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N201 > Pediatric Nursing Part 1 > Flashcards

Pediatric Nursing Part 1 Flashcards

1
Q

Preterm

A

birth btwn 20 - 37 weeks

  • responsible for almost 2/3 of infant deaths
  • ->5x the risk of SIDS
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2
Q

LBW

A

< 2500g (2.5kg); diminished prognosis

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3
Q

VLBW

A

<1500G (1.5kg); poor prognosis

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4
Q

SGA

A

< 10%ile

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5
Q

responsible for 20-30% of preterm births

A

PROM

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6
Q

Vertex-heel length of preterm

A

17-19 inches

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7
Q

Classic Preterm Position

A

Frog-like

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8
Q

Moro, Tonic neck, Babinski reflexes

A

present and normal

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9
Q

Next to establishing respirations, most critical element to NB survival

A

heat regulation

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10
Q

Caloric needs of a NB

A

120-150 cal/kg/day

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11
Q 
Intraventricular Hemorrhage (IVH) 
Incidence
A

(Most common in preterm);
increased risk w/ low birth rate
(VLBW=50%)

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12
Q

s/s of IVH

A 
Intraventricular Hemorrhage 
A.	high pitched cry
B.	signs of increasing intracranial pressure
C.	irritability and convulsions  
D.	focal cerebral signs
E.	pressure on vital centers 
F.	anemia
G.	other unexplained findings
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13
Q

Preterm ABG’s pH

A

7.3 – 7.4

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14
Q

Preterm ABG’s PCO2

A

35-45

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15
Q

Preterm ABG’s PO2

A

50-80

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16
Q

Preterm ABG’s HCO3

A

19-22

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17
Q

Respiratory Distress Syndrome (RDS) onset

A

Onset around 2 hours after birth; worsens 48-72 hrs.

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18
Q

Closure of foramen oval occurs

A

1-2hrs after birth

Permanent closure occurs w/in several months

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19
Q

Effect of O2 on ductus arteriosus

A

O2–>constriction of ductus arteriosus

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20
Q

Functional closure-Ductus Arteriosus

A

15h after birth
Fibrosis- 3wks
–>reversal of bld flow through descending aorta

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21
Q

NB BP is lowest

A

3 hrs after birth

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22
Q

NB BP plateus

A

BP increases and plateaus 4-6d post birth

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23
Q

BP Full Term NB

A

60-80/40-50

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24
Q

NB Blood Volume

A

80-85 ml/Kg

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25
Q

WBC NB

A

10,000-30,000/ mm3

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26
Q

can carry 20-30% more O2 than maternal blood

A

Fetal Hmg

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27
Q

Phenomena in which fetal hct levels decrease progressively w/in 1st week

A

Physiological Anemia Of Infancy

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28
Q

Connects the Umbilical Vein & IVC

A

Ductus Venosus

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29
Q

Shunts blood into the IVC to prevent blood overload of the fetal liver

A

Ductus Venosus

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30
Q

Closure forces perfusion of the liver

A

Ductus Venosus

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31
Q

Opening between the Right and Left Atria in the fetal heart

A

Foramen Ovale

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32
Q

Shunts blood from the RA to LA, bypassing the fetal lungs

A

Foramen Ovale

-only a small amt of blood reaches lungs –>nutrition only

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33
Q

Opening between fetal pulmonary artery and aorta

A

Ductus Arteriosus

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34
Q

causes closure of Ductus Arteriosus

A

d/t increased systemic press & plum bld flow

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35
Q

Closure of Ductus Venosus –>

A

liver perfusion

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36
Q

2 Failure of Transitions

A

PPHN

PDA

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37
Q

PPHN aka

A

Persistant Pulmonary HTN

Persistance of Fetal Circulation

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38
Q

PDA

A

Patent Ductus Arteriosus

Ductus Arteriosus doesn’t close

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39
Q

PDA seen more often in

A

Preterms

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40
Q

S/S PDA

A

Initially Asymptomatic
Pulmonary Congestion
Respiratory Distress
Decreased Growth

