Chapter 46: The Child with a Cardiovascular Alteration Flashcards by Jennifer Latimer

the four pieces to Tetralogy of Fallot

ventricular septal defect
right ventricular hypertrophy
right ventricular outflow tract obstruction
overriding of the aorta

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purpose of using ABGs in diagnosing heart failure

oxygenation of arterial blood

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(ACE inhibitors, digoxin) are preferred to treat heart failure

ACE inhibitors

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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

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in hypertrophic cardiomyopathy, ECG will show changes that may lead to wearing a _______ monitor to screen for asymptomatic dysrhythmias

Holter

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IVIG has a risk for

allergic reaction

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if main treatment for hypoplastic left heart does not work, do these two things

treat for heart failure and put on heart transplant list

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when diagnosing heart failure, echocardiogram can detect these two things

physical changes of the heart
ejection fraction

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before giving digoxin, need to do these three things

baseline ECG
check HR
check kidney function

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in diagnosing infective endocarditis, _____________ are performed to identify the pathogen

blood cultures

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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

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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

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acute febrile inflammatory process that causes generalized vasculitis without a known cause

Kawasaki disease

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children with heart failure have decreased appetite because of this

poor abdominal organ circulation

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this medication is used to reduce the workload of the heart by strengthening myocardial contractility and decreasing heart rate and conductivity

digoxin

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occurs due to malalignment of the ventricles during fetal development

Tetralogy of Fallot

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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

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manifestations of Tetralogy of Fallot get worse as the ______ closes

patent ductus arteriosus (PDA)

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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

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Tetralogy of Fallot is a (cyanotic, acyanotic) heart defect

cyanotic

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in diagnosing rheumatic fever, an ECG is used for this

rule out dysrhythmias

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these medications can be prescribed to treat carditis associated with rheumatic fever

anti-inflammatory medications (steroids, aspirin)

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type of cardiomyopathy characterized by infiltration of the muscle by abnormal material

restrictive cardiomyopathy

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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

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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

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)