Exam 2 Flashcards
What does a Left to Right shunt mean?
Left to Right shunt = pulmonary congestion
- blood flows from high pressure on left side to lower pressure on right side
- increase in blood volume under high pressure on right side (tachypnea, dyspnea, pulmonary edema)
- increases resistance of blood flow to the lungs (pulmonary hypertension)
- need early intervention to avoid irreparable damage to pulmonary system
How does fetal circulation differ from post-birth circulation when the placenta is clamped?
- Lungs are non-functional as a fetus, placenta functions as oxygen
- 2 umbilical arteries (deoxygenated blood) and 1 umbilical vein (oxygenated blood)
- fetal circulation depends on shunts (heart, liver, great vessels)
– blood bypasses hepatic circulation and enters IVC, enters RA, through foramen ovale to go to LA, will enter ventricles and go through aorta (pulmonary has ductus arteriosus so blood from RV goes into aorta)
– blood flows basically from right to left
At birth:
- baby breathes and lungs expand
- increased systemic vascular resistance; pressure of left circulation is higher than right and closes foramen ovale
- high aortic pressure and lower pulmonary pressure ductus arteriosus closes over 3-4 days functionally and is anatomically closed over a few months
- foramen ovale closes after birth with changes in pressure in cardiac chambers with baby’s first breath
What does a Right to Left shunt mean?
Can be seen during what? What does it bypass?
Blood from right side of the heart enters the left side of the heart
- right to left shunt can also be seen in the acute phase of a massive PE
Right to left shunt = hypoxemia (this flow bypasses the lungs)
What are the treatment options of pyloric stenosis?
pyloromyotomy
Common causes and symptoms of UTIs?
infants: diapers and feces can get in easily; any hx of structual issue
younger kids: potty training, wiping improperly
adolescents: sexual activity, bubble baths, bath bombs
- urinary stasis is the most important host factor
- structure of urinary tract accounts for increased incidence in females
symptoms:
- increased urinary frequency
- painful urination
- hematuria
How can exposure to medications through the placenta impact cardiac development?
What is the risk of taking Ibuprofen?
- NSAIDs are given to premature infants to induce closure of the ductus arteriosus
- Exposure to NSAIDs in 3rd trimester can interfere with the close of the DA
- Premature closure of this blood vessel can cause high BP in the lungs of the developing fetus leading to pulmonary hypertension
What is the risk of taking SSRIs (Zoloft)
- PPHN (Persistent pulmonary hypertension of the newborn), cardiac malformations, and arrhythmias
- Increased risk of Ebstein’s anomaly
– Defect of tricuspid valve: two leaflets not in right place
– Hypoplastic right heart
- SSRI in first trimester to be associated with increased risk of severe CHD
- SSRI were found to be associated with two fold increase in risk of CHD overall
cleft lip: why stimulate infant sucking reflex while feeding
Why: Babies with a cleft palate may have an impaired sucking reflex due to the anatomical difference in their oral cavity. Nurses can help by stimulating the infant’s sucking reflex, which may assist in initiating and maintaining the sucking action. Nurses can gently stroke the baby’s lips or encourage sucking by positioning the baby to bring the nipple into contact with the mouth. This tactile stimulation can help encourage the baby to suck more effectively.
What are signs and symptoms of hypertonic dehydration?
The child might show signs like increased thirst, dry mucous membranes, sunken eyes, lethargy, and irritability. Severe dehydration can also lead to neurological changes like confusion or seizures because of the altered osmolarity affecting brain function.
Why does nephrotic syndrome rarely cause HTN?
-
loss of albumin and fluid shift:
– The primary problem in nephrotic syndrome is the loss of protein (especially albumin) into the urine. This decreases the plasma oncotic pressure, which is responsible for drawing water into the bloodstream from the tissues.
As a result, fluid moves out of the bloodstream into the tissues, causing edema (swelling, typically in the legs, abdomen, or face).
This fluid shift often leads to hypovolemia (low blood volume) in the bloodstream. Because there’s less fluid in the circulation, blood pressure tends to be low or normal in nephrotic syndrome. -
reduced renal blood flow and RAAS activation:
– Despite the fluid shift and potential hypovolemia, the kidneys may perceive a reduction in blood flow due to the lower plasma volume and activate the RAAS system to try to conserve sodium and water. However, the response is not usually enough to significantly raise blood pressure because the primary issue is the loss of albumin, not a failure of sodium regulation or vasoconstriction mechanisms.
As a result, while the body tries to compensate by retaining sodium and water, this often does not lead to significant hypertension.
Severe hypertonic dehydration: how is it managed with IV fluids?
Severe hypertonic dehydration is:
- water loss is greater than electrolyte loss
- shock is LESS likely
- neuro changes
- sodium >150mEq/L
- will see: cap refill greater than 4 seconds, tachycardic, orthostatic BP, extreme thirst, very dry mucous membrane, tenting of the skin, hyperpnea, sunken eyeballs, no tears, oliguria or anuria
managed with isotonic IV fluids
fluid replacement (daily maintenance): (1st 10kg x 100) + (2nd 10kg x 50) + (each additional kg x 20)
- hourly: 1st 10kg x 4ml/hr, 2nd 10kg x 2ml/hr, each additional x 1ml/hr (4 2 1 rule)
What is iron deficiency anemia?
- most common anemia in US; deficient in iron - ferritin low
Risk factors:
- Preterm infants: decreased fetal iron supply
– iron stores from mother to fetus are adequate for 5-6 for full term baby, nut only 2-3 months for premature infant
- Children 12-36 months: are at risk as a result of not eating enough iron-rich foods and drinking mainly cow’s milk
- Adolescents: r/t rapid growth rate, combined with menses, obesity, poor eating habits, and/or strenuous activities
What is TGA and TGV?
Transposition of the great arteries and transposition of the great vessels
- mixed defect
- symptoms dependent on type and size of defect
- pulmonary artery leaves the left ventricle and aorta exists the right ventricle with no communication between systemic and pulmonary circulations (pulmonary and aorta have switched from normal)
What is pulmonary stenosis?
- a narrowing of pulmonic valve at entrance of pulmonary artery
- interferes with flow of blood from right ventricle to lungs
- will result in right ventricular hypertrophy due to pressure increases in right ventricle
- may not be evident until adulthood
What is the Jones Criteria for Rheumatic Fever? Major vs Minor criteria?
Used to diagnose rheumatic fever
there must be evidence of streptococcal infection plus 2 major OR 1 major & 2 minor
Major: “CASES”
- Carditis
- Arthritis
- Subcutaneous nodules
- Erythema marginatum
- Syndenham’s chorea
Minor: “FRAPP”
- Fever
- Raised ESR/CRP
- Arthralgia
- Prolonged PR interval
- Previous RF
What is eisenmenger syndrome?
Right to left shunt
- Development of pulmonary HTN due to untreated CHD
- Pulmonary HTN causes long standing L to R shunt to flip to R to L shunt
- Cyanosis, polycythemia, clubbing of fingers
Related to VSD
What is a COA (coarctation of aorta)
- narrowing of the aortic arch near the insertion of the ductus arteriosus
- increase proximal pressure to narrowing and decrease pressure distal to the narrowing
- produces an obstruction of the flow of blood through the aorta causing increased left ventricular pressure and workload
What is hemophilia? What causes it?
