Exam 4 - Peds Flashcards
what is the blood shift with increased pulmonary blood flow?
blood shifts L to R
from high to low pressure
with increased pulmonary blood flow, what would you see manifest in the lungs?
pulmonary edema
what are the 3 types of increased pulmonary blood flow?
- ventricular septal defect
- atrial septal defect
- patent ductus arteriosis
type of heart defect:
hole between R + L atria
atrial septal defect
type of heart defect:
hole between R + L ventricle
ventricular septal defect
ventricular septal defect murmur is best heart where?
L sternal border
which heart defects have a loud + harsh murmur?
atrial septal defect + ventricular septal defect
type of heart defect:
duct between pulmonary artery + aorta doesn’t close @ birth
patent ductus arteriosis
which heart defect murmur sounds like a machine hum?
patent ductus arteriosis
what medication can be given to treat patent ductus arteriosis?
indomethacin (constricts the duct)
this class of defect is defined as blood exiting heart meets narrowed area
obstruction to blood flow
with obstruction to blood flow defects, pressure is increased or decreased BEFORE the obstruction?
increased
with obstruction to blood flow defects, pressure is increased or decreased AFTER the obstruction?
decreased
obstruction to blood flow defects lead to what? (r/t cardiac fxn)
decreased CO
usual tx for obstruction to blood flow defects
cardiac cath - balloon angioplasty
type of heart defect:
narrowing of aortic valve (harder to get blood out to systemic circulation)
aortic stenosis
type of heart defect:
narrowing of pulmonary valve/artery
pulmonary stenosis
s+s of aortic stenosis (6)
think of patho…
- HF
- faint pulses
- hypotension
- tachycardia
- poor feeding (infants)
- exercise intolerance + dizziness (kiddos)
all from not getting enough blood/O2 to system
pulmonary stenosis causes an obstruction of blood flow from the R ventricle into the pulmonary system, which can lead to what happening with the R ventricle?
cardiomegaly - b/c of increased work of heart
pulmonary stenosis can cause which respiratory S+S?
cyanosis w/activity
type of heart defect:
narrowing of lumen of aorta
Coarctation of the aorta
s+s of coarctation of the aorta (5)
- nosebleed
- HF
- elevated BP/pulse in UE
- decreased/cool skin in LE
- leg cramps w/activity (not getting enough blood)
what is the blood shift with decreased pulmonary blood flow?
R to L shift
deoxygenated blood into systemic circulation b/c not reaching lungs
what are the 3 types of obstruction to blood flow defects?
- aortic stenosis
- pulmonary stenosis
- coarctation of the aorta
what are the 2 types of defects that fall under decreased pulmonary blood flow?
- tetralogy of fallot
- tricuspid atresia
2 T’s
tet spells are associated with which class of heart defects?
decreased pulmonary blood flow
tetralogy of fallot has 4 defects. what are they?
- Ventricular septal defect
- Overriding aorta
- Pulmonary stenosis
- Ventricular hypertrophy (from the pulmonary stenosis)
with tetralogy of fallot, tet spells often occur when for infants?
crying + feeding
with tetralogy of fallot, tet spells often occur when for children?
playing
main manifestation of tetralogy of fallot
cyanosis / tet spells
what position can we put an infant in to help with tetralogy of fallot? or a position you might see a kid put themselves in to get better oxygenation?
knees to chest
type of defect:
closure of tricuspid valve + septal defect
tricuspid atreisa
s+s of tricuspid atresia in infants (3)
- cyanosis
- dyspnea
- tachycardia (infants)
s+s of tricuspid atresia in kids (2)
think more long term/chronic
- hypoxemia
2. clubbing
most common complication of patients with congenital heart disease
HF
s+s of R sided HF (6)
- edema
- bulging fontanel (infant)
- swollen eyelids
- weight gain
- swelling in hands + feet
- HTN
- decreased urinary output
s+s of L sided HF (3)
- dyspnea
- orthopnea
- adventitious lung sounds
MOA of digoxin
helps with contractility of heart
therapeutic digoxin range
0.8-1.2
1st s+s of dig toxicity
vomiting
what lab value should be closely monitored with digoxin therapy?
potassium
low levels risk dig toxicity
hold dig for:
child HR: ?
infant HR: ?
child HR: 70 or less
infant HR: 90 or less
after cardiac cath for child, what should happen with dressing?
remove and replace with bandaid after 1 day.
keep dry + clean
no strenuous activity
acute systemic vasculitis (inflammation of vessels) → weaken vessel walls
kawasaki disease
s+s in acute phase of kawasaki disease (9 - move head to toe / all over body)
- high fever (no response to antipyretic)
- enlarged lymph nodes
- red eyes w/o drainage
- bright red + chapped lips + strawberry tongue
- throat inflammation
- heart issues
- swelling + redness in hands + feet
- blistering rash
- joint pain
what is unique about fever in acute phase of kawasaki disease?
doesn’t respond to antipyretics
s+s of subacute phase of kawasaki disease? (3)
- peeling of hands and feet
- fever resolution
- other s+s start to resolve
how long does kawasaki disease take to resolve (lab findings) in the convalescence phase?
