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Pediatrics > Exam 4 (skin and poisoning, etc) 25% of final > Flashcards

Exam 4 (skin and poisoning, etc) 25% of final Flashcards

1
Q

pruritis

A

itching

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2
Q

erythema

A

reddened area caused by increased amounts of oxygenated blood in the dermal vasculature

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3
Q

ecchymoses (bruises)

A

localized red or purple discolorations caused by extravasation of blood into dermis and subcutaneous tissues

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4
Q

petechiae

A

pinpoint tiny and sharp circumscribed spots in the superficial layers of the epidermis

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5
Q

papule

A

palpable solid elevated less than 1cm lesion (wart/mole)

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6
Q

macule

A

nonpalpable flat and circumscribed lesion less than 1cm (freckle)

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7
Q

nodule

A

elevated solid lesion may extend into dermis, greater than 1 cm (fibroma)

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8
Q

wheal

A

localized area of edema, elevated and firm/itchy (mosquito bite)

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9
Q

vesicle

A

elevation of skin filled with clear fluid, less than 1cm (blister, herpes simplex)

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10
Q

pustule

A

elevation of skin filled with pus (acnes, impetigo)

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11
Q

ulcer

A

loss of skin layer, irregular shape, may bleed (pressure sore, chancre)

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12
Q

atrophy

A

thinning of the skin (from steroid use, aging)

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13
Q

types of wound healing

A

primary, secondary, tertiary

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14
Q

primary wound healing

A

all layers of wound are well approximated; heals with minimal scarring; ex is surgical incision; suture clean wound when even margins

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15
Q

secondary wound healing

A

when edges cannot be well approximated; healing occurs after likely debridement; heals from edges/bottom inward and upward

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16
Q

tertiary wound healing

A

suturing is delayed after injury or wound later breaks down and is sutured or re-sutured when granulation is present; increased risk for infection or abscess formation; can be due to a wound-vac

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17
Q

signs of wound infection

A

increased erythema (beyond wound margin), edema, purulent exudate, odor, pain at site or beyond, increased temp (at site and generalized)

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18
Q

bacterial infections of the skin

A

impetigo contagiosa, pyoderma, cellulitis, folliculitis and furuncle and carbuncle, staphylococcus aureus and MRSA

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19
Q

impetigo contagiosa

A

staph or strep infection; begins as reddish macule and becomes vesicular; ruptures easily leaving moist superficial erosion; spreads peripherally in sharp marginated irregular outlines; exudate dries to form heavy honey-colored crusts; pruritis common; loosen scales with burows solution; usually heals without scarring unless secondary infection; highly contagious

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20
Q

pyoderma

A

deeper extension of infection into the dermis; caused by MRSA/Strep/Staph; most common in ages 2-5; can lead to sepsis if untreated

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21
Q

cellulitis

A

inflammation of skin and subcutaneous tissues; characterized by redness, swelling, firm infiltration; can form abscesses

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22
Q

folliculitis, furuncle, carbuncle

A

folliculitis- pimple; furuncle- boil, carbuncle- multiple obils

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23
Q

staphylococcus aureus and MRSA

A

bacterial infection that require certain antibx to treat (often more painful than expected for lesion); can do gentile bleach bath for sterile skin

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24
Q

viral infections

A

verruca, verruca plantaris, herpes simplex virus, varicella zoster virus, molluscum contagiosum

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25
Q

verruca

A

warts; well circumscribed gray or brown, elevated, firm papules; local destructive therapy to remove like liquid nitrogen; common in children and tend to disappear spontaneously

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26
Q

verruca plantaris

A

plantar warts; flattened due to constant pressure; removed via caustic chemical solution or surgical removal

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27
Q

herpes simplex virus

A

grouped burning and itching vesicles in inflammatory base usually near mucosa and skin like nose lips genitalia and buttocks; vesicles dry forming crust then exfoliate and then spontaneously heal after 8-10 days; avoid secondary infection and may require antiviral like acyclovir and valtrex; type 1 can be prevented using sunscreens and protecting against UV rays

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28
Q

varicella zoster virus

A

aka herpes zoster/shingles; same virus that causes chicken pox; preceded by neuralgic pain and itching followed by vesicular pain following dermatone; contagious to anyone who has not had chickenpox or not immune against chicken pox or immunocompromised; treat with pain meds, antivirals, and shingles vaccine for >50yrs

