Ped 2 Review Flashcards
(127 cards)
1
Q
(Infant) How do they interact w/ various ages at their tx or while hospitalized
A
separation anxiety can occur make sure parents are near, and needs are met. Simulate home routine, assign the same nurse, close attention to lights/ sounds, and hold for feeding (comfort). For parents: get them to help, soothing methods, safe restrains, security objects
2
Q
(Toddler) How do they interact w/ various ages at their tx or while hospitalized
A
keep routines, security objects, praise appropriately, provide appropriate outlets for aggression, access finger foods, offer guided choices, and talk through patient care. Procedures: praise, tell them what they will see/smell/feel
3
Q
(Preschooler) How do they interact w/ various ages at their tx or while hospitalized
A
use dolls/ play to help aid procedure preparation, describe what will be felt/heard/ seen/ smelled. Routines, transitional object
4
Q
(School Age) How do they interact w/ various ages at their tx or while hospitalized
A
need models and diagrams rather than dolls, encourage schoolwork, truthful/ realistic explanations
5
Q
(Adolescents) How do they interact w/ various ages at their tx or while hospitalized
A
realistic level, maintain their identity, keep peer relationships,
6
Q
Cardinal Signs of Respiratory Distress:
A
Adventitious/ absent breath sounds (call a rapid response on those)
7
Q
Interventions to ease RR
A
- Positioning
- Warm or cool mist
- Saline nose drops with bulb suction
- Bedrest
8
Q
Therapies for improving oxygenation:
A
- Coughing
- Suctioning
- Nebulizer
- Percussion and postural drainage
- Flutter valve
- Chest physiotherapy
- Sup O2
9
Q
Do we give antibiotics for colds?
A
Colds are viral, don’t give antibiotics
10
Q
Tonsillitis
A
Commonly viral
Treat symptomatically
No antibiotics
11
Q
Strep:
A
Comes on quickly
Treat with antibiotics
If untreated, it can lead to acute rheumatic fever
Should not eat or drink after people
Need to change toothbrush 24/48hr after antibiotics
12
Q
Asthma
A
chronic inflammatory airway disorder. Air obstruction, bronchial irritability, edema of mucous membranes, congestion, etc. Hypersensitivity type 1 immune response: IgE-mediated
13
Q
Asthma CM:
A
dyspnea, expiratory wheezing, cough, prolonged expiratory phase, exacerbation, resp distress, Ronchi, chest tightness
14
Q
Asthma: Different meds and delivery methods
A
- Controllers (prevention meds) - corticosteroids, Long-acting beta 2, mast cell stabilizers, Leujotriene inhibitors, methylxanthines, omalizumab
- Relievers (pressure meds)- short-acting beta 2/ bronchodilators, magnesium sulfate
15
Q
Asthma: Peak flow and tx based on it
A
- FVC- forced vital capacity: the amount of air exhaled with force after you inhale
- FEV- forced expiratory volume: airflow halfway through exhale
- FEF
- PEF
16
Q
Stoplight method of controlling asthma
A
- Green zone 80-100% signals all clear, under reasonably good control. No symp present and routine tx plan
- Yellow zone 50-79% signals caution. Asthma is not well controlled. Acute exacerbations may be present. Maintenance may be needed. Call HCP the child stays in this zone.
- Red zone is below 50% of the medical alert. Severe airway narrowing occuring. Short-acting bronchodilators should be administered. Notify HCP if peak expiratory flow rates do not return immediately and stay in yellow or green.
17
Q
Green zone
A
80-100% signals all clear, under reasonably good control. No symp present and routine tx plan
18
Q
Yellow zone
A
50-79% signals caution. Asthma is not well controlled. Acute exacerbations may be present. Maintenance may be needed. Call HCP the child stays in this zone.
19
Q
Red zone
A
is below 50% of the medical alert. Severe airway narrowing occuring. Short-acting bronchodilators should be administered. Notify HCP if peak expiratory flow rates do not return immediately and stay in yellow or green.
20
Q
you have a list of patients and one has Diminished/ absent breath sounds. What order you want to see them?
A
You want to see them first
21
Q
Tonsillectomy & post care
A
Watch for excessive swallowing, stridor
tx: ice collar, d/c teaching, blood tongue sputum is normal
22
Q
Bronchitis tx
A
- May need O2 but must suction first need a good respiratory assessment to look for suctioning needs before applying O2
- Patient may need fluids if not eating
23
Q
Will kids tell the truth about pain? if they do lie what should the nurse look at?
