Exam 3 (Chapters 14-18, 22) Flashcards
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
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
3
Q
Birth-1 Month Nutrition
A
Eats every 2-3 hours, breast or bottle
2-3 oz per feeding
4
Q
2-4 Months Nutrition
A
Has coordinated suck-swallow
Eats every 3-4 hours
3-4 oz per feeding
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
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
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
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
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%)
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
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
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
13
Q
Vitamin A Deficiency
A
Night blindness, skin dryness, scaling
14
Q
Vitamin A Excess
A
Headache, drowsiness, hepatomegaly, vomiting/diarrhea
15
Q
Vitamin C Deficiency
A
Abnormal hair (coil shaped), skin abnormalities (dermatitis and lesions), purpura, bleeding gums, joint tenderness, sudden heart failure
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
17
Q
Vitamin D Excess
A
Drowsiness
18
Q
Vitamin B Deficiency
A
Weakness, decreased DTRs, dermatitis
19
Q
Protein Deficiency
A
Hepatomegaly, edema, scant depigmented hair
20
Q
Protein Excess
A
Kidney failure
21
Q
Carbohydrate Deficiency
A
Emaciation, decreased energy, retarded growth and development
22
Q
Carbohydrate Excess
A
Overweight
23
Q
Iron Deficiency
A
Lethargy, slowed growth and developmental progression, pallor
24
Q
Iron Excess
A
Vomiting, diarrhea, abdominal pain, pallor, cyanosis, drowsiness, shock
25
Celiac Disease
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
26
Passive Immunity
Maternal antibodies transferred through the placenta and breast milk
27
Active Immunity
Antibody development for specific infections through immunization or exposure to natural disease
28
Immunization
Vaccine that introduces an antigen into the body in order to cause the body to produce antibodies against that antigen
29
Killed Virus Vaccine
A microorganism has been killed but is still capable of causing the human body to produce antibodies
Inactivated poliovirus
30
Toxoid
A toxin has been treated by heat or chemical to weaken its toxic effects but retain effective antigens
Tetanus toxoid
31
Live Virus Vaccine
Microorganism is in a live but attenuated/weakened form
Measles and varicella
32
Recombinant Forms
A genetically altered organism is used in vaccines
Hepatitis B and Acellular Pertussis vaccine
33
Chickenpox (Varicella) Clinical Manifestations
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
34
Medical Management of Chickenpox
Supportive care
IV acyclovir
35
Diphtheria Clinical Manifestations
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
36
Medical Management of Diphtheria
Antibiotic therapy
37
Enterovirus Clinical Manifestations
Irritability, fever, anorexia, malaise, rash, and a sore throat
38
Medical Management of Enterovirus
Supportive care
39
Erythema Infectiosum Clinical Manifestations
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
40
Erythema Infectiosum Medical Management
Supportive care usually leads to spontaneous recovery
41
Haemophilus Influenzae Clinical Manifestations
Begins with a viral upper respiratory infection
42
Medical Management of Haemophilus Influenzae
Treatment for invasive disease is IV antibiotics for 10 days
43
Influenza Clinical Manifestations
Abrupt onset of fever, chills, cough, runny nose, sore throat, malaise, aches, headache, and anorexia
44
Medical Management of Influenza
Treatment is supportive
45
Measles Clinical Manifestations
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
Medical Management of Measles
Supportive care
47
Meningococcus Clinical Manifestations
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
Medical Management of Meningococcus
IV antibiotics with penicillin G, cefotaxime, ceftriaxone, or ampicillin
49
Mononucleosis Clinical Manifestations
Fever, malaise, headache, anorexia, abdominal pain, a painful sore throat, and enlarged cervical lymph nodes
50
Medical Management of Mononucleosis
Supportive care
51
Mumps Clinical Manifestations
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
Medical Management of Mumps
Supportive care focused on symptom relief
53
Pertussis Clinical Manifestations
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
Medical Management of Pertussis
Supportive care, macrolide antibiotics
55
Pneumococcal Infection Clinical Manifestations
Otitis media, bacteremia, pneumonia, meningitis
56
Medical Management of Pneumococcal Infection
Symptomatic care
57
Poliomyelitis Clinical Manifestations
Mild illness: low-grade fever and sore throat
Serious illness: asymmetric flaccid paralysis
58
Medical Management of Poliomyelitis
Supportive therapy
59
Roseola Clinical Manifestations
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
Medical Management of Roseola
Supportive treatment
61
Rotavirus Clinical Manifestations
