Peds Exam 2

Question 1

What are some assessment findings the nurse would notice with hypoxemia?

Answer 1

tachypnea
pallor/cyanosis
s/s of respiratory distress
diminishing air entry
weak peripheral pulses/ club fingers
decrease in LOC
rales/ rhonchi/ wheezing

Question 2

What are the s/s of respiratory distress?

Answer 2

retractions, flaring, grunting on expiration and stridor on inspiration, head bobbing, restlessness, use of accessory muscles

Question 3

What is often the first sign of respiratory illness?

Answer 3

tachypnea

Question 4

The nurse assesses their client and realizes they have hypoxemia. What management techniques will the nurse use?

Answer 4

apply pulse ox, oxygen therapy sessions, chest physiotherapy, suctioning

Question 5

What is the priority of care for a patient with hypoxemia?

Answer 5

Ineffective breathing pattern/ impaired gas exchange/ ineffective airway clearance

Question 6

What is the patho behind cystic fibrosis?

Answer 6

autosomal recessive disorder CFTR gene with various mutations which disrupts chloride ion movement and sodium reabsorption, reducing the amount of water in sections

Question 7

What are some physcial respiratory findings of cystic fibrosis?

Answer 7

Thick, tenacious sputum
Air trapping/ obstruction/ chronic cough/ URI
Unable to clear secretions
RHF (cor pulmonale)
Clubbing/ barrel chest

Question 8

What are some physical GI findings of cystic fibrosis?

Answer 8

dehydration
Thicker bile= cirrhosis/ gallstones
thick mucous
Abdominal distention or difficulty passing stool; bulky, fatty, greasy stools (steatorrhea)
Poor weight gain

Question 9

What causes dehydration in a patient with cystic fibrosis?

Answer 9

chloride and water changes

Question 10

A decrease in what causes mucus to thicken?

Answer 10

pancreatic enzymes

Question 11

What is the diagnostic for cystic fibrosis?

Answer 11

Sweat chloride test

chloride > 40mEq/L in infants, > 60mEq/Dl in children < 3months
sodium >

Question 12

What nursing management priorities will the nurse focus on for pulmonary?

Answer 12

airway clearance therapy, aerosol therapy, o2 as prescribed, monitor for CO2 retention

Question 13

What medication classess will be given to a patient with cystic fibrosis?

Answer 13

bronchodilators and anticholinergics, anti-inflammatory, IV or nebulized ABX

Question 14

What is airway clearance therapy?

Answer 14

chest PT w postural drainage to clear secretions and prevent infection

Question 15

What is aerosol therapy?

Answer 15

pulmonary enzyme (dornase alfa) decreases the viscosity of mucus, improving lung function

Question 16

What are the GI nursing management priorities for cystic fibrosis patients?

Answer 16

Administer laxatives and pancreatic enzymes within 30 minutes of eating a meal or snack
For infants, open capsule and sprinkle on an acidic type food (applesauce)

Question 17

What dietary considerations should be made for a patient with cystic fibrosis?

Answer 17

high protein, high calorie, high amt of fluids

Question 18

What vitamins should patients with cystic fibrosis increase?

Answer 18

D, E, A, K

Question 19

What age group is most commonly affected by croup? After what age is it rare?

Answer 19

3mo- 3yrs, 6 years

Question 20

What are some assessment findings of croup?

Answer 20

“barking cough”, sudden onset at night, gone in the morning, low grade fever, inspiratory stridor, dyspnea, retractions

lasts 3-5 days

Question 21

What additional assessment findings will you see with infants who have croup?

Answer 21

nasal flaring, intercostal retractions

Question 22

What are nursing priorities for croup?

Answer 22

typically managed at home, cool mist humidifier or steamy bathroom, hydration.
if stridor is signoficant or there are severe retractions, O2, continuous oximetry

Question 23

What are medications for moderate/ severe croup?

Answer 23

Dexamethasone IV (corticosteroid) and
Racemic epinephrine

Corticosteroids are used to decrease inflammation
Racemic epinephrine causes vasoconstriction to decrease bronchial edema (short lived effects)

Question 24

What is used for the acute management of asthma?

Answer 24

short acting bronchodilators (albuterol/ levalbuterol), anticholinergics (ipratropium), IV/PO corticosteroids (prednisone)

Question 25

What is albuterol used for in the acute management of asthma?

