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342 Cards in this Set

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Brazelton neonatal assessment
alertness, response to visual and auditory, and motor coordination
absolute contraindication for hormone replacement
thromboembolic disease, estrogen based breast CA, Un DX VAG bleed
monozgotic
a single fertilized ovum twins!
dyzigot
2 separate ovum are fertilized
foramen ovale
heart problem that diverts blood between the atriums
ductus arteriousus
shunt that diverts blood from the pulmonary artery to the aorta
bloody show
dislodging of the mucus plug
frank breech
but presents and legs are pointed up! How cute!
Dont push until fully dilated R/T
fetal hypoxia and maternal exhaustion
American Indians
no meat in pre natal period
bun
8-25
Platelet count
150,000-400,000
Albumin
3.5-5
Ammonia
35-65
Digoxin therapeutic level
.5-2
Lithium therapeutic Leve
.5-1.3
Magnesium
1.6-2.6 mg/dL
Ca
8.6-10 mg/dL
A 3 yr old child is to receive 500 ml of dextrose solution over 8 hrs. At what rate should the nurse set the infusion pump?
500 divided by 8 = 62.5 ml/hr
Burns percentage
ead and neck 9%

trunk: front 18%, back 18%

arms: 9% each

legs: 18% each
Management of Burns
isolation
diet: HIGH protein,carbs,Vitamin C
LIMIT K intake
Systemic Lupus Erythematosus
multi-system inflam d/o involving the connective tissues such as the muscles,kidneys,heart,serous membranes
-may affect the skin,lungs, and nervous system
SIDE EFFECTS
doxorubicin (Adriamycin)
bone marrow suppression, N/V, alopecia, cardiac tocicity
1. The granulocyte colony-stimulating factor (G-CSF), Neupogen, is administered to clients with severe neutropenia resulting from chemotherapy. Which nursing responsibilities are appropriate when administering this medication?
a. Waiting at least 24 hours after the last dose of chemotherapy to begin
2. Clients receiving chemotherapy are at great risk for bone marrow suppression. When WBC counts drop severely, clients are in danger of life-threatening infections. Which would be most important to teach these clients to protect them from infection?
c. Bathing daily and washing their hands frequently, especially after using the restroom or handling contaminated objects.
amoxifen is a selective estrogen receptor modulator (SERM), that may be given to reduce the risk of breast cancer in women at increased risk for breast cancer. Which is a common side-effect that the nurse needs to teach the client about when beginning to take this medication?
hot flashes
Which are common sites for colon cancer metastases?
Urinary tract and liver.
What are the 3 phases of wound healing?
inflammatory, proliferative, and remodeling
Normal HCO3-
22 to 28
Respiratory Acidosis
Signs & Symptoms
1. Hypotension, dysrhythmias, tachycardia
2. Dyspnea
3. Rapid, shallow breaths
4. Muscle weakness & decreased LOC - Tremors, seizures, lethargy, stupor
Fluid volume deficit
Signs & Symptoms
1. Decrease BP
2. Increased, weak pulse
3. Postural hypotension
4. Decreased CVP
5. Elevated temp
Fluid volume excess
Signs & Symptoms
1. Jugular vein distention
2. Increased BP
3. Decreased, bounding pulse
4. Increased CVP
What does the bone marrow produce?
RBC, WBC, platelets
Where is erythropoietin produced?
Kidneys
Where are Kupffer's cells located?
Liver and spleen
When cells hemolyze in excess, what condition may appear related to the liver?
Jaundice--bilirubin broken out of hemoglobin goes into circulation
What does albumin prevent?
Plasma from leaking into the tissues
Reactive stress test shows
reacive is:
1. two FHR accelerations
2. lasting 15 seconds or more
3. over 20 minutes
what do you do when they have non reactive stress test
repeat again about 30 minutes later as the baby might be in a sleep cycle- have a woman eat something cause it'll wake up then
Name all 5 components of Biophysical profile:
biophys profile is:
1. fetal breathing movement
2. fetal movement of body and limbs
3. fetal tone
4. amniotic fluid in pockets visualized
5. reactive FHR with activy (reactive NST)
Ronchi
Low-pitched, rumbling and hyperresonant sounds on inspiration
A nurse is planning to provide a list of instructions to a client being discharged to home with a PICC. The nurse would avoid writing which of the following incorrect items on the instruction sheet?
only minor restrictions apply with this type of catheter. he should protect the site during bathing and shoudl carry or wear a Medic-Alert id. he should also have a repair kit because this is for long-term care
A nurse is assessing the IV dressing of a client with a peripheral IV running. The date on the dressing is 7/25. The nurse documents on the client's record that the dressing should be changed on which of the following dates?
change every 48 - 72 hours, 2-3 days.
A client has just undergone insertion of a central venous catheter at the bedside. A nurse would be sure to check the results of which of the following b4 increasing the flow rate of the IV solution attached to the line from a keep vein open rate to 100 ml/hr?
xray
A client is hypovolemic, and plasma expanders are not availible. A nurse anticipates that which of the following solutions available on the nursing unit will be prescribed by the physician?
a solution of 5% dextrose in 0.45% sodium chloride is hypertonic. An advantage of hypertonic solutions is that they may be used to treat hypovolemia when plasma expanders are not readily available
A nurse is assigned to care for a clt who was just admitted to the hospital for the trmt of iron overload. The nurse reviews the physician's admission orders and anticiptes that the Md will prescribe which med to treat the iron overload?
Deferoxamine is an antidote used to treat iron toxicity.
What are two types of hormonal regulation and give an example of each?
Negative feedback loop (RAAS system) and positive feedback loop (FSH & estrodiol)
What is diabetes insipidus?
A disorder of water metabolism in which there is excess water loss due to hypo secretion of ADH, damage to posterior pituitary or inability of kidney's to respond to ADH.
sickle cell trait
The condition in which a person has one copy of the gene for sickle cell (and is called a sickle heterozygote) but does not have sickle cell disease (which requires two copies of the sickle cell gene).
hodgkin's lymphoma
Lymphoma is a type of cancer involving cells of the immune system, called lymphocytes.
wilms tumor
A cancer of the kidney and one of the most important malignancies in childhood,
Maslow's Hiearchy of basic needs.
Self-Actualization
Esteem
Love and Feeling of Belonging
Safety and Protection
Activity
Physiological Needs
tarasoff act
duty to warn of threatened suicide or harm to others
The nurse receives the preoperative blood work report for a client who's scheduled to undergo surgery. Which of the following laboratory findings should she report to the surgeon?
Rationale: The nurse should call the surgeon for a serum creatinine level of 2.6 mg/dL, which is higher than the normal range of 0.5 to 1.0 mg/dL. An elevated serum creatinine value indicates that the kidneys aren't filtering effectively and has important implications for the surgical client because many of the anesthesia and analgesia medications need to be filtered out through the renal system. The red blood cell count, hemoglobin level, and blood urea nitrogen level are within normal limits and don't need to be reported to the surgeon.
When the nurse administers intravenous midazolam hydrochloride (Versed), the client shows signs of an overdose. Which of the following interventions should the nurse be prepared to implement first?
Rationale: The nurse should have an Ambu bag in the client's room, because if midazolam hydrochloride (Versed) is administered too quickly, it can lead to respiratory arrest. The client doesn't need to be defibrillated into a normal rhythm or to get epinephrine unless cardiac compromise developed after the respiratory arrest. The client would get titrated dosing of flumazenil (Romazicon) to reverse the Versed, but first the nurse would ventilate him.
Clinical Characteristics of Molar Pregnancy
Irregular bleeding
Uterine size > dates
No fetal heart
Abnormally high hCG titers
Development of pregnancy complications
Exaggerated Pregnancy symptoms
Snowstorm ultrasound
Possible malignant transformation
Calcium Supplements Nursing Implications
1. Give with Vitamin D to enhance absorption
2. Take PO 1/2 to 1 hour after meals
3. Prevent IV infiltration - can cause tissue hypoxia and sloughing
4. Do not add Ca+ to solutions containing carbonates or phosphates
5. Use w/ caution in client getting digitalis
6. Monitor infusion rate - sudden increase in serum Ca+ may precipitate severe dysrhythmias
Chvostek's Sign
Spasm of the muscles inervated by the facial nerve when the client's face is tapped lightly below the temple. Sign of hypocalcemia.
Trousseau's Sign
Contraction of the finger and hand, when a BP cuff is kept inflated on the upper arm for 5 minutes at diastolic pressure. Sign of hypocalcemia.
Hypocalcemia
Signs/Symptoms
1. Tetany: + Chvostek's or Trousseau's signs
2. Neuromuscular irritability
3. Numbness and tingling of extremities
4. Seizures
5. Abdominal cramping, distention
6. Hyperreflexia
7. Dysrhythmias
Potassium Supplements Nursing Implications
1. Give oral preparation with full glass of water/juice - Decreases GI upset
2. Ensure urinating adequately before starting admin
3. Parenteral K+ must be diluted and administered by IV drip
4. Do not give K+ IM or by IV push
5. IV K+ is irritating to the vein. If pain occurs, slow infusion rate or dilute solution in larger fluid volume
6. Admin with caution to clients with heart disease or taking digitalis preparations
Indications for the antidysrhythmic drug lidocaine include:
Ventricular arrhythmias.
Lidocaine is a sodium channel blocking drug used specifically to treat ventricular arrhythmias.
When giving adenosine, it is important to remember to:
Give it as a fast intravenous push.
Adenosine must be given as rapidly as possible, followed by a 50 mL normal saline flush in order to get all of the medication into the circulation quickly since the half-life of adenosine is A10 seconds.
Adenosine is used to treat:
Paroxysmal supraventricular tachycardia (PSVT)
The only therapeutic indication of use for adenosine is the treatment of PSVT.
For what potential side effects would the nurse monitor patients prescribed amiodarone?
bluish skin discoloration (pulmonary?), hyper- or hypothyroidism, photosensitivity, visual halos, dry eyes, decreased libido (corneal microdeposits)
A patient with a rapid, irregular heart rhythm is being treated in the emergency department with adenosine. During administration of this drug, the nurse should be prepared to monitor the patient for what effect?
Transitory asystole
When assessing a patinet who has been taking amiodarone for 6 months, what adverse reaction might the nurse identify?
photophobia
The nurse is assessing a patient who has been taking quinidine and asks about adverse effects. Adverse effects associated with the use of this drug include ...
Tinnitus
The nurse is reviewing the medications that have been ordered for a patient for whom a loop diuretic has been newly prescribed. The loop diuretic may have a possible interaction with ...
nsaids
A patient with diabetes has a new prescription for a thiazide diuretic. What statement should the nurse include when teaching the patient about the thiazide drug?
“Monitor your blood glucose closely, because the thiazide may cause the levels to increase”.
The nurse would plan to administer which channel blocking drug to a patient with cerebral arterial spasms following a subarachnoid hemorrhage?
Nimodipine (Nimotop)
Nimodipine crosses the blood-brain barrier and has a greater effect on the cerebral srteries than on other arteries in the body, thus it is indicated for the treatment of cerebral arterial spasm following subarachnoid hemorrhage.
What is the primary purpose of the Self Determination Act?
To allow pts to make informed decisions about lifesaving or life prolonging actions.
Haldol
is a phenothiazine and is capable of causing dystonic reactions- decreases agitation- normal dosage is 5-10mg daily-can cause Akathisia, characterized by restlessness-antidote is prescribed anticholinergic agent – if causes a stiff jaw and difficulty swallowing then give IM benztropine to prevent asphyxia or aspiration – neuroleptic maligment syndrome is a EPS effect of antipsychotic meds –has a rapid increase in temp. Pacing is a form of psychomotor restlessness (akathisia) that can often be relieved by pacing
-causes Parkinson-type symptoms
-Propranolol(Inderal) non-selective beta-adrenergic receptor blocking agent )( relieves akathisia
-Diphenhydramine(Benadryl) provides rapid relief for dystonia
Tricyclic antidepressants
can create fatal cardiac arrhythmias
-Nortriptyline is used for 1st time antidepressant -has few s.e.
-commonly cause orthostatic hypotension and dry mouth and blurred vision = can cause cardiovascular toxicity
-Sedation(drowsiness, tiredness) is a common early adverse effect of imipramine (Tofranil), a tricyclic, antidepressant and usually decreases as tolerance develops.
Neuroleptic Malignant syndrome
NMS
Rigidity, fever, hypertension, diaphoresis
-NMS is caused almost exclusively by antipsychotics, including all types of neuroleptic medicines along with newer antipsychotic drugs
-Dantrolene, a hydantoin reduces the catabolic processes and is admin to alleviate the symptoms of NMS
-
Lithium
chemically similar to sodium, if sodium levels are reduced, such as from sweating or dieresis, lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn’t restrict their intake of sodium and should drink adequate amts of fluid ea day. Signs of Lithium toxicity are diarrhea, vomiting, drowsiness, muscular weakness, ataxia, stupor, and lithargy
=dosages for lithium, an antimania drug. Usually are individualized to achieve a maintenance blood level of 0.6 to 1.2 mEQ/L. – a treatment level 1 to 1.4 mEq/L to prevent or control mania the serum level should measure 0.8-1.2 mEq/L should not exceed 2 mEq/L – used to treat clients with cyclical schizoaffective disorder . lithium helps control the affective component of this disorder. It is a nonantipsychotic drug- common s.e. are nausea, diarrhea, tremor and lithargy
SSRI
Adverse effects of sertraline (Zoloft) a SSRI, are agitation, sleep disturbance and dry mouth
MAOI
NO otcs check with md first
Negative signs of Schizophrenia
absence of typically displayed emotional responses
positive signs of Schizophrenia
auditory or visual hallucination
Schizophrenia
may be from overstimulation of dopamine-cause hallucinatins, agitation, delusional thinking and grandiosity
Theophylline (Theo-Dur) is a
xanthine bronchodilator

