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39 Cards in this Set
- Front
- Back
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True or False:
Children that have strep throat are at risk for developing rheumatic fever, an inflammatory dz of the heart, joints, and CNS, and acute glomerulonephritis, an acute kidney infx |
-True
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A general term used to characterize a group of symptoms including: hoarseness, "barking" cough, varying degrees of inspiratory stridor, and varying degrees of respiratory distress resulting from swelling or obstruction in the region of the larynx
-caused most often by H. influenzae type b (Hib) |
-Croup
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A croup syndrome that is a serious obstruction inflammatory process that occurs predominantly for kids 2-8 yo
-requires immediate attention! -caused by Hib |
-Acute epiglottitis
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Describe s & s of acute epiglottitis:
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-onset of abrupt
-can rapidly progress to severe respiratory distress -child usually goes to bed asymptomatic to awaken later, complaining of sore throat and pain on swallowing -fever -insists on sitting upright and leaning forward, chin thrust out, mouth open, tongue protruding (tripod position) -DROOLING -irritable and extremely restless -frightened expression -voice is thick and muffled -froglike croaking sound on inspiration -retractions -****throat is inflamed, a distinctive large, cherry red, edematous epiglottis is visible on careful throat inspection (never check throat!! wait for md incase intubation is needed) |
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Describe treatment for a child with epiglottitis:
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-should be examined where emergency airway equipment is available
-lateral neck film -humidified O2 -swelling usually decreases after 24 hours of antibiotic therapy -epiglottis is normal by the 3rd day -corticosteriods |
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This croup syndrome is characterized by paroxysmal attacks of laryngeal obstruction that occur chiefly at night
-"spasmodic" croup -inflammation is absent or mild -affects 1-3 yo -child goes to bed feeling well or with mild respiratory symptoms but awakens suddenly with characteristic barking, metallic cough -hoarseness -noisy inspirations -restlessness -child appears anxious and frightened -dyspnea is worsened by excitement -no fever |
-Acute spasmodic laryngitis
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Describe treatment for acute spasmodic laryngitis:
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-most children are managed at home
-cool mist humidifier -relieved by a sudden exposure to cool air -have the child sleep in humidified air until the cough has subsided to prevent further episodes |
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Inflammation of the large airways and frequently associated with an URI
-typically viral -sometimes referred to as tracheobronchitis |
-bronchitis
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Describe s & s and treatment of bronchitis:
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-dry, hacking, nonproductive cough that worsens at night and becomes productive in 2 or 3 days
-analgesics, antipyretics, and humidity -cough suppressants -recovery in 5-10 days |
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This infx of lower airways is an acute viral infx
-occurs primarily in winter and early spring -by age 3, most kids have had this at least once -severe infx of this in the first year of life represent a significant risk factor for the development of asthma -effects the epithelial cells of the resp tract -ciliated cells swell and lose their cilia -lumina fills with mucous and exudate -varying degrees of obstruction produced in small air passages lead to hyperinflation, obstructive emphysema resulting from partial obstruction and patchy areas of atelectasis -air is trapped causing progressive overinflation (emphysema) |
-respiratory syncytial virus (RSV)
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Describe s & s for a child with RSV:
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-usually begins with an URI
-rhinorrhea -low grade fever -OM and conjunctivitis -cough -wheezing -retractions -crackles -dyspnea -tachypnea -diminished breath sounds -apnea may be first sign for very young infants |
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Describe treatment for a child with RSV:
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-treated symptomatically with cool humidified O2, fluid intake, airway maintenance, and medications
-palivizumab is the only preventative treatment (given IM injection monthly) |
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Describe nursing actions for a child with RSV:
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-contact and standard precautions
-make patient assignments so that nurses assigned to kids with RSV are not caring for other kids who are considered high risk |
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This is a chronic inflammatory disorder of the airways in which many inflammatory cells play a role
-causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough (esp at night or in the early morning) -episodes are associated with airflow limitation or obstruction that is reversible either spontaneously or with treatment -inflammation also causes an increase in bronchial hyperresponsiveness to a variety of stimuli -allergy influences and other substances and conditions can serve as triggers -difficulty is more pronounced during the expiration, air then becomes trapped and the person fights to inspire sufficient air |
-Asthma
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What are the 3 mechanisms responsible for the obstructive symptoms in asthma?
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1.) inflammatory response to stimuli
2.) airway edema and accumulation and secretion of mucus 3.) spasm of the smooth muscle of the bronchi and bronchioles |
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Asthma:
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-Increased work of breathing causes fatigue, decreased respiratory effectiveness, and increased O2 consumption
-As the severity of the obstruction worsens, reduced alveolar ventilation with CO2 retention, hypoxemia, respiratory acidosis, and eventually respiratory failure |
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Describe drug therapy for asthma:
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-Corticosteroids: treat reversible airflow obstruction, control symptoms, and reduce bronchial hyperresponsiveness
-B-adrenergic agonists: short acting (albuterol, levalbuterol, terbutaline) treatment of acute exacerbations and for prevention of EIB; bind with B-receptors on smooth muscle to relax them -Salmeterol (Serevent): long-acting B2-agonists; used twice daily and no more; used in conjunction with other treatment; not used in kids <12 yo -Leukotrienes: block inflammatory and bronchospasm effects -Anticholinergics: atropine and atrovent; may also be used for relief of acute bronchospasm; does not cross the blood-brain barrier |
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This dz is inherited as an autosomal recessive trait; gene must be carried by both parents; overall incidence of 1:4
-characterized by increased viscosity of mucous gland secretions, a striking elevation of sweat electrolytes, an increase in several organic and enzymatic constituents of saliva, and abnormalities in ANS function -demonstrate decreased pancreatic secretion of bicarbonate and chloride and an increase in Na and Cl in both saliva and sweat -mechanical obstruction caused by the increased viscosity of mucous gland secretions -small passages in organs such as the pancreas and bronchioles become obstructed by secretion |
-Cystic Fibrosis
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What is the earliest postnatal manifestation of CF?
