quizlet peds exam4
Iron Deficiency Anemia
Pathophysiology:
- Insufficient healthy red blood cells (RBCs) to transport oxygen to the body's tissues.Signs and Symptoms (S/S):
- Tachycardia (increased heart rate).
- Brittle or misshapen nails.
- Poor muscle tone.
- Pale skin.
- Lethargy (extreme tiredness).
- Slowed growth.
- Prone to infections.
- Decreased serum concentrations of proteins: albumin, gamma globulin, and transferrin.Laboratory Findings:
- Low serum iron levels.
- Decreased RBC count.
- Tiny RBCs (microcytic).
- Decreased serum concentrations of proteins: albumin, gamma globulin, and transferrin.Diagnostic Criteria:
- Hemoglobin (Hgb) screening at 12 months.
- Complete Blood Count (CBC) for hemoglobin and hematocrit levels.
- Assessment of RBC size: borderline decrease or actual decrease.
- Serum iron levels low.
- Total Iron Binding Capacity (TIBC).
- Erythropoietin levels.
- Reticulocyte hemoglobin levels.Nursing Interventions:
- Instruct parents about a high-iron diet.
- Administer liquid iron preparations:
- Dilute and administer using a straw to avoid tooth enamel discoloration.
- Monitor for and prevent constipation.
- Overdose precautions must be observed. Iron supplementation may be necessary during adolescence.
- Use Z-track injection method for iron dextran administration.Caregiver Education:
- Use commercial iron-fortified formula; iron supplements not needed if bottle feeding.
- Avoid cow's milk consumption in infants until 12 months old; whole milk recommended from 12 months to 2 years.
- For breastfed infants, provide an iron supplement (1 mg/kg body weight/day) if insufficient iron-rich foods are consumed (Hagan, Shaw, & Duncan, 2017).
- Encourage parents to integrate iron-rich foods into their child’s diet.
Acquired Thrombocytopenia
Pathophysiology:
- Platelet counts decrease due to infections, such as Rocky Mountain Spotted Fever, Colorado Tick Fever, malaria, or other bacterial infections.Signs and Symptoms (S/S):
- Easy bruising.
- Excessive bleeding.
- Bleeding gums.
- Frequent nosebleeds.
- Blood in stool or vomit.
- Petechiae (small red spots on trunk and face).
- Purpura (larger purple spots on extremities).
- Possible causes include chemical exposure (e.g., paint, gasoline, insecticides), recent infections, and insect stings or outdoor exposure.Diagnostic Testing:
- CBC with platelet count revealing decreased platelets (normal ranges:
- Birth: 150 to 450 × 10³/microL.
- Child, adult, and older adult: 140 to 400 × 10³/microL).Nursing Interventions:
- Ensure the patient is cautious to prevent injuries.
- Provide mouth care with soft toothettes.
- Monitor stools for occult or frank blood.
- Steroids may be employed to increase platelet count.
- Aspirin should be avoided due to increased risk of bleeding.Caregiver Education:
- Explain side effects of steroid therapy, including possible fluid retention and weight gain.
- Advise administering steroids with food and limiting sodium intake.
- Provide activity guidelines based on platelet count findings.
- Prevent exposure to identified causative agents.
- Encourage supportive strategies to enhance the child's self-concept and appropriate activities.
Sickle Cell Disease
Pathophysiology:
- Characterized by partial or complete replacement of abnormal hemoglobin S (HbS) for normal hemoglobin A (HbA), leading to sickle-shaped RBCs that can cause clots and occlusions.
- Genetic pattern: ¼ chance of carrying the disease; prevalent in the African American community.High Folate Foods:
- Include legumes, liver, dark green leafy vegetables, lean beef, and potatoes.High Iron Foods:
- Organ meats, shellfish, poultry, legumes, molasses, and fortified cereals.Signs and Symptoms (S/S):
- Asymptomatic until approximately 4-6 months of age, due to fetal hemoglobin (HbF) preventing sickling.
