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Nurs 158- Pediatrics > Week 4 Content > Flashcards

Week 4 Content Flashcards

1
Q

Basic Problems (heart)

Obstruction of Blood Flow- eventually causes _______________

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

A

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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2
Q

Fetal Oxygen saturation is _____%

A

50-55

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3
Q

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

A

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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4
Q

Congestive Heart Failure

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

A

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

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5
Q

Associated Clinical Signs & Symptoms of CHF

  • Diaphoresis
  • Poor _________
  • Irritability
  • Failure to ______

Pulmonary congestion
* __________
* Retractions, nasal _______
* Cough

A
  • Diaphoresis
  • Poor feeding
  • Irritability
  • Failure to thrive

Pulmonary congestion
* Tachypnea
* Retractions, nasal flaring
* Cough

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6
Q

Causes of CHF

  • __________ heart disease
  • Non-structural myocardial factors
    – Viral myocarditis
    – Birth trauma
  • ___________ - Too fast or too slow
A
  • Congenital heart disease
  • Non-structural myocardial factors
    – Viral myocarditis
    – Birth trauma
  • Dysrhythmias - Too fast or too slow
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7
Q

Clinical Manifestations of CHF

Pulmonary congestion
* ____________
* Retractions, nasal flaring
* Cough

A

Tachypnea

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8
Q

Management of the Child with CHF

  • Promote myocardial efficiency
  • _________ , afterload reducers
  • Minimize volume overload
  • __________
  • Decrease cardiac workload
  • Minimize energy expenditures
  • Provide adequate ________
A
  • Promote myocardial efficiency
  • Digoxin, afterload reducers
  • Minimize volume overload
  • Diuretics
  • Decrease cardiac workload
  • Minimize energy expenditures
  • Provide adequate nutrition
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9
Q

CHF Provide Adequate Nutrition

  • Small, ________ feedings
  • Position during feeding
  • Breast vs. bottle
  • High ________ feeding
  • Gavage feeding
  • __________ tube
A
  • Small, frequent feedings
  • Position during feeding
  • Breast vs. bottle
  • High caloric feeding
  • Gavage feeding
  • Gastrostomy tube
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10
Q

Cyanosis

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

A

hemoglobin

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11
Q

Clinical Manifestations of Cyanosis

  • Blue color at _____ , __________ , mucous membranes
  • Tachypnea
  • Cyanosis increases with _______
  • Long-term: polycythemia, __________
A
  • Blue color at lips, nailbeds, mucous membranes
  • Tachypnea
  • Cyanosis increases with crying
  • Long-term: polycythemia, clubbing
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12
Q

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

A
  • Child will usually limit self
  • O2 usually not effective
  • Interventional cardiac catheterization
  • Surgery
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13
Q

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

A
  • Careful H&P
  • Chest X-ray
  • ECG
  • Echocardiogram
  • Cardiac catheterization (+/-)
  • Diagnostic
  • Interventional
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14
Q

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

A
  • Vital signs, pulse oximetry
  • Mark pedal pulses
  • Laboratory analysis
  • Coagulopathies
  • CBC
  • electrolytes
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15
Q

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

A
  • Cardiopulmonary instability
  • Thrombosis
  • Vessel dissection
  • Bleeding at site
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16
Q

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

A
  • 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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17
Q

Patent Ductus Arterious

Common in preterm
__ > ____ shunting
CHF

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

A

Common in preterm
L→R shunting
CHF

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

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18
Q

Ventricular Septal Defect

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

A

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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19
Q

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

A

Classic finding arm BP>leg BP by 10+ mmHg

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20
Q

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

A

40

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21
Q

Tetralogy of Fallot

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

A

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

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22
Q

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

A
  • 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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23
Q

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 __________
A
  • 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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24
Q

Kawasaki Disease (mucocutaneous lymph node syndrome) - _________ unclear

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

Etiology

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25
Q

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

A

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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26
Q

Kawasaki Disease (mucocutaneous lymph node syndrome)

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

A
  • ↑ WBC
  • ↑ sedimentation rate
  • ↑ LFT’s
  • Thrombocytosis
  • Baseline & serial echocardiograms
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27
Q

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)
A
  • 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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28
Q

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

A

1-2

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29
Q

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.

