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cardiac peds Flashcards

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1
Q

group A hemolytic strep (GAS) connected to what disease?

A

connected to rheumatic fever

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2
Q

Rheumatic Fever (RF)- Definition - think rheumatic

A
  • Inflammatory connective tissue disease following -
    Group A B-hemolytic streptococcal pharyngitis (GAS) infection
  • Potentially serious consequences to the heart * Affects: joints, brain, skin tissues
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3
Q

Rheumatic Fever - patho (just antibodies)

A

Autoimmune response
– Body generates antibodies – to destroy bacteria
– Structural similarity between the bacterial cell wall and heart valve tissue
– Results in damage to the valves from the body’s own immune system

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4
Q

know difference between

A

rheumatic fever and rheumatic heart disease

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5
Q

Rheumatic Fever - FACTS

A

Favored by poor living conditions & overcrowding
* Lack of health care * Lack of knowledge

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6
Q

Rheumatic Fever Etiology - when do hallmark signs appear?

(Rhemy is my fav number)

A
  • Major or hallmark signs may occur 1-3 weeks
  • After untreated or partially treated group A beta-hemolytic streptococcal infection
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7
Q

5 Major Clinical Manifestations (rheumatic fever is a SPECC on the door)

A
  • Carditis
  • Polyarthritis
  • Erythema marginatum
    • Subcutaneous nodules
  • Chorea
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8
Q

Rheumatic Fever - which test for the criteria? (it’s a name)

A

jones - on test

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9
Q

Rheumatic Fever affects what part of the heart?

A

heart valves

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10
Q

1st Major Manifestation: Carditis

A

Inflammation of the heart
* Types:
* Pericarditis: inflammation of the pericardium
* Myocarditis: inflammation of myocardium-heart muscle
* Endocarditis: inflammation of the endocardium

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11
Q

Carditis - symptoms - what kind of heart sounds?

A
  • Chest pain
  • Fatigue
  • Fever
  • Tachycardia
  • Pericardial friction rub
  • CHF – signs and symptoms
  • Cardiomegaly
  • Chest x-ray
  • Echocardiogram
  • Activity restrictions
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12
Q

Carditis - does it cause permanent damage?

A

Progressive valve damage in time * Involvement of mitral or aortic
* ONLY manifestation
to cause permanent damage

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13
Q

Polyarthritis - RF

A

Polyarthritis: 2 or More Large Joints

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14
Q

Polyarthritis - what locations in the body?

A
  • Wrists
  • Hips
  • Elbows
  • Shoulders * Knees
  • Ankles
  • Pain
  • Swelling – (edema) * Tenderness
  • Heat
  • Erythema - Red
  • Inflammation
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15
Q

know mitral

A

aortic valves

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16
Q

5th Major Manifestation: Chorea - RF

(corey is a spaz)

A

St Vitus Dance
or Sydenham chorea (SD)
* Involuntary, purposeless, jerking movements of arms, legs, and face
* Facial grimacing
* Speech disturbances
* Emotional changes

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17
Q

5th Major Manifestation: Chorea - does it go away? after how long?

(Korea is only 5)

A

Increased by anxiety & attempts at fine motor
* Will eventually disappear – Can last 5-15 weeks

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18
Q

Antistreptolysis (ALSO) (ASOT)

A

Antistreptolysis-O (ASLO) titers
measures the concentration of antibodies formed in the blood against Streptolysin-O
* Titers rise 7 days after onset reach maximum levels 4-6 weeks
* (2) rising ASLO evidence recent strep infection

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19
Q

Clinical Management for RF - what meds?

A
  • Penicillin – acute & long term (Intramuscular benzathine Penicillin G)
  • Or erythromycin
  • Aspirin – fever, arthritis, & arthralgia’s
  • Corticosteroids - if significant Carditis
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20
Q

People who have RF or RHD - does it reoccur?

A
  • At risks for recurrent episodes
  • Following streptococcal throat infection * IF –they do not receive regular penicillin * Injections or oral
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21
Q

ALSO is

(also the titer)

A

the titer

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22
Q

Kawasaki Disease (KD) - is there a fever?