- Symptoms manifest when HbF decreases and sickle hemoglobin (HbS) predominates, typically around 5 months.Vasoocclusive Crisis:
- Occurs when sickled cells obstruct blood flow, causing tissue hypoxia (low oxygen), potentially leading to necrosis if prolonged.
- Triggered by illness, stress, dehydration, or overexertion.Sickle Cell - Dactylitis:
- Painful swelling of hands and feet due to blocked blood flow.Sickle Cell - Acute Chest Syndrome:
- Medical emergency characterized by vaso-occlusion in the lungs, presenting with chest pain, tachypnea, hypoxia, and increased work of breathing.Sickle Cell - Sequestration Crisis:
- Blood trapped in the spleen leading to spleen enlargement and fragility, raising the risk of rupture.Sickle Cell - Stroke (CVA) Signs:
- Blockage in the brain presents as slurred speech, facial droop, and confusion; requires immediate emergency response.Sickle Cell - Crisis Management:
- Treatment of severe pain from vaso-occlusion employing morphine for pain control, hydration, rest, light activity (walking/stretching), and antibiotics for infections.Sickle Cell - Daily Management:
- Prophylactic penicillin administration, hydroxyurea to reduce crises, blood transfusions if required, and potential splenectomy or stem cell transplant.Caregiver/Parent Education:
- Adherence to medications (penicillin and hydroxyurea).
- Maintain adequate hydration.
- Avoid triggers such as illness, stress, dehydration, and overexertion.
- Stay current with vaccinations.
- Immediate ER care for chest symptoms, stroke signs, and fever (above 100.4°F).Sickle Cell Fever Rules:
- Fever greater than or equal to 100.4°F (38°C) is a cause for concern; seek care as soon as possible due to risk for infection and crises.Sickle Cell - Diagnostics:
- Sickle dex test for detection of Hb S and genetic testing for confirmation.
Aplastic Anemia
Pathophysiology:
- Bone marrow failure leading to a reduction in red blood cells (RBCs), white blood cells (WBCs), and platelets (pancytopenia).Signs and Symptoms (S/S):
- Fatigue.
- Increased susceptibility to infections due to low WBC count.
- Bleeding and bruising from low platelet counts.Diagnostic Testing:
- CBC indicating low counts across all cell lines, including reticulocytes.
- Bone marrow biopsy revealing fatty marrow.Interventions/Treatment:
- Blood transfusions.
- Immunosuppressive therapy.
- Infection prevention strategies (emphasizing hand hygiene).Caregiver Education:
- Strategies for preventing infections, maintaining a balanced diet, and potential for bone marrow transplant as a treatment option.
Hemophilia
Pathophysiology:
- Deficiency of clotting factor, with factor VIII being the most common; results in ineffective blood clotting.Signs and Symptoms (S/S):
- Easy bleeding and bruising.
- Hemarthrosis (bleeding into joints).
- Nosebleeds and hematuria (blood in urine).Diagnostics:
- CBC revealing low platelet levels.
- Prothrombin Time (PT) and partial thromboplastin time (PTT) for coagulation assessment and specific clotting factor levels.Interventions/Treatment:
- Factor replacement therapy (factor VIII or IX).
- DDAVP (desmopressin) for mild cases.
- Avoid aspirin due to bleeding risk.Caregiver Education:
- Prevent injuries and avoid contact sports.
- Use a helmet for head protection.
- Wear a medical alert bracelet indicating hemophilia.
- Use a soft toothbrush for oral care.
Lead Poisoning
Pathophysiology:
- Accumulation of lead in the body leading to damage of the brain and vital organs.Signs and Symptoms (S/S):
- Abdominal pain and vomiting.
- Irritability and hyperactivity.
- Developmental delays.Diagnostics:
- Blood lead level: elevated levels (≥ 5 µg/dL) are concerning, with levels ≥ 45 µg/dL indicating the need for chelation therapy.Treatment:
- Removal of lead sources from the environment.
