Exam 2 Topic Guide PDF Fall 2024

Fall 2024 EXAM 2 TOPIC Guide Please be sure to review the Study Tips and Course Preparation documents on Canvas for general peds exam information. *REMINDER: If you find information that is listed s...

Fall 2024 EXAM 2 TOPIC Guide Please be sure to review the Study Tips and Course Preparation documents on Canvas for general peds exam information. *REMINDER: If you find information that is listed slightly different in the book, go with your PowerPoint. Pediatric Nursing PPT: no questions specifically from a slide, but ALL concepts can be integrated into questions such as atraumatic care, etc. Toddler and Preschool Growth and Development: Remember to use PPT, book and the tables for G/D Theory ○ toddlers (1-3 years) erikson: autonomy vs shame and doubt > - seek to attain autonomy by gaining more self-control (tolleting and food preferences) > - leads to self-confidence and self control piaget: sensorimotor stage ends and preoperational stage begins L object permanence is well developed magical thinking he ability rate of growth slows objects continue to to search exist for hidden even when out of ; understand that objects sight gross motor activity rapidly develops social development, parallel play interaction play alongside ↳ each other without direct very curious, need to explore, testing boundaries, discipline needs to be consistent safety > more - caution curiosity due to ○ preschoolers (3-6 years) erikson: initiative vs guilt > - assert power and control over their environments piaget: preoperational stage progresses magical thinking egocentrism I and slow and steady growth, shape changes physical skills continue to develop language skills are well developed encourages * interactions with peers # associative play → more interactive > - playing interact and share ideas while visual - assessment > auscultation > - palpation  Nutrition day; · approximately eat seven times consuming a more meals than snacks ○ whole milk until age 2 ○ continue to avoid foods that can choke ○ grazers ○ do NOT force feed hydration · Communication/interaction with Toddlers and Preschool ○ expressive language, imitate, no’s!, why’s? ○ exaggerated storytelling · do NOT use magical thinking I will loose credability  Toddler Milestones Preschool Milestones Play (types of, use of play, etc.) ○ associative play → more interactive ○ imagination/magical thinking each other · parallel play- > play alongside without direct interaction  Toy appropriate activities Safety > - unintentional Injury is the #1 cause of death for all children in US  Discipline calm and collected stay · consequences should follow poor behavior ○ needs to be consistent establish and maintain routthes to prevent acting out · Ignore temper tantrums · time-outs *For the below body system topics, you will want to know general information given about the system and variations in anatomy/physiology in pediatric patients skin integrity ○ infants 40-60% thinner than adults → can cause tearing with minimal friction and makes it harder to regulate temperature sebaceous glands and endocrine glands are functional at lower rate apocrine glands do NOT function decreased amount of melanin ○ adolescent skin thickens to full thickness → less likely to have injury with minimal friction eccrine glands fully functional after puberty males sweat more apocrine glands are fully functional after puberty melanin is now at adult level providing full skin color and protection against UV light musculoskeletal and neuromuscular ○ motor development begins at birth and proceeds in predictable sequence ○ full range of motion present at birth ○ spinal cord is more mobile than adult ○ myelinization is not complete until 2 years of age ○ skeleton not completely ossified until late adolescence ○ growth of bones occurs primarily at specialized growth plates at the end of the long bones  ○ bones are more vascular and tend to heal faster than adults ○ growth → fontanels and growth plates ○ nature/characteristics → more porous, less dense ○ alignment → lower limbs · 300 bones at birth and 206 adult bones after ossification cardiac * understand normal blood flow ○ lungs are bypassed in fetal circulation lungs functional baby > - are NOT until takes first breath ligament > becomes - a umbilical vein blood carries to the oxygenated fetus ○ foramen ovale closes with the first breaths-separating