Cardiac PP Flashcards by Rosemary Haas

what is important to start with in cardiac pt.

health history 
physical assessment (palpate/auscultate)

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what s/s on the physical assessment will we find?

turbulent blood flow (heart murmur)
irritable/weak cry
cyanosis (during activity)
tires/sweats while eating
FTT - underweight (high metabolic state, poor feeders, plot at or below 5th percentile)

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what are we looking for in the health history for cardiac pt?

family hx: marfan syndrome, digeorge syndrome
siblings
congenital abnormalities
maternal (rubella)

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s/s of cardiac problems in the older child

chest pain (verbalized)
decreased activity
syncope (fainting)
FTT

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if pt. in a squatting position or knee/chest what do we assume?

tetralogy of fallot

“tet squat”

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when is tetralogy of fallot treated

early in infancy

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if pt. underwent a “tet” spell what interventions would we do

blow-by oxygen
morphine (iv, sub-q), Inderal
calming
place pt. in knee-chest position

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dx tests for cardiac defects

x-ray (cardiomegaly)
holter monitor (24 hr. ekg)
ekg
trans-esophageal echocardiogram (invasive)

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some apnea can be expected in peds pt. t or f

true, called periodic breathing
15sec in neonate
20sec in infancy

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the best cardiac treatment and dx method

cardiac catheterization

note seafood or iodine allergy (dye)

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pre-procedures for cardiac cath

accurate height and weight-determines size of equipment
vitals
h&h (stable)
identify pedal pulses (mark)
NPO - 6 hrs. prior to procedure
iv if child is polycythemic (increased rbc)

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post cardiac cath procedures

vitals

monitor for toxicity to dye(itching)

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home care instructions for card. cath

keep dressing dry/clean in place (24 hours)
avoid exercise
observe site for infection

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what is congestive heart failure

heart is ineffective as a pump

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congestive heart failure in children under 1 year of age is due to

congenital anomalies

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congestive heart failure in children over 1 year with no congenital anomaly may be r/t

acquired diseases (Kawasaki)

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**1 of the earliest signs of CHF

tachycardia

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s/s of CHF

fatigue
irritability
hepatomegaly
tachypnea
cardiomegaly
infant resting pulse of over 160-notify provider

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normal HR for an infant

120-140

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goals of trt for CHF

improve cardiac contractility (digoxin, diuretics, ace inhibitors (prils)
decrease intravascular fluid volume (lasix) - restrict salt and water
provide soothing environment
preserve energy and decrease metabolic demands
***small frequent feedings (increase calories)

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what can we do to increase calories for a child

enteral feedings - supplemental feedings

widen the nipple - not working so hard to feed

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interventions for CHF

fluid/sodium restrictions
diuretics - be sure to take in potassium
bed rest - preserve energy - decrease oxygen demands
oxygen - monitor w/sedatives
small freq feeds
pulse ox
cluster care
daily weights for water balance
loosely attach diapers
check temp q4 hrs

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VSD s/s

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presence of a murmur (turbulent blood flow)
dyspnea on exertion
recurrent resp infections

mgmt of VSD

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medications that increase cardiac output (inotropic)

placement of patch to hole so ventricles don’t communicate

nurs dx of VSD

``` decreased cardiac output activity intolerance ineffective tissue perfusion fluid vol excess risk for injury (cardiac cath) risk for growth and development delay ```

preop for VSD

prepare child w/age approp. explanations monitor baseline VS teach parents what they can expect

post op VSD monitor

hydration status hemorrhage encourage fluid intake - eliminates dye s/s of CHF (tachypnea in left sided HF) - edema, crackles in lungs (fluid is backing up)

trt of CHD w/ increased pulmonary blood flow

limit feedings to 30 minutes daily weights cluster care HOB elevated

what is bacteremia

bacteria in the blood

bacterial endocarditis comes from

bacteremia

what types of bacteria lead to bacterial endocarditis

strep | staph

what is bacterial endocarditis

infection in valves and endocardial surface of the heart

assess for a hx of this with bacterial endocarditis

congestive heart disease Kawasaki disease rheumatic fever prosthetic valves implanted

prevent bacteremia during dental trt/care with?

prophylactic antibiotics

can bacterial endocarditis lead to heart failure

yes - resolve infections, can effect heart and valves

bacterial endocarditis is treated with this

long term antibiotic therapy (2-8 weeks) | requires picc line

do we require repeat blood cultures w/BE

yes - evaluating effect of treatment

is there a surgical approach to BE

yes. scrape heart valve or valve replacement

an ACQUIRED infection that can be the response from a strep throat infection

rheumatic fever

what causes rheumatic fever

a group a b-hemolytic streptococcus | impetigo

rheumatic fever effects..

joints - can lead to arthritis or can effect movements (**chorea/st Vitus dance) - heat/cold trt skin - subcutaneous nodules over bony prominence's; aschoff bodies (bolus lesions in connective tissue (heart vessels, brain))

can rheumatic fever lead to CHF

yes - can lead to carditis (inflammation of the heart) which can lead to HF

a s/s of rheumatic fever

Rash of trunk/extremities (erythema marginatum)

ideal trt for rheumatic fever

penicillin salicylate therapy - reduce fever corticosteroids

is there dx criteria for rheumatic fever

yes - Jones criteria | serum blood test - anti-streptomycin titer

rheumatic fever serum blood test (aslo) is positive for rheumatic fever when

rising ASO (anti-streptomycin) titers between 2 blood draws OR greater than 333 Todd units

most common acquired heart disease in children worldwide

rheumatic heart disease

Kawasaki disease is also known as this

Mucocutaneous lymph node syndrome

In Kawasaki disease what 2 conditions are we concerned with

Vasculitis - Inflammation of vessels leading to aneurysms, which can rupture leading to death Increased platelet formation - risk for an MI

trt for Kawasaki disease

salicylate therapy - 2 purposes high dose to reduce inflammation(80-100 mg/kg/day) afebrile for 48-72hrs -low dose salicylate for anti-platelet effect to avoid MI IVIG - intravenous immunoglobulin G

3 phases to Kawasaki disease

acute phase - abrupt onset of high fever for 4 days, unresponsive to trt; irritability; conjunctivitis (dry); strawberry tongue; edema of hands/feet sub-acute phase - resolution of fever but platelet count is high; (periungual desquamation) peeling of fingers/toes; thrombosis may occur convalescent stage - lasts anywhere from 4-6 weeks, outward signs have disappeared

Labs r/t Kawasaki disease

*elevated ESR (erythrocyte sedimentation rate), WBC count, Platelet counts

s/s of MI in a young child are VAGUE and include:

``` *abdominal pain vomiting restlessness inconsolable crying pallor ```

add warfarin to trt for Kawasaki when this is seen

>8mm aneurysm

should we hold vaccines in children with Kawasaki's

yes delay MMR and varicella due to IVIG; immunizations are not effective in creating an immune response; up to 1 year

trt ivig like this

a blood transfusion | often times there will be a prn order for benadryl and epineprhine in case of an allergic reaction to the IVIG

Cardiac PP Flashcards

(56 cards)