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SAC Peds Exam Test#4

Neonates' major respiratory muscle? Diaphragm
General nursing intervention categories for peds in resp. distress? Maintain patent airway, Assess/Monitor resp system, Ease resp efforts, Maintain calm environment, promote rest and hydration, maintain nutritional needs, reduce fever, admin meds, pt teaching
How much O2 does a simple mask provide? 30-60% (6-10L)
How much O2 does a nonrebreather provide? 50-60% (10-12L)
How much O2 does a FULL nonrebreather provide? almost 100% (10-15L)
How much O2 does a nasal cannula provide? 40% (1/8 - 5L)
How much O2 does a hood provide? close to 100%
When does the incidence of tonsilitis peak? 4-7 yrs old
Clinical manifestations of tonsilitis? Sore throat, Red/swollen tonsils, mouth breathing, sleep apnea, diff swallowing, fever
Diagnostic test for tonsilitis? Throat C&S, Rapid Strep
Nursing actions for Tonsilitis? Ease resp efforts, provide comfort (warm NS, meds, lozenges), reduce fever, promote hydration, antbx tx, rest, pt teaching
#1 post-op nursing care for tonsilectomy? Immediately assess for BLEEDING & ability to SWALLOW secretions
What is bronchiolitis? Acute VIRAL infxn of bronchioles causing inflammation and obstruction
Why is Nasal Swab or Nasal washing obtained with bronchiolitis? Viral Respiratory Panel (VRP)
At what age is RSV usually seen? < 2yrs old, in winter/spring
Palivizumab (Synagis) Humanized monoclonal antibody given IM once a month to high risk infants during RSV season
Priority nursing actions for infant w/ Bronchiolitis w/ +RSV? Raise HOB--> Suction airway --> assess lung sounds
Should a mom breastfeed her baby if he has bronchiolitis and SOB? No, because baby has inc. WOB and may aspirate
4-2-1 method? Child's wt in kg. 1st 10kg x 4 + 2nd 10kg x 2 + rest of kg x 1 = maintenance IV rate
Clinical manifestations of Bronchiolitis/RSV? Rhinorrhea, cough, adventitious lung sounds, inc RR/WOB, resp distress, fever, poor feeding
Nursing implementations for Bronchiolitis/RSV? Raise HOB, Suction, Hypertonic Saline %3 HHN, Bronchodilator, CPT, Fluids, Monitor V/S, Supplement O2, Reduce fever, rest, Handwash
What is Croup? VIRAL Infxn/Swelling of larynx, trachea, epiglottis, bronchi (upper respiratory tract)
Priority nursing actions for croup? Conserve energy, Raise HOB, Assess lung sounds, obtain SpO2
What is decadron and what does it do? Systemic corticosteroid that reduces inflammation
What is acute epiglottitis? Bacterial form of croup affecting epiglottitis
What do you NOT do with acute epiglottitis? Do not examine throat
4 D's of acute epiglottitis? Drooling, Dysphagia, Dysphonia, Distressed Inspiratory Effort
Highest priority for croup/epiglottitis? Maintain patent airway
What is Asthma? An inflammatory disorder of the airways causing episodes of wheezing, breathlessness, chest tightness, and cough.
Clinical manifestations of Bronchial Asthma? Chest tightness, SOB, Tachypnea, SaO2 below 94% on RA, Wheezes, Crackles, Retractions, Nasal flaring,Non-productive cough, Silent Chest, Restlessness, Fatigue Orthopnea, Abdominal Pain, CXR = hyperinflation
Interventions for Bronchial Asthma? Auscultate lung sounds!!, Monitor VS (HR, RR), Monitor SaO2, Monitor respiratory effort, Humified oxygen, Calm environment, Ease respiratory efforts, Promote hydration, Promote rest, Monitor labs/x-rays, Patient teaching
Reason Bronchial Asthmatics are hospitalized? PEFR- < 50% of baseline, Inspiratory & Expiratory Wheezing, Tachycardia & Tachypnea, Dyspnea, retractions, 02 Sat 91% or lower after aggressive tx
Meds for Bronchial Asthma? Albuterol, Cromolyn sodium, Solumedrol, Xopenex, Pulmicort, Singulair, Symbicort, Advair, Antibiotics
Across-tic for A-S-T-H-M-A for patient education? A- Asthma, what is it?; S-S/s; T-Triggers; H-How to control; M-Meds; A-Action plan
Long term goal of Asthma treatment? Minimize symptoms, prevent acute episodes, decrease side effects of therapy, and to help child maintain a normal lifestyle.
