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Exam 3 Flashcards

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1
Q

What does left to right blood flow mean in congestive heart defects

A

Increased pulmonary blood flow
Increased blood flow on the right side of he heart causes increase blood to the lungs—pulmonary edema and pulmonary hypertension

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2
Q

What is polycythemia

A

Increase in RBC that increase viscosity—-decreases ability to perfuse
Risk of stroke and blood clots

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3
Q

What is tetrology of fallot

A

Pulmonary stenosis
Right ventricular hypertrophy
Overriding Aorta
Ventricular septal defect

May also have murmur

R—>L= not enough blood is getting oxygenated, body reacts to make more RBC to carry oxygen—polycythemia (report is hemoglobin is over 22)

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4
Q

What are tet spells

A

They are seen in Tetrology of Fallot
Tet spells=blue when crying, dec oxygen, clubbing of fingertips, polycythemia

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5
Q

What do you do when a baby is having tet spells

A

During episodes—knees to chest, helps blood return to lungs

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6
Q

What are ways to avoid tet spells

A

Don’t wake up, small and frequent feedings, make comfy

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7
Q

What are the 5 heart failure signs in babies

A

Heavy fluid—weight gain
Puffiness around eyes
Cold extremities
Decrease wet diapers
Decrease feedings

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8
Q

T/F children who are hypelipidemia have increased risk of heart disease as an adult

A

T

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9
Q

What are some risk factors for a congenital heart defect

A

Maternal: infection, teratogens, DM
Genetic: hisotry of HD, Down syndrome, other congenital anomalies and chromosomal anomalies

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10
Q

What does L to R heart defects mean

A

Defects that increase pulmonary blood flow
-increase pulmonary volume on right side of
-defects include manifestations and findings of HF

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11
Q

What is VSD and what are the manifestations

A

Ventricular septal defect
Hole in septum
Loud harsh murmur
HF

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12
Q

What are the interventions for a VSD

A

Heart catheter, observe for spontaneous closure
Diuretics

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13
Q

What is ASD and manifestations

A

A hole in atrial septum
Systolic murmur and a fixed split second heart sound
HF
(Possibly asymptomatic)

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14
Q

What are interventions for an ASD

A

Heart cath, diuretics,low dose aspirin after procedure
Could be patched or bypass

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15
Q

What is a PDA and what are the manifestations

A

A condition of normal fetal circulation conduit between PA and aorta fails to close
Systolic murmur (machine hum)
Wide pulse pressure
Bounding pulse
HF
RALES
(Asymptomatic possible)

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16
Q

What are the interventions for a PDA

A

Indomethacine for closure
Diuretics
Extra calories

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17
Q

T/F mothers should take NSAIDs for pain

A

False, mothers shouldn’t take NSAIDs because it will prematurely close PDA in womb

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18
Q

What is coartation of aorta and what are the manifestations

A

Norrowing of the aorta lumen
-elevated BP in arms
-bounding upper extremities pulses
-decreased BP in legs
-cool skin lower extremities
-weak/absent femoral pulses
-dizziness, headaches, fainting, nosebleeds in children
HF in infants

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19
Q

What are the interventions for a coartation of aorta

A

Balloon angioplasty
Placement of shent in older children
Repaired for infants

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20
Q

What is tricuspid atresia and what are the manifestations

A

Must have an accompanied ASD
Complete closure of tricuspid valve(mixed blood flow)
Infants: cyanosis, Dyspnea, tachycardia
Children:hypoxemia, clubbing

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21
Q

What are the interventions for a tricuspid atresia

A

Surgery in 3 stages
Shunt, glen procedure, modified fontan

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22
Q

What is transposition of great arteries and manifestations

A

Switch of great vessels and accompanied by a septal defect
Murmur
Cyanosis
Cardiomegaly (overloading R ventricle
HF

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23
Q

What are interventions for Transposoiton of great arteries

A

Surgery within 2 weeks of life
Acronym SWAP
Severe cyanosis (inc HR, Inc RR, poor feeding, dec growth)
Watch HR, rhythm, O2
Alpostadil (prostaglandin E)
Procedures to correct q

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24
Q

What is truncus arteriosus and manifestations

A

Failure of septum formation, resulting in a single vessel off of ventricles
HF
Murmur
Cyanosis
Poor feeding
Delayed growth

