peds exam 2
Blood flows into the _________ side of the heart, to the _________, to the _________ side of the heart, out to the body, then back to the _______ side of the heart
right, lungs, left, right
how to prevent tooth decay with digoxin
rinse with water after
pts with coarction of the aorta are at risk for...
ruptured aorta, aortic aneurysm, stroke
preteen relationships center around...
same-sex peers
7 yo is absent a lot and there is some talk of some other kids not being nice to him. What might be going on?
school phobia, bullying
school phobia is also called...
school refusal and school avoidance
it is easier to diagnose asthma in __________
school-aged children (6 years and older)
stage IV of asthma
severe, persistent asthma
________ is a part of normal curiosity during preadolescence
sex play
what does school-age stage begin with?
shedding of first deciduous teeth
s/s of coarction of the aorta in infants
show signs of CHF
surgery #1 for tricuspid atresia
shunt to increase blood flow to lungs (create atrial septotomy if ASD is small)
If PVR is > than systemic vascular resistance...
shunt would be right to left
In any child, what is team play supposed to be encouraging?
team work
examples of overuse syndrome
tennis elbow, Osgood-Schlatter disease
bronchiolitis
-Acute viral infection—RSV or other viruses -Occurs primarily at the bronchiolar level -Typically affects infants -May occur in older children with chronic illnesses
nonsurgical tx of intussusception
-Air enema (radiologist guided) with or without contrast -Hydrostatic (saline) enema (ultrasound guided)
prophylaxis for infective endocarditis
-IV abx 1 hour before procedures, may use PO in some cases -meticulous dental hygiene -only for high risk CHD pts
Treatment for Enuresis
-Imipramine (Tofranil) -Oxybutynin -Desmopressin (DDAVP)
social development of school-age child
-Importance of the peer group -Identification with peers is a strong influence in child gaining independence from parents -Formation of groups or clubs
s/s of SEVERE resp distress
-remains sitting upright, refuses to lie down -sudden agitation -agitated child who suddenly becomes quiet -diaphoresis -pale
encopresis
-repeated voluntary or involuntary passage of feces of normal or near normal consistency into places not appropriate for that purpose -not caused by any physiologic effect
when interviewing adolescent, we have a legal duty to...
-report physical or sexual abuse -get others involved if pt is suicidal
detachment/denial phase of separation anxiety
-resignation but not contentment; superficial adjustment -may seriously affect attachment to the parent after separation
in severe cases of VSD...
-resistance in pulm blood flow is > than in systemic circulation -reversal of blood flow through ventricles
secondary sex characteristics
-result of hormonal changes: Voice change, hair growth, breast enlargement, fat deposits -play no direct role in reproduction
school phobia
extreme reluctance to attend school for a sustained period as a result of severe anxiety or fear of school-related experiences
s/s of aortic stenosis that are more common with infants
faint pulses, low BP, tachycardia, poor feeding tolerance
Secondary encopresis
fecal incontinence after a period of prior established fecal continence after age 4 years
Primary encopresis
fecal incontinence after age 4 years
why do tet spells happen?
feeding, crying, defecating, some kind of stress on the child
PDA is more common in ___________
females
minor criteria for rheumatic fever
fever and arthralgia
hallmark s/s of resp infxns
fever, anorexia, vomiting, diarrhea, abd pain, cough, sore throat, nasal blockage/discharge, resp sounds
family history factors that can increase risk for cardiac dysfunction in child
frequent fetal loss; sudden infant deaths; sudden deaths in adults
food/drinks to avoid with gastroenteritis
fruit juices, sodas and gelatin, anything with caffeine, broths high in sodium
most common cause of hypotonic dehydration
giving water to replace vomit
prevention of RSV
good hand washing, avoiding contact with older children/adults who have any respiratory illness
convalescent stage of pertussis
gradual recovery occurs over 2 to 3 weeks, bad cough with whooping
gradual _________ and _________ during school-age
growth, development
murmur
heart sounds that reflect flow of blood within the heart
s/s of coarction of the aorta
high BP and bounding pulses in arms, weak or absent femoral pulses, cool lower extremities with low BP
s/s of croup
hoarseness, "barking" cough, low-grade fever, inspiratory stridor, and varying degrees of respiratory distress
another name for tet spells
hypercyanotic spells
monitor for _______ when giving ACE inhibitors
hyperkalemia
when is parenteral therapy contraindicated?
hypertonic dehydration
s/s of tricuspid atresia in the older child
hypoxemia, clubbing
when do you fix an atrial septal defect?
if it is large or creating s/s in child
_________ ·predisposes infants to fluid imbalances
immature kidney function
when does wheezing occur in school-age children with asthma?
in association with colds
digoxin storage
in locked cabinet
how are androgens secreted?
in small and gradually increasing amounts up to 7 to 9 years, then rapid increase in both sexes until 15 years
when do tet spells occur most often?
in the morning
what causes the ductus arteriosis to close?
increase in arterial oxygen concentration that follows initiation of pulmonary function
what happens as an early sign with decreased O2?
increased RR
what happens when there is an abnormal connection between the 2 sides of the heart (either septal defect or vessels being in the wrong place)?
increased blood volume on the right side of the heart which increases pulmonary blood flow (pulmonary HTN) and decreased flow to the rest of the body
polycythemia
increased number of erythrocytes and hemoglobin in the blood
what does aortic stenosis cause?
increased resistance in left ventricle, decreased CO, L ventricular hypertrophy, and pulmonary vascular congestion
knee-chest position causes...
increased systemic resistance to reverse right to left shunting
weight increase of a school-age child
increases by 2 to 3 kg (4.4 to 6.6 lbs) per year
height increase of a school-age child
increases by 5 cm (2 inches) per year
what does polycythemia do?
increases oxygen carrying capacity of blood
what age is surgery for coarction of the aorta done?
before 2 years
when does the ductus venosus close?
by 6 weeks, it atrophies
pt with tetralogy of fallot is at risk for...
emboli, LOC, sudden death, seizures
examples of corticosteroids used for asthma
prednisone and methylprednisolone
most common cause of secondary amenorrhea
pregnancy
kohlberg moral development older school-age
able to judge an act by the intentions that prompted it
murmurs can reflect...
abnormalities in heart or vessels
Ductus arteriosis SHOULD close by...
about 15 hours after birth
Prepubescence
about 2 years before puberty, heralding physical changes
6 m/o infants are acutely aware of _________ and become fearful of _________
absence of caregiver, unfamiliar people
other causes of secondary amenorrhea
eating disorders, stress, and other causes of severe weight loss
definitive diagnosis for PDA
echo
as the pressures are in the wrong places at the wrong time, ________ happens
pump failure
school-age children may view illness or injury as...
punishment for a real or imagined misdeed
androgens are responsible for...
rapid growth of the early teenager
digoxin has a _______ and _______
rapid onset, short half-life
adolescent growth spurt
-20% to 25% of total height is achieved during puberty -usually occurs within a 24- to 36-month period
needle size for IM injection
-23 to 25 G -5/8" to 1"
needle size for SQ injection
-25 to 29 G -3/8" to 5/8"
mild dehydration
-3-5% in infants -< 3-4% in older children
incidence of congenital heart disease (CHD); how many of these infants are symptomatic in the first year of life?
-5-8/1000 live births -2-3
moderate dehydration
-6%-9% in infants -6%-8% in older children
thelarche (females)
-8 to 13 years -breast buds
adrenarche (females)
-8 to 13 years -pubic hair growth
hours of sleep of a 5 year old
11.5 hrs/night
with mild bronchiolitis, if 2nd score is > 4...
proceed to appropriate pathway
epiglottis affects children under...
2 years
examples of long-acting beta agonists
Advair and Symbicort
diagnosis of RHD
Antistreptolysin-O (ALSO) titer
school-age children expect _______ for misdemeanor
punishment
stage 1 of sexual maturation in males
-9 1/2 to 14 years -testicular enlargement and sparse pubic hair
severe dehydration
->10% in infants ->6% in older children
s/s of epiglottis
-High fever -Sore throat -Difficulty swallowing -Muffled voice
classifications of CHD
cyanotic, acyanotic
encopresis is more common in ___________
males
peak incidence of KD is during...
toddler ages
classic presentation of intussusception
"currant jelly-like stools" that are caused from leaking blood and mucous into intestinal lumen
estrogen
"feminizing hormone"
Freud described prepubescence as...
