Child Health- resp, autism, congenital heart defects, burns

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Children in Respiratory distress may be ___ to improve ventilation	sedated
cardiopulmonary bypass device used when Respiratory failure is severe	Extracorporeal membrane oxygenation
Positioning for child in respiratory failure	upright with head midline
Broad classification of upper airway illnesses caused by inflammation and swelling of epiglottis and larynx, extending into trachea and bronchi	croup
spasmotic laryngitis and laryngotracheobronchitis are ___, but tracheitis and epiglotitis and ___	viral, bacterial
why is the subglottic area of the airway susceptible to occlusion	only area with complete cartilaginous ring, so with edema it cant expand and 1mm of edema decreases airway size by 50%
type of croup often caused by the human parainfluensa virus	laryngotracheobronchitis (LTB)
least serious type of croup with an abrupt onset and afebrile	spasmotic laryngitis
type of croup with mild fever (less than 40) and a gradual onset	LTB
potentially life-threatening type of croup with an onset over 2-5 d, a fever over 39, and thick secretions	bacterial tracheitis
type of croup that is a life-threatening emergency with an onset over hrs, a fever over 39	epiglottitis
type of croup with sore throat, dysphagia, drooling, red epiglottis, and no croup cough	epiglottitis
In bacterial tracheitis, the pt prefers __ position, while in epiglottis, the pt prefers __ position	supine; upright and tripod
throat __ and inspection of the mouth and throat are CI with LBT or epiglottitis because anxiety may cause laryngospasms and airway occlusion	cultures
Rapid acting bronchodialators (beta agonists, beta adrenergics) are given for which types of croup	viral only
medications that temporarily improve symptoms of croup through bronchodilation and decreasing mucous secretion	Beta adrenergics (E) and beta agonists (albuterol)
Medications for longer relief of viral croup symptoms	corticosteroids (IM, PO, nebulized)
besides maintaining adequate body fluids, hydrating the patient also...	thins secretions
Prophylactic ___ is given to child under 48 mon with epiglottitis caused by H. influenzae	rifampin
Most common virus that causes bronchiolitis	Respiratory Syncytial Virus
Nearly all children have been infected by ___ by 2 years, and are often reinfected as there is no immunity built against it	RSV
Damage to airways by RSV	-virus kills mucosal cells of bronchioles and cell debris creates obstruction and irritation -E obstruction -hyperinflation -atelectasis -VQ mismatch -hypoxemia
Symptoms of mild bronchiolitis	cough, rhinnitis, fever, wheese, tachypnea, poor feeding, v/d, dehydration, spit up food, decreased play
symptoms of severe broncchiolitis	-RR greater than 70 -grunting, wheese, retractions, nasal flaring, irritability, lethargy, poor fluid intake, abdominal distension due to hyperinflation, cyanosis, noisier is BETTER
When are chest physio, bronchodilators, and corticosteroids indicated for bronchiolitis?	Not indicated
interventions for bronchiolitis	-humidified O2, fluid, nasal suction and hypertonic saline, bulb syringe nad saline nose dropsantipyretics, sm frequent feedings (suction before and withold feed if tachypnic), encourage rest
When is IM palivizumab given to children	Immunization for RSV given to high risk children q 30 d during RSV season
list 5 types of autism	1. Autistic disorder 2. Asperger Syndrome 3. Rett disorder 4. Childhood disintegrative disorder 5. Pervasive developmental disorder NOS
autistic disorder with impaired social, behavioural, and communication development, which is usually noted during the 1st year of life	Autistic disorder
Asperger symptoms: -Impaired ____ interaction -normal ____ development, spelling and vocabulary -abnormal ___ and ___ of voice -low ____ formation, comprehension, and ___ flexibility -Some times have high ___ in some ares	-social -language -pitch; tone -concept; language -intellect
Type of autism in which the child appears to be normal for first 6-18 mon, and then has symptoms of progressive ataxia, hand-wringing, dementia, growth delay	Rett disorder
Why does Rett disorder only occur in females?	x-linked
Type of autism in which the child appears normal until 2-5 yrs, and then declines/regresses in many areas of functioning	childhood disintegrative disorder
Category of autism that includes severe social impairment without meeting the criteria for any other type of autism	pervasive developmental disorder
what fraction of children have autism spectrum disorder?	1/68
Risk factors for ASD: 1. gender: ___ 2. ___ concordance 3. 5 other conditions: 4. ___ exposure during pregnancy being investigated	1. male 4-5x more 2. 60-90% 3. FAS, Down syndrome, fragile X syndrome, tuberous sclerosis, phenylketonuria 4. drug
What are the 4 red flags of ASD?	1. no babbling or communicative gestures by 12 mon 2. No word by 16 mon 3. No spontaneous 2 word phrase by 24 mon 4. language or social skills regress (and sensory problems ruled out)
