Peds test 2 Flashcards
RR and ages Newborn Infant Toddler Young child older child Adult
NB-6weeks- 30-60 Infant- 6 weeks to 6months 25-40 Toddler-1-3yr 20-30 young children 3-6 yrs 20-25 Older children 10-14 years 15-20
Grunting 3
Abnormal breath sound on expiration due to glottic closure
Stridor 3
High pitch, audible inspiration, upper airway
With kids- one thing that is different about inspiration vs expiration
The inspiration is usually softer and longer
Peak flow how and what is personal best?
Measures the maximum flow of air (in L/s) that can be forcefully exhaled in 1 second
Taken twice a day over 2 weeks when well and we can use a chart.
Upper airway problems 6
Pharyngititis/tonsillitis Adenoiditis Influenza Laryngitis croup Epiglottitis
Lower airway Respiratory problems 8
Bronchiolitis/RSV Pneumonia bronchitis Pertussis TB Asthma Cystic fibrosis SIDS
What is Pharyngitis/tonsillitis.
Usually caused by
S?S 6
A sore throat.
Strep Group A
Sore throat, fever, swallowing issues, HA, ab pain, scarlatinform rash
Group A s/s 4
Exudate, strawberry tongue, patachiae, scarltiniform rash
Complications of group a strep
Scarlet fever, rheumatic fever, rheumatic heart disease, glomerulonephritis, peritosillar or retropharyngeal abcess, osteomyelitis, septic arthritis.
Tonsilectomy one sign to indicate bleeding no-4? no drinks 2 pluse 3 s/s of hem
Freaquent swallowing-
bleeding, no coughing, blowing nose, using straws
no citrus or red/brown drinks
Restlessness, tachycardia, tachypenia
Croup s/s
how long?
6
Lasts 3-5 days
no fever, stridor, seal like cough, hoarsness, worse at night, can develop the bad s/s of respiratory impairment.
What do you need to watch for with croup?
Bacterial tracheitis
age for croup
3months-5years
What causes croup? 6
Viral, parainfluenza, adenovirus, influenza, RSV, measles, mycoplasma
How to treat croup 5
Rest, fluids, steam, cortico, racemicepinephrine
What almost always causes epiglottitis?
Influenza b
Epiglottitis is a what and s/s 7
medical emergency high fever, toxic appearance, severe sore throat, drooling, refusal to lay back, anxiety, respiratory distress
tx epiglottitis
never- 2
keep blank close
insist child lay back or look down their throat, leave alone
emergency airway equipment
RSV 4 one- precautions
WET!, pretty much always viral, contagious (droplet and contact), peaks around 6 months
Pertussis s/s 3
age worse?
Precautions?
Paroxysmal coughing, whoop, coughing lasts for a long time. 3 moths and younger greatest risk for death, droplet and contact
Complications of pertussis 7
Hypoxia, apnea, pneumonia, seizures, encephalopathy, weight loss and death
What is Cystic Fibrosis
where? 3
One thing to remember and one sign
A progressive, genetic disease that causes persistent lung infections and limits ability to breathe over time.
Sticky mucus in lungs, pancreas and other organs
They have a hard time breaking down food
Salty skin
2 devices for cystic fibrosis
ThAIRapy vest, Flutter mucus clearance device
S/S of cysitic fibrosis 4 you don’t know
Abdominal distention, steatorrhea, meconium illeus in new borns,
Age of toddler
1-3
What movements of a toddler
how many blocks can an 18 month old stack?
Walking, running, stand on tiptoes, climbs, builds block tower, kicks a ball, pulls/carries toys
4
Language in toddlers 2
10 words young-250 words old 2-4 word sentences
Vital signs in the toddler HR BP RR What scale to use for pain
HR 70-110
RR-20-30
BP 90-105/55-70
FLACC
When are the chambers of the heart formed?
2-8 weeks gestation
Describe the heart in kids under seven
It lies more horizontally so the apex is higher in the chest and the heart rate is much higher in infants putting them at risk for a decreased cardiac output.
Heart rates Newborn Infant Toddler preschooler schools age adolescence
120-180 80-150 70-120 65-110 60-100 60-90
BP Newborns infants toddlers school age adolescent
50-70 systolic 65-100/55 80-110/55-75 80-120/60-75 90-130/70-80
What is hypertension defined as in kids
Consistently greater than the 95th percentile for gender, age, and height.
What are the five points of the heart and where are they
Aortic- Right 2nd intercostal space pulmonic-left 2nd intercostal space ERBs Left third space tricuspid lower left sternal Mitral-5th intercostal medial to mid-clavicular
S1 and S2
s1 is AV valves
s2 is semilunar valves
Arteriogram-
another name for it
5 things about care
Cardiac cath keep pressure dressing on change after one day keep clean and dry no bath/ strenuous exercise 3 days watch for dehydration bed rest straight for 4-8hrs
Why is digitalis given to children?
Prevent arrhythmias during and after cardiac cath.
Why is digitalis given to children?
Prevent arrhythmias during and after cardiac cath.
Congenital heart diseases associated with which chromosomal defects
Downs, turner, cleft palate, prader-willi syndrome
Transposition of the great arteries
Aorta+ pulmonary artery switched
Total anomalous pulmonary venous connection and one thing to remember
Pulmonary veins don’t connect normally and come out of the R atrium
Most incompatible with life.
