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Pediatrics Unit 1

Intro, Accidents, Comm Disease, Inegumentary, Cardiac

Ericksons; Autonomy vs. Shame and Doubt 1-3 years; increased ability to control self & environment, attains new physical skills & autonomy; Independence "NO" If successful dev. self confidence & willpower if unsuccessful dev shame & doubt about self.
Ericksons; Trust vs. Mistrust Birth to one year; Task of 1st year is to establish trust in people providing care. Mistrust dev if basic needs are not met.
Formal Operations; Piaget 11 years 'till death; Able to locically manipulate abstract & unobservable concepts. Adaptable & flexible, able to deal w/contradiction, scientific approach to solve problems; able to conceive the distant future.
Concrete Operational; Piaget 7-11 years; Thought increasingly logical & coherent; able to shift attention from one perceptual attribute to another (decentration). Concrete thinkers (Black & White) Right/Wrong) no gray, Classify & sort facts, problem solving & conservation skills
Predoperational Theory; Piaget 2-7 years; symbolic thought, egocentrism; no concept of conservation; incr. ability to use language, play bec more socialized; can concentrate on only one characteristic of an object at a time (centration)
Piagets Theory of Cognitive Development Birth - 2 yrs; Sensiormotor; learns about world thru senses and motor activity; Cause and effect, language curiosity, experimentation & exploration result in learning. Object permanence fully developed
Growth and Development for 0-2 months Hgt/Wt.; Head/fontanels; gross motor; fine motor; sensory and social 6-8 lbs; 20" tall; Head (33-35) typically 2" greater than Chest; NO gross motor; Hand primarily closed; hearing, touch, turns & locates sound, smiles at uman face; solitary play.
Growth & Development 2-4 months Hgt/Wt.; Head/Fontanels; Gross Motor; Fine Motor; Sensory & Social Gains 5-7 oz weekly first 6 mo.; Posterior fontanel closed at 3 mo., Gains head control at 4 mo. No Gross/Fine motor skills gained. Ericksons; Trust vs. Mistrust
Growth & Development 4-6 months Hgt/Wt.; Head/Fontanels; Gross Motor; Fine Motor, Sensory & Social Doubles Birthweight in 6 months; Grows 1" monthly for 6 mo.; Gross Motor- Rolls back to front, sensory-Taste preferences
Growth & Development 6-9 months Hgt/Wt.; Head/Fontanels; Gross Motor; Fine Motor, Sensory & Social Gross Motor; sits w/o support at 8 mo; stands holding on at 10 mo. Fine Motor; Holds bottle at 6 mo; transfers hand to hand at 10 mo. Responds to own name.
Growth & Development 9-12 months Hgt/Wt.; Head/Fontanels; Gross Motor; Fine Motor, Sensory & Social Triples birthweight; Height increases 50%; Anterior Fontanel closes (12-18mo); Crawls (10) Walks w/one hand held (12); Pincer Grasp (12) Follows moving object (12) Visual Acuity 20/50 or better (12) Vocalizes 4 words by 12 months.