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29
Q

dermatone

A

area of sensory nerves near the skin that are supplied by specific spinal nerve root

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30
Q

type 1 vs type 2 herpes simplex virus

A

type 1: cold sores, fevers, blisters; type 2: genital

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31
Q

molluscum contagiosum

A

pox virus; occurs in trunk, face, extrem.; common in school aged contact and spread skin to skin; well children resolve spontaneously within 18 mo; chemical treatment

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32
Q

molluscum

A

flesh colored papules with central caseous plug

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33
Q

fungal skin infections

A

tinea capitis, tinea corporis, tinea cruris (jock itch), tinea pedis (athletes foot), tinea unguium (nails); candidiasis

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34
Q

tinea

A

aka ring worm; all are itchy; transmit person to person; good hygiene is important

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35
Q

candidiasis

A

oral thrush in neonates (treat with nystatin); antifungal required based on location

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36
Q

miscellaneous infection of the skin

A

urticaria, intertrigo, psoriasis, alopecia, erythema multiforme

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37
Q

urticaria

A

aka hives; usually allergic response to drugs or infection

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38
Q

intertrigo

A

mechanical trauma/friction due to excessive heat, moisture, and sweat retention

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39
Q

psoriasis

A

cause is unknown; hereditary predisposition; may be triggered by stress

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40
Q

alopecia

A

acreata- sudden onset noninflammatory round, bald patches in hairy parts of body; traumatic- traction based (tight hair styles); trichotilliomania- compulsive hair pulling

41
Q

erythema multiforme

A

steven johnson syndrome; associated with ingestion of some drugs and often follows upper respiratory tract infection; rare and serious disorder causing inflammation and ulcers throughout the body

42
Q

lyme disease

A

most common tickborne disorder in the US; most cases in NE from s. maine to northern virginia; may to october

43
Q

3 stages of lyme disease

A

localized- 3 to 30 days where erythema migrans rash can be seen; early disseminated- 3 to 10 weeks; systemic involvement- 2-12 months, cuases myocarditis and chronic pain

44
Q

treatment for lyme disease

A

all ages take oral doxycycline

45
Q
A
45
Q

scabies

A

endemic infestation caused by scabies mite; lesions created from impregnated females burrow into epidermis to lay eggs and feces; causes inflammatory response and pruritis; transmitted via prolonged personal contact; maculopapular lesions characteristically distributed in skin folds

46
Q

treatment for scabies

A

application of scabicide; permetrin 5% cream (elimite) for > 2 months old; enough meds for everyone in the househould

47
Q

headlice

A

aka pediculosis capitis; observation of white eggs (nits) firmly attached to the hair shaft

48
Q

treatment of headlice

A

application of pediculicides and manual removal of nit; permethrin 1%; repeat 7-10 days to ensure cure; malthion for children >2 yo with recurrent lice; removal of nits with metal comb daily; transmitted via person to person contact/personal items

49
Q

nursing care to prevent spread and recurrence of pediculosis

A

machine wash everything, vacuum all household furniture and accessories; seal non-washable items in plastic bag for 14 days; soak combs/brushes/hair accessories in lice killing products (1hr) or boiling water for (10min); discourage sharing of items among children; avoid physical contact with infected kids; inspect children in group setting regularly; provide education

50
Q

diaper rash

A

diaper dermatitis is caused by prolonged and repetitive contact with an irritant; candida albicans infection (yeast)

51
Q

treatment of diaper rash

A

keep skin dry, use superabsorbent diapers, change diapers as soon as soiled, expose healthy or slightly irritated skin to air, apply ointment like zinc oxide or petrolatum, avoid removing skin barrier cream, avoid washing with perfumed soaps or commercial wipes, may use moisturizer, wipe stool gently with soft cloth and warm water, use disposable diapers (detergent and alcohol free), apply powder

52
Q

atopic dermatitis

A

aka eczema; chronic relapsing inflammatory skin disorder that results in itching and lesions; occurs in 20% of children; unknown cause but likely genetic and environmental causes; symptoms vary but itching is common in all; 3 types based on age and distribution of lesions3 t

