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Peds Lecture > Case Study Questions E2 > Flashcards

Case Study Questions E2 Flashcards

1
Q

How do you indicate how severe dehydration is?

A

Based on % of weight loss
5% - moderate dehydration
10% - severe
13-15% - emergency
Formula: Normal weight - current weight/normal weight multiplied by 100 + % of weight loss

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2
Q

What lab findings should you see with dehydration?

A

Bun elevated + Specific gravity elevated
Creatine should stay the same

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3
Q

What are the types of dehydration? What is most common?

A

Isotonic - based on sodium levels (most common)
Hypotonic + Hypertonic

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4
Q

What are the main causes of diarrhea in infants/children?

A

In home childcare and no rotavirus vaccinations
Other: Bacterial or reaction to meds, sickness in general

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5
Q

What orders should you anticipate for rotavirus?

A

Contact isolation, NPA, daily weight, strict I/O, specific gravity, fluids based on wt
Question Meds: Metronidazole (Flagyl) + Laperamide (Immodium) This

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6
Q

How does dehydration get treated at home? How do you know treatment is effective? Likely Diet, and if tolerated?

A

Oral rehydration; should see increased LOC, output
Small frequent drinks; if emesis wait 10 minutes then resume

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7
Q

How do you calculate wt percentage loss

A

Normal weight - current weight/normal weight multiplied by 100 + % of weight loss

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8
Q

How do you calculate IV bolus?

A
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9
Q

What do you expect to see after the bolus?

A

Increased LOC, irritability, improved vascular response

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10
Q

SEGARS formula

A

0-10 kg: 100 mL/kg
+ 11-20 kg: 50 mL/kg
+ >20 kg: 20 mL/kg

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11
Q

How to calculate minimum urine output

A

1 mL/kg/hr

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12
Q

Post delivery how are cleft lip/palate defects recognized? If not anticipated what nursing interventions?

A

Cleft lips are more obvious, post delivery putting finger in parents mouth. Let parents vent, ask what they’re worried about, help with feeding

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13
Q

What mother history findings are associated with an increased risk for developing cleft lip/palate?

A

Genetics, smoking, alcohol, infections, Dilantin, Retin A, Steroids and low folate

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14
Q

How are cleft lip/palate infants fed formula? How about breastfeeding?

A

Special nipples: Ross, Mead-Johnson, Pigeon
If breast feeding will have to pump first then put milk into squeeze bottle on breast

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15
Q

Parents are concerned about small amounts of feeds that refluxes through childs nose with cleft lip/palate what is your response

A

They should be taught how to use bulb suctions and feedings

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16
Q

What additional teaching is needed for cleft lip/palate infants in regards to infections

A

Patients need to gain weight and should be looked out for OM infections

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17
Q

Post op cleft lip repair
How to you protect suture line from injury? Suture line from infection? Protect airway?

A

Keep on back, use ROSS, logans bow, medications for pain
Suture line: antibiotics, lips moist, well hydrated
Airway: Tongue suture, positioning, monitor vitals

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18
Q

Nursing care r/t arm/elbow restraints for infants post op cleft repair

A

Medical restraints, need to check ROM, skin breakdown and capillary refil

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19
Q

Post op cleft palate repair
How do you protect suture line from injury? Suture line from infection? Protect airway?

A

Nothing in mouth ONLY A CUP, graduate to soft food, medicated for pain
Suture: water chaser after feeds, maybe antibiotics

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20
Q

Post op feeding following cleft palate repair vs cleft lip repair

A

Cleft Lip: Ross nipple
Palate: CUP ONLY with water chaser

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21
Q

What history findings are typical for Hirschsprung disease?

A

Delayed passage of meconium (should be within 12-24 hours, 2 days at latest)

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22
Q

Physical exam findings typical for Hirschsprung?

