Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/114

Click to flip

114 Cards in this Set

  • Front
  • Back
RESPIRATORY DISTRESS SYNDROME
DEFINTION
a syndrom of lung immaturity. This is different from resp distress. found primarlily in neonates, rarely found in neonates who have had intrauterine stressors such as drug use or PIH
also called hyaline membrane disease
RESPIRATORY DISTRESS SYNDROME
RISK FACTORS
white
male
hypovolemia
infant of diabetic mother
RESPIRATORY DISTRESS SYNDROME
patho
lungs lack surfactant so high surface tension making noncompliant or stiff lungs, which increases pressure thus increases work of breathing. Chest wall is compliant and whole sternum retracts as well as intercostal retractions
RESPIRATORY DISTRESS SYNDROME
what do all infants need when have RDS
sirfactamt amd ventilatory support(c-pap, vent)
RESPIRATORY DISTRESS SYNDROME
what can pulmonary HTN lead to
pulm HTN can lead to the opening of the ductus arteriosus thus shunting the blood from the pulmonary artery to the aorta and blood
BYPASSESS THE LUNGS
FYI
Atelectasis to decreased functional residual to ventalation/perfusion imbalance
SO.. less air to lungs and less blood brought to lungs to be infused with O2
RESPIRATORY DISTRESS SYNDROME
two ways to adminsiter surfactant
one way is through ETT on infant
other is to give to mom
RESPIRATORY DISTRESS SYNDROME
ACUTE SIGNS
tachypnea(80-120) and dyspnea
poor air exchange
retraction
fine expiratory rales/crackle
audible expiratory crunt
flaring nares
cyanosis and pallor
RESPIRATORY DISTRESS SYNDROME
Later signs
apnea(15-20 sec normal)
tx is methyl xanthines(caffeine or tehophyline)
Flacid muscle tone
lack of movement
unresponsiveness
diminished breath
RESPIRATORY DISTRESS SYNDROME
SEVERE DISTRESS
hypotension and shock which progressess to bradycardia causing decreased cardiac output
RESPIRATORY DISTRESS SYNDROME
MEDICAL THERAPY AND NURSING INTERVENTIONS
assiss w/ surfactant replace
adm O2 and ventilate lungs
monitor ABGs
maintain neutral thermal environment(eliminates stress
maintain tissue perfussion(IV
maintain fluid/electrolyte balance
why is it important to maintain temp
changes in temp is a stressor to infant because it uses up its energy
RESPIRATORY DISTRESS SYNDROME
areas where you see retractions
intercoastal
suprasternal
supraclavicular
substernal
subcoastal
RESPIRATORY DISTRESS SYNDROME
two types of isolettes
open-used when freq checks are needed
closed isolette-older but still used. used more when infant is stable
RESPIRATORY DISTRESS SYNDROME
ways to administer O2
nasal canula
CPAP
oxy-hood
ventilator
what should the O2 sat be for infants and children
94%
RESPIRATORY DISTRESS SYNDROME
normalcy/prevention
monitor labs and assess for premature delivery
lung maturity
administer corticosteroid medication (betamethasone) to mom before induction if a premature delivery is needed
RESPIRATORY DISTRESS SYNDROME
Ways to test lung maturity
Lecithin Sphingomyelin ratio(2:1 L/S ration)
phosphatidyl choline (PC)
phosphatidyl glycerol(PG)
fetal lung maturity assay-PG in amniotic fluid or tracheal aspirate
RESPIRATORY DISTRESS SYNDROME
Medical complications and nursing assessments
Patent ductus arteriosus-murmor, >CRT
CHF-cracles, >HR, edema
intraventricular heorrhage-assess neuro signs
Bronchopulmonary dysplasia-assess POX and RR
Retinopathy-blindness
necrotizing entercolitis
neurological damage
later use developmenta-denver2 and gest age assess
Complications of high pressures of ventilator therapy
ASSESS BREATH SOUNDS AND RR
pneumomediastinum
pneumopericardium
pneumothorax
emphysema
PROGNOSIS OF RDS
RDS is self limiting
deteriorates at 48h
after 72h improvement may occur
positive prognosis if no complications
may nn prolonged vent therapy
ASSESS SIGNS OF RDS
clincial signs, ie grunting flaring, retractions.....
