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exam 2 study guide Flashcards

1
Q

o inflammation/swelling of larynx, trachea and bronchi: epiglottis, laryngitis, laryngotracheobronchitis (LTB), tracheitis
o Characterized by hoarseness, “barking” cough, inspiratory stridor, and varying degrees of respiratory distress – inspiratory stridor, hoarseness, possible fever, restlessness

A

croup

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2
Q

Clinical manifestations:
• Sore throat, pain, tripod positioning, retractions
• Inspiratory stridor, mild hypoxia, distress
• fever
Therapeutic management:
• Potential for respiratory obstruction- must have emergency equipment for intubation at bedside!
Medical emergency!!!!!!
• TX: airway, humid 02, abx, racemic epi, corticosteroids, IVF
• Prevention: Hib vaccine

A

acute epiglottitis (croup)

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3
Q

Clinical manifestations:
• hoarseness, sore throat, congestion, fever, headache, malaise
• More common in older children and adolescents
• Usually caused by virus
• Generally self-limiting and without long-term problems
Treatment:
• fluids, humid air, symptomatic

A

acute laryngitis (croup)

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4
Q 
Most common of the croup syndromes
Generally, affects children <5 years
Clinical manifestations:
•Inspiratory stridor
•Suprasternal retractions
•Barking or seal-like cough
•Increasing respiratory distress and hypoxia
•Can progress to respiratory acidosis, respiratory failure, and death
Therapeutic management 
•Airway management - Try not to intubate
•Increase hydration (PO or IV)
•High humidity with cool mist
Treatment (nebulizer)
•Epinephrine
•Steroids
A

acute LBT (croup)

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5
Q 
Paroxysmal attacks of laryngeal obstruction
Occur chiefly at night
Inflammation: mild or absent
Most often affects children ages 1-3 years
Therapeutic management:
• humidified air
• limit exposure to cold air
•Racemic Epi if severe
A

Acute Spasmodic Laryngitis (CROUP) (spasmodic croup, midnight croup)

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6
Q 
Infection of the mucosa of the upper trachea
Distinct entity with features of croup and epiglottitis
Clinical manifestations like LTB
May be complication of LTB
Thick, purulent secretions result in respiratory distress
Therapeutic management 
•Humidified oxygen
•Antipyretics
•Antibiotics
•May require intubation
•Monitor for respiratory failure
•May be life threatening!
A

bacterial tracheitis (croup)

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7
Q
  • Exocrine gland dysfunction that produces multisystem involvement
  • Most common lethal genetic illness among Caucasian children
  • Approximately 3% U.S. Caucasian population are symptom-free carriers
  • Autosomal recessive trait
  • Inherits defective gene from both parents, with an overall incidence of 1:4
A

cystic fibrosis

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8
Q

Characterized by several unrelated clinical features
Increased viscosity of mucous gland secretions
• Results in mechanical obstruction
• Thick inspissated mucoprotein accumulates, dilates, precipitates, coagulates to form concretions in glands and ducts
• Respiratory tract and pancreas are predominantly affected
Increased sweat electrolytes
• Basis of the most reliable diagnostic procedure: sweat chloride test
• Sodium and chloride will be 2-5 times greater than in the controls
Abnormalities in nervous system function
o Quantitative sweat chloride test
o Chest x-ray
o Pulmonary function tests (PFTs)
o Stool fat and/or enzyme analysis
o Barium enema
o Positive sweat test

A

diagnosis of cystic fibrosis

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9
Q

oPrevent or minimize pulmonary complications- maintaining open airway, chest physiotherapy, and antibiotics
oAdequate nutrition for growth - pancreatic enzymes and vitamins
oAssist in adapting to chronic illness

