Exam 2 Flashcards
(232 cards)
1
Q
timeline of septal development of the heart
A
conception embryo through utero- delivery
2
Q
whartons jelly
A
covers umbilical cord
contracts around vessels (Vein and 2 arteries) when temp dec (exposed room air)
acts as natural cord clamp
creates high resistance
3
Q
umbilical vein- after delivery
A
does not transport blood- closed
4
Q
inferior vena cava/ superior -after delivery
A
deoxygenated blood fills right atrium/ventricle
shunted to pulmonary arteries
5
Q
lungs- after delivery
A
required for ventilation
air pushes fluid inside the alveoli out
fluid shunted into capillary
inc 02 lvl= stim dilation arteriole
dec PVR from pulmonary artery into lungs
6
Q
foramen ovale -after delivery
A
blood from lungs enters L side heart
dec P in right side
forman ovale flap is pushed shut from pressure of the blood
happens w/in min
7
Q
ductus arteriosus- after delivery
A
dec p in pulmonary artery creates high aortic P
sm musc constricts w/ in 02 in blood and dec in prostaglandins from removal of placenta
happens w/in hours
eventually closes completely
8
Q
umbilical artery- after delivery
A
branch off common iliac
receives oxygenated blood from desc aorta
high 02, low prostaglandins= constriction
inc PVR- dec blood flow
eventually no blood reaches end of cord
9
Q
fetal circulation pathway before birth
A
deoxygenated blood in trhough SVC ductus venosus/IVC to RA
mixes with oxygenated blood in the RV
sent to pulmonary artery, placenta, LA, LV, aorta
patent ductus arteriosus allows mixed blood to flow freely between pulmonary artery and aorta (deoxygenated artery blood mixes w/ oxygenated aorta blood)
10
Q
Fetal circulation changes after birth
A
ductus arteriosus closed
ductus venosus closed
11
Q
fetal circulation- characteristics- blood vessels
A
constricted pulmonary blood v
dilated systemic blood v w/ low resistance
12
Q
fetal circulation- characteristics- patency
A
patent foramen ovale and ductus venosus
13
Q
fetal circulation- characteristics- arteriosus
A
large ductus arteriosus
connects w/ aorta and brings mixed blood to lower body
14
Q
neonatal circulation- blood vessels
A
dilated pulmonary blood v
15
Q
neonatal circ- charact
A
vascular resistance, arterial p and systemic blood vol inc
16
Q
neonatal circ- charact- ductus arteriosus and venosus
A
arteriosus- closes 2-5 days after birth
venosus- closes days after birth
17
Q
neonatal circ- charact- foramen ovale
A
hole in L atria closes and blood flow reverses
18
Q
peripheral vascular assessment
A
color- acrocyanosis (norm up to about 24h) and circumoral pulse cap refill (central and peripherally) skin activity (inc. crying) fluid status pulses (central- femoral) peripheral (brachial) should be equal when compared 2+
19
Q
cardiac assessment
A
heart rate (assess all valves) heart rhythm adven. breath sounds heart sounds (S3 common) chest symmetry and circumference
20
Q
cardiac output- rate factors
A
pressure
dec p= dec co
babies have high hr and low bp at birth
hr dec and bp inc w/ age
21
Q
formula for minimal sbp 1-10 yrs
A
if assessment finding < calculated value= hypotension
2years + 70 mmHg
ex. 4 yr old
24= 8 + 70 + 78
22
Q
function prostaglandin E
A
prevents closure patent ductus arteriosus
can also give ibuprofen
23
Q
indomethacin function
A
closes Patent DA
inhibits prostaglandins
24
Q
function of prostaglandins in heart function
A
prostaglandins inhibit contraction of sm- prevents closure of openings
25
inotrope funtion
used for heart failure
| improves cardiac output, alters force of contractions
26
congenital heart defects- inc pul blood flow- defect types
patent ductus arteriosus (PDA)
atrial septal defect (ASD)
ventricular septal defect (VSD)
atrioventricular canal
27
congenital heart defects- inc pul blood flow- manif
tachypnea, freq respir infections, tachycardia, poor weight gain, heart failure
28
congenital heart defects- DEC pul blood flow- defect types
pulmonic stenosis
