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TEST 2 Flashcards

1
Q

Neuro disorder - Ch 38

At birth, cranial bones are not well developed or fused this increases risk for

A

Fracture

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2
Q

Neuro disorder - Ch 38

At birth, the brain is highly vascular which increases a risk for

A

hemorrhage

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3
Q

Neuro disorder - Ch 38

What history findings are related to neurologic disease in children?

A

Prematurity
Difficult birth
Infection during preg
Falls
Recent trauma

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4
Q

Neuro disorder - Ch 38

5 states of consciousness
Full
Confusion
Obtunded
Stupor
Coma

A

Full -Awake and alert, oriented X4
Confusion - Alert but responds inapproprately
Obtunded - Limited responses to environment and falls asleep unless stimulation
Stupor - Only responds to vigorous stimulation
Coma - Cannot be aroused, even with painful stimuli

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5
Q

Neuro disorder - Ch 38

Early signs of ICP

A

Headache
Vomit (projectile)
Visual changes
Dizziness
Decreasing HR and RR
Changes in pupil reactions
Sunset eyes
Changes in LOC
Seizures
Bulging fontanel and increasing head circumference in infants

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6
Q

Neuro disorder - Ch 38

Late signs of ICP

A

Decreased LOC
Depressed motor, sensory responses
irregular respirations
Cheyne-stokes respirations
Decerebrate/decorticate postures
Fixed and dilated pupils

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7
Q

Neuro disorder - Ch 38

Intracranial regulation

A

Ability of cranial contents to maintain normal intracranial pressure, equilibrium and neurologic function

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8
Q

Neuro disorder - Ch 38

When do brain and spinal cord develop?

A

first 3-4 weeks gestation

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9
Q

What is the earliest indicator of improvment or deterioration of neuro status?

A

LOC

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10
Q

Neuro disorder - Ch 38

Pediatric Glasgow Coma Scale - define
The lower the score =

A

used to standardize degree of
consciousness.

The lower the score, the less responsive the child.

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11
Q

Neuro disorder - Ch 38

Always measure head circumference in children younger than

A

3

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12
Q

Neuro disorder - Ch 38

Cranial nerves
Trigeminal V-
Hypoglossal (XII)-

A

Trigeminal V- responsible for sucking
Hypoglossal (XII)-observed through spontaneous tongue movements

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13
Q

Neuro disorder - Ch 38

Cranial nerves
Dolls eyes (III, IV, VI)
Facial (VII)

A

Dolls eyes (III, IV, VI) -turn head in 1 direction and assess if eyes move symmetrically in other direction. Doll eyes do not move, they just look straight
Facial (VII)- Asymmetry when crying, smiling

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14
Q

Neuro disorder - Ch 38

Cranial Nerves
Oculomotor (III) -
Sunsetting indicates?
Invol rapid eye mvmt indicates?
Olfactory -

A

**Oculomotor (III) **- Observe for sunsetting eyes which indicates increased ICP. Involuntary rapid rhythmic eye movements which indicates brain stem
Olfactory - No evaluated in infants and young children

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15
Q

Neuro disorder - Ch 38

Cranial Nerves
Optic (II)

A

Optic (II) - Fixed dilated pupils report immediatly

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16
Q

Neuro disorder - Ch 38

Motor function
Decorticate -
Decerebrate -

A

Decorticate - Arms adducted wtih extremities flexed and held across chest, occurs with cerebral cortex damage
Decerebrate - Extension adn pronation of arms and legs, occurs wtih brain stem damage

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17
Q

Neuro disorder - Ch 38

Glasgow Coma Scale
1.Scores are based on what 3 responses?
2. Perfect score?
3. The lower the score = ?
4. Severe head injury = ?
5. Moderate head injury?
6. Mild head injury?

A
  1. based on eye opening, motor response and verbal response.
  2. The perfect score is 15.
  3. The lower the score the more severe the injury and prognosis.
  4. Severe head injury = 8 or less.
  5. Moderate head injury = 9-12 points.
  6. Mild head injury= 13 and 15.
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18
Q

Neuro disorder - Ch 38

Lumbar puncture (LP)
Define
How to position NB
How to position older infant
Postive Brudzinski
Postive Kernig

A

Withdrawl of cerebal spinal fluid from subarachnoid space for analysis
Position newborn upright with head flexed forward.
Position older infant/child on their side with head and knees flexed.
–Keep child flat for 1 hour after procedure.
–Apply EMLA cream to puncture site 30-60 min beforehand.
Positive Brudzinski = pain when flexing head forward.
** Positive Kernig** = pain when flexing knee to abdomen.

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19
Q

Neuro disorder - Ch 38

Electroencephalogram (EEG)
Define

A

to detect seizure activity and determine brain death

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20
Q

Neuro disorder - Ch 38

Ultrasound

A

used to assess intracranial hemorrhage in newborns

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21
Q

Neuro disorder - Ch 38

ICP Monitoring catheter

A

ventricular catheter that measures ICP and
drains CSF to reduce ICP.
Keep HOB elevated 15-30 degrees.

