Week 4 Content Flashcards
1
Q
Basic Problems (heart)
Obstruction of Blood Flow- eventually causes _______________
Increased Pulmonary Blood Flow early causes P ________
Later can cause ↑ P Artery _____
A
Obstruction of Blood Flow- eventually causes heart failure
Increased Pulmonary Blood Flow early causes P edema
Later can cause ↑ P Artery HTN
2
Q
Fetal Oxygen saturation is _____%
A
50-55
3
Q
BLUE Baby vs PINK Baby
Depends on __________ and if Foremen Ovale and/or Ductus Arteriosus stays _____.
Blood moves from ___________________________________
Blood moves towards least resistance
Normal Heart- ______ side is higher pressure
If there are holes, blood moves Left to right
A
Depends on shunting and if Foremen Ovale and/or Ductus Arteriosus stays open.
Blood moves from higher pressure to lower pressure
Blood moves towards least resistance
Normal Heart- Left side is higher pressure
If there are holes, blood moves Left to right
4
Q
Congestive Heart Failure
Heart is unable to ______________________________ to meet metabolic demands of the body
A
Heart is unable to pump sufficient cardiac output to meet metabolic demands of the body
5
Q
Associated Clinical Signs & Symptoms of CHF
- Diaphoresis
- Poor _________
- Irritability
- Failure to ______
Pulmonary congestion
* __________
* Retractions, nasal _______
* Cough
A
- Diaphoresis
- Poor feeding
- Irritability
- Failure to thrive
Pulmonary congestion
* Tachypnea
* Retractions, nasal flaring
* Cough
6
Q
Causes of CHF
- __________ heart disease
- Non-structural myocardial factors
– Viral myocarditis
– Birth trauma - ___________ - Too fast or too slow
A
- Congenital heart disease
- Non-structural myocardial factors
– Viral myocarditis
– Birth trauma - Dysrhythmias - Too fast or too slow
7
Q
Clinical Manifestations of CHF
Pulmonary congestion
* ____________
* Retractions, nasal flaring
* Cough
A
Tachypnea
8
Q
Management of the Child with CHF
- Promote myocardial efficiency
- _________ , afterload reducers
- Minimize volume overload
- __________
- Decrease cardiac workload
- Minimize energy expenditures
- Provide adequate ________
A
- Promote myocardial efficiency
- Digoxin, afterload reducers
- Minimize volume overload
- Diuretics
- Decrease cardiac workload
- Minimize energy expenditures
- Provide adequate nutrition
9
Q
CHF Provide Adequate Nutrition
- Small, ________ feedings
- Position during feeding
- Breast vs. bottle
- High ________ feeding
- Gavage feeding
- __________ tube
A
- Small, frequent feedings
- Position during feeding
- Breast vs. bottle
- High caloric feeding
- Gavage feeding
- Gastrostomy tube
10
Q
Cyanosis
Blue color of skin and mucous membranes due to increased concentration of
reduced ____________ (low O2 saturation)
A
hemoglobin
11
Q
Clinical Manifestations of Cyanosis
- Blue color at _____ , __________ , mucous membranes
- Tachypnea
- Cyanosis increases with _______
- Long-term: polycythemia, __________
A
- Blue color at lips, nailbeds, mucous membranes
- Tachypnea
- Cyanosis increases with crying
- Long-term: polycythemia, clubbing
12
Q
Management of Cyanosis
* Child will usually limit self
* ____ usually not effective
* Interventional cardiac _____________
* Surgery
A
- Child will usually limit self
- O2 usually not effective
- Interventional cardiac catheterization
- Surgery
13
Q
Work-up for Congenital Heart Disease
* Careful H&P
* Chest _____
* _____
* Echocardiogram
* Cardiac _____________ (+/-)
* Diagnostic
* Interventional
A
- Careful H&P
- Chest X-ray
- ECG
- Echocardiogram
- Cardiac catheterization (+/-)
- Diagnostic
- Interventional
14
Q
Pre-catheterization procedure
* Vital signs, pulse __________
* Mark ______ pulses
* Laboratory analysis
* ____________
* CBC
* electrolytes
A
- Vital signs, pulse oximetry
- Mark pedal pulses
- Laboratory analysis
- Coagulopathies
- CBC
- electrolytes
15
Q
Post catheterization problems
* Cardiopulmonary instability
* _________
* Vessel dissection
* _______ at site
A
- Cardiopulmonary instability
- Thrombosis
- Vessel dissection
- Bleeding at site
16
Q
Post-cath nursing
* Assess _________ from anesthesia, VS, pulse ox
* Assess cath _______
– pressure dressing __ hours post catheterization
* Assess perfusion distal to cath site
* Keep affected leg “________”
* Discharge:
* Small bandage at site
* no tub bathing for 3 days
A
- Assess recovery from anesthesia, VS, pulse ox
- Assess cath site
– pressure dressing 4 hours post catheterization - Assess perfusion distal to cath site
- Keep affected leg “straight”
- Discharge:
- Small bandage at site
- no tub bathing for 3 days
17
Q
Patent Ductus Arterious
Common in preterm
__ > ____ shunting
CHF
Treatment:
Indomethacin
Interventional cath _____ occlusion
Surgical repair for preterm infants
A
Common in preterm
L→R shunting
CHF
Treatment:
Indomethacin
Interventional cath coil occlusion
Surgical repair for preterm infants
18
Q
Ventricular Septal Defect
Most ________ CHD
High pressure L→R shunt
pulmonary __________
Significant CHF
Repair in first year
CP ________
Interventional cath [not FDA approved]
A
Most common CHD
High pressure L→R shunt
pulmonary hypertension
Significant CHF
Repair in first year
CP bypass
Interventional cath not FDA approved
19
Q
Coarctation of the Aorta
Classic finding _____ BP is higher than _____ BP by 10+ mmHg
Often asymptomatic
Surgical repair does not require CP bypass
Recoarctation – balloon angioplasty
A
Classic finding arm BP>leg BP by 10+ mmHg
20
Q
The cuff bladder width should be approximately ___ % of the circumference of the arm measured at a point midway between the olecranon and acromion.
A
40
21
Q
Tetralogy of Fallot
Most ________ cyanotic heart defect
Mild cyanosis at birth progresses
“tet” (hypercyanotic) spell
Repair as ________
A
Most common cyanotic heart defect
Mild cyanosis at birth progresses
“tet” (hypercyanotic) spell
Repair as infant
22
Q
Infective Endocarditis
- Infection of ____________ & intracardiac ______
** Streptococcus viridans most common agent
— Also staph, candida, gm – organisms
Children with ____ at highest risk of infection
* Valvular abnormalities
* Prosthetic valves
* High pressure shunts
A
- Infection of endocardium & intracardiac valves
** Streptococcus viridans most common agent
— Also staph, candida, gm – organisms
Children with CHD at highest risk of infection
* Valvular abnormalities
* Prosthetic valves
* High pressure shunts
23
Q
Kawasaki Disease (mucocutaneous lymph node syndrome)
- Widespread inflammation of small & medium size _________
> LV dysfunction - Incidence: ~140 per 100,000 children < 5 years
- Males > females
- Disease process is self-limited
- Cardiac sequelae in 25% of children untreated
> Coronary artery __________
A
- Widespread inflammation of small & medium size vessels
> LV dysfunction - Incidence: ~140 per 100,000 children < 5 years
- Males > females
- Disease process is self-limited
- Cardiac sequelae in 25% of children untreated
> Coronary artery aneurysms
24
Q
Kawasaki Disease (mucocutaneous lymph node syndrome) - _________ unclear
- Infectious agent (?)
