PEDIATRIC NURSING ABNORMAL

no cyanosis

non-life-threatening congenital disorders

can delay surgery

ACYANOTIC HEART DEFECTS

with cyanosis, purplish or bluish in color

life-threatening congenital anomaly

poor supply of oxygenated blood

a medical emergency and needs surgery

CYANOTIC HEART DEFECTS

failure of the ductus arteriosus to close at birth or within the first week of life

can be asymptomatic

MURMUR: ____

increased workload in the left side of the heart

due to decreased systemic circulation, ____ compensates

has pulmonary vascular congestion due to increased blood flow resulting to ____

which is a protective mechanism leading to a complication known as ____

MEDICAL MANAGEMENT: ____ AND ____

SURGICAL MANAGEMENT: ____ WHEN: ____ if (+) s/sx; ___ if (-) s/sx

PATENT DUCTUS ARTERIOSUS

MACHINERY-LIKE MURMUR

LEFT VENTRICLE

INCREASED PULMONARY VASCULAR RESISTANCE

PULMONARY VASCULAR OBSTRUCTIVE DISEASE

INDOMETHACIN, IBUPROFEN

LEFT THORACOTOMY, BEFORE 6 MOS, BEFORE 1 YR

narrowing of the aorta → less oxygenated blood in systemic circulation → compensatory mechanism

MANIFESTATIONS:
UPPER EX: ___, ___
LOWER EX: diminished pulse, low BP, cool to touch, pallor, numbness and tingling (___)

COMPLICATIONS: ___, ___, CVA

NON-INVASIVE MNG: ___ minimally invasive procedure using the ___ artery

SURGICAL MNG: ___ to prevent bleeding and hemorrhage

COARCTATION OF THE AORTA

BOUNDING PULSE, HIGH BP

PARESTHESIA

AORTIC ANEURYSM, RUPTURED AORTA

BALLOON ANGIOPLASTY, FEMORAL

SURGICAL REPAIR

patent foramen ovale

hole in between the R and L atrium

vena cava → RA → RV → PA → PV → LA → RA → RV → congestion of the R

MANIFESTATIONS: ____

COMPLICATIONS: Heart failure, atrial dysrhythmia, emboli formation → ___

SURGICAL MNG: Surgical patch closure ____, ____

ATRIAL SEPTAL DEFECT

RIGHT VENTRICLE HYPERTROPHY

PULMONARY VASCULAR OBSTRUCTIVE DISEASE

DACRON PATCH, PERICARDIAL PATCH

hole in between R and L ventricle

same mechanism in ASD

COMPLICATIONS: ___ due to friction

20-30% of this case closes spontaneously during the ___ of life

SURGICAL MANAGEMENT: ____ to protect the lungs, patch

VENTRICULAR SEPTAL DEFECT

BACTERIAL ENDOCARDITIS

1ST YEAR

PULMONARY ARTERY BANDING

narrowing of the pulmonary valve

RA → RV → PA → due to narrowing, decreased blood flow to lungs → RV

MURMUR: ___

MANIFESTATIONS: RVH, dyspnea, signs of HF, mild cyanosis

NON-SURGICAL: ___

SURGICAL: ___

PULMONARY STENOSIS

2ND ICS L

BALLOON ANGIOPLASTY

PULMONARY VALVOTOMY

narrowing of the aortic valve

LA → LV → AORTA → narrowing pushes back blood to the left side of the heart → ____ that interferes with ____ that can lead to ____

COMP MECH: ____

chest pain due to ____

MURMUR: ____

brain hypoperfusion

SURGICAL: ___, ___, ___

AORTIC STENOSIS

LEFT VENTRICULAR HYPERTROPHY, CORONARY ARTERY PERFUSION, MI

TACHYCARDIA

ISCHEMIA

2ND ICS R

AORTIC VALVOTOMY, AORTIC VALVULOPLASTY, AORTIC VALVE REPLACEMENT

RV is connected to aorta, LV is connected to pulmonary artery

___ keeps the patient alive due to blood mixing with the DOC of ___

MANAGEMENT:
Oxygen therapy: __-__ L/min
avoid overfeeding and constrictive clothing

SURGICAL:
___ surgical procedure to create PDA
___ opening the atrial septum to promote blood mixing
___ complete repair of the vessels

