Shared Flashcard Set

Details

Peds Exam 3
N/A
249
Nursing
07/29/2011

Additional Nursing Flashcards

 


 

Cards

Term

 

 

 

Top Causes of Mortality in Children

Definition




Infants: congenital anomalies, RDS, LBW, weight r/t death (complications of prematurity), SIDS

Term

 

 

 

What amount of children are living with complex chronic conditions in the US?

Definition

 

 

 

2.2 - 3.7 million

Term

 

 

 

Children Dealing with Emotions r/t Dying

Definition
  • Children decide to hide their emotions from parents and others
  • Emotions don't differ from adults, but the ability to tolerate emotions can be of limited duration.
  • Want to be like peers
  • Isolation
  • May see illness and procedures as punishment
  • Young children are very egocentric
  • KNOW THEY ARE DYING
Term

 

 

 

Cognitive Concepts of Death

Definition
  • Universality: everyone will die
  • Finality: permanent cessation of bodily functions
  • Nonfunctionality: once the body dies, all functions cease
Term

 

 

 

 

If a child denies feeling any pain should you always take their word for it?

Definition

 

 

 

No, school-age children may deny pain because they don't want a shot or to be hospitalized (not seen in adolescents)

Term

 

 

 

Possible Physical Signs/Symptoms of Pain

Definition
  • Facial expression of discomfort
  • Immobility or guarding of body area
  • Elevated pulse or respirations
  • Irritability or restlessness
  • Decreased appetite
  • Crying
Term

 

 

 

Developmental Responses to Pain

Definition
  • Infants: irritability, crying, poor feeding
  • Toddlers: quiet, regressive behavior, uncooperative
  • Preschoolers: procrastination/pain is punishment
  • School-age: deny pain
  • Adolescents: fears loss of control
Term

 

 

 

 

At what age is self-reported pain valid?

Definition

 

 

 

Over the age of 4 years

Term

 

 

 

 

COMFORT Scale

Definition
  • ONLY tool recommended for use with unconscious and ventilated infants, children, and adolescents
  • 8 indicators (score each between 1 and 5)
  • Alertness; calmness/agitation; respiratory response
  • Physical movement; BP; HR
  • Muscle tone; facial tension
  • Observe for 2 minutes and add the scores of each indicator
  • Ranges from 8-40
  • Score of 17-26 = adequate sedation and pain control
Term

 

 

 

 

Poker Chip Tool

Definition
  • Set of 4 red plastic poker chips
  • Each chip = a "piece of hurt"
  • Scores 0-4
  • Good psychometric testing
Term

 

 

 

FACES Pain Scale

Definition
  • Wong-Baker FACES widely used in the US
  • Wong-Baker 6 cartoon faces from "no pain" to "worst pain"
  • Bieri Faces Revised: six faces 0-5; no smiling face at "no pain" and no tears at "most pain"; equivalent to 0-10 metric system
Term

 

 

 

Numeric Pain Ratings

Definition
  • For ages 8 and older
  • 0-10 scale is widely used
  • Easy to use
Term

 

 

 

Verbal Analog Scale (VAS)

Definition
  • "No hurt" to "biggest hurt" are more appropriate than "least pain" to "worst pain imaginable"
  • Requires higher degree of abstract thinking than numeric pain scale (NRS)
  • Recommended because of lack of supportive evidence through psychometric testing with the NRS in children and adolescents
Term

 

 

 

Adolescent Pediatric Pain Tool (APPT)

 

Definition
  • Assesses pain location, intensity, and quality
  • Anterior and posterior body outline on one side; 100 mm word-graphing rating scale with a pain descriptor
  • Facilitates assessments of pain quality and location
Term

 

 

 

Pediatric Pain Questionnaire (PPQ)

 

Definition
  • Assesses patient and parental perceptions of pain
  • Cognitive and developmental considerations
  • 8 ares of inquiry: pain history, pain language, colors associated with pain, experience, worst pain experiences, ways children cope with pain, positive aspects of pain, and location of child's current pain
  • Three components of PPQ: VASs, color-coded rating scales, and verbal descriptors
  • The child, parent, and physician each complete form separately
Term

 

 

 

 

CRIES Neonatal Pain Scale

Definition
  • Crying
  • Requiring increased oxygen
  • Increased vital signs
  • Expression
  • Sleeplessness
Term

 

 

 

Premature Infant Pain Profile (PIPP)

Definition
  • Specifically developed for premature infants
  • Gives higher pain score to infants with lower gestational age
  • Gives higher pain score to blunted behavioral response
Term

 

 

 

Neonatal Pain, Agitation, and Sedation Scale (NPASS)

Definition
  • Used in neonates from 23 weeks of gestation up to 100 days of age
  • Measures 5 criteria in two dimensions: pain and sedation
Term

 

 

 

Measuring Pain in Children with Communication and Cognitive Impairment

Definition
  • Difficult to measure pain; high risk for inadequate tx of pain
  • NCCPC: non-communicating children's pain checklist
  • PICIC: pain indicator for communicatively impaired children
Term

 

 

 

Cultural Influences on Pediatric Pain Scales

Definition
  • Oucher Pain Scale: for 3-12 year olds; validated with African American and Caucasian children
  • Hispanic versions of APPT scale available for children/adolescents with cancer
Term

 

 

 

Nonpharmacologic Pain Interventions for Infants

Definition
  • Containment
  • Postioning
  • Nonnutritive sucking
  • Kangaroo holding
Term

 

 

 

Patient-Controlled Analgesia (PCA) 

Definition
  • Basal rate: continuous
  • Bolus dose: can be administered by patient, parent, or nurse
Term

 

 

 

Use of Morphine in Pain Management in Children

Definition

GOLD STANDARD; drug of choice for PCA

  • 1 mg/ml typical of PCA usage
Term

 

 

 

Other Opioids Used in Pain Management for Children

Definition
  • Hydromorphone
  • Fentanyl: side effect is rigid chest syndrome
  • Meperidine (Demerol)
  • Oxycodone: available with or without acetaminophen; total dose of acetaminophen considered
Term

 

 

 

Use of Meperidine (Demerol) in Pain Management for Children

Definition
  • May increase risk for seizures due to excitatory effects on nervous system; try not to use with sickle cell patients
  • Recommended use for brief treatment of patients who have shown its effectiveness or who have allergies or uncorrectable intolerances to other opioids
  • Maximum usage: 48 hours or 600 mg/24 hours
Term

 

 

 

Coanalgesics or Adjuvant Analgesics

Definition
  • Used alone or with opioids to control symptoms or side effects
  • Anxiolytics, sedatives, amnesics: diazepam (Valium) or midazolam (Versed)
  • TCAs and antiepileptics for neuropathic pain
  • Stool softeners for diarrhea
  • Antiemetics for n/v
  • Diphenhydramine for itching
Term

 

 

 

 

Placebo Use in Children

Definition
  • Side effects similar to those of opioids
  • May destroy trust; raises serious ethical/legal questions
  • American Society of Pain Management Nursing is against use of placebos
Term

 

 

 

Epidural Anesthesia

Definition
  • Opioid: fentanyl, hydromorphone, or preservative-free morphine
  • Local: bupivicaine or ropivicaine
  • Instilled via single or intermittent bolus, continuous infusion, or PCEA
Term

 

 

 

Nursing Care of Child with Epidural Anesthesia

Definition
  • Careful monitoring for respiratory depression
  • Skin care around catheter insertion site
  • Assessment of pain
Term

 

 

 

Transmucosal and Transdermal Analgesia

Definition
  • Oral transmucosal fentanyl (Oralet)
  • Fentanyl transdermal patch (Duragesic): chronically ill
  • Anesthetic creams (EMLA, LMX): local for IV insertion
  • Refrigerant sprays (ethyl chloride and fluorimethane)
  • Numby stuff
  • LidoSite activated patch
Term

 

 

 

Lidocaine

Definition
  • Side effects: stinging and burning on injection
  • Buffered lidocaine: decreased or eliminated stinging
  • Warming lidocaine to body temp: decreased or eliminated stinging
Term

 

 

 

Tolerance to Pain Medication

Definition
  • Dose must be increased to achieve the same effect
  • May develop after 10-21 days
  • Treatment: increase dose; decrease duration between doses
Term

 

 

 

 

Treatment of Physical Dependence

Definition
  • Gradually reduce dose: one half dose q 6 hours for first 2 days; reduce by 25% q 2 days until totaly daily dose of 0.6 mg/kg/day of morphine (or equivalent) is reached; after 2 days on this dose, discontinue opioid
  • May also switch to oral methadone, using 1/4 of equianalgesic dose as initial weaning dose and proceeding as described above
Term

 

 

 

 

Consequences of Unrelieved Pain in Neonates

Definition
  • Increased ICP, HR, RR, BP
  • Decreased SaO2
  • Muscle rigidity, facial expression, crying, withdrawal, and sleeplessness
Term

 

 

 

Sedation for Nonpainful Procedures

Definition
  • Chloral hydrate, nembutal
  • Careful monitoring during and after procedure
  • Decrease stimuli after procedure
  • "Nembutal rage": agitation during emergence; nembutal severely depresses respiratory system
  • Chloral hydrate: little effect on resp. and BP
Term

 

 

 

 

"Windup Phenomenon"

Definition
  • Studied in neonates
  • Attributed to decreased pain threshold + chronic pain
  • After exposure to pain, altered excitability at multiple levels of spinal cord
  • Nonnoxious stimuli is perceived as noxious
  • Same physiologic response to stress
  • Results in chronic pain; biologic and clinical consequences
Term

 

 

 

Conscious Sedation (Minimal Level of Sedation)

Definition
  • Protective reflexes are maintained
  • Able to maintain a patent airway independently and continuously
  • Patient responds to physical stimulation or verbal command (ex. "open your eyes")
  • Cognitive function may be impaired
Term

 

 

 

 

Moderate Sedation 

Definition
  • Patient not easily aroused but responsible purposefully to verbal commands, either alone or accompanied by light touch
  • May return partial or no protective reflexes
  • Airway, spontaneous ventilation, and cardiovascular function may or may not be adequate without interventions (ex. oxygen)
  • NOT EASILY AROUSED
Term

 

 

