Term
| name 3 parts to assessing GI illness |
|
Definition
history
phys assess
and diag tests |
|
|
Term
| name 4 things you need to know about vomiting to assess prob |
|
Definition
1 projectile or not
2 freq
3 how long
4 consistency |
|
|
Term
| name 4 interventions for vomiting |
|
Definition
-oral hygienge
-rehydration
-comfort measures
-small freq feeds |
|
|
Term
| Phys assessment principals for vomiting (4) |
|
Definition
1 inspection (mm, peristalisis, skin, bleeding, spincter patency)
2 ascultate
3 percuss
4 palpate |
|
|
Term
| name as many causes of diarrhea as you can |
|
Definition
| passing around virus, recent travel, water, soil, child dietary habit, overfeeding, malabsorbtion, F+E imbalance |
|
|
Term
| nursing interventions for diarhea |
|
Definition
reinstate nutrit and hydration
iv fluids
I+Os
daily weights
assess toleration of feeding
purelll for fam
?brat diet?
prevent infection
child family teaching |
|
|
Term
| name 5 lab findings that need to be assessed for diarrhea |
|
Definition
stool anal
stool ph
serum electros
UA
ABG's (if severe) |
|
|
Term
| Name as many causes of constipation as you can |
|
Definition
idiopathic
encopresis (delibrately holding)
change in enviro
anxiety
public bathrooms
change in routine |
|
|
Term
| interventions for constipation |
|
Definition
Varies depending on cause/not total agreement on cause.
colace
fluids
fiber
maybe change in bowel habits (after meals try to go)
find out what meds they are on
min stress
teach parets nutrition high fiber snacks
reassurance |
|
|
Term
|
Definition
| backflow of gaastric contents into the esophogus resulting from relaxation or incompetence of the lower esophogeal spincter. |
|
|
Term
|
Definition
forceful vomiting
weight loss
aspiration
recurrent respiratory infections (r/t aspiration)
cyanotic and apneic episodes
heartburn
abdom pain
bitter taste in mouth |
|
|
Term
lab findings in GER
tests/monitoring they may do |
|
Definition
CBC reveals anemia
intraespphageal ph monitoring |
|
|
Term
How is GER usually resolved?
What is done if GER is severe? |
|
Definition
-resolves on own within year (usually)
-severe: surgery: Nisen procedure-split muscle of gastric fundus, npo , ng tube, |
|
|
Term
if a child has GER and becomes fatigued during eating what should you do/recommend
name 2 meds that dec gastric acid
-what teaching should be done about ger care |
|
Definition
-stop feeding and rest
-simethicone and zantac
-teach positioning and schedules. |
|
|
Term
pyloric stenosis define:
what causes it? |
|
Definition
the narrowing of the lpyloric spincter at the outlet of the stomach.
-cause unknown (idiopathic), maybe heredity |
|
|
Term
| pyloric stenosis s+s (8 things) |
|
Definition
no abnormal sighns in the first weeks after birth.
regurgitation or NON-projectile vomiting that begins at 3 weeks of age
voming increases in force and frequency over next 1-2 wks
no signs of anorexia or pain
weight loss
upper abdominal distention
palpable olive shaped mass in the epigastrium just to the right of the umbillicus
dec freq and volume of stools |
|
|
Term
| labs and studys for pyloric stenosis (5) |
|
Definition
ultrasonography
upper GI
ABGs
electrolyte studies
CBC |
|
|
Term
| care for pyloric stenoris (6 things) |
|
Definition
monitoring feeding and assoc w/ vomiting
assess emesis
promote hydration
prevent aspiration
provide post op care for pyloromyatomy
family teaching |
|
|
Term
| what is a pyloromyatomy for, and what does it entail? |
|
Definition
for pyloric stenosis
incision anterior pylorus to relieve obstruction (the olive thing) |
|
|
Term
define intussusception
what is a major risk of this if not treated within 24 hours? |
|
Definition
an invagination or telescoping of one portion of the intestines into an adjacent portion causing obstruction.
It is one of the most frequent cause of intestinal obstruction in children
risk: bowel strangulation which can lead to necrosis, and death if untreated. |
|
|
Term
| what is the cause of intussception |
|
Definition
| idiopathic, but may be assoc with viral infections, polyps and lymphoma |
|
|
Term
what are its signs and symptoms
when is it most likely to occur |
|
Definition
ss: severe pain esp ascending colin. person will pull legs up to relieve pressure
tender distended abdomin possibly palpable mass.
usually 3mo - 5years old |
|
|
Term
| labs and tests for intussception |
|
Definition
contrast enema
electrolyte study |
|
|
Term
| interventions for intussception 5 things |
|
Definition
promote hydration (parentally)
promote nutrition
monitor eliminations BMs
Monitor for infection
family teaching |
|
|
Term
| what is a tell tale sign of intussception? |
|
Definition
| currant jelly stools from blood and mucous. |
|
|
Term
celiac disease define
when do you usually start to see this? why? |
|
Definition
malabsorbtion syndrome that occurs when the mucosa of the proximal small intestine is sensitive to , or undergoes an immunologic response to gluten.
