Pedi Exam 2


Most common result of GI illness in infants/children

Rehydration therapy

Mildly or moderately dehydrated child must receive this to prevent progression to hypovolemic shock

Oral rehydration

Most common form of rehydration therapy

Intravenous therapy

Key rehydration therapy in severe cases

2 seconds

Capillary refill in mild dehydration

2-4 seconds

Capillary refill in moderate dehydration

Greater than 4 seconds; cool limbs

Capillary refill in severe dehydration


Respiratory rate/pattern in mild dehydration


Respiratory rate/pattern in moderate dehydration

Increased and hyperpnea

Respiratory rate/pattern in severe dehydration


Skin turgor in mild dehydration


Skin turgor in moderate dehydration


Skin turgor in severe dehydration

High or Low

Serum sodium in dehydration


BUN & creatinine in dehydration due to renal hyperprofusion


Lactic acid in dehydration due to poor tissue perfusion


bicarb in dehydration due to high lactic acid

100 ml/kg

First 10 kg

50 ml/kg

Second 10 kg

20 ml/kg

Remaining kg

Maintenance fluid

Add together for total mL needed per 24 hour period; divide total amount by 24 for rate in mL/hr

1st step of physical exam

Assess color, hydration status, abd size & shape, mental status

2nd step of exam

Auscultate bowel sounds

3rd step of exam

Percuss- dullness/flatness found along the right costal margin and 1-3 cm below the costal margin of the liver, and above the symphysis pubis. Remainder of abd should = tympany

4th step of exam

Palpate- light first, then deep. Areas of firmness or masses indicate stool or tumor. Tenderness not nml. Kidneys should only be palpable in neonates.


Immaturity of lower esophageal sphincter

Physiologic GERD

No underlying conditions (spit up infants w/ immature esophageal sphincter)

Pathologic GERD

Esophagitis, strictures, etc.

S/S of GERD in Infants

Crying/irritability, apnea/bradycardia, poor appetite, ALTE/BRUE, Vomiting, Wheezing

S/S of GERD in children

heartburn, vomiting, unhealthy teeth, commonly associated with asthma


defects/sores in the gastroduodenal mucosa

PUD symptoms

abdominal pain (worsens after meals), vomiting, GI bleeding


Syndrome characterized by excessive paroxysmal crying

Colic nursing teaching

Teach parents to rule out hair in eye/hair wrapped around finger, strangulated hernia, torsion, otitis, sepsis


Most common cause of gastroenteritis

Acute diarrhea

Caused by viruses, bacteria, parasites

Chronic diarrhea

Allergies, intolerances, bowel disease, tumors, constipation with encopresis


Soiling of fecal contents into underwear beyond age of expected toilet training

Necrotizing enterocolitis

Most common GI emergency in neonates under 1500 grams; mortality rate 50%

Symptoms of necrotizing enterocolitis

Feeding difficulties, decreased bowel sounds, abd distension, vomiting, hypotension, apnea, jaundice, abd often shiny, bloody stools, bilious vomitus, shock sx

Necrotizing enterocolitis tx

Stop feeds, need NG tube for decompression and surgery to remove dead bowel

Short bowel syndrome

Results from alteration of intestinal digestion and absorption following extensive bowel resection

Short bowel syndrome leading COD

Central line sepsis and liver failure from long term parenteral nutrition


Iron absorption


Carbs, proteins, fat, vitamin absorption


Bile acids, vitamin B-12 absorption

Celiac disease

Autoimmune disorder triggered by gluten and primarily affects the small intestine, leads to flattening of the small intestinal mucosa


Present in wheat, rye, barley

S/S of celiac

Chronic diarrhea, anorexia, abd distention, poor weight gain, vomiting


Endemic in areas of poor sanitation; common in day-care centers/institutions; passed by oral-fecal contamination; highest incidence in western US

S/S of Giardiasis

Sometimes none; diarrhea, abd distension/cramps, flatulence, malodorous/greasy stools


Tx giardiasis

Prevent giardiasis

Hand washing, chlorination of water, avoid eating uncooked foods grown in contaminated water, do not swim in unchlorinated water where children in diapers are swimming