it dilates respiratory airways and relaxes the bronchial smooth muscles
Xanthine bronchodilators stimulate the
CNS and respirations,

dilate coronary and pulmonary vessels, causing diuresis,

and relax smooth muscles
Describe the characterstics of entering the second stage of labor
Extends form the complete dilation of the cervix to delivery of the fetus; duration is 3 hours for nulliparas to 30 minutess for multiparas
ballotable
when presenting part dips into inlet but can be displaced with upward pressure from examiners fingers
In reviewing discharge instructions for a client recently starting on Humalog Insulin. The nurse stresses the importance of eating within _________of taking this medication.
5 to 15 minutes
cor pulmonale
right ventricular enlargement from a primary pulmonary cause
s&s of HEMOLYTIC REACTION
CHILLS, BACKACHE, CYANOSIS, CHEST PAIN, TACHYCARDIA, HEADACHE, hypOtension
What is the function of a Miller-Abbott Tube?
removes fluid and gas from the small intgestines..often used for tx of paralytic ileus
When is a PKU test performed?
breastfed=one week old
bottlefed=3 days old
HIGHEST PRIORITY in caring for a pt with hypoparathyroidism
cardiac dysrhythmias related to low calcium levels
What is Buergers Disease?
An occlusive disease of the median and small arteries and veins
When does the posterior fontanelle close?
2-3 months
Pt on Tetracycline needs to avoid?"
the sun and milk
Diet for a child with Cystic Fibrosis=
High protein, High calories and LOW fat
what is a myelogram?
a lumbar puncure with injection of a contract medium, allowing x-ray visulaization of the vetebral canal
what does impetigo look like?
honey crusted lesions
what does a swan-ganz catheter measure
neasures the pulmonary artery wedge pressure which indirently measures the pressure in the ventricles
Baclofen
Cyclobenzaprine
Dantrolene
Muscle Relaxant
Insulin--regular
ntidiabetic;side effects: hypoglycemia, lipodystrophy; Only insulin than can be given IV
Sub q onset 1/2-1 hr, peak 10-30 minutes duration: 1/2-1hr
IV: onset:10-30min. peak:10-30, duration:.5-1hr
Nursing Interventions to Promote Healing with Infection/Inflammation
1. Increase fluid intake
2. Diet high in protein, carbs, and vitamins A, C, and B complex
3. Immobilize an injured extremity with a cast, splint, bandage
4. Administer antipyretic medications
5. Identify early signs of infection
Signs/Symptoms of Sepsis
1. Increased cardiac output
2. Hypotension, tachypnea
3. Poor regulation of body temp - either up or down
Droplet Precautions
1. Private room
2. Wear mask (surgical) when working within 3 feet of client
3. Keep client door closed
4. Clients w/ meningitis, flu
A 45-year old client is receiving heparin sodium for a pulmonary embolus. The nurse evaluates which of the following laboratory reports of partial thromboplastin time as indicative of effective heparin therapy?
C. Two to 2.5 times the control (normal) value.
During the evening following a partial gastrectormy, a client's oral temperature is 100F. Other data include a blood pressure of 134/68, a pulse of 88, and a respiratory rate of 18. The nurse should:
. Take the temp every hour until it is normal.
client with insulin-dependent diabetes mellitus (IDDM) is being discharged. The nurse knows that the client has understood essential teaching when the following statement is heard:
I need to cut my nails straight across.
A client is on chemotherapy for acute myelogenous leukemia. The nurse assesses the following laboratory test daily:
cbc
client's total parenteral nutrition is 6 hours behind schedulel. The nurse would
check the bs
A client diagnosed with insulin-dependent diabetes mellitus becomes irritable and confused; the skin is cool and clammy, and the pulse rate is 110. The first action of the nurse would be to
. Give a half-cup of orange juice
The nurse injects 0.1 ml of purified protein derivative (PPD) intradermally into the inner aspect of the raction to this test as positive when the following is seen
induration greater than 10 mm
When teaching a client to use the calendar method of contraception, which of the following should the nurse include in her teaching plan?
.Ovulation occurs around day 14 of the menstrual cycle, sperm are viable up to five days, and ovum live for 24 hours.
chylothorax
lymphatic fluid in the pleural space due to a leak in the thoracic duct
pulmonary hypertension
elevated pulmonary pressure resulting from an increase in pulmonary vascular resistance to blood flow through small arteries and arterioles
What is the classic sign of Chronic Venous Insufficiency?
tan or copper skin
What are the three points to Virchow's triad?
- Stasis of blood
- Vessel damage
- Increased blood coagulability
What is the chronic disease of the arterial system characterized by abnormal thickening and hardening of the vessel walls?
Arteriosclerosis
What is a form of arteriosclerosis in which deposits of fat & fibrin obstruct & harden arterial vessels?
Atherosclerosis
What law states that the more the ventricle is filled with blood during diastole (end-diastolic volume), the greater the volume of ejected blood will be during the resulting systolic contraction (stroke volume)?
Starling's Law
The patient's PR interval comprises six small boxes on the ECG graph. The nurse determines that this indicates
The normal PR interval is 0.12 to 0.20 seconds and reflects the time taken for the impulse to spread through the atria, AV node and bundle of His, the bundle branches, and Purkinje fibers. A PR interval of six small boxes is 0.24 seconds and indicates that the conduction of the impulse from the atria to the Purkinje fibers is delayed.
The nurse plans close monitoring for the patient who has undergone electrophysiologic testing because this test:
Electrophysiologic testing involves electrical stimulation to various areas of the atrium and ventricle to determine the inducibility of arrhythmias and frequently induces ventricular tachycardia or ventricular fibrillation. The patient may have "near-death" experiences and requires emotional support if this occurs
A patient with heart disease has a sinus bradycardia of 48 beats/min. The nurse recognizes that the patient is at greatest risk for:
In the presence of heart disease, a slow SA impulse may allow for escape arrhythmias and premature beats that can lead to further arrhythmias and decreased cardiac output.
A patient with an acute MI has a sinus tachycardia of 126 beats/min. The nurse recognizes that if this arrhythmia is not treated, the patient is likely to experience:
Although many factors may cause a sinus tachycardia, in the patient who has had an acute MI, a tachycardia increases myocardial oxygen need in a heart that already has impaired circulation and may lead to increasing angina and further ischemia and necrosis
patient with no history of heart disease has a rhythm strip that shows an occasional distorted P wave followed by normal AV and ventricular conduction. The nurse questions the patient about:
A distorted P wave with normal conduction of the impulse through the ventricles is characteristic of a premature atrial contraction. This arrhythmia is frequently associated in a normal heart with emotional stress or the use of caffeine, tobacco, or alcohol. Aerobic conditioning and holding the breath during exertion (Valsalva's maneuver) often cause bradycardia. Sedatives rarely may slow heart rate.
A patient's rhythm strip indicates a normal HR and rhythm with normal P wave and QRS complex, but the P-R interval is 0.26 seconds. The most appropriate action by the nurse is to:
. A rhythm pattern that is normal except for a prolonged P-R interval is characteristic of a first-degree heart block. First-degree heart blocks are not treated but are observed for progression to higher degrees of heart block.
A patient with an acute MI is having multifocal PVCs and ventricular couplets. He is alert and has a BP of 118/78 with an irregular pulse of 86 beats/min. The most appropriate action by the nurse at this time is to:
. PVCs in a patient with an MI indicate significant ventricular irritability that may lead to ventricular tachycardia or ventricular fibrillation. Antiarrhythmics, such as lidocaine, may be used to control the arrhythmias. Valsalva's maneuver may be used to treat paroxysmal supraventricular tachycardia.
The drug that controls ventricular arrhythmias in the treatment of MI is
iV amiodarone (Cordarone
The drug that helps prevent ventricular remodeling in the treatment of MI is
ace
The drug that is associated with decreased reinfarction and increased survival in the treatment of MI is:
beta
The drug that minimizes bradycardia from vagal stimulation in the treatment of MI is
stol softner
When should the ductus arteriosous close?
By 72 hours of life
the connection between the pulmonary artery and aorta should close
What causes the foramen ovale to close
when the systemic blood presessure rises, and the pressure inside the left atria is greater than the pressure in the right atria.
Who has brown fat, where is it, and why is it important?
Brown fat is found in term infants, superfically deposited around the scapulae, neck, axillae, and around the kidneys. Has a higher capacity for heat production via metabolism
What are the two high electrolytes in neonates?
na and cl
When should the passage of meconium occur?
24 -48 hrs
How often should bf occur?
2-3 hours for 10-15 min per brest
How far can a baby see
8 - 15 inches in front - in 1 month can view 3 feet
What are the two ways to treat hyperbilirubinemia
Phototherapy
Exchange transfusion
moro
this is strongest during the first 2 months it should disappear after 3 to 4 months of age.
early decels
this occurs before the peak of the contraction, it results from fetal head compression.
late decels
this occurs after peak of the contraction; results from cord compression
varible decels
this occurs anytime during contractions, its results from cord compression
Decreased Variabilty
irregular fluctations in the baseline of the Fetal Heart Rate. Usually occurs after narcotics have been adminstered.
fundus
The fundus rises to level to umbilicus to 6 to 12 hours after delivery; beginnging with day one, the fundus descends about 1 fingerbreadth per day.
svt tx
Performing the valsalva maneuver can reverse SVT, blowing should occur for 30 to 60 seconds; other possible vagal maneuvers include ice to the face, holding the breath and bearing down, also massaging the carotid artery on only one side of the neck.
Volkmann Contracture
this is a type of compartment syndrome caused by obstruction of arterial blood flow to the forearm and hand; cannot straighten fingers, has severe pain, and there may be signs of diminished circulation.
Cardiac Tamponade
Diagnostic tests used to detect cardiac tamponade is a chest x-ray which shows a slightly widened mediastinum and enlarged cardiac silhouette.
Emergency Treatment for Cardiac Tamponade
the treatment for cariac tamponade is pericardiocentesis or needle aspiration of pericardial cavity, it is done to relieve tamponade.
Pentamidine Isethionate

