PEDS exam 2 Flashcards
who has higher SG children or infants
children
what percent of body weight is water in newborns? infants? children?
75, 65, 50
Why do infants lose a greater proportion of fluid daily? What does this put them at risk for?
Infants and toddlers < 2 have increased body surface area (more skin compared to the rest of their bodies)
Greater loss through lungs than adults due to faster respiratory rate.
Also infants need more water due to their high metabolism.
Risk for dehydration
What organs are responsible in restoring and maintaining a balance in fluids & electrolytes?
Liver: Synthesizes proteins (hydrogen ions)
Kidneys: Excrete and reabsorb ions, water,
Skin: Insensible water loss
Lungs: Secrete CO2 (hydrogen ions)
Why are children < 2 years of age at risk for dehydration?
Children’s kidneys are immature and do not retain water as well.
Body surface area greater (more water loss through skin)
Higher metabolism rate uses more water
Faster respiratory rate results in more water loss from lungs
Define and name 3 causes of dehydration in infants/children.
Vomiting and diarrhea #1
Nasogastric suctioning
Burns
Describe signs and symptoms a child with moderate dehydration would exhibit.
low BP, high HR, dark yellow urine, normal cap refill
Describe signs and symptoms a child with severe dehydration would exhibit.
very low BP, high HR, no urine, absent tears
Describe how the nurse can assist parents to rehydrate their child at home.
Use of pedialyte or oral rehydration - in very small sips very frequently
Which symptoms would alert the nurse to advise the parents to bring a child to the hospital immediately?
If the child has a change in level of consciousness, sunken fontanels, no wet diapers
What interventions are used by the nurse to determine a child’s hydration status?
Weigh the child daily, vital signs (orthostatic hypotension), Skin turgor LOC, Vital signs, urine & blood specimen collection, I & O (wet diapers), presence of tears
Maintenance fluids:
– Current weight in Kg
* Up to 10 kg 100 ml/kg/24 hour
* 11-20 kg 1000 ml + (50 ml/kg for weight above 10 kg)/24hour
* >20 kg 1500 ml + (20 ml/kg for weight above 20 kg)/24 hour
Replacement fluids
20ml per kg
- Metabolic alkalosis
Increase in bicarb (low potassium) decrease in acid
- Metabolic acidosis
Decrease in bicarb. (vomiting/diarrhea) Increase in other acids (poisonings)
- Respiratory alkalosis:
Loss of CO2.
Hyperventilation Respiratory acidosis
Too much CO2: Increase in intracranial pressure, cardiac arrythmias.
Name 3 nursing diagnoses related to burn care
- Risk for infection
- Deficient fluid volume
- Imbalanced nutrition
List collaborative management of a child with burns
Assess airway, especially with facial burns
Stop the burning process (cool, wet sheets)
Provide tetanus booster
Prevent infection
Provide for pain management
Which burns are the most concerning as far as infection risk?
Circumferential (Burn completely around limb)
Extensive eschar (contractures)
Facial (Possible lung damage)
Perineal (increased risk of infection due to stooling & ability to keep clean)
What are the clinical symptoms of GHD? what gland
ant pituitary - Short stature
Youthful features
Delayed bone, muscle, and secondary sex characteristics
What is the treatment for GHD? How long is it administered?
Growth hormone subQ injections daily or qod.
Until: Desired height is met; Bone age > 14 in girls and > 16 in boys
Describe nursing interventions that will meet the needs of these children.
Encourage well child exams to detect this condition early.
Patient and parent education regarding SQ injections,
Emotional support for the patient and family
Function of LH
Function of FSH
Function of LH
Function of FSH
ovarian develop
follicle develop
testicle
sperm
Etiology of precocious puberty
pre activity of hypothalamus
tx of percocious puberty
lupron
What is the cause of this disease? DI
Deficiency of ADH (antidiuretic hormone) due to tumors of the posterior pituitary gland
Name the principle imbalance with a deficiency of ADH.
dehydration
Identify the main clinical symptoms of DI
Polydipsia and polyuria
Urine is dilute so low specific gravity
And serum Na is high
How is DI treated?
replacement ADH
Nursing Implications: for DI
weight daily and manage fluids
Explain the etiology of this condition. SIADH
, there is too much ADH causing water intoxificaiton or fluid overload without the sodium increase in the blood.
Identify the reasons for the symptoms of SIAHD.
The symptoms are the result of fluid overload:
CHF, crackles in the lungs, wt gain without edema, hypertension.
How does the nurse care for a child with SIADH?
Provide distraction when fluids are limited.
