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Nurse 125-test 4
Peds-cardiac, developmental, dehydration
| Question | Answer |
|---|---|
| What are the normal VS for infants? | HR-120-160 beats/min; RR-23-50 resp/min; BP-110/71 mmHg |
| What is the normal weight gain for an infant? normal height increased? | Should double birth weight by 6 mths; should triple birth weight by 12 mths. Height should increase an inch every month for 1st 6 mths (0-6 mths); should increase half an inch every month for 2nd 6 mths (7-12 mths) |
| What reflexes will the infant lose and when? | Lose moro and babinski reflex around 4-5 mths. Lose sucking reflex around 12 mths-recommended to ween from bottle at this time |
| When does the posterior fontanel close? anterior fontanel? | Posterior closes around 2 mths. Anterior closes around 18 mths. |
| What are the normal VS for a toddler (13-36 mths) | HR-70-110 beats/min; Resp 20-30 resp/min; BP 105/70 mmHg |
| How many inches should a toddler grow each year? | 3 inches per year. |
| What are the gross motor skills developed during toddler stage and when? | By 13-15 mths-walks independently; by 18 mths-stacks 3-4 blocks; by 24 mths-stacks 5 or more blocks; by 36-stacks 9-10 blocks. |
| What are the fine motor skills developed during toddler stage and when? | By 15 mths-recognizes pictures in books; By 18 mths-Points to body parts; 30 mths-gives first and last name; by 36 mths-speaks 2-3 word phrases & names figures in a picture. |
| What are the psychosocial stages for toddlers (Erikson, Piager, Freud) | Erikson-autonomy vs shame & doubt; Piaget-Sensorimotor/Preoperational; Freud-Anal phase |
| at what age are toddlers toilet trained? | 24-36 months. |
| What are some characteristics of toddlerhood? | Negativism "No-No"; Temper tantrums; separation anxiety; have a concept of time. |
| Feeding for a toddler? | 15mths- feeds self with cup, uses spoon; 24 mths-feeds self well; 36 mths- pours from pitcher. |
| How do toddlers play? | parallel play; attention span is short. |
| What are the suggested toys for a toddler? | push-pull toy; telephone; puzzles; tricycle; rocking horse; clay; crayons; pounding toys. |
| What are the VS for a Preschooler? | HR: 65-110; RR: 20-25; BP: 110/75 |
| What is the expected weight gain for preschoolers? | 4-6 lbs/year |
| Body Proportions for preschooler: | loses baby fat & tummy, no waist, legs continue to grow rapidly. Slender |
| What is the gross motor development for preschoolers and when? | 48 mths- hops on 1 foot, dresses self; 52 mths-walks backward heel-toe, balance on 1 foot approx.; 60 mths-skips |
| What is the fine motor development for preschoolers and when? | 48 mths-nonsense words, repeats what he hears |
| at what age would a child's vision be 20/20? | around age 5 |
| What are the psychosocial stages for preschoolers? | Erikson-Initiative vs Guilt; Piaget-Preoperational; Freud-Phallic |
| What are some characteristics for preschoolers? | Imaginative/fantasy; questions everything; cooperative |
| Play for preschoolers: | cooperative play. Imitative and imaginary |
| What are the VS for school age children? | HR 60-95; RR 14-22; BP 120/75 |
| What are the psychosocial stages for school age? | Erikson-Industry vs Inferiority; Piaget-Concrete operations; Freud-Latency |
| Characteristics for 10-12 years old | critical of authority, interested in opposite sex |
| What foods do you avoid in infancy? | Nuts, raisins, hot dogs, popcorn, grapes. No honey until 12 mths. Peanuts no until age 3 |
| What is PKU? | children do not have the enzyme to break down phenylalanine. Phenylalanine is in protein so it leads to build up in body. |
| What can PKU lead to | mental retardation, seizures, skin rashes. Reduce protein in diet. |
| Where can you ascultate the heart on children? | if under 7- at the 4th intercostal space. If over 7- at 5th intercostal space |
| what are signs of failure to thrive? | not growing like they should, length/weight is not increasing. Growth chart doesn't curve, but plateaus. They are disinterested, poor eye contact, irritable. They stop meeting developmental milestones (walking, talking, etc) |
| What are your top 2 worries with a heart anomaly? | Hypoxemia can occur bc the defect prevents blood from getting to lung to be oxygenated; or blood gets oxygenated but does not leave heart to body. HF can occur when too much blood is taken to lungs & congest the lungs or pump fails after prolonged time |
| When is congenital heart disease diagnosed usually? | Usually within first year of life. It is the 2nd leading cause of death in the first year of life. |
| What are some prenatal factors linked to congenital heart disease? | Rubella in first tri; alcoholism; insulin DM during pregnancy; usage of trimethadione for seizure |
| what are other factors linked to CHD? | if sibling or parent has CHD; child with chromosomal abnormalities (Down's) tend to have CHD too. |
| How is CHD diagnosed? | CBC/Sed rate; Pulse Ox; EKG (detects arrhythmias); Chest Xray; Echo (view blood in heart, chambers, valves); Cardiac Cath (shows any blockages, visualize blood flow thru vessels of heart) |
