Exam #3 Cardiac Flashcards

(114 cards)

1
Q

When we are in the uterus, we do not need our lungs. So they are collapsed down, but they still make surfactant.

A

since we do not use lungs as a fetus, we get oxygenated blood via the placenta.

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2
Q

From the placenta… oxygenated blood flows through the umbilical vein to the fetus.

A

Once it enters the fetus….it goes to the liver where we have something that is called the DUCTUS VENOSUS.

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3
Q

What does the ductus venosus do?

A

It shunts the oxygenated blood straight into the inferior vena cava.

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4
Q

Once the blood has been shunted from the ductus venosus into the inferior vena cava…..Where does it go next?

A

Into the right atrium.

In a fetus, the problem is that we do not need it to go to the lungs….because of the pressure…we have a trap door that opens called the Foramen ovale.

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5
Q

What does the foramen ovale do?

A

It is literally a hole between the atriums with a little flap. So blood goes from the right atrium into the left atrium and bypasses the lungs.

And because the pressure is stronger coming from the mother…it keeps it open.

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6
Q

After the blood enters the right atrium and travels through the foramen ovale into the left atrium….where does it go next.

A

It goes through the mitral valve into the left ventricle and out through the aorta.

Most of it goes from the aorta to the brain.

This is where most of it is shunted

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7
Q

Even though fetal circulation bi-passes the lungs….there is still a little bit of leakage through the tricuspid valve into the right ventricle…into the lungs.

A

Even though the fetus does not use the lungs….they still need a little bit of blood in order to make surfactant.

Most of the blood needed is given to the brain due to its rapid growth.

This is done though a shunt called the ductus arteriosis.

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8
Q

What does the ductus arteriosus do?

A

The ductus arteriosus takes most of mommas blood that did

NOT

Go through the foramen ovale and shunts it over to the pulmonary vein…to the left atrium….and left ventricle and out to the brain.

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9
Q

When the fetus is done getting the oxygenated blood from momma, how is the blood returned to the fetus to be reoxygenated?

A

Through the umbilical arteries.

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10
Q

Name the 2 shunting systems that deliver oxygenated blood to the fetus….

A

Ductus Venosus

Ductus Arteriosus

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11
Q

Which one shunts blood into the pulmonary veins?

Ductus Venosus
Ductus Arteriosus

A

Ductus Arteriosus

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12
Q

Which one shunts blood into the inferior vena cava?

Ductus Venosus
Ductus Arteriosus

A

Ductus Venosus

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13
Q

Which one carries oxygenated blood to the fetus?

Umbilical artery
Umbilical vein

A

Umbilical vein

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14
Q

Which one carries unoxygenated blood away from the the fetus?

Umbilical artery
Umbilical vein

A

Umbilical artery

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15
Q

Name the 5 fetal circulation structures.

A
Umbilical vein, 
umbilical arteries
Foramen ovale
Ductus arteriosus
Ductus venosus
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16
Q

Fetal Circulation through the heart….

A
Placenta
umbilical vein
liver, ductus venosus
inferior vena cava
right atrium
foramen ovale
left atrium
mitral valve
left ventricle
aorta
brain
back through umbilical artery
return to the placenta
leak through tricuspid
right ventricle
ductus arterosus
pulmonary vein
left atrium
mitral valve
left ventricle
aorta
brain
back through umbilical artery
return to the placenta
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17
Q

When you are born you come out of the vagina…..you take your first breath of life….it is about 40-60 sonometers of pressure that expands the lungs.

A

When you expand the lungs for the first time….you have changed the whole system.

Meanwhile, when the cord is cut, the pressure of the whole system changes.

The body now has a higher pressure in the lungs, and the placenta is gone.

So the foramen ovale closes.

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18
Q

Why does the foramen ovale close shortly after birth?

A

because we have more pressure from the lungs expanding for the first time.

Now the blood travels through the heart like it is supposed to.

Change Happens in about 1 min.

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19
Q

A fetus is used to getting ___% oxygen from the mother

A

18

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20
Q

Once the cord is cut and the baby is breathing on their own…What percent of oxygen are they now getting?

A

21%

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21
Q

So when we look at congenital heart problems, we are looking at something that has gone wrong with the setup of ____ ______.

A

Fetal Circulation

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22
Q

Most babies will do just fine with a congenital heart condition as long as the fetus is in the uterus getting all of their oxygen from the placenta.

True or false

A

True

When you put them in their own world, that is when any defects in their heart start showing up.

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23
Q

Congenital defects are classified by what?

