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130 Cards in this Set

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In assessing a child with a possible cardiac alteration, look at the ____ history and ______ history such as a history of ______ heart disease, unexplained ____ deaths, or sudden ___ later in _____ or early ______
In assessing a child with a possible cardiac alteration, look at the FAMILY history and HEALTH history such as a history of CONGENITAL heart disease, unexplained INFANT deaths, or sudden DEATH later in CHILDHOOD or early ADULTHOOD
In assessing maternal hx involving cardiac issues look for _______ heart disease, p_________, i_____ during pregnancy such as r______ & c_______, a history of drinking _______, and Diabetes type __ or g______ Diabetes.
In assessing maternal hx involving cardiac issues look for CONGENITAL heart disease, phenylketonuria, infection during pregnancy such as rubella & cytomegalovirus, a history of drinking alcohol, and Diabetes type I or gestational Diabetes.
In assessing birth hx involving cardiac issues, look at the infant's ______ at birth, non-cardiac ______, how many _____ in the umbilical cord, the rate of the fetal _____, and syndromes such ______, _____, _____.
In assessing birth hx involving cardiac issues, look at the infant's weight at birth, non-cardiac anomalies, how many vessels in the umbilical cord, the rate of the fetal heart, and syndromes such Downs, Marfan, and Noonan
In assessing a baby, some things that might clue you in that there is an underlying heart problem include ______ difficulties, poor ____ ___, f_____, ____ changes when crying, and d______, Look at color changes in ___ ___ membranes, ____ beds, c______, and hands, feet, and face.
In assessing a baby, some things that might clue you in that there is an underlying heart problem include feeding difficulties, poor weight gain, fatigue, color changes when crying, and diaphoresis Look at color changes in oral mucous membranes, nail beds, conjunctiva, and hands, feet, and fac
True or False: A somewhat fussy baby is good, an easy baby that rarely cries may have a cardiac issue.
true
_______ at 2 weeks of age is a red flag.
acrocyanosis.
Crackles may indicate ____. There's fluid in the lungs.
CHF
Apical pulse over 7 y old is at ___ intercostal space, under 7 at ____.
5, 4
Murmors are caused by _____ blood flow which could be caused by a bad ____ or a hole between the _____. (inate)
turbulent
valve
ventricles
In assessing murmurs, note the location using _____ points, the timing within the _____ cycle, along with the p_____. Also note the _____, is it short, medium, or long?
In assessing murmurs, note the location using reference points (APETM), the timing within the cardiac cycle, along with the pitch. Also note the duration is it short, medium, or long?
Innocent or _______ murmors do not reflect heart abnormalities but are the sounds made as blood flows. They can be loud or soft and are ______ in quality. They do not affect growth or wellbeing and are common/uncommon in children.
functional
vibratory
common
We hear murmors in kids often because there's nice big open ______ and theres less _____ fat so you can hear the blood flowing through.
vessels
subcutaneous
If a heart issue is expected, how is blood pressure done?
in all 4 extreities
The _____ ____ ____ is the connection between the aorta and the pulmonary artery. Oxygen ____ blood that should go to the body recirculates into the ____.
patent ductus arteriosus
rich
lungs.
an abnormal opening is a ____.
shunt
The PDA starts to close with ___ to ____ hours after birth and almost completely close by day ___.
10-15
8
True or false: there is no known cause for a PDA but is commonly seen in _____ infants and with moms who had ____ during pregnancy
premature (heart not ready to close)
rubella
PDA is a concern because blood vessels in lungs must handle a higher _____ of blood and higher ____ develops in lungs. The lining of the pulmonary ___ becomes irritated and inflamed, increases the risk of ____.
volume
pressure
artery
infection
The more ___ the PDA, the more severe the _____.
open
symptoms
Symptoms of PDA: may be a________, continuous murmor with _____ thrill, ____ heart, ______ pulses, ______, poor ____ and weight gain, fatigue
asymptomatic
suprasternal
enlarged
bounding
tachypnea
poor feeding and weight gain
fatigue
The tx of PDA is determined by child's age, extent of problems, and severity of problems. The medical management includes ____ (an _____ that closes it), _____, and ______. A nonsurgical closure is when there is a ____ placed to promote ______, then ____ are given for 6 months to prevent endocarditis.
indomethacin (an NSAID), digoxin, and diuretics
(Diuretics decrease blood volume and let less blood go to lungs, less work for the heart)
coil
occlusion, antibiotics
A surgical repair of the PDA can be done later at about ___ years old. It is called a _______ which is a big deal. It closes the PDA with a suture. We wait until the child is older and has more weight because the of general anesthesia.
