UNIT 7 CARDIOVASCULAR DISORDERS CHAPTER 42 Flashcards
Fetal circulation
Umbilical vein: During fetal life blood carrying oxygen and nutritive
materials from the placenta enters the fetal system through the
umbilicus via the large umbilical vein
Blood then travels to the inferior vena cava through the ductus
venosus
Foramen ovale: shunts blood from right atrium to left atrium
Ductus arteriosus: connects pulmonary artery to the proximal
descending aorta.
A first time mother has a toddler that has undergone a cardiac cauterization procedure. She insists on giving the toddler a tub bath which is her normal hygiene regimen for the toddler. What is the best nursing action from the nurse?
A. Re-educate the mother, that it is not prohibited to continue tub baths after this invasive procedure. It can lead to further complications.
B. Instruct the mother that tub baths are only prohibited 6 months after the procedure.
C. Sponge baths are the only acceptable hygiene regimen for toddlers after this procedure.
D. Advice the mom that she can only bathe the toddler for a maximum of 4 minutes.
A. Re-educate the mother, that it is not prohibited to continue tub baths after this invasive procedure. It can lead to further complications.
Cover catheter insertion site with an adhesive bandage strip and change daily for 2 days.
Keep site clean and dry. Avoid tub baths and swimming for several days; patient may shower or have a sponge bath.
Observe site for redness, swelling, drainage, and bleeding. Monitor for fever.
Notify the practitioner if these occur.
Encourage rest and quiet activities for the first 3 days and avoid strenuous exercise.
Discuss returning to school and resuming other activities with the practitioner.
Resume regular diet without restrictions.
Use acetaminophen for pain.
Keep follow-up appointments per practitioner’s instruction.
What is the priority nursing action post-op of cardiac catheterization?
A. Assess pulses bilaterally
B. Administer acetominophen
C.
D.
You observe that the cardiac Cath site has site redness, swelling, drainage, and bleeding. You also assess the preschoolers temperature , it is 101.3 degrees Fahrenheit. What is the nurses priority action?
A. Initiate IV fluid
B. Provide therapeutic communication to patients family
C. Call a code
D. Notify the health care provider
D. Notify the health care provider
Observe site for redness, swelling, drainage, and bleeding. Monitor for fever. Notify practitioner if these occur.
Your patient has just had a cardiac catheterization on their left femoral artery. What location should you asses the pulses bilaterally?
A. Carotid pulse
B. Femoral pulse
C. Popliteal pulse
D. Brachial pulse
C. Popliteal pulse
Pulses, especially below the catheterization site, for equality and
symmetry. (Pulse distal to the site may be weaker for the first few
hours after catheterization but should gradually increase in strength.)
Are children ate risk post op Cardiac Catherization for hypovolemia and dehydration
A. Yes
B. No
A. Yes
Fluid intake, both IV and oral, to ensure adequate hydration.
(Blood loss in the catheterization laboratory, the child’s NPO sta- tus, and diuretic actions of dyes used during the procedure put children at risk for hypovolemia and dehydration.)
What is the proper positioning for a pediatric patient op cardiac cath>
A. Legs flexed
B. Trendelenburg positioning
C. right side lying
D. legs extended and straight
D. legs extended and straight
Depending on hospital policy, the child may be kept in bed with the affected extremity maintained straight for 4 to 6 hours after venous catheterization and 6 to 8 hours after arterial catheterization to facilitate healing of the cannulated vessel.
Is coolness of the extremity an expected finding after cardiac Cath site?
A. Yes
B. No
B. No
- Pulses, especially below the catheterization site, for equality and
symmetry. (Pulse distal to the site may be weaker for the first few
hours after catheterization but should gradually increase in strength.) - Temperature and color of the affected extremity because coolness
or blanching may indicate arterial obstruction - Vital signs, which are taken as frequently as every 15 minutes, with
special emphasis on heart rate, which is counted for 1 full minute
for evidence of dysrhythmias or bradycardia - Blood pressure (BP), especially for hypotension, which may indi-
cate hemorrhage from cardiac perforation or bleeding at the site of
initial catheterization - Dressing, for evidence of bleeding or hematoma formation in the
femoral or antecubital area - Fluid intake, both IV and oral, to ensure adequate hydration.