What is Cystic fibrosis? Mutisystem disorder caused by genetic autosomal recessive trait affecting the exocrine glands where the ducts become clogged with thick secretions
How is Cystic fibrosis diagnosed? History of familial disease, Physical findings , Nutritional status, Chest X-Rays, Pulmonary function test, Stool fat/enzyme analysis, Sweat Chloride test, CF Mutation panel
Pulmonary manifestations of CF? Wheezing, Eventual & Progressive, Repeated lung infections, Dry, non-productive coughWet & paroxysmal cough, Emphysema/Atelectasis, Barrel-chest, Clubbing, Cyanosis
GI manifestations of CF? Steatorrhea= large, loose, frothy, and foul-smelling stools, Increased appetiteLoss of appetite, Weight loss, FTT, Distended abdomen, Thin extremities, Deficiency of A,D, E, K, Anemia
Interventions for CF? Airway Clearance - Chest physiotherapy (CPT), Drug Therapy, Nutrition - needs are at 150%, Exercise, Patient Teaching
2 fetal shunts Foramen ovale, Ductus arteriosus
How does foramen ovale close? With 1st breath, inc. pressure in left side of heart forces flap to close
How does ductus arteriosus close? Inc. O2 sat causes it to close within 24hrs after birth
What causes Increased Pulmonary Blood Flow (Acyanotic Heart Defects)? Defects that cause shunting of blood from high pressure L to lower pressure R because of inc. pulmonary blood flow causing dec. systemic O2 blood flow and R/L side hypertrophy; PDA, ASD, VSD
What causes Decreased Pulmonary Blood Flow (Cyanotic Heart Defects)? Unoxygenated, or desaturated, blood is entering the systemic circulation; Tetralogy of Fallot, Transposition of Great Arteries, Pulmonary Stenosis
How does body compensate for Cyanotic heart defects? Increase in RBC (polycythemia)
What causes Obstruction to Systemic Blood Flow (Obstructive Heart Defects)? Blood exiting heart meets narrowed area (stenosis), causing back up of blood into L ventricle, inc. pressure, leading to hypertrophy and low cardiac output; Coarctation of Aorta, Aortic stenosis, Pulmonic stenosis
What is caused by Obstructive Heart defects? CHF w/ pulonary edema and Low Cardia output --> diminished pulses, poor color, prolonged cap refill, dec. urine, leg cramps, unequal pulses
Pulmonary manifestations of CHF? Tachypnea (early symptom,)Dyspnea, Wheezes,Crackles (late sign), Retractions, Nasal Flaring, Congested Cough
Systemic manifestations of CHF? Tachycardia (early sign), Poor growth and development, Hepatomegaly, Decreased Urine Output, JVD (children), Edema (facial), Ascites, Sudden weight gain
Compensatory response for CHF? Tachycardia, Diaphoresis, Fatigue, Poor Feeding, Failure to Thrive (FTT), Exercise Intolerance, Decreased Peripheral Perfusion, Pallor and/or Cyanosis, Cardiomegaly
How do you improve cardiac functions of CHF? Meds- Cardiac glycosides like Digoxin
How do you promote fluid loss for CHF? Diuretics (Lasix, Aldactone, HCTZ), fluid restriction, daily weights, monitor I
How do you decrease cardiac demands on heart of CHF patient? Promote rest, minimize stress, monitor V/S (especially temp)
How do you reduce respiratory distress in CHF? Lift HOB, give O2
How do you maintain nutrition for peds pt w/ CHF? Nipple vs. Gavage feed, GTT, higher calorie feeding
What do left-to-right lung shunting defects produce? Inc. pulmonary blood flow, CHF, Murmurs, Feeding intolerance, Activity intolerance, Poor growth, FTT, Frequent pulmonary infections
What is a PDA? Patent ductus arteriosus- fetal shunt that failed to close causing inc. left ventricle workload and inc. pulmonary blood flow leading to CHF, Left Ventricular hypertrophy, murmur and bounding pulses
What med is given for a PDA? Indocin (indomethicin)- prostaglandin inhibitor - to close PDA
What is VSD? Ventricular Septal Defect - opening between L/R ventricle that allows inc. pulmonary blood flow into R ventricle/atrium causing s/s of CHF, FTT, and murmurs
What do you see with Cyanotic Cardiac Defects (dec. pulmonary blood flow)? O2 desaturation, cyanosis, polycythemia, clubbing, murmurs
What is the Tetrology of Fallot? 4 cardiac anomalies at once: pulmonic stenosis, VSD + overriding aorta, R ventricle hypertrophy
What does PS do in Tetrology of Fallot? Pulmonic stenosis = dec. pulmonary blood flow
What does VSD + OA do in Tetrology of Fallot? Ventricular Septal Defect and Overriding Aorta mix O2 and deoxygenated blood
What does R-ventricle hypertrophy do in Tetrology of Fallot? Forces deoxygenated blood into L-side of heart into aorta
Why is Prostaglandin E1 given for Tetrology of Fallot? Prostaglandin E1 keeps patent ductus arteriosus to inc. pulmonary blood flow and O2 level
Difference between Indocin and Prostaglandin E1? Prostaglandin E1 keeps PDA open, Indocin closes it
What's a TET spell? Hypercyanotic episode where pt changes LOC to irritable and becomes cyanotic
What do you do before giving Digoxin? Make sure HR > 100bpm
What is an effective nursing intervention the RN can do to reduce cardiac demands and decrease cardiac workload? Cluster care
Created by: cobedad