CCRN Flashcards
0
Q
Why is aminophylline no longer considered a first line treatment for asthma?
A
It is a weak bronchodilator that has a narrow window between safety and toxicity.
1
Q
What are the manifestations of moderate to severe hypoxemia?
A
- polycythemia
- clubbing
- fatigue
- poor weight gain
- tachypnea
- dyspnea
- squatting
2
Q
What is brain death?
A
It is the irreversible cessation of all functions of the entire brain, including the brain stem.
3
Q
What is a normal cerebral perfusion pressure?
A
40-65mmhg
4
Q
Identify 3 histamine-2 receptor antagonist and state their MOA.
A
Cimetidine
Ranitidine
Ranitidine
They decrease the secretion of acid.
5
Q
What is a Kasai procedure?
A
It is a surgical procedure where an artificial biliary tree is made from jejunum to drain from liver to duodenum.
6
Q
What is Cullen’s sign?
A
Bruising around umbilicus
7
Q
What type of ventilator settings are usually used for the infant with pulmonary hypoplasia?
A
Low ventilators pressures (PIP <24 cmH20) and high rates (60-90/min) are usually used. If traditional ventilator modes so not work, the infant is placed on ECMO or High Frequency Oscillatory Ventilation.
8
Q
What are ways to manage esophageal varices?
A
Medications that decrease portal hypertension (vasopressin and octreotide)
Endoscopic variceal sclerosis, where a sclerosing agent is injected into varices.
Ligation.
Shunts placed surgically.
9
Q
What are the risk factors for pneumonia?
A
very young chronice dx such as CF or CP immunocompromised at risk for aspiration those with invasive devices
10
Q
When is the production of renin stimulated?
A
When the blood pressure is low.
11
Q
What is the general nursing care of a child with hypoxemia?
A
prevent dehydration monitor fluid status daily weights assess respiratory status protect from infection o2 as needed never give oral feedings to an infant in respiratory distress
12
Q
Why is the normal volume of circulating blood insufficient in the presence of distributive shock?
A
massive blood vessel dilation leads to an enlarged vascular bed causing the normal volume of circulating blood to be inadequate to meet the body’s needs.
13
Q
What causes the breakdown of mast cells and basophils that occurs in anaphylaxis?
A
The release of complement factors.
14
Q
What are common characteristics of perpetrators of Munchausen’s syndrome by proxy?
A
typically the child’s mother feels jealous of the child, felt unwanted as a child, enjoys HCP’s attention.
15
Q
List common manifestations found in acute renal failure.
A
edema, CHF, enlarged liver, tachycardia, cardiac arrhythmias, electrolyte imbalances, seizures, lethargy, decreased or absent urinary output
16
Q
Which are more common brain tumors, infratentorial or supratentorial?
A
infratentorial brain tumors are more common
17
Q
How is transposition of the great vessels permanently corrected?
A
The aorta and the pulmonary artery are transected above the valves and moved to the correct position. The coronariy arteries are also moved and any remaining ASD, VSD, and PDA are closed.
18
Q
Why are children at risk for abdominal trauma?
A
Children’s abdominal organs are located more anteriorly and they have less fat to protect their organs.
19
Q
What is Acute Tubular Necrosis?
A
It is death of the tubular cells leading to changes in glomerular permeability where it is increased for proteins and decreased for potassium.
20
Q
Which opening in fetal circulation allows the blood to bypass the liver?
A
Ductus venosus
21
Q
What is a normal anion gap?
A
10-12 mEq/L
22
Q
Does lactic acidosis cause an increase or decrease in anion gap?
A
increase
23
Q
List factors in the management of anaphylactic shock.
A
Airway management, vascular access, oxygenation, identify and remove source of antigen, antihistamines, bronchodilators, corticosteroids, dopamine, epipen education.
24
What manifestations are typically seen in an infant admitted to the PICU with a DX of shaken baby syndrome?
Altered LOC, retinal hemorrhages, subdural hematomas.
| May also see: bruising around chest and arms, skull fracture.
25
Describe what is seen in Cushing's Reflex.
Increase in systolic BP greater than diastolic BP-widened pulse pressure, bradycardia, apnea (or decrease in resp. rate).
