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Pediatric Nursing > Exam 3 (Chapters 14-18, 22) > Flashcards

Exam 3 (Chapters 14-18, 22) Flashcards

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1
Q

Infant Fluid and Macronutrient Needs

A

Fluid: 140-160 mL/kg/day

Calories: 100-115 kcal/kg/day

Receive approximately 50% of calories from fat

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2
Q

Infancy Weaning

A

8-9 months: cup should be offered to the infant with assistance

1 year: most infants are able to drink most liquids from a cup with a lid

Introduce complementary foods at about 6 months

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3
Q

Birth-1 Month Nutrition

A

Eats every 2-3 hours, breast or bottle

2-3 oz per feeding

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4
Q

2-4 Months Nutrition

A

Has coordinated suck-swallow

Eats every 3-4 hours

3-4 oz per feeding

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5
Q

4-6 Months Nutrition

A

Begins baby food, usually rice cereal, 2-3 T, twice daily

Consumes breast milk or formula 4 or more times daily

4-5 oz per feeding

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6
Q

6-8 Months Nutrition

A

Eats baby food such as rice cereal, fruits, and vegetables

2-5 T, 3 times daily

6-8 oz per feeding

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7
Q

8-10 Months Nutrition

A

Enjoys soft finger foods 3 times daily

Consumes breast milk or formula 4 times daily

6 oz per feeding

Uses cup with lid

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8
Q

10-12 Months Nutrition

A

Eats most soft table foods with family 3 times daily

Uses cup with or without a lid

Attempts to feed self with spoon though spills often

Consumes breast milk or formula 4 times daily

6-8 oz per feeding

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9
Q

Toddlerhood Nutrition

A

Often displays physiologic anorexia, which occurs when the extremely high metabolic demands of infancy slow to keep pace with the more moderate growth rate of toddlerhood

Should drink 16-24 oz of milk daily (whole until age 2, and then switch to 2%)

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10
Q

Preschool Nutrition

A

Enjoy the company of others when they eat and enjoy helping with food preparation and table setting

Food jags: eating only a few foods for several days or weeks

Three meals and two or three snacks daily is the norm

Children can begin to brush their own teeth

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11
Q

School Age Nutrition

A

Nutritional needs increase dramatically with growth spurts

Loss of first deciduous teeth and eruption of permanent teeth usually occur at about 6 years

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12
Q

Adolescent Nutrition

A

Need well over 2000 calories daily to support the growth spurt, and some adolescent boys require nearly 3000 or more calories daily

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13
Q

Vitamin A Deficiency

A

Night blindness, skin dryness, scaling

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14
Q

Vitamin A Excess

A

Headache, drowsiness, hepatomegaly, vomiting/diarrhea

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15
Q

Vitamin C Deficiency

A

Abnormal hair (coil shaped), skin abnormalities (dermatitis and lesions), purpura, bleeding gums, joint tenderness, sudden heart failure

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16
Q

Vitamin D Deficiency

A

Rib deformity, bowed legs, bone and joint pain, muscle weakness, periodontal disease, increased rates of respiratory and skin infections/irritation

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17
Q

Vitamin D Excess

A

Drowsiness

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18
Q

Vitamin B Deficiency

A

Weakness, decreased DTRs, dermatitis

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19
Q

Protein Deficiency

A

Hepatomegaly, edema, scant depigmented hair

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20
Q

Protein Excess

A

Kidney failure

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21
Q

Carbohydrate Deficiency

A

Emaciation, decreased energy, retarded growth and development

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22
Q

Carbohydrate Excess

A

Overweight

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23
Q

Iron Deficiency

A

Lethargy, slowed growth and developmental progression, pallor

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24
Q

Iron Excess

A

Vomiting, diarrhea, abdominal pain, pallor, cyanosis, drowsiness, shock

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25
Q

Celiac Disease

A

Chronic malabsorption syndrome of gluten

Early stages: affects fat absorption resulting in excretion of large quantities of fat in the stools

Classic features include chronic diarrhea, growth impairment, and abdominal distention

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26
Q

Passive Immunity

A

Maternal antibodies transferred through the placenta and breast milk

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27
Q

Active Immunity

A

Antibody development for specific infections through immunization or exposure to natural disease

