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NSG412 OB/Peds > Exam 4 - Peds > Flashcards

Exam 4 - Peds Flashcards

1
Q

what is the blood shift with increased pulmonary blood flow?

A

blood shifts L to R

from high to low pressure

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2
Q

with increased pulmonary blood flow, what would you see manifest in the lungs?

A

pulmonary edema

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3
Q

what are the 3 types of increased pulmonary blood flow?

A
  1. ventricular septal defect
  2. atrial septal defect
  3. patent ductus arteriosis
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4
Q

type of heart defect:

hole between R + L atria

A

atrial septal defect

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5
Q

type of heart defect:

hole between R + L ventricle

A

ventricular septal defect

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6
Q

ventricular septal defect murmur is best heart where?

A

L sternal border

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7
Q

which heart defects have a loud + harsh murmur?

A

atrial septal defect + ventricular septal defect

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8
Q

type of heart defect:

duct between pulmonary artery + aorta doesn’t close @ birth

A

patent ductus arteriosis

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9
Q

which heart defect murmur sounds like a machine hum?

A

patent ductus arteriosis

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10
Q

what medication can be given to treat patent ductus arteriosis?

A

indomethacin (constricts the duct)

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11
Q

this class of defect is defined as blood exiting heart meets narrowed area

A

obstruction to blood flow

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12
Q

with obstruction to blood flow defects, pressure is increased or decreased BEFORE the obstruction?

A

increased

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13
Q

with obstruction to blood flow defects, pressure is increased or decreased AFTER the obstruction?

A

decreased

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14
Q

obstruction to blood flow defects lead to what? (r/t cardiac fxn)

A

decreased CO

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15
Q

usual tx for obstruction to blood flow defects

A

cardiac cath - balloon angioplasty

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16
Q

type of heart defect:

narrowing of aortic valve (harder to get blood out to systemic circulation)

A

aortic stenosis

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17
Q

type of heart defect:

narrowing of pulmonary valve/artery

A

pulmonary stenosis

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18
Q

s+s of aortic stenosis (6)

think of patho…

A
  1. HF
  2. faint pulses
  3. hypotension
  4. tachycardia
  5. poor feeding (infants)
  6. exercise intolerance + dizziness (kiddos)

all from not getting enough blood/O2 to system

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19
Q

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?

A

cardiomegaly - b/c of increased work of heart

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20
Q

pulmonary stenosis can cause which respiratory S+S?

A

cyanosis w/activity

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21
Q

type of heart defect:

narrowing of lumen of aorta

A

Coarctation of the aorta

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22
Q

s+s of coarctation of the aorta (5)

A
  1. nosebleed
  2. HF
  3. elevated BP/pulse in UE
  4. decreased/cool skin in LE
  5. leg cramps w/activity (not getting enough blood)
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23
Q

what is the blood shift with decreased pulmonary blood flow?

A

R to L shift

deoxygenated blood into systemic circulation b/c not reaching lungs

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24
Q

what are the 3 types of obstruction to blood flow defects?

A
  1. aortic stenosis
  2. pulmonary stenosis
  3. coarctation of the aorta
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25
Q

what are the 2 types of defects that fall under decreased pulmonary blood flow?

A
  1. tetralogy of fallot
  2. tricuspid atresia

2 T’s

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26
Q

tet spells are associated with which class of heart defects?

A

decreased pulmonary blood flow

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27
Q

tetralogy of fallot has 4 defects. what are they?

A
  1. Ventricular septal defect
  2. Overriding aorta
  3. Pulmonary stenosis
  4. Ventricular hypertrophy (from the pulmonary stenosis)
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28
Q

with tetralogy of fallot, tet spells often occur when for infants?

A

crying + feeding

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29
Q

with tetralogy of fallot, tet spells often occur when for children?

A

playing

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30
Q

main manifestation of tetralogy of fallot

A

cyanosis / tet spells

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31
Q

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?