(Blood loss in the catheterization laboratory, the child’s NPO sta- tus, and diuretic actions of dyes used during the procedure put children at risk for hypovolemia and dehydration.) - Blood glucose levels for hypoglycemia, especially in infants, who should receive IV fluids containing dextrose
Your 11-year-old client is on a football team. He is about to undergo a cardiac Cath procedure. He wanted to know if he can go to practice 1 day post op of the cardiac procedure. What statement by the nurse warrants immediate intervention?
A. It is prohibited to start strenuous exercise after a cardiac Cath procedure to to risk of bleeding.
B. After the procedure you should be all set to play football again.
C. I would highly recommend you rest after this procedure so you’ll be strong and recovered when you start playing football again.
D. Every child is different but I personally would not give you the ok due to your health being at risk.
B. After the procedure you should be all set to play football again.
Encourage rest and quiet activities for the first 3 days and avoid strenuous exercise.
What is the difference between acquired and congenital heart defects?
Congenital - you have it at birth
*Anatomic: abnormal function
Acquired- you contract it due to environmental factors, something happened and it damaged your heart
*Infection
*Autoimmune responses
* Environmental factors
*Familial tendencies
Which of the following defects would warrant early Pediatric Indicators of Cardiac Dysfunction?
A. low pitch crying
B. poor feedings
C. rooting reflex is gone at 4 months
D. Spontaneous movements
B. poor feedings
Poor feeding
Tachypnea/ tachycardia
Hypoxia
Failure to thrive/poor weight gain/activity intolerance
Developmental delays
Positive prenatal history
Positive family history
IDENTIFY DIAGNOSTIC TEST
Graphic measure of electrical activity of heart
A. Cardiac catherization
B. Ultrasound
C. Electrocardiogram
D. Echocardiography
C. Electrocardiogram
IDENTIFY DIAGNOSTIC TEST
Use of high-frequency sound waves obtained by a transducer to produce an image of cardiac structures
A. Cardiac catherization
B. Ultrasound
C. Electrocardiogram
D. Echocardiography
D. Echocardiography
IDENTIFY DIAGNOSTIC TEST
Imaging study using radiopaque catheters placed in a peripheral blood vessel and advanced into heart to measure pressures and oxygen levels in heart chambers and visualize heart structures and blood flow patterns
A. Cardiac catheterization
B. Ultrasound
C. Electrocardiogram
D. Echocardiography
A. Cardiac catheterization
function of Electrophysiology studies
Electrophysiology studies: Catheters with tiny electrodes that record the impulses of the heart directly from the conduction system are used to evaluate dysrhythmias. Other catheters can destroy abnor- mal pathways that cause rapid rhythms (called ablation).
function of Interventional catheterizations
Interventional catheterizations (therapeutic catheterizations): A bal- loon catheter or other device is used to alter the cardiac anatomy. Examples include dilating stenotic valves or vessels or closing ab- normal connections (Table 42.2).
function of Diagnostic catheterizations
Diagnostic catheterizations: These studies are used to diagnose con-
genital cardiac defects, particularly in symptomatic infants and before surgical repair. They can include right-sided catheteriza- tions, in which the catheter is introduced through a vein (usually the femoral vein) and threaded to the right atrium, and left-sided catheterizations, in which the catheter is threaded through an ar- tery into the aorta and into the heart.
If the cardiac catheter site is bleeding what is the priority action of the nurse?
A. Apply pressure on the site
B. Apply a warm compress to stop the bleeding
C. Apply direct continues pressure 1 inch above the incision cite to localize pressure over the vessel puncture
D. Call a rapid response
C. Apply direct continues pressure 1 inch above the incision cite to localize pressure over the vessel puncture
If bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the percutaneous skin site to localize pressure over the vessel puncture.