Growth & Development 1-3 years Hgt/Wt.; Head/Fontanels; Gross Motor; Fine Motor, Sensory & Social Wt slows down,Ht 2yrs is 50% adult height. 90% adult brain size(2);Walks w/o help, uses cup(15mo) Jumps in Place (18mo)Runs(2)Holds Crayon (2-3) Copies Circle (3); Binocular vision (15mo) Follows direc,short sent., 300 words Parallelplay(2)Shame vs. Doubt
Growth & Development 3-6 years Hgt/Wt.; Head/Fontanels; Gross Motor; Fine Motor, Sensory & Social Gains 45lb/yr; Hgt incr 2-3"/yr; 20 deciduous teeth; Hops on 1 foot (4) Rides tricylcle (3); 2100 words; Assoc play, conscience; Eriksons Initiave vs. Guilt
Growth & Development 6-12 years Hgt/Wt.; Head/Fontanels; Gross Motor; Fine Motor, Sensory & Social Gains 5lbs/yr; Height inc. 1-2"/yr; Loses first teeth (6) All perm teeth but final molars by (12); Good hand/eye coordination; acquires reading/writing skills; vision 20/20 @ 7 yrs. Cooperative play; Team Play; new interest; Erikson; Industry vs. Inferior
Growth & Development 13-18 years Hgt/Wt.; Head/Fontanels; Gross Motor; Fine Motor, Sensory & Social Girs gain 15-55lbs & 3"/yr to 16; Boys gain 15-65lbs & 4"/yr 'till 20; Acne on face, final molars; preoccupied w/appearance, Peer group important; Eriksons Identity vs. Role Confusion
Temperature normal 12 yr and up 97.8 - 98 degrees F
Temperature normal 1-12 yrs 98.1 - 99.9 F
Temperature normal Birth to one year 97.7 to 98.9 F
Posterior Fontanel closes by what age? 2-3 months
Anterior Fontanel closes by what age? 12-18 months
Gross and Fine Motor at 1 month Head Lag, grasp reflex
Gross and Fine Motor at 2 months Lifts head off mattress; holds hand in open position
Gross/Fine motor at 3 months Raises head & shoulders off mattress, no longer has grasp relex; keeps hand loosely open
Gross/Fine motor at 4 months Rolls back to side, places objects in mouth
Gross/Fine Motor at 5 months Rolls front to back; palmar grasp dominant
Gross/Fine motor at 6 months Rolls back to front; holds bottle
Gross/Fine motor at 7 months Bears full weight on feet; moves objects from hand to hand
Gross/Fine motor at 8 months Sits unsupported; begins using pincer grasp
Gross/Fine motor at 9 months Pulls to standing; crude pincer grasp
Gross/Fine motor at 10 months Changes from prone to sitting; grasps rattle by handle
Gross/Fine motor at 11 months Walks holding on to something; placeds objects in container
Gross/Fine motor at 12 months Sits down from standing w/o assistance; tries to build a 2-block tower w/o success
Gross/Fine motor at 15 months Walks w/o help, creeps up stairs, uses a cup well, builds a tower w/2 blocks
Gross/Fine motor at 18 months Assumes standing position; manages a spoon w/o rotation; turns pages in a book 2-3 at a time.
Gross/Fine Motor Skills at 2 years Walks up/down stairs; builds a tower w/6-7 blocks
Gross/Fine Motor Skills 2 1/2 years Jumps in place w/both feet; Stands on one foot momentarily; Draws circles; Has good hand-finger coordination
Gross Motor Skills at 3 years Rides a tricyle; jumps off bottom step; stands on one foot for a few seconds
Gross Motor Skills at 4 years Skips & Hops on one foot; Throws a ball overhead
Gross Motor Skills at 5 years Jumps rope; walks backward w/heel to toe; moves up & down stairs easily
Eriksons Theory; Identity vs. Role Confusion 12-18 years; Rapid physical chgs., preoccupied w/appearance; redifines self, family peers; experiments w/diff roles; peer group important; If successful dev. confidence in self id; if not dev. role confusion
Eriksons Theory; Industry vs Inferiority 6-12 years; New interests/involvement; learns to follow rules, acquires reading, writing, math & social skills; success= confidence & enjoys learning; If not may dev feeling of inferiority
Eriksons Theory; Initiative vs. Guilt 3-6 years; Explores world w/senses, new activities & ideas; Dem initiative formulates & carrys out plan; Dev. conscious, If success= dev direction & purpose; No success= guilt & lack of purpose
Piaget; Sensorimotor defined Birth to 2 years; Growth occurs through the manner in which the child senses their environment & then subsequently acts upon it (cause & effect)
0-1 mo; Sensorimotor inherited, unlearned reflexes
1-4 mo; Sensorimotor Assimiation & accomodation
4-8 mo; Sensorimotor Distinguishes between self & outside objects, intentional acts/goal attainment
8-12 mo; Sensorimotor clear acgts of intelligence, develops object permanence
12-18 mo; Sensorimotor Senses self as separate from others
Preoperational Stage (Piaget) 2- 4 yrs. Egocentric, use of language 5- 7 yrs. Social Communicative Speech
Concrete Operational Piaget 7-11 yrs. Locical manipulation of symbols; recognized cause & effect relationship
Formal Operations (piaget) 11-15 years; Can conceptualize past, present & the future
Social Affective Play infants take pleasure in relationships wih people (adults talk & touch, infants smile and coo)
Sense-Pleasure Play non-social stimulating experience that originates from without (ipad etc.) Objects in the environment attract children's attention, stimulate senses, give pleasure.