What are signs of impaired socialization in an autistic child	-decreased eye contact as infant -rarely smiles as infant -impaired observation of non-verbal behaviour -unable to relate or respond to social cues
What are signs of impaired communication in an autistic child	-no babble by 1 yr or 2-word phrase by 2 yrs -does not converse normally or initiate conversation -regression of language skills -abnormal use of parts of speech -echolalia; repeat questions back -fascinated with rhythmic, repetative songs/verses
What are signs of impaired behaviour in an autistic child	-infant does not point to objects -stereotyped, rigid, excessive behaviours: head banging, twirling, bite themselves, flapping arms or hands -aversion to sensory stimuli -upset if routines disrupted/difficulty with new situations -only eat certain foods -lack imaginative play
What are medications for autism?	None; only to tx associated conditions
What are some examples of complementary therapies parents try for kids with autism?	-no sugar, aspartame, milk, wheat diet -vitamins and probiotics
What are some ways to stabilize the environmental stimuli for a child with autism?	-reduce noise -dim lights -provide familiar routine and toys -consistent placement of objects
What are some tips for communicating with a child with ASD?	-short direct sentences -give choice with objects of choice present to choose otherwise they will echo the last choice -use visual cues -sign language
a defect in the heart or great vessels or persistence of a fetal structure after birth	congenital heart defect
prevelence of CHDs: ___/1000	8-12
Risk factors for CHDs (6)	1. fetal exposure to medications or drugs 2. maternal systemic virus 3. higher maternal age 4. maternal metabolic disorder 5. high altitude 6. genetic
What are 3 categories of CHDs	1. increased pulmonary BF 2. decreased pulmonary BF 3. obstructed systemic BF
Which of the 3 categories of CHDs is decribed by the following symptoms: tachcardia/pnea, CHF, poor weight gain, diaphoresis, periorbital edema, and frequent RTIs	increased pulmonary BF
Which of the 3 categories of CHDs is described by the following symptoms: cyanosis, hypercyanotic episodes, poor wt gain, polycythemia	decreased pulmonary BF
Which of the 3 categories of CHDs is described by the following symptoms: decreased pulses, increased cap refill time, decreased urinary output, CHF and pulmonary edema	obstructed systemic BF
What does the ductus arteriosis connect?	aorta to pulmonary arteries
which category of CHD is a patent ductus arteriosis?	increased pulmonary BF
CHD where oxygenated blood returns to deoxygenated pulmonary artery from the aorta, increasing pulmonary BF	patent ductus arteriosis
The ductus arteriosis usually closes within __ d, but may commonly not close in preterm infants	2-3
when pulmonary BF increases, pulmonary capillaries ___ leading to pulmonary ___	constrict; HTN
Increased pulmonary BF may lead to right ventricular ___because it is pumping against extra resistance	hypertrophy
What are symptoms of CHD: increased pulmonary BF	tachycardia, tachypnea, increased BMR, diaphoresis with feeding, poor weight gain due to increased BMR and poor feeding, CHF: dyspnea, intercostal retractions, periorbital edema, frequent RTIs, murmurs, full, bounding pulse, widened pulse pressure, hypotention if CO deccreases, hepatomegally
Opening between the atria so that oxygenated blood moves from L atrium to deoxygenated R atrium and reenters pulmonary circulation	Atrial septal defect
Opening in ventricular septum so blood moves from L to R ventricle and reenters pulmonary circulation	Ventricular septal defect
if the foramen ovale doesn't close, it is a type of which CHD?	ASD
IV ibuprofen or indomethacin may be given to tx which infant heart defect	stimulates closure of patent ductus arteriosis
When is surgery indicated for an ASD?	has not closed spontaneously within 2 years or CHF occurs
When is surgical closure of a VSD indicated?	if it has not closed spontaneously within 6 mon or if not responding to CHF tx
Type of CHD that increases pulmonary BF and involves defects to the atrial/ventricular septa, and the bicuspid and tricuspid valves	Atrioventricular canal
When is surgery done on an infant with an atrioventriular canal defect?	at 2-4 mon; prophylacticc endocarditis tx 6 mon after surgery
name 4 types of CHDs that increase pulmonary BF	1. patent ductus arteriosis 2. VSD 3. ASD 4. Atrioventricular Canal
CHD category that results from obstruction of BF from right side of the heart to the lungs	decreased pulmonary BF
Why does right to left shunting occur in CHDs that decrease BF to the lungs?	blood can's get to lungs, so pressure builds up in the right side of the heart, and if there is a septal defect, blood is shunted across
what is the classic sign of CHD: pulmonary BF decreased	Cyanosis that is unresponsive to O2 therapy
Why do CHDs with decreased pulmonary blood flow result in polycythemia?	The kidneys respond to low O2 by releasing EPO which stimulates the bone marrow to produce more RBCs.
