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N348 Peds > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

timeline of septal development of the heart

A

conception embryo through utero- delivery

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2
Q

whartons jelly

A

covers umbilical cord
contracts around vessels (Vein and 2 arteries) when temp dec (exposed room air)
acts as natural cord clamp
creates high resistance

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3
Q

umbilical vein- after delivery

A

does not transport blood- closed

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4
Q

inferior vena cava/ superior -after delivery

A

deoxygenated blood fills right atrium/ventricle

shunted to pulmonary arteries

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5
Q

lungs- after delivery

A 
required for ventilation
air pushes fluid inside the alveoli out
fluid shunted into capillary
inc 02 lvl= stim dilation arteriole
      dec PVR from pulmonary artery into lungs
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6
Q

foramen ovale -after delivery

A

blood from lungs enters L side heart
dec P in right side
forman ovale flap is pushed shut from pressure of the blood
happens w/in min

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7
Q

ductus arteriosus- after delivery

A

dec p in pulmonary artery creates high aortic P
sm musc constricts w/ in 02 in blood and dec in prostaglandins from removal of placenta
happens w/in hours
eventually closes completely

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8
Q

umbilical artery- after delivery

A

branch off common iliac
receives oxygenated blood from desc aorta
high 02, low prostaglandins= constriction
inc PVR- dec blood flow
eventually no blood reaches end of cord

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9
Q

fetal circulation pathway before birth

A

deoxygenated blood in trhough SVC ductus venosus/IVC to RA
mixes with oxygenated blood in the RV
sent to pulmonary artery, placenta, LA, LV, aorta
patent ductus arteriosus allows mixed blood to flow freely between pulmonary artery and aorta (deoxygenated artery blood mixes w/ oxygenated aorta blood)

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10
Q

Fetal circulation changes after birth

A

ductus arteriosus closed

ductus venosus closed

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11
Q

fetal circulation- characteristics- blood vessels

A

constricted pulmonary blood v

dilated systemic blood v w/ low resistance

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12
Q

fetal circulation- characteristics- patency

A

patent foramen ovale and ductus venosus

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13
Q

fetal circulation- characteristics- arteriosus

A

large ductus arteriosus

connects w/ aorta and brings mixed blood to lower body

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14
Q

neonatal circulation- blood vessels

A

dilated pulmonary blood v

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15
Q

neonatal circ- charact

A

vascular resistance, arterial p and systemic blood vol inc

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16
Q

neonatal circ- charact- ductus arteriosus and venosus

A

arteriosus- closes 2-5 days after birth

venosus- closes days after birth

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17
Q

neonatal circ- charact- foramen ovale

A

hole in L atria closes and blood flow reverses

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18
Q

peripheral vascular assessment

A 
color- acrocyanosis (norm up to about 24h) and circumoral 
pulse
cap refill (central and peripherally)
skin
activity (inc. crying)
fluid status
pulses (central- femoral)
peripheral (brachial) should be equal when compared 2+
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19
Q

cardiac assessment

A 
heart rate (assess all valves)
heart rhythm
adven. breath sounds
heart sounds (S3 common)
chest symmetry and circumference
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20
Q

cardiac output- rate factors

A

pressure
dec p= dec co

babies have high hr and low bp at birth
hr dec and bp inc w/ age

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21
Q

formula for minimal sbp 1-10 yrs

A

if assessment finding < calculated value= hypotension
2years + 70 mmHg
ex. 4 yr old
24= 8 + 70 + 78

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22
Q

function prostaglandin E

A

prevents closure patent ductus arteriosus

can also give ibuprofen

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23
Q

indomethacin function

A

closes Patent DA

inhibits prostaglandins

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24
Q

function of prostaglandins in heart function

A

prostaglandins inhibit contraction of sm- prevents closure of openings

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25
Q

inotrope funtion

A

used for heart failure

improves cardiac output, alters force of contractions

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26
Q

congenital heart defects- inc pul blood flow- defect types

A

patent ductus arteriosus (PDA)
atrial septal defect (ASD)
ventricular septal defect (VSD)
atrioventricular canal

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27
Q

congenital heart defects- inc pul blood flow- manif

A

tachypnea, freq respir infections, tachycardia, poor weight gain, heart failure

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28
Q

congenital heart defects- DEC pul blood flow- defect types

A

pulmonic stenosis
tetralogy of fallot
pulmonary atresia
tricuspid atresia

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29
Q

congenital heart defects- DEC pul blood flow- manif

A

cyanosis, polycethmia (inc number RBC, can cause clotting disorders), poor weight gain