ABX for pcp tx
clients with AIDS receiving pentamidine isethionate should have their blood sugar levels monitored frequently because that drug can cause permanent diabetes mellitus.
Contagious Infection Period for TB
After 4 weeks of treatment for TB the disease is no longer considered infectious but the client must continue to take their medication.
Ticlopidine
this drug prescribed to prevent a thromboembolic stroke it inhibits platlet aggregation by interferring with adenosine diphosophate releases in the coagulation cascade and is used to prevent thrombomblic stroke
Risk factor for Cataracts
prolonged nsaid use
Trends with ICP
lower the c02 lower the icp!
Early Signs of Myasthenia Gravis
These include Ptosis and Dipolpa. Late signs include dysphagia, and respiratory distress occur later.
Autonomic Dysreflexia
this condition displays an anxiety, flushing above the level of lesion, piloerection, hypertension, and bradycardia.
Rules for Sunctioning
Suction should be applied for 10 to 15 seconds at a time. Sunction is regulated to 80 to 120 cm. Suction should be applied only during withdrawal of the catheter. When suctioning the trachea, the catheter is inserted 4" to 6' or until resistance is felt.
What is Egophony
An abnormal change in tone, somewhat like the bleat of a goat, heard in auscultation of the chest when the subject speaks normally.
What is Fremitus
Vibratory tremors, esp. those felt through the chest wall by palpation.
"99"
What are the signs that will be seen with an emphysema client?
Coughon with thick sputum
Wheezing
SOB on exertion
Weaknes
Lethargy
IncrePased Ant/Post Chest
Pursed Lip Breathing
Ruddy Skin
Clubbed Fingers
What are dietary recommendations for a COPD client?
Low Carb, High Fat/Protein
s4
Atrial gallop, heard before S1, an abnormal heart sound
an acute, potentially fatal exacerbation of hyperthyroidism that may result from manipulation of the thyroid gland during surgery, severe infection, or stress
thyroid storm
a rare but serious disorder that results from persistently low throid production. compa can be precipitated by acute illness, rapid withdrawal of throid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opiod analgesics
myxedema coma
addisonian crisis
a life-threatening disorder caused by adrenal hormone insufficiency; precipitated by infection, trauma, stress or surgery; Death can occur from shock, vascular collapse, or hyperkalemia
Band Neutrophils normal 0-8%
increased in:
acute infection-- shift to the left
Why is colchicine effective in the treatment of gout?
MOA for colchicine is that it DECREASES inflammation by reducing the migration of leukocytes to synovial fluid
What is arthrodesis?
fusion of joints
A child with Wilm’s tumor labs should be checked for
anemia
What is a sign of hypokalemia?
muscle weakness
What is DDH (developmental dysplasia of hip)
DDH is a malformation of the hip joint found in babies or young children

Risk factors include being the first child, being female, a breech delivery, and a family history of the disorder.
What is GANGRENE
lack of oxygen supply that leads to thrombosis and tissue necrosis and localized edema.
s/S of primary dementia of the Alzheimer's type.
slight memory impairment and poor concentration, subtle personality changesand occasional ierritalbe aoutburst and lack of spontaneity
Define Aparazia
inability to carry out motor activities.
Benztropine (Cogentin) is used to treat extrapyramidal effects induced by antipsychotics. this durg exerts its effect by:
blocking the cholinergic activity in the CNS.
A client who is taking antipsychotic medication develops a very high T, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. the snurse suspects what complication of antipsychotic therapy?
Neuroleptic malignant syndrome. a rare but potentially fatal condition of antipsychotic medication.
Important teaching for a cleint receiveing risperidone (Risperdal) would include adivising the client to:
Notify Physician if an increase brusing occurs
. Rationale: Dextroamphetamine is a psychostimulant and acts on the CNS. It would increase anxiety and elevate mood. CNS
Dextroamphetamine (Dexedrine) has been ordered for a client diagnosed with narcolepsy. The nurse understands that this medication act
Which is the drug of choice for treating Tourette syndrome?
haldol
Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)
Rationale: A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine. Because of the risk of agranulocytosis
What is TORCH?
Group of infections that can cause birth defects.
T = Toxoplasmmosis
O = Other infections (Hep B, Syphillis, Herpes Zoster)
R = Rubella
C = Cytomegalovirus
H = Herpes Simplex Virus
What effects can infections have on a pregnant woman?
Sepsis to mother, PROM, Sepsis to neonate (high mortality rate)
What are the types and differences of spontaneous abortions?
Spontaenous abortion – occuring naturally

Types of Spontaneous abortion:
Threatened – Pt has been bleeding
Imminent – Pt is bleeding, cervical os is open, cramping.
Complete – Fetus and placenta are expelled
Incomplete – Fetus is expelled and placenta is left inside.
Missed – Fetus dies before the 20th week of gestation
Habitual – Pt has 3 abortions between 14-16 weeks (usually due to incompetent cervix – cerclage performed)
What are the things to remember with vaginal bleeding durng pregnancy?
it occurs < 12 weeks: It may be a spontaneous abortion which ma herold the need for a D&C

If it occurs > 12 weeks: It is more than likely a placental problem.

WITH BLEEDING FOR PT
What is a Biophysical Profile (BPP)?
ltrasound with Non Stress Test. Check for body movement, muscle tone, breathing movement, amniotic fluid and fetal heart beat. Checking that fetus has enough O2 in the womb.
What is the management taken for a patient with PROM?
emember: Amniotic fluids is continually produced, Hospitalized, Bed Rest, Trendelenberg position – If bag of water is bulging., Daily CBC (look at WBC for infection), CRP (C-reactive protein – checks for inflammation – if elevated = infection), Fetal well-being tests: Non-stress test, Biophysical Profile, Medication: Celestone or Beta methezone (Steroid) – IM injection to help mature baby’s lungs – given 1 – 2 times Q 24 hours. Lung surfactant ratio 2:1 (mature lungs).
What is the management for a patient with an incompetent cervix?
Cervical cultures for GC, GBS (Group B Strep) in first trimester – May cause spontaneous abortion., Bed rest, Trendelenberg position, Shirodkar suture / cerclage - **Cerclage = stitch the cervix but the pt cannot be bleeding or more than 4 cm dilated. Performed at 14 weeks under epidural with no harm to the baby. Before mom gives birth, the stitch can be snipped (around 37 weeks) or it may simply pop so she can go into natural labor.
What is the management taken for a patient in pre-term labor?
Bed rest, Hydration – place IV or drink a pitcher of water. Contraction can be caused by dehydration., Empty bladder – Check for bacteria for UTI – it can cause pre-term labor. If UTI, give antibiotics., Tocolytics – Toco = contractions, Lysis = to kill.: Terbutaline (Brethene) – bronchodilator, stops contractions (give sub-Q Q15 –20 min x 4) Side effects: Tachycardia. Perfect drug choice if the pt is having difficulty breathing and contractions., Mg SO4 – Relaxes the uterus. MgSO4 is not used to decrease BP in this case., Administer Abx – Infection (if PROM), If pt. bleeding – DO NOT PERFORM PHYSICAL VAGINAL CHECK, Perform and reinforce perineal care – for infection, Teach mother signs of labor: It may be pressure, cramping, it is rhythmic., Nitrazine test for amniotic fluid – urine is acid, amniotic fluid is base, Ferning test – performed by MD – fluid placed under microscope to check (+) for amniotic fluid, Possible grief counseling, Place pt. left side lying., If PROM occurs and mother is Rh Neg, Rhogam will be given if it has not been already given during the pregnancy.
What are the things to remember about Magnesium Sulfate (Mg SO4)?
ook out for: Decrease in Respirations, Check Reflexes – should not be slow (Normal reflexes is +2) Mg SO4 relaxes reflexes. **When a person comes close to seizing, they become hyperexcitable / hyperflexive., Check labs, Decrease stimulation for this patient – dim lights, place pt away from the nursing station., Check LOC, Antedote: Calcium Gluconite, You can give Solestom (Steroid) Beta Methadone with Mg SO4 to mature the baby if pre-term.
What are the things to remember about Brethine / Terbutaline?
Look out for: Tachycardia, if HR > 120, hold drug., Antedote: Propranolol (Inderol) – Beta Blocker.
pih
once the fertilized egg is implanted in the uterus, the body’s natural response is to dilate blood vessels to allow more blood to the fetus. However, in PIH, the opposite occurs. The reason is not really known. What happens?: Vasocontriction, Leads to microbreakdown of the vessels (small tears and cracks, Leads to leaking of fluids into the tissues, Causes edema (this is why weight is checked at prenatal visits), Causes protein to be found in the urine. (this is why urine is checked at prenatal visits)

Pregnant women have dependent edema anyway due to the pressure of the growing uterus on vessels. This is why when laying down, particularly while you sleep, it causes more blood to flow, which causes more urine production. Pt’s with chronic HTN may have poor placental implantation.
What to remember about jaundice and newborns
A “normal” jaundice can occur with babies. It happens 24 hours after the baby is born. An “Abnormal” jaundice is seen within 24 hours of delivery. S/S: Yellow skin, sclera of the eye, pale stools, dark urine, elevated liver enzymes (ALT and AST). This is due to intestine’s inability to process bilirubin (excreted through feces). So it builds up in the body (under skin and eyes and body tries to eliminate through urine). If there is too much bilirubin, it can cause Kernicterus – brain damage to the baby.
Causes of Cerebral Palsy
Causes of Cerebral Palsy

• PREMATURE birth
• Perinatal ASPHYXIA
• INFECTION
• Intrauterine ISCHEMIA
• Congenital BRAIN Anomalies
• METABOLIC Disorders
Seizure Types
Seizure Types
• Partial
– Simple
– Complex
• Generalized
– Tonic-Clonic
– Absence
– Atonic
– Akinetic
Etiology of Seizures
Etiology of Seizures

• Idiopathic
• Infectious Process
• Metabolic Imbalance
• Fever
• Brain Injury or Brain Tumor
• Drug Intoxication
• Subtherapeutic Drug Levels
meningitis
MENINGITIS Tx/NSG Intervent.

