Peds cardiac, respiratory, and integumentary

Question 1

What are differences in the airways of children vs adults?

Answer 1

epiglottis: floppier, u-shaped and longer in a child
airway: more anterior and higher, much smaller (infant: 4mm, adult 21mm).
trachea: more flexible in a child

-smaller oral cavities and large tongues in comparison to adults

lower airway: left and right bronchi branch much higher and are at a steeper angle

alveoli: full-term NB have 25 million, not fully functioning, adults have 300 million

muscles: children younger than 6 use diaphragm

Question 2

How to assess pediatric respiratory status

Answer 2

rate, rhythm, depth, symmetry, effort.
cough, when, effort.

coloration: location, cyanotic?, shade, when crying?

adventitious sounds, pain, odors, mucus, position of comfort

Question 3

respiratory distress

Answer 3

Result from the body using compensatory mechanisms to avoid resp failure. Distress state can be maintained for a long time but then failure occurs suddenly.

Hallmark signs: restless, tachycardia, tachypnea, diaphoresis.

S/s: pink/pale in color, wheezing breath sounds that can be auscultated, nasal flaring, retractions, grunting, neuro: irritable, confusion, HA, CV: HTN, tachycardia, diaphoresis, O2 sat slightly lowered or normal- may require o2 to remain > 93. Mild hypoxia. ABG: might be normal, alkalotic or mild acidotic

Question 4

respiratory failure

Answer 4

Compensatory mechanisms can no longer maintain gas exchange; O2 demand > supply.

S/s: gray/cyanotic in color, increased RR progressing to decreased (bradypnea), significantly diminished or adventitious breath sounds, minimal chest expansion, sever retractions, apnea, neuro: limp, difficult to arouse, stupor, coma; CV: extreme tachycardia, bradycardia when hypoxia present, hypotension. Can’t maintain oxygenation, cerebral perfusion is severely affected, acidotic pH

Question 5

respiratory arrest

Question 6

Nursing role in peds resp disorders

Question 7

Resp Distress

Answer 7

s/s:

mgmt:

tx:

pt/parent edu:

Question 8

pertussis

Answer 8

s/s:

mgmt:

tx:

pt/parent edu:

Question 9

croup

Answer 9

inflammation of the epiglottis, larynx, trachea, and possibly even the bronchi.
types: viral (spasmodic laryngitis, and LTB), bacterial (epiglottis and bacterial tracheitis)

s/s: cough, hoarseness, stridor

mgmt:

tx:

pt/parent edu:

Question 10

epiglottitis

Answer 10

Bacterial croup that has a rapid progression of airway narrowing/inflammation of the epiglottis (common in 2-8 yr olds)

s/s: Drooling, Dysphagia, Dysphonia, High fever, Extreme tachycardia, Tachypnea, Stridor that worsens when the child lies supine, Appears toxic. Cherry red epiglottis

mgmt: protect airway (ET tube), keep child calm (crying induces respiratory distress and can close the airway quicker), x ray to dx,

tx: abx, racemic epinephrine, CC, fluids for hydration

pt/parent edu: s/s of distress, complete Abx, hoarse voice will go away

Question 11

pneumonia

Answer 11

s/s:

mgmt:

tx:

pt/parent edu:

Question 12

RSV and bronchiolitis/bronchitis

Answer 12

s/s:

mgmt:

tx:

pt/parent edu:

Question 13

tuberculosis

Answer 13

s/s:

mgmt:

tx:

pt/parent edu:

Question 14

foreign body aspiration

Answer 14

s/s:

mgmt:

tx:

pt/parent edu:

Question 15

ARDS

Answer 15

s/s:

mgmt:

tx:

pt/parent edu:

Question 16

pneumothorax

Answer 16

s/s:

mgmt:

tx:

pt/parent edu:

Question 17

asthma

Answer 17

s/s:

mgmt:

tx:

pt/parent edu:

Question 18

CF

Answer 18

s/s:

mgmt:

tx:

pt/parent edu:

Question 19

Bronchopulmonary Dysplasia

Answer 19

s/s:

mgmt:

tx:

pt/parent edu:

Question 20

Tracheostomy

Answer 20

care at home:
emergency equipment:

s/s:

mgmt:

tx:

pt/parent edu:

Question 21

congenital vs Acquired disorders

Question 22

assessment of pt with cardiac defect

Question 23

nursing role and care around cardiac conditions

Question 24

cyanotic vs acyanotic defects

Question 25

Atrial Septal Defect

Answer 25

what: congenital heart defect that results in increased pulmonary blood flow- due to left to right shunting in the heart (blood shifting from higher pressure to lower) -hole in atrial wall, blood travels between atria presentation (s/s): may be asymptomatic. Large ASDs: HF, failure to thrive (poor wt gain), and child tiring easily, potential murmur. mgmt: - nonsurgical: small will close spontaneously. Larger ASDs or untreated can lead to HF prognosis: repaired- normal healthy lives. unprepared can cause CV and pulm problems in middle adulthood. higher risk for strokes, HF, atrial arrhythmia, and pulmonary HTN.

Question 26

ventricular septal defect

Answer 26

what:congenital heart defect that results in increased pulmonary blood flow due to hole in ventricular wall presentation (s/s): respiratory- tachypnea, SOB, increased pulm infections, pulm HTN. Cardiac- tachy, sweating while feeding, pale skin, holosystolic murmur, failure to thrive mgmt: nonsurgical- aim to prevent HF using diuretics, ace inhibitors to decrease aortic pressure, SVR and left to right shunt if HTN prognosis: surgically closed leads to normal life without restrictions. Moderate/large VSD can lead to HF, pulm HTN

Question 27

patent ductus arteriosus

Answer 27

what: congenital heart defect that results in increased pulmonary blood flow presentation (s/s): (can be asymptomatic), respiratory- tachypnea, dyspnea, intercostal retractions, risk for resp infections. Cardiac: tachy, full and bounding pulses, widened pulse pressure, low CO with hypotension, HF, hepatomegaly, continuous murmur mgmt: nonsurgical- indomethacin, or ibuprofen. surgical ligation of the PDA prognosis: no long-term complications if closed before pulm HTN or vascular disease develops.

Question 28

atrioventricular canal

Answer 28

what: congenital heart defect that results in increased pulmonary blood flow due to failure of endocardial cushions to close which leads to ASD (w/ or w/o VSD) and malformation of the AV valves. can be partial or complete. -complete: involves all 4 chambers and one or both AV valves presentation (s/s): depend on degree of L to R shunting, but reflect HF cardiac- weak pulses, ashen skin color, edema in legs and abdomen, holosytolic murmur. respiratory- tachypnea, increase WOB, recurrent resp infections, resp failure. lack of appetite, poor wt gain. mgmt: surgical repair required prognosis:

Question 29

pulmonic stenosis

Answer 29

what: congenital defect that results in decreased pulmonary blood flow (via pulmonic valve) due to an obstruction in right ventricular outflow types: subvalvular, valvular, and supravalvular; which can all be mild, moderate or severe. presentation (s/s): respiratory- tachy, increased WOB, SOB, cyanosis (if severe) cardiac- tachy, edema in lower extremities, face and abdomen, systolic ejection murmur mgmt: nonsurgical aims to manage HF. surgical- subvalvular stenosis involves a balloon valvuloplasty; supravalvular- augments pulm artery with patch angioplasty. prognosis: normal lives if stenosis is treated. regular follow-up needed.

