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Details Title: MS entry pediatrics Description: Peds test 2 spring 2006 Total Flash Cards: 184 Created: 03/21/2006 17:56:36	To study from this set of flash cards, or to create your own your own study flash cards, register HERE. If you are already a registered user, CLICK HERE.
Cards Term name 3 parts to assessing GI illness Definition history phys assess and diag tests Term name 4 things you need to know about vomiting to assess prob Definition 1 projectile or not 2 freq 3 how long 4 consistency Term name 4 interventions for vomiting Definition -oral hygienge -rehydration -comfort measures -small freq feeds Term Phys assessment principals for vomiting (4) Definition 1 inspection (mm, peristalisis, skin, bleeding, spincter patency) 2 ascultate 3 percuss 4 palpate Term name as many causes of diarrhea as you can Definition passing around virus, recent travel, water, soil, child dietary habit, overfeeding, malabsorbtion, F+E imbalance Term nursing interventions for diarhea Definition reinstate nutrit and hydration iv fluids I+Os daily weights assess toleration of feeding purelll for fam ?brat diet? prevent infection child family teaching Term name 5 lab findings that need to be assessed for diarrhea Definition stool anal stool ph serum electros UA ABG's (if severe) Term Name as many causes of constipation as you can Definition idiopathic encopresis (delibrately holding) change in enviro anxiety public bathrooms change in routine Term interventions for constipation Definition Varies depending on cause/not total agreement on cause. colace fluids fiber maybe change in bowel habits (after meals try to go) find out what meds they are on min stress teach parets nutrition high fiber snacks reassurance Term GER(D) define Definition backflow of gaastric contents into the esophogus resulting from relaxation or incompetence of the lower esophogeal spincter. Term GER s+s (8 things) Definition forceful vomiting weight loss aspiration recurrent respiratory infections (r/t aspiration) cyanotic and apneic episodes heartburn abdom pain bitter taste in mouth Term lab findings in GER tests/monitoring they may do Definition CBC reveals anemia intraespphageal ph monitoring Term How is GER usually resolved? What is done if GER is severe? Definition -resolves on own within year (usually) -severe: surgery: Nisen procedure-split muscle of gastric fundus, npo , ng tube, Term if a child has GER and becomes fatigued during eating what should you do/recommend name 2 meds that dec gastric acid -what teaching should be done about ger care Definition -stop feeding and rest -simethicone and zantac -teach positioning and schedules. Term pyloric stenosis define: what causes it? Definition the narrowing of the lpyloric spincter at the outlet of the stomach. -cause unknown (idiopathic), maybe heredity Term pyloric stenosis s+s (8 things) Definition no abnormal sighns in the first weeks after birth. regurgitation or NON-projectile vomiting that begins at 3 weeks of age voming increases in force and frequency over next 1-2 wks no signs of anorexia or pain weight loss upper abdominal distention palpable olive shaped mass in the epigastrium just to the right of the umbillicus dec freq and volume of stools Term labs and studys for pyloric stenosis (5) Definition ultrasonography upper GI ABGs electrolyte studies CBC Term care for pyloric stenoris (6 things) Definition monitoring feeding and assoc w/ vomiting assess emesis promote hydration prevent aspiration provide post op care for pyloromyatomy family teaching Term what is a pyloromyatomy for, and what does it entail? Definition for pyloric stenosis incision anterior pylorus to relieve obstruction (the olive thing) Term define intussusception what is a major risk of this if not treated within 24 hours? Definition an invagination or telescoping of one portion of the intestines into an adjacent portion causing obstruction. It is one of the most frequent cause of intestinal obstruction in children risk: bowel strangulation which can lead to necrosis, and death if untreated. Term what is the cause of intussception Definition idiopathic, but may be assoc with viral infections, polyps and lymphoma Term what are its signs and symptoms when is it most likely to occur Definition ss: severe pain esp ascending colin. person will pull legs up to relieve pressure tender distended abdomin possibly palpable mass. usually 3mo - 5years old Term labs and tests for intussception Definition contrast enema electrolyte study Term interventions for intussception 5 things Definition promote hydration (parentally) promote nutrition monitor eliminations BMs Monitor for infection family teaching Term what is a tell tale sign of intussception? Definition currant jelly stools from blood and mucous. Term celiac