PEDIA - CONGENITAL DEFECTS Flashcards
(333 cards)
1
Q
What are neonatal congenital defects associated with?
A
They are often linked to maternal health issues during pregnancy.
2
Q
What are the types of congenital heart diseases mentioned?
A
Acyanotic Conditions: Ventricular Septal Defect, Atrial Septal Defect, Patent
Ductus Arteriosus, Coarctation of the Aorta.
Cyanotic conditions: Transposition of the great vessels, Tetralogy of Fallot.
3
Q
What is a left-to-right shunt in acyanotic conditions?
A
aorta DOES NOT get
unoxygenated blood
It is when blood flows from the pressure left side of the heart to the lower
pressure right side, mixing oxygenated and blood.
4
Q
What happens in an atrial septal defect?
A
There is an opening in the septum that causes the blood from the left atria to
be shunted into the right atria due to the septal defect
5
Q
What is the problem in atrial septal defect?
A
The problem would be that the right atria receives
more than the usual amount of blood so it becomes
congested.
6
Q
What is the consequence of increased blood flow to the right atrium in an atrial
septal defect?
A
It causes congestion and enlargement of the right atrium.
7
Q
What is the stretch theory in relation to the myocardium?
A
It initiates the contraction of the heart when the myocardium is stretched due to increased
blood volume.
8
Q
What is the earliest manifestation of congenital heart defects in infants?
A
Tachycardia , or a faster heart rate.
9
Q
What happens to the chambers of the heart when blood becomes congested?
A
The chambers enlarge and the myocardium expands.
10
Q
What happens to the right atrium when there is congestion?
A
It increases in size due to the returning blood.
11
Q
What compensatory mechanism does the heart employ when there is congestion?
A
The heart beats faster , resulting in tachycardia.
12
Q
Why might tachycardia not be alarming to doctors in newborns?
A
It is a normal response for a newborn’s heart after birth.
13
Q
How does the heart’s ability to contract change as the baby grows older?
A
The heart rate increases as the heart compensates for its workload.
14
Q
Which coronary artery is most dangerous to have ischemia?
A
Left anterior descending coronary artery.
15
Q
What is the result of less blood being ejected during heart contractions?
A
It leads to congestive heart failure.
16
Q
What characterizes a Ventricular Septal Defect ( VSD )?
A
It is a hole in the lower septum between the ventricles. AORTA is NOT getting unoxy blood.
17
Q
What happens to blood flow in the heart due to VSD?
A
Blood flows from the left ventricle to the right ventricle due to pressure differences.
18
Q
What is the role of the ligamentum arteriosum in PDA?
A
It connects the aorta and pulmonary artery and should not remain patent.
19
Q
What occurs when blood from the right ventricle cannot eject properly in PDA?
A
Blood returns to the right ventricle, causing congestion.
20
Q
What is coarctation of the aorta?
A
It is a narrowing of the aorta that impedes blood flow.
21
Q
What unique symptoms are observed in babies with coarctation of the aorta?
A
Strong in the artery and weak pulses in the pedal and femoral
arteries.
22
Q
What is the primary complication of acyanotic conditions?
A
Congestive heart failure ( CHF ).
23
Q
What are the symptoms of left-sided heart failure?
A
Symptoms include dyspnea , productive cough, and pulmonary congestion.
24
Q
What does echocardiography help identify?
A
It identifies the type and size of heart defects.
25
What should be monitored during cardiac catheterization?
The temperature , color, and pedal pulse of the legs.
26
What is a potential complication of cardiac catheterization?
Thrombus formation and possible embolism.
27
What does the retrograde approach in cardiac catheterization mean?
It means the catheter is inserted backward towards the heart.
28
What is the purpose of introducing contrast media dye during cardiac
catheterization?
To identify obstructions in the heart.
29
What happens when the catheter enters the left ventricle?
It allows for the administration of contrast media dye to visualize obstructions.
30
What can thrombus and emboli lead to if not addressed?
They can lead to pulmonary embolism.
31
What is the risk if the left anterior descending artery becomes obstructed?
It can lead to ischemia and infarction
32
What is more likely to close spontaneously , ASD or VSD?
ASD has more chances of closing on its own.
33
What is involved in open heart surgery?
Induction of asystole , hypothermia, and use of a bypass machine.
34
What is the purpose of cooling the body during open heart surgery?
It reduces the brain's demand for oxygen.
35
What is the difference between open heart surgery and closed heart surgery?
Open heart surgery involves defects the heart, while closed heart surgery
involves defects the heart.
36
What is the objective of preventing congestive heart failure (CHF)?
If CHF can be prevented, surgery can be postponed.
37
What effect does Digoxin have on heart rate?
It increases the strength of contraction but decreases heart rate.
38
What should be monitored before administering Digoxin to infants?
