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351 terms

Peds test 4 5-2-13

using power points and notes, also dragich's flashcards
STUDY
PLAY
What best describes why children have fewer respiratory tract infections as they grow older?
Repeated exposure to organisms causes increased immunity.
Cool-mist vaporizers rather than steam vaporizers are recommended in home treatment of respiratory tract infections because:
They are safer.
Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include:
Avoiding use for more than 3 days.
When caring for an infant with an upper respiratory tract infection and elevated temperature, an appropriate nursing intervention is to:
Give small amounts of favorite fluids frequently to prevent dehydration.
The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant:
Shows signs of an earache.
It is generally recommended that a child with acute streptococcal pharyngitis can return to school:
After taking antibiotics for 24 hours.
A child is diagnosed with influenza, probably type A disease. Management includes:
Amantadine hydrochloride to reduce symptoms.
Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by:
A feeling of fullness in the ear.
Which statement is characteristic of acute otitis media (AOM)?
It is treated with a broad range of antibiotics.
An infant's parents ask the nurse about preventing otitis media (OM). What should the nurse recommend?
Avoid tobacco smoke.
Which type of croup is always considered a medical emergency?
Epiglottitis
The nurse encourages the mother of a toddler with acute laryngotracheobronchitis to stay at the bedside as much as possible. The nurse's rationale for this action is primarily that:
The mother's presence will reduce anxiety and ease child's respiratory efforts.
A school-age child has had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of:
Bronchitis
Skin testing for tuberculosis the Mantoux test is recommended:
Periodically for children who reside in high-prevalence regions.
The mother of a toddler yells to the nurse, ""Help! He is choking to death on his food."" The nurse determines that lifesaving measures are necessary based on:
Inability to speak
The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include:
Monitor pulse oximetry.
The nurse is caring for a child with carbon monoxide (CO) poisoning associated with smoke inhalation. What is essential in this child's care?
Monitor arterial blood gases.
Asthma in infants is usually triggered by
A viral infection
A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration this suggests?
Asthma
It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because they may develop:
Slowed growth.
Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack, what is their action?
Dilate the bronchioles.
A parent whose two school-age children have asthma asks the nurse in what sports, if any, they can participate, the nurse should recommend?
Swimming
Which statement expresses accurately the genetic implications of cystic fibrosis (CF)?
If it is present in a child, both parents are carriers of this defective gene.
The earliest recognizable clinical manifestation(s) of cystic fibrosis (CF) is:
Meconium ileus.
Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis?
Sweat chloride test
A child with cystic fibrosis is receiving recombinant human deoxyribonuclease rhDNase, his drug:
May cause voice alterations
Pancreatic enzymes are administered to the child with cystic fibrosis, nursing considerations should include:
Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.
In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind?
Diet should be high in carbohydrates and protein.
Cardiopulmonary resuscitation is begun on a toddler. Which pulse is usually palpated because it is the most central and accessible?
Carotid
Which drug is considered the most useful in treating cardiac arrest?
Epinephrine hydrochloride
The Heimlich maneuver is recommended for airway obstruction in children older than?
1 year
An appropriate nursing intervention when caring for a child with pneumonia is to?
Encourage rest.
An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes (choose all that apply):
Cluster care to conserve energy. AND Administration of antibiotics.
The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which interventions should be included in the child's care? Choose all that apply.
Encourage infant to drink 8 ounces of formula every 4 hours. AND Cluster care to encourage adequate rest.AND Place on noninvasive oxygen monitoring.
The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which actions should the nurse include in the child's postoperative care plan? (Choose all that apply.)
Notify the surgeon if the child swallows frequently. AND Place the child on the abdomen until fully awake. AND Allow the child to have diluted juice after the procedure.
A chest x-ray film is ordered for a child with suspected cardiac problems. The child's parent asks the nurse, ""What will the radiograph show about the heart?"" The nurse's response should be based on knowledge that the x-ray film will:
Provide a permanent record of heart size and configuration.
A complication that may occur after a cardiac catheterization is:
Cardiac arrhythmia
Josh is a 4-year-old child scheduled for a cardiac catheterization. Preoperative teaching should be:
Adapted to his level of development so that he can understand.
The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells the nurse that her bandage is ""too wet."" The nurse finds the bandage and bed soaked with blood. The most appropriate initial nursing action is to:
Apply direct pressure above the catheterization site.
Which defect results in increased pulmonary blood flow?
Atrial septal defect
Which structural defects constitute tetralogy of Fallot?
Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
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?
Congestive heart failure
A clinical manifestation of the systemic venous congestion that can occur with congestive heart failure is:
Peripheral edema
A beneficial effect of administering digoxin (Lanoxin) is that it:
Decreases edema.
Which drug is an angiotensin-converting enzyme (ACE) inhibitor?
Captopril (Capoten)
A common sign of digoxin toxicity is:
Vomiting
The parents of a young child with congestive heart failure tell the nurse that they are ""nervous"" about giving digoxin. The nurse's response should be based on knowing that:
Parents must learn specific, important guidelines for administration of digoxin.