tetralogy of fallot
pulmonary atresia
tricuspid atresia
29
congenital heart defects- DEC pul blood flow- manif
cyanosis, polycethmia (inc number RBC, can cause clotting disorders), poor weight gain
30
congenital heart defects- obstruction to systemic blood flow- defect types
coarctation of the aorta
hypoplastic left heart syndrome
mitral stenosis
interrupted aortic arch
31
congenital heart defects- obstruction to systemic blood flow- manif
dimin. pulses, delayed cap refil, poor color, heart failure, pulm edema
32
congenital heart defects- mixed blood flow- defect types
transposition of the great arteries
truncus arteriosus
double outlet right ventricle
33
congenital heart defects- obstruction to systemic blood flow- manif
cyanosis
poor weight gain
pulm congestion
heart failure
34
inc pulm blood flow defect- general
deoxygen blood mixes w/ oxygenated blood
L to R shunting (high to low pressure)
usually more than one type occurs at the same time
35
inc pulm blood flow defect- additional manif
edema, cardiomegaly, failure to thrive
36
PDA- patent ductus arteriosus
inc pul blood flow
ductus arteriosus fails to close (links aorta to pulm artery)
can be asymptomatic
use indomethacin/ ibuprofen IV, surgery
37
ASD- atrial septal defect
```
inc pul blood flow
atrial septal defect
manif depend on size of defect
can close spontaneously
surgical patch
blood L atrium shunts back into R
```
38
VSD- ventricular septal defect
```
patch placed 3-12 mo
monitor for HF
use meds for HF
manif depend on size
can close on own w/in first yr
inc pul blood flow
```
39
atrioventricular canal
inc pul blood flow
bidirectional shunting possible
"endocardial cushion defect"
lifelong prophylaxis for infective endocarditis
dental health is extremely important
aortic and ventricular walls not definitively different
surgical repair w/in 1st yr life
40
dec pul blood flow- general
obstriction of blood to lungs (not complete)
R to L shunting
hypercyanotic spells, hypoxemia and polycethemia
41
pulmonic stenosis
```
dec pul blood flow
right ventr outflow obstruction
subvalvular, valvular or supravalvular
lifelong endocarditis prophylaxis
hf management, surgery
```
42
pulmonary atresia
```
dec pul blood flow
undev pulmonic valve
hypoxia and cyanosis if not managed
PDA must remain open until surgery
use prostaglandins
palliative repair used before surgery
```
43
tetralogy of fallot
dec pul blood flow
need all components for diagnosis
pulmonic stenosis, right ventr hypertrophy, overriding aorta, and vsd
can also have open foramen ovale or Atrial septal defect
*most common cyanotic defect
hypercyanotic episodes
dec systemic venous flow during spells
surgical repair
44
tricuspid atresia
```
dec pulm blood flow
imcomp tricuspid valve, right atrium and ventricle not connected
asd present
prostaglandins immed!
HF meds
3-stage surgical repair
```
45
Coarctation of the aorta
obstruction to systemic blood flow
Narrowing of aorta.
High blood pressure in upper extremities and low blood pressure in lower.
Preductal/ post ductal bp important
Impaired perfusion when PDA closes. (temporary)
Surgical repair.
46
hypoplastic left heart syndrome
```
obstruction to systemic blood flow
underdev left side of heart
must have pda open
can admin prostaglandins before birth
surgical repair
```
47
aortic stenosis
obstruction to systemic blood flow
narrowing aortic valve
exercise restrictions!!!!
surgical or balloon valvuloplasty
48
Transposition of the great arteries:
mixed defect
Arteries connected to wrong ventricles.
Must have another defect for blood flow/O2 mixing.
Prostaglandins to keep PDA open until surgical repair.
49
Truncus arteriosus:
mixed defect
Single great artery with large VSD.
Activity limitations.
Manage heart failure and surgical repair.
50
Double-outlet right ventricle:
mixed defect
Both great arteries exit from right ventricle.
Always has VSD present (required to survive).
Manage heart failure and surgical repair.
