Exam 3 Peds Flashcards
What are 7 common respiratory treatment methods for children?
nebulized aerosol therapy
metered-dose inhaler
dry powder inhaler
chest physiotherapy
oxygen therapy
suctioning
artificial airway
What does pulse oximetry measure? What are nursing considerations for pulse oximetry?
oxygen saturation of arterial blood
find an appropriate site (finger, toes, earlobe, around the foot)
dry site
remove polish
comfortable position
What are nursing considerations is a child’s SaO2 is less than 90-92%?
confirm proper probe placement
confirm patency of oxygen delivery system
place in high Fowler’s
encourage deep breathing
report significant findings
remain with child
What is the interpretation of SaO2 findings?
95-100% expected
91-100% acceptable
<91% requires intervention
<86% life-threatening emergency
What medications can be used in a nebulizer? metered dose or dry powder inhaler?
bronchodilators
corticosteroids
mucolytics
antibiotics
bronchodilators
corticosteroids
What can occur in the mouth with inhaled corticosteroid use? How can it be prevented?
fungal infections
rinse mouth after inhaling, spit
clean MDI and spacer after each use
What are the techniques of chest physiotherapy? What are nursing considerations pertaining to physiotherapy?
manual/mechanical percussion
vibration
cough
forceful expiration, huffing
breathing exercises
schedule before meals or 1 hour after and at bedtime to decrease vomiting or aspiration
administer bronchodilator or nebulized treatment prior
Note characteristics of mucous
Used cupped hand when percussing
document and repeat 3-4Xday
What is hypoxia? Hypoxemia? What can cause hypoxemia? Early signs? Late signs?
Decreased oxgen in the tissue
inadequate O2 in the blood
hypovolemia
hypoventilation
interruption of arterial blood flow
tachypnea
tachycardia
restlessness
pallor
evidence of respiratory distress
confusion
cyanosis
bradypnea
bradycardia
hypo or hypertension
What are signs of respirator distress?
use of accessory muscles
nasal flaring
tracheal tugging
adventitious lung sounds
What are nursing considerations when treating hypoxemia?
warm O2 to prevent hypothermia
place in semi to high Fowler’s
ensure equipment is working
used lowest setting flow that corrects
assess lung sounds, RR
not not blow O2 directly into infant’s face
monitor temp in tent
assess SaO2 and AbGs
oral hygeine
promote coughing and deep breathing
rest and decrease stimuli
What is an O2 hood? What is the flow rate?
small hood that fits over infant’s head
minimum of 4=5L/min
What is the flow rate of a pediatric mask? When is it warranted?
5-10 L/min
short-term therapy
mouth breathers
high O2 flow
What are nursing actions to promote safety when using O2 therapy?
alert combustion hazard with signs
know the closest fire extinguisher
wear cotton to prevent static electricty
ground electric machinery
avoid toys that can spark
no alcohol or acetone
no smoking
What are manifestations of O2 toxicity? What happens to gas levels with hypoventilation?
nonproductive cough
substernal pain
nasal stuffiness
N/V
HA
sore throat
hypoventilation
causes increased PaCo2 levels and leads to uncounsciousness
Whhat are considerations when nasal suctioning? Oral?
clean technique
mushroom tip catheter
clean tech.
hard catheter tip
insert in sides of mouth to prevent choking
What are nursing actions when suctioning an endotracheal or tracheal tube?
high Fowler’s or Fowler’s
select catheter with diameter 1/2 the diameter of the tube
hyperoxygenate at 100%
obtain baseline breath sounds and VS
surgical aseptic tech
ongoing O2 assessment
limit suction to 5 sec for infants and 10 sec for children
allow rest period of 30-60 sec or until O2 sats return to normal
What is a tracheotomy? When is it indicated?
surgical incision in to trachea to establish an airway
emergency airway with epiglottitis, croup, foreign body
scheduled surgical procedure
What is a tracheostomy?
stoma/opening resulting from a tracheotomy. Can be permanent or temporary
Should a tracheostomy be suctioned routinely? What warrants suctioning?
