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Peds-Cardiovascular

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cdunbar4's version from 2017-02-12 18:34

Norms & Cyanotic heart defects

Question Answer
Infant HR120-130bpm
toddler/preschool HR80-105bpm
School age HR70-80bpm
BP _____ with age and HR ______ with ageincreases; decreases
infant BP80/40
toddler BP80-100/64
school age94-112/56-60
Hypotensive formula70mmHg + [child's age in years x2]
Cyanotic heart defects examplestransposition of the great vessels/arteries & Tetralogy of Fallot
Right to left shunts assessmentcyanosis, clubbing, increased P & RR, polycythemia on CBC, history of irritability & feeding difficulties, child positioning, I & O, ECG, Cardiac Cath, Echocardiogram
General Interventions cyanotic heart defectsOxygen, decrease demands, feeding (OT and PT interventions to help get them eating), hydration, preventive antibiotics, skin care, palliative vs corrective procedures
Tetraology of Fallot: Overviewcyanotic heart defect: Pulmonary artery stenosis, ventricular septal defect (VSD), hypertrophy of the right ventricle, Overriding aorta (check feet pulses vs. arms).(dextroposition of the aorta)
Tet of Fallot assessmenttet/blue spells; cyanosis; polycythemia; chronic hypoxia signs (dyspnea, clubbing of digits, failure to thrive, exercise intolerance)
Tet of fallot interventionsCardiac catheterization Surgical repair Care for cyanotic heart defect Decreased oxygen demands Support during Tet spells
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Acyanotic defects

Question Answer
ExamplesVSD, ASD, PDA
Left to right shunt assessment findingsResp distress, congested cough, diaphoresis, fatigue (signs of CHF), Hepatomegaly Frequent resp infections, poor growth and dev, fatigue, heart murmur
General interventions digoxin (**For kids hold if HR <100); diuretics, fluid restrictions, strict I/O's; reduce O2 demands; high calories; prevent cold stress; prevent infection
VSD overview (Ventricular Septal Defect)Acyanotic deficit Most common congenital cardiac anomaly Left-to-right shunting of blood
VSD assessmentAssess for signs for CHF w/ right ventricular hypertrophy Tachycardia Diaphoresis Tachypnea fatigue
VSD assessment findingsAssess for failure to thrive Evaluate exercise/activity intolerance Monitor for recurrent respiratory infections Closure of VSD can interfere with conduction, usually closes on its own
VSD interventionsPrepare for cardiac catheterization Administer Digoxin (must be >100 to administer) Monitor fluid status!!!!! Administer diuretics as ordered Give high caloric foods (22-24 calorie formula or fortified MBM) Prepare for surgical correction
Coarctation of aortadecreased blood flow to the trunk and lower extremities, increased blood flow to the head and arms predisposed to CVA
coarctation of aorta assessment full bounding pulses in arms and weak or absent pulses in the legs same rate increase blood pressure in the arms and decreased blood pressure in the legs Palpate for warm upper body and cool lower body Signs of CHF
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Rheumatic Fever

Question Answer
Rheumatic fever overviewAcquired autoimmune inflammatory disorder Occurs 1-6 weeks after group A beta-hemolytic infection 1-5% incidence after untreated strep throat Scarlet fever (group A strep) Antibodies attack and destroy heart valves
rheumatic fever assessmentClinical Manifestations occur in the heart, joints, skin, and central nervous system
Aschoff bodiesinflammatory hemorrhagic bullous lesions, cause swelling and changes in the connective tissue
complicationsCarditis Polyarthritis Increased serum sedimentation rate (ESR) Chorea (Sudden involuntary movement of the extremities Erythema marginatum (temporary, disk-shaped red macules that are non-pruritic and faded in the center Altered ECG with prolonged PR interval
interventionsPrevention is KEY by treating step throat infections Promote bed rest until ESR normalizes (5 weeks) Administer anti-inflammatory to control the inflammatory process, especially in the joints, and to reduce discomfort Administer penicillin prophylaxis to prevent future attacks 5 years or longer if carditis is present
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Kawasaki Disease

Question Answer
Overview: acute systemic vasculitis. What area is at the most risk?coronary arteries
Self-limiting, usually resolves in how long?6-8 weeks
Why is it the leading cause of acquired heart disease in children?It damages coronary arteries and heart muscle; majority of cases occur in kids <5 years old
complicationsMI by thrombosis or stenosis; fluid overload and CHF
assessment findings acute phaseFever unresponsive to antipyretics Swelling of conjunctive no drainage Inflammation of mouth, lips, tongue (strawberry tongue) Swollen, red hands and feet Cervical lymphadenopathy
assessment findings subacute phaseResolution of fever Hands and feet peel Irritable
assessment findings convalescent phaseClinical signs resolve ESR, and C-Reactive protein return to normal If ESR and C-reactive protein remain elevate risk for Thrombocytosis is still present and arthritis is still present
Kawasaki InterventionsIV IVIG Salicylate therapy Fluids Cardiac Monitoring Symptom relief mouth care cool cloths or baths
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Other bullshit

Question Answer
Peridcarditis infection more common in younger children: viral coxsackie B common can occur post cardiac surgery 10%
EndocarditisProphylaxis recommended for high or moderate riskantiseptic mouth rinse (chlorhexidine before procedure, amox or clindamycin before procedure [Dental, Oral, Genitourinary, Gastrointestinal procedures]
MyocarditisViral most common, infants have a more acute course FLU LIKE SYMPTOMS , NEW ONSET CHF, FEVER, TACHYCARDIA, TACHYPNEA, GALLOP ⅓ resolution, 1/3 residual dysfunction, 1/3 require transplant
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