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Childrens-Redman > exam 4 > Flashcards

exam 4 Flashcards

1
Q

which disorder is caused by dysfunctional immune responses directed
against the body’s own tissues, resulting in chronic, multisystem
impairments that differ in clinical manifestations, course and
outcomes?

A

JIA (juvenile idiopathic arthritis)

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2
Q

what are the principles of standard precautions?

A

applies to all
- hand hygiene before/after
- gloves w/bodily fluids
- masks/goggles if splashing

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3
Q

what are contact precautions?

A
  • gloves
  • hand hygiene after glove removal
  • gown donned before entering and doffed before exiting
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4
Q

what are droplet precautions?

A
  • respiratory or mucous containing pathogens from nose/mouth
  • private room/cohort with like illness
  • wear mask if within 3 ft
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5
Q

what are airborne precautions?

A

used when droplets/dust in air containing infectious particles
- negative pressure room required
- masks/N95
- restriction of susceptible visitors/staff

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6
Q

what are the symptoms of pediculosis capitus (head lice)?

A
  • intense itching (esp. @ night)
  • red bumps on scalp
  • visible nits and lice
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7
Q

what is the treatment for lice?

A
  • pediculicide as directed
  • lice comb hair
  • treat linens
  • toys
  • contact precautions
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8
Q

which pediatric infection is characterized by a paroxysmal cough (whooping cough) and copious nasal/oral secretions?

A

pertussis

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9
Q

what are the preventative measures fort pertussis?

A

vaccination (DTaP @ 2, 4, 6, and 15-18 months and booster at 11 yrs)

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10
Q

what antibiotics are used for pertussis?

A
  • macrolides (-mycins) - erythromycin, azithromycin
  • azithromycin if < 1 month
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11
Q

what nursing interventions are indicated for pertussis?

A
  • high humidity environment
  • observe for airway obstruction
  • push fluids
  • abx compliance
    -droplet/standard precautions
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12
Q

what causes lyme disease?

A

borrelia burgdorferi from deer ticks

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13
Q

how is lyme disease diagnosed?

A

2 step test (+enzyme immunoassay EIA and western immunoblot)

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14
Q

what is the the treatment of lyme disease of those >8yrs old?

A

14-28 days of doxycycline

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15
Q

why is amoxicillin recommended over doxycycline for the treatment of lyme disease in those <8yrs?

A

prevent teeth staining associated with doxycycline

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16
Q

what are the physical cues related to rubeola (measles)?

A
  • maculopapular rash that starts on face >neck> trunk> arms>legs>feet
  • koplik spots
  • fever, cough, malaise, conjunctivitis, nasal inflammation
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17
Q

what precaution is necessary for rubeola (measles)?

A

airborne precautions

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18
Q

what is needed for a hospitalized/immunocompromised child who is 6m-2yrs and has rubeola (measles)?

A

Vitamin A

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19
Q

what type of pediatric cancer is characterized by overproduction of immature leukoblast cells that infiltrate organs and tissues?

A

ALL (acute lymphocytic leukemia)

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20
Q

what s/s are seen with ALL?

A
  • persistent/intermittent fevers
  • recurrent infection
  • fatigue, HA
  • pallor
  • unusual bleeding/bruising
  • abdominal pain/bone pain
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21
Q

what site is the BMA performed?

A
  • most common iliac crest
  • tibia can be used for infants
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22
Q

what position should a BMA performed in? what equipment?

A
  • prone
  • BM procedure tray/needle
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23
Q

what medications are necessary for BMA?

A
  • local/topical anesthetics
  • conscious sedation meds (fentanyl/versed)
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24
Q

what are the pre procedure priorities for a BMA?

A
  • explain procedure
  • comfort
  • infection prevention
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25
Q

what are the post procedure priorities?

A
  • hold pressure
  • pressure dressing
  • monitor for bleeding/infection
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26
Q

what is the priority nursing action for wilm’s tumor?

A

do NOT palpate abdomen

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27
Q

what are the treatment measures for wilm’s tumor?

A

surgical resection (nephrectomy) and chemotherapy

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28
Q

what is seen on the UA for wilms tumor?

A
  • gross/microscopic blood
  • negative HVA and VMA on 24 -hr urine
  • abdominal US/CT/MRI/CXR
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29
Q

what are the s/s of wilm’s tumor?

A
  • swollen, asymmetric abdomen (firm, non-tender mass)
  • hematuria
  • HTN
  • signs of lung mets (dyspnea/cough/CP)
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30
Q

what condition is characterized by factor VIII deficiency?

A

hemophilia a

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31
Q

what are the s/s of of hemophilia a?

A
  • joint swelling
  • pain, bruising, bleeding
  • internal bleeding (chest/abd pain)
  • low H and H
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32
Q

what is the treatment for hemophilia a?