TRANSPOSITION OF THE GREAT ARTERIES

PDA, ALPROSTADIL

6-8

BLALOCK-HANLON OPERATION
BALLOON ATRIAL SEPTOSTOMY/RASHKIND PROCEDURE
JATENE OPERATION

4 heart problems
___ primary problem
___ comp mech
___ causes blood mixing
___ keeps the patient alive

cyanosis observed on distal ends of ext, nail beds, lips, tongue

tet spell

___ test used for clubbing of fingers

MANAGEMENT:
POSITIONING: ___, ___
100% O2
calm comforting approach
DOC: ___

SURGICAL:
___ supplies blood to the pulmonary artery from the ___ to increase pulmonary blood flow
COMPLETE REPAIR
IMPRATUBE GRAFT/GORTEX

PULMONARY STENOSIS
RVH
OVERRIDING AORTA
VSD

SCHAMROTH WINDOW TEST

SQUATTING, TRIPOD; KNEE-CHEST POSITION

MORPHINE

MODIFIED BLALOCK TAUSSIG SHUNT OPERATION, SUBCLAVIAN ARTERY

___ infection of the inner lining of the heart which is the ___

generally involving the valves specifically the ___

occurs secondary to bacteremia which is caused by invasive procedures

CA:
MOST COMMON: ___, ___
CANDIDA ALBICANS

MANAGEMENT:
___ long term management via IV
___ positioning

PREVENTION:
prophylactic antibiotics prior to invasive procedures usually ___ the procedure

BACTERIAL ENDOCARDITIS, ENDOCARDIUM

MITRAL VALVE

STAPHYLOCOCCUS AUREUS, VIRIDIANS

ANTIBIOTICS
ORTHOPNEIC

1 HR BEFORE

___ inflammatory disease that occurs after GABHS infection

onset ___ following GABHS infection

commonly affects ___ children

areas of concern: ___, ___, ___, ___

cause: ___

DIAGNOSTIC: ___ most reliable and standardized evaluation

MAJOR JONES CRITERIA: ___, ___, ___, ___, ___

MINOR JONES CRITERIA: ___, fever, elevated ESR, elevated CRP, prolonged PR interval

MANAGEMENT:
___ anitbiotic
___ salicylates

COMPLICATION: ___ with permanent damage to the ___ valves

RHEUMATIC FEVER

-

SCHOOL AGE

BRAIN, HEART, JOINTS, SKIN

UNMANAGED URTI

CARDITIS, POLYARTHRITIS, ERYTHEMA MARGINATUM, CHOREA, SUBCUTANEOUS NODULES

ARTHRALGIA

PENICILLIN
ASPIRIN

RHEUMATIC HEART DISEASE, CARDIAC

unknown systemic vasculitis (destructive inflammation of the blood vessels); idiopathic

commonly affects ___

areas of concern: ___

MANIFESTATIONS: extensive inflammation of the ___, ___, ___ during acute phase
prolonged elevated temp not attributed to another cause and unresponsive to antibiotics

goal is to prevent ___ complications

COMPLICATIONS: ___ (aneurysm), ___ (mi)

MEDICAL MANAGEMENT:
high dose of ___
salicylate therapy: ___
___ to prevent thrombus formation

KAWASAKI DISEASE/MUCOCUTANEOUS LYMPH NODE SYNDROME

TODDLERS

CARDIOVASCULAR SYSTEM

ARTERIOLES, VENULES, CAPILLARIES

CARDIOVASCULAR

DILATED CORONARY ARTERY, CORONARY THROMBOSIS

IV GABBA GLOBULIN
ANTIPLATETLETS
ABCIXIMAB

3 phases of kawasaki disease

1. ACUTE

2. SUBACUTE

3. CONVALESCENT

this phase of KD,

abrupt onset of high fever: ___

child is very irritable

tongue is called ____

___ rashes with variety of shapes

conjunctival hyperemia/bilateral conjunctivitis leads to ___

ACUTE

38.5 DEGC AND ABOVE

STRAWBERRY TONGUE

POLYMORPHOUS RASH

PHOTOSENSITIVITY

this phase of KD,

resolution of fever

high risk for: ___ seen on ___

___ peeling of the hands and feet during the ___ - ___ week; use ___

cracked lips, use lubricating ointment

SUBACUTE

CORONARY ARTERY ANEURYSM, ECHOCARDIOGRAM

PERIUNGUAL DESQUAMATION, 2ND - 3RD, UNSCENTED LOTIONS

this phase of KD,

the recovery phase usually on the __-__ weeks after onset

all clinical signs are resolved

regained usual temp, energy, and appetite

CONVALESCENT

6TH TO 8TH

nosebleed

most common cause is ___

MANAGEMENT:
Lean: ___
Apply pressure: ___ for at least ___ mins
Cold compress for vasoconstriction not more than __ mins

