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UTA NURS 4431 Exam 2
UTA NURS 4431 Children & Adolescents Exam 2
| Question | Answer |
|---|---|
| Premature infant differences in respiratory system | higher risk for respiratory distress syndrome (RDS) d/t lacking surfactant; more compliant chest wall and weaker respiratory muscles |
| Neonatal differences in respiratory system | increased risk for obstruction by mucus, edema, and foreign bodies d/t smaller airways and undeveloped cartilage; obligate nose breathers until 4wks; use diaphragm to breath; irregular rhythm with periods of apnea; |
| Infant differences in respiratory system | primarily nasal until 5-6 mos; retractions (abnormal movements of chest wall) common |
| Children differences in respiratory system | breathe abdominally; increased normal RR; increased O2 demand d/t increased metabolism; ear infections common d/t horizontal eustachian tubes; larynx more susceptible to spasm; enlarged tonsils |
| Crackle sound | Discontinuous, high-pitched, short, crackling, popping sounds heard during inspiration and not cleared by coughing. |
| Crackle indicates | Fluid in airways (e.g., Late inspiratory crackles occur with restrictive disease: pneumonia, congestive heart failure, and interstitial fibrosis. Early inspiratory crackles occur with obstructive disease: chronic bronchitis and asthma.) |
| High-pitched wheeze sound | High-pitched, musical squeaking sounds |
| High-pitched wheeze indicates | narrowing of the air passages from fluid, swelling, spasm, and tumors (e.g., Obstructive lung disease, such as asthma) |
| Low-pitched wheeze sound | Low-pitched, musical snoring, moaning sounds. |
| Low-pitched wheeze indicates | Airflow obstruction (e.g., Bronchitis) |
| Pleural friction rub | A very superficial sound that is coarse and low-pitched; it has a grating quality, as if two pieces of leather were being rubbed together. |
| Pleural friction rub indicates | pleurae inflamed and lose their normal lubricating fluid (e.g., Pleuritis, accompanied by pain with breathing) |
| nasal cannula indication, amount of oxygen, and flow rate | low-flow delivery system indicated for infants and children who need modest amounts of supplemental oxygen (up to 40%, or a flow rate of 1 to 6 L/min) |
| Simple facemask and Venturi mask indication, amount of oxygen, and flow rate | indicated for infants and children who need modest amounts of supplemental oxygen (35% to 60%, or a flow rate of 6 to 10 L/min) |
| Partial nonrebreather masks amount of oxygen and flow rate | 50% to 60% at a rate of 10 to 12 L/min. |
| full nonrebreather system amount of oxygen and flow rate | close to 100% oxygen at a flow rate of 10 to 15 L/min |
| Cystic fibrosis (CF) | an inherited autosomal recessive disorder affecting the exocrine glands, leading to abnormal accumulation of viscous, dehydrated mucus, causing obstruction in the respiratory, gastrointestinal, integumentary, genitourinary, and reproductive systems. |
| CF manifestations | short stature, sinusitis, failure to thrive, nonproductive cough, increased aneroposterior chest diameter, protuberant abdomen, digital clubbing, steatorrhea (fatty stool) |
| CF early manifestation | wheezing, dry/nonproductive cough, frequent respiratory infections (pneumonia, bronchitis), meconium ileus |
| CF diagnosis | a positive sweat test result (chloride level greater than 60 mEq/L is considered to be diagnostic for CF; a level of 40 to 60 mEq/L is suggestive of CF and requires repeating the test) or DNA testing |
| CF management | CPT, exercise, antibiotics, steroid therapy, nutritional management with administration of pancreatic enzymes |
| Asthma manifestations | dry cough, wheezing, retractions, nasal flaring, stridor, restlessness, apprehension, diaphoresis, abdominal pain, fatigue, chest tightness, dyspnea, worsening of symptoms at night. |
| Mild intermittent asthma | symptoms ≤2/wk or only with exercise, normal peak expiratory flow rate between episodes (80% during exacerbation), brief episodes, Infrequent use of bronchodilator (<2/wk), Few missed school days, Rare activity limitation, rarely disturb sleep (< 2/mos) |
| Mild persistent asthma | symptoms >2/wk but <1/day, may begin to affect activity, require a burst of oral corticosteroids more frequently (≥2/yr; more often in children <4 yrs), Nighttime symptoms 1-4/mos depending on age, PEFR >80% predicted |
| Moderate persistent asthma | daily symptoms and bronchodilator use, require a corticosteroid burst ≥2/yr, > 9 school days missed/yr, Some activity limitation, Sleep disturbed >1/wk, PEFR 60% to 80% of predicted |
| Severe persistent asthma | Throughout the day on a daily basis, Use of bronchodilator several times per day, Severely limited physical activity, Frequent sleep disturbance, Exacerbations requiring corticosteroid bursts occur frequently (≥2/yr), PEFR ≤60% of predicted |
| Apnea | the cessation of breathing for a period of 20 seconds or longer, or for a shorter period but accompanied by bradycardia or cyanosis. |
| Apnea manifestations | apparent life-threatening episode (ALTE) characterized by apnea, color change, change in muscle tone, choking, or gagging in an infant who otherwise appears healthy. |
| Apnea management | apnea monitor, neutral thermal environment, monitor while feeding |
| SIDS | the sudden and unexplained death of an infant younger than 1 year. |
| SIDS Risk Factors | prematurity, use of soft bedding, sleeping prone, maternal smoking during pregnancy, sibling having died of SIDS, LBW, low socioeconomic status |
| Croup | a group of conditions characterized by inspiratory stridor, a harsh (brassy or croupy) cough, hoarseness, and varying degrees of respiratory distress |
| Croup manifestations | Fever, The sudden onset of a harsh, metallic barky cough; sore throat; inspiratory stridor; and hoarseness, The use of accessory muscles (substernal, intercostal, suprasternal retractions) to breathe, Frightened appearance, Agitation, Cyanosis |
