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54/64 Unit 3 > Complex Disruptions In Peds > Flashcards

Complex Disruptions In Peds Flashcards

1
Q

The exchange of CO2 and O2 between the atmosphere and the alveoli

A

Ventilation

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2
Q

The exchange of CO2 and O2 between the alveoli and blood

A

Diffusion

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3
Q

The exchange of CO2 and O2 between the blood and tissues

A

Perfusion

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4
Q

By ___ week gestation, the rudimentary respiratory system appears

A

4th

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5
Q

Respiratory passages elongate between ___ week gestation to birth

A

24th

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6
Q

It is not until the ___ to ___ week of life that typical sharply curved alveoli can be identified

A

6-8th

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7
Q

Between ___-___ weeks gestation lungs are capable of gas exchange, alveolar cells secrete surfactant, and life becomes possible

A

26-28

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8
Q

Postnatal growth of the lungs continues until approximately ___ years of age with an increase in number of alveoli and the dimensions of all the airways

A

8

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9
Q

How are children’s respiratory system different from adults’ respiratory system?

A

Smaller air passage, softer, looser tissues, highly vascular, swell more easily, less oxygen reserve, high peripheral airway resistance

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10
Q

High peripheral airway resistance and smaller diameter predisposes children to

A

Obstruction until 5 years of age

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11
Q

S/S of respiratory distress

A

Tachypnea, nasal flaring, retractions, grunting, see-saw breathing, head-bobbing, stress response, respiratory failure

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12
Q

Normal respiratory rate for infants

A

30-60 breaths/min

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13
Q

Normal respiratory rate for toddlers (1-3 years)

A

24-40 breaths/min

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14
Q

Normal respiratory rate for preschoolers (4-5 years)

A

22-34 breaths/min

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15
Q

Normal respiratory rate for school-age children (6-12 years)

A

18-30 breaths/min

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16
Q

When is it best to observe a child’s respiration?

A

When they are calm

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17
Q

Assessment of respiratory problems: history

A

Health hx, family hx of respiratory disease, smoking in home environment, respiratory disease, current meds

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18
Q

Assessment of respiratory problems: physical examination

A

Exercise tolerance, breaths sounds (strider, grunting, wheezing), barrel chest, chest pain, cough

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19
Q

Clubbing is not only a sign of HF, but also a symptom of chronic _____ issues in older children

A

Lung

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20
Q

Newborns are obligate nose breathers until about ___-___ months of age

A

2-6

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21
Q

Respiratory disease seen exclusively in preterm infants characterized surfactant deficiency, underdeveloped and uninflatable alveoli, and highly compliant chest walls that compromise lung expansion

A

Respiratory Distress Syndrome (RDS) (AKA hyaline membrane disease)

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22
Q

Function of surfactant

A

Reduces surface tension and increases lung expansion

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23
Q

Decreased surfactant production causes the collapse of

A

Alveoli

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24
Q

What are the consequences of surfactant deficiency on the infant’s respiratory system?

A

Inability to keep lungs inflated, greater effort to re-expand alveoli with each breath. Risk for inadequate oxygen exchange

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25
Q

Final unfolding of alveoli occurs in _____ trimester of pregnancy

A

Last

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26
Q

RDS clinical manifestations

A

Rapid respirations (>60), retractions, grunting, nasal flaring, color changes, apnea, changes in ABGs, inspiratory rales, flaccid and unresponsive

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27
Q

Population at risk for bronchopulmonary dysplasia (BPD)

A

Extremely low birth weight (ELBW) and very low birth weight (VLBW) infants with RDS

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28
Q

BPD or chronic lung disease (CLD) pathophysiology

A

Pressures of mechanical ventilation damage bronchial epithelium, initial injury leads to chronic inflammatory process resulting in interstitial edema, epithelial swelling, thickened alveolar walls, and airway edema

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29
Q

Because BPD causes the alveoli to become thick and fibrotic, these children have _________, _________ airways

A

Narrowed, scarred

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30
Q

BPD incidence

A

Premature infants, meconium aspiration, CHD, associated w/ younger gestational age and birth weight

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31
Q

BPD behaviors

A

Hyperactive airway, increased susceptibility to infection, borderline respiratory reserve, tachypnea, increased breathing effort, pallor, cyanosis, activity intolerance, weight loss or poor weight gain, restless/irritable, wheezing, pursing lips, arches

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32
Q

BPD prevention

A

Lowest peak inspiratory pressure, lowest O2 required

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33
Q

BPD treatment

A

Maintain O2, corticosteroids, oral diuretics, bronchodilators

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34
Q

Most frequent cause of hospitalizations in children less than 2 years old

A

Respiratory Syncytial Virus (RSV)