A

glomerulus

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30
Q

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
A
  • 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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31
Q

Nephrotic Syndrome:
↑Permeability of Basement ____________

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

A

↑Permeability of Basement Membrane

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

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32
Q

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 .

A
  • 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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33
Q

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
A
  • ↓ 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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34
Q

Nephrotic syndrome Nursing Assessment

  • Severe generalize __________
  • Lethargy
  • Anorexia
  • ______ yellow urine
  • Difficult IV access
A
  • Severe generalize edema
  • Lethargy
  • Anorexia
  • Frothy yellow urine
  • Difficult IV access
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35
Q

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
A
  • 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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36
Q

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
A
  • 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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37
Q

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

A

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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38
Q

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
A
  • 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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39
Q

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
A
  • edema
  • Hypertension
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40
Q

Acute Glomerulonephritis Lab

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

immune response

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41
Q

Acute Glomerulonephritis

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

A

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

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42
Q

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

A
  • Acute
  • Occurs post strep throat infection
  • Mild loss of protein
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43
Q

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

A
  • More chronic
    Can have remissions and exacerbations over years
  • Most cause is idiopathic
  • Massive loss of protein
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44
Q

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

A
  • Edema- severe generalized
  • Blood Pressure- Normal
  • Urine- dark frothy yellow (tons of protein)
  • ASO titer negative
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45
Q

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

A
  • 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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46
Q

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

A

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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47
Q

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

A

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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48
Q

S & S of DKA

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

_________ Urine Output

_______-smelling breath.

A

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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49
Q

Nonspecific Signs and Symptoms DKA

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

A

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

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50
Q

Diabetic Ketoacidosis (DKA)

Pediatric ____________

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

Therapy: Should be instituted in an ____________________ setting

A

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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51
Q

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

A

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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52
Q

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

A

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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53
Q

Situations that increase need for Insulin

Increased ____________ intake
Illnesses
Decreased ______________

A

Increased carbohydrate intake
Illnesses
Decreased physical activity

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54
Q

Situations that decrease need for Insulin and that can cause hypoglycemia

Missed ______
Increased __________

A

Missed Meal
Increase Exercise

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55
Q

S& S of hypoglycemia

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

A

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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56
Q

Treat Hypoglycemia

Able to take PO
__________
Glucose Gel tabs

Can’t tolerate PO
__________

A

Able to take PO
Orange juice
Glucose Gel tabs

Can’t tolerate PO
IV glucose

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57
Q

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

A

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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58
Q

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.

A

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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59
Q

Basic Problems (heart)

Decreased Pulmonary Blood Flow- ↓ ____________

_______ of Deoxygenated Blood with Oxygenated Blood

A

Decreased Pulmonary Blood Flow- ↓oxygenation

Mixing of Deoxygenated Blood with Oxygenated Blood

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60
Q

If there are holes in heart, blood moves ___________ ?

A

Left to right

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61
Q

A baby has VSD & CHF

He is underweight why?

A

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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62
Q

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

A

abnormal connection

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63
Q

____ are the most common heart defect

A

VSDs

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63
Q

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

A

Heart murmur

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63
Q

Tetralogy of Fallot

A
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63
Q

Infective Endocarditis- portals of Entry

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

A

Dental

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64
Q

Infective Endocarditis Diagnosis

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

A

blood culture

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64
Q

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

A

Antibiotic

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64
Q

Infective Endocarditis Prognosis

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

A

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

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65
Q

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 __________
A
  • 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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65
Q

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

A

rapid

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65
Q

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

A

cyanosis (bluish skin)

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65
Q

Infective Endocarditis Nursing

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

A

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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65
Q

Medications for Congestive Heart Failure (CHF)

A

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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65
Q

Digoxin: To improve heart _____________.

A

contractility

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66
Q

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

A

fluid overload.

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67
Q

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

A

blood pressure

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68
Q

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

A

workload

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69
Q

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.

A

gaining weight

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70
Q

Low Cardiac Output Symptoms:

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

A

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

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71
Q

What pulmonary symptoms occur with congestive heart failure?

A
  • Tachypnea
  • Retractions, nasal flaring
  • Cough

More:
Dyspnea
Exercise intolerance
Orthopnea
hoarseness
Cyanosis
Wheezing
Grunting

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72
Q

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).

