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Peds > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Ipratropium (Atrovent)

A

bronchodilator used to control symptoms of asthma, chronic bronchitis, and emphysema

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2
Q

Albuterol (Proventil)

A

bronchodilator for asthma

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3
Q

Montelukast( Singulair)

A

leukotriene receptor antagonist. Prevents asthma attacks

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4
Q

Magnesium Sulfate

A

bronchodilator used to relieve shortness of breath, for flare-ups of asthma

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5
Q

Pancrelipase (Creon)

A

Used for children with cystic fibrosis

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6
Q

Tobramycin

A

antibiotics that are given aerosolized for cystic fibrosis

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7
Q

Dornase Alfa (Pulmozyme)

A

Cystic fibrosis medication; medication for the management of respiratory and gastrointestinal effects of CF

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8
Q

Corticosteroids

A

Long term management for asthma. First line for management of nephrotic syndrome.

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9
Q

Ibuprofen

A

Common painkiller used to treat cold symptoms or toothache

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10
Q

Dexamethasone (Decatron)

A

Corticosteroid used to treat acute laryngotracheobronchitis

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11
Q

Palivizumab (synagis)

A

Given IM for prevention of RSV for chronically ill infants and preemies

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12
Q

DTaP

A

Given to prevent pertussis at 2,4,6,15 to 18 months, 4-6 years and TdaP given at 13-18 year; every 10 years

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13
Q

Meningococcal Conjugate MCV4

A

Protects against meningitis. Given to preteens 11-13 years old.

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14
Q

ASO Titers

A

a blood test to measure antibodies against streptolycin

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15
Q

Serum Osmolality

A

The concentration of dissolved solutes (NA+ and others) in your serum

  • main contributor is Sodium (Na+)
  • Second most important is Glucose

High osmolality= more particles in your serum (sodium high)

Low osmolality= particles are more dilute (less Na+)

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16
Q

Urine Specific Gravity

A

Urine specific gravity is a laboratory test that shows the concentration of all chemical particles in the urine.

-The normal range for urine specific gravity is 1.005 to 1.030.

Low specific gravity suggests that urine is too diluted. The person may be drinking too much fluid or have a condition that makes them thirsty.

High specific gravity suggests urine is too concentrated indicating dehydration

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17
Q

Physiologic and Developmental causes for increased risk in infants

A
  • Higher % of total body foudi
  • Immature renal system
  • Higher % of ECF
  • Higher Metabolic Rate
  • Greater Body Surface Area
  • Unable to communicate Thirst
  • Immature Gastrointestinal system
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18
Q

Earliest Signs of Dehydration and most reliable signs of Dehydration

A

Earliest Sign: Tachycardia
Worst Signs: Hypotension
Best Way: Weight (weigh every single day at the same time using same scale)

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19
Q

Stable Patient Moderently dehydrated (bolus)- RAPID Neg

A

Bolus over 5-20 min

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20
Q

Unstable Patient- Severely Dehydration (RAPID POSITIVE)

A

Bolus over 5-10 min.
Do NOT give K+ unless patient is stable. If no peeing potassium just builds up. If Cardiac issues: 5-10 ml/kg over 10-20 min)

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21
Q

IV Maintenance Fluids

A

1st 10 kg of weight: # of kg x 100 mL
Next 10 kg of weight: # of kg x 50 mL
Leftover kg of Weight: # of kg x 20 mL

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22
Q

RAPID

A 
R: high HR
A: altered color
P: pee nonexistent
I: Inability to interact
D: decreased BP
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23
Q

Moderately Dehydrated

A 
Weight: Infants: 6-9%
              Children: 6-8%
Pulse: Mildly increased
RR: slight tachypnea
Blood Pressure: Normal to orthostatic less than 10 mm HG change
Anterior Fontanel: Normal to sunken
Skin: Cap Refill 2-4 seconds / low turgor
Urine: Oliguria
Behavior: Irritable and thirsty
Mucous Membranes: Dry
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24
Q

Severe Dehydration

A 
Weight Infants: > or equal to 10%
Weight Children: 10%
Pulse: Very increased
RR: Hyperpnea (deep/rapid)
BP: Orthostatic to shock
Anterior Fontanel: Sunken
Skin: Refill > 4 seconds; Skin tenting, cool, mottled
Urine: Oliguria to Anuria
Behavior: Hyperirritable to lethargic
Mucous Membranes: Parched
25
Q