- Chelation therapy for high blood lead levels.Caregiver Education:
- Educate on eliminating lead exposure (e.g., lead paint, dust).
- Guidelines for cleaning surfaces (using a wet cloth) and possible relocation from contaminated environments.
HIV
Pathophysiology:
- The Human Immunodeficiency Virus (HIV) attacks T-cells, weakening the immune system and increasing susceptibility to infections.Signs and Symptoms (S/S):
- Swelling of lymph nodes.
- Failure to thrive in infants.
- Chronic diarrhea.
- Oral thrush (fungal infection).Diagnostics:
- Polymerase Chain Reaction (PCR) for diagnostic testing in infants.
- Enzyme-Linked Immunosorbent Assay (ELISA) and Western blot for children over 18 months.Treatment:
- Antiretroviral therapy (ART) to manage the infection.
- Preventive measures against opportunistic infections.Caregiver Education:
- Importance of adhering to medication schedules.
- Strategies for preventing infections.
- Maintaining adequate nutrition to support overall health.
Leukemia
Pathophysiology:
- A blood cancer characterized by the uncontrolled proliferation of immature white blood cells in the bone marrow.Signs and Symptoms (S/S):
- Fatigue and paleness.
- Increased susceptibility to infections.
- Bruising and bleeding due to low platelet counts.
- Bone pain.Diagnostics:
- Bone marrow biopsy to confirm diagnosis.
- CBC indicating abnormal white blood cells and possible thrombocytopenia.Treatment:
- Chemotherapy as a primary treatment modality.
- Blood transfusions for managing anemia.
- Stem cell transplant as an option for eligible patients.Caregiver Education:
- Emphasis on infection prevention measures, hand hygiene, and avoiding sick contacts.
Brain Tumor
Signs and Symptoms (S/S):
- Morning headaches.
- Vomiting associated with increased intracranial pressure (ICP) signs.
- Neurological changes such as altered consciousness or seizures.Diagnostics:
- MRI is the preferred imaging modality; CT scan can also be utilized.Treatment:
- Surgical intervention to remove the tumor.
- Chemotherapy and radiation therapy depending on the tumor type and location.
- Continuous monitoring of neurological status.
Wilms Tumor
Key Sign:
- The presence of an abdominal mass; must not palpate the abdomen due to risk of rupture.Treatment:
- Surgical removal of the tumor.
- Chemotherapy as a follow-up treatment approach.Caregiver Education:
- Avoiding pressure on the abdomen and use of loose clothing.
Lymphoma
Pathophysiology:
- Cancer affecting the lymph nodes, can be Hodgkin or Non-Hodgkin Lymphoma.Signs and Symptoms (S/S):
- Swelling of lymph nodes.
- Accompanying symptoms: fever, night sweats, and weight loss.Diagnostics:
- Biopsy to confirm diagnosis.
- Imaging studies such as CT or MRI.
- CBC for overall blood assessment.Treatment:
- Chemotherapy and radiation therapy as primary modalities.
Neoplasm
Pathophysiology:
- Abnormal uncontrolled cell growth, classified as benign (noncancerous) or malignant (cancerous, capable of metastasizing).Signs and Symptoms (S/S):
- Pain, weight loss (cachexia), fatigue, anemia, and increased risk of infection.
- Bruising and bleeding due to bone marrow involvement.Diagnostics:
- CBC for blood cell evaluation.
- Biopsy for definitive cancer diagnosis.
- CT or MRI for further evaluation.Types of Lymphoma:
- Hodgkin Lymphoma:
- Key characteristic: Reed-Sternberg cells.
- Starts in one lymph node, predictable spread, more curable.
- Non-Hodgkin Lymphoma:
- No Reed-Sternberg cells. Multiple lymph nodes involved, aggressive spread.Key Nursing Priority:
- Infection prevention is crucial (Consider absolute neutrophil count (ANC) < 500 as high risk).Oncology Priority Nursing Care:
- Quick triage of patient concerns.