- Late winter, early spring outbreaks
- May be final result of multiple organisms
A
Etiology
25
Kawasaki Disease (mucocutaneous lymph node syndrome)
Child must exhibit ___ of the following (including fever):
* ______ for > 5 days
* Bilateral conjunctival injection without exudate
* ______ mucous membrane erythematous dry, cracked, “strawberry tongue”
* Extremity edema, erythema & desquamation
* Rash varied, not raised
* Cervical lymphadenopathy
Child must exhibit 5 of the following (including fever):
* Fever for > 5 days
* Bilateral conjunctival injection without exudate
* Oral mucous membrane erythematous dry, cracked, “strawberry tongue”
* Extremity edema, erythema & desquamation
* Rash varied, not raised
* Cervical lymphadenopathy
26
Kawasaki Disease (mucocutaneous lymph node syndrome)
Laboratory analysis
* ↑ _____
* ↑ ___________rate
* ↑ LFT’s
* Thrombocytosis
* Baseline & serial echocardiograms
* ↑ WBC
* ↑ sedimentation rate
* ↑ LFT’s
* Thrombocytosis
* Baseline & serial echocardiograms
27
Kawasaki Disease (mucocutaneous lymph node syndrome) Management
* High-dose intravenous immune _____________ (2g/kg IV over 10-12 hours) ASAP
* _______ - initially high (antiinflammatory) then low (antiplatelet) dosing for 6-8 weeks
* Warfarin if giant aneurysms (> 8 mm)
* High-dose intravenous immune globulin (IVIG) (2g/kg IV over 10-12 hours) ASAP
* ASA (Aspirin) - initially high (antiinflammatory) then low (antiplatelet) dosing for 6-8 weeks
* Warfarin if giant aneurysms (> 8 mm)
28
Normal urine output is age-dependent: In general a hospitalized infant and child is expected to have at least ____ ml/kg /hour urine output
1-2
29
Blood enters the healthy __________ where it is filtered of wasted : the glomerulus is attached to the opening of a small fluid-collecting tube called a tubule. Once in the tubule the waste is called urine.
glomerulus
30
Nephrotic Syndrome
* Primary (____%) unclear on why it occurs
Cases can get better only to exacerbate later.
Most children that present have South ______ decent but African American children will have poorer outcomes-the disparities seem to be genetic and how well they respond to Steroid treatment. Need more studies
* Secondary (caused by ___________)
Results from systemic illness, lupus, diabetes, sickle cell
* Primary (80%) unclear on why it occurs
Cases can get better only to exacerbate later.
Most children that present have South Asian decent but African American children will have poorer outcomes-the disparities seem to be genetic and how well they respond to Steroid treatment. Need more studies
* Secondary (caused by something else)
Results from systemic illness, lupus, diabetes, sickle cell
31
Nephrotic Syndrome:
↑Permeability of Basement ____________
Becomes Permeable to ______________ that are normally too big to be filtered out
↑Permeability of Basement Membrane
Becomes Permeable to plasma proteins that are normally too big to be filtered out
32
Nephrotic Syndrome
* __________ : MASSIVE amounts of protein in urine – dark yellow frothy urine
* Most common protein lost is ________ but IMMUNOGLOBULINS also lost in urine
which are important to prevent infections
* – Severe generalized ________ (called Anasara ) Due to loss of serum protein
Due to loss of colloidal pressure: fluids exits the blood vessels and enters the tissues to attempt to equalize the water to protein concentration .
* Proteinuria : MASSIVE amounts of protein in urine – dark yellow frothy urine
* Most common protein lost is ALBUMIN but IMMUNOGLOBULINS also lost in urine
which are important to prevent infections
* – Severe generalized edema (called Anasara ) Due to loss of serum protein
Due to loss of colloidal pressure: fluids exits the blood vessels and enters the tissues to attempt to equalize the water to protein concentration .
33
Nephrotic Syndrome Lab:
* ↓ Serum Total _________
* ↓ Serum _________-
caused increase in serum cholesterol and triglycerides
* ↑ Massive _________
* Usually normal BUN Creatinine
* KIDNEY BIOPSY and analysis is definitive diagnosis
* ↓ Serum Total Protein
* ↓ Serum Albumin-
caused increase in serum cholesterol and triglycerides
* ↑ Massive Proteinuria
* Usually normal BUN Creatinine
* KIDNEY BIOPSY and analysis is definitive diagnosis
34
Nephrotic syndrome Nursing Assessment
* Severe generalize __________
* Lethargy
* Anorexia
* ______ yellow urine
* Difficult IV access
* Severe generalize edema
* Lethargy
* Anorexia
* Frothy yellow urine
* Difficult IV access
35
Nephrotic syndrome Nursing Care
* IV ________
* _________ if not responsive to steroids (non oncologic chemo)
* IV Albumin (increases serum albumin, fluid then is pulled into blood vessels from tissues)
* Diuretics are usually given to follow the albumin
* Diuretics alone do not work well due to low protein concentration in the nephron tubules.
* Protect from infections
* Provide skin care- edematous skin big risk for breakdown
* IV Steroids
* Cytoxin if not responsive to steroids (non oncologic chemo)
* IV Albumin (increases serum albumin, fluid then is pulled into blood vessels from tissues)
* Diuretics are usually given to follow the albumin
* Diuretics alone do not work well due to low protein concentration in the nephron tubules.
* Protect from infections
* Provide skin care- edematous skin big risk for breakdown
36
Nephrotic syndrome Nutrition
* _________ Protein ( high protein can damage nephrons)
* Low ______
* avoid:
processed cheeses.
high-sodium meats (bologna, ham, bacon, sausage, hot dogs)
frozen dinners and entrées.
canned meats.
pickled vegetables.
salted potato chips, popcorn, and nuts.
salted bread.
canned soups /cup of soups
* Normal Protein ( high protein can damage nephrons)
* Low Salt
* avoid:
processed cheeses.
high-sodium meats (bologna, ham, bacon, sausage, hot dogs)
frozen dinners and entrées.
canned meats.
pickled vegetables.
salted potato chips, popcorn, and nuts.
salted bread.
canned soups /cup of soups
37
Acute Glomerulonephritis [post strep] –
__________ complex response
Acute inflammation of the kidney at the __________, caused by an immune antigen/ antibody response.
Antibody complexes clog up glomerulus and decrease filtration.
Leaks Red blood cells and a little protein
immune complex response
Acute inflammation of the kidney at the glomerulus, caused by an immune antigen/ antibody response.
Antibody complexes clog up glomerulus and decrease filtration.
Leaks Red blood cells and a little protein
38
Acute Glomerulonephritis [post strep]
* Congested Inflamed Glomeruli results in ________ __________ of fluid
* Results in fluid retention and Hypertension
* Increase retention of ______ in blood so ↑ serum BUN and Creatinine
* Low urine output can lead to ↑ serum Potassium
* Congested Inflamed Glomeruli results in decrease filtration of fluid
* Results in fluid retention and Hypertension
* Increase retention of waste in blood so ↑ serum BUN and Creatinine
* Low urine output can lead to ↑ serum Potassium
39
Acute Glomerulonephritis [post strep] Nursing Assessment
* Eye and facial ______
* Peripheral edema
* __________
* Irritability
* Urine is dark cola/tea colored
* Light to moderate proteinuria
* Oliguria (decreased urine output) UOP
* edema
* Hypertension
40
Acute Glomerulonephritis Lab
* ↑Antistreptolysin O (ASO) titer due to _____________ (diagnostic)
* ↑ BUN and creatinine
* ↑ Potassium with decreased urine output
immune response
41
Acute Glomerulonephritis
Diet Same as Nephrotic Syndrome
* In addition if low urine output restrict ________
Diet Same as Nephrotic Syndrome
* In addition if low urine output restrict POTASSIUM
42
Acute Glomerulonephritis
* _______
* Occurs post _________ infection
* _____ loss of protein
* Acute
* Occurs post strep throat infection
* Mild loss of protein
43
Nephrotic Syndrome
* More ________
Can have remissions and exacerbations over years
* Most cause is ________
* ________ loss of protein
* More chronic
Can have remissions and exacerbations over years
* Most cause is idiopathic
* Massive loss of protein
44
Nephrotic Syndrome
* ________- severe generalized
* Blood Pressure- Normal
* Urine- dark frothy yellow (tons of protein)
* ASO titer negative
* Edema- severe generalized
* Blood Pressure- Normal
* Urine- dark frothy yellow (tons of protein)
* ASO titer negative
45
Acute Glomerulonephritis
* Edema- milder face around the eyes/possibly extremities
* Blood Pressure _________
* Urine has hematuria (dark cola/tea colored)
* ASO titer ________
* Edema- milder face around the eyes/possibly extremities
* Blood Pressure Elevated
* Urine has hematuria (dark cola/tea colored)
* ASO titer positive
46
DM1
Type 1 DM is believed to be an ___________ disease, arising when a person with a genetic predisposition is exposed to aprecipitating event such as a viral infection.
________ is a prominent factor in the etiology Onset typically in childhood and adolescence but can occur at any age
Most childhood cases <__ yrs. of diabetes mellitus are type 1
Type 1 DM is believed to be an autoimmune disease, arising when a person with a genetic predisposition is exposed to aprecipitating event such as a viral infection.
