Exam 4 Flashcards
Defects where blood is shunted from the left to the right side of the heart (3)
increased pulmonary blood flow
ASD
VSD
PDA
s/s of ASD/VSD/PDA
= Defects where blood is shunted from the left to the right side of the heart
–>Blood enters and then reenters the pulmonary system with increase pulmonary blood flow
> S/S of heart failure + murmur + can be asxs
differences in murmur b/w ASD/VSD/PDA
ASD = loud harsh
VSD= loud hard, left sternal border
PDA- machine hum
which is common in premies: VSD, ASD, or PDA?
PDA
treatments for ASD/VSD/PDA
ASD/VSD/PDA = cadiac cath/ close spontaeously PDA = indomethacin
Defects where blood exiting the heart meets an area of narrowing
Aortic Stenosis
Pulmonary Stenosis
Coarctation of AORTA
Defects where blood exiting the heart meets an area of narrowing result in _______ cardiac output
decreased
s/s aortic stenosis (infants vs children)
- Murmur
- CHF
- Infants – faint pulses, hypotension, tachycardia, poor feeding
- Children – exercise intolerance, dizziness
s/s of pumlonary stenosis
- murmur
- cardiomegaly
- heart failure
- cyanosis w/ activity varies
s/s of coartation of aorta
- Elevated b/p in arms – decreased in lower extremities
* Bounding pulses in upper/ weak, cool skin lower
treatments for
- Aortic stenosis
- Pulmonary stenosis
- Coarctation of the aorta
cardiac cath/balloon angioplasty
Right to left shift letting deoxygenated blood from right side into systemic circulation on left side causes what?
decreased pulmonary blood flow –> deoxygenated blood in body!
2 types of decreased pulmonary blood flow coniditons of heart
- Tetralogy of Fallot
* Tricuspid atresia
what is treatment for
- Tetralogy of Fallot
- Tricuspid atresia
surgical repair
4 defects of tetralogy of fallot
- VSD (ventricular septum defect)
- overriding aorta
- pulmonary stenosis
- right ventricular hypertrophy
s/s of tetralogy of fallot
- TET spells
- Murmur
- Client blue with crying, feeding, play
- Chronic hypoxia (clubbing)
2 characteristics of tricuspid atresia
= Tricuspid valve is closed and septal defect
s/s of tricuspid atresia
- Cyanosis
- dyspnea
- tachycardia
- Hypoxemia
- clubbing
◦ aorta connected to right ventricle
◦ pulmonary artery connected to left ventricle
=
Mixed Blood Flow Defect:::
Transposition of the great arteries
◦ Failure of septum to form =
Mixed blood flow::
Truncus arteriosus
◦ Underdeveloped left side of heart =
Mixed blood flow defect::
Hypoplastic left heart syndrome
s/s of heart failure
- Tachycardia
- Tachypnea
- Weight gain
- Poor Feeding/Growth
- Fatigue
- Decreased output
- Orthopnea
hold rate for digoxin - adult.child/infant
◦ 60/min in adult
◦ 70/min in child
◦ 90/min in infant
feedings for heart failure kids (2 )
- cluster care: Feed every 3 hours
* Polycose to add calories
meds for heart failure (3)
digoxin, lasix, ace inhibitor
dig toxicity:
vision change/vommiting
3 phases of kawaski
acute, subacute, convaslecent
what is kawaski? is it chill or like a big deal?
= acute systemic vasculitis - inflammation that affects arterioles/venules/capillaries
–> Weakens the walls of blood vessels
• potentially fatal
s/s during acute kawaski
high fever unresponsive to antipyretics, eyes red (no drainage), bright red chapped lips, strawberry tongue with red bumps, irritability inflammation in throat, swelling in hands and feet, palms and soles red, non-blistering rash, joint pain bilaterally, myocarditis, LV function decreased, pericardial effusion
s/s during subacute kawaski
fever will break, subsiding of other s/s, irritability, peeling of skin around nails/palms/soles
will lab bindings be normal during convalescent phase of kawaski?
altered lab findings, takes 6-8 weeks from onset to resolve
2 meds for treat kawaski
aspirin high dose, iv immunogobblin
cardiac cath post op care
- tele/o2 monitoring
- assess pulse bilateral pulse
- assess insertion site for bleeding/hematoma
- prevent bleeding by keeping affect extremity straight for 4-8 hours
- clean/dry dressing
- monitor for hypoglycemia
- clear fluids encouraged + voiding to get out contrast medium
*leave dressing on for 24 hours then put on regular bandaid
what med can cause reyes sydrome?
asprin + viral infection
Type of spina bifida:
‣ tuft of hair present, dimpling at base of spine
‣ no protrusion of spinal nerves, but missing bone
oculta
Type of spina bifida:
Protrusion containing meninges and spinal fluid ,,, NO nerves
Meningocele
Type of spina bifida,,,
Protrusion containing meninges, spinal fluid, and nerves
Myelomeningocele
Bladder and bowel issues/paralysis with which types of spina bifida?
Meningocele and Myelomeningocele
Can we take rectal temps on spina bifida patients?