- Neutropenic precautions even in remission; strict hand hygiene mandatory.
Cardiac Conditions
Patent Ductus Arteriosus (PDA):
- Pathophysiology: A vessel connecting the aorta and pulmonary artery remains open post-birth which can lead to excessive blood flow to the lungs and symptoms of heart failure (sweating, poor feeding, tachypnea).
- Diagnosis: Echo shows enlarged left heart; chest x-ray shows pulmonary markings.
- Signs/Symptoms: Machine-like murmur, shortness of breath, wide pulse pressure, poor feeding, and crackles.
- Treatment Options: First-line medication Indomethacin or ibuprofen to close PDA; second-line surgical intervention if necessary.Atrial Septal Defects (ASD):
- Pathophysiology: Hole between atria leading to left-to-right shunting.
- Signs/Symptoms: Often asymptomatic but can include murmurs, fatigue, and frequent respiratory infections.-Diagnostics:chest x ray showing left sided enlargement,
-interventions: blood thinners, dislogdment of patch, bacterial endocarditis prevention with prophylactic antibiotics
- Treatment: Diuretics, digoxin, closure with cardiac catheterization, or surgical repair with patch.Ventricular Septal Defects (VSD):
- Pathophysiology: The most common congenital defect; hole exists between the ventricles leading to left-to-right shunting(pushes more blood to lungs)
- Signs/Symptoms: Loud murmurs, poor feeding, tachypenia, SOB, and respiratory infections.
- Treatment: Observation for small VSDs; surgical patch placement for large defects.Tetralogy of Fallot:
- Pathophysiology: Combination of four defects, including ventricular septal defect and pulmonary stenosis leading to cyanosis due to deoxygenated blood entry into systemic circulation.(r side hypertrophy, overriding aorta, VSD, pulmonary stenosis)Associated with down syndrome
- Signs/Symptoms: Cyanotic spells (Tet spells), clubbing, poor growth, heart murmur
- Management: Knee-to-chest position during Tet spells, morphine for comfort, and prostaglandin E1 to maintain ductal patency pre-surgery.Tricuspid Atresia:
- Pathophysiology: Absence of the tricuspid valve leading to right ventricular outflow obstruction.
- Signs/Symptoms: Cyanosis, shortness of breath, and poor growth.
- Diagnosis and Treatment: Echo and cardiac cath for diagnosis, with the need for prostaglandin E1 and multiple surgical interventions.Hypoplastic Left Heart:
- Pathophysiology: Underdevelopment of the left side of the heart.
- Manifestation: Infants appear stable until duct closure leading to severe cyanosis.
- Management: Prostaglandin E1, staged surgical approach, and possibly heart transplant.
Hypertension
Pathophysiology: Increased arterial pressure leading to increased workload on the heart and potential organ damage over time.
Caregiver Education:
- Emphasize a healthy diet and regular exercise.
- Frequency of blood pressure checks.Nursing Interventions:
- Ensure proper blood pressure monitoring positioning.
- Encourage physical activity and weight management, along with a low-sodium diet.Medications:
- Long-term: ACE inhibitors.
- Emergency: Labetalol.Diagnostics:
- Blood pressure readings above the 95th percentile for age, requiring multiple readings for confirmation.
- Commonly asymptomatic but may lead to headaches and vision changes if untreated.
Subacute Bacterial Endocarditis (SBE)
Pathophysiology: Inflammation of heart lining due to bacterial infection, primarily affecting damaged heart valves post surgical or invasive procedures.
Caregiver Education:
- Importance of maintaining good dental hygiene and taking antibiotics prior to dental procedures.Nursing Interventions:
- Monitor for embolic events and signs of congestive heart failure (CHF).
- Administer antibiotics and maintain fluid balance.Diagnostics:
- Blood cultures, echo, and clinical presentation for diagnosis; expect symptoms like fever and lassitude.
Kawasaki Disease
Pathophysiology: Systemic inflammation of blood vessels, heightening the risk for coronary aneurysms.