A

Distended abdomen, LUQ mass + vomiting, stool (liquids/ribbon) rectum is empty of stool
Pt malnourished and anemic

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23
Q

Lab findings typical with Hirschsprung disease

A

Albumin, low protein, H+H low
Possible diagnostic biopsy

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24
Q

Pt with Hirschsprung suddenly develops increased abdominal distention, tenderness, bloody stools, vomiting, fever and lethargy
What are your concerns? What should you assess? What would you do?

A

Possible C-Diff; Assess LOC, vitals, belly circumference
Dehydration leads to shock
Perforation to sepsis
Temp is unexpected (call) if in signs of shock call rapid; pt likely would have vanco bolus

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25
Q

What preop orders are expected for pts with Hirschsprung going for a temp colostomy with plans for later pull through? How will you know if they are successful?

A

NPO, IV fluids. GoLYTELY per ng, NS edemas until clear then antibiotic enema
Successful: Poop comes out in chunks, abdomen is softer X-ray to verify stool

26
Q

What postop orders are expected for pts with Hirschsprung going for a temp colostomy with plans for later pull through?

A

NPO, NG to LIS (low intermittent suction), Strict I/O, IV fluids, dressing change, colostomy care and pain meds

27
Q

What findings are typical for patients with intussusception? What history information is pertinent?

A
28
Q

What complications are you monitoring for in a patient with intussesception?

A

Dehydration that leads to shock
+ perforation that leads to peritonitis

29
Q

Pt admitted with intussusception has following symptoms: Lethargy, distended rigid abdomen and absent bowel sounds. What are you concerned about?

A

Obstruction or peritonitis (check the temp)
Call provider

30
Q

Discharge teaching for intussusception

A

10% will reoccur within 24-48 hours, bring the patient back

31
Q

What is typical history and exam for pyloric stenosis?

A
32
Q

What are expected findings of pyloric stenosis ultrasound? What is the typical treatment?

A
33
Q

What complications do you assess for in a patient who returned from ___?

A

Airway, bleeding on incision, pain and hydration

34
Q

After a ___ the parents call you into the room and there is a pool of white liquid on the floor, what are you concerns/interventions?

A

No immediate concerns, pt likely ate too fast and should take it slow (white is breastmilk).

35
Q

What history findings are likely related to a GER diagnosis?

A
36
Q

What physical assessment findings would concern you with a GER patient

A
37
Q

Nursing interventions for esophageal pH probe? What are the expected findings?

A
38
Q

Expected lab finding for GER

A
39
Q

How would you treat GER medically vs surgically? What teaching is involved in medical treatment (timing of feeds, positioning, medications)

A
40
Q

Infant develops GERD and a nissen fundoplication is performed. The patient returns post op with an NG to LIS, dressing and IV. What are expected post op exams? If the NG dislodges what are the interventions?

A
41
Q

Newborn coughing, choking and turning cyanotic are first feed. RN is unable to insert an NG, infant is admitted to NICU with probable esophageal atresia (EA) with tracheoesophageal fistula (TEF).
What interventions would be used to stabilize the newborn after the feeding? What preop orders would you anticipate? What post op?

A

Stabilize: Sitting upright, suctioning, O2 and making infant NPO
Pre-OP: IV fluids and sucking on pacifier
Post-OP: Protecting airway, NPO, G-tube

42
Q

Newborn born at home has frequent wet diapers but no stools. Upon presentation to the ER he was transferred to the NICU after there was an absence of an anus, leading to diagnosis of imperforate anus (IA).
Why is he also checked for renal problems? How would you know if he had Anal Atresia?

A

Renal:
Anal Atresia: would still have stools, just smaller

43
Q

Preop treatment for imperforate anus (IA) Post op treatment?

A

Pre-OP: NPO, NG to LIS, IV fluids, nonnutritive suctioning
Post-OP: NPO, NG to LIS, IV fluid, pain control, antibiotics and colostomy care

44
Q

What is VACTERL screening, and when would it be used?

A
45
Q

What physical exam and history findings are typical for advanced cystic fibrosis? What parts are signigicant?

