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NSG 2521 - HoF > Final > Flashcards

Final Flashcards

1
Q

What are the two accessory muscles for inspiration?

A

Sternocleidomastoid and scalene muscles

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2
Q

The higher you see the indrawing, the more _____ the respiratory distress

A

Severe

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3
Q

Do children abdominally or chest breathe?

A

Abdominal breathing

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4
Q

What is see-saw breathing in children?

A

When the chest and abdomen do not move in congruence while breathing

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5
Q

What age does the respiratory tract stop growing?

A

12 years old

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6
Q

How does the child airway differ to adults?

A

Shorter and narrower

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7
Q

Is the relationship between airway diameter and resistance inverse or correlated?

A

Inverse

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8
Q

What age are NBs nose breathers until?

A

Approx 4 weeks

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9
Q

How big is a child’s airway diameter?

A

Typically, the size of a child’s pinky finger

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10
Q

Why do we see a spike in illness in babies after 6 months of age?

A

Introduction of solid foods

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11
Q

When would CRP be high?

A

Inflammation, children with bacterial illness

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12
Q

Why would electrolytes be increased naturally?

A

Increased metabolic work

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13
Q

What do pH, PaCO2, and bicarbonate levels indicate?

A

pH - determines extent of acidity or alkalinity in the body

PaCO2 - reflects the adequacy of ventilation by the lungs

Bicarbonate - reflects the activity of the kidneys in retaining or excreting bicarbonate

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14
Q

What will blood work look like in resp acidosis? (pH, PaCO2, and bicarbonate)

A

pH - decreased

PaCO2 - increased

Bicarbonate - normal

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15
Q

What are the 10 signs and symptoms of resp acidosis?

A

headache, anxiety, blurred vision, restlessness, confusion, fatigue, lethargy, delirium, SOB, coma

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16
Q

What four conditions could possibly cause resp acidosis?

A

Croup, epilgottitis, bronchiolitis, and status asthmaticus

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17
Q

Why does respiratory acidosis occur (general info)?

A

Prolonged periods of apnea, deoxygenation, or an airway obstruction

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18
Q

What will blood work look like in resp alkalosis? (pH, PaCO2, and bicarbonate)

A

pH - increased

PaCO2 - decreased

Bicarbonate - decreased or normal, case dependent

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19
Q

Is resp acidosis or alkalosis more common?

A

Acidosis

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20
Q

What are the six signs and symptoms of resp alkalosis?

A

Lethargy, anxiety, hyperventilation, nausea, confusion, and vomiting

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21
Q

What is one of the most primary signs of resp alkalosis?

A

Hyperventilation

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22
Q

What are the four potential causes of resp alkalosis in children?

A

panic/anxiety attacks, fever, tumour, and trauma/injury

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23
Q

What is circumoral cyanosis?

A

A ring of blue around the mouth

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24
Q

After which VS changes will we see circumoral cyanosis?

A

After RR and HR changes, but before BP changes

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25
Q

Define tonsilitis

A

Inflammation of the tonsils

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26
Q

What does tonsillitis often occur concurrently with?

A

Pharyngitis

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27
Q

What are the five signs and symptoms of tonsillitis?

A

sore throat, fever, difficulty swallowing, enlarged tonsils, and headache

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28
Q

At what stage would a tonsillectomy not be performed?

A

Would not perform a tonsillectomy during a phase of tonsilitis, as the patient is already at risk for infection and OR procedures may elevate risk of sepsis

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29
Q

What are six nursing managements of tonsillitis?

A
  1. saline rinses, warm liquids, honey
  2. Tylenol and Advil for analgesia and antipyretic
  3. cool humidifiers or nebulizers
  4. cool fluids, ice chips
  5. antibiotics for bacterial
  6. discarding toothbrushes to reduce recurrence
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30
Q

What age would we not provide honey for tonsillitis and why?

A

Do not give honey to children under 1 year due to it being unpasteurized and risk of botulism

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31
Q

Define croup

A

A virus that triggers swelling of the trachea around the larynx

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32
Q

Is croup viral or bacterial?

A

Viral

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33
Q

What time of the day is croup typically worsened?

A

At night

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34
Q

What condition causes a bark, seal-like cough?

A

Croup

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35
Q

What adventitious sound would be heard with croup?

A

Stridor

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36
Q

What are four nursing managements for croup?

A
  1. cool humidifier, nebulizer, or cool night air
  2. fluids to soothe throat
  3. steroids such as epinephrine or dexamethasone to decrease swelling and inflammation
  4. offer small, frequent amounts of fluid to maintain hydration
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37
Q

What are the 7 signs and symptoms of croup?

A

cold-like symptoms, hoarse, barking cough, stridor, tachypnea, substernal retractions and increased WOB, and worsened at night

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38
Q

Define RSV/bronchiolitis

A

Lower resp tract illness characterized by inflammation of the bronchioles and increased mucous production

airway obstruction and air trapping occurs, bronchiolar mucosa swells and lumina are filled with mucous and exudate, obstruction in small air passages lead to hyperinflation

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39
Q

At what age is RSV/bronchiolitis most common?

A

Infancy

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40
Q

What is syangis? who is eligible?

A

High risk neonates may qualify for the monthly injections to reduce risk of RSV

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41
Q

what are the 5 common signs/symptoms of RSV?

A

stuffy/runny nose, cough, otitis media, low-grade fever, sore throat

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42
Q

What are the 7 worsening symptoms of RSV?

A

trouble breathing, tachypnea, wheezing, deeper/more frequent coughing, cyanosis, dehydration, poor feeding (bottle or BF)

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43
Q

When is RSV season?

A

October to April

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44
Q

When is the peak of illness for RSV?

A

Day 5

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45
Q

For babies with RSV requiring hydration, how will this be completed? IV NG?

A

We will begin with NG tubes as replacement for hydration than an IV

Those that are extremely ill will receive an IV, but NG tube is first line of treatment

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46
Q

What are the 4 nursing managements of RSV?

A
  1. Supplemental oxygen, suctioning, PO or IV hydration
  2. inhaled bronchodilator (i.e., epinephrine)
  3. chest physio
  4. PPE and hygiene due to infectious nature
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47
Q

Why should we be conservative with suctioning in children with RSV?

A

it will cause the body to produce more mucus rather than reducing it

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48
Q

Define cystic fibrosis

A

Autosomal recessive disorder (chromosome 7) affecting multiple body systems, where mucous builds up and blocks the airways & ducts of the pancreas

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49
Q

Can CF be tested for prenatally?

A

Yes, DNA testing can be done to detect it

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50
Q

What 3 systems are affected by CF?

A

Exocrine gland dysfunction that impacts sweat, GI tract, pancreas, and resp tract

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51
Q

How is the pancreas affected in CF?

A

Blockages in the pancreas prevent digestive enzymes from reaching the small bowel

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52
Q

Why might sputum be blood tinged with CF?

A

Due to scarring and irritation in the airway

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53
Q

What electrolyte may be reduced in CF? Why?

