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
2
Q
Neuro disorder - Ch 38
At birth, the brain is highly vascular which increases a risk for
A
hemorrhage
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
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
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
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
7
Q
Neuro disorder - Ch 38
Intracranial regulation
A
Ability of cranial contents to maintain normal intracranial pressure, equilibrium and neurologic function
8
Q
Neuro disorder - Ch 38
When do brain and spinal cord develop?
A
first 3-4 weeks gestation
9
Q
What is the earliest indicator of improvment or deterioration of neuro status?
A
LOC
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.
11
Q
Neuro disorder - Ch 38
Always measure head circumference in children younger than
A
3
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
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
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
15
Q
Neuro disorder - Ch 38
Cranial Nerves
Optic (II)
A
Optic (II) - Fixed dilated pupils report immediatly
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
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
- based on eye opening, motor response and verbal response.
- The perfect score is 15.
- The lower the score the more severe the injury and prognosis.
- Severe head injury = 8 or less.
- Moderate head injury = 9-12 points.
- Mild head injury= 13 and 15.
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.
19
Q
Neuro disorder - Ch 38
Electroencephalogram (EEG)
Define
A
to detect seizure activity and determine brain death
20
Q
Neuro disorder - Ch 38
Ultrasound
A
used to assess intracranial hemorrhage in newborns
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.
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)
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
24
Q
Neuro disorder - Ch 38
Hyperventilation
A
decreases PaCO2 which causes vasoconstriction
and decreases ICP.
Monitor ABGs.
25
# Neuro disorder - Ch 38
Ventricular tap
to drain CSF
26
# Neuro disorder - Ch 38
Vagal Nerve stimulator
For short and long term seizure mgmt
27
# Neuro disorder - Ch 38
Keto diet
high fat, very low carbs, adequate protein, and mild
dehydration to control seizures through diet
28
# Neuro disorder - Ch 38
Antibiotics
to treat bacterial meningitis and shunt infections
29
# Neuro disorder - Ch 38
Anticonvulsants
control seizures, decrease hyperexcitability of
nerves, do not stop abruptly,
**ie Levetiracetam, Phenytoin,Fosphenytoin, Phenobarbital**
30
# Neuro disorder - Ch 38
Benzodiazepines
ie Diazepam/Lorazepam,
slows down CNS so must monitor LOC, useful for home treatment of seizures
31
# Neuro disorder - Ch 38
Analgesics
pain to help avoid increase in ICP with interventions
that cause pain or stress.
32
# Neuro disorder - Ch 38
Diuretics
Mannitol, monitor electrolytes and I&O
33
# Neuro disorder - Ch 38
Levetiracetam (Keppra)
Used for
Side effects
--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.
34
# Neuro disorder - Ch 38
**Phenytoin **
Route?
IF IV, fluids need to be?
Can be administered through?
Treatment of?
--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.
35
# Neuro disorder - Ch 38
Fosphenytoin
another form of phenytoin, may be tolerated better,
and it can be administered through all IV fluids without
precipitation
36
# Neuro disorder - Ch 38
5 major types of seizures
subtle, tonic, focal clonic, multifocal clonic, and myoclonic
37
# 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 ?
**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.
38
# Neuro disorder - Ch 38
Neural tube defects
**spina bifida, meningocele, anencephaly**
folic acid supplements before pregnancy can reduce incidence by 50%.
39
# Neuro disorder - Ch 38
Microcephaly
small head, large face, expect developmental delays
40
# Neuro disorder - Ch 38
Arnold-Chiari malformation
Type 1
Type 2
** Type 1** = benign, c/o neck pain, H/A,
frequent urination, and lower extremity spasticity.
**Type 2** = associated with hydrocephalus and myelomeningocele
41
# Neuro disorder - Ch 38
**Hydrocephalus**
define
children with this are at increased risk for
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.
42
# Neuro disorder - Ch 38
Intracranial arteriovenous malformation
Intracranial hemorrhage or hemorrhagic stroke is a risk for children with intracranial arteriovenous
malformation.
43
# Neuro disorder - Ch 38
Craniosynostosis
premature closure of the cranial sutures
44
# Neuro disorder - Ch 38
Positional plagiocephaly
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.
