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
2
Q
LBW
A
< 2500g (2.5kg); diminished prognosis
3
Q
VLBW
A
<1500G (1.5kg); poor prognosis
4
Q
SGA
A
< 10%ile
5
Q
responsible for 20-30% of preterm births
A
PROM
6
Q
Vertex-heel length of preterm
A
17-19 inches
7
Q
Classic Preterm Position
A
Frog-like
8
Q
Moro, Tonic neck, Babinski reflexes
A
present and normal
9
Q
Next to establishing respirations, most critical element to NB survival
A
heat regulation
10
Q
Caloric needs of a NB
A
120-150 cal/kg/day
11
Q
Intraventricular Hemorrhage (IVH) Incidence
A
(Most common in preterm);
increased risk w/ low birth rate
(VLBW=50%)
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
13
Q
Preterm ABG’s pH
A
7.3 – 7.4
14
Q
Preterm ABG’s PCO2
A
35-45
15
Q
Preterm ABG’s PO2
A
50-80
16
Q
Preterm ABG’s HCO3
A
19-22
17
Q
Respiratory Distress Syndrome (RDS) onset
A
Onset around 2 hours after birth; worsens 48-72 hrs.
18
Q
Closure of foramen oval occurs
A
1-2hrs after birth
Permanent closure occurs w/in several months
19
Q
Effect of O2 on ductus arteriosus
A
O2–>constriction of ductus arteriosus
20
Q
Functional closure-Ductus Arteriosus
A
15h after birth
Fibrosis- 3wks
–>reversal of bld flow through descending aorta
21
Q
NB BP is lowest
A
3 hrs after birth
22
Q
NB BP plateus
A
BP increases and plateaus 4-6d post birth
23
Q
BP Full Term NB
A
60-80/40-50
24
Q
NB Blood Volume
A
80-85 ml/Kg
25
WBC NB
10,000-30,000/ mm3
26
can carry 20-30% more O2 than maternal blood
Fetal Hmg
27
Phenomena in which fetal hct levels decrease progressively w/in 1st week
Physiological Anemia Of Infancy
28
Connects the Umbilical Vein & IVC
Ductus Venosus
29
Shunts blood into the IVC to prevent blood overload of the fetal liver
Ductus Venosus
30
Closure forces perfusion of the liver
Ductus Venosus
31
Opening between the Right and Left Atria in the fetal heart
Foramen Ovale
32
Shunts blood from the RA to LA, bypassing the fetal lungs
Foramen Ovale
| -only a small amt of blood reaches lungs -->nutrition only
33
Opening between fetal pulmonary artery and aorta
Ductus Arteriosus
34
causes closure of Ductus Arteriosus
d/t increased systemic press & plum bld flow
35
Closure of Ductus Venosus -->
liver perfusion
36
2 Failure of Transitions
PPHN
| PDA
37
PPHN aka
Persistant Pulmonary HTN
| Persistance of Fetal Circulation
38
PDA
Patent Ductus Arteriosus
| Ductus Arteriosus doesn't close
39
PDA seen more often in
Preterms
40
S/S PDA
Initially Asymptomatic
Pulmonary Congestion
Respiratory Distress
Decreased Growth
41
Dx PDA
Murmur
| Cardiac Cath- Increased Pulmonary Artery Oxygenation
42
Tx PDA in Preterm w/ RDS
Tx RDS
| RDS resolves -->DA closes
43
Tx PDA
Indomethicin (IV)
| VATS
44
Indomethicin
Prostaglandin inhibitor
| --> DA closure 50-70% of the T
45
SE of indomethicin
Bleeding
GI
Decreases bone marrow production
46
VATS
visual assisted thoracoptic sx
| -->ligate PDA w/ scope
47
Known causes of Congenital Heart Defects (CHD)
```
Infection (1st Trimester) (Mom)
Alc Abuse/ Poor Nutrition (Mom)
AMA (40+ yo)
IDM (Infants of Diabetic Mom)
Incidence increases with other defects
```
48
CHD Infant Hx (NB)
```
Poor feeding
Tachycardia
Decreased Pulses
Increased Respiratory Rate
Respiratory Distress s/s
Cyanosis
Decreased Growth Pattern
```
49
Cry & Cyanosis Worsens
cardiac
50
Cry & Cyanosis Improves
Respiratory
51
NB HR>160 when sleeping-->
Call MD
52
Measure pressures and oxygenation sats in chambers and vessels
Cardiac Cath
53
--> Structural defects
| Picture inside heart, holes & narrowing
Echo
54
EKG Aortic Stenosis
Left Ventricular Hypertrophy
55
Cath- Aortic Stenosis
delayed emptying
| increased L ventricle pressure
56
Tx Aortic Stenosis
Valve Replacement
57
Coarctation of Aorta
Narrowing of segment of aorta
May be pre/ post ductal
Relative to Ductus Arteriosus
58
S/S of Pre-ductal Coarctation of Aorta
Bounding Pulses, HA, Nose bleeds
59
S/S of Post-ductal Coarctation of Aorta
decreased pulses, decreased lower extremity Pulse Ox
60
CXR- NB
Rib Notching
LV Failure
Coarctation of Aorta
61
Coarctation of Aorta Cath
Increased LV Pressure
62
Tx Coarctation of Aorta
Surgery- Graphing
63
Hole between the ventricles
| -->blood shunts from LV to RV--> Increased Pulmonary Circulation
VSD
64
VSD
Ventral Septal Defect
| -->RV failure --> LV failure--> Heart Failure
65
Increased Pressure in Pulmonary Artery (usually asc w/ VSD)-->
Sx NOW!!!!!