A

May have reduced electrolytes, specifically sodium

Increased sodium excretion through the sweat and mucus secretions

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54
Q

What are the four signs and symptoms of CF?

A
  1. Difficulty breathing and life-altering resp tract problems (wet, rattling cough with mucous)
  2. severe, chronic lung infections (leading to permanent lung damage and disease)
  3. failure to grow and gain weight
  4. difficulty digesting food
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55
Q

What is the leading cause of CF deaths?

A

permanent lung damage and lung disease

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56
Q

What are the 3 nursing managements for CF?

A
  1. minimize pulmonary complications, maximize lung function, and prevent infection
  2. daily chest physio to mobilize secretions from the lungs
  3. medications
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57
Q

what 5 medications would be prescribed to a child with CF?

A
  1. hypertonic saline via nebulizer
  2. inhaled bronchodilators
  3. anti-inflammatory agents
  4. antibiotics
  5. recombinant Dnase can decrease sputum thickness
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58
Q

How do we manage digestive problems in CF?

A

A high calorie and protein diet, pancreatic enzymes to aid digestion, vitamins, and dietary supplements (i.e., NG or TPN)

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59
Q

What does a hypertonic nebulizer do for CF?

A

helps to loosen mucus

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60
Q

When is incentive spirometry and deep breath & cough not useful?

A

When a child is actively in resp distress

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61
Q

Define asthma

A

A chronic inflammatory airway disorder characterized by airway hyper-responsiveness, airway edema, and mucus production

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62
Q

What is the most common chronic illness in children

A

asthma

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63
Q

What is the most severe presentation of asthma?

A

Status asthmaticus

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64
Q

Children with asthma are more susceptible to ___ and ____ respiratory infections

A

Bacterial and viral

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65
Q

What are the 7 signs and symptoms of asthma?

A

frequent cough without a trigger, tachypnea/dyspnea/SOB, wheezing, difficulty speaking, seesaw breathing/retractions, tightened neck/muscles, dark circles under the eyes

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66
Q

What time of day is coughing worsened for asthma?

A

First thing in the morning and night

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67
Q

Describe the step-wise approach for medication asthma treatment

A

Stepwise approach is best:

short-acting bronchodilators may be used in the acute treatment of bronchoconstriction and long-acting to prevent bronchospasm

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68
Q

What is an asthma controller and provide an example of medication

A

Used routinely for management of chronic inflammation in the lungs

Beclomethasone - a corticosteroid

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69
Q

What is an asthma reliever and provide an example of medication

A

used for periods of exacerbation, decreasing response to triggers/allergens

albuterol - adrenergic

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70
Q

What is pseudoephedrine and what is it used for?

A

Adrenergic, decongestant

Symptomatic relief of nasal and nasopharyngeal mucosal congestion due to the common cold, hay fever, or other resp allergies

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71
Q

What drug is pseudophedrine contraindicated with?

A

Should not be taken with MAOIs or within 2 weeks of discontinuation

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72
Q

At what age should there be cautious use of pseudoephedrine?

A

<4 years

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73
Q

What drug could cause rebound congestion?

A

Pseudophedrine

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74
Q

What is acetylcysteine and what is it used for?

A

A mucolytic, acetaminophen antidote

Adjunctive therapy for abnormal and viscous mucous secretions in acute and chronic bronchopulmonary disorders

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75
Q

How should acetylcysteine be taken with a bronchodilator?

A

Bronchodilator should be taken 10-15 mins prior to acetylcysteine nebulizer

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76
Q

Is it normal for a child to have more mucus when first taking acetylcysteine?

A

yes

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77
Q

What is beclomethasone and what is it used for?

A

Corticosteroid, anti-inflammatory, anti-asthmatic

Long-term control of persistent bronchial asthma (i.e., controller)

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78
Q

Should beclamethasone be shaken prior to use? What must be done after administration?

A

Never shake

Rinse mouth and spit to prevent thrush

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79
Q

What should be taken first, controller or reliever?

A

Reliever should be given first and then controller second, as it has the best impacts

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80
Q

What age would we use a mask and spacer?

A

Masks should be used for those under or at 4 years of age, and spacers after 4 years

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81
Q

What is albuterol and what is it used for?

A

adrenergic, agonist, anti-asthmatic, bronchodilator

treatment or prevention of bronchospasm in asthma or COPD

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82
Q

Should albuterol be shaken? how long should a patient wait in between each inhalation?

A

Should be shaken well

Wait 30s-1 min and take normal breaths between

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83
Q

What age does salivary production begin?

A

4 months

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84
Q

what is the stomach capacity of the neonate?

A

10-20ml

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85
Q

Why is regurgitation common in newborns?

A

Immature muscle tone of the LES and low volume capacity of the stomach

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86
Q

Why is the sucking and extrusion reflex important for babies?

A

Sucking and extrusion reflex allows the tongue to thrust any foreign object out of the mouth, such as a finger or soother

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87
Q

What are six reasons that NG tubes may be used?

A

decompress stomach and proximal small intestine, evacuate blood or secretions, control bleeding from gastric and esophageal therapies, administer meds/fluids/TPN, obtain gastric contents, administer lavage or irrigation

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88
Q

Can we add medications to an enteral feeding formula for NG?

A

Never

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89
Q

How can TPN administer via IV? How long should we wait between doses?

A

Either centrally or peripherally

High alert medication - 4 hours between doses

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90
Q

How is TPN dosed/calculated?

A

Prescribed based on age, weight, and nutritional deficits

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91
Q

What three dietary problems are associated with constipation?

A

Decreased fibre, lactose intolerance or too much dairy, and not enough fluids/water

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92
Q

Within what time frame should babies have their first mec?

A

48 hours

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93
Q

How will increasing fibre and fluids aid constipation?

A

Fiber - add bulk to the stool and make it easier to pass

fluids - soften the stool to help

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94
Q

How many stools should a 3mo, 2 yr, and 4yr be having?

A

3mo - ~2-4 stools/day

2yr - ~1-2 stools/day

4yr - ~1 stool/day

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95
Q

What is the best way to potty/bowel train?

A

Implement regular toilet sitting times

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96
Q

Why might rebound constipation occur?

A

May occur if laxatives are stopped abruptly

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97
Q

How long may children be on daily bowel medications? what is the goal?

A

usually at least six months and want to ensure the child has at least one soft stool per day

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98
Q

Define gastroenteritis

A

Inflammation of the stomach and intestines

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99
Q

What pathogens may cause gastroenteritis?

A

Bacteria, viruses, and parasites

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100
Q

What is the leading cause of gastroenteritis?

A

Rotavirus

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101
Q

What are the two complications of gastroenteritis?

A

Dehydration and metabolic acidosis

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102
Q

What type of fluids should be administered for gastroenteritis? What if they have diarrhea and vomiting?

A

Isotonic fluids, potentially boluses

Intermittent hypertonic IV solutions

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103
Q

What are the 6 signs and symptoms of gastroenteritis?