A
  • Acute febrile, systemic vascular inflammatory disorder
  • Leading cause of acquired heart disease
  • Generalized vasculitis of unknown etiology
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23
Q

Who’s at Risk? Kawasaki Disease (KD)

A

50% occur in children under 2 years old * 80% are younger than 5 Years-old
* Higher incidence in
– Asian and Pacific Island origin

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24
Q

use aspirin instead of tylenol

A

because of the platelets

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25
Kawasaki Disease (KD) - is it person to person?
* Etiology unknown * Not spread person-person * Geographic & seasonal outbreaks * Late winter and early spring * Pediatric illness which suggests (?) passive immunity
26
Etiology and Pathophysiology - Kawasaki Disease (KD) - what part of the heart is affected?
* Infectious or possibly toxic trigger initiates immune response * Multisystem inflammatory disease * Affects small, midsize, & coronary arteries * Can cause aneurysms
27
Pathophysiology - kawaski
* Infiltration causes edema and inflammation * Weakened vascular walls * Leading to aneurysms * Fibrous connective tissue forms * Thickening and scarring the vascular walls
28
Pathophysiology - kawasaki
Vascular changes can cause: – Thrombus formation – Myocardial infarction – Death in some children Other complications: * Myocarditis * Impaired left ventricular function * Valve regurgitation * Arrhythmia * Pericardial effusion
29
Clinical Manifestations - 3 stages of kawasaki
1. Acute 2. Subacute 3. Convalescent
30
Acute Stage - kawasaki - lasts how long? (a cutie only lasts for 1-2 weeks)
* Lasting 1-2 weeks * Extreme irritability & inconsolable * Unresponsive to antibiotics & antipyretics
31
Acute Stage – clinical signs - kawaski - eyes? (bloodshot kawaski)
* Extremely bloodshot eyes/red eyes (without pus or drainage) * Inflammation of pharynx & oral mucosa
32
kawasaki - Acute Stage - tongue? (a cutie has a strawberry tongue)
Acute Stage - Strawberry Tongue red tongue with prominent papillae
33
Acute Stage- kawasaki - what about palms? (a cute kawaski makes me red)
* Red palms of hands and soles of feet * Edematous – hands & feet, palms & soles erythematous
34
Acute Stage - kawasaki - lymph nodes - one side or both?
* Unilateral swollen cervical lymph nodes 1.5 cm/larger
35
Subacute Stage - kawasaki - skin? (peeling submarine)
* Peeling of skin in the genital area, hands and feet (esp. around nails, palm, and soles)
36
Subacute Stage - kawasaki - what is the skin like?
Bright red, chapped, or cracked lips * Peeling under fingertips & toes of hands and feet * Joint pain * Cardiac disease
37
Convalescent Stage 6-8 weeks - kawasaki - what might be present?
Child appears normal * Lingering signs of inflammation * Thrombocytosis (high platelet count) may be present * Arthritis may continue * Cardiac complications still a concern
38
Diagnostic Criteria cont - kawasaki - how many symptoms do you need? (4 kawasaki motorcycles)
4 of 5 principal features present * Not explained by other disease process Less than 4 criteria present * Echocardiography or angiography – reveal coronary artery abnormalities
39
what tests for kawasaki - is there anemia?
* WBC - elevated * Anemia * Erythrocyte sedimentation rate (ESR) * C-Reactive protein * Platelet counts * Urinalysis – may show pus * Elevated liver enzymes * Chest-x-ray * Echocardiogram/angi ogram * ECG
40
Clinical Management - kawasaki - what meds? (IV for kawasaki)
* Preventing or reducing coronary artery damage * High dose IV immune globulin (IVIG) * Salicylate therapy (ASPIRIN)
41
Clinical Management - kawasaki - IVIG (I've got kawasaki)
IVIG - * Reduces duration of fever & inflammation * Reduces incidence of coronary artery abnormalities & aneurysms
42
Clinical Management - kawasaki - Aspirin Therapy
* Control fever and promote comfort * 80-100 mg/kg/day in 4 divided doses (every 6 hours) * Afebrile 2-3 days * 2 – 5 mg/kg/day * Low-dose continues if... – Platelet count returns to normal (6-8 weeks) – Coronary abnormalities develop
43
NURSING ALERT - kawasaki
