peds 2 SG

Digoxin

rapid onset, narrow margin of safety

Digoxin dosing

every 12 hours, at same time, if dose missed within 4 hours can readminister, do not readminister if child vomits

Digoxin considerations

low K enhances effects, hold for HR in infants 90, child 70, teen 60

Ace inhibitor

reduce afterload, BP and HR before giving, teratogenic

Ace inhibitor drugs

PRIL

Beta blockers

vasodilation, not for asthma, BP and HR before giving

Beta blockers drugs

OLOL

Cardiac catheterizations

can be diagnostic or interventional

Cardiac catherizations pre op

ht/wt, history, NPO, allergy, s/s infection (diaper rash!), assess and mark bilateral pulses, baseline VS

Cardiac catheterization post op

pulse checks below, if bleeding apply pressure above site and call for help, flat in bed for 4 to 8 hours

Cardiac catheterizations teaching

keep covered 2 to 3 days, no tub baths, no strenuous activity, remove dressing next day, diet as tolerated, monitor for infection

Congestive heart failure

tachypnea (early sign) , SOB, swelling in legs and feet

Congestive heart failure

heart cannot pimp an adequatre amount of O2 to body; poor perfusion leads to oxygenation issues

Rheumatic fever

inflammatory autoimmune disease, from prior group A beta hemolytic strep infection, strep antibodies (inflammation of connective tissue) heart valves

Rheumatic fever who

symptoms appear 2 to 6 weeks after untreated, not fully eradicated strep infection, upper resp infection

Rheumatic fever presentation

recent strep infection, JONES criteria, minor criteria (fever, ESR, arthralgia, long PR interval, CRP, positive strep titers)

CRP and ESR high

inflammation indicator

JONES criteria *R fever

Joints (polyarthritis) Carditis (bleeding lesions around heart) Nodules (subcutaneous) Erythema marginatum (rash) Sydnham chorea (uncoordinated movements)

Rheumatic fever nursing care

prophylaxis antibiotics for dental work, VS monitor, control joint pain, bedrest during febrile phase, seizure precautions

Tetralogy of fallot

decreased pilmpmay blood flow

Tetralogy of fallot defects

pulmonary stenosis, overriding aorta, VSD, right ventricular hypertrophy

Tet spell

hypoxemia and hypercyanotic

Hypoxia

cyanosis, polycythemia, clubbing, squatting, resp distress, metabolic acidosis

Hypercyanotic spell

sudden, brought on by stress (crying illness) emergency, flex knees and hips, call for help, keep calm

Kawasaki disease

mucocutaneous lymph node syndrome, acute systemic vasculitis of unknown cause

Kawasaki disease who

young children, most common acquired heart disease in children, cardiac issues are most serious complication, not contagious

Kawasaki disease acute

FEVER, conjunctival hyperemia, enlarged cervical lymph nodes, irritable, red throat, swollen hands, rash, fever, dry lips

Kawasaki disease subacute

Begins when fever ends; cracked lips, peeling of hands/feet thrombocytosis, joint pain, continued irritability, cardiac manifestations

Kawasaki disease convalescent phase

normal appearance from outside, until LABS normal, IRRITABLE, signs of inflammation, may go on for months, joint pain and irritability

Kawasaki disease nursing care

fever control, monitor for s/s of IVIG transfusion reactions, child may be hypersensitive to touch/light/other stimulation

Kawasaki disease aspirin

BENEFIT outweighs risk of reye's disease, give in high dose

Kawasaki disease meds

aspirin prescribed for antipyretic and antiplatelet effect, high dose until no fever, low dose until platelet counts returns to normal

Kawasaki disease parent education

necessary frequent ECHOs, NO contact sports, irritability can last 2 months, no live vaccine for year after IVIG administration, s/s bleeding and cardiac complications

4.5 to 13.5

WBC

12 to 16

Hemoglobin

34 to 50

Hematocrit

140 to 440

platelet

Low platelet

excessive bleeding, bruising, pinpoint (petechiae) rash, low pulse ox

Low hemoglobin and hematocrit

low energy, pale

Sickle cell crisis

illness, fever, emotional or physical stress

HBG A

normal

HGB S

abnormally sickled shape

Pain plan

similar to asthma action plan but for sickle cell

Hydroxyurea SC

increase flexibility of RBC

Folic acid SC

help with RBC production

Oral penicillin prophylaxis SC

2m to 5 yrs due to risk of death from sepsis

Stool softener SC

as needed, sometimes routine due to pain meds

Sickle cell

use heat packs, avoid cold packs

Sickle cell infant

measure and girth

Sickle cell nutrition

high fat, high calorie, HYDRATION

Hemophilia

bleeding disorder, platelets are not affected = coagulation protein deficiency

Hemophilia A

VIII (8) deficiency of coagulation protein

Hemophilia B

IX (9) deficeicny of coagulation protein

Hemophilia CM

bleeding episodes and lab findings of clotting times, identification of specific coagulation deficiency, abnormal bleeding response to trauma or surgery, bruising, abnormal bleeding response to trauma or surgery, frequent epistaxis

