Final Flashcards
(400 cards)
1
Q
What are the two accessory muscles for inspiration?
A
Sternocleidomastoid and scalene muscles
2
Q
The higher you see the indrawing, the more _____ the respiratory distress
A
Severe
3
Q
Do children abdominally or chest breathe?
A
Abdominal breathing
4
Q
What is see-saw breathing in children?
A
When the chest and abdomen do not move in congruence while breathing
5
Q
What age does the respiratory tract stop growing?
A
12 years old
6
Q
How does the child airway differ to adults?
A
Shorter and narrower
7
Q
Is the relationship between airway diameter and resistance inverse or correlated?
A
Inverse
8
Q
What age are NBs nose breathers until?
A
Approx 4 weeks
9
Q
How big is a child’s airway diameter?
A
Typically, the size of a child’s pinky finger
10
Q
Why do we see a spike in illness in babies after 6 months of age?
A
Introduction of solid foods
11
Q
When would CRP be high?
A
Inflammation, children with bacterial illness
12
Q
Why would electrolytes be increased naturally?
A
Increased metabolic work
13
Q
What do pH, PaCO2, and bicarbonate levels indicate?
A
pH - determines extent of acidity or alkalinity in the body
PaCO2 - reflects the adequacy of ventilation by the lungs
Bicarbonate - reflects the activity of the kidneys in retaining or excreting bicarbonate
14
Q
What will blood work look like in resp acidosis? (pH, PaCO2, and bicarbonate)
A
pH - decreased
PaCO2 - increased
Bicarbonate - normal
15
Q
What are the 10 signs and symptoms of resp acidosis?
A
headache, anxiety, blurred vision, restlessness, confusion, fatigue, lethargy, delirium, SOB, coma
16
Q
What four conditions could possibly cause resp acidosis?
A
Croup, epilgottitis, bronchiolitis, and status asthmaticus
17
Q
Why does respiratory acidosis occur (general info)?
A
Prolonged periods of apnea, deoxygenation, or an airway obstruction
18
Q
What will blood work look like in resp alkalosis? (pH, PaCO2, and bicarbonate)
A
pH - increased
PaCO2 - decreased
Bicarbonate - decreased or normal, case dependent
19
Q
Is resp acidosis or alkalosis more common?
A
Acidosis
20
Q
What are the six signs and symptoms of resp alkalosis?
A
Lethargy, anxiety, hyperventilation, nausea, confusion, and vomiting
21
Q
What is one of the most primary signs of resp alkalosis?
A
Hyperventilation
22
Q
What are the four potential causes of resp alkalosis in children?
A
panic/anxiety attacks, fever, tumour, and trauma/injury
23
Q
What is circumoral cyanosis?
A
A ring of blue around the mouth
24
Q
After which VS changes will we see circumoral cyanosis?
A
After RR and HR changes, but before BP changes
25
Define tonsilitis
Inflammation of the tonsils
26
What does tonsillitis often occur concurrently with?
Pharyngitis
27
What are the five signs and symptoms of tonsillitis?
sore throat, fever, difficulty swallowing, enlarged tonsils, and headache
28
At what stage would a tonsillectomy not be performed?
Would not perform a tonsillectomy during a phase of tonsilitis, as the patient is already at risk for infection and OR procedures may elevate risk of sepsis
29
What are six nursing managements of tonsillitis?
1. saline rinses, warm liquids, honey
2. Tylenol and Advil for analgesia and antipyretic
3. cool humidifiers or nebulizers
4. cool fluids, ice chips
5. antibiotics for bacterial
6. discarding toothbrushes to reduce recurrence
30
What age would we not provide honey for tonsillitis and why?
Do not give honey to children under 1 year due to it being unpasteurized and risk of botulism
31
Define croup
A virus that triggers swelling of the trachea around the larynx
32
Is croup viral or bacterial?
Viral
33
What time of the day is croup typically worsened?
At night
34
What condition causes a bark, seal-like cough?
Croup
35
What adventitious sound would be heard with croup?
Stridor
36
What are four nursing managements for croup?
1. cool humidifier, nebulizer, or cool night air
2. fluids to soothe throat
3. steroids such as epinephrine or dexamethasone to decrease swelling and inflammation
4. offer small, frequent amounts of fluid to maintain hydration
37
What are the 7 signs and symptoms of croup?
cold-like symptoms, hoarse, barking cough, stridor, tachypnea, substernal retractions and increased WOB, and worsened at night
38
Define RSV/bronchiolitis
Lower resp tract illness characterized by inflammation of the bronchioles and increased mucous production
airway obstruction and air trapping occurs, bronchiolar mucosa swells and lumina are filled with mucous and exudate, obstruction in small air passages lead to hyperinflation
39
At what age is RSV/bronchiolitis most common?
Infancy
40
What is syangis? who is eligible?
High risk neonates may qualify for the monthly injections to reduce risk of RSV
41
what are the 5 common signs/symptoms of RSV?
stuffy/runny nose, cough, otitis media, low-grade fever, sore throat
42
What are the 7 worsening symptoms of RSV?
trouble breathing, tachypnea, wheezing, deeper/more frequent coughing, cyanosis, dehydration, poor feeding (bottle or BF)
43
When is RSV season?
October to April
44
When is the peak of illness for RSV?
Day 5
45
For babies with RSV requiring hydration, how will this be completed? IV NG?
We will begin with NG tubes as replacement for hydration than an IV
Those that are extremely ill will receive an IV, but NG tube is first line of treatment
46
What are the 4 nursing managements of RSV?
1. Supplemental oxygen, suctioning, PO or IV hydration
2. inhaled bronchodilator (i.e., epinephrine)
3. chest physio
4. PPE and hygiene due to infectious nature
47
Why should we be conservative with suctioning in children with RSV?
it will cause the body to produce more mucus rather than reducing it
48
Define cystic fibrosis
Autosomal recessive disorder (chromosome 7) affecting multiple body systems, where mucous builds up and blocks the airways & ducts of the pancreas
49
Can CF be tested for prenatally?
Yes, DNA testing can be done to detect it
50
What 3 systems are affected by CF?
Exocrine gland dysfunction that impacts sweat, GI tract, pancreas, and resp tract
51
How is the pancreas affected in CF?
Blockages in the pancreas prevent digestive enzymes from reaching the small bowel
52
Why might sputum be blood tinged with CF?
