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Peds > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

how to diagnose appendicitis (informal)

A

push mcberney’s point
make kid jump off table
low grade fever (high if perforation)
no farting
peritonitis with abdominal tenderness

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2
Q

what to do if you suspect appendicitis

A

If you question it, JUST GET THE PROVIDER
Educate JUST IN CASE “if ______ happens, go to the ER”

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3
Q

why is appendicitis so dangerous

A

if it ruptures, stool content leaks into gut and causes infection (PICC used for this and to give abx, otherwise just remove it)

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4
Q

what to do if appendicitis pain is relieved without intervention

A

ALERT PROVIDER! THIS MEANS PERFORATION

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5
Q

how to diagnose appendicitis (formal)

A

CT is best
sonogram is not always conclusive, esp with buildup of gas
elevated WBC and CRP

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6
Q

asthma precautions/triggers

A

hardwood floor
cover pillows
cig smoke/fireplaces
pets

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7
Q

asthma attack

A

wheezing is hallmark sign (cessation is BAD)
HR and BP are up
back tightens up from breathing so hard
subq emphysema (feels like rice krispies)
RESP THERAPY TO PREVENT INTUBATION

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8
Q

asthma meds

A

albuterol (short acting)
flovent, brio, annuity, symbicort (long acting, can take 2 weeks to build enough)

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9
Q

asthma action plan

A

Green: normal precautions. Long acting, avoid triggers, albuterol if wheezing or before exercise
Yellow: episode/exacerbation/flareup, not an asthma attack. Albuterol q4h instead of PRN. Maybe steroid? Treat this so you don’t get to red, wanna get back to green
Red: extreme trouble breathing, SOB, go to the hospital

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10
Q

spacers

A

great for kids
makes everything disperse and get into airway instead of hitting back of the throat
if you taste a bitter taste, you waste it
just as good as a nebulizer treatment

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11
Q

humidifiers and albuterol

A

break apart congestion
q4h for 48h

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12
Q

if someone is in the hospital for wheezing what should we do?

A

follow up in 24-48 hours to make sure they don’t get worse

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13
Q

health history for asthma

A

Cough, particularly at night that starts as non-productive then productive with frothy sputum
Difficulty breathing: Shortness of breath, chest tightness, dyspnea
Wheezing
Past medical history for allergies, atopic dermatitis (eczema), family history of asthma/atopic derm, recurrent episodes of wheezing or bronchitis, seasonal response to environmental pollen, tobacco smoke exposure, poverty

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14
Q

tripotting

A

kneeling over to catch breath
BAD sign

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15
Q

GERD and asthma

A

seen together a lot but not sure why

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16
Q

asthma and sickness

A

Asthmatic children are more susceptible to bacterial and viral respiratory infections
state of inflammation makes you more likely to have bacteria or virus sitting in you
take allegra or zyrtec every day to decrease inflammation and sickness

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17
Q

physical exam for asthma

A

color
work of breathing (retractions, bobbing, wheezing, barrel chest)
lethargy, anxiety, irritability, air hunger
diminished at bases or throughout?

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18
Q

biologics for asthma

A

good for poor people
injectables once a month

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19
Q

cystic fibrosis

A

autosomal recessive
DNA testing done prenatally and in newborns
seen in europeans
used to be a death sentence, lucky to live until 30

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20
Q

support groups with CF

A

really hard because you can get each other sick

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21
Q

patho of CF

A

thick, tenacious secretions in sweat glands, gastrointestinal tract, pancreas, respiratory tract, and exocrine tissue

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22
Q

management of CF

A

vests to shake (mimics percussion and loosens secretions)
exercise and chest PT with postural drainage
nebulized pulmozyme to thin secretions
aerosolized abx

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23
Q

GI problems in CF

A

electrolyte imbalance and dehydration common
Pancreas does not produce enzymes causing malabsorption of fats, proteins, carbohydrates resulting in poor growth and large, malodorous stools

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24
Q

resp problems in CF

A

Excess mucus is produced by tracheobronchial glands causing abnormally thick mucus plugs in the small airways and greatly increases risk of secondary bacterial infections such as Staph Aureus, Pseudomonas, Burkholderia - thus chronic infection, tissue damage & respiratory failure
nasal polyps and sinusitis

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25
Q

fertility and CF

A

boys have tenacious seminal fluid that blocks vas deferens
girls have thick cervical secretions

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26
Q

meals for CF

A

PANCREATIC ENZYMES with every meal bc they don’t absorb fats, carbs, and proteins
Supplemental fat-soluble vitamins to aid digestion & absorption (ADEK)
Iron supplementation, high sodium, high carb, high protein, high fat

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27
Q

health history in CF

A

Salty taste to skin, meconium ileus as newborn, bulky/greasy stools, poor weight gain and growth despite good appetite, chronic cough and respiratory infections

In those with known CF, note respiratory status, cough, sputum, work of breathing, appetite, weight gain, activity tolerance, increased need for pulmonary and pancreatic medications, fever, bone pain or any other changes.

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28
Q

physical exam of CF

A

Inspection of appearance/color/nasal polyps/finger clubbing/barrel chest, auscultate for adventitious breath sounds, percussion and palpation that reveal hyperresonance due to air trapping, note severity of cough, quality and quantity of sputum, signs of edema (cardiac/liver failure signs from lack of absorption)
Follow with pediatric pulmonologist for the rest of their life (even as adults, stay with pediatric)

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29
Q

diagnosis of CF

A

sweat chloride test (lots of sodium in sweat since they can’t absorb it)
pulse ox
chest x-ray
PFT

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30
Q

promoting growth in CF

A

Administer pancreatic enzymes with all meals and snacks
Can be sprinkled on cereal or applesauce for small children
Additional enzymes will be needed with high protein foods
Promote a well-balanced, high protein, high fat, high calorie, high sodium diet
Some children require 1.5X the amount of recommended daily caloric intake
Infants should breastfeed with enzyme administration, may require fortification of breastmilk or formula
Administer vitamins A, D, E, K
Encourage fluids to decrease dehydration (to thin the secretions)

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31
Q

can we bulb syringe a four year old?

A

NO

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32
Q

preemies

A

babies under 37 weeks
34-36 and 6 days is late preterm

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33
Q

late pretermers

A

do well but are bad feeders
watch weights and feeding
need lots of stimulation

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34
Q

resp system in preemies

A

most affected
Surfactant deficiency since it’s not made until around 36 weeks
2 shots of betamethasone 24h apart helps so much
Surfactant deficiency=resp distress syndrome
Surfactant given to babies when first born or if woman has history of complications

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35
Q

resp complications in preemies

A

Unstable chest wall=atelectasis
Immature resp control centers=apnea
Smaller resp passages=obstruction
Transient tachypnea=needs support!

