Pediatrics Exam 4 with Complete Solutions

fetal circulation: hole between RA & LA? - ANSWER foramen ovale fetal circulation: connects pulmonary artery & aorta; blood bypasses lungs; closes in 12-72 hours? - ANSWER ductus arteriosus fetal circulation: blood bypasses the liver? - ANSWER ductus venosus fetal circulation: oxygenation of blood occurs in the? - ANSWER placenta occurs in 6-8 per 1,000 live births; about 2-3 of these are symptomatic in first year of life; second leading cause of death in ages 1-4 after accidents? - ANSWER congenital heart disease causes of congenital heart disease? - ANSWER chromosomal: genetic, fam-history (most common are atrial septic defect, ventral septal defect, & valve stenosis) acquired: environmental = infections, autoimmune factors, genetic factors, teratogens, chemical or physical agents; maternal factors = fetal alcohol syndrome (50% have CHD), smoking, diabetes, maternal age > 40 pediatric indicators of cardiac dysfunction? - ANSWER failure to thrive (poor weight gain), SGA, dysmorphic features, developmental disabilities, chest wall deformities, clubbing of fingers, scoliosis, tachypnea (frequent upper respiratory infections, cyanosis with crying), tachycardia (> 160 in infants & > 120 in preschool age), diaphoresis, change in peripheral pulses, capillary refill > 2-3 seconds, peripheral edema, thrills, temp changes (cold hands or feet) child with cardiac disease may have the following respiratory symptoms? - ANSWER tachypnea (> 60), frequent resp infections, cyanosis with crying, pulmonary edema, frothy/pink tinged sputum normal BP ranges? - ANSWER neonate: 50-75/30-45 older children: minimum systolic is 70 mm HG + 2 X age in years increase in systolic & decrease in diastolic; can indicate patent ductus arteriosus & increased cerebral pressure? - ANSWER wide pulse pressure high diastolic & low systolic; indicates poor cardiac output? - ANSWER narrow pulse pressure hepatomegaly (felt > 3 cm below right costal margin) can indicate? - ANSWER CHF acrocyanosis is normal for ___ hours after birth? - ANSWER 24 outcomes of CHD: increased pulmonary blood flow = ? - ANSWER CHF outcomes of CHD: decreased pulmonary blood flow = ? - ANSWER cyanosis outcomes of CHD: obstruction of blood flow from ventricles; obstructed L heart = ? - ANSWER CHF outcomes of CHD: obstructed R heart = ? - ANSWER cyanosis outcomes of CHD: mixed blood flow = ? - ANSWER hypoxemia with or without cyanosis, may have CHF anomaly that shunts blood from venous to arterial system; right to left shunt; deoxygenated blood goes to the left side of the heart? - ANSWER cyanotic circulatory anomaly that involves either stricture or shunt that moves oxygenated blood to venous system; obstructive lesions that restrict ventricular outflow; these disorders can cause ineffective pump action & lead to CHF; left to right shunt? - ANSWER acynotic cyanotic defects include? - ANSWER tetralogy of fallot, transportation of the great vessels, truncus arteriosus, tricuspid atresia, hypo plastic left acynotic defects include? - ANSWER PDA, ASD, VSD, aortic stenosis, pulmonic stenosis, coarctation cyanotic heart symptoms? - ANSWER cyanosis (esp with crying), tet spells, hypoxia (clubbing, exertional dyspnea, syncope), squatting, fatigue, failure to thrive, CHF, assume knee chest position at rest, polycythemia, murmur acynotic heart symptoms? - ANSWER usually no cyanosis, pulmonary congestion, ventricular hypertrophy, murmurs, frequent URIs, CHF, slow weight gain acynotic heart defect: left to right shunt; increased pulmonary blood flow defect; fetal structure that is supposed to close within 72 hours of birth; common problem in premature infants- failure to close; increasing risk of CHF & endocarditis; symptoms: murmur, tachypnea, poor feeding, fatigue, sweating, low O2 sat, excessive fluid/weight gain, wide pulse pressure, bounding pulses? - ANSWER patent ductus arteriosus (PDA) treatment of PDA? - ANSWER IV indomethacin (a prostaglandin inhibitor) that constricts & closes the ductus; ibuprofen & acetaminophen given IV can also be used; can be closed surgically if meds fail acynotic heart defect: left to right shunt; increased pulmonary blood flow defect; opening between left & right atrium; most close spontaneously; often asymptomatic; systolic murmur; frequent hx of URI or pneumonia; may fatigue easily or have exertional dyspnea; poor feeding; signs of CHF; easiest defect to fix? - ANSWER atrial septal defect (ASD) treatment of ASD? - ANSWER meds: digoxin or diuretics closure of defect