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Nurse 175 Pediatrics > Test 2 > Flashcards

Test 2 Flashcards

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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

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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

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3
Q

What is an innocent murmur?

A

No anatomic or physiologic abnormality exists

Fever, anemia, rapid growth

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4
Q

What is a functional murmur?

A

No anatomical cardiac defect exists but a physiological abnormality exists

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5
Q

What is an organic murmur?

A

A cardiac defect with or without a physiological abnormality exists

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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

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7
Q

The risk of CHD is much higher if?

A

A first degree relative is affected

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8
Q

What are the 4 classes of CHB?

A

Increased pulmonary blood flow
Decreased pulmonary blood flow
Ductal Dependent/Mixed Defects
Obstructive Defects

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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

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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.

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11
Q

What is an atrial septal defect?

A

An opening in the septum between left and right atria

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12
Q

What is a ventricular septal defect?

A

An opening in the septum between left and right ventricle

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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

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14
Q

What is an atrial-ventricular canal?

A

ASD & VSD allow blood to flow between all 4 chambers

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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

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16
Q

What are the 2 categories of CHB decreased pulmonary blood flow?

A

Tricuspid Atresia
Tetralogy of Fallot

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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

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18
Q

What are the signs and symptoms of Tricuspid Atresia?

A

Cyanosis
Systolic murmur
Poor feeding/weight gain
Fatigue
Clubbing (in older children)

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19
Q

What is the tetralogy of fallot?

A

4 total defects including VSD, Pulmonary stenosis, overriding aorta and RV hypertrophy

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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

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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

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22
Q

What are CHB ductal dependent/mixed defects?

A

Hypo-plastic Left Heart
Transposition of Great vessels

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23
Q

What does survival depend on with CHB ductal dependent/mixed defects?

A

The ability to mix deoxygenated and oxygenated blood

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24
Q

What is Hypo-plastic left heart?

A

An underdeveloped left heart with a hypoplastic aorta or atresia

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25
Q

What are the symptoms of a hypo-plastic left heart?

A

Symptoms such as cyanosis, actvity intolerance, and murmur that increase in the 1st and 2nd week of life

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26
Q

What are the treatment options for a hypo-plastic left heart?

A

ASD or PDA
Inotropic medications
Prostaglandin E
Surgery

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27
Q

What is Transposition of the great vessels?

A

Pulmonary artery leave the LV
Aorta leaves the right ventricle

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28
Q

What are the symptoms of transposition of the great vessels?

A

Cyanosis
Cardiomegaly
Murmur

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29
Q

What are the treatment options of transposition of the great vessels?

A

ASD, VSD or PDA
Oxygenate blood
Prostaglandin E to keep DA open
Surgery

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30
Q

What are the obstructive CHB defects?

A

Defects that cause narrowing of vessels for blood to leave the heart
Aortic Stenosis
Coartation of the Aorta

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31
Q

What is aortic stenosis?

A

Narrowing of aorta between LV and aorta

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32
Q

What is coartication of the aorta?

A

Narrowing at the aortic arch

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33
Q

What are the signs/symptoms of obstructive CHB defects?

A

Activity intolerance
Increased RR/HR
Slow growth
Poor feeding
COA
Pale/cyanotic at rest that worsens with activity
“Death spells”

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34
Q

What are “death spells”?

A

A symptoms of obstructive heart defects that involves rapid color change, dizziness, fainting

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35
Q

What are the interventions of obstructive heart defects?

A

O2
Reshunt
Diuretics
Surgery

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36
Q

What is Kawasaki Disease?

A

Acute vasculitis with an unknown cause that can progress to coronary artery aneurysms in 20% of children

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37
Q

What are the signs/symptoms of Kawasaki Disease?

A

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

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38
Q

What are the treatment/care needs for Kawasaki Disease?

A

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

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39
Q

What are the administration guidelines for IVIG?

A

-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

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40
Q

What are the adminisitration guidelines for Aspirin for Kawasaki Disease?

A

High dose: 80-100mg/kg/day
Once afebrile then 3-5mg/kg/day
Continue for 6-8 weeks

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41
Q

What is Endocarditis?

A

Infection of the endocardial layer of the heart that most often results from a bacterial/fungal infection

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42
Q

What are the risk factors for endocarditis?

A

Children with a history of CHD (congenital, acquired, prosthetic valves, CV shunts, rheumatic fever w/valve involvement)

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43
Q

What are the signs and symptoms of Endocarditis?

A

Unexplained low grade fever
Anorexia/weight loss
General Malaise
New murmurs
Dysrythmias
HF

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44
Q

What are the labs/diagnostics to test for Endocarditis?

A

Labs:
CBC, ESR, Blood Cultures
Diagnostics:
Echo, EKG, CXR

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45
Q

What is the treatment for endocarditis?

A

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*

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46
Q

Which antibiotics and antifungal are given for endocarditis?

A

Antibiotics:
Gentamycin
Streptomycin

Antifungal:
Amphotericin

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47
Q

What is rheumatic fever?

