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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) HOLE

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
nutrtion (FEEDING TUBE)

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

H- *CHF+ Pulmonary ( dyspnea, fatigue , swelling , crackles, sweating+ clammy, activity intolerance
O - often lung infections
L - Low growth weight (FTT),
W- Extra heart sounds

24
Q

VSD ( HOLE) * Define/ S+S/ TX

A

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

s/s=
H- *CHF+ Pulmonary ( dyspnea, fatigue , swelling , crackles, sweating+ clammy
O - often lung infections
L - Low growth weight (FTT), Loud Harsh , Left hypertrophy(pumping harder to get to the body
E- Extra heart sounds

His notes: Loud harsh doesn’t appear until 4-8 weeks because pulmonary pressure drops
CHF
FTT= bc they get so tired to easy and eating during

25
PDA ( s/s HALLMARK SIGN OF SOUND,define, dx)
leaving an opening between pulmonary artery and the aorta; aycyanotic s/s : MACHINE HUM MURMUR (left sternal border), WIDE PULSE PRESSURE ( Diastolic pressure decreased bc less blood leaving heart), 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
COA
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 -lower BP Exercise restrictions
27
Tetralogy of Fallot (define/ s+s/ tx)
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
Transportation of great arteries/vessels
(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
TET spells (5)
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
CHF ASSESSMENT: IMPAIRED Myocardial FUNCTION (7)
-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
CHF ASSESSMENT: Pulmonary Congestion
Tachypnea , dyspnea - Retractions, nasal flares - Stridor, grunting - Exercise intolerance - Recurrent respiratory infections
32
CHF ASSESSMENT: Vascular Congestion
-Peripheral edema- excessive weight gain - Ascites - Neck vein distention- will not see in infants, usually only older children
33
S&S Hypoxemia
-Cyanosis, clubbing - Polycythemia (high HCT) - TET spells CHF
34
Nursing Interventions CHF (7)
- 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
Digoxin: - Do not give if HR is:
- <110 in infants - <90 in 1-6yr old - <70 in 7-15yr old - Put on a cardiac monitor, listen apical for 1 minutes contracts stronger and pumps slower Watch for : Dysrhymias, vomiting, ANcedote : digibidn
36
Diuretics (furosemide)-
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
Asepsis:
patient will have less immune reserves and no energy to fight infection -
38
Diaper loosely-
abdominal breathers... too tight of a diaper can restrict breathing and O2
39
Dx of CHF
Xray first EKG/ECHO Catherization -
40
Post op
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
Kawasaki Disease (define)
widespread inflammation of the small and medium sized blood vessels (coronary arteries are most susceptible) causing damage
42
S/S of Kawaskai
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
Nurse DEj rt Kawaksi
Culture for strep - will be neg mointor strep
44
Treatment rt Kawaksi
IVIG - avoid live vaccine MMR, Varriellca - ASA to decrease BP to avoid anuyrsm

Nur 211 (6 decks)

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