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peds > exam 2 > Flashcards

exam 2 Flashcards

1
Q

celiac

A

cannot tolerate gluten (wheat, barley, rye, oats). A protein that causes immune response
Four characteristics
Impaired fat absorption- steatorrhea
Impaired nutrient absorption
Behavioral changes
Crisis- diarrhea, vomiting

Use corn and rice based foods

Dx by blood work, then do upper GI

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2
Q

hepatitis in children

A

HEP A- fecal-oral. vaccine
Hep B- blood/ body fluids. vaccine

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3
Q

how do patients normally loose water

A

Skin/resp tract, evaporation, urine/stool

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4
Q

what causes increased fluid needs

A

Fever, vomiting, diarrhea, DKA, burns, shock, tachypnea, phototherapy

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5
Q

why do babys loose water fast

A

Kidneys aren’t very efficient. They have a greater body surface area but small body

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6
Q

how is the 4-2-1 rule calculated

A

normometabolic rate at rest

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7
Q

water and salt lost in equal amounts

A

isotonic
NS, LR

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7
Q

lose more electrolytes than water

A

hypotonic solution

from drinking fluids with no salt

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8
Q

lose more water than electrolyes

A

hypertonic solution

from not drinking enough water, meds

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9
Q

s/s of dehydration

A

could be mild to severe

Pulse and RR- normal/slight elevated/significantly elevated

Mucus mem- normal, dry, parched

Any tears?

Normal/irritable/lethargic

Slower cap refill

mild weight-loss 3-5%
moderate weight loss 6-9%
severe weight loss 10% or more

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10
Q

mild and moderate treatment of dehydration

A

oral rehydration

mild- 50mL/kg over 4 hours pedialyte
moderate- 100mL/kg of pedialyte

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11
Q

severe dehydration treatment

A

IVF
20mL/kg isotonic bolus

we never give a bolus of anything except isotonic

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12
Q

diarrhea most common causes

A

rotavirus
salmonella

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13
Q

what diet is constipation more likely in infants

A

formula fed

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14
Q

encorpesis

A

inappropriate passage of feces

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15
Q

hirschsprung disease

A

absent ganglioin cells in intestine, decreases the ability of internal sphincter to relax.

s/s constipation, FTT, ribbonlike stool, abd distention

dx by contrast xray

surgical repair to remove aganlionic portion

congenital, seen more in infant boys

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16
Q

forceful ejection of gastric contents

A

vomiting

different then spitting up or burping

use pedialyte, elevate HOB, withhold food

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16
Q

gastroesophageal reflux

A

return of gastric contents into esophagus

Seen with preemies bc the sphincter hasn’t formed yet. will spit up when they eat, may have FTT, arching back, pneumonia
other symptoms in children may be cough, stomach pain

Don’t lay flat after eating, especially head
Give meds 30 mins before
Thicken there formula
feed smaller amounts more often

possible surgery- nissen fund.

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17
Q

rickets

A

vitamin D deficiency

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18
Q

scurvy

A

vitamin C deficiency

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19
Q

adverse reaction without a immune response

A

intolerance

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20
Q

recurrent abdominal pain

A

3+ episodes abdominal pain over 3 months that impacts daily activities

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21
Q

acute appendicitis

A

most common peds emergency abdominal surgery

RLQ pain (mcburneys point), fever and vomiting come later, elevated WBC

dx by ultrasound and CT

if ruptured pain may subside, risk for peritonitis and sepsis

NPO, Abx before surgery

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22
Q

meckels diverticulum

A

Stomach tissue develops in colon, makes acid bc it thinks it’s the stomach, which causes a ulcer than bleeding

