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N348 Peds > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Growth of bone + bone plates

A

300 at birth- ossify to form 206 bones

plates- open until early 20’s

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2
Q

child v adult bone composition

A

more porous + elastic- less dense
inc strength
thicher periosteal sleeves

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3
Q

bone abnormalities characteristic of childhood

A

flat feet until 6 yrs old (inc stability)
pigeon toed gait until 8 yrs
knock knees until 7 yrs

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4
Q

importance of early ambulation

A

risk for DVT, ileus, and pneumonia

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5
Q

pectus excavatum- def, cause

A

cause- congenital deformity- ribs and sternum grow inward
severity inc during growth spurts
inc risk w/ scoliosis
more common in boys

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6
Q

pectus excavatum- s/s

A

inc risk respir infections, chest pain, fatigue

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7
Q

pectus excavatum- treatment

A 
surgery
physical therapy
straight posture- no lifting for 1st mo PO
PO 3 mo resume normal act. 
no contact sports until 6 mo PO
metal plates removed 2 yrs PO
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8
Q

pectus excavatum- PO considerations

A 
pain management
breathing exercises
IS
monitor respir system
circulation (pulses and cap refill)
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9
Q

pectus excavatum- immediate wheezing

A

med emergency

lung compression

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10
Q

osteogenesis imperfecta- cause, types

A 
genetic collagen (CT protein)  disorder
8 types
type 1 most common and mildest form
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11
Q

osteogenesis imperfecta- s/s

A

frequent fx, blue sclera, hearing loss, short stature, triangular face

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12
Q

osteogenesis imperfecta- trtmnt

A 
palliative
can have rods in femurs
strengthening muscles and preventing fx
aqua therapy (no PT)
encourage activity w/ peers
growth hormones and bisphosphonates (bone growth)
pain management!!!!
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13
Q

osteogenesis imperfecta- considerations during care

A

avoid blood p cuffs, rough handling, no tourniquets

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14
Q

blount disease- cause, def

A

bowed legs
tibial growth plates turns inward of lower legs- worsens w/ time

NOT normal after age 3

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15
Q

blount disease- s/s

A

diff. leg lengths

knee pain

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16
Q

blount disease- inc risk

A

obsese

vitam d deficient

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17
Q

blount disease- trtmnt

A

bracing if < 4yrs
surgery
casts
ex fix postop

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18
Q

blount disease- complications post op

A

inc risk compartment syndrome, DVT (d/t delayed ambulation)

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19
Q

blount disease- PO care

A 
psychosocial support (inc risk of depression)
CMS- cap refil, color, pulses, sensation, skin checks (ex fix)
good nutrition (vitamin D supplementation)
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20
Q

congenital clubfoot

A 
more common in boys
serial casting
change casts weekly (begin early before bones ossify)
bracing 2-4 wks after
COMPLIANCE w/ nonsurg trtmnt key
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21
Q

developmental dysplasia of the hip- def and cause

A

diagnosed during newborn examination (ROM w/ legs and listen for clicks)
may not be noticed until walking
socket more horizontal- easier to dislocate
socket does not cover ball adequately

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22
Q

developmental dysplasia of the hip- s/s

A

limited hip ABduction
uneven thigh skin (if displaced, leg longer and less skin folds)
clicking (Ortolani/barlow test)
limping gait

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23
Q

developmental dysplasia of the hip-trtmnt

A

< 6 mo- bracing (Pavlik harness)
6-24 mo- closed reduction
> 2yrs- open reduction

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24
Q

developmental dysplasia of the hip- PO care

A

spica casting= allow for tissue repair
double diaper, watch for skin brkdwn

CMS, infection and bleeding

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25
Q

rickets- def/ cause

A

young bone does not calcify
cause- vitamin D deficiency

common in dark skin + limited exposure to sun who are exclusive breastfed and do not have vitam d supplement

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26
Q

rickets- trtmnt, s/s

A

diagnosed before 1 yr
s/s- weakness and inability to walk

trtmnt- vitam D supplementation
foods- fortified dairy, eggs, fatty fish, chicken livers
sunlight

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27
Q

rickets- magnesium

A

AVOID mag products

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28
Q

slipped capital femoral epiphysis- def & cause

A

hip disorder
most common disorder in teens
cause- growth spurts

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29
Q

slipped capital femoral epiphysis- inc risk

A 
male
obesity
renal dis
thyroid dis
pituitary disorders
family hx
if happens once unilaterally more common to happen again bilaterally
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30
Q

slipped capital femoral epiphysis- stable v unstable

A

stable- mildy aches, pain and limping
unstable- completely off, cannot walk
MEDICAL EMERGENCY

