CPN Exam Endocrine/Metabolic Flashcards

Question

Diabetes and Exercise

Answer 1

↓ blood glucose and ↓ insulin needs – Either ↓ insulin dose or add 1-2 “uncovered snack(s)”

Answer 2

↑ blood glucose and ↑ insulin needs – “Sick day rules” with more frequent blood glucose monitoring and insulin “touch ups

Answer 3

Give rapid-acting insulin Give fluids without sugar to flush out ketones (This includes IV fluid.)

Answer 4

Give fast-acting carbohydrate (1/2-cup orange juice or soda) -Avoid complex carbohydrates such as a candy bar – Give glucagon for unconscious child Place on side to prevent aspiration with vomiting (i.e. side effect of glucagon)

Answer 5

Lispro/Humalog (Rapid Acting) – Onset: 10-15 minutes – Peaks: 30-90 minutes NPH (Intermediate Acting) – Onset: 2-4 hours – Peaks: 8 hours Lantus (Long Acting) – Basal needs; no peaks; not related to meals

Answer 6

Insulin resistance (varying degrees) with some insulin deficiency

Answer 7

Overweight/obesity Sleep apnea – Hypertension Hyperlipidemia – Acanthosis Nigricans (90% of kids with type 2 DM) -Cutaneous thickening and hyperpigmentation

Answer 8

Bone lengthening happens in epiphyseal plates Damage to plates can impact growth Healing is faster in kids - 1 week for every year of age up to 10

Answer 9

Clavicular Greenstick

Answer 10

Occur during vaginal birth due to width of shoulders

Answer 11

Occur in long bones due to flexibility of growing bones

Answer 12

associated with a twisting force; more closely associated with child abuse than other fractures but also seen in sports injuries like skiing

Answer 13

Bone breaks skin

Answer 14

Bone breaks into pieces

Answer 15

Plaster casts: less common; less expensive Fiberglass casts: more common, lighter, better air flow, better X-ray visualization; more expensive

Answer 16

Assess Circulation: -Color -Pulses -Sensation -Movement -Temperature -Edema -Wiggle toes/fingers without tingling/numbness

Answer 17

Elevate extremity 24-72 hours after placement (reduces swelling and tightness) Antihistamines for itching Nothing inside the cast Regularly assess circulation Check for pressure as child grows Cover cast when bathing/in water

Answer 18

Complication of a fracture causing swelling or bleeding occurs within a compartment leading to increased pressure and disruption of blood flow to muscles and nerves – Can lead to tissue death and permanent disability

Answer 19

Pallor - lack of profusion Pain - most important finding, more intense than expected Pulse - weak or absent Paralysis - inability to wiggle toes or fingers Paresthesia - tingling/Numbness

Answer 20

Designed to decrease muscle spasms and realign and position bone ends

Answer 21

uses adhesive, moleskin, elastic bandage to pull indirectly on the skeleton

Answer 22

Uses pins and tongs to pull on skeleton directly

Answer 23

Assess skin at site of pin insertion Neurovascular assessment of extremity (pulses, warmth, brisk cap refill) Assure that weights hang freely Use pressure reducing surfaces Prevent constipation (fluids, fiber, stool softeners) Manage pain Provide developmental stimulation

Answer 24

Extends from mid-chest to legs Legs are abducted with a bar between them (never lift using bar)

Answer 25

Place disposable diaper under edges to prevent cast from getting soiled Elevate head of bed so urine and stool drain downward Reposition frequently to reduce pressure; check for pressure as the child grows

Answer 26

Abnormal development of the hip socket– Head of the femur comes out of the hip socket Present at birth Can affect one or both hips

Answer 27

Breech Delivery Fetal position in utero genetic predisposition

Answer 28

Ortolani/Barlow Sign or Click Shortened limb on the affected side (telescoping) Asymmetrical skin folds in gluteus and thighs from telescoping and dislocation

Answer 29

Treated with Pavlik harness continuously for 6-12 weeks – Effective in 95% of cases Surgical reduction with hip-spica casting (for those not responsive to Pavlik harness

Answer 30

Genetic disorder characterized by bones that break easily due to a collagen defect– Classified from less to more severe (e.g. from a few to hundreds of fractures in a lifetime)

Answer 31

Bones fracture easily, sclera is a blue tint, brittle teeth, thin skin, small stature, spinal curvature

Answer 32

No cure exists, maximize bone mass and muscle strength through exercise (e.g. swimming and walking, if able

Answer 33

An infection in a bone spreading from the bloodstream, adjacent tissue, or bone injury

Answer 34

most commonly staphylococcus bacteria commonly found on skin and in nose of even healthy individuals

Answer 35

More common in long bones in kids* Fever, pain, swelling, warmth, redness in affected region

Answer 36

4 to 6-week course of antibiotics May require surgical removal of infected or necrotic tissue

Answer 37

A lateral curvature of the spine that may occur in the thoracic, lumbar, or thoracolumbar spinal segment

Answer 38

Impaired growth and development – Impaired mobility – Debilitating pain – Respiratory compromise

Answer 39

Unequal leg lengths Abnormal posture C-shaped curvature of spine – Curve disappears when child bends at the waist to touch the toes (Adams-Bend test)

Answer 40

Shoe lifts (if unequal leg lengths the cause) – Postural exercises (if poor posture is the cause)

Answer 41

An S-shaped curvature of the spine – Asymmetry of hips, ribs, shoulders, scapula – Curve does NOT disappear when the child bends at the waist to touch the toes (Adams-Bend test)

Answer 42

Diagnostic tests – X-rays of the spine (definitive diagnosis)

Answer 43

For mild to moderate curvatures < 40 degreeso Prolonged bracing Tight t-shirt underneath Keep skin beneath the brace clean and dry Wear the brace as ordered (16-23 hours per day) Provide psychological support Traction Electrical stimulation