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54 Cards in this Set

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TEACHING included in DISCHARGE instructions for CARDIAC CATHETERIZATION?
McKinney pg 1259:
1. Inspect Catheter site:
-Assess healing or infection.

2. Limit bathing: No soaking for the 1st 1 to 3 days.
-OK: Shower, Sponge Bath or BRIEF Tub Bath.

3. Avoid Strenuous exercise for up to 1 week:
-NO climbing trees, swimming, contact sports, etc.

4. Child may Return to school on the 3rd day.

5. Notify Cardiologist:
-If Fever > 38.3 degrees C (101 degrees F)
-If Bleeding/Drainage (pus) from catheter site.
-If Pallor, coolness, or numbness in extremities occur.

6. Resume normal feeding patterns & meds.

7. Review need to continue antibiotics for dental or other medical procedures.

8. Follow-up with cardiologist at a regularly scheduled visit.
CARDIAC Assessment: Review ORDER of assessment for all systems.
McKinney p 1256-1258:

Setting:
-Non-threatening Environment
with parent present.
-Establish Trust & cooperation
-Warm & well-lit room

ASSESSMENT -Begin with least threatening steps:
-History
-Inspection
-Auscultation
-Palpation
-Percussion
(Remember to warm the steth & hands before touching the child, esp. important for infants).
Scenerio:

TRISOMY 21 is detected via AMNIOCENTESIS.

Question:

What does this mean to the CARDIAC SYSTEM?
Congenital Heart Defects are the most common disorder of children with Down Syndrome (50% greater risk for CHDs).

McKinney p 1572 Box 54-4:
CARDIAC conditions associated with Down Syndrome:
-Endocardial cushion defect
-Tetralogy of Fallot
-Atrial Septal Defects
-Patent Ductus Arteriosus(PDA)
-Ventricular Septal Defects
A Trisomy exists when each body cell contains an EXTRA COPY of one chromosone.

The most common trisomy is DOWN SYNDROME (aka: Trisomy 21), which can be detected via amniocentesis during pregnancy.
Review:
ADMINISTRATION of DIGOXIN (Lanoxin) to INFANTS.

Question:
WHEN would you HOLD this medication?
McKinney p 1263 Nursing Care Plan for the Child with CHF:

Withhold the dose and notify physician if the heart rate is LESS THAN 100 beats/minute in infants.
Digoxin (Lanoxin) is a cardiac glycoside that increases cardiac output & improves cardiac effectiveness.

Caution: Digoxin has a narrow therapeutic range (0.8 to 2 ng/mL). The Pediatric range is not well defined.

Count Apical HR for 1 full minute.

Digoxin Toxicity may manifest with Slow pulse, vomiting & dysrythmias.
Review Nursing Care:

How do we MANAGE FLUID VOLUME EXCESS in INFANTS?
Unit II
Careful fluid and electrolyte management is essential for the well being of the sick neonate. Inadequate administration of fluids can result in hypovolemia, hypersomolarity, metabolic abnormalities and renal failure. In the near term and term neonate excess fluid administration results in generalized edema and abnormalities of pulmonary function. Excess fluid administration in the very low birth weight infant is associated with patent ductus arteriosis and congestive heart failure, intraventricular hemorrhage, necrotizing enterocolitis and bronchopulmonary dysplasia. A rational approach to the management of fluid and electrolyte therapy in term and preterm neonates requires the understanding of several physiologic principles.
COARCTION of the AORTA:

What would we EXPECT on ASSESSMENT?
McKinney p 1274-1275:

Narrowing of the AORTA:
-left ventricular output obstucted
-increased afterload
-increased work (left ventricle)
-decreased Blood supply to abdominal organs

-possible CHF with low cardiac output.
-Pulmonary congestion or edema as heart pressure increases.

When the Newborn's PDA closes:
-poor lower body perfusion
-metabolic acidosis
-CHF
-Shock

If a PDA is present:
-possible Right-to-left shunting
-Differential cyanosis (sig. diff. in color & O2 sat b/t upper & lower extremities.)
-upper will be higher

In children Dx'd after infancy
-systolic hypertension in upper extremities
*****disparity in pulses & blood pressures b/t the upper & lower extremities.
-Femoral pulses are freq. weak or absent.
-Weakness & tingling in lower extremities
-muscle cramps on exertion
-Systolic murmur accompanied by an ejection click (bicuspid aortic valve) or thrill.



-Can be surgically repaired
POLYCYTHEMIA:
What is it?
Why does it occur?
McKinney p 761, 762, 1302
WHEN do FETAL SHUNTS CLOSE?
McKinney p 1254

From power point notes:
PDA closes within the First Few Days of Life
McKinney p 1259
Shunting: Blood flow through an ABNORMAL opening in the heart or great vessels.
BLOOD PRESSURE:
WHERE is it measured when assessing for CONGENITAL HEART DEFECTS?
BP should be measured in ALL 4 EXTREMITIES when assessing for Congenital Heart Defects.
PARENT TEACHING:
What is FIRST step?
Assess the Family's Readiness to Learn.
WHY do we give PROSTAGLANDIN E to NEWBORNS with HEART DEFECTS?
McKinney p 1275-1276
Prostaglandin E (PGE)
*Vasodilator
NUTRITION:
Review FEEDING of INFANTS with CARDIAC DEFECTS.
Unit II
What would DISCHARGE TEACHING for CHILD with ARRHYTHMIAS include?
Unit II
TETRALOGY OF FALLOT:
What to do FIRST when in DISTRESS?
Unit II
COMPLICATIONS of KAWASAKI Syndrome include?
Unit II
HIV transmission in PEDIATRICS.
Unit II
Children with HIV:
What are recommendations for Immunizations?
Unit II
SYMPTOMS of LUPUS:
Unit II
Cow's Milk:
When would it be appropriate & why?
McKinney p 576
Iron deficiency anemia:
What are the symptoms?
Unit II
Genetic transmission of Sickle-Cell disease?
Unit II
What would be the Nursing Priorities for child in Vaso-Occlusive Crisis?
Unit II
What is the Nursing Priority for Hemarthrosis secondary to Hemophilia?
Unit II
How is Hemophilia passed to children?
What are chances of passing this to the child?
Unit II
ITP
-Idiopathic Thrombocytopenia Purpura