1
thoracotomy
In a ____ ____ ____, oxygen rich blood (arterial) flows from the left ventricle through the opening in the septum and then mixes with oxygen poor blood in the right ventricle.
VSD
If untreated, VSD can cause ___ disease or infection of the heart (______ ) due to inflammation of the heart, too much stress on the heart, and too much blood.
lung

endocarditis
If untreated ____ can cause lung disease, pulmonary HTN, and progressive pulmonary vascular disease and/or heart failure.
VSD
True or False: Symptoms of ventricular septal defect are present at birth.
False, usually none at birth unless very large
S/S of VSD include a _____ if large, may develop into ___, there will be our favorite word: _____, tach___, dys_____, congestion in ____ which will cause ______(sound) , tiring while eating and ____ weight gain.
S/S of VSD include a murmor if large, may develop into CHF, there will be our favorite word: lethargy, tachypnea, dyspnea, congestion in lungs which will cause crackles, tiring while eating and poor weight gain. Remember that if the baby takes an hour to eat, gets sweaty and tired, it's a red flag for a heart problem.
Therapeutic management for a VSD include nutritional support, which is important because it decreases the work of the heart. This includes a ___ calorie formula or ______ and/or supplemental ____ feedings. It may close _______.
high
breastmilk
tube
spontaneously
VSD can also be fixed with surgery. A septal ___ or ____ can close the defect. _______ are given prophylactically PRN. Also, in the cardiac cath lab, a ____ or occluder can be put in to _____ blood flow.
patch
antibiotic
coil
prevent
True or False: Aortic stenosis can be congenital or acquired.
true
In aortic stenosis, the aortic valveis unable to ___ completely. It can be caused by a defect during the ____week of gestation. It can also be acquired after a ____ infection that progresses to _____ ____.
open
8th
strep
rheumatic fever
Aortic stenosis is a concern because it makes the ____ ventricle work harder to move blood through the ____ aortic valve. _______ arteries may not receive enough _____ blood to meet the demands of the ___. There are often ___ leaflets instead of __.
left
narrow/tight
coronary
oxygenated
heart
2, 3
S/S of aortic stenosis
dizziness or syncope (feel like fainting) with exertion
exercise intolerance
SOB
cardiac arrhythmias
chest pain (angina)
True or False: symptoms of aortic stenosis are usually worse on exertion.
true
The tx for aortic stenosis includes the repair of the obstructed valve. This can include 4 options. What are they?
balloon valvuloplasty
valvotomy (cut part of valve, make more open)
aortic valve replacement
aortic homograft (cadaver)
The prognosis for aortic stenosis is good, there is usually normal growth and development. The ____ procedure will need to be repeated with growth. ________ need to be taken PRN and before any procedure that may introduce bacteria such as _____ procedures. Usually one dose is taken the day before or the day of the procedure.
balloon
antibiotics
dental
In tx of aortic stenosis, if an artificial valve is used to as a replacement, ______ may be taken by the child because the valve has a tendency to make ____. This can prevent fibrin from sticking to the valve and causing a ____ or heart attack.
anticoagulants
clots
stroke
Some artificial valves have _______ already imbedded in them.
anticoagulants
What are the 4 complications that define tetrology of fallot? The treatment varies depending on the severity of s/s. A major problem is not enough blood flow to ____. (be sure to look at pic of tetrology of fallot
VSD
Pulmonary (or right ventricular outflow tract) obstruction or stenosis
Overriding aorta- shifted toward right side so it sits over VSD
Right ventricle becomes enlarged (hypertrophy) as it tries to pump past the obstruction into the pulmonary artery

lungs
What are some risk factors for tetralogy of fallot? (3)
maternal alcohol abuse
maternal intake of antiseizures
mothers with PKU
Tetralogy of fallot is a concern because if the ____ ventricle obstruction is severe, or pressure in ____ is high, a large amount of ____ blood passes through the ____, mixes with _____ blood and goes out to the ____. Therefore, ____ amounts of venous blood and ____ amounts of arterial blood lead to severe _____.