R and L atria allows blood non-functioning to bypass the lungs directing fetal it from the RA to the LA ○ ductus arteriosus closes soon after birth ○ infant HR higher (90-160 bpm) decreases as efficiency increases ○ infant B/P is lower (80/55) increases as vessels increase in length and width Skin Lesion types/terms ○ primary: arise from previously healthy skin and are often the first response to injury or infection ○ secondary: arise from changes in a primary lesion ○ macules: flat (non-palpable) pigmented lesion ○ patch: macule greater than 1 cm ○ papule: raised and firm lesion may or may not be pigmented ○ wheal: irregular raised solid area of inflammation (will blanch) ○ vesicle: raised fluid filled lesion ○ pustule: purulent filled vesicle ○ bulla: vesicle larger than 1 cm ○ secondary lesions… burrow, comedone, crusting, erosion, excoriation, fissure, keloid, lichenification, scale, scar, ulcer, telangiectasia Atopic dermatitis (eczema) : including genetic environmental chronic skin disorder withdysfunction multifactorial causes , , skin barrier , and hyper immune activation of T-helper cells that result in dry pruritic skin lesions ○ effects 20% of infants, children and teens , ○ 60% of eczema is developed within the first year of life ○ very pruritic, erythematous, papulovesicular lesions with exudate, crusting, bleeding ○ can be worsened by both allergic and non-allergic triggers ○ can be very disruptive of sleep d/t severe pruritus ○ management educate parents there is NO cure and the rash will reoccur #1 priority is to keep skin hydrated and well-lubricated at all times avoid hot baths and avoid daily baths (bathing every other to every 3 days if possible) > warm - water  · prevent scratching · keep environment cool and humidified · apply moisturizers three times a day avoid soaps, lotions, detergents that smell pretty or look pretty (dyes/perfumes) apply emollient/barrier creams to dampy skin after naths b topical corticosteroids can be given for mild-severe eczema flares oral corticosteroids should be used sparingly for severe flare-ups oral antihistamines can be given for pruritus as well as sedative for nighttime scratching if secondary infection occurs can use topical and/or oral antibiotics allergy skin testing can be performed to determine possible food and/or environmental allergens avoidance of these can be key to keeping eczema under better · wear control loose cotton and blankets , clothing - > avoid wool clothing Impetigo ○ MOST common bacterial skin infection in children ○ highly contagious ○ causes characteristics → honey-colored crusts ○ caused by staph aureus and/or group A beta-hemolytic streptococcus ○ most common with infants and up to age 5 years ○ treatment and contact Isolation · hygiene hand mild infections → topical antibiotics target causing infection > - bacteria the , help to clear the lesions and prevent spread especially further in children who are more susceptible more severe or larger areas → oral antibiotics ○ education keep lesions as clean as possible hand hygiene for everyone no sharing clothes, towels, etc. · surfaces /sinks disenfect toys) complete bathtubs , full of antibiotics Molluscum contagiosum , , course ○ caused by pox virus > common - in children with eczema ○ spread by direct skin contact (including sexual conduct) and contact with contaminated clothing, towels, etc. ○ pearl like flesh colored papules 1-5 mm in size ○ painless ○ lesions will be umbilicated and can develop cheesy white discharge ○ found on trunk, axillae, antecubital and popliteal fossae ○ self resolve within 6 months BUT can reoccur for 2-4 years ○ no treatment typically necessary unless secondary infection occurs d/t excoriation (oral/topical antibiotics) ○ for severe infection cryotherapy or cantharidin can be used  ○ education importance of decreasing transmission Lice (Pediculosis Capitis) ○ most common in ages 3-12 of age ○ ALL socioeconomic populations are affected ○ African-American population very rarely affected > - increased all in hair follicles ○ spread through direct hair contact or hair contact with contaminated objects (towel, brush, hats) lice crawl, they DO NOT fly or hop ○ lice are wingless clear/yellow brown insect about the size of a sesame seed nits are silvery/white, yellow or darker and about 1 mm in size females can lay up to 10 nits (eggs a day) ○ severe pruritus ○ treatment pediculicide shampoo (pyrethrin) and/or ovicidal rinse shampoo (nix-permethrin) → should be applied x 10 minutes rinsed then nits all removed by comb objects · laundered all that cannot be should be placed into clothing bedding MUST stuffed animals be washed · , , Acne sometimes recommended family gets tested/treated that the whole bags for plastic at least 2 weeks ↳ comedones plugged or sebaceous follicles ○ most common skin disorder in pediatric population ○ affects 85% of children 12-25 years of age ○ infants can develop acne during 1st month of life → typically resolves within 1-3 months ○ affects all ethnicities and both males and females although severe acne is more common in males ○ caused when increased hormones increase sebum production resulting in obstruction of follicle canals with comedones ○ closed comedone: whiteheads ○ open comedone: blackheads ○ nodules: inflammation of several hair follicles ○ cysts: compressible nodules without overlying inflammation ○ diagnoses mild acne → non-inflammatory comedones moderate acne → inflammatory comedones, papules and pustules moderate/severe acne → inflammatory, numerous papules, localized cysts OR nodules, face, chest, and back involvement severe acne → nodular and cystic acne on face, back and chest, numerous cystic lesions and pustules may be present  ○ treatment clindamycin erythromycin , ointments > benzoyl peroxide - , topical medications include topical antibiotics, benzoyl peroxide, azelaic acid, and retinoid oral medications include antibiotics, oral contraceptives, and doxycycline minocycline or spironolactone * monitor cholesterol isotretinoin (accutane) → used as last resort d/t females NEGATIVE pregnancy > - need test prior to obtaining pledge program I > - reports of suicidal ideation - > assess emotional health prescription ○ education washing Wash hands before face > - daily hygiene → remind family improvement can take up to 8 weeks after acne treatment begins sweating, heat, humidity, and emotional stress may cause worsening in flare-ups even with treatment misconceptions → NO FOODs have been identified as a cause BUT any skin injury requires good nutrition to aid in healing · do NOT pick or pop keep hair out of face and keep clean Burns ○ 1 of top 5 leading causes of injury related deaths among children 1-14 years of age ○ 10-25% of all burns in children are due to abuse ○ thermal burn: exposure to flames, scalds, or hot objects (stove) ○ chemical burn: touching or ingestion of caustic agent ○ electrical burns: when direct current from high voltage wires, electrical wires, or appliances pass through the tissue continuous monitoring > - cardiac ○ radiation burn: exposure to radioactive substance or sunlight placeareis * · -  ○ management airway maintenance oxygen > - administer 100 % > Obtain - IV access fluid replacement/balance weights specific hospital > - based on and protocols at emotional support family patient > - for and ; chaplain , social work NEED to be involved complications = shock , infection , pain management fluid volume loss , to inability maintain a patent allway , scarring , prevent hypothermia emotional > - monitor temperature trauma , altered body image nutritional support wound care sterile precautions and maintain clean environment cardiac monitoring · apply cool , sterie NS to compress and protect the ○ prevention , skin keep home hot water heater temperature under 120 degrees test bath water and do not leave unattended keep away from open flames and stoves turn pot/pan handles into the stove keep hot liquids out of reach keep clothes irons and curling/flat irons out of reach teach and practice fire drills stay low and go! stop, drop and roll! fire-resistance fabrics sunscreen Seborrheic dermatitis (cradle cap) ○ recurrent inflammation though to be d/t overgrowth of yeast nonpruritic > - ○ mild erythematous, waxy scaling, yellow and red patches with greasy scaling ○ 0-3 months of age and adolescence mild ply balanced > - ○ daily washing of hair with baby shampoo, and can use soft baby hairbrush or soft toothbrush to loosen the plaques > can - use warm dive all to the scalp for 15 minutes shampooed and then brushed , gently · avoid vigorus scrubbing of the scalp ○ adolescents may used shampoos with selenium (head and shoulders) MS/NM Legg-calve perthes - necrosis ○ blood supply to the femoral head is temporarily