Final Flashcards

Question

Patent Ductus Arteriosus

Answer 1

Treated with indomethacin to close

Answer 2

Systolic injfection murmor CHF

Answer 3

Spontaneous closure may occur

Answer 4

Pulmonic stenosis right ventricular hypertrophy overriding aorta ventricular septa defect Treatment: surgery to improve oxygenation S/Sx: TET spell when bending down

Answer 5

Audible murmur during systolic phase of cardiac cycle Click may be heard and thrill may be present

Answer 6

- Blood pressure difference of 20mm between upper/lower extremities S/Sx: - Brachial/radial pulse full - Femoral pulse weak/absent Complication: congestive heart failure

Answer 7

Survival depends on foramen ovale remaining open Symptoms appear at birth or soon after Treatment: surgical correction S/Sx: progressive cyanosis --> hypoxia --> acidosis

Answer 8

Medication: Digoxin, Diuretics Nursing Management: - Promote O2 - Support heart function - Nutrition - Promote Rest Daily weights - Weight gain of more than .5kg/1lb is indicative of fluid retention Monitor for digoxin toxicity

Answer 9

Caused by untreated group b strep Dx based on Jones Criteria - 2 major or 1 major and 2 minor Major S/Sx: joint arthritis, carditis, chorea, slurred speech, subcutaneous nodules Minor: fever, elevated ESR, positive c-reactive protein, prolonged PR on ECG Treatment: - Pain - ***aspirin*** - Bedrest to decrease ESR - Steroid - Antibiotic - penicillin or erthromycin - Monitor Heart

Answer 10

Multisystem vasculitis S/Sx: MUST have 5 out of 6 fever > 5 days, bilateral conjunctivitis, strawberry tongue, red palms, rash, peeling hands/feet, cervical lymphadenopathy Treatment: - IVIG/ IV immunoglobulin - aspirin therapy ***20% of children develop cardiac sequelae*** - MI

Answer 11

Treatment: - Decrease weight with diet/exercise NOT bp meds Children ID'd during health screening Complication: future coronary heart disease

Answer 12

Must be between 90th and 95th percentile on at least 3 occasions Treat with diet/exercise (30-60 minutes day)

Answer 13

Patho: Failure of soft tissue or bony structures to fuse Unilateral or bilateral Dx: Using gloved finger in baby's mouth Signs/Sx: - Difficulty feeding - Spilling formula from nose Risk Factors: - Decreased folic acid in maternal diet - Genetic and environmental Complications: - Chronic otis media - Nutrition - Speech - Parents may feel guilt, grief, anger or sense of loss, it helps to provide photo of before/after Treatment: - Feeding devices - Elevate after feeding and burp regularly - Do not feed longer than 20-30 minutes Surgery typically by 3-5 months of age - Cleft lip performed at 4 weeks - Palate surgery before 12 months of age Post-op Care - Elbow restraint/immobilizer - Avoid sucking/crying - Do not put into prone position

Answer 14

Surgical emergency! Assessed during feeding Patho: - Congenital malformation occurring at 4-5 weeks gestation where esophagus fails to develop as continuous tube Signs/Symptoms: - Excessive drooling or salivation - 3 Classic Signs: Choking, coughing, Cyanosis Complications: - Tracheoesophogeal fistula developed in 90% of cases

Answer 15

Complication of esophageal atresia where esophagus ends in blind pouch or pouch is connected to trachea by fistula

Answer 16

Up to 5% body weight loss, roughly 40-50 ml/kg S/Sx: - Normal VS - Fussy - Restless - Alert - Thirsty - Normal mucous membranes and skin turgor -Anterior fontanel and eyes normal - Cap refill < 3 seconds Treatment: Oral rehydration 5 to 15 mLs of fluid every 10-15 minutes Small amounts, frequent intervals

Answer 17

6-10% body weight loss, 60-90 ml/kg S/Sx: - Increased heart rate - Normal to low bp - lethargic but arousable - dry mucous membranes - Decreased skin turgor - Anterior fontanel sunken and eyes slightly sunken - Cap refill 3-5 seconds - Specific gravity 1.020-1.030 - Decreased urine output and darker color Treatment: Oral rehydration 5 to 15 mLs of fluid every 10-15 minutes Small amounts, frequent intervals

