unit 3 test part 2
foo\llows object 60* horizontally and 30* vertically, blinks at approaching object
1 month vision milestones
reaches and grasps objects, picks up raisin by making raking, transfers objects from hand to hand
7-8 month vision milestones
pokes at holes in a pegboard, well developed pincer grasp, crawls, uncovers hidden toy
8-9 months vision milestones
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?
Cardiac catheterization visualizes the exact location of the ventricular septal defect; also it measures pulmonary pressures. A murmur can be heard with a stethoscope placed at the left lower sternal border. Cardiomegaly and ventricular hypertrophy are both demonstrated on electrocardiography and echocardiography.
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?
Hypoxia leads to poor peripheral circulation; clubbing occurs as a result of additional capillary development and tissue hypertrophy of the fingertips. A fever is not expected unless the child has an infection or is dehydrated; the data do not indicate this. The child's respiratory rate will be increased, not decreased. The child's problems are related to decreased oxygenation, not to a clotting deficiency.
arterial switch corrective for TGA aorta and pulmonary arteries are transected and reattached to the opposite stumps, coronary arteries are moved to a new aorta area
Jatene
A child with a congenital heart defect has a cardiac catheterization. What is an essential element of nursing care after this procedure?
Monitoring the extremity distal to the insertion site for changes in temperature and color should indicate the presence or absence of a clot; comparing pedal pulses of both extremities may reveal clot formation that disrupts circulation. The child is kept in bed at least 6 hours after the procedure. Fluids may be given as soon as tolerated. Pulses, not blood pressure, must be checked for quality and symmetry.
corrective for TGA when a VSD and severe PS is present the aortic root is translocated from the RV, w/ attached coronary vessels to the LV after reconstructing the L and R outflow tracts and patching the VSD
Nikaidoh
A child returns to his room after left-side cardiac catheterization. What is involved in the postprocedure nursing care?
Postprocedure hemorrhage, a life-threatening complication after cardiac catheterization, is possible because arterial blood is under pressure and the catheter has entered an artery. Rest will be encouraged; flexion of the insertion site should be avoided to prevent disturbance of the clot. Comparing blood pressures in the two extremities is unnecessary; the pulse distal to the catheterization insertion site is monitored. The blood pressure will not be unstable unless a problem develops; fluid intake should be encouraged.
acute pain tympanic membrane bulging pulling ear diarrhea vomiting fever irritable night awakening- pressure is increased when prone air/fluid bubbles behind tympanic membrane immobile tympanic membrane, displaced
S&S of acute otitis media
red nasal mucosa/ clear discharge infected throat w/ large tonsils vesicles of palate and pharynx
S&S of nasopharyngitis
A nurse is caring for a child with a cardiac malformation associated with left-to-right shunting. What does the nurse consider the major characteristic of this type of congenital disorder?
With a left-to-right shunt, blood flows through a defect in the ventricular wall of the heart and is shunted from the higher pressure left side to the lower pressure right side. The increased blood flow from the right ventricle results in an increased blood flow to the lungs. Polycythemia and an increased hematocrit are not common in children with a left-to-right shunt. Severe growth retardation is not common in children with a left-to-right shunt. Clubbing is a more common finding in children with a right-to-left shunt.
first line of treatment used if it has not been used in the last 30 days for AOM
amoxicillin
2nd line of treatment for AOM
amoxicillin w/ clavulanate & cefuroxime
10 days less than 6yr 5-7 days older than 6 yr
antibiotic treatment for AOM
electric response to auditory stimuli from 3 surface scalp electrodes. reflects activity of cochlea, cranial, nerve VIII, auditory brainstem pathway detects loss from 1000-8000 false negative for 500-2000 will give a positive result if there is damage to nerve VIII or brainstem pathway even if cochlear loss is not present
auditory brainstem response
rashkind or with trans atrial needle puncture and balloon dilation palliative for COA creates a larger defect at the foramen ovale b/w atria to increase blood mixing
balloon atrial septosomy
palliative for COA a deflated balloon is inserted and inflated to open a narrowed valve or blood vessel. a stent may be inserted to keep the ductus arteriosus open
balloon dilation procedure
palliative for TOF creation of aortopulmonary conduit from the brachiocephalic artery to pulmonary artery to increase pulmonary flow
blalock taussig shunt
this can decrease the chance of otitis media
breastfeeding
how are preschoolers tested for hearing
by repeating whispered words
impacted cerumen swimmers ear trauma tympanic membrane doesn't vibrate- may be restored after infection loss is gradual or rapid
causes of conductive hearing loss
genetic- tay sachs congenital acquired preceded by tinitus
causes of sensorineural loss
IM injection given for AOM
cefdinir cefpodoxime cefuroxime
conditions in external canal or tympanic membrane prevent sound reaching middle ear
conductive loss
children under 2 should not have
cough products
lip read 8 hand shapes= consonant 4 face positions=vowel based on letter sounds, not letters, see hears
cued speech
corrective for TGA pulmonary artery to aortic anastomosis pulmonary artery is cut in 2 w/ the proximal section attached to the ascending aorta, the distal section is sewn over, and a shunt is created b/w the systemic circulation and the pulmonary artery to send blood to the lungs
damus kaye stansel
What common finding can the nurse identify in most children with symptomatic cardiac malformations?
