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Pediatrics > Exam 3 - cardio > Flashcards

Exam 3 - cardio Flashcards

1
Q

when do major changes in the circulatory system occur

A

at birth, after the first breath

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2
Q

what is congenital heart disease

A

primarily anatomic abnormalities present at brith that result in abnormal cardiac function

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3
Q

congenital heart disease results in ____ and ___ ___ ___

A

hypoxemia; congestive heart failure

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4
Q

most common congenital heart defect

A

ventricular septal defect

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5
Q

cause of CHD

A

unknown

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6
Q

CHD risk factors

A

DM
poorly controlled maternal PKU
alcohol consumption
family hx - parent or sibling

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7
Q

CHD is associated with ___ syndrome

A

Downs

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8
Q

what are the 2 main factors affecting blood flow

A

pressure: greater pressure = greater flow
resistance: greater resistance = less flow

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9
Q

where is pressure normally greater?

A

L side of the heart

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10
Q

what are the 3 conditions associated with increased pulmonary blood flow

A

atrial septal defect
ventricular septal defect
patent ductus arteriosus

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11
Q

what is ASD

A

opening between atria causing blood to shunt to the R

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12
Q

what are the effects of ASD

A

L atrial hypertrophy

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13
Q

s/sx of ASD

A

asymptomatic
systolic murmur

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14
Q

is ASD found at birth

A

no, usually a few years old

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15
Q

ASD treatment

A

usually resolves on its own
patch via sx if too large

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16
Q

what is VSD

A

shunt from L to R ventricles, leads to increase pulmonary vascular resistance and L ventricular hypertrophy

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17
Q

what is not uncommon with VSD

A

CHF

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18
Q

what is PDA

A

blood returns to pulmonary artery bc it did not close as it should have after birth

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19
Q

when should PDA close after birth

A

within 10-16 hours

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20
Q

drug of choice for PDA treatment

A

indomethacin (smooth muscle relaxant)

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21
Q

PDA causes an increase workload on the heart which can lead to ___ ___

A

pulmonary edema

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22
Q

what are the 2 conditions that lead to obstructive blood flow

A

aortic stenosis
pulmonic stenosis

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23
Q

what is the result of aortic stenosis

A

decrease CO
decrease BP
tachycardia
difficulty feeding

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24
Q

aortic stenosis can lead to what 2 things

A

MI
L ventricular HF

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25
Q

aortic stenosis treatment

A

angioplasty

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26
Q

pulmonic stenosis s/sx

A

loud systolic murmur
cyanosis
mild CHF

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27
Q

pulmonic stenosis treatment

A

angioplasty

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28
Q

what 4 problems must occur for tetralogy of fallot dx

A

VSD
pulmonic stenosis
R vent. hypertrophy
overriding aorta (abnormal positioning)

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29
Q

what are tets spells

A

hypercyanotic spells

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30
Q

when do tets spells occur

A

crying
defecating

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31
Q

s/sx of tets spells

A

hypoxia
pale
tachypnea
irritable

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32
Q

what has occurred in the heart for mixed blood flow

A

pulmonary artery = L ventricle
aorta = R ventricle

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33
Q

babies with mixed blood flow are severely ___ at bith

A

cyanotic; referred to as blue babies

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34
Q

physiological responses to CHD

A

murmurs
decrease exercise tolerance
dyspnea
tachycardia
cyanosis/hypoxia
polycythemia
HF
growth is affected
recurrent respiratory infections

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35
Q

s/sx of HF

A

difficulty feeding
poor weight gain
mild tachypnea
tachycardia
cardiomegaly
galloping rhythm
poor perfusion
edema
liver, sleep enlargement
mottling, cyanosis, pallor

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36
Q

CHF: feeding interventions

A

relaxed environment
small, frequent feedings
upright position
monitor: tachypnea, diaphoresis, feeding intolerance (vomiting)

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37
Q

when should an NGT be considered

A

unable to consume appropriate amount during 30 minute feeding q3h

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38
Q

causes of IE

A

bacteria
fungus
virus

strep, staph are most common

39
Q

IE is usually resulted from

A

poor hygiene or invasive produre

40
Q

s/sx of IE

A

fever
nausea
fatigue
CP
arthralgia
change in heart murmur

41
Q

how to Dx IE

A

CBC
echo
ESR
CRP
blood cultures

42
Q

IE prophylaxis

A

Amoxicillin 1 hour prior to:

dental procedures
tonsilletomy
adenoidectomy
surgery/sx of respiratory or intestinal mucosa

43
Q

s/s of fast pulse rate

A

won’t feed well
irritable
pale
mottled
poor perfusion
cool extremities
diminished pulses
older children will c/o dizziness, activity intolerance