ABGS/FIO2(vent settings)
POX (pulse ox)
O2 sat
CRT
RESPIRATORY DISTRESS SYNDROME
nursing diagnosis
#1 risk for fluid imbalance
ineffective breathing pattern
impaired gas exchange
risk for injury brain
thermoregulation
infection
nutrition
RESPIRATORY DISTRESS SYNDROME
planning/goals and interventions
airway management- suction, sniffing position, O2 therapy, chest PT, surfactant
GOAL TO MAINTAIN AIRWAY PATENCY
Acid-Base management- ABGs/ O2 rx/Ventilation and rest
GOAL ABGs WNL
RESPIRATORY DISTRESS SYNDROME
nursing car SUCTION
suction only as needed:
PRO: avoids hypoxia, monitor POX when suctioning
CON: bronchospasm, hyposia, increased intracranial pressure leading to brain hemorrage, trauma to airway
RESPIRATORY DISTRESS SYNDROME
POSITIONS TO AVOID
Never place in trendelenburg or have head down should always have head up or flat
RESPIRATORY DISTRESS SYNDROME
Respiratory monitoring-physical assessment
retractions-LOC-restlessness(always think O2 if see)breath sounds. resp tx and response:GOALS: rr 40-60& clear Breath sounds, off vent and extubated, HR 120-160
RESPIRATORY DISTRESS SYNDROME
TEMP REG
MAINTAIN 97.7 OR >
monitor axillary or skin temp
monitor isolette air temp
monitor all settings on isolette (is heat cycling on)
know equip before using
Why must we closely assess temp? what does it mean?
infant may becoming septic and important to detect early as may be fatal
RESPIRATORY DISTRESS SYNDROME
GOALS/IMPLEMENTATION
FEEDING
breast is best
only feed for 20-30 then tube feed
manage BS closely to avoid hypglycemia (don't make me jittery)
manage environment to rpomote rest
manage hypocalcemia
RESPIRATORY DISTRESS SYNDROME
FEEDING GOAL
takes PO feedings
weight gain WNL
Blood sugar WNL
How can you tell if the baby is jittery from low blood sugars vs. seizures?
If it is sugar related baby will stop jittering when swaddled, seizures wont stop
HIRSCHPRUNGS DISEASE/ congenital aganglionic megacolon
DEFINE
most common cause of lwr GI obstruction in neonates. Caused by congenital absence of some or all the normal bowel ganglion cells, beginning at the anus and extending variable lengths proximally.(most in rectosigmoid)
HIRSCHPRUNGS DISEASE/ congenital aganglionic megacolon
what is the role of ganglions
promote peristalsis and relax sphincter for BM
HIRSCHPRUNGS DISEASE/ congenital aganglionic megacolon
how is the colon affected?
It becomes enlarged thus megacolon
HIRSCHPRUNGS DISEASE/ congenital aganglionic megacolon
what may the end result be?
intestinal distention, obstruction and ischemia may result in enterocolitis and death
HIRSCHPRUNGS DISEASE/ congenital aganglionic megacolon
Diagnostic procedures/tests
barium enemas
anorectal manometic measurements
rectal biopsy demonstrates a lack of mensenteric and submucosal plexus (MOST definitive)
signs depend on age
HIRSCHPRUNGS DISEASE/ congenital aganglionic megacolon
Clincial manifestations/newborn
poor feeding
poss. bile stianed vomit-means moving towards obstruction
-failure to pass meconium in 24-48h
-abd distention
-failure to thrive
-constipation
-visible peristalsis
-episodes of N/V
HIRSCHPRUNGS DISEASE/
What signs show it has become and emergency?
-diarrhea is explosive and watery w/ fever and prostration(exhaustion)
-If progressive distension
HIRSCHPRUNGS DISEASE/
childhood S&S
-more chronic
-constipation
-RIBBON LIKE STOOLS/CLASSIC
-abd distention and visable peristalsis
-palpable fecal massess in abd
-poorly nourished and anemic
HIRSCHPRUNGS DISEASE/ Treatment
-Surg is main treatment
-usually a colostomy rest the bowel
-2nd step is soave endorectal pull-through(remove part w/o ganglions and reattach)
-close ostomy
HIRSCHPRUNGS DISEASE/ what are some possible complications of treatment?
rectal stricture and incontinence
HIRSCHPRUNGS DISEASE/ Specific nursing care
-low fiber, high cal, high protein diet
-TPN if needed
-AVOID high fiber foods such as whole grains, raw/dried fruits/ raw brocolli.cabbage. cooked corn, pot, squash
HIRSCHPRUNGS DISEASE/ RN care for constipation
motility; GOAL is bowel elimination. ACTION; enemas use NS only, PREPARE BOWEL FOR SURG-saline enemas, antibiotics to sterlize bowel/colon irrigation
POST OP bowel care- BS, flatus etc...
