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68WM6 Phs2 test 12

68WM6 Phase 2 test 12 Care of Pediatric Patients II

MRSA Carrier Stokes
what physical signs are you looking at when assessing a child for cardia d/o? Inspect nutritional state. Color. Chest deformities. Unusual pulses. Respiratory status. Clubbing of fingers
what is the most commonly used diagnostic tool for cardiac d/o in a child? ECG(non-invasive and painless) 2nd-cardiac cath-most invasive
what type of care could you provide post cardiac cath procedure for bleeding? apply direct continuous pressure 1 inch above site, bedrest 4-6 hours
Did you like this block? I likedit
physical characteristics of congenital heart disease? low oxygen levels in the blood cause the fingers, lips, and toes to be blue (cyanotic)
what are some factors that cause congenital heart disease? Intrauterine rubella exposure. Maternal alcoholism. Diabetes mellitus. Advance maternal age. Maternal drug ingestion. Exposure to environmental toxins and infections. Sibling or parent has history of congenital heart disease. Down Syndrome
clinical manifestations of congenital heart disease Cyanosis. Pallor. Cardiomegaly. Pericardial rubs. Murmurs. Additional Heart Sounds (S3 or S4). Discrepancies between apical and radial pulses. Tachypnea
clinical manifestations of congenital heart disease...there are more... Dyspnea. Grunting. Digital clubbing. Hepatomegaly. Splenomegaly. Discrepancies between upper and lower extremity blood pressures. Crackles and wheezing
what are some tx for congenital heart disease? Median sternotomy with cardiopulmonary bypass. Pulmonary artery banding. Prophylactic antibiotics
Teach family to recognize signs of complications in congenital heart disease, what are some things you can teach? Heart Failure. Digoxin toxicity. Vomiting. Bradycardia Dysrhythmias. Increased respiratory effort. Hypoxemia. Cerebral thrombosis. Cardiovascular collapse
what is another name for dyspneic cyanotic spell blue spell
What is pulmonary artery banding? a strip of woven prosthetic material is passed around the pulmonary artery to constrict it. This reduces the volume and pressure of pulmonary blood flow
Why would you want to minimize crying? Because it can be too tiring for the child and may cause cyanosis due to exhaustion.
atrial septal defect-describe foramen ovale or other opening between atriums and blood from goes from LEFT atrium to RIGHT atrium and causes increased blood flow to lungs
three types of atrial septal defect Ostium primum (ASD 1),  Ostium secundum (ASD 2), Sinus venosus defect
Opening at lower end of septum. May be associated with mitral valve abnormalities Ostium primum (ASD 1):
opening near center of septum Ostium secundum (ASD 2):
Opening near junction of superior vena cava and right atrium. May be associated with partial anomalous pulmonary venous connection Sinus venosus defect
At birth, pressure in left atrium exceeds that in right atrium, causing blood to flow from left to right,Oxygenated blood is forced from left atrium (high pressure) to right atrium (low pressure) which recirculates through the lungs ASD - atrial septal defect
what is the surgical tx for ASD? Surgical dacron patch closure of moderate to large defects, Median sternotomy (open repair) with cardiopulonary bypass is usually performed before school age
Toilet Paper My Ass blood flow through heart - Tricuspid Valve, Pulmonary Valve, Mitral Valve, Aortic Valve -
VSD ventricular septal defect
Loud harsh systolic murmur with palpable thrill is a s/s of ?? VSD
surgical tx for VSD? Median sternotomy with cardiopulmonary bypass. Moderate to large defects are repaired with Dacron patch placed over opening.
failure of fetal ductus arteriosus to completely close within first few weeks after birth Patent Ductus Arteriosus (PDA)
Blood from aorta (high pressure) is forced into pulmonary artery (lower pressure) to be reoxygenated in lungs and returned to left atrium and ventricle, Increases workload on left side of heart due to increased pulmonary blood flow Patent Ductus Arteriosus (PDA)
s/s of a Patent Ductus Arteriosus (PDA) May be asymptomatic in infancy, continuous "machinelike" murmur, left second intercostal space, Full and bounding pulses, Dyspnea with age,Wide range between systolic and diastolic blood pressure, Hypoxia
Visual-Assisted Thoracoscopic Surgery (VATS) ): three small incisions on left side of chest; then a thorascope and instruments are used to place clip on ductus arteriosus.
what is the medical mngt of PDA? indomethacin (Indocin) closes patent ductus in newborns and premature infants
Which defect may be necessary to sustain life in neonates with a cyanotic heart defect? Patent ductus arteriosus
constriction or narrowing of aortic arch, or descending aorta Coarctation of the Aorta (COA)- Increased pressure proximal to defect. Decreased pressure distal to defect.
