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NU 374 > Ch. 27 p. 2 > Flashcards

Ch. 27 p. 2 Flashcards

1
Q

infectious and inflammatory cardiac disorders are caused by

A
  • infection
  • autoimmune response
  • environmental factors
  • familial tendencies
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2
Q

infectious and inflammatory cardiac disorders can occur in

A

the normal heart or in addition to congenital heart defects

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3
Q

cardiac dx testing: Echo

A

ultrasound to visualize the blood flow, structure, valve misfunction: clot, aneurysm

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4
Q

cardiac dx testing: EKG

A

monitors the hearts electrical impulses

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5
Q

rheumatic fever

A

inflammatory heart condition occurring post pharyngitis (GABHS)
- self limiting
- cardiac valve damage can result
- affects ages 5-15 years
- several weeks after a strep infection that was not treated or not treated well
- can lead to rheumatic heart disease if not treated (at all or properly): valve damage

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6
Q

treatment of rheumatic fever is focused on

A
  • resolving infection, minimizing complications, and prevention of recurrence
  • preventing rheumatic heart failure
  • usually very treatable and recoverable
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7
Q

principle manifestations of rheumatic fever involve (what parts of the body/systems)

A

involve the heart, joints, skin, and CNS

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8
Q

jones criteria

A

symptoms/components of dx criteria for rheumatic fever

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9
Q

what are the top 5 clinical manifestations of Jones criteria/which are considered MAJOR?

A

Joint involvement
O looks like a heart- myocarditis
Nodules, subcutaneous (usually on bony parts of the body, ie elbow, ankle)
Erythema marginatum (rash: neck to chest, sometimes fast; flat)
Sydenham chroea (involuntary movements)

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10
Q

in which order do the top 5 clinical manifestations of jones criteria occur?

A

joint involvement
o looks like a heart- myocarditis
nodules, subcutaneous
erythema marginatum
sydenham chroea

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11
Q

which jones criteria clinical manifestations are considered MINOR?

A

CAFE PAL

CRP increased
arthralgia
fever
elevated ESR

prolonged PR interval (need EKG to confirm)
anamnesis of rheumatism (joints inflame at various times)
leukocytosis (increased WBC)

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12
Q

timeline of s/sx of acute rheumatic fever

A
  • polyarithmias
  • carditis
  • erythema marginatum
  • subcutaneous nodules
  • chorea
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13
Q

to diagnose rheumatic fever clinically, you need ____

A
  • two major criteria OR one major and two minor criteria
    AND
  • throat cultures growing GABHS OR elevated anti-streptolysin 0 (ASO) titers
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14
Q

how to manage rheumatic fever (duration of treatment)

A

The duration of therapy is tailored according to the child’s clinical course. Prophylaxis RX depends on age/involvement.
- No carditis: 5 years or until age 21 (whichever is longer)
- Carditis w/o residual heart disease: 10 years or until age 21 (whichever is longer)
- Carditis w/residual heart disease: 10 years or until 40 years of age (whichever is longer) or maybe lifelong.

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15
Q

rheumatic fever: drug therapy

A

penicillin (PCN)
- IM qMonth
- PO BID

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16
Q

kawasaki disease

A

acute systemic vasculitis (inflammation of arteries of heart; increased platelets)
- unknown etiology/cause
- affects children < 5 years
- self-limiting
- very, very irritable- tell parents this is normal per disease
- do an echo

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17
Q

if kawasaki disease is untreated,

A

25% will develop cardiac complications
- MI
- aneurysms (outpouching of vessel- can lead to a clot)

*higher likelihood to occur in infants

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18
Q

kawasaki dx criteria (hint: CREAM)

A

high fever for 5 days (infant 7 days) and 4/5 of the following:
- conjunctivitis (non-exudate)
- rash (polymorphous non-vesicular)
- edema (or erythema of hands/feet)
- adenopathy (cervical, often unilateral)
- mucosal involvement (erythema or fissures or crusting)