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22
Q

Neuro disorder - Ch 38

MRI
Prep procedure

A

No metal. All jewerly and clothing removed
IV contrast may be used. IV needs to be in good working order
If sedated, child will need to be on heart monitor and oxygen
Latex allergy is not contraindication for gadolinium (the contrast used in testing)

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23
Q

Neuro disorder - Ch 38

Ventriculoperitoneal Shunt

A

to drain CSF and decrease ICP. Drains to
peritoneal cavity and is absorbed by the body

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24
Q

Neuro disorder - Ch 38

Hyperventilation

A

decreases PaCO2 which causes vasoconstriction
and decreases ICP.
Monitor ABGs.

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25
Q

Neuro disorder - Ch 38

Ventricular tap

A

to drain CSF

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26
Q

Neuro disorder - Ch 38

Vagal Nerve stimulator

A

For short and long term seizure mgmt

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27
Q

Neuro disorder - Ch 38

Keto diet

A

high fat, very low carbs, adequate protein, and mild
dehydration to control seizures through diet

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28
Q

Neuro disorder - Ch 38

Antibiotics

A

to treat bacterial meningitis and shunt infections

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29
Q

Neuro disorder - Ch 38

Anticonvulsants

A

control seizures, decrease hyperexcitability of
nerves, do not stop abruptly,
ie Levetiracetam, Phenytoin,Fosphenytoin, Phenobarbital

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30
Q

Neuro disorder - Ch 38

Benzodiazepines

A

ie Diazepam/Lorazepam,
slows down CNS so must monitor LOC, useful for home treatment of seizures

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31
Q

Neuro disorder - Ch 38

Analgesics

A

pain to help avoid increase in ICP with interventions
that cause pain or stress.

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32
Q

Neuro disorder - Ch 38

Diuretics

A

Mannitol, monitor electrolytes and I&O

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33
Q

Neuro disorder - Ch 38

Levetiracetam (Keppra)
Used for
Side effects

A

–Used in children to help control seizures.
–Major side effects: difficulty with gait or coordination and
development of
psychiatric symptoms.
–Does not have a therapeutic level so there is no need for
routine lab
tests.

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34
Q

Neuro disorder - Ch 38

**Phenytoin **
Route?
IF IV, fluids need to be?
Can be administered through?
Treatment of?

A

–Can be administered PO or IV.
–If it is to be administered IV, the fluids need to be normal
saline solution.
(Any other type of fluid will cause the drug to precipitate in
the IV tubing.)
There is no need to start an additional peripheral IV. The
drug can be administered via a secondary set through the IV pump.
–Treatment of the seizure is the priority.

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35
Q

Neuro disorder - Ch 38

Fosphenytoin

A

another form of phenytoin, may be tolerated better,
and it can be administered through all IV fluids without
precipitation

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36
Q

Neuro disorder - Ch 38

5 major types of seizures

A

subtle, tonic, focal clonic, multifocal clonic, and myoclonic

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37
Q

Neuro disorder - Ch 38

Myoclonic rarely occur in —period
Subtle seizures affect?
Tonic primarly occur in?
Focal clonic and multifocal clonic are more common in ?

A

myoclonic seizures rarely occur during the neonatal period.
Subtle seizures affect preterm and full-term neonates.
Tonic seizures primarily occur in preterm neonates. **Focal clonic and multifocal clonic **are more common in full-term neonates.

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38
Q

Neuro disorder - Ch 38

Neural tube defects

A

spina bifida, meningocele, anencephaly
folic acid supplements before pregnancy can reduce incidence by 50%.

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39
Q

Neuro disorder - Ch 38

Microcephaly

A

small head, large face, expect developmental delays

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40
Q

Neuro disorder - Ch 38

Arnold-Chiari malformation
Type 1
Type 2

A

** Type 1** = benign, c/o neck pain, H/A,
frequent urination, and lower extremity spasticity.
Type 2 = associated with hydrocephalus and myelomeningocele

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41
Q

Neuro disorder - Ch 38

Hydrocephalus
define
children with this are at increased risk for

A

CFS accumulates within the ventricles and causes
the ventricles to enlarge and ICP increases. Children with
hydrocephalus are at an increased risk for developmental disabilities.

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42
Q

Neuro disorder - Ch 38

Intracranial arteriovenous malformation

A

Intracranial hemorrhage or hemorrhagic stroke is a risk for children with intracranial arteriovenous
malformation.

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43
Q

Neuro disorder - Ch 38

Craniosynostosis

A

premature closure of the cranial sutures

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44
Q

Neuro disorder - Ch 38

Positional plagiocephaly

A

increased incidence since “back to sleep”,
asymmetry in the head without fused sutures, flattening of the back of the head from early closure of the lambdoid suture.

