PRNU 232 peds exam 3

surgical interventions

open heart; closed heart procedures; stage procedures; prepare child/fam for them

systole vs. diastole

s: contraction D: relaxation

scabies

§Pruritic burrows caused by Sarcoptes scabiei mite §Not related to poor hygiene! §Rarely affects face and scalp. Common in groin, buttocks, webs of the fingers, and in the folds of the wrists. §Itch is worse at night §Treatment: topical or oral pediculocide - permethrin, ivermectin §Whole household needs to be treated §

acne

§Treatment of simple acne is stepwise §Wash face BID with mild cleanser §Topical keratolytic: trentinoin-retinoid §Topical antibacterial: benzoyl peroxide, clindamycin §sometimes PO doxycycline or minocycline §OCPs with low androgen effect or spironolactone may be helpful for natal females §If cystic or complicated: intra-lesional steroid or oral retinoid therapy (Accutane) can be started but this is under dermatologist supervision and often requires lab studies to monitor § spironolactone to reduce androgen production

acanthosis nigricans

§Velvety hyperpigmentation of skin, often in folds of skin under arms around neckline, associated with obesity and prediabetes/ insulin resistance. Presence of AN indicates need to screen for diabetes §

peds skin conditions

§A selection of rashes and patches that are particularly relevant in pediatrics §Some conditions presented here may be supplemental to text book; fair game for exam/NCLEX

infectious rashes/exanthems

§An exanthem is a widespread rash, accompanied by systemic symptoms such as fever, headache, malaise §Viral or bacterial etiology: reaction to toxin produced by organism, damage to skin by the organism, immune response to organism §Drug etiology: some exanthems arise due to drugs such as antibiotics, anticonvulsants, NSAIDs §Concern vs. no concern: history, symptoms, severity

measles complications

§Approximately 30% of reported measles cases have one or more complications. The most common complications that occur are: §Diarrhea §Otitis media §Pneumonia (either primary viral or secondary bacterial). This is the most common cause of death. §Other complications: bronchitis, croup, conjunctivitis and/or corneal ulceration leading to blindness (especially if vitamin A deficient), mouth ulceration, acute glomerulonephritis (inflammation of kidneys), acute renal failure and malnutrition (especially lower SES) §Measles infection during pregnancy increases the risk of premature labor and fetal loss. There is also a risk of maternal death. §Immune amnesia: destruction of B-lymphocytes and serious impacts on vaccine-mediated herd immunity §Central nervous system effects which may occur days or years after infection, including primary measles encephalitis, acute post-infectious measles encephalomyelitis

congenital dermal melanocytosis

§CDM - formerly known as Mongolian spots §Slate grey or bluish nevi noted at birth on the backs and/or buttocks. Primarily in people with darker skin or of Asian or African descent §Important to document well and follow at routine visits §Usually fade over time, disappear by puberty

varicella

§Caused by Varicella Zoster Virus §Fever, chills, flu-like symptoms may precede chicken pox rash by 2-3 days §Lesions in various states for 5-10 days §Long period of contagiousness: ~5 days prior to onset of rash and ~6 days after last vesicles heal § §Following chicken pox infection, the varicella virus remains in select cells of the dorsal root ganglion in the spinal cord. It may be stimulated to reappear later in life as herpes zoster aka shingles. §Shingles follows the dermatome. shingles-> painful rash on trunk/ pain can persist after rash is gone

describing skin lesions

§Color §Red, wine, blue, yellow, orange, grey, black §Size §"pin prick" or measure in millimeters or centimeters §Distribution §Single or multiple, pattern or scattered, symmetric/asymmetric, sun exposed/non-sun exposed, full diaper area vs. sparing creases etc. §Morphology §Arrangement §Clustered, diffuse, linear, lacy, circular/nummular, bullseye, discrete, snakelike/reticulated, confluent (run together), grouped §Location §Palms, scalp, perineum, axilla, feet, toes, mucosa, trunk, extremities, ears etc. §Blanching or non-blanching §Petechiae and Purpura are caused by bleeding of the superficial vessels of the skin §Petechiae are pinpoint to < 1cm §Purpura are larger (in severe cases presenting as ecchymosis) §They are non-blanching. This helps distinguish them from inflammatory concerns

