exam 4 Flashcards
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?
JIA (juvenile idiopathic arthritis)
what are the principles of standard precautions?
applies to all
- hand hygiene before/after
- gloves w/bodily fluids
- masks/goggles if splashing
what are contact precautions?
- gloves
- hand hygiene after glove removal
- gown donned before entering and doffed before exiting
what are droplet precautions?
- respiratory or mucous containing pathogens from nose/mouth
- private room/cohort with like illness
- wear mask if within 3 ft
what are airborne precautions?
used when droplets/dust in air containing infectious particles
- negative pressure room required
- masks/N95
- restriction of susceptible visitors/staff
what are the symptoms of pediculosis capitus (head lice)?
- intense itching (esp. @ night)
- red bumps on scalp
- visible nits and lice
what is the treatment for lice?
- pediculicide as directed
- lice comb hair
- treat linens
- toys
- contact precautions
which pediatric infection is characterized by a paroxysmal cough (whooping cough) and copious nasal/oral secretions?
pertussis
what are the preventative measures fort pertussis?
vaccination (DTaP @ 2, 4, 6, and 15-18 months and booster at 11 yrs)
what antibiotics are used for pertussis?
- macrolides (-mycins) - erythromycin, azithromycin
- azithromycin if < 1 month
what nursing interventions are indicated for pertussis?
- high humidity environment
- observe for airway obstruction
- push fluids
- abx compliance
-droplet/standard precautions
what causes lyme disease?
borrelia burgdorferi from deer ticks
how is lyme disease diagnosed?
2 step test (+enzyme immunoassay EIA and western immunoblot)
what is the the treatment of lyme disease of those >8yrs old?
14-28 days of doxycycline
why is amoxicillin recommended over doxycycline for the treatment of lyme disease in those <8yrs?
prevent teeth staining associated with doxycycline
what are the physical cues related to rubeola (measles)?
- maculopapular rash that starts on face >neck> trunk> arms>legs>feet
- koplik spots
- fever, cough, malaise, conjunctivitis, nasal inflammation
what precaution is necessary for rubeola (measles)?
airborne precautions
what is needed for a hospitalized/immunocompromised child who is 6m-2yrs and has rubeola (measles)?
Vitamin A
what type of pediatric cancer is characterized by overproduction of immature leukoblast cells that infiltrate organs and tissues?
ALL (acute lymphocytic leukemia)
what s/s are seen with ALL?
- persistent/intermittent fevers
- recurrent infection
- fatigue, HA
- pallor
- unusual bleeding/bruising
- abdominal pain/bone pain
what site is the BMA performed?
- most common iliac crest
- tibia can be used for infants
what position should a BMA performed in? what equipment?
- prone
- BM procedure tray/needle
what medications are necessary for BMA?
- local/topical anesthetics
- conscious sedation meds (fentanyl/versed)
what are the pre procedure priorities for a BMA?
- explain procedure
- comfort
- infection prevention
what are the post procedure priorities?
- hold pressure
- pressure dressing
- monitor for bleeding/infection
what is the priority nursing action for wilm’s tumor?
do NOT palpate abdomen
what are the treatment measures for wilm’s tumor?
surgical resection (nephrectomy) and chemotherapy
what is seen on the UA for wilms tumor?
- gross/microscopic blood
- negative HVA and VMA on 24 -hr urine
- abdominal US/CT/MRI/CXR
what are the s/s of wilm’s tumor?
- swollen, asymmetric abdomen (firm, non-tender mass)
- hematuria
- HTN
- signs of lung mets (dyspnea/cough/CP)
what condition is characterized by factor VIII deficiency?
hemophilia a
what are the s/s of of hemophilia a?
- joint swelling
- pain, bruising, bleeding
- internal bleeding (chest/abd pain)
- low H and H
what is the treatment for hemophilia a?
- first - factor VII administration for bleeding
- then - compression, ice, elevation and desmopressin (mild cases)
what are the priorities of care for sickle cell anemia?
- pain control (NSAIDs, opioids)
- hydration - double maintenance fluid (150 ml/kg/day)
- hypoxia management - O2 if 92%
what are the s/s of lymphoma?
- painless, enlarged supraclavicular/cervical lymph nodes (sentinel nodes)
- A (asymptomatic) or
- B (fever, night sweats, >10% weight loss, cough, abdominal discomfort, enlarged liver/spleen)
what is the tx for lymphoma?
- chemotherapy is treatment of choice
- radiation added if no remission with chemo
what is the preop for brain tumors?
- monitor for increase ICP and manage
- steroids to decrease intracranial swelling
- pre-op teaching/emotional support
what is the post-op care for brain tumors?
- 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
what are the s/s of iron deficiency?
- pallor
- dizziness
- SOB, irritability, weakness, fatigue, spooning of nails
what are the dx labs for iron deficiency?
- low RBC
- low Hgb and Hct
- low MCV and MCH
- elevated RDW
- low Fe+ and ferritin
what is the tx for iron deficiency?
- Fe fortified formula
- limit cows milk
- Fe-rich foods
- Fe+ supplements
what are the risk factors for lead poisoning?
- old home paint/pipes/soil/toys
- malnutrition
- pica
what are the s/s of of lead poisoning?
- low IQ
- delayed G&D
- abdominal pain/cramping
- ataxia
- dizziness/SOB
- hematuria
- seizures (new onset)
what type of therapy is used for lead poisoning?
chelation therapy for blood levels >45 ug/dL
what are the chelation agents used for lead poisoning?
- succimer/dimercaprol/adetate calcium disodium
what nursing actions are necessary for lead poisoning?
- ensure adequate fluid intake ‘
- monitor I&O’s
what are the characteristics of IgG?
