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114 Cards in this Set
- Front
- Back
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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 |
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RESPIRATORY DISTRESS SYNDROME
RISK FACTORS |
white
male hypovolemia infant of diabetic mother |
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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
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RESPIRATORY DISTRESS SYNDROME
what do all infants need when have RDS |
sirfactamt amd ventilatory support(c-pap, vent)
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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 |
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FYI
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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 |
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RESPIRATORY DISTRESS SYNDROME
two ways to adminsiter surfactant |
one way is through ETT on infant
other is to give to mom |
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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 |
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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 |
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RESPIRATORY DISTRESS SYNDROME
SEVERE DISTRESS |
hypotension and shock which progressess to bradycardia causing decreased cardiac output
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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 |
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why is it important to maintain temp
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changes in temp is a stressor to infant because it uses up its energy
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RESPIRATORY DISTRESS SYNDROME
areas where you see retractions |
intercoastal
suprasternal supraclavicular substernal subcoastal |
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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 |
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RESPIRATORY DISTRESS SYNDROME
ways to administer O2 |
nasal canula
CPAP oxy-hood ventilator |
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what should the O2 sat be for infants and children
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94%
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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 |
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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 |
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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 |
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Complications of high pressures of ventilator therapy
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ASSESS BREATH SOUNDS AND RR
pneumomediastinum pneumopericardium pneumothorax emphysema |
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PROGNOSIS OF RDS
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RDS is self limiting
deteriorates at 48h after 72h improvement may occur positive prognosis if no complications may nn prolonged vent therapy |
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ASSESS SIGNS OF RDS
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clincial signs, ie grunting flaring, retractions.....
ABGS/FIO2(vent settings) POX (pulse ox) O2 sat CRT |
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RESPIRATORY DISTRESS SYNDROME
nursing diagnosis |
#1 risk for fluid imbalance
ineffective breathing pattern impaired gas exchange risk for injury brain thermoregulation infection nutrition |
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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 |
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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 |
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RESPIRATORY DISTRESS SYNDROME
POSITIONS TO AVOID |
Never place in trendelenburg or have head down should always have head up or flat
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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
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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 |
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Why must we closely assess temp? what does it mean?
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infant may becoming septic and important to detect early as may be fatal
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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 |
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RESPIRATORY DISTRESS SYNDROME
FEEDING GOAL |
takes PO feedings
weight gain WNL Blood sugar WNL |
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How can you tell if the baby is jittery from low blood sugars vs. seizures?
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If it is sugar related baby will stop jittering when swaddled, seizures wont stop
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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)
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HIRSCHPRUNGS DISEASE/ congenital aganglionic megacolon
what is the role of ganglions |
promote peristalsis and relax sphincter for BM
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HIRSCHPRUNGS DISEASE/ congenital aganglionic megacolon
how is the colon affected? |
It becomes enlarged thus megacolon
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HIRSCHPRUNGS DISEASE/ congenital aganglionic megacolon
what may the end result be? |
intestinal distention, obstruction and ischemia may result in enterocolitis and death
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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 |
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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 |
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HIRSCHPRUNGS DISEASE/
What signs show it has become and emergency? |
-diarrhea is explosive and watery w/ fever and prostration(exhaustion)
-If progressive distension |
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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 |
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HIRSCHPRUNGS DISEASE/ Treatment
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-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 |
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HIRSCHPRUNGS DISEASE/ what are some possible complications of treatment?
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rectal stricture and incontinence
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HIRSCHPRUNGS DISEASE/ Specific nursing care
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-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 |
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HIRSCHPRUNGS DISEASE/ RN care for constipation
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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... |
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INTUSSUSCEPTION
dEFINE |
the slipping of ne part of the intestine into another part just below it, becoming ensheathed. occurs in the ILEOCECAL area
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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 |
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INTUSSUSCEPTION
Chronic signs |
-diarrhea
-weight loss -occasional vomiting periodic pain |
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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 |
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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 |
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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
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CHRONIC LUNG DISEASE
Other factors increasing CLD |
pulmonary immaturity
surfactant deficiency lung injury as well as barotrauma and O2 therapy |
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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 |
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CLD
Treatment |
ventilatory support
prevent and control infections nutrition and fluid restriction O2 therapy hosp and home meds: diuretics, corticosteroids and bronchodilators |
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CLD
Prevention |
antenatal steroids(betamethsone)
Prevent prematurity lemit vent therapy limit high O2 concentrations |
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CLD
Nursing Care |
Assess: resp status, fluid balance, nutritional intake
Monitor: O2 therapy Increase calorie intake using medium chanin tricglycerides(MCT) and glucose polymers |
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OMPHALOCELE
DEFINE |
Congenital hernia of the umbilicus
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OMPHALOCELE
what happens if diagnosed prenatally |
done by ultrasound and the mom is sent to a tertiary center for delivery
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OMPHALOCELE
Immediate Care at delivery |
saline soaks over the abd cavity then polastic wrap to preserve temp
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OMPHALOCELE
care after immediate care |
Give IV fluids and antibiotics, NG tube inserted and prepared dor surgery.MAINTAIN TEMP
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OMPHALOCELE
SURGERY |
immediately or if it nns to be delayed use a silastic silo pouch to cover
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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
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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
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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 |
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Tracheal-Esophogeal Fistula
what happens if you suction and the infant turns pink |
means it is not a cardiac issue!
