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6th Semester > Pedi Test 3 > Flashcards

Pedi Test 3 Flashcards

1
Q

The ability to discriminate letters or other objects.

A

visual acuity

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2
Q

What is the visual acuity of a neonate?

A

20/100 and 20/400

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3
Q

What is the shape of a neonate’s eye compared to an adult?

A

more spherical

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4
Q

What can the neonate’s vision not accommodate to?

A

near and far objects

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5
Q

What is the distance that the neonate can best see?

A

8 inches or 20 cm away

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6
Q

At what month should the eyes be aligned and coordinated?

A

3 months

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7
Q

Involuntary rapid eye movement.

A

nystagmus

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8
Q

Momentary turning inward of eyes.

A

esotropia

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9
Q

Is nystagmus and esotropia normal at birth?

A

yes

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10
Q

When should nystagmus and esotropia normally fade by?

A

first few months of life

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11
Q

Why do neonates have uncoordinated binoclear vision at birth?

A

their rectus muscles are completely formed

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12
Q

What is a result of trauma during birth on the eyes and usually improves gradually with no lasting effects?

A

conjunctival and retinal hemorrhages

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13
Q

What is examined in children because it is a key method for identifying the presence of retinoblastoma?

A

red reflex

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14
Q

What are some eye conditions common to premature neonates?

A
  • strabismus
  • retinopathy
  • refractive errors
  • color identification deficits
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15
Q

In the infant and young child, what occupies a larger portion of the orbit than in the adult?

A

cornea

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16
Q

How big is the eyeball of a neonate compared to an adult?

A

3/4 the size

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17
Q

How does the sclera of the neonate appear?

A

thin and translucent with a bluish tinge

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18
Q

What colors are the iris’ of the neonate?

A

blue and gray

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19
Q

At what month does eye color change?

A

6 months

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20
Q

Why don’t infants produce tears?

A

the lacrimal system drains them efficiently into the nasal cavity

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21
Q

What is a 2-3 year old’s visual acuity?

A

20/50

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22
Q

What is a 6-7 year old’s visual acuity?

A

20/20

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23
Q

What are the visual milestones of a term neonate?

A
  • demonstrates alertness to light and visual stimulus presented 8-12 inches from the eyes
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24
Q

What are the visual milestones of a 1 month old?

A
  • follows an object 60 degrees horizontally and 30 degrees vertically
  • blinks at an approaching object
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25
Q

What are the visual milestones of a 2 month old?

A
  • follows a person or moving object for 180 degrees from 6 ft
  • smiles in response to a face
  • raises head 30 degrees from prone
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26
Q

What are the visual milestones of a 3 month old?

A
  • tracks an object through 180 degrees
  • regards own hand
  • begins visual-motor coordination
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27
Q

What are the visual milestones of a 4-5 month old?

A
  • social smile
  • reaches for a cube 12 in away
  • notices a raisin 12 in away
  • stares at own hand
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28
Q

What are the visual milestones of a 7-8 month old?

A
  • reaches and grasps an object
  • picks up a raisin by raking
  • transfers objects from hand to hand
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29
Q

What are the visual milestones of a 8-9 month old?

A
  • pokes at holes in a peg board
  • well-developed pincer grasp
  • crawls
  • uncovers toy after seeing it hidden
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30
Q

What are the visual milestones of a 12-14 month old?

A
  • stacks blocks
  • places a peg in a round hole
  • stands and walks
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31
Q

What is the complex process of acquiring meaning from what is seen, involving the eye, brain, and related neurologic and physiologic structures?

A

vision

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32
Q

What connects the nasopharynx to the middle ear?

A

eustachian tube

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33
Q

Inflammation of the middle ear.

A

Otitis media

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34
Q

What is otitis media often accompanied by?

A

Infection

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35
Q

What type of children does otitis media occur mostly in?

A
  • 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
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36
Q

What appears to be protective against otitis media?

A

Breastfeeding

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37
Q

What is the specific cause of otitis media?

A

Unknown

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38
Q

What does otitis media appear to be caused by?

A

Eustachian tube dysfunction

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39
Q

What often precede the deployment of otitis media?

A

Upper respiratory infection

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40
Q

What are the most common caustics organisms of otitis media?

A

Streptococcus pneumonia a, Haemophilus influenzae, and Moraxella catarrhalis

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41
Q

What are some conditions that can obstruct the Eustachian tube which could further cause otitis media?

A

Enlarged adenoids or edema from allergic rhinitis

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42
Q

When is acute otitis media diagnosed?

A

When the child has acute onset of ear pain, marked redness of the tympanic membrane upon otoscopy, and middle ear effusion.

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43
Q

What type of otitis is evidence of fluid in the middle ear without inflammation?

A

Otitis media with effusion

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44
Q

Is otitis media effusion acute or chronic?

A

Chronic

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45
Q

What’s is otitis media with effusion associated with?

A

Hearing loss

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46
Q

What are some behaviors that infants and young children may show when they have otitis media?

A
  • pulling at the ear
  • diarrhea
  • vomiting
  • fever
  • irritability
  • acting out
  • night awakenings with crying
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47
Q

What is diagnosis of otitis media based on?

A

otoscopic examinations

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48
Q

When when a certainty diagnosis of acute otitis media be made?

A

What there is a history of:

  • acute onset
  • presence of middle ear effusion
  • signs and symptoms of inflammation
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49
Q

Which diagnostic tool for otitis media measures the condition of the middle ear by introducing a sound and measuring the tympanic membrane response?

A

special gradient acoustic reflectometry

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50
Q

What does a flat tympanogram indicate in otitis mediain?

A

absence of normal movement for the tympanic membrane

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51
Q

In cases with repeated antibiotic treatment failure in otitis media, what could you do instead?

A

typanocentesis

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52
Q

How would you diagnose otitis media with effusion?

*Remember, it causes hearing impairment!

A
  • otoscopy

- tympanometry

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53
Q

If otitis media with effusion persists for longer than 3 months, what kind of testing can be performed in the pediatric healthcare home?

A

audiologic testing

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54
Q

When would you refer an infant with otitis media to an audiologist?

A

If they fail testing in the office or are less than 4 years of age.

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55
Q

How is acute otitis media treated in children under 6 years?

A

antibiotic treatment for 10 days

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56
Q

How is acute otitis media treated in children 6 years and older?

A

antibiotic treatment for 5-7 days

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57
Q

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?

A

give analgesics but delay antibiotic treatment for 48-72 hours

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58
Q

In acute otitis media, when antibiotic therapy is not prescribed initially, what can the child be given?

A
  • ibuprofen
  • acetaminophen
  • topic aural analgesic
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59
Q

What is the first line antibiotic treatment for otitis media?

A

amoxicillin

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60
Q

What is the dose of amoxicillin for a child with acute otitis media?

A

80-100 mg/kg/day

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61
Q

What is the second line antibiotic treatment for acute otitis media?

A

amoxicillin with clavulanate or cefuroxime

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62
Q

If an intramuscular drug is preferred over an oral antibiotic treatment for acute otitis media, what could be given?