51
cardiovasc disorders- nursing care
```
pain interventions- especially post op
adequate oxygenation
hydration and nutrition
promote growth and dev
provide emotional/psychosocial support
```
52
cardiovasc disorders- oxygenation intervention
dec CO leads to inadeq o2
| admin supply o2 and monitor sat
53
cardiovasc disorders- hydration/nutrition intervention
monitor protein, vitamin intake
| use small, freq meals
54
cardiovasc disorders- grwth/dev intervention
use OT/PT to meet motor milestones
| encourage play/socialization w/ peer to promote psychosocial dev
55
Rheumatic fever- def
autoimmune, inflamm reation to group A strep
can be prevented w/ admin antib for strep pharyngitis
diagnosed using Jones criteria
56
Rheumatic fever- manif/ trtmnt
chorea (unpredictable movements), arthralgia (joint stiffness), fever, carditis, erythema marginatum (pink/red skin rash on trunk), subcutaneous nodules, polyarthritis, and elevated C-reactive proteins.
CRP- systemic inflammatory marker
trt- antib and anti-inflamm
prolonged hospitalizations
57
infective endocarditis- def and cause
infection fo endocardium (inner lining heart)
vegetations grow in valves and lining, causing dysfunction of valves
common cause- bacterial pathogens
diagnosed w/ Duke criteria
58
infective endocarditis- manif/ trtmnt
osler nodules and janeway lesions
erythemic nodes on tips of fingers/toes
trt- antib b4 procedures, and surgeries
oral health!! - directly r/t cardiac health
59
cardiomyopathy- def, types
dis heart musc resulting in defects
types- dilated and hypertrophic
dilated- ventricles enlarge
results in dec contractility and reduced CO
hypertrophic- cardiac music. thickens
60
cardiomyopathy- relation to obstruction
obstructions occur after hypertrophic cardiomyopathy
61
common cause hypertrophic cardiomyopathy
malformation syndromes
62
common cuase dilated cardiomyopathy
myocarditis (viral)
| trt same as HF
63
kawaksi dis- def
acute, idiopathic
systemic vascular inflamm disorder
common in kids younger than 5
64
kawaksi dis- phases
lasts several weeks
acute (abrupt fever)
subacute (fever resolution)
risk for coronary aneurysm highest during subacute stage
convalescent (complete resolution)
phase can take 3 months
65
kawaksi dis- r/t heart dis
kawasaki dis most common cause of acquired heart dis
main- strawberry tongue, fever, erythema hands/feet, cervical lymphadenopathy
66
kawaksi dis- trtmnt
iv immunoglobulin G therapy
| aspirin
67
effects of adversity during childhood
delay cognitive, language and emotional development
68
beginning of neurological dev
soon after conception
| 8 wks brain waves
69
neurological system dev after birth
rapidly during infant and toddler years
70
fontanelles and suture function
brain growth
fontan fuse after brain growth slows
skill thickness inc w/ age
pliability dec w/ age
71
myelination
completed at age 3
72
cerebral metabolism in kids
increased v adults
| have large heads
73
neuro assessment
```
hx
social interactions
visual
cranial/skull _ oral head circum measured in infants and toddlers
spinal nerve
motor dev
reflex testing
```
74
test for vestibular function
vestibular- provides sense balance and info about body position
whisper word and observe head movement
75
interventions for neuro disorders
```
maintain hydration/ nutrition
promote safety (helmet/car seat)
maintain neuro function ( incl playing and social interaction)
prevent/manage infection
promote pain relief/comfort
admin and manage meds
```
76
craniosynostosis- def
```
premature closure of cranial sutures
simple or complex
causes inc ICP/ head malformations
can dampen brain growth
assess sutures of infants at every appointment
```
77
craniosynostosis- trtmnt
surgery before 6 mo and post op helmet
78
deformational plagiocephaly (DP)- def
assymm and flattening of head from external forces
inc w/ back to sleep campaign
skull deformation right occiput more than left occiput
79
deformational plagiocephaly (DP)- prev/ trt
prev- infants prone 30-60 min / day to dec P on skull
| trt- freq repositioning and orthotics (helmet)
80
microcephaly- def
abdnom small head
