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6TH SEMESTER > PEDI EXAM 3 > Flashcards

PEDI EXAM 3 Flashcards

1
Q

– ability to discriminate letters or objects

A

visual acuity

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2
Q

children vision is not as great as adults. their vision is usually between?

A

20/100 - 20/400

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3
Q

kids are usually ___sighted

A

far

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4
Q

kids have not developed the ability to delineate ____ and other details

A

colors

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5
Q

what colors do they see best?

A

black & white

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6
Q

why do you not see infants tears when they cry?

A

o because their lacrimal system drains these tears efficiently into the nasal cavity

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7
Q

o Eye may change color w/in 1st

A

6 months

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8
Q

by 2-3 what is their vision

A

20/50

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9
Q

by 6-7 what is their vision

A

20/20

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10
Q

inflammation of the conjuctiva, the clear membrane that lines the inside of the lid & sclera

A

conjuctivitis

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11
Q

what can cause the conductive to become swollen & red with a clear, yellow, or white discharge.

A 
bacteria
viruses
allegies
trauma
irritants
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12
Q

conjuctivitis AKA

A

“pink eye”

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13
Q

conjuctivitis under 30 days old

A

ophthalmia neonatorium

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14
Q

conjuctivits as a result of a reaction to prophylactic meds

A

chemical conjuctivitis

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15
Q

can occur at any age. characterized by edema of the eyelid, red conductiva & enlarged pre auricular lymph glands

A

bacterial conjuctivitis

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16
Q

commonly bilateral conjunctivas

A

viral conjuctivitis

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17
Q

far-sightnedness

A

hyperopia

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18
Q

nearsightedness

A

myopia

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19
Q

why do infants have more ear problems than adults?

A

eustachain tube is shorter, wider, & more horizontal

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20
Q

connects the nasopharynx to the middle ear

A

eustachian tube

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21
Q

the fetus can hear by week?

A

20

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22
Q

which part of the ear is small @ birth

A

the external ear

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23
Q

which part of the ear is relatively large at birth

A

internal & middle ear

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24
Q

is close to the surface @ birth & can be easily injured

A

tympanic membrane

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25
Q

bacterial conjuctivitis is usually?

A

unilateral

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26
Q

when does bacterial conjunctivitis usually occur?

A

with hand to eye contact

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27
Q

sx of bacterial conjunctivitis

A

red conjuctiva

mucopurulent exudate (eyes become matted together and difficult to open

have itching or burning of the eye and they may be sensitive to light

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28
Q

tx of bacterial conjunctivitis

A

ATB eye drops

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29
Q

what kind of discharge with bacterial conjunctivitis

A

purulent

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30
Q

commonly bilateral & commonly caused by HSV

A

viral conjunctivitis

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31
Q

what kind of discharge with viral conjunctivitis

A

clear

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32
Q

they may also get what with viral conjunctivitis to prevent bacterial infection

A

ATB eye drops

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33
Q

supportive care for viral conjunctivitis

A

clean with warm washcloth

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34
Q

what’s specific to allergic conjunctivitis

A

“cobblestone” appearance

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35
Q

tx allergic conjunctivitis with?

A

antihistamine or decongestant

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36
Q

– infection of eyelid & surrounding tissue

A

Periorbital cellulitis

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37
Q

abnormal turning of eye inward or outward

A

stabismus

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38
Q

when is strabismus seen?

A

birth-6 month

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39
Q

lazy eye;

A

amblyopia

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40
Q

usually with congenital rubella syndrome; blurry film

lens opacity

A

cataracts

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41
Q

– tumor of retina

A

retinoblastoma

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42
Q

increased Intraocular pressure.

from eye injury or steroid use.

sees “halos” around eyes

A

glaucoma

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43
Q

♣ more common in white & black males than females

  • X-linked recessive disorder found mostly in males
  • Red and green is the most common type
A

color blindness

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44
Q

consists of #s embedded in a background that are difficult for persons with color blindness to see

A

ishihara color blindness test

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45
Q

is characterized by progressive changes in the retinal blood vessels & in severe dx by retinal detachment

A

retinopathy of prematurity (ROP)

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46
Q

♣ results from injury to development of capillaries in retina
• Immature BV constrict & become necrotic

A

retinopathy of prematurity (ROP)

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47
Q

retinopathy of prematurity (ROP) occurs in?

A

infants of LBW or premature

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48
Q

retinopathy of prematurity (ROP) can lead to?

A

retinal detachment & blindness or miid myopia

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49
Q

retinopathy of prematurity (ROP) is most common in

A

white infants weighing

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50
Q

o – inflammation of middle ear; accompanied by bacterial infection

A

otitis media

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51
Q

otitis media is more common in what time of year?

A

winter months

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52
Q

otitis media ism ore common in what kids?

A

boys
kids @ daycare
have allergies
parents smoke

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53
Q

protective against otitis media

A

breastfeeding

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54
Q

what often precedes the devilment of otitis media

A

upper resp. infection

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55
Q

don’t let children with otitis media do what

A

lay down with the bottle

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56
Q

otitis media with air or fluid behind the tympanic membrane

A

otitis media with effusion

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57
Q

children with otitis media will do what?

A 
Pulling at ear, 
touching 
diarrhea, 
n/v, 
awaking in middle of night (pain hurts more when prone/sleeping),
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58
Q

how to tx otitis media if they’re less than 6

A

ATB for 10 days (amoxicillin)

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59
Q

if they’re over 6 tx otitis media with?

