Exam 2 (Chapters 10-13, 19-21, 23) Flashcards
Significant Stressors for Hospitalized Children
Separation from parents
Loss of self-control, autonomy, and privacy
Painful and/or invasive procedures
Fear of bodily injury and disfigurement
Infant Hospitalization Stressors
Separation anxiety (biggest one)
Stranger anxiety
Painful, invasive procedures
Immobilization
Sleep deprivation, sensory overload
Infant Responses to Hospitalization
Sleep-wake cycle is disrupted
Feeding routines disrupted
Displays excessive irritability
Toddler Hospitalization Stressors
Separation anxiety
Loss of self-control
Immobilization
Painful, invasive procedures
Bodily injury or mutilation
Fear of the dark
Toddler Responses to Hospitalization
Cries if the parent leaves the bedside
Frightened if forced to lay supine
Wonders why parents do not come to the rescue
Associates pain with punishment
Preschooler Hospitalization Stressors
Separation anxiety and fear of abandonment
Loss of self-control
Bodily injury or mutilation
Painful, invasive procedures
Fear of the dark and monsters
Preschooler Responses to Hospitalization
Displays difficulty separating reality from fantasy
Fears ghosts and monsters
Fears body parts will leak out when skin is not intact
Fears that tubes are permanent
Demonstrates withdrawal, projection, aggression, and regression
School-Age Child Hospitalization Stressors
Loss of control
Loss of privacy and control over bodily functions
Bodily injury
Separation from family and friends
Painful, invasive procedures
Fear of death
School-Age Child Responses to Hospitalization
Displays increased sensitivity to the environment
Demonstrates detailed recall of events to self and other patients
Adolescent Hospitalization Stressors
Loss of control
Fear of altered body image, disfigurement, disability, and death
Separation from peer group
Loss of privacy and identity
Adolescent Responses to Hospitalization
Displays denial, regression, withdrawal, intellectualization, projection, and displacement
Assisting Infant Through Procedure
Before: explain procedure, allow parents option of being there, let parents have contact
During: nursing staff should immobilize infant, perform procedure quickly, ask parents to have contact after procedure
Assisting Toddler Through Procedure
Before: give explanations of procedure and say toddler did nothing wrong
During: perform in treatment room, give short explanations and directions, immobilize toddler, allow child to cry
Assisting Preschooler Through Procedure
Before: give simple explanations, allow child to touch equipment
During: perform in treatment room, give short explanations, allow child to cry, encourage drawing afterwards
Assisting School-Age Child Through Procedure
Before: give clear explanations, teach stress reduction techniques
During: be ready to immobilize child, explanations throughout, facilitate stress control techniques, give praise
Assisting Adolescent Through Procedure
Before: give explanations, teach stress reduction, explore fear of certain procedures
During: assist in self-control, explain expected outcome
Conditions Dependent on Medications or Special Diet
Diabetes mellitus, asthma, seizures, PKU, organ transplantation, CF, celiac disease
Conditions Dependent on Medical Technology
Renal failure, bronchiopulmonary dysplasia
Conditions that Require Increased Use of Healthcare Services
Cancer, sickle cell disease, CF
Conditions that Cause Functional Limitations
Down syndrome, brain injury, autism, myelodysplasia, cerebral palsy
Brain Death Criteria
Child must be unresponsive in an irreversible coma from a known cause and have absence of brainstem reflexes
Apnea testing must reveal hypercarbia
Must be confirmed that child does not have hypothermia, conditions, or medications that could contribute to brain death findings
Infants and Death
Sensorimotor: senses emotions of caregivers and altered routines, senses separation
Resists cuddling and eats less, may have feeding problems, cries excessively, sleeps more than usual
Toddlers and Death
Preoperational: no understanding of death, aware someone is missing, unable to distinguish death from temporary separation
