GI:
The nurse is aware that the most common assessment finding in a child with
ulcerative colitis is:
A. Intense abdominal cramps
B. Profuse diarrhea
C. Anal fissures
D. Abdominal distention
Nurse Nancy is assessing a child with pyloric stenosis; she is likely to note which
of the following?
A. "Currant jelly" stools
B. Regurgitation
C. Steatorrhea
D. Projectile vomiting
Baby Jonathan was born with cleft lip (CL); Nurse Barbara would be alert that
which of the following will most likely be compromised?
A. GI function
B. Locomotion
C. Sucking ability
D. Respiratory status
Which of the following parameters would Nurse Max monitor to evaluate the
effectiveness of thickened feedings for an infant with gastroesophageal reflux
(GER)?
A. Urine
B. Vomiting
C. Weight
D. Stools
During a well-baby visit, Liza asks the nurse when she should start giving her
infant solid foods. The nurse should instruct her to introduce which solid food
first?
A. Applesauce
B. Egg whites
C. Rice cereal
D. Yogurt
Parents bring their infant to the clinic, seeking treatment for vomiting and
diarrhea that has lasted for 2 days. On assessment, the nurse in charge detects
dry mucous membranes and lethargy. What other findings suggest a fluid volume
deficit?
A. A sunken fontanel
B. Decreased pulse rate
C. Increased blood pressure
D. Low urine specific gravity
An 11-year-old girl with celiac disease was discharged from the hospital. An
appropriate teaching was carried out by the nurse if the parents are aware of
avoiding which of the following?
A. Chicken
B. Wheat
C. Milk
D. Rice
Nurse Benjamin, who works at Little Stars Pediatric Hospital, has been assigned
to care for 4-year-old Mia. Mia has been admitted for a corrective surgery related
to her cleft palate. While reviewing Mia’s medical history, Nurse Benjamin
observes that Mia has had multiple instances of otitis media in the past year.
Remembering his pediatric nursing training and understanding the interrelation
between cleft palate and otitis media, Nurse Benjamin anticipates the potential
reasons behind Mia’s recurrent ear infections. He is preparing to discuss these
with Mia’s parents, to help them understand the risks and possible preventative
measures. When assessing a child like Mia with a cleft palate, the nurse
understands that the child is at risk for more frequent episodes of otitis media
due to which of the following reasons?
A. Lowered resistance from malnutrition.
B. Ineffective functioning of the Eustachian tubes.
C. Plugging of the Eustachian tubes with food particles.
D. Associated congenital defects of the middle ear.
E. Nasal congestion leading to impaired drainage.
F. Chronic exposure to upper respiratory tract infections.
In the neonatal intensive care unit (NICU) of Tranquil Beginnings Hospital, Nurse
Veronica is starting her shift. She’s handed over the care of baby Ethan, who was
born 12 hours ago with a noticeable cleft lip. The new parents, first-timers, are
understandably concerned and have a lot of questions. As part of her
assessment and while preparing to guide and reassure the parents, Nurse
Veronica pays particular attention to potential complications that might be directly
related to baby Ethan’s cleft lip. While evaluating a newborn like Ethan with a
cleft lip, which of the following aspects of his health should the nurse be
particularly vigilant about, anticipating that it will most likely be compromised?
A. Sucking ability
B. Respiratory status
C. Locomotion
D. GI function
E. Auditory function
F. Vision
At Joyful Steps Pediatric Center, Nurse Adrian is preparing for the post-operative
care of little Isabelle, an 18-month-old who is soon to undergo surgery for her
cleft palate repair. The child’s parents, both visibly anxious, have been asking
multiple questions about the postoperative period. They express their concerns
about ensuring Isabelle doesn’t hurt herself or disrupt the surgical site. Having
assisted in many such surgeries, Nurse Adrian is familiar with the measures to
ensure safety and minimize trauma to the operative site, including the use of
certain restraints. He gathers the appropriate materials and is prepared to
educate the parents on their application and purpose. Considering Isabelle’s
upcoming cleft palate repair, which type of restraints are typically used
post-operatively to ensure the safety and integrity of the surgical site?