Skill Play: repeating an action over and over
Pretend Play acting out events in everyday life
Onlooker play Onlooker; children watch what others are doing w/no attempt to join.
Solitary play play alone with toys different from those used by other children in the same area.
parallell play play independently but alongside other children with no group interaction.
Associative play play together engaged in a similar activity no group goals
Cooperative play Organized play in groups with other children to make something, attain a competitive goal
Communication; Infancy Nonverbal communication respond to adults nonverbal behaviors, comfort from cuddling, contact, sound of voice.
Communication; Early Childhood Center conversation on them, avoid using phrases that might be misinterpreted, use language that is consistent with developmental level.
Communication; School Age Rely less on what they see & more on what they know when faced with a new problem
Communication; Adolescence Allow to express their feelings, be attentive, try not to interrupt, avoid comments that may convey disapproval, confidentiality.
Weight over the first two years; Regain to birthweight by 10-14 days then gain 1 oz/day. Double birthweight by 4th month. Thriple by end of 1 yr.; quadruple by end of 2nd yr. Then avg. 5 lbs/year.
Height Length doubles by 4th yr. & triples by 13. Increases 9-11" first year. 5" second yr, 3-4" third yr. then 2-3 until puberty.
Adolescent Boys Growth spurt begins at first evidence of puberty. (Enlargment of testes, appearance of pubic hair & thickening of penis) and persist for about four years.
Adolescent Girls Growth spurt begins after first sign of puberty, persist for about 4 years. Puberty onset- breast development around 10yrs of age.
Three stages of separation anxiety Protest, despair and denial
Protest (separation anxiety) react aggressively to separation from parent- this is a positive sign.
Despair (separation anxiety) Crying stops & depression is evident, less active, uninterested in food or play, withdraws from others.
Denial (separation anxiety) Detachment appears to have finally adjusted to loss, result of resignation not a sign of contentment- this is a negative sign.
Functions of play in the hospital Provide diversion; feel more secure; lessen stress; allow for release of tension & expression of feelings; interaction with others; creative ideas & interest; make choices & be in control; means for accomplishing a therapeutic goal
QUEST Question the child Use a pain rating scale Evaluate behavioral & Psych. changes Secure parents involvement Take the cause of pain into account Take action & evaluate results
Pain Management Positioning; Distraction, Therapeutic play; Guided imagery; massage; administer meds
Meds PO Preferred route; liquid or chewable for children under 5 yrs. Infants use syringe or nipple
Meds IM NOT recommended for pain control. Hated by children, preferred sites are deltoid or vastus lateralis if needed.
Ear Drops Administration <3 pull pinna down and back >3 pull pinna up and back
Glascow Coma Scale Minor 13-15 Moderate 9-12 Severe 3-8
Linear Skull Fracture The lines of the frature are predermined by the site & velocity of the impact as well as by the strength of the bone. Uncommon before 2-3 yrs. and is the majority of childhood skull fractures
Depressed Skull Fracture The bone is locally broken, usually into several irregular fragments that are pushed inward causing pressure on the brain. The inner portion is more extensively fragmented than the outer portion.