A

Increased blood flow to the lungs and decreased blood flow to the lungs.

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24
Q

After the baby is born, and the cord is cut….

What stimulates the ductus arteriosus to close?

A

The ductus arteriosus will close slowly ( it constricts) in reaction to the fact that the baby is breathing 21% oxygen.

Also closes in response to a decrease in prostaglandins.

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25
So if we have a good healthy baby (that has not been recusitated), the ductus arteriosus closes and we may hear a _____ in the first 1 - 2 hours of life.
Murmur Because it closes slowly
26
If we have a sick baby, especially a preterm baby…..they will not be getting enough oxygen…This means that their _____ _____ will stay open/patent.
ductus arteriosus It stays open because they baby is not getting enough oxygen and this is what stimulates it to close (along with dropping prostaglandin levels)
27
If a newborn baby that was fine originally gets sick later on 4-5 hours later….will their ductus arteriosus open again?
yes because the body thinks that it is without oxygen and back in the uterus
28
What are the Pediatric Indicators 
of Cardiac Dysfunction. (6 of them)
Poor feeding Tachypnea, tachycardia Failure to thrive, poor weight gain Activity intolerance Developmental delays esp. gross motor Positive family history of cardiac disease
29
What are we looking for on a cardiac assessment of a child?
History – prenatal and postnatal Feeding, respiratory infections, activity ``` Color Auscultation Pulses Blood pressure – 4 extremity Capillary refill Abdomen ```
30
What are the 3 signs that you have an unhealthy baby?
poor feeding tachycardia tachypnea When you see these signs in a baby you have to start going down the list of problems. Do they have a GI bug? Do they have any S/s of illness at all?
31
If a baby has tachycardia but no other signs of illness….what do you do next?
Check temp… | Check o2….make sure oxygenating.
32
The big signs to look for that something may be wrong…that the baby may have a problem is
poor feeding and poor growth.. You will also see a big delay in gross motor... Because the baby will use up all of their calories trying to keep their heart beating and they are unable to grow. and because they are usually short of breath, and working real hard for oxygen anyway because they have poor cardiac output….you will find that they do not have enough effort to be able to develop.
33
So in cardiac babies….you will see a delay mostly in gross motor….
So they will have good interaction….they will be smiling…they will be normal for personal social….they will be normal for language as long as there are no other defects. They will also be normal for fine motor because it does not require a whole lot of effort.
34
What is considered gross motor in a baby...
learning to sit up learning to pull up learning to crawl and walk all of this requires calories and oxygen, along with the ability to not get tired. This is why gross motor is delayed in cardiac babies
35
You must always assess the history of a cardiac baby. What are some important things to consider when asking about the history.
Prenatal and Postnatal history Risk factors for CHD: 2 big ones: Down’s Syndrome and Fetal Alcohol Syndrome. 50% have CHD Maternal Diabetes Rubella
36
When assessing the heart….what do you do first?
YOU LOOK AT THE BABY FIRST Is he tired Is he squatting if older child What is his color Then listen to the heart
37
When listening to the heart what are some things to consider?
With a premie, you can set the stethoscope anywhere For older or bigger babies…. Listen to Aortic, Pulmonic, Tricuspid, and Mitral.. Mitral is where apical pulse is heard. If a patient has a patent ductus…..you have to listen on the back. This is where it is heard the most. After you auscultate you palpate pulses.
38
If on auscultation of the heart you hear a murmur….what are you going to do next?
You immediately go into an assessment ``` assess the pulses, BP on 4 extremities, chest x ray capillary refill palpate abdomen (enlarged liver/spleen) ``` (Feel carotid pulses, femoral, radial, and pedal pulses) The reason is because of coarctation of the aorta that decreases the amount of blood going to the lower part of the body. So BP is greater in the upper part of the body. This is a BIG CLUE FOR COARCTATION OF THE AORTA
39
Suppose you are assessing pulses on a kid and they have great radial pulses but you cannot feel the femoral or pedal pulses…..What are you going to do next?
get 4 extremity BP Capillary refill to assess cardiac output palpate abdomen
40
Just to let you know about murmurs…...
Just because a child has a murmur it does NOT Mean they have a congenital heart defect/disease. If a child has anemia, we will hear a flow murmur until the anemia is corrected Sometimes a child with a fever can have a murmur and it will go away if the fever goes away. This is called an innocent murmur. Heart can make flow noises if it is stressed out.
41
If you hear a murmur…..you put down exactly what you hear….
Do not chart a murmur just because the person in front of you charted a murmur… Maybe they didn't hear one… or maybe it is gone.
42
After a murmur was heard…We have done: x-ray / bloodwork 4- extremity BP Cap refill Pulses ect… What do we do now?
Get Echo to try and locate the defect. Then send to cardiac cath for 2 reasons. ``` #1 - Diagnosis #2 - Nonsurgical repairs of smaller defects. ```
43
Cardiac Catherization potential complications
``` arrhythmias, ***hemorrhage, vascular damage, vasospasm, thrombus, embolus, infection, catheter perforation ```
44
What interventions do you do BEFORE a cardiac cath?
Mark distal pulses before procedure (femoral, pedal) get baseline vitals
45
What interventions do you do AFTER a cardiac cath?
Insertion site dressing checked q 15 min. first 2 hr. Monitor HR and vitals Monitoring for bleeding
46
If you have bleeding from the site…What do you do?
Place your finger 1 inch ABOVE the insertion site and press down firmly to stop the bleeding. Send someone else to call the doctor Stat.
47
What is the discharge teaching for a cardiac cath patient?
Teach them that the dressing has to stay on for 2 days and has to be changed 1 time a day, the child may NOT do PE or any strenuous sports or activities Child may return to school 1 day after cath teach them Place your finger 1 inch ABOVE the insertion site and press down firmly to stop the bleeding.
48
Risk Factors for Congenital Heart Disease (CHD)
