Peds Test 2
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Where do you auscultate baby lung sounds? | Mid Axillary
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| Describe infant breathing patterns. | Obligatory nose breathers and diaphragmatic breathers
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| How long is lung tissue growing? | Until age 8
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| Describe respiratory tract of children 5 and under. | Structures of respiratory tract have a narrower lumen making kids more susceptible to obstruction/distress from inflammation.
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| Why are children 5 and under more susceptible to respirtory obstruction/distress? | Narrower lumen, even more narrow r/t inflammation
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| Most episodes of acute illness in young kids involve... | respirtory systems d/t exposure to infection and decreased immunity.
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| Grunting indicates... | chest pain. (Not "pain" they are reopening airsacks)
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| Respirtory physical assessment includes... | Auscultation of the lung fields
Palpatation (pain, tenderness?)
Percussion (tissue density)
Nasal flaring? (respirtory distress)
Grunting (trying to reopen air sacks)
Skin color
clubbing
cough?
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| Why palpate in respirtory assessment? | Check for pain or tenderness
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| Why percuss in respirtory assessment? | Assess tissue density.
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| Mottling | Patchy red/white skin. Looks like webs on skin
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| Signs of respirtory distress? | Mottling, pallor, cyanosis
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| Cough assessment... | Type
Progress
Pattern
Associated symptoms
Secretions (odor color, consistency)
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| Clubbing | Caused by proliferation of tisssue at the end of the fingers usually from hypoxia. Develops over time
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| Nasopharyngitis | The common cold(usually viral).
Treat symptoms.
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| Pharyngitis | Painful inflamed throat. Usually viral.
Treat symptoms.
Warm salt water gargle.
Antibiotics if bacterial. (strep a)
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| Tonsillitis | Inflammation of tonsils.
Usually occurs with pharyngitis.
Viral or bacterial.
Difficulty Swallowing.
Treat symptoms. Antibiotics if bacterial.
Tonsillectomy for very chronic cases.
Post op care: NO BLOWING NOSE, COUGHING, OR GARGLING
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| Otitis Media | Inflammation of the middle ear - infected fluid in middle ear.
Extremely common.
Often bacterial. Can be alleriges.
Lower incidence in breast feed babes r/t IgA, decreased exposure to pathogens and foreign proteins & more upright feeding position.
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| Otitis Media Tx: | Usually treated with abx, sometimes tubes.
More recent: "ride it out" if >2yo
Tx symptoms, can be r/t allergies.
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| Chronic Otitis Media Tx: | Tubes in ears. No swimming. When tubes come out make sure the holes close!
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| SIDS-Sudden Infant Death Syndrome | SIDs decreased with "back to sleep".
Discourage smoking during pregnancy and around infants.
Discourage bed sharing
Encourage observed tummy time
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| Bronchitis | Inflammation of large airways (often with URI).
Usually viral, bacterial rare.
S/S: Dry hacking cough (non productive then productive).
Tx: symptoms
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| Bronchiolitis | Acute viral infection at bronchiolar lvl.
Respirtory syncytial virus (RSV) causes 80%.RSV invades epithelial cells of nasopharynx, spreads to lower respirtory tract.common cold in adults.
Spread by contact (can live for hours)
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| Bronchiolitis S/S and Tx | S/S: Starts with cold symptoms, most likely to progress in younger children.
Tx: Symptoms (high humidity, fluids, rest)
High risk kids (premature grads, cardiac defects) get monthly Synagis IM
Isolate child to prevent spread
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| Synagis IM | Prophylactic monoclonal antibody against RSV
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| Describe Croup Syndromes | Croup applies to infections characterized by hoarseness barky cough, inspiratory stridor varying degrees of respiratory distress.
Common in younger children.
Smaller diameter of aireway leads to greater narrowing with same degree of inflammation.
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| Acute Laryngotracheobronchitis (LTB) | Viral.
Progresses slowly (often 1-3 days with URI)
S/S: URI, inspiratory stridor, brasy, barky cough, hoarsness, dyspnea, restlessness, irritability, low grade fever
Tx: humidity, racemic epinepherine, and steroids
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| Acute Epiglottitis (Supraglottitis) Define and S/S | Most significant, life threatening Croup.
Bacterial. Usually H. Influenzae.
Rapids progressing of S/S. RISK FOR OCCLUDED AIRWAY!
S/S: Dysphasia, drooling, acute resp distress, high fever, rapid pulse and resps, stridor worse when supine.
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| Acute Epiglottitis (Supraglottitis) Tx: | Abx, protect airway (may need steroids). NPO!
