Exam 1 Flashcards
Body Changes: Infancy-1yo
-Weight x2 by 6mo, x3 1 yr
-Height: Increase by 50% by 1yr
-Fontanels: Posterior close at 2mo, Anterior 18mo
2mo Milestones
-Hold head up on stomach
-Move head in response to sound
-Make noises
-Smiles
4mo Milestones
-Play
-Hold/reach for toy
-Start to roll over
-Remember face and object
6mo Milestones
-Sit up with support
-Stranger danger
-Babble
-Look in mirror
9mo Milestones
-Sit
-Crawl
-Pull to stand
-Object permanence
-Pincer grasp
12mo Milestones
-Begin to walk
-Follow simple command
-Mama and Dada
Baby Safety
-SIDS (sleep on back, no extras in bed, stay close)
-Choking
-Rear facing car seat
- Shaken Baby Syndrome
-Burns form hot water
Eating Plan for Babies
-Formula or breast milk for 6mo
-No cow milk or honey until 12mo
-Teeth at 6mo
-Hydration: 6 wet diaper/day
-Failure to Thrive: Below 5% for height and weight
Toddlerhood Growth
-2yrs: 4x birth weight
-Gain 3-5lbs/year
-Height Increase 2-3in/year
Preschool Age Growth
-5lbs/year
-3in/year
-Begin to lose baby teeth
Scool Age (6-12yo)
-4.5-7lbs/yr
-2.5in/yr
-Getting permanent teeth
Erikson’s Stages
-Stage 1: Trust vs. Mistrust (Infancy from birth to 18 months)
-Stage 2: Autonomy vs. Shame and Doubt (Toddler years from 18 months to three years)
-Stage 3: Initiative vs. Guilt (Preschool years from three to five)
-Stage 4: Industry vs. Inferiority (Middle school years from six to 11)
-Stage 5: Identity vs. Confusion (Teen years from 12 to 18)
-Stage 6: Intimacy vs. Isolation (Young adult years from 18 to 40)
-Stage 7: Generativity vs. Stagnation (Middle age from 40 to 65)
-Stage 8: Integrity vs. Despair (Older adulthood from 65 to death)
Dehydration Lab Values
Increased:
-Hematocrit
-BUN
-Serum Sodium
-Blood Osmolarity
-Specific Gravity
Fluid Overload Lab Values
Decreased:
-Hemoglobin and hematocrit
-Blood osmolarity
-Urine sodium, specific gravity
-BUN
Dehydration Signs and Symptoms
VS
-hypo or hyperthermia
-Tachycardia and weak pulse
-Hypotension
-Tachypnea, hypoxia
Neuro
-Dizziness, syncope (pass out)
-Confused, weak, tired
Fluid Overload Signs and Symptoms
Cardiovascular
-Hypertension
-Tachycardia, bounding pulse
-Tachypnea
Neuro
-Weakness
-Vision Changes
-Paresthesia (tingling/numbness)
-Seizures
Respiratory
-Crackles
-Cough
-Dyspnea
Isotonic Fluids
-0.9 saline
-Lactated Ringer’s (Ca+, K+, H20)
-D5W
Hypotonic
-0.45 saline
-0.33 saline
Hypertonic
-3% saline
-5% saline
-D10W
-D5LR
-D5NS
Respiratory Acidosis (CO2 retention)
-Hypoventilation/shallow breathing
-Airway constriction
-Damage to resp center in medulla
Respiratory Alkalosis (CO2 expulsion)
-Hyperventilation (asthma, anxiety, increased altitude)
Metabolic Acidosis
-Loss of HCO3-
-Increased acid production
-Decreased acid secretion
-Increased chloride
-Kidney failure (fails to absorb HCO3-)
-Diabetes Mellitus ( no insulin, increased ketones-acidic)
-Excess alcohol ingestion
Metabolic Alkalosis
-Constipation (reabsorb more bicarb)
-Excess sodium bicarb ingestion
-Diuretics which cause K+ depletion
-Sever vomiting
Acidosis Signs and Symptoms
-Headache
