Term
| how does an infant/toddler (1-24 months) understand death? |
|
Definition
| They really don't, but can sense something is wrong. Infant can sense parents reaction. They are unable to understand death though. They will have a fear of separation & will be unhappy if the parent is not there. |
|
|
Term
| what is most important to provide in the care of an infant/toddler? |
|
Definition
| help parent provide care. be calm & provide support. Touch, holding, cuddling is important. Nurse can encourage parents to do it. They still need stimulation, music helps.. |
|
|
Term
| Describe how a 3-4 year-old might react to the death of a close family member? |
|
Definition
| 3-4 yo's see death as "sleep" interchangeable with life. They are unable to grasp the permanence of death & do not have any fear of dying. However they may have a fear of sleep. |
|
|
Term
| What questions might a 3-4 yo ask about death? How would you respond? |
|
Definition
| They think death is reversible & need to be told over & over again about deaths finality. They may feel they caused the death & it is imp to reassure them that they did not. Their biggest worry is that they will be left alone, so have someone with them at all times. Do not refer to death as sleep. |
|
|
Term
| What would be appropriate interventions for a preschool child (3-6 year old) who IS dying? |
|
Definition
| Stay with them! (parents should stay w/ them or have a replacement), provide consistency in care (They may have a fear of separation), encourage play to express feelings, stories, videos (may tell their favorite story over & over for comfort, do it!), maintain routines. distract with movies, use fairy tales, stories. child may project feeling they can't verbalize with puppets or drawings. |
|
|
Term
| at what age do most children begin to develop an adult concept of death? |
|
Definition
| gradually around school age they begin... about 9-12. She said end of school age, about 12 they really know it's inevitable, permanent & irreversible. |
|
|
Term
| what behaviors might you see in school age children that help them understand death? |
|
Definition
| They see death through plants & animals that die. Developed through concept of Halloween & boogie man may help understand. They may develop sadness, loneliness, fear of unknown. Help child express feelings & comfort family, clarify what child fears about death with a simple question. |
|
|
Term
| what age group has the most difficulty coping with death - particularly their own? Why is this? |
|
Definition
| Adolescents - they've got their own ideas now, places to go, unfinished business, very concerned with their self-appearance. They do see death as final & this is incongruent with other aspects of their life. Invisibility conflicts with death for adolescents. |
|
|
Term
| how can it help to deal with an adolescent who is dying? |
|
Definition
| They have adult concept of death, nurse should relate to pt as a whole person, allow for their independence & let them do their own care, nurse should act as an advocate & keep in contact with the dying pt. know that they could act out in anger & DENIAL. They still have primary needs: love, care, friendship. Assure them that they will not be abandoned. |
|
|
Term
| Describe the possible responses of siblings to the death of a brother or sister? how could they be involved in their dying siblings care? |
|
Definition
| anger, denial, jealousy. Parents should include them in what's going on. They may think they caused it & need reassurance. Parents encourage d to spend time with well child. Nurse should pay attn to siblings & reassure them. Facilitate support groups. The siblings could help in care by: bringing them to hospital & let them visit, play games with siblings & give them diversion. |
|
|
Term
| how would you respond to parents who are considering not telling their 10 year-old daughter that she is dying? |
|
Definition
| The nurse does not want to destroy trust with the child. The nurse should discuss with parents who wish this up front that they are destroying trust with the child. (usually it's denial on the parents part). The nurse may agree to not bring it up, but if asked by the child directly, the nurse will answer the childs questions honestly. Children can tell & usually know & they'd like to have it verified. It's very difficult for parents to answer b/c of their own feelings. |
|
|
Term
| what are some issues and concerns parents with a dying child have? |
|
Definition
| have Q's about other methods they've heard of, who to call for help, care from hospital to continue at home (advantages & disadvantages), talk about skin, fluids, etc... |
|
|
Term
| What is most often the parents PRIMARY CONCERN? |
|
Definition
|
|
Term
| Why is home care program beneficial for the child? for the family? |
|
Definition
| at home they are in a familiar environment, friends can visit easier, there is less restrictions, the quality time spent with child may decrease the grief when death actually comes, increased comfort, people can come & go, better bereavement when the child dies. |
|
|
Term
| What is child abuse and neglect? |
|
Definition
| at a minimum, any recent act or failure to act that results in imminent risk of serious harm, death, serious physical or emotional harm, sexual abuse, or exploitation or a child (a person under the age of 18, unless the child protection law of the state in which the child resides specifies a younger age for cases not involving sexual abuse by a parent or caretaker (including any employee of a residential facility or any staff person providing out of home care who is responsible for the child's welfare) |
|
|
Term
| who has jurisdiction & responsibility for their own definitions of child abuse & neglect? |
|
Definition
| individual STATES do & how they will set the bill up. |
|
|
Term
| what is the definition of sexual abuse? |
|
Definition
| employment, use, persuasion, inducement, enticement or coercion of the child to engage in or assisting any other person to engage in any sexually explicit conduct or any simulation of such conduct for the purpose of producing any visual depiction of such conduct. The definition also includes rape and in caes caretaker or interfamilial relationships, statutory rape, molestation, prostitution, or other forms of sexual exploitation of children or incest with children. (IT HAS TO BE SOMEONE INVOLVED FOR IT TO BE CONSIDERED "ABUSE" - OTHERWISE IT IS ASSAULT) |
|
|
Term
| The 4 major types of abuse are: |
|
Definition
| physical, neglect, sexual and emotional |
|
|
Term
| __________ abuse is injury d/t infliction of physical injury. Includes: punching, biting, kicking, burning, shaking or otherwise harming the child. |
|
Definition
|
|
Term
| What is minor & major physical abuse? also who determines these categories? |
|
Definition
| Minor injury is responsible for more reported cases. Major physical abuse causes more deaths. Each state determines what to report as a major vs minor abuse. Each state determines what is minor & what is major. |
|
|
Term
| __________ is the most common type of maltreatment for children. |
|
Definition
| neglect. This is failure to provide for the child's basic needs of physical, educational and emotional. |
|
|
Term
| Neglect is failure to provide for a childs basic needs.(physical=depriving food, clothes, hygiene - often result of poverty & they may just not know what to do. emotional=ignorant of what child needs. educational=deprive of education) What else does this include though? |
|
Definition
| also includes fostering maladaptive behaviors such as delinquency and substance abuse. |
|
|
Term
| What % of sexual abuse victims know their abuser? |
|
Definition
|
|
Term
|
Definition
| fondling of a child's genitals, intercourse, incest, exhibitionism, rape, sodomy, and commercial exploitation through prostitution and pornographic materials. |
|
|
Term
| Are sexual abuse relationships short or long term usually? |
|
Definition
| usually long term. Sexual abuse may also include some physical abuse to force compliance. |
|
|
Term
| Emotional abuse is PURPOSEFUL/INTENTIONAL (whereas, neglect may not be intentional). They try to decrease self-esteem & confidence. What's the def of emotional abuse? |
|
Definition
| Includes acts or omissions by the parents or other caretakers that have caused or could cause serious behavior, cognitive, emotional or mental disorders. Almost ALWAYS SEEN WITH OTHER TYPES OF ABUSE. |
|
|
Term
| What are some statistics of abuse? |
|
Definition
| 906,000 children were abused or neglected (3.6 million reported), 60% of these children were victims of neglect, 19% were physically abused, 10% were sexually abused, 5% were victims of emotional abuse. These stats run pretty consistently from year to year. |
|
|
Term
| So what are the highest to lowest rates for the types of abuse? |
|
Definition
| Neglect is the highest, then physical abuse, then sexual abuse and emotional abuse is the smallest percentage. |
|
|
Term
| What risk factors in parents may lead to child abuse? |
|
Definition
* History of abuse or neglect in childhood
* History of severe punishment
* Difficulty controlling aggressive impulses
* Free expression of violence
* Social isolation no support system
* Low self-esteem
* Limited nurturing skills |
|
|
Term
| what factors in a child may present risk for abuse? |
|
Definition
* Temperament
* Position in family
* A “different” child
* Physically ill or disabled
* Illegitimate or unwanted
* “NICU” babies
* A child that reminds the parent of a disliked person |
|
|
Term
| What are some environmental risk factors present with abuse? |
|
Definition
Presence of Chronic Stress
(Poverty, Alcoholism and drug abuse, Violence, Unemployment)
*** Abuse is found in ALL educational, social, racial, cultural, religious, and economic boundaries!!! *** |
|
|
Term
| What age category has the highest % of abuse/neglect? |
|
Definition
| less than 1 year (44%) and then 1-3 years (34%) |
|
|
Term
| What are some signs of physical neglect? |
|
Definition
| Failure to Thrive, Malnutrition, Unclean, poor personal hygiene, Inappropriate dress, Frequent injuries from lack of supervision, Evidence of poor health care |
|
|
Term
| what are some behaviors often encountered for physical abuse/neglect? |
|
Definition
| *Passive, dull behaviors, Self-stimulating behaviors, Excessive school absences, Drug or alcohol abuse, Vandalism or shoplifting |
|
|
Term
| what are some signs of physical abuse? |
|
Definition
| BRUISES & WELTS (Pattern of object used, Various colors indicate stage of healing), BURNS (Shape, Placement, Lack of splash marks), FRACTURES & DISLOCATIONS, MOUTH INJURIES (¡¾ of child abuse cases involve area of mouth, head, face, and neck, Result of force feeding or physical trauma, Dentist had same responsibilities to report suspicious injuries as any other health care professional. However, most dentists are not taught this and are unaware of there legal responsibility to report.) |
|
|
Term
| CONTINUED signs of physical abuse? |
|
Definition
| LACERATIONS & ABRASIONS (Particularly on the backs of arms, legs, and torso, genitalia, or face where child least likely to injure himself during normal play, Human teeth marks), ABD SWELLING AND PAIN-DISCOMFORT FROM BEAING PUNCHED (Bleeding internally can lead to shock, Abdominal injury is the second cause of death with abuse injuries) |
|
|
Term
| what are some BEHAVIORS associated with physical abuse? |
|
Definition
| Child demonstrates fear of contact with parent, Fear of going home, Fails to cry even when in pain, Very watchful of environment, Lies still with little reaction, May display affection and friendliness with no sign of age appropriate separation anxiety, Withdrawal or aggressive behavior to seek attention |
|
|
Term
_________ ______ Syndrome is violent shaking of a baby causing the head to snap back and forth causing a whiplash type of injury.
|
|
Definition
|
|
Term
| What other damage does shaken baby syndrome cause? Are injuries always readily apparent? |
|
Definition
| Also causes retinal hemorrhages and subdural hematomas from torn blood vessels. Injuries are not always readily apparent. Those who survive have major physical and mental deficiencies the rest of their lives. Most die by age 10-15. |
|
|
Term
| what are physical findings related to EMOTIONAL ABUSE & NEGLECT? |
|
Definition
| Failure to Thrive and developmental delays, Feeding problems, Sleep disorder, Enuresis (bed wetting) |
|
|
Term
| Why is shape, placement and lack of splash marks imp for burns? |
|
Definition
| often cigarette burns for shape, dunking burns happen for not potty training & lack of splash marks indicates being dunked also. |
|
|
Term
| What is vietnamese coining? |
|
Definition
| It is not malicious & therefore not considered abuse. Spread oil on the body & rub coin down body hard. this induces bruises & it's to rid body of harmful spirits. |
|
|
Term
| lacerations & abrasions on the front/back of legs is likely normal play, but where might questionable places be? |
|
Definition
| abd, upper back, back of arm, genital area, etc... always match injury to story & are the parents stories consistent? Does it match the childs developmental level? could they possibly have even done that? |
|
|
Term
|
Definition
Self-stimulation behaviors, Withdrawal, Infant lack of social smile and stranger anxiety, Lags in emotional and intellectual development, Destructive behaviors, Unusual fearfulness, Inability to play
(they may withdraw & be anxious, don't smile, decreased development, unusual amt of fear, they don't play) |
|
|
Term
| What are signs of sexual abuse? |
|
Definition
| Bruises, bleeding, lacerations of the external genitalia, mouth, or throat. Torn bloody underclothing. Difficulty walking or sitting. Pain on urinating, itching, swelling of the genital area, recurrent UTI. Penile discharge, STD, Pregnancy. |
|
|
Term
| what are behavioral signs of sexual abuse? |
|
Definition
| Excessive or public masturbation. Inappropriate sexual play, promiscuity. Excessively withdrawn, preoccupied with fantasies, excessive daydreaming, poor peer relationships, clingy behavior. Regressive behaviors ie bedwetting. Decrease in school performance, depression. Sudden onset of phobias and fear, personality changes. |
|
|
Term
| What are some common behaviors of the abuser? |
|
Definition
| Difficulty showing concern for child (Preoccupied with own needs, Inappropriate emotional responses) Give conflicting stories about the incident (Injury inconsistent with cause given, Explanation inconsistent with child’s developmental level, May blame a sibling) History of abuse and frequent visits to ER’s |
|
|
Term
MUNCHAUSEN SYNDROME BY PROXY, what is that?
|
|
Definition
| MSBP refers to an illness that one person fabricates or induces into another person. (Common conditions produced are seizures or apnea caused by suffocating the child. Bleeding by adding blood to urine and presenting a fictitious history. Chronic poisoning the child. Administer substances to cause diarrhea, vomiting, fever, and rash.) |
|
|
Term
| who do you report suspected abuse to in MO? KS? |
|
Definition
| Missouri=Division of Family Services & Kansas=State Department of Social and Rehabilitative Services. ** All health care workers, teachers, law enforcement officers, are required to do mandatory reporting if they suspect abuse ** |
|
|
Term
| what intervention is used for child abuse? |
|
Definition
| Protect the child from further abuse!! Referrals are investigated by child welfare departments and a caseworker investigates, Based on his findings the child may be left in the home or temporarily removed, Child may be hospitalized for medical care of his injuries, Regardless of abuse the needs of these children are the same as any other child in the hospital, An investigation may be ongoing while child is hospitalized. |
|
|
Term
| What nursing interventions are done for child abuse? |
|
Definition
| Family Support!! Be a role model for parents, Encourage child’s relationship with parents, Establish a therapeutic relationship with parents. Keep a positive nonjudgmental attitude, Utilize opportunities to educate parents about physical and emotional needs of child, Nonviolent methods of discipline, Offer praise and encouragement, Referral to appropriate agencies. |
|
|
Term
A nurse should support a non-abusive parent or family member...
