peds chapter 46 powerpoint

changes in circulatory system after birth

Gas exchange is transferred from the placenta to the lungs.
Fetal shunts close.
Resistance to flow in the pulmonary system decreases as systematic resistance increases.
Pulmonary vascular resistance decreases.
Marked increase in pulmonary blood flow follo

Circulatory changes at birth

shunting

abnormal blood flow; occurs:
Abnormal opening or connection
pressure higher on one side (pressure gradient)
SaO2 increased in normally desaturated blood or decreased in normal saturated blood
Newborn screening (2011):
Pulse oximetry no earlier than 24h af

heart failure manifestations

Poor weight gain, failure to thrive
Tachycardia
Cardiomegaly
Galloping rhythm
Poor perfusion
Liver and spleen enlargement
Weight gain

pulmonary hypertension

Mean pulmonary arterial pressure > 20mm Hg @ rest
Management:
Prevent occurrence
Treat s/s heart failure
Avoid strenuous activity & high altitudes

cardiac catheterization

Post - procedure:
Check pulse of affected extremity
Check temperature of affected extremity
Frequent vital signs
Assess temperature & color of extremity
Dressing check for hemorrhage
Keep leg straight for ________ hours
Keep quiet!
Diet as tolerated

digoxin

to improve cardiac function (improve contractility)
Dig= works well in pediatrics. Monitor apical pulse for 1 full minute
Rapid onset, short � life
Dig toxicity symptoms�vomiting, neuro signs, visual disturbances

angiotensin

enzyme inhibitors which reduce the afterload on the heart(preload = stretch. The amount of volume being returned to the right side of the heart from systemic circulation. afterload = squeeze. The amount of resistance the left side of the heart has to over

lasix

to remove excessive fluids� monitor potassium levels. give Potassium supplements�foods bananas, green leafy vegs.
Spironolactone:

prostaglandins

keep PDA open. The drug is indicated for use in the neonate with ductal-dependent pulmonary blood flow, including: pulmonary atresia, tricuspid atresia, Tetralogy of Fallot, and will often improve systemic oxygen saturation in infants with transposition o

indomethacin

PG inhibitor, constricts ductus arteriousus; no effect in full-term infants

adenosine

r SVT. Causes vascular smooth muscle dilation -> vasodilation

feeding infant with CHF

Feed the infant or child in a relaxed environment; frequent, small feedings may be less tiring.
Hold the infant in an upright position. This may provide less stomach compression and improve respiratory effort.
If the child is unable to consume appropriate

decreasing workload on the heart

Limit feeding time.
Elevate the head of the bed.
Provide uninterrupted rest.
Engage in self-limiting activities.
Provide oxygen (depending upon the lesion).

educating parents

Signs and symptoms of heart failure
Increased cyanosis
Dehydration
Infection
Dysrhythmias
Decreased nutritional intake

postoperative management

Monitoring cardiac output
Supporting respiratory function
Monitoring fluid and electrolyte balance
Promoting comfort
Healing and recovery

acquired heart diseases

- Infective endocarditis
- Dysrhythmias
- Rheumatic fever
- Kawasaki disease
- Hypertension
- Cardiomyopathies

endocarditis

Inflammation/infection involving endocardium
Fibrin/platelet deposition
Positive blood culture
New murmur
Confirmed with echocardiogram

Pediatric Dysrhythmias

1)Fast pulse rate
Supraventricular tachycardia
Ventricular tachycardia
2)Slow pulse rate
Bradydysrhythmias
Absent rhythms
- Asystole
- Ventricular fibrillation
- Pulseless electrical activity

Pediatric Dysrhythmias

SVT has a narrow QRS
Tachy: if non-toxic - stable: putting face in ice water or a bag of frozen food on forehead stimulates a vagal response. Blowing through a straw into water (What is a vagal response? - excessive activity of the vagus nerve, causing th

rheumatic fever

Jones Criteria
Diagnosed Group A Strep infection
Major criteria: carditis, polyarthritis, chorea, rash (erythema marginatum)
S/Q nodules over joints
Minor criteria: arthralgia, fever, elevated ESR/CRP, prolonged PR on EKG, abdominal pain, nosebleeds
Migra

rheumatic fever

rheumatic fever management

Antibiotics to be continued for 4-6 weeks. Now go home in 5-7 days and continue therapy at home. PCN drug of choice
Good dental hygiene. Use soft brush. Avoid floss (Iggy page 720)
SBE prophylaxis
Rest with fever or signs of heart failure.
Teach to monito

Kawasaki disease

What? Acute systemic vasculitis. Cause unknown
Who? < 5 years of age. All races
When? Late winter, early spring
How diagnosed? No specific test
Treatment? IV gamma globulin, ASA
Observe for S & S CHF
Baseline EKG

kawasaki treatment

IV Immune gloculin�high dose to reduce duration of fever and incidence of coronary artery abnormalities. Given within the 1st 10 days of the illness.
ASA�initially as antiinflammatory 80-100 mg/kg/day in divided doses q6h for fever and inflammation.
After

hypertension diagnosis

Frequent H/A
Dizziness
Vision changes
After age 3, routine measurement of B/P
BMI, labwork
Non-pharmacological management
Pharmacological management