Chapter 46: The Child with a Cardiovascular Alteration Flashcards
the four pieces to Tetralogy of Fallot
- ventricular septal defect
- right ventricular hypertrophy
- right ventricular outflow tract obstruction
- overriding of the aorta
purpose of using ABGs in diagnosing heart failure
oxygenation of arterial blood
(ACE inhibitors, digoxin) are preferred to treat heart failure
ACE inhibitors
manifestations include mild tachycardia at rest, poor feeding, poor weight gain, dyspnea, tachypnea, fatigue, chronic abdominal pain, galloping rhythm, hepatomegaly, cardiomegaly, splenomegaly, decreased urine output, mottling cyanosis, pallor
heart failure
in hypertrophic cardiomyopathy, ECG will show changes that may lead to wearing a _______ monitor to screen for asymptomatic dysrhythmias
Holter
IVIG has a risk for
allergic reaction
if main treatment for hypoplastic left heart does not work, do these two things
treat for heart failure and put on heart transplant list
when diagnosing heart failure, echocardiogram can detect these two things
physical changes of the heart
ejection fraction
before giving digoxin, need to do these three things
baseline ECG
check HR
check kidney function
in diagnosing infective endocarditis, _____________ are performed to identify the pathogen
blood cultures
to be diagnosed with rheumatic fever, patient must have ___ major manifestation(s) or ___ major manifestation(s) and ____ minor manifestation(s), plus evidence of ________________
2, 1, 2, group A strep infection
this phase of Kawasaki disease lasts from days 1-10 and is characterized by a high fever that is unresponsive to treatment, bilateral conjunctivitis, changes to the mucous membrane, swelling of the hands and feet, generalized erythematous rash, enlarged cervical lymph nodes, and increase in irritability and tachycardia
acute phase
acute febrile inflammatory process that causes generalized vasculitis without a known cause
Kawasaki disease
children with heart failure have decreased appetite because of this
poor abdominal organ circulation
this medication is used to reduce the workload of the heart by strengthening myocardial contractility and decreasing heart rate and conductivity
digoxin
occurs due to malalignment of the ventricles during fetal development
Tetralogy of Fallot
those at highest risk for infective endocarditis are considered for prophylactic antibiotics, including unrepaired ______________, those with a ________________, within 6 months of a(n) _______________, previous _______________, and ____________ patients
cyanotic lesion, prosthetic valve, cardiac repair, infective endocarditis, transplant
manifestations of Tetralogy of Fallot get worse as the ______ closes
patent ductus arteriosus (PDA)
in diagnosing Kawasaki disease, frequent ___________ are done to identify abnormality early at these four time periods
echocardiograms
at diagnosis, 2 weeks, 6-8 weeks, 6-12 months
Tetralogy of Fallot is a (cyanotic, acyanotic) heart defect
cyanotic
in diagnosing rheumatic fever, an ECG is used for this
rule out dysrhythmias
these medications can be prescribed to treat carditis associated with rheumatic fever
anti-inflammatory medications (steroids, aspirin)
type of cardiomyopathy characterized by infiltration of the muscle by abnormal material
restrictive cardiomyopathy
surgical correction of ventricular septal defect includes placing a(n) _____________ device via ___________ or ___________ the opening or placing a _________ via surgery
occluding, heart catheterization, suturing, patch
when giving IVIG, nurse should monitor ____________, rechecking them every _________ for the first hour and then every __________ until infusion complete
vital signs, 15 minutes, 30 minutes
this phase of Kawasaki disease lasts from day 11 to 25, when the fever disappears and most symptoms resolve, but have continued irritability, anorexia, desquamation of palms/fingers/toes, arthritis, cardiac manifestations (coronary artery aneurysms)
subacute phase
two treatments for large patent ductus arteriosus
nonsurgical occlusion via cardiac catheter
surgical occlusion via ligation
most accurate time/age to perform pulse oximetry
after 24 hours old, before discharged
ideally, the ductus arteriosus should close within this time frame
within 24 hours after birth
aspirin regime for Kawasaki disease
80-100 mg/kg/day divided into 4 doses/day and given until fever resolves
after fever resolves, dose dropped to 3-5 mg/kg/day and given once/day for up to 8 weeks (indefinitely with coronary artery aneurysm)
treatment for hypoplastic left heart
surgical ablation of tissue and open ventricle
Once medications for heart failure have been started, persistent symptoms and lack of weight gain indicate the need for this based on underlying cause
surgery
if patient with heart failure does not gain weight with measures taken, may need to change to _______________ formula or place _________
higher calorie, NG tube
diseases of the heart muscles in which the pathology is not the result of congestive heart failure, coronary artery disease, or other systemic cause
cardiomyopathies