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35
Q

RSV strains have 2 subgroups (A&B) and affect _________ cells

A

Epithelial

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36
Q

RSV infections within the first year of life increase risk for development of

A

Asthma

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37
Q

RSV can live for up to ___ days on a surface

A

5

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38
Q

RSV transmission

A

Direct contact with respiratory secretions

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39
Q

RSV behaviors

A

Upper respiratory infection, otitis media, cough, wheezing, air hunger tachypnea, retractions, rhinorrhea, fever

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40
Q

RSV diagnostic tests

A

ELISA (enzyme linked immunofluorescent antibody), IFA (rapid immunosorbent assay), viral culture

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41
Q

RSV treatment

A

High humidity-mist therapy w/ O2, adequate fluid intake, rest, medications, hospitalization

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42
Q

Chronic inflammatory disorder of the airways that may occur in adults or children characterized by recurring symptoms, airway obstruction, and bronchial hyperresponsiveness

A

Asthma

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43
Q

Recurring symptoms of asthma

A

Wheezing, breathlessness, chest tightness, cough (especially at night)

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44
Q

Why is asthma much more serious in children?

A

Children have smaller tracheas, so inflammation will shut the airway off faster

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45
Q

Inhaler should be placed ___ fingers away from mouth

A

Two (children may use spacer)

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46
Q

3 part disease process of asthma

A

1) edema of mucous membranes, 2) accumulation of tenacious secretions from mucus glands, 3) narrowing of breathing passages

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47
Q

Step 1 mild persistent asthma symptoms

A

Symptoms <2 times/month, nighttime symptoms <2 times/month, brief exacerbations (few hours-days) with varying intensity, asymptomatic and normal PEF between exacerbations

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48
Q

Step 1 Mild Intermittent Asthma PEF or FEV1

A

> 80% of predicted value

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49
Q

Step 1 mild intermittent asthma PEF variability

A

< 20%

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50
Q

Step 2 mild persistent asthma symptoms

A

Symptoms >2 times/week but <1 times/day, nighttime symptoms >2 times/month, exacerbations may affect activity

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51
Q

Step 2 mild persistent asthma PEF/FEV

A

> 80 % of predicted value

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52
Q

Step 2 mild persistent asthma PEF variability

A

20-30%

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53
Q

Step 3 moderate persistent asthma symptoms

A

Daily symptoms, daily use of inhaled short active B2 agonists, exacerbations affect activity, exacerbations >2 times/week and may last days, nighttime symptoms >1 times/week

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54
Q

Step 3 moderate persistent asthma PEF/FEV

A

> 60% to <80% of predicted value

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55
Q

Step 3 moderate persistent asthma PEF variability

A

> 30%

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56
Q

Step 4 severe persistent asthma symptoms

A

Continual symptoms, frequent exacerbations, frequent nighttime symptoms, limited physical activity

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57
Q

Step 4 severe persistent asthma Peak flow expiratory flow (PEF) or forced expiratory volume in 1 second (FEV1)

A

<60%

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58
Q

Step 4 severe persistent asthma PEF variability

A

> 30%

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59
Q

Medications for severe persistent asthma

A

Long-acting beta agonists (LABA)

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60
Q

Inhaled steroids patient education

A

Rinse mouth after administration to prevent thrush

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61
Q

Medication used as a rescue inhaler for acute asthma attacks

A

Albuterol

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62
Q

Complications of untreated asthma

A

Respiratory and cardiac arrest

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63
Q

Types of asthma

A

Exercise induced bronchospasm (EIB) and status asthmaticus (medical emergency!)

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64
Q

Most common lethal genetic illness among Caucasian children, adolescent, and young adults

A

Cystic fibrosis

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65
Q

Characteristics of cystic fibrosis

A

Exocrine gland dysfunction, autosomal recessive trait, increased viscosity of mucus gland secretions

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66
Q

What systems are primarily affected with CF?

A

Respiratory, GI, and pancreatic

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67
Q

Intervention for CF

A

Chest percussion therapy

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68
Q

CF pathophysiology

A

Results in failure of chloride conductance of epithelial cells, increased viscosity of secretions in GI, respiratory, and reproductive tracts, and excessive loss of sweat through sweat glands

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69
Q

CF results in increased

A

Sweat, chloride, and sodium

70
Q

CF complications

A

Chronic HF, DM, chronic infections

71
Q

CF sweat chloride test diagnostic

A

> 60 mEq/L

72
Q

Treatment goals for CF

A

Prevent/minimize pulmonary complications, ensure adequate nutrition, encourage physical activity, quality of life

73
Q

Cancer incidence

A

More common in children <15, males, and Caucasians

74
Q

Cancer: increased incidence in what 2 age groups?

