NURS 409 Pediatric Nursing: Perfusion, Gas Exchange, Sensory Perception, Infectious Diseases, and Pain Management

Comprehensive practice flashcards covering pediatric cardiovascular, respiratory, sensory, communicable, and pain management alterations for NURS 409.

Perfusion

The mechanism that facilitates the movement of blood through the tissues.

Congenital Heart Disease (CHD)

A category of pediatric cardiovascular disorders characterized by structural cardiac defects present at birth.

Acquired Heart Disease

Cardiovascular disorders that develop after birth from various causes such as infection, autoimmune disease, or environmental factors.

Preload and Afterload

Preload is the volume of blood in ventricles at the end of diastole (end diastolic pressure), increased in hypervolemia, valve regurgitation, and heart failure; afterload is the systemic resistance the left ventricle must overcome to circulate blood, increased in hypertension and vasoconstriction.

Foramen Ovale

An opening between the right and left atria in fetal circulation that allows blood to flow from right to left; closes after birth due to increased left atrial pressure following the first breath.

Ductus Arteriosus

A fetal vascular channel connecting the pulmonary artery directly to the aorta, shunting blood away from the unexpanded fetal lungs; closes shortly after birth and later becomes the ligamentum arteriosum.

Ductus Venosus

A fetal blood vessel connecting the umbilical vein to the inferior vena cava; closes after birth due to lack of blood flow and vasoconstriction, eventually becoming the ligamentum teres.

Fetal to Neonatal Circulation Transition

At the first breath, newborn lungs inflate, causing a drop in pulmonary vascular resistance and pulmonary artery pressure; blood flow shifts to the left side of the heart, closing the foramen ovale, ductus arteriosus, and ductus venosus.

Pediatric Apex Placement

In children younger than $7$ years of age, the heart lies more horizontally in the chest cavity, resulting in the apex being positioned higher than in adults.

Pediatric Heart Growth Stages

Between ages $1$ and $6$, the child's heart is four times its birth size; between ages $6$ and $12$, it reaches $10$ times its birth size.

Infant Heart Rate and Cardiac Output

Infants have a naturally higher baseline resting heart rate than adults, which limits their physiological capability to increase cardiac output solely by elevating heart rate.

Disorders with Decreased Pulmonary Blood Flow

Cyanotic congenital heart defects characterized by obstruction of pulmonary blood flow and an anatomical defect connecting right and left sides; examples include Tetralogy of Fallot and tricuspid atresia.

Disorders with Increased Pulmonary Blood Flow

Acyanotic congenital heart defects characterized by left-to-right shunting of blood, increasing pulmonary congestion and cardiac workload; examples include patent ductus arteriosus (PDA), atrial septal defect (ASD), and ventricular septal defect (VSD).

Obstructive Cardiovascular Disorders

Congenital heart defects in which blood flow is mechanically obstructed through a cardiac valve or great vessel; includes coarctation of the aorta, aortic stenosis, and pulmonary stenosis.

Mixed Cardiac Disorders

Complex congenital anomalies in which saturated and desaturated systemic and pulmonary blood mix within the heart chambers, reducing systemic arterial oxygen saturation and cardiac output; examples include TGV, TAPVR, truncus arteriosus, and HLHS.

Tetralogy of Fallot (ToF)

A cyanotic congenital heart defect consisting of four distinct structural anomalies: pulmonary stenosis, ventricular septal defect (VSD), overriding aorta, and right ventricular hypertrophy (RVH).

Hypercyanotic Spell ("Tet Spell")

An acute, sudden-onset episode of severe cyanosis, hypoxemia, dyspnea, and agitation observed in children with Tetralogy of Fallot, frequently triggered by crying, feeding, or exertion.

Squatting (Knee-Chest Position)

A compensatory posture adopted by toddlers with Tetralogy of Fallot during a hypercyanotic episode to relieve hypoxemia by increasing systemic vascular resistance and improving pulmonary blood flow.

Tricuspid Atresia

A congenital heart defect where the tricuspid valve between the right atrium and right ventricle fails to develop, resulting in no blood entering the lungs via the pulmonary artery without an atrial septal defect.

Atrial Septal Defect (ASD)

A hole or defect in the interatrial septum that allows oxygenated blood to shunt from the higher-pressure left atrium to the lower-pressure right atrium; small defects may close spontaneously within the first $18$ months of life.

