Pedi Test 3 Flashcards
The ability to discriminate letters or other objects.
visual acuity
What is the visual acuity of a neonate?
20/100 and 20/400
What is the shape of a neonate’s eye compared to an adult?
more spherical
What can the neonate’s vision not accommodate to?
near and far objects
What is the distance that the neonate can best see?
8 inches or 20 cm away
At what month should the eyes be aligned and coordinated?
3 months
Involuntary rapid eye movement.
nystagmus
Momentary turning inward of eyes.
esotropia
Is nystagmus and esotropia normal at birth?
yes
When should nystagmus and esotropia normally fade by?
first few months of life
Why do neonates have uncoordinated binoclear vision at birth?
their rectus muscles are completely formed
What is a result of trauma during birth on the eyes and usually improves gradually with no lasting effects?
conjunctival and retinal hemorrhages
What is examined in children because it is a key method for identifying the presence of retinoblastoma?
red reflex
What are some eye conditions common to premature neonates?
- strabismus
- retinopathy
- refractive errors
- color identification deficits
In the infant and young child, what occupies a larger portion of the orbit than in the adult?
cornea
How big is the eyeball of a neonate compared to an adult?
3/4 the size
How does the sclera of the neonate appear?
thin and translucent with a bluish tinge
What colors are the iris’ of the neonate?
blue and gray
At what month does eye color change?
6 months
Why don’t infants produce tears?
the lacrimal system drains them efficiently into the nasal cavity
What is a 2-3 year old’s visual acuity?
20/50
What is a 6-7 year old’s visual acuity?
20/20
What are the visual milestones of a term neonate?
- demonstrates alertness to light and visual stimulus presented 8-12 inches from the eyes
What are the visual milestones of a 1 month old?
- follows an object 60 degrees horizontally and 30 degrees vertically
- blinks at an approaching object
What are the visual milestones of a 2 month old?
- follows a person or moving object for 180 degrees from 6 ft
- smiles in response to a face
- raises head 30 degrees from prone
What are the visual milestones of a 3 month old?
- tracks an object through 180 degrees
- regards own hand
- begins visual-motor coordination
What are the visual milestones of a 4-5 month old?
- social smile
- reaches for a cube 12 in away
- notices a raisin 12 in away
- stares at own hand
What are the visual milestones of a 7-8 month old?
- reaches and grasps an object
- picks up a raisin by raking
- transfers objects from hand to hand
What are the visual milestones of a 8-9 month old?
- pokes at holes in a peg board
- well-developed pincer grasp
- crawls
- uncovers toy after seeing it hidden
What are the visual milestones of a 12-14 month old?
- stacks blocks
- places a peg in a round hole
- stands and walks
What is the complex process of acquiring meaning from what is seen, involving the eye, brain, and related neurologic and physiologic structures?
vision
What connects the nasopharynx to the middle ear?
eustachian tube
Inflammation of the middle ear.
Otitis media
What is otitis media often accompanied by?
Infection
What type of children does otitis media occur mostly in?
- boys
- children who attend childcare centers
- those with allergies
- children exposed to tobacco exposure
- those who use pacifiers several hours daily
- children with a cleft lip and palate
- Down syndrome
What appears to be protective against otitis media?
Breastfeeding
What is the specific cause of otitis media?
Unknown
What does otitis media appear to be caused by?
Eustachian tube dysfunction
What often precede the deployment of otitis media?
Upper respiratory infection
What are the most common caustics organisms of otitis media?
Streptococcus pneumonia a, Haemophilus influenzae, and Moraxella catarrhalis
What are some conditions that can obstruct the Eustachian tube which could further cause otitis media?
Enlarged adenoids or edema from allergic rhinitis
When is acute otitis media diagnosed?
When the child has acute onset of ear pain, marked redness of the tympanic membrane upon otoscopy, and middle ear effusion.
What type of otitis is evidence of fluid in the middle ear without inflammation?
Otitis media with effusion
Is otitis media effusion acute or chronic?
Chronic
What’s is otitis media with effusion associated with?
Hearing loss
What are some behaviors that infants and young children may show when they have otitis media?
- pulling at the ear
- diarrhea
- vomiting
- fever
- irritability
- acting out
- night awakenings with crying
What is diagnosis of otitis media based on?
otoscopic examinations
When when a certainty diagnosis of acute otitis media be made?
What there is a history of:
- acute onset
- presence of middle ear effusion
- signs and symptoms of inflammation
Which diagnostic tool for otitis media measures the condition of the middle ear by introducing a sound and measuring the tympanic membrane response?
special gradient acoustic reflectometry
What does a flat tympanogram indicate in otitis mediain?
absence of normal movement for the tympanic membrane
In cases with repeated antibiotic treatment failure in otitis media, what could you do instead?
typanocentesis
How would you diagnose otitis media with effusion?
*Remember, it causes hearing impairment!
- otoscopy
- tympanometry
If otitis media with effusion persists for longer than 3 months, what kind of testing can be performed in the pediatric healthcare home?
audiologic testing
When would you refer an infant with otitis media to an audiologist?
If they fail testing in the office or are less than 4 years of age.
How is acute otitis media treated in children under 6 years?
antibiotic treatment for 10 days
How is acute otitis media treated in children 6 years and older?
antibiotic treatment for 5-7 days
In children 6 months-2 years with nonsevere illness at presentation AND uncertain diagnosis, OR in children 2 years and older without severe symptoms OR with uncertain diagnosis, what would you do for treatment?
give analgesics but delay antibiotic treatment for 48-72 hours
In acute otitis media, when antibiotic therapy is not prescribed initially, what can the child be given?
- ibuprofen
- acetaminophen
- topic aural analgesic
What is the first line antibiotic treatment for otitis media?
amoxicillin
What is the dose of amoxicillin for a child with acute otitis media?
80-100 mg/kg/day
What is the second line antibiotic treatment for acute otitis media?
amoxicillin with clavulanate or cefuroxime
If an intramuscular drug is preferred over an oral antibiotic treatment for acute otitis media, what could be given?
- cefdinir at 14 mg/kg/day
- cefpodoxime at 10 mg/kg/day
- cefuroxime at 30 mg/kg/-day
Which otitis media is not treated with antibiotics?
otitis media with effusion
Children with otitis media with effusion generally improve within how many months?
3
What type of psychosocial action should not take place around children with otitis media with effusion?
smoking
If acute otitis media recurs despite of antibiotic treatment OR if otitis media with effusion lasts longer than 4 months with hearing loss, what may be performed?
- myringotomy (surgical incision of the tympanic membrane)
- tympanostomy tubes ( pressure-equalizing tubes)
Is “ear wicking” a good idea to manage otitis media?
no
What are some preventive measures that parents can implement to prevent otitis media?
- don’t smoke around children
- avoid wood burning stoves
- place child in daycare with fewer than 10 children
- breastfeed
- don’t place a baby to sleep with pacifier
- get Hib vaccine
What medications would you explain don’t work for OME?
- antibiotics
- steroids
- antihistamines/decongestants
What are some teaching strategies to reduce the pain of a child with otitis media?
- apply heating pad or warm hot water bottle
- have the child chew gum or blow on balloon
- position the baby with the head slightly elevated
A nosebleed.
epistaxis
What age group is epistaxis common in?
school-aged
What is an area of plentiful veins located in the anterior nares and is a usual source of bleeding in epistaxis?
kiesselbach’s plexus
What are some causes of epistaxis?