A

diarrhea, vomiting, dehydration, lethargy, weight loss, fever

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104
Q

What is the sodium and glucose requirements for oral rehydration therapy?

A

50 mmol/L sodium and 20 g/L glucose

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105
Q

What is the prescribed oral rehydration therapy for children with mild/moderate dehydration?

A

50-100 mL/kg of ORS over 4 hours

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106
Q

What two markers indicate that rehydration has been adequate?

A

No longer feels thirsty and has normal urine output

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107
Q

Define hypertrophic pyloric stenosis

A

Circular muscle of the pylorus becomes hypertrophied, causing thickness in the luminal side of the pyloric canal

This thickness creates a gastric outlet obstruction, causing non bilious vomiting that presents between 3-6 weeks of life

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108
Q

When does hypertrophic pyloric stenosis develop in NB?

A

3-6 weeks of life

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109
Q

How is hypertrophic pyloric stenosis treated?

A

requires surgical intervention - pyloromyotomy to cut the muscle to relieve the obstruction

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110
Q

Will patients be NPO with hypertrophic stenosis?

A

Yes, until after surgery

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111
Q

What are the five signs and symptoms of hypertrophic stenosis?

A

forceful nonbilious vomiting unrelated to feeding position, hunger soon after vomiting, weight loss due to vomiting, progressive dehydration with subsequent lethargy, possible positive family hx

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112
Q

On palpation, what will hypertrophic stenosis feel like?

A

Will feel an olive-shaped mass in the RUQ of abdomen due to hypertrophy

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113
Q

Why would we put sucrose drops on a soother or nipple?

A

To help soothe pain, not for hypoglycaemia

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114
Q

What are the four nursing management for hypertrophic stenosis?

A
  1. fluid management and correcting electrolyte values
  2. provide emotional support
  3. teach about surgical procedure and post-op
  4. PO feedings after 1-2 days post-op
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115
Q

Will WBCs be elevated in pyloric stenosis?

A

yes

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116
Q

Define acute appendicitis

A

An inflammation and obstruction of the blind sac at the end of the cecum

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117
Q

What is the peak incidence of appendicitis?

A

10-12 years

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118
Q

What is the most common surgical disease in children?

A

Appendicitis

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119
Q

What are 7 signs and symptoms of acute appendicitis?

A

mid abdominal cramps and diffuse tenderness, RLQ pain, guarding and rebound tenderness, nausea and vomiting, anorexia, low-grade fever, later will complain of lethargy/irritability/constipation

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120
Q

What is McBurney’s point?

A

RLQ pinpoint of appendicitis pain

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121
Q

What is the most common complication of appendicitis?

A

Peritonitis from rupture

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122
Q

What are the 5 symptoms of peritonitis?

A

fever, abdominal distention and rigidity, sudden relief of pain, decreased bowel sounds, nausea and vomiting

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123
Q

What are two possible complications of appendicitis?

A

ischemic bowel and post-op infection

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124
Q

What is the treatment of peritonitis?

A
  1. use of 2 antibiotics (combination of cephalosporins)
  2. abdominal wash-out surgery
  3. potential bowel resection
  4. longer hospital stay
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125
Q

How is appendicitis managed pre-op?

A

position child in side-lying/semi-fowler, IV fluids to prevent dehydration, NPO, antibiotics

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126
Q

Will heat be applied for appendicitis pain relief?

A

NEVER apply heat to the abdomen as it may cause it to rupture

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127
Q

Define necrotizing enterocolitis (NEC)

A

An inflammatory disease of the bowel which can cause ischemic and necrotic injury in the GI tract

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128
Q

What are the mortality rates of NEC?

A

up to 50%

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129
Q

What is the usual age range for NEC?

A

3-12 days of life but may occur weeks later in NBs

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130
Q

What 4 pathological mechanisms may lead to NEC?

A

Bowel hypoxic ischemia events, perinatal stressors, immature intestinal barrier, abnormal bacterial colonization, formula feeding

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131
Q

What are the first three primary signs of NEC?

A

Feeding intolerance, abdominal distention, and bloody stools in infants receiving enteral feedings

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132
Q

As NEC worsens, infants develop sepsis which has what signs/symptoms?

A

resp distress, temperature instability, lethargy, hypotension, oliguria

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133
Q

What 8 things may be done to improve GI function and reduce risk of NEC?

A

Enteral antibiotics, parenteral fluids, monitoring tolerance of enteral feeds, oral immune therapy, human milk feedings, antenatal corticosteroids, enteral probiotics, slow continuous drip feedings

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134
Q

Why are antenatal corticosteroids administered to reduce NEC? Which pregnancy types will specifically receive it?

A

Antenatal corticosteroids are helpful in those who are for sure going to have a preterm baby

Betamethasone will be given to help improve lung function in these preterm babes

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135
Q

Are ostomies permanent in NEC babies?

A

No, their bodies will typically bounce back

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136
Q

What type of antibiotic will NEC babies be given?

A

Typically broad spectrum such as ceftriaxone

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137
Q

what labs will be used to assess progression of NEC?

A

serial kidney, ureter, and bladder (KUB) x-rays and CRP levels

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138
Q

What is omeprazole? What is it used for?

A

Proton pump inhibitor, antacid, treatment of ulcers

Treatment of gastric and duodenal ulcers, treatment of heartburn or symptoms associated with gastroesophageal reflux

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139
Q

How should omeprazole be timed with feeds?

A

30 minutes before feeds

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140
Q

What medication has cautious use for children <1 mo

A

omeprazole

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141
Q

What is dimenhydrinate? What is it used for?

A

Antiemetic

Motion sickness, N/V, vertigo, post-op N/V

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142
Q

Does dimenhydrinate or ondansetron cause drowsiness?

A

Dimenhydrinate

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143
Q

What is ondansetron? What is it used for?

A

Treatment of nausea

Acute gastroenteritis, chemotherapy-induced N/V, post-op N/V

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144
Q

How do we differentiate burns?

A

Based on the depth of tissue destruction

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145
Q

What degree of burn is a superficial burn ?

A

1st degree

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146
Q

How long do superficial burns take to heal? What symptoms are babies and infants at high risk for?

A

3-5 days without scarring

Increased risk for severe N/V and fluid imbalance

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147
Q

Describe a superficial partial thickness burn and its degree

A

thin-walled fluid-filled blisters that develop within minutes

2nd degree

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148
Q

How long do superficial partial thickness burns take to heal? Is there usually scarring?

A

3-5 weeks with scar formation being unusual

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149
Q

Describe a deep partial thickness burn and its degree. Is there scarring?

A

Waxy white burns that take weeks to heal

2nd degree and typically results in hypertrophic scarring

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150
Q

What type of burn may require antibiotics, skin grafting, or surgery?

A

Deep partial thickness burns

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151
Q

What area of the body is skin taken from for grafting?