A
  • cefdinir at 14 mg/kg/day
  • cefpodoxime at 10 mg/kg/day
  • cefuroxime at 30 mg/kg/-day
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63
Q

Which otitis media is not treated with antibiotics?

A

otitis media with effusion

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64
Q

Children with otitis media with effusion generally improve within how many months?

A

3

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65
Q

What type of psychosocial action should not take place around children with otitis media with effusion?

A

smoking

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66
Q

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?

A
  • myringotomy (surgical incision of the tympanic membrane)

- tympanostomy tubes ( pressure-equalizing tubes)

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67
Q

Is “ear wicking” a good idea to manage otitis media?

A

no

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68
Q

What are some preventive measures that parents can implement to prevent otitis media?

A
  • 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
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69
Q

What medications would you explain don’t work for OME?

A
  • antibiotics
  • steroids
  • antihistamines/decongestants
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70
Q

What are some teaching strategies to reduce the pain of a child with otitis media?

A
  • 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
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71
Q

A nosebleed.

A

epistaxis

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72
Q

What age group is epistaxis common in?

A

school-aged

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73
Q

What is an area of plentiful veins located in the anterior nares and is a usual source of bleeding in epistaxis?

A

kiesselbach’s plexus

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74
Q

What are some causes of epistaxis?

A
  • irritation from nose picking
  • foreign bodies
  • low humidity
  • forceful coughing
  • allergies
  • infections
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75
Q

What type of nosebleed is more serious and usually requires hospitalization?

A

posterior

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76
Q

What is the cause of a posterior nosebleed?

A
  • systemic disease

- injury

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77
Q

To monitor for hypovolemia when there is excessive blood loss in epistaxis, what would you monitor?
* vital signs

A
  • blood pressure

- pulse

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78
Q

To examine the nasal mucosa in a child with an epistaxis, what would you instruct them to do?

A

blow any clots out

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79
Q

A nosebleed confined to one side of the nose is almost always anterior or posterior?

A

anterior

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80
Q

What type of nosebleed can flow on one or both sides?

A

posterior

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81
Q

If blood cannot be seen, what may the child be doing?

A

swallowing it

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82
Q

What type of nosebleed would you suspect if the child has sustained a blunt trauma to the head?

A

posterior

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83
Q

How to treat an anterior nosebleed?

A
  • 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
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84
Q

If an anterior nosebleed doesn’t stop, what could you soak a cotton ball in and insert into the affected nostril to promote vasoconstriction?

A
  • neo-synephrine
  • epinephrine
  • thrombin
  • lidocaine
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85
Q

Once an anterior nosebleed has stopped, what will the doctor have to do?

A

cauterize with silver nitrate or electrocautery

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86
Q

If an anterior nosebleed cannot be stopped, what kind of packing may be used?

A

absorbable

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87
Q

How would you stop a posterior nosebleed?

A
  • pack the nose
  • monitor the child
  • arterial ligation
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88
Q

If significant bleeding has occurred in a child with a nosebleed, what lab values would you monitor for?

A
  • hematocrit

- hemoglobin

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89
Q

What should the child avoid doing to prevent recurrence of nosebleeds?

A
  • avoid bending over
  • avoid stooping
  • avoid strenuous exercise
  • avoid hot drinks
  • avoid hot baths
  • all for the next 3-4 days
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90
Q

How should a child sleep after recovering from a nosebleed?

A
  • head elevated on 2-3 pillows

- humidifier

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91
Q

An inflammation of the conjunctiva, the clear membrane that lines the inside of the lid and sclera.

A

infectious conjunctivitis

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92
Q

Conjunctivitis in an infant under 30 days of age.

A

ophthalmia neonatorum

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93
Q

How is ophthalmia neonatorum usually acquired?

A

during vaginal delivery from discharge

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94
Q

What is instilled into the eyes of newborns soon after birth as a prophylactic measure against ophthalmia neonatorum?

A

antibiotics

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95
Q

Occasionally occurs in newborns as a reaction to prophylactic medication.

A

chemical conjunctivitis

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96
Q

A type of conjunctivitis that is characterized by edema of the eyelid, red conjunctiva, and enlarged preauricular lymph glands. There is usually mucopurulent exudate.

A

bacterial

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97
Q

What do older children with bacterial conjunctivitis complain of?

A
  • itching or burning
  • mild photophobia
  • feeling of scratching under the eyelids
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98
Q

What are most cases of bacterial conjunctivitis caused by>

A

hand-to-eye contact

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99
Q

Which conjunctivitis is commonly bilateral?

A

viral

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100
Q

Signs and symptoms of viral conjunctivitis.

A

Same as bacterial but sometimes they are milder in severity and slower in onset

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101
Q

Can herpes cause viral conjunctivitis?

A

yes

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102
Q

Characteristics of ophthalmic herpes infection.

A
  • unilateral
  • painful
  • vesicular lesions on the eyelids and skin of the face
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103
Q

A common cause of eye discomfort; conjunctivitis caused by an allergy.

A

allergic conjunctivitis

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104
Q

In allergic conjunctivitis, what will the child complain of?

A

intense itching

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105
Q

What will examination of allergic conjunctivitis reveal?

A
  • red eyes
  • watery discharge
  • conjunctivae having a cobblestone appear
  • edematous eyes
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106
Q

What forms of medication are given to the patient with conjunctivitis?

A
  • otic drops

- ointment

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107
Q

What are frequently given to treat bacterial conjunctivitis?

A

fluoroquinolones

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108
Q

What are some other drugs used to treat bacterial conjunctivitis?

A
  • sulfonamides
  • aminoglycosides
  • polymyxin B/ trimethoprim
  • azithromycin
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109
Q

When gonococcal conjunctivitis occurs in newborns, what is given?

A

ceftriaxone

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110
Q

What are Chlamydial infections of the eyes treated with?

A

oral erythromycin or tetracycline

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111
Q

What are some comfort measures to use for viral conjunctivitis?

A
  • cleaning drainage with a warm clean cloth
  • avoid bright lights
  • avoid reading
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112
Q

How is herpes simplex conjunctivitis treated?

A
  • acyclovir parenternal
  • trifluridine topical
  • iododexyuridine topical
  • vidarabine topical
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113
Q

How to treat allergic conjunctivitis?

A
  • systemic or topical antihistamines
  • topical steroids
  • vasoconstrictors
  • decongestants
  • mast cells stabilizers
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114
Q

What are some things to teach parents with a child who has conjunctivitis?

A
  • 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
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115
Q

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.

A

nasopharyngitis

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116
Q

What are the most common viruses that cause nasopharyngitis?

A
  • rhinovirus

- coronavirus

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117
Q

What is the most common bacterium that causes nasopharyngitis?

A
  • Strep A
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118
Q

After organisms causing nasopharyngitis incubate, when is the infection communicable?

A

several hours before symptoms and 1-2 days after they begin

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119
Q

How many days will nasopharyngitis symptoms last?

A

4-10

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120
Q

How are the pathogens of nasopharyngitis believed to be spread?

A

the infected person touches the hand of an uninfected person, who then touches his or her mouth or nose

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121
Q

General symptoms of nasopharyngitis.

