Peds Exam 2 Flashcards
pre-procedure for cardiac cath
-accurate height and weight
-allergy history (especially to iodine)
-NPO for 6-8 prior
-locate and mark distal pulses
post-procedure for cardiac cath
-position affected leg STRAIGHT
-check temperature bilaterally
-ASSESS INSERTION SITE AND PRESSURE DRESSING
-assess peripheral perfusion
disorders with increased pulmonary blood flow
patent ductus arteriosus (PDA), atrial septal defect (ASD), and ventricular septal defect (VSD) in these defects, blood is shunted from high pressure left side to low pressure right side
patent ductus arteriosus (PDA)
passageway (ductus arteriosus) between the aorta and the pulmonary artery remains open (patent) after birth
treatment for patent ductus arteriosus (PDA)
Indomethacin (Indocin)
atrial septal defect (ASD)
an opening in the septum separating the atria; may close spontaneously, if it doesn’t surgical intervention is needed
ventricular septal defect (VSD)
an opening in the septum separating the ventricles; may solve spontaneously, but if VSD is severe enough HF can result
Disorders with decreased pulmonary blood flow
Tetralogy of Fallot, Tricuspid atresia; pressure of right heart is high so desaturated blood from right side shunts to left
What are the 4 defects of Tetralogy of Fallot?
-Pulmonary stenosis
-ventricular septal defect
-overriding aorta
-right ventricular hypertrophy
key symptom of tetralogy of fallot
Tet spells manifested as increased cyanosis, hypoexemia, agitation comes with crying feeding or defacating
for hypercyanotic spells
-calm the child
-knee to chest postion
-administer O2
-administer morphine
-IV fluids
interventions for tetralogy of fallot
KNEE TO CHEST POSITION; helps to improve pulmonary blood flow by increasing systemic vascular resistance
tricuspid atresia
Tricuspid valve orifice fails to develop; right ventricle is hypoplastic
in tricuspid atresia, what must remain open to maintain minimally adequate oxygenation?
foramen ovale and PDA
Tricuspid Atresia Treatment
Prostaglandin (PGE) to maintain patency of PDA, Surgical Repair
coarctation of the aorta
congenital cardiac condition characterized by a narrowing of the aorta
key symptom of coarctation of the aorta
blood pressure higher in the upper extremities and decreased in lower extremities (20mmHg or >)
intervention for coarctation of the aorta
-balloon angioplasty
-resection of narrowed aorta followed by end-to-end reanastomosis
aortic stenosis
narrowing of the aorta; resulting in decreased CO
difference in symptoms for coarctation of the aorta and aortic stenosis
coarctation of the aorta: dizzy and LEG PAIN
aortic stenosis: dizzy and CHEST PAIN
Transposition of the great vessels
a congenital abnormality where the aorta is attached to the right ventricle and the pulmonary artery to the left ventricle (this is backwards and leads to two separate blood routes)
Transposition of the great vessels presents with
significant cyanosis at birth
interventions for Transposition of the great vessels
corrective surgery performed at 4-7 days
Hypoplastic Left Heart Syndrome
underdevelopment of the left side of the heart, usually resulting in an absent or nonfunctional left ventricle
without intervention of hypoplastic left heart syndrome…
death will occur rapidly
treatment of choice for hypoplastic left heart syndrome
heart transplant
s/s of heart failure in children
-weight gain
-activity intolerance
-poor feeding
-depends on L or R side HF
medication for improved cardiac function
digoxin, ACE, B-Blockers
do not give digoxin to infants if pulse is
<90-110bpm
do not give digoxin to older children if pulse is
<70bpm
medication to remove accumulated fluid and sodium
Furosemide
Digoxin effects on heart
slows HR but deepens contractions
interventions for heart failure
-semi-fowlers
-feeding every 3 hours and have infant take required food in within a 30 minute time period
-neutral environment to prevent cold stress
-cool humidified oxygen
rheumatic fever
inflammatory disease that may develop as a delayed reaction to insufficiently treated group A beta-hemolytic streptococcal; effects connective tissues of the heart, joints, skin, blood vessels, CNS
rheumatic fever can manifest
2-6 weeks after strep throat
s/s of rheumatic fever
-chorea
-fever
-carditis
-erythema marginatum
-abdominal pain
-sub-q nodules
-polyarthritis
Erythema marginatum
Small red spots w/ bright red margins, sand papery
rash Rheumatic fever; painless
treatment for rheumatic fever
antibiotics (penicillin) , antiinflammatories
what is needed before the dentist if a child has rheumatic fever
antibiotics
Kawasaki disease
acute systemic vasculitis of unknown cause
S/S of Kawasaki disease
