Extra stuff from review slides Flashcards
What is cleft lip?
failure of the maxillary and median nasal processes to fuse
Visible separation from the upper lip towards the nose
what is cleft palate?
midline fissure of the palate that results from failure of the two palatal processes to fuse
Visible or palpable opening of the palate connecting the mouth to the nasal cavity.
Loss/Presentation of mild dehydration (hint: 4)
- 3%-5% in infants
- 3%-4% in children
- WDL: VS and assessments
- possible slight thirst
Loss/Presentation of moderate dehydration (hint: 9)
- 6-9% in infants
- 6-8% in childen
- capillary refill: 2-4 secs
- slightly increased HR
- normal BP
- dry mucous membranes
- possible thirst & irritability
- slight tachypnea
- normal to sunkin anterior fontanel in infants
Loss/Presentation severe dehydration (hint: 11)
- > 10% infants
- 10% children
- cap refill > 4 seconds
- tachycardic
- orthostatic BP
- extreme thirst
- very dry mucous membranes
- tenting of skin
- hyperpnea
- sunken eyeballs, no tears
- oliguria or anuria
In severe dehydration, tachycardia and orthostatic BP can mean what?
shock
Gastroenteritis…(hint: 5)
Bacterial or Viral
Care is supportive
Diet
Support Hydration
Antibiotics only after supportive care not helping
What is pyloric stenosis?
The circumferential muscle of the pyloric sphincter becomes thickened
Elongation and narrowing of pyloric channel
outlet obstruction, dilation, hypertrophy, & hyperperistalsis of stomach
What is a post surgical complication of Hirschsprung Disease?
Enterocolitis which is the inflammation of the bowel
What are nursing actions for enterocolitis? (hint: 6)
- Monitor VS
- Abdominal Girth
- Monitor for sepsis: shock
- Monitor and manage fluids, electrolytes, and blood products
- Antibiotics
- Anal stricture & incontinence
Causes of appendicitis? (hint: 3)
Cause is obstruction of the lumen of the appendix, by hardened fecal material (fecalith)
Often after a viral infection, swollen lymphoid tissue can obstruct the appendix
Pinworms can also obstruct the appendiceal lumen
what diagnostics are done to determine appendicitis?
CT & ultrasound
what happens after appendix ruptures? (hint: 3)
Often pain abruptly lessens after rupture
Abd may feel stiff on exam
Child will have fever and vomiting
What is Crohn’s disease?
Genetic; Chronic immune process characterized by a T-helper 1 cytokine profile
Involves any part of GI tract mouth-anus, most often terminal ileum
Involves all layers of bowel wall (transmural) in a discontinuous fashion
S&S Crohn’s (hint: 6)
- May result in fistula
- More “colicky pain” and diarrhea
- Fever
- Weight loss r/t malabsorption
- Possible palpable mass stricture can lead to obstruction
- Rectal bleeding is uncommon
Ulcerative colitis…(5 things)
Inflammation is limited to the colon and rectum
Inflammation affects the mucosa and submucosa.
Involves continuous segments along the length of the bowel with varying degrees of bleeding, edema, and ulceration
Toxic megacolon most dangerous form of severe colitis
Fluids and electrolytes can not be absorbed through mucosa
S&S ulcerative colitis (hint: 5)
- Bloody diarrhea
- Significant fluid and electrolyte losses
- Abdominal pain
Mild, moderate, and severe forms of disease :
- Increased stooling with disease (20+/day) progression
- Systemic symptoms with severe form: Fever
Constipation is common when?
during potty training phase
Tx for constipation? (3)
diet
medications
set aside time for child to use bathroom
Constipation is not the absence of stool but rather?
hard, formed stools, that causes straining
Acute Post-Streptococcal Glomerulonephritis:
There is a decrease in ? → this causes ? → leads to ?
decrease in plasma filtration
causes water and sodium retention
leads to edema
in Acute Post-Streptococcal Glomerulonephritis, fluid retention is not the complete cause of ?
hypertension
Nephrotic vs Nephritic syndromes:
Proteinuria?
