Cardiovascular Dysfunction In Children Flashcards by Elizabeth Gausin

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

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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

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

chronic heart disease

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

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

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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

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What is important to monitor for hyper cyanotic spells

Anemia RBCs carry o2 pt may need more RBCs

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Hypoplastic left heart treatment

Prostaglandin infusion helps keep PDA open

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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

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Increase pulmonary blood flow (left to right shunt)

ASD
VSD
PDA

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Decrease pulmonary blood flow right to left shunt

Tetralogy of fallot

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Obstructive defects

COA
AS
PS

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Mixed blood flow defects

Hypoplastic left heart

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Digoxin (lanoxin)

Effects HR
Effects contractions- slower stronger heart beat

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Ace inhibitors meds

Captopril (capoten)
Enalapril(vasotec)
Lisinopril

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Beta blockers

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

Decreases hr , decrease bp , vasodilation

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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