Test Plan Flashcards
Near Drowning- Care of the Patient
CRP Immediately at scene
Management is based on degree of cerebral insult
Hospitalization for observation (24 hrs)
prognosis: best predictor is the length of submersion
Near drowning frequent complication
Aspiration pneumonia
Drowning Patho
Hypoxia (4 mins max)
Aspiration
Hypothermia (Increase BF to extremities, away from vital organs)
Hirschsprung’s Disease
“congenital aganglionic megacolon”
Mechanical obstruction from inadequate motility of intestines.
Doesn’t allow sphincter to relax
Loss of internal anal sphincter to relax
Accumulation of stool with distention
Hirschsprung’s Diagnostic evaluation
Most cases diagnosed in the first few months of life
Complete, careful hx
X-ray, barium enema studies, anorectal exam, rectal biopsy to confirm (Narrow poop ribbon like)
Hirschsprung’s S/S Newborns
Failure to pass meconium stool
Chronic Constipation
Reluctant to eat abdominal distention
Hirschsprung’s S/S Infants
Failure to thrive
Constipation
Abdominal distension
Vomiting
Episodic diarrhea
Hirschsprung’s S/S Toddlers and older children
Foul-smelling stools
Abdominal distention
Visible peristalsis
Palpable fecal mass
Malnourishment
Signs of anemia and hypoproteinemia
Hirschsprung’s therapeutic management
Sugery- removal of aganglionic portion of the bowel to relieve obstruction, restore normal motility, and preserve function of sphincter.
Two stages
-Tempory ostomy
“Pull-through” procedure
Hirschsprung’s preop care
NPO, stable, depends on age and clinical condition, may need to stabilize malnourished child prior to procedure
Hirschsprung’s postop care
Similar to any child with abdominal surgery
Pancreatic Enzymes
Necessary for digestion.
Blocked from reaching duodenum in cystic fibrosis.
W/ cystic fibrosis make sure they have vitamins A, D, E, and K 30 mins before eating.
Digoxin Use
Heart, heart defects, aortic stenosis, or other cardiac problems
Digoxin effect
Improve contractility to lower HR (check apical pulse, may be held if lower than 60BPM, less than 90 BPM for infants)
Increases Cardiac output, decreases heart size, decreases venous pressure, and relief of edema.
Fast effects
Digoxin Toxicity
N/V, anorexia, bradycardia, dysrhythmias.
Monitor with ECG
Synagis
Vaccine for influenza that prevents RSV
Is a monthly antibiotic injection given to infants at risk for RSV
Infants at risk are those in their 1st year who were born before 29 weeks of gestation, and those with chronic lung disease with prematurity (less than 32 weeks) that require less than 21% oxygen for 1 month after birth
Aortic Stenosis Patho
Narrowing of aorta or aortic valve
Left ventricle unable to effectively pump
Aortic Stenosis Effects
Poor perfusion/weak pulses, low BP, heart murmur
Aortic Stenosis Treatment
Valvuloplasty (fix valve), balloon angioplasty (dilate valve), Digoxin
Nutrition in an infant with congenital heart disease
Require more calories than the average infant, but they have less energy to feed.
They should be well rested and fed upon awakening.
Feed for about 30 minutes, but don’t feed longer or you risk exhaustion.
Breastfeeding mothers should alternate with calorie dense formula.
Feed every 3 hours.
Fluids rarely need to be limited since they have difficulty feeding
Heart Failure
Heart’s inability to pump an adequate amount of blood into circulation
Dehydration Management (Goal)
Correct fluid loss or deficit while treating underlying causes.