Due to scarring and irritation in the airway
53
What electrolyte may be reduced in CF? Why?
May have reduced electrolytes, specifically sodium
Increased sodium excretion through the sweat and mucus secretions
54
What are the four signs and symptoms of CF?
1. Difficulty breathing and life-altering resp tract problems (wet, rattling cough with mucous)
2. severe, chronic lung infections (leading to permanent lung damage and disease)
3. failure to grow and gain weight
4. difficulty digesting food
55
What is the leading cause of CF deaths?
permanent lung damage and lung disease
56
What are the 3 nursing managements for CF?
1. minimize pulmonary complications, maximize lung function, and prevent infection
2. daily chest physio to mobilize secretions from the lungs
3. medications
57
what 5 medications would be prescribed to a child with CF?
1. hypertonic saline via nebulizer
2. inhaled bronchodilators
3. anti-inflammatory agents
4. antibiotics
5. recombinant Dnase can decrease sputum thickness
58
How do we manage digestive problems in CF?
A high calorie and protein diet, pancreatic enzymes to aid digestion, vitamins, and dietary supplements (i.e., NG or TPN)
59
What does a hypertonic nebulizer do for CF?
helps to loosen mucus
60
When is incentive spirometry and deep breath & cough not useful?
When a child is actively in resp distress
61
Define asthma
A chronic inflammatory airway disorder characterized by airway hyper-responsiveness, airway edema, and mucus production
62
What is the most common chronic illness in children
asthma
63
What is the most severe presentation of asthma?
Status asthmaticus
64
Children with asthma are more susceptible to ___ and ____ respiratory infections
Bacterial and viral
65
What are the 7 signs and symptoms of asthma?
frequent cough without a trigger, tachypnea/dyspnea/SOB, wheezing, difficulty speaking, seesaw breathing/retractions, tightened neck/muscles, dark circles under the eyes
66
What time of day is coughing worsened for asthma?
First thing in the morning and night
67
Describe the step-wise approach for medication asthma treatment
Stepwise approach is best:
short-acting bronchodilators may be used in the acute treatment of bronchoconstriction and long-acting to prevent bronchospasm
68
What is an asthma controller and provide an example of medication
Used routinely for management of chronic inflammation in the lungs
Beclomethasone - a corticosteroid
69
What is an asthma reliever and provide an example of medication
used for periods of exacerbation, decreasing response to triggers/allergens
albuterol - adrenergic
70
What is pseudoephedrine and what is it used for?
Adrenergic, decongestant
Symptomatic relief of nasal and nasopharyngeal mucosal congestion due to the common cold, hay fever, or other resp allergies
71
What drug is pseudophedrine contraindicated with?
Should not be taken with MAOIs or within 2 weeks of discontinuation
72
At what age should there be cautious use of pseudoephedrine?
<4 years
73
What drug could cause rebound congestion?
Pseudophedrine
74
What is acetylcysteine and what is it used for?
A mucolytic, acetaminophen antidote
Adjunctive therapy for abnormal and viscous mucous secretions in acute and chronic bronchopulmonary disorders
75
How should acetylcysteine be taken with a bronchodilator?
Bronchodilator should be taken 10-15 mins prior to acetylcysteine nebulizer
76
Is it normal for a child to have more mucus when first taking acetylcysteine?
yes
77
What is beclomethasone and what is it used for?
Corticosteroid, anti-inflammatory, anti-asthmatic
Long-term control of persistent bronchial asthma (i.e., controller)
78
Should beclamethasone be shaken prior to use? What must be done after administration?
Never shake
Rinse mouth and spit to prevent thrush
79
What should be taken first, controller or reliever?
Reliever should be given first and then controller second, as it has the best impacts
80
What age would we use a mask and spacer?
Masks should be used for those under or at 4 years of age, and spacers after 4 years
81
What is albuterol and what is it used for?
adrenergic, agonist, anti-asthmatic, bronchodilator
treatment or prevention of bronchospasm in asthma or COPD
82
Should albuterol be shaken? how long should a patient wait in between each inhalation?
Should be shaken well
Wait 30s-1 min and take normal breaths between
83
What age does salivary production begin?
4 months
84
what is the stomach capacity of the neonate?
10-20ml
85
Why is regurgitation common in newborns?
Immature muscle tone of the LES and low volume capacity of the stomach
86
Why is the sucking and extrusion reflex important for babies?
Sucking and extrusion reflex allows the tongue to thrust any foreign object out of the mouth, such as a finger or soother
87
What are six reasons that NG tubes may be used?
decompress stomach and proximal small intestine, evacuate blood or secretions, control bleeding from gastric and esophageal therapies, administer meds/fluids/TPN, obtain gastric contents, administer lavage or irrigation
88
Can we add medications to an enteral feeding formula for NG?
Never
89
How can TPN administer via IV? How long should we wait between doses?
Either centrally or peripherally
High alert medication - 4 hours between doses
90
How is TPN dosed/calculated?
Prescribed based on age, weight, and nutritional deficits
91
What three dietary problems are associated with constipation?
Decreased fibre, lactose intolerance or too much dairy, and not enough fluids/water
92
Within what time frame should babies have their first mec?
48 hours
93
How will increasing fibre and fluids aid constipation?
Fiber - add bulk to the stool and make it easier to pass
fluids - soften the stool to help
94
How many stools should a 3mo, 2 yr, and 4yr be having?
3mo - ~2-4 stools/day
2yr - ~1-2 stools/day
4yr - ~1 stool/day
95
What is the best way to potty/bowel train?
Implement regular toilet sitting times
96
Why might rebound constipation occur?
May occur if laxatives are stopped abruptly
97
How long may children be on daily bowel medications? what is the goal?
usually at least six months and want to ensure the child has at least one soft stool per day
98
Define gastroenteritis
Inflammation of the stomach and intestines
99
What pathogens may cause gastroenteritis?
Bacteria, viruses, and parasites
100
What is the leading cause of gastroenteritis?
Rotavirus
101
What are the two complications of gastroenteritis?
Dehydration and metabolic acidosis
102
What type of fluids should be administered for gastroenteritis? What if they have diarrhea and vomiting?