• Meds: ABX
• Isolation precautions
• Ventilation
• Fluid restriction
(how much? 1/2 to 2/3)
• Monitor for increased ICP
• Comfort measures
• Hearing tests
Most common
causative organisms
of MENINGITIS (80%)
Haemophilus influenza b
(Hib)

• Strep pneumoniae
(pneumococcal)

• Neisseria menigitidis
(meningococcal)
Which of the following signs is considered
a late sign of shock in children?
Hypotension
A nurse is giving discharge instructions to the parents of a child with Kawasaki disease. Which of the following statements shows an
understanding of the treatment plan?
3. “My child should use a soft-bristled toothbrush.”
When assessing a child with suspected
Kawasaki disease, which of the following
symptoms is common
. “Strawberry” tongue

1st sign - HIGH (not low) fever
Kawasaki Disease
* Pathophysiology
awasaki Disease
* Pathophysiology
- VASCULitis (BV inflamm)
- PANCARDitis (inflamm of
ALL structures of heart)
- ECTASIA (dilation of
tubular vessel) on
echocardiogram
Which of the following cardiovascular disorders
is considered acyanotic
1. Patent ductus arteriosus
Administration of which of the following drugs
would be the most important in treating
transposition of the great arteries?
4. Prostaglandin E1
Which of the following home care instructions in included for a child postcatheterization?
1. Encourage fluids and regular diet.
Beta-thalassemia
Medical/Nursing Management
Beta-thalassemia
Medical/Nursing Management

• Medical Tx:
– Chronic transfusions
– Sometimes splenectomy
– Bone marrow transplant
• Nursing Issues:
– Blood Transfusions
– Chelation therapy
– Risk of infection, post-
splenectomy
– Patient/Family Education
Acute Lymphocytic Leukemia
Acute Lymphocytic Leukemia

• Presenting symptoms:
Fever, bone pain,
pallor, bruising

• 3 Treatment phases (chemo)
– Induction (4 weeks)
– Consolidation (6 months)
– Maintenance (2 - 3years)
• For relapse, further chemo
and bone marrow transplant
Acute Myelogenous Leukemia
Malignant proliferation of
myeloid cells n bone marrow

• Presenting symptoms:
Flu-like, bleeding, or as
in ALL

• TX:
– Induction phase
– Intensive chemotherapy

• Increased incidence of DIC
Beta-thalassemia
Beta-thalassemia

• Mediterranean, Middle
East, Africa, South
China, Southeast Asia
• Synthesis beta Hgb chain impaired
• RBCs w/ less Hgb
• RBCs in marrow destroyed
• Increased erythropoietin,
but ineffective RBC
production
• Bone marrow hyperplasia
• Sequelae:
– Severe anemia
– Impaired growth/
development
– Without treatment: death
by 5 – 6 years
A nurse, planning dietary and fluid management for a client with alcohol-induced cirrhosis and elevated serum ammonia levels, recognizes that which of the following is the most appropriate to include in the plan?
Protein restriction of 75 to 100 grams per day

Though dietary needs change as hepatic function fluctuates, sodium is generally restricted to 2 g or less/per day to reduce ascites and generalized edema. Fluids are generally limited to 1500 mL/day. Magnesium deficiency often accompanies alcohol-induced cirrhosis, necessitating magnesium replacement. When serum ammonia levels are high, protein is restricted to 75 to 100 g per day. When serum ammonia levels stabilize, protein intake is allowed as tolerated
The nurse is preparing a client with ascites for an abdominal paracentesis.
he preparation of a client for abdominal paracentesis includes positioning in a sitting position, either in a chair on the side of the bed. Baseline vital signs are obtained, and since this is an invasive procedure, informed consent is also obtained. The client should void immediately prior to the paracentesis to avoid bladder puncture
Sclerotherapy is used to treat
C. Esophageal Varices
Hydroxyzine (Atarax, Vistaril)
antihistamine
s.e.: drowsiness, dry mouth
nurs. consd:
tmt of pruritus, pre-op anxiety, post-op nausea and vomiting, to potentiate opioid analgesics, sedation
-PO; onseet 15-30 min, duration 4-6 hrs
-avoid use of alchohol, other CNS depressants
-teach pt. dizziness/drowsiness may occur, use caution in potentially hazardous activities
-Rx; preg C
Lamotrigine (Lamictal)
Anticonvulsant
s.e.: CNS symptoms, NV, anorexia, abd. pain, dysmenorrhea
N.C.: for mgmt of seizures
in peds, stop at 1st sign of rash, inform M.D.
-take divided doses w/meals or pc to decrease adverse eff.
=use caution w/activitie
=physical dependence, withdrawal problems
- wear med tags
Rx preg C
Phenobarbital (Luminal)
Anticonvulsant
s.e: CNS effects, depressive effects on body systems, rash, initially constricts pupils, Respiratory depression
-mgmt of epilepsy, febrile seizures in child.,sedation, insomnia
-IV: slow rate-crash cart availible
-IM: inject deep into large muscle, onset 10-30 min
-PO: onset 20-60 min pk 8-12 hrs, dur. 6-10 hrs
-caution w/activitie
-Nystagmus may indicate early toxicity
-Physical dependence, withdrawal problems
-give Vit D if long-term use
Rx: C-IV D=PO
Phenytoin (Dilantin)
Anticonvulsant
s.e.: CNS symptoms, wgt loss, photosensitivity
N.C.: mgmt of seizure
-give w/out regard to meals, can put in juice or applesauce
-physical dependence/withdrawal problems
-use caution w/activities
-increase fluid intake-kidney stones
-if eye problems-stop drug
-photosensitivity
-wear med tag
preg C `
Valproic Acid (Depakene, Myproic acid)
Anticonvulsant
CNS symptoms, mental status, behavioral changes, NVCD,heartburn, prolonged bleeding time
N.C.:mgnt of seizures
-take w/meals or pc
-swallow whole,no crushing
-withdrawal problems
-monitor bl. levels, platelets, bleeding time, liver function tests
-onset 2-4 days, pk level of syrup 15-120 min, caps-1-4 hrs,, dur: 6-24 hrs
-wear med tag
-preg D```
Aminoglycosides:
Amikacin, Gentamicin, Tobramycin (Amikin, Garamycin, Tobrax)
Anti-infective
s.e.:do not use during preg. may cause bilateral congenital deafness,
Ototoxicity cranial nerve VIII
Nephrotoxicity
Allegric reactions: fever, diff. breathing, rash
N.C.: trtmt of severs systemic inf. of CNS, resp.,GI, urinary tract, Bone, skin, soft tissures, acute PID
-IV over 1/2 -1 hr: IM deep,slow, never SQ
-monitor bl.levels
-ch peak-2 hrs after admin
-ck trough-at time of dose/prior to med
-monitor for superinfection(diarrhea, URI, coated tongue)
-immediately report hearing or balance problems
-encourage fluids 8-10 glasses daily
preg C
Anti-malarials: Hydrozychloroquine (Plaquenil)
s.e.: eye disturbances, NV, Anorexia
N.C.: mgmt of malaria, lupus erythematosus, rheumatoid arthritis
-peak 1-2 hrs
-take at same time ea day to maintain bl levels
-for malaria, prophylaxis should be started 2 wks b4 exposure and for 4-6 wks after leaving exposure area
preg C
Anti-malarials:
Quinine Sulfate
Anti-infective
s.e.: eye disturbances, NV, Anorexia
N.C.: mgmt of malaria,nocturnal leg cramps
-peak 1-3 hrs
-take same time ea day to maintain bl. levels
-avoid OTC cold meds, tonic water
-preg X
Anti-protozoals: Metronidazole (Flagyl, Flagyl ER)
anti-infective
CNS symptoms, abd cramps, metallic taste,
N.C.: trtmt of wide variety of inf.including trichomoniasis and giardiasis
=IV:immediate onset, PO-pk 1-2 hrs
=dark-reddish brown urine
=avoid hazardous activities
=trtmt in both partners for trichomoniasis
=do not drink alcohol in any form, during and 48 hrs after use, disulfiram-like reaction can occur
preg B
Complications of Thyroidectomy
Includes hypocalcemia injury to parathyroid glands causes decease in serum calcium, thus the RN should assess for hypocalcemia (tingling around the mouth, toes, fingers, and muscular twitching)
PET scan
The priority for patients care is to ensure that the patient will be comfortable and able to lie still through out the procedure, that may last as long as 2 hours
Chadwick's Sign
ncreased vascularization causes a softening and blue-purple discoloration which occurs at about 6 weeks gestational age.
Dupuytren Contracture
a slow progressive contracture of the palmar fascia causing flexion of the 4th and 5th fingers resulting from inherited autosomal dominant trait, occurs most often in men over 50 years of age, of Scandinavian or Celtic descents. Also associated with diabetes mellitus, gout, arthritis, and ETOH use
clozaril
an atypical antipsychotic, side effects include leukopenia, gram-negative septicemia, drowsiness, tachycardia, and hypotension.
Mg
1.6 to 2.6
Location to Auscultate for the Tricuspid
5th Intercostal Space Left Side
Signs and Symptoms of Lithium Toxicity
Diarrhea
* Over sedation
* Tinnitus
* Ataxia
* Slurred Speech
* Muscle Weakness/Twitching
What is precipitate labor?
A labor that is completed in less than three hours. More common with the multiparous woman. Poses risk of trauma to the fetus as well as trauma to the maternal soft tissue.
Early preparation for labor, Support the perineum in case of delivery
What is a second degree laceration during delivery
Tear of: Perineal skin, vaginal mucosa, fascia, muscle of the perineal body.
Obstetric conjugate
Distance from the middle of the sacral promontory to an area approximately 1 cm below the pubic crest.
A Hmong client has just given birth to a five pound baby girl. What culturally sensitive nursing action is appropriate at this time?
Offering the mother a soft-boiled egg to eat is the culturally sensitive nursing action appropriate for the postpartum Hmong client. Commenting on the daintiness of her baby girl and assisting the mother in bathing the baby is not a cultural preference. Warm foods are preferred by this culture at this time so offering cold foods would not be appropriate.
The nurse is caring for a client in the transitional stage of labor. What objective data would indicate that the client is having pain?
Dilated pupils, along with increased blood pressure, pulse and respiration rate, indicate pain. Muscles would be tense.
laboring client complains to the nurse about intense pain located primarily in her back. Which fetal presentation should the nurse expect to see written on the client's chart?
Either occiput-posterior (LOP or ROP) position of the fetus is one that would cause a woman to complain of intense backache as the fetal head presents a larger diameter in the posterior position. The anterior positions or transverse positions do not place additional pressure on the sacrum and are not associated with intense backache.
A pregnant client asks the nurse, "How will I know when I am close to starting labor?" The nurse correctly states that one possible sign of impending labor
Impending labor may be indicated by a weight loss of 2.2 to 6.6 kg (1 to 3 lb) resulting from fluid loss and electrolyte shifts produced by changes in estrogen and progesterone levels. Diarrhea, indigestion, or nausea and vomiting usually occur just prior to the onset of labor. Some women report a sudden burst of energy approximately 24 to 48 hours before labor. Abdominal discomfort can be a sign of false labor.
A nurse is caring for a client during the fourth stage of labor. What are the expected assessment findings at this time?
Decreased blood pressure and increased pulse are the expected assessment findings during the fourth stage of labor.
A nurse assesses a rise in the fundal height and a sudden gush of blood from the vagina of a postpartum client five minutes after birth. The nurse appropriately interprets these finding as
Separation of the placenta is characterized by a rise in fundal height and sudden gush of blood five minutes after birth. Immediate postpartum hemorrhage is not characterized by a rise in fundal height. Late postpartum hemorrhage occurs 24-48 hours or more after birth. Delivery of the placenta is characterized by a decrease in fundal height.
A G4P3 client in the transition phase of labor asks the nurse, "How much longer will it be before I have my baby?" What would be the best estimate that the nurse could provide?
One hour is a reasonable estimate of time until delivery for a multipara woman in transition. Two hours or more would be a more appropriate answer for a nullipara woman.
A nurse is caring for a client admitted to the birthing unit with rupture of membranes for two hours. A pelvic exam reveals a dilatation of 4 cm and the presenting part is not engaged. Which possible complication should the nurse anticipate?
When a pelvic exam reveals a dilatation of 4 cm and the presenting part is not engaged, the nurse should anticipate a prolapsed cord
A client at 39 weeks' gestation calls the clinic nurse with complaints of pelvic pressure, increased urinary frequency, and vaginal secretions. The nurse would correctly interpret these as signs and symptoms of a(n):
pelvic pressure, increased urinary frequency, and vaginal secretions are symptoms of impending labor.
A nurse is reviewing the factors important in the process of labor. Which two pelvic types are favorable for labor and vaginal delivery?
Gynecoid and Anthropoid pelvis types are favorable for labor or delivery, whereas Android and Platypelloid pelvis types are not favorable.
Mydriatics
Dilate the pupils
Miotics
Constrict pupils
What is FAB9 and when should it be started?
Folic acid= B9 (B for Brain decreases neural tube defects)Should begin 3 months prior to pregnancy
Amount of amniotic fluid
500-1200ml
Theraputic drug level of digoxin
0.5-2.0
BUN
7-22
WHAT IS THE TREATMENT FOR HYPOTENSION AFTER AN EPIDURAL ANESTHETIC?
STOP