A

5-6 days of topical eardrops

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60
Q

if meds don’t fix it they may need to get tubes inserted into their ears which is called?

A

myringotomy

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61
Q

treat pain of otitis media with

A

tylenol & ibuprofen

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62
Q

• nose bleed

o Very common in the school age child

A

epitaxis

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63
Q

epitaxis is r/t

A 
nose picking, 
foreign bodies, 
low humidity, 
forceful coughing, 
allergies
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64
Q

o more serious; coming from both sides; hospitalized; often associated with head trauma

A

posterior bleed

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65
Q

comes from one side

A

anterior bleed

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66
Q

what to do if child has anterior bleed

A

sit child upright, head tilted forward to prevent blood from trickling down throat, squeeze nares just below the nasal bone for 10-15 min while child breaths through mouth

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67
Q

if bleeding doesn’t stop with anterior nose bleed

A

q-tip w/ epinephrine, neosynephrine, or lidocaine to promote vasoconstriction, if the bleeding doesn’t stop the physician may cauterize it with silver nitrate

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68
Q

what to monitor for with nose bleeds?

A

pulse
BP
monitor for hypovolemia
check H&H

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69
Q

where to put cold rag to vasoconstrict

A

nose or back of neck

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70
Q

care after the nosebleed stops:

A

♣ Sleep with head elevated, humidifier, after nose bleed avoid bending over, drinking hot liquids, exercising excessively, hot baths/showers 3-4 days after

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71
Q

• upper respiratory infection or common cold

A

Nasopharyngitis

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72
Q

how is Nasopharyngitis spread

A

contact or droplet

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73
Q

Nasopharyngitis patients are usually brought in because?

A

they’re not eating

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74
Q

care for Nasopharyngitis

A

NS drops for baby to clean out nose

nasal decongestants

stay hydrated

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75
Q

– inflammation of one or more of the paranasal sinuses

A

Sinusitis

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76
Q

Sinusitis is usually ____ or ____

A

viral or bacterial

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77
Q

if its bacterial Sinusitis what sx occur?

A

purulent nasal drainage
fever above 102
facial pain

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78
Q

sx of Sinusitis

A 
headache, 
fever, 
pain, 
upper respiratory infection type sx, 
complain of face/mouth/teeth hurting
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79
Q

tx of sinusitis

A

ATB

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80
Q

– infection primarily affecting pharynx & tonsils (throat)

A

Pharyngitis

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81
Q

Pharyngitis is caused by?

A

bacteria (strep)

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82
Q

sx of Pharyngitis

A

o sore throat, redness, pain, exudate in the back of the throat, and swollen lymph nodes.

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83
Q

temp is what for bacterial pharyngitis

A

above 101

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84
Q

what temp for viral pharyngitis

A

below 101

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85
Q

is a good tx of pharyngitis but is very painful

A

penicillin shot

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86
Q

tx of Pharyngitis

A

ATB
tylenol for pain & fever
drinking cool non acidic foods
gargling warm salt water

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87
Q

how long is child contagious if they are taking the oral ATB

A

48 hours

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88
Q

how long are they contagious for bacilli shots?

A

24 hours

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89
Q

what to make sure to tell parents after pharyngitis

A

replace their toothbrush after they are well so they don’t re-infect themselves

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90
Q

• – inflammation of palatine tonsils

A

tonsillitis

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91
Q

sx of tonsilitis

A

Difficulty swallowing or possibly breathing if the tonsils become obstructed
possibly have enlarged cervical nodes

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92
Q

pharyngitis can lead to ____ _____ if untreated.

A

rheumatic fever

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93
Q

when will you get your tonsils taken out?

A

7 episodes in previous year

5 episodes each year for 2 years

3 episodes annually for 3 years

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94
Q

o >3/year

A

tonsillectomy if the symptoms are recurrent

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95
Q

No ibuprofen 2 weeks prior to?

A

tonsillectomy

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96
Q

no school for how many days for tonsillitis

A

2-3 weeks (about 10 days)

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97
Q

no activity for how many weeks with tonsillitis

A

2 weeks

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98
Q

causes of mouth ulcers

A

AIDs
chemotherapy
medications
trauma

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99
Q

use topical analgesics such as ____ for mouth ulcers

A

orajel

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100
Q

Important to teach the parents to provide good oral care by using

A

soft bristled brushes

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101
Q

what kind of foods to avoid with mouth ulcers?

A

spicy & acidic

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102
Q

what to do after meals with mouth ulcers

A

since their mouth out

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103
Q

o Losing a tooth due to injury

A

tooth avulsion

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104
Q

the resp system grows until age?

A

12

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105
Q

shorter – structures are closer together;

A

o Child’s neck =

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106
Q

upper oral-tracheal airway are ____ & ____ which makes a potential for obstruction

A

shorter & narrower

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107
Q

children’s oral cavities & tongue are?

A

shorter

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108
Q

infants up to ___ to __ months of age do not automatically open the mouth to breathe when the nose is obstructed

A

2-3

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109
Q

the larynx & glottis are?

A

higher in the neck which increases their risk of aspiration

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110
Q

o these cartilages are immature – easily collapse when neck is flexed; narrowing airway

A

Thyroid, cricoid, & tracheal

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111
Q

a child’s trachea is the size of?

