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PEDS > Exam 2 !! > Flashcards

Exam 2 !! Flashcards

1
Q

signs and symptoms of kawaski disease?

A

High fever, red eyes, ring around iris, Strawberry tongue, rash (desquamates – skin flakes off)
Serious = MI
Dilation of coronary artery leads to aneurysm (“Giant”)

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1
Q

RWhat is treatment for Kawaski disease?

A

High dose IVIG and salicylate therapy
-suppport kid and families, grumpy kid

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1
Q

What is coarctation of the aorta?

A

narrowing of aorta, usually distal to ascending vessels

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2
Q

S/Sx of coarctation of the aorta?

A

Markedly higher blood pressures and pulses in the upper extremities as compared to those in the lower extremities

If left uncorrected, older children will have recurrent episodes of epistaxis and complaints of leg cramps or leg pain, especially during periods of activity

Surgical repair

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3
Q

Signs and symptoms of hypercyanotic spells?

A

Period of uncontrollable crying / irritability.
Hyperpnoea (rapid, deep respiration)
Worsening hypoxia with cyanosis/pallor.
Decreased intensity of heart murmur.
Limpness, loss of consciousness or convulsions.
Death (in severe or untreated episodes)
-becomes cyanotic when eating, crying, or playing with other children when older

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4
Q

What are nursing interventions post cath?

A

Stop bleeding
Immobilize extremity
pulses (should increase grad)
VS
Neuro checks of extremity
Dressing if bleeding pressure 1” above site
Bed rest 4-6 hours

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5
Q

History of endocarditis?

A

-deformed surfaces
-old rheumatic fever
-birth defects
-prosthetic valves
-needle drug abuse
-give antibiotics before dentistry/procedures to prevent

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6
Q

S/Sx of endocarditis?

A

Low grade, intermittent fever, malaise, arthralgias (joint pain), new murmur, chorea, rash, polyarthritis
Increased ESR, vegetation on ECHO,
Tx: Penicillin

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6
Q

When should digoxin be held?

A

Hold if HR < 90 in small child
Hold if HR < 70 in older child

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7
Q

What are signs of digoxin toxicity?

A

Bradycardia, dysrhythmias
Anorexia, N/V
If child vomits dose, do not give another dose
Instead give the next dose as scheduled
Visual disturbances

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8
Q

CHD lab results?

A
  • CXR - tells size and position of heart
  • ECG - leads / holter
  • ECHO
  • Cardiac Catheterization
  • Exercise Stress Test
  • MRI
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9
Q

What is tetralogy of fallot?m

A

most common decreased pulmonary flow defect

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10
Q

S/Sx of ToF?

A
  • TET spells, child becomes cyanotic especially when crying and while eating (infancy), and during play (older children)
  • Polycythemia, greater than normal number of circulating red blood cells
  • Clubbing of the fingers may develop due to chronic hypoxia
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11
Q

Treatment of ToF?

A
  • Surgical repair
  • Cyanosis that develops during a tet spell can be relieved when the legs and knees are bent, resulting in reduced blood flow to the lower body and improved blood flow to the vital organs
  • Infants should be placed in a knee-chest position
  • If defect has not been repaired, older children usually squat instinctively
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12
Q

What is tricuspid atresia?

A
  • A closed tricuspid valve after birth
  • No movement of blood from the right atrium to the right ventricle
  • Incompatible with life unless another defect is present that allows mixing of the blood.
  • Rapid and sustained cyanosis
  • Immediate surgical repair
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13
Q

rheumatic fever history?

A

untreated strep throat or scarlet fever

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14
Q

Blood flow through heart?

A

BODY > IVC: or HEAD > SVC >
> Right Atrium (RA) > Tricuspid Valve (TV)
> Right Ventricle (RV) > Pulmonic Valve (PA) > Pulmonary Artery (PA) > LUNGS
LUNGS > Pulmonary Veins (PV) > Left Atrium (LA) > Mitral Valve (MV) > Left Ventricle (LV) > Aortic Valve (AV) > Aorta > BODY

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15
Q

What is treatment for SIADH?