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45
Q

Neuro disorder - Ch 38

Hydocephalus
Symptoms
Parents need to know
Risk for infection most common during

A

spasticity of lower extremities, bulging
fontanels, brisk reflexes, and skull asymmetry.
-Parents need to know that hydrocephalus is a chronic illness that requires lifelong follow-up and regular evaluations, including future surgeries as the child grows.
- The risk for infection is ever present, but is most common **1 to 2 months after shunt placement. **

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46
Q

Neuro disorder - Ch 38

**Bacterial meningitis **
Do what immediatly
Symptoms

A

Medical emergency
Start IV antibiotics immediatly
Symptoms - preceding respiratory illness or sore throat, fever, headache, stiff neck, photophobia, vomiting, positive Brudzinski and Kernig signs. In infant, poor feeding, lethargy, weak cry, vomiting, hypothermia

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47
Q

Neuro disorder - Ch 38

With bacterial meningitis, infant may rest in what position?

A

opisthotonic position (back bend)

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48
Q

Neuro disorder - Ch 38

Encephalitis -
Caused by

A

caused by polio, HSV 1 and 2, vector-borne viruses

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49
Q

Reye syndrome
Symptoms
Avoid what?

A

characterized by brain swelling, liver failure, and
death in hours if treatment is not initiated.
Avoid aspirin in children.
Therefore, increased intracranial pressure could occur. Liver enzyme levels and ammonia levels typically increase.

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50
Q

Neuro disorder - Ch 38

Concussion
define
Treatment

A

-most common head injury. confusion, amnesia, may or may not lose consciousness
-Rest, wake every 2 hours for neuro changes. Bring to ER if constant headache that gets worse, vomit more than 2 times, slurred speech, oozing blood or watery fluid from ears or nose

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51
Q

Neuro disorder - Ch 38

Linear skull fracture

A

most common skull fracture, can result from
minor head
injuries

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52
Q

Classic signs of SBS

A

Retinol hemorrhages

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53
Q

In children what is more common? Ischemic or hemorrhagic strokes?

A

Ischemic

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54
Q

Ischemic =
Hemorrhagic =

A

Ischemic = a blood vessel supplying the brain becomes blocked
Hemorrhagic = a blood vessel bursts leaking blood into the brain

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55
Q

Ch 39

When is eye color determined?

A

6-12 mo

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56
Q

Ch 39

When is optic nerve fully myelinated?

A

3 months

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57
Q

Ch 39

What is vision acuity (Sharpness of vision) at birth?
5 months?

A

Birth - 20/400
5 months - 20/20

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58
Q

Ch 39

When is binocular vision achieved?

A

3-7 months

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59
Q

Ch 39

Ptosis?

A

Failure of eyelids to open fully and equally

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60
Q

Ch 39

How to do visual acuity testing in children 3 and under or nonverbal?

A

eval childs ability to fixate on and trace an object. Use black and white patterns

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61
Q

Ch 39

How to do visual acuity testing for children 3-5 years old?

A

Use tumbling E chart. Will be able to indicate direction of arms of E

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62
Q

Ch 39

What is the whisper test ?

A

4 years and older
one ear occulated, examiner stands behind and whispers a word. Child must repeat word correctly

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63
Q

Ch 39

Weber test?

A

6 years old and older.
Place a vibrating fork in middle of top of head and ask if child can hear in one or both ears.
Should hear in both

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64
Q

Ch 39

Tympanometry

A

must be over 7 months
Measures tympanic membrane mobility and determines middle ear pressure

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65
Q

Ch 39

Bacterial conjunctivitis
symptoms
treatment

A

Purulent drainage, mild pain, occasional eyelid edmea
Required antibiotic ointment/drops
infectious

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66
Q

Ch 39

Viral conjunctivitis
Symptoms

A

Tearing, photophobia, lumphadenopathy

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67
Q

Ch 39

Allergic conjunctivitis
Symptoms
treatment

A

Itching, stringy or watery discharge,
Antihistamines

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68
Q

Ch. 39

Treaments for
Conjunctivitis
Astigmatism, hyperopia, myopia
Amblyopia

A

Conjunctivitis - warm compress
Astigmatism, hyperopia, myopia - corrective lens
Amblyopia- patching

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69
Q

Ch 39

Treatment for:
Strabismus
Chronic ottis media with effusion
Hearing impairment

A

Strabismus: Eye muscle surgery
Chronic ottis media with effusion: Pressure equalizing tubes
Hearing impairment; Hearing aid or cochlear implant

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70
Q

Ch 39

Hordeolum (Stye)
Symptoms
Treatment

A

Localized infection of sebaceous gland of eyelid follicle
Painful purulent drainage
Antibiotic

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71
Q

Ch 39

Chalazion

A

Chronic painless infection of meibomian gland

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72
Q

Ch 39

Blepharitis
Symptoms
Treatment

A

Chronic scaling, dryness and discahrge along eyelid. redness, edema, no pain
Needs antibiotic ointment