- irritation from nose picking
- foreign bodies
- low humidity
- forceful coughing
- allergies
- infections
What type of nosebleed is more serious and usually requires hospitalization?
posterior
What is the cause of a posterior nosebleed?
- systemic disease
- injury
To monitor for hypovolemia when there is excessive blood loss in epistaxis, what would you monitor?
* vital signs
- blood pressure
- pulse
To examine the nasal mucosa in a child with an epistaxis, what would you instruct them to do?
blow any clots out
A nosebleed confined to one side of the nose is almost always anterior or posterior?
anterior
What type of nosebleed can flow on one or both sides?
posterior
If blood cannot be seen, what may the child be doing?
swallowing it
What type of nosebleed would you suspect if the child has sustained a blunt trauma to the head?
posterior
How to treat an anterior nosebleed?
- sit upright quietly with head tilted forward
- squeeze nares below the nasal bond and hold for 10-15 mins
- apply an ice bag to the nose or back of the neck
If an anterior nosebleed doesn’t stop, what could you soak a cotton ball in and insert into the affected nostril to promote vasoconstriction?
- neo-synephrine
- epinephrine
- thrombin
- lidocaine
Once an anterior nosebleed has stopped, what will the doctor have to do?
cauterize with silver nitrate or electrocautery
If an anterior nosebleed cannot be stopped, what kind of packing may be used?
absorbable
How would you stop a posterior nosebleed?
- pack the nose
- monitor the child
- arterial ligation
If significant bleeding has occurred in a child with a nosebleed, what lab values would you monitor for?
- hematocrit
- hemoglobin
What should the child avoid doing to prevent recurrence of nosebleeds?
- avoid bending over
- avoid stooping
- avoid strenuous exercise
- avoid hot drinks
- avoid hot baths
- all for the next 3-4 days
How should a child sleep after recovering from a nosebleed?
- head elevated on 2-3 pillows
- humidifier
An inflammation of the conjunctiva, the clear membrane that lines the inside of the lid and sclera.
infectious conjunctivitis
Conjunctivitis in an infant under 30 days of age.
ophthalmia neonatorum
How is ophthalmia neonatorum usually acquired?
during vaginal delivery from discharge
What is instilled into the eyes of newborns soon after birth as a prophylactic measure against ophthalmia neonatorum?
antibiotics
Occasionally occurs in newborns as a reaction to prophylactic medication.
chemical conjunctivitis
A type of conjunctivitis that is characterized by edema of the eyelid, red conjunctiva, and enlarged preauricular lymph glands. There is usually mucopurulent exudate.
bacterial
What do older children with bacterial conjunctivitis complain of?
- itching or burning
- mild photophobia
- feeling of scratching under the eyelids
What are most cases of bacterial conjunctivitis caused by>
hand-to-eye contact
Which conjunctivitis is commonly bilateral?
viral
Signs and symptoms of viral conjunctivitis.
Same as bacterial but sometimes they are milder in severity and slower in onset
Can herpes cause viral conjunctivitis?
yes
Characteristics of ophthalmic herpes infection.
- unilateral
- painful
- vesicular lesions on the eyelids and skin of the face
A common cause of eye discomfort; conjunctivitis caused by an allergy.
allergic conjunctivitis
In allergic conjunctivitis, what will the child complain of?
intense itching
What will examination of allergic conjunctivitis reveal?
- red eyes
- watery discharge
- conjunctivae having a cobblestone appear
- edematous eyes
What forms of medication are given to the patient with conjunctivitis?
- otic drops
- ointment
What are frequently given to treat bacterial conjunctivitis?
fluoroquinolones
What are some other drugs used to treat bacterial conjunctivitis?
- sulfonamides
- aminoglycosides
- polymyxin B/ trimethoprim
- azithromycin
When gonococcal conjunctivitis occurs in newborns, what is given?
ceftriaxone
What are Chlamydial infections of the eyes treated with?
oral erythromycin or tetracycline
What are some comfort measures to use for viral conjunctivitis?
- cleaning drainage with a warm clean cloth
- avoid bright lights
- avoid reading
How is herpes simplex conjunctivitis treated?
- acyclovir parenternal
- trifluridine topical
- iododexyuridine topical
- vidarabine topical
How to treat allergic conjunctivitis?
- systemic or topical antihistamines
- topical steroids
- vasoconstrictors
- decongestants
- mast cells stabilizers
What are some things to teach parents with a child who has conjunctivitis?
- don’t share towels
- don’t return to school until symptoms abate
- don’t rub eyes
- ware cotton mittens
- place cold towel on eyes for several minutes 2-3 times a day
- don’t use contact lenses
- good personal hygiene
Also known as an upper respiratory infection or the common cold; causes inflammation and infection of the nose and throat and is probably the most common illness of infancy and childhood.
nasopharyngitis
What are the most common viruses that cause nasopharyngitis?
- rhinovirus
- coronavirus
What is the most common bacterium that causes nasopharyngitis?
- Strep A
After organisms causing nasopharyngitis incubate, when is the infection communicable?
several hours before symptoms and 1-2 days after they begin
How many days will nasopharyngitis symptoms last?
4-10
How are the pathogens of nasopharyngitis believed to be spread?
the infected person touches the hand of an uninfected person, who then touches his or her mouth or nose
General symptoms of nasopharyngitis.
- red nasal mucosa
- clear nasal discharge
- infected throat with large tonsils
- vesicles on soft palate and in the pharynx
Symptoms of nasopharyngitis in infants younger than 3 months?
- lethargy
- irritability
- feeding poorly
- fever (may be absent)
Symptoms of nasopharyngitis in infants 3 months or older?
- fever
- vomiting
- diarrhea
- sneezing
- anorexia
- irritability
- restlessness
Symptoms of nasopharyngitis in older children?
- dry, irritated nose and throat
- chills, fever
- generalize muscle aches
- headache
- malaise
- anorexia
- postnasal drip
- thin nasal discharge, which may later become thick and purulent
- sneezing
For infants who cannot breathe through the mouth, what should you do if they have nasopharyngitis?
administer normal saline nosedrops every 3-4 hours
For infants older than 9 months with nasal stuffiness, how would would treat it?
normal saline nosedrops
For children over 6 years of age, how would you treat nasopharyngitis?
nasal sprays
In nasopharyngitis, how long can decongestant nosedrops and sprays be used for?
no longer than 4-5 days
What to teach a parent with a child who has nasopharyngitis?
- humidify the room
- give ibuprofen and acetaminophen
- avoid strenuous exercise
- engage in quiet play
- don’t force them to eat
- no medicine or vaccine can prevent the common cold
- proper hand washing
- clean counters, toys, and door knobs
- discourage sharing of food, dishes, and utensils at meals
An inflammation of one or more of the paranasal sinuses.
sinusitis
The sinuses become infected following what type of infection?
viral upper respiratory
What will the child’s history reveal about sinusitis?
upper respiratory infection for several days, followed by improvement in symptoms and a decrease in nasal drainage
In bacterial sinusitis, the upper respiratory infection improves but what increases?
purulent nasal drainage
What is the temperature in bacterial sinusitis?
102 F
How long do the symptoms of bacterial sinusitis last?
10 days
What are the symptoms of bacterial sinusitis accompanied by?
- pain
- headache
- fever
In what uncontrolled conditions will chronic sinusitis occur in?
- asthma
- allergies
What are the symptoms of sinusitis?
- history of upper respiratory infections
- persistent cough
- nasal discharge or swelling
- malodorous breath
- fever
- mouth breathing
- headache
- hyponasal speech
- cervical lymphadenopathy
What will young children with sinusitis show?