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41
Q

Dx PDA

A

Murmur

Cardiac Cath- Increased Pulmonary Artery Oxygenation

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42
Q

Tx PDA in Preterm w/ RDS

A

Tx RDS

RDS resolves –>DA closes

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43
Q

Tx PDA

A

Indomethicin (IV)

VATS

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44
Q

Indomethicin

A

Prostaglandin inhibitor

–> DA closure 50-70% of the T

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45
Q

SE of indomethicin

A

Bleeding
GI
Decreases bone marrow production

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46
Q

VATS

A

visual assisted thoracoptic sx

–>ligate PDA w/ scope

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47
Q

Known causes of Congenital Heart Defects (CHD)

A 
Infection (1st Trimester) (Mom)
Alc Abuse/ Poor Nutrition (Mom)
AMA (40+ yo)
IDM (Infants of Diabetic Mom)
Incidence increases with other defects
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48
Q

CHD Infant Hx (NB)

A 
Poor feeding
Tachycardia
Decreased Pulses
Increased Respiratory Rate
Respiratory Distress s/s
Cyanosis
Decreased Growth Pattern
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49
Q

Cry & Cyanosis Worsens

A

cardiac

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50
Q

Cry & Cyanosis Improves

A

Respiratory

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51
Q

NB HR>160 when sleeping–>

A

Call MD

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52
Q

Measure pressures and oxygenation sats in chambers and vessels

A

Cardiac Cath

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53
Q

–> Structural defects

Picture inside heart, holes & narrowing

A

Echo

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54
Q

EKG Aortic Stenosis

A

Left Ventricular Hypertrophy

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55
Q

Cath- Aortic Stenosis

A

delayed emptying

increased L ventricle pressure

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56
Q

Tx Aortic Stenosis

A

Valve Replacement

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57
Q

Coarctation of Aorta

A

Narrowing of segment of aorta
May be pre/ post ductal
Relative to Ductus Arteriosus

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58
Q

S/S of Pre-ductal Coarctation of Aorta

A

Bounding Pulses, HA, Nose bleeds

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59
Q

S/S of Post-ductal Coarctation of Aorta

A

decreased pulses, decreased lower extremity Pulse Ox

60
Q

CXR- NB
Rib Notching
LV Failure

A

Coarctation of Aorta

61
Q

Coarctation of Aorta Cath

A

Increased LV Pressure

62
Q

Tx Coarctation of Aorta

A

Surgery- Graphing

63
Q

Hole between the ventricles

–>blood shunts from LV to RV–> Increased Pulmonary Circulation

64
Q

VSD

A

Ventral Septal Defect

–>RV failure –> LV failure–> Heart Failure

65
Q

Increased Pressure in Pulmonary Artery (usually asc w/ VSD)–>

A

Sx NOW!!!!!

66
Q

Dx VSD

A

Cath: Increased RV O2 & Pressure

67
Q

High Degree of Shunting w/ VSD

A

Increased fluid in lungs
URI
Pneumonia

68
Q

Tx VSD

A

60% Self-resolving
Monitor for Pulmonary HTN
Synthetic patch/ Tent

69
Q

Atrial Septal Defect

A

hole btwn RA& LA
Not self-resolving (Sx/Tenting)
s/s=respiratory (Volume overload)

70
Q

Contributing Factors of Transient Tachypnea of the Newborn (TTNB)

A

C-Section

Precipitous delivery

71
Q

“artificial lung’

A

ECMO

Last resort- Risk for bleeds, requires anticoagulant therapy

72
Q

When administering surfactant, the nurse must

A

Turn and rotate baby–> cover lung

73
Q

Risk Asc w/ Mechanical Ventilation

A

pulmonary air leaks/ pneumothorax

74
Q

Drawback of PEEP

A

can cause vascular shunting in the pulmonary beds leading to persistent pulmonary hypertension and worsening RDS

75
Q

baby that requires O2 at 36 wks post conception

A

Broncho-Pulmonary Dysplasia (BPD)

76
Q

CANNOT WEIN OFF O2

A

Broncho-Pulmonary Dysplasia (BPD)

