Cardiovascular Pediatrics EXAM 2

Kawasaki disease

Acute systemic vasculitis

Common in children younger than 5

What causes Kawasaki

Possible trigger from infection

Clinical manifestations of Kawasaki

Very irritable

Acute: Red lips, red eyes without drainage, enlarged lymph nodes, non blistering rash

Subacute: Coronary artery aneurism, Temporary arthritis, peeling skin around nails, palms, and soles

Convalescent: Asymptomatic, just altered labs

Abnormal labs for Kawasaki

Increased CRP & ESR

Increased WBC

Low albumin

Low Hemoglobin

Diagnostics for Kawasaki

IVIG: first 10 days 2g/kg over 8-12

Aspirin is given for this only (controls inflammation)

Nurse care for Kawasaki

Monitor VS and cardiac status

Offer soft non acidic cool foods

Monitor I &O/ daily weights

Lip balm and mouth hygiene

Cluster care

Loose clothing/ Cool cloths

Teaching for Kawasaki

Avoid live immunizations for 11months

examples: no flu, MMR, varicella

Acute Rheumatic Fever/Disease

Abnormal immune response after GAS

Group A Beta Street infection

Usually occurs within 2-3 weeks of infection like strep

Acute Rheumatic Fever/ Diseases Clinical manifestations

History of upper respiratory infection (strep)

Chorea

Painful swelling joints

Pink non puritc rash

Tachycardia

Poor concentration

Labs for Acute Rheumatic Fever/Disease

Throat culture

ASO titer

ESR/CRP

EKG/ECHOCARDIOGRAM

Treatment for Acute Rheumatic Fever/Disease

Asprin

Antiinflammatory meds

Prednisone if pericarditis

Prophylactic treatment

IM Penicillin every 28 days

Antibiotic use for Rheumatic Fever/Disease

Rheumatic heart failure- for 5 years until age 21

Rheumatic heart Disease- for 10 years or until 21

Acure rheumatic Fever/disease nurse care

Assess for chorea (involuntary muscle movements)

Encourage bed rest

Take antibiotics as prescribed

Stress importance of cardiac involvement

Shock or circulatory failure

Diminished cardiac output or a reduced circulating blood volume impairs tissue perfusion

Failure to adequately deliver 02 and nutrients to tissues

Hypovolemic Shock

A decrease in blood volume

Distributive shock

Abnormal distribution of blood volume

Obstructive shock

Obstruction of blood flow

Key points in pediatric shock

Decreased cardiac output

Impaired oxygen delivery

Cellular

Compensatory mechanisms

Progressive deterioration

Treatment for shock or circulatory failure

Oxygenation and ventilation(o2, intubate)

Fluid administration (NS/LR)

Improvement of pumping heart (dopamine/ epinephrine)

Nurse care for shock or circulatory failure

Vital signs Q15min.

Ensure ventilation

Measure blood gases/PH/Electrolytes

Family support

Anaphylactic Shcok

Results from a hypersensitivity leads to a massive dilation

Severe reaction is life threatening

Expected findings for anaphylactic shock

Severe anxiety

Sweating

Flushing/uticaria

Sudden hypotension

Tightness in throat

Treatment for anaphylactic shock

Establish airway

Vasopressors (improve cardiac output)

Nursing care for anaphylactic shock

Recognitions of early sings

Elevate HOB

O2

CPR if not breathing

IV access

Monitor vitals and urine output

Education for parents for anaphylactic shock

On epi pens

where to administer

Septic shock

RAPID

Caused by infectious organisms

Septic shock expected findings Stage 1

Chills

fever

vasodilations with increased cardiac output

warm, flushed skin

Blood pressure and I&O are normal

Septic shock expected findings Stage 2

Cool Skin

Urine output diminishes

Blood pressure is normal

Septic shock expected finding stage 3

Hypotension (late sign of shock)

Anuria/oliguria

Function deteriates

Hypothermic

Multi organ failure

Worst stage

Treatment for septic shock

Antibiotics

Fluid volume resucitation (dopamine)

Inotropic agents

Complications of septic shock

Direct lung injury- activation of complement proteins that promote pumping of granulocytes in the lungs, causes fluid to leak in the alveoli causing stiff non compliant lungs

DIC- small clots throughout the body

Systemic inflammatory response syndrome- severe inflammation MEDICAL EMERG.

Cardiac catheterization is done where

Usually in femoral artery or vein in children

Right sided Cath- femoral vein threaded to right atrium

Left sided Cath- into an artery into aorta and into heart

Complication for Cardiac catheterization

Hemorrhage from entry site

Check for allergic reactions

A severe diaper rash is contraindicated for

Femoral catheterizations

Procedure will be canceled

it’s a sign of infection possibly

Why do we get height for a cardiac Cath

To ensure the correct catheter size selection

Be sure to mark pedal pulses

Nursing care prep prior to cardiac Cath.

