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Infant Unit II
Unit 2
| Question | Answer |
|---|---|
| Increase pulmonary blood flow | Atrial Septal Defect |
| Tetrology of Fallot | PS, VSD, Overiding Aorta, R Ventricular Hypertrophy |
| Decrease pulmonary blood flow | Tetrology of Fallot |
| Inability of heart to pump adequate blood to systemic circulation at normal filling pressures to meet metabolic needs | CHF |
| Is a s/s of venous congestion from CHF | Peripheral edema (esp. Periorbital) |
| Increase CO and decreases edema (Inc. Urinary output) | Digoxin |
| Parameter for Digoxin | 90-110 bpm |
| S/S of heart failure | Decrease UOP, sweating, fatigue. |
| Hypotonic musculature, separation of sagital suture, oblique palpebral fissures, depressed nasal bridge, depressed nasal bridge, protruding tounge, short stature, transverse palmar crease, hyperflexibility | Down Syndrome |
| High arched narrow palate, protruding tongue, stubby fingers, hypotonic muscles; Use cool mist Vaporizer for these guys. | DS |
| Usually requires surgery to remove aganglionic portion of bowel | Hirschprung Disease |
| Hirschprung Disease pre-op management | Enemas, Low fiber, High calorie, High Protein diet |
| Pre-op cleft lip and palate | Satisfy sucking needs |
| Asymmetry of gluteal and thigh folds with shortening of the thigh | Galeazzi Sign |
| Limited hip abduction, as seen in flexion | Ortolani Test |
| Apparent shortening of the femur, as indicated by the level of the knees in flexion | Allis Sign |
| Pelvis tilts downward instead of upwards when weight is beared on affected hip | Trandelenburg Sign |
| Hydrocephalus neonate s/s | Bulging fontanel, dilated scalp veins, separated by sutures. |
| Occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportions (Na 130-150 mEq/L) | Isotonic Dehydration |
| Occurs when the electrolyte deficit exceeds the water deficit, (Na <130 mEq/L) | Hypotonic Dehydration |
| Results from water loss in excess of electrolyte loss usually caused by a proportionately larger loss of water or a larger intake of electrolytes (Na >150 mEq/L) | Hypertonic Dehydration (most dangerous) |
| What is the earliest detectable sign of dehydration? | Tachycardia (Followed by dry skin & MM, Sunken fontanel) |
| The initial treatment for diarrhea | ORT or ORS |
| The most frequent pathogen (viral) causing diarrhea in young children | Rotavirus |
| Passage of normal stool brown stool indicates it has resolved, tell MD immediately so they stop treatment right away | Intussusception |
| Avoids eye contact | Non-Organic Failure to Thrive |
| Needs consistent Routine | FTT |
| Ask only factual questions to parents like “what time did this happen?” | SIDS |
| Check several times a day to be sure alarm is working | Home Apnea Monitor |
| RN feeding FTT pt | Remain Face-to-Face |
| Feeding a GERD baby | Small frequent feedings |
| Contraindication for breastfeeding | HIV |
| Before discharge of newborn, make sure they have a folow up appointment within | 2-3days |
| These are signs of Digoxin Toxicity | Vomiting, Nausea, Anorexia, Bradycardia , Dysrhythmias |
| Teach parents they must learn specific way to administer digoxin at home | Check HR |
| May need increase in caloric density | CHF |
| Child with hypoxia and cardiac defect, prevent dehydration | Prevents CVA |
| Babies cannot ______ or ______ urine | dilute; concentrate |
| Best place to check for skin turgor in infants | Abdomen |
| Babies should urinate every ____ hrs | 2 |
| Best place for cap refill | Fingers/toes or nose |
| Slight thirst, visible EJ, 3-5% W.L., >1.020; otherwise normal V/S | Mild dehydration |
| Tachycardic, Tachypnea, Orthos ⁺, Irritable, Mod thirst, MM dry, ↓ tears, sunken fonatel, EJ not visible, 6-9% WL, ↓ turgor, ↑cap refill | Moderate Dehydration |