"latency" period of psychosexual development
androgens
"masculinizing hormones"
Psychological Factors in Enuresis
-"Sleeps more soundly than other children" -Emotional factors -Familial tendency
pathophys of IE
-Altered blood flow and turbulence inside the heart -Damage to valvular endothelium -Rough endothelium increases fibrin and deposition of platelets -Microorganisms grow and form vegetation on the endocardium -Lesion may invade adjacent tissues (valves and myocardium) -May break off and embolize
nursing management of hospitalized adolescent
-Assess knowledge -Encourage questioning regarding fears, or risks -Involve in decision-making -Ask if patient wants parent there -Make as few of restrictions as possible -Suggest ways of maintaining control -Accept regression to more childish ways of coping -Give positive reinforcement -Provide privacy for care -Encourage to wear street clothes and perform normal grooming -Allow favorite food to be brought in if not on a special diet
common s/s of PDA
-BOUNDING peripheral pulses -widened pulse pressure (>25) -murmur ("machinery murmur") at upper left sternal border or in L infraclavicular area. -murmur audible throughout cardiac cycle
phase 3 of parenteral therapy
-Begin oral feeds -Gradually correct total body deficits
tx for enuresis
-Bladder training -Fluid restriction in evenings -Interruption of sleep to void -Conditioned reflex response device -have child empty bladder before going to bed -Avoid fruit and juice drinks after 4 pm -Avoid caffeinated or carbonated beverages after 4 pm
surgical tx of PS
-Brock procedure (bypass to do valvotomy) -usually can repair w/ catheterization
postop complications of cardiac surgery
-CHF -Dysrhythmias -Decreased cardiac output syndrome -Decreased peripheral perfusion -Pulmonary changes -Neurologic changes
reasons for decreased fluid requirements
-CHF -Increased ICP -Oliguric renal failure -SIADH -Mechanical ventilation (we add the fluid to the ventilator itself) -After surgery
major criteria for rheumatic fever
-Carditis -Polyarthritis -Erythema marginatum -Subcutaneous nodules -Chorea
postprocedural care for cardiac cath
-Check the pulse distal to the site -Monitor the temperature and color of extremities -Take the vital signs every 15 minutes -Monitor the blood pressure -Monitor the dressing for bleeding or hematoma -Monitor intake and output -Monitor blood glucose levels
diagnosis of enuresis
-Chronologic or developmental age over 5 years -Two times per week or more for 3 months
s/s of Hirschsprung Disease in childhood
-Constipation -Ribbon-like foul smelling stools -Abdominal distention -Visible peristalsis
Risk Factors That Increase Vulnerability to Stressors of Hospitalization
-Difficult temperament -Lack of fit between a child and a parent -Age (especially age 6 months to 5 years) -Male gender -Below-average intelligence -Multiple and continuing stressors (e.g., frequent hospitalizations)
Erikson: Developing a Sense of Industry (school-age)
-Eager to develop skills and participate in meaningful and socially useful work -Acquire sense of personal and interpersonal competence -Growing sense of independence -Peer approval is strong motivator
Erikson: Sense of identity
-Early adolescent: Group identity versus alienation -Development of personal identity versus role diffusion -Sex role identity -Emotionality
nursing management of KD
-Early diagnosis and treatment -Prevention of cardiovascular complications -Monitor I&O -Provide symptomatic relief -Address patient irritability -Discharge teaching
phase 1 of parenteral therapy
-Expand ECF to improve circulatory and renal function -Isotonic solution 20ml/kg bolus over 5-20 minutes
because the toddler is in the preoperational thought stage...
-Explanations must be in terms of real events -Have a lack understanding of cause and effect relationships
s/s of Hirschsprung Disease in infant
-FTT -Constipation -Abdominal distention -Episodes of diarrhea and vomiting -Signs of enterocolitis - explosive watery diarrhea, fever -Easily palpable fecal mass -Undernourished
s/s of Hirschsprung Disease in newborn period
-Failure to pass meconium within 24 - 48 hours -Refusal to feed -Bilious vomiting -Abdominal distention
postop care after pyloromyotomy
-Feedings begin 4-6 hours after surgery - clear liquids -Increase feedings for 48 hours until back to full feeds -I & O, daily weights (make sure they don't keep vomiting)
Erikson: Industry vs. Inferiority (school-age children)
-Feelings may derive from self or social environment -May occur if incapable or unprepared to assume the responsibilities associated with developing a sense of accomplishment -All children feel some degree of inferiority regarding skill(s) they cannot master
reasons for increased fluid requirements
-Fever, tachypnea, radiant warmer, phototherapy -Vomiting and diarrhea, DI, DKA -Shock, burns, post-op bowel surgery
surgery #3 for tricuspid atresia
-Fontan (or modified Fontan) -pt must have normal ventricular function and a low pulmonary vascular resistance for the procedure to be successful -separates mixed blood, but does not restore normal anatomy or hemodynamics -high surgical mortality rate (<10% survival in some centers)
piaget cognitive development of adolescent
-Formal operations period -Abstract thinking ¤Think beyond present ¤Mental manipulation of multiple variables ¤Concerned about others' thoughts and needs
with severe bronchiolitis, if 2nd score is >9...
-HFNC -O2 for < 90% -NPO, IVF -admit
s/s of KD
-High fever—unresponsive to antipyretics/antibiotics -"Strawberry" tongue -Edema hands and feet -Extreme irritability (inconsolability) -Periungual desquamation (peeling skin) -Arthritis -Coronary complications
when giving rectal suppositories...
-Hold buttocks together for 5 minutes to prevent expulsion -Make sure that the suppository is firm
During Vincent's hospitalization with heart failure, what would his treatment likely be?
-Improve cardiac function. Digoxin slows the heart rate and increases the force of contraction. -ACE inhibitors may be administered to reduce the afterload on the heart (making it easier for the heart to pump) -Diuretics and K replacement PRN -Fluid restriction and monitor for dehydration -Na restriction -Decrease cardiac demand (neutral thermal environment to keep infants and children warm, monitor and treat infections) -Decrease work of breathing by maintaining the patient in a semi-Fowler position -Encourage rest (environment, possible sedation) -Improve tissue oxygenation (humidified oxygen)
infective (bacterial) endocarditis
-Infection in valves and endocardium -Usually sequelae of sepsis in child w/ cardiac disease or congenital anomaly
rheumatic fever
-Inflammatory disease occurring after group A β-hemolytic streptococcal pharyngitis (GABHS) -Infrequently seen in the United States, big problem in developing countries -Self-limiting
s/s of IE
-Insidious, malaise, low-grade fever -New murmur or change in previous murmur -Splenomegaly -Osler nodes -Janeway spots
kohlberg moral development of adolescent
-Internalized set of moral principles -Questioning of existing moral values and relevance to society -Understand duty and obligation, reciprocal rights of others -Concepts of justice, reparation
postop care for cardiac surgery
-Monitor vital signs and arterial/venous pressures -Intraarterial monitoring of BP -Intracardiac monitoring -Respiratory needs -Rest, comfort, and pain management -Fluid management -Progression of activity
rheumatic heart disease
-Most common complication of RF -Damage to valves as a result of RF
management of dysmenorrhea
-NSAIDs -Estrogen therapy -Oral contraceptives -Dietary changes -Exercises -Comfort measures
what do we give for dysmenorrhea?
-NSAIDs -oral contraceptives
preop tx for Hirschsprung's
-Newborn bowel considered sterile so no additional prep -Saline enemas to empty bowel in other children -Oral antibiotics to decrease flora -Colonic irrigations with antibiotic solutions -Nutritional status -depends on age and condition -low fiber, high cal, high protein diet for malnourished children before surgery; tx with enemas until surgery
what does the long-term reorganization process associated with rape trauma syndrome include?
-Nightmares, fears, phobias, panic reactions -Feelings of helplessness, powerlessness -Victim recovery
primary amenorrhea
-No secondary sex characteristics and no menarche by 14 to 15 years of age OR -Secondary sex characteristics are present but menarche has not occurred by age 16 to 16½ years -No uterine bleeding after attaining SMR 5 for 1 year or after breast development for 4 years
s/s of pyloric stenosis
-Nonbilious projectile vomiting may be blood tinged -Visible peristalsis - left to right -Failure to thrive in infant who is "always hungry" -Dehydration -Metabolic acidosis
with moderate bronchiolitis, if 2nd score is 5-8 and >2 for retractions and RR...
-O2 for <90% or inc WBC -consider HFNC -NPO, IVF -admit
stress fractures
-Occur as a result of repeated muscle contraction -Seen most often in repetitive weight-bearing sports
tx of RHD
-PCN or erythromycin -Salicylates -Bed rest -Prophylactic treatment started after acute treatment: monthly IM injections of benzathine pcn G, 2 daily oral doses PCN or one daily dose sulfadiazine -Prophylactic treatment before procedures
with tricuspid atresia, you need to keep open the ______ or ______ with...
