PEDs Test 2 Flashcards
The most common head injury in PEDS is?
concussion
Symptoms of concussion are:
- fatigue
- changes in behavior and mood
- decreased school performance
Common causes of brain injury are:
- falls
- motor vehicle accidents
- sports injuries
Absence seizures are characterized by:
SG 17
- brief loss of consciousness
- often without loss of motor control
- cluster
- last only a few seconds
___ seizures are the most common type of seizure for kids between the ages of 3 month and 3 years
SG 16
febrile
______ seizure is a seizure associated with a febrile illness who does not have a CNS infection
SG 16
febrile
initial treatment of febrile seizures__
SG 16
benzodiazepine
The goals of nursing management of the child with a head injury are to:
(list interventions)
- maintain adequate ventilation, oxygenation, circulation
- monitor and treat increased ICP
- to minimize cerebral oxygen requirements
- to support the child and family during the recovery phase
What are some nursing considerations for a child with head trauma?
- place the child on bed rest
- place the head of the bed elevated slightly and keep the head in the midline position
- keep a quiet environment and turn the lights down
_____ is the most important nursing observation when caring for a child with head trauma
LOC
Signs of increased Intracranial Pressure:
- irritability progressing to lethargy
- High-pitched cry Increased frontooccipital circumference
- Distended scalp veins
- Poor feeding Crying when disturbed
- Setting-sun sign
- confusion
- decreased responsiveness
- decreased ability to follow commands
- pupil dilation with decreased response to light
- reduced spontaneous movement
- deterioration in posture
- cushing’s triad
meningitis in infants is associated with an approximately a _____ mortality rate.
50%
Prior to shunt placement, the focus of nursing care of a patient with hydrocephalus is making sure that the child and family are __________________________.
Physically and emotionally prepared for surgery.
most children with meningitis are seen with:
- fever
- chills
- headache
- vomiting that are quickly followed by alterations in sensorium
___ is the definitive diagnostic test of meningitis
lumbar puncture
VP shunts don’t usually last ______. They can be damaged through _________ or _______.
forever
rough play
trauma
The major complications of VP shunts are ________ and _________.
malfunction
infection
Any child with a history of hydrocephalus with shunt placement who presents with symptoms of increased ICP should be evaluated for assessment of ______________________________?
SG 20
SG 21
shunt malfunction
obstruction.
What are the signs of hydrocephalus
SG 5
- The sunset sign
- a bulging anterior fontanel
- Widened suture lines
Postop care of the child with a VP shunt includes
- regular assessment of head size and behavior
- skin care and infection prevention at the surgical site,
- parent education
the patient with meningitis usually has a high ____
white blood cell count
initial therapy of bacterial meningitis is:
- isolation precautions
- initiation of antimicrobial therapy
- maintenance of hydration
- maintenance of ventilation
- reduction of increased ICP
- management of systemic shock
- control of seizures
- control of temperature
- treatment of complications
maintaining ____ is a prime concern for children with bacterial meningitis?
hydration
what are some quality patient outcomes for patients with bacterial meningitis?
- early recognition of s/s of meningitis
- antibiotics administered as soon as diagnosis is established
- cerbral edema prevented
- exposure prevented by early isolation
- side effects managed
- nuerologic sequelae prevented
a ____ is a blood test used to detect a wide range of disorders including anemia, infection, and leukemia.
CBC - complete blood count
____ carry oxygen to the cells and reflect the health of the bone marrow
RBC
a decrease in RBC will present as:
weakness, fatigue, pallor
average RBC count is ___
4.5 to 5.5 million/mm3
____ reflects primarily the number of RBCs, but can also show the amount of ____ present in each cell.
hemoglobin, hemoglobin
Average hemoglobin values__
11.5 - 15.5 g/dl
______ is the percent volume of packed RBCs
hematacrit
average hematacrit values__
35-45%
__ is the index of production of mature RBCs by the bone marrow
reticulocyte count
average reticulocyte counts are__
0.5-1.5%
an increased amount of ____ is due to some stimulus to the bone marrow to up production
reticulocyte count
____ are on guard to fight infection
WBC
normal WBC count is__
4.5 to 13.5 x 10~3 cells/mm~3
what are the five major types of WBC
- basophils
- eosinophils
- lymphocytes
- monocytes
- neutrophils
___ are readily stainged with basic dyes, and release histamine, heparin, and serotonin
basophils
______ seen in allergies, asthman, eczema, and autoimmune diseases
eosinophils
______ can be type b and t. B become cells that produce antibodies. antibodies attach to a specific antigen making it easier to destroy. T attack antigens directly.
