AdvMS Cardiac and Fundamental Peds Flashcards
(133 cards)
1
Q
peaked T waves occur in
A
hyperkalemia
2
Q
PR interval represents
A
time for impulse to travel from SA node to ventricular depolarization. Prolongation indicates delay in AV function.
3
Q
Normal PRI
A
0.12-0.20 seconds
4
Q
QRS interval represents
A
time required for ventricular depolarization
5
Q
normal QRS interval
A
0.04-0.10 sec or < 0.12 sec
6
Q
RR interval represents
A
regularity of rhythm
7
Q
EKG small square
A
0.04 sec (1mm)
8
Q
EKG large square
A
0.2 sec
9
Q
EKG 5 large squares
A
1 sec
9
Q
EKG 5 large squares
A
1 sec
10
Q
QRS interval measured
A
from first downturn of Q until reaches baseline after S (J-point)
11
Q
ST segment measured
A
from return to baseline after S (J-point) to beginning of T. Should be on isoelectric line, elevation or depression d/t cardiac ischemia/MI
12
Q
to calculate HR on EKG strips
A
count # or R waves on a 6-second strip (30 large boxes) and multiply by 10
Best for irregular rhythms
13
Q
regular rhythm, rate 40-60, normal PRI and QRS
A
sinus bradycardia
14
Q
causes of sinus bradycardia
A
vagal stimulation (vomiting/straining)
MI, IICP, uremia
Dig toxicity, BBs, CCBs
15
Q
sinus bradycardia treatment
A
none unless symptomatic Atropine IVP (to decrease vagal stimulation), withhold meds, PM
16
Q
regular rhythm
HR 100-160
normal PRI and QRS
A
sinus tachycardia
17
Q
causes of sinus tachycardia
A
fever, blood loss, anxiety, HF, meds
Do not ignore, treat cause!
18
Q
p wave is early, abn in size, shape or direction and sometimes hidden in preceding t wave
A
PACs
19
Q
causes of PACs and tx
A
caffeine, nicotine, alcohol
CHF, MI, hypoxia
emotion, can occur in normal hearts
not treated but watch, can signal future arrythmia
19
Q
causes of PACs and tx
A
caffeine, nicotine, alcohol
CHF, MI, hypoxia
emotion, can occur in normal hearts
not treated but watch, can signal future arrythmia
20
Q
atrial rate 250-400, ventricular rate varies with number of impulses that make it through to AV node
Sawtooth wave forms
A
Aflutter
“flutter” waves
21
Q
causes of Aflutter
A
CHF, MI, CAD, cardiomyopathy, hypoxia, thyrotoxicosis, electolyte imbalance
22
Q
Aflutter/Afib tx
A
Dig or Verapamil to convert to A fib, which is easier to treat
RFA (ablation), cardioversion, BBs, dofetilide, ibutilide, IV adenosine or amiodorone
23
grossly irregular rhythm (unless very rapid)
atrial rate unmeasurable (400+), ventricular rate varies with impulses conducted through to AV node. Wavy deflections called f waves, varying rhythm and shapes. PRI unmeasurable, QRS normal
Afib
24
causes of Afib
CHF, MI, CAD, after OHS heart is irritated, pericarditis, heart valve disease, hyperthyroid, hypoxia
25
TEE before cardioversion for afib because
check for clots that could be dislodged once sinus rhythm is restored
25
TEE before cardioversion for afib because
check for clots that could be dislodged once sinus rhythm is restored
26
conplications due to afib
increase risk for clots (**CVA), cardiac output is decreased
27
BIGEMINY
every other beat is a PVC
28
early, wide QRS that differ from the QRSs of the underlying rhythm
PVCs
29
causes of PVCs
hypoxia, MI, hypokalemia, hypomagnesia, acidosis, exercise, Dig toxicity, hyperthyroidism, caffeine, CVADs, idiopathic
30
Regular rhythm, rate 140-250
no visible p waves, hidden in QRS
wide QRS
Vtach
31
causes of Vtach
same as PVCs but more dangerous because of the decrease in CO and tendency to develop into Vfib
32
Vtach tx
with pulse: meds (Lidocaine IVP, IV amio)
| pulseless: CPR, defib starting at 50j, ICD
33
chaotic rhythm
rate=0 because no QRS complexes
no p waves, just "fine" or "coarse" deflections
Vfib
34
Vfib treatment
CPR, defibrillation
35
causes of Vfib
MI, CHF, CAD, ischemia with increased catecholamine levels (shock)
cardiomyopathy, electrolyte imbalance, etc.