-PDA, VSD -continuous infusion of prostaglandin E (until surgery)
with moderate bronchiolitis, if 2nd score is 1-4...
-PO trial possible -observe 1 hr -score -disposition
with moderate bronchiolitis, if 2nd score is 5-8 and <2 for retractions and RR...
-PO trial possible -observe 1 hr -score -disposition
characteristics of s/s of school phobia
-Physical symptoms -Symptoms subside after staying at home -No symptoms on weekends or holidays
preprocedural care for cardiac cath
-Prepare the child and family for the procedure -Use developmentally appropriate materials to explain the procedure to the child -Assess and mark pulses -Baseline O2 sats -Nothing by mouth (NPO) prior to the procedure
pathophysiology of PS
-R vent. hypertrophy, R ventricular failure >> R atrial pressure increases and may reopen foramen ovale -Shunts unoxygenaeted blood to L atrium >> systemic cyanosis -may lead to CHF, often have PDA as well
Total Anomalous Pulmonary Venous Connection
-Rare defect -Pulmonary veins fail to join L atrium -Pulm. veins drain into L atrium -Results in mixed blood
surgery for IE
-Remove vegetation -Valve replacement with prosthetic valves
overuse syndrome
-Repetitive microtrauma -Inflammation of the involved structure -Complaints of pain, tenderness, swelling, disability
phase 2 of parenteral therapy
-Replace deficits, meet maintenance needs, catch up on water loss -K is withheld until renal and circulatory functions restored
status asthmaticus
-Respiratory distress continues despite vigorous therapeutic measures -Concurrent infection in some cases
tx of stress fractures
-Rest to alleviate repetitive stress -Training with alternative exercise regimens -Physical therapy, cryotherapy, cold whirlpools -NSAIDs
what behaviors might the hospitalized preschooler show?
-Separation anxiety generally less than the toddler -Less direct with protests, cries quietly -May be uncooperative -Fear of injury -Loss of control -Guilt and shame
what behaviors might the hospitalized adolescent show?
-Separation from friends rather than family more important -Fear of altered appearance -Will act as though not afraid when they really are -Give them some control to avoid a power struggle
what behaviors might the hospitalized school-age child show?
-Separation: may have already experienced when starting to school -Fear of injury and pain -Want to know reason for procedures and like being involved, want to make choices
s/s of stress fracture
-Sharp, persistent, progressive or deep, dull ache -Pain over the involved bony surface
behaviors related to loss of control of hospitalized school-age child
-Striving for independence and productivity (dependent activities direct threat to their security) -Fears of death, abandonment, permanent injury -Boredom
loss of control related to hospitalized adolescent
-Struggle for independence and liberation - personal identity -Separation from the peer group -May respond with anger and frustration -Need for information about their condition
triad of s/s of intussusception
-Sudden onset of abdominal pain (child screaming and drawing knees to chest) -Abdominal mass "sausage like" RUQ -Bloody stool
surgical tx for intussusception
-Surgical reduction and fixation, or -Excision of nonviable segment of colon
s/s of resp distress
-Tachypnea -Hyperpnea -Nasal flaring -Accessory muscle use -Retractions
surgery for Hirschsprung disease
-Temporary ostomy -Second stage "pull-through" procedure (remove aganglionic section and pull normal bowel through to rectum)
other s/s of intussusception
-Tender distended abdomen -Empty LRQ (Dancer's sign) -Lethargy, vomiting
feeding alterations in infant with GERD
-Thickening feedings (thickened with rice cereal) -Upright positioning -Frequent burping during feeds -Avoid overfeeding -Positioning to promote gastric emptying
piaget concrete operations
-Use thought processes to experience events and actions -Develop understanding of relationships between things and ideas -Able to make judgments based on reason ("conceptual thinking") -Conservation—physical matter does not appear and disappear by magic
4 defects included in tetralogy of fallot
-VSD -Pulmonic stenosis -Overriding aorta -R Ventricular hypertrophy
tetralogy of fallot
-VSD -pulmonic stenosis causing increased pressure being placed by right ventricle which then gets hypertrophied -pushing against pulmonic valve that causes pulmonary stenosis and hypertrophy of right ventricle -mixing because of high pressure in right ventricle and blood goes to least resistance, less resistance in the aorta than there is in pulmonic system -blood backs up in R side of heart and causes desaturated blood to shunt to the left and into systemic circulation
emergency preop care for enterocolitis
-VSS and BP for s/s of shock -fluid and electrolyte replacement -plasma and other blood products -watch for s/s of bowel perforation (fever, abd distention, vomiting, tenderness, irritability, dyspnea, cyanosis)
menarche (females)
-about 2 years after thelarche -menstruation begins
tx of KD
-acetylsalicyclic acid (ASA) for fever -intravenous immunoglobulin (IVIG) -antiplatelet
Kawasaki Disease (KD): Mucocutaneous Lymph Node Syndrome
-acute systemic vasculitis of unknown cause -in 75% of cases, the child is younger than 5 years of age
how do families care for school-age children?
-adjust to child's increasing independence -provide support as unobtrusively as possible -child moves from narrow family relationships to broader world of relationships
clinical manifestations of Hirschsprung Disease
-aganglionic segment of colon -in more than 80% of cases affects the internal sphincter, rectum, and a few centimeters of the sigmoid colon (short-segment disease) -accumulation of stool with distention -failure of internal anal sphincter to relax -enterocolitis may occur
Hirschsprung disease
-aka congenital aganglionic megacolon -mechanical obstruction from inadequate motility of intestine -absence of ganglion cells in colon -accumulation of stool with distention -failure of internal anal sphincter to relax -enterocolitis may occur
bronchiolitis protocol changes
-albuterol nebulizer treatments are ineffective in the infants, side effects may be harmful -do not give O2 until below 89% -steroids are ineffective and side effects may be harmful -don't always give abx for wheezing and fever bc most cases are viral
other s/s of resp distress or failure
-altered RR (fast at the beginning, bradypnea when they get tired) -altered heart rate (increase to make up for lack of O2) -adventitious breath sounds -decreased, absent, or unequal breath sounds
s/s of resp distress or failure
-altered level of consciousness -failure to recognize caregivers -decreased interaction with environment -restlessness -anxiety -confusion (hypoxia has reached the brain) -inability to be consoled
isotonic dehydration
-primary form occurring in children (electrolytes are balanced) -decreased plasma volume -shock is main cause of death
rapid assessment of bronchiolitis
-assess breathing issue or cough -obtain and record initial score -wall suction with nasal aspirator -obtain second score once pt is calm -vitals and leave pulse ox on
atrial septal defect
-atria have a defect between them -mixing of blood -there is less blood going to whole body
types of increased pulmonary blood flow defects
-atrial septal defect -ventricular septal defect -patent ductus arteriosus
cystic fibrosis
-autosomal recessive -characterized by abnormal mucus secretion and obstruction -mucus clogs pancreatic ducts and bronchioles
surgical tx of aortic stenosis
-balloon angioplasty to dilate the valve -Konno procedure [valve replacement] -may require repeat procedures
pathophysiology of atrial septal defect
-bc L atrial pressure is higher than R atrial pressure, blood flows from L to R -causes increased flow of oxygenated blood into the R atria -R atria becomes distended -bc there is low pulmonary vascular resistance, blood backs up into the pulmonary vessels and the R ventricle becomes distended as well. But because it is under low pressure, this is often tolerated very well and the child may be asymptomatic
maturation of systems of school-age child
-bladder capacity increases -heart smaller in relation to the rest of body -immune system increasingly effective -bones increase in ossification -physical maturity not necessarily correlated with emotional and social maturity
ventricular septal defect
-blood is forced from left side backwards into the right side and cause mixing of saturated and desaturated blood -increased pressure to pulmonary system
pathophys of mixed defects
-blood is mixed from pulmonary and systemic circulations within the heart chambers >> relative desaturation of blood in systemic blood flow -cardiac output decreases because of volume load on ventricle
causes of lower airway resp distress or failure
-bronchiolitis -asthma -pneumonia
surgery for coarction of the aorta does not require _________ because...
-bypass -defect is outside pericardium
what can different types of heart defects cause?