Eggs ingested or inhaled; hatch in intestine, then migrate out anus and lay eggs; causes intense itching

Dx pinworms

Tape applied to anal area in AM; tape examined under microscope for pinworms

Management of pinworms

Albendazole is most common tx; 1 pill now & one again in 2 weeks; treat everyone in the house

Prevent pinworms

Good handwashing, keep nails short, wash bedding and PJs everyday for 2-3 weeks

Cleft lip/palate

Facial malformation that occurs during embryonic development

Cleft lip/palate immediate needs

Feeding- reduces ability to suck

Cleft lip/palate tx

Surgical with long term scar revisions

Cleft lip/palate nursing assessment

Coughing, choking w/ feeds, monitor hydration status, monitor weight

Cleft lip/palate post op care

Protect surgery site, monitor airway, position supine or side opposite of defect

Esophageal atresia

Condition where proximal and distal portions of the esophagus do not communicate resulting in blind pouch

Tracheoesophageal fistula

Abnormal communication between the trachea and esophagus

Pyloric stenosis

Hypertrophy of the muscular layer of the pylorus, causing an outlet obstruction

60-80% of pyloric stenosis cases

Have a firm, nontender, and mobile hard pylorus described as an olive in the RUQ


Gold standard of pyloric stenosis dx

Prune Belly Syndrome

Group of birth abnormalities marked by 3 major findings

1st Prune Belly Syndrome finding

lack of development of abd muscles, causing the skin of the belly area to wrinkle like a prune

2nd Prune Belly Syndrome finding

Undescended testicles

3rd Prune Belly Syndrome finding

Urinary tract problems- obstruction, ureter malformations

Tx for Prune Belly Syndrome

Surgical repair of abd wall, repair of GU anomalies; mortality 20%


Protrusion of abdominal contents through the abdominal wall


Protrusion of abdominal contents through the belly button or umbilical cord

Difference between Gastroschisis and Omphalocele

Gastroschisis has no sac and can occur anywhere in abd wall; omphalocele has intact sac

Associated with gastroschisis and omphalocele

Short gut, poor wound healing after surgery, minimal pulmonary reserve resulting in long term trach and ventilator support

Hirschsprung disease

Congenital megacolon

Congenital ganglionosis

Absence of ganglion cells in the distal colon resulting in inadequate motility

When to consider Hirschsprung dx

In any newborn who fails to pass meconium within 24-48 hours of birth

Characteristics of Hirschsprung

Chronic constipation in first month of life; pellet, ribbon-like stools

Hirschsprung disease dx

Barium enema

Hirschsprung disease tx

Diverting colostomy or ileostomy at time of dx; when child weighs more than 10kg, surgical repair; 1% require permanent colostomy; constipation and incontinence may persist after surgery

Imperforate anus

No obvious anal opening


Section of intestine telescopes into the adjoining intestinal lumen, causing bowel obstruction

Most common cause of bowel obstruction in kids <2 years


Classic presentation of intussusception

Sudden onset of intermittent, crampy abd pain; severe pain; vomiting/diarrhea; passage of frank or occult blood per rectum; palpable (sausage shaped) abd mass in upper/mid abd; currant jelly stool

Intussusception dx


Intussuscpetion tx

Barium/ air enema; surgical

Umbilical hernias

Intestinal protrusion through weak abd muscle; painless protrusion when infant cries; usually disappears by age 1; rarely become incarcerated

Inguinal hernia

Results from weakness in abd wall; more common in boys; may be visible only when infant is crying, coughing, or straining during a bowel movement; surgery if hernia becomes bigger after age 2, becomes painful, or is not reducible

Most common cause of emergent abd surgery in children



Median age of appendicitis

S/S of appendicitis

Vague abd which localizes to RLQ (McBurney's point); nausea & vomiting; small volume, frequent stools; fever (low grade unless perforation)

Appendicitis dx

CT; leukocytosis

Biliary atresia

Absence of some or all of the major biliary ducts

What does biliary atresia cause

Obstruction of bile flow

Results from biliary atresia

Secondary cirrhosis

S/S of biliary atresia

Jaundice, dark urine, light stools

Failure to thrive

Growth failure d/t inability to obtain or use calories required for growth

Failure to thrive classifications

Inadequate absorption, inadequate caloric intake, increased metabolism, defective utilization