A
kids may lie & say they are not in pain, so nurses may have to use their s/s
24
Q
digoxin does what and what lab to look at?
A
Digoxin does not lower blood pressure.
It increases cardiac contractility (positive inotrope), improving cardiac output and reducing CHF symptoms.
Low K+ increases risk of digoxin toxicity
25
digoxin: rules for administrations
-1 hr before or 2 hr after eating
-check apical HR for 1min before giving
-do not mix with food or fluid
-put behind teeth & then oral care
26
contraindications for digoxin
- apical pulse **hold if <90-110 for infants & young kids & <70 for older kids**
-low potassium bc will make digoxin work too much
27
if you miss a dose of digoxin, what do you do
if within 4 hr you can give the missed dose, if >4 hr then hold
**if 2 doses missed then notify provider**
28
signs of digoxin toxicity
-vomiting (do not give repeat dose)
-nausea
-bradycardia
-anorexia
-neurologic & visional dysfunction
29
with digoxin toxicity, what should be monitored
dysrhythmias bc digoxin toxicity can cause hyperK+
30
digibind
can bind & then excrete it by kidneys if digoxin levels are too hgih
**watch for drop on K+**
31
obstruction of blood flow: aortic stenosis
narrowing or fusion of aortic valves which interfers with left ventricle outflow. blood backs up into right side of heart and right side of heart enlarges
**results in decreased cardiac output, LVH & pulmonary vascular congestion**
32
When to give prostaglandin E
give prostaglandin E to maintain foreman ovale open. (**need open for mixing of blood, will result in death if not**) then digoxin, diuretics & palliative surgery will help
33
Polycythemia
34
how to treat aortic stenosis
try to fix the valve w/ surgery
35
aortic stenosis serious side effect
-obstruction tends to be progressive
-sudden episodes of MI or low cardiac output, can result in sudden death
**activity is limited but not bed rest**
36
therapeutic mgt of coarctation of the aorta
-**prostaglandin E to maintain PDA**
-balloon angioplasty
-surgery within the first 2 years
37
treatment for transposition of great vessels
once we discover d/t cyanotic spell, we will give prostaglandin E to keep the foramen ovale open until they can have surgery to switch the artery and the aorta
38
cyanotic defects & symptoms
caused by defects result in decreased pulmonary blood flow causing cyanosis, polycythemia (thick blood), digital clubbing & altered ABGs
**pressure greater on pulmonic side so blood shunts from right to left**
39
nursing considerations for cyanotic defects
-prevent polycythemia to avoid clots & assess for clots
-do not let child get dehydrated
-good skin care
-oxygen
-prep for procedures
40
supra ventricular tachycardia
**super high HR**
-rapid, regular heart rate of 200-300 bpm
41
SVT manifestations
-irritable, pale, refusal to eat
-older: dizziness, heart palpitations, chest pain & sweating
42
SVT can be caused by
caffeine and cough meds
43
SVT treatment
-vagal maneuvers (bear down, blow on thumb for 60sec, ice to face, carotid massage) & valsalva maneuver **do not do any of this at home**
-can give adenosine, rapid IVP
-digoxin
-cardioversion
44
Kawasaki Disease (mucocutaneous lymph node syndrome)
acute systemic vasculitis of unknown etiology w/ possible infectious component
**body wide inflammation of veins, capillaries, coronary arteries**
45
Kawasaki Disease clinical manifestations: acute phase (8-10 days)
-fever **does not respond to tyl or ibpro**
-pruritic polymorphic rash
-cervical lymphadenopathy
-dry, red, cracked lips
-strawberry tongue
-bilateral pink eyes w/o the junk
-erythema & swollen palms
46
Kawasaki Disease clinical manifestations: subacute phase (10-35 days)
**starts when fever goes away**
-vasculitis
-desquamation of toes, feet, fingers & palms
-arthritis
-thrombocytosis
47
Kawasaki Disease clinical manifestations: recovery phase (up to 10 wks)
-symptom free
-complete when all blood values return to normal
-**most dangerous phase bc embolisms can form and the kids are at an increased risk of MI**
48
nursing intervention of kawasaki disease
- **TEACH PARENTS CPR**
-most babies will get better on their own but 20% develop serious cardiac sequelae so we treat them all
49
therapeutic treatment for KD
-high dose aspirin for anti inflammatory and then low dose for anti platelet
-if fever is caught within 10 days can give IVIG to decrease heart problems **watch fluid overload**
-vitals & I&Os & daily wts
-IVIG is blood so vitals 15 mins before & after and then every hour until finished
50
hypertension in children
mainly secondary, based on their height, weight, age and gender **not just 1 number**
51
incidence & etiology: HTN in children
-primary is rare
-renal disease
-coarctation of the aorta
