Exam 5

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Principles of Pediatric Nursing
Chapters 18, 21, 25, 26
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1

Digoxin

Increases contractility, decreases heart rate, increases cardiac output

2

Hold digoxin for infants with bpm less than

90

3

Hold digoxin for children with bpm less than

70

4

There is risk for digoxin toxicity with

hypokalemia

5

If a child is on digoxin and vomits:

do not readminister

6

How do you administer digoxin for a child?

direct it to the side and back of mouth. Give water after to protect tooth enamel.

7

Diuretics

the number 1 drug for acute/worsening HF

8

Furosemide is

potassium wasting loop diuretic

9

Do not give furosemide with potassium levelsl

less than 3.5

10

Ace inhibitors

1st choice to lower blood pressure

11

Ace inhibitors

reduce afterload by causing vasodilation, resulting in decreased pulmonary and systemic vascular resistance

12

Shock

acute, complex state of circulatory dysfunction resulting in failure to deliver sufficient oxygen and other nutrients to cells and tissue

13

hypovolemic

inadequate tissue and organ perfusion due to inadequate blood or plasma volume

14

Shock occurs from

plasma loss from burns, nephrotic syndrome, sepsis

15

S/S of shock

dyspnea, breath sounds with crackles, grunting, hypotension, tachycardia, weak peripheral pulses

16

Extracellular fluid-volume deficit causes

Dehydration

17

Interstitial fluid-volume excess causes

edema

18

Extracellular fluid - volume excess causes

sudden weight gain

19

Dehydration is

volume depletion

20

Mild severity of dehydration is

up to 5% of body weight

21

Moderate severity of dehydration is

6-9% of body weight

22

Severe severity of dehydration is

10% or more of body weight

23

S/S of mild severity of dehydration

alert, thirsty, HR regular and strong, usual urine output, slightly increased third, rapid cap. refill, RR regular, eyes: normal

24

S/S of moderate severity of dehydration

Lethargic, irritable, postural hypotension, delayed cap. refill, eyes: slightly sunken or decreased tears, decreased skin turgor, increased HR, decreased urine output, sunken fontanelle

25

S/S of severe severity of dehydration

Lethargic to comatose (infants and young children) often conscious, apprehensive (older children and adolescents), BP: low to undetectable, HR rapid, weak to palpable, very poor skin turgor, fontanelle: sunken, urine output: very decreased or absent, delayed cap. refill (>3-4 seconds), eyes: deeply sunken, absent tears

26

Two signs of severe dehydration are

depressed fontanelles and cap. refill time greater than 3 seconds

27

Isotonic dehydration

occurs in which electrolyte and water are in balanced proportions

28

Hypotonic dehydration

electrolyte deficit exceeds the water deficit

29

Sodium below normal (less than 130) is

hypotonic

30

Hypertonic

water loss in excess of electrolyte loss

31

Sodium levels above normal (150) is

hypertonic

32

Water intoxication is

water overload, when water intake in excess of output

33

Causes of water intoxication

too-rapid dialysis, tap water enemas, feeding incorrectly mixed formula, excessive water ingestion, too rapid reduction of glucose levels in DKA

34

The main concern of a child with a cleft lip and cleft palate is

having the child to eat to avoid Failure to thrive

35

The failure to thrive risk increases in children with cleft lip and cleft palate due to

not being able to suck on nipple

36

Cleft palate children should be:

ween from bottle and should be drinking out of cup because of the sutures (nothing can go into the mouth)

37

For children with isolated cleft lip

use a wide-based nipple for bottle feeding

38

For children with cleft palate or cleft lip and palate

position the infant upright while cradling the head during feeding, burp the infant frequently

39

For children with cleft lip

avoid the prone position, no pressure on lips, no crying, no touching

40

Post op management for children with cleft lip

apply antibiotic ointment and careful cleaning instructions of NS, water, or diluted hydrogen peroxide to clean incision site, gently aspirate sections of mouth

41

Post op management for children with cleft palate

place child in supine or side-lying position, patient should drink out of cup, nothing is to go into the mouth

