Test 2 Flashcards
1
Q
What is the normal flow of blood through the heart?
A
Right atrium->tricuspid valve>right ventricle->pulmonary artery->lungs->pulmonary veins->left atrium->mitral valve->left ventricle->Aorta
2
Q
How are heart murmurs classified?
A
-Location
-Area of the heart where murmur is heard best
-Time of the mumur within S1/S2 cycle
-Intensity of murmur
-Loudness of murmur
3
Q
What is an innocent murmur?
A
No anatomic or physiologic abnormality exists
Fever, anemia, rapid growth
4
Q
What is a functional murmur?
A
No anatomical cardiac defect exists but a physiological abnormality exists
5
Q
What is an organic murmur?
A
A cardiac defect with or without a physiological abnormality exists
6
Q
What are some of the risk factors for heart defects?
A
Trisomy 21 (30-50% of cases)
Trisomy 13
Trisomy 18
Diabetes
Phenylketonuria (poorly controlled)
Alcohol consumption
Environmental toxins
7
Q
The risk of CHD is much higher if?
A
A first degree relative is affected
8
Q
What are the 4 classes of CHB?
A
Increased pulmonary blood flow
Decreased pulmonary blood flow
Ductal Dependent/Mixed Defects
Obstructive Defects
9
Q
What are the 4 types of increased pulmonary blood flow CHB?
A
Atrial Septal Defect
Ventricular Septal Defect
Patent ductus arteriosus
Atria-ventricular canal
10
Q
What is increased pulmonary blood flow CHB?
A
Defects between the left and right sides of the heart with a left to right shunt that cause pulmonary overcirculation, increased vascular resistance and eventual pulmonary hypertension.
11
Q
What is an atrial septal defect?
A
An opening in the septum between left and right atria
12
Q
What is a ventricular septal defect?
A
An opening in the septum between left and right ventricle
13
Q
What is a patent ductus arteriosus?
A
Failure of the ductus arteriosus closure and due to this the aorta and pulmonary artery remain connected
14
Q
What is an atrial-ventricular canal?
A
ASD & VSD allow blood to flow between all 4 chambers
15
Q
What is CHB decreased pulmonary blood flow?
A
Defects with obstructed blood flow to lungs or developmental failure leave no connection for right sided blood to flow into the lungs
16
Q
What are the 2 categories of CHB decreased pulmonary blood flow?
A
Tricuspid Atresia
Tetralogy of Fallot
17
Q
What is Tricuspid Atresia?
A
Decreased pulmonary blood flow due to abcense of tricuspid valve which results in a complete mixing of deoxygenated blood in the heart
18
Q
What are the signs and symptoms of Tricuspid Atresia?
A
Cyanosis
Systolic murmur
Poor feeding/weight gain
Fatigue
Clubbing (in older children)
19
Q
What is the tetralogy of fallot?
A
4 total defects including VSD, Pulmonary stenosis, overriding aorta and RV hypertrophy
20
Q
What are the signs and symptoms of tetralogy of fallot?
A
Cyanosis
Systolic murmur
Clubbing
TET spells (desaturation, worsening cyanosis, squatting)
Increased WOB
Edema
Pulmonary Infections
21
Q
What is the treatment for tetralogy of fallot?
A
-Surgery within the 1st year -Attempt to reshunt by repositioning intrathoracic pressure and putting knees to Chest
22
Q
What are CHB ductal dependent/mixed defects?
A
Hypo-plastic Left Heart
Transposition of Great vessels
23
Q
What does survival depend on with CHB ductal dependent/mixed defects?
A
The ability to mix deoxygenated and oxygenated blood
24
Q
What is Hypo-plastic left heart?
A
An underdeveloped left heart with a hypoplastic aorta or atresia
25
What are the symptoms of a hypo-plastic left heart?
Symptoms such as cyanosis, actvity intolerance, and murmur that increase in the 1st and 2nd week of life
26
What are the treatment options for a hypo-plastic left heart?
ASD or PDA
Inotropic medications
Prostaglandin E
Surgery
27
What is Transposition of the great vessels?
Pulmonary artery leave the LV
Aorta leaves the right ventricle
28
What are the symptoms of transposition of the great vessels?
Cyanosis
Cardiomegaly
Murmur
29
What are the treatment options of transposition of the great vessels?
ASD, VSD or PDA
Oxygenate blood
Prostaglandin E to keep DA open
Surgery
30
What are the obstructive CHB defects?
Defects that cause narrowing of vessels for blood to leave the heart
Aortic Stenosis
Coartation of the Aorta
31
What is aortic stenosis?