A. Elbow restraints
B. Full arm restraints
C. Wrist restraints
D. Mummy restraints
E. Soft mittens
F. Leg restraints
10. Question
Nurse Fiona, a seasoned home care nurse specializing in pediatrics, is visiting
the home of Mrs. Patel, a new mother who recently gave birth to baby Aarav,
diagnosed with a cleft palate. They’re sitting in the softly lit nursery, surrounded
by toys and comforting baby sounds. Nurse Fiona knows the importance of
proper feeding techniques for infants with a cleft palate to ensure they receive
adequate nutrition and prevent complications. She has been explaining the
techniques to Mrs. Patel, emphasizing specific strategies. As the instruction
progresses, Nurse Fiona asks Mrs. Patel to summarize what she has learned to
gauge her understanding. If Mrs. Patel makes which of the following statements,
would Nurse Fiona recognize a need for further clarification and instruction?
A. “I will use a nipple with a small hole to prevent choking.”
B. “I will stimulate sucking by rubbing the nipple on the lower lip.”
C. “I will allow the infant time to swallow.”
D. ”I will allow the infant to rest frequently to provide time for swallowing
what has been placed in the mouth.”
E. “I should hold the baby in a horizontal position during feeding.”
F. "I'll aim the nipple towards the unaffected side of the mouth."
Will is being assessed by Nurse Lucas for possible intussusception. Which of the
following would be least likely to provide valuable information?
A. Abdominal palpation
B. Family history
C. Pain pattern
D. Stool inspection
Baby Ellie is diagnosed with gastroesophageal reflux (GER). Which of the
following nursing diagnoses would be inappropriate?
A. Risk for aspiration
B. Impaired oral mucous membrane
C. Deficient fluid volume
D. Imbalanced nutrition: Less than body requirements
Dustin who was diagnosed with Hirschsprung’s disease has a fever and watery
explosive diarrhea. Which of the following would Nurse Joyce do first?
A. Administer an antidiarrheal.
B. Notify the physician immediately.
C. Monitor the child every 30 minutes.
D. Nothing. (These findings are common in Hirschsprung's disease.)
Mr. and Ms. Byers’ child failed to pass meconium within the first 24 hours after
birth; this may indicate which of the following?
A. Celiac disease
B. Intussusception
C. Hirschsprung's disease
D. Abdominal-wall defect
Steve is diagnosed with celiac disease and experiences celiac crisis secondary
to upper respiratory tract infection; which of the following would Nurse Nancy
expect to assess?
A. Lethargy
B. Weight gain
C. Respiratory distress
D. Watery diarrhea
In pediatric gastroesophageal reflux disease (GERD), the immaturity of lower
esophageal sphincter function is manifested by frequent transient lower
esophageal relaxations, which result in retrograde flow of gastric contents into
the esophagus. Which statement about the esophagus is true? Select all that
apply.
A. It is a cartilaginous tube.
B. It has upper and lower sphincters.
C. It lies anterior to the trachea.
D. It extends from the nasal cavity to the stomach.
E. It is a highway for food and drinks to travel along to make it to the
stomach.
F. All statements describe the esophagus.
Cardiac:
A 5-year-old girl Hannah is recently diagnosed with Kawasaki disease. Apart
from the identified symptoms of the disease, she may also likely develop which of
the following?
A. Sepsis
B. Meningitis
C. Mitral valve disease
D. Aneurysm formation
The Foley Family is caring for their youngest child, Justin, who is suffering from
tetralogy of Fallot. Which of the following are defects associated with this
congenital heart condition?