- refers to a group of bleeding disorders in which there is a deficiency of one of the proteins necessary for coagulation of blood (hemophilia A or B are most common)
- 80% of cases is X-linked recessive; chromosomal mutation characterized by coagulation factor deficiency
Hemophilia A: Factor VIII deficiency (most common)
Hemophilia B: Factor IX deficiency
A newborn is diagnosed with tetralogy of Fallot. The pediatric cardiologist remarks that there is an over-riding PDA, and orders prostaglandin to keep the ductus arteriosis from closing. What is the nurse’s most appropriate action after receiving this order?
Explain to the parents that keeping the ductus arterosis open will make sure that some oxygenated blood will circulate
What are post-op considerations with bladder exstrophy?
- imaging will include renal ultrasounds and pelvic x-ray; prior to surgery: low-dose CT scan to assess pubis diastasis and potential hip issues
- some males: pre-op testosterone is administered 6 weeks before operation and then again 3 weeks before
- ideal age of repair is 4-16 weeks of age
- management of many tubes post op: ureteral stents, bladder suprapubic tube, urethral stent, drain
What is the treatment for nephrotic syndrome?
- manage blood pressure: ACE inhibitors to reduce BP and amount of protein released in urine
- diuretics: decrease overall swelling and increase kidney output
- blood thinners: manage possible increase in coagulation
- steroids: control inflammation
- corticosteroids
- anti-hypertensives
- albumin
complications:
- infections
- circulatory insufficiency
- thromboembolism
- steroid-sensitive nephrotic syndrome (SSNS): when syndrome is sensitive to steroid treatment
– about half with SSNS have frequent releases: two ore more times in 6 months of 4 or more times in one year
What are the symptoms of Post-Streptococcal Glomerulonephritis?
-
cardinal symptom: hematuria
– takes like 1-3 weeks to appear after a strep infection hence “post” - edema
- decreased weight
- urine output decreased
- lethargy
- irritability
- pallor
- febrile
- headaches
- dysuria
- abdominal pain
- elevated BP
- foamy urine
- frequent hiccups
- generalized itching
- nosebleeds
- increased bruising
- seizures
- life-threatening complication: PE
What is the purpose of an EKG (electrocardiogram)? What does it detect?
Records quality of major electrical activity of the heart. Quick snapshot
Helps dx and monitor heart conditions
-arrhythmias/dysrhythmias
-congenital heart defects
-effectivness of medications or procedures
What is GERD?
- transfer of gastric contents into the esophagus
- most commonly after meals and at night
- tissue damage or symptoms
Clinical Manifestations of atrial septal defect (ASD)
acyanotic (absence of cyanosis)
symptoms vary based on the size of the opening:
- fatigue
- difficulty breathing
- recurrent respiratory infections
- poor weight gain
- heart murmu
Asymptomatic
CHF sx’s
Murmur
Atrial Dsyrhythmia
Endocarditis assessment
- malaise
- fever
- new murmur or change in murmur: hallmark sign
- myalgias
- arthralgias
- weight loss
- splenomegaly
- hemorrhages under fingernails
- petechiae
Neonates:
- tachycardia
- feeding problems
- respiratory distress
- heart failure
- septicemia
What symptoms are associated with a left to right shunt?
left to right shunt = pulmonary congestion
- PFO
- ASD
- VSD
tachypnea, dyspnea, pulmonary edema, pulmonary hypertension
- pulmonary HTN in children presents as:
– tachycardia
– tachypnea
– S3 and S4 sounds
– dyspnea
– diaphoresis
– easily fatigued
– difficulty eating
– enlarged spleen/enlarged liver
An 8-year-old client presents with sudden onset of abdominal pain and reddish-brown urine. A urinalysis shows 4+ protein. On taking the child’s health history, the nurse learns that the child had strep throat 9 days ago. Which condition does the nurse suspect?
Glomerulonephritis, inflammation of the glomeruli of the kidney, is most common in children between the ages of 5 and 10 years. The child typically has a history of a recent streptococcal respiratory infection (within 7 to 14 days). Symptoms are as described with this client. Kidney agenesis (absence of kidneys) and polycystic kidneys (formation of large, fluid-filled cysts in the place of normal kidney tissue) are serious congenital conditions that would likely be discovered either in utero or shortly after birth, not conditions that would appear acutely in an 8-year-old child.
What is VSD? Signs/symptoms
ventricular septal defect
- Abnormal opening between left and right ventricles
- 2 types (membranous and muscular)
Heard best in left lower sternal border
Symptoms:
Increased blood pressure
Low Sp02
*Confusion and irritability are signs of low 02
What is appendicitis?
- symptoms, labs, assessment
- inflammation of the vermiform appendix (blind sac at end of cecum)
- cause is obstruction of the lumen of the appendix, by hardened fecal material
- often after a viral infection, swollen lymphoid tissue can obstruct appendix
- pinworms can also obstruct
- most common cause of emergency surgery in childhood
Symptoms:
- umbilical pain
- nausea
- RLQ pain (McBurney point)
- vomiting
- fever
- physical exam findings:
– dunphy’s sign: sharp pain in RLQ with cough; pain caused by peritoneal irritation
– rebound tenderness: pain is greater when deep palpation is quickly released than during palpation; indicates peritoneal irritation
Labs:
- elevated WBC
- CRP > 8mg/L
- UA
Assess:
- mcburney’s point
- iliopsoas test
- obturator test
When should a patient with sickle cell disease contact a physician or go to the ER?
- a fever is a medical emergency
- CVA
- call with s/s of infection
What is Hirschsprung’s Disease?
Congenital Aganglionic Megacolon
- caused by lack of ganglionic cells in segments of the colon, resulting in decreased mobility and mechanical obstruction
Hirschsprung’s Disease is a congenital condition where parts of the colon are missing nerve cells (ganglion cells), leading to a lack of peristalsis (the normal wave-like movement of the intestines). This can cause stool to build up behind the affected section of the colon, leading to bowel obstruction.
How to protect the single kidney from damage?
no contact sports!!
online: To protect a single kidney, focus on a healthy lifestyle, including a balanced diet, regular exercise, staying hydrated, managing blood pressure and blood sugar, and avoiding smoking and excessive alcohol consumption.
How to support a baby with cleft lip trying to eat?
online: Keep your baby upright during the feeding and for 20–30 minutes after to limit nasal regurgitation. If milk leaks out of your baby’s nose, wipe it away with a clean cloth. You do not need to use a suction bulb. Though babies with a cleft palate can’t breastfeed, moms can feed them breast milk in the bottle.
Signs of low cardiac output and what to look for on physical exam
ultimately, myocardial dysfunction
- reduced cardiac output can lead to reduced baroreceptor stimulation: activation of SNS
– increased HR
– increased cardiac contractility
– vasoconstriction
– these three lead to myocardial toxicity, leading to myocardial dysfunction - reduced cardiac output can lead to reduced renal perfusion: activation of RAAS
– vasoconstriction
– sodium and water retention
– these two lead to myocardial apoptosis/fibrosis, leading to myocardial dysfunction
The nurse is educating parents about performing a “tape test” for a child suspected of having pinworms. What is the correct procedure for this test?
The tape test uses transparent tape placed in the perianal area overnight to detect the presence of ova and/or parasites, which will be visible under a microscope. The test should be performed on three consecutive nights and the tape should be removed before the child uses the toilet to defecate.
What is an echocardiogram?
“An echocardiogram uses ultrasound to see the structures of the heart and visualize patterns of blood flow.”