purpose of using CBC in diagnosing heart failure
to detect anemia
major complication of rheumatic fever
rheumatic heart disease (scarring impairs pumping ability)
atrial septal defects may close spontaneously by this age
4 years
in diagnosing rheumatic fever, an echocardiogram detects this
valve damage
this phase of Kawasaki disease begins when symptoms have disappeared and lasts until ESR returns to normal
convalescent phase
rheumatic fever typically occurs _________ after initial strep infection
2-3 weeks
occurs when there is an opening between the cardiac chambers or great arteries
shunting
when treating Kawasaki disease, the nurse should ensure that the patient is adequately ___________
hydrated
machine-like murmur, bounding pulses, widening pulse pressure
patent ductus arteriosus
teach parents to look out for these manifestations of heart failure/congenital heart disease
manifestations of heart failure
increased cyanosis
dehydration
infection
dysrhythmias
decreased nutritional intake
children with this have the highest risk for infective endocarditis
history of heart problems
purpose of using urinalysis in diagnosing heart failure
check kidney function
autoimmune response that can affect the valves of the heart; body creates immune complexes that become lodged in tissues (joints and heart), creating the autoimmune response
rheumatic fever
this treatment for Tetralogy of Fallot helps keep PDA open to help with blood flow
PGE-1 infusions
this medication can help constrict patent ductus arteriosus in preterm infants only
indomethacin (prostaglandin inhibitor)
congenital heart disease is classified based on
blood flow
once diagnosed with hypertrophic cardiomyopathy, the child should be restricted from ________________________________
strenuous and competitive sports
purpose of using ESR in diagnosing heart failure
detect any inflammatory process
if vomit ONE dose of digoxin, do this
do not regive that dose, resume at next dose
because there is a risk of contracting infective endocarditis again, __________________ are needed in either of two cases
prophylactic antibiotics
lifelong or 1 hour before procedures (dental work that manipulates gums, tonsillectomy, adenoidectomy, biopsy)
heart initially responds to impaired pumping ability by _______________ heart rate; over time, the heart muscles become ______________ and _______
increasing, hypertrophied, weak
manifestation of rheumatic fever: involuntary movements of extremities and face that affects speech
chorea
manifestations include hypercyanotic episodes (Tet spells), hypoxia, harsh murmurs, boot shaped heart, cyanosis
Tetralogy of Fallot
_____________ may be performed to release some of the hypertrophy in hypertrophic cardiomyopathy and improve symptoms, but it does not decrease the ________________
Surgery, mortality rate
in infective endocarditis, _____________ can present as clumps of bacteria, fibrin, and platelets, posing a risk of __________
vegetation, embolus
three treatment methods/care for patients with rheumatic fever
warm compresses on joints
placing in position of comfort
seizures precautions (chorea)
IVIG can interfere with _____________ from vaccines; recommended that live virus vaccines are avoided for ____________ after the infusion
immunity, 11 months
patients with rheumatic fever WITHOUT carditis will continue prophylaxis for __________ or until _________ of age (whichever comes last)
5 years, 21 years
up to ___% of cases of ventricular septal defect will close on their own
60
hallmark manifestation of infective endocarditis
new or worsening murmur
congenital heart defect in which tissue is dysfunctional and cannot pump blood effectively
hypoplastic left heart
if forget to give ONE dose of digoxin, then do this
give dose as soon as remember, then resume normal schedule
it will be hard to get a venipuncture on (left, right) arm in a patient with hypoplastic left heart
left
in bacterial infective endocarditis, the bacteria create a __________ on the heart muscles, which acts as a protective armor against antibiotics and makes treatment difficult
biofilm
two treatments for Kawasaki disease
IVIG
high-dose aspirin regime
before giving digoxin, HR needs to be at this level in a pediatric patient
> 100 (hold if <100)
this test is diagnostic for hypertrophic cardiomyopathy
echocardiogram
thrombocytosis occurs during this phase of Kawasaki disease, increasing the risk for emboli and MI
subacute phase
to prevent contracting infective endocarditis, patients should be taught about these two things
good oral hygiene
reducing risk of seeking emergent dental care
caused by untreated or partially treated group A strep infection
rheumatic fever
patients with rheumatic fever WITH carditis will continue prophylaxis for __________ or until _________ of age (whichever is longer)
10 years, 40 years
purpose of using CMP in diagnosing heart failure
check electrolyte levels that may be causing ECG changes that can lead to heart failure
child with rheumatic fever is at an increased risk for ______________________ and must be on a _________________________
