Final Flashcards
MUSCULOSKELETAL: bone fractures
s/s: Pain and joint tenderness, Pulselessness and Paresthesia distal to fracture, Pallor, Paralysis
tx: cast, surgery for open reduction of fracture; realign and immobiize fractured extremity by traction, ilizarov external fixator
*MUSCULOSKELETAL: developmental hip dysplasia/ dislocated hip
s/s: asymmetry of gluteal folds, ortolani’s click [hip click], limited hip abduction, shortened femur, trendelenburg sign [pelvis falls instead of rises w/ stepping of the affected leg/ hip], wide waddling gait
tx: relocate femoral head in acetabulum [may wait and watch w/ NB-6 m.o.], bryant’s traction; pavlik harness [keep child strapped as much as possible; assess for ability to kick, swollen feet]
MUSCULOSKELETAL: bryant’s traction
traction will help position the top of the femur into the hip socket correctly
modified extension traction w/ body as counterweight
risks: circulatory insufficiency
NI: neurovascular assessment, ensure safety
MUSCULOSKELETAL: osteomyelitis
bacterial infection [often staph. aureus] of the bone and soft tissue surrounding the bone, often affected the long bone metaphysis
tx: antibiotics X 4-6 w
- goal is to prevent bone destruction
MUSCULOSKELETAL: osteogenesis imperfecta
characterized by the formation of pathologic fractures resulting from connective tissue and bone defects
- there’s normal Ca and P levels but low collagen formation
risk factors: simple walking > fractures
s/s: multiple fractures, blue sclera, thin soft skin w/ easy bruising, inc’d joint flexibility, short stature, adol. [hypoplastic bluish-grey teeth, conductive hearing loss]
tx: calcitonin to promote healing and biphosphonates to increase bone mass
*MUSCULOSKELETAL: scoliosis
lateral curvature of spine usually associated
tx: goal is to prevent further curvature or help correct severe curvature
- bracing for curvatures of 20-50 degrees usually worn for 16-23 h/day
- - NI: risk for impaired skin integrity, body image disturbance, ineffective health maintenance
- surgery for curvatures of > 45 degrees
- - NI: pain, risk for injury r/t surgical intervention, altered breathing patterns, impaired skin integrity, altered bowel elimination [place on regime], altered urinary elimination
*MUSCULOSKELETAL: duchenne muscular dystrophy
common type of inherited muscular dystrophy
s/s: late accomplishment of gross motor milestones, increasing muscle weakness [including resp. muscles], gower’s sign [using legs to push self up from a sitting to a standing position], waddling gait, difficulty climbing, hypertrophied calf “muscles” [fatty and connective tissues], scoliosis and lordosis, contractures
tx: GOAL IS TO MAXIMIZE BREATHING AND MOVEMENT AS LONG AS POSSIBLE; bracing, orthotics, splints, wheelchair; incentive spirometry; low kcal, high fiber, high fluid, high protein diet
MUSCULOSKELETAL: juvenile arthritis [JA]
autoimmune disease of connective tissue characterized by chronic inflammation of the synovia and possible joint destruction
- episodes recur w/ remissions and exacerbations for a few months up to a life-time
s/s: inflammation around joints; stiffness, pain, guarding at affected joint
tx: reduce stress, climate aggravators; low does corticosteroids or NSAID’s, ROM [delay and prevent damage]; warm compress; splints; preventative eye care, surgery
MUSCULOSKELETAL: skull fractures
types:
- linear: str8 line fracture [dura not involved]
- depressed: bone pressing downward
- basilar: fracture at base of skull
- s/s: battle sign [bleeding behind the ear], racoon eyes, rhinorrhea, otorrhea [careful that drainage is not ICF]
- communicated: fragmentation of bone into many pieces or a multiple fracture line
tx: AVOID ACTIVITIES THAT WILL INCREASE ICP [constipation, suctioning, lying supine. hyperextension or flexion of the neck, stimulating env’t.], frequent neuro. exam.’s
MUSCULOSKELETAL: concussion
a transient or reversible neurologic dysfunction w/ instantaneous loss of AWARENESS and RESPONSIVENESS
- there does not have to be a loss of consciousness
s/s: hematomas, cushing’s triad [bradyc., HTN, resp. depression], anisocoria [unequal pupil sizes], abnormal posturinng, SIADH
tx: AVOID ACTIVITIES THAT WILL INCREASE ICP [constipation, suctioning, lying supine. hyperextension or flexion of the neck, stimulating env’t.], frequent neuro. exam.’s
MUSCULOSKELETAL: intracranial hemorrhage
types:
- epidural hematoma
