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Chronic Conditions A&P 3 > ANP 3 FINAL REVIEW DECK > Flashcards

ANP 3 FINAL REVIEW DECK Flashcards

1
Q

What is Sinemet, what is it used for, and how does it work?

A

Dopaminergic agent

Sinemet is a combination of carbidopa & levodopa and is used to treat symptoms of Parkinson’s (muscle stiffness, tremors, spasms, and poor muscle control)

Parkinson’s may be caused by low levels of dopamine in the brain and Sinemet allows the body to make its own dopamine. The carbidopa makes sure the levodopa gets to the brain where it is needed.

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2
Q

(T or F) You should NOT use Sinemet in someone who has narrow-angle glaucoma.

A

True

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3
Q

(T or F) You should NOT use Sinemet in someone who has used a MAO inhibitor in the last 14 days.

A

True

(MAO inhibitor examples; isocarboxazid, linezolid, methylene blue injection, phenelzine, and ranylcypromine, azilect/rasagiline, eldepryl/selegine)

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4
Q

What does a person taking Sinemet want to avoid?

A

-avoid iron supplements
-avoid high protein diet

(makes it harder for the body to digest and absorb Sinemet)

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5
Q

What diseases can cause constipation?

A

-neurological disorders (Parkinson’s, spinal cord injuries, stroke, multiple sclerosis)
-metabolic and endocrine disorders (hypothyroidism, diabetes, chronic kidney disease, bowel cancer, diverticulitis)

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6
Q

What is the most common childhood leukemia?

A

Acute Lymphoblastic Leukemia

(Bone marrow makes too many lymphocytes)

80% of all pediatric leukemia cases

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7
Q

What are some signs and symptoms of ALL?

A

-bone pain
-symptoms r/t pancytopenia (SOB, dizzness, headache, rapid or irregular heartbeat)
-fever
-fatigue
-pallor
-bleeding
-bruising
-infections

-chills
-sore throat
-mouth sores
-severe cough
-diarrhea
-swollen lymph nodes
-cuts or sores that drain pus
-bruising easily
-heavy or prolonged bleeding
-blood in stools
-petechiae or purpura

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8
Q

What is the normal range for WBC on a CBC?

A

WBC 4500 - 11000 cells per microliter

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9
Q

What is the normal range for RBCs on a CBC?

A

4.5 million - 5.9 million cells per microliter for men

4.1 million - 5.1 million cells per microliter for women

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10
Q

What is the normal range for Hgb?

A

14 - 17 grams per deciliter for men

12.3 - 15.3 grams per deciliter for women

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11
Q

What is the normal range for Hct?

A

41.5% - 50.4% for men

35.9% - 44.6% for women

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12
Q

What is a normal range for MCV?

A

80 - 96

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13
Q

What is a normal range for platelets?

A

150000 - 450000 platelets per microliter

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14
Q

What is SCV syndrome?

A

T-CELL ALL OR T-CELL LYMPHOMA CAN PRESENT WITH AN ANTERIOR
MEDIASTINAL MASS AND SYMPTOMS R/T COMPRESSION OF THE MASS ON THE
TRACHEA AND BLOCKAGE OF VENOUS RETURN AND LYMPHATIC DRAINAGE

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15
Q

How does SVC present?

A
  • SVC PRESENTS WITH WHEEZING, DYSPNEA, DYSPHAGIA, CYANOSIS. PLEURAL
    AND PERICARDIAL EFFUSIONS CAN OCCUR
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16
Q

(T or F) SVC is an oncologic EMERGENCY!

A

T

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17
Q

Is SVC syndrome common in the pediatric population?

A

SVC is rare in the pediatric population. The peak occurrence of SVC syndrome in children is during infancy and another smaller peak during adolescence. The overall morbidity and mortality rates are 30% and 18%, respectively.

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18
Q

What is the most common rheumatologic condition in children?

A

Juvenile Idiopathic Arthritis

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19
Q

What is the single most important disease that is mistaken for juvenile idiopathic arthritis?