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28
Q

Immunization

A

Vaccine that introduces an antigen into the body in order to cause the body to produce antibodies against that antigen

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29
Q

Killed Virus Vaccine

A

A microorganism has been killed but is still capable of causing the human body to produce antibodies

Inactivated poliovirus

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30
Q

Toxoid

A

A toxin has been treated by heat or chemical to weaken its toxic effects but retain effective antigens

Tetanus toxoid

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31
Q

Live Virus Vaccine

A

Microorganism is in a live but attenuated/weakened form

Measles and varicella

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32
Q

Recombinant Forms

A

A genetically altered organism is used in vaccines

Hepatitis B and Acellular Pertussis vaccine

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33
Q

Chickenpox (Varicella) Clinical Manifestations

A

Acute onset of mild fever, malaise, anorexia, headache, mild abdominal pain, and irritability

Begins as a macular rash that progresses to a papule, and then a vesicle

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34
Q

Medical Management of Chickenpox

A

Supportive care

IV acyclovir

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35
Q

Diphtheria Clinical Manifestations

A

Characteristic lesion is a grayish pharyngeal membrane that may extend to the trachea and cause airway obstruction

Sore throat and enlarged tender cervical lymph nodes

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36
Q

Medical Management of Diphtheria

A

Antibiotic therapy

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37
Q

Enterovirus Clinical Manifestations

A

Irritability, fever, anorexia, malaise, rash, and a sore throat

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38
Q

Medical Management of Enterovirus

A

Supportive care

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39
Q

Erythema Infectiosum Clinical Manifestations

A

Stage 1: mild illness (fever, headache, chills, malaise, nausea, body ache) lasting 2-3 days

Stage 2: fiery-red rash on the cheeks, circumoral pallor

Stage 3: over 1-3 weeks the rash fades, but can reappear

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40
Q

Erythema Infectiosum Medical Management

A

Supportive care usually leads to spontaneous recovery

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41
Q

Haemophilus Influenzae Clinical Manifestations

A

Begins with a viral upper respiratory infection

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42
Q

Medical Management of Haemophilus Influenzae

A

Treatment for invasive disease is IV antibiotics for 10 days

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43
Q

Influenza Clinical Manifestations

A

Abrupt onset of fever, chills, cough, runny nose, sore throat, malaise, aches, headache, and anorexia

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44
Q

Medical Management of Influenza

A

Treatment is supportive

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45
Q

Measles Clinical Manifestations

A

Prodromal Stage: high fever, malaise, cough, coryza, conjunctivitis, Koplik spots

Stage 2: maculopapular rash, reaching a peak in 2-4 days when it becomes confluent

Other symptoms include fatigue, photophobia, and generalized lymphadenopathy

46
Q

Medical Management of Measles

A

Supportive care

47
Q

Meningococcus Clinical Manifestations

A

Meningitis: abrupt onset of flulike symptoms of fever, malaise, stiff neck, nausea, vomiting, decreased mental status, seizures, and coma

Meningococcemia: fatigue, vomiting, cold hands and feet, severe aches and pains in muscles, rapid breathing, diarrhea, rash

48
Q

Medical Management of Meningococcus

A

IV antibiotics with penicillin G, cefotaxime, ceftriaxone, or ampicillin

49
Q

Mononucleosis Clinical Manifestations

A

Fever, malaise, headache, anorexia, abdominal pain, a painful sore throat, and enlarged cervical lymph nodes

50
Q

Medical Management of Mononucleosis

A

Supportive care

51
Q

Mumps Clinical Manifestations

A

Acute onset of fever, malaise, muscle aches, and swelling of one or more salivary glands

Earache, headache, pain with chewing, and decreased appetite and activity

52
Q

Medical Management of Mumps

A

Supportive care focused on symptom relief

53
Q

Pertussis Clinical Manifestations

A

Catarrhal Stage: onset is insidious with cold symptoms, a runny nose, mild cough, fever

Paroxysmal Stage: series of rapid coughs followed by a rapid inspiration through a narrowed glottis which causes stridor