Signs & Symptoms of skull fracture; Loss of consciousness; transient period of confusion; sleepiness; listlessness; irritability, pallor, vomiting
Subdural Hematoma; causes S&S and Diagnosis Bleeding bet the dura & cerebrum re; rupture of cortical veins that bridge the subdural space. Result of birth trauma, falls, assaults or violent shaking; S&S; incr ICP Diagnosis with CT scan
Epidural Hematoma; causes S&S Diagnosis Blood accumulates between the dura and the skull. Momentary unconsciousness follwed b a normal period, then lethargy or coma; CT SCAN
Interventions for Head Injury; Check child q2h for chg in responsiveness Waken sleeping child q2h to see if can be roused normally. Hospitalize severe injury, NPO until able to take fluids, strick I&O sutures, surgical reduction if needed.
Concussion; Causes, S&S, Diagnosis Trauma to the head and persists for a relatively short time; Confusion & amnesia for the moment of the injury & a variable period after the injury; CT SCAN for diagnosis
Drowning/Near Drowing Second most common cause of accidental death in children; death from asphyxia while submerged. Near drowing- survival at least 24 hrs after submersion. Management; Blood gases & PH.
Lead Poisoning diagnosis Based only on VENOUS blood specimen. Normal value is 0-10 ug/del. Deposits in tissues, bones and abdomen
Effects of Lead on Body systems; Anemia; impaired calcium function; Neurologically with low dose exposure = distractivility, hyperactive, impulsive, hearing impaired, lead encephalopathy, MR. High-dose= paralysis, blindness, seizures, coma and death.
Treatment with; Chelation Therapy; Levels >35-45 Succimer(Chemet) 19 days Levels >70 Dimercaprol (Bal in Oil) 2-7 days never with iron or peanut allergy. Calcium disodium for 3-5 days.
Five methods of Burn injury Inhalation, (smoke) Chemical, Thermal, Electric, Radiation
Most common types of burns by age group Toddlers: Hot water School Age; flame related Adolescent; flame & electrical related 20% r/t child abuse and children playing with matches or lighters account for 1 in 10 house fires!!
Superficial Burns Pink to Red w/no blisters, mild edema, no eschar; (Sunburn) Heals within 5-10 days. No scarring
Superficial Partial Thickness Burn Pink to Red; blisters, mild to moderate edema no eschar; Flame or burn scalds; heals in 14 days
Deep Partial Thickness Burn Damage to entire epidermis and some parts of the dermis; red to white, no blisters, moderate edema, soft and dry eschar (Flame & burn scalds) Greas, tar or chemical burns or exposure to hot objects for prolonged time; may need grafting; heals 14-36 days
Full Thickness Burn Damage to entire epidermis, dermis and possible subq tissue. Nerve damage. red-tan, black, brown or white in color w/o blisters, severed edema and hard, inelastic eschar, Grafting req., wks to mos to heal w/scarring. Burn scalds,grease, tar chem/elec
Deep full thickness burn Damage to all layers ext to muscle, tendons and bone. Black in color no edema and hard, inelastic eschar. No pain, heels weeks to months w/scarring. Flame, electricl, grease, tar and chemical burns.
Burn interventions; Wound cleaning, debridement, antimicrobial agents q12h; silver sulfadiazine (silvadine) and Sulfamylon. Light dressing.
Burns and fluids rationale IV fluids compensate for water & sodium lost to traumatized areas & interstitial spaces.
Fluids for burns required in the first 24 hrs. Crystalloid solution (Lactated ringers) followed y colloid solution (albumin or FFP)
Parkland Formula for fluid resuscitation 4 ml RL x kgx %TBSA burned 1/2 total admin in 1st 8 hrs. post burn 1/4 total admin in 2nd 8 hrs. post burn 1/4 total admin in 34d 8 hrs. post burn Time calculated from time of injury. UOP s/b 1ml/kg/hr
Other burn therapy High protein, high caloric diet PO Enteral feedings via tube Parenteral hyperalimentation Vitamins A,c, Zinc Sedation and analgesia IV Morphine(duramorph) Midazolam (verse), Fentanyl (sublimaze) and antibiotics prn
Chicken Pox aka Varicella Symptoms treatment Macules, papules, vesicles & pustules appear on the face & trunk. Mild fever, malaise, anorexia, headache, mild abdominal pain & irritability. Antiviral, antihistamines, topicals
Diptheria Symptoms treatment Low greade fever, anorixia, malaise, rhinorrhea w/foul odor, cough sore throat hoareseness stridor or noisy breathing. Antibiotics immunization boosters.
