Exam 2 Flashcards
(115 cards)
1
Q
What are the recommended therapies for small children with nasopharyngitis?
A
Supportive tx with antipyretics, nasal saline irrigation, and adequate fluid hydration. Elevating HOB to drain secretions and suctioning with a bulb syringe.
2
Q
Why shouldn’t cough suppressants be used for nasopharyngitis?
A
Because cough is a protective way to clear secretions. They may be prescribed for a dry hacking cough at night.
3
Q
What do you teach families about URIs?
A
They usually resolve within 4-10 days. They’re frequent in children younger than 3 and by 5 their children will have developed immunity to many viruses.
4
Q
What causes strep throat?
A
Group A Beta-Hemolytic Streptococcus
5
Q
Children with strep throat are at risk for what for 10 days?
A
Acute glomerulonephritis
6
Q
Children with strep throat are at risk for what for 18 days?
A
Acute rheumatic fever
7
Q
Incubation period for strep throat
A
2-4 days
8
Q
When does strep throat usually subside?
A
3-5 days
9
Q
How is strep throat treated?
A
With oral penicillin for 10 days or IM Pen G (very painful, can cause local skin reactions or rash)
10
Q
How to care for tonsillectomy patient
A
Placed on side or abdomen to facilitate drainage, suction cautiously, ice collar to provide relief, prevent coughing/crying/blowing nose
11
Q
Signs of airway obstruction after tonsillectomy
A
Stridor, drooling, restlessness
12
Q
Where is dark brown blood usually found after a tonsillectomy?
A
Nose, emesis, teeth
13
Q
Diet for post-tonsillectomy
A
No fluids with red or brown color, avoid citrus, need soft or liquid diet
14
Q
Signs of post-op bleeding after tonsillectomy
A
High HR, frequent clearing of throat or swallowing, vomiting bright red blood
15
Q
How long will pts have bad breath after a tonsillectomy?
A
5-10 days
16
Q
Highest incidence of otitis media
A
Ages 6-20 months and in winter months
17
Q
Bacterial OM is usually preceded by what?
A
A viral respiratory infection (RSV, Influenza)
18
Q
What causes OM?
A
Malfunctioning eustachian tube. Obstruction of tube causes accumulation of secretions
Can eventually produce an effusion
19
Q
Acute OM
A
Visual inspection shows a purulent
discolored effusion and a bulging
reddened membrane, abrupt onset
20
Q
OM with effusion
A
Inflammation and fluid in the middle ear without s/s of acute infection
- immobile membrane or orange discolored
membrane
Symptoms may be absent, nonspecific
symptoms present (rhinitis, cough, diarrhea)
21
Q
When do pts need hearing evaluations with OM effusion?
A
Every 3-6 months until resolved
22
Q
When are antibiotics given for OM?
A
Less than 6 months, severe s/s of AOM (ear pain for at least 48 hours or temp >102.2F), bilateral AOM without s/s,
23
Q
Tx for unilateral AOM without severe s/s & for 24 months without s/s
A
Either give abx or watch for 48-72 hours for improvement
24
Q
Tx of OME
A
Abx given if fluid present for > 3mo
25
What is IM Rocephin for with OM?
Highly resistant bacteria or noncompliance
26
What is the abx of choice for OM?
Amoxicillin for 10 days (n/v, diarrhea)
Do not give if have PCN allergy
Other abx – augmentin, azithromycin, cephalosporin
27
Myringotomy
Surgical incision of eardrum to provide drainage and relieve pain
28
Tympanostomy tube placement
Tx recurrent chronic AOM (3 bouts in 6 mo, 6 in 12 mo, 6 by 6 years old)
29
Nursing care after a tympanostomy tube placement
Facilitate continued drainage of fluid and allow ventilation of middle ear
30
Prevention of OM
```
Pneumococcal vaccine (PCV7), annual flu vaccine
reduce risk factors - breast feed for at least 6 mo, avoid propping bottle, decrease pacifier use after 6 months, avoid exposure to tobacco smoke
```
31
What to teach family for OM
If tubes in place need earplugs for swimming, avoid getting bathwater and shampoo in ears, show them what tube looks like so can recognize if falls out
32
Nursing care for OM
Relieve pain, facilitate drainage – clean external canal with cotton swabs and antibiotic ointment and protective barrier if skin breaks down, prevent complications and recurrence – complete abx tx
33
Croup
Swelling or obstruction in region of the larynx, barking or brassy cough, stridor
34
Prevention of acute epi
Beginning at two months all children should receive the HIB vaccine
35
Tx of acute epi
Lateral neck x-ray, elective intubation before any procedures, humidified oxygen, IV antibiotics then oral for 7-10 days, Corticosteriods for reducing edema, Airway swelling decreases after 24 hours of abx tx
36
S/s of acute LTB
low grade fever, inspiratory stridor, suprasternal retractions
Develops classic barking (seal-like) cough
Worse at night and crying exacerbates
37
Tx for acute LTB
Maintain airway
High humidity with cool mist (take child outside, stand in front of open freezer, cool basement), cool air vaporizer
Continue fluid intake with mild croup (RR
38
Nursing management of acute LTB
Continuous, vigilant observation and accurate assessment of respiratory status – pulse ox
What are s/s of respiratory distress and airway obstruction?