45
# Neuro disorder - Ch 38
**Hydocephalus**
Symptoms
Parents need to know
Risk for infection most common during
**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. **
46
# Neuro disorder - Ch 38
**Bacterial meningitis **
Do what immediatly
Symptoms
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
47
# Neuro disorder - Ch 38
With bacterial meningitis, infant may rest in what position?
opisthotonic position (back bend)
48
# Neuro disorder - Ch 38
Encephalitis -
Caused by
caused by polio, HSV 1 and 2, vector-borne viruses
49
**Reye syndrome**
Symptoms
Avoid what?
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.
50
# Neuro disorder - Ch 38
**Concussion**
define
Treatment
-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
51
# Neuro disorder - Ch 38
Linear skull fracture
most common skull fracture, can result from
minor head
injuries
52
Classic signs of SBS
Retinol hemorrhages
53
In children what is more common? Ischemic or hemorrhagic strokes?
Ischemic
54
Ischemic =
Hemorrhagic =
**Ischemic** = a blood vessel supplying the brain becomes blocked
**Hemorrhagic** = a blood vessel bursts leaking blood into the brain
55
# Ch 39
When is eye color determined?
6-12 mo
56
# Ch 39
When is optic nerve fully myelinated?
3 months
57
# Ch 39
What is vision acuity (Sharpness of vision) at birth?
5 months?
Birth - 20/400
5 months - 20/20
58
# Ch 39
When is binocular vision achieved?
3-7 months
59
# Ch 39
Ptosis?
Failure of eyelids to open fully and equally
60
# Ch 39
How to do visual acuity testing in children 3 and under or nonverbal?
eval childs ability to fixate on and trace an object. Use black and white patterns
61
# Ch 39
How to do visual acuity testing for children 3-5 years old?
Use tumbling E chart. Will be able to indicate direction of arms of E
62
# Ch 39
What is the whisper test ?
4 years and older
one ear occulated, examiner stands behind and whispers a word. Child must repeat word correctly
63
# Ch 39
Weber test?
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
64
# Ch 39
Tympanometry
must be over 7 months
Measures tympanic membrane mobility and determines middle ear pressure
65
# Ch 39
Bacterial conjunctivitis
symptoms
treatment
Purulent drainage, mild pain, occasional eyelid edmea
Required antibiotic ointment/drops
infectious
66
# Ch 39
Viral conjunctivitis
Symptoms
Tearing, photophobia, lumphadenopathy
67
# Ch 39
**Allergic conjunctivitis**
Symptoms
treatment
Itching, stringy or watery discharge,
Antihistamines
68
# Ch. 39
**Treaments for**
Conjunctivitis
Astigmatism, hyperopia, myopia
Amblyopia
**Conjunctivitis** - warm compress
**Astigmatism, hyperopia, myopia** - corrective lens
**Amblyopia**- patching
69
# Ch 39
Treatment for:
Strabismus
Chronic ottis media with effusion
Hearing impairment
**Strabismus**: Eye muscle surgery
**Chronic ottis media with effusion:** Pressure equalizing tubes
**Hearing impairment;** Hearing aid or cochlear implant
70
# Ch 39
Hordeolum (Stye)
Symptoms
Treatment
Localized infection of sebaceous gland of eyelid follicle
Painful purulent drainage
Antibiotic
71
# Ch 39
Chalazion
Chronic painless infection of meibomian gland
72
# Ch 39
Blepharitis
Symptoms
Treatment
Chronic scaling, dryness and discahrge along eyelid. redness, edema, no pain
Needs antibiotic ointment
73
# Ch 39
Nasolacrimal duct stenosis
Blocked tear duct. Self resolved with massage, not infectious
74
# Ch 39
Periorbital cellulitis
define
symptoms
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
75
# Ch 39
What are refractive errors
OIccurs when the light that enters the lens does not bend appropriately to allow it to fall directly on the retina
76
# Ch 39
Hyperopia
Farsighted, blurriness at close range, child had mild hyperopia until about 5 years old
77
# Ch 39
Myopia
Nearsighted, see well at close range but cant see blackboard
78
# Ch39
Astigmatism
Cornea or lens not perfectly spherical
79
# Ch 39
Strabismus
unequal alignment of eyes, crosseyed. may result in diplopia(double vision) and amblyopia.