through cardiac cath acynotic heart defect: opening between ventricles; most common CHD; vast majority close by 4 years; left to right shunt; increases pulmonary blood flow defect & stiffening of lungs; murmur is loud & harsh at left sternal border; SOB; feeding difficulties; thrill; recurrent upper resp infections; failure to thrive? - ANSWER ventral septal defect (VSD) treatment of VSD? - ANSWER close with cardiac cath; post treatment: monitor site for bleeding & for arrhythmias acynotic heart defect: left to right shunt; obstructive defect; increased BP in upper extremities & decreased BP in lower extremities by 20 mm HG or less; absent or weak arterial femoral & other distal pulses; headache; severe cases: lower body mottling or pallor; systolic murmur; s/s of CHF; rib notching? - ANSWER coarctation of aorta treatment for coarctation of aorta? - ANSWER surgery acynotic heart defect: left to right shunt; obstructive defect; obstruction of blood from L ventricle to aorta; increases workload on left ventricle (hypertrophy); fatigue, chest pain, systolic murmur, syncope, SOB, narrow pulse pressure, poor feeding, tachycardia, hypotension? - ANSWER aortic stenosis treatment of aortic stenosis? - ANSWER prostaglandin to maintain PDA, balloon angioplasty acynotic heart defect: left to right shunt; obstructive defect; constriction of pulmonic valve; right sided pressure is increased as ventricle pumps against the obstruction; increases workload on right ventricle (hypertrophy); usually asymptomatic with a murmur on exam; if severe or progressing: exertional dyspnea, fatigue, CHF, cyanosis w/severe narrowing? - ANSWER pulmonic stenosis treatment of pulmonic stenosis? - ANSWER balloon angioplasty cyanotic heart defect: right to left shunt; decreased pulmonary blood flow; involves 4 defects: pulmonary valve stenosis, ventral septal defect, overriding aorta (overrides ventricular septum), & right ventricular hypertrophy; cyanosis & dyspnea increase by 2-4 months old, poor weight gain, systolic murmur, bounding pulses, polycythemia, tet spells (severe cyanosis that can lead to brain injury & death); squatting noted in older children? - ANSWER tetralogy of fallot treatment for tetralogy of fallot? - ANSWER maintain PDA with prostaglandin E; cardiac cath & multiple open heart surgeries; treatment of tet spells: knee-chest position for infants & squatting for older children cyanotic heart defect: right to left shunt; decreased pulmonary blood flow; missing or defective tricuspid valve; cyanosis 1st week of life, fatigue with effort of crying or feeding, clubbing, hepatomegaly may or may not be present? - ANSWER tricuspid atresia treatment for tricuspid atresia? - ANSWER multiple stages of surgery, maintain PDA with PGE a potent (systemic) vasodilator of smooth muscle tissue; relaxes smooth muscle of the ductus arteriosus; given IV; used to delay closure of PDA or reopen it; contraindication is resp distress syndrome? - ANSWER prostaglandin E1 (PGE1) cyanotic heart defect: right to left shunt; mixed defect; incompatible with life without ASD or VSD that allows blood mixing; often occurs in LGA infants; profound cyanosis within 24 hrs of birth esp with crying; murmur, CHF, tachypnea? - ANSWER transposition of the great arteries treatment for transposition of the great arteries? - ANSWER maintain PDA with prostaglandin E1; surgery cyanotic heart defect: right to left shunt; mixed defect; underdeveloped left heart; leads to pulmonary HTN; asymptomatic until PDA closes; cyanosis, tachypnea, can be fatal in first few days or months of life? - ANSWER hypoplastic left sided heart treatment of hypoplastic left sided heart? - ANSWER IV PGE1; multiple surgeries; heart transplant (high mortality rate) cyanotic heart defect: right to left shunt; mixed defect; failure of septum formation- a single vessel that comes from both ventricles; increased incidence if mother is exposed to rubella, fetal alcohol syndrome, & down's syndrome; symptoms: cyanosis, CHF, murmur, lethargy, fatigue, poor feeding, tachypnea, diaphoresis? - ANSWER truncus arteriosus treatment for truncus arteriosus? - ANSWER surgical repair within first month of life; avoid O2 which sided congestive heart failure is there pulmonary congestion; affects the lungs; blood backs up into left atrium & left pulmonary veins; s/s: tachypnea, dyspnea, resp distress, exercise intolerance, & cyanosis? - ANSWER left side which sided congestive heart failure is there systemic venous congestion; affects body; right ventricle cannot pump enough