How would you differentiate acyanotic and cyanotic
cyanotic baby turns blue or has blue mucous membranes with an increase of activity, feeding , or frying
Acyanotic no visible symptoms of respiratory distress
Digoxin Infant vs Digoxin Adolescent heart rate (AMINISTRATION CONTRAINDICATION)
Adolescents BELOW 70 DO NOT GIVE
Infants BELOW 90 DO NOT GIVE
What is the best indicator of the drug furosemide is working?
a patients weight loss
Defects of increased pulmonary blood
flow
Defects of increased pulmonary blood
flow
ASD
VSD
PDA
Obstructive cardiac defects
Coarctation of the aorta
Aortic stenosis
Pulmonic stenosis
What is the best intervention to correct obstructive cardiac defects
Cardiac catheterized balloon
Defects of decreased pulmonary blood
flow
Defects of decreased pulmonary blood
flow
Tetralogy of Fallot
Tricuspid atresia
When would tetralogy of fallot be considered to be a cyanotic defect?
A. positive tet spell
B. negative tet spell
C. crying baby
D. unresponsive baby
A. positive test spell
Cardiac defects in tetralogy of Fallot
-Overriding aorta
-Pulmonic stenosis
-Ventricular septal defect
-Right ventricular hypertrophy
What is a tet spell
At birth, infants may not show the signs of the cyanosis but later may develop episodes of bluish skin from crying or feeding called “Tet spells
Mixed blood flow
Transposition of the great vessels
Hypoplastic left heart syndrome
What causes atrial septal defect
foramen ovale does not close,
opening in the right atrium
opening in the right atrium
A.PDA
B. VSD
C. ASD
Atrial septal defect
Abnormal opening between right and left ventricular chambers?
A. PDA
B. ASD
C. VSD
C. VSD
Ventricular septal defect
Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first weeks of life
A. PDA
B. VSD
C. ASD
Patent ductucterios arteriosus
Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close within the first weeks of life. The continued patency of this vessel allows blood to flow from the higher-pressure aorta to the lower-pressure pulmonary artery, which causes a left-to-right shunt.
narrowing of Aorta artery wall?
A. pulmonary stenosis
B. aortic stenosis
C.Coarctation of aorta
C.Coarctation of aorta
The effect of a narrowing within the aorta is increased pressure proximal to the defect (upper extremities) and decreased pressure distal to it (lower extremities).
The healthcare provider has diagnosed your patron with Coarctation of the aorta, which of the following statements are true about this cardiac defect?
A.B. the patient has a decreasedblood pressure in arms and increased blood pressure in legs
B. the patient has a increased blood pressure in arms and decreased blood pressure in legs
C. the patient has a decreased blood pressure systemically
D. The patient has present petechia on neck and chest
B. the patient has a increased blood pressure in arms and decreased blood pressure in legs
The effect of a narrowing within the aorta is increased pressure proximal to the defect (upper extremities) and decreased pressure distal to it (lower extremities).
There may be high blood pressure and bounding pulses in the arms, weak or absent femoral pulses, and cool lower extremities with lower blood pressure.
Increased pressure to
head and upper
extremities
Decreased pressure to
lower extremities
What is the treatment of choice for obstructive cardiac defects
Treatment of choice:
balloon angioplast
What drug would you suspect the Health Care Provider to order for an infant with Patent Ductus Arteriosus?
A. Digoxin
B. Methotrexate
C. Indomethacin
D. Furosemide
Indomethacin injection works by causing the PDA to constrict, and this closes the blood vessel. turn the opening into a ligament (normal anatomic structure)
Administration of indomethacin (prostaglandin in- hibitor) has proved successful in closing a patent ductus in premature infants and some newborns.
What are the 4 defects of Tetrology of fallout
- Ventricular Septal defect
2 . Overriding aorta
- Right ventricular hypertrophy
- pulmonary stenosis
Pulmonic stenosis
Narrowing at the entrance to the pulmonary artery. Resistance to blood flow causes right ventricular hypertrophy and decreased pulmonary blood flow. Pulmonary atresia is the extreme form of pulmonic stenosis (PS) in that there is total fusion of the commissures and no blood flows to the lungs. The right ventricle may be hypoplastic.