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73
Q

Ch 39

Nasolacrimal duct stenosis

A

Blocked tear duct. Self resolved with massage, not infectious

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74
Q

Ch 39

Periorbital cellulitis
define
symptoms

A

Acute bacterial infection of eyelid or skin around eye, can also result from sinusitis
-Eyelid edema, purplish eyelid color, clear conjunctivae, no drainage, normal acuity

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75
Q

Ch 39

What are refractive errors

A

OIccurs when the light that enters the lens does not bend appropriately to allow it to fall directly on the retina

76
Q

Ch 39

Hyperopia

A

Farsighted, blurriness at close range, child had mild hyperopia until about 5 years old

77
Q

Ch 39

Myopia

A

Nearsighted, see well at close range but cant see blackboard

78
Q

Ch39

Astigmatism

A

Cornea or lens not perfectly spherical

79
Q

Ch 39

Strabismus

A

unequal alignment of eyes, crosseyed. may result in diplopia(double vision) and amblyopia.
Treatment - eye muscle surgery, patch and corrective lens

80
Q

Ch 39

Amblyopia

A

Lazy eye
Patch on good eye

81
Q

Ch 39

Nystagmus

A

Rapid, irregular eye movmnts,
Most common cause is a neuro problem

82
Q

Ch 39

Glaucoma

A

Increased ICP resulting in large prominent eyes
Vision loss may occur as a result of corneal scarring, optic nerve damage, or amblyopia
Surgery is required

83
Q

Ch 39

Cataracts

A

Opacity of the lens present at birth
leading cause of visual impairment and legal blindness in children
Best outcome is when cataracts is removed before 3 months
symptoms: lack of visual awareness, cloudly cornea, no red reflex

84
Q

Ch 39

Retinopathy of prematurity

A

Rapid growth of nonvascularized rential blood vessels
results in retinal detachment, blindness

85
Q

Ch 39

What heritage is a risk factor for visual impairment

A

African american

86
Q

Ch 39

acute otitis media
- Define
- Risk factors
- Pain mgmt

A

Infected fluid in middle ear,
Risk - occurs in winter, eustachian tube dysfunction, upper respiratory infections
Mgmt - Observation for natural resolution. Give antibiotics if persists with pain mgmt

87
Q

Ch 39

Otitis media with effusion
Define
Adverse effects
Treatment

A

presences of fluid in middle ear with or without infection
May delay speech and language development
Pressure equalizing tubes, wear earplugs while swimming

88
Q

Ch 39

Otitis externa

A

Infection and inflammation of external ear canal
Swimmers ear
Signigicantly painful

89
Q

Ch 39

What decible is
Mild hearing loss?
Moderate?
Severe?
Profound?

A

Mild - 20-40dB
Moderate 40-60db
Severe - 60-80db
Profound greater than 80db

90
Q

Ch 40

What illnesses are more commonly seen in spring?

A

Allergen-related respiratory illness

91
Q

Ch 40

What illnesses are more commonly seen in winter

A

Flu, RSV, pneumonia

92
Q

Ch. 40

What is the most common illness and hospitalization for children

A

Respiratory illness

93
Q

Ch 40

Nose assessment
Obligate nose breathers until?
Obstructed nares leads to
Small nasal passages leads to?
Sinuses do not develop until

A

Nb are obligate nose breathers until 4 weeks of age, breath through mouth only when crying
Obstructed nares leads to feeding difficulties
Small passages can lead to obstruction if excess mucous
Sinuses develop at 6-8 years so less apt for sinus infection

94
Q

Ch 40

Throat assessment
Larger tounges in relation to oropharynx, which can cause?
Children have larger tonsillar and adenoidal tissue which can?

A

Posterior displacment of tounge can cause severe airway obstruction
Larger tonsillar and adenodial tissue can cause airway obstruction

95
Q

Ch. 40

Larynx assessment
Why is larynx funnel shaped in children 10 and younger?
What shape is larynx in teens and adults>
Laryngomalacia ?

A

10 and younger, cricoid cartilage is underdeveloped and results in larynx narrowing creating a funnel shape
Teens and adults, **larynx is cylindrical and uniform
Laryngomalacia = larynx is weak and collapses with inspiration, stridor, improves with time (around1 year old)**

96
Q

Ch 40

When intubated, if you hear breathe sounds louder on the right, what does that mean?

A

EET is too deep and needs to be pulled back

97
Q

Ch 40

How many alveoli does a term baby have?
3-8 year olds?

A

Term baby = 150 million
3-8 year olds = 300 million

98
Q

What does having fewer alveoli put the child at risk for?

A

hypoxemia and carbon dioxide retention

99
Q

Ch 40.

What is the 1st sign of respiratory illnesS?

A

Tachypnea

100
Q

Ch 40

What does slow, irregular breathing with listlessness indicate for a respiratory illness?

A

Worsening condition

101
Q

Ch 40

What does pallor indicate for a child with respiratory illness?

A

Peripheral vasoconstriction to conserve oxygen for vital functions

102
Q

What does cyanosis indicate for a child with respiratory illness?