Ventricular Septal Defect (VSD)

An abnormal opening between the right and left ventricles that allows left-to-right shunting of blood; accounts for approximately $25\%$ of all congenital heart defects, and small defects frequently close spontaneously by age $2$.

Patent Ductus Arteriosus (PDA)

Persistence of the normal fetal connection between the aorta and pulmonary artery after birth, accounting for $10\%$ of CHD cases and leading to left-to-right shunting and increased pulmonary vascular congestion.

Indomethacin

A nonsteroidal anti-inflammatory drug that inhibits prostaglandin synthesis in premature neonates to stimulate the closure of a patent ductus arteriosus (PDA).

Coarctation of the Aorta

Congenital localized narrowing of the aorta typically near the ductus arteriosus, resulting in elevated proximal pressures to the upper extremities and decreased distal pressures to the lower extremities.

Coarctation Blood Pressure Gradient

A clinical assessment finding in coarctation of the aorta where systolic blood pressure measured in the upper extremities is approximately $20\,\text{mmHg}$ higher than in the lower extremities.

Aortic Stenosis

Congenital narrowing or obstruction of blood flow between the left ventricle and the aorta, accounting for $5\%$ of CHD, leading to left ventricular hypertrophy and presenting with a systolic murmur radiating to the right upper sternal border.

Pulmonic Stenosis

Obstruction of blood flow between the right ventricle and the pulmonary artery, causing right ventricular hypertrophy, decreased pulmonary blood flow, and symptoms of dyspnea and fatigue upon exertion.

Transposition of the Great Vessels (TGV)

A congenital heart defect where the pulmonary artery arises from the left ventricle and the aorta arises from the right ventricle, creating two separate parallel circuits and causing organs to receive poorly oxygenated blood.

Cyanosis Without Murmur in Newborn

A classic diagnostic presentation in neonates that strongly indicates Transposition of the Great Vessels (TGV), requiring immediate echocardiographic confirmation.

Hypoplastic Left Heart Syndrome (HLHS)

The fourth most common congenital heart anomaly, characterized by severe underdevelopment of all left-sided cardiac structures (mitral valve, aortic valve, and left ventricle), rendering systemic circulation nonfunctional without surgical staging or transplantation.

Cardiac Catheterization

An invasive fluoroscopic diagnostic or interventional procedure providing a anatomical road map of heart arteries, pressures, valves, chambers, and cardiac muscle function, typically performed via femoral access.

Post-Cardiac Catheterization Positioning

A mandatory postoperative nursing intervention requiring the pediatric patient to remain flat with the affected extremity extended for $4$ to $8$ hours to prevent puncture site hemorrhage or hematoma formation.

Post-Cardiac Catheterization Vital Sign Protocol

Monitoring of vital signs, neurovascular checks of the lower extremities, and site pressure dressing checks every $15$ minutes for the first hour, and every $30$ minutes for the second hour.

Alprostadil

A prostaglandin $E_1$ intravenous infusion that directly vasodilates the smooth muscle of the ductus arteriosus to maintain patency in neonates with ductal-dependent congenital heart defects; carries an apnea risk in $10\%\text{--}20\%$ of neonates.

Digoxin Pediatric Withholding Parameters

A cardiac glycoside that increases contractility; the apical pulse must be counted for one full minute prior to administration and withheld if the pulse is $< 90\,\text{bpm}$ in an infant or $< 60\,\text{bpm}$ in an adolescent.

Digoxin Toxicity

Adverse drug reaction characterized by serum levels exceeding the therapeutic range ($0.8\text{--}2\,\text{ng/mL}$), presenting clinically with bradycardia, nausea, vomiting, diarrhea, lethargy, or visual halo disturbances.

Spironolactone

A potassium-sparing diuretic that competes with aldosterone to increase water and sodium excretion while retaining potassium, indicated for managing pediatric heart failure and hypertension.

Pediatric Congenital Heart Feeding Protocol

Restricting infant feeding duration to no more than $20$ minutes per feed to prevent excessive caloric expenditure, administering any remaining volume via orogastric or nasogastric gavage tube.

Pediatric Heart Failure

A clinical syndrome reflecting the heart's inability to pump effectively to provide adequate blood, oxygen, and nutrients to body tissues, most commonly occurring secondary to congenital heart disease.