A

small finger

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112
Q

how many mm in diameter is the trachea

A

4 mm

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113
Q

under 6 years old they rely on what to breathe?

A

diaphragm

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114
Q

why don’t kids breathe without their diaphragm until 6 y/o

A

their intercostal muscles are not mature

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115
Q

kids have an increased oxygen need especially when?

A

distress

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116
Q

musical lung sounds

A

wheezing

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117
Q

lung sound in which there is air moving over fluids

A

crackles

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118
Q

“snore” lung sound.

clears with coughing

A

rhonchi

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119
Q

• stop breathing for longer than 20 seconds or any pause in respiration with cyanosis, marked pallor, hypotonia, or bradycardia

A

apnea

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120
Q

o absence of nasal airflow when respiratory efforts are present (RSV)
♣ Usually d/t tonsils being enlarged

A

obstructive apnea

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121
Q

• is defined as a frightening episode of apnea accompanied by a skin color change (cyanosis or pallor), limp muscle tone, choking or gagging. – (near miss SIDS)

A
  • Apparent life–threatening events (ALTE)
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122
Q

most common sx of ALTE

A 
♣	Apnea
♣	Cyanosis
♣	Hypotonia
♣	Unresponsiveness 
♣	Labored breathing
♣	Lethargy
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123
Q

who is commonly affected by ALTE

A

Infants at a median age of 2 months, but less than 12 months

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124
Q
  • Overnight 12 hr study – check every hour to see if anything is coming up
  • pH probe down nose to xyphoid process
A

♣ Pneumogram (apnea monitor)

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125
Q

o Physiologic process that ends in respiratory failure begins with hypoventilation of alveoli – occurs when body’s need for O2 exceeds actual O2 intake, airway partially occluded, or exchange of O2 & CO2 in alveoli disrupted

A

Acute respiratory distress syndrome (ARDS)

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126
Q

3 things with ARDS

A

hypoxemia
hypercapnia
hypoxia

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127
Q

multiple factors that cause ARDS

A 
♣	Sepsis
♣	Pneumonia
♣	Meconium aspiration
♣	Gastric content aspiration
♣	Smoke inhalation
♣	Near drowning
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128
Q

sx of ARDS

A

lethargic, cyanotic, diaphoretic, retractions

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129
Q

clinical manifestations of respiratory distress

A 
dyspnea
tachypnea
grunting
nasal flarring
retractions
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130
Q

sx of severe distress. usually with expiration

A

grunting

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131
Q

severe retractions are where

A

♣ supraclavicular & suprasternal

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132
Q

moderate retractions

A

♣ substernal, subcostal

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133
Q

mild retractions

A

Intercostal

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134
Q

usually viral; child all ages;

A

croup syndromes

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135
Q

croup AKA

A

laryngotracheobronchitis (LTB)

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136
Q

sx of croup

A 
o	Mild fever less than 104F 
o	Runny nose
o	Tachypnea
o	Inspiratory stridor
o	Seal-like barking cough
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137
Q

tx of croup

A

supplemental O2 when the level is less than 92%

also corticosteroids

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138
Q

nursing care of croup

A

maintain adequate fluid intake

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139
Q

educate parents of child with croup to call HCP if ?

A

♣ Mild symptoms do not improve after 1 hour of exposure to cool night air or air conditioning
♣ The child’s breathing is rapid and labored
♣ The child does not drink adequate liquids, and urine output is reduced.

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140
Q

Inflammation of the tissues surrounding the epiglottis

A

epiglottiitis

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141
Q

causes of Epiglottitis

A

bacterial (strep or staph)

or

Hemophillus influenza B

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142
Q

4 classic signs of Epiglottitis

A

o Dysphonia: hoarseness
o Dysphagia: trouble swallowing
o Drooling
o Distressed Respiratory effort

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143
Q

what does child look like with Epiglottitis

A

won’t lie down & jaw thrusted forward

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144
Q

what type of breathing with Epiglottitis

A

inspiratory stridor

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145
Q

Do not tempt to visualize their throat or obtain a culture with which 2 conditions

A

Epiglottitis and croup

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146
Q

tx of Epiglottitis

A

ATB and insertion of endotracheal tube

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147
Q

nursing care for Epiglottitis

A

sit child upright or assume a position of comfort

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148
Q
  • Inflammation and obstruction of the small airways, the bronchioles
  • Usually from a virus or bacteria
A

bronchiolitis/respiratory syncytial virus (RSV)

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149
Q

when does RSV usually occur?

A

october - march

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150
Q

age group most often affected by RSV

A

under 2 y/o

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151
Q

sx of RSV

A 
o	Wheezing
o	Tachypnea 
o	Runny nose
o	Dry cough
o	Low grade fever
o	V/D
152
Q

what type of precautions for RSV

A

contact & droplet

153
Q

prevention of RSV

A

synergis–IM injection over a 5 month period

154
Q

supplemental O2 for RSV consists of?

A

♣ Supplemental oxygen with humidity may be provided via nasal cannula, mask, hood or tent.

155
Q

sx of RSV improve in ?

A

24-72 hours

156
Q

o Chronic lung disease that is defined as the need for supplemental oxygen for at least 28 days after premature birth.

