Week 4 Content Flashcards by Sasha K.

Basic Problems (heart)

Obstruction of Blood Flow- eventually causes _______________

Increased Pulmonary Blood Flow early causes P ________
Later can cause ↑ P Artery _____

Obstruction of Blood Flow- eventually causes heart failure

Increased Pulmonary Blood Flow early causes P edema
Later can cause ↑ P Artery HTN

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Fetal Oxygen saturation is _____%

50-55

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BLUE Baby vs PINK Baby

Depends on __________ and if Foremen Ovale and/or Ductus Arteriosus stays _____.

Blood moves from ___________________________________

Blood moves towards least resistance

Normal Heart- ______ side is higher pressure

If there are holes, blood moves Left to right

Depends on shunting and if Foremen Ovale and/or Ductus Arteriosus stays open.

Blood moves from higher pressure to lower pressure

Blood moves towards least resistance

Normal Heart- Left side is higher pressure

If there are holes, blood moves Left to right

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Congestive Heart Failure

Heart is unable to ______________________________ to meet metabolic demands of the body

Heart is unable to pump sufficient cardiac output to meet metabolic demands of the body

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Associated Clinical Signs & Symptoms of CHF

Diaphoresis
Poor _________
Irritability
Failure to ______

Pulmonary congestion
* __________
* Retractions, nasal _______
* Cough

Diaphoresis
Poor feeding
Irritability
Failure to thrive

Pulmonary congestion
* Tachypnea
* Retractions, nasal flaring
* Cough

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Causes of CHF

__________ heart disease
Non-structural myocardial factors
– Viral myocarditis
– Birth trauma
___________ - Too fast or too slow

Congenital heart disease
Non-structural myocardial factors
– Viral myocarditis
– Birth trauma
Dysrhythmias - Too fast or too slow

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Clinical Manifestations of CHF

Pulmonary congestion
* ____________
* Retractions, nasal flaring
* Cough

Tachypnea

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Management of the Child with CHF

Promote myocardial efficiency
_________ , afterload reducers
Minimize volume overload
__________
Decrease cardiac workload
Minimize energy expenditures
Provide adequate ________

Promote myocardial efficiency
Digoxin, afterload reducers
Minimize volume overload
Diuretics
Decrease cardiac workload
Minimize energy expenditures
Provide adequate nutrition

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CHF Provide Adequate Nutrition

Small, ________ feedings
Position during feeding
Breast vs. bottle
High ________ feeding
Gavage feeding
__________ tube

Small, frequent feedings
Position during feeding
Breast vs. bottle
High caloric feeding
Gavage feeding
Gastrostomy tube

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Cyanosis

Blue color of skin and mucous membranes due to increased concentration of
reduced ____________ (low O2 saturation)

hemoglobin

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Clinical Manifestations of Cyanosis

Blue color at _____ , __________ , mucous membranes
Tachypnea
Cyanosis increases with _______
Long-term: polycythemia, __________

Blue color at lips, nailbeds, mucous membranes
Tachypnea
Cyanosis increases with crying
Long-term: polycythemia, clubbing

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Management of Cyanosis
* Child will usually limit self
* ____ usually not effective
* Interventional cardiac _____________
* Surgery

Child will usually limit self
O2 usually not effective
Interventional cardiac catheterization
Surgery

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Work-up for Congenital Heart Disease
* Careful H&P
* Chest _____
* _____
* Echocardiogram
* Cardiac _____________ (+/-)
* Diagnostic
* Interventional

Careful H&P
Chest X-ray
ECG
Echocardiogram
Cardiac catheterization (+/-)
Diagnostic
Interventional

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Pre-catheterization procedure
* Vital signs, pulse __________
* Mark ______ pulses
* Laboratory analysis
* ____________
* CBC
* electrolytes

Vital signs, pulse oximetry
Mark pedal pulses
Laboratory analysis
Coagulopathies
CBC
electrolytes

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Post catheterization problems
* Cardiopulmonary instability
* _________
* Vessel dissection
* _______ at site

Cardiopulmonary instability
Thrombosis
Vessel dissection
Bleeding at site

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Post-cath nursing
* Assess _________ from anesthesia, VS, pulse ox
* Assess cath _______
– pressure dressing __ hours post catheterization
* Assess perfusion distal to cath site
* Keep affected leg “________”
* Discharge:
* Small bandage at site
* no tub bathing for 3 days

Assess recovery from anesthesia, VS, pulse ox
Assess cath site
– pressure dressing 4 hours post catheterization
Assess perfusion distal to cath site
Keep affected leg “straight”
Discharge:
Small bandage at site
no tub bathing for 3 days

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Patent Ductus Arterious

Common in preterm
__ > ____ shunting
CHF

Treatment:
Indomethacin
Interventional cath _____ occlusion
Surgical repair for preterm infants

Common in preterm
L→R shunting
CHF

Treatment:
Indomethacin
Interventional cath coil occlusion
Surgical repair for preterm infants

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Ventricular Septal Defect

Most ________ CHD
High pressure L→R shunt
pulmonary __________
Significant CHF
Repair in first year
CP ________
Interventional cath [not FDA approved]

Most common CHD
High pressure L→R shunt
pulmonary hypertension
Significant CHF
Repair in first year
CP bypass
Interventional cath not FDA approved

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Coarctation of the Aorta

Classic finding _____ BP is higher than _____ BP by 10+ mmHg

Often asymptomatic
Surgical repair does not require CP bypass
Recoarctation – balloon angioplasty

Classic finding arm BP>leg BP by 10+ mmHg

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The cuff bladder width should be approximately ___ % of the circumference of the arm measured at a point midway between the olecranon and acromion.

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Tetralogy of Fallot

Most ________ cyanotic heart defect
Mild cyanosis at birth progresses
“tet” (hypercyanotic) spell
Repair as ________

Most common cyanotic heart defect
Mild cyanosis at birth progresses
“tet” (hypercyanotic) spell
Repair as infant

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Infective Endocarditis

Infection of ____________ & intracardiac ______
** Streptococcus viridans most common agent
— Also staph, candida, gm – organisms

Children with ____ at highest risk of infection
* Valvular abnormalities
* Prosthetic valves
* High pressure shunts

Infection of endocardium & intracardiac valves
** Streptococcus viridans most common agent
— Also staph, candida, gm – organisms

Children with CHD at highest risk of infection
* Valvular abnormalities
* Prosthetic valves
* High pressure shunts

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Kawasaki Disease (mucocutaneous lymph node syndrome)

Widespread inflammation of small & medium size _________
> LV dysfunction
Incidence: ~140 per 100,000 children < 5 years
Males > females
Disease process is self-limited
Cardiac sequelae in 25% of children untreated
> Coronary artery __________

Widespread inflammation of small & medium size vessels
> LV dysfunction
Incidence: ~140 per 100,000 children < 5 years
Males > females
Disease process is self-limited
Cardiac sequelae in 25% of children untreated
> Coronary artery aneurysms

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Kawasaki Disease (mucocutaneous lymph node syndrome) - _________ unclear

Infectious agent (?)
Late winter, early spring outbreaks
May be final result of multiple organisms

Etiology

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Kawasaki Disease (mucocutaneous lymph node syndrome)

Child must exhibit ___ of the following (including fever):
* ______ for > 5 days
* Bilateral conjunctival injection without exudate
* ______ mucous membrane erythematous dry, cracked, “strawberry tongue”
* Extremity edema, erythema & desquamation
* Rash varied, not raised
* Cervical lymphadenopathy

Child must exhibit 5 of the following (including fever):
* Fever for > 5 days
* Bilateral conjunctival injection without exudate
* Oral mucous membrane erythematous dry, cracked, “strawberry tongue”
* Extremity edema, erythema & desquamation
* Rash varied, not raised
* Cervical lymphadenopathy

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Kawasaki Disease (mucocutaneous lymph node syndrome)

Laboratory analysis
* ↑ _____
* ↑ ___________rate
* ↑ LFT’s
* Thrombocytosis
* Baseline & serial echocardiograms