A
  • red nasal mucosa
  • clear nasal discharge
  • infected throat with large tonsils
  • vesicles on soft palate and in the pharynx
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122
Q

Symptoms of nasopharyngitis in infants younger than 3 months?

A
  • lethargy
  • irritability
  • feeding poorly
  • fever (may be absent)
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123
Q

Symptoms of nasopharyngitis in infants 3 months or older?

A
  • fever
  • vomiting
  • diarrhea
  • sneezing
  • anorexia
  • irritability
  • restlessness
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124
Q

Symptoms of nasopharyngitis in older children?

A
  • 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
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125
Q

For infants who cannot breathe through the mouth, what should you do if they have nasopharyngitis?

A

administer normal saline nosedrops every 3-4 hours

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126
Q

For infants older than 9 months with nasal stuffiness, how would would treat it?

A

normal saline nosedrops

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127
Q

For children over 6 years of age, how would you treat nasopharyngitis?

A

nasal sprays

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128
Q

In nasopharyngitis, how long can decongestant nosedrops and sprays be used for?

A

no longer than 4-5 days

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129
Q

What to teach a parent with a child who has nasopharyngitis?

A
  • 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
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130
Q

An inflammation of one or more of the paranasal sinuses.

A

sinusitis

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131
Q

The sinuses become infected following what type of infection?

A

viral upper respiratory

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132
Q

What will the child’s history reveal about sinusitis?

A

upper respiratory infection for several days, followed by improvement in symptoms and a decrease in nasal drainage

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133
Q

In bacterial sinusitis, the upper respiratory infection improves but what increases?

A

purulent nasal drainage

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134
Q

What is the temperature in bacterial sinusitis?

A

102 F

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135
Q

How long do the symptoms of bacterial sinusitis last?

A

10 days

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136
Q

What are the symptoms of bacterial sinusitis accompanied by?

A
  • pain
  • headache
  • fever
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137
Q

In what uncontrolled conditions will chronic sinusitis occur in?

A
  • asthma

- allergies

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138
Q

What are the symptoms of sinusitis?

A
  • history of upper respiratory infections
  • persistent cough
  • nasal discharge or swelling
  • malodorous breath
  • fever
  • mouth breathing
  • headache
  • hyponasal speech
  • cervical lymphadenopathy
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139
Q

What will young children with sinusitis show?

A
  • trouble feeding

- anorexia

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140
Q

What will older children with sinusitis complain of?

A
  • headache

- fatigue

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141
Q

How to diagnose sinusitis?

A
  • MRI or CT

- aspiration of sinus exudate

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142
Q

Many cases of sinusitis clear spontaneously. True or False

A

true

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143
Q

What is the first choice of therapy for sinusitis?

A

amoxicillin

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144
Q

What are some other choices of medication for sinusitis?

A
  • amoxicillin/clavulanate
  • cefuroxime
  • cefdinir
  • azithromycin
  • clarithromycin
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145
Q

What should you do for children with recurrent and chronic sinusitis?

A

refer them to a specialist

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146
Q

What would you teach parents with a child who has sinusitis?

A
  • 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
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147
Q

An infection that primarily affects the pharynx, including the tonsils.

A

pharyngitis

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148
Q

What percentage of viruses causes pharyngitis?

A

80%

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149
Q

Bacteria pharyngitis is also known as?

A

strep throat

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150
Q

What is the major complaint of pharyngitis?

A

sore throat

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151
Q

Are the classic signs of purulent drainage and white patches always present in strep throat?

A

no

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152
Q

What are the signs and symptoms of viral pharyngitis?

A
  • nasal congestion
  • mild sore throat
  • conjunctivitis
  • hoarseness
  • mild pharyngeal redness
  • minimal tonsillar exudate
  • mildly tender anterior cervical lymphadenopathy
  • fever below 101 F
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153
Q

What are the signs and symptoms of strep throat?

A
  • 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
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154
Q

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?

A

these are signs of epiglottis

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155
Q

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.

A

peritonsillar abscess and retropharyngeal abscess

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156
Q

How is strep throat diagnosed?

A

throat culture

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157
Q

How should strep throat be treated?

A
  • oral penicillin for 10 days
  • long-acting penicillin given in one injection
  • if allergic to penicillin, give erythromycin
  • azithromycin and clarithromycin
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158
Q

After giving medicine, how long will the acute symptoms of strep throat resolve in which the child is no longer contagious?

A

24 hours

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159
Q

How to treat viral pharyngitis?

A

treat the symptoms

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160
Q

How to treat a peritonsillar abscess?

A
  • drain the abscess
  • antibiotics
  • hydration
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161
Q

How is a retropharyngeal abscess treated?

A
  • drain the abscess

- IV antibiotics

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162
Q

What would you teach the parents of a child with pharyngitis?

A

− 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

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163
Q

An infection or inflammation (hypertrophy) of the palatine tonsils.

A

tonsilitis and adenoiditis

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164
Q

What causes tonsilitis and adenoiditis?

A

viruses and bacteria

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165
Q

Symptoms of tonsilitis.

A
  • frequent throat infection
  • breathing and swallowing difficulties
  • persistent redness of the anterior pillars
  • enlargement of the cervical lymph nodes
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166
Q

Symptoms of adenoiditis.

A
  • nasal stuffiness
  • discharge
  • postnasal drip
  • coughing
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167
Q

How to diagnose tonsilitis and adenoiditis?

A
  • visual inspection

- clinical manifestations

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168
Q

What is required to diagnose tonsilitis?

A

enlarged tonsils with pain and inflammation

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169
Q

Symptomatic treatment for tonsilitis is the same for what other infection?

A

pharyngitis

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170
Q

When would you consider a tonsillectomy?

A
  • 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
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171
Q

What to a teach the parents of a child with tonsilltis?

A

− 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

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172
Q

What are some discharge instructions and teachings following a tonsillectomy?

A
  • 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
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173
Q

The mouth needs moisture; therefore, what is one condition that causes mouth ulcers?

A

dehydration

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174
Q

What are some disorders that can cause mouth ulcers?

A
  • chemotherapy-related oral mucositis
  • AIDS-related oral mucositis
  • Stevens-Johnson syndrome
  • Aphthous ulcers
  • Herpes simplex gingivostomatitis
  • Traumatic ulcers
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175
Q

How to treat mouth ulcers?

A
  • treat the symptoms
  • keep the mouth clean
  • administer systemic or topical analgesics
  • acyclovir for herpes
  • antibiotics for bacterial infections
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176
Q

How to treat Steven-Johnson syndrome?

A

remove the drug and give oral antihistamines

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177
Q

What are some teaching strategies for mouth ulcers?

A
  • 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
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178
Q

A complete removal of a tooth.

A

avulsion

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179
Q

What to teach the parents with a child who has a tooth avulsion?

A
  • handle the tooth by the crown

- gently rinse the tooth with sterile saline

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180
Q

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

A

B

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181
Q

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

A

foramen ovale

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182
Q

where the majority of blood passes; the channel between the pulmonary artery and the descending aorta, to enter the systemic circulation

A

ductus arteriosus

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183
Q

When does the transition from fetal to pulmonary circulation occur?

