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144 Cards in this Set
- Front
- Back
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Increased pulmonary blood flow & Acyanotic
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atrial septal defect
ventricular septal defect patent ductus arteriosus atrioventricular canal |
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Obstruction to blood flow from ventricles & Acyanotic
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Coarctation of Aorta
Aortic stenosis Pulmonic stenosis |
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Decreased pulmonary blood flow & Cyanotic
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Tetraology of Fallot
tricuspid atresia |
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Mixed blood flow & cyanotic
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transposition of great arteries
total anomalous pulmonary venous return truncus arteriousus hypoplastic left heart syndrome |
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What is caused from left to right shunt that results in increased pulmonary blood flow?
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CHF
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Manifestations of ASD?
Tx? |
asymptomatic; CHF; murmur, atrial dysrhythmias, atrial & ventrical enlargement
-Dacron patch |
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Manifestations of VSD?
Tx? |
CHF, murmur, risk for bacterial endocarditis, pulmonary vascular obstructive disease
-purse string approach or Dacron patch |
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Manifestations of PDA?
Tx? |
asymptomatic; CHF; *machine-like sound murmur, widened pulse pressure and bounding pulses, risk for bacterial endocarditis, pulmonary vascular obstructive disease
-Admis of indomethacin (prostaglandin inhibitor) or surgical VATS: visual assisted thoracoscopic surgery, or use of coils |
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Manifestations of COA?
Tx? |
High blood pressure and bounding pulses in arms, weak or absent femoral pulses, and cool lower extremities with lower blood pressure, CHF in infants and usually admit to ER hypotensive and acidotic
-end to end anastomosis; defect is outside the heart so thoracotomy incision...and is advised within 1st 2 years of life or balloon angioplasty but risk of anuerysm |
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What are pts at risk for with COA?
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hypertension, ruptured aorta, aortic aneurysm, or stroke
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Manifestations of AS?
Tx? |
hypertension, pulmonary edema, enlarged left ventricle, decreased cardiac output, pulmonary vascular congestion, murmur, risk for bacterial endocarditis & MI, coronary insufficiency, and ventricular dysfunction
-Infants will have decrease CO, faint pulses, hypotension, tachycardia, and poor feeding -Children exercise intolerance, chest pain, dizzy when stand too long Tx: aortic valvotomy or replacement valve, balloon angioplasty |
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Manifestations of PS?
Tx? |
asymptomatic, mild cyanosis or CHF, murmur, cariomegaly on CXR, risk for bacterial endocarditis, right ventricle enlargement, may reopen foramen ovale, possible PDA defect to compensate
Tx: balloon angioplasty, |
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Manifestations of TOF?
Tx? |
Infant: cyanotic, murmur, hypoxia with tet spells, decreased pulmonary blood flow
-four defects: VSD, PS, overriding aorta, right ventricle hypertrophy Tx: Blalock-Taussig (shunt) or patch |
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What does the Blalock-Taussig (shunt) do?
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provides blood flow to the pulmonary arteries from the left or right subclavian artery
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What happens in CHF?
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occurs secondary to structural abnormalities that result in increased blood volume and pressure within the heart
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what is.....the right ventricle being unable to pump blood effectively into the pulmonary artery, resulting increased pressure in the right atrium and systemic circulation?
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Right-sided failure
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What do you see in Right-sided failure?
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systemic venous hypertension which causes hepatosplenomegaly and some edema
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what is....the left ventricle being unable to pump blood into the systemic circulation, resulting in increased pressure in the left atrium and pulmonary veins?
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Left-sided failure
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What do you see in Left-sided failure?
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the lungs become congested with blood, causing elevated pulmonary pressures and pulmonary edema
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Despite compensatory mechanisms and therefore decreased cardiac output....what happens?
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Decreased flow to the kidneys continues to stimulate sodium and water reabsorption, leading to fluid overload (FVO), an increased workload on the heart, and congestion in the pulmonary and systemic circulations
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What are the 3 groups of S/S r/t to CHF?
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Impaired MI, Pulmonary Congestion, Systemic Venous Congestion
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What are the S/S of Impaired MI?
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tachycardia, sweating, decreased UO, fatigue, weakness, restlessness, anorexia, pale cool extremities, weak peripheral pulses, decreased blood pressure, gallop rhythm, cardiomegaly
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What are the S/S of Pulmonary Congestion?
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tachypnea, dyspnea, retractions (infants), flaring nares, exercise intolerance, orthopnea, cough hoarseness, cyanosis, wheezing, grunting
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What are the S/S of Systemic Venous Congestion?
