💓 Savvy NurseLouvri aplikasyon an

🧸 Pedyatri · Leson 3 sou 5 · 7 min

Kriz Tet, Koaktasyon ak Lang Frèz la

Tet Spells, Coarctation and the Strawberry Tongue

💙 Yon tibebe ble rale jenou li yo sou pwatrin li epi koulè a amelyore. Li pa jis ap fè bèl. Li ap trete pwòp pwoblèm kè li, epi egzamen an vle ou ede li fè sa.

💙 A blue infant pulls his knees to his chest and the color improves. He is not being cute. He is treating his own heart defect, and the exam wants you to help him do it.

💡 Ide prensipal

Kriz tet: jenou-pwatrin, oksijèn, kalm, morphine. Koaktasyon: bra yo pi wo pase janm yo. Kawasaki: 5 jou lafyèv, lang frèz, men ki dekale; IVIG ak aspirin, siveye koronè yo.

Tet spell: knee-chest, oxygen, calm, morphine. Coarctation: arms higher than legs. Kawasaki: 5 days of fever, strawberry tongue, peeling hands; IVIG and aspirin, watch the coronaries.

🧠 Poukisa sa enpòtan

TETRALOGY OF FALLOT (stenoz pilmonè, defo septal vantrikilè, aòt ki chita sou tou de vantrikil, ipètrofi vantrikil dwat) lakòz syanoz; pandan yon KRIZ TET ipèsyanotik, mete tibebe a nan pozisyon JENOU-PWATRIN (timoun ki pi gran yo akoupi), bay oksijèn, kalme timoun nan, epi bay morphine jan yo òdone pou diminye kriz la. Akoupi ogmante rezistans sistemik epi li pouse san nan poumon yo. COARCTATION OF THE AORTA: tansyon ateryèl ak pulsasyon yo PI WO nan bra yo pase nan janm yo, ak pulsasyon femoral ki fèb oswa ki pa la; tcheke tansyon ateryèl kat ekstrimite yo. Defo ASYANOTIK ak shunt goch-a-dwat (defo septal vantrikilè ak oreyè, kanal ateryèl ki rete louvri) lakòz siy ensifizans kadyak: move alimantasyon, swe pandan manje, reta nan kwasans ak takipne; bay ti kantite souvan ak yon tetin mou epi bay digoxin ak diiretik jan yo òdone. KAWASAKI DISEASE: lafyèv pandan 5 jou oswa plis ansanm ak omwen 4 nan 5 karakteristik prensipal sa yo: woujè konjonktival san ekoulman, yon LANG FRÈZ ak lèv wouj ki fann, yon gratèl, men ak pye ki anfle ak PO KI DEKALE apre, ak gangliyon sèvikal ki anfle. Timoun ki gen mwens karakteristik (Kawasaki enkonplè) ka toujou bezwen evalyasyon ak tretman. Tretman an se iminoglobulin IV ak aspirin (yon nan kèk itilizasyon aspirin kay timoun), ak ekokadyogram pou siveye anevrism atè koronè; vaksen vivan yo ranvwaye pou 11 mwa apre IVIG. RHEUMATIC FEVER vini apre enfeksyon strep gwoup A ki pa trete: doulè nan jwenti, kadit, kore ak yon gratèl; prevansyon se fini tout tretman antibyotik la pou gòj strep.

TETRALOGY OF FALLOT (pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy) causes cyanosis; during a hypercyanotic TET SPELL, place the infant in the KNEE-CHEST position (older children squat), give oxygen, calm the child, and give morphine as ordered to reduce the spell. Squatting increases systemic resistance and pushes blood through the lungs. COARCTATION OF THE AORTA: blood pressure and pulses are HIGHER in the arms than the legs, with weak or absent femoral pulses; check four-extremity blood pressures. ACYANOTIC defects with left-to-right shunts (ventricular and atrial septal defects, patent ductus arteriosus) cause heart failure signs: poor feeding, sweating with feeds, failure to thrive and tachypnea; feed small amounts frequently with a soft nipple and give digoxin and diuretics as ordered. KAWASAKI DISEASE: fever for 5 or more days plus at least 4 of these 5 principal features: conjunctival redness without discharge, a STRAWBERRY TONGUE and cracked red lips, a rash, swollen hands and feet with later PEELING, and swollen cervical nodes. Children with fewer features (incomplete Kawasaki) may still need evaluation and treatment. Treatment is IV immune globulin and aspirin (one of the few pediatric uses of aspirin), with echocardiograms to watch for coronary artery aneurysms; live vaccines are delayed for 11 months after IVIG. RHEUMATIC FEVER follows untreated group A strep infections: joint pain, carditis, chorea and a rash; prevention is finishing the full course of antibiotics for strep throat.

🏥 Nan lavi reyèl

🫀 Yon timoun 4 an ki gen tetralogy of Fallot vin ble fonse epi li pa gen souf pandan li ap kriye pou yon priz san. Li lage kò li akoupi atè a. Enfimyè a pa rale li leve; li rete avèk li, li aplike oksijèn epi li kite akoupi a fè travay li pandan li rele pou morphine. Nan kèk minit koulè li retounen. Ensten timoun nan te entèvansyon liv la.

🫀 A 4-year-old with tetralogy of Fallot becomes dusky and breathless while crying over a blood draw. He drops into a squat on the floor. The nurse does not pull him up; she stays with him, applies oxygen and lets the squat do its work while she calls for morphine. Within minutes his color returns. The child's instinct was the textbook intervention.