recurrent attacks of rheumatic fever, prophylactic antibiotic
To help with lack of weight gain, teach parents to ______ feedings, have ___________ and _____________ feedings (every ____ hours), be in ___________ position while feeding to reduce stomach compression and help with respiratory effort
time, smaller, more frequent, 3, upright
infective carditis is most often (fungal, viral, bacterial)
bacterial
one of these two medications may be prescribed as prophylaxis for ventricular dysrhythmias in a patient with hypertrophic cardiomyopathy
beta blocker
calcium channel blocker
in diagnosing infective endocarditis, a(n) ______________ will show the presence of vegetation
echocardiogram
occurs when the heart is unable to circulate enough blood to meet the demands of the body
heart failure
location to measure pulse oximetry
all four extremities
main/required treatment for Tetralogy of Fallot
surgical correction of defects (open heart procedure that requires cardiopulmonary bypass)
may be asymptomatic but manifestations can include fatigue, dyspnea on exertion, recurrent URI, systolic murmur, mitral valve regurgitation, heart failure, and risk for stroke
small atrial septal defect
hypoplastic left heart is a (cyanotic, acyanotic) heart defect
cyanotic
if forget to give TWO doses of digoxin (or vomit dose TWO times in a row), then do this
call provider immediately for evaluation
In treatment of infective endocarditis, because the dose of antibiotics is so high, ________ and _______________ should be monitored closely, as well as side effects such as ______, ________, and _____________
peak, trough levels, liver, renal, ototoxicity
in diagnosing rheumatic fever, a chest X-ray may reveal this
cardiomegaly
for diagnosis of Kawasaki disease to be confirmed, the patient must have 4 out of 5 of these criteria with no evidence of another disease process
bilateral conjunctivitis
mucus membrane alterations
redness of hands and feet
rash on trunk
cervical lymph node enlargement
four laboratory tests that can be used to diagnose infective endocarditis
CBC, CMP, ESR, rheumatoid factor
may be asymptomatic but manifestations may include loud/shrill murmur, palpable thrill, gallop rhythm, and heart failure
ventricular septal defect
treatment for atrial septal defect may include placement of ____________ device or patch with low dose __________ regime for ____________ (time period) post procedure
occluding, aspirin (high risk for clots), 6 months
this type of cardiomyopathy can be asymptomatic or have very vague symptoms (dyspnea or chest pain with exertion, palpitations)
hypertrophic cardiomyopathy
treatment for TET spells includes ____________ position and giving __________ and _____________
knee to chest, oxygen, morphine (drops tachypnea respirations down)
disease of the heart muscle characterized by dilated and decreased contractility and dilation of the ventricles
cardiomyopathy
if a reaction to IVIG occurs, it is treated with these two things
stopping infusion
administering epinephrine and diphenhydramine
when diagnosing heart failure, chest X-ray can detect these two things
cardiomegaly
pulmonary infiltrates
three risk factors for infective endocarditis
congenital heart disease
previous cardiac surgery
previous infective endocarditis diagnosis
type of cardiomyopathy in which the cardiac muscles are enlarged and stiff and is a leading cause of sudden cardiac death in adolescents
hypertrophic cardiomyopathy
teach parents about these three symptoms of worsening feedings associated with heart failure
increased tachypnea
diaphoresis during feeding
vomiting after feeding
in hypertrophic cardiomyopathy, auscultation of heart sounds may reveal one of these two things
sounds normal
small systolic murmur with recent exertion
manifestation of rheumatic fever: red skin lesions starting on trunk and spreading peripherally
erythema marginatum
the child with hypertrophic cardiomyopathy may have one of these two things placed to help prevent or treat dysrhythmias
pacemaker, internal defibrillator
prophylactic antibiotics for rheumatic fever can be given by these two routes/times
monthly IM
daily oral
three other treatments for Tetralogy of Fallot
PGE1 infusions
management of Tet spells
treatment of iron deficiency anemia
treatment for small patent ductus arteriosus
leave alone to close on own
Jones Criteria for rheumatic fever includes these five major criteria and these four minor criteria
major: carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
minor: fever, polyarthralgia, elevated ESR or positive C-reactive protein, prolonged P-R interval
infective endocarditis is often associated with __________ work that has manipulated the ______
dental, gums
three medications that can help reduce cardiac load when treating heart failure
digoxin
diuretics
ACE inhibitors
manifestation of rheumatic fever: small, nontender swellings often over the joints
subcutaneous nodules
when rheumatic fever is confirmed, treatment includes this
10-day course of antibiotics
treatment for infective endocarditis
high-powered antibiotic for 6-8 weeks (sent home with PICC line)
