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SAC Peds Exam Test#4
| Question | Answer |
|---|---|
| Neonates' major respiratory muscle? | Diaphragm |
| General nursing intervention categories for peds in resp. distress? | Maintain patent airway, Assess/Monitor resp system, Ease resp efforts, Maintain calm environment, promote rest and hydration, maintain nutritional needs, reduce fever, admin meds, pt teaching |
| How much O2 does a simple mask provide? | 30-60% (6-10L) |
| How much O2 does a nonrebreather provide? | 50-60% (10-12L) |
| How much O2 does a FULL nonrebreather provide? | almost 100% (10-15L) |
| How much O2 does a nasal cannula provide? | 40% (1/8 - 5L) |
| How much O2 does a hood provide? | close to 100% |
| When does the incidence of tonsilitis peak? | 4-7 yrs old |
| Clinical manifestations of tonsilitis? | Sore throat, Red/swollen tonsils, mouth breathing, sleep apnea, diff swallowing, fever |
| Diagnostic test for tonsilitis? | Throat C&S, Rapid Strep |
| Nursing actions for Tonsilitis? | Ease resp efforts, provide comfort (warm NS, meds, lozenges), reduce fever, promote hydration, antbx tx, rest, pt teaching |
| #1 post-op nursing care for tonsilectomy? | Immediately assess for BLEEDING & ability to SWALLOW secretions |
| What is bronchiolitis? | Acute VIRAL infxn of bronchioles causing inflammation and obstruction |
| Why is Nasal Swab or Nasal washing obtained with bronchiolitis? | Viral Respiratory Panel (VRP) |
| At what age is RSV usually seen? | < 2yrs old, in winter/spring |
| Palivizumab (Synagis) | Humanized monoclonal antibody given IM once a month to high risk infants during RSV season |
| Priority nursing actions for infant w/ Bronchiolitis w/ +RSV? | Raise HOB--> Suction airway --> assess lung sounds |
| Should a mom breastfeed her baby if he has bronchiolitis and SOB? | No, because baby has inc. WOB and may aspirate |
| 4-2-1 method? | Child's wt in kg. 1st 10kg x 4 + 2nd 10kg x 2 + rest of kg x 1 = maintenance IV rate |
| Clinical manifestations of Bronchiolitis/RSV? | Rhinorrhea, cough, adventitious lung sounds, inc RR/WOB, resp distress, fever, poor feeding |
| Nursing implementations for Bronchiolitis/RSV? | Raise HOB, Suction, Hypertonic Saline %3 HHN, Bronchodilator, CPT, Fluids, Monitor V/S, Supplement O2, Reduce fever, rest, Handwash |
| What is Croup? | VIRAL Infxn/Swelling of larynx, trachea, epiglottis, bronchi (upper respiratory tract) |
| Priority nursing actions for croup? | Conserve energy, Raise HOB, Assess lung sounds, obtain SpO2 |
| What is decadron and what does it do? | Systemic corticosteroid that reduces inflammation |
| What is acute epiglottitis? | Bacterial form of croup affecting epiglottitis |
| What do you NOT do with acute epiglottitis? | Do not examine throat |
| 4 D's of acute epiglottitis? | Drooling, Dysphagia, Dysphonia, Distressed Inspiratory Effort |
| Highest priority for croup/epiglottitis? | Maintain patent airway |
| What is Asthma? | An inflammatory disorder of the airways causing episodes of wheezing, breathlessness, chest tightness, and cough. |
| Clinical manifestations of Bronchial Asthma? | Chest tightness, SOB, Tachypnea, SaO2 below 94% on RA, Wheezes, Crackles, Retractions, Nasal flaring,Non-productive cough, Silent Chest, Restlessness, Fatigue Orthopnea, Abdominal Pain, CXR = hyperinflation |
| Interventions for Bronchial Asthma? | Auscultate lung sounds!!, Monitor VS (HR, RR), Monitor SaO2, Monitor respiratory effort, Humified oxygen, Calm environment, Ease respiratory efforts, Promote hydration, Promote rest, Monitor labs/x-rays, Patient teaching |
| Reason Bronchial Asthmatics are hospitalized? | PEFR- < 50% of baseline, Inspiratory & Expiratory Wheezing, Tachycardia & Tachypnea, Dyspnea, retractions, 02 Sat 91% or lower after aggressive tx |
| Meds for Bronchial Asthma? | Albuterol, Cromolyn sodium, Solumedrol, Xopenex, Pulmicort, Singulair, Symbicort, Advair, Antibiotics |
| Across-tic for A-S-T-H-M-A for patient education? | A- Asthma, what is it?; S-S/s; T-Triggers; H-How to control; M-Meds; A-Action plan |
| Long term goal of Asthma treatment? | Minimize symptoms, prevent acute episodes, decrease side effects of therapy, and to help child maintain a normal lifestyle. |
| What is Cystic fibrosis? | Mutisystem disorder caused by genetic autosomal recessive trait affecting the exocrine glands where the ducts become clogged with thick secretions |
| How is Cystic fibrosis diagnosed? | History of familial disease, Physical findings , Nutritional status, Chest X-Rays, Pulmonary function test, Stool fat/enzyme analysis, Sweat Chloride test, CF Mutation panel |
| Pulmonary manifestations of CF? | Wheezing, Eventual & Progressive, Repeated lung infections, Dry, non-productive coughWet & paroxysmal cough, Emphysema/Atelectasis, Barrel-chest, Clubbing, Cyanosis |