primary or secondary
causes- cognitive impairments
head circum 2 standard deviations below mean
81
microcephaly- trtmnt
supportive care
82
hydrocephalus- def, cause
buildup of CSF in brain
| cause- inc CSF production, dec csf absorption or flow obstruction
83
hydrocephalus- manif
change in consciousness (comm vs not communicating)
depend on age and severity
dilated scalp veins, bulging gontanel, apnea, irritability, ha and vomiting
84
hydrocephalus- trtmnt
```
lumbar punctures (not advised if pt noncommunicating)
ventriculoperitoneal shunt
```
85
ventriculoperitoneal shunt- considerations
```
monitor for infection
may need replacement as child grows
monitor head circum to assess patency
position on non-op side keep HOB elevation below 30 degrees
*assoc w/ hydrocephalus
```
86
meningitis- cause
aseptic (viral)
| septic (bacterial)
87
meningitis- interventions
isolation, seiz precautions, freq neuro assessments and fever management
88
reyes syndrome- common cause
aspirin to children
89
seizure- def and classification
electrical disturb in brain
| classified by location, severity, manif, freq, duration or etiology
90
seizure- risks, environmental factors
can cause motor, sensory and cognitive changes
| some environm can be triggers- inc risk for seizure
91
seizure- focal v generalized
focal- one part of brain
| generalized- entire brain
92
simple seizure
partial
have awareness/memory and conciousness
20-60 seconds
93
complex seizure
```
partial
consciousness impaired (stare/motionless)
45-90 sec.- longer
```
94
focal evolving to generalized seizure
starts as focal and progresses to gen
95
absence seizure
loss of concious w/ vacant stare or unrespon
96
myoclonic seizure
happen suddenly
| forceful contractions of single/multiple musc groups
97
clonic seizure
longer rhythmic jerking activity
98
tonic- clonic seizures
generalized
alternate contraction (tonic)
relaxation (clonic) of music. loss of Concious
abnorm behavior
99
atonic seizure
loss musc tone, person suddenly drops
100
epilepsy def
recurrent, UNprovoked seizures
resolved- if no seizure for 10 yr or dc of meds for 5+ yrs
may be age-related
101
epilepsy- diag criteria
2 unprovoked seiz more than 24hr apart
one unprovoked seizu w/ high probabil of repetition over next 10 yrs
epileptic syndrome present
102
epilepsy- trtmnt
vagal nerve stim if meds are ineffective
| saftey interventions during active seizures
103
status epilepticus- def
constant convulsions
life threatening- med immergency
tonic-clonic- several min at close intervals
104
status ep- trtmnt
iv fluids, o2, iv meds to stop seizure
| medically induced coma if necessary
105
febrile seizures- def
acute seiz in kids younger than 7 by high fever
temp > 101.2
can cause dev of epilepsy
106
febrile seiz- trtmnt
encephalogram for diagnostic testing (EEG)
| self- limiting
107
pharmacological trtmnt for seizure- considerations
```
consistency is key
monotherapy preferred
generalized tonic clonic- carbamazepine, valproic acid, phenytoin, phenobarbital
focal- fosphenytoin, gabapentin
non motor- gen- zarotin
non motor focal- topamax
```
108
head trauma- cause and classfiication
after traumatic brain injury
primary or secondary
accidental or nonaccidental
infants/toddlers are at greatest risk due to large head
109
head trauma- manif
SBS silent condition
110
head trauma- trtmnt
use glasgow coma scale and observe for posturing (decorticate v decerbrate) in kids 8+
monitor for electrolyte abnorm`
111
headaches- classification, cause, manif
class- acute, acute recurrent, chronic progressive, chronic nonprogressive
manif- mild- severe
cause- varies
112
ha- trtmnt
relaxation, OTC
if child wakes up from sleep from ha, eval immed
have parents keep ha journal- determine patterns and causes
113
hearing defects cause
genetic, acquired, unknown
114
hearing defects- implications
can have speech delays, appear to be inattentive
suspect hearing loss if startle (spreading of arms and legs and crying) is absent or no turn to voice /noise at 6 mo
* need to pass hearing screen to leave hospital
115
hearing defects trtmnt
reg hearing screenings