-oral contraception
-steroids
-obesity
-adrenal disorders
**treat cause & get urine analysis**
52
HTN clinical manifestations
-elevated BP
-frequent headaches
-dizziness
-vision changes
53
HTN nursing considerations
-if mild, just monitor
-meds are beta & ace
-teaching (normal BP stuff)
54
how to take BP on kids
need the right size cuff and goes around the arm
55
if your child receives aspirin therapy, what vaccine should they not get
varicella
56
at what age can we start giving aspirin
do not give aspirin until a person is 18 yrs old bc of ryes syndrome **but will give to children w/ RH bc the benefits outweighs the costs**
57
nursing considerations of RF
**prevent the disease**
-encourage compliance w/ drug regimens esp prophylactic
-teach about aspirin therapy and reyes symptoms **let us know if viral infection occurs so we can determine if we need to dc aspirin**
-facilitate recovery
58
rheumatic fever
a systemic inflammatory disease that follows a group A beta hemolytic streptococcus infection **in mitral valve**
**untreated strep which leads to infection of heart which can lead to damage & backflow**
59
nursing considerations of RF
**prevent the disease**
-encourage compliance w/ drug regimens esp prophylactic
-teach about aspirin therapy and reyes symptoms **let us know if viral infection occurs so we can determine if we need to dc aspirin**
-facilitate recovery
60
therapeutic mgt of RF
-eradication of beta hemolytic streptococci (strep) w/ cillin antibiotic
-prevent cardiac damage so will be on aspirin therapy for a couple weeks
-steroids
-bed rest
-give prophylactic antibiotics before any procedure for rest of life
61
general nursing interventions for res distress
-ease respiratory efforts
-promote comfort & proper position
-prevent spread of infection
-promote hydration & nutrition
**need to know**
62
how to ease respiratory efforts / promote rest & comfort
-positioning
-warm or cool mist **no steam vaporizer**
-mist tents
-saline nose drops w/ bulb suctioning
-bedrest or quiet activities
**need to know**
63
how to prevent spread of infection
-handwashing
-teaching
-judicious pt room assignments
-immunization
-antibiotics
**need to know**
64
how to promote hydration & nutrition
-high kcal foods
-avoid caffeine
-allow children to self regulate the diet
65
chronic otitis media treatment
get tubes in ear **once in, no diving, jumping or submerging head in water(can use ear plugs), no lakes or rivers avoid pressure postoperatively**
66
epiglottitis
**bacterial croup**
serious, life threatening obstructive inflammatory process -> lose airway
-usually occurs between 2-5 yrs
-H. influenza B or strep. pneumoniae
**vaccine for it so rare now**
**sounds better than they are**
67
epiglottis clinical presentation
-abrupt onset, starts w/ sore throat
-high fever
-open mouth, tongue out, drooling, agitated
-looks very sicks & wants to be upright
-sore red inflamed throat, difficulty swallowing
-muffled voice, stridor, no spon. cough
68
epiglottitis interventions
**maintain the airway**
-no tongue blades, do not look in throat
-avoid xray & transport (portal if needed)
-let parents be w/ child & keep everyone calm
-**prepare for sedation & intubation -> antibiotic -> extubate**
69
risk factors for otitis medias
-**exposure to cigarette smoke and/or many people**
-**bottles in bed**
-**non immunized**
-**winter**
-non BF infant
-pacifier use beyond infancy
-fam hx
-immun def
-allergic rhinitis
70
therapeutic mgt of an ear infection
**80% of ear infections will go away on its own but causes too much pain & complications to daily life so we treat**
-antibiotics
-tylenol/ibuprofen
-warm compress
71
Prevention for otitis medias
- breast feeding
- immunizations
- avoiding day care/ Being around kids
72
73
discharge education for ALTE
-CPR
-monitor if they go home with it -> interference w/ TV, radio, phones, police scanners
-no extension cords
-emergency # on phones
74
sudden infant death syndrome (SIDS)
the sudden death of an infant under 1 yr old that occurs during sleep & remains unexplained after a complete postmortem examination, including investigation of the death scene and a review of the case hx
**leading cause of death in infants 1-12mo**
75
nursing considerations for SIDS
-safe sleep / back to sleep
-compassionate approach
-ask only factual questions
-allow family time to say goodbye
-provide a keep sake
-arrange home visit
76
risk factors for SIDS
-**overheating**
-**unsafe sleeping arrangements**
-**maternal age**
-**prenatal or postnatal smoking parents**
-**substance abuse parent**
-**poor prenatal care**
-premature
-multiple births (youngest)
-low apgar score
-bottle feed (breast milk is protective)
77
What are some thing that can help a kid when they are sick?