36
most common cause of sudden cardiac death
Vfib
37
regular rhythm and p waves but prolonged PRI, normal QRS (can be wide sometimes with DIVC)
First degree Heart Block
DIVC=delay in ventricle
38
general causes of heart block
MI (can happen initially but then go away)
| Dig, BBs, CCBs
39
treatment of first degree heart block
none, but watch for progression of heart block
40
regular atrial rhythm but irregular ventricular
more p waves than QRS waves
PRI progressively lengthens until a P wave occurs without a QRS, pause follows dropped QRS
Second degree heart block Type 1: Wenckebach
41
regular atrial rhythm, ventricular rate less and will depend on the number of impulses conducted--NO WARNING of a dropped beat, less QRS waves than p waves
Second degree heart block type 2:Mobitz II
less common but more serious than Wenchebach
42
high mortality rate if this is associated with acute MI; pt needs pacemaker and atropine to increase heart rate
Second degree heart block type 2:Mobitz II
43
regular atrial and ventricular rates but they beat independently of each other. No consistent PRI, some p waves hide under QRS (unique to this arrythmia)
Third degree Heart block
44
posterior fontanel closes by
2-3 mos
44
posterior fontanel closes by
2-3 mos
45
anterior fontanel closes by
18 mos
46
vaccines at 2,4,6 mos
```
Hep B
Hib
Prevnar
RV
IPV
Dtap
at 6 mos add Flu
```
47
rooting, palmar grasp, tonic neck (fencer) and Moro (startle) reflexes present
birth-4mos
48
plantar grasp reflex present
birth-8mos
49
Babinski reflex present
birth-1yr
50
rolls front to back by
5 mos
51
rolls back to front by
6 mos
52
crawls, crude pincer grasp and pulls to stand/stands holding on by
9 mos
53
fontanels should be
flat.
sunken=dehydration
bulging=IICP
54
uses cup and spoon, stacks two blocks by
15 mos
55
starting to walk independently by
12 mos
56
sits unsupported by
7-8 mos
57
Ibuprofen only if child is
6 mos+
58
object permanence by
9 mos
59
walks up and down stairs by
2 years
60
jumps with both feet, stands on 1 foot by
2 1/2 years
61
preoperational thought
2-7y
egocentric, only understands own viewpoint
domestic mimicry
62
concrete operations
7-11 yrs
logic, sort and classify
take things literally
63
vaccine at 15-18 mos
Dtap
64
vaccines at 1 year
```
MMR
varicella
Prevnar
Hib
HepA (MVP-HH)
```
65
1st teeth around
6 mos
66
this many teeth by 1 yr
6-8
67
cooperative play and pretend play
preschooler (3-6)
68
vaccines at 4-6y (school shots)
MMR
varicella
IPV
DTap
69
psychosocial stage of preschooler
Initiative vs. guilt
| need to try new things, develop conscience, advance initiative while respecting others
70
psychosocial stage of school age child
industry vs. inferiority
| motivated by tasks that increase self-worth, need to develop competence
71
vaccines at 11-12y
Tdap
HPV (series of 3)
Menactra
72
vaccine at 16-18
Menactra
73
definition and dx FTT
inadequate growth due to inability to obtain or use calories
| <5th percentile of weight for age
74
preconventional moral dev
r/t consequences
| no concept of moral behavior
75
conventional moral dev
obey rules, be nice, good behavior is what is approved of by the group; conformity and loyalty
76
postconventional moral dev
abstract ethical universal principles; correct behavior is defined by individual rights and societal standards
77
triple birth weight by
12 mos
78
double birth weight by
5-6 mos
78
double birth weight by
5-6 mos
79
BMI screening is done ages
2 and up
80
obese
>97th percentile for age and gender BMI
81
overweight
>95th percentile for age and gender BMI
82
s/s FTT besides weight
developmental delays
apathy, poor hygeine,
**withdrawn behavior
avoid eye contact, minimal smiling, stiff or flaccid
83
most important in tx of FTTq
same nurses to do feedings, in a quiet calm environment. face to face contact
84
lead checked at
12 and 24 mos
85
acceptable lead level
<10
86
to combat Pb retention, feed child a diet high in
Fe and Ca
| compete with Pb for storage in bones.
