pedi systems

  1. meaning of failure to thrive
    failure to develop according to establsihed growth parameters for height, weight and head circumference
  2. pruritus in the absence of allergy may indicate
    liver dysfunction
  3. esophageal atresia
    • tissues of GI tract don't separate in early prenatal life
    • esophagus may end in blind pouch or lead into the trachea
    • aka tracheal-esophageal fistula
  4. manifestations of esophageal atresia
    • mother develops polyhdramnios (no fetal swallowing)
    • infant vomits and chokes during first feeding
    • newborn drools; salivary glands not developed for several months
  5. what is the newborn fed during the first feeding
    clear water or colustrum; minimize seriousness of aspiration
  6. nursing care for infant with tracheal-esophageal fistula
    • NPO
    • suction airway
    • position so mucus drains from nose and throat
  7. if a newborn infants meconium stool has not been observed can he be discharged
    • no
    • it must be observed and recorded
  8. imperforate anus
    • lower end of GI tract and anus end in blind pouches
    • infant first temp usually taken rectally to check patency of anus
    • suspected with failure to pass meconium within 24 hours
    • initial surgical procedure may be colostomy
  9. pyloric stenosis
    • caused by hypertrophy of pylorus muscles or spasms of sphincter
    • appears at 2 - 3 weeks
    • most common GI surgery in infants
  10. signs and symptoms of pyloric stenosis
    • projectile vomiting after feeding
    • olive shaped mass in RUQ of abdomen
    • constantly hungry
    • dehydrated
    • stomach outline and peristaltic waves visible; extreme cases
  11. pyloromyotomy
    • treatment for pyloric stenosis
    • pyloric muscle incised; opening is enlarged allowing food to easily pass through
    • oral feedings of small amounts of glucose water until regular formula tolerated; postop
  12. care of an infant with pyloric stenosis
    • IV fluids
    • thickened feeding by nipple or teaspoon
    • remove accumulated gas by burping before and during feedings
    • fowlers aids passage of milk through stomach
    • right side laying aids drainage into intestine
    • refeed if infant vomits
  13. celiac disease
    • aka gluten enteropathy
    • aka sprue
    • #1 malabsorption problem in kids
    • can't digest glutens properly
  14. which foods contain gluten
    • Barley
    • Rye
    • Oats
    • Wheat
  15. signs and symptoms of celiac disease
    • start at 6 months - 2 years when gluten containing foods are introduced
    • repeated exposure to gluten damages villi and cause malabsorption
    • infant presents with failure to thrive
    • large, bulky and frothy stools; contents are undigested
  16. how is celiac disease confirmed
    • serum IgA test
    • small bowel biopsy
  17. hirschsprungs disease (aganglionic megacolon)
    • no nerve endings in a segment of bowel; usually lower sigmoid
    • aganglionic section narrows and creates ribbon-like stools
    • portion of colon nearest narrow segment dilates
    • lack of normal peristalsis causes chronic constipation
    • higher incidence in kids with down's syndrome
    • can be chronic or acute
  18. signs and symptoms of hirschsprungs disease
    • constipation
    • vomiting
    • ribbonlike stools
    • abdominal distention
    • anorexia
    • failure to thrive
    • enterocolitis
  19. enterocolitis
    • inflammation of small bowel and colon
    • fever
    • explosive stools
    • depletion of strength
  20. nursing care and treatment of hirschprungs disease pt
    • impaired section removed, ends anastamosed
    • newborn may have temporary colostomy
    • monitor child as he grows for history of chronic constipation and diarrhea
    • monitor for signs of undernutrition, adbominal distention and poor feeding
    • normal saline when giving enema; megacolon increases water absorption and may cause water intoxication
  21. observations to report when assessing infants with congenital cardiac problems
    • failure to thrive
    • cyanosis/pallor
    • visually observed pulsations in the neck vein
    • tachypnea, dyspnea
    • irregular pusle rate
    • fatigue during feeding or activity
    • excessive perspiration especially over the forehead
  22. heart defects that increase pulmonary blood flow
    • blood returns to right ventricle and recirculates through the lungs before exiting through the left ventricle into the aorta
    • atrial septal defect
    • ventricular septal defect
    • patent ductus arteriosus
  23. atrial septal defect
    • abnormal opening between left and right atria
    • oxygenated blood from left atrium forced back into right atrium
    • no symptoms
    • recognized by murmur
    • repaired with dacron patch or open cardiac surgery
    • low dose aspirin for 6 months after surgery
  24. ventricular septal defect
    • opening between left and right ventricles
    • oxygenated blood forced from left ventricle in right ventricle
    • loud harsh murmur heard combined with a systolic thrill
    • often associated with other defects
    • may close spontaneously or during cardiac catheterization
  25. patent ductus arteriosus
    • passageway from pulmonary artery to aorta doesn't close after birth
    • some oxygenated blood forced into pulmonary artery
    • heart forced to pump harder
    • no symptoms during infancy
    • children experience dyspnea, bounding radial pulse upon exertion and abnormally wide pulse pressure
    • may close for premature infants receiving indomethacin
    • coils inserted in ductus arteriosus will occlude it
    • open heart surgery
  26. characteristic sign of coarctation of the aorta
    significant difference in the blood pressure between upper and lower extremities
  27. coartication of the aorta
    • constriction of the aorta
    • marked difference in blood pressue of the upper and lower extremities
