Week 5/6

Question 1

Define the foramen ovale

Answer 1

small hole between R&L atrium; oxygenated blood to left side of the heart.

Question 2

Define the ductus arteriosus

Answer 2

connects the pulmonary artery to the aorta. Shunts deoxygenated blood from the right ventricle (RV) to the descending aorta bypassing the nonaerated lungs.

Question 3

Define the ductus venosus

Answer 3

shunts oxygenated blood from the umbilical to the inferior vena cava (IVC), bypassing the liver.

Question 4

List the clinical features of mild pneumonia

Answer 4

• Temp < 38.5 degree C
• Mild or absent respiratory distress:
  o Increased RR, but less than the age-specific RR that defines moderate to severe respiratory distress.
  o Mild or absent retractions
  o Mild SOB

Rest normal:
o No grunting
o No nasal flaring
o No apnea
o Normal colour
o Normal mental status
o Normoxemia (sp02 > or equal to 92% on R/A)
o Normal feeding (infants); no vomiting
o Normal heart rate
o Capillary refill <2 seconds

Question 5

What is normal cap refill in children?

Answer 5

2 seconds or less ; <2 seconds

Question 6

List the clinical features of severe pneumonia

Answer 6

• Temp > or equal to 38.5 degree C
• Mod to severe resp distress:
  o RR >70 breaths/min for infants; RR >50 breaths/min for older children
  o Mod/severe suprasternal, intercostal, or subcostal retractions (<12 months)
  o Severe difficulty breathing (> or equal to 12 months)
  o Grunting
  o Nasal flaring
  o Apnea
  o Significant SOB
  o Cyanosis
  o Altered mental status.
  o Hypoxemia (sustained oxygen saturation <90 percent in r/a at sea level)
  o Not feeding (infants) or signs of dehydration (older children).
  o Tachycardia
  o Capillary refill > or equal to 2 seconds.

Question 7

Define hypoxemia

Answer 7

Hypoxemia is a low level of oxygen in the blood.

Question 8

If x-ray shows diffused hyperinflation, that’s indicative of what?

Answer 8

pneumonia

Question 9

If a kid comes in with high-pitched stridor on inhalation, drooling and work of breathing but no viral symptoms, what are you thinking?

Answer 9

Foreign body aspirations

Young children are more prone to foreign body aspirations, they love to put things in their mouths. Their anatomy is not as developed, as floppy epiglottis.

Question 10

Describe physical exam of someone struggling with asthma

Answer 10

o Wheezing
o Crackles in the lung
o Forced & prolonged.
o Expiratory phase
o Muscle retractions
o Often can be normal.

Question 11

What is some at home treatment solutions for asthma?

Answer 11

a. Bronchodilators
i. Short-acting: Ventolin/salbutamol
b. Inhaled corticosteroids
i. Fluticasone/Flovent
c. Combination therapy
i. Inhaled steroid + bronchodilator
d. Leukotriene modifiers
i. Singulair/montelukast

Question 12

What are some in hospital treatment solutions for asthma?

Answer 12

a. Anticholinergic bronchodilator
i. Atrovent/ipratropium bromide
b. Bronchodilators
i. Salbutamol
c. Systemic steroids
i. Dexamethasone
d. Salbutamol nebs/IV
e. Magnesium Sulfate IV

Question 13

Define BRUE

Answer 13

Brief Resolved Unexplained Event
- Episode in an infant that is frightening to the observer and is characterized by some combination of:
o Apnea (central or occasionally obstructive)
o Colour change
o Unresponsiveness
o Change in muscle tone, choking, or gagging.

Question 14

When a child with Tetralogy of Fallot is having a hyper cyanotic episode, what is a priority nursing intervention?

Answer 14

Place child knees to chest in order to increase pulmonary pressure

Question 15

What are the 4 conditions that make up tetralogy of fallot?

Answer 15

1. ventricle septal defect
2. overriding aorta
3. pulmonary stenosis
4. right ventricular hypertrophy