Heart rate should be monitored, especially if it is below 100 bpm.
39
What is the minimum heart rate for children aged 1-4 years before administering
Digoxin?
At least 80 bpm.
40
What is the minimum heart rate for children aged 5-10 years before administering
Digoxin?
At least 70 bpm.
41
What is the minimum heart rate for adolescents before administering Digoxin?
At least 60 bpm.
42
How should fluid output be monitored in patients on diuretics?
By weighing diapers to ensure output exceeds input.
43
What medication is used to improve cardiac output?
Cardiac glycoside, specifically Digoxin, is used.
44
What is the purpose of diuretics like Furosemide?
To prevent sodium retention and promote elimination of excess fluids.
45
What is the function of ACE inhibitors like Captopril?
They prevent the conversion of Angiotensin I to II, controlling blood
pressure.
46
What is the role of angiotensin II in the body?
It is a vasoconstrictor that promotes sodium and water retention.
47
What dietary recommendation is made for patients with heart conditions?
A low sodium diet is recommended.
48
What type of meals are recommended for children with heart conditions?
Small , high-calorie , high-fat meals in frequent intervals are recommended.
49
What is a recommended activity for children to decrease oxygen demand?
Quiet play activities are recommended.
50
What causes children to turn blue in cyanotic conditions?
It is due to the body receiving unoxygenated blood.
51
What happens in transposition of the great vessels?
The aorta receives unoxygenated blood from the right side.
52
How is the insertion of the aorta and pulmonary artery altered in transposition of the great vessels?
The aorta and pulmonary artery are switched in their positions.
53
What happens to the oxygen supply after birth in a baby with transposition of the
great vessels?
The baby begins to receive unoxygenated blood in circulation after the umbilical cord is cut.
54
What happens to a baby with transposition of the great vessels when they cry?
The baby becomes bluer as they cry.
55
What is the pathway of oxygenated blood in a normal heart?
Oxygenated blood goes from the lungs to the left atrium, then to the left ventricle, and out through the aorta.
56
What medication is given to open the ductus arteriosus in newborns?
Prostaglandin E2 ( Dinoprostone )
57
What happens when prostaglandin E2 is administered to a newborn?
It opens the ductus arteriosus , allowing blood from the left ventricle to flow into the
aorta.
58
What is the Jatene Procedure?
It is an arterial switch operation performed within the first 14 days of life.
59
Why is the Jatene Procedure performed?
To correct the heart's structure and ensure proper oxygenation
60
What is the first step in performing a balloon septostomy?
Inserting a catheter into the inferior vena cava.
61
What are the components of Tetralogy of Fallot (TOF)?
- Displaced aorta (overriding)
- Right ventricular hypertrophy (RVH)
- Ventricular septal defect (VSD)
- Pulmonary artery stenosis
62
What does the acronym DROP stand for in Tetralogy of Fallot?
D - Displaced aorta, R - Right ventricular hypertrophy, O - Opening in the septum (VSD), P - Pulmonary artery stenosis.
63
What is the consequence of the combined defects in Tetralogy of Fallot?
It causes cyanosis due to inadequate blood flow to the lungs.
64
Why do symptoms of Tetralogy of Fallot often disappear during quiet moments?
Because the oxygen demand decreases during rest.
65
What is a common symptom of Tetralogy of Fallot during activity?
Exertional dyspnea with central cyanosis.
66
What are " TET " spells and how are they relieved ?
They are episodes of by , which impedes blood flow to
the legs
67
What is the Schamroth technique used for?
To assess for clubbing of fingers.
68
What does clubbing of fingers indicate ?
Chronic peripheral hypoxia
69
What is the normal angle between nail beds in a healthy finger?
160 degrees.
70
What happens to the blood in polycythemia due to chronic hypoxia?
The blood thickens, increasing the risk of thrombosis.
71
What is the normal hematocrit count range in pediatric patients?
35-45 %
72
What is the purpose of phlebotomy in managing polycythemia?
To dilute the blood and reduce the risk of thrombosis
73
to increase blood flow to the pulmonary artery
Alpha-adrenergic agonist (Phenylephrine)
74
What are the overall objectives of nursing care for neural tube defects?
Protect the sac against pressure, injury, and infection
Surgical closure preferred within 24-48 hours after birth
Monitor for signs of infection
75
What is the cause of neural tube defects?
Inadequate intake of folic acid during pregnancy.
76
What is spina bifida?
A condition where there is an incomplete closure of the spinal canal.
77
What is the difference between meningocele and meningomyelocele?
Meningocele contains , while meningomyelocele contains ,
meninges, and spinal cord with nerves.
78
What is the preferred intervention for spina bifida?
Surgical closure within 24-48 hours after birth.
79
Why is it important to keep the sac moist in spina bifida patients?
