Cardiac Flashcards

Question

Heart Failure, cont. (pathophysiology)

Answer 1

* Pathophysiology: Protracted alterations in either preload, afterload, myocardial contractility and heart rate affecting cardiac output may lead to heart failure. * Neurohormal factors: Sympathetic Nervous System and Renin-Angiotensin Aldosterone System are activated due to a fall in cardiac output. Efforts by these systems to maintain homeostasis. With chronic activation results in hemodynamic stress and has harmful effects on the CV system (increased water retention, increased sodium retention, increased blood volume) * S+S Tachycardia, Pallor, Decreased UO, sweating, rise in BP, edema, wt gain

Answer 2

S+S: increased WOB, tachypnea, retractions, grunting, wheezing, cough, rales, DOE, feeding difficulties

Answer 3

* Diastolic dysfunction: * Increased right-sided filling pressure * Hepatic venous congestion * Systemic venous congestion * Pumping against resistance * Increase in myocardial oxygen demand S+S: hepatomegaly, jugular venous distension, periorbital edema

Answer 4

Systolic Dysfunction: increase in preload increases stroke volume – cardiac muscle stretches to accommodate increase in intravascular volume, increased filling pressure, increased demand for oxygen, pulmonary congestion and impaired gas exchange

Answer 5

* Promote oxygenation * Semi-upright position * Suction prn * Chest PT * Oxygen support * Supporting Cardiac function * Meds: digitalis, ACE inhibitors, Diuretics * Observe for S+S of hypotension * Accurate I+O’s / wts * K+ levels * Promote nutrition * Promote rest

Answer 6

* Microbial infection of endothelial surfaces (inner lining) of the heart chambers, septum or valves (most common) * Bacterial (staph and strep) * Fungi (less common) * Risk Factors: * Children with CVC * Children with CHD such as septum or valve defects * Prosthetic valves are at increased risk * IV drug use * Health hx: intermittent, unexplained, low-grade fever * Possibly edema if heart failure present * Petechiae palpebral conjunctivae, oral mucosa, or extremities * Roth spots: splinter hemorrhages with pale centers on sclerae, palate, buccal mucosa, chest, fingers, or toes * Janeway lesions: painless, flat, red or blue hemorrhagic lesions on palms or soles * Osler nodes: small, tender nodules on pads of toes or fingers * Black lines under the nails (hemorrhages) Nursing Management: IV access for at least 4 weeks, Education: if child develops fever or flu-like symptoms seek medical care (for those high-risk) Prevention: Good oral hygiene, those at risk should receive antibiotic prophylaxis prior to dental procedures Labs: -Blood culture -ECHO -CBC -UA

Answer 7

Delayed sequelae of group A streptococcal pharyngeal infection * More often in children between age 5 and 15 years of age, in areas where strep pharyngitis is more prevalent, esp during the colder mos. * Typically develops 2-4 weeks after initial strep infection * Child develops an antibody response to surface proteins of bacteria, antibodies then cross-react with antigens in cardiac muscle and neuronal and synovial tissues. * Results in carditis, arthritis, and chorea * Affects joints, CNS, skin and SQ tissues * Chronic progressive damage to the heart and valves

Answer 8

* Based on modified Jones criteria * Requires presence of either two major criteria or one major plus two minor criteria * Major Criteria * Carditis * Migratory polyarthritis * Subcutaneous nodules * Erythema marginatum * Sydenham chorea (movement d/o of face and upper extremities) * Minor Criteria * Polyarthralgia * Elevated ESR or C-reactive protein * Prolonged PR interval (unless carditis is a major criterion)

Answer 9

* Past hx of recent strep infection or sore throat past 2-3 weeks * Observe Sydenham's chorea * Inspect for rash: erythema marginatum: macpap rash with central clearing and elevated edges * Heart: murmur * Palpate surfaces of wrist, Elbows, and knees for firm, Painless, SQ nodules * EKG: prolonged PR Interval 1 * Antibiotic compliance * Reassurance that chorea sxs will resolve may take several mos * May require neuroleptic (Haldol) to control movements * NSAIDs for joint pain and swelling

Answer 10

* Disease of the heart muscle * Incidence among children is increasing occurs at a rate of 1 per 100000 * Myocardium can not contract properly * May occur: * in children with genetic disorders * In children with congenital heart defects * As a result of an inflammatory process * As a result of an infectious process * As a result of HTN * As a result of cardiac surgery or transpant * MOST COMMONLY IT IS IDIOPATHIC Types of cardiomyopathy: restrictive – rare in children hypertrophic – more common in adolescents dilated –most common in children No cure - heart muscle function can not be restored