Aortic Stenosis
Narrowing or stricture of the aortic valve,
What is the proper positioning of an infant with present Tet spell who has been recently diagnosed with Tetralogy of fallout?
KNEE TO CHEST
They occur more often in the morning and may be pre- ceded by feeding, crying, defecation, or stressful procedures.
*Place infant in knee-chest position (Fig. 42.10).
*Use a calm, comforting approach.
Administer 100% “blow-by” oxygen.
*Give morphine subcutaneously or through an existing intravenous (IV) line. *Begin IV fluid replacement and volume expansion if needed.
*Repeat morphine administration.
Which of the following statements highlight the physical characteristics of Triscupid Astresia?
A. mitral and tricuspid valve formed a fistula caused angioedema
B. pulmonary valve is narrowed
C. tricuspid valve did not flow increasing pulmonary blood flow
D. tricuspid valve has not formed decreased pulmonary blood flow with ventricuar septal defects present
D. tricuspid valve has not formed decreased pulmonary blood flow
Will also have ASD (or
PFO) and VSD
Transposition
of Great
Arteries
(vessels)
The pulmonary artery leaves the left ventricle, and the aorta ex-
its from the right ventricle, with no communication between the systemic and
pulmonary circulations.
clinical findings
Vary according to the type and size of the associ- ated defects. Newborns with minimum communication are severely cyanotic and have depressed function at birth. Those with large septal defects or a patent ductus arteriosus may be less cyanotic but have symptoms of HF. Heart sounds vary according to the type of defect present. Cardiomegaly is usually evident a few weeks after birth.
Hypoplastic left ventricle
Underdevelopment of the left side of the heart with significant hypoplasia of the left ventricle including atresia, stenosis, or hypoplasia
the aortic and/or mitral valves, and hypoplasia of the ascending aorta and arch. Most blood from the left atrium flows across the patent foramen ovale to the right atrium, to the right ventricle, and out the pulmonary artery. The descending aorta receives blood from the patent ductus arteriosus supplying systemic blood flow
What cardiac disorder is this?
LEFT VENTRICLE OF THE HEART IS NOT FORMED WITH THE PRESENT ATRIAL SEPTAL DEFECT.
Hypoplastic left ventricle
Left heart failure Symptoms
-S3 gallop
-frothy pink tinged sputum
-hacking cough
-pulmonary edema
-breathlessness
-crackles in lungs
-wheezes in lungs
-tachypnea
-tachyccardia
Tachypnea
Dyspnea Retractions (infants) Flaring nares Exercise intolerance Orthopnea
Cough, hoarseness Cyanosis Wheezing Grunting
Right heart failure symptoms
-Juglar vein distention
-peripheral edema
-ascities
-spleenomegaly
-hepatomegaly
-tachypnea
-tachyccardia
-oliguria
Weight gain
Hepatomegaly
Peripheral edema, especially periorbital Ascites
Neck vein distention (children)
Can the heart muscle become damaged if heart failure is left untreated?
A. Yes
B. No
A. Yes
What is heart failure
The inability of the heart to pump an adequate amount of blood into the
systemic circulation
A pediatric patient who has been diagnosed with Heart failure by the Health Care Provider. The doctor orders an ECG . What pattern would you suspect to see on the ECG graph?
A. Sinus rhythm
B. Sinus bradycardia
C. ventricular hypertrophy
V. atrial flutter
C. ventricular hypertrophy
ECG indicates ventricular hypertrophy
Your patient with heart failure has gained 5 pounds in a week due to their symptoms of heart failure. What drug would you suspect the Health Care Provider to order?
