Infectious Respiratory Problems in Children
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Questions and Answers

A patient with COPD is prescribed oxygen therapy. Which oxygen saturation range should the nurse aim to maintain for this patient?

  • 92-96%
  • 88-92% (correct)
  • 95-100%
  • 80-85%

A patient with chronic bronchitis is admitted to the hospital. Which assessment finding is most closely associated with this condition?

  • Alveolar damage
  • Air trapping
  • Chronic productive cough (correct)
  • Barrel chest

A cystic fibrosis (CF) patient experiences pancreatic insufficiency. Which dietary modification is most appropriate for managing this complication?

  • Low-calorie, low-protein diet
  • Fluid restriction
  • Low-fat diet with simple carbohydrates
  • High-calorie, high-protein diet (correct)

A patient with a tracheostomy is at risk for tube obstruction due to thick secretions. Which intervention is most important for preventing this complication?

<p>Maintaining adequate humidification (B)</p> Signup and view all the answers

A pregnant patient with preeclampsia is receiving magnesium sulfate. Which assessment finding indicates magnesium toxicity?

<p>Hypotension (B)</p> Signup and view all the answers

A pregnant patient with chronic hypertension requires pharmacological management. Which category of antihypertensive medications should be avoided during pregnancy?

<p>ACE inhibitors (B)</p> Signup and view all the answers

Which of the following is a symptom of HELLP syndrome, a complication of preeclampsia?

<p>Elevated liver enzymes (A)</p> Signup and view all the answers

A patient with COPD is prescribed a beta2-agonist bronchodilator. How does this medication help manage their COPD symptoms?

<p>Dilating the bronchioles (C)</p> Signup and view all the answers

A patient presents with fatigue, pallor, and shortness of breath. Their CBC reveals low hemoglobin and hematocrit levels. Which of the following conditions is most likely?

<p>Anemia (C)</p> Signup and view all the answers

A patient's lab results show microcytic anemia. Which of the following conditions is most likely the cause?

<p>Iron deficiency (D)</p> Signup and view all the answers

A patient with sickle cell disease presents with severe bone pain, fever, and acute chest syndrome. Which of the following interventions is the priority?

<p>Providing hydration, oxygen, and pain control (B)</p> Signup and view all the answers

A patient with a history of chronic alcoholism is diagnosed with macrocytic anemia. Which of the following deficiencies is most likely contributing to this condition?

<p>Folic acid deficiency (B)</p> Signup and view all the answers

Which instruction is most important to emphasize when teaching a patient about taking oral iron supplements for iron deficiency anemia?

<p>Take the supplement on an empty stomach to enhance absorption (A)</p> Signup and view all the answers

A vegan patient presents with fatigue, neuropathy, and glossitis. Which of the following is the most likely cause of these symptoms?

<p>Vitamin B12 deficiency (C)</p> Signup and view all the answers

A pregnant patient is diagnosed with folic acid deficiency. What potential complication should the patient be informed about?

<p>Neural tube defects in the fetus (A)</p> Signup and view all the answers

A patient is diagnosed with aplastic anemia. Which lab findings would the nurse expect to see?

<p>Low RBC, WBC, and platelet counts (D)</p> Signup and view all the answers

An infant presents with a loud, harsh holosystolic murmur at the left lower sternal border, accompanied by poor feeding and failure to thrive. An echocardiogram is most likely to reveal which condition?

<p>Ventricular Septal Defect (VSD) (A)</p> Signup and view all the answers

A child is diagnosed with Coarctation of the Aorta (CoA). Which set of blood pressure readings would the nurse expect to find during the initial assessment?

<p>High BP in upper extremities, low BP in lower extremities. (D)</p> Signup and view all the answers

A newborn is diagnosed with Patent Ductus Arteriosus (PDA). What type of murmur is most closely associated with this condition?

<p>Machinery-like murmur (B)</p> Signup and view all the answers

An infant with Tetralogy of Fallot (TOF) experiences a hypercyanotic episode (Tet spell). Which immediate intervention is most appropriate?

<p>Placing the infant in the knee-chest position. (D)</p> Signup and view all the answers

A child is diagnosed with an Atrial Septal Defect (ASD). The nurse understands that the pathophysiology of ASD involves:

<p>Left-to-right shunting of blood through an atrial defect. (A)</p> Signup and view all the answers

A premature infant is diagnosed with Patent Ductus Arteriosus (PDA). Which medication is typically administered to promote closure of the PDA in premature infants?

