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PEDs > PEDs Test 2 ASH COPY > Flashcards

PEDs Test 2 ASH COPY Flashcards

1
Q

In obstructive acyanotic defects blood is prevented from moving from the _______________ into the ___________ circulation

A
  • Left ventricle

- Systemic

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2
Q

Rheumatic Fever pathology

A

untreated Strep throat causes this multisystem disease

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3
Q

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.

A

tetralogy of Fallot,

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4
Q

Treatment of Kawasaki

A

IV gamma globulin and aspirin (don’t care about Rye risk b/c benefit outweighs)

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5
Q

S&S of Defects causing Mixed Blood Flow

A

cyanosis
L&R heart failure
low PaO2
VERY sick

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6
Q

The current treatment of children with Kawasaki disease includes __________ along with _________

SG 48

A
  • high-dose intravenous immunoglobulin (IVIG) (gamma globulin)
  • aspirin therapy.
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7
Q

The Arteriosus can reopen in response to ?

A

Hypoxemia

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8
Q

Acyanotic Defects that increase pulmonary blood flow include

A
  • Ventricular Septal Defect
  • Atrial Septal Defect
  • Patent Ductus Arteriosus
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9
Q

Cyanotic defects that mix blood flow include?

A
  • Transposition of the Great Vessels
  • Total anomalous pulmonary venous return
  • Truncus arteriosus
  • Hypoplastic left heart syndrom
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10
Q

Rheumatic fever is a multisystem disease that involves joints, skin, brain, mucus membranes and the heart. ___________ damage is the most severe complication.

SG 44

A
  • Cardiac valvular
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11
Q

Main Defect Causing Decreased Pulmonary Blood Flow that we studied

A

Tetralogy of Fallot

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12
Q

The goals of nursing management of the child with a head injury are to:

(list interventions)

A
  • 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
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13
Q

Temporary Treatment for Transposition of Great Vessels until they get major surgery to correct defects

A

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

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14
Q

nursing interventions for hemophilia

SG 36

A
  • prevent bleeding
  • recognize and control bleeding
  • prevent crippling effects of bleeding
  • support the family and prepare for home care
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15
Q

Discharge teaching for a child with a VP shunt

SG - 31

A
  • 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
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16
Q

What do children with Coarctation of the Aorta present with?

A
  • Signs of congestive heart failure
  • elevated pulses and blood pressure above the level of the defect
  • Decreased pulses below the defect
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17
Q

what are some nursing interventions that can be done for a child in VOC (vasoocclusion crisis):

SG 8

A
  • pharmacologic treatments (start with NSAIDS then progress to opioids)
  • hydration
  • physical therapy
  • non-pharmacologic and complementary treatment
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18
Q

Clinical manifestations of congestive heart failure include

SG 38

A
  • irritability
  • tachypnea
  • poor feeding
  • pallor.
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19
Q

Pathology of Kawasaki Disease

A

Acute vasculitis everywhere in body leading to heart damage and coronary aneurysm

Self limiting

No known cause!

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20
Q

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.

A

increased pressure

decreased pressure

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21
Q

Nurse prioritizes nursing management of child with HIV

SG 3

A
  • Education concerning transmission
  • Control of infectious diseases
  • appropriate storage of special medications and equipment (e.g., needles and syringes), are emphasized.
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22
Q

Nursing management for children with Defects obstructing blood flow from the ventricles

A
  • close monitoring of urine output,

- assessment of acid base balance, and observation of level of consciousness.

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23
Q

What are signs and symptoms of Congenital Heart Disease?

A
  • Congestive Heart Failure
  • Pallor or Cyanosis
  • Altered pulses
  • Murmur
  • Fatigue/irritability
  • Poor weight gain
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24
Q

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?

A
  • Decreased urine output
  • Metabolic Acidosis
  • Decreased gastrointestinal function
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25
Q

Because bacterial meningitis can be contagious
_______ & _______ may be necessary.

SG 33

A
  • isolation precautions

- contact tracking

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26
Q

an abnormal, often cancerous, growth of tissue

A

neoplasms

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27
Q

Expected lab values for a child with leukemia

SG 22

A
  • low WBC (leukocyte) count less than 50,000
  • low blood counts
  • Elevated immature cells or blasts.
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28
Q

initial therapy of bacterial meningitis is:

A
  • 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
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29
Q

Early signs of hemarthrosis (bleeding in the joints) are:

SG 36

A
  • feeling of stiffness, tingling, or achiness in the affected joint, followed by a decrease in joint movement
  • bleeding in the neck, mouth or thorax
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30
Q

Signs of a tec spell in children

SG 37

A

Crouching- they can feel the tec spell and crouching causes abdominal pressure, pushing the blood into the right ventricle. This temporarily fixes it.

