Peds Part 2 Exam 7 HOUR 10 Flashcards
Premature infant
a birth before 37th week
The patient name in the system
last name, male or female (baby a or baby b for twins)
Developmental Delay
buildup of bilirubin causes Kernicterus
RDS
a breathing disorder that affects newborn primally before 28 weeks
Premature Lung Tissue
Surfactant missing
Immature muscles and ribs
Lung compliance - alveoli cannot support shape to exchange O2 and CO2
S/S RDS (7)
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
Treatment/Interventions RDS (5)
Positing HOB > 30
Environment
Feeding ( parenteral feedin)
Bathing
Monitor: CPAP + o2 levels
Bronchopulomary Dysplasia
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
S&S BPD (WORSE)
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
Dx BPD
Chest Xray look spongy. Blood test lmk bloodstream helps identify infection
Treatment BPD
Mimize further lung damage providing support to bbaies lungs allwoing them to heal + grow.
Xray of RDS
ground glass
Retinolental Fibroplasia + S/S (9)
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
Tx retinopathy (3)
laser
virectomy
lensectomy
If untreated retinopathy (6)
Nystagmus- wander,shake , unusual movement of eyes
Eyes don’t follow objects
Pupils look white
Trouble recognizing face
Retinal detachement
Nec Enterocolitis Patho ( think of blood vessels OF GI TRACT) with PREMIE BABIES
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.
Factors of Nec Enterocolits (2)
Formula Feedings ( and breastfeed pts but lower chance)
Premie babies have immature GI system ( decreased motility, absorption)
Prevention of Nec Enterocolits (1)
- breastmilk ( provide immunity, contain lactoferin that decreased bacteria growth)
S/S of Nec Enterocolitis ( 9)
- Temp is unmanageable = WhY? sepsis or inflmmation
- bradycardia
- Hypotension - Lethargic/floppy = infection
- Feeding ( Gastric reflux, retention) = intolernace
- 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
Tx of Nec Enterocloits
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
A-cyanotic Defects (4)
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
Cyanotic
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
ASD ( define/ tx/+ repair / s+s) HOLE
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
VSD ( HOLE) * Define/ S+S/ TX
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
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
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
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
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
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
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
CHF ASSESSMENT: Pulmonary Congestion
Tachypnea , dyspnea
- Retractions, nasal flares
- Stridor, grunting
- Exercise intolerance
- Recurrent respiratory infections
CHF ASSESSMENT: Vascular Congestion
-Peripheral edema- excessive weight gain
- Ascites
- Neck vein distention- will not see in infants, usually only older children
S&S Hypoxemia
-Cyanosis, clubbing
- Polycythemia (high HCT)
- TET spells
CHF
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
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
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)
Asepsis:
Diaper loosely-
abdominal breathers… too tight of a diaper can restrict breathing and O2
Dx of CHF
Xray first
EKG/ECHO
Catherization -
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
Kawasaki Disease (define)
widespread inflammation of the small and medium sized blood vessels (coronary
arteries are most susceptible) causing damage
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)
Nurse DEj rt Kawaksi
Culture for strep - will be neg
mointor strep
Treatment rt Kawaksi
IVIG - avoid live vaccine MMR, Varriellca
- ASA to decrease BP to avoid anuyrsm