A

hypoxia (oxygen deficiency)

103
Q

What does circumorla cyanosis look like

A

blue around the mouth

104
Q

What does central cyanosis look like

A

involving midline

105
Q

Why does grunting occur?

A

Occurs with expiration from alveolar collapse of loss of lung volume such as with atelectasis, pneumonia and pulmonary edema

106
Q

What is stridor?

A

High pitched easily heard inspiratory noise that is sign of upper airway obstruction

107
Q

What is involved in respiratory effort?

A

Depth, quality, labored, tachypnea, nasal flaring, retractions

108
Q

What are retractions
Where?

A

INward pulling.
Note whether** intercostal (between ribs), subcoastl (around diaphragm), substernal, supraclavicular, suprasternal **

109
Q

Paradoxical breathing

A

Chest falls on inspiration and rises on expiration

110
Q

What do the following interventions help with?
Oxygen =
High humidity =
Suctioning =
Chest PT =
Saline gargles =
Chest tubes =
Bronchoscopy =

A

Oxygen = respiratory distress, hypoxemia
High humidity = keeps airway/secretions moist to prevent damage
Suctioning = done as needed and carefully especially via ETT or trach
Chest PT = promotes mucus loosening and drainage
Saline gargles = for sore throat in older children
Chest tubes = drainage tube placed in pleural cavity to remove air/fluid (pneumothorax,
empyema)
Bronchoscopy = to diagnose and cleanse the bronchial tre

111
Q

Croup

A

Bark like cough often at night with inspriatory stridor and suprasternal retractions

112
Q

RSV
Peaks?
Begins as a ?
Define?
Symptoms?

A

Peaks in winter
Starts as a respiratory infection
Allows adequate inspiration but prevents full expiration, leading to hyperinflation and atlelctasis, hypoxemia and carbon dioxide retention
Symptoms - copious amounts of secretions, increased work of breathing, hoarseness, sore throat, fever, coughing wheezing, poor feeding, irritable

113
Q

What is treatment for RSV?

A

Position HOB elevated
Supplemental oxygen with continuous pulse ox
Frquent assessment, can deteriote quickly
Droplet precautions
Synagis vaccine - given during RSV months

114
Q

What are symptoms for TB

A

Malaise, weight loss, anorexia, chest tightness, COUGH, hemoptysis (coughing up blood)

115
Q

What is pneumothorax?
how to diagnose?
Symptoms?
Treatment

A

Collection of air in pleural space
dx - decreased or absent lung sounds on affected side
Chest pain, tachypnea, retractions, grunting, cyanosis, tachycardia
Treatment - chest tube placement

116
Q

Allergic Rhinitis
Mediated by what immunoglobulin?
Triggered by
Symptoms?

A

IgE
triggered by dust, pet dander, pollens
Symptoms = Thin watery runny nose, nasal congestion, sneezing

117
Q

Chronic lung disease (Bronchopulmonary dysplasi)
Primarly seen with what age infant?
Highest risk
symptoms

A

Primarly with premature infants
Low birth weight and white males are at risk
Tachypnea and increased work of breathing

118
Q

Cystic fibrosis
What kind of recessive disorder?
Median age of survival?

A

Autosomal recessive disorder
Median age 39.3years

119
Q

ASTHMA
When examining a child with asthma nurse would not do what?
What is hallmark sign of airway obstruction?
Priority treatment?

A

Nurse wouldnt palpation
Wheezing is hallmark sign
Bronchodialtions - admin inhaled short term bronchodilator, start oxygen after, then IV steriods

120
Q

ALbuterol
Salmeterol
Ipratropium

A

Albuterol - short acting b2 adrenerfic agonists - treat acute bronchospasn
Salmeterol - long acting b2 adrenergic - long term control of excecise-induced asthma
Ipratropium - anticholinerfic used in adjunt to b2 agonist for treatment of bronchospasm without systemic effects

121
Q

Montelukast
Cromolyn
Theophylline

A

Montelukast - decreased inflammatory response by antagonising effects of leukotrienes
Cromolyn - a mast cell stabilizer used prophylactucally to prevent release of histamine but not to relieve bronchospasm
Theophylline - provides continuous airway relaxation

122
Q
A
123
Q

In a patient with Cystic Fibrosis
What will their respiratory tract look like?

A

Thick tenacious mucus lining the airways causing decreased resistance to infection adn air trapping
Difficultly clearing secretions, repiratory distress, chronic cough, barrel shaped chest, clubbinh, recurrent pneumonia, cor pulmonale (Right sided heart failure)

124
Q

In a patient with Cystic Fibrosis
What will their GI tract look like?

