Final Flashcards
1
Q
increased risk of insulin omission
A
- poor metabolic control
- previous DKA episode
- adolescent girl (weight control, psychosocial concerns)
- psychiatric dx
- unstable family situation
- lower SES
- limited access to services
- inuslin pump therapy
- short acting insulin
- malfunction causes immediate impact in insulin amount
2
Q
cerebral edema and intubation
A
- intubation predicts poor outcomes
- CO2 levels < 22 associated with poor outcome
- avoid intubation if possible
3
Q
compartment syndrome overview
A
- myelin sheaths overlay bones and muscles
- pressure can increase
- 90% due to IV infiltrate when not checked
- infusing extravascularly
- can get from IVs, fractures, burns
4
Q
nursing assessment for ITP
A
- neuro - low platelets, at risk for bleeding (brain)
- skin assessent - generalized petechiae
- bleeding gum sometimes 1st symptom
- home with supportive care - no sports, safety
- monitor for hematuria
5
Q
if a mom brings a child in with a focal seizure, ask:
A
- when did it start, how long?
- first time? seizure hx?
- family hx?
- fever? sick?
- fall? head injury?
- did he ingest anything? toxic dose, miss a dose? sick or spetic?
6
Q
risk factors for hip dysplasia
A
- premie
- female
- family hx
- first child
- breech during pregnancy
- large birth weight
7
Q
clinical pathway of aplastic anemia
A
- idiopathic
- low RBC
- weakness and fatigue, SOB, pale skin
- low WBC
- frequent or severe infections
- low platelets
- easy bleeding or bruising, bleeding that is hard to stop, petechiae
8
Q
long-term sequelae of cerebral palsy
A
- airway - can’t get up to increase tidal volume (pneumonia); regurgitation/aspiration
- circulation - poor venous return, syncopal episodes, hypotension
- GI - nutrition an issue
- GU - UTIs
- Skin - dependent pressure ulcers b/c of bedrest or can’t move
- musculoskeletal
- contractures
- osteoposoris - kyphosis, scoliosis
9
Q
simple partial seizure
A
- focal seizure with no loss of consciousness
- no postictal confusion
- no aura
- motor symptoms in one extremity
- sensory symptoms
- paresthesias
- auditory/olfactory/visual
- autonomic (sweating)
10
Q
liquid tumors
A
- cancer of the blood or lymphatic system
- leukemia, lymphoma
- ALL, AML
11
Q
Wilms tumor
A
- tumor of kidney
- large, rapidly growing, vascular abdominal tumors
- encapsulated, easier to remove
- quicker but better prognosis than neuroblastoma
- peak age 2-3 yo
- may involve both kidneys
12
Q
skin complications from bed rest
A
- pressure ulcer
- dependent edema
13
Q
skin assessment of liquid tumors
A
- pallor - pale, gray overtones
- usually first predictor when they come in
- iron deficiency
- low platelets
- bruising, ecchymosis unrelated to trauma
14
Q
hydrocephalus
A
- disorder in which an excessive amount of CSF accumulate in cerebral ventricles and/or subarachnoid spaces, which are dilated
- almost always associated with increased intracranial pressure
- can be due to:
- obstruction (non-communicating)
- impaired absorption (communicating)
- excessive production (rare)
15
Q
growth hormone deficiency treatment
A
- synthetic GH
- SC injection 6-7 x/week
- given until bone fusion, decreased growth velocity
- associated with SCFE, hyperglycemia
- most benefit happens in 1st year
16
Q
incidence of Ewing’s sarcoma
A
- 200 cases/year
- risk factors
- retinoblastoma
- environmental
- radiation and treatment for prior malignancies
17
Q
when to suspect acquired heart disease
A
- PMH of viral illness ~ 1 mo
- high fever
- exercise/feeding intolerance
- symptoms of CHF
- cannot lie flat
- SOB, WOB
- diaphoresis
- enlarged liver
- peripheral edema
- palpitations
18
Q
T1DM overview
A
- autoimmune
- most common in childhood
- complete insulin deficiency
- needs insulin tx
- recent intransal insulin not well-accepted
19
Q
truncus arteriosus
A
- PA and Ao don’t separate
- includes a VSD - communication
- complete mixture of systemic and pulmonary return circulations
- decreased systemic blood flow
- leads to decreased systemic oxygen transport
- at risk for coronary ischemia
20
Q
G6PD
A
lack an enzyme for RBC production that causes hemolytic crisis with fava benas or sulfa drugs
21
Q
non-accidental fractures
A