Answer 25

acute exacerbations and excercise induced asthma

Question 26

What is the purpose of ipratropium in the acute management of asthma?

Answer 26

treats bronchospasms

Question 27

What is used for the chronic management of asthma?

Answer 27

long acting bronchodilators (formoterol, salmeterol), inhaled fluticasone, mast cell stablizers (cromolyn), leukotriene receptor agonists (montelukast)

Question 28

What is the purpose of formoterol/ salmeterol in the chronic management of asthma?

Answer 28

prevent exacerbations, esp. at night, must be used alongside anti-inflammatory therapy, not for acute exacerbations

Question 29

What is the purpose of fluticasone in the chronic management of asthma?

Answer 29

daily preventative measure, tx of choice, rinse mouth after use

Question 30

What does cromolyn do in the management of chronic asthma?

Answer 30

prevents histamine release from mast cells, decreases frequency and intensity of allergic reactions Prophylactic, not for relief of bronchospasms

Question 31

What does montelukast do for the management of chronic asthma?

Answer 31

decreases airway resistance, given once daily in evening

Question 32

What are some assessment findings of asthma?

Answer 32

nonproductive hacking cough (worse at night) dyspnea with excercise, chest tightness low O2 wheezing, coarse crackles, diminished silent chest restlessness, irritability, sweating, difficulty talking use of accessory muscles tripod positioning

Question 33

What is silent chest?

Answer 33

ominious sign, no air movement

Question 34

What are some diagnostics for asthma?

Answer 34

CBC: increased WBC and eosinophils ABG: increased CO2, decreased O2 Allergy/ Rast testing: identify triggers SpO2: decreased CXR: hyperinflation Pulmonary function test (spirometry) Peak inspiratory flow test

Question 35

What is a pulmonary function test? What is Peak inspiratory flow rate?

Answer 35

measures lung volume capacity and lung function; flow meter measures the amount of air that can be forcefully exhaled in 1 second

Question 36

What are nursing actions to treat status asthmaticus?

Answer 36

Continuous cardiorespiratory monitoring, O2, ABGs, administration of bronchodilators and anti-inflammatory meds, prepare for emergency intubation

Question 37

Is status asthmaticus mild asthma?

Answer 37

NO, life threatening episode of airway obstruction that is unresponsive to common tx

Question 38

What medications will be used to treat status asthmaticus?

Answer 38

Theophylline – anti-inflammatory and reverses corticosteroid resistance; has risk for toxicity and requires frequent monitoring of blood level Magnesium sulfate IV – relaxes bronchial muscles, expanding airways Heliox (mix of Helium and O2) – decreases airway resistance Ketamine – smooth muscle relaxant

Question 39

What are some assessment findings of epiglottitis?

Answer 39

rapid onset (within hours) high fever and toxic appearance drooling/ dysphagia unable to speal/ whispers tripod position with neck thrust forward absent cough anxiety / frightened appearance

Question 40

What is the priorities of care for epiglottitis?

Answer 40

**Secure airway**: prepare for endotracheal intubation Never attempt to visualize the throat d/t laryngospasm *Do not leave child unattended* No supine positioning 100% O2 in least invasive way Emergency airway equipment at bedside to prep for emergency tracheostomy **ICU admission** Meds: IV ABX; corticosteroids ## Footnote “If you make them cry, they might die”

Question 41

Assessment findings of forgein body aspiration

Answer 41

sudden onset of cough, stridor (foreign body in upper airway) wheeze, gradual respiratory distress

Question 42

What diagnostics will be used for foreign body aspiration?

Answer 42

CXR and bronchoscopy confirms FB presence

Question 43

What are the risk factors for foreign body aspiration?

Answer 43

6mo-3 years, small smooth objects

Question 44

Pt education for foreign body aspiration includes..?

Answer 44

Keep coins, small batteries/objects, latex balloons out of reach of children No popcorn or peanuts until age 3; chop all foods in small pieces

Question 45

S/S of R sided HF in a pediatric patient

Answer 45

Hepatomegaly Edema JVD Periorbital edema Weight gain

Question 46

S/S of L sided HF in a pediatric patient

Answer 46

Increased work of breathing Tachypnea Wheezing Rales Cough dyspnea on exertion feeding difficulties

Question 47

What meds are used to manage HF?