↑ WBC
↑ sedimentation rate
↑ LFT’s
Thrombocytosis
Baseline & serial echocardiograms

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Kawasaki Disease (mucocutaneous lymph node syndrome) Management

High-dose intravenous immune _____________ (2g/kg IV over 10-12 hours) ASAP
_______ - initially high (antiinflammatory) then low (antiplatelet) dosing for 6-8 weeks
Warfarin if giant aneurysms (> 8 mm)

High-dose intravenous immune globulin (IVIG) (2g/kg IV over 10-12 hours) ASAP
ASA (Aspirin) - initially high (antiinflammatory) then low (antiplatelet) dosing for 6-8 weeks
Warfarin if giant aneurysms (> 8 mm)

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Normal urine output is age-dependent: In general a hospitalized infant and child is expected to have at least ____ ml/kg /hour urine output

1-2

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Blood enters the healthy __________ where it is filtered of wasted : the glomerulus is attached to the opening of a small fluid-collecting tube called a tubule. Once in the tubule the waste is called urine.

glomerulus

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Nephrotic Syndrome

Primary (____%) unclear on why it occurs
Cases can get better only to exacerbate later.
Most children that present have South ______ decent but African American children will have poorer outcomes-the disparities seem to be genetic and how well they respond to Steroid treatment. Need more studies
Secondary (caused by ___________)
Results from systemic illness, lupus, diabetes, sickle cell

Primary (80%) unclear on why it occurs
Cases can get better only to exacerbate later.
Most children that present have South Asian decent but African American children will have poorer outcomes-the disparities seem to be genetic and how well they respond to Steroid treatment. Need more studies
Secondary (caused by something else)
Results from systemic illness, lupus, diabetes, sickle cell

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Nephrotic Syndrome:
↑Permeability of Basement ____________

Becomes Permeable to ______________ that are normally too big to be filtered out

↑Permeability of Basement Membrane

Becomes Permeable to plasma proteins that are normally too big to be filtered out

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Nephrotic Syndrome

__________ : MASSIVE amounts of protein in urine – dark yellow frothy urine
Most common protein lost is ________ but IMMUNOGLOBULINS also lost in urine
which are important to prevent infections
– Severe generalized ________ (called Anasara ) Due to loss of serum protein

Due to loss of colloidal pressure: fluids exits the blood vessels and enters the tissues to attempt to equalize the water to protein concentration .

Proteinuria : MASSIVE amounts of protein in urine – dark yellow frothy urine
Most common protein lost is ALBUMIN but IMMUNOGLOBULINS also lost in urine
which are important to prevent infections
– Severe generalized edema (called Anasara ) Due to loss of serum protein

Due to loss of colloidal pressure: fluids exits the blood vessels and enters the tissues to attempt to equalize the water to protein concentration .

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Nephrotic Syndrome Lab:

↓ Serum Total _________
↓ Serum _________-
caused increase in serum cholesterol and triglycerides
↑ Massive _________
Usually normal BUN Creatinine
KIDNEY BIOPSY and analysis is definitive diagnosis

↓ Serum Total Protein
↓ Serum Albumin-
caused increase in serum cholesterol and triglycerides
↑ Massive Proteinuria
Usually normal BUN Creatinine
KIDNEY BIOPSY and analysis is definitive diagnosis

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Nephrotic syndrome Nursing Assessment

Severe generalize __________
Lethargy
Anorexia
______ yellow urine
Difficult IV access

Severe generalize edema
Lethargy
Anorexia
Frothy yellow urine
Difficult IV access

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Nephrotic syndrome Nursing Care

IV ________
_________ if not responsive to steroids (non oncologic chemo)
IV Albumin (increases serum albumin, fluid then is pulled into blood vessels from tissues)
Diuretics are usually given to follow the albumin
Diuretics alone do not work well due to low protein concentration in the nephron tubules.
Protect from infections
Provide skin care- edematous skin big risk for breakdown

IV Steroids
Cytoxin if not responsive to steroids (non oncologic chemo)
IV Albumin (increases serum albumin, fluid then is pulled into blood vessels from tissues)
Diuretics are usually given to follow the albumin
Diuretics alone do not work well due to low protein concentration in the nephron tubules.
Protect from infections
Provide skin care- edematous skin big risk for breakdown

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Nephrotic syndrome Nutrition

_________ Protein ( high protein can damage nephrons)
Low ______
avoid:
processed cheeses.
high-sodium meats (bologna, ham, bacon, sausage, hot dogs)
frozen dinners and entrées.
canned meats.
pickled vegetables.
salted potato chips, popcorn, and nuts.
salted bread.
canned soups /cup of soups

Normal Protein ( high protein can damage nephrons)
Low Salt
avoid:
processed cheeses.
high-sodium meats (bologna, ham, bacon, sausage, hot dogs)
frozen dinners and entrées.
canned meats.
pickled vegetables.
salted potato chips, popcorn, and nuts.
salted bread.
canned soups /cup of soups

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Acute Glomerulonephritis [post strep] –

__________ complex response
Acute inflammation of the kidney at the __________, caused by an immune antigen/ antibody response.
Antibody complexes clog up glomerulus and decrease filtration.
Leaks Red blood cells and a little protein

immune complex response
Acute inflammation of the kidney at the glomerulus, caused by an immune antigen/ antibody response.
Antibody complexes clog up glomerulus and decrease filtration.
Leaks Red blood cells and a little protein

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Acute Glomerulonephritis [post strep]

Congested Inflamed Glomeruli results in ________ __________ of fluid
Results in fluid retention and Hypertension
Increase retention of ______ in blood so ↑ serum BUN and Creatinine
Low urine output can lead to ↑ serum Potassium

Congested Inflamed Glomeruli results in decrease filtration of fluid
Results in fluid retention and Hypertension
Increase retention of waste in blood so ↑ serum BUN and Creatinine
Low urine output can lead to ↑ serum Potassium

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Acute Glomerulonephritis [post strep] Nursing Assessment

Eye and facial ______
Peripheral edema
__________
Irritability
Urine is dark cola/tea colored
Light to moderate proteinuria
Oliguria (decreased urine output) UOP

edema
Hypertension

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Acute Glomerulonephritis Lab

↑Antistreptolysin O (ASO) titer due to _____________ (diagnostic)
↑ BUN and creatinine
↑ Potassium with decreased urine output

immune response

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Acute Glomerulonephritis

Diet Same as Nephrotic Syndrome
* In addition if low urine output restrict ________

Diet Same as Nephrotic Syndrome
* In addition if low urine output restrict POTASSIUM

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Acute Glomerulonephritis
* _______
* Occurs post _________ infection
* _____ loss of protein

Acute
Occurs post strep throat infection
Mild loss of protein

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Nephrotic Syndrome
* More ________
Can have remissions and exacerbations over years
* Most cause is ________
* ________ loss of protein

More chronic
Can have remissions and exacerbations over years
Most cause is idiopathic
Massive loss of protein

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Nephrotic Syndrome
* ________- severe generalized
* Blood Pressure- Normal
* Urine- dark frothy yellow (tons of protein)
* ASO titer negative

Edema- severe generalized
Blood Pressure- Normal
Urine- dark frothy yellow (tons of protein)
ASO titer negative

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Acute Glomerulonephritis
* Edema- milder face around the eyes/possibly extremities
* Blood Pressure _________
* Urine has hematuria (dark cola/tea colored)
* ASO titer ________

Edema- milder face around the eyes/possibly extremities
Blood Pressure Elevated
Urine has hematuria (dark cola/tea colored)
ASO titer positive

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DM1

Type 1 DM is believed to be an ___________ disease, arising when a person with a genetic predisposition is exposed to aprecipitating event such as a viral infection.

________ is a prominent factor in the etiology Onset typically in childhood and adolescence but can occur at any age

Most childhood cases <__ yrs. of diabetes mellitus are type 1

Type 1 DM is believed to be an autoimmune disease, arising when a person with a genetic predisposition is exposed to aprecipitating event such as a viral infection.

