Pedi Exam 2 - Cardiac, Endocrine

Front 1

Patent Ductus Arteriosus (PDA)

Back 1

Failure of the fetal ductus arteriosus to close within the first weeks of life. This makes a reversal in blood flow due to increased aortic pressure.

At risk for endocarditis and pulmonary vascular obstruction disease.

Front 2

PDA Clinical Signs

Back 2

May be asymptomatic or show signs of CHF.

These children may become diaphoretic while eating and they may tire while eating.

Front 3

Murmur

Back 3

A sound that is produced by vibrations within the heart chambers or in the major arteries from the back and forth flow of blood.

rated on a scale of 1-6 with grade 1 and 2 barely audible.

Front 4

Atrial Septal Defect (ASD)

Back 4

An abnormal opening between the atria, allowing blood from the higher pressure left atrium to flow into the lower pressure right-ASD1, ASD2, Sinus venous defect. More common in females.

Front 5

Heart sounds

Back 5

S1-beginning systole, loudest at apex and best heard over the mitrial and tricuspid areas. Closure of the AV valves.
S2- Loudest at the base. Closure of the semilunar valves, best heard over the pulmonic and aortic areas.
S3-Normal in some children and young adults. Best heard over mitrial area.
S4-not usually good to hear.

Front 6

Coarctation of the Aorta

Back 6

Narrowing of the aorta usually distal to the origin of the left subclavian artery.Most common site is at the ductus. Aortic narrowing increases resistance to aortic flow. There will be increase left ventricular pressure and work load.

Coartation common w/ VSD

Front 7

Coartation manifestation

Back 7

Difference in extremity BP’s and pulses-uppers will be hypertensive with bounding pulses while the lower extremity. Pulses may be weak and hypotensive. Decrease systemic perfusion. Always document where pulses were taken on a child.

Front 8

Hemodynamics

Back 8

Older children will have increase blood flow to upper body and decrease blood flow to the lower body. Increase Afterload to left ventricle. The renal arteries will receive decreasing flow. Rennin will then be released, causing hypertension in the ascending aorta.

Associated with neonates with a closed PDA

Front 9

VSD

Back 9

Most common heart defect

Front 10

Ventricular Septal Defect (VSD)

Back 10

Most common CHD.Abnormal opening between the right and left ventricles. 20%-60% are thought to close spontaneously during the first year of life.

Front 11

Tetralogy of Fallot (TET)

Back 11

Most common cyanotic heart defect.10% of CHD.
Requires 4 defects: Pulmonic stenosis, Overriding aorta, ventricular septal defect (VSD), right ventricular hypertrophy.

Front 12

TET Manifestation

Back 12

have episodes of cyanosis or hypoxia
use calm approach, O2, morphine, place in knee-chest position. Possible neurological complications as well as dehydration ( may cause strokes). may have cyanosis, poor weight gain, and short statue.

Front 13

Transposition of the great vessels

Back 13

Pulmonary artery leaves the left ventricle and Aorta exits from the right ventricle. Results in no communication between the systemic and pulmonary circulation.

Front 14

Tricuspid Atresia

Back 14

Failure of the tricuspid valve to develop.
Cyanosis in newborn period, tachycardia and dyspnea.
Older children may have signs of chronic hypoxemia and clubbing. Newborns may be given continuous infusion of prostaglandin E until surgical intervention arranged.

Front 15

Heart Failure

Back 15

Occurs most often with children with a CHD.

Front 16

Cardiomyopathy

Back 16

Myocardium cannot contract properly:
3 types: restrictive, dilated, hypertrophy.

Front 17

Kawasaki Disease

Back 17

Acute systemic vasculitis most commonly seen in infants and young children. Usually seen in winter and spring.

Front 18

Kawasaki manifestation

Back 18

Fever>102.2 x 5 days
Strawberry tongue (cracked and red), Desquamation of perineal area, fingers, toes

Treat with aspirin - prevent clot formation from swelling vessels.

Front 19

Hypertension

Back 19

Primary-rare, but increases with age
Secondary-related to underlying medical problem (usually renal)

Front 20

Prolonged Q-T

Back 20

Usually seen in adolescents.
Complaints of fatigue, syncope, inability to keep up with peers.
Rest, pacemakers.
Decrease physical activity.

Front 21

Growth hormone deficiency (GHD)/ Hypopituitary

Back 21

Inadequate production of secretion of growth hormone which results in poor growth and short stature.
Normal weight and length at birth. By age 1, ht<5% for age and sex. Micropenis and undescended testicles

Front 22

Hyperpituitarism

Back 22

Treat cause-removal of tumor, radiation therapy or oral bromocriptine

Front 23

Diabetes Insipidus

Back 23

Inability to concentrate urine due to deficiency of vasopressin or ADH.

Synthetic vasopressin (DDAVP) administered intranasally, SQ, IM or po-amount dependent on age and how administered. Intranasal given through a small flexible premarked tube twice a day or metered spray twice a day.

Front 24

DI diagnostic

Back 24

Water Deprivation-usually a 7 hour procedure where the child is deprived of water. In a child without DI, you would expect decrease urine output with high urine spec. gravity and no change in the Na level. A child with DI will continue to have large amount of dilute urine with low spec. gravity and increase Na level.

Front 25

SIADH-Syndrome of Inappropriate Antidiuretic Hormone

Back 25

Excessive production or release of ADH or vasopressin.

Fluid retention, weight gain
Hypotonicity

Front 26

Precocious Puberty

Back 26

Puberty before 8 for girls and before 9 for boys

Front 27

Congenital Hypothyroidism

Back 27

Present from birth since the thyroid gland does not produce enough thyroid hormones to meet metabolic needs of the infant.
Untreated leads to mental retardation.

Front 28

Con. Hypothyroidism manifestations

Back 28

Prolong jaundice, lethargy, constipation
Feeding problems, cold to touch, skin mottling, bradycardia
Umbilical hernia, hypotonia/ slow reflexes
Large tongue, large fontanel, distended abdomen

Front 29

hyperthyroidism

Back 29

Goiter, dry, thick skin and course hair, hair loss.
Tiredness/fatigue, cold intolerance, constipation
Weight gain, decreased growth, irregular menses
Edema of face, eyes, and hands

Front 30

Hyperthyroidism Graves’ Disease

Back 30

Excessive thyroid hormone by enlarged thyroid gland
Most in 6-15 year olds. Goiter, weight loss, increased appetite, diarrhea
Nervousness, increased perspiration, tremors, overheated/fatigue during physical exercise
Heat intolerance, increased heart rate