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31
Q

slipped capital femoral epiphysis- trtmnt

A

non WB
surgery
crutches w/ toe touch WB for 6wks PO

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32
Q

slipped capital femoral epiphysis- PO care

A

dressing change, pain management, CMS

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33
Q

legg calve perthes disease (LCP)- def/cause

A

blood supply to femoral head disrupted
causes necrosis and bone cell death
common in 6-10 yrs
inc risk boys

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34
Q

legg calve perthes disease (LCP)- stage 1

A

1- avasc necrosis (LCP can cause SCFE)
damages bone cells
femoral head becomes flattened and deformed

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35
Q

legg calve perthes disease (LCP)- stage 2

A

fragmentation and absorption 1-2 yrs

body remodels dead bone w/ new soft bone

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36
Q

legg calve perthes disease (LCP)- stage 3

A

bone hardens and begins to look regular- multiple years

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37
Q

legg calve perthes disease (LCP)- stage 4

A

healing

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38
Q

legg calve perthes disease (LCP)- s/s

A

dec muscle mass and limping

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39
Q

legg calve perthes disease (LCP)- trtmnt goals

A

relieve pain, protect femoral head shape, restore hip movement

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40
Q

legg calve perthes disease (LCP)- trtmnt

A

< 6yrs- self limiting
6-8- casting
> 8 yrs- surgery
casting PO

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41
Q

legg calve perthes disease (LCP)- PO care/ pt ed

A

trtmnt modes
use assistive devices for ambulation
limit weight bearing

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42
Q

osteomyelitis- def

A

inflamm of bone
secondary to bac infection
cause- bacterial staph aureus
50% happen after trauma or surgery

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43
Q

osteomyelitis- s/s initial v late

A

intitial- vague, systemic, fever, malaise, fatigue

late- bone pain, difficulty bearing weight, swelling, redness, warmth of extremity

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44
Q

osteomyelitis- trtmnt

A

antibiotics
*get blood cul. before prescribing
PIC line w/ long term antib 4-8 wks
IV antib at first, PO after several wks

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45
Q

osteomyelitis- pt ed

A

how to care for drains (wash hands before), changing dressings, s/s of infection, how to care for PIC line

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46
Q

scoliosis- cause/def

A

progressive LATERAL curvature of spine w/ rotation of vertebrae
classified by curve location/ cause
80% idiopathic adolescent

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47
Q

scoliosis- types

A

Infantile scoliosis- < 3yrs Diagnosed after freq respir infections and pneumonia bracing q monthly
Juvenile 3-10
Adolescent > 10yrs
Neuromuscular- diagnosed secondary to neuromusc disease
Idiopathic- most common (happens in adolescents)

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48
Q

scoliosis- s/s

A

truncal asymm, uneven shoulders, raised hips, rib hump

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49
Q

scoliosis- trtmnt

A

bracing
16-23 hours/day
surgery- spinal fusion

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50
Q

scoliosis- PO care + goals day 1 v day 2

A

goals-
day 1- sitting in chair
day 2- ambulating on feet

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51
Q

scoliosis- PO care

A

PCA
epidurals due to muscle spams
neurovasc checks
CMS

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52
Q

scoliosis- pt ed

A 
activity limitations
no bending, lifting or twisting
parental support of child
no school 2-4 wks
normal act. 3-4 mo 
wean off pain meds
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53
Q

strain v sprain

A

strain- stretched or torn muscle/tendon
sprain- injury to ligament
inc risk during growth spurts
common in ankle, knee and shoulder

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54
Q

strain + sprain- s/s

A

pain, swelling, difficulty moving area

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55
Q

strain + sprain- trtmnt

A 
RICE
rest- avoid WB for 48-72 hrs
ice- 10-20 min 3x daily
compression
elevation- above level of heart
immob- 10-14 days 
bracing
PT
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56
Q

fx- growth plate

A

higher risk deformity and impaired healing

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57
Q

fx- s/s

A

swelling, pain, abnormal positioning, inability move affected area

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58
Q

fx- upper extremity

A

more common in kids bc inc activity and dec coordination

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59
Q

fx- trtmnt

A 
reduce fx and immobilize
closed or open
closed- pop back and cast
open- surgery w/ pins/plates
need antib
splint
traction
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60
Q

fx PO care- education

A

educate on s/s infection (fever, myalgia, chills, night sweats)

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61
Q

fx PO care

A

infection control

CMS, tingling, pulses, cap refil

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62
Q

spiral fx and greenstick

A

spiral- < 4ys toddler fx
nondisplaced spiral fx of tibia common
greenstick- break one side of bone