<p>Indomethacin (C)</p> Signup and view all the answers

An X-ray of a child with suspected Coarctation of the Aorta (CoA) reveals 'rib notching.' What causes this radiographic finding?

<p>Increased blood flow through the intercostal arteries. (D)</p> Signup and view all the answers

A 6-month-old infant is diagnosed with Tetralogy of Fallot. What medication might be administered to maintain patency of the ductus arteriosus until surgical correction can be performed?

<p>Prostaglandin E1 (PGE1) (C)</p> Signup and view all the answers

A newborn presents with severe cyanosis unresponsive to oxygen administration. An X-ray reveals an 'egg-on-a-string' heart. Which congenital heart defect is most likely?

<p>Transposition of the Great Arteries (TGA) (D)</p> Signup and view all the answers

An infant with Tricuspid Atresia is being prepared for a three-stage surgical repair. What is the PRIMARY goal of Prostaglandin E1 (PGE1) administration in this patient?

<p>To maintain patency of the ductus arteriosus (A)</p> Signup and view all the answers

An infant with Hypoplastic Left Heart Syndrome (HLHS) is exhibiting weak pulses and cold extremities. Which medication is MOST important to administer?

<p>Prostaglandin E1 (PGE1) (A)</p> Signup and view all the answers

A nurse is caring for an infant with a congenital heart defect and notes increased work of breathing and fluid retention. Which medication would the nurse anticipate administering?

<p>Furosemide (D)</p> Signup and view all the answers

Which nursing intervention is MOST appropriate to include in the care plan for an infant with a cyanotic congenital heart defect to minimize oxygen demand?

<p>Clustering care activities to allow for rest periods (C)</p> Signup and view all the answers

An infant with Transposition of the Great Arteries (TGA) is undergoing a Balloon Septostomy. What is the PRIMARY goal of this procedure?

<p>To create an Atrial Septal Defect (ASD) for improved blood mixing (C)</p> Signup and view all the answers

A preterm infant is diagnosed with a patent ductus arteriosus (PDA). Which medication is MOST likely to be administered to promote closure of the PDA?

<p>Indomethacin (D)</p> Signup and view all the answers

Following a successful Blalock-Taussig (BT) shunt placement for Tetralogy of Fallot (TOF), what assessment finding would indicate the shunt is functioning effectively?

<p>Increased pulmonary blood flow (A)</p> Signup and view all the answers

A pregnant woman is Rh-negative and her fetus is Rh-positive. To prevent Rh incompatibility complications in future pregnancies, which intervention is most appropriate?

<p>Administering RhoGAM at 28 weeks of gestation and postpartum. (A)</p> Signup and view all the answers

A newborn presents with jaundice, and lab results indicate ABO incompatibility. Which treatment is most appropriate to reduce the bilirubin levels?

<p>Initiating phototherapy and encouraging frequent feedings. (C)</p> Signup and view all the answers

A patient with polycythemia vera is at risk for increased blood viscosity and clotting. Besides phlebotomy, which intervention is most important to include in the plan of care?

<p>Encouraging increased fluid intake. (C)</p> Signup and view all the answers

A patient with a history of COPD presents with secondary polycythemia. What is the underlying cause of this condition in this patient?

<p>The kidneys are producing excess erythropoietin due to chronic hypoxia. (A)</p> Signup and view all the answers

Which intervention is most important for a patient experiencing a hypertensive crisis with a blood pressure of 190/130 mmHg?

<p>Initiating intravenous antihypertensive medications. (B)</p> Signup and view all the answers

A child is diagnosed with a congenital heart defect resulting in left-to-right shunting. What is the primary physiological consequence of this type of defect?

<p>Increased pulmonary blood flow leading to pulmonary congestion without cyanosis. (C)</p> Signup and view all the answers

A patient with aplastic anemia is being considered for treatment. Which of the following represents a definitive treatment option for this condition?

<p>Bone marrow transplant to restore hematopoietic function. (D)</p> Signup and view all the answers

What is the primary goal of administering hydroxyurea to a patient with sickle cell disease?

<p>To stimulate the production of fetal hemoglobin (HbF). (A)</p> Signup and view all the answers

A child presents with a barking cough, stridor, and mild retractions. Which intervention is the MOST appropriate initial nursing action?

<p>Administering cool, humidified air. (B)</p> Signup and view all the answers

A patient is suspected of having epiglottitis. Which assessment finding would warrant immediate notification of the healthcare provider?

<p>Exhibiting increased drooling and assuming a tripod position. (A)</p> Signup and view all the answers

A patient with bronchitis is being discharged. Which instruction should the nurse prioritize in discharge teaching?