No
audible secretions
crackles
restlessness
tachypnea
tachycardia
mucus in the airway
What are tonsils? what do they do? What are risk factors for tonsilitis?
lymph-type tissue in the pharyngeal area
filter organisms and contribute to antibody formation
exposure to bacterial agent
immature immune system
What are assessment finding with tonsilitis?
sore throat/difficulty swallowing
Hx of otitis media/hearing difficulties
mouth odor
mouth breathing
snoring
nasal qualities in voice
fever
inflammation, redness, edema
anorexia
What can indicate bleeding r/t tonsilitis or other issues in the throat?
frequent swallowing
clearing throat
restlessness
bright red emesis
tachycardia
pallor
hemoptysis
What are comfort measures for tonsilitis?
liquid anelgesis ro tetracaine lolipops
ice collar
ice chips or sips of water
pain meds on a schedule
clear liquids
avoid citrus or milk
discourage coughing, throat/nose clearing to protect surgical site
there can be blood clots or blood-tinged vomitus
What are the complications associated with tonsillectomy? What is the complication associated with strep infection?
hemorrhage
dehydration
infection
rheumatic fever
What is nasopharyngitis? How long can it persist? What are expected findings? Home care?
common cold
4-10 days
nasal inflammation
dryness and irritation on of nose and pharynx
fever
decreased appetite
restlessness
antipyretic
rest
cool mist air
decongestants for 6+
caution: cough suppressants can cause over-sedation
antihistamines not recommended
antibiotics not indicated
What is GABHS? Nursing care?
strep throat
antibiotics (penicillin or amoxicillin)
antipyretics
or mycins, cephs, amoxicillin with clavulanic acid
What are risk factor for viral infections in children?
ages 3-6 mos-5yrs d/t decreased maternal antibodies
short narrow airways that can easily be obstructed with mucus or edema
shor respiratory tract, infection can travel quickly
short, open eustachian tubes to middle ear
compromised immune system
anemia
nutritional deficiencies
allergies
chronic conditions
exposure to second-hand smoke
seasonal viruses such as RSV
What are the expected findings with bronchitis from a viral infection? Care?
persistant dry cough
inflammation
resolves in 5-10 days
antipyretics
cough suppressant
coll mist humidifier
Wha causes bronchiolitis? What does it primarily affect? What are initial findings? moderate illness? Severe?
RSV
bronchi and bronchioles
rhinorrhea
fever
pharyngitis
coughing
sneezing
wheezing
ear or eye infection
tachypnea
retractions
refusal to nurse
copious secretions
tachypnea >70/min
listlessness
apnea
poor air exchange
poor breath sounds
cyanosis
What is the nursing care for RXV bronchiolitis)?
supplemental O2
fluids
maintain airway
meds
nasal suctioning
encourage breastfeeding
antibiotic
CPT, corticosteroids, bronchodilators not recommended
What are pharmaceutical interventions for allergies?
cortocosteroids (1st line)
antihistamines
beta-adrenergic decongestants
mast cell stabilizers
leukotriene modifiers
ipratroprium
What are the expected findings with bacterial pneumonia?
high fever
cough (unproductive or productive)
tachypnea
retractions and nasal flaring
chest pain
dullness with percussion
ronchi, crackles
pallor, cyanosis
irritability, restlessness, lethargic
abdominal pain, diarrhea, vomiting
anorexia
What is nursing care for viral pneumonia? Bacterial? What are complications with pneumonia?
cool mist
monitor SaO2
antipyretics
monitor I&O
CPT, postural drainage
rest
antibiotics
increased fluids
I&O
antipyretic
CPT
IV fluids
O2, monitor SaO2
pneumothorax
pleural effusion
What is bacterial epiglottis? Expected findings?
a croup syndrome
absence of cough, dysphonia (croaking)
drooling, dysphagia
agitation
inspiratory stridor
retractions
sore throat
high fever
restlessness
What is nursing care for epiglottis?
protect airway
avoid using a tongue blade
prepare for intubation
humidified O2
SaO2
IV fluids
corticosteroids
antibioics
droplet isolation
What is acute laryngotracheobronchitis? What causes the condition? Expected findings? Nursing care?
croup, spasmodic laryngitis
RSV
Influenza A and B
pneumonia
parainfluenza 1, 2 and 3
low-grade fever
restlessness
hoarseness
barky cough
dyspnea
inspiratory or continuous stridor
retractions
nasal flaring
tachypnea
cool mist
O2
monitor SaO2
nebulized epinephrine
corticosteroid
encourage fluid intake
IV fluids
What are risk factors for asthma? What can trigger asthma?
genetics
gender (boys more common until adolescence)
exposure to smoke
low birth weight
obesity
allergens
cold air or temp changes
environmental change
viruses
meds: aspirin, NSAIDs antibiotics, beta blockers
stress
reflux
endocrine factors
What is the most accurate test to diagnose asthma? What is a PEFR and what does it do?
pulmonary function test
peak expiratory flow rate, measures amount of air forcefully exhaled in 1 second
What are the SABA meds for asthma? What are they used for? LABA? cholinergic antagonists? is it for acute or chronic exacerbations? What are antiinflammatory agents ?and long-term meds?