A

Bronchopulmonary Dysplasia (BPD)

157
Q

Bronchopulmonary Dysplasia (BPD) occurs in premature infant weighing less than?

or gestational age of less than ___ weeks and receive mechanical ventilation at time of birth

A

1000 grams & 28 weeks gestation

158
Q

BPD is caused by?

A

pneumonia
meconium aspiration
patent ductus arteriosus

159
Q

sx of BPD

A 
♣	Tachypnea 
♣	Nasal flaring
♣	Grunting
♣	Retractions
♣	Irritability 
     ♣	May have:
       •	Wheezing
       •	Crackles
160
Q

o They tend to have_____ _______, not gaining any weight, and they tend to be re-hospitalized over and over again due to these problems.

A

feeding problems

161
Q

therapy for Bronchopulmonary Dysplasia (BPD)

A

o Therapy focuses on respiratory support and good nutrition to accelerate lung maturity
♣ Tracheostomy for long term airway management
♣ Increased calories
♣ Fluid restrictions
Decreased fluids

162
Q

O2 stat in BPD kids

A

90-92

163
Q

what to asses with kids with VPD

A

growth & development on growth charts

164
Q

Chronic inflammatory d/o; airways narrow; hyperreactive to stimuli that doesn’t affect someone who does not have this

A

asthma

165
Q

o Increased immune system sensitivity to specific irritants (triggers)

A

asthma

166
Q

most common sx of asthma

A

coughing at night & wheezing upon exhalation

167
Q

sx of distress?

A

♣ Rapid labored respiratory effort
♣ Nasal flaring
♣ Retractions
♣ Persistent cough
♣ Audible wheezing
♣ Leaning forward to support their airway
♣ Unable to speak because they are gasping

168
Q

triggers for asthma

A 
cockroaches
o	Strong exercise 
o	Cold or respiratory infection
o	Strong emotion
o	Strong odors & fumes
o	Pollen & weeds
o	Dust mites 
o	Changes in weather especially cold 
o	Smoke
Pets (dander, not hair)
169
Q

o Helps to monitor the child’s airway changes and to identify signs of worsening lung function and beginning of an asthma attack.

A

peak flow meter

170
Q

how to obtain personal best of peak flow meter?

A

do it 2x a day for 2-3 weeks

171
Q

• There are two types of asthma medicines:

A

♣ Long term beta adrenergics along with corticosteroids

o Short-acting rescue medicines

172
Q

• Help prevent asthma symptoms from occurring in the first place.

A

long term control meds

173
Q

how often are long term control meds taken?

A

regular basis regardless of symptoms

174
Q

when should short term or rescue meds be taken?

A

o Should be taken at the first sign of asthma symptoms

o Relief during an asthma attack

175
Q

o Work quickly to open the tightened airways – relax smooth muscles, brochodilate

Used to treat sudden asthma symptoms

A

short term or rescue meds

176
Q

drug of choice for exercise or acute asthma symptoms

A

albuterol

177
Q

how fast does albuterol work ?

A

works in 5-10 minutes

178
Q

how long to hold breath in for albuterol?

A

@ least 10 seconds

179
Q

• Suspends the particles that are delivered by the metered dose inhaler for a longer period of time so the child can take several breaths

A

spacers

180
Q

o Inherited autosomal recessive disorder of the exocrine glands.

o Affects respiratory, GI, and reproductive systems

A

cystic fibrosis

181
Q

sx of CF

A

♣ Persistent cough that produces a very thick mucous
♣ Chronic sinusitis
♣ Barrel chest
♣ Clubbing
♣ Sweat & taste salty
♣ Foul smelling, greasy stool that may have undigested food
♣ Severe constipation

182
Q

testing and treatment of CF

A

genetic testing
and
sweat test

183
Q

λ Most cardiac conditions in children are related to:

A

B. Congenital heart defects

184
Q

o Highest oxygen content is going to go to

A

the heart and the brain

185
Q

are constricted due to the high pulmonary vascular resistance

A

o The pulmonary vessels

186
Q

is low so the blood is going to flow to the extremities easily

A

o The systemic vascular resistance

187
Q

o The fetal lungs do not exchange

A

gas

188
Q

The transition from fetal to pulmonary circulation occurs when

A

the umbilical cord is cut and the baby takes its first breath

189
Q

With the first breath the lungs are going to expand and the blood that flowed through the ductus arteriosus is now going to flow through the

A

lungs

190
Q

what will cause the ductus arteriosus to close and it is done so within 10-15 hours after birth?

A

The higher oxygen saturation

191
Q

o Permanent closure occurs ____-____ days after birth.

A

10-21 days

192
Q

o The systemic vascular resistance helps to increase the pressure in the left atrium and this will stimulate the ____ _____ to close.

A

foramen ovale

193
Q

o When the umbilical cord is cut the ____ _____ begins to close.

A

ductus venosus

194
Q

o At birth the ___ ____is going to be larger than the ___ _____ because of that fetal circulation but it is going to start to reduce in size and that left ventricle will increase in strength after birth.

A

right ventricle; left ventricle

195
Q

fetal circulation

A

Blood leaves the placenta and enters the fetus through the umbilical vein. The ductus venosus, the foramen ovale, and the ductus arteriosus allow the blood to bypass the fetal liver and lungs. After circulating through the fetus, the blood returns to the placenta through the umbilical arteries.