Chromosomal-genetic: Down’s Syndrome, DiGeorge Syndrome 50% have CHD Maternal drug use: Fetal alcohol syndrome: 50% have CHD Maternal illness: Rubella in first 7 weeks of pregnancy Cytomegalovirus, toxoplasmosis IDMs = 10% risk of CHD
49
True or False Increased pulmonary blood flow defects are the ones where the child does NOT turn blue???
True these are Left to Right Shunting Lesions Abnormal connection between two sides of heart….Either the septum or the great vessels Increased blood volume on right side of heart Increased pulmonary blood flow Decreased systemic blood flow
50
What is the usual cause of a LEFT TO RIGHT shunt?
hole in the atrium…..foramen ovale is left open. hole in the ventricles We do not have to worry about this baby getting enough oxygen, but we do have to worry about decreased systemic perfusion….
51
What are the most common LEFT TO RIGHT shunts?
Atrial septal defect (ASD) – Ventricular septal defect (VSD) Patent ductus arteriosus (PDA)
52
Atrial septal defect (ASD) –
Now you can have an ASD and it closes on its own without problems. These are the most common ones. 2 times more common in females Can be asymptomatic until dyspnea and fatigue on exertion The ones that stay open are the ones that cause problems as an adolescent or adult. The reason that they do is because of the extra blood pushing on the pulmonary arteries….over time causes pulmonary vascular disease. if symptomatic….can cath them and scratch it to make bleed and close…or patch it..
53
Ventricular septal defect (VSD) –
Most common congenital lesion Majority close spontaneously Cant miss this one…whole systolic murmur. usually closed by the time the child starts school but normally dont have to do this.
54
Patent ductus arteriosus (PDA)
Patent Ductus Arteriosus…(shunts blood away from the lungs) Most common in premature infants Closes in response to oxygen and decreasing prostaglandins. If open, We try to give them oxygen to close it. If that does not work we give them indomethacin…. if that doesnt work we cath them
55
Indomethacin (Indocin)
Action: Inhibits prostaglandin synthesis Indication: Alternative to surgery for closing the PDA. Adverse effects: Decreased renal blood flow, NEC ``` Nursing considerations: Monitor heart murmur, blood pressure, urine output, serum sodium, glucose, platelet count, electrolytes. ``` Indocin may mask signs of infection
56
Indomethacin (Indocin) dosing
It is given in 3 doses 1 day apart. causes vasoconstriction which can kill the kidneys if they do not get blood flow most important to monitor urine output remember that it can mask an infection
57
Name the Decreased Pulmonary Blood Flow Defects
****Tetralogy of Fallot Tricuspid atresia Transposition of the Great Vessels Right to Left Shunting
58
Tetralogy of Fallot (TOF) is the most classic decreased pulmonary blood flow defect.. What are the 4 characteristics?
#1 they have VSD #2 Overriding Aorta - causes mixed blood-flow #3 Pulmonic Stenosis #4 Right Ventricle Hypertrophy ``` other things to know: Most frequent cyanotic lesion Boot shaped heart May need PGE to keep PDA open Clubbing Cyanotic spells – Tet spells Squatting during tet spells ```
59
Tetralogy of Fallot (TOF) more shit to know
infants need to push knees to chest in a tet spell give prostaglandins to keep ductus open Side effect is respiratory depression
60
Congestive Heart Failure in Children Pulmonary congestion: Left-sided heart failure
``` Tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis, crackles ```
61
Congestive Heart Failure in Children Systemic venous congestion: Right-sided heart failure
``` Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention ``` * *Big liver * *Strong Pulses * *Distended neck veins * *Ascites * *Preorbital edema
62
We want to look for the earliest sign of CHF…What is it?
Tachycardia while sleeping. May have gallop rhythm , fatigue, weakness, restlessness, pale, cool extremities, decreased blood pressure, decreased urinary output
63
Earliest sign of heart failure is tachycardia which is defined in infants as a sleeping heart rate > 160 bpm
true
64
All infant’s energy is used to maintain heart rate and breathing What 3 things will a heart baby have if they are too busy using energy for this
Poor wt gain Tire easily during feeds Developmental delay
65
What are the nursing diagnoses for CHF?
Cardiac output , Decreased R/T Impaired gas exchange R/T Fluid volume, excess R/T Nutrition, Imbalanced: Less than Body Requirements R/T
66
Nursing Interventions – Cardiac Output
#1 med is digoxin Administer digoxin as prescribed ****Monitor for digoxin toxicity Monitor serum potassium levels ****Monitor pulse, Apical before giving Maintain neutral thermal environment Plan frequent rest periods Cluster care/activities to allow for uninterrupted sleep Biggest problem with digoxin is narrow therapeutic window
67
Nursing Interventions – Oxygenation
***Monitor respiratory rate and lung sounds Monitor oxygen saturation Provide oxygen and humidification if prescribed **Observe for diaphoresis, a sign of increased respiratory effort **Position in semi-Fowler to relieve orthopnea
68
Nursing Interventions – Fluid vol.
Strict I&O’s Daily weight, on same scale Measure abdominal girth daily Observe for peripheral edema Administer diuretics as ordered Monitor electrolytes
69
Nursing Interventions -- Nutrition
Maintain nutritional status with small, frequent, high caloric feeds 20 cal increased to 24 cal/oz (breast milk fortifier, change formula) Limit feedings to 20 – 30 min Infant may require tube feeding to conserve energy. Provide pacifier for sucking needs if tube feeding ``` #1 - to keep them from getting lazy #2- It stimulates gastric secretions ```
70
Medications used to treat CHF in children
Enhance myocardial function #1 Oral positive inotropic agents – Digoxin – improve contractility #2 ACE inhibitors – reduces AFTERLOAD on the heart other meds Beta blockers Diuretics
71
Digoxin (Lanoxin) is the #1 treatment for CHF… It slows the heart so that it has time to fill, and increases contractility
Action: Cardiac glycoside that increases the influx of calcium from extracellular to intracellular myocardium. Increases the force of myocardial muscle contraction Depresses firing of SA node and conduction through AV node Indication: Treatment of CHF ``` Adverse effects: Bradycardia, AV block, SA block, Ventricular arrhythmias ```
72
Do not give digoxin to an older kid with a heart rate below?
70
73
Do not give digoxin to an infant/young child with a pulse less than?
90 the other thing is that you have to monitor for toxicity. If the baby vomits, you cannot give another dose until you have a digitalis level. also will have diarrhea and bradycardia
74
Digoxin -- Nursing considerations