53
Q

3 types of eczema

A

infantile eczema- usually begins 2-6 months and undergoes spontaneous remission by 3 yrs; childhood- may follow infantile and occurs 2-3yrs of age and 90% of children have manifestations by age 5; preadolescent and adolescent- begins at 12yrs and may continue into early adulthood or indefinitely

54
Q

atopic dermatitis/eczema management

A

hydrate the skin, relieve pruritis, reduce flare-ups or inflammation, prevent and control secondary infection

55
Q

difference in BSA children vs adult

A

children have increased BSA of head and torso

56
Q

key points of burns

A

fluid treatment for major burns (requires very high volume fluid repletion), monitor UOP; pt lose ability to regulate temp with major burns (keep room 85-100); pain management; frequent PT/OT to prevent contractures; hot water heater set to 120F;

57
Q

1st degree burn

A

epidermis remain intact without blisters; erythema, skin blanches with pressure; painful; discomfort lasts 48-72 hrs and desquamation occurs in 3-7 days

58
Q

2nd degree burn

A

wet, shiny, weeping surface; wound blanches with pressure; painful and sensitive to touch and air; superficial partial heals in <21 days; deep partial heals >21 days; healing depends on depth and presence of infection

59
Q

3rd degree burn

A

color varies from deep red, white, black, brown; surface dry; thrombosed vessels visible; no blanching; insensate (decreased pinprick sensation); autografting necessary for healing

60
Q

4th degree brurn

A

color varies; charring present in deepest areas; extremity movement limited; insensate; amputation of extremities is likely; autografting is required for healing

61
Q

emergency care of poisoning

A
  1. assess victim- ABCs, mental status, trauma/illness associated; 2. terminate exposure- remove object from mouth, remove toxins from skin, remove from inhaled toxins (move to fresh air); 3. identify the poison- ask others, call poison control; 4. prevent poison absorption- prevent aspiration, side lying
62
Q

caustic ingestion

A

can quickly cause severe esophageal and gastric erosion; all caustic ingestions are medical emergency and require 911; ED should have intubation kit ready; teach and reinforce safe storage

63
Q

acetaminophen (tylenol) poisoning

A

most common accidental drug poisoning in children; toxicity occurs from acute ingestion

64
Q

signs and symptoms of tylenol overdose

A

4 stages; start with GI symptoms; lead to liver failure; eventually can lead to death if untreated or undetected

65
Q

antidote for acetaminophen poisoning

A

N-acetylcysteine (mucomyst); equally effective if oral or IV

66
Q

4 stages of acetaminophen poisoning after ingestion

A

0-24hrs: N/V, sweating, pallor; 24-72hrs: patient improves, may have right upper quadrant abdominal pain; 72-96: pain in right upper quadrant, jaundice, vomiting, confusion, stupor, coag. abnormalities, potential renal failure, pancreatitis; more than 5 days: resolution of hepatotoxicity or progress to multiple organ failure, may be fatal

67
Q

lead poisoning

A

most instances of acute childhood lead poisoning from lead based pain in older homes or lead-contaminated bare soil; can have long term systemic affects; need to be <5mcg/dL otherwise need treatment; lead chelation therapy needed for severe cases

68
Q

child neglect

A

lack of intervention or providing of necessary resources

69
Q

physical neglect

A

the deprivation of necessities such as food, clothing, shelter, supervision, medical care, and education

70
Q

emotional neglect

A

failure to meet the childs needs for affection, attention, and emotional nurturance

71
Q

child abuse

A

purposefully inflicting harm; other children within the home are at risk and should be evaluated; children <1 y/o are at highest risk for physical abuse

72
Q

sexual abuse common abuser

A

tends to be male

73
Q

mandated reporter

A

staff members of medical or other public or private institutions, schools or facilities; usually submitted by social worker ED but can be submitted by anyone

74
Q

mandated reporters must…

A

immediately make oral report to DCF, when in professional capacity, they have reasonable cause to believe child under age of 18 years is suffering from abuse and or neglect; must submit written report within 48 hours

75
Q

down syndrome

A

most common chromosomal abnormality of a generalized syndrome; maternal age is known risk factor; degree of cognitive and physical impairment depends on percentage of cells with abnormal chromosome makeup; can be diagnosed with manifestations but should be confirmed with chromosome analysis

