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128 Cards in this Set
- Front
- Back
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What is the most common of all CHD?
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Ventricular septal defect (VSD), it is the smallest and closes spontaneously
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What is the normal heart rate for an infant?
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130 BPM
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What type of shunt is put in for a VSD?
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left to right shunt
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What type of shunt is used for a Patent ductus arteriosus?
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right to left shunt
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If a patient has patent ductus arteriosus or VSD, what else is he/she at risk for?
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CHF
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How can patent ductus arteriosus or VSD be corrected?
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with cardiac catheterization
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If a child has decreased pulmonary blood flow, what is he/she at risk for?
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hypertension, aortic aneurysm, dissection, rupture, brain hemorrhage
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What does left sided stenosis do?
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decreases blood flow systemically
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If a patient has coarctation of the aorta, what could the patient experience?
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different pulsing in the upper extremities and the lower extremities
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What is tetralogy of fallot?
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a ventrical septal defect
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What are some of the reasons that your patient might experience a hypercyanotic spell?
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stress, crying, feeding, defecation, stressful and painful procedures
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What are some nursing interventions that you would do for a patient experiencing a hypercyanotic spell?
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calm the infant, place in knee-chest position, 100% oxygen by face mask, morphine subQ,
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what is seen frequently if a patient has cyanotic lesions?
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cyanosis
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What are mixed lesions?
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cyantic lesions with increased pulmonary blood flow
Failure of fetal heart to develop into separate pulmonary and systemic circulatory systems (a mixing of blood) |
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What does transposition of the great vessels mean?
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the aorta goes into the right ventricle instead of the left
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The doctor has just prescribed Lanoxin for your patient, what should you do BEFORE administering the drug?
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monitor their apical pulse for ONE FULL MINUTE
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When should you withhold Lanoxin from a patient?
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infant: apical pulse is 90 -110
child 2yrs: apical pulse is 70-85 |
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What is some education that you should give to the parent of your pt. on Lanoxin?
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give 2x per day and no less then 12 hours apart, give 1 hour before or 2 hours after eating, do not mix with other fluids or food, DO NOT REPEAT if child vomits
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What are the signs of a lanoxin (digoxin) overdose?
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vomiting, anorexia and slow pulse (bradycardia)
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What is a common sign that a child might be experiencing excess fluid overload?
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the child will squat down
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If your pt. is experiencing ineffective breathing patterns what should you do for them?
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encourage maximum chest expansion, head up 45 degrees, assess RR for 1 min, administer humidified oxygen
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What is the average calories that an infant should have?
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100cal/kg/day or 120 -150cal/kg/day if heart condition
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How much weight should an infant gain?
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1 oz per day
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What is bacterial infectious endocarditis?
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infections of valves and inner lining of the heart
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What are verrucae?
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clumps of bacteria
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What are some portals of entry for bacterial infectious endocarditis?
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dental work, cardiac surgery, central venous caths
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What are some of the clinical manifestations of bacterial infectious endocarditis?
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low grade fever, anorexia, malaise, weight loss,
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What are some cardiac symptoms of BIE?
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CHF, cardiac dysrhythmias, new murmur
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What is Kawasaki syndrome?
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acute febrile illness typically found in toddlers
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What are some of the cardiac effects of Kawasaki syndrome?
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arteritis, progressive inflammation of small arteries, inflammation causes increased number of platelets which can cause increased risk of abnormal clotting
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What can Kawasaki syndrome result in?
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coronary aneurysms, ischemic heart disease, infarcts, death from scar and stenosis of main coronary artery
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What is the criteria for diagnosing Kawasaki syndrome?
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a fever for greater than 5 days and 4/5 classic symptoms
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What are the five classic symptoms of Kawasaki syndrome?
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conjunctivitis without exudate
strawberry tongue intense erythema and swelling of hands and feet erythematous rash on trunk acute cervical lymphadenopathy |
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If your pt. has Kawasaki syndrome, what is he at greatest risk for?