Children with cardiac malformations often require more energy to fulfill the activities of daily living; decreased oxygen utilization and increased energy output in the developing child result in a slow growth rate. Mental retardation is not a common finding in children with congenital heart disease. Cardiac anomalies are more often a result of prenatal, rather than genetic, factors. Clubbing is not characteristic of most children with cardiac anomalies, only of those with more severe hypoxia.
A nurse is reviewing the clinical records of infants and children with cardiac disorders in whom heart failure developed. What does the nurse identify as the last sign of heart failure?
Heart failure is characterized by a decrease in blood flow to the kidneys, causing sodium and water reabsorption and resulting in peripheral edema. The peripheral edema indicates severe cardiac decompensation. Tachypnea and tachycardia constitute an early attempt by the body to compensate for decreased cardiac output. Periorbital edema occurs most noticeably in children with acute poststreptococcal glomerulonephritis, not heart failure.
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?
Polycythemia, reflected in an increased hematocrit reading, is a direct attempt by the body to compensate for the decrease in oxygen to all body cells caused by the mixture of oxygenated and deoxygenated circulating blood. Proteinuria is not a characteristic of heart malformations that cause right-to-left shunting of blood; nor is edema. An absence of pedal pulses is characteristic of coarctation of the aorta, an obstructive malformation.
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?
Pulmonic stenosis increases resistance to blood flow, causing right ventricular hypertrophy; with right ventricular failure there is an increase in pressure on the right side of the heart. Pressure in the left side of the heart is decreased with pulmonic stenosis. Pressure in the pulmonary vein is decreased with pulmonic stenosis. Pressure in the pulmonary artery is decreased with pulmonic stenosis.
The nurse notes asystole on the cardiac monitor. Which action should the nurse take immediately?
Pulse should be immediately assessed because a lead or electrode coming off may mimic this dysrhythmia. Asystole is characterized by complete cessation of electrical activity. A flat baseline is seen, without any evidence of P, QRS, or T waveforms. A pulse is absent, and there is no cardiac output; cardiac arrest has occurred. Once confirmed, Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) protocols are initiated for asystole. Defibrillation is part of the ACLS protocol for ventricular fibrillation.
fever diarrhea anorexia restless vomiting sneezing irritable
S&S of nasopharyngitis in infants older than 3 months
dry, irritated nose and throat chills, fever muscle aches headache thin nasal discharge becomes thick and purulent anorexia malaise sneezing
S&S of nasopharyngitis in older children
lethargy irritable poor feeding fever/no fever
S&S of nasopharyngitis less than 3 months
pain itching pain when tragus is pressed swollen red drainage of canal
S&S of otitis externa
difficulty hearing or responding as expected tympanic membrane retracted or neutral yellow/gray tympanic membrane opaque/thickened membrane
S&S of otitis media w/ effusion
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?
Some mottling is expected because of circulatory disruption and arterial spasm. Further assessment (e.g., palpation of the pedal pulse) is performed to rule out arterial occlusion. Elevation of the leg is contraindicated; elevation may induce bleeding from the puncture site. A blanket will interfere with inspection. Other observations should be made before the primary healthcare provider is notified.
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?
Tachycardia results from sympathetic stimulation in the setting of heart failure; it is the body's attempt to increase cardiac output and increase oxygen supply to the body's cells. The respirations will increase, not decrease, when heart failure occurs. Distended neck veins occur only in adults when heart failure has progressed to systemic congestion. Urinary output is decreased as a result of sodium and water retention.
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?