A

Dehydration of intestinal material, insufficient pancreatic enzymes, pancreas secreate thick mucus, hypersecretion of gastric acids
-Retention of fecal matter (vomit, abdominal distention, cramping, anorexia) fecal impaction, bowel obstruction, obstructive cirrhosis, gallstones, inability to absorb nutrients, failure to thrive, diabetes

125
Q

What is a diet for patinets with Cystic Fibrosis

A

High calories, high protein, low fat
Supplement wtih fat soluable vitamins (A, D, E, K) and pancreatic enzymes to be ingested with every meal (increase with a meal with high fat)

126
Q

Epiglottis
Symptoms
Treatment

A

high fever, dysphagia,
NEVER VISUALIZE the Throat can cause REFLEX LARYNGOSPASM
Treatment: 100% oxygen in least invasive manner, tracheostomy tray prepared

127
Q

A simple mask is used to deliver a flow rate of –/min

A

8L/min

128
Q

A venturi mask woudl be used to deliver..

A

A specific % of oxygen from 24-50%

129
Q

A oxygen hood requires a liter flow of

A

10-15 L/min

130
Q

Perfusion

A

The flow of blood to cells and tissues

131
Q

Ductus arteriosus
define
purpose
Closes?

A

-a fetal vessel that connects pulmonary artery to aorta
-Allows oxygenated blood from mom to bypass pulm circulation and flow directly into systemic circulation
-Closes within 1-2 days after birht

132
Q

Patent Ductus Arteriosus
Symptoms?

A

Vessel stays open
Widening pulse pressure, poor eating, failure to thrive, increased RR, Respiratory distress, sweating with crying or eating, murmur, pulmonary HTN

133
Q

Treatment for PDA

A

Meds - indomethacin, ibuprofen
Surgery - PDA ligation

134
Q

Pulse pressure
define
avg?
Widened?
narrow?

A

Difference between systolic and diastolic
avg 40mmHG
Widened - 100mmHg or over, sign of aortic valve regurgitation
Narrow - 25% or less of SBP; sign of aortic stenosis

135
Q

Heart rate
Infant
Toddler/preschool
School age/adolescent

A

Infant - 90-160bpm
Toddler - 80-115bpm
School age/adolescent - 60-100bpm

136
Q

Blood pressure
Infant -
Toddler -
School age -
Adolescent-

A

Infant - 80-55
Toddler - 90/55 to 100/75
School age - 100/60 to 120/75
Adolescent- 100/70 to 120/80

137
Q

What are the 2 categories of cardiovascular disorder in children?

A

**Congenital heart disease **- anomalies present at birth
Acquired heart disease - disorders that occur after birth

138
Q

Orthopena

A

Infant more comfortable sitting up or over moms shoulder rather than lying flat

139
Q

Signs of dyspnea

A

Grunting, tachypnea, retractions

140
Q

Cyanosis in a nb that does not improve with oxygen suspect?

A

CHD

141
Q

WIdened pulse pressure is associated with

A

PDA, Aortic insufficicney, fever, anemia and complete heart block

142
Q

All murmurs should be evaluated on what 5 characteristics

A
  1. Location
  2. Relation to heart cycle and duration
  3. Intensity grade
  4. Quality of sound, muffles, distant, distinct
  5. Variation while sitting, lying or standing
143
Q

Congenital Heart Disease
Which age has highest incidence
Common chromosomal defect assoc
Screening done when? Passing criteria?

A

Premature highest incidence
Trisomy 21 and Turner syndrome
within 1st 24 hours, must be greater than 95% and 3% or less different between reading on hand and foot

144
Q

Decreased pulmonary blood flow
-define
-2 diagnosed defects

A

obstruction of blood flow to the lungs, pressure increases to the right side of the heart which then shunts to the left side through a structural defect, and oxygenated blood mixes with deoxygenated blood which is pumped through the body.
Tetralogy of Fallot
Tricuspid atresia

145
Q

Increased pulmonary blood flow
Define
3 diagnosed defects

A

efects shunt blood from the higher pressure left side to the lower pressure right side. Increased blood in the right side leads to heart failure early in life and right ventricular hypertrophy.
Patent ductus arteriosus (PDA)
Atrial septal defect (ASD)
Ventricular septal defect (VSD)

146
Q

Obstructive disorders
define
3 types of diagnosed

A

some type of narrowing of a major vessel, interfering with the ability of the blood to flow freely
Coarctation of the aorta
Aortic stenosis
Pulmonary stenosis

147
Q

Mixed defects
-Define
4 diagnosed defects

A

involve a mixing of well-oxygenated blood with poorly oxygenated blood, resulting in systemic blood flow containing a lower oxygen content.
Transposition of the great vessels
Total anomalous pulmonary venous return
Truncus arteriosus
Hypoplastic left heart syndrome

148
Q

Tetralogy of Fallot
Define
Signs

A

4 heart defects (pulmonary stenosis, VSD, enlarged aortic valve, right ventricular hypertrophy).
Hypercyanosis with activity ie feeding, crying where color change occurs suddenly and child may assume a specific position to improve pulmonary blood flow (squatting, bending at the knees, fetal position).

