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NURS 307-PEDS > Week 2 > Flashcards

Week 2 Flashcards

Study Guide (84 cards)

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1
Q

S & Symptoms of Respiratory Distress Syndrome

A

-Expiratory Grunting
-Hypothermia
-Hypotonic Muscle Tone
-Central Cyanosis
-Lethargic
-Hypoglycemia
-Tachypnea

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2
Q

S & S of Neonatal Sepsis

A

-Expiratory Grunting
-Hypothermia
-Hypotonic Muscle Tone
-Lethargy
Tachypnea

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3
Q

S & S of Neonatal Abstinence Syndrome

A

-Hypoglycemia, although strong sucking, will not feed
-Tachypnea
-Tremors

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4
Q

What is a preemie at risk for if respiratory distress syndrome id left untreated?

A

-Increased Atelectasis due to lack of surfactant

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5
Q

The treatment plan for a respiratory exacerbation and failure to thrive for Cystic Fibrosis

A

*airway clearance therapy (chest physiotherapy and postural drainage)
*Nebulized bronchodilators and mucolytics
*High-Calorie diet with pancreatic enzymes (before the meal)
*IV antibiotic therapy
*Regular Pulmonary function tests
*Psychosocial support for the family

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6
Q

Should you give high levels of oxygen to a client with cystic fibrosis?

A

No, due their chronic respiratory condition, their body relies on CO2 levels not o2 levels, like someone with COPD

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7
Q

Place clearance techniques in order for optimal mucous clearance:
1. Administer Bronchodilator (Albuterol) via nebulizer
2. Perform chest physiotherapy and postural drainage
3. Encourage coughing and suction if needed
4. Administer mucolytic agent (Dornase Alfa)

A

1) Administer Bronchodilator (Albuterol) via nebulizer
2) Administer mucolytic agent (Dornase Alfa)
3) Encourage coughing and suction if needed
4) Perform chest physiotherapy and postural drainage

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8
Q

What is cluster care?

A

A nursing technique that involves performing multiple tasks for a patient at the same time, instead of doing them individually-use in order to provide rest/ recovery

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9
Q

Biological Growth and Physical Development-external proportions

A

Infant-growth from trunk
head is the largest part, proportions will alternate with growth

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10
Q

Growth and Development-Skeletal and maturation, most accurate measurement?

A

*epiphyseal plate, site of longitudinal growth of the long bones

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11
Q

Metabolism-Physiological Changes

A

With each degree of fever increase, basal metabolism increases 10%, corresponding increase in fluid requirement

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12
Q

Spends more time in sleep…

A

infants

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13
Q

The most important influence on growth

A

Nutrition

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14
Q

Universal medium of play

A

*children learn what no one else can teach them

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15
Q

What are genes?

A

Segments of DNA that contain genetic information to control certain physiological functions/ characteristics

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16
Q

Congenital anomalies/ birth defects

A

2-4%, classified as deformity, disruption, dysplasia, or malformation

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17
Q

Congenital anomalies (structure) or birth defects are seen…

A

immediately after birth

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18
Q

Genetic Disorders can be caused by…

A

chromosomal abnormalities

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19
Q

Examples of genetic disorders…

A

*sickle cell anemia
*down syndrome
*Turner syndrome
*Muscular dystrophy

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20
Q

Genetic disorders are not…

A

always seen after birth, but growing/ environmental factors

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21
Q

Role of the Nurse in genetics

A

Perform and full assessment (no history), I.D. then refer through testing, educate parents on discovery and treatment

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22
Q

Health problems-Newborns, how does head trauma occur

A

Falls, birth, shaking…ICP can cause brain bleeding
…paralysis (Cranial Nerve 7)-most common

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23
Q

Newborn Head trauma causes intraventricular bleeding which increases ICP effecting…

A

Neural development
-watch for S &S of hemorrhage and neural system decline

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24
Q

The most common newborn fracture is clavicle caused by….

