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119 Cards in this Set
- Front
- Back
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Infants are what type of breathers |
Nose and belly |
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What could be a reason a baby would stop eating? |
Nose is plugged... suction out nose before meals. |
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Grunting, retracting, nasal flaring |
Emergency |
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Cardinal signs of distress |
Restlessness increased respiratory rate Increased pulse rate Diaphoresis |
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Most common illness in infant child? |
Respiratory Immature immune systems Smaller airways Underdeveloped supporting cartilage. |
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Sign of respiratory distress |
Grunting Retractions Decreased breath sounds Apnea Mottling Flaring nostrils Decreased o2 sats Head bobbing sats Head bobbing |
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What is a retraction |
Obstruction to inspiration Muscles pull back to overcome blockage Depends on the level and extent of obstruction |
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Types of o2 administration |
Nasal cannula - older child Face mask- older child O2 hood- for infants O2 tent O2 tent is most common, young children will not keep NC on. |
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Dark circles under eyes |
Sign of allergic rhinitis |
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Allergic salute |
Crease across nose |
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How does a child under age 7 get rid of mucus? |
Throws it up. They can't spit is out. |
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Why are young children more prone to ear infections? |
Eustation tubes are more straight Liquid can collect easier and increase risk of infection |
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Purpose of eustation tube? |
To drain the ear. |
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Otitis media with effusion |
Fluid behind the tympanic membrane |
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Organisms that cause otitis media |
Streptococcus pneumoniae Haemophilus influenza Moraxella catarrhalis Allergies |
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Ear infections are seen the most in what ages? |
6 months to 2 years |
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Ear infection symptoms |
Pulling of ear Bulging tympanic membrane Drainage- if perforated Persistent crying Fever |
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Otitis media with effusion symptoms |
Tinnitis- popping sounds Hearing loss Speech delays Behavior problems Disturbed sleep NO SIGNS of infection |
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Purpose to tube placed in ears |
To allow the ears to drain and prevent infection |
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How long do tube last? |
6 months to 1 year Falls out on its own. |
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What happens if the inner ear bones sit in fluid too long? |
They start to erode |
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With tube it is important to make sure... |
You place cotton or ear plug in the ear to prevent water or other things from getting into the ear. Tubes are a 2 way street. |
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How is otitis media treated? |
Antibiotic for 5-10 days Tylenol to reduce temp Comfort measures Tues placed in ears |
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Family teaching for otitis media |
Take all antibiotics Encourage fluids Prevention Monitor for hearing loss Keep water out of ear if have tubes |
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How to prevent otitis media |
Parents don't smoke Don't feed baby while flat. |
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Bronchiolitis |
Viral infection of the bronchioles Thick secretions Transported by close contact RSV Progressive respiratory illness |
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RSV causes 50% of these cases |
Bronchiolitis |
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What do you not give antibiotics for |
Bronchiolitis Viral |
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Epiglottitis |
MEDICAL EMERGENCY Severe life threatening infection of epiglottis Progresses rapidly Leads to complete airway obstruction |
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What do you not do with a patient with epiglottitis? |
Do not put anything in the mouth. |
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What should you have at the bedside for a pt with epiglottitis? |
Trache Incase airway becomes obstructed |
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Symptoms of epiglottitis |
Tripod position Mouth open Drooling Eyes wide Croaking sound |
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Treatment of epiglottitis |
Antibiotics Intubated |
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Asthma |
Chronic inflammatory Lung disease Involved recurrent breathing problems. |
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Severity of this disease reduces at a child gets older. |
Asthma |
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Asthma symptoms |
Expiratory wheezed Inspiratory strider Sob Retractions Nasal flaring Hypoxia Tachypnea Unproductive cough Restless Tripod Worse at night
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Wheezes go away bit child still looks bad? |
Child is getting worse. |
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Status asthmaticus |
Everything that normally works is not. Can cause respiratory failure and death Need a plan in place |
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Peak flow meter |
Breathe in x3 Average the reading Plot out Green=good yellow= could have an attack Do every day |
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Goal of child with asthma |
To live a normal life as possible. |
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Asthma rescue drugs |
Short acting Albuterol beta 2 agonists Albuterolbeta Xopenex |
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Routine asthma med |