-can cause blood to be shifted from the right side (desaturated blood) to the left side where the saturated blood is supposed to be -or the left side makes backward pressures to the right side which causes pulmonary HTN
repairs of VSD
-cath repairs in clinical trials -surgical repair w/ bypass -pulmonary artery banding (if not too large) or patch
cyanotic CHD
-child may be pink -may develop congestive heart failure (CHF)
circulatory changes at birth
-clamping of umbilical cord cuts off supply of oxygenated blood from the placenta, lungs assume function of oxygenation -inflation of lungs lowers resistance to blood flow through pulmonary system -with increase in pulmonary blood flow and decreased pulmonary resistance, RA pressure falls -LA pressure rises which stimulates closure of the foramen ovale -ductus arteriosus stimulated to close due to increase in O2 sat from changes in pulmonary vascular resistance -remaining fetal circulation structures (umbilical arteries, umbilical vein, and ductus venosus) are obliterated
convalescent phase of KD
-clinical signs have resolved, but lab values have not returned to normal -ends when normal values have returned (within 6-8 weeks)
types of obstructive defects
-coarctation of the aorta -aortic stenosis -pulmonic stenosis
surgical tx for Total Anomalous Pulmonary Venous Connection
-common pulmonary vein is anastomosed to the L atrium, ASD is closed, and anomalous venous connections ligated -success depends on specifics of anomalies
paroxysmal stage of pertussis
-cough more severe over 1 to 2 weeks to paroxysms of rapid coughs from thick mucous with characteristic high-pitched whoop (bronchial tree is getting spastic and high-pitched) -this is when the child is the sickest
causes of upper airway resp distress or failure
-croup -epiglottitis -foreign-body aspiration -pertussis
protest phase of separation anxiety
-crying and screaming -clinging to the parent
despair phase of separation anxiety
-crying stops -evidence of depression
reasons for sexual experimentation
-curiosity -pleasure -conquest -peer pressure to conform
adolescent sexuality
-dating -sexual orientation -sexual experimentation
anatomy and physiology of bronchiolitis
-decreased number of alveoli; less recoil -decreased lung volume -ribs cartilaginous and horizontal -chest wall thin -diaphragm is major mm of breathing
Prepubescence (Preteens)
-defined as 2 years preceding puberty -typically occurs during preadolescence
transposition of the great arteries
-desaturated blood is being pushed out into the peripheral circulation and the blood that is coming back from the lungs that is saturated is going back to the lungs itself, open up the septums -pulmonary artery leaves the L ventricle and the aorta exits from the R ventricle. No communication between the systemic and pulmonary circulations
gynecomastia
-development of breast tissue in males -may occur with normal achievement of male puberty and resolves within 1 year
hypoplastic left-sided heart syndrome
-don't have left side of the heart -all blood is being pumped at the same rate from the right side -desaturated blood is coming in but it is mixing completely with what is coming off of pulmonic return, pooling and being pushed out but only by right side -causes pulmonary HTN and inadequate BP to circulate blood to body
when can murmurs occur?
-during systole or diastole, or both -in a normal heart in periods of stress— anemia, fever, rapid growth
hypotonic dehydration
-electrolyte deficit exceeds water deficit (do not have enough electrolytes) -ICF more concentrated so fluid moves into cell
tx for tricuspid atresia
-emergency repair and then move everything back to create septums because there has to be some way to get blood to the pulmonary system -valve is created very quickly after birth
postop for cleft palate
-ensure proper airway and positioning -protect suture site -manage pain/support family
tricuspid atresia
-failure of the tricuspid valve to develop -means that there is no opening between the right ventricle where the desaturated blood is supposed to come from the body and be pushed to pulmonary system
pathophysiology of tricuspid atresia
-failure of tricuspid valve to develop -no opening between R atrium and R ventricle -blood flows through ASD or patent foramen ovale to L side of heart and through VSD to R ventricle and out to lungs -mixing of oxygenated and unoxygenated blood in L side of heart -systemic desaturation and pulmonary obstruction
indicators of cardiac dysfunction
-failure to thrive, poor weight gain, activity intolerance -developmental delays -positive prenatal history -positive family history of cardiac disease
adolescent development of self concept and body image
-feelings of confusion in early adolescence -acute awareness of appearance, comparison of appearance with others -blemishes and defects magnified out of proportion -matures to self-concept based on uniqueness and individuality
how to communicate with hospitalized school-age child
-find out what child knows, clarify using scientific terminology and how body functions -direct questions more to the child when teaching them (help master over feelings of inferiority) -use audiovisuals, pictures, body outlines -suggest ways of maintaining control (i.e.: deep breathing relaxation) -positive feedback
tx for acne
-general health measures -gentle cleansing
developing body image of school-age child
-generally like their physical selves less as they grow older -influenced by significant others -increased awareness of "differences" may influence feelings of inferiority
social development of adolescent
-goal is to define one's identity independently from parental authority -much ambivalence -intense sociability or intense loneliness -acceptance by peers
reasons for water imbalance of the infant
-greater fluid intake and output relative to size (drinking more and excreting more, kidneys are not fully developed so allow a lot of urine to come out) -disturbances occur more frequently and rapidly -body surface area (BSA) -larger quantities of fluid lost through the skin -higher metabolic rate -greater production of metabolic wastes -immature kidney function -immature and inefficient in excreting waste
chronic diarrhea
-greater than 14 days -malabsorption syndromes, IBD, lactose intolerance, inadequate management of acute diarrhea
therapeutic management of IE
-high-dose IV antibiotics 2-8 weeks -evaluate effectiveness of antibiotics with repeat blood cultures -if no response/minimal response to antibiotics, surgical approach
tet spells
-hypercyanotic spells -when the pressures get so high from right ventricle that it is pushing more desaturated blood through aorta and into circulation
goals of management of kids with cardiac issues
-improve cardiac function (increase contractility and decrease afterload) -decrease preload (remove accumulated fluids and sodium) -decrease cardiac demands -improve tissue oxygenation -decrease oxygen consumption
resp failure is characterized by...
-inadequate oxygenation -inadequate ventilation -combination of both
dietary needs of CF patient
-increased Na since they lose a lot in sweat -may need fat soluble vitamins since they have issues digesting and absorbing fat -Ca because of pancreatic insufficiency -extra calories and protein
control of respiration in infants
-increased arterial carbon dioxide or increased hydrogen concentration results in increased respiratory rate -healthy infants and children compensate for hypercarbia, hypoxia, and acidosis with hyperventilation -premature and young infants less able to compensate
s/s of inadequate oxygenation or ventilation
-increased work of breathing -tripod position -paradoxical respirations -unusual drooling (foreign body aspiration) -decreased gag reflex -pallor or cyanosis -nasal flaring -retractions -head bobbing -grunting (trying to push more air out so they can get more in)
s/s of aortic stenosis
-infants w/ severe defects show signs of decreased CO -faint pulses, hypotension, poor feeding, tachycardia -murmur -exercise intolerance -chest pain -dizziness w/ standing
who can hypertonic dehydration occur in?
-infants who have diarrhea and are given high solute fluids by mouth -children receiving high protein NG feeds (too much concentrate and not enough water in tube formula) -need to have a certain amt of formula and certain amt of water on top of that (parents can fail to give extra water rinse after, don't want to mix water with the feed)
what are the reason school-age children form clubs?
-influence to be a part of a group/club is strong from their peers -important for social development -to break out from their families by merging identity with peers
chronic nonspecific diarrhea
-irritable colon/toddler's diarrhea -growing normally but have loose stools
coarction of the aorta
-kink in the aorta (narrowed near ductus arteriosis) -blood has to be pushed harder to get out of the left ventricle -causes hypertrophy and stricture -destruction of cells because of high turbulence
what should you do if a child arrives with stridor at rest?
