16501914
Description
Flashcards by Aurelea Dyck, updated more than 1 year ago
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Created by Aurelea Dyck
over 5 years ago
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| Question | Answer |
| Children in Respiratory distress may be ___ to improve ventilation | sedated |
| cardiopulmonary bypass device used when Respiratory failure is severe | Extracorporeal membrane oxygenation |
| Positioning for child in respiratory failure | upright with head midline |
| Broad classification of upper airway illnesses caused by inflammation and swelling of epiglottis and larynx, extending into trachea and bronchi | croup |
| spasmotic laryngitis and laryngotracheobronchitis are ___, but tracheitis and epiglotitis and ___ | viral, bacterial |
| why is the subglottic area of the airway susceptible to occlusion | only area with complete cartilaginous ring, so with edema it cant expand and 1mm of edema decreases airway size by 50% |
| type of croup often caused by the human parainfluensa virus | laryngotracheobronchitis (LTB) |
| least serious type of croup with an abrupt onset and afebrile | spasmotic laryngitis |
| type of croup with mild fever (less than 40) and a gradual onset | LTB |
| potentially life-threatening type of croup with an onset over 2-5 d, a fever over 39, and thick secretions | bacterial tracheitis |
| type of croup that is a life-threatening emergency with an onset over hrs, a fever over 39 | epiglottitis |
| type of croup with sore throat, dysphagia, drooling, red epiglottis, and no croup cough | epiglottitis |
| In bacterial tracheitis, the pt prefers __ position, while in epiglottis, the pt prefers __ position | supine; upright and tripod |
| throat __ and inspection of the mouth and throat are CI with LBT or epiglottitis because anxiety may cause laryngospasms and airway occlusion | cultures |
| Rapid acting bronchodialators (beta agonists, beta adrenergics) are given for which types of croup | viral only |
| medications that temporarily improve symptoms of croup through bronchodilation and decreasing mucous secretion | Beta adrenergics (E) and beta agonists (albuterol) |
| Medications for longer relief of viral croup symptoms | corticosteroids (IM, PO, nebulized) |
| besides maintaining adequate body fluids, hydrating the patient also... | thins secretions |
| Prophylactic ___ is given to child under 48 mon with epiglottitis caused by H. influenzae | rifampin |
| Most common virus that causes bronchiolitis | Respiratory Syncytial Virus |
| Nearly all children have been infected by ___ by 2 years, and are often reinfected as there is no immunity built against it | RSV |
| Damage to airways by RSV | -virus kills mucosal cells of bronchioles and cell debris creates obstruction and irritation -E obstruction -hyperinflation -atelectasis -VQ mismatch -hypoxemia |
| Symptoms of mild bronchiolitis | cough, rhinnitis, fever, wheese, tachypnea, poor feeding, v/d, dehydration, spit up food, decreased play |
| symptoms of severe broncchiolitis | -RR greater than 70 -grunting, wheese, retractions, nasal flaring, irritability, lethargy, poor fluid intake, abdominal distension due to hyperinflation, cyanosis, noisier is BETTER |
| When are chest physio, bronchodilators, and corticosteroids indicated for bronchiolitis? | Not indicated |
| interventions for bronchiolitis | -humidified O2, fluid, nasal suction and hypertonic saline, bulb syringe nad saline nose dropsantipyretics, sm frequent feedings (suction before and withold feed if tachypnic), encourage rest |
| When is IM palivizumab given to children | Immunization for RSV given to high risk children q 30 d during RSV season |
| list 5 types of autism | 1. Autistic disorder 2. Asperger Syndrome 3. Rett disorder 4. Childhood disintegrative disorder 5. Pervasive developmental disorder NOS |
| autistic disorder with impaired social, behavioural, and communication development, which is usually noted during the 1st year of life | Autistic disorder |
| Asperger symptoms: -Impaired ____ interaction -normal ____ development, spelling and vocabulary -abnormal ___ and ___ of voice -low ____ formation, comprehension, and ___ flexibility -Some times have high ___ in some ares | -social -language -pitch; tone -concept; language -intellect |
| Type of autism in which the child appears to be normal for first 6-18 mon, and then has symptoms of progressive ataxia, hand-wringing, dementia, growth delay | Rett disorder |
| Why does Rett disorder only occur in females? | x-linked |
