Week 2 Flashcards
Study Guide
S & Symptoms of Respiratory Distress Syndrome
-Expiratory Grunting
-Hypothermia
-Hypotonic Muscle Tone
-Central Cyanosis
-Lethargic
-Hypoglycemia
-Tachypnea
S & S of Neonatal Sepsis
-Expiratory Grunting
-Hypothermia
-Hypotonic Muscle Tone
-Lethargy
Tachypnea
S & S of Neonatal Abstinence Syndrome
-Hypoglycemia, although strong sucking, will not feed
-Tachypnea
-Tremors
What is a preemie at risk for if respiratory distress syndrome id left untreated?
-Increased Atelectasis due to lack of surfactant
The treatment plan for a respiratory exacerbation and failure to thrive for Cystic Fibrosis
*airway clearance therapy (chest physiotherapy and postural drainage)
*Nebulized bronchodilators and mucolytics
*High-Calorie diet with pancreatic enzymes (before the meal)
*IV antibiotic therapy
*Regular Pulmonary function tests
*Psychosocial support for the family
Should you give high levels of oxygen to a client with cystic fibrosis?
No, due their chronic respiratory condition, their body relies on CO2 levels not o2 levels, like someone with COPD
Place clearance techniques in order for optimal mucous clearance:
1. Administer Bronchodilator (Albuterol) via nebulizer
2. Perform chest physiotherapy and postural drainage
3. Encourage coughing and suction if needed
4. Administer mucolytic agent (Dornase Alfa)
1) Administer Bronchodilator (Albuterol) via nebulizer
2) Administer mucolytic agent (Dornase Alfa)
3) Encourage coughing and suction if needed
4) Perform chest physiotherapy and postural drainage
What is cluster care?
A nursing technique that involves performing multiple tasks for a patient at the same time, instead of doing them individually-use in order to provide rest/ recovery
Biological Growth and Physical Development-external proportions
Infant-growth from trunk
head is the largest part, proportions will alternate with growth
Growth and Development-Skeletal and maturation, most accurate measurement?
*epiphyseal plate, site of longitudinal growth of the long bones
Metabolism-Physiological Changes
With each degree of fever increase, basal metabolism increases 10%, corresponding increase in fluid requirement
Spends more time in sleep…
infants
The most important influence on growth
Nutrition
Universal medium of play
*children learn what no one else can teach them
What are genes?
Segments of DNA that contain genetic information to control certain physiological functions/ characteristics
Congenital anomalies/ birth defects
2-4%, classified as deformity, disruption, dysplasia, or malformation
Congenital anomalies (structure) or birth defects are seen…
immediately after birth
Genetic Disorders can be caused by…
chromosomal abnormalities
Examples of genetic disorders…
*sickle cell anemia
*down syndrome
*Turner syndrome
*Muscular dystrophy
Genetic disorders are not…
always seen after birth, but growing/ environmental factors
Role of the Nurse in genetics
Perform and full assessment (no history), I.D. then refer through testing, educate parents on discovery and treatment
Health problems-Newborns, how does head trauma occur
Falls, birth, shaking…ICP can cause brain bleeding
…paralysis (Cranial Nerve 7)-most common
Newborn Head trauma causes intraventricular bleeding which increases ICP effecting…
Neural development
-watch for S &S of hemorrhage and neural system decline
The most common newborn fracture is clavicle caused by….
birth positioning, LGA…immobilize the arm with good alignment w/ the body, tell parents to be gentle
Structural Defects-Cleft lip
-formed during embryonic
-development from incomplete fusion of the oral cavity
-Surgery should be performed first 2-3 months of life
Structural defect-Cleft Palate
Forms during embryonic development, incomplete fusion of the palate
-surgical repair at 6-12 months
Newborns/ infants with a cleft palate are at risk for.
Aspiration, infection, conduction hearing loss and malnutrition
Pre-Op consideration for CL: Educate about proper feeding and care, assess the ability to feed
*encourage breast feeding
*wide based nipples- unidirectional (firm to palate, supine)
*squeeze cheeks to decrease gap
*more burping
*upright position, cradle head
*syringe feedings
*consider aspiration
Educate about proper feeding and care, assess the ability to feed, CP-Pre-Op
-Upright position and cradle head with feeds
-Special bottle one way valve and special nipple, vacuum seal
-Frequent burps
-Syringe feeds
Post-op CL and CP repair
*pain management
*elbow restraints (release hourly)
*no pacifiers (hard)
*Cl repair: supine/ side-lying
*CP repair: prone (drainage), NPO then slow progression>soft diet)
Post-op CP & CL Education/ complications
*diet/ feeding techniques
*complications:
-ear infections (mid ear(
-difficulty eating
-altered structure/ recurrent infections
-speech/ language impairment (CP)
-dental-abnormal eruptions
Before Feeding: CP/ CL
check gag reflex, GI sounds (increase w/ tolerance), swallow reflex
High-risk Newborn (preemie-1st 28-days)…why?