Emergency trachiotomy if epiglotis being pushed or they can't get a tube in.
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| Viral Pneumonia | Inflammation of the pulmonary parenchyma/alveoli.
most common.
Often with URI, usually mild but can lead to bacterial (pts with trach or tubes).
Tx symptoms
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| Primary atypical pneumonia | caused by M Pneumoniae (Community aquired pneumonia) Common in kids 5-12 yo, usually 1-2 wks.
Tx: symptoms, zpack
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| Aspiration Pneumonia | If refluxing or POORLY COORDINATED SUCK/SWALLOW or muscle weakness.
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| Bacterial Pneumonia | Often serious w/ high fever.
X-ray usually shows infiltration.
S/S: high fever, cough, rhonchi or crackles, RETRACTIONS, NASAL FLARING, kids-irritable, restless, lethargic with anorexia, vomiting, diarrhea, abd pain.
Tx: abx, rest and fluids po
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| Asthma | A CHRONIC INFLAMMATORY disorder of the airways (Reactive Airway Disease-RAD)
Most common chronic disease of childhood.
Symptoms can be controlled, doesnt go away.
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| Asthma. REVERSIBLE obstructive airway disease characterized by: | Bronchoconstriction of smooth muscles.
Inflammation and edema of bronchial mucosa.
Increased mucus secretions.
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| Asthma. Exacerbation: | Episodes of progressively worsening shorteness of breath, cough, wheezing, and/or chest tightness.
Status asthmaticus is unrelenting, severe asthma that doesn't respond to tx, usually requiring ICU care.
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| Asthma. Immunologic Factors: | Allergens that evoke the immune response.
IgE mediates the hypersensitive reaction in the bronchial mucosa.
Results in increased bd vessel permeability, contraction of smooth muscles, and stimulation of mucus secretions.
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| Asthma. Obstructive Symptoms: | Inflammation and edema of mucous membranes.
Accumulation of thick secretions.
Spasm of the smooth muschle of bronchi and bronchioles decreaseing caliber of the bronchioles.
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| Asthma. Clinical Manifestations: | Dyspnea, wheezing, and coughing.
May feel itchy, uncomfortable, irritable, or restless.
May c/o HA, feeling tired, or their chest feeling tight.
Symptoms may be less obvious in infants.
Infants may have retractions.
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| Asthma. Diagnosis: | Clinical Manifestations.
History (chronic cough w/o infection)
Physical examination (wheezing?)
Tests: Pulmonary Function Studies, Peak expiratory flow rate
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| Asthma. Pulmonary function: | Based on personal best (or predicted for age).
Green zone: 80-100%, great. asthma well controlled.
Yellow zone: 50-80%, caution, may need to increase therapy.
Red zone: <50%, medical alert! Give tx and call if not improved.
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| Asthma. Management: | Allergen and trigger control to decrease exacerbations.
Chest physiotherapy (CPT) like breathing exercises and physical training may help.
Drug therapy to prevent and control asthma symptoms.
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| Asthma. Medication: | Corticosteroids:most effective anti inflammatory. Give only short term or low dose. Aerosal ideal (Dec Systemic SE)
NSAID-(Cromolyn Sodium). Prophylactic to inhibit release of histamine.
Beta-Adrenergic Agonist: (Albuterol)Rescue med, no response-get he
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| Cystic Fibrosis (CF) | Generated by genetics.
An autosomal recessive disease characterized by altered function of the exocrine glands involving primarily the lungs, pancrease & sweat glands.
Secretions-thick.
Sweat &saliva-high lvls of sodium chloride.
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| Sweat Chloride Test | Heat arm, test sweat.
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| First symptom of CF: | Maconium illeus plugged up, so thick it wont pass. Not a good sign.
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| CF-Pancreatic involvement: | 85% of CF kids have pancreatic involvement.
-Obstruction of pancreatic ducts (eventual fibrosis)
-Absence of enzymes causes malabsorption of fats and proteins.
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| CF-Respirtory involvement: | 99.9% of CF kids have respirtory involvement.
-Increased production of secretions causes airway obstruction.
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| CF effects on... | Pacrease
Respirtory
Liver
Reproductive(male infertility)
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| CF-Diet: | Infant-Predigested formula (pregestimil)
Kids-High cal, High Protein, Low or normal fat, plus fat soluble vitamins.
Need supplemental pancreatic enzymes.
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| Aqudete (sp???) | water soluble enzyme. Given before meal.
Increase or decrease enzymes by consistency of poop.
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| CF-Management: | Promote absorption.
