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Pediatrics > Week 3, Class 2 (9/15) > Flashcards

Week 3, Class 2 (9/15) Flashcards

1
Q

Heart failure assessment findings

A

Tachycardia during rest and slight exertion
Tachypnea
Profuse scalp sweating
Sudden weight gain
Respiratory distress

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2
Q

Heart failure considerations

A

Daily weights (Weight gain of 1lb in 24hr= fluid retention)
Monitor respirations and apical pulse
Monitor for facial or peripheral edema
Elevate HOB

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3
Q

Heart failure nursing considerations cont.

A
  • Administer digoxin, monitor for bradycardia and vomiting—> digoxin toxicity*
    -Dehydration can increase risk for toxicity
    Provide frequent rest periods, Cluster care
    Frequent small feedings
    Monitor for hypokalemia
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4
Q

When do you withhold digoxin in pediatric patients?

A

If the pulse is < 90-110 in an infant or young child
Below 70 in an older child

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5
Q

What to do if you miss a dose of digoxin?

A

If MORE than 4 hours have passed, Withhold the dose and give next dose at scheduled time
If LESS than 4 hours have passed, Administer the missed dose

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6
Q

Types of Cardiac defects due to increased pulmonary blood flow

A

Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Atrioventricular canal defect
Patent ductus anteriosus (PDA)

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7
Q

Atrial septal defect

A

Abnormal opening between the atria results in an increase flow of oxygenated blood into the right side of the heart

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8
Q

Ventricular septal defect

A

Abnormal opening between the right and left ventricles

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9
Q

Atrioventricular canal defect

A

Resulting from incomplete fusion of the endocardial cushions, often seen in children with down syndrome

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10
Q

Patent ductus arteriosus

A

The fetal ductus arteriosus fails to close during the first weeks of life.
Machinery like murmur audible on auscultation
Widened pulse pressure and bounding pulses are present

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11
Q

Medication given to close patent ductus arteriosus

A

Indomethacin, prostaglandin inhibitor

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12
Q

Medication given to keep the patent ductus arteriosus open

A

Prostaglandin E

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13
Q

Obstructive cardiac defects

A

Coarctation of the aorta
Aortic stenosis
Pulmonary stenosis

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14
Q

Coarctation of the aorta

A

Localized narrowing near the insertion of the ductus arteriosus

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15
Q

Coarctation of the aorta findings

A

Blood pressure higher in the arms than in the legs
Coolness in the legs and weak femoral pulses
Headache, dizziness, fainting, epistaxis

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16
Q

Aortic Stenosis

A

Narrowing or stricture of the aortic valve causes resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion.

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17
Q

Aortic stenosis findings

A

Signs of decreased cardiac output: faint pulses, Hypotension, tachycardia, and poor feeding.
Exercise intolerance
Chest pain
Dizziness when standing for long periods of time

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18
Q

Pulmonary stenosis

A

Entrance to the pulmonary artery is narrowed

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19
Q

Pulmonary stenosis findings

A

Newborns with severe narrowing are cyanotic
Pulmonary atresia

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20
Q

Types of Cardiac defects due to decreased pulmonary blood flow

A

Tetralogy of Fallot
Tricuspid Atresia

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21
Q

Tetralogy of Fallot

A

Comprises four defects:
1) Ventricular septal defect
2) Pulmonary stenosis
3) Overriding aorta
4) Right ventricular hypertrophy

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22
Q

Tetralogy of Fallot assessment findings

A

Acute to mild cyanosis
Acute episodes of hypoxia (hyper-cyanotic spells) “Blue spells or Tet spells”, Occurs when the infants oxygen requirements exceed blood supply
Squatting may be noted (shunts blood flow to the head)

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23
Q

Tricuspid atresia

A

Tricuspid valve fails to develop, meaning that there is no communication between the right atrium and the right ventricle.

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24
Q

Tricuspid atresia assessment findings

A

Mixing of unoxygenated and oxygenated blood in the left side of the heart result in systemic desaturation, pulmonary obstruction, and decreased pulmonary blood flow
Cyanosis, tachycardia, and dyspnea seen in affected newborn
Older children exhibit chronic hypoxemia and clubbing

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25
Q

Mixed cardiac defects

A

Transposition of the great arteries/transposition of the great vessels,
Total anomalous pulmonary venous connection,
Truncus arteriosus,
Hypoplastic left heart syndrome
* all cause desaturation of systemic blood flow* 

26
Q

Transposition of the great arteries

A

Aorta and pulmonary arteries are switched
No communication between the systemic and pulmonary circulations

27
Q

Transposition of the great arteries assessment findings

A

Cyanosis
Cardiomegaly

28
Q

Transposition of the great arteries treatment

A

Prostaglandin E1 may be administered to temporarily increase blood mixing

29
Q

Total anomalous pulmonary venous congestion

A

Pulmonary veins fail to join the left atrium
Mixed blood is returned to the right atrium and shunted from the right to the left through an atrial septal defect

30
Q

Total anomalous pulmonary venous congestion assessment findings

A

Right ventricle hypertrophy
Cyanosis

31
Q

Truncus arteriosus

A

a single vessel that overrides both ventricles
Causes desaturation and hypoxemia

32
Q

Hypoplastic left heart syndrome

A

Under development of the left side of the heart resulting in a hypoplastic left ventricle and aortic atresia
Fatal in the first months of life without intervention

33
Q

Basic care and interventions for cardiac defects

A

Monitor for nasal flaring and use of accessory muscles (If respiratory effort is increased place child in reverse Trendelenburg position)
Monitor for hyper cyanotic spells (if one occurs place infant in knee to chest position, administer 100% oxygen by facemask, and administer morphine sulfate and IV fluids as prescribed)
Daily weights,
Provide adequate nutrition (high calorie requirements)

34
Q

Rheumatic fever complication

A

Rheumatic heart disease which affects the cardiac valves, particularly the mitral valve

35
Q

When does rheumatic fever typically appear?

