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WH and Pedi > Pedi Final Focus Areas > Flashcards

Pedi Final Focus Areas Flashcards

1
Q

Depends on child’s: age, cognitive and emotional development *ability to communicate? old enough to self report?, disease- acute or chronic?, prior painful experiences, personality, family dynamics, culture
Reassess frequently at a minimun of Q4 hrs. Include parent in rating pain/reassessment

A

Pediatric Pain

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2
Q

Distraction, relaxation, swaddling, massage, sucking (sucrose), breathing techniques.

A

Nonpharmacological pain management

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3
Q

MIld to moderate pain- Tylenol and Motrin. Moderate to severe pain- opioid. Consider route, side effects (PO/PG, PR, IV, Transdermal). Regular administration, dont get behind! NCA/PCA. Pain team consult.

A

Pharmacologic Pain Management

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4
Q

Caused by diarrhea/vomiting, fever, renal failure, diabetes insipidus, tachypnea, surgery, trauma, burns, shock/anaphylaxis

A

Dehydration (increased fluid requirement)

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5
Q

This condition is caused by CHF, SIADH, mechanical ventilation, post-op, renal failure, increased ICP

A

Edema (decreased fluid requirement)

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6
Q

Tachpnea, nasal flaring, tachycardia, restlessness, diaphoresis, retractions, head bobbing, tracheal tugging, wheezing, grunting, stridor

A

S/s of Respiratory Distress

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7
Q

Increased WOB/Retractions leading to respiratory muscle fatigue leads to decreased chest rise/decreased volume causing hypoventilation

A

Compensation due to respiratory distress

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8
Q

O2 demand is larger than supply. Hypoxia. CO2 increases, apnea. Leads to respiratory arrest.

A

Respiratory Failure S/S

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9
Q

Hypoventilation due to: pulmonary (impaired lung tissue)
acute lung injury (sepsis, pneumonia, aspiration, near drowning)
Other: neuromuscular disease, airway disorders, central apnea.
SUDDEN RAPID DETERIORATION

A

Respiratory Failure General

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10
Q

Maintain patent airway clear/prevent obstruction and pulmonary toileting leading to CPT, suction. C & DB, IS, bubbles/pinwheel, ETT, trach. Maintain effective ventilation. Maintain adequate oxygenation (positioning, supplemental O2, NC, simple mask, NRB). Hydration/nutrition. Prevent infection. pain relief. Adminster medication (abx, bronchodilators, steroids, diuretics, vasopressors, mucolytics). Family support

A

Respiratory Nursing Interventions

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11
Q 
Nasopharyngitis (cold)
Tonsillitis
Croup/LTB (laryngotracheobronchitis)
Epiglottitis
Tracheitis
(Flaring, stridor, tracheal tugging)
A

Upper Airway Respiratory Disorder

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12
Q

Asthma, bronchitis, bronchiolitis/RSV, pneumonia, TB (wheezing, grunting, subcostal/intercostal retractions)
Foreign body aspiration (non-infectious)

A

Lower Airway Respiratory Disorders

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13
Q

ability of heart to produce contraction

A

Contractility

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14
Q

Amount of blood pumped from L ventricle each minute

A

Cardic Output

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15
Q

How much blood pumped with each beat

A

Stroke volume

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16
Q

How much blood in heart/ventricle at end of diastole

A

Preload

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17
Q

How much in great vessels

A

Afterload

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18
Q

Heart Rate x Stroke Volume

A

Cardiac Output formula

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19
Q

Increased Pulmonary Blood Flow, L to R shunt

A

Acyanotic cardio disorders

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20
Q

Patent Ductus Arteriosus (PDA)
Atrial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
Atrioventricular (AV) canal

A

Types of Acyanotic Cardiovascular Disorders

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21
Q

Asymptomatic if small defect, tachypnea; course lung sounds, tachycardia, murmur, diaphoresis, poor weight gain, frequent respiratory infections, hypotension/heart failure

A

S/S of Acyanotic Cardiovascular Disorders

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22
Q

Decreased pulmonary blood flow. Obstruction of blood flow to lungs. Pulmonic valve underdeveloped or closed. Blood cannot get to lungs for oxygenation. Cyanosis immediately. RV and tricuspid valve small, dysfunctional. ASD usually present (R-L shunting)