-leave them in parents arms -some blow by cool mist O2, if tolerated only -give the patient a racemic Epinephine nebulizer treatment, this will hopefully take down the swelling enough to begin moving air again -IV or oral steroids should be given quickly, so that they are systemically working by the time the racemic Epi begins to wear off
pathophys of Hypoplastic Left-Sided Heart Syndrome
-left side of heart is underdeveloped -left ventricle is small and aortic atresia -most blood flows across patent foramen ovale to right atrium to right ventricle and out the pulmonary artery -descending aorta receives blood from the PDA to supply the systemic circulation -PDA closure >> rapid deterioration and CHF
things to keep in mind when interviewing adolescent
-maintain objectivity -avoid assumptions, judgements, lectures -ask open ended questions when possible, more directive questions if necessary -begin with less sensitive issues and procede to more sensitive ones
risk factors for CHD
-maternal diabetes -PKU -alcohol consumption -environmental toxins -infections - Rubella -family history of defect in parent or sibling
tx of ASD
-may be closed in cardiac cath procedure -surgical repair w/ patch (usually before age 6)
spiritual development of adolescent
-may question the values and beliefs of the family -capable of understanding abstract concepts and interpreting analogies and symbols -may fear that others will not understand their feelings -tendency for introspection and emotional intensity
surgery #3 for Hypoplastic Left-Sided Heart Syndrome
-modified Fontan procedure, similar to tricuspid atresia repair -transplant may be option for some patients. Mortality rate very high (30%-50% mortality rates)
cricoid
-narrowest portion of airway -anatomic cuff for tracheal tube
pulmonic stenosis
-narrowing from the right ventricle into the pulmonic system -pulmonary valve is stenosed and there is a narrowing at the entrance so you have right ventricle hypertrophy and decreased pulmonary flow out of the right ventricle into pulmonary system
aortic stenosis
-narrowing of the aortic valve -as the ventricle is trying to push blood into aorta, there is a stenosis that is narrowing the outlet of the ventricle -left vent is pushing harder and harder -turbulence causes destruction of the cells -clotting can occur
tx for transposition of the great arteries
-need to open up spaces and do bypasses so that they can get blood to mix until they can repair the heart (open septums) -arterial switch procedure to resect and reanastomose great vessels -coronary arteries have to be reimplanted to supply myocardial circulation
total anomalous pulmonary venous connection
-none of the blood is going where it is supposed to, it is all circulating -saturated blood is coming off pulmonic vein and going up into artery and coming back to heart through SVC, same saturation of blood is also going out aorta to the rest of the body
school-age children relationships with families
-parents are primary influence in shaping a child's personality, behavior, and value system -increasing independence from parents is the primary goal of middle childhood -children are not ready to abandon parental control
how to care for families of adolescent
-parents need support and guidance -give info regarding developmental changes and process of gaining independence -give help "letting go" and promoting independence
adolescent relationships with peers
-peers assume an increasingly significant role in adolescence ("best friend") -peers provide a sense of belonging and a feeling of strength and power -peers form a transitional world between dependence and autonomy -role of social media and advanced technology
stage 3 of sexual maturation in males
-penile enlargement, voice changes, early facial hair, gynecomastia (temporary breast enlargement) -occurs in 1/3 of males in midpuberty
s/s of hypoxemia
-polycythemia -clubbing -cyanosis
physical indicators of cardiac dysfunction
-poor feeding -tachypnea, tachycardia -diaphoresis -crackles -hepatomegaly -cyanosis -sternal lift -murmur
why is therapeutic management of RSV only done for very high risk infants?
-potential toxic effects of drug to healthcare workers (esp aerosol therapy) -recommended that no pregnant women should be involved -wear masks and goggles when giving therapy
pathophys of VSD
-pressure is higher in L ventricle than in the R ventricle and systemic arterial circulation offers more resistance than the pulmonary circulation -blood flows through the defect and into the pulmonary artery -R ventricle becomes enlarged (hypertrophied), over time the R atria may also become distended
if VSD is large...
-pressures are = in R and L ventricles -blood is shunted in the direction of the least resistance (pulmonary or systemic vascular resistance)
medical management of PDA
-preterm children - INDOMETHACIN to close PDAs, surgical ligation if meds fail -prophylactic abx to prevent bacterial endocarditis
what is the reason school-age children play sports?
-pride in learning and mastering new skills -exercise essential for development and function -importance of physical fitness for children -they like competition
there are minimal s/s of ________ with ASD until...
-pulmonary vascular changes -several decades of unrepaired ASD
adolescent relationships with parents
-roles change from "protection-dependency" to "mutual affection and equality" -process involves turmoil and ambiguity -struggle of privileges and responsibility -emancipation from parents may begin with the rejection of parents by the teenager
When can a child help take care of the family pets?
-school-age (6-12) -pets can have positive effect on physical and emotional health
what behaviors might the hospitalized toddler show?
-separation anxiety -protest and despair -fear of injury and pain -regressive behavior
mixed blood flow is caused by...
-septal defects (either the atrium or the ventricles have septal defects) -causes complete mixing of the blood
What do you do for postop tonsillectomy?
-side-lying or on abd to promote drainage and protect airway -elevate head of bed when fully awake -assess for bleeding (would show frequent swallowing) -quiet environment -minimize agitation and crying -pain control
physiologic changes in adolescence
-size and strength of heart, blood volume, and systolic blood pressure increase -pulse rate and basal heat production decrease -adult values for blood -respiratory volume and vital capacity increase -increased performance capabilities
how to give oral rehydration for fluid loss
-small amounts (2-5 mls) every 2-3 minutes, 5-10 mLs every 2-3 minutes for older children -administer ondansetron (Zofran) -unsweetened Kool-Aid powder enhances flavor -popsicle (frozen ORS)
peak flow meter
-small, hand-held tool used to measure how well air moves out the lungs -rate of air exhaled is indicated by "peak flow meter reading" -for asthmatic the reading can indicate if there is narrowing in the airway before asthma symptoms show
what do we need to think about with gastroenteritis?
-some kids have chronic diarrhea -food allergies/intolerances
what are obstructive defects associated with?
-some kind of kink or stenosis -overriding or coarctation of the aorta that causes kink of aorta
tanner stages of sexual maturity
-stages of development of secondary sex characteristics and genital development -defined as a guide for estimating sexual maturity
tx of barky cough without stridor
-steroids (dexamethasone) and the patient is discharged home with instructions to try running a hot steamy shower, followed by wrapping in towel or blanket and having the child breath cold night air -if the child improves, they can all go back to sleep. If not, bring the child to the ER or call 9-1-1 for transport.
possible stress responses
-stomach pains or headache -sleep problems -bed-wetting -changes in eating habits -aggressive or stubborn behavior -reluctance to participate -regression to earlier behaviors (thumb sucking)
s/s of PS
-systolic ejection murmur -asymptomatic or cyanotic with severe narrowing -s/s of CHF
what would vitals/brief assessment of pt with cardiac dysfunction show?
-tachycardia -difference in BP between upper and lower extremities -decreased pulses in LEs (coarction) -murmur
what do the testes secrete? when do levels increase to their maximum?
-testosterone -at maturity
defects that cause decreased pulmonary blood flow
-tetralogy of fallot -tricuspid atresia
patent ductus arteriosis
-there during fetal circulation to allow blood to circulate from umbilical cord and into and out of the heart -oxygenated blood can circulate around because pulmonary system is not used at that point
adolescence
-transition between childhood and adulthood -time of growing into psychological, social, and physical maturation
reasons for cardiac cath procedures
-transposition of the great vessels -some complex single-ventricle defects -atrial septal defect -pulmonary artery stenosis -can blow holes where they need to, perform shunting, sometimes they need to go in quickly after holes are blown to get everything where it is supposed to go
types of mixed defects
-transposition of the great vessels -total anomalous pulmonary venous connection -hypoplastic heart syndrome (left sided)
jones criteria for rheumatic fever
-two major manifestations -one major manifestation and two minor manifestations
tests for CF
-universal newborn screening -immunoreactive trypsinogen analysis (screen) -sweat chloride test (best for diagnostic) -DNA testing -chest radiography -stool analysis
s/s of Total Anomalous Pulmonary Venous Connection
-usually cyanotic early -condition rapidly deteriorates as pulmonary blood flow increases and causes CHF
complete repair for tetralogy
-usually in first yr of life -repair of VSD, resect stenosed area, and patch R ventricular outflow
acute diarrhea
-viral, bacterial, parasitic -resolves in 14 days
considerations for infant in HF. we can't increase fluids so what do we do?
-want to make sure they are getting enough calories bc they have high metabolism combined with trying to make up for the fact that they aren't getting enough o2 -increase concentration of formula
hypertonic dehydration
-water loss in excess of electrolyte loss (retained electrolytes) -most dangerous type of dehydration -fluid shifts from ICF to ECF -seizures and neurological changes
when should the parent leave the hospital if they have to? what should they do before they leave?
-when the child is awake -leave something of meaning with child life
diagnostics for Hirschsprung disease
-x-ray -barium enema -anorectal manometric exam (internal rectal sphincter is tight, rectum empty of feces) -confirm diagnosis with rectal biopsy
_______ oz = _______ mL
1 oz = 30 mL
bronchiolitis is often a problem in children under...
1 year
Postpubescence
1-2 years after puberty; skeletal growth is complete and reproductive functions become established
syringe size for SQ injection
1-3 mL
syringe size for IM injection
1-5 mL
secondary amenorrhea
absence of menses for 6 months or absence of three cycles after menstruation was previously established
avg age of puberty in girls
12
avg age of puberty in boys
14
tetralogy of fallot progressively worsens over...