<p>The need to maintain adequate hydration and avoid irritants such as smoke. (B)</p> Signup and view all the answers

An infant is diagnosed with bronchiolitis caused by RSV. Which nursing intervention is MOST important for managing this condition?

<p>Providing humidified oxygen and frequent nasal suctioning. (A)</p> Signup and view all the answers

A patient is diagnosed with community-acquired pneumonia (CAP). Which intervention should the nurse prioritize?

<p>Encouraging frequent ambulation and deep breathing exercises. (C)</p> Signup and view all the answers

A patient with a confirmed case of active tuberculosis (TB) is being admitted to the hospital. Which of the following nursing interventions is MOST important?

<p>Placing the patient in a negative-pressure room and wearing an N95 respirator. (A)</p> Signup and view all the answers

A patient is experiencing acute respiratory distress due to a suspected upper airway obstruction from laryngeal edema post-extubation. After initial assessment, what is the priority nursing intervention?

<p>Maintaining airway patency and preparing for re-intubation if necessary. (C)</p> Signup and view all the answers

A patient with asthma is prescribed both albuterol and fluticasone inhalers. What instructions should the nurse provide regarding their use?

<p>Use albuterol first to open airways, then use fluticasone to reduce inflammation. (C)</p> Signup and view all the answers

Flashcards

Croup

A respiratory condition characterized by stridor, barking cough, and retractions in children.

Epiglottitis

A severe throat infection causing high fever, tripod position, drooling, and dysphagia.

Bronchitis

Inflammation of bronchi, usually viral, leading to cough and malaise.

Bronchiolitis (RSV)

A viral infection causing respiratory distress in infants, marked by wheezing and tachypnea.

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Pneumonia

Lung infection categorized as community-acquired or hospital-acquired, showing cough and fever.

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Obstructive Sleep Apnea (OSA)

A sleep disorder characterized by breathing interruptions during sleep, often linked to obesity.

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Asthma Triggers

Factors such as allergens and exercise that can provoke asthma attacks.

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Tuberculosis (TB) Management

Treatment for TB involves a combination of antibiotics and airborne precautions.

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COPD

Chronic Obstructive Pulmonary Disease, including emphysema and chronic bronchitis.

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Emphysema

Type of COPD characterized by alveolar damage and air trapping.

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Chronic Bronchitis

COPD type marked by mucus hypersecretion and chronic cough.

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Oxygen Therapy

Treatment using oxygen delivery methods to maintain SpO2 levels.

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Cystic Fibrosis

Genetic disorder causing thick mucus and frequent lung infections.

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Preeclampsia

Condition in pregnancy marked by hypertension and proteinuria.

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HELLP Syndrome

Severe complication of preeclampsia: Hemolysis, elevated liver enzymes, low platelets.

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Tracheostomy Care

Care for a tracheostomy tube to prevent complications.

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Rh Incompatibility

Occurs when an Rh- mother has an Rh+ fetus, leading to antibody production that may attack fetal RBCs in future pregnancies.

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RhoGAM

A medication given at 28 weeks of pregnancy and postpartum to prevent Rh incompatibility complications.

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Erythroblastosis fetalis

A severe condition in the fetus due to maternal antibody attack on fetal RBCs, causing anemia and hydrops fetalis.

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Neonatal Hyperbilirubinemia

A condition characterized by high bilirubin levels in newborns, caused by factors like Rh/ABO incompatibility and prematurity.

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Phototherapy

A treatment for neonatal hyperbilirubinemia, using light to convert bilirubin to a water-soluble form.

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Polycythemia Vera

A primary condition involving bone marrow overproduction of red blood cells (RBCs).

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Hypertension Crisis

A life-threatening situation when blood pressure exceeds 180/120, requiring immediate IV antihypertensives.

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Congenital Heart Defects (CHDs)

Structural heart defects present at birth, affecting blood flow; can be acyanotic or cyanotic.

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Anemia

Decrease in RBC count, hemoglobin, or hematocrit, reducing oxygen capacity.

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Symptoms of Anemia

Fatigue, dyspnea, palpitations, pallor, dizziness, jaundice.

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Blood Loss Anemia

Anemia caused by acute or chronic blood loss from sources like trauma or ulcers.

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Hemolytic Anemia

Anemia due to increased destruction of RBCs causing signs like jaundice.

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Iron Deficiency Anemia

Anemia from low iron due to poor diet, blood loss, or malabsorption.

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Vitamin B12 Deficiency

Anemia due to lack of intrinsic factor or malabsorption leading to symptoms like neuropathy.

