Pediatric Nursing Flashcards
Tetralogy of Fallot manifestation
cyanosis at birth
murmur
blue spells or tet spells during crying or feeding
complications include: emboli, seizures, loss of consciousness, death from anoxia
tetralogy of Fallot diagnostic studies
echocardiography
chest radiography
Tetralogy of Fallot management/nursing intervention
place infant on side during a tet spell; knees to chest position
older kids can squat which can help with circulation
remain calm and apply 100% oxygen via facemask
administer morphine and IV fluids
monitor adequate fluid status through weight, strict intake and output
give parenteral nutrition
Tetralogy of Fallot caregiver teaching
promptly treat diarrhea, vomiting and fever
good handwashing technique
antibiotics
regular check ups
what is tetralogy of fallot
congenital heart disorder that has 4 types of defects:
VSD, overriding aorta, pulmonic valve stenosis, right ventricular hypertrophy
what is kawasaki disease
happens from an unknown factors but is a acute systemic vasculitis
small and medium vessels become inflamed
then it tries to go back down but then there is scarring, thickening and calcified
most common cause is coronary artery disease
kawasaki disease manifestations
acute: high fever that lasts at least 5 days and is unresponsive to treatment strawberry tongue reddened conjunctivitis rash on main body and genital region reddened palms/sores irritability and cervical lymphadenopathy reddened cracked lips
subacute: acute symptoms go thrombocytosis coronary artery dilated skin peeling of the fingers and toes arthritis affecting the large weight bearing joints
convalescent phase: most of the symptoms go away but abnormal lab values still occur: anemia increased WBCs elevated ALT thrombocytosis albumin <30 urine WBC >10
kawasaki disease diagnostic studies
no specific test is diagnosed
CBC, liver enzymes, urinalysis
echocardiogram
kawasaki nursing managment
pharmacological intervention:
IVIG with salicylate (with this the child needs to be on continuous cardiac monitoring)
- may be premedicated with diphenhydramine and acetaminophen
the nurse should:
monitor cardiovascular status by daily checking weights, intake and output
offer cool cloths, mouth care, lubrication of dry lips and unscented lotion
soft and cool foods
give aspirin for inflammation and acetaminophen for fevers
perform gentle range of motion exercises if child develops arthritis
encourage rest in a quiet environment
kawasaki teaching
teach side effects of aspirin and toxicity
follow up visit with cardiologists within the week of discharge and 4-6 weeks later
avoid MMR and varicella immunizations for about 11 weeks after IVIG therapy
IVIG therapy needs to be started within 10 days of symptoms
what is acute epiglottitis
life threatening bacterial or viral upper airway inflammation that can lead to airway obstructions
often caused by H influenzae type B
manifestations of acute epiglottitis
abrupt onset of sore throat symptoms of upper respiratory infection difficulty swallowing pain drooling, sitting in a tripod position tongue protrusions, agitation, muffled voice
sxs of respiratory distress: retractions, cyanosis and shallow breathing or stridor
acute epiglottitis diagnostic studies
lateral neck radiograph
throat culture
acute epiglottitis management
children with severe respiratory distress will need emergency intubation
iv antibiotics followed by oral antibiotics 7-10 days
the nurse should
remain calm and decrease child’s anxiety
allow child to remain upright and prepare for emergency intubation
monitor for icnreasing respiratory distress
initiate and maintain droplet isolations for 24 horus after antibiotics are started
what is cystic fibrosis
impacts that glands that produce mucous
defect on the chromosome number 7
-cells experience can increase in mucus secretion and obstruction
what are common sites of obstructions in cystic fibrosis
bronchi
small intestines
pancreatic ducts and bile ducts
if it gets in the reproductive tract that could lead to infertility
manifestations of cystic fibrosis
wheezing nonproductive cough chronic cough bronchial obstruction respiratory infections dyspnea atelectasis barrel chest appearance pneumothorax chronic hypoxia (clubbing, cyanosis)
gastrointestinal: meconium ileus fatty/smelly stools (steatorrhea) poor weight gain failure to thrive distended abdomen prolapsed rectum poor vitamin absorptions (A, D, E, K) pancreatic duct blockage - inability to absorb proteins/facts, hyperglycemia
reproductive:
delayed puberty for girls
increased risk for miscarriage and premature delivery
integumentary:
salty skin because salt loss through skin
cystic fibrosis diagnostic studies
sweat chloride test
- positive if over 60
genetic testins for mutation of CFTR gene
chest radiography
pulmonary function tests
contrast edema
stool anaylsis
cystic fibrosis management
pharmacotherapy will include:
bronchodilators,
nebulized hypertonic saline,
dornase alpha - clears airway secretion
collaborate with respiratory therapists
airway clearance therapy will help limit mucus and respiratory infection
percussion and postural drainage through expiratory therapy,
breathin techniques,
high frequency chest compression therapy
monitor for signs of sepsis and pneumothorax
cystic fibrosis nursing goals
prevent respiratory infection
improve nutrition
encourage physical activity
promote overall good quality of life
cystic fibrosis nutrition
assess food intake, weight gain, BMI
assess stools, bowel sounds and abdominal distention
reduce rectal prolapse through manual manipulations
pancreatic enzyme replacements
what is reye syndrome
metabolic encephalopathy
fatty changes to the liver and cerebral edema
reye syndrome manifestation
fever
vomiting
lethargy
delirium
seizures
coma
increasing intracranial pressure
cerebral edema
hepatic dysfunction
reye syndrome diagnostic studies
liver biopsy
elevated ammonia levels
reye syndrome nursing management
the nurse should:
- place the child in a quiet environment
- monitor for increasing intracranial pressure
- monitor intake and output
avoid aspirin or aspiring-containing meds
what are neural tube defects