A. Aorta exits from the right ventricle, pulmonary artery exits from the left
ventricle, and two noncommunicating circulations
B. Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and
right ventricular hypertrophy
C. Coarctation of aorta, aortic valve stenosis, mitral valve stenosis, and
patent ductus arteriosus
D. Tricuspid valve atresia, atrial septal defect, ventricular septal defect,
and hypoplastic right ventricle
Mr. and Mrs. Baker’s only daughter is diagnosed with heart failure. Which of the
following interventions would be appropriate to promote optimal nutrition for the
infant?
A. Replacing regular nipples with easy-to-suck ones
B. Allowing the infant to feed for at least 1 hour
C. Providing large feedings evenly spaced every 4 hours
D. Offering formula that is high in sodium and calories
The ductus arteriosus is another fetal structure that is important in the
intrauterine life. It functions to:
A. Shunts the combined cardiac output from the pulmonary artery to the
aorta going to the lungs
B. Shunts the combined cardiac output from the pulmonary artery to the
systemic circulation
C. Shunts the combined cardiac output from the aorta to the pulmonary
artery and later to the pulmonary veins
D. Shunts the combined cardiac output from the aorta to the pulmonary
artery to the right ventricle
A nurse is monitoring the intake and output of an infant receiving furosemide
(Lasix) IV. Which of the following methods is the most appropriate in measuring
the urine output?
A. Ask the mother regarding the number of diaper changes
B. Compare intake with output
C. Weighing the diaper
D. Insert Foley catheter
Bryce is a child diagnosed with coarctation of aorta. While assessing him, Nurse
Zach would expect to find which of the following?
A. Squatting posture
B. Absent or diminished femoral pulses
C. Severe cyanosis at birth
D. Cyanotic ("tet") episodes
Appropriate intervention is vital for many children with heart disease in order to
go on to live active, full lives. Which of the following outlines an effective nursing
intervention to decrease cardiac demands and minimize cardiac workload?
A. Feeding the infant over long periods
B. Allowing the infant to have her way to avoid conflict
C. Scheduling care to provide for uninterrupted rest periods
D. Developing and implementing a consistent care plan
Which of the following would Nurse Tony suppose to regard as a cardinal
manifestation or symptom of digoxin toxicity to his patient Clay diagnosed with
heart failure?
A. Headache
B. Respiratory distress
C. Extreme bradycardia
D. Constipation
An infant with a patent ductus arteriosus is admitted to the pediatric unit ward.
The nurse anticipates which of the following medications will be given to the
infant?
A. Prednisone
B. Ibuprofen
C. Penicillin
D. Albuterol
A child with Kawasaki disease is admitted to the pediatric ward. Which of the
following medications will you expect to be a part of the treatment? Select all
that apply.
A. Gamma Globulin
B. Warfarin.
C. Acetaminophen
D. Aspirin
E. Atenolol
When creating a teaching program for the parents of Jessica who is diagnosed
with pulmonic stenosis (PS), Nurse Alex would keep in mind that this disorder
involves which of the following?
A. A single vessel arising from both ventricles
B. Obstruction of blood flow from the left ventricle
C. Obstruction of blood flow from the right ventricle
D. Return of blood to the heart without entry to the left atrium
Which of the following disorders leads to cyanosis from deoxygenated blood
entering the systemic arterial circulation?
A. Aortic stenosis (AS)
B. Coarctation of aorta
C. Patent ductus arteriosus (PDA)
D. Tetralogy of Fallot
Clay is an 8-year-old boy diagnosed with heart failure. Which of the following
shows that he is strictly following the directed therapeutic regimen?
A. Daily use of an antibiotic
B. Pulse rate less than 50 beats/minute
C. Normal weight for age
D. Elevation in red blood cell (RBC) count
14. The nurse is aware that the infant born with hypoplastic left heart syndrome
must acquire his or her oxygenated blood through:
a. the patent ductus arteriosus.
b. a ventricular septal defect.
c. the closure of the foramen ovale.
d. an atrial septal defect.