39
Bronchiolitis
Acute viral infection with maximum effect at the bronchiolar level
Occurs in winter and spring – incubation period 2-8 days
RSV responsible for 80% or more of the cases during epidemic periods
RSV makes epithelial cells of resp tract swell, fill with mucus and exudate
Causes obstruction (expiration) and atelectasis
Hyperinflation and progressive overinflation (emphysema)
Transmission is through direct contact with secretions – can live on surfaces for several hours and hands for 30 minutes
Can cause a secondary bacterial infection (OM, pneumonia)
40
How long does pertussis last?
6-10 weeks
41
What is the definite dx of a foreign body ingestion?
Bronchoscopy
42
Tx of foreign body ingestion
-Heimlich Maneuver
1 yo: abdominal thrusts
-No finger sweeps
-Removed through endoscopy under sedation
43
What do you watch for after endoscopy?
For laryngeal edema afterwards
44
Peak Expiratory Flow Rate (PEFR)
Used to measure max flow of air forcefully exhaled in 1 second using flow meter
Find child’s best value as a baseline to compare
45
PFT for asthma
Evaluating the presence and degree of lung disease, response to tx, can be used once child is 5-6 yo
Used on initial dx, after treatment started, and every 1-2 years
46
MDI
Always attach to a spacer to prevent yeast
47
Spacer
Helps increase availability of med
48
Nebulizer
For children who have difficulty using MDI, administers med via compressed air
49
Patho of CF
Increased viscosity of mucous gland secretions
Elevation of sweat electrolytes
Increase in enzymes in saliva
Abnormalities in autonomic nervous system
Obstruction of the pancreas and bronchioles
50
How to dx CF
Sweat chloride test – normal 60 mEq/L is diagnostic of CF
Absence of pancreatic enzymes
X-ray – shows patchy atelectasis and obstructive emphysema
Family history
Newborn screening – required by law
DNA ID of gene following + NB screening
Stool analysis for fat and enzyme analysis
51
GI S/S of CF
```
Meconium ileus
Large, bulky, frothy, foul-smelling stools
Wt loss, growth failure
Distended abd
Vitamin ADEK deficiency
```
52
Salty taste to skin occurs with what disorder?
CF
53
Respiratory S/S of CF
```
Wheezing respirations
Dry, non-prod cough
Increased dyspnea
Obstructive emphysema and atelectasis
Barrel-shaped chest
Cyanosis
Clubbing of fingers and toes
Repeated episodes of bronchitis and bronchopneumonia
```
54
Complications of CF
Restricted growth and development - FTT
Cystic-fibrosis related diabetes (CFRD)
Rectal prolapse
Reproductive system – highly viscous cervical secretion can cause infertility in females, 95% of males with CF are sterile
55
Nursing management of CF
Thorough resp and GI assessment
Maintaining a patent airway
Preventing infection – standard precautions and high alert for hospital acquired infections, avoid contact with other CF patients
Maintaining growth – consult with dietician, may have to teach enteral feeds
Promoting family coping – encourage compliance with complicated regimen
Case management – O2, IV abx, Nebs/Meds, CPT supplies
Preparing family and child for adulthood
56
Trach care
What do you need to know about the pt’s trach?
Suction prn – when?
Supplies needed??
Steps to suction:
100% O2 before suctioning begins
Sterile at the hospital/ aseptic at home
Each pass only 5 seconds
Rest 30-60 sec after each pass
Parent education- change tubes, ties, suctioning, when to call an MD
Daily care – skin assessment, trach ties changed daily, weekly trach changes (2 hours after meals), use 2 people at all times
How to we give oxygen through trach?
57
What are the five factors affecting the process of labor and birth?
1. Passenger
2. Passageway
3. Powers
4. Position of mother
5. Psychological response
58
Refers to the part of the fetus that enters the pelvic inlet first and leaves through the birth canal during labor
Fetal presentation
59
Refers to the part of the fetal body first felt by the examining finger
Fetal presentation
60
The relation of the spine of the fetus to the spine of the mother
Fetal lie
61
The relation of the fetal body parts to one another
Fetal attitude
62
The largest transverse diameter and an important indicator of fetal head size
Biparietal diameter
63
The relationship of a reference point on the presenting part of the fetus to the four quadrants of the mother's pelvis
Fetal position
64
First letter of fetal position abbreviation
The location of the presenting part in the right or left side of the mother's pelvis. (R or L)
65
Second letter of fetal position abbreviation
The specific presenting part of the fetus (Occiput, sacrum, or mentum..O S or M)
66
Third letter of fetal position abbreviation
The location of the presenting part of the fetus in relation to the portion of the maternal pelvis (anterior, posterior, transverse... A P or T)
67
How do you measure the diagonal conjugate?