77
Q

aka chronic lung disease; 5-50% of babies with RDS ventilation therapy

A

Broncho-Pulmonary Dysplasia (BPD)

78
Q

Caused by therapies to treat RDS

A

Broncho-Pulmonary Dysplasia (BPD)

79
Q

Chest Xray –>cardiomegaly, lung hyperinflation, and infiltrates

Noted difficulty weaning/ increased ventilator requirements

A

Broncho-Pulmonary Dysplasia (BPD)

80
Q

decreased lung compliance & pulmonary function 2ndary to fibrosis, atelectasis, increased pulmonary resistance, & over distention of the lungs

A

Broncho-Pulmonary Dysplasia (BPD)

81
Q

Dexamethasone

A

decrease bronchospasm, edema, & inflammation of pulmonary tissue →improved gas exchange
*BPD tx

82
Q

BPD Prognosis

A

vary; prone to respiratory illnesses w/in 1st 2yrs

83
Q

ROP

A

Retinopathy of the Premature

84
Q

Abnormal growth of blood vessels in the baby’s eye

85
Q

Incidence of ROP

A

weight below 900g – 90% chance

<30 wks GA*, w/ unstable clinical course

86
Q

born premature→ low oxygen→ vasoconstriction→ baby gets better, O2 levels return and the blood vessels begin proliferate → too rapid growth→ abnormal growth–>Scar –>contraction → pressure on retina→ potential retinal detachment

87
Q

Tx ROP

A

Once on PO food –>Vitamin E
Maintain PaO2 level 60-80
Laser, cryotherapy, Bevacizumab injections

88
Q

acute inflammatory disease of the bowel

preterm/ babies who suffered asphyxia

89
Q

(NEC)

A

Necrotizing Enterocolitis

90
Q

Three factors–>development of NEC

A
  1. intestinal ischemia
  2. colonization by pathologic bacteria
  3. substrate w/in intestinal lumen (formula w/in intestinal lumen)
91
Q
  • abd distention
  • increase in gastric residuals
  • Bloody stools (+ hemocult); gross blood is rare
92
Q

Onset NEC

A

4-7 after initiation of feedings

93
Q

X-ray NEC

A

intestines are sausage shaped; bubble appearance, gas pockets

94
Q

Tx NEC

A
  • Make NPO
  • NG Tube suction
  • Iv antibiotics
  • TPN feedings
95
Q

When reinitiating food (NEC)

A

Reinitiate → fresh breast milk best, then frozen breast milk

96
Q

Bleeding of IVH originates in

A

germinal matrix (where blood vessels form) d/t sudden change in cerebral blood flow (ie during vaginal delivery) & also occurs with asphyxia

97
Q

Grades (4) of bleeding (IVH) based in

A

bleeding—NOT prognosis

98
Q

IVH typically begins

A

SEE 7-10DAYS AFTER

99
Q

Bulging fontanels = Late Sign

100
Q

change in color
V/S
temperature instability
respiration impacts (vague); Bulging fontanels (LATE SIGN)

101
Q

Dx IVH

A

U/S (7-10d unless other vague s/s)
CT Scan ($$)
LP/ subdural tap–>blood

102
Q

Tx: IVH

A

PREVENTION***
Relief of ICP-(intra-ventricular tap (may be serial) <damaging than shunt
May resolve spontaneously

103
Q

Level I – Nursery

A

Sm. Hospitals refer high risk pts

104
Q

Level II - Nursery

A

Specialized care: kent

105
Q

Level III - Nursery

A

Highest level of care: Christina/ AI DuPont

106
Q

2 predominant types of cellular characteristics r/t SGA

A

Symmetrical (Hypoplasia)

Asymmetrical (late IUGR)

107
Q

Asymmetrical (late IUGR)

A

normal # of cells
reduced CP
Late in pregnancy

108
Q

Symmetrical (Hypoplasia)-

A

deficient # of cells
norm CP
of early growth deficit
Sm organs/ sm organs wt

109
Q

Maternal Factors –> SGA

A 
HTN (chronic or preg)
Heart/ lung disease
Drug use
Malnutrition/ Low socioeconomic
Anemia
Living at high altitudes
110
Q