Heck no!
What kind of dressing goes over lower back of spina bifida patient?
Sterile moist dressing initially, change ever 2 hours
What position do we place new born spina bifida patient in?
Prone
Avoid pressure on sac
What kind of hold is recommended for spina bifida newborn?
Football hold — avoid pressure on sac
Can spina bifida babes be born vaginally?
No! C section
When is surgery done to repair spina bifida site after birth?
Within 24-48 hours of birth
Post op consideration for VP (ventricular peritoneal) Shunt (think: positioning)
position change follows Dr. orders
‣ do not elevate too fast –> fluid drain too quickly –> injury to brain
‣ lay child flat on his or her nonsurgical side to prevent rapid reduction in intracranial fluid
S/s if increased icp in infant
◦ bulging fontanel ◦ increase in head circumference ◦ high pitched cry ◦ lethargic ◦ vomiting ◦ widening of cranial suture lines
S/s of increase ICP IN CHILD
◦ headache ◦ lethargic ◦ n/v ◦ double vision ◦ decreased LOC ◦ seizure
Disorder causing movement, muscle control, and posture deficits caused by hypoxia to the brain
Cerebral palsy
Most common disability of childhood to effect the movement
Cerebral palsy
4 types of cerebral palsy
Spastic
Dyskinentic
Ataxic
Mixed
Type of CP: hypertonicity- muscles tight, increased reflexes, clonus, poor control with balance/ posture/movement, fine/gross motor difficulties, pyramidal, crouched gait with scissoring motion of legs, Babinski reflex
Spastic
Type of CP:
involuntary jerking, slow worm like movements, non-spastic, extrapyramidal, slow twisting movements, drooling and speech impairment
Dyskinetic CP
Type of CP:
wide based gait, difficulty with coordination, can’t do repetitive motions well, difficulty with purposeful movement like reaching for an object
Ataxic CP
Interventions for CP
◦ no cure but can use OT/PT/ surgery/equipment/meds like anti anxiety/seizure meds to manage it
• Safety : protective equipment- helmet/pads, safe toys preventing aspiration, position child upright with feeding, educate parents
Need to differentiate meningitis from ______ ______
Reye’s syndrome
Can cause liver and neuro and looks like meningitis
What can we do to slow the curvature caused by scoliosis?
Bracing
When do we do surgical interventions for scoliosis?
If >45 degrees
Surgical/post op considerations for scoliosis
go to ICU- rod placement surgery very invasive ◦ PCA pump ◦ Supine ◦ Log-rolling every 2 hours ◦ Skin integrity ◦ indications of bleeding/infection
Type of break that can result in altered bone growth
Epiphyseal plate injury
Priority assessments for fracture
Circulation, neuro (CMS from med surg)
5ps of compartment syndrome
‣ pain- unrelieved with elevations/ analgesics that worsens with passive movement
‣ pulselessness: distal to fracture (late finding)
‣ pallor- pale skin
‣ paralysis
‣ parasthesia - numbness (early finding)
Goal of managing juvenile idiopathic arthritis?
Preserve function, control pain and inflammation
Interventions for managing pain and inflammation with JIA
Warm moist heat
NSAIDS – take with food to minimize GI irritation
Prednisone
DMARDS
How do we dose prednisone for kids with JIA?
Lowest effective dose for short-term therapy b/c of adverse effects (ex. take on an alternate day schedule)
• weight gain, alteration in growth
What about psychosocial considerations with JIA?
encourage participation in school activities
2 ways to improve feeding with clefties?
◦ special bottles that can cover palate area
◦ maneuvers: squeeze cheeks for cleft lip
when does surgery happen for cleft lip vs cleft palate?
3 months for lip
18 month for palate
diet for cleft palate post op ?
Clear liquid diet for 24 hours
Liquid diet for 2 weeks
Soft diet for 6 weeks
post op considerations for clefties?
• Avoid trauma to the site by avoiding placing things in the mouth (ex. thermometer, toys)
◦ elbow restraints to keep them from putting hands/objects in mouth
• Avoid client rubbing the site
• Pain relief - pharm/nonpharm
Most reliable indicator of fluid loss for infants and young children=
body weight
s/s of dehydration
• Weight loss, irritability, increased pulse, decrease b/p, increase urine specific gravity
urine specific gravity normal vs dehydration
1.010 to 1.025= normal range
> 1.025 = dehydration
first line intervention with signs of dehydration
oral rehydration therapy
what do we do after rehydration is achieved?