Heredity is a prominent factor in the etiology Onset typically in childhood and adolescence but can occur at any age
Most childhood cases <10 yrs. of diabetes mellitus are type 1
47
Ketoacidosis
When glucose is unavailable for cellular metabolism, the body breaks down ________ and ketones are released.
Excess ketones are eliminated in ______ (ketonuria) or by the _______ (acetone breath)
___________ in the blood are strong acids that decrease serum pH and produce ketoacidosis
When glucose is unavailable for cellular metabolism, the body breaks down proteins and ketones are released.
Excess ketones are eliminated in urine (ketonuria) or by the lungs (acetone breath)
Ketones in the blood are strong acids that decrease serum pH and produce ketoacidosis
48
S & S of DKA
______ deep breathing (Kussmauls Respirations)
body’s attempt to breathe off _____ in an attempt to increase pH
_________ Urine Output
_______-smelling breath.
Fast deep breathing (Kussmauls Respirations)
body’s attempt to breathe off C02 in an attempt to increase pH
Increased Urine Output
Fruity-smelling breath.
49
Nonspecific Signs and Symptoms DKA
_____ skin and mouth.
Flushed face.
________
Nausea and Vomiting
Dry skin and mouth.
Flushed face.
Headaches
Nausea and Vomiting
50
Diabetic Ketoacidosis (DKA)
Pediatric ____________
Results from progressive deterioration with dehydration, electrolyte imbalance, acidosis, coma; may cause death
Therapy: Should be instituted in an ____________________ setting
Pediatric emergency
Results from progressive deterioration with dehydration, electrolyte imbalance, acidosis, coma; may cause death
Therapy: Should be instituted in an intensive care unit setting
51
DKA Treatment in ICU
IV ________ continuous infusion
Every one hour ________
Balance D5W with NS – depends on serum glucose
Monitor Serum Potassium
Never turn off ________ , if glucose drops <250 add more glucose
________ is the only thing that corrects the acidosis
IV Insulin continuous infusion
Every one hour glucose
Balance D5W with NS – depends on serum glucose
Monitor Serum Potassium
Never turn off Insulin, if glucose drops <250 add more glucose
Insulin is the only thing that corrects the acidosis
52
Long-Term Complications of Diabetes Mellitus
___________ complications, especially nephropathy and retinopathy
Macrovascular disease, neuropathy
With poor control, vascular changes as early as 2.5 to 3 years after diagnosis
With excellent control, can be delayed ___ years
Microvascular complications, especially nephropathy and retinopathy
Macrovascular disease, neuropathy
With poor control, vascular changes as early as 2.5 to 3 years after diagnosis
With excellent control, can be delayed 20 years
53
Situations that increase need for Insulin
Increased ____________ intake
Illnesses
Decreased ______________
Increased carbohydrate intake
Illnesses
Decreased physical activity
54
Situations that decrease need for Insulin and that can cause hypoglycemia
Missed ______
Increased __________
Missed Meal
Increase Exercise
55
S& S of hypoglycemia
________..
feeling _________.
dizziness.
feeling ________..
tingling lips.
feeling ________.or trembling.
a fast or pounding ________.(palpitations)
becoming easily ________., tearful, anxious or moody.
sweating.
feeling tired.
dizziness.
feeling hungry.
tingling lips.
feeling shaky or trembling.
a fast or pounding heartbeat (palpitations)
becoming easily irritated, tearful, anxious or moody.
56
Treat Hypoglycemia
Able to take PO
__________
Glucose Gel tabs
Can’t tolerate PO
__________
Able to take PO
Orange juice
Glucose Gel tabs
Can’t tolerate PO
IV glucose
57
Problems with Compliance [T1D]
Parental non- compliance
-Need to have a home with a ___________
-Need to understand life and death consequences
-Always ___________ non- compliance – may need to refer to Child Protective Services.
Adolescents/Young Adults
-Social Services
-Support Group
Parental non- compliance
-Need to have a home with a refridgerator
-Need to understand life and death consequences
-Always investigate non- compliance – may need to refer to Child Protective Services.
Adolescents/Young Adults
-Social Services
-Support Group
58
Monroe Kellie Doctrine:
The Monro-Kellie doctrine or hypothesis states that the sum of volumes of brain, cerebrospinal fluid (CSF) and intracerebral blood is _______.
An increase in one should cause a reciprocal decrease in either one or both of the remaining two.
The Monro-Kellie doctrine or hypothesis states that the sum of volumes of brain, cerebrospinal fluid (CSF) and intracerebral blood is constant.
An increase in one should cause a reciprocal decrease in either one or both of the remaining two.
59
Basic Problems (heart)
Decreased Pulmonary Blood Flow- ↓ ____________
_______ of Deoxygenated Blood with Oxygenated Blood
Decreased Pulmonary Blood Flow- ↓oxygenation
Mixing of Deoxygenated Blood with Oxygenated Blood
60
If there are holes in heart, blood moves ___________ ?
Left to right
61
A baby has VSD & CHF
He is underweight why?
He is underweight because of CHF induced failure to thrive
He is exhuasted, so not eating as much as he should
62
VSD is a birth defect with _________________ between the ventricles of the heart
abnormal connection
63
____ are the most common heart defect
VSDs
63
VSD >
With the holes, the blood pumps from left to right ventricle
This causes mixing of red and blue blood
this may be heard as a
Heart murmur
63
Tetralogy of Fallot
63
Infective Endocarditis- portals of Entry
**_______ work – S. viridans
Cardiac surgery
Indwelling lines
Dental
64
Infective Endocarditis Diagnosis
+ _______________ (definitive diagnosis)
ECG changes (prolonged PR)
Cardiomegaly
Anemia
↑ ESR, WBC
Hematuria
Vegetations seen on echocardiogram
blood culture
64
Infective Endocarditis - PREVENTION is key
_________ (PO or IV) 1 hour prior to procedure
IE prophylaxis for complex cardiac defects
Most dental procedures (including teeth cleaning)
Procedures involving respiratory tract, infected skin, skin structures or musculoskeletal tissue
Antibiotic
64
Infective Endocarditis Prognosis
____% successful if treated early
High risk patients
Infants
Resistant organisms
Fungal infection
Death from CHF, MI, emboli, cardiac perforation
80% successful if treated early
High risk patients
Infants
Resistant organisms
Fungal infection
Death from CHF, MI, emboli, cardiac perforation
65
Nursing Considerations for IVIG
* Blood Product pooled from 1000s of donor concentrated immune globulins
* Modulates the cytokine toxins that contribute to the manifestations of Kawasaki's
* Activates the recipients T cell functions improves immune response
* Must have an informed ________
* Must screen for previous _________ to IVIG
* Must start administration ________ 0.5 to 1ml/kg over 15-30 minutes
* Monitor for reactions similar to blood products but are mostly due to the stabilizing components in manufacturing process.
* This is a manufactured product but does have a rare risk of passing on __________
* Blood Product pooled from 1000s of donor concentrated immune globulins
* Modulates the cytokine toxins that contribute to the manifestations of Kawasaki's
* Activates the recipients T cell functions improves immune response
* Must have an informed Consent
* Must screen for previous reactions to IVIG
* Must start administration slowly 0.5 to 1ml/kg over 15-30 minutes
* Monitor for reactions similar to blood products but are mostly due to the stabilizing components in manufacturing process.
* This is a manufactured product but does have a rare risk of passing on bacteria
65
Left-to-right shunting: Causes pulmonary overcirculation, leading to signs of heart failure like _______ breathing, sweating, and failure to thrive.
rapid
65
Right-to-left shunting: Can lead to______________ , hypoxia, fatigue, and poor feeding, as deoxygenated blood is circulated.
cyanosis (bluish skin)
65
Infective Endocarditis Nursing
METICULOUS ______ health & care
Teach need for & specifics of SBE _________
High index of suspicion for children with CHD
Teach symptoms of SBE
METICULOUS oral health & care
Teach need for & specifics of SBE prophylaxis
High index of suspicion for children with CHD
Teach symptoms of SBE
65
Medications for Congestive Heart Failure (CHF)
Diuretics (e.g., furosemide): To reduce fluid overload.
Digoxin: To improve heart contractility.
ACE inhibitors (e.g., enalapril): To lower blood pressure and reduce strain on the heart.
Beta-blockers (e.g., carvedilol): To decrease the heart's workload.
65
Digoxin: To improve heart _____________.
contractility
66
Diuretics (e.g., furosemide): To reduce _____________
fluid overload.