Heredity is a prominent factor in the etiology Onset typically in childhood and adolescence but can occur at any age

Most childhood cases <10 yrs. of diabetes mellitus are type 1

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Ketoacidosis

When glucose is unavailable for cellular metabolism, the body breaks down ________ and ketones are released.

Excess ketones are eliminated in ______ (ketonuria) or by the _______ (acetone breath)

___________ in the blood are strong acids that decrease serum pH and produce ketoacidosis

When glucose is unavailable for cellular metabolism, the body breaks down proteins and ketones are released.

Excess ketones are eliminated in urine (ketonuria) or by the lungs (acetone breath)

Ketones in the blood are strong acids that decrease serum pH and produce ketoacidosis

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S & S of DKA

______ deep breathing (Kussmauls Respirations)
body’s attempt to breathe off _____ in an attempt to increase pH

_________ Urine Output

_______-smelling breath.

Fast deep breathing (Kussmauls Respirations)
body’s attempt to breathe off C02 in an attempt to increase pH

Increased Urine Output

Fruity-smelling breath.

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Nonspecific Signs and Symptoms DKA

_____ skin and mouth.
Flushed face.
________
Nausea and Vomiting

Dry skin and mouth.
Flushed face.
Headaches
Nausea and Vomiting

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Diabetic Ketoacidosis (DKA)

Pediatric ____________

Results from progressive deterioration with dehydration, electrolyte imbalance, acidosis, coma; may cause death

Therapy: Should be instituted in an ____________________ setting

Pediatric emergency

Results from progressive deterioration with dehydration, electrolyte imbalance, acidosis, coma; may cause death

Therapy: Should be instituted in an intensive care unit setting

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DKA Treatment in ICU

IV ________ continuous infusion
Every one hour ________
Balance D5W with NS – depends on serum glucose
Monitor Serum Potassium
Never turn off ________ , if glucose drops <250 add more glucose
________ is the only thing that corrects the acidosis

IV Insulin continuous infusion
Every one hour glucose
Balance D5W with NS – depends on serum glucose
Monitor Serum Potassium
Never turn off Insulin, if glucose drops <250 add more glucose
Insulin is the only thing that corrects the acidosis

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Long-Term Complications of Diabetes Mellitus

___________ complications, especially nephropathy and retinopathy
Macrovascular disease, neuropathy
With poor control, vascular changes as early as 2.5 to 3 years after diagnosis
With excellent control, can be delayed ___ years

Microvascular complications, especially nephropathy and retinopathy
Macrovascular disease, neuropathy
With poor control, vascular changes as early as 2.5 to 3 years after diagnosis
With excellent control, can be delayed 20 years

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Situations that increase need for Insulin

Increased ____________ intake
Illnesses
Decreased ______________

Increased carbohydrate intake
Illnesses
Decreased physical activity

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Situations that decrease need for Insulin and that can cause hypoglycemia

Missed ______
Increased __________

Missed Meal
Increase Exercise

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S& S of hypoglycemia

________..
feeling _________.
dizziness.
feeling ________..
tingling lips.
feeling ________.or trembling.
a fast or pounding ________.(palpitations)
becoming easily ________., tearful, anxious or moody.

sweating.
feeling tired.
dizziness.
feeling hungry.
tingling lips.
feeling shaky or trembling.
a fast or pounding heartbeat (palpitations)
becoming easily irritated, tearful, anxious or moody.

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Treat Hypoglycemia

Able to take PO
__________
Glucose Gel tabs

Can’t tolerate PO
__________

Able to take PO
Orange juice
Glucose Gel tabs

Can’t tolerate PO
IV glucose

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Problems with Compliance [T1D]

Parental non- compliance
-Need to have a home with a ___________
-Need to understand life and death consequences
-Always ___________ non- compliance – may need to refer to Child Protective Services.
Adolescents/Young Adults
-Social Services
-Support Group

Parental non- compliance
-Need to have a home with a refridgerator
-Need to understand life and death consequences
-Always investigate non- compliance – may need to refer to Child Protective Services.
Adolescents/Young Adults
-Social Services
-Support Group

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Monroe Kellie Doctrine:

The Monro-Kellie doctrine or hypothesis states that the sum of volumes of brain, cerebrospinal fluid (CSF) and intracerebral blood is _______.

An increase in one should cause a reciprocal decrease in either one or both of the remaining two.

The Monro-Kellie doctrine or hypothesis states that the sum of volumes of brain, cerebrospinal fluid (CSF) and intracerebral blood is constant.

An increase in one should cause a reciprocal decrease in either one or both of the remaining two.

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Basic Problems (heart)

Decreased Pulmonary Blood Flow- ↓ ____________

_______ of Deoxygenated Blood with Oxygenated Blood

Decreased Pulmonary Blood Flow- ↓oxygenation

Mixing of Deoxygenated Blood with Oxygenated Blood

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If there are holes in heart, blood moves ___________ ?

Left to right

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A baby has VSD & CHF

He is underweight why?

He is underweight because of CHF induced failure to thrive

He is exhuasted, so not eating as much as he should

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VSD is a birth defect with _________________ between the ventricles of the heart

abnormal connection

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____ are the most common heart defect

VSDs

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VSD >
With the holes, the blood pumps from left to right ventricle
This causes mixing of red and blue blood
this may be heard as a

Heart murmur

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Tetralogy of Fallot

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Infective Endocarditis- portals of Entry

**_______ work – S. viridans
Cardiac surgery
Indwelling lines

Dental

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Infective Endocarditis Diagnosis

+ _______________ (definitive diagnosis)
ECG changes (prolonged PR)
Cardiomegaly
Anemia
↑ ESR, WBC
Hematuria
Vegetations seen on echocardiogram

blood culture

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Infective Endocarditis - PREVENTION is key

_________ (PO or IV) 1 hour prior to procedure

IE prophylaxis for complex cardiac defects
Most dental procedures (including teeth cleaning)
Procedures involving respiratory tract, infected skin, skin structures or musculoskeletal tissue

Antibiotic

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Infective Endocarditis Prognosis

____% successful if treated early
High risk patients
Infants
Resistant organisms
Fungal infection
Death from CHF, MI, emboli, cardiac perforation

80% successful if treated early
High risk patients
Infants
Resistant organisms
Fungal infection
Death from CHF, MI, emboli, cardiac perforation

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Nursing Considerations for IVIG

Blood Product pooled from 1000s of donor concentrated immune globulins
Modulates the cytokine toxins that contribute to the manifestations of Kawasaki’s
Activates the recipients T cell functions improves immune response
Must have an informed ________
Must screen for previous _________ to IVIG
Must start administration ________ 0.5 to 1ml/kg over 15-30 minutes
Monitor for reactions similar to blood products but are mostly due to the stabilizing components in manufacturing process.
This is a manufactured product but does have a rare risk of passing on __________

Blood Product pooled from 1000s of donor concentrated immune globulins
Modulates the cytokine toxins that contribute to the manifestations of Kawasaki’s
Activates the recipients T cell functions improves immune response
Must have an informed Consent
Must screen for previous reactions to IVIG
Must start administration slowly 0.5 to 1ml/kg over 15-30 minutes
Monitor for reactions similar to blood products but are mostly due to the stabilizing components in manufacturing process.
This is a manufactured product but does have a rare risk of passing on bacteria

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Left-to-right shunting: Causes pulmonary overcirculation, leading to signs of heart failure like _______ breathing, sweating, and failure to thrive.

rapid

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Right-to-left shunting: Can lead to______________ , hypoxia, fatigue, and poor feeding, as deoxygenated blood is circulated.

cyanosis (bluish skin)

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Infective Endocarditis Nursing

METICULOUS ______ health & care
Teach need for & specifics of SBE _________
High index of suspicion for children with CHD
Teach symptoms of SBE

METICULOUS oral health & care
Teach need for & specifics of SBE prophylaxis
High index of suspicion for children with CHD
Teach symptoms of SBE

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Medications for Congestive Heart Failure (CHF)

Diuretics (e.g., furosemide): To reduce fluid overload.

Digoxin: To improve heart contractility.

ACE inhibitors (e.g., enalapril): To lower blood pressure and reduce strain on the heart.