usually seen at 16-18 months because child is trying new foods. |
|
|
Term
|
Definition
| results from either an inborn error of metab or abnormal immune response to gluten factor or protien ..probably an inherited disposition. |
|
|
Term
|
Definition
anorexia and ab pain
diarrhea/ const
vomiting
severe ab distention and muscle wasting
behavioral changes |
|
|
Term
| interventions for celiacs (6) |
|
Definition
promote adequate hydration
adherance to dietary guidelines
complications
provide child and family teaching
support
refer to approp resources |
|
|
Term
hernias and hydrocele define each
what causes these? |
|
Definition
hernia: protrusion of the bowel through an abnormal opening in the ab wall. kids usually umbilicus and inguinal wall
hydrocele: presence of ab fluid in the scrotal sac
cause: most commonly from congenial abnormality |
|
|
Term
|
Definition
umb hernia-soft swelling around umb is reducible
inguinal- painless swelling in inguinal area is reducible with finger when standing or stressed it comes out you see distention, obstruction, possibly gangrene |
|
|
Term
|
Definition
noncommunicating: doesn't change with activity
communicating:not reducible , amount of swelling and dist depends on activ and pos? |
|
|
Term
| interventions for hernia and hydrocele 5 |
|
Definition
-assess for signs of incarcerationand strangulation (would need surgery, pain not relieved by change in position)
- perform postop care
-provide child and family teaching
-support the child and family |
|
|
Term
define hirschsprung disease
who is more prone (boys or girls?) |
|
Definition
is a congenital anomaly , absence of nevers to section of intestines which results in mechanical obstruction due to inadequate motility in an nintestinal segment. causes dialated descending colon.
boys more prone |
|
|
Term
| cause of hirschsprung disease |
|
Definition
| familial congenial defect results from failure of the crainiocaudal migration of ganglion nerve cell precursors along the GI tract between the 5th and 12th week of gestation. |
|
|
Term
s+s of hirschsprung dis
lab tests done? |
|
Definition
signs vary with age at time of diagnosis, length of affected bowl, and occurance of complications..newborns not passing meconium.
-fowl smelling ribbon like stool
-labs: barium enema and rectal biopsy |
|
|
Term
| interventions for hirschsprung dis: |
|
Definition
-assess for signs of enterocolitis (report)
-promote adequate hydration/nutrition
-asess bowel functioning
-admin enemas
-avoid rectal temps
-admin prescribed meds
-dec abdom discomfort r/t distention
-teaching
-prepare family for any treatments or procedures
-low residue LOW FIBER diet |
|
|
Term
cleft lip and palate define:
cause: |
|
Definition
failure of the bone and tisue of the upper jaq and palate to fuse completely at the midline
-cause: congenital defects, sometimes inheritence plays role, prenatal exposure to teratogens, chromosomal abnormality.
defect arises in the second month of pregnancy |
|
|
Term
| complications of cleft lip or palate |
|
Definition
abdominal distention from swallowing air
difficulty swallowing.
speech defects
dental and orthodontic probs
nasal defects
alterations in hearing
parentala shock guilt and grief
inc risk for aspiration
URIs and OM |
|
|
Term
medical management of cleft lip:
med management of cleft palate: |
|
Definition
-lip: cheiloplasty, birth to age 3 months , unites the lip and gum edges
-this provides a route for adequate nutrition and sucking, preformed in anticipation of tooth erruption.
-palate: staphylorrhaphy, around 18 mo (to allow for palate growth, must be free of ear and resp infections. |
|
|
Term
| cheiloplasty preop interventions 4 |
|
Definition
small freq feedings/ upright position
burp often
water admin after feedings
promoate sucking between meals |
|
|
Term
| cheiloplasty post-op interventions 6 |
|
Definition
maintain patent airway
assess for cyanosis
maintain intact suture line
feeding schedule
positioning
assess for pain |
|
|
Term
| pre-op staphylorrhaphy care 3 |
|
Definition
weaned from bottle or breast, able to use cup.
use cleft palate nipple to enhance intake
parent education |
|
|
Term
| stphylorrhaphy post op care 6 |
|
Definition
posiitioning
maintain intact suture line
use a cup to feed
feeding schedule
rinse suture line
provide soft toys. |
|
|
Term
| Esophageal atresia and tracheophageal fistula define |
|
Definition
| congenital EA and TEF are rare malformations that represent a failure of the esophogus to develop as a continuous passage and a faulure of the trachea and esophagus to separate into distinct structures. |
|
|
Term
| clinical manisfestations of esophageal atresia and tracheosophageal fistula 3 |
|
Definition
frothy saliva in the mouth and nose
drooling , choking and couhing
if fed= sudden cough and gag --> risk for aspiration |
|
|
Term
sugical repair of esophageal atresia and tracheosophageal fistula:
prognosis:
potential complications: |
|
Definition
-one operation of staged with two or more procedures.