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30
Q

congenital heart defects- obstruction to systemic blood flow- defect types

A

coarctation of the aorta
hypoplastic left heart syndrome
mitral stenosis
interrupted aortic arch

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31
Q

congenital heart defects- obstruction to systemic blood flow- manif

A

dimin. pulses, delayed cap refil, poor color, heart failure, pulm edema

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32
Q

congenital heart defects- mixed blood flow- defect types

A

transposition of the great arteries
truncus arteriosus
double outlet right ventricle

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33
Q

congenital heart defects- obstruction to systemic blood flow- manif

A

cyanosis
poor weight gain
pulm congestion
heart failure

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34
Q

inc pulm blood flow defect- general

A

deoxygen blood mixes w/ oxygenated blood
L to R shunting (high to low pressure)
usually more than one type occurs at the same time

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35
Q

inc pulm blood flow defect- additional manif

A

edema, cardiomegaly, failure to thrive

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36
Q

PDA- patent ductus arteriosus

A

inc pul blood flow
ductus arteriosus fails to close (links aorta to pulm artery)
can be asymptomatic
use indomethacin/ ibuprofen IV, surgery

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37
Q

ASD- atrial septal defect

A 
inc pul blood flow
atrial septal defect
manif depend on size of defect
can close spontaneously
surgical patch
blood L atrium shunts back into R
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38
Q

VSD- ventricular septal defect

A 
patch placed 3-12 mo
monitor for HF
use meds for HF
manif depend on size
can close on own w/in first yr
inc pul blood flow
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39
Q

atrioventricular canal

A

inc pul blood flow
bidirectional shunting possible
“endocardial cushion defect”
lifelong prophylaxis for infective endocarditis
dental health is extremely important
aortic and ventricular walls not definitively different
surgical repair w/in 1st yr life

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40
Q

dec pul blood flow- general

A

obstriction of blood to lungs (not complete)
R to L shunting
hypercyanotic spells, hypoxemia and polycethemia

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41
Q

pulmonic stenosis

A 
dec pul blood flow
right ventr outflow obstruction
subvalvular, valvular or supravalvular
lifelong endocarditis prophylaxis
hf management, surgery
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42
Q

pulmonary atresia

A 
dec pul blood flow
undev pulmonic valve
hypoxia and cyanosis if not managed
PDA must remain open until surgery
use prostaglandins
palliative repair used before surgery
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43
Q

tetralogy of fallot

A

dec pul blood flow
need all components for diagnosis
pulmonic stenosis, right ventr hypertrophy, overriding aorta, and vsd
can also have open foramen ovale or Atrial septal defect

*most common cyanotic defect
hypercyanotic episodes
dec systemic venous flow during spells
surgical repair

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44
Q

tricuspid atresia

A 
dec pulm blood flow
imcomp tricuspid valve, right atrium and ventricle not connected
asd present
prostaglandins immed!
HF meds
3-stage surgical repair
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45
Q

Coarctation of the aorta

A

obstruction to systemic blood flow
Narrowing of aorta.
High blood pressure in upper extremities and low blood pressure in lower.
Preductal/ post ductal bp important
Impaired perfusion when PDA closes. (temporary)
Surgical repair.

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46
Q

hypoplastic left heart syndrome

A 
obstruction to systemic blood flow
underdev left side of heart
must have pda open 
can admin prostaglandins before birth
surgical repair
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47
Q

aortic stenosis

A

obstruction to systemic blood flow
narrowing aortic valve
exercise restrictions!!!!
surgical or balloon valvuloplasty

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48
Q

Transposition of the great arteries:

A

mixed defect
Arteries connected to wrong ventricles.
Must have another defect for blood flow/O2 mixing.
Prostaglandins to keep PDA open until surgical repair.

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49
Q

Truncus arteriosus:

A

mixed defect
Single great artery with large VSD.
Activity limitations.
Manage heart failure and surgical repair.

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50
Q

Double-outlet right ventricle:

A

mixed defect
Both great arteries exit from right ventricle.
Always has VSD present (required to survive).
Manage heart failure and surgical repair.