``` Evaluate HR ( count for full minute) -- If a 1-minute apical pulse is ----less than 90 beats/min for an infant or young child, the digoxin is withheld. ``` ----100 to 120 beats/min is acceptable pulse to give Digoxin in infant or young child Do not give to older child is pulse below 70 bpm
75
Signs of Digitalis toxicity
``` Dyspnea Confusion/Hallucinations Dizziness Headache Agitation Disturbances in color vision – tendency to yellow-green coloring Blurred vision/Halos ****Nausea & Vomiting Diarrhea Bradycardia PVC’s ```
76
Family Digoxin Teaching
Administer regularly – never skip or make up for missed doses Give 1 hour before or 2 hours after meals. DO NOT mix with formula or food Take child’s pulse prior to administration Keep safe in locked cabinet Know signs and symptoms of digoxin toxicity
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(ACE) inhibitors --Captopril (Capoten)—
 Nursing considerations: 

Obtain BP immediately before each dose, and monitor after dose. If rapid fall in BP, place pt. supine with legs elevated Give 1 hour before meals Monitor for proteinuria Assess for anorexia– can cause decrease taste perception Pt./Family education – skipping doses can cause severe rebound hypertension Should not be used in adolescents who are at risk for pregnancy. Teratogenic.
78
Furosemide (Lasix)
Action: Enhances excretion of sodium, chloride, and potassium by direct action at the ascending limb of the loop of Henle. Indication: Diuresis Adverse effects: nausea, GI upset, diarrhea, constipation, electrolyte disturbances. Ototoxicity esp. in renal patients.
79
Furosemide (Lasix)-- Nursing considerations:
Obtain baseline electrolytes. Monitor electrolytes while on Lasix. Monitor output. -Assess for hypokalemia, hyponatremia - Family teaching – report ringing in ears - Eat foods high in K+ - Avoid over-exposure to sunlight and tanning beds
80
FOODS HIGH IN POTASSIUM

