pets 1

S/sx of asthma

SOB, chest tightness, expiratory wheeze, coughing, retractions, barrel chest, tachypnea

medical management of asthma

SABA, LABA, immunotherapy, steroids

diagnostics for asthma

CXR-hyperinflation

PFTs

ABGS-hypercapnia/

hypoxemia

etiology for asthma

triggers- allergies/cold/medications/stress

may be genetic

S/sx of cystic fibrosis

crackles, clubbing, barrel chest, thick mucus, edema, JVD, pancreatic/liver involvement, decreased albumin

medical management cystic fibrosis

chest percussion, postural drainage, pancreatic enzymes, humidifier, cromolyn, corticosteroids, NSAIDS

diagnostics for cystic fibrosis

newborn screening for genetic mutation, sweat chloride test \>60mEq, CXR (hyperinflation, chronical wall thickening, infiltrates), fecal fat, PFT's (decreased vital capacity, decreased exp. volume)

etiology of cystic fibrosis

deletion in chromosome 7

S/sx of pertussis

nasal congestion, watery eyes, sneezing, intense coughing fits, "100 day cough"

medical management of pertussis

ABX, O2, IV/PO hydration, droplet isolation

diagnostics for pertussis

nasopharynx/throat culture gold standard

etiology for pertussis

bacterial infection d/t bordella pertusis

S/sx of TB

Latent- asymptomatic

Active- cough, weight loss, night sweats, wheezing in infants, fever, lymphadenopathy

medical management of TB

Airborne isolation, rifampin, ethambutol, pyrazinamide

diagnostics for TB

CXR, PPD, sputum culture

etiology of TB

exposure to mycobacterium tuberculosis

S/sx of epiglottitis

abrupt onset, sore throat, tripoding, retractions, high fever, diaphoresis, tachypnea

diagnostics for epiglottis

neck x-ray-thumb sign, throat culture if airway secured

medical management of epiglottitis

DO NOT VISUALIZE THROAT. keep child quiet, ABX, IVF, CPOX

etiology of epiglottitis

bacterial infection, most commonly haemophiles influenza

S/sx of otitis media

ear ache, pulling at ears, fever, bulging/red eardrum, purulent drainage, crying, anorexia, crying, vomiting

medical management of otitis media

ABX, myringotomy, tympanostomy

diagnostics for otitis media

otoscopy, tympanometry

etiology of otitis media

viral or bacterial infection, bottle feeding supine may increase risk

post op tonsillectomy care

side lying or prone increases drainage, assess for hemorrhage (frequent swallowing may indicate bleeding), avoid coughing, avoid straw use, soft food, encourage hydration

tx for croup

racemic epi, O2, IVF, dexamethosone, albuterol

tx for PNA

ABX, IVF, O2

how to prevent bronchiolitis

vaccine- palivizumab

s/sx of respiratory distress

tachypnea, nasal flaring, retractions, coughing, tachycardia, hypercapnia, hypoxia, dusky nail beds, strong cry

s/sx of respiratory failure

cyanosis, lethargy, head bobbing, tachycardia, quiet breathing, tripod, seesaw respirations, hypoxemia, little or no crying

s/sx of VSD

right ventricular hypertrophy, murmur, systolic thrill at L sternal border, FTT, cardiomegaly, recurrent resp infections, SOB

diagnostics for VSD

ECHO, CXR, cardiac cath

medical management of VSD

surgery, monitor feeding tolerance, monitor for HF

etiology of VSD

congenital

s/sx of TOF

tet spells (marked increase in cyanosis), irritability, clubbing, murmur, tachycardia, polycythemia, right ventricular hypertrophy

medical management of TOF

prostaglandin E1 IV drip, surgical repair, O2

diagnostics for TOF

ECHO, s/sx

etiology of TOF

commonly associated with DiGeorge and down syndrome

s/sx of TSS

fever, chills, malaise, fatigue, hypotension, vomiting, decreased UO, bruising, decreased liver function