Isotonic fluids, potentially boluses
Intermittent hypertonic IV solutions
103
What are the 6 signs and symptoms of gastroenteritis?
diarrhea, vomiting, dehydration, lethargy, weight loss, fever
104
What is the sodium and glucose requirements for oral rehydration therapy?
50 mmol/L sodium and 20 g/L glucose
105
What is the prescribed oral rehydration therapy for children with mild/moderate dehydration?
50-100 mL/kg of ORS over 4 hours
106
What two markers indicate that rehydration has been adequate?
No longer feels thirsty and has normal urine output
107
Define hypertrophic pyloric stenosis
Circular muscle of the pylorus becomes hypertrophied, causing thickness in the luminal side of the pyloric canal
This thickness creates a gastric outlet obstruction, causing non bilious vomiting that presents between 3-6 weeks of life
108
When does hypertrophic pyloric stenosis develop in NB?
3-6 weeks of life
109
How is hypertrophic pyloric stenosis treated?
requires surgical intervention - pyloromyotomy to cut the muscle to relieve the obstruction
110
Will patients be NPO with hypertrophic stenosis?
Yes, until after surgery
111
What are the five signs and symptoms of hypertrophic stenosis?
forceful nonbilious vomiting unrelated to feeding position, hunger soon after vomiting, weight loss due to vomiting, progressive dehydration with subsequent lethargy, possible positive family hx
112
On palpation, what will hypertrophic stenosis feel like?
Will feel an olive-shaped mass in the RUQ of abdomen due to hypertrophy
113
Why would we put sucrose drops on a soother or nipple?
To help soothe pain, not for hypoglycaemia
114
What are the four nursing management for hypertrophic stenosis?
1. fluid management and correcting electrolyte values
2. provide emotional support
3. teach about surgical procedure and post-op
4. PO feedings after 1-2 days post-op
115
Will WBCs be elevated in pyloric stenosis?
yes
116
Define acute appendicitis
An inflammation and obstruction of the blind sac at the end of the cecum
117
What is the peak incidence of appendicitis?
10-12 years
118
What is the most common surgical disease in children?
Appendicitis
119
What are 7 signs and symptoms of acute appendicitis?
mid abdominal cramps and diffuse tenderness, RLQ pain, guarding and rebound tenderness, nausea and vomiting, anorexia, low-grade fever, later will complain of lethargy/irritability/constipation
120
What is McBurney’s point?
RLQ pinpoint of appendicitis pain
121
What is the most common complication of appendicitis?
Peritonitis from rupture
122
What are the 5 symptoms of peritonitis?
fever, abdominal distention and rigidity, sudden relief of pain, decreased bowel sounds, nausea and vomiting
123
What are two possible complications of appendicitis?
ischemic bowel and post-op infection
124
What is the treatment of peritonitis?
1. use of 2 antibiotics (combination of cephalosporins)
2. abdominal wash-out surgery
3. potential bowel resection
4. longer hospital stay
125
How is appendicitis managed pre-op?
position child in side-lying/semi-fowler, IV fluids to prevent dehydration, NPO, antibiotics
126
Will heat be applied for appendicitis pain relief?
NEVER apply heat to the abdomen as it may cause it to rupture
127
Define necrotizing enterocolitis (NEC)
An inflammatory disease of the bowel which can cause ischemic and necrotic injury in the GI tract
128
What are the mortality rates of NEC?
up to 50%
129
What is the usual age range for NEC?
3-12 days of life but may occur weeks later in NBs
130
What 4 pathological mechanisms may lead to NEC?
Bowel hypoxic ischemia events, perinatal stressors, immature intestinal barrier, abnormal bacterial colonization, formula feeding
131
What are the first three primary signs of NEC?
Feeding intolerance, abdominal distention, and bloody stools in infants receiving enteral feedings
132
As NEC worsens, infants develop sepsis which has what signs/symptoms?
resp distress, temperature instability, lethargy, hypotension, oliguria
133
What 8 things may be done to improve GI function and reduce risk of NEC?
Enteral antibiotics, parenteral fluids, monitoring tolerance of enteral feeds, oral immune therapy, human milk feedings, antenatal corticosteroids, enteral probiotics, slow continuous drip feedings
134
Why are antenatal corticosteroids administered to reduce NEC? Which pregnancy types will specifically receive it?
Antenatal corticosteroids are helpful in those who are for sure going to have a preterm baby
Betamethasone will be given to help improve lung function in these preterm babes
135
Are ostomies permanent in NEC babies?
No, their bodies will typically bounce back
136
What type of antibiotic will NEC babies be given?
Typically broad spectrum such as ceftriaxone
137
what labs will be used to assess progression of NEC?
serial kidney, ureter, and bladder (KUB) x-rays and CRP levels
138
What is omeprazole? What is it used for?
Proton pump inhibitor, antacid, treatment of ulcers
Treatment of gastric and duodenal ulcers, treatment of heartburn or symptoms associated with gastroesophageal reflux
139
How should omeprazole be timed with feeds?
30 minutes before feeds
140
What medication has cautious use for children <1 mo
omeprazole
141
What is dimenhydrinate? What is it used for?
Antiemetic
Motion sickness, N/V, vertigo, post-op N/V
142
Does dimenhydrinate or ondansetron cause drowsiness?
Dimenhydrinate
143
What is ondansetron? What is it used for?
Treatment of nausea
Acute gastroenteritis, chemotherapy-induced N/V, post-op N/V
144
How do we differentiate burns?
Based on the depth of tissue destruction
145
What degree of burn is a superficial burn ?
1st degree
146
How long do superficial burns take to heal? What symptoms are babies and infants at high risk for?
3-5 days without scarring
Increased risk for severe N/V and fluid imbalance
147
Describe a superficial partial thickness burn and its degree
thin-walled fluid-filled blisters that develop within minutes
2nd degree
148
How long do superficial partial thickness burns take to heal? Is there usually scarring?
3-5 weeks with scar formation being unusual
149
Describe a deep partial thickness burn and its degree. Is there scarring?
Waxy white burns that take weeks to heal
2nd degree and typically results in hypertrophic scarring
150
What type of burn may require antibiotics, skin grafting, or surgery?
Deep partial thickness burns
151
What area of the body is skin taken from for grafting?
Thigh
152
Describe a full thickness burn and its degree
Dry, leathery appearance from loss of elasticity to the dermis
3rd degree
153
What is an escharotomy and what type of burn is it performed on?