Dehydration and electrolyte disturbances
62
Medical Management of Rotavirus
Treatment involves adequate amounts of fluid and electrolyte replacement
63
Rubella Clinical Manifestations
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
Medical Management of Rubella
Supportive treatment
65
Streptococcus A Clinical Manifestations
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
Medical Management of Streptococcus A
Prompt oral antibiotic therapy
67
Isotonic Dehydration
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
Hypotonic Dehydration
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
Hypertonic Dehydration
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
Mild Dehydration Clinical Manifestations
Up to 5% body weight lost
Alert, restless, thirsty
Normal BP
Regular and strong pulse
71
Moderate Dehydration Clinical Manifestations
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
Severe Dehydration Clinical Manifestations
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
Rehydration for No Diarrhea, No Dehydration
Continue on age-appropriate diet
74
Rehydration for Minimal Dehydration
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
Rehydration for Moderate Dehydration
Give 50-100 mL ORS in 3-4 hours in addition to replacing fluids lost
76
Rehydration for Severe Dehydration
Child is hospitalized and treated with IV fluids
100 mL/kg ORS in 4 hours
77
Extracellular Fluid Volume Excess
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
Interstitial Fluid Volume Excess
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
Hypernatremia
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
Hyponatremia
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
Hyperkalemia
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
Hypokalemia
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
Hypercalcemia
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
Hypocalcemia
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
Hypermagnesemia
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
Hypomagnesemia
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
Respiratory Acidosis
Decreased pH of the blood caused by inability to release CO2
Causes CNS depression, tachycardia
Treatment requires correction of underlying cause
88
Respiratory Alkalosis
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
Metabolic Acidosis
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
Metabolic Alkalosis
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
Primary Immune Deficiency
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
Secondary Immune Deficiency
Acquired immune deficiency (as in HIV/AIDS)
93
Severe Combined Immunodeficiency Disease
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
Clinical Manifestations of SCID
Susceptibility to infection, recurrent oral candidiasis, failure to thrive, skin infections
95
Clinical Therapy for SCID
IVIG, hematopoietic stem cell transplantation
96
Wiskott-Aldrich Syndrome
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
Treatment for Wiskott-Aldrich Syndrome
Supportive and includes antibiotic prophylaxis, platelet transfusions, IVIG
98
Clinical Manifestations of HIV and AIDS
Asymptomatic at birth
Lymphadenopathy, hepatosplenomegaly, oral candidiasis, failure to thrive and weight loss, delayed development, swelling of the parotid gland, and chronic diarrhea
99
Clinical Therapy for HIV and AIDS
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
Systemic Lupus Erythematosus
Chronic inflammatory, autoimmune disease of unknown origin that involves many organ systems
101
Clinical Manifestations of Systemic Lupus Erythematosus
Acute: onset of nephritis, arthritis, or vasculitis
Gradual onset with nonspecific symptoms
102
Clinical Therapy for Systemic Lupus Erythematosus
Goals are to create a remission of symptoms and to prevent complications
Steroids, NSAIDs, immunosuppressants, diet restrictions, renal transplantation
103
Juvenile Idiopathic Arthritis
Inflammation involving one or more joints, lasting more than 6 weeks, and diagnosed prior to 16 years of age
Decreased mobility, swelling, pain
104
Clinical Manifestations of Juvenile Idiopathic Arthritis
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
Clinical Therapy for Juvenile Idiopathic Arthritis
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
Type I Hypersensitivity Reaction
Localized or systemic reactions (anaphylaxis)
Hypotension, wheezing, spasm of smooth muscle, stridor, wheal, urticaria edema, vomiting, diarrhea
Anaphylaxis, extrinsic asthma
107
Type II Hypersensitivity Reaction
Tissue-specific reactions
Dyspnea or fever
Transfusion reaction, ABO incompatibility, hemolytic anemia
108
Type III Hypersensitivity Reaction
Immune-complex reactions
Urticaria, fever, joint pain
Acute glomerulonephritis, serum sickness
109
Type IV Hypersensitivity Reaction
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
Hypersensitivity Response
Overreaction of the immune system