Administer medications and hypertonic saline IVs as ordered
Too little (Hypothyroidism) s/s
Constipation
Depression
Lethargy
Lowered BP and heart rate
Dry brittle hair
Weight gain
Irregular menses
Too much (Hyperthyroidism or Grave’s Disease) s.s
Diarrhea
Anxiety
Weight loss
High blood pressure and heart rate (tachy)
Tremor
Exophthalmia
Difficulty in attention or studying
Congenital hypothyroidism presents
shortly after birth causing severe cognitive problems and developmental delays if not recognized and treated.
Discuss the treatment of acquired hypothyroidism in children.
LIFELONG synthroid
How might a school-aged child’s hyperthyroidism affect his behavior in school?
Unable to sit still, anxiety, “hyper”, difficulty concentrating, falling asleep in class from exhaustion.
Name the cause of Cushing Syndrome.
pit gland tumor - too much steroids
List the symptoms of cushing syndrome:
Moon face
Weight gain (truncal)
Buffalo hump on back
Hyperglycemia
Hypertension
Poor wound healing
Since corticosteroids decrease inflammation, they can mask an infection until damage is done to organs
When a parent asks the nurse if the symptoms will go away after the medication wears off, what will the nurse respond?
The effects will go away after the steroids are stopped. The main thing is NOT to stop the steroids abruptly!
What nursing implications are there for steroid administration?
Take with food to avoid gastric irritation.
Take at the same time every day
Never stop abruptly! Call the provider if you have concerns.
Other names: Prednisone, prednisolone, hydrocortisone, corticosteroids, glucocorticosteroids, SoluMedrol (IV), cortisol
Congential adrenal hyperplasia
Missing an enzyme necessary to form cortisol or aldosterone
Describe nursing interventions when caring for a child with this disorder.
Describe nursing interventions when caring for a child with this disorder. CAH
steroids for life
Addison’s Disease
Autoimmune disease with deficient cortisol
Corticosteroid oral directions:
- Always give at same time every day (mornings preferred)
- Give with food to prevent GI upset
- Never skip doses
- Do not stop abruptly (must be tapered off)
- Alternate parental form of med must be available in case of stressful situations or unable to take po
Explain the pathophysiology behind DM type
The theory is that a virus triggers antibodies that destroy the Beta cells in the pancreas that manufacture and secrete insulin. Insulin is necessary to allow water and glucose into the body cells for energy. When a child eats, a burst of insulin is release from the pancreas to aid in utilizing carbohydrates ingested.
What happens without insulin?
Cell dehydration, ketone buildup, metabolic acidosis and death
Symptoms: DM
Polyuria, polydipsia, polyphagia (pees a lot, thirsty, and hungry)
Over time, weight loss
In children, enuresis may occur after toilet training complete
Treatment: DM
Basal insulin: Long acting insulin (glargine) that provides a baseline, small amount of constant insulin)
Bolus insulin: Rapid acting insulin (Humalog) that is given with dinner/snacks to allow use of carbs taken in.
Pumps are used often in children to provide insulin and the amount needed is programmed in.
Lispro - onset, peak, duration, type
15, 60-90, 3-4, short
Regular or humulin onset, peak, duration, type
30-60, 2-3, 3-6, intermediate
NPH onset, peak, duration, type
2-4, 4-10, 10-16, long
glargine onset, peak, duration, type
1-2, no peak, 24 hours,
hypoglycemia s/s
Shakiness
Irritability
Difficulty concentrating
Pallor, sweating
hyperglycemia s/s
Fatigue, sleepy
Thirsty
Polyuria
Slowed responses, confusion
Describe the best source of glucose for a child who is having hypoglycemia.
A glass of skim milk.
Do NOT use diet beverages!
Glucose gel
DM type 2 what is it
The child has some insulin but due to the body’s inability to take it in, hyperglycemia develops.
turners syndrome
Missing part or all of the x chromosome gonad dysfunction
klein. syndrome
boys with extra X xsome
acute complication of DM
DKA
2 chronic complications of DM
– Macrovascular: cerebral, cardiac, and peripheral vessel damage
– Microvascular: …”opathies” neuropathy, nephropathy, dermopathy, retinopathy
PKU
recessive - lack liver enzyme for amino acids - inborn error of metabolism
MSUD
3 amino acids unable to be broken down - leads to liver failure
galactosemia
disordered carb metabolism, can’t convert galactose to glucose (no milk - need soy
List some differences between adults and children: respiratory
- Airways smaller
- Lymph nodes bigger
- Epiglottis floppier
- Tracheal cartilage softer
- Immature muscles
- Mucous membranes lining the airway same but they take up more space
- Tongue is bigger in prop. To mouth
most common site of aspiration
R bronchi
How can the nurse tell when a child is having respiratory distress? List the symptoms in order of severity least to most
- Initial: Restlessness, tachypnea/cardia, sweating
- Early decompensation: Retractions, nasal flaring, grunting, HTN, tri-pod positioning
- Late decomp: Dyspnea, bradycardia, cyanosis, stupor & coma
What action would the nurse take (in order) to improve the infant/child’s respiratory status?