They release pressure and prevent compartment syndrome in areas where swelling prevents adequate circulation
154
What are general symptoms associated with compartment syndrome created by burns?
altered perfusion, tingling, changes in sensation, altered cap refill, altered CSM, and increased pain
155
What is the rule of 9s?
Estimation of burn injury - add together the areas of the body experiencing the burn to get a total %
156
What type of fluid will be given to burn victims and at what temp?
Warmed IV RL
157
What are the five general focuses for nursing management of burns?
fluid resuscitation, prevention of hypothermia, promoting oxygenation/ventilation, wound care and infection prevention, and restoration of function
158
Why are children at increased risk of hypothermia when burned?
Excessive heat loss can occur due to loss of protective dermal layer
159
Should we pop or preserve burn blisters?
Never pop
160
What time window is critical for fluid management in burn victims?
first 24 hours
161
How do we monitor I/O in burn victims?
Daily weights and catheterization
162
The ___ system is the first major organ system to develop in the embryo
cardiovascular
163
when does the heart beginning beating in embryo?
4 weeks
164
when is the heart fully formed and functioning in gestation?
8 weeks
165
With a newborn’s first few breaths, what changes occur in the heart?
Blood flow to the left side of the heart increases the pressure in the left atrium leading to a closure of the foramen ovale. The drop in pressure of the pulmonary artery promotes closure of the ductus arteriosis.
166
Where does the heart lie in children less than 7 years old?
more horizontally, resulting in the apex lying higher in the chest
167
Define preload and after load
Pre - volume in the ventricle just before contraction/systole
after - the load to which the heart must pump against
168
Define CO and SV
CO - amount of blood that goes through the circulatory system in one minute
SV - volume of blood pumped out of the L ventricle of the heart during each systolic contraction
169
What may a CBC be ordered to rule out in a cardiac patient?
Endocarditis or infection
170
What is cardiac catheterization used to indicate?
blockage and perfusion of the heart
171
What 2 clinical features are used to classify congenital heart defects?
presence or absence of cyanosis
degree of pulmonary vascularity (increased, decreased, or normal)
172
Define ventricular septal defect and the three conditions it is associated with
Opening of the septum that separates the ventricles causing mixing of oxygenated and deoxygenated blood
Associated with FAS, Down syndrome, and other cardiac deformities
173
What is the most common congenital heart defect?
ventricular septal defect
174
Can ventricular septal defect close spontaneously?
Yes, about 30-50% do
175
What are the five signs and symptoms of ventricular septal defect?
heart murmur, increased fatigue, stunted/limited growth, CHF, increased risk of endocarditis
176
What condition will present with an extra heart sound?
Ventricular septal defect
177
In what condition will babies present with fatigue while feeding?
Ventricular septal defect
178
How will fluid boluses be changed from the standard for babies with ventricular septal defect?
Need to be cautious with hydrating, reduced to 10 mL/kg
179
What is tetralogy of fallot?
A cardiac anomaly that refers to a combination of 4 related heart defects that occur together (pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy)
180
What four defects make up tetralogy of fallot?
pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy
181
What are the seven signs and symptoms of tetralogy of fallot?
murmur, clubbing, cyanosis, color changes with feeding, dyspnea, agitation, squatting
182
What will heart sounds sound like with tetralogy of fallot?
A murmur that sounds like a washing machine or whooshing
183
What defect presents with cyanosis and altered breathing during feeding?
tetralogy of fallot
184
Why might babies squat when they have tetralogy of fallot?
may help bring up venous pressure and counteract discomfort of defect
185
What are five nursing management techniques for tetralogy of fallot?
1. place infant in a knee-to-chest position
2. provide O2
3. Administer morphine (0.1 mg/kg)
4. supply IV fluids
5. administer beta blocker such as propranolol (0.1 mg/kg)
186
What cautions should be taken when taking BP and venipuncture on patient with a shunt placed for tetralogy of fallot?
Avoid BP measurement and venipuncture on the affected arm after a shunt is placed
187
Why would we administer morphine to a patient with tetralogy of fallot?
resp depression to reduce stress on the cardiac system
188
Why is a low stimulus/calm environment critical for tetralogy of fallot pt?
the more upset the child, the more strain on the cardiac system
189
How is a 3-lead ECG placed?
White to the right, smoke over fire (black leads over top of red on left upper chest)
190
What labs are we consistently monitoring in patients with congenital heart defects?
INR, PTT, PT to monitor coagulation
191
What is Idiopathic thrombocytopenia purpura (ITP)?
Idiopathic thrombocytopenia purpura is a type of platelet disorder where the blood does not clot as it should due to low platelet counts
192
What are the six signs and symptoms of ITP?
Petehiae, purpura, excessive bruising, epistaxis, bleeding of the gums, and blood in the stool
193
Can viruses cause ITP?
yes, they may trigger the autoimmune response
194
What will lab findings look like for a patient with ITP?
Low platelet count, normal WBC, normal HgB, and normal hematocrit unless hemorrhage has occurred
195
What drugs should be avoided in children with ITP?
Aspirin, NSAIDs, and antihistamines
196
How is ITP managed?
Many children require no medical treatment, but require close monitoring
However, severe cases may require platelet transfusions
197
Define Kawasaki disease
an autoimmune diseases with no known cause and an acute systemic vasculitis
198
What is the leading cause of acquired heart disease in children?
Kawasaki disease
199
What condition occurs more often in the winter than summer?
Kawasaki disease
200
What is the most common age range of Kawasaki disease?
occurring mostly in children 6mo-5yrs
201
What are the eight signs and symptoms of Kawasaki disease?
fever (high and unresponsive to antibiotics), chills, headache, malaise, extreme irritability, vomiting, diarrhea, and abdominal and joint pain
202
What condition is strawberry tongue associated with?
Kawasaki disease
203
Why are heart murmurs and endocarditis common in Kawasaki disease?
due to the inflammatory process
204
What is the most common history/assessment finding indicating Kawasaki disease?