GU
Preferred nurses at the Nurseslabs Medical Center are about to perform a
procedure related to a genitourinary (GU) problem to a group of pediatric
patients. Which of the following groups would find it especially extra stressful?
A. Infants
B. Toddlers
C. Preschoolers
D. School-age children
What is most likely the underlying physiology of primary enuresis?
A. Psychogenic stress
B. Delayed bladder maturation
C. Urinary tract infection
D. Vesicoureteral reflux
The nurse is evaluating a female child with acute post streptococcal
glomerulonephritis for signs of improvement. Which finding typically is the earliest
sign of improvement?
A. Increased urine output
B. Increased appetite
C. Increased energy level
D. Decreased diarrhea
The nurse is aware that the following laboratory values support a diagnosis of
pyelonephritis?
A. Myoglobinuria
B. Ketonuria
C. Pyuria
D. Low white blood cell (WBC) count
Nurse Elena is handling a 7-year-old child who has cystitis. Which of the
following would Nurse Elena expect when assessing the child?
A. Dysuria
B. Costovertebral tenderness
C. Flank pain
D. High fever
Which of the following organisms is the most common cause of urinary tract
infection (UTI) in children?
A. Klebsiella
B. Staphylococcus
C. Escherichia coli
D. Pseudomonas
Which of the following should be included when developing a teaching plan to
prevent urinary tract infection? Select all that apply.
A. Maintaining adequate fluid intake
B. Avoiding urination before and after intercourse
C. Emptying bladder with urination
D. Wearing underwear made of synthetic material such as nylon
E. Keeping urine alkaline by avoiding acidic beverages
F. Avoiding bubble baths and tight clothing
Stephen was diagnosed with minimal-change nephrotic syndrome; which of the
following signs and symptoms are characteristics of the said disorder?
A. Hypertension, edema, hematuria
B. Hypertension, edema, proteinuria
C. Gross hematuria, fever, proteinuria
D. Poor appetite, edema, proteinuria
Patient S is a sexually active adolescent. Which of the following instructions
would be included in the preventive teaching plan about urinary tract infections?
A. Drinking acidic juices
B. Avoiding urinating before intercourse
C. Wearing nylon underwear
D. Wiping back to front
12-year-old Caroline has recurring nephrotic syndrome. Which of the following
areas of potential disturbances should be a prime consideration when planning
ongoing nursing care?
A. Body image
B. Sexual maturation
C. Muscle coordination
D. Intellectual development
The following are considered functions of the Urinary System, EXCEPT:
A. Vitamin D synthesis
B. Regulation of red blood cell synthesis
C. Excretion
D. Absorption of digested molecules
E. Regulation of blood volume and pressure
Dr. Jones prescribes corticosteroids for a child with nephritic syndrome. What is
the primary purpose of administering corticosteroids to this child?
A. To increase blood pressure
B. To reduce inflammation
C. To decrease proteinuria
D. To prevent infection
Nurse Jeremy is evaluating a client’s fluid intake and output record. Fluid intake
and urine output should relate in which way?
A. Fluid intake should double the urine output.
B. Fluid intake should be approximately equal to the urine output.
C. Fluid intake should be half the urine output.
D. Fluid intake should be inversely proportional to the urine output.
Stefan was diagnosed with secondary vesicoureteral reflux; such condition
usually results from which of the following?
A. Acidic urine
B. Congenital defects
C. Hydronephrosis
D. Infection
Answers
Gastrointestinal (GI)
1. B. Profuse diarrhea
2. D. Projectile vomiting
3. C. Sucking ability
4. B. Vomiting
5. C. Rice cereal
6. A. A sunken fontanel
7. B. Wheat
8. B. Ineffective functioning of the Eustachian tubes
9. A. Sucking ability
10.A. Elbow restraints
11.E. "I should hold the baby in a horizontal position during feeding."
