Test 3 Flashcards
What is abuse?
actual harm, either physical, emotional, or sexual.
What is neglect?
withdrawing or not giving adequate care when they have the means.
What are some methods of physical abuse in children?
hitting, slapping, kicking, or punching. Whipping with belts, shoes or electrical cords. inflicting burns with a lit cigarette or lighter. immersing child or body part into scalding water. shaking the child violently. tying the child to fence, tree, bed, or other object. Throwing against wall, down stairs, etc. choking or gagging the child. fracturing arms, legs, or skull. Deliberately administering excessive amounts of medications/drugs. Deliberately withholding prescribed medications.
What are some common forms of sexual abuse?
oral-genital contact. fondling and caressing the genitals. anal intercourse/sodomy. sexual intercourse. rape. prostitution. forced viewing of or participation of pornography. encouraging nude photos or sexual activity via internet or video.
What are some risk factors for physical abuse?
poverty. violence in the family. prematurity or low birth weight. unrelated male primary caretaker. parents who were abused as a children. age less than 3 years. child disability or condition that requires a great deal of care. parental substance abuse or social isolation.
What are some risk factors for sexual abuse?
absence of natural father or having a step father. being female. mother’s employment outside of the home. poor relationship with parent. parental relationship characterized by conflict. parental substance abuse or social isolation.
What are some clinical manifestations of physical abuse in children and adolescents?
multiple bruises in various stages of healing. scald burns with clear lines of demarcation and in glove or stocking distribution. rope, belt, or cord marks. burn scars in various stages of healing. multiple fractures in various stages of healing. spiral fractures not explained by accident. shortness of breath and distress upon being moved, indicating chest contusions and possible rib fractures. sedation from overmedication. exacerbation of chronic illness. cranial and abdominal injuries. change in behavior or school performance. fear and avoidance of certain people or situations.
What are some clinical manifestations of sexual abuse in children and adolescents?
vaginal discharge. blood stained underpants or diapers. genital redness, pain, itching, or bruising. difficulty walking or sitting. UTI. STIs. sleeping problems. bed-wetting. new or excessive sexual curiosity or play. fear of strangers. constant masturbation. curling into fetal position. changes in eating habits. abrupt changes in behavior or school performance. excessively seductive behavior.
What are some clinical manifestations of neglect?
hungry or dirty a lot. undernourishment. unclean clothes or body. inappropriate clothing for the season. untreated medical or dental problems. poor physical growth or developmental delay. lack of supervision. being withdrawn or stealing food.
How do you evaluate possible abuse?
interview child and parent alone and together. child may hide it and not tell anyone. compare reported incident with degree of injury and child’s developmental level. and consider cultural practices.
What is Munchausen by proxy?
a psychiatric disorder where, typically the mother makes the child sick.
What are characteristics of Munchausen by proxy?
usually children under 6. symptoms disappear when parent is not present. mother seems cooperative and knowledgeable.
Who gets help for Munchausen by proxy?
the mother is proxy 90% of the time and requires psychiatric help.
Are nurses legally required to report suspected abuse?
yes
How do you report suspected abuse?
call cps or police. be judgmental and objective. no opinions. documentation is very important. use photographs and diagrams. use child’s and parents own words.
How do you manage child abuse?
treat physical injuries. provide safe environment. mental health support for child. parental support- may not be abused by parents or abuse is unknown to parents.
How do you prevent abuse and neglect?
know risk factors. identify families at risk. provide resources and support. identify and report suspected abuse and neglect.
What are some pediatric considerations with congenital heart defects?
immature heart more sensitive to volume or pressure overload = increased risk of heart failure.
unable to increase stroke volume to increased cardiac output = decreased compliance.
must increase heart rate to increase cardiac output.
mixing of blood due to defect results in desaturated blood.
chronic hypoxemia = polycythemia
severe hypoxemia = bradycardia and eventually cardiac arrest
What is stroke volume?
the amount of blood ejected from left ventricle with each contraction.
What is cardiac output?
amount of blood ejected each minute.
What is an issue with polycythemia?
more RBC = more viscous blood = increased risk for blood clots
Different findings in assessment with congenital heart defects?
respirations = increased respiratory effort. CHF =wet crackles.
Pulses and Blood Pressure = differences in right and left extremities as well differences in upper and lower extremities.
Color = cyanosis
Heart = abnormal heart sounds, murmurs
Fluid Status = CHF - you don’t want fluid retention
Activity = fatigue easily
General = weight gain
What is the leading cause of death in 1st year of life excluding prematurity?
congenital heart disease.