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25
26
What are the different manifestations of acyanotic and cyanotic defects
Acyanotic—heavy fluid, weight gain, pale cool extremeties, sweating, grunting, Dyspnea and tachycardia Cyanotic—cyanosis/hypoxia, poor feeding, poor growth, clubbing, polycythemia, Dyspnea and tachycardia
27
Spirolactone and furosemide are what drugs
Diuretics
28
What do beta blockers do
Vasodilation, decrease HR and inc contractility
29
What do Ace inhibitors do
Decrease BP and decrease after load/workload
30
What does digidoxin do
Decrease HR to improve filling
31
What do you have to do before administering digoxin
Check HR and check potassium Inc K Dec effects of digoxin Dec K Inc effects: risk for toxicity
32
T/F Kawasaki disease usually goes away by itself
T it usually self treats, but we treat for potential complications
33
What does crash and burn mean with Kawaski
Conjuctivities bilateral Rash Adenoplathy (swollen lymph nodes) Strawberry tongue Hands swelling and peeling Burn-fever
34
What is the sub acute phase of Kawasaki disease
Fever goes away
35
What laboratory tests do you perform for Kawasaki
CBC, crp, esr, albumin, and liver enzymes
36
What nursing cares do you perform for kawasakis
Monitor vitals and potential HF I and O, daily weights IV fluid for dehydration Diet: clear and soft, non acidic foods Aspirin
37
What medications do you give for Kawasaki’s
Gamma globulins: reduce inflammation in blood vessels Aspirin high dose
38
What is a consideration if you give gamma globulin for kawasakis
Avoid live immunizations for 4 months after IVIG
39
What are considerations if you give aspirin for Kawasaki
If they have a coronary abnormality develop, they must be on aspirin indefinitely
40
What causes a sickle cell episode
Triggered by low oxygen or infection High altitude, stress, surgery, blood loss, dehydration, hypothermia
41
What are manifestations of a vaso-occlusive crisis in sickle cell
Severe pain usually in bones,joints, or abdomen Hematuria Obstructive jaundice Visual disturbances
42
What are complications of chronic sickle cell
Increase risks f respiratory infections and osteomyelitis Retinal detachment and blindness Murmurs Renal failure Liver cirrhosis, hepatomegaly Seizures Chronic anemia Prone to gallstones Scarred spleen Acute chest syndrome Priapism
43
What labs show for a sickle cell crisis
Low hgb High EBC High bilirubin and reticulocyte Smear—sickle
44
What are the complications of a scarred spleen in sickle cell
Scarring leads to “functional asplenia” Spleen shrinks scars and doesn’t work Leads to huge infection risk Infection becomes severe bone marrow production shut down—-extreme anemia
45
What medications do you expect to give for a sickle cell patient
Ketoralac—pain killler Glutamine—reduce crisis Folic acid Hydroxyurea—reduce hemoglobin stickiness BMT—decrease process Chealtion—binds to iron to poop iron out Deferoximine B—to treat iron overload (ferritin >0100) makes fluid red, vision changes, nausea
46
What are organ complications with cystic fibrosis of respiratory, GI, reproductive systems
Respiratory: obstruction of airway and fungal growth GI-pancreatic ducts blocked—pancreatic enzymes not secreted Reproductive-vas deferens blocked, and ovarian
47
What is the classic triad of cystic fibrosis
Pulmonary infections Steatorrhea (oily fatty stool) Malnutrition(unable to absorb nutrients)
48
What are some signs of cerebral palsy in children
Gagging and choking feeding Poor suckling Asymmetric crawl Early hand preference Arching back Stiff—ataxia
49
What are some signs of cerebral palsy in infants up to 6 months
Can’t hold head Feels stiff or floppy Legs cross Arch back when held
50
What are some signs of cerebral palsy in infants up greater than 6m
Cannot roll over (should by 4 months) Difficulty putting hands together Reaches w only 1 hand Persistent with reflexes
51
What are signs of cerebral palsy for infants older than 10 months
Crawls lopsided Scoots Cannot stand Persistent reflexes
52
What are medications to treat cerebral palsy
Baclofen—muscle relaxer (intricate pump) Diazepam Tizanidine Botulinum
53
What are maternal risk factors related to spina bifida for mothers pregnant
Hyperthermia: no hot tubs Lack of folic acid: doesn’t close spine —eat leafy greens, organ juice, liver Uncontrolled Diabetes mellitus Taking anticonvulsants
54
What are the two different kinds of spina bifida