📌 Sa pou retni

  • Kriz tet: jenou-pwatrin oswa akoupi, oksijèn, kalm, morphineTet spells: knee-chest or squatting, oxygen, calm, morphine
  • Koaktasyon: tansyon ekstrimite siperyè pi wo pase enferyè, pulsasyon femoral fèbCoarctation: upper extremity pressure higher than lower, weak femoral pulses
  • Kawasaki: IVIG ak aspirin; anevrism koronè yo se danje aKawasaki: IVIG and aspirin; coronary aneurysms are the danger

📖 Tèm nan leson sa a

Kriz Tet (tet spell) (Tet spell): Yon epizòd syanotik sibit nan tetraloji Fallot, pozisyon jenou-pwatrin ak oksijèn soulaje l.

Maladi Kawasaki (Kawasaki disease): Yon maladi timoun ak senk jou lafyèv, yon lang frèz ak men ki dekale, yo trete l ak IVIG ak aspirin pou pwoteje atè koronè yo.

PROVe (tetraloji Fallot) (PROVe (tetralogy of Fallot)): Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, Ventricular septal defect (estenoz pilmonè, ipètwofi vantrikil dwat, awòt ki chita sou tou de, domaj septòm vantrikulè): kat domaj tetraloji Fallot yo, domaj kè syanotik ki dèyè kriz tet yo.

✅ Teste tèt ou

Yon tibebe ki gen tetralogy of Fallot vin syanotik ak iritab sibitman. Ki aksyon enfimyè a ta dwe fè an premye?An infant with tetralogy of Fallot becomes acutely cyanotic and irritable. Which action should the nurse take first?
  1. Mete tibebe a sou do ak janm yo lonjePlace the infant supine with legs extended
  2. Prepare pou operasyon imedyaPrepare for immediate surgery
  3. Ofri yon bibwon fòmil pou kalme tibebe aOffer a bottle of formula to calm the infant
  4. Mete tibebe a nan pozisyon jenou-pwatrinPlace the infant in a knee-chest position

Repons: D · Mete tibebe a nan pozisyon jenou-pwatrin

Pozisyon jenou-pwatrin ogmante rezistans vaskilè sistemik, li dirije plis san nan poumon yo epi li soulaje kriz la; yo bay oksijèn an menm tan. Kalme tibebe a ede, men ofri yon bibwon pandan yon kriz syanotik ogmante bezwen oksijèn epi li pa fè anyen pou redirije sikilasyon san an nan poumon yo.

The knee-chest position increases systemic vascular resistance, directing more blood to the lungs and relieving the spell; oxygen is given at the same time. Calming the infant helps, but offering a bottle during a cyanotic spell increases oxygen demand and does nothing to redirect blood flow to the lungs.

Ki rezilta evalyasyon ki sijere koaktasyon aòt la kay yon tibebe?Which assessment finding suggests coarctation of the aorta in an infant?
  1. Pulsasyon femoral ki bat fòBounding femoral pulses
  2. Pulsasyon femoral ki fèb oswa ki pa laWeak or absent femoral pulses
  3. Syanoz ki amelyore ak kriyeCyanosis that improves with crying
  4. Tansyon ateryèl kat ekstrimite yo egalEqual four-extremity blood pressures

Repons: B · Pulsasyon femoral ki fèb oswa ki pa la

Retresisman ki apre veso bra yo ogmante tansyon nan pati siperyè kò a epi li febli pulsasyon nan pati enferyè a, kidonk tansyon ateryèl pi wo nan bra yo pase nan janm yo. Pulsasyon ki bat fò yo se pou bra yo, anwo retresisman an; pulsasyon femoral yo anba li epi yo resevwa mwens sikilasyon, kidonk yo fèb.

The narrowing distal to the arm vessels raises upper-body pressure and weakens lower-body pulses, so blood pressure is higher in the arms than the legs. Bounding pulses belong to the arms, above the narrowing; the femoral pulses lie below it and receive less flow, so they are weak.

Yon timoun gen lafyèv depi 6 jou, woujè konjonktival bilateral san ekoulman, lèv wouj ki fann ak yon lang frèz, yon gratèl, ak men ki anfle. Ki tretman enfimyè a prevwa?A child has had a fever for 6 days, bilateral conjunctival redness without discharge, red cracked lips with a strawberry tongue, a rash, and swollen hands. Which treatment does the nurse anticipate?
  1. Kortikosteroyid ak repo nan kabannCorticosteroids and bed rest
  2. Medikaman antiviralAntiviral medication
  3. Iminoglobulin IV ak aspirinIV immune globulin and aspirin
  4. Antibyotik sèlmanAntibiotics only

Repons: C · Iminoglobulin IV ak aspirin

Lafyèv pandan 5 jou oswa plis plis omwen kat karakteristik prensipal (isit la woujè konjonktival san ekoulman, chanjman nan bouch, gratèl ak men ki anfle) satisfè kritè Kawasaki disease; timoun ki gen mwens karakteristik ka toujou trete pou Kawasaki disease enkonplè. IVIG bese risk anevrism atè koronè, epi yo bay aspirin pou efè anti-enflamatwa ak antiplakèt li yo. Antibyotik sèlman ta trete yon kòz bakteri tankou scarlet fever, men Kawasaki disease pa yon enfeksyon, epi antibyotik pa pwoteje atè koronè yo.

Fever for 5 or more days plus at least four principal features (here conjunctival redness without discharge, oral changes, rash and swollen hands) meets the criteria for Kawasaki disease; children with fewer features may still be treated for incomplete Kawasaki disease. IVIG lowers the risk of coronary artery aneurysms, and aspirin is given for its anti-inflammatory and antiplatelet effects. Antibiotics only would treat a bacterial cause such as scarlet fever, but Kawasaki disease is not an infection, and antibiotics do not protect the coronary arteries.

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