- trouble feeding
- anorexia
What will older children with sinusitis complain of?
- headache
- fatigue
How to diagnose sinusitis?
- MRI or CT
- aspiration of sinus exudate
Many cases of sinusitis clear spontaneously. True or False
true
What is the first choice of therapy for sinusitis?
amoxicillin
What are some other choices of medication for sinusitis?
- amoxicillin/clavulanate
- cefuroxime
- cefdinir
- azithromycin
- clarithromycin
What should you do for children with recurrent and chronic sinusitis?
refer them to a specialist
What would you teach parents with a child who has sinusitis?
- if child has persistent and purulent nasal drainage, see a healthcare provider - especially if accompanied by facial pain, headache, and fever
- correctly administer antibiotics
- use saline drops for comfort
- infants may need nose cleared with drops and a bulb syringe prior to feedings
An infection that primarily affects the pharynx, including the tonsils.
pharyngitis
What percentage of viruses causes pharyngitis?
80%
Bacteria pharyngitis is also known as?
strep throat
What is the major complaint of pharyngitis?
sore throat
Are the classic signs of purulent drainage and white patches always present in strep throat?
no
What are the signs and symptoms of viral pharyngitis?
- nasal congestion
- mild sore throat
- conjunctivitis
- hoarseness
- mild pharyngeal redness
- minimal tonsillar exudate
- mildly tender anterior cervical lymphadenopathy
- fever below 101 F
What are the signs and symptoms of strep throat?
- abrupt onset
- tonsillar exudate
- painful cervical lymphadenopathy
- anorexia, nausea, vomiting, abdominal pain
- severe sore throat
- headache, malaise
- fever above 101 F
- petechial mottling of soft palate
A child who finds swallowing difficult or extremely painful, who drools, or who exhibits signs of dehydration or respiratory distress should be seen immediately. Why?
these are signs of epiglottis
Two serious conditions of pharyngitis that include: an infected tonsil that spreads to the surrounding tissue and causes cellulitis and an infection of the lymph nodes that drain the adenoids, nasopharynx, and paranasal sinuses.
peritonsillar abscess and retropharyngeal abscess
How is strep throat diagnosed?
throat culture
How should strep throat be treated?
- oral penicillin for 10 days
- long-acting penicillin given in one injection
- if allergic to penicillin, give erythromycin
- azithromycin and clarithromycin
After giving medicine, how long will the acute symptoms of strep throat resolve in which the child is no longer contagious?
24 hours
How to treat viral pharyngitis?
treat the symptoms
How to treat a peritonsillar abscess?
- drain the abscess
- antibiotics
- hydration
How is a retropharyngeal abscess treated?
- drain the abscess
- IV antibiotics
What would you teach the parents of a child with pharyngitis?
− acetaminophen for fever and throat pain
− cool, nonacidic fluids
− soft foods
− ice chips
− frozen juice pops
− humidify room
− chew gum
− gargle warm salt water
− encourage the child to rest
− complete the entire course of antibiotics
− after 2 days of medication, replace the toothbrush
− stress the importance of treating strep throat because it can lead to rheumatic fever, cervical adenitis, sinusitis, glomerulonephritis, or meningitis
An infection or inflammation (hypertrophy) of the palatine tonsils.
tonsilitis and adenoiditis
What causes tonsilitis and adenoiditis?
viruses and bacteria
Symptoms of tonsilitis.
- frequent throat infection
- breathing and swallowing difficulties
- persistent redness of the anterior pillars
- enlargement of the cervical lymph nodes
Symptoms of adenoiditis.
- nasal stuffiness
- discharge
- postnasal drip
- coughing
How to diagnose tonsilitis and adenoiditis?
- visual inspection
- clinical manifestations
What is required to diagnose tonsilitis?
enlarged tonsils with pain and inflammation
Symptomatic treatment for tonsilitis is the same for what other infection?
pharyngitis
When would you consider a tonsillectomy?
- when there are at least 5 episodes of tonsillitis in the previous year
- at least 5 episodes per year for 2 yrs
- at least 3 episodes annually for 3 yrs
What to a teach the parents of a child with tonsilltis?
− acetaminophen for fever and throat pain
− cool, nonacidic fluids
− soft foods
− ice chips
− frozen juice pops
− humidify room
− chew gum
− gargle warm salt water
− encourage the child to rest
− complete the entire course of antibiotics
− after 2 days of medication, replace the toothbrush
− stress the importance of treating strep throat because
What are some discharge instructions and teachings following a tonsillectomy?
- sore throat is normal for 7-10 days
- relieve the child’s throat pain
- ear pain is normal between 4-8 days
- children should be given any liquid they prefer for the first week, except citrus juices
- soft foods
- no vigorous exercise
- may return to school after 10 days
The mouth needs moisture; therefore, what is one condition that causes mouth ulcers?
dehydration
What are some disorders that can cause mouth ulcers?
- chemotherapy-related oral mucositis
- AIDS-related oral mucositis
- Stevens-Johnson syndrome
- Aphthous ulcers
- Herpes simplex gingivostomatitis
- Traumatic ulcers
How to treat mouth ulcers?
- treat the symptoms
- keep the mouth clean
- administer systemic or topical analgesics
- acyclovir for herpes
- antibiotics for bacterial infections
How to treat Steven-Johnson syndrome?
remove the drug and give oral antihistamines
What are some teaching strategies for mouth ulcers?
- good oral care
- brush teeth with soft bristle toothbrush
- rinse the mouth after eating
- encourage a diet with mild foods, avoiding spices and very sweet, sour, and acidic items
A complete removal of a tooth.
avulsion
What to teach the parents with a child who has a tooth avulsion?
- handle the tooth by the crown
- gently rinse the tooth with sterile saline
The parents of a child who had a tonsillectomy 3 days ago call about concerns with symptoms they are seeing. Which symptom would alert the nurse that the child may be having a postoperative problem?
A. The child has white crusts on the back of the throat
B. The child is having increased swallowing
C. The child will only eat popsicles
D. The child complains of throat pain
B
an opening between the atria in the fetal heart, allows blood to flow from the right to the left atrium, and then into the left ventricle
foramen ovale
where the majority of blood passes; the channel between the pulmonary artery and the descending aorta, to enter the systemic circulation
ductus arteriosus
When does the transition from fetal to pulmonary circulation occur?
few hours after birth
What does the first breath do to the lung?
expands them
After the first breath and expansion of the lungs, where does blood begin to flow?
to the lungs
What happens to the pulmonary blood flow after the first breath?
increases
What happens to the pulmonary vascular resistance as a result of the first breath?
decreases
What happens to the pressure in the L atrium as blood flow is returned from the lungs through the pulmonary veins after the first breath?
pressure increases
What happens to the systemic vascular resistance after the first breath?
increases
What happens to the pressure in the R atrium after the umbilical cord is cut?
decreases
What occurs as the pressure in the L atrium increases?
foramen ovale closes
When does the patent ductus begin to close?
10-15 hours after birth
How many days after birth should the patent ductus be completely closed?
10-21 days
The patent ductus may not close if the fetal’s O2 Sat is how?
too low[
What are the key assessments of a child with a cardiac condition?
- vital signs
- skin
- pulse ox
With a cardiac condition, what characteristics about the respirations do you want to assess?
− rate and depth
− cough?
− Tachypnea, dyspnea, retractions, nasal flaring, or expiratory grunting?
− Auscultate breath sounds
With a cardiac condition, what characteristics about the pulse do you want to assess?