Beta-blockers (e.g., carvedilol): To decrease the heart’s workload.

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Digoxin: To improve heart _____________.

contractility

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Diuretics (e.g., furosemide): To reduce _____________

fluid overload.

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ACE inhibitors (e.g., enalapril): To lower ______________ and reduce strain on the heart.

blood pressure

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Beta-blockers (e.g., carvedilol): To decrease the heart’s ___________.

workload

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Infants with congenital heart disease (CHD) often have difficulty _______________ due to poor feeding, increased metabolic demands, and heart failure symptoms that impact their ability to thrive.

gaining weight

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Low Cardiac Output Symptoms:

Fatigue, weak _______, ______ extremities, poor capillary refill, _________ urine output, _____________, and altered mental status.

Fatigue, weak pulses, cold extremities, poor capillary refill, decreased urine output, hypotension, and altered mental status.

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What pulmonary symptoms occur with congestive heart failure?

Tachypnea
Retractions, nasal flaring
Cough

More:
Dyspnea
Exercise intolerance
Orthopnea
hoarseness
Cyanosis
Wheezing
Grunting

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Besides pulmonary symptoms what other organ can be affected in congestive heart failure?

_______ : Hepatomegaly (enlarged liver) from blood backing up in the venous system.
__________ : Decreased perfusion leading to reduced urine output (oliguria).

Liver: Hepatomegaly (enlarged liver) from blood backing up in the venous system.
Kidneys: Decreased perfusion leading to reduced urine output (oliguria).

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What causes clubbing and polycythemia in a cardiac patient?

Clubbing: Chronic _______ (______________) causes the tips of the fingers and toes to become rounded and enlarged.

Polycythemia: The body produces more red blood cells to compensate for _____________

Clubbing: Chronic hypoxia (low oxygen levels) causes the tips of the fingers and toes to become rounded and enlarged.

Polycythemia: The body produces more red blood cells to compensate for chronic hypoxia.

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Nursing care of post cardiac cath pt

How do you keep involved extremity?

Keep affected leg straight

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Nursing care of post cardiac cath pt

how long do you need a pressure dressing or bag

intact for at least 4 hours

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Post-Cardiac Cath Assessments:

Monitor for bleeding at the insertion site.

Check pulses

capillary refill time

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VSD (Ventricular Septal Defect) is a hole in the septum between the left and right ventricles, leading to a _______________, which can cause pulmonary overcirculation and heart failure.

left-to-right shunt

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What complications can occur to a patient’s lungs with a L to R shunt-?

Increased pulmonary blood flow can cause
pulmonary __________
congestive _____________
respiratory __________.

Increased pulmonary blood flow can cause
pulmonary hypertension
congestive heart failure
respiratory distress.

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What are ”sternal precautions “ re: teaching the parents of an infant after cardiac surgery?

No lifting the child under their arms for 6 weeks.

Avoid activities that put strain on the chest (e.g., pushing or pulling objects).

Kawasaki Disease:
An _____________ condition affecting blood vessels, primarily in children.

inflammatory

Kawasaki Disease treatment

high dose: IV immunoglobulin (IVIG) and aspirin

What are teachings to parents for care of child post cardiac surgery regarding preventing endocarditis?

maintaining good oral hygiene
avoiding dental procedures without antibiotic prophylaxis
recognizing signs of infection.

Signs and Symptoms (S&S) of hyperglycemia

Thirst
Nausea or vomiting
Abdominal _______
Constipation
Drowsiness
Dim vision
Increased __________
Headache
Flushed, dry skin
_______ breathing
_______ , rapid pulse
_______(fruity) breath odor

Laboratory values
Urine: Positive for sugar and acetone
Blood glucose: >200 mg/dL

Thirst
Nausea or vomiting
Abdominal pain
Constipation
Drowsiness
Dim vision
Increased urination
Headache
Flushed, dry skin
Rapid breathing
Weak, rapid pulse
Acetone (fruity) breath odor

Laboratory values
Urine: Positive for sugar and acetone
Blood glucose: >200 mg/dL

Cause of Diabetes Mellitus (DM) Type 1:

Believed to be autoimmune _________________________ beta cells in the pancreas. Genetics, environmental factors (like viral infections), and immune responses contribute to the onset

destruction of insulin-producing

What usually precipitates the first time hospital admission in a patient with DM Type 1?

Diabetic ketoacidosis (DKA)

What is diabetic ketoacidosis (DKA)?

accumulation of ___________ in the blood that results from hyperglycemia and leads to metabolic acidosis

accumulation of ketones in the blood that results from hyperglycemia and leads to metabolic acidosis

What symptoms occur when there is an increase in ketones in the blood stream?

_______-smelling breath
Nausea and vomiting
________ pain
Rapid, deep breathing (___________ respirations)
Confusion or lethargy

Fruity-smelling breath
Nausea and vomiting
Abdominal pain
Rapid, deep breathing (Kussmaul respirations)
Confusion or lethargy

Blood pH in DKA:

Blood pH becomes ________ (below 7.35), leading to metabolic acidosis. This results from the accumulation of ketones in the bloodstream.

acidic

Most Important Treatment Medication in DKA:
_______ is the most crucial treatment to reduce blood glucose levels and stop ketone production. Fluids and electrolytes (especially potassium) are also critical.

Insulin

Why is a diabetic on insulin at risk for hypoglycemia?

Excess ________ relative to food intake or activity level can cause blood sugar to drop too low. Missed meals, too much insulin, or increased physical activity can trigger hypoglycemia.

insulin

Treatments for Hypoglycemia:

For patients that can eat/drink: Give 15 grams of a fast-acting _______ (like glucose tablets, juice, or candy) and recheck blood sugar in 15 minutes.

For patients that cannot eat/drink: Administer _______ (injectable) or an intravenous (IV) glucose solution in a hospital setting.

For patients that can eat/drink: Give 15 grams of a fast-acting carbohydrate (like glucose tablets, juice, or candy) and recheck blood sugar in 15 minutes.

For patients that cannot eat/drink: Administer glucagon (injectable) or an intravenous (IV) glucose solution in a hospital setting.

What is characteristic of the immune-mediated type 1 diabetes mellitus?

Ketoacidosis is infrequent.

Onset is gradual.

Age at onset is usually younger than 18 years.

Oral agents are often effective for treatment.

Age at onset is usually younger than 18 years.

Which symptom is considered a cardinal sign of diabetes mellitus?

Nausea

Seizures

Impaired vision

Frequent urination

Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present?

Moist skin

Fluid overload

Weight gain

Poor wound healing

Poor wound healing is often an early sign of type 1 diabetes mellitus

The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that:

Exercise will increase blood glucose.

Exercise should be restricted.

Extra snacks are needed before exercise.

Extra insulin is required during exercise

Extra snacks are needed before exercise.

The nurse is performing a Glasgow Coma Scale (GCS) on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record?

The GCS consists of a three-part assessment: eye opening, verbal response, and motor response. Numeric values of 1 through 5 are assigned to the levels of response in each category. The sum of these numeric values provides an objective measure of the patients level of consciousness (LOC). A person with an unaltered LOC would score the highest, 15. The child who opens eyes spontaneously, obeys commands, and is oriented is scored at a 15.

The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed (Select all that apply)?

Headache

Photophobia

Bulging anterior fontanel

Weak cry

Poor muscle tone

C. Bulging anterior fontanel

D. Weak cry

E. Poor muscle tone

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him:

Prone and tube feed.

Prone, turn head to side, and nipple feed.

Supine in infant carrier and nipple feed.

Supine, with defect supported with rolled blankets, and nipple feed

Prone, turn head to side, and nipple feed.

In the prone position, feeding is a problem. The infant’s head is turned to one side for feeding. If the child is able to nipple feed, no indication is present for tube feeding. Before surgery, the infant is kept in the prone position to minimize tension on the sac and risk of trauma.

Which clinical manifestations would suggest hydrocephalus in a neonate?