|
|
Definition
| Encourage them to support the child and encourage then to help child talk about experience, Alert them for changes in behavior and signs of distress, Help the family member or parent express and deal with their own feelings of guilt, blame, and distress |
|
|
Term
| The nurse needs to pay special attention & _________ everything if the parent comes to visit. |
|
Definition
|
|
Term
| RElationship of abuse & low SES... |
|
Definition
| Abuse is seen in lower SES areas (it is more visible here, but abuse DOES OCCUR IN ALL AREAS OF ECONOMIC INCOME!) |
|
|
Term
| What is MSBP again? (Muchausen Syndrome by Proxy) |
|
Definition
| This is the parent attempting to induce a disease in a child. Pediatric condition is a falsification. |
|
|
Term
| When discharged from the hospital and placed in foster homes what should be done? |
|
Definition
| prepare child for this event, allow them to express their feelings, encourage foster parents to visit while in the hospital, help them to get to know the child. |
|
|
Term
|
Definition
| professional counseling of both the abuse & the victim, anger control, education in childrearing techniques, early identification of high risk populations (home visits to primiparas, teen-age, unmarried, and low SES parents. NICU babies are in risk population) |
|
|
Term
| How is sexual abuse prevented? |
|
Definition
| educate child of self-protection techniques, teach safety & help them id potential risk situations, encourage education programs in schools |
|
|
Term
| why do lesions of the skin happen on children? |
|
Definition
they happen b/c of a variety of etiological factors. Like: Contact injurious agent (Infection, toxic chemicals)
-Heredity factors
-Allergens
-Systemic diseases |
|
|
Term
| What are examples of primary lesions? |
|
Definition
Macule
• Papule
• Patch
• Plaque
• Wheal
• Vesicle
• Pustule
• Bulla |
|
|
Term
| A ___________ is a freckle less than 1 cm. it's flat. |
|
Definition
|
|
Term
| a __________ is an elevated mole. |
|
Definition
|
|
Term
| a ________ is more than 1 cm, irregular in shape & flat. |
|
Definition
|
|
Term
| A ________ is elevated, greater than 1 cm, rough & firm. |
|
Definition
|
|
Term
| A _________ is elevated, irregularly shaped area of cutaneous edema, variable size, pale pink with lighter center. ex/ insect bite, TB test |
|
Definition
|
|
Term
| A ____________ is elevated, filled with serous/clear yellow fluid. It is less than 1 cm. Ex/ blister or varicella. |
|
Definition
|
|
Term
| A __________ is elevated, similar to vesicle, but filled with purulent/pus fluid. example is acne. |
|
Definition
|
|
Term
| A _______ is a vesicle that is greater than 1 cm. |
|
Definition
|
|
Term
| Secondary lesions arise from primary lesions. What are some examples of these? |
|
Definition
| Scale, crust, lichenification, excoriation, fissure |
|
|
Term
|
Definition
| is irregular, thick or thin, dry or oily, flaky exfoliation, heaped up keratinized cells. |
|
|
Term
| a _______ is a scab with dried blood. |
|
Definition
|
|
Term
| ____________ is rough, thickened epidermis, accentuate skin markings caused by rubbing or irritation. ex/ chronic dermatitis |
|
Definition
|
|
Term
| ______________ is loss of the epidermis. linear or hollowed out, but the dermis is exposed. examples are: abrasions of scratches. |
|
Definition
|
|
Term
| ____ is a linear crack or break from the epidermis to the dermis. They are small, deep & red. SPLIT IN THE SKIN. example is athlete's foot. |
|
Definition
|
|
Term
| What % of children develop diaper dermatitis (diaper rash) ? how many develop serious problems? |
|
Definition
| 35% get it. 5% get serious problems from diaper rash. |
|
|
Term
| What is the peak age for diaper dermatitis? Who is it greater in: bottle fed or breast fed? |
|
Definition
| Peak age is 9-12 months. Incidence is greater in BOTTLE FED babies. |
|
|
Term
| What are the principal factors that contribute to developing diaper rash? |
|
Definition
| skin wetness, skin/increased diaper pH, fecal enzymes, chemical irritation, mechanical irritation, infection (candida albicans) that causes bright red lesions with raised borders (pg 593). |
|
|
Term
| Causes of diaper dermatitis (rash) in notes: |
|
Definition
| prolonged and repetitive contact with irritants such as feces and urine also soaps, detergent and friction. The irritant quality of urine is related to the increase in pH from the breakdown of urea in the presence of fecal urease (URINE MIXED WITH STOOL will INCREASE pH and can be VERY IRRITABLE). Feces from breast fed infants have lower fecal enzyme activity and lower more acidic pH (which helps, a higher more basic pH causes rash). Breast fed do NOT have as much of a problem! |
|
|
Term
| Also, know that washing skin can cause breakdown --> diaper rash. The pH of the skin is 4.4-5.5 (basically acidic). The skin needs this acidic environment to maintain. What do poop & pee do the pH level? |
|
Definition
| poop & pee raise the pH & cause breakdown of the skin. |
|
|
Term
| What do babes with diaper dermatitis present like? |
|
Definition
– Usually seen in convex surfaces of buttocks, inner thigh and perineal area. Where ever the diaper has come in contact & touches.
– Candida Albicans can also be a factor causing irritation.
– Candida causes bright red lesions with raised borders and is very painful (Candida is an infection you might see, it's bright red painful rash w/ satellite lesions on stomach) |
|
|
Term
| what nursing care is done to manage diaper rash (dermatitis)? |
|
Definition
Change diaper as soon as it becomes wet or soiled with stool:
• Expose area to air
• Use of a protective barrier such as zinc oxide
• If cause is a fungal agent mycostatin powder may be used under the zinc oxide (VASELINE, PETROLEUM JELLY ARE GREAT!)
• Other diaper pastes (butt balm and Super Dooper Diaper Do)
– Superabsorbent disposable diapers have helped significantly in decreasing diaper dermatitis |
|
|
Term
| If the cause of the diaper rash is a fungal agent, use ____________ powder under the zinc oxide. |
|
Definition
|
|
Term
| What should be used: cornstarch or talcum powder? |
|
Definition
| Cornstarch is more effective in reducing friction and cakes less when wet. Talc is more dangerous b/c it can be inhaled by the baby (Better not to use Talc). Cornstarch is not a danger. What ever powder is used it should be shaken into the caregivers hand first and then applied. (Neither are really recommended, but cornstarch over talc if using... water + mild cleanser is the best way to cleanse the area) |
|
|
Term
| What is seborrheic dermatitis? |
|
Definition
|
|
Term
| Seborrheic dermatitis/cradle cap is what? What causes it? |
|
Definition
| it is a chronic recurrent inflammatory reaction of the skin. It occurs on the scalp (cradle cap) but can also occur on eyelids (blepharitis) or external ear canal (otitis externa). The CAUSE IS UNKNOWN! This is common in early infancy as sebum production is increased. |
|
|
Term
| What does seborrheic dermatitis/cradle cap look like? What should be done to help it? |
|
Definition
| looks like thick, yellow, oily scaly, patches, pruritis may be present. The parent may be fearful of shampooing the "soft spot" and needs some education! Parent needs to shampoo daily with mild soap, leave on to soften crusts. Could cover with warm olive or baby oil for 15 min's, then wash hair, brush out with soft brush, do daily... needs to be consistent. |
|
|
Term
| What is atopic dermatitis (Eczema)? |
|
Definition
| Eczema is a general term used to describe a condition of redness, scaling, vesicles and crusting. |
|
|
Term
| Who does atopic dermatitis (eczema) happen to? Does it happen once or is it recurrent? |
|
Definition
| Atopic Dermatitis (AD) is a common, chronic, relapsing pruritic type of eczema and usually occurs in individuals who have allergies or a family history of such. (Atopy refers to an allergy with a hereditary tendency) |
|
|
Term
| What are the 3 forms of AD (eczema)? |
|
Definition
| 1. Infantile (2-6 months with spontaneous remission by 3 years of age) 2. Childhood (2-3 years of age. 90% manifest disease by 5 years) 3. Preadolescent & adolescent (begins about age 12 years of age and continues into adulthood). All 3 kinds have a genetic predisposition or allergies to having atopic dermatitis (eczema). |
|
|
Term
| An infant who has atopic dermatitis (eczema) will have infantile lesions (erythema, vesicles, papules, weeping areas, oozing, crusting and scaling). The baby will be very, very itchy. When we stop the itching, it does help decrease the inflammation. Where are AD (eczema) lesions usually found on infants? |
|
Definition
| Extensoral Areas. This is the face (cheeks), elbows, knees. |
|
|
Term
| The childhood form of atopic dermatitis (eczema) is clusters of papules, dry, may be hyperpigmented, lichenification with thickened skin especially in creases. The infantile is crusty & weepy while the childhood is more dry & skin becomes a different texture. What surfaces are the childhood forms found on? |
|
Definition
| flexoral surfaces as well as extensor like in baby. Can be face, elbows, knees and neck, wrists, ankles, feet. (Said she s not going to ask specifics of where it's at...) |
|
|
Term
| What is the adolescent form of AD/eczema like? |
|
Definition
| same as the childhood form. it's dry, thick lesions with lichenification. Itching happens with both & unaffected skin is dry and rough. |
|
|
Term
| What causes atopic dermatitis/eczema? what makes it better or worse? |
|
Definition
| cause is UNKNOWN. It will be better in humid weather & worse is fall and winter when homes are heated. These children have increased water loss from their skin & get very dry. This is d/t defective seramide cells... cause the alteration in perspiration. |
|
|
Term
| 50% of children with AD/eczema will develop __________. Majority have a family hx of what? |
|
Definition
| asthma. family hx of: eczema, food allergies or allergic rhinitis. |
|
|
Term
| What nursing care helps manage atopic dermatitis? |
|
Definition
– Hydrate Skin
– Relieve Itching
– Reduce flare-ups and Inflammation
– Control Infection
– Avoid allergens, avoid overheating, avoid skin moisture loss, and topical medications |
|
|
Term
| what is recommended to hydrate skin for atopic dermatitis? |
|
Definition
– Tepid baths with mild soap (Dove, Neutrogena) or no soap, or emulsifying oil (1x/day do this)
– Once or twice a day, no bubble bath
– Lotions such as Aquaphor, Cetaphil, Eucerin
– Nighttime bath followed by emollient (Vaseline is good) and cotton pajamas help alleviate nighttime itching. ** NO BUBBLE BATHS & pat skin dry and do not rub. Colloid bath=2 cups cornstarch & soak. |
|
|
Term
| What can help the pruritis (itching) that happens with atopic dermatitis? |
|
Definition
– Oral antihistamine drugs such as Atarax and Benadryl helpful at night
– Nonsedating antihistamines such as Claritin and Allegra may be helpful during the day
– Topical corticosteroids may also be used
– Secondary infections may be treated with systemic antibiotics |
|
|
Term
| Wet wraps can really help reduce flare-ups from atopic dermatitis. Explain these... |
|
Definition
| • Corticosteroid ointment followed by wrapping child in cool wet wraps for 10 minutes followed by the ointment and a moisturizer |
|
|
Term
| Topical Immunomodulators are a new treatment for AD. When are these best used? What ointment is used? |
|
Definition
| best used at beginning of flare-up when starting to itch & turn red. Tacrolimus (TAC) and pimecrolimus ointments are used. There is a mild burning sensation when applied to skin. The only problem with these are they are occlusive dressing and these are not recommended. Work best, but not usually sealed. |
|
|
Term
| what kind of bath helps atopic dermatitis? |
|
Definition
| tepid bath with mild soap or no soap or emulsifying oils. A colloid bath with oatmeal is fine. Nighttime bath followed by emollient (vaseline is good). Cotton pajamas! Lotions like Aquapoor, Cetaphil, Eucerin are fine. Remember, bubble baths are not ok for atopic dermatitis. |
|
|
Term
| what other nursing care is done for atopic dermatitis? |
|
Definition
– Keep nails short
– Use cotton gloves or socks to discourage scratching
– Avoid wool clothes and blankets
– Dress appropriate for the climate
– Avoid soaps and detergents that cause irritation
– Use a skin cleanser with a NEUTRAL pH. Keep diaper area clean
– Observe any lesions for signs of infection |
|
|
Term
| What is the diet for atopic dermatitis? |
|
Definition
– Food allergies may be involved & controlling these food allergies can help the skin.
– Common allergies in children are eggs, cow’s milk, and peanuts.
– Parent education – to read labels
– Hypoallergenic diet takes time before effects seen
– Parents need reassurance and support |
|
|
Term
| How can "airborne allergens" even effect atopic dermatitis? |
|
Definition
| may cause the eczema to exacerbate. They may be advised to "allergy proof their home." |
|
|
Term
| What family support is imp with atopic dermatitis? |
|
Definition
– Reassure parents that scarring will not occur unless secondary infection presents.
– Emotional stress especially during exacerbations can be overwhelming.
– Need to relieve stress in both child and parent as stress aggravates the severity of the disease. |
|
|
Term
|
Definition
| Very contagious & common skin disorder caused by group A streptococcus or staph aureus. Common in toddlers & preschool. Affects the exposed areas of the body (face, hands, neck & extremities) |
|
|
Term
|
Definition
| begins as a reddish macule and becomes a vesicle that is easily ruptured. It's a superficial, moist erosion. ** The exudates will dry to form heavy crusts!!! ** Itching is common! |
|
|
Term
|
Definition
| REMOVE SKIN CRUSTS & SOFTEN WITH BURROW's SOLUTION COMPRESSES.** Topical bactericidal ointment, oral/parenteral antibiotics (PENICILLIN) is given if severe. Will usually heal without scaring unless a secondary infection is present. |
|
|
Term
| What is taught by nurses to prevent impetigo? |
|
Definition
| Good Hand washing is imperative!!! Before and after contact with child, Towels and washcloths keep separate from other family members, Clothes should be changed daily and washed in hot water. (Tell family to keep towels and washcloths separate and wash clothes in hot water!) |
|
|
Term
| What is the process of impetigo lesions? |
|
Definition
| red lesions begin as macules --> then vesicles --> then rupture --> then exudate dries & it is very itchy. |
|
|
Term
| Where do MRSA colonies congregate? |
|
Definition
| common to find colonization of MRSA in nares and under fingernails of atopic children. It is easily spread by self-inoculation. SHould use good handwashing, keep towels and washclothes separat, change clothes daily & wash in HOT. (Precautions are similar to impetigo) We are seeing an increase in hospital admissions for skin abcesses and other infections due to this organism. |
|
|
Term
| Where does Cellulitis come from? |
|
Definition
| Cellulitis is an INFECTION of the skin from streptococcus, staphylococcus, or haemophilus influenzae bacteria. |
|
|
Term
| how does cellulitis manifest? |
|
Definition
– Inflammation of the skin and subcutaneous tissues with severe redness, swelling, and firm infiltration
– Streaking may be seen and there is involvement of regional lymph nodes
– May progress to form an abscess
– Fever and malaise |
|
|
Term
| how is cellulitis treated? |
|
Definition
– Oral or parenteral antibiotics given
– Rest and IMMOBILIZATION of both the child and affected part
– Hot moist packs are helpful
– Hospitalization required with systemic symptoms |
|
|
Term
| where do fungal infections come from? |
|
Definition
| – Fungal infections are caused by various dermatophytes that infect the nonviable keratinized cutaneous tissues including skin, nail, and hair. |
|
|
Term
| do fungal organisms live "ON" or "IN" the skin? |
|
Definition
|
|
Term
| The term ______ is specific to the part of the body infected with a fungus |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| groin, pubic area, thighs |
|
|
Term
|
Definition
|
|
Term
| Technically all fungal infections are _______ although this term is usually limited to hair & body infestations. |
|
Definition
|
|
Term
| The fungi will release an enzyme that digests and hydrolyzes keratin of hair, nails, etc... & produces _______ spots |
|
Definition
|
|
Term
| All of the fungal infections are easily transmitted from animal to person and person to person. true or false? |
|
Definition
|
|
Term
| Where are the fungi found in infections? how is diagnosis made? |
|
Definition
| around the edge of the inflamed border as they move outward from the inflammation. diagnosis is done from scraping the scales on the periphery of the lesion. |
|
|
Term
| What is tinea capitis? (head) |
|
Definition
| lesions are scale circumscribed patches with areas of alopecia. lesions may extend to hair line or neck. pruritic (itchy) |
|
|
Term
| What is tinea corporis (trunk, legs & arms)? |
|
Definition
| round or oval shaped lesions with erythematous scaling that spreads peripherally and clears centrally. |
|
|
Term
| how are fungal infections spread? |
|
Definition
| transmitted from person to person and from animal to person. |
|
|
Term
| Do fungal infections cause permanent hair loss? |
|
Definition
|
|
Term
| _________ individuals may be more susceptible to fungal infections. |
|
Definition
|
|
Term
| How are fungal infections managed? |
|
Definition
| Need to emphasize good hygiene. DO not share personal items or headgear like hats, scarves, etc.. |
|
|
Term
| How do we treat fungal infections? |
|
Definition
– Shampoos with SELENIUM SULFIDE
• Apply for 5-10 minutes at least 3 times a week
• Once therapy initiated may return to school |
|
|
Term
| Fungal Infections also are managed by giving oral ____________. It is important to maintain prescribed dose and schedule and also take with ____ ____ foods for best absorption. They may have to take them for a long period of time. |
|
Definition
| GRISEOFULVIN. take with HIGH FAT FOODS. (like ice cream, peanuts & avoid GI upset + help absorb) |
|
|
Term
| What topical antifungal ointments help? |
|
Definition
| Clotrimazole, Miconazole, etc... Apply beyond the periphery of the lesion and continue for 1-2 weeks after the lesion is gone! |
|
|
Term
| What are scabies? how long is the inflammatory response after the host becomes sensitized? |
|
Definition
| Scabies is caused by SCABIES MITE (Sarcoptes Scabiei). The pregnant female mite burrows into the skin where she lays her eggs & feces. Eggs hatch & mites travel. Inflammatory reponse in host lasts approximately 30-60 days. |
|
|
Term
| What does scabies present like? |
|
Definition
| They'll have intense itching that leads to excoriation, maculopapular lesions are distributed to hands, wrists, kneeds, elbows and inguinal region. Also see linear red lesions that represent areas where the mite has burrowed. A black dot at the end of a thread like burrow it the mite. |
|
|
Term
| Scabies take how long to transmit? |
|
Definition
| Prolonged contact is usually necessary for transmission of the mite b/c is takes 45 min's for it to burrow under the skin. |
|
|
Term
| how is the dx of scabies made? |
|
Definition
| by microscopic exam of scrapings from the burrow. |
|
|
Term
|
Definition
| Permethrin 5% cream (Elimite) is best. (Lindane lotion can also be used) |
|
|
Term
| explain how the cream is applied to the child for scabies? |
|
Definition
| applied head to toe (not just areas of rash) and even under the fingernails, leave on skin for prescribed period. touching & holding should be kept at a minimum. Wear gloves. Wash previously worn clothin in hot water & put in hot dryer. Mite will be killed, but the inflammatory reaction will not be eliminated for 2-3 weeks. Even after you kill the mite you still might have itching. |
|
|
Term
| What is pediculois capitis? |
|
Definition
|
|
Term
who is at risk for Pediculosis Capitis (Lice)?