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36
Q

cardiac system in preemies

A

was reliant on maternal circulation, now has to circulate blood on their own
increased oxygen levels help transition, if blood continues bypassing lungs, hypoxia occurs
PDA and PFO (close after a while)
impaired BP regulation leading to intercranial hemorrhage

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37
Q

GI in preemies

A

Lack of neuromuscular coordination Perinatal hypoxia causes shunting of blood away from the gut to support the heart and brain - leading to ischemia
Small stomach capacity, impaired ability to digest proteins and absorb nutrients, lack of gag reflex, poor suck = malnutrition
enteral and parenteral feedings necessary - infants under stress expend more energy
Increased caloric needs because they are small
HUMAN MILK greatly reduces complication from necrotizing enterocolitis

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38
Q

renal in preemies

A

infant is unable to concentrate urine appropriately and slow the GFR
This leads to fluid retention with fluid and electrolyte disturbances
Inability to clear drugs from their system increasing the risk for drug toxicity
Imperative to monitor their acid-base balance to monitor metabolic inconsistencies
Watch electrolytes!! If they’re on TPN and meds make sure kidneys and liver are okay

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39
Q

immune system in preemies

A

There is a deficiency of IgG for preemies under 34 weeks gestation
Impaired ability to manufacture antibodies if exposed to pathogens during the birth process
Thin skin & fragile blood vessels provide limited protective barrier
Breastmilk again is important as it provides important antibodies the baby cannot manufacture

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40
Q

breastmilk for preemies

A

Breast milk is better on infant gut than cow milk
Pasteurized breast milk better on gut than cow’s milk
If mom does not pump, pasteurized donor breast milk can be available to this delicate patient population which has proven to be extremely beneficial due to increased fats, nutrients, hormones, prebiotics, and probiotics that are much more easily digestible and absorbed
provides antibodies

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41
Q

CNS in preemies

A

Increased susceptibility to injury and insult to the CNS increases long-term disability (bc its so immature)
If any insult to CNS, long term disability like cerebral palsy
Impaired ability to regulate temperature both through CNS & inadequate subcutaneous & brown fat
It is imperative to prevent cold stress which increase the need for oxygen and metabolic needs
Preemies are especially susceptible to hypoglycemia

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42
Q

nursing interventions for preemies***

A

Promoting oxygenation
Prevent infection
Promote growth and development
Maintain thermoregulation
Provide appropriate stimulation (skin to skin/kangaroo care,shushing)
Promote parental coping (baby and parents will be separated for a few days)
Promote fluid and nutrition balance
Manage pain (pacifier with sucrose water)

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43
Q

concerns with the late pretermer

A

Respiratory distress, thermoregulation, apnea, hypoglycemia
Jaundice and hyperbilirubinemia
Immature suck and swallow reflex so watch nutrition (they get tired, talk to lactation consultant)
Sepsis bc maternal antibodies weren’t completely transferred
Neuro delays
So hard for parents bc baby isn’t on monitors or having a team watching them

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44
Q

discharge teaching for preemie

A

Temp under 97 or above 104 rectally, rare in children! Get them evaluated, could be sepsis or meningitis
not voiding for 12 hours (NOT normal, should be 3-5 wet diapers by the time they’re home)
No BM in 24 hours in pretermers but just make sure plumbing is working
Not right, irritable, lethargic
Tobacco cessation and 2nd hand smoke
Jaundice, poor feeding, vomiting are concerns

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45
Q

transient tachypnea of the newborn and risk factors***

A

Self-limiting condition, due to inadequate/delayed clearance of lung fluid causing transient pulmonary edema
Usually occurs within the first hours after birth and resolves by 72 hours
Risk factors: Low gestational age, C-Sections, perinatal hypoxic stress event & male sex

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46
Q

signs of transient tachypnea

A

tachypnea, expiratory grunting, retractions, labored breathing, nasal flaring & mild cyanosis
Inspect newborns chest for barrel shape (hyperextension)
Auscultate lung sounds which maybe slightly diminished in case of pneumothorax
Chest x ray can aid diagnosis. Blood gas can assess degree of gas exchange and acid-base balance

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47
Q

nursing management of transient tachypnea

A

Supportive care
Provide adequate oxygenation, IV fluids or lavage feedings, thermal regulation
the RR will decline to under 60 respirations per minute as improves
May need IV food for 24-48 hours until tachypnea resolves
Mom should still pump and stuff and try to feed baby esp colostrum

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48
Q

Respiratory distress syndrome

A

from lack of surfactant (early preemies don’t have any)
no surfactant which leads to collapse of alveoli and atelectasis and pulmonary vasoconstriction and right to left shunting and decreased surfactant and hyaline membranes making ground glass look on xray then less oxygen absorption

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49
Q

nursing assessment for RDS

A

Identify signs and symptoms (usually present at birth or within hours), review history for risk factors (prematurity, c-section, cold stress, maternal diabetes as high insulin levels inhibits surfactant production).

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50
Q

S&S of RDS

A

expiratory grunting, shallow breathing, nasal flaring, retractions, seesaw respirations & generalized cyanosis, tachycardia, tachypnea, find inspiratory crackles, apnea/dyspnea, chest wall recessions

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51
Q

treatment for RDS

A

betamethasone
keep babies warm
high insulin can inhibit surfactant production so be careful

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52
Q

nursing management for RDS

A

supportive care for 72h until surfactant develops
mechanical ventilation (CPAP, PEEP), can cause bronchopulmonary dysplasia if settings r too high
maternal steroid 1-7 days before birth not under 24h
oral surfactant replacement therapy
Optimal support, thermoregulation, fluids, nutrition, adequate tissue perfusion

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53
Q

apnea

A

not breathing for 20 seconds
may be seen with bradycardia
can present in the form of acute LT event
can be central (unrelated) or may occur with sepsis, resp infection, meningitis, etc

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54
Q

what 4 things is apnea associated with***

A

HYPOTHERMIA
HYPOGLYCEMIA
INFECTION
HYPERBILIRUBINEMIA

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55
Q

what to ask parents regarding acute LT event

A

events and positioning before event (color changes, did they start breathing on their own again or did they require stimulation, risk factors (anemia, metabolic disorders, prematurity)
Resp infection, sepsis, child abuse, or poisoning (note absence of respirations, position, color, associative findings like emesis on bed/clothes)

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56
Q

what else can cause apnea?

