Block #3 - Renal, Reproductive, Respiratory, and Cardiac Flashcards
1
Q
Anatomy of the Kidney
A
Large in relation to stomach; prone to injury
2
Q
Anatomy of the Urethra
A
Shorter; increased risk for UTI
3
Q
Glomerular Filtration Rate
A
Slower in infants; increased risk for dehydration
4
Q
Bladder Capacity
A
30 mL in newborns; reaches adult size by 1 year
5
Q
Reproductive Organs
A
Immature at birth until adolescence
6
Q
Fluid and Electrolyte Balance
A
Greater risk for imbalance
7
Q
Why are kids at increased risk for dehydration?
A
GFR; greater BSA and a higher percentage of total body water
8
Q
Metabolic Rate in Pediatrics
A
greater than in adults
9
Q
What conditions is there an increased of incidence of?
A
Fever, URI, and gastroenteritis
10
Q
What is the O2 saturation goal for kids?
A
> 98%
11
Q
What is the most common ABG imbalance?
A
Metabolic Acidosis
12
Q
What is the normal UOP for pediatrics?
A
1-2 mL/kg/hr
13
Q
Sodium Levels in Pediatrics
A
130-150
14
Q
Isotonic Dehydration: Description and Cause
A
Na loss = H2O loss
Cause: excessive sweating
15
Q
Hypotonic Dehydration: Description and Causes
A
Na loss (low sodium) > H2O loss
Causes: Burns, diuretics, N/V, and diarrhea
16
Q
Hypertonic Dehydration: Description and Causes
A
Na loss (high sodium) < H2O loss
Causes: Salt water ingestion, rheumatic fever, heat stroke
17
Q
Top 3 S/S of Dehydration** in Pediatrics
A
- Prolonged cap refill
- Decreased turgor
- RR change
18
Q
S/S of Dehydeation in Pediatrics
A
- Loss of skin elasticity (“tenting”)
- Dry mucosa
- Decreased UOP
- Sunken fontanelles
- Tachycardia
- Decreased cap refill
19
Q
Nursing Care for Dehydration
A
1 - obtain daily weights
20
Q
Classifications of Dehydration (% fluid loss)
A
- Mild: 0-5%
- Moderate: 6-10%
- Severe: >10%
21
Q
What is the #1 cause of UTI in young girls?
A
Urinary stasis
22
Q
What is the most common pathogen for UTIs in young girls?
A
E. Coli
23
Q
UTIs are often _______ infections
A
Nosocomial
24
Q
UTI: Diagnostics Process
A
- Clean catch (if potty trained)
- U bag if untrained
25
What is a Nosocomial Infection?
Hospital acquired
26
What is the abx drug of choice to treat UTIs?
Gentamycin
27
What is vesicoureteral reflux (VUR)?
The valve b/w the ureters and bladder isn't working right --> leads to urinary stasis (#1 cause of UTIs)
Should be 1-way valve, works 2-way
28
Vesicoureteral Reflux (VUR): S/S
- Recurrent UTI
- Flank pain
- Abdominal pain
- Enuresis (unable to control peeing)
29
Glomerulonephritis (post-strep)
-Limited filtration causes protein and blood to spill in urine
30
Glomerulonephritis: S/S
- Hematuria
- Tea colored urine
- Periorbital edema
31
Glomerulonephritis: Care
- Daily weights/ Input and Output
- Daily abd girth
- If severe: dialysis
- Assess for URI
- Monitor for HTN
- Steroids increase infection risk
- Don't bed rest
32
Whic type of dialysis is most recommended for pedaitrics?
Peritoneal dialysis
33
Risks fo Steroids
- Increased chance of infection
| - Increased BG
34
What is CPT?
Chest Physiotherapy - patting on chest/back to break up secretions
35
Which condition is CPT a treatment of?
Cystic fibrosis
36
CPT: timing
QID (Before meals/Before bedtime)
37
Sutioning for Pediatrics
- Each pass <5 seconds
| - Suction only on the way out
38
Respiratory Distress: S/S
- Nasal flaring
- Retractions
- Stridor
- Restlessness
39
What is the earliest sign of respiratory distress?
restlessness
40
Treatment for Allergic Rhinitis
Administer antihistamines, identify and remove trigger
41
Quick Relief for astham/allergic reaction
Epinepherine (for antiphylaxis)
42
Long-term Relief for asthma/allergic reaction
Albuterol, MDI
43
Acute Streptoccocal Pharyngitis: major risk
Sequelae
- Rheumatic fever/heart disease (cardiac)
- Glomerulonephritis (renal)
44
Strep. Pharyngitis: S/S
- Fever/chills
- Foul breath
- Dry thoat
- Dysphagia
- Otalgia
- HA
- Malaise
- Muscle pain
- Enlarged cervical nodes
- Mouth breathing
45
Which condition leads to tonsillitis and a possible tonsillectomy?