Polycythemia in children with CHD: decreased pulmonary BF increases risk of...	thromboembolism
Why are children with decreased pulmonary BF and a septal defect at increased risk of systemic infection	Blood that is normally filtered by the lungs bypasses the lungs
Why may a hypercyanotic episode (with decreased pulmonary BF and septal defect) be common in the morning?	There is an abrupt decrease in systemic resistance, Right-left shunting increases, pulmonary BF decreases, and hypoxemia occurs. Hypercyanotic episode occurs when CO also increases such as with crying, feeding, straining, and the respiratory center responds to low PO2 and high PCO2 by increasing respiratory effort
What are symptoms of CHD: decreased pulmonary BF?	cyanosis that does not respond to O2, especially after ductus arteriosis closes dyspnea, loud murmur, ruddy, mottled skin prior to cyanosis, chronic hypoxemia: clubbing, fatigue, delayed development; tire quickly during feeding, diaphoresis while feeding, higher BMI and poor weight gain, CHF
CHD: narrowing of pulmonary valve, valve area, or pulmonary artery; may or may not have open foreamen ovale	pulmonic stenosis
CHD: combination of pulmonic stenosis, VSD, Right ventricular hypertrophy, and overriding of the aorta	Tetrology of Fallot
when is surgery usually done for tetrology of fallot?	at 3 mon if severe, but if not wait until 1-2 yrs
CHD: tricuspid or pulmonary valve is absent so that the only route to the left ventricle is the foramen ovale and the only route to the lungs in the ductus arteriosis from the aorta to the pulmonary artery	tricuspid or pulmonary atresia
Why is prostaglandin E indicated for children with CHD causing decreased pulmonary BF, transposition of the great arteries,	it prevents the ductus arteriosis from closing so there is at least one route for the blood to get to the lungs
hyperpnea	deep breathing
Signs of a hypercyanotic episode	tachycardia, tachypnea, hyperypnea, cyanosis, pallor, decreased tissue perfusion, diaphoresis, irritability, seizures, decreased LOC
What symptom occurs with severe hypoxemia related to respiratory failure or shock that warns of imminent cardiac arrest?	bradycardia
Children with a cyanotic heart defect usually do not have a PaO2 greater than ___mmHg, while the PaO2 with respiratory or neuro problems will be higher	100
What are side effects of prostaglandin E1?	respiratory depression and apnea
How is polycythemia, due to CHD: decreased pulmonary BF treated?	RBC pheresis (filters out RBCs)
Why are antibiotics given to children before heart surgery and 6 mon after?	Prophylaxis of infective endocarditis
What position should you place an infant in who is experiencing a cyanotic episode?	knee-chest- increases systemic vascular resistance
What meds may be given to an infant during a hypercyanotic episode if other tx is not effective? Why?	1. Morphine-depresses the resp center to decrease hyperpnea 2. ketamine sedates and increases systemic vascular resistance 3. Beta blockers decrease HR and heart muscle spasms
list interventions for hypercyanotic episodes	-infant in knee-chest position -Prevent irritation or pain and try to make calm -O2 therapy -notify physician immediately -morphine, ketamine, Beta blockers -PRBcs if anemic
transposition of the great arteries	CHD in which the pulmonary artery exits from the left ventricle and the aorta exits from the right ventricle, so that there are two parallel circuits, and blood is oxygenated, but does not enter systemic circulation. Oxygenated blood can only enter systemic circulation through the ductus arteriosis or foramen ovale if patent
infants with transposition of the great arteries often have tachypnea greater than 60 without ___ or ___	retractions or dyspnea
What procedure may be initially performed on an infant with transposition of the great arteries until corrective surgery can be done at 1-3 wks?	balloon atrial septostomy
mixed CHD in which a single artery trunk empties both ventricles and provides circulation for the pulmonary, systemic, and coronary circulations; usually with a VSD	Truncus arteriosis
Mixed CHD in which the pulmonary veins empty into the right atrium (instead of left); blood can only get to the systemicc circulation through the foramen ovale.	Total anomalous Pulmonary venous return
