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Nursing 132 Exam # 1 > Exam # 1 Peds Review > Flashcards

Exam # 1 Peds Review Flashcards

1
Q

What group of medications should be avoided given to children because of the risk of Reyes Syndrome?

A

NSAIDs

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2
Q

Why is rubbing alcohol contraindicated for a fever?

A

Lowers temperature too quickly, plus the fumes and chemicals can be irritating to the skin and nose.

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3
Q

What is the significance of white speckles or brown discoloration of the teeth (in a child)?

A

Fluorosis - excess amounts of fluoride.

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4
Q

(T/F) Females who are significantly overweight tend to have earlier onset of puberty and menarche.

A

True

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5
Q

What is the major developmental task of adolescents?

A

Identity formation

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6
Q

What are the stages of separation anxiety?

A

1) Protest
2) Despair
3) Detachment

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7
Q

What are some behaviors that often serve as indicators of infant pain?

A

1) Crying
2) Fist clenching
3) Grimacing
4) Wrinkling of the forehead
5) Fussiness
6) Restlessness

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8
Q

What are the SxS of Otitis Media?

A

1) Crying, irritable
2) Pulling or rubbing of ears
3) Rolls head side to side
4) ⬇ appetite
5) Lethargic

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9
Q

What are the Tx for Otitis Media

A

1) Antibiotics
2) Myringotomy w/Tympanostomy tubes - Inserting tube into the tympanic membrane & aspirating the fluid.
3) Adenoidectomy

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10
Q

What are some of the complications that can develop from Chronic Otitis Media?

A

1) Hearing loss
2) Communication difficulties
3) Feelings of fullness in the ears
4) Tinnitus
5) Vertigo

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11
Q

What are some preventative measures to take for Otitis Media?

A

1) Pneumonicocal conjugate vaccine
2) Immune Globulin (for high risk infants)
3) Use upright position when bottle feeding
4) Avoid pacifier use
5) Avoid passive tobacco smoke

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12
Q

Tonsillitis and Pharyngitis may be bacterial or viral in origin. What is the most common bacterial agent that causes this infection?

A

Group A beta-hemolytic streptococcus (Strep Throat)

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13
Q

Why is a tonsillectomy contraindicated in children with cleft palates?

A

In children with cleft palates, the tonsils help prevent air escape during speech.

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14
Q

What is the most serious and life-threatening complication of a tonsillectomy?

A

Postoperative Hemorrhage

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15
Q

(T/F) Smaller more frequent feedings are sometimes better tolerated by infants with respiratory difficulties.

A

True

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16
Q

What is Laryngotracheobronchitis (croup)?

A

An inflammation of the mucosa lining the larynx and trachea resulting in airway narrowing

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17
Q

What are the viral causes of Croup?

A

1) Parainfluenza (mainly)
2) RSV
3) Influenza A and B

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18
Q

What are the SxS of croup

A

1) starts with URI
2) low grade fever
3) irritable, restless, fearful
4) barking cough, inspiratory Stridor
5) retractions
6) use of accessory muscles
7) crackles, wheezing, diminished lung sounds

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19
Q

What are the Tx for Croup (LTB)

A

1) Racemic epinephrine
2) Corticosteroids
3) Bronchodilators
4) Respiratory support
5) Cool air or humidity (shower)

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20
Q

What is the most common cause of epiglottitis?

A

Bacterial (H-flu)

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21
Q

Describe the clinical manifestations epiglottitis?

A

1) Rapid onset: hours
2) no spontaneous cough
3) drooling and tripod position
4) difficulty swallowing, sore throat, refuses to talk
5) agitation
6) toxic high temp
7) cherry red swollen epiglottitis

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22
Q

What are the methodsof treatment used for epiglottitis?

A

1) Oxygen
2) Airway maintenance
3) IV Fluids & Antibiotics
4) Corticosteroids (IV Decadron)
5) Rest & Support

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23
Q

Describe Bronchiolitis. What is the major cause of Bronchilitis?

A

1) Bronchiolitis is an inflammation of the bronchioles with resulting mechanical changes. It manifests as thick mucus production that occluded the bronchioles and small bronchi.
2) Most commonly caused by Respiratory Syncytial Virus (RSV)

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24
Q

What are the clinical manifestations of RSV (Bronchiolitis)

A

1) Starts as an URI
2) Tachypnea: can be 60-80/min due > residual volume
3) retractions and nasal flaring
4) Breath sounds
5) Distended abdomen
6) Feeding problems due to respiratory probs.
7) Intermittent fever

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25
Q

What are the signs of impending respiratory failure in a child with RSV (Bronchiolitis)?

A

1) ⬇ breath sounds
2) Tachypnea (> 70)
3) Cyanosis
4) Pallor
5) Listlessness
6) Apneic episodes

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26
Q

What are the treatments used for RSV (Bronchiolitis)?

