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PEDs > PEDs Tiff COPY > Flashcards

PEDs Tiff COPY Flashcards

1
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
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2
Q

Nursing Interventions for Respiratory Alkalosis

SG 45
SG 46

A
  • Slow patient’s breathing
  • breathe into a paper bag or her cupped hands to restore normal blood levels of carbon dioxide and relieve these symptoms.
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3
Q

What should be done prior to performing a cardiac catheterization on a child? and Why?

A
  • accurate height (essential for correct catheter selection) and weight.
  • Obtaining a history of allergic reactions is important because some of the contrast agents are iodine based.
  • Specific attention to signs and symptoms of infection is crucial.
  • Severe diaper rash may be a reason to cancel the procedure if femoral access is required.
  • Because assessment of pedal pulses is important after catheterization, the nurse should assess and mark the pulses (dorsalis pedis, posterior tibial) before the child goes to the catheterization room.
  • Baseline oxygen saturation using pulse oximetry in children with cyanosis is also recorded.
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4
Q

Nursing Care of patient with Defect causing Mixed Blood Flow

A
  • Reduce cardiac demand
  • Give prostaglandins until surgery -in order to mix blood until surgery
  • Supportive
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5
Q

Symptoms of concussion are:

A
  • fatigue
  • changes in behavior and mood
  • decreased school performance
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6
Q

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

A
  • Left ventricle

- Systemic

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7
Q

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

A

Increased Pulmonary

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8
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.

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9
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 an effort to produce more RBC

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10
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

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11
Q

S&S of Defects causing Mixed Blood Flow

A

cyanosis
L&R heart failure
low PaO2
VERY sick

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12
Q

____ reflects primarily the number of RBCs, but can also show the amount of ____ present in each cell.

A

hemoglobin, hemoglobin

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13
Q

Side effects of a child on prednisone?

SG 12

A
  • growth suppression (adrenal suppression)
  • weight gain
  • decreased bone density.
  • immunosuppressed
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14
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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15
Q

Signs of increased Intracranial Pressure:

A
  • 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
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16
Q

what are some quality patient outcomes for patients with bacterial meningitis?

A
  • 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
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17
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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18
Q

Children with Acyanotic 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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19
Q

Clinical manifestations of congestive heart failure include

SG 38

A
  • irritability
  • tachypnea
  • poor feeding
  • pallor.
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20
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
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21
Q

Treatment of Kawasaki

A
  • IV gamma globulin

- aspirin (don’t care about Rye risk b/c benefit outweighs)

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22
Q

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

SG 33

A
  • isolation precautions

- contact tracking

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23
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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24
Q

S&S of Kawasaki

A
  • High fever unresponsive to antipyretics
  • irritability
  • errythema
  • peeling of skin
  • edema
  • red eyes
  • strawberry tongue
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25
Q

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

A

Prostaglandin E infusion

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26
Q

What defect is caused by narrowing of the aortic arch

A

Coarctation of the aorta

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27
Q

_____ is the most important nursing observation when caring for a child with head trauma

A

LOC

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28
Q

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

A
  • Coarctation of Aorta
  • Aortic Stenosis
  • Pulmonic Stenosis
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29
Q

The goals of nursing interventions for a 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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30
Q

Nurse identifies and describes clinical manifestation of
leukemia

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
-

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31
Q

What defect is a failure of the Foramen Ovale to close?

A

Atrial Septal Defect

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32
Q

Signs and symptoms of Defects Obstructing Blood Flow from the Ventricles

A
  • Congestive Heart Failure

- Decreased systemic perfusion and perfusion

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33
Q

average reticulocyte counts are__

A

0.5-1.5%

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34
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

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35
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.
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36
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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37
Q

average hematacrit values__

A

35-45%

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38
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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39
Q

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

SG 44

A
  • mitral valve
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40
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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41
Q

Prior to shunt placement, the focus of nursing care of a patient with hydrocephalus is making sure that the child and family are __________________________.

A

Physically and emotionally prepared for surgery.

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42
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
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43
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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44
Q

Tetralogy of Fallot

A
  • blue
  • no CHF - b/c blood moves to body ok
  • normal pulse
  • organ hypoxemia
  • tec spells
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45
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.
46
Q

_________ is a Cyanotic defect that decreases pulmonary blood flow include?

A
  • Tetralogy of Fallot
47
Q

What are the Acyanotic Defects?

A
  • Atrial Septal Defect
  • Ventricular Septal Defect
  • Patent Ductus Arteriosus
48
Q

average RBC count is ___

A

4.5 to 5.5 million/mm3

49
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.

50
Q

Cyanotic defects that mix blood flow include?