-Prognosis: survival rate is nearly 100%
-potential comoplications: vary depending on type of defect and surgical repair. |
|
|
Term
| Name 6 physiological differences in children that effect respiratory function |
|
Definition
horizontal ribs
smaller lungs, fewer alveoli, smaller airway diameter (easy to obstruct)
lack of cartilagenous support (can compress bronchi) appears after 7-8 yo
faster metabolism (use more o2)
poorly developed immune system
diaphragmatic breathers obligatory nose breathers (use of accessory muscles to bring in adequate 02) |
|
|
Term
early signs of respiratory failure
caredinal signs of respiratory failure: 4 |
|
Definition
subtle behavioral changes (if child goes into cardiac failure 99% chance they will also go into respiratory failure, preventable if detected, listen to parents)
-cardinal signs
restlessness (vs agitation) consolable
inc resp effort
tachypnea and cardia
diaphoresis (even newborns if they are working that hard) |
|
|
Term
| nursing diagnosis for resp failure/problems |
|
Definition
ineffective airway clearance/obstruction
ineffective breathing pattern (can't move air without access muscles which causes fatigue)
impaired gas exchange- retention of carbon dioxide hyperinflation, hypoinflation. |
|
|
Term
| tachypnea is the same as hyperventilation in children T/F |
|
Definition
| false not true because children have a more immature system and may need more respirations to get the same O2 intake and they don't change the depth. |
|
|
Term
bacterial tracheitis signs and symptoms
usually age range |
|
Definition
high fever
involves trachea but not larynx
not at risk for closing down
ages- 3months to 6 years |
|
|
Term
what causes laryngotracheobronchitis LTB?
what are the signs and symptoms?
age range |
|
Definition
majority is caused by virus
signs
low grade fever
cold congestion
comes on gradually
as imflam continues there is edema of soft tissue and airway is CONSTRICTED
horseness of voice, signs of hypoxia and restlessness
age range 3m0-5years |
|
|
Term
| acute viral laryngitis occurs at an age range of ________ |
|
Definition
|
|
Term
what tests should you do for laryngotracheobronchitis?
what should you NOT do to this type of pt? |
|
Definition
take xray of lateral nexk to check for obstuction and swellling
don't stick tongue blade down which will cause spasm and occlusion |
|
|
Term
| interventions for laryngotracheobronchitis |
|
Definition
racemic epinephrine
neb
sometimes decadron to reduce swelling
close monitoring
if rates decline -->intubation, or sooner if x ray shows lots of swelling
if it closes then they will have to do trach |
|
|
Term
name the 4 D of eppiglottitis
this croup syndrome has the greatest potential for _____________ |
|
Definition
drooling
dysphagia
dysphonia
distress
for airway occlusion |
|
|
Term
| in eppiglotitis what becomes inflamed |
|
Definition
| larynx , trachea and bronchi |
|
|
Term
If child will not jut out chin this is almost diagnostic for _____________
in addition they won't talk, they are ussing all accessory muscles, and look anxious
what type of treatments and interventions are given? |
|
Definition
eppiglotitis
treatments/interventions
will be intubated
steroids because racemic epinephrine doesn't work
also given antibiotics |
|
|
Term
If child will not jut out chin this is almost diagnostic for _____________
in addition they won't talk, they are ussing all accessory muscles, and look anxious
what type of treatments and interventions are given? |
|
Definition
eppiglotitis
treatments/interventions
will be intubated
steroids because racemic epinephrine doesn't work
also given antibiotics |
|
|
Term
bronchiolitis occurs from _________ to _________ or from _________ to _________ day. it is usually caused by ___________.
it usually effects kids under _____ and peaks at ______ |
|
Definition
winter to early spring
or halloween to mothers day
virus ususally RSV |
|
|
Term
which illness is characterized by the following
Inflammation of bronchioles
necrosis of ciliated cells
obstruction of bronchioles (from sloughed necrotic cells)
hyperinflated then collapse of alveoli, atelectasis. |
|
Definition
|
|
Term
name some treatments/interventions for bronchiolitis
what are s+s
what is the incubation time |
|
Definition
nebs if helpful
fluids
chest PT
upright position
prevention (synergis)
***respigam and ribavirin(teratogen) not effective,
s+s
crackles and fline rales
wheezing can't get air out
upper bronchi congestion
well managed in healthy kids, but can cause dealth is those with comorbidities
incubation is 4-6 days |
|
|
Term
rales are heard during _________ and signifies _____ ________ ___________
rhonchi is heard during ________ and clears with ________, signifies _______ ______ involvement
Wheezing is heard during ________ signif, _______ _____ ________.
stridor is |
|
Definition
inspiration
small airway obstruction
expiration
cough
upper airway
wheeze
expiration
lower airway obstruction
stridor
inspiration and expiration (prolongs)
upper airway obstruction |
|
|
Term
| when a child aspirates a small object where does it usually lodge? |
|
Definition
|
|
Term
Pertussus or whooping cough has an increased incidence in _______ and _______
They can't stop coughing because of continuous _____________
this disease is contagious T or F
why is this illness on the rise |
|
Definition
infants and adolescents
continuous perastalisis
True its very contagious
on the rise due to allergic cohort
and some who believe there is a connection to autism. |
|
|
Term
| in a secondary obstruction due to aspiration how can air travel |
|
Definition
|
|
Term
| what is the most common cause of school absence |
|
Definition
|
|
Term
what type of disorder is asthma
what is the eitiology
how is diagnosis made |
|
Definition
inflammatory lung disorder, bronchial irritability in response to stimuli.