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weight gain, hepatomegaly, peripheral edema esp periorbital, ascites, JVD
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How does one treat to improve cardiac function?
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through admin of Digitalis
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What does digitalis do for the body?
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increases CO, decreases heart size, decreases venous pressure, relief of edema
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How does the elixir come for Digitalis?
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0.05 mg/mL for oral admin
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How is the does calculated for infants with Digitalis?
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1000 ug = 1 mg
-given orally or IV in divided doses over 24 hours for optimal effect, and a maintenance dose, given orally twice a day to maintain blood levels |
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Why are ACE inhibitors given?
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inhibit renin-angiotension system in kidneys, so VASODILATION occurs which decreases pulmonary and systemic vascular resistance, decreases blood pressure, and reduction in afterload
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What are the S/E of ACE inhibitors?
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hypotension, cough, renal dysfunction
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Hold dig on an infant or young children if the apical pulse is less than what?
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90 to 120
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Hold dig on older children if the apical pulse is less than what?
adults? |
-70
-60 |
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infants rarely receive how much dig?
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1 mL (50 ug or 0.05 mg)
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common signs of dig toxicity?
GI? Cardiac? |
gi: N/V, anorexia
cardiac: bradycardia, dysrhythmias |
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what are the s/e to be aware of when one is taking Lasix?
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N/V, diarrhea, hypokalemia, dermatitis, postural hypotension
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give dig when in relation to meals?
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at regular intervals usually q 12 hrs ex. 8am and 8pm
-give 1 hr before meal or 2 after eating -do not mix with other foods -brush after admin drug |
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would you still give dig if more than 4 hours has elapsed?
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no, but before yes
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what level should an infant sit or be held at?
how often feed them with CHF? |
45 degree angle
-Q 3 HRS and give them a half hour to eat while in semiupright position |
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give diuretics when?
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early in the day
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what refers to an arterial oxygen tension or pressure that is less than normal and can be identified by a decreased arterial saturation or pressure?
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hypoxemia
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what results from the presence of deoxygenated hemoglobin (hemoglobin not bound to O2) in a concentration of 5 g/dL?
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cyanosis
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why is it considered blue blood the cyanosis?
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in heart defects that cause hypoxemia and cyanosis result from desaturated venous blood entering the systemic circulation without passing through the lungs
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what is when a left to right shunt becomes a right to left shunt?
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Eisenmenger complex (syndrome)
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what 2 things occur with hypoxemia?
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polycythemia and clubbing
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polycythemia does what?
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increases the viscosity of the blood and crowds out clotting factors
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what is most characteristic of children with tetralogy of Fallot?
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squatting..unconscious attemopt to relieve chronic hypoxia, esp during exercise
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what is seen in infants with TOF and may occur in any child whose heart defects include obstruction to pulmonary blood flow and communication b/w ventricles?
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Hypercyanotic spells...blue spells or tet spells
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when do tet spells occur?
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usually during 1st year of life rarely before 2 months of life
- occur in morning ...may be preceded before feeding, crying, defecation, or stressful procedures |
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persistent cyanosis from cardiac defects can place child at risk for what?
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neurological complications: CVA, stroke, brain abscess, developmental delays
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what should the nurse do if an infant is having a tet spell?
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calm infant, place in the knee-chest position, and give supplemental o2
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infant who is cyanotic from tet spells need what?
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keep well hydrated to keep Hct and blood viscosity thinner to reduce CVA
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what can occur after an infection with group A b-hemolytic strept pharyngitis?
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rheumatic fever
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what is the most significant complication of rheumatic fever?
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Cardiac valve damage
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How is the diagnosis made with rheumatic fever?
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Jones criteria
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What suggests it's rheumatic fever with the Jones criteria?
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must have either two major manifestations
OR one major and two minor manifestations 2 |
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what is a reliable test to test for strept?
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ASO titer
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drug of choice for rheumatic fever?
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penicillin or erythromycin if allergic and salicylates for inflammation
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how do you prevent recurrent rheumatic fever?
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prophylactic benzathine penicillin IM (1.2 million U), two daily oral doses of penicillin (200,000 U), or one daily dose of sulfadiazine (1 g)
-follow these children for at least 5 yrs |
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Name major manifestations in rheumatic fever
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Carditis, polyarthritis, erythema marginatum, chorea, sub q nodes
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Name minor manifestations in rheumatic fever
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arthralgia, fever, elevated ESR, c-reactive protein, positive throat culture or rapid strept antigen test or elevated ASO titer
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what is one of the most disturbing and frustrating manifestations seen in rheumatic fever?
