Exam 3 Flashcards
1
Q
2 reasons kids are admitted to hospital
A
GI problems
2
Q
responsibilities of small intestine
A
- osmosis
- carrier-mediated diffusion
- active energy-driven transport (“pump”)
3
Q
responsibilities of large intestine
A
- absorption of water
- absorption of sodium
- role of colonic bacteria
4
Q
what would you expect stool to look like in malabsorption?
A
watery
5
Q
what is included in a GI assessment?
A
- teeth
- swallowing
- auscultate 4 quadrants
- palpate stomach
- see what comes out
6
Q
who is at greater risk for mortality and morbidity among infants and children?
A
those that are <5 years
7
Q
does diarrhea cause metabolic acidosis or alkalosis?
A
metabolic acidosis
8
Q
should an anti-diarrhea medication be given to kids?
A
no, something needs to get out and it can cause an ileus
9
Q
what is important to monitor for and to do with those who have diarrhea?
A
- oral rehydration therapy
- IV
- monitor K+ levels
- I and O
10
Q
BRAT diet
A
Bananas
Rice
Applesauce
Toast
11
Q
should the nurse do anything for vomiting?
A
- no; there is a reason for it
- have the child sit upright so no aspiration
12
Q
best medication for nausea/vomiting
A
zofran
13
Q
leading cause of accidental death in <4 years
A
ingestion of foreign bodies
14
Q
should the nurse attempt to take a foreign body out?
A
only if you can see it
15
Q
should the nurse attempt to take a foreign body out?
A
only if you can see it
16
Q
idiopathic (functional) constipation
A
no known cause
17
Q
chronic constipation
A
may be due to environmental or psychosocial factors (don’t want to poop at school)
18
Q
when should the first meconium be passed?
A
within 24-36 hours of life
19
Q
if no meconium, what should the nurse assess for?
A
- hirschsprung disease, hypothyroidism
- meconium plug, meconium ileus, cystic fibrosis
20
Q
an infant being fed what might develop constipation?
A
formula
21
Q
encopresis
A
inappropriate passage of feces, often with soiling (accidents)
22
Q
if the bowel is obstructed what kind of interventions need to be done?
A
may require 6-12 months of behavioral/dietary/pharmacologic interventions
23
Q
hirschsprung disease
A
- congenital aganglionic megacolon
- absence of ganglion cells in colon
- ribbon like stool
24
Q
gastroesophageal reflux (GER)
A
- transfer of gastric contents into esophagus
- occurs in everyone
25
how can the nurse prevent GER/GERD in children?
- thickening feedings
- upright positioning
- frequent burping during feeds
- avoid overfeeding
- positioning to promote gastric emptying
26
irritable bowel syndrome (IBS)
- cause of recurrent abdominal pain in children
- alternating diarrhea and constipation
27
clinical manifestations of acute appendicitis
- epigastric pain -> McBurney's point - RLQ abd
- fever, nausea, vomiting, pain
28
if someone with signs of appendix suddenly begins to feel better, what would be concerning?
that it ruptured and now they are becoming septic
29
hypertrophic pyloric stenosis (HPS)
- nonbilious projectile vomiting
- visible peristalsis
- FTT in infant who is "always hungry"
- dehydration
- metabolic alkalosis
30
pyloromyotomy
laparoscopic surgery of the pyloric stenosis
31
intussusception
- telescoping or invagination of one portion of intestine into another
- sudden onset of abdominal pain
- abdominal mass "sausage like"
- bloody stool
32
what kind of stools occur in intussusception?
"currant jelly-like stools"; caused form leaking blood and mucus into intestinal lumen
33
what are the top three treatments for intussusception?
1. air enema
2. hydrostatic (saline) enema
3. if unsuccessful, surgery treatment
34
short bowel syndrome (SBS)
- malabsorptive disorder
- diarrhea and watery stools
35
esophageal atresia (EA) and tracheoespophageal fistula (TEF)
- congenital defect where the esophagus fails to develop as a continuous single passage to stomach
- ensure patient airway (suction)
- NPO
36
what are signs that someone has EA or TEF?
Cough
Choke
Cyanosis
37
omphalocele
- sealed in sac
- bowel covered with peritoneal sac, seen at birth or on US
- cover with wet, sterile dressing
38
gastroschisis
- bowel herniates through a defect in the abdominal wall to the right of the umbilical cord
- cover with wet, sterile dressing
39
school aged children ages
6-12 years
40
when do children typically lose their teeth?
usually between kindergarten and 12
41
how much should height increase per year?
2 inches per year
42
how much should weight increase per year?
2-3 kg per year
43
prepubescence
defined as 2 years preceding puberty
44
what is the average age of puberty in girls and boys?
- 12 in girls: breast, bud development
- 14 in boys: testicular descention
45
what is erikson's stages in this age group?
industry vs. inferiority (don't shame them)
46
what is a good way to punish a child?
taking something away from them for a while
47
what perceptions do children have about an illness?
that it is a punishment for something they did
48
what kind of play do children participate in?
team play
49
who is the primary influence in shaping a child's personality, behavior, and value systems?
parents
50
when is an ideal time for formal sex education?
middle childhood
51
how would a child internalize stress?
withdrawing, delaying tactics, and daydreaming
52
how would a child externalize stress?
aggression and delinquency
53
stress responses that should be investigated
- stomach pains or headache
- sleep problems
- bet-wetting
- change in eating
- aggressive or stubborn behavior
- reluctance to participate
- regression to earlier behaviors (thumb sucking)
54
how much sleep should children be getting?
- 9 1/2 hours during school age
- 11 1/2 for 5 year olds
- 9 hours for 11 year olds
55
most common cause of severe injury and death in a school-aged child
motor vehicle crashes
56
what are the rules for carseats and riding in the backseat of a car?