- child abuse is cause of majority of fractures in child less than 1 yo
- a child who cannot walk should not have multiple bruises or fractures
- skeletal survey or bone scan to look at whole picture
22
Q
idiopathic scoliosis incidence
A
- female to male ratio ranges 1.5:1 to 3:1
- increases with age
23
Q
tonic-clonic seizure
A
- generalized seizure (formerly grand mal)
- alternating tonic (stiff and rigid) and clonic (rhythmic jerking) phases
- impaired consciousness
- salivation
- pupil dilation and eye deviation
- tachycardia and hypertension
- apnea - chest wall rigidity
- incontinence
- postictal confusion & sleep (always)
24
Q
early treatment to prevent sickle cell crises
A
- babies tolerate hydroxyuria better
- will start them early
- also on penicillin VK + PO
- to prevent infection by encapsulated bacteria
25
Q
A
- no right ventricle
- b/c no tricuspid valve (tricuspid atresia)
- no fetal blood flow to RV, so didn’t develop
- single ventricle physiology
26
Q
open fracture
A
- bad, high impact fall that causes skin to break
- infection control a concern, after ABC
27
Q
hemolytic crisis
A
- increased RBC destruction
- seen with G6PD
28
Q
special peds considerations for fractures
A
- femur (blood loss)
- ankle (growth plate)
- clavicle (vessels)
- common in newborns
29
Q
respiratory status of lymphoma
A
- cough, SOB, wheezing
- why would they have respiratory complaints?
- many lymph nodes in mediastinal cavity
- may be misdiagnosed as asthma
30
Q
types of anemia
A
- RBC not made
- RBC not healthy
- RBC made and lost
31
Q
treating Kawasaki disease
A
- intra-venous immunoglobulin (IVIG) 2 gm/kg
- ASA 80-100 mg/kg/day until afebrile for 2-3 days, then 3-5 mg/kg/day for 6-8 wks (or until ESR normal)
- enoxaparin SQ 6-12 weeks
32
Q
Tx for Ewing’s and osteosarcoma
A
- challenges: removal and treatment
- bone doesn’t compensate for removal of tumor
- tx after removal
- depends on location, size, how involved it was
- many tx that may or may not be good
- ex: rotationplasty
33
Q
4 typical patients who can benefit from palliative care
A
- cure is possible but may fail
- premature death inevitable, but Tx may prolong quality and quantity of life (i.e. CF)
- progressive conditions w.o curative options where treatment is exclusively palliative, but may extend life
- conditions that are not progressive but render vulnerable and susceptible life-limiting complications
- severe, medically fragile CP (largest population)
34
Q
obstructive lesions overview
A
- low cardiac output
- decreased perfusion to gut
- shock
- myocardial dysfunction
- elevated left and right atrial pressures (depending on location of obstruction):
- congestive heart failure, pulmonary edema (over time)
- over time can lead to LV dysfunction
35
Q
definition of traumatic brain injury
A
complex injury with broad spectrum of symptoms and disabilities. impact on person and family can be devastating
36
Q
SCD symptoms of eyes
A
retinopathy, retinal detachment (diminished vision)
37
Q
hemophilia type A
A
- missing/low levels of clotting factor VIII (8)
- 8/10 people have type A
38
Q
anorexia and bone loss
A
39
Q
transitioning: necessary vitals
A
- glucose stable
- < 200 mg/dL
- acidosis corrected
- pH > 7.3
- HCO3 > 18 (16)
- ketosis resolved
- able to tolerate diet
- at a mealtime is preferred
- smoother transition
40
Q
fasciotomy
A
lateral incision to relieve pressure from compartment syndrome
41
Q
nausea and vomiting during chemo
A
- generally begins 2 hours after chemo starts and persists 6 hours or days post chemo cycle
- increased anxiety
- food aversions
- persists beyond illness course, can affect nutrition
- secondary issues from meds, steroids
- don’t give them their favorite thing until they’re feeling better
42
Q
patent ductus arteriosus
A
- increased pulmonary blood flow
- oxygen-rich blood from aorta flows through PDA into pulmonary artery and into the lungs
- two ways to the lungs: pulmonary artery + PDA
- amount depends on
- size of PDA
- pulmonary and
- systemic resistance pressures
- corrected surgically or with medication
43
Q
restoring intravascular, extracellular volume at moderate pace during DKA episode
A
- NS 10-20 mL/kg over 1 hour (closer to 10ml)
- treat dehdyration