87
research validated pain scale for children 4+
Faces scale
88
research validated pain scale for ages 3 mos-7yrs for kids that can't express their pain
```
FLACC scale
Face
Legs
Activity
Cry
Consolability
```
89
prevent and manage opioid AEs, such as
n/v
constipation
pruritis
sedation
90
rear facing car seat is recommended until
2 years
91
booster seat recommended until
80 lbs. or 4" 9'
92
count RR on infant
1 full minute due to irregularity
93
order of VS for infant, child
```
least invastive to most
RR
pulse
BP
temp
```
94
tuft of hair or dimple at base of spine could signify
spina bifida
95
impetigo
superficial skin infection with honey-colored crusts, caused by GABHS or Staph/MRSA
95
impetigo
superficial skin infection with honey-colored crusts, caused by GABHS or Staph/MRSA
96
impetigo treatment
```
mupirocin ointment (Bactroban)
more serious, 1st gen CS
```
97
resembles a "spider bite" that won't heal
CA-MRSA
98
CA-MRSA Tx
TMP-SMZ (Bactrim), clindamycin, doxycycline
98
CA-MRSA Tx
TMP-SMZ (Bactrim), clindamycin, doxycycline
99
thrush tx
nystantin swish after feeding
boil nipples/pacis
treat bf mom
100
kids often get this from farm animals
tinea corporis (ringworm)
101
ringworm appearance on body
well-defined circle of red bumps, skin in center of circle normal tone
102
treatment for tinea capitis
Griseofulvin PO 3-6 mos
| check LFTs q 4-6 mos
103
tinea versicolor tx
Selsun Blue (SeS)
104
recurrent varicella viral infection causing lesions on oral mucosa, lips, and eyes
Herpes Simplex
105
viral-induced epithelial tumors (HPV)
warts
106
benign viral skin infection due to a contagious pox virus; causes dimpled bumps
molluscum contagiosum
107
scabies
highly contagious infection of skin by itch mite (Sarcoptes scabiei)
108
scabies tx
Elimite cream neck to toes 8-12h, then shower
| wash bedding
109
no sunscreen until
6 mos
110
rose-coored, flaking, self-limiting viral rash with a "herald patch" and symmetric "Christmas tree" pattern
Pityriasis Rocea
111
chronic skin disorder of remissions and exacerbations causing silvery scales
psoriasis
112
atopic dermatitis
excema
chronic superficial inflammation and itching
r/t allergens (often milk)
cheeks--creases of elbows, wrists, and knees
skin cream w/in 3 min of bathing
113
with any CVAD there is increased risk of
infection--use good hygiene and practice
114
a CVAD in an IV catheter with the tip in the
SVC, near RA
114
a CVAD in an IV catheter with the tip in the
SVC, near RA
115
CVAD with a shorter dwell time and increased risk of complications, used in emergent situations, can be inserted at bedside
non-tunneled
116
CVAD placed surgically, longer dwell time (indefinite) lower incidence of infection and can be repaired
tunneled
117
CVAD with indefinite dwell time, no site care when not in use, 1-2000 punctures; implanted in subq
implanted port
118
dwell time of PICC
several months to 1 year
119
catheter of CVAD doesn't go all the way into the SVC
midline catheter
120
pt position for removal of CVAD
supine, flat
pt-bear down as catheter withdrawn
pressure to site
121
s/s of SVC syndrome
periorbital/facial edema
| JVD, HA
121
Myoglobin test usefulness
Useful in r/o acute MI if absent; Peaks in 12h
122
CK-MB
Indicator of acute MI; peaks in 24h
123
Total troponin
Begins 3-5h
Peak 24-48 h
Lasts to 21 d
124
Troponin levels
Normal: 0- 0.10
Ischemia: 0.5-1.0
MI: 1+
