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Questions and Answers
A child with Tetralogy of Fallot is experiencing a hypercyanotic spell. What physiological response underlies the therapeutic effect of placing the child in a squatting position?
A child with Tetralogy of Fallot is experiencing a hypercyanotic spell. What physiological response underlies the therapeutic effect of placing the child in a squatting position?
- Decreasing systemic vascular resistance, which lessens right-to-left shunting.
- Reducing pulmonary vascular resistance, thereby facilitating pulmonary blood flow.
- Increasing systemic vascular resistance, which lessens right-to-left shunting. (correct)
- Increasing venous return from the lower extremities, thus increasing preload.
An infant with a suspected congenital heart defect is exhibiting signs of heart failure. Which assessment finding would be most indicative of fluid overload and the need for diuretic therapy?
An infant with a suspected congenital heart defect is exhibiting signs of heart failure. Which assessment finding would be most indicative of fluid overload and the need for diuretic therapy?
- Decreased central venous pressure
- Crackles upon auscultation of the lungs (correct)
- Bounding peripheral pulses
- Increased urine specific gravity
A child is diagnosed with Kawasaki disease. What is the rationale for administering IV gamma globulin (IVIG) in the acute phase of this illness?
A child is diagnosed with Kawasaki disease. What is the rationale for administering IV gamma globulin (IVIG) in the acute phase of this illness?
- To reduce the risk of coronary artery aneurysms. (correct)
- To prevent the development of hypertension.
- To improve myocardial contractility.
- To alleviate joint pain and inflammation.
An infant with a ventricular septal defect (VSD) is being closely monitored for signs of heart failure. Which assessment finding would be the most concerning and necessitate immediate intervention?
An infant with a ventricular septal defect (VSD) is being closely monitored for signs of heart failure. Which assessment finding would be the most concerning and necessitate immediate intervention?
A newborn is diagnosed with coarctation of the aorta. What assessment finding would be most critical in determining the severity of the coarctation?
A newborn is diagnosed with coarctation of the aorta. What assessment finding would be most critical in determining the severity of the coarctation?
A child with acute rheumatic fever is being treated with penicillin. What teaching point is most important to emphasize to the parents regarding the long-term management of this condition?
A child with acute rheumatic fever is being treated with penicillin. What teaching point is most important to emphasize to the parents regarding the long-term management of this condition?
A preterm infant is diagnosed with patent ductus arteriosus (PDA). What physiological mechanism explains why NSAIDs like ibuprofen are used in the medical management of PDA?
A preterm infant is diagnosed with patent ductus arteriosus (PDA). What physiological mechanism explains why NSAIDs like ibuprofen are used in the medical management of PDA?
What explains the potential for altered drug absorption in a child with Hirschsprung's disease?
What explains the potential for altered drug absorption in a child with Hirschsprung's disease?
A child with a history of frequent urinary tract infections (UTIs) is diagnosed with vesicoureteral reflux (VUR). What is the primary rationale for using prophylactic antibiotics in children with VUR?
A child with a history of frequent urinary tract infections (UTIs) is diagnosed with vesicoureteral reflux (VUR). What is the primary rationale for using prophylactic antibiotics in children with VUR?
An infant is diagnosed with pyloric stenosis. Which acid-base imbalance is most likely to occur as a result of persistent vomiting?
An infant is diagnosed with pyloric stenosis. Which acid-base imbalance is most likely to occur as a result of persistent vomiting?
A child with nephrotic syndrome develops peritonitis. What physiological mechanism explains this increased susceptibility to infection?
A child with nephrotic syndrome develops peritonitis. What physiological mechanism explains this increased susceptibility to infection?
A child with acute kidney injury (AKI) has rapidly increasing serum potassium levels. What is the most immediate nursing intervention to prevent cardiac complications associated with hyperkalemia?
A child with acute kidney injury (AKI) has rapidly increasing serum potassium levels. What is the most immediate nursing intervention to prevent cardiac complications associated with hyperkalemia?
Which statement accurately describes the pathophysiology of intussusception?
Which statement accurately describes the pathophysiology of intussusception?
A child with celiac disease is strictly adhering to a gluten-free diet. What laboratory finding would indicate the diet is effectively managing the disease?
A child with celiac disease is strictly adhering to a gluten-free diet. What laboratory finding would indicate the diet is effectively managing the disease?