A

Pulmonary Atresia

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23
Q

Must be managed at birth- Prostaglandins immediately to keep PDA open.
Goals: Manage hypercyanotic episodes, prevent metabolic acidosis

A

Treatment and Goals for Pulmonary Atresia

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24
Q

Decreased cardiac output. Pulmonary venous congestion: cough, tachypnea, labored breathing and diaphoresis while feeding, crackles, grunting, cyanosis
Systemic venous congestion: Peripheral edema/fluid retention, ascites, enlarged liver, JVD. Impaired CO: tachycardia, pallor, cool periphery, weak pulses, hypotension, delayed cap refill, oliguria, tiring with activity. Increased metabolic demand: diaphoresis, poor weight gain or weight loss, FTT

A

S/S of Heart Failure

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25
Q

Decreased intake and/or increased output, increased sensible loss. Vomiting, diarrhea, fever, sweating, wound/tube drainage. Infants and young children especially vulnerable.

A

Dehydration General

26
Q

3-5% volume loss

A

Mild dehydration

27
Q

6-9% volume loss. Tachycardia, decreased urine output, tachypnea, lower BP, delayed cap refill, irritability, thirsty, restless, sunken eyes, sunken fontanel, dry mucous membranes, decreasd tears

A

Moderate dehydration

28
Q

Over 10% volume loss

A

Severe dehydration

29
Q

Oral: 50ml/kg in first 2-4 hours (1-3 tsp q 15 mins)

A

Rehydration for mild to moderate dehydration

30
Q

IV: 20 ml/kg in 30-60 mins. Continue until hemodyanmically stable (BP and U/O) Many will need 40-60 ml/kg. Replacement fluid vs maintenance fluid

A

Rehydration for severe dehydration

31
Q

Rehydrate. Identify/stop cause. Closely monitor urine output. Prevention

A

Nursing Interventions for Dehydration

32
Q

Kidneys cannot concentrate urine and remove waste: can lead to toxicity/death.
ACUTE- sudden onset (develops over days-weeks), may be reversible. Prerenal AKI- Hypovolemia/dehydration/surgical shock/sepsis
CHRONIC (CKD)- gradual, develops over months-years, permanent and irreversible dialysis, ? Transplant

A

Renal Failure General

33
Q

Azotemia- accumulation of nitrogenous waste in blood
Oliguria/Anuria- very little (dark) or no urine output
Electrolyte abnormalities - low Na+, high K+, low Ca+, high phos
Treatment: Depends on underlying cause; ICU-level care
Nursing: sz? F+E balance, BP, I + O; dialysis (method?), med dosing, immunity, diet restrictions; missed school/development

A

Renal Failure S/S, Treatment and Nursing Interventions

34
Q

Meds that provoke urine output (chronic: diuretics for hypertension)

A

Mannitol and Lasix

35
Q

Meds that reduce blood K+ levels; alleviate acidosis

A

Calcium gluconate and Na+ Bicarb

36
Q

Meds that reduce blood K+ levels by moving K+ and glucose into cells

A

Glucose and insulin

37
Q

Meds that manage hypertension

A

Labetolol or Nipride or Hydralazine

38
Q

Meds that treat anemia

A

Folic acid, RBC’s

39
Q

Infection of the meninges (membranes protecting brain). Spread through respiratory secretions. Bacterial/septic (or viral). S. pneumoniae, N. meningitidis, E. coli or Hib. Pathogen disseminates through CSF into brain.

A

Meningitis General

40
Q

Inflammatory response: fever, headache, stiff neck, lethargy, photophobia, *purpuric rash (treatment immediately). Brudzinksi’s and Kernig’s sign; Lumbar puncture.
Nursing: Isolation! Neuro checks; Antibiotics; supportive case. Prophylaxis for those near

A

Meningitis S/s And Nursing Interventions

41
Q

Photophobia, Nausea/Vom, headache, vertigo, irritability, lethargy, poor feeding, amnesia/confusion, apnea, altered LOC, drainage from ears and nose (CSF)

A

Early signs of Head Trauma

42
Q

Increased ICP, hydrocephalus, seizure activity, posturing, unequal or nonreactive pupils, ecchymosis around eyes, diminished reflexes, herniation, cushing’s triad, coma

