cheo final Flashcards

Question

influenza

Answer 1

Types A and B - Spread by droplet/contact - Severe in infants Symptoms: - dry throat, dry cough, photophobia, myalgia, lack of energy, fever/chills - Can lead to viral pneumonia, encephalitis, secondary bacterial infections - Lasts 4-5 days - In mild cases supportive management at home - no asprin (reye syndrome) In severe cases: - Tamiflu (oseltamivir) 48hrs Prevention: - flu shot!

Answer 2

Caused by: - Bordetella pertussis - Primarily occurs in children under 4 and not immunized - High morbidity and high risk of mortality - PREVENTION is the key - Immunization - Life-long immunity after infection nsg care: - droplet precaution (nasal swab) Management: - Supportive care - erthyromicin

Answer 3

Pneumonia - inflammation of the lungs --> alveoli fill w fluid Etiology In children,usually: - Viral (RSV, influenzas) - Bacterial - Aspiration Pneumonia: Nursing Care Plan - Goal; Decrease respiratory effort, prevent exhaustion and/or Increas eefficacy Interventions: - chest xray - Frequent assessment, close observation depending on presentation - Position, clear airway (suction), offer O2 - Humidified highflow NP - Antibiotics - Promote hydration and nutrition

Answer 4

Autosomal recessive trait - CF gene inherited from both parents (both parents must be carriers) – - Increased Viscosity of Mucous Gland Secretion - Results in mechanical obstruction - Thick mucus accumulates, dilates, precipitates, coagulates and blocks glands, ducts, passageways - 90% have a blocked pancreatic duct - Malnutrition - Respiratory tract and pancreas are predominantly affected

Answer 5

1. decreased fluid intale/increased fluid loss 2. rapid ecf loss (children have less ecf) 3. electrolyete imbalances 4. Icf loss 5. cellular dehydrations 6. hypovolemic shock 7. death key ecf losses - diarrhea and vomitting - blood loss/ wound drainage - insensible losses

Answer 6

isotonic - Na loss = water loss - ecf losses - V+D --> insensibble losses --> decreased PO intake - most common type for children (ECF is high in sodium) hyotonic loss - Na loss > water - ECF to IC space --> increases ECF loss - edema - V+D, burns, renal issues hypertonic - Na loss

Answer 7

CO = HR x SV Compensation: - ↓ Stroke Volume (SV) related to ECF losses causes ↑ - HR to maintain Cardiac Output (CO) - ↓ BP a late sign of shock - Hypotension is followed by rapid decompensation Signs of Shock: - ↑HR - Altered LOC - Poor perfusion

Answer 8

Mild (<5%) - rehydrate with ORS (50ml/kg) over 4 hours - replace ongoing with ORS moderate (5-10%) - rehydrate with ORS (100 ml/kg) over 4 hours - replace ongoing with ORS Severe (> 10%) - IV recussitation with NS or LR (2-40ml/kg) for 1 hour - reasses and repeat if neccessary - begin ORT when pt is stable - replace ongoing loss with ORS

Answer 9

- Color - Nutritional status/Feeding/weight gain or loss (Infants) - imput/ output - Respiratory – rate and ease of breathing - Sweating?!!! (A sign of cardiac issues) - Presence of oedema - Size/shape of chest - Auscultation (Heart sounds/ Murmers Lung sounds – crackles, wheezes decreased/no air entry) - HR, BP, O2 saturations - Pulses and warmth of extremities - Presence of clubbing (Related to hypoxia // chronic resp issues like COPD )

Answer 10

Patent ductus arteriosis (PDA) Etiology: prematurity --> the more preterm – the higher likelihood of PDA - They will have mixing of blood → less effective oxygenation bc of that - Wil be acyanotic Clinical Signs: - increasing respiratory distress due to pulmonary edema; - apnea and bradycardia; - bounding pulses Management: - fluids (furosemide) - oxygen - indomethacin (to help close it) - Surgical ligation