eitiology is unclear may be familial (no gene isolated), allergies (dander dust animals) cold weather, stress
a diagnosis is made based on clinical findings. |
|
|
Term
what disease is characterized by:
Fribrosis of the airways, hlyperplasia of the bronchial epithelium, inc fluid in the lungs, overdistention of aveoli caused by air trapping, and fibrosis, airway edema, and bronchocontriction it is permanent and chron |
|
Definition
| Bronchopulmonary dysplasia (BPD) |
|
|
Term
| management of Bronchopulmonary displasia includes these 4 interventions/treatments |
|
Definition
meds-bronchodialators , anti-inflams
respiratory care= suctioning, humidification, oxy, CPT/PD, ventilary support
nutritional support= high cal
family edu and support |
|
|
Term
| management of Bronchopulmonary displasia includes these 4 interventions/treatments |
|
Definition
meds-bronchodialators , anti-inflams
respiratory care= suctioning, humidification, oxy, CPT/PD, ventilary support
nutritional support= high cal
family edu and support |
|
|
Term
what disease is characterized by:
being inherited as a ressessive trait
generalized disfunction of the exocrine glands with multisystem involvement
pancreatic enzyme deficiency
progressive pulmonary disease
elevated sodium and cloride levels in swe |
|
Definition
|
|
Term
| if two parents are carriers for CF what is the chance the child will be effected with CF? be a carrier, have no genetic inheritance of the gene. |
|
Definition
cf 25%
CARRIER 50%
no prob 25% |
|
|
Term
signs of CF 6 diagnostic or help diagnose
what kind of vitamins do these individuals need? |
|
Definition
born with meconian illeus (tell tale sign of CF)
pancreatic enzyme deficiency (can't digest fats (udually noticed first)
progressive chronic obstructive lung disease
sweat gland dusfunction with inc sodium and chloride loss in the sweat (used to diagnose)
failure to thrive
need fat soluable vitamins |
|
|
Term
| clincal respiratory manifestations of CF 6 |
|
Definition
thick bronchial mucus (greenish thick sticky) leading to bacterial colonization
dec oxy-carbon dioxide exchange (clubbing)
chronic cough
dyspnea
hyperaeration (barrel chest)
sinusitis, nasal polyps |
|
|
Term
| clinical GI manifestations of CF |
|
Definition
steatorrhea, azotorrhea (urea in stool)
intest obstruction
FTT
rectal prolapse
CF diabetes indulin produced but gets plugged up
liver involvement |
|
|
Term
| clinical skin manisfestations of CF |
|
Definition
salty taste r/t inc loss of na and cl
risk for hyponatremic and hypochloremic alkalosis
edema related to hypoalbuminemia |
|
|
Term
| reproductive manifestation of CF |
|
Definition
female:
delayed puberty
dec fertility
inc incidence of premature labor, low birth weight
Males:
most males with CF are sterile |
|
|
Term
| Therapeutic management/ goals of CF care are: |
|
Definition
prevent minimize pulmonary complications (usually cause of death)
ensure adequate nutrition for growth
encourage physical actuvity
promote reasonable quality of life |
|
|
Term
| Therapeutic management of respiratory systoms of cf |
|
Definition
pulmonary hygiene CPT 3-4 times a day, flutter valve, exercise
antibiotics
nebulized/ inhaled meds- pulmozyme
TOBI, bronchodialators, antiinflamatories
cepacia precautions (teratogenic effects)
lung transplant (can extend life) |
|
|
Term
| Gastrointestinal management of CF |
|
Definition
admin pancreatic enzymnes with meals snacks and enteral feedings before eating
high protein, high cal diet, salt supplementation
replacement of fat sol vits
monitor and treat intestinal obstruction |
|
|
Term
| when does the heart begin development in utero |
|
Definition
|
|
Term
| when is fetal cardiac circulation developed by? |
|
Definition
|
|
Term
| when does the fetal heart start beating |
|
Definition
|
|
Term
| what occurs with fetal heart development in the 5th week of gestation? |
|
Definition
| evolves into S shape and single trunk divides into two, the aorta and pumonary artery, |
|
|
Term
| when are the four chambers of the fetal heart evident (soon to be followed by the two vena cava) |
|
Definition
|
|
Term
| which ventricle of the heart has shorter papillary muscle fibers |
|
Definition
|
|
Term
| which ventricle has long striated muscle fibers to pump systemicly |
|
Definition
|
|
Term
| blood will follow the path of ________ _______ |
|
Definition
|
|
Term
| what are the risk fators of a congenital heart defect (CHD) 5 |
|
Definition
family history
environment
toxic maternal exposures
maternal exposures
other syndromes (trisomy 21)
matern condition (perscription drugs or diseases rubella) |
|
|
Term
| fetal liver blood from vena cava mixes with blood from the lower body and drains into the____ ________ |
|
Definition
|
|
Term
| what is the o2 sat of baby during fetal development |
|
Definition
|
|
Term
This closes with the baby's first breath
this occurs becuase of the _____ in _______ concentration |
|
Definition
ductus arteriosus
inc in oxy concentration cuases Da tissue to constrict. |
|
|
Term
| In the newborn heart, how is resistance lowered so that right sided pressure is lowered |
|
Definition
| Inc in pulmonary blood flow with first breath dec pulmonary vascular resistance by 80%! this lowers right sided pressure |
|
|
Term
| what makes the foramen ovale close in the newborn |
|
Definition
|
|
Term
| name 4 things that occur to the newborn upon being born, and say what each things does for baby |
|
Definition
alveoli expands- dec pulmonary vascular resistance and inc pulm blood flow
cord clamed-inc systemic vascular resistance and inc left ventricle pressure
DA closes= systemic vasular resistance is greater than pulmonary vascular resistance
patent foramen ovale clses, umbilical vein and artery and ductus venosus atrophy |
|
|
Term
in children pulse rate is _____ and stroke volume is ______.