A
  • first - factor VII administration for bleeding
  • then - compression, ice, elevation and desmopressin (mild cases)
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33
Q

what are the priorities of care for sickle cell anemia?

A
  • pain control (NSAIDs, opioids)
  • hydration - double maintenance fluid (150 ml/kg/day)
  • hypoxia management - O2 if 92%
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34
Q

what are the s/s of lymphoma?

A
  • painless, enlarged supraclavicular/cervical lymph nodes (sentinel nodes)
  • A (asymptomatic) or
  • B (fever, night sweats, >10% weight loss, cough, abdominal discomfort, enlarged liver/spleen)
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35
Q

what is the tx for lymphoma?

A
  • chemotherapy is treatment of choice
  • radiation added if no remission with chemo
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36
Q

what is the preop for brain tumors?

A
  • monitor for increase ICP and manage
  • steroids to decrease intracranial swelling
  • pre-op teaching/emotional support
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37
Q

what is the post-op care for brain tumors?

A
  • monitor for inc. ICP and manage; I&Os
  • frequent VS, pupil/LOC checks
  • treat hyperthermia with antipyretics
  • HA/pain management
  • position on unaffected side
  • JP drain monitoring/care
  • keep head midline
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38
Q

what are the s/s of iron deficiency?

A
  • pallor
  • dizziness
  • SOB, irritability, weakness, fatigue, spooning of nails
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39
Q

what are the dx labs for iron deficiency?

A
  • low RBC
  • low Hgb and Hct
  • low MCV and MCH
  • elevated RDW
  • low Fe+ and ferritin
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40
Q

what is the tx for iron deficiency?

A
  • Fe fortified formula
  • limit cows milk
  • Fe-rich foods
  • Fe+ supplements
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41
Q

what are the risk factors for lead poisoning?

A
  • old home paint/pipes/soil/toys
  • malnutrition
  • pica
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42
Q

what are the s/s of of lead poisoning?

A
  • low IQ
  • delayed G&D
  • abdominal pain/cramping
  • ataxia
  • dizziness/SOB
  • hematuria
  • seizures (new onset)
43
Q

what type of therapy is used for lead poisoning?

A

chelation therapy for blood levels >45 ug/dL

44
Q

what are the chelation agents used for lead poisoning?

A
  • succimer/dimercaprol/adetate calcium disodium
45
Q

what nursing actions are necessary for lead poisoning?

A
  • ensure adequate fluid intake ‘
  • monitor I&O’s
46
Q

what are the characteristics of IgG?

A
  • protects against viruses, bacteria and toxins
  • only one to cross placenta
  • lack of of causes IgG causes severe immunodeficiency
47
Q

which immunoglobulin is the defense against resp, GI and GU pathogens?

A

IgA

48
Q

which immunoglobulin is present during an active infection?

A

IgM

49
Q

which immunoglobulin increases in allergic states, severe hypersensitivity and parasitic infections?

A

IgE

50
Q

what lab is seen in HIV for children <18 m/those born to infected mother?

A

+PCR and viral culture

51
Q

what HIV lab is seen for children 18 m or older?

A

+ ELISA and + western blot

52
Q

which immunoglobulin is seen during a latex allergy rection?

A

IgE

53
Q

what cross allergies are likely for those who have a latex allergy?

A
  • pear
  • peach
  • passion fruit
  • plum
  • pineapple
54
Q

what are the s/s of allergic reaction/anaphylaxis?

A
  • hives
  • flushing
  • swelling of throat
  • wheezing
55
Q

what causes conductive hearing loss?

A
  • frequent OME or ruptured TM

(transmission of sound through middle ear is disrupted)

56
Q

what causes sensorineural hearing loss?

A
  • ototoxic meds, meningitis, rubella

(damage to the hair cells in the cochlea)

57
Q

what may a lack of startle to loud noise indicate in an infant?

A

hearing loss

58
Q

what may indicate hearing loss for a young child?

A

they communicate their needs through gestures

59
Q

what may be a sign of hearing loss in an older child?

A

they often ask for statements to be repeated

60
Q

what are the s/s of congenital cataracts?

A

cloudy cornea and absent red reflex

61
Q

what tx is indicated in congenital cataract?

A

best outcome when surgically removed before 3month (as early as 2 wks)

62
Q

what causes infantile glaucoma?

A
  • obstruction of aqueous humor, causing high IOP
63
Q

what causes vision loss in infantile glaucoma?

A

retinal scarring and optic nerve damage from increased IOP

64
Q

what are the s/s of infantile glaucoma?

A
  • spasmodic winking
  • corneal clouding
  • enlarged eyeball
  • excessive tearing
  • red reflex appears as gray or green
65
Q

what is strabismus? how is it treated?

A
  • crossed eyes
  • patch or surgery
66
Q

what is amblyopia?
what are the s/s?