Cyanotic heart defects
Decreased pulmonary blood flow:
- tetralogy of fallot
- tricuspid atresia
Mixed blood flow:
- transposition of great arteries
- total anomalous pulmonary venous return
- truncus arteriosus
- hypoplastic left heart syndrome
What is hypoplastic left heart syndrome?
Mixed blood flow, cyanotic defect
- underdevelopment of the left side of the heart
- inability to supply oxygen needs of the body
Etiology:
- unknown
- poor prognosis
- PDA is necessary to sustain life
- symptoms may be mild until ductus arteriosus closes at 2 weeks causing marked cyanosis and decreased cardiac output
The nurse is assessing an infant with intussusception. Which characteristic of the infant’s stools is an expected finding for this condition?
The characteristic appearance of stools for a child with intussusception is “currant-jelly”-like stool. This is from the blood and mucus that is present in the stools of children with this condition.
What is the treatment for intussusception?
can fix itself sometimes
Nursing care:
- stabilize
- IVF
- NGT
- educate
Therapeutic procedures: air enema
Complications: reoccurring intussusception; needs surgery
What does a Holter Monitor assess? When is it used?
Ongoing monitoring.
similar to ekg but worn longer (up to 48 hours)
diagnose arrhytmias
A two-month old has been brought to the emergency department with projectile vomiting, decreased urine output, lethargy, and irritability. The parents report that the infant was previously healthy. The nurse observes peristaltic waves in the abdomen and sunken fontanelles. Which order should the nurse anticipate?
IV fluids, strict I & O and NPO for surgery
The infant is displaying signs of pyloric stenosis and dehydration and should be prepared for surgery. NPO will prevent forceful vomiting and is required pre-operatively to decrease risk of aspiration. IV fluids will replace fluids lost from vomiting. Intake and output should be monitored to assess fluid volume status.
What findings on urinalysis suggest a UTI?
positive nitrites
positive leukocytes: need rapid raise, can be there without a bacterial infection
(hematuria can be seen with other disease processes)
Why does nephritic syndrome often cause HTN?
-
glomerular inflammation and sodium retention:
– In nephritic syndrome, the inflammatory damage to the glomeruli causes reduced glomerular filtration rate (GFR) and impaired kidney function. The kidneys sense a decrease in renal perfusion, leading to activation of the RAAS system.
This results in sodium and water retention, which increases blood volume. The retained fluid leads to increased blood pressure (hypertension). -
vasoconstriction and fluid retention:
– The inflammatory process also promotes vasoconstriction (narrowing of the blood vessels), which increases systemic vascular resistance. This contributes to an increase in blood pressure.
In addition, the kidneys may have reduced ability to excrete sodium and water, further contributing to fluid overload and increasing blood pressure. -
increased permeability to smaller molecules:
– While nephritic syndrome does have proteinuria (like nephrotic syndrome), the level of protein leakage is usually lower, and the more significant issue is the glomerular inflammation that leads to impaired filtration. This leads to retention of both sodium and fluid, which can raise blood pressure.
The nurse is caring for a child with hemophilia A who has developed hemarthrosis in the knee joint. What is the priority nursing intervention?
Intravenous infusion of Factor VIII
-Hemophilia A occurs when a genetic sequence prevents the formation of Factor VIII, which is necessary for clotting.
-The nurses’s first priority in a bleeding situation is to stop the bleeding. This necessitates administering an intravenous infusion of the missing clotting factor. The extremity will be elevated and immobilized to prevent further injury.
What is Kawasaki disease?
AKA mucocutaneous lymph node syndrome
- an infectious or possibly toxic trigger that initiates an immune response that effects medium size arteries: coronary arteries
- inflammatory process that causes thickening and scarring of vascular walls
What are the symptoms of pyloric stenosis?
- forceful vomiting
What are common signs and symptoms of ruptured appendicitis?
online
- sudden, severe pain
- pain spreads
- fever and chills
- weakness and malaise
- swollen abdomen
- urinary symptoms
- bowel paralysis
is a medical emergency
cleft lip: why maintain periodic rest periods for the infant during feedings
Why: Feeding a baby with a cleft palate can be tiring because it often requires more effort to suck and swallow. Rest periods during the feedings allow the baby to recover from fatigue, reducing the risk of them becoming overly tired, which can interfere with proper feeding and increase the chance of aspiration.
What are signs and symptoms of Kawasaki disease?
Acute stage: 10-14 days
- fever (>5 days)
- bilateral non-purulent conjunctivitis
- strawberry tongue
- swelling of hands and feet; erythema of palms and soles
- generalized erythematous rash
- enlarged cervical lymph nodes
- tachycardia
- irritability
Subacute stage: 15-25 days
- fever gone
- anorexia
- irritable
- desquamation of fingers and tones
- arthritis and arthralgia symptoms
- cardiovascular symptoms (CHF, dysrhythmias, coronary aneurysms)
Convalescent stage: 26 days til ESR returns to normal and symptoms disappear
- deep beau lines on nails
- all symptoms disappear unless irreversible complications
What is the treatment for Kawasaki disease?
Goal is to prevent coronary artery complications
- IVIG (IV immune globulin) and anti-pyretic therapy
- aspirin therapy: 10-15mg/kg/dose qh4 (max 3.6g/day)
- corticosteroids can be prescribed
** not live vaccines for at least 11 months after IVIG
Why is it important to caution against ibuprofen use in pregnancy? (Added her info from slide in another card about meds in general)
Online: Ibuprofen use later in pregnancy might also cause premature closure of the ductus arteriosus (an opening between the two major blood vessels leading from the heart).
- If the ductus arteriosus closes before it should, it can cause high blood pressure in the fetal lungs (pulmonary hypertension)
Symptoms of pinworms
- enuresis
- perianal itching
- restlessness
- disturbed sleep
transmission: fecal-oral
What is PDA?
patent ductus arteriosus
- Failure for the DA to close after the first weeks of life
- Machine like murmur
Interventions for RF
- penicillin to treat any remaining group A strep
- ASA or naproxen to reduce inflammation, relieve pain, and minimize joint swelling
- corticosteroids if patient has carditis or if anti-inflammatory agents are non-responsive
- strict bedrest for 5 weeks until ESR returns to normal to reduce cardiac demands
- bedrest, sodium restriction, ACE inhibitors, digoxin, and diuretics to treat heart failure
The nurse is performing an admission assessment on a 2 year old child diagnosed with nephrotic syndrome. Which finding from the physical assessment is most characteristic of nephrotic syndrome?
Common findings on physical assessment for a child with nephrotic syndrome include weight gain, periorbital and facial edema, generalized edema, decreased urinary output, dark, frothy urine, and normal or slightly decreased blood pressure.
What is the most common valved affected by valvular endocarditis?
mitral valve is most infected, followed by aortic
why is it called a boot sign on chest x-ray with TOF?
the upturned cardiac apex (toe of boot) and concave pulmonary artery segment (heel of boot) look like a boot silhouette
what causes the above:
- right ventricular hypertrophy: RV becomes enlarged and hypertrophied due to increased workload from pulmonary stenosis
- upturned cardiac apex: hypertrophy causes apex to point upwards
- concave pulmonary artery segment: pulmonary stenosis leads to reduced pulmonary artery segment
What is nephrotic syndrome?