What symptoms accompany ITP?
Unit II
Fractures:
Why are CHILDREN at HIGHER RISK than ADULTS?
Unit II
Fractures in INFANTS:
What would be Nursing Priority?
Unit II
Skeletal Traction:
Review Nursing Care of this CHILD.
What COMPLICATIONS could arise from traction?
Unit II
CASTING:
What is Normal/Abnormal after casting?
Unit II
Neurovascular checks:
What do we check for?
Unit II
Sed Rate:
What is it?
What does it indicate?
Unit II
Legg-Calve'-Perthes disease:
Review disease for TEACHING urposes.
Unit II
Juvenile Arthritis:
What would DISCHARGE PLANNING include?
Unit II
Pavlik Harness:
What would you include in TEACHING for Parents?
Unit II
Clubfoot casting:
Assessing Parental understanding of treatment plan? How would you evaluate understanding?
Unit II
Chronic Otitis Media:
What should we assess for?
Unit II
Acute Otitis Media:
What is the normal treatment?
Unit II
Tonsillectomy:
-Assessment POST-OP includes?

-An appropriate POST-OP DIET for this pt would be _______?
Unit II
Spasmadic Croup:
Review:
-Symptoms Include?
-Usual Time of ONSET
-Home Treatment
Unit II
Epiglottitis:
-Symptoms Include?
-What should nurse do?
-Priority in Management?
Unit II
Ribaviran:
-What are issues re nursing staff?
-What Types of pts would benefit from this treatment?
Unit II
RSV:
Respiratory syncytial virus
-How is it spread?
McKinney p 1213:
RSV is spread by contact with contaminated surfaces.

Infants usually acquire RSV from older sibling, Adult or Daycare provider (poor hand hygiene prior to contact with infant).
Bronchiolitis:
-Appropriate Nursing Interventions?
McKinney p 1215:
Status Asthmaticus:
-What SYMPTOMS indicate the child is worsening?
McKinney p 1225:
Silent Chest = No audible wheezing indicates Severe respiratory distress & inability ti move air.
McKinney p 1226
Status Asthmaticus:
A medical emergency that can cause respiratory failure & death.
Asthma:
-Expected Symptoms include?
-Common Trigger for attacks?
Unit II
Peak Flow Meter:
-What is it used for?
Unit II
Acute Asthma Attacks:
-Review drugs used for acute attacks.
Unit II
MDI for Exercise Induced Asthma:
-How & When are they used?
Unit II
Cystic Fibrosis:
-Review Meds given.
-Review Dx methods.
Unit II
CHILD: Wt = 20kg
Safe Dose Range:
30-50mg/kg/day
in 3 divided doses.
-----------------------
1. What is the recommended dose range for this child?
_______ to _______ mg q8h


2. Is 200mg q8h a Safe dose for this child? (Yes or No)


3. Is 400mg q8h a Safe dose for this child? (Yes or No)
20kg x 30mg = 600mg/DAY
600mg/3doses = 200mg q8h
________________________
20kg x 50mg = 1000mg/DAY
1000mg / 3doses = 333mg q8h
___________________________
1. Recommended dose range:
200 to 333mg q8h

2. Yes: 200mg q8h is a Safe dose for this child.

3. NO: 400mg q8h is NOT a Safe dose for this child.
Math Practice 2
-----------------------------
CHILD - BSA: 0.41 meters squared
Med Order:
=2.6 mg of drug given t.i.d.
Safe Dose Range:
=15-25mg/meter squared/day.
-----------------------------

What is the dosage for this child:

a. Dosage Per Day = _______ to _______mg

b. Dosage Per 8 h = _______ to _______mg

c. Is this a Safe dose for this child? (Yes or No)
0.41 meters squared x 15mg = 6.15mg/day / 3 doses = 2.05mg

0.41 meters squared x 25mg = 10.25mg/day / 3 doses = 3.42mg

a. 6.2 to 10.3mg per Day
b. 2.1 to 3.4mg q8h
c. Yes: The ordered dose of 2.6mg t.i.d. is safe because it is within the range of 2.1 to 3.4 mg q8h
Math Practice 3
-----------------------------
PATIENT - BSA: 2.17 meters squared
Med Order:
=20 mg dose of drug
Safe Dose Range:
=10mg/meter squared
-----------------------------

What is the recommended dosage for this patient: _______ mg

Is this a Safe dose for this patient? (Yes or No)
Unit II
Math Practice 4
-----------------------------
PATIENT - BSA: 0.77 meters squared

Med Order:
150 mcg dose of drug b.i.d.

Safe Dose Range:
100-150 mcg/meter squared/b.i.d.

***(NOTE: mcg not mg)***
-----------------------------

What is the recommended dosage range for this patient: _______ to _______ mg b.i.d.

Is the ordered dose safe for this patient? (Yes or No)
Unit II
Math Practice 5
-----------------------------
PATIENT - No info given

Med Order:
Erythromycin 300mg

Available form:
Erythromycin 200mg/tsp.
-----------------------------

Give: _______mL
(300mg / 200mg) x 1 tsp (5mL) = 1.5 x 5mL = 7.5mL