NURS 255 - Pediatric Nursing - Exam 2 Study Guide

Flashcards for Pediatric Nursing Exam 2 Study Guide

Tetralogy of Fallot

Combination of 4 defects: pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect.

Tetralogy of Fallot s/s

Cyanosis at birth (hypercyanotic or “Tet” spells), systolic murmur; progressive cyanosis over the first year of life.

Tetralogy of Fallot Tx

Surgical repair in first year of life.

Interventions for hypercyanotic episodes

Bring child’s knees up to chest (knee-chest position), provide IV fluids, apply face mask and deliver 100% o2, administer morphine.

Tricuspid Atresia

Tricuspid valve fails to develop, blood flows thru an ASD or VSD.

Lab values indicating compensation (polycythemia)

Elevated h&h and RBCs

Cardiac Catheterization

Invasive procedure used to dx and repair some congenital heart defects; catheter inserted into the femoral artery and threaded up to the heart

Cardiac Catheterization Pre-Procedure NC

NPO 6-8 hrs prior to procedure; assess for allergy to iodine/shellfish; assess kidney fx (BUN, Cr); assess and mark distal pulses for easy comparison post-procedure.

Cardiac Catheterization Post-Procedure NC

Check insertion site for bleeding; check extremity distal to puncture site: pulse, capillary refill, temp, color; increase fluid intake; keep affected extremity straight for 4-6 hrs.

Cardiac Catheterization Pt education

Monitor for possible complications (bleeding, infection, thrombosis); limit activity for 24 hrs; encourage fluids.

Cardiac Defects

Anatomic abnormality of the heart that results in altered blood flow; fetal heart does not develop normally d/t genetic and environmental factors, resulting in BF abnormalities.

Nursing Care for Cardiac Defects

Provide frequent rest periods, small/frequent meals, oxygen, high calorie formula as prescribed. For cyanotic episodes, bring child’s knees up to chest (knee-chest position)

Increased pulmonary BF (L to R shunt) defects

Atrial septal defect (ASD), Ventricular septal defect (VSD), Atrioventricular canal defect (AV Canal Defect), Patent ductus arteriosus (PDA).

Decreased Pulmonary BF (R to L shunt) defects

Tetralogy of Fallot (TOF), Tricuspid atresia.

Obstruction of BF (stenosis) defects

Coarctation of aorta (COA), Aortic stenosis, Pulmonary stenosis.

Mixed BF (complex abnormalities) defects

Transposition of great arteries (TGA), Total anomalous pulmonary venous connection (TAPVC), Truncus arteriosus, Hypoplastic left heart syndrome.

Aortic Stenosis

Narrowing of the aortic valve, obstructing BF to the body.

Aortic Stenosis s/s

Hypotension, decreased pulses, tachycardia, poor feeding, exercise intolerance, HF.

Aortic Stenosis Tx

Balloon dilation, valvotomy.

Pulmonary Stenosis

Narrowing of the pulmonary valve, obstructing BF to the lungs.

Decreasing Workload of the Heart NC

Maintain bed rest and position in an infant seat or hold at a 45 degree angle.

Digoxin NC

Determine the HR and w/hold the med if it’s below the hold rate specified by provider. Monitor for toxicity AEB bradycardia, dysrhythmias, N/V, or anorexia. Plan to administer digoxin immune fab as an antidote for toxicity.

Captopril or enalopril

ACE inhibitors reduce afterload by causing vasodilation, resulting in decreased pulmonary and systemic vascular resistance; monitor BP before & after, monitor for evidence of hyperkalemia.

Metoprolol or carvedilol

BBs decrease HR and BP, and promote vasodilation; monitor BP and pulse prior to administeration & for adverse effects (dizziness, hypotension, and headache).

PDA (Patent Ductus Arteriosus)

The fetal ductus arteriosus connecting the aorta and pulmonary artery fails to close after birth, incrasing pulmonary blood flow (left to right shunt).

Patent Ductus Arteriosus s/s

“Machine-hum” murmur (systolic), bounding pulses, wide pulse pressure (>20 mmHg), possibly asymptomatic, HF, and rales

Patent Ductus Arteriosus Tx

Indomethacin, coils to occlude PDA during cardiac catheterization

Coarctation of Aorta

Stenosis (narrowing) of the aorta, obstructing blood outflow from the left ventricle

Coarctation of Aorta s/s

Upper extremity HTN/bounding pulses, poor lower extremity perfusion (pallor, cool skin, weak pulses), HF

Coarctation of Aorta Tx

Balloon angioplasty (infants and young children), stents (older kids/adolescents). Surgical removal of coarctation segment and anastomosis to normal aorta. Manage HTN with BP meds.

Brain Tumor

Most commonly occurring solid tumor in children with changes in Behavior and increased ICP

Assessment for Brain Tumor

Thorough neurologic examination before surgery and measure head circumference in child under 18 months

Client Education for Radiation

Don't wash off marks on skin that outline the targeted areas and avoid sun on marked areas

Nursing actions for Chemotherapy

Provide an antiemetic prior to administration of chemotherapy and allow the child several food choices, including their favorite foods

Measures for Skin Breakdown from Chemo

Inspect skin daily; examine rectal mucosa for fissures; avoid rectal temps; provide sitz baths as needed.

Nursing Care for Bone Marrow Suppression

Monitor VS and report temp (>100 deg); assess for signs of infection (lung congestion, mouth lesions, IV site redness/swelling).

Pharm Measures for Pain

2 step approach for pharm management of pain: administer a non-opioid first, then a strong opioid for moderate to severe pain

ALL (Acute Lymphoblastic Leukemia) s/s

Low grade fever; pallor; increased brusing and petechaie; enlarge liver, lymph nodes and joints; abdominal, leg and joint pain; headache vomitng

Mucositis Nursing actions

Provide a soft toothbrush, or swabs, lubricate child’s lips and give soft, nonacidic foods while avoiding hydrogen peroxide and lemon glycerin swabs due to mucosal drying