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Pediatrics > exam 3 > Flashcards

exam 3 Flashcards

1
Q

What are the signs and symptoms of congestive heart failure in children?

A

Impaired myocardial function
–Tachycardia, fatigue, weakness, restlessness, pale, cool extremities, hypotension, decreased urinary output
Pulmonary congestion
–Tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis
Systemic venous congestion
–Peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention

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2
Q

interventions for hypercyanotic spells

A

Put them in Knee chest position to change pressures in heart
Calm, comforting approach
Administer 100% oxygen (blow by - hold it in front of their face)
Morphine sub-Q or through IV line
IV fluid and volume expansion if needed

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3
Q

hypercyanotic spells

A

aka TET spells (can be side effect of TOF)
Kids become acutely cyanotic
Spasm causes decreased pulmonary blood flow and right to left shunting

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4
Q

What treatment is indicated for Kawasaki disease?

A

Tx: minimize heart damage
Symptomatic relief
Anti-inflammatories (ASA 80-100 mg/kg/day)
Gamma globulin (IVIG)
Then 3-5 mg/kg/day anti-platelet

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5
Q

kawasaki disease

A

-Acute systemic vasculitis of unknown cause
-Likely viral, URI reported prior
#1 cause of acquired heart disease in the U.S.

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6
Q

tetralogy of fallot
4 defects

A

Pulmonic stenosis
Overriding aorta
Ventricular septal defect
Right ventricular hypertrophy

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7
Q

What are feeding considerations for an infant with congestive heart failure?

A

-metabolic rate is greater because of poor cardiac function and increased HR and RR
-Caloric needs are greater b/c of increased metabolic rate
-Need to feed easily w/o excess fatigue and need to increase caloric density of formula
-infant should be well rested before feeding and fed soon after awakening to avoid crying, 30 minutes to feed

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8
Q

What can the nurse do to decrease the risk of cerebrovascular accidents (CVA)
(strokes) for children with hypoxia?

A

-Dehydration increases risk for CVAs
–Fluid status is carefully monitored - Is, Os, and daily weight
-Avoid pulmonary infections

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9
Q

What are the clinical manifestations of rheumatic fever? (7)

A

Acute symptoms:
-Fever
-Joint pain & swelling (70% of cases)
-Chorea (involuntary movements – 10% of cases)
-Heart murmurs (carditis in 50-75% of cases)
-EKG changes
-Chest pain
-Dyspnea

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10
Q

for what conditions is cardiac catheterization indicated

A

Transposition of the great vessels
Some complex single-ventricle defects
Atrial septal defect
Pulmonary artery stenosis

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11
Q

cardiac catheterization: nursing care preprocedure

A

-Prepare child and family
-Use developmentally appropriate materials to explain the procedure to the child
-Assess and mark pulses
-Baseline o2 stats
-Nothing by mouth prior

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12
Q

cardiac catheterization: nursing care post procedure

A

Check pulse distal to site
Monitor temp and color of extremities
Take vital signs every 15 mins
Monitor BP
Monitor dressing for bleeding or hematoma
Monitor Is and Os
Monitor blood glucose

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13
Q

what does digoxin do?

A

Improves force and velocity of ventricular contraction in children with CHF
Reduces excitability of myocardium
Decreases HR
* Rapid onset
* Less toxicity
* Micrograms
Verify with second nurse

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14
Q

What is the nursing care of a child with juvenile idiopathic arthritis (JIA)?

A

-Encourage ADLs, play that involves moving/stretching, gradually build tolerance for more active exercise
-Periods of rest with flare-ups
-High protein/high calorie
-Splints
-Positioning
-Firm mattress, small pillow for head but not knees
-Warm, moist packs prior to exercise

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15
Q

What are the features of juvenile idiopathic arthritis (JIA)? (7)

A

-Joint swelling, stiffness, redness, worse in AM and after naps
-Mobility limitations
-Fever
-Rash
-Limp in the morning
-Enlarged lymph nodes
-Delayed growth

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16
Q

What are the features of spastic cerebral palsy?

A

-Hypertonicity
-Impairments in gross and fine motor skills
-All, some or one area
-Crouching gait, scissoring of legs, tip-toe walking

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17
Q

What is the primary risk factor for the development of cerebral palsy?