Tetralogy of fallot is a concern because if the right ventricle obstruction is severe, or pressure in lungs is high, a large amount of venous blood passes through the VSD, mixes with arterial blood and goes out to the body. Therefore, increased amounts of venous blood and decreased amounts of arterial blood lead to severe cyanosis.
What are some s/s of tetralogy of fallot?
cyanotic newborn
cyanosis that worsens w/ crying
tachypnea
tachycardia
ashen or gray color
tire easily
cool skin temp (poor perfusion)
hypercyanotic episodes
With tetrology of fallot, the child is not necessarily ____ but they aren't pink, and the color just doesn't look right.
blue
In assessing activity level, look for ____ changes with activity, feeding, and crying. Is there activity intolerance?
color
When looking at respiratory system, assess the movement, shape, and symmetry. _____ and head _____ are compensating mechanisms.
Tachypnea and head bobbing
If there's a cardiac issue, you might be able to palpate the _____. See if you can hear the PMI. ____ ____ isn't all that important in babies if there is not a cardiac issue.
liver
Blood pressure
What is the most common congenital heart defect?
VSD
What is the hallmark sign of tetrology of fallot?
squatting- the unconscious attempt to relieve chronic hypoxia

A decreased return of poorly oxygenate blood from lower extremities leads to an increase in pulmonary blood flow and eases respiratory effort. It is an unconscious method of compensating, creates a tourniquet effect. Breathing becomes easier, there's less pressure on heart and lungs, and O2 sats improve.
A hypercyanotic episode is also known as a... (2 terms)
blue spell or tet spell
A hypercyanotic episode is when there is a vessel ____ causing increased/decreased pulmonary blood flow. It is preceded by crying, feeding, defecation, or another stressful event, like right before a blood draw.
A hypercyanotic episode is when there is a vessel spasm causing decreased pulmonary blood flow. It is preceded by crying, feeding, defecation, or another stressful event, like right before a blood draw.
In treating a hypercyanotic episode, the goal is to ______ ____ blood flow. Give _____ and put in what position? Administer ____ because it vasodilates, which leads to decrease in cardiac preload and then decreased spasms of the ventricle outflow tract. It is an _____ volume expander.
In treating a hypercyanotic episode, the goal is to increase pulmonary blood flow. Give oxygen and bring knees to chest. Administer morphine because it vasodilates, which leads to decrease in cardiac preload and then decreased spasms of the ventricle outflow tract. It is an isotonic volume expander.
Indural or propynal is a ___ ___ that helps decrease HR and BP.
beta blocker
Management of Tetrology of Fallot includes ______ infusion to .....
Surgical repair of defects before age ___, the VSD is closed with a ____, the obstructed path between the right ventricle and the pulmonary artery is ____ and ____ with a patch.
Management of Tetrology of Fallot includes prostaglandin infusion to keep the PDA open
Surgical repair of defects before age 1, the VSD is closed with a patch, the obstructed path between the right ventricle and the pulmonary artery is opened and enlarged with a patch.
____ are used to close defects in Tetrology of Fallot.
patches
What is the prognosis for tetrology of fallot? How is their development?
good prognosis
normal development
_____ are used prophylactically with tetrology of fallot to prevent ______.
antibiotics, endocarditis
True or False: Kids with tetrology of fallot may be small for their age and will continue to lag on the growth charts throughout adolescence.
False. Once defect is repaired, growth catches up quickly and they may grow several inches in a year.
Hypoplastic Left Heart Syndrome has several anomalies occurring at once and usually has a good/poor prognosis.
poor
With Hypoplastic Left Heart Syndrome, the structures on the left side of the heart are ___ and ______ed. This includes problems with the mitral valve, left ventricle, aortic valve, and aorta. Which defect is most critical?
small & underdeveloped

left ventricle
_____ issues may correspond with heart issues because they have similar timing of development in utero.
Renal
The cause of Hypoplastic Left Heart Syndrome is unknown. It often occurs with other anomalies such as d______ h____, o______, and h_____.