A

Leukemia

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20
Q

What is POTS?

A

Postural Orthostatic Tachycardia Syndrome

(a) frequent complaints of dizziness, lightheadedness, palpitations, tremor
(shakiness), generalized weakness, blurred vision or loss of vision, exercise intolerance, and fatigue;

(b) increase in heart rate of greater than or equal to 30 beats per
minute in adults (>19 years) or 40 beats per minute in children (<18 years) when
moving from a recumbent position to standing, the changes occur within 10 min
of standing; and

(c) the absence of orthostatic hypotension (drop in systolic blood
pressure of more than 20 mmHg)

The accepted duration of symptoms requires a
minimum length of 6 months.

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21
Q

*What position best helps to relieve symptoms of POTS?

A

sitting

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22
Q

*What is the most common type of seizure/epilepsy?

A

absence

23
Q

Treatment for infants, children, and adolescents w GERD that does not improve with conservative treatment?

A

empiric 4 week trial can be considered using acid suppression therapy w histamine H2 receptor antagonists or low dose PPI (“do not use Zantac”)

24
Q

What is an absence seizure?

A

brief (lasting 4 to 30 seconds) vacant episode (loss of awareness and unresponsiveness) with impairment of consciousness associated with abrupt onset and cessation as well as
behavioral arrest or staring with no post-ictal symptoms.
Sometimes accompanied by eyelid fluttering or head-nodding.
These seizures first appear in childhood or adolescence.

25
Q

What is the age and peak for children with absence seizures?

A

The age of onset is typically between 4 and 10 years of age, with a peak between ages 5 and 7 years of age

juvenile peak 10 -12

26
Q

When should a patient with diarrhea be referred to the emergency room?

A

-Patients with acute diarrhea for over 48 hours who also have Renal failure, postural hypotension, fevers or report blood in stools
-These are mostly due to infectious processes- viral,
bacterial, and parasitic
-Patients who can not replace their losses orally

Acute diarrhea is defined as any diarrhea that lasts less than 2 weeks

27
Q

What is the role of the NP in treating GERD in infants?

A

Thickened feeds
* up to one tablespoon of dry cereal per ounce of formula
* oat cereal is now preferred because of concerns about possible contamination of rice cereal with arsenic
* Hypoallergenic formula or extensively hydrolyzed formula
* Positioning
* Smaller, more frequent feeds
* Weight loss in obese children
* Avoiding triggers (ie: tobacco smoke exposure)
* Education!!!

burping

28
Q

What is scoliosis?

A

a three-dimensional spine
deformity characterized by lateral and rotational curvature of the spine

29
Q

What is the most common form of scoliosis?

A

The most common form of scoliosis is idiopathic scoliosis.

30
Q

If using a scoliometer to measure the angle of trunk rotation, what is the recommended threshold for referral to radiography (xray)?

A

5 - 7 degrees

31
Q

What are our indications for referral for someone with scoliosis?

A
  • Radiographic cobb angles are observed if less+++ than 20 degrees

*Remember to specify which tools you used when referring

32
Q

*When does GERD tend to get worse in infants?

A

4 - 6 months

33
Q

*When does GERD tend to get better in infants?

A

about 9 months of age (when they can start pulling themselves up more independently)

34
Q

What period of time is necessary for reliable calculation of height velocity in children older than 2 years old?

A

A period of at least 6 months is necessary for reliable calculation of height velocity in children older than 2 years old.

35
Q

(T or F) Weight and height must be taken for peds at both sick and well visits.

A

F; Heights and weights are taken at well visits. Only weight is taken at sick visits.

36
Q

How is bone age typically determined?

A

Bone age is typically determined from a radiograph of the left hand and wrist and requires expert interpretation.

37
Q

What is the hallmark of most pathologic causes of short stature?

A

Low height velocity is the hallmark of most pathologic causes of short stature.

(height velocity = the rate of change in height)

38
Q

What is Osgood-Schlatter Disease (Osteochondritis)?

