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Test 5 > Peds Congenital & Acquired Cardiac Disorders > Flashcards

Peds Congenital & Acquired Cardiac Disorders Flashcards

1
Q

2 Types of PEDS CARDIAC DISORDERS

A
  1. Congenital Heart Disease (CHD)
  2. Acquired Heart Disease
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2
Q

Define:

Structural cardiac abnormalities that are present at birth

A

Congenital Heart Disease (CHD)

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3
Q

Define:

Cardiac Disorders that occur AFTER birth

A

Acquired Heart Disease

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4
Q

What aspects of a child’s history are important when assessing for a cardiac disorder?

A
  • Symptom Onset: Note when symptoms began and their duration.
  • Symptom History: Assess for history of orthopnea, dyspnea, growth delays, squatting, edema, dizziness, and frequent pneumonia episodes.
  • Feeding and Growth Concerns: Identify poor feeding signs such as fatigue, lethargy, vomiting, and failure to thrive.
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5
Q

What PAST medical history? should be assessed?

A
  • Information about child’s past history and mother’s pregnancy history
  • Frequent infections
  • Chromosomal abnormalities, Autoimmune disorders
  • Prematurity
  • Stress or asphyxia at birth
  • Alcohol, illicit drug use, exposure to radiation
  • Use of medications such as corticosteroids
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6
Q

Physically assess babies ___.

A

undressed!

(no blankets, no clothes)

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7
Q

5 main S/S of babies unable to breath

A
  • Head bobbing: need head up to get more oxygen
  • Sternal & Subcostal retractions: subcostal seen only on babies
  • Belly breathing
  • Tripod position/preferred seating
  • Grunting: WITH EVERY SINGLE RESPIRATION- trying to keep airway open
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8
Q

4 S/S of Circulation problems

A
  1. Mottling/Pallor
  2. Any noticeable & significant bleeding
  3. Cyanosis
  4. abnormal pulses
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9
Q

If you have a baby with BP lower than 80 for babies what do you do FIRST?

A

Check the carotid or femoral pulses!
* Dont immediately start CPR

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10
Q

When Auscultating babies heart, we auscultate where & for how long?

A

1 full minute- APICAL HR

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11
Q

When comparing blood pressure in the upper and lower extremities on a baby, what should be the expected result?

A

There should be no major differences between the blood pressure readings in the upper and lower extremities.

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12
Q

Q: What should be done BEFORE a Cardiac Catheterization on a child?

List 8

A
  • Baseline vital signs – note fever or other signs of infection
  • Height and weight
  • Allergies – especially to iodine/shellfish
  • Review medications – typically hold anticoagulants
  • Assess peripheral pulses – mark pedal pulses with marker
  • NPO 4 to 6 hours before procedure- different than adults
  • Use variety of teaching methods – videotapes, books, etc.
  • Signed consent - from parents
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13
Q

Starting:

Disorders with decreased PULMONARY blood flow

There are 2

A
  • Tetralogy of Fallot
  • Tricuspid Atresia
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14
Q

What happens in disorders with decreased pulmonary blood flow?

A
  • There is some obstruction of blood flow to the LUNGS
  • Oxygen desaturation (50%-90%)- ranging from mild to severe
  • Can lead to severe cyanosis
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15
Q

Q: How do the kidneys compensate for low blood oxygen levels?

A

kidneys produce more erythropoietin, which stimulates the bone marrow to produce more (RBCs).

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16
Q

What are the results of increased erythropoietin production (EPO) in response to low blood oxygen levels?

A
  • Polycythemia
    -Increased blood volume
    -Increased blood viscosity: causes clots
    -Increased workload of the heart
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17
Q

Is there a change in the amount of blood reaching the lungs for oxygenation in decreased pulmonary blood flow disorders?

A

No. Blood flow to the lungs remains unchanged, meaning the same amount of blood reaches the lungs.
* Body adapts thru various mechanisms such as shunting or collateral circulation, to keep blood circulating
* However, this is insufficient for proper oxygenation, leading to compensatory mechanisms like increased RBC produciton, which still does not fully resolve the oxygenation issue.

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18
Q

Q: What is TETRAlogy of Fallot?