| Epiglottitis | bacterial form of croup; inflammation of the epiglottis. |
| Epiglottis manifestations | 4 Ds (dyspnea, Dysphagia, drooling, distress); edematious and cherry red epiglottis, drooling, muffled voice, sore throat, inspiratory stridor, cough, and irritability; can result in airway obstruction and hypoxia, acidosis, and death. |
| Croup management | humidified O2, increased fluids, antipyretics, IVF, corticosteroids, racemic epinephrine, possible intubation |
| Epiglottis management | hospitalization (medical emergency), intubation, IV antibiotics and IVF |
| Bronchiolitis | inflammation of the bronchioles caused by an acute viral infection (usually RSV) which is transmitted predominantly through inadequate handwashing |
| Bronchiolitis manifestations | upper respiratory infection symptoms followed by tachypnea, wheezing/crackles/rhonchi, intercostal and subcostal retractions with or without nasal flaring, and cyanosis |
| Bronchiolitis management | most treated at home with fluids, humidification, and rest; hospitalized treated with cool, humidified oxygen, IVF, elevation of head and chest, and Ribavirin; prevent with RespiGam (in high-risk children) |
| Bronchiolitis teaching | lasts 2-3 wks, hand hygiene, bulb suctioning, when to come back |
| Pneumonia | an inflammation of the lung parenchyma caused by infection (viral or bacterial, ingestion of chemical substances, or foreign body aspiration |
| Pneumonia manifestations | fever, cough, tachypnea, ronchi, crackles, or wheezes, retractions, nasal flaring, chest pain, pallor to cyanosis, irritability, restlessness, lethargy, anorexia, vomiting, diarrhea |
| otitis media | effusion (fluid) and infection or blockage of the middle ear. |
| Acute otitis media (AOM) | effusion and inflammation in the middle ear that occurs suddenly and is associated with other signs of illness. |
| Otitis media with effusion (OME) | the presence of fluid behind the tympanic membrane without signs of infection. |
| Otitis media ear infection | symptoms of upper respiratory infection; infants: irritable, hold or pull at ears, roll head from side to side, or cry while feeding; preschoolers and up report pain; all children have fever, lymphadenopathy, vomiting, diarrhea, mild balance disturbances |
| Otitis media management | no antibiotic or prophylactic antibiotics (when have 3+ episodes in 6 mos or 4+ in 1 year), tube placement (when persistent or >3mos associated with hearing loss) |
| Foreign Body Aspiration manifestation | sudden coughing and gagging; partial obstruction may cause symptoms of respiratory infection for days or weeks; hoarseness, croupy cough, wheezing on one side, dyspnea |
| Chest physiotherapy (CPT) | includes postural drainage, chest percussion and vibration, and coughing and deep-breathing exercises. Requires an order and usually performed 3-4 times/day. |
| tracheostomy | a surgically created opening (stoma) in the trachea. |
| Neonatal sepsis | bacteria or their poisonous products, known as endotoxins, gain access to the bloodstream, causing systemic signs and symptoms. |
| Neonatal sepsis manifestation | temp instability, lethargy, mood/eating pattern changes, abnormal Moro reflex, muscle tone/activity change, pulmonary HTN, fluid/electrolyte & acid-base imbalances, neurologic irritation, jaundice or hepatosplenomegaly, and hyper- or hypoglycemia. |
| Nonatal sepsis management | supportive treatment, IV antibiotics, environmental temperature control, respiratory support with O2, possible intubation and mechanical ventilation. |
| Bronchopulmonary Dysplasia (BPD) | chronic obstructive pulmonary disease that occurs as a result of acute lung injury in some infants who have received supplemental oxygen and mechanical ventilation. |
| BPD manifestations | tachycardia, tachypnea, wheezing, nasal flaring, retractions, grunting (from prolonged expiratory effort), pallor, cyanosis in response to feeding/handling, restlessness and irritability, failure to thrive |
| Retractions | Abnormal movements of the chest wall during inspiration; may be subcostal, intercostal, substernal, suprasternal, or supraclavicular. |
| Acute respiratory distress manifestations | tachypnea (60-80), tachycardia (>140), wheezing/crackles/rhonchi, Intercostal and subcostal retractions with or without nasal flaring, cyanosis |
| BPD management | adequate oxygenation (oxygen therapy), prevention of further lung disease (medication), promotion of lung healing (medication), and nutrition |
| Cleft Lip and Palate | abnormal openings in the lip or palate. The defects may occur unilaterally (on either side) or bilaterally and are the most common congenital craniofacial deformity. |
| Cleft Lip and Palate management | A number of professionals are involved in this process, including surgeons; nurses; geneticists; psychologists or psychiatrists; ear, nose, and throat specialists; audiologists; and occupational and speech therapists. |
| Esophageal Atresia with Tracheoesophageal Fistula | congenital malformations in which the esophagus terminates before it reaches the stomach and/or a fistula is present that forms an unnatural connection between the esophagus and the trachea. |
| Esophageal Atresia with Tracheoesophageal Fistula manifestations | Three Cs: coughing, choking, cyanosis; feeding causes regurgication and coughing, constant flow of saliva, gastric distention |
| Esophageal Atresia with Tracheoesophageal Fistula management | surgical repair to ligate fistula and anastomose esophagus |
| Immunization cautions for children with immunodeficiency | can’t have any live vaccines (chickenpox [varicella], MMR [measles-mumps-rubella], intranasal influenza) |
| Incubation period | time between exposure and disease outbreak |
| Infectious period | period when organism can move from the host to another individual |
| Prodromal period | time between initial symptoms and presence of the full-blown disease |
| Viral exanthema | an eruption or rash on the skin caused by a virus |
| Aspirin concern | risk of developing Reye syndrome |