The cause of Hypoplastic Left Heart Syndrome is unknown. It often occurs with other anomalies such as diaphragmatic hernia, omphalocele, and hypospadias.
S/S of Hypoplastic Left Heart Syndrome
cyanosis- greyish blue
cool skin
tachycardia
tachypnea
With Hypoplastic Left Heart Syndrome, the baby was doing ok at first, then the ____ closes and the baby goes down hill. Keeping this open keeps him alive and is achieved with the use of _____.
With Hypoplastic Left Heart Syndrome, the baby was doing ok at first, then the PDA closes and the baby goes down hill. Keeping this open keeps him alive and is achieved with the use of prostaglandins.
True or False: prostaglandins keep PDA open, NSAIDS close it.
true
Hypoplastic Left Heart Syndrome is managed with prostaglandins to keep the PDA open, and a 3 stage surgery involving many shunts is done shortly after ____ if repairable, at 6 months, and at 12-18 months. The best outcome is achieved with a ___ ____.
Hypoplastic Left Heart Syndrome is managed with prostaglandins to keep the PDA open, and a 3 stage surgery involving many shunts is done shortly after birth if repairable, at 6 months, and at 12-18 months. The best outcome is achieved with a heat transplant. This syndrome is a major reason for a heart transplant in the first few days of life.
Congestive Heart Failure (CHF) is a _______ of an underlying ____ problem. The heart cannot pump enough ___ blood to meet the ____ of the body.
Congestive Heart Failure (CHF) is a symptom of an underlying cardiac problem. The heart cannot pump enough oxygenated blood to meet the demands of the body.
Causes of CHF
heart valve disease
endocarditis
cardiac arrhythmias
cardiomyopathy
chronic lung disease
HTN
_______ is a muscle disease in which a virus attacks the heart muscle.
cardiomyopathy
CHF can involve either left or right sided heart failure. Which is more severe?
left
In right sided heart failure, heart can't pump into ____, blood flows back up into ____, and you will see ____ of the feet, ankles, eyelids, face, and abdomen especially when?
In right sided heart failure, heart can't pump into lungs, blood flows back up into vein, and you will see edema of the feet, ankles, eyelids, face, and abdomen especially late in the day.
In left sided heart failure, the heart can't pump blood out to the ____, the blood flows back into the ____, the _____ become stressed due to the extra pressure and volume. The ____ does not receive enough oxygenated blood to meet its needs and therefore what things can happen?
poor growth
fatigue
FTT
not meeting dev. milestones
S/S of CHF (relating to right or left sided)
tachycardia- gallop rhythm (both)
visible edema (right)
tachypnea after exertion (left)
SOB (left)
What are some more general signs of CHF
profuse scalp sweating
fall asleep while eating (too much work)
wt. gain even when appetite is poor due to fluid retention
cough & congestion in lungs
Treatment for CHF
treat underlying cause surgically
Digoxin
ACE inhibitors
Diuretics
True or False: Digoxin takes 1- 2 days to lose half of what's in the system, is a potentially dangerous drug, and often requires a 2 RN check.
true
Digoxin ______ myocardial contraction, increases _____, slows _____. There is a very ____ therapeutic, toxic, and lethal range. What is the therapeutic level?
Digoxin strengthens myocardial contraction, increases output, slows HR. There is a very narrow therapeutic, toxic, and lethal range. Therapeutic level 0.5 -2.... units??? mg /dl?
Digoxiin should be held if apical pulse less than ____ for infants 1 year or less, hold if less than ____ in children 1-12 years old, and if less than ____ in adults
90 infants
70 children
60 adults
What are some signs of digoxin toxicity in children? What is the early sign?
early sign- refusal to eat

nausea & vomiting
bradycardia
dysrthythmias
ACE inhibitors end in ____. An example is _____, which decreases the ______, lowers the ____, and has a side effect of _____ and a ___ ___ ___. They cause vasodilation. What needs to be monitored?