A

few hours after birth

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184
Q

What does the first breath do to the lung?

A

expands them

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185
Q

After the first breath and expansion of the lungs, where does blood begin to flow?

A

to the lungs

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186
Q

What happens to the pulmonary blood flow after the first breath?

A

increases

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187
Q

What happens to the pulmonary vascular resistance as a result of the first breath?

A

decreases

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188
Q

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?

A

pressure increases

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189
Q

What happens to the systemic vascular resistance after the first breath?

A

increases

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190
Q

What happens to the pressure in the R atrium after the umbilical cord is cut?

A

decreases

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191
Q

What occurs as the pressure in the L atrium increases?

A

foramen ovale closes

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192
Q

When does the patent ductus begin to close?

A

10-15 hours after birth

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193
Q

How many days after birth should the patent ductus be completely closed?

A

10-21 days

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194
Q

The patent ductus may not close if the fetal’s O2 Sat is how?

A

too low[

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195
Q

What are the key assessments of a child with a cardiac condition?

A
  • vital signs
  • skin
  • pulse ox
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196
Q

With a cardiac condition, what characteristics about the respirations do you want to assess?

A

− rate and depth
− cough?
− Tachypnea, dyspnea, retractions, nasal flaring, or expiratory grunting?
− Auscultate breath sounds

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197
Q

With a cardiac condition, what characteristics about the pulse do you want to assess?

A

− Assess the rate, rhythm, and quality

− Compare the pulse sites for strength and rate

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198
Q

With a cardiac condition, what characteristics about the blood pressure do you want to assess?

A

− Compare BP to expected value for age, gender, and height percentile
− Compare BP values between upper and lower extremities

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199
Q

With a cardiac condition, what characteristics about the color of the skin do you want to assess?

A

− Note pallor, dusky, or cyanosis
− Compare in peripheral and central locations
− Does crying improve or worsen the color?
− Pulse oximetry

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200
Q

With a cardiac condition, what characteristics about the chest do you want to assess?

A

− Inspect the anterior and posterior for any abnormalities, bulging, or heaving
− Palpate the chest wall over the heart
− Locate the point of maximum intensity

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201
Q

With a cardiac condition, what characteristics about heart auscultation do you want to assess?

A

− 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

202
Q

With a cardiac condition, what characteristics about the fluid status do you want to assess?

A

− 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

203
Q

With a cardiac condition, what characteristics about the activity and behavior do you want to assess?

A

− 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

204
Q

With a cardiac condition, what characteristics in general do you want to assess?

A
  • assess patterns of growth
205
Q

Defects that obstruct the flow of blood from the R side of the heart to the lungs _________ pulmonary blood flow.

A

decreases

206
Q

If there is little or no blood reaching the lungs, the blood is not getting __________.

A

oxygenated

207
Q

One of the most common congenital heart defects causing cyanosis.

A

tetralogy of fallot

208
Q

In tetralogy of fallot, what kind of shunt is it?

A

right to left

209
Q

What is the classic sign of tetralogy of fallot?

A

when you put the child on oxygen they are supposed to pink up, with this condition, they won’t

210
Q

What are the four defects of tetralogy of fallot?

A
  • ventricular septal defect
  • pulmonary stenosis
  • overriding of the aorta
  • hypertrophy of right ventricle
211
Q

What is pulmonary stenosis?

A

narrowing of the pulmonary valve

212
Q

What is ventricular septal defect?

A

opening between the ventricles

213
Q

In tetralogy of fallow, what is the 5th defect?

A

atrial septal defect

214
Q

The overriding aorta and VSD of tetralogy of fallot allows __________ blood to pass into the systemic circulation.

A

unoxygenated

215
Q

Manifestations of tetralogy of fallot.

A
  • cyanosis
  • squatting
  • clubbing
  • systolic murmur heard in the pulmonic area
  • palpable thrill
  • polycythemia
  • metabolic acidosis
  • poor growth
  • exercise intolerance
216
Q

What are some complications of tetralogy of fallot?

A
  • CHF
  • developmental delays
  • CVA
217
Q

What is the clinical therapy for tetralogy of fallot?

A
  • manage hypercyanotic episodes
  • monitor for metabolic acidosis
  • corrective surgery
  • prophylaxis antibiotic for surgery
  • palliative surgery
  • PGE1 if patent ductus isn’t closed
218
Q

How to manage a hypercyanotic episode?

A
  • 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
219
Q

What is the nursing care of tetralogy of fallot?

A
  • 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
220
Q

An abrupt decrease in systemic vascular resistance and pulmonary blood flow with an increase in cardiac output and sudden venous return.

A

hypercyanotic episode

221
Q

What worsens a hypercyanotic episode?

A
  • waking up
  • crying
  • bathing
  • straining at bowel movement
222
Q

Disorder of circulation in which cardiac output is inadequate to support body’s circulatory and metabolic needs.

A

CHF

223
Q

What does CHF result from?

A

May result from congenital heart defect that causes either increased pulmonary blood flow or obstruction to the systemic outflow tract

224
Q

Initial signs of CHF in infants

A
  • 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
225
Q

Initial signs of CHF in children

A
  • Exercise intolerance
  • Dyspnea
  • Abdominal pain or distention
  • Peripheral edema
  • Skin color changes such as mottling or pallor
  • Parents may notice coughing
226
Q

Signs of CHF as the disease progresses

A
  • 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
227
Q

During CHF, what does the heart do to compensate in order to maintain cardiac output?

A

enlarges

228
Q

If left untreated, what can CHF lead to?

A

cardiogenic shock

229
Q

What are the precursors for cardiogenic shock?

A
  • Cyanosis
  • Weak peripheral pulses
  • Cool extremities
  • Hypotension
  • Murmur
230
Q

What are some diagnostic procedures done for CHF?

A
  • observe manifestations
  • chest radiography
  • echocardiography
  • electrocardiogram
  • renal and liver function tests
  • electrolytes and ABG
  • CBC
231
Q

What is the #1 goal of clinical therapy for CHF?

A

treat the cause

232
Q

What is the #2 goal of clinical therapy for CHF?

A

maximize the cardiac output and tissue perfusion

233
Q

Which medications may be given for CHF?

A
  • diuretics
  • ACE inhibitors
  • digoxin
234
Q

If CHF is difficult to manage, what will be done

A

surgery or interventional catheterization will be done

235
Q

During nursing management, to diagnose a patient with CHF, what would the physiologic assessment consist of?

A
  • 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
236
Q

During nursing management, to diagnose a patient with CHF, what would the family assessment consist of?

A
  • 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
237
Q

During nursing management, to diagnose a patient with CHF, what would the developmental assessment consist of?

A
  • 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
238
Q

For a patient with CHF, what must the nurse do before giving digoxin?

A
  • establish baseline vitals;
  • assess the quality of the peripheral pulses and clinical symptoms;
  • obtain an electrocardiogram;
  • check the apical pulse for 1 minute
239
Q

For a patient with CHF, when would you contact the MD before giving digoxin?

A
  • 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
240
Q

For the patient with CHF, how would the nurse maintain oxygenation and myocardial function?

A
  • 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
241
Q

For the patient with CHF, how would the nurse promote rest?