A

Infancy to 4 years old, 15-19 years old

75
Q

Programmed cell death

A

Apoptosis

76
Q

Genes that activate tumor growth

A

Oncogenes

77
Q

Genes that keep tumor growth in check

A

Tumor suppressor genes

78
Q

Genetic alteration resulting in unregulated proliferation of cells affecting apoptosis, oncogenes, and tumor suppressor genes

A

Cancer

79
Q

T or F: Unlike in adults, lifestyle related factors have little to no effect on cancer in children

A

True

80
Q

Pediatric cancer risk factors

A

Exposure to radiation, carcinogenic drugs, immunosuppression therapy, certain viral infections (EBV, HPV), race/ethnicity, genetic conditions

81
Q

Risk associated with curative treatment for childhood cancer

A

Risk of developing secondary malignant neoplasms

82
Q

Cancer treatment that mutates and kills cells

A

Radiation

83
Q

Describe how chemotherapy works

A

Different chemos target different areas of the cell cycle. Chemo targets all and any cells that are replicating (RBCs, bone marrow, platelets, hair, stomach lining, etc)

84
Q

Cancer is considered “cured” if

A

Completion of all therapy, no clinical and radiological evidence of diseases, and 5 years since diagnosis

85
Q

Long-term side effects of childhood cancer

A

Can impact growth and development, organ function, fertility and reproduction, psychosocial, and cancer (recurrent primary cancer and subsequent neoplasms)

86
Q

Cardinal signs of cancer in children

A

An unusual lump or swelling, unexplained paleness and loss of energy, easy bruising or bleeding, ongoing pain in one area of the body, limping, unexplained fever or illness that does not resolve, frequent headaches often with vomiting, sudden eye or vision changes, sudden and unexplained weight loss

87
Q

Pediatric cancer treatment plan

A

Multimodal: surgery, radiation, chemotherapy, biological, stem cell transplant

88
Q

Cancer treatment that stimulates antibodies that target cancer cells and stimulate general immune system interfering with tumor growth molecules

A

Biologic

89
Q

Stem cells derived from compatible donor, often familial

A

Allogeneic

90
Q

Stem cells derived from self

A

Autologous

91
Q

Major risk associated with cancer treatment

A

Infection (most deaths result from sepsis)

92
Q

Managing infection in cancer patients

A

Monitor S/S of infection/sepsis, IV therapy treatment, prophylaxis common, biologics, prevent infection!

93
Q

Nursing interventions to prevent hemorrhage in cancer patients

A

Avoid skin puncture when possible, avoid additional trauma, platelet transfusion during bleeding episodes

94
Q

Anemia nursing interventions

A

RNC transfusions, let child regulate activity

95
Q

Medications for N/V in cancer patients

A

Pheng, compazine, tigan

96
Q

Interventions for altered nutrition in cancer patients

A

Assess weight, intake, height; high calorie foods

97
Q

Interventions for mucosal ulceration in cancer patients

A

Bland food, soft toothbrush or toothsponge, antiseptic mouth washes, warm sitz bath, ointments

98
Q

S/S of neurotoxicity related to cancer treatment

A

Jaw pain, foot drop, numbness, weakness, constipation

99
Q

Preventing hemorrhagic cystitis as a side effect of chemotherapy

A

Lots of fluid before, during, and after chemo

100
Q

Broad categories of neoplastic disorders

A

Blood neoplasms, bone and soft tissue cancers, organ neoplasms

101
Q

Umbrella term for cancers of the blood, bone marrow, and lymphatic system

A

Leukemias

102
Q

In healthy children, bone marrow makes _______________ which mature into lymphoid or myeloid stem cells

A

Blood stem cells

103
Q

Myeloid stem cells

A

RBCs, platelets, WBCs

104
Q

Lymphoid stem cells

A

Lymphoblasts (become B and T lymphocytes) and natural killer cells

105
Q

Types of leukemias

A

Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML)

106
Q

Most common form of childhood cancer

A

Acute Lymphoblastic Leukemia (ALL)

107
Q

Most common solid tumor in children

A

Tumors of the CNS

108
Q

60% of tumors are

A

Infratentorial (posterior - primarily brainstem and cerebellum)

