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cardiac peds Flashcards

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
Q

Kawasaki Disease (KD) - is it person to person?

A
  • Etiology unknown
  • Not spread person-person
  • Geographic & seasonal outbreaks * Late winter and early spring
  • Pediatric illness which suggests (?) passive immunity
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26
Q

Etiology and Pathophysiology - Kawasaki Disease (KD) - what part of the heart is affected?

A
  • Infectious or possibly toxic trigger initiates immune response
  • Multisystem inflammatory disease
  • Affects small, midsize, & coronary arteries * Can cause aneurysms
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27
Q

Pathophysiology - kawaski

A
  • Infiltration causes edema and inflammation
  • Weakened vascular walls
  • Leading to aneurysms
  • Fibrous connective tissue forms
  • Thickening and scarring the vascular walls
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28
Q

Pathophysiology - kawasaki

A

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
Q

Clinical Manifestations - 3 stages of kawasaki

A
  1. Acute
  2. Subacute
  3. Convalescent
30
Q

Acute Stage - kawasaki - lasts how long?

(a cutie only lasts for 1-2 weeks)

A
  • Lasting 1-2 weeks
  • Extreme irritability & inconsolable
  • Unresponsive to antibiotics & antipyretics
31
Q

Acute Stage – clinical signs
- kawaski - eyes?

(bloodshot kawaski)

A
  • Extremely bloodshot eyes/red eyes (without pus or drainage)
  • Inflammation of pharynx & oral mucosa
32
Q

kawasaki - Acute Stage - tongue?

(a cutie has a strawberry tongue)

A

Acute Stage - Strawberry Tongue red tongue with prominent papillae

33
Q

Acute Stage- kawasaki - what about palms?

(a cute kawaski makes me red)

A
  • Red palms of hands and soles of feet
  • Edematous – hands & feet, palms & soles erythematous
34
Q

Acute Stage - kawasaki - lymph nodes - one side or both?

A
  • Unilateral swollen cervical lymph nodes 1.5 cm/larger
35
Q

Subacute Stage - kawasaki - skin?

(peeling submarine)

A
  • Peeling of skin in the genital area, hands and feet (esp. around nails, palm, and soles)
36
Q

Subacute Stage - kawasaki - what is the skin like?

A

Bright red, chapped, or cracked lips
* Peeling under fingertips & toes of hands and feet
* Joint pain
* Cardiac disease

37
Q

Convalescent Stage 6-8 weeks - kawasaki - what might be present?

A

Child appears normal
* Lingering signs of inflammation
* Thrombocytosis (high platelet count) may be present
* Arthritis may continue
* Cardiac complications still a concern

38
Q

Diagnostic Criteria cont - kawasaki - how many symptoms do you need?

(4 kawasaki motorcycles)

A

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
Q

what tests for kawasaki - is there anemia?

A
  • 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
Q

Clinical Management - kawasaki - what meds?

(IV for kawasaki)

A
  • Preventing or reducing coronary artery damage
  • High dose IV immune globulin (IVIG) * Salicylate therapy (ASPIRIN)
41
Q

Clinical Management - kawasaki - IVIG

(I’ve got kawasaki)

A

IVIG - * Reduces duration of fever & inflammation
* Reduces incidence of coronary artery abnormalities & aneurysms

42
Q

Clinical Management - kawasaki - Aspirin Therapy

A
  • 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
Q

NURSING ALERT - kawasaki

A

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
Q

Nursing Tip - kawasaki

A
  • 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
Q

Discharge Teaching - kawasaki - what about temp?

A
  • Information about KD
  • Importance of follow- up
  • Passive ROM, antiarthritic agents
  • Take temperature for 2 weeks – keep log
  • CallifTempabove- 38.3 C (101F)
46
Q

Discharge teaching - kawasaki

A
  • 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
Q

Discharge Teaching - kawasaki - how long for antiplatelet therapy?

A

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
Q

Nursing Considerations - kawasaki

A
  • Challenging
  • Symptomatic relief
  • Emotional support
  • Diagnostic assistance
  • Medication administration
  • Education of child and family
49
Q

know which direction

A

heart shunts

50
Q

know the defects

A
51
Q

PDA, ASV, and VSD

A

shunts - know these

52
Q

4th Major Manifestation: Subcutaneous Nodule on Elbow - RF - are they painful?

A

Non-tender,0.5-1cm, persist indefinitely, gradually resolve, rare, may be found in crops; feet, hands, elbows, scalp, scapulae & vertebrae.

53
Q

Jones criteria for diagnosing acute rheumatic fever:

(Jones is major)

A

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
Q

jones - major criteria - just the 5 you memorized - by the door

A

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
Q

jones - minor criteria

A
  • Fever
  • Arthralgia
  • Previous acute RF or RHD
  • Acute-phrase reactants-
    erythrocyte sedimentation rate, C-
    reactive protein, leukocytosis
  • Electrocardiogram-prolonged PR
    level
56
Q

jones - evidence of strep

A
  • *
    Positive throat culture/Positive rapid strep antigen detection tests
    Elevated antistreptolysin 0 titer (ASOT)
    Scarlet fever
57
Q

polyarthritis - how long is it painful for?

(poly can only last a day)

A
  • Painful for 1-2 days after which another joint is affected
58
Q

kawaski disease - inflammation of what?

A
  • Involves inflammation of small & medium sized arteries
  • Including coronary arteries - most susceptible
59
Q

kawaski - what’s the rash like?

A
  • Skin rashes on the trunk & perineum, NOT blister-like - may desquamate
60
Q

acute stage - kawaski - stomach pain?

A
  • Diarrhea – abdominal pain * Hepatic dysfunction
61
Q

kawaski - subacute stage - how long does it last?

(24 is below a cutie)

A

Lasting 2-4
weeks

62
Q

kawaski - subacute stage - what about the heart? at risk for what?

(kawaski throbs)

A

Cardio vascular manifestations Heart failure Arrhythmias
Thrombocytosis - High risk

63
Q

kawaski - convalscent stage - what about blood values?

A
  • Phase complete – all blood values normal (6-8 weeks)
  • Normal temperament, energy, & appetite
64
Q

when to give IVIG for Kawasaki?

(one week for IV)

A
  • 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
Q

PDA shunt

A

left to right

66
Q

ASD shunt - shunt which direction?

A

left to right

67
Q

VSD - which way is the shunt?

(vent to the left)

A

left to right

68
Q

kawaski acute stage - how long does the fever last?

(kawasaki is hot for more than 5 days)

A
  • High fever (longer than 5 days)

XIO (325 decks)

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