ADMINISTRATION OF IVIG * Follow hospital guidelines for blood products * IV Diphenhydramine * Monitoring of vital signs If adverse reaction * Rash, fever, shaking, facial flushing, chest tightness, or chills – DC infusion immediately & notify provider
44
Nursing Tip - kawasaki
* ADMINISTRATION OF ASPIRIN * Give with meals, with milk or an antacid to prevent GI upset. * Monitor for side effects - bleeding * If flu or chickenpox is suspected – discontinue and notify provider
45
Discharge Teaching - kawasaki - what about temp?
* Information about KD * Importance of follow- up * Passive ROM, antiarthritic agents * Take temperature for 2 weeks – keep log * CallifTempabove- 38.3 C (101F)
46
Discharge teaching - kawasaki
* How to administer ASA * Watch for side effects * Stop ASA if exposed to chicken pox or influenza (Reye syndrome) * Follow-up care to monitor cardiac complications * CPR
47
Discharge Teaching - kawasaki - how long for antiplatelet therapy?
Coronary Abnormalities * Indefinite antiplatelet therapy * Avoid contact sports – bleeding * Limit strenuous activity Stay Healthy * Yearly influenza vaccine * MMR/Varicella delayed for 11 months after IVIG – Body may not produce appropriate amount of antibodies * Nutrition
48
Nursing Considerations - kawasaki
* Challenging * Symptomatic relief * Emotional support * Diagnostic assistance * Medication administration * Education of child and family
49
know which direction
heart shunts
50
know the defects
51
PDA, ASV, and VSD
shunts - know these
52
4th Major Manifestation: Subcutaneous Nodule on Elbow - RF - are they painful?
Non-tender,0.5-1cm, persist indefinitely, gradually resolve, rare, may be found in crops; feet, hands, elbows, scalp, scapulae & vertebrae.
53
Jones criteria for diagnosing acute rheumatic fever: (Jones is major)
major, minor and evidence of strep Diagnosis requires 2 major, or 1 major and 2 minor, criteria and evidence of streptococcal infection or chorea alone
54
jones - major criteria - just the 5 you memorized - by the door
Major criteria * Carditis-tissue inflammation or new changing murmur * Polyarthritis-migratory pain in limb joints * Chorea-abrupt, purposeless movements with or without emotional changes * Erythema marginatum-nonpruritic rash, spares face * Subcutaneous nodules-painless, firm, on bones or tendons
55
jones - minor criteria
* Fever * Arthralgia * Previous acute RF or RHD * Acute-phrase reactants- erythrocyte sedimentation rate, C- reactive protein, leukocytosis * Electrocardiogram-prolonged PR level
56
jones - evidence of strep
* * Positive throat culture/Positive rapid strep antigen detection tests Elevated antistreptolysin 0 titer (ASOT) Scarlet fever
57
polyarthritis - how long is it painful for? (poly can only last a day)
* Painful for 1-2 days after which another joint is affected
58
kawaski disease - inflammation of what?
* Involves inflammation of small & medium sized arteries * Including coronary arteries - most susceptible
59
kawaski - what's the rash like?
* Skin rashes on the trunk & perineum, NOT blister-like - may desquamate
60
acute stage - kawaski - stomach pain?
* Diarrhea – abdominal pain * Hepatic dysfunction
61
kawaski - subacute stage - how long does it last? (24 is below a cutie)
Lasting 2-4 weeks
62
kawaski - subacute stage - what about the heart? at risk for what? (kawaski throbs)
Cardio vascular manifestations Heart failure Arrhythmias Thrombocytosis - High risk
63
kawaski - convalscent stage - what about blood values?
* Phase complete – all blood values normal (6-8 weeks) * Normal temperament, energy, & appetite
64
when to give IVIG for Kawasaki? (one week for IV)
* When given within 7-10 days * Single large infusion 2 g/kg over 10 -12 hours * Start - 0.5 ml/kg/hour for 30 minutes * Gradually increase to 2 ml/kg/hour
65
PDA shunt
left to right
66
ASD shunt - shunt which direction?
left to right
67
VSD - which way is the shunt? (vent to the left)
left to right
68
kawaski acute stage - how long does the fever last? (kawasaki is hot for more than 5 days)
* High fever (longer than 5 days)

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