disease define when do you usually start to see this? why? Definition malabsorbtion syndrome that occurs when the mucosa of the proximal small intestine is sensitive to , or undergoes an immunologic response to gluten. usually seen at 16-18 months because child is trying new foods. Term what cuases celieac's Definition results from either an inborn error of metab or abnormal immune response to gluten factor or protien ..probably an inherited disposition. Term celiacs s+s (5) Definition anorexia and ab pain diarrhea/ const vomiting severe ab distention and muscle wasting behavioral changes Term interventions for celiacs (6) Definition promote adequate hydration adherance to dietary guidelines complications provide child and family teaching support refer to approp resources Term hernias and hydrocele define each what causes these? Definition hernia: protrusion of the bowel through an abnormal opening in the ab wall. kids usually umbilicus and inguinal wall hydrocele: presence of ab fluid in the scrotal sac cause: most commonly from congenial abnormality Term clinical s+s of hernia 2 Definition umb hernia-soft swelling around umb is reducible inguinal- painless swelling in inguinal area is reducible with finger when standing or stressed it comes out you see distention, obstruction, possibly gangrene Term s+s of hydrocele Definition noncommunicating: doesn't change with activity communicating:not reducible , amount of swelling and dist depends on activ and pos? Term interventions for hernia and hydrocele 5 Definition -assess for signs of incarcerationand strangulation (would need surgery, pain not relieved by change in position) - perform postop care -provide child and family teaching -support the child and family Term define hirschsprung disease who is more prone (boys or girls?) Definition is a congenital anomaly , absence of nevers to section of intestines which results in mechanical obstruction due to inadequate motility in an nintestinal segment. causes dialated descending colon. boys more prone Term cause of hirschsprung disease Definition familial congenial defect results from failure of the crainiocaudal migration of ganglion nerve cell precursors along the GI tract between the 5th and 12th week of gestation. Term s+s of hirschsprung dis lab tests done? Definition signs vary with age at time of diagnosis, length of affected bowl, and occurance of complications..newborns not passing meconium. -fowl smelling ribbon like stool -labs: barium enema and rectal biopsy Term interventions for hirschsprung dis: Definition -assess for signs of enterocolitis (report) -promote adequate hydration/nutrition -asess bowel functioning -admin enemas -avoid rectal temps -admin prescribed meds -dec abdom discomfort r/t distention -teaching -prepare family for any treatments or procedures -low residue LOW FIBER diet Term cleft lip and palate define: cause: Definition failure of the bone and tisue of the upper jaq and palate to fuse completely at the midline -cause: congenital defects, sometimes inheritence plays role, prenatal exposure to teratogens, chromosomal abnormality. defect arises in the second month of pregnancy Term complications of cleft lip or palate Definition abdominal distention from swallowing air difficulty swallowing. speech defects dental and orthodontic probs nasal defects alterations in hearing parentala shock guilt and grief inc risk for aspiration URIs and OM Term medical management of cleft lip: med management of cleft palate: Definition -lip: cheiloplasty, birth to age 3 months , unites the lip and gum edges -this provides a route for adequate nutrition and sucking, preformed in anticipation of tooth erruption. -palate: staphylorrhaphy, around 18 mo (to allow for palate growth, must be free of ear and resp infections. Term cheiloplasty preop interventions 4 Definition small freq feedings/ upright position burp often water admin after feedings promoate sucking between meals Term cheiloplasty post-op interventions 6 Definition maintain patent airway assess for cyanosis maintain intact suture line feeding schedule positioning assess for pain Term pre-op staphylorrhaphy care 3 Definition weaned from bottle or breast, able to use cup. use cleft palate nipple to enhance intake parent education Term stphylorrhaphy post op care 6 Definition posiitioning maintain intact suture line use a cup to feed feeding schedule rinse suture line provide soft toys. Term Esophageal atresia and tracheophageal fistula define Definition congenital EA and TEF are rare malformations that represent a failure of the esophogus to develop as a continuous passage and a faulure of the trachea and esophagus to separate into distinct structures. Term clinical manisfestations of esophageal atresia and tracheosophageal fistula 3 Definition frothy saliva in the mouth