chap 25 peds, cardiac disorders

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signs related to cardiac problems

failure to thrive and/or poor weight gain, cyanosis,pallor, visually observed pulsations in neck veins, tachypnea, dyspnea, irregular pulse rate, clubbing of fingers, fatigue during feeding or activity, excessive perspiration, esp. over forehead 611

differences in childs cardio system

chest walls are thin, heart rate is higher in newborns and infants then adults 612

thoracotomy

a chest incision

blood always flows from path an area of high pressure to

an area of low pressure and takes the path of least resistence

congenital heart defects that cause the blood to return to the right ventricle and recirculate through the lungs before exiting the left ventricle

increase pulmonary blood flow

ventrical septal defect, atrial septal defect, and patent ductus arteriosus do what to the pulmonary blood flow

they increase the pulmonary blood flow because of a left to right shunt

ventricular septal defect

most common heart anomaly, opening between the right and left ventricles of the heart, increased pressure in the left ventricle forces blood into the right

signs of VSD

loud harsh murmur with a systolic thrill

patent ductus arteriosus

happens when ductus arteriosus doesn't close, blood continues to pass from aorta, where pressure is higher, to the pulmonary artery, causes oxygenated blood to be recycled

symptoms of patent ductus arteriosus

in infancy may go unnoticed, as child grows dyspnea, full and bounding radial pulse, wide pulse pressure, has a characteristic machinery type murmur

drug used in premmies to close PDA

indomethacin therapy

coarctation of the aorta

when there is a narrowing of the aortic arch or the descending aorta, an obstructive defect

symptoms of coarctation of the aorta

marked difference in the blood pressure and pulses of the upper and lower extremities, may not develop symptoms till late childhood

treatment of coarctation of the aorta

a graft surgery is done called anastomosis, graft does not grow so best time to do surgery is between 2 and 4 yrs old

if coarctation of aorta is untreated what can happen

hypertension, CHF, and infective endocarditis

a defect that causes a decrease in pulmonary blood flow

tetralogy of fallot

the defects associated with tetralogy of fallot

narrowing of pulmonary artery, hypertrophy of RV, dextroposition of the aorta, and VSD

signs associated with tetralogy of fallot

cyanosis, clubbing of fingers and toes, will squat to breathe easier, feeding problems, growth retardation, resp. infections, polycythemia, severe dyspnea on exerction

polycythemia

an increase in red blood cells, happens when body tries to compensate for lack of oxygen

paroxysmal hypercyanotic episodes

also called tet spells, when spontaneous episodes of cyanosis, resp. distress, weakness, and syncope occur

what to do when infant has a tet spell

place in knee chest position

complications associated with tetralogy of fallot

cerebral thrombosis caused by polycythemia, esp if dehydration occurs, Iron deficiency anemia

treatment for tetralogy of fallot is designed to

increase pulmonary blood flow to relieve hypoxia

drug therapy used to open a constricted ductus arteriosus and allow oxygenation of body till surgery is performed for tetrology of fallot

IV prostaglandin E therapy

hypoplastic left heart syndrome

an underdevelopment of the left side of the heart, an absent otr nonfunctioning left ventricle and hypoplasiaof the ascending aorta

survival of hypoplastic left heart syndrome depends on what

patent foramen ovale and ductus arteriosus to provide a pathway for oxygenated blood to the body

symptoms associated with hypoplastic left heart syndrome

grayish bluish color of the skin and mucous membranes, signs of CHF (dyspnea, weak pulses, and a cardiac murmur)

in congenital heart defects should immunizations be given

yes, need to be emphasized

after cardiac transplant what needs to be placed on hold

immunizations

vacations in high altitudes or very cold climate can cause

an adverse reaction to a child who is already hypoxic or has cardiac problems

drainage systems are always kept at what level

at a level below the chest

what is kept at bedside with drainage systems

2 rubber shod kelley clamps, applied to the tubes as close to childs body if break occurs

an acquired heart disease is

condition that occurs after birth

early signs of CHF in child

tachycafatigue during feeding, sweating around scalp and forehead, dyspnea, suddden weight gain

heart rate of newborn needs to be reported if over what at rest

60

what is usually first sign of CHF

tachycardia

nursing goals in CHF

reduce work load on heart, maintain proper nutrition, prevent infection, reduce patient anxiety, improve respiration, support and instruct parents

if child tires easily when feeding what can help

a nipple with larger holes so they don't have to put so much effort into sucking

drugs given to slow and strengthen heartbeat

digitoxin and digoxin (lanoxin)

before administering dig nurse needs to

count pulse for 1 minute

hold dig if HR of newborn is below what

100

symptoms of dig toxicity

N&V, anorexia, irreg or sudden change in pulse

foods high in potassium

bananas, oranges, milk, potatoes, and prune juice

when child is given diuretic such as lasix or chlorothiazide(Diulil) what are they at risk for

electrolyte imbalances esp. potassium

rheumatic fever causes scarring of what

mitral valves

rheumatic fever is caused by

a complication of untreated group A beta-hemolytic streptococcus infection of the throat

sypmtoms of rheumatic fever may not appear till when

1 to 6 weeks after a strep infection

classic symptoms of rheumatic fever are

migratory polyarthritis(wandering joint pain), skin eruptions, chorea(nervous disorder), inflammation of the heart

the standard test for rheumatic fever

an elevated ASO titer

erythema marginatum

a rash seen in RF, has small red circles with red colored margins, and wavy lines apperearing on trunk and abdomen

with chorea the child may

laugh or cry at inappropriate times, may even stop talking at all, usually disappers on its own but may take weeks or months

rheumatic carditis

an inflammation of the heart seen in RF, often involves the mitral valve, left atrium works harder in this condition

aschoff's bodies

myocardial lesions that are characteristic in rheumatic carditis

jones criteria

used in diagnosis of RF, must have 2 major signs or 1 major and 2 minor

the major criteria in the jones chart

carditis, polyarthritis, erythema marginatum, chorea, subcutaneous nodules

the minor criteria in the jones chart

fever, arthralgia, previous hx of rheumatic heart disease, elevated erythrocyte sed rate, leukocytosis, altered PR interval, positive c reactive protein

IM benzathine penicillin G is given monthly to children with hx of RF for minimum of

5 years or till reach 18

drug used for chorea

phenobarbital

disorders that account for secondary hypertension

renal, congenital, vascular, and endocrine

things that can contribute to any type of hypertension

heredity, obesity, stress, poor diet and exercise

primary hypertension implies that

there is no known underlying cause

main focus of a hypertensive prevention program is

patient education

good cholesterol

high density lipoproteins

bad cholesterol

low density lipoproteins

2 consecutive blood levels exceeding what need to be monitored

170

kawasaki disease also called

mucocutaneous lymph node syndrome

kawasaki disease is leading cause of

acquired cardiovascular disease

kawasaki disease causes an inflammation of

the vessels in the cardiovascular system, often results in an aneurysm

symptoms of kawasaki disease

fever of 104 that wont go away lasts more then 5 days, conjunctivitis without drainage, fissured lips, strawberry tongue, inflammed mouth or membranes, enlarged nontender lymph nodes, erythematous skin rash, swollen hands, peeling of hands and soles of feet

if given this drug early with kawasaki disease it can prevent coronary pathology

IV gamma globulin

after receiving immune globulin need to

postpone immunizations for several months

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