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Exam 3 Peds Flashcards

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1
Q

What are 7 common respiratory treatment methods for children?

A

nebulized aerosol therapy
metered-dose inhaler
dry powder inhaler
chest physiotherapy
oxygen therapy
suctioning
artificial airway

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2
Q

What does pulse oximetry measure? What are nursing considerations for pulse oximetry?

A

oxygen saturation of arterial blood

find an appropriate site (finger, toes, earlobe, around the foot)
dry site
remove polish
comfortable position

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3
Q

What are nursing considerations is a child’s SaO2 is less than 90-92%?

A

confirm proper probe placement
confirm patency of oxygen delivery system
place in high Fowler’s
encourage deep breathing
report significant findings
remain with child

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4
Q

What is the interpretation of SaO2 findings?

A

95-100% expected
91-100% acceptable
<91% requires intervention
<86% life-threatening emergency

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5
Q

What medications can be used in a nebulizer? metered dose or dry powder inhaler?

A

bronchodilators
corticosteroids
mucolytics
antibiotics

bronchodilators
corticosteroids

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6
Q

What can occur in the mouth with inhaled corticosteroid use? How can it be prevented?

A

fungal infections

rinse mouth after inhaling, spit
clean MDI and spacer after each use

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7
Q

What are the techniques of chest physiotherapy? What are nursing considerations pertaining to physiotherapy?

A

manual/mechanical percussion
vibration
cough
forceful expiration, huffing
breathing exercises

schedule before meals or 1 hour after and at bedtime to decrease vomiting or aspiration
administer bronchodilator or nebulized treatment prior
Note characteristics of mucous
Used cupped hand when percussing
document and repeat 3-4Xday

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8
Q

What is hypoxia? Hypoxemia? What can cause hypoxemia? Early signs? Late signs?

A

Decreased oxgen in the tissue

inadequate O2 in the blood

hypovolemia
hypoventilation
interruption of arterial blood flow

tachypnea
tachycardia
restlessness
pallor
evidence of respiratory distress

confusion
cyanosis
bradypnea
bradycardia
hypo or hypertension

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9
Q

What are signs of respirator distress?

A

use of accessory muscles
nasal flaring
tracheal tugging
adventitious lung sounds

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10
Q

What are nursing considerations when treating hypoxemia?

A

warm O2 to prevent hypothermia
place in semi to high Fowler’s
ensure equipment is working
used lowest setting flow that corrects
assess lung sounds, RR
not not blow O2 directly into infant’s face
monitor temp in tent
assess SaO2 and AbGs
oral hygeine
promote coughing and deep breathing
rest and decrease stimuli

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11
Q

What is an O2 hood? What is the flow rate?

A

small hood that fits over infant’s head

minimum of 4=5L/min

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12
Q

What is the flow rate of a pediatric mask? When is it warranted?

A

5-10 L/min

short-term therapy
mouth breathers
high O2 flow

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13
Q

What are nursing actions to promote safety when using O2 therapy?

A

alert combustion hazard with signs
know the closest fire extinguisher
wear cotton to prevent static electricty
ground electric machinery
avoid toys that can spark
no alcohol or acetone
no smoking

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14
Q

What are manifestations of O2 toxicity? What happens to gas levels with hypoventilation?

A

nonproductive cough
substernal pain
nasal stuffiness
N/V
HA
sore throat
hypoventilation

causes increased PaCo2 levels and leads to uncounsciousness

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15
Q

Whhat are considerations when nasal suctioning? Oral?

A

clean technique
mushroom tip catheter

clean tech.
hard catheter tip
insert in sides of mouth to prevent choking

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16
Q

What are nursing actions when suctioning an endotracheal or tracheal tube?

A

high Fowler’s or Fowler’s
select catheter with diameter 1/2 the diameter of the tube
hyperoxygenate at 100%
obtain baseline breath sounds and VS
surgical aseptic tech
ongoing O2 assessment
limit suction to 5 sec for infants and 10 sec for children
allow rest period of 30-60 sec or until O2 sats return to normal

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17
Q

What is a tracheotomy? When is it indicated?

A

surgical incision in to trachea to establish an airway

emergency airway with epiglottitis, croup, foreign body
scheduled surgical procedure

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18
Q

What is a tracheostomy?

A

stoma/opening resulting from a tracheotomy. Can be permanent or temporary

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19
Q

Should a tracheostomy be suctioned routinely? What warrants suctioning?

A

No

audible secretions
crackles
restlessness
tachypnea
tachycardia
mucus in the airway

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20
Q

What are tonsils? what do they do? What are risk factors for tonsilitis?