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51
Q

cardiovasc disorders- nursing care

A 
pain interventions- especially post op
adequate oxygenation
hydration and nutrition
promote growth and dev
provide emotional/psychosocial support
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52
Q

cardiovasc disorders- oxygenation intervention

A

dec CO leads to inadeq o2

admin supply o2 and monitor sat

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53
Q

cardiovasc disorders- hydration/nutrition intervention

A

monitor protein, vitamin intake

use small, freq meals

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54
Q

cardiovasc disorders- grwth/dev intervention

A

use OT/PT to meet motor milestones

encourage play/socialization w/ peer to promote psychosocial dev

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55
Q

Rheumatic fever- def

A

autoimmune, inflamm reation to group A strep
can be prevented w/ admin antib for strep pharyngitis
diagnosed using Jones criteria

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56
Q

Rheumatic fever- manif/ trtmnt

A

chorea (unpredictable movements), arthralgia (joint stiffness), fever, carditis, erythema marginatum (pink/red skin rash on trunk), subcutaneous nodules, polyarthritis, and elevated C-reactive proteins.
CRP- systemic inflammatory marker

trt- antib and anti-inflamm

prolonged hospitalizations

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57
Q

infective endocarditis- def and cause

A

infection fo endocardium (inner lining heart)
vegetations grow in valves and lining, causing dysfunction of valves
common cause- bacterial pathogens

diagnosed w/ Duke criteria

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58
Q

infective endocarditis- manif/ trtmnt

A

osler nodules and janeway lesions
erythemic nodes on tips of fingers/toes

trt- antib b4 procedures, and surgeries

oral health!! - directly r/t cardiac health

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59
Q

cardiomyopathy- def, types

A

dis heart musc resulting in defects
types- dilated and hypertrophic
dilated- ventricles enlarge
results in dec contractility and reduced CO

hypertrophic- cardiac music. thickens

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60
Q

cardiomyopathy- relation to obstruction

A

obstructions occur after hypertrophic cardiomyopathy

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61
Q

common cause hypertrophic cardiomyopathy

A

malformation syndromes

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62
Q

common cuase dilated cardiomyopathy

A

myocarditis (viral)

trt same as HF

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63
Q

kawaksi dis- def

A

acute, idiopathic
systemic vascular inflamm disorder

common in kids younger than 5

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64
Q

kawaksi dis- phases

A

lasts several weeks
acute (abrupt fever)

subacute (fever resolution)
risk for coronary aneurysm highest during subacute stage

convalescent (complete resolution)
phase can take 3 months

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65
Q

kawaksi dis- r/t heart dis

A

kawasaki dis most common cause of acquired heart dis

main- strawberry tongue, fever, erythema hands/feet, cervical lymphadenopathy

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66
Q

kawaksi dis- trtmnt

A

iv immunoglobulin G therapy

aspirin

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67
Q

effects of adversity during childhood

A

delay cognitive, language and emotional development

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68
Q

beginning of neurological dev

A

soon after conception

8 wks brain waves

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69
Q

neurological system dev after birth

A

rapidly during infant and toddler years

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70
Q

fontanelles and suture function

A

brain growth
fontan fuse after brain growth slows
skill thickness inc w/ age
pliability dec w/ age

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71
Q

myelination

A

completed at age 3

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72
Q

cerebral metabolism in kids

A

increased v adults

have large heads

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73
Q

neuro assessment

A 
hx
social interactions
visual
cranial/skull _ oral head circum measured in infants and toddlers
spinal nerve
motor dev
reflex testing
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74
Q

test for vestibular function

A

vestibular- provides sense balance and info about body position

whisper word and observe head movement

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75
Q

interventions for neuro disorders

A 
maintain hydration/ nutrition
promote safety (helmet/car seat)
maintain neuro function ( incl playing and social interaction)
prevent/manage infection
promote pain relief/comfort
admin and manage meds
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76
Q

craniosynostosis- def

A 
premature closure of cranial sutures
simple or complex
causes inc ICP/ head malformations
can dampen brain growth
assess sutures of infants at every appointment
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77
Q

craniosynostosis- trtmnt

A

surgery before 6 mo and post op helmet

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78
Q

deformational plagiocephaly (DP)- def

A

assymm and flattening of head from external forces
inc w/ back to sleep campaign
skull deformation right occiput more than left occiput

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79
Q

deformational plagiocephaly (DP)- prev/ trt

A

prev- infants prone 30-60 min / day to dec P on skull

trt- freq repositioning and orthotics (helmet)

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80
Q

microcephaly- def

A

abdnom small head
primary or secondary
causes- cognitive impairments
head circum 2 standard deviations below mean

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81
Q

microcephaly- trtmnt

A

supportive care

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82
Q

hydrocephalus- def, cause

A

buildup of CSF in brain

cause- inc CSF production, dec csf absorption or flow obstruction

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83
Q

hydrocephalus- manif

A

change in consciousness (comm vs not communicating)
depend on age and severity
dilated scalp veins, bulging gontanel, apnea, irritability, ha and vomiting