| Tachycardic ↑, Hyperpnea, Shock, Hyperirritable-lethargy, ↑ thirst, MM parched, Absent tears/sunken eyes, Fontanels sunken, Anuria, >10% WL | Severe Dehydration |
| Daily Maintenance Fluid Requirements | 100, 50, 20ml/kg/day |
| Dont add K unless pt has good _____ function | Renal |
| Normal Urine Specific Gravity | 1.010-1.015 |
| If they dont complete Rota vaccine by 6 mo | They dont get it! |
| Is contagious (Contact), spread by fecal-oral route, can happen at any age; kills normal flora of gut (Give soy formula) | Rotavirus |
| If going out of the country | Use bottled water |
| Pediatric Indicators of Cardiac Dysfunction | Poor Feed, Tachypnea, Tachycardia, FTT, Poor weight gain, A.I., DD, PPH, PFH. |
| The most common cause of death in the 1st year | Heart Disease |
| Most common cardiac anomaly | VSD |
| NPO on babies for ____ to ____ hours before cardiac cath | 4; 6hrs |
| Ortolani and Barlow test best before | 4wks (1mo) |
| The primary diagnostic tools to diagnose hydrocephalus in older infants and children | CT or MRI |
| Posterior fontanel closed by this age | 2mo |
| Anterior fontanel close by this age | 18mo |
| Post-op care for VP shunt placement | Place on unoperated side with HOB flat (or MD order) |
| Shrill, brief, high pitched cry, poor suck/feed, bossing, setting-sun, pupils sluggish | Late s/s of ↑ ICP |
| What are some early s/s of hydrocephalus? | Irritability, seizures, lethargy. (LOC change) |
| The most serous complication of VP shunt placement | Infection (1-2mo after placement) |
| Any suspected drainage post VP shunt is inspected for this? | Glucose |
| Are common post cardiac cath procedure during the first 24hrs? | Dysrhythmias |
| Start feeding ASAP, keep in bed 24hrs with extremities straight, CMS, check site for bleeding or phlebitis | Post Cardiac Cath |
| Closes as a result of ↑O₂ tension in arterial blood (Closes 10-15hrs after birth) | PDA |
| Closes as a result of the loss of blood flow from the placenta | Ductus Venosus |
| Increases Pulmonary blood flow | Left to Right shunt |
| Decreases Pulmonary blood flow | Right to Left shunt |
| What are 4 CHD that ↑ pulmonary blood flow | PDA, VSD, ASD, Atrioventricular Canal |
| What are 3 Obstructive CHD? | Coarctation of Aorta, PS, AS. |
| What are 2 CHD ↓ Pulmonary blood flow | Tetrology of Fallot & Tricuspid Atresia |
| Transposition of the Great Arteries, Total Anomalous Pulmonary Venous Return, Truncus Arteriosus, Hypoplastic Left Heart Syndrome | Mixed Blood Flow CHD |
| Machine type murmur, Widened pulse pressure, bounding HR, Tachycardia, Cardiomegaly | PDA |
| Treatment can wait 1-2yr, Preemie Indomethacin, 6mo-1yr=Coils, 1-2yr=Clips | PDA Treatment |
| PDA murmurs are very _____ | Noisey |
| VSD best heard over | Left Sternal border |
| Treatment for VSD | Banding or Dacron patch for Lrg defects |
| If a VSD is small they may do this | Wait, to close on its own |
| Is done based on the narrowness of the pulmonic valve. If it is too small the procedure will not be performed | Ballon Angioplasty |
| RVH-Cardiomegaly, ↓ Pulmonary Blood flow, Dyspnea, Fatigue, Cyanosis | Pulmonic Stenosis |
| ↑ systemic blood pressure and bounding pulses in the arms, weak or absent femoral pulses, Cool lower extremities, Dizzy, HA, fainting, Epistaxis | Coarctation of Aorta |
| Complications of Coarctation of Aorta | HTN, ruptured Aorta, Aortic Aneurysm, and Stroke |
| Treatment for Coarctation of Aorta | End-to-end Anastomosis, or Ballon Angioplasty |
| This is very important post-op Coarctation repair | BP control w/ BB, ACE inhibitor and Diuretics |
| Complications of Tetrology of Fallot | Polycythemia and CVD |
| More RBC production causes blood to ______. | Thicken |
| During a Tet spell place baby in this position | Knee-to-chest positio, supp O₂, Morphine |
| Clubbing is not seen in ______ only in _____ children. | Infants; older |
