Exam 2 Peds - Summary Set Flashcards
children ages 6-12 should grow about ___ lbs per year
5
children ages 6-12 should grow about ___ inches in height per year
2
when do the lungs fully mature?
age 6-8
____ injuries are common in children ages 6-12
overuse
name at least 3 cognitive developments of children ages 6-12
(1) mastering skills
(2) language - rapid development
(3) logical thinking
(4) perspective (others)
(5) increased attention span
(6) understanding major concepts
ages 6-12 is the age of ___
exploration
brain size is complete by age ___
10
learning rules of interactions, social rules, and self-esteem occurs at which age?
ages 6-12
____ peaks in school-aged and up through teen years in the US
obesity
obesity in children can lead to what 3 health issues?
(1) fatty liver
(2) high cholesterol
(3) high BP
____ are strange teeth formations
malocclusions
ages 6-12 should get ___ hours of sleep/night
9-10
____ are changes to adrenal gland and release of androgen
adrenarche
puberty can start as young as ___ in females
8
___ is when secondary sex characteristics begin, tanner stage 2-3
thelarche
____ onset is 16
menarche
____ is tanner stage 3-4, 1.5-2 years after Thelarche, linear growth slows
Menarche
growth is complete ____ years after menses for girls
1-1.5 years
___ have a longer and slower process for sexual development
males
___ is testicular enlargement that starts around age 14 (as early as age 9)
gonardarche
tanner stage 2 is associated with ____
gonadarche
pubic hair and penile growth are characteristic of Tanner stage ___
3
peak height velocity, muscle over fat is what Tanner stage?
Tanner stage 4
growth is complete by Tanner stage
5
Treat ____ as a normal part of growth and development
sex
name at least 3 considerations for working with school-aged kids
(1) consistent limits
(2) realistic expectations
(3) family responsibilities
(4) natural consequences
(5) communication with teachers
name at least 3 stressors in school-aged kids
(1) food insecurity
(2) anxiety
(3) bullying
(4) over-scheduling
name at least 3 traits of early adolescence (11-14)
(1) same-sex friends
(2) egocentric
(3) “imaginary audience”
(4) “invincibility”
name at least 3 traits of middle adolescence (15-17)
(1) platonic to romantic
(2) peer group conformity
(3) impulsive and impatient
(4) negotiate choices & limits
name at least 3 traits of late adolescence (18-21+)
(1) idealistic, modified by experience
(2) uniqueness prevails
(3) relationships less turbulent
(4) mature social relationships
(5) emancipation & career goals
higher reasoning, impulse control, and emotional lability will continue to develop until around ____ age
26 yo
name 3 cognitive developments of adolescents
(1) concrete to abstract
(2) focus on community / society
(3) decision-making
(4) consequences of alternatives
(5) prioritization
seeking autonomy, parental relationship shifts, and peer relationships as primary role are characteristic in what age group?
adolescents
nursing considerations when working with adolescents include:
(1) allow space for private conversation
(2) explain limits of confidentiality
(3) ask open-ended questions
Name at least 3 decisions that can impact adolescent health
(1) tattoos / piercings
(2) tanning
(3) substance use
(4) sexual activity
what should you screen for in a sexual risk assessment?
(1) consent
(2) number of partners
(3) pregnancy
(4) STIs
what does the daily discrimination tool tell us?
if you score higher on the scale, you are more likely to have health-related issues d/t discrimination
mental health routine screening is recommended at age ____
10 yo
____ is a suicide screening tool
ASQ
____ is characterized by uncontrolled growth and spread of abnormal cells, which, if not adequately treated, results in death
cancer
most childhood cancers arise from the ____
mesoderm
what two cancers make up the majority of pediatric cancer diagnoses?
(1) leukemia
(2) lymphoma
what is the #1 cause of death in children by disease?
cancer
how do we prevent cancer in childhood?
not yet possible
early detection in childhood vs. adulthood
childhood - usually accidental, no screening
adulthood - possible with screening
stage at diagnosis - childhood vs. adult
80% metastatic in childhood
local or regional in adulthood
the response to chemo in childhood is ___
very chemosensitive
what are the effects of treatment in childhood?