lymphocytes
______ are phagocytic, they are formed in the bone marrow, they change into macrophages and eat harmful bacteri, viruses, and fungi
monocytes
___they are produced in the bone marry and are also phagocytic
neutrophils
chronic anemia will manifest itself as__
SG 9
fatigue, decreased growth and pallor
one of the nurse’s responsibilities, when anemia is suspected, is to _____
SG 9
- assess baseline energy functioning
- minimize demands
______ is the most prevalent and most preventable nutritional disorder in the US
SG 9
iron deficiency anemia
the term infant will run out of iron stores at about ___ while a premature infant stores may last only _____
6 months
2-3 months
an adequate dosage of iron turns the stools _____
tarry green or black color
What are signs and symptoms of Congenital Heart Disease?
- Congestive Heart Failure
- Pallor or Cyanosis
- Altered pulses
- Murmur
- Fatigue/irritability
- Poor weight gain
Signs of Congestive heart failure
- Tachypnea
- Tachycardia
- Diaphoresis
- Cardiomegaly
- Hepatomegaly
- Edema
____________ includes primarily anatomic abnormalities present at birth that result in abnormal cardiac function.
Congenital heart disease (CHD)
More frequently the diagnosis of Congenital Heart Disease will be made ___________ but can be seen _______ in severe cases
sometime after birth
In Utero
It is important to remember that in infants and children, congestive heart failure is almost always a manifestation of ____________________
another underlying problem.
Primary congestive heart failure is ____________ in children.
very rare
______________ is an abnormal opening between the left and the right atria
Atrial Septal Defect
How does the blood flow in a child with an Atrial septal defect?
Blood flows from the left atrium through the defect into the lower pressure right atrium.
In patients with an Atrial Septal Defect blood flows from the left to the right atrium, causing an ___________flow of ___________ blood into the right side of the heart.
- increased
- oxygenated
Patients with an Atrial Septal Defect have an __________ ______________ Blood flow
Increased Pulmonary
Because of their compromised lung status, children with Increased Pulmonary Blood Flow are at increased risk of ________________ and also increased risk of _____________ and _________ Deficiencies
- Severe respiratory infection.
- Poor growth
- Nutritional deficiencies
Infants with Increased Pulmonary Blood Flow may due best with _________________ feedings?
Small frequent feedings
Many children with cardiac defects that similar to ASD will require diuretic therapy and medications such as ______________ and __________________ for the treatment of Congestive Heart Failure
- Lasix
- Digoxin
Which heart defect is often very well tolerated?
It can be a ___________ finding.
- Atrial Septal Defect
- Incidental
How is Atrial Septal Defect treated?
- Surgical Patch - blocks hole
- Repaired surgically
What defect is a failure of the Foramen Ovale to close?
Atrial Septal Defect
What is a Ventricular septal defect ?
an abnormal opening between the left and the right ventricle.
Why is a Ventricular Septal Defect hemodynamically more significant?
B/c there is greater difference in pressure between the right and the left ventricle thus larger amounts of blood may flow from the left ventricle to the right ventricle
Congestive Heart Failure is ________ is patients with Ventricular Septal Defect
Common
Like ASD Ventricular Septal Defect can be repaired _______ or _____________?
- surgically with sutures
- by placing a block
What are the Acyanotic Defects?
- Atrial Septal Defect
- Ventricular Septal Defect
- Patent Ductus Arteriosus
What causes the Ductus Arteriosus to close soon after birth ?
- Constricts in response to Oxygen and the loss of prostaglandins
Patent Ductus Arteriosus is extremely common in ______________ ?
premature infants
The Arteriosus can reopen in response to ?