alternate oral rehydration therapy with low-sodium solution (water, breast milk, lactose free formula)
urine output for infant vs child
- Child= > 1ml/kg/hr
* Infant= >2ml/kg/hr
s/s of adequate fluid volume
- Moist mucus membranes
- Cap refill of 2 seconds or less
- Brisk skin turgor
- Balanced fluid intake and output
- Electrolytes in expected range
mild/mod/severe dehydration:
◦ weight loss 3-5% infant ◦ weight loss 3-4% children
mild
mild/mod/severe dehydration:
◦ weight loss 6-9% infant ◦ weight loss 6-8% children
moderate
mild/mod/severe dehydration:
◦ weight loss >10% in infants ◦ weight loss >10% in children
severe
how does BP change from mild/mod/severe dehydration
mild = normal mod = orthostatic severe= orthostatic --> shock
cap refill mod/mild/severe dehydration
mild = >2
mod 2-4
severe = >4
breathing mild/mod/severe dehydration
mild: normal
mod: slgiht tachypnea
severe: hyperpnea
s/s of severe dehydration
cap refill >4 seconds, tachycardia, orthostatic BP can progress to shock, extreme thirst, very dry mucous membrane, tented skin, hyperpnea, no tearing, sunken eyeballs, sunken anterior fontanel, oliguria to anuria
GERD vs GER?
• Gastric contents come back up into esophagus causing injury
*becomes disease when tissue damage is done
infant vs children s/s of GERD
Signs/Symptoms Infants::
-Vomiting, irritability, arching of back, weight loss, failure to thrive, wheezing, respiratory problems
Signs/Symptoms Children::
-Heartburn, difficulty swallowing, chronic cough (different than adults –> like asthma in kids)
interventions for GERD
- small frequent meals
- thicken infant formula with 1 tsp to 1 tbsp rice cereal/ 1 oz milk
- elevate head after meals for 1 hour
- avoid irritating foods
Narrowing/thickening of the pyloric sphincter causing an obstruction =
pyloric stenosis
s/s of pyloric stenosis
- Vomiting after feedings – projectile vomiting
- Projective vomiting followed by hunger
- Olive shaped mass in RUQ;
- possible peristaltic wave from left to right
- dehydration
intervention for pyloric stenosis
pylorotomy / pyloromyotomy
complications from pyloric stenosis
recurrent pneumonia, weight loss, failure to thrive
Proximal segment of bowel telescopes into distal section of bowel =
Intussusception
s/s of intussesception
- Palpable mass in RUQ of abdomen
- Stools mixed with blood and mucus (red currant jelly stools)
- Vomiting; Lethargy
- Drawing knees to the chest in severe pain then normal behavior
- Eventual fever and signs of peritonitis
treatment for intussesception?
air enema
Mechanical obstruction from inadequate motility of part of intestine due te lack of ganglionic cells in segments of colon =
Hirschsprung Disease
s/s of appendicitis
• Pain, fever, rigid abdomen • Anticipate need for appendectomy • Avoid enemas and laxatives • Rovsing’s sign – appendicitis ◦ Tenderness in RLQ with palpation of any quadrant
appendix PERFORATION s/s
- Sudden decrease in abdominal pain (short time before peritonitis)
- Peritonitis
- Distended abdomen
- Fever – high
RBC/WBC/Neutrophils/Lymphocytes ofr appendicitis
RBC 4-5.5 million/mm3
WBC 5,000- 10,000/mm3
Neutrophils 3,000-5,800/mm3
Lymphocytes 1,000-4,000/mm3
what causes Acute Glomerulonephritis
streptococcal infection
findings of acute glomer
- Oliguria, edema of face, hypertension, hematuria, cloudy tea colored urine from RBC, some protein in urine, encephalopathy
- Increased BUN (greater than 20 mg/dL) and creatinine
- Increased RBC in urine
- Low GFR
- Throat culture, urinalysis
findings of nephrotic syndrome
- Weight gain, Facial and periorbital edema, ascites, decreased frothy urine, lines on fingernails, more protein in urine
- Normal to low b/p
- Labs – proteinuria (greater than 2+); Reduced serum protein and albumin
meds for neprotic syndrome
• Corticosteroids (helps slow protein loss), Diuretic, 25% albumin
meds for acute glomer
Diuretics and Antihypertensives
nursing care for acute glomer
- Check daily weight
- Monitor I&O, B/P
- Low sodium, Fluid restricted diet
- watch for high potassium
nursing care for nephrotic syndrome
• Limit sodium and fluid restriction, Daily weights, Testing urine for protein, Monitor for signs of an infection, and prevent infection
difference b/w type.1 and type 2 diabetes
1 =Destruction of beta cells of pancreas –> insulin deficiency (• insulin dependent)
2 =insulin insufficiency and not using insulin properly in body
safety education for type 1 diabetes
have simple sugar with them at all times, caregivers aware of s/s of hypoglycemia
prevention of hypoglycemia
exercise can lower CBG so eat a snack 30 minutes before activity + snack during for prolonged exercise
s/s of hyperglycemia
thirst, polyuria (early), oliguria (late), N/V, abdominal pain, skin that is warm/dry/flushed with poor turgor, dry mucous membranes, confusion, weak, lethargic, weak pulse, diminished reflexes, rapid/deep resps. fruity odor
sick day rules for type 1 diabetes
- always give prescribed insulin
- check CBG every 4 hours
- ketone testing w/ every void
- calorie containing liquids in place of solid foods
- hospitalize if cannot retain fluids or food
- know when to contact provider
are oral hypoglycemic agents used with type 1 diabetes?
no! inly type 2
