Exam 3 Flashcards

1
Q

Mannitol

A

Preferred diuretic for increased ICP

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2
Q

Mannitol What it does

A

Osmotic diuretic for ICP, decreased ICP

Works quickly, lasts longer,
*Does NOT affect sodium levels compared to other diuretic

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3
Q

Mannitol Nursing considerations

A

Administered intravenously is the drug most frequently used for rapid reduction.
The infusion is generally given slowly but may be pushed rapidly in cases of herniation or impending herniation

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4
Q

Digoxin

A

Improves cardiac function in heart failure patients

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5
Q

Digoxin What it does

A
Improves contractility
Increases CO
Decreased heart size
Decreased venous pressure
Relief of edema
Rapid onset
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6
Q

Digoxin Side effects

A

Dysrhythmias
Toxicity: narrow therapeutic range
Note: a ↓ serum K+ increases the risk for Digoxin toxicity

Dig toxicity signs:
N/V
Anorexia
Bradycardia
Dysrhythmias
Blurred vision
Weakness
Yellow halos
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7
Q

Digoxin Nursing considerations

A
Check K+ levels
**Check apical pulse!!!!**
Hold if < 90-110 for infants
Hold if <70 for children 
Check dig levels! 

Infants rarely receive > 1 mL in one dose

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8
Q

Lasix

A

Common diuretic used in heart failure pediatric patients

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9
Q

Lasix What it does

A

Removes accumulated fluid and sodium associated with heart failure.

Works in loop of henle

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10
Q

Lasik Side effects

A

Hypokalemia (not potassium sparing!)

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11
Q

Lasik Nursing Considerations

A

Check K+ levels. Be careful because Digoxin and Lasix are commonly used together in HF.

Low K+ can cause Dig toxicity.

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12
Q

Baclofen

A

Muscle relaxant for cerebral palsy patients

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13
Q

Baclofen What it does

A

Centrally acting skeletal muscle relaxant

Decreased hypertonia; decreases spasm and spasticit

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14
Q

Baclofen Side effects

A

Drowsiness and confusion

““The most common side effects of these agents include drowsiness, fatigue, and muscle weakness; less commonly, central nervous system (CNS) depression, hypotension, diaphoresis, and constipation may be seen with baclofen”

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15
Q

Midazolam

A

Treatment for febrile seizure

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16
Q

Midazolam Side effects

A

More than 2 doses can cause resp. depression

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17
Q

Midazolam Nursing Consideration

A

Commonly administered buccally or intranasally

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18
Q

VSD Pathophysiology

A
  • abnormal opening between right and left ventricles
  • membranous (80%) or muscular
  • left to right shunt
  • increased blood volume to lungs
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19
Q

VSD Clinical Presentation (Manifestations):

A
  • HF Common
  • loud holosystolic murmur LSB
  • increased risk for pulmonary vascular obstructive disease
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20
Q

VSD Management/Surgical Treatment:

A

palliative: PA band
- complete repair:
- small: closed with suture
- large: Dacron patch

Prognosis Depends on:

- location of defect
- number of defects
- other associated defects
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21
Q

PDA (Patent Ductus Arteriosus) Pathophysiology:

A
  • Failure of fetal Ductus Arteriosus to close
    • Blood flows from high pressure aorta to lower pressure pulmonary artery
    • Left to right shunt
    • Increase workload on Left side of heart
    • Increase pulmonary congestion
    • May cause increase in right ventricle pressure and hypertrophy
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22
Q

PDA Clinical Presentation:

A
  • HF
    • Machine like murmur
    • Widening pulse pressure
    • Bounding Pulses
    • Crackles, SOB
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23
Q

PDA Treatment:

A
  • Medical: Administer Indomethacin
    • Surgical: Ligation of patent vessel
    • Coils used to occlude PDA
    • Low risk: increased in preterm infants
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24
Q