(1) decreased acute toxicity
(2) increased long-term effects
name at least 4 childhood cancer warning signs
(1) pallor, bruising, bleeding
(2) general bone pain
(3) lumps or swelling
(4) unexplained weight loss
(5) fever
(6) sweating at night
(7) eye changes
(8) abdominal swelling
(9) headaches, dizziness
what is the goal of the children’s oncology group (COG)?
share protocols freely to provide state-of-the-art care
low birthweight is associated with which cancer?
hepatoblastoma
there are possible correlations between certain ____ and leukemia
medications
chemotherapy typically lasts ___
3 months to 2.5 years
the function of chemo is
to target rapidly dividing cells to slow or stop growth
what are the 3 routes for chemo in children?
(1) oral
(2) IV
(3) intrathecal
children need ____ doses of chemo, compared to adults
higher
___ is critical in delivering chemotherapy
timing
what is combination chemotherapy?
(1) combines 2 or more agents
(2) together or in a planned sequence
(3) produces higher response rates
T/F: Children’s organ systems can tolerate higher doses of chemo
T
the most common short-term effects of chemo are ___ and ___
bone marrow suppression; mucositis
___ is sores in the mouth and GI tract
mucositis
name the 5 short-term effects of chemo
(1) bone marrow suppression
(2) mucositis
(3) N/V
(4) neuropathy
(5) hair loss
name the 5 long-term / late effects of chemo on children:
(1) cognitive changes
(2) cardiac, pulmonary, GI, renal issues
(3) hearing issues
(4) fertility and other endocrine issues
(5) second malignancies
____ is a treatment option for solid tumors
surgery
name 4 common tumors in children
(1) brain tumors
(2) Wilms
(3) neuroblastoma
(4) osteosarcoma
what is the goal of radiation therapy?
deliver therapeutic dose while sparing healthy cells as much as possible
which type of radiation is more specific, delivers a low dose in front of tumor, and minimal exit radiation?
proton beam
____ are calculations to figure out the exact angle of the radiation
dosemetry
what therapy can be super painful?
biotherapy - immunotherapy
name 2 types of biotherapy / immunotherapy
(1) monoclonal antibodies
(2) adoptive cell transfer
____ are drugs designed to bind to specific targets in the body
monoclonal antibodies
____ boosts the natural ability of T cells to fight cancer
adoptive cell transfer
____ aims to more selectively attack the cancer cell or its immediate supportive environment
precision medicine
one of the most common treatments for leukemias and lymphomas that are resistant to other types of treatment is ____
stem cell transplant
name at least 3 nursing considerations for cancer treatment
(1) manage pain and symptoms
(2) monitor for signs of infection
(3) optimize nutrition, growth, and development
(4) provide education
(5) assess coping
(6) optimize strength and mobility
severe neutropenia is ____
absolute neutrophil count (ANC) < 500 mm^3
neutropenia +/- ____ creates high risk for infection
fever
name at least 3 priorities for someone with severe neutropenia
(1) HH
(2) avoid ill contact (no school)
(3) daily bath and oral cares
(4) nothing rectally
(5) awareness of implanted devices
(6) potential medical emergency
(7) cultures and abx within an hour
severe thrombocytopenia is ____
<25,000
what are the 2 priorities with thrombocytopenia?
(1) watch for bruising, bleeding, epistaxis, and heavy menses
(2) avoid NSAIDs and contact sports
when should someone with anemia receive a transfusion?
Hgb < 7-8 g/dL
dizziness, fatigue, and SOB are symptoms of ____
anemia
the routine lab / blood count for neutropenia is ___
CBC with diff and platelets
name at least 4 ways to manage N/V symptoms
(1) small, frequent meals
(2) high protein and caloric foods
(3) monitor fluids
(4) avoid strong odors
(5) administer antiemetics
(6) aromatherapy
(7) sea bands
(8) acupressure
name at least 3 ways to manage mucositis
(1) oral cares 2x daily
(2) manage pain
(3) special rinses
(4) keep up intake - can even switch to NGT if needed
3 ways to manage fatigue in children with cancer is
(1) yoga
(2) PT for rehab or structured activity
(3) nutrition
name at least 3 ways to manage neuropathies
(1) footboard in bed to prevent foot drop
(2) high-top shoes
(3) PT/OT
(4) encourage mobilization
(5) medications for neuropathic pain
3 ways to address diarrhea / constipation in cancer patients is:
(1) increase dietary fiber
(2) monitor fluids
(3) mush, then push
name at least 3 considerations related to mood / coping with cancer patients
(1) body image
(2) high symptom burden
(3) isolation
(4) provide socialization
(5) provide space
(6) involve psychosocial team
the 3 most common types of cancer are:
(1) leukemias
(2) lymphomas
(3) CNS tumors
high-grade gliomas and DIPG have ___ outcomes
poor
in the last 20 years, almost every diagnosis has seen an uptick in ____
survival rates
name at least 3 improvements based on COGS studies
(1) reduced radiation
(2) reduce dose and frequency of chemo
(3) targeted therapy
(4) earlier referrals to palliative care
____ is low RBC count that leads to decreased O2 supply to the cells
anemia
the 2 main causes of anemia are ___ and ___
iron deficiency; genetic syndromes
name at least 3 s/s of anemia
(1) pallor
(2) fatigue
(3) muscle weakness
(4) SOB
(5) dizziness
(6) tachycardia
which treatment for anemia is common but has low compliance?