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coronary artery aneurysm
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What is IVIG?
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Intravenous Gamma Globulin
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What is IVIG given for?
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reduces inflammation, reduces risk of coronary artery damage if given within first 10 days of illness
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What are some ASA side effects?
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GI upset, bruising/bleeding,
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What is rheumatic fever?
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inflammatory condition that affects heart, joints, subQ tissue, brain and blood vessels
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What is the treatment for RF?
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PenVK for 10 days, anti-inflammatory medications, ASA
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What are dysrhymias associated with?
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with underlying CHD or with normal hearts
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When is there an increase prevelance for a dysrhythmia?
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following post surgery for CHD
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What is a dysrythmia?
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an abnormal electrical conduction
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What should you be looking for when assessing for a dysrythmia?
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pulse as high as 300, color, diminished pulses, delayed capillary refill, irritability
older chldren might express: palpitations, dizziness, syncope and exercise intolerance |
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What is the most common hematologic disorder of childhood?
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anemia
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What is anemia?
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decrease in number of RBC's and/or hemoglobin concentration below normal
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Who is at greatest risk of iron deficiency anemia? Why?
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toddlers, because they tend to drink alot of milk which is a poor source of iron. You should limit the milk intake to 24 oz per day so that they will eat more iron rich foods and not fill up on the milk
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When should iron be added to an infants diet?
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5-6 months of age
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What are some of the treatments for Iron deficiency anemia?
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iron supplements for 3 months (iron rich foods are not enough once anemic) give ferrous iron in 2 divided doses between meals.
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What should you give the child along with ferrous iron?
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citrus fruit or juice
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What are some administration considerations when giving your patient iron?
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use a medicine dropper or straw to prevent teeth staining, expect tarry, dark green, blackish stools
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When is sickle cell anemia diagnosed?
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at birth with the infant newborn screening
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What group of people does sickle cell anemia usually effect?
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african americans
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Explain what happens when a pt. has sickle cell anemia?
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usually the fetal hemoglobin gets replaced with adult hemoglobin but when a pt. has sickle cell anemia that fetal hemoglobin gets replaced with sickle cells instead
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What happens to a pt. with sickle cell anemia who is experiencing low oxygen, low pH or low temperature?
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the HbS cells become elongated, rigid, sickle shaped and cause hemolysis
Circulation is impaired by clogged capillaries causing pain, infarctions and swelling |
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What is splenic sequestration?
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increased breakdown of RBCs by the spleen and liver
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When do symptoms of sickle cell first present themselves?
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begin in the 2nd 6 months of life
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What are some of the symptoms of sickle cell anemia?
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pale, slightly jaundiced with splenomegaly, Hgb 5-9g/dl, increased WBC, platelets and reticulocyte count, fever, abd. pain or chest pain, painful selling of hands or feet due to infarction
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What is the main marker of sickle cell anemia?
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pain
Must be aggressively managed and believed (PCA pump) |
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What are some of the measured used to manage sickle cell anemia?
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manage pain (PCA pump), Prophylactic Penicillin V, vaccines, prompt treatment of infections and maintenance of hydration and body temp., folic acid if needed
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What is hemophilia?
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it is when a pt has a deficiency of Hemophilia A-factor VIII
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Who usually gets hemophilia?
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usually men, women are usually carriers
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What are some of the manifestations of Hemophilia?
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mild to severe bleeding depending on severity of injury
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What is an X linked recessive inheritance?
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it is when the males (x chomo) are affected almost exclusively
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What are some interventions for hemophilia?
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provide a safe environment, avoidance of obesity, use electric razors over reg. razors, care with dental procedures
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What should you do for bleeding in a pt. with hemophilia?
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superficial bleeding: pressure for 15 minutes plus ice
significant bleeding: transfuse wtih antihemophilic factor (through a port) |
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what is done for a pt with hemarthrosis?
