage)

Question 33

What can be given for children at high risk for ineffective endocarditis

Answer 33

Antibiotic prophylaxis (amoxicillin 50 mg/kg one hour prior to dental procedure not to exceed 2 g

Maintain good oral health

Question 34

KD acute phase
First 10 days

Answer 34

Fever 5 or more days (high 102or^)no response to pyrectic
Very irratable** hallmark sign
Erythema /Edema of hands n feet
Red eyes-no drainage
Strawberry tongue /diffuse redness or oral cavity
Polymorphous rash -irregular
Cervical lymphadenopathy

Question 35

Sub acute phaseKD

Answer 35

When rash/fever/lymph resolves
Desqumation of fingers and toes
Continued irritability
Coronary artery aneurism
May hav thrombocytoSIS
>600,00-800,000

11-25 days

Question 36

KD convalescent phase

Answer 36

Begins when all clinical signs have resolved blood values return to normal
Beus lines on finger and toes
6-8 wks

Question 37

Treatment of KD

Answer 37

IVGG - high doses- helps reduce incidence of coronary artery
Abnormalities (if givin within first 7-10 days
Aspirin for fever and inflammation 80-100 mg/kg

Then we lower to ntiplatelet dosage after fever subsides 3-5 mg/kg/day

Question 38

What if there is no abnormalities w coronary artery what will we do then

Answer 38

Continue aspirin until platelet level comes down will not have to do anti platelet dosage