What is the most common cause of heart failure in children?
congenital heart disease.
What is a major concern with congenital heart disease?
altered perfusion
What do you need to treat prophylactically with congenital heart disease?
infective endocarditis.
What is infective endocarditis?
the endocardium is injured by high velocity blood flow through a stenotic valve, by turbulent blood flow across a septal defect, or by the positioning of a central venous catheter. fibrin and platelets migrate to the site of the endothelial damage, becoming the formation of nonbacterial thrombotic emboli, where the infective organisms settle.
What are some medications used in infective endocarditis prophylaxis?
amoxicillin for oral use. ampicillin for IM or IV use.
if allergic to penicillin: cephalexin, clindamycin, azithromycin, and clarithromycin.
What are some general symptoms of CHD?
vary by type and size of defect. may be asymptomatic. murmur. poor growth. tire easily. exercise intolerance. chest pain. arrhythmias. syncope.
What defects have increased pulmonary blood flow?
patent ductus arteriosus (PSA) and ventricular septal defect (VSD)
What defect has decreased pulmonary blood flow?
tetralogy of fallot (TOF)
What defect has obstructed systemic blood flow?
coarctation of the aorta (COA)
What defect has mixed defects?
transposition of the great arteries.
With congenial heart defects, when do they require infective endocarditis prophylaxis?
before and perhaps after surgery.
What are symptoms of increased pulmonary blood flow defects (PDA & VSD)?
increased HR, RR, BMR. Murmur. diaphoresis during feeds. poor weight gain. frequent respiratory infections. fluid in lungs. congestive heart failure = if not treated properly.
When is Patent ductus arteriosus more common?
pre-term babies
What is patent ductus arteriosus?
blood shunts from aorta to pulmonary arteries. L to R shunt.
What additional symptoms occur with patent ductus arteriosus?
bounding pulses. widened pulse pressure ( increase in systolic, decrease in diastolic). hypotension when cardiac output is low.
What is the treatment for PDA?
treat medically first, IV indomethacin and IV ibuprofen to inhibit prostaglandin action and stimulate the closure in premature infants. if this does not work, surgical ligation is required.
What happens if PDA is left untreated?
pulmonary hypertension.
What is the most common congenital heart defect?
Ventricular Septal Defect (VSD)
What is ventricular septal defect?
septal opening between ventricles. L to R shunt.
What are additional symptoms with VSD?
may be asymptomatic if small. can have a loud, harsh systolic murmur.
What is the treatment for VSD?
most small ones close on their own. surgery for large or if CHF develops. surgical patching or closure of the hole.
What are symptoms of decreased pulmonary blood flow defects?
murmur, hypoxia = cyanosis, clubbing. hyper cyanotic episodes ( tet spells). polycythemia. poor growth. delayed milestones. exercise intolerance. fatigue. doesn’t feed well. oxygen not getting to brain.
What four defects are included in tetralogy of fallot (TOF)?
pulmonic stenosis (primary defect).right ventricular hypertrophy. VSD. overriding aorta.
What is the treatment for TOF?
Prostaglandin E1 (PGE1) for cyanosis in newborns = keeps ductus arteriosus open allowing oxygenation of the blood. surgical repair at 1-2 years
What is the treatment of tet spells?
knee chest position, toddlers will squat. calm infant or child. supplemental oxygen.
What is a more aggressive treatment of tet spells?
IV morphine & propranolol - sedation. IV fluid bolus. Dopamine or phenylephrine.
What can tet spells lead to?
seizures, CVA, or death.
What symptoms occur with obstructed systemic blood flow defects?
murmur. diminished pulses. poor color. delayed cap refill. urine output is decreased. CHF with pulmonary edema.
What is coarctation of the aorta?
constriction in the aorta that obstructs systemic blood outflow. often in the descending aorta.
What are additional symptoms of coarctation of the aorta?
may be asymptomatic.
mild = feet cooler than hands, leg cramps.
BP lower in legs than arms. UE pulses bounding, LE weak or absent
What percentage of babies with COA develop CHF?
30% develop CHF by 3 months
What is the treatment of COA?
in a symptomatic newborn: PEG1. inotropic medications - digoxin, dopamine, milrinone. Diuretics to keep fluid levels low. oxygen. surgery includes balloon dilation or surgical resection.
Can coarctation of the aorta return after a surgical fix?
yes
What is the goal in the treatment of COA?
prevent congestive heart failure.
