Unit 2

How is foreign body aspiration diagnosed

Diagnosis is based on history & S/S X Ray, CT, MRI

What are S/S of pertussis (whooping cough)

Early- URI, sneezing, lacrimation, cough, low fever Late- vomit, dry hacking cough (short & rapid), sudden inspiration causes child to sound like a whoop

How is Influenza prevented

Immunization 1st seasonal vaccine for children 6 months - 8 years -need 2 injections at least 28 days apart -not protected until 2 weeks after 2nd vaccine

What is the pathology of Congestive Heart Failure (CHF)

Inability of heart to pump adequate amount of blood to meet bodily demands R/T structural abnormality, can be septic or anemia Right sided- RV unable to effectively pump blood to the lungs (systemic venous congestion) Left sided- LV unable to effectively pump blood to circulation (pulmonary congestion)

How are CHD classified

Increased Pulmonary Blood Flow Decreased Pulmonary Blood Flow Obstructive Disorders Mixed Disorder

A nurse teaches the parents of an infant with a cardiac defect how to detect impending heart failure. What should the parents be taught to identify as an early sign? Slowed respiration Increased heart rate Distended neck veins Increased urine output

Increased heart rate

An infant with a congenital heart defect is returned to the unit after cardiac catheterization. The nurse manager is observing a nurse newly assigned to the unit. Which nursing intervention should the nurse manager interrupt? Offering fluids and foods as tolerated Performing range-of-motion exercises Monitoring the apical pulse for rate and rhythm Assessing the pulses distal to the catheterization site

Performing range-of-motion exercises

How is tuberculosis diagnosed

Physical exam, history, skin test, x ray w/ TB pattern, sputum test

What is Wolf Parkinson White Syndrome (WPW), & How is it treated

Pre-excitatory syndrome -tachycardia, syncope, chest palpitations Ablation required to treat -surgical removal of faulty electrical pathway HR for 1 min, 12 point lead EKG, & 24 hr halter monitor

What are nursing considerations for Esophageal Atresia & Tracheoesophageal Fistula

Prepare for surgery Admin surfactant Assist with ECMO Pre op & Post op cares Caregiver education No suction post op Know they are getting food if gain weight

What are nursing considerations for asthma

Prevention is key Calm nursing presence Monitor pulse oximetry Allow older children to sit up if more comfortable Allow parents to remain with children

What are nursing considerations for shock

Providing emergency cares -med admin -IV access -Supply O2 -Encourage fluids to (↑ volume & ↑ BP)

What causes pneumonia

virus, bacteria, mycoplasma, & foreign substance aspiration [viral is more common ] (can be primary diseases or a complication of another issue)

What are crackles (rales)

wet, crackling sounds in the lungs air moves through fluid filled alveoli, as in pneumonia (may not clear with cough)

What is tachypnea

↑ RR

Who is responsible for transplant organ distribution in U.S.

UNOS (United Network Organ Sharing)

Lithium use during pregnancy can cause which type of heart defect

An Epstein anomaly -causes TV to be in the RV, enlarged RA & cardiomegaly

How is Cardiomyopathy diagnosed

Chest x ray, EKG, Cardiac catheterization

How is Congestive Heart Failure (CHF) treated

O2, high-calorie diet, sodium restriction, digoxin, lasix, ↓cardiac demands

What respiratory sounds are expected for pneumonia

crackles

The nurse is providing care for an infant with an middle ear infection. The nurse is aware that the condition has occurred multiple times in a 3-month period. Which comment by the parent indicates to the nurse that specific teaching is needed regarding the incidences of infection? "Her older brother brings colds home from school." "She likes her ears submerged while bathing." "I clean her ears with cotton swabs." "I now put her to bed with a bottle."

"I now put her to bed with a bottle."

A nurse caring for a child with Eisenmengers syndrome should assess for all of the following except: 1. Fatigue. 2. Acrocyanosis. 3. Shortness of breath. 4. Blood pressure.

2. Acrocyanosis. (child will have cyanosis)

What would be the respiratory rate in two-year-old child? 20 30 40 50

30

A 16 year old who is in the ER after an automobile accident is exhibiting signs of shock. The assessment indicates that the teen has a steering wheel bruise mark on his chest. The teen is exhibiting signs of cardiogenic shock. The nurse working with the trauma team knows the patient: 1. Has had a large loss of blood, which causes cardiogenic shock. 2. Has overwhelming sepsis from the accident, which is causing the cardiogenic shock. 3. The bruising to the chest could have caused damage to the heart, causing it to not be an effective pump, which results in cardiogenic shock. 4. The trauma to the chest has caused capillary leaking, leading to cardiogenic shock.

3. The bruising to the chest could have caused damage to the heart, causing it to not be an effective pump, which results in cardiogenic shock.

A 6 month old has a known diagnosis of an Atrial Septal Defect (ASD). The nurse would anticipate all except which of the following during an assessment? 1. Shortness of breath 2. Enlarged liver 3. Poor feeding 4. A diastolic murmur

4. A diastolic murmur (systolic murmur, blood being forced through PV)

A nurse should be most concerned about which type cyanosis in a newborn infant? 1. Cyanosis of the hands 2. Cyanosis of the feet 3. Periorbital cyanosis 4. Circumoral cyanosis

4. Circumoral cyanosis (indicates central cyanosis)

How often are congenital heart defects present

6-8 defects in every 1000 live births - 2-3 are symptomatic within 1 year - 28% have another presenting anomaly

What are the types of croup syndromes

Acute Laryngitis Acute Spasmodic Laryngitis (spasmodic croup) Laryngotracheobronchitis (LTB) Laryngotracheitis Epiglottitis

What is patent ductus arteriosus (PDA)

An opening b/w aorta→pulmonary artery pre birth Closes within 4 days post birth

Chest pain is a(n) _____ symptom in a pediatric cardiac client. A. common B. rare C. permanent D. imagine

B. rare

How is Pulmonic *S*tenosis treated

Balloon angioplasty or Valvuloplasty

A 5-year old patient with pertussis is admitted for IV therapy and antibiotics. Which intervention is not appropriate? Bed rest Cardiac/Respiratory monitoring Pulse oxygenation monitoring Adequate caloric intake

Bed rest

What is Otitis Media (OM) pathophysiology

Common after previous respiratory infection

How is Aortic *S*tenosis treated

Digoxin, Diuretics Prostaglandin E Pain med's Surgery -balloon dilation (valvuloplasty) -cardiac catheterization

What are the types of Cardiac Dysrhythmias

Supraventricular Tachycardia Ventricular Tachycardia Torsades de pointes Bradycardia Wolf Parkinson White Syndrome (WPW)

How is Cardiomyopathy treated

Valve replacement Heart transplant if warranted

What happens during the P wave

Atrial depolarization (atrium contract & push blood into ventricles)

What are Obstructive Disorder CHD's

*[obstructive PASS COA]* Pulmonary Atresia *(PA)* Pulmonary *S*tenosis (PS) Aortic *S*tenosis (AS) Coarctation of the Aorta (*COA*)

What is clubbing

enlargement of terminal phalanx of fingers

All of the following are s/s of otitis media except? Irritability Fever of 103 Constipation Rolling head from side to side

Constipation

What are nursing considerations for bronchiolitis

Continually monitor cardiac & resp, Nebulizer treatment, blood gases Contact precautions, spreading prevention, cluster cares to allow period of rest

What are key points of foreign body aspiration

More common in children 1-3 years old May result in life-threatening airway obstruction Can be toy, nuts, coin, latex balloon

How is Acute Laryngotracheobronchitis (LTB) treated

Airway management Maintain hydration (oral or IV) High/cool mist humidity, high-flow O2, take outdoors Nebulizer treatments -epinephrine/racemic & steroids

What is pertussis (whooping cough) caused by

Bordetella pertussis

How is Pulmonic *S*tenosis diagnosed

ECG & Cardiac catheterization

3 year old comes to ER with fever, unable to eat/drink, ↑ HR, & ↑ RR. What does the nurse suspect is the diagnosis? What should the nurse do?

Epiglottitis Get x ray, keep child calm, prep for intubation, get IV ready [*don't* stimulate throat]

What are S/S of Pulmonary Atresia *PA*

Fatigue, SOB, severe cyanosis at birth Tachycardia, murmur associated w/ VSD/PDA Poor weight gain & feeding

What is bronchitis

Inflammation of the large airways Also known as tracheobronchitis

An infant is admitted to the pediatric unit with bronchiolitis caused by respiratory syncytial virus (RSV). What interventions are appropriate nursing care for the infant? *Select all that apply.* Limiting fluid intake Instilling saline nose drops Maintaining contact precautions Suctioning mucus with a bulb syringe Administering warm humidified oxygen

Instilling saline nose drops Maintaining contact precautions Suctioning mucus with a bulb syringe

What are common side effects of lasix

K+ < 3.5 mEq/L Excessive diuresis Hypomagnesemia

What is the pathology of *H*ypoplastic Left-Sided Heart Syndrome

Left side of heart is underdeveloped Problems w/ AV, aorta, PDA 2nd most common congenital heart defect Fatal in 1st few days/months if left untreated

What are S/S of Patent Ductus Arteriosus/*PDA*

Murmur [systolic murmur] Crackles, tachypnea, ↑ WOB Poor feeding, weight gain, growth Fatigue, sweating, fluid weight gain

How is Tracheitis diagnosed

No improvement after corticosteroids & neb-epi Bronchoscopy

What is done for Cardiac Catheter PreProcedure Care

Prepare child & family for procedure Explain procedure w/ developmental appropriate materials Assess & mark pulses Baseline O2 saturation Nothing by mouth (NPO)

What is cyanosis

blue tinged skin or mucous membranes

Which drug is administered to close a PDA? captopril indomethacin digoxin prostaglandin E

indomethacin

What are S/S of Pulmonic *S*tenosis

↑ workload on right ventricle CHF, Murmur, Hepatomegaly (enlarged liver) SOB, cyanosis

The nurse in a pediatric clinic is assessing a toddler brought in by a parent who states, "I have noticed some increasing incidents of coughing and wheezing over the last few weeks." Auscultation by the nurse reveals some adventitious breath sounds in the upper right lobe. Which questions does the nurse ask the parent? *Select all that apply.* "Is there an older child who gives this child food?" "Have you noticed any missing small toys?" "How often is the child allowed to self-feed?" "Have you noticed any foreign objects in the child's stool?" "Can you recall a specific time of gagging or cyanosis?"