 

Deep Sedation/Anesthesia

Definition
  • Patient cannot be easily aroused
  • No protective reflexes
  • Unable to maintain a patent airway; ventilatory and cardiovascular function independently may be impaired
  • Continuous monitoring q 5 minutes
Term

 

 

 

Emergency Equipment for Moderate and Deep Sedation

Definition
  • Suction apparatus with catheters
  • Oxygen source, oral and nasal airways, ETTs, laryngoscope/blades, Ambu bag/mask
  • Medications for resuscitation and drug antagonism
  • IV access
  • Trained individual (MD, RN) whose sole responsibility is to monitor patient
Term

 

 

 

Pain in Children with Sickle Cell Disease

Definition
  • Opioids are considered the major therapy and are started in early childhood and continued throughout adult life
  • Nonpharmacologic interventions
  • Goals of treatment of acute episodes
  • Pseudoaddiction
Term

 

 

 

Pain Management for Childhood Cancers

Definition
  • Sources/type of pain: bone, visceral, neuropathic, treatment-related
  • Interventions
  • Obstacles to successful analgesia
Term

 

 

 

Ketamine Use in Children

Definition
  • Often used for analgesia and sedation during procedures in kids
  • Subanesthetic doses uses plus high dose opioids for uncontrolled cancer pain
  • Appeared to improve pain control and to have opioid-sparing effect; dosage range (0.1 to 1 mg/kg/hr) lower than that used for anesthetic purposes
  • Give lorazepam (0.025 mg/kg/12 hr) concurrently with ketamine
  • Continuous monitoring (BP, RR, HR, SaO2)
Term

 

 

 

Definition of Cognitive Impairment

Definition

 

 

 

Any type of intellectual disability

Term

 

 

 

 

Diagnostic Criteria for CI

Definition
  • Emphasis on functional strengths and weaknesses and supports needed
  • Classifications describe real-world adaptiave skills
  • Onset before age 18
  • Subaverage intellectual functioning (IQ=70-75 or below)
  • Functional impairment in at least 2 adaptive skill domains: communication; self-care; home living; social skills; use of community resources; self-direction; health and safety; functional academics; leisure; work
Term

 

 

 

Developmental Delay (Definition)

Definition
  • Any significant lag or delay in physical, cognitive, behavioral, emotional, or social development
  • Routine developmental screening can assist in early identification
  • Most common delays: language and cognitive skills; fine and gross motor skills
Term

 

 

 

 

CI Emphasis

Definition
  • Emphasizes abilities, environments, supports, and empowerment
  • Classifications of support required: intermittent, limited, extensive, or pervasive
  • Underlying assumption: function improves with support
Term

 

 

 

Etiology of CI

Definition
  • Familial, social, environmental, organic, and unknown causes
  • Chromosomal disorders: Down Syndrome and Fragile X Syndrome
  • Prenatal toxin exposure: FAS accounts for sizable proportion of causes
  • Other identifiable disorders or syndromes: severe CP, microcephaly, and infantile spasms
Term

 

 

 

Diagnostic Tests for CI

Definition
  • Bayley Scales of Infant Development
  • Mullen Scale of Early Learning
  • The Harris Infant Neuromotor Test (HINT)
  • Wechsler Intelligence Scale for Children for school-agers
  • Stanford-Binet Intelligence Scale and Kaufman Assessment Battery from toddlerhood through school age
  • Leiter International Performance Scale for children who speak a different language, nonverbal children, or those with significant language or motor impairment
  • Individually tested by specially trained clinicians
Term

 

 

 

Primary Prevention of CI 

Definition
  • Avoidance of prenatal rubella infection - keep immunizations current
  • Genetic counseling, especially regarding risk of Down syndrome or Fragil X syndrome
  • Use of folic acid supplements 
  • Education regarding dangers of smoking or ETOH use during pregnancy and ingesting lead during childhood
  • Reduction of head injuries
  • Future gene therapy for genetic disorders, such as PKU
Term

 

 

 

 

Secondary Prevention of CI

Definition
  • Early identification to initiate treatment to avert damage
  • Prenatal diagnosis or carrier detection of disorders such as Down syndrome
  • Newborn screening for treatable inborn errors of metabolism: congenital hypothyroidism, PKU, galactosemia
Term

 

 

 

Tertiary Prevention of CI

Definition
  • Tx to minimize LT consequence
  • Early identification of therapies and rehabilitation services
  • Treatment of coexisting problems; programs for infant stimulation, parent training, preschool education; counseling services to preserve the family unit
Term

 

 

 

Goal for Caring for CI

Definition
  • Promote optimum social, physical, cognitive, and adaptive development as individuals within a family and community
Term

 

 

 

 

Early Behavioral Signs of Cognitive Impairment

Definition
  • No response to contact, voice, movement
  • Irritability
  • Poor/slow feeding
  • Poor eye contact during feeding
  • Diminished spontaneous activity
Term

 

 

 

Promoting Optimum Development

Definition
  • Acceptable social behavior
  • Personal feelings of self-esteem, worth, and security
Term

 

 

 

Development of Communication

Definition
  • Both receptive and expressive skills
  • Sign language
  • Message boards
Term

 

 

 

 

Discipline in the child with CI

Definition
  • Simple, consistent limit setting
  • Must be appropriate for child's mental age
  • Control measures based on specific behavior
  • Behavior modification: reinforcement of desired actions; use of time-out
Term

 

 

 

Socialization in the child with CI

Definition
  • Acquisition of social skills
  • Active rehearsal
  • Positive reinforcement for desired behavior
Term

 

 

 

Play and Exercise in the Child with CI

Definition

Benefits of exercise

  • Development of coordination
  • Cardiovascular fitness
  • Weight management
May not be able to initiate appropriate play activities on their own
Term

 

 

 

 

Promoting Independence in the Child with CI

Definition

Parents may need assistance to promote independent self-help skills

  • Feeding
  • Toilet training
  • Dressing
  • Grooming
Term

 

 

 

Classification of CI

Definition
  • Educable/mild: IQ 50-75
  • Trainable/moderate: IQ 36-49
  • Severe: IQ 20-35
  • Profound: IQ less than 20
Term

 

 

 

Care of Child with CI During Hospitalization

Definition
  • Detailed hx with special focus on self-care abilities
  • Assess developmental age
  • Communication with child appropriate to cognitive level
Term

 

 

 

Down Syndrome (Definition)

Definition

Also called Trisomy 21

  • Extra chromosome 21 in 97%
  • Translocation of chromosome 21 in 3-6%
  • Mosaicism in 1-3%
  • Etiology unknown, likely multiple causes
  • Most common chromosome abnormality; 1 in 800-1000 live births
  • Most common genetic cause of CI
Term

 

 

 

Down Syndrome (Possible Etiologies)

Definition

Maternal Age

  • Overall incidence
  • 80% of infants with Down syndrome born to mothers <35 years
  • Age 35 + incidence approx. 1 in 350
  • Age 40 + incidence approx. 1 in 100
Paternal Age
  • Less than 5% of cases extra chromosome is from father if >55 years old
Term

 

 

 

Genetic Counseling

Definition
  • Degree of physical and cognitive impairment is r/t percentage of cells with abnormal chromosomal makeup
  • Nondisjunction: usually sporadic event; low risk for recurrence
  • Hereditary translocation: higher risk of recurrence, testing of the parents is necessary to ID the carrier and offer genetic counseling
Term

 

 

 

Down Syndrome (Manifestations)

Definition
  • Head, face, eyes, musculoskeletal
  • Chest, neck, abdomen
  • Genitalia, skin
  • Hands, feet
Term

 

 

 

Down Syndrome IQ

Definition
  • Wide variation from severely CI to low-average intelligence
  • Generally mild to moderate CI
  • Initial development may appear normal
  • Social development may be 2-3 years > mental age
Term

 

 

 

Down Syndrome Congenital Anomalies

Definition
  • 40-45% heart defects: septal defects
  • Renal, Hirschsprung, tracheoesophageal fistula
  • Altered immune function
  • Musculoskeletal: hypotonic muscles, hyperextensible joints, atlantoaxial instability (15-20%)
  • Sensory
  • Growth: weight v. height
  • Sexual development
Term

 

 

 

 

Down Syndrome Treatment and Prognosis

Definition

Atlantoaxial Instability

  • Urgen if sudden signs of spinal compression
  • If present, may need to avoid activities stressful to head and neck
  • May require surgical intervention
Life Expectancy for DS
  • 80% to age 55+
  • Remains lower than general population
Term

 

 

 

 

Fragile X Syndrome (Definition)

Definition
  • Most common inherited cause of CI
  • Second most common genetic cause of CI after Down syndrome
  • Incidence 1 in 2000-5000 live births
  • Occurs more frequently in males, approx. 1 in 4000 males; approx. 1 in 8000 females
  • Affects males more severely than females (only one X)
Term

 

 

 

Fragile X Syndrome: Gender Differences

Definition
  • Most males are mentally deficient
  • 30% of females are mentaly deficient
  • Males have only the nonfunctioning X
  • Females have one normally functioning X and one nonfunctioning X
Term

 

 

 

Etiology of Fragile X Syndrome

Definition
  • Abnormal mutation on lower end of the long arm of the X chromosome; occurs in affected males and females, occurs in carrier females
  • Fragile site fails to condense during mitosis, results in mutation
  • Prenatal dx is possible
  • Cognitively impaired individuals without known family hx need DNA testing to determine cause of CI
Term

 

 

 

 

X-Linked Carrier Status r/t Fragile X Syndrome

Definition

Classic X-linked recessive pattern

  • All carrier females are normal
  • All affected males have sx of the disorder, and no males are carriers
X-linked dominant with reduced penetrance
  • 80% of these males are affected
  • 30% of these females are affected
  • Other females do not have classic physical appearance but may have learning and psychosocial difficulties
  • Affected members of both sexes can be "carriers"
Term

 

 

 

 

Classic Physical Appearance of Fragile X Syndrome

Definition
  • Large head circumference, long face, prognathism, large ears, long palpebral fissures, strabismus (improper eye alignment)
  • High-arched palate
  • Mitral valve prolapse
  • Macroorchidism (large testicles)
  • Hyperextensible finger joints, palmar crease
  • Flat feet
Term