A

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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73
Q

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 _____________

A

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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74
Q

Nursing care of post cardiac cath pt

How do you keep involved extremity?

A

Keep affected leg straight

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75
Q

Nursing care of post cardiac cath pt

how long do you need a pressure dressing or bag

A

intact for at least 4 hours

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76
Q

Post-Cardiac Cath Assessments:

A

Monitor for bleeding at the insertion site.

Check pulses

capillary refill time

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77
Q

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.

A

left-to-right shunt

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78
Q

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

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

A

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

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79
Q

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

A

No lifting the child under their arms for 6 weeks.

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

80
Q

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

A

inflammatory

81
Q

Kawasaki Disease treatment

A

high dose: IV immunoglobulin (IVIG) and aspirin

82
Q

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

A

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

83
Q

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

A

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

84
Q

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

A

destruction of insulin-producing

85
Q

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

A

Diabetic ketoacidosis (DKA)

86
Q

What is diabetic ketoacidosis (DKA)?

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

A

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

87
Q

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

A

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

88
Q

Blood pH in DKA:

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

A

acidic

89
Q

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.

A

Insulin

90
Q

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.

A

insulin

91
Q

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.

A

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.

92
Q

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.​

A

Age at onset is usually younger than 18 years.​

93
Q

Which symptom is considered a cardinal sign of diabetes mellitus?​

Nausea​

Seizures​

Impaired vision​

Frequent urination

A

Frequent urination

93
Q

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

Moist skin​

Fluid overload​

Weight gain​

Poor wound healing

A

Poor wound healing​

​

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

93
Q

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

A

Extra snacks are needed before exercise.​

94
Q

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?​

​

8​

11​

13​

15

A

15​

​

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.​

95
Q

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​

A

C. Bulging anterior fontanel​

D. Weak cry​

E. Poor muscle tone​

96
Q

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

A

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.​

96
Q

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​

A

Bulging fontanel and dilated scalp veins​

96
Q

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

A

Describe and record the seizure activity observed​

​

97
Q

Which defect results in increased pulmonary blood flow?​

​

Pulmonic stenosis​

Atrial septal defect​

Tricuspid atresia​

Transposition of the great arteries

A

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

98
Q

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

A

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.

99
Q

Pulmonary congestion is an excessive accumulation of ______ in the lungs

A

fluid

100
Q

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

​

Decreases edema​

Decreases cardiac output​

Increases heart size​

Increases venous pressure

A

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

101
Q

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.​

A

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

102
Q

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​

A

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

​

Tetralogy of Fallot has these four characteristics

103
Q

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.
A
  • 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.
104
Q

Urinary System Includes: kidneys, ureters, bladder and urethra

A

kidneys, ureters, bladder and urethra

105
Q

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

A

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

106
Q

Upper Urinary Tract Infections UTI

  • Lower:
    Occurs when bacteria travel as high as the __________
  • Upper:
    When bacteria travels past the bladder into the ___________
A
  • Lower:
    Occurs when bacteria travel as high as the urethra or bladder
  • Upper:
    When bacteria travels past the bladder into the ureters or kidneys
107
Q

Typical Symptoms of Lower UTI in Adults

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

A

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

108
Q

Typical Symptoms of Upper UTI in Adults

High _____
Back or side pain
Feeling sick
Diarrhea

A

High fever
Back or side pain
Feeling sick
Diarrhea

109
Q

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

  • Fever
  • Irritability
  • Crying
  • Vomiting
  • Poor feeding
A
  • Fever
  • Irritability
  • Crying
  • Vomiting
  • Poor feeding
110
Q

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 ________
A
  • 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
111
Q

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
A

Urethra and Bladder

112
Q

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
A
  • 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
113
Q

Diagnosis of UTI

  • Urinalysis
  • Urine Culture and Sensitivity
A
  • Urinalysis
  • Urine Culture and Sensitivity
114
Q

UTI Treatment

  • Antibiotics
  • Pain/Comfort Management
  • Getting plenty of ______
A
  • Antibiotics
  • Pain/Comfort Management
  • Getting plenty of fluids
115
Q

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
A
  • 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
116
Q

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
A

bladder and the Ureter

117
Q

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.
A
  • 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.
118
Q

Enuresis

  • ________ – nighttime; most common
  • Diurnal - daytime
A

Nocturnal

119
Q

Enuresis - Proposed Pathophysiology

  • Excessive _______ Urine Production
  • Bladder _______
  • Failure to awaken in response to bladder sensations
A
  • Excessive Nocturnal Urine Production
  • Bladder overactivity
  • Failure to awaken in response to bladder sensations
120
Q

Excessive Nocturnal Urine Production

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

vasopressin

121
Q

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.