s/s- painless rectal bleeding, abdominal pain

surgical repair to remove diverticulum

more common in males, typically diagnosed by age 2

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23
Q

UC vs Chrohns

A

chrohns can be anywhere, UC is in one spot

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24
Q

IBD

A

chrohns and UC
inflammation causing ulceration

abdominal pain, bleeding, edema, diarrhea, weight loss

increases w stress

do endoscopy, colonoscopy, CT, US

help get right nutrition in, drug therapy, surgery if needed

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25
Q

peptic ulcer disease

A

most commonly caused by H pylori. can slo be caused by NSAIDs, stress, alcohol

s/s- dull stomach ache, n/v, bloating

dx by upper GI

pain management, meds

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26
Q

when to get surgery for cleft lip

A

2-3 months of age

Lips get repaired early bc of speech and feeding

baby may need restraints postop

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27
Q

when to get surgery for cleft palate

A

6-12 months
Palate cant be done until child has transition off a bottle because the roof of mouth has sutures, and suction can rip them out

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28
Q

who is cleft lip/palate more common in

A

native american populations

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29
Q

esophageal atresia

A

failure of esophagus to develop continuously, there is a gap

Food will come back up after first feed, aspiration. No food goes to belly, surgery needed

may have excessive saliva on day 1 bc it cant be swallowed since it has no where to go. choking may also be seen

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30
Q

tracheosophageal fistula

A

failure of the trachea to separate into a distinct structure. maintain patent airway

Some food will go to belly, some will go to lungs via fistula. surgery

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31
Q

what often accompanies tracheosophageal fistula

A

esophageal atresia

if you have one you likely have both, all food would go to lungs.
often caught with good prenatal care and can be fixed before we give first feeding

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32
Q

what do we want umbilical hernia to be

A

soft

these typically go away on own

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33
Q

hypertrophic pyloric stenosis

A

muscle arounds pylorus enlarges and thickens, narrows opening and leads to obstruction.

usually found within first few weeks of life

dx by ultrasound

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33
Q

hypertrophic pyloric stenosis s/s

A

olive size mass on palpation , projectile vomiting during/after eating, poor weight, dehydration,

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34
Q

hypertrophic pyloric stenosis care

A

rehydration comes first. do bolus then see if electrolytes needed

pyloromyotomy surgery after

post op- dont feed right away. go on feeding plan

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35
Q

pylorus

A

valve between end of stomach and start of small intestine

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36
Q

intrasusception

A

Telescoping of intestine. obstruction, Causes edema and stopping of blood flow. Could cause necrosis

s/s- loud crying, abdominal pain, red “currant jelly” stools, vomiting

DX- us, barium enema

treated -air enema then use contrast dye if that doesn’t work. if that doesn’t work surgery is needed. this problem may be reoccurring if not fixed by surgery.

prevent peritonitis

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37
Q

imperforate anus

A

no anal opening. surgical repair needed

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38
Q

GU assessment

A

potty trained? regression?
voiding quality, quantity, freq, urgency, pain
anorexia or weight loss
BP
labs
UA/urine culture

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39
Q

who are UTI mostly seen in

A

Seen in uncircumcised boys under 3 months

Seen in girls under 12 months and continued thru toddler hood

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40
Q

how many colonies/mL for UTI dx

A

50k

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41
Q

most important host factor in UTI

A

urinary stasis

bacteria can grow if bladder is retaining urine

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42
Q

urine collection methods for UTI

A

Urinary Cath most accurate for under age 2, clean catch for kids potty trained

Have girls sit backward on toilet to help with clean catch
For uncircumcised boys, clean the meatus and retract foreskin

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43
Q

urine collection bag

A

sticks to patients genitalia region

Less invasive, not completely sterile, can leak

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44
Q

predicative test of UTI

A

Leukocytes- WBC (infection)
nitrates- bacteria

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45
Q

uti education and meds

A

meds- penicillin, bactrim, cephalosporins

wipe front to back, no bubble baths, avoid tight clothes, complete emptying, avoid caffeine, void 15-20 mins after intercourse, fluid intake.

irritated urethra makes them more prone to infection

46
Q

Vesicouretral reflux (VUR)

