PEDs Tiff COPY Flashcards
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
Nursing Interventions for Respiratory Alkalosis
SG 45
SG 46
- 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.
What should be done prior to performing a cardiac catheterization on a child? and Why?
- 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.
Nursing Care of patient with Defect causing Mixed Blood Flow
- Reduce cardiac demand
- Give prostaglandins until surgery -in order to mix blood until surgery
- Supportive
Symptoms of concussion are:
- fatigue
- changes in behavior and mood
- decreased school performance
In obstructive acyanotic defects blood is prevented from moving from the _______________ into the ___________ circulation
- Left ventricle
- Systemic
Patients with an Atrial Septal Defect have an __________ ______________ Blood flow
Increased Pulmonary
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.
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 an effort to produce more RBC
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
S&S of Defects causing Mixed Blood Flow
cyanosis
L&R heart failure
low PaO2
VERY sick
____ reflects primarily the number of RBCs, but can also show the amount of ____ present in each cell.
hemoglobin, hemoglobin
Side effects of a child on prednisone?
SG 12
- growth suppression (adrenal suppression)
- weight gain
- decreased bone density.
- immunosuppressed
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,
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
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
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
Children with Acyanotic Defects obstructing blood flow from the ventricles will frequently have
- decreased pulses
- decreased urine output
- poor gastrointestinal function
- metabolic acidosis.
Clinical manifestations of congestive heart failure include
SG 38
- irritability
- tachypnea
- poor feeding
- pallor.
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
Treatment of Kawasaki
- IV gamma globulin
- aspirin (don’t care about Rye risk b/c benefit outweighs)
Because bacterial meningitis can be contagious
_______ & _______ may be necessary.
SG 33
- isolation precautions
- contact tracking
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
S&S of Kawasaki
- High fever unresponsive to antipyretics
- irritability
- errythema
- peeling of skin
- edema
- red eyes
- strawberry tongue
Neonates with a Coarctation of the Aorta will be treated with a _________________ infusion.
Prostaglandin E infusion
What defect is caused by narrowing of the aortic arch
Coarctation of the aorta
_____ is the most important nursing observation when caring for a child with head trauma
LOC
Acyanotic Defects that obstruct blood from ventricles into the body include?
- Coarctation of Aorta
- Aortic Stenosis
- Pulmonic Stenosis
The goals of nursing interventions for a 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
Nurse identifies and describes clinical manifestation of
leukemia
SG 2
-infection
-fever
-enlarged spleen
-lymph nodes and liver enlargement
-persistent fatigue
-weakness
-easy bleeding or bruising
-bone pain or tenderness
-weight loss
-
What defect is a failure of the Foramen Ovale to close?
Atrial Septal Defect
Signs and symptoms of Defects Obstructing Blood Flow from the Ventricles
- Congestive Heart Failure
- Decreased systemic perfusion and perfusion
average reticulocyte counts are__
0.5-1.5%
In Children with Sickle Cell Anemia, oral ____________ prophylaxis is recommended by 2 months old to reduce the chance of pneumococcal sepsis.
SG 29
penicillin
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.
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
average hematacrit values__
35-45%
What are signs and symptoms of Congenital Heart Disease?
- Congestive Heart Failure
- Pallor or Cyanosis
- Altered pulses
- Murmur
- Fatigue/irritability
- Poor weight gain
What valve is most frequently affected in a patient with Rheumatic Fever?
SG 44
- mitral valve
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
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.
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
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.
Tetralogy of Fallot
- blue
- no CHF - b/c blood moves to body ok
- normal pulse
- organ hypoxemia
- tec spells
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.
_________ is a Cyanotic defect that decreases pulmonary blood flow include?
- Tetralogy of Fallot
What are the Acyanotic Defects?
- Atrial Septal Defect
- Ventricular Septal Defect
- Patent Ductus Arteriosus
average RBC count is ___
4.5 to 5.5 million/mm3
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.
Cyanotic defects that mix blood flow include?
