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Research > Peds Exam 2 > Flashcards

Peds Exam 2 Flashcards

1
Q

What is kawasaki’s disease?

A

An autoimmune disease, also called muco-cutaneous lymph node syndrome.
-Vasculitis affecting medium arteries in many body systems

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2
Q

What is the most common cause of acquired heart disease in children?

A

Kawasaki disease

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3
Q

Pathophysiology of Kawasaki’s disease?

A

Inflammatory process of medium arteries. Most common in kids 5 and younger (esp Asian children)

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4
Q

Signs and symptoms of Kawasaki disease?

A

***increased platelet count and signs of CHF

Stage 1: fever >5 days; conjunctivities, dried lips/mucous membranes, strawberry tongue, swollen hands/feet/ red body rash, lymphadenopathy (esp in neck)

Stage 2: fever resolves, irritable, anorexia, DESQUAMATION of hands/feet (peeling), arthritis/arthralgia, CV issues

Stage 3: ESR (inflammatory marker) decreases, disease appears to resolve (but it’s not)

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5
Q

Treatment of Kawasaki disease?

A
  • IVIG administration (decreases inflammatory affects)

- aspirin (decreases clot formation and inflammation)

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6
Q

Cardinal sign of Kawasaki disease?

A

fever for more than 5 days

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7
Q

Name 2 diseases where it is OK to give kids aspirin

A

Rheumatic fever and Kawasaki disease

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8
Q

How does Rheumatic fever come about?

A

A diagnosed streptococcus infection combined with some Jones’ criteria

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9
Q

How much Jones’ criteria needs to be met to diagnose rheumatic fever?

A

2 major criteria OR 1 major and 2 minor criteria

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10
Q

function of the epiglottis

A

protection of the airway

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11
Q

Cardiac assessment in children

A 
Assess for full minute at 4th intercostal space if:
-up to 2 yo
-known cardiac abnormality
-sick
Don't let them know you're counting!
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12
Q

Normal HR in infants

A

80-140

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13
Q

normal HR in adolescents

A

60-100

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14
Q

how is the heart blood shunted in ACYANOTIC cardiac anomalies

A

from left to right

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15
Q

how is the heart blood shunted in CYANOTIC cardiac anomalies

A

from right to left

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16
Q

Name 3 ACYANOTIC cardiac anomalies

A
  1. atrial septal defect
  2. ventricular septal defect
  3. coarctation of the aorta
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17
Q

what is an atrial septal defect?

A
  • a hole exists btwn L and R atria
  • wal defect allows L–>R shunting
  • there’s incr pulmonary blood flow (pressure is pushing oxygenated blood to cycle back thru th R side of heart thru to lungs)
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18
Q

Signs and Sx of ASD

A
  • can sometimes be asymptomatic
  • paradoxical embolus (can happen if straining (i.e. bathroom) can cause R pressure to overcome L-side pressure
  • Dyspnea; easily fatigued
  • SYSTOLIC MURMUR at pulmonic region
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19
Q

What would you see on an echocardiogram of a child with ASD?

A

right ventricular hypertrophy

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20
Q

What might you hear on auscultation of a child with ASD?

A

split S2 sound

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21
Q

Antibiotic prophylaxis education, according to AHA, is recommended for anyone who:

A
  • has had heart surgery and is in their 1st 6 months post heart surgery
  • has had a prosthetic device place
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22
Q

What is a ventricular septal defect

A

-hole btwn R and L ventricles (allow L to R shunting

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23
Q

Signs and Sx of VSD

A
  • can be asymptomatic
  • if larger, can cause: tachypnea; dyspnea; fatigue
  • SYSTOLIC MURMUR at LLSB
  • congestive heart failure
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24
Q

What would you see on an ECG of a child with VSD

A

right ventricular hypertrophy

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25
Q

Which cardiac defect is more likely to close on its own btwn ASD and VSD?

A

VSD

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26
Q

Oral health teaching for children with ASD and VSD

A
  • counsel parents of high-risk children about need for both prophylactic antibiotics for dental procedures and maintaining excellent oral health.
  • child’s dentist should be aware of the child’s cardiac condition.
  • Dental procedures should be done to maintain a high level of oral health
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27
Q

What is coarctation of the aorta?

