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PEDS > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

genetics of club foot

A

congenital anomaly

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2
Q

s/s of club foot

A

muscles, tendons and ligaments are twisted out of shape

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3
Q

3 tx for club foot and how long for each

A

serial casting changed every 1-2 weeks , surgery NO younger then 3 months, denis brown splint

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4
Q

goal of care for club foot

A

lengthen and straighten ligaments and tendons

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5
Q

s/s of congenital hip dysplasia

A

limited abduction from asymmetry of gluteal folds + ortolani barlow, and limp and abnormal gait

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6
Q

what is ortolani barlow

A

Ortolani: Feeling the head of the femur return to the hip joint in infants

Barlow:
Anterior pressure pushes femoral head out of hip joint

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7
Q

2 tx for hip dysplasia

A

Pavlik Harness (< 6 mo. Worn 23 hours a day) – it maintains correct position of femoral head in the acetabulum

Closed reduction with spica cast (cast that covers lower half of body except perineal area)

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8
Q

path of legg calve

A

Avascular necrosis of femoral head due to lack of blood supply

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9
Q

who is most at risk for legg caffe

A

M 2-12 yr olds

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10
Q

s/s of legg caffee

A

pain
limp
limited ROM
weakness
muscle wasting

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11
Q

tx for leg caffee

A

toronto splint

alignment

rehab

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12
Q

patho of scoliosis

A

Curvature of the spine laterally 10% to > 40%

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13
Q

s/s of scoliosis

A

no pain unless >40%

uneven hips and shoulders

prominent scapula

resp obstruction

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14
Q

tx for scoliosis

A

boston splin

halo brace

spinal fusion

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15
Q

priority asessment after surgery for scoliosis

A

oxygenation (chest tube stats, skin color, LOc)

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16
Q

path of osteomyelitis

A

bone infection usually caused by staph

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17
Q

s/s of osteomyelitis

A

pain, fever, edema, low mobility

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18
Q

labs needed for osteomyelitis

A

lyme, CBC, PPD, needle aspiration

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19
Q

tx for osteomyelitis

A

IV abx for 3-6 wks

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20
Q

achondroplasia patho

A

dwarfism, 58 inches or less

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21
Q

marfan syndrome patho

A

MV prolapses, aortic regurgitation, long arms and legs, lens subluxation

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22
Q

what are marfan syndrome poeple at risk for

A

cardiac pblms

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23
Q

who should marfan syndrome person see

A

cardiologist, opthalmologist

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24
Q

what causes osteogenesis imperfecta

A

defect in production of collagen

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25
Q

scan to test for osteogenesis imperfecta

A

DEXA

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26
Q

infant bones are ___ ossified

A

65%

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27
Q

what is early sign of Nv complications

A

pain increasing even with pain meds

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28
Q

4 s/s of basilar head fracture

A

raccoon eyes

battle sign

cushings

nasal hemorrhage

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29
Q

where do kids with basilar fracture go

A

PICU

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30
Q

what is muscular dystrophy

A

inherited progressive muscle degeneration

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31
Q

when is onset of duchenne Md

A

3-5 years

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32
Q

what does duchnee Md affect

A

voluntary muscle groups

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33
Q

life expectancy for ducc MD

A

15-30 yrs

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34
Q

Trendelenburg sign

A

Hip rises on side of weight bearing. Done on older children

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35
Q

Telescoping of the hip

A

Movement of the hip above acetabulum in older children

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36
Q

Name 6 differences in children regarding the Musculoskeletal system:

A
  • Fibrous membranes between cranial bones allow for birth (fontanels)
  • Brain growth almost complete at 2 y.o.
  • Long bones are more porous, less dense
  • Epiphyseal cartilage is slowly replaced by bone by 20 y.o.
  • Growing pains are real
  • Ligaments and tendons are stronger than bone
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37
Q

