NUR500 unit 2 notes

2/18/2014 7:03:00 AM

GABHS should always be on differential for preschool/schoolage children with fever (will not present with classic triad of symptoms) Acute streptococcal pharyngitis - group a beta hemolytic strep Brief illness, symptoms vary from subclinical (no symptoms) to severe toxicity not serious but can lead to acute rheumatic fever (inflamm. Disease of heart, joints, and CNS ~18 days after) acute glomerulonephritis ~ 10 days after strep is leading cause MANIFESTATIONS: ABRUPT onset, pharyngitis, fever, abd pain, tender anterior cervical lymphadenopathy, tonsillar and pharyngeal inflammation and exudate goes away 3-5 days unless complicated by another infection not infectious to others 24 hours after initiation of antibiotics therapy, go back to school and discard toothbrush at this time

CARDIAC ASSESSMENT + COMMON PROBLEMS

**know the red flags , athlete clearance, s2 split in children

AV valves lined with chorea tendinae Left ventricle is dominant in adults , fetus right ventricle is dominant **FETAL CIRCULATION: (think of them as aquatic creatures) placenta responsible for blood oxygenation and elimination of waste products SHUNTS(know) o Liver bypassed by ductus venosus . venous blood bypasses liver thru ductus venosis to the IVC. BLOOD FROM IVC crosses right atrium thru foramen ovale to left atrium o Right atrium mixing of oxygenated and deoxygenated blood

o After birth, SVR rises and over time LV develops to normal o In infancy, heart muscle fibers are less developed and they are at risk for volume overload and HF o o o SHUNTS TO KNOW Patent Foramen Ovale (PFO) closes with rising left-sided pressure Patent Ductus Arteriosus (PDA) constricts and closes with exposure to oxygen and decreasing levels of ciculatory prostaglandin Ductus Venosus closes in response to extrauterine life HISTORY: key questions to ask with heart problem babies Did mother have rubella, drug/med exposure, fevers Maternal h/o diabetes? Lupus? IF LUPUS BABY NEEDS EKG BECAUSE PREDISPSURE TO HEART BLOCK Does baby fatigue easily, resp distress? Tachypnea, color changes, cyanosis? How has child been growing Family history red flags: congental heart problems, chromosomal **premature MI, **history of sudden cardiac death **family history of arrhythmias

*****If a murmur is not heard sitting but heard lying down usually innocent If a murmur is heard sitting up, but not lying down usually pathologic
Systolic murmur between s1 and s2 (lub ss dub) Holosystolic

o Obscure s1 partially or completely (shhh dub ssdub) Grade 1 = very faint, may not be heard in all positions Grade 2, faint but readily audible 3 moderately loud, no thrill grade 4= loud, +/- palpable thrill 5 very loud with thrill edge of stethoscope partially off chest wall 6= very loud; stethoscope 1 cm above chest wall

always do femoral pulse in pedi weaker lower pulses worry about HF

2/18/2014 7:03:00 AM

2/18/2014 7:03:00 AM