- predominantly between the ages of 2-7
- males more than females
- may be a metabolic, physiochemical, biochemical, or immune mediated disturbance that causes the basement membrane of the glomeruli to become permeable to protein
- one of 4 types of renal lesions
characterized by: hypoalbuminemia, edema, proteinuria
BP usually normal
Types:
- primary or MCNS (minimal change nephrotic syndrome) - most common
- systemic: lupus erythematous, cancer, heavy metal poisoning, hepatitis
How do you assess if a patient has enough urine output?
1-2ml/kg/hour
How to educate parents about colostomy care and when to contact a surgeon
online: To effectively educate parents about colostomy care, nurses should focus on practical skills like pouching, skin care, and dietary guidelines, while also emphasizing when to contact a surgeon for concerns like persistent diarrhea, bleeding, or skin irritation
What is aortic stenosis?
- narrowing of aortic valve which interferes with flow of blood out of left ventricle to aorta
- causes left ventricle wall to thicken as result of pressure to pump blood through aortic valve
etiology:
- congenital birth defect
- rheumatic fever
- worsens as heart grows
What are the causes of nephrotic syndrome?
- may be a metabolic, physiochemical, biochemical, or immune mediated disturbance that causes the basement membrane of the glomeruli to become permeable to protein
What are the symptoms of nephrotic syndrome?
- edema
- anorexia
- abdominal pain
- fatigue
- BP normal or slightly decreased
- susceptible to infection
- hyperalbuminurea (high in urine)
- hypoalbuminemia (low in blood)
- hypovolemia
nephrOtic = prOtein loss = in urine
What are common nursing measures with Hypoplastic Left Heart Syndrome?
- if PDA closes: infant will progressively deteriorate with worsening cyanosis, decreased cardiac output, and eventual cardiac collapse
- echo will visualize the defect
online: common nursing measures focus on maintaining a balance between systemic and pulmonary blood flow, ensuring adequate cardiac output and oxygen saturation, and providing supportive care before and after surgeries, including the Norwood, Glenn, and Fontan procedures
What is an Atrial Septal Defect (ASD)?
acyanotic
is under left to right shunt
Abnormal opening between the R and L atrium (is an opening in the atrial septum; what separates the two artia)
- allows blood to flow directly from LA to RA leading to increased blood volume in right side of heart; extra blood can be pumped to lungs
- leads to increased pressure in lung and strain on heart overtime
- murmur commonly heard along upper left sternal border (typically systolic)
- Incompetent foramen ovale is the most common defect
– Three types of abnormalities cause incorrect development of atrial septum
Nephritic Syndrome Features: (Proteinuria, Hematuria, Edema, HTN, Urine output, common causes, treatment)
- Proteinuria: mild to moderate
- Hematuria: present (tea colored)
- Edema: mild to moderate
- HTN: common
- urine output: decreased
- common causes: PSGN, IgA nephropathy
- treatment: antibiotics, diuretics, anti-HTNs, immunosuppressants
Ductus venous is necessary to bypass what organ
the liver
A nurse is preparing to administer digoxin to a 6-month-old infant. Prior to administering the dose, the nurse measures the apical heart rate. The nurse should withhold the dose if the infant’s apical heart rate is less than what rate?
The nurse should withhold the digoxin dose for heart rate of 60/min or below in an adult, 70/min or below in a child, and 90/min or below in an infant.
What symptoms following a head injury require urgent attention?
online: Following a head injury, seek immediate medical attention if you experience repeated vomiting, a worsening headache, loss of consciousness, seizures, unequal pupil size, slurred speech, or unusual behavior.
cleft lip: why hold the bottle at 180 degrees
Why: Positioning the bottle at a 180-degree angle (parallel to the floor) helps control the flow of milk and reduces the risk of milk flowing too quickly or too slowly, which can be difficult for an infant with a cleft palate to manage. Holding the bottle this way also helps prevent aspiration because the milk doesn’t flow directly into the baby’s mouth without control.
Pulmonary stenosis assessment
- may be asymptomatic
- mild stenosis
- signs of heart failure
- loud murmur
- angina and dyspnea
- increased risk for bacterial endocarditis
Pain management strategies for sickle cell disease
- acute crisis: narcotics/opioids IV, codeine PO
- a parenteral NSAID (ketorlac, toradol)
- mild analgesic: PO NSAID
- IV methylprednisone:
– decreases duration of severe pain in children
– decreases inflammatory response
What are common considerations for post-operative care after a renal biopsy?
online: After a renal biopsy, common nursing considerations include monitoring vital signs, urine output, and the biopsy site for bleeding or infection, while also educating the patient about activity restrictions and when to seek medical attention.
How to recognize Failure to Thrive on a growth chart?
- typically when child falls below the 5th percentile for child’s age
Why is abdominal circumference important?
- Abdominal circumference is a key indicator of internal changes, especially in infants who have undergone surgery. An increase in the abdominal girth could indicate the development of complications like intestinal obstruction, bowel perforation, or infection.
- After a colostomy, the infant is recovering from major surgery, and the nurse must monitor the infant for signs of complications, such as ileus (a temporary paralysis of the bowel), bowel distention, or sepsis.
-
A 3 cm increase in abdominal circumference over a 2-hour period is a significant and concerning finding because:
– Bowel Obstruction: In the case of Hirschsprung’s disease, the absence of nerve cells in the colon can lead to bowel obstruction, where stool cannot pass properly. This can cause distention of the abdomen as gas and stool accumulate behind the blockage.
– Ileus: After surgery, it’s normal for the intestines to take some time to “wake up” and resume normal function. However, a significant increase in abdominal girth might indicate that the bowel is not functioning properly (ileus) or has become obstructed.
– Perforation or Sepsis: Another concern is that a rapid increase in abdominal size could signal a bowel perforation (a hole in the intestines), which allows air and waste to leak into the abdominal cavity. This is a medical emergency and can lead to peritonitis (infection of the abdominal cavity) and sepsis.
What is epispadias?
- urethral opening on top of penile shaft
- mild to severe: severe associated with exstrophy of the bladder
- male infant should not be circumcised until corrective surgery is done
The nurse is caring for a 6 month old infant with gastroenteritis. The nurse understands that which assessment is the most reliable indicator of fluid loss?
Body weight is the most reliable indicator of fluid loss (Note: this is a very testable concept!!!) in infants and children. It can more accurately reflect the amount of fluid loss than other indicators of dehydration.
**Although skin integrity can be impaired as a result of dehydration, it is usually a late sign and does not directly reflect the amount of fluid loss.
A sunken anterior fontanelle (the posterior one should be closed for this 6 month-old infant) is also a sign of dehydration but is not as reliable as a loss of weight and does not adequately measure the amount of fluid loss.
Tachypnea can occur with dehydration but is not a direct indicator of fluid loss.
What is the presentation of Hirschsprung’s Disease? Differences in newborn vs older infants?
Newborn:
- failure to pass meconium within 24-48 hours after birth
- bilious emesis
- abdominal distention
- refusing to eat
Infants:
- FTT
- constipation
- vomiting
- diarrhea
Children:
- undernourished
- abdominal distention
- visible peristalsis
- palpable fecal mass
- foul smelling, ribbon-like stool
- constipation
cleft lip: why assess the infant’s swallowing during the feeding to prevent aspiration
Why: Infants with cleft palates are at higher risk for aspiration because the gap in the palate can interfere with the proper closure of the oral cavity, making it easier for milk to enter the airway. Monitoring swallowing helps ensure the baby is safely swallowing milk and not aspirating it into the lungs, which could lead to choking or respiratory issues.