 

 

 

 

Classic Behavioral Features of Fragile X Syndrome

Definition
  • Mild to severe CI, normal IQ with learning difficulties
  • Delayed speech and language
  • Hyperactivity
  • Autistic-like behaviors
  • Aggressive behaviors
Term

 

 

 

Therapeutic Management of Fragile X Syndrome

Definition
  • Tegretol, Prozac: behavioral control
  • Stimulants for hyperactivity (similar to ADHD management)
  • Mimic behavior: "mainstream management"
Term

 

 

 

Hearing Impairment (Overview)

Definition
  • Incidence is 3 in 1000 births; if child in NICU 2-4 in 1000 births
  • Ranges from slight to profound
  • Deaf: a person whose hearing disability precludes processing linguistic information with or without hearing aid
  • Hard of hearing: generally able to hear with hearing aid
Term

 

 

 

Etiology of Hearing Impairments

Definition
  • Anatomic malformation
  • LBW
  • Ototoxic drugs
  • Chronic ear infections (otitis media)
  • Perinatal asphyxia
  • Perinatal infections
  • Prenatal substance use/abuse
  • Cerebral palsy
Term

 

 

 

NICU: Potential Effects on Hearing

Definition

Sensorineural hearing loss

  • From exposure to continuous humming sounds
  • From high noise levels of equipment
May worsen when combined with potentially ototoxic antibiotics
Term

 

 

 

Pathology of Hearing Impairments

Definition
  • Conductive hearing loss: middle ear
  • Sensorineural hearing loss: nerve deafness
  • Mixed conductive-sensorineural loss: may follow recurrent OM with complications
  • Central auditory interception: organic or functional
Term

 

 

 

Symptom Severity of Hearing Impairment

Definition
  • Measured in decibels (dB)
  • Hearing threshold 
  • Effect on speech
Term

 

 

 

Therapeutic Interventions for Hearing Impairment

Definition

Conductive Defects

  • Medication (antibiotics)
  • Hearing aids to amplify sound
Sensorineural
  • Hearing aids not beneficial
  • Cochlear implant may be beneficial
Term

 

 

 

Manifestations of Hearing Impairment in Infancy

Definition
  • Lack of startle reflex
  • Absence of babbling by age 7 months
  • General indifference to sound
  • Lack of response to spoken word
Term

 

 

 

Manifestations of Hearing Impairment in Childhood

Definition
  • Profound deafness likely to be dx in infancy
  • Entry into school
  • Concerns with speech development
Term

 

 

 

 

Promoting Communication with Hearing Impairment

Definition
  • Lip reading
  • Cued speech
  • Sign language
  • Speech language therapy
  • Socialization
  • Additional aids
Term

 

 

 

Care for Hearing-Impaired Child During Hospitalization

Definition
  • Reassess understanding of instructions given
  • Supplement with visual and tactile media
  • Communication devices: picture board, common words and needs (food, water, toilet)
Term

 

 

 

Prevention of Hearing Loss

Definition
  • Treatment and management of recurrent OM
  • Prenatal preventive measures
  • Avoid exposure to noise pollution
Term

 

 

 

Visual Impairment (Definition)

Definition

 

 

 

General term that refers to visual loss that cannot be corrected with regular prescription lenses

Term

 

 

 

Visual Impairment Classification

Definition

Partially Sighted

  • Acuity of 20/70 to 20/200
  • Education usually in public school system
Legal Blindness
  • Acuity of 20/200 or less
  • Legal as well as medical term
Term

 

 

 

Etiology of Visual Impairments

Definition
  • Perinatal or postnatal infections (gonorrhea, chlamydia, rubella, syphilis, toxoplasmosis)
  • Retinopathy of prematurity
  • Perinatal or postnatal trauma
  • Other disorders
  • Unknown causes
Term

 

 

 

Refractive Errors in Visual Impairment

Definition
  • Refraction: bending of light rays through the lens of the eye
  • Myopia
  • Hyperopia
  • Astigmatism
  • Strabismus (may or may not be refractive)
Term

 

 

 

Other Visual Impairments

Definition
  • Astigmatism (blurry vision)
  • Amblyopia (lazy eye)
  • Strabismus
  • Cataracts
  • Glaucoma
Term

 

 

 

 Infections of the Eye

Definition

Conjunctivitis

  • Ophthalmic antibiotics
  • Systemic antibiotics in some cases
  • Caution with use of steroids: may exacerbate viral infections
  • Infection control concerns
Term

 

 

 

Nursing Assessment with Visual Impairment

Definition

Infancy

  • Response to visual stimuli
  • Parental observations and concerns
  • Expect binocularity by age 6 months
Childhood
  • Visual acuity testing
Term

 

 

 

Promoting Child's Optimum Development with Visual Impairment

Definition
  • Play and socialization
  • Development of independence
  • Education: braille, audio books and learning materials
Term

 

 

 

Hospitalization of the Visually Impaired Child

Definition
  • Safe environment
  • Reassurance
  • Orient child to surroundings
  • Encourage independence
  • Consistency of team members
Term

 

 

 

 

Measures to Prevent Visual Impairment

Definition
  • Prenatal care/prevention of prematurity
  • Rubella immunizations for all children
  • Safety counseling for preventing eye injuries
Term

 

 

 

Periodic Recommended Screening for Visual Impairments

Definition
  • Prenatal
  • Newborns through preschoolers
  • Children of all ages
Term

 

 

 

Emergency Treatment for Eye Injuries

Definition
  • Foreign body
  • Chemicals
  • UV burns
  • Hematoma
  • Penetrating injuries
Term

 

 

 

 

Hearing and Visual Impairment in Children

Definition
  • Historic cause: congenital rubella syndrome
  • Profound effects on development
  • Motor milestones usually achieved
  • Other development often delayed
  • "Finger spelling"
  • Developing future goals for the child
Term

 

 

 

Communication Impairment (Definition)

Definition
  • Inability to receive, process, transmit, or represent symbol systems for the spoken word 
  • Delayed language and speech is most common developmental delay in children
  • Speech problems are more prevalent than language disorders
  • Both types decline as children grow older
Term

 

 

 

Autistic Spectrum Disorders (ASD)

Definition
  • Complex brain dysfunction accompanied by broad range and severity of intellectual and behavioral deficits
  • Etiology unknown; genetic basis
  • ASD usually appears from 18-36 months 
  • 4x more common in males
  • Encompasses autistic disorder, Aspberger syndrome, and pervasive developmental disorder
Term

 

 

 

Diagnostic Criteria for Autistic Disorder

Definition
  • Qualitative impairment in social interaction
  • Qualitative impairment in communication
  • Restricted repetitive and stereotypical patterns of behavior, interests, and activities
  • Delays or abnormal functioning with onset before 3 years
Term

 

 

 

 

Nursing Considerations for Autism

Definition
  • Wide variation in individual client response to tx efforts
  • No cure for autism
  • Most promising results seem to be through highly structured routines and intensive behavior modification programs
Term

 

 

 

 

What is the critical time period for hearing loss?

Definition

 

 

 

Birth to 3.5 years

Term

 

 

 

 

 Pediatric Differences in Musculoskeletal System

Definition
  • Ossification: continues until 18-21
  • Bones: less dense and more porous
  • Epiphyseal plate
  • Tendons and ligaments: stronger than bones
  • Calcium intake
Term

 

 

 

 

Assessment of Neurovascular Status (NVS)

Definition

 

 

 

Assess NVS q hour for 24 h, then 4-8 h

 
Term

 

 

 

Compartment Syndrome

Definition

LIMB-THREATENING EMERGENCY

  • May result in permanent neuromuscular disability (if not tx within 4-6 hours)
  • Severe swelling and paresthesia occur in digits below affected compartment
  • Treatment is immediate relief of pressure
Term

 

 

 

Bryant's Traction

Definition

USED PRIMARILY IN CHILDREN

  • Both legs are at 90 degree angle in bed
  • Buttocks slightly lifted off mattress
  • Used for fractured femur and dislocated hip
  • Usually for children less than 3 years, weighing less than 30 lbs.
Term

 

 

 

Forms of Skin Traction

Definition
  • Buck Extension (affected leg flat on bed)
  • Russell Traction (affected leg lifted at knee)
  • Cervical Traction 
Term

 

 

 

Forms of Skeletal Traction

Definition
  • Crutchfield Tongs (top of head pulled up)
  • Balanced Suspension (weights on both ends of bed)
  • 90/90 Femoral Traction (knee bent up at 90 degree angle)
  • Dunlop Traction
Term

 

 

 

Distraction r/t Fractures (Definition)

Definition

 

 

 

The process of separating opposing bones to enhance bone regeneration in the created space.