A

Desmopressin

122
Q

Within the fixed skull, there are 3 things:

A

Brain tissue
CSF
Blood

123
Q

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

A

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

124
Q

Increased ICP from too much Brain Tissue is Called :

A

Cerebral Edema

125
Q

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

A

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

125
Q

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

A

Swelling of the Brain caused by excessive fluid

Many causes of Cerebral edema, including Hyponatremia

126
Q

Treatment for ^ ICP

Brain tissue
________ – Manitol,
Hypertonic Saline

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

A

Brain tissue
Diuretics – Manitol,
Hypertonic Saline

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

127
Q

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

A

Cushing’s

128
Q

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

↑ ___ very high
↓ ___ very low
↓ ___

A

↑ BP very high
↓ HR very low
↓ RR

129
Q

DECREASE ICP- Fastest

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

hyperventilation

130
Q

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

A

Ventricular Drain

131
Q

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

A

blood

132
Q
  • Cerebral Palsy
  • Spina Bifida
  • Neuromuscular Diseases

These are all:

A

Chronic

133
Q

HYDROCEPHALUS - Increased :

A

Cerebral Spinal Fluid

134
Q

HYDROCEPHALUS

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

Increased _________________

A

Head circumference

135
Q

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.

A

arachnoid villi

136
Q

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

A

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

137
Q

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

A
  • more common in boys
  • Caucasian 3x > African American
  • 50% caused from nutritional deficiency of folic acid
138
Q

Symptoms of Spina Bifida Occulta

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

Bowel/bladder

139
Q

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
A

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

140
Q

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

A
  • Support family
  • Protect neonate from infection; identify early signs of infection
  • Support sac to prevent further damage
  • Skin care
  • Latex allergies a potential problem
141
Q

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

A

-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

142
Q

What are the isolation precautions for Bacterial Meningitis?

A

Droplet

143
Q

Seizure Disorder
* Brain’s ________ system malfunctions

A

electrical

144
Q

_________ - chronic seizure disorder with recurrent and unprovoked seizures

A

Epilepsy

145
Q

Etiology of Seizures

  • Most are _________________
  • Acquired - brain injury during prenatal or postnatal period: trauma, hypoxia, infections, toxins, electrolyte disturbances, brain tumor etc….
A
  • Most are idiopathic (never find cause)
  • Acquired - brain injury during prenatal or postnatal period: trauma, hypoxia, infections, toxins, electrolyte disturbances, brain tumor etc….
146
Q

Ages 0-3 Seizures are usually

A

caused by infection

147
Q

Partial seizure

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

A

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

148
Q

Generalized seizure

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

A

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

149
Q

Acute Seizures may be caused by

Infection
Hyponatremia
Brain Tumors
Head Injury

A

Infection
Hyponatremia
Brain Tumors
Head Injury

150
Q

Chronic Seizures may occur with ___________

A

Cerebral Palsy

151
Q

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
A
  • 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
152
Q

Don’t put anything in ______ of a seizing patient

A

mouth

153
Q

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.

A

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.

154
Q

Status Epilepticus – defined as seizure lasting :

A

> 5 min

155
Q

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

A

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

156
Q

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

A

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

157
Q

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
A
  • 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
157
Q

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 - ____________

A

meningococemia

158
Q

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

A

some other thing going on

159
Q

3 behaviours assessed in the Glasgow Coma Scoring Tool

A

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

160
Q

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

A

Social services

161
Q

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.

A

hydrocephalus

162
Q

Know infection or malfunction of VP shunt is an _________ situation

A

urgent

163
Q

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
A
  • 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
164
Q

Nephrotic syndrome - Complications of IV steroids

A

difficult IV access?

