Peds Exam 2 Flashcards
What are some assessment findings the nurse would notice with hypoxemia?
tachypnea
pallor/cyanosis
s/s of respiratory distress
diminishing air entry
weak peripheral pulses/ club fingers
decrease in LOC
rales/ rhonchi/ wheezing
What are the s/s of respiratory distress?
retractions, flaring, grunting on expiration and stridor on inspiration, head bobbing, restlessness, use of accessory muscles
What is often the first sign of respiratory illness?
tachypnea
The nurse assesses their client and realizes they have hypoxemia. What management techniques will the nurse use?
apply pulse ox, oxygen therapy sessions, chest physiotherapy, suctioning
What is the priority of care for a patient with hypoxemia?
Ineffective breathing pattern/ impaired gas exchange/ ineffective airway clearance
What is the patho behind cystic fibrosis?
autosomal recessive disorder CFTR gene with various mutations which disrupts chloride ion movement and sodium reabsorption, reducing the amount of water in sections
What are some physcial respiratory findings of cystic fibrosis?
Thick, tenacious sputum
Air trapping/ obstruction/ chronic cough/ URI
Unable to clear secretions
RHF (cor pulmonale)
Clubbing/ barrel chest
What are some physical GI findings of cystic fibrosis?
dehydration
Thicker bile= cirrhosis/ gallstones
thick mucous
Abdominal distention or difficulty passing stool; bulky, fatty, greasy stools (steatorrhea)
Poor weight gain
What causes dehydration in a patient with cystic fibrosis?
chloride and water changes
A decrease in what causes mucus to thicken?
pancreatic enzymes
What is the diagnostic for cystic fibrosis?
Sweat chloride test
chloride > 40mEq/L in infants, > 60mEq/Dl in children < 3months
sodium >
What nursing management priorities will the nurse focus on for pulmonary?
airway clearance therapy, aerosol therapy, o2 as prescribed, monitor for CO2 retention
What medication classess will be given to a patient with cystic fibrosis?
bronchodilators and anticholinergics, anti-inflammatory, IV or nebulized ABX
What is airway clearance therapy?
chest PT w postural drainage to clear secretions and prevent infection
What is aerosol therapy?
pulmonary enzyme (dornase alfa) decreases the viscosity of mucus, improving lung function
What are the GI nursing management priorities for cystic fibrosis patients?
Administer laxatives and pancreatic enzymes within 30 minutes of eating a meal or snack
For infants, open capsule and sprinkle on an acidic type food (applesauce)
What dietary considerations should be made for a patient with cystic fibrosis?
high protein, high calorie, high amt of fluids
What vitamins should patients with cystic fibrosis increase?
D, E, A, K
What age group is most commonly affected by croup? After what age is it rare?
3mo- 3yrs, 6 years
What are some assessment findings of croup?
“barking cough”, sudden onset at night, gone in the morning, low grade fever, inspiratory stridor, dyspnea, retractions
lasts 3-5 days
What additional assessment findings will you see with infants who have croup?
nasal flaring, intercostal retractions
What are nursing priorities for croup?
typically managed at home, cool mist humidifier or steamy bathroom, hydration.
if stridor is signoficant or there are severe retractions, O2, continuous oximetry
What are medications for moderate/ severe croup?
Dexamethasone IV (corticosteroid) and
Racemic epinephrine
Corticosteroids are used to decrease inflammation
Racemic epinephrine causes vasoconstriction to decrease bronchial edema (short lived effects)
What is used for the acute management of asthma?
short acting bronchodilators (albuterol/ levalbuterol), anticholinergics (ipratropium), IV/PO corticosteroids (prednisone)
What is albuterol used for in the acute management of asthma?
acute exacerbations and excercise induced asthma
What is the purpose of ipratropium in the acute management of asthma?
treats bronchospasms
What is used for the chronic management of asthma?
long acting bronchodilators (formoterol, salmeterol), inhaled fluticasone, mast cell stablizers (cromolyn), leukotriene receptor agonists (montelukast)
What is the purpose of formoterol/ salmeterol in the chronic management of asthma?
prevent exacerbations, esp. at night, must be used alongside anti-inflammatory therapy, not for acute exacerbations
What is the purpose of fluticasone in the chronic management of asthma?
daily preventative measure, tx of choice, rinse mouth after use
What does cromolyn do in the management of chronic asthma?
prevents histamine release from mast cells, decreases frequency and intensity of allergic reactions
Prophylactic, not for relief of bronchospasms
What does montelukast do for the management of chronic asthma?
decreases airway resistance, given once daily in evening
What are some assessment findings of asthma?
nonproductive hacking cough (worse at night)
dyspnea with excercise, chest tightness
low O2
wheezing, coarse crackles, diminished
silent chest
restlessness, irritability, sweating, difficulty talking
use of accessory muscles
tripod positioning
What is silent chest?
ominious sign, no air movement
What are some diagnostics for asthma?