44
Q

what will correct fast pulse rates

A

adenosine
vagal maneuver

45
Q

when can a slow pulse rate occur

A

after sx
congenital
r/t heart block

46
Q

what is rheumatic fever

A

diffuse inflammatory condition of connective tissue

involves heart, joints, subq tissue, brain, blood vessels

47
Q

what is the most serious complication of rheumatic fever

A

rheumatic heart disease

results in permanent damage to cardiac valves (commonly mitral and aortic)

48
Q

when does rheumatic fever usually occur

A

2-6 weeks after untreated or partially treated strep infection

49
Q

how long can rheumatic fever last

A

up to 3 months

50
Q

review side 31

A

review slide 31

51
Q

what is used to Dx rheumatic fever

A

Jones criteria
must be at least 1 major or 2 minor manifestations

52
Q

rheumatic fever treatment

A

10 days of PO PCN or 1 dose of PCN IM
ASA
corticosteriods

cephalosporins or erythromycin if PCN allergy

53
Q

mattress placement with rheumatic fever

A

on the floor d/t fall risk r/t syndenham chorea

54
Q

review slide 34

A

review slide 34

55
Q

Kawasaki disease is common in ___ less than __

A

boys; < 2

frequently seen in children < 5
rarely dx after 8 y/o

56
Q

cause of Kawasaki disease

A

unknown

57
Q

kawasaki disease is aka

A

mucocutaneosu lymph node syndrome

58
Q

what is the major cause of acquired heart disease in children

A

kawasaki disease

59
Q

complication of kawasaki disease

A

coronary artery aneurysum

60
Q

how long does the acute phase of kawasaki disease last

A

10 days

61
Q

kawasaki disease is characterized by what

A

high fever persisting longer than 5 days

62
Q

is a fever responsive to abx with kawasaki disease

A

No

63
Q

kawasaki disease acute phase s/sx

A

high fever > 5 days
bilateral, nonpurulent conjunctivitis
strawberry tongue
cracked lips
swellings: hands, feet
erythema: palms, soles
generalized erythematous rash
enlarged cervical lymph nodes
tachycardia
extreme irritability

64
Q

how long is the subacute phase of kawaski disease

A

11-25 days

65
Q

s/sx of kawasaki disease subacute phase

A

fever disappears, most symptoms resolve
continued irritability
anorexia
desquamation of fingers, toes
arthritis
arthralgia
severe thromybocytosis
HF, dysrhythmias, coronary aneurysms

66
Q

when is an echo done with kawasaki disease

A

at Dx
repeat in 2 weeks
again 6-8 months

67
Q

how long does the convalescent stage last with kawasaki disease

A

until ERS returns to normal

68
Q

convalescent stage s/sx with kawasaki disease

A

most have disappeared
Beau’s lines

69
Q

what is the focus with kawasaki disease

A

preventing, reducing coronary artery damage

70
Q

when is ASA and IVIG therapy most prevalent with kawasaki disease

A

when given within 10 days of fever onset

71
Q

how long will a child be on ASA after kawasaki disease dx

A

2 months

72
Q

review slide 30

A

review slide 39

73
Q

ASA should be administered with what

A

milk or food

74
Q

how long to delay MMR, varicella vaccine after Kawasaki IVIG

A

11 months

75
Q

s/sx of IVIG adverse reaction

A

flushing
chest tightness
chills
dizziness
N/V
diaphoresis
hypotension

76
Q

kawaski interventions

A

hydration (ice pops)
high calorie food
sponge baths
keep environment clean

77
Q

BP must be high on __ different occasions for HTN dx

A

3

78
Q

HTN is seen in ___ r/t to obesity

A

adolescents

79
Q

educations measures to prevent HTN

A

weight reduction
dietary modifications
relaxation techniques

80
Q

IV infusion of HTN meds must be done ___ ___

A

very slowly

monitor for sudden hypotension

81
Q

what must be maintained for IV infusion of HTN meds

A

art line

82
Q

define cardiomyopathies

A

diseased heart muscle NOT r/t CHD, CAD, or other systemic cause

83
Q

hypertrophic vs. restrictive cardomyopathy

A

H: hypertrophic ventricles, impaired filling
**common in athletes who suddenly die

R: infiltration of muscle of abnormal material
**often congenital

84
Q

when to assess baseline lipids

A

around 9-11; again around 19-20

85
Q

digoxin therapeutic level

A

0.8-2

86
Q

apical pulse range for infants and > 2

A

I: 90-110

> 2: 70

87
Q

when are therapeutic ranges measured with digoxin

A

6 hour after dose

88
Q

should digoxin doses be verified with another nurse

A

yes

89
Q

hypercyantic spells treatment

A

knee to chest position
calm approach
100% O2 by mask
morphine IV
IVF to prevent dehydration

90
Q

how much fluid should be consumed daily to prevent dehydration

A

150 mL/kg/day

91
Q

sx: children under 5 worry about what

A

what will happen when they wake up

92
Q

sx: school aged children fear what

A

anesthesisa

93
Q

sx: 9-10 year olds fear what

A

death

Pediatrics (12 decks)

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