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)

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

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

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)

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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