Cardiovascular Dysfunction In Children Flashcards
What drugs taken while a mother is pregnant that can contribute to Chronic heart disease or heart issue?
Medication such as phenytoin Dilantin
Illegal drugs
Alcohol which leads to fetal alcohol syndrome
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?
Low dose aspirin for 6 mo after to prevent clot formation on the device
If mom has diabetes or lupus or even rubella what can these lead to
chronic heart disease
What is taken to help close patent dictums arteriosus (PDA)
Indomethacin (indocin)
Prostaglandin inhibitor (for premature infants and some new borns)
Tetralogy of fallout hyper cyanotic spells treatment
Knee to chest
Calm environment
Blow by o2 to oxygenate blood
Off re[;ace,emt of needed
Repeat morphine to help with spasms
What is important to monitor for hyper cyanotic spells
Anemia RBCs carry o2 pt may need more RBCs
Hypoplastic left heart treatment
Prostaglandin infusion helps keep PDA open
Staged reconstruction for hypoplastic left heart
Series of 3 operations
During first wk after born
2nd at 3-6mo of age
3rd is 2-5 yrs old
Increase pulmonary blood flow (left to right shunt)
ASD
VSD
PDA
Decrease pulmonary blood flow right to left shunt
Tetralogy of fallot
Obstructive defects
COA
AS
PS
Mixed blood flow defects
Hypoplastic left heart
Digoxin (lanoxin)
Effects HR
Effects contractions- slower stronger heart beat
Ace inhibitors meds
Captopril (capoten)
Enalapril(vasotec)
Lisinopril
Beta blockers
Carvedilol (Coreg)
Most common
In children w chronic heart failure
Decreases hr , decrease bp , vasodilation
Beneficial effects of digoxin
Increase cardiac output
Decrease heart size
Decrease venous pressure
Relief edem
Digoxin admin
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
When do we hold digoxin in infant to young children
Hold for HR 90-110 bpm
Depending on age and normal HR doc will specify
When do we hold digoxin in an older child
Hold for HR less than 70 BPM
S/s of digoxin toxicity
N&v
Anorexia
Bradycardia
Dysrhythmias
So teach pars to check apical puls
What is significant about digoxin and potassium
Adverse relationship w potassium so increase k = will diminish digoxin
Low k+= will enhance digoxin effects
So keep a balance
Ace inhibitors
Reduces secretion of aldosterone= excrete NA and increase k+ now
Prevents volume expansion from fluid retention and decreases risk for hypokalemia
Nursing alert with ace inhibitors
Since it blocks the action of aldosterone the addition of k+ supplement or spironolactone to the drug regiment may cause hyperkalemia
Side effects of ace inhibitors
Hypotension
Dry cough
Renal dysfunction
Beta blockers side effects
Dizziness
Headache
Hypotension
Major clinical findings in rheumatic fever
Carditis
Poly arthritis ( knees ankles, elbows wrist - larger joints)
Erythema marginatum - distinct rash
Chorea - jerky movements irregular and facial grimace
Subq nodules
Minor manifestations of RF
Arthralgia ( no arthritis, joint pain)
Fever
Lab findings consistent w inflammation
(Ear , crp)
What permanent damages does RF cause a
Mitral valve issues and carditis
RF treatment
Penicillin 10 day course
Followed by prophylactic treatment (daily PO or monthly IM) for at least 10 years after or indefinitely
Aspirin and prednisone in RF
Aspirin is preferably helps w fever and inflammation
Prednisone helps only with inflammation
What is recommended for carditis in RF
BED. Rest during acute illness
Ineffective endocarditis treatment
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)
What can be given for children at high risk for ineffective endocarditis
Antibiotic prophylaxis (amoxicillin 50 mg/kg one hour prior to dental procedure not to exceed 2 g
Maintain good oral health
KD acute phase
First 10 days
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
Sub acute phaseKD
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
KD convalescent phase
Begins when all clinical signs have resolved blood values return to normal
Beus lines on finger and toes
6-8 wks
Treatment of KD
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
What if there is no abnormalities w coronary artery what will we do then
Continue aspirin until platelet level comes down will not have to do anti platelet dosage