Dx/Tx failure to thrive

Evidence of growth failure, complete health and family hx, treat underlying cause

Failure to thrive nursing care

Positive feeding environment, minimize distractions during feeding, be consistent and persistent

Premature infants nutritional considerations

Have poor muscle tone in lower esophagus (GERD), have higher demand for nutrients (more calories)

Older children nutritional considerations

Nutritional needs dependent on level of activity, amount of gut available for nutritional absorption

Naso/Oral Gastric tubes

cxr is gold standard for checking placement

uses of naso/oral gastric tubes

Enteral feeding, medication administration, gavage feeds

G-tubes long term placement

Placed either surgically, endoscopically, or IR; after about 6 weeks, then can insert G-button or Mickey

J-tubes long term placement

Inserted the same way as G-tube; if becomes dislodged, Foley cath insertion to keep stoma open until physician can replace

Pediatric GU differences

Urethra is shorter (risk of UTIs), blood flow to kidneys (GFR) is slower, newborn bladder capacity is 30 mL, kidney large r/t size of abd


Comes from breakdown of proteins from food and metabolism

Normal BUN

7-20 mg/dl


Waste product of muscle activity

Normal creatinine

0.5-1.5 mg/dl


More accurate way to measure how well kidneys filter waste from the blood; can be estimated from serum creatinine using a formula


Normal GFR in children

<15 GFR

End stage renal failure in children

Bladder exstrophy

Bladder is outside abd wall; have urethral tube malformation & separation of the pelvic bones

Catheterizing urethral stoma

If bladder tissue is insufficient for repair; allows for urinary continence; urine tends to be mucous-like and often cloudier; teach parents how to catheterize and signs of UTI to report


on the low side


on top

Vesicoureteral reflux

Retrograde flow of urine from bladder into ureters during bladder contraction when voiding

Primary VUR

Congenital anomaly, runs in families

Secondary VUR

Acquired, UTI, obstruction

VUR Grade I

Minor dilation of proximal ureter

VUR Grade I & II

Typically resolve spontaneously

VUR Grade V

Severe dilation of ureter and kidney pelvis

VUR Grades III, IV, & V

Typically warrant surgical intervention

Obstructive uropathy

May occur at any site in the urinary system

Most common obstructive uropathy

Posterior urethral valves, and ureteropelvic junction


Pelvis and calyces of kidney are dilated

Hydronephrosis complications

Renal insufficiency, HTN, renal failure


Bacterial invasion of urinary tract from skin flora or GI tract


Child unable to control bladder fx by age expected or after successful completion of bladder control program

Primary enuresis

Onset of wetting occurs after a period of established urinary continence

Secondary enuresis

Onset of wetting occurs after a period of established urinary continence

Nephrotic syndrome

Triad: massive proteinuria, hypoalbuminemia, and edema

Nephrotic syndrome therapeutic management

reduce excretion of urine protein, maintain protein-free urine, reduce edema, prevent infection, and minimize complications

Nephrotic syndrome monitoring

Strict I&O and vital signs, urine for specific gravity and protein, edema

Nephrotic syndrome management

Remission: regular diet w/o added sodium, sodium restricted diet (fluid restriction) in periods of massive edema, corticosteroids upon dx, immunosuppressive therapy to reduce relapse rate, diuretics, instruct parents to test urine and minimize sick contac


Group of kidney disorders characterized by inflammatory injury to the glomerulus

Causes of glomerulonephritis

post infection, viral infection, systemic disorders

Glomerulonephritis volume overload

Assess airway, wt, VS, dyspnea, rapid pulse, dysrhythmias, distended hand and neck veins, level of edema, amount of urine output

signs of glomerulonephritis

Periorbital edema, loss of appetite, decreased UOP, dark urine, irritability, lethargic, dysuria, HTN, and abd pain

Complications of glomerulonephritis

Kidney failure, hypertensive encephalopathy, pulmonary edema, heart failure, seizures