Answer 11

* Goal is to improve heart function and BP * Mechanical ventilation in some children * ACE inhibitors, calcium channel blockers, beta-blockers * Pacemakers * Surgery * Heart transplantation if medical management not successful

Answer 12

* Monitor for complications: blood clots, arrhythmias * Similar to heart failure * Vasoactive medications * Choose activities that fit within their prescribed limitations * Emotional support

Answer 13

Assess health hx for risk factors: CHD, cardiac surgery, Duchenne or Becker muscular dystrophy, myocarditis, HIV infection, Kawasaki, HTN, Drugs/ETOH or radiation exposure, connective tissue, autoimmune or endocrine disease, Maternal diabetes or family hx of sudden death * Ask about hx of symptoms such as: poor growth, resp distress, fatigue, dizziness, syncope * Assess: Extremities for edema, abdominal distension, WOB, tachycardia, heart rhythm. * ECG * CXR * Cardiac Cath

Answer 14

- Independently associated with BMI and waist circumference - Child/Adolescent HTN often leads to long-term health consequences such as CV disease and LVH - Values based on age, height, and gender Children age 1-13 yo * Stage 1: BP persistently > or equal to 95th percentile for age, gender and height OR less than 95th percentile plus 12mm Hg (whichever is lower) * Stage 2: BP > or = to 95th percentile plus 12mm Hg or 140/90 (whichever is lower) * For adolescents 13 yo and older * Stage 1: BP 130/80 to 139/89 * * Stage 2: BP 140/90 or >

Answer 15

* Management: * Labs, lipid profile * Stress management * Education, diet, exercise, low sodium diet/low fat diet * In some, antihypertensives/diuretic therapy

Answer 16

An acute systemic vasculitis * Most common 6mos – 5 years of age * Leading cause of acquired heart disease * Winter and summer mos most common * Self–limited syndrome * Can cause cardiovascular complications: coronary artery aneurysm, cardiomyopathy

Answer 17

* Focused on decreasing inflammation in walls of coronary arteries * Preventing coronary thrombosis * Preventing myocardial ischemia * High dose ASA and IVIG

Answer 18

* etiology UK? Infectious process * autoimmune response – leading to vasculitis * Systemic vasculitis t/o body * May lead to coronary dilation or aneurysm

Answer 19

High FEVER 39.9C of AT LEAST 5 days duration * Chills * HA * Malaise * Irritability * Vomiting/diarrhea * Abdominal pain * Joint pain

Answer 20

* SIGNIFICANT bilateral conjunctivitis without exudate * Dry fissured lips * Strawberry tongue (cracked and red) * Pharyngeal and oral mucosa erythema * Hyperdynamic precordium * Diffuse, erythematous polymorphous rash * Edema of hands and feet * Erythema and painful induration of palms and soles * Desquamation of perineal region, fingers and toes, extends to palms and soles * Possible jaundice * Possible cervical lymphadenopathy (unilateral) * Liver enlargement possible * Possible tachycardia, murmur, gallop Criteria: at least four of five features: bilateral conjunctival injection, changes in the lips and oral cavity, cervical lymphadenopathy, extremity changes, and polymorphous rash AND fever for at least 5 days duration Diagnostic: * CBC elevated WBC (acute) / elevated platelet count (later) * ESR and CRP elevated * ECHO

Answer 21

* Meds: ASA and IVIG * Monitor Cardiac Status: Strict I + O / serial ECHOs / S+S of developing heart failure – tachycardia, gallop, decreased UO, or resp distress / assess pulses/cardiac monitoring / rapid identification of any arryhthmias * Promote Comfort: Fever management with Acetaminophen, cool cloths, cluster nursing care, Vaseline to lips, ice chips/popsicles / positions of comfort esp if joint pain / irritability a key feature – comfort as possible * Education: course of illness, monitor illness even when discharged until afebrile for several days, irritability may last up to 2 mos – * Educate on TOXIC effects of ASA therapy: HA, confusion, dizziness, or tinnitus * No NSAIDS with ASA therapy * Joint pain – ROM / warm baths * No live vaccines for 11mos after IVIG * Critical: f/u with cards long term * CPR if severe cardiac involvement

Cardiac Flashcards

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