Corticosteroids Anti-inflammatory Bronchiodilators |
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What is a spacer |
Device used to help kids with an inhaler. Med stays in tube and kid can breathe it in over several breaths |
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Cystic fibrosis |
Inherited autosomal restive disorder of the exocrine glands |
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Over production of mucus Specifically lungs and pancreatic duct |
Cystic fibrosis |
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What does cystic fibrosis affect? |
O2 consumption Nutrient absorbtion |
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Cystic fibrosis symptoms |
Wasted butt Club fingers Short stature Chronic cough Bronchitis Repeated pneumonia Purulent and copious sputum Sweat a lot - lose sodium |
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What happens toward the end of life with cystic fibrosis? |
Very fibrous lungs. Decreased gas exchange Decreased lung expansion |
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Dysfunction of mucus producing glands leads to? |
Absorption problems Blocked pancreatic ducts No secretion of enzymes |
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Digestive symptoms with cystic fibrosis |
Steatorrhea Fat soluble vitamin deficiency Mal absorbtion - thin underweight Protuberant abdomen Wasted butt Thin extremities Meconoum ileus- inverted rectum, prolapsed |
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Children with cystic fibrosis are at risk for? |
Hyponatrema Dehydration |
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Dignostic tests for cystic fibrosis |
Sweat test. >60 positive Newborn screen - done after 24 hrs 72 hr fecal fat determination |
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Positive newborn screen for cystic fibrosis |
Doesn't mean they have it, just that they have to gene |
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Cystic fibrosis treatment |
Lifelong Will eventually die from it Promote activities they can to - swimming Maintain nutritional status Mucolytic agents Bronchodialators Control infections |
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Cystic fibrosis diet. |
Increase calories (150%) Increased protein Pancreatic enzyme replacement |
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Cystic fibrosis meds |
Enzymes Antibiotics to control infections Bronchodilators Vit c to improve absorb tin of meds Fat soluble vit- E A D K |
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Tuberculosis |
Airborne Usually infected by family member Reportable contagious disease Common in upper lungs |
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Why is tb resistant to antibiotics? |
Has a waxy coating to protect it from wbcs |
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Tb test |
Read in 48-72hours Is it red? Is it flat? Is it raised? |
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Symptoms of tb |
Nightsweats Coughing Fever Malaise Weight loss Anorexia |
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Tb exposure |
Person has come in significant contact with someone with tb |
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Tb infection |
Positive skin test No xray changes No symptoms |
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Tb disease |
Chest xray changes Positive skin test |
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How long does someone with tb have to take antibiotics? |
6 months to 1 year Possibly longer |
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Treatment of Tb infection |
INH - isoniazid Rifadin Multi drug regimen Dosages will be higher |
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Treatment of tb disease |
Optimal nutrition Preventing infection Emphasize importance of following med regimen. Children are rarely Contagious |
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Cardiac assessment |
History Inspection Auscultatio Palpation Start with least invasive. |
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What should pregnant women never be around? |
Rubella No vaccine while pregnant. |
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Diagnostic tests for cardiac system |
Radiography Echocardiography- blood flow/direction Electrocardiogram Holter monitor Stress electrocardiogram Mri Cardiac cath |
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What can be used to both test and treat a cardiac problem? |
Cardiac cath |
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Main way to make the child and parent less scared about medical procedures |
The more the parent/child know the less scared they will be. |
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A cardiac cath does what? |
Visualizes the heart and vessels Measures o2 sat of chambers Measures intra cardiac pressures Determines muscle function and pumping action of the heart. |
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Post op cardiac cath care |
Keep legs straight 4-6 hrs Monitor pedal pulses- make sure u get it before procedure po Monitor for bleeding Monitor pulses Iv until tolerates po Monitor for bleedingMonitor pulsesMonitor for infectionPain medication as orderedAssess for dye reaction Monitor for infection po Monitor for bleedingMonitor pulsesMonitor for infectionPain medication as orderedAssess for dye reaction Pain medication as ordered Assess for dye reaction |
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Congenital heart defect |
Born with it. Most common in infants /children Genetic |
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Congestive heart failure |
Acquired after birth Decrease in cardiac output needed to meet metabolic demands |
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Early symptoms of CHF |
Mild resting tachycardia Mild cyanosis Increasing difficulty feeding Failure to thrive Sudden weight gain |
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CHF treatment |
Decrease cardiac workload Improve output Maintain nutritional status |
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Meds for CHF |
Dig- slows and strengthens Diuretics "Prils" angiotensin converting enzymes inhibitors |
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Signs of dig toxicity |