67
ACE inhibitors (e.g., enalapril): To lower ______________ and reduce strain on the heart.
blood pressure
68
Beta-blockers (e.g., carvedilol): To decrease the heart's ___________.
workload
69
Infants with congenital heart disease (CHD) often have difficulty _______________ due to poor feeding, increased metabolic demands, and heart failure symptoms that impact their ability to thrive.
gaining weight
70
Low Cardiac Output Symptoms:
Fatigue, weak _______, ______ extremities, poor capillary refill, _________ urine output, _____________, and altered mental status.
Fatigue, weak pulses, cold extremities, poor capillary refill, decreased urine output, hypotension, and altered mental status.
71
What pulmonary symptoms occur with congestive heart failure?
* Tachypnea
* Retractions, nasal flaring
* Cough
More:
Dyspnea
Exercise intolerance
Orthopnea
hoarseness
Cyanosis
Wheezing
Grunting
72
Besides pulmonary symptoms what other organ can be affected in congestive heart failure?
_______ : Hepatomegaly (enlarged liver) from blood backing up in the venous system.
__________ : Decreased perfusion leading to reduced urine output (oliguria).
Liver: Hepatomegaly (enlarged liver) from blood backing up in the venous system.
Kidneys: Decreased perfusion leading to reduced urine output (oliguria).
73
What causes clubbing and polycythemia in a cardiac patient?
Clubbing: Chronic _______ (______________) causes the tips of the fingers and toes to become rounded and enlarged.
Polycythemia: The body produces more red blood cells to compensate for _____________
Clubbing: Chronic hypoxia (low oxygen levels) causes the tips of the fingers and toes to become rounded and enlarged.
Polycythemia: The body produces more red blood cells to compensate for chronic hypoxia.
74
Nursing care of post cardiac cath pt
How do you keep involved extremity?
Keep affected leg straight
75
Nursing care of post cardiac cath pt
how long do you need a pressure dressing or bag
intact for at least 4 hours
76
Post-Cardiac Cath Assessments:
Monitor for bleeding at the insertion site.
Check pulses
capillary refill time
77
VSD (Ventricular Septal Defect) is a hole in the septum between the left and right ventricles, leading to a _______________, which can cause pulmonary overcirculation and heart failure.
left-to-right shunt
78
What complications can occur to a patient’s lungs with a L to R shunt-?
Increased pulmonary blood flow can cause
pulmonary __________
congestive _____________
respiratory __________.
Increased pulmonary blood flow can cause
pulmonary hypertension
congestive heart failure
respiratory distress.
79
What are ”sternal precautions “ re: teaching the parents of an infant after cardiac surgery?
No lifting the child under their arms for 6 weeks.
Avoid activities that put strain on the chest (e.g., pushing or pulling objects).
80
Kawasaki Disease:
An _____________ condition affecting blood vessels, primarily in children.
inflammatory
81
Kawasaki Disease treatment
high dose: IV immunoglobulin (IVIG) and aspirin
82
What are teachings to parents for care of child post cardiac surgery regarding preventing endocarditis?
maintaining good oral hygiene
avoiding dental procedures without antibiotic prophylaxis
recognizing signs of infection.
83
Signs and Symptoms (S&S) of hyperglycemia
Thirst
Nausea or vomiting
Abdominal _______
Constipation
Drowsiness
Dim vision
Increased __________
Headache
Flushed, dry skin
_______ breathing
_______ , rapid pulse
_______(fruity) breath odor
Laboratory values
Urine: Positive for sugar and acetone
Blood glucose: >200 mg/dL
Thirst
Nausea or vomiting
Abdominal pain
Constipation
Drowsiness
Dim vision
Increased urination
Headache
Flushed, dry skin
Rapid breathing
Weak, rapid pulse
Acetone (fruity) breath odor
Laboratory values
Urine: Positive for sugar and acetone
Blood glucose: >200 mg/dL
84
Cause of Diabetes Mellitus (DM) Type 1:
Believed to be autoimmune _________________________ beta cells in the pancreas. Genetics, environmental factors (like viral infections), and immune responses contribute to the onset
destruction of insulin-producing
85
What usually precipitates the first time hospital admission in a patient with DM Type 1?
Diabetic ketoacidosis (DKA)
86
What is diabetic ketoacidosis (DKA)?
accumulation of ___________ in the blood that results from hyperglycemia and leads to metabolic acidosis
accumulation of ketones in the blood that results from hyperglycemia and leads to metabolic acidosis
87
What symptoms occur when there is an increase in ketones in the blood stream?
_______-smelling breath
Nausea and vomiting
________ pain
Rapid, deep breathing (___________ respirations)
Confusion or lethargy
Fruity-smelling breath
Nausea and vomiting
Abdominal pain
Rapid, deep breathing (Kussmaul respirations)
Confusion or lethargy
88
Blood pH in DKA:
Blood pH becomes ________ (below 7.35), leading to metabolic acidosis. This results from the accumulation of ketones in the bloodstream.
acidic
89
Most Important Treatment Medication in DKA:
_______ is the most crucial treatment to reduce blood glucose levels and stop ketone production. Fluids and electrolytes (especially potassium) are also critical.
Insulin
90
Why is a diabetic on insulin at risk for hypoglycemia?
Excess ________ relative to food intake or activity level can cause blood sugar to drop too low. Missed meals, too much insulin, or increased physical activity can trigger hypoglycemia.
insulin
91
Treatments for Hypoglycemia:
For patients that can eat/drink: Give 15 grams of a fast-acting _______ (like glucose tablets, juice, or candy) and recheck blood sugar in 15 minutes.
For patients that cannot eat/drink: Administer _______ (injectable) or an intravenous (IV) glucose solution in a hospital setting.
For patients that can eat/drink: Give 15 grams of a fast-acting carbohydrate (like glucose tablets, juice, or candy) and recheck blood sugar in 15 minutes.
For patients that cannot eat/drink: Administer glucagon (injectable) or an intravenous (IV) glucose solution in a hospital setting.
92
What is characteristic of the immune-mediated type 1 diabetes mellitus?
Ketoacidosis is infrequent.
Onset is gradual.
Age at onset is usually younger than 18 years.
Oral agents are often effective for treatment.
Age at onset is usually younger than 18 years.
93
Which symptom is considered a cardinal sign of diabetes mellitus?
Nausea
Seizures
Impaired vision
Frequent urination
Frequent urination
93
Type 1 diabetes mellitus is suspected in an adolescent. Which clinical manifestation may be present?
Moist skin
Fluid overload
Weight gain
Poor wound healing
Poor wound healing
Poor wound healing is often an early sign of type 1 diabetes mellitus
93
The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. The nurse should explain that:
Exercise will increase blood glucose.
Exercise should be restricted.
Extra snacks are needed before exercise.
Extra insulin is required during exercise
Extra snacks are needed before exercise.
94
The nurse is performing a Glasgow Coma Scale (GCS) on a school-age child with a head injury. The child opens eyes spontaneously, obeys commands, and is oriented to person, time, and place. Which is the score the nurse should record?
8
11
13
15
15
The GCS consists of a three-part assessment: eye opening, verbal response, and motor response. Numeric values of 1 through 5 are assigned to the levels of response in each category. The sum of these numeric values provides an objective measure of the patients level of consciousness (LOC). A person with an unaltered LOC would score the highest, 15. The child who opens eyes spontaneously, obeys commands, and is oriented is scored at a 15.
95
The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed (Select all that apply)?
Headache
Photophobia
Bulging anterior fontanel
Weak cry
Poor muscle tone
C. Bulging anterior fontanel
D. Weak cry
E. Poor muscle tone
96
The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him:
Prone and tube feed.
Prone, turn head to side, and nipple feed.
Supine in infant carrier and nipple feed.
Supine, with defect supported with rolled blankets, and nipple feed
Prone, turn head to side, and nipple feed.
In the prone position, feeding is a problem. The infant’s head is turned to one side for feeding. If the child is able to nipple feed, no indication is present for tube feeding. Before surgery, the infant is kept in the prone position to minimize tension on the sac and risk of trauma.
96
Which clinical manifestations would suggest hydrocephalus in a neonate?
Bulging fontanel and dilated scalp veins
Closed fontanel and high-pitched cry
Constant low-pitched cry and restlessness
Depressed fontanel and decreased blood pressure
Bulging fontanel and dilated scalp veins
96
An important nursing intervention when caring for a child who is experiencing a seizure is to:
Describe and record the seizure activity observed
Restrain the child when seizure occurs to prevent bodily harm
Place a tongue blade between the teeth if they become clenched
Suction the child during a seizure to prevent aspiration
Describe and record the seizure activity observed
97
Which defect results in increased pulmonary blood flow?