Role of Prostaglandin E

A
  • Patent ductus arteriosus, give indomethacin which blocks Prostaglandin E, which is how PDA closes.
  • Prostaglandin E keeps the duct open! Defect that keeps producing Prostaglandin E.
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25
Increased pulmonary blood flow:
VSD | PDA
26
Decreased Pulmonary blood flow:
Tetralogy of fallot
27
Obstruction of blood flow from the heart:
COA (Coarctation of the Aorta)
28
Ventricular Septal Defects (VSD) Patho
Abnormal opening between R & L ventricles L → R shunt Blood flows from higher pressure L. vent to lower pressure R. vent Increased blood to lungs **increased blood flow to lungs**
29
Ventricular Septal Defects (VSD) Manifestations
HF Loud holosystolic murmur (blood is flowing through hole that should not be there) ↑ risk pulmonary vascular disease
30
Ventricular Septal Defects (VSD) Treatment
Medical management initially Surgical closure if past one year of age Palliative: PA band (↓ pulmonary blood flow) Complete repair: if small close w/ suture, if large dacron patch
31
Patent Ductus Arteriosus (PDA) Patho
Failure of fetal Ductus Arteriosus to close L → R shunt Blood flows from high pressure aorta to lower pressure pulmonary artery *causes HIGH pulmonary blood flow, LOW systemic blood flow
32
Patent Ductus Arteriosus (PDA) Manifestations
HF Machine like murmur Bounding pulses Widened pulse pressure
33
Patent Ductus Arteriosus (PDA) Nursing Management/Treatment
Nursing Management: Administer Indomethacin for PDA repair (blocks prostaglandin E) Treatment: Surgical -Ligation of patent vessel (thoracotomy/through thorascope) Nonsurgical- Coils used to occlude PDA
34
Coarctation of the Aorta (COA) Patho
Localized narrowing near insertion of the Ductus Arteriosus ↑ Pressure proximal to defect (Head & Upper extremities) ↓ Pressure distal to obstruction (Lower extremities)
35
Coarctation of the Aorta (COA) Manifestations
HF in infants → deteriorate fast (acidosis & hypotension) ↑ BP & weak pulses in legs/feet ↓ BP & bounding pulses in arms Older Children: Dizziness, headaches, fainting spells, epistaxis
36
Coarctation of the Aorta (COA) Treatment
Treatment: Surgical for < 6 month old: -End to end anastomosis -Graft prosthetic Nonsurgical: - Balloon angioplasty - Post-op HTN is treated with Nipride esmolol or Milirinone - Oral: ACE inhibitors or Beta blockers
37
Tetralogy of Fallot Patho
4 Defects: - Pulmonary Stenosis - Right Ventricular Hypertrophy - Overriding Aorta - Ventricular Septal Defect Normal O2 sat is ~80%
38
Tetralogy of Fallot Manifestations
Mild - severe cyanosis Systolic murmur Hypercyanotic Tet Spells (acute episodes of cyanosis & hypoxia) - KNEES TO CHEST POSITION *happens usually during crying or after feeding Polycythemia: due to deoxygenated blood being in the systemic circulation resulting in a need for increased RBCs (thick blood)
39
Tetralogy of Fallot Nursing Management/Treatment
``` Nursing Management of Tet Spells: Knee-chest position O2 Morphine IV fluid bolus ``` Treatment for TOF: Palliative shunt (Modified Blalock-Taussig Shunt) Complete repair
40
Prenatal risk factors of CHD
Maternal: chronic illness, ETOH consumption, exposure to environmental toxins, infections, family hx of CHD Child Risk Factors: Chromosomal abnormalities Down Syndrome: Trisomy 21 (AV Canal) Trisomy 13 & Trisomy 18 DiGeorge Syndrome: 22q11 deletion (interrupted Aortic Arch, Truncus Arteriosus, Tetralogy of Fallot, VSD) Noonan Syndrome: Pulmonic valve anomalies, cardiomyopathy Williams Syndrome: Aortic & pulmonic stenosis Extracardiac defects Renal abnormalities: TE fistula, diaphragmatic hernia
41
intrauterine to postnatal circulation
- The right and left side of the heart have equal pressure until the transition to postnatal, when the Left side has more pressure. - Ductus Venosus and Ductus Arteriosus go away - Foramen Ovale closes - Pulmonary Vascular resistance goes down and Systemic Vascular resistance goes up
42
Tet spell Interventions
-R vent is spasmism. Not pushing out blood. Push blood to it - knee to chest. Increases blood flow to heart and lungs. - Admin O2 - Admin Morphine (vasodilator; helps relieve the spasm) - Fluid bolus. To increase vascular volume. Give slowly to avoid overwhelming heart.