and nose drooling , choking and couhing if fed= sudden cough and gag --> risk for aspiration Term sugical repair of esophageal atresia and tracheosophageal fistula: prognosis: potential complications: Definition -one operation of staged with two or more procedures. -Prognosis: survival rate is nearly 100% -potential comoplications: vary depending on type of defect and surgical repair. Term Name 6 physiological differences in children that effect respiratory function Definition horizontal ribs smaller lungs, fewer alveoli, smaller airway diameter (easy to obstruct) lack of cartilagenous support (can compress bronchi) appears after 7-8 yo faster metabolism (use more o2) poorly developed immune system diaphragmatic breathers obligatory nose breathers (use of accessory muscles to bring in adequate 02) Term early signs of respiratory failure caredinal signs of respiratory failure: 4 Definition subtle behavioral changes (if child goes into cardiac failure 99% chance they will also go into respiratory failure, preventable if detected, listen to parents) -cardinal signs restlessness (vs agitation) consolable inc resp effort tachypnea and cardia diaphoresis (even newborns if they are working that hard) Term nursing diagnosis for resp failure/problems Definition ineffective airway clearance/obstruction ineffective breathing pattern (can't move air without access muscles which causes fatigue) impaired gas exchange- retention of carbon dioxide hyperinflation, hypoinflation. Term tachypnea is the same as hyperventilation in children T/F Definition false not true because children have a more immature system and may need more respirations to get the same O2 intake and they don't change the depth. Term bacterial tracheitis signs and symptoms usually age range Definition high fever involves trachea but not larynx not at risk for closing down ages- 3months to 6 years Term what causes laryngotracheobronchitis LTB? what are the signs and symptoms? age range Definition majority is caused by virus signs low grade fever cold congestion comes on gradually as imflam continues there is edema of soft tissue and airway is CONSTRICTED horseness of voice, signs of hypoxia and restlessness age range 3m0-5years Term acute viral laryngitis occurs at an age range of ________ Definition 3mo-1yr Term what tests should you do for laryngotracheobronchitis? what should you NOT do to this type of pt? Definition take xray of lateral nexk to check for obstuction and swellling don't stick tongue blade down which will cause spasm and occlusion Term interventions for laryngotracheobronchitis Definition racemic epinephrine neb sometimes decadron to reduce swelling close monitoring if rates decline -->intubation, or sooner if x ray shows lots of swelling if it closes then they will have to do trach Term name the 4 D of eppiglottitis this croup syndrome has the greatest potential for _____________ Definition drooling dysphagia dysphonia distress for airway occlusion Term in eppiglotitis what becomes inflamed Definition larynx , trachea and bronchi Term If child will not jut out chin this is almost diagnostic for _____________ in addition they won't talk, they are ussing all accessory muscles, and look anxious what type of treatments and interventions are given? Definition eppiglotitis treatments/interventions will be intubated steroids because racemic epinephrine doesn't work also given antibiotics Term If child will not jut out chin this is almost diagnostic for _____________ in addition they won't talk, they are ussing all accessory muscles, and look anxious what type of treatments and interventions are given? Definition eppiglotitis treatments/interventions will be intubated steroids because racemic epinephrine doesn't work also given antibiotics Term bronchiolitis occurs from _________ to _________ or from _________ to _________ day. it is usually caused by ___________. it usually effects kids under _____ and peaks at ______ Definition winter to early spring or halloween to mothers day virus ususally RSV Term which illness is characterized by the following Inflammation of bronchioles necrosis of ciliated cells obstruction of bronchioles (from sloughed necrotic cells) hyperinflated then collapse of alveoli, atelectasis. Definition bronchiolitis Term name some treatments/interventions for bronchiolitis what are s+s what is the incubation time Definition nebs if helpful fluids chest PT upright position prevention (synergis) ***respigam and ribavirin(teratogen) not effective, s+s crackles and fline rales wheezing can't get air out upper bronchi congestion well managed in healthy kids, but can cause dealth is those with comorbidities incubation is 4-6 days Term rales are heard during _________ and signifies _____ ________ ___________ rhonchi is heard during ________ and clears with ________, signifies _______ ______ involvement Wheezing is heard during ________ signif, _______ _____ ________. stridor is Definition inspiration small airway obstruction expiration cough upper airway wheeze expiration lower airway obstruction stridor inspiration and expiration (prolongs) upper airway obstruction Term when a child aspirates a small object where does it usually lodge? Definition right main bronchus Term Pertussus or whooping cough has an increased incidence in _______ and _______ They can't stop coughing because of continuous _____________ this disease is contagious T or F why is this illness on the rise Definition infants and adolescents continuous perastalisis True its very contagious on the rise due to allergic cohort and some who believe there is a connection to autism. Term in a secondary obstruction due to aspiration how can air travel Definition into lungs but not out! Term what is the most common cause of school absence Definition asthma Term what type of disorder is asthma what is the eitiology how is diagnosis made Definition inflammatory lung disorder, bronchial irritability in response to stimuli. eitiology is unclear may be familial (no gene isolated), allergies (dander dust animals) cold weather, stress a diagnosis is made based on clinical findings. Term what disease is characterized by: Fribrosis of the airways, hlyperplasia of the bronchial epithelium, inc fluid in the lungs, overdistention of aveoli caused by air trapping, and fibrosis, airway edema, and bronchocontriction it is permanent and chron Definition Bronchopulmonary dysplasia (BPD) Term management of Bronchopulmonary displasia includes these 4 interventions/treatments Definition meds-bronchodialators , anti-inflams respiratory care= suctioning, humidification, oxy, CPT/PD, ventilary support nutritional support= high cal family edu and support Term management of Bronchopulmonary displasia includes these 4 interventions/treatments Definition meds-bronchodialators , anti-inflams respiratory care= suctioning, humidification, oxy, CPT/PD, ventilary support nutritional support= high cal family edu and support Term what disease is characterized by: being inherited as a ressessive trait generalized disfunction of the exocrine glands with multisystem involvement pancreatic enzyme deficiency progressive pulmonary disease elevated sodium and cloride levels in swe Definition cystic fibrosis Term if two parents are carriers for CF what is the chance the child will be effected with CF? be a carrier, have no genetic inheritance of the gene. Definition cf 25% CARRIER 50% no prob 25% Term signs of CF 6 diagnostic or help diagnose what kind of vitamins do these individuals need? Definition born with meconian illeus (tell tale sign of CF) pancreatic enzyme deficiency (can't digest fats (udually noticed first) progressive chronic obstructive lung disease sweat gland dusfunction with inc sodium and chloride loss in the sweat (used to diagnose) failure to thrive need fat soluable vitamins Term clincal respiratory manifestations of CF 6 Definition thick bronchial mucus (greenish thick sticky) leading to bacterial colonization dec oxy-carbon dioxide exchange (clubbing) chronic cough dyspnea hyperaeration (barrel chest) sinusitis, nasal polyps Term clinical GI manifestations of CF Definition steatorrhea, azotorrhea (urea in stool) intest obstruction FTT rectal prolapse CF diabetes indulin produced but gets plugged up liver involvement Term clinical skin manisfestations of CF Definition salty taste r/t inc loss of na and cl risk for hyponatremic and hypochloremic alkalosis edema related to hypoalbuminemia Term reproductive manifestation of CF Definition female: delayed puberty dec fertility inc incidence of premature labor, low birth weight Males: most males with CF are sterile Term Therapeutic management/ goals of CF care are: Definition prevent minimize pulmonary complications (usually cause of death) ensure adequate nutrition for growth encourage physical actuvity promote reasonable quality of life Term Therapeutic management of respiratory systoms of cf Definition pulmonary hygiene CPT 3-4 times a day, flutter valve, exercise antibiotics nebulized/ inhaled meds- pulmozyme TOBI, bronchodialators, antiinflamatories cepacia precautions (teratogenic effects) lung transplant (can extend life) Term Gastrointestinal management of CF Definition admin pancreatic enzymnes with meals snacks and enteral feedings before eating high protein, high cal diet, salt supplementation replacement of fat sol vits monitor and treat intestinal obstruction Term when does the heart begin development in utero Definition first 3 weeks Term when is fetal cardiac circulation developed by? Definition the 8th week Term when does the fetal heart start beating Definition end of 3rd week Term what occurs