A

treatment of CF

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10
Q 
o	Wheezing respiration; dry, nonproductive cough
o	Generalized obstructive emphysema
o	Patchy atelectasis
o	Cyanosis
o	Clubbing of fingers and toes
o	Repeated bronchitis and pneumonia
o	Meconium ileus
o	Distal intestinal obstruction syndrome
o	Excretion of undigested food in stool—increased bulk, frothy, and foul
o	Prolapse of the rectum
o	Delayed puberty in females
o	Sterility in males
o	Dehydration
o	Hyponatremic or hypochloremic alkalosis
o	Hypoalbuminemia
A

signs and symptoms of CF

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11
Q 
o	RR, rhythm, and effort
o	Use of accessory muscles
o	Pulse oximetry
o	Cough
o	Presence of sputum
o	Skin color
o	Cap refill
o	Lung sounds
o	Maintaining a calm demeanor
o	Administer oxygen
o	Place in Fowlers position
o	Monitor heart rate and rhythm
o	Administer medications as ordered
o	Establish IV access
A

nursing interventions/assessment

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12
Q
  • Chronic inflammatory disorder of the tracheobronchial tree
  • Asthma attacks influenced by variety of triggers
  • Each child has specific triggers
A

asthma

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13
Q

signs/symptoms
o SOB, wheezing, productive cough, chest tightness
o Tachycardia, tachypnea
o Anxiety
o Extended expiratory phase
o Low SaO2
o Sluggish cap refill
treatment/prevention
o Bronchodilators and anti-inflammatory drugs
o Goals: Maintain activity levels, pulmonary fx, prevent exacerbations, allergy control

A

asthma

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14
Q 
o	Long-term control medications
o	Quick relief medications
o	Metered-dose inhaler (MDI)
o	Corticosteroids
o	Albuterol, metaproterenol, terbutaline
o	Long-term bronchodilators (salmeterol [Serevent])
o	Theophylline—monitor serum levels
o	Leukotriene modifiers
o	Others
A

drug therapy for asthma

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15
Q 
o	Avoid exacerbation
o	Avoid allergens
o	Relieve asthmatic episodes promptly
o	Relieve bronchospasm
o	Monitor function with peak flow meter
o	Self-management of inhalers, devices, and activity regulation
A

goal of management for asthma

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16
Q

o Respiratory distress continues despite vigorous therapeutic measures
o Emergency treatment: epinephrine 0.01 ml/kg SC (maximum dose 0.3 ml)
o Concurrent infection in some cases
- life threatening

A

status asthmatics

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17
Q

o Antibiotic education
o Post op – highest risk for bleeding at 24 hours and 10 days out
o Liquids and soft foods only – no red food coloring
o Bleeding is medical emergency!!
o Discourage coughing/clearing/nose blowing
o Frequent inspection
o Ice collar

A

education for tonsillectomy

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18
Q

o Destruction of beta cells, causing absolute insulin deficiency
o Fasting blood glucose greater than 126 mg/dL
o Hemoglobin A1c (HbA1c)
 Normal 4-6%
 Child with diabetes 7.5%
 Average blood glucose of 120 days

A

diagnosis of diabetes

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19
Q

o Insulin therapy – injections or insulin pump
o Glucose monitoring: goal range 80-120 mg/dl
o Laboratory measurement of hemoglobin A1c
o Urine testing for ketones:
 Not routinely used EXCEPT:
• Helpful to test q 3 hr during illness and whenever glucose is ≥240 mg/dl when illness not present

A

treatment of diabetes

20
Q 
Stop activity
Check BS
Treat with 15 grams of CHO
Recheck BS in 15 min
Repeat until BS within normal range
Then give child long acting snack or meal
A

what you do for hypoglycemia

21
Q

 Also called Insulin Dependent or Juvenile Diabetes
 Pancreas doesn’t make insulin
 10 % of the total number of diabetes patients

A

type 1 diabetes

22
Q

 Also called Adult Onset Diabetes
 Pancreas initially makes enough (or too much insulin) but doesn’t use effectively
 90% of those with Diabetes