| What pre-procedure care for cardiac cath? | Consent, assess for allergy to shellfish or iodine dye |
| what is post-procedure care for cardiac cath? | VS q 15 mins; every time you check VS, assess for s/s of bleeding, palpate for hematoma (firmness), put sandbag back on site after each assessment. Assess color, temp, & pedal pulses. Bedrest 4-6 hrs, keep leg straight and lay flat. |
| What are the s/s of CHD in an infant? in children? | Infants- poor feeding, irritability, SOB, excessive sweat, adventitious LS. Children-poor growth, SOB, exercise intolerance, adventitious LS |
| What are s/s of peripheral edema? | puffy eyelids, swelling of hands and feet, bulging fontanels |
| what are the 3 types of acyanotic defects? | VSD, ASD, PDA. Left to right shunting occurs, so you have extra blood going to lungs because oxygenated blood flows into R ventricle which is full of deoxygenated blood, then pumped to lungs. |
| What is the most common CHD? | Ventricular septal defect- an abnormal opening in the septum separating the R & L ventricle. |
| what are the S/S of VSD? | May be asymptomatic if opening is small. Harsh murmur with a thrill, s/s of HF (SOB, feeding difficulties, crackles, pulmonary infections, poor growth, fatigue, congestion) |
| How is VSD diagnosed? | S/S (murmur), xray, echo, EKG |
| What is the treatment for VSD? | monitor- can close on it's own if small enough; If s/s of HF-may use digoxin and lasix. Surgical intervention-will either stitch closed or patch closed. |
| What is ASD? | L to R shunting in atrium caused by incomplete closing of the foramen ovale. The foramen ovale not closing properly allows for oxygenated blood to combine with deoxy. blood in R atrium, flowing back into the lungs. |
| What are the s/s of ASD? | may be asymptomatic, may or may not have a murmur, s/s of HF (SOB, resp distress, failure to thrive, periorbital edema, resp infections) |
| How is ASD diagnosed? | S/S (Murmur), Echo, EKG, Cardiac Cath |
| What is PDA? | This is L to R shunting between the pulmonary artery and the aorta. The ductus arterious did not close. Lungs get oxygenated and deoxygenated blood from this opening. |
| what are the s/s of PDA? | may be asymptomatic; have a machine-like humming murmur heard under L clavicle; if bad enough, will have s/s of HF |
| How is PDA diagnosed? | S/S and machine like murmur under L clavicle; echo. Cardiac Cath is not necessary!! |
| How is PDA treated? | Indomethacin or Ibuprofen IV. The administration will force closure of the ductus arterious. This is very successful in premies. If IV meds don't work, ligation will be done. |
| What do you expect to see in assessment for all acyanotic CHD? | s/s of CHF, heart murmurs (all can have murmuers but ASD may not), exercise intolerance and growth failure. |
| What is the therapeutic level for Digoxin? What do you assess prior to giving it? | 0.5-2; assess apical, hold if <60. Give water to rinse mouth after admin bc it can harm teeth. |
| What are the s/s of Dig toxicity? | halo, nausea, vomiting, decreased appetite |
| How is dig toxicity treated (digitalis toxicity)? | administer Digibind. Low K potentiates Dig, so monitor K levels |
| Lasix is potassium wasting, therefore important to monitor what? How is Lasix given to children? | Monitor K levels bc it is K wasting. Give with juice bc it is bitter. |
| May be given prophylactic antibiotics to prevent what? | Endocarditis, and possibly respiratory infections due to the overload of blood in the lungs. |
| What are the 2 cyanotic heart defects? | Tetralogy of Fallot and Transposition of the Great Vessels. Right to Left shunting so deoxygenated blood goes to body. TETs is the most common cyanotic defect. |
| What 4 defects make up TETs? | VSD, Overriding Aorta, Pulmonary stenosis, R Ventricular hypertrophy |
| What is overriding aorta? | aorta is saddling both ventricles. It allows for blood from R ventricle to go into aorta (unoxygenated) to the body. |
| what is pulmonary stenosis? | the opening of the pulmonary artery is smaller than normal, less blood is able to be oxygenated, R vent has to pump harder to move the blood. |
| what causes R ventricular hypertrophy? | the pulmonary stenosis causes it to work harder and the extra blood from VSD just makes it worse. The more you work a muscle the larger it gets. |
| When do TETs spells occur? | During crying, exercise, or feedings. The child become very blue. |
| What causes polycythemia to occur with TETs? | chronic lack of O2, causes the brain to have the body create more RBCs (more taxis) to carry O2. |
| What are the s/s of TETs? | cyanosis of hands, feet, & mouth; fainting; difficulty breathing; weakness; growth retardation; developmental delays; clubbing of fingertips in older childrem |
| What will see children of TETs do alot? | squatting, it is a natural instinct. Helps release some pressure in heart and blood flows better. Draw knees up to chest in infants or knee to chest position. |
| How is TETs diagnosed? | S/S; xray (may see boot shaped heart); echo; EKG; may use cardiac cath |