|
|
Definition
– Children between 3 and 10 years of age and their families are infested most
– Females have more head lice than males in a 2:1 ratio
– White children are affected more often that black children by almost 99%
– Probably because North American species cannot grip the oval-hair shaft characteristic of African Americans
(White girls, age 3-10 & their families are highest incidence of lice!) |
|
|
Term
How are Pediculosis Capitis (Lice) transmitted?
|
|
Definition
– Direct Physical contact: head to head.
– Lice cannot fly or jump. They crawl.
– Transmission can occur with shared use of personal belongings. Avoid sharing head gear, combs, etc. |
|
|
Term
what is Pediculus humanus capitis?
|
|
Definition
| head lice. Small parasitic insect that resides on the scalp and neck hairs of a human host. |
|
|
Term
|
Pediculus humanus capitis
commonly infests... |
|
Definition
|
|
Term
| what are the manifestations of head lice? |
|
Definition
| – Itching caused by insect saliva |
|
|
Term
| what is the diagnosis of head lice? |
|
Definition
• Diagnosis by presence of nits (white eggs) firmly attached to the hair shaft
• Most eggs and case are attached within ¼ to ½ inch from scalp
• Viable/live nits are colored tan.
• Empty cases are white or grey. |
|
|
Term
| Treatment for pediculosis capitis (head lice): |
|
Definition
– Application of pediculicides and manual removal of nit cases
– PERMETHRIN 1% cream rinse is drug of choice (Nix) (nonprescription drug)
– MALATHION 5% is a prescription drug that may be used
– Daily removal of nits with a metal nit or flea comb following the pediculicide is essential for control |
|
|
Term
What nursing care is done for a child with Pediculosis Capitis?
|
|
Definition
– Complete combing of the child’s entire head of hair every day until no more nits are found
– Encourage parents to read instructions on shampoo label and follow carefully
– Nits can be removed with tweezers and fingernails also
– Avoid eye irritation (tilt head back! shampoo irritates eyes!)
-be sure to vacuum & laudner.
-put stuff in plastic bag & it will die in a couple of days. |
|
|
Term
| What psychological effect can pediculosis capitis (Head lice) have on a child? How is it prevented? |
|
Definition
– Response of others to diagnosis of lice stressful to children. Makes them feel ashamed or guilty.
• Prevention for head lice:
– Incidence of lice infection in schools has become a serious concern for school nurses.
– School nurses coordinate prevention and control programs for lice.
– There is Controversy over “No Nit” school policies. |
|
|
Term
| ________ most frequent reason for absenteeism in school |
|
Definition
|
|
Term
| how many kids are affected by some sort of pulmonary alteration? |
|
Definition
|
|
Term
| pulmonary problems happen b/c of "intrinsic" and or "extrinsic" factors. what does that mean? |
|
Definition
| INTRINSIC: smaller airway, congenital , second to other (cardiac) problem. chronic respiratory problems, respiratory connects w/ cardiac so any heart problems, TE fistula or any problems in trachea, asthma-highest admission month is October, allergies, aspiration of a foreign body- peanuts are higher EXTRINSIC: virus, infection, aspiration of foreign material. |
|
|
Term
| how would you tell the diff between child w/ asthma or aspirated something? |
|
Definition
| You’ll ausculate an abnormality over an area where they’ve aspirated the foreign body, whereas asthma would be more diffused. |
|
|
Term
| what kind of breathing used for babies 1-3 weeks? what about children? |
|
Definition
| Nose breathing 1st 3 weeks of life (Nose breathers for first few weeks, so if nose becomes occluded w/ something respiratory, they don’t have ability to breathe through mouth & will be admitted to the hospital). Children use ABDOMINAL breathing (abdomen will become distended easier & so this affects their breathing more.) |
|
|
Term
| What are some differences in a child's pulmonary system? |
|
Definition
smaller airway size than in adults, Less muscles in airways (small airway and less muscles result in increased edema), the Larynx is higher in vertebrae (easier for them to aspirate than adults), Cartilage trachea & bronchi are not well developed, Cough not well developed until 6 years (they don’t have ability to do big cough to get secretions out. You’ll have to do suction to get secretions out. They have a productive cough, but they’re then swallowing it.)
• They have Immature immune systems
• Plus, Increased exposure to all types of viruses & put fingers in mouth, young kids just don’t have good hygiene. |
|
|
Term
| what clinical manifestations will children with pulmonary disorders present with? |
|
Definition
• Cyanosis (African American? Check nailbeds & mucous membranes)
• Cough
• Changes in respirations
• Grunting common when they have respiratory problems
• Nasal flaring
• Head bobbing
• Clubbing (angles greater than 160, have to have a chronic disease like CF & chest is more barrel shaped)
• Chest shape
• Stridor (any kind of airway obstruction or edema)
• Wheeze (hear wheezing on expiration, but not during inspiration)
• Rales
• Restlessness
• Retractions (usually only see substernal so straight in and subcostal retractions at the end, as distress increases you’ll get other retractions) |
|
|
Term
| how do kids with a pulmonary problems with breathing sit? |
|
Definition
| Kids sit in tripod position: sitting fwd, upstraight, tongue is hanging out as they’re trying to breathe. |
|
|
Term
| Asthma is not diagnosed before __ months b/c the smooth muscle is not developed. children have less muscle in their airways. |
|
Definition
|
|
Term
| Asthma presents 1st with _____________ wheezes. |
|
Definition
| expiratory wheezing. May develop inspiratory with complicated. |
|
|
Term
| Remember to always obtain a hx before giving oxygen. why? |
|
Definition
| Some pt's may have a heart defect & that means they could have lower parameters. |
|
|
Term
| What type of retractions are the most common? |
|
Definition
| subcostal. These are at the very bottom & side of rib cage. If the child has retractions, look for compensatory respiratory mechanisms, such as nasal flaring during inspiration, grunting during expiration, or the use of accessory muscles in the neck and shoulders. |
|
|
Term
| What are the normal respiratory rates for infant, preschooler & school age children? |
|
Definition
| A normal respiratory rate for an infant averages approximately 40 breaths per minute, for a preschool child 30 breaths per minute, and for a school age child 20 breaths per minute. Abdominal breathing is common and normal in infants. |
|
|
Term
| How much oxygen can be used with infant (less than 2), toddler & school age? |
|
Definition
| infant is 2 L nasal cannula max + humidify with warmer. Toddlers = 4 L nasal cannula max. School age = 6 L nasal cannula max. |
|
|
Term
| When do you place a young infant or child in oxygen? How? |
|
Definition
| Oxygen Therapy: Normal O2 stat is 100. 95-100 is normal in a child. Usually put them on oxygen if their O2 stat is below 92%. Want to get to know child in assessment and what is their baseline or normal O2 stat. If it’s their first time in hospital, they will be put on oxygen. If they have a chronic disease, then ask what their normal is. |
|
|
Term
| how much oxygen is given to an infant, pre-schooler & school age child? |
|
Definition
infant? 2 L
Toddler/preschool? 4 L
Adolescents? 6 L
With children they often put moisture on their oxygen.
Less than 6 m o’s of age |
|
|
Term
what are the Cardinal Signs Respiratory Failure?
|
|
Definition
| Restlessness>listlessness, Tachypnea, Tachycardia, Diaphoresis, Decreasing stridor or wheezing may be sign that they’re having respiratory shutdown b/c airway is more obstructed & less air is coming through), Retractions without clinical improvement and are becoming deeper, then you’re thinking impending resp failure. Also if child goes from being very irritable to lethargic. |
|
|
Term
What is Bronchopulmonary Dysplasia (BPD)? are the born with it?
|
|
Definition
| • Chronic neonatal respiratory problem (causes chronic lung problems). NO, they are NOT born with it. BPD happens to a susceptible host. |
|
|
Term
| how does BPD happen if they are not born with it? |
|
Definition
| Respiratory Failure happens & is treated with O2 & or positive pressure ventilation. This causes damage to small airways. Interstitial fibrosis & edema occur. There is abnormal ventilation distribution that causes atelectasis (collapse of alveoli) & emphysema will result in BPD. These patients do not live past 20 years. |
|
|
Term
| What children does BPD happen to? |
|
Definition
| 90% were less than 1,500 grams & less than 28 weeks gestation. So, PREMATURE! They are then treated with oxygen and/or ventilation therapy for more than 28 days. Find abnormal findings on the chest x-rays. * You can see, The more premature you are the longer you’ll be on vent & higher incidence of developing bronchopulmonary dysplasia. Hard to extubate from vent and they’re on oxygen for awhile, might just be a little. |
|
|
Term
| What are the morbidity & mortality rates for BPD children? |
|
Definition
• Inc. risk morbidity & mortality 1st 2 years life
• Mortality 7x normal rate for age
• Recurrent respiratory infection
• Delays in G & D
• Abnormal persistent lung function in absence inc. O2 requirement & clinical symptoms *(They’re using all their energy just to breathe, may need an increase in calories. They’re really young, less than 28 weeks of age. Long-term it’s unknown what they’ll develop, at 45 may develop COPD easier for example. Their pulmonary results will be abnormal when checked at school age, though feeling alright at that time.)* |
|
|
Term
|
Definition
• Prevention
• Goal is to maintain adequate arterial blood gases with administration of oxygen and to avoid progression of the disease. Babies have chest tubes (jet ventilator causes less pressure)
• Corticosteroid therapy? Don’t like b/c sd effects, may give temporary burst. Try not to have continual basis.
• Oral diuretics for edema
• Bronchodilators
• Prophylactic administration of Palivizumab (Synagis) given once a month during RSV season. They get 5 doses & it’s $1200 an injection. Gives a 55% reduction in hospitalizations though.
• Supplemental nutrition? They may have an NG or GT tube, they may have a nighttime feeding while they’re asleep |
|
|
Term
| What nursing interventions help for BPD? |
|
Definition
• Early detection of problems (especially signs of further respiratory compromise & overhydration and underhydration) Change quickly, easy overhydration or underhydration. Really want to promote growth & development, just assess before and after play to see tolerance. Only suctioning them AS NEEDED, not every 4 hours or whatever!
• Providing periods of rest
• Evaluation of the need for suctioning
• Control & evaluation of weaning from respiratory support
• Feeding evaluation & techniques |
|
|
Term
|
What are the Nursing Interventions
with Feeding (Individualized) and BPD
|
|
Definition
| • Need higher than average caloric requirement (120-150 kcal/kg/day or greater) Require more calories than their age. Need 120-150 cal/kg. Need ¼-1/2 times what a normal baby their age would need in calories. • Promote nonnutritional sucking Frequent feedings (limit length of fdg) • Elevate HOB (more prone reflux) • May need supplemental NG or GT feedings (these babies may be in the hospital for months.) • Increase OXYGEN if O2 starts to drop when they’re eating. Feeding time should only take 20 min's, careful doesn’t take too long. Anything remaining, needs to be given through a tube. • Decrease environmental stimuli • Swaddle |
|
|
Term
| We are much more hesitant to do a trach on BPD babies, but they may have an NG tube to help eat. How can nurses include parents? |
|
Definition
| Involve parents as much as possible. One way, is if doing an NG feeding, the parent could be holding the feeding and stuff like that. We’ll take the baby out of isolation and give them to the parents and stuff like that. |
|
|
Term
| BPD babies should have consistency with caregivers & really requires a lot of parent teaching & effort to include them. Developmental enhancement is really important b/c they're stuck in the hosp for long periods. what are some interventions for this? |
|
Definition
| For developmental enhancement we really want to keep sound down. If you’re outside an isolate – then you only want to whisper. Because to them it’s equal sound to a jet. Children grew up with hearing damage. Might tape record parents voices, cover with a comforter, as get older may bring more into the environement. Want to be careful not to put anything that smells in the isolate (even an alcohol swab) or have IV tubing outside. They really enjoy touch at this point though for stimulation, wrap & bundle them up for security. |
|
|
Term
| what nursing interventions should be assured for BPD patient? |
|
Definition
– Quiet environment
– Personalized developmental care plan
– Provide appropriate quiet stimulation
– Observe response to stimulation
– Pacifier |
|
|
Term
| what nursing interventions are done to set up home care for BPD child? |
|
Definition
• Home Assessment - is this home able to handle this child? Need a house that can have oxygen and gas tanks. Have to have families able to care + feed baby, they’ll be evaluated carefully.