A

2 to 6 weeks after an untreated or partially treated group a beta-hemolytic streptococcal infection

36
Q

Rheumatic fever assessment findings

A

** Fever with history of sore throat**

37
Q

Rheumatic fever nursing considerations

A

Control joint pain and inflammation
Administer antibiotics (penicillin) as prescribed
Administer salicylates an anti-inflammatory agents
Initiate seizure precautions
Provide bedrest during the acute febrile phase

38
Q

Kawasaki disease

A

Acute systemic inflammatory illness that can lead to myocardial infarction.
Unknown cause

39
Q

Acute stage Kawasaki disease assessment findings 

A

Strawberry tongue
Conjunctival hyperemia
Fever
Swollen hands and rash
Enlarged cervical lymph nodes

40
Q

Subacute stage Kawasaki disease assessment findings

A

Cracked lips and fissures
Desquamation of skin on the tips of the fingers and toes (peeling)
Joint pain
Cardiac manifestations (Greatest risk for coronary aneurysm during the stage) 

41
Q

Convalescent stage Kawasaki’s disease assessment findings

A

Normal appearance but signs of inflammation may be present

42
Q

Kawasaki disease nursing considerations/treatment

A

* Administer acetylsalicylic acid as prescribed for its antipyretic and anti-platelet affects*
*Administer immunoglobulin IV as prescribed to shorten duration of fever and reduce risk of coronary artery lesions and aneurysms. *
Examine eyes for conjunctivitis
Monitor mucous membranes for inflammation 
Assess temperature frequently


43
Q

When should hematology assessments/screenings be performed?

A

*Once during:
Infancy (9–12 months of age)
Childhood (1–5 years of age)
Late childhood (5–12 years of age)
Adolescence (14–20 years of age)

44
Q

What is a hematology assessment comprised of?

A

CBC
History and physical exam
Assessment of activity level
Any bleeding
Frequent infections
Food diary
Any comments the parents have regarding child

45
Q

Supportive care for RBC disorders

A

IV fluids to replace intravascular volume
Oxygen therapy
Bedrest

46
Q

Common hematologic disorders

A

Sickle cell anemia
Iron deficiency anemia
Hemophilia
Beta-thalassemia 

47
Q

Pathophysiology of iron deficiency anemia

A

Iron deficiency anemia is caused by any number of factors that decrease supply or impair absorption of iron
“ Milk babies”, Common in 6–24 months, consuming greater than 32 ounces of milk per day

48
Q

Iron deficiency anemia assessment findings

A

Pallor/paleness of mucous membranes
Tiredness and fatigue
PICA habit 

49
Q

Iron deficiency anemia nursing interventions

A

Administer ferrous sulfate (remember how to administer correctly)
Encourage iron rich foods
Provide frequent rest periods
Support child’s need to limit activity

50
Q

Iron administration NCLEX hints

A

Give on an empty stomach (for better absorption) BETWEEN meals!
Give with citrus juice (vitamin C for absorption)
Use dropper or straw aimed at the back of the mouth to avoid discoloring teeth
Teach that stools may become tarry 
Teach that iron can be fatal overdosed, keep out of reach of children
DO NOT give with any dairy products

51
Q

Hemophilia

A

Deficiency of specific clotting factors
Inheritable pattern is X-linked recessive
Identification of a specific factor deficiency allows for definitive treatment

52
Q

Hemophilia A

A

“ Classic hemophilia”
Deficiency of factor 8 

53
Q

Hemophilia B

A

A.k.a. “ Christmas disease”
Caused by deficiency of factor 9 

54
Q

Von Willebrand disease

A

Deficiency of Von Willebrand factor

55
Q

Hemophilia assessment findings

A
  • Spontaneous bleeding into muscles and tissues and joint cavity (hemiarthrosis)*
    Loss of motion and joints
    Prolonged bleeding in the umbilical cord or injection sites
    Easy bruising and prolonged bleeding with minor trauma
56
Q

Hemophilia interventions

A

Teach local treatment for minor bleeds (RICE and splinting)
Provide child with soft toys and use bedrails
Have child wear medical alert bracelet
Teach the importance of administration of clotting factor

57
Q

** HEMOPHILIA NCLEX HINTS **

A

Replace missing clotting factors
-Aggressive replacement therapy with factor eight concentrate
Desmopressin
-IV administration or nasal spray
-Causes 2 to 4 times increase in factor eight activity
-Used for mild hemophilia
Amicar (Aminocarproic acid)
-Promotes clotting 

58
Q

Newborn sickle cell anemia

A

Newborns typically do not show symptoms at birth
Fetal hemoglobin protects the red blood cells from sticking

59
Q

Sickle cell anemia interventions

A

Keep child well hydrated
Avoid strenuous exercise
Avoid high altitudes
Seek care at first sign of infection
Do not withhold fluids at night due to enuresis

60
Q

Sickle cell anemia vaso-occlusive crisis assessment findings

A

Absent/blocked blood flow to tissue causing hypoxia necrosis
-fever
-Severe abdominal pain
- Painful edematous and feet
-joint pain

61
Q

Sickle cell anemia interventions/treatment for vaso-occlusive crisis

A

Provide intense hydration while maintaining fluid and electrolyte balance
* Pain medication: Adequate nursing care involves managing pain
-Tylenol/ibuprofen (Mild)
-Opioids; Morphine, Dilaudid (severe)
Administer oxygen therapy as prescribed for hypoxemia
Monitor intake and output
Use caution with potassium replacement
Promote rest

Pediatrics (20 decks)

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