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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
how what percentage of children are innocent murmurs heard?
50%
26
What is involved in post-op care?
- 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
When should you notify the surgeon regarding chest tube drainage?
Chest tube drainage is: > 3 ml/kg/hr X 3 consecutive hours, OR 5-10 ml/kg in any 1 hr
28
How often, and what, do you monitor the chest tube drainage after a patient comes back from OR for cardiac surgery?
EVERY HOUR; FOR COLOUR, AND AMOUNT
29
When should you be concerned about a post-op patient's urine output?
UO is < 1 ml/kg/hr --> possible renal failure + concerns for decreased CO
30
What is Kawasaki Disease?
- 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
What are S/S of Kawasaki disease?
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
What does periungual peeling of fingers and toe indicate?
Subacute phase of Kawasaki disease
33
What is the nurses' role in caring for a child with Kawasaki disease?
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
Right sided heart failure vs. left sided heart failure
Right - reduced FN, systemic edema Left - increased pressure, lung congestion, trouble breathing
35
What is scoliosis?
complex deformity w/ lateral curvature, spinal rotation, rib asymmetry, and thoracic hypokyphosis
36
What is thoracolumbosacral orthosis (TLSO)?
- a device that supports the spine and prevents the progression of curves in the spine during ambulation
37
What is the Milwaukee brace?
a body brace is worn to minimize the progression of scoliosis and kyphosis - used for more severe forms
38
What are some medications used to improve cardiac function? How do they work?
Digitalis glycosides, ACE inhibitors - increases contractility and decreases afterload
39
What are ways to decrease preload in heart failure patients?
- take diuretics - fluid restriction - limit added salts in diet
40
What are ways to decrease cardiac demands in heart failure patients?
- provide a neutral thermal environment - treat infections aggressively - reduce the effort of breathing by positioning - rest and limit environmental stimuli
41
How does Digoxin work?
- 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
What are warnings for digoxin. How do we ensure safety?
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
Nursing care for closed head injuries
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
What are signs of ICP in infants?
- 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
What are signs of ICP in children?
- 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
What are late signs of ICP in children?
- 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
What are the different types of seizures?
- partial - generalized - atonic and kinetic
48
How is epilepsy diagnosed?
2 or more unprovoked seizures
49
What is involved in the therapeutic management of seizures
- control, reduce frequency and severity - drug therapy - ketogenic diet (high fat, low carbs --> by mouth of G tube) - vagus nerve stimulation - surgical therapy
50
What is a seizure that lasts > 30 mins called?
Status epilepticus
51
What do you do when caring for a patient who has been seizing for 30 minutes?
- 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
What are nursing care management for seizure patients?
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
Do we give antipyretics or anticonvulsants to prevent febrile seizures?
little evidence to support this - primarily give antipyretics to increase comfort

Peds - Growth and Development (7 decks)

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