| Rubeola | Measles |
| Rubeola distinguishing manifestations | rash duration: 6-7 days (vs. 1-3 days for Rubella); Koplik spots (small, blue-white spots with a red base that cluster near the molars on the buccal mucosa) appear before rash |
| Rubeola rash | deep-red, macular rash that usually begins on the face and neck and spreads down the trunk and extremities to the feet. |
| Rubeola complications | secondary bacterial infections such as otitis media, croup, or bronchopneumonia |
| Rubella | German measles, 3-day measles |
| Rubella distinguishing manifestations | rash duration: 1-3 days (vs. 6-7 for Rubeola); Forschheimer’s sign (Petechiae (spots), which are red or purple color and pinpoint in size, may occur on the soft palate); As the rash spreads to the trunk, the rash on the face begins to fade. |
| Rubella rash | Pinkish rose maculopapular rash that begins on the face, scalp, and neck which spreads downward to include the entire body within 1 to 3 days. As the rash spreads to the trunk, the rash on the face begins to fade. |
| Rubella complication | thrombocytopenia |
| Varicella | Chickenpox |
| Varicella (Chickenpox) rash | lesions begin as macular; appear in crops, progress to papules, then vesicles to pustules |
| Zoster | Shingles |
| Zoster (shingles) rash | lesions are unilateral macular/popular and follow a dermatome root |
| Varicella-Zoster infectious period | 1 to 2 days before the onset of rash until all lesions are dried (crusted over), usually 5 to 7 days |
| Erythema Infectiosum | Fifth Disease, Parvovirus B19 |
| Erythema Infectiosum (Fifth Disease) rash | maculopapular, lacy rash on trunk and extremities; fiery red, edematous rash on cheeks (“slapped cheek” sign) |
| Roseola Infantum | Sixth Disease, Exanthem Subitum |
| Roseola Infantum (Sixth Disease) rash | rose-pink maculopapules or macules that blanch with pressure that occurs predominantly on the neck and trunk and may be surrounded by a whitish ring. |
| Mumps manifestations | classic clinical sign of parotid glandular swelling (parotitis) often follows fever, myalgia, headache, and malaise, although a substantial number of individuals have no such swelling. |
| Mumps complication | aseptic meningitis; orchitis (inflammation of a testis) |
| Epstein-Barr | Mononucleosis |
| Epstein-Barr (Mononucleosis) manifestations | fever, exudative pharyngitis, lymphadenopathy, and hepatosplenomegaly. Some children develop a maculopapular rash (with admin of penicillin). |
| Epstein-Barr (Mononucleosis) complications | splenic rupture; swelling of pharynx and tonsils severe enough to compromise respiration |
| Epstein-Barr (Mononucleosis) education | avoid contact sports or anything that can cause contact to abdomen, don’t share food/drink/utensils, keep hydrated, hand hygiene, importance of rest and lengthy convalescence |
| Rabies management | prevention (vaccinate animals, avoid wild animals); treat with HRIG (human rabies immune globulin) administered locally around wound and IM; HDCV (human diploid cell vaccine) administered 48 hrs after bite, then on days 3, 7, 14, and 28. |
| Pertussis | Whooping Cough |
| Pertussis catarrhal manifestations | Symptoms of upper respiratory tract infection (rhinorrhea, lacrimation, mild cough, low-grade fever) |
| Pertussis paroxysmal manifestations | Repetitive series of coughs, followed by massive inspiration with a whoop. Cyanosis, protrusion of tongue, salivation, distention of neck veins. Coughing spells may be triggered by yawning, sneezing, eating, or drinking and may induce vomiting. |
| Pertussis convalescent manifestations | Episodes of coughing, whooping, and vomiting that decrease in frequency and severity. Cough may persist for several months. |
| Pertussis complication | pneumonia, respiratory failure, and death |
| Pertussis management | erythromycin to infected child and all nonimmune close contacts |
| Rocky Mountain Spotted Fever transmission | wood tick or dog tick bite |
| Rocky Mountain Spotted Fever manifestations | maculopapular or petechial rash that begins on extremities and spreads to body. Rash progresses to hemorrhagic and necrotic lesions. |
| Rocky Mountain Spotted Fever complications | gangrene of the distal parts of the body can result in thrombosis |
| Rocky Mountain Spotted Fever management | doxycycline within 5 days of onset |
| Lyme Disease rash | erythematous macule or papule forms at the site of the tick bite with a clearing in the center (erythema migrans, or “bull's eye” rash) |
| Scarlet Fever manifestations | fine red papular rash appears in the axillae, groin, and neck, which feels like sandpaper to the touch. |
| Scarlet Fever causative agent | Group A beta-hemolytic streptococci |
| Smallpox causative agent | variola virus |
| Smallpox manifestations | Lesions appear as red spots in the mouth and on the tongue, develop into sores and break, progress into pustules, then form scabs; After a few days a generalized vesicular rash appears |
| Poliomyelitis causative agent | poliovirus |
| Poliomyelitis manifestations | Flaccid paralysis, especially of lower extremities. Fever, malaise, anorexia, nausea, headache, sore throat, and generalized abdominal pain, which begin as mild symptoms, then grow more intense. |
| Poliomyelitis complications | Cervical involvement, called bulbar polio, affects the respiratory and vasomotor centers, resulting in potential damage to respiratory centers and inability to breathe |
| Diptheria manifestations | Hallmark sign: thin, gray membrane on the tonsils and pharynx, causing “bull neck,” or neck edema; Respiratory compromise due to a narrowing of the upper airway |
| Normal blood flow | superior & inferior vena cava to R atrium > tricuspid valve to R ventricle > pulmonic valve & pulmonary arteries to lungs > pulmonary veins to L atrium > mitral valve to L ventricle > aortic valve & aorta to systemic circulation |
| Indicator of decompensated shock in Neonates and Infants | Hypotension (late indicator) |