"Is there an older child who gives this child food?" "Can you recall a specific time of gagging or cyanosis?"

The nurse is conducting a class for parents of children with asthma. After covering the topic of asthma triggers, the nurse asks for feedback on the information. Which statements indicate the parents understand actions to reduce asthma triggers? *Select all that apply.* "Now may be the time to relocate to a warmer climate." "Reorganizing schedules will definitely reduce stress." "I think that we will need to stop using the fireplace." "We will be rethinking the possibility of a family pet." "No more going outside without a mask from now on."

"Reorganizing schedules will definitely reduce stress." "I think that we will need to stop using the fireplace." "We will be rethinking the possibility of a family pet."

What are Decreased Pulmonary Blood Flow CHD's

*[decrease TA Fall]* Tricuspid Atresia (*TA*) Tetralogy of *Fall*ot (TOF)

What are Increased Pulmonary Blood Flow CHD's

*[increase PDA Defects]* Patent Ductus Arteriosus (*PDA*) Atrial Septal *Defects* (ASDs) Ventricular Septal *Defects* (VSDs)

What are Mixed Disorder CHD's

*[mixed Great TAP H]* Transposition of the *Great* Vessels (TGA) Total Anomalous Pulmonary Venous Return (*TAP*VR) *H*ypoplastic Left Heart (HLH)

What are nursing considerations for tonsillitis

-Big risk after surgery is Bleeding -Avoid acidic, highly seasoned, hard/sharp foods 2 wks -Post op, avoid coughing, suctioning, using straw, & blowing nose -Place side-lying or prone to assist w/ secretion drainage -Avoid vomiting & crying -Pain relief & hydration are key

What are developmental size differences in the respiratory system

-Smaller airway diameter -Shorter distance b/w structures (allows more organisms to rapidly move down) -Short/Open Eustachian tubes (↑ instances of otitis media, can lead to respiratory infections & vice versa)

What are developmental age differences in the respiratory system

-Under 3 months, infants still have maternal antibody protection -Infections ↑ after 3 months & continue being high (toddlers/preschoolers go to daycare/school)

ECHMO is commonly used as a treatment for a baby with which defect/syndrome? 1. Eisenmengers syndrome 2. Coarctation of the aorta 3. ASD 4. Tetralogy of Fallot

1. Eisenmengers syndrome (acts as heart/lung bypass to get enough O2 for body)

Beginning with the highest priority (1), put the nursing interventions that a client should receive to manage CHF from in order, 1-5. Weigh all diapers & measure urine specific gravity Monitor cardiac output Elevate HOB while child is sleeping Maintain calorie count to ensure nutrition's maintained Involve the parents in care

1. Monitor cardiac output 2. Weigh all diapers & measure urine specific gravity 3. Maintain calorie count to ensure maintained nutrition 4. Elevate HOB while child is sleeping 5. Involve the parents in care

An infant with a patent ductus arteriosus will exhibit which type of heart murmur? 1. Washing machine murmur 2. Gallop style murmur 3. Clicking murmur 4. Harsh, loud murmur

1. Washing machine murmur (due to pulmonary congestion)

Which respiratory infections should the nurse monitor the toddler-age client for based on structural differences during this stage of development? *Select all that apply.* 1 Bronchiolitis 2 Ear infection 3 Acute sinusitis 4 Laryngotracheobronchitis 5 Inflammation of the tonsils

2 Ear infection 3 Acute sinusitis 5 Inflammation of the tonsils

A child with a known diagnosis of coarctation of the aorta will have an increase in: 1. Blood pressure in the lower extremities. 2. Blood pressure in the upper extremities. 3. Blood pressure in the heart. 4. Blood pressure in the aortic arch.

2. Blood pressure in the upper extremities.

In a newborn nursery, a nurse indicates she hears a soft murmur in one of the newborns. After obtaining blood pressures on all four extremities, she finds that the blood pressure is higher in the right arm than the right leg. The nurse knows this can indicate: 1. Nothing, as this is a normal finding. 2. Coarctation of the aorta. 3. Ventricular septal defect. 4. Shock due to poor perfusion in the lower extremities.

2. Coarctation of the aorta.

A 12 year old comes in with her mother and has the following symptoms: a 40.0 C fever, chills, coughing, and chest pains. Her mother states that she just finished Amoxicillin for strep throat and her chest x-ray shows consolidation. Based on these findings, what would be possible nursing interventions to manage this patient? 1. Monitor oxygenation status and results of sputum culture, CBC, PTT, and sweat chloride test from the laboratory 2. Monitor respiratory, oxygenation, and hydration status and give antibiotics as ordered 3. Monitor respiratory and oxygenation status and give pneumococcal vaccine injection as ordered 4. Monitor oxygenation and hydration status and inform mother that antibiotics would be ineffective for her daughter

2. Monitor respiratory, oxygenation, & hydration status & give antibiotics as ordered (indicative of bacterial pneumonia, Tx w/ AB's)

Identify the heart condition that will cause profound cyanosis, shock, and congestive heart failure if the PDA closes. 1. Truncus arteriosus 2. Total anomalous pulmonary venous return 3. Transposition of the greater vessels 4. ASD

2. Total anomalous pulmonary venous return (to allow O2 from pulmonary veins to move to LA)

A father brings his 6-month-old infant into the clinic with a four day history of nighttime, seal-like cough. The infant is afebrile, tachycardic, and tachypneic with a pulse oximetry reading of 98 percent. What interventions would you expect the physician to order for this child? 1. Cool mist tent w/ supplemental O2, racemic epi, & corticosteroids 2. Beta adrenergics aerosolized, cool mist tent, & periodic BS testing 3. Closely monitor resp status, cool mist tent, beta adrenergics, & corticosteroids 4. Close monitoring of respiratory status, supplemental oxygen with simple mask, and racemic epinephrine

3. Closely monitor resp status, cool mist tent, beta adrenergics, & corticosteroids (croup like S/S)

Treatment for otitis externa (OE) is usually: 1. No treatment because it resolves on its own. 2. Antibiotic therapy. 3. Corticosteroid therapy. 4. Applying a warm pack to the area for comfort.

3. Corticosteroid therapy.

The nurse knows that Kawasaki disease is: 1. Contagious, especially for kids in close settings (ex. day-care) 2. Mainly due to a cascading process. 3. Diagnosed as an exclusion process. 4. Most prevalent when S/S have been present for < 3 days.

3. Diagnosed as an exclusion process.

What is the most accurate statement regarding Palivizumab? 1. It is a humanized monoclonal antibody given as an IM injection before the start of HPV season. 2. It is recommended for premature infants with 29-35 weeks gestation, children with congenital heart defects, and the elderly. 3. It is costly and is given usually between October to May in a series of five injections. 4. Before administering, you need to evaluate results of complete blood count and electrolyte panel from the laboratory.

3. It is costly and is given usually between October to May in a series of five injections. (prophylactically for RSV) [nurse evaluate platelets & coagulants pre admin]

An 8 year old is receiving Digoxin (Lanoxin) for congestive heart failure. The nurse provides the caregiver with the following education, indicating that the medication is effective when: 1. The child is happy and active. 2. The child is pink and breathing easily. 3. The child's urine output increases. 4. The child's sleep at night improves.

3. The child's urine output increases. (↑cardiac output leads to ↑urine output)

What is the pathology of Tetralogy of *Fall*ot

4 defects present -pulmonary stenosis (PS) -right ventricular hypertrophy (thickening) -overriding aorta - ventricular septal defect (VSD) Blood shunts from right→left through VSD -mixes unoxygenated blood w/ oxygenated blood -oxygenated blood→circulation & oxygenated again

The nurse knows that one of the most likely symptoms of congestive heart failure (CHF) in infants is: 1. Jugular vein distention (JVD). 2. Decreased blood pressure. 3. Periorbital edema. 4. Diaphoresis with feedings.

4. Diaphoresis with feedings. (due to sympathetic stimulation)

The most accurate physiologic reason for respiratory distress in respiratory distress syndrome (RDS) is: 1. Altered surface tension causes fluid and protein leak, preventing atelectasis and ground glass appearance on CXR. 2. Infants with RDS are premature and incidence of RDS increases with increased gestational age. 3. Infants with RDS have a decreased number of alveoli, increased surface tension, and decreased AP diameter, limiting lung development. 4. Infants with RDS have altered surface tension, which produces hyaline membrane, atelectasis, and hypoventilation.

4. Infants with RDS have altered surface tension, which produces hyaline membrane, atelectasis, and hypoventilation.

Identify a common characteristic of pulmonary atresia. 1. Acrocyanosis at birth 2. Weight gain is similar to that of well newborns. 3. A murmur will be noted with an ASD or a PDA. 4. Severe cyanosis will be present at birth.