5 differences in children neuro

A
  • Top heavy head
  • Cranial bones thinner
  • Neck muscles not strong
  • Unfused sutures until age 12 but after 5 y.o., no expansion of skull possible
  • By 2 years, fontanels closed
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38
Q

infant increased ICP s/s 7

A
  • Irritability
  • Bulging fontanels
  • Poor feeding, sucking
  • Nuchal rigidity
  • Unequal pupils
  • Seizures (late)
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39
Q

child increased ICP s/s

A
  • Headache
  • Visual changes
  • N/V
  • Vertigo
  • Irritability
  • Ataxia
  • Nuchal rigidity
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40
Q

decorticate posiiton means damage where

A

above brainstem

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41
Q

what 3 things does glasgow scale measure

A

eye opening, verbal response, motor response

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42
Q

severe coma numbers

A

3-8

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43
Q

status elipticus

A

seizure >10 min or on and off for 20

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44
Q

tx for status elipticus

A

airway, suction, O2, Iv access

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45
Q

dx for seizure

A

LP to test for meningitis

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46
Q

meds for seizure

A

SLOWLY PUSH ativan, valium

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47
Q

med to treat chronic seizure

A

phenytoin

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48
Q

Nursing care of a patient who is epileptic and having a seizure in the hospital includes: Select all that apply.

A. Place a padded tongue blade in their mouth
B. Call a code.
C. Check the vital signs
D. Observe respirations and time the seizure
E. Restrict the patient’s movements as much as possible
F. Give epinephrine immediately

A

D

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49
Q

cause of viral meningitis

A

enteroviruses

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50
Q

how to dx viral meningitis

A

neg bacterial culture on LP and PCR

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51
Q

education for viral meningitis

A

resolves in 3-10 days

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52
Q

cause of bacterial meningitis

A

HIB

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53
Q

5 s/s of bacterial meningitis

A

HA , fever, irritability, stiff neck, n/v

54
Q

what to do if suspect bacterial meningitis

A

LP and CSF culture then start abx while waiting results

55
Q

3 complications of bacterial meningitis

A

ICP, SIADH, DI

56
Q

enviornment for bacterial meningitis

A

isolation, dark, quiet room

57
Q

patho of reyes syndrome

A

Encephalopathy and lever damage related to viral infection and use of aspirin

58
Q

cause of hydrocephalus

A

ventricles blocked or CSF not being reabsorbed

59
Q

4 s/s of hydrocephalus

A

poor feeding
poor muscle tone
irritability
sunset eyes

60
Q

what position for post shunt

A

flat

61
Q

what is a shunt

A

placed in one of the ventricles and the excess CSF travels through a one-way or controlling valve under the skin (tunneled) to the peritoneum where the CSF is absorbed by the body.

62
Q

What are complications associated with VP shunts and what can the nurse do about them?

A
  1. Blockage or valve failure: Signs of Increasing ICP
  2. Infections: Careful incision care, hygiene
63
Q

path of C2 mamlfromation

A

herniation of brainstem into cervical spaces

64
Q

patho of myelomeningocele

A

sacs of spinal column contents present at birth

65
Q

5 caring for myelo.

A

Cover with moist cover
Leave diaper off
Measure head circumference
Don’t touch it
Avoid latex

66
Q

3 education for myelomen

A

Pts may need catheter for life
Have mobility issues
Have latex allergies

67
Q

s/s of cerebral pasley 9

A

spastic muscles, abnormal gait, contractures, jerking, temors, seizure, sensory problems, delayed intellect, poor feeding

68
Q

CP does not __

A

progress

69
Q

6 care for CP child

A

skincare
check splint fittings
refer to other providers
dietary fiber
meds
maintain function

70
Q

path of ADHD

A

CNS with variation in its ability to deal with attention

71
Q

tx for ADHD first

A

behavior modifications

72
Q

what must be ruled out before amphetamine therapy for ADHD

A

cardiac pblms

73
Q

ADHD enviornment

A

less stimulation, reward pos behavior, consistency,

74
Q

intellectual disability is

A

IQ<70

75
Q

what is fragile X

A

Recessive gene abnormality on X chromosome. Lack a protein that enables brain to grow properly.