| technological (hearing aids), sign lang
116
causes of mental health disorders
genetics, physiological changes and environ exposure
117
mental health def
state well being in which every indiv realizes his or her own potential, can cope with normal stresses of life, can work productively and fruitfully, is able to make contribution to community
118
cognition def
process of thought and knowing that is acquired through experiences and maturation
119
children v adult mental health
children have diff scope, presentation, and progression of mental/cog disorders
definitions of dis. still same for kids and adults
120
factors in good cognitive dev of kids
access to good nutrition, positive relationships, safe housing
121
cognitive/mental health assessment- subjective
birth hx, past med hx, family and social hx, behavioral symptoms
122
cognitive/mental health assessment- objective
developmental screenigs
physical exam
diagn testing to assess for organic causes
123
supportive care for mental health
play therapy
therapeutic play
art therapy
124
play therapy
psychotherapy
encourages kids express feelings/emotions through play
kids 3-12 yrs
125
therapeutic play
used by child life specialists for hospitalized kids
126
art therapy
incorp creativity in healing and expressing childhood emotions
used in all ages
127
learning disabilities- def
difficulties in recieving and processing infor and generating appropriate responses
128
dyslexia- def
most common learning disorder
receptive language that creates difficulty using letters to decode written language
trouble w/ letters/numbers
not recog till school age
129
dyslexia- manif
slower acqusition of langu and math skills, difficulty recogn letters and numbers, problems w/ reading comprehension, and hearing deficiet
130
dyslexia- trtmnt
assess for sensory difficulties
| individualized education plan (IEP) to foster appropr growth/dev
131
autism spectrum disorder (ASD)- def
continuum of neurobiological symptoms that results in difficulty- communication, beh social interaction
usually present by age 3
presentations look diff for e/ indivi
inc incidence in boys
genetic and environmental factor link
132
ASD- manif
```
stereotypy (hand flapping)
obsessive beh
difficulty w/ sensory integration
echolalia (repiti of words w/o knowing meaning)
avoidance of eye contact
```
133
ASD- well child visits
extremely important!
| use standardized developmental screening
134
ASD- trtmnt cornerstones
early identification and referral to early intervention programs
135
ASD- trtmnt
plan educational act. that limit overstimulation
collab w/ school to limit kids distress and maximize learning
use speech therapist
multidisciplinary approach (beh health specialists, dev pediatricians, OT)
136
ADHD- def
inattentiveness w/ or w/o hyperactiv and impulsivity
neurobehavioral
impulsivity more common in boys
137
ADHD- patho and manif
cause unclear, may have genetic component
| manif- short attention span, impulsivity, difficulties w/ movement
138
ADHD- diagnosing
rule out sensory/ organic causes first
| diag w/ formal eval and psychological testing ( includes md, teacher, parent, etc)
139
ADHD- trtmnt general
caregiver education, dev of individualized ed plans (IEP), pharmacotherapy
140
ADHD- meds
stimulants- Ritalin, ADderall and Focalin
controlled substances
ae- weight loss, dec appetite, tachycardia, hypertension, dec salivation
* important to have good oral health, drink water for dry mouth instead of juice to dec risk dental caries
monitor- serum liver/kidney function lvls during trtmnt
141
anxiety- def, cause and manif
worry, fear, anxiety extend past normal adaptive coping mech
significant impairment
cause- combo of genetic and environmental factors
manif- abdom pain, nausea, palpitations, dyspnea, aggression, vomiting, dizziness
142
anxiety- categories
generalized anxiety dis
separation anxiety dis
panic disorder
use standardized rating sales and structured diagnostic interviewing to diagnose
143
anxiety- trtmnt
exposure-based cognitive behavioral therapy (for seperation anxiety and school refusal)
SSRI- fluoxitine (can inc risk suicide in pediatric pop)