Answer 18

Greater than 10% body weight loss, 100mL/kg - Increased HR, weak heart - Low BP - Rapid, Deep respirations - Drowsy to comatose, not arousable - Parched mucous membranes - Very poor skin turgor - Anterior fontanel sunken - Eyes sunken - no tears - Cap refill >5 seconds - Specific gravity > 1.030 - Decreased to absent UOP

Answer 19

Patho Increased stool frequency or decrease in consistency Loose watery stools Classification: - Acute <14 days - Chronic >14 days - stool culture needed Treatment: - Rehydration therapy - Pedialyte/electrolytes

Answer 20

Forceful expulsion of stomach contents Complications - Metabolic alkalosis - Dehydration Treatment IV fluids according to maintenance fluid calculation Always monitor kidney function before adding potassium chloride to primary IV fluids

Answer 21

Patho - Narrowing between stomach and duodenum S/Sx: Projectile vomiting - up to 3ft Visible peristaltic waves from left to right Failure to thrive/weight loss Dx: - US or upper GI series Treatment: - Laparoscopic pyloromyotomy surgery

Answer 22

Gastric content reflux into lower esophagus causing tissue inflammation, scarring, stricture S/Sx: - Infant eats often but not gaining weight - Chronic vomiting - Hematemsis - Failure to thrive - Abdominal pain - Irritability Dx: - Barrium swallow and Upper GI endoscopy Management: - Revise feeding - thickened foods - Elevate during feeding - Post feeding prone position with elevated head for 1-2 hours - Smaller feeding volume, more frequent - Sometimes surgery for FTT - fundoplication w/ gtube Complications: -Aspiration -Apnea

Answer 23

Patho - Telescoping of one part of bowel into another S/Sx - Currant jelly-like stool - Palpable sausage shaped abdominal mass Treatment: - Contrast/air enema Risk Factors: - CF - Henoch-schonlein pupura - chrons disease - celiac disease

Answer 24

Patho: - Congenital aganglionic megacolon - Proximal bowel dilates and fecal matter collects due to absence of ganglion cells and lack of peristalsis S/Sx: - Failure to pass meconium for 24-48 hours - Failure to thrive/ inadequate weight gain - bile stained vomiting - frequent foul-smelling ribbon-like stools - Distended abdomen - Poor feeding Treatment - Remove aganglionic portion of intestine - Temporary colostomy Complications: - Enterocolitis - inflammation of small intestine and colon (life threatening)

Answer 25

Most common pediatric condition requiring abdominal surgery S/Sx: #1 Periumbillical pain #2 RLQ pain Assessment: - Rebound tenderness Treatment: - Surgery

Answer 26

Nervous Stomach Recurrent abdominal pain in children S/Sx - Abdominal pain - Flatus - Bloating, - Constipation - Diarrhea (or both) Dx: No specific test Treatment: - Dietary changes

Answer 27

Patho: -IBD - NO CURE - Chronic inflammatory process with exacerbation and remission S/Sx: - Abdominal pain with cramps - diarrhea - weight loss - anorexia - fever (may be present) - Rectal bleeding/perineal discomfort Dx: - CBC - ESR - C-reactive protein - elevated - Low protein/albumin, iron, zinc, magnesium, B12 Treatment: - Pharmacological - antidiarrheal, antiinflammatory, immunosuppressants, analgesics, antibiotics - Nutrition and vitamins - Surgery for pallative care

Answer 28

Patho - Acute or chronic bowel inflammation S/Sx: - Recurrent bloody diarrhea - abdominal pain - urgency - tenesmus Treatment: - Curable with surgery - illeostomy

Answer 29

Life threatening inflammatory disease of intestinal tract - Common in premature infants - Manifests during 2nd week of life after enteral feedings begin Treatment: Needs to be immediate to decrease morbiditiy and mortality

Answer 30

Patho: - Inability to digest protein of wheat, barley, rye and oats - life-long S/Sx: Early: diarrhea, vomiting, failure to gain weight, constipation, abdominal pain, fatty stool Late: behavior change, muscle wasting Celiac Crisis: electrolyte imbalance, dehydration, severe acidosis Treatment: - High calorie and protein diet with simple carbs,