What symptoms are associated with a right to left shunt?
Right to left shunt = hypoxemia (this flow bypasses the lungs)
- Eisenmenger syndrome
- pulmonary atresia
- TOF
- transposition of the great arteries
Result -> Hypoxemia, cyanosis
Polycythemia -> increase in viscosity of blood
emboli
What is PDA? (patent ductus arteriosus)
acyanotic L to R shunt
- failure of ductus arteriosus to close after the first weeks of life
- left to right shunt
- higher pressure aorta to lower pressure pulmonary artery
- alteration in blood flow:
– increase workload on left side of heart
– increase pulmonary vascular congestion and resistance
– potential increase in right ventricular pressure and hypertrophy
Which finding is typically present in acute glomerulonephritis but absent in nephrotic syndrome?
Hematuria
Blood in the urine (hematuria) is the cardinal sign of acute glomerulonephritis. Urine in nephrotic syndrome is dark and frothy, but generally not bloody.
Edema, decreased urine output (oliguria), and massive proteinuria are common to both disorders and reflect impaired renal function.
What is the treatment of sickle cell disease?
- daily hydroxyurea
- oxygen PRN
- oral penicillin prophylaxis
- hydration
- blood transfusions
- electrolyte replacement
- analgesics
- antibiotics
- avoid the cold (sickles)
Nephrotic Syndrome Features: (Proteinuria, Hematuria, Edema, HTN, Urine output, common causes, treatment)
- Proteinuria: Massive > 3.5g/day
- Hematuria: usually, absent
- Edema: significant
- HTN: rare
- Urine output: normal or decreased
- Common causes: minimal change disease, FSGS, membranous nephropathy
- Treatment: steroids, diuretics, ACE inhibitors
What is nephritic syndrome characterized by?
Nephritic syndrome, on the other hand, is typically characterized by hematuria (blood in the urine), proteinuria, hypertension, and azotemia (elevated blood urea nitrogen and creatinine levels).
- The glomeruli are damaged by an inflammatory process, often due to an infection or autoimmune response, which leads to the formation of immune complexes that obstruct the glomerular filtration barrier and cause inflammation.
An infant with bladder exstrophy is awaiting surgical repair. What is the priority nursing intervention for this child?
Exstrophy of the bladder is a congenital defect in which the bladder is exposed on the outside of the infant’s abdomen. It must be corrected from surgery. In order to protect the bladder, the priority is to keep the bladder moist and protected from pathogens with a sterile plastic bag.
Petroleum jelly gauze should not be used because this type of dressing can dry out, adhere to the mucosa, and damage the delicate tissue when removed.
The infant should be sponge-bathed rather than immersed in a tub bath to prevent injury to the bladder, which should not be washed with soap and water.
Although the infant’s diaper should be changed frequently to avoid contamination of the bladder with fecal material, this is not the priority intervention.
What is glomerulonephritis?
kidney disorders characterized by injury to the glomerulus; both primary and secondary diseases result in glomerular injury
types:
- systemic/infectious: caused glomerular inflammation
- acute: sudden inflammatory process of glomerular
- acute post-streptococcal glomerulonephritis (APGSN); most common in peds
What is the treatment for Post-Streptococcal Glomerulonephritis?
- sodium and fluid restriction for treatment of s/s of fluid retention
- bed rest recommended until signs of glomerular inflammation and circulatory congestion subside
- long term monitoring
online: Treatment for Post-Streptococcal Glomerulonephritis (PSGN) focuses on managing symptoms and preventing complications, often including antibiotics to eradicate any remaining streptococcal bacteria, and medications to control blood pressure and swelling.
nursing interventions:
- physical examinations
- assess weight daily b/c fluid elimination
– need to watch because of excess fluid volume
- monitor fluid intake and output every 4 hours
– watch for altered urinary elimination
- assess vital signs: monitor BP and PR ever hour to assess HTN
– also temp b/c hyperthermia r/t ineffectiveness of thermoregulation secondary to infection
- assess breath sounds and pattern
- monitor imbalanced nutrition less than body requirements r/t decreased appetite, N/V
What are common signs and symptoms of iron deficiency anemia on exam?
- tachycardia
- pallor
- brittle, spoon-shaped fingernails (koilonychia)
- fatigue, irritability, muscle weakness
- systolic heart murmur
- cravings for non-nutritive substances (ice, dirt, paper): PICA
Labs:
- decreased RBC, Hgb, Hct levels (Hgb level varies with age)
- microcytic-hypochromic
- Reticulocytes can be decreased
- total iron binding capacity (TIBC): elevated
- transferrin: 10% indicate of anemia
- stool analysis: guaiac test
schedule universal anemia screens at 12 months of age
Management for infants with GERD and how to assess treatment effectiveness?
Management:
- diet
- medications
– H2-RAs: reduce amount of acid produced by cells in lining of stomach, block histamine receptors, reduction of gastric acid and pepsin production
– PPIs: blocks proton pumps of stomach; prevent final step of acid production - decreasing level of acid
- surgery (nissen fundoplication; watch for long-term complications)
Complications:
- FTT
- recurrent pneumonia
- weight loss
nursing: probably watching for improvement in symptoms, weight gain, no pneumonia
*I think part of the answer is making sure they’re upright for 30 minutes after meals
acute chest syndrome.
Why do we use normal saline when treating hypertonic dehydration?
What is Normal Saline? Normal saline (0.9% sodium chloride) is isotonic, meaning it has a similar concentration of sodium and water to that of normal blood plasma. It is used to gradually expand the extracellular fluid volume without introducing significant shifts in osmolarity.
Why 0.9% NaCl? Normal saline is used because it is isotonic, which means it will not drastically alter the balance of sodium in the blood. In cases of hypertonic dehydration, the goal is to slowly rehydrate the child without making their sodium levels drop too quickly. If hypotonic fluids (like water or 0.45% saline) were used too early, they could cause the cells to absorb too much water, increasing the risk of cerebral edema.
Colostomy: what is it, signs of infection, feeding difficulties, abnormal vital signs, increased pain
This surgical procedure involves creating an opening (stoma) on the abdominal wall to divert stool into an external bag, bypassing the part of the colon affected by Hirschsprung’s disease. Babies will have a colostomy and then eventually a pull through procedure. How will you help care for a colostomy after the surgery – same typical surgical recovery principles apply.
- Signs of Infection: Redness, warmth, or drainage around the surgical site.
- Feeding Difficulties: The infant may refuse feedings or vomit, especially if there’s a bowel obstruction.
- Abnormal Vital Signs: Elevated heart rate, fever, or low blood pressure can indicate infection or sepsis, including measuring abd circumference.
- Increased Pain: The baby may show signs of discomfort or pain (e.g., crying, irritability, or stiffening of the body).
A nurse is caring for a 12 year-old child who has been admitted to the hospital with sickle cell crisis. The nurse observes that the child suddenly appears confused and uncoordinated with right-sided weakness, slurred speech. The client is also reporting a severe headache and double vision. The nurse immediately contacts the provider to report that the patient may be experiencing which condition?
CVA can occur in patients with sickle cell disease when sickled red blood cells obstruct blood vessels in the brain. This situation requires immediate intervention. The condition is marked by severe headache, seizure activity, unusual behaviors, one sided weakness, slurred speech or sudden onset of stuttering, uncoordinated gait, and visual disturbances.