with fetal heart development in the 5th week of gestation? Definition evolves into S shape and single trunk divides into two, the aorta and pumonary artery, Term when are the four chambers of the fetal heart evident (soon to be followed by the two vena cava) Definition 7th week Term which ventricle of the heart has shorter papillary muscle fibers Definition the right Term which ventricle has long striated muscle fibers to pump systemicly Definition the left Term blood will follow the path of ________ _______ Definition least resistance Term what are the risk fators of a congenital heart defect (CHD) 5 Definition family history environment toxic maternal exposures maternal exposures other syndromes (trisomy 21) matern condition (perscription drugs or diseases rubella) Term fetal liver blood from vena cava mixes with blood from the lower body and drains into the____ ________ Definition right atrium Term what is the o2 sat of baby during fetal development Definition 75% Term This closes with the baby's first breath this occurs becuase of the _____ in _______ concentration Definition ductus arteriosus inc in oxy concentration cuases Da tissue to constrict. Term In the newborn heart, how is resistance lowered so that right sided pressure is lowered Definition Inc in pulmonary blood flow with first breath dec pulmonary vascular resistance by 80%! this lowers right sided pressure Term what makes the foramen ovale close in the newborn Definition high let atria pressure Term name 4 things that occur to the newborn upon being born, and say what each things does for baby Definition alveoli expands- dec pulmonary vascular resistance and inc pulm blood flow cord clamed-inc systemic vascular resistance and inc left ventricle pressure DA closes= systemic vasular resistance is greater than pulmonary vascular resistance patent foramen ovale clses, umbilical vein and artery and ductus venosus atrophy Term in children pulse rate is _____ and stroke volume is ______. and the apical impulse is ______ Definition increased and stroke vol is decreased variable Term How is Cardiac Output calculated in young children what is the definition of stroke volume? is Heart rate or stroke volume more fixed in young children Definition CO = SV x HR amount of blood ejected by left ventricle per beat SV is more fixed and CO is regulated by the heart rate. Term define preload what does hypovolemia do to preload? what does fluid overload do to the preload? Definition end diastolic stretch, will inc strength of the fiber and contraction of the left ventricle hypovolemia decreases preload fluid overload causes an increase Term define contractility what are three body states that would cause a dec in contractility Definition pumping force and effectiveness of the heart muscle hypoxemia acidosis electrolyte imbalance Term define afterload Definition resistance in which ventricles must pump against Term excessive perspiration in infants indicates Definition CHF and is caused by catecholamine release don't put powder on infant Term what is mottling and what causes this in children with cong heart def? Definition cold stress caused by blood shunting to center and there is dec perfusion to the periphery. Term why does hepatomeagaly occur with children with CHD? Definition happens because decreased blood flow to the liver causes low liver resivior for dead rbc's Term what are two prenal tests that can diagnose CHD Definition fetal echo amniocentesis Term how is CHD diagnosed in newborn already delivered in an infant? name 5 diagnostic tests Definition neonatal cyanosis with cry murmur shock like symptoms infants= FTT tests: oxy challenge xray, echo, EKG, holter monitor, TEE (tracheal esoph echo), ABG, HCT, Cardiac cath (used more as intervention for patent DA) Term A child with a patent DA get a cardiac cath what are the needed interventions for pre and post cath insertion Definition PRE prehydration status NPO prior Premark pedal pulses baseline HCT and V/S prepare child based on developmental age POST vs q 15 min check dressing quality of pedal pulses q 1/2 hour keep extremity straight for at least 6 hours check under the child and in diaper for bleeding Term What are the 4 categories of congenital heart disease Definition inc pulm blood flow dec pulm blood flow obstructive lesions mixed lesions Term Inc pulmon blood flow can be caused by Definition Problems that cause a left to right shunt such as: -patent DA -atrial septal defent -ventricular septal defect membranous and muscular -complete atrio ventricular canal Term when can you remove the dressing after a cardiac cath? what type of dressing is it Definition the day following catheterization its a pressure dressing. Term Name 7 clincal manifestations of left to right shunting in heart Definition tachycardia/tachypnea inc WOB