A

lymph-type tissue in the pharyngeal area

filter organisms and contribute to antibody formation

exposure to bacterial agent
immature immune system

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21
Q

What are assessment finding with tonsilitis?

A

sore throat/difficulty swallowing
Hx of otitis media/hearing difficulties
mouth odor
mouth breathing
snoring
nasal qualities in voice
fever
inflammation, redness, edema
anorexia

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22
Q

What can indicate bleeding r/t tonsilitis or other issues in the throat?

A

frequent swallowing
clearing throat
restlessness
bright red emesis
tachycardia
pallor
hemoptysis

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23
Q

What are comfort measures for tonsilitis?

A

liquid anelgesis ro tetracaine lolipops
ice collar
ice chips or sips of water
pain meds on a schedule
clear liquids
avoid citrus or milk
discourage coughing, throat/nose clearing to protect surgical site
there can be blood clots or blood-tinged vomitus

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24
Q

What are the complications associated with tonsillectomy? What is the complication associated with strep infection?

A

hemorrhage
dehydration
infection

rheumatic fever

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25
What is nasopharyngitis? How long can it persist? What are expected findings? Home care?
common cold 4-10 days nasal inflammation dryness and irritation on of nose and pharynx fever decreased appetite restlessness antipyretic rest cool mist air decongestants for 6+ caution: cough suppressants can cause over-sedation antihistamines not recommended antibiotics not indicated
26
What is GABHS? Nursing care?
strep throat antibiotics (penicillin or amoxicillin) antipyretics or mycins, cephs, amoxicillin with clavulanic acid
27
What are risk factor for viral infections in children?
ages 3-6 mos-5yrs d/t decreased maternal antibodies short narrow airways that can easily be obstructed with mucus or edema shor respiratory tract, infection can travel quickly short, open eustachian tubes to middle ear compromised immune system anemia nutritional deficiencies allergies chronic conditions exposure to second-hand smoke seasonal viruses such as RSV
28
What are the expected findings with bronchitis from a viral infection? Care?
persistant dry cough inflammation resolves in 5-10 days antipyretics cough suppressant coll mist humidifier
29
Wha causes bronchiolitis? What does it primarily affect? What are initial findings? moderate illness? Severe?
RSV bronchi and bronchioles rhinorrhea fever pharyngitis coughing sneezing wheezing ear or eye infection tachypnea retractions refusal to nurse copious secretions tachypnea >70/min listlessness apnea poor air exchange poor breath sounds cyanosis
30
What is the nursing care for RXV bronchiolitis)?
supplemental O2 fluids maintain airway meds nasal suctioning encourage breastfeeding antibiotic CPT, corticosteroids, bronchodilators not recommended
31
What are pharmaceutical interventions for allergies?
cortocosteroids (1st line) antihistamines beta-adrenergic decongestants mast cell stabilizers leukotriene modifiers ipratroprium
32
What are the expected findings with bacterial pneumonia?
high fever cough (unproductive or productive) tachypnea retractions and nasal flaring chest pain dullness with percussion ronchi, crackles pallor, cyanosis irritability, restlessness, lethargic abdominal pain, diarrhea, vomiting anorexia
33
What is nursing care for viral pneumonia? Bacterial? What are complications with pneumonia?
cool mist monitor SaO2 antipyretics monitor I&O CPT, postural drainage rest antibiotics increased fluids I&O antipyretic CPT IV fluids O2, monitor SaO2 pneumothorax pleural effusion
34
What is bacterial epiglottis? Expected findings?
a croup syndrome absence of cough, dysphonia (croaking) drooling, dysphagia agitation inspiratory stridor retractions sore throat high fever restlessness
35
What is nursing care for epiglottis?
protect airway avoid using a tongue blade prepare for intubation humidified O2 SaO2 IV fluids corticosteroids antibioics droplet isolation
36
What is acute laryngotracheobronchitis? What causes the condition? Expected findings? Nursing care?
croup, spasmodic laryngitis RSV Influenza A and B pneumonia parainfluenza 1, 2 and 3 low-grade fever restlessness hoarseness barky cough dyspnea inspiratory or continuous stridor retractions nasal flaring tachypnea cool mist O2 monitor SaO2 nebulized epinephrine corticosteroid encourage fluid intake IV fluids
37
What are risk factors for asthma? What can trigger asthma?
genetics gender (boys more common until adolescence) exposure to smoke low birth weight obesity allergens cold air or temp changes environmental change viruses meds: aspirin, NSAIDs antibiotics, beta blockers stress reflux endocrine factors
38
What is the most accurate test to diagnose asthma? What is a PEFR and what does it do?