Nausea Vomiting Anorexia Bradycardia |
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What should the pulse be before giving dig |
100 <1year 70>1 year |
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What are the 2 major classifications of CHF |
Acyanotic- not blue Cyanotic - blue |
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How does the blood flow |
From high pressures to low pressures Path of least resistance |
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Acyanotic defect path of blood |
Blood recirculates through the lungs Already oxygenated blood circulating so not blue Increased pulmonary pressure |
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Cyanotic defect blood flow |
Unoxgenated blood is returned to the body by the aorta Right to left shunt |
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Patent ductus arteriosus symptoms |
Allows blood back into the lungs Does not close Widened pulse pressures Murmur Weight gain -increased fluid Bounding pulse |
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Patent ductus arteriosus treatment |
Dig Diuretics Increased calories Rest periods Promote constriction of opening Surgery within 1st year Coil to close |
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Atrial septal defect |
Opening between upper chambers |
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Symptoms of atrial septal defect |
If small- asymptomatic Systolic murmur in pulmonic area Splitting s2 Dyspnea Fatigue Poor growth |
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Therapeutic management of ASD |
Asymptomatic - follow up Symptomatic- diuretics Dig Surgery depends on severity Antibiotics to prevent bacterial endocarditis |
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Surgical management of ASD |
Patch Coil |
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Ventricular septal defect |
Hole between lower chambers Blood goes back to the lungs |
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Vsd symptoms |
Dyspnea Poor feeding Loud harsh murmur systolic thrill Depends on size of defect Usually not seen at birth only after a few weeks |
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Treatment of VSD |
Increase calorie formula Nasogastric feedings Surgical management later Prophylactic antibiotics for dental |
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Coarctation of the aorta |
Narrowing of the decending aorta Restricts blood flow leaving heart Restricts blood flow to abdominal organs May need to leave open |
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Increased BP in upper extremities Decreased BP in lower extremities |
Coarctation of aorta |
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Surgical treatment of coarctation of the aorta |
Graft Remove bad part. |
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How to correct if the suture areas of the graft in the aorta doesn't grow? |
Use a balloon to stretch out. |
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Symptoms of left to right shunting |
Different bps in upper and lower extremities Dyspnea Exercise intolerance Weak femoral pulses May be asymptomatic |
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Are prophylactic antibiotics needed for dental procedures for left to right shunting? |
Yes |
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Most common cyanotic defect |
Tetrology of fallot |
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Tetrology of fallot 4 defects |
Ventricular septal defect Pulmonary stenosis Overriding of the aorta Right ventricular hypertrophy |
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Polycythemia |
Excessive amount of red blood cells |
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Tetralogy symptoms |
Clubbing of fingers Exercise intolerance Polycythemia Harsh systolic murmur Poor growth Poor feeding Tet spells- hypoxia, pallor,tachypnea |
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Medical management of tetralogy |
Therapeutic management- medication to maintain prostaglandin, pallative surgery to improve oxygenation. Surgical management-includes patching and relieving pulmonary stenosis. |
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Endocarditis |
Infection of the inner lining of the heart. |
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Endocarditis is caused by |
Strep |
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Treatment of endocarditis |
Agressive Antibiotics ( if not respond in few days) Remove veg Remove valve, replace |
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Rheumatic fever |
2-6 weeks after strep Autoimmune Acute phase - rash, migrating joint pain, sub q nodules |
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Path to endocarditis |
Strep Rheumatic fever Rheumatic heart disease Endocarditis |
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Most common valve affected by Rheumatic fever |
Mitral |
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Symptoms of rheumatic fever |
Arthritis Carditis Chorea Sub q nodules Erythema marginatum |
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Treatment of rheumatic fever |
Pcn shot to prevent progression 1 per month Until 21 or 10 years whichever longer Aspirin or corticosteroids Education important for compliance |
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What does an aso titer tell? |
Recent strep infection Within 2 months |
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Sedimentation rate tells? |
Inflamation |
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Kawasaki disease |
Affects medium size arteries Especially coronary arteries Arteries weaken and rupture |
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Who is most commonly affected by kawasaki disease |
Little boys Asian decent |
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Symptoms of kawasaki disease |
Pink eye Strawberry tounge Peeling skin High fever |
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Most common age for kawasaki disease |
6 months to 2 years |
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Treatment of kawasaki |
Intravenous gamma globulin High dose aspirin Low dose aspirin at discharge Base line echo to assess coronary artery status. |