196
Q

should close with first breath or within first few weeks, if does not will hear a murmur

A

PDA–patent ductus arteriosus

197
Q

λ Which behavior during feeding is suspect of heart disease in an infant?

A

sweating

198
Q

o Heart muscle is not fully developed until __ years of age

A

5

199
Q

how to check hr

A

auscultate apical pulse for 1 min

200
Q

• Murmurs can be intensified by

A

fever, excitement, and exercise

201
Q

Murmurs will be classified by

A

their intensity, location, radiation, timing and quality of sound.

202
Q

o Cardiac output depends on ___ ____ until fully developed at 5 years old

A

heart rate

203
Q

o Identify any signs of distress

A 
o	Tachnypic 
o	Retractions
o	Nasal flaring
o	Accessory muscles
o	Cyanosis
o	Grunting
204
Q

when to take BP

A

3 years old & older unless cardiac heart condition

205
Q

normal O2 stat in children

A

95-98

206
Q

o Some children with heart condition will stay around ___ and this is good for them

A

90%

207
Q

o Capillary refill should be within

A

2-3 seconds

208
Q

is going to be an early sign of CHF

A

o Diaphoresis

209
Q

λ The loudness of a murmur indicates the severity of the defect.

A

FALSE

210
Q

• The more narrow the opening, the

A

louder the sound

211
Q

enlarged heart

A

cardiomegaly

212
Q

heart on the wrong side

A

dextroversion

213
Q

• Will show any type of arrhythmia

A

ECG leads (rhythm)

214
Q

how many leads for adults

A

12

215
Q

how many leads for pedi’s

A

15 leads

216
Q

o wears it 24 hours; want to see what is happening all day. Parents (or child if old enough) must record what they were doing at specific times every day (running around, eating, sleeping, etc)

A

holter monitor

217
Q

complications of holter monitor

A

• it is labor intensive, problem keeping it on children with all the wires and everything else, one nurse invented a little backpack to carry it around

218
Q

ultrasound of the heart; one of the most frequent tests done in children

A

echo cardiogram

219
Q

With the echo cardiogram you can measure the

A

shunting of the blood if its occurring.

220
Q

o They can visualize valve defects as well as other defects such as

A

(septal defects, dilated or hyperfitrated ventricles)

221
Q

∏ A tube is inserted and goes behind the heart, so an image can be seen behind the heart as well as in the front. (This one is invasive but not as invasive as a heart cath).

A

transesopheageal echo

222
Q

what are they looking at with a transesophageal echo

A

the posterior heart

223
Q

o An invasive procedure that passes a radiopaque catheter through a large vein or artery in an arm or leg to the heart. The catheter is threaded to the heart chambers or coronary arteries, or both, guided by fluoroscopy.

A

heart catheterization

224
Q

o The procedure enables precise measurement of ___ _____ within the heart’s chambers and great arteries and ____ _____ in the pulmonary vessels or heart chambers.

A

oxygen saturation; pressure gradients

225
Q

They can also determine _____ ______ with the cath

A

muscle function

226
Q

o heart cath helps assess for:

A
  • Congenital heart defects
  • Cardiac valvular disease
  • Coronary artery disease
  • Evaluation of artificial valves
227
Q

. If you see a horrible rash that is open and red, then it may be necessary to

A

wait to do a heart cath.

228
Q

• Once the wire is removed, hold pressure for ___ ____ then place a pressure dressing over the site

A

15 minutes

229
Q

bed rest for how long after heart cath

A

4-6 hours

230
Q

VS q __ min for post heart cath

A

15

231
Q

• Check for signs of complications several times in first

A

24 hours

232
Q

sx of complications of heart cath

A

fever

bleeding

Bruise increasing in size at cath site

Foot on side of cath site is cooler than other foot

Loss of feeling in foot on side of cath

233
Q

sx of dehydration

A

dry MM

no tears

sunken fontanels

234
Q

what is d/c before heart cath

A

anticoagulants

no food or fluid 6-8 hours prior

235
Q

∏ Results from increased pulmonary blood flow or obstruction to systemic outflow, or contractility problem

A

Congestive Heart Failure

236
Q

CHF can cause

A

pulmonary artery HTN (irreversible & life threatening)

237
Q

∏ Contractions of heart reduced with CHF which can lead to:

A

systemic edema, pulmonary congestion

238
Q

o CHF sx May develop subtly, and symptoms may not be recognized initially. examples????

A
  • Infant tires easily, especially during feeding
  • Weight loss or lack of normal weight gain
  • Diaphoresis
  • Irritability
  • Frequent respiratory infections
239
Q

older children sx of CHF

A
  • Exercise intolerance
  • Dyspnea
  • Abdominal pain or distention
  • Peripheral edema
  • Skin color changes such as mottling or pallor
240
Q

Progression of CHF

A 
tachypnea, 
tachycardia, pallor/
cyanosis/
nasal flaring/
grunting/ 
retractions/ 
productive cough/ 
crackles – 
S3 gallop
241
Q

(a third heart sound that produces a rhythm like gait of a horse)

A

S3 gallop

242
Q

∏ If congestive heart failure is not diagnosed it could lead to

A

cardiomegaly

243
Q

occurs as heart attempts to maintain CO; cyanosis, weak peripheral pulses, cool extremities, hypotension, & heart murmur cardiogenic shock

A

cardiomegaly

244
Q

goal of CHF

A

make heart work more efficiently, remove excess fluid, decrease workload & improve systemic circulation

245
Q

dx of CHF

A

o Primarily dependent on the physical symptoms

246
Q

∏ Helps increase the myocardial contractility so it will improve the systemic circulation

A

DIGOXIN

for tx of CHF

247
Q

∏ increases the force of the myocardial contraction; increases systemic circulation

A

DIGOXIN

248
Q

what to do before admin of digoxin

A

take apical pulse for 1 full minute

249
Q

therapeutic level of digoxin

A

0.8-2mg/ml

250
Q

when to check digoxin levels?