S=STOP PITOCIN IF INFUSING
T=TURN CLIENT ON LEFT SIDE
O=OXYGEN ADMINISTRATION
P=PUSH IV FLUIDS
MAOI (Antidepressant)

Foods to Avoid
Tyramine-rich foods
Matured/aged cheeses,
(incl. pizza, pastas that include their use)
Air dried, aged, and fermented meats,
Pickled herring
Broad bean pods
All tap & unpasteurized beers
Marmite, Sauerkraut,
Soy sauce, Soybean condiments
Nefazodone (Serzone)

Drug Class
SNRI (Antidepressant)
Fluvoxamine (Luvox)

Drug Class
SSRI (Antidepressant)
Imipramine (Tofranil)

Drug Class
Tricyclic Antidepressant
· Acyanotic heart defects: blood is shunted left to right side of the heart
Types of acyanotic defects:

§ Aortic stenosis

§ Atrial septal defect

§ Coarctation of aorta

§ Patent ductus arteriosus

§ Pulmonary artery stenosis

§ Ventricular septal defect
Acyanotic heart defects clinical findings
Diaphoresis

§ Congested cough

§ Fatigue

§ Machinelike heart murmur

§ Mild cyanosis

§ Respiratory distress

§ Tachycardia

§ Tachypnea

§ Frequent respiratory infections

§ Hepatomegaly
Acyanotic heart defects tx
Aortic stenosis: surgery

§ Atrial septal defect: surgery to patch hole

§ Coarctation of aorta: closed heart resection

§ Patent ductus arteriosus: ligation of patent ductus arteriosus

§ Pulmonary artery stenosis: open heart surgery

§ Ventricular septal defect: pulmonary artery banding

§ Drug therapy:

· Cardiac glycoside:

o Digoxin (Lanoxin) apical rate for 1 full minute hold for heart rate less than 60 beats/minute

· Diuretic:

o Furosemide (Lasix)
Acyanotic heart defects monitor
Monitor:

· Cardiovascular status

· Respiratory status

· Vital signs

· Pulse ox

· I&O

· Weight

· Fluid and electrolyte status

§ Fluid restriction

§ Weight child daily

§ High calorie; easy to chew diet

§ Maintain normal body temperature

§ Activity with frequent rest periods

§ Head of bed elevated
· Cyanotic heart defects:
Types of cyanotic defects:

§ Transposition of great vessels

§ Tetralogy of Fallot

§ Hypoplastic left heart syndrome

§ Truncus arteriosus
Contributing factors:

§ Conditions that increase pulmonary vascular resistance

§ Structural defects
Cyanotic heart defects:
Cyanosis

§ Crouching position

§ Clubbing

§ Irritability

§ Tachycardia

§ Tachypnea

§ History of poor feeding
Cyanotic heart defects tx
Transposition of great vessels corrective surgery by age of one

§ Tetralogy of Fallot surgical repair before age of one

§ Hypoplastic left heart syndrome heart transplant

§ Truncus arteriosus medial management until surgical repair

§ Drug therapy:

· Prostaglandin E prevent closure of ductus arteriosus

· Beta-adrenergic blocker:

o Propranolol (Inderal)

· Narcotic analgesic:

o Morphine
Cyanotic heart defects monitor
Monitor:

· Cardiovascular status

· Respiratory status

· Vital signs

· Pulse ox

· I&O

§ Oxygen

§ Decrease oxygen consumption

§ Adequate hydration

§ Prevent patient distress
Rheumatic fever: this is a inflammatory disease that occurs 1-3 weeks after a beta-hemolytic streptococcal infection

o Contributing factors:
Production of antibodies against group A beta-hemolytic streptococcal

§ Untreated beta-hemolytic streptococcal
Rheumatic fever criteria
§ Jones criteria:

· Chorea repetitive, jerky dance-like movements

· Carditis

· Subcutaneous nodules

· Erythema marginatum:

o Temporary, disk-shaped, non-pruritic, reddened macules that fade in the center, that leaves raised margins

§ Arthralgia

§ Presence of beta-hemolytic streptococcal infection

§ Fever
Rheumatic fever diagnostic tests
§ Increase Sedimentation rate

§ EKG prolonged PR interval
Rheumatic fever tx
Bed rest until fever and sedimentation rate returns to normal

§ Drug therapy:

· Antibiotics

o Penicillin until age of 20 or 5 years after attack, whatever is longer
Respiratory System:
The child’s respiratory status differs from the adult in the following ways:

· Lungs are not fully developed at birth

· There is an increase in size and number of alveoli until the age of 8

· Until age of 5; there is a narrower lumen when compared to the adult

· Increase in elastic connective tissue as child grows

· Child’s higher respiratory rate
· Asthma inflammation of the respiratory tract
Contributing factors:

§ Hyperresponsiveness of lower airway

o Clinical findings:

§ Lung sounds:

· Prolonged expiration

· Expiratory wheeze

· Unequal or decreased breath sounds

· Possible inspiratory wheeze

§ Diaphoresis

§ Dyspnea

§ Use of accessory muscles

o Diagnostic tests:

§ Pulse ox

§ ABGs
Asthma tx
Treatments:

§ Chest physiotherapy

§ Allergy shots

§ Encourage PO fluids

§ Oxygen therapy

§ Drug therapy:

· Bronchodilators:

o Albuterol (Proventil)

· Chromone derivative:

o Cromolyn (Intal)
Asthma monitor
Respiratory status

· Cardiovascular status

· Vital signs

· Cough:

o Description

o S/S of infection

· Exposure to smoke

§ Raise mouth after inhaling medication

§ Modify inhalant to avoid allergens

§ During attacks:

· High fowler’s position

· Monitor for distress

· Calm environment

· Assess affective of drug therapy
· Bronchiolitis
This is an infection of the lower respiratory tract that is spread by secretions.
Bronchiolitis
Contributing factors:

§ Virus

o Clinical findings:

§ Sternal retractions

§ Tachypnea

§ Atelectasis

§ Thick mucus
Bronchiolitis TX
Diagnostic tests:

§ Mucus culture

o Treatments:

§ Humidified oxygen

§ IV fluids

§ Cool mist tent

§ Drug therapy:

· Bronchodilators

o Albuterol (Proventil)
Bronchiolitis monitor
Monitor:

· Respiratory status

· Cardiovascular status

· Vital signs

· Pulse ox

· I&O

§ Use aseptic technique

§ Chest physiotherapy
Bronchopulmonary dysplasia
This is a disorder that occurs in infants that require high positive pressure ventilation in the first two weeks of life. It is chronic disease.

o Contributing factors:

§ Oxygen toxicity

§ Prematurity

§ Damage to bronchiolar epithelium

§ Possible genetic connection
Bronchopulmonary dysplasia
Clinical findings:

§ Dyspnea

§ Sternal retractions

§ Crackles

§ Rhonchi

§ Wheezes

§ Hypoxia with ventilation

§ Pallor

§ Circumoral cyanosis

§ Right-sided heart failure

§ Prolonged capillary refill

§ Delayed development

§ Weight loss

o Diagnostic tests:

§ Chest X-ray

§ ABGs
Bronchopulmonary dysplasia
Treatments:

§ Chest physiotherapy

§ Continue ventilator support and oxygen

§ Drug therapy:

· Bronchodilators

o Albuterol (Proventil)

· Corticosteroid

o Dexamethasone (Decadron)

· Diuretic

o Furosemide (Lasix)

§ Monitor:

· Respiratory status

· Cardiovascular status

· Vital signs

· Pulse ox

· I&O

§ Provide adequate rest periods

§ Quiet environment
croup
This is a condition of acute spasms of laryngitis that commonly affects toddlers.

o Contributing factors:

§ Virus induced edema

o Clinical findings:

§ Cough:

· Barky

· Brassy

· “Seal like”

§ Inspiratory stridor

§ Begins at night

§ Occurs more frequently in the cold weather

§ Crackles and decreased breath sounds

§ Onset can be gradual or sudden
croup
Diagnostic tests:

§ Neck X-ray

§ Laryngoscopy

o Treatments:

§ Cool humidification

§ Encourage clear liquid

§ Rest

§ Tracheostomy if necessary

§ Drug therapy:

· Inhaled racemic epinephrine

· Corticosteroids (Solu-Medrol)
croup
§ Monitor:

· Respiratory status

· Cardiovascular status

· Vital signs

· Pulse ox

· I&O

· For rebound obstruction

§ Provide emotional support

§ Age appropriate activities
cf
This is a generalized disorder of the exocrine glands. This is an autosomal recessive disorder. The symptoms of this condition may becomes apparent shortly after birth or take years to develop.

o Contributing factors:

§ Genetic inheritance

o Clinical findings:

§ History of:

· Chronic productive cough

· Recurrent respiratory infections

§ Salty taste to child’s skin

§ Meconium ileus

§ Bulky, greasy foul-smelling stool

§ Distended abdomen

§ Failure to thrive

§ Voracious appetite

§ Sweat contains elevated levels of sodium and chloride
cf
Diagnostic tests:

§ Sweat test

§ Chest X-ray

§ Stool analysis

o Treatments:

§ Chest physiotherapy

§ Fat-soluble multivitamin two times per day

§ High protein diet or formula

§ Drug therapy:

· Oral pancreatic enzyme

o Pancrelipase (Pancrease) administer with meals and snacks

· IV antibiotics if necessary

· Mucolytic and bronchodilators
cf
Monitor:

· Respiratory status

· Cardiovascular status

· Vital signs

· Pulse ox

· I&O

§ Breathing exercises

§ Encourage physical activity
Epiglottiditis
This is a life threatening infection. This infection can cause inflammation and edema of the epiglottis.

o Contributing factors:

§ Bacterial Haemophililus influenza

§ Pneumococci

§ Group A beta-hemolytic streptococcal
Epiglottiditis
Clinical findings:

§ Difficult and painful swallowing

§ Increase in drooling

§ Restlessness

§ Stridor

§ Cough

§ Extends the neck in the sniffing position

§ Fever

§ Irritability

§ Retractions

§ Pallor

§ Refusal to drink

§ Rapid pulse and respirations

o Diagnostic tests:

§ Lateral X-ray of neck

§ Throat examination large edematous; bright red epiglottis
Epiglottiditis
Emergency endotracheal intubation

§ Oxygen

§ Cool mist tent

§ IV fluid

§ Drug therapy:

· Antibiotics

§ Monitor:

· Respiratory status

· Cardiovascular status

· Vital signs

· Pulse ox

· I&O

§ Avoid inspection of throat until emergency equipment is available

§ Emergency tracheotomy and intubation equipment available at the bed side

§ Allow activities that reduce child’s anxiety

§ Provide emotional support to both child and parents
SIDS
his condition is associated with the sudden death of an infant that is unexplained in postmortem examination.

o Contributing factors:

§ Undetached abnormalities

§ Abnormalities in ventilator control center

o Clinical findings:

§ Death occurs while child is asleep

§ No noise or sign of struggle

§ History of:

· Low birth weight

· Siblings with SIDS
SIDS
Diagnostic tests:

§ Autopsy

o Treatments:

§ Allow parents to interact with child allows parents to say good-bye

§ Allow parents to express grief

§ Provide emotional support

§ Reassure parents there was nothing they could have done
Pedi AIDS
Contributing factors:

o Clinical findings:

§ Failure to thrive

§ Weight loss

§ Recurrent diarrhea

§ Fever

§ Malnutrition

§ Fatigue and weakness

§ Night sweats

§ Opportunistic infections

§ Pallor
Pedi AIDS
Diagnostic tests:

§ CD4 T-cell less than 200cells/ul

§ ELISA positive HIV antibody titer

§ Western blot: positive

§ Decrease in:

· WBC

· RBC

· Platelets
Pedi AIDS
High calorie, protein diet in small frequent meals

§ Activity as tolerated

§ Drug therapy:

· Antibiotic therapy:

o Trimethoprim and sulfamethoxazole (Bactrim)

· Antiemetic:

o Prochlorperazine (Compazine)

· Antifungal:

o Fluconazole (Diflucan)

· Antiviral:

o Zidovudine (Retrovir)

· Monthly gamma globulin administration

§ Good oral hygiene

§ Allow patient to express feelings

§ Community support

§ Early diagnosis and treatment for infection

§ Teach patient or parents the importance of proper medication administration

§ Prevention of disease transmission

§ Age appropriate activities
· Reye’s syndrome
This is an acute illness that results in fatty infiltration in the liver, kidney, brain and myocardium. Possible complications include: hyperammonemia, encephalopathy and increased intracranial pressure(ICP).

o Contributing factors:

§ Acute viral infection

§ Use of aspirin during viral infection
Reye's syndrome
ive stages of Reye’s syndrome:

· Stage 1:

o Vomiting

o Lethargy

o Hepatic dysfunction

· Stage 2:

o Hyperventilation

o Delirium

o Hyperactive reflexes

o Hepatic dysfunction

· Stage 3:

o Coma

o Hyperventilation

o Decorticate

o Hepatic dysfunction

· Stage 4:

o Deepening coma

o Decerebrate

o Large fixed pupils

o Minimal hepatic dysfunction

· Stage 5:

o Seizures

o Loss of deep tendon reflexes

o Flaccidity

o Respiratory arrest
Reye's syndrome
Elevated serum ammonia levels

§ Prolonged PT and PTT

§ Elevated liver function

§ Liver biopsy

o Treatments:

§ Endotracheal intubation and mechanical ventilation

§ Induce hypothermia

§ Exchange transfusion

§ Enteral or parenteral nutrition

§ Transfusion of fresh frozen plasma

§ Drug therapy:

· Osmotic diuretic:

o Mannitol (Osmitrol)

· Vitamin:

o Phytonadione (AquaMEPHYTON)
Reye's syndrome
respiratory status

· Cardiovascular status

· Neurological status

· ICP

· Vital signs

· Pulse ox

· I&O

· Seizure activity

· Blood glucose level

· Temperature every 15-30 minutes while using hypothermia blanket

· Reflexes

§ Seizure precaution

§ Head of bed 30o

§ Oxygen therapy

§ Hypothermia blanket

§ Provide skin and mouth care

§ Provide emotional support to patient and family
sickle cell
This is a congenital abnormality. It is a recessive gene that cause a change in the Hb chain of the RBCs



o Contributing factors:

§ Genetic inheritance
sickle cell
Infants:

· Colic pain abdominal infarction

· Splenomegaly

· Dactylitis sausage like shape of finger and toes

§ Toddlers and preschoolers:

· Hypovolemia and shock shifting of blood to spleen

· Pain

§ School-age and adolescents:

· Enuresis

· Priapism

· Extreme pain

· Poor wound healing

· History of pneumococcal infections

o Diagnostic tests:

§ Hb electrophoresis
sickle cell care
o Treatments:

§ Warm compress for pain relief

§ Blood transfusion

§ Drug therapy: Morphine or Demerol

§ Iron and folic acid supplements

§ Hydration: IV fluids and PO

§ Bed rest during crisis

§ Oxygen

§ Maintain body temperature

§ Allow patient to verbalize feeling

§ Genetic counseling
· Attention deficit hyperactivity disorder(ADHD):
This disorder was also known as attention deficit disorder. This condition is associated hyperactive, impulsive and inattentive behavior.

o Contributing factors:

§ Possible neurotransmitter deficit
ADHD
Clinical findings:

§ Poor attention span

§ Poor organization

§ Easily distracted

§ Difficulty waiting turn

§ Excessive climbing, running or talking

§ Frequent forgetfulness

§ Impulsive behavior

§ Failure to:

· To listen

· Follow directions

o Diagnostic tests:

§ Complete psychological, medical and neurologic evaluation

o Treatments:
ADHD
eatments:

§ Behavior modification

§ Interdisciplinary interventions

§ Drug therapy:

· Amphetamines:

o Methylphenidate (Ritalin)

§ Monitor:

· Growth

· Nutritional status

§ Provide simple directions

§ Provide calm environment

§ Provide schedule for child

§ Give mediations in the morning
Cerebral palsy

This is a neuromuscular disorder that is result of damage or defect in the part of the brain that controls motor function. Classifications of cerebral palsy
1. Ataxia type: lack of coordination least common

2. Athetoid type: involuntary, incoordinate motion with varying degrees of muscle tension

3. Spastic type: hyperactive stretching of muscle group; most common type

4. Rigidity type: rigid posture and lack of active movement

5. Mixed type: a mixture of cerebral palsy
CP
Anoxia before, during or after delivery

§ Trauma

§ Infection

§ Low brith weight

§ Low 5 minute Apgar

§ Metabolic disturbances

§ Seizures

o Clinical findings:

§ All types:

· Abnormal muscle tone

· Poor coordination

· Dental abnormalities

· Varying degrees of mental retardation

· Seizures

· Disturbances of:

o Speech

o Vision

o Hearing
cp
Diagnostic tests:

§ Neuroimaging studies

§ Cytogenic studies

§ Metabolic studies

o Treatments:

§ Braces or splints

§ Adaptive tools

§ High caloric diet

§ Artificial urinary sphincter

§ Range of motion (ROM)

§ Drug therapy:

· Muscle relaxants

· Anticonvulsants:

o Phenytoin (Dilantin)

o Phenobarbital (Luminal)

§ Assist in movement

§ Divide tasks into smaller components

§ Refer:

· Speech therapy

· Nutritional therapy

· Physical therapy

§ Provide safe environment
Down syndrome :
This is a chromosomal disorder associated with mental retardation, dysmorphic facial features and other distinct abnormalities(such as heart disease, respiratory infections, chronic myelogenous leukemia and weakened immune system).

o Contributing factors:

§ Genetic disorders

§ Maternal age
DOWN syndrome
Mild to moderate retardation

§ Short stature

§ Pudgy hands

§ Small head with slow growing brain

§ Upward slanting of eyes

o Diagnostic tests:

§ Amniocentesis

§ Karyotype specific chromosomal abnormalities

o Treatments:

§ Treat coexisting conditions

§ Drug therapy:

· Megavitamin

§ Set realistic and achievable goals

§ Provide level appropriate stimulation and communication

§ Provide appropriate toys

§ Provide safe environment

§ Maintain daily routine

§ Behavior modification
Hydrocephalus:
increase in CSF Contributing factors:

§ Arnold-Chiari malformation

§ Overproduction of CSF

§ Congenital abnormalities

§ Tumors

§ Hemorrhage
Hydrocephalus:
High-pitched cry

§ Rapid increase in head circumference

§ When percussing head the is a “cracked pot” sound

§ Distended scalp veins

§ Irritability

§ Lethargy

§ Decrease attention span

o Diagnostic tests:

§ Skull X-ray

§ Light reflects off opposite side of skull with transillumination

§ Angiography

§ CT scan

§ MRI
Hydrocephalus:
reatments:

§ Ventriculo-peritoneal shunt

§ Drug therapy:

· Anticonvulsants:

o Phenytoin (Dilantin)

o Phenobarbital (Luminal)

o Carbamazepine (Tegretol)

o Diazepam (Valium)

§ Monitor:

· Respiratory status

· Cardiovascular status

· Neurological status

· Vital signs

· Pulse ox

· I&O

· S/S of increased ICP

· S/S of infection

§ Do not lay child on side of shunt

§ Lay child flat

§ Support child’s head when upright

§ Proper skin care to head
Meningitis:

This is inflammation of the brain and/or spinal cord meninges.

o Contributing factors:

§ Viral or bacterial agents
Clinical findings:

§ Nuchal rigidity

§ Positive Brudzinski’s sign

§ Positive Kernig’s sign

§ Coma

§ Delirium

§ Fever

§ Headache

§ Irritability

§ High-pitched cry

§ Petechial or purpuric lesions associated with bacterial meningitis
meningitis
Lumbar puncture:

· Cloudy color

· Elevated WBCs

· Elevated protein level

· Decreased glucose level if bacterial

o Treatments:

§ Droplet precaution for 24 hours after start of antibiotic therapy

§ Seizure precaution

§ Hypothermia blanket

§ Oxygen therapy

§ Mechanical ventilation maybe required

§ Drug therapy:

· Corticosteroids:

o Dexamethasone (Decadron)

· Antibiotics:

o Ceftazidime (Fortaz)

o Ceftriaxone (Rocephin)
SZ
Monitor:

· Respiratory status

· Cardiovascular status

· Neurological status

· Vital signs

· Pulse ox

· I&O

· Assess fontanels for bulging

§ Provide calm environment

§ Provide emotional support

§ Gentle activities
Spina bifida:
This disorder is the result of the incomplete closure of the vertebrae.

