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Peds > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

My friends call me lazy

I blame it on my friend’s strabismus and ptosis

I cause one eye not to see so good

I cause an asymmetrical corneal light reflex

Playing pirates for several hours a day and vision therapy make me better

A

Amblyopia

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2
Q

Amblyopia Therapeutic Management

A

Patching (the stronger eye) for several hours a day OR Atropine drops in the stronger eye daily

Vision therapy

Eye muscle surgery

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3
Q

I block light from entering the eye

I am a leading cause of visual impairment & blindness

You won’t see a red reflex with me

Surgery makes me go away-the earlier the better

A

Congenital Cataracts

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4
Q

Congenital Cataract Patho

A

Opacity of the optic lens preventing light from entering into eye - will lead to severe amblyopia if not treated

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5
Q

Congenital Cataract assessment cues and management

A

Surgical removal of cataract and placement of implantable lens

Post-op care: Eye patching, Elbow restraints

Antibiotic & steroid drops (parent education)

Patching of normal eye after surgical eye has healed to strengthen vision

Sunglasses when outside to protect against UV rays

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6
Q

I make the ear feel full

Making air bubbles is my specialty

I make the TM look dull, orangish and have decreased movement

I can make you say “Huh?”

I usually go away on my own

A

Otitis Media With Effusion (OME) Non-infectious

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7
Q

Otitis Media With Effusion (OME) Non-infectious Assessment Cues and Management

A

Antihistamines, steroids, and decongestants do not help resolve

Usually spontaneously resolves but should be rechecked every 4 weeks

Do not feed in a supine position and avoid bottle propping

If OME persists for >3 months, refer to ENT and assess carefully for hearing loss or speech delay
It can also cause balance disturbance

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8
Q

I can visit infants and young children often, usually with my neighbor URI

I cause rubbing and pulling of ears

I cause the TM to look dull, red and bulging

I can cause hearing difficulties & speech delays if I visit often

A

Acute Otitis Media

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9
Q

Acute Otitis Media Assessment Cues and Management

A

Symptomatic management of otalgia and fever
* Acetaminophen and ibuprofen -mild to moderate pain
* Narcotics for severe
* Benzocaine (Auralgan) drops may also be prescribed for pain if the TM is not ruptured

Warm heat or cool compresses may be effective

Antibiotic therapy - Amoxicillin, Amoxicillin-clavulanate (Augmentin), Azithromycin – PO (10-14 days)

Pneumatic otoscope- used to visualize the TM and assess its movement

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10
Q

Conductive Hearing Loss

A

Transmission of sound through the middle ear is disrupted (i.e. frequent OM)

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11
Q

Sensorineural Hearing Loss

A

Damage to the hair cells in the cochlea or along the auditory pathway (i.e. ototoxic medication, meningitis, CMV, rubella, excessive noise)

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12
Q

Mixed Hearing Loss

A

attributed to both conductive and sensorineural problem

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13
Q

I take the pressure off

I am needed when OM visits often

I allow the infection to get out

I fall out on my own

A

Tympanostomy Tubes

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14
Q

Tympanostomy Tubes Management and Education

A

Myringotomy (~15 minute surgery) uses general anesthesia; PACU recover, discharged home same day
*Post Op pain is not common

Teach ear drop administration if prescribed post-op and tubes remain in place for several months; usually fall out spontaneously (~8-18 months)

Ear plugs recommended when swimming; if water enters ear, allow it to drain out

Report drainage

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15
Q

I like to get in the way of the aqueous humor flow
I cause optic nerve damage and vision loss
You may see a gray or green light reflex in only one eye
Surgery makes me go away

A

Infantile glaucoma

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16
Q

Infantile glaucoma Physical Cues

A

Keeping eyes closed
Frequent eye rubbing
Spasmodic winking
Corneal clouding
Enlargement of eyeball
Excessive tearing or conjunctivitis
Red reflex may appear gray or green

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17
Q

Infantile glaucoma Management/Education

A

Surgical intervention is first-line treatment – 3-4 surgeries may be needed

Post-op Care - Protect surgical site: Elbow restraints, maintain eye patch and bedrest; provide distraction activities

Discharge teaching: Teach parents how to administer eye medications; No rough-housing or contact sports for 2 weeks