ACE inhibitors end in "pril." An example is captopril, which decreases the afterload, lowers the BP, and has a side effect of hypotension and a dry, hacky cough. Potassium
______ eliminate excess fluid and decreases workload of heart. An example of a commonly used one is _____, which inhibits the reabsorption of Na and Cl in the loop of henle and increases renal excretion of water.
diuretic
lasix
Usual dosage of lasix is ..

What needs to be monitored?
IV: 1mg/kg q2h not to exceed
6mg /kg
hydration status, especially potassium (may develop hypokalemia), I & O
____ and ____ attach to the same receptor sites on the cell. So if there's decreased _____ there's more places for ____ to bind, and more likely to get toxic levels and hypo____.
Digoxin and Potassium attach to the same receptor sites on the cell. So if there's decreased potassium there's more places for digoxin to bind, and more likely to get toxic levels and hypokalemia.
_____ occurs when blood flow to lungs is insufficient. ______ blood is pumped out to body.
cyanosis
deoxygenated
Clinical consequence of chronic cyanosis is ______, a compensating mechanism. Additional blood cells, especially RBC's are produces, blood has increased viscocity, there's a greater risk of ____ and ____ as well as CNS injury because there's not enough ___ and ____.
Clinical consequence of chronic cyanosis is polycythemia, a compensating mechanism. Additional blood cells, especially RBC's are produces, blood has increased viscocity, there's a greater risk of bleeding and infection as well as CNS injury because there's not enough WBCs and platelets. RBC's are the priority blood cell, and this is the consequence of polycythemia.
Children with chronic cyanosis are prone to frequent ____, hypercyanotic or ___ spells, and _____ can be life threatening.
Children with chronic cyanosis are prone to frequent URI, hypercyanotic or tet spells, and dehydration can be life threatening.
For the child undergoing cardiac surgery, provide family with verbal and written info, remember there's a high level of anxiety, give a tour of ICU, explain monitors, tubes, etc (may be multiple lines etc), explain sequence of events, be appropriate for developmental level of child. Try not to give an exact ____ ___ because parents will assume the worst.
time frame

say 4-6 hours etc
Post op after cardiac surgery, be sure to monitor BP and vital signs, auscultate lungs and be alert for diminished or absent sounds and ____. Avoid _____ because ____ can increase metabolic need and increase cardiac demand.
Post op after cardiac surgery, be sure to monitor BP and vital signs, auscultate lungs and be alert for diminished or absent sounds and crackles. Avoid hypothermia because chills can increase metabolic need and increase cardiac demand.
Chest tubes _____ lung pressure. Be sure to monitor I & O carefully as well as IV fluids. Ask how much drainage you should see from the chest tube. How much may be a sign of hemorrhage? Remember that VS changes are a late sign.
equalize

3ml/kg/h for 3 h may be a sign of hemorrhage
Post cardiac surgery, remember that the chest was cut open so ___ is a major issue that needs to be alleviated. examples of meds used...
pain
morphine, NSAIDS, toredol, tylenol, oxycodone
Infective endocarditis is an infection of the _____ of the heart & valves. _____ enters the bloodstream and lodges in the heart lining where rough or ___ tissue has developed. How can this bacteria enter the body?
Infective endocarditis is an infection of the lining of the of the heart & valves. Bacteria enters the bloodstream and lodges in the heart lining where rough or scar tissue has developed. Bacteria enters the body through dental procedures, tonsillectomy, bronchoscopy, and other operative procedures.
Infective endocarditis can be caused by untreated ____. ___ tissue has sluggish blood flow, so that's why the bacteria can't get flushed out of the system.
Infective endocarditis can be caused by untreated strep, scar tissue has sluggish blood flow, so that's why the bacteria can't get flushed out of the system.
S/S of infective endocarditis
fever
anorexia
malaise
new or changing murmor
CHF
With infective endocarditis, tiny pieces of blood in different places travel through the body and go down to the ____ level before lodging somewhere. This is called an _________ emboli. What are some s/s of this?
With infective endocarditis, tiny pieces of blood in different places travel through the body and go down to the capillary level before lodging somewhere. This is called an extracardiac emboli.