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19
Q

kawasaki “red” PE findings

A

strawberry tongue, red eyes, red lips

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20
Q

kawasaki disease treatment

A
  • ASA 80-100 mg/kg/day: fever and inflammation (prevents clotting- these kids are at risk for clotting)
  • IVIG: immunoglobulins, give antibodies to protect the body; check VS, two nurse check, and pre-medicate with tylenol and benedryl// infuse as long as 8 hours
  • antiplatelet (ASA) 3-5 mg/kg/day

duration of therapy is dependent on z-score

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21
Q

kawasaki disease: acute phase

A
  • High fever x 5 days or more (unresponsive to ABT and antipyretics)
  • 2/3 report GI illness
  • erythema of palms/soles, edema of hands/feet
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22
Q

kawasaki disease: sub-acute phase

A
  • resolution of fever
  • onset of other symptoms
  • Lasts until all outward clinical signs have resolved.
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23
Q

kawasaki disease: convalescence phase

A
  • abnormal labs linger (elevated sed rate, C-reactive protein)
  • Thrombocytosis (high level of platelets) still present
  • Arthritis continues, cardiac sequelae still a concern (peak 4-6 wks. After onset)
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24
Q

kawasaki disease nursing management

A
  • monitor cardiac status
  • promote comfort
  • offer emotional support
  • provide diagnostic assistance
  • perform med administration
  • implement pt/family
  • ice pops: swollen tongue and sore throat
  • hand cream: dry, cracking hands
  • cool compress, antipyretics: fever
  • warm compress: protruding lymph node
25
Q

kawasaki disease: what happens if the urine output decreases?

A

indicative of heart failure

26
Q

kawasaki disease: can this child have an MI?

A

yes
- most common cause of MI in children

27
Q

MIS-C

A

multisystem inflammatory syndrome- covid related
- some mucocutaneous signs mimic kawasaki
- cardiac involvement can be significant
- can involve any organ system
- involves 2 organs

28
Q

MIS-C manifestations

A
  • Fever > 38 C (100.4 F) for 24 hrs. (can be subjectively reported)
  • Lab evidence of inflammation
  • Evidence of clinically severe illness requiring hospitalization with at least 2 organ systems involved (ex. Myocarditis)
  • No alternative plan or diagnosis
  • Currently or recently COVID-19 + (within the last four weeks)
  • elevated platelets
29
Q

MIS-C treatment

A
  • IVIG
  • Steroids (systemic)
  • Anti-inflammatories
  • Ibuprofen/acetaminophen
  • Depends on severity*
30
Q

MIS-C elevated inflammatory lab values

A
  • CRP*
  • ESR*
  • platelets* (clotting)
  • cardiac enzymes: troponin, BNP*
  • Fibrinogen
  • Procalcitonin
  • D-dimer
  • Ferritin
  • Lactic acid dehydrogenase (LDH)
  • Neutrophils
31
Q

MIS-C decreased inflammatory lab values

A
  • lymphocytes
  • albumin*
32
Q

evaluation and treatment of MIS-C

A
  • Labs
  • Diagnostics (EKG, Echo, CXR)
  • Consultations
  • Pharmacology
  • Ongoing follow-up
  • supportive measures
33
Q

treatments/supportive measures for MIS-C

A
  • fluid resuscitation
  • inotropic support
  • respiratory support
  • extracorporeal membranous oxygenation (ECMO)
  • IVIG*
  • Steroids*
34
Q

BP screenings for children

A
  • Routine w/ annual check-ups
  • assess age three and beyond manually, not with an automatic device
  • really need 3 abnormally high readings to dx HTN (white coat syndrome- high BP bc child is at dr- recheck in 10-15 min, come back in a couple. days)
35
Q

what conditions could HTN indicate?