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elevation, immobilization of the affected joint, ice, analgesics, ROM
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What is the 2nd leading cause of death in children ages 1 - 14?
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cancer
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What are the manifestations for pediatric cancer?
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can be vague: symptoms are usually dismissed as something else (common illnesses)
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What are some common presenting symptoms of cancer in children?
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anemia, pallor, bruising, petechiae or frank bleeding, cachexia (weight loss, anorexia, weakness, anemia), infection, Neurologic symptoms(headaches, muscle weakness, incontinence, visual changes), visible or palpable mass
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What should be included in your initial assessment of a pediatric cancer pt?
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family hx, personal hx of increased risk disorders, symptoms, development and immunization status, growth and nutrition, hydration, pain, emotional state
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How should you deal with a pediatric cancer pt and his/her family?
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be honest and realistic, deal with TODAY, educate and empower the family, help with maintenace of the childs routine and setting limits
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Whate are some diagnostic tests used to help diagnose cancer in a pediatric pt.?
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CBC with differenial, complete metabolic panel, renal function tests (BUN, creatinine), liver function tests, urinalysis
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What does the ANC mean?
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below 1000 means the pt. is at risk for infection (<500 is very low and increases infection risk
if the neutrophil count is high then the pt. has a bacterial infection |
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What does a biopsy show in a cancer pt?
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it identifies, classifies and stages the cancer
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What does TNMS stand for?
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T: tumor characteristic
N: lymph node involvement M: metastasis S: extent of disease |
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What is a bone marrow biopsy performed for and where?
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in the iliac crest, sternum
for diagnosis and monitoring of effectiveness of therapy |
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What are colony stimulating factors?
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glycoproteins that stimulate bone marrow to increase production of various cell types
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What does Neupogen do? When can you not give them?
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stimulates production of neutrophils, can be given within 48 hours of receiving chemotherapy
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When do you stop giving Neupogen?
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when the pt ANC is >10,000 or for up to 14 days
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what does erythropoietin do and what is a serious side effect?
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stimulates erythrocyte production (RBC), hypertension
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What are some nursing considerations for a pt. on chemotherapy?
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have pt. avoid aspirin (interferes with blood coagulation), administer vitamins without folic acid (can effect drug effectiveness), do not administer live virus vaccines (pt. in an immunocompromised state)
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What are some of the side effects of chemo and how can you help your pt. with them?
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Nausea/vomiting: assess fluid/electrolytes, give antiemetics
Malnutrition: provide high protein, high calorie foods constipation/diarrhea Stomatitis: soft sponge toothbrush, good mouth care before and after meals |
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What is stomatitis?
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mouth sores
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Why would you never take a rectal temperature on a pt. undergoing chemotherapy?
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because one of the side effects of chemo is rectal ulcers.
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What can you do for your pt. if they experience rectal ulcers?
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warm, sitz bath, meticulous cleaning of area
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What is hemorrhagic cystitis and what should you do for it?
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bleeding from the bladder, incr. fluids up to 1.5 times the normal maintenance rate, encourage frequent voiding
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Why should your neutropenic pt. be placed in a private room?
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because they are too susceptable to getting an infection from others
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What should you be assessing frequently in your neutropenic pt and why?
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their vital signs, because you are looking out for septic shock.
often the only symptom of infection will be fever or an incr. pulse or respiratory rate |
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What does it mean if your pt is thrombocytopenic?
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that their platelets are low
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What should you watch for in a pt. with thrombocytopenia?
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watch for signs of bleeding and bruising
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When is radition therapy NOT effective?
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on cells with low O2 content or during cell division
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What are some immediate side effects of radiation therapy?
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fatigue, anorexia, nausea, vomiting
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What are some nursing care for the pt. who is undergoing radiation therapy?
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no creams or lotions to irradiated areas, meticulous mouth and skin care, adequate nutrition, fluid intake, antiemetics/antispasmotics, head covering, preserve skin markings
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What is the #1 cancer that children get?