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18
Q

Nursing care for Visual Impairment

A

Use child’s name to gain attention; Identify your presence first before touching child

Name and describe people/objects to make child more aware of what is happening

Discuss upcoming activities

Use touch and tone of voice appropriate to the situation

Use simple and specific directions

Use parts of the child’s body as reference points for location of items

Encourage exploration of objects through touch

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19
Q

Symptoms of hearing loss of infants

A

Wakes only to touch, not room noise

Does not babble by 6 months

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20
Q

Symptoms of hearing loss for Young Child

A

Does not speak by age 2 years

Communicates needs through gestures

Focuses on facial expressions when communicating

Does not respond to doorbell or telephone

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21
Q

Symptom of hearing loss for Older child

A

Often asks for statements to be repeated

Inattentive or daydreams

Poor school performance

Monotone speech

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22
Q

Proper ear drop administration

A

For children under 3: Hold ear lobe and gently pull down and back.

For children 3 and over: Hold upper part of ear and gently pull up and back.

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23
Q

Fe+ supplements

Place behind teeth to avoid teeth stains

Cause constipation – increase fluids and may need stool softeners

Cause dark, green stools – this is normal

A

Iron Deficiency Anemia

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24
Q

Iron Deficiency Anemia PhysicaL cUES

A

Irritability, HA
Unsteady gait, weakness,fatigue
Dizziness, sob, pallor skin, mm, conjunctiva assess for difficulty feeding, pica spooning of nails

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25
Q

Iron deficiency anemia lab cues

A

Decrease
RBC, Hgb, Hct, MCV, MCH, and Ferritin

Increase
RDW

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26
Q

Iron deficiency Diagnostic Findings

A

Peak at 12-24 month and adolescence

Low RBC, Hgb, Hct, MCV, MCH (mean cell hgb), RDW (red cell distribution width), and ferritin

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27
Q

Iron Deficiency Management

A

Feed only formula fortified with Fe+, supplementation by 4-5 months

Mothers increase Fe+ in their diet

Limit cow’s milk in children >1yr. to 24oz/day

Nutrition (Fe+ rich food): Red meant, tuna, salmon, eggs, tofu, enriched grains, dried beans and peas, dried fruits, leafy green vegetables, and Fe+ fortified cereal

Fe+ supplement
Put behind teeth to avoid teeth stains, can cause constipation, and cause dark, green stool (normal)
Give with vitamin C, do not give with milk, color stools and black urine may be normal, stain teeth, drink with straw, and may cause constipation

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28
Q

Overproduction of immature lymphoblast cells (WBC) with infiltration of organs and tissues

A

Acute Lymphoblastic Leukemia

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29
Q

Acute Lymphoblastic Leukemia Physical Cues

A

Low-grade fever, signs of infection, pallor, bruising/petechiae/purpura, leg pain, joint pain, enlarged liver, lymph nodes, headache, N/V, abdominal pain

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30
Q

Acute Lymphoblastic Leukemia Lab Cues

A

Bone Marrow Aspirate (BMA) - most definitive test, determines lymphoid or myeloid and cell types, and prolific quantities of blasts. (Determine MLL or ALL)

CBC - Low Hgb, Low Hct, Low RBCs, low/normal/high WBCs

Blood Smear - may reveal blasts

LP – whether leukemic cells in CNS

CXR – to detect PNA or mediastinal mass

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31
Q

Deficiency of Factor VIII which is essential to activate factor X, which converts prothrombin to thrombin, without it, platelets cannot make clots

A

Hemophilia

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32
Q

Hemophilia Physical Cues

A

Joint swelling, pain, bruising, bleeding (nose, gums, hemoptysis, hematemesis, heavy menstrual); chest or abdominal pain (internal bleeding)

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33
Q

Hemophilia Lab Cues

A

CBC – possible low Hgb & Hct

Coags – PTT prolonged; normal PT & Platelets

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34
Q

Hemophilia Management/Treatment of Bleeding Episodes

A

FIRST - Factor VIII administration (slow IV push)

Then; aply direct pressure to external bleeding; if joint bleeding, apply ice or cold compresses and elevate extremity unless contraindicated by causing further injury

Desmopressin (DDAVP) (in mild cases) – triggers the endothelium of bld vessels to release Factor VIII

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35
Q

18 month-old presents with…
Reports of watery diarrhea
Asymmetric abdomen
Nontender mass in right abdomen
Proptosis in right eye
Elevated HVA & VMA levels
Arises from embryonic neuroblasts (nerve cells)

A

Neuroblastoma

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36
Q

Neuroblastoma Patho

A

A malignancy that occurs in the adrenal gland, sympathetic chain of the retroperitoneal area, head, neck, pelvis, or chest.