- under 4' 9" in a booster
- 13 and under in the backseat
57
what could bet wetting be a sign of?
- regression
- UTI
- endocrine problems
- stress
- sexual abuse
- if occurs at least 2 weeks for at least 3 months
58
who is bet wetting more common in?
boys
59
when does bet wetting end?
between 6-8 years
60
how many mL of fluid is sufficient to hold a night's urine?
300-350 mL
61
drugs that help with enuresis
- imipramine (tofranil)
- oxybutynin
- DDAVP
62
encopresis
repeated voluntary or involuntary passage of feces
63
who is encopresis more common in?
males
64
when would encopresis be a concern?
if occurs once a month for 3 months
65
characteristics of ADHD
- inattention, impulsiveness, and hyperactivity
- onset before age 7
- more common in boys than girls
- get them some activity!
66
medications for ADHD
stimulants:
- dextroamphetamine (dexedrine or adderall)
- amphetamine
- caffeine is a stimulant; it calms them down
67
side effects of medications used for ADHD
- high risk of abuse, so use as last resort
- insomnia
- anorexia and weight loss
- hypertension
- if used long-term, may suppress growth
68
symptoms of conversion reactions
- abdominal pain
- fainting
- pseudo seizures (rule out with EEG)
- paralysis
- headaches
visual field restriction
69
when do psychotic orders appear?
after age 4-5
70
what does TDAP vaccine focus on and what age is it adminitered?
- focuses on pertussis
- school requires it
- age 11-12
71
is it normal for kids to be weak or lethargic?
NO
72
what is the most common permanent physical disability in childhood?
cerebral palsy (CP)
73
most common form of CP
spasticity is most common with 68% of cases ~ muscles are stiff and tight
74
signs of CP
- poor head control after 3 months
- stiff or rigid limbs
- arching back/pushing away ~ head-to-heals
- floppy tone
- unable to sit without support at 8 months
- clenched fists after 3 months
- excessive irritability
- no smiling by 3 months
- feeding difficulties
75
what pharmacologic interventions help with spasms in CP?
baclofen and diazepam (valium)
76
what is good to include in the mother's diet to avoid neural tube defects (NTD)?
folic acid
77
most serious NTD
anencephaly
78
anencephaly
- do not have a brain
- brainstem function keeps them breathing
- incompatible with life
- many are stillborn
- provide comfort but no resuscitation
79
myelomeningocele
- 75% of spinal cord in lumbar area
- hydrocephalus most frequently associated anomaly
80
what kind of allergy would the nurse expect in someone with spina bifida?
latex allergy
81
guillain-barre syndrome
- ascending muscular weakness
- Ground to Brain
- can happen after flu shots
- most deaths are due to respiratory failure, so have intubation ready
82
tetanus
"lockjaw" produced by a toxin
83
where would you find botulism?
- in improperly sterilized home-canned foods for older children
- honey and light or dark corn syrup in infants
84
CMS acronym for assessing casts
Circulation
Movement
Sensation - have them look away
85
most frequently broken bone in children
forearm ~ clavicle is 2nd
86
RICE for sports injury
Rest the injured part
Ice immediately (30 minutes at a time)
Compress with wet elastic bandage
Elevation of the extremity
87
ICES for sports injury
Ice
Compression
Elevation
Support
88
hallmark signs of diabetes
poluria, polydipsia, polyphagia
89
DKA acronym for clinical manifestations of DKA
D
Decreased LOC
Dehydration
K
Kussmal RR
Ketones
K+ = Kardiac
A
Acid
+ Anion - Acid gain
Airway
90
what do you do first in kids with DKA?
rehydrate them! 1u = 1mL
91
hypoglycemia S/S
- shakiness
- palpitations
- nervousness
- diaphoresis
- anxiety
- hunger
- pallor
92
what is more life-threatening: hypo- or hyper- glycemia?
hypoglycemia ~ always treat something as hypoglycemia
93
treatment for hypoglycemia
- consume 15 g of a simple car like fruit juice or a soft drink, 4-6 oz = 15g
- recheck glucose in 15 minutes
- repeat step 1 if still less than 70
- avoid foods with fat
- give complex CHO after recovery
94
how do you treat hypoglycemia if the patient is not alert enough to swallow?
- 50% D IV push
- glucagon 1 mg IM or SQ
95
what does insulin do to K?
decreases
96
in GH deficiency, what is the primary site of dysfunction?
hypothalamus
97
when does pituitary hyperfunction occur?
when someone reaches heights of 8 feet or more
98
precocious puberty
- sexual development before age 9 in boys or age 8 in girls
- no causative factor in 80%-90% girls and 50% boys
99
how do we treat precocious puberty?
lupron
100
S/S of hypothyroidism
- LOW AND SLOW
- hair loss
- apathy
- lethargy
- dry skin
- muscle aches and weakness
- constipation
- intolerance to cold
- receding hairline
- facial and eyelid edema
- dull-blank expression
- extreme fatigue
- thick tongue - slow speech
- anorexia
- brittle nails and hair
- menstrual disturbances
101
what is a concern with a goiter?
that the airway can be impacted
102
what happen with thyroid hormones in hypothyroidism? hyperthyroidism?
- hypo: TSH inc. T3 and T4 dec.
- hyper: TSH dec. T3 and T4 inc.
103
S/S hyperthyroidism
- FAST AND ELEVATED
- finger clubbing
- tremors
- diarrhea
- menstrual changes (amenorrhea)
- intolerance to heat
- fine, straight hair
- bulging eyes
- facial flushing
- tachycardia
- inc. systolic BP
- breast enlargement
- weight loss
- muscle wasting
- localized edema
104
rapid insulin
humalog and lispro
104
rapid insulin
humalog and lispro