-Confusion, drowsiness
-Increased RR
-Vasodilation (hypotension, decreased cardiac output, dysrhythmias, palpitations)
-Shock
Alkalosis Signs and Symptoms
-Lightheadedness
-Inability to concentrate
-Numbness, tingling
-Tinnitus
Metabolic Acidosis Interventions
-Airway management
-Bicarb infusion IV
-Oral bicarb if chronic
Metabolic Alkalosis Interventions
-Restore fluid volume
-Treat underlying cause
-Admin KCl and NaCl solutions
-Cl- promotes renal HCO3- excretion
-Monitor I+O
ROME Method
Respiratory Opposite
-pH increase, PCO2 decrease=Alkalosis
-pH decrease, PCO2 increase=Acidosis
Metabolic Equal
-pH increase, HCO3 increase=Alkalosis
-pH decrease, HCO3 decrease=Acidosis
Acid Base Compensation
-Uncompensated: pH abnormal, 1 abnormal, 1 normal
-Partially Comp: All abnormal
-Fully Compensated: pH normal, both abnormal
Upper Respiratory Tract Anatomy
-Nasopharynx
-Oropharynx
-Laryngopharynx
-Epiglottitis
-Larynx
-Trachea
Lower Respiratory Tract
-Left Bronchus
-Right Bronchus
-Bronchioles
COPD
-Chronic bronchitis and emphysema
-Airway abnormalities
-Retain air, alveoli shrink
Chronic Bronchitis: Blue Bloater
-Mucus and edema inhibit ventilation
-Pt cannot get air in (cyanosis, chronic hypoxia, clubbed fingers)
-Cough
-Right sided heart failure, JVD, ascites (swollen abd), hepatosplenomegaly, ankle edema
Emphysema: Pink Puffer
-Alveoli integrity destroyed, like overdistended balloons, non-recoiling alveoli, CO2 retention
-Patient cannot get air OUT
Prolonged exhalation, barrel chest, chronic hypercapnia, shallow respirations
COPD Clinical Presentation
-Exertional dyspnea
-Chronic cough
-Sputum production
-Wheezing and chest tightness
Advanced COPD Clinical Presentation
-Barrel chest
-Weight loss
-Right sided heart failure, leads to edema
-Clubbing fingers
-Decreased O2 sats
-Altered ABGs
Pneumonia Overview:
-Lung infection
-Caused by: bacterial or virus
Pneumonia Clinical Presentation
-Cough, dyspnea
-Pleuritic chest pain
-Fever, malaise, myalgia
-Decreased appetite
Pneumonia Interventions
-Encourage coughing to remove secretions
-Titrate O2
-Fowlers
-Increase fluids
-Antibiotics
Traumatic Pneumothorax
-Open (wound, has sucking sound)
-Iatrogenic (human error during procedure)
Spontaneous Pneumothorax
-Primary Spontaneous: no underlying conditions, common in males 20-30
-Secondary Spontaneous: Have underlying lung disease (COPD), usually older 60-65
Pneumothorax Manifestations
-Resp discomfort/pleuritic chest pain
-Increased RR
Asymmetrical Lung expansion
-Decreased tactile fremitus
-hyper resonant percussion notes
Decreased or absent lung sounds
Tension Pneumothorax
-Manifestations of pneumothorax and…
-Tachycardia
-Hypotension
-TRACHEAL DEVIATION, JVD
Hemothorax Pathyphysiology
-Blood in pleural space associated with trauma
Blunt chest trauma from motor vehicle accident, stabbing
Hemothorax Manifestations
-Similar to pneumothorax
-No JVD
-Loss of blood into chest cavity leads to hypovolemia
Hemothorax Treatment
-Chest tube to rain blood or thoracentesis
Chest Tube Uses