12.B. Family history
13.B. Impaired oral mucous membrane
14.B. Notify the physician immediately.
15.C. Hirschsprung's disease
16.D. Watery diarrhea
17.B. It has upper and lower sphincters.
C. It lies anterior to the trachea.
E. It is a highway for food and drinks to travel along to make it to the stomach.
Cardiac
18.D. Aneurysm formation
19.B. Ventricular septal defect, overriding aorta, pulmonic stenosis (PS), and right
ventricular hypertrophy
20.A. Replacing regular nipples with easy-to-suck ones
21.B. Shunts the combined cardiac output from the pulmonary artery to the systemic
circulation
22.C. Weighing the diaper
23.B. Absent or diminished femoral pulses
24.C. Scheduling care to provide for uninterrupted rest periods
25.C. Extreme bradycardia
26.B. Ibuprofen
27.A. Gamma Globulin
D. Aspirin
28.C. Obstruction of blood flow from the right ventricle
29.D. Tetralogy of Fallot
30.C. Normal weight for age
Genitourinary (GU)
31.C. Preschoolers
32.B. Delayed bladder maturation
33.A. Increased urine output
34.C. Pyuria
35.A. Increased urine output
36.A. Dysuria
37.C. Escherichia coli
38.A. Maintaining adequate fluid intake
C. Emptying bladder with urination
F. Avoiding bubble baths and tight clothing
39.D. Poor appetite, edema, proteinuria
40.A. Drinking acidic juices
41.A. Body image
42.D. Absorption of digested molecules
43.B. To reduce inflammation
44.B. Fluid intake should be approximately equal to the urine output.
45.D. Infection
More practice Quizlet:
[Link]
Exam Review
NSG 341 Exam 2 Review Questions
Renal
· List is order of ascension the pathogenesis of a UTI:
A bacteria enters the urethra via an external source and trends up the urethra and into
the bladder. Then it ascends to the ureters and finally the kidney. Therefore, UTIs can spread,
leading to cystitis or pyelonephritis and then AKI. Prevention of infection is key.
· List three disposing factors for a UTI:
Poor perineal hygiene (not wiping from front to back), prolonged baths (dirty bath water
gets into urethra), not peeing after sexual intercourse (sex allows for bacteria to get into
urethra), having a short urethra (females, shorter distance for bacteria to travel), being
dehydration or not urinating (allows the bacteria to sit in the urinary tract)
· What is the backwards flow of urine in the urinary tract when voiding?
The backwards flow of urine during voiding is called vesicoureteral reflux. This is caused
by strictures in the ureter or narrowing at the ureteropelvic junction. This should be considered
for children who have had 2 or more UTIs with a fever, as it can be a sign that there is a
structural problem within the urinary tract.
· What is the gold standard diagnostic for this diagnosis?
The gold standard for VUR is a VCUG. This essentially tracts the flow of urine from the
kidneys, down the ureter, into the bladder, and out the urethra. This can tell us if there is that
backflow of urine into the kidneys. The treatment for this diagnosis are stents or a tube that
keeps the ureter open, to prevent backflow.
· List a nursing consideration/intervention related to primary enuresis:
Important considerations for children who are struggling with enuresis is to make sure
they maintain dryness. If they are sleeping/sitting in their urine for a prolonged period of time
this can lead to skin irritation or UTIs. Sometimes primary enuresis can be due to drinking water
before bed, and the child does not wake to use the restroom. Positive reinforcement + consider
secondary causes (stress, bullying at school, rule out UTI incontinence).
· What is the treatment for hypospadias?
The treatment for hypospadias is surgical correction. It’s very important to find
hypospadias early on and prevent circumcision, as we need the foreskin for reconstruction.
· What are the diagnostic differences between Acute Glomerulonephritis and
Nephrotic Syndrome?