4. Severe cyanosis will be present at birth. (doesn't allow blood to lungs to be oxygenated)

When a child with transposition of the greater vessels is assessed, the nurse should anticipate that: 1. The lower extremities will have bounding pulses. 2. Cyanosis will be noted when the child is sleeping on his/her back. 3. An ASD murmur will be present. 4. The O2 sat in upper extremities will be lower than O2 sat in lower extremities.

4. The O2 sat in upper extremities will be lower than O2 sat in lower extremities. (because aorta is recieving deoxygenated blood)

What is the foramen ovale

A shunt from RA→LA pre birth to bypass lungs Closes within hours post birth

The nurse is providing care for an infant who is 2 months old. Which assessment finding will cause the nurse to suspect an upper respiratory infection? Adventitious lung sounds bilaterally A fever, lethargy, and skin pallor A stuffy nose and reddened eardrums A raspy cry and occasional cough

A stuffy nose and reddened eardrums

What is the pathology of Increased Pulmonary Blood Flow CHDs

Abnormal connection b/w both sides of heart -either the septum or the great vessels ↑ blood volume on right side of heart ↑ pulmonary blood flow ↓ systemic blood flow (body not get enough blood) SOB, fatigue, tachycardia, feet/leg swelling, murmur, S/S of CHF

How is Kawasaki Disease (KD) Mucocutaneous Lymph Node Syndrome treated

Acetylsalicyclic acid (ASA)/Aspirin 80-100 mg/kg/day -for fever, 6-8 weeks Intravenous immunoglobulin (IVIG) -to prevent coronary aneurism, for 10 days 3-5 mg/kg/day antiplatelet Transplant

What are nursing considerations for Cardiomyopathy

Acute Phase -IV fluids, ventilation, ECMO, diuretics, anti-coagulation therapy, ACE inhibitors, beta blockers, calcium channel blockers, & nutritional supplements Chronic Phase -Monitor, control arrhythmia's & CHF, monitor ACE inhibitor use, potassium levels for diuretic use, hydration levels, digoxin use Prepare family for severity of condition, may be terminal, activity restrictions, & frequent hospitalizations

What is bronchiolitis

Acute inflammation of the bronchioles (similar to RSV)

What are S/S of Kawasaki Disease (KD) Mucocutaneous Lymph Node Syndrome

Acute phase -sudden, high fever -unresponsive to antipyretics & antibiotics Subacute phase -lasts from end of fever until the end of KD clinical S/S Convalescent phase -clinical signs have resolved -lab values haven't returned to normal -ends when normal values returned (6-8 weeks) Lymph node swelling Strawberry tongue Peeling of hands & feet Painful joints Mimics scarlet fever

What is the pathology of Kawasaki Disease (KD) Mucocutaneous Lymph Node Syndrome

Acute systemic vasculitis of unknown cause -whole vascular system is swollen In 75% of cases, child is < 5 years old, peaks in toddlers Occurs in 3 phases- Acute, Subacute, Convalescent *MI* occurs in 73% of cases in 1st year of diagnosis Most kids recover fine

An 8-year-old child with a history of asthma is brought to the emergency department because of respiratory distress. The nurse immediately places the child in a bed with the head of the bed elevated and administers oxygen by means of a face mask. The healthcare provider performs a physical assessment, writes prescriptions, and admits the child to the pediatric unit. Which instruction should the nurse carry out first? Teach incentive spirometer use. Administer the nebulizer treatment. Obtain a blood specimen for a complete blood count. Notify the respiratory therapist to perform chest physiotherapy.

Administer the nebulizer treatment.

A 30-month-old boy with cystic fibrosis is admitted to the pediatric unit with a severe upper respiratory infection. The toddler is small for his age. What pathologic process does the nurse know is the cause of his small stature? Increased salt retention An atrioventricular defect Retention of carbon dioxide An absence of pancreatic enzymes

An absence of pancreatic enzymes

How is Otitis Media (OM) treated

Antibiotics -ensure full course of treatment used Surgical [↓pressure & allow drainage] -Tympanoplasty & Myringotomy (myringotomy-cut in membrane, tympanoplasty-tubes)

What are treatments for infections

Antibiotics (gentamycin, ampicillin, vancomycin, arythromycin) IV fluids O2 therapy Cardiac & O2 sat monitors Blood evaluations (WBC)

How is Rheumatic Fever & Rheumatic Heart Disease (RF & RHD) treated

Antibiotics for strep -Penicillin (PCN) or Sulfa Acetylsalicylic Acid (ASA)/Aspirin -inflammatory process Prophylactic antibiotics before procedure (dental) -may be for 5-10 years to prevent heart disease

What is the pathology of Transposition of the *Great* Vessels TGA

Aorta rises from RV Pulmonary artery rises from LV (MIX UP-aorta & pulmonary artery reversed) No Communication w/ systemic & pulmonary circulation Nonoxygenated blood flows to brain -results in damage RV→Body & LV→Lungs

What are nursing considerations for foreign body aspiration

Assess respiratory status Remove object at bedside/surgery Observe for edema post op Antibiotics Educate parents on prevention

How is Otitis Media (OM) diagnosed

Assessment of ear (no visible bone or light reflex)

What are S/S of Total Anomalous Pulmonary Venous Connection *TAP*VC

Asymptomatic until PDA duct close Profound cyanosis, severe shock, CHF

What are S/S of *H*ypoplastic Left-Sided Heart Syndrome

Asymptomatic until PDA duct close Profound cyanosis, severe shock, CHF Pulmonary venous congestion & edema Ashen, dusky skin, difficult breathing & feeding

Left to right shunting occurs because of opening b/w the 2 atria

Atrial septal defect ASD

A 5-year-old child undergoes cardiac catheterization. The child is in the post-cardiac catheterization unit for 2 hours when the incoming nurse receives the report from the outgoing nurse. Which part of the child's report should the incoming nurse question? Vital signs every 30 minutes Voided 100 mL since admission Pressure dressing over entry site Bed rest with bathroom privileges

Bed rest with bathroom privileges

The nurse is caring for a 3-year old with croup with a pulse ox of 92%. What nursing intervention is most appropriate? Begin oxygen supplementation Obtain Chest X-ray Prepare for intubation Assess airway for patency

Begin oxygen supplementation

Which is not a major presentation of cysitc fibrosis? Newborn meconium ileus Failure to thrive Bladder Prolapse Chronic respiratory infection

Bladder Prolapse

What is the pathology of shock

Body unable to maintain adequate blood flow & O2 to tissues that is needed for metabolism 3 types- Hypovolemic, Cardiogenic, & Septic Diagnosing shock cause is essential to treat effectively

An infant with a cardiac defect is fed in the semi-Fowler position. After the nurse feeds and burps the infant and changes the infant's position, the infant has a bowel movement and almost immediately becomes cyanotic, diaphoretic, and limp. Which activity most likely caused the infant's response? Burping Feeding Position change Bowel movement

Bowel movement

The nurse is providing postoperative teaching to the parents of a preschool child after a tonsillectomy. For which events does the nurse prompt the parents to contact the physician? *Select all that apply.* Bright red blood is noticed in the child's mouth. The child keeps an emesis basin close by. The child is frequently swallowing w/o food or fluids. The child refuses pain pills because it hurts to swallow. The child is asking for ice chips and popsicles.

Bright red blood is noticed in the child's mouth. The child is frequently swallowing w/o food or fluids.

What are types of infections of Lower Airways

Bronchitis Bronchiolitis Pneumonia Pertussis (whooping cough) Tuberculosi

What is subglottic stenosis? A. A congenital laryngeal cartilage abnormality in which the tissue is soft and floppy, collapsing in on itself B. Viral inflammation of the glottis and subglottic region C. The narrowing of the airway within the rigid cricoid cartilage D. The rapidly progressing inflammation of the larynx and epiglottis

C. The narrowing of the airway within the rigid cricoid cartilage

Two hours after a 1-year-old child with acute laryngitis is admitted to the hospital, the nurse observes increases in the child's respiratory and cardiac rates, increased restlessness, and substernal and intercostal retractions. What action should the nurse take immediately? Removing the secretions with a suction apparatus Increasing the concentration of oxygen that is being delivered Striking the child on the back repeatedly to help dislodge the mucus Calling the healthcare provider to report the child's respiratory status

Calling the healthcare provider to report the child's respiratory status

What are the types of acquired heart disease

Cardiomyopathy Congestive Heart Failure (CHF)

What are S/S of Rheumatic Fever & Rheumatic Heart Disease (RF & RHD)

Carditis -tachycardia, cardiomegaly, new murmur, muffled heart sounds, friction rub, chest pain, changes in ECG Polyarthritis -swollen hot red painful joints after 1-2 days Erythema Marginatum -pink rash, not itchy -macules w/ clear center & wavy well-demarcated border Chorea -sudden aimless irregular movements of extremities -involuntary facial grimaces & speech disturbances

What are S/S of respiratory failure

Change in mental status Extreme irritability Circumoral cyanosis or mottled skin Lethargy Grunting Head bobbing Continuous cough Use of accessory muscles Retractions Quiet breathing Tripod position Normal/Shallow respiration's Seesaw respiration's Hypopnea Hypoxemia Weak/Absent cry Tachycardia (further elevated)

What is done for Cardiac Catheter PostProcedure Care

Check pulse distal to site Monitor temp & color of extremities Take vitals q 15 min Monitor BP Monitor dressing for bleeding or hematoma Monitor I & O Monitor blood glucose levels

Which intervention indicates an RN is responding most appropriately to a complication after a T & A? Administer demerol for a FACES score of 3 Apply an ice collar with cartoon print for comfort Check the throat when frequent swallowing is noted Decrease the IV rate when child is drinking well