A
  • Transposition of the Great Vessels
51
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

52
Q

an increased amount of ____ is due to some stimulus to the bone marrow to up production

A

reticulocyte count

53
Q

Parent teaching for a child with a febrile seizure

SG 17

A
  • Note any changes in behaviors observed before or after the seizure
  • Note activities during the seizure
54
Q

symptoms of thalassemia major are

A
  • lacking the ability to produce normal, adult hemoglobin
  • chronic fatigue
  • failure to thrive
55
Q

___ are readily stained with basic dyes, and release histamine, heparin, and serotonin

A

basophils

56
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
57
Q

Nursing assessment for a child on prostaglandin-e

SG 30

A
  • APNEA
  • Fever
  • flushing
  • Vasodialtor
58
Q

Congestive Heart Failure is ________ is patients with Ventricular Septal Defect

A

Common

59
Q

Signs of Congestive heart failure

A
  • Tachypnea
  • Tachycardia
  • Diaphoresis
  • Cardiomegaly
  • Hepatomegaly
  • Edema
60
Q

Nursing interventions for a child with a new VP 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.
61
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
62
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

63
Q

pre-chemo:

CHEMO

A 
C- consent procedures
H- health assessment
E- evaluation of parents understanding
M- securing presence of child's mother or father
O- overview of treatment
64
Q

______ 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.

A

lymphocytes

65
Q

_____________ offers a curative treatment for children with SCD

A

hematopoietic stem cell transplant (HSCT)

66
Q

Main Defect Causing Decreased Pulmonary Blood Flow that we studied

A

Tetralogy of Fallot

67
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)

68
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
69
Q

Average hemoglobin values__

A

11.5 - 15.5 g/dl

70
Q

post-chemo:

SOUND

A

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

71
Q

The cardinal sign of Coarctation of the aorta is?

A

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

72
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.
73
Q

What are the signs of hydrocephalus

SG 5

A
  • The sunset sign
  • a bulging anterior fontanel
  • Widened suture lines
74
Q

What is polycythemia

A

increased production of RBC b/c the body wants more O2. Causes viscous blood, can lead to ischemia, stroke

75
Q

Absence seizures are characterized by:

SG 17

A
  • brief loss of consciousness
  • often without loss of motor control
  • cluster
  • last only a few seconds
76
Q

Common causes of brain injury are:

A
  • falls
  • motor vehicle accidents
  • sports injuries
77
Q

S&S of Rheumatic Fever

A

Eye inflammation

Heart, brain, cardiac damage

78
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

79
Q

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

A
  • Lasix

- Digoxin

80
Q

Treatment of Rheumatic fever

A

antibiotics

long term aspirin?? verify this

81
Q

normal WBC count is__

A

4.5 to 13.5 x 10~3 cells/mm~3

82
Q

chronic anemia will manifest itself as__

SG 9

A

fatigue, decreased growth and pallor

83
Q

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

A
  • surgically with sutures

- by placing a block

84
Q

intra-chemo:

SAFE

A

S- safe administration
A- assessments of intravenous central line site
F- provision of IV fluids
E- assessment of electrolytes

85
Q

______ seen in allergies, asthman, eczema, and autoimmune diseases

A

eosinophils

86
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.

87
Q

a decrease in RBC will present as:

A

weakness, fatigue, pallor

88
Q

an abnormal, often cancerous, growth of tissue

A

neoplasms

89
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
90
Q

Nursing Care for Rheumatic fever

A
  • strep care
  • prevent recurring infxns
  • prevent longterm heart damage (every recurrence of this disease is worse)
  • Penicillin is the drug of choice
  • Control inflammatory process
91
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
92
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
93
Q

treatments of SCA

A

blood transfusions

hematopoietic stem cell transplant (HSCT)

94
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
95
Q

__ is the index of production of mature RBCs by the bone marrow

A

reticulocyte count

96
Q

What are some nursing considerations for a child with head trauma?

A
  • 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
97
Q

Nursing Interventions for Respiratory Acidosis

SG 45
SG 46

A
  • Administer oxygen

- encourage deep breathing

98
Q

Normal Pa02

SG 45
SG 46

A

80 -100mmHg

99
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.

100
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

101
Q

______ is the percent volume of packed RBCs

A

hematacrit

102
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

103
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
104
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
105
Q

3 Acquired Cardiac Disorders we discussed

A

Bacterial Endocarditis
Rheumatic Fever
Kawasaki Disease

106
Q

Acyanotic Defects that increase pulmonary blood flow include

A
  • Ventricular Septal Defect
  • Atrial Septal Defect
  • Patent Ductus Arteriosus
107
Q

Treating Hypercyanotic Spells

A
  • Place infant in knee/ chest position
  • Use a calm, comforting approach.
  • Administer 100% “blow-by” oxygen.
  • Give morphine subcutaneously or through an existing IV line.
  • Begin IV fluid replacement and volume expansion if needed.
  • Repeat morphine administration. IV, Intravenous.
108
Q

Defects that allow blood flow from the higher pressure left side of the heart to the lower pressure right side result in ______________ and cause HF.

A

increased pulmonary blood flow

109
Q

Obstructive defects impede blood flow out of the ventricles; whereas obstruction on the left side of the heart results in ________, severe obstruction on the right side causes ________.

A
  • Heart failure

- Cyanosis

110
Q

Mixed lesions present a variable clinical picture based on the degree of mixing and amount of pulmonary blood flow; _______________________________ usually occur together.

A

hypoxemia (with or without cyanosis) and HF

111
Q

The objective of nursing care for Rheumatic Fever is, first, _________. For the child with ARF, nursing care (1) encourages compliance with drug regimens, (2) facilitates recovery from the illness, and (3) provides emotional support.

A

prevention

112
Q

Children with acyanotic defects frequently display both signs and symptoms of ____________, ____ ,____________

A
  • Congestive heart failure
  • Decreased systemic perfusion
  • Decreased organ perfusion

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