Oxygen Caution in Left-to-Right Shunts

A physiological warning that supplemental oxygen acts as a potent pulmonary vasodilator, lowering pulmonary vascular resistance and increasing systemic resistance, which dangerously exacerbates left-to-right shunting.

Infective Endocarditis (IE)

A microbial infection of the endothelial lining of the heart's chambers, septum, or valves, characterized by turbulent blood flow causing platelet-fibrin deposition and vegetation formation.

Peripheral Manifestations of Infective Endocarditis

Characteristic physical findings of infective endocarditis including Osler nodes (painful red nodules on finger/toe pads), Janeway lesions (painless flat red spots on palms/soles), Roth spots (splinter hemorrhages with pale centers), and subungual splinter hemorrhages.

Osler Nodes

Painful, palpable, red erythematous nodules located specifically on the pads of the fingers and toes in patients with infective endocarditis.

Janeway Lesions

Painless, flat, erythematous or bluish macules and hemorrhagic spots found on the palms of the hands and soles of the feet in patients with infective endocarditis.

Roth Spots

Retinal hemorrhages with pale, white centers visible on ophthalmoscopic exam in patients with infective endocarditis.

IE Prophylaxis Protocol

Oral or IV antibiotics administered exactly $1$ hour prior to dental work, invasive respiratory procedures, or infected soft tissue treatments in patients with high-risk congenital heart defects.

Acute Rheumatic Fever (ARF)

A delayed autoimmune inflammatory multi-system illness affecting joints, CNS, skin, and heart, developing $2$ to $4$ weeks following untreated Group A beta-hemolytic streptococcal pharyngitis in children aged $5\text{--}15$.

Modified Jones Criteria

Diagnostic criteria for acute rheumatic fever requiring documentation of recent streptococcal infection plus two major criteria OR one major and two minor criteria.

Erythema Marginatum

A major diagnostic criterion for acute rheumatic fever presenting as a transitory, nonpruritic erythematous macular rash on the trunk and proximal extremities featuring distinct red elevated margins and clear centers.

Sydenham Chorea

A neurological manifestation of acute rheumatic fever characterized by involuntary, random, purposeless, jerky movements of the upper extremities and facial twitching that can persist for several months.

Cardiomyopathy

A disease of the heart muscle in which the myocardium cannot contract properly ($1\,\text{per } 100{,}000$ children), resulting in heart failure symptoms and often requiring heart transplantation as the only long-term curative option.

Pediatric Hypertension Criteria

Blood pressure persistently at or above the $95\text{th}$ percentile for gender, age, and height on three separate, consecutive manual assessments.

Kawasaki Disease

An acute, self-limiting systemic vasculitis primarily affecting children aged $6$ months to $5$ years, lasting $6$ to $8$ weeks and carrying a $20\%\text{--}25\%$ risk of coronary artery aneurysms if untreated.

Strawberry Tongue

An oral manifestation of Kawasaki disease and scarlet fever characterized by a bright red, swollen, papillated tongue accompanied by dry, cracked erythematous lips.

Periungual Desquamation

A subacute hallmark feature of Kawasaki disease characterized by sheet-like peeling of the skin surrounding the fingernails and toenails.

Kawasaki Pharmacotherapy

Immediate administration of high-dose aspirin divided into four daily doses alongside a single high-dose intravenous immunoglobulin (IVIG) infusion to prevent coronary artery aneurysms.

Vaccine Delay After IVIG

A mandatory immunization protocol requiring live virus vaccines (measles, mumps, rubella, and varicella) to be deferred for exactly $11$ months following IVIG administration.

Pediatric Hyperlipidemia Cutoffs

Screening parameters targeting total cholesterol levels below $170\,\text{mg/dL}$ and low-density lipoprotein (LDL) levels below $110\,\text{mg/dL}$, with universal lipid screening recommended at ages $9\text{--}11$ and $18\text{--}21$.

Clubbing

Softening of nail beds followed by enlargement and rounding of the fingertips and toes, presenting typically after $1$ year of age as an indicator of chronic tissue hypoxia in cyanotic congenital heart disease.

Tracheal Bifurcation Level (Pediatric)

In children, the trachea bifurcates at the level of the $3\text{rd}$ thoracic vertebra ($T3$), compared to the $6\text{th}$ thoracic vertebra in adults, which increases the risk of right mainstem bronchus intubation and requires shallow suctioning.