The infant is experiencing a hypercyanotic ("tet" spell) episode caused by a sudden decrease in pulmonary blood flow and an increase in right-to-left shunting. It usually occurs after increased activity. The knee-chest position decreases venous return from the legs, which increases systemic vascular resistance, thereby increasing pulmonary blood flow. The supine and lateral positions increase venous return, which exacerbates the problem. Although the semi-Fowler position is recommended for infants with cardiac disease, it is not adequate for an infant experiencing a tet spell.
these have been shown to not be effective to treat otitis media
antihistamine decongestant
corrective for COA resection of narrowed section of the aorta and connection of the proximal distal section
aorta end to end anastomosis
used on children 3yrs and older various sounds a presented via earphones child raises hand when sound is hear detects sensorineural loss CANT detect loss from effusion
audiography
no sound at all can be heard
deaf over 90db
corrective procedure for ASD, VSD, PDA Closure of ductus arteriousos by an umbrella or coil device and closure of septal defect by a septal occluder
device closure
A child being treated with cardiac drugs developed vomiting, bradycardia, anorexia, and dysrhythmias. Which drug toxicity is responsible for these symptoms?
digoxin Digoxin helps improve pumping efficacy of the heart, but overdose can cause toxicity leading to nausea, vomiting, bradycardia, anorexia, and dysrhythmias. The side effects of nesiritide may include effects like headache, insomnia, and hypotension. Dobutamine does not cause nausea or vomiting but may cause hypertension and hypotension. Spironolactone may cause edema.
this can cause hearing loss
fluid accumulation
treatment for conductive hearing loss
hearing aid
microphone picks up sound outside the body speech processor organizes sound from microphone behind ear on belt transmitter transfers sound into electric impulses (part of headpiece behind ear) electrode sends signals to brain, receiver in skin behind ear w/ wire leading to cochlear fluid in middle ear
how cochlear implants work
long term use of nasal spray and meds w/ multiple ingredients for nasopharyngitis
is not recommended
most normal conversation speech sounds are missed
moderate 41-60 db
URI/cold imflamation and infection of the nose and throat. common in infancy and child hood. most common virus is the rhino, corona, most common bacteria is group a strep. RSV incubates 1-3 days. communicable several hours before symptoms and 1-2 days after. lasts 4-10 days
nasopharyngitis
alert to light and visual stimulus 20-30 cm from eye
neonate vision milestones
strep pneumonia H. influenza Maraxella catarhalls
organisms that cause otitis media
inflammation of skin and surrounding soft tissues of canal (swimmers ear), hot muggy weather, injury, drainage of fluid post tube placement, allergic reaction
otitis externa
inflammation of the middle ear sometimes caused by infection. common in boys and those in childcare centers, allergies, tobacco users, pacifier use, winter months, cleft lip/palate & down syndrome
otitis media
collection of fluid in middle ear behind tympanic membrane that is not infected with bacteria and NOT inflamed can cause hearing loss
otitis media w/ effusion
measures of low intensity sounds from the cochlear hair cells in response to clicks from a probe placed in the ear canal. sensitive in ranges above 1500 false negative for loss less than 1000-1500 detects inner ear loss does not detect loss from nerve VIII sensitive to outer ear obstruction or middle ear effusion
otoacoustic emission
positive pressure used to measure movement of membrane
otoscopy
corrective for COA insertion of a dacron patch or opened L subclavian vein to expand the lumen of the aorta
patch aortoplasty
50% is genetic, recessive trait 25% is related to inury, disease, ototoxic drug, head injury, noise
patho for hearing loss
eustachian tube dysfunction preceded by URI, causes tubes to become edema and block airflow to middle ear and it is reabsorbed in the blood. fluid is pulled from the mucosal lining into airspace which allows bacterial growth and infects the tympanic membrane and fluid
patho for otitis media
neonate visual acuity- 20/100, 20/400 lens more circular- cant accommodate near & far, sees best at 20cm optic nerve not myelinated- cant distinguish color preterm <32 wk- vascularization of retina incomplete pupil reflection-28-30wk rectus muscle for binocular vision uncoordinated at birth- aligned by 3months transient nystagmus & estropia common in neonates but decrease hemorrhage is common but corrects itself red reflex assessed 4 retinoblastoma, cornea occupies more space more susceptible to injury sclera is thin and translucent w/ blue tinge eye color changes- 6 months tears are not seen because they drain into nasal cavity
pediatric differences in the eyes
nasal breathers-6 months edema and nasal discharge interfere w/ air intake and feeding mucosal and swelling block nasal passages increase for resp. infection due to immature immune system and exposure tonsils- large nasopharyngeal tonsils located posterior wall of nasopharynx above oropharynx adenoids can enlarge and harbor bacteria which interferes w/ breathing sucking promotes muscles and speech taste present at birth first tooth-6 months 2yr- all primary teeth toothloss- 5-6yr
pediatric differences of the nose throat and mouth
greater infection risk due to shorter, horizonatal, wider eustachian tube fetus hears at 20 wks auditory nerve function mature-5 months small external, middle, and internal ear canal large ear and tympanic membrane is close to surface increasing injury risk
pediatric ear differences
used to diagnose otitis media w/ effusion
pneumatic otoscopy tympanometry
children should receive this 2 wks before receiving a cochlear implant less than 5- PCV7 greater than 5- PPV23
pneumococcal vaccine
myringotomy tubes to equalize pressure
possible treatments for multiple ear infections
encourage fluid intake Tylenol ear drops activity restriction watch getting water in ears watch for tube dislodgement report purulent drainage
post op interventions for tube placement
no speech sounds can be heard, legally deaf
profound 81-90 db
palliative for VSD placement of constricting band around pulmonary artery to reduce pulmonary blood flow and pressure
pulmonary artery banding
corrective for TGA w/ pulmonic stenosis, TOF creation of a conduit between the RV to pulmonary artery w/ closure of the ventricular septal defect.