As part of the treatment for congestive heart failure, the child takes the diuretic furosemide. As part of teaching home care, the nurse encourages the family to give the child foods such as bananas, oranges, and leafy vegetables. These foods are recommended because they are high in:
Potassium
An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse's first action should be to:
Place the child in the knee-chest position
The nurse is caring for a child with persistent hypoxia secondary to a cardiac defect. The nurse recognizes that a risk of cerebrovascular accidents strokes exists. An important objective to decrease this risk is to:
Prevent dehydration
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
When preparing a school-age child and the family for heart surgery, the nurse should consider?
Letting child hear the sounds of an electrocardiograph monitor
Seventy-two hours after cardiac surgery, a young child has a temperature of 101 degrees Fahrenheit, the nurse should?
Report findings to physician.
An important nursing consideration when suctioning a young child who has had heart surgery is to?
Administer supplemental oxygen before and after suctioning.
The nurse is caring for a child after heart surgery. What should he or she do if evidence is found of cardiac tamponade?
Immediately report this to the physician.
An important nursing consideration when chest tubes will be removed from a child is to?
Administer analgesics before procedure.
The most common causative agent of bacterial endocarditis is?
Streptococcus viridans.
What painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis?
Osler nodes
The primary nursing intervention to prevent bacterial endocarditis is to?
Counsel parents of high-risk children about prophylactic antibiotics.
A common, serious complication of rheumatic fever is?
Cardiac valve damage
A major clinical manifestation of rheumatic fever is?
Polyarthritis
When discussing hyperlipidemia with a group of adolescents, the nurse should explain that high levels of what substance are thought to protect against cardiovascular disease?
High-density lipoproteins (HDLs).
The leading cause of death after heart transplantation is?
Rejection
One of the most frequent causes of hypovolemic shock in children is?
Blood loss
What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy?
Anaphylactic shock
What occurs in septic shock?
Increased cardiac output
A child is brought to the emergency department experiencing an anaphylactic reaction to a bee sting. While an airway is being established, what medication should the nurse prepare for immediate administration?
Epinephrine
Nursing interventions for the child after a cardiac catheterization include choose all that apply
Assess the affected extremity for temperature and color. AND Maintain a patent peripheral intravenous catheter until discharge.
Which clinical manifestations would the nurse expect to see as shock progresses in a child and becomes decompensated shock, choose all that apply.
Cool extremities and decreased skin turgor AND Confusion and somnolence AND Tachypnea and poor capillary refill time
An accurate description of anemia is?
Decreased oxygen-carrying capacity of blood.
Several blood tests are ordered for a preschool child with severe anemia. She is crying and upset because she remembers the venipuncture done at the clinic 2 days ago, the nurse should explain that?
Topical application of local anesthetic can eliminate venipuncture pain.
The most appropriate nursing diagnosis for a child with anemia is?
Activity Intolerance related to generalized weakness.
What explains why iron deficiency anemia is common during toddlerhood?
Milk is a poor source of iron.
When teaching the mother of a 9-month-old infant about administering liquid iron preparations, the nurse should include that:
Adequate dosage will turn the stools a tarry green color.
What is often administered to prevent or control hemorrhage in a child with cancer?
Platelets
Which term is used to describe a child's level of consciousness when the child can be aroused with stimulation?
Obtundation
Which term is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation?
Stupor
Which drug would be used to treat a child who has increased intracranial pressure (ICP) resulting from cerebral edema?
Mannitol
What is descriptive of a concussion?
It is a transient, reversible neuronal dysfunction.
Which type of fracture describes traumatic separation of cranial sutures?
Diastatic
What clinical manifestations would suggest hydrocephalus in a neonate?
Bulging fontanel and dilated scalp veins
Exophthalmos (protruding eyeballs) may occur in children with:
Hyperthyroidism
The nurse is teaching the parents of a child who is receiving propylthiouracil for the treatment of hyperthyroidism (Graves' disease). Which statement made by the parent indicates a correct understanding of the teaching?
If my child develops a sore throat and fever, I should contact the physician immediately.
What effect does immobilization have on the cardiovascular system? It causes:
Venous stasis.
True false : If an infant with nasopharyngitis shows signs of an earache, it may indicate respiratory complications and possible secondary infections.
False
True false: Acute streptococcal pharyngitis must be treated with antibiotics to prevent acute rheumatic fever.
True
What is the significance of continuous swallowing after a tonsillectomy?
There may be bleeding.
True false: Clinical symptoms and blood test are both needed to establish the diagnosis of infectious mononucleosis.
True
True false: benzocaine ear drops cannot provide topical relief for the pain of otitis media.
True
What instructions should the nurse practitionergive the parents of a child with otitis media and has a prescription foramoxicillin?
If the child has had it before and also has a severe case of AOM give in high doses (80 to 90 mg/kg/day, divided twice daily) for 10 days. For a child with mild to moderate AOM who is 6 or older, a 5 to 7 day course is accurate.
True false: eliminating tobacco smoke from the environment can help prevent otitis media.
True
Define otitis media with effusion.
Fluid in the middle ear space without symptoms of acute infection.