and the apical impulse is ______ |
|
Definition
increased and stroke vol is decreased
variable |
|
|
Term
How is Cardiac Output calculated in young children
what is the definition of stroke volume?
is Heart rate or stroke volume more fixed in young children |
|
Definition
CO = SV x HR
amount of blood ejected by left ventricle per beat
SV is more fixed and CO is regulated by the heart rate. |
|
|
Term
define preload
what does hypovolemia do to preload?
what does fluid overload do to the preload? |
|
Definition
end diastolic stretch, will inc strength of the fiber and contraction of the left ventricle
hypovolemia decreases preload
fluid overload causes an increase |
|
|
Term
define contractility
what are three body states that would cause a dec in contractility |
|
Definition
pumping force and effectiveness of the heart muscle
hypoxemia
acidosis
electrolyte imbalance |
|
|
Term
|
Definition
| resistance in which ventricles must pump against |
|
|
Term
| excessive perspiration in infants indicates |
|
Definition
CHF and is caused by catecholamine release
don't put powder on infant |
|
|
Term
| what is mottling and what causes this in children with cong heart def? |
|
Definition
| cold stress caused by blood shunting to center and there is dec perfusion to the periphery. |
|
|
Term
| why does hepatomeagaly occur with children with CHD? |
|
Definition
| happens because decreased blood flow to the liver causes low liver resivior for dead rbc's |
|
|
Term
| what are two prenal tests that can diagnose CHD |
|
Definition
|
|
Term
how is CHD diagnosed in newborn already delivered
in an infant?
name 5 diagnostic tests |
|
Definition
neonatal cyanosis with cry
murmur
shock like symptoms
infants= FTT
tests: oxy challenge
xray, echo, EKG, holter monitor, TEE (tracheal esoph echo), ABG, HCT, Cardiac cath (used more as intervention for patent DA) |
|
|
Term
| A child with a patent DA get a cardiac cath what are the needed interventions for pre and post cath insertion |
|
Definition
PRE
prehydration status
NPO prior
Premark pedal pulses
baseline HCT and V/S
prepare child based on developmental age
POST
vs q 15 min
check dressing
quality of pedal pulses q 1/2 hour
keep extremity straight for at least 6 hours
check under the child and in diaper for bleeding |
|
|
Term
| What are the 4 categories of congenital heart disease |
|
Definition
inc pulm blood flow
dec pulm blood flow
obstructive lesions
mixed lesions |
|
|
Term
| Inc pulmon blood flow can be caused by |
|
Definition
Problems that cause a left to right shunt such as:
-patent DA
-atrial septal defent
-ventricular septal defect membranous and muscular
-complete atrio ventricular canal |
|
|
Term
| when can you remove the dressing after a cardiac cath? what type of dressing is it |
|
Definition
the day following catheterization
its a pressure dressing. |
|
|
Term
| Name 7 clincal manifestations of left to right shunting in heart |
|
Definition
tachycardia/tachypnea
inc WOB
hypoxia-fatigue irritability anxiety
feeds slowly - tires easily
poor weight gain
dec U/O
poor perfusion=cool extremities pale prolonged cap refill, weak pulses |
|
|
Term
| when you have a Left to right shunt, more blood flows to the__________ |
|
Definition
|
|
Term
| name 4 examples of a left to right shunt |
|
Definition
patent DA
atrial septal defect
ventricular septal defect membranous and muscular
complete atrio-ventricular canal |
|
|
Term
| most ventricular septal defects are repaired __________ |
|
Definition
| on their own, if not by 12 then surgery |
|
|
Term
| The ductus arteriosus is located between the |
|
Definition
| pulmonary artery and the aorta |
|
|
Term
| an atrial septal defect involves ______ to _________ shunting |
|
Definition
|
|
Term
name 3 atrial septal defects and where they are located in the septum
how does the blood shunt? |
|
Definition
sinus venosis (high in septum)
ostium primum low in septum, inferior to patent foraman ovale
ostium secundum - mid septum most common
these kids don't look that sick. They are pretty active.
left to right shunting. |
|
|
Term
| in a ventricular septal defect there is ___ to ____shunting of blood between the _________ |
|
Definition
left to right
between the ventricles
there is allot of blood mixing in this defect/most common/ most resolve on their own. |
|
|
Term
| When is an atrioventricular defect fixed/ |
|
Definition
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Term
| Name 4 complications of imcreased pulmonary blood flow |
|
Definition
inc pulmonary vascular resistance
vasoconstriction
pulmonary vessel hypertrophy
pulmonary hypertension-irreversible damage. |
|
|
Term
| Name 3 types of congestive heart failure |
|
Definition
systemic venous congestion (R)
Pulmonary venous congestion (L)
Compensatory response |
|
|
Term
what type of congestive heart failure is characterized by:
weight gain, hepatomeagaly, edema (sacral and periorbital) ascites, and neck vein distention |
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Definition
| systemic venous congestion (r) |
|
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Term
what type of CHF causes tbe following characteristics:
tachpnea , dyspnea, retractions, flaring, grunting , wheeze, cough, pallor, and exercise intolerance |
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Definition
| pulmonary venous congestion (L) |
|
|
Term
the type of CHF characterized by :
tachycardia, cardiomegaly diaphoresis, fatigue and FTTq |
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Definition
|
|
Term
how many calories are required for a normal neonate?