The nurse is assessing a toddler for signs and symptoms of iron-deficiency anemia. Which assessment findings support this diagnosis?
Expected findings in a child with anemia include pallor of the conjunctiva, oral mucosa, nail beds, and palmar surfaces, fatigue and lethargy, thin, spoon-shaped nails, and tachycardia. In advanced cases, a flow murmur, decreased oxygen saturation and neurologic effects, such as inability to eat sufficiently and impaired mobility.
What activities are safe for a patient with hemophilia?
- do not give IM injections
online: low-impact exercises like walking, swimming, cycling, and yoga, while avoiding contact sports like football, hockey, or wrestling
Treatment for endocarditis
- treat to eradicate the infecting organism
- first line of therapy is usually combo of penicillin and gentamycin
- IV abx should start promptly and continue 4-6 weeks
- will need prophylactic abx before, during, and after dental work, GU, GYN, or GI procedures
What is encopresis? What are symptoms?
fecal incontinence
“when children poop in their pants”
- when constipation causes impacted stool to fill colon and liquid stool leaks out
symptoms:
- may not notice they have pooped their pants
- feces in pants
- prob shit streaks is a big sign (skidmarks lol)
The nurse is teaching an adolescent female with iron deficiency anemia about foods high in iron. The nurse knows that the teaching has been effective if the girl reports that she will eat which foods?
Red meats, dark meat chicken, organ meats, dried beans, green leafy vegetables, and fortified cereals are good sources of iron. Animal sources of iron contain heme iron, which is easier to absorb. Plant foods have iron that is less easily absorbed but still beneficial if they are consumed in adequate amounts.
Milk does not contain sufficient iron and the calcium can inhibit absorption of iron if consumed with other foods.
What is acute post-streptococcal glomerulonephritis?
- most common of the post-infectious renal diseases in childhood
- APSGN is an immune disease that occurs after a group A beta-hemolytic streptococcal infection
– latent period - more prominent in the late summer or early fall when associated with impetigo
- can’t go to the heart and cause rheumatic fever
If a patient has a large opening in their palate, how will that affect their suck? What, as their nurse, will you need to help the parents understand and do?
- use an enlarged nipple if bottle feeding
- stimulate infant suck reflex while feeding
- assess the infant’s swallowing during feeding to prevent aspiration
- maintain periodic rest periods for the infant during feedings
- hold bottle at 180 degrees
A nurse is caring for an infant who has severe dehydration from acute gastroenteritis. Which finding should the nurse expect?
13% weight loss
A weight loss greater than 10% is a manifestation of severe dehydration in an infant.
Sunken fontanelles,
Tachypnea
A capillary refill of 4 seconds or greater is a sign of dehydration.
The nurse is caring for a newborn with hypospadias. The parents are questioning why their son can not have a circumcision. What is the best explanation the nurse can offer?
“The surgeons will need the foreskin to repair the defect.”
Hypospadias is abnormal placement of the urethral meatus on the ventral side of the penis. The opening may be near the glans, on the shaft of the penis, or at the base of the penis. It is usually corrected between 6 and 12 months of age to prevent later erectile dysfunction and infertility. To repair the defect, surgery is performed to extend the urethra to the normal position in the center of the glans. Foreskin is used in the surgical procedure to . Attention is paid to both the functional and cosmetic outcome of the procedure.
What is the treatment for Hirschsprung’s Disease?
- fluid and electrolyte replacement
- TPN
- low fiber, high protein, high calorie diet
- enemas
- surgical management
- temporary ostomy
- pull-through procedure
nursing:
- developmentally prepare the child for surgery
- IVF
- bowel prep: pre-op
- post-op care/colostomy care
- nutritional education and supplements
goal is to preserve as much of bowel as possible, maintain child’s nutritional status, growth, development, stimulate intestinal adaptation with TPN, minimize complications r/t disease process
What to do with a nosebleed?
Application of pressure to the nares will help stop bleeding (applying pressure for like 5-10 minutes). Ice will reduce bleeding and swelling at the injury site.
Positioning should be upright with the head tilted slightly forward to prevent aspiration. The patient should not be supine.
Forcefully blowing the nose will not stop the bleeding. The patient should be instructed to breathe through the mouth until the bleeding stops.
What are strategies for managing symptoms of encopresis?
- usually occurs with potty training
– if learning or withholding, it builds up and body turns off signal, so keep eating and continue to impact feces - need retraining of bowel to not hold feces
The nurse is caring for a 2 year old client with nephrotic syndrome. The child weighs 33 pounds. The nurse notes that the client has voided 120 mL at the end of the 12 hour shift. The adequate urinary output for a child is 1-2 mg/kg/hour.
True or False: The nurse needs to inform the provider that the child has insufficient output.
To calculate the adequate urinary output for a child, first convert the child’s weight to kg: 33 lbs divided by 2.2 = 15 kg.
Then, multiply the weight in kg by the number of hours in the shift = 15x 12 = 180. If 1-2 mL/kg is adequate, the range is 180 - 360 mL for this child.
Now compare the child’s output (120 mL) to the bottom number (180); the child’s output is not adequate and should be reported to the provider.
A nurse is providing teaching about dietary recommendations to the parents of a toddler who has iron deficiency anemia. Which of the following dietary recommendations should the nurse include as a food that enhances iron absorption when consumed with nonheme iron?
Bell peppers are a rich source of Vitamin C, which facilitates absorption of iron.
Calcium inhibits the absorption of iron; one of the leading causes of iron deficiency anemia in children is over-reliance on cow’s milk in the diet. This is common in older infants and toddlers when fetal iron stores are depleted.
Tannins in tea inhibit the absorption of iron. Additionally, tea contains caffeine which is not appropriate for toddlers.
Dried beans are high in phytates, which inhibit the absorption of iron and zinc.
What information does an ECHO (echocardiogram) provide?
Identifies heart structure
Identifies the pattern of movement
-allows visualization of blood flow movement
-allows visualization of heart movement
Cardiac structures and heart movement
The nurse is taking a health history of a toddler with a suspected congenital heart defect. Which response by the mother could indicate that the child is experiencing hypercyanotic spells?
The walking toddler may squat periodically to relieve a hypercyanotic spell. This position serves to improve pulmonary blood flow by increasing systemic vascular resistance.
A nurse in a pediatric clinic is caring for a child who has iron deficiency anemia and a new prescription for ferrous sulfate elixir. Which instruction, made by the nurse, represents accurate patient teaching?
Ferrous sulfate elixir can stain the teeth and gums. Rinsing with plain water can help prevent this.
Ferrous sulfate is poorly absorbed if given with foods, drinks, or supplements containing calcium.
Ferrous sulfate is absorbed better when given on an empty stomach. It is not usually advised to give with meals.
Management of sickle cell disease?
- prevention is key
– routine vaccinations
– oral penicillin prophylaxis
– daily hydroxyurea
– oxygen PRN if hypoxic
– avoid aspirin - prevent the sickling that is responsible for pathologic sequalae
- manage medical emergencies of SCD
- provide rest
- hydration: oral and IV
- electrolyte replacement
- blood transfusions: provides hydration, decreases sickle cells, reduces blood viscosity
– hemaphresis: blood replacement with patient’s own blood - analgesics (opioids best)
- antibiotics
What are care recommendations for UTIs?