A
  • lazy eye
  • asymmetric corneal light reflex
67
Q

which eye is treated for amblyopia?

A

patch or drops to the stronger eye

68
Q

how are ear drops administered to a child < 3 yr?

A

pinna down and back

69
Q

how are ear drops administered to a child >3 yrs?

A

pinna up and back

70
Q

how does the TM appear with acute otitis media?

A
  • dull, red, bulging and decreased/no movement
71
Q

what are the s/s of acute otitis media?

A
  • fever, ear pulling, irritability, poor feeding and lymphadenopathy
72
Q

what are the tx medications for acute otitis media ?

A

amoxicillin/Augmentin or azithromycin
or
1 dose ceftriaxone IM

73
Q

what supportive medications are used for acute otitis media?

A
  • Tylenol/ibuprofen to manage otalgia (ear pain) and fever
  • benzocaine drops for pain (if TM is intact)
74
Q

what are the manifestations of OME?

A
  • TM - dull, orange discoloration, air bubbles, decreased movement
  • feeling of fullness and possible transient hearing loss
75
Q

what is the tx for OME?

A
  • generally resolves on its own
  • if it persists >3m, refer to ENT and assess for hearing loss/speech delay
76
Q

what is the likely cause for OME?

A

collection of fluid in the middle ear r/t allergies or large adenoids

77
Q

how does tretinoin work for acne?

A

interrupts abnormal keratinization

78
Q

how does benzoyl peroxide?

A

inhibits growth of p. acnes

79
Q

how do oral contraceptives manage acne?

A

decrease endogenous androgen production

80
Q

where are the common sites of eczema?

A
  • wrists
  • antecubital of arm
  • popliteal space
81
Q

which immunoglobulin is elevated with atopic dermatitis?

A

IgE

82
Q

what causes atopic dermatitis?

A

antigen response to environmental factors, temperature changes and sweating

83
Q

what medications are used for eczema?

A
  • topical corticosteroid
  • immune modulators (tacrolimus)
  • antihistamines
84
Q

what education should be provided for eczema?

A
  • avoid hot water bath
  • bathe 2x/day in warm water
  • avoid soaps w/perfumes, dyes, fragrance
  • apply moisturizers while skin is still moist (eucerin, aquaphor, vasline, crisco) multiple times daily
  • 100% cotton; avoid synthetics/wool
  • keep fingernails short
85
Q

what causes diaper dermatitis?

A

urine/feces, harsh soaps or wipes

86
Q

what is the treatment for diaper dermatitis?

A

topical a, d, e or zinc oxide

87
Q

what is the treatment for candida albicans, a fungal yeast infection associated with diaper dermatitis?

A

nystatin or miconazole cream

88
Q

what pain management is necessary for burns?

A
  • admin pain meds 45 min before dressing changes/procedures (opioids - morphine or fentanyl) in conjunction with sedatives (midazolam)
  • nonpharm - music, distraction
89
Q

what nursing actions are indicated for pain medication administration r/t to burns?

A
  • monitor for respiratory depression
90
Q

what fluid is used for the first 24 hrs in the management of burns?

A

LR

91
Q

when are colloids like albumin and FFP (fresh frozen plasma) used to manage burns?

A

around hours 24 -48, when capillary permeability improves

92
Q

what is the necessary UOP while managing a pediatric burn patient?

A

1-2 ml/kg/hr

93
Q

what nursing actions should be taken related to fluid resuscitation of a pediatric burn patient (what to monitor)?

A
  • monitor daily weights
  • monitor F and E
  • I &O
94
Q

what are 4 complications of burn?

A
  • inhalation injury
  • carbon monoxide injury
  • shock (septic/hypovolemic)
  • wound infections
95
Q

what are the physical findings of inhalation injury r/t burns?

A
  • wheezing
  • hoarseness
  • singed nasal hairs
  • soot-tinged secretions
96
Q

what is included in primary burn survey?

A
  • airway
  • resp effort
  • skin color
97
Q

what is included in the burn secondary survey?

A
  • burn depth
  • BSA
  • other traumatic injuries
98
Q

how does a 1st degree (superficial) burn appear?

A

pink to red
blanches
no blister

99
Q

how does a 2nd degree (superficial-partial) burn appear?

A

moist, red
blisters
mild-moderate edema
blanches

100
Q

how does a 2nd degree (deep-partial) burn appear?

A

mottled
red to white
blisters and moderate edema
blanches

101
Q

how does a 3rd degree (full-thickness) burn appear?

A

red to tan, black, brown or waxy white
dry leathery
no blanching

102
Q

how does a 4th degree (deep-full thickness) burn appear?

A

color variable
dull and dry
charring
possible visible ligaments, bone and tendon

103
Q

what are the expected lab cues for hemophilia ?

A
  • prolonged PTT
  • low H & H
  • normal PT and platelets

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