What are symptoms of congestive heart failure?
tires easily. poor weight gain. diaphoresis. irritability. frequent infections. respiratory symptoms - distress, productive cough, fine or coarse crackles. periorbital or facial edema. JVD in older children. cardiomegaly. weak peripheral pulses. hypotension.
What is the goal in treatment of CHF?
make heart pump more efficiently and remove excess fluid. correction of defect. supportive therapy.
What are some medications for treatment of CHF?
digoxin (lanoxin), furosemide (Lasix), thiazides (diuril). Spironolactone (Aldactone). ACE inhbitors, and Carvedilol (Coreg).
What is the action of Digoxin?
slows the heart rate, increases cardiac filling time, and increases cardiac output. .
When is digoxin used?
with increased pulmonary blood flow
What is the action of furosemide?
rapid diuresis; blocks reabsorption of sodium and water in renal tubules.
What is the action of thiazides?
maintains diuresis, decreases absorption of sodium, water, potassium, chloride, and bicarbonate in renal tubules.
What is the action of spironolactone?
maintains diuresis (potassium sparing)
What is the action of ACE inhibitors?
promotes vascular relaxation and reduced peripheral vascular resistance, reduces afterload.
What is the action of carvedilol?
improves left ventricular function, promotes vasodilation of systemic circulation.
When is carvedilol used?
for chronic heart failure and dilated cardiomyopathy.
What is some preoperative nursing care done for heart surgery?
assess and manage symptoms of CHF. monitor PGE1 therapy. manage tet spells. monitor for thromboembolism. prevent infection. reduce fatigue. optimize nutrition. optimize cognitive and physical development. administer medications. teach surgical and postop expectations. provide psychological support. teach home care.
What are some nursing diagnoses with heart defects?
risk for infection. decreased nutrition : less than bodily requirements. delayed growth and development activity intolerance/fatigue caregiver role strain.
What is some postoperative nursing care done for heart surgery?
Provide pain control. promote respiratory function. assess for complications. manage fluids. careful I/Os. gradually increase activity levels.
What is some home care teaching post-op from heart surgery?
place infants and children in car safety seats with a small blanket over the incision to protect from straps. sponge bathe children. avoid soaking incision until sutures are out and incision is healed. do not use oils creams, lotions, or ointments on the incision. cover incision with clean shirt, keep it dry and clean. do not lift child by arms. encourage a nutritious diet. gradually increase activity as tolerated. no rough play for 6 weeks. can return to school in 3 weeks but no backpack for several weeks.give meds for prophylaxis and pain control as prescribed. report any signs of infection or complication. live virus vaccinations should be delayed.
Do infants have a concept of death?
no, but can see changes in parents
How do toddlers react to death?
cannot separate temporary abandonment and death. may react to changes in parents behavior and daily routines.
How do preschoolers react to death?
aware of body changes and deterioration. death is temporary. magical thinking, feelings of guilt if sibling dies. think they can bring someone back.
How do school age children react to death?
have increased awareness sand preoccupation with death = death anxiety.
How do adolescents react to death?
death is difficult. doesn’t want to be dependent or different. hard for this age group to accept own death.
What are fontanels?
fibrous membranes in the skull that allow for growth of the brain and skull.
When do fontanels close?
anterior = 18 months posterior = 2-3 months
When does the fontanels stop fusing?
2 years of age
When is the skull full size?
16 years of age
What are some pediatric differences in the musculoskeletal system?
fontanels
long bones are porous and less dense = high fracture rates
rapid bone growth facilitates healing.
ends of long bones are cartilaginous, growth occurs and epiphyses.
ligaments and tendons are stronger than bone until puberty
What do you assess in the musculoskeletal system?
muscles, joints, bones, tendons, ligaments, mobility, range of motion, limitations, symmetry, and length.
What is club foot (talipes equinovarus)?
congenital abnormality of foot position, etiology unknown. can be unilateral or bilateral
What are the three deformities of club foot?
forefoot - equinus (toward the heel)
midfoot - supination (downward)
hindfoot - varus (inward)
How is club foot diagnosed?
ultrasound at 16-20 weeks gestation
appearance at birth
xray to determine severity.
What is the treatment of club foot?
in utero - nothing
tx occurs after birth, the sooner the better, before ossification of the bones.
serial casting is the treatment of choice - long leg casts changed weekly.
surgery if needed.
What is developmental dysplasia of the hip (DDH)?
femoral head & acetabulum are improperly aligned. not always a true dislocation. etiology unknown. can be unilateral or bilateral. formally called congenial dislocated hip.