A

is a congenital heart defect that consists of FOUR abnormalities

  1. Pulmonary stenosis
  2. Right ventricular hypertrophy
  3. Overriding aorta: aorta positioned directly over ventricular septal defect (VSD) instead of arising solely from L. Ventricle
  4. Ventricular septal defect (VSD)
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19
Q

When is Tetralogy of Fallot usually diagnosed, and what are the common signs?

A
  • Usually diagnosed in the first weeks of life due to the presence of a murmur or cyanosis (a bluish tint to the skin from low oxygen levels).
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20
Q

What happens as the Patent Ductus Arteriosus (PDA) closes in the first few days of life in Tetralogy of Fallot?

A

more severe cyanosis can occur
* due to decreased blood flow to the lungs, further limiting oxygenation.

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21
Q

What are common symptoms of Tetralogy of Fallot in infants?

A
  • Difficulty feeding
  • Limited weight gain
  • Polycythemia (increased RBCs)
  • Dyspnea (shortness of breath)
  • Hypercyanotic spells (Tet spells): episodes of severe cyanosis, often triggered by crying or feeding
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22
Q

How should hypercyanotic (Tet spells) be managed?

List 6

A
  • Provide a calm, comforting approach
  • Place the infant or child in a knee-to-chest position
  • Provide supplemental oxygen
  • Supply IV fluids: Restores circulation and helps improve oxygen delivery
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23
Q

2 MEDS given for Hypercyanotic (Tet Spells)

A
  1. Administer morphine sulfate (0.1 mg/kg IV, IM, or SQ): Relieves pain and reduces the respiratory rate, improving oxygenation
  2. Administer propranolol (0.1 mg/kg IV): beta blocker- Reduces the frequency and severity of Tet spells by improving right ventricular function
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24
Q

How is Tetralogy of Fallot managed?

A
  • Surgery for the 4 defects: Typically required during the first year of life to correct the defects.
  • REgular follow up visits with Cardiologists
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25
Q

What is the prognosis for most infants after surgery for Tetralogy of Fallot?

A

Most infants can expect to live active, healthy lives after surgery

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26
Q

2nd form of Decreased Pulmonary Blood Flow

A

Tricuspid Atresia

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27
Q

Q: What is Tricuspid Atresia?

A
  • A congenital heart defect where the TRICUSPID VALVE is absent
  • Blocking blood flow from the right atrium to the right ventricle.
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28
Q

How does blood flow to the lungs in Tricuspid Atresia?

A
  • Right side of the heart unable to pump blood to the lungs
  • Blood must flow through an atrial septal defect (ASD) (or patent foramen ovale (PFO)) to allow some oxygen-poor blood from the right side of the heart to mix with oxygen-rich blood in the left ventricle and then flow directly into the pulmonary artery.
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29
Q

In tricuspid atresia, many patients may also have a ___ defect.

A

Ventricular septal defect (VSD)

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30
Q

What happens if a LARGE Ventricular septal defect (VSD) is present in Tricuspid Atresia?

A

A large VSD allows more blood to move into the lungs, which can lead to heart failure (cor pulmonale)

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31
Q

What are common S/S of Tricuspid Atresia?

A
  • Blue or gray skin and lips due to low blood oxygen levels (hypoxia)
  • Tachycardia
  • Difficulty breathing (dyspnea)
  • Tiring easily
  • Poor feeding or slow weight gain
  • Symptoms of heart failure
  • Clubbing of fingers with chronic hypoxemia
  • Increased risk of RESPIRATORY infections
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32
Q

Tricuspid Atresia Management

A
  • Monitor BP and HR closely: detect any changes in stability.
  • Monitor cardiac rhythm: Watch for atrial arrhythmias
  • Observe for signs of hypoxia: administer oxygen as needed.
  • Echocardiogram: confirms the absence of the tricuspid valve
  • Cardiac catheterization (angiography): reveals full extent of structural defects and blood flow issues.
  • Early surgical correction: ESSENTIAL!!
  • Prostaglandin e1 (Alprostadil): Medication that keeps the ductus arteriosus open to ensure blood flow to the lungs until surgery can be performed. -KNOW!!!!
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33
Q

Prostaglandin E1 is made by what woman organ during pregnancy?

A

Placenta

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34
Q

Can pregnant women take acetaminophen or ibuprofen for pain (headache) relief?