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chorea...onset gradual can last months...there is sudden aimless, irregular movements of extremities, involuntary facial grimaces, speech disturbances, emotional liability, muscle weakness, & exaggerated movements when attempting fine motor activity
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what is an acute systemic vasculitis of unknown cause, that is self-limited, and reported in late winter & early spring?
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kawasaki disease
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what occurs in kawasaki disease?
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extensive inflammation of arterioles, venules, & capillaries which later progresses to formation of coronary artery aneurysms...can lead to coronary thrombosis or severe scar formation and stenosis of main coronary artery
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How is kawasaki disease dx?
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by clinical manifestations
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what is involved in the acute phase of kawasaki disease?
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abrupt onset of fever that is unresponsive to Abx and antipyretics
- child is very irritable |
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what is involved in the subacute phase of kawasaki disease?
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-begins with resolution of the fever and lasts until all clinical signs of KD have disappeared....
stage where child is GREATEST risk for coronary artery aneurysms -child still irritable |
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what is involved in the convalescent phase of kawasaki disease?
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all the clinical signs of KD are gone, but the LAB values are not normal...this phase is complete once LAB values are normal (6 to 8 wks)
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what is the most serious complication of kawasaki disease?
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potential for MI
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what are the main symptoms of acute MI in children?
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abd pain, vomitting, restlessness, inconsolable crying, pallor, and shock
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what is the current treatment for kawasaki disease?
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high dose IV gamma globulin along with salicylate therapy
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how do you give IV gamma globulin?
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give within 1st 10 days of illness ....by a single, large infusion of 2 g/kg over 10 to 12 hrs
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how is aspirin given?
coumadin? |
80 to 100 mg/kg/day in divided does q 6 hrs then low-dose aspirin is continued at a antiplatelet dose ( 3 to 5 mg/kg/day)
-only if have giant aneurysms |
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what is the most challenging for the parents or caregivers?
hallmark sign |
the irritability of the child....which can last up to 2 months
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what else occurs with kawasaki disease?
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peeling of the hands and feet (painless), signs of CHF (decreased UO, gallop rhythm, tachycardia, resp distress), arthritis
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what is deferred for 11 months after receiving the gamma globulin?
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any live immunizations (MMR, varicella) because the body might not produce the appropriate amount of antibodies
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what refers to the abnormal retrograde flow of bladder urine into the ureters? During voiding, urine is swept back into the empty bladder...
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Vesicoureteral reflux
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Vesicoureteral reflux is associated with?
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recurring kidney infections rather bladder infections
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what are some S/S of Vesicoureteral Reflux (VUR)?
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high fevers, vomiting, and chills...can have renal scarring
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what should be done with VUR?
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managed with low-dose Abx, a urine culture done q 2 to 3 months and any time child has fever, with an annual voiding cystourethrogram
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how is a urine sample best retrieved with infants and young children?
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suprapubic aspiration of urine or sterile cath
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what s/s could be indicative of UTI in an infant (birth to 1 month old)?
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poor feeding, vomiting, failure to gain wgt, rapid resp (acidosis), resp distress, spont pneumothorax, freq urine, scream on urine, poor urine stream, jaundice, seizures, dehydration, enlarged kidneys or bladder
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what s/s could be indicative of UTI in an infant (1 month to 24 months)?
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poor feeding, vomiting, failure to gain wgt, scream on urine, freq urine, seizures, dehydration, enlarged kidneys or bladder, excessive thirst, foul smell urine, pallor, fever, persistent diaper rash
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what s/s could be indicative of UTI in an childhood (2 yrs to 14 yrs)?
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poor feeding, vomiting, growth failure, excessive thirst, enuresis, incontinence, freq urine, painful urination, swelling of face, seizures, pallor, fatigue, blood in urine, abd or back pain, edema, HTN, tetany
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what other tests can be done after the infection subsides to identify anatomic abnormalities contributing to the development of infection and existing kidney changes from recurrent infections?
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Ultrasound, VCUG, IVP, DSMA
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What is hydrocele and how is it managed?
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fluid in the scrotum and by surgical repair indicated if spontaneous resolution is not accomplished in 1 yr
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what is hypospadias and how is it managed?
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urethral opening located behind the glans penis or anywhere along the ventral surface of penile shaft...
by surgical correction...want adequate sexual organ and to improve appearance & void in usual manner |
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what is cryptorchidism and how is it managed?
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failure of one or both tested to descend through inguinal canal.....