Hemolytic-Uremic syndrome

Defined by hemolytic anemia, thrombocytopenia, ARF

S/S of hemolytic uremic syndrome

Marked pallor, irritability, lethargy, vomiting, bloody diarrhea, hemorrhagic manifestations, decreased/no UOP, CNS involvment

Labs in hemolytic uremic syndrome

H&H decreased, BUN and creatinine increased

Hemolytic uremic syndrome tx

Early dialysis, strict I&O adequate nutrition, blood transfusions

Polycystic kidney disease

Autosomal recessive and dominant forms, multiple cysts in kidneys, may involve liver and other organs

S/S of polycystic kidney disease

HTN, hematuria, frequent urination, poor growth, UTI, proteinuria

Polycystic kidney disease tx

No cure, good outcomes w supportive care, dialysis, transplant

Renal failure

Inability of the kidneys to excrete waste products, concentrate urine, conserve electrolytes

S/S of renal failure

Oliguria, edema, drowsiness, circulatory congestion, cardiac arrhythmia, seizures, tachypnea

Acute renal failure

Sudden onset, multiple causes, usually reversible; manage HTN, restore fluid/electrolyte balance, educate family

Chronic renal failure

Progression of acute renal failure into ESRD; dialysis and kidney transplant are treatment modalities

Early renal failure

GFR 50-75% normal, decreased renal reserve but normal excretory and regulatory function

Chronic renal insufficiency

GFR 25-50% normal, associated impairment of excretory and regulatory functions

Chronic renal failure

GFR 10-25% normal, increasing clinical manifestations of renal failure

End stage renal disease

GFR 10% or less, renal replacement therapy necessary to sustain life


phosphorus binding agents, supplement calcium and vitamin D, control acidosis


Blood is circulated outside the body through an artificial semipermeable membrane permitting diffusion and ultrafiltration

AVF/AVG care

Palpate thrill daily (call if absent), avoid tight clothing or watches on access extremity, avoid sleeping on the arm with the graft, no blood pressures or venipunctures in graft extremity, graft should only be accessed by dialysis staff

Nursing care for hemodialysis

Obtain pre-dialysis wt, T, BP, HR, MAP; prepare access site with betadine, insert needles, connect tubing; check and record BP, HR, and machine pressures q 1hr and prn; set machine for amount of fluid to remove and length of tx; tx any complications appro

Peritoneal dialysis

Abd cavity acts as a semipermeable membrane; Tenckhoff catheter is inserted through the abdominal wall into the peritoneal cavity, Dialysate solution introduced into peritoneum, left to dwell then drained out

Continuous venovenous hemofiltration

Ultrafiltration of blood at a slow rate; may add dialysate; used primarily for critically ill patients

Nursing care plan for child with chronic renal failure

Risk for tissue injury r/t elevated electrolytes and waste products; fluid volume excess r/t renal failure; altered nutrition: less than body requirements r/t restricted diet; body image disturbance r/t chronic illness, impaired growth, and perception of

Pediatric renal transplant criteria

Chronic or end stage renal disease; age and wt to accommodate adult kidney; good nutritional status; absence of active infection, obstructed urinary tract, GI, liver, pancreas, or CV disease, severe mental retardation, serious psychosocial or behavior pro

Hyper acute transplant rejection

Irreversible, immediate, or a few hours after revascularization

Acute transplant rejection

Few days to 6 months after transplant; fever, swelling, and tenderness over graft site; hypertension

Chronic transplant rejection

Slow deterioration of function 6 months or more after transplant; total loss of organ

Labial adhesion/fusion

Partial or complete adherence to labia minora, UTI may result from stasis of urine behind bladder, younger girls have increased risk, administer topical estrogen cream as prescribed


Results from bacterial invasion through vagina, ascending through cervix into uterus and fallopian tubes

Chlamydia trachomatis and gonorrhoeae

Most common causes of PID

S/S of PID

Fever, abd pain, pain with intercourse, dysmenorrhea, abnl uterine bleeding

Complications of PID

Chronic pelvic pain, ectopic pregnancy, infertility r/t scarring


One or both testes fail to descend through inguinal canal into scrotal sac


Peritoneal fluid in the scrotum; usually resolves spontaneously by 1 year


Foreskin of the penis cannot be retracted; local irritation, balanitis, or UTI can occur


