Study Guide Quizlet Flashcards
Quizlet
Near Drowning
Requires immediate resuscitative care. Give the child oxygen, or entubation/endotracheal tube if the kid is severely affected
Near Drowning Monitor
Monitor vitals closely as well as blood gases
Requires 6-8 hours of monitoring after the incident. Aspiration pneumonia may occur 48-72 hours afterwards. Aspiration is the greatest risk
Try to care for the family as well, let them know everything is being done for the child
Hirschsprung Disease
Rare congenital anomaly where the absence of ganglions in the colon causes the internal anal sphincter to be unable to relax, and subsequent stool accumulation
Hirschsprung Disease S/S
S/S: Newborn- no meconium stool, constipation, reluctant to eat, abdominal distention. Infant- failure to thrive, constipation, abdominal distention, vomiting, diarrhea. Foul smelling ribbon like stools”. Toddlers/Children- foul smelling stool, abdominal distention, visible peristalsis, palpable fecal mass, malnourishment, signs of anemia/hypoproteinemia
Hirschsprung Disease Diagnosis
Diagnosis: x-ray, barium enema study, anorectal exam, rectal biopsy. These are performed when the S/S point to this
Hirschsprung Disease Management
Management: surgical removal of aganglionic portion of bowel to restore motility. 1st stage is a temporary ostomy, 2nd stage is a “pull-through” procedure
Hirschsprung Disease Care
Care: peroperative- stablaize malnourished child; postoperative- slow reintroduction to food, take it easy
Diarrhea Types
Acute, Chronic, Acute infectious/infectious gastroenteritis, Intractable diarrhea of infancy, Chronic nonspecific diarrhea (CNSD)
Acute Diarrhea
sudden increase in stool frequency and change in consistency, last less than 14 days, no meds given.
Acute infectious/infectious gastroenteritis
caused by infectious agent in GI tract.
Chronic nonspecific diarrhea (CNSD)
irritable colon of childhood and toddler’s diarrhea, loose stools, often with undigested food particles, lasting no more than 2 weeks
Chronic Diarrhea
duration of more than 14 days, often caused by chronic conditions (malabsorption syndromes, inflammatory bowel disease, etc.)
Intractable diarrhea of infancy
occurs in first few months of life, persists no more than 2 weeks
Diarrhea causes
Caused by a number of different infectious agents, as well as antibiotic side effects (prevent with probiotics)
Diarrhea management
assess fluid and electrolyte status, avoid rectal temp when taking vitals. Rehydration is the goal, give fluid capsules such as pedialyte (enhances fluid reabsorption), move onto IV rehydration if it fails. Reintroduce an adequate diet, give antidiarreals and antibiotics as ordered. For the infant, take special care of the skin in the diaper area (irritation risk)
Diarrhea
Frequent loose, watery stools
Diarrhea Goals
Goals: urine gravity 1.005-1.020, 1-2 mL/kg of urine. No vomiting, diarrhea (less than 4 per day), regular diet, and maintained skin integrity
Dehydration
When fluid output exceeds intake, kids are more sensible
Dehydration causes
Causes: insensible fluid loss (fever, sweating), excessive renal excretion, GI dysfunction (n/v), ketoacidosis (vomiting), and burns
Dehydration management
Management: give small but frequent opportunities for oral intake for mild cases, move onto IV rehydration if it fails or for moderate-severe cases
Measurement: 1 gram of wet diaper = 1 mL of urine. Monitor amount, color, consistency, and time of vomiting, and sweating.
Daily weights are the best indicator: same time and scale each day. In infants their fontanels become sunken
Cleft Lip post-surgery care
protect the suture line- don’t let the baby lie prone. Manage the pain with meds or other methods, use distraction. Position the baby on their back and for feedings use a syringe/dropper inside the mouth
CHD Postop Care (Congestive Heart Disease)
Most patients need IV analgesics immediately after surgery, the strength of the drug can be decreased as IV and tubes are removed.