| Is an increase in the with of the fingers due to chronic hypoxia in the area | Clubbing |
| Is the 1st repair done in the Tet patients. | Palliative Sunt |
| Complete repair of Tetrology of Fallot | Performed in the 1st year of life |
| Is one of the most frequently used tests for detecting cardiac dysfunction in children | Echocardiography |
| ↓ Environmental stimuli, HOB up, Neutral thermal environment, Txt infections | HF pts |
| Check this before giving ACE inhibitors | BP |
| Administer PO meds to infants | Via bottle nipple |
| Feeding schedule for HF pts | Q 3hrs, for 30min/feed |
| Do not give _____ to a baby under 6mo | water |
| Babies should dress with ____ layer more than you have | 1 |
| ***Study: Does stenting help for Coarctation of Aorta | Yes, safe and effective procedure before major Sxg. |
| ***Study: KD ↑ risk of Coronary Abnormalities, ↑ risk of death, Harder to Diagnose, s/s not that Obvious | <6mo |
| ***Study: ↑ shunt malfunction, very costly to families and hospitals, economic burdens, need to find better ways to treat. | Hydrocephalus |
| ***Study: Intrauterine sxg repair improves outcomes and may decrease risk of neurogenic bladder although comes with risks. | Spina Bifida repair |
| ***Study: Mothers that strictly breast fed ↓ risk; Mothers that formula bottle fed ↑ risk x4 | Pyloric Stenosis |
| ***Study:Diagnostic w/ amniosynthesis in utero, 32wks gestation, ANP, ILAP, AFT, Biochemical link; ↑ preplanning to avoid feedings and immediate surgery; ↑amniotic fluid. | TE Fistula Diagnosis in Utero |
| ***Study: Air vs hydrostatic water; result Air is better. | Intussusception Reduction |
| Tachycardia, Sweating (inappropriate), ↓UO, Fatigue, Weakness, Restlessness, Anorexia, Pale cool extremities, weak peripheral pulse, ↓BP, Gallop rhythm, Cardiomegaly | Impaired Myocardial Function |
| Tachypnea, dyspnea, Retractions, Flaring nares*, Exercise intolerance, Orthopnea, cough, horseness, Cyanosis, wheezing, Grunting* | Pulmonary Congestion |
| Weight gain, Hepatomegaly, Peripheral edema, Ascities, Neck vein distention | Systemic Venous Congestion |
| Cause of acute systemic vasculitis (KD) | Unknown |
| Sudden high fever, unresponsive to antipyretics and antibiotics | Acute KD |
| End of fever through end of all KD signs | Subacute KD |
| Clinical signs resolved, but laboratory values not returned to normal; completed with normal values | Convalescent KD |
| Believed to be autoimmune disease- infection possible trigger | Kawasaki’s Syndrome |
| Age range for KD | <5y/o peaks @ 2 |
| Fever for >5days, + Bilateral conjunctivitis, erythema of the lips, *strawberry tongue, peeling hand & feet (2nd-3rd wk), Polymorphous Rash, Cervical Lymphadenophathy >1.5cm | Diagnosis for KD |
| Children diagnosed with KD are at risk for this? | Myocardial Infarction |
| Abd. Pain, Vomiting, Restlessness, Inconsolable, Crying, Palor to shock. | M.I. Kids |
| Large single dose over 10-12 hrs of IVIG or IVGG within 10 days of symptoms and ASA for fever | KD treatment |
| Do not give this within 11 mo of receiving IVIG? | Live Vaccines |
| Intervention for arthritic pain r/t KD | Warm tub |
| 90% of SIDS deaths occur by ___mo of age | 6 |
| ↑ risk Male, Winter, African-american, Native American, Hispanic, Lower socioeconomic class, Pre-term infants, Low APGAR, First born and multiples | SIDS epidemiology |
| Putting a baby to sleep with a ______ can help ↓ risk of SIDS | Pacifier |
| Do not use soft bedding or fluffy pillows, stuffed animals, Do not sleep with infant, put babies of there BACK to sleep | Teaching SIDS |
| Provide a false sense of security and go off too often | Home Apnea Monitors |
| “_____” ok and babies should never be in between parents | Co-sleeper |
| Allow ____ to spend unlimited time with their baby in a SIDS case. | Parents |