high risk neonates such as those with CHF require |
|
Definition
100-120 kcal/kg
120-150 kcal/kg |
|
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Term
| You should put infants on fluid restriction if they have CHF. T or F |
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Definition
| F. They won't be able to get any calories. |
|
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Term
lasix works on the ______ loop of henle to
while diuril works on the _____ loop of henle and should be given with ________
aldactone is a __ ___________ diuretic, and works on _____, while blocking ____ |
|
Definition
ascending
decending
should be given with lasix
K sparing
works on ald and blocks ADH |
|
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Term
Name two meds that are afterload reducers
name 3 inotropic drugs that inc contractility
what does oxygen do? |
|
Definition
captopril (to dialate aorta and pulm artery) and enalapril
digoxin, dopamine, dobutamine
used sparingly doesn't help with o2 sats and ca. |
|
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Term
| Decreased pulmonary blood flow is caused by a -------- to ------- shunt |
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Definition
|
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Term
| Name 3 examples of defects with right to left shunts |
|
Definition
tetralogy of fallot (TOF)
Tricuspid atresia
Pulmonary atresia |
|
|
Term
| clinical manifestations of right to left shunting include 10 |
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Definition
cyanosis
FTT
respiratory distress -decreased oxygen
polycythemia- risk stroke emboli ( to compensate for low 02 sat)
inc systemic blood flow
systemic congestion-CHF
distended neck veins (blood v. viscous)
hepatomegally (destruction of rbcs)
fluid retention- sudden weight gain.
facial edema- dependant edema
clubbing |
|
|
Term
| name the 4 defects in tetrology of fallot |
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Definition
narrow opening to pulmonary artery due to stenosis
right ventricle hypertrophy d/t inc in pressure
ventricular septal defect
an overriding aorta that is sitting above the VSD and more mixed blood is going systemically. |
|
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Term
| surgery for tetrology of fallot is done at the age of |
|
Definition
|
|
Term
what is a tet spell
what can cause a tet spell
inc pulmonary resistance causes VSD to shunt which way?
if a child has a tet spell what should you do?
how do you treat it |
|
Definition
-hypoxic episode
- stress, defecation, cry (valsalva)
-shunts systemically (right to left, not enough to lungs)
take to the ER
-morphine (smooth muscle relaxer) and bring knees to chest position crunch them red blood going back to heart causes spasms to relax |
|
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Term
what is different about a heart with a transposition?
how do they look at first?
when do they do the surgery?
what is the best surgery? |
|
Definition
The aorta is comming out of the rt ventricle which is pumping deoxygenated blood systemically and the pulmonary artery is attatched to the left ventricle and is pumping to the lungs.
look healthy at first
do surgery instantly before they go home.
the best is the jatene arterial switch done at less than 2 weeks of age. switch arteries and switch coronary arteries. (you must assess coranary art suffificency |
|
|
Term
what is the course of illness of a one ventricle heart (one with only a rt ventricle)?
what are the treatments |
|
Definition
the aortic valve is stenotic, no blood goes to the left venticle so no flow no grow...
wither paliation or heart transplant. |
|
|
Term
| Name 3 obstructive lesions of the heart |
|
Definition
coarctation
aortic stenosis
pulmonary stenosis/ pulmonary atresia |
|
|
Term
what are the clinical manisfestations of obstructive lesions such as coarctation
aortic stenosis and pulmonary atresia? |
|
Definition
depends on severity of obstruction and which structure is obstructed
CHF and/or cyanosis
Blood pressure gradient between upper and lowwer extremities. Upper extremities high BP while lower extremities has low blood pressure |
|
|
Term
| obstructive defects are surgically repaired, but tend to __________ |
|
Definition
|
|
Term
| What are the nursing interventions when caring for a child with obstructive lesions |
|
Definition
support parents
support groups
Encourage family participation
cluster care
emphasize positive aspects
hospital breaks, volunteers
education |
|
|
Term
PDA
when should this close?
what is the corrective procedure when symptomatic?
what does the murmur sound like
what type of flow problem does this have
what risks does this problem have on the circulatory sys |
|
Definition
closes at 1-8 weeks of age
corrective proced is meds indomethacin IV.
tbe either ligation and or device closure (depends on size.)
sounds like a machine
increased pulmonary flow
risks are pulmonary edema and CHF |
|
|
Term
VSD ven septal defect:
Name 4 types
what is the corrective procedure
what type of flow problem does this defect have
what determines degree of pulmonary vascular resistance
at risk for..? |
|
Definition
3 types: membranous, atrioventricular, muscular (swiss cheese)
small defects may not need corrects and may even close by themself. large defects are controled by pulmonary banding in early infancy (pallative) or if really lg by suture or patch
inc pulmonary flow
pvr is determined by size and location of defect
at risk for CHF, infections and pulmonary vascular hypertention |
|
|
Term
secundom defect define
when is corrective procedure preformed
what type of defect is this characterized as
what is the type of blood flow problem |
|
Definition
define- a hole located anywhere onlong the interatrial septum (another way to say PDA)
preformed at 2-6 yo to prevent PVD. called VATS
arterial septal defect
inc pumonary flow |
|
|
Term
ostium primum defect define
what is the category of defect this falls under?