Insert 2 fingers into the vagina until they reach the sacral promontory.
68
How long should the diagonal conjugate be?
Greater than 11.5 cm
69
The distance from the sacral promontory to the exterior portion of the symphysis
The diagonal conjugate
70
The bony pelvis is divided into what?
True and false portions
71
The upper flared parts of the two iliac bones and the base of the sacrum
The false portions
72
Bony passageway through which the fetus must travel
True portions
73
Allows entrance into the true pelvis
Pelvic inlet
74
Occupies the space between the inlet and the outlet
Mid-pelvis
75
Bound by the ischial tuberosities and lower rim of the symphysis pubis and the tip of the coccyx
Pelvic outlet
76
Classic female pelvic shape
Gynecoid
77
Resembles the male pelvis
Android
78
Resembles the pelvis of anthropoid apes, adequate for vertex birth, oval shape
Anthropoid
79
Flat pelvis, rectangular
Platypelloid
80
The relation of the presenting part of the fetus to an imaginary line drawn between the maternal ischial spines
Station
81
A measure of the degree of descent of the presenting part of the fetus through the birth canal
Station
82
How to measure the placement of the presenting part of the fetus?
In cm above or below the ischial spines
83
The largest transverse diameter of the presenting part that has passes through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to 0 station
Engagement
84
The presenting part of the fetus is usually which diameter?
Biparietal
85
The fetal head is positioned in the pelvic cavity at an angle
Asynclitism
86
Soft tissues include what?
Distensible lower uterine segment, cervix, pelvic floor muscles, vagina, and introitus
87
After labor begins uterine contractions cause the uterine body to have what?
A thick muscular upper segment and a thin-walled, passive, muscular lower segment
88
Primary contractions
Involuntary, responsible for effacement, dilation, and descent
89
Secondary contractions
Augment the force of the involuntary contractions, mother bears down, have no effect on dilation or expulsion
90
When the presenting part of the fetus descends into the true pelvis
Lightening
91
Hormones at onset of labor
Increasing estrogen and prostaglandin and decreasing progesterone
92
First stage of labor phases
Latent, active, transition
93
When does the 1st stage of labor occur
From the onset of regular uterine contractions to full dilation of the cervix
94
Latent phase
0-3 cm dilated
95
Active phase
3-7 cm dilated
96
Transition phase
8-10 cm dilated
97
When does the 2nd stage of labor occur
Begins with full cervical dilation and complete effacement and eggs with the baby's birth
98
When does the 3rd stage of labor occur
From the birth of the baby until the placenta is expelled
99
Placental separation is indicated by what?
Firmly contracting fundus, changing uterus from discoid to globular shape, placenta moves into the lower uterine segment, a gush of dark blood, lengthening of the cord
100
When does the 4th stage of labor occur
Begins with the delivery of eh placenta to the first 1-2 hours after birth
101
How should the uterus be during the 4th stage of labor
Firm and well contracted, hypotonic bladder
102
What to monitor for with hemodynamic changes
Blood loss ranging to 250-500mL, blood redistributed into venous beds, moderate drop in both systolic and diastolic BP, increase pulse pressure, moderate tachycardia
103
The turns and other adjustments necessary in the human birth process
Mechanism of labor (cardinal movements)
104
Cardinal movements
1. Engagement
2. Descent
3. Flexion
4. Internal rotation
5. Extension
6. External rotation
(restitution)
7. Expulsion
105
Bradley Method
?
106
Sedatives given during labor
Seconal, phenergan, valium, vistaril
107
Narcotics given during labor
Demreol, dilaudid, fentanyl, nubain, stadol
108
Pudendal block
Injected directly into the pudendal nerve
109
When is the pudendal block used?
Second stage of labor, birth, forceps or vacuum assisted delivery, episiotomy repair
110
When is a spinal block used?
For C-sections or difficult forceps delivery
111
Disadvantages to spinal blocks
Hypotension, total spinal block, drug reaction, spinal HA
112
Epidural contraindications
Infection, coagulation dx, drug allergy
113
How do you treat epidural induced maternal hypotension?
IV bolus and ephedrine
114
Disadvantages to epidurals
Pruritus, slowed pushing efforts, increased use of vacuum and forceps, delay in return of bladder sensation
115
Combined spinal and epidural
Involves inserting the epidural needle into the epidural space and subsequently inserting a smaller gauge spinal needle through the epidural needle into the subarachnoid space, rapid onset and duration of pain relief, allows motor function and pushing efforts to remain active