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63
Q

cast care

A 
elevate and ice to prevent swelling
assess s/s infection (odor, drainage, fever, warmth)
assess skin brkdwn
hair dyer blow up cast to dec itching
avoid prolonged sun exposure
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64
Q

compartment syndrome- def

A

fascia not allow swelling to distribute

can impair tissue circ. and cause necrosis

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65
Q

compartment syndrome- inc risk

A

cast, trauma, bone fx

casting- edema builds inside rigid cast

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66
Q

compartment syndrome- s/s

A 
pain unrelieved by meds and not proportional to injury
pallor
pain
paresthesia (tingling)
paralysis
pulselessness
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67
Q

compartment syndrome- trtmnt

A

MED EMERGENCY

remove cast or fasciotomy

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68
Q

compartment syndrome- PO care

A

freq dressing changes
wound vac
CMS
monitor for s/s worsening compartment syndrome

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69
Q

traction- purpose

A

puts bones in alignment before surgery

improves pain and dec music. spasms

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70
Q

traction- types skin v skeletal

A

skin- indirect pulling on skin, puts traction on muscle and bone (BUCKS, bryant or russel)
skel- surgically placed pins through bone
ex. cervical halo

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71
Q

traction-positioning and care

A

straight and supine espec w/ skin traction

freq repositioning, and neurovasc checks

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72
Q

traction- common types

A

buck extension- 20 lbs
russell
cervical

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73
Q

stress fx- stage 1

A

pain after physical activity

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74
Q

stress fx- stage 2

A

pain during act- not restrict performance

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75
Q

stress fx- stage 3

A

pain during act- restricts performance

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76
Q

stress fx- stage 4

A

chronic pain during act. And rest

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77
Q

stress fx- def

A

microtrauma damage to bone, muscle, tendon from repetitive stress w/o time to heal
common in athletes- 4 stages

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78
Q

common overuse injuries

A

osgood schlatter dis (patellar issue)
patellar tendonitis
stress fx
throwing injuries

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79
Q

stress fx- trtmnt

A 
prevention is key
PT, stretching
limit activity
take 2-3 mo off / yr
multisport athletes should have strength/conditioning training
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80
Q

sensory v motor

A

sensory- afferent

motor- efferent

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81
Q

neuromusc system in children

A

fully formed at birth but immature

gross and fine dev over first 2 yrs

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82
Q

age specific developmental milestones

A

3 mo- hold head up
6 mo- sitting
9 mo- crawling
12 mo- walking

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83
Q

intrinsic v extrinsic factors neuromusc dev

A

intrin- event at birth

extrin- neglect

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84
Q

developmental primitive reflexes

A

Babinski, rooting, palmar

not normal after 3 mo

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85
Q

Cranial nerves- 1-6

A 
I - olfactory
II- optic
III- oculomotor
IV- trochlear
V- trigeminal
VI- abducens
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86
Q

Cranial nerves- 7-12

A 
VII- facial
VIII- vestibulochoclear
IX- glossopharyngeal
X-vagus
XI- accessory
XII- hypoglossal
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87
Q

CN- I

A

olfactory

reaction to noxious odor

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88
Q

CN- II

A

optic
ability to regard person’s face
maintain eye contact
trach and reach for object

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89
Q

CN-III

A

oculomotor
move bright color toy through visual fields to see if tracking
corneal light reflex
pupillary respone

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90
Q

CN- IV

A

trochlear

symm. eye movmnts and corneal light reflex

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91
Q

CN- V

A

trigeminal

response to light touch on face

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92
Q

CN- VI

A

abducens

same as trochlear (IV)- symm eye mvmnt

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93
Q

CN I, II, III, and VI

A

move bright toy to assess

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94
Q

CN VII

A

facial

Facial symmetry during crying (motor) and response to salt solution on tongue (sensory)- saline solution on tongue

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95
Q

CN VIII

A

vestibulocochlear

Ability to startle to loud noises and turn to a familiar voicenormal- turn towards noise

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96
Q

CN IX

A

glossopharyngeal
observe strength, quality of cry
ability to suck/swallow
gag reflex

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97
Q

CN X

A

vagus
same as glossoph.
gag reflux
suck and swallow

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98
Q

CN XI

A

accessory

ability to perform coord movmnts of neck and shoulders

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99
Q

CN XII

A

hypoglossal

symm movmnts of tongue

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100
Q

neuromusc assessment- musc tone

A 
hypotonia or hypertonia (contractures)
active and passive ROM
5 point scale
0- flaccid
3- overcome gravity
5- normal
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101
Q

neuromusc assessment- coordination

A

walking, finger and thumb

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102
Q

neuromusc assessment- tendon reflexes

A

biceps, triceps, brachiorad, patellar, achilles

103
Q

diaphragmatic weakness care

A

positive pressure ventilation

104
Q

cerebral palsy- cause/def

A 
nonprogressive, permanent disorder
cause- improper dev or insult to brain
85-90% congenital
ex. brain damaged at birth or in utero
uterine infection, infarct (cord compression)
105
Q

cerebral palsy- aquired

A

after birth up to first 28 days
infection - group b strep, meningitis, trauma, bleeding or stroke
*importance of vitamin K