A

cardiac or neuro problems

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57
Q

do babies’ hearts stop?

A

no! they stop breathing and THAT stops their hearts

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58
Q

what to teach parents regarding apnea

A

know how to do CPR

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59
Q

chronic lung disease

A

bronchopulmonary dysplasia
Most commonly seen in premature infants due to - pulmonary immaturity, acute lung injury, barotrauma, inflammatory mediators & volutrauma. The growth and development of the lung structures are affected as well as cilia loss/airway lining denudation reduce normal cleansing abilities of the lung and the normal alveoli are reduced by ⅓-½
may need long term oxygen

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60
Q

nursing assessment of chronic lung disease

A

Observe for tachypnea & increased work of breathing which are characteristic of Chronic Lung Disease. Determine level of dyspnea associated with oral feeding. Take note of growth parameters, identify failure to thrive. Auscultate breath sounds noting wheezing or rales

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61
Q

nursing management of chronic lung disease

A

educate parents about oxygen tanks, nasal cannula use, Pulse Oximetry use and nebulizer treatments
Counsel parents on importance of increased caloric formulas
Breastmilk can be fortified to increase caloric intake
Encourage follow-up ecgs to determine resolution of pulmonary hypertension prior to weaning from oxygen
Educate about developmentally appropriate activities
it maybe difficult to reach gross motor milestones in the oxygen dependent infant because of the length of the oxygen tube to explore their environment
Parental support!

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62
Q

retinopathy of prematurity

A

rapid growth of retinal blood vessels in preemie
incomplete retinal vascularization, but vessels continue to grow between the vascularized and nonvascularized retina

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63
Q

risk factors for ROP

A

Low Birth weight, early gestation, sepsis, high light intensity and hypothermia. It is thought that high concentrations of supplemental oxygen play an important role in development of ROP

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64
Q

follow ups and surgery for ROP

A

Premature infants require serial exams by an ophthalmologist until ROP has regressed and normal vascularization is seen. Laser surgery may be necessary if ROP continues to progress to prevent blindness
follow up until the child is about 3

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65
Q

nursing assessment for ROP

A

Ensure all former premature infants are routinely screened for visual deficits
Be sure to discuss developmental progress with parents
Observe for development of strabismus, manifested by an Asymmetric Corneal light reflex
Management is focused on ensuring family compliance with ophthalmologist’s follow up recommendations
Even if ROP is considered resolved, these children still may have refractive errors and must maintain appropriate ophthalmology follow-up

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66
Q

periventricular hemorrhage

A

most vulnerable part of the brain in preemies
each ventricular area is very vascular and can rupture easily

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67
Q

complications of periventricular hemorrhage

A

Hydrocephalus, seizure disorder, periventricular leukomalacia, Cerebral Palsy, learning disabilities, vision or hearing deficits, cognitive impairment or death

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68
Q

no vitamin k shot increases risk of?

A

periventricular hemorrhage

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69
Q

how to treat periventricular hemorrhage

A

no treatment, just supportive care
Make sure anemia, acidosis, and hypotension are corrected by fluids and meds
Fluids given slowly to avoid fluctuations in BP or rapid volume expansion which affects cerebral perfusion
Minimize cluster care, don’t overstimulate newborn and stress them out
Support parents in coping, neurodevelopment may be bad

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70
Q

NEC important concepts

A

NOTHING PO!! NO BOTTLE FEEDS OR ANYTHING AT ALL IN THEIR MOUTH!! THEIR GUT IS ROTTING!!
DON’T PUT THEM ON BELLY BC TOO MUCH PRESSURE

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71
Q

how to improve GI function and reduce NEC

A

Enteral feedings, judicious administration of parenteral fluids, HUMAN MILK FEEDINGS, antenatal corticosteroids, enteral probiotics and slow continuous drip feedings

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72
Q

signs of NEC

A

feeding intolerance
abdominal distension
bloody stools
progresses to sepsis, resp distress, lethargy, hypotension, oliguria, and temp instability

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73
Q

nursing assessment of NEC

A

Always remains suspicious for development of NEC in the preterm infant esp if getting formula
Note respiratory distress, cyanosis, lethargy, decreased activity level, temperature instability, feeding intolerance, diarrhea, bile-stained emesis or gross bloody stools
Assessed blood pressure, noting hypotension.
Evaluate neonates abdomen for distension, tenderness, visible loops of bowel - measure abdominal circumference noting increase.
Determine residual gastric volume prior to feeding, when elevated suspect NEC

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74
Q

nursing management of NEC

A

NOTHING PO UNTIL COMPLETELY EVALUATED AND SURGERY IS INSTITUTED
IV FLUIDS
TPN IF ORDERED
IV ABX TO PREVENT SEPSIS
DON’T PUT PRESSURE ON BELLY
Gastric decompression (oral gastric tube on low intermittent suction)
STRICT I&Os
Normal abdominal exam postop from surgeon and baby is cleared
Check stools for blood, hypotension, abd girth, tenderness and rigidity, normal bowel sounds in all quadrants, oxygen sat and blood gasses, redness or shininess of abdomen (peritonitis), emotional support and education for family
HUMAN MILK DECREASES RISK

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75
Q

encephalitis vs meningitis

A

meningitis: inflammation of thin tissue layer surrounding brain and spinal cord
encephalitis: swelling of the brain itself

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76
Q

two types of meningitis

A

bacterial and viral (aseptic)

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77
Q

complications of meningitis

A

brain damage, nerve damage, deafness, stroke, and death

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78
Q

big cause of meningitis

A

hib

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79
Q

what can meningitis occur secondary to

A

URI, Sinus or ear infection, skull fracture/severe head injury, neurosurgical intervention, congenital structural abnormalities (spina bifida), or presence of foreign bodies (ventricular shunt, cochlear implants, during lumbar puncture)

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80
Q

treatment of meningitis

A

HURRY THEY ONLY HAVE 24H
After lumbar puncture & blood cultures have been obtained when suspected, IV antibiotics will be started immediately. Corticosteroids are used to help reduce the inflammatory process. Treatment based on causative organism give broad spectrum abx while waiting for culture

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81
Q

S&S of meningitis

A

headache, neck pain, fever, lethargy, arched back, can’t curl forward from inflammation and rigidity in spine and brain
Seizures, vomiting, photophobia, and etc later
HALLMARK IS NONBLANCHABLE RASH! GLASS SKIN TEST

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82
Q

close contacts for meningitis

A

go on abx

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83
Q

meningitis B vaccine regimen

A

meningitis B recommended
ACWY required
hs seniors get men B vaccine before college

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84
Q

priorities in meningitis

A

ICP, seizure precautions, safety, LOC
antipyretics ordered when possible but not priority

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85
Q

temperature in meningitis

A

keep them cool but make sure they don’t shiver!