AGN Nephrotic Syndrome
-tea colored urine -frothy colored urine
-mild proteinuria -MASSIVE proteinuria (3+, 4+)
-positive ASO titer -MASSIVE edema
-RBC in urine inc, WBC inc, ESR inc -hypoalbuminemia
-increased specific gravity
GI
· List a pre-op teaching point for cleft lip/cleft palate:
It is super crucial that we make sure the baby is still feeding before the procedure to
ensure proper growth and development. However, due to the deformity it can be difficult so we
have different feeding techniques: a spoon bottle and a lamb’s nipple bottle. These two
techniques bypass the hard palate, allowing for sucking and feeding. It is also important to
educate the parents on the procedure, and what they should expect post-operatively. The baby
will have stitches on the lips, and will not be able to feed for 7-10d. Further, the baby will have
elbow restraints to prevent them from pulling on the sutures. Provide emotional support to the
parents as this can be scary looking or stressful.
· List two clinical presentations for pyloric stenosis:
Clinical presentations of pyloric stenosis are projectile vomiting, weight loss, nonbilious
emesis, and an olive mass on the stomach. We might also see irritability from inability to
feed properly. Metabolic alkalosis (due to vomiting up all the acidic contents,
hypochloremia, and hypokalemia)
· What is the treatment/procedure for Malro/Volvulus?
The treatment for Malro/volvulus is Ladd’s procedure. This is where the surgeon goes in
to mechanically relay the bowel.
· What is the gold standard diagnostic for Intussusception?
Gold standard diagnostic for intussusception is an air enema. Not only does this
diagnose the disorder but it also treats it by pressing out the bowel. Intussusception is the
twisting of the bowel. It is characterized by 10/10 paroxysmal intermittent pain that then goes to
a 2/10, red-currant jelly stools, and bilious-emesis.
· What is the treatment for Gastroschisis?
The treatment for gastroschisis is to cover it with a sterile bag and warm saline. We want
to ensure that the bowels stay nice and moist. We also can position the bag in a way that
presses into the abdominal cavity to use gravity to put the bowels back into the body. If there is
any abnormal way the bowels are laying after they re-enter, we can go in and do a Ladd’s
procedure. We don't surgically operate on these patients to put the bowel back in as they dont
have the room in their abdominal cavity.
· What is the pathophysiology for Hirschsprung’s Disease?
The pathology for Hirschsprung’s disease is mainly unknown, but can be due to immune
or genetic causes (amish). The rectum and lower colon is aganglionic, meaning that it is missing
ganglions and there is no signal from the CNS to start peristalsis. This leads to a dead bowel
that is hard to push stool through. This is why we see foul smelly, ribbon-like stools. We
diagnose this with a barium enema, a rectal biopsy (gold standard), or a anal-spchinter
manometry. The treatment of this disease is to cut out the dead bowel and have a temporary
ostomy. When the child grows later in life, we will anastomose the bowel. Nursing
considerations are to hook the pt up to NG LIWS to mimic the natural bowel and prevent
perforation. Signs of perforation are sudden, severe abdominal pain, N/V, change in BM and
bloody stool.
· List a nursing consideration/intervention for an Appendicitis:
Nursing considerations for appendicitis are to NOT use heat. Monitor for signs of a relief
in pain (appendix rupture). Provide pain meds and fever control. Offer emotional support,
educate the family on soft, non irritating foods, and limit activity for 2-4 weeks. ADAT tool helps
assess if it is appendicitis. Take symptoms, diet, labs to consider if its possible.
· What is the pathophysiology of Celiac Disease?
Celiac disease is an autoimmune disease where the immune system attacks the bowel
when it comes into contact with gluten. In the body, gluten is turned into gilidin, then turned to
glutamine. This glutamine increases in amount until it begins to attack/destroy the microvilli in
the intestines. This leads to decreased absorption of fats and fat soluble vitamins, resulting in
fatty stools. We should treat this with avoidance of gluten and supplement with fat soluble
vitamins.