106
Q

cerebral palsy- spastic

A

most common

hypertonic, rigid

107
Q

cerebral palsy- dyskinetic

A

inc and dec tone, difficulty using voluntary muscles

108
Q

cerebral palsy- ataxic

A

abonormal gait

109
Q

cerebral palsy- considerations

A

not always cognitively delayed

most common disability in kids

110
Q

cerebral palsy- s/s

A

inc or dec musc tone, gross/fine motor delays, feeding difficul, seizures, joint deformities

111
Q

cerebral palsy- what o/ condition is commonly associated

A

scoliosis

112
Q

cerebral palsy- trtmnt

A 
PT, OT, Speech
case manager- community resources
EARLY INTERVENTION
assistive technology
baclofen pump- dec music. spasticity
vagal nerve stimulator
113
Q

spinal muscular atrophy- cause/def

A

loss motor function of entire body
cause- mutation in survival of motor neuron
degen of motor neurons in anterior horn cells of SC

114
Q

spinal muscular atrophy- characteristics

A

progressive
symmetrical weakness
atrophy of prox muscles
premature death

115
Q

spinal muscular atrophy- infantile

A

most severe
freq respir complications, belly breathingdiagn 1-3 mo ages.
Do not live past 2yrs w/o medical intervention

116
Q

spinal muscular atrophy-s/s

A

musc weakness, hypotonia, respir compromise, inadeq weight gain, contractures, scoliosis

cannot hold head up, can’t roll over
diaphragmatic breathing

117
Q

spinal muscular atrophy- trtmnt

A

early PT
braces/orthotics
stretching

118
Q

spinal muscular atrophy- pulmonary interventions

A

chest physiotherapy- shaky vest
1-2x day break up secretions

trac/vent
noninvasive BPAP/CPAP

119
Q

spinal muscular atrophy- feeding interventions

A

enteral feeding

risk of aspiration

120
Q

spinal muscular atrophy- medications

A 
Beta-2 adrenergic agonist to facilitate breathing (albuterol)
Medications for gastrointestinal reflux
Prophylactic antibiotics (UTI, pneumonia)
121
Q

spinal cord injury- common locations based on age

A

toddlers- cerv
5-8 yrs- thoracic
teens- lumbar

122
Q

SC injury- SCIWORA

A

spinal cord injury w/o obvious radiographic abnormality
spinal cord moved but bone was not affected, only impinged
common in kids

123
Q

SP injury- s/s- cervical

A

C-5 and below = stay alive

C-5 and above= diaphragm not innervated, need vent

124
Q

spinal shock

A

Low sensation, movement below location of injury

No reflexes, flaccidity

125
Q

autonomic dysreflexia

A

internal stimuli to spinal cord- ex. Full bladder brain activates parasympathetic
s/s bradycardia, hypertension, facial flushing & HA
Trtmnt- resolve underlying cause

126
Q

SC injury- trtmnt

A

immobilize
surgical decompression
manage spasticity (PT, stretching, splinting, meds)

127
Q

poikilothermia

A

(child adapts environmental temperature)

128
Q

guillain barre syndrome- def/cause

A

after respir infection or acute otitis media (recent bac or viral infection)
acute inflamm demyelinating polyradiculoneuropathy

autoimmune attack on periph nerves
demyelination of periph nerves

129
Q

guillain barre syndrome- charac

A

ascending
paralysis
starts in feet and moves up

CSF has protein levels 2x more than normal value

130
Q

guillain barre syndrome- s/s

A 
ascending hypotonia
numbness
pain
dec or absent DTR 
weakness develops over days and up to 4 wks
131
Q

guillain barre syndrome- trtmnt

A

intubation, respir support
IVIG - IV immune globulin
5 consec days
plasmapheresis= alternative to IVIG- not preferred
periph nerve function + strength will return

132
Q

guillain barre syndrome- pt ed

A

can progress 4-6 wks after initial diagnosis

133
Q

botulism- cause/def

A

neuroparalytic
cause- clostridium botulinum bacteria
neurotoxin from spores
not give honey < 1yrs

134
Q

botulism- classification cause

A

foodborne, wound, adult intestinal colonization, dirt/soil, poorly canned food

135
Q

botulism- s/s

A

poor feeding, drooling, floppy, constipation
hypoxia, tachypnea
DESCENDING

136
Q

botulism- trtmnt

A

supportive care
botulism immune globulin
fluids, nutrition, respir support, therapy

137
Q

botulism- considerations

A

delay immunizations for 11 mo after admin

rash most common side effect

138
Q

immune- natural barriers

A

skin (low pH) hard for bac to live

normal flora

139
Q

inflammatory response

A

chem released in response to an infection
macrophages attack foreign antigens
presents bac on surface after attacking