To prevent infection and protect the exposed tissues.
80
What should be avoided when caring for a patient with spina bifida?
Using a diaper that can cover the sac.
81
What is the role of positioning in the care of spina bifida patients?
To prevent pressure on the sac and reduce the risk of SIDS.
82
What should be done if a patient with spina bifida shows signs of infection?
Monitor for signs of infection and notify the healthcare provider immediately.
83
What is the purpose of monitoring hemoglobin and hematocrit counts in patients
with congenital heart defects?
To detect early polycythemia.
84
What is the significance of maintaining hydration in patients with polycythemia?
To prevent blood thickening and dehydration
85
What are the two types of fluids recommended for hydration?
Drinkable fluids (liquids) and eatable fluids (solids).
86
What is the recommended position during TET spells?
Knee-chest position or squatting.
87
How can respiratory infections affect patients with congenital heart defects?
They can worsen hypoxemia and reduce oxygenation.
88
What is the overall objective of nursing care for the sac?
To protect the sac against pressure , injury , and infection.
89
Why should the head be turned to the opposite direction when in a prone position?
To monitor for the risk of Sudden Infant Death Syndrome ( SIDS ).
90
What position is allowable for a baby with a sac issue?
Prone position, but it must be monitored closely.
91
What is a potential complication of spina bifida if not managed properly?
Hydrocephalus.
92
What are some signs of hydrocephalus?
Bulb-shaped head, bulging fontanel, high-pitched cry, and projectile vomiting.
93
How does increased intracranial pressure (ICP) affect vital signs?
It can cause decreased heart rate, decreased respiratory rate, and hypertension.
94
What is mannitol used for in medical management?
It is an osmotic diuretic given as an IV drip to promote urination.
95
What is the purpose of dexamethasone in treatment?
It is a steroid used as an anti-inflammatory.
96
When is a ventriculoperitoneal (VP) shunt inserted?
To bypass the point of obstruction and prevent CSF buildup in the brain.
97
What should be done if a baby has a sac issue but no hydrocephalus?
Closing of the sac is the solution.
98
What is cleft lip and how can it occur ?
Cleft lip can be hereditary or due to excess vitamin ADEK intake.
99
Does having a cleft lip always mean there is a cleft palate?
No , cleft lip and cleft palate are separate conditions that may exist individually.
100
What is the rule of 10 for cleft lip surgery?
The baby must be at least 10 weeks old, weigh at least 10lbs, have hemoglobin of
10 grams, and a WBC count <10,000.
101
What is the ideal age for cleft palate repair?
Around 8-10 months old.
102
What is the purpose of using a Haberman feeder preoperatively?
It helps infants who cannot suck effectively to feed better.
103
What position should a baby be in post-op after cleft lip surgery?
Supine position with the head tilted to the side.
104
What should be used to clean suture lines after feeding?
Cooled boiled water or sterile water.
105
What is the purpose of Logan’s device after surgery?
To prevent dehiscence and evisceration of the sutures.
106
What is the difference between cleft lip and cleft palate in terms of intervention?
The difference lies in the post-operative intervention required.
107
Why is it beneficial to repair cleft lip and cleft palate at different times?
Because as the baby , the cleft becomes smaller, making repair
easier.
108
What is the main concern when a baby has a cleft palate?
It can hinder speech development.
109
What is the purpose of pre-operative management for cleft palate?
To prepare the baby for feeding and ensure proper nutrition before surgery.
110
What should be done if a baby is 1 week old with a cleft palate?
Surgical intervention is needed for uranoplasty/palatoplasty.
111
What are the signs and symptoms of hydrocephalus?
Bulb-shaped head
Bulging fontanel
High-pitched shrill cry
Projectile vomiting
Macrocephaly (large head)
Distention of veins on the head
Changes in vital signs ( decreased HR, decreased RR, hypertension)
112
What are the stages of repair for uranoplasty/palatoplasty?
1. Soft palate repair at 3-6 months
2. Hard palate repair at 6-18 months
113
Why is it advantageous to not repair cleft lip and cleft palate simultaneously?
Because as the baby grows older, the cleft palate becomes smaller.
114
When should the repair of the cleft palate ideally occur?
Before speech development begins.
115
What are the two separate occasions for surgery if a baby is at risk?
1. Close the soft palate (3 to 6 months) to lessen aspiration risk.
2. Repair the hard palate before speech development (6 to 18 months).
116
Why is a long surgical procedure dangerous for a baby?
It poses a risk to the development of the brain due to prolonged sedation.
117
What is a difficulty in post-operative care of uranoplasty and palatoplasty?
There is a between the care plans for post-cheiloplasty and posturanoplasty.
118
What position should a patient be in after uranoplasty?
The patient should be in a prone position.
119
Why is the prone position recommended after surgery?
