exam 2 Flashcards
What are S/SX for Kawasaki disease?
- high fever, red eyes (red ring around iris), bright, strawberry red tongue, rash (desquamates: skin comes off in scales, peeling hands and feet), irritability
- Leading cause of acquired heart disease in children
- follows viral infx and toxic exposure
- Acute vasculitis: inflammation of small and medium-sized vessels, generally coronary arteries
What are S/SX for Coarctation of aorta?
- S/sx: higher BP and pulses in upper extremities compared to lower extremities
- Narrowing/constriction of aorta
What are S/SX for Hypercyanotic spell?
- S/sx: cyanotic (when crying, eating, during play) with increased respirations, uncontrollable crying, worsening cyanosis, hypoxia
- Addition sx of ToF itself: polycythemia, hypoxia, finger clubbing
- ToF = tetralogy of fallot = most common decreased pulmonary blood flow defect
What is the tx for Hypercyanotic spell?
- Knees to chest: increases return of blood to heart, increases SVR which increases blood flow to pulmonary artery
- Oxygen
- Morphine to relax
Post Cath care
- Stop bleeding
- 1If bleeding occurs, pull dressing and assess
- Pressure and dressing 1” above site and call physician, stay with patient, hold until bleeding stops or MD arrives
- Site assessment: soft, hematoma
- Immobilize extremity
- Monitor distal pulses (should increase gradually)
- Vitals q15min x1 h, q30min for 1hr, q1h for 6 hrs
- Neuro checks of effected extremity
- Bed rest 4-6hrs
Endocarditis hx
- Infx of heart valves and inner lining, consequence of bacteremia
- Usually occurs in children with indwelling central lines
- Cause: drug abuse, hx of strep throat
- Sx: low grade, intermittent fever, malaise, arthralgias, weight loss, new murmur
- Increased ESR (= inflammation), vegetation on ECHO
- Roth’s spots: hemorrhage in retina with white center—may be first of signs along with fever
- Osler’s nodes: small, tender, transient, nodules in pads of fingers/toes, palms and soles; they can roll around—high indicative of bacterial infx
- Tx: penicillin/abx
- Prevention: Abx before dentist/procedures
- Education!
Digoxin therapeutic range
0.8-2.0 mcg/L
Digoxin nursing considerations
- Apical HR for 1 min
- infant/toddler: hold for HR < 90
- School age < 70
- Adolescent < 60
- Missed dose or vomits dose?—call MD for recommendation
- abnormal levels of K+ & Mg
What are the s/sx for digoxin toxicity?
s/sx of toxicity: N/V (first), bradycardia, dysrhythmias, anorexia, visual disturbances/halo vision
CHD – lab results
CBC: low hgb, low hit, high RBC, polycythemia, anemia
The cause of clubbing of fingers and toes is…
hypoxia- chronic low oxygen
ToF
Decreased pulmonary blood flow defects
clinically not enough blood to lungs
* cause by: ToF and Tricuspid Atresia
- ToF is the worst and is most common decreased pulmonary blood flow defect
What does Tetralogy of Fallot include
4 defects:
- pulmonic stenosis
- overriding aorta
- ventral septal defect
- right ventricular hypertrophy (develops over time as ventricle is overworked due to other defects)
S/Sx: polycythemia, finger clubbing, TET/hypercyanotic spells
Tricuspid Atresia
- tricuspid valve never developed/is underdeveloped so it stays closed; no movement of blood from R atrium to R ventricle creating an underdeveloped R ventricle, diminished R ventricle unable to sustain/perform pulmonary blood flow
- Incompatible with life; rapid and sustained cyanosis upon birth
- Requires immediate surgical repair
Electrolytes and diuretics
- Increased pulmonary blood flow patients: administer diuretics which can decrease electrolytes, specifically potassium (unless potassium sparing OR administering potassium)
- ACE inhibitors enhance diuretic action
Heart sounds
- Murmur: whooshing
- Small defect = large whooshing, and vice versa
Accusation of valves
- Aortic: 2nd intercostal R side
- Pulmonic: 2nd intercostal L side
- Tricuspid: 4th intercostal L side
- Mitral: 5th intercostal midclavicular
Rheumatic fever history
- Hx of strep
- Strep causes: rheumatic, endocarditis, scarlet fever, glomerulonephritis
Flow of blood through the heart
Inferior and superior vena cava -> right atrium -> tricuspid valve -> right ventricle -> pulmonary valve -> pulmonary arteries -> lungs -> pulmonary veins -> left atrium -> bicuspid/mitral valve -> left ventricle -> aortic valve -> aorta -> body
SIADH – treatment
- SIADH = soggy sid
- Excess ADH
- S/sx: fluid retention, edema, elevated urine osmolality, hyponatremia, anorexia, irritability/personality changes, decreased urine output
- Dx: urine/serum osmolality, electrolyte imbalance, low BUN
- Tx: monitor I&O, daily weights, monitor for s/sx fluid overload, declomycin for hyponatremia, Na supplements, diuretics, fluid restriction
What is HgB A1C ?