``` Apricots (dried or fresh) Avocado Bananas Mango Cantaloupe Oranges Orange juice has a higher potassium than a fresh orange Prunes Raisins ``` ``` Artichoke All Greens except Kale Dried Beans – all kinds have varied mg of K but all are in the high range Butternut, Acorn Squash Spinach Tomatoes Potatoes ```
81
Hypokalemia
``` Muscle weakness Muscle cramping Hyporeflexia Hypotension Cardiac arrhythmias, gallop rhythm Tachycardia or bradycardia Ileus/Abdominal distension Irritability and fatigue ```
82
Hyperkalemia
``` Muscle weakness Flaccid paralysis Hyperreflexia Bradycardia Ventricular fibrillation and cardiac arrest Twitching Oliguria Apnea ```
83
Spironolactone (Aldactone) -- Nursing considerations
Administer with food. Monitor serum potassium, sodium, and renal function. ***May cause false elevations in digitalis levels. Teach children to avoid high potassium diets, salt substitutes, and natural licorice.
84
Beta-Adrenergic blockers
Can cause hypoglycemia in children. May mask symptoms of hypoglycemia. Sleep disturbances, drowsiness, fatigue, bradycardia, hypotension
85
Sinus Tachycardia Nursing Considerations
``` Fever Stress Pain Agitation Hypovolemia (Shock) Congestive Heart Failure ``` Medical Management Identify and treat underlying cause Infants < 220 bpm Children < 180 bpm
86
Supraventricular Tachycardia (SVT)
Infants > 220 bpm | Children > 180 bpm
87
Nursing Considerations for Stable SVT
``` Vagal Maneuvers Ice to face (INFANTS) Have patient bear down Have patient blow through a straw (OLDER KID) Suction the nasopharynx ``` Administer Adenosine
88
Nursing Considerations for Unstable SVT
No LOC, no pulses Synchronized cardioversion
89
Common causes of bradycardia in a neonate
Suctioning Reflux Apnea of Prematurity Other causes: Most often caused by hypoxemia ``` Hypothermia Head injury Heart block Heart transplant Toxins/poisons/drugs Increased vagal tone Central Line in Right Atrium ```
90
Cardiogenic Shock
Congenital Heart Disease/ Heart Surgery 5 – 10 mL/kg NS/LR bolus and repeat as necessary after listening to lungs Vasoactive infusion
91
Endocarditis
Bacterial endocarditis (BE), infective endocarditis (IE), or subacute bacterial endocarditis (SBE) Streptococcal Staphylococcal Fungal infections Prophylaxis: 1 hour before procedures (IV) or may use PO in some cases
92
Complications of Infective Endocarditis
Ischemic Stroke Cerebral hemorrhage Meningitis Brain abscess Osler nodes are a clinical manifestation of endocarditis
93
Prevention of IE
Prophylactic antibiotics ONLY for highest-risk CHD patients Recent changes in prophylaxis guidelines Prophylaxis before dental work, invasive respiratory treatment, or procedures on soft tissue infections No prophylaxis for GI/GU procedures Administer prophylaxis 1 hour before procedure Meticulous dental hygiene
94
Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD)
RF Inflammatory disease occurs after group A β-hemolytic streptococcal pharyngitis Infrequently seen in United States; big problem in Third World Self-limiting Affects joints, skin, brain, serous surfaces, and heart RHD Most common complication of RF Damage to valves as result of RF
95
Clinical Manifestations of RF
Carditis – Chest pain, shortness of breath Fever Tachycardia, even during sleep Polyarthritis – migratory large-joint pain Erythema marginatum – rash starts at trunk Subcutaneous nodules over bony prominences Chorea – irregular involuntary movements
96
Rheumatic Fever (RF)
Lab Findings: Elevated Erythrocyte sedimentation rate Elevated ASLO (antistreptolysin O) titer – rise in titers begins about 7 days post onset of infection
97
Prevention of Rheumatic Heart Disease
Treatment of choice: Penicillin for 10 days Erythromycin if allergic to PCN Prophylactic treatment against recurrent Rheumatic Fever -- Penicillin
98
Kawasaki Disease
Another name: Mucocutaneous Lymph Node Syndrome An acute systemic vasculitis of unknown cause Most common adverse result is coronary artery aneurysm 75% of cases in children <5 years old
