EXAM 2 Flashcards
Describe the SHARE acronym for shared decision making
SEEK pt participation
HELP you pt explore tx options
ASSES pt values/preferences
REACH a decision w/ your pt
EVALUATE pt’s decision
define Cognitive Impairment
Cognitive impairment” (CI) is a general term that encompasses
any type of mental difficulty or deficiency
Used synonymously with “intellectual disability”
Diagnosis
◦ Made after a period of suspicion by family or health
professionals
◦ In some instances, made at birth
To be Dx w/ an Intellectual disability, you must…
Have an IQ of 70-75 or below
Impairment in 2 of 10 adaptive skills
Younger than age 18 at the time of diagnoses
Diagnosis of mildly impaired characterizes __% of the
population with cognitive impairment
85
Can be in school and become educated
Diagnosis of moderately impaired characterizes __% of the population with
10
what are two Measures to Prevent Cognitive
Impairment
rubella immunization
folic acid supplementation
What is the Most common
chromosome
abnormality
Down Syndrome
slanted, upturned eyes
small ears
flat nose bridge
short neck
square head
tongue poking out
What are down syndrome causes
Extra chromosome 21 in 95% of cases
Maternal age
◦ Age 35: risk is 1 per 350 births
◦ Age 40: risk is 1 per 100 births
What are some physical problems children with down syndrome may experience
◦ Congenital heart disease
◦ Hypothyroidism
◦ Leukemia
◦ Atlanto-axial instability @ c-spine
The second most common genetic cause
of cognitive impairment after Down
syndrome
Fragile X Syndrome
Large ears, long face, big forehead, intellectual disability
Fragile X Syndrome is caused by
Caused by abnormal gene on the
lower end of the long arm of the X
chromosome
14
Fragile X Syndrome:
Classic Behavioral Features
Mild to severe cognitive impairment
Delayed speech and language
Hyperactivity
Hypersensitivity to taste, sounds, and touch
Autistic-like behaviors
Aggressive behaviors
Fragile X Syndrome:
Therapeutic Management
Tegretol/Prozac for behavioral control
Stimulants for hyperactivity (similar to management of attention
deficit/hyperactivity disorder)
Referral to early intervention program
Slight to moderately severe hearing impairment
Residual hearing with the use of an aid
Severe to profound hearing loss
Cannot process linguistic information
What are two common hearing impairment causes
chronic ear infections and environment
Conductive hearing loss affects the…
middle ear
Sensorineural hearing loss reflects damage to the…
inner ear or auditory
nerve
Mixed conductive-sensorineural loss: interfers with…
transmission of sound
what are Manifestations of hearing impairment in Infancy
Lack of startle reflex
Absence of reaction to auditory stimuli
Absence of well-formed syllables by age 11 months
General indifference to sound
Lack of response to spoken word
what are Manifestations of hearing impairment in childhood
If not detected in infancy, identified upon entry into school
Abnormalities in speech development
Learning disabilities
partially sighted children have a visual acuity of…
20/70 to 20/200
legally blind children have a visual acuity of…
Acuity of 20/200 or poorer
what are some disorders that can cuase visual impairment in children
◦ Sickle cell disease
◦ Juvenile rheumatoid arthritis
◦ Tay-Sachs disease
Suspect visual impairment in a child of any age when…
pupils do
not react to light
The Most common congenital malignant intraocular tumor in children is…
Retinoblastoma
Manifestations
◦ WHITE EYE REFLEX
◦ Strabismus
◦ Blindness
Describe Esotropia
eye looks to center
Describe Exotropia
eye looks to outside
Describe Hypertropia
eye looks up
Describe Hypotropia
eye looks down
Children with autism display uncharacteristic behaviors in regards to..
◦ Socialization
◦ Communication
◦ Behavior
◦ Difficulty with eye and body contact
◦ Language delay
Diagnosis often delayed until age 2-3 years
Although autism isn’t curable, doing things like ___ will help the pt manage daily activities
◦ Attempt behavior modification
◦ Provide a structured routine
◦ Decrease unacceptable behavior
______ _____ _ ________ is good source of information for parents with autisitc children
Autism Society of America
What are indications a child may have ADHD or another learning disorder
Developmentally inappropriate inattention, impulsivity, and
hyperactivity
What do you test to determine if a kid had ADHD/LD
IQ
Hand-eye coordination
Visual and auditory perception
Comprehension
Memory
Name the three types of medications used for ADHD
Stimulants, Tricyclic Antidepressants, and Norepinephrine transport inhibition
◦ Dexedrine
◦ Methylphenidate (Concerta, Metadate, Ritalin)
◦ Dextroamphetamine (Adderall)
◦ Dexmethylphenidate (Focalin)
Examples of tricyclic antidepressants used to treat ADHD
◦ Clonidine
◦ Guanfacine (Intuniv)
Examples of Norepinephrine transport inhibition used to treat ADHD
◦ Atomexatine (Straterra)
The Upper respiratory tract anatomically consists of the…
▶ Oronasopharynx, pharynx
▶ Larynx, upper trachea
The Lower respiratory tract anatomically consists of the…
▶ Lower trachea, bronchi
▶ Bronchioles, alveoli
3
The nurse is discussing sexuality with the parents of an adolescent girl with moderate cognitive impairment. What should the nurse consider when dealing with this issue?
Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct.
What are the Five stages of coping (for Children with Special Needs)
Develops competence and optimism
Feels different and withdraws
Irritable, moody, acting out
Complies with treatment
Seeks support
T/F: Alway pair a bolus feed through a G/J tube with a pacifier
True.
sucking = as belly get full, it helps the infant realize satiation
Describe a 6 month old and younger’s Understanding and Reaction to Death
unaffected
Describe a 6 month old and older’s Understanding and Reaction to Death
affected by loss
Describe a toddler’s Understanding and Reaction to Death
egocentric, more affected by change in lifestyle
Describe a preschool age child’s Understanding and Reaction to Death
magical thinking, powerful thinking, death isn’t permanent- just sleeping
at what age do children develop permanence that death is final
around age 9
Describe a School age child’s Understanding and Reaction to Death
seen as a punishment or evil thing
once they turn 9 they have an adult understanding of death
Can a child designate themselves as a DNR/DNI?
A DNR may be placed by a physician’s who has the consent of the patient or, if the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order, upon the request of and with the consent of the person authorized to consent on the patient’s behalf.
How should you act after a patient’s family begins to mourn terrible news
Stay with family
Sit quietly
Avoid judgmental statements, rationalizations, or artificial consolation
Name 5 infectious agents that cause pediatric URIs
Respiratory syncytial virus (RSV)
Group A β-hemolytic streptococci
Staphylococci
Haemophilus influenzae
Chlamydia trachomatis
At what age is there an increase in Mycoplasma pneumoniae and β-hemolytic streptococcal infections
5 years and up
How long do maternal antibodies last for
0-3 months
what seasons have the most URIs/RSV
winter and spring
Which URI is most common in fall and winter
Mycoplasmal infections
Infection-related asthma: more frequent in ___ weather
cold
__mo – __yr respond more to resp infections
6mo – 3 yr
Describe symptoms of Meningism found in children with an URI
Meningism is defined as signs of meningeal irritation occurring without other features of meningitis or noninflammatory meningeal involvement (eg, in a patient with high-grade fever unrelated to a central nervous system [CNS] disorder).
Neck stiffness, back pain when lying and flexing leg/chin upwards
What symptoms could mean something more serious in children with a URI
Deterioration
Increase respiratory distress
Increase RR
increase HR
Worsening hypoxia
Poor perfusion
Decrease LOC
Lethargy
A child should be voiding at least (_ml/kg/h <__kg and __ml/h >__kg)
Voiding (1ml/kg/h <30kg and 30ml/h >30kg)
How can you make a child with a URI more comfortable
Moisturized air
FluiNose drops/throat garles
Nasal aspirator/bulb syringe
Vapor rubs (>2 yo)
Teach children how to cough/sneeze
Controlling fever important for comfort
Name signs/sx of ACUTE STREPTOCOCCAL PHARYNGITIS in children
skin (impetigo/pyoderma)
What infection can cause rheumatic fever (inflammatory disease of the heart, joints & CNS) & acute glomerulonephritis
Group A β-hemolytic streptococcal infection
What are the symptomatic differences between a strep and viral URI
STREP:
Sudden onset
Fever: 103-104
c/o Sore throat, erythema, exudate, tonsillitis, abd pain, HA
Positive RST, high elevation of WBC
VIRAL
Gradual onset
Low grade fever
c/o slight sore throat, less erythema, hoarseness, cough, rhinitis
Negative RST, slight elevation of WBC
Continuous swallowing in children could be a sign of
bleeding from tonsillectomy
Hemorrhage unusual but could occur btwn 5-10 days
How do you cure tonsilitis
Tonsillectomy and adenoidectomy
What medication can you give children with the flu
Oseltamivir all ages, start within 2 days onset of s/s
OTITIS MEDIA OM is the inflammation of the…
middle ear without infectious process present
OTITIS MEDIA AOM is the inflammation of the…
middle ear with rapid onset of S&S of acute infection (ie, fever & otalgia)