A
  • Rocking is restful and comforting for infants

- Encourage older children to engage in quiet activities

242
Q

For the patient with CHF, how would the nurse foster development?

A
  • 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
243
Q

For the patient with CHF, how would the nurse provide adequate nutrition?

A
  • 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
244
Q

For the patient with CHF, how would the nurse provide emotional support?

A
  • 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
245
Q

For the patient with CHF, how would the nurse plan for discharge and home care?

A
  • Arrange for home care nursing visits
  • Ensure the family has a phone contact for emergency
  • Medication administration
  • Assessment for worsening condition
246
Q

When should a child report worsening conditions of CHF to the MD?

A
  • watch for increased feeding difficulty
  • irritability
  • lethargy
  • breathing difficulty
  • and puffiness around the eyes and extremities
247
Q

What is the maintenance level of digoxin?

A

0.8-2 mg/mL

248
Q

Infection in an individual with endocardial cell damage

A

endocarditis

249
Q

Inflammation or infection of the heart valve or the heart lining

A

endocarditis

250
Q

What is endocarditis associated with?

A 
o	Congenital heart defects
o	Rheumatic heart disease
o	Central venous catheter
o	Heart surgery 
o	IV drug abuse
251
Q

What is the most common symptom of endocarditis?

A

recurrent fever

252
Q

What are other symptoms of endocarditis?

A
  • 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
253
Q

Children with indwelling catheters may have what type of symptoms?

A

pulmonary

254
Q

Diagnostic procedures for endocarditis.

A
  • 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
255
Q

What is types of medications are given for endocarditis?

A 
Administer high doses of bactericidal antibiotics:
•	Penicillin G
•	Ceftriaxone
•	Vancomycin
•	Nafcillin
•	Oxacillin
•	Gentamicin
•	Ciprofloxacin
•	Cefazolin
256
Q

IV administration of antibiotics in endocarditis is preferred if the therapy is continued for how many weeks?

A

4-8 weeks

257
Q

What is the nursing assessment and diagnosis for a child with endocarditis?

A
  • 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
258
Q

What is the planning and intervention for a nurse for a child with endocarditis?

A
  • 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
259
Q

What does discharge planning and home care teaching consist of with a child who has endocarditis?

A
  • 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
260
Q

•An inflammatory connective tissue disorder that results from strep A

A

rheumatic fever

261
Q

Manifestations of rheumatic fever

A

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

262
Q

Diagnostic procedures for rheumatic fever

A
  • 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
263
Q

What antibiotics will be given for rheumatic fever?

A
  • Penicillin
  • Sulfadiazine
  • Erythromycin
264
Q

How to treat fever, arthritis, and arthralgia in rheumatic fever?

A

aspirin

265
Q

How to treat severe carditis in rheumatic fever?

A

corticosteroids

266
Q

What are some long-term antibiotics for prophylaxis of rheumatic fever?

A
  • IM benzathine penicillin
  • Oral penicillin V
  • Oral sulfadiazine
267
Q

Children with heart valve damage need antibiotic prophylaxis for _________.

A

endocarditis

268
Q

How will a nurse manage the acute inflammatory phase of rheumatic fever?

A

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

269
Q

How will a nurse manage the recovery phase of rheumatic fever?

A

o Generally cared for at home
o Activities are limited
o Help parents plan quiet activities

270
Q

What discharge action will a nurse take for a child with rheumatic fever?

A

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

271
Q

Acute febrile, systemic inflammatory illness affecting small and midsize arteries

A

kawasaki disease

272
Q

Kawasakie disease an cause ________ in arteries including coronary arteries therefore it important to diagnose early to prevent this

A

aneurysms

273
Q

Manifestations of the acute phase of kawasaki disease.

A

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.

274
Q

Manifestations of the subacute phase of kawasaki disease.

A

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

275
Q

Manifestations of the convalescent phase of kawasaki disease.

A

6-8 weeks after illness began, child appears normal but lingering signs of inflammation may be present

276
Q

Other symptoms of kawasaki disease.

A
  • Arthralgia
  • Abdominal pain
  • Diarrhea
  • Vomiting
  • Hepatic dysfunction
  • Gallbladder hydrops
  • Aseptic meningitis
  • Hearing loss
277
Q

What is the diagnostic criteria for kawasaki disease?

A
  • 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
278
Q

What is the clinical therapy of kawasaki disease?

A
  • IV IVIG within 7-10 days

* High doses of aspirin – 8-100 mg/kg/day to reduce fever

279
Q

What is the nurses role in assessing and diagnosing kawasaki disease?

A
  • 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
280
Q

What is the nurses role in planning and implementing care with kawasaki disease?

A
  • 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
281
Q

What is the role of the nurse in discharge planning and home care teaching?

A
  • 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
282
Q

abnormal heart rhythms

A

arrhythmias

283
Q

What are examples of fast arrhythmias?

A
  • tacharrhythmias (sinus tachycardia)
284
Q

What are examples of slow arrhythmias?

A
  • bradyarrhythmias (sinus bradycardia)
285
Q

What are some examples where there is no pulse?

A

ventricular tachycardia, ventricular fibrillation, pulseless, aystole

286
Q

What are arrhythmias associated with?

A

o Postoperative complications of congenital heart disease
o Kawasaki disease with coronary involvement
o Rheumatic heart disease
o Cardiomyopathy
o Electrolyte abnormalities

287
Q

Arrhythmias must be recognized because they can cause ________ cardiac output and CHF

A

decrease

288
Q

Causes of tachycardia.

A
  • Hypoxia
  • Anemia
  • Hypovolemia
  • Shock
  • Hyper or hypokalemia
  • Hyperthyroidism
  • Catecholamine medications
  • Stimulant or illicit drug use
289
Q

Causes of bradycardia.

A
  • Hypoxemia
  • Hypothermia
  • Increased intracranial pressure
  • Heart block
  • Hypothyroidism
  • Sick sinus syndrome
  • Digoxin, beta-blockers, calcium channel blockers, and cholinergic agents
290
Q

Manifestations of bradycardia.

A
  • 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
291
Q

Manifestations of tachycardia

A 
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
292
Q

Manifestations of long QT syndrome

A
  • Episodic dizziness
  • Palpitations
  • Syncope
  • Seizure
  • Cardiac arrest
293
Q

What triggers a long QT syndrome?

A

demanding physical exercise, a strong emotional reaction, or an abrupt loud noise

294
Q

What is initially used to diagnose an arrhythmia?

A

electrocardiogram

295
Q

If symptoms are episodic for arrhythmias, what would be done to diagnose it?

A

24 hour Holter monitor or an event monitor may be used to capture the arrhythmia

296
Q

What may be performed when exercise either triggers or is associated with the symptoms of arrhythmias?

A

stress test

297
Q

What are some invasive procedures to diagnose arrhythmias?

A

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

298
Q

Clinical therapy for bradycardia.

A
  • Oxygen
  • Ventilation
  • Epinephrine
  • Atropine
  • Pacemaker
299
Q

Clinical therapy for tachycardia.