Answer 11

Shock in the 1st hour after birth - Severe respiratory distress - Cyanosis - Poor perfusion Or nonspecific and difficult to differentiate from respiratory causes - If cyanosed – and oxygen helps, this can rule out cyanotic heart disease. - If cyanosed and oxygen does not help, this can indicate cyanotic heart disease. - do not to give cyanotic heart issue babies very much oxygen its not gonan help and it shifts their circulation

Answer 12

VSD - shunt creation between the right and left ventricles - It allows oxygen-rich blood to move back into the lungs instead of being pumped to the rest of the body. ASD - a birth defect of the heart in which there is a hole in the wall (septum) that divides the upper chambers (atria) of the heart. normal heart pressure and o2 sats - pressures are higher in left

Answer 13

- Coarctation of the aorta is a narrowing (constriction) in a part of the body's main artery (aorta). - The heart must pump more forcefully to send blood through the aorta and on to the rest of the body TOF - Ventricular septal defect, overriding aorta, pulmonary stenosis and right ventricular hypertrophy. - These problems result in cyanotic, or blue, skin on babies because of a lack of oxygen.

Answer 14

- Aorta and pulmonary artery switched - oxygen-poor blood from the body enters the right side of the heart but the blood is pumped directly back out to the rest of the body through the aorta. - Oxygen-rich blood from the lungs entering the heart is pumped straight back to the lungs through the main pulmonary artery. - End up with very cyanotic picture because body can't access the pulmonary system - PDA in this case would be important

Answer 15

- Infection of valves/inner lining of heart Causes: - Altered blood flow and turbulence inside the heart - Damage to valvular endothelium - increases fibrin and deposition of platelets --> Microorganisms grow and form vegetation on the endocardium - Lesion may invade adjacent tissues (valves and myocardium) - Risk of emboli

Answer 16

- contractility (medications – eg digoxin) - vasodilaters (ACE inhibitors --> to reduce resistance - eg captopril) - Remove excess fluid and sodium (decrease pre-load) (medications – diuretics) - Rest - Nutrition without fatigue (NG feeds) - Comfort and positioning (+/- sedation) - Improve oxygenation & decrease oxygen consumption - Preparation for invasive procedures and surgery

Answer 17

Rheumatic Fever - Inflammatory disease which occurs after group A β hemolytic streptococcal pharyngitis - Rheumatic heart disease: most significant complication of Rheumatic Fever. - Causes damage to heart valves; usually mitral valve

Answer 18

infant - Change in feeding, vomiting - Altered LOC (irritability, restlessness, poor consolability, lethargy) - Bulging fontanels - High-pitched cry - increased HC (head circumference) - separation of cranial sutures Child - Nausea/Vomiting - Altered LOC - Diplopia/blurred vision - Slurred speech - Seizures

Answer 19

- Alteration in pupil size and reactivity - Decreased motor or sensory response - Coma - Posturing (decerebrate/decorticate) - Papilledema - Projectile vomiting - Changes in Vital Signs - Bradycardia - Irregular or decreased respirations - Cheyne Stoke

Answer 20

Decreased heart rate and resp rate which causes --> Decreased O2 and increased CO2 which causes --> Decebral vasodialation to increased O2 --> Causes increased ICP which further decreases resp rate Increased Temp (or instability) which causes --> Increased metabolic needs of brain which causes --> Seizures related to increased ICP which causes --> Increased metabolic rate and thus increased ICP

Answer 21

Patho - organisms from the nasopharynx invade the underlying blood vessels, cross the blood–brain barrier, and multiply in the CSF) - inflammation, exudation, white blood cell accumulation, and varying degrees of tissue damage. - cerebral edema, purulent exudate, fibrin, or adhesions may occlude the narrow passages and obstruct the flow of CSF Usually abrupt onset - Fever/Chills/ Headache - Vomiting - Seizures (often the initial sign) - bulging fontanelles - infants may not have nuchal rigidity - Nuchal rigidity: May progress to opisthotonos - Positive Kernig and Brudzinski signs Signs and symptoms peculiar to individual organisms: - Petechial or purpuric rashes (meningococcal infection), especially when associated with a shocklike state - Joint involvement (meningococcal and Haemophilus influenzae infection) - Chronically draining ear (pneumococcal meningitis)