| HF manifestations | mild tachypnea (70 to 100 breaths per minute) at rest and sometimes difficulty feeding and failure to thrive. |
| HF management | positive inotropes (e.g., digoxin), diuretics (e.g., Lasix), and angiotensin-converting enzyme (ACE) inhibitors (e.g., Catopril) |
| When to withhold Digoxin (Lanoxin) | HR < 100 beats/min in infants; HR is prgessively decreasing or markedly lower than previous rates. |
| Digoxin toxicity manifestations | Level > 2ng/mL; slow pulse, vomiting, and arrhythmias. |
| When to withhold Furosemide (Lasix) | Patient is hypokalemic or having postural hypotension |
| Left-to-right shunting lesions | lesions that increase pulmonary blood flow (e.g., Atrial septal defect (ASD), Ventral septal defect (VSD), Patent ductus arteriosus (PDA), Endocardial cushion defect) |
| Left-to-right shunting lesion effects and consequences | Effects: volume overload in R side of heart and in pulmonary artery causes cardiac workload increase; Consequences: HF, pulmonary vascular disease, pulmonary HTN, Eisenmenger syndrome, & frequent resp infections (can progress to respiratory failure) |
| Obstructive or stenotic lesions | lesions that decrease cardiac outflow (e.g., Pulmonary stenosis, Aortic stenosis, Coarctation of the aorta) |
| Stenosis | the narrowing or constriction of an opening |
| Atresia | Absence or abnormal closure of a normal body orifice or passage. |
| Obstructive or stenotic lesion effects and consequences | effects: increased cardiac workload and ventricular strain; consequences: HF, decreased cardiac output, and pump failure. |
| Cyanotic lesions with decreased pulmonary blood flow | hypoplasia (incomplete development), malalignment, or obstruction on R side of the heart, and decreased amount of blood volume to the lungs (e.g., tetralogy of fallot, tricuspid valve abnormalities, pulmonary atresia with intact ventricular septum) |
| Cyanotic lesions with decreased pulmonary blood flow effects and consequences | effects: hypoxema, increased cardiac workload, and ventricular strain; consequences: upper respiratory infection, severely limited pulmonary blood flow, and marked exercise intolerance. |
| Cyanotic lesions with increased pulmonary blood flow | heart fails to develop into separate pulmonary and systemic circulations or there is a reversal of circulation so that desaturated blood goes to the systemic circulation and saturated blood to the pulmonary circulation |
| Cyanotic lesions with increased pulmonary blood flow effects and consequences | effects: increased cardiac workload, ventricular strain, and decreased cardiac output; consequences: appear ruddy or cyanotic, with increased respiratory effort, or, if systemic circulation is compromised, may be dusky or gray and in cardiogenic shock |
| Patent ductus arteriosus (PDA) | lesion that increases pulmonary blood flow; failure of fetal ductus arteriosus to close completely, causing saturated blood from aorta to move back into pulmonary arteries, increasing left-sided workload and pulmonary blood flow. |
| PDA manifestations | HF, continuous murmur (machinery-like sound), widened pulse pressure, bounding pulses, tachypnea, poor feeding/weight gain, frequent respiratory tract infections, fatigue, diaphoresis, cardiac enlargement |
| PDA management | HF interventions, idomethacin (Indocin) to constrict ductus, cardiac catheterization, surgical management (ligation of ductus via left thoractomy) |
| Atrial-Septal Defect | lesion that increases pulmonary blood flow; abnormal opening between the atria |
| ASD manifestations | may be asymptomatic, systolic murmur in the pulmonic area, splitting S2, dyspnea, fatigue and poor growth |
| ASD management | if asymptomatic, f/u with cardiologist; if symptomatic, administer diuretics and digoxin for HF signs, antiarrhythmics for arrhythmias, interventional cardiac catheterization, surgical placement of sutures or patch |
| Ventricular Septal Defect (VSD) | lesion that increases pulmonary blood flow; Abnormal opening between the ventricles |
| VSD manifestations | may be asymptomatic, tachypnea, dyspnea, poor growth, palpable thrill, systolic murmur at the left lower sternal border |
| VSD management | if asymptomatic, f/u with cardiologist; Diuretics, digoxin, and medications for afterload reduction (e.g., angiotensin-converting enzyme [ACE] inhibitors), Interventional Cardiac Catheterization, Suture or patch closure |
| Atrioventricular Septal Defect (AVSD; Endocardial Cushion Defect) | lesion that increases pulmonary blood flow often associated with genetic syndromes (e.g., Down syndrome); Abnormal endocardial tissue development affecting the atrial and ventricular septum and mitral and tricuspid valves (AV valves). |
| AVSD manifestations | murmur, CHF, mild cyanosis that increases with crying |
| AVSD management | Symptomatic treatment of HF with diuretics, digoxin and ACE inhibitors; surgical repair |
| Pulmonary Stenosis | Stenotic Lesion; Narrowing at entrance to the pulmonary artery at the valve, below the valve, or above the valve |
| Pulmonary Stenosis manifestations | may be asymptomatic, exercise intolerance, right-sided HF, murmur, palpable thrill, cardiomegaly, cyanosis |
| Pulmonary Stenosis management | observation and antibiotic prophylaxis for asymptomatic, Interventional catheterization or surgical management (valvulotomy or shunt) for severe stenosis, PGE1 (prostaglandin) infusion to keep ductus arteriosus open |
| Coarctation of the Aorta | Obstructive lesion; Aorta is constricted near the ductus arteriosus insertion location |
| Coarctation of the Aorta manifestations | asymptomatic, BP difference of 20 mm Hg between upper and lower extremities, brachial and radial pulses full, femoral pulses weak, HS, vertigo, epistaxis, exercise intolerance, dyspnea |
| Coarctation of the Aorta management | Diuretics & digoxin; PGE1; Interventional Cardiac Catheterization (balloon dilation with placement of stent) or Surgical management (end-to-end anastomosis, prosthetic patch); prophylaxis for endocarditis with antibiotics for surgical or dental procedures |