Bulging fontanel and dilated scalp veins

Closed fontanel and high-pitched cry

Constant low-pitched cry and restlessness

Depressed fontanel and decreased blood pressure

Bulging fontanel and dilated scalp veins

An important nursing intervention when caring for a child who is experiencing a seizure is to:

Describe and record the seizure activity observed

Restrain the child when seizure occurs to prevent bodily harm

Place a tongue blade between the teeth if they become clenched

Suction the child during a seizure to prevent aspiration

Describe and record the seizure activity observed

Which defect results in increased pulmonary blood flow?

Pulmonic stenosis

Atrial septal defect

Tricuspid atresia

Transposition of the great arteries

Atrial septal defect

Atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery

What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?

Pulmonary convection

Congestive heart defect

Congestive heart failure

Systemic venous congestio

Congestive heart failure

The definition of congestive heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body.

Pulmonary congestion is an excessive accumulation of ______ in the lungs

fluid

A beneficial effect of administering digoxin (Lanoxin) is that it:

Decreases edema

Decreases cardiac output

Increases heart size

Increases venous pressure

Decreases edema

Digoxin has a rapid onset and is useful in increasing cardiac output, decreasing venous pressure, and as a result decreasing edema. Heart size is decreased by digoxin

Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse’s reply should be based on knowing that:

The child needs opportunities to play with peers.

The child needs to understand that peer’s activities are too strenuous.

Parents can meet all of the child’s needs.

Constant parental supervision is needed to avoid overexertion.

The child needs opportunities to play with peers.

The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace and regulate their activities. The child will limit activities as necessary. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence

Which structural defects constitute tetralogy of Fallot?

Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy

Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy

Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

Tetralogy of Fallot has these four characteristics

Urinary Tract Infection UTI

One of the most common bacterial infections in childhood
About 8: 100 girls and 2:100 boys will experience before age 5
______ is the most common bacteria associated with UTI
E coli is found in the stool : Migration occurs from perineum via urethra.

One of the most common bacterial infections in childhood
About 8: 100 girls and 2:100 boys will experience before age 5
E coli is the most common bacteria associated with UTI
E coli is found in the stool : Migration occurs from perineum via urethra.

Urinary System Includes: kidneys, ureters, bladder and urethra

kidneys, ureters, bladder and urethra

Infection of:
Kidney is called: “________”
Ureter is called: _________”
Bladder is called: “________“
Urethra is called:”________”

Kidney is called: “Pyelonephritis”
Ureter is called: Ureteritis”
Bladder is called: “Cystitis “
Urethra is called:”Urethritis”

Upper Urinary Tract Infections UTI

Lower:
Occurs when bacteria travel as high as the __________
Upper:
When bacteria travels past the bladder into the ___________

Lower:
Occurs when bacteria travel as high as the urethra or bladder
Upper:
When bacteria travels past the bladder into the ureters or kidneys

Typical Symptoms of Lower UTI in Adults

Dysuria
Increased urinary frequency and urgency
Foul smelling urine
Cloudy urine
Abdominal pain

Typical Symptoms of Upper UTI in Adults

High _____
Back or side pain
Feeling sick
Diarrhea

High fever
Back or side pain
Feeling sick
Diarrhea

Symptoms of UTI -Non verbal infants/toddlers
Generalized for both upper and lower UTIs

Fever
Irritability
Crying
Vomiting
Poor feeding

Fever
Irritability
Crying
Vomiting
Poor feeding

Symptoms of UTI in older child

Waking up at night to use the bathroom
Stinging, burning or _____ while urinating
Stinging when sitting in warm bath water
Bed-wetting even when potty trained
Poor ________

Waking up at night to use the bathroom
Stinging, burning or pain while urinating
Stinging when sitting in warm bath water
Bed-wetting even when potty trained
Poor appetite

Most Common site of UTI in children

The lower urinary tract is the most common site - ____________
Serious problems can result if UTI spreads to kidneys

Urethra and Bladder

What Children are at Risk for UTI?

Not common in children less than ___ years of age
More common in _____ due to short urethra
Unlikely in boys at any age, unless part of the urinary tract is blocked
Uncircumcised boys are more at risk than circumcised boys
Bubble baths may irritate the urethra and allow bacterial growth
Incorrect wiping after bowel movement (teach front to back)
Constipated kids and those that delay going to the bathroom

Not common in children less than 5 years of age
More common in girls due to short urethra
Unlikely in boys at any age, unless part of the urinary tract is blocked
Uncircumcised boys are more at risk than circumcised boys
Bubble baths may irritate the urethra and allow bacterial growth
Incorrect wiping after bowel movement (teach front to back)
Constipated kids and those that delay going to the bathroom

Diagnosis of UTI

Urinalysis
Urine Culture and Sensitivity

Urinalysis
Urine Culture and Sensitivity

UTI Treatment

Antibiotics
Pain/Comfort Management
Getting plenty of ______

Antibiotics
Pain/Comfort Management
Getting plenty of fluids

Prevent UTI

Have child drink plenty of ________ (amount normal for age)
Coach child to ________ bladder fully when urinating
Teach girls to wipe from front to back when going to bathroom
Make sure child doesn’t get constipated

Have child drink plenty of fluids (amount normal for age)
Coach child to empty bladder fully when urinating
Teach girls to wipe from front to back when going to bathroom
Make sure child doesn’t get constipated

Congenital Obstructive Defect

Defect in the functional valve(s) between the ____________
Urine flows backwards into the one or both Ureters and sometimes Kidneys.
Often child is placed on prophylactic antibiotics

bladder and the Ureter

Untreated or Chronic UTIs

Untreated can lead to more serious infections that can travel to the _____________ and cause _______.
Chronic upper UTI can lead to parenchymal damage in the kidneys.
This can result in _________ and/or permanent kidney damage.

Untreated can lead to more serious infections that can travel to the blood stream and cause sepsis.
Chronic upper UTI can lead to parenchymal damage in the kidneys.
This can result in hypertension and/or permanent kidney damage.

Enuresis

________ – nighttime; most common
Diurnal - daytime

Nocturnal

Enuresis - Proposed Pathophysiology

Excessive _______ Urine Production
Bladder _______
Failure to awaken in response to bladder sensations

Excessive Nocturnal Urine Production
Bladder overactivity
Failure to awaken in response to bladder sensations

Excessive Nocturnal Urine Production

Abnormal nocturnal plasma ___________ release
Deficit in the circadian rhythm of vasopressin – nocturnal lack of the
antidiuretic pituitary hormone - vasopressin

vasopressin

Enuresis Medications
* _____________ – DDAVP (ADH) works but only when used. Children will eventually grow out of bedwetting.
* Tricyclic antidepressant- noradrenergic action at brainstem. Same as DDAVP.

Desmopressin

Within the fixed skull, there are 3 things:

Brain tissue
CSF
Blood

Brain tissue- about ___ %
* Cerebral Spinal Fluid (CSF) - about ___ %
* Blood Supply- about ___ %

Brain tissue- about 80%
* Cerebral Spinal Fluid (CSF) - about 10%
* Blood Supply- about 10%

Increased ICP from too much Brain Tissue is Called :

Cerebral Edema

ASSESSMENT: Symptoms of ↑ ICP

Nonverbal Patient
Irritably
Inconsolability
Feeding difficulties
Vomiting
Seizures
Lethargy
Loss of consciousness (LOC)

Verbal Patient
Headache
Confusion
Nausea
Vomiting
Weakness
Seizures
Lethargy
Loss of Consciousness

Nonverbal Patient
Irritably
Inconsolability
Feeding difficulties
Vomiting
Seizures
Lethargy
Loss of consciousness (LOC)

Verbal Patient
Headache
Confusion
Nausea
Vomiting
Weakness
Seizures
Lethargy
Loss of Consciousness

Increased ICP from too much Brain Tissue is Called Cerebral Edema

_______ of the Brain caused by excessive fluid

Many causes of Cerebral edema, including Hyponatremia

Swelling of the Brain caused by excessive fluid

Many causes of Cerebral edema, including Hyponatremia

Treatment for ^ ICP

Brain tissue
________ – Manitol,
Hypertonic Saline

Blood
Actually ________ in surgery
Temporarily ↓ blood flow to brain by hyperventilation ↓ CO2 ↓ vasoconstricts cerebral blood flow