Measurement of BS regulation over 90 days
Hypoglycemia – symptoms (TSSCCCHAID)
- Tachycardia
- Shaking
- Sweating
- Clammy skin
- Cold
- Confusion
- Hunger
- Anxiety
- Irritability
- Dizziness/Decreased LOC/Confusion—appearance of a stroke
Hyperglycemia - symptoms (FBNPPP)
- Fatigue
- Blurry vision
- N/V
- Polyuria
- Polydipsia
- Polyphagia
What is Diabetes Insipidus?
- DI = dry inside
- First sign: bedwetting
- Sx: dry mucus membranes, dehydration, decreased tear production, tachycardia, thready/false pulse, hypotension, hypernatremia, polyuria, polydipsia, low-grade fever, irritability, diminished skin turgor
- Tx: strict I&O, vasopressin
Diabetic Ketoacidosis – s/sx
- Dry skin/mucus membranes
- Tachypnea
- Flushed face
- Fruity breath
- Fatigue
- N/V
- Altered LOC/confusion
Diabetes education
- Healthy eating habits, low carb, create diet plan
- Daily exercise, create exercise plan
- Encouragement, support and resources for weight loss
- Blood glucose monitoring
- Medication adherence
- Monitor for s/sx hypo/hyperglycemia
- Always keep emergency glucagon and diabetic candy for hypoglycemia
Somogyi effect
hyperglycemia in the morning in response to overnight hypoglycemia
- Tx: give bedtime snack with appropriate insulin
Dawn phenomenon
elevation of BS btw 5-6am r/t GH release
- Tx: may require slightly elevated dose of long-acting insulin
Graves disease
- Autoimmune related hyperthyroidism, 5x higher in girls, children prone to hyperthyroid rather than hypo
- S/sx: enlarged thyroid gland (goiter), exophthalmos, tachycardia, tremors, sweating, weight loss, diarrhea, muscle weakness, fatigue, irritability
- Tx: antithyroid drugs (beta blockers, methimazole, propylthiouracil)
Priority treatment for status epilepticus
- Series of seizure activity with lack of consciousness btw seizures, or seizures lasting 30 min or longer
- Airway management and IV/rectal valium (diazepam)
- Try to establish IV access if not already present
- Turn on side
- Oxygen and suction
- Thermoregulation
- Document length and symptoms occurring during seizure
- Home care: educate on use of rectal Valium
Seizures – risk factors
- Seizures = most common pediatric neurological disorder
- Abnormal electrical discharges in brain
- Seizures are a sx of underlying disease process
- Potential causes: low BS, low Na, genetic (epilepsy), head trauma, meningitis, fever, hyponatremia
- infx, intracranial lesions, intracranial hemorrhage, metabolic disorders, brain malformations, genetic disorders, toxic ingestion, trauma
Early signs of increased ICP
- Headaches
- Diplopia (blurred vision)
- Confusion
- N/V
- Vertigo
- Seizures
- Infants:
- Wide sutures
- Tense or bulging fontanels
- High pitched cry
- Setting-sun sign (eyes appear driven downward bilaterally)
Late signs of increased ICP
- Decreased LOC
- Decreased motor response
- Diminished response to pain
- Cushing’s Reflex:
- Bradycardia
- Increased BP with widened pulse pressure
- Slow, irregular breathing
What are the 3 signs related to meningitis?
- Kernig’s: flex hip to 90 deg, pains child to straighten, inability to straighten the leg due to hamstring rigidity (kernig cant straighten)
- Brudzinski: forced flexion of neck elicits reflex flexion of hips (bruz bring head = flex)
- Nuchal rigidity: neck stiffness, pain to flexion
Which vaccine will prevent Bacterial meningitis?
Hib vaccine
Bacterial meningitis
- S/sx: onset abrupt-fever, chills, HA, vomiting
- CSF: increased WBC, increased protein, decreased glucose, positive culture
- Dx: lumbar puncture; CT if puncture contraindicated
- Rapid tx to prevent death
- Start with isolation
- Antimicrobial therapy—initiate immediately then adjust accordingly after cultures
- Fluids
- Ventilation if needed
What is primary problem of near drowning?
Hypoxia
Near drowning
- Hypoxia, hypothermia, aspiration
- Outcome impacted by length of submersion and dive reflex (automatic breath holding when submerged; in response to cold water, body shunts blood from periphery to vital organs)
- Neuron damage after 4 - 6min of hypoxia, heart and lungs 30 min
- Issue in south due to proximity to water
- Childrens curiosity leads to accidents—increased supervision
- Shelby county requires fenced in swimming pools
- Children less than 1 usually in bathtub
- Infants usually in pail of water and unable to free self
What are the components of the Glasgow Coma Scale?
- Verbal response
- Motor response
- Eye opening response
What is the priority tx for Botulism?
IVIG (immunoglobulin) administration immediately, even prior to culture return
- ICU, monitor muscle impairment, monitor fluid and electrolyte imbalance
*** antibiotics are used as well
Botulism
- Toxin released by Clostridium botulinum bacteria = serious food poisoning
o Improperly sterilized food
o Never give infants honey, corn syrup - Sx: blurry vision, dizziness, N/V, dysphagia, descending paralysis and dyspnea
- Dx: based on hx and physical and cultural isolation of organism
When do you suspect Cerebral Palsy?