disrupted → AVN pr death of the bone cells progression > slow - ○ children ages 4-8, boys more common (2-9 yrs) treatment : ○ exact cause unknown, but there are suspected risk factors long recovery time (several years) ○ clinical manifestations depends age on at time of dx limping inability * weight leg and goals to bear on the affected = pain control maintain sudden pain which is referred to groin, thigh, or knee , shape of femoral head , restore increase with mvt, decrease with rest, and limpness hip movement , preserve bone density decreased ROM AVN from blood · loss to femoral head head · can become misshapen occurs over 1-4 years > - Stages prenecrosis · necrosis · · revascularization remodeling ·  hip internal rotation Slipped capital femoral epiphysis (SCFE) hip deformity > - of childhood ○ intermittent pain to the hip, knee, or groin on the affected side, limping ○ stable or unstable ○ gradual or acute onset ○ risk factors ○ any child who is limping and reports pain to groin, hip, thigh, or knee should be evaluated ○ limping/pain increase after activity; affected leg turns outward; decreased ROM ○ x-ray to confirm diagnosis ○ treatment stabalize joint epiphysiodesis the hip promote avoid further plate , , injury to growth crutched/wheelchair for 6-8 weeks , DVT , infection , improve NWB hip function open reduction and internal fixation Developmental dysplasia of the hip ○ dislocation of hip from in utero positioning or congenital anomaly ○ most often diagnosed during the newborn exam but can be missed until older ○ clinical presentation/manifestations limited hip abduction, absence of knee flexion contractures difference in leg lengths, asymmetrical thigh skinfolds palpable and audible clicks as the femoral head moves out of the acetabulum trendelenburg gait (in older children) "Swinging galt ○ assessments ortolani test: abduct hip while applying anterior force to reduce hip joint barlow test: adduct hip while applying posterior force to promote dislocation ○ treatment - turn Q2H-Q4H finger , neurovascular Q2H tight oxycodone , two padding to make sure its not too , , , diapers or Urinal/bedpan surgery may be required · neuro checks Fractures/cast care (buckle) Atorus fractures are most common - the bone bends and buckles maturing ↳ more complicated cartilaginous due to bones , growth plates features , and open ○ children’s bones are more porous and so are more likely to buckle or bow than to break > - "bend they before break" ○ periosteum is thicker and stronger, so usually more stable and more likely to heal sheath covering the bones I a developing new bone and also on their own ↳ stabalizes supplying fracture healing , promotes blood ○ physeal plate (growth plate) involvement → higher risk for complications with healing and deformity prognosis > - poor ○ clinical manifestations: pain, swelling, inability to move extremity ○ assessment: history, neurovascular status, radiological studies ○ be aware of fractures that may indicate abuse ○ treatment reduction (open vs closed) immobilization (spica cast) prevent infection (osteomyelitis) neurovascular status medications Soploid pain control/constipation prevention > - ↑ consumption of clear fluids, fruits vegetables , patient and family education > - cast management , infection prevention ○ cast care elevate the cast above the level of the heart and ice to prevent swelling assess for bleeding if applied postoperatively assess for signs of infection → foul odor, drainage, fever, warmth, redness assess for skin breakdown and pressure points keep cast clean and dry never put anything inside the cast prepare patients and caregivers before cast removal ○ five P’s of tissue ischemia pain → location, duration, quality pulses → quality of peripheral pulses distal to casted extremity pallor → pallor, cyanosis, capillary refill distal to casted extremity paresthesia → numbness or tingling, ability to feel tactile stimuli distal to cast  paralysis → ability to move area distal to casted extremity ○ compartment syndrome assess neurovascular status (5 P’s) signs pain out of proportion with injury and unrelieved by opiods pain with movement (passive) persistent deep aching pain Scoliosis ○ progressive lateral curvature of the spine resulting in S-shaped appearance occurs before 6 months ○ classified by location (thoracic or lumbar) OR by cause (congential, Juvenile before 10 Y.. 0 