INTUSSUSCEPTION
dEFINE
the slipping of ne part of the intestine into another part just below it, becoming ensheathed. occurs in the ILEOCECAL area
INTUSSUSCEPTION
Assessment
-nursing data base(hx, physical)
-observe stool patterns
-PRE-OR CURRANT JELLY STOOL (blood and mucous) CLASSIC
-tender, distended abd
-URQ sausage-like mass and empty RLQ
-Intermittent acute abd pain and guarding
-vomiting and apathy
-usually b/w 3mo and 5yr
INTUSSUSCEPTION
Chronic signs
-diarrhea
-weight loss
-occasional vomiting
periodic pain
INTUSSUSCEPTION
Care of child during diagnosis and treatment
-abd x-ray (looks for free air in the peritoneum if perforation)
- barium enema if no perforation
-barium enema or h2o soluble contrast media and pressure to ruduce the intussception if not critically ill
-resection of bowel if needed
INTUSSUSCEPTION
Nursing care and diagnosis
-Acute pain SIGNIFICANT
-risk for injury
-family process interuppted
-PASSAGE OF BM MEANS RESOLUTIN OF THE PROBLEM and surg may nn to be cancelled
-use post op care for abd
BRONCHOPULMONARY DYSPLASIA OR
CHRONIC LUNG DISEASE
DEFINE
NEED for supplemntal o2 in an infant born prematurely. results in acute state from alveolar damage from lung disease and prolonged lung exposure to high peak pressures of artifical vents and O2 therpay
CHRONIC LUNG DISEASE
Other factors increasing CLD
pulmonary immaturity
surfactant deficiency
lung injury
as well as barotrauma and O2 therapy
CHRONIC LUNG DISEASE
Assess
-signs are retractions and tachypnea
-intolerance to hold & feeding (activity intolert)
-nasal flaring & Grunting
increased work of breathing
crackles, decreased air movement
expitaory wheeze
CLD
Treatment
ventilatory support
prevent and control infections
nutrition and fluid restriction
O2 therapy hosp and home
meds: diuretics, corticosteroids and bronchodilators
CLD
Prevention
antenatal steroids(betamethsone)
Prevent prematurity
lemit vent therapy
limit high O2 concentrations
CLD
Nursing Care
Assess: resp status, fluid balance, nutritional intake
Monitor: O2 therapy
Increase calorie intake using medium chanin tricglycerides(MCT) and glucose polymers
OMPHALOCELE
DEFINE
Congenital hernia of the umbilicus
OMPHALOCELE
what happens if diagnosed prenatally
done by ultrasound and the mom is sent to a tertiary center for delivery
OMPHALOCELE
Immediate Care at delivery
saline soaks over the abd cavity then polastic wrap to preserve temp
OMPHALOCELE
care after immediate care
Give IV fluids and antibiotics, NG tube inserted and prepared dor surgery.MAINTAIN TEMP
OMPHALOCELE
SURGERY
immediately or if it nns to be delayed use a silastic silo pouch to cover
OMPHALOCELE
what can you tell parents to promote normalacy
this happens b/c at a point in fetal development where the intestines go out and then back in so this fetus stopped developing early and doesn't get carried to the next level
Tracheal-Esophogeal Fistula
Define
trachea and esophagus don't form normally so it is easy to aspirate food/fluids in lung and air in stomach
Tracheal-Esophogeal Fistula
Signs and Symptoms
3 C's COUGH, CHOKING,CYANOSIS
Frothy saliva in mouth and nose early sign. Drooling is an early sign of not being able to swallow, apnea Abd distention form air
resp distress with feeding
Tracheal-Esophogeal Fistula
what happens if you suction and the infant turns pink
means it is not a cardiac issue!
Tracheal-Esophogeal FistulaTherapy/nursing
reason sterile water first feed is b/c risk of TEF
NPO
-oral and gastric and pouch suction
-postion on abd w/30defree head elevated for drainage
-prophylactic antibiotics(aspiration pneumo)
-prepare for transport/surgery
Tracheal-Esophogeal Fistula
therapy/nursing cont...
