Girl idk what is going on in Peds

ACYANOTIC DISEASE: only congential hd with normal O2 SATs

VSD- too much pulmonary circulation

  • sweat and sleeps during feedings

  • tachycardia

  • tachypnea

  • nasal flaring, substernal retractions

  • spo2 97%

  • murrmur

  • diaphoretic

  • coarse/fine rales

  • fluid overload

OR

fluid overload

Nursing action: diuretics to help with preload, i and o, daily weight, monitor for hypervolemia

Coartcation of Aorta (coa)

  • dc u.o

  • hypotension on LE, hypertension on UE

  • mumrmue

  • cold feed

  • headache

  • bloody nose

Nursing diagnosis: ineffective tissue perfusion (low pressure low flow in LE)

Tx: OR, cath lab

  • afterload reduction: ace inhibitor, bb? (not in young kids, remember bb will lower hr)

Nursing action: meds, VS, socks wont make feet warm

CHD CYANOTIC:

TGA:

  • cyanotic

  • 165 rr, tachypnea

  • spo2 desaturation

  • heart looks like egg

  • left ventricle attached to LV and aorta is attached to RV (not right lol)

  • PDA open so blood can mix

  • murmur

  • cool periphery

  • cyanosis of lips and nialbeds

  • metabolic issues: high bicarb- contracted metabolic acidosis (girlllll)

Tx: prostaglandin: SI- dc r rate,

Tetology of Fallot

4 defects:

  1. pulmonary artery stenosis

  2. 2

  3. 2

  4. 2

Sx:

  • desaturation

  • cyanosis inc with exertion

  • murmr

  • skin is cool

  • hypercyanotic spells (TET spells)

Nursing dx: dc pulmonary blood flow/ inadequate tissue perfusion

Tx: OR, preload and afterload reduction

Nursing Action: to stop TET spells: KNEE TO CHEST

AQUIRED HD

Infective endocarditis????????

  • inc instistial flluid

  • cardiomegaly

  • malaise

  • night sweats and chills

  • anorexia

  • low grade fevers

  • flushed cheeks

  • CRP lvl high (memorize normal lvl)

  • ESR lvl high

  • gram positive growth

  • WBC down

  • janeway spots, osler nodes

  • splinter hemorhae

Nursing diagnosis: risk of sepsis, dc cardiac output

Dx: antibiotics (not on exam), treat HF

Infective endocarditis

  • crp level high

Dilated cardiomypotathy: HF

  • fatigue

  • irritability

  • difficulty breathing

  • poor pulses

  • generalized edema

  • S3 heard

  • anxious

  • rales with nasal flaring and orthopnea

  • cool extremities

  • occasional PVC and PAC

  • EF: low

  • hard to gain weight due to cardiac demand

Nursing diagnosis: dc c.o

Tx: furosemide, IV lasix to help preload, ace inhibitor and bb to help with afterload,

Nursing action: daily weight

Kawasaki’s

  • conjuntivitis

  • rash

  • red tounge

  • high rr

  • irritable

  • rspirations are nonlabored'

  • high WBC

  • high inflammatory markers: CRP, ESR, ferritin, high plt

Nursing diagnosis: altered comfort

Tx: antipyeretic, analgesics, high dose ASA

  • IV/IG

Nursing action: enviornment, encourage parent presence, cool clothes and baths

Rheumatic Heart Disease- autoimmune response that causes inflammation in mitral valve, another infetion can make the inflammation worst

  • arthritis of the joints

  • hx of strep a infection which tx was not completed

  • fever

  • high RR

  • cardiac is normal?

  • ASO titer high

  • lung sounds nrmal

  • cardiac murmur

Nursing diagnosis: infection, altered confort

Tx: antibiotic, propholaxis, prophylatic antibiotics for rest of life

Nursing

MISE- can cause myocarditis

  • similar to kawasakis but

  • hypotension SEVERE

  • AKI (BUN and Cr high)

  • inflammatory markers higher than kawasakis

  • higher bmp

  • generalized edema'

  • cau

Nursing diagnosis: dc c.o, comfort, skin integrity

Tx: andkinra (help turn off immune system), meds for dc co

Nursing aciton:

GI DISORDERS

UPPER AIRWAY

Strep Throat

  • tonslar hypertophy (big ass tonsils)

  • desats can occur during sleep?

  • exudate

  • strep throat postiive titers

  • Resp unlabored, normal lung assess

  • trouble swallowing

  • dc po intake

  • WBC inc

Nursing daignosis: INFECTION altered comfort, fluid volumeee overload,

tx: antibiotics, antipyertics, IV fluids, tonsilectomy with failed management

Nursing actions: comfort, oxy with um like tylenol,

tonsilectomy: check for bright red blood and inc swallowing

CROUP

  • brassy/ barking cough

  • noisy breathing

  • substernal retractions

  • stridor

Nursing diagnosis: ineffective breathing pattern

Tx: o2 as needed, nebulizer, prn epi (can cause high hr), corticosteroid (dexamethasone)

Nursing action: position for comfort

LOWER AIRWAY

epiglottitis

  • MEDICAL EMERGENCY

  • secure the airway

  • muffled stridor

  • high neutrophils, plt, cbc

Nursing diagnosis: ineffective breahting pattern, once intubated infection is number 1

Tx:

Nursing action:

WOOPing cough/ pertussis - cilia is parlyzed

  • intense coughing with loud woop at end

  • post tussive vomiting

  • lowgrade fever

  • lung sounds coarse’

  • non productive cough

  • resp panel positive for perrtussis

Nursing diagnosis: ineffective airway clearance

Tx: ANTIBITOCIS, hydration: Iv or ng tube

Nursing action: chest pt and suctioning , hydration, o2 as needed but usually they dont need it

RSV/ bronchiolitis

  • significant rhinorrhea

  • tachypnea

  • difficulty breathing

  • loose moist cough

nursing diagnosis: ineffective airway clearance

tx: 3% saline nebs, chest vt and suctioning, ng hydration

nursing action: hydraiton, comfort, suction, supportive care

goals for discarge: tolerate po, rr <60, O2 >92

CHRONIC

Cystic Fibrosis

  • 3 day fever

  • cough with large amt of thick green mucus

  • mucus in poop

  • in work of breathing

  • weight loss

  • fatigue

  • tachypnea

  • substernal retraction

  • nasal flaring

  • coarse rochi

  • high wbc and crp

  • clogs pancreatic duct which makes them not digested

Nursing diagnosis: ineffective airway clearance, infectton, nutrition does not meet body requirements

Tx:

Nursing ACtion: eat whatever you want bc weight losss is a problem

Asthma: al

chest pt

pulses paradoxes!!

talks in 3 word sentences

inhaled corticosteroid (bitch you need to pick yours up from the pharmacy)

BRUE CAN HAPPEN AT ANY TIME

CHECK FOR UTI

NO CAUSE