42

Esophageal atresia is

when the esophagus has a blockage

43

Tracheoesophageal fistula

when the other end of the esophagus is connected to the windpipe

44

You will not be able to pass a NG tube with a patient with

esophageal atresia

45

Manifestations for esophageal atresia and tracheoesophageal fistula

frothy saliva, drooling, choking and coughing

46

Nursing for for esophageal atresia and tracheoesophageal fistula

provide suction, position infant in supine position with head elevated 30 degrees

47

Preop nursing diagnosis for esophageal atresia and tracheoesophageal fistula

risk for aspiration re/t regurgitation

48

Pyloric stenosis causes a

high risk for failure to thrive

49

Pyloric stenosis is

the obstruction between the stomach and the duodenum

50

Manifestations of pyloric stenosis

projectile vomiting, weight loss, visible peristaltic waves

51

Management of pyloric stenosis

pyloromyotomy

52

Pyloromyotomy risks

feeding problems post feeding (emesis after each feeding)

53

Gastroesophageal reflux

transfer of stomach contents into the esophagus

54

3 mechanisms allow reflux to occur:

lower esophageal relaxations, incompetent lower esophageal sphincter, anatomic disruption of esophagogastric junction

55

Manifestations of GER

spitting up, excessive crying, recurrent pneumonia, heartburn, diff. swallowing, irritability, blood in vomit

56

Post op risk for GER

do not replace NG if it is accidently removed because of possible injury to the operative site

57

Omphalocele is

abdominal contents that protrude through the umbilical ring

58

If the bowel is exposed for a pt with omphalocele you want to:

cover with a bowel bag or moist dressing to prevent drying and excessive fluid loss

59

For a pt with omphalocele, you instruct the nursing aide to

prepare a warmer

60

Gastroschisis

When the bowel herniates through the abdominal wall, to the right of the umbilical cord and through the rectus muscle

61

Management of gastroschisis

cover with a bowel bag or loose, moist dressing, IV fluids and antibiotics

62

Intussusception

causes obstruction, decreased natural flow, or necrosis

63

Manifestations of intussusception

high-pitched crying, current-jelly stools, drawing knees up to chest, N/V, crampy, abd pain

64

Management of intussuception

pneumoenema (air) with or without contrast (barium) or saline enema

65

Hischsprung's disease

aganglionic megacolon - mechanical obsruction from inadequate motility of part of the intestine

66

Manifestations of hischsprung's disease

vary with age, abdominal distention, failure to pass meconium within 24-48 hrs, N/V

67

Management of hischsprung's disease

give stool softener, enemas

68

Hernia

Protrusion of the intestine through the umbilical ring

69

Congenital diaphragmatic hernia

protrusion of abdominal contents into thoracic cavity

70

Ostomies

An opening into the small or large intestine that diverts fecal mater when nonfunction of obstruction prevents normal elimination

71

Management of ostomies

Good skin care, care of the stoma, appliance removal and application, frequency of changes

72

Appendicitis

Inflammation of the appendix

73

Manifestation of appendicitis

Rebound tenderness

74

Appendix care

antibiotics, NG tube, vitals every 4 hours, monitor bowel sounds

75

S/P appendectomy care

ambulation: pain medication as ordered and a pillow on the abdomen

76

Necrotizing enterocolitis

inflammation of the bowel (life-threatening)

77

Manifestations of necrotizing enterocolitis

feeding intolerance, blood diarrhea, lethargy, periods of apnea and bradycardia, temperature instability

78

Management of enterocolitis:

NPO, NG suction, antibitoic therapy, TPN, measure abdominal girth

79

Meckel diverticulum

failure of the omphalomesenteric duct to fuse during fetal development

80

Manifestations of meckle diverticulum:

abdominal pain, blood stools (look like currant-jelly), anemia and shock

81

Management of meckel diverticulum:

surgical removal

82

Nursing care of meckel diverticulum

IV fluid therapy, NG tube, education

83

Complications of meckel diverticulum:

GI hemorrhage, bowel obstruction for untreated pts

84

Crohn's disease

Chronic inflammatory process, causes ulcers to form

85

Manifestations of crohn's disease:

crampy abdominal pain, diarrhea, fever, anorexia, weight loss, malaise, joint pain

86

Ulcerative colitis

Chronic, recurrent disease of the large intestine and rectal mucosa

87

Manifestations of colitis:

Diarrhea, lower abdominal pain, blood and mucus in stool, weight loss, nutritional deficiencies

88

Peptic ulcer

Erosion of the mucosal tissue of the lower esophagus, stomach or duodenum

89

Manifestations of peptic ulcer

abdominal pain on an empty stomach, vomiting and pain after meals, blood in stool, anemia, waking the child at night

90

Acute diarrhea

Symptom resulting from a disorder involving digestive, absorptive, and secretory functions

91

Acute diarrhea is usually caused by

infectious agent and is self-limiting(14 days)

92

Treatment for acute diarrhea

no specific treatment

93

Chronic diarrhea

increase in stool frequency and increased water content for more than 14 days

94

Rotavirus is the most important cause of

gastroenteritis among children

95

Management of diarrhea

Oral rehydration therapy

96

Short bowel syndrome

malabsorption disorder; decreased ability to absorb and digest a regular diet due to a shortened intestine

97

Treatment for short bowel syndrome:

TPN for the initial period, continuous enteral feedings with TPN as the bowel beings to recover

98

Hyperbilirubinemia of the Newborn

excess level of accumulated bilirubin in the blood

99

Treatment for hyperbilirubinemia

phototherapy

100

Biliary atresia

extrahepatic bile ducts fail to develop or are closed

101

Management of biliary atresia

kasai procedure

102

Viral hepatitis

inflammation of the liver caused by a viral infection

103

Hep A

highly contagious (fecal-oral route),

104

How is Hep A transmitted?

person to person or ingestion of contaminated food or water

105

Hep B

exchange of body fluids, sexual activity or mom-to-fetus in utero

106

Hep C

Most common, chronic blood infection

107

How is Hep C transmitted

IV drug use, needlestick, birth to a mother infected with HepC

108

Hep D

Defective virus that gains entry only in connection with Hep B

109

Hep E

Contaminated water in underdeveloped countries

110

Prodromal phase Manifestations of Hepatitis:

Nausea, vomiting, fatigue, abdominal pain, joint pain, pruritis, urticarial

111

Icteric phase manifestations of hepatitis:

jaundice, grey or pale-colored bowel movements, RUQ pain, GI symptoms

112

Convalescent phase manifestations of hepatitis:

jaundice resolves and lab values return to normal

113

Management of hepatitis:

bedrest, hydration and adequate nutrition

114

There are hepatitis vaccines for

hep a and b

115

cirrhosis

degenerative disease process with fibrotic changes and fatty infiltration of the liver occurs (progressive scarring of the liver that causes altered blood flow that leads to deterioration of liver function

116

Manifestations of cirrhosis

hepatomegaly, jaundice, ascites, portal hypertension, encephalopathy

117

Management of cirrhosis

treating symptoms, liver transplant

118

GER treatment in infant

fundal wrap

119

Orogastric lavage of neonate

if there is a significant amount of residual hold for residual and notify the physician.

120

what is needed for bilirubin to be excreted from the body

good hydration

121

Kidney development begins

within the first few weeks of life

122

When is kidney development complete?

the end of the first year after birth

123

Bladder

stores urine

124

Ureters

carry waste fluid from kidneys to bladder

125

Urethra

excretes urine

126

Urine excretion occurs around

the 12th week of gestation

127

How do you calculate bladder capacity?

add 2 to the child's age

128

Level for specific gravity

1.001-1.030

129

Urinary tract infections can be

viral, bacterial, fungal

130

Bacteriuria

bacteria in the urine

131

Cystitis

inflammation in the bladder

132

Urethritis

inflammation of the urethra

133

pyelonephritis

inflammation of the upper urinary tract and kidneys

134

Younger children are more at risk for UTIs due to

shorter urethras

135

Females are more susceptible for

UTIs

136

Highest rate of UTIs are found in

caucasians, females, and uncircumcised males

137

Etiology of UTIs

E. coli, klebsiella, pseudomonas, and staphylococcus

138

How can you get a UTI?