Treatment - eye muscle surgery, patch and corrective lens
80
# Ch 39
Amblyopia
Lazy eye
Patch on good eye
81
# Ch 39
Nystagmus
Rapid, irregular eye movmnts,
Most common cause is a neuro problem
82
# Ch 39
Glaucoma
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
# Ch 39
Cataracts
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
# Ch 39
Retinopathy of prematurity
Rapid growth of nonvascularized rential blood vessels
results in retinal detachment, blindness
85
# Ch 39
What heritage is a risk factor for visual impairment
African american
86
# Ch 39
acute otitis media
- Define
- Risk factors
- Pain mgmt
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
# Ch 39
Otitis media with effusion
Define
Adverse effects
Treatment
presences of fluid in middle ear with or without infection
May delay speech and language development
Pressure equalizing tubes, wear earplugs while swimming
88
# Ch 39
Otitis externa
Infection and inflammation of external ear canal
Swimmers ear
Signigicantly painful
89
# Ch 39
What decible is
Mild hearing loss?
Moderate?
Severe?
Profound?
Mild - 20-40dB
Moderate 40-60db
Severe - 60-80db
Profound greater than 80db
90
# Ch 40
What illnesses are more commonly seen in spring?
Allergen-related respiratory illness
91
# Ch 40
What illnesses are more commonly seen in winter
Flu, RSV, pneumonia
92
# Ch. 40
What is the most common illness and hospitalization for children
Respiratory illness
93
# Ch 40
Nose assessment
Obligate nose breathers until?
Obstructed nares leads to
Small nasal passages leads to?
Sinuses do not develop until
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
# Ch 40
Throat assessment
Larger tounges in relation to oropharynx, which can cause?
Children have larger tonsillar and adenoidal tissue which can?
Posterior displacment of tounge can cause **severe airway obstruction**
Larger tonsillar and adenodial tissue can cause **airway obstruction**
95
# Ch. 40
Larynx assessment
Why is larynx funnel shaped in children 10 and younger?
What shape is larynx in teens and adults>
Laryngomalacia ?
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
# Ch 40
When intubated, if you hear breathe sounds louder on the right, what does that mean?
EET is too deep and needs to be pulled back
97
# Ch 40
How many alveoli does a term baby have?
3-8 year olds?
Term baby = 150 million
3-8 year olds = 300 million
98
What does having fewer alveoli put the child at risk for?
hypoxemia and carbon dioxide retention
99
# Ch 40.
What is the 1st sign of respiratory illnesS?
Tachypnea
100
# Ch 40
What does slow, irregular breathing with listlessness indicate for a respiratory illness?
Worsening condition
101
# Ch 40
What does pallor indicate for a child with respiratory illness?
Peripheral vasoconstriction to conserve oxygen for vital functions
102
What does cyanosis indicate for a child with respiratory illness?
hypoxia (oxygen deficiency)
103
What does circumorla cyanosis look like
blue around the mouth
104
What does central cyanosis look like
involving midline
105
Why does grunting occur?
Occurs with expiration from alveolar collapse of loss of lung volume such as with atelectasis, pneumonia and pulmonary edema
106
What is stridor?
High pitched easily heard inspiratory noise that is sign of upper airway obstruction
107
What is involved in respiratory effort?
Depth, quality, labored, tachypnea, nasal flaring, retractions
108
What are retractions
Where?
INward pulling.
Note whether** intercostal **(between ribs), **subcoastl** (around diaphragm), s**ubsternal, supraclavicular, suprasternal **
109
Paradoxical breathing
Chest falls on inspiration and rises on expiration
110
What do the following interventions help with?
Oxygen =
High humidity =
Suctioning =
Chest PT =
Saline gargles =
Chest tubes =
Bronchoscopy =
**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
Croup
Bark like cough often at night with inspriatory stridor and suprasternal retractions
112
RSV
Peaks?
Begins as a ?
Define?
Symptoms?
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
What is treatment for RSV?