− Assess the rate, rhythm, and quality
− Compare the pulse sites for strength and rate
With a cardiac condition, what characteristics about the blood pressure do you want to assess?
− Compare BP to expected value for age, gender, and height percentile
− Compare BP values between upper and lower extremities
With a cardiac condition, what characteristics about the color of the skin do you want to assess?
− Note pallor, dusky, or cyanosis
− Compare in peripheral and central locations
− Does crying improve or worsen the color?
− Pulse oximetry
With a cardiac condition, what characteristics about the chest do you want to assess?
− Inspect the anterior and posterior for any abnormalities, bulging, or heaving
− Palpate the chest wall over the heart
− Locate the point of maximum intensity
With a cardiac condition, what characteristics about heart auscultation do you want to assess?
− Auscultate the heart for the heart sounds and their quality
− Are any extra heart sounds present
− Describe murmurs present
− Auscultate the heart with the child in sitting and reclining positions to detect differences in sounds
With a cardiac condition, what characteristics about the fluid status do you want to assess?
− Observe for signs of periorbital, facial, or peripheral edema, or for dehydration
− Observe for abdominal distention
− Palpate the liver to detect hepatomegaly
− Assess capillary refill
With a cardiac condition, what characteristics about the activity and behavior do you want to assess?
− Determine if exercise intolerance is present of if the child tires with feeding
− Note presence of diaphoresis and when it occurs
− Identify changes in activity level
With a cardiac condition, what characteristics in general do you want to assess?
- assess patterns of growth
Defects that obstruct the flow of blood from the R side of the heart to the lungs _________ pulmonary blood flow.
decreases
If there is little or no blood reaching the lungs, the blood is not getting __________.
oxygenated
One of the most common congenital heart defects causing cyanosis.
tetralogy of fallot
In tetralogy of fallot, what kind of shunt is it?
right to left
What is the classic sign of tetralogy of fallot?
when you put the child on oxygen they are supposed to pink up, with this condition, they won’t
What are the four defects of tetralogy of fallot?
- ventricular septal defect
- pulmonary stenosis
- overriding of the aorta
- hypertrophy of right ventricle
What is pulmonary stenosis?
narrowing of the pulmonary valve
What is ventricular septal defect?
opening between the ventricles
In tetralogy of fallow, what is the 5th defect?
atrial septal defect
The overriding aorta and VSD of tetralogy of fallot allows __________ blood to pass into the systemic circulation.
unoxygenated
Manifestations of tetralogy of fallot.
- cyanosis
- squatting
- clubbing
- systolic murmur heard in the pulmonic area
- palpable thrill
- polycythemia
- metabolic acidosis
- poor growth
- exercise intolerance
What are some complications of tetralogy of fallot?
- CHF
- developmental delays
- CVA
What is the clinical therapy for tetralogy of fallot?
- manage hypercyanotic episodes
- monitor for metabolic acidosis
- corrective surgery
- prophylaxis antibiotic for surgery
- palliative surgery
- PGE1 if patent ductus isn’t closed
How to manage a hypercyanotic episode?
- Oral propranolol may be given
- Place them in a knee-chest position
- Reduce irritation or painful stimuli
- Start an IV line to provide sedation, morphine, and a fluid bolus if it does not resolve
- Give a beta-blocker to reduce HR and muscle spasms
- Give dopamine and phenylephrine to increase systemic vascular resistance
What is the nursing care of tetralogy of fallot?
- Educate parents on condition, tell them what to do when having hypercyanotic epidose
- Put child in a chest-knee position
- Take pulse ox daily,teach parents how to work it
- Parents need to be taught CPR before they leave the hospital
- If child starts having any illnesses then they will have to report to dr immediately
An abrupt decrease in systemic vascular resistance and pulmonary blood flow with an increase in cardiac output and sudden venous return.
hypercyanotic episode
What worsens a hypercyanotic episode?
- waking up
- crying
- bathing
- straining at bowel movement
Disorder of circulation in which cardiac output is inadequate to support body’s circulatory and metabolic needs.
CHF
What does CHF result from?
May result from congenital heart defect that causes either increased pulmonary blood flow or obstruction to the systemic outflow tract
Initial signs of CHF in infants
- Infant tires easily, especially during feeding. Eat less and
- Weight loss or lack of weight gain
- Diaphoresis while eating is abnormal
- Irritability
- Frequent respiratory infections
Initial signs of CHF in children
- Exercise intolerance
- Dyspnea
- Abdominal pain or distention
- Peripheral edema
- Skin color changes such as mottling or pallor
- Parents may notice coughing
Signs of CHF as the disease progresses
- Tachypnea and tachycardia
- Pallor, cyanosis
- Exercise intolerance
- Wheezing
- Anorexia
- Cough
- Nasal flaring, grunting, retractions, cough, crackles
- S3 gallop: a third heart sound that produces a rhythm like a gait of a horse
- Generalize fluid volume overload – hepatomegaly, facial edema
- Jugular vein distention
During CHF, what does the heart do to compensate in order to maintain cardiac output?
enlarges
If left untreated, what can CHF lead to?
cardiogenic shock
What are the precursors for cardiogenic shock?
- Cyanosis
- Weak peripheral pulses
- Cool extremities
- Hypotension
- Murmur
What are some diagnostic procedures done for CHF?
- observe manifestations
- chest radiography
- echocardiography
- electrocardiogram
- renal and liver function tests
- electrolytes and ABG
- CBC
What is the #1 goal of clinical therapy for CHF?
treat the cause
What is the #2 goal of clinical therapy for CHF?
maximize the cardiac output and tissue perfusion
Which medications may be given for CHF?
- diuretics
- ACE inhibitors
- digoxin
If CHF is difficult to manage, what will be done
surgery or interventional catheterization will be done
During nursing management, to diagnose a patient with CHF, what would the physiologic assessment consist of?
- A diagnosis depends on physical symptoms
- Assess their behavioral patterns, cardiac function, respiratory function, and fluid status
- Obtain a detailed history of the onset of symptoms from the parents
- Be suspicious of developing CHF if feedings take 30 minutes or longer
- Monitor intake and output;
- Weigh them at the same time everyday;
- Observe for changes in peripheral edema and circulation;
- Measure stomach for ascites;
- Turn them frequently
During nursing management, to diagnose a patient with CHF, what would the family assessment consist of?
- Take a history of the child’s previous hospitalizations;
- Assess the family’s knowledge about the child’s condition;
- Assess the family’s anxiety level and coping strategies;
- Evaluate the family’s economic status;
- Assess the parents’ ability to provide care at home
During nursing management, to diagnose a patient with CHF, what would the developmental assessment consist of?
- Perform developmental assessment with the Denver II;
- Assess infants and toddlers every 2-3 months;
- Ask parents about contact and play with other children and a typical day’s activity schedule
For a patient with CHF, what must the nurse do before giving digoxin?
- establish baseline vitals;
- assess the quality of the peripheral pulses and clinical symptoms;
- obtain an electrocardiogram;
- check the apical pulse for 1 minute
For a patient with CHF, when would you contact the MD before giving digoxin?
- the HR is less than 60-100 bpm, or is higher or lower than the guideline noted in the order
- OR changes in the heart rhythm or quality
For the patient with CHF, how would the nurse maintain oxygenation and myocardial function?
- Ensure that tubing is patent, the O2 flow rate is correct, the O2 delivery device is working, and humidification is provided
- Keep the child calm and quiet
- Place the child in a semi-Fowler degree angle position
For the patient with CHF, how would the nurse promote rest?
- Rocking is restful and comforting for infants
- Encourage older children to engage in quiet activities
For the patient with CHF, how would the nurse foster development?
