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333 Cards in this Set
- Front
- Back
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Involution
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return of the uterus to normal state
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umb: immediately after birth
12 hours later 24 hours each day after wards |
2 cm below umbilicus
1 cm above level with 1 cm per day below |
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Lochia Rubra
define and length |
menstrual-like discharge that lasts about the first 3 days
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Lochia Serosa
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pinkish stats about he 4th day
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Lochia Alba
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whitish, occurring 10-14 days
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Cervix after delivery
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flabby and formless
lateral slit 2 fingers after birth, 1 finger after 1st week |
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Vagina after delivery
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adematous and bruised
normal size in 3 weeks |
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degree of perineum
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1st- superficial
2nd- in between 3rd- tears to rectum 4th- tears into the rectum |
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Menstruation after delivery
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non nursing mothers- 6-10 weeks after birth
nursing- depends on length of time breastfeeding |
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effects of hormones on breasts after delivery
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rapid decrease in estrogen and progesterone levels allow prolactin to secrete mild
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engorgement
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result of venous and lymphatic congestion
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maternal Hematology : Hemoglobin, WBC, Platelet, and fibrinogen
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hemoglobin levels- initial decrease after birth then an increase
WBC remains elevated but should not increase Platelet and fibrinogen levels increase to clot |
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temperature after delivery
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slightly increased
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Respiratory system
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returns to pre-pregnant state
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Renal system in mother after birth
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prepregnant state in 6-12 weeks
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Immune system after delivery
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delayed response to infection. evaluate for need of rubella and RhoGam
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receive injection of Rh immune globin within 72 hours after delivery
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Rh negative mothers who deliver Rh positive babies
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pregnancy after RhoGam shot
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don't get pregnancy within 3 months of being given vaccine
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Gastrointestinal system after delivery
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sluggish due to progesterone
decreased muscle tone C-section-gas and abdominal distension Fear of elimination Ambulation to help pass gas |
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Pregnancy and Integument system
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abdominal skin and musculature are loose and flabby
striae fade |
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maternal vital signs
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slight rise in temp
B/P should remain stable Bradycardia is normal Respirations should remain normal |
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Breast assessment
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size symmetry, shape, areola and nipple.
Soft and nontender first 1-2 days |
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lactation suppression measures
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tight bra, ice packs, analgesics, avoid warm water,do not massage, green cabbage leaves
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Fundus assessment
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location firmness
most common cause of fundus that is higher than expected and not midline is a full bladder |
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REEDA
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redness
edema ecchymosis discharge approximation |
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Lochia assessment
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Must have pad for atleast an hour
odor amount if fundus is firm, bleeding could mean vaginal or cervical laceration |
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Maternal Dietary requirements
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Non-nursing- decrease calories by 300kcal
Nursing- increase by 500 kcal |
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Psychological assessment
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attachments
bonding Maternal touch- fingertipping, stroking, whole hand |
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Maternal role adaptation
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Taking in phase
taking hold phase letting go phase |
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taking in phase
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mother focuses on own needs
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taking hold phase
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focus shifts from her own needs to infant
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Letting go phase
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relinquish previous roles
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warning signs of ineffective bonding
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unwillingness to care for infant
marked depression excessive physical fatigue excessive preoccupation of self |
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Common problems and patient teaching
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when baby sleeps, you sleep, will probably need lubricant because of uncomfortable sex
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BUBBLEHE
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Breast, uterus, bladder, bowels, lochia, episiotomy, homans, emotions
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Amish/ Plain Mennonite
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prefers natural products
breastfeeding |
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American Indian
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twins not looked on favorably
bury placenta |
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Vietnamese
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avoids stroking head
bury placenta avoids "cold" things discards colostrum |
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Muslim
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practice circumcision
mother kept in seclusion for 40 days prefers females seclusion during menstrual cycle |
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considerations when choosing a contraceptive method
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acceptability
convenience education needed benefits side effects interference with spontaneity |
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sterilization
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permanent, tubal ligation, vasectomy
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Hormonal methods
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alter the normal hormone fluctuation of menstrual cycle
