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Nurse 125-test 4

Peds-cardiac, developmental, dehydration

QuestionAnswer
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.
Created by: 705757596