| Type of autism in which the child appears normal until 2-5 yrs, and then declines/regresses in many areas of functioning | childhood disintegrative disorder |
| Category of autism that includes severe social impairment without meeting the criteria for any other type of autism | pervasive developmental disorder |
| what fraction of children have autism spectrum disorder? | 1/68 |
| Risk factors for ASD: 1. gender: ___ 2. ___ concordance 3. 5 other conditions: 4. ___ exposure during pregnancy being investigated | 1. male 4-5x more 2. 60-90% 3. FAS, Down syndrome, fragile X syndrome, tuberous sclerosis, phenylketonuria 4. drug |
| What are the 4 red flags of ASD? | 1. no babbling or communicative gestures by 12 mon 2. No word by 16 mon 3. No spontaneous 2 word phrase by 24 mon 4. language or social skills regress (and sensory problems ruled out) |
| What are signs of impaired socialization in an autistic child | -decreased eye contact as infant -rarely smiles as infant -impaired observation of non-verbal behaviour -unable to relate or respond to social cues |
| What are signs of impaired communication in an autistic child | -no babble by 1 yr or 2-word phrase by 2 yrs -does not converse normally or initiate conversation -regression of language skills -abnormal use of parts of speech -echolalia; repeat questions back -fascinated with rhythmic, repetative songs/verses |
| What are signs of impaired behaviour in an autistic child | -infant does not point to objects -stereotyped, rigid, excessive behaviours: head banging, twirling, bite themselves, flapping arms or hands -aversion to sensory stimuli -upset if routines disrupted/difficulty with new situations -only eat certain foods -lack imaginative play |
| What are medications for autism? | None; only to tx associated conditions |
| What are some examples of complementary therapies parents try for kids with autism? | -no sugar, aspartame, milk, wheat diet -vitamins and probiotics |
| What are some ways to stabilize the environmental stimuli for a child with autism? | -reduce noise -dim lights -provide familiar routine and toys -consistent placement of objects |
| What are some tips for communicating with a child with ASD? | -short direct sentences -give choice with objects of choice present to choose otherwise they will echo the last choice -use visual cues -sign language |
| a defect in the heart or great vessels or persistence of a fetal structure after birth | congenital heart defect |
| prevelence of CHDs: ___/1000 | 8-12 |
| Risk factors for CHDs (6) | 1. fetal exposure to medications or drugs 2. maternal systemic virus 3. higher maternal age 4. maternal metabolic disorder 5. high altitude 6. genetic |
| What are 3 categories of CHDs | 1. increased pulmonary BF 2. decreased pulmonary BF 3. obstructed systemic BF |
| Which of the 3 categories of CHDs is decribed by the following symptoms: tachcardia/pnea, CHF, poor weight gain, diaphoresis, periorbital edema, and frequent RTIs | increased pulmonary BF |
| Which of the 3 categories of CHDs is described by the following symptoms: cyanosis, hypercyanotic episodes, poor wt gain, polycythemia | decreased pulmonary BF |
| Which of the 3 categories of CHDs is described by the following symptoms: decreased pulses, increased cap refill time, decreased urinary output, CHF and pulmonary edema | obstructed systemic BF |
| What does the ductus arteriosis connect? | aorta to pulmonary arteries |
| which category of CHD is a patent ductus arteriosis? | increased pulmonary BF |
| CHD where oxygenated blood returns to deoxygenated pulmonary artery from the aorta, increasing pulmonary BF | patent ductus arteriosis |
| The ductus arteriosis usually closes within __ d, but may commonly not close in preterm infants | 2-3 |
| when pulmonary BF increases, pulmonary capillaries ___ leading to pulmonary ___ | constrict; HTN |
| Increased pulmonary BF may lead to right ventricular ___because it is pumping against extra resistance | hypertrophy |
| What are symptoms of CHD: increased pulmonary BF | tachycardia, tachypnea, increased BMR, diaphoresis with feeding, poor weight gain due to increased BMR and poor feeding, CHF: dyspnea, intercostal retractions, periorbital edema, frequent RTIs, murmurs, full, bounding pulse, widened pulse pressure, hypotention if CO deccreases, hepatomegally |
| Opening between the atria so that oxygenated blood moves from L atrium to deoxygenated R atrium and reenters pulmonary circulation | Atrial septal defect |
| Opening in ventricular septum so blood moves from L to R ventricle and reenters pulmonary circulation | Ventricular septal defect |