149
Q

Transposition of great vessels
Define
Treatment

A

Artery and aorta are transposed
Prostaglandin to keep ductus arteriosus open until surgery

150
Q

Electrocardiogram

A

= evaluates the pattern or rhythm of the heart’s beating using electrodes attached to the chest

child must lie still for 5 minutes

151
Q

Holter monitor

A

is an ambulatory ECG that monitors the heart’s electrical patterns for 24 hours during normal daily activity

152
Q

Echocardiogram

A

= noninvasive ultrasound using a gel-coated wand to visualize chambers, heart wall thickness, value motion, hemodynamics of the great vessels, and structural defects

153
Q

Arteriogram/cardiac cath

A

= visualize arteries and veins using radiopaque contrast;

consent must be signed; NPO before procedure; maintain bedrest after procedure (can’t get up to the bathroom during specified bedrest timeframe); monitor puncture site for bleeding; monitor pulse distal to puncture site; assess VS frequently (Q15min-1hour).

154
Q

Digoxin
Effect
Monitor for
hold if
Signs of toxicity

A

-to reach maximum cardiac effect by increasing contractility. -monitor ECG for prolonged PR interval and decreased ventricular rate. Count apical pulse rate for 1 full minute. -Hold digoxin if HR <60 bpm in adolescent or <90 bpm in an infant.
-S/S toxicity = N/V, lethargy, bradycardia.

155
Q

Infective endocarditis
-define
-Treatment
-Signs

A

Bacterial infection of the endothelial surfaces of the heart such as the valves, chambers, septum
-heparin or another thrombolytic to prevent clots
Must be on antibiotics or antifungal meds for 4-6 weeks
🡪 intermittent unexplained low fever, fatigue, weight loss, flu-like symptoms, petechiae on the palpebral conjunctiva, microscopic hematuria, anemia with leukocytosis, dysrhythmias such as prolonged PR interval, adventitious lung sounds, signs of extracardiac emboli such as Roth spots (splinter hemorrhages with pale centers), Janeway lesions, black lines, and Osler nodes.

156
Q

Acute Rheumatic Fever
-Preceded by
-Cheif complaint
-Classic rash
-Movment disorder
-Mgmt

A

Usually preceded by strep throat

Chief complaint is typically fever with joint pain 2-3 weeks after sore throat or strep throat

Erythema marginatum is a classic rash

Sydenham chorea is a movement disorder of the face and upper extremities associated with acute rheumatic fever

Management 🡪 manage inflammation and fever, eradicate bacteria, prevent permanent heart damage, and prevent recurrences

157
Q

Cholesterol levels
Desirable
Borderline
high

A

Cholesterol < 170 = desirable
Cholesterol 170-199 = borderline
Cholesterol > 200 = high

158
Q

Kawasaki Disease
Occurs in what age
Leading cause of
Mgmt

A

-Occurs mostly in children 6-months to 5-years old
-Leading cause of acquired heart disease among children
-Management focuses on reducing inflammation in the walls of the coronary arteries and preventing coronary thrombosis
high-dose aspirin in four divided doses daily and one single infusion of IVIG (immunoglobulin), acetaminophen for fever
Avoid nonsteroidal anti-inflammatories (ie ibuprofen) while on aspirin
Apply petroleum to dry fissured lips
Strawberry tongue is distinctive

159
Q

Dysphagia

A

Difficult or painful swallowing

160
Q

INTESTINES
Small intestine mature at birth?
full term infant —Cm sm bowel?
adults —cm sm bowel?

A

Sm intestine not mature at birth
Infant 250cm
Adult 600cm

161
Q

Insensible fluid loss occurs in children in what 3 ways?

A
  1. With fever
  2. Through skin
  3. higher metabolic rate needed to support growth
162
Q

ORal candidiasis (Thrush)
-define
-Treatment

A

Fungal infection of mouth
also w/ beefy red diaper rash
Treat: nystatin or fluconazole

163
Q

Hypertonic pyloric stenosis
Define
Signs
Treatments

A

Pyloric valve between stomach and sm intestine thickens and causes obstruction

Projectile vomit immediately after feeding, olive shaped mas in uppper right quad

Requires surgery

164
Q

Intussesception
Define
Signs

A

Bowel segment telescopes into a more distal segment, causing edema, impaired circulation and obstruction

Sausage shaped mass in upper mid abdomen, severe ab pain, vomit, diarrhea, jelly stools (blood),

165
Q

Malrotation with volvulus
Define
Signs

A

Intestine abnormally attached and mesentery narrows, twisting itself

bilious vomiting, ab distention, bloody stools, usually in 1st week of life

166
Q

Appendicitis
Define
Signs

A

Obstrcution due to fecal matter which causes inflammatory fluid anc bacteria to leak into peritoneal cavity

tender lower right quad - Mcburney point

167
Q

Peptic Ulcer Disease
Define
Signes
Diagnostic test

A

Variety of disorders involving upper GI / mucosal inflammation caused by Hpylor, excess acid production, stress and meds

Mostly epigastric or umbilical pain worsening after meals

Urea breath test / hold proton pump inhibitors 5 days prior to test

168
Q

Stages of dehydration
Mild
Moderate
Severe

A

Mild - Output slightly decreased
Moderate - sunken fontanels, delayed cap refill, urine 1 ml/kg/hr
Severe - dusky cool extremities, dry mucous membranes, no tears, skn tenting, output less than 1ml/kg/hr, hypotension

169
Q

Cleft lip and palate
Freq occur w/
Complications?
repair time?
Major risk factor?