-non-nutritive sucking is important. do before progressing to eating
-No IPPB (Intermittent Positive pressure breather) air enters the stomach
-G-tube
-Do not need to do post-op care
NEONATAL SEPSIS
DEFINE
presence of micro-organism or toxins in the blood or other tissues. onset may be early or late.
NEONATAL SEPSIS
cause
Ifm does not cross the placenta so immune system is not fully developed. IgA and IgM are low in neonate
What are the main neonate infections
pneumo, meningitis, gastroenteritis, conjuntivitis and omphalitis
NEONATAL SEPSIS
Risk Factors
neonates who are premature or with a difficult labor
NEONATAL SEPSIS
Assist in medical diagnosis
culture of blood, umbilicus, throat and ear canals, skin lesions, stool and urine
assist with Lumbar punction and CSF
Direct bilirubin
assess labs for anemia
NEONATAL SEPSIS
Leukocytosis or Leukopenia
a late sign with poorest prognosis b/c low WBCs mean failure to be able to fight infection
NEONATAL SEPSIS
clinical manifestations to assess
-looks ill or not feeling well
-lethargy, poor feeding/wt gain
-irritability
-hypothermia/temp instability
-older kids/adults are HYPER
-cardiac-HR, arrhytmias,irregular hb, pallor, cyanosis,mottling,edema,hypotension, cool clammy skin
NEONATAL SEPSIS
WHAT IS THE BIG SIGN FOR KIDS
decreased perfussion indicated by and increased capillary refill
NEONATAL SEPSIS
worst case scenerio
bllod infection-sepsis-decreased BP-septic shock
hard to reverse so tend to overtreat if sepsis is suspected
NECROTIZING ENTEROCOLITIS
DEFINE
SEVERE damage to the intestinal mucosa of the preterm infant due to ischemia resulting from asphyxia or prolonged hypoxemia. most common in neonate under 2000g or 2Kg
NECROTIZING ENTEROCOLITIS
Onset
4-10 days post initiation of feeding
-can be later if preterm may take up to a month
NECROTIZING ENTEROCOLITIS
Risk factors
intestinal ischemia
intestinal hypoxia
pathogen colonization causing air in the submucosa
excessive formula in the intestine
IF LOWBIRTH WT DO NOT OVERFEED
NECROTIZING ENTEROCOLITIS
CLINCIAL MANIFESTATIONS
lethargy and poor feeding
-hypotension&bradycardia
-decreased urine output
-apnea&desaturations (A&D's)
-unstable temp and O2 Sat
-jaundice
-vomiting-poss bilious
-distended abd and gastric retention
-blood in stools or gastric content
-X-ray loop distention and air in abd
NECROTIZING ENTEROCOLITIS
interventions to implement
STOP ALL PO FEEDINGS give IV
NG gastric suction to low suction
antibiotic therapy
maintain F&E balance
maintain O2 sat
assess for perforation
if perf occurs prepare for surgical resection, ileostomy, colostomy and jejunostomy
NECROTIZING ENTEROCOLITIS
EARLY RECOGNITION OF CLINICAL MANIFESTATIONS
-measure abd girth for distention !!!
-measure residual tube feeding
-listen for BS
-monitor for shock
NECROTIZING ENTEROCOLITIS

RN care summary
avoid pressure on the abd
nono-nutritive sucking during feedings, attention to feeding and fluid balance, assess sepsis, hypoglycemia and DIC
WHY IS IT IMPORTATNT TO PROVIDE NON-NUTRITIVE SUCKING
Very important for children who can't eat-want to keep sucking reflex
MERCONIUM ASPIRATION SYNDROME
DEFINE
aspiration of meconium stained amniotic fluid by the neonate at birth:causes chemical pneumonia
MERCONIUM ASPIRATION SYNDROME
what causes MSS
meconium staining occurs with fetal distress
MERCONIUM ASPIRATION SYNDROME
Medical diagnosis&signs, labs nursing monitors
-respiratory distress and acidosis
-chext X-ray-alveolar densitites
-CBC and blood cultures
-Assess for bacterial pneumonia
MERCONIUM ASPIRATION SYNDROME
Treatment and nursing care
THE MOUTH & NOSE ARE SUCTIONED ON THE PERINEUM PRIOR TO THE FIRST BREATH
-airway mngmt-suction trachea and assist w/ endotracheal entubation if nn
-Treat Resp distress, O2, rest, position, head up, consult with RT & MD
-Acid-base mgmnt
-nursing same as RDS/may use surfactant
GERD
Define
lwr esophageal sphincter allows reflux into the esophagus
GERD
what happens
delayed gastric emptying
poor clearance of esophageal acid, esophagus susceptible to acid injury. Gastric contents enter esophagus
GERD
When does anatomy matures
matures by 6mo of age. reflux before 6mo of age has a positive prognosis
GERD
What happen is gastric acid is near the larynx
apnea and bradycardia occur along with stimulation of the vagal nerve which drops the HR
GERD
what is the result of esophagitis w/ bleeding?