26
T/F-Glucagon is produced in the delta cells of the pancreas?
False. Glucagon is produced in the alpha cells.
27
What are common causes of post renal failure?
Wilm's tumor, stones, blood clots, edema.
28
What is the pathophysiology of ARDS?
The lungs are injured by infection, disease, fluid aspiration, burns, inhalation, or fat embolism. Progressive hypoxemia is seen. Blood and fluid leak into alveoli of injured lungs, preventing oxygen from entering alveoli.
Inflammation of lungs leads to scar tissue formation.
29
In ITP, are the following increased, decreased, or within normal range?
Platelets
PT and PTT
FSP
Platelets are decreased
PT and PTT are usually normal
FSP is normal
30
What are the most common cause of distributive shock?
septic shock, anaphylaxis, neurologic damage
31
What are some manifestations of emotional abuse?
speech effects, physical development lags, failure to thrive, flat affect, nightmares, anxiety, behavioral changes, biting/head banging/hyperactivity
32
What is the greatest risk of thrombocytopenia?
Intracranial bleeding
33
Who is at highest risk for trauma?
Males
34
List ways to manage hyperkalemia.
sodium bicarbonate, glucose & insulin to help potassium move into the cells
Dialysis, cation exchange resins, or furosemide to remove K+ from the tissues
Calcium to stabilize excitable tissue
35
What is Guillian Barre disorder?
It is an acute inflammatory demyelinating disorder where ascending symmetric paralysis is seen usually beginning in the legs.
36
The ability to stretch when there is a change in volume and pressure is referred to as:
compliance
37
What are some factors that decrease compliance?
pulmonary edema, pneumothorax, atelactasis
38
What are the 3 most common types of pulmonary embolisms?
thromboemboli, air emboli, fat emboil
39
What is preload?
It is te elasticity in the myocardium at the end of diastole, when ventricles are filled to max and the stretch is the greatest. It is based on the volume present in the ventricles.
40
What is the leading cause of death in children over 1?
Traumatic Brain Injury
41
Is Arnold-Chiari type II hydrocephalus an example of obstructive (non-communicating) or non-obstructive (communicating) hydrocephalus?
Obstructive/non-communicating hydrocephalus
42
What injuries are associated with seat belt syndrome?
Abdominal wall bruising, intra-abdominal injury, and vertebral fracture
43
Type 1 epithelial cells are responsible for:
allowing for rapid gas exchange
44
List manifestations associated with submersion injuries.
hypothermia, impaired myocardial contractility, persistent hypoxemia, acidosis, electrolyte imbalance
45
What is resiliency?
The capacity to cope with illness and return to a previous level of health.
46
What is bacterial endocarditis?
Infection of valves and inner lining of heart, typically cause by streptococcus.
47
What are typical causes of falsely low measurements in a child being hemodynamically monitored?
kind in the tubing, clot in the tubing, placing the transducer too high, air in the system, loose connections
48
What are the 2 most common types of supratentorial tumors?
Astrocytoma, craniopharyngioma
49
What hormone is released by the anterior pituitary in shock states that results in increased cortisol levels?
ACTH
50
What is the lifespan of a platelet?
7-10 days
51
What neurotransmitter assists in the regulation of homeostasis by reducing blood through vasoconstricion?
Serotonin
52
What is a norwood procedure?
Pulmonary artery is connected to aorta so that the R ventricle can pump blood into circulation.
53
What is hypercyanotic or 'tet' spell?
It is a sudden, severe episode of extreme cyanosis that may occur in any child who's heart defect includes obstruction to pulmonary blood flow and communication between the ventricles.
54
What 4 defects are present in Tetrology of Fallot?
Pulmonary stenosis, hypertrophy of the Right Ventricle, overriding aorta, VSD
55
In addition to a positive apnea test, what other cerebral reflexes are tested and found to be absent in brain death?
Pupils have no response to light, lack of ocular movement-"dolls eyes" are present and no vestibulo-occular reflexes exist, no gag & cough present, no corneal reflex, no grimace or pain
56
A child is described as having moderate stability. What would this represent?