Term

 

 

 

Soft-Tissue Injury 

Definition
  • Includes injuries to muscles, ligaments, and tendons
  • Common in children
  • Results from mishaps during play or sports
Term

 

 

 

 

Soft-Tissue Injury Treatment

Definition

Rest - anywhere from several hours to several days

Ice - on for 30 minutes; off for 15

Compression - elastic bandage

Elevation - elevate injured part level with or above heart

Term

 

 

 

Fractures in Infants

Definition
  • RARE
  • Usually result from birth trauma or non-accidental injury
  • Nonmobile with broken extremity should be considered abuse
  • Multiple fractures: osteogenesis imperfecta or abuse
Term

 

 

 

Fractures in Children

Definition
  • Increased mobility and inadequate or immature motor and cognitive skills
  • Occur most often in play or sports or recreational activities
  • Trauma: frequent cause of fractures
  • Auto injury: Waddell's triad (fractured femoral shaft, intra-thoracic/intra-abdominal injuries, contralateral head injury)
  • Falls: fractured wrists, elbows due to parachute reflex
Term

 

 

 

 

Waddell's Triad

Definition
  1. Fractured femoral shaft
  2. Intra-thoracic/intra-abdominal injuries
  3. Contralateral head injury
Term

 

 

 

Clinical Manifestations of Fractures

Definition

Signs of Injury

  • Generalized swelling
  • Pain or tenderness
  • Deformity
  • Diminished functional use of affected part
May also demonstrate
  • Bruising
  • Severe muscle rigidity
  • Crepitus
Term

 

 

 

 

Emergency Treatment for Fractures

Definition
  • Assess the extent of injury - 5 Ps of vascular impairment
  • Determine the mechanism of injury
  • Avoid moving the injured part as much as possible
  • Apply sterile or clean dressing to open wound
  • Immobilize limb
  • Reassess NVS
  • Elevate
  • Apply cold to area
  • Call EMS
Term

 

 

 

Therapeutic Management of Fractures

Definition
  • Reduction: correct alignment of bony fragments
  • Immobilization: to maintain alignment
  • Restore to function
  • Prevent further injury
Term

 

 

 

Traumatic Amputation

Definition
  • Severed part: wrapped lighlty in clean cloth or gauze saturated in saline and sealed in a watertight plastic bag, keep cool do NOT freeze
  • Label bag: name, date, time
  • Bag should be taken to the hospital with child
Term

 

 

 

Osteomyelitis

Definition
  • Etiology: older child - staph; younger child - h. influenzae
  • Clinical Manifestations: very ill, irritable, localized tenderness
Diagnosis
  • Elevated WBCs
  • Elevated ESR
  • Elevated C-reactive protein
  • + blood culture
  • X-ray, technetium-labeled bone scan, US, CT, MRI
  • 2-7 day hx of pain, warmth, tenderness, decreased ROM in affected limb, fever, irritability, lethargy
Treatment
  • IV Abx 4-6 weeks
  • Complete bedrest (VERY IMPORTANT)
Term

 

 

 

Osteomyelitis Nursing Management

Definition
  • Position
  • Contact precaution
  • Medications (IV abx)
  • VS, NVS
  • Nutrition - increased protein and calories
  • Diversional activity
  • Additional assessments (psychosocial, etc.)
Term

 

 

 

Legg-Calve-Perthes Disease (LCP)

(Definition, Stages and Etiology)

Definition

AVASCULAR NECROSIS OF FEMORAL HEAD; ages 3-12 years

  • Primarily affects boys; Caucasians
  • Self-limiting
  • Worse prognosis in older children
Stages
  1. Initial (avascular necrosis)
  2. Fragmentation
  3. Reparative
  4. Regenerative
Term

 

 

 

LCP Clinical Manifestations, Diagnosis and Management

Definition

Clinical Manifestations

  • Insidious onset
  • Limp
  • Hip soreness, ache, or stiffness
  • Pain
Diagnosis
  • Radiographic exam
  • MRI (definitive)
Management
  • Goal: stabilize head of femur in acetabulum and maintain full ROM
  • Conservative management
  • Surgical management
  • Diversional and play activities
Term

 

 

 

Slipped Femoral Capital Epiphysis (SFCE)

(Definition, Etiology and Clinical Manifestations)

Definition

Spontaneous displacement of proximal femoral epiphysis; occurs in older children

  • Incidence is greatest during rapid growth spurt during adolescence
  • Twice as frequent in males
  • Unknown cause
Clinical Manifestations
  • May be obese
  • Limp on affected side
  • Pain in hip
  • Restricted internal rotation on adduction with external rotation deformity
  • Loss of abduction and internal rotation
  • Shortening of lower extremity
Term

 

 

 

SFCE Management

Definition
  • Therapeutic goals: avoid further damage
Nursing Care
  • Place child on bedrest
  • Prepare client for surgery
  • Discourage activities that may increase slippage (contact sports)
  • Provide post op care (traction after surgery)
  • Educate family
  • May use crutches; keep out of wheelchair!
Term

 

 

 

Scoliosis 

Definition

LATERAL CURVATURE OF THE SPINE

 

Diagnosis

  • Screening techniques; x-ray
Bracing
  • May need to be worn for as long as 23 hours a day; usually does not correct curve, only may stop from worsening
  • Types: Boston, Wilmington, Thoracolumbarsacral orthotic (TLSO), Milwaukee
Spinal Fusion
  • Herrington rod (surgically inserted)
  • NVS check q hour after surgery
Term

 

 

 

Juvenile Idiopathic Arthritis

(Definition and Diagnosis)

Definition

Types

  • Systemic
  • Pauclarticular
  • Polyarticular
Diagnosis
  • NO DEFINITIVE TEST
  • Increased ESR; may or may not be present
  • Leukocytosis may be present with exacerbations
  • Increased anti-nuclear antibody (ANA) may be present (may be useful in determining child at risk for uveitis)
  • X-rays
Term

 

 

 

Juvenile Idiopathic Arthritis (JIA) Management

Definition

Drug Therapy

  • NSAIDs: ibuprofen, naproxen, tolectin sodium (DOC)
  • Cytotoxic drugs (methotrexate), corticosteroids, immunologic modulators
  • Slow-acting anti-rheumatic drugs (SAARDs): sulfasalazine, gold, D-penicillamine
  • Assess for hearing loss: high dose aspirin can be ototoxic
Other Management
  • Physical/occupational therapy
  • Comfort measures
  • Opthalmic exams
  • Dietary management
  • School management
  • Psychosocial management
Term

 

 

 

Osteogenesis Imperfecta (OI)

(Definition and Clinical Manifestations)

Definition

Group of 4 types of heterogenous inherited disorders - characterized by connective tissue and bone defects

  • Abnormal precollagen type 1 OI is most common and mildest
  • Type II is most severe and often leads to early death
  • Most common genetic bone disease - usually autosomal dominant, may be recessive
Clinical Manifestations
  • Frequent fractures
  • Thin skin
  • Hyperextensible ligaments
  • Epistaxis
  • Blue sclera
  • Easy bruising
  • Excess diaphoresis
  • Mild hyperpyrexia
Term

 

 

 

OI Diagnosis and Management

Definition

Diagnosis

  • X-rays: indicate multiple fracture healing sites
  • US can detect some types
  • Rule out all other possibilities before diagnosis
Management
  • Assess for fractures and injuries
  • Prevent injury
  • Discuss home care with family; educate
  • Provide support
  • Refer to OI foundation; genetic counseling
  • Provide parents with proof of dx for explanations of fractures
  • Do NOT lift child by extremities ever
Term

 

 

 

Systemic Lupus Erythematosus (SLE)

(Definition and Clinical Manifestations)

Definition

Disease of connective tissues and blood vessels; characterized by inflammation

  • Variable and unpredictable
  • Unknown cause; suspected triggers; autoimmune
Clinical Manifestations
  • Constitutional: fever, fatigue, anorexia
  • Cutaneous: butterfly rash
  • MS: arthritis, myalgia
  • Neuro: HA, seizure, behavior change, stroke
  • Pulmonary and CV: pleuritis, pericarditis
  • Renal: glomerulonephritis, nephrotic syndrome (NS), HTN
  • GI disturbances
  • Hepatic problems
Term

 

 

 

SLE Diagnosis, Clinical and Nursing Management

Definition

Diagnosis

  • Established when 4 of 11 diagnostic criteria are met
Medications
  • Corticosteroids
  • NSAIDs
  • Antimalarial preparations
  • Immunosuppressive agents
  • Antihypertensives
  • ASA
  • Antibiotics
Nursing Management
  • Help recognize signs of exacerbation
  • Assist in dealing with body image issues
  • Support child and family
  • Provide patient and family teaching
Term

 

 

 

 

Muscular Dystrophy

Definition

PROGRESSIVE, TERMINAL ILLNESS

 

Clinical Manifestations

  • Muscle weakness at approx. age 3 (preschool age)
  • Calf muscles hypertrophy
  • Waddle gait
  • Gower's sign (use hands/arms to "walk up" body)
Diagnosis
  • DNA analysis of peripheral blood or muscle biopsy
  • Serum enzyme: CPK, aldolase, SGOT (AST)
  • EMG
Nursing Management
  • Parental reactions
  • Physical therapy (VERY important)
  • Referrals
  • Maintain independence for as long as possible
Term

 

 

 

Cerebral Palsy (CP)

(Definition, Clinical Manifestations and Associated Complications)

Definition

Non-progressive motor (upper motor neuron) and posture dysfunction

  • Anoxic damage
  • Most common chronic childhood disorder
Clinical Manifestations
  • Abnormal muscle tone
  • Lack of coordination
  • Delayed in meeting developmental milestones
  • Age related
  • Dependent on area of brain involved
  • Cannot suck properly
Associated Complications
  • Visual defects: strabismus, nystagmus, refractory errors
  • Hearing loss
  • Speech/language delays
  • Speech impediments
  • Seizures
  • Hyperactivity
  • Mental retardation
Term

 

 

 

CP Etiology, Types, Diagnosis and Prognosis

Definition

Etiology

  • Trauma
  • Infection
  • Lesion
Types
  • Pyramidal or spastic
  • Extrapyramidal: ataxic, dyskinetic or athetoid, mixed
Diagnosis
  • Neurological exam
  • History
  • MRI
Prognosis
  • 30-50% mentally retarded
  • Growth is affected
Term

 

 

 

 

CP Medical and Nursing Management

Definition

Medical Management

  • Help child develop maximum potential
  • Referrals: PT, OT, speech therapy, special education
  • Surgical intervention: achilles tendon, hamstrings
Nursing Management
  • Adequate nutrition
  • Skin integrity
  • Physical mobility
  • Safety
  • Growth and development
  • Parental teaching
  • Emotional support
  • Care in community
Term

 

 

 

Guillain-Barre Syndrome (GBS)

(Definition and Clinical Manifestations)

Definition

Often follows respiratory or GI viral infection

  • Cause is unknown; affects children and adults
  • Most often in school-age children and adolescents
Clinical Findings
  • Generalized weakness
  • Paresthesia
  • Diplopia
  • Paralysis
  • Respiratory paralysis
  • Hypertension
  • Tachycardia
  • Low-grade fever
  • Incontinence
  • Ascending weakness
Term

 

 

 

GBS Diagnosis, Intervention and Nursing Implications

Definition

Diagnosis

  • Clinical history
  • Significant signs: paresthesia, paralysis, CSF findings
  • Major dx tests: exam of CSF, nerve conduction tests
Therapeutic Intervention
  • Steroids
  • Plasmaphersis (plasma exchange)
  • Support of vital functions (possible ventilation)
Nursing Implications
  • Assess for respiratory failure
  • Monitor and manage pain
  • Provide passive ROM 
  • Protect against skin breakdown
  • Maintain fluid and electrolyte balance
  • Provide emotional support
  • Provide education
Term