CBC: increased WBC and eosinophils
ABG: increased CO2, decreased O2
Allergy/ Rast testing: identify triggers
SpO2: decreased
CXR: hyperinflation
Pulmonary function test (spirometry)
Peak inspiratory flow test
What is a pulmonary function test? What is Peak inspiratory flow rate?
measures lung volume capacity and lung function; flow meter measures the amount of air that can be forcefully exhaled in 1 second
What are nursing actions to treat status asthmaticus?
Continuous cardiorespiratory monitoring, O2, ABGs,
administration of bronchodilators and anti-inflammatory meds,
prepare for emergency intubation
Is status asthmaticus mild asthma?
NO, life threatening episode of airway obstruction that is unresponsive to common tx
What medications will be used to treat status asthmaticus?
Theophylline – anti-inflammatory and reverses corticosteroid resistance; has risk for toxicity and requires frequent monitoring of blood level
Magnesium sulfate IV – relaxes bronchial muscles, expanding airways
Heliox (mix of Helium and O2) – decreases airway resistance
Ketamine – smooth muscle relaxant
What are some assessment findings of epiglottitis?
rapid onset (within hours) high fever and toxic appearance
drooling/ dysphagia
unable to speal/ whispers
tripod position with neck thrust forward
absent cough
anxiety / frightened appearance
What is the priorities of care for epiglottitis?
Secure airway: prepare for endotracheal intubation
Never attempt to visualize the throat d/t laryngospasm
Do not leave child unattended
No supine positioning
100% O2 in least invasive way
Emergency airway equipment at bedside to prep for emergency tracheostomy
ICU admission
Meds: IV ABX; corticosteroids
“If you make them cry, they might die”
Assessment findings of forgein body aspiration
sudden onset of cough, stridor (foreign body in upper airway) wheeze, gradual respiratory distress
What diagnostics will be used for foreign body aspiration?
CXR and bronchoscopy confirms FB presence
What are the risk factors for foreign body aspiration?
6mo-3 years, small smooth objects
Pt education for foreign body aspiration includes..?
Keep coins, small batteries/objects, latex balloons out of reach of children
No popcorn or peanuts until age 3; chop all foods in small pieces
S/S of R sided HF in a pediatric patient
Hepatomegaly
Edema
JVD
Periorbital edema
Weight gain
S/S of L sided HF in a pediatric patient
Increased work of breathing
Tachypnea
Wheezing
Rales
Cough
dyspnea on exertion
feeding difficulties
What meds are used to manage HF?
Beta Blocker (metoprolol)
ACE inhibitor (catopril)
Loop Diuretic (lasix)
Glycoside (digoxin)
How does metoprolol manage HF?
decreases HR and BP, promotes vasodilation
Monitor HR and BP prior to admin
s/e: dizziness, hypotension, headache
How does catopril/ enalapril manage HF?
reduces afterload by causing vasodilation»_space; decreased pulmonary and systemic vascular resistance
Monitor BP before and after administration
How does a loop diuretic manage HF?
used to manage edema (rids body of excess fluid and sodium)
K+ wasting
Monitor BP, K+ levels, I&O, weight daily
s/e: hypokalemia, N/V, dizziness, ototoxicity
How does digoxin manage HF?
increases contractility of heart muscle
Count apical pulse for 1 full min; hold if <90 bpm in infant; <70 in child; < 60 in adolescent
Monitor serum digoxin levels (0.8-2ng/mL)
Signs of toxicity: N/V, anorexia, bradycardia, dysrhythmias. Antidote: Digoxin immune Fab
Priorities of care for a child with HF/CHD includes what three topics?
oxygenation, nutrition, assessment triangle
What will the nurse focus on with “ oxygenation” when caring for a pt with HF?
Airway patency
Fowlers or Semi fowlers to facilitate lung expansion and decrease WOB and workload of heart
Suction and CPT PRN
Humidified O2 as ordered, monitor SpO2 and s/s of respiratory distress, intubation with PEEP if severe
Relieve cyanotic spells
What nursing interventions will be included in nutrition with a pediatric HF patient?
150calories/kg/day for nutrition with small, frequent feedings
Concentrate infant formula to 24-28 calories/oz per directions
Feedings should be limited to 20’ then reminder via OG/NG tube
Cutting hole or cross in nipples decreases work of bottle feeding
Semi upright position
Breast milk or infant formula PO or gavage feedings; breast feeding requires less energy
Human milk fortifier added to breast milk w gavage feedings to increase calories
Formula fed infants with addition of polycose/vegetable oil to increase calories
Appearance in HF pts
abnormal tone
decreased activity level
decreased consolability
abnormal look/ gaze
WOB in HF pts
abnormal sound
abnormal position
retractions
flaring
apnea
gasping
Circulation to skin in pts with HF
pallor, mottling, cyanosis
What is a coarctation of the aorta?
Narrowing of the aorta that occurs most often near or beyond PDA, pressure increases near the defect and distal to it, causing an increase in BP in upper extremities, and decreased BP in lower extremities
What are some assessment findings with a coartaction of aorta?
Full bounding pulses in upper extremities
Weak or absent pulses in lower extremities
Soft or moderately loud systolic murmur at base or left axilla
Frequent epistaxis; leg pain with activity d/t decreased CO (older child)
What are some diagnostics for coartaction of aorta?