ADMIN HGC Human chorionic gonadotropin or surgery: ORCHIOPEXY |
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what is characteristic of massive proteinuria, hypoalbuminemia. hyperlipemia, and edema?
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Nephrotic syndrome
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What occurs with Nephrotic syndrome?
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disturbance to the basement membrane of the glomeruli that's permeable to protein
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Nephrotic syndrome shows what?
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lots of protein in the urine, less protein in the blood serum
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What happens where there in less albumin in the serum?
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decreases the colloidal osmotic pressure in the capillaries causing edema and ascites...which causes...HYPOVOLEMIA
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what are the S/S of Nephrotic syndrome?
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wgt gain, puffiness in face, esp around eyes which is evident in am, ascites, pleural effusion, labial or scrotum swelling, poss diarrhea, anorexia, poor intestinal absorption, ankle/leg swelling, easily fatigued, irritable, lethargic, change in BP, infection, decrease volume with frothy appearance
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what is the hallmark of Nephrotic syndrome?
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massive proteinuria 3+ on dipstick
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what is the 1st line of therapy for Nephrotic syndrome?
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corticosteriods...Prednisone usually 2 mg/kg/day then tapered
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what are the s/e of corticosteroids?
long-term use? |
weight gain, rounding of the face, and increased appetite
-hirsutism, growth retardation, cataracts, HTN, GI bleed, bone demineralization, infection, and hyperglycemia |
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what are 1st episodes and relapses associated with?
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viral or bacterial infection, or allergies and immunizations
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what are some common features of Acute glomerulonephritis (AGN)?
how are they acquired? |
oliguria, edema, HTN, circulatory congestion, hematuria, and proteinuria
-from post strept or viral infection |
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APSGN occurs when?
what's the pathophysiology? |
after strept infection Group A b-hemolytic
-immune complexes are deposited in membrane and the glomeruli become edematous and infiltrated..so there is edema and circulatory congestion |
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What are the clinical manifestations of APSGN?
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edema, esp periorbital, facial edema seen best in am, anorexia, urine is cloudy, smoky brown (tea or cola color) with severe reduced amt, pallor, irritability, lethargy, child appears ill, older children say have HA, abd discomfort, dysuria, poss vomit, higher BP
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what are the clinical manifestations of an infant with ICP?
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tense/bulging fontanel, separated cranial sutures, Macewen (crack-pot sound on percussion), irritability, crying high-pitch, increased occ/frontal circum, change in feeding, distended scalp veins, cry when disturbed, setting sun sign in eyes
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what are the clinical manifestations in children with ICP?
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HA, N/V, diplopia, blurred vision, seizures
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what are the personality and behavior signs seen in ICP?
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irritability, restlessness, indifference, drowsiness, decline in school, less physical activity, increased sleeping, memory loss, can't follow simple commands, lethargic and drowsy
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what are the late signs seen in ICP?
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breadycardia, lower LOC, decrease motor & sensory response, alterations in pupil size, cheyne-stokes resp, papilledema, coma
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how is the cranium made up?
brain____ CSF____ blood_____ |
brain 80% CSF 10% blood 10%
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somebody who is arousable with stimulation?
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obtundation
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one who remains in a deep sleep, responsive only to vigorous and repeated stimulation
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stupor
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no motor or verbal response to noxious painful stimuli
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coma
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according to glasgow coma scale....what is considered deep coma
highest score? what is considered definition of coma? |
lowest score 3
-highest 15 -score of 8 or below |
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acute inflammation of the meninges?
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bacterial meningitis
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what has led to the most dramatic change in the epidemiology of bacterial meningitis?
occurs most when the infection? |
vaccines against Haemophilus influenzae type B (Hib vaccine)
-b/w 1 month and 5 yrs of age |
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most common route of infection comes from where in bacterial meningitis?
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by vascular dissemination from a focus of infection elsewhere but also from cuts, lumbar puncture, surgery, anatomic abnormalities (spina bifida)
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where does the infection occur?
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in the cerebral spinal fluid CSF in the subarachnoid space
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what is the definitive diagnostic test with bacterial meningitis?
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Lumbar puncture: fluid pressure is measured and samples are obtained for cultures, gram stain, and blood cell count, determination of glucose and protein content
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what is the child given to sedate and alleviate pain during a Lumbar puncture?
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meperidine (Demerol) or fentanyl (Sublimaze) and midazolam ( Versed)
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what are the typical labs with CSF?
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glucose level reduced, protein increased
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is bacterial meningitis a medical emergency?
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YES!!!!
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What is the therapeutic regimen for bacterial meningitis?