A
  • Vagal maneuvers
  • valsalva maneuver
  • Adenosine
  • Amiodarone
  • Procainamide
300
Q

What would be applied to infants with tachycardia as clinical therapy to reduce HR?

A

Apply ice or iced saline solution to the face or rectal stimulation with a thermometer

301
Q

If a child with tachycardia doesn’t return to sinus rhythm, what would happen?

A
  • Synchronized cardioversion

- Esophageal overdrive

302
Q

What are some long term medications that may be given for someone with recurrent SVT?

A 
o	Digoxin
o	Verapamil
o	Propranolol
o	Procainamide
o	Amiodarone
303
Q

If a child is suspected of having an arrhythmia, what would the nurse monitor?

A
  • Level of consciousness
  • Heart rate
  • Other vital signs
304
Q

What would a nurse do to assess and diagnose a child with an arrhythmia?

A
  • Use a cardiorespiratory monitor and pulse OX to identify deterioration
  • Changes in color, weakness, irritability, and changes in feeding pattern indicate hypoxia
305
Q

What would a nurse do to plan and implement interventions for a child with an arrhythmia?

A
  • Attach the cardiorespiratory monitor
  • Assist the child with Valsalva maneuvers
  • Administer meds
  • Provide rest
  • Have emergence equipment available
306
Q

The most abundant of the cellular elements of blood

A

RBC

307
Q

RBCs are formed through ______

A

erythropoiesis

308
Q

Primary function of RBCs.

A

transport O2 from the lungs to the tissues AND carry CO2 from the tissues back to the lungs

309
Q

essential to RBCs function

A

hemoglobin

310
Q

lifespan of RBCs

A

120 days

311
Q

The ______ destroys RBCs and the iron from the cell is stored for later use

A

spleen

312
Q

hormone produced by the kidney that stimulates RBC production

A

Erythropoietin

313
Q

above-average increase in RBC

A

Polycythemia

314
Q

What is a cause of polycythemia?

A

anemia

315
Q

RBC value

A

3.8-5.03

316
Q

Hgb value

A

10.2-13.4

317
Q

Hct value

A

31.7-39.8

318
Q

o Mobile units of the body’s protective system

A

WBC

319
Q

Where are WBC formed

A

bone marrow and lymph tissue

320
Q

percentage of the different types of WBCs and can help discern the cause of an illness

A

differential

321
Q

decrease in the number of WBC

A

leukopenia

322
Q

Type of WBC- Phagocytosis; bands- immature; segs- mature

A

neutrophils

323
Q

Type of WBC- allergic reactions

A

eosinophils

324
Q

Type of WBC- inflammatory reactions

A

basophils

325
Q

Type of WBC- phagocytosis and antigen processsing

A

monocytes

326
Q

type of WBC- humoral and cellular immunity

A

lymphocytes

327
Q

neutrophil value

A

22.4-74.7

328
Q

basophil value

A

0-4.7

329
Q

eosinophil value

A

0.1-0.6

330
Q

monocyte value

A

4.1-12.3

331
Q

lymphocyte value

A

18.1-57.8

332
Q

o Cell fragments that can form hemostatic plugs to stop bleeding

A

platelets

333
Q

Platelets are synthesized from components in the red bone marrow and are stored in the ______

A

spleen

334
Q

Thrombocytopenia

A

platelet deficit

335
Q

• Reduction in the number of RBCs, the quantity of hemoglobin, and the volume of packed RBCs to below normal levels.

A

anemia

336
Q

causes of anemia

A 
o	Blood loss (trauma)
o	Body not producing enough RBC or body destroying RBC 
o	Nutrition deficiency
o	Menstrual cycle 
o	Hypersplenism
337
Q

causes of iron deficit. anemia

A 
o	Not starting infants on baby foods after 6 months
o	Blood loss
o	Malabsorption
o	Increased physiologic demands 
o	Pica
338
Q

signs of iron deficit. anemia

A 
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
339
Q

clinical therapy for iron deficit. anemia

A
  • Oral elemental iron preparations for 4 months
  • Ferrous sulfate 3-6 mg/kg/day for 4 weeks
  • Evaluate for 6 months for recurring anemia
340
Q

When to screen for iron deficit anemia

A
  • 9-12 months
  • 15-18 months
  • Adolescents (menstrual cycle)
  • Males- routine exam during growth spurts
  • Diet history and analysis
341
Q

eat foods with what vitamin for iron deficit anemia

A

c

342
Q

what kind of milk to avoid for iron deficit anemia

A

cow

343
Q

side effects of ferrous sulfate

A

o Black, green, or “tarry” stools; constipation; and a foul aftertaste

344
Q

signs of overdose of iron

A

o Abdominal pain, vomiting, bloody diarrhea, SOB, and shock

345
Q

An inflammation of the tissues surround the epiglottis.

A

Epiglottis

346
Q

When does edema develop in epiglottis?

A

Within minutes or hours

347
Q

What kind of condition is epiglottis

A

Life threatening

348
Q

What is epiglottis caused by

A

Bacteria

349
Q

What kind of fever is present in epiglottis

A

Greater than 102

350
Q

What kind of sore throat during epiglottis

A

Sever

351
Q

Classic signs of epiglottis

A

Dysphonia
Dysphagia
Drooling
Distressed respiratory with inspiratory stridor

352
Q

What kind of position does the child resume in epiglottis

A

Tripod

353
Q

What is contraindicated in epiglottis

A

Visual inspection of the mouth and throat

354
Q

What is done immediately for a child with epiglottis

A

Endotracheal tube

355
Q

What two meds don’t work for epiglottis

A

Epi and corticosteroids

356
Q

What color is their epiglottis during epiglottitis

A

Cherry red

357
Q

If a child wit epiglottitis is quiet, what do you do

A

Make sure they are awake and get medical attention FAST

358
Q

What kind of environment does a child with epiglottitis need to be in before they are seen by a doctor

A

Quiet

359
Q

A term applied to a broad classification of upper airway illness that result from inflammation and swelling of the epiglottis and larynx

A

Croup

360
Q

A viral invasion of the upper respiratory airway that extends throughout the larynx, trachea, and bronchi

A

Laryngotracheobronchitis

361
Q

How do the tracheal and laryngeal airway tissues respond to a virus

A

They inflame

362
Q

After the child’s airway inflames following a virus, what happens to their secretions

A

Increase

363
Q

The laryngeal inflammation causes the airway diameter to narrow in what area

A

Subglottic

364
Q

Symptoms of LTB

A
  • low grade fever
  • cough and hoarseness
  • runny nose
  • tachypnea
  • inspiratory stridor
  • seal-like barking cough
365
Q

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?

A

Severe

366
Q

In LTB, changes in what indicate the development of hypoxemia and potential respiratory failure

A

Mental status

367
Q

In LTB, when do you give supplemental oxygen

A

If their sat is less than 92

368
Q

What kind of onset does LTB have

A

Gradual

369
Q

What does LTB start with

A

URI

370
Q

Within how many hours will LTB progress to symptoms of respiratory distress and airway obstruction

A

24-48 hrs

371
Q

In LTB, what kind of breathing verified adequate energy stores, noisy or quiet?