Acyclovir Given to immunocompromised patients with chicken pox. Side effects; nausea, vomiting, diarrhea, abdominal pain, skin reactions, headache.
Fifth's Disease Symptoms & Treatment Stage 1 flulike illness, Stage 2 fiery-red rash on cheeks & circumoral pallor State 3 rash fades but can reappear if skin irritated or exposed to sunlight. Treat with acetaminiphen for fever, soothing oatmeal baths for pruritic rash.
Roseola Symptoms & Treatment high fever up to 105 for 3-8/d followed by pale pink, discrete, maculopapular rash, lasting 1-2/d, starting on the trunk and spreading to the face. Mild upper resp. symptoms, typanic membrane redness and lymphadenopathy. Give non-aspirin antipyretics.
Measles (Rubeola) Symptoms & treatment High fever, conjunctivitis, coryza, cough, anorexia & malaise. Koplik spots on buccal mucosa red blotchy maculopapular rash. Treat w/antitussives for cough, maintain fluids, bedrest.Immune globulin may halp prevent up to 6 days postexposure.
Mumps (Parotitis) Symptoms & Treatment Malaise, low-grade fever, earache, headache, pain w/chewing, decr. appetite and activity bilateral or unilateral parotid gland swelling. Therapy is supportive; analgesics, antipyretics, fluids, cold/heat compresses.
Pertussis (whooping cough) Symptoms & Treatment Begins w/nasal cong,runny nose, low-grade fever and miild nonproductive cough (2wk) cough becomes more severe causing a "whooping sound" up to 6 weeks Treatment w/macrolide antibiotics (erythromycin, azithromycin and clarithromycin); corticosteroids.
Rubella (German Measles) Symptoms & Treatment Pink, nonconfluent, maculopapular rash that appears on the face and progresses to the trunk and legs and disappears in the same order. Treatment is supportive. antipyretic & analgesic prm. Isolate from pregnant women.
Scarlet Fever Symptoms & Treatment Symptoms appear as streptococcal pharyngitis- strawberry tongue (scarlet red throat) Treatment; penicillin, BR during febrile phase, analgesics for sore throat.
Rotavirus Vaccine 3 dose schedule ages 2.4.6 months should be given for infants >12wks and not after 32wks.
Influenza vaccine Now recommended for all children ages 6-months through 18 years.
Varicella Vaccine First does should be admin. at 12-15 mo second dose at age 4-6 years.
HPV (human papilloma virus) 3 dose schedule with second and third doses given 2 and 6 months after the first. Females ages 11-12 and as young as 9 and those 13-26 who have not been prev vaccinated.
Vaccines for adolescents Varicella, Hep B, MMR, Tetanus-Diptheria, HPV
Vaccines for college students Menigococcus (menactra)
Pediarix One vaccine for five diseases given at 2mo/4mo/6mo incl; Deptheria, Tetanus, Pertussis, Hep B and Polio. Hep B still given at birth.
Impetigo Bacterial Skin inf.;contagious; secondary caused by staph, strep; Treat w/bactroban/bacitracin. Oral/IV antibiotics in severe cases. Complication; acute glomerulonephritis
Cellulitis Bact. Inf.-SQ tissue/dermis. Strep/H.influenza. Red, hot, tender, indurated, fever, malaise, HA; IM or IV dose followed by 10d/antibiotics. BR w/leg elevated, warm soaks q4h monitor for sepsis
Candidiasis (aka thrush) Superficial fungal inf.-oral in infants; neonate:birth canal, infant:immunosuppressed, antibiotic therapy, inf. breasts of mom, unclean bottles/pacifier Treat w/nyastatin to mouth and Lotrimin to diaper area
Scabies (itch mite) S&S- intense itch, papules, vesicles, nodules on wrists, elbows, axillae, groin burrows into skin (gray, threadlike lines) Treat w/kwell, scabene cream, elimite
Eczema (atopic dermatitis) chronic, allergic, inflammatory disease. S&S; erythema, edema, severed pruritis (worse in winter) flexar surfaces (wrists, ankles,elbows) Treat w/antihistamines, creams (eucerin) corticosteroid creme.