Check the throat when frequent swallowing is noted

A cardiac catheterization is performed on an infant. After the procedure, the leg used for the catheter insertion site becomes mottled. What is the best action by the nurse? Elevating the leg Covering the leg with a blanket Checking the pulse in the extremity Notifying the primary healthcare provider

Checking the pulse in the extremity

What are S/S of Aortic *S*tenosis

Chest pain, fatigue, syncope, SOB Systolic ejection murmur Exercise intolerance -can lead to sudden death ↑ pressure load on LV

How is Total Anomalous Pulmonary Venous Connection *TAP*VC diagnosed

Chest x ray -normal/small heart, figure 8 sign, & pulmonary edema O2 sat, ECg

What is the pathology of Cardiomyopathy

Chronic progressive disease Occurs in the heart muscle itself Dilated, Hypertrophic, & Restrictive Caused by infections, low blood flow to heart, ↓O2 level, or ↑BP R/T Chemo, Metabolic disorders, or viral infections Leading cause of kid heart transplants even though rare

A 3-year-old child with the diagnosis of tetralogy of Fallot is brought to the United States by a charitable organization for cardiac surgery. What should the nurse expect when conducting an admission assessment of the child? Clubbing of fingers Increased temperature Slow, irregular respirations Subcutaneous hemorrhages

Clubbing of fingers

What are S/S of shock

Confusion, lack of alertness Sudden, rapid heartbeat, sweating, pale skin, weak pulse, tachypnea, ↓ urine output, cool hands & feet

What is laryngomalacia

Congenital condition laryngeal cartilage abnormality Tissue is soft & floppy Collapses in on self, obstructing upper airway

What are rales? A. Fine cracking noises heard on inspiration B. Low-pitched sounds heard throughout respiration C. High-pitched sounds heard on inspiration in the upper airway D. High-pitched musical sounds heard throughout respiration

Crackles *A.* Fine cracking noises heard on inspiration

The child with a barky, seal-like cough is mostly likely to have which condition? Bronchiolitis Croup Pnuemonia TB

Croup

What are S/S of Transposition of the *Great* Vessels TGA

Cyanosis especially while crying, SOB, poor feeding, hypoxemia, Low pulse ox Lower pulse ox in right arm than rest of the body

What are S/S of Tricuspid Atresia *TA*

Cyanosis, SOB, Clubbing of fingers in older kids Poor feeding, weight gain, growth Murmur due to atrial septal defect ASD

Which of the following is the leading cause of acquired heart disease in children in the developed world? A. Hyperlipidemia B. Hypertension C. Rheumatism D. Kawasaki disease

D. Kawasaki disease

A preterm infant with respiratory distress syndrome (RDS) has blood drawn for an arterial blood gas analysis. Which test result should the nurse anticipate for this infant? Increased Po2 Lowered HCO3 Decreased Pco2 Decreased blood pH

Decreased blood pH

What common finding can the nurse identify in most children with symptomatic cardiac malformations? Mental retardation Inherited genetic disorders Delayed physical growth Clubbing of the fingertips

Delayed physical growth

What are S/S of Cardiomyopathy

Dependent on type Ventricles are primarily affected & enlarged Heart muscle no longer pumps effectively S/S of CHF -sweaty, dizziness, weight loss Murmur -gallop Hepatomegaly, Fatigue, Frequent colds, Dysrhythmia

A nurse is reviewing previous education with the parents and a 12-year-old child with cystic fibrosis (CF). The disease was diagnosed when the child was 3 years old and has resulted in one hospitalization for a respiratory infection. For which potential complications of CF should the family be alert? *Select all that apply* Diabetes Hematuria Nasal polyps Prolapsed rectum Pulmonary infections Urinary tract infections

Diabetes Nasal polyps Prolapsed rectum Pulmonary infections

The nurse is caring for a newborn diagnosed with esophageal atresia and tracheoesophageal fistula. Which information does the nurse provide to the parents? *Select all that apply.* Diagnostic tests performed since the birth The manifestation supporting the diagnosis Methods of treating the condition Actions for promoting recovery Prenatal conditions that contribute to the problem

Diagnostic tests performed since the birth The manifestation supporting the diagnosis Methods of treating the condition Actions for promoting recovery

A child being treated with cardiac drugs developed vomiting, bradycardia, anorexia, and dysrhythmias. Which drug toxicity is responsible for these symptoms? Digoxin Nesiritide Dobutamine Spironolactone

Digoxin

How is Atrial Septal *Defect* treated

Digoxin, Diuretics Surgery -suture through cardiac catheter if small defect -patch w/ own, artificial, or bovine tissue if moderate - severe defect

How is Ventricular Septal *Defect* treated

Digoxin, Diuretics Surgery [open heart surgery] -usually wait until 6-12 months old -cardiac catheter suture if small defect -patch w/ own, artificial, or bovine tissue if moderate - severe defect

How is *H*ypoplastic Left-Sided Heart Syndrome treated

Digoxin, Diuretics -for CHF Prostaglandin E -to keep PDA open until surgery Surgery -Norwood 30 stage procedure (to ↑ ventricular function) -heart transplant, lifelong follow-up

How is Coarctation of the Aorta *COA* treated

Digoxin, Diuretics -for CHF S/S Surgery -balloon dilation and stint placement

Which type of cardiomyopathy may require blood-thinning med's

Dilated cardiomyopathy -slow-moving blood (heart ineffectively pumps blood out of chambers, increasing clot formation)

What are S/S of bronchitis

Dry hacking nonproductive cough Becomes productive after 2-3 days Wheezing

What are S/S of asthma

Dyspnea, wheezes, cough, SOB, anxiety Recurring episodic symptoms -wheezing -breathlessness -chest tightness -cough (especially at night) Limited air flow/Obstruction reverses spontaneously or w/ treatment Bronchial hyperresponsiveness

What are the different types of Esophageal Atresia & Tracheoesophageal Fistula

EA without fistula -will find quickly, no nutrients get to stomach -no food in trachea, no fistula exists EA with proximal fistula -esophagus attached to airway, not stomach -food goes into airway EA with distal tracheoesophageal fistula -esophagus not attached to stomach -airway attached to stomach -child coughs a lot, distended, & choking EA with proximal & distal fistulas TE Fistula -harder to diagnose -depends how big opening is b/w esophagus & trachea & with different positioning -child may have more coughing & choking -food & air can interchange b/w stomach & lungs

How is Ventricular Septal *Defect* diagnosed

ECG -large left atrium Chest x ray -cardiomegaly of left heart(enlarged), ↑ pulmonary vascularity

How is Tricuspid Atresia *TA* diagnosed

ECG , EKG, Chest x ray, Cardiac Catheterization

How is Atrial Septal *Defect* diagnosed

ECG shows enlargement of right atrium & ventricle Chest x ray shows enlargement of the heart

How is Coarctation of the Aorta *COA* diagnosed

ECG, Chest x ray, Cardiac catheterization

How is Pulmonary Atresia *PA* diagnosed

ECG, EKG, CXR, Pulse ox, & cardiac catheterization -to determine the atresia

How is Tetralogy of *Fall*ot diagnosed

EKG & Chest x ray

How is Aortic *S*tenosis diagnosed

EKG, Chest x ray, Cardiac Catheterization

What happens during the ST segment

Early ventricular repolarization

What are the nursing interventions for respiratory infections

Ease respiratory effort Manage fever (antipyretic's, luke warm bath, lightly dressed, drink cool liquids) Promote rest & comfort (mist tent, humidifier, blow nose, bulb syringe, saline before sleep/eating, decongestants/nasal drops/topical vapor rub[2+ years]) Control infection (hand hygiene, dispose tissue, don't share drinks/utensils/rags) Promote hydration & nutrition (ORS, pedialyte, popscicles breastfeed as much as possible, IV fluids) Provide family support & teaching

What are nursing considerations for Pharyngitis

Educate on avoiding sharing germs Throw away tooth brushes Compliance with antibiotic therapy

A 10-year-old child undergoes open heart surgery to repair a cardiac defect. The healthcare provider informs the parents that antibiotics are required before any dental work is performed. Later the parents ask the nurse why this is necessary. When responding, the nurse explains that this is done to prevent what type of infection? Gingivitis Pericarditis Myocarditis Endocarditis

Endocarditis

An infant who has undergone cardiac surgery for a congenital defect is to be discharged. What should the nurse emphasize to the parents regarding administration of the prescribed antibiotic? Give the antibiotic between feedings. Ensure that the antibiotic is administered as prescribed. Shake the bottle thoroughly before giving the antibiotic. Keep antibiotic in refrigerator after bottle has been opened.

Ensure that the antibiotic is administered as prescribed.