Regresses to younger stage of development, clingy, whiny, irritable, problems with eating and sleeping, fearfulness
Preschoolers and Death
Preoperational: believes death is temporary, experiences magical thinking, confuses death with being away, has beginning experience with death of animals
Regression to earlier developmental stage, bowel/bladder control issues, tantrums, withdrawal from activities, fear of sleep, asks a lot of questions, abdominal pain
School-Aged Children and Death
Concrete Operations: understands what death is, knows it’s permanent, may have guilt or assume blame for death
Crying, moody, decreased concentration on schoolwork, psychosomatic complaints, may fear another loved one will die
Adolescents and Death
Formal Operations: understands death, sense of invincibility conflicts with fear of death, able to recognize effect of death on others
May have severe depression, may seek comfort from friends, eating/sleeping problems, may act-out, may assume responsibility
Infectious Conjunctivitis
Viral or bacterial
Viral: chlamydia, gonorrhea, herpes (can cause blindness)
Bacterial: staphylococcus, haemophilus, streptococcus, moraxella
Periorbital Cellulitis
Bacterial infection of the eyelid and surrounding tissue caused by streptococcus or staphylococcus
S/S: Swollen, tender, red/purple eyelids, restricted and painful movement of the eye, fever
Tx: IV antibiotics
Hyperopia
Farsightedness
All children have some degree until 9-10 years of age
Blurring only occurs with excessive hyperopia
Amblyopia can occur if treatment is not obtained
Myopia
Nearsightedness
Most commonly develops at about 8 years of age
Children may complain of headaches and squint to improve distance vision
Astigmatism
Child often holds pages very close to the face in order to obtain the best visual image
Strabismus
S/S include squinting and frowning when reading, closing one eye to see, having trouble picking up objects, dizziness, headache
Corneal light reflex and cover-uncover tests to confirm
Most common in children with cerebral palsy, hydrocephalus, Down syndrome, and seizure disorder
Amblyopia
Lazy eye
Caused by untreated strabismus, congenital cataracts, or uncorrected refractive errors
Tx: compensatory lenses, occlusion therapy, vision therapy, atropine drops
Retinopathy of Prematurity
Occurs when immature blood vessels of the retina constrict and become necrotic
May occur in infants of low birth weight or of short gestation
Associated with oxygen therapy
Otitis Media
Bulging tympanic membrane, air/fluid bubbles behind tympanic membrane, immobile/poorly mobile tympanic membrane, red tympanic membrane, reduced visibility
Otitis Media with Effusion
Tympanic membrane is retracted or neutral, immobile/partly mobile tympanic membrane
Difficulty hearing or responding as expected to sounds
Nasopharyngitis
URI causes inflammation and infection of the nose and throat and is a common illness in infancy and childhood
Red nasal mucosa with clear nasal discharge and an infected throat with enlarged tonsils
Sinusitis
Inflammation of one or more of the paranasal sinuses
History of URIs is common, persistent cough from postnasal drip
Malodorous breath, fever, mouth breathing, hyponasal speech, cervical lymphadenopathy
Pharyngitis
Infection that primarily affects the pharynx, including the tonsils
Major complaint is a sore throat
Minimal throat redness, exudate, mild lymphadenopathy, and low-grade fever are also common
Tonsillitis
Infection or inflammation of the palatine tonsils
Frequent throat infections with breathing and swallowing difficulties, persistent redness of the anterior pillars, and enlargement of the cervical lymph nodes
Adenoiditis
Nasal stuffiness, discharge, postnasal drip
Initial Signs of Respiratory Failure
Restlessness, tachypnea, tachycardia, diaphoresis
Early Decompensation of Respiratory Failure
Nasal flaring, retractions, grunting, wheezing, anxiety, irritability, mood changes, headache, hypertension, confusion
Severe Hypoxia and Imminent Respiratory Arrest
Dyspnea, bradycardia, cyanosis, stupor, coma