• Family Support & Follow-up
• Teaching Plan:
– Disease process
– Ability evaluate infant’s respiratory status
– Feeding plan
– Medications
– Care & use of oxygen equipment
– Special care needs
- Indications for emergency action & steps that need to be taken |
|
|
Term
|
__________ is the Inflammation of palatine tonsils (lymphoid tissue) in the oral pharynx
|
|
Definition
|
|
Term
| tonsilitis can be viral or bacterial. how is viral treated? |
|
Definition
| viral is less acute, but throat is still red, swollen tonsils & throat tenderness. Viral can be treated at home by gargling with salt water. Give some Tylenol too perhaps. |
|
|
Term
| what about bacterial tonsillitis? |
|
Definition
| bacterial throat is red, may see drainage, tongue may be grey & furry, red, swollen tonsils, swollen uvula, whitish spots on tonsils. Bacterial requires person to COME TO THE HEALTH CENTER. |
|
|
Term
Viral pharyngitis is self limiting. If the Throat cultures positive for _______ then treat with antibiotics. What about surgery?
|
|
Definition
| GABHS. Surgical treatment is controversial, but if the child is treated for 5-6 strep infections in a year they need to consider taking the tonsils out. Especially, for insurance to pay. |
|
|
Term
| What needs to be taught by nurses for tonsillitis care? |
|
Definition
• Compliance with medication
• Symptomatic care
– Really need to teach parents compliance on meds. Offer the one injection of penicillin. |
|
|
Term
| What nursing considerations must be done before a tonsillectomy? |
|
Definition
| The lymphatic tissue can regrow if they’re taken out too early. They have to be free of infection at the time of surgery too. |
|
|
Term
| what position should pt be in after tonsillectomy? |
|
Definition
| Want on abdomen or side until they’re conscious is back to normal. Helps to drain mucous and stuff |
|
|
Term
| after tonsillectomy it is imp to avoid trauma to the surg site & observe for complications. how? |
|
Definition
| the child is not going to open up mouth, but you need to check it every once in awhile. Not going to suction back there, unless it’s a last resort. Observe for signs of hemmorhage at sirg site, infection (could be days), symptoms of restlessness, n/v, FREQUENT THROAT CLEARING. 1st sign is frequent SWALLOWING. Then it becomes emesis, then change in VS. Post-op: really need to watch for ear pain b/c ears & throat are closely connected & ear infections are common after surgery. |
|
|
Term
| Croup Syndromes involve several disorders. what are they? |
|
Definition
| 1. Acute Epiglottitis 2. Acute Larnygotracheobronchitis (LTB) ( <-What croup really is medically & is the MOST COMMON), 3. Acute Spasmodic Laryngitis 4. Acute Tracheitis |
|
|
Term
| what is acute epiglottis? what is it caused by? |
|
Definition
| This is the more severe version, Serious bacterial infection causing inflammation epiglottis. Caused by: Usually Hemophilus influenzae Type B, 1-8 years |
|
|
Term
| What are the 3 CARDINAL signs of acute epiglottis? |
|
Definition
– No spontaneous cough
– Drooling Why would a child be drooling? Can’t swallow, no place for spit to go. You’d be thinking obstruction.
– Agitated b/c they can’t breathe |
|
|
Term
| Other signs of epiglottis? |
|
Definition
• Cherry-red edematous epiglottis (Very big! – REMEMBER nothing in the throat!! Could hit this.)
• Severe INSPIRATORY stridor
• No hoarseness
• Febrile- greater than 39 celcius. fever is 103, really high.
• Tripod position
– Sitting upright and leaning forward with chin thrust out
– Mouth open
– Tongue protruding
• Sudden onset
• Complete obstruction may occur 6-12 hrs if left untreated. |
|
|
Term
| how is acute epiglottis medically managed? |
|
Definition
• Think arrest- endotracheal intubation or tracheostomy
• Antibiotics (cefurozime 100mg/kg/24hrs)
*INTUBATED WITH ANTIBIOTICS!*
• Corticosteroids
• Chest x-ray “thumb sign” ← actually seeing the swelling. Looks like thumb sign
• Lab work- elevated WBC
• Extubated often after 24hrs of antibiotic and corticosteroid therapy
• Prevention is key- H. influenzae type B conjugate vaccine (H. Influenzae is most common cause, so get the vaccine as prevention. Others do cause though, like strep, so it’s not totally stopped)
• Rifampin 20mg/kg x 1 for all contacts less than 4 years old prophylactically
• May occur other bacterial organisms |
|
|
Term
| What are the nursing interventions for epiglottis? |
|
Definition
• Prepare for intubation (In this rare situation, you would intubate before IV. B/c when IV is started, they’ll cry and could totally obstruct.)
• NO throat examination or throat culture
• NO x-ray or IV before intubation
• YES Elevate HOB
• Keep them calm & avoid crying
• Emotional support parents (Reassure that this will rarely happen again, it’s kind of a 1 time thing!)
• Care similar any other child with respiratory distress & ventilator support |
|
|
Term
what is Acute Laryngotracheobronchitis (LTB)
?
|
|
Definition
This is the croup you hear about - this is d/t a VIRUS.
• Inflammation of the mucosa lining the larynx & trachea causing narrowing airway- subglottic area narrowest part |
|
|
Term
| What age group does LTB (Croup) happen to? |
|
Definition
|
|
Term
| why does LTB (Croup) occur? |
|
Definition
| Parainfluenza virus type 1 (also RSV, adenovirus). it IS A VIRUS! |
|
|
Term
| WHat is the big difference for LTB/croup diagnosis? |
|
Definition
History of URI & have harsh barky cough, may have mild stridor & may have mild to moderate respiratory distress.
– We Do not give cough meds, may cause to constrict and make it worse. Parents may use humidifier or vaporizer, need to emphasize COLD water. Needs to be cleaned extensively every 24 hrs otherwise they’re blowing mold out in the air.
- May give dose of steroids & then go home |
|
|
Term
| what are the clinical manifestations of LTB/croup developing? |
|
Definition
• Takes several days (1-3 days hx URI) to develop
• Harsh, barky cough
• Hoarse voice
• Low grade fever
• Mild inspiratory stridor
• Mild to moderate respiratory failure |
|
|
Term
| How is MILD LTB/croup managed? |
|
Definition
• Generally self-limiting
• Corticosteroids 2mg/kg x 1 up to 4 doses po daily or Dexamethasone 0.6mg/kg IM x1
• Cool-air vaporizer? For safety reasons b/c kids have been burned w/ vaporizers & humidifiers
• Encourage fluids
• No antihistamines or cough medicines
• If severe distress & or resp rate > 60/min needs to be hospitalized. Make sure haven’t developed pneumonia or other infection. |
|
|
Term
| How is SEVERE LTB/croup managed? |
|
Definition
• Normal WBC & blood culture
• X-ray shows subglottic narrowing “steeple sign”
• Nebulized racemic epinephrine
• Corticosteroids
• Symptomatic care
• Mist tent?? Not used much anymore, sometimes did give a calming effect. Nursing interventions you’d want to worry about in a mist tent: Change linen frequently so they’re not in wet environement. Wet environment can really cool them off. So watch for wet linen & their temperature to make sure they don’t get too cold. |
|
|
Term
| What are some nursing interventions for LTB? |
|
Definition
• Continuous assessment respiratory status (Baby breathing faster than 60, you will want to hospitalize them.)
• Look sign secondary infection (it can recur, but more than 2-3 times it is probably something else)
• Have intubation equipment near
• IV therapy- may po if resp rate <60/min
• Keep calm
• Family support
TPN after 3 days |
|
|
Term
|
What is this -- > Paroxysmal attacks of laryngeal obstruction that occur chiefly at night. Pt is 1-3 years age. What kind of history do they have?
|
|
Definition
Acute Spasmodic Laryngitis.
• History of previous attacks
• History allergies
They're ok when they go to bed, but then wake up with attacks. |
|
|
Term
| What are the clinical manifestations of ASL? |
|
Definition
| Kid 1-3 goes to be well or with very mild resp symptoms. Suddenly develops a "barky cough", noisy inspirations and restlessness. Child is anxious & frustrated. Experiencing dyspnea (SOB) aggravated by excitement. NO FEVER. Symptoms subside in a few hours & they're normal the next day. |
|
|
Term
|
Definition
| It is managed at home, cool mist? warm mist? no... If symptoms moderate to severe may be hospitalized. Treatment is then similar to LTB. |
|
|
Term
| What nursing interventions are done for ASL? |
|
Definition
| Symptomatic care & family support. If hospitalized the treatment is similar to LTB, but this is uncommon (corticosteroids PO or Dexamethasone IM, encourage fluids, NO antihistamines or cough meds.) |
|
|
Term
| What is bacterial tracheitis? |
|
Definition
| Infection of the mucosa of the upper trachea. (May have started as LTB, but developed a secondary infection in that mucosa) |
|
|
Term
| what is the most common cause of bacterial tracheitis? |
|
Definition
|
|
Term
| What are the symptoms of bacterial tracheitis? |
|
Definition
| They’ll have PURULENT secretions (may have to suction this child to get those secretions out) (Others you don’t suction (viral), but w/ this you’re going to suction). |
|
|
Term
| What age group is affected by bacterial tracheitis? what is the most common cause? |
|
Definition
| 1 mo - 6 yrs, common cause = staph aureus |
|
|
Term
What are the Clinical Manifestations- Acute Tracheitis?
|
|
Definition
• URI
• Croupy cough
• Stridor
• PURULENT SECRETIONS
• High fever
• No response to LTB therapy |
|
|
Term
| how is bacterial tracheitis managed? |
|
Definition
• Humidified oxygen if O2 low
• Frequently endotracheal intubation if severe cough
• Antipyretics
• Antibiotics |
|
|
Term
| What are the nursing considerations of bacterial trancheitis? |
|
Definition
• Continuous assessment respiratory status
• Frequent suctioning
• Assist with intubation
• Frequent assessment of temperature
• IV therapy- may be PO if resp rate <60/min
• Keep calm
• Family support
(Take Liquid clendomycin & it’s most disgusting tasting thing… some have to stay in hosp if they can’t take. Must stress to parents that they need this, if won’t take than come back in) |
|
|
Term
| Bronchiolitis happens in the _______ airways. |
|
Definition
|
|
Term
| What is Bronchiolitis caused by? what time of year? |
|
Definition
| 80%+ cases due to Respiratory Syncytial Virus (RSV). It is most common in winter & early spring. |
|
|
Term
| what age group is most affected by bronchiolitis? |
|
Definition
|
|
Term
| how is bronchilitis transmitted? |
|
Definition
| • Transmitted through direct contact with secretions (it is not airborne - causes lots of clear nasal drainage & it’s passed pretty easily). |
|
|
Term
| what living conditions is bronchilitis commonly found in? how many develop asthma? |
|
Definition
• Found more in crowded living conditions
• >50% develop asthma |
|
|
Term
| bronchilitis is caused by ___ 80% of the time. |
|
Definition
|
|
Term
What are the Clinical Manifestations of Bronchiolitis?
|
|
Definition
• URI symptoms for several days
• Sneezing
• Clear nasal drainage
• DIFFICULTY FEEDING (may come in & mom says have cold, but not eating)
• Cough may develop
• Wheezing, rales, retractions
• Again, Hospitalized resp >60/min, less than 6 weeks age, or has other chronic respiratory illnesses (can’t breathe through mouth maybe if nose gets occluded. |
|
|
Term
|
Medical Management-Bronchiolitis is:
|
|
Definition
• Based on symptoms.
• Look at secondary infection.
• Diagnosed enzyme-linked immunosorbent assay (ELISA) test Can tell if + for RSV w/in an hour often. TAKE AN ELISA TEST!
• Steroids not beneficial (sometimes improve, sometimes don’t – may try a one time trial).
• No antibiotics unless secondary infection
• Try Chest physiotherapy (CPT) see if it helps, have seen it doesn’t.
* Do give Bronchodilators. |
|
|
Term
| Continued management of bronchiolitis... |
|
Definition
• No mist therapy unless on oxygen
• Ribarvirin- broad spectrum antiviral agent used in pass- present usage controversial (tetragenic) – make sure no pregnant nurses or mom’s are close. Now it’s optional. For a 3 day treatment, it’s $10,000 so if we don’t know if it’s working, why do it?
• Contact Isolation- sheds virus 1-3 weeks & coughs for 3-6 weeks technically it’s contact isolation, but have to think about secretions, you still may inhale them.
• Palivizumab (Synagis) prophylactically for prevention in high-risk infants (note guidelines p. 1368 Wong) there are guidelines to give to child b/c of the expense. |
|
|
Term
| What are the nursing interventions for bronchiolitis? |
|
Definition
Symptomatic care (looking for that secondary infection. Going to elevate HOB – anything to make them comfortable. Using lots of energy up… will go from irritable to really lethargic) They are NPO if respirations are greater than 60.
• Isolation precautions
• HOB elevated
• Frequent assessment of VS & respiratory status
• Nutrition- sm freq fdgs, no po resp> 60/min
• IV
• Family support - Remember, parents are really exhausted here. |
|
|
Term
|
Pertussis (Whooping Cough)
Etiology/Risk Factors
(parents may think it’s this, but it’s usually croup). If it is Pertussis (Whooping cough) what is it caused by? who does it happen to?
|
|
Definition
| Bordetella pertussis. Happens to children under 4 who are NOT IMMUNIZED! during July to October. |
|
|
Term
|
Definition
| • Transmission direct contact or droplet spread |
|
|
Term
| What is the incubation period for Pertussis? |
|
Definition
| Incubation: 5-21 days; usually 10 days |
|
|
Term
| Have pertussis rates increased or decreased since 1976? |
|
Definition
• Increased #’s since 1976
• Pertussis causes 350,000-500,000 world-wide deaths per year |
|
|
Term
| why is a booster recommended of Pertussis before going to college? |
|
Definition
| booster is recommended before college b/c it peaks in dorms. Happens to young mothers too. |
|
|
Term
| What are the clinical manifestations of Pertussis? |
|
Definition
• it is a Lengthy disease
• 3 stages- duration is dependent on pts’ age & immunization status |
|
|
Term
| Catarrhal Stage is Stage 1 of Pertussis/Whooping cough. what happens here? |
|
Definition
Begins with symptoms URI (Symptoms are milder & they may think it’s going to go away & it gets worse)
Sneezing, Cough & Low-grade fever. Progresses to 1-2 weeks with dry hacking cough. |
|
|
Term
What happens during stage 2 - the Paroxysmal stage?
|
|
Definition
| real cough w/ severe spasms, worse at night, burst of coughing swells & hear high pitch whoop. May take 1-2 weeks to get to 2nd stage with symptoms (can really expose a lot during this 2 weeks). Cough usually occurs at night, Short, rapid cough (machine-gun burst), Followed by sudden inspiratory high pitched “whoop”, During paroxysms, cheeks are flushed or cyanotic, eyes bulge, tongue protrudes, May continue till thick mucus plug dislodges (usually vomits afterwards), Stage usually lasts 4-6 weeks |
|
|
Term
What happens during stage 3 - Convalescent stage?
|
|
Definition
| Cough may be louder at times, gradually decreases in frequency for several weeks (Could be coughing for 3 months!) |
|
|
Term
| how is pertussis medically managed? |
|
Definition
• Give Analgesic for pain
• Antipyretics for fever
• Erythromycin is given for whooping cough
Anyone exposed? Give immunoglobulin
• Bedrest
• Hospitalization if refuses to drink or dehydration or respiratory complications
on antibiotics for a week or so before go back to school |
|
|
Term
| What nursing interventions are done for pertussis? |
|
Definition
• Isolation during catarrhal stage
• Bedrest as long as febrile
• Reduce environmental factors that may promote paroxysms
• Encourage frequent small amounts fluid
• Humidifier? Suction? Only use if needed b/c trying to prevent spasms. Avoid smoking dust, smells, excitement in these children. Think, what would be good for these children to play with? May do puzzle.
