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Nur 211 > Peds Part 2 Exam 7 HOUR 10 > Flashcards

Peds Part 2 Exam 7 HOUR 10 Flashcards

1
Q

Premature infant

A

a birth before 37th week

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2
Q

The patient name in the system

A

last name, male or female (baby a or baby b for twins)

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3
Q

Developmental Delay

A

buildup of bilirubin causes Kernicterus

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4
Q

RDS

A

a breathing disorder that affects newborn primally before 28 weeks

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5
Q

Premature Lung Tissue

A

Surfactant missing
Immature muscles and ribs
Lung compliance - alveoli cannot support shape to exchange O2 and CO2

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6
Q

S/S RDS (7)

A

Tachypnea < 60
Retractions
Grunting - attempting to keep Alevoli open
Flaring Nares - allowing more oxygen to enter lungs
Pale - poor oxygenation
Decreased urine output- shunting blood to vital organs
Frog postion - conserve energy
Hypothermia- immature thermoregu
Diminished Breath Sounds
Crackles

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7
Q

Treatment/Interventions RDS (5)

A

Positing HOB > 30
Environment
Feeding ( parenteral feedin)
Bathing
Monitor: CPAP + o2 levels

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8
Q

Bronchopulomary Dysplasia

A

Chronic Lung disease affecting newborns, most often thos born prematurely and needing oxygen therapy. Lungs and airways are damaged causing tissue destruction in the alveoli

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9
Q

S&S BPD (WORSE)

A

Rapid Breathing
Labored Breathing; drawing in the lower chest = while breathing
Need for o2 therapy after 36 weeks
Dyspena
Repeated lung infections

Wheezing
Oxygen Depdenent ( try to stay away)
R repeated lung infections Wheezing Oxygen
S SCARRING
E fort breathing

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10
Q

Dx BPD

A

Chest Xray look spongy. Blood test lmk bloodstream helps identify infection

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11
Q

Treatment BPD

A

Mimize further lung damage providing support to bbaies lungs allwoing them to heal + grow.

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12
Q

Xray of RDS

A

ground glass

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13
Q

Retinolental Fibroplasia + S/S (9)

A

blood vessel development in the retina is abnormal.

Visual Disturbance
Retinal Detachment
Absent Pupillary Light reflexes - contrcct absent during light shined in infant eyes
Potential Blindness
Dilated/ Twisted vessels
Opaque retrolental eye membrane
Retinal Edema
Retinal Hemorrhages

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14
Q

Tx retinopathy (3)

A

laser
virectomy
lensectomy

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15
Q

If untreated retinopathy (6)

A

Nystagmus- wander,shake , unusual movement of eyes
Eyes don’t follow objects
Pupils look white
Trouble recognizing face
Retinal detachement

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16
Q

Nec Enterocolitis Patho ( think of blood vessels OF GI TRACT) with PREMIE BABIES

A

Necrosis of the bowel-colon; the body shunts blood from GI tract to maintain heart and brain circulation causing ischemia wit intestine that can perforation.

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17
Q

Factors of Nec Enterocolits (2)

A

Formula Feedings ( and breastfeed pts but lower chance)
Premie babies have immature GI system ( decreased motility, absorption)

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18
Q

Prevention of Nec Enterocolits (1)

A
  • breastmilk ( provide immunity, contain lactoferin that decreased bacteria growth)
19
Q

S/S of Nec Enterocolitis ( 9)

A
  1. Temp is unmanageable = WhY? sepsis or inflmmation
    - bradycardia
    - Hypotension
  2. Lethargic/floppy = infection
  3. Feeding ( Gastric reflux, retention) = intolernace
  4. Upper Gi: regurgitation, vomiting (green)

5.Lower Gi: distention, hypoactive sounds <2 min, diarhera/ dark/bloody stools
6.Pertitionits,
7.Jaundice
8. Oliguria = poor blood flow
9. Apena
red/blue, gray discoloration

20
Q

Tx of Nec Enterocloits

A

O2 - oxyhood, isolette
NPO at first sign of regurgation
NG suction - keep stomach empty
IV/TPN
Abdominal measurements/ Xrays
Monitor VS
Monitor stool
Postion patient supine
Thermoregulation
Isolation
Colostomy - LAST RESORT

21
Q

A-cyanotic Defects (4)

A

Acyanotic: left to right shunts, Blood flow to the lungs in increased

  • ASD: Atrial septal Defect
    Abnormal opening between the atria and foramen ovale

–VSD: Ventricular Septal Defect
-Abnormal opening between the ventricles

  • PDA: Patent Ductus Arteriosus
    Failure of the fetal ductus arteriosus to close
  • Coarctation of Aorta
    Narrowing of the aorta beyond aortic arch
22
Q

Cyanotic

A

right to left shunts, blood flow to the lungs is decreased
- TGA or TGV: Transposition of the great arteries or vessels
Pulmonary artery leaves the left ventricle, aorta exits from the right ventricle

  • Tetralogy of Fallot: 4 defects
  • VSD
  • Pulmonic stenosis
  • Overriding aorta
  • Right ventricular hypertrophy
23
Q

ASD ( define/ tx/+ repair / s+s)

A

opening between atria (a cyanotic)

repair at 5 to 6 years old w/ surgical patch * patch bc atria is less force*/cardiac cath
require 6 months of ASA
closes on its own

s/s:
LOUD, harsh murmur
mild CHF
Possible enlarged RA
pressure is still low

24
Q

VSD

A

opening between ventricles
Often close by three years of age. or patch or open heart surgey ( ventricles are bigger)

s/s= Loud harsh doesnt appear until 4-8 weeks because pulomary pressure drops
CHF
FTT= bc they get so tired to easy and eating during