Serious disorder caused by retraction of phimotic prepuce, leading to constricting band behind the glans of the penis; incarceration if left untreated

Testicular torsion

A testicle is abnormally attached to the scrotum and twisted

Skin differences in infants

Epidermis thinner, more blood vessels closer to the surface (loses heat more readily through skin surface; substances are more easily absorbed through the skin), skin contains more water (epidermis loosely bound to the dermis, friction more easily results


<1 cm; flat


<0.5 cm; elevated and rounded bump


Like a papule but >5 cm


Ring around it






Rogue, red, slightly elevated rash usually seen d/t rxn to medication

Causes of integumentary disorders

Exposure to infection microorganisms, hypersensitivity reactions (contact dermatitis), hormonal influences (acne), genetic predisposition (psoriasis), injuries

Bacterial skin infections

Impetigo, folliculitis, cellulitis, MRSA, staphylococcal scalded skin syndrome

Fungal skin infections

Tinea (pedis, corporis, versicolor, capitis, and cruris), candida albicans

Viral skin infections

Viral exanthems (rashes), herpes simplex (cold sore)


bacterial infxn that has a papule with honey colored exudate that ruptures and causes and honey colored crust


Inflammation of the hair follicles


Infection usually from site of trauma on skin


Looks like a pimple with swelling around it

Staphylococcal scalded skin syndrome

Staph produces a toxin that causes exfoliation, skin redness, and tenderness. Common in infancy and rare after age 5. Tx like a burn

Tinea capitis

Affecting the scalp, eyebrows, or eyelashes

Tinea cruris

Affecting the groin

Tinea pedis

Affecting the feet

Tinea corporis

Affecting the arms or legs

Tinea versicolor

Presents differently; tan or hypopigmented lesions on upper body; occurs on the trunk and extremities

Diaper dermatitis

Inflammatory reaction of the skin in the diaper area to an irritant

Causes of diaper dermatitis

Prolonged exposure to urine and feces, overgrowth of C. albicans

Diaper dermatitis tx

Ointments and cream; vit. A, D, E, and zinc oxide; petrolatum

Diaper dermatitis prevention

Change diapers frequently, avoid rubber pants, harsh soaps, and baby wipes with fragrance or preservatives

Contact dermatitis causes

Antigenic substance exposure; allergy to nickel or cobalt in clothing, hardware, or dyes; exposure to highly allergic plants (poison ivy, oak, and sumac)

Contact dermatitis complications

Secondary bacterial skin infection; lichenification (thickening), or hyperpigmentation

Contact dermatitis management

Topical corticosteroids; control itching (cool compress, antihistamines)

Erythema multiforme

Acute, self-limiting hypersensitivity reactions

Stevens-Johnson syndrome and toxic epidermal necrolysis

Rare reactions to certain medications, skin peels off in sheaths and rots. Often get treated and admitted to burn units

Causes of erythema multiforme

Viral infection, drug (most common), food reaction

Erythema multiforme management

Supportive tx, d/c causing agent, oral hydration, analgesics and antihistamines as prescribed


Hypersensitivity reaction

Urticaria causes

Foods, drugs, animal stings, infections, environmental stimuli, stress

Urticaria management

D/C causing agent; administer antihistamines, corticosteroids, and topical antipruritics as prescribed

Urticaria assessment

Detailed hx of new foods, medications, sx of recent infxns, changes in environment, unusal stress

Atopic dermatitis (eczema) causes

Food or environmental allergies; associated with asthma and allergic rhinitis

Atopic dermatitis complications

Chronic itching can lead to psychological distress, self-image issues, difficulty sleeping, bacterial infection

Atopic dermatitis management

Promote skin hydration, maintain skin integrity, and prevent infection

Atopic dermatitis tx

Topical immunomodulators (moderate to severe), coal tar preparations


Chronic inflammatory dermatitis, occurs on skin and scalp, commonly known as cradle cap in infants and dandruff in adolescents