| Aortic Stenosis | Stenotic Lesion; Narrowing of the entrance to the aorta |
| Aortic Stenosis manifestations | murmur, chest pain, exercise intolerance, dizziness when standing for long period, faint pulses, hypotension, tachycardia, poor feeding |
| Aortic Stenosis management | regular follow-up (especially for athletes), Interventional catheterization or surgical management |
| Tetralogy of Fallot | Cyanotic Lesions with Decreased Pulmonary Blood Flow; Combines four defects: VSD, pulmonary stenosis, right ventricular hypertrophy, overriding aorta |
| Tetralogy of Fallot manifestations | systolic murmur in the pulmonic area, polycythemia, metabolic acidosis, poor growth/poor feeders, exercise intolerance, clubbing of digits, TET spells (hypoxia, pallor, tachypnea) |
| Tetralogy of Fallot management | PGE1; management of hypercyanotic episodes; treatment of iron deficiency anemia; surgical management (patching VSD and relieving pulmonary stenosis) |
| Pulmonary Atresia | Cyanotic Lesions with Decreased Pulmonary Blood Flow; Failure of the pulmonary valve to develop |
| Pulmonary Atresia manifestations | Profound cyanosis; survival depends on a PDA, Single second heart sound, PDA murmur |
| Pulmonary Atresia management | Continuous PGE1 infusion; Interventional catheterization or surgical management |
| Transposition of the Great Arteries | Cyanotic Lesions with Increased Pulmonary Blood Flow; Abnormal separation and rotation of the fetal common truncal vessel causes the aorta to arise from the right ventricle and the pulmonary artery to arise from the left ventricle |
| Transposition of the Great Arteries manifestations | Cyanosis at birth; Hypoxemia, despite oxygen administration; Progressive desaturation and acidosis; developing HF |
| Transposition of the Great Arteries management | PGE1; Interventional Cardiac Catheterization (Balloon atrial septostomy) or surgical management (Arterial switch procedure) |
| Hypoplastic Left Heart Syndrome | Cyanotic Lesions with Increased Pulmonary Blood Flow; Inadequate development of the left side of the heart results in one effective ventricle |
| Hypoplastic Left Heart Syndrome manifestations | HF from increased pulmonary blood flow; tachypnea; Systemic hypoperfusion and shock as ductus arteriosus begins to close; Infant is grayish blue, has dyspnea and hypotension |
| Hypoplastic Left Heart Syndrome management | correct acid-base and electrolyte imbalances; PGE1 until surgery; surgical management (cardiac transplantation or three-stage palliative repair that will result in a single right ventricle) |
| Heart surgery teaching regarding activity | resume regular schedules; omit contact play or activities that could cause fall; avoid ill contacts; avoid large crowds |
| Heart surgery teaching regarding diet | resume regular formula/baby foods; no new foods; adequate liquid intake; expect improvement in appetite |
| Heart surgery teaching regarding incision | do not bathe until instructed to do so (then normal way, patting incision dry); cover incision to avoid drool; Do not use creams, lotions, or powders on incision; Report any redness, drainage, or signs of infection at the incision or suture sites. |
| Heart surgery teaching regarding school | return to school second to third week after discharge; half days for first few days; should not participate in PE until 2 mos postoperatively |
| Heart surgery teaching regarding notifying physician | Faster, harder breathing than normal when child is at rest; Temp above 100° F; New, frequent coughing; Turning blue or bluer than normal; Any swelling, redness, or drainage of the incision; Frequent vomiting/diarrhea; Pain worse; Appetite worse. |
| Heart surgery teaching regarding checkup | 1-2 week follow-up after discharge; no immunization for 4-6 weeks postoperatively |
| Endocarditis | an inflammation resulting from infection of the cardiac valves and endocardium (inner lining of heart) by a bacterial or occasionally a fungal or viral agent. |
| Endocarditis manifestations | fever; nonspecific complaints of anorexia, nausea, fatigue, and malaise; arthralgias; chest pain; heart failure; petechiae; neurologic impairment as a result of embolic events; and presence of, or change in, a heart murmur |
| Endocardits management | high-dose antibiotics, removal of vegetations, valve replacement; prophylaxis with antibiotics for dental work and tonsillectomy and adenoidectomy |
| Rheumatic Fever | diffuse inflammatory condition of connective tissue, primarily of the heart, joints, subcutaneous tissues, brain, and blood vessels, most probably of autoimmune origin |
| Rheumatic Fever manifestations | Chorea (involuntary movements of extremities and face), fever, carditis, erythema marginatum (red skin lesions starting on trunk and spreading peripherally), abdominal pain, subcutaneous nodules (small, nontender swellings often over joints), polyarthrits |
| Rheumatic Fever complication | rheumatic heart disease, which can result in permanent damage to the cardiac valves, most commonly the mitral and aortic valves |
| Rheumatic Fever management | Penicillin; aspirin or corticosteroids |
| Kawasaki Disease | also called mucocutaneous lymph node syndrome; an acute, febrile, exanthematous illness of children with a generalized vasculitis of unknown etiology. |
| Kawasaki Disease manifestations (acute phase) | days 1-10; fever, red eyes, swollen hands and feet, red palms and soles, rash, enlarged cervical lymph nodes |
| Kawasaki Disease manifestations (subacute phase) | days 10-25; cracking lips, desquamation of the skin on tips of fingers and toes, cardiac disease, and thrombocytosis |
| Kawasaki Disease manifestations (convalescent phase) | days 26-40; lingering signs of inflammation |
| Kawasaki Disease management | high-dose aspirin while elevated temperature; IVIG (IV gamma globulin); teach to avoid persons with viral illness while taking aspirin |