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types of hormonal methods of contraception and how they work
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alter the hormone fluctuation of menstrual cycle
inhibit ovulation and thicken cervical mucus Implant, injection, patch or vaginal ring , or orally |
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failure rate of hormonal implant
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1% failure rate
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Hormonal Injections
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3% failure rate
Depo-Provera administered q 3 months. Probably will not have period |
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Oral contraceptives
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3-8% failure rate
combination of estrogen and progesterone most common Progestin only (mini pills) with no hormone free days |
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Vaginal ring
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8% fail rate
ring into vagina and leaves it in for 3 weeks releases small amounts of progestin and estrogen to prevent ovulation removes ring at the end of week 3 and bleeding occurs |
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intrauterine devices (2)
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paragard (0.8%)- changes uterine and tubal fluids. effective for 10 years
Mirena (0.1%) continuously releases progestin must be released q 5 |
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Intrauterine devices-teaching
side effects |
cramping and bleeding with insertion
paragard- Menorrhagia Mirena- Irregular bleeding and spelling early than amenorrhea check presence of "tail" once a week for 1st for weeks, than monthly |
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barrier methods of contraception
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chemical- spermacides 26% failure rate
Mechanical barriers- placed over penis or cervix. condom- 85% effective, female condom- 79% effective |
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Diaphragm
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84% barrier to prevent fertilization, spermicide around edges kill any sperm that might get around
refitted after each pregnancy or weight change of 10 lbs |
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Natural family planning
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based on calendar and timing of menses
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sympto-thermal method
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84%
takes temp q morning. 0.5 degrees increase the day of ovulation last safe day is one week before the earliest recorded day of temp rise |
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Ovulation-Mucus method
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mucous is more watery and increase of susceptibility
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dehydration
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mild moderate severe on pg 1382
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fluid replacement
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Maintenance plus replacement fluid
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Maintenance fluid calculations
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allow 100 ml/kg first 10 kg
50 ml/kg for 2nd 10 kg 20 ml/kg for remaining body wt |
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fluid replacement: amount and time frame to give
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1.5 x maintenance
50% first 8 hours 50 percent next 16 hours |
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Diarrhea etiology
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Rotavirus (most common), salmonella, cryptosporidium (C-diff)
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Antidiarrheals in children
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not generally recommended in children
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Oral rehydration solutions
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give 40-50 ml/kg over last 4 hours
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prevention of diarrhea
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spread by fecal-oral route, teach personal hygiene, clean water supply, careful food prep, handwashing
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gastroenteritis
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throwing up and diarrhea
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enteritis
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small intestine diarrhea
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colitis
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large intestine diarrhea
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Enerocolitis
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small and large intestine diarrhea
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when meconium should be passed
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first meconium should be passed within 24-36 hours of life
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constipation in infants
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often related to diet
95% of breast milk is used- little constipation 55% is used- some constipation |
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Constipation in children
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often due to environmental changes or control over body functions
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encoropresis
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inappropriate passage of feces, often with soiling
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GER
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Gastroesophageal Reflux- defined as transfer of gastric contents into the esophagus
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appendicitis
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ruptured appendix
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indications of pyloric stenosis
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projectile vomiting, dehyrdated, vomit at every feeding
visible pyloric mass |
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Intussesception: define and symptoms
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S&S- telescoping or invagination of one portion of intestine into another
Pain occurs, subsides, and reoccurs for several hours then constant |
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Failure to thrive
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sudden slowing or stopping of maturation
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Enterobiasis
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Pinworms
most common helminthic infection in US |
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Traditional family structure
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shares roles, responsibility
both blended and extended family |
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Non-traditional family
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2 partners, foster care, gang, single parents
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affection
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sense of belonging and identity
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socialization
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values, belief, rituals are transfered thru family
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economic security
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food, clothing, shelter
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relationship function
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how people get along
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health function
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health practices, sleep and health habits, self care
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Family development theory
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look at families over time-structure, function, role changes