A

birth positioning, LGA…immobilize the arm with good alignment w/ the body, tell parents to be gentle

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25
Structural Defects-Cleft lip
-formed during embryonic -development from incomplete fusion of the oral cavity -Surgery should be performed first 2-3 months of life
26
Structural defect-Cleft Palate
Forms during embryonic development, incomplete fusion of the palate -surgical repair at 6-12 months
27
Newborns/ infants with a cleft palate are at risk for.
Aspiration, infection, conduction hearing loss and malnutrition
28
Pre-Op consideration for CL: Educate about proper feeding and care, assess the ability to feed
*encourage breast feeding *wide based nipples- unidirectional (firm to palate, supine) *squeeze cheeks to decrease gap *more burping *upright position, cradle head *syringe feedings *consider aspiration
29
Educate about proper feeding and care, assess the ability to feed, CP-Pre-Op
-Upright position and cradle head with feeds -Special bottle one way valve and special nipple, vacuum seal -Frequent burps -Syringe feeds
30
Post-op CL and CP repair
*pain management *elbow restraints (release hourly) *no pacifiers (hard) *Cl repair: supine/ side-lying *CP repair: prone (drainage), NPO then slow progression>soft diet)
31
Post-op CP & CL Education/ complications
*diet/ feeding techniques *complications: -ear infections (mid ear( -difficulty eating -altered structure/ recurrent infections -speech/ language impairment (CP) -dental-abnormal eruptions
32
Before Feeding: CP/ CL
check gag reflex, GI sounds (increase w/ tolerance), swallow reflex
33
High-risk Newborn (preemie-1st 28-days)...why?
Hyperbilirubinemia Respiratory Destress neonatal seizure newborn sepsis NEC Drug-exposure Phenylketonuria
34
Hyperbilirubinemia-characterized by:
*jaundice, yellow skin/ sclera/ nails
35
Hyperbilirubinemia-Causes *ask if previous hx. w/ other children
-Physiological Jaundice-inability to excrete bili initially -breastfeeding-hormone increase bili, not enough milk (dehydration), C-section -Hemolysis (ABO incompatible/ hemolytic disease) -inadequate liver function -cephalic hematoma -umbilical cord (broken RBC)
36
Hyperbilirubinemia- Diagnosis
Blood test, heel-stick
37
bilirubin encephalopathy
-deposits of unconjugated bilirubin into brain cells
38
Kernicterus
yellow staining of brain cell from bilirubin ecepalopathy
39
Bilirubinemia-Treatment
-prevent increase in bili, minimize treatment S/E -phototherapy -exchange transfusion -hydration/ breast milk-remove for only 15 min. pump after for bottle
40
Phototherapy-insoluble bili to soluble
*IV fluids-fluid loss-sweat *moves to stool (yellow)-effective -recheck labs for decrease
41
Exchange transfusion-aggressive
*through central line-umbilical cord, * (3) nurse documents VS-every 5 minutes @ bedside *after-phototherapy
42
Respiratory Distress Syndrome, high risk-preemies
*developmental delay in lung maturation, not enough surfactant, alveoli collapse expiration (atelectasis), unequal alveoli inflation (inhalation) *unable to inflate lungs
43
RDS- clinical manifestation
-tachypnea -dyspnea -intercostal/ substernal retractions -fine inspiratory crackles -nasal flaring -pallor -cyanosis -grunting
44
RDS-management (preemie anticipation-dexamethasone)
*Intubation *Provide liquid surfactant (inhalation) *half-dose one side, middle, other side rest of dose (push ambu after dosing) -prevent hypotension, acid-base balance
45
RDS- dessating before surfactant
1) suction first-cannot 1-2 hours after med admin 2) give oxygen 3)then fluids (electrolyte imbalances) -order ABGs/ BMP -keep warm
46
Neonatal Sepsis- causes
-bacterial infection in blood stream -across placenta (bloodstream, birth) -ingestion/ aspiration infected amniotic
47
PKU expected findings
-FTT -vomiting -irritable -musty urine odor -microcephaly -heart defects
48
Neonatal Sepsis-early (< 3 days after birth), late (1-3 weeks), diagnosis (clinical S/S), manifestations?
-hypothermia -drainage -weak suck/ decreased intake -V/ Diarrhea -poor weight gain -large residual (gavage) -abd. distension -respiratory distress -hypoactive/ tonic -pale
49
Prevent Neonatal Sepsis
Screen mom-GBS good hygiene isolation breastfeeding
50
Manage/ Care Neonatal Sepsis
-supportive (O2), fluids, transfusion, electrolyte acid-base balance -Pan-Culture (blood, stool, urine), 3 days, 1 week -give broad spectrum, them specified antibiotic -Perform BMP/ ABG
51
Neonatal Sepsis- closely assess/ monitor...complications
-meningitis and septic shock
52
NEC-life-threatening, preemies high-risk
*poor blood supply causes infection
53
Why NEC?
Intestinal ischemia and inflammation Bacterial/viral infection Enteral feeding Immature GI mucosa Medical NEC**
54
What to do...NEC?