Contact Dermatitis Inflamm. reaction to irritants; contact diaper derm. TX; cool compresses, antipruritic lotion, aveeno baths steroid creams, antihistamines.
Ductus Venosus Accessory (extra) vein, carries oygenated blood from umbilical vein into lower venous system.
Foramen ovale Shunts mixed blood from right atrium to left atrium (hole in the atrial septum)
Ductus arteriosus Accessory (extra) artery, shunts mixed blood away from lungs to descending aorta
How does fetus receive sufficient 02 from the maternal blood supply? Fetal hemoglobin carries 20-20% more oxygen than maternal HgB. Fetal HgB concentration is 50% greater than mothers. Fetal HR 120-160bpm (increases cardiac output)
What happens to the Ductus Arteriosis after birth? Over 24 hours, pressure in the LV is greater than the PA and closes the ductus arteriosis.
What happens to the foramen ovale after birth? Closes w/pressure. the pressure is the LA is greater than the pressure in the RA which leads to immediate closure.
What happens to the ductus venosus after birth? Absent blood flow through the umbilicus gradually closes the ductus venosus over 12 hours to 2 weeks.
Cardiac Catheterization . Primary method to measure extent of cardiac disease in children shows type and severity of the CHD. Intervention r/t blockage.
Congestive Heart Failure defined Left ventricle is not pumping well. Heart doesn't pump blood well enough and cannot provide adequate cardiac output due to impaired myocardial contractility. Causes in children; defects, acquired heart disease and infections.
Congestive heart failure symptoms; TACHYCARDIA is first sign. Tires easily, rapid, labored breathing, decr UOP, fluid/sodium retained, incr. sweating, pallor, peripheral edema.
CHF Diagnosis Chest XRay- shows enlargement Echo- shows dilated heart vessels, hypertrophy and increased heart size
CHF Treatment Aimed at reducing volume overload, improve contractility. May require surgery. Digoxin- helps strengthen the hearth muscle, enables it to pump more efficiently. Lasix- helps kidneys remove excess fluid.
S&S of Digoxin toxicity vomiting, bradycardia. Need HR, EKG, Drug levels. Check apical pulse first do not give if HR <100bpm in infants and <70bpm in children.
Blood flows from _____ pressure to ______ pressure High to Low (left side to right side)
Acynatic heart defects; (too much mixed blood to lungs)Septal defects; VSD, ASD and PDA
Obstructive Cyanotic defects- Reduced blood flow(Kink somewhere) Pulmonic Stenosis and Coarctatio of the aorta
Cyanotic Defects Poor perfusion- Tetrology of Fallot
Septal defects Increased pulmonary blood flow (Left to right shunting) Sends already sat blood back to lungs. Incr. cardiac workload, excessive pulmonary blood flow, right ventricular strain, dilation, hypertrophy
Ventricular Septal Defect general info "Hole in the heart" High pressure in LV forces blood back to RV. Results in increased pulmonary blood flow (heart must pump extra blood) higher than normal arterial pressure. No immediate clinical symptoms.
Ventricular Septal Defect S&S Vary w/size of defect. 4-8wks dev. loud, harsh systolic heart murmur. RV hypertrophy, 20-60% close spontaneously, cardiac cath shows 02 level of RV higher than normal. LG defects; dev CHF, foor feeding and failure to thrive
Ventricular Septal Defect treatment Small defects; followed by cardiologist, prophylactic ABX Lg. Defect; open heart surgery w/cardiopulmonary bypass will suture or patch hole closed. If child unstable may do pulmonary artery banding to reduce blood flow to lungs.