66
Dx VSD
Cath: Increased RV O2 & Pressure
67
High Degree of Shunting w/ VSD
Increased fluid in lungs
URI
Pneumonia
68
Tx VSD
60% Self-resolving
Monitor for Pulmonary HTN
Synthetic patch/ Tent
69
Atrial Septal Defect
hole btwn RA& LA
Not self-resolving (Sx/Tenting)
s/s=respiratory (Volume overload)
70
Contributing Factors of Transient Tachypnea of the Newborn (TTNB)
C-Section
| Precipitous delivery
71
“artificial lung’
ECMO
| Last resort- Risk for bleeds, requires anticoagulant therapy
72
When administering surfactant, the nurse must
Turn and rotate baby--> cover lung
73
Risk Asc w/ Mechanical Ventilation
pulmonary air leaks/ pneumothorax
74
Drawback of PEEP
can cause vascular shunting in the pulmonary beds leading to persistent pulmonary hypertension and worsening RDS
75
baby that requires O2 at 36 wks post conception
Broncho-Pulmonary Dysplasia (BPD)
76
CANNOT WEIN OFF O2
Broncho-Pulmonary Dysplasia (BPD)
77
aka chronic lung disease; 5-50% of babies with RDS ventilation therapy
Broncho-Pulmonary Dysplasia (BPD)
78
Caused by therapies to treat RDS
Broncho-Pulmonary Dysplasia (BPD)
79
Chest Xray -->cardiomegaly, lung hyperinflation, and infiltrates
Noted difficulty weaning/ increased ventilator requirements
Broncho-Pulmonary Dysplasia (BPD)
80
decreased lung compliance & pulmonary function 2ndary to fibrosis, atelectasis, increased pulmonary resistance, & over distention of the lungs
Broncho-Pulmonary Dysplasia (BPD)
81
Dexamethasone
decrease bronchospasm, edema, & inflammation of pulmonary tissue →improved gas exchange
*BPD tx
82
BPD Prognosis
vary; prone to respiratory illnesses w/in 1st 2yrs
83
ROP
Retinopathy of the Premature
84
Abnormal growth of blood vessels in the baby's eye
ROP
85
Incidence of ROP
weight below 900g – 90% chance
| <30 wks GA*, w/ unstable clinical course
86
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
ROP
87
Tx ROP
Once on PO food -->Vitamin E
Maintain PaO2 level 60-80
Laser, cryotherapy, Bevacizumab injections
88
acute inflammatory disease of the bowel
| preterm/ babies who suffered asphyxia
(NEC)
89
(NEC)
Necrotizing Enterocolitis
90
Three factors-->development of NEC
1. intestinal ischemia
2. colonization by pathologic bacteria
3. substrate w/in intestinal lumen (formula w/in intestinal lumen)
91
- abd distention
- increase in gastric residuals
- Bloody stools (+ hemocult); gross blood is rare
NEC
92
Onset NEC
4-7 after initiation of feedings
93
X-ray NEC
intestines are sausage shaped; bubble appearance, gas pockets
94
Tx NEC
- Make NPO
- NG Tube suction
- Iv antibiotics
- TPN feedings
95
When reinitiating food (NEC)
Reinitiate → fresh breast milk best, then frozen breast milk
96
Bleeding of IVH originates in
germinal matrix (where blood vessels form) d/t sudden change in cerebral blood flow (ie during vaginal delivery) & also occurs with asphyxia
97
Grades (4) of bleeding (IVH) based in
bleeding—NOT prognosis
98
IVH typically begins
SEE 7-10DAYS AFTER
99
Bulging fontanels = Late Sign
IVH
100
change in color
V/S
temperature instability
respiration impacts (vague); Bulging fontanels (LATE SIGN)
IVH
101
Dx IVH
U/S (7-10d unless other vague s/s)
CT Scan ($$)
LP/ subdural tap-->blood
102
Tx: IVH
PREVENTION***
Relief of ICP-(intra-ventricular tap (may be serial)
103
Level I – Nursery
Sm. Hospitals refer high risk pts
104
Level II - Nursery
Specialized care: kent
105
Level III - Nursery
Highest level of care: Christina/ AI DuPont
106