A

– Descended aorta has narrowing/constriction (BOTTLENECK) leading to decr blood flow to periphery & rest of body

  • often occurs near ductus arteriosus
  • can lead to CHF and death
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28
Q

what are signs and Sx of coarctation of the aorta?

A
  • cold feet
  • cramping of lower extremities
  • BP and pulse differences (upper is stronger than lower)
  • Excercise intolerance and dyspnea
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29
Q

What would you see on a ECG and x-ray test of a child with a coarctation of the aorta?

A

ECG: coarc is visible

X-ray: heart may be enlarged

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30
Q

Surgery options for coarc of the aorta

A

if mild coarc: balloon catheterization w/ stents

if moderate/severe: whole coarc is opened, coarc removed and patched with GORTEX PATCH

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31
Q

Name 3 CYANOTIC heart anomalies

A
  1. tetralogy of fallot
  2. transposition of the great vessels
  3. hypospalstic left heart syndrome
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32
Q

What are the 4 defects that exist in Tetralogy of Fallot?

A
  1. pulmonic stenosis (hardening of pulmonic valve)
  2. R ventricular hypertrophy
  3. ventricular septal defect
  4. overriding aorta
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33
Q

what is tetralogy of Fallot?

A

-4 defects of heart which create a R to L shunting of blood
-Deoxygenated blood gets pushed out from RV through a VSD and an overriding aorta leading to deoxygenated blood getting pushed out to body
(constant battle of blood to get into either the pulmonary artery or the aorta)

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34
Q

Signs and Sx of tetralogy of fallot

A
  • “TET” spells
  • SYSTOLIC MURMUR an pulonic region (caused by harsh blood flow thru defects)
  • clubbing
  • Persistent hypoxemia stimulates erythropoiesis, which results in polycythemia, (increased RBCs).
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35
Q

What is a tet spell?

A
  • Life threatening
  • caused by crying, tantrums, stooling, feeding (d/t incr in R to L shunting into aorta bc pulmonary resistance has suddenly increased.
  • induces hypoxia, pallor, tachypnea
36
Q

nursing intervention for tet spell

A

squatting (for kids) or knees to chest (for infants)

37
Q

nursing interventions for tetralogy of fallot

A
  • keep ductus arteriosus open (GIVE PROSTAGLANDINS)
  • teach about signs, Sx, and relief of TET spells
  • post-surgical teaching (ALL PTS WILL NEED MULTIPLE SURGERY)
38
Q

what is Transposition of the Great Vessels?

A
  • switching of great vessels (aorta is connected to RV and pulmonary artery is connected to LV)
  • right to left shunting occurs and CYANOSIS
  • Creates 2 independent, closed pathways of circulation
  • definitely needs another anomaly/defect to survive (ASD, VSD, or PDA)
39
Q

Signs and Sx of transposition of the great vessels

A 
–	Cyanosis
–	Hypoxia
–	Tachypnea
–	Poor feeding ( too tired to eat)
–	Failure to thrive
40
Q

-Nursing interventions for transposition of great vessels

A
  • keep ductus arteriosus open (PROSTAGLANDINS)

- post surgery teaching (surgery is obligatory)

41
Q

What is Hypoplastic Left Heart Syndrome (HLHS)

A
  • very small (thick) left ventricle

- inability to adequately pump oxygenated blood to aorta and systemic circulation

42
Q

Patho of hypoplastic left heart syndrome

A
  • Aortic and mitral valves tend to be absent or stenotic (bc no blood is pumping through them)
  • leads to hypertrophy of R ventricle
43
Q

signs and Sx of hypoplastic left heart syndrome

A 
–	Tachypnea
–	Increased work of breathing
–	Cyanosis
–	Poor peripheral perfusion
–	If not treated, it will ALWAYS result in Congestive heart failure
44
Q

nursing interventions for HLHS

A
  • surgery needed ASAP (multiple surgeries necessary for life)
  • Keep ductus arteriosus open (Prostaglandins)
45
Q

Nursing Dx for CYANOTIC cardiac defects

A
  • Ineffective cardiopulmonary tissue perfusion
  • At risk for infection
  • Risk for imbalanced nutrition: less than body requirements
  • Risk for impaired gas exchange
  • Risk for decreased cardiac output
46
Q

name 3 acquired heart illnesses

A

rheumatic fever, kawasaki’s disease, congestive heart failure

47
Q

Definition of rheumatic heart disease

A
  • systemic inflammatory disease,
  • heart and joint involvement,
  • may involve connective tissue
48
Q

Patho/etiology of rheumatic fever

A
  • occurs 1-3 weeks after STREP infection
  • acute phase (2-3 weeks): inflammation of connective tissue in the heart, joints, and skin
  • proliferative phase: cardiac valves scar–>stenosis occurs
49
Q

how is rheumatic fever diagnosed?