OTITIS MEDIA OME is the inflammation of the…
middle ear space without symptoms of acute infection
OTITIS MEDIA is most common in what age group
first 2 years of life
When would you consider TM tubes +/- adenoidectomy
> 3 episodes in <6 months
What age group does croup affect the most
Generally affects children <5 years of age (3 months – 3 years)
Croup is Most often caused by
H. influenzae type B
What are the two famous symptoms of croup
Inspiratory stridor, seal like cough
How do you treat croup
Maintaining the airway
Maintain hydration, orally or intravenously
Nebulized mist with supplemental O2
Nebulizer treatments
Epinephrine
Steroids
Describe ACUTE SPASMODIC LARYNGITIS
Also known as “spasmodic croup”
Paroxysmal attacks of laryngeal obstruction
Occurs chiefly at night
Inflammation: mild or absent
Most often affects children 1-3 years of age
Therapeutic management
Similar to that for infectious croup
Hot shower running in bathroom
BACTERIAL TRACHEITIS has similar sx to croup (and is often a result of it) expect for…
Thick, purulent secretions that result in respiratory distress
Vigorous management
Humidified oxygen
Antipyretics
Antibiotics
Possible need for intubation
Mechanical ventilation
Describe ACUTE EPIGLOTTITIS
A MEDICAL EMERGENCY
Might lose their airway
Sx include Sore throat, pain, tripod positioning
Drooling, difficulty swallowing
Inspiratory stridor, mild hypoxia, distress
Increased HR & RR. Substernal, suprasternal, intercostal retractions. Nasal flaring & increased restlessness
T/F: Cartilaginous support not fully developed until adolescence
True
The most frequent cause of hospitalization for those under 2 years is
RESPIRATORY SYNCYTIAL VIRUS
T/F: Risk factor for asthma later if severe RSV infection in first year of life
True
What medication can you take for RSV
Ribarvirin – inhaled antiviral (controversial)
** Synagis prevention for high risk infants
Whooping cough is caused by
Bordetella pertussis
TB test 5mm means
recent contact w/ TB positive person
TB test 5mm means
Has had TB in the past 5 years but is asymptomatic
TB test 5mm means
They have TB
SX FOREIGN BODY ASPIRATION include
dyspnea, cough, stridor, hoarseness, cyanosis
Name some substances that can cause severe aspiration pneumonia if aspirated
Hydrocarbons, lipids
Solvents
Talcum powder
what are risk factors for asthma
Atopy
Heredity
Gender
Smoking exposure
Maternal smoking in pregnancy
Ethnicity
Low birth weight
Being overweight
What is considered when deciding the classification of Asthma?
Symptom frequency day
Nighttime symptoms (waking)
PEF
Use of rescue inhaler (short acting b agonist)
Interference of normal activity
CLASSIFICATION OF ASTHMA SEVERITY
IN CHILDREN AGED 5 YEARS & OLDER Step 1:
mild, intermittent asthma
CLASSIFICATION OF ASTHMA SEVERITY
IN CHILDREN AGED 5 YEARS & OLDER Step 2:
mild, persistent asthma
CLASSIFICATION OF ASTHMA SEVERITY
IN CHILDREN AGED 5 YEARS & OLDER Step 3 or 4:
moderate, persistent asthma
CLASSIFICATION OF ASTHMA SEVERITY
IN CHILDREN AGED 5 YEARS & OLDER Step 5 or 6:
severe, persistent asthma
Name 6 DRUG THERAPies FOR ASTHMA
Albuterol, metaproterenol, terbutaline
Long-term bronchodilators (salmeterol [Serevent])
Theophylline: monitor serum levels
Leukotriene modifiers
Cromolyn sodium
What is Peak Flow Rate
The maximum flow rate that can be generated during a forced expiratory maneuver with full inflated lungs (L/min)
What is the “green zone” of Peak Flow Rate
80-100% of personal best, avoid things that make it worse
What is the “yellow zone” of Peak Flow Rate
50-80% of personal best, take medication to relieve episodes
What is the “red zone” of Peak Flow Rate
<50% of personal best, call MD or seek care immediately
describe STATUS ASTHMATICUS
Medical emergency
Respiratory failure and death if untreated
Continuation of respiratory distress despite vigorous therapeutic measures
Concurrent infection in some cases
Therapeutic intervention
Improving ventilation
Pharmacologic agents
what are 3 signs of chronic allergy
Allergic salute 🡪 transverse crease on upper nose