Narrowing of aorta between LV and aorta
32
What is coartication of the aorta?
Narrowing at the aortic arch
33
What are the signs/symptoms of obstructive CHB defects?
Activity intolerance
Increased RR/HR
Slow growth
Poor feeding
COA
Pale/cyanotic at rest that worsens with activity
"Death spells"
34
What are "death spells"?
A symptoms of obstructive heart defects that involves rapid color change, dizziness, fainting
35
What are the interventions of obstructive heart defects?
O2
Reshunt
Diuretics
Surgery
36
What is Kawasaki Disease?
Acute vasculitis with an unknown cause that can progress to coronary artery aneurysms in 20% of children
37
What are the signs/symptoms of Kawasaki Disease?
Must have 5 for diagnosis*
Fever for 5+ days
Bilateral conjunctival inflammation w/no exhudate
Oral mucosa changes (dry, cracked lips, strawberry tongue, reddening of oral cavity)
Extremity changes (like edema)
Polymorphous rash
Cervical lymphadenopathy
38
What are the treatment/care needs for Kawasaki Disease?
Monitor cardiac status (assess for symptoms of heart failure)
ECHO to monitor coronary artery dilation or aneurysm formation
Daily weights
I &Os
Administration of fluids
Medication
Supportive care
39
What are the administration guidelines for IVIG?
-Give over 10-12 hours
-monitor BP for signs and symptoms of allergic rxn
-Administer within first 7 days of illness
-Educate to avoid any live immunizations for 11 months after therapy
-Watch for signs of fever
40
What are the adminisitration guidelines for Aspirin for Kawasaki Disease?
High dose: 80-100mg/kg/day
Once afebrile then 3-5mg/kg/day
Continue for 6-8 weeks
41
What is Endocarditis?
Infection of the endocardial layer of the heart that most often results from a bacterial/fungal infection
42
What are the risk factors for endocarditis?
Children with a history of CHD (congenital, acquired, prosthetic valves, CV shunts, rheumatic fever w/valve involvement)
43
What are the signs and symptoms of Endocarditis?
Unexplained low grade fever
Anorexia/weight loss
General Malaise
New murmurs
Dysrythmias
HF
44
What are the labs/diagnostics to test for Endocarditis?
Labs:
CBC, ESR, Blood Cultures
Diagnostics:
Echo, EKG, CXR
45
What is the treatment for endocarditis?
Bed Rest
Administration of organsim specific antibiotic/antifungal meds for 2-8 weeks
PICC line for long term therapy
Will have to take prophylactic antibiotics for the rest of life*
46
Which antibiotics and antifungal are given for endocarditis?
Antibiotics:
Gentamycin
Streptomycin
Antifungal:
Amphotericin
47
What is rheumatic fever?
Inflammatory disease that occurs within 2-6 weeks after rxn to group A beta hemolytic strep that may result in vascular damage
48
What are the signs/symptoms of rheumatic fever?
Joint pain
Edema
Fever
Non-itchy rash to trunk and proximal extremties
Mitral valve murmur
Chorea (odd little movements)
49
What are the labs/diagnostics to test for rheumatic fever?
CRP
ESR
ASO titer
RST
Throat culture
ECHO
EKG
50
When is Prostaglandin E used?
In hypo-plastic left heart
Transposition of great vessels
Tricusptid Atresia
51
When is indomethacin used?
In Patent ductus arteriousus
52
What are the risk factors for UTIs?
Caucasians
Uncircumcised males <3 months
Females <12 months
53
What are the most common symptoms of a UTI in children under 2 years?
Fever
Irritability
Lethargy
Poor Feeding
Vomiting
Diarrhea
54
What are the most common symptoms of a UTI in children older than 2?
Enuresis
Daytime incontinence
Fever
Foul smelling urine
Flank pain
Severe abdominal pain
55
What are the most common symptoms of a UTI in older children/adolescents?
Frequent and painful urination of a small amount of turbulent urine that may be bloody
Fever is usually absent or low grade
Upper UTI characterized by fever and chillds
56
What are the preventative measures for UTIs?
Perineal hygiene
Cotton underwear
Complete emptying/avoiding over distention of bladder
57
What is the cause of acute glomerulonephritis?
GABHS
58
What age is acute glomerulonephritis seen in?
School age children ages 6-7 years
59
What are the signs and symptoms of acute glomerulonephritis?
Tea colored urine
Hematuria
Mild protein****
Puffiness of face (esp around eyes)
Anorexia
Increased BP RR (can have dyspnea and crackles)
Lethargy
Can be placed on seizure precautions
60
What are the labs to test for acute glomerulonephritis?
