Peds exam 2 - Acquired Cardiac Flashcards by Jane Daum

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

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clinical manifestations of bacterial endocarditis

janeway spots, osler nodes, splinter hemorrhages under nails
-petechiae
-anorexia
-joint pain
-murmur

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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

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nursing considerations of BE

-teach prophylatic antibiotic therapy
-teach family to give IV antibiotics at home
-symptomatic relief
-monitor for emboli

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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

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incidence & etiology RF

-school aged children
-strep infection a few weeks prior to dx
-more common in males during late winter & early spring

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clinical manifestations of RF: major

-polyarthritis
-carditis
-chorea (shakiness, dont do fine motor things)
-erthema marginatum (large red dots)
-subcutaneous

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clinical manifestations of RF: minor

-arthralgia (joint pain)
-low grade fever
-elevated ASO titer
-abdominal pain

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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

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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

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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

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Kawasaki Disease (mucocutaneous lymph node syndrome)

acute systemic vasculitis of unknown etiology w/ possible infectious component
body wide inflammation of veins, capillaries, coronary arteries

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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

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Kawasaki Disease clinical manifestations: subacute phase (10-35 days)

starts when fever goes away
-vasculitis
-desquamation of toes, feet, fingers & palms
-arthritis
-thrombocytosis

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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

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nursing intervention of kawasaki disease

-most babies will get better on their own but 20% develop serious cardiac sequelae so we treat them all

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sign / symptoms of myocardial infection in children

-pain in chest or back or no symptoms at all
-abdominal pain
-restlessness
-inconsolable crying
-pallor
-shock

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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

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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