To remove air, blood, or fluid from pleural space and reestablish negative pressure
-Pneumothorax
-Hemothorax
-Post-op chest drainage (open heart)
-Pleural effusion
-Pulmonary empyema (pus around lung)
Wet Seal Chamber
A:
-Suction control
-set at -20cm
-Wet system: expect gentle bubbling (not vigorous or continuous)
B+C:
-Water seal chamber (allows air to leave but not re-enter)
-Tiddling expected
-Monitor for continuous bubbling (indicates air leak)
D:
-Drainage chamber
-Closed system
-If full, get new chest tube
Dry Seal Chamber
A:
-Set at -20cm
B+E:
-Will have ball or accordion mechanism
C:
-Water seal chamber (allows air out but not back in)
-Tiddling expected
-Monitor for continuous bubbling (indicates air leak)
D:
-Closed system
-If full, get new chest tube
Removing Chest Tube
-Pain med
-Assist provider
-Instruct pt to bear down (Valsalva)
-Cover site with petroleum gauze
-Chest x-ray
-Monitor
Pediatric vs Adult Anatomy
-Nose breathers
-Chest wall more circular (quicker muscle fatigue)
-Larger tongues
-Narrower nasal cavity
-Upper resp structures shorter and narrower
-Less alveoli, less gas exchange
-Born w/ fewer sinuses
Acute Respiratory Infection Pathophys
-Spread via contact or droplets
-Cause inflammation of airway tissues, nasal drainage, and congestion
-Incubation 1-3 days
-Illness 4-10 days
Acute Respiratory Infection Clinical Presentation
-Sneeze, cough, eye drainage, headache, low-grade fever
Serious Effects:
-Tachypnea
-Increased respiratory effort
-Wheezing or other lung sounds
-Hypoxia
-Retractions
-Nasal flaring
-LOC changes
Croup Pathophys
-Upper/middle airway swelling result in restricted airflow
-May be caused by allergen, virus, or bacteria
-Short deration, slef-limiting, typically non-emergent
-Typically occur at night
BARKY COUGH
Croup Risk Factors
-6mo-3yr
-Previous family history
-Peak times: Autumn and early winter
-Often follows reported history of nasal drainage
Croup Clinical Presentation
-1-2days congestion and discharge
-Day 3: fever, barky cough, hoarseness
-Swelling in airway
-Increased RR and Inspiratory phase
-Potential resp distress
Croup Treatment
-Cool humidifier
-Nebulized meds
-Oral or injectable steroids
-Shower steam or cold outside air
-Severe cases: mechanical ventilation
Epiglottitis Causes
-Haemophilus influenzae type b (Hib)
Epiglottitis Overview
-Non-infectious
-5yo and younger highest risk and not Hib vaccinated
Epiglottitis Clinical Manifestations
-Similar to croup
-More severe resp distress
-Prefer orthopnea (tripod) position
-DROOLING
Bronchiolitis Pathophys
-Lining of bronchi becomes edematous
-Bronchi produce mucus, often causing a coughing response
Bronchiolitis Causes
-Caused by viral pathogen
-Flu, RSV, Covid-19
Bronchiolitis Risk Factors
-Children under 2
-Premi babies (low birth weight)
-Underlying hear condition/disease
-Immnocompromised
Bronchiolitis Clinical Presentation
-Cough
-Fever
-Tachypnea
-Wheezing/crackles
-Hist of URI
-Diff breathing
-Retractions
-Hypoxia
Bronchiolitis Treatment
-Hydration
-Fever management
-Nasal drops
-Nasal suctioning
What does RSV stand for?