It promotes natural drainage of secretions.
120
What is nasal twang in speech evaluation?
Nasal twang refers to the sound produced that may indicate issues after surgery.
121
What is suggested after the surgical repair of the palate?
It is suggested that the baby undergoes speech therapy.
122
What should be the feeding position post-operatively?
The feeding position should be upright.
123
Why should a straw not be used for drinking post-operatively?
Using a straw creates negative pressure, increasing the risk of bleeding.
124
What is atresia of the esophagus?
The lower and upper segments of the esophagus do not connect.
The upper end ends in a blind pouch.
125
What does the letter "H" represent in H-type tracheoesophageal fistula?
The " H " represents the trachea, esophagus, and the fistula forming an H shape.
126
What are the problems associated with tracheoesophageal fistula?
Aspiration
Nutritional problems due to food not reaching the stomach
127
What is the priority problem in tracheoesophageal fistula cases?
Aspiration is prioritized over nutritional problems.
128
How does aspiration occur in tracheoesophageal fistula?
Liquid goes to the trachea instead of the stomach, leading to into the lungs.
129
What are the symptoms of tracheoesophageal fistula?
Coughing, choking , and cyanosis during feeding
130
What does polyhydramnios indicate during pregnancy?
It indicates that the baby is not swallowing , leading to high levels of amniotic fluid.
131
What should suctioning be based on in newborns?
Suctioning should only be done when there is mucus or if the amniotic
fluid is
excessive
green.
132
What are the 3 C's during feeding that indicate aspiration in a baby?
Coughing , choking , and cyanosis
133
What does coiling of the nasogastric tube indicate?
It indicates that the tube is not reaching the stomach due to a lack of connection.
134
What should be done for a newborn with tracheoesophageal fistula before surgery?
The baby should stay in the ICU to build up resistance and gain weight
135
What is the pre-operative management to prevent pneumonia?
Consider possible risks of pneumonia
Keep the baby in an upright position (60-degree angle)
136
What is aspiration pneumonia?
It occurs when liquid goes into the lungs, initiating a pneumonic process.
137
How can aspiration pneumonia be prevented in newborns?
By always keeping them in an upright position.
138
What is the recommended angle for keeping a newborn in an upright position?
60-degree angle.
139
What is the purpose of using a pacifier for newborns who are NPO?
A allows for non-nutritive sucking, providing sucking without
nutrition
140
Who proposed that one of the needs of an infant is to give pleasure of sucking?
Sigmund Freud.
141
How is breastmilk or formula provided to newborns who cannot feed orally?
Through feeding, where a temporary opening is created in the
stomach.
142
What is the difference between nasogastric tube and gastrostomy feeding?
Nasogastric tube goes through the nose , while gastrostomy goes directly into the
stomach.
143
What is pyloric stenosis?
It is caused by hypertrophy of the muscles of the pyloric sphincter, leading to
constriction.
144
What happens to food in the stomach before it exits through the pyloric sphincter?
Food must be digested into pieces before it can pass through the pyloric sphincter.
145
What are the symptoms of pyloric stenosis?
Abdominal distention after feeding with peristaltic waves.
Projectile vomiting.
Dehydration due to fluid loss.
Weight loss and muscle weakness.
Palpable olive-shaped mass in the right upper quadrant (RUQ).
146
What is a classic manifestation of pyloric stenosis?
A palpable olive-shaped mass in the right upper quadrant (RUQ).
147
What is the purpose of barium swallow and barium enema?
Barium swallow is for upper GI, while barium enema is for lower GI.
148
What is the management for pyloric stenosis?
Pyloromyotomy (opening pylorus) with pyloroplasty (repair).
Correct fluid and electrolyte imbalances before surgery.
Small frequent feedings of breastmilk or thickened formula.
149
What should be done before surgery for pyloric stenosis?
Correct fluid and electrolyte imbalances first.
150
What are the post-operative care instructions for a baby after pyloric stenosis
surgery?
Administer small amounts of oral rehydrating solution.
Burp well after feeding.
Position the baby on the right side after feeding to promote gastric emptying.
Monitor for vomiting and care for the incision site.
151
What is intussusception ?
A condition where a portion of the small intestines telescopes into
the lumen of another.
hyperactive
It causes obstruction and can lead to severe complications.
152
What are the symptoms of intussusception?
Spasmodic abdominal pain, blood with mucus in stool (currant jelly stool), and
bile-stained vomitus.
153
What does currant jelly stool indicate?
It indicates the presence of blood with mucus in the stool due to intussusception.
154
What does fecaloid vomitus suggest?
It suggests that the obstruction is in the due to the presence of fecal
materials
154
What does bile-stained vomitus indicate?
It indicates that the obstruction is in the small intestine.
155
What are the characteristics of vomitus that should be documented?