A

abnormal flow of urine from bladder to kidneys.
increases risk of UTIs

could be primary or secondary
treated w prophylaxis abx or surgery. goal is not to damage kidney

dx by UA, k&b, US, VCUB

could be grade 1 (mildest) to grade 5 (severe)

If left untreated can lead to bed wetting, constipation, loss of control, high BP, proteinuria, kidney failure

47
Q

VCUB for VUR

A

X-rays and contrast dye of bladder when full to look for abnormalities. Use catheter to insert dye, bladder will get Xray in multiple positions, catheter will be removed, child will void and they will take x-rays to look at function of how bladder is being emptied
this will be graded into terms of reflex.

48
Q

primary vs secondary VUR

A

Primary reflex- born w a defecting valve. Can be outgrown
Secondary- reflex urinary tract malfunction, like high pressure in bladder

49
Q

Enuresis (bed wetting)

A

continued incontinence of urine past potty training

Dx at least 2x week for 3 months after age 5

Rule out other causes like diabetes, sickle cell, UTI, spina bififa, diuretic, emotional factor

Most common in boys and those who sleep deep

meds to help- antidiuretics, tricyclic antidepressants, antispasmodics, desmopressin nasal spray

do a bathroom schedule

50
Q

primary vs secondary enuresis

A

Primary- never achieved complete control
Secondary- the child achieved control but lost it

51
Q

Protrusion of abdominal contents through inguinal canal into scrotum

A

inguinal hernia

52
Q

presence of peritoneal fluid in the scrotum

A

hydrocele

53
Q

narrowing or stenosis of the preputial opening of the foreskin that prevents retraction of the foreskin over the glans penis

A

phimosis

54
Q

Ventral curvature of penis, often associated with hypospadias

A

chordee

55
Q

Failure of testes to descend

A

cryptorchidism

56
Q

is an exposed or open dorsal urethra

A

epispadias

57
Q

hypospadias

A

urethra meatus is located on the ventral side along the shaft
associated with chordee

Surgical repair. Don’t circumcise these children at birth bc they could use the skin later
Avoided until age 6-12 months
Make sure they can void while they are standing

58
Q

exstrophy

A

bladder is external and inside out. this is due to failure of abdominal wall and structures to fuse in utero.
surgery usually at first 72 hours off life

Bladder doesn’t store urine, urine produced by kidneys will drain into a open area

Bladder needs to cover with film to prevent urine seepage and skin irritation. These children will need sponge baths and monitored output.
Goal Is to avoid UTI, regain renal function, gain urine control

may not ever be fully continent and may to to self cath

59
Q

ambiguous genitalia

A

mutations in genes early on will lead to various disorders of sex development, making it hard to tell if person is boy/girl

congenital adrenal hyperplasia is most common cause.

surgery based on type/severity

*Psychosocial emergency for family

60
Q

nephrotic syndrome

A

increases glomerular permeability to proteins (especially albumin)

protein loss causes decreased osmotic pressure, causing fluid escape=edema.
will see massive proteinuria, albuminuria. urine will be dark/frothy/ Pt may also have weight gain, fatigue

low albumin in blood, we need to replace this, use steroids to suppress immune system, FLUID RESTRICTION

common in ages 2-7

61
Q

what causes nephrotic syndrome

A

unknown, associated w immunologic causes like lupus, diabetes, infection, allergies

62
Q

nursing considerations for nephrotic syndrome

A

strict i&o
daily weight
assess edema
check f&e
turn frequently. avoid IM injections
high calorie/HIGH protein
LOW salt intake and fluid restriction
corticosteroids
25% albumin admin

63
Q

glomernephritis

A

Involves glomeruli- supply blood flow to nephrons, which filter urine. These become inflamed and impair the kidney to do the filtering

occurs after STREP

hematuria, proteinuria, decreased output, edema

do throat culture, blood and urine test

treatment is supportive. need hospitalization for bad BP and UO

RESTRICT sodium and fluids
high calorie, LOW protein
strict I&O
may need diuretics, antihyp
last 3 weeks. most common in ages 4-7