| if the foramen ovale doesn't close, it is a type of which CHD? | ASD |
| IV ibuprofen or indomethacin may be given to tx which infant heart defect | stimulates closure of patent ductus arteriosis |
| When is surgery indicated for an ASD? | has not closed spontaneously within 2 years or CHF occurs |
| When is surgical closure of a VSD indicated? | if it has not closed spontaneously within 6 mon or if not responding to CHF tx |
| Type of CHD that increases pulmonary BF and involves defects to the atrial/ventricular septa, and the bicuspid and tricuspid valves | Atrioventricular canal |
| When is surgery done on an infant with an atrioventriular canal defect? | at 2-4 mon; prophylacticc endocarditis tx 6 mon after surgery |
| name 4 types of CHDs that increase pulmonary BF | 1. patent ductus arteriosis 2. VSD 3. ASD 4. Atrioventricular Canal |
| CHD category that results from obstruction of BF from right side of the heart to the lungs | decreased pulmonary BF |
| Why does right to left shunting occur in CHDs that decrease BF to the lungs? | blood can's get to lungs, so pressure builds up in the right side of the heart, and if there is a septal defect, blood is shunted across |
| what is the classic sign of CHD: pulmonary BF decreased | Cyanosis that is unresponsive to O2 therapy |
| Why do CHDs with decreased pulmonary blood flow result in polycythemia? | The kidneys respond to low O2 by releasing EPO which stimulates the bone marrow to produce more RBCs. |
| Polycythemia in children with CHD: decreased pulmonary BF increases risk of... | thromboembolism |
| Why are children with decreased pulmonary BF and a septal defect at increased risk of systemic infection | Blood that is normally filtered by the lungs bypasses the lungs |
| Why may a hypercyanotic episode (with decreased pulmonary BF and septal defect) be common in the morning? | There is an abrupt decrease in systemic resistance, Right-left shunting increases, pulmonary BF decreases, and hypoxemia occurs. Hypercyanotic episode occurs when CO also increases such as with crying, feeding, straining, and the respiratory center responds to low PO2 and high PCO2 by increasing respiratory effort |
| What are symptoms of CHD: decreased pulmonary BF? | cyanosis that does not respond to O2, especially after ductus arteriosis closes dyspnea, loud murmur, ruddy, mottled skin prior to cyanosis, chronic hypoxemia: clubbing, fatigue, delayed development; tire quickly during feeding, diaphoresis while feeding, higher BMI and poor weight gain, CHF |
| CHD: narrowing of pulmonary valve, valve area, or pulmonary artery; may or may not have open foreamen ovale | pulmonic stenosis |
| CHD: combination of pulmonic stenosis, VSD, Right ventricular hypertrophy, and overriding of the aorta | Tetrology of Fallot |
| when is surgery usually done for tetrology of fallot? | at 3 mon if severe, but if not wait until 1-2 yrs |
| CHD: tricuspid or pulmonary valve is absent so that the only route to the left ventricle is the foramen ovale and the only route to the lungs in the ductus arteriosis from the aorta to the pulmonary artery | tricuspid or pulmonary atresia |
| Why is prostaglandin E indicated for children with CHD causing decreased pulmonary BF, transposition of the great arteries, | it prevents the ductus arteriosis from closing so there is at least one route for the blood to get to the lungs |
| hyperpnea | deep breathing |
| Signs of a hypercyanotic episode | tachycardia, tachypnea, hyperypnea, cyanosis, pallor, decreased tissue perfusion, diaphoresis, irritability, seizures, decreased LOC |
| What symptom occurs with severe hypoxemia related to respiratory failure or shock that warns of imminent cardiac arrest? | bradycardia |
| Children with a cyanotic heart defect usually do not have a PaO2 greater than ___mmHg, while the PaO2 with respiratory or neuro problems will be higher | 100 |
| What are side effects of prostaglandin E1? | respiratory depression and apnea |
| How is polycythemia, due to CHD: decreased pulmonary BF treated? | RBC pheresis (filters out RBCs) |
| Why are antibiotics given to children before heart surgery and 6 mon after? | Prophylaxis of infective endocarditis |
| What position should you place an infant in who is experiencing a cyanotic episode? | knee-chest- increases systemic vascular resistance |
| What meds may be given to an infant during a hypercyanotic episode if other tx is not effective? Why? | 1. Morphine-depresses the resp center to decrease hyperpnea 2. ketamine sedates and increases systemic vascular resistance 3. Beta blockers decrease HR and heart muscle spasms |