anemia
GERD
tests
cardiogram/pneumogram
GERD
risk factors for the older child
caffeine, chocolate, spicy foods weaken the lwr esophgeal spinchter
a
ETOH, tobacco
obesity
GERD
why is Gerd so significant in the neonate?
in pediatric patients can cause life-threatening events
GERD
S/S in the infant
-spitting up or vomiting
-wt loss and irritability
-gagging&choking at end of feeding(may do odd thing w/ mouth)
-Respiratory problems
-APNEA OR LIFE THREATENING EPISODES
-hematemesis
-melena or tarry stool/anemia
-
GERD
S/S in child
-heartburn
-abd pain
-chest pain
-chronic cough
-dysphagia
-nocturnal asthma
-recurrent asthma
GERD
Nursing care
-record and report s/s
-cardipneumogram w/ pH probe
-scintiography w/ radiographic liquid to assess gastric emptying
-may be physical immaturity
-may have hiatal hernia/stomach protruding the
esophageal hiatus of th ediaphragm
GERD
therapeutic management
-sm freq feeding
-NG feeding if nn
-thickened feeding-contraversal
-position/prone w/ head elevated or flat
-H2 blockers-give on reg schedule(zantac,pepcid,)
-Prilosec-proton pump inhibitor
-Reglan, increases gastric motility-GIVE BEFORE feeding(may cause extrapyridamal SE
GERD
nursing care to assist medical mgmt
surgery if acute life threatening events or esophagitis
-surgery is a fundal plication-
-gastrostomy or gastrojejunostomy
what does fundal plicaiton mean?
wrapping the fundus of the stomach around the distal esophagus
GERD
complications of GERD (the disease)
-aspiration pneumonia
-respiratory distress
-esophageal strictures
GERD
Specific nursing care
-assess clincial manisfestations
-usually improves by 12-18mo
-educate parents on feeding
-use of a harness or dannysling
-POST_OP- same as abd surg
-G-tube mangmt
GERD
nursing diagnoses
nutrition,imbalanced
aspiration, risk for
pain, acute
What is a danny sling?
sling used to keep infant at top of the mattress. keeps them from sliding down to the bottom of mattress if head elevated.
Diaphramatic hernia
define
intestinal contents enter the thoracic cavity b/c of congenitally issing portion of the diaphragm
Diaphramatic hernia
clincially
respiratory distress, scaphoid abd (abd has sunken appearence)and possible lung collapse
Diaphramatic hernia
how is it diagnosed
ultra sound
Diaphramatic hernia
immediate treatment
tracheal intubation and ventilation
-head up position
-gastric intubation and IV therpay
prepare for surgery
RETINOPATHY
RETROLENTAL FIBROPLASIA
DEFINE
abnormal increase in retinal vasculature results in retinal edema, hemorrhage, detachment and potential blindness(worst case)
RETINOPATHY
Risk factors
-prematurity/light stimulation(not proven)
hypoxemia/hyperoxemia(dx AGB)
prenatal complications&other illnesses
RETINOPATHY
nursing care
evaluate risk factors
decrease environmental light, stimuli, that cause stress/VS flucuations
monitor ABG's to avoid hyper/hypoxemia
laser therapy perioperative/LID EDEMA EXPECTED
partial or complete visual impairment may occur
Persistent Pulmonary HTN of the newborn (PPHN) also called
Persistent fetal circulation
reversal to blood flow.
pulm HTN
shunting of blood bypasses lung
born term or post term w/tachycardia and cyanosis that progresses to resp acidosis and pulmonary vasoconstriction
occurs as a result of hypoxia and acidosis
PPHN MAY BE ASSOCIATED WITH..
-MERCONIUM ASPIRATION SYNDROME
-CONGENITAL DIAPHRAMATIC HERNIA
-RESPIRATORY DISTRESS SYNDROME
-NEONATAL PNEUMONIA
-NEONATAL SEPSIS