Nephrotic: masssive > 3.5 g/day
Nephritic: mild to moderate
Nephrotic vs Nephritic syndromes:
Hematuria?
Nephrotic: usually absent
Nephritic: present (tea colored)
Nephrotic vs Nephritic syndromes:
Edema?
Nephrotic: significant
Nephritic: mild to moderate
Nephrotic vs Nephritic syndromes:
Hypertension?
Nephrotic: rare
Nephritic: common
Nephrotic vs Nephritic syndromes:
Urine output?
Nephrotic: normal or decreased
Nephritic: decreased
Nephrotic vs Nephritic syndromes:
Common causes?
Nephrotic: Minimal change disease, FSGS, membranous nephropathy
Nephritic: PSGN, IgA nephropathy
Nephrotic vs Nephritic syndromes:
Treatment?
Nephrotic: Steroids, diuretics, ACE inhibitors
Nephritic: Abx, diuretics, Antihypertensives, immunosuppressants
Nephrotic syndrome predominantly occurs between what ages?
2 and 7
What is the male to female ratio for nephrotic syndrome?
2:1
What is nephrotic syndrome characterized by?
Hypoalbuminemia
edema
proteinuria
BP in nephrotic syndrome?
usually normal
Nursing interventions for Nephrotic Syndrome (10)
Administer medications, such as diuretics, antibiotics, and corticosteroids as ordered.
Ask dietitian to plan a low-sodium diet with moderate amounts of protein.
Provide meticulous skin care to combat the edema that usually occurs with nephrotic syndrome.
Encourage activity and exercise and provide antiembolism stockings as ordered.
Frequently check the patient’s urine for protein, indicated by frothy appearance.
Monitor and document the location and character of edema.
Measure blood pressure while the patient is in s supine position and standing.
Monitor intake and output hourly.
Assess the patient’s response to prescribed medications.
Stress the importance of adhering to the special diet.
Hemolytic Uremic Syndrome (HUS)…(3)
Uncommon, acute renal disease
Primarily affects infants and children 6months-5years
One of the most frequent acquired Acute Renal Failure in children
Clinical features of Hemolytic Uremic Syndrome (5)
- Thrombocytopenia
- Acquired Hemolytic Anemia
- CNS symptoms
- Renal Injury
- Clinical presentation: history of illness followed by sudden onset of hemolysis and renal failure.
Hemolytic Uremic Syndrome Causes
Associated with bacterial toxins, viruses, & chemicals
Multiple cases caused by E.coli 0157:H7 and have been traced to undercooked meat.
Sx of Hemolytic Uremic Syndrome (8)
Irritability
Vomiting
Lethargy
Pallor
Bruising
Jaundice
Petechiae
Bloody Diarrhea
Sometimes hemolytic uremic syndrome can cause acute renal failure signs including: (5)
HTN
Oliguria
Anuria
Seizures
Coma
What is a definite positive urine analysis?
A definite positive urine analysis typically refers to the presence of certain substances or markers in urine that indicate a specific condition or substance use.
For example:
- Drug Screening → A definite positive result in a drug screening urine analysis indicates the presence of a particular drug or its metabolites above a specified cutoff level.
- Medical Conditions → In medical diagnostics, a definite positive urine analysis might indicate the presence of abnormal levels of proteins, glucose, ketones, or other substances, which can suggest conditions like diabetes, kidney disease, or urinary tract infections.
What is clean catch urine?
In children who are toilet trained, the clean-catch method, which involves using a sterile cup to obtain midstream urine, is preferred
What is hypospadias?
Urethral opening located behind glans penis or anywhere along ventral surface of penile shaft
What can SSRIs during pregnancy cause?