Pulmonic stenosis
Atrial septal defect
Tricuspid atresia
Transposition of the great arteries
Atrial septal defect
Atrial septal defect results in increased pulmonary blood flow. Blood flows from the left atrium (higher pressure) into the right atrium (lower pressure) and then to the lungs via the pulmonary artery
98
What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?
Pulmonary convection
Congestive heart defect
Congestive heart failure
Systemic venous congestio
Congestive heart failure
The definition of congestive heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the metabolic demands of the body.
99
Pulmonary congestion is an excessive accumulation of ______ in the lungs
fluid
100
A beneficial effect of administering digoxin (Lanoxin) is that it:
Decreases edema
Decreases cardiac output
Increases heart size
Increases venous pressure
Decreases edema
Digoxin has a rapid onset and is useful in increasing cardiac output, decreasing venous pressure, and as a result decreasing edema. Heart size is decreased by digoxin
101
Parents of a 3-year-old child with congenital heart disease are afraid to let their child play with other children because of possible overexertion. The nurse’s reply should be based on knowing that:
The child needs opportunities to play with peers.
The child needs to understand that peer’s activities are too strenuous.
Parents can meet all of the child’s needs.
Constant parental supervision is needed to avoid overexertion.
The child needs opportunities to play with peers.
The child needs opportunities for social development. Children usually limit their activities if allowed to set their own pace and regulate their activities. The child will limit activities as necessary. Parents must be encouraged to seek appropriate social activities for the child, especially before kindergarten. The child needs to have activities that foster independence
102
Which structural defects constitute tetralogy of Fallot?
Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
Aortic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
Aortic stenosis, atrial septal defect, overriding aorta, left ventricular hypertrophy
Pulmonic stenosis, ventricular septal defect, aortic hypertrophy, left ventricular hypertrophy
Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
Tetralogy of Fallot has these four characteristics
103
Urinary Tract Infection UTI
* One of the most common bacterial infections in childhood
* About 8: 100 girls and 2:100 boys will experience before age 5
* ______ is the most common bacteria associated with UTI
* E coli is found in the stool : Migration occurs from perineum via urethra.
* One of the most common bacterial infections in childhood
* About 8: 100 girls and 2:100 boys will experience before age 5
* E coli is the most common bacteria associated with UTI
* E coli is found in the stool : Migration occurs from perineum via urethra.
104
Urinary System Includes: kidneys, ureters, bladder and urethra
kidneys, ureters, bladder and urethra
105
Infection of:
Kidney is called: “________”
Ureter is called: _________”
Bladder is called: “________“
Urethra is called:”________"
Kidney is called: “Pyelonephritis”
Ureter is called: Ureteritis”
Bladder is called: “Cystitis “
Urethra is called:”Urethritis"
106
Upper Urinary Tract Infections UTI
* Lower:
Occurs when bacteria travel as high as the __________
* Upper:
When bacteria travels past the bladder into the ___________
* Lower:
Occurs when bacteria travel as high as the urethra or bladder
* Upper:
When bacteria travels past the bladder into the ureters or kidneys
107
Typical Symptoms of Lower UTI in Adults
Dysuria
Increased urinary frequency and urgency
Foul smelling urine
Cloudy urine
Abdominal pain
Dysuria
Increased urinary frequency and urgency
Foul smelling urine
Cloudy urine
Abdominal pain
108
Typical Symptoms of Upper UTI in Adults
High _____
Back or side pain
Feeling sick
Diarrhea
High fever
Back or side pain
Feeling sick
Diarrhea
109
Symptoms of UTI -Non verbal infants/toddlers
Generalized for both upper and lower UTIs
* Fever
* Irritability
* Crying
* Vomiting
* Poor feeding
* Fever
* Irritability
* Crying
* Vomiting
* Poor feeding
110
Symptoms of UTI in older child
* Waking up at night to use the bathroom
* Stinging, burning or _____ while urinating
* Stinging when sitting in warm bath water
* Bed-wetting even when potty trained
* Poor ________
* Waking up at night to use the bathroom
* Stinging, burning or pain while urinating
* Stinging when sitting in warm bath water
* Bed-wetting even when potty trained
* Poor appetite
111
Most Common site of UTI in children
* The lower urinary tract is the most common site - ____________
* Serious problems can result if UTI spreads to kidneys
Urethra and Bladder
112
What Children are at Risk for UTI?
* Not common in children less than ___ years of age
* More common in _____ due to short urethra
* Unlikely in boys at any age, unless part of the urinary tract is blocked
* Uncircumcised boys are more at risk than circumcised boys
* Bubble baths may irritate the urethra and allow bacterial growth
* Incorrect wiping after bowel movement (teach front to back)
* Constipated kids and those that delay going to the bathroom
* Not common in children less than 5 years of age
* More common in girls due to short urethra
* Unlikely in boys at any age, unless part of the urinary tract is blocked
* Uncircumcised boys are more at risk than circumcised boys
* Bubble baths may irritate the urethra and allow bacterial growth
* Incorrect wiping after bowel movement (teach front to back)
* Constipated kids and those that delay going to the bathroom
113
Diagnosis of UTI
* Urinalysis
* Urine Culture and Sensitivity
* Urinalysis
* Urine Culture and Sensitivity
114
UTI Treatment
* Antibiotics
* Pain/Comfort Management
* Getting plenty of ______
* Antibiotics
* Pain/Comfort Management
* Getting plenty of fluids
115
Prevent UTI
* Have child drink plenty of ________ (amount normal for age)
* Coach child to ________ bladder fully when urinating
* Teach girls to wipe from front to back when going to bathroom
* Make sure child doesn’t get constipated
* Have child drink plenty of fluids (amount normal for age)
* Coach child to empty bladder fully when urinating
* Teach girls to wipe from front to back when going to bathroom
* Make sure child doesn’t get constipated
116
Congenital Obstructive Defect
* Defect in the functional valve(s) between the ____________
* Urine flows backwards into the one or both Ureters and sometimes Kidneys.
* Often child is placed on prophylactic antibiotics
bladder and the Ureter
117
Untreated or Chronic UTIs
* Untreated can lead to more serious infections that can travel to the _____________ and cause _______.
* Chronic upper UTI can lead to parenchymal damage in the kidneys.
This can result in _________ and/or permanent kidney damage.
* Untreated can lead to more serious infections that can travel to the blood stream and cause sepsis.
* Chronic upper UTI can lead to parenchymal damage in the kidneys.
This can result in hypertension and/or permanent kidney damage.
118
Enuresis
* ________ – nighttime; most common
* Diurnal - daytime
Nocturnal
119
Enuresis - Proposed Pathophysiology
* Excessive _______ Urine Production
* Bladder _______
* Failure to awaken in response to bladder sensations
* Excessive Nocturnal Urine Production
* Bladder overactivity
* Failure to awaken in response to bladder sensations
120
Excessive Nocturnal Urine Production
* Abnormal nocturnal plasma ___________ release
* Deficit in the circadian rhythm of vasopressin – nocturnal lack of the
antidiuretic pituitary hormone - vasopressin
vasopressin
121
Enuresis Medications
* _____________ – DDAVP (ADH) works but only when used. Children will eventually grow out of bedwetting.
* Tricyclic antidepressant- noradrenergic action at brainstem. Same as DDAVP.