A

1) Respiratory isolation (quarantine RSV kids together)
2) Mist therapy with oxygen
3) Monitor O2 sat
4) HOB elevated 30-40 degrees
5) NPO if tachypneic ( >60 bpm)
6) Discourage cough suppressants
7) Monitor I/O: because of Tachypnea
8) Nebulized adrenaline
9) Ribavirin
10) Albuterol and steroids

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27
Q

Are antibiotics used to treat Bronchiolitis?

A

Only if the there is a secondary infection. Bronchiolitis (RSV) is a viral infection.

28
Q

How is Heliox used as a treatment for asthma?

A

Heiliox - 70:30 helium to oxygen ratio mix administered my face mask. It improves response to aerosol Tx by ⬇ airway resistance and ⬇ the work of breathing.

29
Q

With an asthmatic PT, what does the absence of wheezing (“Silent Chest”) signify?

A

Severe attacks may have no audible wheezing because the airway is too narrow

30
Q

What is the earliest clinical manifestation of CF in the neonate?

A

Meconium ILeus

31
Q

What are the early clinical manifestations of CF?

A

1) Failure to grow
2) Digital clubbing
3) Persistent cough with mucous production
4) Tachypnea

32
Q

What is the effect of CF on the digestive system?

A

The enzymes trypsinogen, lipase, amylase do not reach the intestines to digest ingested nutrients. This results in steatorrhea (fatty greasy stools).

33
Q

Why does the severity of asthma often decrease as the child gets older?

A

1) Increased airway size
2) Improved diaphragmatic support
3) Better clearing of mucous

34
Q

What are some of the triggers of Asthma?

A

1) Exercise
2) Cold Air
3) Smoke
4) Allergens
5) Viral Infection
6) Stress
7) Environmental Pollutants
8) Food

35
Q

How is an episode of acute asthma treated?

A

1) Use and inhaled (SABA) Short Acting B-adrenergic Agonist by MDI (i.e., albuterol)
2) Oxygen is often administered as well
3) Systemic Corticosteroid if response to B-adrenergic agonist is insufficient (i.e., beclomethasone or budesonide).
4) Anticholinergics (i.e., Ipatropium).
5) Methylxanthines (i.e., Theophyline)

36
Q

What are the 4 types of Anti-Inflammatory drugs used to treat Asthma?

A

1) Corticosteroids
2) Mast Cell Stabilizers
3) Leukotriene Modifiers
4) Monoclonal Antibody to IgE

37
Q

What is the major side effect of inhaled Corticosteroids and how can it be reduced?

A

Corticosteroids upsets the normal flora and ⬆ the risk of yeast infections. This can be reduced by having the PT use a spacer or rinsing the mouth after each use.

38
Q

What is the difference between the inhaled form and the systemic form of Corticosteroids?

A

1) Inhaled Corticosteroids - Used used in longterm control of Asthma.
2) Systemic Form - Used to control exacerbations and manage persistent asthma.

39
Q

What types of medications are used in the longterm treatment of Asthma?

A

1) Inhaled Corticosteroids
2) LABA - Long-Acting Beta2-adrenergic Agonists
3) Combination meds such as Symbicort
4) Leukotriene Blockers
5) Monoclonal antibody to IgE
6) Mast Cell Stabilizers

40
Q

Describe the Mechanism of Action for the Following Routine Asthmatic Drugs:

1) Corticosteroids
2) Mast Cell Stabilizers
3) Monoclonal Antibody to IgE
4) Leukotriene Blockers

A

1) Corticosteroids - Suppresses inflammatory response
2) Mast Cell Stabilizers - Inhibit IgE-mediated release of inflammatory mast cells.
3) Monoclonal Antibody to IgE - Prevents IgE from attaching to mast cells, preventing release of chemical mediators.
4) Leukotriene Blockers - Blocks action of Leukotrienes (a potent bronchoconstrictor)

41
Q

Name the 3 types of Bronchodilators that are great for bronchospasms and acute Asthmatic attacks.

A

1) B2-Adrenergic Agonists
2) Methylxanthines (i.e., Theophyline)
3) Anticholinergics

42
Q

Which class of asthmatic drug is most effective if used 10-20 mins before exercise, as a prophylactic for exercise induced asthma attacks?

A

Mast Cell Stabalizers

43
Q

What is is a major Nursing Consideration when administering Methylxanthines (i.e., Theophyline)?

A

It has a very narrow therapeutic range. The margin of safety is small.

44
Q

What are the Adverse Effects of Theophyline?

A

1) Anorexia
2) Nausea and Vomiting
3) Headache
4) Restlessness
5) Tachycardia & Arrhythmias
6) Seizures

45
Q

What are the Adverse Effects of B2-Adrenergics (i.e., Albuterol)?

A

1) ⬆ Pulse rate
2) Nervousness
3) Restlessness
4) Jitters and tremors

46
Q

What is the most common side effect of Anticholinergics (i.e., Ipratropium)?