A

-80% attributed to non-progressive disturbances that occurred in the developing fetal or infant brain

Highest prevalence in premature birth before 28 weeks

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18
Q

What are the medication treatments for cerebral palsy?

A

-baclofen
-diazepam
-botox
-gabapentin

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19
Q

Myelomeningocele

A

saclike protrusion that contains meninges, spinal fluid and nerves

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20
Q

What is the nursing care of a newborn with myelomeningocele?

A

-Infant usually in incubator or warmer
-Dressings over defect requires more frequent moistening if over head warmer is used
-Apply sterile, moist, non adherent dressing
-Change dressings every 2-4 hours
-Inspect sac for leaks, abrasions, irritation and infection
-Place infant in prone position

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21
Q

What teaching is needed for parents taking home an infant with spina bifida?

A

-Positioning, feeding, skin care and ROM exercises
-Know signs of complication (different notecard)

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22
Q

How is urinary distention (neurogenic bladder) managed?

A

Clean intermittent catheterization

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23
Q

What are the features of muscular dystrophy? (12)

A

-Fatigue
-Muscle weakness beginning in lower extremities
-Unsteady gait
-Lordosis
-Delayed motor skill development
-Frequent falling
-Difficulty getting out of bed, rising from a seated position, climbing stairs
-Learning difficulties, mild cognitive delays
-Progressive difficulty walking with possible loss of ability by age 12
-Progressive muscle atrophy
-Respiratory and cardiac difficulties usually start by age 20
-Gower’s sign

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24
Q

features of bones and fractures in children (4)

A

Softer bones
Heal more quickly
Can cause growth plate problems
Often bend rather than break

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25
Q

how much of your skeleton is replaced within 1st year of life

A

100%

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26
Q

how to handle casts initially

A

Use palm, not fingers to handle wet cast
Keep cast uncovered until fully dry
turn/reposition child until cast is dry
Fan or cool air setting of hair dryer
Support casted extremity with pillow

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27
Q

how to maintain skin integrity around the cast

A

Avoid lotions/powders
Petal cast
Keep cast clean, dry

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28
Q

teaching points for family for cast care

A

How to assess cast and skin integrity
Crutch/walker use, if applicable
Controlling pain/spasms: med admin
How to keep skin intact- – Cleaning under cast edges with alcohol wipes “toughens” skin
How to keep cast clean
Preparation for home care/safety
Follow up needed w/ Orthopedics
How to transport in car or wheelchair safely

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29
Q

cast removal teaching points

A

Usually scary for children
Has become one with them
Prepare them for procedure
Cast cutter won’t cut skin when pressed lightly on skin
Noisy
Tickles
Generates warmth
Skin care after

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30
Q

neurovascular check

A

Monitor neurovascular status - looking at points distal of the cast to check for circulation
Temp
Cap refill
Mvmt of fingers/toes
Color
pain/numbness
Tingling
Pulse strength decreased distal edge of cast
Pain, spasms
Presence of hot spots
Temperature
Integrity of cast (soiling, wet, soft, drainage, blood stains, color)

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31
Q

care for child in spica cast

A

-Cast has to remain uncovered until it is dry from the inside out
-Turn child every 2 hours in a plaster cast to help dry the cast evenly and prevent complications
-Need to monitor for compartment syndrome
-Reduce by elevating body part to increase venous return

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32
Q

What are uneven folds in the back of an infant’s legs indicative of?

A

hip dysplasia

33
Q

What are the treatment recommendations for a child with developmental dysplasia of the
Hip (newborn)?

A

Newborn to 6 months
Pavlik harness worn continuously until hip is stable

34
Q

What are the treatment recommendations for a child with developmental dysplasia of the
Hip? 6-24 months

A

Less severe - hip abduction orthosis
Adduction contracture present - traction
Hip subluxation or dislocation - surgical closed reduction

35
Q

What are the treatment recommendations for a child with developmental dysplasia of the
Hip?
(older children)

A

Operative reduction / preoperative traction, lengthening of contracted muscles and pelvic osteotomy procedures

36
Q

What are the features of a slipped capital femoral epiphysis?