Respiratory Syncytial Virus
RSV Pathophys
-Direct contact via nasal or eye mucus membrane
-Droplet
-Virus live hrs on surface
-Incubation 4-6 days, sheds 11 days
RSV Risk Factors
-Younger than 6mo
-Born premi
-Born during fall/winter
-Down syndrome
-Low body weight
-Underlying heart/lung condition
-Immunocompromised
-School/daycare exposure
RSV Presentation
-Lower respiratory
-Decreased airflow, increased mucus, stasis
-Wheezing/crackles
-Irregular RR/Pattern
-Bronchospasms leads to coughing
-Tachycardia
RSV Treatment
-Airway management
Drugs
-Palivizumab, Nirsemivab, maternal vaccine
Cystic Fibrosis (CF) Pathophys
-Development due to abnormality in protein responsible for making mucus in organ
-Mucus syrupy and thick
-Protein abnormality affects movement of Na+ and H2O
-Na+ decreased in blood
CF Etiology
-Genetic condition caused by absent or mutated protein needed to properly distribute Na+ across body tissues
CF Presentation
-Newborn, not passing meconium stool
-Chronic decreased O2 and Resp
-Chronic cough and obstructive emphysema
-Chronic constipation, steatorrhea, abd discomfort
-Low BMI, decreased growth, delayed puberty
-Increased Na+ in sweat
CF Testing
-Genetic test
-CBC
-Chest x-ray
-Sweat chloride test
-Sputum culture
-Pulmonary function test
-Stool analysis
CF Treatment
-No cure
-Maintain health
-Chest x-ray
-Humidified O2
-Chest physiotherapy
-Bronchodilators, mucolytics
-Antibiotics
-CF transmembrane conductance regulators (CFTR)
-Supplements
Rheumatoid Arthritis Overview
-Autoimmune disorder
-Fever, pain, malaise, weakness, joint stiffness/swelling, nodule
Osteoarthritis Overview
-Wear and tear or injury
-Degenerative disease
-Painful/still joints, muscle atrophy, bone deformity, crepitus
Viral Infections Facts
-Not living
-RNA or DNA surrounded by protein shell
-Require a host cell to reproduce
-Often systemic infections
Bacterial Infection Facts
-Single celled organism
-Can live in variety of environments
-Multiply quickly- disrupts and kills tissue
-Often start localized and then spread
-Antibiotics
Peritonitis Overview
-Inflammation of peritoneum and lining of abdominal cavity
-Can be life threatening
Peritonitis Causes
-Bowel perforation
-Peritoneal perforation
-Perforated Diverticula
-Ruptured appendix
-Surgery
Peritonitis Signs and Symptoms
-RIGID, BOARD LIKE ABDOMEN
-Distention
-Fever
-Rebound tenderness
-Tachycardia
Peritonitis Immediate Actions
-Call Dr.
-Take vital
-Ensure oxygenation
-Semi-fowler’s
-NPO
-Admin antibiotics, fluids, electrolytes
Peritonitis Diagnoses
-X-ray
-CT scan
-Culture
HIV/AIDS Spread
Blood, semen, rectal/vaginal fluid, breastmilk
AIDS Definition
-Acquired Immunodeficiency Syndrome
-Occurs when immune system has been significantly weakened and multiple body systems are affected
HIV/AIDS Treatment
-Antiretroviral Therapy
Not cure
Lower viral load leads to decreased transmission
Meningitis Overview
-Inflammation of meninges
-Can also effect subarachnoid space
Meningitis Causes
-MOST commonly caused by bacterial or viral infections
-Can also be caused by: fungi, parasites, amoeba, trauma, meds
Meningitis Clinical Presentation Infants
-Anorexia
-Vomiting
-Diarrhea
-Irritability
-Rash
-Resp Symptoms
Meningitis Clinical Presentation Adults
-STIFF NECK
-FEVER
-Headache
-Seizures
-Photosensitivity