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86
Q

management of viral meningitis

A

Aggressive treatment until diagnosis confirmed
Antibiotics until causative viral diagnosis then d/c’d
Usually self-limiting 3-10 days, supportive therapy
Child often can be cared for at home when viral

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87
Q

nursing assessment of viral meningitis

A

Fever, malaise, headache, photophobia, poor feeding, nausea, vomiting, irritability, lethargy, neck pain, positive Kernig & Brudzinski signs
Onset of symptoms can be abrupt or gradual - similar to bacterial meningitis but less severe

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88
Q

what may viral meningitis follow?

A

sinusitis, pharyngitis otitis

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89
Q

risk factors for meningitis

A

young
shunt
cochlear implants
immunocompromised

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90
Q

Reye syndrome

A

NO ASPIRIN OR PEPTO BISMOL

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91
Q

febrile seizures

A

benign but have them worked up anyways bc could be underlying illness like meningitis or sepsis
at risk for it happening again

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92
Q

treatment for febrile seizures

A

no antiseizure meds
rapid rise in core body above 102.2 and lasts for under 15 mins or shorter. Occurs once in 24h
diagnosed by history and physical
lumbar puncture or brain imaging to r/o meningitis or encephalitis

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93
Q

risks for febrile seizures

A

age of first one, family hx, high fever
does not cause damage or cognitive decline

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94
Q

nursing management of febrile seizures

A

teach parents this is benign
teach how important it is to give antipyretics (weight based)
how to keep child safe
keep child cool
don’t give antiseizure meds
when to bring kid to ER

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95
Q

sepsis and parental concerns

A

parents know their kid! Listen to their concerns!
high or low temps, urine output, intake - solids/fluids, signs of dehydration, temperament, blue or cold extremities very late sign

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96
Q

order of cultures

A

blood, urine culture, UA, lumbar

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97
Q

septic shock manifestations

A

low blood flow, multi-organ failure, decreased level of consciousness or arousal, weak cry, lack of responsiveness, tachypnea, increase work of breathing, hyper or hypothermia, tachycardia, hypotension, oliguria, signs of poor perfusion all indicate signs of septic shock (late stage)!!!!
MEDICAL EMERGENCY

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98
Q

pregnancy and sepsis

A

high risk bc always touching and putting things in

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99
Q

chorioamnionitis

A

should be suspected in pregnant women with a fever
infection of chorion, can lead to child being septic
child goes to NICU and goes on IV abx for 48h
can decompensate FAST

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100
Q

group b strep

A

screened at 35th week
given intrapartum abx to prevent transmission

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101
Q

sepsis cultures

A

2 DIFFERENT SITES

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102
Q

TIME pneumonic sepsis

A

temp (high or low)
infection (S&S)
mental decline
extremely ill (severe pain, discomfort, SOB)

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103
Q

cellulitis

A

can become sepsis!

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104
Q

HUS

A

not born with it
due to e.coli or other toxins

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105
Q

3 features of HUS

A

hemolytic anemia
thrombocytopenia
acute renal failure

Usually following acute diarrheal illness

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106
Q

causes of HUS

A

can be caused by inheritance, related to malignancy, transplantation or malignant hypotension
thrombocytic events in glomerulus can cause renal failure

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107
Q

complications of HUS

A

Chronic renal failure
Seizures
Coma
Pancreatitis
Intussusception
Rectal prolapse
Cardiomyopathy
Congestive heart failure
Acute respiratory distress syndrome (ARDS)

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108
Q

antidiarrheals for HUS

A

NO!!

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109
Q

nursing assessment of HUS

A

description of present illness
BLOODY DIARRHEA IS HALLMARK
cramping and sometimes vomiting
assess risk factors like raw meat, zoo, or water parks
has the child used abx or antidiarrheals

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110
Q

mani of HUS

A

pallor, toxic appearance, edema, decreased urine output, elevated BP, abdominal tenderness. Is child irritable, have an altered level of consciousness, seizures, posturing or coma

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111
Q

nursing management of HUS

A

Close observation - adequate nutrition, bleeding, blood chemistries, fatigue, pallor - report changes to provider
Contact Precautions to prevent spread of E Coli (can shed for 17 days after resolution of diarrhea)
Strict I/O to evaluate progression toward renal failure
Antihypertensives & Diuretics as ordered
Dialysis and blood transfusion maybe needed

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112
Q

when to consider HUS

A

if child is very swollen, could have seizures, be lethargic and have kidney failure
supportive care (no abx since it’s viral)
plasma infusion
CNS meds

113
Q

nephrotic syndrome

A

Fluid retention
Decreased urine output
Acute weight gain
Do daily weights
“Spin cycle is broken”

114
Q

3 forms of nephrotic syndrome

A

congenital (will need kidney transplant)
idiopathic (minimal change, most common)
secondary to lupus, henoch-schonlein purpura or diabetes

115
Q

complications of nephrotic syndrome

A

Anemia
Infection
Poor growth
Peritonitis
Thrombosis - HIGH RISK!
Renal failure

116
Q

therapeutic management of nephrotic syndrome

A

Corticosteroids
IV albumin if severely edematous
Diuretics in edematous phase
Long-term steroid therapy to induce remission
Immunosuppressive therapy also may be necessary
Watch these children once this has happened

117
Q

symptoms of nephrotic syndrome

A

Elicit description of present illness and chief complaint
Common symptoms: Nausea, vomiting, recent weight gain, periorbital edema upon waking progressing to generalized edema throughout the day, weakness, fatigue, irritability

118
Q

risk factors for nephrotic syndrome

A

IUGR, <3, male

119
Q

physical exam of nephrotic syndrome

A

edema
tight skin, pallor, breakdown from edema
height and WEIGHT
increased RR
elevated BP from renal failure
auscultate heart and lungs
palpate skin for tautness
palpate abdomen for ascites
pulmonary edema
protein loss in urine

120
Q

management of nephrotic syndrome

A

Promote diuresis
Prevent infection
Adequate growth and nutrition
Educate family
Provide support (long term corticosteroids can cause problems)

121
Q

promoting diuresis in nephrotic syndrome

A

corticosteroids (taper off)
diuretics (give K+ supplement)
I&Os and urine protein
pulse/BP to detect hypovolemia from fluid shift
IV albumin to help w fluid shift

