Peds Exam 2 Flashcards
What is kawasaki’s disease?
An autoimmune disease, also called muco-cutaneous lymph node syndrome.
-Vasculitis affecting medium arteries in many body systems
What is the most common cause of acquired heart disease in children?
Kawasaki disease
Pathophysiology of Kawasaki’s disease?
Inflammatory process of medium arteries. Most common in kids 5 and younger (esp Asian children)
Signs and symptoms of Kawasaki disease?
***increased platelet count and signs of CHF
Stage 1: fever >5 days; conjunctivities, dried lips/mucous membranes, strawberry tongue, swollen hands/feet/ red body rash, lymphadenopathy (esp in neck)
Stage 2: fever resolves, irritable, anorexia, DESQUAMATION of hands/feet (peeling), arthritis/arthralgia, CV issues
Stage 3: ESR (inflammatory marker) decreases, disease appears to resolve (but it’s not)
Treatment of Kawasaki disease?
- IVIG administration (decreases inflammatory affects)
- aspirin (decreases clot formation and inflammation)
Cardinal sign of Kawasaki disease?
fever for more than 5 days
Name 2 diseases where it is OK to give kids aspirin
Rheumatic fever and Kawasaki disease
How does Rheumatic fever come about?
A diagnosed streptococcus infection combined with some Jones’ criteria
How much Jones’ criteria needs to be met to diagnose rheumatic fever?
2 major criteria OR 1 major and 2 minor criteria
function of the epiglottis
protection of the airway
Cardiac assessment in children
Assess for full minute at 4th intercostal space if: -up to 2 yo -known cardiac abnormality -sick Don't let them know you're counting!
Normal HR in infants
80-140
normal HR in adolescents
60-100
how is the heart blood shunted in ACYANOTIC cardiac anomalies
from left to right
how is the heart blood shunted in CYANOTIC cardiac anomalies
from right to left
Name 3 ACYANOTIC cardiac anomalies
- atrial septal defect
- ventricular septal defect
- coarctation of the aorta
what is an atrial septal defect?
- a hole exists btwn L and R atria
- wal defect allows L–>R shunting
- there’s incr pulmonary blood flow (pressure is pushing oxygenated blood to cycle back thru th R side of heart thru to lungs)
Signs and Sx of ASD
- can sometimes be asymptomatic
- paradoxical embolus (can happen if straining (i.e. bathroom) can cause R pressure to overcome L-side pressure
- Dyspnea; easily fatigued
- SYSTOLIC MURMUR at pulmonic region
What would you see on an echocardiogram of a child with ASD?
right ventricular hypertrophy
What might you hear on auscultation of a child with ASD?
split S2 sound
Antibiotic prophylaxis education, according to AHA, is recommended for anyone who:
- has had heart surgery and is in their 1st 6 months post heart surgery
- has had a prosthetic device place
What is a ventricular septal defect
-hole btwn R and L ventricles (allow L to R shunting
Signs and Sx of VSD
- can be asymptomatic
- if larger, can cause: tachypnea; dyspnea; fatigue
- SYSTOLIC MURMUR at LLSB
- congestive heart failure
What would you see on an ECG of a child with VSD
right ventricular hypertrophy
Which cardiac defect is more likely to close on its own btwn ASD and VSD?
VSD
Oral health teaching for children with ASD and VSD
- counsel parents of high-risk children about need for both prophylactic antibiotics for dental procedures and maintaining excellent oral health.
- child’s dentist should be aware of the child’s cardiac condition.
- Dental procedures should be done to maintain a high level of oral health
What is coarctation of the aorta?
– Descended aorta has narrowing/constriction (BOTTLENECK) leading to decr blood flow to periphery & rest of body
- often occurs near ductus arteriosus
- can lead to CHF and death
what are signs and Sx of coarctation of the aorta?
- cold feet
- cramping of lower extremities
- BP and pulse differences (upper is stronger than lower)
- Excercise intolerance and dyspnea
What would you see on a ECG and x-ray test of a child with a coarctation of the aorta?
ECG: coarc is visible
X-ray: heart may be enlarged
Surgery options for coarc of the aorta
if mild coarc: balloon catheterization w/ stents
if moderate/severe: whole coarc is opened, coarc removed and patched with GORTEX PATCH
Name 3 CYANOTIC heart anomalies
- tetralogy of fallot
- transposition of the great vessels
- hypospalstic left heart syndrome
What are the 4 defects that exist in Tetralogy of Fallot?
- pulmonic stenosis (hardening of pulmonic valve)
- R ventricular hypertrophy
- ventricular septal defect
- overriding aorta
what is tetralogy of Fallot?
-4 defects of heart which create a R to L shunting of blood
-Deoxygenated blood gets pushed out from RV through a VSD and an overriding aorta leading to deoxygenated blood getting pushed out to body
(constant battle of blood to get into either the pulmonary artery or the aorta)
Signs and Sx of tetralogy of fallot
- “TET” spells
- SYSTOLIC MURMUR an pulonic region (caused by harsh blood flow thru defects)
- clubbing
- Persistent hypoxemia stimulates erythropoiesis, which results in polycythemia, (increased RBCs).