oral iron
if oral iron is not being taken, you can switch to ____
iron infusions
what do you treat anemia with if it is really severe?
transfusions (PRBCs)
4 nursing considerations for anemia are
(1) constipation / diarrhea
(2) N/V
(3) monitor labs
(4) provide rehab
___ is often triggered by illness, infection, fever, or dehydration
sickle cell
SOB, congestion, pain, jaundice, headache, and hematuria are all S/S of ____
sickle cell
name at least 3 long-term consequences of sickle cell
(1) osteomyelitis
(2) retinal detachment / blindness
(3) renal failure
(4) cirrhosis
(5) hepatomegaly
(6) skeletal deformities, avascular decrosis
delay in tx of sickle cell can result in:
(1) severe dehydration
(2) hypovolemic shock
(3) stroke
(4) CVA
(5) acute chest syndrome
what are the first two priorities in patients with sickle cell?
(1) fluids
(2) pain management
what is the primary medication for sickle cell?
hydroxyurea
how old does the child need to be to receive hydroxyurea?
at least 6-7 yo
name 6 treatments for sickle cell
(1) fluids
(2) pain management
(3) antibiotics
(4) O2
(5) RBCs
(6) stem cell transplant
name at least 3 nursing considerations for sickle cell
(1) pain management
(2) treat and prevent infection
(3) monitor F&E
(4) provide education
(5) mobilization
(6) monitor for CVA
____ is a deficiency in clotting factors
hemophilia
hemophilia is often identified in infants during ____
circumcision
the most common type of hemophilia is ____
hemophilia A
hemophilia A is a deficiency in ____
factor VIII
name at least 3 s/s of hemophilia
(1) nose bleeds (epistaxis)
(2) bruising
(3) excessive bleeding
(4) joint pain
(5) headache / changes in speech / LOC
2 long-term consequences of hemophilia are:
(1) joint deterioration
(2) stroke
the main priority for hemophilia is ___
administer exogenous factor and blood products
name at least 3 nursing considerations for hemophilia
(1) teach parents how to administer exogenous factor
(2) monitor for bleeding
(3) control bleeding and RICE
(4) provide pain mgmt
(5) provide education
(6) rehab for strengthening
(7) low contact activities
____ still includes curative care, while ____ is when we stop trying to cure the disease
palliative care; hospice
name the 5 goals of palliative care
(1) establish trust
(2) review and prioritize goals of care
(3) provide optimal pain and symptom management
(4) add layer of support
(5) provide anticipatory guidance
____ is the specialty of palliative care
ongoing pain and symptom management
T/F: Kids who receive palliative are earlier tend to live longer than those who delay palliative care
T
3 common conditions seen in palliative care are:
(1) neurodegenerative disorders
(2) CHD
(3) genetic disorders
name at least 3 nursing considerations for palliative and hospice care
(1) manage pain and symptoms
(2) provide support
(3) create space
(4) be present
(5) involve and update teammates
when the esophagus doesn’t form a continuous tube
esophageal atresia (EA)
an abnormal connection between the esophagus and trachea
tracheoesophageal fistula (TEF)
3 s/s of EA with distal TEF are:
(1) feedings that cause regurgitation and coughing
(2) constant flow of saliva
(3) gastric distention
the treatment for EA with TEF is ____
surgical repair
what are the nursing considerations for someone with EA and TEF?