neural tube that contains the spinal cord fails to close in utero
occurs more often in girls and the Hispanic population
neural tube defects risk factors
exposure to drugs
malnutritions
radiation
chemicals or genetic mutations
neural tube defects manifestations
spina bifida:
no sac but you may have a dimple or a tuft of hair
bladder and bowel dysfunction
port wine angiomatous veti
meningocele:
saclike protrusion that contain the meninges and cerebrospinal fluid
myelomeningocele: saclike protrusion that contains the meninges, nerves and cerebrospinal fluid may result in lower limb paralysis bladder and bowel dysfunction rectal prolapse joint deformities
neural tube defects diagnostic studies
ultrasonography
CT
MRI
history and physical assessment
neural tube defects management
surgery in order to close the sac
prior to surgery, use padding instead of diaper
- change often to decrease infection
a protective covering on the sac
checks vitals, intake and output, pain and incision
urinary catheterization may be necessary
moist covering on sac
- changed every 2-4 hours
the infant should be lying in a prone position in an incubator or a temperature radiant
you can place the infant on a pressure reducing mattress
they may have an increasing risk of getting a latex allergy so monitor for reactions
perform gentle range of motion to prevent contractures
caregiver teaching:
bond with infant through touching, caressing and stroking
best position is prone or side lying
monitor incision site for pain and infection
perform prescribed exercises and monitor for complications
what is duchenne muscular dystrophy
most common and severe form of muscular dystrophy
X-linked recessive trait found in biopsy
symptoms typically begin to appear at the ages 3-5 years old
small muscles are destroyed and joint deformities happen
in the end stage, the muscles get to the respiratory and cardiovascular –> so it gets to the heart and lungs
duchenne muscular dystrophy manifestations
initial symptoms are:
lordosis= inward curvature of the spine especially the lower back
waddling gait
frequent falls
toe walking
difficulty climbing stairs or getting up from a chair
progressive symptoms are:
muscle wasting
contractures
weakness
scoliosis
atrophy
infection
obesity
death from respiratory failure and cardiac failure
loss of ambulation by age 9-12
positive gowers sign: when trying to sit up, you need to walk your hands up your legs to stand
duchenne muscular dystrophy diagnostic studies
genetic testing
muscle biopdy
serum enzyme measurements
serum CK levels
EMG
DNA anaylsis of blood and muscle tissue
Duchenne muscular dystrophy management
there is no curative treatment
corticosteroids
- to improve respiratory function
bracing, knee-ankle orthotics may be used to prevent contractures
the nurse should:
include stretching and exercises that strengthen the muscles
use incentive spirometry:
- BiPAP,
- MAC ventilator,
- chest physiotherapy
- tracheostomy
consider long term and palliative care
caregiver teaching:
teach how to record and use pulse oximetry to monitor when they are sleeping
keep them active as long as possible
only use a wheelchair as a last resort
fall prevention and safety
siblings who feel isolated may need psychological counseling
get genetic counseling
duchenne muscular dystrophy care team
pulmonologist cardiologist speech therapy physical therapist dietician orthopedist
what is hirchsprung disease
it is due to the absence of ganglionic cells
there will be a delayed in peristalsis
wont be able to relax the colon sphincter in order to pass stool
portion of the colon may be affected or the entire colon and small intestine
hirchsprung disease manifestations
newborn symptoms;
no meconium stools after birth
bilious vomiting
abdominal distention
refusing feeding
infancy symptoms:
abdominal distention
fever
explosive watery, diarrhea or vomiting
constipation
childhood symptoms:
ribbon like stool
constipation
palpable fecal mass
enterocolitis is a common complication of hirchsprung disease
hirschsprung disease diagnostic studies
rectal biopsy
contrast enema
anorectal manometry
hirschsprung disease management
surgery is necessary in order to fix it. you will take out the aganglionic portion in order to restore function
preoperatively:
for older children, give saline enema before surgery
give oral or IV antibiotics
monitor vitals, bowel movements, measure abdominal distentions and review fluid and electrolytes
child with malnourishment should
- eat low in fiber,
- high calories and high protein
postoperatively:
monitor their bowel movements, vitals, and abdomen
child may need anal dilations daily, so teach caregivers how to perform those
if a child has a colostomy, teach how to manage those
make sure that the skin around the colostomy is intact
what is pyloric stenosis
occurs when the pyloric sphincter is obstructed
happens in the first few weeks of life–> mostly seen in white infant males
pyloric stenosis manifestation
projectile vomiting
chronic pain
hunger
palpable olive-shaped mass in the right upper quadrant
dehydration
metabolic alkalosis
**dehydration and electrolyte status is something you really need to consider in pyloric stenosis because it will be imbalanced
pyloric stenosis diagnostic studesi
ultrasonography
history and physical assessment
labs:
- decreased sodium and potassium,
- increased BUN and pH
pyloric stenosis management
pyloromyotomy is the standard surgical procedure for this condition
preoperatively:
- make sure that they are getting their fluids and electrolytes
- should be NPO before surgery
insert a NG tube if you need to decompress the stomach
postoepratively:
- monitor intake and output, vitals, incisions and pain after procedure
- feedings should occur 4-6 hours after surgery
- feedings should starts with fluids with added electrolytes and small, frequent feedings
once they are able to tolerate that then move them to breast milk or formula
have moms give breast milk in a bottle in order to measure accurate intake
what is intusussception
intestinal obstruction
the proximal section of the intestine telescopes into the distal part of the section
blockage of arterial blood flow –> tissue necrosis of the intestine