albuterol, levalbuterol, terbutaline
acute exacerbations
prevent exercise-induced asthma
formoterol, salmeterol
atropine, ipratropium
acute
corticosteroids
leukotriene modifiers (“kasts”)
mast cell stabelizer like cromolyn
What are risk factors for cystic fibrosis? What deficiencies can be expected? What are some managment considerations? Complications of cystic fibrosis?
autosomal recessive
white ethnicity
vitamins ADEK
diet high in protein and calories
3 meals plus snacks
encourage fluids
pancreatic enzymes within 30 min of eating
vitamin supplements
stool softeners
monitor blood glucose
CPT and breathing exercises
immunizations
respiratory infections
bronchial cysts
emphysema
pneumothorax
nasal polyps
ileus
rectal prolapse
intestinal obstructions
GERD
DM
What does congenital heart disease generally lead to?
heart failure
hypoxemia
How are anatomic defects to the heart categorized? What defects increase pulmonary blood flow? Decrease blood flow? Obstructs blood flow? Combination?
by blood flow patterns
ASD
VSD
PDA
tetraology of fallot
tricuspid atresia
coarctation of the aorta
pulmonary stenosis
aortic stenosis
transposition
truncus arteriosus
hypoplastic left heart syndrome
What are risk factors for heart defects?
infection
maternal alcohol use
maternal DM
genetic Hx
downs syndrome and other anomalies
What is ventricular septal defect (VSD)? What is the result? How is it identified? Do they often close on their own? Treatment from least to most invasive?
hole in the septum between right and left ventricle
increased blood flow from the left to the right ventricle through the defect
loud murmur at left sternal border
heart failure
yes, many do
closure during cardiac catheterization
diuretics
spontaneous closure
pulmonary artery banding
complete repair
What is an atrial septal defect (ASD)? Findings? Treatment from least to most invasive?
hole between the right and left atria resulting in increased blood flow from the left to right atrium
loud murmur with split second heart sound
heart failure
often asymptomatic
closure during catheterization
diuretics
low-dose aspirin after the procedure
patch closure
cardiopulmonary bypass
What is a patent ductus ateriosis (PDA)? Finding? Treatment from least to most invasive?
condition where the conduit between the pulmonary artery and aorta fails to close increasing left to right blood flow
systolic murmur
wide pulse pressure
bounding pulses
can be asymptomatic
HF
rales
administer indomethacin to allow closure
occlude during catheterization
diuretics
extra calories
thoracoscopic repair
What is a pulmonary stenosis? Findings? Treatment from least to most invasive?
narrowing of the pulmonary valve resulting in obstruction of flow from the ventricles
systolic ejection murmur
asymptomatic
cyanosis
cardiomegaly
HF
Brock procedure
pulmonary valvotomy
What is an aortic stenosis? findings? Treatment from least to most invasive?
narrowing of the aortic valve
faint pulses
hypotension
tachycardia
poor feeding tolerance
intolerance to exertion
dizziness
chest pain
Norwood procedure
aortic valvotomy
What is coarctation of the aorta? Findings? Treatment from least to most invasive?
narrowing of the lumen of the aorta, obstructing flow from the ventricles
elevated BP and bounding pulses in arms
decreased BP in lower extremities
weak femoral pulses
HF
balloon angioplasty (infants and children)
stents (adolescents)
repair for infants <6mos
What is tricuspid atresia? Findings? Treatment from least to most invasive?
closure of the tricuspid valve. Only an atrial septal opening would allow blood to flow into the left atrium
cyanosis
dyspnea
tachycardia
hypoxemia
clubbing of fingernails
3 stages of surgery
shunt
Glenn procedure
Fontan procedure
What is tetralogy of fallot? Findings? Treatment from least to most invasive?
4 defects: VSD, overriding aorta, pulmonary stenosis and ventricular hypertrophy
cyanosis at birth
systolic murmur
Tet spells (blue spells of acute cyanosis and hypoxia)
shunt
primary repair
complete repair within 1st year of life
What is a transposition of the great arteries? Findings? Treatment from least to most invasive?
aorta and pulmonary artery are flipped-flopped with blood oxygenating only if there is a septal defect or PDA
possible murmur
cyanosis
cardiomegaly
HF
Surgery in first 2 weeks of life
IV prostaglandin to keep ducts open
What is truncus arteriosis? findings? Treatment from least to most invasive?
failure of septum formation resulting in a single vessel that comes off the ventricles
HF
murmur
cyanosis
delayed growth
lethargy
poor feeding
surgical repair in 1st month
What is hypoplastic left heart syndrome? Treatment from least to most invasive?
underdeveloped left side
cyanosis
HF
lethargy
cold hands and feet
once PDA closes (only way to oxygenate blood) cyanosis progresses and cardiac collapse
3 stages of surgery
Norwood
Glenn shunt
Fontan
What is the purpose of digoxin? What are s/s of toxicity? What are nursing actions with this med?
