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NUR 417: Peds Lecture > Exam 3 > Flashcards

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
Q

Increased pulmonary blood flow:

A

VSD

PDA

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26
Q

Decreased Pulmonary blood flow:

A

Tetralogy of fallot

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27
Q

Obstruction of blood flow from the heart:

A

COA (Coarctation of the Aorta)

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28
Q

Ventricular Septal Defects (VSD) Patho

A

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

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29
Q

Ventricular Septal Defects (VSD) Manifestations

A

HF
Loud holosystolic murmur (blood is flowing through hole that should not be there)
↑ risk pulmonary vascular disease

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30
Q

Ventricular Septal Defects (VSD) Treatment

A

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

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31
Q

Patent Ductus Arteriosus (PDA) Patho

A

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

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32
Q

Patent Ductus Arteriosus (PDA) Manifestations

A

HF
Machine like murmur
Bounding pulses
Widened pulse pressure

33
Q

Patent Ductus Arteriosus (PDA) Nursing Management/Treatment

A

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
Q

Coarctation of the Aorta (COA) Patho

A

Localized narrowing near insertion of the Ductus Arteriosus

↑ Pressure proximal to defect (Head & Upper extremities)
↓ Pressure distal to obstruction (Lower extremities)

35
Q

Coarctation of the Aorta (COA) Manifestations

A

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
Q

Coarctation of the Aorta (COA) Treatment

A

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
Q

Tetralogy of Fallot Patho

A

4 Defects:

  • Pulmonary Stenosis
  • Right Ventricular Hypertrophy
  • Overriding Aorta
  • Ventricular Septal Defect

Normal O2 sat is ~80%

38
Q

Tetralogy of Fallot Manifestations

A

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
Q

Tetralogy of Fallot Nursing Management/Treatment

A 
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
Q

Prenatal risk factors of CHD

A

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
Q

intrauterine to postnatal circulation

A
  • 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
Q

Tet spell Interventions

A

-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
Q

Bacterial Meningitis S/S Children & Adolescents

A
  • 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
Q

Bacterial Meningitis S/S Infants & Young Children

A
  • 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
Q

Bacterial Meningitis S/S Neonates

A
  • 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
Q

Viral Meningitis S/S & Treatment

A
  • 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
Q

Bacterial Meningitis plan of care

A
  • 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
Q

Bacterial Meningitis Nursing interventions

A

*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
Q

lumbar puncture plan of care

A

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
Q

prolonged seizures medications

A

Benzodiazepines:
IV lorazepam
Diazepam
Midazolam

51
Q

Haemophilus influenzae type B (HIB)

A

(2,4,6,12 months)

-H influenzae causes meningitis in kids

52
Q

Pneumococcal conjugate vaccine- PCV13

A

(2,4,6,12 months)

-Protects against pneumococcal meningitis

53
Q

Meningococcal polysaccharide vaccine - Menactra

A

(for older kids)

11-13 and 16 y/o

54
Q

Increased ICP S/S Infants:

A
  • 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
Q

Increased ICP S/S Children:

A
  • 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
Q

Late Signs of Increased ICP:

A

-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
Q

Cushing’s Triad

A

Increased BP
Decreased HR
Decreased RR

*Treat with mannitol

58
Q

Hydrocephalus S/S

A
  • 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
Q

Hydrocephalus Treatment:

A 
Ventriculoperitoneal Shunt 
Ventricular catheter
Flush pump
Unidirectional flow valve
Distal catheter
60
Q

Hydrocephalus Infections

A
  • 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
Q

Meningitis Bacterial Manifestations

A 
WBC count: ↑ with ↑ polys
Protein Count: increased
Glucose Content: ↓ Decreased
Gram Stain: Culture Positive
Color: Cloudy/ Purulent
62
Q

Meningitis Viral Manifestations

A 
WBC count: Slightly ↑ with ↑  lymphs
Protein Count: Normal or slightly elevated
Glucose Content: Normal
Gram Stain: Culture Negative
Color: Clear
63
Q

Febrile Seizures

A
  • 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
Q

Head Trauma Subsequent complications

A

Hypoxia from brain damage
Increased ICP
Infection
Cerebral edema

65
Q

Linear Skull Fracture

A
  • Single fracture line

- Does not cross suture line

66
Q

Depressed Skull Fracture

A
  • Several irregular fragments

- Pushed inward

67
Q

Comminuted Skull Fracture

A
  • Multiple linear fractures

- May suggest child abuse

68
Q

Basilar Skull Fracture

A
  • Bones at base of skull
  • posterior and anterior region
  • Serious do to proximity to brainstem
69
Q

Open Skull Fracture

A

-Communication between skull and scalp

70
Q

Growing Skull Fracture

A

Associated with underlying dura tear that does not heal properly

71
Q

Statistic CP:

A

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
Q

Dyskinetic CP:

A 
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
Q

Ataxic CP:

A 
Injury to cerebellum
5-10% of cases
Weakness
Lack of coordination 
Decreased muscle tone
Difficulty with fine motor skills
Wide-based gait
74
Q

Mixed Type CP:

A

Combination of spastic and dyskinetic types
Often have ataxia
Spastic Ataxic Diplegia is a common mixed type/ Often associated with hydrocephalus

75
Q

Developmental Milestones

A 
Delayed gross motor development 
Abnormal motor performance 
Alterations in muscle tone 
Abnormal postures
Reflex abnormalities
76
Q

Baclofen CP

A
  • centrally acting skeletal muscle relaxant
  • Decreases spasms and spasticity
  • Can cause diaphoresis and/or constipation
77
Q

Diazepam: CP

A
  • skeletal muscle relaxant

- Decreases muscle spasms and spasticity

78
Q

Botulinum toxin A: CP

A
  • blocks nerve activity in muscles

- Causes a temporary reduction in muscle activity and reduces spasticity for specific muscle groups

NUR 417: Peds Lecture (12 decks)

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