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84
Q

hydrocephalus- trtmnt

A 
lumbar punctures (not advised if pt noncommunicating)
ventriculoperitoneal shunt
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85
Q

ventriculoperitoneal shunt- considerations

A 
monitor for infection
may need replacement as child grows
monitor head circum to assess patency
position on non-op side keep HOB elevation below 30 degrees
*assoc w/ hydrocephalus
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86
Q

meningitis- cause

A

aseptic (viral)

septic (bacterial)

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87
Q

meningitis- interventions

A

isolation, seiz precautions, freq neuro assessments and fever management

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88
Q

reyes syndrome- common cause

A

aspirin to children

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89
Q

seizure- def and classification

A

electrical disturb in brain

classified by location, severity, manif, freq, duration or etiology

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90
Q

seizure- risks, environmental factors

A

can cause motor, sensory and cognitive changes

some environm can be triggers- inc risk for seizure

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91
Q

seizure- focal v generalized

A

focal- one part of brain

generalized- entire brain

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92
Q

simple seizure

A

partial
have awareness/memory and conciousness
20-60 seconds

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93
Q

complex seizure

A 
partial
consciousness impaired (stare/motionless)
45-90 sec.- longer
94
Q

focal evolving to generalized seizure

A

starts as focal and progresses to gen

95
Q

absence seizure

A

loss of concious w/ vacant stare or unrespon

96
Q

myoclonic seizure

A

happen suddenly

forceful contractions of single/multiple musc groups

97
Q

clonic seizure

A

longer rhythmic jerking activity

98
Q

tonic- clonic seizures

A

generalized
alternate contraction (tonic)
relaxation (clonic) of music. loss of Concious
abnorm behavior

99
Q

atonic seizure

A

loss musc tone, person suddenly drops

100
Q

epilepsy def

A

recurrent, UNprovoked seizures
resolved- if no seizure for 10 yr or dc of meds for 5+ yrs
may be age-related

101
Q

epilepsy- diag criteria

A

2 unprovoked seiz more than 24hr apart
one unprovoked seizu w/ high probabil of repetition over next 10 yrs
epileptic syndrome present

102
Q

epilepsy- trtmnt

A

vagal nerve stim if meds are ineffective

saftey interventions during active seizures

103
Q

status epilepticus- def

A

constant convulsions
life threatening- med immergency
tonic-clonic- several min at close intervals

104
Q

status ep- trtmnt

A

iv fluids, o2, iv meds to stop seizure

medically induced coma if necessary

105
Q

febrile seizures- def

A

acute seiz in kids younger than 7 by high fever
temp > 101.2
can cause dev of epilepsy

106
Q

febrile seiz- trtmnt

A

encephalogram for diagnostic testing (EEG)

self- limiting

107
Q

pharmacological trtmnt for seizure- considerations

A 
consistency is key
monotherapy preferred
generalized tonic clonic- carbamazepine, valproic acid, phenytoin, phenobarbital
focal- fosphenytoin, gabapentin
non motor- gen- zarotin
non motor focal- topamax
108
Q

head trauma- cause and classfiication

A

after traumatic brain injury
primary or secondary
accidental or nonaccidental
infants/toddlers are at greatest risk due to large head

109
Q

head trauma- manif

A

SBS silent condition

110
Q

head trauma- trtmnt

A

use glasgow coma scale and observe for posturing (decorticate v decerbrate) in kids 8+
monitor for electrolyte abnorm`

111
Q

headaches- classification, cause, manif

A

class- acute, acute recurrent, chronic progressive, chronic nonprogressive
manif- mild- severe
cause- varies

112
Q

ha- trtmnt

A

relaxation, OTC
if child wakes up from sleep from ha, eval immed
have parents keep ha journal- determine patterns and causes

113
Q

hearing defects cause

A

genetic, acquired, unknown

114
Q

hearing defects- implications

A

can have speech delays, appear to be inattentive
suspect hearing loss if startle (spreading of arms and legs and crying) is absent or no turn to voice /noise at 6 mo
* need to pass hearing screen to leave hospital

115
Q

hearing defects trtmnt

A

reg hearing screenings

technological (hearing aids), sign lang

116
Q

causes of mental health disorders

A

genetics, physiological changes and environ exposure

117
Q

mental health def

A

state well being in which every indiv realizes his or her own potential, can cope with normal stresses of life, can work productively and fruitfully, is able to make contribution to community

118
Q

cognition def

A

process of thought and knowing that is acquired through experiences and maturation