A. Aspirin
B. Furosemide
C. Enoxaparin
D. Clopidogrel
B. Furosemide
Drug of choice in severe heart failure Causes excretion of chloride and potassium
(hypokalemia may precipitate digitalis toxicity)
Treatment goals for HEART FAILURE
- Improvedcardiacfunction
- Preventionoffluidandsodiumoverload
- Decreasedcardiacdemands
- Improvedoxygenation
- Reducedrespiratorydistress
IMPROVE CARDIAC FUNCTION
Digoxin (improves contractility)- *high alert med- toxicity potential!
ACE inhibitors (reduces afterload, makes it easier to pump)
Beta Blockers
Resynchronization Therapy via pacing
REMOVE ACCUMALTION FLUID AND SODIUM
Diuretics
DECREASE CARDIAC DEMANDS
REST IS NECESSARY
Improve tissue oxygenation
Oxygen may be indicated, but we only use it when necessary
Which of the following disorders are acquired cardiac defects?
A. Atrial septal defect
B. Ventricular septal defect
C. Endocarditis
D. Tetralogy of fallout
C. Endocarditis
What is Endocarditis
Infective endocarditis (IE) (also called bacterial endocarditis or sub- acute bacterial endocarditis [SBE] in the past) is an infection of the inner lining of the heart (endocardium), generally involving the valves.
Where does the bacteria generally grow when a patient has Endocarditis?
A. The right atrium
B. all four chambers of the heart
C The apex of the heart
D. The valves of the heart
D. The valves of the heart
S/S of endocarditis
Onset usually insidious(any disease that comes on slowly and does not have obvious symptoms at first. )
Unexplained fever (low grade and intermittent)
Anorexia
Malaise
Weight loss
* Petechiae on oral mucous membranes
Characteristic findings caused by extracardiac emboli formation:
* Splinter hemorrhages(thin black lines) under the nails
*Osler nodes(red, painful intradermal nodes found on pads of phalanges) *
*Janeway lesions (painless hemorrhagic areas on palms and soles)
Does Endocarditis occur suddenly or slowly?
slowly
Risk factors of Endocarditis
The most common causative agents are Staphylococcus aureus and viridans streptococci;
Invasive Cardiac surgery
Invasive Gastrointestinal surgery
Invasive Genuitory surgery
especially if synthetic material is used (valves, patches, conduits); or from long-term indwelling catheters.
exposure to bacteria by brushing teeth
dental work
What is the treatment for Endocarditis
High dose antibiotics for 2-8 weeks
Blood cultures are taken periodically to evaluate the response to antibiotic therapy. Frequent echocardiograms are done to monitor for vegetations, valve function, and ventricular function. Heart surgery to repair or replace the affected valve may be necessary.
Treatment of endocarditis requires long-term parenteral drug therapy. In many cases, IV antibiotics may be administered at home with nursing supervision.
When should you administer a Prophylaxis with a patient who is diagnosed used with Ineffective Endocarditis when scheduled for a dental procedure ?
A. 24 hours before the dental procedure
B. 12 hours before dental procedure
C. 30 minutes before the dental procedure
D. 1 hour before the dental procedure
D. 1 hour before dental procedure
Prevention involves administration of prophylactic antibiotic ther- apy to high-risk patients prior to dental procedures that are associated with the risk of entry of organisms (Box 42.9). Drugs of choice for prophylaxis, given 1 hour prior to the procedure, include amoxicillin, ampicillin, and clindamycin in penicillin-allergic patients
Can signs of heart failure be present in a patient who is diagnosed with Endocarditis?
May be present:
* Heart failure
* Cardiac dysrhythmias
*New murmur or change in previously existing one
Nursing Interventions/ Management for Endocarditis
Nurses counsel parents of high-risk children concerning the signs and symptoms of endocarditis and the need for prophylactic antibiotic therapy before dental work.
Keep oral care a priority to prevent furthermore bacterial complications
Your pediatric patient presents with these symptoms who has been diagnosed with Endocarditis
“unexplained fever, weight loss, or change in behavior (lethargy, malaise, anorexia) .”