Maintain airway
Prevent lung infection (TX WITH ABX)
Assist child/family in adapting to a chronic disorder.
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| What pancreatic symptoms might you expect to find in an infant or child with CF? | Poor Growth, failure to thrive; frequent, large foul smelling, foamy, fatty stools
containing undigested food; protruding abdomen with atrophy of extremities and
buttock; sx from deficiency of fat soluble vitamins (A, D, E, K); anemia
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| What respiratory symptoms might you see in CF pt? | barrel chest, clubbing of nails, decreased
exercise tolerance; frequent productive cough frequent pneumonia
(may see atelectasis, inflitrations, emphysemic changes on x-ray; abnormal
pulmonary function studies or ABG;s showing resp acidosis)
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| CF-Excessive sweating: | May need salt pill. Losing too much Na+.
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| Tonsillectomy | Post op no gargling, nose blowing, or coughing.
Comfort measures, HOB up, WATCH FOR SIGNS OF HEMORRHAGE!
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| Nursing Care for Acute Epiglottitis (Supraglottitis) | Constant vigilant observation and accurate assessment of respirtory status.
-Facilitate resp efforts.
-Promote rest/comfort.
-Prevent Spread of Infection and complications.
-Decrease temp.
-Educate/Support family.
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| Chest Xray | Provides a permanent record of the hearts size and configuration, its chambers and great vessels as well as the pattern of blood flow, esp in pulmonary vessels.
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| Fluroscopy | Used mainly in conjunction with cardiac catheterization
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| Electrocardiogram (ECG) | Measures electrical activity of heart and records it on graph paper
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| Echocardiography | Involves the use of ultra high frequenc sound wave to produce an image of the hearts structure
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| Heart Cath | Can give info on O2 sat, pressure changes in heart, cardiac output or stroke volume, anatomic abnormalities. Can sometimes be used to tx problems like valvular pulmonic stenosis and patent ductus arteriosus.
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| Nursing Care for heart cath | Pulses, temp, and color of extremity important!. VS esp HR r/t risk for dysrythmias or bradycardia and BP for hypotention (could indicate bleed or hematoma.) Go in right side of heart.
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| Hemodynamics | Blood flows b/c of pressure gradients in different parts of the body &b/c hearts pumping action
Blood flows from area of high pressure 2 1of low pressure; &toward the path of least resistance
Rate of flow is directly proportional 2the pressure gradient
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| Post natal circulation | Ductus venosus constricts in 3-7 day after birth &eventually becomes ligamentum venosum
Foramen ovale closes when pressure in LA exceeds pressure in RA in 1st wk w/deposit of fibirn
Ductus arteriosus closes by 1-3wks
May hear murmurs til shunts closed
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| Congenital heart anomolies Etiology, Contributing Factors | Etiology: 90% unknown. Multifactoral inheritance (genetic or enviormental)
Prenatal factors-maternal chronic illnesses drugs, alcohol, smoking, >35, infections like rubella and CMV, diabetes. Genetic factors-family hx or chromosomal abnormalities
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| Congenital Heart anomalies: Acyanotic heart defects | Oxygenated blood shunted from systemic to pulmonary circulation (L to R shunt) and bd leaving aorta is completely oxygenated
Inc bd volume on R side of heart results in hypertrophy of R ventricle
Eventually leads to CHF
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| Congenital Heart Anomalies: Cyanotic heart defects | Unoxygenated bd shunted from R to L where it mixes with oxygenated bd
The bd pumped to the peripheral tissue has a much lower oxygen content than normal, causing the bluish color called cyanosis
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| Congenital Heart Anolmalies: Acyanotic heart defects-Atrial Septal Defect (ASD) | increased pulmonary bd flow
abnormal opening in the septum b/w L and R atria causing L to R shunt
Dec exercise tolerance, dyspnea, systolic ejection murmur
Usually corrected Surgically
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| Congenital Heart Anolmalies: Acyanotic heart defects-Ventricular Septal Defect (VSD) | increasedpulmonary bd flow
opening in the septum b/w ventricles, causing L2R shunt
Small VSDs may b asymptomatic; larger may cause hypertrophy, failure of R ventricles &/or CHF
Surgical correction if meds don’t decrease symptoms or if continues
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| Congenital Heart Anolmalies: Acyanotic heart defects-Patent Ductus Arteriosus (PDA) | failure to close at birth
Allows oxygenated blood pumped into the aorta from the L ventricle to return to the lungs
Small PDA may b asymptomatic;larger causes excess bd in lungs&volume overload, leading to CHF
Indomethacin may work in premies or ligati
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| Congenital Heart Anomalies: Acyanotic defects-obstructive defects | Coarctation of aorta-narrowing of aorta. pressure increase proximal 2narrowing&decreases distally.
