PEDs Test 2 ASH COPY Flashcards
In obstructive acyanotic defects blood is prevented from moving from the _______________ into the ___________ circulation
- Left ventricle
- Systemic
Rheumatic Fever pathology
untreated Strep throat causes this multisystem disease
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,
Treatment of Kawasaki
IV gamma globulin and aspirin (don’t care about Rye risk b/c benefit outweighs)
S&S of Defects causing Mixed Blood Flow
cyanosis
L&R heart failure
low PaO2
VERY sick
The current treatment of children with Kawasaki disease includes __________ along with _________
SG 48
- high-dose intravenous immunoglobulin (IVIG) (gamma globulin)
- aspirin therapy.
The Arteriosus can reopen in response to ?
Hypoxemia
Acyanotic Defects that increase pulmonary blood flow include
- Ventricular Septal Defect
- Atrial Septal Defect
- Patent Ductus Arteriosus
Cyanotic defects that mix blood flow include?
- Transposition of the Great Vessels
- Total anomalous pulmonary venous return
- Truncus arteriosus
- Hypoplastic left heart syndrom
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
Main Defect Causing Decreased Pulmonary Blood Flow that we studied
Tetralogy of Fallot
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
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
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
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
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 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
Clinical manifestations of congestive heart failure include
SG 38
- irritability
- tachypnea
- poor feeding
- pallor.
Pathology of Kawasaki Disease
Acute vasculitis everywhere in body leading to heart damage and coronary aneurysm
Self limiting
No known cause!
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
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.
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.
What are signs and symptoms of Congenital Heart Disease?
- Congestive Heart Failure
- Pallor or Cyanosis
- Altered pulses
- Murmur
- Fatigue/irritability
- Poor weight gain
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
Because bacterial meningitis can be contagious
_______ & _______ may be necessary.
SG 33
- isolation precautions
- contact tracking
an abnormal, often cancerous, growth of tissue
neoplasms
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.
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
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
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 Interventions for Respiratory Alkalosis
SG 45
SG 46
- Prevent patient from hyperventilating/ slow breathing
Children with Defects obstructing blood flow from the ventricles will frequently have
- decreased pulses
- decreased urine output
- poor gastrointestinal function
- metabolic acidosis.
What defect is caused by narrowing of the aortic arch
Coarctation of the aorta
Nursing Care for Rheumatic fever
- strep care
- prevent recurring infxns
- prevent longterm heart damage (every recurrence of this disease is worse)
Patients with an Atrial Septal Defect have an __________ ______________ Blood flow
Increased Pulmonary
Definitive diagnosis of leukemia is based on
bone marrow aspiration and/or biopsy
Like ASD Ventricular Septal Defect can be repaired _______ or _____________?
- surgically with sutures
- by placing a block
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.
Signs of Congestive heart failure
- Tachypnea
- Tachycardia
- Diaphoresis
- Cardiomegaly
- Hepatomegaly
- Edema
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
Normal Pa02
SG 45
SG 46
80 -100mmHg
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
In Children with Sickle Cell Anemia, oral ____________ prophylaxis is recommended by 2 months old to reduce the chance of pneumococcal sepsis.
SG 29
penicillin
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.
the only treatment to combat Cooley anemia is ____ and _____
- regular blood transfusions
- iron chelation therapy
What causes the Ductus Arteriosus to close soon after birth ?
- Constricts in response to Oxygen and the loss of prostaglandins
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
Signs and symptoms of Defects Obstructing Blood Flow from the Ventricles
- Congestive Heart Failure
- Decreased systemic perfusion and perfusion
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.
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
-
A PaO2 of 100 mm Hg or higher suggests ______ disease, and a PaO2 lower than 100 mm Hg suggests ________ disease
SG 44
- lung
- cardiac
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.
S&S of Rheumatic Fever
Eye inflammation
Heart, brain, cardiac damage
Tetralogy of Fallot SS
blue no CHF - b/c blood moves to body ok normal pulse organ hypoxemia tec spells
treatments of SCA
blood transfusions
hematopoietic stem cell transplant (HSCT)
Neonates with a Coarctation of the Aorta will be treated with a _________________ infusion.
Prostaglandin E infusion
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
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
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.
What are the Acyanotic Defects?
- Atrial Septal Defect
- Ventricular Septal Defect
- Patent Ductus Arteriosus
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
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
How is Atrial Septal Defect treated?
- Surgical Patch - blocks hole
- Repaired surgically
symptoms of thalassemia major are
- lacking the ability to produce normal, adult hemoglobin
- chronic fatigue
- failure to thrive
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
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
Nursing Care of patient with Defect causing Mixed Blood Flow
- Reduce cardiac demand
- Give prostaglandins til surgery
Supportive
For many premies and some newborns a Patent Ductus Arteriosus defect can be successfully medically treated with a relatively high dose of ____________
indomethacin
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
Side effects of a child on prednisone?
SG 12
- growth suppression (adrenal suppression)
- weight gain
- decreased bone density.
- immunosuppressed
S&S of Kawasaki
High fever unresponsive to antipyretics irritability errythema peeling of skin edema red eyes strawberry tongue
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
3 Acquired Cardiac Disorders we discussed
Bacterial Endocarditis
Rheumatic Fever
Kawasaki Disease
A synthetic form of vasopressin, also known as ________, increases plasma factor VIII activity and is the treatment of choice in mild __________
DDAVP
hemophilia
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
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
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
a decrease in RBC will present as:
weakness, fatigue, pallor
one of the nurse’s responsibilities, when anemia is suspected, is to _____
SG 9
- assess baseline energy functioning
- minimize demands
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
Cyanotic defects that decrease pulmonary blood flow include?
- Tetralogy of Fallot
- Tricuspid atresia
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
Signs of increased Intracranial Pressure:
- confusion
- decreased responsiveness
- decreased ability to follow commands
- pupil dilation with decreased response to light
- reduced spontaneous movement
- deterioration in posture
- cushing’s triad
What valve is most frequently affected in a patient with Rheumatic Fever?
SG 44
- mitral valve
Infants with Increased Pulmonary Blood Flow may due best with _________________ feedings?
Small frequent feedings
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
Treatment of Rheumatic fever
antibiotics
long term aspirin?? verify this
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.
most children with meningitis are seen with:
- fever
- chills
- headache
- vomiting that are quickly followed by alterations in sensorium
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.
Acyanotic Defects that obstruct blood from ventricles into the body include?
- Coarctation of Aorta
- Aortic Stenosis
- Pulmonic Stenosis
Sa02
SG 45
SG 46
93 - 100
in people with leukemia, the _________ produces abnormal white blood cells, which don’t function properly
bone marrow
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
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
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)
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
Nursing Interventions for Respiratory Acidosis
SG 45
SG 46
- Administer oxygen
- encourage deep breathing
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.
What is the inheritance pattern of Sickle Cell Disorder?
SG 1.
essentially that of an autosomal recessive disorder.
Normal range for PaC02
SG 45
SG 46
35 - 45
Patent Ductus Arteriosus is extremely common in ______________ ?
premature infants
Treatment of a Patent Ductus Arteriosus
- Surgically
- Place a block in the Cath lab
The cardinal sign of Coarctation of the aorta is?
Marked gradient between pulses and blood pressure in the upper and lower extremities
Normal range for HC03
SG 45
SG 46
22 - 26
Nursing assessment for a child on prostaglandin-e
SG 30
- 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.
