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Peds - Cardiac
Test 2
| Question | Answer |
|---|---|
| congenital heart defects associated with genetic abnormalities | when caring for a child with a syndrome, just know that there are certain possible heart defects that you should be concerned about |
| Congenital Heart Defects | a child born to a mother/father who have a congenital heart defect are at increased risk for having a congenital heart defect |
| what happens if the ductus doesn't close? | increased pulmonary pressure, decreased systemic pressure |
| PDA - premature Tx | Indocin/Indomethacin; Lateral thoracotomy |
| PDA - infant and older Tx | transcatheter coil closure |
| prostaglandin E inhibitor | Indocin and Indomethacin. |
| Prostaglandin E | keeps the ductus open. an inhibitor closes it. |
| lateral thoracotomy | surgical ligation of the ductus |
| transcatheter coil closure | catheter up vena cava, RA, tricuspid valve, to pulmonary artery, leave the coil in the ductus, blood clots around it, clots off ductus. |
| PDA | Patent Ductus Arteriosus. blood flows from aorta into pulmonary arteries. |
| VSD | Ventricular Septal Defect- blood flows from LV to RV |
| what happens with VSD? | pulmonary pressure increases, systemic pressure decreases. |
| ASD | Atrial Septal Defect - blood flows from LA to RA. |
| What is the management for ASD or VSD? | treat CHF. surgical - interventional cardiac catheterization or open heart surgery (vortex patch). atrial dysrhythmias (electrical pathway is interrupted). |
| what types of cardiac conditions do you see CHF? | ASD, VSD, PDA, AS, CoA, cardiomyopathy, rheumatic heart disease, Kawaskai's disease, Duchenne muscular dystrophy, and much more. |
| CHF - Management Goals | improve cardiac Fx. remove accumulated fluids and Na+. decreased cardiac demands. improve tissue oxygenation. |
| CHF Meds | Digoxin. Diuretics. O2. |
| Dig Tox S/Sx | anorexia. nausea. vomiting. pulse irregularities. |
| CHF - Nursing Management | avoid increasing cardiac demands. monitor weight. admin meds/O2. accurate/strict I&Os. protect from infection. |
| interventricular cardiac catheterization | insert device into septum, open "umbrella", pull back a bit, open other "umbrella", now the hole is closed. |
| ADS and VDS closer with device risk | Atrial Dysrhythmias. these devices go right what the electrical current goes. |
| obstructions to systemic blood flow | aortic stenosis coartication of the aorta. |
| aortic stenosis | valvue doesn't open all the way. not much blood can leave the heart, decreased systemic blood flow. |
| effects of AS | poor tissue perfusion, cyanosis. increased workload for LV --> LV hypertrophy, blood into the lungs. exercise intolerance. |
| coartication of the aorta (CoA) | narrowing outside of the heart. lower BP in lower extremities (<8mmHg diff = significant). |
| why is BP normal or near normal in upper extremities with CoA? | upper extremities get their normal blood flow usually, through the subclavian arteries. |
| CoA Tx | end-to-end anastomosis |
| decreased pulmonary blood flow causes | pulmonary stenosis (subvavular, valvular, peripheral). Tetralogy of Fallot. |
| Pulmonary stenosis | depends how much blood is getting to the lungs (can be incompatible with life). will likely be cyanotic. |
| Pulmonary Stenosis Tx | catheter through the vena cava, open balloon to open the valve, then pull out the balloon. |
| Tetralogy of Fallot (what is the Tet?) | 1. VSD. 2. pulmonary stenosis (below or at the level of the valve). 3. overriding aorta (sites over the ventricular aorta). 4. R ventricular hypertrophy. |
| "pink tet" | not a severe FoT. not too much pulmonary stenosis. no/little blood blood passing into the aorta. |
| when is FoT usually repaired? | at birth. |
| What is a "tet spell"? | activity, L valve narrows, less blood to lungs, child turns very dark blue. |
| What will a ToF child do when having a "tet spell"? | squat down. |
| Decreased pulmonary blood flow Tx | prostaglandin E. O2 management. surgery. |
| decreased pulmonary blood flow - prostaglandin E | to keep the ductus open until new ductus can be made (through surgery). |
| if a child is cyanotic for a long period of time, what could they develop? | polycythemia |
| polycythemia | Hgb and Hct increase. cyanotic, kidneys think the need more RBCs, make more RBCs, drive Hgb and HCt up. blood is thicker, espeically on hot days (dehydrated - more hemoconcentrated) |
| decreased pulmonary blood flow surgery | palliative (give us time before we can do something else - BP shunt). Corrective (fixes the problem). |
| Blalock-Taussig Shunt | a gortex shunt that connects the pulmonary system to the arterial system. |
| Mixed-Blood flow defects | Transposition of the great vessels. ToF (mixing of the blood happens). |
| transposition of the great vessels | pulmonary arteries aries from the LV, aorta from the RV (vice versa from normal). |
| Mixed Blood Flow Tx | prostaglandin E. possible balloon atrial septostomy. O2 management (will never be at 100% unless surgically corrected). surgery. cyanosis. |
| Acquired heart disease | rhuematic fever. Kawasaki's disease |
| Rheumatic Fever | 2º to GABHS. |
| GABHS | group A beta-hemolytic strep. untreated, can cause acute glomerular nephritis or rheumatic fever. |
| Rheumatic Fever - Major Sx | carditis. migratory polyarthritic. erythema marginatum. chorea. subcutaneous nodules. |
| Rheumatic Fever - Dx | requires 2 major sx, or 1 major sx and 1 minor sx. |
| Rheumatic Fever - Minor Sx | fever, arthalgis, hx of RF, increased ESR or C-reative protein, prolonged PR interval. |
| Rheumatic Fever Management | antibodies. anti-inflammatory medications. supportive therapy. |
| Rheumatic Fever Complications | if untreated can lead to rheumatic heart disease. |
| Kawasaki's Disease - Sx | fever > 5 days and 4 of the following: bilateral conjuctivitis; mucosal changes; changes in extremities; truncal rash; cervical lymphadenopathy. |
| Kawasaki's - management | IV gamma globulin. salicylata (ASA). support. |
| Kawasaki's - complication | usually do well w/ tx. coronary artery abnormalities/aneurysms. pericardial effusion. myocardial inflammation. death. |
| kawasaki's phases | acute - 8-12 days. subacute - 10-14 days. convalescence - 6-10 months. |
| Cardiovascular Risk Factors | Hyperlipidemia. Hypertension |
| Hyperlipidemia - risk factors | family. diet. |
| Hyperlipidemia screening | age 2+ w the following risk factors: known familial hyperlipidemia. CV before age 55. BP >90% for age, sex, and height. diabetes. BMI > 85%. |
| hypertension | screen children yearly. signif HTN 95th and 99th %ile. severe > 99%ile. on at least 3 separate occasions. if 2º, treat underlying cause. otherwise, change diet and lifestyle. |
Created by:
malysab14
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