140
Q

specific immune response- antibody and antigen

A

antibody- proteins produced in the body, specific to different antigens

antibody binds to antigen (marks for macrophage)

141
Q

ability to “gain immunity” means

A

ability to produce antibodies

142
Q

b lymphocytes

A

type of WBC
humoral response- w/in fluids of the body
made in bone marrow
function- to produce antibodies in response to antigens

143
Q

T lymphocytes

A

Cell mediated response
Kill cells already replicated by virus

Made in thymus
Produces cellular death

144
Q

killer t cells

A

find infected cells, bind to them and kill

145
Q

helper T cell

A

initiates cell mediated AND humoral response
cells are activated after they bind to the antigen

activate killer T cells- cell mediated response
signal macrophages to kill
tells B cells the shape of the antigen (creates antib)- humoral response

146
Q

stages of immunity- initial response

A 
b cells (humoral) and killer t cells (cell mediated)
first exposure
147
Q

protective immunity

A

inapparent reinfection

body takes care of itself

148
Q

immunity memory

A

mild or inapparent reinfection

149
Q

function of immune system

A

defend against infection and maintain equilibrium

150
Q

immunodeficiency v autoimmune disorder

A

immunodef- under-functioning

autoimmune disorder- over functioning (hypersensitivity reactions)

151
Q

humoral immunity

A

involves b cells

recognized specific antigens and secrete antibodies

152
Q

cell mediated immunity

A

t cells

attack antigens marked by the b cells

153
Q

innate immunity

A

nonspecific immune functions
protective barriers
activated in presence of antigen but not specific to that antigen
first line of defense

154
Q

adaptive immunity

A

humoral or cell mediated
2nd line of defense
lasts wks-months even yrs

155
Q

child differences- immune function

A

lymphoid organs are large at birth - adult size by 6wks
shrink at puberty

*except -spleen does not reach full size until adulthood
less fat on stomach= higher risk for splenic rupture

immune system less effective- dec amnts of immunoglobulins

lymphoid (peyers patches) line intestine- peak btw 15-25 and then dec

156
Q

immune system responses- abnormalitites

A

higher risk of developing infections and sepsis
s/s of infection less prominent in kis
inc spread of infection d/t close contact and poor hygiene

157
Q

active immunity v passive immunity

A

active- humoral and cell-mediated (adaptive)

passive- immediate but short term (innate)

158
Q

live attenuated vaccine

A

ex. MMR
made of weakened pathogen
contraindicated if immunocompromised

159
Q

inactive vaccines

A

ex. polio
dead virus
dont create long lasting immunity

160
Q

Sub-unit vaccine

A

ex. influenza

made from antigen of virus

161
Q

DNA vaccine

A

Genes injected stimulate body to make antigens (of virus)
Body reacts and produces antibodies
Creates memory

162
Q

immune- nursing interventions

A

prevent/manage allergic response (teach about triggers)
promote skin integrity
promote comfort/pain relief

163
Q

immunity- vaccine considerations

A

If vaccine admin 4-5 days before minimum age
not valid
Ex. Recommended at 4 months
If kid is 3 months and 25 days. Have to repeat vaccine

164
Q

immunodeficiency disorders- cause and s/s

A

usually inherited/ congenital
s/s- repeated and persistent infections
opportunistic infections (yeast), frequent skin lesions
(rash/ skin condition first sign)

165
Q

immunodeficiency disorders- risks assoc. w/ and trtmnt

A

risks- developmental delay!!

trt- hematopoietic stem cell transplantation
IVIG prophylactically until transplantation (intravenous immune globulin)

166
Q

allergy- def

A

response to antigen (allergen) from exposure to environment or food
causes hypersensitivity rxn
after 2nd exposure to allergen rxn can be immed or delayed

167
Q

allergies- diagnosis

A

personal/medical hx
physical examination
diagnostic testing (lab)

can use allergy testing to diag. and id allergens

168
Q

allergy- s/s and trtmnt

A

s/s- itchy eyes, hives, cough, wheezing, sob, redness, pain, throat closing, rash

trtmnt- antihistamines, bronchodilators, corticosteroids, preventative inhaled meds

169
Q

food allergies

A

IgE mediated or non IgE mediated

170
Q

allergies- wheezing

A

indicates edema in airway

sign of respiratory distress

171
Q

food intolerance

A

abnormal physiological but not immunological response

provide teaching on how to read food labels

172
Q

key consideration w/ allergy trtmnt

A

avoid exposure to allergen

173
Q

reactions to natural latex

A

IgE mediated
cell-mediated contact dermatitis
irritant dermatitis

174
Q

anaphylaxis

A

acute, immed IgE mediated response to an allergen
occurs w/ in 5-10 min of contact w/ allergen
common triggers- nuts, shellfish, eggs, insect stings, penicillin, nsaids, dyes and latex