A

Thigh

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152
Q

Describe a full thickness burn and its degree

A

Dry, leathery appearance from loss of elasticity to the dermis

3rd degree

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153
Q

What is an escharotomy and what type of burn is it performed on?

A

They release pressure and prevent compartment syndrome in areas where swelling prevents adequate circulation

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154
Q

What are general symptoms associated with compartment syndrome created by burns?

A

altered perfusion, tingling, changes in sensation, altered cap refill, altered CSM, and increased pain

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155
Q

What is the rule of 9s?

A

Estimation of burn injury - add together the areas of the body experiencing the burn to get a total %

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156
Q

What type of fluid will be given to burn victims and at what temp?

A

Warmed IV RL

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157
Q

What are the five general focuses for nursing management of burns?

A

fluid resuscitation, prevention of hypothermia, promoting oxygenation/ventilation, wound care and infection prevention, and restoration of function

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158
Q

Why are children at increased risk of hypothermia when burned?

A

Excessive heat loss can occur due to loss of protective dermal layer

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159
Q

Should we pop or preserve burn blisters?

A

Never pop

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160
Q

What time window is critical for fluid management in burn victims?

A

first 24 hours

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161
Q

How do we monitor I/O in burn victims?

A

Daily weights and catheterization

162
Q

The ___ system is the first major organ system to develop in the embryo

A

cardiovascular

163
Q

when does the heart beginning beating in embryo?

A

4 weeks

164
Q

when is the heart fully formed and functioning in gestation?

A

8 weeks

165
Q

With a newborn’s first few breaths, what changes occur in the heart?

A

Blood flow to the left side of the heart increases the pressure in the left atrium leading to a closure of the foramen ovale. The drop in pressure of the pulmonary artery promotes closure of the ductus arteriosis.

166
Q

Where does the heart lie in children less than 7 years old?

A

more horizontally, resulting in the apex lying higher in the chest

167
Q

Define preload and after load

A

Pre - volume in the ventricle just before contraction/systole

after - the load to which the heart must pump against

168
Q

Define CO and SV

A

CO - amount of blood that goes through the circulatory system in one minute

SV - volume of blood pumped out of the L ventricle of the heart during each systolic contraction

169
Q

What may a CBC be ordered to rule out in a cardiac patient?

A

Endocarditis or infection

170
Q

What is cardiac catheterization used to indicate?

A

blockage and perfusion of the heart

171
Q

What 2 clinical features are used to classify congenital heart defects?

A

presence or absence of cyanosis

degree of pulmonary vascularity (increased, decreased, or normal)

172
Q

Define ventricular septal defect and the three conditions it is associated with

A

Opening of the septum that separates the ventricles causing mixing of oxygenated and deoxygenated blood

Associated with FAS, Down syndrome, and other cardiac deformities

173
Q

What is the most common congenital heart defect?

A

ventricular septal defect

174
Q

Can ventricular septal defect close spontaneously?

A

Yes, about 30-50% do

175
Q

What are the five signs and symptoms of ventricular septal defect?

A

heart murmur, increased fatigue, stunted/limited growth, CHF, increased risk of endocarditis

176
Q

What condition will present with an extra heart sound?

A

Ventricular septal defect

177
Q

In what condition will babies present with fatigue while feeding?

A

Ventricular septal defect

178
Q

How will fluid boluses be changed from the standard for babies with ventricular septal defect?

A

Need to be cautious with hydrating, reduced to 10 mL/kg

179
Q

What is tetralogy of fallot?

A

A cardiac anomaly that refers to a combination of 4 related heart defects that occur together (pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy)

180
Q

What four defects make up tetralogy of fallot?

A

pulmonary stenosis, VSD, overriding aorta, and right ventricular hypertrophy

181
Q

What are the seven signs and symptoms of tetralogy of fallot?

A

murmur, clubbing, cyanosis, color changes with feeding, dyspnea, agitation, squatting

182
Q

What will heart sounds sound like with tetralogy of fallot?

A

A murmur that sounds like a washing machine or whooshing

183
Q

What defect presents with cyanosis and altered breathing during feeding?

A

tetralogy of fallot

184
Q

Why might babies squat when they have tetralogy of fallot?

A

may help bring up venous pressure and counteract discomfort of defect

185
Q

What are five nursing management techniques for tetralogy of fallot?

A
  1. place infant in a knee-to-chest position
  2. provide O2
  3. Administer morphine (0.1 mg/kg)
  4. supply IV fluids
  5. administer beta blocker such as propranolol (0.1 mg/kg)
186
Q

What cautions should be taken when taking BP and venipuncture on patient with a shunt placed for tetralogy of fallot?

A

Avoid BP measurement and venipuncture on the affected arm after a shunt is placed

187
Q

Why would we administer morphine to a patient with tetralogy of fallot?

A

resp depression to reduce stress on the cardiac system

188
Q

Why is a low stimulus/calm environment critical for tetralogy of fallot pt?

A

the more upset the child, the more strain on the cardiac system

189
Q

How is a 3-lead ECG placed?

A

White to the right, smoke over fire (black leads over top of red on left upper chest)

190
Q

What labs are we consistently monitoring in patients with congenital heart defects?

A

INR, PTT, PT to monitor coagulation

191
Q

What is Idiopathic thrombocytopenia purpura (ITP)?

A

Idiopathic thrombocytopenia purpura is a type of platelet disorder where the blood does not clot as it should due to low platelet counts

192
Q

What are the six signs and symptoms of ITP?

A

Petehiae, purpura, excessive bruising, epistaxis, bleeding of the gums, and blood in the stool

193
Q

Can viruses cause ITP?

A

yes, they may trigger the autoimmune response

194
Q

What will lab findings look like for a patient with ITP?

A

Low platelet count, normal WBC, normal HgB, and normal hematocrit unless hemorrhage has occurred

195
Q

What drugs should be avoided in children with ITP?

A

Aspirin, NSAIDs, and antihistamines

196
Q

How is ITP managed?

A

Many children require no medical treatment, but require close monitoring

However, severe cases may require platelet transfusions

197
Q

Define Kawasaki disease

A

an autoimmune diseases with no known cause and an acute systemic vasculitis

198
Q

What is the leading cause of acquired heart disease in children?

A

Kawasaki disease

199
Q

What condition occurs more often in the winter than summer?

A

Kawasaki disease

200
Q

What is the most common age range of Kawasaki disease?

A

occurring mostly in children 6mo-5yrs

201
Q

What are the eight signs and symptoms of Kawasaki disease?

A

fever (high and unresponsive to antibiotics), chills, headache, malaise, extreme irritability, vomiting, diarrhea, and abdominal and joint pain

202
Q

What condition is strawberry tongue associated with?

A

Kawasaki disease

203
Q

Why are heart murmurs and endocarditis common in Kawasaki disease?

A

due to the inflammatory process

204
Q

What is the most common history/assessment finding indicating Kawasaki disease?

A

A high fever (>39.9) of at least 5 days with no responsiveness to antibiotics

205
Q

What three physical findings may be present in Kawasaki disease assessment?