76
Q

A nurse is asked by a pregnant woman during prenatal clinic, how much alcohol use in pregnancy will cause an effect on her baby?

A

The answer is unknown so all women are cautioned against any use in pregnancy.

77
Q

path of retinopathy

A

Blood vessel constriction/damage, then vascular overgrowth on retina happening after birth

78
Q

s/s of strabismus

A

lazy eye that gets worse

79
Q

tx for strabismus

A

occlusion therapy

80
Q

7 s.s of TBI

A

Irritability

Cardiac instability

Respiratory depression

Increased ICP

Drowsy to comatose

Seizure risk

Shock

81
Q

While developing a plan of care for a 7 y.o. child with ASD, the nurse will provide the following interventions: (Select all that apply.) A, B, C, & F (D & E offer too many choices)

A. Allow the child to keep to exactly the same routine each day.
B. Keep explanations short and to the point.
C. Explore what activities are important to the child.
D. Provide explanations in detail and give written handouts.
E. Ask the child to select from a menu what he wants to eat.
F. Ask parents to bring in familiar objects from home.

A

ABCF

82
Q

2 causes of iron def anemia

A
  1. Poor nutritional intake of iron rich foods
  2. Loss of blood volume or cells
83
Q

what is IDA

A

Onset after 6 months in infants who have not started having solid foods
Excessive milk ingestion

84
Q

5 s/s of IDA

A

Fatigue
Heart murmur
Tachycardia
Pale mucous membranes
Headache

85
Q

5 cell morphology of IDA

A
  • Small RBC microlytic2
  • H and H low
  • Ferritin
  • TIBC
  • Serum Fe
86
Q

foods high in iron

A

green veg, red meat, raisins, iron cereal

87
Q

when should child be screened for IDA

A

9mo-1 yr
preschool
school age
adolesc.

88
Q

what is sickle cell anemia

A

autosomal recessive genetic disorder. Cells contain Hemoglobin S which causes sickling of the cells. Sickled cells are unable to attach to oxygen molecules.

89
Q

what 2 body areas does SCA damage

A

spleen and bone marrow

90
Q

4 triggers of SCA

A

Hypoxia
Dehydration
Stress
Anything that increases O2 demand

91
Q

8 s/s of SCA

A

PAIN
Swollen joints
Fatigue
Tachycardia
Abdominal pain
N/V, anorexia
Fever
Pallor

92
Q

only cure for SCA

A

stem cell transplant from family who is identical

93
Q

hemophillia is

A

is caused by a lack of a factor in the blood clotting cascade. It is an X linked genetic disorder which results in mostly males with the disease.

94
Q

hemophilia is most common in

A

males

95
Q

7 ed for hemophillia

A

Shave with an electric razor,
Avoid contact sports
Use paper tape
Pain management
Emotional support
Impaired mobility in some cases
Medication and blood administration

96
Q

3 ss of hemophillia

A

Bleeding into joint spaces
Bruising more than indicated
Epistaxis, hematuria

97
Q

4 immmune diff in child

A

Carry over immunity from mother after birth
until about 18 months

Thymus gland large at birth and play large part
in production of T cells

Spleen and tonsils large and work more in
children

Low in immunoglobins (IgG) but cellular
immunity stronger

98
Q

child carries HIV igG over after birth for

A

6 mo and HIB antibodies for 18 months

99
Q

What role does the thymus gland, spleen, and tonsils play in the immunity in newborns?

A

All provide T cells and assist in immune system to protect child from infections

100
Q

How is HIV transmitted to newborn?

A

Vertical transmission during birth or during breast feeding after birth

101
Q

5 ss of HIV in infants

A

FTT
Diarrhea
Skin disorders
Hepatosplenomegaly
Opportunistic infections

102
Q

If a mother is treated for HIV during her pregnancy with anti retroviral therapy, the risk of passing the HIV to her child drops from 25% to:

A

2

103
Q

7 ed for HIV child

A

Maintain weight, nutrition
Stimulate normal growth & development
Monitor for signs of infection
Fluid maintenance
Universal precautions
Support groups
Education on transmission, risks.