EPISTAXIS

TRAUMA

FORWARD

SOFT TISSUES OF THE NOSE, 5 MINS

20 MINS

deficiency in clotting factor which results to bleeding

FEMALE: ___, MALE: ___

MANIFESTATIONS: easy bruising, prolonged bleeding time (N: _-_ mins), trauma, ___ (bleeding joints, use RICE), ___ (classic sign)

MANAGEMENT: ___, bleeding precautions: avoid ___ sports, use ___ toothbrush, use ___ razor

HEMOPHILIA

CARRIER, MANIFESTS THE DISEASE

1-10 MINS, HEMARTHROSIS, SPONTANEOUS HEMATURIA

CRYOPRECIPITATE, CONTACT, SOFT BRISTLES, ELECTRIC

clAssic hemophilia

HEMOPHILIA A, CF 8

christmas disease

HEMOPHILIA B, CF 9

ros(C)ental syndrome

HEMOPHILIA C, CF 11

inability of the platelets to adhere which causes excessive bleeding

problem is ___

VON WILLEBRAND DISEASE

___ supports the production of hemoglobin

AT RISK:
___ d/t inadequate iron stores; the storage of iron in the liver and bone marrow starts at ___ of gestation
___ d/t poor eating habits, menstruation

MANAGEMENT: iron rich foods, oral iron supplements: ___ for ___ months
antidote for iron toxicity: ___
if in liquid form, use ___, ___, ___
do not store for more than a ___

IRON

PRETERM, 8TH MONTH
ADOLESCENTS

FERROUS SULFATE, 3 MONTHS

DEFEROXAMINE

STRAW, SYRINGE, DROPPER

MONTH

irregular shaped RBC: ___ (N: ___) d/t presence of ___

___ carrier of oxygenated blood

MANIFESTATIONS: underweight, chronic anemia, fatigue, severe pain

MANAGEMENT: hydration, oxygen therapy, ___ (antimetabolite)

SICKLE CELL ANEMIA

CRESCENT, BICONCAVE, HBS GENE

RBC

HYDROXYUREA

extra chromosome at the 21st chromosome (___)

normal no. of chromosomes: ___ (__ pairs)

MANIFESTATIONS:
large protruding tongue which leads to difficulty of ___ → ___ → ___
VSD
mental retardation → specialized ___

DOWN SYNDROME

46, 23

FEEDING, MALNUTRITION, DEATH

EDUCATION

inflammation of the meninges which is the membrane that covers the brain and spinal cord. it also supports the brain

inflammation of the brain

MENINGITIS

ENCEPHALITIS

manifestations of meningitis:

• irritability

• high pitched cry or ____

• projectile vomiting

• seizure due to ____

• nuchal rigidity or ____

• ____ flexion of the knees → hamstring pain

• ____ flexion of the neck → flexion of the knee

• ____ exaggerated arching of the back; intervention is ____

SHRILL

INCREASED ICP

STIFF NECK

KERNIG’S SIGN

BRUDZINSKI’S SIGN

OPISTHOTONUS; SIDE LYING POSITION

causative agent of meningitis: ____

____ most common

haemophilus influenzae; prevention is ____

streptococcus pneumoniae

BACTERIA

NEISSERIA MENINGITIDIS

HIB VACCINATION (PENTAVALENT)

diagnostics of meningitis:____ between __ and __

contraindicated in ___ because it can lead to ___

immobilize the child

during: ___ position

after: ___ to prevent spinal headache

LUMBAR PUNCTURE/LUMBAR/SPINAL TAP; L4 AND L5

INCREASED ICP; BRAIN HERNIATION

FETAL

FLAT ON BED

enlarged ventricles due to overproduction of CSF by the ____ and underabsorption of the ____

this type is due to the obstruction such as tumor growth

HYDROCEPHALUS; CHOROID PLEXUS; ARACHNOID VILLI

NON-COMMUNICATING HYDROCEPHALUS

manifestations:

• head enlargement

• bossing forehead

• bulging fonatenelles

• dilated scalp veins

• sunset eyes which is a ____

• increased ICP (N: ___)

• irritability

• shrill

• ALOC

• projectile vomiting

• cushing’s triad (___, ___, ___)