Color
Smell
Taste
Amount
156
What should be included in documentation/charting when describing vomitus?
It should include color , amount , taste , and smell.
157
Why is it important to describe vomitus in detail?
It helps identify the location of an obstruction in the gastrointestinal tract.
158
What is the color of bile-stained vomitus?
Green
159
What is the role of bile in digestion?
Bile is needed for the emulsification of fats.
160
What does fecaloid vomitus look like?
It is brown and smells very foul.
161
What does the presence of fecaloid vomitus suggest about the obstruction?
It suggests that the obstruction is in the large intestine.
162
How can colorectal cancer lead to fecaloid vomitus?
It can cause in the , preventing feces from exiting the
body.
163
What is a sausage-shaped mass in the abdomen indicative of?
It indicates a palpable mass in the small intestine.
164
What can happen if a portion of the bowel becomes intussuscepted?
There is a possibility for the bowel to perforate or burst
165
What are the management techniques for intussusception?
Hydrostatic Reduction Technique (Barium or Saline)
Air (Pneumatic Insufflation)
Surgery (Manual Reduction, resection with anastomosis if necrosis is present)
166
How does the hydrostatic reduction technique work?
It uses pressure to reduce the telescoping of the bowel
167
What is the risk of using barium enema in a baby with intussusception?
It can be used to treat intussusception by pushing the telescoped bowel out.
168
What happens if a part of the bowel is necrotic during intussusception
management?
It must be surgically removed to prevent further complications
169
What is Hirschsprung's disease?
It is a congenital condition characterized by the of
nerve supply in the large intestines.
170
What is the consequence of the absence of ganglion cells in Hirschsprung's disease?
It leads to the absence of peristalsis in the affected segment of the intestine.
171
What is the genetic basis of Hirschsprung's disease?
It is associated with an abnormal gene on Chromosome 10.
172
What are the early signs of Hirschsprung's disease?
Delayed meconium passage within the first 24 to 48 hours after birth.
173
What are the late signs of Hirschsprung's disease?
Constipation , ribbon-like or pellet-like stool, abdominal distention, and weight loss.
174
What is the purpose of a rectal exam in diagnosing Hirschsprung's disease?
To check for the presence of fecal material in the rectum.
175
What is the definitive diagnostic test for Hirschsprung's disease?
Rectal biopsy.
176
What is the pre-operative management for a baby with Hirschsprung's disease?
Promote elimination with stool softeners and normal saline enemas.
177
What is the management for an imperforate anus?
Colostomy in the nursery as a palliative measure.
178
What are the signs of an imperforate anus?
Absence of meconium and inability to insert a rectal thermometer.
179
What is the compensatory mechanism in males with an imperforate anus?
Greenish urine may indicate a recto-vesical fistula.
180
What is the management step for males with an imperforate anus?
Corrective surgery should be scheduled before 1 year of age.
181
What is the cause of pharyngitis/tonsillitis?
It is caused by Group A Beta Hemolytic Streptococcal Infection.
182
What are the potential sequelae of streptococcal infection?
Rheumatic fever, rheumatic heart disease, and glomerulonephritis.
183
Why is surgery not advised during the acute inflammatory stage of tonsillitis?
Because the tonsils are highly vascular and may bleed
184
Why is it important to complete the antibiotic dosage for GABHS infection?
To ensure all microorganisms are eliminated and prevent resistance.
185
What are some complications that may arise from infection?
Rheumatic fever, rheumatic heart disease, and glomerulonephritis
186
Why is surgery not advised during the acute inflammatory stage of tonsillitis?
Because the tonsils are highly vascular and can bleed
187
What is the recommended course of action before scheduling a tonsillectomy?
Complete a full course of antibiotics
188
What antibiotic is recommended for GABHS infection if the patient has an allergy?
Erythromycin
189
Why is it important to complete the dosage of antibiotics prescribed by a physician?
To prevent the microorganisms from recovering and developing drug resistance
190
What should be avoided when administering antipyretics?
Aspirin (ASA)
191
What are the risks of not controlling fever in children?
It can lead to convulsions
192
What is the purpose of a tepid sponge bath for a child with fever?
To open skin pores and promote evaporation of body heat
193
Under what conditions is tonsillectomy indicated?
Recurrent , peritonsillar abscess, or massive causing
dyspnea
194
What should be checked during pre-operative management for tonsillectomy?
Dental status for loose teeth and bleeding disorders
195
How many deciduous teeth do children typically have?
20 deciduous teeth
196
What position should a child be placed in while asleep to promote drainage of
secretions?
Prone or lateral position
197
What are signs of potential bleeding after tonsillectomy?
Frequent swallowing and restlessness
198
What type of diet should be resumed after tonsillectomy?
Cold , clear , non-irritating fluids
199
Why is milk not advisable after tonsillectomy?
