Peds Finals PDF

Case Studies will be: 1. an infant with a VSD VSD: 1. Hole in septum between the right and left ventricle which increases pulmonary blood flow from left to righ 2. The pulmonary artery has to work harder 3. Assessment: Heart failure, pulmonary hypertension, lung inflammation, low growt...

Case Studies will be: 1. an infant with a VSD VSD: 1. Hole in septum between the right and left ventricle which increases pulmonary blood flow from left to righ 2. The pulmonary artery has to work harder 3. Assessment: Heart failure, pulmonary hypertension, lung inflammation, low growth weight, extra heart so 4. Management: ACE-inhibitor and Digoxin (at least 60 HR) 5. Basically extra blood just mixing 2. an 8 year-old with sickle cell anemia Sickle Cell Anemia 1. Autosomal. Abnormal Hgb S replaces Hgb A 2. Sickling RBCs 3. When RBCs sickle = more viscous, increase occlusion risk, decreases oxygen carrying capacity 4. Cells sickle under stress: fever, dehydration, acidosis, hypoxia 5. Labs: CBC, sickle turbidity, Hgb Electrophoresis 6. During a crisis: decreased Hgb, increased WBC, increased Bilirubin, increased Reticulocytes, blood sme 7. Diagnostics: Transcranial Doppler Test is done annually to assess risk for CVA 8. Vaso-Occlusive Crisis: most common, occurs when RBCs stick together which decreases blood to organ a. Mild to Moderate pain: Acetaminophen or Ibuprofen b. Severe pain: Opioid Analgesics c. Provide heat packs to joints d. 3+ doses of opioids = admission for pain control 9. Possible gallstones, stroke, eye problems, leg ulcers 10. Medications: Hydroxyurea: prevents formation of sickled RBCs, pain meds  11. Procedures: Exchange Perfusions: replaces sickled cells with normal cells, Hematopoietic Stem Cell Tra 12. Education: promote growth, healthy diet, hydration, stress management, immunizations, early managem 3. A 10-year-old with asthma Asthma: 1. Narrowed / Inflamed Airway 2. Risk Factors: family history of asthma and allergies, exposure to smoking, low / overweight 3. Assessment: Dyspnea, cough, audible wheezing, accessory muscle use, tripod positioning, inaudible bre 4. Diagnostics: PFTs / Peak Flow Meter 5. Medications: Corticosteroids, Albuterol, Montelukast. a. ER / PICU: Theophylline, Magnesium Sulfate 6. Assess airway, respirations, use of accessory muscles, educate about medications and triggers 4. A 16-year-old with cystic fibrosis Cystic Fibrosis: 1. Thick mucus in lungs 2. Early signs: wheezing, rhonchi, dry-non productive cough 3. Increased signs: dyspnea, emphysema, atelectasis 4. Advanced signs: cyanosis, barrel chest, clubbing 5. Large, greasy, bulky, foul stool 6. Assess lung sounds, respiratory, growth and development, PIV, sputum culture 7. Education: High calorie and high protein diet, enzymes 30 minutes before meals, oral fluids, stool soften 5. A 3-year-old with Hirschsprung's Disease Hirschsprung’s Disease:  1. No nerve cells in the distal bowel and rectum 2. Assessment: constipation since birth, abdomen distension, observable peristaltic waves, ribbon-like stoo 3. Diagnosis: Rectal Biopsy (for ganglion cells), x-ray 4. Management: surgery (once or twice), high calorie, high protein, low-fiber diet, possible TPN 5. Monitor for signs of Enterocolitis: foul-smelling diarrhea, fevers, abdomen distension, poor feeding, letha a. Management for Enterocolitis: ABX, IVF, bowel decompression 6. A 7 year old with ALL 1. WBCs become neoplastic 2. Early signs: low grade fever, pallor, increased bruising / petechiae, enlarged liver / lymph nodes / joints, v 3. Late signs: pain, hematuria, mouth ulcers, enlarged kidneys, increased ICP 4. Labs: CBC: anemia, thrombocytopenia, neutropenia, leukemic blasts (immature WBCs), blood smear 5. Diagnostics: a. Bone Marrow Aspiration / Biopsy (#1): will show immature leukemic blast cells, assist provider, to 7. A 4-week-old with pyloric stenosis Pyloric Stenosis: 1. Thickened pyloric sphincter = narrowing and obstruction 2. Assessment: projectile