Dark circle under eyes
Post nasal drip
Describe the signs of CYSTIC FIBROSIS
Increased viscosity of mucous gland secretions
Elevation of sweat electrolytes
Increase in enzymatic constituents of saliva
Autonomic nervous system abnormalities
Delayed puberty in girls
Sterility in boys
Parents’ report: child’s skin tastes “salty”
Dehydration
Hyponatremic/hypochloremic alkalosis
Hypoalbuminemia
How do you diagnose cystic fibrosis
Sweat chloride test
Newborn screening
DNA identification of mutant genes
Abnormal measurement of nasal potential difference
Describe the symptoms of CYSTIC FIBROSIS
Wheezing respiration, dry nonproductive cough
Generalized obstructive emphysema
Patchy atelectasis
Cyanosis
Clubbing of fingers and toes
Repeated bronchitis and pneumonia
Meconium ileus
Distal intestinal obstruction syndrome
Excretion of undigested food in stool; increased bulk, frothiness, and foul odor
Wasting of tissues
Prolapse of the rectum
Describe the long term effects of cystic fibrosis
Chronic hypoxemia: causes contraction/hypertrophy of muscle fibers in pulmonary arteries/arterioles
Pulmonary hypertension
Cor pulmonale
Pneumothorax
Hemoptysis
Eventually pancreatic fibrosis occurs;
diabetes mellitus may result
Focal biliary obstruction results in multilobular biliary cirrhosis
Pancreatic enzyme deficiency
Sweat gland dysfunction
Failure to thrive
Increased weight loss despite increased appetite
How do you manage cystic fibrosis
Airway clearance therapies
Bronchodilator medication
Physical exercise
Aggressive treatment of pulmonary infections
Aerosolized antibiotics
Home intravenous antibiotic therapy
Replacement of pancreatic enzymes
High-protein, high-calorie diet: as much as 150% recommended dietary allowance (Supplemental Vit A, D, E, K)
Relief of intestinal obstruction (ileus)
Reduction of rectal prolapse
Treatment of chronic gastrointestinal reflux
Describe situations in which a pt would need more fluid
Fever
Vomiting, diarrhea
High-output kidney failure
Diabetes insipidus
Diabetic ketoacidosis
Burns
Shock
Tachypnea
Radiant warmer (preterm infant)
Phototherapy (infants)
Postoperative bowel surgery
Describe situations in which a pt would need less fluid
Heart failure
Syndrome of inappropriate antidiuretic hormone
Mechanical ventilation
After surgery
Oliguric renal failure
Increased intracranial pressure
If a pt has a fever, they require __% more fluids
15
how do you calculate fluids for an adult
30 ML/KG
Describe isotonic dehydration
Water & salt are lost in equal amounts
This is the primary form of dehydration in children
Reduction of plasma volume and circulating blood volume
Shock greatest risk (hypovolemic)
Describe hypotonic dehydration
Loss of electrolytes (electrolyte deficit exceeds water deficit)
ECF loss is greater = physical signs more severe
Na <130 mEq/L
Describe hypertonic dehydration
Loss of water (larger loss of water or larger intake of electrolytes)
Most dangerous 🡪 specific fluid therapy
Acute ________ is leading cause of illness in children < 5 years of age
diarrhea
Of all deaths in developing countries, 24% are related to diarrhea & dehydration
Gastroenteritis affects the…
stomach and intestines
enteritis affects the…
Small intestine
colitis affects the…
Colon
enterocolitis affects the…
Colon and intestines
What are the 5 types of diarheas
acute, infectious, chronic, nonspecific, intractable diarrhea of infancy
Therapeutic Management of Diarrhea
Low sodium broth
Apple juice (not great since high CHO and low electrolyte) and water 1:1
Pedialyte or other ors
Popsicles (Pedialyte popsicles)
No BRAT little nutritional value and high CHO, low electrolytes
First meconium should be passed within __-___ hours after birth
24-36
If First meconium should be passed within 24-36 hours after birth, you should suspect one of these three things…
Intestinal atresia, stenosis
Hirschsprung disease, hypothyroidism
Meconium plug, meconium ileus (CF)
What re 4 interventions for Constipation during Infancy
INTERVENTIONS:
PRUNE(S)/ JUICE
INCREASE WATER INTAKE
GLYCERIN SUPP.