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leukemia
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What is leukemia?
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overproduction of abnormal WBCs
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What are some of the symptoms of Leukemia?
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anemia from decr.RBC formation, infection from neutropenia, bleeding/ bruising from decr. platelets, bone, joint pain from leukemic cells invading the periosteum
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What is the most definitive way to diagnose leukemia?
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bone marrow aspiration
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What are the two different types of leukemia?
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ALL: Acute Lymphoid Leukemia (has the best prognosis) immature lymphocytes
AML: Acute Myelogenous Leukemia - immature myelocytes |
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What is the goal of combination therapy for pt. with leukemia?
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to induce remission with multiple drugs
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when is cranial irradiation done on a pt. with leukemia?
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as a last resort, high risk only
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What are the indications that a pt. is a candidate for a bone marrow transplant (BMT)?
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induction failures, relapses within one year of completion of therapy, high risk presentation (very young, high WBC count)
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What is the 2nd most common malignant tumor in a child?
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neuroblastoma
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Where does a neuroblastoma originate from?
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nerve tissue (adrenal glands, neck, chest, spinal cord)
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What are some symptoms of a neuroblastoma?
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pain often results from compression of organs, abdominal mass (crosses the midline), urinary retention or frequency, ecchymosis, periorbital edema, pallor, weakness, anorexia, weight loss
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What are lymphomas?
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lymph system malignancies
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What are the two types of lymphomas?
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hodgkins and non-hodgkins
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Where does hodgkins lymphoma originate from and where does it travel to?
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lymphatic system, metastasizes to non-nodal sites such as the spleen, liver, bone marrow, lungs
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What is the first sign of hodgkins disease?
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painless lymph node enlargement most commonly in the cervical or supraclavicular
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What are the s/s of hodgkins disease?
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fever weight loss, night sweats, lymph node enlargement
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What is the serum alkaline phosphatasa indicative of?
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indicative of bone growth in a child. It is normal for a small child to have a high level but not an older child
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How often should the following ages get a health exam?
newborn to 6 months? 6-12 months? 12-24 months? |
newborn to 6 months: every 2 months
6-12 months: every 3 months 12-24 months: every 6 months |
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Where do most children cluster on the growth chart?
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3rd to 97th percentile
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If a child is under the 3rd percent on the head circumference chart what is this indicative of?
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microcephaly
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If a child is over the 97th percentile on the head circumference chart, what is this indicative of?
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macrocephaly
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What is considered normal on the bmi chart for a child?
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3rd percentile to 84th percentile
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At what point on the bmi chart is a child considered at risk for being overweight?
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85% to 94%
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At what point on the bmi chart is a child considered overweight?
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above the 95th percentile
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What are some of the health consequences of a child being overweight?
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hypertension, osteoarthritis, dyslipidemia, type 2 diabetes, CHF, stroke, gallbladder disease, sleep apnea/respiratory problems
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What is the goal of the healthy people 2010?
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to reduce the proportion of children and adolescents who are overweight or obese to 5%
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What is the formula for calculating bmi?
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lb/height/height x 703
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What does active immunization do?
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mimics the infectious agent or a component of that agent. stimulates memory cells
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When is the initial reaction to a vaccine? initial memory?
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initial reaction: 4-7 days
initial memory: 1-3 days |
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When is the peak response to a vaccine? peak memory?
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peak response:7-10 days
peak memory: 3-5 days |
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When does IgG start to cross the placenta to the fetus?
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32 weeks
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At what point is a full term infant no longer pretected by maternal antibodies?
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approx. 6 months
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Where are vaccines given in a toddler? in an adolescent?
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toddler: in the vastus lateralus or ventrogluteal
adolescent: deltoid |
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What is the normal heart rate for an infant?
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120-140 bpm
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What is the normal respiratory rate for an infant?
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30 - 60 per min.
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