Acute strep. pharyngitis
46
Pharyngitis: nursing care
- Give abx
- Bed rest
- Apply warm/cold compresses to neck
- Warm saline gargle
- Foods and liquids as tolerated
- Teach hand washing
47
Pharyngitis: S/S
- Abrupt illness
- HA, fever, and abd pain
- Tonsils amnd pharynx (inflamed, red, covered in yellow exudate)
- Inflammed painful lymph nodes
- Pain on swallowing
48
Tonsillectomy Post-op Care
Assess for post-op bleeding: frequent swallowing
49
Croup: Nursing Care
- Maintain airway
- Cool mist vaporizer
- Corticosteroids
- Nebulized Epi
- Monitor respiratory and cardiac systems
- **Never assess with tongue blade
50
Croup: S/S
- Hoarseness
- Barking cough, inspiratory stridor
- Respiratory distress
- Respiratory infection
- Effects on the larynx, trachea, and bronchi
51
Which retractions indicates the most severe distress?
Clavicular
52
What is the most lethal genetic illness in white children?
Cystic Fibrosis
53
Cystic Fibrosis: Patho
- Increased production and viscosity of mucus
- Mucus forms concretions in glands and ducts
- Elevation of sweat electrolytes
Mainly affects the respiratory tract and the pancreas
54
Cystic Fibrosis: Diagnostics
- Sweat chloride test
- Chest X Ray
- Stool fat and/or enzyme analysis
- Barium enema
55
Cystic Fibrosis: GI Effects
- Impaired fat/protein digestion = steatorrhea, azotorrhea
- Clubbing
- Sterility in males
- Delayed puberty in females
- Rectal prolapse
- **Children "taste salty"
- Dehydration
56
Epiglottitis (croup exacerbation): S/S
- Sore throat
- Pain
- Tripod sitting
- Retractions
- Stridor
- Mild hypoxia
- Distress
57
Epiglottitis: prevention
Hib Vaccine
58
Epiglottitis: Nursing care
Trach kit at bedside
59
Apnea
Defined: >20 seconds without breathing
Stimulate child to breathe before calling a code
60
Hypoxemia
- Chronic can cause clubbing
| - Keep O2 >98%
61
Esophageal Atresia
EMERGENCY
S/S: frothing/bubbling at the mouth/nose, excessive drooling, coughing, cyanosis, respiratory distress
62
Tetralogy of Fallot (TOF) 4 conditions in 1
- VSD (Ventricular septal defect)
- Pulmonic Stenosis
- Overriding Aorta (shifted)
- Right Ventricular Hypertrophy
63
TOF: S/S
- Cyanosis with crying or playing
| - TET spells
64
TOF: Care
- Requires surgical repair
- Post op management
- Subacute Bacterial Endocarditis Prophylaxis (SBE)
65
Congenital Heart Defects
- Increases respiratory infection risk
- Impaired myocardial function
- Pulmonary congestion
66
CHD: Causes
-Maternal drug use
-Teratogenic conditions during pregnancy
Rubella (german measles), Chickenpox, 5th disease
-Infant to diabetic mother (IDM)
67
Systemic Venous Congestion: S/S
- Pleural effusions
- Hepatic enlargement
- Ascites
- Edema
- JVD
68
Rheumatic Fever: S/S
- Carditis
- Polyarthritis (>5 joints)
- Erythema marginatum (rash)
- Subcutaneous Nodes (non-tender nodes over bony prominence)
69
Activity Recommendations for CHD kids
- Activity is fine
| - Recommend frequent rests as needed
70
Ventricular Septal Defect (SVD)
A hole b/w the ventricles, causing oxygenated and deoxygenated blood to mix
May need surgical repair
71
SVD: S/S
- SOB
- Feeding difficulties
- Poor growth
- Easily fatigued
- Heart murmur with thrill
72
Coarctation of the Aorta (CoA)
Narrowing of the aorta (may be from ductus arteriosus closure scarring)
73
CoA: S/S
- Rapid RR
- Heavy breathing
- CHF
- Poor weight gain
- BP difference b/w arms and legs
- Lower extremities = cool
- Upper extremities = warm
74
Aortic Stenosis (AS or AVS)
Abnormality in development of the aortic valve; progressively worsens = blood flow alterations
Frequently missed diagnosis
75
Aortic Stenosis: S/S
- Fatigue
- SOB
- Tachycardia
- Chest pain
- Decreased CO
- Possible sudden death
- Clubbing (10-11 yr)
76
Pulmonic Stenosis (PS or PVS)
Narrowing of the opening of the pulmonic valve. RV must push harder to get blood through = dysrythmia
77
Pulmonic Stenosis: S/S
- Skin pale, cool, clammy
- Unable to exercise
- Fatigue
- Heavy/rapid breathing
- Whooshing breaths
78
Pulmonic Stenosis: tx
Balloon valvuloplasty or open heart surgery
79
Patent Ductus Arteriosus (PDA)
Ductus arteriosus fails to close = blood flow from the left side of the heart into the lungs
80
PDA: S/S
- Murmur
- Frequent colds
- Susceptible to RSV
- Fatigue
- Poor feeding
- Poor growth pattern
81
PDA: Care
- Closed surgically
| - Indomethacin (Indocin)
82
Blood Flow
```
Vena Cava
RA--> tricuspid
RV--> pulmonary valve --> pulmonary arteries
Lungs--> pulmonary veins
LA--> bicuspid (mitral) valve
LV--> aortic semilunar valve
Aorta
Body
```
83
CPR Guidelines for Peds
Unwitnessed: CPR 2 mins, then call for help
Witnessed: Call for help and begin CPR immediately
1- 30:2
2- 15:2
