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chap 25 peds, cardiac disorders

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
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
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
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
what is usually first sign of CHF
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
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
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
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