Answer 22

- A medical emergency (and ICU care) - Isolation precautions - Initiation of antimicrobial therapy - Maintenance of hydration - Maintenance of ventilation - Reduction of increased ICP - Management of systemic shock - Control of seizures - Control of temperature - Treatment of complications

Answer 23

- caused by an abnormal buildup of cerebrospinal fluid in the ventricles (cavities) deep within the brain - Ventricles engorged with CSF → infants can compensate well - Can be congenital or acquired Management - For congenital they will place a shunt to drain inside body → can get blocked or infected - Relieve, prevent ICP r/t hydrocephalus - Monitoring and early intervention for problems related to surgery

Answer 24

What - Lateralcurvature of the spine that usually involves spinal rotation (Structural or Non-Structural). - Curves with Cobb angle > 10 degrees = scoliosis. - Curves with Cobb angle < 10 degrees = spinal asymmetry and have no long-term significance. Classification of Scoliosis A. Early Onset Scoliosis B. Late Onset Scoliosis - Congenital Scoliosis - Neuromuscular Scoliosis - Idiopathic Scoliosis

Answer 25

Neuromuscular Scoliosis - Result of muscle imbalance and lack of trunk control - Early detection is important as early intervention may help improve function and delay progression - Lots are wheelchair ambulators (ie dont walk most of the time) → we want to help them with their posture until we must operate - Function can include: ambulation, positioning in wheel chairs, prevention of pressure ulcers, and cardio-pulmonary function

Answer 26

3 subcategories: - Infantile: 0 to 3 years - Juvenile: 4 to 9 years - Adolescent: ≥ 10 years Adolescent Idiopathic Scoliosis (AIS) - most common form; 80 – 85% of cases. - The primary concerns regarding scoliosis often involve activities of daily living, as well as aesthetic appearance - When the scoliosis angle increases over 70 degrees, other organ systems can be affected (Heart/lungs)

Answer 27

Inspection - Shoulder height asymmetry - Pelvic/hip asymmetry - Head in line with center of sacrum Adam’s forward-bending test (AFBT) - Assess degree of rotation and deformity - Patient bends forward at waist with knees straight and palms together - Thoracic or lumbar prominence noted Scoliometer (optional) - Measures angle of trunk rotation: run along spine from top to bottom during forward bend test more signs - Cafe au lait spors

Answer 28

Xray required to confirm diagnosis and is indicated if: - Clinically evident scoliosis based on physical exam - Thoracic or lumbar asymmetry on physical exam - Family history of scoliosis 3 Foot Spine Xray (PA/LAT) identifies: - site of deformity (thoracic or lumbar) and curve pattern - Magnitude of curve (Cobb angle) - Skeletal maturity (Risser sign + Sanders) - Spondylolysis/Spondylolisthesis Cobb Angle - Degree of curvature measured according to Cobb method. - Gold standard for assessing degree of curve. - Essential to determine management of scoliosis and risk of progression. risser sign (pelvis) - Degree of ossification and fusion of iliac crest/apophysis. - Used to assess skeletal maturity using xray. - Maturity occurs in a stepwise fashion from lateral to medial.

Answer 29

Monitor patients if… - Cobb angle <25 ° & still growing at time of presentation - Curve more than 45° and finished spinal growth. Treat patients if still growing and… - Cobb angles >25° considered for bracing if skeletally immature (Risser 0-2). - Cobb angles >45-50° at time of diagnosis will likely require surgery.