incomplete bladder emptying, bubble baths, poor hygiene

139

Manifestations of UTI

fever, irritability, lethargy, poor feeding, N/V, foul smelling urine, frequency, urgency and dysuria, flank pain, abdominal pain

140

Diagnosis for UTI

C&S

141

When do you start the antibiotics for UTI?

right after getting a sample

142

Bladder control milestones for a 1 1/2 year old

passes urine at regular intervals

143

Bladder control milestones for a 2 year old

announces when voiding is taking place

144

Bladder control milestone at 3 years old

goes to the bathroom alone

145

Bladder exstrophy

bladder is on the outside of the body (rare congenital defect)

146

Epispadias also occurs with

bladder exstrophy

147

How to take care of bladder exstrophy

cover the exposed bladder with plastic wrap to keep the mucosa moist until surgery (cover with sterile gauze and sterile water)

148

Hypospadias

congenital anomalies where the ureteral meatus is located on the underside of the penis may also include cordee

149

Epispasdias

congential anomalies where the canal is open on the dorsal surface

150

Enuresis is

repeated involuntary voiding by a child old enough for bladder control (bed wetting)

151

Golden age for potty training is

4 years old

152

Noctural

bedwetting at night

153

Diurnal is

involuntary voiding during the day

154

Primary enuresis

child has never had a dry night

155

Secondary enuresis

child has been reliably dry for at least 6 months begins bedwetting, associated with stress, infections or sleep disorders

156

How to prevent bed wetting?

limit excessive fluids at night

157

Bladder training

have the patient drink, then have them wait to urinate, try to have them start and stop their urination

158

oxybutynin is

an anticholinergic that improves storage function, decreases overactivity of detrusor muscle (reduces bladder contractions

159

What should you not do with a bedwetting child?

do not scold, belittle or ridicule the child

160

Nephrotic syndrome

kidney is inflammed, you will see high protein in the urine

161

Manifestations of nephrotic syndrome

weight gain, edema, decreased urine output

162

Management of nephrotic syndrome

prednisone

163

How do you know prednisone is working for nephrotic syndrome?

You will see less protein in the urine

164

Acute glomerulonephritis

occurs as a by-product of a streptococcal infection, occurs 1-2 weeks after a throat infection, usually self-limiting - clears up in 14 days by itself

165

Diagnostic test for acute glomerulonephritis

ASO titer

166

In Acute glomerulonephritis, you will see

RBCs, WBCs, protein in the urine

167

Management of acute glomerulonephritis is

Educate on nutrition: low protein, NAS diet, foods high in sodium and salty snacks are elimitied

168

Nursing diagnosis for acute glomerulonephritis is

fluid volume excess r/t decreased plasma filtration

169

Possible complication for acute glomerulonephritis

encephalopathy

170

Acute rental failure - initial kidney injury is usually associated with

sepsis, trauma, or hypotension

171

manifestations of acute rental failiure

oliguria, urinary output <1 ml/kg/hr

172

Cyclosporine is given

to suppress rejection of the new kidney

173

Polycystic kidney disease

genetic disorder that has both autosomal recessive and dominant forms

174

Treatment for polycystic kidney disease

antihypertensives, growth hormones, dialysis, supportive, transplantation

175

Criptorchidism

having descended testicles

176

Orchiopexy surgery

usually done if testicles do not descend on its own, usually at 6 months of age

177

Undescended testicles could cause

sterility

178

Inguinal hernia

painless swelling in the inguinal or scrotal area when abdominal tissue extends into the inguinal canal

179

Hydrocele

fluid-filled mass in scrotum

180

Pelvic inflammatory disease risks

number of sexual partners increases, not using barrier protection, history of STDs

181

Condom use:

decreases the risk of STDs

182

Pelvic inflammatory disease is

a serious infection of the upper genital tract caused by spread of organsims in the cervix and vagina