A

acetaminophen- tylenol

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35
Q

There are 3 things that CLOSE a ductus arteriosus

A
  1. Prostaglandi E1 supply is cut OFF
  2. Oxygen (O2)
  3. Anti-inflammatory meds: ibuprofen, etc
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36
Q

Q: A newborn is diagnosed with Tricuspid Atresia. Which of the following interventions is most important to ensure proper pulmonary blood circulation until surgical correction can be performed?

a) Administering intravenous fluids
b) Keeping the ductus arteriosus open with prostaglandin (Alprostadil)
c) Monitoring for signs of hypoxia and administering oxygen
d) Administering antibiotics to prevent infection

A

b) Keeping the ductus arteriosus open with prostaglandin E1 (Alprostadil)

Explanation: In tricuspid atresia, the absence of the tricuspid valve causes blood flow obstruction to the lungs. The ductus arteriosus, a fetal blood vessel, allows blood to bypass the nonfunctional right side of the heart and reach the lungs. Prostaglandin (Alprostadil) is used to keep the ductus arteriosus open until surgical intervention can correct the heart defect. This is a critical step in ensuring adequate oxygenation and blood flow to the lungs in these patients.

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37
Q

Next Congenital Disorder:

3 Disorders with INCREASED pulmonary blood flow

A
  • Atrial Septal Defect
  • Ventricular Septal Defect
  • Patent Ductus Arteriosus
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38
Q

S/S of INCREASED Pulmonary Blood Flow

A
  • Most CHDs involve INCREASED pulmonary blood flow: Many congenital heart defects result in more blood being directed to the lungs.
  • LEFT side of the heart has HIGHER pressure than the right side: This pressure difference is a key factor in blood flow patterns in the heart.
  • Increased blood flowto the RIGHT side of the heart: Leads to higher pressure in the lungs.-right side sends blood to lungs
  • Increased blood flow to the lungs: Elevates the risk of pulmonary infections.
  • Heart failure (HF) may develop EARLY in life: If the blood flowing to the lungs is excessive, heart failure can occur.
  • Heart failure is a common reason for hospitalization:
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39
Q

____ is the most common cause for admission in children with Congenital Heart Defects (CHD).

A

Heart Failure (HF)

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40
Q

Interventions for INCREASED Pulmonary Blood Flow

A

Digitalis, ACE inhibitors, and diuretics to improve heart function and reduce fluid overload.
* Monitor for signs of digoxin (dig) toxicity
* Measure blood pressure (BP) before and after ACE-I administration: Hold the medication if BP drops more than 15 mmHg.
* Daily weights: Track fluid balance and detect early signs of fluid retention.
* Carefully monitor potassium levels:
* Oxygen supplementation is generally NOT helpful

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41
Q

Why is O2 supplementation generally NOT helpful for patients with INCREASED pulmonary blood flow?

A

Oxygen acts as a pulmonary vasodilator, which can increase blood flow to the lungs and worsen congestion.

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42
Q

1st Disorder:

What is Atrial Septal Defect (ASD)

A
  • A hole exists in the wall (septum) between the right atrium and left atrium.
  • Blood flows from the left atrium to the right atrium, causing an increased volume of blood in the right atrium.
  • This results in increased blood flow to the lungs, which can lead to congestion and additional strain on the heart.
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43
Q

Smaller Atrial Septal Defects might remain undetected until

A

middle age or later.

44
Q

Larger Atrial Septal Defects appear AFTER

A

birth throughout childhood
-S/s:
* Fatigue
* Dyspnea on exertion
* Recurrent respiratory infections
* Heart murmur

45
Q

What complications can arise if a LARGE Atrial Septal Defect is left UNTREATED?

A

Can lead to:
* pulmonary hypertension
* heart failure
* atrial fibrillation/flutter **
* risk of stroke from paradoxical embolus: Normally, clots in the venous system go to the lungs, but a paradoxical embolus bypasses this route due to these structural heart defects such as ASD. There are moments where the right atrium has higher pressure than the left atrium which allows clots (if any) to be pushed into the left atrium, down the left ventricle, and up the aortic valve -potentially blocking blood flow in areas like the brain, causing a stroke.

46
Q

ASD Management:

Q: What is the management for a SMALL atrial septal defect (ASD)?

A

A SMALL ASD often closes spontaneously within the first 18 months.

47
Q

What is the recommended surgical intervention for an ASD that does NOT close spontaneously?

A

A: Surgical correction is recommended by age 3 if the ASD does not close.

48
Q

Q: What long-term monitoring is required AFTER surgical closure of an ASD?

