Peds- Exam 2 Flashcards
Congenital heart disease usually stems from
Anatomic abnormalities often present at birth
can overall lead to heart failure and hypoxemia
What is heart failure
when the heart can’t pump enough blood to meet our body’s demands or needs
Pediatric vs. adult cardio
Children’s hearts are smaller and have rapid growth and very fast heart rates.
Children are also most likely to have congenital heart defects
ASD
hole between the atria > oxygen-rich blood mixes with deoxygenated blood ->increased blood flow to lungs
VSD
the hole between ventricles> oxygenated blood from left ventricle going into the right ventricle and then lungs - > increase blood flow
PDA
very common, open blood vessel, blood flows between aorta and pulmonary artery causes excess blood flow to lungs
Tetralogy of Fallot
four issues that reduce blood flow to the lungs, causing oxygen-poor blood to circulate in the body
ASD Signs & Symptoms
Loud harsh murmur -> fixed split-second heart sounds (LUSB)
heart failure
often asymptomatic
Coarctation of the aorta
narrpwing of aorta, near ductus arteriousus, bounding pulses, fainting, nose bleeds, lower extremities weak pulses
CHD Risk Factors
Maternal: Infection, alcohol/ substance abuse, dm
Genetic: Hx, trisomy 21, presence of other congenital anomalies or chromosomal abnormalities
VSD Signs & symptoms
loud, harsh murmur heard at LSB
Heart failure
(VSD often closes spontaneously early in life)
PDA Signs & symptoms
Systolic murmur (machine hum) because of persistent blood flow of the aorta to the pulmonary artery (mostly heard in systole)
wide pulse pressure (systolic rises because of increased blood flow, diastolic remains relatively low
often asymptomatic
RALES- because of excess flow you’ll have pulmonary congestion
Tetralogy of Fallot
Cyanosis at birth -> progressive over the first year of life.
systolic murmur
Episodes of acute cyanosis and hypoxia (tet spell) respiratory distress
Treatments VSD
Nonsurgical
- Observe for spontaneous closure *
-Closure during cat procedure
- diuretics to manage symptoms
Surgical
- pulmonary artery banding
- complete repair with a patch
symptom and family specific
what causes a tet spell
caused by a sudden decrease in the amount of blood flowing to the lungs
because you have increased light to left shunting or decreased pulmonary blood flow.
expected findings for Coarctation of the aorta
-^ Pressure in arms
-Bounding pulses on upper extremities
-decreased blood pressure in lower extremities
-weak/ absent femoral pulses
-heart failure in infants
- cool skin of lower extremities
Treatments ASD
Nonsurgical
-Closure during cardiac cath
-Diuretics for symptom management
- low dose aspirin 6 months after procedure (cath)
Surgical
- patch closure
- cardiopulmonary bypass
Treatments PDA
Nonsurgical
-Diuretics
- Indomethacin (promotes closing of PDA)
- poor feeding so work on extra calories
Treatments of tetralogy of Fallot
Surgical (must be done within 1st year of life)
-shunt placement until able to undergo primary repair
-complete repair within the first year of life
Treatment Coarctation of aorta
Nonsurgical
-infants & children: balloon angioplasty
-Adolescents: placement of stents
Surgical
-repair of defect recommended for infants less than 6 months of age
Nursing Consideration
PDA
- Monitor vitals
-Medication administration (give indomethacin -> look for GI symptoms)
-nutritional support ( provide extra calories and monitor growth)
-Post-procedure care (education)
Nursing Consideration
COA
-Vital signs (BP in both upper and lower extremities-> key indicator ^ in arms decrease in legs)
-Pulse checks (assess for bounding pulses in the upper, check for a weak or absent femoral pulse
-Skin temp. ( observe for cold lower extremities)
-symptom monitoring ( headaches, nosebleeds, heart failure, poor feeding)
Nursing Consideration
VSD
-Monitor 4 Heart failure
(assess resp. distress, poor feeding, edema)
- Medication Management
(diuretic to manage fluid overload)
-Growth & Development
(make sure proper growth)
-Patient & Family Education
(educate on worsening signs & symptoms of heart failure, discuss follow-up care, etc.
Nursing Consideration
ASD
-Assess heart sounds & Symptoms
(listen for murmurs, monitor for fatigue or resp. issues)
-Medication and post-procedure care
(administer diuretics, monitor for complications)
- educate and follow up
( explain signs of complications and the importance of low-dose aspirin (because of clotting risk and only if prescribed, stress follow-up appointments )
How does Rheumatic Fever occur
usually happens after A strep infection.
-if not treated properly or recognized
Labs for Rheumatic Fever
Sore throat = throat culture GABHS
Blood antistreptolysin O titer- most reliable diagnostic test
CRP-elevated in response to an inflammatory reaction
Erythrocyte sedimentation rate - response to inflammation
Rheumatic fever diagnostic Jones criteria
Minor: fever, arthralgia
Major: carditis, subcutaneous nodules, polyarthritis, rash, chorea ( neurological)
Signs & Symptoms for Rheumatic Fever
Recent upper resp. infection
fever (high 5 days- to a week)
pericardial friction tub
painful swelling in large joints
involuntary facial movements
pink, nonpruritic macular rash (trunk and inner surface if extremities)
^HR
Jones Criteria
demonstrate at least 2 major criteria or one major 2 minors
Medication for rheumatic fever
antibiotic prophylaxis - treatment will vary depending on the damage to the heart patient-specific can range from 5 years to indefinitely
what medications are used to help with rheumatic fever
two daily doses of penicillin V
monthly IM injection of penicillin G
daily oral dose of sulfadiazine
Nursing Consideration for rheumatic fever
rest during the acute phase, proper nutrition, seeking care for recurring infection, follow-ups with cardiologist,
Kawasaki Disease
acute systemic vasculitis, inflammation in artery walls including coronary which supply blood to the heart muscle
AKA: mucocutaneous lymph node syndrome
Kawasaki Expected findings Acute
Fever: 5 days - 2 weeks
Irritability: Bloodshot eyes
Strawberry tongue: tell-tale sign ( red tongue white coating/ bumps)
Oral Mucosa: red
swelling to extremities- hands and feet
Rash- no blistering
Painful Joints
Lymphedema- enlarged lymph nodes
Desquamation- perineum area
Cardiac- myocarditis decreases left ventricular function
Kawasaki Expected findings Sub Acute
Fever
Irritability
Skin
Arthritis
Kawasaki Expected findings Convalescent phase
Manifestations: no symptoms except altered laboratory findings
Resoluution: about 6-8 weeks from onset
Nursing consideration Kawasaki
Monitor Vital signs
Assess heart failure
Track I&O, Daily weight
IV Fluids
Diet- , nonacidic due to pain liquid
Medication Consideration- IV Gamma Globulin: modulates immune response to prevent complications (Given within first 10 days of symptoms)
aspirin- anti-inflammatory, antiplatelet
*Comfort care: no hot baths, no scented soaps, offer lip balm, proper oral care
Labs for Kawasakis
Labs: CBC, CRP, ESR ( might see elevated liver enzymes reflecting the extent of systemic inflammation)
Diagnostics for Kawasaki
Chest X-ray, echo, EKG (looking for myocarditis and prolonged PR Intervals or non-specific st and t waves)
Lumbar puncture: looking for aseptic meningitis and inflammation
Nursing Education for Kawasaki
-Maintain follow-up appointments,
-monitor for complications carditis, inflammation of blood vessels, Afib, irregular heartbeats, embolism
- blood and urine testing