How is pertussis (whooping cough) treated

Erythromycin Pertussis IgG bordetella vaccine for prevention

What are the types of upper airway non infectious disorders

Esophageal Atresia & Tracheoesophageal Fistula (EA & TEF) Laryngomalacia Subglottic Stenosis Croup Syndromes

What is the pathology of Esophageal Atresia & Tracheoesophageal Fistula

Esophagus fails to develop as a continuous passage separate from trachea Most common S/S is the 3 C's -Coughing, Cyanosis, & Choking Signs of respiratory distress - apnea, ↑ respiration's during feedings, abdominal distention, frothy saliva

What is cystic fibrosis/CF

Exocrine gland dysfunction that affects mucus production in the body Affects endocrine, respiratory & GI systems

What are nursing considerations for Otitis Media (OM)

Feed infant in upright position Avoid propping bottle Keep immunizations up to date Prevention of recurrence (can cause hearing loss)

What are S/S of heart transplant rejection

Fever ↓ urine output/Fewer wet diapers ↑HR ↑RR Weight gain Fatigue Irritability Poor appetite Random episodes Palpitations Anxiety Lightheadedness

How is shock treated

Fluids Blood & Blood products Antibiotics Inotropic agents -to ↑BP & help oxygenation

What are the types of noninfectious disorders

Foreign body aspiration Bronchopulmonary dysplasia (BPD) Apnea Apparent life-threatening event (ALTE) Pneumothorax Sudden infant death syndrome (SIDS)

A toddler who swallowed drain cleaner is hospitalized for observation because of the risk for vomiting and aspiration. Over the next 24 hours the child does not exhibit any respiratory distress and does not vomit. At discharge the nurse emphasizes that the parents should monitor their child for the onset of what? Tonic-clonic seizures Yellow-tinged sclera Gagging and vomiting Abdominal pain and diarrhea

Gagging and vomiting

What is done in a respiratory assessment

General history -gestational age -medical history (current S/S) -family history -exposure to irritants -eating/sleeping patterns -growth/development Physical assessment -barrel chest, skin color, cap refill, clubbing, hydration status -work of breathing, respiratory effort, depth & rhythm -HR, RR, temp, O2 sat (pulse ox is routine assessment for all kids w/ resp condition) -LOC, level of comfort, activity level -flaring, tachypnea, retractions, paradoxical breathing -fever, anorexia, vomiting, diarrhea, abdominal pain, cough, nasal drainage Auscultation for sounds -crackles, rhonchi, stridor, wheezes, diminished, vesicular Percussion & Palpate

A school-aged child who has undergone cardiac catheterization is being discharged. What should the nurse include in the discharge instructions to the parents? Limit fluid intake for 3 days to prevent nausea. Give sponge baths for 3 days to prevent infection. Return to the clinic in 5 days to have the pressure dressing removed. Apply ice compresses q 20 min on the first day to lessen edema.

Give sponge baths for 3 days to prevent infection.

A 13-month-old toddler has a respiratory tract infection with a low-grade fever. When teaching the parents, which intervention should the nurse emphasize? Encouraging high-calorie snacks to prevent weight loss Keeping the toddler wrapped in blankets to prevent shivering Giving small amounts of clear liquids frequently to prevent dehydration Using cool-water baths to prevent the toddler's fever from increasing further

Giving small amounts of clear liquids frequently to prevent dehydration

How is tuberculosis treated

Goal to sterilize TB lesion & treat S/S Combined drug therapy -ethambutol, isoniazid , rifampin, & pyrazinamide Monitor respiratory status, hydration Bacille Calmette-Guerin (BCG ) vaccine for prevention

What is Supraventricular Tachycardia & How is it treated

HR > 220 bpm Vagal response through nasal suctioning -sudden ↓HR & ↓BP Ice to forehead Bearing down If not effective, move to medical cardioversion Rapid Adenosine IV push Repeat in 2 min If not effective → synchronized cardioversion HR for 1 min, 12 point lead EKG, & 24 hr halter monitor

Neonate normal vitals

HR: 120-160 RR: 30-60 T: 36.5 - 37.5°C BP: 67-84/35-53

Infant normal vitals

HR: 120-160 RR: 30-60 T: 36.5-37.5°C BP: 72-104/37-56

Adolescents normal vitals

HR: 55-100 RR: 15-20 T: 36.5 - 37°C BP: 110-131/64-83

Preschooler normal vitals

HR: 65-110 RR: 20-25 T: 36.5 - 37.5°C BP:95-110/60-75

Toddler normal vitals

HR: 70-110 RR: 20-30 T: 36.5-37.5°C BP: 90-105/55-70

School-age normal vitals

HR: 85-95 RR: 17-25 T: 36.5 - 37.5°C BP: 95-120/55-76

How is Kawasaki Disease (KD) Mucocutaneous Lymph Node Syndrome diagnosed

Hard to diagnose Diagnosis of exclusion -it mimics scarlet fever, TSS, mono, & mycoplasma

The parents of three children aged 4, 6, and 9 years are preparing to travel abroad as missionaries. The children are in good health and up to date for immunizations; however, the parents are concerned about the high level of TB in the area to which they are assigned. Which recommendation does the nurse make for the protection of the children? Start the children on preventive medication. Have the children receive the BCG vaccine. Protect the children with good nutrition. Arrange for monthly TB testing for the family.

Have the children receive the BCG vaccine.

What are key points of pertussis (whooping cough)

Highest incidence is in spring & summer Highly contagious, especially to young infants & non immunized Vaccine effective for 10 years (then a booster)

How is Endocarditis diagnosed

History & Physical exam Blood cultures CBC EKG Transesophageal ECG

How is Rheumatic Fever & Rheumatic Heart Disease (RF & RHD) diagnosed

History of infection Tested for antistreptolysin O titer (ASO titer) ESR & CRP labs are usually elevated

How is Congestive Heart Failure (CHF) diagnosed

History/Physical exam,chest x ray, EKG, urine & blood tests

What is the pathology of Atrial Septal *Defect*

Hole from left atrium to right atrium Oxygenated blood flows from LA→RA (foramen ovale = RA→LA)

What Is the pathology of Ventricular Septal *Defect*

Hole from left ventricle to right ventricle Oxygenated blood flows from LV→RV (PDA = RV→LV) [Most Common Defect]

The nurse is interviewing an adolescent patient 17 years of age who was diagnosed with cystic fibrosis (CF) as an infant. The patient shares feelings of frustration about needing to always live with parents. Which information provided by the nurse is likely to be most important to the patient? How chest physiotherapy (CPT) can be performed independently The availability of home meal delivery to those needing a therapeutic diet A list of social organizations available for young persons who have special needs Organizations that will provide transportation for persons with chronic illness

How chest physiotherapy (CPT) can be performed independently

A nurse is planning care for a school-aged child experiencing respiratory acidosis. What is the sequence of events that occurs in the child's respiratory response to acidosis? Place the physiologic responses in the order in which they occur. Decreased blood H+ ions Increased pH Hyperventilation Increased CO2 elimination

Hyperventilation Increased CO2 elimination Decreased blood H+ ions Increased pH

How is Endocarditis treated

IV antibiotics Prophylactic antibiotics before dental procedures

A 5-year-old child with a ventricular septal defect (VSD) is scheduled for cardiac catheterization. The parents ask the nurse why this test is being done. While formulating a reply, what does the nurse recall is the function of the test? Identifies the specific location of the defect Confirms the presence of a pansystolic murmur Reveals the degree of cardiomegaly that is present Establishes the presence of ventricular hypertrophy

Identifies the specific location of the defect

How is tonsillitis treated

If strep test positive, treat with penicillin Tonsillectomy, possible adenoidectomy, for chronic inflammation

What are risk factors for respiratory complications in children

Immune system deficiencies Prematurity Current infections (rsv, pneumonia) Allergies/Asthma Cardiac anomalies Cystic fibrosis Exposure to infections at daycare Exposure to 2nd hand smoke

What are S/S of Congestive Heart Failure (CHF)

Impaired myocardial function -tachycardia, fatigue, weakness, restlessness, pale, cool extremities, ↓BP, ↓urinary output Left sided (pulmonary congestion) -tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis Right sided (systemic venous congestion) -peripheral & periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention

A 1-year-old child has a congenital cardiac malformation that causes right-to-left shunting of blood through the heart. What clinical finding should the nurse expect? Proteinuria Peripheral edema Increased hematocrit Absence of pedal pulses

Increased hematocrit

How is Patent Ductus Arteriosus/*PDA* treated

Indomethacin to close PDA hole digoxin, dopamine, ibuprofen Prostaglandin E to keep PDA hole open (if another defect to allow blood flow) Surgical options -Thoracotomy (ligation of the duct) -Catheterization (coil occlusion)

The nurse in an acute care pediatric facility is preparing to assume care of multiple patients at the change of shift. Which patient will the nurse plan to assess first? Preschooler with pneumonia who has poor skin turgor Toddler who exhibits clubbing of the fingertips Infant who prefers a tripod position instead of lying down Infant who can sleep only with the head of the bed elevated

Infant who prefers tripod position instead of lying down

What is the pathology of Endocarditis

Infection of the endocardium & heart valves Usually caused by strep or staph infection

What is Tonsillitis pathophysiology

Inflammation of palatine tonsils -common in 4-7 year old's -graded +1 - +4 Edema in the throat, difficulty swallowing & breathing

What is Pharyngitis pathophysiology

Inflammation of the throat & underlying structure -triad of sore throat, fever, & pharyngeal inflammation Causes/Risks -viral, bacterial, fungal, noninfectious agents Clinical manifestations -fever, HA, abdominal pain, sore throat, inflamed tonsils, puss pustules

What is the pathology of Rheumatic Fever & Rheumatic Heart Disease (RF & RHD)

Inflammatory disease Occurs in response to group A beta hemolytic infection -usually streptococcal Rarely seen in U.S., U.S. treats strep infections Effects heart, joints, skin, brain, & serous heart surfaces Most common complication is damage to valves

The registered nurse (RN) delegates the collection of respiratory rate data to a licensed practical nurse (LPN) for a client who is experiencing severe dehydration and whose condition is unstable. The LPN reports the data to the RN. The RN rechecks the data and finds that the report no longer reflects the client's current condition. Which characteristic of communication has interfered with the delegation process? Information decay Information salience Confidence in abilities Synergy between team members

Information decay

What is the most effective method for inhaled med to be given to a 2 yr old with asthma? Dry powder inhaler Metered-dose inhaler Nebulizer with a mouthpiece Inhaler and spacer with a mask

Inhaler and spacer with a mask

Where is the best place to assess the child's skin color

Inside the mouth in the cheek area.