• Observe signs airway obstruction
• Family support |
|
|
Term
Allergic Rhinitis. Child may have red nose with crease (allergic salute), watery eyes
It is very common, 20% have...
|
|
Definition
| • Familial predisposition (genetic) to allergies |
|
|
Term
Allergic Rhinitis causes irritation upon Exposure to allergen (It is seasonal, usually have other allergies). what are some of the manifestations of allergies?
|
|
Definition
• Watery rhinorrhea
• Nasal obstruction
• Sneezing
• Nasal pruritus
• “Allergic shiners”
• “Allergic gape”
• “Allergic salute” |
|
|
Term
| what tests can tell if a person has allergic rhinitis (allergies)? |
|
Definition
• Nasal Smear (increased eosinophils)
• Blood- total IgE (would be elevated)
• RAST
• Skin testing (scratch on back, whatever allergic to swells & so a lot of itching) |
|
|
Term
| how is allergic rhinitis managed? |
|
Definition
• Avoidance of allergen
(treatment = 1. avoid what you’re sensitive to. 2) antihistamine 3. Nasal corticosteroids.
• Medication (only affective in 40-50% of cases)
• Immunotherapy (Need injections weekly for 4-6 months, monthly for years…) |
|
|
Term
Nursing Interventions for Allergic Rhinitis:
|
|
Definition
• Diagnosis
• Preparation for treatment
• Medication Education |
|
|
Term
| Asthma: what process is happening? |
|
Definition
inflammation→ airway decreases → then it fills up w/ mucous.
• Airway obstruction & inflammation in response to a variety of factors that include:
– Spasm of airways smooth muscle
– Edema of airway mucosa
– Increased mucus secretion
– Cellular, esp. eosinophilic, infiltration of the airway walls
– Injury and desquamation of the airway epithelium
• Involves biochemical, immunologic, endocrine, infectious, autonomic, and psychological factors |
|
|
Term
| What are the risk factors for asthma? |
|
Definition
• Age (most diagnosed before childs 4-5)
• Heredity (definite patterns in families)
• Gender
• Obesity
• GERD would be ruled out if they develop asthma later, usually dxed around 4-5. Asthma develops in person with severe GERD. The reflux goes into trachea & irritates, causes scar tissue & develops scar tissue.
• High-risk populations
• Children of young mothers
• Smoking (2nd hand smoking is esp irritating & smoke in car – like smoking 14 cigarettes)
• Lack access to medical care
• Stress
• Previous life-threatening exacerbations |
|
|
Term
| what are triggers for asthma? |
|
Definition
Environmental factors
• Allergens
• Irritants - as what kind of heat there is, if they use fire - burning wood also burning mold. Gas logs are about all you can use w/ asthma child
• Medication families often noncompliant b/c child seems better. Child’s also sensitive to aspirin or beta blockers often when have asthma.
• Food
• Stress - anyone’s under stress, just crying will cause the constriction & cause problems with asthma. Tickling someone & laughing for a long period can even cause that process. |
|
|
Term
| continued triggers for asthma? |
|
Definition
• Infection/illness
• Strong emotions
• Exercise
• Changes in temperature
• Odors - nurses never want to wear perfumes b/c can make asthma worse
• Smoking
• Cockroaches – older homes may have more cockroaches
• Dust mites – problems at night time? Often d/t dustmites. During the day it accumulates & then lay down in bed with it.
• Animal dander - all make asthma worse
(When roadways got better they thought asthma would get better & it gots worse. Black specks in air, it is latex. As tires wear down, the rubber goes in air… a lot of research looking at that right now) |
|
|
Term
|
Definition
| 1. Cigarettes 2. Cats (2 things kids are highly allergic to) |
|
|
Term
| Pulmonary Function Tests are done to diagnose asthma. These are used to evaluate 3 aspects of lung function: |
|
Definition
• Lung volume
• Airway function
• Gas exchange. |
|
|
Term
| Asthma is an obstructive & inflammatory disorder. |
|
Definition
*Expiration primarily affected in obstructive disorders* ← these affect patency & latency of airway, more airway resistance. Ex/ Asthma or COPD!!! (have to remember previous!!!)
*Loss of lung volume is found in restrictive disorders* (CF, Chest wall trauma, pneumothorax affect lung volume)
The results are interpreted according to age, gender, race, height, weight, and smoking status. Effort dependent |
|
|
Term
| Spirometer is a procedure that is used |
|
Definition
at the bedside, PCP office, or pulmonary lab.
• Pt takes full breath in & blows OUT hard & completely as possible.
• Test repeated 2-3 times and average of the 2 highest readings recorded |
|
|
Term
| What do the spirometer results tell? The ______ is the maximum amt of air expelled quickly after maximum inspiration. |
|
Definition
| FVC - Forced vital capacity |
|
|
Term
The spirometer results of: ________ are the volume air remaining in the lungs
|
|
Definition
|
|
Term
| • The spirometer can also tell the: ________________ maximum amount of air in the lungs- (___is the sum of the FVC and RV) |
|
Definition
| Total Lung Capacity (TLC)- |
|
|
Term
| With asthma, often the FVC is affected & pt cannot blow out as hard (expiration is affected). What about the RV & TLC? |
|
Definition
| It’s increased, they can’t blow the air out & it’s trapped in their lungs |
|
|
Term
| With obstructive disorders like Asthma & COPD, what happens to the FVC, RV and TLC? |
|
Definition
|
|
Term
| With restrictive disorders like emphysema, trauma or pneumo, what happens to the FVC, RV and TLC? |
|
Definition
| They are all decrease. RV might be normal to decreased. |
|
|
Term
| What are the nursing interventions for using the incentive spirometer? |
|
Definition
Have they had this test before? Really need a bronchodilator if having this test done, but don’t use 6 hrs before. Might do testing, then use bronchodilator though as part of the testing. • Assess knowledge.
• Explain procedure.
• Monitor respiratory status.
• Reassure and assist.
• No bronchodilators 6 hours before PFT’s |
|
|
Term
The ________________ is a Test used to see a change in a pulmonary condition, not to diagnose.
|
|
Definition
| Peak Expiratory Flow Rate (PEFR) |
|
|
Term
| What is the procedure for PEFR (Peak expiratory flow rate)? |
|
Definition
• Exhale forcefully over a short period of time to obtain the highest level on a meter
• Use the highest of 3 readings
• Need to take 2 times per day over a 2 week period during a normal respiratory state to determine a patient’s personal best reading |
|
|
Term
| Interpretations of PEFR results are Green, Yellow and then Red Zones. What does the green zone mean? |
|
Definition
• Green Zone (80-100% personal best)
-asthma controlled
-no symptoms
-continue present treatment plan
-may need medication before exercise |
|
|
Term
| what does the yellow zone mean? |
|
Definition
• Yellow Zone (50-80%)
-no well controlled- be careful
-start to see symptoms
-take medications as told
-encourage adequate hydration |
|
|
Term
| What does the Red zone mean? |
|
Definition
• Red Zone (50% or <)
-symptoms are significant (SOB, continuous wheezing)
-use bronchodilator
-call PCP is stays in zone (use bronchodilator and if they don’t return to yellow or green, then call primary care provider)
-rest
-call 911 severe chest tightness, SOB, difficulty walking or talking, or any cyanosis |
|
|
Term
| "Mild Intermittent" classification of asthma means: |
|
Definition
Symptoms brief, <=2/wk & nighttime symptoms <= 2/mo
Asymptomatic between episodes
PEF >= 80% predicted value |
|
|
Term
| "Mild Persistent" classification of asthma means: |
|
Definition
| Symptoms >2/wk, <1/day & nighttime symptoms >2/mo, Episodes may affect activity, PEF>=80% predicted value, some variability |
|
|
Term
| "Moderate Persistent" classification of asthma means |
|
Definition
Daily symptoms
Episodes >2/wk & nighttime symptoms>1/wk
Daily use of bronchodilators
Episodes affect activity
PEF >60% & <80% best, increased variability |
|
|
Term
| "Severe Persistent" diagnosis of asthma means: |
|
Definition
Continuous symptoms
Frequent episodes & nighttime symptoms
Limited activity
PEF<60%, increased variability |
|
|
Term
| What are some clinical manifestations of asthma? |
|
Definition
• Drop in peak flow readings
• Cough
• Chest tightness or “tummy hurts” with kids you really need to clarify their symptoms.
• Exercise intolerance bronchodilator is usually taken 20 min’s before sports. Intermittent sports are better than continuous (tennis, baseball) Sports are possible for most kids, don’t let parents say, “oh they’ve got asthma.”
• Wheezing
• Restlessness
• Signs respiratory failure |
|
|
Term
| Medical Management of Asthma is both allergen control & pharm treatment: |
|
Definition
| During treatments, have kids away for a few hours. Change linens once a week. Encase mattress & pillow to keep dustmites out. Don’t want a comforter that you can never wash. Blinds on windows might now be good. Maybe shades you can wipe off or window cover you can wash. Instead of 40 stuffed animals in the room, have 3-4 favorites. Maybe in bookcase, rather then in bed with them. Want to vacuum once every week or so. (Not doing it every day b/c it stirs up dust mites) Same thing for dusting. Kids should not do dusting/vacuuming chores. |
|
|
Term
| What is the pharm treatments for asthma? |
|
Definition
– Based on the severity of the asthma
– Long-term control medications
– Short-term relief medications
– MDI/Turbuhaler/Diskus inhaler/Nebulization
– Corticosteriods
– Leukotriene modifiers
– Hyposensitization
– If using bronchodilator more than 2x week then take a steroid.
– If they need to increase steroids, try not to do more than once every other day to keep sd effects down.
– Inhaler Steroids do not affect overall growth of kids if taken daily (oral steroids would) |
|
|
Term
| What are the nursing interventions & asthma discharge teaching? |
|
Definition
• Identifying triggers
• Environmental control measures
• Recognizing s/s of an episode
• Importance relaxation & exercise
• Daily PEFR readings |
|
|
Term
| continued Nursing Interventions - Asthma discharge teaching... |
|
Definition
- Treatment plan-plan of action (really reemphasize stuff each time they come in, they can get really overwhelmed)
- Correct use of medication and equipment
- Breathing techniques
- Importance of follow-up care
- Teaching others involved with patient
- Support groups – camp is wonderful for kids |
|
|
Term
| At what age are they ready to take over asthma control? Kids should use ________ with inhaler. |
|
Definition
| 9 years old. SPACERS with inhaler. |
|
|
Term
| What is status asthmaticus? |
|
Definition
• Respiratory distress despite vigorous therapeutic measures Almost always in intensive care in order to be observed
• ER>PICU
• Frequent assessment respiratory status
• PEFR ??
• Oxygen keep O2 sat > 90%
• Inhales aerosolized short-acting B2-agonists
• IV Corticosteroids
• IV fluids- *don’t overhydrate
• Correct acidosis
• High-Fowler position
• Anxious child & family |
|
|
Term
| What really needs to be stressed to parent if their child with status asthmaticus is having distress? |
|
Definition
| Need to reinforce & tell parents if they’re having distress, call 911. Parent wants to take the child in the car & they’ll stop breathing on the way, time & time again. |
|
|
Term
| Why does CYSTIC FIBROSIS happen? |
|
Definition
| CF is due to an INHERITED AUTOSOMAL RECESSIVE TRAIT |
|
|
Term
| If CF requires an inherited autosomal trait, then what are the chances of having CF is both parents are carriers? chance the child is a carrier? |
|
Definition
| 2 parents are carriers for CF. 1 in 4 chance for child w/ CF. Chance the child is a carrier? 50%. Tell parents you roll the dice with each pregnancy. If you have one, you could have another, though it’s only a 25% chance. |
|
|
Term
| how much of the population are carriers for cystic fibrosis? |
|
Definition
|
|
Term
| Cystic Fibrosis occurs because of mutations on chromosome ___. |
|
Definition
| 7. (can inhale this chromosome for $10,000, but it only lasts a month, just info) |
|
|
Term
| What does Chloride have to do with Cystic Fibrosis? |
|
Definition
| WIth CF, there is - Abnormal chloride movements in cells causing increase in viscosity mucus gland secretions. (Abnormal Cl- in cells, causes thick secretions) (Affects ANY organ that has mucous (bronchi, pancreatic ducts, bile ducts) ← chart in the ppt notes. |
|
|
Term
| There is an Exocrine Gland Dysfunction with Cystic Fibrosis. what happens b/c of this? |
|
Definition
| 90% males are infertile, 50% women are infertile b/c of this. |
|
|
Term
| how many people have CF in US? how long is the life expectancy? |
|
Definition
| • 30,000 children & young adults in US • Life expectancy 31 years, now it’s about 40 years, but varies. |
|
|
Term
| What clinical manifestations happen in the GI system that are risk factors for Cystic Fibrosis? |
|
Definition
Ø Meconium ileus in hx. A baby means they didn’t poop until after 24 hrs. If this occurs, they check for CF.
Ø Constipation>obstruction
Ø Obstruction pancreatic duct
Ø Large, frothy, loose stools with foul odor
Ø FTT have failure to thrive
Ø Vitamin deficiencies (amazing what they eat & don’t gain wt. can’t absorb fat soluble vitamins. So they’re always on vitamins) Have extra concentration of chloride or salt on their skin (kiss of death when mom kisses their babies head after being born and tastes salt. |
|
|
Term
What clinical manifestations happen in the REPRODUCTIVE system that are risk factors for Cystic Fibrosis?
|
|
Definition
Ø Delayed puberty
Ø Infertility
Ø Pregnancy- inc premature birth, LBW |
|
|
Term
What clinical manifestations happen in the INTEGUMENTARY system that are risk factors for Cystic Fibrosis?
|
|
Definition
Ø Abnormally HIGH sodium & chloride concentrations
Ø Limited fluid stores- rapidly developing DEHYDRATION
Ø Diminished protein absorption- inc edema |
|
|
Term
|
Definition
Newborn screening is done, but since NB's do not produce sweat we must wait until child is 3-6 wks old. THe Sweat chloride test (is the Gold standard for diagnosing CF)
Ø Need 2 positive results of 60 meq/liter of chloride for diagnosis |
|
|
Term
| what other tests are done (besides Sweat Chloride Test that is best!) for CF: |
|
Definition
• Chromosome testing
• PFT’s
• Chest x-ray assure child doesn’t have pneumonia
• Stool analysis for fat & enzyme
• if they do a: Sputum culture might do a bronchoscopy to look at bacteria & culture. Might also do totry to clear out some thick mucous plugs. Any baby coming back from bronchoscopy is fussy & crying. You need to assure a GAG reflex before they eat though!