Hypoxemia
What is the pathway of blood in a child with Patent Ductus Arteriosus?
blood is shunted from the aorta through the ductus into the pulmonary artery and back to the lungs leading to congestive heart failure
For many premies and some newborns a Patent Ductus Arteriosus defect can be successfully medically treated with a relatively high dose of ____________
indomethacin
Why can indomethacin be used to treat preemies and some newborns for Patent Ductus Arteriosus?
B/c it is an NSAID which are prostaglandin inhibitors
Treatment of a Patent Ductus Arteriosus
- Surgically
- Place a block in the Cath lab
Signs and symptoms of Defects Obstructing Blood Flow from the Ventricles
- Congestive Heart Failure
- Decreased systemic perfusion and perfusion
What should be done prior to performing a cardiac catheterization on a child? and Why?
- Assessment of the pedal pulse and capillary refill
- b/c the Femoral Vein and artery are almost always used during the procedure
In obstructive acyanotic defects blood is prevented from moving from the _______________ into the ___________ circulation
- Left ventricle
- Systemic
Children with Defects obstructing blood flow from the ventricles will frequently have
- decreased pulses
- decreased urine output
- poor gastrointestinal function
- metabolic acidosis.
Nursing management for children with Defects obstructing blood flow from the ventricles
- close monitoring of urine output,
- assessment of acid base balance, and observation of level of consciousness.
Newborn infants with defects obstructing blood flow from the ventricles will often be placed on a _____________ infusion to maintain the ____________________ until reparative or palliative surgery can be performed
- prostaglandin e
- patency of the ductus arteriosus
In Sickle cell anemia the sickled ___________ form stiff rods in the RBC, preventing easy passage through the vessels, and they can cause blockage or
SG 4
- hemoglobin
- vasoocclusion
_______ is called a “painful episode” that is characterized by ischemia causing mild to severe pain that may last from minutes to days longer in children with Sickle Cell anemia
SG 4
vasoocclusive crisis
Nursing management for a child in sickle cell crisis
SG 8
- rest
- hydration/fluids
- electrolyte replacement
- analgesia
- blood replacement
- antibiotics to treat any existing infection
____ is a pooling of a large amount of blood usually in the spleen and infrequently the liver that causes a decreased blood volume and ultimately shock
sequestration crisis
if the mother and father are both carriers, what are the chances that their offspring will have sickle cell anemia?
SG 1
1 in 4
Given that stroke can be a complication of SCA what is an intracranial doppler used for?
to monitor intracranial vascular flow and is performed yearly from 2-16.
treatments of SCA
blood transfusions
hematopoietic stem cell transplant (HSCT)
_____________ offers a curative treatment for children with SCD
hematopoietic stem cell transplant (HSCT)
the defect in (thalassemia major) Cooley anemia lies in the deficiency to some degree in the ____. the hemoglobin is defective and the RBC’s are weak, easily destroyed, leading to anemia.
beta chain
symptoms of thalassemia major are
- lacking the ability to produce normal, adult hemoglobin
- chronic fatigue
- failure to thrive
two major consequences of thalassemia are __ and ____, which leads to poor growth, impaired physical activity, facial and other bone deformities, fragile bones and enlargement of the liver and spleen.
- severe anemia
- expansion of the bone marrow in the bodies effort to produce more RBC
the only treatment to combat Cooley anemia is ____ and _____
- regular blood transfusions
- iron chelation therapy
Early signs of hemarthrosis (bleeding in the joints) are:
SG 36
- feeling of stiffness, tingling, or achiness in the affected joint, followed by a decrease in joint movement
- bleeding in the neck, mouth or thorax
treatment of hemophilia:
- DDVAP: helps release the manufactures of factor VIII (can be used as a preventative treatment prior to procedures, such as dentistry or sports).
- clotting factors VIII or IX
- recombinant clotting factors (bb) manufactured
General signs and symptoms of Defects Causing Decreased Pulmonary Blood Flow
hypoxemia
cyanosis
increased resp rate w/o resp distress
poor growth
clubbing
polycythemia
low PaO2 and O2 sat
What is polycythemia
increased production of RBC b/c the body wants more O2. Causes viscous blood, can lead to ischemia, stroke
Main Defect Causing Decreased Pulmonary Blood Flow that we studied
Tetralogy of Fallot
Tetralogy of Fallot SS
blue no CHF - b/c blood moves to body ok normal pulse organ hypoxemia tec spells
Tec Spell (hypercyanotic spell)
SG 37
Severe, sudden anoxia
Workload on the heart is too high so the heart beats harder and harder.