(1) no oral feeding
(2) need IV access
(3) may be associated with a syndrome
(4) surgery as neonate
(5) at risk for infection (lung or pneumonia)
____ is a hole in the diaphragm in utero
congenital diaphragmatic hernia
congential diaphragmatic hernia results in ___ and ___
GI issues; respiratory impairment
congenital diaphragmatic hernia treatment
requires urgent surgical repair after birth or fetal surgery
name at least 3 nursing considerations for congenital diaphragmatic hernia
(1) requires mechanical ventilation
(2) underdeveloped lungs
(3) chronic issues
(4) parental support during fetal surgery
a potential long-term result of congenital diaphragmatic hernia is ____
restrictive lung disease
____ is a defect near the umbilicus where there is an opening and some of the abdominal contents is outside of the body
oomphalocele & gastroschesis
name at least 3 nursing considerations for oomphalocele and gastroschesis
(1) nutrition - parenteral and decompression
(2) infection risk
(3) fluids b/c of increased loss
(4) respiratory support
(5) watch for necrotizing entercolitis
____ requires primary or staged surgical intervention
oomphalocele & gastroschesis
___ may result in chronic GU issues
imperforate anus
name at least 3 nursing considerations for imperforate anus
(1) parenteral nutrition and decompression
(2) fluid losses
(3) constipation
(4) bowel and bladder function
(5) parental support
name 3 reasons why children have a higher risk of fluid loss
(1) higher body surface area
(2) higher respiratory rates
(3) higher metabolic rates
the 4 main causes of diarrhea in peds are:
(1) intestinal infection
(2) intestinal obstruction or intussusception
(3) malabsorption
(4) inflammatory bowel disease
what are 4 red flags in diarrhea?
(1) blood
(2) fever
(3) poor growth
(4) severe belly pain
4 main causes of GI pain in peds are
(1) appendicitis
(2) acute gastroenteritis
(3) UC
(4) Crohn’s
RLQ is characteristic of ___
appendicitis
we will always see N/V in ____
appendicitis
the biggest differentiator between UC and Crohn’s is…
UC - pus or blood in stools
Crohn’s - constipation; sometimes rectal bleeding
diarrhea, N/V, fever, crampy, and poor intake are characteristic of ___
acute gastroenteritis
frequent urge to defecate is ___
tenesmus
pus or blood in stools, rectal bleeding, poor appetite, and tenesmus are s/s of ___
ulcerative colitis (UC)
key s/s of Crohn’s are
(1) constipation
(2) night sweats
(3) loss of menstrual cycle
(4) tenesmus
____ is when the body is unable to absorb nutrients
Short Bowel Syndrome
SBS can occur in the neonatal period if they experience ___
necrotizing enterocolitis
3 s/s of SBS are
(1) loose, watery stool
(2) hard time gaining weight
(3) failure to thrive
___ is the treatment for SBS
long-term parenteral nutrition (TPN)
what is the risk of long-term TPN?
can lead to total liver failure or definite liver issues by around 5-6 yo
name at least 3 nursing considerations related to SBS
(1) risk for infection
(2) risk for altered fluid balance
(3) poor weight gain
(4) liver failure
(5) liver / bowel transplant
fungal overgrowth from candida is ___
oral thrush
the most common reason for thrush is ____
baby’s falling asleep with a bottle in their mouths
oral thrush is common in…
(1) infants
(2) immune disorders
(3) DM
(4) antibiotic overuse
how do you treat thrush?
(1) antifungal lozenge
(2) swab
(3) rinse
___ is caused by coxsackie virus
hand foot and mouth
how is hand foot mouth spread?
contact
how do you treat hand foot mouth?
(1) supportive care - manage fever and pain
(2) no effective treatment!
3 s/s of hand foot mouth are
(1) fever
(2) sore throat
(3) blisters
viral illness - parvovirus is ___
fifths disease
how is fifths disease spread?
droplet infection
name at least 3 s/s of fifths disease
(1) headache
(2) runny nose
(3) low-grade fever
(4) lacy rash
___ is caused by herpes virus
roseola
high fever and flat rash on trunk and neck is characteristic of ____
roseola
how do you treat roseola?
(1) control fever
(2) monitor for seizures
(3) supportive care
____ is caused by untreated strep throat
strep rash / scarlet fever
what age group can get scarlet fever?
5-15 yo
name 3 s/s of strep rash / scarlet fever
(1) sore throat
(2) high fever
(3) diffuse bumpy rash
(4) red tongue / “strawberry”
we treat strep rash / scarlet fever with ____
antibiotics
____ conjunctivitis is VERY contagious
bacterial
we can see purulent drainage in ____ conjunctivitis
bacterial
redness, swelling, and sensitivity to light are s/s of ____
pink eye / conjunctivitis
how do you treat pink eye / conjunctivitis?