43
Bacterial Meningitis S/S Children & Adolescents
- Abrupt onset - Fever - Chills - Headache - Seizures - Irritability - Nuchal rigidity (can’t extend neck to chest) - + Kernig (inability to straighten leg/ hamstring tightness causes spinal cord stretching) - + Brudzinski signs (neck stiffness w/ lower knee movement to stretch spine) - Petechial or purpuric rashes (non-blanching) - Agitatio
44
Bacterial Meningitis S/S Infants & Young Children
- Classic presentation rarely occurs in children 3-2 years - Fever - if baby shows up in hospital with fever will get sepsis workup → lumbar puncture, blood, urine, stool cultures, CBC, CMP → start on broad spectrum ABX (Gent & Amp) and usually more than one - Poor feeding - Marked irritability - Seizures - High pitched cry - Bulging fontanel
45
Bacterial Meningitis S/S Neonates
* at greater risk due to not having their vaccines yet - Look well at birth and then begin to look & act poorly - Refuses feedings - Poor sucking - Vomiting or diarrhea - Poor tone - Lack of movement - Weak cry - Full, tense, bulging, fontanel
46
Viral Meningitis S/S & Treatment
- May be preceded with viral infection, rash - Diagnostics: LP, CSF eval (mildly elevated WBC, negative gram stain, normal glucose) Treatment: self-limiting, resolves in 7-14 days, monitor in hospital until ABC’s are stable Medications: antivirals (Acyclovir) Not contagious
47
Bacterial Meningitis plan of care
- Protect self - Place on C/D precautions for both until it is known what type - Assess V/S and behavior - Antibiotics - Monitor lab values - Strict I&O’s - Monitor fontanels and head circumference as applicable (up to 3 years of age) - Bedrest: do not flex neck - Comforting: they are very irritable
48
Bacterial Meningitis Nursing interventions
*Protect self first Diagnostics: LP, CSF eval (increase WBCs, gram stain +, increase protein, decrease in glucose) Treatment: ABCDs, cerebral edema, seizure control, antibiotics, steroids Contagious – contact droplet isolation at least 24 hrs after initiation of ABX Prevention: Vaccination (HiB & Pneumococcal at 2, 4, 6, and 12 mos) Infants/Neonates at GREATEST risk
49
lumbar puncture plan of care
Pain/ Fear: Sedate with fentanyl/ versed Know your ICP: Brain could herniate in skull if LP is done with high ICP (ask for CT scan first) Advocate for your patient *if ICP suspected than a lumbar puncture is contraindicated
50
prolonged seizures medications
Benzodiazepines: IV lorazepam Diazepam Midazolam
51
Haemophilus influenzae type B (HIB)
(2,4,6,12 months) | -H influenzae causes meningitis in kids
52
Pneumococcal conjugate vaccine- PCV13
(2,4,6,12 months) | -Protects against pneumococcal meningitis
53
Meningococcal polysaccharide vaccine - Menactra
(for older kids) | 11-13 and 16 y/o
54
Increased ICP S/S Infants:
- Tense bulging fontanel - Wide sutures - MacEwen sign (palpation of skull, feels like cracked pot) - Dilated scalp veins (blood trying to go places) - High pitched cry - Irritability or restlessness - Poor feeding (obtunded, don't wanna eat) - Increase in head circumference
55
Increased ICP S/S Children:
- Headache (holding head may be a cue) - Nausea and forceful vomiting - Blurred vision (watch for them walking funny) - Seizures - Lethargy - Inability to follow simple commands - Increased sleeping, altered LOC
56
Late Signs of Increased ICP:
-Bradycardia -Decreased motor response to commands -Decreased sensory response to painful stimuli -Alterations in pupil size and reactivity -Change in resp pattern (Cheyne-Stokes respirations) (irregular apneic episodes; fast, shallow, ineffective breathing that blows off Co2, following by apnea or extremely slow, heavy breathing) -D/t dysregulated breathing center d/t high ICP. -Papilledema -Sunset eyes (setting sun sign) -Decreased or change in LOC -Extension or flexion posturing -Decorticate: flexed, holding onto cord -Decerebrate, extending
57
Cushing's Triad
Increased BP Decreased HR Decreased RR *Treat with mannitol
58
Hydrocephalus S/S