s/s of a COA Blood pressure in arms will be 20mmHg higher than in legs.   Bounding pulses in upper extremities. Signs of heart failure. Leg cramping on exertion in older children. Epistaxis.
what are some surgical tx for a COA? Anastomosis(surgical connection between two structures), Graft replacement of narrowed section of aorta, Closed heart surgery is performed because structures are outside of heart. Aorta will grow but graft will not
what is a non-surgical tx for COA? Ballon angioplasty
Hypertension. Abdominal pain associated with nausea and vomiting. Leukocytosis. Gastrointestinal bleeding or obstruction are all things watched for when? post-op COA correction
What is the treatment for coarctation of the aorta? surgical repair
TETRALOGY OF FALLOT (TOF) four abnormalities that results in insufficiently oxygenated blood pumped into body.
what are the four defects that define TOF? Ventricular septal defect, Pulmonic stenosis, Overriding (dextraposition- to the right) aorta, Right ventricular hypertrophy
Dextraposition of the aorta condition in which the heart is pointed toward the right side of the chest instead of normally pointing to the left
s/s of TOF Clubbing of fingers and toes, poor growth. Cyanosis increases with age. Feeding problems. Growth retardation. Frequent respiratory infections. Dyspnea on exertion. Polycythemia
what is the surgical procedure called to correct TOF? Blalock-Taussig procedure
HYPOPLASTIC LEFT HEART SYNDROME (HLHS) underdevelopment of the left side of the heart, resulting in an absent or nonfunctional ventricle and hypoplasia of the ascending aorta
Most blood from left atrium flows across a patent foramen ovale into right atrium where it mixes with desaturated blood. Blood flows to right ventricle & into pulmonary artery, Descending aorta receives mixed blood HYPOPLASTIC LEFT HEART SYNDROME (HLHS)
what are three procedures used to tx HLHS? Norwood & Modified Fontan procedure, Bidirectional Glenn shunt
Modified Fontan procedure systemic venous return is directed to the lungs without a ventricular pump through surgical connections between the right atrium and the pulmonary artery
Norwood procedure anastomosis of the main pulmonary artery.
What two defects are necessary for survival with hypoplastic left heart syndrome? Patent foramen ovale and patent ductus arteriosus
the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body CHF
s/s of pulmonary congestion Tachypnea and dyspnea. Retractions and nasal flaring. Exercise intolerance. Orthopnea. Cough, hoarseness. Cyanosis. Wheezing. Grunting
s/s of Systemic Venous Congestion Weight gain. Hepatomegaly. Peripheral edema. Ascites. Neck vein distension
what are the therapeutic goals of tx for CHF? Improve cardiac function. Remove accumulated fluid and sodium. Decrease cardiac demands. Improve tissue oxygenation
what drugs would you expect to be ordered to increase contractility and decrease afterload r/t CHF? Digoxin (Lanoxin): slow and strengthen the heartbeat, ACE inhibitors-Catopril & Enalapril
what drugs would expect to use to remove accumulated fluid and sodium? Diuretics: furosemide (Lasix). chlorothiazide (Diuril). spironolactone (Aldactone).
what things can you teach/do to reduce cardiac demands for your pt? Limit physical activity. Preserving body temperature. Treating infections. Reduce the effort of breathing. Prescribed medications to sedate an irritable child.
_______ humidification is necessary to counteract the drying effects of the oxygen cool
Congestive Heart Failure Nursing Considerations Position for optimal ventilation. Administer oxygen. IV access. Cardiac monitor and pulse oximetry. Assist in measures to improve cardiac function. Decrease cardiac demands
more Congestive Heart Failure Nursing Considerations Reduce respiratory distress. Protect child from infections. Maintain nutritional status. Assist in measures to promote fluid loss. Support child and family
most common cause of bacterial endocarditis? streptococcus viridans, also Staphylococcus aureus. Gram-negative bacteria. Fungi: candida albicans
where can organisms that cause bacterial endocarditis enter the body? mouth after dental work, UTI, heart from cardiac surgery, directly
Once a patient has been diagnosed with bacterial endocarditis, what must be done in order to prevent recurrence prior to invasive procedures? Preventative measures include prophylactic antibiotic therapy 1 week prior to procedures.