What is the nurses priority action?
must be brought to the practitioner’s attention
Nursing goals during Long term IV therapy for Endocarditis
Nursing goals during this period are (1) prepara- tion of the child for IV infusion, usually with an intermittent infusion device and several venipunctures for blood cultures;
(2) observation for side effects of antibiotics, especially inflammation along venipuncture sites;
(3) observation for complications, including embolism and HF; and
(4) education on the importance of follow-up visits for cardiac evaluation, echocardiographic monitoring, and blood cultures. Some children may need preparation for surgery and, later, postoperat
How is Rheumatoid fever caused?
Acute rheumatic fever (ARF) is a result of an abnormal immune re- sponse to a group A strep (GAS) infection, usually pharyngitis, in a genetically susceptible host
can rheumatoid fever cause cardiac heart valve damage
A. Yes
B.No
A. Yes
ARF is a self-limited illness that involves the joints, skin, brain, and heart, but cardiac valve damage, which is referred to as rheumatic heart disease (RHD),
Which valve is most affected in Rheumatoid heart disease
A.Tricuspid
B. Pulmonic
C. Aortic
D. Mitral
. D. Mitral
The mitral valve is most often affected. In developed countries,
Does rheumatoid fever cause joint, skin pain?
A. Yes
B. No
A. Yes
Affects joints, skin, brain, and
heart
Reoccurring infection
If children have one strep infection, they are at greater risk for repeated infec- tions, and recurrent infections cause the cumulative valve damage of RHD.
What is the best diagnostic test for rheumatoid fever
A. ASO titer
B. Echocardiogram
C. Cardiac Catherization
D. Sweat test
A. ASO titer
Children suspected of having ARF are tested for streptococcal anti- bodies. The most reliable and best standardized test is an elevated or rising antistreptolysin O (ASO or ASLO) titer, which occurs in 80% of children with ARF.
What is the best way to prevent ARF
PREVENTING THE DEVELOPMENT OF ARF BY TREATING STREP THROAT INFECTIONS
Primary prevention involves prompt diagnosis and treatment of strep throat infections so that ARF does not occur. Penicillin is the drug of choice or an alternative in penicillin-sensitive children (Gerber, Baltimore, Eaton, et al., 2009).
Therapy Management for Rheumatoid Fever
For children with ARF, treatment includes antibiotics, anti-inflammatory therapy, and supportive care and management of HF in some. Antibiotics are given to treat the GAS infection and long-term prophylactic treatment to prevent future infections
Penicillin is the drug of choice. ANTIBIOTIC
Salicylates are used to control the inflammatory process, especially in the joints, and reduce fever and discomfort.
Bed rest, quiet activity
Prophylactic antibiotic therapy- before dental procedures
The diagnosis must be confirmed before aspirin therapy is started so that clinical signs are not masked by the therapy. Aspirin up to 80 to 100 mg/kg/day has traditionally been given in four or five divided doses as initial therapy
Supportive care involves initial bed rest during the acute illness and then quiet activities as symptoms subside. Good nutrition is important. Care for children with significant carditis includes HF therapies such as supplemental oxygen, diuretics, fluid and salt restric- tion, digoxin, or ACE inhibitors.
S/S OF RHEUMATOID FEVER
*Carditis (seen in 50%–70% of cases):inflammation of the heart and valves especially mitral valve
*New murmur of valve regurgitation (mitral valve most common)
*Echo Doppler evidence of cardiac involvement
*Tachycardia out of proportion to fever
*Pericardial friction rub
*Chest pain
*Muffled heart sounds
*Cardiomegaly on chest x-ray
*Prolonged PR interval on ECG
*Polyarthritis (tender joints, elbow, knee, ankles)
*Chorea: involuntary movements of extremities and face affects speech
Quality Patient Outcomes for Rheumatoid fever
*GroupAstrep(GAS) tonsillo pharyngitis identified and treated
* Early recognition and treatment to prevent cardiac valve damage
* Recurrence prevented with prophylaxis compliance
What is Kawasaki Syndrome
Acute systemic vasculitis of unknown cause; not transmitted person to person
inflammation of vessels
What is the cause of Kawasaki Syndrome?