A

frq occur w/ other anomalies, heart defects, ear, skeletal and gu abnormalities

complications: feeding diff, altered dentation, speech, otitis media

Lip 2-3months repair, palate 6-9months

Materal smoking - risk factors

170
Q

Hernias
Inguinal-
Umbilical-

A

Inguinal - ab or pelvic viscera goes through internal inguinal ring into inguinal canal (males - hernia contains bowel, females - ovaries/fallopian tubes / buldging mass in lower ab groin

Umbilical - common in preterm & african american. Incomplete closure of umbilical ring allowing intestines to herniate; spontaneous closure by 4 years old

171
Q

GERD
Signs
Mgmt

A

Irritability, arching with feed, wet burp, vomit

HOB up or hold child up for 30 mins after feed
Smaller more frq meals, meds,

172
Q

Constipation & encopresis
Define

A

Constipation - less than 3 bowel weekly, hard, painful stool
Encopresis - fecal in underwear of older children. Withheld stool stretches rectal muscle and liquid leaks around mass into underwear

173
Q

Hirschsprung Disease
Define
Trtment

A

Disorder of motility of intestinal track resulting in obstrcution, failure to pass stool within 1st 24 hours of life, lack of ganglion cells in intestine

Surgical resection and reanastomosis of bowel with ostomy that is closed at later date once bowel heals

174
Q

Short Bowel Syndrome
-Define
Trtment

A

Massive small intestine loss, results in nutrient malabsoprtion, excessive fluid and electrolyte loss

May require long term TPN (damages liver)

175
Q

Inflammatory bowel disease
Chrons Disease
Ulcerative colitis
Sgns
trtmnet

A

Chrons - 10-20years old onset, cobblestone bowel wall appearance, low iron, perianal skin tags, abdominal tenderness

Ulcerative colitis - 10-20yrs onset, involves total colon, elevated WBCs

signs - ab cramping, blood stool, fever, weight loss, poor growth

Trtment - high protein & carb, avoid lactose, take vitamins and iron supplements, antibiotics

176
Q

Celiac disease
Define
Signs
Foods to avoid
Foods allowed

A

-Gluten causes damage to sm intestine
S/S - fatty, greasy stool, diarrhea, constipation, weight loss
Avoid - wheat, flavored yogurt, rye, creamed veggies
Allowed - Peanut butter, carbonated drinks, shellfish, jelly, fruit juice

177
Q

Pancreatitis
Define
Trtment

A

Acute onset of mid-epigastric pain that radiate to the back or check with vomit and fever
-Serum amylase and lipase levels are elevated at 3 times the normal value, CRP is elevated

-Place on immediate NPO and NGT for stomach decompression, IVFs

178
Q

Gall bladder disease
Signs
Gall stones assoc w/

A

**S/S **- R upper quad pain, pain increase after eating greasy fatty food
Assoc w/ - high cholesterol, obesity, pregnancy, female and entering puberity

179
Q

Biliary Atresia
Define
Signs
Trtment

A

Absence of biliary ducts resulting in obstrcution of bile flow = choestasis - jaundice and cirrhosis of liver
S/s- clay stools, jaundice, hard enlarged liver
Trtment- surgery (most successful in infants up to 45 days of life)

180
Q

Hepatitis
Define
S/S
A
B
C

A

inflammation of the liver caused by viral infections, bacterial invasion, metabolic disorders, chemical toxicity, trauma
** –s/s** 🡪 jaundice, abnormal liver/spleen size and tenderness, elevated liver enzymes
Hepatitis A = oral-fecal route, poor sanitation
Hepatitis B = sex, IV drug use, blood transfusion, prenatally from mom to infant
Hepatitis C = blood transfusion, IV drug use

181
Q

Cirrhosis / Portal htn
-Cirrhosis
-Causes
-Major complication
-Cure
-Portal HTN

A

-Cirrhosis = liver damage
-Causes - biliary disorder, chronic hep, prolonged TPN
-Major complication - portal HTN
-Cure - liver transplant
-Portal HTN - blood flow to, through and from liver meets resistance. Pressure rises = GI bleed

182
Q

GFR measures?

A

Glomerular filtration rate (GFR) 🡪 the blood flow through the kidneys

183
Q

BUN measures

A

BUN 🡪 indirect measure of renal function; may be elevated with high protein diet or dehydration; may be low if overhydrated or malnourished

184
Q
A
184
Q

Creatinine measures

A

🡪 direct measure of renal function; best indicator of renal function

185
Q

Total protein measures?
Albumin measures?

A

Total protein 🡪 to monitor chronic renal failure
Albumin 🡪 low levels contribute to extent of edema

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