Exam # 1 Peds Review Flashcards
What group of medications should be avoided given to children because of the risk of Reyes Syndrome?
NSAIDs
Why is rubbing alcohol contraindicated for a fever?
Lowers temperature too quickly, plus the fumes and chemicals can be irritating to the skin and nose.
What is the significance of white speckles or brown discoloration of the teeth (in a child)?
Fluorosis - excess amounts of fluoride.
(T/F) Females who are significantly overweight tend to have earlier onset of puberty and menarche.
True
What is the major developmental task of adolescents?
Identity formation
What are the stages of separation anxiety?
1) Protest
2) Despair
3) Detachment
What are some behaviors that often serve as indicators of infant pain?
1) Crying
2) Fist clenching
3) Grimacing
4) Wrinkling of the forehead
5) Fussiness
6) Restlessness
What are the SxS of Otitis Media?
1) Crying, irritable
2) Pulling or rubbing of ears
3) Rolls head side to side
4) ⬇ appetite
5) Lethargic
What are the Tx for Otitis Media
1) Antibiotics
2) Myringotomy w/Tympanostomy tubes - Inserting tube into the tympanic membrane & aspirating the fluid.
3) Adenoidectomy
What are some of the complications that can develop from Chronic Otitis Media?
1) Hearing loss
2) Communication difficulties
3) Feelings of fullness in the ears
4) Tinnitus
5) Vertigo
What are some preventative measures to take for Otitis Media?
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
Tonsillitis and Pharyngitis may be bacterial or viral in origin. What is the most common bacterial agent that causes this infection?
Group A beta-hemolytic streptococcus (Strep Throat)
Why is a tonsillectomy contraindicated in children with cleft palates?
In children with cleft palates, the tonsils help prevent air escape during speech.
What is the most serious and life-threatening complication of a tonsillectomy?
Postoperative Hemorrhage
(T/F) Smaller more frequent feedings are sometimes better tolerated by infants with respiratory difficulties.
True
What is Laryngotracheobronchitis (croup)?
An inflammation of the mucosa lining the larynx and trachea resulting in airway narrowing
What are the viral causes of Croup?
1) Parainfluenza (mainly)
2) RSV
3) Influenza A and B
What are the SxS of croup
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
What are the Tx for Croup (LTB)
1) Racemic epinephrine
2) Corticosteroids
3) Bronchodilators
4) Respiratory support
5) Cool air or humidity (shower)
What is the most common cause of epiglottitis?
Bacterial (H-flu)
Describe the clinical manifestations epiglottitis?
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
What are the methodsof treatment used for epiglottitis?
1) Oxygen
2) Airway maintenance
3) IV Fluids & Antibiotics
4) Corticosteroids (IV Decadron)
5) Rest & Support
Describe Bronchiolitis. What is the major cause of Bronchilitis?
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)
What are the clinical manifestations of RSV (Bronchiolitis)
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
What are the signs of impending respiratory failure in a child with RSV (Bronchiolitis)?
1) ⬇ breath sounds
2) Tachypnea (> 70)
3) Cyanosis
4) Pallor
5) Listlessness
6) Apneic episodes
What are the treatments used for RSV (Bronchiolitis)?
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
Are antibiotics used to treat Bronchiolitis?
Only if the there is a secondary infection. Bronchiolitis (RSV) is a viral infection.
How is Heliox used as a treatment for asthma?
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.
With an asthmatic PT, what does the absence of wheezing (“Silent Chest”) signify?
Severe attacks may have no audible wheezing because the airway is too narrow
What is the earliest clinical manifestation of CF in the neonate?
Meconium ILeus
What are the early clinical manifestations of CF?
1) Failure to grow
2) Digital clubbing
3) Persistent cough with mucous production
4) Tachypnea
What is the effect of CF on the digestive system?
The enzymes trypsinogen, lipase, amylase do not reach the intestines to digest ingested nutrients. This results in steatorrhea (fatty greasy stools).
Why does the severity of asthma often decrease as the child gets older?
1) Increased airway size
2) Improved diaphragmatic support
3) Better clearing of mucous
What are some of the triggers of Asthma?
