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Peds - Cardiac

Test 2

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