A

Fluid restriction- ¼­-½ maintenance intake
Diuretics
Declomycin
NA supplements

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16
Q

Nursing considerations for SIADH?

A

Accurate I&O
Daily weights
Monitor for fluid overload
Seizure precautions
neuro checks

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17
Q

What is normal A1c?

A

5.6 or less

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18
Q

A1c for pre-diabetes?

A

5.7-6.4

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19
Q

a1c for diabetes?

A

6.5 or greater

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20
Q

What is the first sign of diabetes insipidus?

A

bed wetting of potty-trained child

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21
Q

S/Sx of diabetic ketoacidosis?

A

vomiting, excessive thirst, dehydration, urinating more often than usual, kussumaul respirations, fruitty smelling breath, stomach pain/nausea, drowsiness, weight loss, increased heart rate

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22
Q

S/Sx of graves disease?

A

ophthalmopathy
A fine tremor of the hands or fingers.
Heat sensitivity
Weight loss
goiter
Frequent bowel movements.
-low tsh, increased t3 and t4

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23
Q

What is priority treatment for status epilecticus?

A

Airway-Oxygen-Suction
IV medications
Thermoregulation

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24
Q

What are risk factors for seizures?

A

Acute symptomatic: head trauma or meningitis
Remote symptomatic: cause identifiable injury
- fever
- low sodium
- trauma
- brain bleed / tumor

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25
Q

What are early signs of increased ICP?

A

Headaches
Diplopia (blurred vision)
Nausea & Vomiting
Vertigo
Seizures
increased sleeping
pupillary response alteration
decreased sensory response

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26
Q

What are signs of increased ICP in infants?

A

Wide sutures
Tense or bulging Fontanels
High pitch cry
Setting-sun sign

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27
Q

What are late signs of increased ICP?

A

Bradycardia
decreased LOC
Decreased motor response
Diminished response to pain
Cushing reflex (slow pulse and increased BP, irregular respirations)

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28
Q

What are considerations in dear-drowning experiences?

A

Outcome is impacted by length of submersion & dive reflex: cold water: shunt blood from periphery
-neuron irreversible damage happens after 4-6 mins in water (hypoxia)
-aspiration and hypothermia also important to watch out for

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29
Q

Priority tx for botulism?

A

antitoxin
Hx PE, isolation of organism
Botulisim IVIG -
ICU
Monitor muscle impairment etc
FEB

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30
Q

What are assessment/development findings in cerebral palsy?

A

Persistent reflexes
Delayed developmental milestones
Apparent early preference for one hand
Poor suck, tongue thrust
Spasticity “difficulty with diapering”
Involuntary movements
Scissoring of legs
Seizures

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31
Q

Maternal factors with neural tube defects?

A

-folate deficiency (vit b12)
- certainanti-seizure medications
-diabetes
-obesity
-opioid use during pregnancy

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32
Q

What is the blood test for NTD?

A

maternal AFP (alpha fetoprotein level)

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33
Q

Signs of Duchene muscle dystrophy?

A

gowers sign, waddling gait, clumsiness, muscle weakness

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34
Q

Guillian barre symptoms?

A

-paresthesias in hands and feet
-symmetrical muscle weakness usually beginning in legs and then ascends
-severe resp muscle weakness usually needing support
-absent or depressed deep tendon reflexes

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35
Q

What are the 5 ps of ischemia in casting?

A

-pain
-pallor
-pulselessness
-paresthesia
-paralysis

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36
Q

What are reasons for traction?

A

Resist the response of the muscle
Immobilization
Alignment
Prevent contracture

37
Q

Osteogenesis imperfecta clinical signs?

A

fragile bones, deformity, fractures, blue sclerae, hearing loss, hypoplastic discolored teeth

38
Q

How is bryants traction helpful?