Question 30

aortic stenosis

Answer 30

what: congenital disorder that involves stenosis of aortic valve leaflets resulting in obstruction to systemic blood flow -subvalvular, aortic or supravalvular. presentation (s/s): resp- DOE, cardiac- does a cardiac murmur, narrow, pulse pressure and low blood pressure with decrease peripheral pulses in severe cases. mgmt: balloon valvuloplasty or surgical valvotomy. Ross procedure prognosis:

Question 31

coarctation of the aorta

Answer 31

what: congenital disorder that involves narrowing of the proximal portion of the descending aorta (distal to left subclavian) resulting in obstruction to systemic blood flow. If PDA remains open, perfusion to lower extremities is adequate. presentation (s/s): resp- Tachy, increased WOB. cardiac: upper extremity HTN (lower extremity BP is lower than uppers), weak/absent/delayed femoral pulses, pale/cold skin on lower extremities, sweating, loud S2, systolic ejection murmur, palpable thrill in suprasternal notch severe: if ductus arteriosus closes around 3-7 days of life, shock, HF, metabolic acidosis, hypoglycemia, renal failure, NEC and hypothermia could develop. poor feeding and wt gain, irritable. mgmt: nonsurgical- prostaglandin infusion required to keep DA open, tx wit diuretic, O2 and and inotropes surgical- synthetic pads aortoplasty, resection with end-to-end anastomosis, resection with end-to-side anastomosis prognosis:

Question 32

truncus arteriosus

Answer 32

what: involves the mixing of oxygenated and deoxygenated blood due to the presence of a single great artery functioning as the aorta and pulm artery, resulting in lower oxygenation status, decreased CO with potential HF presentation (s/s): resp- cyanosis, tachypnea, dyspnea, retractions, nasal flaring, frequent resp infection, pulm HTN. cardiac- wide pulse pressure, irritable, facial swelling, cardiomegaly over time, polycythemia, clubbing of fingers. fatigue and poor feeding/growth mgmt: nonsurgical- treat HF with diuretics surgical- 3 components: separate pulm arteries from main trunk, close VSD with patch, and create connection between R vent and pulm arteries via graft. prognosis:

Question 33

transposition of great vessels (arteries)

Answer 33

what: involves the mixing of oxygenated and deoxygenated blood because the aorta and pulm arteries are connected to the wrong ventricles, resulting in lower oxygenation status, decreased CO with potential HF presentation (s/s): resp- cyanosis doesn't improve with supplemental oxygen, hypoxia tachypnea without signs of respiratory distress. cardiac- S2 is loud, systolic murmur if VSD is present, signs of heart failure, polycythemia. failure to gain wt mgmt: nonsurgical- prostaglandins, monitor and treat HF surgical- ballon atrial septostomy to make ASD larger to improve O2 saturation within the mixed blood. Arterial switch operation within first 2 weeks of life. prognosis:

Question 34

tricuspid atresia

Answer 34

what: congenital defect that results in decreased pulmonary blood flow due to failure of the tricuspid valve (right side) to form. -cyanotic heart defect -ASD present with right to left shunting presentation (s/s): respiratory- cyanosis present at birth, tachypnea, pulmonary edema, hypoxic episodes. cardiac- continuous murmur from PDA, single S2 heart sound in aortic area, HF, hepatomegaly, polycythemia. delayed growth mgmt: nonsurgical- prostaglandins started immediately to keep ductus arteriosus open. This provides the only blood flow to the lungs in primary tricuspid atresia. Close monitoring of oxygen status. surgical- 3 separate surgeries to regulate pulmonary circulation (last one is in toddlerhood) prognosis:

Question 35

tetralogy of fallot

Answer 35

what: congenital defect that results in decreased pulmonary blood flow due to R ventricular outflow obstruction, R vent hypertrophy, VSD, and overriding aorta. the right vent is undeveloped and not properly aligned. The aorta and VSD allow for deoxygenated blood to enter systemic circulation (cyanosis) presentation (s/s): respiratory- mold-to-severe cyanosis, tachypnea. cardiac- loud, harsh systolic ejection murmur, polycythemia, clubbing of fingers over time, squatting in toddlers. failure to gain wt mgmt: nonsurgical- manage hyper cyanotic episodes, calm child, knees to chest to augment preload, avoid dehydration surgical- close VSD with graft or patch, augment the right vent outflow tract, and ASD may be closed or left open. prognosis:

Question 36

Total anomalous pulmonary venous return (TAPVR)

Answer 36

what: involves the mixing of oxygenated and deoxygenated blood due to the pulm arteries dumping back into right atrium or systemic circulation which makes its way back to right atria, resulting in lower oxygenation status, decreased CO with potential HF. foramen ovale must be open to keep the body partially oxygenated. presentation (s/s): resp- Tachy, mild cyanosis which increases with feedings (esophagus compressed the common pulm vein-- results in tachycardia, dyspnea, retractions, crackles, pulmonary edema, hepatomegaly, irritability, poor feeding.) cardiac: tachycardia, heart failure, palpable, precordial bulge, S2 has a wide fixed split gallop rhythm. (third sounds heard). failure to thrive. mgmt: nonsurgical- monitor for s/s of HF, prep for urgent surgery surgery- palliative: balloon atrial septoplasty to increase blood flow to left side of heart corrective- reconnect pulmonary veins to the back of the left atrium. prognosis:

Question 37

hypoplastic left heart

Answer 37

what: congenital disorder that involves stenosis of entire left side of heart resulting in obstruction to systemic blood flow. usually acompanied with other stenotic defects. presentation (s/s): resp- Tacho, increasing resp distress, cyanosis. cardiac- decreased pulses, signs of low CO. feeding difficulties, irritable, not easily consoled, lethargy (late sign) mgmt: nonsurgical- prostaglandins surgical- right vent converted to pulm function and systemic function, which later allows for separation prognosis:

Question 38

HF

Answer 38

recognition: mgmt: long term effects:

Question 39

ineffective endocarditis

Answer 39

recognition: mgmt: long term effects:

Question 40

acute rheumatic fever

Answer 40

recognition: mgmt: long term effects:

Question 41

kawasaki disease

Answer 41

recognition: mgmt: long term effects:

Question 42

cardiomyopathy

Answer 42

recognition: mgmt: long term effects:

Question 43

Digoxin/digitalis

Answer 43

how to give: toxicity s/s: monitoring labs

Question 44

indomethacin

Answer 44

use in PDA: how to give: considerations

Question 45

Aspirin and IVIG

Answer 45

kawasaki indication:

Question 46

prostaglandins for cardiac defects

Answer 46

how they help: how to give: considerations:

Question 47

ACE-inhibitors and beta blockers

Answer 47

how to give: considerations: which conditions they're indicated for:

Question 48

difference in skin of children and adults

Question 49

cradle cap (seborrheic dermatitis on scalp)

Answer 49

RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 50

acne

Answer 50

types: classifications and their tx: RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 51

bacterial infections of the skin

Answer 51

impetigo, MRSA, SSSS, cellulitis

Question 52

Impetigo

Answer 52

RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 53

MRSA

Answer 53

RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 54

SSSS

Answer 54

RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 55

cellulitis

Answer 55

RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 56

pediculosis (infestation)

Answer 56

RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 57

scabies (infestation)

Answer 57

RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 58

tick bites

Answer 58

RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 59

dermatitis

Answer 59

contact, atopic, diaper RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 60

psoriasis

Answer 60

RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 61

dermatophytosis

Answer 61

RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 62

tinea corporis

Answer 62

RF: s/s: dx: nurse mgmt: tx: pt/parent edu:

Question 63

how to treat/prevent big bites

Answer 63

(dogs, cats, humans, wild animals)

Question 64

Burns

Answer 64

prevention:

Question 65

sunburn prevention

Question 66

Burn specification

Answer 66

depth of damage: TBSA% that needs to admitted to hospital: Parts of body that require hospitalization immediately:

Question 67

burn complications and most common

Question 68

how to treat burns home vs hospital

Answer 68

minor vs moderate to severe

Question 69

main goals of burn care and considerations within peds population