VSD medical management for infants not medically stable for surgery or awaiting surgery Digoxin to improve cardiac output, Oxygen and Lasix/Potassium.
Atrial Septal Defect general info Pressure in LA is greater than RA (blood flows from left to right) 02 righ blood leaks back to RA to RV and then pumped back to the lungs resulting in ventricular hypertrophy. few symptoms at birth, over time may show fatigue, dyspnea on exertion.
S1;S2 Av valves close then semilunar valves close
Atrial Septal defect clinical presentation Lg. defect may cause CHF. Harsh systolic murmor, second heart sound is split "fixed splitting". Pulmonary valve closes later than aortic valve (risk for pul edema) Echo shows enlarged right side of heart; incr pulmonary circulation.
Fixed splitting AV closed, semilunar split, pulmonary artery closes after aorta.
ASD management Nonsurical Mgmt; prosthetic patch Surgical Mgmt; open heart w/CP bypass, edges are sutured or will use patch to cover hole. Diuretics to control symptoms until repair is performed.
Patent Ductus Arteriosus general info Failure of ductus arteriosus to close completely at birth. Blood from the aorta flows into the pulmonary arteries to be reoxygenated in the lungs, returns to LA and LV. More common in preemies.
PDA S&S Preterm; present w/CHF & resp. distress Fullterm: may be asymptomatic w/continous "machinery" type murmor Tire easily, growth retardation, prone to frq resp tract inf. Early problems from birth.
PDA Management Chest XRay show enlarged LA & LV Indomethacin to stimulate ductus to constrict Surgery; ductus is divided & ligated (usually in 1st yr to decr risk for bacterial endocarditis
Acyanotic defects caused by VSD & ASD Right CHF, pulmonary edema, pulmonary HTN
Acyanotic defects caused by PDA Pulmonary edema, pulmonary HTN
Obstructive Defects (cyanotic) Decreased pulmonary blood flow. Right to left shunt unsaturated blood into saturated blood. Pulmonic Stenosis and Coarctation of the Aorta
Pulmonary Stenosis general info Obstruction of the right ventricular outflow tract. Decreased pulmonary blood flow
Pulmonary Stenosis symptoms RRV hypertophy. High vent press may cause blood to back up into RA & force foramen ovale to open & allow blood flow from RA to LA. Mild Mod: Asymptomatic, systolic ejction murmur w/palp thrill. Severe: RV failure, CHF & mild-mod cyanosis w/R to L shunt
Medical Mgmt of Pulmonary Stenosis If asymptomatic; cardiac follow up & prophylactic ABX. Surgery; pulmonary baloon valvuloplasty via cardiac cath if no success then valvotomy.
Coarctation of Aorta Localized construction of the aorta at or near the insertion site of the ductus arteriosus. Reduces cardiac output (impedes blood flow fr heart to body) Aortic pressure is high proximal to constriction and low distal to the constriction CVA. Stroke risk.
S&S of Coarctation of Aorta rel to severity of the constriction & presence of ass defects. Mild; asymptomatic, sys murmor, dim pulses in lower ext. Severe: poor low body perfusion, metabloic acidosis, CHF, syst htn. In both; BP is 20mmHG higher in arms than lower body.
Treatment of Coarctation of Aorta Digoxin, Diuretic to manage CHF, PGE1 (prostaglandin)infusions to maintain ductal patency & imp perfusion to lower ext. will cause inc pulm flow- surgical repair within 1 year.
Cyanotic defects general info Decrease dpulmonary blood flow. Transposition of the greater vessels. Tetrology of Fallot and Hypoplastic Left Heart.
Tetralogy of Fallot Has four parts; VSD, RV hypertropy, Overriding Aorta, Pulmonic Stenosis; impedes blood flow to the lungs, forces unosygenated blood thru the VSD & into aorta.