| Kawasaki Disease diagnostic evaluation | Fever of 5 days duration in conjunction with at least four of the five primary clinical findings for the acute phase and no other known disease process to explain s/s |
| Arrhythmia | a cardiac rhythm disturbance |
| Arrhythmia manifestations | diminished cardiac output causing poor feeding, irritability, lethargy, pale/mottled color, poor peripheral perfusion, decreased urine output, HF, palpitations, dizziness, syncope, and exercise intolerance |
| Arrhythmia management | drug therapy, radiofrequency ablation, cardioversion, and pacemakers; the choice of treatment is guided by the origin of the arrhythmia and the clinical consequences |
| Supraventricular Tachycardia (SVT) | a narrow QRS tachycardia (Rates can be in the range of 220 to 300 beats/min) |
| SVT management | vagal maneuvers, antiarrhythmics (e.g., Adenosine), radiofrequency ablation, or synchronized cardioversion (treatment of choice for the child with profound cardiovascular compromise) |
| Developmental Dysplasia of the Hip | variety of conditions in which the femoral head and acetabulum are improperly aligned |
| Developmental Dysplasia of the Hip predisposing factors | twins, breech delivery, maternal hormones, large infant |
| Developmental Dysplasia of the Hip manifestations | positive Barlow and Ortolani tests, asymmetry of gluteal skin folds, limited ROM, asymmetric abduction, femur appears short, minimal to pronounced variations in gait with lurching towards one side |
| Ortolani test | abduct the thighs and apply gentle pressure forward over the greater trochanter. A “clunking” sensation indicates a dislocated femoral head moving into the acetabulum. A hip click may be felt or heard, but is usually normal. |
| Barlow test | adduct the hips and apply gentle pressure down and back with the thumbs. In hip dysplasia, the examiner can feel the femoral head move out of the acetabulum. |
| Developmental Dysplasia of the Hip management | newborn: splinting hips with pavlik harness to maintain flexion, abduction, and external rotation; older children: surgery |
| Clubfoot | congenital malformation of the lower extremity that affects the lower leg, ankle, and foot |
| Clubfoot manifestations | plantar flexion, dorsiflexion, varus deviation (foot turns in), valgus deviation (foot turns out) |
| Clubfoot management | serial manipulation and casting; surgery (if sufficient correction not achieved within 3-6 mos); longterm follow-up |
| Slipped capital femoral epiphysis (SCFE) | condition that occurs during a period of rapid growth in adolescence. Shearing stress causes the femoral capital (upper) epiphysis (growth plate) to displace from its normal position relative to the femoral neck. |
| SCFE manifestations | limp and pain in the hip aggravated by activity, groin, thigh, or knee area |
| SCFE management | bed rest, Buck’s traction, surgical internal fixation |
| Osteosarcoma | also called osteogenic sarcoma; the most common primary bone malignancy in children; usually occurs in long bones (arms, legs, pelvis) |
| Osteosarcoma manifestations | progressive, insidious, or intermittent pain at the tumor site; a palpable mass; limping, if a weight-bearing limb is affected; progressive, limited range of motion; and eventually pathologic fractures at the tumor site. |
| Osteosarcoma management | surgery (biopsy, resections, bone/skin grafts, limb salvage procedures, reconstructions), amputation, chemotherapy, radiation |
| Ewing sarcoma | second most common bone tumor seen in children occurring most commonly in the diaphysis of the femur, the tibia and humerus |
| Ewing sarcoma manifestations | pain, soft tissue swelling around the affected bone, fever, anorexia, malaise, fatigue, and weight loss; neurologic symptoms (if vertebral) or respiratory symptoms (if rib tumor) |
| Ewing sarcoma management | surgery, chemo, radiation, amputation, resections |
| Buck’s traction | used for knee immobilization or for short-term immobilization of a fracture |
| Bryant’s traction | Used to treat very young children (less than 2 years) with femur fractures or developmental dysplasia of the hip. |
| Dunlop’s traction | used for supracondylar (around elbow) fractures of the humerus |
| Russell’s traction | used for fractures of the femur and lower leg |
| Fracture reduction complications | infection, nerve compression syndrome, kidney stones, pulmonary emboli, circulatory impairment, fat embolism |
| five Ps | used as a guide for assessing neurovascular status: Pain unrelieved by analgesia, Pallor, Pulselessness or lack of capillary refill, Paresthesia, Paralysis or progressive loss of motion |
| Fracture | A break or disruption in a bone's continuity. |
| Greenstick fracture | break occurs through the periosteum on one side of the bone while only bowing or buckling on the other side; most frequently in forearm |
| Spiral fracture | tristed or circular break that affects the length rather than the width; seen frequently in child abuse |
| Complete (Oblique) fracture | diagonal or slanting break that occurs between the horizontal and perpendicular planes of the bone |
| Transverse fracture | break or fracture line occurs at right angles to the long axis of the bone |
| Fracture management | reduction and fixation (closed or open), retention (cast or traction) |
| Contusion | damage to soft tissue, subcutaneous structures, and muscle |
| Dislocation | Displacement of a bone from its normal articulation within a joint |
| Sprain | trauma to a joint in which ligaments are stretched or are partially or completely torn |
| Strain | (aka pulls, tears, or ruptures) excessive stretch of muscle. |
| RICE | Rest, Ice, Compression, Elevation |
| Scoliosis | lateral curvature of the spine |
| Scoliosis manifestations | visible curve, rib hump when bending forward, asymmetric rib cage, uneven should or pelvic heights, prominence of the scapula or hip, difference in space between arms and trunk when standing, apparent leg-length discrepancy |