A

Displacement backwards of proximal femoral epiphysis
* Acute or chronic
* Seen before growth spurt/puberty
* Can be bilateral

37
Q

etiology of slipped capital femoral epiphysis?

A

primarily idiopathic and associated with:
–Male gender more frequent
–Obesity
–Abnormal epiphyseal anatomy
–Hormone changes/steroid use

38
Q

is slipped capital femoral epiphysis an medical emergency

A

yes
Complete non weight bearing
Possible pre-op traction
Surgical pinning

38
Q

What are the recommendations to prevent urinary tract infections in children?

A

-Perineal hygiene
-fluid intake w/ routine voiding
-Cotton underwear
-Discourage bubble baths, hot tubs, bath oils
-encourage potty training

39
Q

What are the treatment recommendations for children with urinary tract infections?

A

-Trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin
-Amoxicillin
-Cephalexin
-Others, such as gentamycin or carbenicillin
-Pyridium (over-the-counter medication)
-Combination agents (e.g., Urised) are used to relieve pain
-Preparations with methylene blue tint

40
Q

What medications are used for minimal change nephrotic syndrome?

A

-Corticosteroids (prednisone)
-Autoimmune disorder Immunomodulators
(Ergamisol, Cytoxan, Decreased immune response)
-Immunosuppressant
CellCept (inhibits antibody production)
-Diuretics
-Antibiotics

41
Q

What is the anatomical finding for a newborn with hypospadias?

A

Congenital anomalies involving abnormal location of the urethral meatus in males
Hypo = below

42
Q

What is the post surgical treatment of for a child with a hypospadias repair?

A

Double diapering
Have catheter in new hole but don’t want it to be in contact with feces
Inner diaper collects stool and outer diaper collects urine from draining stent

43
Q

What are the urinalysis findings of a child with acute glomerulonephritis?

A

hematuria
proteinuria
oliguria

44
Q

hematuria

A

Bleeding in upper urinary tract resulting in smoky brown urine (tea or cola colored)

45
Q

proteinuria

A

Increased amt of protein signifies increased severity of renal disease

46
Q

types of glomerulonephritis

A
  1. Most are postinfectious (pneumococcal, streptococcal, or viral)
  2. May be primary event
  3. OR may be manifestation of a systematic disorder (SLE or Sickle cell)
47
Q

s/s of glomerulonephritis

A

-Generalized edema d/t to decreased glomerular filtration, Especially in periorbital area
-Facial edema is more prominent in the morning –> Spreads during the day to involve lower extremities and abdomen
-HTN d/t increased extracellular fluid
-Oliguria (severe reduced volume)
-hematuria
-proteinuria

48
Q

Why are daily weights necessary for children hospitalized with glomerulonephritis?

A

manage edema

49
Q

advantage of peritoneal dialysis

A

Independence
Live further form medical centers
Few dietary restrictions
gentler
Electrolyte changes are slower so less muscle cramping than hemodialysis
No hemodialysis catheter so if PD catheter gets infected, it is not an immediate blood stream
infection

50
Q

What are the serum and urinalysis/urine output findings for a child with acute renal failure?

A

hyperkalemia (cardiac)
hyponatremia (seizures)
hypocalcemia (seizure precautions)

51
Q

concrete operations

A

7-11 years old
You can manipulate what you see in front of you with thought
Turn what you’re doing into concepts
Not reflecting on concepts

52
Q

what age is considered school age

A

6-12

53
Q

cognitive abilities of school age children

A

industry vs. inferiority
concrete operations

54
Q

bullying

A

any recurring activity that intends to cause harm, distress or control towards another in which there is perceived imbalance of power b/w aggressors and victim

55
Q

long term consequences of bullying for bullies

A

higher risk for problems, hyperactivity, school dropout, unemployment, criminal behavior
Inability to develop and maintain relationships

56
Q

long term consequences of bullying for victims

A

decreased self esteem, anxiety, depression, insecurity, loneliness, poor academics, psychosomatic complaints

57
Q

cognitive development adolescents

A

identity vs. role confusion: 12-18 years
Formal operations: 11+
(Ability to think about thinking)