· What disease process include a finding of a cobblestone like appearance?
A cobblestone like appearance is a result of Crohn's disease where the bowel is
hypertrophied and fissures. Upon an endoscopy, we will see a cobblestone-like appearance in
the inside of the intestine. We might also see bleeding, fatigue, loss of weight, anemia,
abdominal pain, urgency to have a bowel movement.
· What is the primary concern with gastroenteritis?
The primary concern with gastroenteritis is dehydration. In children younger than two
with fevers, their body is losing a lot of fluid especially from vomiting or diarrhea. Therefore, it's
important to make sure they are adequately hydrated. We should be paying attention to fluid
and electrolyte balances and H+H.
· Name three foods to avoid with PKU:
Meats, beans, and fish. Hamburger, eggs, cheese, nuts, beans, milk
Cardiac
· Differentiate between a right to left and a left to right shunt with a CHD?
A left to right shunt is an acyanotic, or increased pulmonary flow heart defect. We have
oxygenated blood from the left side of the heart, moving to the right side of the heart and going
back through the pulmonary circulation. Any blood flow that enters circulation is oxygenated,
even if its abnormal circulation.
A right to left shunt is cyanotic, or decreased pulmonary flow heart defect. We have
deoxygenated blood from the right side of the heart going to the left side and then moving to
systemic circulation. Here we have a mixing of blood that turns mostly deoxygenated due to less
blood flowing through pulmonary circulation.
· List the four defects associated with Tetralogy of Fallot:
The four defects are DROP: displaced aorta, right sided hypertrophy, opening in the
septum (VSD), and pulmonic stenosis.
· List three common signs of cardiac problems in infants:
Three common signs of cardiac problems in infants are poor feeding, diaphoresis when
feeding, FTT, cyanosis with crying.
· What are two primary objectives in treating congestive heart failure?
Two primary objectives in treating congestive heart failure is to get rid of excess fluid and
increase cardiac output and tissue perfusion.
· What position would best relieve a child experiencing a TET spell?
The best position would be a knee chest position. We also want to calm the child and
provide oxygen.
· Describe two nursing interventions that would reduce the workload on the
heart:
Two nursing interventions that would reduce the workload on the heart resting or having
the child play quietly instead of running or active play. Another option would be to give oxygen or
digoxin to increase heart contractility while decreasing workload (makes more effective
contractions). Elevate HOB monitor Is+Os and daily weights.
· What are common signs of digoxin toxicity?
Hyperkalemia, low blood pressure, yellow hallow, anorexia, vomiting. Weak/irregular
heartbeat.
· What is a risk associated with Cardiac Catheterization?
Arrhythmias, bleeding, perforation, phlebitis
· What cardiac complications are associated with Kawasaki Disease?
Dilation of coronary arteries, coronary artery aneurysm
· What medications are used to treat Rheumatic Fever?