skin peds considerations

§Dermis and epidermis loosely attached - prone to blistering and separation §Epidermis thinner with less subcu tissue - more susceptible to heat and water loss, superficial bacterial infections §Impaired barrier function of still-developing infant skin §Young children w skin conditions are more likely to have associated systemic manifestations §Skin of infants and young children is more likely to react to primary irritant §Avoid topical iodine or chlorhexadine in <2mo due to high permeability

lyme disease

§Diagnosed primarily on history; serologic testing is not reliable but is used. §ELISA and Western Blot §Prevention is key - light colored clothing, showering after play outside/woods/long grass, DEET or permethrin in high risk areas such as New England §Prophylaxis if taking off an engorged tick - single dose doxycycline §Treatment for ALL AGES is doxycycline per CDC §Most common tick borne disorder §Localized redness followed in 3-30 days by erythema migrans §Fever, headache, malaise, stiff neck, sore throat, cranial nerve palsy §Arthritis, cardiac, neurologic in severe cases §

six diseases of childhood

§First Disease: measles §Second Disease: scarlet fever/scarlatina - GAS §Third Disease: rubella §Fourth Disease: Staphylococcal Scalded Skin Syndrome §Fifth Disease: erythema infectiosum §Sixth Disease: roseola §**but, exanthems can accompany a simple URI as well

shades of skin

§Hypopigmentation or hyperpigmentation possible following healing of dermatologic conditions §Hypertrophic scars and keloids more common in people with darker skin tones § §Important to note that some "classic" rashes look different on darker skin tones than the widely-accepted description §Using resources such as www.brownskinmatters.com or Visual Diagnosis (VisualDx) important for better quality care §

dermatitis

§Inflammation of dermis §May be acute or chronic §Contact dermatitis §Atopic dermatitis (eczema) in response to allergen §Seborrheic dermatitis

seborrheic dermatitis - cradle cap

§Oily crusts, usually limited to scalp but can progress to face and behind ears §Treatment: benign neglect (time), hygiene, emollients, anti-seborrheic shampoos, tea tree oil, hydrocortisone cream or anti-fungals §

head lice

§Pediculus humanus capitis louse can live in the hair, eyelashes, eyebrows of humans §Life cycle 1 month with female laying 7-10 eggs daily. Much less common among Black children. §Schools have eliminated no nit policy. Per CDC child diagnosed with live lice at school may stay until the end of the day, return when appropriate treatment has begun. §Treatment: combing, combing, combing §Cetaphil, pediculocides (permethrin = Nix). Nits are becoming resistant to treatment products... §

tricuspid atresia

- cyanotic defect - decreased pulmonary blood flow Failure of tricuspid valve to develop No communication btw the right atrium and right ventricle ASD and VSD cause complete mixing of oxygenated and deoxygenated blood leading to systemic desaturation and cyanosis PDA is needed to help with get more blood from pulmonary artery into lungs, therefore treatment with prostaglandin to maintain patency of ductus arteriosus until surgery performed Palliative shunt placed until stage surgeries begin between 4-9 months

transposition of great arteries

- mixed blood flow Cyanotic No communication between the systemic and pulmonary circulation ASD, or PDA be present for blood to mix Often VSD, Patent foramen ovale is present as well Depending on severity, severe cyanosis can be seen Treatment: prostaglandins to keep PDA open until surgery, cardiac cath to inflate ASD further to increase mixing of blood Surgical repair: Atrial Switch, happens in first few weeks of life

hypoplastic left heart

- mixed blood flow Cyanotic Underdevelopment of left ventricle and aortic atresia Blood flows across patent foramen ovale to right atrium then to right ventricle and out pulmonary artery to lungs through patent ductus arteriosus to systemic circulation via aorta Mild cyanosis then when ductus arteriosus closes progressive deterioration and severe cyanosis occurs Treatment with prostaglandin to maintain patent ductus until multiple stage surgery is used. Heart transplant is another option for these infants