A

6-8 hours after dose

251
Q

∏ Digoxin toxicity:

A 
¬	Irregular heart rate 
¬	Cardiac arrhythmias 
¬	Altered level of consciousness
¬	Vision changes
¬	May notice a decrease in appetite 
¬	Decrease in urine output
252
Q

∏ Most common congenital heart defect

increased pulmonary blood flow

∏ Opening in the ventricular septum

A

ventricular septal defect (VSD)

253
Q

what type of shunt for VSD

A

left to right

254
Q

blood is shunted into the ___ ____ and it’s going to increase the pulmonary blood flow

A

pulmonary artery

255
Q

∏ Most small VSD’s will close spontaneously within

A

6 months of life

256
Q

∏ Treatment of VSD is conservative unless CHF or Pulmonary HTN present. then they will be treated with

A
  • Lasix
  • Digoxin
  • ACE inhibitors
  • Possibly surgery
257
Q

sx of VSD

A 
o	diaphoresis when eating
o	poor weight gain
o	increased HR & RR
o	heart murmur
o	frequent respiratory infections
o	may develop CHF, dyspnea, tachypnea, retractions
258
Q

∏ If poor weight gain or it’s affecting growth then they will do a ____ for VSD

A

patch

259
Q

∏ If poor weight gain or it’s affecting growth then they will do a patch for VSD

A

λ B. Worsens the cyanosis

260
Q

∏ Decreased Pulmonary Blood Flow; little/no blood flow to lungs to be oxygenated

A

Tetralogy of Fallot

261
Q

classic sx of TOF

A

o cyanosis that does not respond as expected to oxygen

262
Q

∏ One of most common congenital heart defects causing cyanosis.

A

TOF

263
Q

∏ Four Components of TOF

A

VSD
pulmonary stenosis
overriding of the aorta
hypertrophy of the right ventricle

264
Q

narrowing of pulmonary valve; degree of stenosis determines the severity of symptoms

A

Pulmonary stenosis –

265
Q

o – aortic valve is enlarged and appears to arise from both the left and right ventricles instead of the left ventricle (more toward the R)

A

Overriding of the aorta

266
Q

o – thickening of the muscular walls because of the right ventricle pumping at high pressure

A

Hypertrophy of right ventricle

267
Q

TOF is what type of shunt?

A

right to left

268
Q

sx of TOF

A

dyspnea,

clubbing of fingers/toes, cyanosis,

exertion dyspnea,

delayed developmental milestones,

poor weight gain,

difficulty eating/eat really slow,

sweating while eating

269
Q

an abrupt decrease in systemic vascular resistance & pulmonary blood flow with increased cardiac output & sudden venous return (see child squatting down)

A

o Hypercyanotic episodes-

270
Q

o Hypercyanotic episodes are triggered by?

A

• activities such as feeding, crying, exercise, warm baths, straining with bowel movement, waking up in morning or from nap

271
Q

• ___ will decrease and ____ will increase so their hypoxemia worsens; RR increase so cardiac output will decrease

A

Po2; Pco2

272
Q

nursing care for TOF

A

hold in knee-chest position

273
Q

∏ Inflammation or infection of the heart valves or the heart lining.

A

Infective Endocarditis

274
Q

most common sx of infective endocarditis

A

recurrent fever

275
Q

sx of infective endocarditis

A 
recurrent fever
diaphoresis
roth spots
olser nodes
janeway lesions
fatigue
weiht loss
weakness
joint/muscle aches
diaphoresis
276
Q

(lesions on retina – adolescents

A

roth spots

277
Q

(red, painful, non-hemorrhagic nodules on pads of fingers/toes

A

olser nodes

278
Q

(non-tender, blanching macular lesions on palms/soles),

A

janeway lesions

279
Q

tx of infective endocarditis

A

ATB

surgery to repair/replace damaged heart valve

280
Q

what kind of ATB for infective endocarditis

A

penicillin/vancomycin for 2-8 weeks

281
Q

prevention of infective endocarditis

A

prophylactic ATB before dental/other procedures, something by mouth 30-60min prior to procedure

282
Q

encourage patients with infective endocarditis not to do what?

A

get piercings or tattoos

283
Q

λ A child with a diagnosis of “rule out rheumatic fever” has all of the following laboratory findings. Which finding supports the diagnosis of rheumatic fever?

A

C. Elevated anti-streptolysin

284
Q

An inflammatory connective tissue disorder that follows an initial infection by some strains of group A beta-hemolytic streptococci.

