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PediatricLifeSupport

QuestionAnswer
Airway Nuances in Children Upper airway is funnel shape and narrowed Tongue is relatively large Epiglottis floppier and larger Larynx is more ant and superior Trachea is narrow and less Rigid Occiput more rounded Narrowest at cricoid
Implications for practice in Pediatric Patients (airway) Towel Roll Cuffed ETT not until 8 yoa Head position Suction airway
Breathing Nuances in Children Children cannot increase tital volume due to highly complicated chest wall, so they increase RR instead Immaturity of chest wall muscles and the position of the diaphragm and ribs lead to early signs of resp distress
Minute Ventilation Respiratory Rate X Tidal Volume
Early Signs of Respiratory Distress SEE SAW BREATHING, Retractions
Implications for practice in Pediatric Patients (breathing) monitor signs for increase RR Assessment of breathing, provide support! BEFORE assessment, gather RR HR first, child should react to this. THINK RACE
Nursing care for pediatric breathing Provide 02, elevate HOB, alternate tylenol and ibu q 6 hr, decompress stomach is air is trapped r/t bagging
Circulation Nuances in children HR X SV = CO however children cannot decrease the SV,HR increases during times of stress. CO is higher in children Decreased BP, late sign of shock! Develop metabolic acidosis and hypoglycemia due to higher met and immature organ system
NORMALS For Systolic pressures Newborn-: 60mm 1 mo-1 yr: 70mm 2yr-10ys: 70+ (2xage in years) >10 yr: >90 mm
Implications for practice (circulation) Investigate causes of an increased HR: fever, pain, blood volume, hypoglycemia?
Implications for practice: Low systolic pressure in ped. patient Accompanied with LOC and UOP show signs for decompensated shock, and require rapid fluid resuscitation and vasopressor support.
Promoiting Perfusion: Nursing implications for the pediatric client in emergency 20ml/kg of crystalloid iv fluid (ns/lr) by rapid infusion; consider vasopressor support.
Lack of surfactant Atelectosis- hypoxia- pulm vasc constriction- increased pulm htn-increased vent/perf mismatch & anoxia of endo lining-capillary leak of fiiber and protein- hyleine membrane of lungs..both lead to resp acidosis
Signs and symptoms of hypoglycemia jitterines eye roll cyanosis poor feeding irritability seizures apnea hypotonia
Signs and Symptoms of RDS Grunting nasal flaring retractions cyanosis (LATE) crackels
Cold stress response norepi released. vasoconstriction-hypox AND fat met kicks in, increased o2 consum...HYPOX & anerobic met-- met acidosis
Lactase defieciency 34 weeks
gavage feeding oral gt perferred as they are obligate nose breathers
negative effects in the NICU auditory stim, tactile, visual, sensory, all r/t icp watch stress levels HRV and cortisol
infant stress cues glassy eyes tachys acrocyanosis burrowed brow spit up sneezes yawning hiccups hypotonia
Signs of NEC emesis, temp instability, distension, poor feeding, decreased bowels, blood in stool, low platelet count
d/x of nec s/s abd xray pneumatosis intestinalis pnuemoperitoneum sentinel loop (loop that is dilated)
Signs and Symptoms of RDS Grunting nasal flaring retractions cyanosis (LATE) crackels
Cold stress response norepi released. vasoconstriction-hypox AND fat met kicks in, increased o2 consum...HYPOX & anerobic met-- met acidosis
Lactase defieciency 34 weeks
gavage feeding oral gt perferred as they are obligate nose breathers
negative effects in the NICU auditory stim, tactile, visual, sensory, all r/t icp watch stress levels HRV and cortisol
infant stress cues glassy eyes tachys acrocyanosis burrowed brow spit up sneezes yawning hiccups hypotonia
Signs of NEC emesis, temp instability, distension, poor feeding, decreased bowels, blood in stool, low platelet count
d/x of nec s/s abd xray pneumatosis intestinalis pnuemoperitoneum sentinel loop (loop that is dilated)
Acyanotic CHD PDA VSA ASD
PDA MIXING of blood, indomethacin to synthesis prostaglandins S/S include bounding pulse murmur chf Cardiac cath can fix it or a ligation via thoracotomy
VSD Left to right shunting hepatomegaly pulm htn chf murmur swelling of hands and feet rt ventricle jugular distention hypertophy surgical closer is needed..if not closed within the first year
ASD Similar to vsd except less noticeable because the force is not as great.