 

 

 

Congenital Clubfoot

Definition

Foot twisted out of normal position

  • Occurs approx. in 1-3 in 1000 births
  • Affects boys x2 as often 
  • Bilateral in about 50% of cases
  • Positive family hx
Clinical Therapy
  • Diagnosis is made at birth (visual inspection)
  • Radiographs used to confirm severity
  • Early tx is essential
  • Serial casting is treatment of choice
  • Surgery between 3-12 months of age
  • Assess 5 Ps after surgery/casting
Term

 

 

 

Developmental Dysplasia of Hip (DDH)

(Definition, Clinical Manifestations and Diagnosis)

Definition

Abnormal development of the hip

  • May develop at any time during fetal life, infancy, or childhood
  • Commonly involve: left hip, girls, Caucasian children
Clinical Manifestations
  • Unequal leg length
  • Asymmetry of thigh and gluteal folds
  • Limited abduction
  • Abnormal gaits
Diagnosis
  • Usually diagnosed at birth
  • Barlow maneuver (bring thigh midline by pressure on knee)
  • Ortolani test (flex hips/kness at 90 degrees and abduct)
  • Radiographic exam
Term

 

 

 

DDH Therapeutic and Nursing Management

Definition

Therapeutic Management

  • Newborn-6 months: abduction device; worn 24 h/day
  • Ages 6-18 months: traction; open reduction; spica cast
  • Older child: correction is more difficult
Nursing Management
  • Early detection
  • Consider normal growth and development
  • Educate parents on application/maintenance of reduction device and/or cast care
Term

 

 

 

Renal Development and Function in Infancy

Definition
  • Glomerular filtration and absorption low in infancy until age 1-2
  • Newborn unable to concentrate urine effectively
  • Newborn unable to reabsorb sodium and water
  • Newborn produces very dilute urine
  • More liable to develop severe metabolic acidosis
Term

 

 

 

Normal Urinalysis

Definition
  • pH 5-9
  • Specific gravity 1.001 to 1.035
  • Protein <20 mg/dL
  • Urobilinogen up to 1 mg/dL
  • NONE of the following: glucose, ketones, Hgb, WBCs, RBCs, casts, nitrites
Term

 

 

 

Normal Characteristics of Urine

Definition
  • Clear
  • Newborn production about 1-2 mL/kg/hr
  • Child production about 1 mL/kg/hr
Term

 

 

 

Urinary Tract Infection 

(Definition, Causes and Classification)

Definition

Second most common bacterial disease

  • UTIs account for more than 8 million office visits per year
  • >15% patients who develop gram-negative bacteria die
  • 1/3 of gram-negative infections originate in urinary tract
Causes
  • E. coli is most common pathogen; others are streptococci and staph saprophyticus
  • Occasionally fungal and parasitic pathogens
  • Gram-negative bacilli from GI tract common cause
  • Fungal generally after multiple abx courses
  • Also more common with immunosuppressed patients or diabetics
Classification
  • Upper tract involves renal parenchyma, pelvis, and ureters: typically causes fever, chills, flank pain
  • Lower tract: no systemic manifestations
Term

 

 

 

 

Complicated UTI Infections

Definition
  • Stones
  • Obstruction
  • Catheters
  • Diabetes or neurologic disease
  • Recurrent infections
Term

 

 

 

Types of UTIs

Definition

Recurrent 

  • Reinfection in person whose prior infection was successfully eradicated
  • Unresolved bacteriuria - bacteria resistant or drug discontinued before bacteriuria was eradicated
Persistent - bacteriuria despite antibiotics
  • Bacterial persistence - resistance developed or foreign body in urinary system serves as harbor and anchor for bacteria to survive despite therapy
Febrile - typically indicates pyelonephritis
Urosepsis - bacterial illness; urinary pathogens in blood
Term

 

 

 

Etiology and Pathophysiology of UTIs

Definition
  • Physiologic and mechanical defense mechanisms maintain sterility
  • Emptying bladder - stasis most important factor in UTI
  • Normal antibacterial properties of urine and tract
  • Ureterovesical junction competence
  • Peristatic activity
  • Alteration of defense mechanisms increases risk
  • Organisms usually introduced via ascending route from urethra; less common routes: bloodstream and lymphatic system
Term

 

 

 

 

For a kidney infection to occur from hematogenous transmission, there must be ____

Definition

 

 

 

prior injury to urinary tract (obstruction of ureter, damage from stones, renal scars)

Term

 

 

 

 

Pediatric patients with significant bacteriuria may have no symptoms or nonspecific symptoms with UTI like ___ or ____.

Definition

 

 

 

fatigue or anorexia

Term

 

 

 

 

Pediatric Manifestations of UTI

Definition
  • Frequency of urination
  • Fever in some cases, hypothermia in newborn
  • Odiferous urine
  • Blood or blood-tinged urine
  • Sometimes no sx except generalized sepsis
  • Squirming
  • Irritability
  • Vomiting, diarrhea and other GI signs
Term

 

 

 

 

UTI Diagnostic Studies

Definition
  • Dipstick: identify presence of nitrates, WBCs and leukocyte esterase
  • Microscopic urinalysis
  • Imaging studies for suspected obstruction (IVP or abdominal CT)

Culture: indicated in complicated or nosocomial, persistent bacteria, or frequently recurring (>2 episodes annually)

  • Clean catch preferred; U-bag from child
  • Specimen obtained by catheterization or suprapubic needle aspiration has more accurate results
Term

 

 

 

 

UTI Collaborative Care Drug Therapy

(Antibiotics)

Definition

Trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin

  • Used to tx empiric uncomplicated or initial UTI
  • Inexpensive
  • Take twice daily
Amoxicillin
Cephalexin
Others
  • Gentamycin
  • Carbenicillin
Pyridium (OTC)
  • Provides soothing effect on urinary tract mucosa
  • Stains urine reddish-orange that can be mistaken for blood
  • Effective in relieving discomfort
Combination Agents (ex. Urised) 
  • Used to relieve pain
  • Preparations with methylene blue tint
Term

 

 

 

 

UTI Collaborative Care Drug Therapy for Repeated UTIs

Definition
  • Prophylactic or suppressive antibiotics
  • TMP-SMX administered every day to prevent recurrence or single dose before events likely to cause UTI
Term

 

 

 

Vesicoureteral Reflux (VUR)

Definition
RETROGRADE FLOW OF BLADDER URINE INTO URETERS
  • Increases potential for infection
  • Primary v. secondary reflux
  • +Primary - screen siblings
Term

 

 

 

Acute Pyelonephritis 

(Etiology and Pathophysiology)

Definition

Inflammation caused by bacteria, fungi, protozoa, or viruses infecting kidneys

  • Urosepsis - systemic infection from urologic source (can lead to septic shock and death in 15% of cases)
  • Usually infection is via ascending urethral route
  • Frequent causes - E. coli, proteus, Klebsiella, enterobacter
  • Preexisting factors - VUR; dysfunction of lower urinary tract (obstruction or structure)
  • Commonly starts in renal medulla and spreads to adjacent cortex
  • Recurring episodes lead to scarred, poorly functioning kidneys and chronic pyelonephritis
Term

 

 

 

Clinical Manifestations of Acute Pyelonephritis

Definition
  • Vary from mild to "classic" to very severe
  • Costovertebral tenderness
  • Sx often subside in a few days, even without therapy (bacteriuria and pyuria still persist)
Presenting Symptoms
  • N/V, anorexia, chills, nocturia, frequency, urgency
  • Suprapubic or low back pain, dysuria
  • Fever, hematuria, foul-smelling urine
Term

 

 

 

Diagnostic Studies of Acute Pyelonephritis

Definition
  • Urinalysis - shows pyuria, bacteriuria, and hematuria
  • WBC casts - indicate involvement of renal parenchyma
  • CBC - show leukocytosis with increase in immature bands
  • Imaging studies (IVP or CT)
  • Ultrasound
  • Prompt recognition and treatment of septic shock may prevent irreversible damage or death
Term

 

 

 

Collaborative Care of Acute Pyelonephritis

Definition
  • Hospitalization - patients with severe infections and complications such as n/v with dehydration
  • Parenteral antibiotics - to establish high serum levels
  • Relapses treated within 6-week course of antibiotics
  • Reinfections treated as individual episodes or managed with long-term therapy (prophylaxis may be used for recurrent infections)
Term

 

 

 

 

Acute Glomerulonephritis

(Definition and Types)

Definition
  • May be primary event or evidence of systemic disorder
  • Range from minimum to severe
Common features
  • Oliguria, hematuria, proteinuria
  • Edema
  • Hypertension
  • Circulatory congestion
Types
  • Most are postinfectious (pneumococcal, streptococcal, or viral)
  • May distinct entity OR
  • May be manifestation of a systemic disorder (SLE, sickle cell disease, others)
Term

 

 

 

Glomerulonephritis Symptoms

Definition
  • Generalized edema r/t decreased GFR (begins with periorbital, progresses to lower extremities and then to ascites)
  • HTN r/t increased ECF
  • Oliguria
  • Hematuria (bleeding in upper urinary tract = smoky urine)
  • Proteinuria (increased amount of protein = increase in severity of renal disease)
Term

 

 

 

Acute Poststreptococcal Glomerulonephritis (APSGN)

(Definition and Etiology)

Definition

NONINFECTIOUS RENAL DISEASE (autoimmune)

  • Onset 5-12 days after other type of infection
  • Often group A beta-hemolytic streptococci
  • Most common in children 6-7 years old
  • Uncommon in children younger than 2 years old
  • Can occur at any age
  • Winter and spring for poststreptococcal pharyngitis
  • Summer and fall for impetigo
Pathophysiology
  • Immune complexes deposited in glomerular basement membrane = edema and infiltration by PMNs = occlusion of capillary lumen
  • Decrease in plasma filtration = increase in fluid and retention of sodium = circulatory congestion and edema
  • Increased plasma volume leads to HTN; increased renin may also be involved
Term

 

 

 