A

rheumatic fever

285
Q

what causes rheumatic fever

A

strep throat

286
Q

rheumatic fever Can cause long-term damage to

A

heart valves

287
Q

1-3 weeks after an untreated strep infection the hallmark signs may occur which is:

A

carditis, new heart murmur, complain of chest pain; 2 or more of their large joints become inflamed – painful, tender, redness, heat at site; non-pruritic pink rash on trunk – not on face/hands; Sydenham chorea

288
Q

if CNS is affected with rheumatic fever they will have aimless movements of extremities & facial known as:

A

Sydenham

289
Q

tx of Rheumatic Fever

A

ATB

290
Q

∏ Acute febrile, systemic inflammatory illness affecting small and midsize arteries. It can also affect the arteries in the heart

A

Kawasaki Disease

291
Q

Kawasaki Disease is the leading cause of acquired ___ ____ in children

A

heart disease

292
Q

Kawasaki Disease is more common in?

A

males & children under 5 y/o

293
Q

3 stages of Kawasaki Disease

A

acute
sub-acute
convalescnet

294
Q

– irritability, high fever lasting for 5 days or longer, conjunctival hyperemia, red throat, swollen hands and feet, rash on trunk and perineal area, unilateral enlargement of anterior cervical lymph nodes, diarrhea, and hepatic dysfunction

A

acute phase of Kawasaki Disease

295
Q

cracking lips with fissures, desquamation of the skin on the tips of fingers and toes, joint pain, cardiac disease, & thrombocytosis.

A

sub-acute phase of Kawasaki Disease

296
Q

o child appears normal but lingering signs of inflammation may be present

A

convalescent phase of Kawasaki Disease

297
Q

how long does acute phase of Kawasaki Disease last

A

1-2 weeks

298
Q

how long does sub-acute phase of Kawasaki Disease last?

A

2-4 weeks

299
Q

when does convalescent phase of Kawasaki Disease occur

A

6-8 weeks after illness began

300
Q

fever with kawasaki dx is?

A

> 102.2 and persists 5+ days

301
Q

the fever must have 4 of the following criteria not explained by another dx process:

A

∏ Bilateral bulbar conjunctivitis w/out exudate

∏ Intense erythema of buccal & pharyngeal surfaces w/ dry, swollen, cracked, & fissuring lips & strawberry tongue

∏ Erythema of palms & soles, edema of hands & feet, & desquamation after 2+ wks of symptoms

∏ Dermatitis of trunk with erythematous maculopapular rash

∏ Cervical lymphadenopathy, frequently unilateral, with a node >1.5cm in diameter found early in disease

302
Q

tx of kawasaki dx

A

administer IV immunoglobulin & oral aspirin

303
Q

2 types of cardiac arrhythmias

A

bradycardia

tachycardia

304
Q

bradycardia is seen with?

A

• Hypoxemia, vagal stimulation, hypothermia, some meds (digoxin)

305
Q

when does bradycardia usually resolve?

A

when condition causing it is treated

306
Q

bradycardia is treated with?

A

O2,

epinephrine,

atropine,

pacemaker insertion

307
Q

bradycardia in infants HR is?

A

below 80

308
Q

bradycardia in children/adolescents HR is?

A

below 60

309
Q

tachycardia is caused by?

A

• Hypoxia, anemia, hypovolemia, shock, illicit drug use

310
Q

most common tachycardia

A

SVT

311
Q

tachycardia is treated with?

A

Valsalva maneuver, adenosine IV, synchronized cardioversion

312
Q

rectal stimulation, ice to their face, hold breath & bear down like bowel movement

A

Valsalva maneuver

313
Q

tachycardia for infants =

A

above 220

314
Q

tachycardia for older children

A

above 180-240

315
Q

why can’t kids with tachycardia have decongestants?

A

∏ (they have cardio stimulants in them that can trigger SVT)

316
Q

main fun of RBCs

A

transport oxygen from lungs to the tissues

317
Q

lifespan of RBCs

A

120 days

318
Q

above average # of RBCs

A

polycythemia

319
Q

decreased # of RBCs

A

anemia

320
Q

RBC levels

A

3.8-5.03

321
Q

Hgb levels

A

10.2-13.4

322
Q

Hct levels

A

31.7-39.8

323
Q

ex of WBCs

A 
neutrophils
eosinophils
basophils
monocytes
lymphocytes
324
Q

increase with infection

A

neutrophils

325
Q

increase with allergies

A

eosinophils

326
Q

inflammation

A

eosinophils

327
Q

humoral immunity

A

lymphocytes

328
Q

decrease in the number of WBCs

A

leukopenia

329
Q

normal range for WBCs

A

4.86-11.4

330
Q

differentials show?

A

different types of WBCs

331
Q

platelets AKA

A

thrombocytes

332
Q

fxn of platelets

A

clot blood

333
Q

o Several clotting factors are low in infants, so as a baby they will get the ___ ___ shot to help with this

A

vitamin K

334
Q

o Normal range of platelets =

A

202-367

335
Q

who has to verify blood before hanging it?

A

2 licensed people

336
Q

• Stay ___-____ minutes to see if they have any reaction to the blood

A

20-30

337
Q

• Premedicate them with _____ and _____ before giving the blood (usually standard oh physicians orders)

A

Benadryl and Tylenol

338
Q 
♣	Reaction to the protein in the blood
♣	Manifestations 
       •	 Rash 
       •	Itching 
       •	Could end up having respiratory distress
A

allergic rxn to blood

339
Q

♣ Wrong type of blood
♣ Also if they have had multiple infusions
♣ Or if you are infusing something other than NS with the blood

A

hemolytic rxn to blood

340
Q

sx of hemolytic rxn to blood

A

• Fever, chills, headache, chest pain

341
Q

o With the allergic and hemolytic reactions we want to ?