Desmopressin
122
Within the fixed skull, there are 3 things:
Brain tissue
CSF
Blood
123
Brain tissue- about ___ %
* Cerebral Spinal Fluid (CSF) - about ___ %
* Blood Supply- about ___ %
Brain tissue- about 80%
* Cerebral Spinal Fluid (CSF) - about 10%
* Blood Supply- about 10%
124
Increased ICP from too much Brain Tissue is Called :
Cerebral Edema
125
ASSESSMENT: Symptoms of ↑ ICP
Nonverbal Patient
Irritably
Inconsolability
Feeding difficulties
Vomiting
Seizures
Lethargy
Loss of consciousness (LOC)
Verbal Patient
Headache
Confusion
Nausea
Vomiting
Weakness
Seizures
Lethargy
Loss of Consciousness
Nonverbal Patient
Irritably
Inconsolability
Feeding difficulties
Vomiting
Seizures
Lethargy
Loss of consciousness (LOC)
Verbal Patient
Headache
Confusion
Nausea
Vomiting
Weakness
Seizures
Lethargy
Loss of Consciousness
125
Increased ICP from too much Brain Tissue is Called Cerebral Edema
_______ of the Brain caused by excessive fluid
Many causes of Cerebral edema, including Hyponatremia
Swelling of the Brain caused by excessive fluid
Many causes of Cerebral edema, including Hyponatremia
126
Treatment for ^ ICP
Brain tissue
________ – Manitol,
Hypertonic Saline
Blood
Actually ________ in surgery
Temporarily ↓ blood flow to brain by hyperventilation ↓ CO2 ↓ vasoconstricts cerebral blood flow
Brain tissue
Diuretics – Manitol,
Hypertonic Saline
Blood
Actually remove in surgery
Temporarily ↓ blood flow to brain by hyperventilation ↓ CO2 ↓ vasoconstricts cerebral blood flow
127
________ Triad – Severe ↑ ICP
Very late signs of neurological dysfunction
Cushing’s
128
Cushing’s Triad – Severe ↑ ICP
Very late signs of neurological dysfunction - Vital signs
↑ ___ very high
↓ ___ very low
↓ ___
↑ BP very high
↓ HR very low
↓ RR
129
DECREASE ICP- Fastest
* Decrease Blood Flow to Brain with _____________
* Decrease Brain Tissue with Hyperosmolar Diuretics/Hypertonic Saline
hyperventilation
130
Decrease ICP – Procedure
* Decrease amount of CSF- Place External ________________
Ventricular Drain
131
Decrease ICP-Surgery
* Remove _______ and or part of skull
blood
132
* Cerebral Palsy
* Spina Bifida
* Neuromuscular Diseases
These are all:
Chronic
133
HYDROCEPHALUS - Increased :
Cerebral Spinal Fluid
134
HYDROCEPHALUS
Impaired absorption of CSF by arachnoid villi
Over production of CSF
Obstruction to flow through Ventricles
Increased _________________
Head circumference
135
CSF is absorbed through tiny, specialized cell clusters called ____________ near the top and midline of the brain. The CSF then passes through the arachnoid villi into the superior sagittal sinus, a large vein, and is absorbed into the bloodstream.
Once in the bloodstream, it is carried away and filtered by the kidneys and liver in the same way as other bodily fluids.
arachnoid villi
136
Neural Tube Defects
Spinal Bifida: Failure of the ___________ to close
Spina bifida occulta
Not visible externally; occurs in lumbosacral area
Occurs in 10-30% of the population
Spina bifida cystica
______ defect with an external sac-like appearance
Meningocele – meninges and spinal fluid
Myelomeningocele – meninges, spinal fluid & nerves
Spinal Bifida: Failure of the bony spine to close
Spina bifida occulta
Not visible externally; occurs in lumbosacral area
Occurs in 10-30% of the population
Spina bifida cystica
Visible defect with an external sac-like appearance
Meningocele – meninges and spinal fluid
Myelomeningocele – meninges, spinal fluid & nerves
137
Occurrence of Neural Tube Defects
* more common in ____
* Caucasian 3x > African American
* 50% caused from nutritional deficiency of _____ acid
* more common in boys
* Caucasian 3x > African American
* 50% caused from nutritional deficiency of folic acid
138
Symptoms of Spina Bifida Occulta
* May have no neurologic disturbances
* Symptoms may not appear until child walks
* Foot weakness, change in gait
* ___________ disturbances
Bowel/bladder
139
Spina Bifida Cystica
Myelomeningocele
Diagnosis & Clinical Manifestations:
* Prenatal detection - ↑ AFP (16-18weeks)
* MRI, CT or myelography to determine severity of defect
* Defect below L2:
flaccid, areflexic partial ________ of lower extremities
Varying degrees of _________ deficit
Poor bowel/bladder control
Joint deformities
flaccid, areflexic partial paralysis of lower extremities
Varying degrees of sensory deficit
Poor bowel/bladder control
Joint deformities
140
Nursing Care: Myelomeningocele
* Support family
* Protect neonate from _______; identify early signs of infection
* Support _____ to prevent further damage
* Skin care
* Latex allergies a potential problem
* Support family
* Protect neonate from infection; identify early signs of infection
* Support sac to prevent further damage
* Skin care
* Latex allergies a potential problem
141
Treatment: Myelomeningocele
-Closure of spine within 12-18 hours to decrease further neurologic damage and protect from infection
-________ placement for hydrocephalus
-Orthopedic management
-___________ management
-________ control- PRONE TO CONSTIPATION
-Interdisciplinary management CRITICAL
-Closure of spine within 12-18 hours to decrease further neurologic damage and protect from infection
-VP Shunt placement for hydrocephalus
-Orthopedic management
-Genitourinary management
-Bowel control- PRONE TO CONSTIPATION
-Interdisciplinary management CRITICAL
142
What are the isolation precautions for Bacterial Meningitis?
Droplet
143
Seizure Disorder
* Brain’s ________ system malfunctions
electrical
144
_________ - chronic seizure disorder with recurrent and unprovoked seizures
Epilepsy
145
Etiology of Seizures
* Most are _________________
* Acquired - brain injury during prenatal or postnatal period: trauma, hypoxia, infections, toxins, electrolyte disturbances, brain tumor etc….
* Most are idiopathic (never find cause)
* Acquired - brain injury during prenatal or postnatal period: trauma, hypoxia, infections, toxins, electrolyte disturbances, brain tumor etc….
146
Ages 0-3 Seizures are usually
caused by infection
147
Partial seizure
________ motor or sensory symptoms - psychic, ___________
May have change in level of consciousness or progress to generalized seizure
localized motor or sensory symptoms - psychic, lip smacking
May have change in level of consciousness or progress to generalized seizure
148
Generalized seizure
__________: LOC (loss of consciousness),
apneic, “grand mal”
tonic-clonic: LOC (loss of consciousness),
apneic, “grand mal”
149
Acute Seizures may be caused by
Infection
Hyponatremia
Brain Tumors
Head Injury
Infection
Hyponatremia
Brain Tumors
Head Injury
150
Chronic Seizures may occur with ___________
Cerebral Palsy
151
Nursing Care of Child w/seizures
* Protect head & airway
* Place on _____ to facilitate drainage of oral secretions ,
* Maintain patent airway might need to reposition head
* Reassure child and parent after
* VS after seizure
Record _______ of seizure and other observations
* Protect head & airway
* Place on side to facilitate drainage of oral secretions ,
* Maintain patent airway might need to reposition head
* Reassure child and parent after
* VS after seizure
Record length of seizure and other observations
152
Don’t put anything in ______ of a seizing patient
mouth
153
First Line “Rescue” Seizure Medications
Benzodiazepams – Ativan, or Versed, or _______
Family and Paramedics use ______________
Chronic kids Family have rectal valium and give for seizures lasting for > 5min
Paramedics carry Rectal valium and give for all seizures they encounter.
Benzodiazepams – Ativan, or Versed, or Valium
Family and Paramedics use RECTAL Valium
Chronic kids Family have rectal valium and give for seizures lasting for > 5min
Paramedics carry Rectal valium and give for all seizures they encounter.
154
Status Epilepticus – defined as seizure lasting :
> 5 min
155
Meningitis
Acute inflammation of meninges
Bacterial: S. pneumoniae, strep and gram negative bacilli & Neisseria meningitidis
(H. influenza-HiB vaccine) very few cases in U.S.
Viral
___% of cases in children 1 month - 5 years
Acute inflammation of meninges
Bacterial: S. pneumoniae, strep and gram negative bacilli & Neisseria meningitidis
(H. influenza-HiB vaccine) very few cases in U.S.