| Scoliosis management | regular and periodic observation, bracing, or spinal fusion surgery depending on extent of the curve, child’s age, projected growth and associated complications |
| Osteomyelitis | a bacterial infection of the bone that involves the cortex or marrow cavity. |
| Osteomyelitis manifestations | infant: fever, irritability, feeding difficulties, signs of sepsis; older child: pain, warmth, tenderness over site, favoring of extremity, erythema, limited ROM, fever, lethargy |
| Osteomyelitis management | high-dose IV antibiotics, bed rest, immobilization, or surgical intervention (if abscess present or antibiotic fails) |
| Osteogenesis imperfecta | “brittle bone disease” that results from defect in the synthesis of collagen |
| Osteogenesis imperfecta manifestations | osteoporosis; excessive bone fragility; increased joint flexibility; blue sclera; discolored teeth; conductive hearing loss by age 20-30 yrs; translucent skin; easily bruised; short stature; multiple fractures tend to cause limb and spinal deformities |
| Osteogenesis imperfecta management | fracture prevention; medication (calcitonin, biphosphonates); orthopedic stabilization (traction, casting, fixation) |
| Cerebral palsy | a chronic, nonprogressive disorder of posture and movement characterized by difficulty in controlling the muscles because of an abnormality in the extrapyramidal or pyramidal motor system (motor cortex, basal ganglia, cerebellum) |
| Cerebral palsy manifestations | poor head control after 3 mos, stiff/rigid arms/legs, pushing away/arching back, floppy/limp posture, cannot sit up without support by 8 mos, uses only one side, clenched fists after 3 mos |
| Cerebral palsy management | early recognition and intervention to maximize abilities |
| Muscular Dystrophies | progressively degenerative, inherited diseases that affect the muscle cells of specific muscle groups, causing weakness and atrophy. |
| Duchenne muscular dystrophy | most common muscular dystrophy; progressive, symmetrical muscle wasting and weakness without loss of sensation first appear after walking is achieved (usually 3 to 7 years); loss of walking by 9-12 yr; death in late teens |
| Muscular Dystrophy manifestations | waddling, wide-based gait; Lordosis; difficulty climbing, running, or pedaling; Gower’s sign; pseudohypertrophy; scolios and long bone fractures |
| Muscular Dystrophy management | maintenance of ambulation and independence as long as possible; high protein, low calorie, high fiber diet; palliative care |
| Respiratory alteration after burn | Upper airway tissue injury with respiratory distress, possible obstruction; Lower airway tissue injury; Carbon monoxide inhalation, hypoxia; Limited chest expansion |
| Cardiovascular alteration after burn | Fluid volume deficit with decreased cardiac output; tachycardia; vasodilation then vasoconstriction; Edema, compartment syndrome; Elevated hemoglobin, hematocrit levels; Increase followed by decrease in serum potassium levels; Decreased sodium levels |
| Gastrointestinal alteration after burn | Gastric dilation, paralytic ileus; Thirst |
| Renal alteration after burn | Oliguria, elevated blood urea nitrogen and creatinine values; Risk for acute tubular necrosis |
| Metabolic alterations after burn | Increased metabolic rate with elevated body temperature and massive evaporative heat loss; Catecholamine release; Hyperglycemia |
| Hematologic alterations after burn | Decreased hematocrit level follows initial hematocrit increase (from hemoconcentration); Coagulation disorders; Increased immature neutrophils to digest products of injury; High risk for infection, wound sepsis, septic shock |
| Vesicles | fluid filled lesions |
| Papules | flesh colored lesions |
| Pustules | pus filled lesions |
| Cysts | may be solid-ish lesion |
| Impetigo | Staphylococcus aureus infection that begins in an area of broken skin, such as an insect bite, scabies, or atopic dermatitis |
| Impetigo manifestations | honey crusted lesions (crusted impetigo); shiny, lacquered-appearing lesions surrounded by scaly rim (bullous impetigo) |
| Impetigo management | topical and/or oral antibiotics |
| Cellulitis | bacterial infection of the subcutaneous tissue and the dermis that is usually associated with a break in the skin, although cellulitis of the head and neck can follow an upper respiratory tract infection, sinusitis, otitis media, or tooth abscess. |
| Cellulitis manifestations | red, hot, tender, and indurated; purplish tinge (if H. influenzae); lymphangitis; fever, malaise, and headache |
| Cellulitis management | IM or IV antibiotics, then 10 days of oral antibiotics |
| Pediculosis Capitis | infestation of lice on the scalp |
| Pediculosis Capitis (Head Lice) manifestations | Nits are visible and are attached firmly to the hair shafts near the scalp; commonly behind ears and nape of neck |
| Pediculosis Capitis (Head Lice) management | kill lice with a pendiculicide; remove nits; prevent spread and recurrence |
| Scabies | a contagious condition that results from infestation with Sarcoptes scabiei, the “itch mite.” |
| Scabies manifestation | intense pruitus, especially at night and nap times; irritability, restless, fitful sleep |
| Scabies management | scabicidal medications (permethrin, lidane, crotamiton); oral antihistamines; antibiotics (if secondary infection); soothing creams/lotions |
| Eczema (Atopic Dermatitis) | common chronic inflammatory disease of the skin characterized by severe pruritus. |
| Eczema (Atopic Dermatitis) manifestations | erythematious areas of oozing and crusting; papulovesicular rash and scaly red plaques; dry, scaly popular patches |
| Eczema (Atopic Dermatitis) management | anti-inflammatory corticosteroid creams and ointments; antihistamines; oral antibiotics (if skin breakdown/infection) |
| Seborrheic Dermatitis | a chronic inflammatory skin condition seen frequently in infants. It is referred to as “cradle cap” when located on the scalp. |