119
Q

children v adult mental health

A

children have diff scope, presentation, and progression of mental/cog disorders
definitions of dis. still same for kids and adults

120
Q

factors in good cognitive dev of kids

A

access to good nutrition, positive relationships, safe housing

121
Q

cognitive/mental health assessment- subjective

A

birth hx, past med hx, family and social hx, behavioral symptoms

122
Q

cognitive/mental health assessment- objective

A

developmental screenigs
physical exam
diagn testing to assess for organic causes

123
Q

supportive care for mental health

A

play therapy
therapeutic play
art therapy

124
Q

play therapy

A

psychotherapy
encourages kids express feelings/emotions through play
kids 3-12 yrs

125
Q

therapeutic play

A

used by child life specialists for hospitalized kids

126
Q

art therapy

A

incorp creativity in healing and expressing childhood emotions
used in all ages

127
Q

learning disabilities- def

A

difficulties in recieving and processing infor and generating appropriate responses

128
Q

dyslexia- def

A

most common learning disorder
receptive language that creates difficulty using letters to decode written language
trouble w/ letters/numbers

not recog till school age

129
Q

dyslexia- manif

A

slower acqusition of langu and math skills, difficulty recogn letters and numbers, problems w/ reading comprehension, and hearing deficiet

130
Q

dyslexia- trtmnt

A

assess for sensory difficulties

individualized education plan (IEP) to foster appropr growth/dev

131
Q

autism spectrum disorder (ASD)- def

A

continuum of neurobiological symptoms that results in difficulty- communication, beh social interaction

usually present by age 3
presentations look diff for e/ indivi
inc incidence in boys
genetic and environmental factor link

132
Q

ASD- manif

A 
stereotypy (hand flapping)
obsessive beh
difficulty w/ sensory integration
echolalia (repiti of words w/o knowing meaning)
avoidance of eye contact
133
Q

ASD- well child visits

A

extremely important!

use standardized developmental screening

134
Q

ASD- trtmnt cornerstones

A

early identification and referral to early intervention programs

135
Q

ASD- trtmnt

A

plan educational act. that limit overstimulation
collab w/ school to limit kids distress and maximize learning
use speech therapist
multidisciplinary approach (beh health specialists, dev pediatricians, OT)

136
Q

ADHD- def

A

inattentiveness w/ or w/o hyperactiv and impulsivity
neurobehavioral
impulsivity more common in boys

137
Q

ADHD- patho and manif

A

cause unclear, may have genetic component

manif- short attention span, impulsivity, difficulties w/ movement

138
Q

ADHD- diagnosing

A

rule out sensory/ organic causes first

diag w/ formal eval and psychological testing ( includes md, teacher, parent, etc)

139
Q

ADHD- trtmnt general

A

caregiver education, dev of individualized ed plans (IEP), pharmacotherapy

140
Q

ADHD- meds

A

stimulants- Ritalin, ADderall and Focalin
controlled substances
ae- weight loss, dec appetite, tachycardia, hypertension, dec salivation
* important to have good oral health, drink water for dry mouth instead of juice to dec risk dental caries
monitor- serum liver/kidney function lvls during trtmnt

141
Q

anxiety- def, cause and manif

A

worry, fear, anxiety extend past normal adaptive coping mech
significant impairment
cause- combo of genetic and environmental factors
manif- abdom pain, nausea, palpitations, dyspnea, aggression, vomiting, dizziness

142
Q

anxiety- categories

A

generalized anxiety dis
separation anxiety dis
panic disorder
use standardized rating sales and structured diagnostic interviewing to diagnose

143
Q

anxiety- trtmnt

A

exposure-based cognitive behavioral therapy (for seperation anxiety and school refusal)
SSRI- fluoxitine (can inc risk suicide in pediatric pop)

144
Q

anorexia nervosa- manif

A

depression, dehydration, cold intol, hypotension

145
Q

bulimia nervosa- manif

A

thinning hair, calluses on backs of hands and fingers

146
Q

abuse/violence- category

A

physical, emotional, sexual abuse

exposure to domestic violence and neglect (medical/physical)

147
Q

abuse/violence- risk factors- caregiver

A

mental illness, lack knowledge, poor self esteem, alcoh abuse, poor coping, hx of being victim of

148
Q

abuse/violence- risk factors- environmental

A

low income, unemployment, domestic violence, lack support, low education attainment

149
Q

abuse/violence- manif

A

multiple fx in various stages healing, suspicious bruising, sTI, enuresis, vague somatic complaints

