ATI NURSING CARE OF CHILDREN STUDY GUIDE FOR PROCTORED EXAM LATEST VERSION

Chapter 17: Acute and infectious respiratory illness Tonsillitis  Signs o Sore throat, difficulty swallowing, fever, bad breath, and redness and swelling of the tonsils.  Meds for the fever and antibiotics  May need a tonsillectomy if recurrent o Keep in side lying position after surgery o Assess for bleeding. Look for frequent swallowing and clearing of the throat. o Clear fluids and liquids, avoid red colored liquids, no citrus juices, no milk products, and no rough or sharp foods. o Discourage any coughing, throat clearing or nose blowing o There may be blood clots in emesis or mucous o Limit strenuous activity, full recovery in two weeks Bacterial epiglottitis  Signs o Drooling, hoarseness difficulty speaking, difficulty swallowing, and high fever.  Do not put anything in their throat, no culture, no tongue blade  Antibiotic therapy, starting with IV antibiotics  Have intubation supplies close by Influenza  Signs o Fever, body aches, nasal congestion, dry cough, photophobia  Antiviral meds can only be given within the first 48 hours Complications  Pneumothorax and pleural effusion  Place a chest tube  Signs o Chest pain, difficulty breathing, tachycardia, decreased oxygen saturation How to prevent the spread of these  Hand hygiene Chapter 18: Asthma  Can be triggered by allergens, cold weather, exercise, smoking  Symptoms o Difficulty breathing, wheezing, anxiety, use of accessory muscles  Treatment o Bronchodilators: albuterol, comes with tachycardia and tremors. o Anticholinergic: ipratropium o Anti-inflammatory: corticosteroid such as prednisone. Rinse mouth after steroid inhaler. o Peak flow meter: child stands up, ensure the machine is zeroed out, place lips around device and blow as hard and as fast as they can. They do these three times, taking the highest reading.  Complications o Status asthmaticus: airway obstruction that is not relieved by medications that are given. Prepare for intubation and mechanical ventilation. Chapter 19: Cystic fibrosis  Caused by a genetic mutation where both parents have to carry recessive traits for the disease**  Disease causes an increase in the quantity of thick, tenacious mucous. If affects the pancreas, the lungs, the liver, the reproductive system, and the small intestine.  Symptoms o Wheezing, nonproductive cough, dyspnea, mucus plus, cyanosis, barrel shaped chest and clubbing of fingers. o GI: large, loose, fatty, sticky, and foul-smelling stools o Failure to thrive, delayed growth patterns, and deficiency of fat-soluble vitamins. Sweat and tears are extremely salty.  Diagnosing o Sweat chloride test o DNA testing: to check for mutation o Pulmonary function tests  Chest physiotherapy is very important for these patients  GI management o Eat a diet that is high in calories and protein. Take pancreatic enzymes with meals to help with digestion. Also need a vitamin supplement.  Meds o Albuterol o Anticholinergics: ipratropium Chapter 20: Cardiovascular Congenital Heart Defects:  Result in two things: hypoxemia and heart failure  Symptoms o Tachypnea, dyspnea, tachycardia, peripheral edema, cyanosis, intolerance to exercise, and polycythemia.  Increase pulmonary blood flow o Ventricular septal defect (VSD)  Creates a loud, harsh murmur heard at the left sternal border. o Atrial septal defect (ASD)  Loud, harsh murmur with a fixed split-second sound. o Patent ductus arteriosus (PDA)  Bounding pulses and a machine hum murmur  Decreased pulmonary blood flow o Tricuspid atresia  Complete closure of the tricuspid valve  Will also have an ASD o Tetralogy of the fallot  Pulmonary stenosis  Right ventricular hypertrophy  Overriding aorta  Ventricular septal defect  Obstruct blood flow o Pulmonary stenosis  Narrowing of the pulmonary valve  Creates a systolic ejection murmur o Aortic stenosis  Narrowing of the aortic valve o Coarctation of the aorta  Bounding pulses and high blood pressure on the upper half of body  Lower half of body has low blood pressure, faint pulses, cold feet  Narrowing of the aorta near ductus arteriosus  Mixed blood flow o Transposition of the great arteries  Aorta is connected to the right ventricle instead of the left  Pulmonary artery is connected to the left ventricle instead of the right  Requires surgery within the first two weeks of life. Can cause major cyanosis.