Causes decrease in bd flow2 abdomen &legs w/ majority of bd shunted2 UB
S/S: BP & pulse pressure higher in arms than legs, warm ub, cool lb, nosebleeds, H
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| Congenital Heart Anomalies: Cyanotic defects-Tetrology of Fallot (TOF) | combo of4defects-VSD,Pulmonary stenosis (PS), overriding aorta,R ventricular hypertrophy.Degree PS determines bd flow. Aorta sits near core of <3 over VSD getting bd fm both ventricles. < blood flow 2lungs;mix of unO2ed bd go 2aorta cause cyanosis&dyspnea
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| Congenital Heart Anomalies: Cyanotic defects-Tetrology of Fallot (TOF)-S/S | TET Spells, Polycythemia, Dyspnea on exertion, irritability, poor exercise tolerance, poor growth and development, murmur.
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| TET spells | Hypoxic episodes caused by transient inc in the obstruction of the R ventricular outflow of tract.
S/S:cyanosis tachypnea,flaccidity,altered LOC,maybe seizures,CVA,dealth
Precipitated by crying,feeding,defecation
Tx:knee-chest position,O2,Propranolol,M
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| Congenital Heart Anomalies: Cyanotic defects-Tetrology of Fallot (TOF) TX | Surgical correction-when infant/child becomes symptomatic.
Palliative w/goal2 increase bd flow2 lungs
Total repair with patch closure of VSD& correction of pulmonary stenosis
Lifelong antibiotic prophylaxis (to prevent endocarditis) for certain procedu
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| Congenital Heart Anomalies: Cyanotic defects-Mixed blood flow | Transport of the great arteries or vessels (TGA or V)-aorta arises fm R ventri;pulmon art arises fm L ventri (O2ed bd circulates thru L side of <3 2lungs&back2 L side;uno2ed bd enters R atrium fm bod, goes2R ventri&back 2the body w/o bing 02ed!)
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| Congenital Heart Anomalies: Cyanotic defects-Congestive Heart Failure (CHF) | Due2 surgery correctable structural abnormality of the <3resulting in increased bd volume pres
A symptom complex reflecting the<3s inability2meet the metabolic demands of the<3
Manage:improve<3function/save energy(digitalis,diuretics&ACE HTN&increase ca
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| CHF S/S | Tachycardia, gallop rhythm, cardiomegaly, decreased peripheral pulses, and mottling of the extremities
Tachypnea,retractions,grunt,nose flaring, cough,cyanosis,orthopnea
Hepatomegaly,edema,big neck&peripheral veins, low urine out, exercise intolerance
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| Classical Symptom of Left Ventricular Heart Failure | (labored breathing that occurs when lying flat and is relieved by sitting up)
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| CHF Tx | Decrease energy expenditure,Freq rest, small/freq feeds,no crys or cold
gd food/gd growth& dev
Est daily cal req.,soft nipple, consider gavage,I/O, daily wt, Digoxin, diuretic, ?ACE HTN, more upright or knee-chest 4cyanotic <3 disease
Prevent infection
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| What is rheumatic fever? | An inflammatory disorder that may involve the <3, joints, connective tissue, &the CNS. Believed 2b autoimmune reaction to Group A beta hemolytic strep(often strep throat)strep resembles <3 valves causing antibodies made against strep2also attack <3valves
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| How do you check for rheumatic fever? | No single symptom or lab test to definitely dx RF. Dx based on set of guidelines recommended by the American Heart Association
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| Major Manifestations of Rheumatic Fever | Polyartrhritis- migratory inflammation of joints, Erythema marginatum-transitory, nonpurritic
Chorea-sudden, irregular movements of extremities, facial, speech, emotional liability, weak muscle, sleep helps
Subcutaneous nodules
Arthralgia-joint pain
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| Nursing Care for Rheumatic Fever | Teach to support home care. Promote compliance w/bed rest. Monitor VS. Promote quiet diversional activities. Alleviate discomfort. Promote normal development.
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| Rheumatic Fever Tx | Prevention(tx strep!), if rheumatic fever develops eradicate strep w/penicillin, suppress inflammation w/ salicylates, rest to decrease workload on <3. Can reoccur, prophylactic ordered throughout childhood. If <3disease, need lifelong prophylaxis
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| How often are children checked for anemia? | Once at infancy, b/w 6-9 months, 1-5yrs, and 5-12 yrs.