109
Q

Manifestations/behaviors of brain tumors

A

S/S directly related to location and size, headache and vomiting upon waking (increased ICP), behavioral changes, visual disturbances, motor skill disruption, seizures, hemiparesis

110
Q

Pituitary tumors may lead to

A

Hormonal related disease processes

111
Q

Brain tumors diagnosis

A

Clinical S/S, imaging, biopsy (usually done during surgery)

112
Q

Brain tumor treatment

A

Depends on type of tumor involved; surgery (survival increases with complete removal), chemotherapy, radiation (shrinks tumors before surgery, kills remaining tumor cells after surgery)

113
Q

Manifestations of bone tumors

A

Pain in affected site, limping, stops physical activity, unable to hold heave objects, palpable mass, cord compression and respiratory distress (Ewing’s sarcoma)

114
Q

Bone tumor diagnosis

A

Rule out infection or trauma, imaging, needle or surgical biopsy

115
Q

Most common bone tumor is adolescents and young adults thought to originate during rapid bone growth

A

Osteosarcoma

116
Q

Osteosarcoma tumor sites

A

Often in long bones near growth plate (40% in femur)

117
Q

Less common bone tumors predominately in caucasians with more than half the population affected being adolescents

A

Ewing’s sarcoma

118
Q

Surgery that preserves an arm or leg by replacing cancerous bone with an expandable prosthesis

A

Limb-salvage surgery

119
Q

Most common extracranial childhood solid tumor that arises from embryonic neural crest cells

A

Neuroblastoma

120
Q

Median age at diagnosis of neuroblastoma

A

19 months (disease of infancy and early childhood)

121
Q

Cells that become the adrenal medulla and sympathetic nervous system

A

Embryonic neural crest cells

122
Q

Neuroblastoma manifestations

A

Depends on location and extent of disease progression; firm, non-tender, irregular mass that crosses the midline

123
Q

Most common site for neuroblastoma

A

Abdomen (other sites: head and neck, chest, pelvis)

124
Q

Most common kidney tumor of childhood

A

Wilms tumor (nephroblastoma)

125
Q

Average age at diagnosis for single kidney wilms tumor

A

44 months (almost 4 years old)

126
Q

Average age at diagnosis for bilateral wilms tumor

A

31 months

127
Q

Approximately 10% of children with wilms have

A

Congenital anomalies (higher rate of bilateral disease)

128
Q

Wilms tumor manifestations

A

Swelling or mass in abdomen that does not cross midline, mass if firm, non-tender, one sided, deep in flank, pain, hematuria

129
Q

Wilms tumor treatment

A

Surgery (nephrectomy for unilateral, renal transplant for bilateral/Stage V), chemotherapy, radiation (for advanced disease)

130
Q

Chemotherapy for wilms tumor

A

Vincristine, dactinomycin, doxorubicin, cyclophosphamide, etoposide

131
Q

Wilms tumor prognosis

A

5 year survival rates are 90%; worse prognosis with advanced disease or bilateral renal involvement

132
Q

Wilms tumor nursing consideration

A

Do NOT palpate abdomen! Risk of disseminating cancer cells into abdominal cavity

133
Q

Cancer that arises from striated (rhabdo) tissue originating from muscles, tendons, bursae, and fascia

A

Rhabdomyosarcoma

134
Q

Most common primary sites of rhabdomyosarcoma

A

Head and neck (especially the orbit)

135
Q

2/3 of rhabdomyosarcoma cases occur in children under the age of ___ with a smaller peak incidence in early to middle adolescence

A

10

136
Q

Manifestations of rhabdomyosarcoma

A

Related to site of tumor and compression of other organs, tend to be vague (frequently suggest a common childhood illness), often not possible to determine primary tumor location

137
Q

Rhabdomyosarcoma treatment

A

Chemotherapy, surgical resection, radiation in limited cases

138
Q

Chemotherapy for rhabdomyosarcoma

A

Vincristine, dactinomycin, cyclophosphamide, isofamide

139
Q

Rhabdomyosarcoma prognosis

A

Related to age, children 1-9 years old have highest survival, poor prognosis if relapse occurs

140
Q

Most common intraocular malignancy of childhood that arises from the retina

A

Retinoblastoma

141
Q

Characteristics of retinoblastoma

A

Can be present at birth, unilateral or bilateral, has a heritable form, most cases diagnosed before 3-4 years of age

142
Q

Retinoblastoma manifestations

A

Whitish glow in the pupil (cats eye reflex); visualization of light as it hits the mass often seen with flash photography; strabismus

143
Q

Retinoblastoma treatment

A

brachytherapy, photocoagulation, cryotherapy, for advanced disease: chemotherapy, radiation, stem cell transplant, surgical removal of eye

144
Q

Retinoblastoma prognosis

A

10-year survival rate is 90% for both unilateral and bilateral tumors

145
Q

Pulse oximetry nursing care

A

Choose probe site that is dry with adequate circulation, compare radial pulse to reading for accuracy, set high/low alarms, rotate probe site q4-8h on infants with impaired skin integrity to prevent pressure necrosis

146
Q

What is the expected O2 range? What level requires nursing intervention?