Parents bring a toddler who is 2-1/2 years old to the hospital because of observed difficulty with breathing. In addition, they share that at bedtime the toddler has a barky cough. The toddler is diagnosed with laryngotracheobronchitis, commonly referred to as croup. Which assessment finding does the nurse expect related to the diagnosis? Snoring sounds throughout respirations Inspiratory stridor heard in the upper airway Elevated temperature and diaphoresis Fever accompanied by a congested cough

Inspiratory stridor heard in the upper airway

What are S/S of Acute Laryngotracheobronchitis (LTB)

Inspiratory stridor, retractions, ↑ WOB, wheezing Suprasternal retractions, cough, fever Barking or seal-like cough ↑ respiratory distress & hypoxia Can progress to respiratory acidosis, respiratory failure, & death

What are common side effects of digoxin

K+ < 3.5 mEq/L Sinus bradycardia Arrhythmia's

What is the focus of nursing care for a newborn with respiratory distress syndrome (RDS)? Tapping the toes to stimulate respirations Turning the infant frequently to prevent apnea Maintaining oxygen concentration at 40% to support respiration Keeping infant warm to maintain body temperature at 98° F (37° C)

Keeping infant warm to maintain body temperature at 98° F (37° C)

A 3-month-old infant with tetralogy of Fallot is admitted for a diagnostic workup in preparation for corrective surgery. The morning after cardiac catheterization the infant suddenly becomes cyanotic and begins breathing rapidly. In what position should the nurse immediately place the infant? Supine Lateral Knee-chest Semi-Fowler

Knee-chest

What are S/S of tuberculosis

Latent- positive TB test, not contagious, no S/S, can be activated Active- persistent cough/3 weeks, fatigue, weight loss, fever, anorexia, night sweats, wheezing, ↓breath sounds, lymphadenopathy Later S/S- malaise, fever, weight loss, meningitis, lymphadenitis, hepatosplenomegaly, osteoarthritis, pneumonia

What are acute laryngitis key points

Loss of voice Rest, self-limiting, oral fluids

What makes up the lower respiratory tract

Lower Trachea, Bronchi, Bronchioles, Alveoli

What causes tuberculosis

M. tuberculosis & Mycobacterium bovis (exposed to by infected family member/frequent visitor) Can be latent or dormant (years before active)

What are nursing considerations for Congestive Heart Failure (CHF)

Maintain Oxygen -elevate HOB -cluster cares -minimize stimulation & WOB -monitor respiratory status -supplemental O2 if needed (improve tissue oxygenation) Monitor I& O & daily weight Encourage high-calorie formula Avoid sodium rich foods Digoxin -↑ cardiac function Diuretics -remove accumulated fluid (Monitor HR & Electrolyte Labs [potassium]) Decrease cardiac demands -↓anxiety, ↓environmental stimuli, maintain temp,treat infections

What are nursing considerations for Total Anomalous Pulmonary Venous Connection *TAP*VC

Maintain PDA & Airway Monitor strict I & O Diuretics for CHF & arterial blood gases

What are nursing considerations for *H*ypoplastic Left-Sided Heart Syndrome

Maintain PDA & airway Prepare family for lifelong treatment & transplant

What are nursing considerations for Pulmonary Atresia *PA*

Maintain Prostaglandin E Monitor pulse ox Post-op stabilization

What are nursing considerations for Kawasaki Disease (KD) Mucocutaneous Lymph Node Syndrome

Maintain anti inflammatory med's -high dose salicylate therapy -acetylsalicyclic acid (ASA)/aspirin Intravenous immunoglobulin Antiplatelet's Goal of S/S relief Monitoring cardiac status for S/S of -CHF, myocarditis, pericarditis, aneurism, leaking valves, pericardial effusion, & MI

How is cystic fibrosis/CF treated

Maintain respiratory function Pulmonary therapy to loosen secretions -chest physiotherapy Prevent infections [antibiotics] -may need higher doses r/t higher drug clearance Clear airways with mucolytic agents, bronchodilators Replacement of pancreatic enzymes Adequate nutrition for growth & development -high protein/calorie diet personalized w/ fat-soluble A, D, E, & K supplements Treat constipation Reduction of rectal prolapse If Diabetic -insulin administration -monitor blood glucose levels -exercise -regular eye examinations Treat the family Coping w/ emotional needs of child & family Child requires treatment multiple times/day Frequent hospitalizations Implications of disease genetic transmission

What are risk factors for SIDS

Maternal smoking Co sleeping Prone sleeping Soft bedding Low birth weight or prematurity Low APGAR score

What are epiglottitis key points

Medical Emergency Serious obstructive inflammatory process Usually caused by Hib S/S: sore throat, pain, tripod position, resp distress, stridor, hypoxia, drooling Treatment: resp monitoring, steroids, cool mist humidity, prepare to intubate [no throat stimulation]

What are nursing considerations for Pulmonic *S*tenosis

Monitor BP Post-op cares & education after cardiac catheterization

What are nursing considerations for Aortic *S*tenosis

Monitor for S/S of CHF Prepare for A-fib Pain med's Prostaglandin E -maintain PDA until surgery

What are nursing considerations for Tracheitis

Monitor for acute respiratory distress Supplemental O2 if hypoxic Keep child calm Prepare for intubation Delay any painful procedures Administer antibiotics

A 3.5-year-old child is returned to the room after a cardiac catheterization. What is the priority nursing intervention after this procedure? Encouraging early ambulation Monitoring the insertion site for bleeding Comparing the blood pressures in the extremities Restricting fluids until the blood pressure stabilizes

Monitoring the insertion site for bleeding

A 3-year-old child is scheduled for cardiac catheterization. What is the priority nursing care after this procedure? Encouraging early ambulation Monitoring the site for bleeding Restricting fluids until the blood pressure has stabilized Comparing blood pressure readings in the lower extremities

Monitoring the site for bleeding

What is Acute Laryngotracheobronchitis (LTB) pathophysiology

Most common croup syndrome Generally affects children < 5 years old Caused by RSV, parainfluenza virus, mycoplasma pneumoniae, influenza A & B

What are laryngotracheitis key points

Most common type of croup Gradual onset that progresses to respiratory distress S/S of low-grade fever, hoarseness, harsh barking cough, stridor, retractions, cyanosis

A child with respiratory distress can experience dehydration because: The child is not drinking enough fluids. The body requires an increased amount of fluids when sick. The child is retaining water in kidneys since the body is using all the O2 in the lungs. Mouth breathing occurs when in distress, so the child is losing hydration.

Mouth breathing occurs when in distress, so the child is losing hydration.

What is the pathology of Pulmonic *S*tenosis

Narrowing at entrance of of pulmonary artery or PV Decreases Blood from RV→Lungs

What is Subglottic Stenosis

Narrowing of airway in the rigid cricoid cartilage Congenital or result from prolonged intubation

What is the pathology of Coarctation of the Aorta *COA*

Narrowing of the aorta Typically below subclavian artery Prevent blood flow to rest of body Effects the LV -left ventricular hypertrophy -left sided heart failure Usually presents at birth

What is the pathology of Aortic *S*tenosis

Narrowing or stricture of the aortic valve LV hypertrophy -block blood from LV→ rest of body

What is the appropriate route to give a 12-year old child an inhaled medication Nebulizer with mouth piece Nebulizer with mask Inhaler with spacer Inhaler and spacer with mask

Nebulizer with mouth piece

How is asthma treated

Nebulizers, Inhalers, corticosteroids -albuterol, xopenex -long term (preventative) short term (rescue) -meter dosed inhaler (MDI) -spacer inhaler Avoid exposure to triggers -pets, dander, smoke, allergies Chest physical therapy (CPT) Exercises Hyposensitization

How is Transposition of the *Great* Vessels TGA diagnosed

Negative hyper-oxygenation test ECG, Chest x ray, Cardiac catheterization

What are nursing considerations for tuberculosis

Negative-pressure room Airborne & Droplet precautions Promote nutrition Treat other family members prophylactically Ensure medication regimen is followed

Newborn airway size vs Adult airway size

Newborn= 4 mm diameter Adult= 20 mm -1 mm C. of inflammation ↓ diameter by 50% (risk for narrowing/obstruction)

Newborn vs Adult amount of alveolis

Newborns have about 25 million Adults have about 300 million

Newborn metabolic rate vs Adult metabolic rate

Newborns metabolic rate is 2x ↑ -kids use 4-8 mL O2/min -adults use 3-4 mL O2/min

What makes up the upper respiratory tract

Nose, Pharynx, Larynx, Upper Trachea

What is hypoxia

O2 deficiency

What are croup syndromes

Obstruction of respiratory passages by edema & laryngospasms Characterized by hoarseness, barking cough, inspiratory stridor, & varying degrees of respiratory distress

What is Ventricular Tachycardia

Occurs in ventricles Causes loss of consciousness & sudden death HR for 1 min, 12 point lead EKG, & 24 hr halter monitor

A child undergoes tonsillectomy and adenoidectomy for numerous recurrent respiratory tract infections. After the surgery, what should the nurse teach the parents to do? Offer crushed ice chips. Encourage the intake of ice cream. Keep the child in the supine position. Gargle with a diluted mouthwash solution.

Offer crushed ice chips.

What are S/S of Ventricular Septal *Defect*

Often asymptomatic or w/ heart murmur SOB, Recurrent respiratory infections Poor feeding, weight gain, growth

How is asthma diagnosed

Often diagnosed before 5 years old pulmonary function test & peak expiratory flow rate (PFT & PEFR)

How is Pharyngitis treated

Oral penicillin (entire 10 days)

What are upper airway infectious disorders

Otitis Sinusitis Pharyngitis Nasopharyngitis Influenza Tonsillitis Tracheitis (croup syndromes)

What disorder is common in neonate and is due to persistent fetal circulation It is characterized by a left to right shunt

Patent ductus arteriosus PDA

When assessing a 12-year-old girl with the diagnosis of pneumonia, the nurse performs percussion. The lower left lobe is noted to have a dull sound. What should the nurse do next? Call the doctor with the assessment. Check the orders and start chest physiotherapy. Palpate the chest to check for tactile fremitus. Place the child on oxygen.