An infant with a cleft lip and palate is having difficulty feeding. What intervention should the nurse prioritize to promote adequate nutrition?
An infant with a cleft lip and palate is having difficulty feeding. What intervention should the nurse prioritize to promote adequate nutrition?
A newborn is diagnosed with biliary atresia. What pathophysiological process underlies the development of cirrhosis in this condition?
A newborn is diagnosed with biliary atresia. What pathophysiological process underlies the development of cirrhosis in this condition?
A school-age child is diagnosed with Henoch-Schönlein purpura (HSP). What assessment finding should the nurse prioritize to monitor for a potentially serious complication of this condition?
A school-age child is diagnosed with Henoch-Schönlein purpura (HSP). What assessment finding should the nurse prioritize to monitor for a potentially serious complication of this condition?
What is the clinical significance of monitoring weight in babies with GER?
What is the clinical significance of monitoring weight in babies with GER?
What is the underlying pathology of Hirschsprung's disease that leads to the observed clinical manifestations?
What is the underlying pathology of Hirschsprung's disease that leads to the observed clinical manifestations?
A child with nephrotic syndrome presents with increased abdominal pain and distension. Which complication should the nurse suspect, and what is the underlying cause?
A child with nephrotic syndrome presents with increased abdominal pain and distension. Which complication should the nurse suspect, and what is the underlying cause?
Select the best position for a Tetralogy of Fallot child experiencing a TET spell?
Select the best position for a Tetralogy of Fallot child experiencing a TET spell?
What factor can lead to the damaging of heart valves in acute Rheumatic fever?
What factor can lead to the damaging of heart valves in acute Rheumatic fever?
What could a purpuric rash indicate in Henoch-Schönlein?
What could a purpuric rash indicate in Henoch-Schönlein?
An infant with pyloric stenosis is admitted for surgical correction. What is the priority nursing intervention in the preoperative period to address the most immediate physiological risk?
An infant with pyloric stenosis is admitted for surgical correction. What is the priority nursing intervention in the preoperative period to address the most immediate physiological risk?
A toddler with nephrotic syndrome is prescribed prednisone. What is the rationale for using corticosteroids in the treatment of nephrotic syndrome?
A toddler with nephrotic syndrome is prescribed prednisone. What is the rationale for using corticosteroids in the treatment of nephrotic syndrome?
An adolescent with acute postinfectious glomerulonephritis (APIGN) has significant edema and hypertension. Which dietary modification is most appropriate for managing these symptoms?
An adolescent with acute postinfectious glomerulonephritis (APIGN) has significant edema and hypertension. Which dietary modification is most appropriate for managing these symptoms?
A nurse is assessing a child with suspected appendicitis. In what order should the nurse perform the steps of the abdominal assessment to avoid causing unnecessary pain and potentially altering physical findings?
A nurse is assessing a child with suspected appendicitis. In what order should the nurse perform the steps of the abdominal assessment to avoid causing unnecessary pain and potentially altering physical findings?
What is the most significant post operative care for cleft palate baby after surgery?
What is the most significant post operative care for cleft palate baby after surgery?
What is the major difference between omphalocele and gastroschisis? Select the best answer.
What is the major difference between omphalocele and gastroschisis? Select the best answer.
What lab order should you expect to be ordered when determining signs of celiac disease?
What lab order should you expect to be ordered when determining signs of celiac disease?
In a patient presenting AKI, what signs will be expected on the labs?
In a patient presenting AKI, what signs will be expected on the labs?
A nurse is educating the parents of a child newly diagnosed with vesicoureteral reflux (VUR). What should the teaching plan include regarding the administration of prophylactic antibiotics?
A nurse is educating the parents of a child newly diagnosed with vesicoureteral reflux (VUR). What should the teaching plan include regarding the administration of prophylactic antibiotics?
When should cardiac and respiratory assessment be done in context?
When should cardiac and respiratory assessment be done in context?
A child receiving digoxin displays signs of digoxin toxicity. What predisposing factor most likely contributed to this adverse reaction?
A child receiving digoxin displays signs of digoxin toxicity. What predisposing factor most likely contributed to this adverse reaction?
How does pyloric stenosis block food from exiting, and what are some early signs of pyloric stenosis?
How does pyloric stenosis block food from exiting, and what are some early signs of pyloric stenosis?