- emptying bladder every 6-8 hours
- proper education on hygiene, wiping properly
- if a child has a history of recurrent UTIs: repeat UA and UCX 7 days after treatment
The nurse is caring for a child with acute glomerulonephritis who has just undergone a renal biopsy. Which interventions should be part of the child’s plan of care to prevent complications of the procedure?
Bedrest is standard care for children who have had a renal biopsy. It is thought that bedrest, preferably with supine positioning, decreases the risk of bleeding.
A pressure dressing is usually in place to prevent bleeding at the biopsy site, and the complete blood count is assessed 6 hours post-operatively and the next day to ensure that the hemoglobin and hematocrit are stable and do not indicate blood loss.
The patient should be NPO prior to the procedure and usually follows a clear liquid diet in the immediate post-op period.
The nurse is caring for a 12 month-old child with iron deficiency anemia and teaching the parents about liquid iron supplements because the child is unable to swallow pills or chew tablets.
Which statement indicates that the parents require further teaching?
“I will place the liquid in the front of the mouth right near the gum line.”
Liquid iron supplements usually have an unpleasant flavor and infants or young children frequently try to spit them out. Therefore, the parent should take the dropper or syringe and aim for the side of the child’s mouth, further back. The medication can be dispensed in small squirts, and may be mixed with a small amount of sweet liquid, such as orange juice.
It is important to shake the bottle to ensure that the supplement is equally distributed. Accurate measurement of the dose is important to avoid iron toxicity which can be lethal for small children.
Milk and other foods that interfere with iron absorption should be offered at least two hours before or after administration of the iron supplement.
Treatment for pinworms
highly contagious so treat whole household
- pyrantel pamoate: common first line
- mebendazole
- albendazole
- meds typically given as single dose then followed by second two weeks later to ensure any newly hatches are killed
improve hygiene practices:
- handwashing
- keep fingernails short and clean
- launder in hot water
- clean surfaces
- avoid scratching
A nurse is assessing an infant, whose parent brought the child for care because of poor feeding and fussiness. The nurse notes pallor of the lower extremities, “ruddy” color in the face and upper extremities, weak femoral, popliteal, and pedal pulses, bounding radial, brachial, and carotid pulses, and increased blood pressures in the upper extremities with decreased blood pressure in the lower extremities.
What congenital heart defect does the nurse suspect?
Coarctation of the Aorta
How is rheumatic fever staged?
It is an inflammatory disease that occurs as a reaction to Group A beta-hemolytic strep infection of throat
- acute phase
- rheumatic heart disease
- secondary prevention?
– after acute phase, child on long-term prophylactic abx
– treatment continues for 5 years or until 21 (whichever is longer)
- prophylactic abx for all dental work and other invasive procedures to prevent endocarditis
2-6 weeks of a strep infection
expected findings:
- irritable
- CNS involvement
- Hx of URi
- fever
- cardiac symptoms
- subcutaneous nodules over bony prominence
- larger joints
- pink, macular rash
Reasons that toddlers and preschoolers get UTIs
infants: diapers and feces can get in easily; any hx of structual issue
younger kids: potty training, wiping improperly
adolescents: sexual activity, bubble baths, bath bombs
What is intussusception?
- most common cause of intestinal obstruction in children 3mo-3 years
– more common in boys than girls - cause unknown
- is telescoping or invagination of one portion of intestine into another
What are expected exam findings of coarctation of the aorta? (upper ad lower extremity BP and pulses)
- increased BP and bounding pulses in arms
- weak or absent femoral pulses
- cool lower extremities
- increased deterioration of symptoms: severe acidotic and hypotensive
older children: dizziness, faintness, headaches, epistaxis (increased BP)
What are symptoms of tetrology of fallot (tet spell)
child showing signs and symptoms of decreased pulmonary blood flow and possible hypercyanotic (tet) spell, which includes a toddler with tetralogy of Fallot squatting.
- Squatting increases systemic vascular resistance and forces blood to flow through the narrow pulmonary valve to improve oxygenation.
- It is the child’s natural response during a “tet spell” to reverse abnormal shunting of blood.
Is epispadias common?
no. very rare
Epispadias is a very rare birth defect affecting the urethra, occurring in about 1 in 117,000 newborn boys and 1 in 484,000 newborn girls.
The foramen ovale is necessary to bypass what organ?
serves purpose of bypassing the lungs in utero
How is vesicoureteral reflux managed?
online: Vesicoureteral reflux (VUR) management aims to prevent kidney infections and scarring, and can involve non-surgical approaches like antibiotic therapy and minimally invasive procedures like endoscopic injection, or surgical options like ureteral reimplantation.
What are symptoms of Wilms tumor? What is the treatment?
- peaks between 2-5 years old; 5-10% involve both kidneys and can be simultaneous or one after another
- hematuria
- fatigue and malaise
- HTN
- weight loss
- fever
- abdominal swelling or mass
– firm
– nontender
– confined to one side
DO NOT PALPATE THE ABDOMEN!!!!!
- high risk of rupture and metastasis
Treatment:
- surgery 24-48 hours of admission
- tumor, affected kidney, and adjacent adrenal gland are removed
- keep encapsulated tumor intact
- other kidney inspected carefully and biopsied later
- B/L kidneys: chemo or radiotherapy
– agents: actinomycin D
– cyclophosphamide can be added for unfavorable histologic characteristics or advanced in disease progress of tumor
- possible partial nephrectomy on one side and total nephrectomy on other side; depends on stage/spread
What are common signs and symptoms of intussusception?
Diagnosis: based on subjective findings, ultrasound, enema
Symptoms:
- abdominal pain
- loud crying
- bilious vomitus
- abdominal mass: palpable sausage shaped mass in RUQ
- jelly-like bloody stools
Cleft lip: why use an enlarged nipple if bottle feeding
Why: Infants with a cleft palate often struggle to create enough suction to draw milk from a standard bottle nipple because of the gap in their palate. The enlarged nipple helps the baby get enough milk by providing a more controlled flow, making it easier for the baby to feed without having to generate as much suction. The nipple will have to help fill in the opening so that the infant can get a good seal to be able to feed.
What is bladder exstrophy?
- congenital defect
- bladder is open and exposed to the outside of the abdomen
- highest priority is skin disruption related to the exposed bladder mucosa
What are the causes of Post-Streptococcal Glomerulonephritis?
- immune disease that occurs after a group A beta-hemolytic streptococcal infection
- pathophysiology unknown
- immune complexes are deposited in the basement membrane:
– glomeruli become edematous and infiltrated with polymorphonuclear leukocytes, which occlude the capillary lumen
– there is a decrease in plasma filtration -> causes water and sodium retention -> leads to edema
– fluid retention is not the complete cause of HTN
How doe we treat hypertonic dehydration and what is the fluid replacement rate?
When hypertonic dehydration is severe, the osmolarity in the blood is high, and the cells may have lost water to try to balance this high osmotic pressure. If you correct the dehydration too quickly, there’s a risk of causing cerebral edema (swelling of the brain). This happens because the sudden influx of water into the bloodstream could cause water to shift back into the cells too quickly, particularly in the brain, where cells are sensitive to osmotic changes.
Fluid Replacement Rate: The body needs time to adjust to the new balance of fluids and electrolytes. A rapid correction could lead to serious complications. Generally, the goal is to replace the fluid over 48 hours or longer, depending on the severity.