- Persistent Pulmonary Hypertension of the Newborn (PPHN)
- Increased risk of Ebstein’s anomaly
- Hypoplastic right heart
- SSRI in the first trimester to be associated with increased risk of severe CHD
- SSRI were found to be associated with a two-fold increase in the risk of CHD overall
What is Ebstein’s anomaly?
a defect of the tricuspid valve - two leaflets of the tricuspid valve are not in the right place
Foramen Ovale serves the purpose of what?
bypassing the lungs in utero
when does foramen ovale close ?
when baby is born and takes first breath
Ductus venous is necessary to bypass what organ?
liver
when does ductus venous close?
with the clamping of the cord
in a few days to weeks the ductus venous becomes what?
ligamentum venosum
After ductus venous closes after clamping of cord, now with blood flowing to the liver it is able to?
process nutrients and metabolize (such as bilirubin to help resolve newborn jaundice).
Difference btwn EKG and Holter monitor?
EKG is a quick snapshot while holter is a look over a longer period of time
What is atrial septal defect (ASD)?
Congenital defect
Abnormal opening in the atrial septum – the wall that separates the 2 upper chambers of the heart.
This opening allows blood to flow directly from the left atrium to the right atrium – extra blood can be pumped to the lungs
what does ASD lead to?
increased pressure in the lung and strain on the heart overtime
where is the murmur for ASD commonly heard?
along the upper left sternal border
typically a systolic murmur – heard during contraction
Acyanotic defects we discussed? (3)
ASD
VSD
PDA
ASD is when O2 rich blood from LA flows into RA, leading to ?
increased blood volume in the right side of heart
Sx of ASD vary on the size of opening: (5)
- fatigue
- difficulty breathing
- recurrent resp infections
- poor weight gain
- heart murmur
Sx of VSD depend on size: (6)
Fatigue
poor weight gain
rapid breathing
frequent respiratory infections
heart murmur
May exhibit signs of congestive heart failure, such as difficulty breathing and poor feeding
most common VSD? where is defect located?
Preimembranous or Membranous is most common.
Defect is near the junction of the ventricular septum and the atrioventricular valves.
Muscular VSD occurs within ..?
the muscular part of the septum and is usually smaller in size.
VSD accounts for…?
20-30% of congenital heart defects
Aortic stenosis….(4)
Interferes with the flow of blood from the left ventricle of the heart into the aorta:
Reduces Cardiac Output
Left ventricle hypertrophy: thickening of the wall occurs due to increased workload placed on left ventricle
Increases risk of heart failure
Pulmonary stenosis….(3)
Causes narrowing of the pulmonic valves at the entrance of the pulmonary artery
Pulmonary stenosis interferes with the flow of blood from the right ventricle to the pulmonary artery.
Pulmonary stenosis will cause right ventricular hypertrophy due to pressure increases in the right ventricle.
What is tricuspid atresia?
Tricuspid Atresia is a heart defect where the tricuspid valve that normally allows blood to flow from the right atria to the right ventricle is either completely absent or abnormally developed
Blood can not flow from the right atria into the right ventricle.
what physiological changes does tricuspid atresia lead to? (5)
Alternative pathways for circulation
Mixing of oxygenated and deoxygenated blood
Pulmonary hypertension
RVH
Cyanosis
Norwood procedure for hypoplastic left heart syndrome?
reconstructs the aorta and connects it to the right ventricle to create a source of pulmonary blood flow.
done birth
Bidirectional Glenn or Hemi-Fontan procedure for hypoplastic left heart syndrome?
redirecting venous blood from the upper body directly to the pulmonary arteries, bypassing the right ventricle
done at 4-6 months
Fontan procedure for hypoplastic left heart syndrome?
redirects the remaining venous blood directly to the pulmonary arteries, completing the separation of systemic and pulmonary circulations
In hypoplastic left heart syndrome, the DA remaining open allows the blood to bypass the underdeveloped left side of the heart. When it closes there is…(3)
decreased pulmonary blood flow (cyanosis)
increase right ventricular workload (RVH)
Systemic to pulmonary shunting
How long is prophylactic abx given for rheumatic fever?
Treatment continues for 5 years or until age 21 whichever is longer
In rheumatic fever, why are prophylactic abx given for all dental work and invasive or surgical procedures?
to prevent endocarditis
why is strict bed rest needed for rheumatic fever?
ro reduce cardiac demands
In acute phase of rheumatic fever, resting heart rate of 60-100 would ?
still require bedrest
