Neonate characteristics: - Answer- Birth to 4 weeks
If preterm neonate until original due date plus 28 days
Loses 5-10% weight by 3-4th day of
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Flexion normal posture
Limited glycogen store
Nose breathers
Infant characteristics: - Answer- Nose breather until 6months
And muscle to breathe
Metabolic rate 2x adult (increased need for oxygen and glucose)
Toddler characteristics: - Answer- Babinski réflex normal until walking
Plantar réflex at 2 years
And muscles to breathe
Most common cause of bradycardia in peds - Answer- hypoxia
When to begin chest compressions in peds - Answer- when HR is below 60bpm
Suctioning the neonate - Answer- increases the risk for decreased cerebral blood flow
decreased pulmonary oxygenation
bradycardia
suction mouth then nose
Neonate first minute emphasis - Answer- ventilation not intubation
Lower glucose levels in Neonate - Answer- associated with potential for brain injury
stress of respiratory and circulatory efforts metabolize existing glucose
D10 IV for glucose <40mg/dL
normal heel stick at birth 30 mg/dL
normal heel stick at 24h 45 mg/dL
Neonatal CHD - Answer- compare pulse ox from right hand to either foot (difference >3% suggest dx)
considered in infant presenting with respiratory distress or shock (with absence of fever)
s/s include shock, cyanosis, tachypnea, or pulmonary edema
Neonatal cyanosis - Answer- look inside the mouth at gum line for purple/blue color of tongue and gums - central
look for hands and feet to change color - peripheral
Respiratory Distress in peds patient - Answer- characterized by increased respiratory rate
increased heart rate
skin color changes
increased WOB (grunting, nasal flaring, head bobbing, accessory muscle use)
wheezing
diaphoresis
abnormal upper airway (sounds such as stridor)
change in mentation (irritable or agitated)
Laryngotracheobronchitis (Croup) - Answer- viral illness that account 90% peds stridor
inflammation, exudates and edema of larynx l/d narrowing of upper airway
tx with dexamethasone and racemic epi (nebulized epinephrine)
tx with antipyretics for fever
Pertussis (whooping cough) - Answer- acute bacterial infection of the respiratory tract that is highly contagious
characterized by spasmodic, hacking cough followed by whooping noise upon breath intake
tx with erythromycin, azithromycin, clarithromycin or trimethoprim-sulfamethoxazole
cystic fibrosis (CF) - Answer- genetic condition r/t exocrine dysfunction
result in thick mucous production
persistent productive cough, hyperinflated lungs, diminished pulmonary function and increased susceptibility to ch. bacterial resp infections
tx with abx, steroids for asthma-like s/s, brochodilator followed by nebulized hypertonic saline and dornase alfa
Pneumothorax - Answer- simple - when air enters pleural space (monitor)
large - s/s hypotension, distended neck veins, pale and diaphoretic skin, decreased or absence BS on affected side, hyper-resonance to percussion (Chest tube)
spontaneous - no known trauma or injury (most cases is ruptured bleb)
Heart Failure in peds - Answer- inadequate CO r/t ventricle unable to either fill with blood or eject blood
can be result of sepsis, renal dx, inflammatory conditions, dysrythmias, muscular dystrophy, chemotherapy or blunt chest traumas
tx by position of comfort, record weight daily, BB,
avoid vasodilators and caution of diuretics
Cardiomyopathy in peds - Answer- left ventricular hypertrophy (thickened muscle wall)
dilated cardiomyopathy (left ventricular enlarged and weakened)
cause include coronary artery dx, HTN, obesity, drug tox and kawasaki dx
tx by position of comfort, record weight daily, BB,
avoid vasodilators and caution of diuretics
Myocarditis - Answer- inflammation of the heart muscle that has significant mortality and morbidity in peds
viral, bacterial, toxic and autoimmune etiologies
s/s include fever, malaise (general unwell) and myalgia (soreness/achiness in muscles); SHOB at rest and crackles on auscultation; dysrhytmias; HF; elevated enxymes; syncope
Percarditis - Answer- inflammation of pericardial sac of heart
infectious (viral/bacterial) or dug (PCN, phenytoin), post cardiac surg, metabolic or immune mediated
tx NSAIDS and possible pericardiocentesis
Marfan Syndrome - Answer- inherited autosomal dominant dx
connective tissue dx
s/s - thin, tall with long extremities, flat feet, pectus excavatum (caved-in chest) or pectus carinatum (protruding "pigeon" chest)
tx with BB or angiotensin-receptor blocker
Kawaski Disease - Answer- vasculitis of unknown cause
may be r/t infection (viral/bacterial)
L/T coronary artery aneurysms, progressive stenosis, ischemic heart disease, myocardial infarction, HG or sudden cardiac death
Reversible causes of peds cardiac arrest - Answer- Hypovolemia
hypoxia
hydrogen ion (acid-base illness)
hypokalemia/hyperkalemia (glucose also)
hypothermia
tension pneumothorax
tamponade (cardiac)
toxins/tablets
thrombosis (PE, MI)
hypovolemic shock - Answer- decreased intravascular volume
fluid volume loss - n/v/d, UO, hemorrhage, burns, and fluid shift into third space
most common shock in children
distributive shock - Answer- characterized by vasodilation and maldistribution of blood volume
anaphylactic - allergen exposure and histamine release cause vasodilation
septic - endotoxin release cause increased vascular permebility and vasodilation
neurogenic - SCI, spinal anesthesia or nervous system damage cause loss of sympathetic tone and vasodilation
obstructive shock - Answer- obstruction that decreases the heart's ability to pump blood or venous return of the heart
cause include pericardial tamponade, tension pneumothorax, CHD and PE
cadiogenic shock - Answer- characterized by decreased cardiac contractility and output secondary to abnormal pump function or pump failure
cause by myocardial injury (myocarditis or trauma),
CHD or dysrhythmias
Compensated shock (Stage I) - Answer- tachycardia, mild tachypnea, slightly delayed cap refil, and subtle changes ****** [Show Less]