lyme #3: A school nurse is talking to a group of middle schoolers about ways to prevent Lyme disease. What teaching information should the nurse include? Select all that apply. 1. Wear long pants and tuck into boots when spending long periods of time in wooded areas 2. Get the Lyme disease vaccine as part of your routinely scheduled vaccines 3. Apply bug spray when spending time in wooded areas 4. Avoid tick infested areas especially in May, June, and July 5. Perform tick checks after being outside for long periods of time 6. If a tick is found on someone leave it until a provider is seen

1,3,4,5; There is no Lyme disease vaccine and when a tick is found it should be removed immediately

lyme #1: A patient is diagnosed with late persistent Lyme disease. The nurse assesses for which characteristics of this stage? 1.Severe headache, arthritis, arthralgia 2. Nausea, arrhythmias, dry cough 3. Rash, flu like symptoms 4. Proteinuria, diuresis, elevated serum creatinine

1; Rationale: In the late stages of Lyme disease, the infection progresses causing these serious effects and more. It is crucial to receive antibiotic treatment as soon as possible and to treat pain with OTC medications.

lyme q2: A 10 year old is diagnosed with Lyme disease, and says his friend had heart issues because of Lyme disease. He asks if this will affect his heart. What should the nurse respond with? NCLEX Question 2 ø. 1. "It is possible. We can't be certain." 2. "It can, but you will be monitored closely for cardiac complications." 3. "No. The heart is not affected by Lyme disease." 4. "It is unlikely to happen in people your age."

2; In the second stage of Lyme disease, bacteria can enter the heart tissue causing cardiac complications (Lyme carditis), chest pain, SOB, etc

A nurse is caring for a 2 year old child who has a health defect and is scheduled for a cardiac catheterization. Which of the following actions should the nurse take? A. Place on NPO status for 12 hours prior to the procedure B. Check for iodine or shellfish allergies prior to the procedure C. Elevate the affected extremity following the procedure D. Limit fluid intake following the procedure.

A.NPO 4 -6 hours prior ***B.Correct Iodine dyes can be used C.extremity should be straight D. fluids should be encouraged

atrial septal defect

Acyanotic Blood flow from left to right shunt Increased oxygenated blood to the right side of heart Patients may be asymptomatic depending on size of defect, patients may also have signs of heart failure particulalry later in life Characteristic murmur heard Surgery: surgical patch closure or nonsurgical with a device in cardiac cath lab

patent ductus arteriosus

Acyanotic Fetal ductus arteriosus (connecting aorta and pulmonary vein) remains open This patency allows blood to flow from higher pressure in the aorta to lower pressure in the pulmonary artery (left to right shunting) Blood recirculates to the lungs and then the left side of the heart, increase left heart workload, as well as increased pulmonary congestion To treat you can administer indomethacin (prostaglandin inhibitor) which in turn will cause PDA to close in some newborns and premies, if this does not work surgery is done or coils placed in cath lab

coarctation of aorta

Acyanotic Narrowing of aorta near the insertion of the ductus arteriosus Increased pressure to head and upper extremities Decreased pressure to body and lower extremities High blood pressure and bounding pulses in arms, weak pulses in lower extremities Surgery for those needing repair early infancy, older infants and adults stents may be placed

aortic stenosis

Acyanotic Narrowing of aortic valve, leading to decreased output from left ventricle, left ventricle hypertrophy, and pulmonary congestion Depending on amount of restriction of blood flow, decreased output can cause faint pulses, tachycardia, hypotension, poor feeding Treatment usually done with balloon dilation in cath lab http://www.wkhs.com/heart/services/Transcatheter-Aortic-Valve-Replacement.aspx

ventricular septal defect

Acyanotic Opening between right and left ventricle, varying in size Oxygen rich blood shunts from left ventricle to right ventricle and then to lungs Right ventricular hypertrophy due to increased work to push increased volume out of right ventricle Heart failure is common, murmur is heard Surgical repair is needed although in we are seeing some cases done in cardiac cath lab

pulmonic stenosis

Acyanotic in most cases but in severe cases may see some cyanosis Narrowing of pulmonary artery Decreased pulmonary blood flow & right ventricular hypertrophy Varies in severity, can cause complete block of flow from right ventricle Increase right atrial pressure may cause foramen ovale to reopen and shunt blood in left atrium (pressure higher with stenosis on right side) Surgical repair or nonsurgical balloon insertion if able in cath lab Http://www.cvcavets.com/canine-dog-pulmonic-stenosis.asp