Answer 31

Patho: - Common cause is E. Coli - Young girls prone b/c short urethra - no bubble baths Children S/Sx: - Fever w/o focus - Abdominal pain - Urinary frequency and urgency - dysuria - fever - new onset. enuresis Infant S/Sx: fever, irritability, dysuria, crying when voiding, change in urine color/odor, poor weight gain, feeding difficulty Treatment: - Antibiotics for 7-10 days - Always test for cure following treatment

Answer 32

Patho: - Congenital abnormality - Vesicoureteral is a valve between ureter and bladder designed to prevent urine refluxing into ureter Dx: - Renal ultrasound - Voiding Cystourethrogram VCUG Grading: I-III - no surgery, prophylactic antibiotic, monitoring for a few months and usually resolves on own IV, V - surgery to reimplant ureters into bladder, prophylactic antibiotics and antispasmodics; kidney damage will occur if not corrected UTI Complications Causes: - Bacteria in urine carried back up ureter causing pyelonphritis and renal damage - Small reflux leaves residual and breeding ground for bacteria

Answer 33

Patho - Autoimmune - Loss of protein into urine (>3g day) S/Sx: Na decrease, fluid shift, edema, decrease UOP Albumin decrease Protein decrease (3g/day in urine) Hyperlipidemia Renal vein thrombis Orbital edema Thromboembolism Infection Coagulation Weight gain, anorexia, fatigue, abdominal pain Types: Primary - disorder within glomerulus, common in kids Secondary - secondary to disease like hep, lupus, cancer, etc. Treatment: - Prednisone 2mg/kg/day for 2 or 3 times/day until zero trace of protein in urine for 5-7 days - Must taper steroids - NO salt diet

Answer 34

Patho - Follows strep A infection S/Sx: - Hematuria/Coca cola urine - Proteinuria - Edema - Renal insufficiency - Hypertension Treatment: - NO antibiotics if strep is neg - bed rest - monitor fluid/electroylytes, daily weights - possible fluid restriction - Restrict protein, sodium and potassium ***These kids are very sick and need LOTS of support***

Answer 35

Patho: - Most common cause of renal failure in peds - Consumption of beef w/ e-coli S/Sx: - gastroenteritis, bloody diarrhea, URI or UTI precede infection - HTN - Pallor - Bruising - Oliguria - Fever - Vomiting - Jaundice - Neuro involvement Treatment: - Acute renal failure - fluid restriction, high calorie, high carb, low protein, Na, K - PD - Strict I&Os Prevention - NO RARE hamburgers, NO PINK - Wash hands when handling raw beef

Answer 36

Patho: - Undescended testes - Usually detected during newborn assessment Treatment: - Most testes spontaneously descend by 3-months - If not, orchiopexy performed at 12-months Risks: - Sterility - Testicular cancer

Answer 37

Infant S/Sx: -Positive Ortolani (assess click) and Barlow (feel for click) - Shortening of limb on affected side - Unequal gluteal folds - Restricted hip abduction on affected side Toddlers/Older Children: - waddling gait - Lordosis when standing - Affected leg shorter than other leg - Trendelenburg Sign - weakness in hip abductor muscles (gluteus medius/minimus) Assessment: - Dx made during neonatal period - US (4 months and younger) - Xray - (4 months and older) Treatment: - Initiated before 2-months of age for most success - Ongoing hip exam until child begins to walk -Pavlik harness - Corrective device placed during neonatal period to maintain hip flexion/abduction

Answer 38

Patho - lateral curvature in spine >10 degrees - Occurs anywhere along spine, thoracic region most common - Idiopathic Scoliosis common in adolescence Dx: - Screening: Forward bending test - Xray of spine - anteroposterior and lateral Treatment: - Monitored every 3-12 months if curve <20 - Curve 20-40 degrees - bracing w/ exercise - Curves >40 - surgery

Answer 39

Patho: - Infection of bone - Common between 5-14, especially boys - Can occur due to penetrating injury or wound or result from infection elsewhere in body S/Sx: - Fever - Abrupt pain - Unwillingness to bear weight or move limb - Irritable - Possible dehydration/poor appetite Treatment: - IV antibiotics for 4-6 weeks - Bed rest - Affected limb may be cast or splint - Surgery