pulmonary function test peak expiratory flow rate, measures amount of air forcefully exhaled in 1 second
39
What are the SABA meds for asthma? What are they used for? LABA? cholinergic antagonists? is it for acute or chronic exacerbations? What are antiinflammatory agents ?and long-term meds?
albuterol, levalbuterol, terbutaline acute exacerbations prevent exercise-induced asthma formoterol, salmeterol atropine, ipratropium acute corticosteroids leukotriene modifiers ("kasts") mast cell stabelizer like cromolyn
40
What are risk factors for cystic fibrosis? What deficiencies can be expected? What are some managment considerations? Complications of cystic fibrosis?
autosomal recessive white ethnicity vitamins ADEK diet high in protein and calories 3 meals plus snacks encourage fluids pancreatic enzymes within 30 min of eating vitamin supplements stool softeners monitor blood glucose CPT and breathing exercises immunizations respiratory infections bronchial cysts emphysema pneumothorax nasal polyps ileus rectal prolapse intestinal obstructions GERD DM
41
What does congenital heart disease generally lead to?
heart failure hypoxemia
42
How are anatomic defects to the heart categorized? What defects increase pulmonary blood flow? Decrease blood flow? Obstructs blood flow? Combination?
by blood flow patterns ASD VSD PDA tetraology of fallot tricuspid atresia coarctation of the aorta pulmonary stenosis aortic stenosis transposition truncus arteriosus hypoplastic left heart syndrome
43
What are risk factors for heart defects?
infection maternal alcohol use maternal DM genetic Hx downs syndrome and other anomalies
44
What is ventricular septal defect (VSD)? What is the result? How is it identified? Do they often close on their own? Treatment from least to most invasive?
hole in the septum between right and left ventricle increased blood flow from the left to the right ventricle through the defect loud murmur at left sternal border heart failure yes, many do closure during cardiac catheterization diuretics spontaneous closure pulmonary artery banding complete repair
45
What is an atrial septal defect (ASD)? Findings? Treatment from least to most invasive?
hole between the right and left atria resulting in increased blood flow from the left to right atrium loud murmur with split second heart sound heart failure often asymptomatic closure during catheterization diuretics low-dose aspirin after the procedure patch closure cardiopulmonary bypass
46
What is a patent ductus ateriosis (PDA)? Finding? Treatment from least to most invasive?
condition where the conduit between the pulmonary artery and aorta fails to close increasing left to right blood flow systolic murmur wide pulse pressure bounding pulses can be asymptomatic HF rales administer indomethacin to allow closure occlude during catheterization diuretics extra calories thoracoscopic repair
47
What is a pulmonary stenosis? Findings? Treatment from least to most invasive?
narrowing of the pulmonary valve resulting in obstruction of flow from the ventricles systolic ejection murmur asymptomatic cyanosis cardiomegaly HF Brock procedure pulmonary valvotomy
48
What is an aortic stenosis? findings? Treatment from least to most invasive?
narrowing of the aortic valve faint pulses hypotension tachycardia poor feeding tolerance intolerance to exertion dizziness chest pain Norwood procedure aortic valvotomy
49
What is coarctation of the aorta? Findings? Treatment from least to most invasive?
narrowing of the lumen of the aorta, obstructing flow from the ventricles elevated BP and bounding pulses in arms decreased BP in lower extremities weak femoral pulses HF balloon angioplasty (infants and children) stents (adolescents) repair for infants <6mos
50
What is tricuspid atresia? Findings? Treatment from least to most invasive?
closure of the tricuspid valve. Only an atrial septal opening would allow blood to flow into the left atrium cyanosis dyspnea tachycardia hypoxemia clubbing of fingernails 3 stages of surgery shunt Glenn procedure Fontan procedure
51
What is tetralogy of fallot? Findings? Treatment from least to most invasive?
4 defects: VSD, overriding aorta, pulmonary stenosis and ventricular hypertrophy cyanosis at birth systolic murmur Tet spells (blue spells of acute cyanosis and hypoxia) shunt primary repair complete repair within 1st year of life
52
What is a transposition of the great arteries? Findings? Treatment from least to most invasive?
aorta and pulmonary artery are flipped-flopped with blood oxygenating only if there is a septal defect or PDA possible murmur cyanosis cardiomegaly HF Surgery in first 2 weeks of life IV prostaglandin to keep ducts open
53
What is truncus arteriosis? findings? Treatment from least to most invasive?
failure of septum formation resulting in a single vessel that comes off the ventricles HF murmur cyanosis delayed growth lethargy poor feeding surgical repair in 1st month
54