Meningitis Diagnoses
Lumbar Puncture
-CSF proteins
-Culture
Fifths Disease Cause
-Human parvovirus B19
-Spread by resp droplet
-Common 5-15yo
Fifths Disease Signs and Symptoms
-Low fever
-Mild cold-like symptoms
-RASH: “Slapped Cheek” appears on face and moves to body
-Joint pain
Fifths Disease Management
-Supportive care
Strep Throat Causess
Group A Streptococcus bacteria
Strep Throat Symptoms
-Sore throat, difficulty swallowing
-Fever
-Swollen Lymph Nodes
-Red, swollen tonsils, often with white patches
Strep Throat Diagnose
-Rapid strep test
-Throat culture if needed
Strep Throat Treatment
-Antibiotics
-Pain Relief
Strep Throat Complications
-Scarlet fever (body rash)
-Rheumatic fever
-Post Streptococcal Glomerulonephritis
Otitis Media Cause
Bacterial or viral
Otitis Media Symptoms
-Ear pain
-Decreased hearing
-Fever
-Drainage (if eardrum ruptures)
Otitis Media Treatment
-Antibiotics
-Pain malmanagement (Tylenol, Motrin)
Otitis Externa Cause
-Infection of the outer ear canal
-Often caused by water exposure
Otitis Externa Symptoms
-Ear pain (especially when touched)
-Itching
-Redness
-Swelling
-Discharge
Otitis Externa Treatment
-Antibiotics
-Antifungal
-Pain relief
-Avoid water in ear
What is Pertussis also known as?
Whooping Cough
Pertussis Sympotms
-Paroxysmal cough
-Coughing fits followed by ‘whooop’
Pertussis Diagnoses
-Nasopharyngeal culture
-PCR test
Pertussis Treatment
-Antibiotics
-Comfort
Pertussis Complications
-Difficult breathing due to mucus accumulation
-High risk of secondary infections
-Potential for respiratory failure
Pertussis Prevention
-Vaccine
-Infant under 5yo highest risk
What is Varicella also known as?
Chicken Pox
Varicella Causes
-Viral infection caused by varicella zoster virus
-Appears 10-21 days after exposure
-Lasts 5-10 days
Varicella Symptoms
-RASH: raised pink/red bumps, small fluid filled blisters, crusts and scabs
-Fever
-Headache
-Body malaise
Varicella Diagnoses
PCR
Varicella Treatment
-Antiviral therapy if within 24 hrs of rash for kids >12yo
-Trim fingernails
-High risk for pregnant
Impetigo Causes
-Strepto- and Staphylococcus
-Highly contagious
-2-6yo most affected
-Bacteria gets into open area on skin
Impetigo Symptoms
-Mostly on face and progressive
-Itchy, painful red blister or bump (may rupture)
-Lesions start to leak honey-colored fluid (strep) or clear/pus (staph)
Red patches that crust over with YELLOWISH BROWN CRUST
Impetigo Treatment
-Topical or oral antibiotic
-Remove crust prior to applying ointment
Impetigo Family Precautions
-Contact precautions
-Don’t touch
-Use different linens and hand hygiene
-Still contagious 48hrs after topical and 24hrs after oral
Roseola
-Viral illness
-Fever to rash
-High fever 3-5 days, rash appears after
-Treat symptoms
-Keep kid comfortable
Neonatal Fever
Rectal temp of 100.4F or higher in infant <3mo
-Take to Dr. or ER
-Can indicate early or late-onset sepsis
Hyponatremia Symptoms
-Confusion
-SEIZURES
-Weakness
Hypernatremia Symptoms
-Muscle Weakness
-Decreased DTR
-SEIZURES
Hyperkalemia Symptoms
-Cardiac dysrhythmias
-Peak T-wave
Hypokalemia Symptoms
-Weakness
-Cardiac dysrhythmias
-U-wave
Hypocalcemia Symptoms
-Tetany (whole body cramps)
-Chvostek’s (face twitching)
-Trousseau’s (arm cramp)
-Hyperactive reflexes
Hypercalcemia Symptoms
-Muscle weakness
-Hypertension
