Peds Cardiac problems

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Peds Cardiac problems
2012-11-17 23:08:10

Pediatric Cardiac Dysfunction
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  1. What is the 100% Oxygen challange?
    • – Helpful in differentiating between cardiac and noncardiac causes of cyanosis
    • – After providing 10 minutes of 100% O2:
    • • A noncardiac disease would have at least a 10% change in oxygen saturation (pox) and a significant change in measured PO2
    • --Or to put it another way, a pulomary problem is going to change O2 sats right away. 
    • • A cardiac disease would have a minimal change in oxygen saturation (pox) and measured PO2. Lungs are oxygenating blood, so little change in O2 sats, but heart is not perfusing adequately. 
  2. How can you tell if a cardiac problem is cyanotic?
    • –  May not be detected in the newborn nursery dt the patency of the ductus arteriosus (PDA) 
    • –  Requires immediate attention and evaluation
  3. How can you tell if a cardiac problem is acyanotic?
    • –  Typically presents with s/s of congestive heart failure
    • –  More gradual clinical decompensation
    • –  May not present until after the first 2-3 weeks of age
    • • Classic symptoms: tachypnea, tachycardia, hepatomegaly
    • • History may include: poor or slow feeding, sweating, color change with feeding, and poor weight gain (FTT)
  4. What is right-sided CHF?
    • • RV is unable to effectively pump blood
    • effectively into the pulmonary artery

    • – Results in increased pressure in RA and systemic
    • venous circulation

    – Hepatosplenomegaly, edema, weight gain occur 
  5. What is left-sided CHF?
    • • The left ventricle is unable to effectively pump
    • blood into the systemic circulation

    • – Results in increased pressure in the LA and
    • pulmonary veins.

    • • Lungs become congested with blood, causing elevated
    • pulmonary pressures and pulmonary edema
  6. What are the three groups of cardiac dysfunction?
    • Impaired myocardial function
    • Pulmonary congestion
    • Systemic venous congestion 
  7. What are some SnSs of Impaired myocardial function?
    • Tachycardia
    • weakness/fatigue
    • sweating
    • v BP
    • Gallop heart rhythm
    • cardiomegaly
    • anorexia
    • v periferal pulses

    Theme = weak heart
  8. What are some SnSs of Pulmonary Congestion?
    • Tachypnea
    • dyspnea
    • retractions in infants
    • flaring nares
    • Orthopnea
    • cough
    • cyanosis 
    • wheezing
    • grunting

    Theme =  respiratory distress
  9. What are some SnSs of Systemic Venous Congestion?
    • Weight gain
    • Hepatomegaly
    • Periferal edema, esp. periorbital
    • Ascities
    • Neck vein distention, esp in children

    Theme = puffiness
  10. What are the primary nursing priorities with any heart defect?
    • Decrease oxygen and cardiac
    • demands! 
    • Balance oxygen supply and oxygen
    • demand! 
  11. What are some things to look for after heart Sx.
    • • Congestive heart failure
    • • Dysrhythmias: Irregular rhythms
    • • Tamponade: Blood or fluid in the pericardial space containing the heart
  12. What are some SnSs of tampenade?
    • Compression of the heart due to fluid in the pericardium.
    • • Chest tube with sudden stop in drainage
    • • v BP
    • • v Oxygen level
    • • vHeart sounds
    • • Cool periphery
  13. What are some pulmonary complications to look for after heart Sx?
    • • Atelectasis
    • • Pumonary Edema
    • • Pleural Effusions
    • • Pneumothorax 
  14. What are some neurological issues to look for after heart Sx?
    • Seizures

    • • CVA (stroke), cerebral edema, neurological
    • defects 
  15. What is something to look for in a child with tetralogy of fallot?
    • • Hypercyanotic Spells (aka “TET spells” “blue spells”)
    • Acute cyanosis and hyperpneic (rapid and/or deep breathing)
    • Due to v pulmonary blood flow and increased R→L shunting

    • Treatment: **knee-chest position, calm child, 100% O2,
    • Morphine
  16. What do you need to be concerned with in situations where blood shunts from rt-->lt?
    • – Air from the venous side is allowed to flow into
    • the arterial system and go directly to the brain,
    • resulting in air embolism

    • – Utilize extreme care, filters, pumps with
    • sensors, etc. 
  17. What are you worried about in pts on Digoxin?
    • • Monitor serum K+ (Potassium)
    • – A fall in the serum K+ enhances the effects of Digoxin, increasing risk for Digoxin toxicity 
    • SnSs of Dig toxicity:
    • GI
    • --Nausea/Vomitng
    • --Anorexia
    • Cardiac
    • --Bradycardia
    • --Dysrhythmias 
  18. What is the most likely pathogen involved in aquired endocarditis?
    • Streptococcus viridans 
    • Invades inner lining and valves. 
  19. SnSs of bacterial endocarditis?
    • – Unexplained fever
    • – Anorexia
    • – Malaise
    • – Weight loss
    • – Splinter hemorrhages
    • – Petechia 
  20. What is treatment and prevention of bact. endocard?
    • • Treatment: Immediate use of high dose antibiotics, long-term (2-8 weeks)
    • • Prevention: Prophylactic antibiotic administration before procedures that risk entry of organisms to child 
  21. What is Rheumatic Fever?
    • Occurs after infection with Group A B-Hemolytic Strep

    • Self limited, affecting the joints, skin, brain, serous surfaces and the heart

    • Diagnosis based on JONES CRITERIA (a group of major and minor manifestations)

    • S/S: carditis, polyarthritis, chorea, sub-Q nodules, arthralgia, fever 
  22. What is Kawasaki's Disease?
    • Acute systemic vasculitis of unknown cause
    • 80% of cases in children under 5 years of age
    • 3 phases
    • Cardiac involvement is most serious complication and risks include the potential for MI (due to inflammation)
    • S/S: strawberry tongue, pink eyes (conjunctivitis but without discharge), trunk rash, dry/cracked lips, redness, swelling, flaking of palms and soles of feet

    Treatment: Aspirin, IV Ig 
  23. Look up anaphylactic
    and hypovolemic shock