What is hypoplastic left heart syndrome? Treatment from least to most invasive?
underdeveloped left side cyanosis HF lethargy cold hands and feet once PDA closes (only way to oxygenate blood) cyanosis progresses and cardiac collapse 3 stages of surgery Norwood Glenn shunt Fontan
55
What is the purpose of digoxin? What are s/s of toxicity? What are nursing actions with this med?
improves myocardial contractility which improves cardiac output bradycardia dysrythmia N/V anorexia monitor pulse withhold if less than 90/min (infant) and 70/min (child) monitor for toxicity digoxin immune fag (antidote)
56
What is the cardiac purpose of administering ACE inhibitors (angiotensin-converting enzyme)? What are some examples of this class of med? Nursing actions?
reduces afterload by causing vasodilation reduce pulmonary and vascular resistance captopril, enalapril ("prils") monitor BP monitor for hyperkalemia
57
What is the cardiac purpose for administering beta blockers? Examples? Nursing actions?
decrease HR and blood pressure "olols": metroprolol, carvedilol Check BP prior to administration Monitor for dizziness, hypotension and HA
58
What is the cardiac benefit of furosimide or chlorothiazide? Nursing actions?
rids the body of excess fluid watch potassium monitor I&O AE: hypokalemia, N/V, dizziness daily weights
59
What is the onset of rheumatic fever? Findings? Complications?
2-6 weeks following untreated strep Hx of strep fever tachycardia cardiomegly murmur nodules over bony prominences swollen joints rash on trunk CNS: muscle weakness, uncoordinated movements irritability, poor concentration carditis heart disease atrial fibrillation embolism
60
What is kawasaki disease? Findings? Complications? Why is high does aspirin therapy warranted?
acute systemic vasculitis lasting 8 weeks high fever unresponsive to antipyretics irritability red eyes red. chapped lips strawberry tongue red oral mucous and inflammation swelling of extremities red palms and soles rash joint pain enlarge lymph nodes cardiac manifestations aneurysm heart attack the risk or an aneurysm outweighs the risk for Reye's
61
How is asthma categorized? 4
Intermittent (0-2x/wk, no activity limitations, medication <2x/wk) Mild persistent (>2x/wk, minimal nighttime disturbances, minor activity limitations, medication>2x/wk Moderate persistent (daily, moderate nighttime disturbances, some activity limitations, daily medication needs) Severe persistent (continuous, frequent nighttime disturbances, extreme activity limitations, multiple daily use of medication)
62
What are complications of asthma?
Status asthmaticus (life-threatening episode of airway obstruction) Respiratory failure
63
What are 3 differences between fetal hearts and adult hearts?
Heart is in the center of thoracic cavity Transition from fetal circulation to adult circulation 3 Fetal shunts Foramen ovale (closes shortly after birth-25% stay open) Ductus arteriosus (within 2-3 days after birth) Ductus venosis (closed shortly after birth)
64
What are pre procedure nursing considerations for cardiac catheterization?
Pre-procedure: Vital signs Perform a nursing hx Provide teaching Check for allergies to iodine & shellfish Provide NPO status 4-6 hours prior to the procedure Locate & mark dorsalis pedis & posterior tibial pulses on both extremities Administer pre-sedation as prescribed based on age, height, weight, condition, & type of procedure
65
What are post-procedure nursing considerations for cardiac catheterization?
Assess HR & RR for 1 full minute Assess sedation Assess pedal pulses for equality & symmetry Assess temperature & color Monitor for hypoglycemia Provide continuous cardiac monitoring & oxygen Assess insertion site (femoral or antecubital area) for bleeding &/or hematoma Prevent bleeding by maintaining the affected extremity in a straight position for 4-8 hours (preferably supine) Monitor for complications (infection, bleeding, & thrombosis)
66
How does left-sided heart failure present?
Usually systolic (pulmonary hypertension) increased pulmonary blood flow Crackles & wheezes Cough Dyspnea Grunting, nasal flaring & retractions (infants) Periods of cyanosis Tachypnea
67
How does right-sided heart failure present?
Usually diastolic (backing up to the body) decreased pulmonary blood flow Ascites Hepatosplenomegaly Jugular vein distention Oliguria Peripheral edema, esp. dependent & periorbital Weight gain
68
What are interventions for heart failure?
Monitor for early signs of HF VS, Temp, I&O, Weight, Edema Elevate HOB, provide low dose O2 Cluster care, reduce O2 consumption Provide small, frequent feedings, increase kcals, NG or feeding devices Labs Administer medications Digoxin, ACE inhibitors, Beta-blockers, Diuretics (what are you monitoring?)
69
What closes a symptomatic PDA?
prostaglandin inhibitor
70
What is chorea?
involuntary muscle movements
71
Whate is the Jone's criteria?
carditis chorea acute arthritis with rheumatic fever

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