- Positioning
- Suction airway
- Oxygen delivery
- Cpap
- Mechanical ventilation (via endotracheal tube or trach)
Epiglottitis: s/s
- Absence of cough
- Presence of drooling
- Agitation
SIDS infant risk factors
premies, males, maternal drugs
SIDS enviornment risk factors
sleeping prone, bed sharing, soft bedding, overheating, secondhand smoke
What is the etiology of LTB?
upper airway inflamm
s/s of LTB
- Barky cough, tachypnea, retractions, low 02 sats.
What is the nursing management for LTB?
monitor for resp distress
How is LTB treated
steroids and O2
Which children are most at risk for RSV infections?
- premies, re-infection can occur, chronic respiratory disease
s/s of RSV
- s/s? Tachypnea, wheezing, fatique
tx for RSV
- Hydration, 02 – supportive measures
patho of asthma
Reversible disease of airways characterized by bronchospasms and inflammation
causes of asthma
– Prematurity
– Lung tissue restructuring
CF patho
Exocrine gland dysfunction: Defective gene causes abnormal transport of chloride and sodium ions across the cell membrane. Autosomal, recessive disorder.
s/s of CF
- Salty taste to skin
- Frothy, foul smelling, fatty stools that float
- Chronic productive cough
- Clubbing & barrel chest
- FTT & G & D delays
dx for CF
newborn screen and sweat test
How is CF managed?
- Medications - respiratory and pancreatic enzymes are key
Congenital heart defects are categorized by
pathophysiology
and hemodynamics rather than by the presence of cyanosis.
CHD that increase pulm blood flow
- Blood flows from left to right side of heart due to higher pressure on left side of heart
- Size of defect and amount of blood flow determine how quickly pulmonary HTN &/or CHF will develop
- The increase in blood flow to lungs = pulmonary vascular resistance which leads to pulmonary hypertension
INC pulm pressure result = - Tachypnea, tachycardia, ↑ metabolic rate, murmur
- FTT due to poor intake.
- CHF: Dyspnea, increased efforts of breathing, periorbital edema, peripheral edema, hepatomegaly
- Frequent respiratory infections
types:
* Patent Ductus Arteriosus (PDA)
* Atrial Septal Defect (ASD)
* Ventricular Septal Defect (VSD)
* Atrioventricular Canal (Endocardial Cushion) Defect (AV Canal)
CHD that sec pulm flow ‘cyanosis’
- Pulmonic stenosis (valve) : Artery narrowed. Prevents blood going to lungs, backs up (edema) Corrected with balloon cath
- Pulmonic atresia: Artery blocked. No blood flow to lung = cyanotic at birth. Alternate pathway created.
- Tetralogy of Fallot (TOF) – TET or cyanotic spell: toddlers squat to increase blood flow to lungs
- Pulm. Stenosis: None to CHF & chest pain
- Pum. Atresia: Cyanosis at birth, usually has VSD
- TOF: Hypoxic and cyanotic at birth. Cyanosis with feeding/crying. Squats to increase blood flower to the heart.
- -Pulmonic stenosis
-R ventricular hypertrophy
-VSD (and sometimes ASD)
-Overriding aorta
CHD that obstruct systemic circulation
- Aortic Stenosis
- Coarctation of the Aorta: Allows increase blood to upper extremities (HTN and bounding pulses in upper arms) and decreases blood flow to legs.
- HLHS (Hypoplastic Left Heart Syndrome)
nursing care after cardiac cath
- Check for the following during the first 24 hours after catheterization:
- Encourage fluids to help flush the dye out of the body and to prevent dehydration (I & O)
- Allow quiet play such as games, puzzles, and videos for the first 24 hours after the procedure
After cardiac surgery, the child will
stay in ICU until stable. The ICU nurses will monitor vital signs, telemetry, behavior, LOC, respiratory status, I & O, hydration, and the incision for bleeding.
tetrology of fallot
group of CHD that can cause a child to have “tet” or “blue” spells. When this happens, the child will squat to decrease blood return to the heart and increase systemic vascular resistance. The nurse can position an infant to achieve this same effect
coarctation of the aorta will cause
pulses and blood pressures in the arms to be stronger than those in the legs.
what must stay open after birth
ductus ateriosis
When the body recognizes there is less blood available to the peripheral system, it signals the heart to increase cardiac output. How does the heart attempt to do this?