what procedure is used to fix this?
what are the risks if not corrected? |
|
Definition
located low in the interatrial septom where inferior margin formed by fused septal leaflets of the mitral valve
arterial septal defect
VATS
generally they are asymptomatic, there is a risk of chronic pulmonary changes if not repaired during childhood. |
|
|
Term
what is a coarctation of the aorta
how is it treated
what strange vital signs readings does this defect have?
what type of blood flow prob does this have
even after correction this obstruction may return t or f |
|
Definition
narrowing of the aorta distal to the left subclavian artery
resection of narrowed section. end to end anastomosis, graft may not be needed in child.
high bp in upper extremities, low in low (preop)
dec systemic flow/obstructed flow
true |
|
|
Term
tetrology of fallot
name the 4 defects
what is the dangerous risk that can occur agter a tet spell?
when can this be repaired?
what causes the risk of dehydration?
what type of blood flow prob |
|
Definition
defects are large VSD
overiding aorta
pulmonary stenosis
and right ventricular hypertrophy
dangerous risk of tet spell is CVA.
complete repair during infancy before 6 months. good prognosis
polycythemia causes dehydration
dec pulmonary flow |
|
|
Term
define tricuspid atresia
explain the path of the blood shunting
what is the only source of pulmonary flow
what is the surgery/treatment
what other defect is NEEDED to maintain life
flow problem? |
|
Definition
absent tricuspid valve hypoplastic RV
PFO-->LA--> MV -->LV-->aorta
only from patent ductus arteriosus.
palliative surgery BT shunt followed by fontan-conduit from RA to PA (done once symptomatic)
need either a PFO or ASD and a PDA
dec pulm flow |
|
|
Term
| sub acute bacterial endocarditis define |
|
Definition
| the formation of noninfected thrombus on abnormal endothelial surface, secondary infection w bacteria circulating in blood, proliferation of bacteria/vegetations on the cardiac valves |
|
|
Term
| Name the five aquired heart diseases found in kids |
|
Definition
kawasaki disease
rheumatic fever
endocarditis
cardiomyopathy
dysrhythmias |
|
|
Term
| what is kawasaki disease? |
|
Definition
mucocutaneous lymph node syndrome, no infectious ideology, system vasculitis involving arterioles capillaries and venules. later coronary and larger arteris may be involved
may lead to long term cardiac probs |
|
|
Term
How long does the acute phase of kawasaki last
what is always present, how long?
should antibiotics be used?
what types of oral cavity changes are seen
eye problems? |
|
Definition
from day 0-10
always a fever for greater than 5 days
they are unresponsive to antibiotics
strawberry tongue lips and pharynx
bilat conjunctivitis non purulent |
|
|
Term
what are some of the clinical manifestations of kawasaki disease in the acute phase?
sub acute phase?
convelescent phase |
|
Definition
acute= arthralgia, elevated sed, c reative p, and LFTs
cervical lymphadenopathy
erythmia on hands and feet
rash worse in groin
enlargement of gallbladder (ab pain)
sub acute phase (day 11-25)
disappearance of fever rash and lymphdenopathy
c react sed and platelets elev
anemia
arthritis worsens
desquamation of hands and feet
coronary artery aneurisms pericardial effusion
ST-T segment changes
convelescent phase: until labs are WNL
presist coronary art anuerysms
aortic stenosis |
|
|
Term
| treatment of kawasaki 4 things |
|
Definition
| ASA, IVIG, antithrombotic therapy (coumadin, persantine), dec cardiac workload captopril, digoxin, diuretics |
|
|
Term
Acute theumatic fever/heart disease
how many days of latency
what age range is most susceptibl
what groups is this highest in |
|
Definition
20 days latency
most susceptible 5-15
highest in females and blacks
(caused by an organism?) |
|
|
Term
What is Jones criteria for RHF?
what are the major signs
minor? |
|
Definition
2 major symtoms supporting evidence of GABHS, or 1 major and two minor with history of GABHS.
major signs are carditis, polyarthritis, syden hams chorea, erythema marginatum, sub cue nodules
Minor signs: polyarthralgia
fever, elev sed, +c react prot, prolonged PR on EKG, previous history of RHF. |
|
|
Term
| what is the treatment options for RHD, 6 |
|
Definition
ASA substantial improvement in 2 days,
cortico steroids, supportive care for CHF, bedrest for duration of fever and inflam process, penicillin-G 1.2 mu IM Q month |
|
|
Term
| In kids the epiphyseal growth plates are ______ and more prone to _______ |
|
Definition
| weaker than adults and more prone to fractures. |
|
|
Term
| the periosteum in kids is ________ and heals more _________ |
|
Definition
|
|
Term
childrens bones are more ________ than adults and therefore are more prone to ______ than to sprains.
compared to adults, children have a ________ ROM |
|
Definition
more flexible
prone to strains
larger ROM |
|
|
Term
define strain
what kind of activities usually cause this
what is the presenting symptom?
what is prince? |
|
Definition
tearing or stretching injury to muscle tendon unit causeing either a partial or complete tear or rupture of muscle, tendons or fascia that support a joint
individual sports
symptom=PAIN
prince is treatment and stands for protect, rest, ice, NSAIDS, compress, elevate |
|
|
Term
define sprain
how does this usually occur
who is this less common in?
what symptom is predominant?
treatment? |
|
Definition
traumatic joint twist that results in stretching or tearing of connective tissue
usually outside force team or contact sport
less common in prepubital children
symptom= swelling! (NOT PAIN)
treat=Prince= protect, rest, ice, NSAISA, compress, elevate |
|
|
Term
| what is the most common fracture? |
|
Definition
|
|
Term
| what did you break if you broke your supracondylar? |
|
Definition
|
|
Term
what does it mean to have an avulsion fracture?
occult?