150
Q

Abuse/violence identification

A

forensic medical team (SANE nurse)
sexual assult nurse examiner
radiographys, CT scans
nurses are mandatory reporters

151
Q

abuse/violence- trtmnt

A

prevention

educate caregivers on expected growth/dev milestones (crying, waking in the night)

152
Q

munchausen syndrome by proxy (MBP)- def and contrib factors

A

misinterpretation or presentation of exaggerated or absent symptoms in child to gain entry into medical setting
often imposed by mother
factors of perpetrator- past hx abuse, personality disorders, somatic symptom disorder, pathological lying

153
Q

munchausen syndrome by proxy (MBP)- manif and trtmnt

A

manif- freq medical visits for false symptoms, purposeful inducement of physical symptoms, manipulation of lab tests to produce clinical s/s of disease
trtmt- ensure child is safe, in-home therapy, foster home placement, incarceration

154
Q

renal/ urethral child vs adult

A 
larger kidneys (prone to injury)
urethral opening closer to rectum (inc risk UTI)
shorter urethra in girls (inc risk UTI)
155
Q

renal function- child v adult

A

nephrons immature at birth
reduced GFR
unable to concentrate urine (inc risk for electrolyte abnormalities)
lower BUN and Cr
less urine output /day
increased amount voids (smaller bladders)

156
Q

reproductive system structure- child v adult

A

immature until puberty

157
Q

GI assessment

A 
urine/voiding charac
pain (when urinating or in flank)
genitalia (urethra location)
edema (r/t kidney func)
CT, biopsy, BUN, Cr
158
Q

normal urine output

A

infant- 1-3 mL/kg/h
children- 0.5-1 mL/kg/h
min output is 1 mL/kg/h

159
Q

calculating output

A

total amount out/ hours/ weight

ex. 300 mL, 12 hr and 18 kg

300/ 12/ 18= 1.4
AHW

160
Q

bolus- type of fluid and amount

A

isotonic
NS or LR

20 mL/kg

161
Q

bolus calculations

A

20 mg/kg
ex. 10 kg= 200 mL

ex. 11 kg
11* 20 = 220 mL/hr

162
Q

bolus rate

A

ex. 11 kg
220 mL bolus/ hr

admin in 30 min= 2202= 440 mL/hr
admin in 20 min= 220 3= 660 mL/hr

163
Q

GI disorders interventions

A

maintain hydration, electrolyte balance, and nutritional requirements
prevent infection, promote freq bladder emptying

164
Q

UTI- lower v upper

A

cystitis- inflamm of urethra or bladder

pyelonephritis- ureters, renal pelvis or renal parenchyma

165
Q

UTI- risk factors

A

structural v environmental
appropriate way to wipe
bubble bath
short urethra

166
Q

UTI- cause

A

ecoli and staph

167
Q

UTI- manifestations

A

infants- fever, lethargic, poor feeding, irritability (straight cath sample)
abdominal pain, burning, dark/foul smelling urine

168
Q

UTI- trtmnt

A 
require full diagnostic work up if 2+ UTI
antibiotic therapy (IV is pyeloneph)
push fluids
Peridium (numbing)
phenazopyridine

VCUG- voiding cystogram catheter dye (radiology)
can detect if bladder not emptying fully, if ureter is too low and eval function of vesicle ureter reflex

169
Q

enuresis

A

incontin of urine in kids 3+
diurnal (daytime) or nocturnal
primary- always wet bed, small bladder, drink water at night, kid sleeps hard
or
secondary- random accid after 6 mo being continent (due to stress, constipation)

170
Q

enuresis- interventions

A

assess for asymptom UTI

171
Q

enuresis- trtmnt

A

fluid restriction ( no water 1.5 hrs before bed)
bladder exercises
timed voiding (5-7 yr olds)
alarms
antidiuretic hormones (reabsorb urine) (vasopressin)
tricyclic antidep
anticholinergics (dec output)

172
Q

phimosis- def

A

foreskin penis cannot be retracted (normal in newborns)
concerning after toddler age (2-3)
EMERGENCY

173
Q

phimosis- complications

A 
venous stasis and swelling
dec circulation
paraphimosis- medical emergency- requires reduction
inc risk UTI
inc chance to happen again
174
Q

phimosis- s/s

A

irritation, bleeding, erythema, pain, dysuria, discharge

175
Q

phimosis- trtmnt

A

topical steroid cream twice daily for 2-8 wks
betamethasone
circumcision

176
Q

cryptorchidism- def

A

undescen testes
one or both testes fail to descent through inguinal canal into scrotom
mechanical, hormonal, enzymatic or chromosomal