A

Noisy

372
Q

What kind of position in LTB does the child assume

A

Upright or lying with the head elevated

373
Q

What two meds can be given with LTB

A

Beta-agonists and corticosteroids

374
Q

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

A, E, F

375
Q

When the body can no longer maintain effective gas exchange

A

Respiratory failure

376
Q

Do the alveoli hypo or hyperventilate during respiratory failure

A

Hypo

377
Q

Lower than normal blood oxygen level

A

Hypoxemia

378
Q

Excess of carbon dioxide

A

Hypercapnia

379
Q

Lower than normal oxygen level in tissues

A

Hypoxia

380
Q

Acute respiratory failure caused by lung injury that does not respond to supplemental oxygen

A

ARDS

381
Q

Examples of conditions that damage the lungs

A 
Pneumonia
Sepsis
Meconium aspiration
Aspiration of stomach contents 
Smoke inhalation 
Near drowning
382
Q

What happens to the alveolar-capillary membrane after the lungs are injured

A

Damaged

383
Q

What happens to the permeability of the alveolar-capillary membrane after the lungs are damaged

A

Increases - fluid and protein accumulate in the alveoli

384
Q

What results if the alveoli are filled with fluid and protein

A

Pulmonary edema

385
Q

What is mismatched in ARDS

A

ventilation-perfusion

386
Q

In infants, what is a sign of sever distress and a need for mechanical vent

A

Grunting

387
Q

Signs of initial respiratory failure

A

Restlessness
Tachypnea
Tachycardia
Diaphoresis

388
Q

What are signs of early decompensation

A 
Nasal flaring
Retractions
Grunting 
Wheezing 
Anxiety and irritability mood changes
Headache 
Hypertension 
Confusion
389
Q

Signs of sever hypoxia and imminent respiratory arrest

A

Dyspnea
Bradycardia
Cyanosis
Stupor and coma

390
Q

Hypercarbia in the presence of what condition is a sign of respiratory failure?

Acidosis or alkalosis

A

Acidosis

391
Q

As the child is more hypoxic, what happens to their level of consciousness

A

Decreases

392
Q

What will doctors do if a child is hypoxic and their level of responsiveness decreases in order to stabilize the airway?

A

Insert an endotracheal tube

393
Q

Creation of a surgical opening into the trachea through the neck to give long term airway

A

Tracheostomy

394
Q

Are children sedated to optimize their ventilation

A

Yes

395
Q

If acute respiratory failure becomes life threatening, what will be initiated?

A

ECMO

396
Q

What does an ECMO allow the lungs to do

A

Rest and heal

397
Q

Complications of ECMO

A 
Bleeding
Stroke 
Renal insufficiency 
Hypertension 
Seizures 
Electrolyte abnormalities 
Pneumothorax 
Cardiac dysfunction 
Infection
398
Q

Irregular rhythm with occasional pauses up to 20 seconds between breaths

A

Periodic breathing

399
Q

Cessation of respiration lasting longer than 20 seconds or any pause in respiration associated with cyanosis, marked pallor, hypotonia, or bradycardia

A

Apnea

400
Q

When is the child removed from a ventilator

A

When they begin to respond to clinical therapy

401
Q

Type of apnea - complete cessation of breathing effort

A

Central

402
Q

Type of apnea - absence of nasal airflow when respiratory efforts are present

A

Obstructive

403
Q

Type of apnea - central respiratory pause that either precedes or follows an airway obstruction

A

Mixed

404
Q

Apnea in an infant born in before 37 weeks and is associated with respiratory control

A

Apnea of prematurity

405
Q

When do apneic episodes often occur

A

During periods of active sleep

406
Q

What are infants with apnea of prematurity treated with

A

Methxanthines

407
Q

If apnea of prematurity is severe, what will be used

A

Ventilator support

408
Q

When do episodes of premature apnea disappear

A

By 37 weeks

409
Q

How should the neonate with AOP be placed

A

Head at midline and neck in neutral position or slightly extended

410
Q

What kind of stimulation will halt an apneic episode

A

Tactile - run their back or feet

411
Q

Signs of caffeine toxicity

A 
Tachycardia 
Tachypnea 
Jitteriness 
Tremors 
Unexplained seizures 
Vomiting
412
Q

Frightening episode of apnea

A

Apparent life threatening event

413
Q

What is ALTE accompanied with

A

Cyanosis or pallor
Limp muscle tone
Choking
Gagging

414
Q

Associated conditions of ALTE

A

Reflux
Seizures
Lower tract infections

415
Q

Should child abuse be considered as a cause of ALTE

A

Yes

416
Q

Coming signs of ALTE

A 
Apnea
Cyanosis
Hypotonia 
Unresponsiveness
Labored breathing 
Lethargy
417
Q

When does ALTE occur

A

Sleep
Wakefulness
Feeding

418
Q

complete cessation of breathing effort

A

central apnea

419
Q

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

A

obstructive apnea

420
Q

central respiratory pause that either precedes or follows airway obstruction

A

mixed apnea

421
Q

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

A

obstructive sleep apnea

422
Q

o Results in breathing difficulty and snoring when the child sleeps

A

obstructive sleep apnea

423
Q

treatment for obstructive sleep apnea

A
  • Adenotonsillectomy
  • Weight loss
  • Craniofacial surgery
  • Tracheostomy
424
Q

if untreated, what can obstructive sleep apnea lead to

A

Pulmonary hypertension, cor pulmonale, pulmonary edema, systemic hypertension, & cognitive impairment

425
Q

apnea that occurs before 37 weeks

A

AOP

426
Q

what med to give for AOP

A

methylxanthines

427
Q

if AOP is severe what other treatment is used

A

ventilator and CPAP

428
Q

what can nurses do for AOP

A

tactile stimulation

429
Q

defined as a frightening episode of apnea (central or obstructive) accompanied by a skin color change, limp muscle tone, choking, or gagging

A

ALTA

430
Q

causes of ALTA

A

gastrointestinal reflux, seizures, lower tract infections

431
Q

s/sx of ALTA

A

o apnea, cyanosis, hypotonia, unresponsiveness, labored breathing, and lethargy, limp muscle tone. May have pallor, or occasionally erythema rather than cyanosis

432
Q

when does ALTA occur

A

sleep, feeding, or wakefulness, swinging

433
Q
  • lower resp. tract infection

- It causes inflammation & obstruction of the bronchioles

A

o Bronchiolitis

434
Q

caused by Respiratory Syncytial Virus

A

Bronchiolitis

435
Q

bronchiolitis puts infants at increased risk for what in adulthood

A

of asthma and wheezing

436
Q

When do RSV infections occur

A

October & run through about March

437
Q

how is RSV transmitted

A

Contact & respiratory

438
Q

High risk for RSV

A 
°	Immunosuppressed
°	Lung disease 
°	Severe neuromuscular disease 
°	Complicated congenital heart defects
°	Very low birth weight
439
Q

In RSV, during expiration, a child will experience __________ and you will hear wheezing and crackles

A

bronchospasm

440
Q

what kind of purulent is seen in RSV

A

mucous

441
Q

Mild s/sx of RSV

A
  • rhinitis
  • cough
  • low grade fever
  • wheezing
  • tachypnea
  • poor feeding
  • vomiting
  • diarrhea
  • dehydration
442
Q

severe s/sx of RSV

A
  • Tachypnea greater than 70 bpm
  • Grunt
  • Increased wheezing
  • Retractions
  • Nasal flaring
  • Irritability
  • Lethargy
  • Poor fluid intake
  • Distended abdomen
  • Cyanosis
  • Decreased mental status
443
Q

Is there a treatment for RSV

A

no

444
Q

What kind of precaution is a child with RSV placed on?