Renal function test to look for increased BUN/Creatinine (normal 5-18mg/dL)
UA: look for color, protein, hematuria, and high specific gravity
BMP: increased K+/Mag, Na+
CBC: increasing WBC
61
What are the nursing interventions for acute glomerulonephritis?
Vital signs (esp. blood pressure)
Fluid Balance
Skin Integrity (from edema)
62
What are the medications given for acute glomerulonephritis?
Duiretics: Furosemide or Aldactone
Antihypertensives: Beta blocker is most common
63
what is the diet for a child with acute glomerulonephritis?
Regular but without added salt
64
What ages do we commonly see nephrotic syndrome?
Ages 2-7
65
What are the symptoms of nephrotic syndrome?
Fever
Edema
Weight gain
Decreased urine output
Pallor
Fatigue
MASSIVE proteinuria
hypoalbuminemia
hyperlipidemia
JVD can be present
66
What is the most prominent lab/diagnostic for nephrotic syndrome?
24/7 urine monitoring looking for decreased protein/albumin (<2g/dL), specific gravity and color
Serum cholesterol may be as high as 450 to 1500mg/dL
67
What is the primary objective of nursing care for nephrotic syndrome?
Reduce the amount urinary protein excretion
68
What are the nursing interventions for nephrotic syndrome?
24/7 urine collection
I & Os
Daily weights
Monitor BP
Watch for signs of shockqq
Low protein diet with no extra salt and low fat
69
In what age groups do we see HUS (Hemolytic Uremic Syndrome)?
Ages 6 months to 3 years
70
What are the signs and symptoms of HUS?
AKI
Hemolytic Anemia
Thrombocytopenia
Renal Failure
Oliguria
Anuria
Red urine
71
What are the two types of HUS?
Diarrhea + (90% of all cases, caused by ecoli)
Diarrhea -
72
What are the nursing care interventions for HUS?
Monitor renal function and UOP
Assess for bleeding (if actively bleeding administer FFP, plasma pheresis, PRBCs)
Possible Dialysis
Fluid replacement
Treatment of hypertension
Correction of acid/base balances
73
What is a Wilms Tumor (nephroblastoma)?
Most common kidney tumor in children, with the left kidney being more common
74
What age groups are Wilms Tumors normally seen in?
3-4yrs more common in males
75
What are the signs/symptoms of Wilms tumors?
Swelling or mass in abdomen (pain only seen in ~40% of pts)
1/4 of children have hematuria
Weight loss
Hypertension
Fever
76
What does the mass of a Wilms tumor feel like?
Mass is firm, nontender, confined to one side and deep within flank
77
What are the lab/diagnostics for a Wilms tumor?
CT
U/S
CBC to check for polycythemia b/c tumor can secrete excess erythropoietin
78
What is the preoperative nursing care for a Wilms Tumor?
NEVER palpate the tumor
Assess for allergies, V/S, renal function, UOP, CBC, consent, education and NPO status
79
What is the postoperative nursing care for a Wilms tumor?
Assess and trend V/S
I &Os
F.U with chemo, radiation within 48 hours
Pain management
Recommend support groups for family
80
What are the categories of ARF (Acute renal failure)?
Filter/No filter
Acute vs. Chronic
81
What are the types of no filter ARF?
Infections
Blockages
Ability to take fluids
Diseases include: Pyleo, Cystitis, Renal Calculi, VUR
82
What are the signs of filter related ARF?
Oliguria to Anuria
Decreased GFR
Diseases Include: Renal Failure, Glomerulonephritis, Nephrotic syndrome
83
What are the signs of acute renal failure?
Sudden stop of renal function/regulation
Compromised urine
84
What can acute renal failure be caused by?
Illness/Infection
Severe Dehydration
Acute Renal Injury
Fits into 3 categories (pre/intra/post)
85
What are the signs of chronic renal failure?
Progressive loss of renal function/regulation
May or may not have symptoms
Uremia present
86
What can chronic renal failure be caused by?
Congenital renal malformations
Chronic pyelo
Glomerulonephritis
87
What are the care differences between acute and chronic renal failure?
Acute is uncommon in pediatrics but critical to treat/resolve
88
What the labs to test for renal failure?
U/A
BMP
CBC
ABG
Drug test
89
What are the diagnosis to test for renal failure?
KUB
Retrograde pyelogram
Renal arteriogram
VCUG
Renal Biopsy
Renal Endscopy
Nephroscopy
X-ray
90
What are the signs and symptoms of renal failure?