Truncus arteriosus
Only one major art comes out of the heart to supply systemic And pulm circ
Dijoxin what does it do
Increases contractility-helps the heart pump stronger.
When to withhold digoxin?
When not to give oral
<60 bpm in an adolescent, <90 bpm in an infant.
with food
Infective endocarditis what is it
Infects 3
who is at higher risk 3
Bacteria colonize on the thrombi and platelets that form on damaged endothelium and valves
Chambers, septum or valves
Prosthetic valves/CHD/Invasive stuff
Acute Rheumatic fever what causes it? 3 areas What is it from? what age is more likely how long?
Antibody response cross reacts with antigens on cardiac mm neuronal and synovial tissue
Group A strep
5-15
2-4 weeks
What does Acute rheumatic fever cause? 3
effects 4
Carditis, arthritis, chorea
joints, CNS, skin, subcut tissue
How long does Acute Rheumatic fever last and one thing to remember
6-12 weeks
may recur
S/s of ARF
3 what joints?
Fever, painful joints ankle, knees, elbows wrists, red hot
Major criteria of ARF 5
Migratory polyarthritis, carditis, erythema marginatum, syndenham chorea, subcut nodules
Minor criteria of ARF 4
Arthralgia, fever, first degree heart block, elevated inflam markers ESR and CRP
tx ARF
Penicillin
tx ARF
Penicillin
What is Kawaski disease
Acute, systemic, necrotizing pan-vasculitis affecting medium-sized arts
What does kawasaki disease do?
autoimmune disease that causes damage to epithelial walls of vessels causing coronary art dilation
What can kawaski diseases cause
Coronary art aneurysms
s/s of Kawasaki disease 7
Conjunctivitis, red tongue, swollen lymph, rash, edema, peeling, vasculitis
Tx for Kawasaki
3 things
IVIG, Asprin for a long time no live vaccines
What are the congenital defects that decrease pulmonary blood flow
Tetralogy of Fallot and tricuspid atresia
mother teresa was with a fellow
What are the congenital defects that increase pulmonary blood flow
Atrial septal defect ventricular septal defect atrioventricular canal defect patent ductus arteriosis A duck went down two septic canals.
What are the congenital heart defects that obstruct blood flow?
Coarctation of the aorta and aortic and pulmonary stenosis
2 stans walked up an arch
What congenital heart birth defects cause mixed blood?
Transposition of the great arteries
Total anomalous pulmonary/ventricular connection
Truncus Arteriosis
hypoplastic left heart syndrome
The totally great trunk was wrapped in plastic
What congenital heart defect causes cyanosis
ToF, Atresia, truncus, transposition
Tetralogy of fallot 4 things that cause it
Pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect
Tetralogy of fallot 4 things that cause it
Pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect
s/s of Tet of fal 5
Blue babes, loud and harsh murmur, tet or blue spells, anoxic spells, squating
one thing to remember with decreased pulm blood flow congenital heart defects
Polycthemia
Where to listen for ASD? when?
Pulmonic valve area during systole
Murmur with VSD
Loud holosystolic at left sternal border
one thing to remember about septal defects
usually Spontaneously close
What happens in the atrioventricular canal defect
Failure of the endocardial cushions to fuse causes
low ASD and a High VSD to meet and clefts in valves
One thing to remember about atrioventricular canal defect
These kids are really wet
Patent ductus arteriosis tx
Prostaglandin inhib and surgical ligation
what is coarctation of the aorta
narrowing of the aorta neer the ductus art
s/s of coarctation of the aorta 5
epistaxis, leg pain with activity, HA, dizzy, higher BP up high lower BP down low
s/s of coarctation of the aorta 5
epistaxis, leg pain with activity, HA, dizzy, higher BP up high lower BP down low
RSV s/s 8
rapid onset, wheezes decreased breath sounds, low grade fever, cyanosis, tachypnea, tachycardia, poor feeding, apnea
What is the treatment for RSV? 1
Don’t what?
supportive care
Do not breastfeed due to aspiration risk. RR 64 to high to feed.
Which resp illnesses do we hear stridor in? 2
Croup, epiglottitis
What are risk factors for acute otitis me? 8
Child angle of estuation tubes, teething, facial deformities, not breastfeeding, bottle propping, down syndrome, strep, secondhand smoke, recurrent URI, bacterial conjunctivitis, allergies,
What are three biggest nursing problems with pertussis?
Poor nutrition and gas exchange, and dehydration.
Strabismus
Eyes don’t properly align when looking at something
Astigmatism
distorted vision
Ptosis
droopy eyelid
Hyperopia
myopia
Far and near
When to treat acute otitis media with antibiotics 5
The child is younger than 6 months
the child is older than 6 months sever signs
the child is younger than age 2 with bilateral
the child has craniofacial abnormalities,
immunosuppression, downs or cochlear implants
the child can’t be monitored by parent for the first 3 days
What is otitis media with effusion
Its om without any s/s
points to listen to heart
aortic - r 2nd pulmonic-l 2nd erbs L 3rd tricuspid- L 4th mitral- 5th mid clavicular
Hypoplastic left heart syndrome
All structures on left side of heart are under developed