Answer 30

Bracing - Does not correct curvature!!! - Objective: Arrest curve progression. - Reduces chance of progressing to surgery - Must be skeletally immature (Risser 0-2) - TLSO (thoraco-lumbar-sacral orthosis) or Providence (night- time) brace routinely used. - Time in brace varies

Answer 31

- VS & Neurovascular checks with ankle dorsiflexion - Monitoring effect of PCA and PO analgesia ( nausea, vomiting, pruritis) - Monitor respiratory status + leg paresthesias - Assessment of peripheral neurologic signs in extremities is essential after spinal surgery (changes can occur up to 48 hours post op) - In/Out monitoring: Fluids, Drains – hemovac + foley - Activity - POD#1: Standing at bedside BID - POD#2: Walking BID or more. essential to progress recovery and avoid complications - Dressing intact and clean until discharge day then changed --> check Q4H.

Answer 32

- Follow up with surgeon 1-2 weeks post-op. - Activity restrictions – return to school 1 month post op, no contact sports x 6 months. - Frequent position changes - Monitor for signs of infection – fever, drainage, inc. pain - May shower 5-7 days post op, no baths or soaking for 6 weeks. Medications: - Narcotic PRN, - Tylenol str x3D then PRN - Celebrex x5D - PEG 3350 and Baclofen x5D

Answer 33

- DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH) Risk Factors 5 F’s: - Family History - Fetal position – Feet first/ Breech presentation more likely - First born infant - increased risk with Females - Fluid – history of oligohydramnios (low amniotic fluid levels) - Family Hx of Breech position = Most Important RF

Answer 34

Hip Exam: - Asymmetrical creases (thigh or gluteal) - Range of Motion (? Limited abduction) - Barlow or Ortolani maneuver - Galeazzi sign (knee level) Neck: - Preference to one side - Plagiocephaly (flat back of head) - Torticollis & strength (stiff neck) Spine: - Dysraphism (spina bifida) Upper & Lower Extremities: - Generalized motor assessment & reflexes - Foot abnormalities (MA or club foot)

Answer 35

- Cultures that keep the baby’s hips in an “M” style or wide position have lower rates of hip dysplasia - Hip-Safe swaddling methods are recommended for newborn infants. Pavlik Harness Treatment - Goal: To obtain and maintain concentric reduction of the hip and allow for healthy development of the acetabulum and hip joint. Success of Pavlik treatment - 80-95% How does it help? - Holds hips in a flexion position (>90-100 degrees) AND abduction position (optimal position for hip development) - Prevents adduction of the hip

Answer 36

When? - If the infant has failed the Pavlik harness treatment - If the child is over 6-12 months at diagnosis (grey area for Pavlik use) - We will put them in a cast instead types - Fixed abduction brace - Closed reduction under anesthesia & hip spica cast (can be tried up until 2 years of age) - Open reduction +/- pelvic osteotomy & hip spica cast

Answer 37

what - A plaster cast from upper torso (nipple line) down tothe ankles Types - Bilateral full leg - Unilateral - Bilateral short leg (rare) - A-Frame/Petrie (phasing out) Objective: Immobilization of the hip, pelvis and/or femur

Answer 38

- Epidural sometimes but mostly single shot epimorph (usually cast will help pain after 48 hours) - IV narcotics - PO narcotics - Antispasmodics for first 48 hours - Movement is difficult with a spica cast – on both patient and parents. (bean bag chair lol) - Reposition frequently and support legs with pillows - Watch feet for pressure sores Transfers depend on size of child - independent (parents) vs mechanical lift in older child. - Standard wheelchair not appropriate (use spika wheelchair) - Spica table

Answer 39

- Make sure cast is not too tight - Check skin for breakdown from cast. - Keep cast as clean and dry as possible - reverse Trendelenberg position is key → must be used so that the urine and BM go down and not towards the cast - Sponge bath only while in cast - Combat smells with eucalyptus oil Teaching - Clothing to the upper body only - has to be loose and larger than typical size. - Check skin daily for sores. - Casts are NOT waterproof – no bathing/swimming. - Watch food that may spill into the front of the cast or get trapped inside.

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cheo final Flashcards

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