A

Respiratory: chronic infections
GI: underweight, diagnosed with Failure to Thrive
Disease History: more frequent hospitalizations which can indicate more serious disease

46
Q

What labs/diagnostics are ordered for a pt admitted with cystic fibrosis, what do you expect the findings to be?

A

WBC (increased) RBC H+H (decreased r/t anemia + not eating) Electrolytes (normal) BUN - hydration (increased) Creatine - renal function (normal, elevated would be un expected) Chest X-ray

47
Q

What inpatient orders are expected for a patient with cystic fibrosis?

A

Labs, IV fluids (SEGARS) Antibiotics (peaks/troughs if indicated), Pain/ Fever control (Tylenol) Keep O2 88-92%, Albuterol, Respiratory steroid, Chest PT and drainage, High cal, protein and fat diet with calorie count, pancrease, VS Q4, daily weight

48
Q

How would you organize medications + treatments for cystic fibrosis

A

Respiratory - Albuterol, pulmozyme then chest PT. Antibiotics and steroids then GI meds and encouraging feeding with pancreases

49
Q

Match the ABG’s to the severity of asthma
ABG #1
pO2 85
pH 7.50
pCO2 30
HCO3 24
ABG #2
pO2 75
pH 7.35
pCO2 45
HCO3 24
ABG #3
pO2 55
pH 7.25
pCO2 65
HCO3 27

A

ABG #1: Mild
ABG #2: Moderate
ABG #3: Severe

50
Q

What physical exam findings are anticipated in a child with severe asthma

A

Cough, wheezing, high HR + RR, pale, non-responsive, inspiratory and expiratory wheezing

51
Q

Patient admitted with severe asthma becomes status asthmaticus what are your interventions?

A

Switch to 100% O2 (non-rebreather) give rescue med (watch for a response) keep environment calm, once stabilized give steroid, respiratory failure is the most common cause for heart failure

Pt would be getting better: Increased LOC, better O2 states, HR and RR should go down

52
Q

Patient with severe asthma - Lungs are clear, no retracting. He is complaining left ear pain. Right TM yellow, retracted with air bubbles and no light reflex. Left TM red and bulging. What is the significance of these findings

A

This would be an indication of an ear infection likely the trigger of the asthma attack. Pt would need antibiotics to treat the infection

53
Q

What is an important thing for parents to know when treating an URI in a child that has asthma

A

They should not use cough medications and should anticipate having to increase rescue medications

54
Q

What history/physical findings are typical with bronchiolitis?

A

Started with a cold, dehydrated, decreased respiratory status

55
Q

What indicates calling a pediatric code blue?

A

Any time a heart rate is under 60

56
Q

A 2 yo is admitted and his has recently started using the potty, what should you tell the parents?

A

There will likely be a regression and he might not continue with his current habits

57
Q

How can you treat croup at home?

A

Fluids, cool air/mist, monitor for respiratory distress, monitor LOC and get steroids

58
Q

Epiglottitis and roommates

A

Pt must have isolation until they have had 12 hours on an antibotic

59
Q

What are the 4 D’s of epiglottitis + other symptoms

A

Drooling, Dysphagia, Dysphonia, Distress

Abrupt onset, high fever (103), ‘toxic’ appearance, soft stridor

60
Q

If a patient is diagnosed with possible epiglottitis what are your priorties?

A

No pokes or looking at the airway until time to intubate or post procedure. It is important to stay calm, since families and the pt will feed off of that. Have a peds trach tray and crash cart available

61
Q

What would lead to a tonsillectomy?

A

Frequent ear infections (Otitis media with effusion)

62
Q

Tonsillectomy teaching

A

Diet no irritant (cold/popsicles) expect a slight temp for a few days with pain in ears/throat that shound me mediated around the clock, no vigorous activities or gargling, back to school in 7-10 days, call if they start bleeding again after 5-10 days

Peds Lecture (3 decks)

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