Define otitis externa.
Infection of the external ear resulting from normal ear flora that assume pathogenic characteristics under conditions of excessive wetness or dryness.
List the symptoms of acute otitis media.
fever and otalgia, ear pain
What disorder should you suspect if a preschooler has "froglike croaking" sound on inspiration, is agitated.
Acute epiglottis
Why would you not want to examine a child's throat that has drooling and is very sore?
They might aspirate, refer them to primary care provider immediately, and put resuscitation and suctioning equipment by the bedside.
What interventions should be done for mild croup?
cool mist
What organism is thought to cause epiglottis?
Hemophilus influenzae
Stridor is aggravated when a child with epiglottis is spine?
True
What is the value of having a parent at the bedside of a child with laryngo-tracheobronchitis?
They may comfort the child by holding them and rocking them.
What is usually the causative organism of bronchiolitis?
Human meta-pneumovirus
If a child is positive for Human Meta-pneumovirus what type of precautions should be implemented?
Use contact and standard precautions, and put child in separate rooms, may need to use droplet precautions.
What nursing interventions are necessary for a child with staphylococcal pneumonia?
Watch vital signs, especially respiratory; give caution when giving fluids.
What causes a young child to have a foul smelling discharge and frequent sneezing?
a foreign body
What test should be used to monitor carbon monoxide poisoning?
ABG's and COhB
What is the primary factor responsible for possible multiple clinical signs and symptoms of cystic fibrosis?
Mechanical obstruction caused by increased viscosity of mucous gland secretions.
What is the earliest clinical manifestation of Cystic fibrosis?
Meconium ileus
What tests aid in the diagnosis of cystic fibrosis?
Sweat test, absence of pancreatic enzymes, radiography, COPD, and family hx.
Children with CF should receive aerosolized bronchodilator when?
Once or twice a day
What is DNase?
Dornase alfa, which decreases the viscosity of mucous.
What are significant side effects?
voice alterations and laryngitis
What are signs of pneumothorax in a child?
Tachypnea, tachycardia, dyspnea, pallor, and cyanosis
What are the nursing considerations with administering pancreatic enzymes to a child with CF?
Only proprietary enzymes should be given to children, generic enzymes are not considered adequate.
What measures are used for pain control after a tonysilectomy?
Ice collar, analgesics, tetrecaine lollipops or ice pops, antiemetic's
What is laryngomalcia?
A very common condition of infancy, in which the soft, immature cartilage of the upper larynx collapses inward during inhalation, causing airway obstruction.
What is broncho-pulmonary dysplasia?
A chronicling condition that affects newborn babies who were either put on a breathing machine after birth or were born very early, prematurely.
What medications are used for broncho-pulmonary-dysplasia?
Corticosteroids, oxygen, Synagis, Palivizumab
What are indications of tubes in the ears?
Persistent ear infections
What are the complications of tonsillitis?
URI, OM
Is there scarring with Impetigo?
No scarring
What often causes cellulitis?
Strep or staph
What are some manifestations of hypoglycemia?
Weakness,dizziness, difficulty concentrating ,speaking ,focusing ,and coordianting ,seating and pallor
What is Gower's sign?
It is a characteristic way of rising from a squatting or sitting position on the floor
This disorder has Gower's sign ,waddling gait ,and lordosis. What is it?
Duchenne Muscular dystrophy
What is the first action anurs should do if achild has a hypercynotic dspell?
Place the child in a knew chest position
What is the blood flow pattern in Ventricular sepatl defect?
There is increase pulmonary blood flow because of the left to right shunt
What complication is prevented when surgery is donefor apatent ductus arteiosus?
Prevent pulmonary vascularngestion
Which of the following defects results in obstruction of blood flow---aortic stensois ,trcuspid atresia or atrial septal defect?
Aortic stensois
Pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertropophy make up what syanotic heart defect?
Tetralogy of Fallot
Does the child with congenital heart disease need the opportunity to play with others?
Yes the child needs opportunity for socialization
What refers to involuntary, rhythmic and repetitive muscular contractions, that occur usually in the ankles, wrist and the kneecap or patella, ankles are the most commonly affected?
Clonus
What are the symptoms of bacterial endocarditis?
Decreased appetite ,intermittent fevers, muscle and joints ache, does not seem like self
What is the primary nursing intervention to prevent bacterial endocarditis?
Counsel parents of high risk kids about the need for good dental health.
If a child has symptoms of bacterial endocariditis ,can they wait until a clinical appointment is arranged to see a medical provider?
No, the child needs to be seen immediately for an evaluation
How can the school nurse prevent rheumatic fever?
Refer the child with symptoms for a throat culture
What medications are used for the treatment of Kawasaki disease?
High dose Intravenous gamma globulin and salicylate therapy
Why is nursing care for a child with Kawasaki challenging?
The child is very irritable
When is selective cholesterol screening recommended for children over 2years of age?
When body mass index = 95 percentile
The mother of a young infant is worried her child is going to get meningitis. What should yo say to this mother?
Vaccinations to prevent pneumococcal and H Influenza type B are available
What are petechiae?