A
  • a confirmed strep test (ASLO (anti-streptolysin O titel) is best)
  • Jones’ criteria
50
Q

What are the “major” Jones’ criteria?

A
  • Joint pain/involvement
  • Carditis (murmur, pericardial friction rub, EKG changes, tachycardia)
  • nodules- non-tender nodules/masses on flexor surfaces
  • Erythema marginatum: macular rash (red and patchy, esp on trunk), erythematous
  • chorea: involuntary movement of limbs, slurred speech
51
Q

What are the “minor” Jones’ criteria?

A
  • Fever
  • arthralgia
  • prolonged P-R and/or QT interval on EKG
  • elevated ESR and CRP and reduced RBC
52
Q

How do you treat rheumatic fever?

A
  • Aspirin
  • prednisone (helps to reduce inflammation)
  • bed rest (until ESR normalizes) (be sure to provide mental stimulation, e.g. bring HW to hospital)
  • don’t move joints during acute phase
53
Q

What is the most serious complication of Kawasaki’s disease?

A

coronary artery aneurysms and potential for MI in kids w/ aneurysm formation

54
Q

What is congestive heart failure?

A

when the heart is unable to affectively pump blood to the body (occurs SECONDARY to cardiac defect (it’s not its own illness)

55
Q

Treatment for CHF?

A
  • Fix the underlying problem

- Meds: digoxin (monitor for bradycardia), furosemide/lasix (monitor electrolytes), and ACE inhibitors

56
Q

what is laryngotracheobronchitis?

A

viral croup

57
Q

what is bacterial croup?

A

epiglottitis

58
Q

Etiology of croup

A

usually comes from RSV or influenza infection (but can be from any virus)

59
Q

Signs and Sx of croup

A 
–	Monitor for respiratory distress
•	Inspiratory stridor (EMERGENCY)
•	Retractions
•	Nasal flaring
•	Decreased pulse-ox
•	Coughing (very specific sound, like a seal or dog barking)
•	NO DROOLING (these pts can swallow) NO TRIPOD (pts can lay down fine)
•	Very low-grade fever
60
Q

differences btwn croup and epiglottitis?

A

In epiglottitis there is drooling, tripodding, and a high fever

61
Q

what precautions are necessary for a croup patient?

A

droplet precautions (bc they’re coughing so much)

62
Q

Nursing interventions for croup

A

– Monitor for respiratory distress.
• Homeopathic interventions: Provide cool mist humidified oxygen. Cool, humid walk outside. Head in fridge. Elevate HOB
• Provide fluids and comfort measures (mild croup)
• Keep child calm as best as possible

– Medications as ordered
• Oxygen
• Dexamethosone

63
Q

How does epiglottitis come about?

A

from a Haemophilus influenzae type b infection

64
Q

Signs and Sx of epiglottitis? (think of the 4 D’s)

A 
–	**Tripodding
–	4 D’s: 
•	Dysphonia: Muffled voice/hot potato voice/frog voice
•	Dysphagia: Painful swallowing
•	Dyspnea: Trouble breathing [STRIDOR]
•	**Drooling 
-NO COUGHING
65
Q

Nursing interventions for epiglottitis

A

– ***Nothing by mouth!
– Reduce stimuli (keep kid distracted and calm bc crying/screaming can aggravate the epiglottis)
– **Airway tray ready/intubation tray ready
– Antibiotics/fluids as ordered (full course critical but be ready to intubate bc child may get upset when IV is put in)
– Continuous pulse ox (stay in hospital until Sx are relieved)
– Calm the child
– Use strict hygiene measures
- teach importance of HIB vaccine

66
Q

what is the number 1 cause of bronchiolitis?

A

RSV

67
Q

What is bronchiolitis?

A

inflammation of the bronchioles (lower airway)

68
Q

What are the signs and Sx of bronchiolitis?