64
Q

Glomernephritis “HADSTREP”

A

Htn
ASO titer positive
Decreased GFR
Swelling of face worse in AM
Tea colored urine
Recent strep infection
Elevated BUN/creatine
proteinuria

65
Q

hemolytic uremic syndrome

A

child ingests e. coli
endothelial lining of glomerular arterioles become swollen and occluded w platelets, RBC bc damages when they move through, spleen takes them out causing anemia. Kidneys are blocked and cant do there jobs

starts w GI/resp symptoms. later bruising, pallor, hematuria, albumin in urine
can cause hemolytic anemia, thrombocytopenia, acute renal failure.

treatment is supportive, anticipate dialysis

FLUID restriction

66
Q

common ways children ingest e coli

A

petting zoos, unpasteurized milk, undercooked meat, contaminated water

67
Q

acute kidney injury (AKI)

A

kidneys suddenly do not regulate volume/composition of urine.
usually associated with HUS and glomerulonephritis.

oliguria, low UO, n/v, azotemia, htn, edema
BUN/creatine increases, GFR decreases

often revirsable.
MONITOR NEURO STATIS, sodium drops, toxic symptoms build up. Increase seizure risk

68
Q

AKI nursing considerations

A

rule our urinary retention first

strict i&o, monitor electrolytes
control BP, maintain fluid balance and calories

complications are hyperkalemia, htn, anemia, seizures

69
Q

when do we give transfusion for hgb in AKI pts

A

hgb <6

70
Q

chronic kidney disease

A

diseased kidneys no longer maintain normal structures of bodily fluids. progressive deterioration over months/years

anticipate growth issues
Pallor, fatigue, decreased appetite, headache, nausea, weight loss, facial edema, bruised skin, elevated BP

promote renal function, maintain f&e, treat complications

Dialysis or transplant needed

71
Q

hemodialysis vs peritoneal

A

hemo removes blood thru semipermeable membrane circulated outside body

peritoneal removes toxins via the peritoneal membrane

72
Q

most common issue w renal transplant

A

rejection. if living donor rejected than a cadaver is used

73
Q

what do pts need to be on indefinitely after transplant

A

immunosupressants
lots of side effects- htn, obesity, growth retardation, Cushing syndrome, infection risk

74
Q

long term effects related to pain

A

physiological, psychosocial, and behavioral consequences

remember that people deal with pain differently

75
Q

FLACC scale

A

used for pain in ages from birth yo 7 years

the most common behavioral pain scale

looks at face expressions, legs, activity, cry, consolability

0 is the best score, 10 is the worst

76
Q

wong baker faces pain scale

A

for ages 4-8

6 faces to choose from

77
Q

at what age can you use numerical pain scale

A

8 and up

78
Q

revised flacc scale

A

for children with cognitive impairments like cerebral palsy

looks at behaviors such as tenseness

79
Q

ibuprofen dose

A

10 mg/kg/dose

given every 6 hours

monitor for GI bleed

80
Q

ketorolac (toradol) dose

A

1.5 mg/kg/dose

monitor for GI bleed

81
Q

tylenol dose

A

10-15 mg/kg/dose

given every 4-6 hours

monitor for liver toxicity

82
Q

morphine dose

A

0.05 to 0.1 mg/kg/dose IV

83
Q

pros of dilaudid (hydropmorphone HCL)

A

Longer lasting, less side effects than morphine

84
Q

what drug is 100x stronger than morphine

A

sublimaze (fentanyl citrate)

85
Q

diazepam (valium)

A

for muscle spasms and anxiety

not compatible with NS, mix w sterlie water

86
Q

midazolam (versed)

A

sedates them and chills them out

has retrograde amnesia effect!