A high fever (>39.9) of at least 5 days with no responsiveness to antibiotics
205
What three physical findings may be present in Kawasaki disease assessment?
cervical lymphadenopathy (unilateral lump on neck), joint tenderness, and liver enlargement
206
What two cardiovascular complications may Kawasaki disease cause?
coronary artery aneurysm and cardiomyopathy
207
What signs and symptoms would indicate heart failure in a patient with Kawasaki disease?
tachycardia, gallop or murmur, decreased urine output, resp distress
208
What two things is therapeutic management focused on for Kawasaki disease?
reducing inflammation in the walls of the coronary arteries and preventing coronary thrombosis during initial phase
preventing myocardial ischemia
209
What two medications will be administered to a patient with Kawasaki disease?
high dose aspirin in four doses daily to reduce clotting AND single infusion of IV immunoglobulin to decrease inflammation
210
Define acute lymphoblastic leukaemia
Cancer that originates as an issue in the bone marrow where abnormal WBCs are produced
Irregular lymphoid and myeloid cell development
211
What is the most common type of paediatric cancer?
Acute lymphoblastic leukaemia
212
How does the Philadelphia chromosome affect ALL treatment?
It makes it more complex and longer
213
How does the type of cell involved change treatment for cancer?
Treatment is dependent on the type of cells being effected
214
What are the eight signs and symptoms of a new diagnosis of ALL
fever, pain, petechiae, purpura, unexplained bruising, signs of infection such as pneumonia, splenomegaly and hepatomegaly, swollen lymph nodes
215
Describe the induction stage of leukaemia treatment and its duration
Hit them hard with heavy hitter chemo drugs, aiming to kill as many cancer cells as quickly as possible
lasts about 3-4 weeks
216
Describe the consolidation stage of leukaemia treatment and its duration
strengthen remission and decreases leukaemia cells
treatment duration varies but a long period of time is often spent in this stage
217
Describe the maintenance stage of leukaemia treatment and its duration
Eliminates all residual leukaemia cells
~2-3 years
218
How does ALL treatment duration differ between boys and girls?
Boys will typically be in treatment for 3 years and girls 2 years because of the testes being complex
219
Define chemotherapy
A medication used to kill fast-dividing cells in the body
May be nephrotoxic and have many adverse effects because healthy cells are also impacted
220
How long after diagnosis will children be given a central line?
within 24 hours
221
Describe radiation therapy
Kills malignant cells
222
What three types of medications may be prescribed to combat symptoms of cancer treatment?
Steroids, anti-emetics, and pain meds
223
Define gestational hypertension
Hypertension that begins during pregnancy and a BP reading of >140/90 on more than two occasions
224
What point of gestation does hypertension typically occur? And what type of pregnancy is it more common in?
after 20 weeks and more common in nulliparous women
225
What are 9 risk factors of gestational hypertension?
young or advanced maternal age, weight abnormalities, lifestyle (smoking, alcohol, etc), previous miscarriage, assisted reproduction, multiple gestation, history of preeclampsia, gestational diabetes, and history of cardiac or renal disorders
226
What are the 7 signs and symptoms of gestational hypertension?
Increased BP (higher than baseline), absence or presence of protein in the urine, edema, sudden weight gain, visual changes such as blurred vision, N/V, urinating small amounts
227
what is a marker of pre-eclampsia
protein in the urine
228
Describe mild-home management of gestational hypertension
bed rest, quiet environment, lateral positions, monitoring protein in urine, and a low sodium and high protein diet
229
Describe a mild-hospital management of gestational hypertension
monitor trending BP, daily weights, monitor neurological signs, may be on antihypertensives
230
What is bed rest?
No lifting above 10lb, no sexual intercourse until stable BP or delivery (pelvic rest), no housework, reducing standing for prolonged periods, restricted driving
231
Describe severe management of gestational hypertension
C/S delivery, oxytocin to stimulate contraction, and magnesium sulphate to prevent seizures
232
What does HELLP syndrome stand for and what may cause it?
hemolysis (abnormal clotting), elevated liver enzymes, and low platelets
caused by severe gestational hypertension
233
Define placental abruption
the premature separation of the normally implanted placenta from the uterine wall
234
What two pregnancies is a placental abruption most common in?
multigravidae and advanced maternal age
235
What comorbidity increases the risk of a placental abruption?
gestational hypertension
236
What are the four signs and symptoms of a placental abruption
dark red blood, uterine tenderness/constant pain, firm to rigid abdomen, and fetal distress
237
Define placenta previa
placental implantation in the lower uterine segment where it can occlude the cervical os
238
What seven factors contribute to the development of placenta previa?
uterine fibroids/scars, defective vascularization, multiple gestations, previous uterine surgery, advanced maternal age, smoking & cocaine use
239
what are 8 signs and symptoms of placenta previa?
painless vaginal bleeding, uterus is soft, non-tender, bright red vaginal bleeding, FHR usually normal, fetal malpresentation or high presenting, shock and anemia due to blood loss
240
How is FHR in placenta previa?
usually normal
241
If the placenta is only covering part of the os, will it move?
The patient will be monitored and the hope is that it will stretch upward
242
What weeks make up preterm labour?
regular uterine contractions with cervical effacement and dilation between 20-37 weeks gestation
243
What is a tocolytic and what drug is often used in preterm pregnancy?
A drug that suppresses labor and magnesium sulphate
244
Why are corticosteroids administered in preterm pregnancies?
administered as a protective mechanism through the mom – acts as a boost for the baby’s respiratory system (betamethasone)
245
Define labour induction
stimulating contractions via medical or surgical means
246
Define augmentation and what medication will be used to complete it
enhancing ineffective contractions after labor has begun
oxytocin to strengthen contractions
247
What are common indications for induction and augmentation?
post-term gestation, pre-labor rupture of membranes, hypertensive disorder, renal disease, fetal demise, placenta abruption, SROM
248
What are the indications for forceps or vacuum delivery?
Prolonged 2nd stage of labor, abnormal FHR pattern, failure of the presenting part to fully rotate and descend in the pelvis, limited sensation and inability to push effectively due to the effects of regional anaesthesia, high risk clients, and client exhaustion
249
What four criteria are required for forceps and vacuum?