A

the child’s body and the weights are used as tension to keep the end of the femur (the large bone that goes from the knee to the hip) in the hip socket.

39
Q

What is the gold standard for scoliosis?

A

bracing

40
Q

What is care preop for myelomeningocele?

A

Care must be taken to protect the exposed meninges in the spinal lesion until surgical closure can be performed. The infant must be nursed prone and not dressed to prevent injury to the lesion. Use an incubator or radiant warmer.
-lay on side and cover w saline soaked gauze

41
Q

What is the most common fracture site in children?

A

growth plate

42
Q

treatment for sickle cell anemia?

A

Hydroxyurea
Penicillin
Oxygen- only when hypoxic!
Rest
Pain medication
Hydration
Electrolytes
Blood transfusion
ABX
Splenectomy

43
Q

Diagnosis of sickle cell anemia?

A

Newborn screening
Sickledex heel/finger stick
Hemoglobin electrophoresis

44
Q

How to diagnose anemia?

A

Physical exam
Fatigue
Decreased energy
Pallor
CBC

45
Q

Treatment for anemia?

A

Treat underlying cause
Replace deficiency
RBC transfusion and fluids
O2 and bed rest

46
Q

What is beta thalassemia?

A

Microcytic Anemia Non-Responsive To Iron Supplementation
Associated With People Of Mediterranean Origin

47
Q

CMs of beta thalassemia?

A

Small stature
Delayed sexual maturation
Bronzed, freckled complexion
Bone changes (older children):
Enlarged head
Prominent malar eminences
Flat or depressed bridge of nose
Enlarged maxilla
Protrusion of the lip and upper central incisors and eventual malocclusion
Generalized osteoporosis

48
Q

What is diagnosis of beta thassalemia?

A

hgb electrophoresis

49
Q

Treatment of beta thassalemia?

A

Blood transfusions
Chelation therapy
Splenectomy- when indicated

50
Q

What is the most common form of childhood cancer?

A

leukemia

51
Q

Diagnosuis of leukemia?

A

H&P
Labs
Bone marrow biopsy
Blood smear
Chest x-ray
Lumbar puncture

51
Q

CMs of leukemia?

A

Pallor
Listless
Irritable
Febrile
Weight loss
Bone/joint pain
Petechiae
Bruising
Anemia
Bleeding

51
Q

Treatment of leukemia?

A

Remission induction
Consolidation/Intensification
Maintenance
Chemotherapy
Radiation therapy
Chemotherapy with stem cell transplant
Targeted therapy

52
Q

Hodgkin lymphoma CMs?

A

Painless enlarged lymph nodes
Depends on the location of involvement
Systemic symptoms
Low-grade fever
Anorexia
Nausea
Weight loss
Night sweats
Pruritus

53
Q

Risk factors for NHL?

A

EBV infection
Inherited or acquired immunodeficiency
DNA repair syndromes
Previous cancer

53
Q

CMs of NHL?

A

Painless enlarged lymph nodes
Depends on the location of involvement
Systemic symptoms
Low-grade fever
Anorexia
Nausea
Weight loss
Night sweats
Pruritus

54
Q

What are the decreased pulmonary blood flow defects?

A
  1. tetralogy of fallot
  2. tricuspid atresia
    -blood bypasses pulm system
55
Q

What are the increased pulm blood flow defects?

A

ASD, VSD, PDSA, AV canal

56
Q

Patent Ductus arteriosis important shit?

A

-fetal duct fails to close between pulm artery and aorta
-may close on its own or indomethacin may be used to medically close

57
Q

What is ventricular septal defect?

A

-most common congenital heart defect
-hole between ventricles
-may close on own, indomethacin if not

58
Q

What defects does tetralogy of fallot involve ?

A

VSD, right ventricular hypertrophy, pulm stenosis, overriding aorta

59
Q

CMs of hyperkalemia?