A

Inflammatory disease that occurs within 2-6 weeks after rxn to group A beta hemolytic strep that may result in vascular damage

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48
Q

What are the signs/symptoms of rheumatic fever?

A

Joint pain
Edema
Fever
Non-itchy rash to trunk and proximal extremties
Mitral valve murmur
Chorea (odd little movements)

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49
Q

What are the labs/diagnostics to test for rheumatic fever?

A

CRP
ESR
ASO titer
RST
Throat culture
ECHO
EKG

50
Q

When is Prostaglandin E used?

A

In hypo-plastic left heart
Transposition of great vessels
Tricusptid Atresia

51
Q

When is indomethacin used?

A

In Patent ductus arteriousus

52
Q

What are the risk factors for UTIs?

A

Caucasians
Uncircumcised males <3 months
Females <12 months

53
Q

What are the most common symptoms of a UTI in children under 2 years?

A

Fever
Irritability
Lethargy
Poor Feeding
Vomiting
Diarrhea

54
Q

What are the most common symptoms of a UTI in children older than 2?

A

Enuresis
Daytime incontinence
Fever
Foul smelling urine
Flank pain
Severe abdominal pain

55
Q

What are the most common symptoms of a UTI in older children/adolescents?

A

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
Q

What are the preventative measures for UTIs?

A

Perineal hygiene
Cotton underwear
Complete emptying/avoiding over distention of bladder

57
Q

What is the cause of acute glomerulonephritis?

A

GABHS

58
Q

What age is acute glomerulonephritis seen in?

A

School age children ages 6-7 years

59
Q

What are the signs and symptoms of acute glomerulonephritis?

A

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
Q

What are the labs to test for acute glomerulonephritis?

A

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
Q

What are the nursing interventions for acute glomerulonephritis?

A

Vital signs (esp. blood pressure)
Fluid Balance
Skin Integrity (from edema)

62
Q

What are the medications given for acute glomerulonephritis?

A

Duiretics: Furosemide or Aldactone
Antihypertensives: Beta blocker is most common

63
Q

what is the diet for a child with acute glomerulonephritis?

A

Regular but without added salt

64
Q

What ages do we commonly see nephrotic syndrome?

A

Ages 2-7

65
Q

What are the symptoms of nephrotic syndrome?

A

Fever
Edema
Weight gain
Decreased urine output
Pallor
Fatigue
MASSIVE proteinuria
hypoalbuminemia
hyperlipidemia
JVD can be present

66
Q

What is the most prominent lab/diagnostic for nephrotic syndrome?

A

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
Q

What is the primary objective of nursing care for nephrotic syndrome?

A

Reduce the amount urinary protein excretion

68
Q

What are the nursing interventions for nephrotic syndrome?

A

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
Q

In what age groups do we see HUS (Hemolytic Uremic Syndrome)?

A

Ages 6 months to 3 years

70
Q

What are the signs and symptoms of HUS?

A

AKI
Hemolytic Anemia
Thrombocytopenia
Renal Failure
Oliguria
Anuria
Red urine

71
Q

What are the two types of HUS?

A

Diarrhea + (90% of all cases, caused by ecoli)
Diarrhea -

72
Q

What are the nursing care interventions for HUS?

A

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
Q

What is a Wilms Tumor (nephroblastoma)?

A

Most common kidney tumor in children, with the left kidney being more common

74
Q

What age groups are Wilms Tumors normally seen in?

A

3-4yrs more common in males

75
Q

What are the signs/symptoms of Wilms tumors?

A

Swelling or mass in abdomen (pain only seen in ~40% of pts)
1/4 of children have hematuria
Weight loss
Hypertension
Fever

76
Q

What does the mass of a Wilms tumor feel like?

A

Mass is firm, nontender, confined to one side and deep within flank

77
Q

What are the lab/diagnostics for a Wilms tumor?

A

CT
U/S
CBC to check for polycythemia b/c tumor can secrete excess erythropoietin

78
Q

What is the preoperative nursing care for a Wilms Tumor?

A

NEVER palpate the tumor
Assess for allergies, V/S, renal function, UOP, CBC, consent, education and NPO status

79
Q

What is the postoperative nursing care for a Wilms tumor?

A

Assess and trend V/S
I &Os
F.U with chemo, radiation within 48 hours
Pain management
Recommend support groups for family

80
Q

What are the categories of ARF (Acute renal failure)?

A

Filter/No filter
Acute vs. Chronic

81
Q

What are the types of no filter ARF?

A

Infections
Blockages
Ability to take fluids

Diseases include: Pyleo, Cystitis, Renal Calculi, VUR

82
Q

What are the signs of filter related ARF?

A

Oliguria to Anuria
Decreased GFR

Diseases Include: Renal Failure, Glomerulonephritis, Nephrotic syndrome

83
Q

What are the signs of acute renal failure?

A

Sudden stop of renal function/regulation
Compromised urine

84
Q

What can acute renal failure be caused by?