177
Q

cryptorchidism- s/s

A

asymptom

evaluate calm child in warm environment

178
Q

cryptorchidism- trtmnt

A

orchiopexy (cut and move)
pain control, adeq nutrition and s/s infection
often descend on own after 2 mo

179
Q

cryptorchidism- complications

A

if not desc

infertility, inc risk for testicular CA in teens

180
Q

inguinal hernia- def

A

intra-abdominal structures protrude through abdominal wall

181
Q

inguinal hernia- s/s

A

palpable, round, smooth, and nontender mass
size of bulge inc when infant cries/strains
if can’t poke back into hole- MED EMERGENCY

182
Q

inguinal hernia- trtmnt

A

outpatient surgery

common during 3-6 wks

183
Q

incarcerated hernias

A

med emergency
can cause bowel ischemia
kids are inconsolable, knees drawn up, pain not resolved with medication

184
Q

hydrocele- def and trtmnt

A

fluid accum in scrotal sac (can see with pen light)
r/t hernia (fluid not being reabsorbed)
self-limiting- resolves by 1 yr of age

if persists beyond 12-18 mo= surgery

185
Q

testicular torsion-def and cause

A

testicle rotates, twists spermatic cord, cutting off circulation to scrotom
MEDICAL EMERGENCY

caused by excessive mobility of tests (too long or attached too high)

186
Q

testicular torsion- s/s, risks, trtmnt

A

s/s- sudden severe pain, swelling and n/v
absent cremasteric reflex (stroke inside thigh, testes shoot up)
risks- uncommon before 10 yrs- usually happens to teens, bell clapper deformity inc risk

trtmnt- surgery

187
Q

testicular torsion- pain

A

most common pain felt by males 12+

188
Q

hypospadias and epispadias- def

A

urethral meatus no at end of penis
hypospadias- ventral side (bottom)
epispadias- dorsal side (top)

can be linked to inguinal hernia
congenital
common in NICU babies

189
Q

hypospadias and epispadias- interventions/considerations

A 
assess for chordee (fibrous band causing downward curve)
avoid circumcision ( foreskin used in repair)
surgery btw 6-12 mo
double diaper post op
190
Q

vesicoureteral reflex- def

A

retrograde flow urine from bladder into ureters and renal pelvis
may occur in one or b/ ureters
evaluated in VCUG

191
Q

vesicoureteral reflex- s/s

A

s/s- asymptom w/out UTI
30% in girls w/ UTI
inc risk for UTI/pyeloneph
voiding cystourethrogram to diagnose

192
Q

vesicoureteral reflex- grading

A

1-5 based on degree of backflow

3-5= surgery

193
Q

vesicoureteral reflex- trtmnt

A 
surgery 3-5 (re-locate ureters)
suprapubic and foley catheters
prophylactic antib at bedtime
antispasmatic
pain management!!
194
Q

vesicoureteral reflex- primary v secondary

A

primary- congenital malformation

secondary- bladder obstruction

195
Q

hydronephrosis- def

A

dilation renal pelvis and calyces d/t urinary obstruction
recurrent UTI/ pyelo common
can be asymptom at first

196
Q

hydronephrosis- complications, trtmnt and education

A

complications- renal insufficiency, failure and hypertension (alteration in RAAS)
trtnt- urinary cath to promote drainage, pyeloplasty and valve repair (fix valve at end ureter)
education- s/s infection after surgery and UTI

197
Q

nephrotic syndrome- def

A

kidney damage and elevated lvl protein in urine (albumin)
congenital, primary or secondary
inc glomerular basement mem permeability

198
Q

nephrotic syndrome- 3 signs

A

proteinuria (dec albumin in circ (hypoalbunemia)
water moves into interstitial space- edema (dependent)
hyperlipidemia

199
Q

nephrotic syndrome- s/s

A

frothy/ milky urine, irritable and tired

200
Q

nephrotic syndrome- interventions

A 
albumin supplement
replace fluids
accurate I+O's
skin assessment (weeping edema)
nutrition supplement 
prevent infection
dec proteinuria
201
Q

nephrotic syndrome- causes

A

Lupus, NSAIDS, hepatitis

202
Q

acute poststreptococal glomerulonephritis- def

A

inflammation and cellular proliferation of glomeruli caused by indirect infection of kidneys
impaired capillary perfusion and dec glomerular filtration
affects 4-12 yr olds