What is a tet spell?
- Life threatening
- caused by crying, tantrums, stooling, feeding (d/t incr in R to L shunting into aorta bc pulmonary resistance has suddenly increased.
- induces hypoxia, pallor, tachypnea
nursing intervention for tet spell
squatting (for kids) or knees to chest (for infants)
nursing interventions for tetralogy of fallot
- keep ductus arteriosus open (GIVE PROSTAGLANDINS)
- teach about signs, Sx, and relief of TET spells
- post-surgical teaching (ALL PTS WILL NEED MULTIPLE SURGERY)
what is Transposition of the Great Vessels?
- switching of great vessels (aorta is connected to RV and pulmonary artery is connected to LV)
- right to left shunting occurs and CYANOSIS
- Creates 2 independent, closed pathways of circulation
- definitely needs another anomaly/defect to survive (ASD, VSD, or PDA)
Signs and Sx of transposition of the great vessels
– Cyanosis – Hypoxia – Tachypnea – Poor feeding ( too tired to eat) – Failure to thrive
-Nursing interventions for transposition of great vessels
- keep ductus arteriosus open (PROSTAGLANDINS)
- post surgery teaching (surgery is obligatory)
What is Hypoplastic Left Heart Syndrome (HLHS)
- very small (thick) left ventricle
- inability to adequately pump oxygenated blood to aorta and systemic circulation
Patho of hypoplastic left heart syndrome
- Aortic and mitral valves tend to be absent or stenotic (bc no blood is pumping through them)
- leads to hypertrophy of R ventricle
signs and Sx of hypoplastic left heart syndrome
– Tachypnea – Increased work of breathing – Cyanosis – Poor peripheral perfusion – If not treated, it will ALWAYS result in Congestive heart failure
nursing interventions for HLHS
- surgery needed ASAP (multiple surgeries necessary for life)
- Keep ductus arteriosus open (Prostaglandins)
Nursing Dx for CYANOTIC cardiac defects
- Ineffective cardiopulmonary tissue perfusion
- At risk for infection
- Risk for imbalanced nutrition: less than body requirements
- Risk for impaired gas exchange
- Risk for decreased cardiac output
name 3 acquired heart illnesses
rheumatic fever, kawasaki’s disease, congestive heart failure
Definition of rheumatic heart disease
- systemic inflammatory disease,
- heart and joint involvement,
- may involve connective tissue
Patho/etiology of rheumatic fever
- occurs 1-3 weeks after STREP infection
- acute phase (2-3 weeks): inflammation of connective tissue in the heart, joints, and skin
- proliferative phase: cardiac valves scar–>stenosis occurs
how is rheumatic fever diagnosed?
- a confirmed strep test (ASLO (anti-streptolysin O titel) is best)
- Jones’ criteria
What are the “major” Jones’ criteria?
- Joint pain/involvement
- Carditis (murmur, pericardial friction rub, EKG changes, tachycardia)
- nodules- non-tender nodules/masses on flexor surfaces
- Erythema marginatum: macular rash (red and patchy, esp on trunk), erythematous
- chorea: involuntary movement of limbs, slurred speech
What are the “minor” Jones’ criteria?
- Fever
- arthralgia
- prolonged P-R and/or QT interval on EKG
- elevated ESR and CRP and reduced RBC
How do you treat rheumatic fever?
- Aspirin
- prednisone (helps to reduce inflammation)
- bed rest (until ESR normalizes) (be sure to provide mental stimulation, e.g. bring HW to hospital)
- don’t move joints during acute phase
What is the most serious complication of Kawasaki’s disease?
coronary artery aneurysms and potential for MI in kids w/ aneurysm formation
What is congestive heart failure?
when the heart is unable to affectively pump blood to the body (occurs SECONDARY to cardiac defect (it’s not its own illness)
Treatment for CHF?
- Fix the underlying problem
- Meds: digoxin (monitor for bradycardia), furosemide/lasix (monitor electrolytes), and ACE inhibitors
what is laryngotracheobronchitis?
viral croup
what is bacterial croup?
epiglottitis
Etiology of croup
usually comes from RSV or influenza infection (but can be from any virus)
Signs and Sx of croup
– Monitor for respiratory distress • Inspiratory stridor (EMERGENCY) • Retractions • Nasal flaring • Decreased pulse-ox • Coughing (very specific sound, like a seal or dog barking) • NO DROOLING (these pts can swallow) NO TRIPOD (pts can lay down fine) • Very low-grade fever
differences btwn croup and epiglottitis?
In epiglottitis there is drooling, tripodding, and a high fever
what precautions are necessary for a croup patient?
droplet precautions (bc they’re coughing so much)
Nursing interventions for croup
– Monitor for respiratory distress.