| GI manifestations of CF? | Steatorrhea= large, loose, frothy, and foul-smelling stools, Increased appetiteLoss of appetite, Weight loss, FTT, Distended abdomen, Thin extremities, Deficiency of A,D, E, K, Anemia |
| Interventions for CF? | Airway Clearance - Chest physiotherapy (CPT), Drug Therapy, Nutrition - needs are at 150%, Exercise, Patient Teaching |
| 2 fetal shunts | Foramen ovale, Ductus arteriosus |
| How does foramen ovale close? | With 1st breath, inc. pressure in left side of heart forces flap to close |
| How does ductus arteriosus close? | Inc. O2 sat causes it to close within 24hrs after birth |
| What causes Increased Pulmonary Blood Flow (Acyanotic Heart Defects)? | Defects that cause shunting of blood from high pressure L to lower pressure R because of inc. pulmonary blood flow causing dec. systemic O2 blood flow and R/L side hypertrophy; PDA, ASD, VSD |
| What causes Decreased Pulmonary Blood Flow (Cyanotic Heart Defects)? | Unoxygenated, or desaturated, blood is entering the systemic circulation; Tetralogy of Fallot, Transposition of Great Arteries, Pulmonary Stenosis |
| How does body compensate for Cyanotic heart defects? | Increase in RBC (polycythemia) |
| What causes Obstruction to Systemic Blood Flow (Obstructive Heart Defects)? | Blood exiting heart meets narrowed area (stenosis), causing back up of blood into L ventricle, inc. pressure, leading to hypertrophy and low cardiac output; Coarctation of Aorta, Aortic stenosis, Pulmonic stenosis |
| What is caused by Obstructive Heart defects? | CHF w/ pulonary edema and Low Cardia output --> diminished pulses, poor color, prolonged cap refill, dec. urine, leg cramps, unequal pulses |
| Pulmonary manifestations of CHF? | Tachypnea (early symptom,)Dyspnea, Wheezes,Crackles (late sign), Retractions, Nasal Flaring, Congested Cough |
| Systemic manifestations of CHF? | Tachycardia (early sign), Poor growth and development, Hepatomegaly, Decreased Urine Output, JVD (children), Edema (facial), Ascites, Sudden weight gain |
| Compensatory response for CHF? | Tachycardia, Diaphoresis, Fatigue, Poor Feeding, Failure to Thrive (FTT), Exercise Intolerance, Decreased Peripheral Perfusion, Pallor and/or Cyanosis, Cardiomegaly |
| How do you improve cardiac functions of CHF? | Meds- Cardiac glycosides like Digoxin |
| How do you promote fluid loss for CHF? | Diuretics (Lasix, Aldactone, HCTZ), fluid restriction, daily weights, monitor I |
| How do you decrease cardiac demands on heart of CHF patient? | Promote rest, minimize stress, monitor V/S (especially temp) |
| How do you reduce respiratory distress in CHF? | Lift HOB, give O2 |
| How do you maintain nutrition for peds pt w/ CHF? | Nipple vs. Gavage feed, GTT, higher calorie feeding |
| What do left-to-right lung shunting defects produce? | Inc. pulmonary blood flow, CHF, Murmurs, Feeding intolerance, Activity intolerance, Poor growth, FTT, Frequent pulmonary infections |
| What is a PDA? | Patent ductus arteriosus- fetal shunt that failed to close causing inc. left ventricle workload and inc. pulmonary blood flow leading to CHF, Left Ventricular hypertrophy, murmur and bounding pulses |
| What med is given for a PDA? | Indocin (indomethicin)- prostaglandin inhibitor - to close PDA |
| What is VSD? | Ventricular Septal Defect - opening between L/R ventricle that allows inc. pulmonary blood flow into R ventricle/atrium causing s/s of CHF, FTT, and murmurs |
| What do you see with Cyanotic Cardiac Defects (dec. pulmonary blood flow)? | O2 desaturation, cyanosis, polycythemia, clubbing, murmurs |
| What is the Tetrology of Fallot? | 4 cardiac anomalies at once: pulmonic stenosis, VSD + overriding aorta, R ventricle hypertrophy |
| What does PS do in Tetrology of Fallot? | Pulmonic stenosis = dec. pulmonary blood flow |
| What does VSD + OA do in Tetrology of Fallot? | Ventricular Septal Defect and Overriding Aorta mix O2 and deoxygenated blood |
| What does R-ventricle hypertrophy do in Tetrology of Fallot? | Forces deoxygenated blood into L-side of heart into aorta |
| Why is Prostaglandin E1 given for Tetrology of Fallot? | Prostaglandin E1 keeps patent ductus arteriosus to inc. pulmonary blood flow and O2 level |
| Difference between Indocin and Prostaglandin E1? | Prostaglandin E1 keeps PDA open, Indocin closes it |
| What's a TET spell? | Hypercyanotic episode where pt changes LOC to irritable and becomes cyanotic |
| What do you do before giving Digoxin? | Make sure HR > 100bpm |
| What is an effective nursing intervention the RN can do to reduce cardiac demands and decrease cardiac workload? | Cluster care |
Created by:
cobedad
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