Vertex presentation, cervix is fully dilated and membranes ruptured, head is fully engaged, client’s bladder has been emptied
250
Define a PPH and specific values for vag and c/s
any amount of bleeding that places the mother in hemodynamic jeopardy - may be early or late (before or after 24 hours)
Vag >500 mL
c/s > 1000mL
251
What are the four Ts of PPH?
tone, tissue, trauma, and thrombosis
252
Of the four Ts, which is the most common cause of PPH?
tone
253
what tonal issues effect PPH
over distended uterus, prolonged or rapid labor
254
what tissue issues effect PPH
failure to complete separation of placenta from uterine wall, does not allow uterus to contract fully
fragments prevent uterus to contract fully
255
what trauma issues effect PPH
prolonged or vigorous labor, uterus remains firm, or cervical lacerations
256
What are six nursing management techniques for PPH?
Fundal massage, pad count, fluid administration, blood products PRN, medication admin PRN, catheterization, and monitoring for signs/symptoms of shock
257
What are cytotec and hemabate used to manage?
PPH
258
When is internal FHR monitoring indicated?
Indicated for women or fetuses considered high risk
259
Where are electrodes placed in internal FHR monitoring?
electrode is placed on the fetal presenting part to assess FHR
260
What four criteria are required to do internal FHR monitoring?
ruptured membranes, cervical dilation of min 2cm, presenting fetal part low enough to identify correctly and allow placement of the scalp electrode, and skilled practitioner
261
What is one thing that external monitoring of FHR cannot detect?
cannot detect short-term variability
262
Describe accelerations in FHR
increased FHR by 15bpm from baseline that lasts between 15-30 secs
263
When is accelerations a sign of fetal wellbeing?
when they accompany fetal movement
264
Describe FHR decelerations and list the types
decreased FHR below baseline
early, late, variable, and prolonged
265
What are two potential causes of accelerations?
increased maternal activity or spontaneous fetal movement
266
Define early decelerations
Have a shape that is symmetrical with a gradual decrease and return of FHR to baseline in association with a contraction
Are like a mirror or inversely related - increase in contraction = dip in FHR
267
What deceleration can be thought as a mirror?
early
268
Describe late decelerations
Have a shape that is symmetrical with a gradual decrease and return of FHR to baseline in association with a contraction
Late onset of FHR dropping and late recovery after contraction
269
What may be causing late decelerations
disruption of oxygen transfer
270
Define variable decelerations
An abrupt onset of decreased FHR below baseline that may occur with or after a contraction
Sudden drops and rapid returns - less predictable
271
What often causes variable decelerations
cord compression
272
Describe prolonged decelerations
>15bpm and lasts greater than 2 minutes but less than 10 minutes from onset to return to baseline
273
What are five potential causes of prolonged decelerations
placental insufficiency, uterine rupture, cord compression/entanglement/prolapse, maternal hypotension, or cervical exam
274
If we are becoming concerned for FHR and intrauterine resuscitation is required, describe 7 interventions
change maternal position, stop or decrease oxytocin infusion, administer IV bolus, perform vaginal exam to assess labor progress, oxygen supplement (8-10 L/min), modify breathing or pushing, and reduce maternal anxiety
275
What terms define high-risk NBs
preterm born less than or equal to 37 weeks or post-term greater than 42 weeks
276
What five factors indicate high risk NBs
SGA or LGA, breathing difficulties at birth, suffered hypothermia, infection, or born to mothers with high-risk prenatal conditions
277
Why is a NB more prone to developing hypothermia?
large surface area per unit of body weight, less SC fat and reduced brown fat
278
How does metabolism of brown fat effect temperature in NB?
Increases heat production - blood flowing through the brown fat becomes warm and heats the rest of the body
279
What are seven signs/symptoms of hypothermia in NB?
cool/cold to touch, cyanosis, shallow/slow resp, lethargy and hypotonia, poor feeding, feeble cry, and hypoglycaemia
280
What are four interventions to reduce hypothermia in NB?
Warm baby immediately after delivery, delay bath until temperature stabilizes, hourly temp checks in first hours of life, encourage feeding
281
What is Cefaclor and what is it used for?
Anti-infective cephalosporins
treatment of resp, dermatological, urinary, and middle ear infections caused by bacteria
282
What is cotrimoxazole and what is it used for?
Anti-infective sulfonamides
treatment of UTI, acute otitis media, exacerbation of bronchitis, diarrhea, and pneumonia
283
What ages is cotrimoxazole contraindicated in?
infants <2mo
284
What is magnesium sulphate and what is it used for?
electrolyte supplement and antiseizure agent, potent vasodilator
treatment/prevention of hypomagnesemia, treatment of hypertension and pre-eclampsia, prevention of seizures associated with severe eclampsia, preterm labor
285
What drug is used for pre-eclampsia, gestational hypertension, preterm labor, and seizures r/t eclampsia?
Magnesium sulfate
286
What is the antidote for magnesium sulfate?
calcium gluconate
287
What drug decreases labor contractions?
Magnesium sulfate
288
What is labetalol and what is it used for?
Beta blocker with alpha blocking; antihypertensive
treatment of hypertension
289
How/when should labetalol be taken?
Take with a meal/food, and if you forget to take a dose, take it asap
290
What is oxytocin and what is it used for?
Oxytocic agent
Stimulates uterine smooth muscle, producing uterine contractions - has vasopressor and antidiuretic effects
291
What is important to monitor when giving oxytocin to a woman in labour?
Monitor for FHR decelerations
292
At what time of age will pathologic jaundice occur? When will clinical jaundice occur?
Within the first 48-72 hours, whereas clinical will be weeks or days later
293
Provide 8 nursing interventions or education for a baby with hyperbilirubemia
bili blanket/phototherapy, temperature regulation (isolatte), positioning (skin exposed and eye shield), strict I/O, feeding q2-3 hours or 3-4 hours if more stable, skin-to-skin, monitor bill levels, no lotions
294
How does phototherapy help the baby excrete bilirubin?
It allows the bilirubin to be converted from fat to water and be excreted through the kidneys
295
What does a positive DAT test indicate?
direct antiglobulin test - may indicate pathologic jaundice
296
What is the target range for a random BG?
4-7 mmol/L not influenced by diet
297
What is a fasting blood glucose used to screen for and how long does someone need to fast for?
Screens for type 1 diabetes and GDM
Measures plasma glucose levels after 8hrs fasting
298
Define GDM and why it occurs physiologically
hyperglycaemia that develops during pregnancy
The placenta produces hormones which blocks the body’s use of insulin making insulin less effective
299
Does GDM subside after delivery?