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Single young adults
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accept responsibility
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Newly married
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realign relationships
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family with young children
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child rearing, financial and household tasks
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family and adolescents
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flexibility of family boundaries
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launching children
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renegotiation of adult relationships
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family in later life
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shifting roles, dealing with disabilities, death of family, peers, spouse
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Family stress theory
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stress- disturbed equilibrium
consider how families react to stress protective factors: social relationships |
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patient aspects to consider while giving care
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health beliefs
communication space-touching time family roles |
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Ethnocentrism
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thinking ones culture is supreme to others
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acculturation
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people mix previous culture with new culture
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assimilation
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loss of all previous culture
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calgary family assessment model
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structure
Developemental Functional |
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Challenges to family health
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disease and age related risk
lifestyle environment (social and economic) |
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Genogram
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disease and disability map being transferred from family members
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Environmental risks
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social, economic, Ecomap
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Ecomap
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looks at relationship between family and friends, church, school, and work, etc
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how to develop coping strategies
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educate, effective problem solving, effective communication patterns,
encourage social support |
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5 S's
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Swaddling- Down Up Down Up
Side position- shushing- shush as loud as baby is crying Swinging- juggling baby Sucking- Don't use nipple until breastfeeding well |
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neonatal head to chest sizes
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is 2-3 cm bigger than chest
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starting Respiratory in newborn
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needs external stimulus like chest compression
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establishments of respiration depends on...
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amount of fluid squeezed from the lungs
adequate pulmonary blood flow capacity for surfactant production |
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Surfactant
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lowers surface tension and maintains the aveleolar patency when air enters
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neonate normal respiration rate
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30-60 breaths per minute
apnea of 5-15 seconds- normal over 15 seconds is not normal regular when sleeping irregular when awake |
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respiration- chest and abdomen
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go up and down together
opposite is a respiratory problem |
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breathing preference
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breathe mostly through nose
obstruction can cause respiratory distress |
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cardiovascular system changes in neonate
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baby takes first breath, lungs inflate, pulmonary blood flow increases, decreased pulmonary vascular resistance
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hypoxia and heart in neonate
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can reopen the foreman ovale
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Ductus arterious closes in...
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15-20 hours
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Neonate normal BPM range
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110-160 bpm
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Neonate heart murmer
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Normal, possibly the foreman ovale
check for cyanosis |
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Blood volumes cause rise in...
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Hgb, RBC's, and Hematocrit
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Reason for RBC elevation in newborn
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due to Increased levels of oxygen diffusion
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% of fetal Hemoglobin in newborn
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80% will be fetal hemoglobin-->die off quicker-->cause an increase of buliruben-->jaundice
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RBC's in Neonate
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drop after birth d/t shorter life span of rbc's due to fetal hemoglobin
55% dead by 5 weeks 95% dead by 20 weeks |
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Leukocyte changes in Neonate
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Normal at birth, then slight increase 1st day, then rapid drop to 11,500
Risk for infection! |
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Normal Leukocytes in Neonate
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9,000-30,000
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Platelet norms
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200,000-300,000
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liver synthesis of coagulation factors are...
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decreased during first days of life.
activated by vitamin K, which is the reason for synthesized K+ shot |
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Heat production by neonate
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does not shiver
metabolizes fat flexed postition dependent on environment |
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hypoglycemia and cold stress
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hypoglycemia from burning energy-->uses 3-4x amount of glucose-->depletion of existing stores
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Consequences of Cold Stress
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Hypoglycemia
Hypoxia Inhabitation of surfactant production Pulmonary Vasoconstriction |
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Prevention of cold stress
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breastfeeding
swaddling kangaroo care |
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Hyperthermia of neonate
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more rapidly
unable to sweat cerebral damage or death from dehydration or heat stroke |
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How does newborn loose fluid and electrolytes?