LATE SIGN

<15 MMHG

HYPERTENSION, BRADYCARDIA, BRADYPNIA

management of hydrocephalus

• ____

• ____

• support the neck and head

• skin care to moisturize. do not use alcohol and scented

VENTRICULOPERINOTAL SHUNT

TUMOR RESECTION

due to high fever which is ___ deg c

immaturity of the hypothalamus

FEBRILE SEIZURE

>= 38.5

management of febrile seizure:

• seizure precaution

• anticonvulsants: ____

• never stop abruptly!!! as it can cause ____, taper only

• use soft-bristled toothbrush for oral care to prevent ____

PHENYTOIN (DILANTIN)

STATUS EPILEPTICUS

GINGIVAL HYPERPLASIA

during seizure episode:

• promote ___ by removing pillows and raising side rails

• maintain ___ by side-lying/lateral position

SAFETY

PATENT AIRWAY

failure of the spine to fuse at the center

deficiency in ____

NEURAL TUBE DEFECTS

FOLIC ACID (VITAMIN B9)

absence of the skull

ANENCEPHALY

this neural tube defect:

• (-) sac

• (+) skin depression/dimpling

• (+) dark tuffs of hair

• (-) paralysis

• (+) weakness

• (-) alterations in bowel and bladder function

• frequently no observable manifestations

• no surgery needed

complications:

• short term: ___

• long term: ___

SPINA BIFIDA OCCULTA

MENINGITIS

HYDROCEPHALUS

this neural tube defect:

• (+) sac

• (+) paralysis

• (+) alteration in bowel and bladder function

• incontinence

• urine dribbling

____ with spinal cord

____ pure CSF

management:

• prevent damage of the sac by prone position with no diapers and apply sterile, moist, and non occlusive dressing

SPINA BIFIDA CYSTICA

MYELOMENINGOCELE

MENINGOCELE

a birth defect characterized by absence of extremities

cause by ____ drug such as ___

AMELIA

ANTIEMETIC DRUGS; THALIDOMIDE

common in male

problem is poor sucking ability → malnutrition (_INTERVENTION_) and aspiration (_INTERVENTION_)

high risk for infection

surgery: ____ at 2 months

CLEFT LIP

CROSS CUT NIPPLE; FEED IN UPRIGHT

CHEILOPLASTY

common in female

problem is speech

surgery:___ at 12-18 months

CLEFT PALATE

PALATOPLASTY

failure of the esophagus to develop as a continuous passage

manifestations:

• coughing

• choking

• cyanosis

management:

• maintain patent airway

• prevention of pneumonia

• surgical repair

ESOPHAGEAL ATRESIA

failure of the trachea and esophagus to separate

manifestations:

• coughing

• choking

• cyanosis

management:

• maintain patent airway

• prevention of pneumonia

• surgical repair

TRACHEOESOPHAGEAL FISTULA

narrowing of the pylorus

thickening of the pyloric sphincter

manifestations:

• upper abdominal distention

• projectile vomiting

• vomitus: ___

• signs of dehydration

• metabolic ___

• malnutrition and weight loss

• visible peristaltic movement from L to R

• _____ mass in RUQ

management:

• increase oral fluid intake

• assess the vomitus

• high fowlers to avoid gas forming foods

HYOPERTROPHIC PYLORIC STENOSIS

diagnostic of hypertrophic pyloric stenosis

surgery: ___

ABDOMINAL ULTRASOUND

PYLOROTOMY

telescoping of the colon

site: ____ boundary of the small and large intestine

manifestations:

• sudden abdominal pain: ____

• abdominal distention

• _____ stool

• _____ mass

management:

• assess borborygmus

• assess abdominal distention

• NGT insertion

passage of a ____ stool indicates that the intussusception has reduced

INTUSSUSCEPTION

ILEOCECAL VALVE

COLICKY

RED CURRANT JELLY STOOL

SAUSAGE-SHAPED MASS

diagnostic of intussusception: ____ confirmatory, barium enema, ____ (fecal occult blood test)

before the procedure:

• avoid intake of ____, dark colored foods, ___, NSAIDS

surgery: ____ resection of the colon

UTZ, GUAIAC’S TEST

VITAMIN C, IRON

LAPAROTOMY

____ is the absence of ____ which is a nerve essential for peristalsis and nutrient absorption

it is also known as aganglionic megacolon

stool is ____

manifestations:

• (-) peristalsis

• enlarged colon

• ____ mass

• bile-stained foul smelling emesis

• foul breath

• malnutrition

HIRSCHPRUNG’S DISEASE, GANGLION

RIBBON-LIKE STOOL, PENCIL-SHAPED, STRING-LIKE

FECAL-SHAPED

diagnostic for aganglionic megacolon

surgery: ___

management:

• high calorie diet

• assess the stoma

  • N:___ color

  • AB:___ color → necrosis → report!

colostomy care:

• size: ___ larger than the stoma

• epmtying: __ - __ full

RECTAL BIOPSY

SWENSON PULL-THROUGH

PINKISH

BLUISH/GRAY

1/8

1/3-1/2

gluten intolerance

manifestations:

• diarrhea

• steatorrhea

• malnutrition

• severe abdominal distention

complication: malignant ____ of the small intestines

CELIAC DISEASE

LYMPHOMA

management of celiac disease:

• avoid foods with gluten

  • do not consume BROW (___, ___, ___, ___)

diagnostic: ____ confirmatory

BARLEY, RYE, OAT, WHEAT

BIOPSY

all secretions are viscous

organs affected: ___, ___, ___, ___

manifestations

• meconium ileus

• thick bronchial secretions

• difficulty breathing

• very salty sweat

• acute pancreatitis d/t ____

CYSTIC FIBROSIS

INTESTINES, LUNGS, SKIN, PANCREAS

OTTODIGESTION

management of cystic fibrosis:

• _____ with doctor’s order

• pancreatic enzymes after meals

complications:

• female: ___

• male: ___

CHEST PHYSIOTHERAPY

DECREASED FERTILITY

STERILITY

caused by extrinsic allergens

____ → bronchoconstriction

____ → swelling of goblet cells

O2 and CO2 are _____ proportional

manifestations:

• dyspnea

• use of accessory muscles

• hyperventilation

  • initially: respiratory ____

  • late: respiratory ____

management:

• positioning: ____

• brochodilators: ____

• oxygen

• corticosteroids: ____

BRONCHIAL ASTHMA

LEUKOTRINES

HISTAMINE

INVERSELY

ALKALOSIS

ACIDOSIS

ORTHOPNEIC

ALBUTEROL

BECLOMETHASONE

____ is the inflammation of the tonsils cause by too much ____ which attracts microbes

CA: ____

manifestations:

• hyperthermia

• dysphagia

complications:

• bacteremia

• endocarditis

management:

• antibiotics

• increase oral fluid intake

• gargling solutions

criteria: 3-5x a year

surgery: ___, post-op: ___

TONSILITIS

GLUCOSE

GROUP A BETA HEMOLYTIC STREPTOCOCCUS

___ is the inflammation of the adenoids caused by ____ weather

manifestations:

• hyperthermia

• dysphagia

complications:

• bacteremia

• endocarditis

management:

• antibiotics

• increase oral fluid intake

• gargling solutions

criteria: 3-5x a year

surgery: ___

ADENOIDITIS, COLD

ADENOIDECTOMY

manifestations:

• hyperthermia

• oliguria

• periorbital edema

• hematuria

• hypertension

management:

• constant monitoring of BP: ___

• loop diuretics: ____

ACUTE GLOMERULONEPHRITIS

EVERY 4 HRS

FUROSEMIDE

this is caused by e. coli which is a bacteria

common in female because their urethra is shorter (__-__ inches)

manifestations:

• dysuria

• cloudy urine

• hyoerthermia

complications:

• cystitis

• pyelonephritis

UTI

2-3 INCHES

protein-losing nephropathy

prevalence: ___-___ y/o in male

causes:

• idiopathic/childhood npehrosis

• secondary to glomerular damage

• recessive disorder

diagnostics:

• urinalysis (+) protein

• blood test

• ____ confirmatory

NEPHROTIC SYNDROME

2-7

RENAL BIOPSY

manifestations of nephrotic syndrome:

• massive ____

  • frothy and cloudy urine

  • recurrent infections d/t loss of _____

  • hypercoagulability d/t loss of _____

• hypoalbuminemia

• hyperlipidemia

protein is essential to maintain: ____

complications:

• circulatory collapse

• thromboembolism

management:

• low sodium diet

• high-biological protein diet

• fluid restriction

• corticosteroids: ____

• prevention of infection

PROTEINURIA

IMMUNOGLOBULINS

ANTITHROMBIN III

ONCOTIC PRESSURE

PREDNISONE

a cancer originated in kidneys

management:

• constant monitoring of BP

• avoid abdominal pressure

manifestations:

• abdominal mass (never palpate!)

• painless hematuria

• high blood pressure

• general manifestations of cancer

WILM’S TUMOR