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31
Q

Nursing Interventions for Respiratory Alkalosis

SG 45
SG 46

A
  • Prevent patient from hyperventilating/ slow breathing
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32
Q

Children with Defects obstructing blood flow from the ventricles will frequently have

A
  • decreased pulses
  • decreased urine output
  • poor gastrointestinal function
  • metabolic acidosis.
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33
Q

What defect is caused by narrowing of the aortic arch

A

Coarctation of the aorta

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34
Q

Nursing Care for Rheumatic fever

A
  • strep care
  • prevent recurring infxns
  • prevent longterm heart damage (every recurrence of this disease is worse)
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35
Q

Patients with an Atrial Septal Defect have an __________ ______________ Blood flow

A

Increased Pulmonary

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36
Q

Definitive diagnosis of leukemia is based on

A

bone marrow aspiration and/or biopsy

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37
Q

Like ASD Ventricular Septal Defect can be repaired _______ or _____________?

A
  • surgically with sutures

- by placing a block

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38
Q

Family education for child with sickle cell

SG 8

A

(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.

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39
Q

Signs of Congestive heart failure

A
  • Tachypnea
  • Tachycardia
  • Diaphoresis
  • Cardiomegaly
  • Hepatomegaly
  • Edema
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40
Q

The Administration of what three vaccines are recommended for children with Sickle Cell Anemia due to their susceptibility to infection?

SG 29

A
  1. pneumococcal
  2. H. influenzae
  3. meningococcal
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41
Q

Normal Pa02

SG 45
SG 46

A

80 -100mmHg

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42
Q

Why is a Ventricular Septal Defect hemodynamically more significant?

A

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

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43
Q

In Children with Sickle Cell Anemia, oral ____________ prophylaxis is recommended by 2 months old to reduce the chance of pneumococcal sepsis.

SG 29

A

penicillin

44
Q

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

A

shunt malfunction

obstruction.

45
Q

the only treatment to combat Cooley anemia is ____ and _____

A
  • regular blood transfusions

- iron chelation therapy

46
Q

What causes the Ductus Arteriosus to close soon after birth ?

A
  • Constricts in response to Oxygen and the loss of prostaglandins
47
Q

Postop care of the child with a VP shunt includes

A
  • regular assessment of head size and behavior
  • skin care and infection prevention at the surgical site,
  • parent education
48
Q

Signs and symptoms of Defects Obstructing Blood Flow from the Ventricles

A
  • Congestive Heart Failure

- Decreased systemic perfusion and perfusion

49
Q

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

A
  • elevated temperature
  • poor feeding
  • vomiting
  • decreased responsiveness, and seizure activity.
50
Q

Symptoms of leukemia are:

SG 2

A

-infection
-fever
-enlarged spleen
-lymph nodes and liver enlargement
-persistent fatigue
-weakness
-easy bleeding or bruising
-bone pain or tenderness
-weight loss
-

51
Q

A PaO2 of 100 mm Hg or higher suggests ______ disease, and a PaO2 lower than 100 mm Hg suggests ________ disease

SG 44

A
  • lung

- cardiac

52
Q

The objectives of nursing care for a patient with thalassemia are to

SG 27

A

(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.

53
Q

S&S of Rheumatic Fever

A

Eye inflammation

Heart, brain, cardiac damage

54
Q

Tetralogy of Fallot SS

A 
blue
no CHF - b/c blood moves to body ok
normal pulse
organ hypoxemia
tec spells
55
Q

treatments of SCA

A

blood transfusions

hematopoietic stem cell transplant (HSCT)

56
Q

Neonates with a Coarctation of the Aorta will be treated with a _________________ infusion.

A

Prostaglandin E infusion

57
Q

Parent teaching for a child with a febrile seizure

SG 16

A
  • 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
58
Q

General signs and symptoms of Defects Causing Decreased Pulmonary Blood Flow

A

hypoxemia

cyanosis

increased resp rate w/o resp distress

poor growth

clubbing

polycythemia

low PaO2 and O2 sat

59
Q

How does the blood flow in a child with an Atrial septal defect?

A

Blood flows from the left atrium through the defect into the lower pressure right atrium.

60
Q

What are the Acyanotic Defects?

A
  • Atrial Septal Defect
  • Ventricular Septal Defect
  • Patent Ductus Arteriosus
61
Q

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.

A
  • severe anemia

- expansion of the bone marrow in the bodies effort to produce more RBC

62
Q

Nursing intervention for tec spell

SG 37

A
  • Bend legs to belly if not already there

- Morphine. O2 won’t do much but we often still give to these kids

63
Q

How is Atrial Septal Defect treated?

A
  • Surgical Patch - blocks hole

- Repaired surgically

64
Q

symptoms of thalassemia major are

A
  • lacking the ability to produce normal, adult hemoglobin
  • chronic fatigue
  • failure to thrive
65
Q

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

A
  • prostaglandin e

- patency of the ductus arteriosus

66
Q

Because of their compromised lung status, children with Increased Pulmonary Blood Flow are at increased risk of ________________ and also increased risk of _____________ and _________ Deficiencies

A
  • Severe respiratory infection.
  • Poor growth
  • Nutritional deficiencies
67
Q

Nursing Care of patient with Defect causing Mixed Blood Flow

A
  • Reduce cardiac demand
  • Give prostaglandins til surgery
    Supportive
68
Q

For many premies and some newborns a Patent Ductus Arteriosus defect can be successfully medically treated with a relatively high dose of ____________

A

indomethacin

69
Q

What is the pathway of blood in a child with Patent Ductus Arteriosus?