A 
–	Tachypnea
–	Wheezing
–	Cough
–	Rhinnorhea
–	Sneezing
69
Q

Nursing interventions for bronchiolitis

A 
–	**Positioning (sitting up)
–	Monitor pulse ox
–	Suctioning 
–	Oxygen as ordered
–	**No antibiotics! (it’s virus)
–	**No cough suppressants!
–	Teach abt vaccinations (for high risk children there is a vaccine for RSV. Also push influenza vaccine)
70
Q

How is RSV transmitted?

A

VIA DROPLETS, USE DROPLET PRECAUTION

71
Q

What is pneumonia?

A

inflammation/infection of the alveoli

72
Q

What are the types of pneumonia (3)?

A

viral; bacterial (most severe) and aspiration

73
Q

Nursing interventions for pneumonia?

A

– Chest PT (to loosen secretions)
– Monitor pulse-ox (give O2 & meds as per ordered)
– Lay on affected side
– Monitor of signs and Sx of dehydration
– Administer liquids to break up secretions as best possible

74
Q

definition of asthma

A

chronic airway inflammation

75
Q

what is the leading cause of chronic illness in kids?

A

asthma

76
Q

Signs and Sx of asthma

A

– Dyspnea
– Wheezing (esp distinctive on auscultation)
– Chest tightness (in older kids, might be only complaint)
– Non-productive cough
– Tachypnea
– Hypoxia
– Prolonged expiration (d/t air trapping)
– Symptoms increase with exercise (some kids have exercise-induced asthma, they should use albuterol prior to exercise)

77
Q

nursing interventions for asthma

A

– Monitor pulse-ox
– Administer O2/meds per order
• **Short-acting beta-2 agonist: Albuterol (w/ 1ST symptoms
– Prior to activity for exercise-induced asthma
• *IInhaled corticosteroids: Pulmocort (budesonide) or Flovent (fluircasone)
• Systemic cortiosteroids: Prednisone
– Airway tray available

78
Q

what is cystic fibrosis

A
  • multisystem autosomal recessive trait disorder
  • overproduction of thick muous resulting in insult to the respiration, GI & reproductive systems
  • Mechanical obstruction caused by increased viscosity of mucous gland secretions
79
Q

How is cystic fibrosis diagnosed?

A

– *Positive newborn screen

– *Confirmed by sweat chloride test

80
Q

Signs and Sx of cystic fibrosis

A 
–	Cough
–	Clubbing 
–	Barrel chest
–	Intestinal obstruction (d/t mucus)
–	Frothy/foul-smelling stool 
–	Failure to thrive
–	earliest clinical manifestation of CF is a meconium ileus (bowel obstruction)
81
Q

nursing interventions for cystic fibrosis

A

• Nursing interventions:
– Chest PT (daily, sometimes multiple times/day)
• Administer bronchodilator meds BEFORE chest PT
– Monitor pulse-ox
– Administer O2/meds as per orders
– Monitor of signs and Sx of dehydration
– **high cal high protein diet (very important!)

82
Q

signs and Sx of foreign body obstruction

A 
–	Cough
–	Choking
–	Gagging
–	Unresponsive
–	*Stridor 
–	*Wheezing
–	Asymmetric breath sounds
•	Unilateral foul-smelling nasal discharge & frequent sneezing
–	Asphyxiation (condition of severely deficient O2 supply to body that arises from abnormal breathing)
83
Q

Prevention and teaching strategies for foreign body obstruction

A
  • Dangers of certain foods/which foods are common choking hazards
  • Toy age requirements
  • Heimlich maneuver (teach it to parents!)
84
Q

Emergency measures for foreign body obstruction

A
  • Activate emergency response
  • Perform Heimlich maneuver
  • Place IV
  • Prepare for endoscopy
85
Q

What is SIDS?

A

– Unexpected death of previously healthy infant less than ONE year old

86
Q

What is nursing teaching for SIDS?

A
  • **Back to sleep (big push on this since 1994)
  • Crib
  • No blankets/toys
  • No smoking
87
Q

An infant has tetralogy of Fallot. In reviewing the record, what laboratory result should the nurse expect to be documented?

a. Leukopenia
b. Polycythemia
c. Anemia
d. Increased platelet level

A

b. Polycythemia

Persistent hypoxemia that occurs with tetralogy of Fallot stimulates erythropoiesis, which results in polycythemia, an increased number of red blood cells.

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