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urine, feces, lungs, increased metabolism and limited intake
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Normal body weight maintenance for 1st few days of newborn
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3-5 days weight loss of 5-10%
10 days regained weight |
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Newborn voids: # and amount
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1st and 2nd day: 2-6 voids 30-60ml
3rd day: 5-25 voids, 100-300ml Must void by 48 hours |
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Newborn stomach
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50-60ml, the size of a walnut
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Newborn and intestines
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longer for more absorption, wet diapers means enough milk intake
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GI variations
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Epstein pearls
teeth No bacteria in bowels until digestion of milk |
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Meconium
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formed in fetal life from amniotic fluid, intestinal secretions-bilirubin and cells
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time frame for first stool
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generally within 24 hours, if not within 48 hours, evaluate
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Stool transition
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Meconium (tacky and black)--> Transitional (greenish)-->Breast (pale yellow)/ bottle(yellowbrown)
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Stool frequencies
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8-10 per day-1q 2-3 days
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when to assess blood glucose levels
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Jittery, LGA, SGA, pre-term, post-term
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Jaundice
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hyperbilirubinemia
may occur after 1st week of life. |
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assess for jaundice
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put pressure on nose and let off, yellow color of skin and sclera
seen from head down |
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Jaundice under 24 hours
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Pathological, is NOT NORMAL
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Factors that increase jaundice
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short RBC life, liver immacturity, lack of intestinal flora, trauma
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Neonates and immune system: IgG, IgM, I gA
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IgG antibodies provide passive immunity across the placenta.
IgM antibodies suggest infection in utero if present at birth IgA immunoglobins are received via colostrum and milk, protect against respiratory, GI, and eye |
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Apgar scores
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1 min and 5 min
7-10 normal 4-6 moderate difficulty <3 severe distress pg 625 |
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1st wake cycle
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15min-1.5 hrs
active, strong suck reflex good time to breastfeed |
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sleep phase
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minutes to 2-4 hours
hr and rr decrease |
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2nd awake phase
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awake and alert
4-6 hours watch periods of apnea Good time to bring back to mom |
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2 sleep states
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deep sleep
light sleep |
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4 wake states
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Drowsy
quiet alert-optimal time of arousal active alert crying |
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newborn behaviors that control environment
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actively withdraw by increasing distance
push away close eyes/sleep to decrease sensitivity signal with fussing or crying |
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Mongolian spots
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look like bruise
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Malia
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clotted subaccious glands on nose, chin and cheeks
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cephala hematoma
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bleeding under periosteum. Does not cross suture line
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simian crease
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possible indicator of down syndrome
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Unequal gluteal folds
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possible hipdysplasia
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Healthy therapeutic interventions in first 2 hours of birth
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erythromycin ointment in eyes
vitamin K initial bath |
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assessment of 2hours after birth until discharge
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Hearing test
blood sugars urine specimen PKU-metabolic disorders |
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Cord Care
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promote drying
keep open to air wipe with alcohol |
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Post Circumcision care
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assess for bleeding q 15 min, q 1h x 4 hours
direct pressure if bleeding |
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Signs of illness to report
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fever above 100.4
poor feeding vomiting decreased urination labored breathing/apnea > 15 sec. cyanosis jaundice bleeding around cord or circ |
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amount of kcal in breastmilk and formula
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20 kcal/oz for both, majority from fat in breastmilk
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amount of formula a newborn will drink
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10-15 ml/feeding initially
2nd week- 90-150 ml/feeding |
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growth spurts/appetite increases
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7-10 days
3 weeks 6 weeks 3 months 6 months |
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formula guidance
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never heat in microwave
avoid propping bottles discard open bottles after 1 hour |
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Basis of commercial formula
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based on milk
soy based- constipating for baby |
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neonate
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birth-one month
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Infant
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birth to 1 year
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biological development
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cephalocaudal and proximodistal
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Proportional changes in weight
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5-6 months-doubled
1 year- tripled |
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proportional changes in height
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6 months- 1in/mo
12 months- 150% |
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changes in newborn head size
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6 mo- 6/10 in/mo
6-12 mo- 2/10in/mo |
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Fontenel closing
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posterior- 8 weeks
Anterior- 12-18 months |
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brain growth at 1 year
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increased by 2.5 times
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teach parents to avoid putting infant to bed with a bottle because
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increases risk of ear infection
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High levels of HbgF (fetal hemoglobin) cause depression of...