APSGN Clinical Manifestations and Prognosis

Definition

Clinical Manifestations

  • Edema (periorbital, facial edema more pronounced in the AM)
  • Anorexia
  • Urine - cloudy, smoky-brown, decreased volume
  • Pallor
  • Irritability
  • Lethargy
  • Headaches
  • Abdominal discomfort
  • Dysuria
  • Mild to moderate increased blood pressure
Prognosis
  • 95% - rapid improvement to complete recovery
  • 5-15% - chronic glomerulonephritis
  • 1% - irreversible damage
Term

 

 

 

APSGN Complications and Diagnosis

Definition

Complications

  • Hepatic encephalopathy - headache, dizziness, abdominal discomfort, vomiting, loss of vision, hemiparesis, disorientation, seizures
  • Acute cardiac decompensation
  • Acute renal failure
Diagnosis
  • Urinalysis
  • CBC
  • BUN
  • Serum creatinine
  • Albumin
  • Complement levels and ASO titer
  • Renal biopsy (as indicated)
Term

 

 

 

 

APSGN Treatment and Management

Definition

Treatment

  • Primarily symptomatic
  • Diet - no salt added to foods
  • Fluids and daily weight
  • Electrolytes
  • HTN - antihypertensives
Nursing Management
  • Manage edema (daily weights, accurate I&O, daily abdominal girth)
  • Nutrition (low sodium, low-moderate protein)
  • Susceptibility to infections
  • Bedrest is not necessary (most children will normally restrict activity due to malaise)
Term

 

 

 

Nephrotic Syndrome

(Definition and Types)

Definition

Most common presentation of glomerular injury in children

Characteristics

  • Proteinuria
  • Hypoalbuminemia
  • Hyperlipidemia
  • Edema
  • Massive urinary protein loss
Types
  • Minimal change nephrotic syndrome (MCNS): most common; pathogenesis unknown
  • Congenital nephrotic syndrome
  • Secondary nephrotic syndrome
Term

 

 

 

 

Nephrotic Syndrome

(Changes and Prognosis)

Definition

Changes

  • Glomerular membrane - normally impermeable to large proteins; becomes permeable to albumin; albumin lost in urine; fluid shifts from plasma to interstitial spaces 
  • "Edema phase"
  • "Remission phase"
Prognosis
  • Usually good for ultimate recovery in most cases (80%)
  • Self-limiting
  • If child responds to steroids will usually do well
  • Early detection and tx to decrease proteinuria and permanent renal damage
  • Abotu 20% will have relapses for up to 5 years, some up to 10
Term

 

 

 

Nephrotic Syndrome

(Clinical Manifestations, Management and Family Issues)

Definition

Clinical Manifestations

  • Edema (eyes, face, abdomen, and lower limbs)
  • Weight gain r/t fluid retention, weight loss from poor appetite
  • Diarrhea, loss of appetite, and poor intestinal absorption
  • Decreased urine
  • Pallor
  • Irritability, fatigue
Management
  • Diet - low to moderate protein; sodium restrictions
  • Steroids - 2 mg/kg divided into bid doses; Prednisone DOC
  • Immunosuppressant therapy (Cytoxan)
  • Diuretics
Family Issues
  • Chronic condition with relapses
  • Developmental milestones
  • Social isolation - lack of energy; immunosuppression/protection; change in appearance due to edema (self-image)
Term

 

 

 

Nephrogenic Diabetes Insipidus (NDI)

 

Definition

Major disorder associated with a defect in ability to concentrate urine

  • Distal tubules and collecting ducts are insensitive to action of ADH (vasopressin)
  • X-linked recessive inheritance
Clinical Manifestations
  • Newborn - vomiting, fever, failure to thrive, hypernatremia
  • Copious amounts of dilute urine
Management
  • Fluid management (management of extreme thirst in child)
  • Pharmacologic interventions
Term

 

 

 

Hemolytic-Uremic Syndrome

(Clinical Features and Associated Organisms)

Definition

Clinical Features

  • Hemolytic anemia
  • Thrombocytopenia
  • Renal injury
  • CNS symptoms
  • Hypertension
Associated Organisms
  • Rickettsia
  • Viruses (Coxsackievirus, echovirus, adenovirus)
  • E. coli (uncooked meat, raw veggies, swimming pools, etc.)
  • Pneumococci
  • Shigella
  • Salmonella
Pathophysiology
  • Starts with gastroenteritis or URI
  • Injury to endothelial lining of glomerular arterioles (become swollen and occluded with platelet and fibrin deposits)
  • Damaged RBCs are removed by the speen - anemia
  • Platelet damage or "clumps" = thrombocytopenia
Term

 

 

 

Hemolytic-Uremic Syndrome

(Clinical Manifestations and Diagnosis)

Definition

Clinical Manifestations

  • Vomiting
  • Irritability
  • Lethargy
  • Marked pallor
  • Hemorrhagic manifestations (bruising, petechiae, jaundice, etc.)
  • Oliguria or anuria
  • CNS (seizures, stupor, coma)
  • Signs of acute heart failure (fluid volume overload)
Diagnosis
  • Triad of symptoms: anemia, thrombocytopenia, renal failure
  • Urine: proteinuria, hematuria, urinary casts
  • Elevated BUN and creatinine
  • Decreased Hgb, Hct, and platelets
  • High reticulocyte count: confirms hemolytic anemia
Term

 

 

 

Hemolytic-Uremic Syndrome

Definition

Therapeutic Management

  • Supportive care
  • Dialysis
  • Fresh frozen plasma
  • Packed cells
Prognosis
  • Recovery rate - 95%
  • May have long-term impairment: chronic renal failure, hypertension, CNS disorders
Nursing Care
  • Emotional reaction of parents and child to sudden life-threatening illness
Term

 

 

 

 

Renal Trauma

Definition
  • Kidneys in children are more mobile than in adults, and the outer borders of kidneys of children are less well protected
  • Injuries usually are from blunt trauma (falls, sports injuries, etc.)
  • Amount of hematuria is not r/t degree of injury
Term

 

 

 

Renal Failure

Definition

Acute Renal Failure (ARF)

  • Response to inadequate perfusion
  • Kidney disease
  • Urinary tract obstruction
Chronic Renal Failure (CRF)
Term

 

 

 

 

Acute Renal Failure (ARF)

(Definition, Patho and Clinical Manifestations)

Definition

Kidneys suddenly unable to regulate volume and composition of urine

  • Not common in children
  • Principal feature is oliguria (assoc. with azotemia, metabolic acidosis and electrolyte disturbances)
  • Most common pathologic cause: transient renal failure from severe dehydration
Pathophysiology
  • Usually reversible; severe reduction in GFR
  • Elevated BUN, reduction in renal blood flow
  • Severe oliguria followed by diuresis
  • Cortical necrosis - usually fatal
  • Tubular necrosis
Clinical Manifestations
  • Oliguria
  • Anuria - rare
  • N/V
  • Drowsiness
  • Seizures
  • Edema
  • HTN
  • Sx of underlying disorder
Term

 

 

 

 

ARF Diagnosis, Management and Complications

Definition

Diagnosis

  • BUN
  • Creatinine
  • pH
  • Electrolytes - Na, K, calcium
  • Dx of underlying disorder
Management
  • Prevention; tx underlying disorder
  • Provision of supportive therapy
  • Maintain zero water balance
  • Oliguria - mannitol, furosemide
  • Diet - low in protein, sodium, and potassium
Complications
  • Hyperkalemia
  • HTN
  • Anemia
  • Seizures
  • Hypervolemia
  • Cardiac failure with pulmonary edema
Term

 

 

 

Hyperkalemia

 

Definition

MEDICAL EMERGENCY

  • Serum potassium above 7 mEq/L
Presence of EKG changes
  • Loss of P wave
  • Prolonged QRS complex
  • Depressed ST segment
  • High-peaked T waves
  • Bradycardia
  • Heart block
Treatment
  • Kayexalate & dialysis
  • Calcium gluconate
  • Sodium bicarbonate
  • Glucose
  • Insulin
Accelerated by acidosis, stress, and tissue breakdown
Term

 

 

 

Chronic Renal Failure (CRF)

(Definition, Etiology and Patho)

Definition

Begins when diseased kidneys cannot maintain normal chemical structure of body fluids; clinical syndrome called uremia

 

Etiology

  • Congenital renal and urinary tract malformations
  • VUR associated with recurrent UTIs
  • Chronic pyelonephritis
  • Chronic glumerulonephritis
  • SLE
Pathophysiology
  • Gradual onset - destruction of nephrons
  • Retention of waste products
  • Water and Na retention
  • Hyperkalemia
  • Metabolic acidosis
  • Ca and phosphorus disturbances
  • Decreased erythropoietin - anemia
  • Growth disturbance
  • Susceptible to infection
Term

 

 

 

CRF Clinical Manifestations

Definition

Clinical Manifestations

  • Early signs: loss of energy, increased fatigue on exertion, pallor, elevated BP
  • With progression: decreased appetite esp. at breakfast, less interest in normal activities, increased or decreased urine output, sallow, muddy appearance of skin
  • Headache
  • Muscle cramps
  • Nausea
  • Weight loss
  • Facial edema
  • Bone or joint pain
  • Growth retardation
  • Dryness or itching of skin
  • Bruised skin
  • Sensory or motor loss
  • Amenorrhea
Term

 

 

 

Untreated Uremic Syndrome

Definition

GI Symptoms

  • Anorexia; N/V
Bleeding Tendencies
  • Brusies
  • Bloody diarrhea
  • Stomatitis
  • Bleeding from lips and mouth
  • Intractable itching
Other
  • Uremic frost - urea crystals
  • Unpleasant "uremic" breath odor
  • Deep respirations
  • HTN
  • Congestive heart failure
  • Pulmonary edema
CNS
  • Progressive confusion
  • Dulled senses
  • Coma
  • Tremors; muscular twitching
  • Seizures 
Term

 

 

 

CRF Diagnosis, Management and Considerations

Definition

Diagnosis

  • Initial signs vague and nonspecific
Management
  • Manage diet, HTN, recurrent infections, seizures
  • Activity
  • Osteodystrophy (bone mineralization deficiency)
  • Acidosis
  • Anemia
  • Growth retardation
Considerations
  • Minimize growth and developmental effects of disease
  • Remain free of complications
  • Child and family will receive appropriate support/education
Term