-fever
-strawberry tongue
-conjunctival redness
-red throat
-erythematous body rash
-swollen hands and soled of feet
-desquamation of skin on tips of fingers and toes
-red dry cracked lips
-enlarged cervical lymphnodes
Treatment for Kawasaki disease
Aspirin and IV gamma globulin
aspirin in kawasaki’s disease is initially used for
fever, then for antiplatelet use
interventions for kawasaki disease
-measures to lower fever
-monitor signs of bleeding sue to aspirin therapy
-passive ROM to facilitate joint movement
-monitor cardiac
-oral hygiene; lips moist
common respiratory infection manifestation
-tachypnea (>60)
-tachycardia (>160)
-cyanosis
-nasal flaring
-grunting
-apnea/dyspnea
-retractions
-fever, V/D/abd pain
-wheeze, crackles, absence of breath sounds
common management for respiratory infection
-fluids
-cool mist
-rest: play quietly
-handwashing
-acetaminophen/ibuprofen
-OCT cold meds
Acute Viral Nasopharyngitis
common cold
management of Acute Viral Nasopharyngitis
-fluid
-rest
-humidified air
-handwashing
-elevate HOB
-suctioning
acute infections pharyngitis
strep
diagnosis of acute infections pharyngitis
throat swab; infection with group A-B hemolytic streptoccus
treatment for acute infections pharyngitis
azithromycin
strep increases the risk for
rheumatic fever
tonsillitis s/s
-swollen red tonsils
-Sore throat
-Difficulty swallowing
-White or yellow coating or patches
-Fever
management for tonsillitis
tonsillectomy
Post-op of Tonsillectomy
-position prone/side lying to facilitate drainage
-watch for FREQUENT SWALLOWING
-no milk products
otitis media s/s
-crying, irritability
-rolling head side to side
-rubbing ear
prevention from otitis media
feed upright, maintain routine immunizations
interventions for otitis media
-increase fluid
-avoid chewing during acute phase (chewing increases pain)
when giving medication in the ear of a child <3y/o
pull ear lobe down and back
medication for otitis media
amoxicillin
infective agent for mononucleosis
epstein barr virus
diagnosis for mononucleosis
monospot test
S/S of mononucleosis
-fever
-sore throat
-swollen lymph nodes
-increased WBC,
-fatigue
-lyphadenopathy and hepatosplenomegaly
interventions for mononucleosis
no specific treatment; self-limiting monitor for signs of splenic rupture
Croup (laryngotracheobronchitis)
inflammation of larynx, trachea, and bronchi
S/S of croup
-Hoarseness
-barking cough with inspiratory stridor
-low-grade or no fever
what should be avoided in patients with croup
cough syrup and cold medications as it can dry and thicken secretions
Epiglottitis
medical emergency; inflammation of epiglottis, can rapidly develop to respiratory distress
what vaccine decrease risk factor of epiglottitis
Hib
s/s of epiglottitis
-drooling
-difficulty swallowing
-retractions
-inspiratory stridor
-sore throst
-tripod
interventions of epiglottitis
-NO THROAT INSPECTION BY NURSE
-resuscitation equipment
-intubation or trachepstomy
bronchitis
inflammation of the bronchi; viral, mostly self limiting
S/S of bronchitis
-dry hacking non productiv ecough
-worse at night
-fever
management for bronchitis
cough suppressanrs, fluids, rest (basically treat the symptoms)
bronchiolitis and respiratory syncytial virus (RSV)
inflammation of the bronchioles that causes production of thick mucus, RSV is acute viral infection that causes this
s/s of bronchiolitis and respiratory syncytial virus (RSV)
-rhinorrhea
-coughing
-sneezing
-wheezing
-ear and eye drainage
protection from RSV
Palivizumab (synagis), monthly injection
pertusis (whooping cough)
A HIGHLY CONTAGIOUS acute upper respiratory infection caused by the bacterium Bordetella pertussis.
s/s of pertusis (whooping cough)
-severe cough with loud whooping inspiration
-cyanosis
-tongue pertrusion
management for pertusis (whooping cough)
-airborne, droplet, contact precautions
-Tdap should be administered for prevention
-antimicrobial therapy
-hydration, suction, humidified air
foreign body aspiration
swallowing/aspiration of objects into air passages
s/s of foreign body aspiration
Choking, gagging, coughing
intervention for foreign body aspiration
abdominal thrust maneuver
prevention of foreign body aspiration
-Teach parents how to prevent foreign body aspiration
-Very mindful of small pieces around infants/children that can be easily put into their mouths
asthma
chronic inflammatory disorder of the airways
s/s of asthma
-Sense of breathlessness
-Tightening of the chest
-Wheezing
-Dyspnea
-Cough
Drug therapy for asthma
-albuterol (SABA)
-salmeterol (serevent) (LABA)
-methoprednisone
peak flow meter
tests severity of asthma
status asthmaticus
a severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure.