A

Dry Mouth

47
Q

Describe the “Green Zone” of Asthmatic management

A

1) 80 to 100% of personal best of PEFR
2) No symptoms
3) Can do ADLs and sleep without SxS

48
Q

Describe the “Yellow Zone” of Asthmatic management

A

1) 50 to 79% of personal best of PEFR
2) Something is triggering Asthma
3) SxS include coughing, wheezing and chest tightness
4) Difficulty with ADLs, sleep disturbed

49
Q

Describe the “Red Zone” of Asthmatic management

A

1) 50% or less of personal best of PEFR
2) Indicates serious problem
3) Take yellow zone meds plus oral steroids
4) Must seek healthcare provider

50
Q

What is the narrowest portion of the airway in children under 8 years?

A

Cricoid Cartilage (which is why they may not need a cuff on an ET tube)

51
Q

How is Bronchiolitis most commonly diagnosed?

A

1) Cest X-ray will show hyperinflation of lungs (Thick mucus makes expiration of air difficult, trapping air in lungs).
2) Virus Isolation from secretions

52
Q

What are the advantages of a fever?

A

1) Inhibits viral growth
2) ⬆ bactericidal activity
3) ⬆ Rest

53
Q

What are the disadvantages to a fever?

A

1) Dehydration due to anorexia and fluid loss
2) ⬆ Metabolic Rate (⬆ O2 and Caloric demand)
3) Discomfort leading to lethargy

54
Q

What level of temperature indicates febrile episode is serious and what should be done?

A

104 to 105 degrees. Call healthcare worker immediately!

55
Q

What duration of fever indicates the febrile episode is serious?

A

1) > 24 hrs without probable cause
2) > 72 hrs
3) If fever disappears for 24 hrs and then returns

56
Q

List three underlying factors for serious infection

A

1) HIV
2) Sickle Cell Anemia
3) Immunosuppressed Child

57
Q

List the differences in the Upper Airway Anatomy and Physiology of a child as opposed to an adult

A

1) Airway is shorter
2) Smaller Nasopharynx which occluded easily
3) Lymph tissue grows rapidly
4) Small mouth and large tongue
4) Long/floppy epiglottis
5) Immature cricoid cartilage, trachea, & thyroid soft and collapse easily.

58
Q

List the differences in the Lower Airway Anatomy and Physiology of a child as opposed to an adult

A

1) Immature alveoli (25 million at birth, 300 million by 8 yrs, fully mature at 12 years)
2) ⬇ Bronchial smooth muscle at birth, but developed by 5 yrs
3) Chest wall more flexible make retractions visible during respiratory distress

59
Q

List the differences in the Anatomy and Physiology of a child as opposed to an adult for the following:

1) Larynx
2) Lower Airways
3) Ribs
4) Chest Wall
5) Metabolic Rate

A

1) Larynx - Larger and softer, neck flexion may occlude airway
2) Lower Airways - Smaller and less developed
3) Ribs - More pliable and easily moved, poorly developed intercostal muscles.
4) Chest Wall - Thinner, sounds transmit easily
5) Metabolic Rate - ⬆ O2 consumption, hypoxia develops more quickly.

60
Q

Lost the clinical manifestations of respiratory distress in infants and children.

A

1) Behavioral Change - i.e., restless, irritable, anxious, fatigue
2) Retractions
3) Nasal Flaring
4) Head Bobbing
5) Grunting - Epiglottis closing
6) Intercostal Bulging
7) Stridor
8) Color Change - Cyanosis, pallor, mottling

61
Q

(T/F) Croup (LTB) tend to reoccur but kids eventually outgrow it.

A

True

62
Q

Discuss the differences between Epiglottitis and Croup (LTB)

A

1) Cause - Epiglottitis is bacterial while Croup is Viral
2) Onset - Epiglottitis has a rapid onset while Croup Gradual
3) Cough - Epiglottits has no spontaneous cough while Croup manifests as a barky/brassy cough.

63
Q

Describe the genetic potential of the possible offspring of parents who are both carries of the CF gene.

A

1) 25% chance of a child having CF
2) 25% chance of a child not having CF
3) 50 % chance of a child being carrier of the gene

64
Q

Why is a humidified atmosphere recommended for a child with an URI?

A

It is soothing to inflamed mucous membrane

65
Q

Asthma is now classified into four categories: Mild Intermittent, Mild Persistent, Moderate Persistent, Severe Persistent. What clinical features are used to differentiate these categories?

A

1) Lung Function
2) Frequency of Symptoms
3) Frequency and severity of exacerbations

66
Q

What is the difference between a tonsillectomy and an Adenoidectomy?

A

1) Tonsillectomy - DC palatine tonsils

2) Adenoidectomy - DC pharyngeal tonsils

67
Q

A child with acute streptococcal pharyngitis is treated with antibiotics to prevent which two problems?

A

1) Rheumatic fever

2) Glomerulonephritis

Nursing 132 Exam # 1 (3 decks)

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