Apnea
Cessation of respiration lasting longer than 20 seconds, or any pause in respiration associated with cyanosis, marked pallor, hypotonia, or bradycardia
Acute Spasmodic Laryngitis
Croup syndrome
Least serious
Abrupt nighttime onset, resolves over 24-48 hours
Afebrile, mild respiratory distress, no signs of respiratory infection
Laryngotracheobronchitis
Caused by RSV virus
Gradual onset as a URI, progressing to respiratory distress and potential airway obstruction over 24-48 hours
Increased RR, stridor, normal expiration, no retractions, no apnea
Bacterial Tracheitis
Caused by staphylococcus, moraxella, haemophilus
Progressive over 2-5 days, may present like LTB initially, but worsens
High fever, URI, stridor, purulent secretions, toxic appearance, dysphagia
Epiglottitis
Caused by haemophilus, streptococcus, staphylococcus
Progresses rapidly, may progress to complete airway obstruction
Increased respiratory rate, stridor, normal expiration, positive retractions
Bronchitis
Classic symptom is a dry, hacking cough that increases in severity at night
Rarely occurs as an isolated problem
Bronchiolitis
Air trapping condition common in premature infants, immunosuppressed children, children who attend daycare
Caused by RSV
Increased RR, normal inspiration, longer expiration, positive retractions, positive apnea
Pneumonia
Inflammation or infection of the bronchioles and alveolar spaces of the lungs
Bronchopulmonary Dysplasia
Also called chronic lung disease of prematurity
Defined as the need for supplemental oxygen for at least 28 days after premature birth
Short Term Treatment for Asthma
Short acting rescue inhaler/bronchodilator
Long Term Treatment for Asthma
Corticosteroid or long acting bronchodilator
Upper Respiratory Symptoms of Cystic Fibrosis
Clogged sinuses
Nasal polyps, chronic sinusitis, frontal headache, purulent nasal discharge, postnasal discharge
Lower Respiratory Symptoms of Cystic Fibrosis
Reduced ciliary clearance, obstructed airways, air trapping and hyperinflation, bacterial colonization, chronic fibrotic lung changes
Moist cough, wheezing, coarse crackles, frequent infections, SOB, barrel chest
Pancreatic Symptoms of Cystic Fibrosis
Poorly digested food, vitamin deficiencies, poor weight gain or failure to thrive, delayed onset of puberty, CF-related diabetes mellitus
Gastrointestinal Symptoms of Cystic Fibrosis
Meconium ileus at birth, abdominal distention, steatorrhea, constipation or intestinal obstruction, rectal prolapse, liver cirrhosis
Characteristic Features of Heart Disease
Exercise intolerance
Fatigue (during feeding the infant)
Post-Op Care for Heart Surgeries
Take heart rate for one whole minute apically
Respiratory status
Intake and output
Pain control
Watch for bleeding
Blood pressure/pulses
Medications Used for Heart Disease
Lanoxin
ACE Inhibitors
Beta Blockers
Diuretics
Antiarrhythmics
Antibiotics
Aspirin
Bacterial Endocarditis Presents with…
Fever, pallor, petechiae, anorexia, fatigue, rheumatic fever
Risk Factors for Development of Congenital Heart Disease
Maternal rubella
Maternal alcoholism
Maternal age over 40 years
Maternal Type I Diabetes
Sibling/parent with a heart defect, chromosomal aberration, other congenital anomalies
Hemodynamics
High to low pressure, will take the path of least resistance
Pressure in the Heart
Pressure on the right side is lower than the left
Resistance in pulmonary circulation is less than systemic circulation
Left to Right Shunt
No cyanosis
Oxygenated blood is sent back to the lungs
Fully oxygenated blood still going out to systemic circulation
Right to Left Shunt
Causes cyanosis
Deoxygenated blood is being pushed to the left
Deoxygenated blood goes out into systemic circulation
Increased Pulmonary Blood Flow
Shift: Left to Right
No cyanosis
S/S of CHF
ASD, VSD, PDA
Decreased Pulmonary Blood Flow
Shift: Right to Left
Cyanosis
No CHF symptoms
Tetralogy of Fallot, Tricuspid Atresia
Tetralogy of Fallot
Four abnormalities that result in insufficiently oxygenated blood being pumped to the body
- Narrowing of the pulmonary valve
- Thickening of the right ventricle