Flashcards
Atrial Septal Defect (ASD)
Atrial Septal Defect (ASD)
Abnormal formation of the septal walls causing more blood flow between atria.
Ventricular Septal Defect (VSD)
Ventricular Septal Defect (VSD)
Most common congenital heart disease; blood shunts from left to right ventricle.
Tetralogy of Fallot
Tetralogy of Fallot
Congenital heart defect with four distinct abnormalities (pulmonary stenosis, VSD, overriding aorta, right ventricular hypertrophy).
Kawasaki Disease Treatment
Kawasaki Disease Treatment
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Urinary Tract Infection (UTI)
Urinary Tract Infection (UTI)
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Vesicoureteral Reflux (VUR) Assessment
Vesicoureteral Reflux (VUR) Assessment
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Nephrotic Syndrome
Nephrotic Syndrome
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Acute Postinfectious Glomerulonephritis Assessment
Acute Postinfectious Glomerulonephritis Assessment
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Hemolytic Uremic Syndrome (HUS) Assessment
Hemolytic Uremic Syndrome (HUS) Assessment
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Acute Kidney Injury (AKI)
Acute Kidney Injury (AKI)
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Post ASD Cardiac Catherization Priority Care
Post ASD Cardiac Catherization Priority Care
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Ventricular Septal Defect (VSD)
Ventricular Septal Defect (VSD)
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Tet Spells
Tet Spells
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Coarctation of the Aorta
Coarctation of the Aorta
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Hypoplastic Left Heart
Hypoplastic Left Heart
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Acute Rheumatic Disease
Acute Rheumatic Disease
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PDA Medical Management
PDA Medical Management
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Nephrotic Syndrome
Nephrotic Syndrome
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Intussusception
Intussusception
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Hirschsprung Disease
Hirschsprung Disease
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Study Notes
Heart Disease Assessment Findings
- Clubbing of fingers, cyanosis, and chest wall deformities are key assessment findings
- Genetic risk factors include family history of congenital heart failure
- Maternal risk factors include maternal drug/alcohol use and diabetes
Patent Ductus Arteriosus (PDA)
- PDA involves left-to-right shunting
- Assessment findings include a systolic murmur, bounding pulses, rales/crackles, wide pulse pressure, poor weight gain, and feeding difficulties
- Medical management involves administering NSAIDs (Ibuprofen)
Atrial Septal Defect (ASD)
- ASD occurs when the septal walls fail to form, causing more blood flow from the left atrium to the right side of the heart
- Assessment findings include a systolic murmur, recurrent respiratory infections, poor feeding, and shortness of breath
- Diagnostic testing includes an echocardiogram
- Medical management includes digoxin administration and surgical closure
Post-Op Care for ASD after Cardiac Catheterization
- Monitor for cyanosis, poor weight gain, respiratory distress, and bleeding from the insertion site
Ventricular Septal Defect (VSD)
- VSD is the most common overall congenital heart disease
- VSD can result in right ventricular hypertrophy with left-to-right shunting
- VSD causes an increase in pulmonary blood flow
Tetralogy of Fallot
- Tetralogy of Fallot includes four separate defects
- TET spells involve a sudden marked increase in cyanosis, which can lead to hypoxic brain injury and death
- Place the child in a squatting position during a TET spell to promote blood flow from the lower extremities back to the vital organs
Tricuspid Atresia
- Tricuspid Atresia involves a defective or missing tricuspid valve, which blocks blood flow from the right atrium to the left ventricle
- Diagnostic testing includes echocardiogram, electrocardiogram (EKG), chest x-ray, and cardiac catheterization
Coarctation of the Aorta
- Coarctation of the Aorta results in a narrowing of the aorta between the upper and lower extremities
- Assessment findings include decreased femoral pulses, poor perfusion, cool extremities, and higher blood pressure in the upper extremities compared to the lower extremities
Obstructive Disorders
- Congenital heart defects classified as obstructive disorders obstruct blood flow in or out of the heart
Hypoplastic Left Heart
- Hypoplastic left heart is the second most common congenital heart defect