improves myocardial contractility which improves cardiac output
bradycardia
dysrythmia
N/V
anorexia
monitor pulse
withhold if less than 90/min (infant) and 70/min (child)
monitor for toxicity
digoxin immune fag (antidote)
What is the cardiac purpose of administering ACE inhibitors (angiotensin-converting enzyme)? What are some examples of this class of med? Nursing actions?
reduces afterload by causing vasodilation
reduce pulmonary and vascular resistance
captopril, enalapril (“prils”)
monitor BP
monitor for hyperkalemia
What is the cardiac purpose for administering beta blockers? Examples? Nursing actions?
decrease HR and blood pressure
“olols”: metroprolol, carvedilol
Check BP prior to administration
Monitor for dizziness, hypotension and HA
What is the cardiac benefit of furosimide or chlorothiazide? Nursing actions?
rids the body of excess fluid
watch potassium
monitor I&O
AE: hypokalemia, N/V, dizziness
daily weights
What is the onset of rheumatic fever? Findings? Complications?
2-6 weeks following untreated strep
Hx of strep
fever
tachycardia
cardiomegly
murmur
nodules over bony prominences
swollen joints
rash on trunk
CNS: muscle weakness, uncoordinated movements
irritability, poor concentration
carditis
heart disease
atrial fibrillation
embolism
What is kawasaki disease? Findings? Complications? Why is high does aspirin therapy warranted?
acute systemic vasculitis lasting 8 weeks
high fever unresponsive to antipyretics
irritability
red eyes
red. chapped lips
strawberry tongue
red oral mucous and inflammation
swelling of extremities
red palms and soles
rash
joint pain
enlarge lymph nodes
cardiac manifestations
aneurysm
heart attack
the risk or an aneurysm outweighs the risk for Reye’s
How is asthma categorized? 4
Intermittent (0-2x/wk, no activity limitations, medication <2x/wk)
Mild persistent (>2x/wk, minimal nighttime disturbances, minor activity limitations, medication>2x/wk
Moderate persistent (daily, moderate nighttime disturbances, some activity limitations, daily medication needs)
Severe persistent (continuous, frequent nighttime disturbances, extreme activity limitations, multiple daily use of medication)
What are complications of asthma?
Status asthmaticus (life-threatening episode of airway obstruction)
Respiratory failure
What are 3 differences between fetal hearts and adult hearts?
Heart is in the center of thoracic cavity
Transition from fetal circulation to adult circulation
3 Fetal shunts
Foramen ovale (closes shortly after birth-25% stay open)
Ductus arteriosus (within 2-3 days after birth)
Ductus venosis (closed shortly after birth)
What are pre procedure nursing considerations for cardiac catheterization?
Pre-procedure:
Vital signs
Perform a nursing hx
Provide teaching
Check for allergies to iodine & shellfish
Provide NPO status 4-6 hours prior to the procedure
Locate & mark dorsalis pedis & posterior tibial pulses on both extremities
Administer pre-sedation as prescribed based on age, height, weight, condition, & type of procedure
What are post-procedure nursing considerations for cardiac catheterization?
Assess HR & RR for 1 full minute
Assess sedation
Assess pedal pulses for equality & symmetry
Assess temperature & color
Monitor for hypoglycemia
Provide continuous cardiac monitoring & oxygen
Assess insertion site (femoral or antecubital area) for bleeding &/or hematoma
Prevent bleeding by maintaining the affected extremity in a straight position for 4-8 hours (preferably supine)
Monitor for complications (infection, bleeding, & thrombosis)
How does left-sided heart failure present?
Usually systolic (pulmonary hypertension) increased pulmonary blood flow
Crackles & wheezes
Cough
Dyspnea
Grunting, nasal flaring & retractions (infants)
Periods of cyanosis
Tachypnea
How does right-sided heart failure present?
Usually diastolic (backing up to the body) decreased pulmonary blood flow
Ascites
Hepatosplenomegaly
Jugular vein distention
Oliguria
Peripheral edema, esp. dependent & periorbital
Weight gain
What are interventions for heart failure?
Monitor for early signs of HF
VS, Temp, I&O, Weight, Edema
Elevate HOB, provide low dose O2
Cluster care, reduce O2 consumption
Provide small, frequent feedings, increase kcals, NG or feeding devices
Labs
Administer medications
Digoxin, ACE inhibitors, Beta-blockers, Diuretics (what are you monitoring?)
What closes a symptomatic PDA?
prostaglandin inhibitor
What is chorea?
involuntary muscle movements
Whate is the Jone’s criteria?
carditis
chorea
acute arthritis
with rheumatic fever