Because it can irritate the throat
200
What is the bottom line regarding tonsillectomy?
It should be avoided unless absolutely necessary due to the presence of antibodies
201
What is the cause of spasmodic croup (laryngotracheobronchitis)?
Virus
202
What are the symptoms of laryngotracheobronchitis ?
Hoarseness, inspiratory stridor, and fever
203
What is the relationship between laryngospasm and recurrent coughing?
Recurrent coughing can lead to laryngospasm , causing respiratory distress
204
What should be avoided to prevent laryngospasm during an attack?
Avoid respiratory irritants and sudden temperature changes
205
What is the purpose of administering high humidity with mist therapy during asthma
attacks?
To humidify or liquefy secretions
206
What is the cause of epiglottitis?
Haemophilus influenzae
207
What are the signs and symptoms of epiglottitis ?
Drooling, dystonia, and dysphagia
208
What position does a child with epiglottitis typically adopt?
Upright , leaning forward with chin thrust out
209
What vaccine is used for the prevention of epiglottitis?
influenzae Type B (Hib) Vaccine
210
What is the difference between bronchial asthma and COPD in adults?
Bronchial asthma is acute and can be cured , while COPD is chronic and not
curable
211
What area is primarily affected during an asthmatic attack in children?
The bronchial area
212
What is the role of histamine in asthma symptoms?
Histamine leads to changes in the air passages and causes symptoms
213
What is bronchospasm and how is it related to asthma?
Bronchospasm is the of muscles around the , leading to difficulty breathing in asthma
214
What is the nutritional benefit of egg yolk?
It is rich in iron.
215
What can happen to a baby due to overfeeding milk?
Anemia can occur.
216
Which foods are known to cause asthma due to allergens?
Chicken and peanuts.
217
What are intrinsic factors in asthma?
They are idiopathic or inner factors related to the patient, such as stress or anxiety.
218
What does histamine do in the body?
It leads to changes in the air passages and the body's response.
219
What is bronchospasm?
It is a tightening of the muscles around the air passages.
220
What does histamine cause in the air passages?
It causes swelling of the linings and production of secretions.
221
What happens to bronchioles in adults with asthma?
Even the alveoli can become involved.
222
What is emphysema in relation to asthma?
It occurs when the alveoli are distended and the condition is no longer reversible.
223
Why are patients taken to the hospital during an asthma attack?
To relieve the symptoms.
224
What are the symptoms of asthma exacerbation?
Inflammation and edema of the airways, and accumulation of secretions
225
What is allergen control in asthma management?
It involves skin testing followed by hyposensitization.
226
What is hyposensitization?
It is a process to increase tolerance to allergens over three years.
227
What is anaphylaxis?
It is a severe allergic reaction that can cause death.
228
What is asthma exacerbation?
It is when asthma symptoms are present and the patient is symptomatic.
229
What is the desired outcome during hyposensitization?
For the patient to experience remission or absence of symptoms.
230
What should be done if a patient exacerbates during treatment?
Open the airways and administer medicines.
231
What is the first procedure for asthma exacerbation management?
To inhale through nebulization.
232
What type of bronchodilator is administered for asthma relief?
Rapid-acting bronchodilators.
233
What are intravenous drugs used for in asthma management?
Aminophylline and steroids
234
What does the administration of steroids indicate during an asthma attack?
It means the asthma is hard to treat and bronchodilators are insufficient.
235
What are examples of steroids used in asthma treatment?
Prednisolone and Hydrocortisone.
236
What is the position recommended for patients during asthma attacks?
Orthopneic position.
237
Why should patients lean forward during an asthma attack
It helps with lung expansion and reduces chest heaviness.
238
What should be promoted for hydration in asthma patients?
Oral fluids with aspiration precautions
239
Why should milk be limited in asthma patients?
Milk can make secretions thicker.
240
Why should vitamin C be avoided in high doses for asthma patients?
Higher doses can trigger asthma attacks
241
What is the recommended daily allowance of vitamin C?
500 mg.
242
What breathing exercise is recommended for asthma patients?
Pursed-lip breathing.
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What is the purpose of pursed-lip breathing?
To expel carbon dioxide and prevent acidosis.
244
What is rheumatic fever a complication of?
Streptococcal infection.
245
What can effective management of rheumatic fever prevent?
It can prevent rheumatic heart disease.
245
Who is more prone to rheumatic fever?
School-aged children and adolescents.
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What are common symptoms of streptococcal infection?
Tonsillitis , dental caries, and otitis media.
247
What are the minor criteria for diagnosing rheumatic fever according to Jones
criteria?
CRP increased
Arthralgia
Fever
Elevated ESR
Prolonged PR interval
Anamnesis of rheumatism
Leukocytosis
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What is migratory polyarthritis?