S/S:
splinter hemorrhage under nails (tiny clots lodged here)
Ossler nodes (painful area on fingers)
Janeway lesions (feet)
Petechiae on mucous membranes sch as eyes
Diagnosis for ____ ____ includes blood cultures, echocardiam, ESR, C-Reactive Protein level. Blood should be drawn from at least 2 sites because...
infective endocarditis

infection may not be evenly distributed
Infective endocarditis is treated with IV antibiotics for ___ to ___ weeks and it's not easy to get rid of. Prevention is achieved with antibiotics prior to invasive procedures such as ______ PO 1 hour before surgeries, dental procedures, and tonsillectomy or adenoidectomy.
2-8
Amoxicillin
____ ____ is strep throat with a rash.
scarlet fever
Rheumatic fever is a chronic/acute local/systemic ______ disease affecting multiple organs ans systems such as:
Rheumatic fever is an acute systemic, inflammatory disease affecting multiple organs ans systems such as:
Joints
CNS
Heart
Rheumatic fever can cause temporary/permanent damage to the heart ____. The heart valve is damaged by streptococcus from ____ ____ progressed to rheumatic fever.
Rheumatic fever can cause permanent damage to the heart valves. The heart valve is damaged by streptococcus from strep throat progressed to rheumatic fever. It occurs 2-6 weeks after strep infection.
Major symptoms of Rheumatic Fever include carditis (inflamed heart) which involves t______, c_______, m______, and CHF. Migratory _______ involves ______, ___, ____, ___joints which is migratory and irreversible/reversible.
Major symptoms of Rheumatic Fever include carditis (inflamed heart) which involves tachycardia, cardiomegaly, murmor, and CHF. Migratory polyarthritis involves swollen, hot, red, painful joints which is migratory and reversible.
True or False: Heart damage from rheumatic fever is often permanent while joint issues are reversible.
true
Sydenham's chorea: St. Vitus Dance (Rheumatic Fever) involves sudden, aimless, _____ movements of extremities, involuntary facial _____, speech _______, emotional lability, and muscle _____. This is reversible/irreversible.
Sydenham's chorea: St. Vitus Dance (Rheumatic Fever) involves sudden, aimless, involuntary movements of extremities, involuntary facial grimaces, speech disturbances emotional lability, and muscle weakness. This is reversible, parents need lots of reassurance that child will improve.
________ Marginatum is a reddish pink rash seen with rheumatic fever and is often found on the ____. All patients with rheumatic fever will experience ____ problems but may or may not have rash, joint, or neuro issues.
Erythema Marginatum is a reddish pink rash seen with rheumatic fever and is often found on the trunk. All patients with rheumatic fever will experience heart problems but may or may not have rash, joint, or neuro issues.
Rheumatic fever also can develop subcutaneous _____ which are small, round, freely movable, painful/painless swelling. They are located on hands, feet, and other bony ________. They resolve without permanent _____.
Rheumatic fever also can develop subcutaneous nodules which are small, round, freely movable, painless swelling. They are located on hands, feet, and other bony prominences. They resolve without permanent damage.
Minor manifestations of rheumatic fever include fever, fatigue, arthralgia, and an elevated ___ and ____.
ESR and CRP
Treatment for rheumatic fever involves bed rest, anti_______, and anti______. PreveThe goal in treating rheumatic fever is prevention of ____ ____. Maintain strict _____, monitor ____ pulse, evaluate tolerance to activity, if HR increases more than ___ bpm over resting rate, return to bed (too much work for heart) Low -___ diet to decrease fluid retention and administer ____ per MD order.ntion is key- treat ___ ___ promptly with antibiotics.
antibiotics
anti-inflammatories
strep throat
The goal in treating rheumatic fever is prevention of ____ ____. Maintain strict _____, monitor ____ pulse, evaluate tolerance to activity, if HR increases more than ___ bpm over resting rate, return to bed (too much work for heart) Low -___ diet to decrease fluid retention and administer ____ per MD order.
The goal in treating rheumatic fever is prevention of cardiac damage. Maintain strict bedrest, monitor apical pulse, evaluate tolerance to activity, if HR increases more than 20 bpm over resting rate, return to bed (too much work for heart) Low -salt diet to decrease fluid retention and administer oxygen per MD order.