Answer 40

Patho - posterior vertebral arches fail to fuse - no herniation or loss of function - may have dimple or tuft of hair Types: - Occulta - tuft of hair - Meningocele - saclike protrusion w/ menings/CSF - Myelomeningocele - saclike protrusion w/ CSF, meninges, nerve roots and spinal cord Treatment: - Meningocele will have sac repaired in first 48-hours - If sac located outside of spinal cord - prone posiiton, no rectal temps, keep sac moist - Straight cath due to neurogenic bladder (except in occulta) - Bowel management program Prevention: - Folic acid during pregnancy Risks: - Latex allergy - Hydrocephalus - measure head, monitor for ICP

Answer 41

Patho: - nonprogressive motor disorder of CNS resulting in alteration in movement/posture - Leading cause of anoxia or hypoxia at birth Classifications: - Spastic - most common - Athetoid - Ataxic -Mixed S/Sx: - Primative reflexes - Delayed gross motor development - Lack of progression through developmental milestones - Uncontrolled movements in extremity Complications: - Gait disturbance - Seizure ADD - sensory impairment - Failure of automatic reactions - Speech and swallowing impairment

Answer 42

Patho - Highly contagious bacterial infection - Staph or Strep (or both) S/Sx: - Leasion start as vesicle or pustule w/ edema and erythema then erupt leaving honey-colored exudate Prevention: - Hand washing - Short nails Treatment: - Remove crust from lesion prior to applying topical antibiotic medication - Severe cases require systemic antibiotic

Answer 43

Patho: - Bacterial infection entering through opened skin due to derm issue or trauma - Staph or Strep most common S/Sx: - Edematous - Redness - Warm, hot to touch - Pain in affected area Treatment: - Mild: home w/ oral antibiotics -Severe - IV atbx and possible incision/drainage (I&D)

Answer 44

Patho: - Headlice S/Sx: - Itching is only symptom Treatment: rid hair of nits - Application of pediculicides AND manual removal of nits - Drug of choice: NIX ***Children should stay in school even if NOT ALL NITS are removed***

Answer 45

HIV destroys body's ability to fight infection Most cases related to perinatal transmission S/Sx: Range from none to mild or moderate - AIDS is most severe Pregnant women treated with zidovudine and infant treated for 6 weeks post delivery. If mom NOT treated then infant followed for 18 months and ELISA test performed

Answer 46

S/Sx: Single or multiple joint involvement Stiffness Swelling Loss of motion in affected joints Dx: No definitive tests, symptoms present for > 6 weeks Treatment: NSAIDS PT OT

Answer 47

Most infants born with enough stored maternal iron to last 4 to 6 months At Risk: If infant does not take appropriate solid foods and consuming breast milk or formula w/o iron are at risk Infants given whole milk before 12 months or drinking too much milk and few solid foods Treatment: - Give iron on empty stomach w/ vitamin C to aid absorption - Administer in back of mouth b/c stains teeth

Answer 48

Leads to complications such as behavior problems and learning difficulties, encephalopathy, seizures and brain damage

Answer 49

Autosomal Recessive - each pregnancy has 25% chance if both parents carry recessive trait Crisis Triggers: Hypxoia Fever Dehydration Emotional Stress Headaches can trigger cerebral vascular events Treatment: Hydration to prevent sickling Oxygen Pain management Warm compress Transfusion

Answer 50

Bleeding that can occur anywhere, but mostly in joint spaces Treatment: - Apply pressure for 15-20 minutes - RICE - Regular exercise recommended to strengthen joints and decrease # of spontaneous bleeding episodes - Swimming is best

Answer 51

Dx: Bone marrow aspiration and biopsy Treatment: Aggressive chemo

Answer 52

Seen in: adolescents and young adults Cell - Reed-Sternberg cell "owel eyes" Prognosis - great w/ chemo and radiation

Answer 53

Only seen in children Cause unknown Prognosis depends on presence and extent, usually removes surgicallly

Answer 54

Highest survival rate among all childhood cancers Affeced kidney removed and will need radiation and/or chemo