A
  • Characterized by pain and swelling at the tibial tubercle,
    the point of insertion of the patellar tendon
  • Results from inflammation due to traction of the patellar
    tendon at the skeletally immature tibial tubercle with
    repetitive quadriceps contraction
  • Generally, occurs in children 9 to 14 years of age who
    have undergone a rapid growth spurt
  • More common in boys
  • An overuse injury caused by repetitive strain and chronic
    avulsion of the secondary ossification center (apophysis)
    of the tibial tubercle
39
Q

What is the most common presenting complaint for a 9 - 14 year old child with Osgood- Schlatter?

A

*anterior knee pain that increases gradually
over time, from a low-grade ache to pain that causes a limp and/or impairs activity
* Pain is exacerbated by direct trauma, kneeling, running, jumping, squatting,
climbing stairs, or walking uphill, and is relieved by rest
* Involvement usually is asymmetric, although both knees are involved in 25 to 50
percent of cases

40
Q

How is Osgood-Schlatter diagnosed?

A

-Clinical evaluation (no need for xray unless atypical/concerning complaints)

41
Q

What are characteristic findings on examination for Osgood-Schlatter?

A

Characteristic examination findings of Osgood-Schlatter disease include
tenderness and soft tissue or bony prominence of the tibial tubercle

42
Q

How can pain be reproduced in a 9 - 14 year old with Osgood-Schlatter?

A
  • Pain may be reproduced by extending the knee against resistance, stressing the
    quadriceps, or squatting with the knee in full flexion
  • Straight-leg raising usually is painless
43
Q

What is the treatment for someone diagnosed with Osgood-Schlatter?

A

Teaching/reassurance;
-Osgood-Schlatter is typically benign and self limiting
-Lasts about 6 - 18 months, will come and go, and resolve once growth plate is ossified

Treatment;
-NSAIDS (3 - 4 days)
-ice after activity
-continuation of activity
-PT to strengthen quads and increase hamstring flexibility

REFER IF
-pt still having persistent pain that alters the ability to play sports for more than 3 months!

44
Q

S/S of GERD in infants/children

A

-regurg
-cough
-wheezing
-forceful vomiting
-nocturnal vomiting
-bloody vomiting/
diarrhea
-rectal bleeding
-abd distention
-dysphagia
-gagging

-spec to infants;
vomiting, choking, cough during feed, FTT, lethargy, apnea

-older children;
heartburn, epigastric pain, halitosis

45
Q

What are the modes of transmission for Hep A, b, and C?

A

Hep A- oral/fecal, contaminated water and food, particularly shellfish
Hep B- blood and all body fluids; sexual activity, mother to infant
Hep C- needles, blood transfusions, hemodialysis

46
Q

Hep treatment

A

-rest during active phase of infection
-encourage fluid intake to prevent electrolyte or fluid imbalances
-vitamin K is recommended for patients with prolonged prothrombin time longer than 15 seconds
-avoid excessive protein
-avoid alcohol
-avoid meds that are metabolized by the liver

vax;
hep A- 1 yr old
Hep B- w in 12 hr of birth, 1 mo, 6 mo

47
Q

How would someone w hepatitis present?

A

-clay-colored stools
-jaundice
-RUQ abd pain
-N/V
-decreased appetite
-general malaise
-dark urine

48
Q

Labs to order when you suspect hepatitis?

A

CBC
CMP
liver
albumin
PT-INR

49
Q

What is the hallmark of most constitutional causes of short stature?

A

delayed skeletal age

(refer to endo)

50
Q

What will we do for a patient who has folate AND B12 deficiency?

A

refer

51
Q

What are we concerned about in childhood if height (but not weight) decreases?

A

This can lead to increased chance of pathological process

52
Q

(T or F) B12 deficiency is a common reason for bone pain and fatigue in teenagers (especially females)

A

T

53
Q
A
54
Q

What are two medication classes that can affect the growth (peds)?

A

stimulants
steroids

Chronic Conditions A&P 3 (4 decks)

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