| Seborrheic Dermatitis manifestations | nonpruritic, oily, yellow scales that block sweat and sebaceous glands, causing retained secretions and inflammation in affected areas |
| Seborrheic Dermatitis management | over-the-counter antiseborrheic shampoo containing sulfur and salicylic acid (Fostex Medicated Cleansing, P&S, Sebulex), selenium, or tar (Neutrogena T/Gel, Polytar) |
| Tinea | a superficial skin infection caused by a group of fungi known as dermatophytes. |
| Tinea corporis | ringworm; a fungal infection of the face, trunk, or extremities. |
| tinea capitis | fungus invades the hair shafts, causing the hairs to become brittle and to break off at the level of the scalp, leaving an area of stubby, black-dotted alopecia. |
| Tinea cruris | jock itch; characterized by an intense inflammatory reaction with severe pruritus. |
| Tinea pedis | athlete's foot; may become chronic, particularly in adolescents who wear unventilated athletic shoes. |
| Tinea management | topical antifungal |
| Poison Ivy, Oak, and Sumac management | oral antihistamines, steroids |
| Acne | a disorder of the sebaceous hair follicles which begins when sebaceous glands, stimulated by androgens at the onset of puberty, enlarge and secrete increased amounts of sebum. The sebaceous glands become plugged and dilated with sebum. |
| Contact dermatitis | an inflammatory reaction of the skin either caused by direct exposure to an irritant (irritant contact dermatitis) or a delayed hypersensitivity response to an allergen (allergic contact dermatitis). |
| Contact dermatitis manifestations | irritant: dry, inflamed, and pruritic skin which correlates with skin surface in contact with offending agent; allergic: blistering, weeping lesions over an area of inflamed skin, intense pruritus, and crusted, scaly lesions |
| Contact dermatitis management | discontinuing exposure by washing skin; cool compresses, Burow’s solution or steroid cream; possibly oral steroids |
| Stevens-Johnson Syndrome | Acute, sometimes recurrent autoimmune disease that may be triggered by infections or medications, such as sulfonamides or anticonvulsants. |
| Stevens-Johnson Syndrome manifestations | After a prodromal respiratory illness, bullae appear on the lips, mouth, eyes, and genitalia. Fever, chills, malaise, neutropenia, anemia, weakness. Purulent conjunctivitis is common. Skin lesions rupture and may lead to significant fluid loss. |
| Stevens-Johnson Syndrome management | withdraw triggering medication; Treatment of skin lesions similar to treatment of extensive burns |
| Molluscum Contagiosum | Viral infection of the skin and mucous membranes transmitted by skin-to-skin and fomite-to-skin contact or sexual contact. |
| Molluscum Contagiosum manifestations | Firm, solid, pink papules changing into soft, waxy, umbilicated papules. Curdlike core of the lesion can be expressed. Most common sites: face, trunk, extremities, oral mucous membranes, conjunctiva, genitalia. |
| Molluscum Contagiosum management | Lesions may be treated with cantharidin, cryotherapy, tretinoin, or imiquimod. Spontaneous disappearance is common. |
| Daily fluid requirements for 0-10kg | 100mL/kg |
| Daily fluid requirements for 10-20kg | 1000mL + 50mL/kg for each additional kg over 10 kg |
| Daily fluid requirements for 20+ kg | 1500mL + 20mL/kg for each additional kg over 20 kg |
| Erikson’s Stage for Preschoolers | Initiative vs. Guilt: Development of a can-do attitude about the self; behavior becomes goal-directed, competitive, and imaginative; initiation into gender role; characterized by purpose. |
| Piaget’s Period for Preschoolers | Preoperational Stage: Preconceptual (3-4 yrs) and Intuitive thought (4-5 yrs): Thinking remains egocentric, becomes magical, and is dominated by perception. Transductive reasoning; field dependency thinking; centration; irreversibility in thought. |
| Transductive reasoning | Seen in preschoolers in the preconceptual phase of Piaget’s preoperational stage; Reasoning from the particular to the particular rather than from the general to the particular. |
| Field dependency thinking | Seen in preschoolers in the preconceptual phase of Piaget’s preoperational stage; difficulty focusing on the important aspects of a situation (everything is important and interdependent). |
| Centration | Seen in preschoolers in the intuitive phase of Piaget’s preoperational stage; the tendency to center or focus on one part of a situation and ignore the other parts. |
| Irreversibility | Seen in preschoolers in the intuitive phase of Piaget’s preoperational stage; the inability to understand a process in reverse or mentally undo an action that has been performed. |
| Erikson’s Stage for School Aged | Industry vs. Inferiority: Mastering of useful skills and tools of the culture; learning how to play and work with peers; characterized by competence. |
| Piaget’s Period for School Aged | Concrete Operations: Thinking becomes more systematic and logical, but concrete objects and activities are needed. Characterized by reversibility, conservation, classification, logic, humor |
| Reversibility | Seen in school aged in Piaget’s concrete operations stage; can understand a process in reverse or mentally undo an action that has been performed. |
| Conservation | Seen in school aged in Piaget’s concrete operations stage; Ability to understand that certain properties of objects do not change simply because their order, form, or appearance has changed. |
| 3 year milestones | brush teeth; put on clothes; build tower of 4-6 cubes; names familiar pictures; throws a ball overhand; jumps; kicks a ball forward |
| 5 year milestones | puts t-shirt on; washes hands; stand on one foot; jump rope; adjectives (tired, hot) |
| 6-8 year milestones | self-esteem, tie shoes, expansive vocabulary, love sports and games |
| 9-11 year milestones | peer opinions more important than parents, clubs, hero worship, boy crazy, away from home experiences, full developed hand-eye coordination and fine motor control, read a lot |
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