A. The cause is unknown
B. Group Strep A
C. H. influenzae
D. Varicella
A. The cause is unknown
Risk of Kawasaki syndrome
unknown
Asians and island pacific are the targeted population
How is Kawasaki syndrome diagnosed
by its symptoms
Classic Kawasaki disease criteria include fever for 5 calendar days along with four of five clinical criteriaa (diagnosis may be made on day 4 of fever by an experienced clinician in children with fever and more than four clinical criteria):
- Changes in the extremities: In the acute phase, edema or erythema of the
palms and soles; in the subacute phase, periungual desquamation (peeling)
of the hands and feet - Bilateral conjunctival injection (inflammation) without exudation
- Changes in the oral mucous membranes, such as erythema, cracking of the
lips, oropharyngeal reddening; or “strawberry tongue” (large papillae are
exposed) - Rash: Maculopapular, diffuse erythroderma, or erythema multiforme-like
- Cervical lymphadenopathy (typically unilateral .1.5 cm)
- Strawberry tongue
- Colicky abdominal pain
- redness over trunk
Therapy Management of Kawasaki Syndrome
High-dose IVIG within first 7 days of illness, high-dose aspirin therapy
Quiet environment, promote rest
Aspirin has been used historically to control fever and symptoms of inflammation. Initial doses of aspirin have ranged from moderate to high dose (30 to 50 mg/kg/day in divided doses every 6 hours up to 80 to 100 mg/kg/day in divided doses every 6 hours).
Why is Aspirin used for in Kawasaki syndrome
NSAID
non-steroidal anti-inflammatory drug
Aspirin has been used historically to control fever and symptoms of inflammation. Initial doses of aspirin have ranged from moderate to high dose (30 to 50 mg/kg/day in divided doses every 6 hours up to 80 to 100 mg/kg/day in divided doses every 6 hours).
Acute phase of Kawasaki Syndrome findings
Acute stage
a. Fever
b. Conjunctival hyperemia
c. Mucositis(cracked red lips and a“strawberry tongue”)
d. Extremity changes, including swelling of the hands and feet and erythema of the palms and soles
e. Rash
f. Enlargement of cervical lymphnodes
g. Increased irritability
h. Arthritis
i. Cardiovascular findings, including tachycardia and gallop sounds
Sub Acute phase of Kawasaki Syndrome findings
Subacute stage: Begins with resolution of fever and continues until outward clinical manifestations have resolved
a. Cracking lips and fissures
b. Desquamation of the skin on the tips of the fingers and toes
c. Jointpain
d. Cardiac manifestations
e. Thrombocytosis (hypercoagulability)
Convalescent Stage of Kawasaki Syndrome finding
Convalescent stage: Child appears normal, but signs of inflammation may be present, and laboratory values may be abnormal.
Your pediatric patient is currently on Immunoglobulin therapy. He has been diagnosed with Kawasaki syndrome. Which of the following prescriptions would you question as a nurse?
A. Aspirin
B. Physical Therapy
C. IV fluid
D. Varicella vaccine
D. Varicella vaccine
Avoid administration of measles, mumps, and rubella (MMR) or varicella vaccine to the child for 11 months after intravenous immunoglobulin therapy, if appropriate.
- The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin. Which statement made by the parent indicates the need for further instruction?
- “I will not mix the medication with food.”
- “If more than one dose is missed, I will call the
pediatrician.” - “I will take my child’s pulse before administering
the medication.” - “If my child vomits after medication administration, I will repeat the dose.”
- “If my child vomits after medication administration, I will repeat the dose.”
- On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical manifestation of the acute stage of the disease?
- Cracked lips
- Normal appearance
- Conjunctival hyperemia
- Desquamation of the skin
- Conjunctival hyperemia
- The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which laboratory study would assist in confirming the diagnosis?
- Immunoglobulin
- Red blood cell count
- White blood cell count
- Anti–streptolysin O titer
- Anti–streptolysin O titer
- The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse would assess the infant for which early sign of HF?