Pinpoint flat round red spots under the skin surface caused by intradermal hemorrhage, bleeding into the skin.
A child arrives on the floor with possible bacterial meningitis.When should the nurse start the antibiotic?
As soon as possible
When planning care for a a school age child with bacterial meningitis, What intervention should be included?
Keep environmental stimuli to a minimum
How can one reduce the incidence of Reye Syndome?
Avoid ASA for children with a viral illness
What is an important intervention for child with Syndrome of inappropriate ADH secretion?
Restrict fluids
What are the hallmark symptoms of diabetes Mellitus?
Frequent urination, polyuria , Glycosuria ,and polydipsa
What should a child with Diabetes carry when exercising?
Extra snacks
This disorder is caused by aspirochete spread by ticks?
What is Lyme disease
IS there still a" no nits policy" in most schools?
The child can remain in school with treatment done at home
What is the inappropriate voiding of urine at least twice a week?
Enuresis
When does enuresis cease? Enuresis ends between 6 and 8 years of age
Enuresis ends between 6 and 8 years of age
What is encoporesis?
a child may be unaware of a prior sensation or be unable to control the urge to defecate once it begins
What advice should parents receive from a nurse regarding encoporesis?
Are parents that most problems with encoporesis resolve successfully with some relapse periods
What are important points regarding the diagnosis of ADHD?
A multidisciplinary evaluation is important. Need to determine whether the child's behavior is age appropriate or problematic
What is the goal for children with cognitive impairment?
The goal for children with cognitive impairment is the promotion of optimal social,physical, cognitive ,and adaptive development
Name a secondary prevention activity for children with cognitive impairment.
Newborn screening for treatable inborn errors of metabolism
The AAIDD classifies mental retardation based on what?
Adaptive skills domain.
Name on intervention that parents can do to prevent lice from spreading.
Discourage your child from sharing items such as hats, scarves, and hair ornaments
What guidance can the nurse give to parents of cognitive impaired children about discipline?
Clear limit setting .Behavior modification is excellent to use
What are appropriate interventions to foster social development in children with cognitive imparement?
peer experiences, infant stimulation and preschool programs
What are characteristics associated with Down's syndrome?
Oblique palebral fissures, depressed nasal bridge, protruding tongue, transverse palmer creases
True or False: The child with Down's syndrome is unable to cling or "cuddle up" like other children
True
What is the second most common genetic cause of cognitive impairment?
Fragile X Syndrome
How does one define cardiac output?
It is the volume of blood ejected by the heart in 1 minutes
What should preoperative education for a six year old undergoing cardiac catheterization do?
adapted to the child's a level of understanding
What should be prevented in children with hypoxia secondary to a cardiac defect?
Dehydration
Why do infants with congestive heart failure have a need for more calories?
Infants with CHF have a greater metabolic rate because of poor cardiac function and increased heart and respiratory rate
What is a common sign of digoxin toxicity?
Vomiting
When should you with hold digoxin in a toddler?
If a 1 minute pulse is less than 90 beats per minutes
The bandages and sheets of a child who just had a cardiac cath are soaked with blood, what should th enurse do?
apply direct pressure above catheterization site
True or false: CHD is an underlying problem in CHF in children
true
What is a goal of therapy for children with derebral palsy?
Maximize the child's capabilities
What would you expect to observe in a child with severe spastic cerebral palsy?
Scissoring of the legs
Ringworm, dermatophytoses are __________ infections of the skin, hair ,or nails
Fungi
Children with Tourette's syndrome can be treated by what drug?
Haldol
A child receives Ritalin for ADHD, what is a therapeutic effect of this drug?
Increase attention span
What lab finding should you expect to see with a child who has tetralogy of fallot
Polycythemia
What medication is used to close the patent ductus arteriosus?
Indomethacin
The parents of a child with tetralogy of Fallot asked why the infant's fingers are "clubbed", how would you answer them?
It is the result of extra capillaries forming in the tips of extremities as the body attempts to send blood to all body parts
This defect requires the nurse to take blood pressure readings in the upper and lower extremities. It is __________
Coaractation of the aorta
A child has developed rheumatic fever. The nurse considers the possibility that the child had what earlier _____________
Strep throat, impetigo, or scarlet fever
A parent of a toddler who has Kawasaki's is concerned because the child is very irritable. The nurse tells the parent _________
Irritability is part of Kawasaki's disease
What is often the first symptom of a Acyanotic heart defect?
Heart murmur
What is a condition that places the child at risk for infective endocarditis?
Congenital heart defect
How can the incidence of rheumatic fever be reduced?
By culturing and treating strep infection
What should be the emphasize of discharge teaching for a child who has rheumatic fever?
Compliance with long term antibiotic therapy
How is hyperlipidemia Managed in most children?
Diet and weight loss
Children with Kawasaki Disease receive aspirin for what reason?
Antithrombolytic therapy
Name three clinical manifestations of chronic hypoxemia in children
Squatting, clubbing, polycythemia
This term refers to the resistance against which the ventricles must pump against
Afterload
An expected finding in an analysis of CSF in a child with bacterial meningitis is _________
Cloudy
A child has pneumococcal meningitis. The nurse review the child's hisitory. What might have caused this or transmitted this infectious agent?