 

 

 

 

Types of Dialysis

Definition
  • Hemodialysis
  • Peritoneal dialysis
  • Hemofiltration
Term

 

 

 

 

Hemodialysis

Definition
  • Requires creation of vascular access and special dialysis equipment
  • Best suited for children who can be brought to facility 3x a week for 3-5 hours
  • Achieves rapid correction of fluid and electrolyte abnormalities
  • Adolescents and hemodialysis
  • Provide diversional activities during hemodialysis to lessen boredom
Term

 

 

 

Peritoneal Dialysis

Definition
  • Abdominal cavity acts as semipermeable membrane for filtration
  • Can be managed at home in some cases
  • Warmed solution enters peritoneal cavity by gravity; remains for period of time before removal
  • Peritonitis - potential complication
Term

 

 

 

 

Continuous Venovenous Hemofiltration

Definition
  • Uses technique for ultrafiltration of blood continuously at a very slow rate
  • Works with fluid overload in postoperative period
  • Successful alternative for critically ill children who might not survive rapid volume changes of hemodialysis and/or PD
Term

 

 

 

 

Transplantation

Definition
  • Can be from living, related donor or cadaver donor
  • Primary goal is long-term survival of grafted tissue
  • Immunosuppressant therapy
Rejection
  • Fever
  • Swelling and tenderness
  • Decreased urine output
  • Elevated BP
  • Elevated creatinine
Term

 

 

 

 

Phimosis

Definition
  • Narrowing or stenosis of preputial opening of foreskin, preventing retraction of foreskin over glans
  • Normal in infants and young children
  • Usually disappears as child grows
  • Balanitis - inflammation of foreskin
Term

 

 

 

Foreskin Hygiene

Definition
  • Uncircumcised infants - external cleansing of phimotic foreskin during routine bathing
  • Never forcibly retract foreskin
  • Expect natural retraction of foreskin in later childhood (5-10 years old)
Term

 

 

 

Hydrocele

Definition
  • Presence of fluid in processus vaginalis; fluid filled sac in spermatic cord
  • Scrotum appears enlarged, especially after activity in childhood
  • May need surgical repair
Term

 

 

 

Cryptorchidism

Definition
  • Up to 45% in preterm males; 3-4% in full-term males
  • Undescended, retractile, or absence of testes
Management
  • Hormone therapy may be attempted
  • Orchiopexy (move testicle into scrotum surgically) at 1-2 y/o
  • Testicular self-exam important - more likely to develop cancer
Term

 

 

 

Hypospadias

Definition
  • Urethral opening of male located below the glans or underneath the penile shaft
  • 1 in 300 live births
  • Familial tendency
  • Repair at 6-12 months before body image develops
Term

 

 

 

 

Chordee

Definition
  • Ventral curvature of the penis
  • Often accompanies more severe forms of hypospadias
  • Foreskin may be absent ventrally
  • Hooded or crooked appearance of penis
  • Surgical repair
Term

 

 

 

Epispadias Exstrophy Complex

Definition
  • Bladder exstrophy is a severe defect with externalization of bladder and associated tissues
  • Results from failure of abdominal wall to fuse in utero
  • May be assoc. with epispadias, undescended testes, and/or inguinal hernia
Clinical Manifestations
  • Depends on location of obstructing lesion, its severity, and underlying cause
  • May be asx
  • May cause UTIs
  • May have abdominal mass
  • May produce "renal colic"
Therapeutic Goals of EPISPADIAS
  • Preserve renal function; attain urinary control
  • Repair for psychological benefit
  • Prevent UTIs
  • Preservation of optimum external genitalia w/ continence and sexual function
Considerations
  • Challenging preoperative care
  • Prevent infection
  • Family support for emotional impact of defect
Term

 

 

 

 

Obstructive Uropathy

Definition

Ureterohydronephrosis; hydronephrosis (unilateral or bilateral, congenital or acquired)

 

Clinical Manifestations

  • Depend on location of obstructing lesion, its severity, and underlying cause
  • May be asx; may cause UTIs
  • May have abdominal mass
  • May cause "renal colic"
Management
  • Transient or permanent urinary diversion in some situations
  • Endoscopic procedures
  • Prognosis variable depending on defect
 
Term

 

 

 

Etiologies of Ambiguous Genitalia

Definition
  • Abnormalities of chromosomal complement
  • Defects of embryogenesis
  • Hormonal or biochemical abnormalities
Term

 

 

 

Conditions Producing Ambiguous Genitalia in Newborn

Definition
  • Masculinized female
  • Incompletely masculinized male
  • Presence of both male and female sexual organs
  • Mixed gonadal dysgenesis
Term

 

 

 

 

Congenital Adrenogenital Hyperplasia (CAH)

Definition

MOST COMMON type of ambiguous genitalia

  • Inherited deficiency of adrenal-cortical hormones
  • Masculinization of external genitalia with normal internal female anatomy
  • Life-threatening alteration of adrenal-cortical hormones
Term

 

 

 

Incompletely Masculinized Male

Definition

Potential Causes

  • Deficient production of fetal androgen
  • Deficiency of enzymes needed for testosterone biosynthesis
  • Unresponsiveness of genitalia to testosterone
Term

 

 

 

 

Mixed Gonadal Dysgenesis

Definition
  • Infants are sex chromosome mosaics
  • Genitalia vary greatly
  • Those appearing predominately female but with dysplastic testes may experience masculinization at puberty
Term

 

 

 

Nursing Considerations of Ambiguous Genitalia

Definition
  • Decision for gender assignment is often difficult
  • Need family support: dealing with feelings of guilt and shame; concern for child's future
Term

 

 

 

When does the foramen ovale close?

Definition

 

 

 

 

At birth in most individuals

Term

 

 

 

How long does it take the ductus arteriosus to close?

Definition

 

 

 

15 hours, but can take 1-2 weeks

Term

 

 

 

 

Pediatric Indicators of Cardiac Dysfunction

Definition
  • Poor feeding
  • Tachypnea/tachycardia
  • Failure to thrive/poor weight gain/activity intolerance
  • Developmental delays
  • Prenatal hx
  • Family hx of cardiac disease
Term

 

 

 

 

Tests of Cardiac Function

Definition
  • Chest x-ray: can see heart size and vasculature
  • ECG
  • Echocardiography: under 3 may need sedation (use chloral hydrate), monitor q 15 minutes
  • Cardiac catheterization: moderate IV sedation; can also fix some defects in cath lab
Term

 

 

 

Interventional Cardiac Catheterization Procedures in Children

Definition
  • Transposition of great vessels repair
  • Some complex single-ventricle defects
  • ASD repair
  • Pulmonary artery stenosis repair
  • Valvular pulmonic stenosis - balloon dilation
  • Recurrent coarctation of aorta - balloon dilation
  • Congenital mitral stenosis - balloon dilation
Term

 

 

 

 

Murmurs

Definition
  • Heart sounds that reflect flow of blood within heart
  • May occur in systole, diastole, or both (diastolic very concerning)
  • Can occur during normal periods of stress (anemia, fever, etc.)
  • Innocent murmurs: normal cardiac anatomy and function; occur in up to 50% of all children at some time
Term

 

 

 

Two Types of Cardiac Defects

Definition

Congenital

  • Anatomic: abnormal function
Acquired
  • Infection
  • Autoimmune response
  • Environmental factors
  • Familial tendencies
Term

 

 

 

Causes of Congenital Heart Disease

Definition

Maternal or environmental (1-2%)

  • FAS - 50% have CHD
  • Rubella in first 7 wks = 50% risk of defects including PDA and pulmonary branch stenosis
  • CMV, toxoplasmosis, other viral illnesses = cardaic defects
  • IDMs = 10% risk of CHD (VSD, cardiomyopathy, TGA most common)
Chromosomal or genetic (10-12%)
Multifactorial (85%)
Term

 

 

 

 

CHD Overview/Incidence

Definition
  • 5-8 per 1000 live births; about 2-3 are sx in first year of life
  • Major cause of death in first year of life (after prematurity)
  • Most common anomaly is VSD
  • 28% of children with CHD have another recognized anomaly (trisomy 21, 13, 18)
Term

 

 

 

CHF in Children

Definition

Impaired myocardial function

  • tachycardia, fatigue, weakness, restlessness, pale extremities, decreased urine output
Pulmonary congestion
  • tachypnea, dyspnea, respiratory distress, exercise intolerance, cyanosis
Systemic venous congestion
  • peripheral and periorbital edema, weight gain, ascites, hepatomegaly, neck vein distention
Term

 

 

 

 

New Classifications of CHD

Definition

By hemodynamic characteristics

  • Increased pulmonary blood flow
  • Decreased pulmonary blood flow
  • Obstruction of blood flow from the heart
  • Mixed blood flow
Term

 

 

 

Increased Pulmonary Blood Flow Defects

Definition
  • Abnormal connection between 2 sides of the heart; either the septum or the great vessels
  • Increased blood volume on the R side of the heart
  • Increased pulmonary blood flow
  • Decreased systemic blood flow
  • Atrial septal defect (ASD)
  • Ventricular septal defect (VSD)
  • Patent ductus arteriosus (PDA)
Term

 

 

 

Atrial Septal Defect (ASD)

Definition
  • Hole between atriums; closed in cath lab usually
  • Blood flows over to R side, pumping high on L
  • Kids usually tolerate this well
  • Increased risk for thrombi/emboli
  • May have dysrhythmias
Term

 

 

 

Vetricular Septal Defect (VSD)

Definition
  • Hole between ventricles; can sometimes repair in cath lab
  • Most common CHD
  • Usually children outgrow this; just watch it for worsening
  • R ventricle becomes hypertrophic
  • Murmur will be heard
  • CHF and bacterial endocarditis can occur
Term

 

 

 

Patent Ductus Arteriosus (PDA)

Definition
  • Hole between pulmonary artery and aorta
  • LOUD machinery murmur
  • Blood flows into pulmonary vessels
  • Prostaglandin keeps PDA open; many premies have PDA
  • Indomethacin usually closes; or fix in cath lab
Term