Isotonic Dehydration: most common

Serum Sodium/ Osmolality and Symptoms

A

Sodium Loss= Water loss from ECF
Serum Sodium: no change
Serum Osmolality: no change
Symptoms: dry skin/mucous membranes, decreased skin turgor, orthostatic hypotension, thirsty, dizzy, constipated, decreased urine volume, decreased tears

26
Q

Hypotonic Dehydration: most common

Serum Sodium/ Osmolality and Symptoms

A

Serum Sodium: Low ( < 130)
Serum Osmolality: Low
Children’s symptoms are more severe as they have more water than adults
Symptoms: Dry skin/mucus membranes, Lower skin turgor, mental status abnormalities, shock confusion, lower bP, lower Cap refill

27
Q

Hypertonic Dehydration: most common

Serum Sodium/ Osmolality and Symptoms

A 
More water than sodium loss
Serum Sodium is HIGH: > 150
Serum Osmolality is HIGH
Water moves to ECF: cells shrink
Symptoms: Altered mental status, low kin turgor, HR Up and BP low, lack of tears Excessive diarrhea, too many electrolytes, too much sodium. MOST DANGEROUS. Potential for cerebral water intoxication.
28
Q

Calculate Normal Urine Output

A

Infant (up to 3)- 1.5 min-2mL/kg/hr

Children and Adolescents- 1 ML/kg/hr

29
Q

Fluids used for oral rehydration:

A

Pedialyte; infalyte, rehydralyte, can add 1 tsp of unsweetened Kool-Aid to each 60-90 Ml; breast milk formula

DO NOT USE: soft drinks, fruit juice, sport drinks broth, plain water

30
Q

Mild Dehydration: Signs and Rehydration Therapy

A

5-6%
-Increased thirst, normal to slightly dry mucous membranes
ORS 50 ml/kg- within 4 hours

31
Q

Moderate Dehydration: Signs and Symptoms and Rehydration Therapy

A

7-9%
-loss of skin turgor, dry mucous membranes, sunken fontanel
ORS 100 ml/kg within 4 hours

32
Q

Severe Dehydration Signs and Symptoms and Rehydration Therapy

A

> 9%

  • moderate dehydration signs + rapid thready pulse, cyanosis, tachypnea, lethargy or coma
  • IV fluids 20ml/kg over 5-10 minutes until pulse and mental status return to normal
33
Q

Acute Glomerulonephritis

A

Immune Complex Disease exposed to something that triggered something. Occurs after we are exposed to streptococci infection. 10-21 days later our immune system does not shut off. Strep Test negative; but ASO titer HIGH

34
Q

Nephrotic Syndrome

A

Allows Protein into the urine. Massive Proteinuria (2-3+ protein in the urine).
-hypoalbuminemia: we lose protein (albumin) in urine
-Edema
Primary Disease: Ideopathic Nephrosis
Secondary Disease: glomerular damage
Congenital: Autosomal recessive disorder
Drops our BP and reduces vascular fluid volume leading to hypovolemia

35
Q

Symptoms of Nephrotic Syndrome (SOLEY)

A 
HyPOtension
LFT and CMP and Lip Panel Lab
Pale Frothy Urin
HyPERlipidemia
HyPOalbuminemia (protein)
Facial Edema
Ascites
Cause: Bac or Viral Infection
HyPOvolemia
Congenital
High Protein in Urine 2+
Corticosteroids
Increased risk of infection
Weight Gain
36
Q

Symptoms of AGN (SOLELY)

A 
Urine: cloudy, smoky grown (due to RBC's_
HypERtension
HypERvolemia
autoimmune
HyPOnatremia
BUN and Creatinine RAISED
History of Strep
Periorbital edmal 
Headaches due to HTN
CBC lab

Good progjosis

37
Q

Nephrotic Interventions and Education

A

-Reduce excretion of protein, edema, prevent infection
-Potential dietary restriction (don’t do with kids), diuretics, 25% albumin infusions
-Corticosteroids
-relapses can be triggered by allergies or immunizations
-Complications: infection, thromboembolism, hypovolemia
-Daily weight/ abdominal girth, assess edema, address loss of appetite
Creatinine: < 1 ok Greater than 1 TROUBLE

38
Q

AGN interventions and education

A
  • can be treated at home
  • requires hospitalization: oliguria, HTN, gross hematuria, sig edema
  • Daily Weights, Strict I &O, vitals
  • Treatment: dietary restrictions, monitor electrolytes, may need antibiotics
39
Q