Place the child on oxygen. (lower lobe's not expanding)

What are nursing considerations for Tricuspid Atresia *TA*

Prepare family for multiple surgeries & lifelong cardiology care Prostaglandin E -keeps PDA open for blood flow to lungs until surgery

What are nursing considerations for heart transplant

Prepare family for surgery & post-op cares Educate S/S of rejection, & follow up cares Educate on anti-rejection med's

How is Total Anomalous Pulmonary Venous Connection *TAP*VC treated

Prostaglandin E Digoxin, Diuretics for CHF Surgery -valvular repair -reanastamosis of pulmonary vein to correct location

How is Tricuspid Atresia *TA* treated

Prostaglandin E Surgery Balloon septostomy -create opening if missing tricuspid valve -then reconstructive surgeries later Heart transplant may be necessary

How is Pulmonary Atresia *PA* treated

Prostaglandin E to keep ducts open Surgery -balloon atrial septostomy (to keep foramen ovale open)

How is Transposition of the *Great* Vessels TGA treated

Prostoglandin E -keep PDA open until surgery ACE inhibitors (Captopril/Enalapril) -antihypertensive, helps relax coronary arteries Surgery -cardiac cath to enlarge foramen ovale until surgery -jatene arterial switch procedure -balloon atrial septostom

What are nursing considerations for Coarctation of the Aorta *COA*

Provide rest Monitor for CHF & ↑ WOB Monitor perfusion Obtain 4 point BP's

What are nursing considerations for Atrial Septal *Defect*

Provide rest, Monitor for CHF & ↑WOB Strict I & O, daily weight, & monitor feeding tolerance

What are nursing considerations for Ventricular Septal *Defect*

Provide rest, Monitor for CHF, & ↑ WOB Strict I & O, daily weight, & monitor feeding tolerance Check rubella infection or if pregnant mom on lithium

What are nursing considerations for Tetralogy of *Fall*ot

Provide rest, cluster nursing cares Prevent agitation & crying through pain med's/sedation Provide O2 to reduce pulmonary vasoconstriction Prepare family for multiple surgeries Teach family infant knee-chest position for tet spells Kids squat while playing when older to feel better

What are nursing considerations for Patent Ductus Arteriosus/*PDA*

Provide rest, do not cluster cares Strict I & O, daily weight, & monitor feedings

A patient is admitted with a presumed diagnosis of asthma. What is the best test to make the initial diagnosis? Pulmonary Function Tests Chest Physiotherapy Peak expiratory flow rate Regimented Breathing Exercises

Pulmonary Function Tests

What is the pathology of Pulmonary Atresia *PA*

Pulmonary artery or PV doesn't form properly Less blood flow to the lungs (not enough O2) Want PDA open to allow blood flow

A 6-year-old patient is being assessed by the pediatrician for breathing difficulties. The pediatrician expresses a need for diagnostic tests to identify or rule out asthma. Which tests does the nurse anticipate ordering? Pulmonary function test Throat culture Electrocardiogram Peak flow meter

Pulmonary function test

What are causes of Laryngotracheobronchitis (LTB)

RSV & Parainfluenza

What are causes of bronchiolitis

RSV, parainfluenza, human metapneumovirus, adenovirus, influenza

How is Pharyngitis diagnosed

Rapid strep test, culture

What is the pathology of Total Anomalous Pulmonary Venous Connection *TAP*VC

Rare defect Pulmonary veins fail to join left atrium Mixed blood returns to right atrium Blood is shunted right→left through ASD Usually fatal in 1st few days/months if left untreated

What is Tracheitis pathophysiology

Rare, rapid onset of life-threatening bacterial inflammation of trachea

What happens during the T wave

Repolarization of the ventricle (ventricles relax)

A school-aged child with cystic fibrosis has been admitted with a respiratory infection. The child has been very disruptive and angry with staff and parents. What does the nurse suspect is the reason for the child's uncooperative behavior? Spoiled and needs to be adequately disciplined Resentful of the restriction of the hospitalizations Having a reaction to the new respiratory medications Angry about dietary restrictions related to the disease

Resentful of the restriction of the hospitalizations

What are noninfectious disorders of lower airways

Respiratory distress syndrome Congenital diaphragmatic hernia Cystic fibrosis (CF) Asthma

What is Bradycardia

Response to hypoxia & hypotension or hypervagal tone. May be a heart block -AV block may require a permanent pacemaker HR for 1 min, 12 point lead EKG, & 24 hr halter monitor

A toddler undergoes cardiac catheterization as part of a diagnostic workup for pulmonic stenosis. In which part of the cardiovascular system should the nurse expect an increase in pressure? Left atrium Right ventricle Pulmonary vein Pulmonary artery

Right ventricle

What are S/S of tracheitis

S/S mimic croup & epiglottitis -stridor, hypoxia, ↑WOB, retractions

How is *H*ypoplastic Left-Sided Heart Syndrome diagnosed

S2 gallop, ECG, Chest x ray

What are S/S of Atrial Septal *Defect*

SOB, heart palpitations, fatigue, ↑ WOB Atrial dysrhythmias, Ejection systolic murmur Recurrent respiratory infections Poor feeding, weight gain, growth

What are Acute Spasmodic Laryngitis key points

Seal-like cough present at night Stridor & seal, like cough Monitor resp status, fluid hydrate, steroids, rest

A 2-year-old child is brought to the emergency department after the sudden onset of high fever, drooling, and respiratory distress. What nursing actions should the nurse perform? *Select all that apply.* Start an intravenous line. Draw a blood sample for a complete blood count and differential. Examine child's throat with flashlight & tongue depressor for swelling. Assess O2 sat of blood & administer O2 by mask if below 94%. Ask parents to remain in waiting room during exam & interventions. Assess child's temp & give antipyretic if rectal temp > 101° F (38.3° C).

Start an intravenous line. Draw a blood sample for a complete blood count and differential. Assess O2 sat of blood & administer O2 by mask if below 94%. Assess child's temp & give antipyretic if rectal temp > 101° F (38.3° C).

A 6-year-old child with acute spasmodic bronchitis who is receiving humidified air removes the mask, and while bathing the child the nurse notes increasing respiratory distress. What is the most appropriate nursing intervention? Stopping the bath and replacing the mask Performing postural drainage and clapping the chest Placing child in orthopneic position and calling the practitioner Suctioning child's nasal passages and waiting for dyspnea to subside

Stopping the bath and replacing the mask

What is Torsades de pointes & How is it treated

Sudden onset of ventricular tachycardia Rapid ↓BP, fainting, V-fib, & death Remove cause Med admin Unsynchronized defibrillation HR for 1 min, 12 point lead EKG, & 24 hr halter monitor

A 4-year-old child returns from cardiac catheterization that was performed through the groin area. In what position should the nurse place the child during the immediate postoperative period? Semi-Fowler Trendelenburg Supine, with the bed flat Side-lying, with the knees flexed

Supine, with the bed flat

How is Esophageal Atresia & Tracheoesophageal Fistula treated

Surgery needed to repair fistula -usually hours or days after birth Surfactant for lung maturity, ECMO NPO Immediately when suspected IV fluids started Position child -facilitate drainage/secretions & ↓ aspiration

What are nursing considerations for Transposition of the *Great* Vessels TGA

Sustain O2 sat in right arm above 75% Medication management Post-operative cares

How is cystic fibrosis/CF diagnosed

Sweat chloride test is best Chest x-ray Pulmonary function test (PFT) Stool fat &/or enzyme analysis Barium enema

How is pneumonia treated

Symptomatic treatment for viral Antibiotics for bacterial Rest, conserve energy

What are S/S of Coarctation of the Aorta *COA*

Systolic ejection murmur Tachycardia cyanotic, ↓femoral pulses & ↓BP in lower extremities Good color, pulses & BP in upper extremities Cardiomegaly, HA, hypertension SOB, symptoms of CHF Poor feeding, weight gain, growth

A 5-month-old infant is admitted with a diagnosis of respiratory syncytial virus (RSV) infection. The infant's condition suddenly deteriorates, and a dose of epinephrine is prescribed to relieve bronchospasm. For what side effect of the medication should the nurse assess the infant? Tachycardia Hypotension Respiratory arrest Central nervous system depression

Tachycardia

What are S/S of respiratory distress

Tachypnea Dyspnea Hypernea Nasal flaring Use accessory muscles Retractions HOB elevated Intermittent cough Adventitious breath sounds Tachycardia Dusky nail beds Hypercapnia Hypoxia Strong crying

How is Influenza treated

Tamiflu, symptomatic treatment, antipyretics, hydration

After multiple upper respiratory infections, a school-aged child undergoes a tonsillectomy and adenoidectomy. Two weeks after surgery the nurse assesses the child's condition. On what should the nurse focus? *Select all that apply.* Taste Smell Hearing Breathing Facial symmetry

Taste Smell Hearing Breathing

S/S of infections

Temp 39.5-40.5 C (103-105 F) [1st sign] Restless, Irritable Watch for febrile seizure Poor feeding/Anorexia Vomit/Dia Abdominal pain Nasal blockage/drainage Cough/Respiratory sounds Sore throat Meningismus/Pseudo meningitus HA, Neck/Back pain/stiffness

A 5-year-old child is returned to the pediatric intensive care unit after cardiac surgery. The child has a left chest tube attached to water-seal drainage, an intravenous line running of D5 ½ NS at 4 mL/hr, and a double-lumen nasogastric tube connected to continuous suction. A cardiac monitor is in place, as is a dressing on the left side of the chest dressing. What is the priority nursing intervention? Auscultating breath sounds Testing the level of consciousness Measuring drainage from both tubes Determining the suction pressure of the nasogastric tube

Testing the level of consciousness

What are S/S for Tetralogy of *Fall*ot

Tet spells (sudden cyanosis & syncope) Clubbing, cyanosis during irritability & crying Poor feeding, weight gain, growth Murmur, dyspnea on exertion, fainting

This common cardiac defect is characterized by 4 distinct defects causing the heart to shunt from right to left

Tetraology of fallot TOF

The nurse on a pediatric acute care unit is providing care for an infant who is 11 months of age. The infant is diagnosed with a lower respiratory infection that produces large amounts of thick secretions the infant cannot cough up. When planning to suction the infant, which factor is important to remember? The parents are likely to become angry about the procedure. The infant will respond negatively to a temporary loss of breath. The nurse should apologize after the procedure for stress related to the procedure. The nurse should have assistance to immobilize the infant during the procedure.