Educate the the family on medications, activity restrictions, diet (more protein), wound care, follow ups, community resources, and postop problem S/S
Make the child and parents feel more at ease by including them in the care process and explanations
Hypercyanotic Spell (Tet/Blue Spell)
Acute episodes of cyanosis and hypoxia when they cry, defecate, or feed (stressful situation).
Hypercyanotic Spell (Tet/Blue Spell) occurrence
Can occur with any type of pulmonary blood obstruction, manifests most frequently in the 1st year of life
Hypercyanotic Spell (Tet/Blue Spell) intervention
Put them in a squatting position and calm them down. They often hold their breath
Keep them in a quiet area, cluster care. Put them into a knee to chest position to increase vascular systemic resistance
Hypercyanotic Spell (Tet/Blue Spell) risk
Risk for great neuro damage, requires prompt intervention
Hypercyanotic Spell (Tet/Blue Spell) Meds
Digoxin is used to strengthen squeeze of heart and to control its rate and rhythm. Prostaglandins and morphine are also used, eventually there may be surgery. 100% oxygen, morphine, IV fluid. Calm them first
Rheumatic Fever
Inflammatory disease that occurs after group A β-hemolytic streptococcal pharyngitis
WBCs attack joints, skin, brain, serous surfaces, and heart. Mitral valve is most often affected
Rheumatic Fever S/S
fever, rash, swollen and painful joints
Rheumatic Fever Goal
eradicate infection, prevent permanent damage, prevent recurrences. Salicylates (prednisone) control inflammation, then bedrest, aspirin, and penicillin are prescribed
What can Rheumatic Fever progress to?
Rheumatic heart disease, causing permanent valve disease
Tonsillectomy
Used to relieve tonsillitis
Tonsillectomy Postop care
Maintain an upright position to allow drainage
Tonsillectomy Assess for
Signs of bleeding, airway patency, and vital signs
Tonsillectomy Diet
Clear liquids, then advance to soft foods, then bland foods. No red roods (color can be confused with bleeding)
Offer Ice collar, ice chips, and pain meds for comfort
Tonsillectomy Instructions
Protect surgical site
Viral Respiratory infections
Include influenza, bronchitis, and RSV
Viral Respiratory infections manage/monitor
Manage w/ hydration, monitor I/Os & weights daily, monitor pulse ox, decrease anxiety, monitor airways
Bacterial Respiratory Infections
Includes strep throat, TB, and tracheitis.
Can create thick purulent secretions that can cause respiratory distress
Bacterial Respiratory Infections- Manage
With humidified oxygen, antipyretics, antibiotics. May need intubation until swelling decreases or mechanical ventilation
The more serious type of infection
Cardiac Catherization
Invasive procedure looks at oxygen/pressure levels in each chamber and their structure. Can also blow a balloon to expand a heart chamber.
Cardiac Catherization Risk
Risk for bleeding, pulse lost in cathed extremity
Cardiac Catherization Postop Care
Strict bed rest for 6 hours with a quiet environment, check vitals, capillary refill, swelling. Give pressure dressings, give more dressings if bleeding present, don’t take off.
Patient will lose a lot of fluid so monitor I/O’s, blood glucose. Make sure affected limb is extended and flat.
Pyloric Stenosis Patho
The circumferential muscle of the pyloric sphincter becomes thickened. Obstructs outlet and causes dilation, hypertrophy, and hyperperistalsis of the stomach.
Usually develops in first 2-5 weeks of life
Pyloric Stenosis S/S
Projectile vomiting, with hunger afterwards.
Weight loss, dehydration, lethargy, palpable mass in RUQ
Pyloric Stenosis Treatment
Pyloromyotomy-incision non the pylorus, high success rate. NPO and educate preoperatively. Post-op: slowly resume food per orders, IV fluids, comfort and rest, and incision care.
Intussusception Patho
Portion of intestine slides into another or invagination (inside out) of one portion of intestine into another.
Most common cause of intestinal obstruction of children 3 months- 3 years.