Describe Hirschsprung Disease
Also called “congenital aganglionic megacolon”
Congenital anomaly
Mechanical obstruction from inadequate motility of intestine
Incidence: 1 per 5000 live births; more common in boys and in children with down syndrome
Absence of ganglion cells in colon
Describe Encopresis
inappropriate passage of feces, often with soiling
What are the two stages of Therapeutic Management for Hirschsprung Disease
- Temporary ostomy
Second stage: “pull-through” procedure
A Green, bilous vomit may be an indication of
bowel obstruction
Forceful vomiting is otherwise known as
pyloric stenosis
Headache with vomiting may be an indication of
CNS or metabolic disorder
Abd pain & vomit may be an indication of
appendicitis, pancreatitis, PUD
When Do We Worry about vomiting?
BRB
COFFEE GROUNDS
ABSENCE OF NAUSEA
MIDDLE OF THE NIGHT OR 1ST THING IN THE AM
FTT
Treatment of Gastroesophageal Reflux (GER) in infants
THICKEN FEEDS
SMALLER, FREQUENT MEALS
H2 ANTAGONISTS (ZANTAC) & PPI’S (PREVACID, NEXIUM)
KEEP UPRIGHT AFTER MEALS
Signs of Acute Appendicitis
McBurney point (tenderness from umbilicus to RLQ)
Inflammatory Bowel Disease (IBD) includes these two diseases
ulcerative colitis and crohn’s disease
What dietary changes should you consider with Inflammatory Bowel Disease (IBD)
High protein high calorie diet (well balanced)
MVI, iron, folic acid
What are the difference in symptoms between ulcerative colitis and crohn’s disease
ulcerative colitis: rectal bleeding, diarrhea, no pain, some anorexia/weight loss, and mild rash/joint pain
crohns disease: no rectal bleeding, severe pain, diarrhea, severe anorexia/weight loss/growth retardation, anal lesions, fistulas, and mild rash/joint pain
how is Hepatitis A transmitted
fecal oral route
describe BILIARY ATRESIA
childhood disease of the liver in which one or more bile ducts are abnormally narrow, blocked, or absent. It can be congenital or acquired
CLEFT LIP AND CLEFT PALATE type A
only affects lip
CLEFT LIP AND CLEFT PALATE type B
affects lip and palate
CLEFT LIP AND CLEFT PALATE type C
y shaped, affects two parts of lip and one lie centered through palate
CLEFT LIP AND CLEFT PALATE type D
only affects palate
SURGICAL CORRECTION OF CLEFT LIP
Closure of lip defect precedes correction of the palate
Performed when patients are 2-3 months of age
Protect suture line
SURGICAL CORRECTION OF CLEFT palate
Typically performed when patients are 6-12 months of age
describe Esophageal atresia
failure of esophagus to develop as a continuous passage
describe TRACHEOESOPHAGEAL FISTULA (TEF)
Tef: failure of the trachea to separate into a distinct structure
MANAGEMENT OF TEF
Maintenance of a patent airway
Prevention of pneumonia
Gastric or blind pouch decompression
Supportive therapy
Surgical repair
concerns/types of HERNIA
Danger of incarceration/strangulation
Types
Diaphragmatic
Abdominal wall
Inguinal canal
describe **HYPERTROPHIC PYLORIC STENOSIS
Constriction of pyloric sphincter with obstruction of gastric outlet
describe * INTUSSUSCEPTION
Telescoping or invagination of one portion of intestine into another
Most common cause of intestinal obstruction in children aged 3 months to 3 years
Occasionally due to intestinal lesions (10%)
Cause is often unknown
Red currant jelly stool
describe the difference between MALROTATION AND VOLVULUS
Malrotation: abnormal rotation of intestine around the superior mesenteric artery during embryologic development
Volvulus: twisting of intestine around itself, thereby compromising blood supply to intestines
May cause necrosis, peritonitis, perforation, and death
Obese: generally considered when body mass index (bmi) is in ___th percentile for age, gender, and height
> 95th
Overweight: generally considered when bmi is between the __th and 95th percentile
85
How can nurses teach cognitively impaired patients
these children can learn to discriminate if the cues are presented in an exaggerated, concrete form and if all extraneous stimuli are eliminated.
demonstration is preferable to verbal explanation, and learning should be directed toward mastering a skill rather than understanding the scientific principles underlying a procedure.
they need simple, one-step directions (task analysis, see how to break a task down)
positive reinforcement to encourage the accomplishment of specific tasks or behaviors.
you get hep a from
food and water. you can get post-exposure immunoglobins to treat. IGM means active infection, IGG means antibodies, no infection. prevent w/ vaccine and handwashing
describe hep b
get it from iv drug use, birth, and sex. HBSnG postive means active infection and can spread. antibodies indicate immunity, no infection
