PEDS Final Review – Practice Exam Questions and Comprehensive Study Guide | Pediatric Nursing Revision

PEDS Final Review
 Protection
 Rheumatic fever
 Patho
 Abnormal response to group A beta H strep (GABHS)
 Immune process which causes inflammation of the heart, joints, skin
and brain
 Rheumatic heart disease- cardiac valve damage occurs in ½ of cases
 **partially treated/untreated strep can lead to rheumatic fever
 S/S- Jones criteria (2 major or 1 major/2 minor)
 Major
 Carditis
 Polyarthritis (painful swelling of large joints)
 Subq nodules (non-tender0
 Chorea (involuntary muscle movements)
 Erythema marginatum (scarlet, nonpainful rash of trunk/limbs)
 Minor
 Fever
 ESR >60 mm or CRP >3
 Prolonged PR interval
 Arthralgias (joint pain)
 Diagnosis
 + GABHs throat culture (strep)
 Labs- ** + ASLD (strep antibody, meaning recent infection)
 Chest x-ray- cardiomegaly
 Echocardiogram- presents of carditis
 EKG- prolonged PR interval
 Treatment
 10 day penicillin
 Salicylates (aspirin)- lowers inflammation process
 Educate parents to watch for varicella/flu
 Bed rest and quiet activities
 Good nutrition
 HF therapies for significant carditis
 Protection for injury/physical stress for chorea
 Haloperidol (Haldol) may be needed to manage chorea
 Nursing management
 Identify and treat strep infection
 Early recognition and treatment to prevent cardiac valve damage
 Patient teaching
 Prophylactic ABX can be used for residual heart disease until 21 year old
or 40 years old for PHD
 Encourage compliance with drug regiments
 Lifelong management- education and monitoring

,  HF
 Progressive valve disease
 Surgery may be needed for replacement valves
 Endocarditis (infective)
 Pathophysiology
 Vegetative growths on heat valves or endocardium
 Infection of the endocardium (inner heart lining) and involving the valves
 Can result from bacteremia with underlying heart condition/long-term
central cath use (most common strep viridian and s. aureus)
 Occurs from
 Local infection
 Dental procedures
 Invasive GI/GU
 Synthetic materials in body
 Long term indwelling catheter
 S/S
 Bacteremia
 Splinter hemorrhage- blood spots under fingernails
 Petechiae
 Splenomegaly
 HF symptoms
 New/change in murmur
 Emboli formation elsewhere in body- pads of fingers, palms, soles
 Diagnosis
 Blood culture- +bacteria/fungus
 CBC count- anemia, leukocytosis
 Increased ESR
 Increased c-reactive protein
 UA- microscopic hematuria
 Echocardiogram
 Cardiomegaly
 Area of vegetation
 Abnormal valve function
 Decrease ventricular function
 EKG changes- prolonged PR interval
 Chest x-ray- cardiomegaly
 Treatment
 High dose IV antibiotics for 2-8 weeks (PICC line)
 Monitor blood cultures
 Repeat echo to evaluate ventricular function, vegetation on valves, valve
disease
 Heart surgery possible to repair/replace damaged valves
 Nursing management
 Teach parents of high risk symptoms s/s of endocarditis

,  Prophylactic abx before dental work
 Observe for complications- embolism/HF
 Patient teaching
 Prevention: prophylactic abx to high risk patients before
 Dental procedures
 Invasive respiratory tract procedures
 Procedures on infected skin
 Maintain excellent oral hygiene and notify dentist of risk
 Meningitis/encephalitis
 Pathophysiology
 Acute inflammation of the menigies
 Bacterial causes
 Streptococcus pneumonae (Prevnar vax)
 Group B strep (GBS)- infants
 Meningococcal- spreads through droplet respiratory secretions
 Signs and symptoms
 Fever
 Vomiting
 High pitched cry
 Nuchal rigidity
 Hypotonia
 Photophobia
 Diagnosis
 Lumbar puncture- definitive diagnostic
 Blood culture
 Nose and throat culture
 Urine
 Treatment
 Antibiotics (bacterial)
 Analgesics
 Anticonvulsants
 Nursing management
 Isolation precautions when suspected and confirmed
 Droplet for first 24 hours of abx therapy
 Maintain ventilation
 Maintain hydration
 Decrease ICP- quiet environment, lower stimuli
 Manage shock
 Control seizures
 Control temperatures
 Don’t start abx until all cultures have been obtained
 Patient teaching
 Prevention- vaccination
 HIB