Oral rehydration
is initiated for mild cases, if tolerated (Pedialyte)
Parental Fluid
If oral rehydration doesn’t meet needs
Accurate measurements of I&O’s
Urine and stool (amount, color, consistency and time) (1g of wet diaper = 1mL of urine)
Vomitus (amount, color, consistency, and time) Sweating
Daily weights (same scale same time)
Fontanels in infants (sunken in dehydration)
Cleft-Lip (postop care)
Protect suture line
Pain management
Distraction
Position on back
Use syringe or dropper inside mouth for feeds
Congenital heart Defects (postop care)
Most patients need IV analgesics immediately after surgery, the strength of the drug can be decreased as IV and tubes are removed.
Educate the family on medications, activity restrictions, diet (more protein), wound care, follow-ups, community resources, and postop problem S/S
Make the child and parents feel more at ease by including them in the care process and explanations
Hypercyanotic Spell
Tet/blue spell
Acute episodes of cyanosis and hypoxia (when they cry, feed, poop)
Hypercyanotic Spell Interventions
1) calm down the kid
2) knees to chest
3) give O2
(they often hold their breath, risk for neuro damage, requires prompt intervention
Rheumatic Fever
Untreated strep
Inflammatory disease occurs after group A B-hemolytic strep. Pharyngitis
Rheumatic Fever Affects
Body attacks own joints, skin, brain, serous surfaces, and heart (mitral valve) causing inflammation
Fever, joint pain (tender to the touch), SOB, chest pain, splotchy rash
Rheumatic Fever Goals
Eradicate infection (antibiotics)
Prevent permanent damage, prevent recurrences
Salicylates are used to control inflammatory damage
What can Rheumatic Fever lead to
Rheumatic Heart Disease (permanent valve damage)
Tonsillectomy Postop Assessment
Position to facilitate drainage
Signs of bleeding- labs (pt and clotting factors, constant swallowing)
Airway, vitals (low BP = shock) (no poking in mouth)
Tonsillectomy Postop comfort measures
Ice collar, Ice chips, scheduled meds
Tonsillectomy Postop Diet
Advance w/ soft bland foods –> No red stuff (Looks like blood)
Tonsillectomy Postop Instruction
Protect surgical site (no vigorous activities like blowing nose, coughing hard)
Bacterial Respiratory Infections
Strep throat, TB, Tracheitis
Can create purulent secreations that can cause resp. distress
Bacterial Respiratory Infections Management
w/ humidified oxygen, antipyretics, antibiotics
May need intubation until swelling goes down or mechanical ventilation
More serious type of infection.
Viral Respiratory Infections
Influenza, bronchiolitis, and RSV
Viral Respiratory Infections Management
w/ hydration (monitor I&O’s + daily weights)
Usually does not require much intervention (manage symptoms)
CAN’T TREAT WITH ANTIBIOTICS
Cardiac Cath post care (possible complications)
Hemorrhage, fever, N/V, loss of pulse in catheterized extremity (usually transient) and transient dysrhythmias
Cardiac Cath post care
VS, pulses, fluid intake, blood glucose, discharge teaching
*lay flat, BR for 4-6 hours
Pyloric Stenosis
Constriction of pyloric sphincter w/ obstruction of gastric outlet
Usually develops in first 2-5 weeks of life
Pyloric Stenosis Patho
Circumferential muscle of pyloric sphincter becomes thickened, obstructs outlet and causes dilation, hypertrophy, and hyperperistalsis of stomach
Pyloric Stenosis Main Symptom
Projectile vomiting!
Feel mass on empty stomach
Pyloric Stenosis therapeutic management
Pyloromyotomy (decreases thickness of pyloric muscle)
Pyloric Stenosis per op
NPO, education
Pyloric Stenosis Post op
Slowly resume foods pre orders, IV fluids, comfort and rest, incision care.
Intussusception
Portion of intestine slides into the other (telescopes)
Most common cause of intestinal lesions in childre 3m-3y
Cause is often unknown
Intussusception subjective findings
Abdominal pain, vomiting, dark/bloody stools, currant jelly stools
Intussusception Interventions
Spontaneous resolution in 10% of patients
Air enema or ultrasound-guided hydrostatic enema
Croup
“barking cough”, inspiratory stridor and varying degrees of resp. distress
Affects the larynx, trachea, and bronchi
Croup caused by
H. Influenzae type B
Epiglottitis S/S
A medical Emergency!!!
