Peds exam 2 - Acquired Cardiac Flashcards
bacterial endocarditis
an inflammatory process resulting from infection of the valves and inner lining of the heart
can occur from a line or dental procedure, ect
clinical manifestations of bacterial endocarditis
janeway spots, osler nodes, splinter hemorrhages under nails
-petechiae
-anorexia
-joint pain
-murmur
bacterial endocarditis therapeutic mgt
-IV antibiotics for 2 to 8 wks
-surgical removal of significant emboli and/or valve replacement
-prevention: prophylactic antibiotics 1hr before risky procedure for high risk kids
nursing considerations of BE
-teach prophylatic antibiotic therapy
-teach family to give IV antibiotics at home
-symptomatic relief
-monitor for emboli
rheumatic fever
a systemic inflammatory disease that follows a group A beta hemolytic streptococcus infection in mitral valve
untreated strep which leads to infection of heart which can lead to damage & backflow
incidence & etiology RF
-school aged children
-strep infection a few weeks prior to dx
-more common in males during late winter & early spring
clinical manifestations of RF: major
-polyarthritis
-carditis
-chorea (shakiness, dont do fine motor things)
-erthema marginatum (large red dots)
-subcutaneous
clinical manifestations of RF: minor
-arthralgia (joint pain)
-low grade fever
-elevated ASO titer
-abdominal pain
therapeutic mgt of RF
-eradication of beta hemolytic streptococci (strep) w/ cillin antibiotic
-prevent cardiac damage so will be on aspirin therapy for a couple weeks
-steroids
-bed rest
-give prophylactic antibiotics before any procedure for rest of life
at what age can we start giving aspirin
do not give aspirin until a person is 18 yrs old bc of ryes syndrome but will give to children w/ RH bc the benefits outweighs the costs
nursing considerations of RF
prevent the disease
-encourage compliance w/ drug regimens esp prophylactic
-teach about aspirin therapy and reyes symptoms let us know if viral infection occurs so we can determine if we need to dc aspirin
-facilitate recovery
Kawasaki Disease (mucocutaneous lymph node syndrome)
acute systemic vasculitis of unknown etiology w/ possible infectious component
body wide inflammation of veins, capillaries, coronary arteries
Kawasaki Disease clinical manifestations: acute phase (8-10 days)
-fever does not respond to tyl or ibpro
-pruritic polymorphic rash
-cervical lymphadenopathy
-dry, red, cracked lips
-strawberry tongue
-bilateral pink eyes w/o the junk
-erythema & swollen palms
Kawasaki Disease clinical manifestations: subacute phase (10-35 days)
starts when fever goes away
-vasculitis
-desquamation of toes, feet, fingers & palms
-arthritis
-thrombocytosis
Kawasaki Disease clinical manifestations: recovery phase (up to 10 wks)
-symptom free
-complete when all blood values return to normal
-most dangerous phase bc embolisms can form and the kids are at an increased risk of MI
nursing intervention of kawasaki disease
-most babies will get better on their own but 20% develop serious cardiac sequelae so we treat them all
sign / symptoms of myocardial infection in children
-pain in chest or back or no symptoms at all
-abdominal pain
-restlessness
-inconsolable crying
-pallor
-shock
therapeutic treatment for KD
-high dose aspirin for anti inflammatory and then low dose for anti platelet
-if fever is caught within 10 days can give IVIG to decrease heart problems watch fluid overload
-vitals & I&Os & daily wts
-IVIG is blood so vitals 15 mins before & after and then every hour until finished
hypertension in children
mainly secondary, based on their height, weight, age and gender not just 1 number
incidence & etiology: HTN in children
-primary is rare
-renal disease
-coarctation of the aorta
-oral contraception
-steroids
-obesity
-adrenal disorders
treat cause & get urine analysis
HTN clinical manifestations
-elevated BP
-frequent headaches
-dizziness
-vision changes
HTN nursing considerations
-if mild, just monitor
-meds are beta & ace
-teaching (normal BP stuff)
how to take BP on kids
need the right size cuff and goes around the arm
HLD in children
rare and usually would only see in adolescents
selectively screen
cholesterol goal level
<170
HLD treatment
suggest healthy life style, diet and exercise
fat intake should never be limited in children from birth to 2 yrs old
supra ventricular tachycardia
super high HR
-rapid, regular heart rate of 200-300 bpm
SVT manifestations
-irritable, pale, refusal to eat
-older: dizziness, heart palpitations, chest pain & sweating
cardiomyopathy
myocardial abnormalities which impair the cardiac muscles ability to contract
cardiomyopathy: dilated
ventricular dilatation w/ greatly decreased contractility leading to CHF
cardiomyopathy: hypertrophic
increase in heart muscle mass without an increase in cavity size, usually LV
most common
cardiomyopathy: restrictive
restriction to ventricular filling caused by endocardial or myocardial disease or both. leads to CHF
cardiomyopathy etiology
familial or genetic causes, infection, deficiency states, metabolic abnormalities & collagen vascular disease
rare & most are idiopathic
nursing considerations for KD
-unscented moisturizers
-mouth care
-clear liquids & soft foods
-irritable child so very calm
how long should you avoid immunization after receiving IVIG
11 months because you might not be able to build the antibodies
if your child receives aspirin therapy, what vaccine should they not get
varicella
dysrhythmias in children
dx w/ 24hr holter monitor, ECG & transesophageal recording
bradydysrhythmias
sinus braadycardia
-complete atrioventricular block (AV block)
-resolve by self
tachydysrhythmias
sinus tachycardia
-caused by stress, anxiety, fever, pain and dehydration
-will go away on own
SVT treatment
-vagal maneuvers (bear down, blow on thumb for 60sec, ice to face, carotid massage) & valsalva maneuver do not do any of this at home
-can give adenosine, rapid IVP
-digoxin
-cardioversion
SVT can be caused by
caffeine and cough meds
sinus arrhythmia
-regular irregularity
-normal in school age child
-have child hold breath and it should regualt
cardiomyopathy clinical manifestations
-CHF
-dysrhythmias
-syncope
-sudden death
cardiomyopathy therapeutic mgt
-digoxin helps heart beat stronger
-diuretics
-beta blockers
-calcium channel blockers
-anticoags
-transplant
cardiomyopathy nursing considerations
-kids struggle adjusting to lack of energy
-include child in discussions and decisions
-teach about psychological preparation for transplant & post opt care