Before age the of 10 (early-onset) adolescent idiopathic, or neuromuscular) through young adulthood affects children a neurological curs in children with ○ adolescent idiopathic is the most common stage age growth conditions at any any of and and more girls common in · development ○ assessment truncal asymmetry; uneven shoulders, raised hips, rib hump adema’s forward-bending test some back pain scoliometer to measure degree of curvature diagnosis confirmed through radiographs ○ treatment bracing surgical correction (spinal fusion) post-operative care ○ neurovascular status pallor > - pulses temperature , , cap refill , ○ pain control - PCA pump > - monitor for constipation - develop > can an ileus ○ turn Q2H (logrolling technique) Usually > - moving pt. up and 24 hours later ○ goals for ambulation ○ activity restrictions → no bending or twisting of the torso, return to school 2-4 weeks, resume normal activities over 3 months-1 year ○ pain control → gradual reduction of pain medication monitor bowel function constipation > - risk for ○ support body image concerns curvature of… - inherited ○ types I-IV → denotes severity ↳ 1 is the least severe ○ assessment signs of fractures muscle weakness bone deformities short stature hearing loss sclera for blue tinting ○ long term goals treatment is palliative prevent complications → contractures, deformities, muscle weakness, osteoporosis, misalignment of lower extremities ○ other considerations need to participate in physical activity and exercise teach parents proper handling changes padding > - diaper repositioning , the floors and furniture, caution when differentiate from child abuse → careful H&P, letter with diagnosis to carry · careful taking with BP- > noninvasive BP measures Cerebral palsy > - affects motor development in children ○ most common physical disability in childhood (umbrella term) hypoxic > - event to the brain ○ multifactorial, non-progressive, permanent ○ varying degrees of disability ○ incidence increasing due to improved survival of low birthweight and premature infants ○ etiology developing brain fails to form correctly or recieves some type of insult congenital vs. acquired ○ four types reflex exagerrated spastic (80%) vigid : and difficult to move - Increased tone that make very smooth coordinated movements difficult dyskinetic · voluntary muscle : muscles alternating movements are between difficult increase and decrease tone to control limp and flaccid with uncontrolled slow S ataxic : difficult with coordination steady galt and "worn' movements functioherdecreased depthperceptionguage mixed : two or delay more together mixed skill a most common is spastic and dyskinetic  ○ clinical manifestations developmental delay (usually fine or gross motor) feeding difficulties seizures cognitive delay NO CURE ○ goals : earlier intervention = better outcomes attain maximum physical abilities promote growth and development successful communication adequate nutrition social, academic, and recreational activities appropriate for development early intervention developmental physician OT/PT/ST physical therapy designed > - mobility is ROM to maintain optimizes and and muscle control and balance adaptive devices individualized education plan in the school setting ○ education/teaching/discharge planning support and resources for parents education (parental) education (child, IEP) early intervention medications → prevent seizures, manage spasticity (Baclofen) prevent manage UTIs , pain routine dental care → enamel defects and malocclusion are common assistive and safety devices Muscular dystrophy ○ inherited disease; progressive muscle weakness, muscle fiber degeneration, muscle wasting Inherited through the mother ○ duchenne muscular dystrophy (DMD); X-linked, affects males only > - ○ may also occur from spontaneous genetic mutation ○ genetic testing for female relatives (including mother due to spontaneous mutation) ○ clinical manifestations affects proximal (close > - body) muscles to the affects core first and then later the distal muscles (close to gower sign extremities) gross motor delay muscle weakness difficulty or inability navigating stairs clumsiness elevated CK level  ○ genetic testing for diagnosis; muscle biopsy may still be used in some situations ○ early diagnosis and initiation of therapy ○ activities to promote/maintain positive self-image and self-esteem ○ treatment/management glucocorticoids to slow the loss of ambulation, prevent scoliosis, preserve lung function physical therapy monitoring and preserving lung and cardiac function high risk of malignant hyperthermia during surgery assess growth and nutritional status focus on quality foods thicken fluids and cut up foods as condition progresses may need feeding tube to maintain adequate caloric intake Spina bifida ○ failure of the neural tube to fuse in the lower spinal area → open vertebral arches → sac protruding from the spinal area or a lesion covered with skin ○ risk for infection and trauma during gestation and birth > - CANNOT through come birth canal ○ neurological impairment → paralysis below the level of the defect, orthopedic difficulties, potential cognitive disabilities ○ may also have chiari II malformation, hydrocephalus ○ three types spina bifida occulta: skin intact, no obvious protrusion; bony abnormality; hair tuft in area of defect spina bifida with meningocele: obvious protrusion of meninges spins bifida with myelomeningocele: obvious protrusion; sac contains meninges and spinal cord ○ management support oxygenation, ventilation, thermoregulation, prevent infection at birth cover lesion with sterile, non-permeable gauze soaked in warm saline saline at bedside to keep dressing moist (hourly) prevent heat and fluid loss surgical closure of spine to prevent trauma and infection serial head circumference measurements assess for signs of increased ICP (hydrocephalus occurs in 90% of these patients) latex-free precautions post-op  feed Q2H position prone or on side due to nerve innervation risk for tethered cord after surgery → many will require surgery later to untether the cord long-term emotional and family support · multidisciplinary team needed& heurosurgery neurology , , pediatrics , PT , OT , speech therapy , social work , urology education , , CLS Cardiac Assessment and general interventions associated with Peds ○ do NOT cluster care ○ monitor apical pulse ○ thorough skin assessments to assess for cyanosis ○ promote rest and comfort Medications for heart defects and disorders (you do NOT need know dosing) ○ vasoactive medications epinephrine and norepinephrine for shock * Infuse vasodilator umbilical cord large into vein or & signs ○ prostaglandin of E > - drip ordered to keep oxygenation the PDA open > - relaxes blood smooth flow w/ muscles of increased the blood ductus arteriosus and - lower increasespulmonary body perfusion toxicity lethargy = n/v , diarrhea, , anorexia , bradycardia improves myocardial contractility ○ digoxin apical > - (QIZH) pulse before administration , regular repeat intervals vomiting , I l before OR 24 after meals , do NOT after , do NOT administer extra dose Verify If one is missed , monitor serum digoxin levels verify , with second nurse , contraindications oral elixir - toward side and back of mouth and rinse with water Coarctation of the Aorta (COA) , ○ narrowing of the aorta part > - bodyobstruct blood flow to lower of ○ increased pressure and blood flow in heart and upper body backup of blood causes increased workload of the heart ○ decreased pressure and blood flow in lower part of body artery (4 release) > - renal renin > - HTN ○ clinical manifestations difference in BP and pulses of the upper and lower extremities acyanotic tachypnea/dyspnea diaphoresis poor growth profound shock, metabolic acidosis, end-organ ischemia systolic murmur · headache ○ treatment/management CHF medications digoxin > - Lasix , repair by widening; resection of the aorta; cadaver replacement improve/maintain equal pressure/blood flow administration of CHF medications monitor perfusion obtain upper and lower B/P x 4 decrease rigorous activity  monitor for CHF or worsening monitor growth family education prevention > - of bacterial endocarditis PDA: patent ductus arteriosus ductus - alterious pulmonary artery connects the aorta to the outside the heart ○ acyanotic defect ○ left → right shunting lungs : into the pulmonary arteries and - pulmonary blood returns to LA + LVe enters dorta - travels to the arteries ○ increase in pulmonary blood flow both lungs get ○ oxygenated blood flows back to lungsOxygenated > - sood ↓ lung and - congestion > - compliance ○ can be asymptomatic → heart failure ○ increase in work of breathing and pulmonary HTN · poor common in preterm babies ○ clinical