an inflammatory disease that occurs after infection with group A beta hemolytic streptococcal pharyngitis Rheumatic Fever
a strong relationship between upper respiratory infection with group A beta hemolytic streptococci and development of RF etiology of Rheumatic Fever
what are two drugs used to kill Rheumatic Fever? Penicillin and Erythromycin
what two medications can be given to tx hyperlipidemia? and what is their action? Cholestyramine (Questran), Colestipol (Colestid), bile acid-resins or sequestrants which act by binding bile acids in the intestines
what are some side effects of hyperlipidemia drugs? Constipation. Abdominal pain. GI bloating. Flatulence. Nausea
what would you teach parents r/t hyperlipidemia? About cholesterol, HDLs and LDLs and triglycerides. Behavioral risk factors. Medications. Dietary changes. Keeping all appointments
True or False: Treatment of high cholesterol is primarily through changing the diet. True. Medications are only used if there is no response from changing the diet
abnormality in myocardium where cardiac contraction is impaired Cardiomyopathy
what are some factors for cardiomyopathy? Familial or genetic causes. Infection. Deficiency states. Metabolic abnormalities. Collagen vascular disease
what are three types of cardiomyopathy? Dilated cardiomyopathy. Hypertrophic cardiomyopathy. Restrictive cardiomyopathy.
ventricles are dilated and contractility is greatly decreased. s/s: Tachycardia. Dyspnea. Hepatosplenomegaly. Fatigue. Poor growth Dilated Cardiomyopathy
Describes a restriction to ventricular filling caused by endocardial disease Restrictive Cardiomyopathy
Characterized by an increase in heart muscle mass without an increase in cavity size Hypertrophic Cardiomyopathy
what are s/s of Hypertrophic Cardiomyopathy Chest pain. Dysrhythmias. Syncope. Chest x-rays show enlarged heart. ECG shows ST-T changes
meds given for cardiomyopathy Digoxin. Diuretics. Beta Blocker: propranolol (Inderal). Calcium-Channel blocker: verapamil (Calan).
what are the two major categories of systemic HTN? essential and secondary
what regulates the production of blood? erythropoietin
what does the lymphatic system do? drains regions of the body to lymph nodes
What are the three formed elements of blood? Erythrocytes, leukocytes and thrombocytes
r/t Peds, what are signs of dehydration? Level of consciousness. Response to stimuli. Decreased skin turgor. Prolonged capillary refill. Increased heart rate. Sunken eyes or fontanel
Percentage of weight loss, increased pulse, irritability and lethargy, dry mucous membranes, absence of tears, sunken eyes or fontanel and delayed capillary refill? signs of dehydration
Caused by abnormal intestinal water and electrolyte transport diarrhea
Referred to as acute infectious gastroenteritis caused by a variety of viral, bacterial and parasitic pathogens acute diarrhea
diarrhea that occurs in first few months of life and lasts longer than 2 weeks Intractable diarrhea
most common cause of serious gastroenteritis rotavirus
what types of hydration methods should you not use if you are dehydrated? Avoid fruit juices and carbonated and/or caffeinated soft drinks
when there are long intervals between stools Obstipation
constipation with fecal soiling Encopresis
r/t Peds, what are signs of dehydration? Level of consciousness. Response to stimuli. Decreased skin turgor. Prolonged capillary refill. Increased heart rate. Sunken eyes or fontanel
Percentage of weight loss, increased pulse, irritability and lethargy, dry mucous membranes, absence of tears, sunken eyes or fontanel and delayed capillary refill? signs of dehydration
Caused by abnormal intestinal water and electrolyte transport diarrhea
Referred to as acute infectious gastroenteritis caused by a variety of viral, bacterial and parasitic pathogens acute diarrhea
diarrhea that occurs in first few months of life and lasts longer than 2 weeks Intractable diarrhea
most common cause of serious gastroenteritis rotavirus
what types of hydration methods should you not use if you are dehydrated? Avoid fruit juices and carbonated and/or caffeinated soft drinks
when there are long intervals between stools Obstipation
constipation with fecal soiling Encopresis
avg age for appendicitis? 10 yrs
pain in LRQ, vomiting, infrequent mucus diarrhea, guarding, rebound tenderness, elevated WBC, pain when lifting thigh while supine, are s/s of what? appendicitis
what are three post op goals after a appendectomy? Pain management. Prevention of infection. Early ambulation
small blind pouch near the ileocecal valve fails to disappear completely and may be connected to the umbilicus by a cord Meckel’s Diverticulum
most common congenital malformation of the GI tract Meckel’s Diverticulum
what is the age and s/s for Meckel's Diverticulum? Symptoms before 2 years. Painless bright red or dark red bleeding. Abdominal pain. Barium enema for diagnosis
Is a chronic inflammation that involves all layers of the bowel wall Crohn's Disease
s/s of Crohn's Disease Abdominal pain, Weight loss, Fever, Anorexia, Rectal bleeding, Anal fistulas, frequent diarrhea, blood poop, mucous in poop,
what meds would you expect to be given to your pt with Crohn's Disease? corticosteriods, sulfasalazine, antibiotics
what type of diet would you expect for Crohn's Disease pt? well-balanced, high-protein, high-calorie
what are the four types of ulcers? gastric, duodenal, primary, secondary
gastric ulcer includes: the mucosa of the stomach
duodenal ulcers include: pylorus or duodenum
a primary ulcer _______ Absence of predisposing factors and common in children over 6 years
secondary ulcers _______ Result from other factors and are more common in infants and children less than 6 months
peptic ulcer disease is know to have what present? helicobacter pylori
s/s of peptic ulcer disease Epigastric abdominal pain. Nocturnal pain. Oral regurgitation. Heart burn. Weight loss. Hematemesis. Melana
what is the most reliable way of diagnosing peptic ulcer disease? endoscopy
Cimetidine (Tagamet). Rantidine (Zantac). Famotidine (Pepcid). H2 receptor antagonists
Proton pump inhibitors omeprazole (Prilosec, Prilosec OTC). lansoprazole (Prevacid).
