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exam 2 Flashcards

1
Q

What are S/SX for Kawasaki disease?

A
  • 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
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2
Q

What are S/SX for Coarctation of aorta?

A
  • S/sx: higher BP and pulses in upper extremities compared to lower extremities
  • Narrowing/constriction of aorta
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3
Q

What are S/SX for Hypercyanotic spell?

A
  • 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
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4
Q

What is the tx for Hypercyanotic spell?

A
  • Knees to chest: increases return of blood to heart, increases SVR which increases blood flow to pulmonary artery
  • Oxygen
  • Morphine to relax
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5
Q

Post Cath care

A
  • 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
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6
Q

Endocarditis hx

A
  • 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!
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7
Q

Digoxin therapeutic range

A

0.8-2.0 mcg/L

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8
Q

Digoxin nursing considerations

A
  • 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
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9
Q

What are the s/sx for digoxin toxicity?

A

s/sx of toxicity: N/V (first), bradycardia, dysrhythmias, anorexia, visual disturbances/halo vision

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10
Q

CHD – lab results

A

CBC: low hgb, low hit, high RBC, polycythemia, anemia

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11
Q

The cause of clubbing of fingers and toes is…

A

hypoxia- chronic low oxygen
ToF

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12
Q

Decreased pulmonary blood flow defects

A

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

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13
Q

What does Tetralogy of Fallot include

A

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

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14
Q

Tricuspid Atresia

A
  • 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
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15
Q

Electrolytes and diuretics

A
  • Increased pulmonary blood flow patients: administer diuretics which can decrease electrolytes, specifically potassium (unless potassium sparing OR administering potassium)
  • ACE inhibitors enhance diuretic action
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16
Q

Heart sounds

A
  • Murmur: whooshing
  • Small defect = large whooshing, and vice versa
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17
Q

Accusation of valves

A
  • Aortic: 2nd intercostal R side
  • Pulmonic: 2nd intercostal L side
  • Tricuspid: 4th intercostal L side
  • Mitral: 5th intercostal midclavicular
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18
Q

Rheumatic fever history

A
  • Hx of strep
  • Strep causes: rheumatic, endocarditis, scarlet fever, glomerulonephritis
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19
Q

Flow of blood through the heart

A

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

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20
Q

SIADH – treatment

A
  • 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
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21
Q

What is HgB A1C ?

A

Measurement of BS regulation over 90 days

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22
Q

Hypoglycemia – symptoms (TSSCCCHAID)

A
  • Tachycardia
  • Shaking
  • Sweating
  • Clammy skin
  • Cold
  • Confusion
  • Hunger
  • Anxiety
  • Irritability
  • Dizziness/Decreased LOC/Confusion—appearance of a stroke
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23
Q

Hyperglycemia - symptoms (FBNPPP)

A
  • Fatigue
  • Blurry vision
  • N/V
  • Polyuria
  • Polydipsia
  • Polyphagia
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24
Q

What is Diabetes Insipidus?

A
  • 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
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25
Q

Diabetic Ketoacidosis – s/sx

A
  • Dry skin/mucus membranes
  • Tachypnea
  • Flushed face
  • Fruity breath
  • Fatigue
  • N/V
  • Altered LOC/confusion
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26
Q

Diabetes education

A
  • 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
27
Q

Somogyi effect

A

hyperglycemia in the morning in response to overnight hypoglycemia
- Tx: give bedtime snack with appropriate insulin

28
Q

Dawn phenomenon

A

elevation of BS btw 5-6am r/t GH release
- Tx: may require slightly elevated dose of long-acting insulin

29
Q

Graves disease

A
  • 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)
30
Q

Priority treatment for status epilepticus

A
  • 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
31
Q

Seizures – risk factors

A
  • 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
32
Q

Early signs of increased ICP

A
  • 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)
33
Q

Late signs of increased ICP

A
  • Decreased LOC
  • Decreased motor response
  • Diminished response to pain
  • Cushing’s Reflex:
  • Bradycardia
  • Increased BP with widened pulse pressure
  • Slow, irregular breathing
34
Q

What are the 3 signs related to meningitis?

A
  • 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
35
Q

Which vaccine will prevent Bacterial meningitis?

A

Hib vaccine

36
Q

Bacterial meningitis

A
  • 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
37
Q

What is primary problem of near drowning?

A

Hypoxia

38
Q

Near drowning

A
  • 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
39
Q

What are the components of the Glasgow Coma Scale?

A
  • Verbal response
  • Motor response
  • Eye opening response
40
Q

What is the priority tx for Botulism?

A

IVIG (immunoglobulin) administration immediately, even prior to culture return
- ICU, monitor muscle impairment, monitor fluid and electrolyte imbalance
*** antibiotics are used as well

41
Q

Botulism

A
  • 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
42
Q

When do you suspect Cerebral Palsy?

A
  • Missed developmental milestone = sign of CP: inability of infant to hold head up by 3 mos
    ** usually related to birth trauma
43
Q

Tetanus

A

immunization booster every 10 years
- grows in spores: dirt, soil, intestinal tract
- S/SX: stiff neck, unconscious, very rigid, intubated, locked jaw

44
Q

Neural tube defects

A
  • 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
45
Q

What is the first sign of Duchene Muscular Dystrophy?

A

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

46
Q

Duchene Muscular Dystrophy

A
  • 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
47
Q

What is Guillain-Barre most often associated with?

A

Viral/flu shot associated

48
Q

Guillain-Barre

A
  • 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
49
Q

The 5 P’s related to cast care

A

Pain, pallor, pulselessness, paresthesia, paralysis

50
Q

which is most ominous and when should you call physician when dealing with a cast?

A

redness, swelling and drainage – call HCP and get cast saw

51
Q

What are the Reasons for Traction?

A

(PAIR)
- Prevent contractures
- Alignment
- Immobilization
- Resist response of the muscle

52
Q

Osteogenesis Imperfecta

A
  • “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
53
Q

How does Bryant’s traction help?

A
  • 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
54
Q

Traction care

A
  • 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
55
Q

What is the gold standard treatment for scoliosis?

A

bracing (compliance can be difficult due to body image issues)

56
Q

what is kyphosis?

A

convex curvature

57
Q

what is lordosis?

A

cervical or lumbar curvature beyond physiologic limits

58
Q

what is scoliosis?

A

lateral (S) curvature—most common

59
Q

Myelomenigocele

A
  • 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 AFPCT, MRI, ultrasound
  • Tx: around 7mos intrauterine surgery is possible to correct defect
    o Closely associated with folic acid deficiency
60
Q

What is the care prior to surgery for myelomeningocele?

A

lay on side, saline soaked gauze over protrusion until asap surgery

61
Q

What fracture is the most common site in children?

A

Growth plate
- Can stunt growth, shortening of limbs

62
Q

What type of fracture is seen with child abuse?

A

spiral fracture and most common in femur

63
Q

What is the Tylenol safe dosage?

A

10 – 15mg/kg/dose up to 5x in 24hrs, not to exceed 72 hrs in a row

peds (4 decks)

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