Depends mostly on the condition that is the cause and the type
Common symptoms are dysuria, urine color changes, proteinuria, decreased GFR (under 90mL/min)
91
What are the nursing interventions for renal failure?
Treat Cause
Assess V/S (especially BP)
Daily weights
I &Os
Neuro (LOC, seizure precautions)
Treat electrolyte imbalances
Cardaic Monitoring
Watch for infection
92
What are the two types of Dialysis?
Peritoneal and Hemodialysis
93
What is peritoneal dialysis?
Visible catheter through the abdomen that either drains or pumps into the peritoneal space
94
Who can perform peritoneal dialysis?
The patient (depending on age) or the family member
95
Which dialysis method is preferable for pediatrics?
Peritoneal dialysis is preferred for pediatric cases because it can be performed at night by the family and allows child more freedom
96
What is hemodialysis?
Waste products from the blood go through an artificial membrane called dialysate
97
Which type of dialysis is more effective?
Hemodialysis
98
Who can perform hemodialysis?
The permanent port and administration is performed by staff at the clinic 3-4 times per week for 4-6 hours.
It requires the insertion of two needles
99
What types of renal failure or other conditions can hemodialysis be used for?
It can be used for both acute and chronic plus poisonings
100
What are the cons of hemodialysis?
Risks for :
F & E imbalance
Shock
Seizure
HF
Infection
Requires a strict diet and has more side effects
101
What are the other types of medications used for renal failure?
Supplements such as Iron and Folic Acid
Erythropoiten
Alkaseltzers (Sodium bicarb for met. acidosis)
Growth hormone for poor growth
102
Type 1 diabetes is ________________ and has a _________ onset and is what type of insulin deficency?
Type 1 diabetes is a genetic predisposition and has a rapid onset with total insulin deficiency.
103
Type 2 diabetes is an _________________ ________________ and is correlated with ___________ diabetes had has _____________ onset with what kind of symptoms?
Type 2 diabetes is an insulin resistance and is correlated with familial diabetes (90-95% of all cases) with a gradual onset and is normally asymptomatic.
104
What are the risk factors for type 2 diabetes?
Race/Ethnicity
Obesity
Family history
Poor diet
Lack of exercise
105
What is the management of type 2 diabetes?
Weight management
Exercise
Evaluate serum glucose
Nutrition support
Medications (normally metformin)
106
What are the lab values for pediatric hyperglycemia?
>240mg/dL
107
What are the lab values for pediatric hypoglycemia?
<70mg/dL
108
What is some of the parental/patient education for diabetes?
Increased risk of skin injury/infection
No hot water bottles
No heating pads
Watch all healing lesions
No going barefoot
Avoid open toed shoes
Eat at regular intervals without skipping
109
What is the carbohydrate to CHO exchange?
15g carbs=1 CHO exchange
110
What can be done to increase CHO metabolism?
Increase fiber intake to help CHO metabolism and cholesterol.
Avoid sweets
111
In what age will the child patient be developmentally ready to learn about insulin administration?
Normally children over 10
112
What are some if the main insulin administration teaching points?
Rotation of injection sites
Injection angle
Clear before cloudy
113
What are the cons to an insulin pump?
Expensive and requires commitment
Math skills are needed to calculate infusion rates
Pump should not be removed for more than 1 hr at a time
Skin infections are common
114
What is the diagnosis criteria for DKA?
Polyphagia
Polydipsia
Poor Weight gain
Polyuria
Glycosuria
115
What are the assessments for DKA?
Dehydration
N/V
Increased urination
Thirst
Hunger
Neuro-changes
Kussmaul respirations (Rapid RR, fruity scent)
116
What are the interventions for DKA?
Fluid Therapy
0.1 unit insulin
117
What are numerical criteria for DKA?
Glucose concetration >200 mg/dL
Fasting blood glucose >126 mg/dL
2 hr glucose >200mg/dL
ABG can show the metabolic acidosis created by DKA
118
Conversions:
____tsp=____tbsp=_____fl.oz=_____cups=_____mL
3 tsp = 1tbsp = 1/2 fl.oz = 1/16cups =15mL
119
What are the dosing criteria of digoxin for infants?
What about for young children?
Infants: Do not give if pulse is below 90 bpm
Young children: 70 bpm
120
What are the common signs of digoxin toxicity?
bradycardia (although other dysrhythmias may occur), anorexia, nausea, and vomiting
121
What are the therapeutic digoxin levels for pediatrics?
Therapeutic serum digoxin levels range from 0.8 to 2 mcg/L
122
What is the average digoxin dose for pediatrics?
Infants rarely receive more than 1 ml (50 mcg, or 0.05 mg) in one dose