Middle ear infection
Which of the following positions is appropriate following feeding after pyloric stenosis?
right side it promotes drainage
Toddler treatment for pinworms, what is important for mom to do to prevent reinfection?
wash their hands
A 2 day old infant has heart murmur, EKG normal, what disorder most likely?
patent ductus arteriosis
A 3 year old diagnosed with intussuseption what symptom would make you suspect this?
bloody mucus or current jelly stool
A 3 year old child with cardiac cath, what would you watch for post procedure?
pedal pulses, swelling can cause problems
A 6 month old has roseola, classic sign of this is?
temp falls, rash appears
8 month old with VSD, nursing diagnosis
ineffective heart as a pump
A child who has anemia, needs blood transfusion, what do you give?
give packed red blood cells
After surgery for pyloric stenosis, (well bubbled) burp baby to?
prevent pressure on incision line
An infant has surgery to relieve pyloric stenosis, immediate post op priority is?
infection
Child is born with VSD, goal of closing is to prevent?
cardiac failure
Coarctation demonstrates few symptoms but you'll find?
femoral pulses upper B/P will be higher than lower
Cystic fibrosis poo is?
fatty frothy and foul
Early manifestations of cystic fibrosis?
male sterility
Greatest cyanosis shows in infant with what condition?
transposition of the great vessicles
Infant with congenital heart disease shouldn't become dehydrated because?
cerebral vascular accident, at risk for clots, has high hematocrit
On assessment immediately following cardiac surgery, what would you expect to find?
hypothermia, they should be cold
Why is it important to do a sweat test on an infant with meconeum ileus?
meconium ileus is symptom of cystic fibrosis
Scarlett fever caused by?
streptococci
School age child, rheumatic fever, health history reveals?
knee pain, subcutaneous nodules
Teach mom of tetrology of fallot if he become cyanotic to?
use knee chest maneuver toddler may squat
Tetrology of fallot, what would you discover?
polycythemia
The best way to identify food allergies?
elimination diet
To assess for cyanosis for infant with cardiovascular disease?
check buccal membrane and tongue
How does cystic fibrosis affect the body?
Dysfunction of the exocrine glands leads to overproduction of thick, tenacious mucus affecting the: lungs, small intestine, pancreas, and liver.
Cystic Fibrosis Symptoms
Impaired digestion, fatty stool, distended abdomen, impaired growth, cyanosis, shortness of breath, chronic cough, barrel-shaped chest
How does CF manifest in infancy?
Newborns can have a 'meconium ileus' at birth, where the newborn fails to pass the first meconium stool. Distended abdomen, inability to pass stool, and bile-stained emesis
Patient Education for CF
Teach parents about equipment chest physiotherapy, respiratory meds pancreatic enzymes with meals & snacks, monitor blood sugar, regular follow-up visits, immunizations, etc.
Esophageal Atresia & Tracheoesophageal Fistula:
failure of the esophagus to develop as a continuous passage during fetal development.
Esophageal Atresia & Tracheoesophageal Fistula Symptoms
Symptoms: frothing and bubbling at the mouth and nose, excessive drooling, coughing, cyanosis, respiratory distress.
Esophageal Atresia & Tracheoesophageal Fistula NSG Care
maintain patent airway, prevent aspiration, monitor vitals, prevent infection, parental nutrition. After surgical repair, advance from water to oral feedings to make sure there is no leaking after surgery
Congenital Diaphragmatic Hernia
Life threatening congenital abnormality associated with a pulmonary hypoplasia as a result of abdominal contents herniating into chest
Congenital Diaphragmatic Hernia Symptoms
severe respiratory distress, scaphoid abdomen, bowel sounds heard in chest.
Pertussis Symptoms
"whooping cough": characterized by cough with a whooping sound on inspiration.
Pertussis NSG Care
place on droplet precautions, monitor vitals and oxygen saturation, hydration, nutrition, fluids, administer antibiotics
Hypertrophic pyloric Stenosis Symptoms
Olive-shaped mass in the right upper quadrant, "peristaltic wave" that occurs when the patient is lying down, vomiting occurs 30-60 minutes after eating, and as obstruction worsens vomiting becomes projectile.
Hirschsprung Symptoms
Newborn failure to thrive, inability to pass stool meconium within the first 24-48 hours, refuses to eat, vomits bile, and abdominal distention
infant failure to thrive, constipation, abdominal distention, episodic vomiting & diarrhea, child-constipation, abdominal distention, visible peristalsis, ribbon-like stool, palpable fecal mass, and malnourishment.