- Encourage the parents to play with the child, using toys to stimulate eye-hand coordination and fine motor movements
- Encourage sitting, standing, or walking for shore periods with adequate rest
- Singing, talking, and playing music will improve language
For the patient with CHF, how would the nurse provide adequate nutrition?
- Don’t discourage the mother from breastfeeding
- Frequent small feedings is the best approach
- Burp infants frequently
- Hold the infant at a 45 degree angle
- Limit feeing time to 30-40 mins
- Permit the infant to set the rhythm for feeding and resting
- Follow the infant’s cues for hunger, satiety, and tiring
For the patient with CHF, how would the nurse provide emotional support?
- Give parents an opportunity to express concerns
- Explain the treatment regiment and make sure they understand
- Provide information and relay questions the doctor
- Refer to support groups
For the patient with CHF, how would the nurse plan for discharge and home care?
- Arrange for home care nursing visits
- Ensure the family has a phone contact for emergency
- Medication administration
- Assessment for worsening condition
When should a child report worsening conditions of CHF to the MD?
- watch for increased feeding difficulty
- irritability
- lethargy
- breathing difficulty
- and puffiness around the eyes and extremities
What is the maintenance level of digoxin?
0.8-2 mg/mL
Infection in an individual with endocardial cell damage
endocarditis
Inflammation or infection of the heart valve or the heart lining
endocarditis
What is endocarditis associated with?
o Congenital heart defects o Rheumatic heart disease o Central venous catheter o Heart surgery o IV drug abuse
What is the most common symptom of endocarditis?
recurrent fever
What are other symptoms of endocarditis?
- Fatigue
- Weight loss
- Weakness
- Headache
- Joint and muscle aches
- Diaphoresis
- New heart murmur
- Hepatospenomegaly
- CHF
- Petechial
- Splinter hemorrhages under the nail
- Roth spots – exudative lesions of the retina
- Osler nodes- red, painful nonhemorrhagic nodules on the pads of the fingers and toes
- Janeway lesions – nontender, blanching macular lesions on the palms and soles
Children with indwelling catheters may have what type of symptoms?
pulmonary
Diagnostic procedures for endocarditis.
- Primarily a blood culture
- An elevated erythrocyte sedimentation rate, anemia, elevated C-reactive protein level, and increase white blood cell count may be present
- Transesophageal and transthoracic echocardiography detect the vegetation
What is types of medications are given for endocarditis?
Administer high doses of bactericidal antibiotics: • Penicillin G • Ceftriaxone • Vancomycin • Nafcillin • Oxacillin • Gentamicin • Ciprofloxacin • Cefazolin
IV administration of antibiotics in endocarditis is preferred if the therapy is continued for how many weeks?
4-8 weeks
What is the nursing assessment and diagnosis for a child with endocarditis?
- Assess the child’s respiratory and cardiovascular status
- Pay careful attention the vital signs. Oxygen saturation, and level of consciousness
- Monitor temperature, intake and output, and level of comfort
- Monitor for the development of complications such as embolus
- Monitor the parents’ coping skills and need for information
What is the planning and intervention for a nurse for a child with endocarditis?
- Administer medications as ordered
- Monitor serum antibiotic levels
- Monitor for side effects of antibiotics and for infiltration or extravasation at the infusion site
- Keep invasive procedures to a minimum
- Use aseptic technique when managing central lines and venous access dives
- Encourage parents to assist with the child’s care and plan quiet age-appropriate activities
- Permit time for them to express their feelings
What does discharge planning and home care teaching consist of with a child who has endocarditis?
- Home infusion antibiotic therapy mat be ordered
- Arrange home health nursing
- Homeschooling is needed
- Help parents maintain contact with child’s friends
- Reinforce the need for follow-up visits
•An inflammatory connective tissue disorder that results from strep A
rheumatic fever
Manifestations of rheumatic fever
o New heart murmur
o Carditis
o Chest pain
o 2 or more large joints become inflamed
o Rash on their trunk (won’t be on hands or face and it is nonpruritic)
o Sydenham chorea- movements of the extremities plus facial grimacing
Diagnostic procedures for rheumatic fever
- Based on clinical signs and evidence of preceding group A streptococcal infection either:
- A positive throat culture or rapid streptococcal antigen test OR an elevated or risking streptococcal antibody titer
- An elevated antistreptolysin-O titer of 333 Todd units indicates a recent streptococcal infection
What antibiotics will be given for rheumatic fever?
- Penicillin
- Sulfadiazine
- Erythromycin
How to treat fever, arthritis, and arthralgia in rheumatic fever?
aspirin
How to treat severe carditis in rheumatic fever?
corticosteroids
What are some long-term antibiotics for prophylaxis of rheumatic fever?
- IM benzathine penicillin
- Oral penicillin V
- Oral sulfadiazine
Children with heart valve damage need antibiotic prophylaxis for _________.
endocarditis
How will a nurse manage the acute inflammatory phase of rheumatic fever?
o Take the temperature at least every 4 hours
o Monitor vitals
o Bed rest to monitor for carditis and for 4 weeks if it develops
o Auscultate heart sounds
o Observe changes in skin, joints, or behavior
o Administer the medication as ordered
o Place the joints in a neutral position
o Provide quiet activates and encourage visits
How will a nurse manage the recovery phase of rheumatic fever?
o Generally cared for at home
o Activities are limited
o Help parents plan quiet activities
What discharge action will a nurse take for a child with rheumatic fever?
o Daily oral low-dose antibiotic is given or a monthly long-active antibiotic
o Stress the importance of telling future healthcare providers about the rheumatic fever history
Acute febrile, systemic inflammatory illness affecting small and midsize arteries
kawasaki disease
Kawasakie disease an cause ________ in arteries including coronary arteries therefore it important to diagnose early to prevent this
aneurysms
Manifestations of the acute phase of kawasaki disease.
irritability, high fever lasting for 5 days or longer, conjuctival hyperemia, red throat, swollen hands and feet, rash on trunk and perineal area, unilateral enlargement of anterior cervical lymph nodes, diarrhea, and hepatic dysfunction. Lasts 1-2 weeks.
Manifestations of the subacute phase of kawasaki disease.
cracking lips with fissures, desquamation of the skin on tips of fingers and toes, joint pain, cardiac disease and thrombocytosis. Lasts for 2-4 weeks
Manifestations of the convalescent phase of kawasaki disease.
6-8 weeks after illness began, child appears normal but lingering signs of inflammation may be present
Other symptoms of kawasaki disease.
- Arthralgia
- Abdominal pain
- Diarrhea
- Vomiting
- Hepatic dysfunction
- Gallbladder hydrops
- Aseptic meningitis
- Hearing loss
What is the diagnostic criteria for kawasaki disease?
- When a high spiking fever over 102.2 F for 5 days or longer
OR - 4 or 5 of the following criteria:
• bilateral bulbar conjunctivitis without exudate
• intense redness of the buccal and pharyngeal surfaces wit dry, swollen, cracked, and fissuring lips and a strawberry tongue
• redness of the palms and soles, swellings of the hands and feet, and then desquamation after 2-3 weeks
• polymorphic rash
• cervical lymphadenopathy
What is the clinical therapy of kawasaki disease?
- IV IVIG within 7-10 days
* High doses of aspirin – 8-100 mg/kg/day to reduce fever
What is the nurses role in assessing and diagnosing kawasaki disease?