Hemophilia sign

bleeding cascade

Joint bleeding care

RICE (rest, ice, compress, elevate)

No ROM

DURING bleeds

Hemophilia

no contact sports but encourage activity

Hemophilia care

joint bleed care (RICE), no ROM during bleeds, replace clotting factor (prophalaxis), monitor for hematuria, prevent bleeds, at risk for intracranial hemmorrge

ADHD

inattention, overactivity, impulsive behavior

ADHD dx

early is imperative, made by self report, teacher observation and parent report (Must be in more than one setting)

ADHD test

vanderbilt screening

ADHD care

behavioral therapy and meds, limit setting, create routine and consistency, praise positive behavior, CONSISTENCY is key

ADHD meds

addreall and ritalin

ADHD med ADR

appetite suppression, nervousness, insomnia

Febrile seizure

unusual after age 5

Hydrocephalus

increased level of CSF within the ventricles of the brain causing increased ICP/head enlargement

Hydrocephalus types

obstructive (non communicating), communicating (impaired absorption, communicating but not the way it should)

Ventriculoperitoneal shunt

internal, straw to drain excess CSF into abdomen to be absorbed and excreted

Ventriculoperitoneal shunt complications

infection, can move around, frequent revisions as child grows

Ventriculoperitoneal shunt pre op

NPO, position for comfort, protect skin integrity, family support and education (educate on signs of increased ICP)

Ventriculoperitoneal shunt post op

VS, neuro checks, position flat on operative side, monitor s/s increased ICP, measure HC, comfort measures, strict I&O, antiemetics due to risk of vomit, bowel sounds present before PO feeds, risk of infection (antibiotics necessary), assess for leakage, peritonitis, malfunction/occlusion

Hydrocephelus infant

high shrill cry, irritability, lethargy, poor feeding

Hydrocephalus toddler

headache, lack of appetite, falling over/lack of coordination

Hydrocephalus older child

alteration in LOC

Meningitis

inflammation of meninges and CSF

Meningitis CM

acute onset, muscle pain, confused with flu, neck pain, increased ICP, toxic appearance, photosensitive

Meningitis dx

lumbar puncture

Meningitis IV antibiotics

priority intervention, start immediately (definitive diagnosis will take 72 hours) (rifampin, cetrifaxone, ciprofloxcin)

Meningitis antibiotics also for

direct contact with patient (family members, direct exposure to patients secretions = ate/slept/stayed in the home; flights over 8 hours)

(Meningitis) Brunzinski sign

life head when supine, positive if patient flexes knees

(Meningitis) kernig's sign

flex hip to 90, extend knee, positive if patient experiences back pain

Meningitis spinal fluid

decreased glucose, cloudy appearance, increased WBC, increased protein

Meningitis care

strict I&O, NPO, IV fluid, frequent vitals, droplet and seizure precautions, quiet calm enviorment, HOB slightly elevated

Seizure care

time of onset, aura/behavior before, monitor for apnea, cyanoisis, post pehavior, nothing in mouth, turn if risk for aspiration

Seizure long term care

medications (taise threshold of excitability, sleepy is a side effect, taper when discontinuing), vagal nerve stimulator, ketogenic diet, surgery

Reye syndrome goal

minimize cerebral perfusion and control increasing ICP

Reye syndrome

acute encephalitis, swelling in the liver and brain (found by liver biopsy)

Reye syndrome CM

fever, vomiting, dehydration, general malaise, progressive neuro deterioration, increased ammonia levels, history of viral illness in 4 to 7 days

Reye prevention

NO aspirin in kids

Reye syndrome treatment

rest, decreased stimulation, frequent VS, Q2 neuro checks, seizure, Vitamin K, IV glucose, anticonvulsants, diuretics, strict I&Os, miralax

Reye syndrome labs

elevated liver function, prolonged PT & PTT, hypoglycemia, elevated ammonia level tx, normal bilirubin

Depression

family history, traumatic event, sad expression, withdrawing from friends and fam, tearful, wt loss or gain

Depression meds

tricylic antidepressant, SSRI

Congenital clubfoot treatment

serial casting immediately after birth, new cast q 1 to 2 weeks or surgery if not corrected in 3 to 6 m

Congenital clubfoot

diagnosed at birth, forefoot pointed / midfoot turned out / hindfoot varus / ankle equinus

Congenital clubfoot goal

flat food for panless walking

Duchenne Muscular dystrophy

degeneration of muscle fibers (ALS in kids)

Duchenne Muscular dystrophy hallmark

persistent gowers maneuver (tripod and climb to stand) AFTER age 3

Duchenne Muscular dystrophy who

almost all males, X linked recessive trait, develops 3 to 5yrs