Hirschsprung's disease
lack of ganglionic cells in the colon results in mechanical obstruction stool then accumulates in the bowel, causing dilation, treated with surgical removal of aganglionac section and possible temp, colostomy
Hypertrophic Pyloric Stenosis
thickening of the pyloric sphincter, which creates an obstruction, treated with pylorotomy
When administering digoxin (Lanoxin) to an infant, the medication should be withheld and the physician notified if the:
pulse rate is below 100 beats/min
Prevention of rheumatic fever can best be accomplished by:
having sore throats cultured as soon as possible
The nurse is assessing a child admitted with possible Kawasaki's disease. A characteristic sign or symptom that the nurse should observe and document would be:
peeling skin on fingers
A child who has had heart surgery returns to the pediatric unit with a chest tube and drainage bottles in place. What is a priority nursing responsiblity when caring for a child with chest tubes?
keep the drainage bottle below the chest level at all times
When the patient experiences apprehension and urticaria while receiving a blood transfusion, the nurse:
stops the transfusion, allows normal saline solutions to run slowly, and notifies the charge nurse
Thalassemia major (Cooley's anemia) is treated primarily with:
multiple blood transfusions
Which principle should the nurse teach the parent concerning administering liquid iron preparations to the child with iron-deficiency anemia?
administer between meals
What is a characteristic manifestation of Hodgkin's Disease?
enlarged lymph nodes
The pathologic disturbance of pyloric stenosis results from:
hypertrophy of the pyloric muscle
Which menu selections are best for a child diagnosed with celiac disease?
corn tortilla and fresh fruit
After surgery for pyloric stenosis, the nurse could anticipate that the infant will:
Be fed clear liquids within 6 hours
The administration of prednisone to children with nephrosis creates the problem of:
increased risk of infection
Daily weights are obtained in children with nephrosis to monitor:
changes in the amount of edema
What may indicate a need for insulin in a diabetic child?
red lips and fruity odor to the breath
The nurse teaches the diabetic child to rotate sites of insulin injection in order to:
prevent lipoatrophy of subcutaneous fat
Kussmaul's respirations are seen in diabetic children with:
ketoacidosis
Fetal Circulation: Ductus Venosus -
Shunts blood past portal circulation
Fetal Circulation: Ductus Arteriosus -
Shunts blood past the lungs
Fetal Circulation: Foramen Ovale -
Shunts blood past lungs
Right Side of Heart:
SVC/IVC, RA, Tricuspid Valve, RV, Pulmonic Valve, Pulmonic Artery, Lungs
Left Side of Heart:
Pulmonary Veins, LA, Mitral Valve, LV, Aortic Valve, Aorta/Lg. Arteries/Capillaries/VC
Cardiac Output:
Volume of blood ejected from heart in 1 min, CO = HR x SV
Stroke Volume:
Amount of blood ejected by heart in any 1 contraction
3 Factors that Influence Stroke Volume:
Preload, Afterload, Contractability
Preload:
Volume of blood returning to heart
Afterload:
Resistance against which ventricles must pump when ejecting blood
Contractility:
Efficiency of the myocardial fiber to act as a pump
Subtle Symptoms of CV Dysfunction:
Duskiness w/ feeding & exertion, Dyspnea w/ physical effort, Fatigue, Sweating w/ feeding, Excessive sweating, Expiratory grunt, Squatting, Clubbing (LT), Failure to Thrive
Diagnosing CV Dysfunction:
Radiography, ECG, Echocardiography, Cardiac Catheterization
Radiography:
Permanent record of heart size and configuration, it's chambers and great vessels
ECG:
Detects arrhythmias, muscular damage, hypertrophy, effects of electrolyte imbalance
Echocardiography:
Uses high frequency sound waves obtained by a transducer to produce an image of cardiac structure
Cardiac Catheterization:
Uses radiopaque catheters placed in peripheral blood vessel and advanced into heart to measure pressures and oxygen levels in heart chambers & visualize heart structures & blood flow patterns.
Defects of Increased Pulmonary Flow:
Patent Ductus Arteriosus (PDA), Atrial Septal Defect (ASD), Ventrical Septal Defect (VSD), Artioventricular Canal Defect (AVC)
Defects of Increased Pulmonary Flow: Patent Ductus Arteriosus (PDA)
Failure of the fetal ductus arteriosus (artery connecting the aorta and pulmonary artery) to close w/in the 1st weeks of life.
Patent Ductus Arteriosus (PDA): Symptoms -
May Be Asymptomatic, CHF, Full Bounding Pulses, Machine Like Murmur
Patent Ductus Arteriosus (PDA): Treatment -
Prostaglandin Inhibitors, Surgical Ligation
Patent Ductus Arteriosus (PDA): Risks -
Bacterial Endocarditis, Pulmonary Vascular Obstructive Disease later in life
Defects w/ Increased Pulmonary Flow: Atrial Septal Defect (ASD) -
Abnormal opening RA and LA that allows blood from the higher pressure LA to the lower pressure RA. Larger the hole larger the problem.
Atrial Septal Defect (ASD): Symptoms -
May be Asymptomatic, CHF, Murmur
Atrial Septal Defect (ASD): Treatment -
Surgical Patch Closure
Atrial Septal Defect (ASD): Risks -
Bacterial Endocarditis, Atrial Dysrhythmias
Defects w/ Increased Pulmonary Flow: Ventrical Septal Defect (VSD) -
Abnormal opening between the RV and LV. Blood goes from higher pressure LV to lower pressure RV.