99
Kawasaki Disease 3 Phases
Acute: abrupt onset of high fever, lasting at least 5 days, unresponsive to antipyretics and antibiotics Subacute: Resolution of fever through end of all KD clinical signs Convalescent: clinical signs resolved, but laboratory values not returned to normal; completed with normal values (6-8
100
Kawasaki Acute Phase
``` Clinical manifestations: Cervical lymphadenopathy Red, cracked lips Strawberry tongue Erythematous palms Reddened, dry eyes Hands and feet edematous Palms and soles erythematous ```
101
Kawasaki Acute Phase
Inflammatory markers on labs are elevated: C-reactive protein, erythrocyte sedimentaion rate Very irritable and inconsolable Arthritis in small joints
102
Subacute Phase
Begins with the resolution of fever Risk of coronary thrombosis Peeling of hands and feet Arthritis in large wt. bearing joints Irritability persisting
103
Convalescent Phase
Clinical signs resolved May still have elevated sed rate and CRP May still have arthritis
104
Treatment of KD
High Dose IVIG 2g/kg over 8 – 12 hours High Dose Aspirin 80 – 100 mg/kg/day q 6 hours Then 3-5 mg/kg/day—antiplatelet after fever
105
IVIG (Intravenous Immune Globulin)
Informed and Written Consent Contraindications: IVIG is contraindicated in recipients: known to have had a previous history of a severe systemic or anaphylactic response to IVIG NOTE: IVIG interferes with the efficiency of live vaccines.
106
Family Education for KD
Irritability may persist for 2 months or more Take temperature daily after discharge Continue passive range of motion during bath to ease arthritis pain Avoid live vaccines for 11 months post administration of IVIG Avoid children with viral illnesses (Reye’s syndrome) Know signs of aspirin toxicity
107
Aspirin toxicity signs
``` Ringing in ears Headache Dizziness Confusion Easy bruising (avoid contact sports) ``` Severe toxicity can lead to hyperventilation leading to respiratory alkalosis (Sensorineural hearing loss is associated with KD, but is rare)
108
Systemic Hypertension
``` Primary: no known cause Secondary: identifiable cause Pediatrics: hypertension generally secondary to structural abnormality or underlying pathologic condition: Renal disease (most common) Cardiovascular disease Endocrine or neurologic disorders ```
109
Blood Pressure Screenings for Children
Blood pressure screenings should begin at 3 years of age
110
Cuff size
# Choose a cuff with a bladder width approximately 40% of the arm circumference Too small and the reading is falsely high Too large and the reading is falsely low BP readings using a Dinamap (oscillometry) are about 10 mm Hg higher than measurements using auscultation
111
Hyperlipidemia Children more than 2 years of age should be screened if they have any of the following risk factors
Obesity -- A BMI in the 95th percentile or higher is considered obese. Hypertension A parent or grandparent with a cholesterol level of 240 mg/dl or higher Early cardiovascular disease in a first- or second-degree relative is a risk factor.
112
Hyperlipidemia
Identify kids at risk and treat early Full Lipid profile should be drawn after a 12 hour fast Do not do lipid panel within 3 weeks of a febrile illness Elevated cholesterol in children: Total cholesterol > 200 mg/dl LDL > 130 mg/dl
113
Bile-acid-resin binders
Cholestyramine (Questran) Colestipol (Colestid) Side effects: Constipation, N&V, indigestion Nursing considerations: Interferes with fat soluble vitamin absorption so needs supplements Administer before meals
114
Statins
HMG-CoA reductase inhibitors -- Lovastatin (Altocor) Side effects: HA and abdominal pain rarely Rare but serious – rhabdomyolysis Discontinue medicine immediately with new onset of muscle aches or dark brown urine Nursing considerations: Take in evening Teratogenic Grapefruit juice may increase risk of side effects