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production of erythropoietin, which is a hormone that controls RBC production
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iron supply in mother
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decreases after 5-6 months
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start of salivation
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3 months-drooling occurs
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begins breaking down complex carbohydrates
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4-5 months
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sign of dehydration in newborn
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no tears and sunken fontenels
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newborn and renal system
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unable to concentrate urine until after 1 year
kidney mass increases 3 fold, but filtration rate remains low |
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visual acuity at birth
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can see at birth about 10 inches
binocular vision begins at 6 weeks and established by 4 months |
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Head lag
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immediate- extreme lag
2 months- decreased lag 4 months- hold head in straight line investigate if longer |
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newborn and rolling
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can happen at any time
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sitting and 6 months...7 months
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sit breifly while leaning on hands
can sit alone |
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walking and newborn
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8-14 months is normal
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psychosocial development
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have trust, learn mistrust
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object permanence
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understands that objects exist even though they are not around
6-12 months |
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separation anxiety
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6-7 months
prefer parents or caregivers |
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language 1-3mo
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social smile
throaty sounds |
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language 3-4 months
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babbling
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language 4-6
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constant babbling
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language 8-9 months
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string of vowels and consonants
first words |
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language 9-12 months
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2-3 words
gestures may slow when beginning to walk |
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most important aspect of play
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human aspect
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in home care
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live in or comes to home
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licensed family day care
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up to 5 children
meets minimum standards |
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center-based care
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cares for more than 6
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limit setting and discipline
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anticipating dangerous areas and actions
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pacifier in bed
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decreases SIDS
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teething
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6-8 months
cause high grade fever |
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shoes
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for protection only, after 6 months
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Nutrition first 6 months
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human milk
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newborn nutrition 4-6 months
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can add solid foods like potatoes or rice
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Introducing food
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cereal, then fruits, than veggies, then meat
one new food every 4-7 days |
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weaning
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gradually replace one breast or bottle feeding at a time
night feeding usually last to eliminate |
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tandem feeding
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when feeding a previous child plus a newborn.
Newborn gets breast first |
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Hypospadius
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Meatus is below glans penis on ventral surface, in scrotum, or perineum
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How to and reason for repairing hypospadius
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1-multiple surgical operations
appearance, urinate standing, sexually adequate organ |
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Meateotomy
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repairing a hypospadius by creating a urethra
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Considerations for meateotomy
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NO circumcision- needed for surgical repair
penis will be bruised and swollen |
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Post-operative care of meateotomy
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penis is taped to abdomen
encourage fluids catheter care wound care NO immersion in tub |
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Cryptorchidism
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undescended testicle(s)
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when/how is cryptochidism repaired?