KD #2: Isaiah is a 2 year old male admitted with a high fever, swollen lymph nodes, bilateral conjunctivitis, and redness of his lips, tongue, and feet. What testing can the nurse expect to confirm suspected Kawasaki Disease? A. urine culture B. MRI C. arterial blood gas D. there is no specific test

Answer: D, nurse will draw labs and urine sample for other disease rule out, but there is no specific testing for Kawasaki Disease

KD #3: A 4 year old girl with Kawasaki Disease is complaining of a rash in the groin area and peeling of skin on her fingers and toes. What parent teaching should the nurse give to promote skin repair? A. keep the area moist B. encourage a high protein diet C. pick off loose skin D. avoid foods high in protein

Answer: B, protein will promote skin repair

DS#2: A couple has just learned that their son will be born with Down Syndrome. The nurse shows a lack of understanding when making which statement? a. "We have counseling services available, and I recommend them to everyone facing these circumstances." b. "I will alert your entire family about this so you don't have to." c. "I will support you in any decision that you make." d. "I will give you as much information as I can about this condition.

B

lyme disease student prez

Caused by Spirochete Borrelia Burgdorferi bacteria ● Transmission = tick bite ● Most common vector borne diseases in US ● Erythema migrans (bulls eye) rash is the first sign of Lyme disease ● Antibiotics are the first line treatment for lyme disease, and then symptom relief medication becomes the next line of treatment. ● Prevention of the disease and catching it early is an important part in preventing late stage lyme disease.

tetralogy of Fallot

Cyanotic Ventricular Septal Defect Pulmonic Stenosis Overriding aorta Right Ventricular hypertrophy Characteristic murmur Anoxic spells (Tet spells) Surgical repair necessary

DS #1 When planning care for an 8-year-old boy with Down Syndrome, the nurse should: a. Plan interventions according to the developmental levels of a 5-year-old because the child will have developmental delays. b. Plan interventions according to the developmental level of a 8-year-old child because that's the child's age. c. Direct all teaching to the parents because the child can't understand. d. Assess the child's current developmental level and plan care accordingly.

D

down syndrome

Down Syndrome is a genetic disorder caused by an extra copy of chromosome 21 during fetal development. - Early identification efforts involve prenatal testing and diagnostic testing at birth. - Down Syndrome clinically presents both physically and cognitively... there is not just one defining characteristic. - It is a lifelong condition with no prevention or cure, and every patient outcome is different depending on the individual and the management of their secondary health conditions, if any

heart failure

Failure of heart to meet demands of systemic circulation •Volume overload: left to right shunt, hypertrophy of right ventricle •Pressure overload: obstructive disorders •Decreased contractility: decreased efficiency of myocardium •High cardiac output demands: sepsis, hyperthyroidism, anemia

fetal heart circulation

Fetal: Blood enters from umbilical vein To liver To inferior vena cava via ductus venosus A, Prenatal circulation. B, Postnatal circulation. Arrows indicate direction of blood flow. Although four pulmonary veins enter the LA, for simplicity this diagram shows only two. RA, Right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle.

care of fam/child with CHD

Help family adjust to the disorder Educate family Prepare child and family for surgery https://www.thegreathospitaladventure.org/

pharm used with CVD

IV IgG Digoxin (Lanoxin) ACE inhibitors ASA, NSAIDs Lasix Spironolactone (Aldactone) Digoxin to improve cardiac function (improve contractility) Angiotensin enzyme inhibitors—reduce the afterload on the heart Digoxin = works well in pediatrics Rapid onset, short half-life Digoxin toxicity symptoms—vomiting, neuro signs, visual disturbances Lasix to remove excessive fluids—give potassium supplements—foods bananas, green leafy vegs.