A

A: Lifelong monitoring for atrial arrhythmias after surgical closure of an ASD.

49
Q

2nd Defect:

What is a Ventricular septal defect (VSD)?

A
  • A VSD is a hole in the septum between the RIGHT and LEFT ventricles
  • In a VSD, there is left-to-right shunting of blood: bc pressure in LEFT side is higher, it pushes blood to right ventricle.
  • Increased blood flow to the lungs (pulmonary HTN)
50
Q

What can occur if pulmonary vascular resistance EXCEEDS systemic vascular resistance in Ventricular Septal Defect?

A
  • The shunt reverses to right-to-left
  • leading to pulmonary hypertension and cyanosis.
51
Q

Q: What are the manifestations of a SMALL ventricular septal defect (VSD)?

A
  • usually no symptoms and may close on its own.
  • regular follow-up with cardiologist
52
Q

What are the manifestations of medium to large VSDs?

A

These are SYMPTOMATIC:

  • Holosystolic harsh murmur: loud, rough, or coarse noise murmur lasts for the entire duration of systole, rather than being confined to part of the systolic phase.
  • Ventricular arrhythmias- HIGH RISK
  • frequent respiratory infections
  • risk for ENDOCARDITIS - TEST!!!!
53
Q

When is surgical repair indicated for a VSD?

A

Within the first few weeks of life

-Might be closed with suture via cardiac cath
-More common: patch sewn over hole

54
Q

Q: What EKG monitoring is needed for VSD?

A

Monitoring for ventricular arrhythmias or AV block is important.

55
Q

3rd Type of Defect:

What is Patent Ductus Arteriosus (PDA)

A
  • PDA is the failure of the ductus arteriosus to close within the first few weeks of life, leading to abnormal blood flow between the aorta and pulmonary artery.
56
Q

In which infants does PDA most commonly occur?

A

premature infants

KNOW THAT PDA IS FOR PREMATURE BABIES

57
Q

What are the consequences of PDA?

A
  • Extra blood gets pumped from the aorta into the lungs.
  • leads to increased pulmonary blood flow
  • potentially causing pulmonary hypertension and heart failure.
58
Q

Patent Ductus Arteriosus (PDA) S/S

A
  • Poor feeding/Poor growth
  • Sweating with crying or eating
  • Dyspnea/tachypnea
  • Tachycardia/Palpitations
  • Easily fatigued
  • Frequent lung infections
  • Increased risk for endocarditis
  • Heart failure if not treated
59
Q

What is the first-line medication used to help close a PDA in premature infants?

A

A: NSAIDs- specifically indomethacin

60
Q

What MEDS are used if a premature infant with PDA shows signs of heart failure?

A

Diuretics

61
Q

What procedures can be used to close a PDA?

A
  1. PDA Ligation: A surgical procedure to close the PDA.
  2. Cardiac catheterization: A procedure where a plug or coil is inserted to close the PDA.
  3. Open Surgery: Used if the PDA is large or if complications arise; the PDA is closed using stitches or clips.
62
Q

What are the 3 Obstructive Disorders that cause too LITTLE blood to travel to the body

A
  1. Coarctation of the Aorta
  2. Aortic Stenosis
  3. Pulmonary Stenosis
63
Q

1st Obstructive Disorder:

What is Coarctation of the Aorta?

A
  • a congenital condition characterized by the narrowing of the aorta.
  • disrupts blood flow- increasing pressure in the heart and upper part of the body, while decreasing pressure in the lower part of the body. - KNOW!!
64
Q

The only 2 times Coarctation of Aorta is ASYMPTOMATIC

A
  • If PDA IS OPEN
    or
  • if coarcation is NOT severe
65
Q

5 S/S of Coarctation of Aorta if Symptomatic

A
  • Hypertension
  • Blood Pressure Differences:
    -Increased in upper extremities
    -Decreased in lower extremities
  • Pulse Characteristics:
    -Bounding pulses in upper extremities
    -Weak or absent femoral pulses in lower extremities
  • Pounding headache
  • Cool bilateral lower extremities
66
Q

Q: An infant with coarctation of the aorta has a recently closed patent ductus arteriosus (PDA). Which signs would indicate heart failure in this infant? (Select all that apply)

A. Poor feeding
B. Increased weight gain
C. Tachypnea
D. Sweating with feeds
E. Lethargy
F. Hepatomegaly

A

Answer: A, C, D, E, F

Rationale: Signs of heart failure in infants with a recently closed PDA include poor feeding, tachypnea, sweating with feeds, lethargy, and hepatomegaly (due to fluid overload). Increased weight gain would not be expected; instead, these infants may show failure to thrive due to difficulty feeding and decreased appetite.