Convalescent Stage: up to 6-10 weeks later paroxysms gradually subside

54
Q

Medical Management of Pertussis

A

Supportive care, macrolide antibiotics

55
Q

Pneumococcal Infection Clinical Manifestations

A

Otitis media, bacteremia, pneumonia, meningitis

56
Q

Medical Management of Pneumococcal Infection

A

Symptomatic care

57
Q

Poliomyelitis Clinical Manifestations

A

Mild illness: low-grade fever and sore throat

Serious illness: asymmetric flaccid paralysis

58
Q

Medical Management of Poliomyelitis

A

Supportive therapy

59
Q

Roseola Clinical Manifestations

A

Prodromal Stage: sudden fever greater than 103 degrees for 3-7 days

Rash Stage: a characteristic pale pink maculopapular rash that starts on the trunk and spreads to the extremities

60
Q

Medical Management of Roseola

A

Supportive treatment

61
Q

Rotavirus Clinical Manifestations

A

Dehydration and electrolyte disturbances

62
Q

Medical Management of Rotavirus

A

Treatment involves adequate amounts of fluid and electrolyte replacement

63
Q

Rubella Clinical Manifestations

A

Prodromal Stage: asymptomatic or low grade fever, malaise, coryza, and sore throat

Rash Stage: 1-5 days later a pink, maculopapular rash appears on the face and neck

64
Q

Medical Management of Rubella

A

Supportive treatment

65
Q

Streptococcus A Clinical Manifestations

A

Pharyngeal: abrupt onset of a sore throat, dysphagia, tender cervical lymph nodes, malaise, high fever, chills, headache, abdominal pain

GAS Respiratory Tract Infection: children younger than 3 may have serious rhinitis, moderate fever, irritability, and anorexia

Scarlet Fever: characteristic erythematous rash starting on the neck and spreading to the trunk and extremities

66
Q

Medical Management of Streptococcus A

A

Prompt oral antibiotic therapy

67
Q

Isotonic Dehydration

A

Occurs when fluid loss is not balanced by intake, and the loss of water and sodium are in proportion

Commonly manifested in children as vomiting and diarrhea

68
Q

Hypotonic Dehydration

A

Occurs when fluid loss is characterized by proportionately greater loss of sodium than water; serum sodium is below normal levels

Can be caused by prolonged vomiting and diarrhea, burns, and renal disease

69
Q

Hypertonic Dehydration

A

Occurs when fluid loss is characterized by a proportionately greater loss of water than sodium; serum sodium is above normal levels

Neurologic symptoms

May be caused by health problems such as diabetes insipidus or administration of IV fluid with high electrolyte levels

70
Q

Mild Dehydration Clinical Manifestations

A

Up to 5% body weight lost

Alert, restless, thirsty

Normal BP

Regular and strong pulse

71
Q

Moderate Dehydration Clinical Manifestations

A

6-9% body weight lost

Irritable or lethargic, alert, thirsty, restless

Normal or low blood pressure

Rapid pulse

Poor skin turgor

Decreased urinary output, increased specific gravity

Moderately increased thirst

Sunken fontanelles

Delayed capillary refill

Usual or rapid respirations

Slightly sunken eyes with decreased tears

72
Q

Severe Dehydration Clinical Manifestations

A

10% or more body weight lost

Lethargic to comatose

BP low to undetectable

Rapid pulse, weak to nonpalpable

Very poor skin turgor

Parched mucous membranes

Very decreased or absent output

Sunken fontanelles

Cool, discolored, delayed capillary refill

Changing rate and regularity of respirations

Deeply sunken eyes and absent tears

73
Q

Rehydration for No Diarrhea, No Dehydration

A

Continue on age-appropriate diet

74
Q

Rehydration for Minimal Dehydration

A

If child weighs < 22 pounds –> give 60-120 mL ORS for each vomiting/stool episode

If child weighs > 22 pounds, give 120-240 mL ORS for each vomiting/stool episode

Continue breastfeeding or resume age-appropriate diet after initial hydration

75
Q

Rehydration for Moderate Dehydration

A

Give 50-100 mL ORS in 3-4 hours in addition to replacing fluids lost

76
Q

Rehydration for Severe Dehydration

A

Child is hospitalized and treated with IV fluids

100 mL/kg ORS in 4 hours

77
Q

Extracellular Fluid Volume Excess

A

Children have a condition that causes them to retain saline

Characterized by sudden weight gain

Clinical manifestations include bounding pulse, distended neck veins, periorbital edema, hepatomegaly, dyspnea, orthopnea, and lung crackles