The child is able to maintain a stable state for limited period of time and responds to therapies to a certain degree.
57
What is VILI and how is it avoided?
VLI is ventilator induced lung injury. It is trauma from the lungs being over expanded by increased pressures and volumes. It is prevented by avoiding high pressures and high volumes when possible.
58
List 3 contraindications to peritoneal dialysis.
Abdominal incisions, bowel perforations, respiratory distress
59
What is clinical inquiry?
It is a continuum of questioning and evaluating practice where changes are based on evidence based practice, research utilization and experience.
60
What are manifestations of an iron overdose?
vomiting, diarrhea, abdominal pain, GI irritation and bleeding
61
What are common manifestations of physical abuse?
Bruises to the face, head, and areas under clothing that are in various stages of healing.
Bites, burns, injuries to internal organs, long bone fractures, head trauma
62
List 3 rapid acting anticonvulsants used for seizures.
Diazepam
Lorazepam
Midazolam
63
How is an infant with diaphragmatic hernia managed?
Immediate gastric decompression
Immediate intubation/avoiding bag-mask ventilation
Low PIP, low PEEP, rapid rate
ECMO
Surgical repair once respiratory status is stable
64
What is the most frequency reported type of abuse?
Neglect
65
A child is described as minimally vulnerable and safe. He is considered to be improving and is expected to make a full recovery. What level of vulnerability does this represent?
Level 5-or minimal vulnerability
66
What is a Blalock-Taussig (BT) shunt?
A B-T shunt is done to increase pulmonary blood flow. It connects one of the branches of the aorta (usually the subclavian artery) to one of the pulmonary arteries
67
What manifestations are commonly seen in MODS?
depressed cardiac function, ARDS may develop, renal failure, thrombycytopenia may develop, DIC, liver damage, bowel necrosis
68
What kind of behaviors would be seen at the competency level of advocacy/moral agency?
working on behalf of the patient and family
incorporating patient values into care
supporting colleagues in ethical and clinical issues
awareness of patient and family rights
69
What is DIC?
It is a secondary condition where clotting is accelerated, followed by a decrease in clotting factors and platelets which results in excessive bleeding
70
What are reticulocytes?
Immature red blood cells
71
What is the life of a mature red blood cell?
120 days
72
In a situation such as a hemorrhage, would the reticulocyte count be increased or decreased?
Increased
73
What is SIRS and how is sepsis different from SIRS?
SIRS is a generalized widespread inflammatory state affecting the whole body where mediators are formed and realeased
sepsis is the presence of SIRS in the presence of an infection
74
What are the manifestations of Reye syndrome?
Increased liver enzymes, increased ammonia, decreased glucose, coagulation abnormalities, cerebral edema, increased ICP, may lead to multi-system organ failure
75
What is Brudinski's sign?
The hips and knees flex when the neck is flexed.
76
According to the synergy model, what is nursing practice driven by?
The needs of patients and families
77
If untreated, diabetes insipidus can result in electrolyte imbalances and ___________.
Hypovolemic shock due to profound fluid loss
78
What type of fluid should be used to restore lfuid volume in children with DI?
Unless the child is in hypovolemic shock (isotonic fluids are then used for rapid volume expansion), the fluids should be hypotonic. 1/2 or 1/4 NS is used as they are hypotonic.
79
What is the most common congenital heart defect?
VSD
80
What are the 2 primary problems associated with near drowning?
hypoxemia, acidosis
81
What are esophageal varices?
They are dilated veins in the lower esophagus that occur due to portal hypertension.
82
Easy buising occurs when the platelet count falls below what level?
50,000
83
What is collaboration?
It is working as a team in a way that promotes each member's contributions toward achieving patient goals.
84
What is system thinking?
It is the knowledge and tools that the nurse uses to manage care.
85
How is level I complexity described?
It is a high level of complexity where intricate patient and family dynamics exist, and/or an unusual pattern of illness.
86
Define muscular dystrophy.
MD is an inherited, non-inflammatory progressive muscle disorder caused by muscle fiber degeneration.
87
What is a common cause of an epidural hemorrhage and is it typically due to an arterial or venous bleed?