hypoxia-fatigue irritability anxiety feeds slowly - tires easily poor weight gain dec U/O poor perfusion=cool extremities pale prolonged cap refill, weak pulses Term when you have a Left to right shunt, more blood flows to the__________ Definition lungs Term name 4 examples of a left to right shunt Definition patent DA atrial septal defect ventricular septal defect membranous and muscular complete atrio-ventricular canal Term most ventricular septal defects are repaired __________ Definition on their own, if not by 12 then surgery Term The ductus arteriosus is located between the Definition pulmonary artery and the aorta Term an atrial septal defect involves ______ to _________ shunting Definition left to right Term name 3 atrial septal defects and where they are located in the septum how does the blood shunt? Definition sinus venosis (high in septum) ostium primum low in septum, inferior to patent foraman ovale ostium secundum - mid septum most common these kids don't look that sick. They are pretty active. left to right shunting. Term in a ventricular septal defect there is ___ to ____shunting of blood between the _________ Definition left to right between the ventricles there is allot of blood mixing in this defect/most common/ most resolve on their own. Term When is an atrioventricular defect fixed/ Definition 3-6 MONTHS Term Name 4 complications of imcreased pulmonary blood flow Definition inc pulmonary vascular resistance vasoconstriction pulmonary vessel hypertrophy pulmonary hypertension-irreversible damage. Term Name 3 types of congestive heart failure Definition systemic venous congestion (R) Pulmonary venous congestion (L) Compensatory response Term what type of congestive heart failure is characterized by: weight gain, hepatomeagaly, edema (sacral and periorbital) ascites, and neck vein distention Definition systemic venous congestion (r) Term what type of CHF causes tbe following characteristics: tachpnea , dyspnea, retractions, flaring, grunting , wheeze, cough, pallor, and exercise intolerance Definition pulmonary venous congestion (L) Term the type of CHF characterized by : tachycardia, cardiomegaly diaphoresis, fatigue and FTTq Definition compensatory response Term how many calories are required for a normal neonate? high risk neonates such as those with CHF require Definition 100-120 kcal/kg 120-150 kcal/kg Term You should put infants on fluid restriction if they have CHF. T or F Definition F. They won't be able to get any calories. Term lasix works on the ______ loop of henle to while diuril works on the _____ loop of henle and should be given with ________ aldactone is a __ ___________ diuretic, and works on _____, while blocking ____ Definition ascending decending should be given with lasix K sparing works on ald and blocks ADH Term Name two meds that are afterload reducers name 3 inotropic drugs that inc contractility what does oxygen do? Definition captopril (to dialate aorta and pulm artery) and enalapril digoxin, dopamine, dobutamine used sparingly doesn't help with o2 sats and ca. Term Decreased pulmonary blood flow is caused by a -------- to ------- shunt Definition right to left Term Name 3 examples of defects with right to left shunts Definition tetralogy of fallot (TOF) Tricuspid atresia Pulmonary atresia Term clinical manifestations of right to left shunting include 10 Definition cyanosis FTT respiratory distress -decreased oxygen polycythemia- risk stroke emboli ( to compensate for low 02 sat) inc systemic blood flow systemic congestion-CHF distended neck veins (blood v. viscous) hepatomegally (destruction of rbcs) fluid retention- sudden weight gain. facial edema- dependant edema clubbing Term name the 4 defects in tetrology of fallot Definition narrow opening to pulmonary artery due to stenosis right ventricle hypertrophy d/t inc in pressure ventricular septal defect an overriding aorta that is sitting above the VSD and more mixed blood is going systemically. Term surgery for tetrology of fallot is done at the age of Definition 3 months of age Term what is a tet spell what can cause a tet spell inc pulmonary resistance causes VSD to shunt which way? if a child has a tet spell what should you do? how do you treat it Definition -hypoxic episode - stress, defecation, cry (valsalva) -shunts systemically (right to left, not enough to lungs) take to the ER -morphine (smooth muscle relaxer) and bring knees to chest position crunch them red blood going back to heart causes spasms to relax Term what is different about a heart with a transposition? how do they look at first? when do they do the surgery? what is the best surgery? Definition The aorta is comming out of the rt ventricle which is pumping deoxygenated blood systemically and the pulmonary artery is attatched to the left ventricle and is pumping to the