76
Q

clinical manifestations of down syndrome

A

oblique palprebal fissures (upward, outward slant), small nose, depressed nasal bridge (saddle nose), high arched narrow palate, neck skin excess and laxity, congenital defect, wide space between big and 2nd toes, plantar crease between big and 2nd toe, hyperflex ability and muscle weakness

77
Q

fragile x syndrome

A

most common inherited cause of cognitive impairment and second most common genetic cause of cognitive impairment or intellectual disability after down syndrome; caused by abnormal gene on lower end of the long arm of x chromosome

78
Q

fragile x clinical manifestations

A

increased head circumference, long wide or protruding ears, long narrow face with prominent jaw, strabismus, mitral valve prolapse, aortic root dilation, hypotonia, enlarged testicles, behavior features, mild to severe cognitive impairment, speech delay (may be rapid with stuttering and repetition), short attention span/hyperactivity, hypersensitivity to tastes sounds and touch, intolerance to routine change, autistic like behaviors (gaze and social anxiety), possible aggressive behavior

79
Q

hearing impaired children

A

should have hearing screen (AABR) prior to discharge; may be caused by prenatal and postnatal conditions

80
Q

hearing aid behaviors in infants

A

lack of startle reflex for sounds, failure to awake from loud sounds, failure to localize source of sound by 6 mo, absence of babble or voice inflections by 7 mo, general indifference to sound, lack of response to spoken word, failure to follow verbal directions, response to loud noises as opposed to voice

81
Q

safety teaching for hearing aid batteries

A

store where children cannot reach; do no allow children to change batteries themselves

82
Q

visually impaired children

A

consists of myopia, hyperopia, amblyopia, strabismus

83
Q

myopia

A

nearsightedness- ability to see objects clearly at close range but not at distance; correct with biconcave lenses that focus rays on retina; may be corrected with laser surgery

84
Q

hyperopia

A

farsightedness- ability to see objects at a distance but not close range; correct with convex lenses when required that focus rays on retina; may be corrected with laser surgery

85
Q

amblyopia

A

lazy eye- reduced visual acuity in one eye; poor vision in affected eye; preventable treatment of primary visual defect before 6 years old

86
Q

strabismus

A

squint or malalignment of eyes; esotropia- inward deviation of eye; exotropia- outward deviation of eye; need to treat underlying cause

87
Q

autism spectrum disorders

A

complex neurodevelopmental disorders of unknown etiology; consist of difficulties in social communication, social interaction, restricted repetitive behavior interest or activities; 1 out of ever 68 US children; males 4x more likely to be dx; commonly diagnosed at younger age d/t early signs; provide support with diagnosis and therapies

88
Q

chronic conditions in children

A

medical condition that persists for > 1 yr; affects several organ systems or critically affects one system and needs specialty expertise

89
Q

nursing care considerations for chronic conditions

A

focus on development, family centered care, help child and family with coping mechanisms

90
Q

nursing care of family and child with complex or chronic conditions

A

proper assessment; provide support at time of diagnosis; special considerations for congenital anomaly, cognitive impairment, physical disability, chronic illness, multiple disabilities, terminal illness

91
Q

separation anxiety

A

age increases understanding and tolerance; regression and additional comfort needs common when child is hospitalized/has chronic illness

92
Q

stages of separation anxiety in young children

A

stage of protest- crying, screaming, physical behavior against care givers, can last hours to days; stage of despair- withdrawing, depressed, sad, regress to earlier behaviors like bedwetting or thumb sucking; stage of detachment- usually occurs after prolonged separation, build new relationships with providers, may appear happy

93
Q

palliative care of the child

A

once death is discussed as the outcome it is necessary to determine childs and familys preference for location of palliative care; could be hospital, home, or hospice; prioritize comfort and pt wishes

94
Q

common physical symptoms of dying child

A

fear, anxiety, pain, decreased RR, SOB

95
Q

when discussing death to child

A

children can be very aware with what is going on with them/around them; important to explain in child appropriate terms

96
Q

unexpected childhood death

A

occurs from trauma, SIDS (peaks 1-4 mo, sudden death <1yr)

97
Q

if childs family not present at time of death…

A

provide calm clear explanation of childs status, provide opportunity to see boy and repeat offer at later time if denied, warn how child may appear (tubes, lines), provide bereavement kit lik locks of hair or foot/hand print), limit providers present when family with child

Pediatrics (4 decks)

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