144
anorexia nervosa- manif
depression, dehydration, cold intol, hypotension
145
bulimia nervosa- manif
thinning hair, calluses on backs of hands and fingers
146
abuse/violence- category
physical, emotional, sexual abuse
| exposure to domestic violence and neglect (medical/physical)
147
abuse/violence- risk factors- caregiver
mental illness, lack knowledge, poor self esteem, alcoh abuse, poor coping, hx of being victim of
148
abuse/violence- risk factors- environmental
low income, unemployment, domestic violence, lack support, low education attainment
149
abuse/violence- manif
multiple fx in various stages healing, suspicious bruising, sTI, enuresis, vague somatic complaints
150
Abuse/violence identification
forensic medical team (SANE nurse)
sexual assult nurse examiner
radiographys, CT scans
nurses are mandatory reporters
151
abuse/violence- trtmnt
prevention
| educate caregivers on expected growth/dev milestones (crying, waking in the night)
152
munchausen syndrome by proxy (MBP)- def and contrib factors
misinterpretation or presentation of exaggerated or absent symptoms in child to gain entry into medical setting
often imposed by mother
factors of perpetrator- past hx abuse, personality disorders, somatic symptom disorder, pathological lying
153
munchausen syndrome by proxy (MBP)- manif and trtmnt
manif- freq medical visits for false symptoms, purposeful inducement of physical symptoms, manipulation of lab tests to produce clinical s/s of disease
trtmt- ensure child is safe, in-home therapy, foster home placement, incarceration
154
renal/ urethral child vs adult
```
larger kidneys (prone to injury)
urethral opening closer to rectum (inc risk UTI)
shorter urethra in girls (inc risk UTI)
```
155
renal function- child v adult
nephrons immature at birth
reduced GFR
unable to concentrate urine (inc risk for electrolyte abnormalities)
lower BUN and Cr
less urine output /day
increased amount voids (smaller bladders)
156
reproductive system structure- child v adult
immature until puberty
157
GI assessment
```
urine/voiding charac
pain (when urinating or in flank)
genitalia (urethra location)
edema (r/t kidney func)
CT, biopsy, BUN, Cr
```
158
normal urine output
infant- 1-3 mL/kg/h
children- 0.5-1 mL/kg/h
min output is 1 mL/kg/h
159
calculating output
total amount out/ hours/ weight
ex. 300 mL, 12 hr and 18 kg
300/ 12/ 18= 1.4
AHW
160
bolus- type of fluid and amount
isotonic
NS or LR
20 mL/kg
161
bolus calculations
20 mg/kg
ex. 10 kg= 200 mL
ex. 11 kg
11* 20 = 220 mL/hr
162
bolus rate
ex. 11 kg
220 mL bolus/ hr
admin in 30 min= 220*2= 440 mL/hr
admin in 20 min= 220* 3= 660 mL/hr
163
GI disorders interventions
maintain hydration, electrolyte balance, and nutritional requirements
prevent infection, promote freq bladder emptying
164
UTI- lower v upper
cystitis- inflamm of urethra or bladder
pyelonephritis- ureters, renal pelvis or renal parenchyma
165
UTI- risk factors
structural v environmental
appropriate way to wipe
bubble bath
short urethra
166
UTI- cause
ecoli and staph
167
UTI- manifestations
infants- fever, lethargic, poor feeding, irritability (straight cath sample)
abdominal pain, burning, dark/foul smelling urine
168
UTI- trtmnt
```
require full diagnostic work up if 2+ UTI
antibiotic therapy (IV is pyeloneph)
push fluids
Peridium (numbing)
phenazopyridine
```
VCUG- voiding cystogram catheter dye (radiology)
can detect if bladder not emptying fully, if ureter is too low and eval function of vesicle ureter reflex
169
enuresis
incontin of urine in kids 3+
diurnal (daytime) or nocturnal
primary- always wet bed, small bladder, drink water at night, kid sleeps hard
or
secondary- random accid after 6 mo being continent (due to stress, constipation)
170
enuresis- interventions
assess for asymptom UTI
171
enuresis- trtmnt
fluid restriction ( no water 1.5 hrs before bed)
bladder exercises
timed voiding (5-7 yr olds)
alarms
antidiuretic hormones (reabsorb urine) (vasopressin)
tricyclic antidep
anticholinergics (dec output)
172
phimosis- def
foreskin penis cannot be retracted (normal in newborns)