1st year of life
how long is abx tx for endocarditis?
2-8 weeks
encourage school-age child to be _________
active in decision-making
order of blood flow through the heart
IVC/SVC--> R atrium--> tricuspid valve--> R ventricle--> pulm valve--> pulm artery--> pulm veins--> L atrium--> mitral valve--> L ventricle--> aortic valve--> aorta--> body
causes of water intoxication
IVs, dialysis, tap water enemas, too rapid reduction of glucose levels in DKA, parents mixing formula with water
Some shunting of blood after closure of the ductus arteriosis may occur up to...
24 hours after life
First meconium should be passed within...
24-36 hrs of life
epiglottis is an __________ infxn
acute bacterial
pertussis is a _________ infxn
acute bacterial (presents as a cold)
leading cause of illness in children younger than 5 years of age
acute diarrhea
etiology of CHD
85% unknown, thought to be multifactorial
hours of sleep of 11 year old
9 hrs/night
avg sleep for school-age child
9½ hours/night
possible renal failure = urine output of __________
<1 ml/kg/hr
infants with tetralogy of fallot may be ________ after feeding
anoxic
bladder volume of _________ is sufficient to hold a night's urine
300 to 350 mL
A 2 month old breast fed infant is successfully rehydrated with oral rehydration solutions for acute diarrhea. Instructions to the mother about breastfeeding should include which of the following? a. Continue breastfeeding b. Stop breastfeeding until breast milk is cultured c. Stop breastfeeding until diarrhea is absent for 24 hours d. Express breast milk and dilute with sterile water before feeding
A
A child is admitted with gastroenteritis. To prevent the spread of this disease, the nurse should: a.Observe standard precautions b.Administer antibiotics as soon as possible c.Single-bag all linens d.Use sterilizable eating utensils
A
s/s of cardiac dysfunction may appear at...
4-12 weeks after birth
what does cyanosis indicate?
5 g/dL of oxygenated hemoglobin in capillaries
age of school-age children
6-12
what ages does croup affect?
6-36 months
enuresis usually ceases by age _______
6-8
incubation pd of pertussis
7-10 days
what age does the respiratory system continue to develop until?
7-8 years
what age child may resist going to bed?
8-11
A nurse receives a child with a cleft palate on the pediatric unit. Which action is best for the nurse to take? a) to ask the nursing assistant to obtain necessary feeding equipment for the client while the nurse completes the admission assessment. b) to ask the nursing assistant to take the child's vital signs while the nurse calls the physician c) to ask the LPN/LVN to talk to the parents while the nurse administers a tube feeding to the child in the next room d) to ask the parents to leave the room while the nurse completes the admission assessment
A
Greg, age 2½ years, was admitted to the pediatric unit yesterday. His parents are making plans to visit as often as possible during his hospitalization. Greg's parents complain to the nurse that the child "cries, screams, and throws himself" whenever they leave the hospital to eat. The nurse should do which of the following? A. Explain that his behavior is a normal response to hospitalization. B. Explain that this behavior will diminish in a few days. C. Encourage the parents not to leave the child's room. D. Encourage the parents to leave when the child is asleep.
A
Which of the following parameters would the nurse monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageal reflux (GER)? a. Vomiting b. Stools c. Uterine d. Weight
A
While assessing a newborn with cleft lip, the nurse would be alert that which of the following will most likely be compromised? a. Sucking ability b. Respiratory status c. Locomotion d. GI function
A
With gastroesophageal reflux symptoms, the purpose of esophageal pH monitoring is evaluating for: A. esophagitis from the reflux. B. frequency of the reflux. C. gastric emptying delays. D. possible obstructions.
A
1.When observing manifestations of separation anxiety in young children, what might a nurse expect to see? Select all that apply. A.Crying B.Screaming C.Searching for their parent with their eyes D.Physically attacks strangers (e.g., bites, hits) E.Clinging to the parent F.Very interested in their surroundings
A, B, C, D, E
Vincent is discharged after the cardiac catheterization. He is readmitted 2 months later with heart failure. Which of the following assessment findings are likely? (Select all that apply.) A. Sweating B. Weak, thready pulses C. Dependent edema D. Fatigue E. Tachycardia
A, B, C, D, E
3.Factors affecting the parents' reactions to their child's illness include: Select all that apply. A.Seriousness of the threat to the child B.Previous experience with illness or hospitalization C.Available support systems D.Previous coping abilities E.The type of food served to the patient and family F.Communication patterns among family members
A, B, C, D, F
Which of the following findings would likely be present if Vincent's digoxin level was toxic? (Select all that apply.) A. Halos and blurred vision B. Tachycardia C. Vomiting D. Poor feeding
A, C, D
Vincent was a full-term, appropriate-for-gestational age infant who was discharged at 2 days old with his mother. At 6 weeks old, he is referred to the pediatric cardiologist with a possible ventricular septal defect (VSD). Vincent is hospitalized for a cardiac catheterization. Which of the following are expected findings following the procedure? (Select all that apply.) A. Weaker pulses below the catheterization site B. Sustained bradycardia or irregular heart rate C. Severe pain D. Small amount of dried blood on the dressing
A, D
what are in control of hormonal changes during adolescence?
anterior pituitary and hypothalamus
infants can sense _________ that parents are feeling
anxiety
An 8-month-old is admitted for severe diarrhea. Which of the following would be a significant finding for this child? a.Absent bowel sounds b.Depressed anterior fontanel c.Pale yellow urine d.Marked skin turgor
B
When providing postoperative care for the child with a cleft palate, the nurse should position the child in which of the following positions? a. Supine b. Prone c. In an infant seat d. On the side
B
where can VSD occur?
anywhere in muscle or membranous ventricular septum
surgery #2 for tricuspid atresia
Bidirectional Glenn shunt (cavopulmonary anastomosis) at 6-9 months of age
stage 1 of tetralogy repair surgery
Blalock or modified Blalock shunt >> blood to pulmonary arteries from L or R subclavian artery
A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solution (ORS). The child's mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend which of the following? a. Bring the child to the hospital for IV fluids b. Alternate giving ORS and carbonated drinks c. Continue to give ORS frequently in small amounts d. Institute NPO status for the child for 8 hours and resume ORS if vomiting has subsided.
C
Adolescents, unless previously immunized, should receive three doses of what vaccine? A. Hepatitis A (hep A) B. Measles-mumps-rubella (MMR) C. Human papillomavirus (HPV) D. Diphtheria-pertussis-tetanus (DPT)
C
The child is undergoing repair of cleft lip and palate. What should the nurse prepare in the room while waiting for the child? a) papoose board b) mummy restraint c) elbow restraint d) jacket restraint
C
Which of the following factors predispose an infant to fluid imbalances? a. Decreased surface area b. Lower metabolic rate c. Immature kidney functioning d. Decreased daily exchange of extracellular fluid
C
Which of the following statements best describes the relationship school-age children have with their families? A.Children desire to spend equal time with family and peers. B.Children are prepared to reject parental controls. C.Children need and want restrictions placed on their behaviour by the family. D.The peer group replaces the family as the primary influence in setting standards of behaviour and rules
C
risk factor for intussusception
CF
most common cause of death in the first year of life (after prematurity)
CHD
s/s of large PDA
CHF w/ tachypnea, dyspnea, hoarse cry
what can pulmonary HTN cause?
CHF, pump failure
if abx for IE are unsuccessful, ________ or ________ can develop
CHF, valvular damage
what age is surgery performed for PDA?
between 1-2 yrs
pyloric stenosis
Constriction of the pyloric sphincter (thickening) with obstruction of the gastric outlet
A 7-year-old child with acute diarrhea has been rehydrated with oral rehydration therapy. Which of the following changes in the child's diet should the nurse recommend? A. Clear liquids B. BRAT diet (banana, rice, apple, toast or tea) C. High-carbohydrate diet D. Regular diet
D
After the child returns from cardiac catheterization, the nurse monitors the child's vital signs. For how many seconds should the heart rate be counted? A. 10 seconds B. 15 seconds C. 30 seconds D. 60 seconds
D
When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration include: a. Tachycardia, decreased tears, 5% weight loss b. Normal pulse and blood pressure, intense thirst c. Irritability, moderate thirst, normal eyes and fontanels d. Tachycardia, greater than 10% weight loss, sunken eyes and fontanels
D
Which of the following is the best way for the nurse to maintain adequate fluid intake for a toddler with nausea, vomiting, and diarrhea? a. Keep the patient NPO and give hypotonic solutions IV b. Force fluids and give hypertonic solutions IV c. Provide Jell-O and Popsicles to increase fluid intake d. Offer oral rehydration solutions (ORS) to rehydrate the patient
D
Which of the following nursing diagnoses would be inappropriate for the infant with gastroesophageal reflux(GER)? a. Fluid volume deficit b. Risk for aspiration c. Altered nutrition: less than body requirements d. Altered oral mucous membranes
D
when to hold digoxin in an infant
HR less than 90
postop complication of surgery for coarction of the aorta
HTN
diagnostics for RSV
IFA, ELISA (both rapid and have specificities of 90%, done by nasal swab or nasal wash)
surgery #2 for Hypoplastic Left-Sided Heart Syndrome
bidrectional Glenn shunt at 6-9 months age to reduce volume load on the R ventricle
when to hold digoxin in child
HR less than 70
what do we assess for if meconium is not passed within 24-36 hrs?