Signs and Symptoms (S/S):
- Persistent fever (> 5 days).
- Strawberry tongue appearance.
- Red, chapped lips.
- Rash, swollen hands/feet, conjunctivitis, lymphadenopathy, irritability.Diagnostic Testing:
- Primarily a clinical diagnosis with echo to evaluate coronary arteries.Treatment:
- Intr
Rheumatic Heart Disease:
- Pathophysiology: A complication of untreated streptococcal throat infection leading to inflammation of the heart, often affecting the heart valves.
- Signs and Symptoms (S/S): Chest pain, shortness of breath, fatigue, and heart palpitations; may present with fever and joint pain during the acute phase.
- Diagnostics: Echocardiogram to assess valve function, history of rheumatic fever, and laboratory tests for streptococcal infection (throat swab, antistreptolysin O titer).
- Treatment: Long-term antibiotics to prevent recurrence, anti-inflammatory medications, and possible surgical intervention for valve repair.
- Caregiver Education: Importance of completing antibiotic prescriptions and regular follow-ups to monitor heart health.
Supraventricular Tachycardia (SVT)
Signs and Symptoms (S/S)
Heart Rate (HR) > 220 in kids
Palpitations
Poor perfusion
Treatment:
Vagal maneuvers (e.g., ice to face)
Adenosine IV
Ventricular Tachycardia
Signs and Symptoms (S/S):
Loss of consciousness
Can lead to sudden death
Treatment:
Emergency defibrillation
Torsades de Pointes
Cause:
Electrolyte imbalance (low K⁺, Mg²⁺)
Signs and Symptoms (S/S):
Fainting
Irregular rhythm
Treatment:
Magnesium
Defibrillation
Bradycardia
Pathophysiology: Slow HR
Treatment: Possible pacemakers
Aortic Stenosis:
- Pathophysiology: Narrowing of the aortic valve, obstructing blood flow from the heart to the aorta.
- Signs/Symptoms: Symptoms may not appear until severe; include shortness of breath, chest pain, fatigue, and fainting during exertion.
- Diagnosis: Echo showing thickened valve and possible left ventricular hypertrophy.
- Treatment Options: Surgical valve replacement or balloon valvuloplasty in certain cases.
- Mitral Stenosis:
- Pathophysiology: Narrowing of the mitral valve, restricting blood flow from the left atrium to the left ventricle.
- Signs/Symptoms: Symptoms may include exertional dyspnea, fatigue, palpitations, and signs of heart failure.
- Diagnosis: Echo demonstrating a thickened mitral valve and possible left atrial enlargement.
- Treatment: Options include balloon valvuloplasty or valve replacement depending on severity and symptoms.
- Pulmonary Stenosis:
- Pathophysiology: Narrowing of the pulmonary valve that impedes blood flow from the right ventricle to the pulmonary artery.
- Signs/Symptoms: May include fatigue, shortness of breath, and cyanosis in severe cases.
- Diagnosis: Echo showing thickened valve leaflets and outflow tract obstruction.
- Treatment: Balloon valvuloplasty is often the initial treatment; surgical intervention may be required if significant stenosis persists or if symptoms worsen.
Eisenmenger Syndrome:
Pathophysiology: A condition characterized by a long-standing left-to-right shunt due to congenital heart defects, leading to pulmonary hypertension and subsequent reversal of the shunt into right-to-left flow.
Signs and Symptoms (S/S):
Cyanosis due to decreased oxygenation.
Fatigue and exertional dyspnea.
Clubbing of fingers and toes.
Diagnosis:
Echocardiogram to visualize heart structure and blood flow patterns.
Right heart catheterization to assess pulmonary artery pressures.
Management:
Avoidance of physical exertion and oxygen supplementation.
Medications to manage pulmonary hypertension.
Surgical interventions may be considered in select cases.