concerning after toddler age (2-3)
EMERGENCY
173
phimosis- complications
```
venous stasis and swelling
dec circulation
paraphimosis- medical emergency- requires reduction
inc risk UTI
inc chance to happen again
```
174
phimosis- s/s
irritation, bleeding, erythema, pain, dysuria, discharge
175
phimosis- trtmnt
topical steroid cream twice daily for 2-8 wks
betamethasone
circumcision
176
cryptorchidism- def
undescen testes
one or both testes fail to descent through inguinal canal into scrotom
mechanical, hormonal, enzymatic or chromosomal
177
cryptorchidism- s/s
asymptom
| evaluate calm child in warm environment
178
cryptorchidism- trtmnt
orchiopexy (cut and move)
pain control, adeq nutrition and s/s infection
often descend on own after 2 mo
179
cryptorchidism- complications
if not desc
| infertility, inc risk for testicular CA in teens
180
inguinal hernia- def
intra-abdominal structures protrude through abdominal wall
181
inguinal hernia- s/s
palpable, round, smooth, and nontender mass
size of bulge inc when infant cries/strains
if can't poke back into hole- MED EMERGENCY
182
inguinal hernia- trtmnt
outpatient surgery
| common during 3-6 wks
183
incarcerated hernias
med emergency
can cause bowel ischemia
kids are inconsolable, knees drawn up, pain not resolved with medication
184
hydrocele- def and trtmnt
fluid accum in scrotal sac (can see with pen light)
r/t hernia (fluid not being reabsorbed)
self-limiting- resolves by 1 yr of age
if persists beyond 12-18 mo= surgery
185
testicular torsion-def and cause
testicle rotates, twists spermatic cord, cutting off circulation to scrotom
MEDICAL EMERGENCY
caused by excessive mobility of tests (too long or attached too high)
186
testicular torsion- s/s, risks, trtmnt
s/s- sudden severe pain, swelling and n/v
absent cremasteric reflex (stroke inside thigh, testes shoot up)
risks- uncommon before 10 yrs- usually happens to teens, bell clapper deformity inc risk
trtmnt- surgery
187
testicular torsion- pain
most common pain felt by males 12+
188
hypospadias and epispadias- def
urethral meatus no at end of penis
hypospadias- ventral side (bottom)
epispadias- dorsal side (top)
can be linked to inguinal hernia
congenital
common in NICU babies
189
hypospadias and epispadias- interventions/considerations
```
assess for chordee (fibrous band causing downward curve)
avoid circumcision ( foreskin used in repair)
surgery btw 6-12 mo
double diaper post op
```
190
vesicoureteral reflex- def
retrograde flow urine from bladder into ureters and renal pelvis
may occur in one or b/ ureters
evaluated in VCUG
191
vesicoureteral reflex- s/s
s/s- asymptom w/out UTI
30% in girls w/ UTI
inc risk for UTI/pyeloneph
voiding cystourethrogram to diagnose
192
vesicoureteral reflex- grading
1-5 based on degree of backflow
| 3-5= surgery
193
vesicoureteral reflex- trtmnt
```
surgery 3-5 (re-locate ureters)
suprapubic and foley catheters
prophylactic antib at bedtime
antispasmatic
pain management!!
```
194
vesicoureteral reflex- primary v secondary
primary- congenital malformation
| secondary- bladder obstruction
195
hydronephrosis- def
dilation renal pelvis and calyces d/t urinary obstruction
recurrent UTI/ pyelo common
can be asymptom at first
196
hydronephrosis- complications, trtmnt and education
complications- renal insufficiency, failure and hypertension (alteration in RAAS)
trtnt- urinary cath to promote drainage, pyeloplasty and valve repair (fix valve at end ureter)
education- s/s infection after surgery and UTI
197
nephrotic syndrome- def
kidney damage and elevated lvl protein in urine (albumin)
congenital, primary or secondary
inc glomerular basement mem permeability
198
nephrotic syndrome- 3 signs
proteinuria (dec albumin in circ (hypoalbunemia)
water moves into interstitial space- edema (dependent)
hyperlipidemia
199
nephrotic syndrome- s/s
frothy/ milky urine, irritable and tired
200
nephrotic syndrome- interventions
```
albumin supplement
replace fluids
accurate I+O's
skin assessment (weeping edema)
nutrition supplement
prevent infection
dec proteinuria
```
201
nephrotic syndrome- causes
Lupus, NSAIDS, hepatitis
202