Position HOB elevated
Supplemental oxygen with continuous pulse ox
Frquent assessment, can deteriote quickly
Droplet precautions
Synagis vaccine - given during RSV months
114
What are symptoms for TB
Malaise, weight loss, anorexia, chest tightness, COUGH, hemoptysis (coughing up blood)
115
What is pneumothorax?
how to diagnose?
Symptoms?
Treatment
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
**Allergic Rhinitis**
Mediated by what immunoglobulin?
Triggered by
Symptoms?
IgE
triggered by dust, pet dander, pollens
Symptoms = Thin watery runny nose, nasal congestion, sneezing
117
**Chronic lung disease (Bronchopulmonary dysplasi)**
Primarly seen with what age infant?
Highest risk
symptoms
Primarly with premature infants
Low birth weight and white males are at risk
Tachypnea and increased work of breathing
118
**Cystic fibrosis**
What kind of recessive disorder?
Median age of survival?
Autosomal recessive disorder
Median age 39.3years
119
**ASTHMA**
When examining a child with asthma nurse would not do what?
What is hallmark sign of airway obstruction?
Priority treatment?
Nurse wouldnt palpation
Wheezing is hallmark sign
Bronchodialtions - admin inhaled short term bronchodilator, start oxygen after, then IV steriods
120
ALbuterol
Salmeterol
Ipratropium
**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
Montelukast
Cromolyn
Theophylline
**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
123
In a patient with Cystic Fibrosis
What will their respiratory tract look like?
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
In a patient with Cystic Fibrosis
What will their GI tract look like?
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
What is a diet for patinets with Cystic Fibrosis
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
**Epiglottis**
Symptoms
Treatment
high fever, dysphagia,
NEVER VISUALIZE the Throat can cause REFLEX LARYNGOSPASM
Treatment: 100% oxygen in least invasive manner, tracheostomy tray prepared
127
A simple mask is used to deliver a flow rate of --/min
8L/min
128
A venturi mask woudl be used to deliver..
A specific % of oxygen from 24-50%
129
A oxygen hood requires a liter flow of
10-15 L/min
130
Perfusion
The flow of blood to cells and tissues
131
Ductus arteriosus
define
purpose
Closes?
-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
Patent Ductus Arteriosus
Symptoms?
Vessel stays open
Widening pulse pressure, poor eating, failure to thrive, increased RR, Respiratory distress, sweating with crying or eating, murmur, pulmonary HTN
133
Treatment for PDA
Meds - indomethacin, ibuprofen
Surgery - PDA ligation
134
Pulse pressure
define
avg?
Widened?
narrow?
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
**Heart rate**
Infant
Toddler/preschool
School age/adolescent
Infant - 90-160bpm
Toddler - 80-115bpm
School age/adolescent - 60-100bpm
136
**Blood pressure**
Infant -
Toddler -
School age -
Adolescent-
**Infant** - 80-55
**Toddler** - 90/55 to 100/75
**School age** - 100/60 to 120/75
**Adolescent**- 100/70 to 120/80
137
What are the 2 categories of cardiovascular disorder in children?
**Congenital heart disease **- anomalies present at birth
**Acquired heart disease** - disorders that occur after birth
138
Orthopena
Infant more comfortable sitting up or over moms shoulder rather than lying flat
139
Signs of dyspnea
Grunting, tachypnea, retractions
140
Cyanosis in a nb that does not improve with oxygen suspect?
CHD
141
WIdened pulse pressure is associated with
PDA, Aortic insufficicney, fever, anemia and complete heart block
142
All murmurs should be evaluated on what 5 characteristics
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
**Congenital Heart Disease**
Which age has highest incidence
Common chromosomal defect assoc
Screening done when? Passing criteria?