Because of this, the musculature around the pulmonary valve can’t relax, and the RV to pulmonary artery passage becomes obstructed by this tension. Patient gets super cyanotic and passes out
Signs of a tec spell in children
SG 37
Crouching- they can feel the tec spell and crouching causes abdominal pressure, pushing the blood into the right ventricle. This temporarily fixes it.
Nursing intervention for tec spell
SG 37
- Bend legs to belly if not already there
- Morphine. O2 won’t do much but we often still give to these kids
Nursing Management for Tetralogy of Fallot
O2 not really useful so don’t give much.
Reduce cardiac demands.
Supportive care until surgery (will have in first year of life to correct the defects)
S&S of Defects causing Mixed Blood Flow
cyanosis
L&R heart failure
low PaO2
VERY sick
Nursing Care of patient with Defect causing Mixed Blood Flow
- Reduce cardiac demand
- Give prostaglandins til surgery
Supportive
General pathology of Defects causing Mixed Blood Flow
Blood comes from both sides of heart and mixes therefore low PaO2 b/c of the mixing
Transposition of Great Vessels pathology
Aorta rises off RV and pulmonary artery off LV.
2 Completely separate circulations!
2 Closed systems:
-One that is highly oxygenated and keeps going to lungs
-Second is low O2 and keeps going to body
To prevent baby from dying, body has open ductus arteriosus and a VSD to allow some mixing.
Temporary Treatment for Transposition of Great Vessels until they get major surgery to correct defects
Prostoglandins!!! Then, in cath lab they pass a balloon thru the forament ovale, blow it thru the LA and yank it back thru the atrial septum to make an ASD and allow more mixing
3 Acquired Cardiac Disorders we discussed
Bacterial Endocarditis
Rheumatic Fever
Kawasaki Disease
Rheumatic Fever pathology
untreated Strep throat causes this multisystem disease
S&S of Rheumatic Fever
Eye inflammation
Heart, brain, cardiac damage
Treatment of Rheumatic fever
antibiotics
long term aspirin?? verify this
Nursing Care for Rheumatic fever
- strep care
- prevent recurring infxns
- prevent longterm heart damage (every recurrence of this disease is worse)
Pathology of Kawasaki Disease
Acute vasculitis everywhere in body leading to heart damage and coronary aneurysm
Self limiting
No known cause!
S&S of Kawasaki
High fever unresponsive to antipyretics irritability errythema peeling of skin edema red eyes strawberry tongue
Treatment of Kawasaki
IV gamma globulin and aspirin (don’t care about Rye risk b/c benefit outweighs)
an abnormal, often cancerous, growth of tissue
neoplasms
in people with leukemia, the _________ produces abnormal white blood cells, which don’t function properly
bone marrow
Definitive diagnosis of leukemia is based on
bone marrow aspiration and/or biopsy
Symptoms of leukemia are:
SG 2
-infection
-fever
-enlarged spleen
-lymph nodes and liver enlargement
-persistent fatigue
-weakness
-easy bleeding or bruising
-bone pain or tenderness
-weight loss
-
pre-chemo:
CHEMO
C- consent procedures H- health assessment E- evaluation of parents understanding M- securing presence of child's mother or father O- overview of treatment
intra-chemo:
SAFE
S- safe administration
A- assessments of intravenous central line site
F- provision of IV fluids
E- assessment of electrolytes
post-chemo:
SOUND
S- symptoms needing attention
O- observation for adverse effects of chemo
U- adequacy of urine output
N- need for nursing care/ further education
D- drugs needed for symptom management such as nausea or mouth care
What defect is caused by narrowing of the aortic arch
Coarctation of the aorta
Coarctation of the aorta is characterized by localized narrowing near the insertion of the ductus arteriosus, which results in _____________ in the head and upper extremities and ___________ in the body and lower extremities.
increased pressure
decreased pressure
How is HIV transmitted in children most commonly?