122
Q

preventing infection in nephrotic syndrome

A

monitor temp
pneumococcal vaccine
prophylactic abx
live vaccine 2 weeks after steroid therapy
(if not immunized to chickenpox, go to nephrologist and get varicella immunoglobulin)

123
Q

big warning signs of nephrotic syndrome

A

periorbital edema
clothes don’t fit
ascites

124
Q

nutrition for nephrotic syndrome

A

nutrient rich
fluid restriction
low sodium
high protein
dietician! may need shakes

125
Q

family education for nephrotic syndrome

A

meds and effects
urine dipstick for protein
record dipstick results
decrease exposure to sick ppl
monitor temp and do more dipsticks when child is sick to identify relapse

126
Q

pertussis

A

whooping cough and copious secretions
under a year is scary!
incubated for a week and a half

127
Q

symptoms of pertussis

A

Starts with 7-10 days of cold symptoms
Whooping cough then begins and can last 1-4 weeks

128
Q

treatment of pertussis

A

erythromycin can be used but we may not pick it up before there’s lasting damage
vaccine is best

129
Q

when to see children for pertussis vaccine

A

15

130
Q

kawasaki disease

A

FEVER 5+ DAYS ADMIT AND TREAT

131
Q

mani of kawasaki

A

Red, bloodshot eyes
Red, swollen hands
Red, swollen feet
Red, cracked lips
Red, beefy tongue (strawberry tongue)
High fever → at least 102
Rash involving much of the body
Red patches and bumps

132
Q

treatment for kawasaki

A

IVIG
ECG
Presents and is treated the same as multi-inflammatory syndrome
very strict I & O
Assess for heart failure
Apply petroleum jelly to lips
Ice chips, popsicles
Joint pain
parents learn CPR THEY CAN HAVE AN MI

133
Q

UTI presentation

A

Sudden bedwetting issues
Need to have timely diagnosis
Could lead to kidney infection and sepsis
may need cath for clean catch
chronic constipation can cause urinary stasis

133
Q

UTI treatment

A

5 day abx
can’t take antibiotic and probiotic at the same time (need probiotic to rebuild good bacteria)
lots of fluids to flush everything out!

134
Q

culture and prevention of UTI

A

Always do culture first, then do UA
Monitor closely → may need to stop or switch antibiotic
Alert provider immediately
Make sure clothes are comfortable and breathable
Wipe front to back

135
Q

pertussis contagion

A

cough of 100 days not whooping and they have some immunity and can still spread it

136
Q

pertussis vaccine in pregnancy

A

Mom can get vaccine at 28 weeks and partners also because it passes the placental membrane
caregivers should get vaccinated even if they just have a cough

137
Q

management of pertussis and for close contacts

A

provide respiratory support
Infants older than 1 month = macrolide (erythromycin, clarithromycin & azithromycin) UNDER 1 month Azithromycin
Macrolides recommended for close contacts regardless of age or immunization status
Close contacts under 7 who are unimmunized or underimmunized should initiate or complete vaccine series
Want to treat them asap

138
Q

assessment of pertussis

A

immunization status***
history of cold and cough that progresses into whooping cough spells
cyanosis and tongue protrusion (can’t breathe and choking for air)
fluids can flow from mouth, nose, and eyes
auscultate lungs between episodes to assess air exchange

139
Q

management of pertussis

A

high humidity environment
suctioning
signs of obstruction
fluids
reassure family
droplet and standard precautions
NG tube for babies

140
Q

Acute Poststreptococcal Glomerulonephritis (APSGN)

A

immune injury to glomeruli
inflammation
occurs following skin or upper resp infection (strep and staph most common)
impetigo
Caused by antibody-antigen reaction secondary to infection

141
Q

impetigo

A

gross honey crusted licking snot that crusts over

142
Q

what can blood in urine be

A

strep!

143
Q

complications of APSGN

A

uremia and renal failure

144
Q

treatment for APSGN

A

maintain fluid volume and HTN

145
Q

if APGSN with evidence of strep infection how do we treat

A

10 days of abx

146
Q

health history for APGSN

A

recent pharyngitis, fever, lethargy, headache, decreased urine output, abdominal pain, vomiting and/or anorexia
Check for palate petechiae if other symptoms are present
Adults show up with flu symptoms (joint pain)
Not always a sore throat

147
Q

physical exam for APGSN

A

high BP
mild edema
cardiopulmonary congestion (increased work of breathing or cough)
auscultate lungs for crackles and heart for gallop

148
Q

urine dipstick for APGSN

A

proteinuria and hematuria (cola or tea colored?) means kidney damage

149
Q

bloodwork in APGSN

A

cr and BUN normal or elevated, ESR elevated, ASO titer and DNAse B antigen titer positive (looks for strep)

150
Q

nursing management of APGSN

A

hypertensives (labetalol or nifedipine)
diuretics (watch electrolytes)
maintain sodium and fluid restrictions when there is edema
I&Os
daily weights
document urine edema changes
neuro eval
bed rest during acute phase
dialysis if progression
can be managed at home if mild edema and no HTN

151
Q

education for APGSN

A

Monitor urine output and color
Take BP regularly
Restrict diet as prescribed
No strenuous activities until proteinuria and hematuria resolve
Avoid NSAIDS because we are worried about renal function and your kidneys filtering the meds out properly

152
Q

rheumatic fever (ARF)

A

sequelae of group A strep
develops 2-4 weeks after
believed that antibodies are produced and then it reacts with antigens

153
Q

what does ARF lead to?***

A

carditis, arthritis & chorea (involuntary random, jerking movements)

154
Q

what does ARF effect?

A

joints, CNS, skin, and sq tissue causing PERMANENT damage to heart and valves BADD
Resolves but could go back

155
Q

jones major criteria

A

carditis
migratory polyarthritis
subq nodules
erythema marginatum
sydenham chorea

156
Q

jones minor criteria

A

polyarthralgia
elevated ESR or CRP
prolonged PRI (unless carditis is a major criteria)

157
Q

management of ARF

A

directed at managing inflammation and fever
10-day PCN
steroids
NSAIDS (to prevent clots)
children w valvular disease will get pcn prophylaxis (CONTINUED INTO ADULTHOOD)***

158
Q

does ARF resolve

A

yes but may have subsequent strep infections

159
Q

nursing assessment of ARF

A

description noting fever and joint pain
risk factors (history or strep within last 2-4w)
sydenham chorea (movement disorder of face and upper extremities)
maculopapular red rash with central clearing and elevated edges
auscultate heart murmur
palpate joints for firm, painless nodules (very obvious)
prolonged PRI
throat culture or strep antibody test
echo for carditis

160
Q

nursing management of ARF

A

compliance and rest are key
let child verbalize frustration with chorea and offer support
will disappear
may give children haldol
corticosteroids and NSAIDS for pain and swelling

161
Q

what to do when we suspect something?