Pediatric Diff of Respiratory System

A
  • smaller nasopharynx (can occlude)
  • Lymph tissue (tonsils and adenoids grow rapid in childhood
  • Smaller Nares (can occlude)
  • Small oral cavity and large tongue
  • long floppy epiglottis vulnerable to swelling
  • larynx and glottis are higher in neck can cause aspiration
  • Thyroid, cricoid, and tracheal cartilages are immature and can collapse if neck flexed
  • Fewer muscles are functional in airway and is less able to compensate for edema or trauma
  • Large amounts of soft tissue and loosely anchored mucous membranes line airway and increase risk of edema or obstruction
  • RR higher at baseline. We can only breath hard for so long and can cause Cardiac arrest
  • sleep more than adults reduces functional capacity (air left in lung)
  • increased potential for atelectasis (lung collapse)
  • Peep: positive end expiratory pressure: the risidual pressure that keep them open just a smidge after exhalation
  • fewer and smaller alveoli; walls of alveoli are thicker
  • premature cilia (cilia move mucus out of nose and trachea)
40
Q

Newborn airway size

A

4mm

41
Q

Retraction locations

A

Suprasternal: above sternum
Intercostal: between ribs
Substernal: below sternum
Subcostal: below ribs

42
Q

Cardinal Sign of Respiratory Distress

A

Restlessness, tachycardia, diaphoresis, Tachypnea

43
Q

Respiratory Arrest

A

complete absence of respirations

44
Q

Cynosis located where?

A

Circumoral, chest and umbilicus

45
Q

Grunting:

A

When patient takes a deep breath in and upon expiratory grunting sounds; the child is trying to create peep in their alveoli

46
Q

Signs and Symptoms of Asthma attack

A

Expiratory wheezing, breathlessness, chest tightness, cough (tend to present at night or after recess)

47
Q

Peak Flow Meter

A

Measure how fast air can be expelled from lungs
3 zones:
Green (under control)
Yellow ( asthma is not well controlled)
Red: severe narrowing of airway may be occurring

48
Q

Treatment of Asthma

A

Control Allergins and remove such as carpet and humidifiers, air conditioners

Quick relief:

Beta Adrenergic Agonists: albuterol
Anticholinergics: (higher side effects): Atrovent

Number 1 trigger: second-hand smoke!

49
Q

Cystic Fibrosis

A

Due to defective/mutated gene on the arm of chromosome seven. This gene carries the code for a protein known as CFTR

Lungs: mucus becomes viscous, thick, clogs airways

50
Q

Cystic Fibrosis Treatment

A

-Airway clearance therapies, continuous postural therapy, percussion and postural drainage, high frequency chest compressions, exercise, huffing

  • Medication:
  • maintenance meds (aerosolized medications such as bronchodilators) GIVE FIRST
  • Antibiotics (for respiratroy infections: Tobramycin (usually aerosolized)

02 CAUTIOUSLY; due to chronic CO2 retention, can cause bone marrow depression

51
Q

Cystic Fibrosis related to diabetes

A

Effects on pancreas of abnormal mucus secretion and obstruction: pancreatic insufficiency due to blockage of pancreatic ducts due to mucus

  • lack of pancreatic enzymes and treated with (CREON): helps them to absorb the fat
  • CF related to diabetes (CFRD): presents challenges with diet, additional insult to respiratory, 50% of those over 30 have CFRD, BOTH INSULIN RESISTANT AND DEFICIENT
52
Q

Nursing Education

A

Monitor patient tolerance to procedures, encourage medication compliance in child AND adult

Diet: need good fat and high protein

Patients Self-Image

53
Q

Creon

A

Adjust based on how many stools child had.
Creon helps absorb fat
Supplement the diet with fat soluble vitamins (A, D, E,K) give with enzymes and a high fat meal to help the body absorb those vitamins

54
Q

RSV

A

Caused by a virus at bronchiolar level ( a LOWER) respiratory inflammation of lungs. Infection causes cells to die and those cells fuse together to create a mass of dead cells

55
Q

RSV Symptoms

A

Rhinorrhea, low grade fever (usually first), then coughing, wheezing, retractions, tachypnea; most commonly preset with apnea.

56
Q

RSV Risk Factors:

A

Males, birth within 6 months of RSV season, multiple births, premature babies, non-breastfed infants, young mothers, mothers who smoke, babies in crowded living conditions

57
Q

RSV Vaccine:

A

Palivizumab (Synagis) : given to chronically ill infants and premature babies IM once a month

58
Q

Epiglottitis

A

Obstructive Inflammatory process; supraglottic obstruction. MEDICAL EMERGENCY

Peds (3 decks)

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