May not be responsive

165
Q

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+​

A

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+​

166
Q

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

A

boys

167
Q

Acute post-streptococcal glomerulonephritis (AGN)

Manifestation: ​

A

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

168
Q

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)​

A

permeable to protein​

169
Q

Nephrotic Syndrome (NS)​ Manifestations:

A

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

170
Q

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

A

embryonic structure

171
Q

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​

A

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​

172
Q

Ventricular septal defect (VSD)​

Atrial septal defect (ASD)​

Patent ductus arteriosus (PDA)​

Coarctation of the aorta​

Aortic stenosis

are all

A

acyanotic defects

173
Q

Tetralogy of Fallot​

Truncus arteriosus​

Transposition of the great vessels

are all

A

cyanotic defects

174
Q

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

-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)​

175
Q

VENTRICULAR SEPTAL DEFECT (VSD)​ Signs:

poor ______ , FTT, tachypnea, ________ with feeding​

A

poor eating, FTT, tachypnea, fatigue with feeding​

176
Q

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​

A

-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​

177
Q

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​

A

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​

178
Q

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​

A

hypoxic

179
Q

*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​

A

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​

180
Q

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

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

A

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

181
Q

Pulmonary congestion​ (CHF) S&S

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

A

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

182
Q

Systemic venous congestion​ (CHF)

____________​

_______ (periorbital, ascites)​

_______/pericardial effusions

A

Hepatomegaly​

Edema (periorbital, ascites)​

Pleural/pericardial effusions

183
Q

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

A

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

184
Q

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​

A

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​

185
Q

PEDIATRIC GLASGOW COMA SCALE​

Best score 15;
____ is coma​

A

< 8

186
Q

INTERVENTIONS FOR BACTERIAL MENINGITIS

Administer ____ within 30 minutes of presentation​

Isolate at least 24 hours: DROPLET​

A

ABX

187
Q

FOCAL/PARTIAL SEIZURES

Arises from ___________ of the brain, limited symptoms​

Simple-consciousness not impaired​

Complex-consciousness impaired

A

specific area

188
Q

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 ​

A

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 ​

189
Q

Do not use tongue blade during a seizure!​

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

A

ANYTHING

190
Q

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

A

folic acid

191
Q

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

A

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

192
Q

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

A

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

193
Q

PROBLEMS ASSOCIATED WITH MYELOMENINGOCELE​

____________ (90%) - circulation of CSF is interrupted​

Neurogenic bladder, poor anal sphincter tone​Congenital dislocated hips​

Club feet​

Skin problems associated with anesthesia below the defect​

Scoliosis

A

Hydrocephalus (90%) - circulation of CSF is interrupted​

Neurogenic bladder, poor anal sphincter tone​Congenital dislocated hips​

Club feet​

Skin problems associated with anesthesia below the defect​

Scoliosis

194
Q

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!

A

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!

195
Q

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​
A

increased ICP​

196
Q

SIGNS OF INCREASED ICP​ [infants[

Irritability, lethargy​

Increasing head circumference​

Bulging fontanels​

Widening suture lines​

“Sunset” eyes​

High-pitched cry​

A

Irritability, lethargy​

Increasing head circumference​

Bulging fontanels​

Widening suture lines​

“Sunset” eyes​

High-pitched cry​

197
Q

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

A

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

198
Q

ASSESS FOR SIGNS OF VP SHUNT MALFUNCTION [infant]

Bulging fontanels, sutures separated​

Irritability, lethargy or seizures​

Altered vital signs​

Altered feeding behavior​

A

Bulging fontanels, sutures separated​

Irritability, lethargy or seizures​

Altered vital signs​

Altered feeding behavior​

199
Q

ASSESS FOR SIGNS OF VP SHUNT MALFUNCTION [older child]

Change in LOC​

Headache​

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

A

Change in LOC​

Headache​

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

200
Q

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​

​

A

absorb

201
Q

average life span of infant shunt :

A

2 years!​

202
Q

INCREASED INTRACRANIAL PRESSURE - OPPOSITE OF SHOCK

Shock: increased pulse, decreased blood pressure​

Increased ICP: _________________________________

A

decreased pulse, increased blood pressure​

203
Q

TYPE 1 DIABETES

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

A

insulin deficiency

204
Q

Classic three P’s​ [Diabetes type 1]

A

Polydipsia​
Polyphagia​
Polyuria​

205
Q

KETOACIDOSIS​

Ketones in the blood are strong acids that ________ serum pH

A

decrease

206
Q

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​

A

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​

Nurs 158- Pediatrics (9 decks)

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