Study topic
Paediatric cardiac and endocrine
NCLEX pediatric heart and endocrine: tet spells, post-cath checks, infant HF and digoxin, Kawasaki coronary risk, diabetes sick-day and hypo treatment, PKU diet.
Pediatric cardiac and endocrine items ask for the position that breaks a tet spell, the pulse check after cath, and whether a shaky school-age child needs juice or glucagon.
Congenital heart and catheterization
| Situation | Action |
|---|---|
| Tet / hypercyanotic spell | Knee-chest, calm, O2, escalate |
| Post-cath | Pressure, distal neurovascular checks, report bleed |
| Coarctation pattern | Arm-leg BP/pulse difference — report |
Infant heart failure and Kawasaki
- HF infants tire at the breast/bottle — small frequent feeds, calorie density as ordered, upright after.
- Digoxin: apical pulse first; hold for bradycardia per the pediatric order; teach toxicity cues (vomiting, bradycardia).
- Kawasaki: treat as ordered; watch for coronary complications in teaching and follow-up.
Diabetes, hypoglycemia, metabolic disorders
- Recognize hypo: shakiness, sweat, hunger, confusion, behavior change.
- If awake and able to swallow: fast-acting carbohydrate (~15 g), recheck per protocol.
- If unresponsive or seizing: glucagon / emergency services — protect airway.
- Sick days: continue insulin plan, check ketones, hydrate, call for persistent vomiting.
Safety
Do not pour juice into an unconscious hypoglycemic child’s mouth. Airway first, then glucagon/EMS.
| Disorder | Teaching |
|---|---|
| PKU | Low phenylalanine diet/formula for life; dietitian partnership |
| Congenital hypothyroidism | Daily thyroid hormone — early treatment protects growth/brain |
Priority map
| Picture | First move |
|---|---|
| Infant suddenly deep blue, crying hard | Knee-chest + O2 + help |
| Post-cath groin wet/expanding | Pressure; escalate |
| School glucose 55, awake | Fast carbs |
| Unresponsive known diabetic | Glucagon/EMS |
| PKU diet question | Low phenylalanine |
Must know
- 1Hypercyanotic (tet) spell: knee-chest position, calm, oxygen, notify — reduce venous return / increase SVR pattern per protocol.
- 2Post cardiac cath (any age): pressure on site, check distal pulses/color, watch for bleeding/hematoma; keep limb still per order.
- 3Coarctation cue: higher BP/stronger pulses in arms than legs.
- 4Infant HF: poor feeding, diaphoresis with feeds, tachypnea, failure to thrive. Small frequent feeds.
- 5Infant digoxin: check apical HR; hold for bradycardia per pediatric parameter (protocol-specific — often hold under ~90–110 in infants; follow the order).
- 6Kawasaki: prolonged fever, strawberry tongue, rash, extremity changes — coronary artery aneurysm risk; aspirin/IVIG as ordered.
- 7Pediatric hypo: shaky/sweaty/confused — 15 g fast carbs if awake; if unresponsive, glucagon per plan, not oral gel forced into an airway.
- 8Sick-day diabetes: never stop insulin without a plan; check glucose/ketones; hydrate; call for persistent vomiting/high ketones.
- 9PKU: lifelong low-phenylalanine diet; special formula. Congenital hypothyroidism: start thyroid hormone early to protect development.
Memory hooks
Knees to chest for tet
During a hypercyanotic spell, knee-chest is the classic first positioning move while you call for help and give oxygen.
Site and pulse after cath
Bleeding at the puncture and a cold pulseless distal limb beat a casual snack tray.
Awake carbs, out glucagon
Conscious hypoglycemic kids get fast sugar. Unresponsive kids get glucagon/emergency pathway — not forced oral liquids.
How it's tested
Stems show a blue tet spell, a bleeding cath site, infant digoxin hold parameters, Kawasaki fever days, or a school nurse with glucose 55. Distractors lay a tet infant flat or force juice into an unconscious child.