Ebstein's Anomaly:
Pathophysiology: A rare congenital heart defect where the tricuspid valve is malformed and positioned lower than normal in the right ventricle, leading to a variety of hemodynamic abnormalities.
Signs and Symptoms (S/S):
Symptoms can include cyanosis, palpitations due to arrhythmias, and signs of heart failure (fatigue, tachycardia).
Diagnosis:
Echocardiogram is essential for diagnosing Ebstein's anomaly by visualizing the tricuspid valve and associated structural defects.
Management:
Medical management includes controlling arrhythmias and heart failure symptoms.
Surgical repair may be necessary for severe cases to correct the tricuspid valve position and function.
Transportation of Great Vessels
Pathophysiology: A congenital heart defect characterized by the aorta and pulmonary artery being switched, resulting in oxygen-rich blood circulating back to the body while oxygen-poor blood recirculates to the lungs, leading to serious health complications if not corrected.
Signs/Symptoms (S/S): Cyanosis, difficulty breathing, poor feeding in infants.
Management: Surgical intervention is often required to correct the positioning of the vessels.
Caregiver Education:
Explain the condition and the necessity for surgical correction.
Educate caregivers on recognizing signs of complications, such as cyanosis or difficulty breathing, and the importance of seeking immediate medical care.
Discuss the importance of follow-up appointments to monitor heart function and development of the child.
Nursing Interventions:
Monitor vital signs closely, especially oxygen saturation and heart rate.
Provide pre-operative and post-operative care, ensuring the child is stable.
Educate families about the recovery process and signs of infection or complications post-surgery.
Coarctation of the Aorta
Pathophysiology: Involves a narrowing of the aorta, typically occurring just after the ductus arteriosus.
Signs/Symptoms (S/S): Symptoms can range from high blood pressure in the arms and low blood pressure in the legs to heart failure in severe cases.
Treatment: Surgical repair or balloon angioplasty is typically performed to relieve the obstruction and restore normal blood flow.
Caregiver Education:
Teach the caregivers about the condition and its potential symptoms, including changes in blood pressure readings.
Stress the importance of maintaining regular follow-up appointments for monitoring blood pressure and heart health.
Educate on dietary recommendations and healthy lifestyle choices to promote cardiovascular health.
Nursing Interventions:
Monitor blood pressure in both arms and legs to assess for differences indicative of coarctation.
Administer medications as required for blood pressure management.
Provide education on post-operative care if surgical correction is performed, including wound care and recognizing complications.
Truncus Arteriosus
Pathophysiology:
A congenital heart defect where a single large vessel leaves the heart instead of two separate vessels (the aorta and pulmonary artery).
This leads to mixed oxygenated and deoxygenated blood circulation, causing volume overload of the lungs and body.
Associated with other congenital syndromes, such as DiGeorge syndrome.
Signs and Symptoms (S/S):
Cyanosis due to decreased oxygenation.
Difficulty breathing and poor feeding in infants.
Heart murmur detected upon examination.
Fatigue and poor growth due to heart failure.
Diagnosis:
Echocardiogram: Visualizes heart structure and blood flow.
Chest X-Ray: Shows cardiomegaly and increased pulmonary blood flow.
Classic Appearance: May demonstrate the "egg on a string" appearance due to a narrow mediastinum and a single great vessel.
Treatment:
Surgical repair is necessary to separate the pulmonary artery from the aorta, creating a functioning pathway for blood flow.
Medications may include diuretics and other heart failure medications to manage symptoms until surgery can be performed.
Nursing Interventions:
Monitor vital signs, including heart rate and oxygen saturation, to assess the child’s condition.
Provide supplemental oxygen as needed to alleviate hypoxia.
Establish IV access for administration of medications and fluids.
Educate and support the family regarding the child’s condition and treatment plan.
Caregiver Education:
Explain the condition and the need for surgical correction.
Educate caregivers on recognizing signs of complications, such as difficulty breathing or cyanosis, and the importance of seeking immediate medical care.
Discuss the significance of follow-up appointments to monitor heart function as the child grows.