Hyperbilirubinemia
Respiratory Destress
neonatal seizure
newborn sepsis
NEC
Drug-exposure
Phenylketonuria
Hyperbilirubinemia-characterized by:
*jaundice, yellow skin/ sclera/ nails
Hyperbilirubinemia-Causes
*ask if previous hx. w/ other children
-Physiological Jaundice-inability to excrete bili initially
-breastfeeding-hormone increase bili, not enough milk (dehydration), C-section
-Hemolysis (ABO incompatible/ hemolytic disease)
-inadequate liver function
-cephalic hematoma
-umbilical cord (broken RBC)
Hyperbilirubinemia- Diagnosis
Blood test, heel-stick
bilirubin encephalopathy
-deposits of unconjugated bilirubin into brain cells
Kernicterus
yellow staining of brain cell from bilirubin ecepalopathy
Bilirubinemia-Treatment
-prevent increase in bili, minimize treatment S/E
-phototherapy
-exchange transfusion
-hydration/ breast milk-remove for only 15 min. pump after for bottle
Phototherapy-insoluble bili to soluble
*IV fluids-fluid loss-sweat
*moves to stool (yellow)-effective
-recheck labs for decrease
Exchange transfusion-aggressive
*through central line-umbilical cord, * (3) nurse documents VS-every 5 minutes @ bedside
*after-phototherapy
Respiratory Distress Syndrome, high risk-preemies
*developmental delay in lung maturation, not enough surfactant, alveoli collapse expiration (atelectasis), unequal alveoli inflation (inhalation)
*unable to inflate lungs
RDS- clinical manifestation
-tachypnea
-dyspnea
-intercostal/ substernal retractions
-fine inspiratory crackles
-nasal flaring
-pallor
-cyanosis
-grunting
RDS-management (preemie anticipation-dexamethasone)
*Intubation
*Provide liquid surfactant (inhalation)
*half-dose one side, middle, other side rest of dose (push ambu after dosing)
-prevent hypotension, acid-base balance
RDS- dessating before surfactant
1) suction first-cannot 1-2 hours after med admin
2) give oxygen
3)then fluids (electrolyte imbalances)
-order ABGs/ BMP
-keep warm
Neonatal Sepsis- causes
-bacterial infection in blood stream
-across placenta (bloodstream, birth)
-ingestion/ aspiration infected amniotic
PKU expected findings
-FTT
-vomiting
-irritable
-musty urine odor
-microcephaly
-heart defects
Neonatal Sepsis-early (< 3 days after birth), late (1-3 weeks), diagnosis (clinical S/S), manifestations?
-hypothermia
-drainage
-weak suck/ decreased intake
-V/ Diarrhea
-poor weight gain
-large residual (gavage)
-abd. distension
-respiratory distress
-hypoactive/ tonic
-pale
Prevent Neonatal Sepsis
Screen mom-GBS
good hygiene
isolation
breastfeeding
Manage/ Care Neonatal Sepsis
-supportive (O2), fluids, transfusion, electrolyte acid-base balance
-Pan-Culture (blood, stool, urine), 3 days, 1 week
-give broad spectrum, them specified antibiotic
-Perform BMP/ ABG
Neonatal Sepsis- closely assess/ monitor…complications
-meningitis and septic shock
NEC-life-threatening, preemies high-risk
*poor blood supply causes infection
Why NEC?
Intestinal ischemia and inflammation
Bacterial/viral infection
Enteral feeding
Immature GI mucosa
Medical NEC**
What to do…NEC?
Serial X-ray and abd girths (4-6 hr)
Monitor for blood emesis and stools
Watch labs, cultures for changes and growth
NPO for bowel rest (5-7 days)
begin antibiotics, NGT suctioning (low-intermittent)
CVC and TPN/ IL nutrtion
Drug Exposed Infant (Alteration in breathing to death), how to test?