| What is the treatment for TETs? | Sqautting or knees to chest to help facilitate blood flow; oxygen therapy; and surgery to repair the defects (VSD, Overriding Aorta, Pulmonary stenosis, R Vent Hypertrophy) |
| What are the complications associated with TETs? | Heart failure and stroke (due to polycythemia causing clots) |
| what is transposition of the great arteries (vessels)? | the aorta and pulmonary arteries are switched. The aorta is receiving unoxygenated blood from R vent & going to the body, while the pulmonary arteries are receiving oxygenated blood from the L side of the heart-from L vent to lungs, and back to L atrium. |
| Why doesn't the newborn die from transposition of the great arteries? | A patent ductus arterious and foramne ovale allow enough of the oxygenated blood circling in the L side of the heart to shift to the right and then reach the body. Prostaglandin Infusion (PGEI) will be given to keep these open until surgery can be done. |
| How is transposition of great arteries diagnosed? | thru clinical presentation. Infant will be cyanotic as the PDA closes.. cyanotic all the time!! Chest xray, Echo, and Cardiac cath (100% definitive) |
| What is the treatment for transposition of the great arteries? | Prostaglandin Infusion to keep the ductus arteriosus & foramen ovale open until surgery can be done. Atrial septostomy to put a larger opening in so blood can continue to flow & eventually an atrial switch procedure to switch the location of the vessels |
| What are the defects that obstruct left ventricular outflow? | Coarctation of Aorta; Aortic Stenosis, Hypoplastic L Heart syndrome |
| What is coarctation of the aorta? | stenosis or narrowing within the thoracis aorta. |
| what are the s/s of coarctation of the aorta? | HTN in upper extremities compared to lower extremities. Normally BP is higher in legs than arm and higher in R vs L arm. Headaches; nosebleeds; vertigo; weak or absent pulses in lower extremities. |
| How is coarctation of the aorta diagnosed? | S/S (the difference between BP between upper and lower); Echo; Chest xray |
| How is coarctation treated? | balloon angioplasty and stent placed; more severe cases, may have to cut out the stenotic part and reanastomose the vessels. |
| What is aortic stenosis? | aortic valve does not open or is narrowed and blood pools in L vent. Heart works hard to move blood so this can lead to L vent hypertrophy. |
| What are the s/s of aortic stenosis? | asymptomatic; fatigue; SOB; hypotension; dizziness; syncope on exertion. Mild stenosis-fatigue/dyspnea; severe-critical/emergency or death. |
| How is aortic stenosis diagnosed? | s/s; chest xray (enlargement); echo; cardiac cath |
| what is the treatment for aortic stenosis? | if young, may give prostaglandin infusion to keep ductus arteriosus patent; a balloon valvuoplasty to open aortic valve; may have to replace valve later on. |
| What is hypoplastic L heart syndrome? | L vent doesn't develop like it should and will not work properly-body will not get enough O2. You will see cyanosis immediately at birth (hours), hypotension, tachycardia. |
| How is Hypoplastic L heart diagnosed? | echocradiogram |
| What is the treatment for hypoplastic L heart? | no intervention=death; prostaglandin infusion followed by palliative surgeries in several stages. Cardiac transplant is usually what these children end up with. |
| What is kawasaki disease? | rare childhood disease; characterized by swelling of arteries (usually cardiac). It is NOT contagious but may occur from virus or bacteria. Unknown cause. |
| What are risk factors for developing Kawasaki? | between 2-5 yrs; boys; Asian |
| first 10 days, think what? (Kawasaki) | FIRE! You will see multisystem vasculitis; ectasia (dilation of coronary arteries); pancarditis |
| 10-40 days, what occurs in Kawasaki? | if the swelling isn't reversed, can lead to dmg of coronary arteries, which leads to an aneurysm. scarring may occur from all this dmg. |
| after 40 days, you will begin to see? (Kawasaki) | progressive fibrosis and healing |
| What are the s/s associated with the acute phase of Kawasaki? | FIRE! Fever for 5 days in a row (104-105); swelling of cervical lymph nodes; swelling and redness of feet/hands; irritation of mouth, strawberry tongue, sores on interior of mouth; conjunctivitis without exudate |
| What are the s/s associated with subacute phase of Kawasaki? | peeling of toes/fingers (desquamation); joint pain; diarrhea and vomiting. |
| How is Kawasaki diagnosed? | S/S (fever plus 4 other acute s/s); Echo; EKG; blood test (sed rate=inflammation). Rule out everything else first! |
| How is Kawasaki treated? | IV immune globulin solution (reduces immune response); aspirin therapy for anti-inflammatory effect (bonus clot prevention); Coumadin to aneurysm to prevent clot from forming. |
| Nursing management for Kawasaki? | admin immune globulin and ASA; monitor for s/e and results; assess for s/s CHF; quiet supportive environment; soft foods and cool nonacidic liquids. |
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