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Folic Acid Deficiency

Anemia caused by poor diet or pregnancy, leading to neural tube defects.

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Aplastic Anemia

Anemia from bone marrow failure resulting in low RBC, WBC, platelets.

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Atrial Septal Defect (ASD)

A hole between the atria causing left-to-right shunting of oxygenated blood.

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Symptoms of ASD

Often asymptomatic; symptoms may include fatigue, shortness of breath, and respiratory infections.

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Ventricular Septal Defect (VSD)

A hole between the ventricles, leading to increased pulmonary blood flow.

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Symptoms of VSD

Loud holosystolic murmur, poor feeding, failure to thrive, potential pulmonary hypertension.

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Patent Ductus Arteriosus (PDA)

Failure of ductus arteriosus to close post-birth, causing left-to-right shunting.

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Symptoms of PDA

Machinery-like continuous murmur, bounding pulses, and frequent respiratory infections.

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Coarctation of the Aorta (CoA)

Narrowing of the aorta that obstructs blood flow to the lower body.

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Symptoms of CoA

High blood pressure in upper body, low in lower body, weak femoral pulses, and cold extremities.

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Transposition of the Great Arteries (TGA)

A congenital heart defect where the aorta and pulmonary artery are switched, leading to two separate circulations.

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Treatment for TGA

Prostaglandin E1 (PGE1) to keep PDA open and atrial switch surgery (Mustard or Jatene procedure).

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Tricuspid Atresia

A condition where the tricuspid valve is missing, preventing blood flow from the right atrium to right ventricle.

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Symptoms of Tricuspid Atresia

Cyanosis, failure to thrive (FTT), and murmurs due to associated VSD or PDA.

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Hypoplastic Left Heart Syndrome (HLHS)

Underdevelopment of the left ventricle, causing the right ventricle to pump for the whole body.

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PGE1 in Cyanotic Defects

Prostaglandin E1 is used to keep the ductus arteriosus open in cyanotic heart defects like TGA and HLHS.

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General Nursing Care for Cardiac Defects

Monitor oxygenation, fluid status, optimize nutrition, and provide parental support for management.

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Study Notes

Infectious Respiratory Problems

  • Croup:

    • Signs and symptoms include stridor, barking cough, retractions, and respiratory distress.
    • Management involves cool humidified air, corticosteroids, racemic epinephrine, fluids, and maintaining calm, while monitoring vital signs.
  • Epiglottitis:

    • Signs and symptoms include high fever, tripod position, drooling, dysphagia, and respiratory distress.
    • Management requires avoiding throat examination, emergency intubation, humidified oxygen, and intravenous antibiotics.
  • Bronchitis:

    • Cause: Viral infection
    • Symptoms include gradual onset, rhonchi, productive cough, malaise, and low-grade fever.
    • Management involves rest, fluids, humidification, avoiding cough suppressants, and antibiotics if bacterial.
  • Bronchiolitis (RSV):

    • Cause: Respiratory Syncytial Virus (RSV)
    • Symptoms include tachypnea, wheezing, crackles, and retractions.
    • Management involves humidified oxygen, suctioning, hydration, and elevating the head of the bed.
  • Pneumonia:

    • Types include community-acquired (CAP), hospital-acquired (HAP), and ventilator-associated (VAP).
    • Symptoms include dyspnea, cough, fever, crackles, and decreased breath sounds.
    • Management involves oxygen, hydration, incentive spirometry, bronchodilators, and antibiotics.
  • Influenza & COVID-19:

    • Symptoms include fever, cough, fatigue, myalgia, shortness of breath (SOB), and anosmia (COVID-19).

Non-Infectious Respiratory Problems

  • Upper Airway Obstruction:

    • Causes include tongue/laryngeal edema, trauma, abscess, and foreign body aspiration.
    • Assessment involves stridor, cyanosis, anxiety, and hypoxia.
    • Management includes airway clearance, bronchoscopy, and emergency tracheostomy.
  • Obstructive Sleep Apnea (OSA):

    • Risk factors include obesity, large uvula, and short neck.
    • Symptoms include snoring, daytime sleepiness, and morning headaches.
    • Management includes continuous positive airway pressure (CPAP) and surgery (Uvulopalatopharyngoplasty).
  • Asthma:

    • Triggers include allergens, exercise, NSAIDs, and GERD.
    • Symptoms include wheezing, dyspnea, cough, and chest tightness.
    • Management includes rescue medication (short-acting beta2-agonists like albuterol), control medications (inhaled corticosteroids, leukotriene modifiers), and emergency management (oxygen, IV steroids, bronchodilators).
  • COPD (Chronic Obstructive Pulmonary Disease):

    • Types include emphysema and chronic bronchitis.
    • Symptoms include dyspnea, productive cough, cyanosis, and clubbing.
    • Management involves medications, breathing techniques, and oxygen therapy.
  • Cystic Fibrosis (CF):

    • Cause: Autosomal recessive disorder affecting chloride transport.
    • Symptoms include thick mucus, frequent lung infections, pancreatic insufficiency, and malnutrition.
    • Management includes airway clearance, high-calorie, high-protein diet, pancreatic enzyme replacement, and infection prevention.