To decrease _____ with rheumatic fever, use bed cradle to keep linens off painful joints, administer ____ per MD order, massage and reposition, give analgesics as ordered and use hot or cold to affected joint. Don't do ____ because it's too painful.
To decrease discomfort, use bed cradle to keep linens off painful joints, administer aspirin per MD order, massage and reposition, give analgesics as ordered and use hot or cold to affected joint. Don't do ROM because it's too painful.
To promote safety and prevent injury related to ______, use side rails and ____ them, don't do ___ temps, ____ feed to prevent damage to oral cavity, assist with ADLs.
To promote safety and prevent injury related to chorea, use side rails and pad them, don't do oral temps, spoon feed to prevent damage to oral cavity, assist with ADLs.
In treating rheumatic fever, encourage family and child to comply with ___-____ antibiotic therapy. Administer antibiotics Penicillin IV in hospital, and Penicillin ___ q ___ ____ for undetermined time. They will likely have a PICC line and a home health nurse. Prepare family for ___ year follow up. Enlist child's cooperation with therapy "hero badge" and stress the need for an exact schedule.
In treating rheumatic fever, encourage family and child to comply with long-term antibiotic therapy. Administer antibiotics Penicillin IV in hospital, and Penicillin IM q 4 weeks for undetermined time. They will likely have a PICC line and a home health nurse. Prepare family for 5 year follow up. Enlist child's cooperation with therapy "hero badge" and stress the need for an exact schedule.
In treating rheumatic fever, stress that ultimate prognosis depends on amount of cardiac damage. Teach necessity for long term prophylactic therapy for 5 years with lifetime followup especially for ____ care, c_____, and surgery. They may whether the rheumatic fever but suffer cardiac damage, in which they may need____ replacement.
In treating rheumatic fever, stress that ultimate prognosis depends on amount of cardiac damage. Teach necessity for long term prophylactic therapy for 5 years with lifetime followup especially for dental care, childbirth, and surgery. They may whether the rheumatic fever but suffer cardiac damage, in which they may need valve replacement.
Is the rash with rheumatic fever itchy?
no
The major cause of acquired heart disease in children is _______ ______.
Kawasaki Disease
Kawasaki disease causes major inflammation of many tissues of the body especially the ....8
hands, feet, eyes, mouth, lips, throat, heart and major problems with blood vessels, especially coronary artery vessels.
Kawasaki Disease mainly affects children younger than 5 with peak age between 8-24 months. It occurs often/rarely in the US, but most often in _____. Children of ____ descent are more often affected.
Kawasaki Disease mainly affects children younger than 5 with peak age between 8-24 months. It occurs often/rarely in the US, but most often in Jaspan. Children of Asian descent are more often affected.
The cause of Kawasaki disease may be an ____-mediated vasculitis triggered by a ____ or ______ toxin. Vasculitis means inflammation of the vessels There is a theory that it may be caused by toxins released in _____ cleaning.
The cause of Kawasaki disease may be an immune-mediated vasculitis triggered by a virus or bacterial toxin. Vasculitis means inflammation of the vessels There is a theory that it may be caused by toxins released in carpet cleaning.
An ______ is a ballooned or weakened area of a blood vessel.
aneurism
Kawasaki has inflammation that _____ over time. The main threat to the child is damage to ___ and _____ vessels. The coronary arteries may develop ______. Blood ____ form in irritated arteries. ________ becomes inflamed. And d______ (hear rhythm) may occur.
Kawasaki has inflammation that resolves over time. The main threat to the child is damage to heart and coronary vessels. The coronary arteries may develop aneurisms Blood clots form in irritated arteries. Myocardium becomes inflamed. And dysrythmias (hear rhythm) may occur.
Kawasaki Disease has 3 phases: acute, subacute, and the final or ______ phase.
convalescent
The acute phase of Kawasaki Disease lasts 10-14 days and involves a high ____ unresponsive to antibiotics that persists longer than 5 days. There is bilateral non-______ conjunctivitis where there is no drainage or pus and the eyes are ______. There are swollen ____ glands in the neck and the patient may experience irritability.