monitor fluid status

Intake ØAll IV fluids ØAll flushes, other intake Output ØFrom all sources •Chest tube, urine, NG, surgical drains; also include blood drawn for lab work ØUrine output <1 ml/kg/hr = possible renal failure •Concern r/t decreased cardiac output

MIS-C vs Kawasaki

MIS-C: - mean age 10-11 - individs w/ African heritage appear at highest risk - severe ab pain -myocarditis/myo dysfunction - acute kidney injury - NT-pro-BNP and troponin INCREASE - ferritin, triglycerides and CRP INCREASE - low platelet count (normalizes with recovery) - lymphopenia -association w/ SARS-CoV2 infection (2-4 wk prior) KD: - mean age 2yr -asians at highest risk - less severe GI complaints - coronary artery abnormalities (25-60% in KD shock syndrome) - renal involvement very rare - myocardial dysfunct less severe (but generally normal to mildly increased levels) - less severe elevation in ferritin/triglycerides/CRP - marked thrombocytosis by day 10-14 - no lymphopenia - specific etiology still unknown

chest tubes after cardiac surgery

Monitor chest tube drainage q hour for COLOR ØImmediate postop may be bright red, but changing to serous Monitor chest tube drainage for quantity ØNotify surgeon if chest tube drainage >3 ml/kg/hr ×3 consecutive hours OR 5-10 ml/kg in any 1 hour (possible hemorrhage)

colombia suicide scale

Not mental health training required Linking systems Inpt -> bridge ->outpt (enables quicker response to those who need it due to precision of communication) Asking questions about suicide actually reduces burden *******1-5 rating of suicidal ideation with increasing serverity 1.Have you wished you were dead? 2.Have you actually had any thoughts of killing yourself? If no to both move on to behavior assess If yes then move to active thoughts question 3. Have you been thinking about how you might do this? 4/ have you had these thoughts and had some intention of acting on them? 5. Have you started to work out a plan? Do you intend to carry it out? **AUDitory hallucinations qualify as ideation*** Question 6 is suicide behavior ****Multiple sources of information subject/family/community members

post op care for child

Open heart Surgery = ICU 2-4 days ØMonitor vital signs and arterial/venous pressures ØIntraarterial monitoring of BP ØIntracardiac monitoring ØRespiratory needs ØRest, comfort, and pain management ØFluid management 5 - 7 more days in hospital ØProgression of activity 4 - 6 weeks to recover at home

suicide attempt

Self injurious act committed with at least some intent to die, as a result of the act Just the potential for harm is needed Intent and behavior must be linked**** Can infer intent to die Clinically at least Different types of attempts - Interrupted When someone or something stops the person - Aborted When the person stops themselves - Preparatory acts or behaviors Any other behavior (more than just saying it) with suicidal intent

DS #3: Which of the following assessment findings would lead the nurse to suspect Down Syndrome in an infant? Select all that apply. a. Decreased muscle tone b. Flattened nose c. Increased muscle tone d. Upward slanting of the eyes

a,b,d

KD question #1: The nurse is examining a 3 year old male patient admitted for acute-stage Kawasaki Disease. What signs and symptoms will you expect to see? Select all that apply. A.redness of lips and mouth lining B. hypothermia C. strawberry-red tongue D. swollen hands and feet

a,c,d

A nurse is providing teaching to a mother of an infant who has a prescription for digoxin. Which of the following instruction should the nurse include? A. Do not offer your baby fluids after giving the medication B. Digoxin increases your baby's heart rate C. Give the correct does of medication at regularly scheduled times. D. If your baby vomits a dose, you should repeat the dose to ensure that he gets the corrct amount.