Ø Infant & child- staph aureus & haemophilus influenza
Ø Adolescent- pseudamonas aeruginosa |
|
|
Term
| What is the primary treatment goal for CF? |
|
Definition
| Effective Airway Clearance. These kids will be doing chest physiotherapy 2-3x/day & will use a Flutter mucus clearance device (ball causes cough & has them get rid of mucous) |
|
|
Term
what does a ThAIRapy vest do for CF?
|
|
Definition
| high frequency oscillating device, air vibrates in different areas & helps break loose the mucous) |
|
|
Term
What does "Recombinant human D’Nase" do for CF?
|
|
Definition
| decreases the viscosity of secretions & mucous in CF. Making them more thin & easier to handle. |
|
|
Term
| what vitamins, enzymes & diet are given for CF patients? |
|
Definition
| Need Fat-soluble vitamins, Pancreatic enzymes (need to take enzymes to break down fats, only take when eating), Bronchodilators and inhaled corticosteroids, if hx asthma (0ver 50% have asthma), Well balanced, high-protein, high-caloric, moderate fat (things added to meals to make them high-caloric), Free water & salt |
|
|
Term
| What is given to CF patients who have hx of asthma (50% of patients do... ) |
|
Definition
| Bronchodilators and inhaled corticosteroids |
|
|
Term
| If CF patient has bronchoscopy, what needs to be intact to give anything by mouth? |
|
Definition
|
|
Term
| eventually CF patients will need a ____ transplant. |
|
Definition
|
|
Term
| What are some nursing interventions for CF? |
|
Definition
• Respiratory & GI assessment
• Monitor oxygen administration carefully
• Cough assist & assist with other therapies (CPT)
• Nutrition & fluid management
• Medication administration CF foundation will help with meds
• Skin care may be needed b/c of fatty stools
• Education home care
• Psychological support child & family support may be needed. |
|
|
Term
| Can CF kids go to camp or get together? |
|
Definition
| NO, they cannot d/t a highly succeptible infection w/ no anitbody for it (Cepecia). There are support groups, but not for the kids unfortunately. Know that 2 CF kids will never be put together in the hospital. |
|
|
Term
| how can you eliminate dust mite allergies? |
|
Definition
| encase mattress & pillow, dust & vacuum weekly |
|
|
Term
| How far do you insert the suction cath in a child with an ET or Trach tube? |
|
Definition
| You do not put it in until they cough with a child. No greater than .5 cm beyond the tip of the tube b/c you can cause permanent damage to the trach. |
|
|
Term
| What may be a sign of total obstruction? |
|
Definition
| Not hearing any wheezing at all. |
|
|
Term
| What are the chances of having a child who carries the gene for CF? |
|
Definition
|
|
Term
| What is a test used to diagnose CF? |
|
Definition
|
|
Term
| What are the fat soluble vitamins? |
|
Definition
|
|
Term
| What is the position; sitting uptight leaning fwd, chin thrust out, mouth open & tongue protruding? |
|
Definition
|
|
Term
| What are the spirometer readings of obstructive disorders? |
|
Definition
| Increased or normal TLC, RV and normal or decreased PFV |
|
|
Term
| What are the #1 allergen triggers for individuals with asthma? |
|
Definition
| Cats (cigarette smoking is an irritant) |
|
|
Term
| What is the hemophlus influezae type B vaccine responsible for the decrease incidence of epiglottitis? |
|
Definition
|
|
Term
| What clinical manifestations occur during the paroxysmal stage of pertussis? |
|
Definition
| Short rapid cough followed by rapid whoop |
|
|
Term
| #1 sign of hemorrhage following a T & A (tonsillectomy)? |
|
Definition
|
|
Term
|
Definition
| Peak flow reading of 50% or < of personal best |
|
|
Term
| Med not to give when the child is NPO? |
|
Definition
|
|
Term
| What are the 3 cardinal signs of epiglottitis? |
|
Definition
| No spontaneous cough, drooling, agitation |
|
|
Term
| A clinical manifestation of acute tracheitis? |
|
Definition
| Thick purulent secretions |
|
|
Term
|
Definition
| Prematurity, genetics, asphyxia |
|
|
Term
| A child with BPD requires how many calories? |
|
Definition
|
|
Term
Which child would the RN assess first?
1. Child with hx of bronchioltitis – O2 sat monitor is alarming.
2. Child with CF is coughing and having an emesis
3. Child w/ asthma is jumping on the bed
|
|
Definition
|
|
Term
What is the RSV monoclonal antibody used for prophylactic treatment of RSV? (Neonaties with BPD are at high risk for RSV)
|
|
Definition
| Answer: Palivizumab (Synagis) |
|
|
Term
| A diet for child with CF? |
|
Definition
| high protein, high-caloric, moderate fat diet |
|
|
Term
| (If you overstimulate a child with BPD) Potential responses d/t over stimulation? |
|
Definition
| Increased HR, decreased O2 saturation & restlessness |
|
|
Term
You get an order to perform a throat culture on a 6 year-old child that is febrile? |
|
Definition
| question the order, procedure may obstruct the childs throat |
|
|
Term
| What are potential signs of fluid overload? |
|
Definition
| Increase in oxygen requirement & wt, RR>60 |
|
|
Term
| What does the x-ray show with severe LTV? |
|
Definition
|
|
Term
| What are the cardinal signs of respiratory failure? |
|
Definition
| Diaphoresis , HR 172, RR 68, listlessness |
|
|
Term
|
What is the #1 trigger (allergen) for individuals with asthma?
|
|
Definition
|
|
Term
| ways to decrease dust mites in the bedroom? |
|
Definition
| Encase mattress & pillow, dust & vacuum weekly |
|
|
Term
What is a potentially dangerous comment? May be a sign of total obstruction.
|
|
Definition
| “Why was he admitted again, I don’t hear any wheezing at all?” |
|
|
Term
|
Definition
| Peak Flow Reading 50% or < of personal best |
|
|
Term
What are spirometer readings of obstructive disorders (asthma, COPD)?
|
|
Definition
| Normal or dec FVC, inc TLC & inc RV |
|
|
Term
What is a test used to diagnosis CF?
|
|
Definition
|
|
Term
| what are the chances of having a child who carries the gene for CF? |
|
Definition
|
|
Term
what are the chances of having a child who displays the gene for CF?
|
|
Definition
|
|
Term
| What med should not be given when the child is NPO? |
|
Definition
|
|
Term
| what diet is a child with Cystic Fibrosis on? |
|
Definition
| a well balanced, high-proten, high-caloric, moderate fat diet? |
|
|
Term
| 3 cardinal signs of epiglottis: |
|
Definition
| No spontaneous cough, drooling, agitation |
|
|
Term
What is the Hemophilus influenzae Type B vaccine responsible for the decrease incidence of epiglottitis?
|
|
Definition
|
|
Term
| what is a clinical manifestation of acute tracheitis? |
|
Definition
| thick, purulent secretions |
|
|
Term
| what does the x-ray show with severe LTB? |
|
Definition
|
|
Term
| What are risk factors for BPD? |
|
Definition
| Prematurity, genetics, asphyxia & infection |
|
|
Term
| what are the caloric requirements for a NB with BPD? |
|
Definition
| 120-150 Kcal/Kg/day or more |
|
|
Term
What is a RSV monoclonal antibody used for prophylactic treatment of RSV? (Neonates with BPD are at high risk for RSV)
|
|
Definition
|
|
Term
What are potential responses due to over stimulation?
|
|
Definition
| Increase HR, decreased O2 saturation, & restlessness |
|
|
Term
What are potential signs of fluid overload?
|
|
Definition
| Increase in oxygen requirement & weight, RR >60 |
|
|
Term
|
What is an early sign of hemorrhage in a child following a T & A?
|
|
Definition
|
|
Term
|
What clinical manifestations occur during the paroxysmal
stage of pertussis?
|
|
Definition
Short, rapid cough followed
by sudden inspiratory
high pitched “whoop” |
|
|
Term
|
How far do you insert the suction catheter in a child with an ET or Trach tube?
|
|
Definition
| No greater than .5cm beyond the tip of the tube |
|
|
Term
Which child would the RN assesses 1st after report?
|
|
Definition
*1.Child with hx bonchioltitis- O2 sat monitor is alarming.
2. Child with CF is coughing and having an emesis
3. Child with asthma is jumping on the bed |
|
|
Term
What should be done for an order to perform a throat culture on a 6-yr old child that is, febrile, drooling and has a sore throat
|
|
Definition
| Question the order, it may obstruct the child's throat |
|
|
Term
| Cardinal signs of Resp Failure are: |
|
Definition
| Diaphoresis, HR 172, RR 68, Listlessness |
|
|
Term
| What are congenital heart defects due to? |
|
Definition
| anatomic abnormalities→ abnormal cardiac function. They are present at birth & may not manifest for weeks or months. |
|
|
Term
| Acquired cardiac disorders are due to a disease process related to: |
|
Definition
• Infection
• Autoimmune responses
• Environmental factors
• Familial tendencies |
|
|
Term
Septal Development of the Heart:
Cardiac Malformation occurs during the ____________________ (when heart is really formed). So much occurs before women realize they’re pregnant.
|
|
Definition
|
|
Term
| How many fetal circulation structures are there? |
|
Definition
| 4 fetal circulation structures. Know there are 4. Know what they close on their own & in the first couple of weeks of life. when they do not close - we develop problems. |
|
|
Term
| Main thing to know in regard to fetal circulation? |
|
Definition
| we shunt it away from non-function lungs b/c we don’t need it there. |
|
|
Term
| Old classification of CHD? |
|
Definition
| Acyanotic & Cyanotic (just 2 categories) |
|
|
Term
| Newer classifications of CHD are: |
|
Definition
♥ Obstructive Defects
♥ Increased Pulmonary Blood Flow
♥ Mixed Blood Flow
♥ Decreased Pulmonary Blood Flow |
|
|
Term
|
Definition
♥ Obstructive Defects
♥ Increased Pulmonary Blood Flow |
|
|
Term
|
Definition
♥ Mixed Blood Flow
♥ Decreased Pulmonary Blood Flow |
|
|
Term
| What are obstructive defects? |
|
Definition
| Anatomic obstruction to blood flow out of the heart. These are ACYANOTIC defects. There is no mixing of blood unless there is a coexisting lesion. |
|
|
Term
| what are some examples of obstructive defects? |
|
Definition
♥ Coarctation of the aorta
♥ Aortic stenosis
♥ Pulmonic stenosis |
|
|
Term
_________ of the ________ is essentially a narrowing of the aorta. (big variance of the defect). It is backed up there proximal to defect & causes hypertrophy. The superior vena cava is backed up (distal to the obstruction): and it affects the UPPER EXTREMITIES & head.
|
|
Definition
|
|
Term
| Does Coarcatation of the Aorta cause increased AFTERLOAD or increased PRELOAD? |
|
Definition
| INCREASED AFTERLOAD! due to the LV having to generate increased systolic (contracting) pressure. Causes LV failure. |
|
|
Term
| What are the clinical manifestations of coarctation of the aorta in upper extremities? |
|
Definition
| HTN of upper extremities, Pulses (esp carotid) are bounding, headache, dizziness, epistaxis, fainting, potential for CVA. |
|
|
Term
What are the clinical manifestations of coarctation of the aorta in lower extremities?
|
|
Definition
| Lower body: has hypotension of lower extremities, weak femoral pulses, pulses lower are weak or absent, leg muscle cramps during exercise, lower extremities are cooler. There is a massive difference in extremities & pulses, how it’s picked up. |
|
|
Term
| Coarctation of the aorta causes increased ____________ due to the resistence the left ventricle must overcome to circulate the blood. |
|
Definition
|
|
Term
|
Definition
| Aortic valve—narrowing or stricture. We will not be seeing the increased pressure between the upper & lower extremities here. |
|
|
Term
| What happens if an infant has aortic stenosis? |
|
Definition
| Infants may have critical aortic stenosis, progresses rapidly to CHF, may be life threatening |
|
|
Term
What happens if an older child has aortic stenosis?
|
|
Definition
| Stenosis is progressive, mild- need to observe, moderate/severe – likely to develop an obstruction. Can be present for years until it’s picked up in the older child. |
|
|
Term
| Most children with Aortic Stenosis have ___________ _____________ b/c of potential for progressive stenosis and sudden death. |
|
Definition
|
|
Term
| Children with congenital heart disease may develop what kind of gross motor development alterations? what about fine motor alterations? cognitive alterations? |
|
Definition
gross motor: Delays (if present) are secondary to limited cardiac output. The Child lacks energy and strength to sit up, walk, etc. Fine motor—less impaired. Cognitive: Most have normal ability, Mental impairment (Certain genetic syndromes
Severe hypoxia) |
|
|
Term
| What should a nurse teach to for parents/children with Congenital Heart Disease? |
|
Definition
| Promote Normal Social and Physical Activities. They may need referral to Infant Stimulation Program. Discourage overprotectiveness. Encourage discipline/limit setting. Encourage play with other children. Help parents to accept child’s limitations. Foster independencepromote self esteem. |
|
|
Term
| how should a preschooler be prepped for cardiac surgery? |
|
Definition
♥ Gear to developmental level
♥ Simple, concrete wording
♥ Involve parents to promote security
♥ Visit ICU at time of minimum activity
♥ Equipment on doll—play sessions |
|
|
Term
| Congenital Heart Disease: Increased Pulmonary Blood Flow. (this is an abnormal connection between 2 sides of the heart). So what kind of shunt is this? IMPORTANT! |
|
Definition
| LEFT to RIGHT SHUNT. Left atrium to right atrium or Left ventricle to right ventricle. Causes pulmonary congestion. |
|
|
Term
The Eisenmenger Complex
Complication R/T Increased Pulmonary Blood Flow. There is increased volume of blood to the lungs. What happens to the pulmonary vessels?