67
Q

Q: An infant with severe coarctation of the aorta is experiencing symptoms of poor blood flow to the lower body. What is the priority intervention to improve circulation in this infant?

A. Administer diuretics to reduce fluid overload
B. Increase feeding frequency to promote weight gain
C. Keep the patent ductus arteriosus (PDA) open
D. Elevate the infant’s legs to improve blood flow

A

Answer: C. Keep the patent ductus arteriosus (PDA) open

Rationale: In infants with severe coarctation of the aorta, keeping the PDA open allows blood to bypass the narrowing and improves blood flow to the lower body. Prostaglandins are often administered to maintain the PDA until corrective surgery can be performed.

68
Q

Q: What are the management options for coarctation of the aorta in an infant?

A
  • Antihypertensives: to control blood pressure before surgery
  • Prostaglandin medications: to keep the ductus arteriosus open in severe cases, allowing blood to bypass the narrowed area of the aorta until surgery -TEST!!!
  • Balloon angioplasty and stenting: to widen the narrowed segment of the aorta
  • Surgical resection with end-to-end re-anastomosis: to remove the narrowed section and reattach the healthy ends of the aorta
69
Q

On a routine examination, the nurse discovers that an adolescent has increased blood pressure in the upper extremities and decreased blood pressure in the lower extremities. The nurse suspects the child may have coarctation of the aorta. What other findings might the nurse expect to see? Select all that apply.

A. Delayed femoral pulses
B. Cyanosis of the lips
C. Clubbing of the fingernails
D. Bounding pedal pulses
E. Diminished radial pulses
F. Cyanotic toes

A

A. Delayed femoral pulses
F. Cyanotic toes

Rationale: Coarctation of the aorta typically causes increased blood pressure and bounding pulses in the upper extremities, while blood flow to the lower extremities is reduced. This can lead to delayed or weak femoral pulses and cyanosis of the toes due to poor circulation. Cyanosis of the lips, clubbing of the fingernails, and diminished radial pulses are not typical findings in coarctation of the aorta.

70
Q

2nd Obstructive Disorder:

What is Aortic Stenosis?

A
  • Condition where the AORTIC valve becomes narrowed, restricting blood flow from the left ventricle to the aorta and the rest of the body.
  • This narrowing causes an obstruction that increases the workload on the LEFT ventricle, which can lead to left ventricular hypertrophy (thickening of the heart muscle) over time.
71
Q

Q: What happens when LEFT ventricular failure occurs?

A
  • Left ventricular failure leads to a backup of pressure in the pulmonary circulation, causing pulmonary edema.
    -When the left ventricle fails to pump blood effectively, pressure increases in the left atrium, then in the pulmonary veins and capillaries. This increased pressure causes fluid to leak into the lungs, resulting in pulmonary edema, which impairs oxygen exchange and causes symptoms such as shortness of breath.
72
Q

S/S of Aortic Stenosis

A
  • Asymptomatic
  • S/S If severe:
    -decreased cardiac output
    -Systolic ejection murmur: heard during systole (heart contraction)-blood flows through a narrowed area
    -Risk for bacterial endocarditis
73
Q

4 S/S of Newborn decreased cardiac output

A
  • Faint pulses
  • Hypotension
  • Tachycardia
  • Poor feeding
74
Q

3 S/S of Children decreased cardiac output

A
  • Exercise intolerance
  • Chest pain
  • Dizziness when standing for long period of time
75
Q

Q: What is the initial procedure for managing aortic stenosis?