A

cervical lymphadenopathy (unilateral lump on neck), joint tenderness, and liver enlargement

206
Q

What two cardiovascular complications may Kawasaki disease cause?

A

coronary artery aneurysm and cardiomyopathy

207
Q

What signs and symptoms would indicate heart failure in a patient with Kawasaki disease?

A

tachycardia, gallop or murmur, decreased urine output, resp distress

208
Q

What two things is therapeutic management focused on for Kawasaki disease?

A

reducing inflammation in the walls of the coronary arteries and preventing coronary thrombosis during initial phase

preventing myocardial ischemia

209
Q

What two medications will be administered to a patient with Kawasaki disease?

A

high dose aspirin in four doses daily to reduce clotting AND single infusion of IV immunoglobulin to decrease inflammation

210
Q

Define acute lymphoblastic leukaemia

A

Cancer that originates as an issue in the bone marrow where abnormal WBCs are produced

Irregular lymphoid and myeloid cell development

211
Q

What is the most common type of paediatric cancer?

A

Acute lymphoblastic leukaemia

212
Q

How does the Philadelphia chromosome affect ALL treatment?

A

It makes it more complex and longer

213
Q

How does the type of cell involved change treatment for cancer?

A

Treatment is dependent on the type of cells being effected

214
Q

What are the eight signs and symptoms of a new diagnosis of ALL

A

fever, pain, petechiae, purpura, unexplained bruising, signs of infection such as pneumonia, splenomegaly and hepatomegaly, swollen lymph nodes

215
Q

Describe the induction stage of leukaemia treatment and its duration

A

Hit them hard with heavy hitter chemo drugs, aiming to kill as many cancer cells as quickly as possible

lasts about 3-4 weeks

216
Q

Describe the consolidation stage of leukaemia treatment and its duration

A

strengthen remission and decreases leukaemia cells

treatment duration varies but a long period of time is often spent in this stage

217
Q

Describe the maintenance stage of leukaemia treatment and its duration

A

Eliminates all residual leukaemia cells

~2-3 years

218
Q

How does ALL treatment duration differ between boys and girls?

A

Boys will typically be in treatment for 3 years and girls 2 years because of the testes being complex

219
Q

Define chemotherapy

A

A medication used to kill fast-dividing cells in the body

May be nephrotoxic and have many adverse effects because healthy cells are also impacted

220
Q

How long after diagnosis will children be given a central line?

A

within 24 hours

221
Q

Describe radiation therapy

A

Kills malignant cells

222
Q

What three types of medications may be prescribed to combat symptoms of cancer treatment?

A

Steroids, anti-emetics, and pain meds

223
Q

Define gestational hypertension

A

Hypertension that begins during pregnancy and a BP reading of >140/90 on more than two occasions

224
Q

What point of gestation does hypertension typically occur? And what type of pregnancy is it more common in?

A

after 20 weeks and more common in nulliparous women

225
Q

What are 9 risk factors of gestational hypertension?

A

young or advanced maternal age, weight abnormalities, lifestyle (smoking, alcohol, etc), previous miscarriage, assisted reproduction, multiple gestation, history of preeclampsia, gestational diabetes, and history of cardiac or renal disorders

226
Q

What are the 7 signs and symptoms of gestational hypertension?

A

Increased BP (higher than baseline), absence or presence of protein in the urine, edema, sudden weight gain, visual changes such as blurred vision, N/V, urinating small amounts

227
Q

what is a marker of pre-eclampsia

A

protein in the urine

228
Q

Describe mild-home management of gestational hypertension

A

bed rest, quiet environment, lateral positions, monitoring protein in urine, and a low sodium and high protein diet

229
Q

Describe a mild-hospital management of gestational hypertension

A

monitor trending BP, daily weights, monitor neurological signs, may be on antihypertensives

230
Q

What is bed rest?

A

No lifting above 10lb, no sexual intercourse until stable BP or delivery (pelvic rest), no housework, reducing standing for prolonged periods, restricted driving

231
Q

Describe severe management of gestational hypertension

A

C/S delivery, oxytocin to stimulate contraction, and magnesium sulphate to prevent seizures

232
Q

What does HELLP syndrome stand for and what may cause it?

A

hemolysis (abnormal clotting), elevated liver enzymes, and low platelets

caused by severe gestational hypertension

233
Q

Define placental abruption

A

the premature separation of the normally implanted placenta from the uterine wall

234
Q

What two pregnancies is a placental abruption most common in?

A

multigravidae and advanced maternal age

235
Q

What comorbidity increases the risk of a placental abruption?

A

gestational hypertension

236
Q

What are the four signs and symptoms of a placental abruption

A

dark red blood, uterine tenderness/constant pain, firm to rigid abdomen, and fetal distress

237
Q

Define placenta previa

A

placental implantation in the lower uterine segment where it can occlude the cervical os

238
Q

What seven factors contribute to the development of placenta previa?

A

uterine fibroids/scars, defective vascularization, multiple gestations, previous uterine surgery, advanced maternal age, smoking & cocaine use

239
Q

what are 8 signs and symptoms of placenta previa?

A

painless vaginal bleeding, uterus is soft, non-tender, bright red vaginal bleeding, FHR usually normal, fetal malpresentation or high presenting, shock and anemia due to blood loss

240
Q

How is FHR in placenta previa?

A

usually normal

241
Q

If the placenta is only covering part of the os, will it move?

A

The patient will be monitored and the hope is that it will stretch upward

242
Q

What weeks make up preterm labour?

A

regular uterine contractions with cervical effacement and dilation between 20-37 weeks gestation

243
Q

What is a tocolytic and what drug is often used in preterm pregnancy?

A

A drug that suppresses labor and magnesium sulphate

244
Q

Why are corticosteroids administered in preterm pregnancies?

A

administered as a protective mechanism through the mom – acts as a boost for the baby’s respiratory system (betamethasone)

245
Q

Define labour induction

A

stimulating contractions via medical or surgical means

246
Q

Define augmentation and what medication will be used to complete it

A

enhancing ineffective contractions after labor has begun

oxytocin to strengthen contractions

247
Q

What are common indications for induction and augmentation?

A

post-term gestation, pre-labor rupture of membranes, hypertensive disorder, renal disease, fetal demise, placenta abruption, SROM

248
Q

What are the indications for forceps or vacuum delivery?

A

Prolonged 2nd stage of labor, abnormal FHR pattern, failure of the presenting part to fully rotate and descend in the pelvis, limited sensation and inability to push effectively due to the effects of regional anaesthesia, high risk clients, and client exhaustion

249
Q

What four criteria are required for forceps and vacuum?

A

Vertex presentation, cervix is fully dilated and membranes ruptured, head is fully engaged, client’s bladder has been emptied

250
Q

Define a PPH and specific values for vag and c/s

A

any amount of bleeding that places the mother in hemodynamic jeopardy - may be early or late (before or after 24 hours)

Vag >500 mL
c/s > 1000mL

251
Q

What are the four Ts of PPH?

