heart failure
reduced function in the RV, increased CVP/systemic venous engorgement, edema
What does post op care look like
monitor VS, intra-arterial monitor of BP, monitor respiratory status, manage hypothermia, rest/pain/comfort, fluid management, progression of activity
What is infective endocarditis
infection of the inner lining of the heart, generally involving valves
What causes rheumatic fever/heart disease
inflammatory diseases after β-hemolytic streptococcal pharyngitis
What are the classifications for 1-13 yrs old and over 13
Elevated is between the 90-95th percentile
Stage 1 is the 95th percentile plus 12
Stage 2 is greater than the 95th percentile plus 12
Classification (above 13)
Elevated is 120-129/ <80
Stage 1 is 130-139/80-89
Stage 2 is >140 /90
What does left-sided heart failure include
Reduced function in the LV, increased pressure in the LA/PV, lungs become congested with blood (pulmonary pressure and edema)
monitor for quality and color
What are the manifestations
Unexplained low-grade fever
Malaise, HF S/S, weight loss, arthralgias
New murmur or change in previous murmur
Splenomegaly
Osler Nodes (red, painful nodes on the pads of the fingers)
Janeway Spots (painless hemorrhagic spots on the palms and soles)
What are the manifestations
Carditis**** (permanent damage)
Polyarthritis (first 1-2 weeks)
Chorea (irregular movements of extremities, muscle wknss, emotional lability, facial grimace)
Subcutaneous Nodules (nontender swelling)
Erythema Marginatum (pink rash with pale center and wavy on the trunk and extremities)
When do you start screening for HTN
screening at 3-year-old well-child checks
What are the manifestations of impaired myocardial function
Tachycardia, sweating, fatigue, weakness, restlessness, pale, cool extremities, decreased BP, decreased UO, weak peripheral pulse, slow cap refill, gallop, poor feeding
What should the color and quantity look like for a chest tube
notify for more than 3ml/kg/hr x3 consecutive hours OR 5-10 mL/kg for any 1 hour OR chest tube abruptly stops and may be bright red to serous
* Can indicate hemorrhage that can lead to cardiac tamponade
What is the management for IE
high-dose antibiotics (2-8 wks and repeat blood cultures), serial echocardiograms, surgical approach (valve)
What is Kawasaki
acute systemic vasculitis (vessel damage)
What is the treatment for HTN
ACE Inhibitors and ARBS
What are the manifestations of Pulmonary Congestion and Systemic Venous Congestion
Tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis, wheezing, grunting
Peripheral/perorbital edema, weight gain, ascites, hepatomegaly, neck vein distention
How would you monitor for fluid, and what is at risk
fluid overload is a risk; ALL IVs and flushes for intake and output for ALL sources (even blood work)
UO less than 1/mL/kg/hr can indicate possible renal failure
Who is most at risk
Artificial heart valves, previous diagnosis, CHD, cardiac transplant with valvulopathy
Unrepaired cyanotic CHD, including palliative shunts and conduits
Repaired CHD using prosthetic material or device during the first 6 months after the procedure
Residual defects after CHD repair at the site or adjacent to the site of a prosthetic patch or prosthetic device
What are the manifestations of Kawasaki
Strawberry tongue
High fever that does not respond to medication
Edema in the hands and feet
EXTREME irritability
Periungual desquamation (shedding off of finger and toenails)
Arthritis
Coronary Complications (aneurysms) leading to MI)
Who is at risk for Sinus Bradycardia and complete heart block
infants after atrial repairs and congential/after surgery
What is the management for heart failure
Improve cardiac function: digoxin, ACE inhibitors
Remove accumulated fluid or sodium
Decrease cardiac demands: normothermic environment, rest, decrease stimuli, easy flow bottle
Improve tissue oxygenation: oxygen
What are the potential complications
CHF (excessive pulmonary blood flow or fluid overload)
Dysrhythmias (electrolyte imbalance or intervention to the septum)
Decreased Cardiac Output Syndrome/Peripheral Perfusion (hypothermia or inability for the LV to maintain circulation)- cool extremities, weak pulses, decreased BP, increased cap refill time
Pulmonary Changes (atelectasis due to deflation of lung during bypass)
Neurological Changes (seizures)
What do we do for patients at risk
Prophylaxis (ABX 1 hour before procedures)
* amoxicillin, ampicillin, clindamycin
What is the treatment for Kawasaki
IVIG (high dose) within 7-10 days and Salicylate (Asprin) 80-100 mg/kg/day for fever, then 3-5 antiplatelet doses
What is the heart rate or SVT and treatment
200-300 bpm
vagal maneuver (ice to the face/masage carotid), adenosine (0.1 mg/kg RAPID IVP followed by flush), synchronized cardioversion, propranolol, atenolol, ablation