| Denial, anger, hysteria, withdrawal, intense guilt, no visible response, mourning may take up to 1 year or more | Common grief responses |
| A _____ study may be done before the leave the hospital to see if there are excessive periods of apnea. | Sleep |
| RSV infection causes a prolonged ________ phase | Expiratory |
| Age ranges for RSV | 2-12mo rare >2yrs |
| Bronchioles become inflamed and swollen; lumina filled with exudates | RSV infection |
| Diagnosing RSV | ELISA & Nasal drainage |
| Infants with RSV | Suction before feedings |
| Obstruction to the flow of CSF through the ventricular system | Non-Communicating |
| Impaired absorption of CSF within the subarachnoid space, malfunction of the arachnoid villi | Communicating Hydrocephalus |
| Needs to be measured at every healthy check-up | Head circumference |
| This is a late sign of hydrocephalus | High pitched cry |
| Due to failure of the neural tube to close during embryonic development | Spina Bifida |
| Defect that is not visible externally | Spina Bifida Occulta |
| Encases meninges and spinal fluid but no neural elements. | Meningocele |
| Contains meninges, spinal fluid, and nerves. | Myelominingocele |
| Meningocele or Myelomeningocele can be r/o with _____ testing | Ultrasound |
| Possibility of bowel and bladder problems; ataxia; foot drop and might be subtle to very obvious; born by C-section. | Spina Bifida later problems |
| Positioning for Spina Bifida | Prone w/ knees bent; |
| Covering for Spina Bifida pre-op | Moist sterile dressing, no clothing, no covers, assess for hydrocephalus |
| Feeding for Spina Bifida pre-op | Prone with head turned to side. |
| Identified as a serious health hazard when a child w/ spina bifida experienced anaphylaxis due to this? | Latex Allergy |
| Range from urticaria, wheezing, rash, to anaphylaxis. | Allergic reactions to Latex |
| Banana, avocado, kiwi, chestnuts. | Cross reactions Latex |
| Shallow acetabulum; delay in acetabular development; No dislocation or subluxation | Preluxation |
| Incomplete dislocation; a disloactable hip; femur in contact w acetabulum; not displaced due to a stretch ligamentum teres and capsule | Subluxation |
| Femoral head loses contact w acetabulum and is displaced posteriorly and superiorly | Dislocation |
| Asymmetry best viewed in this position | Prone |
| Loosens ligaments and muscles easier to treat dislocation | Bryant’s Traction |
| Important consideration for a child in a cast? | Skin care |
| Handling wet cast should be done with _____. | Palms of hands |
| Eating with a hip spica is sometimes done _____ depending on age. | Prone |
| Keep on except during bathing; Keeps hips abducted; triple diapers do the same thing; used for infants <6mo | Pavlik Harness |
| With a Pavlik Harness always do these 4 things | Undershirt, Check frequently, Gently massage, Diaper under straps. |
| Infants older than age ___ and in children, X-ray is used to confirm DDH | 4mo |
| Treatment with Pavlik Harness typically lasts for | 6-12wks |
| What is the Hallmark sign of Pyloric Stenosis | Olive size mass |
| Projectile vomiting; non bilious, Baby is always hungry, signs of dehydration, BUN/Creat ↑, stools decrease, Visible Peristaltic waves | Pyloric Stenosis |
| How is Pyloric stenosis diagnosed | Ultrasound or upper GI |
| Pyloric stenosis is treated w this minor procedure; post-op vomiting common; Begin feeding 4-6hrs; 24hrs give formula; HOB ↑fowlers; Burp frequently | Fredet-Ramstedt procedure |
| Nursing diagnosis for a pt w/ TE fistula | Alteration in Nutrition Less body requirements. |
| Failed separation of the esophagus and trachea by the forth week of gestation. | Tracheoesophageal Fistula |
| Clinical manifestations of TE fistula | Excessive Salivation and Drooling |
| Three C’s of TE Fistula | Coughing, Choking, Cyanosis |
| Common clinical manifestations of TE Fistula | Apnea, ↑ respiratory distress after feeding, Abd. Distention |