tissues of the gastrointestinal tract fail to separate properly from the respiratory tract in utero Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF)
VATER vertebral, anorectal, tracheoesophageal, renal
VACTERL vertebral, anorectal, cardiovascular, tracheoesophageal, renal, limb
three C's r/t EA & TEF coughing, choking, cyanosis
s/s for EA & TEF Excessive salivation and drooling. Three C’s: coughing, choking, cyanosis. Apnea. Increased respiratory distress after feeding. Abdominal distension
EA is not a surgical emergency. T / F False
what are the 1st things you would want to do when you suspect your pt has an EA? Upon suspicion, keep infant NPO, start an IV and place in position to prevent aspiration & notify the Provider immediately
If special problems occur during an TEF or EA, what will you do? Respiratory complications. Provide a pacifier for non-nutritive sucking to prevent oral aversions. Support the parents
what are Signs of constriction of the esophagus Poor feeding. Dysphasia. Regurgitation of undigested food
a protrusion of part of the abdominal contents into the groin Inguinal hernia
a protrusion of part of the intestines through the umbilical ring Umbilical hernia
____________hernia can be put back into place by gentle pressure reducible
_____________ hernia cannot be reduced. incarcerated
_________ hernia has a diminished blood supply and occurs before 6 months of life strangulated
What is the surgery called to repair a hernia? Herniorrhaphy
Narrowing of the lower end of the stomach occurs related to hypertrophy of the circular muscles of the pylorus or by spasms of the sphincter Pyloric Stenosis
s/s of Pyloric Stenosis Symptoms at 2-3 weeks of age. Projectile vomiting. Constant hunger. Dehydration. Olive-shaped mass in RUQ
tx for Pyloric Stenosis Pyloromyotomy. IV therapy. Thickened feedings. Burp before & during feedings. Daily weights. I & O. Frequent position changes. Monitor VS. Avoid overfeeding
It is a surgical procedure in which the pyloric muscle is incised to enlarge the opening to allow food to pass. pyloromyotomy
A slipping of one part of the intestine into another portion of the intestine below it ("telescoping of the bowel"). Intussusception
s/s of Intussusception Sudden, severe abdominal pain. Loud cry, straining efforts, kicks & draws legs in. Vomiting. Diminished flatus & BMs. Currant jelly stools. Febrile. Shock. Rigid abdomen
Intussusception is a medical emergency. T/F ? True
what tx would you expect for a Intussusception? surgery, barium enema
Currant-jelly stools Children with Intussusception may have bowel movements containing blood and mucus and no feces. What are these called?
Leading malabsorption disorder in children, Inherited disposition, Symptoms at 1 year to 5 years of age Celiac Disease
Celiac Disease Manifestations Failure to thrive. Large, bulky & frothy stools. Abdominal distention with atrophy of buttocks.