- Missed developmental milestone = sign of CP: inability of infant to hold head up by 3 mos
** usually related to birth trauma
Tetanus
immunization booster every 10 years
- grows in spores: dirt, soil, intestinal tract
- S/SX: stiff neck, unconscious, very rigid, intubated, locked jaw
Neural tube defects
- Amniocentesis for Maternal AFP test: if abnormal, CT, MRI and ultrasound are performed to determine if defect present
- Risk for AFP is premature rupture of membranes
- Closely associated with folic acid deficiency during pregnancy
Sac protruding -> sterile wet dressing and lay them on side or prone
Spinal bidfadia -> AFP 12-16 wks if elevated neural tube defect to prevent there’s a medicine nyocin
Amniocentesis -> complication premature rupture of membranes and U/S
What is the first sign of Duchene Muscular Dystrophy?
difficulty rising from sitting or supine position
- Gower’s Sign: roll over onto stomach, push selves up to knees, walk their hands up their legs in order to stand
Duchene Muscular Dystrophy
- Most severe form of MD, progressive weakness and wasting of muscles
- other sx: waddling gait, motor developmental delay, clumsiness, frequent falls, stair difficulty
- Dx: genetic blood work, muscle biopsy
- Tx: no effective tx, supportive (respite care)
- Complications: contractures, disuse atrophy (loss of muscles in arms and legs), infections, obesity, resp/cardiac problems
- Nursing care: prepare for cardiac and respiratory difficulties (breathing muscles, heart muscle), mobility, fatigue, diet, psychological effects
What is Guillain-Barre most often associated with?
Viral/flu shot associated
Guillain-Barre
- Acute demyelinating disease of nervous system, infectious polyneuritis— immune mediated
*** ascending paralysis starts at the feet and goes up; immune response - Preceded by mild flu-like illness or sore throat, post-vaccine association, although true etiology is unknown
- Assess for: muscle weakness, paresthesia, cramps, decreased or absent DTR, swallow/gag reflex, facial droop, pupillary problems
- DX: EMG or lumbar puncture
- Nursing care: supportive
- Ventilatory support
- IV immunoglobulin
- Steroids
- Pain control
- DVT prevention
The 5 P’s related to cast care
Pain, pallor, pulselessness, paresthesia, paralysis
which is most ominous and when should you call physician when dealing with a cast?
redness, swelling and drainage – call HCP and get cast saw
What are the Reasons for Traction?
(PAIR)
- Prevent contractures
- Alignment
- Immobilization
- Resist response of the muscle
Osteogenesis Imperfecta
- “brittle bone disease”
- Unknown cause, genetic
- S/sx: fragile bones, deformity, fractures, blue sclera, hearing loss, hypoplastic, discolored teeth (dentinogenetic imperfecta), short stature, thin/soft/easily bruising skin
- Prevent fractures: patient education, avoid lifting by one arm or leg, use blankets
- Tx: bisphosphate therapy with IV pamidronate, calcitonin, GH
- Parents should carry documentation to prove OI dx to prevent abuse suspicion due to frequent fractures
How does Bryant’s traction help?
- Helps—realigns and helps pain
- Type of skin traction
- Holds extremity at right angle to the joint, children under 3 or less than 35 lbs, fractured femur or congenital hip dysplasia, hips flex 90 deg has weights at end of bed
Traction care
- Maintain tension
- Don’t let weights touch floor
- Keep pins clean, ointment as prescribed
- Frequent checks for 5 Ps
- Careful moving, will have to support the weights when repositioning- 3 ppl min, hold pt, hold leg, hold weights
What is the gold standard treatment for scoliosis?
bracing (compliance can be difficult due to body image issues)
what is kyphosis?
convex curvature
what is lordosis?
cervical or lumbar curvature beyond physiologic limits
what is scoliosis?
lateral (S) curvature—most common
Myelomenigocele
- Spina Bifida Cystica: neural tube fails to close in utero; sac like protrusion containing CSF and nerves
o Usually lumbar area
o Frequently associated with hydrocephalus
o 50% have a latex allergy - spina bifida meninges, spinal fluid and nerves
- Sx depend on location:
o Leg paralysis
o Loss of bowel and bladder fx
o Hip dislocations and club feet
o May or may not have mental deficit - Dx: maternal AFPCT, MRI, ultrasound
- Tx: around 7mos intrauterine surgery is possible to correct defect
o Closely associated with folic acid deficiency
What is the care prior to surgery for myelomeningocele?
lay on side, saline soaked gauze over protrusion until asap surgery
What fracture is the most common site in children?
Growth plate
- Can stunt growth, shortening of limbs
What type of fracture is seen with child abuse?
spiral fracture and most common in femur
What is the Tylenol safe dosage?
10 – 15mg/kg/dose up to 5x in 24hrs, not to exceed 72 hrs in a row