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37
Q

Neuroblastoma Physical Cues

A

Most commonly occurs unilateral in the abdomen (mainly in the adrenal gland) and sometimes in chest or retroperitoneal space

Swollen asymmetric abdomen, proptosis, bruising, watery diarrhea, and enlarged nodes firm and nontender
Neuro deficits, bone pain and limp

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38
Q

Neuroblastoma Diagnostics findings

A

24-hour urine for elevated homovanillic acid (HVA) and vanillylmandelic acid (VMA)

CT/MRI, CXR, bone scan, BMA, BX, and skeletal survey

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39
Q

A 16-year-old presents with…
Painless, enlarged cervical lymph nodes
Fever & reports of night sweats
20% weight loss

A

Lymphoma - Hodgkin Disease

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40
Q

Lymphoma - Hodgkin Disease - Physical Cues

A

Main symptoms: Painless, enlarged supraclavicular or cervical lymph nodes (“sentinel nodes”)

Classified A (Asymptomatic) or B (Fever, night sweats, >10% weight loss, cough, abdominal discomfort, enlarged liver or spleen)

41
Q

Lymphoma - Hodgkin Disease - Diagnosis/Biopsy Results

A

Reed-Sternberg Cells

Malignancy of the lymph system primarily involves lymph nodes that often metastasize to spleen, liver, bone marrow, lungs, heart and its vessels, trachea, esophagus, thymus

42
Q

15-year-old presents with…
Complaints of dull right leg pain
Erythema & swelling around the right knee
Limited ROM in right knee; limped into exam room
Bone scan results: mass in right distal femur

A

Osteosarcoma

43
Q

Osteosarcoma Common Sites

A

Most common sites are proximal humerus, tibia and distal femur (50% of cases)

44
Q

Osteosarcoma Assessment Cues

A

Dull bone pain for possibly several months, limp, or limited ROM; Inspect for erythema and swelling

Palpate for tenderness and size of any soft tissue masses

45
Q

Osteosarcoma Treatment

A

Chemotherapy

Amputation (depends on size of tumor)

Limb-sparing procedures of the affected extremity – tumor removed by wide local excision & tissue & bone removed and replaced with bone graft or artificial bone implant

46
Q

Common Cancer Treatment

A

Mucosal ulceration, skin breakdown, neuropathy, pain, NV, loss of appetite, hemorrhagic cystitis, alopecia, cardiomyopathy (late), and cognitive defects.

47
Q

Chemotherapy and RT AE/Management

A

Anemia
Limit blood draws
Fe-rich foods
Use of synthetic Erythropoietin (Epoetin)

Thrombocytopenia
Avoid rectal temps & meds
Avoid IMs or LPs
Avoid ASA & NSAIDS – give Acetaminophen instead

Neutropenia
Private room
Meticulous hand hygiene before and after care
Prophylactic antibiotics
Absolute Neutrophil Count (ANC) <1000

Nausea/Vomiting/Anorexia
Offer bland, dry foods
Offer small, frequent meals
Offer ice, carbonated drinks, popsicles throughout day
Complementary remedies (relaxation, guided imagery)

48
Q

Radiation Therapy AE/Common Complication/Management

A

Altered Skin Integrity
Wash skin with mild soap & water
Avoid lotions/powders/ointments
Avoid sun or heat exposure
Diphenhydramine or hydrocortisone cream for itching
Antimicrobial cream to desquamation
Moisturize with aloe vera

Preventing hemorrhage, preventing infection, preventing anemia, and managing nausea, vomiting, and anorexia.

Radiation Management
Assess for skin irradiated areas, moisturize, antimicrobial cream, and itching cream (diphenhydramine or hydrocortisone)
Patient teaching: do not wash off marks for target areas, use mild soap and water, do not apply ointment on irradiated areas, avoid sun exposure to affected area, and use loose soft clothing.