Usually, but around 30% will develop type 2 within 10 to 15 yrs
300
When will insulin be given/prescribed to a mom with GDM? Why will it be given?
To prevent birth defects - if client is unable to achieve glucose targets within 2 weeks of initiating nutrition and PA therapy
301
At what week is GDM screening done?
24-28 weeks for all women
302
What is a non-stress test in pregnancy?
FHR in response to maternal activity – may be placed on a bike or treadmill to ensure baby has normal responses
303
What are the symptoms of HYPOglycemia?
pale, shakey, tremors, cool/clammy skin, diaphoresis, lethargic/altered LOC, irritable, nausea
304
What are the symptoms of HYPERglycemia?
3 polys (uria, phagia, dipsia), dry skin, fruity breath, heart palpitations, nausea, dehydrated, vision changes, neurological changes
305
The 3 polys, polyuria, polyphagia, and polydipsia, are associated with what?
Hyperglycemia
306
What is DKA?
the overproduction of ketone bodies and decreased ability of kidneys to excrete acids leading to CNS depression, arrhythmia, coma, and cardiac arrest
307
What will pH, PaCO2, and bicarbonate look like in DKA labs?
pH - decreased
PaCO2 - normal
bicarbonate - decreased
308
How is DKA treated?
Insulin infusion and fluids
309
Is DKA or alkalosis more common in children? Why?
DKA because children have immature kidneys and pancreas
310
What will pH, PaCO2, and bicarbonate look like in metabolic alkalosis labs?
pH - increased
PaCO2 - normal
bicarbonate - increased
311
Is insulin an endogenous or exogenous hormone?
endogenous
312
Describe how quickly short/rapid acting insulin works, how long it lasts, and another name for it
Works within minutes and lasts a few hours
Is called a bolus insulin
313
Describe how quickly intermediate/long acting insulin works, how long it lasts, and another name for it
works within 1-2 hours and lasts a long time
functions as a basal insulin
314
What is the onset of rapid-acting insulin and what is the best route to administer it?
10-15 mins SC
315
Why must patients eat a meal after taking rapid or short acting insulin?
Glucose spikes are rapid and need to ensure they don’t become hypoglycaemic
316
Is rapid/short acting insulin clear or cloudy?
Clear
317
What is the onset for short-acting insulin and when is the best time to give it?
30 minutes
15-30 minutes before meals
318
Can short acting insulin be given IV?
Yes
319
What medication needs to be double primed if given IV?
Short-acting insulin
320
Is intermediate and long acting insulin clear or cloudy?
Cloudy
321
What time of the day should intermediate or long-acting insulin be given?
Usually at bedtime - may be given QD or BID
322
What is the onset of intermediate and long-acting insulin?
1-3 hours
323
What is the best way to determine if a basal insulin dose is working well?
by assessing the BG first thing in the morning and analyzing the BG response to the dose given at bedtime
324
Should PA be avoided or encouraged after insulin injection?
Encouraged because it enhances the absorption of insulin from the injection site
325
What five physiological aspects categorize type 1 DM?
loss of beta cells
presence of islet cell antibody
lack of insulin
excess glucagon
altered metabolism of fat, protein, and carbs
326
What three actors are likely the root cause of type 1 DM?
genetic factors, autoimmune factors, and may develop due to a viral infection
327
does type 1 DM have a rapid or long onset?
very rapid onset within weeks
328
What is the ‘pancreas’ last stand’ in type 1 DM in children?
The body may go through a one time remission where symptoms dissipate shortly after insulin treatment is started
this is a last ditch effort by the pancreas to make insulin. However, the body will eventually start to show signs of hyperglycaemia and then they will be insulin dependent for life
329
How is type 1 DM treated in children?
With continuous BG monitoring and insulin via injection or pump
330
What factors determine the insulin needs of a child?
PUBERTY, emotions, nutrition, PA, and illness
331
What macronutrient must be counted for children with diabetes type 1 and are insulin doses affected?
Carbohydrates must be counted and insulin will be adjusted based on consumption
for example, for every 5g of carbs, you take 1 unit of insulin
332
What is the insulin to carb ratio?
1 unit of insulin will cover a certain number of grams of carbs eaten
333
What is the best way to eat carbs for good BG management?
eat the same amount of carbs at meals and snacks each day
334
How does fibre affect carb counting in diabetes?
For every 5g of fibre, you can subtract from your total carbohydrates
335
If a child with diabetes is ill, how do BG and ketone checks change?
BGs and ketones should be checked every 1-4 hours to ensure the child does not go into DKA
336
What five complications will be screened throughout life in children with diabetes type 1
nephropathy, retinopathy, neuropathy, dyslipidemia, and hypertension
337
What is the Cushing’s triad?
RR - apneas, irregular, decreased
HR - bradycardia
BP - elevated
opposite to septic shock
338
What does an EEG test for?
observing for seizure activity
339
What is important to do in preparation of an EEG?
Get the child more sleep deprived prior to, as seizure activity is more common during these states
340
What might be given to a child prior to an MRI/CT to help with anxiety?
Conscious sedation, such as lorazepam or intranasal midazolam
341
What does a lumbar puncture test for? What might be present in CSF?
Testing for meningitis - testing for cultures, WBC, colour, and glucose
342
What is the most common cause of febrile seizures?
viral infection
343
Describe how febrile seizures present/last
generalized seizure that is short-lived (<15min) and not repeated within a 24 hour period
344
are febrile seizures more commonly seen in boys or girls?
Boys
345
Does the higher the fever correlate to worse/more probability of a seizure?
No
346
How are febrile seizures treated?
Determination of the cause of fever and interventions focused on controlling it
347
are febrile seizures benign?
yes
348
What are ten common triggers for seizures?
missing medications, lack of sleep, missing meals, hormonal changes, stress/emotions, illness, fever, flickering lights, alcohol withdrawal, and street drugs
349
Define a generalized seizure
widespread electrical activity in the left and right hemispheres
350
What does it mean when a patient reports feeling an aura?
this is a partial seizure that precedes a generalized one and is considered as a warning sign
they may report feeling impending doom, seeing spiders, smelling burning toast, and having tingling fingers
351
Are generalized seizures convulsive?
They can or cannot be
352
Define epilepsy
A generalized seizure condition in which seizures are triggered recurrently from within the brain
353
Can children outgrow epilepsy symptoms?