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surgically after 1 year of age
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Risks associated with cryptochidism
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9.7 times greater risk of testicular malignancy and sterility from heat if not repaired
hernias |
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Acute Glomerulonephritis
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kidney disease in which the part of your kidneys that helps filter waste and fluids from the blood is damaged
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Types of Glomerulonephritis
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Pneumococcal, strptococcal, viral
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APSGN
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Acute Post-Strep Gomerulonephritis
most common non-infectious renal disorder in children |
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who does APSGN mostly affect
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early school-age, mostly age 6-7
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Path of APSGN
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strep infection-->release of membrane like material from organism which is antigen-->antibodies formed and immune complex formed-->gets trapped in glomerular capillary bed--> swelling of glomerular capillary loops-->renal damage--> decreased filtration
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Manifestations of APSGN
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Onset 10-14 days after infection
Dark Urine from hematuria and Proteinuria Edema in face, hands, and feet hypertension anorexia lethargic, abdominal pain, activity intolerance |
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Diagnosing APSGN
|
UA shows hematuria & protienuria
BMP- elevated BUN and creatinine recent strep infection azotemia- a decreased renal function |
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Prognosis of APSGN
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95% rapid improvement to complete recovery
5-15% chronic glomerulonephritis 1% irreversible damage |
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Interventions for APSGN
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VS, I&O, sodium and fluid restrictions, limit k+ if oliguria present, and protein restriction if severe azotemia
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What is the measure of pH
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the measure of the body's free H+ ion level in fluid
ex. increase in pH means less free flowing hydrogen |
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pH stands for
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potential Hydrogen
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acidosis
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pH<7.35
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alkalosis
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pH>7.45
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____ excretes H+ and retain HCO3
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Kidneys
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lungs exhale....
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CO2
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CO2 combines with ____ and becomes ____. Show the molecule formation
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H20
acid H2CO3-->HCO3+H |
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Chemical buffering
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Lungs try to compensate for kidney
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Respiratory acidosis
|
not blowing off CO2
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Respiratory alkalosis
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exhaling too much CO2
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Metabolic acidosis
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not reabsorbing enough bicarbinate
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Metabolic alkalosis
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reabsorbing too much bicarbinate
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acid
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substance that releases H+ ions when dissolved in water
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base
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substance binding H+ ions when dissolved in water
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buffer
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a substance capable of binding a H+ or releasing a H+.
Helps maintain homeostasis |
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Hypoxemia
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decrease of O2 in blood
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Hypoxia
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decrease of O2 in the tissue
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acidemia
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increase of H+ ions in the blood
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acidosis
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increase of H+ in the tissue
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asphixia
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combination of hypoxemia, hypoxia,acidemia, and acidosis
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carbonic acid
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H2CO3
most common acid |
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Bicarbonate
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HCO3-
most common base |
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What is the 'EFFECT' of 'BETA-2 RECEPTORS' on 'SMOOTH MUSCLES'?
(*THERE ARE 4 OF THEM) |
INHIBITION:
1. VASODILATION 2. UTERINE RELAXATION 3. INTESTINAL RELAXATION 4. BRONCHODILATION (*SIMILAR TO PARASYMPATHETIC RESPONSE) |
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Sources of acids
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glucose metabolism-CO2
fat metabolism-fatty acids protein metabolism-sulfuric acid anaerobic metabolism- lactic acid stomach Cell destruction- from cell structure |
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sources of bicarbonate
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breakdown of carbonic acid
ingestion of bicarbonate pancreatic production movement of cellular bicarbonate to ECF Kidney reabsorption |
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Chemical buffers
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main buffers
bicarbonate in ECF Phosphate in ICF |
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2 buffers
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Protein and chemical
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Homeostasis of pH is maintained by...