Mixed CHD in which the aorta and pulmonary artery both arise from the right ventricle and the only outlet for the left ventricle is a VSD	Double outlet Right ventricle
CHD category caused by a stenotic valve or great vessel	Defects obstructing systemic BF
narrowing at or near the aortic valve	Aortic stenosis
What are symptoms of CHDs obstructing systemic BF?	decreased CO: shock, diminished pulses, poor color, delayed cap refill, decreased urinary output, CHF and pulmonary edema, left ventricular hyperdecreased BF to the GI tract; If mild: leg cramps, cool feet and hands, pulses and BP stronger in upper extremities than lower; narrow pulse pressure,
What could result from decreased BF to the GI tract in infants with defects obstructing systemicc BF?	necrotizing enterocolitis
Why is prostaglandin E given to keep the ductus arteriosis open for defects that obstruct BF?	?to let blood enter systemic circulation from the pulmonary arteries even though it is not oxygenated?
CHD: constricted descending aorta	coarctation of the aorta
CHD: absent or stenotic mitral or arotic valves associated with a small left ventricle and aortic arch	hypoplastic left heart syndrome
Disorder in which heart function is impaired and cardiac output is inadequate to meet body circulatory and metabolic needs	congestive heart failure
What categories of congenital heart defects cause CHF	1. increased pulmonary BF 2. defects that obstruct systemic BF ?(Whereas with decreased pulmonary BF, blood is still going to systemic circulation, it just doesn't contain enough O2- but text says that CHF can also occur with tricuspid or pulmonary atresia and pulmonic stenosis, but NOT tetrology of fallot so...maybe due to right heart pumping against high afterload, so eventually fails??)
In CHF pulmonary BF ___ resulting in ___, and systemic BF ___	increases; pulmonary HTN; decreases
Defects that obstruct systemic BF cause hypertrophy, and eventually heart cannot keep up with demand and CO is inadequate. When CO is inadequate, BP ____ and perfusion ___, causing activation of ___ which leads to...	decreases; decreases SNS: catecholamines released, tachycardia, increased contractility, vasoconstriction, decreased BF to kidneys, RAAS, fluid and Na+ retention, temporary myocardial stretch to accommodate for increased fluid until it cannot stretch anymore, results in P+P edema
Symptoms of CHF	-pulmonary edema: crackles, dyspnea, wheeze, cough, retractions, grunting, nasal flaring, respiratory infections, tachypnea, diaphoresis -peripheral edema: periorbital, dependant areas (sacrum), fingers, weight gain -decreased CO and perfusion: mottling, pallor, cyanosis, tachycardia, weak pulses, hypotension, delayed cap refill, cool extremities, decreased urinary output -pulmonary HTN -hepatomegally, ascites, -S3 gallop -JVD -Increased BMI: Avoidant restrictive food intake disorder
What is the 1st goal of medical management of CHF in children	Treat the CHD or arrhythmia causing problem
How do diuretics help tx CHF?	remove excess fluid and decrease preload
What are 5 examples of inotropic medications?	1. dopamine 2. donutamine 3. isoproterenol 4. epinephrine 5. digoxin
What is a medication used to tx CHF that decreases afterload and heart workload?	ACE inhibitors
When are inotropic medications prescribed for CHF?	in critical are management when there is need to quickly increase CO and perfusion by increasing contractility
What is the action of dopamine when used to treat CHF?	1. alpha 1 agonist: vasoconstriction 2. beta 1 agonist: increases contractility
What is the action of dobutramine when used to treat CHF?	beta 1 adrenergic agonist: increases contractility
What is the action of digoxin when used to treat CHF?	increases contractility by inhibiting K/Na pump, so Na+ accumulates in the cell, causing Ca+2 release; Rarely prescribed, but may be prescribed because it decreases HR and does not increase myocardial O2 consumption
What is the action of carvedilol to treat CHF?	improves left ventricular function, promotes systemic vasodilation for chronic HF and dilated cardiomyopathy
Why does a child's skin absorb topical medications faster and layers separate easily with blistering	skin is thinner and the epidermis is loosely bound to the dermis