| list interventions for hypercyanotic episodes | -infant in knee-chest position -Prevent irritation or pain and try to make calm -O2 therapy -notify physician immediately -morphine, ketamine, Beta blockers -PRBcs if anemic |
| transposition of the great arteries | CHD in which the pulmonary artery exits from the left ventricle and the aorta exits from the right ventricle, so that there are two parallel circuits, and blood is oxygenated, but does not enter systemic circulation. Oxygenated blood can only enter systemic circulation through the ductus arteriosis or foramen ovale if patent |
| infants with transposition of the great arteries often have tachypnea greater than 60 without ___ or ___ | retractions or dyspnea |
| What procedure may be initially performed on an infant with transposition of the great arteries until corrective surgery can be done at 1-3 wks? | balloon atrial septostomy |
| mixed CHD in which a single artery trunk empties both ventricles and provides circulation for the pulmonary, systemic, and coronary circulations; usually with a VSD | Truncus arteriosis |
| Mixed CHD in which the pulmonary veins empty into the right atrium (instead of left); blood can only get to the systemicc circulation through the foramen ovale. | Total anomalous Pulmonary venous return |
| Mixed CHD in which the aorta and pulmonary artery both arise from the right ventricle and the only outlet for the left ventricle is a VSD | Double outlet Right ventricle |
| CHD category caused by a stenotic valve or great vessel | Defects obstructing systemic BF |
| narrowing at or near the aortic valve | Aortic stenosis |
| What are symptoms of CHDs obstructing systemic BF? | decreased CO: shock, diminished pulses, poor color, delayed cap refill, decreased urinary output, CHF and pulmonary edema, left ventricular hyperdecreased BF to the GI tract; If mild: leg cramps, cool feet and hands, pulses and BP stronger in upper extremities than lower; narrow pulse pressure, |
| What could result from decreased BF to the GI tract in infants with defects obstructing systemicc BF? | necrotizing enterocolitis |
| Why is prostaglandin E given to keep the ductus arteriosis open for defects that obstruct BF? | ?to let blood enter systemic circulation from the pulmonary arteries even though it is not oxygenated? |
| CHD: constricted descending aorta | coarctation of the aorta |
| CHD: absent or stenotic mitral or arotic valves associated with a small left ventricle and aortic arch | hypoplastic left heart syndrome |
| Disorder in which heart function is impaired and cardiac output is inadequate to meet body circulatory and metabolic needs | congestive heart failure |
| What categories of congenital heart defects cause CHF | 1. increased pulmonary BF 2. defects that obstruct systemic BF ?(Whereas with decreased pulmonary BF, blood is still going to systemic circulation, it just doesn't contain enough O2- but text says that CHF can also occur with tricuspid or pulmonary atresia and pulmonic stenosis, but NOT tetrology of fallot so...maybe due to right heart pumping against high afterload, so eventually fails??) |
| In CHF pulmonary BF ___ resulting in ___, and systemic BF ___ | increases; pulmonary HTN; decreases |
| Defects that obstruct systemic BF cause hypertrophy, and eventually heart cannot keep up with demand and CO is inadequate. When CO is inadequate, BP ____ and perfusion ___, causing activation of ___ which leads to... | decreases; decreases SNS: catecholamines released, tachycardia, increased contractility, vasoconstriction, decreased BF to kidneys, RAAS, fluid and Na+ retention, temporary myocardial stretch to accommodate for increased fluid until it cannot stretch anymore, results in P+P edema |
| Symptoms of CHF | -pulmonary edema: crackles, dyspnea, wheeze, cough, retractions, grunting, nasal flaring, respiratory infections, tachypnea, diaphoresis -peripheral edema: periorbital, dependant areas (sacrum), fingers, weight gain -decreased CO and perfusion: mottling, pallor, cyanosis, tachycardia, weak pulses, hypotension, delayed cap refill, cool extremities, decreased urinary output -pulmonary HTN -hepatomegally, ascites, -S3 gallop -JVD -Increased BMI: Avoidant restrictive food intake disorder |
| What is the 1st goal of medical management of CHF in children | Treat the CHD or arrhythmia causing problem |
| How do diuretics help tx CHF? | remove excess fluid and decrease preload |
