exam 1 Flashcards

Question

Cardiac cath- post op cares, complications, discharge teaching

Answer 1

POST OP Post Op Nursing Implications Typically out patient unless otherwise required Child must lay as flat as possible 4-8 hours (depending on approach) Assess for post op complications- bleeding at insertion site!! Monitor I&O- contrast has a diuretic effect Discharge teaching COMPLICATIONS Signs of infection, streaking, fever, redness, swelling, poor circulation DISCHARGE TEACHING Monitor site for redness, irritation, bleeding- report to APRN or MD Assess temperature, color, sensation and pulses Resume regular diet after procedure Check for s/sx of infection via temp daily for 3 days post (100.4F at home, 38.2C in hospital) No submerging in the tub for 3 days No strenuous activities x3 days Watch for changes in appearance such as color, complaints of heart flutter or heart skipping a beat, fever, or difficulty breathing Give acetaminophen or ibuprofen for pain Follow up instructions

Answer 2

CLINICAL MANIFESTATIONS Edema: face, hands, and lower extremities Increased work of breathing nasal flaring cough that can be productive or not presence of bloody mucus Auscultate the heart and lungs for quality of sound and variances of abnormal abdominal distention indicative of ascites, hepatomegaly or splenomegaly DIGOXIN ADMINISTRATION Increases contractility of the heart MUST be administered accurately Double check the dose and volume before administration Check pulse prior to administration If dose is missed, administer if within 2 hours of missed dose. Otherwise wait until next dose is due Monitor for toxicity Nausea, vomiting, abdominal pain, visual changes Administer on an empty stomach. (1 hour before meal or 2 hours after meal) dont give if HR >60bpm ``` NURSING INTERVENTIONS Oxygenation Positioning of the infant/child Suctioning Chest physiotherapy/IS ``` ``` Cardiac function Digitalis-Education!! Diuretics Daily weights Nutrition Higher caloric intake Smaller more frequent feedings/meals PO to NG (HR>60) Rest Age/development appropriate activities at rest Home school Cluster cares No crying it out! ```

Answer 3

increased pulmonary flow defect The blood shifts against the normal flow. Blood that is already oxygenated is put back into the right side of the heart and recirculated into the lungs, thus increasing the volume. If untreated, the defect can cause problems such as pulmonary hypertension and heart failure. hole between right and left atrium When small, up to 80% of infants may have spontaneous closure by 18 months of age May be asymptomatic. Large defect will lead to heart failure, shortness of breath, fatigue, or poor growth.

Answer 4

increased pulmonary flow defect The left to right shunt happens when the pulmonary resistance is low. There is an increase in blood flow to the right ventricle and then also increased blood flow to the lungs. There is risk for right ventricle hypertrophy in attempts to shunt enough blood to the lungs. Opening between the right and left ventricular chambers of the heart Spontaneous closure of small defect occurs in about half of children by 2 years of age. Surgical repair is recommended by age 2 to decreased pulmonary hypertension. May not show immediate signs and symptoms at birth because left to right shunting is minimal due to high pulmonary resistance common after birth

Answer 5

increased pulmonary flow defect Failure of the ductus arteriosus, a fetal circulatory structure, to close within the first weeks of life Higher incidence in premature infants and infants born at high altitudes Left to right shunt Not enough o2 to the organs Continuous blood flow from the aorta to the pulmonary artery Altered blood flow pattern increases the workload of the left side of the heart leading to left ventricular hypertrophy If small, asymptomatic. Some demonstrate signs and symptoms of heart failure

Answer 6

PRE-OP History and physical Baseline vital signs Labs: CBC, clotting studies, electrolytes, urinalysis. Radiology: chest , ECG, or Echo. By this time a cardiac should have been completed but could come up if further complications have arisen. POST-OP Frequent assessment>Intervention>Reassessment is crucial VS q 1hour until stable then as ordered ABCs are vital! Incisional assessment Super accurate I&O and nutrition- will be on the dry side! Pain and LOC assessment Daily weight Support and education Safety!! Color of skin and mucus membranes, pulses, rate and rhythm of heart Chest tube output must be accurately measured Ventilator or not, oxygenation, deep breathing/cough/IS/Pinwheel when ready EDUCATION Heart anatomy and how the defect is affecting the function Processes of surgery, for example the pre-op bath and scrub down in the OR Location of post op and what they can expect- ICU, monitors, tubes, dressings Post-op activity level: this will include IS or deep coughing (RT will direct) also getting out of bed, bathroom privileges vs urinal/bedpan vs catheter. Also visitors and when will they go home! This is something that families need to be given information carefully! Set goals, not expectations in the event there are set backs. Nutrition instructions- NPO times super important! (solids- 6hrs, liquids- 2hrs) Medications: Current meds and when to stop is important. Also education on anesthesia and meds to expect post op