A

knees to chest

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32
Q

type of defect:

closure of tricuspid valve + septal defect

A

tricuspid atreisa

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33
Q

s+s of tricuspid atresia in infants (3)

A
  1. cyanosis
  2. dyspnea
  3. tachycardia (infants)
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34
Q

s+s of tricuspid atresia in kids (2)

think more long term/chronic

A
  1. hypoxemia

2. clubbing

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35
Q

most common complication of patients with congenital heart disease

A

HF

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36
Q

s+s of R sided HF (6)

A
  1. edema
  2. bulging fontanel (infant)
  3. swollen eyelids
  4. weight gain
  5. swelling in hands + feet
  6. HTN
  7. decreased urinary output
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37
Q

s+s of L sided HF (3)

A
  1. dyspnea
  2. orthopnea
  3. adventitious lung sounds
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38
Q

MOA of digoxin

A

helps with contractility of heart

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39
Q

therapeutic digoxin range

A

0.8-1.2

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40
Q

1st s+s of dig toxicity

A

vomiting

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41
Q

what lab value should be closely monitored with digoxin therapy?

A

potassium

low levels risk dig toxicity

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42
Q

hold dig for:

child HR: ?
infant HR: ?

A

child HR: 70 or less

infant HR: 90 or less

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43
Q

after cardiac cath for child, what should happen with dressing?

A

remove and replace with bandaid after 1 day.

keep dry + clean

no strenuous activity

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44
Q

acute systemic vasculitis (inflammation of vessels) → weaken vessel walls

A

kawasaki disease

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45
Q

s+s in acute phase of kawasaki disease (9 - move head to toe / all over body)

A
  1. high fever (no response to antipyretic)
  2. enlarged lymph nodes
  3. red eyes w/o drainage
  4. bright red + chapped lips + strawberry tongue
  5. throat inflammation
  6. heart issues
  7. swelling + redness in hands + feet
  8. blistering rash
  9. joint pain
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46
Q

what is unique about fever in acute phase of kawasaki disease?

A

doesn’t respond to antipyretics

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47
Q

s+s of subacute phase of kawasaki disease? (3)

A
  1. peeling of hands and feet
  2. fever resolution
  3. other s+s start to resolve
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48
Q

how long does kawasaki disease take to resolve (lab findings) in the convalescence phase?

A

6-8 weeks

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49
Q

2 tx for kawasaki disease. + what is ideal timeframe for starting this tx?

A
  1. IV gamma globulin - within 10 days of onset

2. ASA (ok in this instance)

50
Q

s+s of increased ICP with infants (6)

A
  1. bulging fontanel*
  2. widening of cranial suture lines*
  3. increased head circumference*
  4. high pitched cry*
  5. lethargy
  6. vomiting
51
Q

s+s of increased ICP with kids (5)

A
  1. HA
  2. lethargy
  3. double vision
  4. vomiting
  5. decreased LOC → seizures
52
Q

late sign of increased ICP

A

bradycardia

53
Q

lumbosacral area affected but not seen visibly on outside of skin; may see tuft of hair or dimpling at base of spine

A

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”

54
Q

visible sac protruding (spinal fluid + meninges)

A

Meningocele

55
Q

visible sac protruding (spinal fluid, meninges + nerves visible in sac)

A

Myelomeningocele

56
Q

re: spina bifida, with visible sacs, a C section should happen within what time frame?

A

72 hrs

57
Q

re: spina bifida, with visible sacs, what is priority intervention until surgery?

A

PROTECT THE SAC - no rectal temps, sterile moist dressing, no pressure (prone)

58
Q

b/c of the bladder dysfxn with spina bifida, what should happen to prevent UTI?

A

intermittent cath q4h

59
Q

imbalance of production or reabsorption of CSF → accumulate in brain

A

hydrocephalus

60
Q

what is a VP shunt? what is it for?

A

to drain CSF from ventricles in brain to peritoneal cavity - used for hydrocephalus

61
Q

what is very important piece of education and post op care for VP shunt?

A

POSITIONING - don’t want it to drain too quickly

flat on non surgical side

62
Q

what should parents be taught if child is discharged with VP shunt?