Seborrhea nursing management

Wash/shampoo with mild soap, mineral oil for cradle cap

Seborrhea tx

Corticosteroid creams or lotions, antidandruff shampoo


Chronic inflammatory skin disease with periods of remission and exacerbation; hyperproliferation of the epidermis; rash develops at sites of trauma; genetic predisposition

Psoriasis tx

Emollient creams, coal tar preparations, topical steroids, UV light (sunlight), mineral oil and warm towels to soak and remove thick plaques

Acne neonatorum

maternal androgens or transient androgen production in the newborn; may be present immediately after birth, most often between 2-4 weeks of age

Mild acne

primarily noninflammatory lesions (comedones)

Moderate acne

Comedones plus inflammatory lesions such as papules or pustules (localized to face or back)

Severe acne

Lesions similar to moderate acne, but more widespread, and/or presence of cysts or nodules. Associated more frequently with scarring

Thermal burn

Flame, hot surface, hot liquids, sun

Electrical burn

Outlet hazards/cords, lightening

Chemical burn

Household cleaning agents

Radioactive burn

Medical exposure, UV light

1st step in burn care

Stop the burning process

2nd step in burn care

Assess- primary and secondary survey

3rd step in burn care

Cover the burn with clean dry cloth. Cover the child. Vital for thermoregulation and to prevent water loss

4th step in burn care

Transport to emergency facility

5th step in burn care

Provide reassurance

Management of minor burns

Get tetanus hx, cleanse with mild soap/tepid water, debride, cover with antimicrobial ointment, dress with fine-mesh gauze, mild analgesic, caregiver instructions

Severity of burns

Assessed as a percentage of total body surface area burned

First degree burns


Second degree burns

Superficial/deep partial thickness; painful, red, moist, blistered; involves epidermis and some degree of dermis

Third degree burns

Full thickness; entire epidermis, dermis, and hypodermis; red to tan, waxy white, brown, black, dry and leathery; severe pain r/t severity; requires surgical excision/graft

Fourth degree burns

Full thickness; involves muscle, fascia, and bone; appears dull, dry; ligaments, tendons, bone exposure

Zone of hyperemia

Outer layer; peripheral area of burn, limited inflammation, increased blood flow; recovers without intervention

Zones of stasis

Around center; area surrounding zone of coagulation; inflammation, decreased blood flow; requires early resuscitation to survive; may convert to a zone of coagulation if not recovered correctly

Zone of coagulation (necrosis)

Center; area nearest the burn, ruptured cell membranes, clotted blood/thrombosis; tissue is dead and will not return

Minor burn

<10% TBSA partial thickness; treated as outpatient

Specialized burn center

>10% TBSA partial thickness burns; all full thickness burns; face/hands/feet/perineum/major joints; chemical/electrical/inhalation; with a trauma

Cardiovascular response to burns

Immediate postburn period= burn shock (drop in output precedes change in plasma volume); capillary permeability; rapid fluid shift to interstitial spaces; edema rapid first 18 hours post burn, maximum at 48 hours

Renal response to burns

<2 yrs increased risk for dehydration; fluid replacement important; BUN/Cr increased; myoglobin lost in urine

Gastrointestinal response to burns

Decreased blood flow; ischemia results; can lead to ulcers, enterocolitis; portal of sepsis; need for NG tube until motility restored (prevents aspiration); metabolism greatly accelerated

Neuroendocrine response to burns

Increase epinephrine, norepinephrine, aldosterone, antidiuretic hormone

Pulmonary system complications

Inhalation injury; wheezing, secretions, hoarseness, wet rales; aspiration of gastric contents; bacterial pneumonia; pulmonary edema (due to fluid overload or ARDS; pulmonary emboli)

GI complications

Feeding intolerances; mucosal changes (may see within 72 hours of a major burn; leading to ulceration); bleeding; paralytic ileus (due to trauma, sepsis, narcotics, renal failure); enteral feeding (provides nutrition; early feedings may prevent some compl