Serial X-ray and abd girths (4-6 hr) Monitor for blood emesis and stools Watch labs, cultures for changes and growth NPO for bowel rest (5-7 days) begin antibiotics, NGT suctioning (low-intermittent) CVC and TPN/ IL nutrtion
55
Drug Exposed Infant (Alteration in breathing to death), how to test?
Newborn urine, hair, or meconium sampling Before feeding and at least 2 hours after birth, then every time before feeding NAS score b/c putting on medication can be discharged after 24-hours of low NAS score and mother is provided stability
56
PKU-test
heel-stick to assess at least 24-hours after birth b/c they have to eat first retest in 7-10 days to ensure no false negatives
57
PKU?
inborn error of metabolism inherited as an autosomal recessive trait (the PAH gene is located on chromosome 12q24), is caused by a deficiency or absence of the enzyme needed to metabolize the essential amino acid phenylalanine
58
PKU confirmation
Places infant at risk for convulsion, diagnose 24 hours after fed, if the test is confirmed for a second time provide a low protein formula
59
SIDS
Third leading cause of infant mortality under 1 year of age Education about Back to Sleep Campaign  Pacifier use linked to decreased incidences
60
Poisoning-Emergency Treatment
First Priority: Stabilize the patient, then determine what was consumed. Treatment: Remove from exposure. Chelation therapy (lead poisoning antidote) may be needed. Screening: Screen for lead poisoning at 1 year old. Health Effects: Brain/nervous system damage. Learning/behavioral issues. Slowed growth, hearing/speech problems, lower IQ. Decreased attention span and school performance. Gasoline Poisoning: Be aware of risks; follow similar treatment guidelines. Always call poison control first for advice.
61
Testicular Torsion
Testicular Torsion, testes rotate on spermatic cord, cutting off blood supply, must fix within 6 hours to save, can be caused by trauma or birth defect
62
Sexually transmitted infections
*best is prevention, educate!!! *any case of STI must report to the health department
63
Airway Diameter
If infection of inflammation they can block to airway
64
Pulse Oximeter: Respiratory
Always connect to pulse oximeter. Position patient to facilitate oxygen intake. Be cautious: the light from the pulse oximeter can burn the baby’s skin. Check/change the pulse oximeter every few hours, especially in infants or preemies. Readings may not be accurate if not positioned properly.
65
Inhaler Use
With metered-dose inhalers or dry powder inhalers, ask children to rinse their mouth after use. This helps avoid thrush or candida infections from steroid medication.
66
Do NOT perform CPT on patients with
Blood clots Pulmonary embolism Broken ribs Spinal injuries High intracranial pressure (ICP
67
Early signs of hypoxia
Tachycardia (increased heart rate) Tachypnea (increased breathing rate) Restlessness Pale skin
68
late signs: hypoxia
Bradycardia (decreased heart rate) Bradypnea (decreased breathing rate) Lethargy Confusion Cyanosis (bluish skin color)
69
100% O2
Oxygen saturation of 100% is not ideal; it can lead to oxygen toxicity, which can affect hearing.
70
Suctioning
Hold suction for less than 5 seconds for infants. Hold suction for 10 seconds for toddlers and older children. Oxygen levels will drop during suctioning but should return to normal once suctioning stops.
71
VAP
Ventilator associated pneumonia
72
Artificial airways complication
Artificial Airways Suctioning Oral care (VAP!) Complications Decannulation, occlusion
73
Otitis Externa
swimmers ear not drying, main cause inflammation -S & S-itching, drainage Treat w/ steroid ear drops, Tylenol for pain/ itching, irrigate ears
74
otitis media
Child often tugs on affected ear, fussiness, fever Short eustachian tubes Recurrent if smokers in family Recurrent can lead to tonsillitis
75
Tonsillitis
Enlarged tonsils can interfere with breathing, nasal and sinus drainage, sleeping, swallowing, and speaking.
76
Enlarged tonsils also can disrupt the function of the eustachian tube, which can impede hearing.
Risk for recurrent otitis media!
77
Acute tonsillitis
Tonsils become inflamed and reddened Small patches of yellowish pus also may become visible. Acute tonsillitis may become chronic
78
More serious in pediatric airway due to smaller airway
Tonsillitis
79
Positive culture for Group A beta hemolytic strep (GABHS)
tonsilitis
80
Epiglottitis
Not as threatening since Hib vaccine Look for inspiratory stridor, drooling
81
Laryngotracheobronchitis
Barking cough
82
croup syndromes
life-threatening condition; partial or full occlusion, horse/ froggy/ stridor, chest retractions, dyspneic, must have intubation ready at bedside fever
83
lateral neck X-ray to confirm diagnose, never culture the throat-will make it worse
croup syndrome
84

NURS 307-PEDS (2 decks)

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