175
Q

anaphylaxis- s/s

A

rash, coughing, lip/tongue swelling, stridor, extreme anxiety, asthma, loss of consciousness

176
Q

anaphylaxis trtmnt/interventions

A

trt- epinephrine, corticosteroids, antihistamines
support airway w/ intubation and ventilation if tongue swelling and airway compromise occurs
assess circulation
admin IV fluids- promote volume expansion
monitor for 2+ hrs after reaction
outpatient setting- epi pen and call 911

177
Q

epi pen instructions

A

sit/lie down
fist grip
press colored end into leg, hold for 10 seconds
call 911
admin if 2+ symptoms (harder to stop rxn the longer you wait)

178
Q

function of endocrine system

A

glands secrete hormone to entire body via blood stream

target cells receive hormone and create rxn

179
Q

water soluble v lipid soluble hormones

A

water sol.- ex. epinephrine
bind to cell protein, use signal transduction

lipid soluble- ex. testosterone
move through cell bilayer
direct contact w/ cell nucleus

180
Q

peds v adult endocrine

A

gonads develop overtime
gonads differentiate into testes/ovaries by week 10 gestation
important for growth and dev

181
Q

anterior pituitary

A

Anterior pituitary:
Hormones: growth hormone, thyroid-stimulating, adrenocorticotropic, prolactin, follicle-stimulating, and luteinizing
Action- cell growth
Location- hypothalamus

182
Q

posterior pituitary

A

Hormones: Antidiuretic and oxytocin
Action- water balance (retains fluid)
Location- hypothalamus

183
Q

thyroid

A 
Hormones: Thyroxine (T4), triiodothyronine (T3)
Action- metabolism
Hyperactive thyroid- high metabolism
Cushing syndrome- hypoactive thyroid		
s/s- obesity, moon face, abdominal striae
Calcitonin
Action- lowers blood Ca
Location- throat
Stimulated by High blood Ca
184
Q

parathyroid

A

Hormones: Parathyroid
Action- raises blood Ca
Stimulated by low blood Ca

185
Q

adrenal medulla

A

Hormones: Epinephrine and norepinephrine

action- fight or flight

186
Q

adrenal cortex

A

Hormones: Cortisol and aldosterone (glucocorticoids)
Action- anti inflammatory
Activated by pituitary glands

187
Q

pancreas

A 
Hormones: Insulin
Action- lowers blood glucose
glucagon
Action- raises blood glucose
Releases glycogen from liver
188
Q

testes

A

Hormones: Testosterone

189
Q

ovaries

A

Hormones: Estrogens and progesterone

190
Q

thymus

A

Hormones: Thymosin
location- btw lungs
spot of T cell maturation

191
Q

pineal

A

w/in brain
Hormones: Melatonin
Secreted at night
Action- circadian rhythm

192
Q

congenital hypothyroidism- def and cause

A

cause- congenital, autosomal recessive trait
deficient production of thyroid hormones
thyroid absent, or reduced in size

193
Q

congenital hypothyroidism- s/s, diagnosis

A

s/s= low t3/t4, persistent open posterior fontanel, thickened tongue, dull expression, hypotonia, protruding abdomen, bradycardia, trouble feeding, constipation

id via neonatal metabolic screening

194
Q

congenital hypothyroidism- trtmnt

A

synthetic thyroid hormone (sodium levothyroxine); frequent monitoring of levels.
Administer before eating (30- 1hr before breakfast)
Begin w/in 1-2 wks after birth
If untreated- can develop intellectual disabilities + slow growth
Monitor growth using growth charts and follow-up with pediatric endocrinologist.

195
Q

acquired hypothyroidism- cause

A

underactive thyroid

cause- diet, hashimotos (autoimmune), thyroiditis, meds, isolated thyroid-stimulating hormone deficiency

196
Q

acquired hypothyroidism- s/s and diagnosis

A

s/s- inc fatigue, weight gain, cold intol, goiter, joint muscle pain, constipation, depression, bradycardia
diagnosed- t3/t4 tests, radiology

197
Q

acquired hypothyroidism- trtmt

A

Treat with supplemental thyroid hormone (lower dose than in congenital hypothyroidism).
Avoid administering this medication near food consumption because it impairs absorption.