CNS complications

Burn encephalopathy; symptoms: lethargy, withdrawal, coma; causes: hypoxemia, hyponatremia, hypovolemia, septicemia, meds; usually full neuro recovery

Wound sepsis in burns

Major complication; dead tissue/exudate is bacterial growth medium; occlusion of blood supply impairs delivery of phagocytic cells; granulation tissue forms by third week; good vascular supply affords better immune response

First degree tissue repair

Heals in 3-5 days

Superficial partial thickness tissue repair

Healing in around 14 days without scarring

Deep partial thickness tissue repair

May require several months; scarring common

Full thickness tissue repair

Severe edema, extensive metabolic changes; dead tissue turns to leathery eschar in 48-72 hours; eschar separates in 12-21 days if not excised; high risk of infection; severe scarring

Burn management

Fluid resuscitation; wound care; prevention of infection; restoration of function; goal is to close the wound

Elements of burn wound tx

Primary excision of eschar; hygiene with hydrotherapy; dressings; topical antimicrobials (silver sulfadiazine, sulfamylon, bacitracin)

Temporary skin substitues

Allograft skin from human cadavers; porcine xenograft

Burn wound tx

Synthetic skin coverings; artificial skin to prepare wound for graft, permanent skin coverings, permanent epithelium

Acute burn phase

1st 24-48 hours; tx of burn shock and management of pulmonary status

Management of major burns

Adequate airway, IV fluid administration, nutrition, medication, positioning & splinting, treatment of anemia and hypoproteinemia, psychosocial support, rehabilitation

Congenital heart disease

Structural anomalies present at birth; accounts for the largest percentage of all birth defects; non-cardiac anomalies occur in over 28% of children; commonly associated with chromosomal abnormalities

Acquired heart disease

Disorders that occur after birth; develop from a wide range of causes or may occur as a complication/long term side effect of CHD

Pediatric CV differences

Infants- children <7 years of age: the heart lies more horizontally; apex is higher in the chest, below the 4th intercostal space

Post op cardiac catheterization

Monitor pulses; extremity temperature and color, bp and hr, and dressing for evidence of bleeding

Bleeding dressing

Apply pressure 1 inch above the site to create pressure over the vessel, thereby reducing the blood flow to the area. Should first apply pressure and then notify the physician if this measure is ineffective or the bleeding increases. The child should main


Sign of right sided heart failure in kids

1/6 murmur

Very faint; not always heard in all positions

2/6 murmur

Quiet but not difficult to hear

3/6 murmur

Moderately loud

4/6 murmur

Loud +/- thrills

5/6 murmur

Very loud +/- thrills; may be heard with stethoscope partly off chest

6/6 murmur

May be heard with stethoscope completely off chest; +/- thrills


Direct vasodilation of the ductus arteriosus smooth muscle. Indicated for temporary maintenance of ductus arteriosus patency in infants with ductal dependent congenital heart defects


Increases contractility of the heart muscle by decreasing conduction and increasing force. Used for HF, A-fib, a-flutter and SVT


Inhibits reabsorption of Na and Cl. Used to manage edema and in combo with antihypertensives


Inhibits prostaglandin synthesis in order to close patent ductus arteriosus

Disorders of decreased pulmonary blood flow

Tetralogy of Fallot; Tricuspid atresia

Decreased pulmonary blood flow

The blood has difficulty exiting the right side of the heart via the pulmonary artery, pressure on the rt side increase, exceeding left sided pressure. This allows desaturated blood to shunt right to left, causing desaturation in the left side of the hear

Tetralogy of Fallot

4 congenital heart defects that occur together. 1. ventricular septal defect. 2. overriding aorta 3. pulmonary stenosis 4. right ventricular hypertrophy

Tricuspid atresia

Missing or abnormally developed tricuspid valve. Blocks blood flow from right atrium to right ventricle

Disorders of increased pulmonary blood flow

Patent ductus arteriosus, atrial septal defect, ventricular septal defect

Obstructive disorders

Coarctation of the aorta; aortic stenosis and pulmonary stenosis

Mixed disorders

Transposition of the great vessels, total anomalous pulmonary venous return, truncus arteriosus and hypoplastic left heart