The acute phase of Kawasaki Disease lasts 10-14 days and involves a high fever unresponsive to antibiotics that persists longer than 5 days. There is bilateral non-______ conjunctivitis where there is no drainage or pus and the eyes are bloodshot. There are swollen lymph glands in the neck and the patient may experience irritability.
In the acute phase of Kawasaki, there is also a spotty ____ on the abdomen, chest back, groin, a swollen, coated _____, and p______, which may lead to a false diagnosis of ______.
In the acute phase, there is also a spotty rash on the abdomen, chest back, groin, a swollen, coated tongue, and photophobia, which may lead to a false diagnosis of meningitis.
Then, there are signs in the acute phase of Kawasaki that tell us it's not meningitis. These include dry, red, cracked ____, dark red interior surface of the ___, ____ of palms and soles, and t_____.
Then, there are signs in the acute phase of Kawasaki that tell us it's not meningitis. These include dry, red, cracked lips, dark red interior surface of the mouth, erythema of palms and soles, and tachycardia.
The subacute phase of Kawasaki Disease lasts 15-25 days and the _____ disappears and most symptoms _____. There will be continued _____ with lots of crying. The skin ____ around the nail beds, hands, or feet. There are swollen, painful _____.
The subacute phase of Kawasaki Disease lasts 15-25 days and the fever disappears and most symptoms subside. There will be continued irritability with lots of crying. The skin peels around the nail beds, hands, or feet. There are swollen, painful joints.
Cardiovascular manifestations of Kawasaki Disease include CHF, Dysrthythmias, and coronary ______. A baseline _____ is performed and repeated at 2 weeks, 6-8 weeks, and again at 6-12 months. They are checking and rechecking the heart to see if there's any damage. If a coronary artery has an aneurism, this can let do a ___ when it ruptures.
aneurism
echocardiogram
MI
The final or convalescent stage of Kawasaki Disease starts on Day 26 until the ___ returns to normal and all of the s/s are gone.
ESR
Tx for Kawasaki Disease involves IV _____ ____ which may reduce the risk of heart damage. ____ or ____ are used to decrease inflammation and prevent clots. Symptomatic tx includes reducing _____, keeping ____ low, lots of ______ to decrease workload of heart, and encourage fluid intake (depending on degree of ____ involved).
Tx for Kawasaki Disease involves IV gamma globulin which may reduce the risk of heart damage. Aspirin or NSAIDS are used to decrease inflammation and prevent clots. Symptomatic tx includes reducing fever, keeping lights dim, lots of bedrest to decrease workload of heart, and encourage fluid intake (depending on degree of CHF involved).
The prognosis of Kawasaki Disease is good. Eighty percent recover with no residual effects, and recovery may take weeks. Twenty percent have heart damage and must have ___ ___.
follow up
____ healthy habits should be encouraged during childhood such as maintaining a normal weight, adequate nutrition, and regular exercise.
Heart
It's important to identify children at risk for heart problems. If a there's a family history of a CVA or coronary artery disease before age ____ it's a risk factor, not a risk factor if at age 80 etc. If one parent has a total cholesterol greater than or equal to ____ mg/dl or the child demonstrates other risk factors and parent's hx is unavailable, they should get screened. Children have risk factors independent of family hx such as ______, no ______, and excessive ___ ____.
It's important to identify children at risk for heart problems. If a there's a family history of a CVA or coronary artery disease before age 55 it's a risk factor, not a risk factor if at age 80 etc. If one parent has a total cholesterol greater than or equal to 240 mg/dl or the child demonstrates other risk factors and parent's hx is unavailable, they should get screened. Children have risk factors independent of family hx such as smoking, no exercise, and excessive fat intake
True or False: The Mediterranean Diet is best diet for decreasing cholesterol.
true
Thereapeutic management for kids with high cholesterol includes encouraging a low ___ diet, an exercise program, maintain a normal weight, and monitor cholesterol. Children and adolescents should exercise how often?
Thereapeutic management for kids with high cholesterol includes encouraging a low fat diet, an exercise program, maintain a normal weight, and monitor cholesterol. Children and adolescents should exercise at least one hour per day.