Week 4.2 - CDV & Dehydration Flashcards
What are the systemic effects of cardiovascular failure? (Resp, Neuro, GU)
RESP: tachy, wheezing, grunting
NEURO: Lethargy, malaise, agitation, confusion, LoC changes, hypotonia
GU: Less than 1ml/kg/hr in infants, less than 0.5 ml/kg/hr in children
What weight loss changes are indicative of mild, moderate, and severe dehydration in children?
3-5% mild
6-9% Mod
10+% Severe
How does blood pressure change with mild, moderate and severe dehydration?
Normal - mild
Mod - orthostatic less than 10 mmHg
severe - Orthostatic to shock
What is the pathophysiology of dehydration?
Decreased fluid intake or increased fluid loss –> Rapid ECF loss –> Electrolyte imbalances –> ICF losses
–> Cell dysfunction –> Hypovolemic shock –> Death
What is the most common kind of dehydration?
Isotonic dehydration
–> ECF losses only with no changes in Na
What is hypotonic dehydration? What is the pathophysiology of it?
Na Less than 130 mEq/L
ECF enters IC space, increased ECF loss
What causes hypotonic dehydration
V&D, burns, 3rd spacing, renal issues
what causes hypertonic dehydration?
V&D, DM, increased sodium intake
What is considered hypertonic dehydration? What is the pathophysiology of it?
When sodium loss is less than water loss. Na concentration is greater than 150 mEq/L
ICF moves to EC space, maintaining ECF.
What are signs of shock in children?
Tachycardia, altered LoC, altered perfusion
Hypotension late sign
How to calculate fluid deficit in children?
Weight (kg) x % fluid loss = deficit in L
How do you calculate the fluid requirements of a child?
Add fluid deficit to maintenance fluids
Over what period of time and with what volume would you replace the fluids of a child with mild, moderate, and severe dehydration?
Mild: 50 ml/kg over 4 hours (ORS)
Moderate: 100 ml/kg over 4 hour (ORS)
Severe: IV NS/RL (20-40 ml/kg for 1 hour) Reassess and repeat as necessary
What are the ideal concentration of sodium and glucose for ORT?
40-90 Na
110-140 glucose
What is the osmolality of the luminal fluid in the intestines?
290 mOsm/L
Are clear fluids acceptable to use for ORT?
Not juices, pop, or sports drinks
–> d/t high sugar, osmolarity, and inadequate sodium
What can diaphoresis indicate in an infant/child?
cardiovascular issues
–> Stimulation of cholinergic fibers
Poor feeding, tachy/tachy, failure to thrive, cyanosis, diaphoresis, and dyspnea might indicate what?
Cardiac dysfunction - consider sepsis
What might cause PDA?
Prematurity - increased risk
What are clinical signs of PDA?
Increases respiratory distress d/t pulmonary edema, apnea and bradycardia, bounding pulses
How is PDA managed?
Fluids/furosemide
O2
Indomethacin
Surgical ligation
What kinds of acyanotic CHD would lead to increased pulmonary blood flow?
Atrial septal defect
Ventricular septal defect
PDA
AV canal defect
What kind of acyanotic CHD would lead to obstruction to blood flow from ventricles?
Coarctation of aorta
Aortic stenosis
Pulmonary stenosis
What kind of cyanotic CHD leads to mixed blood flow?
Transposition of great arteries
Total anomalous pulmonary venous system
Truncus arteriosus
Hypoplastic left heart syndrome
What kind of cyanotic CHD leads to decreased pulmonary blood flow?
ToF - also mixing
Tricuspid atresia
When can cyanotic heart heart disease be ruled out?
If oxygen helps improve cyanosis
Why would you not put oxygen on a child with a cyanotic heart disease?
Change the partial pressure in heart chambers and alter circulation
What could be done to manage health for children with CHD?
Support/improve cardiac function
–> Contractility w digoxin, vasodilation w ACE inhibitors
Decrease pre-load
–> Diuretics
improve oxygenation and decrease oxygen consumption
What are the who main kinds of acquired heart disease?
Infectious & Inflammatory
What are some infectious etiologies of acquired heart disease?
Infective endocarditis
Rheumatic fever
Pulmonary hypertension
Cardiomyopathy
What are some inflammatory etiologies of acquired heart disease?
Kawasaki disease
Systemic hypertension
Hyperlipidemia (athero)
Cardiac dysthymias
What valve is usually affected by rheumatic heart disease? Which bacteria causes is?
GAS
–> Mitral
What are some complications of infective endocarditis?
Altered blood flow and turbulence, increased fibrin and deposits of platelets, risk of emboli
–> Lesions may invade adjacent tissues
What is the most dangerous type of dehydration?
Hypertonic Dehydration
–> Disrupts cellular functioning, SCD
What structures are affected by rheumatic fever?
Joints, skin, brain, serious surfaces, heart
What is the most common congenital heart defect?
VSD
What kind of defect is known as cyanotic?
Right-to-left shunting
–> Blood bypassing pulmonary circulation and reentering systemic circulation. Results in mixing of deoxygenated blood with oxygenated blood.
How do heart chamber septal defects affect circulation? Which is more dangerous?
They result in left-to-right shunting (noncyanotic)
–> Increased pulmonary pressure and blood flow and common clinical manifestation if HR.
–> More dangerous/worse prognosis if VSD.
What kind of murmur is heard with septal defects?
Systolic murmur
What is an atrioventricular canal defect?
Incomplete fusion of endocardial cushions resulting is low ASD that is continuous with high VSD
–> Moderate to severe HF
What kind of heart defect is most common in children with down syndrome?
Atrioventricular canal defect
How does PDA affect hemodynamics?
Results in blood shunting from aorta to pulmonary arteries
What does coarctation of the aorta result in?
High blood pressure and bounding pulses in the arms, and weak or absent femoral pulses with cool lower extremities
What is aortic stenosis?
Narrowing or stricture of the aortic valve resulting in decreased cardiac output, Left-vent hypertrophy, and pulmonary vascular resistance.
What is pulmonic stenosis?
Narrowing of the entrance of the pulmonary artery resulting in decreased pulmonary blood flow and right-vent hypertrophy
What is tetralogy of fallot?
1 - VSD
2 - Pulmonic stenosis
3 - Overriding aorta
4 - Right-vent hypertrophy
Results in blood overriding pulmonary circulation from right ventricle into aorta through septal defect.
What is tricuspid atresia?
When the tricuspid valve fails to develop and there is no communication between the right atrium and ventricle.
Blood instead flows between an ASD into left atrium, and then through VSD back into aorta and lungs - results in decreased pulmonary blood flow and chronic hypoxia
What is transposition of the great arteries?
No communication between systemic and pulmonary circulation.
–> Without additional septal defects the child will be severely cyanotic and not survive
Why is prostaglandin E1 given to neonates with transposition of the great arteries?
To keep the ductus arteriosus temporality open
What is total anomalous pulmonary venous connection?
Failure of the pulmonary veins to join the left atrium and are instead abnormally connected the the systemic venous circuit
–> Cyanotic, complete mixing of blood
What is truncus arteriosus?
Failure of normal septation results in a single vessel that overrides both ventricles. Complete mixing.
–> Increased pulmonary bloodflow, decreased systemic bloodflow
What is hypoplastic left heart syndrome?
Aortic atresia with PDA and patent foramen ovale results in complete mixing right vent and severely underdeveloped left side of the heart.
What electrolyte imbalance is common with furosemide?
hypoK
What is Kawasaki disease?
Acute systemic vasculitis of unknown cause, can result in coronary artery dilation and aneurism formation