Brain tissue
Diuretics – Manitol,
Hypertonic Saline

Blood
Actually remove in surgery
Temporarily ↓ blood flow to brain by hyperventilation ↓ CO2 ↓ vasoconstricts cerebral blood flow

________ Triad – Severe ↑ ICP
Very late signs of neurological dysfunction

Cushing’s

Cushing’s Triad – Severe ↑ ICP
Very late signs of neurological dysfunction - Vital signs

↑ ___ very high
↓ ___ very low
↓ ___

↑ BP very high
↓ HR very low
↓ RR

DECREASE ICP- Fastest

Decrease Blood Flow to Brain with _____________
Decrease Brain Tissue with Hyperosmolar Diuretics/Hypertonic Saline

hyperventilation

Decrease ICP – Procedure
* Decrease amount of CSF- Place External ________________

Ventricular Drain

Decrease ICP-Surgery
* Remove _______ and or part of skull

blood

Cerebral Palsy
Spina Bifida
Neuromuscular Diseases

These are all:

Chronic

HYDROCEPHALUS - Increased :

Cerebral Spinal Fluid

HYDROCEPHALUS

Impaired absorption of CSF by arachnoid villi
Over production of CSF
Obstruction to flow through Ventricles

Increased _________________

Head circumference

CSF is absorbed through tiny, specialized cell clusters called ____________ near the top and midline of the brain. The CSF then passes through the arachnoid villi into the superior sagittal sinus, a large vein, and is absorbed into the bloodstream.
Once in the bloodstream, it is carried away and filtered by the kidneys and liver in the same way as other bodily fluids.

arachnoid villi

Neural Tube Defects
Spinal Bifida: Failure of the ___________ to close

Spina bifida occulta
Not visible externally; occurs in lumbosacral area
Occurs in 10-30% of the population

Spina bifida cystica
______ defect with an external sac-like appearance
Meningocele – meninges and spinal fluid
Myelomeningocele – meninges, spinal fluid & nerves

Spinal Bifida: Failure of the bony spine to close

Spina bifida occulta
Not visible externally; occurs in lumbosacral area
Occurs in 10-30% of the population

Spina bifida cystica
Visible defect with an external sac-like appearance
Meningocele – meninges and spinal fluid
Myelomeningocele – meninges, spinal fluid & nerves

Occurrence of Neural Tube Defects
* more common in ____
* Caucasian 3x > African American
* 50% caused from nutritional deficiency of _____ acid

more common in boys
Caucasian 3x > African American
50% caused from nutritional deficiency of folic acid

Symptoms of Spina Bifida Occulta

May have no neurologic disturbances
Symptoms may not appear until child walks
Foot weakness, change in gait
___________ disturbances

Bowel/bladder

Spina Bifida Cystica
Myelomeningocele

Diagnosis & Clinical Manifestations:
* Prenatal detection - ↑ AFP (16-18weeks)
* MRI, CT or myelography to determine severity of defect

Defect below L2:
flaccid, areflexic partial ________ of lower extremities
Varying degrees of _________ deficit
Poor bowel/bladder control
Joint deformities

flaccid, areflexic partial paralysis of lower extremities
Varying degrees of sensory deficit
Poor bowel/bladder control
Joint deformities

Nursing Care: Myelomeningocele
* Support family
* Protect neonate from _______; identify early signs of infection
* Support _____ to prevent further damage
* Skin care
* Latex allergies a potential problem

Support family
Protect neonate from infection; identify early signs of infection
Support sac to prevent further damage
Skin care
Latex allergies a potential problem

Treatment: Myelomeningocele

-Closure of spine within 12-18 hours to decrease further neurologic damage and protect from infection
-________ placement for hydrocephalus
-Orthopedic management
-___________ management
-________ control- PRONE TO CONSTIPATION
-Interdisciplinary management CRITICAL

-Closure of spine within 12-18 hours to decrease further neurologic damage and protect from infection
-VP Shunt placement for hydrocephalus
-Orthopedic management
-Genitourinary management
-Bowel control- PRONE TO CONSTIPATION
-Interdisciplinary management CRITICAL

What are the isolation precautions for Bacterial Meningitis?

Droplet

Seizure Disorder
* Brain’s ________ system malfunctions

electrical

_________ - chronic seizure disorder with recurrent and unprovoked seizures

Epilepsy

Etiology of Seizures

Most are _________________
Acquired - brain injury during prenatal or postnatal period: trauma, hypoxia, infections, toxins, electrolyte disturbances, brain tumor etc….

Most are idiopathic (never find cause)
Acquired - brain injury during prenatal or postnatal period: trauma, hypoxia, infections, toxins, electrolyte disturbances, brain tumor etc….

Ages 0-3 Seizures are usually

caused by infection

Partial seizure

________ motor or sensory symptoms - psychic, ___________
May have change in level of consciousness or progress to generalized seizure

localized motor or sensory symptoms - psychic, lip smacking
May have change in level of consciousness or progress to generalized seizure

Generalized seizure

__________: LOC (loss of consciousness),
apneic, “grand mal”

tonic-clonic: LOC (loss of consciousness),
apneic, “grand mal”

Acute Seizures may be caused by

Infection
Hyponatremia
Brain Tumors
Head Injury

Chronic Seizures may occur with ___________

Cerebral Palsy

Nursing Care of Child w/seizures

Protect head & airway
Place on _____ to facilitate drainage of oral secretions ,
Maintain patent airway might need to reposition head
Reassure child and parent after
VS after seizure
Record _______ of seizure and other observations

Protect head & airway
Place on side to facilitate drainage of oral secretions ,
Maintain patent airway might need to reposition head
Reassure child and parent after
VS after seizure
Record length of seizure and other observations

Don’t put anything in ______ of a seizing patient

mouth

First Line “Rescue” Seizure Medications

Benzodiazepams – Ativan, or Versed, or _______
Family and Paramedics use ______________
Chronic kids Family have rectal valium and give for seizures lasting for > 5min
Paramedics carry Rectal valium and give for all seizures they encounter.

Benzodiazepams – Ativan, or Versed, or Valium
Family and Paramedics use RECTAL Valium
Chronic kids Family have rectal valium and give for seizures lasting for > 5min
Paramedics carry Rectal valium and give for all seizures they encounter.

Status Epilepticus – defined as seizure lasting :

> 5 min

Meningitis

Acute inflammation of meninges
Bacterial: S. pneumoniae, strep and gram negative bacilli & Neisseria meningitidis
(H. influenza-HiB vaccine) very few cases in U.S.

Viral
___% of cases in children 1 month - 5 years

Acute inflammation of meninges
Bacterial: S. pneumoniae, strep and gram negative bacilli & Neisseria meningitidis
(H. influenza-HiB vaccine) very few cases in U.S.

Viral
90% of cases in children 1 month - 5 years

Bacterial Meningitis

More common in _____
Neonate to 4 years old - greatest morbidity

^ susceptibility – central nervous system abnormality, /sickle cell, other infections
Meningococcal meningitis may occur in epidemic

form & is readily transmitted by _______ infection from secretions

More common in boys
Neonate to 4 years old - greatest morbidity

^ susceptibility – central nervous system abnormality, /sickle cell, other infections
Meningococcal meningitis may occur in epidemic

form & is readily transmitted by droplet infection from secretions

Treatment:Bacterial Meningitis - MEDICAL EMERGENCY

_________ Isolation
IV ________ @ dose (blood brain barrier)
Monitor neurologic signs
Maintain optimum hydration & ventilation
Monitor clotting times (DIC)
Observe for signs of shock
Treat seizures

Droplet Isolation
IV antibiotics @ dose (blood brain barrier)
Monitor neurologic signs
Maintain optimum hydration & ventilation
Monitor clotting times (DIC)
Observe for signs of shock
Treat seizures