78
Q

Interstitial Fluid Volume Excess

A

Edema occurs if the balance of hydrostatic pressure, interstitial osmotic pressure, blood colloid osmotic pressure, and interstitial fluid hydrostatic pressure is altered so that excess fluid either leaves or enters the interstitial compartment

79
Q

Hypernatremia

A

Serum sodium level above 146 mmol/L in children

Caused by conditions that cause the body to lose relatively more water than sodium or to gain relatively more sodium than water

Generally thirsty, small urine output, decreased LOC, seizures, death

Treated with hypotonic IV fluid

80
Q

Hyponatremia

A

Serum sodium level below 134 mmol/L in children

Caused by conditions that cause gain of relatively more water than sodium or loss of relatively more sodium than water

Decreased LOC, anorexia, headache, nausea, vomiting, muscle weakness, decreased DTRs, agitation, lethargy, confusion

Can progress to respiratory arrest, dilated pupils, decorticate posturing, and coma

Hypertonic IV fluids used for treatment

81
Q

Hyperkalemia

A

Excess of 5.7 mmol/L of potassium in the blood

Caused by conditions that include increased potassium intake, shift of potassium from cells to extracellular fluid, and decreased potassium excretion

Cramping, diarrhea, muscle weakness, cardiac arrhythmias

Potassium is removed by peritoneal dialysis, potassium-wasting diuretics, or cation exchange resin

82
Q

Hypokalemia

A

Serum potassium level below 3.7 mmol/L

Caused by increased potassium excretion, decreased potassium intake, and loss of potassium by an abnormal route

Abdominal distention, muscle dysfunction, constipation, paralytic ileus, cardiac arrhythmias, fatigue, polyuria

Potassium replacement may be given orally or IV

83
Q

Hypercalcemia

A

Plasma excess of total calcium above 2.7 mmol/L

Caused by vitamin D overdose, hyperparathyroidism, bone tumors and other cancers, thiazide diuretics, and familial hypercalcemia

May have nonspecific symptoms; decreased neuromuscular excitability, constipation, anorexia, nausea, vomiting, muscle weakness

Treat underlying cause of the condition

84
Q

Hypocalcemia

A

Serum deficit of calcium below 2.1 mmol/L

Caused by insufficient dietary calcium and vitamin D intake, chronic diarrhea, laxative abuse, malabsorption, chronic renal insufficiency, hypoparathyroidism, alkalosis, large transfusion of citrated blood, rapid infusion of plasma expanders

Increased neuromuscular excitability (tetany)

Treated by oral or IV administration of calcium

85
Q

Hypermagnesemia

A

Plasma magnesium concentration above 2.4 mg/dL

Caused by impaired renal function

Decreased muscle irritability, hypotension, bradycardia, drowsiness, lethargy, weak deep tendon reflexes

Treated by increasing urinary excretion of magnesium

86
Q

Hypomagnesemia

A

Plasma magnesium concentration below 1.6 mg/dL

Caused by chronic malnutrition, decreased intake, chronic diarrhea, short bowel syndrome, steatorrhea

Increased neuromuscular excitability (tetany)

Managed by administering magnesium and treating underlying cause of imbalance

87
Q

Respiratory Acidosis

A

Decreased pH of the blood caused by inability to release CO2

Causes CNS depression, tachycardia

Treatment requires correction of underlying cause

88
Q

Respiratory Alkalosis

A

Increased pH of the blood caused by too much excretion of CO2

Muscle cramping, dizziness, confusion

Treatment requires correction of the condition that caused the hyperventilation

89
Q

Metabolic Acidosis

A

Caused by an imbalance in production and excretion of acid or by excess loss of bicarbonate

Diarrhea, fistulas, and ileal drainage are all possible sources of bicarbonate loss

Rate and depth of breathing increase, Kussmaul respirations, cardiac arrhythmias, hypotension, pulmonary edema, tissue hypoxia, confusion, drowsiness

Treatment depends on correction of the underlying cause

90
Q

Metabolic Alkalosis

A

A gain in bicarbonate or a loss of metabolic acid

Acid can be lost through severe vomiting, gastric suctioning

Bicarbonate is gained through excessive intake of bicarbonate antacids or baking soda