A

tone, tissue, trauma, and thrombosis

252
Q

Of the four Ts, which is the most common cause of PPH?

A

tone

253
Q

what tonal issues effect PPH

A

over distended uterus, prolonged or rapid labor

254
Q

what tissue issues effect PPH

A

failure to complete separation of placenta from uterine wall, does not allow uterus to contract fully

fragments prevent uterus to contract fully

255
Q

what trauma issues effect PPH

A

prolonged or vigorous labor, uterus remains firm, or cervical lacerations

256
Q

What are six nursing management techniques for PPH?

A

Fundal massage, pad count, fluid administration, blood products PRN, medication admin PRN, catheterization, and monitoring for signs/symptoms of shock

257
Q

What are cytotec and hemabate used to manage?

A

PPH

258
Q

When is internal FHR monitoring indicated?

A

Indicated for women or fetuses considered high risk

259
Q

Where are electrodes placed in internal FHR monitoring?

A

electrode is placed on the fetal presenting part to assess FHR

260
Q

What four criteria are required to do internal FHR monitoring?

A

ruptured membranes, cervical dilation of min 2cm, presenting fetal part low enough to identify correctly and allow placement of the scalp electrode, and skilled practitioner

261
Q

What is one thing that external monitoring of FHR cannot detect?

A

cannot detect short-term variability

262
Q

Describe accelerations in FHR

A

increased FHR by 15bpm from baseline that lasts between 15-30 secs

263
Q

When is accelerations a sign of fetal wellbeing?

A

when they accompany fetal movement

264
Q

Describe FHR decelerations and list the types

A

decreased FHR below baseline

early, late, variable, and prolonged

265
Q

What are two potential causes of accelerations?

A

increased maternal activity or spontaneous fetal movement

266
Q

Define early decelerations

A

Have a shape that is symmetrical with a gradual decrease and return of FHR to baseline in association with a contraction

Are like a mirror or inversely related - increase in contraction = dip in FHR

267
Q

What deceleration can be thought as a mirror?

A

early

268
Q

Describe late decelerations

A

Have a shape that is symmetrical with a gradual decrease and return of FHR to baseline in association with a contraction

Late onset of FHR dropping and late recovery after contraction

269
Q

What may be causing late decelerations

A

disruption of oxygen transfer

270
Q

Define variable decelerations

A

An abrupt onset of decreased FHR below baseline that may occur with or after a contraction

Sudden drops and rapid returns - less predictable

271
Q

What often causes variable decelerations

A

cord compression

272
Q

Describe prolonged decelerations

A

> 15bpm and lasts greater than 2 minutes but less than 10 minutes from onset to return to baseline

273
Q

What are five potential causes of prolonged decelerations

A

placental insufficiency, uterine rupture, cord compression/entanglement/prolapse, maternal hypotension, or cervical exam

274
Q

If we are becoming concerned for FHR and intrauterine resuscitation is required, describe 7 interventions

A

change maternal position, stop or decrease oxytocin infusion, administer IV bolus, perform vaginal exam to assess labor progress, oxygen supplement (8-10 L/min), modify breathing or pushing, and reduce maternal anxiety

275
Q

What terms define high-risk NBs

A

preterm born less than or equal to 37 weeks or post-term greater than 42 weeks

276
Q

What five factors indicate high risk NBs

A

SGA or LGA, breathing difficulties at birth, suffered hypothermia, infection, or born to mothers with high-risk prenatal conditions

277
Q

Why is a NB more prone to developing hypothermia?

A

large surface area per unit of body weight, less SC fat and reduced brown fat

278
Q

How does metabolism of brown fat effect temperature in NB?

A

Increases heat production - blood flowing through the brown fat becomes warm and heats the rest of the body

279
Q

What are seven signs/symptoms of hypothermia in NB?

A

cool/cold to touch, cyanosis, shallow/slow resp, lethargy and hypotonia, poor feeding, feeble cry, and hypoglycaemia

280
Q

What are four interventions to reduce hypothermia in NB?

A

Warm baby immediately after delivery, delay bath until temperature stabilizes, hourly temp checks in first hours of life, encourage feeding

281
Q

What is Cefaclor and what is it used for?

A

Anti-infective cephalosporins

treatment of resp, dermatological, urinary, and middle ear infections caused by bacteria

282
Q

What is cotrimoxazole and what is it used for?

A

Anti-infective sulfonamides

treatment of UTI, acute otitis media, exacerbation of bronchitis, diarrhea, and pneumonia

283
Q

What ages is cotrimoxazole contraindicated in?

A

infants <2mo

284
Q

What is magnesium sulphate and what is it used for?

A

electrolyte supplement and antiseizure agent, potent vasodilator

treatment/prevention of hypomagnesemia, treatment of hypertension and pre-eclampsia, prevention of seizures associated with severe eclampsia, preterm labor

285
Q

What drug is used for pre-eclampsia, gestational hypertension, preterm labor, and seizures r/t eclampsia?

A

Magnesium sulfate

286
Q

What is the antidote for magnesium sulfate?

A

calcium gluconate

287
Q

What drug decreases labor contractions?

A

Magnesium sulfate

288
Q

What is labetalol and what is it used for?

A

Beta blocker with alpha blocking; antihypertensive

treatment of hypertension

289
Q

How/when should labetalol be taken?

A

Take with a meal/food, and if you forget to take a dose, take it asap

290
Q

What is oxytocin and what is it used for?

A

Oxytocic agent

Stimulates uterine smooth muscle, producing uterine contractions - has vasopressor and antidiuretic effects

291
Q

What is important to monitor when giving oxytocin to a woman in labour?

A

Monitor for FHR decelerations

292
Q

At what time of age will pathologic jaundice occur? When will clinical jaundice occur?

A

Within the first 48-72 hours, whereas clinical will be weeks or days later

293
Q

Provide 8 nursing interventions or education for a baby with hyperbilirubemia

A

bili blanket/phototherapy, temperature regulation (isolatte), positioning (skin exposed and eye shield), strict I/O, feeding q2-3 hours or 3-4 hours if more stable, skin-to-skin, monitor bill levels, no lotions

294
Q

How does phototherapy help the baby excrete bilirubin?

A

It allows the bilirubin to be converted from fat to water and be excreted through the kidneys

295
Q

What does a positive DAT test indicate?

A

direct antiglobulin test - may indicate pathologic jaundice

296
Q

What is the target range for a random BG?

A

4-7 mmol/L not influenced by diet

297
Q

What is a fasting blood glucose used to screen for and how long does someone need to fast for?

A

Screens for type 1 diabetes and GDM

Measures plasma glucose levels after 8hrs fasting

298
Q

Define GDM and why it occurs physiologically

A

hyperglycaemia that develops during pregnancy

The placenta produces hormones which blocks the body’s use of insulin making insulin less effective

299
Q

Does GDM subside after delivery?