A

type 2 diabetes

23
Q

o A characteristic group of manifestations caused by excessive circulating free cortisol
o May be caused by excessive or prolonged steroid therapy or adrenal tumor
o Condition is reversible once steroids are discontinued
o Abrupt withdrawal of steroids may precipitate acute adrenal insufficiency

A

cushings syndrome etiology

24
Q 
Symptoms
o	Excessive hair growth
o	Moon face, red cheeks
o	Weight gain
o	Pendulous abdomen with red striae
o	Poor wound healing
o	Ecchymosis
Treatment
o	Surgery if adrenal cause
	Adrenalectomy
	Pituitary tumor, surgery/radiation 
•	Replacement of GH, ADH, TH, gonadotropins, and steroids
o	If from steroid use may decrease dose
A

cushings syndrome

25
Q 
o	Decelerated growth
o	Myxedematous skin changes:
	Dry skin
	Sparse hair
	Periorbital edema
o	Constipation
o	Sleepiness
o	Mental decline
A

hypothyroidism

26
Q

Most common form in children, water and electrolytes are lost in equal amounts.

A

isotonic dehydration

27
Q

occurs when electrolyte loss exceeds the water deficit.

A

hypotonic dehydration

28
Q

occurs with water loss is greater than electrolyte loss.
most dangerous due to increase in sodium levels
- risk for seizures, brain swelling and cardiac issues

A

hypertonic dehydration

29
Q 
Signs/symptoms
o	Spitting up/regurgitation
o	N/V, diarrhea, constipation
o	Abdominal pain/distention, GI bleeding
o	Jaundice
o	Dysphagia
o	fever
management
o	Rehydration solution consisting of 75-90 mEq of Na+
o	Give 40-50 ml/kg rehydration over 4 hours
o	Maintenance fluids
o	Reevaluate!
A

dehyrdation

30
Q

low BP, tachycardia, parched mucous membranes, sunken fontanels, and shock

A

s/s of severe dehydration

31
Q 
o	Occurs primarily in 5th week of life
o	Projectile vomiting
o	Typically “good eater”
o	Hungry all the time
o	Causes vomiting, dehydration
o	And FTT
A

pyloric stenosis

32
Q 
Diagnosis
o	CXR with catheter
Management
o	Surgery
o	NPO/suction
o	Elevate head of bed
nursing interventions
o	Watch at first feeding s/s of obstruction or respiratory distress
o	Cyanosis
o	Educate
o	Promote bonding
A

Tracheoesophageal fistula (TEF)

33
Q 
Etiology
o	Results from decreased mucosal surface area, usually as result of small bowel resection – malabsorptive disorder
Management
o	Preserve as much bowel as possible
o	Maintain growth and development
o	Enteral feeding
o	Minimize complications
Nursing interventions
o	Family support
o	Education on feedings
o	Follow up with specialists as necessary
A

short bowel syndrome

34
Q 
Etiology
o	Neural ganglia that cause normal peristalsis are absent
o	Inadequate gastrointestinal motility causes a mechanical obstruction of the large intestine 
Diagnosis
o	X-ray, barium enema
o	Anorectal manometric examination
o	Confirm diagnosis with rectal biopsy
Management
o	low-fiber diet, adequate fluids, stool softeners, enemas and possibly surgical colostomy (removal of the aganglioic portion of the bowel)
Nursing interventions
o	Careful observation of newborns for passage of meconium
o	Careful history of bowel habits
o	Teaching – colostomy
	-Assist parents in adjustment
	-Foster bonding
	-Prepare for treatment
A

hirschsprung

35
Q 
signs/symptoms
o	Massive proteinuria
o	Hypoalbuminemia
o	Hyperlipidemia
o	Edema
Diagnosis
o	Generalized edema (develops gradually or rapidly) 
o	Proteinuria 2+ on dipstick testing
o	Hypoalbuminemia
o	Hypercholesterolemia (in the absence of hematuria and hypertension)
o	Low serum protein and sodium
o	May require renal biopsy to distinguish from other types of nephrotic syndrome
A

nephrotic syndrome

36
Q

management
o Supportive care
o Diet
 Low to moderate protein
 Sodium restrictions when large amounts of edema are present
o Steroids (first line of therapy)
 Dose is 2 mg/kg divided into twice-a-day doses
 Prednisone is the drug of choice (least expensive and safest)
o Immunosuppressant therapy (cyclophosphamide [Cytoxan])
o Diuretics