During childbirth or breastfeeding for young children; risky behaviors for 13-24 yr olds
What do children with Coarctation of the Aorta present with?
- Signs of congestive heart failure
- elevated pulses and blood pressure above the level of the defect
- Decreased pulses below the defect
What changes would you see in the urinary system, blood gas and GI system be affected in a patient with a Coarctation of the Aorta who has a severe stricture?
- Decreased urine output
- Metabolic Acidosis
- Decreased gastrointestinal function
What do children with Coarctation of the Aorta present with?
- Signs of congestive heart failure
- elevated pulses and blood pressure above the level of the defect
- Decreased pulses below the defect
How will the urinary system, blood gas and GI system be affected in a patient with a Coarctation of the Aorta who has a severe stricture?
- Decreased urine output
- Metabolic Acidosis
- Decreased gastrointestinal function
What is Polycythemia
an increased number of red blood cells, increases the oxygen-carrying capacity of the blood.
Neonates with a Coarctation of the Aorta will be treated with a _________________ infusion.
Prostaglandin E infusion
Preoperative care of the child with coarctation of the aorta focuses on _____________ and ________________________________ that may develop due to poor organ perfusion.
- Stabilization
- Correcting metabolic abnormalities
The cardinal sign of Coarctation of the aorta is?
Marked gradient between pulses and blood pressure in the upper and lower extremities
Acyanotic Defects that increase pulmonary blood flow include
- Ventricular Septal Defect
- Atrial Septal Defect
- Patent Ductus Arteriosus
Acyanotic Defects that obstruct blood from ventricles into the body include?
- Coarctation of Aorta
- Aortic Stenosis
- Pulmonic Stenosis
Cyanotic defects that decrease pulmonary blood flow include?
- Tetralogy of Fallot
- Tricuspid atresia
Cyanotic defects that mix blood flow include?
- Transposition of the Great Vessels
- Total anomalous pulmonary venous return
- Truncus arteriosus
- Hypoplastic left heart syndrom
polycythemia
Elevated Red Blood Cells
Hypercyanotic spells, also referred to as blue spells or tet spells because they are often seen in infants with ____________ may occur in any child whose heart defect includes obstruction to pulmonary blood flow and communication between the ventricles.
tetralogy of Fallot,
what are some nursing interventions that can be done for a child in VOC (vasoocclusion crisis):
SG 8
- pharmacologic treatments (start with NSAIDS then progress to opioids)
- hydration
- physical therapy
- non-pharmacologic and complementary treatment
Family education for child with sickle cell
SG 8
(1) seek early intervention for problems, such as fever of 38.5 ° C (101.3 ° F) or greater;
(2) give penicillin as ordered;
(3) recognize signs and symptoms of stroke, splenic sequestration, as well as respiratory problems that can lead to hypoxia
(4) treat the child normally.
If a febrile seizure lasts more than ___ minutes, parents should seek medical attention right away. Parents should call for emergency assistance (911) and not place the child who is actively having a seizure in the car.
SG 16
5
An infant with suspected or confirmed hydrocephalus is observed carefully for signs of increasing ventricular size and increasing ICP. In infants, the head is measured ______at the point of __________ measurement, the frontooccipital circumference
SG 13
SG 20
SG 21
- daily
- largest
Nursing interventions for a child with a new ventriculoperitoneal shunt?
SG 20
SG 21
- Accurate and frequent documentation of the incision site;
- amount, color, and consistency of drainage into the device
- the child’s vital and neurologic signs are an important part of the nursing care.
Because infection is the greatest hazard of the postoperative period of a VP shunt placement, nurses are continually on the alert for the usual manifestations of CSF infection, including
SG 20
SG 21
SG 31
- elevated temperature
- poor feeding
- vomiting
- decreased responsiveness, and seizure activity.
nursing interventions for hemophilia
SG 36
- prevent bleeding
- recognize and control bleeding
- prevent crippling effects of bleeding
- support the family and prepare for home care
The objectives of nursing care for a patient with thalassemia are to
SG 27
(1) promote compliance with transfusion and chelation therapy,
(2) assist the child in coping with the anxiety-provoking treatments and the effects of the illness
(3) foster the child’s and family’s adjustment to a chronic illness
4) observe for complications of multiple blood transfusions.