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| Iron deficency Anemia | Most common. Due to inadequate supply of dietary iron. Infant maternal iron stores adequate 1st 5-6months. Premies storage doesn't last long. Can also be r/t malabsorption
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| Iron deficency Anemia. Whos at risk? | Lower income kids, kids whose diet consists mainly of cows milk (low in absorbable iron). Adolescents r/t fast growth, poor eating habits. Pregnant women. Women w/heavy periods.
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| Iron deficency Anemia. S/S | S/S:not noticed til severe, milk babes (babes on cows milk too early)fatigue, pallor, SOB, tachycardia, weakness
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| Iron deficency Anemia. Tx | Prevention! Fe fortified formula or breast 1st yr, Fe fortified cereal, Fe supplement for premies, Limit qL formula/day, Fe rich foods (vit C helps), oral supplements
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| Iron IM | Z-track, chnge needle, don't massage if need to give IM iron.
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| What is sickle cell anemia | a disease in which normal adult hemoglobin is partly or completely replaced by abnormal sickle hemoglobin (HgbS). It is a hemolytic anemia-premature red cell destruction.
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| Sickle Cell anemia S/S | pallor, fatigue, jaundice, irritability, anorexia, poor healing, initially enlarged spleen, altered liver function, kidney abnormalities, bone changes
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| Sickle cell anemia, increased sicking with- | Caused by autosomal recessive gene. Hypoxia (high altitudes), dehydration or acidosis
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| Sickle cell anemia more prevalent... | in parts of Africa where having the trait may be protective against certain forms of malaria
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| Priapism | errection that wont go away
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| Sickle cell anemia crises | vaso occulusiive or thrombotic. "log jam or microcirculation. Sequestration-cells clog outlet of spleen, trap cells. Aplastic-profound anemia (if increased erythropoiesis compromised. Hyperhymolytic-rare, but an increase in hemolysis of cells
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| Sickle Cell anemia-tx | Minimize crisis (nutrition, avoid infection, hand washig prophylactic meds), minimize deO2ation, hydrate, encourage screening, educate and support, rest, heat, I&O
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| Hemophilia A | KNOW: FACTOR 8, delayed, prolonged bleeding. classic 75% of cases, X-linked (carried on monther transfered to boy) recessive. FACTOR PRODUCED IN LIVER
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| Hemophilia B | Factor 9, Christmas disease (Christmas tree shaped rash on back), 15% of cases, X-linkied recessive. Clinically can't distinguish between Hemophilia A, except rash. (carried on mother, trasfered to boy)
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| Hemophilia C | Factor 11, autosomal recessive in males and females-usually less severe.
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| Hemophilia S/S | Bloody nose, bleeding gums, heavy periods.
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| Hemarthrosis concern | repeated bleeding into a joint results in a swollen and painful joint with limited mobility
may result in contractures and possible degeneration of joint: knees, ankles, elbows, wrists most often affected.
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| Hemarthrosis Diagnostics | Platelet count normal, but anemia.
Prolonged coagulation time: PTT increased.
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| Hemophilia tx | Replace missing factor via transfusion.
Control acute bleeding episodes-RICE. Rest, ices, compression(15minutes), elevation. Provide care for hemarthrosis. For joint bleeding, imobilize joint and control acute bleeding, elevate slightly flexed position.
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| Leukemia what is it? | Cancers of the blood and lymph system leukemia is the most common form of childhood ca. Leukemia is classified by morphology.
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| Leukemia types? | Acute lymphoid leukemia LL) most common with best prognosis.
Acute myelogenous leukemia AML) is also acute nonlymphocytic leukemia (ANLL) not good
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| Leukemia what is it | Proliferation of abnormal white blood cells that do not mature beyond the blast phase crowding out healthy blood cells leading to bone marrow suppression.
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| Leukemia S/S | infection, anemia, bruising, pallor, enlarged lymph nodes, spleen, liver. fatigue. abd pain, weight loss anorexia, bone pain
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| Leukemia Dx | Dx with blood studies, bone marrow aspirate, and biopsy. Induction is intense. CNS prophylaxis done to prevent CNS disease. Maintenance usually 2-3 yrs.
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| Intrathecal | when chemo is injected during a spinal tap directly into the CSF
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| Leukemia (bone marrow transplant) | Reserved for ALL kids with relapse (in 2nd remission) since good outcome with chemo or AML kids in 1st remission if donor available.
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| Bone marrow transplant | 1st, Knock out immune system so you don't reject it. 2nd processed, goes into body with large catheter like blood transfusion. then it lays itself down where bone marrow is. (supposed to happen) Can still reject transfusion down the road.
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