Intussusception S/S
Abdominal pain, vomiting, dark/bloody stools (currant jelly stools)
Intussusception Treatment
Air enema or ultrasound-guided hydrostatic enema; nonoperative reduction successful in ~80% of cases, 10% of cases resolve spontaneously.
Pancreatic Enzymes
Necessary for digestion. Blocked from reaching duodenum in cystic fibrosis.
W/ cystic fibrosis, make sure they have vitamins A, D, E, and K 30 minutes before eating
Digoxin Use
Heart, Heart defects, aortic stenosis, or other cardiac problems.
Digoxin Effect
Improve contractility to lower HR (check apical pulse, may be held if lower than 60 BPM, less than 90 BPM for infants)
Increased cardiac output, decrease heart size, decrease venous pressure, and relief of edema. Fast effects
Digoxin Toxicity
N/V, anorexia, bradycardia, dysrhythmias. Monitor with ECG.
Synagis
Vaccine for influenza that prevents RSV.
Is a monthly antibody injection given to infants at risk for RSV.
Synagis Infants at risk
Infants at risk those in their 1st year of life who were born before 29 weeks before gestation, and those with chronic lung disease with prematurity (less than 32 weeks) that require less than 21% oxygen for 1 month after birth
Aortic Stenosis Patho
Narrowing of aorta of aortic valve, left ventricle unable to effectively pump
Aortic Stenosis Effects
Poor perfusion/weak pulses, low BP, heart murmur.
Aortic Stenosis Treatment
Valvuloplasty (fix valve), balloon angioplasty (dilate valve), digoxin.
Croup Patho
Infection that affects larynx, trachea, bronchi
Croup S/S
Barking cough, hoarseness, inspiratory stridor, and respiratory distress.
Can range from not very threatening to medical emergency.
Croup Cause
Most often caused by H. influenzae type B, can be bacterial/viral
Acute Epiglottitis
Medical emergency!
Nothing in mouth- no throat culture or tongue blade!
Epiglottitis Cause
HB. Influenzae, group A beta-hemolytic strep, staphylococcus. Type of croup
Epiglottitis S/S
Sore throat, pain, tripod positioning (upright position).
Drooling, difficulty swallowing (obstruction).
Inspiratory stridor, mild hypoxia, distress.
Increased HR, RR
Epiglottitis Onset
Occurs over the course of hours (rapid)
Affects ages 2-8 years
Epiglottitis Management
Prevention of obstruction, protect airway, prepare for intubation/tracheostomy, humidified oxygen, continuous pulse ox
Anticipate racemic epinephrine, corticosteroids, IV fluids, and antibiotics.
Get x-ray in bed or have people you need with you.
Head Injury Causes
1) Falls
2) struck by something
3) motor vehicle
Primary Hear Injuries
-Skull fracture
-Contusions (bruise on brain)
-Intracranial hematoma (clot formation on brain)
-Diffuse Injury (injury surrounding brain)
Head Injury Assessment
LOC changes, irritability, confusion are the 1st signs. Fontanels may be bulging, child may lie in a flexed/extended position, neck stiffness, pain, eyes (not PERRLA)
Head Injury Complications
Epidural Hemorrhage, subdural hemorrhage, cerebral edema
Epidural Hemorrhage
Bleeding between the skull and the dura (starts when lucid and rapid decline LOC, possible coma and death.
Subdural Hemorrhage
Bleeding between the dura and the arachnoid membrane (slow changes, decrease LOC overtime)
Cerebral Edema
Associated with traumatic brain injury
Increased ICP with herniation (no turning back, death)
Head trauma Diagnostic Evaluation
Detailed Hx
Assessment of ABC’s (stabilize neck)
Evaluation of shock
Neuro Exam and LOC assessment!!
Assess VS
CT, scan, MRI, behavioral assessment
Head Trauma Management
Care in hospital if severe injuries, LOC for several minutes, Prolonged of continued seizures.
Nothing administered orally at first
Surgical therapy
Prognosis