Buckle or torus?
greenstick? |
|
Definition
a-fracture pulls bone from usually pt of contact
-hidden
-buckle or torus-bone inbeds instead of breaking
-greenstick= incomplete break |
|
|
Term
| Name the 5 types of fractures |
|
Definition
comminuted
compound
compressed
displaced
spiral |
|
|
Term
what are the 7 clinical manisfestations of a fracture
what should you assess? |
|
Definition
7= DB stamp
dec use
bruise
swell
tender
any dec of neurovascular status
pain
assess 5 P's= pain, pallor, pulse loss, perithesia, paralysis. |
|
|
Term
| name the two ways to do a reduction of a fracture and what each means |
|
Definition
closed and open
closed= setting bones
open means plates or pins |
|
|
Term
Name the 3 types of casts
how long does plater take to dry
4 ways to care for a cast |
|
Definition
hip spica
leg cast
arm cast
dries in 12 hours to 3 days
cast care= HEEK Handle wet cast carefully with palms, elevate, expose to air, keep clean and dry. |
|
|
Term
what is compartment syndrome?
s+s?
what is there risk for
what should you do immed |
|
Definition
orthospedic emergency where there is a build up of fluid in an enclosed space.
s+s= pain out of proportion to injury, passive ROM creates pain, muscle ischemia, neural injury.
pulmonary embolus and infection
tell doc immed |
|
|
Term
| name 6 n. interventions for compartment syndrome |
|
Definition
respiratory assessment, CSM monitoring
passive ROM
skin care
cast care
pain management
as child recovers= exercise, gait training, bracing |
|
|
Term
developmental dysplasia of the hip can occur
which sex is it more prominent
which is more likely affected
define DD of the hip |
|
Definition
anytime in the 1st year of life
more prominent in females
the left is more likely affected
define- complete dislovation
subluxtion and unstable hip and weight bearing |
|
|
Term
dev dys of the hip
when should you assess?
what confims in infants
in older childre? |
|
Definition
assess hips the whole first year of well child visit
in infants
barlow confirms instability
and ortolani confirms joint is reducible
in an older child you
look for galeazzi sign
and trendelenburg sign |
|
|
Term
| How is dev dys of the hip managed in neonates?olde infants? greater than 18 months |
|
Definition
neo- pavlik harness
older infants= closed reduction and cast after bryants traction
after 18 months may require an open reduction |
|
|
Term
is torticollis acquired or congenital?
what happens/
when is surgerical correction done |
|
Definition
both
there is a shortening of sternocleidomastoid muscle (neck)
head tilted towards effected side has a palpable mass
1yr-1 1/2 |
|
|
Term
these traits are characteristic of what problem:
adduction of forefoot
foot plantar flexed at ankle
forefoot curves in
foot cannot be manually corrected to neutral, early referral, splinting/serial casting |
|
Definition
| Talipes Equivarus clubfoot |
|
|
Term
Genu Varum also known as bow legs is a product of __________ and is corrected by ________.
Genu Valgum is known as knocked knees is also ___________ |
|
Definition
in utero positioning
corrected by itself (self limiting)
also self limiting (generally) |
|
|
Term
Scoliosis definition/cause?
who is at highest risk |
|
Definition
later curve greater than 10 def usually in thoracic or lumbar
cause ideopathic if thoracic lumbar or thoracolumbar, double major
if cause is congenital it is more likely to progress and is noticible earlier
hgihest risk age 10-16 females |
|
|
Term
| what is the surgical intervention for scoliosis |
|
Definition
| spinal fusion (post op care intense) |
|
|
Term
Osgood schlater disease, thomas got from _______
what happens on exam
x rays?
care? |
|
Definition
jump roping
tenderness at tibial tubercle
no x ray needed
PRINCE for 2-3 months |
|
|
Term
Juv RHeum arth is?
the cause is? any links? |
|
Definition
an autoimmune inflammatory disorder
it is one of the most common chronic diseases in children
the outcome is variable and unpredictable in individual children
the causes is unknown but infectios and genetic origins have been proven |
|
|
Term
| What are the 3 classifications of Juv R arth |
|
Definition
systemic
pauciarticular
polyarticular |
|
|
Term
| what is the treatment of JRA based on? |
|
Definition
|
|
Term
| what are the nursing care interventions for JRA? |
|
Definition
assess joint function and extra articular manifestations
administer prescribed meds
relieve pain
promote joint function
promote self care
encourage act with family and peers
assist the fam in meeting the childs needs
jprovide child and family teaching
(and annual eye exam) |
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