manifestations tachypnea breathing> - indicates increased work of dyspnea/apnea breathing I workload tachycardia machine sounding murmur fatigue poor feeding sweating with feeds bounding pulses widen pulse pressures ○ treatment/management & ductus by inhibiting prostagladhelp close the arterious in E > reduces - abnormal blood flow and alleviates symptoms indomethacin OR ibuprofen results complete > - by facilitating in cessation of ductal flow necrosis of the ductus Intima of the duct occlusion via heart cath arteriosus surgical closure via thoracotomy decrease work of breathing frequent short interactions oxygen delivery do NOT cluster care - > maximize to tissue frequent small feeds strict intake/output monitoring - strict restrictions, monitor wine , administer diuretics output as ordered administration of medications digoxin > - , diuretics monitor daily weights > monitor - for fluid overload pre/post-op care Transposition of the Great Vessels transposed : pulmonary artery and aorta are > creates - closed system of two circulatory systems & Orta is connected to RV artery Instead of LV AND pulmonary is connect to LV instead of RV ○ de-oxygenated systemic blood enters the RA → RV → aorta → body AND oxygenated pulmonary blood enters LA → LV → pulmonary artery → lungs significantly decreased systemic oxygenation ○ profound hypoxia and cyanosis ○ decrease in cardiac output → heart failure not compatible with life  ○ clinical manifestations profound cyanosis (unchanged with supplemental oxygen) tachypnea tachycardia poor feeding poor growth signs of CHF ○ treatment/management prostaglandin E atrial septostomy surgical reconstruction complete open heart surgery > - increase oxygenation oxygen pre/post-op care administration of medications Digoxin > - Lasix , strict intake/output monitoring family education/support VSD: ventricular septal defect > - defect opening or in the septal right wall between the and left ventricle chambers * one of the most common ○ acyanotic defect ○ left → right shunting ○ increase in pulmonary blood flow ○ oxygenated blood flows back to lungs ○ can be asymptomatic → heart failure ○ increase in work of breathing and pulmonary HTN · hypertrophy ventricle ○ clinical manifestations can be asymptomatic > seen - with smaller defects tachypnea dyspnea/apnea tachycardia fatigue poor feeding Irritability > - growth : affects development and sweating with feeds congestive heart failure ○ treatment/management may * walt seeI f naturally to closure occurs surgical patch/repair open heart spontaneous > can - see closure in small USD by age 2 valve occluder (like PDA) via heart cath decrease work of breathing frequent short interactions > - do NOT cluster care  frequent small feeds strict intake/output monitoring administration of medications Monitor daily weights watch for s/s of CHF pre/post-op care Kawasaki ○ acute systemic vasculitis * autoimmune response ○ self-limiting inflammatory response to an infection (thought to be d/t viral illness) ○ prolonged high fever * seen ○ leading cause of acquired heart disease among children more in winter and summer ○ can lead to coronary aneurysm and cardiomyopathy ○ higher incidence in children of Asian descent ○ seen typically in young children (6 months - 5 years) ○ consists of 3 stages ○ clinical manifestations * anverysms can occur fever > - given medications improving If not extreme irritability conjunctival hyperemia > redness of the - eyes oral/pharyngeal erythema and inflammation cherry red and peeling lipids strawberry tongue swollen hands and feet erythema to palms and soles erythematous/maculopapular rash erythema/desquamation to perineum enlarged lymph nodes cardiac involvement diarrhea hepatic dysfunction vessel inflammation test to confirm -not really one labs: anemia, elevated WBC, CRP, ESR, liver enzymes, platelets sub-acute phase (2-4 weeks) · resolution of fever worsening racking lips and fissures desquamation of palms/soles/around nail beds joint pain cardiac disease · thrombocytosis - > ↑ platlets > - aneurysms can occur  convalescent phase 6-8 weeks after onset basically normal but may have lingering effects ○ treatment/management obtain Echo > - Obtains baseline must be hospitalized begin IVIG infusions begin aspirin (ASA) clotting helps joint > - decreases and pain * cluster care* promote rest/comfort > keep - calm monitor cardiac status administer