58
Q

formal operations

A

-Increasingly capable of using formal logic to make decisions (ability to systematically solve a problem in a logical and methodical way)
-Think beyond current circumstances
-Able to understand how the actions of an individual influence others
-Capable of evaluating the quality of their own thinking
-Able to maintain attention for longer periods of time
-Highly imaginative and idealistic
-Able to think through more than two categories of variables concurrently

59
Q

weight based IV replacement for infant with dehydration (mild / moderate)

A

Start with 50 ml/kg of ORT, increase 100ml/kg for moderate cases
Replace fluids q 4-6 hours

60
Q

weight based IV replacement for infant with severe dehydration

A

20 ml/kg over 5-20 mins
Isotonic IVF for replacement: NS or LR

61
Q

What are the signs of hyperkalemia in a child with acute renal failure?

A

QT prolongation and other cardiac arrhythmias
EKG - peaked T wave
Could result in nausea, vomiting and tingling

62
Q

ventricular septal defect

A

An opening between the right and left ventricles (shunt) causing increased pulmonary blood flow and decreased systemic blood flow (may hear a swishing sound or a murmur)

63
Q

What would a urinalysis result obtained from a child with a urinary tract infection look like?

A

WBC - increased
Specific Gravity - increased
Blood - potentially
Protein - present
Nitrates - present

64
Q

medications for juvenile arthritis

A

i. NSAIDs
ii. Disease-modifying antirheumatic drugs (DMARDs) - i.e. methotrexate
iii. Corticosteroids - in acute arthritis… not good to manage kids on steroids for very long
iv. Biologic disease-modifying drugs (Biologic DMARDs) - i.e. Etanercept (Enbrel) - tumor necrosis factor alpha-receptor blocker

65
Q

physical assessment findings of spastic CP

A

i. Failure to meet developmental milestones
ii. Persistent primitive reflexes (moro, tonic neck remain)
iii. Gagging or choking with feeding, poor sucking reflex
iv. Tongue thrust after 6 months
v. Poor head control (may have head lag past 4 months)
vi. Rigid posture and extremities, abnormal posturing
vii. Asymmetric crawl
viii. Hyperreflexia
ix. Vision or hearing impairments
x. Seizures
xi. Impaired social relationships

66
Q

what is hemiplegia and how do you approach child?

A

Paralysis of one side of the body

From the front and favor the side that is functioning

67
Q

spina bifida complications

A

Skin ulceration - important to provide adequate skincare
May have latex allergy (also bananas, avocados, kiwis, chestnuts)
Frequent health checks - increased risk for intracranial pressure particularly after surgery, may have shunts
Orthopedic issues- Clubfoot, scoliosis, other malformations of the feet and legs
Bladder problems (may have a neurogenic bladder which means they don’t have the nerve endings to have normal urination)

68
Q

when do hypercyanotic spells occur

A

Occur more frequently in the AM and may be preceded by feeding, crying, defecation or stressful procedures

69
Q

daily maintenance fluid requirements formula

A

= or <10kg give 100 ml/kg/day
next 10kg give 50 ml/kg/day
for each additional kg give 20 ml/kg/day
divide total amount by 24 hours to obtain rate ml/hour

70
Q

How does strength and quality of the pulse differ among congenital heart defects?

A

With all of the kinds of stenosis, the pulse strength is higher before the constriction and lower after it

71
Q

normal urine ph

A

5.0-9.0

72
Q

normal specific gravity

A

1.001 (dilute) to 1.035 (very concentrated)

73
Q

normal urine protein levels

A

less than 20 mg/dl

74
Q

how is baclofen delivered

A

Oral or intrathecal via pump

75
Q

how is hyperkalemia treated

A

10% calcium gluconate, Kayexalate

76
Q

what is Vesicoureteral reflux?

A

Abnormal retrograde flow of bladder urine into the ureters - valves remain open

77
Q

Acute poststreptococcal glomerulonephritis (APSGN)

A

An immune complex disease
Occurs after antecedent streptococcal infection and strains of Group A B-hemolytic streptococcus (GABHS)
Latent period of 10-21 days b/w infection and onset of manifestations

78
Q

most common cause of acute renal failure in kids

A

severe
dehydration

Pediatrics (4 decks)

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