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PEDS > Exam 1 > Flashcards

Exam 1 Flashcards

0
Q

Sitting up unsupported?

A

By 8 months

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1
Q

Rolling over?

A

4 months back to side

5 months tummy to back

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2
Q

Standing

A

Supported by 9 months, unsupported around 12 month

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3
Q

Cruising

A

By 11 months

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4
Q

Walking

A

By 12 months

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5
Q

Separation anxiety

A

Btwn 4-8 months

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6
Q

Object permanence

A

9-10 months

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7
Q

Understands “no”; obeys simple commands by?

A

9-10 months

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8
Q

Introducing solids

A

4-6 months

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9
Q

Head lag gone by?

A

At 4 months there should be almost no head lag, totally gone by 5 months

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10
Q

Tripod sitting?

A

6 months

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11
Q

By 6 months, birthweight has…

A

Doubled

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12
Q

By 1 year, birthweight has…

A

Tripled

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13
Q

By one year, height has increased by…

A

50%

Ie born 20 inches, now 30 inches

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15
Q

Measure head circumference until…

A

36 months

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16
Q

Posterior fontanel closed by…

A

2 months

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17
Q

Anterior fontanel closed by…

A

By 16 months but varies

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18
Q

Neat pincer grasp by…

A

11 months

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24
Q

Cleft lip vs cleft palate surgery age?

A

Lip corrected in first month

Palate done after one year

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25
Q

Referrals needed for cleft lip and palate?

A

Lactation consultant for help feeding
Early intervention to speech therapist
Audiologist bc ear infections
Pediatric dentist

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26
Q

Priorities for infants post op

A 
Elbow restraints
Airway mgmt (sit supine, suctioning)
Minimize crying
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27
Q

Symptoms at birth for esophageal atresia?

A

Drooling and frothy mucus

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28
Q

Different presentations of EA?

A

Esophagus dead ends
Esophagus connects to trachea
Esophagus goes through trachea
Esophagus…..?

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29
Q

Pre-op EA interventions?

A 
Sit upright.
Put on NPO.
NG tube to suction.
Nexium IV to reduce stomach acid.
TPN if needed to stabilize.
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30
Q

Expected care post op for EA?

A

Gastrostomy tube to protect suture healing.

Chest tube to restore negative lung pressure.

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31
Q

TEF?

A

???

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32
Q

Pyloric stenosis: what happens?

A

Pyloric muscle hypertrophic&raquo_space; narrowing btwn stomach and duodenum&raquo_space; buildup and vomit&raquo_space; inflammation and edema&raquo_space; complete closure

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33
Q

What side does stomach empty on?

A

Right

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34
Q

What are clinical symptoms of pyloric stenosis?

A

Non bilious projectile vomiting

Hyperistaltic waves from left to right

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35
Q

Is pyloric stenosis a surgical emergency?

A

No. Medical emergency.

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36
Q

Fluid imbalance risks associated with pyloric stenosis?

A

Bco vomiting, dehydration, metabolic alkalosis, hypokalemia, hyponatremia

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37
Q

Pyloric stenosis interventions?

A

NG tube
Keep flat with head elevated
Elbow restraints
IV til fluid labs are ok

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38
Q

Intussuption is what?

A

Telescoping/invagination of passing matter on ileocecal valve&raquo_space; moves valve along&raquo_space; cramping to push valve back out&raquo_space; if can’t resolve, blood supply blocked and tissue necroses&raquo_space; weeps bloody secretions

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39
Q

Cardinal sign of intussuption?

A

Currant jelly stool

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40
Q

Is intussuption a surgical emergency?

A

Yes

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41
Q

How is intussuption treated?

A

Barium enema via Foley catheter

After third time, tissue surgically repaired.

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42
Q

Interventions for imperforate anus?

A 
Initiate IV
NG tube to suction
I&O
Keep site very clean
Zinc oxide if opening exists
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43
Q

Other concerns with imperforate anus?

A

Full exam bc rarely isolated

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44
Q

Appendicitis presents with pain where?

A

Starts at belly button and moves to lower right side of abdomen (mcburney’s point)

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45
Q

Antibiotic treatment: perforated vs non perforated appendix?

A

Triple strength if perforated

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46
Q

Nursing interventions for appendicitis post op?

A 
Strict I&O
Monitor for return of bowel sounds
Dressing change
Ambulate to move leftover gas from surgery
Cough and breathe
Pain management
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47
Q

Etiology of hirschprung’s?

A

No ganglia in lower intestine, colon.

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48
Q

Pathology of hirschprung’s?

A

Mega colon&raquo_space; no signal cells that urge voiding&raquo_space; distention, ischemia, necrosis

49
Q

First sign of hirschprung’s?

A

Doesn’t pass meconium

50
Q

Pre-op nursing care for hirschprung’s?

A

Put on TPN or low fiber, high cal diet
Mark measurements on abdomen to note distention
Saline enema
Colostomy

51
Q

Cardinal sign of celiac disease?

A

Stetthorea (white greasy stools bc can’t absorb fat)

52
Q

What is celiac crisis?

A

Episode of diarrhea and vomiting that canbe. Brought on by stress

53
Q

GI lymphoma risk heightened with what condition?

A

Celiac diet–noncompliance

54
Q

Colic is diagnosed with how much crying?

A

More than 3 hrs a day

55
Q

When does colic resolve itself?