– Tachycardia, increase Na & H2O, cardiohypertrophy
The early symptom of CHF are subtle in children:
– Fatigue, poor feeder, poor wt gain, edema
Later symptoms of CHF include:
– Cyanosis, weak peripheral pulses
– Crackles, tachy, respiratory distress
Treatment includes treating the underlying condition. What are the two medications used to treat CHF?
digoxin and diuretics
When should digoxin levels be drawn after the last dose of digoxin?
6hr after last dose
What is the most common sign of digoxin toxicity in children?
n/v
What are some differences in the GI system in children than adults?
- Stomach capacity smaller
- Increased intestinal peristalsis
- Deficient in some enzymes until 4-6 mo. old
- Immature liver function until 2 years
- LES (lower esophageal sphincter) not strong so babies spit up
- Swallowing becomes voluntary around 4-6 mo.
- Teeth begin erupting at 4-6 months
What are the classic signs of this condition? EA and TF
- Symptoms: Excessive drooling
– Three “C”s: Cyanosis, choking, coughing
What symptoms will the nurse note if this condition continues without treatment? for pyloric stenosis
Projectile vomiting EMESIS IS NOT BILIUS,
Describe the surgery that will correct this condition and the nursing care after surgery. pyloric stenosis
– Pyloromyotomy (splitting the constricting muscle) – gets it at usually 1 to 3 months of age
– SLIDE DIAPER and monitor emesis
When would the nurse instruct parents to call their provider after a pyloromyotomy?
Your baby vomits more than 2 times in 1 day or vomits more than 2 days in a row.
Gastroschisis and Omphaloceles
Explain the differences in these two conditions
- Omphalocele: Covered by peritoneum & amniotic membrane – gastroschisis is not covered
- Gastroschisis: Intestines are outside body
most common cause of intestinal obstruction in children
intersucception
What is the classic sign of this condition? What is it caused by? intuss.
red jelly stool
volvulus s/s
DARK green bilious vomit
cause of volvulus and what happens
malrotation of the intestines result in a twisting of the bowel. When the bowel is cut off from it’s blood supply, it may become necrotic. Emergency surgery is usually necessary to correct this. It can recur.
cause of hirshsprung
Congenital absence of ganglion (nerve) cells causing lack of peristalsis = backup
Which major symptoms is seen with this? hirsch.
– Failure to pass meconium, enterocolitis if not dx
– Constipation, malnutrition
tx of hirsch
pull through surgery
what is NEC
condition of premature infants and has a 50% mortality rate. Caused by inflammation of immature gut.
s/s of NEC
- Distention, bloody diarrhea, poor feeder
tx in NICU for NEC
xrays every 6 hours, NO oral feedings
meckel diverticulitis
- Presence of remnant duct between yolk sac and midgut which is supposed to disappear when the placenta takes over at 8 wga.
gold standard for dx celiac
biopsy
Short Bowel Syndrome
What are the two requirements for this condition?
- Malabsorption due to loss of intestine and need for TPN
Biliary Atresia:
Bile ducts are not fully developed resulting in the lack of bile into the intestines. Malabsorption disorder.
s/s of biliary atresia
– Jaundice
– Steatorrhea
– Hepatomegaly
– FTT, malnutrition
hydronephrosis
– This is a symptom of a process, not a disease itself, due to poor drainage from kidney – usually due to some kind of blockage.
UTI caused by
ecoli
s/s of UTI
urgency, frequency, dysuria, abdominal pain, incontinence
hypospadias
hole of penis at bottom
enuresis tx in order
Fluid restricton, bladder training, alarms, then medication
Nephrotic Syndrome is not a disease but a groups of symptoms true or false
true
What are the three major symptoms of this syndrome? nephrotic syndrom
Proteinuria, hypoalbuminemia, edema
tx for nephrotic syndrome
steroids for 12 weeks
Acute Post-streptococcal Glomerulonephritis
Damaged loops from migrating strep bacteria/antibody complex material blocking them causes increase in water retention and sodium reabsorption = edema from expanded fluid volume
s/s of APSG
- Edema, anorexia, tea-colored urine,
Irritable, lethargy, hypertension(not as much albumin loss)
tx for APSG
Treatment is supportive and will resolve in 4-10 days.
major complications of APSG
Hypertensive encephalopathy, acute cardiac decompensation, ARF
Monitor BP every 4-6 hours, get urinalysis
Hemolytic-Uremic syndrome cause
uncooked or bad meat
Cryptorchidism:
undescended testicles
Cryptorchidism: danger
heat can cause sterility
Discuss changes when child takes 1st breath:
Increased oxygen in the lungs causes a decrease in blood flow resistance to the lungs. Blood flow resistance of the baby’s blood vessels also increases. Fluid drains or is absorbed from the respiratory system.
When planning nursing care, the nurse recognizes that the area the parents and child will need the most assistance in to prevent failure to thrive is:
?