    • cardiac enlargement caused by increase pressure above the constriction
    • symptoms: hypertension, CHF, infective endocardititis
  28. tetralogy of fallot
    • stenosis of of pulmonary artery
    • hypertrophy of the right ventricle
    • dextroposition of the aorta (shifted to the right) allowing blood from both ventricles to enter (oxygenated and deoxygenated)
    • ventricular septal defect
  29. signs and symptoms of tetralogy of fallot
    • clubbing of fingers and toes
    • feeding problems
    • growth retardation
    • frequent respiratory infections
    • severe dyspnea upon exertion
    • polycythemia
    • resting in squatting position to breathe easier
  30. parosyxmal hypercyanotic episodes aka "tet spells"
    • symptoms occur spontaneously duringĀ  first 2 years of life
    • cyanosis
    • respiratory distress
    • weakness
    • syncope
  31. what should be done during a tet spell
    • place child in knee-chest position
    • older children will spontaneously squat
  32. complications of tetralogy of fallot
    • cerebral thrombosis due to polycythemia
    • anemia
    • bacterial endocardiditis
  33. blalock-taussig procedure
    surgical procedure to correct tetralolgy of fallot
  34. hypoplasic left heart syndrome
    • underdeveloped left side of the heart; left ventricle usually non-functional
    • foramen ovale and ductus arteriosus must remain patent after birth
    • can diagnose before birth
    • heart transplant needed ASAP
  35. symptoms of hypoplastic left heart syndrome
    • grayish blue skin and mucous membranes
    • dyspnea
    • weak pulses
    • cardiac murmur
  36. treating kids with congenital heart defects
    • do not limit and overprotect from normal activities related to optimal growth and development
    • immunizations before and after cardiac transplant are placed on hold
    • dental care is important to prevent bacterial endocarditis
    • avoid competitive sports the pressue may cause them to ignore symptoms
  37. early signs of CHF in an infant that should be reported
    • tachycardia at rest
    • fatigue during feeding
    • sweating around scalp and forehead
    • dyspnea
    • sudden weight gain
  38. rheumatic fever
    • autoimmune disease thats a complication of group A beta-hemolytic strep infection of the throat
    • usually scars the mitral valves
    • symptoms don't show up until 1 to 6 weeks after strep throat infection
    • it recurs and each attack may further damage heart
    • elevated antistreptolysin O titer (ASO) is standard diagnostic test
  39. signs and symptoms of rheumatic fever
    • migratory poly arthritis; wandering joint pains that don't cause permanent damage
    • skin eruptions (erythema marginatum); small red circles with red-colored margins, a pale center and wavy lines appearing on the trunk and abdomen
    • chorea
    • inflammation of the heart
    • abdominal pain
  40. kawasaki disease
    • inflammation of blood vessels that usually causes an aneurysm
    • abrupt onset with a sustained fever and doesn't respond to antipyretics and antibiotics
    • conjunctivitis without discharge
    • fissured lips
    • strawberry tongue
    • inflamed mouth and lymph nodes
    • swollen hands and desquamation of the palms and soles
  41. Characeristic sign of subacute kawasaki syndrome
    peeling of the palms and soles
  42. when giving digoxin to a child
    • dose checked by 2 nurses
    • dose exceeding 0.05 mg should be reconfirmed by healthcare provider
    • hold if pulse of infant or child is less than 100
    • hold if pulse of older child is below 70
  43. s/sx of respiratory distress in the infant or child
    • restlessness
    • grunting
    • stridor
    • flaring nostrils
    • cough
    • intercostal retraction
    • rales, ronchi and wheezin
    • using accesory muscles to breathe
    • tachypnea
    • club fingers
    • cyanosis
  44. croup
    • barking cough and inspiratory stridor heard in a variety of conditions
    • usually caused by laryngotracheobronchitis
    • viral condition causes edema, destruction of respiratory cilia and exudate resulting in respiratory obstruction
  45. treatment of acute croup
    • increase humidity level to relieve respiratory distress and laryngeal spasm
    • nebulizer therapy or mist tent (croupette)
    • iv fluids to prevent dehydration
    • opiates are contraindicated because of respiratory depression
    • sedatives are contraindicated because they may mask signs of restlessness
    • nebulized epinephrine may relieve symptoms of respiratory obstruction
    • corticosteroids reduce edema
  46. epiglottitis
    • swelling of the epiglottis caused by h. influenza type B bacteria
    • sticking objects in the throat may cause spasms
    • life threatening medical emergency
    • treated with immediate tracheostomy or endotracheal intubation
    • parenteral antibiotic therapy results in dramatic improvement within a few days
  47. s/sx of pneumonia
    • dry cough that gradually becomes productive
    • fever as high as 104
    • tachypnea (40 -80 infants, 30-50 older children)
    • shallow respirations to reduce chest pain
    • sternal retractions
    • flaring nostrils
    • listless and has poor appetite
  48. post op tonsilectomy care
    • position child partly on side and partly on abdomen with the knee of the uppermost leg flexed
    • watch for evidence of bleeding
    • frequent swallowing may indicate bleeding
    • small amounts of clear fluids initially given
    • if popsicle is tolerated progess to soft foods
    • no spicy foods or gargling for 1 week
    • avoid coughing, clearing throat and blowing nose'
    • ice collar provides relief
  49. bryants traction
    • treats femur fractures in children under 2 or under 20 - 30 pounds
    • legs are suspended vertically
  50. russell traction
    • sling placed under knee to suspend thigh above the bed
    • prevents dislocation of the tibia on the femur
Card Set
pedi systems
pedi systems