Sore throat, pain, tripod positioning
Drooling, difficulty swallowing (obstruction)
Inspiratory stridor, mild hypoxia, distress
Epiglottitis Therapeutic Management
Prevention of progressive resp. obstruction
Protect airway
Prepare for intubation (have people that you need near by at all times)
Humidified Oxygen
Continuous pulse ox
NOTING IN MOUTH
NO THROAT CULTURE OR TONGUE BLADE
Head Injury Assessment
LOC changes, irritability, confusion are the 1st signs. Fontanels may be bulging, child may lie in a flexed/extended position, neck stiffness, pain, eyes not PERRLA
Head Injury Worsening
Epidural hemorrhage- bleeding between the skull and the dura
Subdural hemorrhage- bleeding between the dura and the arachnoid membrane
Cerebral edema- associated with traumatic brain injury, increased ICP wither herniation
Keep environment and avoid coughing/deep breathing
Reye’s Syndrome
A disorder defined as toxic encephalopathy associated with other characteristic organ involvement (ASPIRIN USE)
Most cases follow common viral illnesses (Influenza, varicella)
Reye’s Syndrome Characteristic
Fever, decreased LOC, hepatic dysfunction
Reye’s Syndrome Diagnostic eval
Liver biopsy
Reye’s Syndrome Therapeutic Management
Early diagnosis and aggressive therapy (liver injury–> worried about bleeding, not making enough clotting factors)
Congenital Heart Defect Screening
-Electrocardiography: Checks heart rhythm
-Echocardiography: looks at how heart pumps
-Cardiac Catheterization: Invasive, looks at oxygen/pressure levels in each chamber and their structure.
-Interventional: balloon at end of catheter can inflate structures
-Electrophysiology studies: sees how messages are sent to heart
Trisomy 21 (down syndrome) increases risk
Cystic Fibrosis Patho
Less water and chloride in mucus causes it to dry up and allow foreign agents to collect in the airways
Cystic Fibrosis Growth and Development
Food goes undigested and stools are more abundant and noxious.
Pancreatic enzymes can’t reach duodenum causing nutrition absorption of fat/protein to be impaired.
Eventual pancreatic fibrosis can cause diabetes mellitus.
Resp. infections are common; the lung muscles are weaker
Chronic hypoxia causes contraction/hypertrophy of the pulmonary artery muscle fibers
Cystic Fibrosis 1st Symptom
Meconium ileus
Cystic Fibrosis Health Promotion
Recommended physical exercise, aggressive treatment of infections, postural drainage, and chest physiotherapy (give bronchodilators beforehand)
Puberty in girls is delayed, and boys are sterile.
Failure to thrive in infants, increased weight loss despite appetite
What do Cystic Fibrosis Patients need extra of
Vitamin A, D, E, K, high protein, and high calorie
Cerebral Contusion S/S
Vary from mild, transient weakness of a limb to prolonged unconsciousness and paralysis.
Cerebral Contusion
Visible Bruising of cerebral tissue from physical trauma, petechial hemorrhages present.
Children are more susceptible to these as they have bigger heads that weigh them down and weaker muscles
Separation anxiety Despair phase
Cessation of crying; evidence of depression
Development of a Hospitalized Child Goal
Maintain normal development for the child as much as possible.
Minimize/prevent separation from the family, allow freedom of movement, maintain their routine, and encourage independence.
Provide developmentally appropriate activities, such as giving toys, reading books, or inviting friends to play.