acute poststreptococal glomerulonephritis- def
inflammation and cellular proliferation of glomeruli caused by indirect infection of kidneys
impaired capillary perfusion and dec glomerular filtration
affects 4-12 yr olds
203
acute poststreptococal glomerulonephritis- cause
often after strep infection (exposure group A strep)
1-2 wks strep throat
2-4 wks skin infection
204
acute poststreptococal glomerulonephritis- s/s
```
hematuria (red or coca cola brown)
edema
proteinuria
dec GFR
HTN
dec urine output
```
205
acute poststreptococal glomerulonephritis- trtmnt
control bp and fluid volume
| many need transplant
206
nephrotic v acute poststreptococcal glomerulonephritis-
nephrotic- s/s edema, proteinuria, hyperlipidemia
poststrep glomerulonephritis- s/s- hematuria, edema, HTN
207
hemolytic uremic syndrome- characteristics
thrombocytopenia, microangiopathic hemolytic anemia, acute renal failure
208
hemolytic uremic syndrome- associ w/
causes acute kidney injury
happens after Shiga toxin ecoli infection O157 or verotoxin and diarrhea
common in pre-K and school aged
209
hemolytic uremic syndrome- s/s
vomiting, abdominal pain, anorexia, ascites
| dec urine output, jaundice, splenomegaly
210
hemolytic uremic syndrome- trtmnt
symptomatic treatment
| I+O, fluids, pain
211
renal failure- def
kidneys unable to concen. urine and adequately excrete waste products
212
renal failure- acute
dev. days-wks
| may be reversible
213
renal failure- chronic
dev months- yrs
| permanent, irreversible
214
renal failure- cause/type
prerenal- dehydration (#1 cause)
intrinsic- toxins, nsaids
post renal- obstruction
215
renal failure- s/s
dec urine output, electrolyte abnormalities
216
renal failure- trtmnt
depends on cause
maintain fluid/electrolyte balance
monitor for htn and hypotension
dialysis and kidney transplant
217
GI system- function and includes
fun- route for ingestion and absorption of food/fluids
| inc. mouth, esophagus, stomach, pancreas, sm in, lrg in, liver and gallbladder
218
gallbladder- fun
stores/concentrates bile
219
liver fun
stores vitamines, secretes bile/bilirubin, metabolizes fats, proteins and carbs
220
gi system assessment
```
mouth/esophagus- ulcers common w/ hand, foot and mouth
abdomen- inspect and auscultate first
emesis/stool
skin
fluid status- edema, skin turgor
```
221
GI disorders- nursing interventions
maintain- ventilation, hydration, nutrition, prevent infection
222
meckel diverticulum- def
outpouching of lwr sm in.
| assoc. w/ o/ congenital abnormalities
223
meckel diverticulum- complications, s/s
complications, bowel obstruction, rupture
s/s- present at 1-2 yrs
painless rectal bleeding (jelly red stools)
224
meckel diverticulum- trtmnt
surgical resection
225
omphalocele- def
internal organs eviscerate through sac in umbilicle cord
diagnosed w/ US in utero
bubble w/ belly
226
omphalocele- trtmnt
```
dress w/ saline soaked gauze at delivery
protect sac, prevent hypothermia and infection
surgery
hydration (iv fluids)
monitor electrolytes
ng tube to decompress stomach (NPO)
use cylo winder
```
227
gastroschisis- def, trtmnt, s/s
intestines outside of body
no sac covering organs (inc risk for infection)
can have respir distress
prompt surgery
228
cleft lip/cleft palate trtmnt and interventions
surgery
lip 2-3 mo
palate 9-18 mo
```
pain management
suture care
feeding equipment
I+Os- especially PO intake
no binkies or sucking thumb
```
229
gastroschisis v omphalocele
omphalocele- sac, larger, normal bowel character, enteral nutrition normal, o/ abnormalities common
gastroschisis- no sac, smaller, inflamed bowel character, delayed nutrition, no link to o/ abnormalities
230
congenital diaphragmatic hernia
hole in diaphgram
severe respir distress, auscul changes
significant morbidity
intestines can migrate to chest cavity ( inc risk respir failure)
231
anorectal malformations
stenosis, prolapse or atresia
trtmnt- dilation 2x day or surgery
temporary colostomy to allow for healing
232
dehydration- types, cause
```
isotonic-
hypotonic
hypertonic
cause- dec intake, increased output, inc insensible loss
mild 3-5%
moderate 6-9%
```