Why do children lose heat quickly through their skin?	thin SC layer
what is the pH of an infant's skin at birth	neutral; becomes acidic in 1st mon
What two factors increase risk of inflammation and irritation of skin in infants	neutral pH and high water loss through the skin
list four types of burns	1. Thermal 2. Chemical 3. Electrical 4. Radioactive
Describe a 1st degree (superficial partial thickness) burn	-erythema -blanches on pressure -no bullae -peeling in a few days -only epidermis damage -painful -heals in a few days
Describe a 2nd degree (partial thickness) burn	-blisters/ bullae present -erythema -blanches on pressure -painful and sensitive to cold air -minimal scar formation -upper layer of dermis damaged -may have sparing of sweat and sebacious glands -heals in 10-14 d
Describe a 3rd degree (full thickness) burn	-brown, black, deep red, white, grey, waxy, translucent -may appear sunken -usually painless as nerve endings destroyed all of dermis damaged and may involve underlying tissue -requires skin graft
Describe the pathophysiology of burns	1. Intense vasoconstriction due to substances released by injured cells: tissue ischemia; may increase burn depth; increased resistance and impaired cardiac contractility and CO 2. Vasoactive hormones increase capillary permeability: fluid shift from IV space to Interstitial, edema in burned and unburned skin- hypovolemia and decreased CO 3. Loss of water, electrolytes, and heat: BMR increases to try to make up for last heat and begin healing, and protein stores deplete, and glucocorticoids, glucagon, and dopamine increase 4. Airway inflammation/edema due to inhaled hot air or smoke
tough, leathery scab that forms over burned areas	eschar
what causes poor cap refill and ischemia with burns?	vasoconstriction and decreased CO
What are signs of airway inflammation due to burns?	cough, wheeze, respiratory distress, hypoxemia, soot in sputum, airway sloughing
Why might PRBCs be indicated for a pt with a burn?	bone marrow suppression resulting in anemia
Why should a burn pt be put on a high protein, high carb, low fat diet?	Increased BMR and healing depletes protein stores, and catecholamine and glucocorticoid release increases lactate
Why might a person with a burn need insulin	Increased glucocorticoids and glucagon cause hyperglycemia
why is propranolol prescribed for a person with burns?	decreases protein metabolism
symptoms of autism on the autism Calgary checklist	-Unusual eye contact. -Impaired communication. Ex. no speech, lack conversation skills, highly verbal but get stuck in a subject. -guide adult’s hand to what he/she wants. -Rigidity or inflexibility; anxious or upset with changes in routine. -Difficulty interacting with other children, making or keeping friends. -Marked physical over-activity or extreme passivity. -Sensitivity to sensory stimulus or constantly seeking sensory input (hugs, compression, jumping, spinning) -wide range of intellectual abilities. - problems with sleeping, eating, and toileting
What are the 9 areas of respiratory assessment of a child with a respiratory condition?	1. Position of Comfort: 2. Vital Signs: 3. Lung Auscultation: 4. Respiratory Effort (Work of Breathing): 5. Colour: 6. Cough: 7. Secretions: 8. Behaviour Change: 9. Family History:
List potential life threatening symptoms of bronchiolitis	-central cyanosis -RR greater than 70 -listlessness -apnea -hyperinflated chest and diminished breath sounds -
What children may require RSV prophylaxis?	1. under 2 yrs with chronic lung disease of prematurity requiring therapy in 6 wks prior to RSV season 2. under 2 yrs with CHD requiring therapy for CHF or pulmonary HTN 3. Infants born before 32 wks gestation who require O2 for at least 28 d of life 4. born before 29 wks gestation
What are 7 topics of nursing are to focus on for a patient with burns?	Pain Infection Fluid imbalance Mobility Developmental progress Nutrition Anxiety
What are two priorities in initial tx of an acute burn?	1. ABCs 2. stop burning process with moist soaks, ice, and clothing removal
Why would a child with a burn have a fever without infection?	?Increased BMR and inflammatory response?