a.Dig can be given without regard to fluid intake b.Dig slows the heart rate ****c.Correct - need consistent level in the blood d.It is impossible to know how much medication was lost

acyanotic vs, cyanotic

a: - inc. pulmonary blood flow= (atrial/ventricular septal defect, patent ductus arteriosus, atrioventricular canal) - obstruction to blood flow from ventricles (coarctation of aorta; aortic/pulmonic stenosis) cyanotic: - dec. pulmonary blood flow (TOF/tricuspid atresia) - mixed blood flow (transposition of great artery; total anomalous pulmonary ven; truncus arteriosus; hypoplastic left HR syndrome)

stroke volume: - preload - afterload -contractility

amount of blood ejected by one contraction -preload: volume of blood returning to HR - afterload: resistance against which ventricles must pump when ejecting blood - contractility: efficiency of the myocardium

tests of cardiac function

chest x-ray ECG echo cardiac catheterization

obstructive defects

coarctation of aorta aortic stenosis pulmonic stenosis

nonsuicidal self injurious behavior

engaging in behavior purely for reasons other than to end one's life Self mutilation -> feel better or relieve pain (internal state) Get sympathy/attention -> external state ***operationalized for next steps and management methods

tetralogy of fallot

exhibit bluish skin during episodes or crying/feeding (tet spell)

role of nurse in dermatitis

pt edu; (etiology/patho; skin hygiene; avoid scratching) remover irritant/soothe immune response Be aware of allergen(s) and do best to avoid Avoid hot water/showers, use mild soaps/shower products Avoid perfumes and products with added fragrance Apply moisturizers multiple times daily, ideally after bath or shower Ointments or creams, not lotions Recommended brands: Eucerin, Aquaphor, Vaseline Distraction to avoid scratching Keep fingernails short Cleanse and bandage breaks in skin to prevent infection Avoid wool or synthetic fabrics, cotton is less irritating Dust covers on pillows, sleep surfaces

cardiac output

volume of blood ejected by the heart in 1 min

measles

§WHO declared measles eradicated from the USA in 2000, however, incomplete immunization has led to resurgence §Symptoms: similar to common cold with cough, runny nose, sore throat, fever, conjunctivitis. §Enanathem - Koplik spots (white spots in mouth) a few days prior to development of generalized blotchy rash §

measles outbreak

§https://edition.cnn.com/2019/02/04/health/washington-measles-outbreak/index.html §Per CDC: from January 1 to December 31, 2019, 1,282* individual cases of measles were confirmed in 31 states. §This is the greatest number of cases reported in the U.S. since 1992. The majority of cases were among people who were not vaccinated against measles. Measles is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated.

embryonic cardiac structure

• •Umbilical vein: •brings oxygenated blood from placenta to fetus • •umbilical arteries: carries deoxygenated blood back to placenta for reoxygenation. • •Foramen ovale: shunts oxygenated blood from right to left atrium • • •Ductus arteriosus: shunts blood from lungs to prevent pulmonary overload • • •Ductus venosus: bypasses the liver •

clinical manifestations of RF

•Carditis •Polyarthritis Erythema marginatum •Transitory rash on trunk and proximal extremities •Nonpruritic Subcutaneous nodules •Occur in crops over bony prominences

cardiac heart defects

•Congenital •Anatomic abnormalities •Present at birth •Abnormal cardiac function •Acquired •Abnormalities that occur after birth •Either in the normal heart or in CHD

history/physical exam

•Detailed history: growth and development, family history of cardiac disease, in toddler or child "do they keep up with other children on the playground?" • •Vital signs •Heart rate •Blood Pressure •Difference between upper and lower extremities •Pulses •Murmurs •

Clinical Manifestations of HF

•Impaired myocardial function •Tachycardia >160 b/m; fatigue; weakness; restlessness; pale, cool extremities; decreased BP; decreased urine output Pulmonary congestion •Tachypnea >60 b/m, dyspnea, respiratory distress, exercise intolerance, cyanosis Systemic venous congestion •Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention • hypoxemia (lower than normal arterial oxygen tension) hypoxia (reduction in tissue oxygenation) cyanosis polycythemia (inc, HgB) clubbing hypercyanotic spells (TET spells)

management of TOF/HF/CHD

•Improve cardiac function: meds digoxin improves cardiac contractibility & ace inhibitors reducing afterload (resistance) •Decrease preload (volume of blood returning to the heart): diuretics •Decrease cardiac demands: maintain thermal environment, treat infection •Improve tissue oxygenation: administer O2 •What would the nursing considerations be for the above management?