Aspirin and ABX: penicillin
Nephritic Syndrome VS. Nephrotic Syndrome
Nephritic Syndrome Nephrotic Syndrome
● Inflammation of the glomerulus ● Changes to the glomerulus and
causing the filter to leak red blood leaking of MASSIVE proteins
cells and MILD protein ○ NOT RBCs only proteins
● Main cause: post streptococcal ● Main cause: unknown
infection 14 days post infection ○ Minimal change disease (most
common cause) damage to
S+S glomeruli cells
○ Secondary: lupus, diabetes,
● “HAD STREP” HF
○ H: hypertension
○ A: ASO titer + ● Losing lots of albumin in the urine
○ D: decreased GFR low UOP causes a decrease serum level
○ S: swelling in face/eyes (mild (hypoalbuminemia)
edema)
○ T: tea colored urine (d/t S+S
blood)
○ R: recent strep infection ● Proteinuria MASSIVE
○ E: Elevated BUN and ○ 3+ 4+
creatinine ○ Foamy, frothy urine, dark
○ P: proteinuria (mild) yellow
● Hyperalbuminemia
Main Nursing Concerns: ○ Decrease protein in the blood
○ Causes MASSIVE edema:
● Monitor BP: antihypertensive drugs, weight gain, face+extremities,
diuretics abdomen
● Monitor fluid status: Is+Os and daily ○ PERIORBITAL EDEMA FIRST
weights SIGN
● Limiting sodium and fluid restriction
● Anticonvulsants for hypertensive Main Nursing Concerns:
encephalopathy
● Sodium restriction and high protein
diet
● 1st line: corticosteroids
● Albumin infusion and then diuretics
● Risk for infection
● May have hyperlipidemia due to liver
compromising for decreased proteins
Crohn's Disease Vs. Ulcerative Colitis
Crohn's Disease Ulcerative Colitis
● ALL BOWEL, HYPERTROPHY, ● SUPERFICIAL, ULCERS, COLON +
FISSURES RECTUM
● Cobblestone appearance ● ulcers
Similarities:
● Form of IBD
● Cause inflammation and ulcers
● Cause is unknown: autoimmune (environment and genetics)
● Flare-ups followed by remission
● Both can cause weight loss due to malabsorption
● Watch for foods that can cause flare ups: high fiber, hard to digest, fatty, spicy, dairy
● Consume: high protein, low fiber, stay hydrated
Management:
● 5-ASA
● Immune modulating agents
● TNF inhibitors
● Steroids
● Pain meds
● Antibiotics if infection
Kawasaki’s Disease
● Systemic inflammation of the blood vessels (vasculitis)
● Cause unknown: exaggerated immune response to infection
● 3 phases
○ Acute:
■ Red conjunctivitis (strawberry tongue)
■ Arthritis
■ High fever UNRESPONSIVE TO ANTIPYRETICS
■ Erythema on the body (eyes, chapped cracked lips, oral mucosa red,
patients palms and soles red)
■ Enlarged cervical lymph nodes
■ Dysrhythmias and myocarditis
○ Subacute:
■ Peeling of the nails, palms, soles
■ Arthritis
■ Fever resolves
○ Convalescent
■ Clearance of symptoms and abnormal labs may be present
● Labs
○ Elevation in ESR and CRP
○ Decrease in albumin levels
● Diagnosis:
○ Fever for over 5 days and ⅘ symptoms
● Treatment
○ High dose aspirin
○ IVIG
● Nursing care:
○ Closely monitor cardiac function (carditis)
○ Daily weights and Is+O
○ Risk for aneurysms
○ NO LIVE VACCINES FOR 11 MONTHS
CREAM
C: conjunctivitis
R: rash
E: extremity changes (peeling subacute, and redness initial)
A: adenopathy (enlarged lymph nodes
M: mucosal changes (red cracked lips, strawberries tongue)
Rheumatic Fever
● Inflammatory disorder of the heart, blood vessels, and joints
● Patho:
○ Abnormal immune response to a group A beta-hemolytic strep infection
○ Widespread inflammation in the body
○ Cardiac damage long term
● Risk factor: recent pharyngitis (untreated/partially treated)
● Signs and symptoms:
○ Fever
○ Arthritis of large joints
○ Carditis
○ Chorea (involuntary movements of muscles)
○ Polyarthritis
○ Erythema marginatum: transitory rash on trunk and proximal extremities,
nonpruritic, painless
○ Subcutaneous nodules: over bony prominences
● Labs:
○ ASO + titer
○ Throat culture for GABAS
○ ESR and CRP levels elevated (inflammation)
● Diagnosis
○ Elevated ESR and positive ASO titer
● Treatment:
○ Penicillin, sulfas for underlying step treatment
○ Aspirin (anticoag and inflammation)
● Nursing considerations
○ Monitor for high fever
○ Assess for signs of cardiac stress
○ Assist with ambulation: PT/OT
○ Admin meds