25
Q

PDA ( s/s HALLMARK SIGN OF SOUND,define, dx)

A

leaving an opening between
pulmonary artery and the aorta; aycyanotic

s/s : MACHINE HUM MURMUR, WIDE PULSE PRESSURE, BOUNDING PULSES
Closes 72 hrs and 2-3 weeks

DX: Echo, closure via cardiac cauterization or surgery . If this doesn’t work then open heart surgery Indomethacin

26
Q

COA

A

narrowing of aorta beyond aortic arch leading to obstructed blood flow

S/S
Higher BP and O2 in upper extremities
-nose bleeds
-dizziness, headache
bounding carotids

Lower extremities
-cool
-weak pulses
-leg cramps/ decrease muscle tone
- CHF Regime

Exercise restrictions

27
Q

Tetralogy of Fallot (define/ s+s/ tx)

A

Combinations of VSD, pulmonic stenosis (narrowing artery, causes low blood flow to lungs), overriding aorta, right ventricular hypertrophy ( thick right ventricle wall, results in small RV and increased BP.

S/S=. CYANOSIS, Systolic murmur, TET spells/blue spells

Prostaglandin E infusion keep PDA open, small frequent meals (increase meals can decrease TET spells). Surgical repair with 1 year of life as TET spells increase, CHF regime

28
Q

Transportation of great arteries/vessels

A

(TGA/TGV): pulmonary artery and aorta are switched
imposition- results in no communication between pulmonary circulation (oxygenated blood) and
systemic circulation (unoxygenated blood)

TX: Keep as many prenatal structures open as possible to promote mixing of the oxygenated
and unoxygenated blood- some oxygenation is better than none

  • Give prostaglandin E (remember these structures close naturally after birth as a
    result of natural decrease of mom’s prostaglandin E; giving helps keep those
    structures open
    VSD help mix ventricular blood
    SURGERY
29
Q

TET spells (5)

A

PT looks = blue/dusky tinge to fingers, toes + mouth later with excretion

Blue spells ; hyper cyanotic spells
Sudden increase of cyanosis leads to syncope , hypoxic and DEATH.

Tx: BRING KNEES TO CHEST AND HOLD. Older pts SQUAT
Blow 100% O2
IV/SQ morphine : decrease RR drive
Epinephrine: increase pressure + BF to lungs
IVF replacement

30
Q

CHF ASSESSMENT: IMPAIRED Myocardial FUNCTION (7)

A

-Tachycardia,
-diaphoresis
- Decreased output
- Fatigue, pale and cool extremities w/ weak peripheral pulses
- FFT/anorexia (eating is hard work- easily fatigued
- Peripheral and central cyanosis
- Respiratory infections d/t pulmonary overload and edema

31
Q

CHF ASSESSMENT: Pulmonary Congestion

A

Tachypnea , dyspnea
- Retractions, nasal flares
- Stridor, grunting
- Exercise intolerance
- Recurrent respiratory infections

32
Q

CHF ASSESSMENT: Vascular Congestion

A

-Peripheral edema- excessive weight gain
- Ascites
- Neck vein distention- will not see in infants, usually only older children

33
Q

S&S Hypoxemia

A

-Cyanosis, clubbing
- Polycythemia (high HCT)
- TET spells
CHF

34
Q

Nursing Interventions CHF (7)

A
  • HOB at 30 degrees, cluster care w/ feedings to allow for good periods of rest
  • Give morphine to decrease RR if tachypneic
  • Only feed orally if RR is <60 and baby is alert, otherwise NG or OG only
  • O2 PRN- do not let O2 go <90%
  • Asepsis: patient will have less immune reserves and no energy to fight infection
  • Assess hydration status!
  • Diaper loosely- abdominal breathers… too tight of a diaper can restrict breathing and O2
35
Q

Digoxin:
- Do not give if HR is:

A
  • <110 in infants
  • <90 in 1-6yr old
  • <70 in 7-15yr old
  • Put on a cardiac monitor
36
Q

Diuretics (furosemide)-

A

will be diuretic dependent to decrease fluid volume
- tenth of ML
- Too much fluid increases risk of bacterial endocarditis and valve damage
- Use a low sodium formula (decreases water volume)

37
Q

Asepsis:

A
38
Q

Diaper loosely-

A

abdominal breathers… too tight of a diaper can restrict breathing and O2

39
Q

Dx of CHF

A

Xray first
EKG/ECHO
Catherization -

40
Q

Post op

A

Risk : thrombosis/embolism formation, puncture of vessel or heart, bleeding
decrease cirulation to lower extremities
keep flat 4-6 hrs
Rewarm słowy
Feedng tube (NG)
Sedation + pain med
Possible chest tube, ETT multiple IV

41
Q

Kawasaki Disease (define)

A

widespread inflammation of the small and medium sized blood vessels (coronary
arteries are most susceptible) causing damage

42
Q

S/S of Kawaskai

A

Mimics strep HALLMARK SIGN NEG STREP WITH:
- Erythema of palms and soles of feet, strawberry tongue, cracked lips

  • Acute Phase: rapid onset fever (not resolved with antipyretics), irritable, erythema of
    palms/soles, edema of oral mucosa
  • Subacute: from when fever resolves, highest risk of coronary artery
    aneurysms during this time, get a baseline EKG/Echo
  • Convalescent: PHYSICAL SYMPTOMS ARE RESLOVED resolve, but blood work is still not normal (high WBC)
43
Q

Nurse DEj rt Kawaksi

A

Culture for strep - will be neg
mointor strep

44
Q

Treatment rt Kawaksi

A

IVIG - avoid live vaccine MMR, Varriellca
- ASA to decrease BP to avoid anuyrsm

Nur 211 (2 decks)

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