A

don’t diagnose! we tell provider

162
Q

fever in sickness

A

fever is a protective mechanism, treat symptoms not the fever
don’t treat if child is playful, treat if lethargic
PREVENT DEHYDRATION

163
Q

norovirus

A

ALCOHOL DOESN’T KILL THIS OR C.DIFF
COMES OUT BOTH ENDS VIOLENTLY
seen on cruise ships

164
Q

blood from infant (feet)

A

heel stick
stick outside V

165
Q

breastfeeding when sick with communicable disease? (HIV, hep b and c, HSV, varicella, TB)

A

No HIV
No if active bleeding in nipple for hep b and c (pump and dump or flash pasteurize)
No if HSV with lesions on breast
expressed breast milk (squeezed out) is fine with varicella or active TB

166
Q

late sign of sepsis (bp)

A

HYPOtension

167
Q

vaccine teaching

A

vaccine info sheets (VIS) required to be given to parents prior to vaccine
this info is in portal but nobody looks
ask about previous reactions to vaccine
screen for precautions and contraindications

168
Q

documentation of vaccines

A

Name of vaccine, lot number, expiration date, manufacturer, date given, site and route, edition of VIS given to parents, name & address of facility giving vaccine and the name of person administering
ALL vaccines reported

169
Q

illness and vaccinations

A

runny nose and cough is fine, fever DON’T give vaccine
strep is fine though you can give shot if you find it during well visit

170
Q

live vaccines

A

MMR
varicella

171
Q

postponed or spread vaccines

A

not as effective

172
Q

what to do if baby doesn’t want bottle

A

have someone else feed so they can’t smell mom
watch closely after 4w and in 1st month (babies miss hunger cues bc of pacifier but they don’t starve themselves, they know to wake up)
give bottle every not and then by the time they’re 2-3w old

173
Q

failure to thrive (FTT)

A

failing to demonstrate weight gain over prolonged period of time
may affect height and head circumference (measured for 2 years)
common w special needs
early screening
school is important bc it gives parents a reason to get physical done for kids
may have developmental delay or LOSS OF MILESTONES

174
Q

ADHD meds and FTT

A

appetite suppression
see child q3m then q1y

175
Q

feeding in FTT

A

may refuse feeding or have problems with sucking/progression from liquid to puree to texture

176
Q

developmental disability causes of FTT

A

(mental or physical or combination impairment that results in lifelong disability) - often contributes to FTT due to the child’s inability to consume adequate nutrition due to sensory or motor delays (Cerebral Palsy)

177
Q

organic causes of FTT

A

Inability to suck/swallow correctly, malabsorption, diarrhea, vomiting, alterations in metabolism & caloric/nutrient needs as in chronic illness. Cardiac, Metabolic or Pulmonary Diseases as well as cleft palate and GERD put the child considerably at risk. Feeding disorders as a result of long term ventilation or enteral tube feedings or even a choking episode can cause feeding aversions

178
Q

non-organic causes of FTT

A

Poverty, Neglect, abuse, behavioral problems, lack of appropriate maternal interaction, poor feeding techniques, lack of parental knowledge or parental mental illness

179
Q

nursing interventions for FTT

A

detailed history and 3-day food diary
parent-child interaction
observe feeding
is the nipple of the bottle too big that they’re choking?
small frequent feedings when sick

180
Q

feeds for FTT

A

enteral if it’s that bad
some PO so they still know how to suck and swallow (unless current NEC)

181
Q

infants and sickle cell

A

asymptomatic for 3-4 months bc of fetal hgb

182
Q

complications of sickle cell

A

splenic sequestration, reduced visual acuity related to decrease in retinal blood flow, chronic leg ulcers, cholestasis & gallstones, delayed growth & development, delayed puberty & priapism
increased enuresis bc kidneys can’t concentrate urine

183
Q

triggers for sickle cell***

A

STRESS
TRAUMA LIKE INFECTION
fever
DEHYDRATION
exertion
cold
hypoxia

184
Q

management of sickle cell

A

1.5-2x more fluid!!
GET KID VACCINATED
NSAIDS r not effective, meds are scheduled not PRN
prevent crisis and infection
prophylactic abx
nonpharm techniques w meds
OXYGEN, HYDRATION, PAIN MEDS
hgb, hct, and reticulocytes to determine if transfusion needed

185
Q

blood transfusion in sickle cell

A

hemolysis can cause increased K+, watch for SOB, palpitations, chest pain, N/V
give benadryl prior

186
Q

low BP in sickle cell

A

severe anemia or sickle cell neuropathy

187
Q

what 2 organs may enlarge in sickle cell

A

liver and spleen

188
Q

hemophilia

A

x-linked recessive
3 types

189
Q

hemophilia A is a deficiency in which factor

A

factor VIII (no clotting factor!)

190
Q

factor X

A

required for the conversion of prothrombin into thrombin, resulting in the inability of platelets to be used in clot formation

191
Q

never/always as an answer choice

A

DON’T PICK THEM

192
Q

good sport for hemophiliacs

A

swimming, running, tennis
we want to avoid high injury like football, skateboarding, and motorcycles

193
Q

when to administer factor

A

after getting hurt or before bleeding such as surgery, injections, and dental care

194
Q

bruising in hemophilia

A

bruising is bleeding
BAD!

195
Q

chest/abdominal pain in hemophilia

A

internal bleeding

196
Q

how is factor VIII given

A

SLOW IV PUSH

197
Q

ASA/NSAIDS for hemophilia

A

AVOID

198
Q

school and parent teaching for hemophilia

A

teach parents and pt how to give injections
heavy periods!
make school aware of diagnosis (alert parents of injury to head, abdomen, or orbit***)
medical ID bracelet!