- occurs b/w the skull and the dura w/ brain herniation and compression of the brain stem; life-threatening
- subdural hematoma
- occurs b/w the dura and arachnoid dura
- s/s: H/A, confusion, seizures, coma
tx: AVOID ACTIVITIES THAT WILL INCREASE ICP [constipation, suctioning, lying supine. hyperextension or flexion of the neck, stimulating env’t.], frequent neuro. exam.’s
- s/s: H/A, confusion, seizures, coma
CV: fetal circulation
goal of fetal circulation is to perfuse the fetus w/ highest amount of O2 possible
- placenta works as the lungs; lungs are fluid-filled w/ pulmonary vessels vasoconstricted causing an inc’d pulmonary vascular resistance
blood flows via ductus venosus, foramen ovale, ductus arteriosus
- these shunts close w/i 24-48 h’s p/ birth
upon birth lungs inflate reducing pulmonary resistance > pulmonary artery pressure drops > increasing blood flow to lungs > R-side pressure drops and L-side increases > change in pressures closes foramen ovale, ductus arteriosus > lack of blood flow results in ductus venosus closure
*CV: care for a child undergoing cardiac catheterization
pre-procedure - obtain an accurate weight [determines hydration status] - assess of skin - assess and mark pedal pulses - O2 sat. - vital signs [to compare a/ and p/] - voiding [ensures contrast can get excreted] -sedation post-procedure - assess site/ dressing - assess pulses in lower extremities - lay supine and flat [~4-6 h] - vital signs [q15m x3, q30m X3] - monitor catheterization site - fluid status - immobolize extremity [may > bleeding - home care [area cannot become saturated]
*CV: congestive heart failure [CHF]
s/s: tachyc., diaphoresis, low urine output, fatigue [from inc’d metabolic needs], restlessness [from dec’d O2], anorexia, poor peripheral circulation, cardiomegaly [b/c of inc’d work], inc’d volume, gallop rhythm, resp. distress, intolerance, anasarca
goals of tx: improve cardiac contractility [digoxin; 0.8-2 ng/mL], preserve energy and decrease metabolic demands, decrease IV fluid volume [diuretics]
NI: strict I/O, daily weights, inc’d HOB [promote diaphragmatic excursion and lung expansion], hi kcal diet, cluster nursing care, decrease risk of infection, monitor electrolytes [Na [decreases fluid overload], K [decreases risk of arrhythmias]; teach parents how to perform CPR and to assess pulses [if child is on digoxin] and provide use and s.e. of digoxin and diuretics
CV: classification of congenital heart disease
acyanotic
- inc’d pulmonary blood flow
– atrial septal defect, ventricular septal defect, PDA, AV canal
- obstruction to blood flow from ventricles
– coarctation of aorta, aortic stenosis, pulmonic stenosis
cyanotic
- dec’d plmonary blood flow
– tetralogy of fallot, tricuspid atresia
- mixed blood flow
– transposition of great arteries, total anomalous pulmonary venous connection, truncus arteriosus, hypoplactic L-heart syndrome
CV: atrial septal defect [ASD]
opening b/w the wall that divides the R and L atrium causes shunting of blood from LA [higher pressure] to RA [lower] causing mixing of deO and O blood
risks: inc’d volume > inc’d workload
tx: may resolve spontaneously [w/i 18 m], surgery [patch]
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daaily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
CV: ventricular septal defect
opening b/w the R and L ventricles causing shunting of blood from LV [higher pressure] to RV [lower] causing mixing of deO and O blood
risks: dec’d volume going to body
tx: may resolve spontaneously [w/i 3 y]
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
CV: atrioventricular canal septal defect [AVSD]
endocardial cushions fail to develop [needed to separate the mitral and tricuspid valves] causing a central hole
tx: septal and valve repair
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
*CV: patent ductus arteriosus [PDA]
communication b/w the pulmonary artery and aorta [which should’ve closed during the 1st days of life] causing deO blood in the pulmonary artery to enter the aorta and out into the system w/o becoming oxygenated]
s/s: symptomatic; bounding pulses, machinery-like systolic murmur
tx: indomethcin IV w/i 1st 2 weeks of life [inhibits prostaglandin (present in vitro) to encourage closure; s.e.: masks s/s infection, edema, thickens blood]
- if DA needs to remain open, administer prostaglandin [s.e.: apnea [ventilator use], flushing, hTN, bradyc., bleeding]