49
Q

When the circulation of blood vessels is obstructed by abnormally shaped RBCs causing ischemia & infarction

A

Sickle Cell Disease

50
Q

Sickle Cell Disease Physical/Labs Cues

A

Physical Cues
Extreme fatigue or irritability
Pain: abdomen, thorax, joints, digits
Dactylitis
Cough, ↑WOB, fever, tachypnea, hypoxia (ACS s/s)
Splenomegaly
Jaundice (from hemolysis) or pale conjunctiva, palms, soles, and skin

Labs
↓ H&H, ↑ Platelets (SC increases plt activation), ↑reticulocyte count

51
Q

Sickle Cell Disease Management

A

Pain Control
Standard child pain scale for age with frequent assessments
Opioid medication for moderate to severe pain on a regular schedule or via PCA
NSAIDs or acetaminophen for less severe pain combined with distraction
Apply warm compresses to inflamed joints

Hydration
Provide up to double maintenance fluid requirements (150ml/kg/day) either orally or IV; Maintain F/E balance; monitor electrolytes

Hypoxia
Encourage incentive spirometry use to decrease incidence of ACS
O2 via NC if SpO2 is <92% (O2 given in the absence of hypoxia may inhibit erythropoiesis)

52
Q

BM Aspirate Procedure and Monitoring

A

Prone position
Posterior or anterior iliac crest is most common bone used; may use tibia in infants
BM procedure tray/needle equipment

Medication: Local/topical anesthetic and conscious sedation meds (Fentanyl/Versed)

Pre-procedure priorities
Explain procedure, comfort, infection prevention

Post-procedure priorities
Hold pressure/pressure dressing and monitoring for bleeding and infection
Apply pressure for 5-10 minutes then apply pressure dressing; Monitor for bleeding

53
Q

General Neutropenic Precaution

A

Private room
Meticulous hand hygiene before and after care
VS Q4H and assess for signs of infection Q8H and PRN
Avoid rectal temps, enemas, suppositories, urinary catheters, and invasive procedures
Restrict visitors
No raw fruits, vegetables, fresh flowers, or live plants in room
Mask on child when outside room
Soft toothbrush

54
Q

Types of skin Lesions

A

Macule - circular, flat discoloration <1cm
Papule – superficial, solid, elevated <0.5 cm
Annular – ring-like with central clearing
Vesicle – circular collection of free fluid < 1 cm
Pustule – vesicle containing pus

55
Q

Macule

A

Circular, flat discoloration <1cm

56
Q

Papule

A

Superficial, solid, elevated <0.5 cm

57
Q

Annular

A

Ring-like with central clearing

58
Q

Vesicle

A

Circular collection of free fluid < 1 cm

59
Q

Pustule

A

Vesicle containing pus

60
Q

Skin Common Lab and Diagnostics test

A

Blood Tests:
Complete blood count (CBC)
Erythrocyte sedimentation rate (ESR) (shows inflammation)
Immunoglobulin E (IgE)

Culture and sensitivity of wound drainage
Potassium hydroxide (KOH) prep
Patch or skin allergy testing
Woods Lamp
Skin Biopsy (less common)

61
Q

I come in many different shapes & sizes
Mom says this, Dad says that of how I came to be
Poverty, prematurity & chronic illness can lead to me
The buttocks, back & thighs are hiding places of thee
Pattern markings can be key

A

Skin injuries

62
Q

Skin injuries Types and Risk Factor

A

Types
Abrasion, laceration, bites, bruises, and burns

Risk Factors
Poverty, prematurity (<1 yr), chronic illness, intellectual disability, parent w/ abuse history, unrelated partner, alcohol/substance abuse, and extreme stressor

63
Q

Skin Injuries Suspicious cues

A

Injuries in uncommon locations, bruises in infants <9 months (not able to walk or be active), multiple injuries other than lower extremities, frequent ED visits (or delayed in seeking care), inconsistent stories, and unusual caregiver-child interaction.