6-8 weeks
2 tx for kawasaki disease. + what is ideal timeframe for starting this tx?
- IV gamma globulin - within 10 days of onset
2. ASA (ok in this instance)
s+s of increased ICP with infants (6)
- bulging fontanel*
- widening of cranial suture lines*
- increased head circumference*
- high pitched cry*
- lethargy
- vomiting
s+s of increased ICP with kids (5)
- HA
- lethargy
- double vision
- vomiting
- decreased LOC → seizures
late sign of increased ICP
bradycardia
lumbosacral area affected but not seen visibly on outside of skin; may see tuft of hair or dimpling at base of spine
spina bifida occulta
“if you’re in a CULT, people may not be able to see the problems completely from the outside, but something may look a little off”
visible sac protruding (spinal fluid + meninges)
Meningocele
visible sac protruding (spinal fluid, meninges + nerves visible in sac)
Myelomeningocele
re: spina bifida, with visible sacs, a C section should happen within what time frame?
72 hrs
re: spina bifida, with visible sacs, what is priority intervention until surgery?
PROTECT THE SAC - no rectal temps, sterile moist dressing, no pressure (prone)
b/c of the bladder dysfxn with spina bifida, what should happen to prevent UTI?
intermittent cath q4h
imbalance of production or reabsorption of CSF → accumulate in brain
hydrocephalus
what is a VP shunt? what is it for?
to drain CSF from ventricles in brain to peritoneal cavity - used for hydrocephalus
what is very important piece of education and post op care for VP shunt?
POSITIONING - don’t want it to drain too quickly
flat on non surgical side
what should parents be taught if child is discharged with VP shunt?
can become obstructed over time - watch for s+s of increased ICP
this condition is not progressive but cannot be cured and affects movement, motor fxn, muscle control, coordination + posture
cerebral palsy
what is the most common movement disability in childhood ?
cerebral palsy
what is cerebral palsy caused by?
hypoxic event of the brain
type of CP:
hypertonicity (tight muscles, increased reflexes, clonus, poor balance control + fine/gross motor skills)
spastic
type of CP:
involuntary jerking movements, slow wormlike
dyskinetic
type of CP:
wide-based gate, difficulty with motion or purposeful movement
ataxic
infection/inflammation of nervous system (meninges of brain + spinal cord)
meningitis
what precautions should be in place for someone with bacterial meningitis?
isolation precautions - droplet?
s+s of meningitis (7)
- stiff / painful neck
- severe HA
- altered mental status
- sudden high fever
- bulging fontanel (infants)
- photosensitivity
- rash (BAD SIGN - indicative of a very serious bacterial meningitis)
re: fractures and compartment syndrome, what are the 5 P’s?
- pain
- pulselessness
- paresthesia
- paralysis
- pallor
what is our main assessment with cast placement or patient with cast?
CMS (circulation, movement, sensation)
deformity of spine (lateral curvature)
scoliosis
visible asymmetry of hips, shoulders, spine, scapula
if patient with scoliosis has surgery (spinal fusion w/rod), what is expected care post-op? (5)
(in ICU)
- PCA pump
- log roll q2h
- watch for bleeding
- watch for infection
- use IS
interventions for juvenile arthritis
- Warm, moist heat
- NSAIDs (w/food)
- Steroids
- Encourage participating in school activities :)
incomplete fusion of oral cavity
cleft lip or palate
when is surgery usually performed to repair cleft lip?
3 months
when is surgery usually performed to repair cleft palate?
18 months
post op care for cleft lip or palate (re: feeding progression)
clear liquid: 24 hrs
liquid: 2 weeks
soft: 6 weeks
post op care/interventions for cleft lip or palate surgery (4)
- avoid lying prone (so they don’t rub their face)
- nothing hard or traumatic in mouth (paci, thermometer, etc)
- elbow restraints (check integrity)
- head upright
what are some consults you might see with cleft lip/palate?