Epidural hemorrhages are usually arterial in nature and are often caused by falls.
88
Pulmonary artery wedge pressure should be representative of what?
Left arterial pressure
89
Diabetes Insipidus is a condition of too much or too little ADH?
Too little
90
What are manifestations of uncompensated shock?
Hypotension, rapid respirations, tachycardia, mental status change, increased BUN and creatinine, liver enzyme increase, DIC
91
What is failure to thrive?
It is when the child's height, weight, and head circumference falls below 3rd percentile or 20% below ideal weight for height. It can be organic or non-organic.
92
What is d-dimer?
D-dimer is a by-product of the breakdown of fibrin.
93
What is fresh frozen plasma (FFP) used for?
It is given when plasma coagulation factors are needed (prolonged PT, PTT) and for volume expansion.
94
In normal situations, are there more anticoagulants or pro-coagulants circulating?
Anticoagulants
95
What is a common cause of pancreatic injuries?
Falling over the handle bars of a bike.
96
What is an encephalocele?
It is a protrusion of nervous tissue through a defect in the skull.
97
How do children support a higher cardiac output?
It is supported with a faster heart rate.
98
Managing a child with a seizure disorder should include:
Protecting the airway, protecting the child from injury, controlling the seizure, monitoring the child during the post-ictal stage, teaching needs for the child
99
What is hemolytic uremic syndrome (HUS)?
It is a microvascular disease of kidneys, GI tract, and central nervous system. It includes platelet aggregation and fibrin deposition.
100
What is epiglottitis?
It is an infection of the epiglottis where the thickened epiglottis and surrounding folds leads to obstruction and turbulent gas flow. It can be life threatening.
101
```
In DIC are:
Platelets are increased or decreased?
PT and PTT shortened or prolonged?
Fibrinogen increased or decreased?
FSP increased or decreased?
D-dimer increased or decreased?
```
```
Platelets are decreased
PT and PTT is prolonged
Fibrinogen is decreased
FSP is increased
D-dimer is increased
```
102
```
Fill in the blanks of the range of norms for an arterial blood gas:
pH ___to___
pO2 ___to___
pCO2 ___to___
HCO3 ___to___
```
pH 7.35 to 7.45
pO2 80 to 100
pCO2 35 to 45
HCO3 22-26
103
What are some common side effects of Phenytoin?
Gingival hyperplasia, lymphadenopathy, hirsutism, acromegaloid facies (thick lips, gums, and eyelids), ataxia, nystagamus, rickets, folate deficiency
104
What is hydrocephalus?
An abnormal accumulation o f CSF inside each of the four ventricles of the brain.
105
T/F? Spinal reflexes are always absent when brain death is diagnosed?
False. Spinal reflexes may still be present despite brain death.
106
How is serum osmolarity calculated?
(2 x Na) + (glucose/18) + (BUN/18)
107
What causes airway obstruction in bronchiolitis?
Edema and abnormal secretions
108
What are common causes of prerenal failure in children?
congenital and acquired heart disease, dehydration due to gastroenteritis, peripheral dilation (eg. sepsis)
109
What major complication is associated with peritoneal dialysis?
Peritonitis
110
How is a bite determined to be from an adult instead of a child?
The maxillary intercanine distance is measured and if it is found to be greater than 3cm, it indicates an adult bite.
111
How does Nitric Oxide work?
Nitric Oxide is an inhaled bronchodilator that affects the pulmonary vasculature without affecting the systemic circulation as it rapidly binds to hemoglobin and is inactivated.
112
What is facilitation of learning?
It is the ability to assist with the learning process for patients, families, healthcare team, and the community. It incorporates formal and informal learning.
113
If a child under the age of 3 presents with rib fractures and no other injuries, what should be ruled out?
Child abuse
114
In a non diabetic child, when insulin is released, glucose is converted to ________ and fatty acids are converted to ___________.
glycogen
| triglycerides
115
Bleeding occurs when the platelet count falls below:
25,000
116
What is the most common type of shock in children?
Hypovolemic
117
A nurse who seeks opportunities to mentor and to be mentored, facilitates active involvement of others in team meetings regarding practice issues is acting at what level of collaborations?