It is joint pain that moves from one joint to another.
249
What is chorea in the context of rheumatic fever?
It refers to involuntary jerks or movements
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What is erythema marginatum?
It is a rash that appears on the trunk.
251
What are subcutaneous nodules in rheumatic fever?
They are palpable lumps under the skin.
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What is carditis in the context of rheumatic fever?
It is inflammation of the heart's endocardium.
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What is the goal of management for rheumatic fever?
To decrease demand from the weakened heart.
254
What is the role of penicillin in rheumatic fever management?
It is used to prevent further infections.
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What can happen with continuous exposure to streptococcal infection?
It can lead to permanent damage to the mitral valve.
256
What medications are used for chorea in rheumatic fever?
Phenobarbital and Diazepam.
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What is the second goal of administering penicillin?
The second goal is the administration of penicillin.
258
Why are oral NSAIDs preferred over steroidal medicine?
Oral NSAIDs are safer because steroids can lead to syndrome due to their
long duration of effect.
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What is the goal of administering oral NSAIDs in the context of joint inflammation?
The goal is to decrease the pain due to swelling.
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What is the objective related to preventing further cardiac damage?
The objective is to prevent further cardiac damage due to rheumatic heart disease.
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What medications are used for chorea?
Phenobarbital and Diazepam (Valium) are used for chorea.
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Why is it preferable for children with chorea to avoid stairs?
Because they may experience involuntary jerks that could lead to falls.
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What is the recommended dosage of Benzathine Penicillin for prevention of
rheumatic fever?
2 million units IM monthly until years old; if with valve damage, until years
old.
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What advice is given to women with rheumatic heart disease regarding pregnancy?
They are advised not to get pregnant while on antibiotic therapy.
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What is the effect of pregnancy on blood volume in women with rheumatic heart
disease?
Pregnancy can increase blood volume by to percent, putting stress on the
heart
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What can happen if a mother self-medicates during pregnancy?
Self-medication can lead to the development of antibiotic resistance.
267
What kidney problem can occur in children due to chronic glomerulonephritis?
Renal failure can occur in children.
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What is glomerulonephritis?
Glomerulonephritis is one of the pre-renal causes of kidney problems in children.
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What is the similarity and difference between nephritis and nephrosis?
Both are renal problems; the difference lies in age, symptoms, and cause.
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What microorganism is associated with nephritis
Group A beta-hemolytic Streptococcus (GABHS).
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What symptom indicates kidney injury in nephritis?
Hematuria, or urinating blood, indicates kidney injury.
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What causes periorbital edema in nephritis?
Periorbital edema is caused by fluid retention due to kidney injury.
273
What triggers the Renin-Angiotensin mechanism in response to kidney injury?
The kidney responds to injury by triggering the Renin-Angiotensin mechanism.
274
What is an effective intervention for hypertension related to kidney injury?
ACE inhibitors are effective in preventing the conversion of Angiotensin I to II.
275
What management strategies are recommended during the acute stage of kidney
injury?
CBR (complete bed rest), antihypertensives, diuretics, and antibiotics
276
Why is a low protein diet recommended during the acute stage of kidney injury?
A protein diet is recommended because the kidneys cannot waste
products like creatinine.
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What is the importance of skin care in patients with kidney injury?
Good skin care is important because edematous areas are prone to injury
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What is nephrotic syndrome characterized by?
Nephrotic syndrome is characterized by a group of symptoms, not an inflammatory
condition.
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What is proteinuria?
Proteinuria is the presence of protein in urine, indicating kidney dysfunction.
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What is the etiology of nephrotic syndrome?
The etiology is unknown but is thought to be autoimmune.
281
What happens to protein levels in the blood during nephrotic syndrome?
Hypoproteinemia occurs, leading to a decrease in protein levels in the blood.
282
What is the effect of low plasma osmotic pressure in nephrotic syndrome?
Low plasma osmotic pressure leads to more edema , such as ascites and anasarca.
283
What is hyperlipidemia in the context of nephrotic syndrome?
Hyperlipidemia is characterized by protein levels and fat levels in the
blood.
284
What causes hypotension in nephrotic syndrome?
Hypotension occurs due to , as fluid shifts from inside the blood vessels
to outside.
285
What is the management strategy for preventing bedsores in nephrotic syndrome
patients?
Ambulation as tolerated is recommended to prevent bedsores.
286
What is the role of diuretics in nephrotic syndrome management?
Diuretics are used to remove excess fluids from the body.
287
Why are steroids like Prednisone used in nephrotic syndrome?
Steroids are used as immunosuppressants in nephrotic syndrome management.
288
At what age is iron deficiency anemia more common in children?
Iron deficiency anemia is more common in children 6 months and older.
288
What dietary changes are recommended for nephrotic syndrome patients?