A

Late signs of head trauma

43
Q

Rapid recognition, diagnosis, treatment critical for good outcomes. Classifcation based on GCS score. Exam/LOC/Q1hr neuro checks, CT/MRI, ICP monitoring, Central Perfusion Pressure + MAP - ICP. Posturimg? Decorticate or decebrate (brainstem)

A

Head Trauma General

44
Q

Supportive; neuroprotective - HOB, Na+, cool, quiet. Period of peak swelling-m 72 hours.
Priorities: Maintain adequate BP, O2 sat, ventilation, anti-seizure, keep electrolytes WNL, prevent hypoglycemia, monitor urine output (DI/SIADH), Mannitol, 3% saline, Nutrition
Discharge: Rehab, trach, helmet?

A

Head Trauma Treatment and Nursing Interventions

45
Q

Common complaint, mild to severe. Acute. If recurrent its a migrane, girls more than boys. Paroxysmal. Chronic - tension; psych. Chronic non-progressive - abnormal: increased ICP, tumor

A

Headaches General

46
Q

Assess location and accompanying symptoms. Treat underlying cause. OTC meds, relaxation, triggers. Journaling.
Requires immediate follow up for: Increase in frequency and severity. Awaken a child from sleep. Occurs early in am, become worse on arising. Persistent in frontal or occipital area. Change in gait, personality/behavior. Made worse by Valsalva

A

Headaches Treatment and Nursing Interventions

47
Q

Kidneys cannot concentrate urine. Lack of/decreased sensitivity to Vasopressin (ADH). Nephrogenic (rare) vs Central (lesion, tumor, injury).

A

Diabetes Insipidus

48
Q

Polyuria, polydipsia, nocturia, enuresis, dehydration, increased Na +, increased osm, decreased specific gravity

A

Diabetes Insipidus S/S

49
Q

Control dehydration. Vasopressin (oral, intra-nasal, IV). Low Na+, low protein diet.
Teach: prevent dehydration! S/s dehydration, monitoring I and O. Medical alert bracelet

A

Diabetes Insipidus Treatment and Nursing Interventions

50
Q

Over 250 mg/dL. kidneys cannot absorb excess glucose: increased urine output; increased thirst.

A

Hyperglycemia

51
Q

Below 60 mg/dL; not enough glucose to fuel brain: HA, sweaty, shaky, behavior change, decreased LOC

A

Hypoglycemia

52
Q 
Autoimmune; pancreatic beta cell damage impairing insulin secretion. T-lymphocytes attack beta cells. 0.2% of pediatric population. 
S/s: polyuria, polydipsia, fatigue, blurred vision, mood changes, weight loss.
DKA- emergency- glucose over 330; acidosis leading to vomiting, tachycardia, fruity breath, confusion, coma.
Hemoglobin A1c (HbA1C), glucose levels (random, fasting, 2 hour)
A

Type 1 Diabetes General

53
Q

Treatment is multifaceted.
Nursing: Glucose monitoring, insulin therapy, nutrition, psychosocial; school; stress/exercise/illness; skin; yearly eye exams
Frequency of monitoring: hourly? continuous?

A

Type 1 Diabetes Treatment and Nursing

54
Q

Insulin is produced, but unable to be utilized by the body (insulin-resistant). Now occurring more in school aged and teenaged children due to childhood obesity.
Acanthosis nigricans - dark pathes on back of neck, inner thighs, axillae; polydipsia, polyuria, polyphagia

A

Type 2 Diabetes General

55
Q

Treatment: Diet changes, increase in activity (initial), metformin if not controlled.
Nursing: teach! glucose monitoring; lifestyle changes; consider socioeconomic status

A

Type 2 Diabetes Treatment and Nursing Interventions

56
Q

indicates bacterial infection, beginning of immune response. If count is 0, pt is neutropenic/completely immunocompromised

A

Increased neutrophils

57
Q

Indicates viral infection

A

Increased lymphocytes

58
Q

Indicates low immunity

A

Decreased leukocytes

59
Q

Indicates clotting issue

A

Decreased thrombocytes

60
Q

Myelosuppression, mucositis, skin breakdown, neuropathy (feet, jaw, constipation), pain, loss of appetite, hemorrhage cystitis, alopecia, toxicity/organ failure, cardiomyopathy, cognitive/psychological effects

A

Adverse effects of chemotherapy

WH and Pedi (20 decks)

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