199
Q

how to make pt involved in hemophilia care

A

younger children may want to hold bandaid
older children may want to help with dilution and mixing of factor
teach teens how to self administer

200
Q

severe hemophilia

A

frequent infusions
may have central venous access port

201
Q

von willebrand vs hemophilia

A

like hemophilia but not as bad
hemophilia is factor VIII, vwb is vwb factor
vwb is also fixed with desmopressin
von willebrand is genetically transmitted (dominant)

202
Q

von willebrand factor

A

binds to factor VIII to protect from breakdown
serves as glue to attach plts to site of injury

203
Q

bleeding seen in vwb

A

bruise easily, epistaxis (nosebleeds), bleeding after oral surgery, menorrhagia, chronic anemia

204
Q

desmopressin for vwb

A

raises plasma level from stores in endothelium of blood vessels which helps release VIII & vWF into the bloodstream
Administered before dental work/surgery
given nasally, IV, or sq
antidiuretic (watch fluid balance)
24h between doses or else tolerance builds

205
Q

what metabolism is impaired in diabetes

A

carb, protein, and lipids
insulin turning all this into energy so they’re always hungry

206
Q

type 1 vs 2 DM

A

1: deficiency of insulin due to beta cell damage
2: insulin resistance

207
Q

trigger for diabetes 1 onset

A

random virus like the common cold

208
Q

management of diabetic toddler

A

navigate pickiness by letting them pick their meals
find a word or phrase they can say when they feel hypoglycemic

209
Q

management of a diabetic preschooler

A

play therapy
have child participate when appropriate
simple explanations

210
Q

management of diabetic school-age child

A

concise and concrete terms
let child go at their own rate
test and inject during school day
plan for field trips
involve school nurse
have child participate but make sure parent supervises
regular attendance and extracurriculars
flexible care schedule
educate other care providers

211
Q

management of diabetic adolescent

A

minor parental supervision
find right balance of shared management
parents provide guidance and stay involved and assess adherence to care regimen
S&S of risky behaviors, EDs, depression
help teen transition to independence later and adult doctor

212
Q

weight loss in type 1 DM

A

Early stages dm1 will lose lots of weight at once (body breaking down muscle and fat bc energy can’t be converted from other sources)

213
Q

DKA

A

body uses fat instead of glucose for energy
leads to anorexia, N/V, lethargy, stupor, altered LOC, kussmaul respirations, air hunger, fruity or acetone breath, ketonuria, tachy, coma, and death

214
Q

DKA triggers

A

stress, surgery, or illness

215
Q

prolonged exposure to hyperglycemia can cause?

A

damage to blood vessels and nerves
failure to grow, delayed sexual maturation, retinopathy, skin infections, poor wound healing, neuropathy, nephropathy, cerebro/peripheral/cardiovascular disease, loss of limbs

216
Q

when to do blood glucose checks

A

before meals and bedtime AT LEAST
after meals and fasting in morning
keep food diary!

217
Q

A1c and recommended number

A

long term
<7.5%

218
Q

when to increase dosing of insulin

A

during stress, illness, or pubertal growth spurts

219
Q

benefits of continuous insulin pump

A

less injections
more accurate
easily adjusts
programmed to changes in activity, school days, weekends
RAPID ACTING ONLY

220
Q

diet for dm

A

Limit sweets, eat often avoid skipping meals, monitor carbohydrates, eat whole grains & fruits/veggies and limit fat

221
Q

exercise in dm

A

Can cause hyper and hypo-glycemia so tight glucose monitoring is important. In children with Type 2 DM, plays important part in weight control and hypoglycemic effects of medications

222
Q

monitoring for dm complications

A

eye exams
microalbuminuria screening
foot exams annually
lipid profiles esp dm2 annually
BP (HTN)
autoimmune disorders in dm1 (celiac and hyperthyroid)
EDs at 10-12yo
psychosocial distress at 7

223
Q

foods to give with hypoglycemia

A

simple carbohydrate such as orange juice followed by a complex carb such as peanut butter & crackers to maintain glucose levels

224
Q

DKA management

A

DON’T DROP GLUCOSE TOO QUICK! CEREBRAL EDEMA
fluids for dehydration and watch electrolytes
IV regular insulin

225
Q

education concepts for dm

A

basic concepts
15-20 min education for kids
45-60 min for caregivers
look at dev level (roleplay)

226
Q

what to include in dm education

A

glucose measurement
ketone testing in urine
proper med use
when glucagon is needed
S&S of hypo/hyperglycemia and treatment
diet and exercise
diary and follow up care
tight control and contact provider when child is sick (>2 days long)

227
Q

sick day rules

A

take meds as usual
check sugar q4h
extra fluids
weigh every day (losing weight means high glucose)
check temp (infection)
hard to control sugar

228
Q

amblyopia

A

lazy eye
IDENTIFY EARLY
untreated can cause blindness in weak eye (stronger eye is taking over)
normal in babies 6-8 weeks old

229
Q

management of amblyopia

A

wearing eye patch on stronger eye to help weak eye catch up
atropine in strong eye to make it blurry so weak eye can catch up

230
Q

nursing assessment of amblyopia

A

screen pre-schoolers 3+
look for asymmetry of corneal light reflexes
encourage child and parents to comply w treatment and education
strong eye injury can result in total blindness

231
Q

diplopia

A

double vision
one eye shuts off to compensate

232
Q

strabismus guidelines

A

should resolve by 3-6 months of age - IF PERSISTENT BY 4 months → refer to ophthalmologist
TREAT EARLY
patch, surgery, or corrective lenses

233
Q

what to ask parents of strabismus

A

does it occur more when child is tired? Does child bump into objects (depth perception issues), do they tilt their head, squint or close eyes in sunlight. Observe for obvious Eso/Exotropia. Corneal light reflex is helpful or the “cover test”

234
Q

AOM

A

bacterial or viral infection of fluid in the ear
TREAT IF THERE’S HIGH FEVER, CRY, OR YANK THE EAR
worried under age of 2 bc of language development

235
Q

when does AOM resolve

A

usually 2 weeks

236
Q

health history for AOM

A

Fever, ear pain, fussiness, crying, pulling at ears, poor feeding/appetite, difficulty sleeping, increased crying when lying down, drainage from ear

237
Q

nursing management of AOM (followup instructions)

A

supportive
analgesics, warm heat or cold compress
lie on affected side with heating pad or cold compress on that ear
see child in 2-3 days if no improvement or worsening
see doc after 2 weeks if no improvement

238
Q

prevention of AOM

A

breastfeeding bc antibodies
avoid upper resp infections
no 2ndhand smoke
immunize!

239
Q

otitis media with effusion

A

fluid, not infection
complications are AOM, hearing loss, deafness

240
Q

health history for otitis media w effusion

A

fullness of ear drum or popping sensation

241
Q

management of otitis media w effusion

A

can take months to fully resolve, focus on education and monitoring for hearing loss

242
Q

what not to give for otitis media w effusion

A

antihistamines, decongestants, abx, steroids

243
Q

how to feed baby with otitis media w effusion

A

NOT supine

244
Q

baby pushing you away during feeding

A

they’re massaging the breast this is good!