A

nephritic syndrome

37
Q

signs/symptoms
o generalized edema due to decreased glomerular filtration
o hypertension due to increased extracellular fluid
o oliguria (severely reduced volume)

A

glomerulonephritis

38
Q 
o	Organisms that commonly cause UTIs
	Escherichia coli is the most common pathogen (80% of cases)
	Streptococci
	Staphylococcus saprophyticus
	Occasionally, fungal and parasitic pathogens
o	Anatomic or physical causes
	Short urethra in girls
	Uncircumcised males
A

UTI

39
Q

symptoms
o intense itching
treatment
o pediculicides and removal of nits
o Treat family and repeat treatment in 10 days
Education
o Adult lives 48 hours without human host, female has life span of 30 days

A

head lice

40
Q

o Newborn rashes – common in the newborn, usually benign, self-resolving
o Dermatitis – general term meaning inflammation of dermis
o Seborrheic dermatitis – cradle cap
o Diaper dermatitis - irritation from urine or stool
o Contact dermatitis – reaction to allergen causing inflammation at the area of contact

A

dermatitis

41
Q 
•	Diagnosis
o	X-ray and clinical presentation 
•	Management
o	Surgery
o	NPO/suction NG or OG
o	Elevate head of bed
o	Feed them through TPN or G-button 
•	nursing interventions
o	Watch at first feeding s/s of obstruction or respiratory distress
o	Cyanosis
o	Coughing
o	Choking
A

tracheoesophageal fistula (TEF)

42
Q

• signs/symptoms
o abdominal swelling or mass that is not painful
• management
o Surgical removal within 24 hours and after…
o Chemotherapy and/or radiation
• Diagnosis
o X-ray, ultrasound, MRI, bone marrow aspiration
• Nursing interventions
o DO NOT PALPATE ABDOMEN
o Support and explanations for family

A

wilm’s tumor

43
Q

• signs/symptoms
o Massive proteinuria
o Hypoalbuminemia
o Edema
o Hypertension
• Etiology
o Glomerular (filtration) injury – the strainer has big holes so everything can get through, like WBC, etc.
• Diagnosis
o Generalized edema (develops gradually or rapidly)
o Proteinuria 2+ on dipstick testing
o Hypoalbuminemia because they are losing protein through urine
• management
o Supportive care
o Diet
 Low to moderate protein
 Sodium restrictions when large amounts of edema are present
o Steroids (first line of therapy)
 Dose is 2 mg/kg divided into twice-a-day doses
 Prednisone is the drug of choice (least expensive and safest)

A

nephrotic syndrome

44
Q

• Etiology
o Strainer has become clogged, maybe due to an infection
o Can be caused by strep
• signs/symptoms
o generalized edema due to decreased glomerular filtration
o hypertension due to increased extracellular fluid
o oliguria (severely reduced volume)
• diagnosis
o urine analysis and signs and symptoms
• Management
o Manage edema (I/O), monitor for hypertension and low sodium and protein
o Strict I/O and steroids to correct inflammation
• associated lab values
o hematuria*

A

glomerulonephritis

45
Q

• Etiology
o Oral route from uncooked meats, unpasteurized milk, unwashed fruits/veggies
o Develops clots and damages RBC and causes hemolytic anemia
• Signs/symptoms
o Super sick
o Anemia, pale, kidney failure, elevated bun and creatine
• nursing interventions
o dialysis, blood transfusions or steroids
o lots of support
o ask if they’ve been to petting zoo

A

HUS

Peds (4 decks)

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