- protects against viruses, bacteria and toxins
- only one to cross placenta
- lack of of causes IgG causes severe immunodeficiency
which immunoglobulin is the defense against resp, GI and GU pathogens?
IgA
which immunoglobulin is present during an active infection?
IgM
which immunoglobulin increases in allergic states, severe hypersensitivity and parasitic infections?
IgE
what lab is seen in HIV for children <18 m/those born to infected mother?
+PCR and viral culture
what HIV lab is seen for children 18 m or older?
+ ELISA and + western blot
which immunoglobulin is seen during a latex allergy rection?
IgE
what cross allergies are likely for those who have a latex allergy?
- pear
- peach
- passion fruit
- plum
- pineapple
what are the s/s of allergic reaction/anaphylaxis?
- hives
- flushing
- swelling of throat
- wheezing
what causes conductive hearing loss?
- frequent OME or ruptured TM
(transmission of sound through middle ear is disrupted)
what causes sensorineural hearing loss?
- ototoxic meds, meningitis, rubella
(damage to the hair cells in the cochlea)
what may a lack of startle to loud noise indicate in an infant?
hearing loss
what may indicate hearing loss for a young child?
they communicate their needs through gestures
what may be a sign of hearing loss in an older child?
they often ask for statements to be repeated
what are the s/s of congenital cataracts?
cloudy cornea and absent red reflex
what tx is indicated in congenital cataract?
best outcome when surgically removed before 3month (as early as 2 wks)
what causes infantile glaucoma?
- obstruction of aqueous humor, causing high IOP
what causes vision loss in infantile glaucoma?
retinal scarring and optic nerve damage from increased IOP
what are the s/s of infantile glaucoma?
- spasmodic winking
- corneal clouding
- enlarged eyeball
- excessive tearing
- red reflex appears as gray or green
what is strabismus? how is it treated?
- crossed eyes
- patch or surgery
what is amblyopia?
what are the s/s?
- lazy eye
- asymmetric corneal light reflex
which eye is treated for amblyopia?
patch or drops to the stronger eye
how are ear drops administered to a child < 3 yr?
pinna down and back
how are ear drops administered to a child >3 yrs?
pinna up and back
how does the TM appear with acute otitis media?
- dull, red, bulging and decreased/no movement
what are the s/s of acute otitis media?
- fever, ear pulling, irritability, poor feeding and lymphadenopathy
what are the tx medications for acute otitis media ?
amoxicillin/Augmentin or azithromycin
or
1 dose ceftriaxone IM
what supportive medications are used for acute otitis media?
- Tylenol/ibuprofen to manage otalgia (ear pain) and fever
- benzocaine drops for pain (if TM is intact)
what are the manifestations of OME?
- TM - dull, orange discoloration, air bubbles, decreased movement
- feeling of fullness and possible transient hearing loss
what is the tx for OME?
- generally resolves on its own
- if it persists >3m, refer to ENT and assess for hearing loss/speech delay
what is the likely cause for OME?
collection of fluid in the middle ear r/t allergies or large adenoids
how does tretinoin work for acne?
interrupts abnormal keratinization
how does benzoyl peroxide?
inhibits growth of p. acnes
how do oral contraceptives manage acne?
decrease endogenous androgen production
where are the common sites of eczema?
- wrists
- antecubital of arm
- popliteal space
which immunoglobulin is elevated with atopic dermatitis?
IgE
what causes atopic dermatitis?
antigen response to environmental factors, temperature changes and sweating
what medications are used for eczema?
- topical corticosteroid
- immune modulators (tacrolimus)
- antihistamines
what education should be provided for eczema?
- 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
what causes diaper dermatitis?
urine/feces, harsh soaps or wipes
what is the treatment for diaper dermatitis?
topical a, d, e or zinc oxide
what is the treatment for candida albicans, a fungal yeast infection associated with diaper dermatitis?
nystatin or miconazole cream
what pain management is necessary for burns?
- admin pain meds 45 min before dressing changes/procedures (opioids - morphine or fentanyl) in conjunction with sedatives (midazolam)
- nonpharm - music, distraction
what nursing actions are indicated for pain medication administration r/t to burns?
- monitor for respiratory depression
what fluid is used for the first 24 hrs in the management of burns?
LR
when are colloids like albumin and FFP (fresh frozen plasma) used to manage burns?
around hours 24 -48, when capillary permeability improves
what is the necessary UOP while managing a pediatric burn patient?
1-2 ml/kg/hr
what nursing actions should be taken related to fluid resuscitation of a pediatric burn patient (what to monitor)?
- monitor daily weights
- monitor F and E
- I &O
what are 4 complications of burn?
- inhalation injury
- carbon monoxide injury
- shock (septic/hypovolemic)
- wound infections
what are the physical findings of inhalation injury r/t burns?
- wheezing
- hoarseness
- singed nasal hairs
- soot-tinged secretions
what is included in primary burn survey?
- airway
- resp effort
- skin color
what is included in the burn secondary survey?
- burn depth
- BSA
- other traumatic injuries
how does a 1st degree (superficial) burn appear?
pink to red
blanches
no blister
how does a 2nd degree (superficial-partial) burn appear?
moist, red
blisters
mild-moderate edema
blanches
how does a 2nd degree (deep-partial) burn appear?
mottled
red to white
blisters and moderate edema
blanches
how does a 3rd degree (full-thickness) burn appear?
red to tan, black, brown or waxy white
dry leathery
no blanching
how does a 4th degree (deep-full thickness) burn appear?
color variable
dull and dry
charring
possible visible ligaments, bone and tendon
what are the expected lab cues for hemophilia ?
- prolonged PTT
- low H & H
- normal PT and platelets