245
Q

persistence of primitive reflexes

A

All but Babinski diminish over the first few months of life - Persistence of primitive reflexes in children over a year may indicate abnormality of the neurologic system and must be investigated

246
Q

why is head trauma so prevalent in kids

A

they TODDLE
big heads, center of gravity is off
high activity level, curiosity, incomplete motor development, lack of knowledge & judgment skills

247
Q

hitting front of head

A

will have a big egg for 4-6 weeks then blood absorbs back in
better than hitting the back

248
Q

kids choking

A

they hide and don’t know to get help because they probably did something they weren’t supposed to do

249
Q

furniture and kids

A

anchor them to the wall so they don’t topple over
2 year olds are curious, 3 year olds wanna die

250
Q

nursing assessment of traumatic brain injury

A

Events surrounding injury
Mental status
loss of consciousness BAD
irritability, lethargy, abnormal behavior
vomiting (if so how many times) BAD
seizure activity
headache, vision change. neck pain
Asymmetry (facial palsy) VERY IMPORTANT
Combativeness

251
Q

physical exam of TBI

A

ABCs
neuro assessment (LOC, pupils, seizure activity, prompt intervention!)

252
Q

mild to moderate head injury

A

brain injury w no penetrating injury
no LOC or injury to other parts of body, normal behavior
minor cognitive changes for the first few days are normal (may have hard time paying attention, be forgetful, or not understand things properly)
usually full recovery
take it easy bc second one after first hasn’t recovered is bad

253
Q

watching child after minor head injury

A

stay w child for 24h
sleep w them
wake child q2-4h
after 6 hours you’re usually good but still

254
Q

when to bring child to ER after head injury

A

Constant headache that gets worse
Slurred speech
Dizziness that does not go away
Extreme irritability or other abnormal behavior
Vomiting more than two times (really more than once because of ICP)
Clumsiness or difficulty walking
Oozing blood or watery fluid from ears or nose
Difficulty waking up
Unequal-sized pupils
Unusual paleness that lasts longer than 1 hour
Seizures
Sx increased ICP

255
Q

severe head injury

A

usually LOC
requires ICU

256
Q

focuses in severe head injury

A

ABCs
Neurologic checks
Prevent/cease seizure activity
Treating other injuries relating to trauma (prioritize brain injury tho)
Monitor changes in LOC
Sx Increased ICP
Monitor for complications (hemorrhage, infection, cerebral edema and herniation)

257
Q

nonaccidental head trauma

A

high risk of injuries from child abuse
shaken baby syndrome bc big head and weak muscles

258
Q

shaken baby syndrome (SBS)

A

have parents watch educational video
teen parents and caregivers*
NO INTENT TO CAUSE HARM***

259
Q

when do we find out extent of damage by SBS

A

YEARS
many of them have profound intellectual disability, spastic quadriplegia, or severe motor dysfunction/blindness

260
Q

how does SBS present itself

A

as increased ICP
always question why children are coming in with ICP
pay attention to explanation of story and be aware of discrepancies/previous head injury that can’t be explained

261
Q

S&S of SBS

A

poor feeding, sucking, vomiting, lethargy or irritability, failure to thrive, increased sleeping, difficulty arousing, seizure, apnea, bradycardia, decreased LOC or bulging fontanel.
Could also be a brain tumor or something
For SBS there is usually no evidence of external trauma however intracranial and intraocular hemorrhages is classic presentation (HALLMARK)

262
Q

risk factors of SBS

A

Single parent, young parent, substance abuse parent, premature/sick infant, infant with colic and families with financial/social/physical burdens
Do the postpartum depression test
Late afternoon and evening time can be difficult because they cry more (purple period)

263
Q

results of child abuse

A

physical injury, poor physical health and in some cases impaired brain development
Leads to developmental, cognitive and behavioral problems
poor academic achievement and deficits in relationships

264
Q

risk factors for child abuse

A

poverty, prematurity, cerebral palsy, chronic illness or intellectual disability
parent being abused, substance abuse or extreme stress
Does child hurt self or others, run away, attempted suicide, or high risk behaviors
inappropriate sexual behavior (chronic sore throat, chronic genital complaints that indicate sexual abuse)
nonspecific symptoms consistent with emotional abuse
Low self-confidence, sleep issues, hypervigilance, head or stomach ache

265
Q

physical exam of child abuse

A

Inspect skin for bruising, burns, cuts abrasions, scars, contusions or anything suspicious
especially when multiple injuries are in different stages of healing

266
Q

risk factors of substance abuse

A

family history of substance abuse, parental use, dysfunction in the family, mental health disorders, aggressive behaviors, poor self esteem, negative life events, poor social skills or friend groups that use substances

267
Q

nursing management of substance abuse

A

Help child acknowledge they have a problem
Discuss negative consequences of substance abuse
Remain empathetic while leaving the responsibility with the adolescent
Refer to substance abuse program if applicable
Prevention is important and building trusting relationships with children/adolescents is key

268
Q

Spiral fracture

A

comes from arm being twisted, SUSPICIOUS

269
Q

nursing management of fractures

A

Cold therapy for first 48 hours -reduce swelling
Elevate above level of the heart
Neurovascular checks*** (pulses)
Administer Tetanus booster for open fractures if not gotten booster in last 5 years
External fixation for complicated fractures

270
Q

tractions/splints

A

immobilizes and aligns injury
external fixation

271
Q

5 Ps of fractures

A

pain
pallor
pulse
paresthesia
paralysis

272
Q

when to do scoliosis testing

A

YEARLY DURING PUBERTY

273
Q

degrees in scoliosis

A

more than 10 degrees
25-45 degrees = brace
45 degrees+ = surgery

274
Q

effect of scoliosis on other body systems

A

cardio and resp affected

275
Q

nursing management of scoliosis

A

Encourage compliance with bracing
Must be worn 18 hours per day
Skin integrity
Might wear tank top under it
Is often uncomfortable
Teens are concerned with body image
Inspect skin for evidence of breakdown from rubbing by the brace - teach family about proper skin care and checking brace for fit and area of breakage
express body image concerns
deep breathing (coughing=resp compromise)

276
Q

Kawasaki followup care

A

Irritability can last for 2 months
Monitor temp for a few days after discharge
ROM
Don’t get MMR or varicella for 11 months
cardio follow up in a few years

277
Q

IV albumin and diuretics

A

nephrotic syndrome
give diuretic immediately to have optimal diuresis and prevention of overload

Peds (4 decks)

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