- Take the temperature every 4 hours and before each dose of aspirin
- Assess the extremities for edema, redness, and desquamation every 8 hours
- Examine the eyes for conjunctivitis and the mucous membranes for inflammation
What is the nurses role in planning and implementing care with kawasaki disease?
- Administer aspirin and IVIG as prescribed
- Monitor for side effects of aspirin and reactions to the infusion
- Promote the child’s comfort
- Assess pain
- Keep skin clean and dry
- Lubricate the lips
- Use cool compresses to make the child comfortable
- Change the clothes frequently
- Give small frequent feedings of soft foods and liquids
- Plan rest periods
What is the role of the nurse in discharge planning and home care teaching?
- Teach the parents to administer aspiring
- Check temperature daily for first 2 weeks
- Any fever above 101 F needs to be reported
- Limit strenuous activity for aneurysms and stenosis
abnormal heart rhythms
arrhythmias
What are examples of fast arrhythmias?
- tacharrhythmias (sinus tachycardia)
What are examples of slow arrhythmias?
- bradyarrhythmias (sinus bradycardia)
What are some examples where there is no pulse?
ventricular tachycardia, ventricular fibrillation, pulseless, aystole
What are arrhythmias associated with?
o Postoperative complications of congenital heart disease
o Kawasaki disease with coronary involvement
o Rheumatic heart disease
o Cardiomyopathy
o Electrolyte abnormalities
Arrhythmias must be recognized because they can cause ________ cardiac output and CHF
decrease
Causes of tachycardia.
- Hypoxia
- Anemia
- Hypovolemia
- Shock
- Hyper or hypokalemia
- Hyperthyroidism
- Catecholamine medications
- Stimulant or illicit drug use
Causes of bradycardia.
- Hypoxemia
- Hypothermia
- Increased intracranial pressure
- Heart block
- Hypothyroidism
- Sick sinus syndrome
- Digoxin, beta-blockers, calcium channel blockers, and cholinergic agents
Manifestations of bradycardia.
- HR less than 80 bpm in infants
- HR less than 60 bpm in children and adolescents
- Associated with poor systemic perfusion
- Fatigue, exercise intolerance, dizziness, and syncope
Manifestations of tachycardia
Supraventricular tachycardia – abrupt onset of a rapid, regular HR • Greater than 220 bpm in infants • Greater than 180-240 bpm in older children • Infants o Poor feeding o Irritability o Pallor • Older children o Palpitations o Chest pain o Dizziness o SOB o Decrease exercise intolerance o Syncope o Long QT syndrome
Manifestations of long QT syndrome
- Episodic dizziness
- Palpitations
- Syncope
- Seizure
- Cardiac arrest
What triggers a long QT syndrome?
demanding physical exercise, a strong emotional reaction, or an abrupt loud noise
What is initially used to diagnose an arrhythmia?
electrocardiogram
If symptoms are episodic for arrhythmias, what would be done to diagnose it?
24 hour Holter monitor or an event monitor may be used to capture the arrhythmia
What may be performed when exercise either triggers or is associated with the symptoms of arrhythmias?
stress test
What are some invasive procedures to diagnose arrhythmias?
Electrophysiologic cardiac catheterization – allows electrode catheters to be placed in the right side of the heart
o Areas of the heart can be selectively stimulated to trigger an arrhythmia
o Then meds will be given
Transesophageal recordering – pass an electrode catheter into the lower esophagus to stimulate and record the arrhythmia
Clinical therapy for bradycardia.
- Oxygen
- Ventilation
- Epinephrine
- Atropine
- Pacemaker
Clinical therapy for tachycardia.
- Vagal maneuvers
- valsalva maneuver
- Adenosine
- Amiodarone
- Procainamide
What would be applied to infants with tachycardia as clinical therapy to reduce HR?
Apply ice or iced saline solution to the face or rectal stimulation with a thermometer
If a child with tachycardia doesn’t return to sinus rhythm, what would happen?
- Synchronized cardioversion
- Esophageal overdrive
What are some long term medications that may be given for someone with recurrent SVT?
o Digoxin o Verapamil o Propranolol o Procainamide o Amiodarone
If a child is suspected of having an arrhythmia, what would the nurse monitor?
- Level of consciousness
- Heart rate
- Other vital signs
What would a nurse do to assess and diagnose a child with an arrhythmia?
- Use a cardiorespiratory monitor and pulse OX to identify deterioration
- Changes in color, weakness, irritability, and changes in feeding pattern indicate hypoxia
What would a nurse do to plan and implement interventions for a child with an arrhythmia?
- Attach the cardiorespiratory monitor
- Assist the child with Valsalva maneuvers
- Administer meds
- Provide rest
- Have emergence equipment available
The most abundant of the cellular elements of blood
RBC
RBCs are formed through ______
erythropoiesis
Primary function of RBCs.
transport O2 from the lungs to the tissues AND carry CO2 from the tissues back to the lungs
essential to RBCs function
hemoglobin
lifespan of RBCs
120 days
The ______ destroys RBCs and the iron from the cell is stored for later use
spleen
hormone produced by the kidney that stimulates RBC production
Erythropoietin
above-average increase in RBC
Polycythemia
What is a cause of polycythemia?
anemia
RBC value
3.8-5.03
Hgb value
10.2-13.4
Hct value
31.7-39.8
o Mobile units of the body’s protective system
WBC
Where are WBC formed
bone marrow and lymph tissue
percentage of the different types of WBCs and can help discern the cause of an illness
differential
decrease in the number of WBC
leukopenia
Type of WBC- Phagocytosis; bands- immature; segs- mature
neutrophils
Type of WBC- allergic reactions
eosinophils
Type of WBC- inflammatory reactions
basophils
Type of WBC- phagocytosis and antigen processsing
monocytes
type of WBC- humoral and cellular immunity
lymphocytes
neutrophil value
22.4-74.7
basophil value
0-4.7
eosinophil value
0.1-0.6
monocyte value
4.1-12.3
lymphocyte value
18.1-57.8
o Cell fragments that can form hemostatic plugs to stop bleeding
platelets
Platelets are synthesized from components in the red bone marrow and are stored in the ______
spleen
Thrombocytopenia
platelet deficit
• Reduction in the number of RBCs, the quantity of hemoglobin, and the volume of packed RBCs to below normal levels.
anemia
causes of anemia
o Blood loss (trauma) o Body not producing enough RBC or body destroying RBC o Nutrition deficiency o Menstrual cycle o Hypersplenism
causes of iron deficit. anemia
o Not starting infants on baby foods after 6 months o Blood loss o Malabsorption o Increased physiologic demands o Pica
signs of iron deficit. anemia
o Pale o Fatigue o Low energy o Irritable o Complain of headaches o Nail bed deformities o Growth retardation o Developmental delay o Tachycardia o Systolic heart murmur
clinical therapy for iron deficit. anemia
- Oral elemental iron preparations for 4 months
- Ferrous sulfate 3-6 mg/kg/day for 4 weeks
- Evaluate for 6 months for recurring anemia
When to screen for iron deficit anemia
- 9-12 months
- 15-18 months
- Adolescents (menstrual cycle)
- Males- routine exam during growth spurts
- Diet history and analysis
eat foods with what vitamin for iron deficit anemia
c
what kind of milk to avoid for iron deficit anemia
cow
side effects of ferrous sulfate
o Black, green, or “tarry” stools; constipation; and a foul aftertaste
signs of overdose of iron
o Abdominal pain, vomiting, bloody diarrhea, SOB, and shock
An inflammation of the tissues surround the epiglottis.
Epiglottis
When does edema develop in epiglottis?