A

blood is shunted from the aorta through the ductus into the pulmonary artery and back to the lungs leading to congestive heart failure

70
Q

Side effects of a child on prednisone?

SG 12

A
  • growth suppression (adrenal suppression)
  • weight gain
  • decreased bone density.
  • immunosuppressed
71
Q

S&S of Kawasaki

A 
High fever unresponsive to antipyretics
irritability
errythema 
peeling of skin
edema
red eyes
strawberry tongue
72
Q

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.

A
  • increased

- oxygenated

73
Q

3 Acquired Cardiac Disorders we discussed

A

Bacterial Endocarditis
Rheumatic Fever
Kawasaki Disease

74
Q

A synthetic form of vasopressin, also known as ________, increases plasma factor VIII activity and is the treatment of choice in mild __________

A

DDAVP

hemophilia

75
Q

Why can indomethacin be used to treat preemies and some newborns for Patent Ductus Arteriosus?

A

B/c it is an NSAID which are prostaglandin inhibitors

76
Q

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

A
  • hemoglobin

- vasoocclusion

77
Q

General pathology of Defects causing Mixed Blood Flow

A

Blood comes from both sides of heart and mixes therefore low PaO2 b/c of the mixing

78
Q

a decrease in RBC will present as:

A

weakness, fatigue, pallor

79
Q

one of the nurse’s responsibilities, when anemia is suspected, is to _____

SG 9

A
  • assess baseline energy functioning

- minimize demands

80
Q

Tec Spell (hypercyanotic spell)

SG 37

A

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

81
Q

Cyanotic defects that decrease pulmonary blood flow include?

A
  • Tetralogy of Fallot

- Tricuspid atresia

82
Q

Preoperative care of the child with coarctation of the aorta focuses on _____________ and ________________________________ that may develop due to poor organ perfusion.

A
  • Stabilization

- Correcting metabolic abnormalities

83
Q

Signs of increased Intracranial Pressure:

A
  • confusion
  • decreased responsiveness
  • decreased ability to follow commands
  • pupil dilation with decreased response to light
  • reduced spontaneous movement
  • deterioration in posture
  • cushing’s triad
84
Q

What valve is most frequently affected in a patient with Rheumatic Fever?

SG 44

A
  • mitral valve
85
Q

Infants with Increased Pulmonary Blood Flow may due best with _________________ feedings?

A

Small frequent feedings

86
Q

Teaching priorities for a child with sickle cell disorder

SG 15

A
  • 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
87
Q

Treatment of Rheumatic fever

A

antibiotics

long term aspirin?? verify this

88
Q

Care of the child with meningitis focuses on

SG 33

A
  • systemic care of the child
  • identification and treatment of the causative organism
  • preventing brain injury caused by increased intercranial pressure.
89
Q

most children with meningitis are seen with:

A
  • fever
  • chills
  • headache
  • vomiting that are quickly followed by alterations in sensorium
90
Q

Transposition of Great Vessels pathology

A

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.

91
Q

Acyanotic Defects that obstruct blood from ventricles into the body include?

A
  • Coarctation of Aorta
  • Aortic Stenosis
  • Pulmonic Stenosis
92
Q

Sa02

SG 45
SG 46

A

93 - 100

93
Q

in people with leukemia, the _________ produces abnormal white blood cells, which don’t function properly

A

bone marrow

94
Q

treatment of hemophilia:

A
  • 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
95
Q

Nursing management for a child in sickle cell crisis

SG 8

A
  • rest
  • hydration/fluids
  • electrolyte replacement
  • analgesia
  • blood replacement
  • antibiotics to treat any existing infection
96
Q

Nursing Management for Tetralogy of Fallot

A

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)

97
Q

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?

A
  • Decreased urine output
  • Metabolic Acidosis
  • Decreased gastrointestinal function
98
Q

Nursing Interventions for Respiratory Acidosis

SG 45
SG 46

A
  • Administer oxygen

- encourage deep breathing

99
Q

Nursing interventions for a child with a new ventriculoperitoneal shunt?

SG 20
SG 21

A
  • 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.
100
Q

What is the inheritance pattern of Sickle Cell Disorder?

SG 1.

A

essentially that of an autosomal recessive disorder.

101
Q

Normal range for PaC02

SG 45
SG 46

A

35 - 45

102
Q

Patent Ductus Arteriosus is extremely common in ______________ ?

A

premature infants

103
Q

Treatment of a Patent Ductus Arteriosus

A
  • Surgically

- Place a block in the Cath lab

104
Q

The cardinal sign of Coarctation of the aorta is?

A

Marked gradient between pulses and blood pressure in the upper and lower extremities

105
Q

Normal range for HC03

SG 45
SG 46

A

22 - 26

106
Q

Nursing assessment for a child on prostaglandin-e

SG 30

A
  • monitor pulmonary artery and descending
    aorta pressures
  • side effects apnea, fever, flushing
  • 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.

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