Occulta: not visible, vertebral bone is missing, no spinal cord involvement Cystica: protrusion of sac —miningocelle—sac contains CSF and meninges (increase risk of infection and rupture)(no neuro defects —myelomingocele (most common) sac contains CSF, meninges, and nerves, failure of neural tube to close. Decrease motor and sensory function
55
What are expected findings of occulta and cystica
Occulta—dimpling in back, pigmentation, and hair tuffs Cystica—deep tendon reflexes, flaccid muscles, urine dribbling, foot contractures, spinal spinal curvature abnormalities, protruding sac
56
What are pre op procedures for spina bifida Cystica
Do not remove dressing if it becomes dry Avoid rectal temps Prone position
57
What are post op procedures for spina bifida
Use paper tape Resume oral feedings
58
What are manifestations for hydrocephaly
Infant: high pitched cry, lethargy, vomiting, buldging fontanels Children: headache but better after vomiting, lethargy, strabismus, confused
59
What are nursing actions for hydrocephaly
Use gentle movement when ROM Minimize environment stressors
60
What is macEvan’s sign
Touch sutures “watery sound”
61
What are treatments for hydrocephaly
Acetazolamide: decrease CSF production Furosemide: pees CSF VP shunt: drains to abdomen —-risk for kinking, plugging, infection
62
What are nursing cares for hydrocephaly
Monitor head circumference and signs of increase intracranial pressure
63
What are signs of increased intracranial pressure
Dilated pupils and change in vitals signs Cushing’s triad: widened pulse pressure, bradycardia, irregular respirations
64
What are pre-op nursing cares for pts with hydrocephaly
Frequent position changes (scalp skin is thin) No scalp IVs Position opposite side of operating side (<30) Monitor increase abdominal girth Peritonitis: firm tender abdominal
65
What are long term considerations for treating hydrocephaly
Prepare for several shunt revisions Life long considerations (sports and activities)
66
T/F duchenne muscle dystrophy is x linked dominant
F X linked recessive
67
What are later manifestations of duchennes muscular dystrophy
Muscle wasting @ 3-7 years old First signs when running, climbing, bicycle Waddling hair, lordosis, falls frequent Lose ambulation 9-12 years old
68
What is gowler’s sign
Hands to push up from knees to get up (Walking themselves up)
69
Do children die from duchenes dystrophy
Deaths occurs from respiratory failure or cardiac failure
70
What are pulmonary considerations for duchene muscular dystrophy
Infection dt decrease pulmonary vital capacity Vigorous early antibiotics and aggressive airway clearance Weak muscles—ineffective cough
71
What are cardiac considerations for duchenne muscle dystrophy
Failure occurs in children who are still ambulatory
72
What are labs and tests for duchennes
PCR - gene mutation Serum CK—muscle enzyme EMG-electromyelogram—see muscle contraction Biopsy Surgery: aid mobility correct scoliosis Corticosteroids-improve muscle strength Dietary—prevent constipation and obesity
73
74
What is the first sign of CF
Meconium ileus at birth manifested as distention of abdomen, vomiting, and inability to pass stool
75
What are other characteristics of CF
Respiratory infections, growth failure underweight 10%, protrudent abdomen with thin extremities, deficiency of fat soluble vitamins, anemia, and constipation
76
What lab and diagnosic testing can we do for CF
Fat soluble vitamins ADEK, sputum cultures DNA testing: PFT (evaluate small airways) Abdominal X-ray (detect meconium ileus) Duadonal analysis(analyze pancreatic trypsin levels) Sweat chloride test (<3 months >40, >months >60)
77
What is the gold standard to test for CF in children
Sweat chloride test <3 m >40, >3m >60
78
What pulmonary nursing cares do you provide for CF patients
Assist in providing airway clearance therapy 2x/day —avoid before and after meals Chest physiotherapy before eating Administer aerosol therapy Monitor for hemoptasis or pneumothorax
79
What are GI nursing cares for CF patients
Inc calories Inc protein, fat and fiber Administer pancreatic enzymes within 30 minutes of eating Vitamins ADEK Stool softeners
80
When do you administer pancreatic enzymes for CF patients
Within 30 minutes of eating
81
What medications do you give for CF patients
Tobramycin—pulmonary infections Pulmozyme—mucolytic (voice changes, watery eyes and nose) Fluticsone—inhaled corticosteroid Metoclorpramide—increase GI mobility
82

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