There are main forms:

-spina bifida occulta: incomplete closure of vertebrae; without spinal cord involvement

-spina bifida cystica: incomplete closure of the vertebrae; with protrusion of spinal cord
spinal bifida
There are two classifications:

-myelomeningocele: external sac contains meninges, CSF, and portion of spinal

cord

-meningocele: external sac contains meninges and CSF

o Contributing factors:

§ Low maternal folic acid intake

§ Genetic and environmental factors

§ Exposure to teratogen`
spinal bifida
Spina bifida occulta :

· Dimpling of skin over affected area

· Not associated with neurological dysfunction

· Port wine nevi

· Soft fatty deposits

· Trophic skin disturbances

· Tuft of hair

§ Meningocele:

· Not associated with neurological dysfunction

· Saclike protrusion over spine

§ Myelomeningocele:

· Hydrocephalus

· Permanent neurological dysfunction

· Arnold-Chiari syndrome

· Possible mental retardation

· Curvature of spine

· Knee contractures

· Clubfoot

· Saclike protrusion over spine
Spinal bifida
Diagnostic tests:

§ Elevated alpha-fetal protein

§ Amniocentesis

§ Acetylcholinesterase

o Treatments:

§ Surgical repair of meningocele and myelomeningocele

§ No treatment for spina bifida occulta

§ Per-operative interventions:

· Monitor:

o S/S of infection

o S/S of hydrocephalus

o Measure head circumference daily

o I&O

· Position infant on abdomen

· High caloric diet

· ROM

· Clean, inspect and cover sac with sterile dressings moistened with sterile saline

· Usually unable to diaper infant

§ Post-operative interventions:

· Monitor:

o S/S of hydrocephalus

o Daily head circumference

o Vital signs

o Drainage from surgical site

· Prone position

· Allow parent to express emotions
Clubfoot

This is a congenital abnormality in which foot and ankle are twisted and cannot be manipulated into correct alignment.
o Contributing factors:

§ Genetic predisposition

§ Arrested development at 9th-10th week gestation

o Clinical findings:

§ Deformity obvious at birth

§ Unable to correct with manipulation

o Diagnostic tests:

§ X-rays

o Treatments:

§ Three stages of correction:

· Series of cast to stretch tendons

· Maintain correction until muscle balance is gained

· Monitor for signs of recurrence of deformity

§ Ensure proper fitting shoes

§ Assess for neurovascular status
· Developmental hip dysplasia:

This condition is a result of abnormal development of hip socket.
Contributing factors:

§ Genetic predisposition

§ Breech delivery

§ In utero fetal position

§ Laxity of ligaments

o Clinical findings:

§ Shorter limb on affected side

§ Restricted abduction of hips

§ Increase number of folds, on affected side when child is supine with knees bent
· Developmental hip dysplasia:
Diagnostic tests:

§ Barlow’s sign

§ Ortolani’s click

§ Trendelenburg’s test is positive

§ X-rays

o Treatments:

§ Hip-spica cast for older children

§ Corrective surgery

§ Bryant’s traction

§ Casting or Pavlik harness for 3 months

§ Provide assurance to parents that condition is correctable

§ Provide assurances to parents that child will adjust to cast

§ Provide proper skin care

§ Monitor circulation
Duchenne’s muscular dystrophy:

This genetic disorder occurs only in males. It is associated with progressive muscular degeneration throughout childhood. Death is generally a result of cardiac or respiratory arrest in the late teens or early 20’s.
contributing factors:

§ Sex-linked recessive trait

o Clinical findings:

§ Weakness of pelvic girdle, seen by waddling gait or frequent falls early sign

§ Gowers’ sign use of hand to push owns self up from the floor

§ Eventual muscle weakness and wasting

§ Delayed motor development

§ Cardiac or respiratory failure

§ Inability to perform activities of daily living(ADLs)

o Diagnostic tests:

§ Muscle biopsy

§ Electromyography

o Treatments:

§ Physical therapy

§ Supportive devices: splints, braces and wheel chair

§ High protein and fiber; low calorie diet

§ Gene therapy investigational stage

§ ROM

§ Encourage coughing, deep breathing and diaphragmatic breathing

§ Use of high-top sneakers and foot cradle prevent foot drop

§ Provide emotional support to both parent and child

§ Genetic counseling
Juvenile rheumatoid arthritis:

This is an autoimmune disease of the connective tissue. It is associated with inflammation of the synovial and possible joint destruction.

o Contributing factors:

§ Genetic predisposition

§ Autoimmune
o Clinical findings:

§ Inflammation of joints

§ Stiffness, pain and guarding of affected joints

o Diagnostic tests:

§ Elevated sedimentation rate

§ Positive antinuclear antibody test

§ Positive rheumatoid facture

o Treatments:

§ Splint application

§ Heat therapy

§ Drug therapy:

· Low-dose corticosteroids

· Low-dose methotrexate

· Nonsteroidal anti-inflammatory

§ Monitor for joint deformity

§ ROM

§ Provide assistance devices
Scoliosis:

This condition is the lateral curvature of the spine. This condition is more common is adolescence females.

o Contributing factors:

§ Poor posture

§ Unequal leg length

§ Poor vision

§ Spinal or rib changes
Clinical findings:

§ Spinal column curve disappears when child bends to touch toes Nonstructural

§ Spinal column fails to straighten when child bends forward; child hips, ribs and shoulders are asymmetrical structural

o Diagnostic tests:

§ X-rays

o Treatments:

§ Nonstructural

· Postural exercises

· Shoe lifts

· Corrective lenses

§ Structural

· Possible prolonged bracing

· Harrington, Luque or Cotrel-Dubousset rods

· Spinal fusion surgery
post spinal fusion surgery
Post-spinal fusion and rod insertion surgery

· Position in correct body alignment

· Maintain bed in flat position

· Logroll turn child only

· Monitor:

o Vital sign

o I&O

o Self-esteem

· Allow child to express emotions and ask questions
Celiac disease:

This disease is the result of decrease in amount or activity of intestinal enzymes. This results in a poor absorption of food and intolerance of gluten. Gluten is a protein found in grains. This disorder becomes apparent at 6-18 months
Contributing factors:

§ Immunoglobin A deficiency

§ Too-introduction of proteins solids

§ Gluten intolerance

o Clinical findings:

§ Generalized malnutrition

§ Failure to thrive

§ Steatorrhea

§ Height and weight below normal

§ Anorexia

§ Abdominal distention

§ Irritability
Celiac disease:
Diagnostic tests:

§ Immunological assay

§ Intestinal biopsy

§ Stool specimen high fat content

o Treatments:

§ Gluten-free diet; rice and corn allowed

§ Vitamins:

· Folic acid

· Iron

· Vitamin A and D

§ Small frequent meals

§ Monitor growth and development

§ Record stool:

· Color

· Consistency

· Appearance

· Number of stools
Cleft lip and palate

In this condition there is a failure of the bone and tissue to fuse completely at the midline
Contributing factors:

§ Prenatal exposure to teratogens

§ Congenital defects

§ Part of another chromosomal abnormality

o Clinical findings:

§ Ranges from a simple notch on upper lip to a complete cleft from lip edge to floor of nostril

o Diagnostic tests:

§ Prenatal ultrasound
cleft
Treatments:

§ Cheiloplasty uniting of lips and gums at 3 months old

§ Cleft palate repair surgery 18months old

§ Consults:

· Speech therapy

· Dental care

· Nutritional therapy

§ Monitor:

· Respiratory status

· Vital signs

· Nutritional status

· Quality of suck

§ Preoperative care:

· Feed infant slowly in upright position

· Burp frequently

· Give small frequent meals

· Sips of water after feeding

§ Postoperative care:

· Monitor for signs of cyanosis

· Avoid infant touching incision restraints maybe necessary

· Place patient on right side; not prone

· Provide feedings through a syringe into side of mouth

· Cleanse wound with half strength hydrogen peroxide

· Anticipate needs avoid crying

· Provide emotional support

· Monitor for S/S of pain
Intestinal obstruction:

This is the complete or partial blockage in the lumen of the small or large intestines. It can occur in three forms: simple blockage of intestinal contents, no other complcation, strangulated lack of blood supply in addition to the blockage in the lumen or closed-loop occlusion of two ends of the intestines.
Contributing factors:

§ Mechanical:

· Adhesions

· Strangulated hernia

· Carcinomas

· Congenital bowel deformities

§ Other:

· Electrolyte imbalances

· Paralytic ileus

· Sepsis

· Neurogenic abnormalities

· Thrombus or embolus
obstruction
Clinical findings:

§ Partial small-bowel obstruction:

· Constipation

· Vomiting and nausea

· Abdominal distention

· Colicky pain

· Dry mucosal membranes

· Intense thirst

· Malaise

§ Complete small-bowel obstruction:

· Persistent epigastric or periumbilical pain

· Peristaltic waves forces fecal content toward mouth

§ Partial large-bowel obstruction:

· Leakage of liquid stool

· Abdominal distention

· Colicky pain

· Hypogastric pain

· Nausea

· Visible loops of large bowel on abdomen

§ Complete large-bowel obstruction:

· Fecal vomiting

· Localized peritonitis

· Continuous pain
obstruction
Diagnostic tests:

§ Abdominal X-rays

§ Barium enema large-bowel obstruction

o Treatments:

§ IV hydration

§ NG tube for gastric decompression

§ Surgical resection with:

· Anastomosis

· Colostomy

· Ileostomy

§ Proper nutrition TPN if required

§ Drug therapy:

· Analgesics

· Antibiotics

§ Monitor:

· Cardiovascular status

· S/S of metabolic alkalosis:

o Slow and shallow respirations

o Hypertonic muscles

o Tetany

· S/S of metabolic acidosis:

o Dyspnea on exertion

o Disorientation

o Later sign: weakness and malaise

· Vital signs

· S/S of infection

· I&O

· Abdominal girth

· For return of bowel sounds

§ Provide proper mouth and skin care

§ Fowler position

§ Provide education on ostomy care if necessary
Pyloric stenosis

This is a condition of poor gastric empting related to narrowing of pyloric canal. It is usually seen in males between the ages of 1-6 mouths.