Placental Factors–>SGA

A

Placental insufficient
Abnormal cord insertion
Single umbilical artery

111
Q

Fetal Factors–>SGA

A

Intrauterine infection
Multiple gestation
Congenital deformities

112
Q

Most Common Fetal Factor –>SGA

A

Intrauterine infection

113
Q

Sutures: widely spaced d/t inadequate bone growth
Fontanels: large

114
Q

Leading cause of death SGA

115
Q

Pregnant nurses should not care for this baby

A

Immunologic problems

116
Q

Dx SGA

A

Decreased maternal weight
Fundal Ht Less than expected (McDonald’s Rule)
Both Decreased–>U/S

117
Q

Common Metabolic Problems of SGA

A

Hypoglycemia
Hypocalcemia
Hyperbilirubinemia

118
Q

Type II Respiratory Distress Syndrome (Retained lung fluid)

119
Q

Factors Contributing to TTNB

A

C/Section

Breech birth

120
Q

Factors Contributing to TTNB

A

C/Section

Breech birth

121
Q

maternal history (diabetes→ effects synthesis of phospholipids)
Easily oxygenate
Respiratory failure is rare
Usually Term

A

Transient tachypnea of Newborn

122
Q

DO NOT use a bag and mask

Must immediately intubated

A

Diaphragmatic hernia:

123
Q

Diaphragmatic hernia: (POSITION)

A

Place on effected side→ upper lung expand fully

124
Q

Diaphragmatic hernia: (POSITION)

A

Place on effected side→ upper lung expand fully

125
Q

Similar to RDS

resolves by ~24h; self-limiting; no risk of reoccurrence

126
Q 
Barrel shaped chest
Tachypnea
Respiratory distress
Cyanosis
High oxygen concentration to relieve cyanosis
A

Meconium Aspiration Syndrome (MAS)

127
Q

GA* MAS

A

Term, post-term, SGA

128
Q

Contributing Factors MAS

A

Intrauterine stress
IUGR
Postmaturity
Breech delivery

129
Q

complications d/t MAS

A

Pneumothorax
Pulmonary air leaks
Hypoxic damage to vital organs (brain, kidneys, liver)

130
Q

CXR–>Over-aeration

Air trapping

131
Q

CXR:
Ground glass appearance
Under-aeration

132
Q

MAS Clinical Course

A

Respiratory support

Mortality high if develop severe respiratory distress

133
Q

Clinical Course RDS

A

Progressive hypoxia & hypercapnea
Admin surfactant
Respiratory support

134
Q

Contributing factors Pneumonia

A 
Prematurity
MAS
PROM
Maternal Fever or UTI
Prolonged labor
135
Q

GA RDS

A

Pre-term, IDM

136
Q

Complications of pneumonia

A

DIC
Shock
Hypoperfusion

137
Q

Clinical Picture

A

Latent pd then acute onset of RDS
Apnea early on
Increasing need for O2

138
Q

CXR: Similar to RDS

Patchy infiltrates

139
Q

Causative Organisms Pneumonia

A

Pneumococcus
Staph pneumonia
Group B strep

140
Q

Cause of Hypoglycemia SGA

A 
No stores (Symmetrical) or used all stores (asymmetrical)
Decreased Supply of Enzymes
141
Q

Cause of Hypoglycemia Preterm

A

Sm glycogen stores in the liver

Liver = immature

142
Q

Caloric Needs SGA

A

130-150 cal/kg/24h

Normal or Larger

143
Q

Position Bili Lights

A

The fluorescent “bili lights” should be positioned 18 to 20 inches from the infant

144
Q

Accounts for 50% of all deaths in the 1st yr of life

145
Q

Echo–>holes & narrowing

146
Q

Hyperoxia test

A 
cry test 
baseline Pulse Ox/abgs
100% O2/2MINS
pULSE OX/ABGS
respiratory problems stats increase
147
Q

Loud Washing-Machine Murmur

N201 (21 decks)

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