Infant Obligate Nose Breathing

An anatomical respiratory variation where infants exclusively breathe through their nose until approximately $4$ weeks of age, making nasal congestion and small obstruction life-threatening.

Pediatric Airway Resistance Rule ($1\,\text{mm}$ Edema)

Due to a smaller baseline airway lumen, $1\,\text{mm}$ of circumferential edema exponentially reduces the cross-sectional airway diameter by up to $50\%$ in a young child, markedly increasing work of breathing.

Oxyhemoglobin Curve Right Shift

A physiological alteration caused by acidosis, hyperthermia, or hypercarbia that decreases hemoglobin's affinity for oxygen, promoting rapid oxygen unloading to peripheral tissues.

Oxyhemoglobin Curve Left Shift

A physiological alteration triggered by alkalosis, hypothermia, hypocarbia, anemia, or fetal hemoglobin that increases hemoglobin's affinity for oxygen, inhibiting release at the tissue level.

Retractions

Inward pulling of the soft tissues of the chest wall during inspiration, categorized anatomically as intercostal, subcostal, substernal, suprasternal, or supraclavicular.

Grunting

A compensatory expiratory sound produced by premature glottic closure in an infant attempting to preserve functional residual capacity and prevent alveolar collapse.

Tripod Position

A physical posture assumed by children in significant respiratory distress, sitting upright, leaning forward with arms supported on knees or bedside table to maximize lung expansion and airway diameter.

Rales (Crackles)

Fine crackling or discontinuous bubbling lung sounds auscultated when alveoli become fluid-filled, commonly heard in pneumonia.

Wheezing

A high-pitched musical sound heard during inspiration or expiration caused by turbulent airflow through narrowed or obstructed lower bronchioles, seen in asthma and bronchiolitis.

Stridor

A harsh, high-pitched, crowing inspiratory sound caused by obstruction, narrowing, or subglottic stenosis in the larynx or upper trachea, characteristic of croup and foreign body aspiration.

Oxygen Delivery Devices (Pediatric)

Devices for supplemental oxygen administration: nasal cannula delivers approximately $4\%$ oxygen concentration per $1\,\text{L/min}$ of flow; simple mask delivers $40\%$; nonrebreather mask delivers $80\%\text{--}100\%$ oxygen.

Paranasal Sinus Development

In young children, only the maxillary and ethmoid sinuses are present and susceptible to infection; the frontal sinuses do not fully develop until ages $8\text{--}10$ years.

Sinusitis (Rhinosinusitis)

A bacterial infection of the paranasal sinuses marked by persistent cold symptoms, nasal congestion, rhinorrhea, foul breath odor, eyelid swelling, cough, fever, and facial pain lasting up to $30$ days (acute) or longer (chronic).

Influenza (Pediatric Management)

A highly contagious viral infection characterized by sudden onset of high fever ($39.5^\circ\text{C}$), myalgias, rigors, and dry cough; treated with oseltamivir (Tamiflu) for $5$ days if initiated within the first $48$ hours of symptom onset.

Pharyngeal Exudate and Palatal Petechiae

Oropharyngeal examination findings consisting of erythematous tonsillar enlargement, purulent white exudate, and small pinpoint hemorrhagic lesions on the soft palate, suggestive of Group A Streptococcal pharyngitis.

Strep Throat Exclusion Guideline

Children with confirmed Group A Streptococcal pharyngitis on oral antibiotics are considered non-contagious and may return to school after completing a full $24$ hours of antibiotic therapy.

Tonsillectomy Postoperative Hemorrhage

A severe surgical complication characterized by fresh bleeding in the throat or frequent swallowing, which can occur up to $10$ days postoperatively as the surgical scab sloughs off.

Tonsillectomy Dietary and Activity Restrictions

Postoperative care requiring the avoidance of coughing, throat clearing, vigorous nose blowing, and consumption of red, brown, or citrus liquids that could obscure bleeding or irritate surgical sites.

Infectious Mononucleosis

A self-limiting viral infection caused by the Epstein-Barr virus (EBV), transmitted via oropharyngeal secretions and presenting with fever, malaise, sore throat, lymphadenopathy, splenomegaly, and hepatomegaly.