lungs. look healthy at first do surgery instantly before they go home. the best is the jatene arterial switch done at less than 2 weeks of age. switch arteries and switch coronary arteries. (you must assess coranary art suffificency Term what is the course of illness of a one ventricle heart (one with only a rt ventricle)? what are the treatments Definition the aortic valve is stenotic, no blood goes to the left venticle so no flow no grow... wither paliation or heart transplant. Term Name 3 obstructive lesions of the heart Definition coarctation aortic stenosis pulmonary stenosis/ pulmonary atresia Term what are the clinical manisfestations of obstructive lesions such as coarctation aortic stenosis and pulmonary atresia? Definition depends on severity of obstruction and which structure is obstructed CHF and/or cyanosis Blood pressure gradient between upper and lowwer extremities. Upper extremities high BP while lower extremities has low blood pressure Term obstructive defects are surgically repaired, but tend to __________ Definition reoccur Term What are the nursing interventions when caring for a child with obstructive lesions Definition support parents support groups Encourage family participation cluster care emphasize positive aspects hospital breaks, volunteers education Term PDA when should this close? what is the corrective procedure when symptomatic? what does the murmur sound like what type of flow problem does this have what risks does this problem have on the circulatory sys Definition closes at 1-8 weeks of age corrective proced is meds indomethacin IV. tbe either ligation and or device closure (depends on size.) sounds like a machine increased pulmonary flow risks are pulmonary edema and CHF Term VSD ven septal defect: Name 4 types what is the corrective procedure what type of flow problem does this defect have what determines degree of pulmonary vascular resistance at risk for..? Definition 3 types: membranous, atrioventricular, muscular (swiss cheese) small defects may not need corrects and may even close by themself. large defects are controled by pulmonary banding in early infancy (pallative) or if really lg by suture or patch inc pulmonary flow pvr is determined by size and location of defect at risk for CHF, infections and pulmonary vascular hypertention Term secundom defect define when is corrective procedure preformed what type of defect is this characterized as what is the type of blood flow problem Definition define- a hole located anywhere onlong the interatrial septum (another way to say PDA) preformed at 2-6 yo to prevent PVD. called VATS arterial septal defect inc pumonary flow Term ostium primum defect define what is the category of defect this falls under? what procedure is used to fix this? what are the risks if not corrected? Definition located low in the interatrial septom where inferior margin formed by fused septal leaflets of the mitral valve arterial septal defect VATS generally they are asymptomatic, there is a risk of chronic pulmonary changes if not repaired during childhood. Term what is a coarctation of the aorta how is it treated what strange vital signs readings does this defect have? what type of blood flow prob does this have even after correction this obstruction may return t or f Definition narrowing of the aorta distal to the left subclavian artery resection of narrowed section. end to end anastomosis, graft may not be needed in child. high bp in upper extremities, low in low (preop) dec systemic flow/obstructed flow true Term tetrology of fallot name the 4 defects what is the dangerous risk that can occur agter a tet spell? when can this be repaired? what causes the risk of dehydration? what type of blood flow prob Definition defects are large VSD overiding aorta pulmonary stenosis and right ventricular hypertrophy dangerous risk of tet spell is CVA. complete repair during infancy before 6 months. good prognosis polycythemia causes dehydration dec pulmonary flow Term define tricuspid atresia explain the path of the blood shunting what is the only source of pulmonary flow what is the surgery/treatment what other defect is NEEDED to maintain life flow problem? Definition absent tricuspid valve hypoplastic RV PFO-->LA--> MV -->LV-->aorta only from patent ductus arteriosus. palliative surgery BT shunt followed by fontan-conduit from RA to PA (done once symptomatic) need either a PFO or ASD and a PDA dec pulm flow Term sub acute bacterial endocarditis define Definition the formation of noninfected thrombus on abnormal endothelial surface, secondary infection w bacteria circulating in blood, proliferation of bacteria/vegetations on the cardiac valves Term Name the five aquired heart diseases found in kids Definition kawasaki disease rheumatic fever endocarditis cardiomyopathy dysrhythmias Term