Hirschsprung disease, hypothyroidism, meconium plug, meconium ileus (CF)
what is the diet after you have rehydrated a patient?
bland foods
preferred long-term control therapy for asthma
Inhaled corticosteroids (Ventolin inhalers)
what would you hear in pt with ASD?
LOUD harsh murmur with fixed split S2
s/s of tet spell
blue spells, hyperpneic, acute cyanosis
surgery for severe GERD
Nissen fundoplication
surgery #1 for Hypoplastic Left-Sided Heart Syndrome
Norwood procedure to create a new aorta using the main pulmonary artery and creation of large ASD
s/s of mottliing
body may be hot (fever), extremities are cool to touch
Why do we not use 60 cc syringe to push 20 mL of fluid?
Pushing fluid in larger syringe into 20 guage IV is difficult to push
pulmonic stenosis and narrowing at the entrance of pulm artery causes...
R ventricular hypertrophy and decreased pulm blood flow
Meckel Diverticulum
Remnant of fetal life - failure of the omphalomesenteric duct to fuse
Puberty
Sexual maturity is achieved
enuresis is more common in _________
boys
hallmark sign of dig toxicity
bradycardia
agents associated with infective endocarditis
Staph, Strep, Candida, gram-negative bacteria
s/s of dig toxicity
bradycardia, dysrhythmias, nausea, vomiting, anorexia
intussusception
Telescoping or invagination of one portion of intestine into another
management of tet spells
bring knees up to chest to change pressures
RSV primarily affects the...
bronchi and bronchioles
do NOT crush...
enteric coated or timed-release capsules
most serious complication of Hirschsprung's
enterocolitis
thumb sign
epiglottis looks like the child's thumb, posterior triangle on lateral neck film
Do NOT mix crushed meds with...
essentials fluids such as formula
_________ causes small amount of hormone secretion before puberty
adrenal cortex
ACE inhibitors reduce the ______ of the heart
afterload
s/s of externalizing stress
aggression and delinquency
examples of short-acting beta agonists
albuterol, levalbuterol, terbutaline
meds used for fungal endocarditis
amphotericin or flucytosine
what can gynecomastia be caused by?
anabolic steroid use or endocrine disorders
in 28% of kids with CHD...
another recognized anomaly is also present
when does the ductus arteriosus close?
around the 4th day of life
how may toddlers view illness or hospitalization?
as punishment for misdeeds
when does the foramen ovale close?
at or soon after birth
with ASD, there is a risk for _________ later in life if defect is unrepaired
atrial dysrhythmias and emboli formation
in males, there is gradual production of _________ throughout maturation
estrogen
low production of ______ during childhood
estrogen
what happens when left side pushes blood backwards into the right side?
excess pressure to the pulmonary veins and arteries, pulmonary HTN
s/s of aortic stenosis that are more common with older children
exercise intolerance
risks associated with VSD
bacterial endocarditis, pulmonary vascular obstructive disease
nonsurgical tx of coarction of the aorta
balloon angioplasty (usually effective)
medical tx of PS
balloon angioplasty to dilate the valve
BRAT diet for gastroenteritis
bananas, rice, applesauce, tea and toast
first sign of croup
barky cough
why can children lose a larger percentage of their body weight faster?
bc they weigh less to begin with
when are tet spells rarely seen?
before 2 months of age (increases during first year of life)
Primary sex characteristics
external and internal organs necessary for reproduction
what would CXR of pt with PS show?
cardiomegaly
Hypercyanotic spell can lead to...
cerebral hypoxemia and should be treated as an emergency
adolescence ends with...
cessation of body growth at 18 to 20 years
s/s of VSD
characteristic murmur; CHF is common
with acyanotic CHD...
child may become cyanotic
bladder capacity equation
child's age + 2 = expected bladder capacity in ounces
asthma
chronic inflammatory disorder of the airways that results in intermittent and reversible airflow obstruction of the bronchioles
what does clubbing indicate?
chronic tissue hypoxia and polycythemia
VSD may...
close spontaneously
small to moderate VSDs may...
close spontaneously within first yr of life
school-age children are motivated to...
complete tasks
school-age children think in _______ terms
concrete
self-concept (developed by school-age)
conscious awareness of a variety of self-perceptions (abilities, values, appearance, etc.)
long-term control meds for asthma focus on...
controlling the damaging inflammatory response associated with asthma and not simply treating symptoms
hallmark s/s of asthma
cough, wheezing, breathlessness, chest tightness
s/s of RSV
coughing that progresses toward wheezing, increased respiratory rate, nasal flaring, retractions and cyanosis
tx for total anomalous pulmonary venous connection
create shunting right away at birth to get blood where it is supposed to go so that it comes back through SVC
s/s of tricuspid atresia in the infant
cyanosis, dyspnea, tachycardia
what happens when blood that is shifted from the right to the left is more desaturated than it should be?
cyanotic episodes
what kind of restraints do you use for children who are postop from cleft palate repair?
elbow splints or restraints
you do not want child on BRAT diet for...
days at a time
polysymptomatic enuresis
daytime urgency
what happens with water intoxication?
decrease in serum sodium leads to CNS symptoms
what happens as a late sign with decreased O2?
decreased RR
water content of the older child
decreases to 45%
site if the child is older than 18 mnths and need fast absorption
deltoid
RSV usually starts as upper airway infxn, but...
depending on the size of the airway, can progress to pneumonia
s/s of mixed defects
desats, cyanosis, and CHF but variable depending on anatomy
pressures moving from right to left causes...
desaturated blood to go to the left side of the heart and get mixed into the circulating blood that is going to the rest of the body
_________ blood is on the right side of the heart and _________ blood is on the left side
desaturated, saturated
most common cause of isotonic dehydration
diarrhea
with mild bronchiolitis, if 2nd score is 1-4...
discharge
s/s of coarction of the aorta in older children
dizziness, h/a, fainting, epistaxis (nosebleeds) from hypertension
if dose of digoxin is missed...
do NOT give extra dose or increase next dose
if child vomits while giving digoxin...
do not readminister
when giving information to hospitalized family...
don't give too much info to the point that it is scary and overwhelming, but give enough that it puts the family at ease
with intubation of infants, we will put the cuff tube in but...
don't inflate it unless we really need to
monosymptomatic enuresis (most common)
dry during the day
when are most male reproductive anomalies identified?
early childhood
VSD is an error in...
early fetal development
when taking abx for gastroenteritis...
eat yogurt in between doses to replace bacteria that is needed for digestion, NOT with doses
catarrhal stage of pertussis
insidious onset of URI symptoms
rheumatic fever affects...
joints, skin, brain, serous surfaces, and heart
medical tx of Hypoplastic Left-Sided Heart Syndrome
keep ductus open w/ prostaglandin E infusion
nursing management of hypoxemia
knee-chest position, calm child, call for help
what structures does croup affect?
larynx (hoarse voice), trachea, and bronchi
subacute phase of KD
lasts from the end of fever through the end of all KD clinical signs
stronger side of the heart
left
Patent DA allows blood to flow from...
left to right
s/s of water intoxication
lethargy, seizures esp in younger kids, irritability, somnolence, headache, vomiting, diarrhea
Montelukast (singulair)
leukotriene receptor agonist that is approved for the treatment of preschool children older than 5 months of age
what meds are effective in school-age children with asthma?
long-acting beta agonists
why should we provide the hospitalized toddler with autonomy?
loss of control may lead to regression of behavior, negativity, and temper tantrums
infants are accustomed to having basic needs of food and sleep met by parent/primary caregiver and constraints of hospitalization results in...