198
Q

diabetes patho

A 
CHO (carbs) used for energy
	broke down into glucose (simple sugar)
Glucose absorbed into blood 
	enter cells w/ help of insulin
	excess stored in liver
199
Q

glucagon pathway

A

low blood sugar
secretes glucagon
stimulates liver to release stored glucose

200
Q

insulin pathway

A

high blood sugar stimulates insulin secretion

allows cells to absorb glucose

201
Q

diabetes- cause

A 
type 1 or type 2
Decrease in insulin production or insulin resistance
Overload of glucagon in blood
	not consumed by cells
		hyperglycemia
202
Q

DM type 1- diagnosis, s/s, management

A

Autoimmune condition resulting in pancreatic damage and lack of insulin.
Manifestations: weight loss, polydipsia, polyphagia, polyuria, fatigue, blurred vision, and mood changes.
Diagnose with laboratory testing (e.g., hemoglobin A1C, fasting glucose, and plasma glucose).
Management is multi-faceted and includes:
Insulin therapy
Glucose monitoring
Insulin education
Maintaining proper nutrition
Patient and family education

203
Q

type 1 diabetes s/s

A

weight loss, polydipsia (thirst) , polyphagia (hungry), polyuria (urination), fatigue, blurred vision, mood change

204
Q

insulin types

A 
rapid acting- Novolog, humalog
duration 3-5 hrs
short-acting- regular 5-8 hrs
intermediate-acting- NPH 10-18 hrs
long-acting- lantus 18-24 hrs
205
Q

DM type 2- cause and def

A

May occur in teenage and school-aged children due to the increase in childhood obesity.
Pancreas produces insulin, but it is unable to be used by the body (insulin resistance).

206
Q

DM type 2- inc risk and s/s

A

Inc risk- girls, early teens, weight, family hx, black, Hispanic, American Indian, maternal GA, LBW, preterm birth

can develop slowly, acanthosis nigricans (darkening of skin on back of the neck), polydipsia, polyphagia, and polyuria

207
Q

DM type 2- trtmnt and considerations

A

increase in physical activity, diet changes, and metformin (antidiabetic agent) and insulin
insulin sub q 2xday before meals

Consider ethical concerns and the family’s socioeconomic status

208
Q

DM associated conditions

A

affects kidneys, blood vessels, nerves, and eyes

depression, adhd, anxiety, hypertension, kidney disease, nerve damage

209
Q

DM- inc risk for

A

high cholesterol, stroke, kidney damage, hyper/hypoglycemia, DKA

210
Q

DKA- characteristics

A

hyperglycemia, hyperketonemia, metabolic acidosis
Kussmaul respirations
osmotic diuresis
inc Na- initial lvls may be normal due to excess free water
dec K- can be normal at first d/t extracellular k migration from acidosis

211
Q

considerations w/ insulin admin- electrolyte shifts

A

push K into cells
can cause hypokalemia
weakness, muscle cramps, palpitations

212
Q

DKA- s/s, cause and trtmnt

A 
S/S
n/v, cerebral edema
Causes
Infection, dehydration, lack of insulin, trauma
Treatment
Volume expansion
Insulin replacement (drip)
Prevention of hypokalemia
Cardiac monitoring
Prevention of cerebral edema
213
Q

emergency assessment priority steps

A

ventilation, oxygenation and perfusion

vent- is airway patent and maintainable?
hear adven sounds, inc rate?

oxygenation- o2 sat

perfusion- cap refil, pulses, color, temperature

214
Q

initial emergency assessment- SABCD

A 
S- scene safety
A- assess need for CPR
spend less than 10 sec assessing for central pulse
head tilt/ jaw thrust to assess airway 
monitor chest rise/ respirations
cap refill, bleeding, perip pulses, bp
neuro assessment, Glasgow coma scale
215
Q

neuro assessment- avpu

A

alert
verbal stim
painful stim
unresponsive

216
Q

central pulses

A

kid- carotid

baby-brachial

217
Q

immed signs- need for CPR

A

HR < 60

brain, kidneys, and heart not adeq perfusing

218
Q

atropine

A

anticholingergic
inc hr and cardiac output
use if hr <60
for intubation and suctioning

219
Q

epinephrine

A

inc hr and systemic vasc. resistence
vasoconstrictor
used to realign heart rate

220
Q

naloxone

A

for opioid overdose
reverses respir depression and hypotension

ae- pulmonary edema

221
Q

respiratory arrest- def

A

severe respir dysfunction that leads to inadqe ventilation and oxygenation
usually proceeded by respir distress

222
Q

respir distress pathway

A

distress (interventions= intubation, cpap) s/s= compensatory mech.
failure (s/s grunting)
arrest
death

223
Q

respir arrest- complications

A

cardiopulmonary arrest if untreated

224
Q

respir arrest- s/s

A

respir rate change
shallow chest rise
cynaosis
altered mental status

225
Q

respir arrest- trtmnt

A 
reverse if fix cause of distress
open airway
use bag valve mask until advanced airway placed (endotrach tube)
    chest should rise symmetrically
encourage parent presence during CPR
ventilation needed after intubation
226
Q

respir arrest- common causes- upper, lower, neuro, cardiac and trauma

A

upper airway- croup, epiglottitis- trt w/ steroids and racemic epineph
lower airway- asthma, bronchitis, pneumonia- albuterol
neuro- seizures, SIDS
cardiac- arrhythmias, myocarditis
trauma- burns, drowning, MVA
shock, CF, DKA, reflux!!