vomiting, failed formula changes, olive-shaped mass in RUQ, dehydration, fluid a 3. Diagnostic: ultrasound 4. Management: correct fluid and electrolyte imbalances 5. Considerations: IVF before surgery, NPO, pain-management, slow-feedings after surgery (clear liquids) 8. a 12-month-old with intussusception Intussusception:  1. Telescoping of bowel on itself 2. Results in lymphatic and venous obstruction = edema 3. Sudden and excruciating intermittent pain, knees to chest, jelly-stools, sausage shaped palpable mass 4. Diagnostic: Ultrasound 5. Treatment: Air enema (causes bowel to untelescope), surgery if recurrence 9. A 5 year old with acute renal failure Acute Renal Failure: 1. Sudden decrease in renal function, kidneys no longer to excrete waste material, concentrate urine, and c 2. Risk Factors: a. Pre-renal: dehydration secondary to diarrheal disease or persistent vomiting, surgical shock and b. Intrinsic: damage to glomeruli, tubules, or renal vasculature or nephrotoxicity (glomerulonephritis c. Post-renal: obstruction (renal calculi, enlarged prostate, stroke) 3. Labs / Diagnostics: Hyperkalemia, hyponatremia, hypocalcemia, acidosis, anemia, elevated BUN / creat 4. Expected findings: oliguria, abrupt diuresis, edema, drowsiness, cardiac arrhythmias (from hyperkalemia 5. Nursing care: treat underlying cause, admit to PICU, strict I/Os, daily wights, slow IVF, urinary catheteriz 6. Medications: Mannitol / Furosemide: help provoke a flow or urine in a child who has oliguria a. Calcium Gluconate: reduces blood potassium levels, can give every 2-4 minutes, ECG monitor b. Sodium Bicarbonate: elevates blood pH and to reduce potassium, every 30-60 minutes c. Glucose and Insulin IV: reduces potassium levels, causes glucose and potassium move into cells d. Antihypertensives 10. A 12 year old with a leg fracture Leg Fracture: 1. Assessment: pain, crepitus, deformity, edema, ecchymosis, warmth of redness, decreased use of affecte 2. Nursing care: assess neurovascular status, remove jewelry or object that can cause constriction, provide  3. Medications: NSAIDs, opioids, immunizations (TDAP for open fractures), antibiotics 4. Casting: should be moved into proper alignment prior to cast 5. Traction: used when fractured bone cannot be moved into alignment manually, weight exerts traction fati 6. Nursing considerations: assess 6 P’s, neurovascular status every 2 hours, signs of Fat Embolism and Co 11. A 5-year-old with rheumatic fever Rheumatic Fever: 1. Autoimmune inflammatory reaction 2. 2-4 weeks post-strep infection 3. Affects heart (carditis), blood vessels, joints 4. Assessment: carditis, subcutaneous nodules, polyarthritis (elbows and knees), rash, chorea (purposeles 5. Diagnostics: Blood Antistrep O titer (#1), Strep Swab, increased CRP, increased ESR, Echo (pericardium 6. Considerations: education (finish antibiotics), bed-rest, prevention 7. Treatment: Antibiotics to treat and prevent complications (BID Penicillin or monthly IM Penicillin), length 12. A 14 year old with nephrotic syndrome Nephrotic Syndrome: 1. Protein (albumin) passes to uterine which decreases blood osmotic pressure which leads to proteinuria, 2. Primary: unknown, several causes such as metabolic, biochemica, physicochemical disturbances in the 3. Secondary: due to glomeruli damage: lupus, diabetes, heart failure 4. Assessment: weight gain, periorbital and facial edema (decreases throughout the day), ascites, lower ex 5. Labs: 24 hour urine, decrease albumin, increased lipids 6. Diagnostics: kidney biopsy 7. Considerations:Fluid status, swelling, administer albumin and steroids to decrease swelling, infection, ca 8. Medications: Prednisone, Furosemide, 25% Albumin: increases plasma and decreases edema (monito Nephrotic Syndrome  Age HR RR SBP Newborn 110-160 30-60 50-75 1-6 months 100-160 30-60 70-95 6 months 90-120 25-40 80-100 1 year 90-120 20-30 80-100 3 years 80-120 20-30 80-110 6 years 70-100 18-25 80-110 10 years+ 60-90 15-20 90-120