(1) depends on cause
(2) bacterial - ABX
(3) clogged duct or viral - no abx
how is head lice spread?
direct contact
itching, sores on head, neck and shoulders are characteristic of
head lice
____ is difficulty to treat
head lice
spinosad, malathion, and ivermectin are all meds to treat ____
head lice
____ is the least developed system at birth
endocrine
when does the endocrine system reach full functioning?
12-18 months of age
what hormones does the anterior pituitary secrete?
(1) adrenocorticotropin
(2) TSH
(3) FSH
(4) LH
(5) prolactin
(6) GH
what hormones does the posterior pituitary secrete?
(1) vasopressin
(2) oxytocin
____ is an aplastic, underdeveloped thyroid gland or poor TSH secretion
congenital hypothyroidism
name at least 3 s/s of congenital hypothyroidism
(1) low T4, high TSH
(2) large tongue
(3) hypotonia
(4) distended abdomen
(5) slow reflexes
(6) large anterior fontanelle
(7) skin mottling
congenital hypothyroidism treatment
lifelong levothyroxine
congenital hypothyroidism effect
can lead to irreversible cognitive impairment
congenital hypothyroidism nursing considerations
(1) newborn screen
(2) monitor levels
(3) education
___ is an autosomal recessive disorder
congenital adrenal hyperplasia
name at least 3 s/s of congenital adrenal hyperplasia
(1) dehydration
(2) failure to thrive
(3) hyponatremia
(4) hyperkalemia
congenital adrenal hyperplasia treatment
lifelong glucocorticoid treatment
congenital adrenal hyperplasia effect
(1) ambiguous genitalia in females
(2) salt wasting
congenital adrenal hyperplasia nursing considerations
(1) newborn screen
(2) monitor electrolytes
(3) dose adjustments when ill
(4) education
the 2 acquired endocrine disorders of the thyroid are __ and __
hypothyroidism; hyperthyroidism
acquired hypothyroidism causes
(1) autoimmune
(2) enlarged thyroid (goiter)
acquired hypothyroidism s/s
(1) dry, thick skin
(2) coarse, dull hair
(3) fatigue
(4) constipation
(5) weight gain, edema
acquired hypothyroidism treatment
thyroid hormone replacement
acquired hypothyroidism nursing considerations
(1) monitor weight
(2) monitor bowel function
(3) monitor cognitive function
(4) growth & development
causes of acquired hyperthyroidism are ___ and ___
autoimmune; graves disease
acquired hyperthyroidism s/s
(1) diarrhea
(2) weight loss
(3) prominent eyes
(4) hyperactivity / nervousness
(5) increased HR and BP
(6) muscle weakness
acquired hyperthyroidism treatment
(1) antithyroid medication (PTU)
(2) ablation
acquired hyperthyroidism nursing considerations
(1) optimize mobility
(2) growth & development
____ is 10x more likely in girls than in boys
precocious puberty
the biggest problem with precocious puberty is ____
it can cause growth limitations
onset of precocious puberty in girls starts at about age ___ and the cause is ____
8; idiopathic
onset of precocious puberty in boys starts at age ____ and the cause is ____
9; usually associated with a genetic syndrome
what is the main goal of treatment for precocious puberty?
stop / reverse development of secondary sexual characteristics
what is the treatment for precocious puberty?
hormone agonists
name s/s of growth hormone deficiency
(1) hypoglycemia
(2) height < 5th percentile
(3) cherubic face
(4) increased body fat to muscle
___ may be associated with Turner’s or Prader-Willi syndromes
growth hormone deficiency
how do you treat GH deficiency?
(1) daily SQ injections of GH
(2) manage self-esteem
T1DM diagnosis peak age is
12 yo
name 4 genetic and environmental factors at play with T1DM
(1) infections
(2) dietary toxins
(3) obesity
(4) chemical exposure
name at least 4 s/s of T1DM
(1) polyuria
(2) polydipsia
(3) polyphagia
(4) fatigue
(5) blurred vision
the 3 treatments for T1DM are ___, ___, and ___
SQ insulin, diet, and exercise
SQ insulin is fastest absorbed in the ___
abdomen
SQ insulin is slowest-absorbed in the
thighs
s/s of hypoglycemia
(1) clammy
(2) sweaty
(3) pale
(4) tachycardia
(5) slurred speech
(6) decreased LOC
(7) seizure
hypoglycemia, glucose is ___
<60 mg/dL
causes of hypoglycemia
(1) too much insulin
(2) excessive activity
(3) poor intake
hypoglycemia treatment
(1) 15 g of carbs
(2) glucagon if LOC / seizures
hyperglycemia s/s
(1) fatigue
(2) thirst
(3) blurred vision / headaches
(4) weight loss
(5) headache
(6) emotionally labile
hyperglycemia blood glucose levels
> 160 mg/dL
hyperglycemia causes
(1) excessive intake
(2) poor activity
(3) insufficient insulin
hyperglycemia treatment
(1) insulin
(2) increased activity
DKA s/s
(1) acetone / fruity breath
(2) kussmaul breathing
(3) sunken eyes
(4) n/v
(5) increased HR and RR
(6) decreased UO
(7) dry mouth and lips
(8) lethargy
(9) coma
DKA blood glucose levels
> 200 mg/dL
DKA causes
(1) excessive stress
(2) insufficient insulin
DKA treatment
(1) IV Fluids
(2) IV Insulin
insulin should be ____ not ____ to mix
rolled; not shaken
regular insulin peaks in ____
2-3 hours
example of rapid-acting insulin
Humalog, Novolog
rapid-acting insulin peak is
30-60 minutes
when mixing insulin in a syringe, which should come first?