|
|
Definition
Pulmonary vessels
Hypertrophy
Thicken
Diminished vessel diameter
Vessels lose elasticity
Progressive ↑ pulmonary vascular resistance
CAUSING PULMONARY HYPERTENSION. |
|
|
Term
| There is a potential shunt reversal due to the Eisenmenger Complex (increased pulmonary blood flow) that may cause: (IMPORTANT!) |
|
Definition
| POTENTIAL SHUNT REVERSAL: LEFT TO RIGHT SHUNT becomes a RIGHT TO LEFT SHUNT. |
|
|
Term
| Some examples of Increased Pulmonary Blood Defects are: |
|
Definition
♥ Ventricular septal defect
♥ Atrial septal defect
♥ Patent ductus arteriosus |
|
|
Term
|
Ventricular Septal Defects may cause an abnormal opening in the ventricular septum. This can be any variable size. This is the most common congenital heart defect. Which way does the blood shunt? (IMPORTANT) |
|
Definition
| LEFT to RIGHT SHUNT OF BLOOD. The OXYGENATED blood returns RV & is recirculated to the lungs. |
|
|
Term
| Atrial Septal Defects cause an abnormal opening in the atrial septum. Which way is blood being shunted? |
|
Definition
LEFT to RIGHT SHUNTING with ATRIAL SEPTAL DEFECTS. The OXYGENATED BLOOD returns to RA and RV & is
Recirculated to the lungs. |
|
|
Term
| What is a normal resp rate? average RR at rest? If a RR is above __ than it is unusual. |
|
Definition
| 30-60. RR at rest = 35. above 40 is unusual at rest. |
|
|
Term
| Is periodic breathing normal in a neonate? |
|
Definition
Yes, periodic breathing Occurs in normal neonates,
Occasional intermittent bursts of rapid respirations. |
|
|
Term
| what is a normal resting apical pulse? what is the apical pulse on average? |
|
Definition
| normal=70-180. Average at rest is 120. |
|
|
Term
| Congestive heart failure is the inability of the heart to pump an adequate amount of blood to the systemic circulation to meet the body’s metabolic demands. What VS & clinical signs would be found with CHF? |
|
Definition
| Increased RR (~70), Increased Apical Pulse (~180), BP is low (72/40), Periorbital Edema. Signs of Left Sided HF: Intercostal retractions, Expiratory grunt, Bilateral rales. Hepatomegaly—liver is 3 cm below right costal margin. Child has wet only 1 diaper. Cardiomegaly. |
|
|
Term
|
Definition
| 1. IMPAIRED MYOCARDIAL FUNCTION (Tachycardia, fatigue, weakness, pale cool extremities, decreased BP, decreased urine output) 2. PULMONARY CONGESTION (Tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis) 3. SYSTEMIC VENOUS CONGESTION (Periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention (older child). |
|
|
Term
| 3 main things from last slide that happen from CHF in children: |
|
Definition
| 1. IMPAIRED MYOCARDIAL FUNCTION 2. PULMONARY CONGESTION 3. SYSTEMIC VENOUS CONGESTION |
|
|
Term
| Clinical signs of infant displaying CHF: |
|
Definition
| Edema (generalized & difficult to detect), way be sweating when they are only resting, have retractions & grunting. These children have no neck vein distention b/c they have short, fat necks. KEY SIGN of CHF in infant is: POOR FEEDING & FTT! |
|
|
Term
| A parent who has a child with CHF will have concerns even if their child has a good prognosis. What are some common concerns? |
|
Definition
| People see the heart as a life force & fear their child will die. They have Grief. Concern about symptoms. The parents will feel guilty, which is wrong b/c 90% time we don't know the cause. Note: tell the mom that falling down at 6 months did NOT cause her heart defect. |
|
|
Term
| What is the incidence of CHD caused by environmental/maternal risk factors? |
|
Definition
| 1-2%. Maternal illness like Rubella in the first 7 weeks of pg, Or any TORCH infectionL CMV, toxoplasmosis, other viral illnesses, insulin dependent diabetes. Maternal drug use: drug therapy, fetal alcohol syndrome. Maternal age over 40 years old. |
|
|
Term
| What is the incidence of CHD - genetic/chromosomal risk factors? |
|
Definition
| 10-12%. Familial: mom had CHD=16%, father w/ CHD=1-4%, sibling with CHD=1-4%. Chromosomal aberrations (eg DOWNS SYNDROME <-- IMPORTANT) |
|
|
Term
| WHat parental coping should be done to help diagnosis of CHD? |
|
Definition
REASSURE mother—not responsible for anomaly
♥ PREPARE effectively—procedures, surgery, home care, etc.
♥ Provide CONSISTENT INFO
♥ Help family COPE WITH THE EFFECTS of the disorder
♥ PRAISE parent for what they do
♥ Resources
Support groups
Home health agency referral
American Heart Association
Children’s Health Information Network |
|
|
Term
| CHF leads to DECREASED FEEDING. what factors promote the poor feeding? |
|
Definition
* Infant has trouble sucking, breathing, and swallowing simultaneously
* Prolonged length of time to feed
* Falls asleep exhausted after taking small amount of feeding |
|
|
Term
| What should be done to enhance the nutritional intake of children with CHF? |
|
Definition
Minimize fatigue by:Feed at first sign of hunger
Promote rest before and after feeding
Frequent, small feeding q 3 hr
Feed no more than 30 minutes at a time
NIGHT FEEDING —is very IMPORTANT to meet metabolic needs
Soft nipple—moderately enlarged hole
NG feeding may be necessary |
|
|
Term
| What POSITION should the pt be in during feeding to enhance the nutritional intake of child? |
|
Definition
Semi-upright
Keep up 30 minutes after feeding |
|
|
Term
| What diet is a baby who has CHF on? |
|
Definition
HIGH/ENHANCE THE CALORIC INTAKE! babies need 150 calories per kg/day, Formula (24 to 30 cal/oz)
Strategies: Concentrate formula, Polycose, MCT oil |
|
|
Term
| What interventions help decrease the workload of the heart? |
|
Definition
| Provide neutral thermal environment (avoid extreme environmental temps, monitor body temp every 2-4 hrs, hypothermia-blanket, radiant heater) Prevent & treat infection: (Report fever, Handwashing, etc., Routine immunizations, Antibiotics, Existing infection, Before invasive procedures) |
|
|
Term
| What other intervention can help decrease the workload of the heart? What should the nurse be doing??? |
|
Definition
| Provide rest/decrease stimuli: (Anticipate child’s needs, Respond promptly to crying/distress, Organize care to provide for frequent rest periods/sleep, Adjust physical activity as needed, Decrease anxiety) |
|
|
Term
| Pt's with CHD need help to remove fluid & sodium. Diuretics are administered & UO should be: __ ml/kg/hr. |
|
Definition
|
|
Term
| Infants should have ___ - ___ diapers/day |
|
Definition
|
|
Term
| Children with CHD will be getting diuretics. Will be increase or restrict their fluids possibly? |
|
Definition
Possible Fluid RESTRICTIONS. Weigh daily—same time, same scale
Report excessive weight gain: Infant—greater than 50 g/day, Children—greater than 200 g/day, Strict I & O, ** Infants—rarely restrict fluids |
|
|
Term
| CHF may also require possible ________ restrictions, but this is less often in children. |
|
Definition
| Sodium (NO table salt & avoid highly salty foods) |
|
|
Term
| What interventions help improve tissue oxygenation in CHF patients? |
|
Definition
Cool humidified oxygen, Monitor respiratory rate for 1 full min. Report signs of respiratory distress: Tachypnea, Dyspnea, Nasal flaring, Grunting, Retractions.
♥ Monitor skin color
♥ Monitor oxygen saturation |
|
|
Term
| What positions help for CHF pt's to breathe better? |
|
Definition
| ♥ Semi-Fowler’s Position.. So, elevate the HOB. Infant seat works really well. Many children will sleep in infant seat for most of their infanthood. |
|
|
Term
Digoxin Administration
Nursing Actions: |
|
Definition
♥ Check dosage with another nurse
♥ CHECK APICAL PULSE FOR 1 FULL MINUTE BEFORE ADMINISTERING!
HR parameters from physician
Withhold if HR too low:
Infants—less than 110
Young children—less than 90
Older children—less than 70
♥ Monitor for digitalis toxicity
♥ Monitor serum digoxin level
♥ Monitor serum potassium level |
|
|
Term
| Infants rarely receive more than 1 ml (50 mcg or 0.05 mg) in one dose. What would you do if there was more than 1 mL (50 mcg or 0.05 mg) of Digoxin ordered in one dose? |
|
Definition
|
|
Term
| The physician ordered Lanoxin (elixir) 0.018 mg po BID for Russell who weighs 3.6 kg. The available Lanoxin is 50 mcg/ml. How much Lanoxin will you instruct Russell’s parents to give? |
|
Definition
| 18 mcg: x = 50 mcg: 1 ml 50 x = 18 x = 0.36 ml OR 0.018 mg: x = 0.05 mg: 1 ml 0.05 x = 0.018 x = 0.36 ml |
|
|
Term
| Digoxin signs of an effective response: |
|
Definition
♥ Decrease in pulse and respirations
♥ Increased urine output (better kidney perfusion)
♥ Improvement in skin color and temperature (better perfusion of peripheral tissues) |
|
|
Term
| We MUST monitor Digoxin level. What is an appropriate range? |
|
Definition
|
|
Term
| What are the signs of Digoxin toxicity? |
|
Definition
♥ Bradycardia
♥ Arrhythmia (may be only sign in young child)
♥ Anorexia
♥ Nausea
♥ Vomiting |
|
|
Term
| What else needs to be monitored with administering Digoxin? What is the therapeutic range? |
|
Definition
| Potassium = 3.5-5.0 mEq/L. |
|
|
Term
| Why would hypokalemia occur? what happens to digoxin then? |
|
Definition
| Related to use of potassium-losing diuretic, Enhances the effects of digoxin, Potential toxicity |
|
|
Term
| What happens if hyperkalemia occurs? |
|
Definition
| Hyperkalemia Diminishes digoxin’s effect |
|
|
Term
| What should the nurse teach the parent about giving Digoxin to their child? |
|
Definition
♥ Digoxin—slows and strengthens contraction of heart
♥ Check dosage—twice
♥ Timing: Give at regular intervals—usually every 12 hours, Give 1 hour before or 2 hours after feedings
♥ Administration: Do NOT MIX WITH FOOD OR FLUID, Use syringe not dropper in bottle, Administer carefully to side and back of mouth
♥ Child with low HR—hold according to physician |
|
|
Term
| What dental care is necessary with Digoxin? |
|
Definition
Very important to: Brush teeth
Give small amount of water after administering drug. |
|
|
Term
| What should parent do if the digoxin dose is forgotten? |
|
Definition
| If it is more than 4 hours? Do not give the dose & do not increase the next dose. What if it is less than 4 hours? Go ahead & give the missed dose. |
|
|
Term
| What do you do if the child vomits after Digoxin is given? |
|
Definition
| do not repeat! Watch for toxicity & safety issues |
|
|
Term
| What are signs of an effective Lasix response? |
|
Definition
♥ Increased urine output
♥ Decreased edema (e.g., periorbital, sacral)
♥ Decreased weight
♥ Clearing of adventitious lung sounds—breathe easier |
|
|
Term
| What Lasix administration is done to parents: |
|
Definition
♥ Monitor urine output—6 to 8 wet diapers/day
♥ Administration time (not as important with infants)
♥ Monitor for hypokalemia (muscle weakness, fatigue, apathy, irritability)
♥ Provide potassium (Elixir form, very Bitter taste, Mix with fruit juice (e.g., red punch, grape juice) to disguise taste and prevent GI irritation. Foods—oranges, bananas, grapefruit, prune juice, canned apricots, peaches, potatoes, carrots, milk |
|
|
Term
| What are signs of CHF to report to the physician? |
|
Definition
Poor feeding
Weight LOSS
Periorbital edema
Diaphoresis—especially at rest
Fewer than 6 to 8 wet diapers/day
Pulmonary symptoms—grunting, retractions.
Other signs of infection are: elevated temperature, respiratory infection, etc.. |
|
|
Term
| What is the function of the Ductus Arteriosus in Utero? |
|
Definition
| Ductus arteriosus is a fetal structure. Blood entering PA (pulmonary artery) from the RV (right ventricle) is diverted through the ductus to the aorta: away from the nonfunctioning lung & to the systemic circulation. |
|
|
Term
| What is Patent Ductus Arteriosus' blood flow? |
|
Definition
| It is failure of the fetal ductus to close after birth. The blood flow is: LEFT TO RIGHT SHUNT through patent ductus. Goes from aorta (hi pressure) to pulmonary artery (lower pressure). |
|
|
Term
| What is the result of patent ductus arteriosus? |
|
Definition
| Increased volume of OXYGENATED blood is recrculated to the lungs. |
|
|
Term
| Patent Ductus Arteriosus (PDA) is more common in premature infants. Why? |
|
Definition
| preterm babes have increased prostaglandin E1 levels. ** PROSTAGLANDINS maintain the patency of the ductus & keep it open ** |
|
|
Term
| What will a PDA murmur sound like when ausculated? |
|
Definition
♥ Harsh, rumbling, MACHINERY-LIKE MURMUR
♥ Heard in second left ICS
♥ Continuous throughout systole and diastole |
|
|
Term
| CHF in Patent ductus arteriosus (PDA) causes ____ to _____ shunting. |
|
Definition
| LEFT to RIGHT. So, an increased volume of blood is recirculated to the lungs, Results in volume overload. |
|
|
Term
| How is Patent Ductus Arteriosus (PDA) managed? |
|
Definition
| give INDOMETHACIN (prostaglandin inhibitor). It will close the duct sin NB, best result is in preterm infants, do before 10 days of age. Digitalis for CHF. Diuretics for CHF. |
|
|
Term
| What drug facilitates closure of patent ductus arteriosus? |
|
Definition
| Indomethacin (prostaglandin inhibitor) |
|
|
Term
| What is the primary goal of closing the Patent Ductus Arteriosus in NB? |
|
Definition
| Prevention of PULMONARY HYPERTENSION |
|
|
Term
| What are characteristic findings of mixed blood flow defects? |
|
Definition
| The Child needs another defect (e.g., PDA, ASD), Allows mixing of systemic and pulmonary circulations, Promotes survival |
|
|
Term
| For a pt with mixed blood flow defect in heart: |
|
Definition
| They Must have ASD, patent ductus arteriosus or VSD for babies to transfer blood appropriately, Typically these are not sufficient, Surgery can be an arterial or venous switch |
|
|
Term
| Total Anomalous Pulmonary Venous Connection is a rare defect. |
|
Definition
Where the Pulm vein dumps into right atria (b/c fails to join L. Atria)
Atrial Septal Defect (ASD) is present
CHF rapidly occurs
Surgical success depends on specifics of anomalies |
|
|
Term
| What is a hypoplastic left heart? |
|
Definition
Most blood flows across ductus arteriosus and ASD
As the ductus closes, symptoms develop quickly
Series of surgeries or transplant are only options
Mortality 30-50% |
|
|
Term
| how is hypolastic left heart treated? |
|
Definition
| Keep ductus open w/ Prostaglandin E infusion before surgery happens. Prostaglandin E is a potent vasodilating agent. |
|
|
Term
| What are the tests for cardiac function? |
|
Definition
♥ Chest x-ray
♥ ECG
♥ Echocardiography
♥ Cardiac Catheterization |
|
|
Term
| What are the complications of a cardiac cath? |
|
Definition
♥ Dysrhythmias
♥ Hemorrhage
Site
Perforation during procedure
♥ Thrombosis
♥ Dehydration (volume deficit)
♥ Infection |
|
|
Term
| What is assessed post-cardiac cath? |
|
Definition
♥ Monitor: Vital signs, ECG, Oxygen saturation
♥ Observe cath site/dressing
♥ Palpate pulses distal to cath site—compare with opposite extremity
♥ Assess warmth and color of involved extremity—compare with opposite extremity
♥ Monitor hydration status |
|
|
Term
| What positioning is used post cardiac cath? |
|
Definition
♥ Minimize movement of affected extremity
♥ Leg flat and straight
Venous cath—4 to 6 hours
Arterial cath—6 to 8 hours |
|
|
Term
| How do we assess for post cardiac cath bleeding? |
|
Definition
♥ Apply direct, continuous pressure (1 inch above the insertion site for 10 to 15 minutes)
♥ Notify cardiologist |
|
|
Term
| We must MONITOR FLUIDS CAREFULLY AFTER A CARDIAC CATH. WHy? |
|
Definition
Cyanotic heart disease/polycythemia (INADEQUATE FLUIDS could promote POTENTIAL FOR THROMBUS FORMATION)
Clear fluids—gradually increase as tolerated
Intravenous fluids may be needed for longer period of time |
|
|
Term
| post cardiac cath it is important to assess pulses distal to the cath site & compare to other extremity. What should be reported? |
|
Definition
| WEAK PULSE (means potential obstruction) & monitor warmth & color of extremities (report COOLNESS & BLANCHING - arterial obstruction) |
|
|
Term
| Dehydration post cardiac cath increases risk of: |
|
Definition
|
|
Term
| Discharge teaching after cardiac cath: |
|
Definition
♥ Prevent infection (Keep cath site clean and dry, Sponge bath first 1 to 3 days after procedure)
♥ Monitor and report (Signs of redness, swelling, drainage, and bleeding at site, Fever above 38.3oC (101oF)
♥ Avoid strenuous exercise for 1 week after procedure |
|
|
Term
| Decreased Pulmonary Blood Flow (CHD) is |
|
Definition
♥ Abnormal communication between two sides of the heart.