A

can become obstructed over time - watch for s+s of increased ICP

63
Q

this condition is not progressive but cannot be cured and affects movement, motor fxn, muscle control, coordination + posture

A

cerebral palsy

64
Q

what is the most common movement disability in childhood ?

A

cerebral palsy

65
Q

what is cerebral palsy caused by?

A

hypoxic event of the brain

66
Q

type of CP:

hypertonicity (tight muscles, increased reflexes, clonus, poor balance control + fine/gross motor skills)

A

spastic

67
Q

type of CP:

involuntary jerking movements, slow wormlike

A

dyskinetic

68
Q

type of CP:

wide-based gate, difficulty with motion or purposeful movement

A

ataxic

69
Q

infection/inflammation of nervous system (meninges of brain + spinal cord)

A

meningitis

70
Q

what precautions should be in place for someone with bacterial meningitis?

A

isolation precautions - droplet?

71
Q

s+s of meningitis (7)

A
  1. stiff / painful neck
  2. severe HA
  3. altered mental status
  4. sudden high fever
  5. bulging fontanel (infants)
  6. photosensitivity
  7. rash (BAD SIGN - indicative of a very serious bacterial meningitis)
72
Q

re: fractures and compartment syndrome, what are the 5 P’s?

A
  1. pain
  2. pulselessness
  3. paresthesia
  4. paralysis
  5. pallor
73
Q

what is our main assessment with cast placement or patient with cast?

A

CMS (circulation, movement, sensation)

74
Q

deformity of spine (lateral curvature)

A

scoliosis

visible asymmetry of hips, shoulders, spine, scapula

75
Q

if patient with scoliosis has surgery (spinal fusion w/rod), what is expected care post-op? (5)

A

(in ICU)

  1. PCA pump
  2. log roll q2h
  3. watch for bleeding
  4. watch for infection
  5. use IS
76
Q

interventions for juvenile arthritis

A
  1. Warm, moist heat
  2. NSAIDs (w/food)
  3. Steroids
  4. Encourage participating in school activities :)
77
Q

incomplete fusion of oral cavity

A

cleft lip or palate

78
Q

when is surgery usually performed to repair cleft lip?

A

3 months

79
Q

when is surgery usually performed to repair cleft palate?

A

18 months

80
Q

post op care for cleft lip or palate (re: feeding progression)

A

clear liquid: 24 hrs

liquid: 2 weeks
soft: 6 weeks

81
Q

post op care/interventions for cleft lip or palate surgery (4)

A
  1. avoid lying prone (so they don’t rub their face)
  2. nothing hard or traumatic in mouth (paci, thermometer, etc)
  3. elbow restraints (check integrity)
  4. head upright
82
Q

what are some consults you might see with cleft lip/palate?

A
  1. OT
  2. SLP
  3. audiology
  4. orthodontics
  5. nutrition
83
Q

what is most reliable indicator of fluid loss in children?

A

body weight

84
Q

s+s of dehydration

A
  1. weight loss
  2. sunken fontanel (infant)
  3. tachycardia
  4. hypotension
  5. increased urine specific gravity
  6. dry mucus membranes
  7. tented skin
  8. abnormal electrolyte levels
85
Q

what is normal urine specific gravity?

A

1.010-1.025

86
Q

with mild + moderate dehydration, what is 1st line tx?

A

oral rehydration w/pedialyte or infalyte

87
Q

after rehydration has occurred via oral, what is next step?

A

low sodium solution (H2O, breast milk, formula)

88
Q

what is the rehydration formula / calculation for mild dehydration?

A

50mL/kg q 4-6 hrs

89
Q

what is the rehydration formula / calculation for moderate dehydration?

A

100mL/kg q 4-6 hrs

90
Q

type of dehydration:

H2O + Na loss in equal amounts

example?

A

isotonic

vomiting

91
Q

type of dehydration:

electrolyte loss > H2O loss

example?

A

hypotonic

ex: excessive vomiting, burns, giving plain H2O to young infant

92
Q

type of dehydration:

H2O loss > electrolyte loss

example?

