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Peds - Growth and Development > Hospitalized children and acute illnesses (week 4) > Flashcards

Hospitalized children and acute illnesses (week 4) Flashcards

1
Q

At what age group is separation anxiety the highest

A

early childhood

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2
Q

What is hospitalization associated with in later childhood and adolescence?

A

feelings of loneliness and isolation
fear of treatments
anger, sadness, stress
“why me?”

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3
Q

What is included in a patient-family-centred approach to hospitalization?

A

information sharing
- keeping the family in the loop

admission assessment
- health hx
- orientation to the setting

collaborate w/ family and ensure support
- minimize separation
- encourage family involvement

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4
Q

How do we minimize loss of control?

A
  • promote freedom of movement
  • preserve parent-child contact
  • prevent or minimize the fear of bodily injury
  • maintain routine and independence (anticipatory preparation, provide info and resources)
  • PFCC nursing
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5
Q

Why is play important in hospitals?

A
  • allows child to act out fears and anxieties (i.e. through drawings, writing, music)
  • assists w/ coping, preparation, and education
  • used for diversion and recreation
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6
Q

What are the goals for using preoperative meds?

A
  • anxiety reduction - child life + play
  • amnesia - midazolam
  • sedation - chloral hydrate
  • antiemetic effect - zofran
  • reduction of secretions - atropine
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7
Q

How do we position pediatric patients for procedures?

A

position of comfort

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8
Q

What are some physical restraints used during surgery?

A
  • therapeutic hugging
  • jacket restraints
  • mummy or swaddle
  • limb restraints
  • crib dome
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9
Q

What is shock?

A
  • inadequate tissue perfusion –> inability to meet metabolic demands –> cellular dysFN + organ failure
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10
Q

What is hypovolemic shock? Causes? Characteristics?

A

Causes: blood loss (trauma, GI bleed), vomiting, diarrhea, heatstroke, burns, sepsis

Characteristics
- reduction in size of vascular compartment
- falling BP
- poor cap refill
- low CVP

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11
Q

What are distributive shocks? What are the causes and characteristics?

A

anaphylactic shock - caused by allergy
Septic shock - d/t widespread infection neurogenic shock - d/t spinal cord injury
also caused by myocardial depression and peripheral dilation - d/t exposure to anesthesia

characteristics
- reduction in peripheral vascular resistance
- profound inadequate tissue perfusion
- increased venous capacity and pooling
- acute reduction in blood return to the heart
- diminished cardiac output

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12
Q

What is cardiogenic shock?

A

characteristic: decreased cardiac output

causes:
- after cardiac surgery
- primary pump failure (myocarditis, myocardial trauma, heart failure)
- dysrhythmias - SVT, AV block

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13
Q

what is obstructive shock?

A

Characteristic
- mechanical obstruction of blood flow to or from heart

causes
- tension pneumothorax
- cardiac tamponade
- pulmonary embolism
- congenital heart defects

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14
Q

What is considered a septic shock alert?

A

hypotension OR more than 3 of 8 criteria met OR high risk + more than 2 of 8 criteria met

criteria
- temp abnormality
- tachycardia (or bradycardia in <1 year olds)
- tachypnea
- hypotension
- cap refill > 3 seconds or < 1 second
- pulse abnormal
- skin abnormal (cool/mottled, or flushed)
- mental status abnormal

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15
Q

What is considered high-risk conditions for sepsis screening?

A

age < 3 months
malignancy
asplenia (sickle cell disease)
solid organ or bone marrow transplant
central or indwelling catheter
global developmental delay or complex care
immunodeficiency or immunocompromised
recent surgery

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16
Q

What is toxic shock syndrome caused by?

A

toxins produced by staphylococcus bacteria
- happens with extended tampon use

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17
Q

What is PEWS?

A

Pediatric early warning system - promotes early identification and mitigation of deterioration in hospitalized pediatric patients.
- a change in 1 point can mean quick deterioration - need quick intervention
- can also help determine the appropriate nurse:pt ratio

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18
Q

What are pediatric indicators of cardiac dysFN?

A
  • poor feeding
  • tachypnea/tachycardia
  • failure to thrive/poor weight gain
  • activity intolerance
  • developmental delays
  • prenatal Hx
  • Family Hx of cardiac disease
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19
Q

What are maternal causes of congenital heart defects?