loss of needs being met
what will you hear with VSD?
loud harsh murmur at left sternal border
patient with transposition of the great arteries will have...
low pulse-ox, permissive hypoxia
fluids when child is sick or has a fever
maintenance fluids plus a little more
Hirschsprung disease is more common in...
males and those with down syndrome
__________ produces biologic changes of puberty
maturation of gonads
s/s of small PDA
may be asymptomatic
What vaccines would a 14 yo have to catch up on if they have not been vaccinated in the past few years d/t insurance changes or other issues?
meningococcal, tdap, HPV (3 doses)
ideal time for formal sex education
middle childhood
stage I of asthma
mild, intermittent
stage II of asthma
mild, persistent asthma
stage III of asthma
moderate, persistent asthma
single greatest cause of serious and fatal injuries in teens
motor vehicle crashes
most common cause of severe injury and death in school-age children
motor vehicle crashes (pedestrian and passenger)
________ are used in schools for children with asthma
nebulizers
rules and judgements become more founded on _______ in school-age
needs and desires of others
puberty "delay" in females
no thelarche by age 13 years
innocent murmurs
normal cardiac anatomy and cardiac function
no ________ temp when child has gastroenteritis
rectal
risk of _______ with surgery for coarction of the aorta
recurrence
what happens when the closing of the ductus arteriosis doesn't happen?
pressure of the blood from the aorta pushes its way back into the pulmonary system and causes pulmonary HTN
primary nursing goal for hospitalized child
preventing or minimizing separation
osler nodes
red, painful nodes on pads of fingers
Asthma is associated with a higher prevalence of...
psychiatric disorders including anxiety and depression
what does school-age stage end with?
puberty with acquisition of final permanent teeth
Erythema marginatum
pink, non-puritic macular rash on the trunk and inner surfaces of the extremities that appears and disappears quickly
kohlberg moral development age 6-7
reward and punishment guide choices
when the blood is being shunted from the left to the right and pressure on the left is higher, it will go into...
pulmonary system and cause pulmonary HTN and HF
transposition of the great vessels
plumbing is messed up and the blood is not going where it needs to go
What is revealed in abd exam of a child with pyloric stenosis?
olive shaped mass in RUQ, most palpable when stomach is empty
Before the age of 6 many children wheeze, but...
only 40% of these early wheezers develop asthma
when do you give serum bicarb concentration for dehydration?
only when bicarb level is low
adolescence begins with...
onset of puberty
secondary enuresis
onset of wetting after established urinary continence
primary enuresis
onset of wetting in children who have never been dry for extended periods of time
therapeutic management of dehydration
oral rehydration over 4-6 hours replacing fluid loss
school-age child begins to internalize __________
outside opinions
sex hormones are secreted by...
ovaries, testes, and adrenal glands
janeway spots
painless hemorrhagic spots on palms and soles
Sex roles of school-age child are strongly influenced by __________
peer relationships
examples of high-dose abx used for infective endocarditis
penicillin, amipicillin, methicillin, cloxacillin, streptomycin, gentamicin
stage 5 of sexual maturation in males
penile growth, first ejaculation, axillary, groin, and facial hair, final voice change
s/s of systemic venous congestion
peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention
advantage of peak flow meter
person can take medications early before symptoms develop
________ for obesity in children is typically not recommended
pharm therapy
school-age children progress with __________ maturity
physical and emotional
When we have a child with bed wetting, what is the first thing we look for?
physical causes
causes of vaginitis may be...
physical, chemical, or infectious
rapid _______ maturation in adolescence
physical, cognitive, social, and emotional
size of VSD can be...
pinhole size to absence of entire septum
tx for hypoplastic left-sided heart syndrome
shunts, try to get desaturated blood to go into pulmonary system, use large right ventricle to also give some force to blood that is going to peripheral circulation through aorta
why do we give small amts of fluids at a time for replacement?
sick bellies don't like volume (once the gut fills they can vomit causing further dehydration)
__________ are important in school-age child shaping self-concept
significant adults
s/s of VSD depend on...
size of VSD and degree of shunting
what is the issue with small tracheal diameter in infant?
small amount of edema can cause obstruction
with KD, there is widespread inflammation of...
small and medium-size arteries
what can improve self-esteem of school-age child?
small successes
tx for tet spells
sometimes they grow out of it but often times a repair is done
respiratory distress
state characterized by signs of increased work of breathing
what kind of stools will CF patients have if they are not properly managing enzymes?
steatorrhea
obstructive blood flow is caused by...
stenosis
phimosis
stenosis or narrowing of foreskin so that it cannot be retracted over the glans penis
9 yo coming to nurses office almost daily and complaining about stomach pain, completed schoolwork but has been getting more aggressive in the classroom. What might be the problem?
stress
what do you absolutely not do for postop tonsillectomy?
suctioning
acute phase of KD
sudden high fever, unresponsive to antipyretics and antibiotics
__________ can be present with dehydration
sweating
s/s of impaired myocardial function
sweating; tachycardia; fatigue; weakness; restlessness; pale, cool extremities; decreased BP; decreased urine output; gallop rhythm; cardiomegaly
croup
swelling and narrowing of the airway around the vocal cords
intractable diarrhea
syndrome noted in first few months of life
oral meds for acne
systemic antibiotic therapy, oral contraceptive, isoretinoin, retinoic acid
what could you hear in pt with tetralogy of fallot?
systolic murmur
earliest sign of dehydration
tachycardia
s/s of severe dehydration
tachycardia, greater than 10% weight loss, sunken eyes and fontanels
s/s of pulmonary congestion
tachypnea, dyspnea, retractions, nasal flaring, grunting wheezing, cough, orthopnea, respiratory distress, exercise intolerance, cyanosis
Are bronchiolitis and RSV risk factors for developing asthma?
there is an increased risk but they are not absolute causes of asthma in toddlers
because the L ventricle hypertrophied with aortic stenosis...
there is increased pulmonary vascular resistance and pulmonary HTN and decreased coronary artery perfusion and increased risk of MI
why is it a big deal when baby has decreased urine output?
they are unregulated and putting it out like crazy
what children may be diagnosed with bronchiolitis after 1 year?
those who were premature, small stature, under 20th percentile on growth chart
which infants are more likely to have cardiac anomalies than general infant population?
those with IUGR
what are bronchodilators or inhalers used for in asthma pts?
to quickly relieve any moderate or severe asthma attack
Egocentric and magical thinking is typical of __________
toddlers
What age group is most impacted by separation anxiety?
toddlers
why can flexion or hyperextension in infant collapse the airway?
tracheal rings are c-shaped
topical meds for acne
tretinoin, benzoyl peroxide, topical antibiotic
extreme form of PS
tricuspid atresia
you rarely see CHF pts in ___________
uncomplicated ASD
in what pts do we need to regulate temp?
under 1 month because thermoreg hasn't developed
when do estrogen levels increase in females?
until about 3 years after menarche, then remains at this maximum level throughout reproductive life
what percentage of children experience innocent murmurs?
up to 50%
water content of the newborn
up to 75%
children with enuresis may have ________ or ________
urgency, frequency
aortic stenosis location
usually malformed in the bicuspid valve rather than the tricuspid valve
diagnosis of vaginitis is done by...
vaginal examination and microscopic evaluation of vaginal secretions
Prepubescence age
varying ages from 9 to 12 (girls about 2 years earlier than boys)
injection sites for child < 3 y.o.
vastus lateralis and rectus femoris
most common cardiac anomaly
ventricular septal defect
IM sites for child older than 3 yrs and walking
ventrogluteal or dorsogluteal
croup is a _______ illness
viral
The majority of asthma exacerbations in school-aged children are associated with ________
viral infxns
pneumonia can be caused by...
virus, bacteria, parasite, or fungus
Overweight is generally considered when...
weight is more than the 90th percentile
Obesity is generally considered when...
weight is more than the 95th percentile for age, gender, and height
when are repairs for tetralogy indicated?
when tet spells and hypercyanotic spells increase
when can RN not delegate vitals?
when they are the FIRST set
paradoxical respirations
when you see the chest falling on inspiration and rising on expiration, the opposite of normal respirations
s/s of internalizing stress
withdrawal, delaying tactics, and daydreaming
Do school-age children like rules?
yes, see a need for rules in games they play
prevention of RHD
•Treatment of streptococcal tonsillitis/pharyngitis -Penicillin G—IM ×1 -Penicillin V—oral ×10 days -Sulfa—oral ×10 days -Erythromycin (if allergic to above)—oral ×10 days •Treatment of recurrent RF -Same as above