- Pallor
- Cough
- Tachycardia
- Slow and shallow breathing
- Tachycardia
- The nurse is closely monitoring the intake and output of an infant with heart failure who is re- ceiving diuretic therapy. The nurse would use which most appropriate method to assess the urine output?
- Weighing the diapers
- Inserting a urinary catheter
- Comparing intake with output
- Measuring the amount of water added to formula
- Weighing the diapers
- The clinic nurse reviews the record of a child just seen by the pediatrician and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?
- Pallor
- Hyperactivity
- Activity intolerance
- Gastrointestinal disturbances
- Activity intolerance
A child with aortic stenosis shows signs of activity intolerance, chest pain, and dizziness when standing for long periods.
- A child with rheumatic fever will be arriving at the nursing unit for admission. On admission assess- ment, the nurse would ask the parents which question to elicit assessment information specic to the development of rheumatic fever?
- “Has the child complained of back pain?”
- “Has the child complained of headaches?”
- “Has the child had any nausea or vomiting?”
- “Did the child have a sore throat or fever within the last 2 months?”
- “Did the child have a sore throat or fever within the last 2 months?”
Rheumatic fever characteristically manifests 2 to 6 weeks after an untreated or partially treated group A beta- hemolytic streptococcal infection of the upper respiratory tract.
- A pediatrician has prescribed oxygen as needed for an infant with heart failure. Which situation would likely increase the oxygen demand, requiring the nurse to administer oxygen to the infant?
- During sleep
- When changing the infant’s diapers
- When a parent is holding the infant
- When drawing blood for electrolyte level testing
- When drawing blood for electrolyte level testing
Digoxin and furosemide Interventions
Withhold digoxin if the apical pulse is
less than 90 to 110 beats per minute in infants and young children and less than 70 beats per minute in older children, as prescribed.
Encourage foods that the child will eat that are high in potassium, as appropriate, such as bananas, baked potato skins, and peanut butter.
a. Monitor for signs and symptoms of hypoka- lemia (serum potassium level <3.5 mEq/L [3.5 mmol/L]), including muscle weakness and cramping, confusion, irritability, rest- lessness, and inverted T waves or prominent U waves on the electrocardiogram.
b. If signs and symptoms of hypokalemia are present and the child is also being admin- istered digoxin, monitor closely for digoxin toxicity, because hypokalemia potentiates digoxin toxicity.
22. Administer potassium supplements and pro- vide dietary sources of potassium as prescribed. a. Supplemental potassium would be given
only if indicated by serum potassium lev- els and if adequate renal function is evident and is usually necessary when administering a potassium-losing diuretic such as furosem- ide.
Home Care instructions for Digoxin
■ Administer as prescribed.
■ Use an accurate measuring device as provided by the phar-
macist.
■ Administer 1 hour before or 2 hours after feedings.
■ Use a calendar to mark off the dose administered.
■ Do not mix medication with foods or uid.
■ If a dose is missed and more than 4 hours has elapsed,
withhold the dose and give the next dose at the sched- uled time; if less than 4 hours has elapsed, administer the missed dose.
■ If the child vomits, do not administer a second dose. (Fol- low the pediatrician’s prescription.)
■ If more than 2 consecutive doses have been missed, notify the pediatrician; do not increase or double the dose for missed doses.
■ If the child has teeth, give water after the medication; if possible, brush the teeth to prevent tooth decay from the sweetened liquid.
■ Monitor for signs of toxicity, such as poor feeding or vom- iting.
■ If the child becomes ill, notify the pediatrician.
■ Keep the medication in a locked cabinet.
■ Call the Poison Control Center immediately if accidental
overdose occur
S/S of decreased cardiac output
ASD
PVD
VSD
■Activity intolerance
■ Decreased peripheral pulses
■ Feeding diffculties (POOR FEEDING)
■ Hypotension
■ Irritability, restlessness, lethargy
■ Oliguria
■ Pale, cool extremities
■ Tachycardia
PVD-MACHINE LIKE MURMUR LOUD
ASD- LOW MURMUR