Oxygen Therapy & Tracheostomy Care

  • Oxygen Therapy:

    • Delivery methods include low-flow (nasal cannula, simple mask) and high-flow (Venturi mask, high-flow nasal cannula).
    • Noninvasive ventilation includes CPAP and BIPAP.
    • Precautions include oxygen toxicity, combustion risk.
  • Tracheostomy Care:

    • Indications include airway obstruction, and prolonged ventilation.
    • Complications include tube obstruction, accidental decannulation, and infection.
    • Management includes preventing thick secretions (humidification and suctioning), and maintaining sterile site care and suctioning.

Vascular and Cardiac Conditions

  • Hypertension in Pregnancy:

    • Risk factors include first pregnancy, family history, age >35, chronic hypertension, obesity, and diabetes.
    • Gestational Hypertension: BP >140/90 after 20 weeks, resolves postpartum, no proteinuria.
    • Management includes methyldopa, beta-blockers, calcium channel blockers (avoid ACE inhibitors).
  • Preeclampsia & Eclampsia:

    • Pathophysiology is generalized vasospasm.
    • Symptoms include hypertension, proteinuria, edema, vision changes, liver dysfunction, and headache.
    • Management involves magnesium sulfate, antihypertensives, fetal monitoring, and possible HELLP Syndrome management.
  • Chronic Hypertension in Pregnancy:

    • Management involves methyldopa, beta-blockers, calcium channel blockers (avoid ACE inhibitors).
  • Heart Failure:

    • Types include left-sided (pulmonary congestion, dyspnea, orthopnea, fatigue) and right-sided (peripheral edema, jugular venous distension, ascites, hepatomegaly).
    • Systolic heart failure (HFrEF) is characterized by decreased contractility and EF <40%.
    • Diastolic heart failure (HFpEF) is characterized by poor ventricular filling and EF >40%.
    • Compensation mechanisms include SNS activation, RAAS activation, and BNP release.
    • Management involves medications and lifestyle modifications.
  • Valvular Heart Disorders:

    • Types include mitral stenosis, mitral regurgitation, aortic stenosis, and aortic regurgitation.
    • Treatment includes non-surgical (beta-blockers, diuretics, ACE inhibitors, anticoagulation) and surgical (valve replacement or balloon valvuloplasty).
  • Hypertension & Peripheral Vascular Disease:

    • Types include essential, secondary, and hypertensive crisis.
    • Peripheral Artery Disease (PAD) involves narrowing of arteries, leading to pain, coolness, weak pulses, and ulcers.
    • Peripheral Venous Disease (PVD) involves venous disease that can lead to edema, stasis dermatitis, varicose veins, and ulcers.
    • Management and treatment are specific to the type, usually involving medications, lifestyle changes, and/or surgical interventions.
  • Congenital Heart Anomalies & Pregnancy:

    • Acyanotic Defects: Left-to-right shunting, increased pulmonary blood flow or obstruction; examples: ASD, VSD
    • Cyanotic Defects: Right-to-left shunting, decreased pulmonary blood flow or mixed circulation; examples: TOF, TGA, PDA, Coarctation of the Aorta, Hypoplastic Left Heart
  • Heart Failure in Pregnancy:

    • Class I & II: Activity modification, infection prevention
    • Class III & IV: Bed rest, oxygen, fetal monitoring
    • Medications: Heparin, digoxin, diuretics
  • Anemia Overview:

    • Definition: Decrease in red blood cells (RBC), hemoglobin (Hgb), or hematocrit (Hct), leading to lower oxygen-carrying capacity.
    • Common Symptoms include fatigue, dyspnea, palpitations, pallor, dizziness, and jaundice (in hemolytic anemia).

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Description

Overview of common infectious respiratory problems in children, including croup, epiglottitis, bronchitis, and bronchiolitis (RSV). Focuses on signs, symptoms, and management strategies for each condition. Includes treatments like humidified oxygen and antibiotics.

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