A

Maternal drug use
- fetal alcohol syndrome - 50% have CHD

Maternal illness
- rubella in first 7 weeks of pregnancy - 50% risk
- cytomegalovirus (CMV), toxoplasmosis

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20
Q

What percentage of cardiac defects can be attributed to genetics?

A

10-12%

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21
Q

What is acyanotic CHD? What are the 2 types?

A

Acyanotic = defect does not affect O2 levels in the body

  1. Defect causes increased pulmonary blood flow
    - occurs in atrial septal defect, ventricular septal defect, patent ductus arteriosus, atrioventricular canal
  2. Defect obstructs blood flow from the ventricles
    - occurs in coarctation of aorta, aortic stenosis, pulmonary stenosis
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22
Q

What is cyanotic CHD? What are the 2 types?

A

Defect lowers the amount of O2 in the body
- requires immediate surgery

  1. decreased pulmonary blood flow
    - occurs in tetralogy of fallot: combination of 4 heart defects (ventricular septal defect, overriding aorta, pulmonary stenosis and right ventricular hypertrophy)
  2. Mixed blood flow
    - a hole in the heart causes the mixing of deO2 and O2 blood
    - if blood is shunting from the deoxygenated side to the oxygenated side, the child will look cyanotic
    - occurs in transposition of the great arteries, total anomalous pulmonary venous return, truncus arteriosus, hypoplastic left heart syndrome
23
Q

What are the 3 types of heart defects? Give examples of each.

A

1) obstructive
- coarctation of aorta
- aortic stenosis
- pulmonary stenosis

2) decreased pulmonary flow
- Tetrology of Fallot
- tricuspid atresia

3) mixed defects
- transposition of great vessels
- total anomalous pulmonary venous connection
- hypoplastic heart syndrome

24
Q

What are heart murmurs? What do they indicate?

A

heart sound that reflects the flow of blood within the heart.

May be heard in a normal heart in periods of stress - anemia, fever, rapid growth

May reflect abnormalities in the heart or vessels

25
Q

how what percentage of children are innocent murmurs heard?

A

50%

26
Q

What is involved in post-op care?

A
  • continuous VS monitoring
  • intra-arterial monitoring of BP
  • intracardiac monitoring
  • respiratory needs
  • rest, comfort, and pain management
  • fluid management
  • progression of activity
  • monitor surgical site, drains, tubes
  • monitor I/O
  • encourage child to stay still and rest
  • pain management
27
Q

When should you notify the surgeon regarding chest tube drainage?

A

Chest tube drainage is:
> 3 ml/kg/hr X 3 consecutive hours, OR
5-10 ml/kg in any 1 hr

28
Q

How often, and what, do you monitor the chest tube drainage after a patient comes back from OR for cardiac surgery?

A

EVERY HOUR; FOR COLOUR, AND AMOUNT

29
Q

When should you be concerned about a post-op patient’s urine output?

A

UO is < 1 ml/kg/hr –> possible renal failure + concerns for decreased CO

30
Q

What is Kawasaki Disease?

A
  • Acute systemic vasculitis, unknown causes
  • causes widespread inflammation of small and medium sized arteries
  • duration: 6-8 weeks, self-limiting
  • w/o tx, 20-25% have cardiac complications (dilation of coronary arteries, coronary artery aneurysm)
31
Q

What are S/S of Kawasaki disease?

A

Fever lasting at least 5 days, plus:
4/5 symptoms:
- changes in extremities
- polymorphous exanthem
- bilateral bulbar conjunctival infection w/o exudate (red eyes, no discharge)
- erythema and cracking of lips, strawberry tongue, erythema of oral and pharyngeal mucosa
- cervical lymphadenopathy

32
Q

What does periungual peeling of fingers and toe indicate?

A

Subacute phase of Kawasaki disease

33
Q

What is the nurses’ role in caring for a child with Kawasaki disease?

A

Early diagnosis and tx
- give IVIG and high doses of aspirin to prevent cardiovascular complications

monitor I/O
provide symptomatic relief
address irritability
discharge teaching
- safety
- immunization (I.e. no live vaccines 6-12 months after IVIG)
- follow up (blood work and echogram)
- taking baby aspirin

34
Q

Right sided heart failure vs. left sided heart failure

A

Right - reduced FN, systemic edema
Left - increased pressure, lung congestion, trouble breathing

35
Q

What is scoliosis?