1) Exercise
2) Cold Air
3) Smoke
4) Allergens
5) Viral Infection
6) Stress
7) Environmental Pollutants
8) Food
How is an episode of acute asthma treated?
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)
What are the 4 types of Anti-Inflammatory drugs used to treat Asthma?
1) Corticosteroids
2) Mast Cell Stabilizers
3) Leukotriene Modifiers
4) Monoclonal Antibody to IgE
What is the major side effect of inhaled Corticosteroids and how can it be reduced?
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.
What is the difference between the inhaled form and the systemic form of Corticosteroids?
1) Inhaled Corticosteroids - Used used in longterm control of Asthma.
2) Systemic Form - Used to control exacerbations and manage persistent asthma.
What types of medications are used in the longterm treatment of Asthma?
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
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
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)
Name the 3 types of Bronchodilators that are great for bronchospasms and acute Asthmatic attacks.
1) B2-Adrenergic Agonists
2) Methylxanthines (i.e., Theophyline)
3) Anticholinergics
Which class of asthmatic drug is most effective if used 10-20 mins before exercise, as a prophylactic for exercise induced asthma attacks?
Mast Cell Stabalizers
What is is a major Nursing Consideration when administering Methylxanthines (i.e., Theophyline)?
It has a very narrow therapeutic range. The margin of safety is small.
What are the Adverse Effects of Theophyline?
1) Anorexia
2) Nausea and Vomiting
3) Headache
4) Restlessness
5) Tachycardia & Arrhythmias
6) Seizures
What are the Adverse Effects of B2-Adrenergics (i.e., Albuterol)?
1) ⬆ Pulse rate
2) Nervousness
3) Restlessness
4) Jitters and tremors
What is the most common side effect of Anticholinergics (i.e., Ipratropium)?
Dry Mouth
Describe the “Green Zone” of Asthmatic management
1) 80 to 100% of personal best of PEFR
2) No symptoms
3) Can do ADLs and sleep without SxS
Describe the “Yellow Zone” of Asthmatic management
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
Describe the “Red Zone” of Asthmatic management
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
What is the narrowest portion of the airway in children under 8 years?
Cricoid Cartilage (which is why they may not need a cuff on an ET tube)
How is Bronchiolitis most commonly diagnosed?
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
What are the advantages of a fever?
1) Inhibits viral growth
2) ⬆ bactericidal activity
3) ⬆ Rest
What are the disadvantages to a fever?
1) Dehydration due to anorexia and fluid loss
2) ⬆ Metabolic Rate (⬆ O2 and Caloric demand)
3) Discomfort leading to lethargy
What level of temperature indicates febrile episode is serious and what should be done?
104 to 105 degrees. Call healthcare worker immediately!
What duration of fever indicates the febrile episode is serious?
1) > 24 hrs without probable cause
2) > 72 hrs
3) If fever disappears for 24 hrs and then returns
List three underlying factors for serious infection
1) HIV
2) Sickle Cell Anemia
3) Immunosuppressed Child
List the differences in the Upper Airway Anatomy and Physiology of a child as opposed to an adult
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.
List the differences in the Lower Airway Anatomy and Physiology of a child as opposed to an adult
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
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
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.
Lost the clinical manifestations of respiratory distress in infants and children.
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
(T/F) Croup (LTB) tend to reoccur but kids eventually outgrow it.
True
Discuss the differences between Epiglottitis and Croup (LTB)
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.
Describe the genetic potential of the possible offspring of parents who are both carries of the CF gene.
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
Why is a humidified atmosphere recommended for a child with an URI?
It is soothing to inflamed mucous membrane
Asthma is now classified into four categories: Mild Intermittent, Mild Persistent, Moderate Persistent, Severe Persistent. What clinical features are used to differentiate these categories?
1) Lung Function
2) Frequency of Symptoms
3) Frequency and severity of exacerbations
What is the difference between a tonsillectomy and an Adenoidectomy?
1) Tonsillectomy - DC palatine tonsils
2) Adenoidectomy - DC pharyngeal tonsils
A child with acute streptococcal pharyngitis is treated with antibiotics to prevent which two problems?
1) Rheumatic fever
2) Glomerulonephritis