Monospot Diagnostic Window

A rapid heterophile antibody test for mononucleosis that carries a high false-negative rate during the first $7\text{--}10$ days of illness, whereas EBV specific antibody titers remain reliable throughout.

Contact Sports Restriction in Mononucleosis

Mandatory physical activity restriction prohibiting contact sports and strenuous exercise during active EBV infection to prevent life-threatening splenic rupture associated with splenomegaly.

Croup (Laryngotracheobronchitis)

A viral infection commonly caused by Parainfluenza virus in children aged $3$ months to $3$ years, characterized by subglottic inflammation, inspiratory stridor, hoarseness, and a barking, seal-like cough worsening at night.

Steeple Sign

A classic radiographic finding seen on an anteroposterior neck X-ray showing symmetric subglottic narrowing of the trachea resembling a church steeple in children with croup.

Racemic Epinephrine

An aerosolized medication that rapidly stimulates alpha-adrenergic receptors in the subglottic mucosa, producing vasoconstriction and decreasing mucosal edema in moderate to severe croup.

Epiglottitis

A medical emergency caused by Haemophilus influenzae type b in children aged $1\text{--}8$ years, presenting with high fever, toxic appearance, dysphagia, drooling, dysphonia, and severe respiratory distress.

Thumbprint Sign (Epiglottitis)

A lateral neck radiograph hallmark showing an enlarged, rounded, edematous epiglottis that protrudes into the hypopharynx, resembling an adult thumb.

Epiglottitis Throat Inspection Contraindication

An absolute nursing restriction prohibiting any attempt to visualize the throat or insert a tongue blade, which can precipitate immediate, complete, and fatal airway laryngospasm.

Bronchiolitis (RSV)

An acute viral lower respiratory infection primarily caused by Respiratory Syncytial Virus (RSV) resulting in necrosis of respiratory epithelium, small airway obstruction, copious mucus, wheezing, and air trapping.

RSV Symptom Peak Timeline

The clinical course of RSV bronchiolitis where respiratory symptoms and copious secretions progressively worsen before improving, consistently peaking in severity between days $3$ and $5$ of illness.

Abrysvo

A maternal RSV bivalent vaccine administered at $32\text{--}36$ weeks gestation that confers passive antibody protection to the infant against RSV for approximately $5$ months after birth.

Bronchitis

Inflammation of the major bronchi and trachea, often viral in etiology, characterized by fever and a dry, hacking cough that gradually becomes productive, managed primarily with supportive care.

Foreign Body Aspiration Radiograph

A chest radiograph demonstrating an aspirated radiopaque foreign object (such as a coin or button battery) lodged in the pediatric respiratory or upper digestive tract, requiring emergent airway protection.

Epistaxis Emergency Positioning

Instructing the child to sit upright and lean forward while applying firm, continuous pressure to the anterior cartilaginous portion of the nose for $10\text{--}15$ minutes to prevent blood aspiration.

Pneumothorax

An abnormal accumulation of air trapped within the pleural space resulting in partial or complete collapse of the affected lung, presenting with sudden chest pain, tachypnea, and asymmetric chest excursion.

Chest Tube Container Dislodgement Protocol

If a chest tube becomes dislodged from the drainage collection system, the tube must be clamped immediately or placed into a container of sterile water/saline to re-establish a water seal and prevent air entry.

Chest Tube Patient Insertion Dislodgement

If a chest tube is accidentally pulled completely out of the patient's chest wall, immediately apply a sterile Vaseline occlusive gauze dressing taped on three sides over the insertion site.

Allergic Rhinitis

An IgE-mediated chronic inflammatory condition of the nasal mucosa triggered by airborne allergen exposure, resulting in histamine and leukotriene release from mast cells.

Atopic Triad

A clinical triumvirate consisting of allergic rhinitis, atopic dermatitis (eczema), and asthma, reflecting an underlying systemic IgE-mediated hyperresponsiveness.

Allergic Shiners and Allergic Salute

Classic physical findings of allergic rhinitis: allergic shiners are bluish or dark discoloration under the eyes due to venous stasis, and an allergic salute is upward palm-rubbing of the nose creating a transverse nasal crease.

Asthma

A chronic inflammatory disorder of the airways characterized by hyperresponsiveness, reversible airway obstruction, bronchospasm, and mucous plugging, commonly presenting with dyspnea, wheezing, and nighttime coughing.