| What are 5 examples of inotropic medications? | 1. dopamine 2. donutamine 3. isoproterenol 4. epinephrine 5. digoxin |
| What is a medication used to tx CHF that decreases afterload and heart workload? | ACE inhibitors |
| When are inotropic medications prescribed for CHF? | in critical are management when there is need to quickly increase CO and perfusion by increasing contractility |
| What is the action of dopamine when used to treat CHF? | 1. alpha 1 agonist: vasoconstriction 2. beta 1 agonist: increases contractility |
| What is the action of dobutramine when used to treat CHF? | beta 1 adrenergic agonist: increases contractility |
| What is the action of digoxin when used to treat CHF? | increases contractility by inhibiting K/Na pump, so Na+ accumulates in the cell, causing Ca+2 release; Rarely prescribed, but may be prescribed because it decreases HR and does not increase myocardial O2 consumption |
| What is the action of carvedilol to treat CHF? | improves left ventricular function, promotes systemic vasodilation for chronic HF and dilated cardiomyopathy |
| Why does a child's skin absorb topical medications faster and layers separate easily with blistering | skin is thinner and the epidermis is loosely bound to the dermis |
| Why do children lose heat quickly through their skin? | thin SC layer |
| what is the pH of an infant's skin at birth | neutral; becomes acidic in 1st mon |
| What two factors increase risk of inflammation and irritation of skin in infants | neutral pH and high water loss through the skin |
| list four types of burns | 1. Thermal 2. Chemical 3. Electrical 4. Radioactive |
| Describe a 1st degree (superficial partial thickness) burn | -erythema -blanches on pressure -no bullae -peeling in a few days -only epidermis damage -painful -heals in a few days |
| Describe a 2nd degree (partial thickness) burn | -blisters/ bullae present -erythema -blanches on pressure -painful and sensitive to cold air -minimal scar formation -upper layer of dermis damaged -may have sparing of sweat and sebacious glands -heals in 10-14 d |
| Describe a 3rd degree (full thickness) burn | -brown, black, deep red, white, grey, waxy, translucent -may appear sunken -usually painless as nerve endings destroyed all of dermis damaged and may involve underlying tissue -requires skin graft |
| Describe the pathophysiology of burns | 1. Intense vasoconstriction due to substances released by injured cells: tissue ischemia; may increase burn depth; increased resistance and impaired cardiac contractility and CO 2. Vasoactive hormones increase capillary permeability: fluid shift from IV space to Interstitial, edema in burned and unburned skin- hypovolemia and decreased CO 3. Loss of water, electrolytes, and heat: BMR increases to try to make up for last heat and begin healing, and protein stores deplete, and glucocorticoids, glucagon, and dopamine increase 4. Airway inflammation/edema due to inhaled hot air or smoke |
| tough, leathery scab that forms over burned areas | eschar |
| what causes poor cap refill and ischemia with burns? | vasoconstriction and decreased CO |
| What are signs of airway inflammation due to burns? | cough, wheeze, respiratory distress, hypoxemia, soot in sputum, airway sloughing |
| Why might PRBCs be indicated for a pt with a burn? | bone marrow suppression resulting in anemia |
| Why should a burn pt be put on a high protein, high carb, low fat diet? | Increased BMR and healing depletes protein stores, and catecholamine and glucocorticoid release increases lactate |
| Why might a person with a burn need insulin | Increased glucocorticoids and glucagon cause hyperglycemia |
| why is propranolol prescribed for a person with burns? | decreases protein metabolism |
| symptoms of autism on the autism Calgary checklist | -Unusual eye contact. -Impaired communication. Ex. no speech, lack conversation skills, highly verbal but get stuck in a subject. -guide adult’s hand to what he/she wants. -Rigidity or inflexibility; anxious or upset with changes in routine. -Difficulty interacting with other children, making or keeping friends. -Marked physical over-activity or extreme passivity. -Sensitivity to sensory stimulus or constantly seeking sensory input (hugs, compression, jumping, spinning) -wide range of intellectual abilities. - problems with sleeping, eating, and toileting |
| What are the 9 areas of respiratory assessment of a child with a respiratory condition? | 1. Position of Comfort: 2. Vital Signs: 3. Lung Auscultation: 4. Respiratory Effort (Work of Breathing): 5. Colour: 6. Cough: 7. Secretions: 8. Behaviour Change: 9. Family History: |