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Buffers, Respiratory system, and Renal system
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Respiratory system response to pH
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fast response
hyper/hypoventilation |
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Renal system response to pH
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slow response
Movement of bicarbonate formation of acids formation of ammonium |
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Normal pH
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7.35-7.45
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Normal PaO2
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80-100
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Normal PaCO2
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35-45
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Normal PaCO3
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22-26
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ROME
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Respiratory
Opposite-based on PCO2 (acid) Metabolic Equal- based on PCO3 (base) |
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Symptoms of Respiratory acidosis
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HA, hypoventilation, hypoxia, hyperkalemia- acid pushes K+ out of cell, increase BP & CO
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Etiology of Respiratory acidosis
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chronic lung disease, inadequate chest expansion
CNS depression, asphyxia, hypoventilation, reduced alveolar diffusion |
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Treatment of Resp. acidosis
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bronchodilators
supplemental O2 compensatory hyperkalemia |
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symptoms of Respiratory alkalosis
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seizures
lightheadedness Hyperventilation Hypokalemia-increase K+ going into cell tingling in extremities confusion blue around mouth |
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Causes of Resp. alkalosis
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Hyperventilation
Respiratory stimulation Drugs Disease Fever |
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Treatment for Resp. Alkalosis
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Fever reduction
Eliminate source of sepsis sedative if anxious *Rebreath exhaled CO2 |
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symptoms of Metabolic acidosis
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Kussmaul respirations- Deep fast heavy breathing
HA and disorientation change in LOC Hyperkalemia Muscle twitching |
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Causes of Metabolic acidosis
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vomiting/Diarrhea-most common
DM Lactic acidosis Renal failure |
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Treatment of Metabolic acidosis
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Antidiarrheal if older than 4
Insulin for DM |
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Symptoms of Metabolic Alkalosis
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Dysrhythmias
Compensatory Hypoventilation Change in LOC and lethargic N/V/D Hypokalemia Slow respers |
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Causes of Metabolic alkalosis
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Drugs
NG tube suctioning the acid from stomach Cushing's disease excessive ingestion/administration of alkali- tums, mylanta |
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treatment of metabolic alkalosis
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Diuretic to increase HCO3 excretion
Diamox-interferes w/ bicarbinate reabsorption in the kidneys Mechanical ventilation if not resolved by compensation |
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Order of looking at ABG's
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1st-look at pH
2nd-look at PCO2 3rd-look at p02 level 4th-look at HCO3 |
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pH example:
pH: 7.46 pCO2: 46 HCO3: 29 PO2: 96 |
alkalosis
PCO2 and HCO3 is elevated so metabolic with partial respiratory compensation |
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The kidneys regulate pH by controlling what?
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excretion of H+ and retaining bicarbinate
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PO2 levels
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Normal range: 80-100
mild hypoxia: 60-80 moderate hypoxia: 40-60 severe hypoxia: <40 |
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7 main respiratory differences in children
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smaller airways
nose breathers lymph tissue enlargement shape of chest- affects capacity epiglottis large in proportion to mouth Flexible larynx-more susceptible to spasm Less alveoli |
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Bronchial breath sounds
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heard over trachea
loud and hollow |
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bronchovesicular breath sounds
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heard over 1st and 2nd intercostal spaces
medium intensity, still hollow |
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vesicular breath sounds
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Heard over periphery of lungs
soft or low intensity |
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Crackles
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discontinuous sound that varies from high to low pitched.
Fine, medium, and course tend to occur more at the end of inspiration |
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Wheeze
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continuous sounds caused by narrow airways
ex: asthma most commonly heard during expiration, sometimes during inspiration |
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Rhonchi
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continuous sound, course, loud, snoring
caused by obstruction primarily during expiration |
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Impaired gas exchange
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alteration in the exchange of O2 and CO2 in the lungs or at the cellular level
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Ineffective airway clearance
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secretions can not adequately be cleared from the airways
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assessment findings of Ineffective airway clearance
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dyspnea, tachypnea
wheezing, crackles, rhonchi cough decreased breath sounds cyanosis |
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Fear
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experiences feelings of physiologic or emotional disruption r/t an identifiable source that is perceived as dangerous
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anxiety
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feelings of uneasiness and activation of autonomic nervous system in response to a vague, non-specific threat
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Ineffective breathing pattern symptoms
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tachypnea, grunting, retractions-causes extreme fatigue
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monitoring a child with a respiratory illness
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observe effort and color
pulse ox q4h w/ child vitals auscultate breath sounds ABG's IV fluids, I&O, weight |
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Respiratory treatments
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bronchodilators- albuterol
steroids- help w/ edema in airways apply O2 |
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ways to keep a child calm
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same nurse
paretns present talk to child and parents plan and diversion take care of the parents |
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Nasal cannula
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1-6 Liters
24% at 1L, 44% at 6L watch for skin damage |
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simple mask
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6-15L
over nose and mouth, holes on side to let air out 40-90% dont use less than 6L |
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ventimask
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specific percentage on mask
24-50% cannot add humidity |
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Partial rebreather
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usually 6-15L, keep bag at least 1/3 inflated
60-90% depending on seal Dangerous for children because of possibly kinked tubing causing suffocation |
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Oxygen blow-by
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generally only during procedures
not measurable |
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Bronchiolitis
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Inflammation of the bronchioles, viral infection of lower airways
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most common cause of Bronchiolitis
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RSV
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symptoms of Bronchiolitis
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rhinorrhea,cough, low grad fever, restlessness, poor appetite
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Manifestations of Bronchiolitis
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wheeze
crackles decreased breath sounds signs of respiratory distress |
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Laryngotracheobronchitis
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inflammation of the larynx, trachea and mainstem bronchi
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Manifestations of Laryngotracheobronchitis
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stridor, cough, signs of respiratory distress
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epiglottitis
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Medical emergency!!