Viral
90% of cases in children 1 month - 5 years
156
Bacterial Meningitis
More common in _____
Neonate to 4 years old - greatest morbidity
^ susceptibility – central nervous system abnormality, /sickle cell, other infections
Meningococcal meningitis may occur in epidemic
form & is readily transmitted by _______ infection from secretions
More common in boys
Neonate to 4 years old - greatest morbidity
^ susceptibility – central nervous system abnormality, /sickle cell, other infections
Meningococcal meningitis may occur in epidemic
form & is readily transmitted by droplet infection from secretions
157
Treatment:Bacterial Meningitis - MEDICAL EMERGENCY
* _________ Isolation
* IV ________ @ dose (blood brain barrier)
* Monitor neurologic signs
* Maintain optimum hydration & ventilation
* Monitor clotting times (DIC)
* Observe for signs of shock
* Treat seizures
* Droplet Isolation
* IV antibiotics @ dose (blood brain barrier)
* Monitor neurologic signs
* Maintain optimum hydration & ventilation
* Monitor clotting times (DIC)
* Observe for signs of shock
* Treat seizures
157
Clinical Manifestations:Bacterial Meningitis
Infants: fever, poor feeding, vomiting, bulging fontanel
Children: fever, chills, headache, vomiting, seizure, photophobia, nuchal rigidity, + Kernig, Brudzinski; may have slow onset with days of GI or URI petechial rash w/ shock - ____________
meningococemia
158
New onset (first time) acute seizure is usually a symptom of :
some other thing going on
159
3 behaviours assessed in the Glasgow Coma Scoring Tool
Eye Opening (response to stimuli)
Verbal Response (crying, cooing, or vocalization)
Motor Response (movement, reflexes)
160
[Spina Bifida] sometime parents do not comply after excellent teaching and that is a red flag. Need ___________
Social services
161
Ventriculoperitoneal Shunt- (VP shunt)
A Ventriculoperitoneal (VP) shunt is a medical device used to treat ___________ , a condition where there is an abnormal buildup of cerebrospinal fluid (CSF) in the brain’s ventricles. This buildup increases intracranial pressure, which can damage brain tissue.
hydrocephalus
162
Know infection or malfunction of VP shunt is an _________ situation
urgent
163
Nursing Considerations: For all Acute Neuro problems that might increase ICP
* Decrease environmental _______
* HOB ___ degrees
* Head Midline
* Treat pain and discomfort
* ________ precaution
* Maintain ______-thermia (no cooling in peds- NICU cools anoxic head but that the only condition backed be EBP)
* Monitor ICP
* Maintain Normal glucose
* Decrease environmental stimuli
* HOB 30 degrees
* Head Midline
* Treat pain and discomfort
* Seizure precaution
* Maintain Normo-thermia (no cooling in peds- NICU cools anoxic head but that the only condition backed be EBP)
* Monitor ICP
* Maintain Normal glucose
164
Nephrotic syndrome - Complications of IV steroids
difficult IV access?
May not be responsive
165
Acute post-streptococcal glomerulonephritis (AGN)
Acute inflammation of kidney at ____________
Antigen-antibody complexes (from previous strep infection) cause ________.
Clog up glomerulus and decrease filtration --> fluid retention & HTN
Increased retention in blood
Leaks RBCs and a little protein
Low WO --> increased serium K+
Acute inflammation of kidney at glomerulus
Antigen-antibody complexes (from previous strep infection) cause swelling.
Clog up glomerulus and decrease filtration --> fluid retention & HTN
Increased retention in blood
Leaks RBCs and a little protein
Low WO --> increased serium K+
166
Acute post-streptococcal glomerulonephritis (AGN) More common in _____ age 6-10.
boys
167
Acute post-streptococcal glomerulonephritis (AGN)
Manifestation:
Periorbital edema, tea-colored urine, hypertension, anorexia, HA, abd pain, oliguria
168
Nephrotic Syndrome (NS)
The glomerular basement membrane becomes increasingly _______________
Most common protein lost is albumin, but immunoglobulins also lost in urine (important to prevent infex)
Loss of serum protein --> loss of colloidal pressure in vasculature --> fluids leak from blood vessels and enters extracellular tissues in attempt to = water:protein concentration --> severe generalized edema (anasarca)
permeable to protein
169
Nephrotic Syndrome (NS) Manifestations:
severe and generalized edema, oliguria, dark and frothy urine, lethargy, irritability, hypotension, increased respiratory rate from pleural effusions
170
Most heart conditions in children result from defects in _____________ . Heart structure develops and begins beating soon after gestation
embryonic structure
171
CONGENITAL HEART DEFECTS Acyanotic VS Cyanotic
Acyanotic- *** cause an _________ in pulmonary blood flow, allow blood to mix, less likely to cause cyanosis
Cyanotic- *** cause a ________ in pulmonary blood flow, obstruct blood flow, more likely to cause cyanosis
Acyanotic- *** cause an increase in pulmonary blood flow, allow blood to mix, less likely to cause cyanosis
Cyanotic- *** cause a decrease in pulmonary blood flow, obstruct blood flow, more likely to cause cyanosis
172
Ventricular septal defect (VSD)
Atrial septal defect (ASD)
Patent ductus arteriosus (PDA)
Coarctation of the aorta
Aortic stenosis
are all
acyanotic defects
173
Tetralogy of Fallot
Truncus arteriosus
Transposition of the great vessels
are all
cyanotic defects
174
VENTRICULAR SEPTAL DEFECT (VSD)
-A ______ between the ventricles
-Oxygenated blood from left ventricle is shunted to right ventricle and recirculated to the lungs - acyanotic
-Increases the pulmonary vascular resistance
-May have enlarged right ventricle
-Small defects may close spontaneously
-Large defects cause congestive heart failure and require surgical closures
-Most common congenital anomaly (associated with _______ )
-A hole between the ventricles
-Oxygenated blood from left ventricle is shunted to right ventricle and recirculated to the lungs - acyanotic
-Increases the pulmonary vascular resistance
-May have enlarged right ventricle
-Small defects may close spontaneously
-Large defects cause congestive heart failure and require surgical closures
-Most common congenital anomaly (associated with Downs)
175
VENTRICULAR SEPTAL DEFECT (VSD) Signs:
poor ______ , FTT, tachypnea, ________ with feeding
poor eating, FTT, tachypnea, fatigue with feeding
176
PATENT DUCTUS ARTERIOSUS
-An abnormal _______ between the aorta AND the pulmonary artery
-Failure of the fetal ductus arteriosus to ______ after birth
-Usually closes within 72 hours after birth
-If it remains patent, oxygenated blood from the aorta returns to the pulmonary artery
-Increased effort of the left and right side of the heart
-Increased blood flow to the lungs causes pulmonary hypertension
-may require medical intervention with indomethacin (Indocin) administration or surgical closure
Signs: FTT, SOB, murmur, tachypnea
-An abnormal opening between the aorta AND the pulmonary artery
-Failure of the fetal ductus arteriosus to close after birth
-Usually closes within 72 hours after birth
-If it remains patent, oxygenated blood from the aorta returns to the pulmonary artery
-Increased effort of the left and right side of the heart
-Increased blood flow to the lungs causes pulmonary hypertension
-may require medical intervention with indomethacin (Indocin) administration or surgical closure
Signs: FTT, SOB, murmur, tachypnea
177
COARCTATION OF THE AORTA
Obstructive ________ of aorta
Most common sites are the aortic valve and the aorta near the ductus arteriosus
A common finding is __________ in the upper extremities and decreased or absent pulses in the lower extremities
It may require surgical correction
Signs: hypertension in upper extremities, pale skin, leg cramps, cold feet, headache
Risk for hypertension, ruptured aorta, aortic aneurysm, and stroke
Obstructive narrowing of aorta
Most common sites are the aortic valve and the aorta near the ductus arteriosus
A common finding is hypertension in the upper extremities and decreased or absent pulses in the lower extremities
It may require surgical correction
Signs: hypertension in upper extremities, pale skin, leg cramps, cold feet, headache
Risk for hypertension, ruptured aorta, aortic aneurysm, and stroke
178
TETRALOGY OF FALLOT
The child experiences “tet” spells, or _________ episodes after crying, feeding or when agitated that are relieved by the child’s squatting or being placed in the knee-chest position
hypoxic
179
*CARDIAC CATHETERIZATION [post-care]
Vital signs, insertion site observed, distal pulses checked Q 15 minutes x 1 hour, then Q 30 minutes
Observe for ________ at site, pallor, loss of ______, ________ of extremity
Push fluids to flush dye out of body
Observe for reactions to dye (vomiting, rash, increased creatinine, decreased urinary output)
Keep leg “still” for 4 to 8 hours