o Contributing factors:

§ Unknown
Clinical findings:

§ Projectile vomiting during or shortly after feedings

§ Bulge palpable over the right costal margin

§ S/S of dehydration and malnutrition

o Diagnostic tests:

§ Ultrasound

§ Endoscopy

o Treatments:

§ IV fluid to correct fluid and electrolyte imbalances

§ NPO

§ NG tube for gastric decompression

§ Surgical repair

§ Monitor:

· Cardiovascular status

· Abdominal status

· Vital signs

· I&O

· S/S of metabolic alkalosis

· S/S of dehydration

· Daily weights

§ Provide small frequent feedings

§ Thickened formula

§ Head of bed elevated

§ Position patient of right side

§ Postoperative care:

· Feed patient oral electrolyte solution in initial post-operative period and advance to formula as tolerated

· Routine post-operative care

· Position patient on side

· Monitor incision and keep clean

· Provide pacifier
Hypothyroidism :

This is the result of the thyroid gland not producing enough hormone. This can be present at birth or develop later. This disorder was cover earlier in the adult section, child specific issues will be covered here.
Contributing factors:

§ Congenital abnormality

§ Autoimmune disorders

§ Inherited disorder

o Clinical findings:

§ All S/S mentioned earlier

§ In infants:

· Persistent jaundice

· Hoarse cry

· Respiratory difficulties

§ In older children:

· Bone and muscle dystrophy

· Stunted growth

· Cognitive problem

o Diagnostic tests:

§ Low T3 and T4 levels

o Treatments:

§ Treatment same as adult
Hypospadias

This is a congenital condition where the urethral opening maybe anywhere along the vertical side of the penis. This condition can result in an increase risk of infection.
Contributing factors:

§ Genetic factors

o Clinical findings:

§ Altered angle of urination

o Diagnostic tests:

§ Diagnosis confirmed by physical assessment

o Treatments:

§ Avoid circumcision

§ No treatment if mild

§ Meatotomy surgical extension of urethra into normal position

§ Drug therapy:

· Analgesics:

o Meperidine (Demerol)

o Acetaminophen (Tylenol)

· Antispasmodic:

o Propantheline (Pro-Banthine)

§ Monitor:

· Urine output 5-10ml/hr

§ Allow parents to express emotions

§ Clean area well

§ Postoperative care:

· Apply pressure dressing

· Assess penis tip should be pink and viable

· Avoid trauma to penis no pressure on catheter

· Early ambulation
· Nephritis:

This condition is an infection of the renal system.

o Contributing factors:

§ Bacterial infection

§ Septicemia

§ Inability to empty bladder fully

§ Lymphatic infection
Clinical findings:

§ Burning on urination

§ Flank pain

§ Anorexia

§ Fever 102oF or higher

§ Chills

§ Urinary urgency

§ Cloudy urine that is foul smelling

§ Hematuria

§ Fatigue

§ Dysuria

o Diagnostic tests:

§ Urinalysis

o Treatments:

§ Antibiotic therapy

§ Surgical repair of any abnormality

§ Monitor:

· Vital signs

· Renal status

· I&O

· Urine output

§ Encourage fluids

§ Diet high in calcium
Nephroblastoma

This disorder is also known as Wilms’ tumor. This is an embryonal cancer that diagnosed at age of 2-4 years old
Contributing factors:

§ Genetic predisposition

o Clinical findings:

§ Nontender mass

§ Associated congenital abnormalities:

· Microcephaly

· Mental retardation

· Genitourinary problems

§ Hypertension

§ Constipation

§ Abdominal pain

§ Hematuria

o Diagnostic tests:

§ Urography

§ CT scan

o Treatments:

§ Nephrectomy within 24-48 hours

§ Radiation post-operatively

§ Drug therapy:

· Chemotherapy:

o Vincristine (Oncovin)

o Dactinomycin (Cosmegen)

· Analgesics as necessary

§ Monitor:

· Vital signs

· I&O

· After surgery:

o Urine output report less than 30ml/hr

o Respiratory status

o Pain level

o Dressing S/S of bleeding

o Postoperative complications

§ Do not palpate abdomen

§ Careful handling of child

§ Provide emotional support to child and family

§ Prepare patient and family for surgery
Contact dermatitis:

This is a localized rash in the area normally covered by a diaper. It is also known as diaper rash.
Contributing factors:

§ Harsh soaps and bubble baths

§ Clothing dye

§ Prolonged exposure to urine or stool

§ Moist warm environment

o Clinical findings:

§ Bright red maculopapular rash in diaper area

§ Irritability secondary to pain

o Diagnostic tests:

§ Based on physical inspection

o Treatments:

§ Clean with mild soap and water

§ Leave area exposed to air

§ Drug therapy:

· Vitamin A and D

· Zinc oxide

· Antibiotic cream if secondary infection occurs

§ Clean diaper area as clean as possible

§ Change diaper frequently

§ Avoid commercial diaper wipes on broken skin
Impetigo

This is a highly contagious superficial infection of the skin.
Contributing factors:

§ Group A beta-hemolytic streptococcal

§ Staphylococci

o Clinical findings:

§ Macular rash

§ Progresses to a papular and vesicular rash

§ As rash advances; oozes and forms a moist honey-colored crust

§ Commonly seen on:

· Face

· Extremities

· May spread to other parts of the body with scratching

o Diagnostic tests:

§ Based on physical inspection

o Treatments:

§ Wash area carefully with disinfectant soap three time a day

§ Drug therapy:

· Topical antibiotics

· Systemic antibiotics in severe cases

§ Cut child nails

§ Cover hands if necessary to prevent spreading

§ Cover lesions
Physiologic and Psychological changes post-delivery:
Vascular system:

o Decrease in blood volume

o Increase in hematocrit

o Increase in activation of blood-clotting factors

o Normalcy return within 3 weeks

· Reproductive system:

o Uterine involution occurs

o Progesterone production ceases until next ovulation

o Cervical opening changes occur changes from a circle to post delivery slit

· Gastrointestinal system:

o Increase in appetite

o Increase thirst

o Delayed bowel movement secondary to decrease muscle tone in intestines

· Genitourinary system:

o Increase in bladder capacity

o Increase urine output in the first 24 hours after delivery

o Decreased sensation of bladder filling

· Endocrine system:

o Increase in:

§ Thyroid hormones

§ Anterior pituitary gonadotropic

o Other hormone return to normal level

· Postpartum depression:

o AKA Baby blues

o Occurs in greater than 50% of mothers

o Occurs in the first 3 week post-delivery

o Subsides within 1-10 days
Postpartum Assessments:
onitor: Vital signs every 15minutes first 1-2hrs; then every 4 for first 24hrs

o Respiratory rate: should return to normal after delivery

o Temperature:

§ May be slightly elevated 100.40F related to dehydration or exertion

o Heart rate:

§ May 50-70 beats per minute due to decrease cardiac strain post delivery

o Blood pressure:

§ Return to normal within 24 hours

· Fundus: assess every 15mins first 1-2hrs; then every shift

o Monitor fundus tone and location

o Location should be:

§ 1-2 hours post delivery: midway between umbilicus and symphysis

§ 12 hours post delivery: at or 1cm above the level of the umbilicus

§ 3rd day post delivery: 3cm below umbilicus

o Tone: should be firm

o Nursing actions required:

§ Massage boggy(soft) fundus
· Lochia: discharge form uterine deciduas
Lochia rubra:

§ Bloody with small clots

§ Fleshy odor

§ Lasts 2-3 post delivery

o Lochia serosa:

§ Pinkish or brown

§ Serosanguineous consistency

§ Fleshy odor

§ Lasts 3-9 days post delivery

o Lochia alba:

§ Yellow to white discharge

§ 10 days-6 weeks

o Lochia appearance that requires further assessment:

§ Lochia may be scant; must always be present absence indicates infection

§ Foul-smelling

§ Large clots

§ Saturation of sanitary pad within 45 minutes

§ Seepage of bright red blood
· Episiotomy: surgical incision into perineum and vagina
Monitor every shift for:

§ Erythemia

§ Intactness of stitches

§ Edema

§ Odor

§ Drainage

o Within 24 hours incision edges should be sealed
Mastitis:

This is an infection of the lactating breast
Contributing factors:

· Staphylococcus aureus most common cause

· Engorgement and milk stasis

· Bra that is too tight

· Injury to nipple



Clinical findings:

· Localized area of reddens and inflammation

· Temperature of 101.10F or greater

· Chills

· Purulent drainage

· Edema or heaviness of breast

· Flue like symptoms:

o Aching muscles

o Fatigue

o Headache
mastitis
Diagnostic tests:

· Culture of drainage

Treatments:

· Moist heat application

· Pumping of breast milk

· Incision and drainage only to treat abscess

· Drug therapy:

o Antibiotics:

§ Cephalexin (Keftab)

§ Clindamycin (Cleocin)

o Analgesics:

§ Acetaminophen (Tylenol)

§ Ibuprofen (Motrin)

· Monitor vital signs

· Teaching tips:

o Breast feeding every 2-3 hours

o Change nipple shields often

o If abscess develops pump and discharge breast milk
PG Psychological Maladaptation:

This is a condition of depression of serve duration and depth, lasting longer than 2 weeks.

Contributing factors:

· Neonatal complications

· Hormonal shifts

· Poor family support or self-esteem

· Stress

· Troubled childhood

· Difficult pregnancy, labor or delivery
Clinical findings:

· Increase anxiety about the health of baby and self

· Inability to stop crying

· Anxiety about being left alone

· Overwhelming feeling of sadness



Treatments:

· Psychotherapy

· Counseling for patient and family at risk

· Group therapy

· Drug therapy:

o Antidepressants:

§ Imipramine (Tofranil)

§ Nortriptyline (Pamelor)

· Monitor:

o Health history

o Maternal support system

o Maternal-infant bond

· Provide emotional support
Puerperal Infections:

This is a bacterial infection that can occur after childbirth. It occurs in 2-5% of vaginal births and 15-20% of cesarean deliveries.
Contributing factors:

· Catheterization

· Colonization of lower genital tract with pathogenic organisms

· Forceps deliveries

· Multiple vaginal examinations

· Intrauterine fetal monitoring

· Cesarean deliveries

· History of:

o Previous infections

o Pre-existing medical problems

o Poor general health

o Poor nutrition

· Lower socioeconomic status

· Retention of placental fragments

· Prolonged labor or rupture of membranes

· Trauma
Puerperal Infections:
Lochia:

o Purulent

o Foul-smelling

· Abdominal pain

· Tachycardia

· Uterine cramping

· Subinvolution of uterus

· Fever

· Chills

· Lethargy

· Malaise

· Anorexia



Diagnostic tests:

· Elevated WBCs

· Cultures of blood and endometrial cavity

Treatments:

· Proper hydration IV or PO as needed

· Drug therapy:

o Broad-spectrum antibiotics

· Monitor:

o Vital signs every 4 hours

o Pain level

o Cardiovascular status

· Fowler’s position

· Provide emotional support