S/S of CHF Mycardial dysfunciton pulmonary congestion systemic congestion
treatment of chf improve cardiac function- improve contractility decrease preload by removing fluids (diuretic/ACE) decrease cardiac demands improve tissue oxygenation
obstructive CHD Coarction of aorta pulmonic stenosis aortic stenosis
coarction of aorta pinching of aorta after 3 main vessels: subclavian carotid innertion high bp to upper extremities and low bp to lower, resulting in either bounding or faint pulses. lt side hf. pulm edmea crackles s/s dizziness headaches hemodynamic changes fainting
pulmonic stenosis rt sided failure: decrease bf to lungs-> decreased bf to lt side of heart, systemic congestion,
aortic stenosis lt heart failure, decreased co, pulm an venous htn, hypertrophy, weak pulses, decreased exercise tolerance, chest pain tachy, htn, tx open heart valvotomy or ballon angio
decreased pulm flow tetrology of fallot
tetralogy of fallot vsd overrrideing aorta ps vent hypertrophy mixing of blood, rt ventricle has to work harder bc there is high volume and high resistance surgical repair within first year bt shunt to increase bf to lungs
mixed blood flow transposition of great vessels
trasposition of great vessels switch of aorta and pulmonary bf. must keep pda open by increasing prosta, arterial switch of coronary arteries, septosomy and great ASD
Glenn shunt off of vena cava and bypasses the right therefore decreased flow to the rt side of heart
bt shunt after 3 cornonary arterties and attached from aorta to pulm artyer to increase flow to the lungs
CHF:Myocardial dysfunction r/t low ca/k/mg hypoxemia with acidodic possibly related to diuretic therapy (ex:transposistion, tetrology)
CHF: Pulm congestion r/t volume overload (ex: VSD, coarction)
CHF: systemic congestion r/t heart failure and high pressure in the heart r/t back up in chambers
CHF: increased cardiac demand r/t virus, anemia, infection
CHF: Myocardial dysfunction s/s inc hr inc rr dec co hypotension dec uo polycythemia mottled color weakness fatigue
CHF: Pulmonary congestion s/s rale crackles activity intolerance tachy X 2 cardiomegaly
CHF: Systemic congestion s/s periorbital edema, distal limb pitting, jugular distention, weight gain
CHF: Increased Cardiac Demand s/s tachy X 2, resp distress, fatigue, weakness, altered perfusion, mottled colord >cap refill, dec uo, decreased bp
systolic BP guidline: pediatric newborn- 60 1 mo- 1 yr 70 2-10 yr 70+(2xage) >10 90 minimum
Digoxin: Purpose and Administration Inotrope increased cardiac output Chronotrope slows heart rate (increasing force of contraction) 10mcg/kg max is 50 mcg/dose watch for dig tox!!! .8-2 mcg/l blood level do not give if hr <90-110 K+ LEVEL! q 12 on empty stomach do not give again if
ACE: Function Stops renin angiotensin cycle, heart doesn't work as hard. dec afterload and svr empty stomach
Diuretic: Function monitor i and o, decreased fluid volume and preload.
Nurse Monitoring: CHF vitals! RACE! hr CVP (3-5) Weight activity tolerance lyte levels dig tox
Digoxin Toxicity Brady anorexia vomiting arrhythmia
Created by: 1255770087