Answer 7

Rheumatic Fever Delayed sequelae of group A strep Occurs more often in school age children 5-15 yo Can happen 2-4 weeks after initial infection (strep) Antibodies cross-react with antigens in cardiac muscle and neuronal and synovial tissue Results in carditis, arthritis, and chorea (involuntary random jerking movements) Attacks last 6-12 weeks and then resolve May recur with subsequent strep infections inflammatory disease involving the joint, heart, skin & nervous system ``` Management/treatment Compliance of antibiotic treatment-10 day course Prophylactic antibiotics Aspirin after diagnosis Frustration outlet ``` Kawasaki Acute systemic vasculitis, ages 6 months- 5 years of age Leading cause of acquired heart disease Patho Etiology unknown Autoimmune response Generalized systemic vasculitis occurs in the blood vessels due to inflammation and edema and can lead to coronary dilatation and aneurysm Not everyone develops coronary artery changes Diffuse erythematous polymorphous rash Edema of the hands and feet Erythema and painful induration of the palms and soles Desquamation/peeling of the perineal region, fingers, toes, palms, and feet Possible jaundice Management Acute phase- High dose aspirin in 4 divided doses daily Single does of IVIg within first 7-10 days of dx Monitory cardiac status Promote comfort-cluster cares, acetaminophen for fever management

Answer 8

Primary Hypertension- post pubertal children, African Americans, and children who are overweight or obese Secondary hypertension- occurs with an underlying medical problem (heart disease, kidney disease, etc.) Educate on dietary restrictions Exercise Medication compliance Regular BP checks

Answer 9

Inactivated—IM Recommended annually for all children older than 6 months High risk (long term aspirin, asthma, CHF, diabetes, sickle cell disease) Live—intranasal Approved for healthy children and adults from 5 through 49 years of age Do NOT give to high risk individuals and those younger than 5 or older than 50 years - if it is the first time getting vaccine they will need 2 doses, must be 6 months of age contraindications Illness—moderate to severe Allergies to certain medications, food or any vaccine Serious reaction to vaccine in past Immunocompromised—NO live vaccine Immunosuppressive therapy—NO live vaccine Blood products, plasma or immune globulin in past year—NO live vaccine Pregnancy or chance of pregnancy in next month—NO live vaccine ``` Need to be properly stored. Understand manufacture directions clearly All doses are 0.5ml. IM vs Subq? Rotate sites 25 mm (7/8 to 1 in) needle Avoid dorsogluteal muscle- use vastus lateralis newborns & young infants. May use Deltoid if over 1 year age. ```

Answer 10

Make sure epinephrine 1:1000 is available Anaphylactic reaction Systemic—bronchospasms, laryngeal edema, flushing, nausea, vomiting, anxiety etc Local– hives edema, warm, and erythema parents About 1% of the pediatric population are unvaccinated Different reasons often fear of side effects Question need for Excessive # may weaken immune system Can have an alternate schedule Can use medication to help with the pain EMLA (mix of lidocaine and prilocaine) apply at least 1 hrs before. Also use distraction techniques

Answer 11

fifths- lacelike rash on extremities, rash on face lyme- bullseye rash roseola- rash all over scarlet fever- rash, strawberry tongue, desquamation

Answer 12

CONTACT DERMATITIS: avoid triggers URTICARIA/HIVES: Remove cause, provide antihistamines or steroids SEBORRHEA/CRADLE CAP: head & shoulders ANIMAL BITES: Administer meds: Vaccine, antibiotic, etc Irrigate Prepare for closure INSECT BITES: Stinger-remove it and apply ice Antihistamine Avoidance- clothing Deet SCABIES: Treatment- must kill the mites and eggs Topical- apply for 8 hours Oral IMPETIGO: Treat- oral or topic antibiotics May return to school after 24 hours of treatment TINEA: Topical Antifungals Antibiotics for secondary bacterial infections

Answer 13

Also known as Atopic Dermatitis Associated with allergies and asthma Before age of 2 onset Chronic itch Itchy, inflamed, red, swollen skin Response to allergens (foods), environmental triggers (mold, dust, pets, pollen, etc) Other triggers: extreme temp changes, skin irritants, stress Assessment History- disrupted sleep, scratch marks, wiggling or scratching, familial history, asthma, food or environment allergies Physical findings Dry, scaly, flakey skin Lesions… are they infected? Under 2- face, scalp, wrists and extensior surfaces Older children- can be anywhere, more common on flexor sites Erythema or warmth to skin- infection?! Hyper or hypo pigmentation- prior exacerbation Respiratory symptoms associated with flare up Tx Avoid hot water and any smelly lotion or soaps Mild soaps to clean only dirty areas Pat skin dry, no rubbing- leave the child moist!! Lather them up, the more slippery the better: Eucerin, Aquaphor, Vaseline Cut fingernails

Answer 14

Prevention Smoke detectors Water safety- pour/splash injury, Set temp <120 degrees F Fireworks Cares at Home Seek attention if it appears to be worse than first-degree Steps to treat (extensive) Remove clothing only if it comes off easily or if still smoldering ABCs/CPR Do not apply ice, butter, ointment, or cream Cover with clean, lint free bandage or sheet Do not attempt breaking blisters Identify shock Steps to treat (superficial) Run cool water until pain lessens Do not apply ice, butter, ointment, or cream Cover lightly with clean, non adhesive, bandage Tylenol or Ibuprofen for pain Be seen within 24 hours

Answer 15

pubic hair: stage 1: preadolescent; no sexual hair stage 2: sparse, pigmented, long, straight, mainly along labia and at base of penis stage 3: darker, coarser, curlier stage 4: adult, but decreased distribution stage 5: adult in quantity and type with spread to medial thighs ``` breast: stage 1: preadolescent stage 2: breast budding stage 3: continued enlargement stage 4: areola and papilla form secondary mount stage 5: mature female breasts ``` male genitalia: stage 1: preadolescent stage 2: enlargement, change in texture stage 3: growth in length and circumference stage 4: further development of glans penis, darkening of scrotal skin stage 5: adult genitalia