A

contact isolation

445
Q

In a RSV child, when would you use humidified O2?

A

if the O2 sat is below 90%

446
Q

When does RSV usually resolve

A

5-7 days

447
Q

What is the best indicator of severe disease in RSV?

A

O2 sat below 90%

448
Q

When do s/sx of RSV decrease

A

24-72 hrs

449
Q

Complete resolution of RSV s/sx

A

weeks

450
Q

What is normal after RSV

A

coughing

451
Q

When would you call the MD in a child with RSV

A
  • breathing is rapid/difficult
  • s/sx interfere with sleeping/eating
  • s/sx persist
  • child acts sicker
452
Q

o The need for supplemental O2 for at least 28 days after premature birth.

A

bronchopulmonary dysplasia

453
Q

What is the birth weight and the gestational age for bronchopulmonary dysplasia?

A

less than 1000g and 28 weeks or less

454
Q

Causes of bronchopulmonary dysplasia

A

− 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

455
Q

A chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation

A

Asthma

456
Q

What are some things that cause asthma?

A
  • genes
  • indoor air contaminants
  • outdoor air pollutants
  • recurrent resp viral infection
  • allergic disease
457
Q

In asthma, what causes the normal protective mechanisms (mucous formation, mucosal swelling, and airway muscle contraction) to overreact?

A

Inflammation

458
Q

What are some asthma triggers?

A
  • exercise
  • viral or bacterial agents
  • allergens
  • fragrances
  • food additives
  • pollutants
  • weather changes
  • emotions or stress
459
Q

In asthma, with exposure to a trigger, what is activated?

A

IgE and sensitized mast cells

460
Q

After the triggers of asthma occur and IgE and mast cells are activated, what is released?

A

Inflammatory mediators - histamines, prostaglandin, and leukotriens

461
Q

In asthma, what does airway narrowing result from?

A

Bronchial constriction

Swelling and production of mucous

462
Q

In asthma, does mucous plug small or large airways?

A

Small

463
Q

The sudden appearance of breathing difficulty (cough, wheeze, or breathlessness) is often referred to as what kind of asthma?

A

Acute asthma episode or asthma attach

464
Q

What is the warning signal that the child’s airway is very sensitive to stimuli?

A

Frequent night coughing

465
Q

During an acute asthma episode, are the respiration a slow or rapid?

A

Rapid

466
Q

Are nasal flaring and retractions visible in an asthma attack?

A

Yes

467
Q

What kind of cough will the child have if they are having an asthma attack?

A

Productive

468
Q

What kind of wheezing is seen in an asthma attack?

A

Expiratory

469
Q

Will a child with an asthma attack use their accessory muscles?

A

Yes

470
Q

What will the child having an asthma attack complain of?

A

Chest tightness

471
Q

In an asthma attach with sever obstruction, will wheezing be heard?

A

No

472
Q

Present in a sever asthma attack, when the arterial blood pressure decrease during inspiration by 10 mmHg?

A

Pulsus paradoxus

473
Q

In some cases, unrelenting, severe respiratory distress and bronchospasm persists despite medicine. These children are in acute respiratory distress. What are some s/sx?

A
  • use of accessory muscles
  • restlessness
  • anxiety
  • altered mental status
  • inability to say more than a word or two without gasping for breath
  • diaphoresis
  • cyanosis
474
Q

What are signs of impending respiratory failure?

A
  • inability to speak
  • inability to lie down
  • altered mental status
  • intercostal retractions
  • worsening fatigue
475
Q

Clinical therapy for exercise-induced asthma.

A

pretreatment with short-acting beta2-agonists before exercise

476
Q

Clinical manifestations of exercise-induced asthmas.

A
  • cough
  • wheeze
  • chest pain
  • chest tightness
  • SOB
  • fatigue
477
Q

Clinical therapy for acute asthma episode.

A
  • continuouse albuterol by nebulizer
  • oral systemic corticosteroids
  • inhaled ipratropium
478
Q

Clinical therapy for a severe asthma exacerbations.

A
  • IV mag sulfate

- other meds for acute exacerbation

479
Q

If the child w/ asthma is exhibiting breathing difficulty, give supplemental O2 via?

A
  • nasal cannula

- face mask

480
Q

What kind of O2 should be used to prevent drying and thickening of mucous secretions?

A

humidified

481
Q

In asthma, how are most medications given?

A

inhalation route

482
Q

Why is the inhalation route preferred when giving meds to a child w/ asthma?

A

pulmonary blood vessels will rapidly absorb the med while minimizing the systemic effects

483
Q

In a child w/ asthma, what is essential to thin and break up trapped mucous plugs in the narrowed airways?

A

adequate hydration

484
Q

What kind of fluids do children w/ asthma need?

A
  • room-temperature

- slightly cooled fluids w/out ice

485
Q

How can a nurse teach a toddler how to practice blowing into a peak flow meter?

A

blowing into party fevers

486
Q

What does a PEFM rate of 80-100% mean?

A

good asthma control

487
Q

What does a PEFM rate of 50-80% mean?

A

caution

488
Q

What does a PEFM rate of less than 50% mean?

A

danger

489
Q

If a child w/ asthma is taking oral corticosteroids, what type of vaccines may need to be postponed?

A

live

490
Q 
What kind of condition is asthma?
A. chronic
B. acute
C. progressive
D. abrupt
E. episodic

Selcet all

A

A and C

491
Q

o Inherited autosomal recessive disorder of the exocrine glands that effects the respiratory system, GI system, and reproductive system

A

cystic fibrosis

492
Q

What does cystic fibrosis cause the body to produce?

A

an unusually thick sticky mucous that will clog the lungs and cause them to have infections

493
Q

s/sx of cystic fibrosis

A

− 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

494
Q

diagnosis criteria for cystic fibrosis

A

° Newborn meconium ileus
° Malabsorption or failure to thrive
° Chronic respiratory infections
° Fecal impaction and intussusception

495
Q

• Bone marrow does not produce adequate numbers of circulating red blood cells
•

A

aplastic anemia

496
Q

s/sx of aplastic anemia

A 
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
497
Q

• Hereditary bleeding disorder with deficiency in specific clotting factors

A

Hemophilia

498
Q

Hereditary bleeding disorder with deficiency in specific clotting factors

A

Immune (idiopathic) Thrombocytopenic Purpura

499
Q

• Partial or complete replacement of normal hemoglobin with abnormal hemoglobin

A

Sickle Cell Anemia

500
Q

What does sickle cell cause

A

• Causes occlusion of small blood vessels, ischemia, and damage to affected organs

6th Semester (4 decks)

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