A

Muscle weakness, twitching, bradycardia, V Fib, oliguria, apnea

60
Q

CMs of hypokalemia?

A

Muscle weakness
Hypotension,
Dysrthymias (tachy or bradycardia)
Irritability
Drowsiness

61
Q

Tx of rheumatic fever?

A

Prevention of strep
cardiac damage prevention
recurrence prevention
Pen G

62
Q

Repair for aortic and pulmonic stenosis?

A

balloon angioplasty or surgical repair

63
Q

Heart pressures and blood flow?

A

Pressure on the right side of the heart is lower than that on the left
Blood flow from high pressure to low
Bigger the hole (defect) more blood goes in that direction

64
Q

What kind of posturing is decorticate?

A

flexion

65
Q

What kind of posturing is decerebrate?

A

extension

66
Q

What vaccines can prevent bacterial meningitis?

A

Hib vaccine, group b streptococci

67
Q

What is kernigs sign?

A

Resistance to extension of the child’s leg from a flexed osition

68
Q

What is brudzinski sign?

A

Flexion of extremities occuring with deliberate flexion of the child’s neck

69
Q

What is nuchal rigidity?

A

inability to flex neck and place chin on chest

70
Q

What are the reflexes that can help diagnose bacterial meningitis?

A

Kernig sign, nuchal rigidity, brudzinski

71
Q

What is onset, peak, duration of rapid-acting insulin? (Novolog)

A

15 mins, 30-90 mins, 5 hrs

72
Q

O, P, D of short acting insulin? (Novolin R)

A

30, 2-4, 4-8

73
Q

What is O,P, D of intermediate insulin? (Novolin N)

A

2-6 hrs, 4-14, 14-20

74
Q

What is O,P, D of long-acting? (lantus)

A

6-14, none to very small peak at 10-16 20-24 hrs

75
Q

Nursing care of guillian barre syndrome?

A

-vent
-IVIG
-steroids, pain control
-plasmapheresis
-DVT prevention

76
Q

What are causes of botulism?

A

honey, corn syrup in infant
-improperly sterilized food

77
Q

Symptoms of botulism?

A

blurred vision, dizziness, vomiting, dysphagia, paralysis, dyspnea

78
Q

Tx of CHF?

A

-oxygen
-ace inhibitors, digoxin, diuretics

79
Q

What is therapeutic range of digoxin?

A

0.8-2.0

80
Q

How is SIADH diagnosed?

A

-sodium <120
-low serum osmolality
-elevated urine osmolality

81
Q

Reflexes that can indicate altered LOC?

A

-Absent corneal reflex & presence of tonic neck reflex-severe damage
-young infants: presence of Moro, tonic neck, and withdrawal reflexes
- Babinski: dorsiflexion of big toe and fanning of toes – should be absent after 1 yr or locomotion

82
Q

S/Sx of hydrocephalus?

A

-caused by arnold chiari syndrome
-signs: sunset signs, increased head circumference, high pitched cry, poor feeding if ICP too high
-surgical repair using shunt is fix, infection highest priority

83
Q

What is teaching for iron deficiency anemia medication?

A

-take with vitamin c
-do not take with milk products

84
Q

What are CMs of vaso-occlusive crisis?

A

-pain
-priapism
-acute chest sydrome
-stroke

85
Q

What is aplastic anemia?

A

rare and life-threatening bone marrow failure where formed elements of the blood are depressed

86
Q

S/Sx of aplastic anemia?

A

Overwhelming infection
Pallor and patchy brown or yellow skin
Weakness, fever, and dyspnea
Uncontrolled bleeding and ecchymosis

87
Q

Risk factors for vaso-occlusive crisis?

A

Cold climates, changes in altitude, and Infection

88
Q

S/Sx of tetanus?

A

-lockjaw
-painful muscular rigidity involving neck muscles

89
Q

Nursing care for tetanus?

A

-quiet environment
-sedatives
-pavulon
-F/E management
-OG feedings
-IV therapy

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