Patients should have a diet high in carbohydrates , low in sodium , and low in fat.
289
What is the importance of meticulous skin care in nephrotic syndrome patients?
Meticulous skin care is important to prevent injury in edematous areas.
289
What is the purpose of IV albumin in nephrotic syndrome management?
IV albumin is used to help maintain protein levels in the blood.
289
What is pernicious anemia associated with?
Pernicious anemia is associated with vitamin B12 deficiency.
289
What is the recommended daily limit of milk for toddlers to prevent iron deficiency
anemia?
Toddlers should not exceed 30 oz of milk per day.
290
What is the management strategy for introducing complementary feedings to
infants?
Introduce one food at a time to rule out allergies.
291
What are some iron-rich foods recommended for children?
Cereals, egg yolk, dark green leafy vegetables, and dark meat ( meat) are
recommended.
292
What is hemophilia characterized by?
Hemophilia is transmitted as X-linked from a carrier mother to an affected son.
293
Who is affected by hemophilia?
Hemophilia affects males primarily.
294
What symptoms indicate hemophilia in newborns?
Prolonged from the umbilical cord and skin petechiae are early
symptoms.
295
What are later symptoms of hemophilia?
Later symptoms include easy bruising , easy epistaxis , and gum bleeding.
296
What can happen to bones due to hemarthrosis?
Bones can become soft and spongy due to prolonged exposure to blood.
297
What is the condition characterized by bleeding that occurs throughout a person's
life?
Hemophilia
298
Which joints are most often damaged by bleeding in hemophilia?
The hinge joints: knees, ankles, and elbows
299
Why do hinge joints bleed more often than ball-and-socket joints?
Hinge joints have little protection from side-to-side stresses
300
Which joints are classified as ball-and-socket joints?
The hip and shoulder joints
301
What is the purpose of DDAVP in hemophilia management?
It is used for the lack of Factor VIII
302
What types of sports should individuals with hemophilia avoid?
Contact sports like wrestling, basketball, and football
303
What does the PRICES technique stand for in managing hemophilia?
P: Protect (use protective devices)
R: Rest (immobilize)
I: Ice (vasoconstriction)
C: Compress (apply pressure)
E: Elevate (above the heart)
S: Support (from healthcare professionals)
304
Why should aspirin be avoided in patients with hemophilia?
Aspirin may cause bleeding
305
What is the significance of physical therapy in hemophilia management?
It helps patients return to regular activities after bleeding stops
306
What is the purpose of cell transplantation in hemophilia?
It is considered when there is no cure available
307
What is the most common form of childhood cancer?
Leukemia
308
What type of blood cells are primarily affected in leukemia?
White blood cells (WBC)
308
What is the role of lymphocytes in the immune system?
Lymphocytes are responsible for phagocytosis and fighting infections
309
What is the major problem caused by the presence of lymphoblasts in the body?
They make the body very prone to infection
310
What are the forms of leukemia?
Lymphocytic Leukemia: Acute (ALL) or Chronic (CLL)
Myelocytic Leukemia: Acute (AML) or Chronic (CML)
311
What is the primary symptom of myelocytic leukemia?
Infection, anemia, and bleeding
311
What is the prognosis for acute lymphocytic leukemia (ALL) in children?
It has a great response to chemotherapy and there is a potential cure
312
What is the definitive test for diagnosing leukemia?
Bone marrow biopsy
313
What is the typical positioning for a pediatric patient during a bone marrow biopsy?
Prone position
314
What does a complete blood count (CBC) indicate in relation to leukemia?
It shows values the normal range but does not definitively diagnose
leukemia
315
What are the stages of leukemia management?
1. Remission Induction: IV systemic chemotherapy
2. CNS Prophylactic Therapy: Intrathecal chemotherapy
3. or Consolidation Therapy: Regular systemic and intrathecal
chemotherapy
Intensification
4. Maintenance Therapy: Regular monitoring and treatment
316
What is the goal of remission induction in leukemia treatment?
To achieve remission through systemic chemotherapy
317
Why is CNS prophylactic therapy important in leukemia treatment?
It prevents the spread of cancer cells to the central nervous system
318
What is the ideal intervention for leukemia treatment?
Bone marrow transplant
319
What are the challenges associated with bone marrow transplantation?
Compatibility issues and high expenses
320
How do children's concepts of death vary by age?
Below 5 years: Death is seen as reversible, like sleep
6-9 years: Death is personified and seen as reversible
Above 9 years: Death is understood as irreversible and final
321
How do preschoolers perceive death?
As a form of sleep or reversible
322
What do children aged 6-9 years associate with death?
They see death as a person, like the grim reaper
323
What is the understanding of death for children above 9 years old?
They recognize it as the end of life and irreversible
324
How do nurses perceive death?
As the beginning of new life