short-acting, then long-acting (cloudy)
NPH insulin peak
4-10 hours
Lantus is an example of ____
long-acting insulin
Apidra is ____ insulin
rapid-acting
add ____ g of carbs for each 45-60 minutes of exercise
15-30
glucose levels in infants
90-130 mg/dL
glucose in toddlers should be
100-180 mg/dL
3 key s/s of T2DM are
(1) fatigue
(2) blurred vision
(3) frequent urination
the biggest long-term risks of T2DM are
HTN and HLD
front-line therapy for T2DM is
diet, exercise, and oral agents
long-term consequences of T2DM are:
(1) retinopathy
(2) cardiovascular disease
(3) peripheral neuropathy
(4) nephropathy
___ youth are more likely to be referred to juvenile system than mental health provider
BIPOC youth
what are the 4 types of externalizing disorders?
(1) oppositional defiant disorder (ODD)
(2) conduct disorder (CD)
(3) ADD/ADHD
(4) autism spectrum disorder (ASD)
what are the 4 categories of internalizing disorders?
(1) depression and mood disorders
(2) anxiety disorders
(3) feeding and eating disorders
(4) trauma and stressor-related disorders
name the 6 risk factors for externalizing disorders
(1) genetics
(2) child abuse history
(3) environmental adversity
(4) poor family functioning
(5) parents with disorders
(6) SES
name at least 3 temperamental traits of someone with an externalizing disorder
(1) high anxiety
(2) distractibility
(3) high intensity
(4) poor reaction to new stimuli
(5) poor adaptability
(6) strong-willed
(7) low sensory threshold
(8) negative mood
persistent pattern or resistance to authority, angry outbursts, and blaming others
oppositional defiant disorder (ODD)
breaks the law, antisocial behavior, aggressive towards people and animals, steals, and destroy property
conduct disorder (CD)
name 3 ways to support someone with ODD or CD
(1) cue for transitions
(2) low stimulus environment
(3) graceful exit
(4) realistic choices to give some control
name at least 3 complications associated with ADD
(1) accidents
(2) school or job failure
(3) substance abuse
(4) depression
(5) anxiety
(6) relationship / family stress
(7) delinquency
the 3 sub-types of ADD are…
(1) inattentive
(2) hyperactive / impulsive
(3) combined
what is the criteria for ADD diagnosis?
(1) inattention
(2) hyperactivity
(3) impulsivity
name at least 3 potential risk factors for ADD
(1) exposure to lead or pesticides
(2) low birth weight
(3) premature birth
(4) brain injury
what may worsen but does NOT cause ADD?