congenital heart defects

•Incidence: 5 to 8 per 1000 live births •Major cause of death in first year of life (after prematurity) • •Most common anomaly is VSD • •28% of children with CHD have another recognized anomaly (trisomy 21, 13, 18, + + +) Congenital ØAnatomic abnormalities ØPresent at birth ØAbnormal cardiac function Acquired ØAbnormalities that occur after birth ØEither in the normal heart or in CHD

CAUSES OF CHD (congenital heart disease)

•Maternal or environmental = 1% to 2% •Maternal drug use •Fetal alcohol syndrome—50% have CHD Matearnal illness •Rubella in first 7 weeks of pregnancy → 50% risk of defects including PDA and pulmonary branch stenosis •CMV, toxoplasmosis, other viral illnesses → cardiac defects •Infants of Diabetic mothers = 10% risk of CHD (VSD, cardiomyopathy, TGA most common) Chromosomal or genetic = 10-12 % Multifactorial = 85% •

murmurs

•Murmurs = heart sounds that reflect flow of blood within the heart •May occur in systole or diastole, or both •*****Can occur in a normal heart in periods of stress— anemia, fever, or rapid growth •Can reflect abnormalities in heart or vessels •"Innocent murmurs" = normal cardiac anatomy and cardiac function •Occur in up to 50% of all children at some time •

pediatric indicators of cardiac dysfunction

•Poor feeding •Tachypnea/tachycardia •Failure to thrive/poor weight gain/activity intolerance •Developmental delays •Prenatal history •Family history of cardiac disease

CCHD screening (critical congenital heart disease)

•Prenatal ultrasound only detects half of babies born with CCHD. 25% of CHD are considered CCHD's, 18 per 10,000 babies born with CCHD •Fail if difference 3 % between right hand and foot or if <90%

Nursing care of pt in cath lab

•Preprocedural care •Preparation/explanation geared towards developmental level •Sedation •NPO Postprocedural care •Cardiac and pulse oximetry monitoring •Monitor pulses, temperature, color of extremity •Vital signs q15, Bp (watching for hypotension) •Dressing for bleeding/hematoma •I&O •Hypoglycemia

rheumatic fever and HD

•RF •Inflammatory disease occurs after group A β-hemolytic streptococcal pharyngitis •Infrequently seen in United States; big problem in Third World •Self-limiting •Affects joints, skin, brain, serous surfaces, and heart Rheumatic heart disease •Most common complication of RF •Damage to valves as result of RF

prevention of RHD

•Treatment of streptococcal tonsillitis/pharyngitis •Penicillin G—IM ×1 •Penicillin V—oral ×10 days •Sulfa—oral ×10 days •Erythromycin (if allergic to above)—oral ×10 days Treatment of recurrent RF •Same as above

after birth: first breath

•Umbilical vein is clamped which results in systemic resistance and increased pulmonary blood flow • •Foramen ovale closes because of increased pressure left atria, closure occurs over first week • •Ductus venosus: closes in first few hours after birth and becomes ligaments. • •Ductus arteriosus: closes in first few hours after birth • •Umbilical artery clamped: constriction and become ligaments

Kawasaki disease summary

●Kawasaki Disease is an acute systemic vasculitis, thought to be from a mutation in the ITPKC gene leading to inflammation and tissue damage. ●Clinical Manifestations include a "strawberry-red" tongue, fever, rash, swollen feet, skin peeling at fingers and toes. ●The condition occurs most in children 6 months - 5 years of age, and is more common in males. ●There is no specific testing, other testing can be used as rule out. ●Treatment with IVIG and high-dose aspirin therapy.