NURS 3230 Peds Cardiac Exam Study Guide 2024

What medications taken during pregnancy are teratogens? - SSRIs (zoloft, lexapro, prozac, celexa), some antiepileptic meds, acne meds (tretinoin) What is a teratogen? - can cause a birth defect What hx should you check in an infant? - feeding and weight gain, breathing, diaphoresis, developmental milestones Is diaphoresis normal in an infant? - no What in the environment can effect peds cardiac? - smoking What is chest pain usually related to for a child? - respiratory What is sinus arrhythmia? - heart rate speeds up and slows down sometimes Is sinus arrhythmia normal in babies? - yes What should you assess in a peds cardiac assessment? - general, respiratory, cardiac rate and rhythym, BP, color, auscultation Where do you listen for a child's apical pulse? - 4th ICS, mid clavicular line Why do you do a chest xray? - to see the size and shape of heart, be careful because of radiation exposure What is an echocardiogram? - US of the heart What is electrocardiogram? - EKG, ECG What is telemetry? - provides rhythm and rate wear for 2 days, records continuously take off in the shower What is a holter monitor? - wear it longer and also have recording box where you can press for sxs What percentile do you not want to be over? - 85th What percentile to you want to be at? - 50th What is the blood pressure percentile for elevated or pre-hypertension? - 85-95% How can you diagnose if the blood pressure is high? - 3 separate occasions at least 6-8 hrs apart What percentile is considered hypertension? - >95% What are education topics for high blood pressure? - daily aerobic exercise healthy eating- fruits and veggies, no sugary drinks avoid high salt stop smoking weight loss sleep hygiene What are drugs used to control blood pressure? - ACE inhibitors, channel blockers, diuretic What is rheumatic fever? - it is an inflammatory disease that may develop after an infection with streptococcus bacteria (such as strep throat or scarlet fever) What are sxs of rheumatic fever? - fever, polyarthritis, subcu nodules, erythema marginatum, chorea, carditis (murmur, tachycardia, cardiomegaly, CHF) Where is rheumatic fever common? - third world countries <3% of strep and population develops RF What is arthritis in RF? - is reversible and migratory, especially in large joints Migratory - affects joint for 1-2 days, hot and painful and then moves to another joint. What is subcutaneous nodules? - small, non tender nodules appear over bony prominences hands, feet, elbows, scalp Persists indefinitely after onset of the disease and resolves w no resulting damage What is erythema marginatum? - rash, usually on trunk and proximal portion of the extremities. Red macule w clear center and wavy, well-demarcated border What is chorea? - movement disorder that causes jerking in limbs and body. take phenobarbital What is carditis? - inflammation of endocardium, pericadium, and myocardium. Most common. The mitral valve and aortic valve are affected differently What happens if the valves are damaged by rheumatic fever? - may not be able to open fully, causing narrowing of the valve (stenosis). or valves may not be able to close fully, resulting in a leak or not enough blood to supply What is valvulitis? - inflammation of the valve flaps Myocarditis? - inflammation of heart muscle pericarditis? - inflammation of the membrane or outer covering of the heart What is jones criteria? - 2 major sxs or 1 major and 2 minor What sxs are on the jones criteria? - Polyarthritis Erythema marginatum Subcutaneous nodules Chorea Carditis Fever 101 Elevated CRP Elevated sed rate Heart block- prolonged PR interva; What labs do you draw for rheumatic fever? - antistreptolysin (ASLO) Sed rate CRP CXR/Echo/EKG What is antistreptolysin ASLO? - blood test to measure antibpdies against streptolysin O, a substance produced by group A streptococcus bacteria. Positive test means you had strep recently even if you had no sxs Lab results increase 3-5 weeks after infection What is sed rate? - blood test that measures how quickly RBC (erythrocytes) settle in a test tube in one hour. The more RBCs that fall to the bottom of the test tube in one hour, the higher the sed rate (inflammation) When inflammation is present in the body, certain proteins cause RBC to stick together and fall more quickly than normal to the bottom of the tube What is a normal sed rate in children? - 0-10 what is a normal sed rate in adults? - 0-20 What is a CRP? - blood test that measures the amount of C reactive protein, which measures general levels of inflammation in your body. This protein is produced by the liver shortly after the start of the inflammation process What are high levels of CRP caused by? - infections and long term diseases What is a normal CRP? - <1 or <3 What drugs are used for tx of rheumatic fever? - Penicillin Aspirin Prednisone Phenobarbital-maybe Are patients susceptible to lifetime rheumatic fever? - yes if there is cardiac valve damage, Rheumatic heart disease When do you give PCN for RF? - drug of choice for strep, 10 days. If allergic use macrolides or cephalosporins Patient may still be a carrier for strep What is aspirin used for in RF? - to reduce fever and for comfort, control inflammation of joints What is prednisone used for RF? - inflammation what is phenobarbital used for RF? - chorea What is prophylaxis tx for RF? - for children with acute RF, PCN injection. Length of time depends on the involvement If no proven carditis, still could get a PCN monthly injection for 5 yrs or until 21 What is Kawasaki disease? - acute systemic vasculitis, inflammation of small blood vessels, then progresses to med size vessels which become damaged and can lead to aneurysms What is kawasaki disease caused by? - not contagious or congenital but could be geophraphical, seasonal, genetic Could be triggered by some infectious agent will most children fully recover from kawasaki disease? - yes Who does kawasaki disease usually effect? - asian males <5yo What are sxs of kawasaki disease? - Fever +4 Red eyes Red tongue Raised cervical lymph nodes- unilateral Rash- diaper area Red palms and soles then peeling Raised WBC Extreme irritability Cardiac involvement Fever with kawasaki disease? - >101.3 and unresponsive to antipyretics for 5 or more days What labs do you draw for kawasaki disease? - CRP and Sed rate What are nursing interventions for kawasaki disease? - VS- temperature PO fluids emollient for lips IV fluids quiet environment defer live vaccines 6mo What are live vaccine? - MMR, varicella, rotavirus, influenza