- Caused by the underdevelopment of the left side of the heart, including the aorta, aortic valve, left ventricle, and mitral valve
- Medical management includes surgical correction or transplantation, lifelong follow-ups with a pediatric cardiologist, long-term cardiac medications, and bacterial endocarditis protocols
Digoxin
- Digoxin requires close attention to parent education for administration
- Do not administer if the patient's heart rate is below 70 bpm
- Do not increase or change the dose, and do not re-dose if the patient vomits
- Teach parents how to take a pulse
Heart Sounds
- Review what the heart is doing when you hear S1 or S2
Acute Rheumatic Disease
- Acute Rheumatic Disease is a systemic inflammatory disease that occurs in response to Group A beta-hemolytic streptococcal infection
- Untreated strep can lead to damage of the heart valves
- Auscultation of heart sounds is a priority assessment, as an abnormal rate or rhythm indicates cardiac involvement
Kawasaki Disease
- Kawasaki Disease is the leading cause of acquired heart disease in children and it can lead to coronary artery aneurysm
- Symptoms include persistent high fever, strawberry tongue, swelling to the hands and feet, enlarged lymph nodes, and bilateral conjunctivitis (eyes)
- Medical management includes administering IV gamma globulin and aspirin
Shock
- Review s/s of shock, treatment, positioning, and family education
Gastrointestinal Anatomy
- Review the anatomy of the GI tract, including:
- Cleft lip = lip
- GER = lower esophagus
- Volvulus = any part of the intestine
- Hirschsprung dx = colon
Abdominal Assessment
- Always auscultate before palpating, even if the baby is screaming
- Use comfort measures like a pacifier
Dehydration
- Vital signs are an important sign to check for in a patient with dehydration
- If a patient has not had a wet diaper in 8 hours, that can indicate dehydration
Celiac Disease
- Provider may order immunoglobulin A
- Increased IgA is indicative of Celiac Disease
- A care plan should include referral to nutritionist and grief counselor, but not increased bread intake
Appendicitis
- Appendicitis is the inflammation of the appendix and is one of the most common surgical conditions affecting children
- Assessment findings include pain in the periumbilical area that moves to the right lower quadrant, fever, nausea, vomiting, and rebound pain with palpation at McBurney's point
- Pain with sudden resolution indicates a ruptured appendix
- Nursing care includes keeping the patient NPO, positioning the patient in a position of comfort, preparing for surgery, and starting antibiotics
Gastroesophageal Reflux Disease (GERD)
- Is caused by the immaturity of the lower esophageal sphincter
- Important to closely monitor weight of babies with GERD
Pyloric Stenosis
- Pyloric Stenosis: in infants the plyorus blocks food from entering the small intestine
- Infants present with projectile vomiting and appear hungry constantly
- Assessment includes: palpable pyloric mass, dehydration, poor weight gain
- Diagnostics: olive sign, upper GI series, CBC, and ultrasound.
Volvulus
- Volvulus is an abnormal twisting of a portion of the GI tract, which can impair blood flow leading to gangrene and death of the involved segment
- Monitor for s/s of necrosis, intestinal perforation and peritonitis.
- Patients should be NPO
Intussusception
- Intussusception occurs when part of the intestine slips into an adjacent part
- Review s/s of intussusception and the nursing interventions
- Treatment of intussusception includes reduction via barium enema, air insufflation, or water-soluble solution, with surgery as a potential option
Hirschsprung Disease
- Hirschsprung Disease is a congenital condition that causes blockage of the intestine due to a lack of nerves at the bottom segment of the colon
- Assessment findings include failure to pass meconium in the first 24 hours, constipation, bowel movement once per week, ribbon-like or watery stools
- Review the definition of constipation and the treatment for constipation caused by Hirschsprung's, including the use of Miralax
Omphalocele and Gastroschisis
- Omphalocele: the stomach and intestines are contained in a sac outside of the abdomen.
- Gastroschisis: an opening on the right side of the umbilical cord that affects the stomach, small and large intestine, and sometimes the liver
- Review care for both of these disorders
Biliary Atresia
- Biliary Atresia is a congenital absence or closure of the major bile ducts resulting in a progressive inflammatory process that may cause cirrhosis of the liver
- Assessment Findings: SIGNIFICANT jaundice at 2 wks of age, DARK urine, light-colored stools, enlarged liver, increase in the direct bilirubin.