Newborn urine, hair, or meconium sampling
Before feeding and at least 2 hours after birth, then every time before feeding NAS score b/c putting on medication can be discharged after 24-hours of low NAS score and mother is provided stability
PKU-test
heel-stick to assess at least 24-hours after birth b/c they have to eat first retest in 7-10 days to ensure no false negatives
PKU?
inborn error of metabolism inherited as an autosomal recessive trait (the PAH gene is located on chromosome 12q24), is caused by a deficiency or absence of the enzyme needed to metabolize the essential amino acid phenylalanine
PKU confirmation
Places infant at risk for convulsion, diagnose 24 hours after fed, if the test is confirmed for a second time provide a low protein formula
SIDS
Third leading cause of infant mortality under 1 year of age
Education aboutBack to SleepCampaign
Pacifier use linked to decreasedincidences
Poisoning-Emergency Treatment
First Priority: Stabilize the patient, then determine what was consumed.
Treatment:
Remove from exposure.
Chelation therapy (lead poisoning antidote) may be needed.
Screening:
Screen for lead poisoning at 1 year old.
Health Effects:
Brain/nervous system damage.
Learning/behavioral issues.
Slowed growth, hearing/speech problems, lower IQ.
Decreased attention span and school performance.
Gasoline Poisoning: Be aware of risks; follow similar treatment guidelines.
Always call poison control first for advice.
Testicular Torsion
Testicular Torsion, testes rotate on spermatic cord, cutting off blood supply, must fix within 6 hours to save, can be caused by trauma or birth defect
Sexually transmitted infections
*best is prevention, educate!!!
*any case of STI must report to the health department
Airway Diameter
If infection of inflammation they can block to airway
Pulse Oximeter: Respiratory
Always connect to pulse oximeter.
Position patient to facilitate oxygen intake.
Be cautious: the light from the pulse oximeter can burn the baby’s skin.
Check/change the pulse oximeter every few hours, especially in infants or preemies.
Readings may not be accurate if not positioned properly.
Inhaler Use
With metered-dose inhalers or dry powder inhalers, ask children to rinse their mouth after use.
This helps avoid thrush or candida infections from steroid medication.
Do NOT perform CPT on patients with
Blood clots
Pulmonary embolism
Broken ribs
Spinal injuries
High intracranial pressure (ICP
Early signs of hypoxia
Tachycardia (increased heart rate)
Tachypnea (increased breathing rate)
Restlessness
Pale skin
late signs: hypoxia
Bradycardia (decreased heart rate)
Bradypnea (decreased breathing rate)
Lethargy
Confusion
Cyanosis (bluish skin color)
100% O2
Oxygen saturation of 100% is not ideal; it can lead to oxygen toxicity, which can affect hearing.
Suctioning
Hold suction for less than 5 seconds for infants.
Hold suction for 10 seconds for toddlers and older children.
Oxygen levels will drop during suctioning but should return to normal once suctioning stops.
VAP
Ventilator associated pneumonia
Artificial airways complication
Artificial Airways
Suctioning
Oral care (VAP!)
Complications
Decannulation, occlusion
Otitis Externa
swimmers ear
not drying, main cause inflammation
-S & S-itching, drainage
Treat w/ steroid ear drops, Tylenol for pain/ itching, irrigate ears
otitis media
Child often tugs on affected ear, fussiness, fever
Short eustachian tubes
Recurrent if smokers in family
Recurrent can lead to tonsillitis
Tonsillitis
Enlarged tonsils can interfere with breathing, nasal and sinus drainage, sleeping, swallowing, and speaking.
Enlarged tonsils also can disrupt the function of the eustachian tube, which can impede hearing.
Risk for recurrent otitis media!
Acute tonsillitis
Tonsils become inflamed and reddened
Small patches of yellowish pus also may become visible.
Acute tonsillitis may become chronic
More serious in pediatric airway due to smaller airway
Tonsillitis
Positive culture for Group A beta hemolytic strep (GABHS)
tonsilitis
Epiglottitis
Not as threatening since Hib vaccine
Look for inspiratory stridor, drooling
Laryngotracheobronchitis
Barking cough
croup syndromes
life-threatening condition; partial or full occlusion, horse/ froggy/ stridor, chest retractions, dyspneic, must have intubation ready at bedside
fever
lateral neck X-ray to confirm diagnose, never culture the throat-will make it worse
croup syndrome