A

hypertonic (hypernatremia)

ex: tube feedings or IV fluids

93
Q

level of dehydration:

irritability, VS changes + assessment changes, fontanel sunken

A

moderate

94
Q

level of dehydration:

> 10% weight loss, VS changes → shock, tented skin, oliguria or anuria, no tears

A

severe

95
Q

expected urine output for infant

A

> 2mL/kg/hr

96
Q

expected urine output for child

A

> 1mL/kg/hr

97
Q

gastric contents up from stomach + through esophageal sphincter

A

GERD

98
Q

s+s of GERD in infant/child (7)

A
  1. vomiting
  2. irritability
  3. arching of back (pain)**
  4. weight loss
  5. respiratory problems** (wheezing)
  6. dysphagia
  7. chronic cough**
99
Q

besides the usual adult interventions for GERD, what are additional ones for infant/child? (2)

A
  1. slow flow nipple

2. thickened milk w/rice cereal

100
Q

narrowing of pyloric sphincter (stomach to small intestine)

A

pyloric stenosis

contents cannot be emptied

101
Q

s+s of pyloric stenosis

A
  1. projectile vomiting
  2. hunger after vomiting
  3. olive-shaped mass
  4. peristaltic wave
102
Q

intervention for pyloric stenosis

A

pyloromyotomy (cutting part of the sphincter)

103
Q

section of colon with decreased motility + mechanical obstruction (b/c no ganglionic cells)

A

Hirschsprung’s

104
Q

s+s of Hirschsprung’s

A
  1. signs of malnourishment

2. ribbon-like stools

105
Q

tx for Hirschsprung’s

A

2 part surgery

  1. remove affected part of colon + create ostomy
  2. remove ostomy and reattach healthy part of colon to anus
106
Q

proximal segment of bowel telescopes into distal section

A

Intussusception

107
Q

s+s of intussusception (6)

A
  1. red currant jelly stools (blood + mucus in stool)
  2. sausage-shaped mass in RUQ
  3. lethargy
  4. severe abdominal pain (drawing knees to chest)
  5. fever
  6. S+S of peritonitis
108
Q

tx for intussusception

A

air enema

109
Q

s+s of appendicitis (5)

A
  1. periumbilical pain (start)
  2. RLQ pain*
  3. low grade fever
  4. rigid abdomen
  5. V/D
110
Q

what should NOT be given with appendicitis? why?

A

no laxatives or enemas - can cause rupture

111
Q

s+s of peritonitis (3)

A
  1. sudden decrease in abd pain
  2. distended board-like abdomen
  3. high fever
112
Q

what should ppl with celiac supplement with?

A

folate + fat soluble vitamins

113
Q

inflammation of glomerulus

A

Glomerulonephritis

114
Q

common cause of Glomerulonephritis

A

recent streptococcal infection

need ASO titer

115
Q

s+s of Glomerulonephritis (7)

A
  1. oliguria
  2. edema - face + periorbital edema
  3. tea-colored urine (RBCs)
  4. HTN
  5. hematuria
  6. proteinuria (LESS than nephrotic syndrome)
  7. increased BUN/creatinine/GFR
116
Q

important teaching with glomerulonephritis

A

infection prevention!!

117
Q

nursing care for glomerulonephritis (6)

A
  1. monitor daily weight
  2. watch electrolytes (esp for hyperkalemia - not filtering)
  3. monitor I+O
  4. monitor BP
  5. low sodium / fluid restricted diet
  6. diuretics + antihypertensives
118
Q

with the alteration in the glomerulus membrane with nephrotic syndrome, what happens?

A

TONS of protein spills into the urine

119
Q

s+s of nephrotic syndrome (8)

A
  1. weight gain
  2. face + periorbital edema
  3. frothy urine (decreased amt)
  4. ascites
  5. BP changes
  6. immune defenses impacted
  7. proteinuria (>2+)
  8. reduced serum protein + albumin
120
Q

nursing care for nephrotic syndrome (5 - meds grouped together)

A
  1. sodium + fluid restriction
  2. daily weights
  3. test urine for protein
  4. watch for signs of infection***
  5. steroids, diuretic, albumin

NSG412 OB/Peds (5 decks)

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