A

A: Balloon dilation of the aortic valve

76
Q

Aortic Stenosis:

Long-term aortic regurgitation may require

A

valve replacement

77
Q

3rd Obstructive Disorder:

What is Pulmonary Stenosis

A
  • Narrowing of the pulmonary valve, causing an obstruction between the right ventricle and the pulmonary arteries.
  • Leads to right ventricular hypertrophy and decreased pulmonary blood flow.
78
Q

S/S of Pulmonary Stenosis

List 5

A
  • Often associated with Patent Ductus Arteriosus (PDA) to compensate for the obstruction, which shunts blood from the aorta to the pulmonary artery and into the lungs.
  • May also have a patent foramen ovale.
  • Asymptomatic in some children.
  • Some children may exhibit dyspnea and fatigue with exertion, similar to a hypercyanotic spell seen in children with tetralogy of Fallot.
  • May have a loud systolic ejection murmur.
79
Q

Pulmonary Stenosis Management

A
  • Prostaglandin (Alprostadil) is used to keep the ductus arteriosus open, allowing blood to flow to the lungs.
  • Balloon dilation of the pulmonic valve is very effective in relieving the obstruction.
  • Pulmonary valve replacement is only considered in the most severe cases.
80
Q

Type of Mixed Defects

A
  • Transposition of the Great Vessels (TGA)
81
Q

Whats the main problem with Mixed defects?

A

Blood mixing together

82
Q

Babies who have blood mixing together have what colored skin?

A

Blue/Purple (cyanotic)

  • This mixture results in less oxygenated blood being pumped into the systemic circulation, which leads to a drop in oxygen saturation throughout the body.
    As a result, tissues and organs receive insufficient oxygen, causing cyanosis (a bluish tint to the skin, lips, or extremities due to low oxygen levels).
83
Q

What 2 vessels in the body are considered ‘GREAT VESSELS’

A

Pulmonary Artery and Aorta

84
Q

What is Transportation of the Great Vessels (TGA)

A

Is a congenital heart defect where the pulmonary artery and the aorta are switched (or transposed) from their normal positions

85
Q

When is transposition of the great arteries usually diagnosed?

A

in the first few days of life when the ductus arteriosus closes, and the infant experiences cyanosis due to inadequate oxygenation

86
Q

What happens to the blood flow in Transposition of the Great Arteries?

A

In this condition, oxygenated blood continues to circulate back to the lungs, while deoxygenated blood continues to be pumped to the body, leading to cyanosis and insufficient oxygen delivery to the tissues.

87
Q

6 Manifestations of TGA

A
  • Significant cyanosis without a murmur
  • Cyanosis may not be present until PDA closes (as blood flow may temporarily be redirected via the patent ductus arteriosus)
  • Hypoxemia with minimal response to oxygen
  • Poor feeding: due to insufficient oxygenation
  • Clubbing of fingers and toes (indicating chronic hypoxia)
  • Increased pulmonary blood flow can lead to signs of heart failure:
    -Edema
    -Shortness of breath
    -Tachypnea (rapid breathing)
    -Adventitious lung sounds (such as crackles or wheezes, indicating pulmonary congestion)
88
Q

4 Managements for TGA

A
  • Prostaglandin (Alprostadil) to maintain open ductus arteriosus
  • Oxygen as needed
  • Balloon atrial septostomy
  • Surgical correction to switch arteries into their normal positions: usually performed by age 4 to 7 days
89
Q

2 Acquired Cardio Disorders
(develops- not born with it)

A
  • Kawasaki Disease
  • Heart Failure
90
Q

1st Acquired Disorder:

What is Kawasaki Disease

A
  • An illness that causes inflammation of the blood vessels throughout the body, particularly the coronary arteries, which supply blood to the heart.
  • Leading cause of acquired heart disease
91
Q

The main S/S of Kawasaki Disease

A

Fever!!!
- has had it for 5 days
- 103-104 F

92
Q

5 main S/S of Kawasaki Disease

A
  • High fever that doesn’t respond to treatment
  • Swollen hands and feet/Joint swelling
  • Strawberry tongue, red lips, red eyes
  • Enlarged lymph nodes
  • Peeling of skin on hands, feet, perineal area
93
Q

What are the potential complications of Kawasaki Disease?

A
  • Coronary aneurysms: Ballooning of the coronary arteries due to inflammation
    -Coronary thrombosis
    -Myocardial infarction (MI)
    -Cardiac tamponade
  • Myocarditis: Inflammation of the heart muscle, which can weaken the heart and affect its function
    -Bleeding (due to aspirin therapy)
94
Q

Management of Kawasaki Disease: Acute Phase

A
  • HIGH-dose ASPIRIN in 4 divided doses daily- 900mg/day
    -Anti-inflammatory
    -Reduce fever
    -Ease pain and discomfort
  • Proton Pump Inhibitor (PPI): bc aspirin is hard on GI
  • Single infusion of Intravenous Immunoglobulin (IVIG)
    -Antibodies to help the immune system fight the infection
    -Can reduce fever and decrease risk of heart problems
  • Monitor for heart problems
    -Follow-up with cardiology
    -Echocardiogram
95
Q

Why is aspirin for children given only in Kawasaki disease patients?