Location can be determined based on location of injury

64
Q

I’m busiest in the summertime
15 or higher is the best # to be
Broad spectrum & Oxybenzone free is the best kind of me
I do my best work before and during fun in the sun

A

Sunscreen/Sunburn Prevention

65
Q

Sunscreen/Sunburn Prevention Prevention and Education

A

Infants <6 months out of direct sunlight, minimal sunscreen use
Hats, sun shirts
Limit sun exposure between 10 am – 4 pm

Sunscreen:
Broad spectrum (screens out both UVB & UVA rays)
Fragrance and oxybenzone-free
SPF 15 or higher; Zinc oxide products for nose, cheeks, ears, shoulders

Apply 30 minutes prior to sun activity, reapply at least every two hours or every 60-80 minutes while in the water
Use on sunny & overcast days

66
Q

Atopic Dermatitis (eczema) Physical Cues

A

Extreme itching
Erythema, inflammation
Variety of lesions/rash (plaques, papules, scaling, vesicles) on face, scalp, wrists or arms, elbows/antecubital, knees/popliteal areas

67
Q

Atopic Dermatitis Diagnostic Findings

A

Elevated IgE levels
Presence of wheezing (asthma is common)

68
Q

Temperature changes and sweating makes me come out to play
I can make you wiggle and scratch all day & night
Sometimes I bring my friend wheeze
I make IgE levels rise

A

Atopic Dermatitis

69
Q

Atopic Dermatitis (Eczema) Management

A

Medications: Topical corticosteroids & Immunomodulators-tacrolimus
Avoid hot water and bathe 2X/day in warm water
Avoid soaps containing perfumes, dyes, or fragrances (Dove, Caress, Cetaphil, Aquanil)
Pat skin dry and leave moist while apply moisturizers (Eucerin, Aquaphor, Vaseline, Crisco) multiple times daily
100% cotton clothing and bed linens, avoiding synthetics and wool; Keep fingernails short
Antihistamines at HS may assist with itching; Behavior modification during waking hours (clickers, distraction, reward)

70
Q

Diaper Dermatitis Physical Cues

A

Non-candida – red, shiny; affects skin on buttocks, thighs, abdomen & waist, usually not creases or folds
Candida – deep red color, scaly with patches outside of diaper area, usually affects creases & folds
May also have thrush in mouth
Does not improve with standard diaper cream

71
Q

Diaper Dermatitis Management

A

Change diapers frequently
Avoid rubber pants, harsh soaps, and baby wipes with fragrance or preservatives

Skin barriers (zinc oxide); Antifungal (Nystatin) if Candida albicans
Allow the infant or child to go diaperless for a period of time daily to allow healing
Blow-dry the diaper area/rash area with the dryer set on the warm (not hot) setting for 3-5 minutes Candida

Non-candida - Skin barriers (zinc oxide, A,D & E ointments, petroleum)
Candida - Antifungal (Nystatin)
Diaper-less for a period of time daily to allow healing
Blow-dry the diaper area/rash area with the dryer set on the warm (not hot) setting for 3-5 minutes

72
Q

Bacterial Skin Infection Physical Cues

A

Impetigo (can turn into papules and vesicles)

Cellulitis (localized inflammation)

Staphylococcal scalded Skin Syndrome (burn-like appearance - leaves red, weeping surface)

73
Q

Bacterial Skin Infection Therapeutic Management

A

Usually cause by Staphylococcus aureus or MRSA
Impetigo: Antibiotic ointment or oral antibiotic (soak and clean impetigo before applying antibiotics)
Cellulitis: oral or parenteral antibiotic, rest and immobilize affected areas
SSSS: Mild (oral antibiotics), Severe (IV antibiotics, fluid management, and burn tx)

74
Q

When Staph aureus or MRSA come to town that’s when I come around
My favorite hang outs are around the nose and mouth
My spots fill up with fluid then erupt
Some say I look like the color of honey

A

Impetigo

75
Q

Impetigo Physical Cues

A

Common infection of superficial layers of epidermis - primary or secondary. Papules → vesicles or pustules w/honey-colored exudate/crusts; itchy or painful

76
Q

Impetigo Management/Education

A

Soak impetigo lesions in appropriate solution before applying antibiotics

Treat topically with antibiotic ointment or oral antibiotics; hygiene/linens, avoid contact

77
Q

Staph aureus is my name and producing toxin is my game
I can make babies’ skin weep and peel
I sometimes look like a bad sunburn

A

Staphylococcal scalded Skin Syndrome (SSSS)