Avoid isolation whenever possible
Separation anxiety Protest phase
Crying and screaming, clinging to parent
Separation anxiety detachment phase
Denial; resignation but not contentment
Possible serious effects on attachment to parent after separation
Development of a 9-month-old
Pincer grasp develops, mainly crawls but can stand
Development of a 12-month-old
Weight is tripled birth weight, head size increases by 33%, walks alone, says 3-5 words, begins exploring unfamiliar environments near parent.
Attempts to build block tower but fails, able to grasp things but difficulty releasing them
Development of a 18-month-old
Can walk alone, can follow simple commands, tries to use cups/utensils. Throws ball while standing, attempts to run.
What is important for all ages
Play is very important for kids, do not allow any procedures to be performed in their room for the chronically ill kid.
Caring for a patient with hearing impairment
Promote communication as much as possible.
Make sure that any instructions given are understood.
Supplement with visual and tactile media.
Utilize picture boards with common words, child life specialists, and other aids such as sign language or a visible mouth.
Caring for a child with autism spectrum disorder in the hospital
Attempt behavior modification, such as getting them more accustomed to socializing and completing tasks.
Keep a structured routine and discourage unacceptable behavior.
Support the family as well, give them referrals and stress counseling.
Sibling perception/feelings toward a child with chronic illness
Experiencing many changes and being too young to understand them.
Being cared for by nonrelatives or outside of the home.
Receiving little information about the ill brother or sister.
Perceiving that parents will treat the sick child differently.
It is a good idea to reward children who care for or help their ill sibling.
Restraining (Alternative Methods)
CONSIDER FIRST
Diversional activities
Parental participation
Therapeutic holding
Restraints
Can be used for children after surgery who may try to pick at suture line risking them to being undone, such as cleft palate repair
Should not be used for seizures
Restraining (Medical-surgical Restraints)
A necessary part of the procedure
Restraining (Behavioral Restraints)
Used if risk that patient will harm self, or others is high (assess every 15 minutes)
Heart Failure S/S
Pulmonary congestion (lungs, increased RR, retractions, cyanosis)- Left sided
Systemic venous congestion (peripheral edema, JVD)- Right sided
Right sided also damages kidneys causing fluid buildup. BNP is above 100
Sweating, weight gain, and tachycardia
Heart Failure Therapeutic Management
Improve cardiac fx (digoxin)
Remove accumulates fluid and sodium
Decrease cardiac demands (calm)
Improve tissue oxygenation (give O2, goal O2)
Respiratory Distress in Children S/S
Nasal flaring, retractions, and grunting are tell tale signs.
RR not 30-60, hypoxemia.
Can come from thick secretions or constricted airways
Respiratory emergency
Resp. failure, apnea, resp. arrest.
Resp. failure is the most common cause of cardiopulmonary arrest in children
Respiratory Emergency Management
Maintain ventilation and maximize O2 delivery.
Correct hypoxemia and hypercapnia.
Treat underlying cause.
Minimize extrapulmonary organ failure.
Control O2 demands.
Anticipate complications.
Group B Streptococci
Can cause bacterial meningitis, acute glomerulonephritis, endocarditis, and most importantly rheumatic fever.
Must be eradicated quickly to prevent permanent damage.
Wilms Tumor Patho
Malignant intraabdominal tumor on the kidney (nephroblastoma)
Most commonly diagnosed at 3 years old in black boys
Wilms Tumor Management
Surgical removal, great care to keep the encapsulated tumor intact.
Chemo and radiation are used.
Wilms Tumor Interventions
Monitor BP, fluids, drug side effects, signs for infection, and manage pain.
**Do not palpate abdomen before surgery unless absolutely necessary, can cause the cancer to disseminate.
Nephrosis
Nephrotic syndrome
Disease state as a result from damage to the kidney, commonly effects children between 2-7 years.
Nephrosis S/S
Massive proteinuria, hypoalbuminemia (lost in urine), hyperlipidemia, pitting edema (due to loss of albumin)
Nephrosis Management
Corticosteroids and diuretics (Lasik) are 1st line therapy.