227
Q

submersion- risk factors

A

can’t swim, no physical barriers to water, lack close supervision

age 1-4 leading cause of death
males inc risk

228
Q

submersion- pathway

A

after submersion
hold breath, panic, swallow water, aspirate, laryngospasm
hypoxia and hypercapnia= unconciousness

229
Q

submersion- complications

A

brain damage, acute respir distress syndrome, lung infection

5 min under can cause brain damage

230
Q

submersion- s/s

A

tachypnea, labored breathing, wheezing, sob, hypoxemia

231
Q

submersion- trtmnt

A 
CPR
high flow O2
ventilation to dec CO2
monitor temp
fluids and inotropic to restore volume

*monitor for pulmonary edema

232
Q

submersion- trtmnt goals

A

optimizing oxygenation and cardiac output and controlling temp

233
Q

shock- def

A

reduction in tissue perfusion= dec oxygen delivery to tissues and dec removal of metabolic by products (lactic acid)

prolonged o2 deprevation= cellular hypoxia and death

234
Q

shock- types

A

hypovolemic, distributive, obstructive, cardiogenic

235
Q

shock- classificaitons

A

type and then
compensated (homeostatic mech)
decomp (hypoten and rapid deterioration)
irrev (death)

236
Q

shock- compensated

A

inc hr, inc rr, warm or cool skin

bp last thing to change usually normal

237
Q

shock- decomp

A

cool skin, dec periph pulses, dec urinary output, high hr, hypotension, altered neuro

238
Q

shock- irreversible

A

dec hr, dec bp that is
UNresponsive to trtmnt
End organ damage

239
Q

hypovolemic shock

A

loss of plasma or blood from intravasc space
DKA, n/v, dirrhea, dehydration, sepsis, burns

admin IV fluid replacement

assess for s/s fluid overload
inotropic meds if unresponsive to flid replacemnt

240
Q

distributive shock

A

abnorm distribution of blood 2ndary to vasodil and cap perm.

less blood is returned to the heart- more blood in periphery
vessel problem

cause- sepsis, Spinal cord injury, anaphlaxis

241
Q

distrib shock- trtmnt

A

anaph- fluids, epinephrine, hydorcortisone
sepsis- antib therapy and fluids
s/s- fever, <1 sec immed cap refil
spinal cord- reverse cause

242
Q

obstructive shock

A

blockage blood to heart and major vessels

cause- tension pneumo (needle aspir + chest tube)
PE, congenital outflow obstruction, chest trauma

trt underlying cause- pericard drain for tamponade
chest tube for pneumoth
anticoag for PE
surgery

243
Q

cardiogenic shock

A

impaired myocard function
unable maintain cardiac o and tissue perfusion

cause- cardiomyopathy, myocarditis (gallop when listening), electrolyte imbal, acid base imbal

trt- SMALL fluid bolus 10mL/kg- admin slowly 10-20 min
vasodilators

244
Q

corrosives- trtmnt

A

give milk
do not induce vomiting
can cause respir compromise and respir depression (opioids)

245
Q

poisoning- s/s

A

pallor, sweating, n/v, hypoten, tachypnea, seziures, bradycardia

246
Q

hydrocarbons- trtmnt

A

call poison control

need mechanical ventilation

247
Q

beta blocker antidote

A

glucagon

monitor w/ EKG for hypoten and bradycardia

248
Q

meth antidote

A

supportive care- fluids

tachycardia and hallucinations

249
Q

activated charcol

A

use w/in 1 hr of ingestion

250
Q

tylenol antidote

A 
mucomyst
acetylcystiene
s/s- inc LFTs and bilirubin
r upper quadrant pain upon palpitation
n/v
251
Q

aspirin antidote

A

sodium bicarb and charcol

monitor for bleeding and kidney function

252
Q

compensatory mech for shock- maintain cardiovasc function

A

heart- inc hr and contractility

blood vessels- vasoconstriction of vessels in skin and nonvital organs

253
Q

compensatory mech for shock- maintain blood volume

A

hypothal- stimulatino of thirst

posterior pit- stimulation of ADH release and RAAS activated

adrenal cortex- release of aldosterone

kidney- sodium and water retention
dec urine output

liver- constriction of veins and sinusoids w/ mobilization of blood stored in liver
produces glucose

N348 Peds (5 decks)

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