Clinical Manifestations:Bacterial Meningitis

Infants: fever, poor feeding, vomiting, bulging fontanel

Children: fever, chills, headache, vomiting, seizure, photophobia, nuchal rigidity, + Kernig, Brudzinski; may have slow onset with days of GI or URI petechial rash w/ shock - ____________

meningococemia

New onset (first time) acute seizure is usually a symptom of :

some other thing going on

3 behaviours assessed in the Glasgow Coma Scoring Tool

Eye Opening (response to stimuli)
Verbal Response (crying, cooing, or vocalization)
Motor Response (movement, reflexes)

[Spina Bifida] sometime parents do not comply after excellent teaching and that is a red flag. Need ___________

Social services

Ventriculoperitoneal Shunt- (VP shunt)

A Ventriculoperitoneal (VP) shunt is a medical device used to treat ___________ , a condition where there is an abnormal buildup of cerebrospinal fluid (CSF) in the brain’s ventricles. This buildup increases intracranial pressure, which can damage brain tissue.

hydrocephalus

Know infection or malfunction of VP shunt is an _________ situation

urgent

Nursing Considerations: For all Acute Neuro problems that might increase ICP

Decrease environmental _______
HOB ___ degrees
Head Midline
Treat pain and discomfort
________ precaution
Maintain ______-thermia (no cooling in peds- NICU cools anoxic head but that the only condition backed be EBP)
Monitor ICP
Maintain Normal glucose

Decrease environmental stimuli
HOB 30 degrees
Head Midline
Treat pain and discomfort
Seizure precaution
Maintain Normo-thermia (no cooling in peds- NICU cools anoxic head but that the only condition backed be EBP)
Monitor ICP
Maintain Normal glucose

Nephrotic syndrome - Complications of IV steroids

difficult IV access?

May not be responsive

Acute post-streptococcal glomerulonephritis (AGN)

Acute inflammation of kidney at ____________

Antigen-antibody complexes (from previous strep infection) cause ________.

Clog up glomerulus and decrease filtration –> fluid retention & HTN

Increased retention in blood

Leaks RBCs and a little protein

Low WO –> increased serium K+

Acute inflammation of kidney at glomerulus

Antigen-antibody complexes (from previous strep infection) cause swelling.

Clog up glomerulus and decrease filtration –> fluid retention & HTN

Increased retention in blood

Leaks RBCs and a little protein

Low WO –> increased serium K+

Acute post-streptococcal glomerulonephritis (AGN) More common in _____ age 6-10.

boys

Acute post-streptococcal glomerulonephritis (AGN)

Manifestation:

Periorbital edema, tea-colored urine, hypertension, anorexia, HA, abd pain, oliguria

Nephrotic Syndrome (NS)

The glomerular basement membrane becomes increasingly _______________

Most common protein lost is albumin, but immunoglobulins also lost in urine (important to prevent infex)

Loss of serum protein –> loss of colloidal pressure in vasculature –> fluids leak from blood vessels and enters extracellular tissues in attempt to = water:protein concentration –> severe generalized edema (anasarca)

permeable to protein

Nephrotic Syndrome (NS) Manifestations:

severe and generalized edema, oliguria, dark and frothy urine, lethargy, irritability, hypotension, increased respiratory rate from pleural effusions

Most heart conditions in children result from defects in _____________ . Heart structure develops and begins beating soon after gestation

embryonic structure

CONGENITAL HEART DEFECTS Acyanotic VS Cyanotic

Acyanotic- *** cause an _________ in pulmonary blood flow, allow blood to mix, less likely to cause cyanosis

Cyanotic- *** cause a ________ in pulmonary blood flow, obstruct blood flow, more likely to cause cyanosis

Acyanotic- *** cause an increase in pulmonary blood flow, allow blood to mix, less likely to cause cyanosis

Cyanotic- *** cause a decrease in pulmonary blood flow, obstruct blood flow, more likely to cause cyanosis

Ventricular septal defect (VSD)

Atrial septal defect (ASD)

Patent ductus arteriosus (PDA)

Coarctation of the aorta

Aortic stenosis

are all

acyanotic defects

Tetralogy of Fallot

Truncus arteriosus

Transposition of the great vessels

are all

cyanotic defects

VENTRICULAR SEPTAL DEFECT (VSD)

-A ______ between the ventricles
-Oxygenated blood from left ventricle is shunted to right ventricle and recirculated to the lungs - acyanotic
-Increases the pulmonary vascular resistance
-May have enlarged right ventricle
-Small defects may close spontaneously
-Large defects cause congestive heart failure and require surgical closures
-Most common congenital anomaly (associated with _______ )

-A hole between the ventricles
-Oxygenated blood from left ventricle is shunted to right ventricle and recirculated to the lungs - acyanotic
-Increases the pulmonary vascular resistance
-May have enlarged right ventricle
-Small defects may close spontaneously
-Large defects cause congestive heart failure and require surgical closures
-Most common congenital anomaly (associated with Downs)

VENTRICULAR SEPTAL DEFECT (VSD) Signs:

poor ______ , FTT, tachypnea, ________ with feeding

poor eating, FTT, tachypnea, fatigue with feeding

PATENT DUCTUS ARTERIOSUS

-An abnormal _______ between the aorta AND the pulmonary artery
-Failure of the fetal ductus arteriosus to ______ after birth
-Usually closes within 72 hours after birth
-If it remains patent, oxygenated blood from the aorta returns to the pulmonary artery
-Increased effort of the left and right side of the heart
-Increased blood flow to the lungs causes pulmonary hypertension
-may require medical intervention with indomethacin (Indocin) administration or surgical closure

Signs: FTT, SOB, murmur, tachypnea

-An abnormal opening between the aorta AND the pulmonary artery
-Failure of the fetal ductus arteriosus to close after birth
-Usually closes within 72 hours after birth
-If it remains patent, oxygenated blood from the aorta returns to the pulmonary artery
-Increased effort of the left and right side of the heart
-Increased blood flow to the lungs causes pulmonary hypertension
-may require medical intervention with indomethacin (Indocin) administration or surgical closure

Signs: FTT, SOB, murmur, tachypnea

COARCTATION OF THE AORTA

Obstructive ________ of aorta

Most common sites are the aortic valve and the aorta near the ductus arteriosus

A common finding is __________ in the upper extremities and decreased or absent pulses in the lower extremities

It may require surgical correction

Signs: hypertension in upper extremities, pale skin, leg cramps, cold feet, headache

Risk for hypertension, ruptured aorta, aortic aneurysm, and stroke

Obstructive narrowing of aorta

Most common sites are the aortic valve and the aorta near the ductus arteriosus

A common finding is hypertension in the upper extremities and decreased or absent pulses in the lower extremities

It may require surgical correction

Signs: hypertension in upper extremities, pale skin, leg cramps, cold feet, headache

Risk for hypertension, ruptured aorta, aortic aneurysm, and stroke

TETRALOGY OF FALLOT

The child experiences “tet” spells, or _________ episodes after crying, feeding or when agitated that are relieved by the child’s squatting or being placed in the knee-chest position

hypoxic

*CARDIAC CATHETERIZATION [post-care]

Vital signs, insertion site observed, distal pulses checked Q 15 minutes x 1 hour, then Q 30 minutes

Observe for ________ at site, pallor, loss of ______, ________ of extremity

Push fluids to flush dye out of body

Observe for reactions to dye (vomiting, rash, increased creatinine, decreased urinary output)

Keep leg “still” for 4 to 8 hours

Pressure on incision site if bleeding occurs

Vital signs, insertion site observed, distal pulses checked Q 15 minutes x 1 hour, then Q 30 minutes

Observe for bleeding at site, pallor, loss of pulses, coolness of extremity

Push fluids to flush dye out of body

Observe for reactions to dye (vomiting, rash, increased creatinine, decreased urinary output)

Keep leg “still” for 4 to 8 hours

Pressure on incision site if bleeding occurs

Low cardiac output (impaired myocardial function) - S&S

__________ at rest
decreased peripheral perfusion
pale _____ extremities
anorexia
_________ BP
cardiomegaly
oliguria

Tachycardia at rest
decreased peripheral perfusion
pale cool extremities
anorexia
decreased BP
cardiomegaly
oliguria