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Tracheal-Esophogeal FistulaTherapy/nursing
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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 |
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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 |
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NEONATAL SEPSIS
DEFINE |
presence of micro-organism or toxins in the blood or other tissues. onset may be early or late.
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NEONATAL SEPSIS
cause |
Ifm does not cross the placenta so immune system is not fully developed. IgA and IgM are low in neonate
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What are the main neonate infections
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pneumo, meningitis, gastroenteritis, conjuntivitis and omphalitis
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NEONATAL SEPSIS
Risk Factors |
neonates who are premature or with a difficult labor
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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 |
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NEONATAL SEPSIS
Leukocytosis or Leukopenia |
a late sign with poorest prognosis b/c low WBCs mean failure to be able to fight infection
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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 |
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NEONATAL SEPSIS
WHAT IS THE BIG SIGN FOR KIDS |
decreased perfussion indicated by and increased capillary refill
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NEONATAL SEPSIS
worst case scenerio |
bllod infection-sepsis-decreased BP-septic shock
hard to reverse so tend to overtreat if sepsis is suspected |
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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
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NECROTIZING ENTEROCOLITIS
Onset |
4-10 days post initiation of feeding
-can be later if preterm may take up to a month |
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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 |
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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 |
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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 |
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NECROTIZING ENTEROCOLITIS
EARLY RECOGNITION OF CLINICAL MANIFESTATIONS |
-measure abd girth for distention !!!
-measure residual tube feeding -listen for BS -monitor for shock |
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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 |
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WHY IS IT IMPORTATNT TO PROVIDE NON-NUTRITIVE SUCKING
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Very important for children who can't eat-want to keep sucking reflex
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MERCONIUM ASPIRATION SYNDROME
DEFINE |
aspiration of meconium stained amniotic fluid by the neonate at birth:causes chemical pneumonia
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MERCONIUM ASPIRATION SYNDROME
what causes MSS |
meconium staining occurs with fetal distress
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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 |
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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 |
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GERD
Define |
lwr esophageal sphincter allows reflux into the esophagus
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GERD
what happens |
delayed gastric emptying
poor clearance of esophageal acid, esophagus susceptible to acid injury. Gastric contents enter esophagus |
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GERD
When does anatomy matures |
matures by 6mo of age. reflux before 6mo of age has a positive prognosis
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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
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GERD
what is the result of esophagitis w/ bleeding? |
anemia
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GERD
tests |
cardiogram/pneumogram
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GERD
risk factors for the older child |
caffeine, chocolate, spicy foods weaken the lwr esophgeal spinchter
a ETOH, tobacco obesity |
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GERD
why is Gerd so significant in the neonate? |
in pediatric patients can cause life-threatening events
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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 - |
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GERD
S/S in child |
-heartburn
-abd pain -chest pain -chronic cough -dysphagia -nocturnal asthma -recurrent asthma |
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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 |
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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 |
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GERD
nursing care to assist medical mgmt |
surgery if acute life threatening events or esophagitis
-surgery is a fundal plication- -gastrostomy or gastrojejunostomy |
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what does fundal plicaiton mean?
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wrapping the fundus of the stomach around the distal esophagus
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GERD
complications of GERD (the disease) |
-aspiration pneumonia
-respiratory distress -esophageal strictures |
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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 |
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GERD
nursing diagnoses |
nutrition,imbalanced
aspiration, risk for pain, acute |
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What is a danny sling?
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sling used to keep infant at top of the mattress. keeps them from sliding down to the bottom of mattress if head elevated.
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Diaphramatic hernia
define |
intestinal contents enter the thoracic cavity b/c of congenitally issing portion of the diaphragm
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Diaphramatic hernia
clincially |
respiratory distress, scaphoid abd (abd has sunken appearence)and possible lung collapse
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Diaphramatic hernia
how is it diagnosed |
ultra sound
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Diaphramatic hernia
immediate treatment |
tracheal intubation and ventilation
-head up position -gastric intubation and IV therpay prepare for surgery |
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RETINOPATHY
RETROLENTAL FIBROPLASIA DEFINE |
abnormal increase in retinal vasculature results in retinal edema, hemorrhage, detachment and potential blindness(worst case)
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RETINOPATHY
Risk factors |
-prematurity/light stimulation(not proven)
hypoxemia/hyperoxemia(dx AGB) prenatal complications&other illnesses |
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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 |
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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 |
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PPHN MAY BE ASSOCIATED WITH..
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-MERCONIUM ASPIRATION SYNDROME
-CONGENITAL DIAPHRAMATIC HERNIA -RESPIRATORY DISTRESS SYNDROME -NEONATAL PNEUMONIA -NEONATAL SEPSIS |