what is kawasaki disease? Definition mucocutaneous lymph node syndrome, no infectious ideology, system vasculitis involving arterioles capillaries and venules. later coronary and larger arteris may be involved may lead to long term cardiac probs Term How long does the acute phase of kawasaki last what is always present, how long? should antibiotics be used? what types of oral cavity changes are seen eye problems? Definition from day 0-10 always a fever for greater than 5 days they are unresponsive to antibiotics strawberry tongue lips and pharynx bilat conjunctivitis non purulent Term what are some of the clinical manifestations of kawasaki disease in the acute phase? sub acute phase? convelescent phase Definition acute= arthralgia, elevated sed, c reative p, and LFTs cervical lymphadenopathy erythmia on hands and feet rash worse in groin enlargement of gallbladder (ab pain) sub acute phase (day 11-25) disappearance of fever rash and lymphdenopathy c react sed and platelets elev anemia arthritis worsens desquamation of hands and feet coronary artery aneurisms pericardial effusion ST-T segment changes convelescent phase: until labs are WNL presist coronary art anuerysms aortic stenosis Term treatment of kawasaki 4 things Definition ASA, IVIG, antithrombotic therapy (coumadin, persantine), dec cardiac workload captopril, digoxin, diuretics Term Acute theumatic fever/heart disease how many days of latency what age range is most susceptibl what groups is this highest in Definition 20 days latency most susceptible 5-15 highest in females and blacks (caused by an organism?) Term What is Jones criteria for RHF? what are the major signs minor? Definition 2 major symtoms supporting evidence of GABHS, or 1 major and two minor with history of GABHS. major signs are carditis, polyarthritis, syden hams chorea, erythema marginatum, sub cue nodules Minor signs: polyarthralgia fever, elev sed, +c react prot, prolonged PR on EKG, previous history of RHF. Term what is the treatment options for RHD, 6 Definition ASA substantial improvement in 2 days, cortico steroids, supportive care for CHF, bedrest for duration of fever and inflam process, penicillin-G 1.2 mu IM Q month Term In kids the epiphyseal growth plates are ______ and more prone to _______ Definition weaker than adults and more prone to fractures. Term the periosteum in kids is ________ and heals more _________ Definition thicker more quickly Term childrens bones are more ________ than adults and therefore are more prone to ______ than to sprains. compared to adults, children have a ________ ROM Definition more flexible prone to strains larger ROM Term define strain what kind of activities usually cause this what is the presenting symptom? what is prince? Definition tearing or stretching injury to muscle tendon unit causeing either a partial or complete tear or rupture of muscle, tendons or fascia that support a joint individual sports symptom=PAIN prince is treatment and stands for protect, rest, ice, NSAIDS, compress, elevate Term define sprain how does this usually occur who is this less common in? what symptom is predominant? treatment? Definition traumatic joint twist that results in stretching or tearing of connective tissue usually outside force team or contact sport less common in prepubital children symptom= swelling! (NOT PAIN) treat=Prince= protect, rest, ice, NSAISA, compress, elevate Term what is the most common fracture? Definition clavicle Term what did you break if you broke your supracondylar? Definition elbow Term what does it mean to have an avulsion fracture? occult? Buckle or torus? greenstick? Definition a-fracture pulls bone from usually pt of contact -hidden -buckle or torus-bone inbeds instead of breaking -greenstick= incomplete break Term Name the 5 types of fractures Definition comminuted compound compressed displaced spiral Term what are the 7 clinical manisfestations of a fracture what should you assess? Definition 7= DB stamp dec use bruise swell tender any dec of neurovascular status pain assess 5 P's= pain, pallor, pulse loss, perithesia, paralysis. Term name the two ways to do a reduction of a fracture and what each means Definition closed and open closed= setting bones open means plates or pins Term Name the 3 types of casts how long does plater take to dry 4 ways to care for a cast Definition hip spica leg cast arm cast dries in 12 hours to 3 days cast care= HEEK Handle wet cast carefully with palms, elevate, expose to air, keep clean and dry. Term what is compartment syndrome? s+s? what is there risk for what should you do immed Definition orthospedic emergency where there is a build up of fluid in an enclosed space. s+s= pain out of proportion to injury, passive ROM creates pain, muscle ischemia, neural injury. pulmonary embolus and infection tell doc immed Term