- OT
- SLP
- audiology
- orthodontics
- nutrition
what is most reliable indicator of fluid loss in children?
body weight
s+s of dehydration
- weight loss
- sunken fontanel (infant)
- tachycardia
- hypotension
- increased urine specific gravity
- dry mucus membranes
- tented skin
- abnormal electrolyte levels
what is normal urine specific gravity?
1.010-1.025
with mild + moderate dehydration, what is 1st line tx?
oral rehydration w/pedialyte or infalyte
after rehydration has occurred via oral, what is next step?
low sodium solution (H2O, breast milk, formula)
what is the rehydration formula / calculation for mild dehydration?
50mL/kg q 4-6 hrs
what is the rehydration formula / calculation for moderate dehydration?
100mL/kg q 4-6 hrs
type of dehydration:
H2O + Na loss in equal amounts
example?
isotonic
vomiting
type of dehydration:
electrolyte loss > H2O loss
example?
hypotonic
ex: excessive vomiting, burns, giving plain H2O to young infant
type of dehydration:
H2O loss > electrolyte loss
example?
hypertonic (hypernatremia)
ex: tube feedings or IV fluids
level of dehydration:
irritability, VS changes + assessment changes, fontanel sunken
moderate
level of dehydration:
> 10% weight loss, VS changes → shock, tented skin, oliguria or anuria, no tears
severe
expected urine output for infant
> 2mL/kg/hr
expected urine output for child
> 1mL/kg/hr
gastric contents up from stomach + through esophageal sphincter
GERD
s+s of GERD in infant/child (7)
- vomiting
- irritability
- arching of back (pain)**
- weight loss
- respiratory problems** (wheezing)
- dysphagia
- chronic cough**
besides the usual adult interventions for GERD, what are additional ones for infant/child? (2)
- slow flow nipple
2. thickened milk w/rice cereal
narrowing of pyloric sphincter (stomach to small intestine)
pyloric stenosis
contents cannot be emptied
s+s of pyloric stenosis
- projectile vomiting
- hunger after vomiting
- olive-shaped mass
- peristaltic wave
intervention for pyloric stenosis
pyloromyotomy (cutting part of the sphincter)
section of colon with decreased motility + mechanical obstruction (b/c no ganglionic cells)
Hirschsprung’s
s+s of Hirschsprung’s
- signs of malnourishment
2. ribbon-like stools
tx for Hirschsprung’s
2 part surgery
- remove affected part of colon + create ostomy
- remove ostomy and reattach healthy part of colon to anus
proximal segment of bowel telescopes into distal section
Intussusception
s+s of intussusception (6)
- red currant jelly stools (blood + mucus in stool)
- sausage-shaped mass in RUQ
- lethargy
- severe abdominal pain (drawing knees to chest)
- fever
- S+S of peritonitis
tx for intussusception
air enema
s+s of appendicitis (5)
- periumbilical pain (start)
- RLQ pain*
- low grade fever
- rigid abdomen
- V/D
what should NOT be given with appendicitis? why?
no laxatives or enemas - can cause rupture
s+s of peritonitis (3)
- sudden decrease in abd pain
- distended board-like abdomen
- high fever
what should ppl with celiac supplement with?
folate + fat soluble vitamins
inflammation of glomerulus
Glomerulonephritis
common cause of Glomerulonephritis
recent streptococcal infection
need ASO titer
s+s of Glomerulonephritis (7)
- oliguria
- edema - face + periorbital edema
- tea-colored urine (RBCs)
- HTN
- hematuria
- proteinuria (LESS than nephrotic syndrome)
- increased BUN/creatinine/GFR
important teaching with glomerulonephritis
infection prevention!!
nursing care for glomerulonephritis (6)
- monitor daily weight
- watch electrolytes (esp for hyperkalemia - not filtering)
- monitor I+O
- monitor BP
- low sodium / fluid restricted diet
- diuretics + antihypertensives
with the alteration in the glomerulus membrane with nephrotic syndrome, what happens?
TONS of protein spills into the urine
s+s of nephrotic syndrome (8)
- weight gain
- face + periorbital edema
- frothy urine (decreased amt)
- ascites
- BP changes
- immune defenses impacted
- proteinuria (>2+)
- reduced serum protein + albumin
nursing care for nephrotic syndrome (5 - meds grouped together)
- sodium + fluid restriction
- daily weights
- test urine for protein
- watch for signs of infection***
- steroids, diuretic, albumin