87
Q

morphine side effects to monitor for

A

decreased RR rate
constipation
pruritis
hallucinations
urinary rentention

88
Q

at what age can a child use PCA

A

5/6

could be basal rate (continuous) or bolus

set to avoid OD

89
Q

epidural analgesia

A

at lumbar level

common meds- morphine, fentanyl, hydromorphone

local anesthetic added- bupivacaine or ropivacaine

***keep dressing dry and clean. infection in this region could cause meningitis

90
Q

LMX4 4% lidocaine

A

transdermal analgesia for needle stick pocks

leave on for 30 mins before inserting IV

91
Q

EMLA- lidocaine and prilocaine

A

transdermal analgesia for IV sticks

leave on for 60 mins before stick

92
Q

vapocoolant spray

A

transdermal analgesia for needle sticks

cold feeling

leave on for 4-10 mins

93
Q

nonpharm pain management

A

distraction
relaxation techniques
guided imagery
cutaneous stimulation
containment and swaddling
nonnutritive sucking- sweeties
kangaroo care- skin to skin

94
Q

priority for OD of narcotics

A

narcan

94
Q

how to know if you are giving a incorrect dose of meds to peds

A

pay attn to weight

95
Q

when do you assess pain after PO meds

A

1 hour

96
Q

when to assess pain after IV meds

A

30 mins

97
Q

lewis Blackman act

A

right to ask for an attending at any time

98
Q

who can help with coping mechanisms in crises

A

social workers

99
Q

what does family need to have good adjustment to childs chronic illness/end of life care

A

support

100
Q

5 coping methods children use w chronic illness

A
  1. Confidence and optimism*** WE WANT THIS
  2. Different and withdrawn
  3. Irritable and act out
  4. Comply w treatment
  5. Seek support
101
Q

where can hospice nurses go

A

at home, or at hospital

101
Q

grief

A

A process- denial, anger, bargaining, depression, acceptance
Highly individual

check on parent, siblings, and even nurses that took care of that pt

102
Q

can children have aspirin

A

No

103
Q

what to do if child OD on tylenol

A

induce vomiting
give N- acetylcystine, the antidote, which is effective in 8-10 hours

104
Q

most common substances that cause poisoning in peds

A

aspirin
acetaminophen
lead

105
Q

treatment for lead toxicity

A

dimercaprol and calcium disodium IV, these help excrete the lead

action is taken if lead level above 5mcg/dL

106
Q

impetigo

A

caused by staph

vesicular lesions that rupture easily
moist with pruritis
honey colored crust

use burrows solution and topical abx
if severe use oral PCN

107
Q

cellulitis

A

caused by strep, staph, haemophilius influenza

skin and SQ tissue inflammation
s/s- erythema, edema, streaking, fever

treated by topical, PO or IV abx
incision and drainage may be needed

mark erythema with sharpie and assess for bettering or worsening

108
Q

lice (pediculosis capitis)

A

paraside
lay eggs

treated my permethrin cream, malathion cream

comb out nits

retreat in 7 days for missed nits

109
Q

eczema (atopic dermatitis)

A

inflammation of the epidermis
dry skin, may have scaling
rash is due to itching

hereditary

hydrate skin- aquafor, eucerin
steroid prn- triamcinolone

110
Q

herpes zoster (shinges)

A

caused by varicella virus
airborne and contact precautions

vesicles
on dermatome, so doesnt cross one side of body
neuralgic pain

meds- antivirals (acyclovir/Zovirax), analgesics

111
Q

1st degree burn

A

epidermis (sun burn)

112
Q

2nd degree burn

A

epidermis and dermis

most painful
pink/red and shiny

113
Q

treatment for burns

A

stop burning process
ABCs
begin fluids asap 1.5x maint. fluids in first 8 hours
debridement

114
Q

3rd degree burn

A

epidermis, dermis, SQ

May appear white, black, leathery

cant feel as nerves are ruined

skin graph needed

peds (4 decks)

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