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-Meconium ileus: small intestine is blocked with thick meconium
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What happens to the pancreas when a person has CF?
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-Pancreatic fibrosis: thick secretions block ducts
-this blockage prevents enzymes from reaching the duodenum therefore causing absorption problems -results in bulky stools that are frothy from undigested fat (foul smelling) |
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What is the RR for an infant? Preschool age child? School-age child? Adolescence?
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-30-60 at rest
-23 -18-20 -16-18 |
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This cardiac abnormality is caused when blood flow is shunted from LA to RA
-oxygenated blood is circulated to the lungs -murmur is present -high risk of CHF -blood is oxygenated so acyanotic -no visual s & s |
-Atrial Septic Defect (ASD)
**Increased pulmonary blood flow |
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This cardiac defect:
-blood is shunted from LV to RV -increased blood volume is pumped into the lungs -increased oxygenated blood goes to the lungs -muscle hypertrophies -CHF is common -acyanotic -no visual s & s |
-Ventricular Septic Defect (VSD)
**Increased pulmonary blood flow |
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This is an obstructive cardiac defect:
-characterized by local narrowing of the aorta -common sign is increased BP and pulse in upper extremities and decreased BP and pulse in lower extremities -signs of CHF -at risk for HTN, ruptured aorta, aortic aneurysm, stroke -surgical repair |
-Coarctation of the aorta
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This obstructive cardiac defect:
-occurs with narrowing of the aortic valve -LV blood flow resistance (leads to pulmonary edema) -decreased CO -LV hypertrophy -tachycardia -poor feeding -decreased peripheral pulses -exercise intolerance/dizziness -increased end-diastolic pressure |
-Aortic Stenosis
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This obstructive cardiac defect:
-narrowing of the pulmonic valve -RV hypertrophy -may result in reopening of foramen ovale -murmur may be heard -balloon angioplasty is usually performed |
-Pulmonic Stenosis
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This cardiac defect:
-decreases pulmonary blood flow -VSD is usually large and therefore RV and LV have equal pressures -shunting depends on which side has higher pressure -pulmonic stenosis decreases blood flow to the lungs an therefore causing RV hypertrophy -depending on the position of the aorta, blood flow from both ventricles may flow systemically -can be acutely cyanotic at birth or mildly that progresses the 1st year -systolic murmur -blue or tet spells |
-Tetralogy of Fallot
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What are the 4 classic forms of Tertralogy of Fallot?
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1.) VSD
2.) Pulmonic Stenosis 3.) Overriding aorta 4.) RV hypertrophy |
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This cardiac defect:
-decreases pulmonary blood flow -tricuspid valve fails to develop -no blood flow between the RA and RV -cyanotic -blood flows through the ASD or a patent foramen ovale into the LA to the LV through the VSD to the RV and to the lungs -mixing of oxygenated and deoxygenated blood -often Trisomy 21 -tet or blue spells -increased risk of SCD, seizures, stroke, emboli -place an artificial shunt that acts as a patent ductus/foramen ovale |
-Tricuspid Atresia
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This cardiac defect:
-mixed blood flow -pulmonary artery leaves the LV -aorta exits from the RV -no connection between oxygenated and deoxygenated blood -can live b/c of shunting from a patent foramen ovale -typically receiving meds to avoid closing -cyanotic |
-Transposition of the Great Arteries
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This cardiac defect:
-mixed blood flow defect -underdevelopment of the left side of the heart -hypoplastic LV -aortic atresia -a patent foramen ovale is what is allowing living -immediate intervention is needed to survive -cyanotic |
-Hypoplastic Left Heart Syndrome
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Inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures to meet the body's metabolic demands:
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-congestive heart failure
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What are important data that must be known prior to giving any child digoxin?
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-AP: hold if: infants <90; children <70
-always want to know their K levels! -check dose with another nurse -comes as 50 mcg/cc |
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Describe an infant that is NOT in respiratory distress:
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-No retractions
-No nares dilation -No expiratory grunts |
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Describe an infant that is in moderate respiratory distress:
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-Retractions are just visible
-Minimal nares dilation -Expiratory grunt only audible with stethoscope |
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Describe an infant that is in major respiratory distress:
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-Retractions are marked
-Marked nares dilation -Expiratory grunts are audible with the naked ear |
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Describe s & s of hemophilia:
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-excessive bleeding after circumcision
-increased bruising -painful bruising -frequent nosebleeds -Plt, PTT within normal limits -thromboplastin test abnormal |
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This disorder is lacking in factor 8
-typically found in white, males |
-Hemophilia
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Describe nursing actions for patients with hemophilia:
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-Mangage bleeding: pressure; ice; avoid unnecessary IM, IV injections
-Receive FFP, while blood, factor 8 -Manage Pain: ibuprofen, Tylenol, Motrin (controversial), NO ASPIRIN |