Pressure on incision site if bleeding occurs
Vital signs, insertion site observed, distal pulses checked Q 15 minutes x 1 hour, then Q 30 minutes
Observe for bleeding at site, pallor, loss of pulses, coolness of extremity
Push fluids to flush dye out of body
Observe for reactions to dye (vomiting, rash, increased creatinine, decreased urinary output)
Keep leg “still” for 4 to 8 hours
Pressure on incision site if bleeding occurs
180
Low cardiac output (impaired myocardial function) - S&S
__________ at rest
decreased peripheral perfusion
pale _____ extremities
anorexia
_________ BP
cardiomegaly
oliguria
Tachycardia at rest
decreased peripheral perfusion
pale cool extremities
anorexia
decreased BP
cardiomegaly
oliguria
181
Pulmonary congestion (CHF) S&S
Tachypnea, orthopnea
_________, nasal flaring
Cough
Wheezing, ________
Cyanosis
Tachypnea, orthopnea
Retractions, nasal flaring
Cough
Wheezing, grunting
Cyanosis
182
Systemic venous congestion (CHF)
____________
_______ (periorbital, ascites)
_______/pericardial effusions
Hepatomegaly
Edema (periorbital, ascites)
Pleural/pericardial effusions
183
KAWASAKI’S DISEASE
Acute systemic vasculitis that can damage ________________, including the coronary arteries
Can cause permanent damage to the main arteries to the heart, resulting in the _________ of the coronary artery
Acute systemic vasculitis that can damage blood vessels, including the coronary arteries
Can cause permanent damage to the main arteries to the heart, resulting in the aneurysm of the coronary artery
184
KAWASAKI TREATMENT
Administer intravenous ___________ (IVIG)
High dose ________
Monitor cardiac status & daily weights, strict Is & Os
Minimize skin discomfort with lotions and cool compresses
Initiate meticulous mouth care
Monitor intake of clear liquids and soft foods
Administer intravenous immunoglobulin (IVIG)
High dose aspirin
Monitor cardiac status & daily weights, strict Is & Os
Minimize skin discomfort with lotions and cool compresses
Initiate meticulous mouth care
Monitor intake of clear liquids and soft foods
185
PEDIATRIC GLASGOW COMA SCALE
Best score 15;
____ is coma
< 8
186
INTERVENTIONS FOR BACTERIAL MENINGITIS
Administer ____ within 30 minutes of presentation
Isolate at least 24 hours: DROPLET
ABX
187
FOCAL/PARTIAL SEIZURES
Arises from ___________ of the brain, limited symptoms
Simple-consciousness not impaired
Complex-consciousness impaired
specific area
188
Seizure care
Maintain _________ during seizure
Turn client on _____ to aid ventilation
Do not restrain client
Protect from injury during seizure, and support ________
Administer anticonvulsants
Nasally (e.g. ______)
Rectal diazepam
Maintain airway during seizure
Turn client on side to aid ventilation
Do not restrain client
Protect from injury during seizure, and support head
Administer anticonvulsants
Nasally (e.g. Ativan)
Rectal diazepam
189
Do not use tongue blade during a seizure!
DO NOT PUT _________ IN THE MOUTH OF AN ACTIVELY SEIZING PATIENT!
ANYTHING
190
SPINA BIFIDA *Prevention: __________ daily at least 3 months prior to and during pregnancy
folic acid
191
Spina bifida occulta: dimple with or without hair tuft at base of spine - No ____ present
Meningocele: sac contains only meninges and spinal fluid, no _______ in spinal sac
Myelomeningocele: ____ contains spinal fluid, meninges and nerves, client has sensory and motor defects, flaccid paralysis and limited or no feeling below the defect
Spina bifida occulta: dimple with or without hair tuft at base of spine - No sac present
Meningocele: sac contains only meninges and spinal fluid, no nerves in spinal sac
Myelomeningocele: sac contains spinal fluid, meninges and nerves, client has sensory and motor defects, flaccid paralysis and limited or no feeling below the defect
192
MYELOMENINGOCELE
First 28 days of pregnancy neural tube fails to _____
____ protrudes in membrane, usually in lumbosacral area
Location and _______ of defect determine type extent and of neurologic involvement
First 28 days of pregnancy neural tube fails to close
Sac protrudes in membrane, usually in lumbosacral area
Location and size of defect determine type extent and of neurologic involvement
193
PROBLEMS ASSOCIATED WITH MYELOMENINGOCELE
____________ (90%) - circulation of CSF is interrupted
Neurogenic bladder, poor anal sphincter toneCongenital dislocated hips
Club feet
Skin problems associated with anesthesia below the defect
Scoliosis
Hydrocephalus (90%) - circulation of CSF is interrupted
Neurogenic bladder, poor anal sphincter toneCongenital dislocated hips
Club feet
Skin problems associated with anesthesia below the defect
Scoliosis
194
MYELOMENINGOCELE: LONG-TERM CARE (NO CURE)
Administer propantheline or bethanechol to improve ___________ (lessen bladder spasms)
Assess skin condition frequently
Develop bowel program (pt is incontinent, more prone to diarrhea, still need to have a bowel everyday )
Assist with range of motion exercises, ambulation, and bracing
Every child with a history of spina bifida should be screened for ______ allergies
*** If parents do not comply after excellent teaching, ____________ should be contacted!
Administer propantheline or bethanechol to improve continence (lessen bladder spasms)
Assess skin condition frequently
Develop bowel program (pt is incontinent, more prone to diarrhea, still need to have a bowel everyday )
Assist with range of motion exercises, ambulation, and bracing
Every child with a history of spina bifida should be screened for latex allergies
*** If parents do not comply after excellent teaching, social services should be contacted!
195
HYDROCEPHALUS - An abnormal accumulation of CSF within the ventricles of the brain: leads to _______________
Can be caused by:
- obstruction in the flow of CSF between the ventricles
- overproduction of CSF fluid
- congenital malformation blocking normal drainage
- head injuries
- infection (meningitis)
- spina bifida
increased ICP
196
SIGNS OF INCREASED ICP [infants[
Irritability, lethargy
Increasing head circumference
Bulging fontanels
Widening suture lines
“Sunset” eyes
High-pitched cry
Irritability, lethargy
Increasing head circumference
Bulging fontanels
Widening suture lines
“Sunset” eyes
High-pitched cry
197
SIGNS OF INCREASED ICP [older children]
Change in level of consciousness
**Increased blood pressure
**Decreased respiratory rate
Irritability
Vomiting, nausea (at night, not associated with eating)
Headache on awakening
Motor dysfunction
Unequal pupil response
Seizures, sleepiness
Decline in academics
Change in personality
Change in level of consciousness
**Increased blood pressure
**Decreased respiratory rate
Irritability
Vomiting, nausea (at night, not associated with eating)
Headache on awakening
Motor dysfunction
Unequal pupil response
Seizures, sleepiness
Decline in academics
Change in personality
198
ASSESS FOR SIGNS OF VP SHUNT MALFUNCTION [infant]
Bulging fontanels, sutures separated
Irritability, lethargy or seizures
Altered vital signs
Altered feeding behavior
Bulging fontanels, sutures separated
Irritability, lethargy or seizures
Altered vital signs
Altered feeding behavior
199
ASSESS FOR SIGNS OF VP SHUNT MALFUNCTION [older child]
Change in LOC
Headache
Changes in customary behavior (sleep patterns, developmental capabilities, poor feeding)
Change in LOC
Headache
Changes in customary behavior (sleep patterns, developmental capabilities, poor feeding)
200
VENTRICULOPERITONEAL SHUNT (VP)
Shunt placement to re-route flow → _____ CSF
May need to be changed as child grows, becomes obstructed, becomes infected
CSF brought down to another part of the body to be absorbed
absorb
201
average life span of infant shunt :
2 years!
202
INCREASED INTRACRANIAL PRESSURE - OPPOSITE OF SHOCK
Shock: increased pulse, decreased blood pressure
Increased ICP: _________________________________
decreased pulse, increased blood pressure
203
TYPE 1 DIABETES
Immune-mediated disease associated with absolute _________ _________ (body’s own T-cells destroy pancreatic beta cells, which are the source of insulin)
insulin deficiency
204
Classic three P’s [Diabetes type 1]
Polydipsia
Polyphagia
Polyuria
205
KETOACIDOSIS
Ketones in the blood are strong acids that ________ serum pH
decrease
206
DKA INTERVENTIONS
__________ common - initial hydration NS 20ml/kg with potassium started after patient has peed (no Pee = no K)
Low dose ________ IV - slowly decrease serum glucose to reduce chance of cerebral edema during rehydration
Never turn off ________ - only thing that corrects the acidosis
Dehydration common - initial hydration NS 20ml/kg with potassium started after patient has peed (no Pee = no K)
Low dose insulin IV - slowly decrease serum glucose to reduce chance of cerebral edema during rehydration
Never turn off insulin - only thing that corrects the acidosis