• Homeopathic interventions: Provide cool mist humidified oxygen. Cool, humid walk outside. Head in fridge. Elevate HOB
• Provide fluids and comfort measures (mild croup)
• Keep child calm as best as possible
– Medications as ordered
• Oxygen
• Dexamethosone
How does epiglottitis come about?
from a Haemophilus influenzae type b infection
Signs and Sx of epiglottitis? (think of the 4 D’s)
– **Tripodding – 4 D’s: • Dysphonia: Muffled voice/hot potato voice/frog voice • Dysphagia: Painful swallowing • Dyspnea: Trouble breathing [STRIDOR] • **Drooling -NO COUGHING
Nursing interventions for epiglottitis
– ***Nothing by mouth!
– Reduce stimuli (keep kid distracted and calm bc crying/screaming can aggravate the epiglottis)
– **Airway tray ready/intubation tray ready
– Antibiotics/fluids as ordered (full course critical but be ready to intubate bc child may get upset when IV is put in)
– Continuous pulse ox (stay in hospital until Sx are relieved)
– Calm the child
– Use strict hygiene measures
- teach importance of HIB vaccine
what is the number 1 cause of bronchiolitis?
RSV
What is bronchiolitis?
inflammation of the bronchioles (lower airway)
What are the signs and Sx of bronchiolitis?
– Tachypnea – Wheezing – Cough – Rhinnorhea – Sneezing
Nursing interventions for bronchiolitis
– **Positioning (sitting up) – Monitor pulse ox – Suctioning – Oxygen as ordered – **No antibiotics! (it’s virus) – **No cough suppressants! – Teach abt vaccinations (for high risk children there is a vaccine for RSV. Also push influenza vaccine)
How is RSV transmitted?
VIA DROPLETS, USE DROPLET PRECAUTION
What is pneumonia?
inflammation/infection of the alveoli
What are the types of pneumonia (3)?
viral; bacterial (most severe) and aspiration
Nursing interventions for pneumonia?
– Chest PT (to loosen secretions)
– Monitor pulse-ox (give O2 & meds as per ordered)
– Lay on affected side
– Monitor of signs and Sx of dehydration
– Administer liquids to break up secretions as best possible
definition of asthma
chronic airway inflammation
what is the leading cause of chronic illness in kids?
asthma
Signs and Sx of asthma
– Dyspnea
– Wheezing (esp distinctive on auscultation)
– Chest tightness (in older kids, might be only complaint)
– Non-productive cough
– Tachypnea
– Hypoxia
– Prolonged expiration (d/t air trapping)
– Symptoms increase with exercise (some kids have exercise-induced asthma, they should use albuterol prior to exercise)
nursing interventions for asthma
– Monitor pulse-ox
– Administer O2/meds per order
• **Short-acting beta-2 agonist: Albuterol (w/ 1ST symptoms
– Prior to activity for exercise-induced asthma
• *IInhaled corticosteroids: Pulmocort (budesonide) or Flovent (fluircasone)
• Systemic cortiosteroids: Prednisone
– Airway tray available
what is cystic fibrosis
- multisystem autosomal recessive trait disorder
- overproduction of thick muous resulting in insult to the respiration, GI & reproductive systems
- Mechanical obstruction caused by increased viscosity of mucous gland secretions
How is cystic fibrosis diagnosed?
– *Positive newborn screen
– *Confirmed by sweat chloride test
Signs and Sx of cystic fibrosis
– Cough – Clubbing – Barrel chest – Intestinal obstruction (d/t mucus) – Frothy/foul-smelling stool – Failure to thrive – earliest clinical manifestation of CF is a meconium ileus (bowel obstruction)
nursing interventions for cystic fibrosis
• Nursing interventions:
– Chest PT (daily, sometimes multiple times/day)
• Administer bronchodilator meds BEFORE chest PT
– Monitor pulse-ox
– Administer O2/meds as per orders
– Monitor of signs and Sx of dehydration
– **high cal high protein diet (very important!)
signs and Sx of foreign body obstruction
– Cough – Choking – Gagging – Unresponsive – *Stridor – *Wheezing – Asymmetric breath sounds • Unilateral foul-smelling nasal discharge & frequent sneezing – Asphyxiation (condition of severely deficient O2 supply to body that arises from abnormal breathing)
Prevention and teaching strategies for foreign body obstruction
- Dangers of certain foods/which foods are common choking hazards
- Toy age requirements
- Heimlich maneuver (teach it to parents!)
Emergency measures for foreign body obstruction
- Activate emergency response
- Perform Heimlich maneuver
- Place IV
- Prepare for endoscopy
What is SIDS?
– Unexpected death of previously healthy infant less than ONE year old
What is nursing teaching for SIDS?
- **Back to sleep (big push on this since 1994)
- Crib
- No blankets/toys
- No smoking
An infant has tetralogy of Fallot. In reviewing the record, what laboratory result should the nurse expect to be documented?
a. Leukopenia
b. Polycythemia
c. Anemia
d. Increased platelet level
b. Polycythemia
Persistent hypoxemia that occurs with tetralogy of Fallot stimulates erythropoiesis, which results in polycythemia, an increased number of red blood cells.