Pulmonary congestion (CHF) S&S

Tachypnea, orthopnea
_________, nasal flaring
Cough
Wheezing, ________
Cyanosis

Tachypnea, orthopnea
Retractions, nasal flaring
Cough
Wheezing, grunting
Cyanosis

Systemic venous congestion (CHF)

____________

_______ (periorbital, ascites)

_______/pericardial effusions

Hepatomegaly

Edema (periorbital, ascites)

Pleural/pericardial effusions

KAWASAKI’S DISEASE

Acute systemic vasculitis that can damage ________________, including the coronary arteries

Can cause permanent damage to the main arteries to the heart, resulting in the _________ of the coronary artery

Acute systemic vasculitis that can damage blood vessels, including the coronary arteries

Can cause permanent damage to the main arteries to the heart, resulting in the aneurysm of the coronary artery

KAWASAKI TREATMENT

Administer intravenous ___________ (IVIG)

High dose ________

Monitor cardiac status & daily weights, strict Is & Os
Minimize skin discomfort with lotions and cool compresses
Initiate meticulous mouth care
Monitor intake of clear liquids and soft foods

Administer intravenous immunoglobulin (IVIG)

High dose aspirin

Monitor cardiac status & daily weights, strict Is & Os
Minimize skin discomfort with lotions and cool compresses
Initiate meticulous mouth care
Monitor intake of clear liquids and soft foods

PEDIATRIC GLASGOW COMA SCALE

Best score 15;
____ is coma

< 8

INTERVENTIONS FOR BACTERIAL MENINGITIS

Administer ____ within 30 minutes of presentation

Isolate at least 24 hours: DROPLET

ABX

FOCAL/PARTIAL SEIZURES

Arises from ___________ of the brain, limited symptoms

Simple-consciousness not impaired

Complex-consciousness impaired

specific area

Seizure care

Maintain _________ during seizure

Turn client on _____ to aid ventilation

Do not restrain client

Protect from injury during seizure, and support ________

Administer anticonvulsants
Nasally (e.g. ______)
Rectal diazepam

Maintain airway during seizure

Turn client on side to aid ventilation

Do not restrain client

Protect from injury during seizure, and support head

Administer anticonvulsants
Nasally (e.g. Ativan)
Rectal diazepam

Do not use tongue blade during a seizure!

DO NOT PUT _________ IN THE MOUTH OF AN ACTIVELY SEIZING PATIENT!

ANYTHING

SPINA BIFIDA *Prevention: __________ daily at least 3 months prior to and during pregnancy

folic acid

Spina bifida occulta: dimple with or without hair tuft at base of spine - No ____ present

Meningocele: sac contains only meninges and spinal fluid, no _______ in spinal sac

Myelomeningocele: ____ contains spinal fluid, meninges and nerves, client has sensory and motor defects, flaccid paralysis and limited or no feeling below the defect

Spina bifida occulta: dimple with or without hair tuft at base of spine - No sac present

Meningocele: sac contains only meninges and spinal fluid, no nerves in spinal sac

Myelomeningocele: sac contains spinal fluid, meninges and nerves, client has sensory and motor defects, flaccid paralysis and limited or no feeling below the defect

MYELOMENINGOCELE

First 28 days of pregnancy neural tube fails to _____

____ protrudes in membrane, usually in lumbosacral area

Location and _______ of defect determine type extent and of neurologic involvement

First 28 days of pregnancy neural tube fails to close

Sac protrudes in membrane, usually in lumbosacral area

Location and size of defect determine type extent and of neurologic involvement

PROBLEMS ASSOCIATED WITH MYELOMENINGOCELE

____________ (90%) - circulation of CSF is interrupted

Neurogenic bladder, poor anal sphincter toneCongenital dislocated hips

Club feet

Skin problems associated with anesthesia below the defect

Scoliosis

Hydrocephalus (90%) - circulation of CSF is interrupted

Neurogenic bladder, poor anal sphincter toneCongenital dislocated hips

Club feet

Skin problems associated with anesthesia below the defect

Scoliosis

MYELOMENINGOCELE: LONG-TERM CARE (NO CURE)

Administer propantheline or bethanechol to improve ___________ (lessen bladder spasms)

Assess skin condition frequently

Develop bowel program (pt is incontinent, more prone to diarrhea, still need to have a bowel everyday )

Assist with range of motion exercises, ambulation, and bracing

Every child with a history of spina bifida should be screened for ______ allergies

*** If parents do not comply after excellent teaching, ____________ should be contacted!

Administer propantheline or bethanechol to improve continence (lessen bladder spasms)

Assess skin condition frequently

Develop bowel program (pt is incontinent, more prone to diarrhea, still need to have a bowel everyday )

Assist with range of motion exercises, ambulation, and bracing

Every child with a history of spina bifida should be screened for latex allergies

*** If parents do not comply after excellent teaching, social services should be contacted!

HYDROCEPHALUS - An abnormal accumulation of CSF within the ventricles of the brain: leads to _______________

Can be caused by:

obstruction in the flow of CSF between the ventricles
overproduction of CSF fluid
congenital malformation blocking normal drainage
head injuries
infection (meningitis)
spina bifida

increased ICP

SIGNS OF INCREASED ICP [infants[

Irritability, lethargy

Increasing head circumference

Bulging fontanels

Widening suture lines

“Sunset” eyes

High-pitched cry

Irritability, lethargy

Increasing head circumference

Bulging fontanels

Widening suture lines

“Sunset” eyes

High-pitched cry

SIGNS OF INCREASED ICP [older children]

Change in level of consciousness

**Increased blood pressure

**Decreased respiratory rate

Irritability

Vomiting, nausea (at night, not associated with eating)

Headache on awakening

Motor dysfunction

Unequal pupil response

Seizures, sleepiness

Decline in academics

Change in personality

Change in level of consciousness

**Increased blood pressure

**Decreased respiratory rate

Irritability

Vomiting, nausea (at night, not associated with eating)

Headache on awakening

Motor dysfunction

Unequal pupil response

Seizures, sleepiness

Decline in academics

Change in personality

ASSESS FOR SIGNS OF VP SHUNT MALFUNCTION [infant]

Bulging fontanels, sutures separated

Irritability, lethargy or seizures

Altered vital signs

Altered feeding behavior

Bulging fontanels, sutures separated

Irritability, lethargy or seizures

Altered vital signs

Altered feeding behavior

ASSESS FOR SIGNS OF VP SHUNT MALFUNCTION [older child]

Change in LOC

Headache

Changes in customary behavior (sleep patterns, developmental capabilities, poor feeding)

Change in LOC

Headache

Changes in customary behavior (sleep patterns, developmental capabilities, poor feeding)

VENTRICULOPERITONEAL SHUNT (VP)

Shunt placement to re-route flow → _____ CSF

May need to be changed as child grows, becomes obstructed, becomes infected

CSF brought down to another part of the body to be absorbed

absorb

average life span of infant shunt :

2 years!

INCREASED INTRACRANIAL PRESSURE - OPPOSITE OF SHOCK

Shock: increased pulse, decreased blood pressure

Increased ICP: _________________________________

decreased pulse, increased blood pressure

TYPE 1 DIABETES

Immune-mediated disease associated with absolute _________ _________ (body’s own T-cells destroy pancreatic beta cells, which are the source of insulin)

insulin deficiency

Classic three P’s [Diabetes type 1]

Polydipsia
Polyphagia
Polyuria

KETOACIDOSIS

Ketones in the blood are strong acids that ________ serum pH

decrease

DKA INTERVENTIONS

__________ common - initial hydration NS 20ml/kg with potassium started after patient has peed (no Pee = no K)

Low dose ________ IV - slowly decrease serum glucose to reduce chance of cerebral edema during rehydration

Never turn off ________ - only thing that corrects the acidosis

Dehydration common - initial hydration NS 20ml/kg with potassium started after patient has peed (no Pee = no K)

Low dose insulin IV - slowly decrease serum glucose to reduce chance of cerebral edema during rehydration

Never turn off insulin - only thing that corrects the acidosis

Brainscape's Knowledge GenomeTM

Week 4 Content Flashcards

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