Within minutes or hours
What kind of condition is epiglottis
Life threatening
What is epiglottis caused by
Bacteria
What kind of fever is present in epiglottis
Greater than 102
What kind of sore throat during epiglottis
Sever
Classic signs of epiglottis
Dysphonia
Dysphagia
Drooling
Distressed respiratory with inspiratory stridor
What kind of position does the child resume in epiglottis
Tripod
What is contraindicated in epiglottis
Visual inspection of the mouth and throat
What is done immediately for a child with epiglottis
Endotracheal tube
What two meds don’t work for epiglottis
Epi and corticosteroids
What color is their epiglottis during epiglottitis
Cherry red
If a child wit epiglottitis is quiet, what do you do
Make sure they are awake and get medical attention FAST
What kind of environment does a child with epiglottitis need to be in before they are seen by a doctor
Quiet
A term applied to a broad classification of upper airway illness that result from inflammation and swelling of the epiglottis and larynx
Croup
A viral invasion of the upper respiratory airway that extends throughout the larynx, trachea, and bronchi
Laryngotracheobronchitis
How do the tracheal and laryngeal airway tissues respond to a virus
They inflame
After the child’s airway inflames following a virus, what happens to their secretions
Increase
The laryngeal inflammation causes the airway diameter to narrow in what area
Subglottic
Symptoms of LTB
- low grade fever
- cough and hoarseness
- runny nose
- tachypnea
- inspiratory stridor
- seal-like barking cough
The presence of expiratory stridor, severe tachypnea, retractions, and oxygen desaturation are associated in a more mild or sever airway inflammation and swelling in LTB?
Severe
In LTB, changes in what indicate the development of hypoxemia and potential respiratory failure
Mental status
In LTB, when do you give supplemental oxygen
If their sat is less than 92
What kind of onset does LTB have
Gradual
What does LTB start with
URI
Within how many hours will LTB progress to symptoms of respiratory distress and airway obstruction
24-48 hrs
In LTB, what kind of breathing verified adequate energy stores, noisy or quiet?
Noisy
What kind of position in LTB does the child assume
Upright or lying with the head elevated
What two meds can be given with LTB
Beta-agonists and corticosteroids
When does a parent need to call the healthcare provider with a child who has LTB?
A. Mild symptoms do not improve after 1 hour
B. Childs breathing is slow
C. Child drinks a lot of fluids and urine output is increased
D. Mild symptoms do not improve within 30 minutes
E. Childs breathing or rapid
F. Child doesn’t drink a lot and urine output is decreased
A, E, F
When the body can no longer maintain effective gas exchange
Respiratory failure
Do the alveoli hypo or hyperventilate during respiratory failure
Hypo
Lower than normal blood oxygen level
Hypoxemia
Excess of carbon dioxide
Hypercapnia
Lower than normal oxygen level in tissues
Hypoxia
Acute respiratory failure caused by lung injury that does not respond to supplemental oxygen
ARDS
Examples of conditions that damage the lungs
Pneumonia Sepsis Meconium aspiration Aspiration of stomach contents Smoke inhalation Near drowning
What happens to the alveolar-capillary membrane after the lungs are injured
Damaged
What happens to the permeability of the alveolar-capillary membrane after the lungs are damaged
Increases - fluid and protein accumulate in the alveoli
What results if the alveoli are filled with fluid and protein
Pulmonary edema
What is mismatched in ARDS
ventilation-perfusion
In infants, what is a sign of sever distress and a need for mechanical vent
Grunting
Signs of initial respiratory failure
Restlessness
Tachypnea
Tachycardia
Diaphoresis
What are signs of early decompensation
Nasal flaring Retractions Grunting Wheezing Anxiety and irritability mood changes Headache Hypertension Confusion
Signs of sever hypoxia and imminent respiratory arrest
Dyspnea
Bradycardia
Cyanosis
Stupor and coma
Hypercarbia in the presence of what condition is a sign of respiratory failure?
Acidosis or alkalosis
Acidosis
As the child is more hypoxic, what happens to their level of consciousness
Decreases
What will doctors do if a child is hypoxic and their level of responsiveness decreases in order to stabilize the airway?
Insert an endotracheal tube
Creation of a surgical opening into the trachea through the neck to give long term airway
Tracheostomy
Are children sedated to optimize their ventilation
Yes
If acute respiratory failure becomes life threatening, what will be initiated?
ECMO
What does an ECMO allow the lungs to do
Rest and heal
Complications of ECMO
Bleeding Stroke Renal insufficiency Hypertension Seizures Electrolyte abnormalities Pneumothorax Cardiac dysfunction Infection
Irregular rhythm with occasional pauses up to 20 seconds between breaths
Periodic breathing
Cessation of respiration lasting longer than 20 seconds or any pause in respiration associated with cyanosis, marked pallor, hypotonia, or bradycardia
Apnea
When is the child removed from a ventilator
When they begin to respond to clinical therapy
Type of apnea - complete cessation of breathing effort
Central
Type of apnea - absence of nasal airflow when respiratory efforts are present
Obstructive
Type of apnea - central respiratory pause that either precedes or follows an airway obstruction
Mixed
Apnea in an infant born in before 37 weeks and is associated with respiratory control
Apnea of prematurity
When do apneic episodes often occur
During periods of active sleep
What are infants with apnea of prematurity treated with
Methxanthines
If apnea of prematurity is severe, what will be used
Ventilator support
When do episodes of premature apnea disappear
By 37 weeks
How should the neonate with AOP be placed
Head at midline and neck in neutral position or slightly extended
What kind of stimulation will halt an apneic episode
Tactile - run their back or feet
Signs of caffeine toxicity
Tachycardia Tachypnea Jitteriness Tremors Unexplained seizures Vomiting
Frightening episode of apnea
Apparent life threatening event
What is ALTE accompanied with
Cyanosis or pallor
Limp muscle tone
Choking
Gagging
Associated conditions of ALTE
Reflux
Seizures
Lower tract infections
Should child abuse be considered as a cause of ALTE
Yes
Coming signs of ALTE
Apnea Cyanosis Hypotonia Unresponsiveness Labored breathing Lethargy
When does ALTE occur
Sleep
Wakefulness
Feeding
complete cessation of breathing effort
central apnea
a disorder of breathing during sleep that is characterized by recurrent episodes of partial and complete obstruction of the upper airway that disrupts normal ventilation and sleep patterns
obstructive apnea
central respiratory pause that either precedes or follows airway obstruction
mixed apnea
disorder of breathing during sleep that is characterized by recurrent episodes of partial & complete obstruction of the upper airway that disrupts normal ventilation & sleep pattern
obstructive sleep apnea
o Results in breathing difficulty and snoring when the child sleeps
obstructive sleep apnea
treatment for obstructive sleep apnea
- Adenotonsillectomy
- Weight loss
- Craniofacial surgery
- Tracheostomy
if untreated, what can obstructive sleep apnea lead to
Pulmonary hypertension, cor pulmonale, pulmonary edema, systemic hypertension, & cognitive impairment
apnea that occurs before 37 weeks
AOP
what med to give for AOP
methylxanthines
if AOP is severe what other treatment is used
ventilator and CPAP
what can nurses do for AOP
tactile stimulation
defined as a frightening episode of apnea (central or obstructive) accompanied by a skin color change, limp muscle tone, choking, or gagging
ALTA
causes of ALTA
gastrointestinal reflux, seizures, lower tract infections
s/sx of ALTA
o apnea, cyanosis, hypotonia, unresponsiveness, labored breathing, and lethargy, limp muscle tone. May have pallor, or occasionally erythema rather than cyanosis
when does ALTA occur
sleep, feeding, or wakefulness, swinging
- lower resp. tract infection
- It causes inflammation & obstruction of the bronchioles
o Bronchiolitis
caused by Respiratory Syncytial Virus
Bronchiolitis
bronchiolitis puts infants at increased risk for what in adulthood
of asthma and wheezing
When do RSV infections occur
October & run through about March
how is RSV transmitted
Contact & respiratory
High risk for RSV
° Immunosuppressed ° Lung disease ° Severe neuromuscular disease ° Complicated congenital heart defects ° Very low birth weight
In RSV, during expiration, a child will experience __________ and you will hear wheezing and crackles
bronchospasm
what kind of purulent is seen in RSV
mucous
Mild s/sx of RSV
- rhinitis
- cough
- low grade fever
- wheezing
- tachypnea
- poor feeding
- vomiting
- diarrhea
- dehydration
severe s/sx of RSV
- Tachypnea greater than 70 bpm
- Grunt
- Increased wheezing
- Retractions
- Nasal flaring
- Irritability
- Lethargy
- Poor fluid intake
- Distended abdomen
- Cyanosis
- Decreased mental status
Is there a treatment for RSV
no
What kind of precaution is a child with RSV placed on?
