week 2 infant reveiw (coup, bronchitis, febril seizure, vsd, asd, trollogy of fallot, congestive heart failure)

A parent asks why their child's croup symptoms seem to worsen significantly at night. Which physiological explanation should the nurse provide?

Endogenous cortisol levels decrease at night and airway edema increases in the supine position.(lying flat increases venous return to the upper airway, worsening localized edema.)

A nurse is assessing an infant with a large Ventricular Septal Defect (VSD) for signs of congestive heart failure. Which findings are consistent with this peds-specific diagnosis?

Periorbital and sacral edema. Hepatomegaly. Tachycardia, tachypnea

Which anatomical feature of the pediatric airway specifically increases the risk of upper airway obstruction during an inflammatory process like croup?

A long, floppy epiglottis that is vulnerable to swelling.

During the peak of bronchiolitis (days 3-5), what clinical trend should the nurse most closely monitor for?

A VQ mismatch leading to worsening hypoxemia as airway obstruction peaks. (As mucus and sloughed cells peak, air cannot reach the alveoli effectively, leading to a Ventilation-Perfusion mismatch.)

A nurse is administering Enalapril (an ACE inhibitor) to an infant with VSD. What is a critical nursing consideration for this medication based on the lecture material?

Monitor for hypotension and avoid assuming 'cough' is the primary side effect to watch for.

What is the primary goal of administering Furosemide (Lasix) in the context of an infant with a large VSD experiencing new crackles and periorbital edema?

To decrease preload by removing accumulated fluid and sodium.

A child presents with inspiratory stridor, a barking cough, and suprasternal retractions. Which interventions should the nurse prioritize to keep the child calm?

• Provide 'comfort measures' like stickers or favorite clear fluids if appropriate.

• Encourage 'parental presence' and allow the parent to hold the child during assessments.

• Minimize unnecessary interactions and cluster all invasive procedures.

Why is 'flattening of the head' (plagiocephaly) a specific risk for infants with chronic conditions like a large VSD or TEF?

Long-term hospitalization often results in the infant lying in one position for extended periods.

An infant is noted to have a respiratory rate of 80 bpm, nasal flaring, and 'chest-wall in-drawing'. Which classifications of respiratory distress are being demonstrated?

• Increased work of breathing

• Compensatory respiratory mechanism.

• Tachypnea

What does the term 'RSV Syncytia' refer to in the context of bronchiolitis pathophysiology?

The fusion of infected respiratory epithelial cells into large, multi-nucleated masses.

what is the Primary are infants under 6 months of age at higher risk for hypoxemia during a simple viral upper respiratory infection (URI)?

They are obligate nose breathers, and nasal congestion can easily occlude their primary airway.

An infant with VSD is receiving oxygen via nasal cannula. The nurse notes that the infant's respiratory rate has increased from 40 to 65 bpm over the last 4 hours. What is the most appropriate next step in the 'Responding' phase of the nursing process?

Assess for other signs of heart failure (edema, hepatomegaly) and consider the need for 'NPO' status.

A nurse is evaluating the effectiveness of Lasix (furosemide) administration in an infant with VSD. Which finding most directly indicates a positive response to the medication?

Weight loss of 150 grams and increased urine output in the last 8 hours.

S/S of VSD

“HOLE”

H: heart failure and pulmonary edema

• dyspnea, fatigue, edema, crackles, sweating (activation of sympathetic NS

O: often lung infections

L: low growth weight, loss of weight

E: extra heart sounds (murmur)

Medication interventions for VSD

• digoxin: stronger slower contractions

• Diuretics: remove excess fluids

• Ace inhibitors: decrease bp= decrease LV BP= decrease left to right shunting

What do you have to be carful of when combining digoxin with diuretics?

Use a potassium sparing diuretic because otherwise the low serum potassium can cause digoxin toxicity

If VSD goes untreated what conditions can occur (in order)

1. Pulmonary hypertension

2. Heart failure

3. Eisenmenger syndrome

What are the 4 defects in tetralogy of fallot

“RAPS”

R: right ventricular hypertrophy

A: aorta displacement

P: pulmonary stenosis

S: septal defect

S/S of tetralogy of fallot

“AFFLICT”

A: activity causes cyanosis and tet spells

F: fingernail changes (clubbing)

F: fatigues/ faints easy

L: lifts knees to chest

I: inability to grow

C: cardiac sounds (murmur and thrills)

T: trouble feeding and thriving

Treatment for tetralogy of fallot

• alprostadil/prostaglandin E: keeps ductus arteriosus open and allows for blood to shunt from aorta to pulmonary artery in newborns

• Surgury

What is the main goals during a tet spell

• increase systemic vascular resistance

• Decrease metabolic rate

3 c’s to treat tetralogy of fallot

Clamp: increase screen

Chill out: morphine or ketamine (reduces agitation)

Correct: hypoxic induced acidosis (admin o2; bicarbonate)- decreases pulmonary vascular resistance ( decreases vasoconstriction of pulmonary capillaries so increases gas exchange)