2 predominant types of cellular characteristics r/t SGA
Symmetrical (Hypoplasia)
| Asymmetrical (late IUGR)
107
Asymmetrical (late IUGR)
normal # of cells
reduced CP
Late in pregnancy
108
Symmetrical (Hypoplasia)-
deficient # of cells
norm CP
of early growth deficit
Sm organs/ sm organs wt
109
Maternal Factors --> SGA
```
HTN (chronic or preg)
Heart/ lung disease
Drug use
Malnutrition/ Low socioeconomic
Anemia
Living at high altitudes
```
110
Placental Factors-->SGA
Placental insufficient
Abnormal cord insertion
Single umbilical artery
111
Fetal Factors-->SGA
Intrauterine infection
Multiple gestation
Congenital deformities
112
Most Common Fetal Factor -->SGA
Intrauterine infection
113
Sutures: widely spaced d/t inadequate bone growth
Fontanels: large
SGA
114
Leading cause of death SGA
Asphyxia
115
Pregnant nurses should not care for this baby
Immunologic problems
116
Dx SGA
Decreased maternal weight
Fundal Ht Less than expected (McDonald’s Rule)
Both Decreased-->U/S
117
Common Metabolic Problems of SGA
Hypoglycemia
Hypocalcemia
Hyperbilirubinemia
118
Type II Respiratory Distress Syndrome (Retained lung fluid)
TTNB
119
Factors Contributing to TTNB
C/Section
| Breech birth
120
Factors Contributing to TTNB
C/Section
| Breech birth
121
maternal history (diabetes→ effects synthesis of phospholipids)
Easily oxygenate
Respiratory failure is rare
Usually Term
Transient tachypnea of Newborn
122
DO NOT use a bag and mask
| Must immediately intubated
Diaphragmatic hernia:
123
Diaphragmatic hernia: (POSITION)
Place on effected side→ upper lung expand fully
124
Diaphragmatic hernia: (POSITION)
Place on effected side→ upper lung expand fully
125
Similar to RDS
| resolves by ~24h; self-limiting; no risk of reoccurrence
TTNB
126
```
Barrel shaped chest
Tachypnea
Respiratory distress
Cyanosis
High oxygen concentration to relieve cyanosis
```
Meconium Aspiration Syndrome (MAS)
127
GA* MAS
Term, post-term, SGA
128
Contributing Factors MAS
Intrauterine stress
IUGR
Postmaturity
Breech delivery
129
complications d/t MAS
Pneumothorax
Pulmonary air leaks
Hypoxic damage to vital organs (brain, kidneys, liver)
130
CXR-->Over-aeration
| Air trapping
MAS
131
CXR:
Ground glass appearance
Under-aeration
RDS
132
MAS Clinical Course
Respiratory support
| Mortality high if develop severe respiratory distress
133
Clinical Course RDS
Progressive hypoxia & hypercapnea
Admin surfactant
Respiratory support
134
Contributing factors Pneumonia
```
Prematurity
MAS
PROM
Maternal Fever or UTI
Prolonged labor
```
135
GA RDS
Pre-term, IDM
136
Complications of pneumonia
DIC
Shock
Hypoperfusion
137
Clinical Picture
Latent pd then acute onset of RDS
Apnea early on
Increasing need for O2
138
CXR: Similar to RDS
| Patchy infiltrates
Pneumonia
139
Causative Organisms Pneumonia
Pneumococcus
Staph pneumonia
Group B strep
140
Cause of Hypoglycemia SGA
```
No stores (Symmetrical) or used all stores (asymmetrical)
Decreased Supply of Enzymes
```
141
Cause of Hypoglycemia Preterm
Sm glycogen stores in the liver
| Liver = immature
142
Caloric Needs SGA
130-150 cal/kg/24h
| Normal or Larger
143
Position Bili Lights
The fluorescent "bili lights" should be positioned 18 to 20 inches from the infant
144
Accounts for 50% of all deaths in the 1st yr of life
CHD
145
Echo-->holes & narrowing
CHD
146
Hyperoxia test
```
cry test
baseline Pulse Ox/abgs
100% O2/2MINS
pULSE OX/ABGS
respiratory problems stats increase
```
147
Loud Washing-Machine Murmur
VSD
