Acquired cardiac Disorders

Question 1

Bacterial endocarditis

Answer 1

inflam process resulting from infx of valves and inner lining of heart

Question 2

inc risk of bac endocarditis

Answer 2

-inc sus with CHD or acquired heart disease
-inc risk after dental procedures, surgery, intracardiac lines
- common cause–Streptococcus viridans, satph aureus, gram-neg bact, fungus

Question 3

BE patho

Answer 3

• org enters blood from area of localized infx and grow on endocardium
• vegetations, fibrin deposits, platelet thrombi form
• lesions may invade adjacent tissue and break off and embolize elsewhere

Question 4

BE CM

Answer 4

• low fever
• anorexia
• malaise
• joint pain
• • cultures
• new heart murmur
• petechiae of mucus mem
• janeway spots (painless hemorrhagic areas on palms/soles)
• osler nodes (painful white spots on pads of fingers and toes)
• splinter hemorrhages under nails

Question 5

Therapeutics for BC

Answer 5

• long-term antibiotics for 2-8weeks
• surgical removal of emboli or valve replacement
• prevent with prophylactic antibiotics 1h before surg (if at high risk like CHD)

Question 6

BE NC

Answer 6

• teach prophylactic antibiotic therapy
• teach fam to give IV antibiox at home
• sx relief–soak hands, lotion
• monitor for emboli (SOB, swell)

Question 7

Rheumatic fever

Answer 7

sys inflam following group A beta hemolytic strep infx; autoimmune response to strep antibodies (when strep not treated soon enough)
- Aschoff bodies–infalm hemorrhagic bullous lesions that are formed and cause swelling, fragmentation, alterations in conn tissues
- rheumatic heart disease may dev–fever that causes heart probs

Question 8

Rheumatic fever diagnosis

Answer 8

Jones criteria
- often school age
- URI in weeks prior
- more freq in males, later winter or early spring

Question 9

RF CM

Answer 9

• polyarthritis
• carditis
• chorea (sudden abnormal mvt of extremities)
• muscle weakness
• erythema marginatum
• subcutaneous nodules
• arthraglia
• low fever
  -elevated ASO titer; antistreptolysin-O
• ab pain

Question 10

RF treatment

Answer 10

• get rid of strep with antibiotics
• prevent cardiac damage and relieve sx with giving aspirin (salicylates), steroids, bed rest
• prevention of reccurence and endocarditis (sus for rest of life, esp next 5Y)

Question 11

Can you give aspirin to kids with RF?

Answer 11

Yes if it the benefits may outweigh risk of getting Reye’s syndrome

Question 12

RF NC

Answer 12

• prevent disease
• encourage compliance with drugs esp antibiotics
• facilitate recovery, rest, adequate nutrition, pain management
• provide emo support

Question 13

Kawasaki disease (mucocutaneous lymph nose syndrome)

Answer 13

• acute systemic vasculitis of unknown etiology
• thought to have infectious component

Question 14

Kawasaki disease

Answer 14

• pre-pubertal kids, esp boys under 2 Y
• more freq in winter and spring
• usually self-limit and resolve but 20% get serious cardiac prob

Question 15

KD CM (acute phase)

Answer 15

• fever non-reponsive to drugs
• pruritic polymorphic rash
• cervical lymphadenopathy
• dry, red lips
• strawberry tongue
• bilateral conjunctivits, injection (inflam w/o exudation)
• erythema and swell of palms and soles

Question 16

KD subacute phase (10-35 days)

Answer 16

• begin with resolution of fever and lasts until all s/s are gone
• vasculitis and inc platelets–bad combo
• desquamous of toes, feet, fingers, palms
• arthritis
• thrombocytosis

Question 17

KD convalescent or recovery phase (up to 10 weeks)

Answer 17

• sx free
• phase complete when all blood values have returned to normal
  most dangerous phase–no sx or pain in chest and back but highest risk of myocardial infarction here

Question 18

s/s myocardial infarction in kids

Answer 18

• ab pain
• vom
• restless
  -inconsolable cry
  -pallor
  -shock

Question 19

Therapeutic management of KD

Answer 19

• salicylates for anti-inflam and anti-plt effect–high dose ASA is begun and continue until child has been afebrile for 48-72h; start on low dose ASA and may be on forever
• high dose IV gamma globulin has to start w/i 10 days of fever

Question 20

NC for KD

Answer 20

• monitor cardiac status carefully (O2 and resp monitoring very imp, I&O, V/S q1-2, DW, admin fluids with care, watch for signs of MI
• safely admin gamma globulin–blood product with usual precautions, immunizations, possibility of MI
• symptomatic relief incl skin discomfort, mouth care, clear liquids and soft foods, irritability
• D/C teaching–accurate info regarding progression, immunizations, possibility of MI

Question 21

Hypertension in kids

Answer 21

• consistent elevation of BP beyond the upper limits of normal
• major categories–essential or primary, no identifiable cause; secondary–subsequent to an identifiable cause; mild, significant or severe hypertension

Question 22

Hypertension in kids is based on…

Answer 22

age, wt, ht

Question 23

Primary hypertension prevalence

Answer 23

rare in kids

Question 24

Secondary hypertension causes

Answer 24

• renal disease
• coarctation of the aorta
• oral contraception
• steroids
• obesity
• adrenal disorders

Question 25

CM of hypertension in kids

Answer 25

- high BP - headache - dizzy

Question 26

Hypertension tx

Answer 26

- ID and treat underlying cause - monitor if mild - combo of nonpharm and pharm therapy

Question 27

Hypertension NC

Answer 27

- detection--calm child and use proper cuff - teach--how to monitor child's BP, diet and exercise, precautions with antihypertensive drugs, avoid alc and stay on prescribed diet, no oral contraceptives

Question 28

HLD in kids

Answer 28

- presymptomatic phase of atherosclerosis - AAP recommends selective screening - total chol over 170 - fat intake never limited in kids from birth-2Y

Question 29

HLD tx

Answer 29

- dietary; step diet - pharm, cholestyramine or Colestipol- nursing, screening, edu, support

Question 30

Dysrhythmias in kids

Answer 30

- Diagnosis--24h Holter monitor, ECG, transesophageal recording - Bradyarrhythmia (sinus brady (slower) or complete AV block) - Tachyarrhythmias (sinus tachy from fever or anxiety, pain, dehydration) or supraventricular tachy

Question 31

Supraventricular tachy

Answer 31

- rapid, regular HR 200-300 - tx--vagal maneuver like ice on face, bare down, carotid massage--do NOT do these at home - adenosine impairs AV conduction, rapid IV push as fast as you can and flush as fast as can - radio-freq ablation, digoxin - often self-limiting - can be caused by caffeine - education

Question 32

Sinus arrhythmia

Answer 32

- regular irregularity - normal in school age child - have child hold breath and it should regulate

Question 33

Cardiomyopathy

Answer 33

Cardiac muscles can't contract as should - dilated ventricular dilation with greatly inc contractility leading to CHF - restrictive ventricular filling cause by disease (vent not filling as should) - hypertropic heart

Question 34

Cardiomyopathy in kids

Answer 34

- rare - genetic cause, infection, deficiency, metabolic abnormalities, collagen vasc disease - most are idiopathic

Question 35

Cardiomyopathy tx

Answer 35

- Digoxin - diuretics - beta blockers - anticoags - calcium channel blockers - transplant

Question 36

NC for cardiomyopathy

Answer 36

- getting kids to adjust to failing health--can't play soccer and run around like others - include kids in discussion and decisions about transplant etc - teach psych prep and postop care