inflammation of the epiglottis bacterial in origin |
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Apnea of infancy
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cessation of breathing for 15-20 seconds in infant 37+ weeks gestation
ALTE |
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ALTE
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Apparent Life Threatening Even
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Presentation of infancy apnea
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color change
change in muscle tone choking or gagging apnea |
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Diagnosis of infancy apnea
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detailed history and PE
Pneumocardiogram- sleep study |
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Treatment
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Monitor
caffeine theopylline |
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SIDS
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Sudden Infant Death Syndrome
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Risks of SIDS
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sleeping on stomach
soft bedding overheating multiple births smoking/drugs teen mothers |
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recommendations to reduce SIDS
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position supine
firm bedding cool room sleep alone no smoking around infant |
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Emergency Department Care
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Greif and morning
ask factual questions parents with child, stay with parents autopsy |
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cause of Influenza
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viral
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manifestations of influenza
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HA, general body aches, fever
fatigue, sore throat, cough |
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treatment of influenza
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antiviral, start within 72 hours of symptoms
palliative measures NO aspirin |
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influenza Prevention
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flu shot
6mo-59 mo Over 50 |
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Otitis Media
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middle ear infection
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Pathophysiology of otitis media
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inflammation of the middle ear
infection |
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Predisposing factors of children for otitis media
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the eustachian tubes- smaller, lower angle than adult
abundant lymph tussue lying down positions and pooling of fluid passive smoking |
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Manifestations
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Pain
fever lymphadenopathy other URI symptoms |
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Diagnostic testing of otitis media
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Use of otoscope- swelling, redness, drainage
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Treatment of Otitis media
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pressure equalizing tubes
antibiotics-ex: amoxicillin Pain reliever- tylenol |
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Nursing Care/prevention
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importance of antibiotics
pain control immunizations |
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Complications of AOM
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hearing loss
tympanosclerosis perforation mastoiditis |
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tonsillitis/tonsillectomy and adenoidectomy
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inflammation and removal of tonsils and adenoids
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clinical manifestations of tonsillitis
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pain
difficulty swallowing difficulty breathing snoring |
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Viral tonsillitis manifestations
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red and swollen
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bacterial tonsillitis manifestations
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white spots on tonsils
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grading of of tonsillitis
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Grade 1-barely visible
2-in between 3-Uvula 4-kissing |
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Management of tonsillitis
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viral- treat symptoms
bacterial- antibiotic |
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do before tonsillectomy
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treat with antibiotics to care for infection before surgery
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Reasons for tonsillectomy
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7 or more episodes of pharyngitis in a year
5/year for 2 years 3/year for 3 years |
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Post-op risks of tonsillectomy
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bleeding
dehydration voice change |
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Post-op care of tonsillectomy
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look for frequent swallowing
spitting bright red blood |