A

95-100%; intervention required for 91-92% or lower

147
Q

What is the concentration of O2 in room air?

A

21%

148
Q

Nasal cannula characteristics

A

Delivers 24-40% FiO2, safe and tolerated well, child can eat and talk while using

149
Q

Nasal cannula nursing care

A

Ensure patency of nares, skin intact

150
Q

Oxygen hood for an infant must use a minimum flow rate of __ to __ L/min

A

4-5

151
Q

Oxygen hood nursing care

A

Ensure chin, neck, and shoulders do not rub

152
Q

Face mask characteristics

A

Short-term therapy, flow rate of 5-10 L/min, requires snug fit

153
Q

Inhalation that breaks up medication into minute particles (significantly finer particles compared to inhalers) that can be dispersed throughout the respiratory tract; most effective for getting medication into alveoli

A

Nebulized aerosol therapy

154
Q

Inhalation therapies that allow child to self-administer medication

A

MDIs or dry powder inhalers

155
Q

Nursing care for MDIs or dry powder inhalers

A

Teach at child level, ensure child uses proper technique

156
Q

Set of techniques that aid in the removal of excessive secretions through manual/mechanical percussion, vibration, cough, forceful expiration, and breathing exercises

A

Chest physiotherapy

157
Q

Chest physiotherapy patient positioning to promote drainage of apical sections of upper lobe

A

Fowler’s

158
Q

Chest physiotherapy patient positioning to promote drainage of posterior sections of upper lobe

A

Sitting leaning forward curled over pillows

159
Q

Chest physiotherapy patient positioning to promote drainage of anterior segments of both upper lobes

A

Supine and slightly rotated away from side being drained

160
Q

Chest physiotherapy patient positioning to promote drainage of superior segments of both lower lobes

A

Prone with hips elevated

161
Q

Chest physiotherapy nursing care

A

Medicate prior w/ bronchodilators, remain in position for 20-30 min after (longer if tolerated), assess lungs before and after therapy, assess amount, color, and character of secretions

162
Q

Side effects of cancer treatment

A

Infection, hemorrhage, anemia, N/V, altered nutrition, mucosal ulceration, neurologic problems, hemorrhagic cystitis

163
Q

With pediatric cancer, between long-term adjustments are associated with parents who:

A

Are employed, have social support, experience lower levels of parenting stress, view their child’s quality of life positively, have positive expectations from treatment outcome

164
Q

With pediatric cancer, poor long-term adjustments are associated with parents who:

A

Have low parental expectations for positive outcomes, experience feelings of helplessness, uncertainty, and anxiety, low social support, have negative interactions w/ health care members, negative assessment of child’s quality of life

165
Q

Research has shown that children develop an awareness regarding the seriousness of their diagnosis. Failure to have open and honest discussions result in:

A

Fear, guilt, misconceptions, pain of grieving alone, psychological problems for surviving siblings

166
Q

Discussing death with children

A

Be honest and accurate regardless of age, be age-appropriate, identify specific fears and anxiety

167
Q

Preschool children reactions to dying

A

Have some sense of meaning for the word “death”, may perceive death as temporary and reversible (dead person still eats, breathes, drinks, sleeps, etc.), no understanding of finality of death, may perceive illness as punishment, parents grief may be perceived as a rejection of them, blame disruptions on the ill child, greatest fear is separation from parents

168
Q

School-age children reactions to dying

A

Deeper understanding of death in concrete sense, curious about what happens after death (be factual!), most have an adult understanding of death by age 7, fear of unknown, fear of death is a tremendous threat to sense of security and ego strength, fear exhibited through verbal uncooperativeness

169
Q

Adolescents reactions to dying

A

Mature understanding but sense of invincibility, more worried about bodily changes and socialization than possibility of death

170
Q

Nursing care for adolescent reactions to dying

A

Allow as much independence and control as possible, answer questions honestly, treat them as an individual, be neutral - no alliance with child or parent, allow parents and child to express frustrations w/o judgement

54/64 Unit 3 (8 decks)

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