203
Q

acute poststreptococal glomerulonephritis- cause

A

often after strep infection (exposure group A strep)
1-2 wks strep throat
2-4 wks skin infection

204
Q

acute poststreptococal glomerulonephritis- s/s

A 
hematuria (red or coca cola brown)
edema
proteinuria
dec GFR
HTN
dec urine output
205
Q

acute poststreptococal glomerulonephritis- trtmnt

A

control bp and fluid volume

many need transplant

206
Q

nephrotic v acute poststreptococcal glomerulonephritis-

A

nephrotic- s/s edema, proteinuria, hyperlipidemia

poststrep glomerulonephritis- s/s- hematuria, edema, HTN

207
Q

hemolytic uremic syndrome- characteristics

A

thrombocytopenia, microangiopathic hemolytic anemia, acute renal failure

208
Q

hemolytic uremic syndrome- associ w/

A

causes acute kidney injury
happens after Shiga toxin ecoli infection O157 or verotoxin and diarrhea
common in pre-K and school aged

209
Q

hemolytic uremic syndrome- s/s

A

vomiting, abdominal pain, anorexia, ascites

dec urine output, jaundice, splenomegaly

210
Q

hemolytic uremic syndrome- trtmnt

A

symptomatic treatment

I+O, fluids, pain

211
Q

renal failure- def

A

kidneys unable to concen. urine and adequately excrete waste products

212
Q

renal failure- acute

A

dev. days-wks

may be reversible

213
Q

renal failure- chronic

A

dev months- yrs

permanent, irreversible

214
Q

renal failure- cause/type

A

prerenal- dehydration (#1 cause)
intrinsic- toxins, nsaids
post renal- obstruction

215
Q

renal failure- s/s

A

dec urine output, electrolyte abnormalities

216
Q

renal failure- trtmnt

A

depends on cause
maintain fluid/electrolyte balance
monitor for htn and hypotension
dialysis and kidney transplant

217
Q

GI system- function and includes

A

fun- route for ingestion and absorption of food/fluids

inc. mouth, esophagus, stomach, pancreas, sm in, lrg in, liver and gallbladder

218
Q

gallbladder- fun

A

stores/concentrates bile

219
Q

liver fun

A

stores vitamines, secretes bile/bilirubin, metabolizes fats, proteins and carbs

220
Q

gi system assessment

A 
mouth/esophagus- ulcers common w/ hand, foot and mouth
abdomen- inspect and auscultate first
emesis/stool
skin
fluid status- edema, skin turgor
221
Q

GI disorders- nursing interventions

A

maintain- ventilation, hydration, nutrition, prevent infection

222
Q

meckel diverticulum- def

A

outpouching of lwr sm in.

assoc. w/ o/ congenital abnormalities

223
Q

meckel diverticulum- complications, s/s

A

complications, bowel obstruction, rupture
s/s- present at 1-2 yrs
painless rectal bleeding (jelly red stools)

224
Q

meckel diverticulum- trtmnt

A

surgical resection

225
Q

omphalocele- def

A

internal organs eviscerate through sac in umbilicle cord
diagnosed w/ US in utero
bubble w/ belly

226
Q

omphalocele- trtmnt

A 
dress w/ saline soaked gauze at delivery
protect sac, prevent hypothermia and infection
surgery
hydration (iv fluids)
monitor electrolytes
ng tube to decompress stomach (NPO)
use cylo winder
227
Q

gastroschisis- def, trtmnt, s/s

A

intestines outside of body
no sac covering organs (inc risk for infection)
can have respir distress
prompt surgery

228
Q

cleft lip/cleft palate trtmnt and interventions

A

surgery
lip 2-3 mo
palate 9-18 mo

pain management
suture care
feeding equipment
I+Os- especially PO intake
no binkies or sucking thumb
229
Q

gastroschisis v omphalocele

A

omphalocele- sac, larger, normal bowel character, enteral nutrition normal, o/ abnormalities common
gastroschisis- no sac, smaller, inflamed bowel character, delayed nutrition, no link to o/ abnormalities

230
Q

congenital diaphragmatic hernia

A

hole in diaphgram
severe respir distress, auscul changes
significant morbidity
intestines can migrate to chest cavity ( inc risk respir failure)

231
Q

anorectal malformations

A

stenosis, prolapse or atresia
trtmnt- dilation 2x day or surgery
temporary colostomy to allow for healing

232
Q

dehydration- types, cause

A 
isotonic- 
hypotonic 
hypertonic 
cause- dec intake, increased output, inc insensible loss
mild 3-5% 
moderate 6-9%

N348 Peds (5 decks)

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