A

Illness/Infection
Severe Dehydration
Acute Renal Injury

Fits into 3 categories (pre/intra/post)

85
Q

What are the signs of chronic renal failure?

A

Progressive loss of renal function/regulation
May or may not have symptoms
Uremia present

86
Q

What can chronic renal failure be caused by?

A

Congenital renal malformations
Chronic pyelo
Glomerulonephritis

87
Q

What are the care differences between acute and chronic renal failure?

A

Acute is uncommon in pediatrics but critical to treat/resolve

88
Q

What the labs to test for renal failure?

A

U/A
BMP
CBC
ABG
Drug test

89
Q

What are the diagnosis to test for renal failure?

A

KUB
Retrograde pyelogram
Renal arteriogram
VCUG
Renal Biopsy
Renal Endscopy
Nephroscopy
X-ray

90
Q

What are the signs and symptoms of renal failure?

A

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
Q

What are the nursing interventions for renal failure?

A

Treat Cause
Assess V/S (especially BP)
Daily weights
I &Os
Neuro (LOC, seizure precautions)
Treat electrolyte imbalances
Cardaic Monitoring
Watch for infection

92
Q

What are the two types of Dialysis?

A

Peritoneal and Hemodialysis

93
Q

What is peritoneal dialysis?

A

Visible catheter through the abdomen that either drains or pumps into the peritoneal space

94
Q

Who can perform peritoneal dialysis?

A

The patient (depending on age) or the family member

95
Q

Which dialysis method is preferable for pediatrics?

A

Peritoneal dialysis is preferred for pediatric cases because it can be performed at night by the family and allows child more freedom

96
Q

What is hemodialysis?

A

Waste products from the blood go through an artificial membrane called dialysate

97
Q

Which type of dialysis is more effective?

A

Hemodialysis

98
Q

Who can perform hemodialysis?

A

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
Q

What types of renal failure or other conditions can hemodialysis be used for?

A

It can be used for both acute and chronic plus poisonings

100
Q

What are the cons of hemodialysis?

A

Risks for :
F & E imbalance
Shock
Seizure
HF
Infection

Requires a strict diet and has more side effects

101
Q

What are the other types of medications used for renal failure?

A

Supplements such as Iron and Folic Acid
Erythropoiten
Alkaseltzers (Sodium bicarb for met. acidosis)
Growth hormone for poor growth

102
Q

Type 1 diabetes is ________________ and has a _________ onset and is what type of insulin deficency?

A

Type 1 diabetes is a genetic predisposition and has a rapid onset with total insulin deficiency.

103
Q

Type 2 diabetes is an _________________ ________________ and is correlated with ___________ diabetes had has _____________ onset with what kind of symptoms?

A

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
Q

What are the risk factors for type 2 diabetes?

A

Race/Ethnicity
Obesity
Family history
Poor diet
Lack of exercise

105
Q

What is the management of type 2 diabetes?

A

Weight management
Exercise
Evaluate serum glucose
Nutrition support
Medications (normally metformin)

106
Q

What are the lab values for pediatric hyperglycemia?

A

> 240mg/dL

107
Q

What are the lab values for pediatric hypoglycemia?

A

<70mg/dL

108
Q

What is some of the parental/patient education for diabetes?

A

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
Q

What is the carbohydrate to CHO exchange?

A

15g carbs=1 CHO exchange

110
Q

What can be done to increase CHO metabolism?

A

Increase fiber intake to help CHO metabolism and cholesterol.
Avoid sweets

111
Q

In what age will the child patient be developmentally ready to learn about insulin administration?

A

Normally children over 10

112
Q

What are some if the main insulin administration teaching points?

A

Rotation of injection sites
Injection angle
Clear before cloudy

113
Q

What are the cons to an insulin pump?

A

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
Q

What is the diagnosis criteria for DKA?

A

Polyphagia
Polydipsia
Poor Weight gain
Polyuria
Glycosuria

115
Q

What are the assessments for DKA?

A

Dehydration
N/V
Increased urination
Thirst
Hunger
Neuro-changes
Kussmaul respirations (Rapid RR, fruity scent)

116
Q

What are the interventions for DKA?

A

Fluid Therapy
0.1 unit insulin

117
Q

What are numerical criteria for DKA?

A

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
Q

Conversions:
____tsp=____tbsp=_____fl.oz=_____cups=_____mL

A

3 tsp = 1tbsp = 1/2 fl.oz = 1/16cups =15mL

119
Q

What are the dosing criteria of digoxin for infants?
What about for young children?

A

Infants: Do not give if pulse is below 90 bpm
Young children: 70 bpm

120
Q

What are the common signs of digoxin toxicity?

A

bradycardia (although other dysrhythmias may occur), anorexia, nausea, and vomiting

121
Q

What are the therapeutic digoxin levels for pediatrics?

A

Therapeutic serum digoxin levels range from 0.8 to 2 mcg/L

122
Q

What is the average digoxin dose for pediatrics?

A

Infants rarely receive more than 1 ml (50 mcg, or 0.05 mg) in one dose

Nurse 175 Pediatrics (2 decks)

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