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated
*CV: coarctation of the aorta
narrowing in the aortic arch resulting in L-ventricular overload
risks: L-sided CHF, aneuryms [b/c of Hi pressure against narrowing]
s/s: may present w/ other heart deformities; murmurs, change in BP, irritability, tachypnea, poor feedings > no weight gain
tx: PDA [administer prostaglandin] NEEDED UNTIL REPAIR CAN BE MADE; surgery, resection angioplasty
NI: CHECK BP/ PULSE IN ALL 4 EXTREMITIES [BP inc’d in areas a/ narrowing/ and vice versa]
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
CV: aortic valve stenosis
obstruction of blood flow from the L-ventricle to aorta > blood back flow into lungs
risks: L-sided HF, delayed development [from dec’d blood getting to brain], bacterial endocarditis [w/ valve replacement]
s/s: angina, dizziness, poor feeding
tx: balloon angioplasty, aortic valve replacement
NI: stress follow-up care for life p/ valve replacement
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
CV: pulmonary valve stenosis
obstruction of blood flow from the R-ventricle to the pulmonary artery > blood back flow into system
risks: R-sided heart failure
s/s: lethargic,
tx: PDA or ASD needed until repair can be made; balloon angioplsty, pulmonic valve replacement
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
CV: tetralogy of fallot [TOF]
involves 4 defects: RV hypertrophy [inc’d work from pushing blood via stenosed p. valve], overriding aorta [valve present in both ventricular chambers when it should only be in the L-chamber], VSD, pulmonary valve stenosis
s/s: cyanosis [d/o amount of pulmonary stenosis], tet spells
tx: PDA [give prostaglandin] NEEDED UNTIL REPAIR CAN BE MADE; blalock-taussing shunt [anastomosis R-subclavian to pulm. artery to increases pulmonary circulation], cardio-pulmonary bypass
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
*CV: tet spells
inc’d constriction of the R ventricular outflow > sudden dec’d oxygenation in the child > cyanosis
may be precipitated by crying, feeding, procedures
s/s: do not occur until p/ the closure of the DA
NI: help child bend knees to chest to increase venous return to the heart [improves oxygenation]; be aware of hypoxia-inducing experiences; O2 therapy may help slightly but not to the full affect until defects are fixed
CV: tricuspid atresia
no communication [no tricuspid valve] b/w the RA and RV > mixing of deO and O blood
risks: hypoplastic RV, under-developed pulm. artery [since no blood flow is going via RV]
tx: PDA or foramen ovale needed until repair can be made
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
CV: pulmonary valve atresia
no communication b/w RV and PA > blood cannot leave the RV
- usually presents w/ a VSD and/or ASD [creating mixing of blood so that child. can get some O into system]
tx: PDA needed until repair can be made
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
CV: transposition of the great vessels
position of the aorta and pulmonary artery are switched creating 2 separate circulations [R-side pumps to system, L-side pumps to lungs]
tx: PDA, VSD, etc. needed until repair can be made; atrial septotomy
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
CV: truncus arteriosus
one major artery leaving the R and L ventricles > mixing of blood
risks: CHF of both sides, pulmonary vascular disease
tx: separation of the pulmonary artery from the aorta
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
CV: hypoplastic L-heart syndrome
mitral and aortic valve are not properly formed, ascending aorta is underdeveloped, ASD
s/s: pale, poor perfusion, tachyc., tachyp., metabolic acidosis, poor feeding
NI: vitals [esp. pulse ox.], monitor for sx.’s of CHF, strict I&O, daily weights, hi kcal diet, cluster care, allow for extended rest periods, HOB elevated; post-op. [activity restrictions, incision site care, place on reverse isolation, manage pain, educate for follow-up care]
CV: bacterial endocarditis
infection of the inner lining of the heart or valves
risk factors: CHD, valvular disease/ repairs
causes: dental work, non-sterile/ indwelling catheterization
s/s: low-grade fever, maliase, wt. loss, H/A, myalgia, splenomegaly, osler nodes [lesions of fingers/ toes], janeway spots [hardened lesions on hands/ feet], mucosal petechiae
dx: CBC, cardiogram
tx: antibiotics
NI: prophylactic antibiotics for certain procedures