Obtain consent

NPO 6-8 hours on average

Teach parents age appropriate care

Post procedure for cardiac Cath. nursing care

Pulses weaker 1st few hours

Temperature and color (cool/blanching can indicate arterial obstruction)

Vital signs every 15 min. be sure to get apical pulse for one full minute

Blood pressure- hypotension late sign of bleeding

Dressing- NEVER REMOVE

Fluid intake- to flush out dye

Blood glucose levels- Especially infants

Labs post procedure of cardiac cath

HCT/HGB EVERY 6 HOUR OR SOONER IF INDICATION OF BLEEDING

Nursing interventions/teaching

Keep patient in bed with the affected extremity maintained straight (have parent lay with them, distract them)

Avoid tub baths

Avoid Strenuous activity

Use Tylenol for pain NO NSAIDS

Signs and symptoms of bleeding (bruising, tachycardia, low bp, pale, low cap refill)

Digoxin during initiation of therapy

Monitor ECG to observe for desired effects

Digoxin is

the only inotopric agent available for infants and children

Monitor potassium levels

Increased potassium diminishes digoxin effect

Low potassium increases the digoxin toxicity

Before administering digoxin

Check apical pulse for 1 full minute

If below 90 hold for infants

If below 70 hold for older children

Signs of digoxin toxicity

GI- nausea, vomiting, anorexia

Cardiac- Bradycardia, dysrythmias

Parent education for digoxin

Demonstrate and return demonstration on how to administer medication (apical ulse for 1 full minute)

Review signs of toxicity

If a dose is missed do NOT give an extra dose

If child vomits do not give EXTRA dose

Do NOT mix with formula

Patent Ductus Arteriosus

Left to right shunt

PDA didn’t close

Increasing workload on Left side of heart causing pulmonary congestion

PDA signs and symptoms

Washing machine/ humming murmur(expected)

Crackles/ Dyspnea/tachypnea

Bounding pulses

Clammy/ sweaty

Heart failure

Poor feeding

PDA nursing interventions

Increased caloric intake (toleration of feeds)

Monitor for signs and symptoms of heart failure

PDA treatment

Surgery to close with coils with a cardiac Cath.

Medication- Indomethacin (NSAID) (TO HELP CLOSE)

Ventricular Septal Defect (VSD)

Increased pulmonary blood flow

Whole between right and left ventricle

Over circulation of flow

Signs and symptoms of Ventricular Septal Defect

Enlarged heart

Heart murmur

Difficulty breathing/ SOB

Tachycardia

High Blood Pressure

Ventricular Septal Defect nursing interventions

Alleviate respiratory symptoms

Treatment for Ventricular Septal Defect

Medications: Digoxin, Diuretics, Ace inhibitors

Surgery- Band pulmonary artery to decrease blood flow

Tetralogy of Fallot

Decreased pulmonary blood flow

4 defects

Pulmonary stenosis

Right ventricular hypertrophy

Overriding aorta (displaced)

Ventricular septal defect

Tetralogy of fallot signs and symptoms

@birth cyanotic and progressively gets worse

Blue or wet spells (infants knees to chest, toddler squats)

Syncope

Limited activity

Clubbing of fingers and nails

Hypoxia

Tetralogy of fallot Nursing interventions

Teach parent

Limit activity (do what they can, toddlers self regulate so they’ll stop on their own)

Treatment for Tetralogy of fallot

Surgery to patch hole

Shunt placement until primary repair

Medication for newborn: prostaglandin E1 (to keep whole open)

Coarctation of the Aorta

Obstructive defects

Narrowing of the aorta causing increase pressure to upper extremities, and decrease pressure to lower extremities causing damage to organs in lower body

Coarctation of the aorta signs and symptoms

Increased BP in upper extremities

Decreased BP in lower extremities

Absent femoral pulse

Cool extremities

Nosebleeds

Stroke

Coarctation of the aorta nursing interventions

Monitor BP on all four extremities

Post op care

Treatment for Coarctation of the Aorta

Meds: digoxin, diuretics, prostaglandin E1

Balloon with cardiac Cath.

Less than 6 months old they do surgery repair

Transposition of the great arteries

Mixed defects

Fully saturated blood mixing with desaturated blood

Life threatening

Aorta is attached to Right ventricle (not right)

Pulmonary to left ventricle (not right)

PDA must exist to sustain life

Transposition of the great arteries signs and symptoms

Profound cyanosis (especially when crying)

Tachypnea

Heart failure

Cardiomegaly

Cool skin

Nursing Interventions for Transposition of the Great Arteries

CCHD screen (done in nursery)

Pulse ox on both limbs if 4% difference there’s a problem

Treatment for Transposition of the Great Arteries

Meds: Prostaglandin E1 (to keep it open)

Balloon angioplasty

Cardiac Cath. to enlarge whole

Major heart surgery (arterial switch)

Hypoplastic Left heart syndrome

Mixed defects

Left side of heart is under developed

Need PDA

Emergent

Hypoplastic left heart syndrome signs and symptoms

Mild cyanosis

Cold hands/feet

Lethargy

Hypoplastic Left Heart Syndrome Nursing interventions

Monitor for signs and symptoms of heart failure

Hypoplastic Left heart syndrome Treatment

Surgery: Norwood

Life long heart meds

Heart transplant

Prostaglandin E1 (keep PDA open)