contact isolation
In a RSV child, when would you use humidified O2?
if the O2 sat is below 90%
When does RSV usually resolve
5-7 days
What is the best indicator of severe disease in RSV?
O2 sat below 90%
When do s/sx of RSV decrease
24-72 hrs
Complete resolution of RSV s/sx
weeks
What is normal after RSV
coughing
When would you call the MD in a child with RSV
- breathing is rapid/difficult
- s/sx interfere with sleeping/eating
- s/sx persist
- child acts sicker
o The need for supplemental O2 for at least 28 days after premature birth.
bronchopulmonary dysplasia
What is the birth weight and the gestational age for bronchopulmonary dysplasia?
less than 1000g and 28 weeks or less
Causes of bronchopulmonary dysplasia
− Positive pressure ventilator or bag & mask after birth. They think this positive pressure is damaging their alveoli
− Meconium aspiration
− Neonatal pneumonia b/c the fluid is deterring alveoli to expand like they should
− Intrauterine infection
− Patent ductus arteriosus
− Sepsis
− Diaphragmatic hernia
A chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation
Asthma
What are some things that cause asthma?
- genes
- indoor air contaminants
- outdoor air pollutants
- recurrent resp viral infection
- allergic disease
In asthma, what causes the normal protective mechanisms (mucous formation, mucosal swelling, and airway muscle contraction) to overreact?
Inflammation
What are some asthma triggers?
- exercise
- viral or bacterial agents
- allergens
- fragrances
- food additives
- pollutants
- weather changes
- emotions or stress
In asthma, with exposure to a trigger, what is activated?
IgE and sensitized mast cells
After the triggers of asthma occur and IgE and mast cells are activated, what is released?
Inflammatory mediators - histamines, prostaglandin, and leukotriens
In asthma, what does airway narrowing result from?
Bronchial constriction
Swelling and production of mucous
In asthma, does mucous plug small or large airways?
Small
The sudden appearance of breathing difficulty (cough, wheeze, or breathlessness) is often referred to as what kind of asthma?
Acute asthma episode or asthma attach
What is the warning signal that the child’s airway is very sensitive to stimuli?
Frequent night coughing
During an acute asthma episode, are the respiration a slow or rapid?
Rapid
Are nasal flaring and retractions visible in an asthma attack?
Yes
What kind of cough will the child have if they are having an asthma attack?
Productive
What kind of wheezing is seen in an asthma attack?
Expiratory
Will a child with an asthma attack use their accessory muscles?
Yes
What will the child having an asthma attack complain of?
Chest tightness
In an asthma attach with sever obstruction, will wheezing be heard?
No
Present in a sever asthma attack, when the arterial blood pressure decrease during inspiration by 10 mmHg?
Pulsus paradoxus
In some cases, unrelenting, severe respiratory distress and bronchospasm persists despite medicine. These children are in acute respiratory distress. What are some s/sx?
- use of accessory muscles
- restlessness
- anxiety
- altered mental status
- inability to say more than a word or two without gasping for breath
- diaphoresis
- cyanosis
What are signs of impending respiratory failure?
- inability to speak
- inability to lie down
- altered mental status
- intercostal retractions
- worsening fatigue
Clinical therapy for exercise-induced asthma.
pretreatment with short-acting beta2-agonists before exercise
Clinical manifestations of exercise-induced asthmas.
- cough
- wheeze
- chest pain
- chest tightness
- SOB
- fatigue
Clinical therapy for acute asthma episode.
- continuouse albuterol by nebulizer
- oral systemic corticosteroids
- inhaled ipratropium
Clinical therapy for a severe asthma exacerbations.
- IV mag sulfate
- other meds for acute exacerbation
If the child w/ asthma is exhibiting breathing difficulty, give supplemental O2 via?
- nasal cannula
- face mask
What kind of O2 should be used to prevent drying and thickening of mucous secretions?
humidified
In asthma, how are most medications given?
inhalation route
Why is the inhalation route preferred when giving meds to a child w/ asthma?
pulmonary blood vessels will rapidly absorb the med while minimizing the systemic effects
In a child w/ asthma, what is essential to thin and break up trapped mucous plugs in the narrowed airways?
adequate hydration
What kind of fluids do children w/ asthma need?
- room-temperature
- slightly cooled fluids w/out ice
How can a nurse teach a toddler how to practice blowing into a peak flow meter?
blowing into party fevers
What does a PEFM rate of 80-100% mean?
good asthma control
What does a PEFM rate of 50-80% mean?
caution
What does a PEFM rate of less than 50% mean?
danger
If a child w/ asthma is taking oral corticosteroids, what type of vaccines may need to be postponed?
live
What kind of condition is asthma? A. chronic B. acute C. progressive D. abrupt E. episodic
Selcet all
A and C
o Inherited autosomal recessive disorder of the exocrine glands that effects the respiratory system, GI system, and reproductive system
cystic fibrosis
What does cystic fibrosis cause the body to produce?
an unusually thick sticky mucous that will clog the lungs and cause them to have infections
s/sx of cystic fibrosis
− Salty taste on skin
− Stools are different (fatty/ greasy look, frothy, fowl smelling, & will float)
− Prone to constipation
− Chronic moist productive cough
− Frequent resp. infections and sinus infections
− Wheezing, nasal drainage
− Later on might realize: clubbing of finger nails or toe nails, barrel chest
diagnosis criteria for cystic fibrosis
° Newborn meconium ileus
° Malabsorption or failure to thrive
° Chronic respiratory infections
° Fecal impaction and intussusception
• Bone marrow does not produce adequate numbers of circulating red blood cells
•
aplastic anemia
s/sx of aplastic anemia
o the most common is bleeding o petechiae on the mucous membranes o purpura o bloody stolls o epistaxis o retinal bleeding o weakness o tachycardia o pallor o fatigue o tachycardia o CHF o Fever o Bacterial infections
• Hereditary bleeding disorder with deficiency in specific clotting factors
Hemophilia
Hereditary bleeding disorder with deficiency in specific clotting factors
Immune (idiopathic) Thrombocytopenic Purpura
• Partial or complete replacement of normal hemoglobin with abnormal hemoglobin
Sickle Cell Anemia
What does sickle cell cause
• Causes occlusion of small blood vessels, ischemia, and damage to affected organs