What is the Parkland Formula for fluid needs of a burned child?	4ml x kg x % body surface area burned + maintenance fluids = 24 hour total fluid replacement
Which CHD is most common in children with Down Syndrome?	ASD (40%)
What May untreated ASD lead to?	severe pulmonary hypertension, infective endocarditis, and atrial fibrillation in adults
What is the most common CHD	VSD
T/F 60% of VSDs close spontaneously in the first 2 yrs of life	T
Why are children with VSD often tx with high calorie feeds?	They often have poor feeding
What medication is used to treat a CHD: patent ductus arteriosis?	Indomethacin inhibits prostaglandins that maintain PDA
How are chromosomes abnormal in down syndrome?	there is an extra copy of chromosome 21 (trisomy)
Possible symptoms of Down syndrome: 1. Wide space between ___ and ___ ___ ___ loss Increased incidence of ___ hypotonia ___ head ____ forehead ___ neck ____ eye folds ___ nose ____, ___ set ears ____ tongue ____ ____ across palm	Wide space between first and second toes Hearing loss Increased incidence of CHD, hypotonia Small head Flattened forehead Wider neck Epicanthal eye folds Flat nose Small, low set ears Protruding tongue Single crease across palm
A child has RSV. List the following in order of priority: Activity intolerance Feeding pattern impaired perfusion FVE related to HF and pul overload Risk for infection	1. FVE related to HF and pul overload 2. impaired perfusion 3. Feeding pattern 4. Risk for infection 5. Activity intolerance
Why would restraint by swaddling be appropriate during necessary procedures on children with respiratory distress?	Easier to perform quickly and cluster care
What are 5 components of programming for ASD by CBE	communication skills self-help skills basic conceptual skills environmental knowledge community awareness
Why is the right ventricle proportionally larger at birth	high fetal pulmonary resistance
Until the age of 5, CO is dependant on ___	HR
What are the 9 components of assessment of a child with CHDs	1. Respirations: rate, depth, cough, effort, retractions, nasal flaring, e grunting, wheezes, crackles 2. Pulse characteristics: rate, rhythm, quality, compare sites 3. BP: compare upper and lower extremities as obstruction causes higher in upper?? 4. Color: pallor, dusky, cyanosis, with crying, spo2 5. Chest: bulging, heaving, pulsations, lifts, vibrations, PMI 6. Auscultate heart: murmurs 7. Fluid status: periorbital, facial, and peripheral edema, dehydration, abdominal distention, hepatomegaly, cap refill 8. Actvity and behaviour: exercise intoleranccce, feeding, diaphoresis, lethargy, restlessness 9. General: growth
What are nursing interventions for CHD	Support nutrition: reduce stress of sucking, small frequent feedings Reduce stress on heart: Promote rest ABX prevent subacute bacterial endocarditis pulmonary hygiene Monitor for CHF
The immature infant heart is vulnerable to __ and __ overload	volume; pressure
What are early signs of CHF?	tachycardia, fatigue, poor feeding, diaphoresis, lethargy
Why is head bobbing a sign of CHF	-Accessory muscle use to assist in ventilation -Infants neck extensor muscles are not strong enough to stabilize the head
What is a consideration to monitor for with edematous skin	prevent skin breakdown
Why should O2 be used with caution in pts with CHF?	it is a vasodilator
What serious complication could RSV lead to in children under 3	pneumonia

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Child Health- resp, autism, congenital heart defects, burns

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	Erstellt von Aurelea Dyck vor fast 6 Jahre