♥ Increased pressure in right heart related to:
Eisenmenger Complex
OR
Obstruction to blood flow |
|
|
Term
| What kind of shunt happens with decreased pulmonary blood flow? |
|
Definition
| ♥ Right to left shunt—increased blood volume in left heart (IN RED, VERY IMPORTANT!) |
|
|
Term
| With CHD 'Decreased Pulmonary Blood Flow' there is movement of blood: |
|
Definition
| AWAY FROM PULMONARY TO SYSTEMIC CIRCULATION when there is decreased blood flow in heart. |
|
|
Term
| Decreased Pulmonary Blood flow causes: |
|
Definition
| ♥ Deoxygenated blood to aorta causes 1. Persistent hypoxemia, Cyanosis, Polycythemia --> CVA 2. Brain abscess |
|
|
Term
|
Definition
| PULMONARY STENTIC valve impedes blood flow to the lungs. there is a right to left shunt through VSD (VENTRICULAR SEPTAL DEFECTS), the desaturated blood is forced into the OVERRIDING AORTA, pumped into systemic circulation. Increased workload on the right heart causes RIGHT VENTRICULAR HYPERTROPHY. There is risk for decreased pulmonary blood flow: resulting in chronic hypoxemia: chronic hypoxia & polycythemia. |
|
|
Term
| ___________ usually occurs after 6 months+ of desaturation. This is a nail angle of becomes greater than ____. |
|
Definition
| clubbing, greater than 180. |
|
|
Term
| Cyanotic Congenital Heart Disease: Hypercyanotic spells. Cause is thought to result from... |
|
Definition
|
|
Term
| Hypercyanotic spells typically happen in the morning & follow crying, defacating, feeding. What position should nurse put in asap? |
|
Definition
| Place in kKNEE/CHEST SQUATTING POSITION IMMEDIATELY. The nurse should comfort & calm the infant or child. Administer 100% oxygen. Administer morphine as needed. notify physician, give fluilds, ventilatory support. |
|
|
Term
| Positions to help hypercyanotic spells in infant & child? |
|
Definition
| infant: knee to chest position on shoulder holding. Child: squatting position on ground. |
|
|
Term
| What are the consequences of 'persistent hypoxemia' from cyanotic CHD? |
|
Definition
| There is an INCREASED RISK FOR THROMBUS FORMATION (DVT) esp if Hct is above 60%. Result of persistent hypoxemia is Right to Left shunt bypassing the lungs & causing an increased RISK OF STROKE & INCREASED RISK OF BRAIN ABCESSES. |
|
|
Term
| What is the MOST important hypoxemia intevention? |
|
Definition
| MAINTAIN HYDRATION - It is VERY IMPORTANT TO DECREASE THE VISCOUS BLOOD. (also adequate iron intake, good dental hygiene & meticulous care of IV line) |
|
|
Term
| What is tricuspid atresia? |
|
Definition
| surgical shunting procedure to increase blood flow to the lungs. Some have too much blood flowing to the lungs. may need a pulmonary artery banding to decrease blood flow to the lungs |
|
|
Term
| What chest tube drainage is REPORTED after cardiac surgery? |
|
Definition
more than 3 ml/kg/hr 3 or more hours—REPORT!
5 ml/kg for any 1 hour—REPORT! |
|
|
Term
| What Urine Output is REPORTED following cardiac surgery? |
|
Definition
| less than 1 ml/kg/hr—REPORT |
|
|
Term
| what temperature is REPORTED following cardiac surgery? |
|
Definition
Before 48 hr post-op = inflammation.
After 48 hr post-op=infection? REPORT |
|
|
Term
| _________ are the single most powerful non-pharm pain relief for children. |
|
Definition
|
|
Term
| What instructions are given following cardiac surgery? |
|
Definition
| gradually increase activites, avoid activities where child could fall & place pressure on sternum, no added salt in diet, to prevent infection: avoid large crowds for 4 weeks, sponge bath for 1st week, keep incision clean/dry, report incisional redness, drainage, swelling. BACTERIAL ENDOCARDITIS PROPHYLAXIS. report CHF, elevated temp & increased pain. |
|
|
Term
| Bacterial Endocarditis Prophylaxis: what is done? why? |
|
Definition
| Take ANTIOBIOTICS 1 HOUR BEFORE PROCEDURES. *** It is better to prevent SBE than to treat.*** Treatment requires 4-6 weeks IV antibiotics! |
|
|
Term
| What are the painless nodules on palms of hands & soles of feet? |
|
Definition
| Bacterial Endocarditis - Janeway Lesions. |
|
|
Term
| What are the red painful intradermal nodes on the pads of the phalanges (fingers) called? |
|
Definition
| Bacterial Endocarditis - Osler Nodes |
|
|
Term
| Now we have finished congenital heart diseases & will move on to ACQUIRED CARDIO DISEASES of childhood... |
|
Definition
|
|
Term
| What is Acute Rheumatic Fever caused by? |
|
Definition
| GROUP A BETA HEMOLYTIC STREPTOCOCCAL INFECTION OF THE THROAT. (10 days after pharyngitis (about 10 days) --> there is an autoimmune response. strep anitbodies proliferate & cause caridac damage in a small # of chilren. |
|
|
Term
| It is very important to get a _______ __________ if a child has a sore throat without signs of viral illness. |
|
Definition
|
|
Term
| Incidence of Rhematic Fever: |
|
Definition
♥ Age = 5 to 15 years
♥ Average age is 8 years old
♥ Child under 2 years are not seen
♥ It is rare in third year of life |
|
|
Term
| Case study that supports diagnosis of acute rheumatic fever: |
|
Definition
♥ History of sore throat 2 weeks ago
♥ Temperature 101.2 F
♥ Resting pulse 110
♥ Systolic murmur (carditis)
♥ Exercise intolerance, dyspnea—signs of CHF
♥ Left knee—warm, swollen, and very painful
♥ Lab Data—ESR, C-Reactive Protein, WBC
♥ ECG—prolonged PR interval |
|
|
Term
| What is the Revised Jones Criteria manifestations? |
|
Definition
CARDITIS (MOST IMPORTANT TO KNOW!!!): may develop rheumatic heart disease, r/t to damage in mitral & aortic valves. ♥ Polyarthritis
♥ Erythema Marginatum (red spots on abd)
♥ Subcutaneous Nodules (pic on shoulder blades)
♥ Sydenham’s Chorea (rapid involuntary jerking or twitching movements of the patient's face, limbs, and upper body) |
|
|
Term
| How does Rheumatic Heart Disease become CHF? |
|
Definition
♥ Damaged valves cause obstruction to blood flow
♥ Myocardium has to pump against increased resistance |
|
|
Term
| Revised Jones Criteria: minor manifestations. |
|
Definition
♥ Previous hx of rheumatic fever
♥ Arthralgia (inflammatory arthritis)
♥ Fever
♥ Prolonged PR interval on ECG
♥ Elevated acute phase reactants |
|
|
Term
| Acute Rheumatic Fever's Revised Jones Criteria includes: |
|
Definition
Child MUST have either: 1. Two major criteria + history of previous strep infection * OR *
One major and two minor criteria + history of previous strep infection (VERY IMPORTANT!) |
|
|
Term
| Major & Minor classificiations: |
|
Definition
MAJOR:
♥ Carditis
May develop rheumatic heart disease
Related to damage to mitral and aortic valves
♥ Polyarthritis
♥ Erythema Marginatum
♥ Subcutaneous Nodules
♥ Sydenham’s Chorea (rapid involuntary jerking or twitching movements of the patient's face, limbs, and upper body).
MINOR:
♥ Previous hx of rheumatic fever
♥ Arthralgia
♥ Fever
♥ Prolonged PR interval on ECG
♥ Elevated acute phase reactants |
|
|
Term
| What are the acute rheumatic fever diagnostic tests? |
|
Definition
♥ Erythrocyte sedimentation rate (ASR)
♥ C-reactive protein
♥ White blood count
♥ Antistreptolysin O (ASO) titer |
|
|
Term
| What is the ASO titer used to diagnose Acute Rheumatic Fever? |
|
Definition
Strep secretes enzyme—streptolysin O
♥ Streptolysin O
An antigen (Everything previous was in RED!)
Stimulates the immune system to develop
anti-streptolysin O antibodies
♥ Elevated titer indicates recent strep infection |
|
|
Term
| What medications are given to treat a strep infection? Thus preventing ARF (acute rheumatic fever) |
|
Definition
Penicillin
Erythromycin (if allergic to penicillin)
(BOTH IN RED!) |
|
|
Term
| What prophylactic meds are given to prevent Acute Rheumatic Fever? |
|
Definition
without carditis—for 5 yrs or until age 21 (whichever longer)
with carditis—for 10 yrs or into adulthood (whichever longer)
residual heart damage—at least to age 40 |
|
|
Term
| What anti-inflammatory agents are given for ARF? |
|
Definition
| 1. ASPIRIN (Use with patients with minimal or no carditis, Control pain, Suppress rheumatic activity) 2. CORTICOSTEROIDS (Use with child with pancarditis, congestive heart failure, valvular involvement, Example—prednisone) |
|
|
Term
| What Acute Rheumatic Fever meds help control Congestive Heart Failure?? |
|
Definition
♥ Diuretics
♥ Digoxin
♥ Potassium |
|
|
Term
| What nursing intervention is the biggest for ARF? What are we listening for when ausculating? |
|
Definition
♥ Close monitoring of cardiac status:
Signs of CHF
SYSTOLIC MURMUR
Tachycardia at rest |
|
|
Term
| What other nursing interventions are important for Acute Rheumatic Fever? |
|
Definition
♥ Administer medications as ordered
♥ Activity restriction—based on fever and cardiac involvement
♥ Quiet diversional activities—if on bedrest
♥ Alleviate discomfort—analgesics, minimize handling
♥ Safety precautions—e.g., with chorea |
|
|
Term
| What must nurses teach when discharging pt with Acute Rheumatic Fever? |
|
Definition
♥ Importance of compliance to antibiotics:
Prevent further cardiac damage
Long term antibiotics
Standard bacterial endocarditis prophylaxis
♥ Physical activity:
Unrestricted if no cardiac damage
Restricted if cardiac problems (e.g., cardiomegaly, aortic/mitral regurgitation)
♥ Birth control education:
Warn against use of IUDs—source of potential infection and bacterial endocarditis
Diaphragm and some oral contraceptive agents are safe |
|
|
Term
| What is Kawasaki Disease? |
|
Definition
| an acute multisystem vasculitis of infancy and early childhood |
|
|
Term
| What causes Kawasaki Disease? |
|
Definition
| It is UNKNOWN (in red!) There are suggested causes: Hypersensitivity reaction, Environmental toxin, Infection. These are unproven theories. Know the cause of Kawasaki Disease is UNKNOWN. |
|
|
Term
| What criteria is needed to diagnose Kawasaki Disease? |
|
Definition
| Temp 39.4 C and Five days or longer (in red!). Then they need 4 of 5 of these criteria: Conjunctival (eye) injection, Mouth and pharynx changes (strawberry red tongue and dry red, cracked fissured lips), Peripheral extremity changes (swollen palms) and desquamation of the fingertips (peeling fingertips), Erythematous rash, Enlarged lymph node measuring more than 1.5 cm in diameter |
|
|
Term
| There are 3 phases in Kawasaki Disease. There is the Acute phase, the Subacute phase & the Convalescent Phase. Describe how long each takes... |
|
Definition
| Acute=onset to day 10. Subacute=day 10 to day 25. Convalescent=day 26 until resolved. |
|
|
Term
| What are some diagnostic findings of Kawasaki Disease: |
|
Definition
♥ Leukocytosis (more than 20,000 WBC)
♥ Elevated ESR
♥ Elevated C-reactive protein
♥ Thrombocytosis (600,000 to 2,000,000 platelets after acute phase)
♥ Moderate anemia
♥ ECG, echocardiogram abnormalities |
|
|
Term
| What is the MOST SERIOUS COMPLICATION of Kawasaki Disease? |
|
Definition
♥ Coronary artery abnormalities:
-Coronary artery aneurysms
-Myocardial infarctions
-Myocarditiis or pericarditis |
|
|
Term
| What is the treatment of Kawasaki Disease? |
|
Definition
♥ IV IgG
high dose of ASA 80-100 mg/kg/day—fever
Then 3-5 mg/kg/day—antiplatelet |
|
|
Term
| REMEMBER, what is NOT beneficial for Kawasaki Disease? |
|
Definition
♥ Antibiotics are NOT beneficial
♥ Corticosteroids are contraindicated (coronary aneurysms more frequent) |
|
|
Term
| How does Aspirin effect Kawasaki Disease? |
|
Definition
♥ Anti-inflammatory
♥ Antipyretic
♥ Antiplatelet aggregation (antithrombolytic) .
** Included Graph where IVIG + Asprin was given & it significantly reduced temperature in Kawasaki. ** |
|
|
Term
| How should aspirin be taken? Teach them this on discharge from Kawasaki... |
|
Definition
♥ Aspirin administration will Minimize gastric distress:
Give with food, milk or large glass of water
Monitor for potential side effects:
-Petechiae
-Bleeding gums
-Tinnitus
-Hematuria
-Hematochezia
-Hematemesis
Monitor temperature! |
|
|
Term
| Discharge teaching needs from Kawasaki needs to know to report back to physician if: |
|
Definition
| Exposure/development of varicella or influenza |
|
|
Term
| Discharge teaching for Kawasaki Disease should include long term care: |
|
Definition
| DELAY LIVE VIRUS VACCINES FOR ATLEAST 6 months after IVIG!!! also teach family cpr, give flu vaccine, potential activity restriction. REPORT EXPOSURE TO VARICELLA OR INFLUENZA. |
|
|
Term
| Kawasaki disease is an acute, self-limiting disease. In other words, what does IVIG in the FIRST TEN DAYS OF THE ILLNESS greatly reduce risk for? |
|
Definition
| risk of aneurysms is reduced to 4%. (If you do not use it: 20% chance to develop aneurysms.) |
|
|
Term
| Kawasaki disease brings risk for what CORONARY ARTERY ABNORMALITIES? (in red) |
|
Definition
| Myocardial ischemia, Coronary artery aneurysms, Myocardial infarction, Potential for sudden death |
|
|