What are pulmonary symptoms associated with left to right shunt?
pulmonary congestion
The nurse is assessing a pediatric client with severe abdominal pain. Palpation over McBurney’s point elicits extreme tenderness
Tenderness at McBurney’s point is characteristic of appendicitis. The nurse should give SBAR to the provider and recommend surgical consultation.
The nurse is working with a child who is in sickle cell crisis. Treatment and nursing care for this child include which actions
A vaso-occlusive crisis occurs when sickle-shaped cells are clumped together in a joint or organ. This causes severe pain and hypoxia to the tissues. The management for a vaso-occlusive crisis is to :
provide adequate pain relief, oxygen to correct the hypoxemia, and increased IV fluids to thin out viscosity and allow the cells to flow in the vascular system.
The nurse is caring for a child with Hemophilia A. The child is scheduled for wisdom tooth extraction. Which of the following orders should the nurse anticipate for this client prior to surgery to control bleeding?
DDAVP (desmopressin) is a synthetic version of vasopressin. It acts as as an antidiuretic hormone and controls bleeding. It is given to clients with hemophilia prior to minor surgical procedures.
Clinical manifestations of PDA
- asymptomatic
- CHF symptoms
- machinery like murmur “humming top”
- widened pulse pressure
- bounding pulse
What is a ventricular septal defect
- abnormal opening between L and R ventricles (L/R shunt)
- 50% close spontaneously
clinical manifestations and complications:
- CHF, murmur, bacterial endocarditis, eisenmenger syndrome
The nurse is caring for a child with Hemophilia A. The child has sustained a fall with possible head injury. Which signs and symptoms require immediate intervention?
The patient with hemophilia is susceptible to bleeding in the brain after a head injury. Signs and symptoms of this include severe headache, alteration in level of consciousness, vomiting, and seizures. There may be visual changes as well.
Diagnosis and testing of pinworms
tape test: clear tape pressed to anal area to collect eggs which are examined under a microscope
- can also do visual inspection and microscopic exam of stool
What is hypertonic dehydration and what causes it?
occurs when the loss of water exceeds the loss of electrolytes, leading to an imbalance where the extracellular fluid has a higher concentration of solutes (like sodium) than normal. This results in a higher osmolarity in the blood, causing fluid to shift from the intracellular space to the extracellular space in an attempt to balance the osmotic pressure.
Cause:
This can happen due to excessive fluid loss (through vomiting, diarrhea, or inadequate fluid intake) or due to high intake of salt or other solutes without enough water.
What does a chest x-ray evaluate?
Reveals size and contour of the heart
Visualizes characteristics of Pulmonary Vascular markings
Which laboratory finding is expected in nephrotic syndrome?
Massive Proteinuria is characteristic of nephrotic syndrome. This is typically accompanied by increased BUN and Creatinine, decreased serum albumin, and hyperlipidemia.
What is Failure to Thrive?
- growth failure
- inadequate growth from an inability to obtain or use calories required for growth
- typically when child falls below 5th percentile for child’s age
greater risk with illnesses and diseases:
- chemo and cancer
- HIV
- CF
- SCD
- low birth weight
- GI malabsorption
- nephrosis
What are signs and symptoms of Tetralogy of Fallot (TOF)?
And risks
Clinical Manifestations:
- Cyanosis,
- Clubbing
- Systolic Murmur
- Delayed growth and development
- Hypoxia -> “tet” Spells, Squatting
Risks:
- Emboli
- Brain Abscess
- Seizures
- LOC
- Sudden Death
Symptoms of hemophilia? Nursing management?
Physical assessment:
- active bleeding
- hematomas/bruising
- hemarthrosis
- headache
- prolonged bleeding at umbilical cord stump or circumcision site
- less severe: increase bruising following immunizations; lack of symptoms until trauma or surgical procedure
Nursing Hospital Management:
- avoid IM injections -> administer subQ
- avoid unnecessary skin punctures
- venipunctures are preferred over heel sticks
- monitor urine, stool, and NG output for blood
- DO NOT administer ASA
- acetaminophen is acceptable
What is tricuspid atresia
- failure of tricuspid valve to develop
- defect prevents blood from entering the right ventricle from the right atrium
Assessment:
- postnatal cyanosis
- tachycardia and dyspnea
- heart murmur
- echo: enlarged right atrium and decreased pulmonary blood flow
What is the correction for bladder exstrophy?
surgery
What is vesicoureteral reflux?
from ATI: A weakening at the vesicoureteral (urethral-bladder) junction allows urine to backflow when the bladder contracts during urination.
- abnormal retrograde flow of bladder urine into the ureteres
- causes frequent UTIs in infants and children
- kidney scarring and kidney failure can occur
Primary: defect at ureterovesical junction
Secondary: blockage
Acyanotic heart defects
increase pulmonary flow (think left to right shunt causing pulmonary congestion)
- ASD
- VSD
- PDA (Patent Ductus Arteriosus)
- AVC (atrioventricular canal defect)
What are the symptoms of sickle cell disease?
- pain
- fatigue
- jaundice
- hand and foot swelling and joint pain (dactylitis)
- skin rash
- SOB
- priapism
Sever complications:
- vaso-occlusive crisis: painful episode; ischemia causes mild to severe pain and can last minutes to days
- splenic sequestration: pooling of large amount of blood in spleen; can lead to shock
- hyper hemolytic crisis
- aplastic crisis
- acute chest syndrome: presence of new pulmonary infiltrate
– S/S: chest pain, fever, tachypnea, cough, hypoxia, wheezing
– leading cause of death in SCD
– a temperature is a medical emergency
- CVA
- infection
Parents are told that their infant has a heart defect with a left-to-right shunt. What is the best way for the nurse to explain this type of shunting to the parents?
This type of shunting causes an increase of blood to the lungs.
When does the ductus venous close and why?
closes with the clamping of the cord
In a few days to weeks; become ligamentum venosum
Now with blood flowing to liver – able to process nutrients and metabolize (such as bilirubin to help resolve newborn jaundice) – takes about 3 to 5 days for liver to mature
What is the Tetralogy of Fallot (TOF)?
Cyanotic Defects (Decrease Pulmonary blood flow)
Four Main Defects
- Pulmonary Stenosis
- Ventricular Septal Defect
- Overriding Aorta
- Right Ventricular Hypertrophy
- these defects collectively lead to mixing of oxygenated and deoxygenated blood:
– cyanosis
– varying degrees of oxygen saturation in the blood
Most common type of Cyanotic Defect
When the RV contracts there is resistance of blood r/t to pulmonary stenosis. The blood is shunted across the VSD into the aorta and LV giving persistent arterial unsaturation and cyanosis
Surgical repair to correct anatomical abnormalities and improve blood flow and oxygenation
What is valvular endocarditis?
is a bacterial infection of the inner lining of the heart and the valves that can enter the bloodstream
- the hallmark sign is a NEW murmur
- need 3 or more blood cultures in a 24 hours period for a confirmatory diagnosis, each from separate venipuncture site identifies the causative agent
- labs: CBC, UA, Blood culture (positive for diagnosis), ESR
risks:
- congenital or acquired disease
- indwelling catheter
What is pyloric stenosis?
hypertrophic pyloric stenosis (HPS)
- circumferential muscle of pyloric sphincter becomes thickened
- elongation and narrowing of pyloric channel
- outlet obstruction, dilation, hypertrophy
- hyperperistalsis of the stomach
noticed in 2-5 weeks of life