A

3 months after due date

56
Q

GERD usually resolves when?

A

At six months when they sit up

57
Q

Nursing interventions for severe GERD?

A 
Sit upright
Thicken food
Small feeds with frequent burping
Liquid nexium
I&O (document vomiting)
Avoid fruits, acid
58
Q

Malrotation symptoms?

A

Intermittent bilious vomiting
Abdominal pain and distention
Lower GI bleeding

59
Q

Malrotation pathology?

A

Bowel obstructs, small intestine pretzels and cuts off blood supply&raquo_space; necrosis

60
Q

Nursing interventions for Malrotation?

A

NPO
I&O
NG tube for suctioning
IV fluids

61
Q

Is Malrotation a surgical emergency?

A

Yes

62
Q

Post op complications with Malrotation

A

Short gut syndrome

63
Q

Three types of hernias?

A

Congenital diaphragmatic hernia
Umbilical hernia
Inguinal hernia

64
Q

What is osmotic pressure?

A

The force that pulls water into capillaries

65
Q

Normal pH?

A

7.35-7.45

66
Q

Normal CO2?

A

35-45

67
Q

Na

A

135-145

68
Q

Normal K+

A

3.5-5.5

69
Q

Normal albumin

A

3.5-5.5

70
Q

Normal CO3?

A

22-26

71
Q

Values indicating respiratory acidosis?

A

pH less than 7.35

CO2 more than 45

72
Q

pH 7.3 and CO2 55

What do we suspect?

A

Respiratory acidosis

73
Q

Lab values for metabolic acidosis?

A

PH less than 7.5
Co2 normal btwn 35-45
HCO3 less than 22

74
Q

Patient presents with pH of 7.3 and CO2 of 40. What do we suspect?

A

Metabolic acidosis

75
Q

Metabolics: which is poop, which is vom?

A

Vom is metabolic acidosis

Pooping is metabolic alkalosis

76
Q

Respiratory alkalosis labs?

A

PH over 7.45

Co2 under 35

77
Q

If pH is 7.5 and CO2 is 25, what do we suspect?

A

Respiratory alkalosis

78
Q

In cases of respiratory alkalosis, how do we instruct patients to breathe?

A

Slowly, or into a bag

79
Q

Metabolic alkalosis lab values?

A

PH over 7.45
CO2 normal
hCo3 higher than 26

80
Q

If pH is 7.55, co2 is 35.45, what do we expect?

A

Metabolic alkalosis

81
Q

Hyperkalemia lab values?

A

K greater than 5.5

82
Q

What should we be cautious about when diagnosing Hyperkalemia?

A

Small peds needles can lyse RBCs, giving a false elevated reading

83
Q

Percentage body weight that’s water in adults vs children vs infants

A

Adults 50%
Children 65%
Infants 80%

84
Q

Extra cellular compartment is expanded until what age?

A

2 years

85
Q

Hypokalemia lab values?

A

K less than 3.5

86
Q

Two causes of hypokalemia?

A 
Being on lasix or digoxin
Metabolic acidosis (vomiting)
87
Q

Clinical symptoms of hypokalemia?

A

Reported leg weakness

Decreased bowel sounds

88
Q

What is the specific gravity of children?

A

1005-1010 bco immature kidneys

89
Q

Hyper natremic lab values?

A

Na greater than 145

90
Q

Hypo natremic lab values?

A

Na less than 135

91
Q

Managing hypernatremia?

A

Give water!

92
Q

Kids BMR relative to adults?

A

Much higher than ours!

93
Q

Minimum urine output for babies?

A

2-3 ml/kg/hr

94
Q

Minimum urine output for children?

A

1-2 ml/kg/hr

95
Q

Minimum urine output for teens and up?

A

1 ml/kg/hr

96
Q

Daily maintenance fluid for 1-10kg child?

A

100 ml/kg

97
Q

Daily maintenance fluid for 10-20 kg child?

A

1000 ml + 50 ml/kg over 10 kg

98
Q

Daily maintenance for child over 20 kg?

A

1500 ml + 20 ml/kg over 20kg

99
Q

Hypotonic dehydration?

A

Na loss greater than water loss

100
Q

Hypertonic dehydration?

A

H2o loss greater than na loss

101
Q

Degree of dehydration relative to body weight loss?

A

Mild 5%
Moderate 10%
Severe 15%

102
Q

What kind of dehydration most common in children? What’s the risk?

A

Isotonic, hypovolemic shock

103
Q

Interventions for vomiting?

A

Mouth care
Small sips
Zofran

104
Q

Systemic causes of constipation?

A

Hypothyroidism
Lead poisoning
Drug side effects
Psychosocial

105
Q

Fluid volume deficit interventions

A

Give oxygen to ease hearts workload

106
Q

With pyloric stenosis, how long after surgery might baby vomit?

A

24-48 hours

110
Q

Baby shot schedule (6)

A

2 months / 4 months / 6 months

Hep B
Rotavirus
Hib+
Polio
Dtap
Prevnar/pneumococcal
111
Q

1 year shots

A

MMR
Varicella
Hep A

112
Q

Which vaccines are live? Contraindications?

A

MMR & varicella

Contraindicated with the immunosuppressed.

113
Q

15 month shots?

A

Boosters of baby shots

114
Q

Which vaccines subQ?

A

MMR & varicella

PEDS (2 decks)

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