Increase hydration, get out mucous (encourage cough), chest physiotherapy
78
Constipation management
**After 6mo**
1. Fluids (H2O)
2. Add fruit juice to help pull water in colon
3. Miralax
79
What foods are choking hazards
- grapes
- hard candy
- popcorn
- hot dogs
- raw mini carrots
- smooth hard foods
80
Pre procedural care for child going to cath lab
-NPO for 4-6 hours, clarify morning meds
-assessment (includes ht & wt)
-assess skin **do not bring if diaper rash or lots of ache**
**mark pedal pulses**
81
what pedal pulse will be weaker after cath
the effect side so if they went in on the right side, right pedal pulse will be weaker
82
post opt care for cardiac catheterization
observe:
-color & LOC
-VS & res status
-distal extremities
-dressing for bleeding
-fluids
-BS, esp hyper
-keep flat for 4-6 hrs
83
if you think there is bleeding under the dressing, what should you do
circle the dressing to see if the bleeding spreads out
**if bleeding put pressure 1in above the insertion site & then call for help**
84
general clinical finding for cardiac defects
-dyspnea
-**FTT**
-res infections
-high HR
-sweating
-choking & blue
-murmur
85
what are our 4 main goals of CHF (ther mgt)
-improve cardiac function
-remove accumulated fluid & Na
-decrease cardiac demands
-improve tissue oxygenation & decrease oxygen consumption
- increase kcal
86
FTT
Failure to Thrive. It describes a child who is not gaining weight or height at the expected rate for their age, indicating that they are not developing normally.
(seen in cardiac defects
87
two types of failure to thrive
1) because something is wrong with the child **organic**
2) idiopathic **non organic**
88
intussusception
89
what is the guidelines to dx FTT
-not growing
-under 5th %ile, drop off the curve
**not concerned about height**
90
what is the guidelines to dx FTT
-not growing
-under 5th %ile, drop off the curve
**not concerned about height**
91
therapeutic mgt of FTT
-catch up growth
-correct nutritional deficiencies
-treat underlying cause
-educate parents or primary care givers
-multidis team (SLP,OT,ND)
92
what happens when a pt gets admitted for FTT
**observation**
feed the child and watch parent interaction then give pointers (if they are not burping or positioning)
93
what to monitor for FTT
-I&Os
-daily wts
-routine being followed
-parents well being (support and be positive to)
94
post op care for cleft L/P
-**restrains so they do not pick at sutures, to protect surgical site**
-protect airway & prevent infection
-pain mgt
-fluids
-careful suctioning
95
clinical manifestation of mild dehydration:
wt loss, appearance, cap re, pulse, res, BP, muc mem, tears, eyes, skin, fontanel, urine flow
3-5%, active/alert, normal, normal, normal, normal, moist, present, normal, springs back, normal, normal
96
clinical manifestation of moderate dehydration:
wt loss, appearance, cap re, pulse, res, BP, muc mem, tears, eyes, skin, fontanel, urine flow
6-9%, irritable/alert/thirsty, >/3, slightly inc, slight tachy, normal or low ortho, dry, less than expected, normal, tents briefly, normal or slightly sunken, reduced
97
clinical manifestation of severe dehydration:
wt loss, appearance, cap re, pulse, res, BP, muc mem, tears, eyes, skin, fontanel, urine flow
>/10%, lethargic/sick, delayed >4, fast & thready, fast & deep, ortho to shock, parched, absent, sunken, prolonged, sunken significantly, severely reduced
98
how do you diagnosis dehydration
clinical signs: abnormal turgor, respiratory pattern & prolonged cap refill
**labs not needed**
99
types of dehydration: isotonic
-lytes = water
-serum Na 135-145
-80% of all dehydration pts
**no need to correct slowly**
100
types of dehydration: hypertonic
-water loss > lyte loss
-Na > 145
-15% of all dehydration pts
-dry doughy skin
-if lowered too quickly causes massive cerebral edema or seizure
**correct Na slowly**
101
types of dehydration: hypotonic
-lyte loss > water loss
-Na <135
-5% all dehydration pts d/t GI loss
-shift from ECF to ICF
-child appears ill
**correct very slowly**
102
rehydration therapy for mild dehydration