Expected lab values for a child with leukemia
SG 22
- low WBC (leukocyte) count less than 50,000
- low blood counts
- Elevated immature cells or blasts.
A PaO2 of 100 mm Hg or higher suggests ______ disease, and a PaO2 lower than 100 mm Hg suggests ________ disease
SG 44
- lung
- cardiac
Side effects of a child on prednisone?
SG 12
- growth suppression (adrenal suppression)
- weight gain
- decreased bone density.
- immunosuppressed
What is the inheritance pattern of Sickle Cell Disorder?
SG 1.
essentially that of an autosomal recessive disorder.
The Administration of what three vaccines are recommended for children with Sickle Cell Anemia due to their susceptibility to infection?
SG 29
- pneumococcal
- H. influenzae
- meningococcal
In addition to routine immunizations, children with SCD should receive a yearly ___________ vaccination
SG 29
influenza
In Children with Sickle Cell Anemia, oral ____________ prophylaxis is recommended by 2 months old to reduce the chance of pneumococcal sepsis.
SG 29
penicillin
Teaching priorities for a child with sickle cell disorder
SG 15
- Explain signs of developing complications
- Reinforce basic info about inheritance
- Offer genetic counseling if appropriate
- Stress importance of adequate nutrition
- Stress infection prevention/
- Encourage frequent health evaluations
Nurse prioritizes nursing management of child with HIV
SG 3
- Education concerning transmission
- Control of infectious diseases
- appropriate storage of special medications and equipment (e.g., needles and syringes), are emphasized.
Discharge teaching for a child with a VP shunt
SG - 31
- Keep child flat in supine position
- Child will require life long treatment
- Child will require more than 1 shunt in their life time
- Head circumference should gradually decrease
Parent teaching for a child with a febrile seizure
SG 16
- Children with a family history of febrile seizures are at increased risk for both a single & recurrent febrile seizure
- If a febrile seizure lasts more than 5 minutes, parents should seek medical attention right away.
- reassurance that children who have had febrile seizures but do not have underlying developmental problems will perform as well as other children academically and behaviorally
Parent teaching for a child with a febrile seizure
SG 17
- Note any changes in behaviors observed before or after the seizure
- Not activities during the seizure
Care of the child with meningitis focuses on
SG 33
- systemic care of the child
- identification and treatment of the causative organism
- preventing brain injury caused by increased intercranial pressure.
Because bacterial meningitis can be contagious
_______ & _______ may be necessary.
SG 33
- isolation precautions
- contact tracking
Nursing assessment for a child on prostaglandin-e
SG 30
- monitor pulmonary artery and descending
aorta pressures - Palpate femoral pulse frequently to assess
- monitor urinary output.
circulation to lower extremities.
-BP may be monitored in a lower and an upper extremity
simultaneously.
Clinical manifestations of congestive heart failure include
SG 38
- irritability
- tachypnea
- poor feeding
- pallor.
Normal Pa02
SG 45
SG 46
80 -100mmHg
Normal range for PaC02
SG 45
SG 46
35 - 45
Normal range for HC03
SG 45
SG 46
22 - 26
Sa02
SG 45
SG 46
93 - 100
Nursing Interventions for Respiratory Alkalosis
SG 45
SG 46
- Prevent patient from hyperventilating/ slow breathing
- Breath into a paper bag
Nursing Interventions for Respiratory Acidosis
SG 45
SG 46
- Administer oxygen
- encourage deep breathing
The current treatment of children with Kawasaki disease includes __________ along with _________
SG 48
- high-dose intravenous immunoglobulin (IVIG) (gamma globulin)
- aspirin therapy.
Rheumatic fever is a multisystem disease that involves joints, skin, brain, mucus membranes and the heart. ___________ damage is the most severe complication.
SG 44
- Cardiac valvular
What valve is most frequently affected in a patient with Rheumatic Fever?
SG 44
- mitral valve
A synthetic form of vasopressin, also known as ________, increases plasma factor VIII activity and is the treatment of choice in mild __________
DDAVP
hemophilia