A

Usually, but around 30% will develop type 2 within 10 to 15 yrs

300
Q

When will insulin be given/prescribed to a mom with GDM? Why will it be given?

A

To prevent birth defects - if client is unable to achieve glucose targets within 2 weeks of initiating nutrition and PA therapy

301
Q

At what week is GDM screening done?

A

24-28 weeks for all women

302
Q

What is a non-stress test in pregnancy?

A

FHR in response to maternal activity – may be placed on a bike or treadmill to ensure baby has normal responses

303
Q

What are the symptoms of HYPOglycemia?

A

pale, shakey, tremors, cool/clammy skin, diaphoresis, lethargic/altered LOC, irritable, nausea

304
Q

What are the symptoms of HYPERglycemia?

A

3 polys (uria, phagia, dipsia), dry skin, fruity breath, heart palpitations, nausea, dehydrated, vision changes, neurological changes

305
Q

The 3 polys, polyuria, polyphagia, and polydipsia, are associated with what?

A

Hyperglycemia

306
Q

What is DKA?

A

the overproduction of ketone bodies and decreased ability of kidneys to excrete acids leading to CNS depression, arrhythmia, coma, and cardiac arrest

307
Q

What will pH, PaCO2, and bicarbonate look like in DKA labs?

A

pH - decreased

PaCO2 - normal

bicarbonate - decreased

308
Q

How is DKA treated?

A

Insulin infusion and fluids

309
Q

Is DKA or alkalosis more common in children? Why?

A

DKA because children have immature kidneys and pancreas

310
Q

What will pH, PaCO2, and bicarbonate look like in metabolic alkalosis labs?

A

pH - increased

PaCO2 - normal

bicarbonate - increased

311
Q

Is insulin an endogenous or exogenous hormone?

A

endogenous

312
Q

Describe how quickly short/rapid acting insulin works, how long it lasts, and another name for it

A

Works within minutes and lasts a few hours

Is called a bolus insulin

313
Q

Describe how quickly intermediate/long acting insulin works, how long it lasts, and another name for it

A

works within 1-2 hours and lasts a long time

functions as a basal insulin

314
Q

What is the onset of rapid-acting insulin and what is the best route to administer it?

A

10-15 mins SC

315
Q

Why must patients eat a meal after taking rapid or short acting insulin?

A

Glucose spikes are rapid and need to ensure they don’t become hypoglycaemic

316
Q

Is rapid/short acting insulin clear or cloudy?

A

Clear

317
Q

What is the onset for short-acting insulin and when is the best time to give it?

A

30 minutes

15-30 minutes before meals

318
Q

Can short acting insulin be given IV?

A

Yes

319
Q

What medication needs to be double primed if given IV?

A

Short-acting insulin

320
Q

Is intermediate and long acting insulin clear or cloudy?

A

Cloudy

321
Q

What time of the day should intermediate or long-acting insulin be given?

A

Usually at bedtime - may be given QD or BID

322
Q

What is the onset of intermediate and long-acting insulin?

A

1-3 hours

323
Q

What is the best way to determine if a basal insulin dose is working well?

A

by assessing the BG first thing in the morning and analyzing the BG response to the dose given at bedtime

324
Q

Should PA be avoided or encouraged after insulin injection?

A

Encouraged because it enhances the absorption of insulin from the injection site

325
Q

What five physiological aspects categorize type 1 DM?

A

loss of beta cells

presence of islet cell antibody

lack of insulin

excess glucagon

altered metabolism of fat, protein, and carbs

326
Q

What three actors are likely the root cause of type 1 DM?

A

genetic factors, autoimmune factors, and may develop due to a viral infection

327
Q

does type 1 DM have a rapid or long onset?

A

very rapid onset within weeks

328
Q

What is the ‘pancreas’ last stand’ in type 1 DM in children?

A

The body may go through a one time remission where symptoms dissipate shortly after insulin treatment is started

this is a last ditch effort by the pancreas to make insulin. However, the body will eventually start to show signs of hyperglycaemia and then they will be insulin dependent for life

329
Q

How is type 1 DM treated in children?

A

With continuous BG monitoring and insulin via injection or pump

330
Q

What factors determine the insulin needs of a child?

A

PUBERTY, emotions, nutrition, PA, and illness

331
Q

What macronutrient must be counted for children with diabetes type 1 and are insulin doses affected?

A

Carbohydrates must be counted and insulin will be adjusted based on consumption

for example, for every 5g of carbs, you take 1 unit of insulin

332
Q

What is the insulin to carb ratio?

A

1 unit of insulin will cover a certain number of grams of carbs eaten

333
Q

What is the best way to eat carbs for good BG management?

A

eat the same amount of carbs at meals and snacks each day

334
Q

How does fibre affect carb counting in diabetes?

A

For every 5g of fibre, you can subtract from your total carbohydrates

335
Q

If a child with diabetes is ill, how do BG and ketone checks change?

A

BGs and ketones should be checked every 1-4 hours to ensure the child does not go into DKA

336
Q

What five complications will be screened throughout life in children with diabetes type 1

A

nephropathy, retinopathy, neuropathy, dyslipidemia, and hypertension

337
Q

What is the Cushing’s triad?

A

RR - apneas, irregular, decreased

HR - bradycardia

BP - elevated

opposite to septic shock

338
Q

What does an EEG test for?

A

observing for seizure activity

339
Q

What is important to do in preparation of an EEG?

A

Get the child more sleep deprived prior to, as seizure activity is more common during these states

340
Q

What might be given to a child prior to an MRI/CT to help with anxiety?

A

Conscious sedation, such as lorazepam or intranasal midazolam

341
Q

What does a lumbar puncture test for? What might be present in CSF?

A

Testing for meningitis - testing for cultures, WBC, colour, and glucose

342
Q

What is the most common cause of febrile seizures?

A

viral infection

343
Q

Describe how febrile seizures present/last

A

generalized seizure that is short-lived (<15min) and not repeated within a 24 hour period

344
Q

are febrile seizures more commonly seen in boys or girls?

A

Boys

345
Q

Does the higher the fever correlate to worse/more probability of a seizure?

A

No

346
Q

How are febrile seizures treated?

A

Determination of the cause of fever and interventions focused on controlling it

347
Q

are febrile seizures benign?

A

yes

348
Q

What are ten common triggers for seizures?

A

missing medications, lack of sleep, missing meals, hormonal changes, stress/emotions, illness, fever, flickering lights, alcohol withdrawal, and street drugs

349
Q

Define a generalized seizure

A

widespread electrical activity in the left and right hemispheres

350
Q

What does it mean when a patient reports feeling an aura?

A

this is a partial seizure that precedes a generalized one and is considered as a warning sign

they may report feeling impending doom, seeing spiders, smelling burning toast, and having tingling fingers

351
Q

Are generalized seizures convulsive?

A

They can or cannot be

352
Q

Define epilepsy

A

A generalized seizure condition in which seizures are triggered recurrently from within the brain

353
Q

Can children outgrow epilepsy symptoms?