ORS 50ml/kg within 4hrs + add fluid for each stool (10ml/kg) & emesis (5-10ml every 5min)
103
rehydration therapy for moderate dehydration
ORS 100 ml/kg within 4 hrs + add fluid for each stool (10ml/kg) & emesis (5-10ml every 5min)
104
rehydration therapy for severe dehydration
IV fluids 40ml/kg/hr until pulse & consciousness return (after kidney function verified may add K+) then 50-100 cc/kg of ORS
105
dx of appendicitis
H&P, CBC & ultrasound
**if confirmed, remove appendix**
106
nursing considerations for appendicitis
-assessments
-avoid enemas & heating pads
-prep for surgery
-post op care (pain meds)
107
peritonitis
from rupture appendix -> need fluids, antibiotic, NG tube, and has delayed closure to prevent abscess formation
108
what type of gauge do we put in for IV fluids
smallest possible (22-24 G) unless surgery then 18-20 G
109
post op for hypertrophic pyloric stenosis
move from NPO to IV fluids to feedings **ok if they throw up, give them time to recover and then feed again. slowly increase feeds**
110
hypertrophic pyloric stenosis
circular muscle of the pylorus becomes thickened causing obstruction of the gastric outlet leading to failure to thrive and baby to projectile vomit w/o bile
**will feel olive shaped mass that, surgery needed**
111
clinical manifestations of intussusception
-pain
-**drawing knees to chest**
-vomiting
-palpable sausage shaped mass URQ
-jelly like stools
-tender and distended abdomen
112
therapeutic mgt of intussusception
dx:H&P, flat plate for free air followed by barium enema (straightens it out)
-non surgical hydrostatic reduction
-surgical reduction & resection
113
treatment of CF
CFTR modulation, aggressive pulmonary toilet, nutritional therapy and antibiotic use
114
non pharm medical mgt of CF
-anti inflammatory agents & protease inhibitors
-immunizations including yearly influenza vaccine
-lung transplant will give 5-10 more years
115
nursing considerations in a CF child
-careful respiratory assessment
-constant assessment of IV site
-enzyme replacement
-exercise & fun
-possible isolation **CF pts cannot mix w/ other CF pt**
-high cal, full fat foods & nutrition evals
-family impact
-hospital & home care
-picc line care
116
what electrolytes does CF cause a problem with
sodium and chloride
117
drugs for CF
-bronchodilators
-mucolytics
-chloride channel activators & sodium channel blockers
-antibiotic therapy
118
what do CF pts take before meals
pancreatic enzymes by mouth (only consumes in graduals)
119
supplements for CF pts
-fat sol vit
-stool softeners prn
-NaCl tabs when hot out
-oral iron sups
120
how would you give pancreatic enzymes to an infant
sprinkle on a food like applesauce
**does not dissolve in water**
121
aggressive airway clearance for CF (need to know)
-percussion by manual, PEP mask and vest
-airway clearance therapy
-postural drainage
-breathing exercises
-physical exercise
-oxygen therapy & nebs **only if needed bc hard to wean**
-isolation while in hospital
122
cyanotic spells o2 consideration
acyanotic- give 02.
Cyanotic- don’t give O2
123
guidelines for hypercyanotic spell
**employ calm, comforting approach**
-knee to chest position
-100% oxygen by face mask
-give morphine
-IV fluid replacement & volume expansion if needed
-repeat morphine if needed
**be able to list, do this one at a time and only continue if needed**
124
discharge planning post cardiac cath
-pressure dressing x24 hr
-no tub baths for 48hrs
-rest 1 night then can resume activities
-teach S/s of infections
125
Asthma Emergency Treatment
Inhaler is the rescue drug not the steroid which only a twice a day drug
126
therapeutic mgt of gastroschisis
-baby born via c section
-loosely cover organs w/ saline soaked pads & plastic drape
-give fluids & antibiotics
-bring to nicu
-multiple surgical corrections , place in silo in between
127
holliday segar formula
**need to have memorized**
-first 10kg add 100 ml/kg/d
-next 10kg add 50 ml/kg/d
->20kg add 20 ml/kg/d
ex) 7kg child would get 700 ml
ex) 12kg (10x100)+(2x50) = 1100 ml
ex) 30kg (10x100)+(10X50)+(10x20) =
1700 ml
divide by 24 to get per hr