| Immediately NPO; HOB up; suction frequently; begin abx; Keep g-tube unclamped | Suspected TE Fistula |
| Respiratory conditions; G-tube feedings and Tracheomalasia (inspiratory stridor) | Post-op TE Fistula repair |
| Absence of autonomic parasympathetic ganglion cells in one section of the colon | Hirschsprung’s Disease |
| Accumulation of int. Contents and distention of the bowel ______ to the defect causes a large or megacolon. | Proximal |
| HD is diagnosed with this | Rectal Biopsy |
| Most common area for HD to occur? | Rectosigmoid |
| What is the leading cause of death of HD in infants | Enterocolitis (Fever may indicate this) |
| [Newborn]No meconium stool w/in 24-48hrs, ↓ PO intake, Bile stained vomit, Abd. Distention[INFANT], FTT, constipation, Diarrhea & Vomit(explosive watery) | HD Clinical Manifestations |
| [Childhood] Chronic constipation, ribbon-like, foul smelling stool, Fecal mass, Visible peristalsis, poorly nourished & anemic | HD Clinical Manifestations cont. |
| Done NB and preemie; insert cylinder w/ 3 ballons- test reflex response of sphincters; internal sphincters dont relax. | Anorectal Mamometry |
| Remove aganglionic colon (2mo-1yr); at 20lbs they do sphincterotomy & pull down. | 2 Stage repair for HD |
| _______ preparation for colostomy. | Psychological |
| NPO; IV; abd. Dressings; perianal dsgs; may have NG tube; colostomy care. | HD post-op |
| Cause unknown; ↑males; may be viral;↑ CF and Celiac disease; 50% <1y/o; most frequent cause of intestinal obstruction during infancy. | Intussusception |
| How do you teach intussusception to parents. | Glove with water |
| Most common area for intussusception | Illeosecal valve |
| Bad complications of intussusception. | Hemorrhage, Perforation, Peritonitis |
| Sudden acute pain w/ intervals where child is normal; vomiting; red-current jelly stools; abd. Tender and distended; Sausage RUQ; Dance’s sign | Intussusception Clinical Manifestations |
| How do you diagnose Intussusception. | Ultrasound |
| Is the passive transfer of gastric contents into the esophagus | GE Reflux |
| What is the hallmark of GERD. | Grimace and Cry; after feeding. |
| A ↓ in GERD will help ↓ ______ | Asthma |
| PWG; anemia, irritability, gagging & chocking, apnea, recurrent pneumonia’s, heme-positive emesis or stools. | GERD s/s |
| Hx of feedings; stool guaic; growth assessment; Esophageal pH monitoring, Endoscopy, Scintigraphy | Diagnostic for GERD |
| Thicken formula w/ this for GERD pts. | Rice cereal |
| Positioning for GERD pts after feedings | Supine HOB 30 degrees or Prone HOB ↑ 30 for 30min while watching them. |
| Low dose Erythromicin for GERD does this. | Speeds up motility |
| Tagament, Zantac, Pepsid (reduce acid in gastric contents) | Antacids or H2 blockers |
| Reglan, Urecholine; may ↓ reflux. | Prokinetic meds |
| Do not ______ nipple hole. | Widen |
| Increase sucking helps clear food from esophagus; keep quiet after feeding. | Give Pacifier GERD post feeding |
| Prognosis for GERD | Good most cured by 18mo |
| In severe cases of GERD this Sxg is required. | Nissen Fundoplication |
| How do you asses a Cleft palate? | Gloved finger or visual inspection |
| This children have trouble sucking and seem to choke alot while feeding. | Cleft Lip/Palate |
| Repair _____ first (2-3mo) and _____(6-12mo). | Lip; Palate |
| Protect by logan bow or butterfly suture; Do NOT put on stomachs; Elbow Restraints. | Cleft Lip/Palate Post-op |
| Best way to breast feed a kid with Cleft lip/palate. | Football hold; keep head upright |
| Long-term problems of cleft lip/palate | Speech impairment and OM |
| No tongue blades, No straws, No oral temps, No forks; WIDE BOWL SPOON; Soft Diet; Rinse mouth after feeding; may have breathing problems. | Cleft Lip/Palate Repair Post-op |
| What is on the Left side of “My Plate” | Vegetables and Fruits |