Respirations decrease, increased neuromuscular excitability, cramping, paresthesia, tetany, seizures, and excitation can occur

Treatment depends on correction of the underlying cause

91
Q

Primary Immune Deficiency

A

Children are born with a failure of humoral antibody formation (B-cell disorder), a deficient cellular immune system (T-cell disorder), or a combination of both defects

92
Q

Secondary Immune Deficiency

A

Acquired immune deficiency (as in HIV/AIDS)

93
Q

Severe Combined Immunodeficiency Disease

A

Congenital condition characterized by the absence of both humoral and cellular immunity that is manifested by lack of appropriately functioning T-cells and B-cells

X-linked recessive and autosomal recessive forms

94
Q

Clinical Manifestations of SCID

A

Susceptibility to infection, recurrent oral candidiasis, failure to thrive, skin infections

95
Q

Clinical Therapy for SCID

A

IVIG, hematopoietic stem cell transplantation

96
Q

Wiskott-Aldrich Syndrome

A

Combined congenital immunodeficiency syndrome; IgM levels are low, IgG levels are normal or slightly low, and IgA and IgE levels are elevated

Diagnosis made in early neonatal period on the basis of thrombocytopenia, eczema, recurrent infections

97
Q

Treatment for Wiskott-Aldrich Syndrome

A

Supportive and includes antibiotic prophylaxis, platelet transfusions, IVIG

98
Q

Clinical Manifestations of HIV and AIDS

A

Asymptomatic at birth

Lymphadenopathy, hepatosplenomegaly, oral candidiasis, failure to thrive and weight loss, delayed development, swelling of the parotid gland, and chronic diarrhea

99
Q

Clinical Therapy for HIV and AIDS

A

Care focuses on the prevention of HIV transmission, the detection of the presence of HIV, aggressive therapy to reduce progression to AIDS, and promotion of the child’s growth and development and survival

Combinations of antiretroviral drugs

100
Q

Systemic Lupus Erythematosus

A

Chronic inflammatory, autoimmune disease of unknown origin that involves many organ systems

101
Q

Clinical Manifestations of Systemic Lupus Erythematosus

A

Acute: onset of nephritis, arthritis, or vasculitis

Gradual onset with nonspecific symptoms

102
Q

Clinical Therapy for Systemic Lupus Erythematosus

A

Goals are to create a remission of symptoms and to prevent complications

Steroids, NSAIDs, immunosuppressants, diet restrictions, renal transplantation

103
Q

Juvenile Idiopathic Arthritis

A

Inflammation involving one or more joints, lasting more than 6 weeks, and diagnosed prior to 16 years of age

Decreased mobility, swelling, pain

104
Q

Clinical Manifestations of Juvenile Idiopathic Arthritis

A

Fever, rash, lymphadenopathy, splenomegaly, and hepatomegaly

Disease is frequently chronic, extending over several years after an initial manifestation with pain and other symptoms

Remissions and exacerbations are characteristic

105
Q

Clinical Therapy for Juvenile Idiopathic Arthritis

A

Child may present with anemia and leukocytosis

Goals of treatment are to relieve pain, control inflammation, preserve joint function, prevent deformities, achieve remission of the disease, minimize the side effects, and promote normal growth and development

NSAIDs, steroids, biologic response modifiers

106
Q

Type I Hypersensitivity Reaction

A

Localized or systemic reactions (anaphylaxis)

Hypotension, wheezing, spasm of smooth muscle, stridor, wheal, urticaria edema, vomiting, diarrhea

Anaphylaxis, extrinsic asthma

107
Q

Type II Hypersensitivity Reaction

A

Tissue-specific reactions

Dyspnea or fever

Transfusion reaction, ABO incompatibility, hemolytic anemia

108
Q

Type III Hypersensitivity Reaction

A

Immune-complex reactions

Urticaria, fever, joint pain

Acute glomerulonephritis, serum sickness

109
Q

Type IV Hypersensitivity Reaction

A

Delayed reactions

May include fever, erythema, pruritus, contact dermatitis, blistering

Contact dermatitis, tuberculin skin test, graft-versus-host disease, Stevens-Johnson syndrome, allograft rejection

110
Q

Hypersensitivity Response

A

Overreaction of the immune system

Pediatric Nursing (7 decks)

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