78
Q

SSSS Cues

A

S.aureus produces a toxin that causes the skin to exfoliate causing diffuse erythema and tenderness and a burn-like appearance – leaves red, weeping surface (face, neck, axillary, groin)

79
Q

SSSS Treatment

A

Mild: Oral antibiotics

Severe: IV antibiotics, fluid management, burn treatment

80
Q

Cellulitis Patho

A

Localized infection or inflammation; Firm, swollen, red area of skin and subcutaneous tissue (red, warm, swollen, pain, tenderness) & possible systemic effects (fever, malaise)

81
Q

Cellulitis Treatment and Education

A

Oral or parenteral antibiotics

Rest and immobilize affected area

82
Q

Viral Skin Infection - Varruca Physical Cues

A

Verruca (warts) (human papillomavirus)
Elevated, rough, gray-brown firn papules, single or in groups.
Treatment: Surgical removal, electrocautery, cryotherapy, laser

83
Q

Viral Skin Infection

A

Molloscum contagiosum (Poxivurs)
Flesh-colored papules on stalks (extremities, face, and trunk)
Resolves spontaneously in 18 months
Complicated cases: remove pox chemically or with curettage, cryotherapy or electro dissection

84
Q

Tinea (Fungal) infection Diagnostic

A

Presence of skin lesions, type, distribution, and any rashes
Skin scrapings, KOH preparations, and hair plucking

85
Q

Pedis

A

Feet

86
Q

Corporis

A

Arms or legs

87
Q

Versicolor

A

Hypopigmented areas on neck, trunk, proximal arms

88
Q

Capitis

A

Scalp, eyebrows, or eyelashes

89
Q

Cruris

A

Inguinal creases and inner thighs

90
Q

Tinea capitis - Therapeutic Management

A

Oral griseofulvin for 4-6 weeks; Hair will regrow in 3-12 months after TX initiated; No school for 1 wk after tx started

91
Q

Tinea corporis - Therapeutic Management

A

Contagious; Topical antifungal (clotrimazole) at least 4 weeks; May return to school or daycare once TX began

92
Q

Tinea pedis - Therapeutic Management

A

Topical antifungal cream, powder, spray; Keep feet clean and dry; May use water with vinegar solution for soaking; Cotton socks only; Flip-flops/slides around pools and in locker rooms

93
Q

Tinea Versicolor - Therapeutic Management

A

Selenium sulfide shampoo weekly x 4 wks or topical antifungal cream; Skin pigmentation will return to normal in several months

94
Q

Tinea Cruris - Therapeutic Management

A

Topical antifungal cream x 4-6 weeks; Cotton underwear, loose clothing should be worn with good hygiene

95
Q

Topical antifungal cream

A

Powder, spray; Keep feet clean and dry; Vinegar solution for soaking; Cotton socks only; Flip-flops/slides around pools and in locker rooms

96
Q

Topical antifungal (clotrimazole)

A

At least 4 weeks; Linens and clothing must be washed in hot water to reduce spread.

97
Q

Acne History and Physical Cues

A

Onset of lesions and family HX (Begins as early as age 7, affecting 85% of adolescents)
Use of any medications that may exacerbate (steroids, androgens, lithium, phenytoin, isoniazid)
HX of endocrine disorder
Date of LMP for females (worse 2-7 days prior to start of menses)
Presence of comedones (papules – blackheads or whiteheads), pustules, nodules, and hypertrophic scarring (occurs on face, chest and back)
Note oily skin/hair

98
Q

Acne Management

A

Education: Avoid oil-based cosmetics and hair products; Headbands, helmets/hats may exacerbate; balanced diet
Clean skin with mild soap and water BID; shampoo hair regularly * Avoid picking/squeezing comedones
Use topical medications as prescribed; may take 4-6 weeks for improvement
Tretinoin – interrupts abnormal keratinization that causes microcomedones
Benzoyl peroxide (OTC products) – inhibits growth of P. acnes
Topical antibacterials (Clindamycin); Oral – Tetracycline, Erythromycin
Isotretinoin – for severe cases, dermatologist prescribed, teratogenic
Oral contraceptives – decreases endogenous androgen production
Emotional counseling if acne is severe
Complications: Infection & Cellulitis

Peds (4 decks)

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