104
Q

Anti retroviral therapy involves

A

several medications designed to limit the progression of the disease.

105
Q

better prognosis for AIDS if

A

the child takes longer to develop AIDS

106
Q

5 cell differences in children

A

More embryonic cell types vs epithelial cells

Cell growth is more rapid in children

Cancer growth, therefore, is more rapid

Fetal cells more vulnerable and present at birth

Fewer phagocytes present in children < 1 month of
age.

107
Q

proto oncogene

A

regulates cell division

108
Q

tumro supressor gene

A

Counteracts oncogenes to
control cell proliferation.

109
Q

oncogene

A

allows for uncontrolled proliferation

110
Q

Childhood cancers are more aggressive than adult cancers. Why is this? 3

A

Embryonic cells involved vs epithelial cells
Higher rate of cell growth and metabolism in children
Less phagocytes in children < 1 month old

111
Q

How does chemotherapy work?

A

Kills off cells, both healthy and cancerous

112
Q

what to not give child in mouth after chemo

A

lidocaine

113
Q

When planning a bone marrow transplant, the patient will

A

receive intense chemo followed by radiation to kill off all blood an d bone marrow cells.

114
Q

After injection of donor bone marrow

A

, it takes 2-3 weeks for cells to grow.

115
Q

brain tumor

A

solid mass, originate in CNS

116
Q

neuroblastomas

A

originate in SNS

117
Q

s/s of wilms tumor

A

palpable mass, HTN, hematuria

118
Q

problem is nurse sees what with wilms tumor

A

palpation

119
Q

what is leukemia

A

Immature stem cells create immature lymphocytes that crowd out RBC, WBCs, and platelets in the bone marrow and blood

120
Q

2 types of leukemia

A

Acute lymphoblastic leukemia (ALL)
Acute myloid leukemia (AML)

121
Q

CNS complications have been decreased due to the administration of what antimetabolite?

A

methotrexate

122
Q

Symptoms of ALL leukemia include: 6

A

Pallor, fever, bleeding, joint pain due to loss of RBCs, splenic involvement, loss of platelets, bleeding into joint spaces.

123
Q

tx for leukemia

A

chemo radiation and BM transplant

124
Q

how do infants and toddlers percieve death

A

Do not understand concept but know they feel bad and other are upset

125
Q

how do school age child percieve death

A

Understand death but may not be a realistic understanding. Older school aged children may understand the permanence of death

126
Q

how do adolescents percieve death

A

Understand and may go through grieving process. Body image and need for socialization are strong needs at this age. Social isolation may occur as friends may not know how to respond.

127
Q

milestones for
1
2
4
6
9
12
18
2 yrs

A

1 - hold hand in fist
2-holds rattle, can turn from side to back, holds head up
4-grasp objects, manipulate objects, stand when being held
6- sit alone without support
9-pincer grasp, crawls
12-place object in hole, standing, walking
18-runs, stairs, pushes and pulls
2 yr - jumps kicks throws ball, draws, scribbles

128
Q

dev tasks for
preschool
school age
adolesc

A

initiative v guilt
The young child
initiates new activities and considers new ideas. This interest in
exploring the world creates a child who is involved and busy.

industry v inferiority
new
interests and by involvement in activities. The child takes pride
in accomplishments in sports, school, home, and community. If
the child cannot accomplish what is expected, however, the result
will be a sense of inferiority.

Identity Versus Role Confusion (12 to 18 Years). In adolescence,
as the body matures and thought processes become more
complex, a new sense of identity, or self, is established. The self,
family, peer group, and community are all examined and redefined.
The adolescent who is unable to establish a meaningful definition
of self will experience confusion in one or more roles of life.

129
Q

common symptom of sickle cell anemia

A

splenomegaly

130
Q

what does DDAVP do

A

hemophillia

131
Q

ewing sarcoma

A

type of bone cancer that happens during time of growth

PEDS (4 decks)

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