blood into pulmonary artery; s/s: peripheral & periorbital edema, weight gain, ascites, hepatomegaly, & neck vein distention? - ANSWER right side given to slow heart beat (chromotropic); makes heart beat stronger (inotropic); has rapid onset; available as elixir; given po or IV; must check dose with another nurse before giving; do not repeat dose if child vomits; take apical pulse for 1 minute & hold in infant if HR < 90, children HR < 70, & adults HR < 60; monitor for toxicity: n/v, diarrhea, visual disturbances (halos); administer 1 hr before or 2 hrs after meals; therapeutic levels: 0.8-2 mcg/L? - ANSWER digoxin (cardiac glycoside) inflammatory disease that occurs 2-6 weeks after a strep infection; self-limiting: affects joints, skin, brain, serous surfaces, & heart? - ANSWER rheumatic fever most common complication of rheumatic fever; damage to valves as result of the fever; carditis: mitral valve often affected; polyarthritis: reversible & migratory; erythema marginatum: rash on trunk; subcutaneous nodules: small, non-tender appearing over bony prominences of hands, scalp, etc., & resolve without damage; chorea: uncontrolled movements & go away on own? - ANSWER rheumatic heart disease treatment of rheumatic heart disease? - ANSWER antibiotics, anti-inflammatory meds, hospitalization, bedrest, good nutrition, antibiotic prophylaxis for at least 5 years prevention of rheumatic heart disease? - ANSWER treatment of strep with penicillin or erythromycin if allergic to penicillin inflammation of inner lining of heart; bacterial: strep or staph; fungal: candida albicans; s/s: fever, fatigue, cough, heart murmur, SOB, joint pain, weight loss, flank pain, CHF; roth spots: white spots in retina in early stages; janeway lesions: flat, painless red spots on palms & soles of feet; osler nodes: painful, red, raised lesions on palms & soles; black lines: splinter-like bits under the nails? - ANSWER endocarditis treatment for endocarditis? - ANSWER antibiotics IV for 2-8 weeks; prophylactic antibiotics before procedures endocarditis is most likely to occur from? - ANSWER simple cuts, dental work, teeth brushing, URI, catheters an acute systemic vasculitis of unknown cause; up to 85% of cases in children < 5; leading cause of acquired heart disease in children; complications of being left untreated can be fatal; not contagious? - ANSWER kawasaki disease diagnosis of kawasaki disease (no specific diagnostic test)? - ANSWER must have fever for 5 days that is unresponsive to antipyretics ; conjunctivas: bilateral; erythematous rash on trunk & extremities; red lips & strawberry tongue; swelling of hands & feet; non-blistering rash on palms & soles or desquamation of hands & feet; cervical lymphadenopathy; myocarditis (71% have MI within 1st year) what disease is C-reactive protein > 3.0 and/or ESR > 40 = inflammation must have at least 3 of the following: albumin < 3, anemia for age, elevation of alanine aminotransferase, platelets after 7th day > 450,000, WBC > 15,000, urine > 10 WBC/HPF, positive ECG? - ANSWER kawasaki disease which stage of kawasaki disease is there sudden high fever, unresponsive to antibiotics & antipyretics (days 0-14)? - ANSWER stage 1 acute which stage of kawasaki disease is end of fever through all end of all clinical signs; death from cardiac complications 15-45 days after onset of fever; greatest risk of coronary artery aneurysms? - ANSWER stage 2 subacute which stage of kawasaki disease are clinical signs resolved, but lab values have not returned to normal; completed with normal values 6-8 weeks from onset? - ANSWER stage 3 convalescent which stage of kawasaki disease is from 40 days to years after illness onset? - ANSWER stage 4 chronic treatment of kawasaki disease? - ANSWER IV immune globulin (high dose); ASA normal hypertension? - ANSWER less than 90th percentile prehypertension? - ANSWER 90-95th percentile stage 1 hypertension? - ANSWER 95th-99th percentile + 5 mm Hg stage 2 hypertension? - ANSWER 99th percentile + 5 mm Hg anual screening for hypertension should begin at what age? - ANSWER 3 leading cause of heart transplants in children; usually terminal; can develop as complication from rheumatic fever or kawasaki disease; s/s: CHF, sweating, dizziness, weight loss, murmur, hepatomegaly, fatigue, frequent URIs, dysrhythmias? - ANSWER cardiomyopathy which WBC indicate a long term infectious process? - ANSWER monocytes which WBC indicates a viral infection? - ANSWER lymphocytes which WBC indicates allergic or parasitic conditions? - ANSWER eosinophils