A

Yes, most children do

354
Q

List the three signs and symptoms of an absence seizure and what type it is

A

blank state lasting less than 10 seconds, starts and stops abruptly, and may experience several hundred/day

generalized

355
Q

List the three signs and symptoms of a tonic and clonic, how long they last, and what type it is

A

tonic - crying out, groans, falls
clonic - convulsions, jerking, twitching of the muscles

may be incontinent, may turn grey blue

lasts 1-3 mins

generalized

356
Q

Describe a myoclonic seizure and what part of the brain it uses

A

May occur with other seizure forms, sudden brief massive muscle jerks, may or may not lose consciousness

involves the motor cortex

357
Q

Describe an atonic seizure

A

sudden loss of muscle tone with regain of consciousness within a few seconds to a minute

may be as simple as the drop of the head

358
Q

Define a partial seizure

A

occurs when seizure activity is limited to a part of one brain hemisphere

359
Q

Describe the differences between a simple and complex partial seizure

A

Simple - remains aware but cannot control function or behaviour, may have an aura, lasts seconds to minutes

Complex - experiences altered awareness and random movements, has a blank/empty stare, unaware of environment and dazed, lasts from 2-4 mins, unresponsive, and period of confusion after seizure

360
Q

Define meningitis

A

inflammation of the meninges

361
Q

can meningitis be viral or bacterial or both?

A

Can be either

362
Q

does viral or bacterial meningitis have higher mortality rates?

A

bacterial

363
Q

what is the most common virus causing meningitis?

A

enterovirus

364
Q

Will anti-virals be given for meningitis?

A

Yes

365
Q

provide the 9 signs and symptoms of meningitis

A

sluggish/dilated/unequal pupils, general malaise, headache, photophobia, poor feeding, nausea, vomiting irritability, nuchal rigidity

366
Q

What triad is evident in meningitis patients?

A

Cushing’s triad

367
Q

What type of antivirals and antibacterials will someone be on for meningitis?

A

Antiviral - acyclovir

Antibacterial - gentamicin and cephalosporins

368
Q

Provide the signs and symptoms of NAS

A

CNS hypersensitivity, autonomic dysfunction, resp distress, temp instability, hypoglycaemia, tremors, seizures, abnormal cry, and feeding difficulties

369
Q

What three medications may an NAS baby be prescribed?

A

morphine, phenobarbital, and clonazepam to help with tremors/seizures

370
Q

What is ESR and what does it test for?

A

erythrocyte sedimentation rate - detects inflammation and may indicate juvenile idiopathic arthritis

371
Q

What is ANA and what does it test for?

A

antinuclear antibody - detects autoimmune disorders

372
Q

Why are bowing/buckle fractures more common in children?

A

increased vascularity and decreased mineral content of bones makes them more flexible

373
Q

what are the three most common fracture sites in children?

A

forearm, wrist, and femur

374
Q

What are the four common pediatric fractures? Briefly describe each

A

bowing - bending without breaking of the bone

buckle - bone buckles rather than breaks

greenstick - incomplete fracture of the bone

complete - bone breaks into two pieces

375
Q

Why do we place the fractured limb above the level of the heart?

A

Elevate above the level of the heart to reduce swelling and bring blood back centrally

376
Q

What is a hip spica cast?

A

Used for femur fractures - hard covering over the waist, hips, and legs that prevents movement of the hips - a bar between the legs strengthens the cast

377
Q

Describe traction

A

a method of slow and gentle immobilization which may be used to reduce and/or immobilize a fracture, to align an injured extremity, help reduce pain before surgery, and to allow the extremity to be restored to its normal length.

378
Q

Why might external fixations be used instead of internal?

A

if there is increased risk for infection or compartment syndrome

379
Q

Why does compartment syndrome occur in a cast? How long does it take to manifest?

A

increased pressure in a limited space comprises circulation and nerve innervation, leading to ischemia

clinical manifestations begin within 30 mins of tissue ischemia

380
Q

What are the 6 Ps and 3 As in compartment syndrome?

A

Pain, pressure, paresthesia, paresis, pallor, pulselessness, analgesic requirement increasing, anxiety, and agitation

381
Q

How do we reduce compartment syndrome once it has started? (3)

A

split plaster casts and release constrictive bandages

position limb to promote improved circulation

surgical decompression or fasciotomy

382
Q

Define osteomyelitis

A

Bacterial infection of the bone and soft tissue surrounding the bone that is acquired by a bacterial invasion spread through the bloodstream

383
Q

What four bacterias are common causes of osteomyelitis

A

Staphylococcus aureus, E coli, streptococcus, and influenza

384
Q

what are the four signs/symptoms of osteomyelitis

A

pain, difficulty moving the affected area, fever, and redness/swelling of the affected area

385
Q

Can osteomyelitis occur spontaneously?

A

Yes, it often occurs spontaneously in children

386
Q

What is the treatment course for osteomyelitis?

A

4-6 weeks of antibiotics, beginning with IV and transitioning to PO

387
Q

What are three nursing managements of osteomyelitis?

A

Encourage movement of unaffected limbs, bed rest, pain control

388
Q

What is glucagon and what is it used for?

A

Glycogenolytic agent

Used to treat hypoglycaemia

389
Q

What are three common side effects associated with glucagon?

A

Headache, nausea, and skin rash

390
Q

What is phenytoin and what is it used for?

A

Anti-seizure medication and used for the control of tonic-clonic and motor seizures, as well as control of status epilepticus

391
Q

What is the most common adverse effect of phenytoin?

A

CNS alterations

392
Q

What dental effect may phenytoin have on long-term use?

A

Gingival hyperplasia - swelling of the gums

393
Q

What is phenobarbital and what is it used for?

A

anti-seizure medication

used for long-term treatment of tonic-clonic and focal seizures, emergency control of status epilepticus, eclampsia, and meningitis associated seizures

394
Q

Why should a patient be slowly titrated off phenobarbital?

A

if abruptly taken off, it can present with severe withdrawal symptoms and worsened seizures

395
Q

What are five adverse effects of phenobarbital?

A

somnolence or insomnia, vertigo, nightmares, hallucinations, bradycardia, hypotension

396
Q

What is diazepam and what is it used for?

A

Anti-seizure and anti-anxiety

management of epilepsy and used as an adjunct with other medications for complicated seizure management

397
Q

Why is non-compliance common with diazepam?

A

Due to the adverse effects of the drug, such as dizziness, lethargy, sedation, diarrhea, and urinary retention

398
Q

What is carbamazepine and what is it used for?

A

Anti-seizure medication

used for treatment of seizure disorders including epilepsy, partial seizures and mixed seizures

399
Q

What is a common adverse effect of carbamazepine?

A

Ataxia presenting as falls or clumsiness

400
Q

Why do children on morphine or other opioids need to be monitored more closely than adults?

A

They are opioid naive and need to be monitored more carefully for CNS effects

NSG 2521 - HoF (2 decks)

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