(1) watching too much TV
(2) eating sugar
(3) family stress
(4) trauma
considerations for preschoolers with ADHD
(1) childcare issues
(2) family relationships
(3) social skills
considerations for school-aged children with ADHD
(1) childcare issues / summer camp
(2) family relationships
(3) social skills
persistent deficits in social communication and social interaction
autism spectrum disorder (ASD)
____ is characterized by restricted, repetitive patterns of behavior, interests, or activities
ASD
3 potential risk factors for ASD are
(1) older parents
(2) genetics
(3) environmental exposure
name at least 3 ways externalizing disorders may affect executive functioning
(1) organization and planning
(2) problem solving
(3) working memory
(4) considering previous experience
(5) separate feelings from problem
name at least 3 ways externalizing disorders may affect social functioning
(1) paying to attention to social cues
(2) connecting cues to past experiences
(4) planning and responding to outcomes
name at least 3 nursing considerations for children with ADD and ASD
(1) short, clear instructions
(2) daily routine
(3) break tasks into smaller portions
(4) get child’s attention
(5) cue transitions
(6) manage stimulation
name at least 3 nursing considerations for ODD/CD
(1) teach collaborative problem-solving
(2) set clear rules and consequences
(3) be nonjudgmental
(4) work on talking vs. acting out
____ is the best form of de-escalation
prevention
patients with ____ need consistent limits to help them feel safe and contained
reactive attachment disorder (RAD)
RAD has a higher prevalence in ___
kids in multiple settings in a short amount of time
name at least 3 risk factors for RAD
(1) early trauma
(2) removed from caregivers
(3) multiple parent figures
(4) neglect
(5) institutional care
name at least 3 s/s of RAD
(1) lack of positive emotions
(2) avoidant of eye contact / touch
(3) tantrums / anger
(4) limited social interactions
(5) withdrawn
s/s of disinhibited social engagement disorder (DSED)
(1) breaks rules
(2) attention-seeking
(3) overly affectionate
(4) poor boundaries
(5) inappropriate social behavior
children with RAD are at risk for…
(1) developmental delays
(2) mood disorders
(3) school issues
(4) relationship issues
(5) risk-taking
____ is the most common mental health condition
anxiety
only about ___% of children with anxiety receive treatment
36.9
about ____% of children 13-18 have anxiety
25%
MDD, persistent depressive disorder, BPAD, SAD, and PMDD are examples of ____
mood disorders
_____ and ____ disorders can affect the ability to learn, thrive, and grow
anxiety; mood
3 biological nursing considerations for anxiety and mood disorders
(1) improve sleep
(2) reduce stimulants
(3) maintain adequate diet and eating patterns
4 behavioral nursing considerations for anxiety & mood disorders
(1) muscle relaxation and breathing
(2) imagery / meditation
(3) behavioral modification
(4) behavioral activation
cognitive interventions for anxiety & mood disorders
(1) distraction
(2) positive self-talk
(3) CBT
(4) psychoeducation
social interventions for anxiety & mood disorders
(1) stress and time management
(2) family psychoeducation and/or therapy
(3) increased social contact
(4) group therapy
we screen for suicide as young as ____
10 yo
higher social media use is associated with _____
higher anxiety incidence and symptoms
name at least 3 types of child maltreatment
(1) physical abuse
(2) sexual abuse
(3) mental injury
(4) threatened injury
(5) neglect
(6) substantial child endangerment
T/F: Failure to report is a misdemeanor
T
how do you make a report as a mandated reporter?
verbal - within 24 hours;
written - within 72 hours
call ____ when immediate safety is not a concern but maltreatment is suspected
CPS
call ____ when immediate safety is an issue
law enforcement (LE)
what are the only two services in MN that can put a hold on a child to keep them for 48 to 72 hours?
CPS and LE
___ determines if an investigation is warranted
CPS
if investigations are positive, it goes to ___
criminal or civil court
T/F: Corporal punishment is legal in MN
T
___ is NOT a primary prevention option for child maltreatment and abuse
CPS
while a child is on a protective hold, who is the legal decision-maker?
the parent
name at least 3 signs of abuse in children
(1) histories are inconsistent with injury
(2) delay in seeking medical care
(3) changing story
(4) physical signs
name at least 3 physical signs of abuse
(1) bruises on infants
(2) bruises on face, trunk, hands, ears, genitalia, or butt
(3) patterned bruises or burns
(4) fracture of ribs, sternum, and scapula
(5) shaken baby
___ is a leading cause of serious injury in small children
abusive head trauma
premature infants, twins, children with moms < 18, and children in military families are at higher risk for ____
incidence of head trauma
___ is failure of a caregiver to provide needed food, clothing, shelter, medical or mental healthcare, education, or appropriate supervision
neglect
evidence collection window for SANE pre-pubertal
up to 24 hours
evidence collection window for SANE post-pubertal
up to 72 hours
2 emotional signs of secondary traumatic stress
(1) feeling numb
(2) feeling overwhelmed or hopeless
___ is a physical sign of secondary traumatic stress
low energy / fatigue
changing routine and self-destructive behavior may be signs of ___
secondary traumatic stress
___ is the most common congenital condition
congenital heart disease
what is the order of cardiac physical assessment?
inspection
auscultation
palpation
____ is a sign of advanced CHD
nail clubbing
why do we monitor HR and BP?
we want to track over time to look at trends
___ is the #1 acquired heart disease in children in the US
Kawasaki Disease
what is the diagnosis for Kawasaki disease?
history of fever for 5 days AND 4 or more of the following:
(1) conjunctivitis w/o exudate
(2) nonspecific skin rash
(3) fissured lips and erythema of the buccal mucosa
(4) cervical lymphadenopathy
(5) palmar erythema and swelling of hands or feet
Kawasaki disease etiology
unknown
___ is an acute, febrile, systemic vasculitis
Kawasaki Disease
what is the treatment for Kawasaki Disease?
