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Peds-Cardiovascular

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olanjones's version from 2017-02-22 23:00

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 (MAP must be >37 up to 40 wks gestational age in NICU - think need for perfusion)
toddler BP80-100/64
school age BP94-112/56-60
Hypotensive formula (age 1-10)70mmHg + [child's age in years x2]
Cyanotic heart defects examples(R -> L shunts) transposition of the great vessels/arteries & Tetralogy of Fallot
Right to left shunts assessmentcyanosis, clubbing, ↑ P & RR, polycythemia on CBC (may cause clotting prob), hx of irritability & feeding difficulties, child positioning, I&O, ECG, Cardiac Cath, Echocardiogram
General Interventions cyanotic heart defectsOxygen, ↓ demands, feeding (OT/PT interventions to help get them eating), hydration, preventive antibiotics, skin care, palliative vs corrective procedures
Tetraology of Fallot: Overview[PROV]: Pulmonary artery stenosis, Right ventricle hypertrophy, Overriding aorta/dextroposition of aorta (ck feet pulses vs arms), Ventricular septal defect (VSD)
Tet of Fallot assessmenttet/blue spells; cyanosis; polycythemia; chronic hypoxia signs (dyspnea, clubbing of digits, FTT, exercise intolerance)
Tet of Fallot interventionsCardiac cath, Surgical repair, Care for cyanotic heart defect, ↓ oxygen demands, Support during Tet spells (child to assume position of comfort)
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Acyanotic defects

Question Answer
ExamplesVSD, ASD, PDA
Left to right shunt assessment findingsResp distress, congested cough, diaphoresis (BOLO for provider), fatigue (signs of CHF), Hepatomegaly Frequent resp infections, poor growth & dev, fatigue, heart murmur
General interventionsdigoxin (**For kids hold if HR <100); diuretics, fluid restrictions, strict I/O's; reduce O2 demands; high calories; prevent cold stress; prevent infection
PDA txProstaglandins may be used to keep PDA open (if helping by ↑ O2 sat), Prostaglandin inhibitors may be used to close PDA
VSD overview (Ventricular Septal Defect)Most common congenital cardiac anomaly - Left-to-right shunting of blood (acyanotic deficit)
VSD assessmentAssess for signs for CHF w/ right ventricular hypertrophy, tachycardia, diaphoresis, tachypnea, fatigue
VSD assessment findingsFTT, Exercise/activity intolerance, Recurrent respiratory infections - Closure of VSD can interfere with conduction, usu closes on its own by age 3 (sx closure may lead to prob later in life)
VSD interventionsPrepare for cardiac cath, Administer Digoxin (must be >100 to administer), Monitor fluid status!!!!! Administer diuretics as ordered, Give ↑ caloric foods (22-24 calorie formula/fortified MBM) Prepare for surgical correction
Coarctation of aortadecreased blood flow to the trunk and lower extremities, ↑ blood flow to the head and arms - predisposed to CVA
coarctation of aorta assessmentfull bounding pulses in arms and weak or absent pulses in the legs same rate, ↑ BP in arms & ↓ BP in legs, Palpate for warm upper body/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/destroy heart valves
rheumatic fever assessmentClinical Manifestations occur in the heart, joints, skin, & CNS
Aschoff bodiesinflammatory hemorrhagic bullous lesions, cause swelling/changes in connective tissue
complicationsCarditis, Polyarthritis, ↑ESR, Chorea (sudden involuntary movement of the extremities), Erythema marginatum (temporary, disk-shaped red macules that are non-pruritic/faded in the center), Altered ECG w/ prolonged PR interval
interventionsPrevention is KEY by treating step throat infections! Promote bed rest until ESR normalizes (5 wks), Administer anti-inflammatory (control inflammatory process, esp in joints, & to ↓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 & heart muscle; majority of cases occur in kids <5 years old
complicationsMI by thrombosis or stenosis (BOLO: vomiting, pallor); fluid overload & CHF
assessment findings - acute phaseFever unresponsive to antipyretics, Swelling of conjunctive no drainage, Inflammation of mouth/lips/tongue (strawberry tongue), Swollen/red hands & feet, Cervical lymphadenopathy
assessment findings - subacute phaseResolution of fever, Hands/feet peel, Irritable
assessment findings - convalescent phaseClinical signs resolve, ESR & C-Reactive protein return to normal; If ESR & CPR remain elevated risk for Thrombocytosis is still present & arthritis is still present
Kawasaki InterventionsIV IVIG (1:1 nurse care), Salicylate therapy, Fluids, Cardiac Monitoring, Symptom relief (mouth care, cool cloths, or baths)
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Other bullshit

Question Answer
Peridcarditisinfection more common in younger children: viral coxsackie B common; can occur post cardiac surgery 10%
EndocarditisProphylaxis recommended for high or moderate risk: antiseptic 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, ⅓ residual dysfunction, ⅓ require transplant
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