rastelli
3 acute otitis media in 6 months or 4 otitis media in 12 months
recurrent otitis media
used in classroom to eliminate background noise speaker wears transmitter that picks up the voice and sends to receiver worn by child
remote microscope system
familial torch virus birth weight less than 2500/3.3 O2 >5 day Lasix, ototoxic drugs, hyperbilirubinemia requiring exchange transfusion chemo w/ aminoglycoside >5 days head trauma-basal, temporal ventilation >5 days down syndrome, pierre, robin, Arnold chiari,neurofibromatosis, osteopetrosis, hunter
risk factors for hearing loss
when hair in cochlea or along vestibulocochlear nerve VIII are damaged, hearing loss is permanent
sensorineural loss
speech sounds cannot be heard at a normal conversational level
severe 61-80 db
some speech sounds are difficult to perceive particularly unvoiced consonant sounds
slight loss 20-40db
measures the condition of the middle ear by introducing a sound and measuring the tympanic membrane.
special gradient acoustic reflectometry
corrective for COA division of the distal subclavian artery and insertion of a flap into the aorta through coarcted segment
subclavin flap ortoplast
A client at 28 weeks' gestation with previously diagnosed mitral valve stenosis is being evaluated in the clinic. Which sign or symptom indicates that the client is experiencing cardiac difficulties?
syncope on exertion syncope on exertion is a definitive sign of cardiac decompensation; cardiac output is not meeting cellular oxygen needs. Systolic murmur may occur in a healthy pregnant woman because of the displacement of the heart, caused by the enlarging uterus that shifts the contents of the thoracic cavity and the increased blood volume and cardiac output. Heart palpitations and a displaced apical pulse both may occur in a healthy pregnant woman because of displacement of the heart caused by enlargement of the uterus that shifts the contents of the thoracic cavity, and the increased blood volume and cardiac output.
screen before 1 month detect loss by 2-3 months interventions by 6 months
therapy for hearing loss detection
why are antibiotics only used for recurrent and bilateral infections and in children less than 24 months
to prevent antibiotic resistance
anesthetic drops, tyelonol check for intact membrane observe for 2-3 days if not improved give an antibiotic if severe or bilateral give anitbiotic
treatment for acute otitis media
remove dried epithelium and cerumen irrigate w/ burrow or NS solutions if membrane is intact steroid drops decrease inflammation antibiotics w/ infection, no ototoxic antibiotics (quinolone) w/ tubes or perforated membrane keep ears dry, blow dry after swimming no qtips or sprays
treatment for otitis externa
not treated with antibiotics monitored, improves usually in 3 months watch for hearing impairment
treatment for otitis media w/ effusion
pain relief assess hearing/speech assess development
treatment for otitis media w/ effusion
cochlear implant and conduction aids
treatment for sensorineural hearing loss
saline nose drops 3-4 hr, before feeding followed by bulb
treatment of nasopharyngitis for nosebreathers
a graph of the ability of the middle ear to transmit sound used for conductive hearing loss airtight probe inserted into external canal and tone is emitted. measures pressure and plotted on graph Flat= hearing loss
typonagram
how are school age and adolescents tested for hearing
weber and rhinne test
stacks blocks, places peg in round hole, stands and walks
12-14 months vision milestones
follows person/object 180* from 2M away. smiles at faces, raises head 30* from prone
2 month vision milestones
what is the visual acuity for a 6-7 yoa
20/20
what is the visual acuity to a 2-3 yoa
20/50
when do eyes slow growth and then reach adult size
3 14
tracks objects via 180*, regards own hands, visual motor coordination
3 month vision milestones
miss 50% of everyday conversation
35-40db
what is the longest time that decongestants should be used
4-5 days
social smile, reaches for cube 30 cm away, notices raisin 30 cm away, stares at own hand
4-5 month vision milestones
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?
A discrepancy in blood pressures from the arms to the legs indicates arterial stenosis caused by coarctation of the aorta. Projectile vomiting commonly results from pyloric stenosis; it is not of cardiac origin and does not occur immediately after birth. An irregular respiratory rhythm is common and expected in the healthy newborn. Hyperreflexia of the extremities may be indicative of a neurologic, not cardiac, problem.