(1) administer anti-inflammatory medication - aspirin
(2) administer IVIG within 10 days of symptom onset
describe the steps of normal blood flow
SVC & IVC ->
R atrium ->
Tricuspid valve ->
R ventricle ->
Pulmonary valve ->
Lungs
Pulmonary artery ->
L atrium ->
Mitral valve ->
L ventricle
Aortic valve
aorta
body
is the pulse oximetry reading an arterial saturation or venous saturation?
arterial
R atrium normal pressure
5 mmHg
R ventricle normal pressure
25-30 mmHg
L atrium normal pressure
10 mmHg
L ventricle normal pressure
100 mmHg
which side of the heart will have lower pressures?
Right (compared to left)
if blood is fully saturated as it leaves the left ventricle, you can assume it’s ____% saturated
75%
at what phase of the cardiac cycle are the coronary arteries perfused?
diastole
name the parts of the cardiac conduction system
(1) SA node
(2) AV node
(3) bundle of His
(4) Purkinje fibers
____ is the pacemaker of the heart
SA node
list the acyanotic cardiac defects
(1) patent ductus arteriosus (PDA)
(2) atrial septal defect (ASD)
(3) ventricular septal defect (VSD)
(4) AVSD
___ is when the ductus arteriosus does not close after birth
patent ductus arteriosus (PDA)
In PDA, the ductus arteriosus does not close because of…
(1) prematurity
(2) hypoxia
how do we treat premature infants with PDA?
(1) fluid restriction
(2) diuretics
(3) digoxin
(4) indomethacin
how do we treat larger kids with PDA?
coil occlusion / surgical correction
___ is a major risk factor for stroke
PDA closure
___ is a hole in the wall separating the atrium
atrial septal defect (ASD)
ASD results in ____ in the right heart
increased workload
___ is a hole between the ventricles
ventricular septal defect (VSD)
VSD results in ____ in the right heart
increased workload
what determines the magnitude of symptoms in VSD?
(1) size of defect
(2) pressures in the lungs (lower is worse)
the most common acyanotic defect that obstructs blood flow is ___
coarctation of the aorta (COA)
____ is the narrowing of the aorta that hinders blood flow
coarctation of the aorta (COA)
what is the result of COA?
increased resistance to blood flow to the body
COA presentation
(1) cardiac collapse at birth
(2) extremely high BP in teens
what is the overall goal with COA?
prevent end organ damage
before the narrowing in COA, pressures ____; after the narrowing, pressures are ____
high; low
the 3 Ts and H represent what category of heart diseases?
cyanotic defects with increased pulmonary vascularity
in ____, the aorta rises from the right ventricle and has no opportunity to be oxygenated
D-Transposition of the Great Arteries
what does the child require with D-Transposition of the Great Arteries?
intracardiac mixing to survive
___ is when the pulmonary veins have no connection to the left side of the heart
Total Anomalous Pulmonary Venous Return (TAPVR)
what are the characteristics of blood flow pathway in TAPVR?
(1) overcirculation on the R side
(2) inadequate blood flow to the body
____ results from inadequate division of the common great vessel during fetal development
Truncus Arteriosus
what is the key result of truncus arteriosus?
not enough blood flow to the body
Tetralogy of Fallot (TOF) is what type of defect?
cyanotic defect with decreased pulmonary vascularity
what are the 4 defects that make up the tetralogy of fallot?
(1) pulmonary valve stenosis / atresia / RVOT obstruction
(2) right ventricular hypertrophy
(3) overriding aorta
(4) VSD
the main thing to monitor with TOF is ____
hypercyanotic or “tet” spells
causes of tet spells with increased R ventricular outflow tet resistance
(1) crying
(2) stooling
(3) feeding
(4) noxious stimuli
(5) any stressors
causes of tet spells with decreased systemic vascular resistance
(1) fever
(2) dehydration
if a patient has multiple Tet spells, what happens nest?
this can bump up their surgery date