A
  • kidney issues
36
Q

systemic HTN can lead to

A

long-term consequences
- CVD

37
Q

systemic HTN: BP is based on

A
  • age
  • gender
  • height
    (for ages 1-13)
  • assess at PE in ages 3+ manually with correct sized-cuff
  • categorical cut points for children 13+
  • need 3 abnormal readings to SBAR for a workup
38
Q

elevated BP

A

children 1-13 years:
- SBP or SBP falls >90<95th percentile or 120/80 to <95th percentile (whichever is lower) persistently

children 13+:
SBP 120-129
DBP <80

39
Q

stage 1 HTN

A

children 1-13 years:
- BPs at or >95th percentile to less than 95th +12 mm/Hg or 130/80-139/89 (whichever is lower) persistently

children 13+:
SBP 130-139
DBP 80-89

40
Q

stage 2 HTN

A

children 1-13 years:
- BPs at or >95th +12 mm/Hg or 140/90 or greater persistently

children 13+:
SBP 140+
DBP 90+

41
Q

why would BP be measured before age 3 years?

A

if a history of health conditions
- COA
- prematurity
- murmurs
- seizures
- abdominal mass
- unexplained HF
- ascites
- sleep apnea
- unexplained headaches
- renal failure, FTT, etc.)

42
Q

selecting proper BP cuff size

A
  • Bladder width must be at least 40% (typically, it extends approximately 2/3 of the upper arm.
  • Bladder length should cover 80-100% of the upper arm circumference
  • Upper extremity readings preferred
43
Q

If elevated, b/p will need to be rechecked in

A

6 months

44
Q

POC interventions for HTN

A
  • Dietary teaching (salt restriction)
  • Weight management/reduction
  • Portion control; healthier food choices
  • Increase physical activity
  • Medication teaching (if pharm. Tx required)
  • b/p management at home
  • Routine checkups

*implemented for children above 90th but below 95th percentile!

45
Q

resuscitation guidelines: inadequate breathing with HR > 60bpm

A

rescue breathing

46
Q

resuscitation guidelines: inadequate breathing with HR < 60bpm (and poor perfusion)

A

begin compressions and rescue breathing per CPR guidelines

47
Q

if a child is in cardiogenic shock or decompensating, the nurse may need to ___

A

call a rapid response and help with resuscitation

48
Q

pericardium refers to

A

the sac of the heart

49
Q

myocardium refers to

A

the muscle of the heart

50
Q

endocardium refers to

A

the valves of the heart

51
Q

incomplete presentation of kawasaki disease (infant)

A

fever for 7 days AND

if CRP < 3.0mg/dL and ESR < 40 mm/hr:
- serial clinical and lab re-eval if fever persists; Echo if typical peeling develops

if CRP >/= 3.0mg/dL and ESR >/= 40 mm/hr: 3 or more lab findings
1. anemia
2. platelet count >450,000 after day 7 of fever
3. albumin </= 3.0 g/dL
4. elevated ALT
5. WBC of >/= 15,000 mm3
6. urine >/= 10 WBC/hpf
OR postive Echo

52
Q

live vaccines and IVIG

A

delay live vaccines for a whole year after IVIG
- live vaccines at 1 year: varicella and MMR

53
Q

ASA major side effect

A

ototoxicity: ear issues, hearing issues

54
Q

can you give ASA with NSAIDs?

A

no- bc ASA is considered an NSAID and we don’t give 2 NSAIDs together
- ASA and tylenol is okay NOT ASA and ibuprofen

55
Q

HTN medications

A
  • beta blockers
  • angiotensin receptor blockers and ACEI- NO adolescent female bc of fetal risks
56
Q

normal heart rhythm/EKG strip

A

normal sinus arrhythmia
- seen in sleep

57
Q

heart rhythm: SVT

A
  • consistently very quick
  • kids can go as high as 200-300
  • can lead to heart failure
58
Q

what can you do if child is in SVT?

A

ice pack (bag of frozen veggies) on one side of face
carotid massage on one side of face
ice water
meds: adenosine (kicks in 10-20 sec), long-term digoxin
procedure: ablation

ALWAYS JUST ONE SIDE

NU 374 (18 decks)

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