Answer 47

Beta Blocker (metoprolol) ACE inhibitor (catopril) Loop Diuretic (lasix) Glycoside (digoxin)

Question 48

How does metoprolol manage HF?

Answer 48

decreases HR and BP, promotes vasodilation Monitor HR and BP prior to admin s/e: dizziness, hypotension, headache

Question 49

How does catopril/ enalapril manage HF?

Answer 49

reduces afterload by causing vasodilation >> decreased pulmonary and systemic vascular resistance Monitor BP before and after administration

Question 50

How does a loop diuretic manage HF?

Answer 50

used to manage edema (rids body of excess fluid and sodium) K+ wasting Monitor BP, K+ levels, I&O, weight daily s/e: hypokalemia, N/V, dizziness, ototoxicity

Question 51

How does digoxin manage HF?

Answer 51

increases contractility of heart muscle Count apical pulse for 1 full min; hold if <90 bpm in infant; <70 in child; < 60 in adolescent Monitor serum digoxin levels (0.8-2ng/mL) Signs of toxicity: N/V, anorexia, bradycardia, dysrhythmias. Antidote: Digoxin immune Fab

Question 52

Priorities of care for a child with HF/CHD includes what three topics?

Answer 52

oxygenation, nutrition, assessment triangle

Question 53

What will the nurse focus on with " oxygenation" when caring for a pt with HF?

Answer 53

Airway patency Fowlers or Semi fowlers to facilitate lung expansion and decrease WOB and workload of heart Suction and CPT PRN Humidified O2 as ordered, monitor SpO2 and s/s of respiratory distress, intubation with PEEP if severe Relieve cyanotic spells

Question 54

What nursing interventions will be included in nutrition with a pediatric HF patient?

Answer 54

150calories/kg/day for nutrition with small, frequent feedings Concentrate infant formula to 24-28 calories/oz per directions Feedings should be limited to 20’ then reminder via OG/NG tube Cutting hole or cross in nipples decreases work of bottle feeding Semi upright position Breast milk or infant formula PO or gavage feedings; breast feeding requires less energy Human milk fortifier added to breast milk w gavage feedings to increase calories Formula fed infants with addition of polycose/vegetable oil to increase calories

Question 55

Appearance in HF pts

Answer 55

abnormal tone decreased activity level decreased consolability abnormal look/ gaze

Question 56

WOB in HF pts

Answer 56

abnormal sound abnormal position retractions flaring apnea gasping

Question 57

Circulation to skin in pts with HF

Answer 57

pallor, mottling, cyanosis

Question 58

What is a coarctation of the aorta?

Answer 58

Narrowing of the aorta that occurs most often near or beyond PDA, pressure increases near the defect and distal to it, ***causing an increase in BP in upper extremities, and decreased BP in lower extremities***

Question 59

What are some assessment findings with a coartaction of aorta?

Answer 59

Full bounding pulses in upper extremities Weak or absent pulses in lower extremities Soft or moderately loud systolic murmur at base or left axilla Frequent epistaxis; leg pain with activity d/t decreased CO (older child)

Question 60

What are some diagnostics for coartaction of aorta?

Answer 60

ECHO: extent of narrowing and collateral circulation CXR: L sided cardiomegaly, rib notching CT, MRI, ECG: prn

Question 61

What is the patho behind ventricular septal defect?

Answer 61

Acyanotic heart defect, opening between R and L ventricles of heart causing a LEFT to RIGHT shunt. increased blood flow to RV causes an increase in blood flow to the lung, leading to PA, HTN, RVH ## Footnote most common heart defect, 50% of cases resolve spontaneously

Question 62

What are assessment findings of VSD?

Answer 62

Holosystolic heart murmur along left sternal border, palpable thrill in chest, CHF systems

Question 63

What labs/ diagnostics will be done for a VSD?

Answer 63

Echo/cardiac MRI: looks at the extent of L --> R shunt Cardiac cath or surgery for larger defects to patch opening and pulmonary artery banding: eval hemodynamic flow pressures

Question 64

What is the Patent ductus arteriosus (PDA)?

Answer 64

failure of PDA to close resulting in a connection between aorta and pulmonary arteries, more common in premature infants ## Footnote normal at birth, but should spontaneously closed by 2 weeks of age (after maternal prostaglandins have cleared)

Question 65

What assessment findings will you see with PDA?

