Exam #3 Cardiac Flashcards Preview

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Flashcards in Exam #3 Cardiac Deck (114)
1


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

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

2

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

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

3

What does the ductus venosus do?

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

4

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

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.

5

What does the foramen ovale do?

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.

6

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

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

7

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.

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.

8

What does the ductus arteriosus do?

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.

9

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

Through the umbilical arteries.

10

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

Ductus Venosus
Ductus Arteriosus

11

Which one shunts blood into the pulmonary veins?

Ductus Venosus
Ductus Arteriosus

Ductus Arteriosus

12

Which one shunts blood into the inferior vena cava?

Ductus Venosus
Ductus Arteriosus

Ductus Venosus

13

Which one carries oxygenated blood to the fetus?

Umbilical artery
Umbilical vein

Umbilical vein

14

Which one carries unoxygenated blood away from the the fetus?

Umbilical artery
Umbilical vein

Umbilical artery

15

Name the 5 fetal circulation structures.

Umbilical vein,
umbilical arteries
Foramen ovale
Ductus arteriosus
Ductus venosus

16

Fetal Circulation through the heart….

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

17

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.

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.

18

Why does the foramen ovale close shortly after birth?

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.

19

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

18

20

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

21%

21

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

Fetal Circulation

22

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

True

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

23

Congenital defects are classified by what?

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

24

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

What stimulates the ductus arteriosus to close?

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.

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

77

(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