 

 

 

Obstructive Defects of Heart

Definition
  • Coarctation of the aorta
  • Aortic stenosis
  • Pulmonic stenosis
Term

 

 

 

Coarctation of the Aorta (COA)

Definition
  • Narrowing along the arch (usually near ductus arteriosus)
  • Headaches, dizziness, pulses dec. in lower extremities, high BP
  • CHF; aortic aneurysm; stroke; aortic rupture
  • Can fix in the cath lab
  • Possible complication of HTN
Term

 

 

 

 

Aortic Stenosis (AS)

Definition
  • Hypotension, faint pulses, murmur, chest pain, poor feeding, etc.
  • Can fix with angioplasty in cath lab
  • Blood pools in lungs; L ventricle becomes hypertrophic
  • Pulmonary HTN; coronary arteries don't get a lot of blood = at risk for ischemic MI
Term

 

 

 

Pulmonic Stenosis (PS)

Definition
  • R ventricle becomes hypertrophic, blood backs into it
  • Foramen ovale can open back up
  • Cyanotic, may have CHF
  • Often have PDA also
  • Usually repaired in cath lab
Term

 

 

 

Decreased Pulmonary Blood Flow Defects

Definition
  • Tetralogy of Fallot
  • Tricuspid atresia
Term

 

 

 

Tetralogy of Fallot (TOF)

Definition
  1. Pulmonary stenosis
  2. R ventricle hypertrophy
  3. VSD
  4. Overriding aorta
  • Polycythemia, chronic hypoxia, clubbing, increased clot formation
  • Chest x-ray: heart looks like a boot
  • TET spells: hypercyanotic spells
  • Increased flow away from lungs (not well oxygenated)
  • Give morphine, oxygen, and use knee-chest position
  • At extreme risk for stroke; turbulent blood flow, mixing, thick blood
  • Correct in stages, depending on # of TET spells
Term

 

 

 

 

Tricuspid Atresia

Definition
  • No tricuspid valve; need PDA and ASD
  • Give prostaglandin to keep PDA open
  • Evident at birth
  • Cath lab: tear hole between atria, done in NICU right after birth
  • GLENN shunt
Term

 

 

 

 

Mixed Defects

Definition
  • Transposition of great vessels
  • Total anomalous pulmonary venous connection
  • Hypoplastic heart syndrome (L or R)
Term

 

 

 

Transposition of Great Vessels

Definition
  • Pulmonary artery and aorta are switched
  • Have PDA and ASD
  • Cath lab: open btwn atria; surgically switch aorta and pulmonary artery
  • Very delicate surgery because coronary arteries come off of the aorta
Term

 

 

 

Total Anomalous Pulmonary Venous Connection (TAPVC)

Definition
  • Must be repaired surgically
  • ASD; lots of mixing of blood
Term

 

 

 

Hypoplastic Left Heart Syndrome

Definition
  • Aortic valve stenosis resulting in narrowed aorta
  • HAS to have PDA; sx may not be seen until PDA closes
  • Repaired in 3 stages
Term

 

 

 

Postoperative Care for the Child with CHD

Definition
  • Monitor VS and arterial/venous pressures
  • Intraarterial monitoring of BP
  • Intracardiac monitoring
  • Respiratory needs
  • Rest, comfort, and pain management
  • Fluid management
  • Progression of activity
Term

 

 

 

Chest Tubes After Cardiac Surgery

Definition
  • Monitor chest tube drainage q hour for color: immediate postop may be bright red
  • Monitor chest tube drainage for quantity: notify surgeon if chest tube drainage >3 ml/kg/hr x3 consecutive hours OR 5-10 ml/kg in any 1 hour (possible hemorrhage)
  • Be alert for cardiac tamponade (rapid onset)
  • Look for bleeding in chest tubes
Term

 

 

 

Postpericardiotomy Syndrome

Definition
  • Symptoms: fever, rub, pericardial and pleural effusion
  • Occurs in immediate postoperative period; also can occur later (7-21 days postop)
  • Unknown cause
  • May require pericardiocentesis or pleurocentesis
Theories of Etiology
  • Viral infection
  • Autoimmune response
  • Reaction to blood in pericardium
Term

 

 

 

Endocarditis

Definition
  • Bacterial endocarditis (BE)
  • Infective endocarditis (IE)
  • Subacute BE (SBE)
  • Streptococci
  • Sthapylococci
  • Fungal infections
  • Prophylaxis: 1 hour before procedures (IV) or may use PO in some cases
Term

 

 

 

Pathophysiology of IE

Definition
  • Altered blood flow and turbulence inside the heart
  • Damage to valvular endothelium
  • Rough endothelium increases fibrin and deposition of platelets
  • Microorganisms grow and form vegetation on endocardium
  • Lesion may invade adjacent tissues (valves and myocardium)
  • May break off and embolize
Term

 

 

 

Clinical Manifestations of IE

Definition
  • Insidious, malaise, low-grade fever
  • New murmur or change in previous murmur 
  • Splenomegaly 
  • Osler nodes - red, painful nodes on pads of fingers
  • Janeway spots - painless hemorrhagic spots on palms and soles
Term

 

 

 

Duke Criteria for IE

Definition

Major criteria

  • Blood cultures
  • Echo findings of endocardial involvement
Minor criteria
  • Fever
  • Predisposing risk factors
  • Vascular and immunologic findings
Term

 

 

 

 

Therapeutic Management of IE

Definition
  • High-dose IV antibiotics 2-8 weeks
  • Evaluate effectiveness of abx with repeat blood cultures
  • If no response/minimal response to abx: surgical approach (remove vegetation, valve replacement with prosthetic valves)
Term

 

 

 

Prevention of IE

Definition
  • Prophylactic antibiotics ONLY for highest-risk CHD patients
  • Recent changes in prophylaxis guidelines
  • Prophylaxis before dental work, invasive respiratory treatments, or procedures on soft tissue infections
  • No prophylaxis for GI/GU procedures
  • Administer prophylaxis 1 hour before procedure
  • Meticulous dental hygiene
Term

 

 

 

Rheumatic Fever (RF) and Rheumatic Heart Disease

Definition

RF

  • Inflammatory disease occurs after group A beta-hemolytic streptococcal pharyngitis; infrequently seen in US
  • Self-limiting
  • Affects joints, skin, brain, serous surfaces, and heart
Rheumatic Heart Disease
  • Most common complication of RF
  • Damage to valves as a result of RF
Term

 

 

 

 

Clinical Manifestations of RF

Definition
  • Carditis
  • Polyarthritis
  • Erythema marginatum: transitory rash on trunk and proximal extremities; nonpruritic
  • Subcutaneous nodules: occur in crops over bony prominences
Term

 

 

 

St. Vitus Dance: The 5th Manifestation

Definition
  • St. Vitus dance (aka chorea) reflects CNS involvement
  • Definition: chorea refers to sudden, aimless movements of extremities, involuntary facial grimaces, speech disturbances, emotional lability, and muscle weakness
  • Worse with anxiety and relieved by rest
Term

 

 

 

Prevention of RHD

Definition

Treatment of streptococcal tonsilitis/pharyngitis

  • Penicillin G - IM x1
  • Penicillin V - PO x 10 days
  • Sulfa - PO x 10 days
  • Erythromycin (if allergic to above) - PO x 10 days
Treatment of recurrent RF
  • Same as above
Term

 

 

 

Kawasaki Disease 

(Overview and Etiology)

Definition

Acute systemic vasculitis; unknown cause

  • Duration 6-8 weeks, self-limiting
  • Without tx of KD, 20-25% have cardiac complications
  • Dilation of coronary arteries (ectasia)
  • Coronary artery aneurysms (giant aneurysms >8 mm)
  • Acute, subacute, convalescent phases
Etiology of KD
  • Peak incidence in toddler ages
  • Seasonal variations (late winter/early spring)
  • Widespread inflammation of small and medium-size arteries
Term

 

 

 

KD Clinical Manifestations

Definition
  • High fever - unresponsive to antipyretics/antibiotics
  • "Strawberry" tongue
  • Edema of hands and feet
  • Extreme irritability/inconsolability
  • Periungal desquamation
  • Arthritis
  • Coronary complications
Term

 

 

 

Systemic HTN

Definition
  • Primary - no known cause
  • Secondary - identifiable cause
  • Pediatrics - HTN generally secondary to structural abnormality or underlying pathology (renal dz, CV dz, endocrine or neurologic disorders)
Term

 

 

 

Hyperlipidemia

Definition
  • Identify children at risk and tx early
  • Treatment = dietary; restrict intake of cholesterol and fats
  • If no response to diet: Rx (colestipol [Colestid] or cholestyramine [Questran])
Term

 

 

 

Cardiac Dysrhythmias

Definition

Diagnosis

  • EKG monitoring
  • Holter monitoring
  • Electrophysiological cardiac catheter
  • Transesophageal recording
Bradydysrhythmias
  • AV block
  • May use pacemaker
Tachydysrhythmias
  • SVT most common tachydysrhythmia
  • Treatments
Term

 

 

 

 

Pulmonary Artery Hypertension

Definition
Progressive, eventually fatal, no known cure
  • CHD with large left-to-right shunts at high risk for pulmonary HTN
  • Eisenmenger syndrome: right-sided heart failure as pump ineffective against increased pulmonary resistance; seen less frequently due to cardiac surgical repairs at younger ages
Term

 

 

 

 

Cardiomyopathy

(Definition, Management and Interventions)

Definition

Contractility of myocardium is impaired

  • Secondary cardiomyopathy
  • Dilated cardiomyopathy - most common
  • Hypertrophic cardiomyopathy
  • Restrictive cardiomyopathy
Management
  • Correct underlying cause if possible
  • Often tx is aimed at managing CHF and dysrhythmias
Pharmacologic Interventions
  • Digoxin
  • Diuretics
  • Beta blockers, CCBs
  • Dobutamine
  • Nitroprusside
  • Amrinone
Term

 

 

 

Heart Transplantation

Definition
  • Orthotopic transplant (remove heart & replace with someone's)
  • Heterotopic transplant (piggyback)
Texas Children's Hospital
  • Organ donation issues
  • Nursing considerations