Answer 65

Tachycardia Diastolic BP decreased d/t shunting Harsh, continuous machine-like murmur loudest under left clavicle at 1st/ 2nd ICS Bounding peripheral pulses (from increased CO) Widened peripheral pulses (>30mmHg) Hypoxia/ resp. distress (d/t pulmonary edema)

Question 66

What treatment will you use for PDA?

Answer 66

Nonsurgical: Admin of ***indomethacin*** (NSAID that inhibits prostaglandins) , Diuretics, extra calories for infants Surgical: thoracoscopic repair (ligate vessels), insertion of coils to occlude to PED

Question 67

What is the fatal four of tetralogy of fallot?

Answer 67

1. Ventricular septal defect 2. Pulmonary stenosis >> R --> L shunt 3. Hypertrophy of Right ventricle > L Ventricle causing R- -> L shunt 4. Overriding Aorta --> hypoxemia

Question 68

What are the clinical features of tetralogy of fallot?

Answer 68

Fainting, difficulty breathing, easy fatigue, color changes w/ feeding, crying **Loud harsh systolic murmur** Polycythemia (results in increased blood viscosity) from kidneys stimulating RBC production d/t hypoxia TET spells (blue baby) – especially in morning; cyanosis, hypoxemia, dyspnea, agitation --> progresses to anoxia and unresponsiveness

Question 69

What nursing interventions would be used to treat tetralogy of fallot?

Answer 69

Use a calm, comforting approach Knee to chest position/ squatting to treat Provide supplemental oxygen Administer morphine sulfate (0.1mg/kg IV, IM, or SQ)- improves TET symptoms Supply IV fluids Administer propranolol

Question 70

How do you treat tetralogy of fallot?

Answer 70

Prostaglandins (keep PDA open to increase pulmonary blood flow) Surgical repair of R ventricular outflow obstruction and VSD closure

Question 71

What is kawasaki disease?

Answer 71

Acquired Cardiovascular Disorder: acute, febrile systemic vasculitis in blood vessels due to inflammation and edema; autoimmune response by unknown infectious organism , usually in child <5yrs

Question 72

What assessment findings will you see in the acute phase of kawasaki disease?

Answer 72

Extreme irritability Significant bilat. Conjunctivitis without exudate Bright red chapped lips, strawberry tongue, red inflamed pharyngeal mucosa Bilateral joint pain Enlarged lymph nodes desquamation (peeling) of fingers, toes, and perineal area; rash over body tachycardia, gallop, or murmur

Question 73

What is the nurse's priority of care with kawasaki disease?

Answer 73

reduce inflammation of walls of coronary arteries and prevent thrombosis Acute Phase: onset of high fever – prevent MI ischemia SubAcute Phase: resolution of fever and gradual resolution of other s/s

Question 74

What nursing actions will be completed for the cardiac status in a patient with kawasaki disease?

Answer 74

V S/Telemetry, Assess for S/S of HF (↓UOP, gallop, tachycardia, Resp. distress) Monitor strict I&Os, Daily weights

Question 75

What nursing interventions for promoting comfort will be included in patients with kawasaki disease?

Answer 75

Admin acetaminophen for fever and cool cloths if tolerated Rest/quiet/atraumatic care Irritability/ inconsolable: most difficult problem, need rest and quiet family support Clear liquids; soft foods; lip lubricants and mouth care

Question 76

What medications are used in the treatment of kawasaki disease?

Answer 76

Immunoglobulin (IVIG): high dose IV ( 2g/kg) over 8-12hr High- Dose Aspirin: 80-100mg/kg/day q6hr followed by 3-5mg/kg/day after fever breaks; indefinite if aneurysms develop Additional anticoagulants if large aneurysms

Question 77

What is the patho behind acute rheumatic fever?

Answer 77

Group A streptococcus (GAS) triggered by strep bacteria, attacks cardiac muscle and neuronal synovial tissue affects CNS, joints, and skin and subq tissue. Causes progressive heart and mitral valve damage. Results in heart murmur, painful joints, fever of 38.2-38.8

Question 78

What will you see in a patient hx with ARF?

Answer 78

Sore throat (pharyngitis) w/in past 2-3 weeks, recurrent URI or skin infections, reports of fever and joint pain. Child aged 5-15years; during colder months.