- Transposition of the Great Vessels
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
an increased amount of ____ is due to some stimulus to the bone marrow to up production
reticulocyte count
Parent teaching for a child with a febrile seizure
SG 17
- Note any changes in behaviors observed before or after the seizure
- Note activities during the seizure
symptoms of thalassemia major are
- lacking the ability to produce normal, adult hemoglobin
- chronic fatigue
- failure to thrive
___ are readily stained with basic dyes, and release histamine, heparin, and serotonin
basophils
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
Nursing assessment for a child on prostaglandin-e
SG 30
- APNEA
- Fever
- flushing
- Vasodialtor
Congestive Heart Failure is ________ is patients with Ventricular Septal Defect
Common
Signs of Congestive heart failure
- Tachypnea
- Tachycardia
- Diaphoresis
- Cardiomegaly
- Hepatomegaly
- Edema
Nursing interventions for a child with a new VP 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.
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
A synthetic form of vasopressin, also known as ________, increases plasma factor VIII activity and is the treatment of choice in mild __________
DDAVP
hemophilia
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
______ 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
_____________ offers a curative treatment for children with SCD
hematopoietic stem cell transplant (HSCT)
Main Defect Causing Decreased Pulmonary Blood Flow that we studied
Tetralogy of Fallot
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)
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
Average hemoglobin values__
11.5 - 15.5 g/dl
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
The cardinal sign of Coarctation of the aorta is?
Marked gradient between pulses and blood pressure in the upper and lower extremities
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.
What are the signs of hydrocephalus
SG 5
- The sunset sign
- a bulging anterior fontanel
- Widened suture lines
What is polycythemia
increased production of RBC b/c the body wants more O2. Causes viscous blood, can lead to ischemia, stroke
Absence seizures are characterized by:
SG 17
- brief loss of consciousness
- often without loss of motor control
- cluster
- last only a few seconds
Common causes of brain injury are:
- falls
- motor vehicle accidents
- sports injuries
S&S of Rheumatic Fever
Eye inflammation
Heart, brain, cardiac damage
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
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
Treatment of Rheumatic fever
antibiotics
long term aspirin?? verify this
normal WBC count is__
4.5 to 13.5 x 10~3 cells/mm~3
chronic anemia will manifest itself as__
SG 9
fatigue, decreased growth and pallor
Like ASD Ventricular Septal Defect can be repaired _______ or _____________?
- surgically with sutures
- by placing a block
intra-chemo:
SAFE
S- safe administration
A- assessments of intravenous central line site
F- provision of IV fluids
E- assessment of electrolytes
______ seen in allergies, asthman, eczema, and autoimmune diseases
eosinophils
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.
a decrease in RBC will present as:
weakness, fatigue, pallor
an abnormal, often cancerous, growth of tissue
neoplasms
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
Nursing Care for Rheumatic fever
- 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
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
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
treatments of SCA
blood transfusions
hematopoietic stem cell transplant (HSCT)
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
__ is the index of production of mature RBCs by the bone marrow
reticulocyte count
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
Nursing Interventions for Respiratory Acidosis
SG 45
SG 46
- Administer oxygen
- encourage deep breathing
Normal Pa02
SG 45
SG 46
80 -100mmHg
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.
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
______ is the percent volume of packed RBCs
hematacrit
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 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
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
3 Acquired Cardiac Disorders we discussed
Bacterial Endocarditis
Rheumatic Fever
Kawasaki Disease
Acyanotic Defects that increase pulmonary blood flow include
- Ventricular Septal Defect
- Atrial Septal Defect
- Patent Ductus Arteriosus
Treating Hypercyanotic Spells
- 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.
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.
increased pulmonary blood flow
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 ________.
- Heart failure
- Cyanosis
Mixed lesions present a variable clinical picture based on the degree of mixing and amount of pulmonary blood flow; _______________________________ usually occur together.
hypoxemia (with or without cyanosis) and HF
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.
prevention
Children with acyanotic defects frequently display both signs and symptoms of ____________, ____ ,____________
- Congestive heart failure
- Decreased systemic perfusion
- Decreased organ perfusion