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
**Decreased pulmonary blood flow**
-define
-2 diagnosed defects
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
**Increased pulmonary blood flow**
Define
3 diagnosed defects
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
**Obstructive disorders**
define
3 types of diagnosed
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
**Mixed defects**
-Define
4 diagnosed defects
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
Tetralogy of Fallot
Define
Signs
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
Transposition of great vessels
Define
Treatment
Artery and aorta are transposed
Prostaglandin to keep ductus arteriosus open until surgery
150
Electrocardiogram
= evaluates the pattern or rhythm of the heart’s beating using electrodes attached to the chest
child must lie still for 5 minutes
151
Holter monitor
is an ambulatory ECG that monitors the heart’s electrical patterns for 24 hours during normal daily activity
152
Echocardiogram
= noninvasive ultrasound using a gel-coated wand to visualize chambers, heart wall thickness, value motion, hemodynamics of the great vessels, and structural defects
153
Arteriogram/cardiac cath
= 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
Digoxin
Effect
Monitor for
hold if
Signs of toxicity
-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
Infective endocarditis
-define
-Treatment
-Signs
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
**Acute Rheumatic Fever**
-Preceded by
-Cheif complaint
-Classic rash
-Movment disorder
-Mgmt
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
**Cholesterol levels**
Desirable
Borderline
high
Cholesterol < 170 = desirable
Cholesterol 170-199 = borderline
Cholesterol > 200 = high
158
**Kawasaki Disease**
Occurs in what age
Leading cause of
Mgmt
-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
Dysphagia
Difficult or painful swallowing
160
**INTESTINES**
Small intestine mature at birth?
full term infant ---Cm sm bowel?
adults ---cm sm bowel?
Sm intestine not mature at birth
Infant 250cm
Adult 600cm
161
Insensible fluid loss occurs in children in what 3 ways?
1. With fever
2. Through skin
3. higher metabolic rate needed to support growth
162
ORal candidiasis (Thrush)
-define
-Treatment
Fungal infection of mouth
also w/ beefy red diaper rash
Treat: nystatin or fluconazole
163
**Hypertonic pyloric stenosis**
Define
Signs
Treatments
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
**Intussesception**
Define
Signs
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),
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**Malrotation with volvulus**
Define
Signs
Intestine abnormally attached and mesentery narrows, twisting itself
bilious vomiting, ab distention, bloody stools, usually in 1st week of life
166
**Appendicitis**
Define
Signs
Obstrcution due to fecal matter which causes inflammatory fluid anc bacteria to leak into peritoneal cavity
tender lower right quad - Mcburney point
167
**Peptic Ulcer Disease**
Define
Signes
Diagnostic test
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
**Stages of dehydration**
Mild
Moderate
Severe
**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
**Cleft lip and palate**
Freq occur w/
Complications?
repair time?
Major risk factor?
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
**Hernias**
Inguinal-
Umbilical-
**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
**GERD**
Signs
Mgmt
Irritability, arching with feed, wet burp, vomit
HOB up or hold child up for 30 mins after feed
Smaller more frq meals, meds,
172
Constipation & encopresis
Define
**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
**Hirschsprung Disease**
Define
Trtment
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
**Short Bowel Syndrome**
-Define
Trtment
Massive small intestine loss, results in nutrient malabsoprtion, excessive fluid and electrolyte loss
May require long term TPN (damages liver)
175
**Inflammatory bowel disease**
Chrons Disease
Ulcerative colitis
Sgns
trtmnet
**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
**Celiac disease**
Define
Signs
Foods to avoid
Foods allowed
-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
**Pancreatitis**
Define
Trtment
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
**Gall bladder disease**
Signs
Gall stones assoc w/
**S/S **- R upper quad pain, pain increase after eating greasy fatty food
**Assoc w/** - high cholesterol, obesity, pregnancy, female and entering puberity
179
**Biliary Atresia**
Define
Signs
Trtment
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
**Hepatitis**
Define
S/S
A
B
C
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
**Cirrhosis / Portal htn**
-Cirrhosis
-Causes
-Major complication
-Cure
-Portal HTN
-**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
GFR measures?
Glomerular filtration rate (GFR) 🡪 the blood flow through the kidneys
183
BUN measures
BUN 🡪 indirect measure of renal function; may be elevated with high protein diet or dehydration; may be low if overhydrated or malnourished
184
184
Creatinine measures
🡪 direct measure of renal function; best indicator of renal function
185
Total protein measures?
Albumin measures?
Total protein 🡪 to monitor chronic renal failure
Albumin 🡪 low levels contribute to extent of edema