Ventrical Septal Defect (VSD): Symptoms -
CHF, Murmur, Frequently assoc. w/ other defects
Ventrical Septal Defect (VSD): Treatment -
Pulmonary Artery Banding, Suture or Patching
Ventrical Septal Defect (VSD): Risks -
Bacterial Endocarditis, Pulmonary Vascular Obstructive Disease
Defects w/ Increased Pulmonary Blood Flow: Artioventricular Canal Defect (AVC) -
Incomplete fusion of the endcardial cushions.Large opening in the center of the heart which allows blood to flow between all four chambers. Common in DS children.
Artioventricular Canal Defect (AVC): Symptoms -
Mod - Sev. CHF, Murmur, Mild cyanosis w/ crying
Artioventricular Canal Defect (AVC): Treatment -
Banding, Patch Closure
Artioventricular Canal Defect (AVC): Risks -
Bacterial Endocarditis, Pulmonary Obstructive Vascular Disease
Defects w/ Decreased Pulmonary Flow:
Tetralogy of Fallot, Tricuspid Atresia
Defects w/ Decreased Pulmonary Flow: Tetralogy of Fallot -
4 Classic Defects, VSD, Aorta laying over VSD, Pulmonary Stenosis, Right Ventricular Hypertrophy
Tetralogy of Fallot: Symptoms -
Cyanosis, Murmur, Tet Spells
Tetralogy of Fallot: Tet Spells -
Acute spells of cyanosis w/ hyperpnea (deeper more rapid respirations). May occur during crying, defecating of feeding.
Tetralogy of Fallot: Treatment of Tet Spells -
Calm infant, Place in knee to chest position, Give blow by O2, Call for assistance, IV Morphine, Fluid Replacement
Tetralogy of Fallot: Treatment -
Surgical Repair
Defects w/ Decreased Pulmonary Blood Flow: Tricuspid Atresia -
Failure of tricuspid valve to develop resulting in lack of communication between RA and RV. PDA allows child to remain alive.
Tricuspid Atresia: Symptoms -
Cyanosis,Tachycardia, Dypnea, Hypoxemia, Clubbing (LT)
Tricuspid Atresia: Treatment -
Prostaglandin to maintain patency of PDA, Surgical Repair
Tricuspid Atresia: Risk -
Bacterial Endocarditis
Obstructive Defects:
Aortic Stenosis, Pulmonic Stenosis, Coarctation of the Aorta
Obstructive Defects: Aortic Stenosis -
Narrow aortic valve d/t thickened or deformed valve cusps.
Aortic Stenosis: Symptoms -
Murmur, Decreased CO2, Faint Pulses, Hypotension, Tachycardia, Poor Feeding, Exercise Intolerance
Aortic Stenosis: Risks -
Bacterial Endocarditis, Coronary Insufficiency, Ventricular Dysfunction
Aortic Stenosis: Treatment -
Balloon Angioplasty, Aortic Valvotomy, Rarely results in "normal" valve
Obstructive Defects: Pulmonic Stenosis -
Narrowing at the entrance to the pulmonary artery.
Pulmonic Stenosis: Symptoms -
May be asymptomatic, Murmur, CHF, Cyanosis (severe)
Pulmonic Stenosis: Risks -
Bacterial Endocarditis, Ventricular Hypertrophy
Pulmonic Stenosis: Treatment -
Balloon Angioplasty
Obstructive Defects: Coarctation of the Aorta -
Localized narrowing of the aorta near the ductus arterosis
Coarctation of the Aorta: Symptoms -
Increased pressure in head & upper extremities, Decreased pressure in body and lower extremities, *BP and Pulse vary between upper and lower extremities
Coarctation of the Aorta: Treatment -
Balloon Angioplasty
Mixed Blood Flow Defects:
Transposition of the Great Vessels, Truncus Arteriosus, Hypoplastic Left Heart Syndrome
Mixed Blood Flow Defects: Transposition of the Great Vessels -
No communication between systemic and pulmonary circulation. PDA keeps patient alive.
Transposition of the Great Vessels: Symptoms -
Dependant on severity and PDA, Cyanosis, CHF, Depressed Functioning
Transposition of the Great Vessels: Treatment -
Surgery - arterial switch
Mixed Blood Flow Defects: Truncus Arteriosis -
One artery arises from the heart and forms both aorta and pulmonary artery
Truncus Arteriosis: Symptoms -
May be asymptomatic, Variable cyanosis, Poor growth, Activity intolerance
Truncus Arteriosis: Risks -
Bacterial Endocarditis
Truncus Arteriosis: Treatment -
Surgical Repair
Mixed Blood Flow Defects: Hypoplastic Left Heart Syndrome -
Underdevelopment of the left side of the heart.
Hypoplastic Left Heart Syndrome: 4 Common Defects -
Hypoplastic left heart & ascending aorta, Coarctation of the aorta, Aortic and mitral valve defects, Progressive deterioration and cardiovascular collapse if PDA closes
Hypoplastic Left Heart Syndrome: Symptoms -
Mild Cyanosis, CHF until PDA closes
Hypoplastic Left Heart Syndrome: Treatment -
Multi-stage surgical repair
Congestive Heart Failure:
Inability of the heart to pump an adequate amount of blood to systemic circulation to meet body demands.