A child diagnosed with celiac disease must restrict foods containing what? gluten
s/s of Hep A Fever. Anorexia. Headache. Abdominal pain. Malaise. Jaundice. Dark urine. Chalk-like bowel movements
what is the incubation time and contagious period for Hep A? 15-50 days(avg 25-30); uncertain, virus may be shielded for 6 months in neonates
what is the incubations period; contagious period r/t Hep B? 30-180 days (average 50); uncertain, may persist in carrier state
what can the nurse do/teach to help prevent Hep B? Immunize with HBV vaccine during newborn period. Interferon or reverse transcriptase inhibitors may be an effective treatment. Immune globulin may be indicated for exposed, susceptible children
oral secretions, spread by direct contact only and s/s include low grade fever, malaise, jaundice, enlarged spleen Infectious Mononucleosis (Mono)
how is Mono spread; incubation period direct contact only; 4-6 wks
the source is respiratory tract secretions, blood, and urine of infected person and the s/s are Fever, cough, and conjunctivitis. Koplik's spots. Maculopapular rash erupts. Measles
what's the incubation period and and contagious period of Measles? 2-3 wks; from 4 days before to 5 days after rash appears
what are two unique interventions r/t measles? protect against photophobia, detailed oral care
how can measles be prevented? Vaccine at 15 months. If exposed without vaccine, gamma globulin may be given after exposure. Vitamin A is recommended to reduce morbidity
source and s/s of mumps saliva of infected person; Fever, headache, and vomiting. Painful swelling of glands near ear and jaw line. Enlarged parotid gland. May be bilateral
what is the incubation and contagious periods for mumps? 14-21 days (average 18d); prior to, and until all swelling subsides
what are three interventions for Mumps? Encourage fluids. Isolate. Ice compresses to neck for comfort
s/s include Headache, fever. Stiff neck and stiff back. Paralysis Polio
Incubation and congious periods for Polio are 7-14 days; 1 week for throat secretions; 4 weeks for feces
what type of interventions would you expect to do for a pt w/Polio? Isolate. Bed rest. Observe for respiratory distress. Position; physiotherapy. Range of movement exercises
Source:airborne; contact with an infected person. s/s include:Low grade fever, malaise, anorexia, weight loss, cough, and night sweats TB
who is at an increased risk for TB. Immunocompromised patients, such as with AIDS
what is the incubation and contagious period for TB? 2-10 wks; after treatment when cough subsides
What is the confirmation test for TB? sputum culture
TB meds
Source: discharge from respiratory tract of infected person; s/s: cold-like symptoms, fever, cold, cough. Spells of coughing, accompanied by a noisy gasp for air that creates "whoop“. Whooping Cough
contagious period and infectious period 5-21 days (Avg 10); several wks
Source: contact with a patient or carrier; s/s include:Common cold with purulent nasal discharge. Malaise, sore throat. White or gray membrane forms in the throat, causing respiratory distress. Diphtheria
what is the incubation period and contagious period for Diphtheria? 2-5 days; usually 2 wks
Source: viral; s/s include: Persistent high (103-105 F) fever that drops rapidly as the rash appears. Macupapular rash is non-pruritic and blanches easily Roseola
Incubation Period and Contagious Period for Roseola. 5-15 days; until rash fades
when giving an oral med to ped child? oral syringe, medication cup, (household spoons are not reliable)
at what age do you NOT offer choices for medication administration? Toddlers - be firm
nursing considerations for a preschool aged child r/t med administration offer choices, give praise/sticker/prize
give choices, concrete explanations, interact with pt, and the use of medical play can help you give meds to what age? school-age
what are nursing considerations for adolescents Use more abstract rationale for medication. Include in decision making especially for long term medication administration
select your needle size for an IM injection based on: amount to be given, viscosity, amount of tissue to be penetrated
what's the location of choice for IM injection r/t peds? vastus lateralis
what are the limits for IM volume r/t injections? Infant: < 0.5 mL. Toddler: < 1 mL. Pre-School: < 2 mL
what is the preferred needle size for a ped infants and toddlers? 5/8 to 1 inch
what location is NOT safe for an infant or toddler under the age of 5 r/t injections? dorsogluteal
what's the amount of fluid and size of needle that can be given into the dorsogluteal? 1.5 - 2 ml; 1/2 inch to 1 inch
how might an infant show signs of manifestation of systemic HTN? Irritability. Head-banging or head-rubbing. May wake up screaming at night
how might an adolescent or older child show signs of systemic HTN? Frequent headaches. Dizziness. Changes in vision
significant HTN is BP persistently in the ___% and the ___% 95 - 99
severe HTN is bp persistently at or above the ___% 99
what is an example of a nursing diagnosis r/t Wilms Tumor r/t surgery? High risk ineffective airway clearance related to poor cough effort associated with post anesthesia, postoperative immobility, and pain
Respiratory and Throat Specimens are contraindicated when DO NOT ATTEMPT IF ACUTE EPIGLOTTITIS IS EXPECTED
what are the two major goups of cardiac d/o in children? congenital(anatomic abnormality), acquired (after birth)
Created by: jrstrader