A

complex deformity w/ lateral curvature, spinal rotation, rib asymmetry, and thoracic hypokyphosis

36
Q

What is thoracolumbosacral orthosis (TLSO)?

A
  • a device that supports the spine and prevents the progression of curves in the spine during ambulation
37
Q

What is the Milwaukee brace?

A

a body brace is worn to minimize the progression of scoliosis and kyphosis
- used for more severe forms

38
Q

What are some medications used to improve cardiac function? How do they work?

A

Digitalis glycosides, ACE inhibitors
- increases contractility and decreases afterload

39
Q

What are ways to decrease preload in heart failure patients?

A
  • take diuretics
  • fluid restriction
  • limit added salts in diet
40
Q

What are ways to decrease cardiac demands in heart failure patients?

A
  • provide a neutral thermal environment
  • treat infections aggressively
  • reduce the effort of breathing by positioning
  • rest and limit environmental stimuli
41
Q

How does Digoxin work?

A
  • increases the force of contraction and decreases HR
  • indirectly enhances diuresis by increasing renal perfusion
  • increases CO, decreases heart size, decreases venous pressure, and reduces edema
42
Q

What are warnings for digoxin. How do we ensure safety?

A

IT CAN CAUSE HEART FAILURE
- narrow margin of safety
- careful cardiac monitoring is needed in the initial dosing
- taking an apical pulse everytime before administering
- parameter: infants/young children: 90-110bpm; older children: 70 bpm

43
Q

Nursing care for closed head injuries

A

frequent assessments
- VS + Neuro
- every hour until stable, or q2-4hrs

bed rest - HOB slightly elevated and in the midline
seizure precautions
sedation and pain management
limit stimulation (turn off lights)
documentation
family support
plan for the healing process and rehab

44
Q

What are signs of ICP in infants?

A
  • tense, bulging fontanel
  • separated cranial sutures
  • Macewam (cracked-pot) sign
  • irritability and restlessness
  • drowsiness
  • high pitched cry
  • increased frontooccipital circumference
  • distended scalp veins
  • crying when disturbed
  • setting-sun sign
45
Q

What are signs of ICP in children?

A
  • headache
  • nausea
  • forceful vomiting
  • diplopia, blurry vision
  • seizures
  • drowsiness
  • decline in school performance
  • diminished physical activity and motor performance
  • increased sleeping
  • inability to follow simple commands
  • lethargy
46
Q

What are late signs of ICP in children?

A
  • bradycardia
  • decreased motor response to command
  • decreased sensory response to painful stimuli
  • alteration in pupil size
  • extension or flexion posturing
  • cheyne-stokes resp
  • papilloedema
  • decreased consciousness and coma
47
Q

What are the different types of seizures?

A
  • partial
  • generalized
  • atonic and kinetic
48
Q

How is epilepsy diagnosed?

A

2 or more unprovoked seizures

49
Q

What is involved in the therapeutic management of seizures

A
  • control, reduce frequency and severity
  • drug therapy
  • ketogenic diet (high fat, low carbs –> by mouth of G tube)
  • vagus nerve stimulation
  • surgical therapy
50
Q

What is a seizure that lasts > 30 mins called?

A

Status epilepticus

51
Q

What do you do when caring for a patient who has been seizing for 30 minutes?

A
  • maintain a patent airway
  • ensure safety
  • assessments and documentation
  • administer lorazepam, diazepam, and midazolam (Q5 mins x 2, then IV loading dose then IV continuous infusion
  • consult PICU
  • Support the family
52
Q

What are nursing care management for seizure patients?

A

Seizure precautions, prevent injury
Long-term care and support to child and family
Education and anticipatory guidance
Medication compliance and administration
Prevention of triggers
Nutritional support (vitamin D and folic acid)
School plans to ensure safety and medication

53
Q

Do we give antipyretics or anticonvulsants to prevent febrile seizures?

A

little evidence to support this
- primarily give antipyretics to increase comfort

Peds - Growth and Development (7 decks)

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