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PediatricLifeSupport
| Question | Answer |
|---|---|
| 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 |
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