Level 5-expert
118
List some risk factors for abuse.
Poverty, single parent families, parental substance abuse, history of parental abuse, increased family stress, child with a chronic illness, child with a disability, child who was premature
119
What are the 4 components of the synergy model?
core concepts
patient and family characteristics
nurse compentencies
outcomes
120
What is the most common cause of child abuse related death?
Head injury
121
What is the most common cause of pediatric acute renal failure?
pre-renal-->decreased perfusion
122
What major side effect can be seen in all rapid acting anti-convultants?
Respiratory depression
123
What is MODS?
Altered organ function in an acutely ill child requiring intervention to maintain homeostasis.
124
What manifestations might be seen in failure to thrive?
Height, weight, head circumference below the 3rd percentile, disinterested in their surroundings, avoid eye contact, irritability, not reaching developmental milestones
125
What type of developmental delays can exist in a child?
motor, language, cognitive/adaptive, social
126
What is response to diversity?
It is the ability to recognize, appreciate, and incorporate differences into care and treatment.
127
In adults, cardiogenic shock is usually secondary to a myocardial infarction. What is the main cause of cardiogenic shock in children?
Congenital heart defects
128
What type of injuries are most likely to lead to death?
head injuries
129
What are common manifestations of a pulmonary embolism?
```
Decreased breath sounds
dyspnea & tachypnea
diaphoresis
hemoptysis
fever
tachycardia
pulmonary hypertension
shock
```
130
What is bronchopulmonary dysplasia? (BPD)?
It is a chronic lung disease with alveolar damage from inflammation and scar tissue caused by an abnormal pulmonary inflammatory response. It follows a course of mechanical ventilation with O2 dependency persisting beyond 36 weeks corrected gestational age.
131
What are the 4 most common types of infratentorial tumors?
Medulloblastoma
Astrocytoma
Ependymomas
Brainstem gliomas
132
Name the 4 hormones released during hypoglycemia
Epinephrine
Glucagon
Glucocorticoids
Growth hormones
133
What are common causes of intrinsic renal failure?
HUS, ATN, Glomerulonephritis
134
What are the precipitating factors for necrotizing enterocolitis?
Bowel ischemia injures the intestinal mucosa and allows bacteria to enter.
Bacterial colonization of the intestine.
Enteral feedings, where bacteria thrive.
135
Type II epithelial cells are responsible for:
Preventing collapse by lowering surface tension and maintaining patency through the secretion of a surfactant like substance.
136
Identify complications associated with submersion injuries.
ARDS, Bronchospasm, cardiac complications, coagulopathy, electrolyte abnormalities, hypothermia, multi-system organ failure, neurological injury, pulmonary edema, renal failure.
137
Identify ways to manage a child with a submersion injury.
Core rewarming, warmed IV fluids/heated O2, NG to decrease risk of aspiration, mechanical ventilation, fluid resuscitation, acidosis and electrolyte imbalances are corrected, inotropic agents, bronchodilator
138
Leukotriene inhibitors are part of the long term management of asthma. What does cysteinyl leukotriene do?
Cysteinyl leukotriene causes bronchoconstriction, mucus secretion, increased vascular permeability, and eosinophil to migrate to the airway.
139
What is resource availability?
Resources the patient and family bring with them.
140
What is the normal cardiac output of a newborn?
200 ML/KG/MIN
141
What is minute ventilation?
Minute ventilation (Ve) is the volume of air inspired over one minute; Ve=RR x Tidal volume
142
Why do pulmonary contusions lead to ventilation perfusion mismatching?
V/Q mismatch occurs due to blood in the alveoli.
143
What are the manifestations of a diaphragmatic hernia?
```
Scaphoid abdomen
Barrel-shaped chest
Cyanosis
Respiratory Distress
Altered breath sounds to affected side
```
144
Identify negative effects of PEEP.
```
Barotrauma
Increased ICP
Decreased venous return
Decreased cardiac output
Decreased renal perfusion
Increased hepatic congestion
```
145
What is the difference between azotemia and uremia?
Azotemia is an increase in nitrogenous wastes in the body.
| Uremia is azotemia that causes toxic symptoms.