The infant will respond negatively to a temporary loss of breath.

What happens during the PR interval

The time it takes for impulse to reach AV node

What happens during the QT interval

Time it takes for heart to contract & refill w/ blood before beginning next contraction

This cyanotic heart defect occurs when the aorta serves as the outflow tract for the heart

Transposition of the great vessels (TGA)

Based on the assessment of a full-term infant, the nurse suspects a cardiac anomaly. Which clinical manifestation does the nurse identify that indicates a cardiac anomaly? Projectile vomiting Irregular respiratory rhythm Hyperreflexia of the extremities Unequal peripheral blood pressures

Unequal peripheral blood pressures

What are nursing considerations for Endocarditis

Untreated, vegetation can clump, break off, & travel to lungs, brain, kidneys Monitor for stroke Maintain intensive antibiotics (2-8 weeks) Monitor fluid balances Monitor S/S of CHF Monitor valve for failure & for cardiac failure Educate on future dental health

What should be included in home care instructions for a 3 yr old with otitis media? Ask DR for an antihistamine if fluid remains after 2 weeks Use a pillow at bedtime to decrease discomfort Take the antibiotic until the pain subsides Use an OTC decongestant to hasten absorption of fluid

Use a pillow at bedtime to decrease discomfort

What is Influenza pathophysiology

Usually abrupt onset Dry cough, fever, hoarseness, exhaustion Can be complicated by pneumonia or ear infection

What are S/S of Endocarditis

Vague symptoms -low-grade fever, fatigue, cough, chills, SOB, joint pain, murmur Loss of appetite, weight loss, flank pain, petechiae *Osler Nodes* -painful nodes on pads of fingers *Roth Spots* -round or oval white spots on retina *Janeway Lesions* -flat painless red to bluish-red spots on palms of feet *Splinter Hemorrhages* -black or brown lines under nails

What is the pathology of Tricuspid Atresia *TA*

Valve defect -tricuspid valve fails to develop (missing/defective) Blocks blood flow RA→RV (diminished blood→lungs) May have w/ other defects -often w/ VSD

What is the blood pathway of the heart

Vena Cava→Right Atrium→Tricuspid Valve→Right Ventricle→Pulmonic Valve→Pulmonary Arteries→Lungs(O2)→Pulmonary Veins→Left Atrium→Mitral Valve→Left Ventricle→Aortic Valve→Aorta→Body (cycle restarts, returns to vena cava) VC→RA→t→RV→p→PA→L→PV→LA→m→LV→A→B R - L [A then V] Valve order mnemonic toilet (tricuspid) paper (pulmonic) my (mitral) ass (aortic)

What happens during the QRS complex

Ventricle depolarization (ventricles contract & push blood from heart to arteries)

Because of opening b/w ventricle, there's ↑pulmonary blood flow

Ventricular septal defect VSD

What are nursing considerations for pneumonia

Vitals, lung sounds, pulse ox, Isolation

The nurse performs a respiratory assessment and auscultates breath sounds that are high pitched, creaking, and accentuated on expiration. Which term best describes the findings? Rhonchi Wheezes Pleural friction rub Bronchovesicular

Wheezes

What are S/S of cystic fibrosis/CF

Wheezes, dry nonproductive cough, thick mucus Generalized obstructive emphysema or COPD Patchy atelectasis Cyanosis Clubbing of fingers & toes Repeated bouts of bronchitis & pneumonia Meconium ileus -earliest postnatal S/S Prolapse of the rectum Distal intestinal obstruction syndrome Excretion of undigested food in stool -stool is bulky, frothy, & foul smelling Pancreatic enzyme deficiency Sweat gland dysfunction -sweat tastes salty Failure to thrive -↑ weight loss despite ↑ appetite

How is Tetralogy of *Fall*ot treated

Within 1st year of life Open heart surgery On bypass Ventricular septal defect VSD patch Pulmonary stenosis PS resection

How are infections diagnosed & evaluated

X ray Blood gasses Pulse oximeter CT Ultrasound MRI Bronchoscopy PFT's Sweat test Nasal, Throat swab Sputum culture Blood cultures Urine Cerebrospinal fluid CBC H&H CRP

How is bronchiolitis diagnosed

X-ray, history, clinical s/s (differentiate b/w bronchiolitis & RSV by nasal swab)

How is Esophageal Atresia & Tracheoesophageal Fistula diagnosed

X-ray, tracheoscopy, echocardiography, & ultrasound ↑ risk of polyhydramnios & ultrasound diagnosed prenatally

What is atelectasis

a collapsed or airless portion of the lung

How is bronchitis treated

analgesics, antipyretics, humidity

What intervention should be implemented after a child has a cardiac cath? bedrest for 12 hrs maintain semi-Fowler's position apply sandbags to groin remove pressure dressing after 2 hours

apply sandbags to groin

Which intervention should be included in the post op care of an infant after cleft lip repair? avoid suctioning the mouth to prevent disruption of sutures clean the suture line with mild soap and water do not administer any meds that would promote sedation instruct infant to swish water around mouth to clean mouth

avoid suctioning the mouth to prevent disruption of sutures

The nurse will obtain the specimen from what source for a monospot test? blood specimen nasal wash sputum specimen throat culture

blood specimen

What is asthma

chronic inflammatory disorder of the airways

What congenital defect is present in this picture? aortic stenosis coarcation of the aorta tetralogy of fallot ventricular septal defect

coarcation of the aorta

What are nursing considerations for pertussis (whooping cough)

contact & droplet isolation assess for dehydration assess respiratory status ↑ O2 with humidity if needed give appropriate fluid intake IV therapy if necessary antipyretics

What are S/S of bronchiolitis

copious nasal drainage, mild fever, resp distress, wheezes/crackles, apnea, tachypnea

What are S/S of foreign body aspiration

coughing, wheezing, stridor, gagging, possible cyanosis

What are stridor

high pitched musical sounds heard on inspirations in upper airways due to obstruction (croup or other upper airway conditions)

What are wheezes

high pitched musical sounds heard throughout respiration's as air passes through constricted bronchioles or narrowed smaller airways (asthma)

What are the causes of acquired heart disease

infection, autoimmune factors, genetic factors, teratogens, chemical agents, infectious agents, maternal factors, & physical agents

Children with CHD may be given prophylactic antibiotics to prevent which problem? hyperlipidemia infective endocarditis kawasaki disease rheumatic fever

infective endocarditis

What are retractions

inward pulling of chest with respiration

A child's eustachian tube... is longer than that of an adult is more angled than that of an adult lies more horizontally than that of an adult is closed until adolescence

lies more horizontally than that of an adult

What are rhonchi (snoring)

low pitched snoring sounds heard in lungs throughout respiration's as air passes through thick secretions (may clear with cough)

What are S/S of pneumonia

low/high fever, slight/severe cough (nonproductive), malaise, wheezes/crackles

How do infants/young kids (6 months-3 years) react to acute respiratory infections compared to older kids

more severely

What device may be used at home as an indicator of the effectiveness of asthma management? apnea monitor peak flow meter pulse oximeter spirometer

peak flow meter

Transposition of the great vessels TGA involves the aorta and which other vessel? Inferior vena cava pulmonary vein pulmonary artery superior vena cava

pulmonary artery

In infants, grunting respirations may herald the onset of what condition? asthma laryngotracheobronchitis respiratory failure sleep apnea

respiratory failure

What causes bronchitis

rhinovirus

What can asthma progress to

status asthmaticus -medical emergency requiring epinephrine to treat respiratory distress -prevention is key

What respiratory sounds are expected for croup

stridor

What is SIDS

sudden death of infant < 1 year old that's unexplained

What diagnostic test provides a definitive diagnosis of cystic fibrosis? Blood sodium level Chest x-ray forced vital capacity sweat chloride test

sweat chloride test

How is bronchiolitis treated

symptomatic treatment, high humidity, IV fluid support, O2

An infant with COA is likely to experience which manifestation? circumoral cyanosis pedal edema hypertension in lower extremities weak femoral pulses

weak femoral pulses

What respiratory sounds are expected for asthma

wheezes

When is a heart transplant indicated

when there is serious heart dysfunction (congenital heart disease, or cardiomyopathy)

How is Patent Ductus Arteriosus/*PDA* diagnosed

wide pulse pressures, prolonged cap refill, chest x ray, O2 sat, bounding pulses, ECG

When caring for a 3 year old w/ RR 70, what interventions should be considered

withholding oral fluids test pulse ox assess lung sounds/function/respiratory effort assess pulse

How is pneumonia diagnosed

x ray, sputum culture, CBC