A

stop the blood infusion and call the physician; monitor vital signs frequently, give them antihistamines and NS

342
Q

♣ Could be a contaminant in the blood or some other idiopathic reason

A

febrile rxn

343
Q

sx of febrile rxns

A

• Chills, fever, headache, leg and back pain, BP will drop

344
Q

♣ Transfusion too fast or given too much

A

circulatory overload

345
Q

sx of circulatory overload

A

• Crackles in the lungs (wet sounds), distended neck veins, complain of chest and low back pain, labored breathing, productive cough

346
Q

what to give kids with circulatory overload

A

diuretics

347
Q

♣ – increase O2 carrying capacity in anemic patient and for some leukemias. Also given in some cases of hypovolemic shock

A

packed RBCs

348
Q

♣ – replace blood volume. Generally given in hypovolemic shock

A

whole blood

349
Q

expand blood volume

A

♣ Fresh Frozen Plasma –

350
Q

expand blood volume in shock or trauma

A

♣ Albumin –

351
Q

to treat factor VIII deficiency (hemophilia A) and von Willebrand disease

A

♣ Factor VIII concentrate:

352
Q

to treat factor IX deficiency (hemophilia B)

A

♣ Factor IX concentrate:

353
Q

causes of anemia

A

o Blood loss

o Increased destruction of RBCs

o Decreased production of RBCs

o Teenage girls – menstrual cycle

o Genetic

o Nutrition-Not enough iron in their diet

354
Q

o Most common anemia in children

A

iron def. anemia

355
Q

causes of iron def. anemia

A

malnutrition (not getting solid foods after 6 mo of age)

poor absorption

heavy blood loss

356
Q

sx of iron def. anemia

A

o Pale
o Fatigued
o Irritable
o Older kids complain of headache

357
Q

o Autosomal recessive disorder

A

sickle cell anemia

358
Q

if Both parents carry the trait sickle cell what chance does the kid have of getting it?

A

25%

359
Q

the RBCs in sickle cell are sickle shaped which does what?

A

not enough oxygen

clogs the veins

360
Q

triggers for sickle cell

A

o fever, infection, hypoxia, physical/emotional stress, trauma, dehydration, extremes in temp (change in seasons), altitude, vomiting, fatigue, alcohol consumption, pregnancy, elevated hgb levels, elevated reticulocyte levels, excessive exercise or physical activity, acidosis

361
Q

the first organ affected by sickle cell?

A

spleen

362
Q

common sx of sickle cell

A 
o	Infections
o	Impaired respirations
o	Neurologic symptoms
o	Pain
o	Skin changes
363
Q

types of crisis for sickle cell

A

vaso-occlusive
splenic sequestration
asplastic crisis

364
Q

♣ Most common type
♣ Pain crisis
♣ Can last several weeks

♣ Caused by: dehydration, exposure to cold, localized hypoxemia, change in temperature

♣ Joints may be swollen & painful (one joint or multiple joints - hands/feet), fever, complain of severe abdominal pain

A

o Vaso-occlusive

365
Q

♣ Life-threatening crisis
♣ Death within hours if not treated
♣ Blood pools in spleen can go into hypovolemic shock
♣ Splenectomy

A

o Splenic sequestration

366
Q

♣ Decreased production with increased destruction of RBCs

♣ Usually caused by viral infection or depletion in folic acid

♣ Severe anemia, pale, & fatigued

♣ Usually on folic acid

A

o Aplastic crisis

367
Q
  • Congenital (autosomal recessive) or acquired deficiency in number of blood cells
  • Bone marrow does not produce adequate numbers of circulating red blood cells
  • Manifestations depend on degree of thrombocytopenia, anemia & neutropenia
A

aplastic anemia

368
Q

treatment of choice for aplastic anemia

A

Hematopoietic stem cell transplantation

369
Q

• Hereditary bleeding disorders with deficiency in specific clotting factors (A – Clotting Factor 8, B – Clotting Factor 9)

o X-linked recessive disorder – affects mainly males

o Females carry but no symptoms (may have prolonged bleeding & slow to clot; 50% chance of having son with hemophilia)

A

hemophilia

370
Q

sx may not show up until ___ months with hemophilia

A

6

371
Q

sx of hemophilia

A

o Bleeding in joints – pain & swelling – limited ROM

o Easy bruising

o Nosebleeds, blood in diaper or urine, spontaneous bleeding

o Bleeding after minor trauma, surgeries, brushing their teeth, etc.

o If lose a tooth – lot of bleeding – hold pressure for while

372
Q

cause is unknown, usually follows viral infection

A

o Idiopathic

373
Q

o blood does not have enough platelets. Platelet production normal in bone marrow, but spleen increased destruction.

A

thrombocytopenic

374
Q

o blood leaking under skin, petechiae or ecchymosis

A

purpura

375
Q

sx of Immune (Idiopathic) thrombocytopenic purpura

A

o Platelet count less than 20,000, ecchymosis, petechiae

o Normal Hgb & WBC counts

o Blood clotting slows

o Nose bleeds, bleeding
from mouth/gums

o Usually virus occurs before this

6TH SEMESTER (22 decks)

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