A
  • Aspirin is ONLY used in ACUTE Kawasaki disease
  • Aspirin is typically avoided in children due to the risk of Reye’s syndrome, a rare but serious condition that can cause liver and brain damage.
  • However, in Kawasaki disease (KD), aspirin is used because the benefits outweigh the risks.
  • Carefully monitored by Doctors.
96
Q

Kawasaki Disease:

After receiving a single infusion of Intravenous Immunoglobulin (IVIG), how long should a patient wait before getting a live vaccine, such as for chickenpox or measles?

A

A patient should wait at least 11 months AFTER receiving a single infusion of IVIG

97
Q

2nd Acquired Disease:

Heart Failure

A
  • Aondition where the heart is unable to pump blood effectively to meet the body’s needs.
  • It can result from conditions that damage the heart, such as coronary artery disease, high blood pressure, or previous heart attacks.
  • The heart becomes weakened or stiff, leading to a reduced ability to circulate oxygen and nutrients throughout the body.
98
Q

HF Management

A
  • Improve Cardiac Function
    -Digoxin
    -ACE Inhibitors
    -Beta Blockers
  • Remove Accumulated Fluid
    -Diuretics – What is best way to measure fluid balance?- daily weights!!!
    -Not usually, but possible fluid or sodium restriction
    -Potassium supplements
99
Q

HF:

Digoxin is held for babies with what HR

A

HR is < 80-90

(Normal:

100
Q

What are signs and symptoms of hypotension on babies?

A
  • No BP
  • lethargic
  • pale
  • cool
  • mottled
101
Q

The nurse is caring for a 14-year-old girl with atrial fibrillation. Which medication would the nurse expect to be prescribed?

A. Indomethacin
B. Digoxin
C. Furosemide
D. Prostaglandin

A

B. Digoxin

Rationale: Digoxin helps the heart pump more efficiently. It increases the strength of the heart’s contractions and helps the heart beat more regularly. This is especially helpful in conditions like heart failure and certain arrhythmias (irregular heartbeats). It works by slowing down the heart rate and improving its ability to pump blood, which can help relieve symptoms like shortness of breath and fatigue.

102
Q

The nurse is caring for an infant prescribed oral digoxin. Which finding will cause the nurse to hold the dosage and notify the primary health care provider?

A. The apical heart rate is 98 bpm
B. The infant last ate 45 minutes ago
C. The serum digoxin level is 4.0 ng/mL
D. The respiratory rate is 58 breaths/min

A

C. The serum digoxin level is 4.0 ng/mL

(therapeutic level is same for babies and adults)

Rationale:
The therapeutic range for digoxin serum levels is typically 0.5 to 2.0 ng/mL. A level of 4.0 ng/mL is considered toxic and can increase the risk of digoxin toxicity, which can lead to serious adverse effects like arrhythmias, nausea, vomiting, and even death. Therefore, the nurse should hold the dosage and notify the primary health care provider.

103
Q

How to decrease cardiac demands for HF patients

A
  • Promote rest – child with HF will usually self-limit activities based on energy level
  • Adequate sleep
  • Quite time activities – board games, coloring, drawing, video games
104
Q

How to improve tissue oxygenation for HF paitients

A
  • Semi upright position
  • Chest physiotherapy
  • Monitor oxygen levels – administer O2 as needed
  • Intubation – positive pressure ventilation
105
Q

REview HF chapter

A

know meds to give, nursing implications, how to treat HF

106
Q

In Tricuspid Atresia, which pathway is more important: Atrial septal defect (aka patent foramen ovale) , ventricular septal defecr, or patent Ductus arteriosus?

A
  • Patent Ductus Arteriosus: bc it conects the aorta DIRECTLY to the pulmonary artery, allowing blood from aorta to bypass directly into the lungs allowing for adequate pulmonary blood flow. This is essential in tricuspid Atresia.
  • atrial septal defect & ventricular septal defect do not directly help with LUNG PERFUSSION (insufficient), they allow only mixing of blood.

Test 5 (3 decks)

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