Cleft Lip/Palate
- Infants with a cleft palate or lip will need a multidisciplinary approach to care
- The care team includes Speech, Child life, and Surgical team
- Evaluate for swallow and feeding difficulties as a priority to start appropriate interventions
- Once the patient has had appropriate growth, surgery is an option
- Review post op care for this type of surgery: proper restraints, clear liquid diet to soft foods within 48 hours, and perioperative feeding techniques
Renal System Anatomy
- Review the anatomy of the renal system
- Including bladder, kidneys, ureters
- Review their functions
Lab Values
- Review expected lab values of the renal system
Urinary Tract Infection (UTIs)
- An infection that involves the urethra, bladder, ureters, renal pelvis, renal calyces, and renal parenchyma
- UTIs are commonly seen in children ages 2 - 6
- The most common site of infection in a febril infant without a recognizable source of infection is a UTI.
- The most common cause of a UTI is E. Coli
- Assessments: fever, vomiting, abdominal pain, flank pain, urgency, dysuria, and frequency
- Review the appropriate way to obtain a UA, clean catch, suprapubic tap and catheterization
- A bag specimen is NOT appropriate for diagnosis and children who are not potty trained will need catheterization
Vesicourecteral Reflux
- Vesicourecteral Reflux: a congenital anatomical abnormality that allows the retrograde flow of urine from the bladder into the ureters
- Most cases of VUR will resolve over time
- Assessment findings: Frequent UTIs, urinary incontinence, family history of VUR, suprapubic pain.
- Review table 17-3 for the stages of VUR and review nursing interventions and care
Nephrotic Syndrome
- Nephrotic Syndrome is the most common kidney disease in children
- Characterized by a combo of clinical manifestations: massive proteinuria, HYPOalbuminemia, edema, and HYPERlipidemia of unknown etiology.
- Nephrotic syndrome often occurs after an upper respiratory infection
- Complications include peritonitis, thromboemolism, AKI, and malnutrition
- Assessment findings: edema, decreased urine output, weight gain, anorexia, fatigue, and HTN
- Diagnostic findings: PROTEINURIA: What does the urine look like with significant proteinuria?
Acute Postinfectious Glomerulonephritis
- Acute Postinfectious Glomerulonephritis: inflammation of the glomeruli in response to a preceding illness, most commonly caused by streptococcal URI or skin infection
- Assessment findings: hematuria (tea-colored urine), proteinuria, decrease urine output (oliguria), recent infections (uri, skin, strep), and edema
- Resolution usually represented by fluid balance, pts begin to have less edema and UO becomes normal as the glomerular changes are reversed with appropriate treatment
- APIGN Treatment is Divided into Emergent, Acute and Chronic phases
Henoch-Schonlein Purpura
- Henoch-Schonlein Purpura: HSP is a multisystem vasculitic disorder
- It is classified by a tetrad of symptoms: rash, arthralgias, abdonmial pain, and hematuria.
- Assessment findings: colicky abdominal pain, palable purpura (most prominent finding), arthritis, edema to feet, lips, hands, face and scrotum, anorexia, malaise.
- Diagnostic testing:
- CBC = anemia w/ hemolysis thrombocytosis leukocytosis
- Erythrocyte Sed Rate = elevated
- C-reactive protein = elevated
- Elevated serum creatinine
- Renal biopsy = iga deposition
Hemolytic Uremic Syndrome
- Hemolytic Uremic Syndrome. UNKNOWN ETIOLOGY but is the most significant complication of an E.Coli infection!!!
- Assessment Findings: bloody diarrhea, pallor, oliguria (decreased UO), hypertension, purpura/petechiae, edema, irritability
- Diagnostic testing: UA, CBC, BUN, Creatinine.
- Nursing Care/Treatment: prepare family/pt for possible dialysis, administration of a blood transfusion, and antieileptic medication.
Acute Kidney Injury (AKI)
- Acute Kidney Injury: Poor renal perfusion or injury. Volume depletion is the most common cause in pediatrics
- Assessment findings: hx of fluid loss (vomiting, diarrhea, burns), oliguria, hypertension, changes in LOC, anemia, seizures, edema.
- Renal replacement therapy (dialysis) is the gold standard for treatment
- Review Lab Findings for a pt with AKI:
- BUN = Decrease
- Creatinine = Increase
- HYPERkalemia/HYPOnatremia & Metablic Acidosis
- Renal pt require special attention to nutrition and multidisciplinary approach
Med Math
- Convert lbs to kg, because every dose is weight based in the PEDS world!
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