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Isolation precautions, start Abx therapy, hydrate, ventilate, reduce ICP, manage bacterial shock, control seizures, correct anemia, treat complications
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What is the drug of choice for treatment of bacterial meningitis?
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Dexamethasone for the treatment of H. influenzae to decrease risk of neurologic sequelae
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what are the clinical manifestations of bacterial meningitis in children and adolescents?
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usually abrupt onset: fever, chills, HA, vomit, sensory alterations, seizures (initial sign), irritability, agitation
May develop: photophobia, delirium, hallucinations agressive behavior, drowsiness, stupor, coma, nuchal rigidity, hyperactive, petechial or purpuric rashes (meniingococcal infection),draining ear (pneumoccal meningitis), joint involvement (menigococcal & H. influenzae) |
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what are the clinical manifestations of bacterial meningitis in infants and young children?
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fever, poor feeding, vomit, marked irritability, freq seizures, bulging fontanel, nuchal rigidity, subdural empyema
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what are the clinical manifestations of bacterial meningitis in neonates with SPECIFIC signs?
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difficult to dx, vague symptoms, refuse to feed, poor sucking, vomit or diarrhea, poor tone, lack of movement, weak cry, full, tense bulging fontanel, neck supple
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what are the clinical manifestations of bacterial meningitis in neonates with NONSPECIFIC signs?
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hypothermia or fever, jaundice, irritability, drowsiness, seizures, resp irregularities, cyanosis, wgt loss
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what is a condition caused by an imbalance in the production and absorption of CSF in the ventricular system?
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hydrocephalus: which has passive dilation of the ventricles
-congenital or acquired (neoplasm, hemorrhage, or infection) |
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what is seen in hydrocephalus?
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enlargement of skull, sutures may open,
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2 factors that influence clinical pic are....
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time of onset and presence of preexisting structural lesions
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what is the predominant sign in infants with hydrocephalus?
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before the closure of the cranial sutures, head enlargement!
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what is the predominant sign in older infants and children with hydrocephalus?
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the lesions responsible produce other neurological signs through pressure on adjacent structures
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primary dx tools for hydrocephalus?
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CT and MRI...sedation required!
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Treatment for hydrocephalus?
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surgical...either direct removal of obstruction (tumor) or placement of a shunt (VP shunt) Ventriculoperitoneal
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what is the major complication of VP shunts?
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Most serious....Infection!!..mostly 1 to 2 months after initial placement
& Malfunction ( from displacement from growth)! |
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what are the clinical manifestations of hydrocephalus in infancy (early)?
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abnormal rapid head growth, bulging fontanels, esp ant, dilated scalp veins, Macewen sign, thinning of skull bones
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what are the clinical manifestations of hydrocephalus in infancy (later)?
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frontal enlargement or bossing, depressed eyes, setting sun eyes (sclera visible above the iris), pupils sluggish with unequal response
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what are the clinical manifestations of hydrocephalus in infancy (general)?
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irritability, infant cries when picked up or rocked then quiet when laid down, early reflexes, change in LOC, spastic lower extremity, vomit, advanced: difficulty sucking and feeding, shrill, brief, high pitch cry, cardio probs
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what are the clinical manifestations of hydrocephalus with children?
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HA on awakening, improve after emesis or upright position, papilledema, strabismus, estrapyramidal tract signs, ataxia, irritability, lethargy, apathy, confusion, incoherence, vomit
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Sedation is required for them to stay still for tomography...what do they receive?
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IV phenobarbital or oral chloral hydrate
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Post op care for hydrocephalus?
what if there is increased ICP? |
have them lay on unoperated side and have child lay flat
-MD will prescribe elevation of the HOB and child can sit up to enhance gravity |
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what other complications are observed post op hydrocephalus?
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peritonitis or postop ileus
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normal RBC
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4.5 to 5.5 million
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normal hemoglobin (Hgb)
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11.5 to 15.5 g/dL
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normal hematocrit (Hct)
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35% to 45 %
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anemia is what?
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number of RBC and hemoglobin is reduced below normal so the O2-carrying capacity of the blood is diminished, causing a reduction in the O2 available to the tissues
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what occurs in the body due to anemia?
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decreased peripheral resistance, causing greater quantities of blood to return to the heart. The increased circulation an turbulence within heart may produce murmur...so cardiac workload is increased
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1st clue to anemia?
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alterations in CBC Hgb below 10 or 11 g/dL
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severe anemia requires what?
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o2 therapy, bed rest, replacement of intravascular volume with IV fluids
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