S&S of Tetralogy of Fallot The degree of pulmonic stenosis governs the onset and severity of symptoms. Mild little to no R-L shunting infants has tet spells (hypercyanotic episodes) Mod-Severe; some cyanotic at birth when PDA closes, other infants incr cyanotic over first few mos.
General Symptoms of Teralogy of Fallot Tires easily w/exertion, difficulty feeding and gaining weight. Chronic hypoxia. Tet spells
Tet spells Hypercyanotic episodes. Often preceded by crying, feeding or stooling, worsening cyanosis, increased RR may lose consciousness. Treatment= Chest knee position and apply 02. Do not leave child alone cyanosis can cause LOC, death.
Medical Management fo rTetralogy of Fallot Symptomatic newborn; PGE1infusion to maintain ductal patency. Older; close monitoring for worsening hypoxia. Surgery; done at 3-12 mo in stages. Primary open heart repair; close VSD, open pul valve, remove obstructing muscle.
Nursing Care for the child with a congenital heart defect Teach parents about care; review emergency mgmt (S&S resp distress, CPR) Promote normalcy within the limits of the childs condition.
Four acquired Heart Diseases; HTN, Endocarditis, Rheumatic Fever and Kawasaki Disease.
Hypertension is broken down into Primary- Caused by incr body bass, genetics. and Secondary- cause is from an underlying condition s/a kidney disease or heart defects.
What is used to diagose HTN in children? Need to compare rate to childs age, gender and height. Unlike adults, there is no set range. Three readings >95% for that child confirms diagnosis.
Hypertension Management Eliminate primary cause if possible. Exercise, lifestyle mods. ACE inhibitors, ARBs, Beta Blockers and Calcium Channel blockers
Infective endocarditis defined Inflammation of the lining of the valves & arteries. Caused by bacterial and fungal infections in the blood stream that infects an already existing injred endocardium. At risk; cardiac defects, severe valve disorders.
Symptoms and treatment for Endocarditis S&S- Weight loss, fever,fatigue, headache, N/V, new or changed murmur, CHF, dyspnea. Treatment: Antibiotics IV for 2-8 weeks, surgery to replace valves, treatment of CHF.
Rheumatic Fever defined Leading cause of acquired heart disease. Inflamatory autoimmune condition. Seen in children 5-15 Usually follows untreated strep A infection. Causes scarrring of the mitral valves. (left side, which you want to work well)
S&S Rheumatic Fever Tacycardia, polyarthritis, Carditis, chrea, erythema marginatum, subcutaneous nodules.
What confirms diagnosis of Rheumatic Fever? Antistreptolysin (ASO titer)
Management of Rheumatic Fever Treat infection, treat other symptoms, strep prophylaxis long term to prevent getting strep. PCN IM q mont or PCN PO BID
Kawasaki Disease overview Acquired heart disease in children under age 5. Boys>Girls; asian descent, multisystem vasculits (infl of blood vessels) 3 stages; affects coronary arteries. Occurs due to antibody vascular injury post infection.
Kawasaki Disease first stage: Prolonged fever; bilateral, nonpurlent conjunctivitis, chages in mouth (erythema, fissures, crusting of lips, strawberry tongue); induration of hands/feet, erythema of palms, soles, rash and enlarged cervical lymph nodes
Kawasaki Disease second stage day 15-25 Fever and most of the previous symptoms resolve; extreme irritability dev. Anorexia, Lip cracking & fissuring, Desquamation of fingers/toes; arthritis, vascular changes in myocardium & coronary arteries.
Kawasaki Disease Third Phase day 26-40 Lasts until erythrocyte sed rate returns to normal and all symptoms disappear.
Management of Kawasaki Disease Prevent/reduce coronary artery disease. Gamma-globulin IV followed by high dose aspirin therapy at same time (80-100mg/kg/day) once daily continue thru weeks 6-8 of disease.
What is the aspirin therapy for Kawasaki Disease? 100 mg/kg/day once daily
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