- Enlargement of skull - Dilation of ventricles - Separation of sagittal sutures in < 12 years of age - Developmental defects - Chiari malformation - Aqueduct stenosis (clog in the drain that drains the ventricles) - Dandy-Walker syndrome - Myelomeningocele - Intrauterine infection - Intraventricular hemorrhage - Intracranial masses or infections in older children
59
Hydrocephalus Treatment:
``` Ventriculoperitoneal Shunt Ventricular catheter Flush pump Unidirectional flow valve Distal catheter ```
60
Hydrocephalus Infections
- Highest risk within the first 6 months after placement - Sepsis - Bacterial endocarditis - Shunt nephritis - Meningitis - Ventriculitis - Wound infection *Treat with antibiotics for 7-10 days IV or intrathecally. May need removal and placement of an EVD until CSF is stable
61
Meningitis Bacterial Manifestations
``` WBC count: ↑ with ↑ polys Protein Count: increased Glucose Content: ↓ Decreased Gram Stain: Culture Positive Color: Cloudy/ Purulent ```
62
Meningitis Viral Manifestations
``` WBC count: Slightly ↑ with ↑ lymphs Protein Count: Normal or slightly elevated Glucose Content: Normal Gram Stain: Culture Negative Color: Clear ```
63
Febrile Seizures
- Seizure activity related to fever (above 38.8’C or 101.8’F) - due to rapid temperature elevation - Uniquely pediatrics - between 6months and 5 years. 6 or 7 y/o cannot develop febrile seizures. - Usually not chronic condition - ⅓ will have another seizure associated w/ fever - 1% will develop epilepsy - Associated infections: otitis media, pharyngitis, adenitis, UTI - No negative outcome from these seizures related to intelligence, behavior, academic performance → NO long lasting effects - If febrile seizure lasts > 5 minutes, call 911 - Give acetaminophen PRN * Antiepileptic medications are NOT indicated * Antipyretic therapies will not prevent a seizure → treats fever as a symptom (what infections could cause a fever? UTI, ear, pneumonia, strep) * Tepid sponge baths are NOT recommended
64
Head Trauma Subsequent complications
Hypoxia from brain damage Increased ICP Infection Cerebral edema
65
Linear Skull Fracture
- Single fracture line | - Does not cross suture line
66
Depressed Skull Fracture
- Several irregular fragments | - Pushed inward
67
Comminuted Skull Fracture
- Multiple linear fractures | - May suggest child abuse
68
Basilar Skull Fracture
- Bones at base of skull - posterior and anterior region - Serious do to proximity to brainstem
69
Open Skull Fracture
-Communication between skull and scalp
70
Growing Skull Fracture
Associated with underlying dura tear that does not heal properly
71
Statistic CP:
Pyramidal (hypertonicity, posture, balance) Most common form of CP (77%) Damage to cortical motor areas of the brain Spastic Hemiplegia: affecting only one side of the body Spastic Monoplegia: affecting only 1 limb Spastic Diplegia: affecting all extremities Spastic Quadriplegia or Tetraplegia: affecting all extremities as well as torso and face Hypertonia Contractures
72
Dyskinetic CP:
``` Extrapyramidal (movement disorder) Two subtypes: Athetoid/ Dystonic Injury to basal ganglia Affects 11-15% Slow, involuntary movements of extremities Speech and language disorders Can have increased and decreased muscle tone ```
73
Ataxic CP:
``` Injury to cerebellum 5-10% of cases Weakness Lack of coordination Decreased muscle tone Difficulty with fine motor skills Wide-based gait ```
74
Mixed Type CP:
Combination of spastic and dyskinetic types Often have ataxia Spastic Ataxic Diplegia is a common mixed type/ Often associated with hydrocephalus
75
Developmental Milestones
``` Delayed gross motor development Abnormal motor performance Alterations in muscle tone Abnormal postures Reflex abnormalities ```
76
Baclofen CP
- centrally acting skeletal muscle relaxant - Decreases spasms and spasticity - Can cause diaphoresis and/or constipation
77
Diazepam: CP
- skeletal muscle relaxant | - Decreases muscle spasms and spasticity
78
Botulinum toxin A: CP
- blocks nerve activity in muscles | - Causes a temporary reduction in muscle activity and reduces spasticity for specific muscle groups