Low salt (sodium) diet is prescribed, and in severe cases there will be fluid restriction.
Keep strict I&O’s
Assess for infection, reduce protein excretion, and reduce fluid retention
Tracheoesophageal Fistula (TEF)
Failure of the trachea to separate into a distinct structure
Cause unknown
Tracheoesophageal Fistula (TEF) Diagnosis
Radiographic studies
Tracheoesophageal Fistula (TEF) S/S
Excessive salivation, increase resp. distress, and drooling while feeding.
3 C’s (Chocking, coughing, cyanosis), apnea, increased resp. distress during and after feeds, abdominal distension
Tracheoesophageal Fistula (TEF) Management
Maintain patent airway, NPO, IV fluids, upright position to prevent pneumonia, gastric/blind pouch decompression, surgical repair
Esophageal Atresia
Failure of esophagus to develop as a continuous passage
Esophageal Atresia S/S
Excessive salivation, increase resp. distress, and drooling while feeding.
3 C’s (Chocking, coughing, cyanosis), apnea, increased resp. distress during and after feeds, abdominal distension
Esophageal Atresia Management
Maintain patent airway, NPO, IV fluids, upright position to prevent pneumonia, gastric/blind pouch decompression, surgical repair
Esophageal Atresia Diagnosis
Radiographic studies
Gastroschisis
Bowel herniates through abdominal wall, usually to the right of the umbilical cord, NO membraned is covering exposed bowel.
Gastroschisis Management
Immediately cover with warm moist sterile gauze and wrap with plastic to keep moisture in and preserve heat.
NPO- assess for signs of ileus
Maintain body temp, repair w/ surgery
Can lead to short bowel syndrome which causes poor food absorption
Chronic Glomerulonephritis
Primary event of manifestation of another disorder
After acute streptococcal infection
After infection with certain strains of hemolytic streptococcus
Latent period of 10-21 days
Glomerulonephritis S/S
Oliguria (low urine), edema, HTN,
hematuria (bleeding in upper urinary tract causes urine to appear smoky “coke-a-cola”),
proteinuria (increased amount of protein reflects increased severity of renal disease)
Glomerulonephritis Management
Manage edema
Daily weight measurements
Accurate I%O’s
Daily abdominal girth measurements
Nutrition
Low sodium fluid restriction
Plan activities to allow for rest periods
Susceptibility to infections
Weekly, then monthly follow-up visits for evaluation and urinalysis
Acute appendicitis
Inflammation of the vermiform appendix
Acute appendicitis causes and patho
Obstruction of the lumen of the appendix, usually by hardened fecal material.
Swollen lymphoid tissue can also obstruct the appendix.
Obstruction causes compression of blood vessels, resulting in ischemia. Necrosis causes perforation.
Acute appendicitis diagnosis
Abdominal ultrasounds and CT scans, evaluation for several hours
Acute appendicitis early S/S
Periumbilical cramps, abdominal tenderness, anorexia, nausea, and fever.
Acute appendicitis late S/S
Guarding, rigidity, N/V, rebound tenderness in RLQ.
McBurney’s point (halfway between the anterior superior iliac crest and the umbilicus)- often spot of most intense pain.
Acute appendicitis Management
Immediate surgical removal.
Treat ruptured appendix.
Postop give liquid diet and move gradually to solids, use stool softeners and pain management.
Kawasaki Disease
Acute inflammatory disease of the cardiovascular system.
75% of cases: in children < 5
Self-limiting
Increased risk of formation of coronary artery aneurysm
Kawasaki Disease S/S
Red bloodshot eyes
Red swollen hands and feet
Rash involving much of the body and high fever
Red cracked lips
Red tongue (strawberry tongue)
Kawasaki Disease Management
Watch platelet count, may increase.
Aspirin commonly used for treatment.
Small frequent meals, cool baths, gentle oral care, IV-IG for immunity.