- Displacement of aorta over ventricular septal defect
- Ventricular septal defect
Obstruction to Blood Flow Out of the Heart
Shift: Left to Right
No cyanosis
CHF symptoms
COA, AS, PS
Mixed Blood Flow
Shift: Right to Left and Left to Right
Cyanosis: Yes and No
CHF symptoms
Transposition of the great vessels, truncus, hypoplastic left heart
Congestive Heart Failure
Inability of the heart to pump adequate amount of blood to systemic circulation at normal filling pressures to meet metabolic demands of the body
Septal defects, cardiomyopathy, sepsis, anemia
Kawasaki Disease
Acute systemic vasculitis
Etiology unknown
Extensive inflammation of arterioles, venules, and capillaries
Acute Kawasaki Disease
Abrupt onset of high fever, unresponsive to antibiotics and antipyretics
Child is very irritable
Subacute Kawasaki Disease
Begins with resolution of fever and lasts until all clinical signs have disappeared
Greatest risk for coronary artery aneurysms
Convalescent Kawasaki Disease
6-8 weeks after onset
Therapeutic Management of Kawasaki Disease
High-dose IV gamma globulin
Aspirin
Sickle Cell Anemia (HbSS)
Most common type of sickle cell disease
RBCs are crescent-shaped
Homozygous condition
Child is subject to sickle cell crises
Average lifespan is 45 years of age
Sickle C Disease (HbSC)
Child inherits one HbS gene and one HbC gene
RBCs are C shaped
Anemia is generally milder than sickle cell disease
Painful crises occur about 50% as often as in HbSS disease
Average lifespan is 64 years of age
Sickle Beta + Thalassemia Disease (Hb + SB) and Sickle Beta 0 Thalassemia Disease (Hb0 SB)
Combination of sickle cell trait and thalassemia trait
In sickle cell beta +, there is a reduced amount of beta+, there is a reduced amount of hemoglobin A, and the lifespan is near normal
In sickle cell beta 0, there is no hemoglobin A and the lifespan is mid-50s
Vaso-Occlusive Crisis
Most common type of crisis; caused by stasis of blood with clumping of cells in the microcirculation, ischemia, and infarction
Precipitated by dehydration, temperature extremes, infection, localized hypoxemia, physical/emotional stress
Clinical Manifestations of Vaso-Occlusive Crisis
Extremely painful
Fever, tissue engorgement, painful swelling of joints in hands and feet, priapism, severe abdominal pain
Severity of Vaso-Occlusive Crisis
Thrombosis and infarction of local tissue may occur if the crisis is not reversed
Cerebral occlusion can result in stroke, manifested by paralysis and/or other CNS complications
Splenic Sequestration
Pooling of blood in the spleen
Clinical Manifestations of Splenic Sequestration
Profound anemia, hypovolemia, and shock
Severity of Splenic Sequestration
Life-threatening crisis
Death can occur within hours
Aplastic Crisis
Triggered by infection with parvovirus B19 or depletion of folic acid
Clinical Manifestations of Aplastic Crisis
Diminished production and increased destruction of red blood cells
Signs include profound anemia, pallor
Severity of Aplastic Crisis
Life-threatening
Thalassemias
Group of inherited blood disorders of hemoglobin synthesis characterized by anemia that can be mild or severe
Pallor, jaundice, growth retardation, irritability, hepatomegaly, and splenomegaly are common
Hereditary Spherocytosis
Hemolytic disorder occurring in 1 in 5000 people of Northern European descent
Clinical manifestations appear in the neonatal/early infancy stages; mild jaundice is usually evident
Aplastic crises is the most serious complication
Disseminated Intravascular Coagulation
Life-threatening, acquired pathologic process in which the clotting system is abnormally activated, resulting in widespread clot formation in small vessels in the body
Most common cause is sepsis
Gingival bleeding, mucosal bleeding, hemoptysis, petechiae, purpura, bruising, oozing of blood after injection, hematuria, frank bleeding from incisions, tachycardia, and hypotension
Immune Thrombocytopenic Purpura
Bleeding disorder characterized by increased destruction of platelets in the spleen
Multiple ecchymoses and petechiae and mucosal bleeding in the mouth or nose