| List potential life threatening symptoms of bronchiolitis | -central cyanosis -RR greater than 70 -listlessness -apnea -hyperinflated chest and diminished breath sounds - |
| What children may require RSV prophylaxis? | 1. under 2 yrs with chronic lung disease of prematurity requiring therapy in 6 wks prior to RSV season 2. under 2 yrs with CHD requiring therapy for CHF or pulmonary HTN 3. Infants born before 32 wks gestation who require O2 for at least 28 d of life 4. born before 29 wks gestation |
| What are 7 topics of nursing are to focus on for a patient with burns? | Pain Infection Fluid imbalance Mobility Developmental progress Nutrition Anxiety |
| What are two priorities in initial tx of an acute burn? | 1. ABCs 2. stop burning process with moist soaks, ice, and clothing removal |
| Why would a child with a burn have a fever without infection? | ?Increased BMR and inflammatory response? |
| What is the Parkland Formula for fluid needs of a burned child? | 4ml x kg x % body surface area burned + maintenance fluids = 24 hour total fluid replacement |
| Which CHD is most common in children with Down Syndrome? | ASD (40%) |
| What May untreated ASD lead to? | severe pulmonary hypertension, infective endocarditis, and atrial fibrillation in adults |
| What is the most common CHD | VSD |
| T/F 60% of VSDs close spontaneously in the first 2 yrs of life | T |
| Why are children with VSD often tx with high calorie feeds? | They often have poor feeding |
| What medication is used to treat a CHD: patent ductus arteriosis? | Indomethacin inhibits prostaglandins that maintain PDA |
| How are chromosomes abnormal in down syndrome? | there is an extra copy of chromosome 21 (trisomy) |
| Possible symptoms of Down syndrome: 1. Wide space between ___ and ___ ___ ___ loss Increased incidence of ___ hypotonia ___ head ____ forehead ___ neck ____ eye folds ___ nose ____, ___ set ears ____ tongue ____ ____ across palm | Wide space between first and second toes Hearing loss Increased incidence of CHD, hypotonia Small head Flattened forehead Wider neck Epicanthal eye folds Flat nose Small, low set ears Protruding tongue Single crease across palm |
| A child has RSV. List the following in order of priority: Activity intolerance Feeding pattern impaired perfusion FVE related to HF and pul overload Risk for infection | 1. FVE related to HF and pul overload 2. impaired perfusion 3. Feeding pattern 4. Risk for infection 5. Activity intolerance |
| Why would restraint by swaddling be appropriate during necessary procedures on children with respiratory distress? | Easier to perform quickly and cluster care |
| What are 5 components of programming for ASD by CBE | communication skills self-help skills basic conceptual skills environmental knowledge community awareness |
| Why is the right ventricle proportionally larger at birth | high fetal pulmonary resistance |
| Until the age of 5, CO is dependant on ___ | HR |
| What are the 9 components of assessment of a child with CHDs | 1. Respirations: rate, depth, cough, effort, retractions, nasal flaring, e grunting, wheezes, crackles 2. Pulse characteristics: rate, rhythm, quality, compare sites 3. BP: compare upper and lower extremities as obstruction causes higher in upper?? 4. Color: pallor, dusky, cyanosis, with crying, spo2 5. Chest: bulging, heaving, pulsations, lifts, vibrations, PMI 6. Auscultate heart: murmurs 7. Fluid status: periorbital, facial, and peripheral edema, dehydration, abdominal distention, hepatomegaly, cap refill 8. Actvity and behaviour: exercise intoleranccce, feeding, diaphoresis, lethargy, restlessness 9. General: growth |
| What are nursing interventions for CHD | Support nutrition: reduce stress of sucking, small frequent feedings Reduce stress on heart: Promote rest ABX prevent subacute bacterial endocarditis pulmonary hygiene Monitor for CHF |
| The immature infant heart is vulnerable to __ and __ overload | volume; pressure |
| What are early signs of CHF? | tachycardia, fatigue, poor feeding, diaphoresis, lethargy |
| Why is head bobbing a sign of CHF | -Accessory muscle use to assist in ventilation -Infants neck extensor muscles are not strong enough to stabilize the head |
| What is a consideration to monitor for with edematous skin | prevent skin breakdown |
| Why should O2 be used with caution in pts with CHF? | it is a vasodilator |
| What serious complication could RSV lead to in children under 3 | pneumonia |
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