| What is on the Right side of “My Plate” | Grains and Proteins (Dairy on side) |
| RBC and/or Hgb depletion | Anemia |
| Wait ___ sec to clamp cord helps prevent anemia. | 60 |
| If infant is pale, cyanotic, not growing well; check this. | CBC |
| Encourage _______ while breast feeding to help prevent anemia. | Prenatal Vitamins |
| Caused by inadequate supply of dietary Iron. | Iron Deficiency Anemia |
| Fetal iron stores good for ______ mo and preemies _____ mo. | 5-6; 2-3 |
| Teaching for Iron administration. | Use syringe or straw(Age app), Brush teeth, Z-track if IM, Give with Vit C (O.J.); Acidic environment |
| Iron supplementation may cause dark stools and/or constipation | DONT stop look at Diet |
| Refers to a state of inadequate growth from inability to obtain and/or use calories required for growth; Fall off the Growth Chart; <5th percentile; Symptom. | FTT |
| Result from a physical cause (CHD, neuro prob, chronic UTI); accounts for 50%; r/o with H&P | OFTT |
| Definable cause that is unrelated to disease; psycho social factors; poor parenting; lack of knowledge; disturbance of mother/child attachment. | NFTT |
| Poverty, health beliefs, inadequate nutritional knowledge, family stress, feeding resistance, insufficient breast milk | Factor ↑ NFTT |
| Unexplained, but usually accounted with NFTT | Idiopathic or Mixed FTT |
| Diagnosis for FTT | Plot on curve; Diet hx; H&P |
| This is characteristic behavior of caregiver w/ NFTT child. | No Name Given to baby; negative comments; inadequate support; substance abuse. |
| Reversing malnutrition; Structuring environment for positive psychosocial interactions; multidisciplinary team to work w/ family. | Goal for FTT pt |
| Extra chromosome 21 (92-95%); Translocation of chromosome 21(3-6%); Mosaicism (1-3%); Rinse mouth After feedings | Trisomy 21 or Down Syndrome |
| ↑ risk with maternal age >40y/o, although most infants w/ DS have mothers ____ | <35y/o |
| Most kids with DS cannot play any contact sports because of this skeletal defect. | Atlantoaxial Instability |
| Wide variation of DS; with __________ to low-average intelligence. | Severely retarded |
| Better outcome for children with DS with these 2 things. | Early intervention & promoting development. |
| ↓ Birth weight ↑ risk of ____. | CHD |
| ↑Birth weight ↑ risk of _____. | Heart Disease |
| First sign of compartment syndrome. | Cyanosis |
| Use small, _____ ______ _____ to push food toward the back and side of mouth w/ kids with Down Syndrome | Straight handled spoon |
| This prenatal supplement ↓ risk of NTD. | Folic Acid |
| Iron should be administered in ______ meals in an acidic environment. | Between |
| This is the best iron supplement for infants 4-6mo of age. | Iron fortified Cereal |
| Wide base nipple for _____. | Cleft lip (CL) |
| Best time to give PPI’s ____ before breakfast and/or dinner. | 30min |
| RSV pt are under these 2 precautions. | Contact and Droplet |
| Antiviral agent specific for RSV; Expensive; Teratogenic. | Ribavirin |
| Helps PREVENT RSV infections; require monthly IM injections; must meet criteria | Palivizumab (Synagis) |
| Best time to bulb suction a kid with RSV? | Before feeding and before bedtime |
| What are 3 interventions that ↓risk of SIDS? | Pacifier, Breast milk, & Immunizations |
| Alternating the position of an infants head prevents this. | Plagiocephaly |
| Is the most important determinant in fluid loss. | Daily Weight |
| Loss of ______ is one of the first BEHAVIORS observed in dehydration. | Appetite |
| _______ is not a contraindication for ORT’s unless severe. | Vomiting |
| _______ is not a contraindication to breastfeed. | Mastitis |
| Whole cows milk before 1y/o l/t these possible problems. | Intestinal bleeding & Anemia |
Created by:
BOjangles1006
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