Yes, most children do
354
List the three signs and symptoms of an absence seizure and what type it is
blank state lasting less than 10 seconds, starts and stops abruptly, and may experience several hundred/day
generalized
355
List the three signs and symptoms of a tonic and clonic, how long they last, and what type it is
tonic - crying out, groans, falls
clonic - convulsions, jerking, twitching of the muscles
may be incontinent, may turn grey blue
lasts 1-3 mins
generalized
356
Describe a myoclonic seizure and what part of the brain it uses
May occur with other seizure forms, sudden brief massive muscle jerks, may or may not lose consciousness
involves the motor cortex
357
Describe an atonic seizure
sudden loss of muscle tone with regain of consciousness within a few seconds to a minute
may be as simple as the drop of the head
358
Define a partial seizure
occurs when seizure activity is limited to a part of one brain hemisphere
359
Describe the differences between a simple and complex partial seizure
Simple - remains aware but cannot control function or behaviour, may have an aura, lasts seconds to minutes
Complex - experiences altered awareness and random movements, has a blank/empty stare, unaware of environment and dazed, lasts from 2-4 mins, unresponsive, and period of confusion after seizure
360
Define meningitis
inflammation of the meninges
361
can meningitis be viral or bacterial or both?
Can be either
362
does viral or bacterial meningitis have higher mortality rates?
bacterial
363
what is the most common virus causing meningitis?
enterovirus
364
Will anti-virals be given for meningitis?
Yes
365
provide the 9 signs and symptoms of meningitis
sluggish/dilated/unequal pupils, general malaise, headache, photophobia, poor feeding, nausea, vomiting irritability, nuchal rigidity
366
What triad is evident in meningitis patients?
Cushing’s triad
367
What type of antivirals and antibacterials will someone be on for meningitis?
Antiviral - acyclovir
Antibacterial - gentamicin and cephalosporins
368
Provide the signs and symptoms of NAS
CNS hypersensitivity, autonomic dysfunction, resp distress, temp instability, hypoglycaemia, tremors, seizures, abnormal cry, and feeding difficulties
369
What three medications may an NAS baby be prescribed?
morphine, phenobarbital, and clonazepam to help with tremors/seizures
370
What is ESR and what does it test for?
erythrocyte sedimentation rate - detects inflammation and may indicate juvenile idiopathic arthritis
371
What is ANA and what does it test for?
antinuclear antibody - detects autoimmune disorders
372
Why are bowing/buckle fractures more common in children?
increased vascularity and decreased mineral content of bones makes them more flexible
373
what are the three most common fracture sites in children?
forearm, wrist, and femur
374
What are the four common pediatric fractures? Briefly describe each
bowing - bending without breaking of the bone
buckle - bone buckles rather than breaks
greenstick - incomplete fracture of the bone
complete - bone breaks into two pieces
375
Why do we place the fractured limb above the level of the heart?
Elevate above the level of the heart to reduce swelling and bring blood back centrally
376
What is a hip spica cast?
Used for femur fractures - hard covering over the waist, hips, and legs that prevents movement of the hips - a bar between the legs strengthens the cast
377
Describe traction
a method of slow and gentle immobilization which may be used to reduce and/or immobilize a fracture, to align an injured extremity, help reduce pain before surgery, and to allow the extremity to be restored to its normal length.
378
Why might external fixations be used instead of internal?
if there is increased risk for infection or compartment syndrome
379
Why does compartment syndrome occur in a cast? How long does it take to manifest?
increased pressure in a limited space comprises circulation and nerve innervation, leading to ischemia
clinical manifestations begin within 30 mins of tissue ischemia
380
What are the 6 Ps and 3 As in compartment syndrome?
Pain, pressure, paresthesia, paresis, pallor, pulselessness, analgesic requirement increasing, anxiety, and agitation
381
How do we reduce compartment syndrome once it has started? (3)
split plaster casts and release constrictive bandages
position limb to promote improved circulation
surgical decompression or fasciotomy
382
Define osteomyelitis
Bacterial infection of the bone and soft tissue surrounding the bone that is acquired by a bacterial invasion spread through the bloodstream
383
What four bacterias are common causes of osteomyelitis
Staphylococcus aureus, E coli, streptococcus, and influenza
384
what are the four signs/symptoms of osteomyelitis
pain, difficulty moving the affected area, fever, and redness/swelling of the affected area
385
Can osteomyelitis occur spontaneously?
Yes, it often occurs spontaneously in children
386
What is the treatment course for osteomyelitis?
4-6 weeks of antibiotics, beginning with IV and transitioning to PO
387
What are three nursing managements of osteomyelitis?
Encourage movement of unaffected limbs, bed rest, pain control
388
What is glucagon and what is it used for?
Glycogenolytic agent
Used to treat hypoglycaemia
389
What are three common side effects associated with glucagon?
Headache, nausea, and skin rash
390
What is phenytoin and what is it used for?
Anti-seizure medication and used for the control of tonic-clonic and motor seizures, as well as control of status epilepticus
391
What is the most common adverse effect of phenytoin?
CNS alterations
392
What dental effect may phenytoin have on long-term use?
Gingival hyperplasia - swelling of the gums
393
What is phenobarbital and what is it used for?
anti-seizure medication
used for long-term treatment of tonic-clonic and focal seizures, emergency control of status epilepticus, eclampsia, and meningitis associated seizures
394
Why should a patient be slowly titrated off phenobarbital?
if abruptly taken off, it can present with severe withdrawal symptoms and worsened seizures
395
What are five adverse effects of phenobarbital?
somnolence or insomnia, vertigo, nightmares, hallucinations, bradycardia, hypotension
396
What is diazepam and what is it used for?
Anti-seizure and anti-anxiety
management of epilepsy and used as an adjunct with other medications for complicated seizure management
397
Why is non-compliance common with diazepam?
Due to the adverse effects of the drug, such as dizziness, lethargy, sedation, diarrhea, and urinary retention
398
What is carbamazepine and what is it used for?
Anti-seizure medication
used for treatment of seizure disorders including epilepsy, partial seizures and mixed seizures
399
What is a common adverse effect of carbamazepine?
Ataxia presenting as falls or clumsiness
400
Why do children on morphine or other opioids need to be monitored more closely than adults?
They are opioid naive and need to be monitored more carefully for CNS effects