medical management of TSS

ABX, IVF, vasopressors, blood transfusions

diagnostics for TSS

s/sx, culture, hx

etiology of TSS

most often tampons left in for too long

s/sx of heart transplant rejection

fever, decreased UO, tachycardia/pnea, weight gain, activity intolerance

s/sx of cardiomyopathy

fatigue, edema, SOB, hepatomegaly, sweating with feedings, dysthymias

diagnostics for cardiomyopathy

EKG, ECHO, CXR, cardiac cath

medical management of cardiomyopathy

diuretics, antiarrhythmics, ACES, blood thinners, BB

etiology of cardiomyopathy

chemo, viral infections, genetics, persistent arrythmias

Nursing care s/p cardiac cath

monitor insertion site for bleeding

Function of prostaglandin E1 drip

vasodilator, keeps the PDA open

heart sounds with VSD

murmur, systolic thrill at L sternal border

describe dilated cardiomyopathy

enlarged, weak, and ineffective

describe hypertrophic cardiomyopathy

enlarged heart, leaky valves,

describe restrictive cardiomyopathy

heart becomes rigid and fails to relax

what medications should be avoided in cardiomyopathy

Dig, verapamil, ADHD meds

discharge teaching s/p heart transplant

provide education on s/sx of rejection, medications will be taken lifelong to prevent rejection and maintain optimal function of the heart

heart surgery post op care

VS, need ABX with dental treatments, monitor site, monitor labs

tx of tet spells

knees to chest to reperfuse brain

Define a neural tube defect

incomplete closure of the neural tube

What are neural tube defects commonly caused by

folate deficiency, genetics, environmental

what are the 4 types of neural tube defects

spina bifida cystica, spina bifida occulta, meningocele, chiari malforation

s/sx of spina bifida cystica

paralysis and hydrocephaly

s/sx of spina bifida occulta

hairy patch on lower back, dimple or mass, nerves unaffected

S/sx of chiari malformation

dizziness, headache, numbness, vision problems

treatment for neural tube defects

surgery in utero or post natal

how to measure head circumference

measure with a disposable tape above the eyebrows around the largest part of the head

What is hydrocephalus?

obstruction of the cerebral duct that leads to extra CSF in the ventricles

s/sx of hydrocephalus

high pitched cry, vomiting, lethargy, head ache, poor PO intake, sluggish pupils

tx for hydrocephalus

VP shunt

Nursing care for seizure management

make area safe, stay with child until seizure is over, loosen tight clothing, do not put anything in mouth, check a BG after, administer medications as prescribed

Medications/routes for seizure management

Diazepam PR, Depakote PO, Valproic acid PO/IV

Complications of VP shunt

infection, over drainage, malfunction

s/sx of tourettes

involuntary motor tics, verbal tics, eye blinking, grimacing, switches, sniffling

normal fontanel findings

soft, even with skull

Abnormal Fontanelle Findings

bulging, depressed

S/sx of increased ICP

Increased CPP, Cushing's triad, decreased LOC, nausea

formula to calculate CCP

MAP-ICP

formula to calculate MAP

diastolic + 1/3 (systolic+diasolic)

value for increased ICP in infants <1yo

\>15

value for increased ICP in children \>1yo

\>20

tx for increased ICP

mannitol, 3% NS, hyperventilation, EVD/IVD, pentobarbital

s/sx of beckers muscular dystrophy

progressive weakness of the legs, usually noticeable around 12 y/o, cardiomyopathy may occur

What is Cushing's triad?

hypertension

bradycardia

irregular respirations

Describe Dandy-Walker syndrome

enlargement of the 4th ventricle, malformations of heart, face, limbs and digits common,

What is meningitis?

inflammation of the meninges d/t viral or bacterial infection

nursing care for s/p VP shunt

assess for increased ICP, assess pain, monitor for infection, HA, patency of shunt

examples of accidental TBIs

falls, MVA

examples of non-accidental TBIs

abuse, assaults

sign of a non accidental TBI

cerebral hypoxic ischemia

nursing care for a TBI

Airway, breathing, C-spine, fluid and electrolyte management, sedation, ICP monitoring, vasopressors, head CT minimize secondary brain injuries