CHF: Causes -
Volume Overload, Pressure Overload, Decreased Contractility, High Cardia Output Demands
CHF: Manifestation Classifications -
Impaired Myocardial Function, Pulmonary Congestion, Systemic Venous Congestions
CHF: Symptoms of Impaired Myocardial Function -
Tachycardia, Inappropriate Sweating, Oliguria, Fatigue/Weakness, Restlessness, Anorexia, Weak Peripheral Pulses/Pale Cool Extremities, Hypotension, Gallop Rhythm, Cardiomegaly
CHF: Symptoms of Pulmonary Congestion -
Tachypnea, Dyspnea, Retractions (infants), Flaring Nares, Exercise Intolerance, Feeding Difficulties, Cyanosis, Irritability, Wheezing/Crackles/Grunting/Cough
CHF: Symptoms of Systemic Venous Congestions -
*Weight Gain, Hepatomegaly, Peripheral Edema, Ascites, Neck Vein Distension
CHF: Signs of Impending Heart Failure -
Increase in Weight, Pulse, Cyanosis
CHF: Goals of Treatment -
Improve Cardiac Function, Remove Accumulated Fluid and Sodium, Decrease Cardiac Demands
CHF: Medications to Improve Cardiac Function -
Digoxin, ACE Inhibitors
CHF: Digoxin -
Increases contractility, Slows conduction through AV node, Enhances diuresis
CHF: Digoxin Toxicity -
Bradycardia, Nausea, Vomiting, Visual Disturbances
CHF: Digoxin Administration -
2 RN's check dosage, 1 min. apical pulse, Hold if pulse below 100, Monitor I&O, Between 0.8-2ug/L,
CHF: ACE Inhibitors -
Blocks conversion of angiotension I to angiotension II, Catopril, Enalapril, lisinopril
CHF: Treatment of Fluid Accumulation -
Diuretics, Fluid Restriction
CHF: Treatment to Decrease Cardiac Demands -
Minimize metabolic needs (avoid cold stress), Treat infection, Reduce breathing effort (semi-fowlers), Sedation, Rest, Frequent small meals, Administer ordered O2
Hypoxemia:
Arterial oxygen tension (or pressure) that is lower then normal. Identified by measuring arterial oxygen saturation (SaO2) or PaO2.
Hypoxemia: 2 Physiological Changes -
Polthycemia, Clubbing
Hypoxemia: Polthycemia -
Increased number of RBC's
Hypoxemia: Clubbing -
A thickening and flattening of the tips of the fingers and toes.
Acquired Cardiovascular Disorders:
Bacterial Endocarditis, Rheumatic Fever, Kawasaki Disease
Bacterial Endocarditis:
Infection of the valves and inner lining of the heart. Most commonly caused by Strepococcus viridians but many also be caused by Staphlococcus aureus or Candida albicans
Bacterial Endocarditis: Symptoms -
Low grade fever, Anorexia, Malaise, Headache, Weight loss, New/different murmur, Osler Nodes, Janeway Spots
Bacterial Endocarditis: Diagnosis -
Echocardiogram, ECGBlood Cultures
Rheumatic Fever:
An autoimmune illness resulting from a systemic inflammatory collagen disease that follows a group A beta hemolytic streptococcal infection.
Rheumatic Fever: Compilications -
Rheumatic Heart Disease
Rheumatic Fever: Aschoff Bodies -
Inflammatory hemorrhagic bullous lesions in connective tissue, blood vessels, brain, joints, pleura
Rheumatic Fever: Prevention -
Screen all sore throats
Rheumatic Fever: Treatment -
Antibiotic, Aspirin, Bed rest, Long term antibiotic prophylaxis
Kawasaki Disease:
Mucocutaneous Lymph Node Syndrome. Acute systemic vasculitis of unknown cause.
Kawasaki Disease: Diagnostic Criteria -
Fever lasts 5+ days, Bacterial conjunctivitis w/out exudate, Changes in oral mucosa (erythema, dryness, lip fissures, strawberry tongue), Changes in extremities (peripheral edema, erythema of palms/soles, peeling of hands/feet), Cervical lymphadenopathy, Polymorphous rash
Kawasaki Disease: Risks -
Damage to CV system, Leading cause of acquired HD in US (scarring)
Systemic Hypertension:
Consistent elevation of B/P
Systemic Hypertension: Causes -
Renal dysfunction, CV dysfunction, Endocrine dysfunction, Neurologic dysfunction, Drugs
Systemic Hypertension: Symptoms -
Frequent headaches, Dizziness, Vision changes,
Systemic Hypertension: Symptoms in Infants:
Irritability, Head banging/rubbing, Night screaming
Hyperlipidemia:
Increased amount of lipids, play and important role in producing atherosclerosis leading to coronary artery disease
Hyperlipidemia: Plaque Detection -
May be seen as early as 2 yrs old.