ECHO: extent of narrowing and collateral circulation
CXR: L sided cardiomegaly, rib notching
CT, MRI, ECG: prn
What is the patho behind ventricular septal defect?
Acyanotic heart defect, opening between R and L ventricles of heart causing a LEFT to RIGHT shunt. increased blood flow to RV causes an increase in blood flow to the lung, leading to PA, HTN, RVH
most common heart defect, 50% of cases resolve spontaneously
What are assessment findings of VSD?
Holosystolic heart murmur along left sternal border, palpable thrill in chest, CHF systems
What labs/ diagnostics will be done for a VSD?
Echo/cardiac MRI: looks at the extent of L –> R shunt
Cardiac cath or surgery for larger defects to patch opening and pulmonary artery banding: eval hemodynamic flow pressures
What is the Patent ductus arteriosus (PDA)?
failure of PDA to close resulting in a connection between aorta and pulmonary arteries, more common in premature infants
normal at birth, but should spontaneously closed by 2 weeks of age (after maternal prostaglandins have cleared)
What assessment findings will you see with PDA?
Tachycardia
Diastolic BP decreased d/t shunting
Harsh, continuous machine-like murmur loudest under left clavicle at 1st/ 2nd ICS
Bounding peripheral pulses (from increased CO)
Widened peripheral pulses (>30mmHg)
Hypoxia/ resp. distress (d/t pulmonary edema)
What treatment will you use for PDA?
Nonsurgical: Admin of indomethacin (NSAID that inhibits prostaglandins) , Diuretics, extra calories for infants
Surgical: thoracoscopic repair (ligate vessels), insertion of coils to occlude to PED
What is the fatal four of tetralogy of fallot?
- Ventricular septal defect
- Pulmonary stenosis»_space; R –> L shunt
- Hypertrophy of Right ventricle > L Ventricle causing R- -> L shunt
- Overriding Aorta –> hypoxemia
What are the clinical features of tetralogy of fallot?
Fainting, difficulty breathing, easy fatigue, color changes w/ feeding, crying
Loud harsh systolic murmur
Polycythemia (results in increased blood viscosity) from kidneys stimulating RBC production d/t hypoxia
TET spells (blue baby) – especially in morning; cyanosis, hypoxemia, dyspnea, agitation –> progresses to anoxia and unresponsiveness
What nursing interventions would be used to treat tetralogy of fallot?
Use a calm, comforting approach
Knee to chest position/ squatting to treat
Provide supplemental oxygen
Administer morphine sulfate (0.1mg/kg IV, IM, or SQ)- improves TET symptoms
Supply IV fluids
Administer propranolol
How do you treat tetralogy of fallot?
Prostaglandins (keep PDA open to increase pulmonary blood flow)
Surgical repair of R ventricular outflow obstruction and VSD closure
What is kawasaki disease?
Acquired Cardiovascular Disorder: acute, febrile systemic vasculitis in blood vessels due to inflammation and edema; autoimmune response by unknown infectious organism , usually in child <5yrs
What assessment findings will you see in the acute phase of kawasaki disease?
Extreme irritability
Significant bilat. Conjunctivitis without exudate
Bright red chapped lips, strawberry tongue, red inflamed pharyngeal mucosa
Bilateral joint pain
Enlarged lymph nodes
desquamation (peeling) of fingers, toes, and perineal area; rash over body
tachycardia, gallop, or murmur
What is the nurse’s priority of care with kawasaki disease?
reduce inflammation of walls of coronary arteries and prevent thrombosis
Acute Phase: onset of high fever – prevent MI ischemia
SubAcute Phase: resolution of fever and gradual resolution of other s/s
What nursing actions will be completed for the cardiac status in a patient with kawasaki disease?
V S/Telemetry, Assess for S/S of HF (↓UOP, gallop, tachycardia, Resp. distress)
Monitor strict I&Os, Daily weights
What nursing interventions for promoting comfort will be included in patients with kawasaki disease?
Admin acetaminophen for fever and cool cloths if tolerated
Rest/quiet/atraumatic care
Irritability/ inconsolable: most difficult problem, need rest and quiet family support
Clear liquids; soft foods; lip lubricants and mouth care
What medications are used in the treatment of kawasaki disease?
Immunoglobulin (IVIG): high dose IV ( 2g/kg) over 8-12hr
High- Dose Aspirin: 80-100mg/kg/day q6hr followed by 3-5mg/kg/day after fever breaks; indefinite if aneurysms develop
Additional anticoagulants if large aneurysms
What is the patho behind acute rheumatic fever?
Group A streptococcus (GAS) triggered by strep bacteria, attacks cardiac muscle and neuronal synovial tissue affects CNS, joints, and skin and subq tissue. Causes progressive heart and mitral valve damage. Results in heart murmur, painful joints, fever of 38.2-38.8
What will you see in a patient hx with ARF?
Sore throat (pharyngitis) w/in past 2-3 weeks, recurrent URI or skin infections, reports of fever and joint pain. Child aged 5-15years; during colder months.