medications vitals esp temp Q4H · monitor VS before administering aspirin provide family education and support HTN * do NOT check BP until 3 y. 0 usually. ○ pediatric normals for BP and grading of HTN is based on…gender, age, height NO underlying cause ○ & primary HTN: higher in African American and obese children Do not underlying treat cause ○ - secondary HTN: seen in children with underlying medical issues renal or cardiac issue than extremity ○ has to be more than 1 occasion ○ treatment usually begins with nutrition and activity modifications with primary HTN Dyslipidemia: higher levels of lipids (fats) in the blood ↳disorder oflipid metabolism ○ asymptomatic ○ usually does not cause issues as a child BUT significant increases the risk for cardiovascular issues in adulthood questionaire ○ risk assessment screening begins at 24 months again age > - at 4, 6, 8 , 12-17 years of ○ serum lipid levels are recommended once @ 9-11 yrs and then 18-21 yrs ○ treatment begins with diet and exercise modifications ○ medications if diet/exercise is not helpful ○ family education Rheumatic Fever ○ inflammatory (autoimmune) response to strep pharyngitis → group A beta hemolytic streptococci (GABHS) & autoimmune response to infection that affects connective tissue - > affects heart, CNS ○ can be from untreated strep infection or severe infection that did not respond to antibiotic treatment ○ clinical manifestations spiking fever inflamed, painful joints palpable subcutaneous nodules near joints  sydenham chorea (st. vitus dance) elevated ASO antibody titer rash (erythema marginatum) goes > - comes and ○ diagnosis modified jones criteria must have TWO MAJOR OR ONE MAJOR AND TWO MINOR criteria AND + ASO (anti-streptolysin) titer major ○ carditis inflammation > - of the heart ○ migratory polyarthritis type pain - from of arthritis where or inflammation moves joint one to ○ sub Q nodules firm , bumps form > - raised that under the skin another ○ erythema marginatum -bright pink or led, , circular lesions that appear on the arms , trunk and legs ○ sydenham chorea -jerky purposeless , uncontrollable and movements of the hands shoulder facelea , arms , , minor ○ arthralgia joint > - pain ○ fever sedimentation rate erythrocyte - ○ elevated ESR or CRP response inflammatory > - elevated in to an reaction C-reactive protein treatment/management PCN 10-14 days corticosteroids NSAIDS antibiotic prophylaxis ongoing cardiac follow-up if necessary family education > - complete full encourage course flu of antibiotics, prophylaxis immunization/annual shot , antibiotic therapy for dental work Tetralogy of Fallot (TOF) USD right > - left between defects -> more and ventricles patients seen in with other chromosomal in males ○ cyanotic defect (systemic cyanosis) ○ right → left shunting ○ have a coinciding ASD/VSD causing obstruction to blood flow ○ deoxygenated blood to return to body ○ decrease pulmonary blood flow enlargement of the aortic value ○ 4 defects → pulmonary stenosis, overriding aorta, right ventricular hypertrophy, LER shunting narrowing of the pulmonary value > thickening - obstruction of of muscle walls of the heart VSD I s - blood flow from RV to pulmonary obstructed and slowed due to artery ; blood flow from RV pulmonary stenosist decreased blood ↓ pressure flow to the lungs for oxygenation and decrease ○ clinical manifestations a the amount of oxygenated in returning blood to the LA from the lungs cyanosis (perioral and peripheral) body trying > mouth - trying , get hands feet I , organs to compensate and to blood to vital exertional dyspnea/apnea polycythemia irritability poor growth  fatigue brain death biological response hypoxic Injury or TET spells signifigant quick > - get and drop squatting in O2 try to systemic into fetal or position = ↑ vascular resistance which helps Irritability during feedings crying bowel movements improve pulmonary blood flow ○ treatment/management , , prostaglandin E infusion keeps PDA open > - surgical * intervention required repair/replacement of pulmonic valve enlargement of pulmonary artery VSD closure increase oxygenation provide oxygen pulmonary > - to reduce vasoconstriction decrease O2 demand pre/post op care knee-to-chest position keep baby calm frequent short interactions oxygenation adequate > - periods increases ; allow rest frequent small feeds strict intake/output monitoring administratio