- may repeat ONCE if clinically indicated
- no more tahn 40 ml/kg in 1st 4 hours
- fluids
- 0.45-0.9% saline maintenance or 1.5 x maintenance
- no more than 4L/m2/day
- replace deficit over 36-48 hours
- therapy should normalize osmolality changes from vomiting and diarrhea and decrease symptoms
- 0.45-0.9% saline maintenance or 1.5 x maintenance
44
Q
primary issue with complex partial seizure patients
A
SAFETY
45
Q
anemia where RBC is made but lost
A
- spleen issues
- splenic sequestration
- femur fracture
46
Q
nursing interventions for septic arthritis
A
- derm and drugs and disability
- antibiotics, resting, keep joint still, raise joint, cool compress for pain, exercise for healing process
- fluids and electrlytes
- aspirate joint fluid for cell count, gram stain, culture
- MRI, ultrasound, good hx, good assessment
- differentiate between osteomyelitis and septic arthritis
47
Q
TBI from child abuse
A
- usually shaking
- irritable
- retinal hemorrhaging
48
Q
HDL cholesterol
A
- builds/maintains cell membranes
- necessary to manufacture bile
- necessary to absorb fat and ADEK
- insulates nerve fibers
- aids in production of adrenal gland hormones
- aids in production of sex hormones
- helps remove LDL
- carries LDL to liver for breakdown and metabolism
49
Q
assessment QUESTIONS for brain tumors
A
- how long? what makes it better? what do you do?
- can you bend your neck? ruling in/out meningitis
- is it worse in the morning? do you have emesis with your headache? when, how much?
- tired?
- photophobia?
- PERRLA
- Glasgow
- head circumference if fontanels not fused
50
Q
other risk factors for cerebral edema r/t DKA
A
- insulin bolus > 0.1 units/kg
- more fluid and solute in 1st 6 hours
- younger age
- new onset
- longer duration of symptoms
- severity of acidosis
- effective plasma osmolality drop from 300 to 285
- BUT do not see expected rise in serum Na as glucose falls
51
Q
contracoup
A
opposite side of brain from impact of TBI
52
Q
electrolyte complications from bedrest
A
high creatinine from muscle breakdown
53
Q
nursing interventions for osteomyelitis
A
- blood culture
- skin care
- asceptic technique when changing dressings
- support affected limb
- pain meds
- antibiotics
- well balanced diet to promote healing
54
Q
The B symptoms of lymphoma
A
- fever
- significant weight loss
- drenching night sweats
- indicates poorer prognosis of Hodgkins’ lymphoma
55
Q
A
- no inferior vena cava
- big VSD
- translocation of aorta and pulmonary artery
- total anomalous pulmonary venous return
56
Q
downside of pump + CGM
A
- < 15% downloaded data more often than 1x month
- 41% discontinued use within 1 year
57
Q
aortic stenosis
A
- obstructive lesion
- blocking blood from coming out of left ventricle into systemic circulation
- if there’s no communication to right side:
- blood backs up in LV to LA to pulmonary veins and back into lungs
- overcirculation into lungs
- tachypnic, may or may not be blue
- can have same symptoms from other defects, however
58
Q
pulmonary stenosis
A
- narrowing/stenosis of pulmonic valve
- increased work on RV
- severity of defect determines presentation
- can be severe in infants, causing cyanosis
- treatment
- initial - balloon valvotomy
- surgery
59
Q
musculoskeletal complications from bedrest
A
- lose 1-2% of muscle every day
- decreased strength
- decreased ROM
- muscle weakness
60
Q
pathophysiology and treatment of hypercanotic spells (TET spells) in tetrology of fallot
A
- occur b/c of change in blood flow. try to:
- increase systemic vascular resistance
- decrease pulmonary vascular resistance
- kids will instinctively squat to push up blood to heart (especially from liver)
- put babies in fetal position
61
Q
humalog (insulin lispro)
A
- rapid acting
- onset 5-15 minutes
- peak 1-2 hours
- duration of action 3-4 hours
- 10 units/mL for children < 15 kg
62
Q
restrictive cardiomyopathy: treatment
A
- none specific
- CHF
- symptom tx options
- diruetics
- digitalis
- vasodilators
- antiarrhythmics
- lifestyle changes
63
Q
CNS pathophysiology of drowning
A
- 2 minutes to lose consciousness
- 4 minutes for irreversible brain damage
- cerebral edema
- hyperglycemia
- seizures
- cause you to swallow water
64
Q
receiving clotting factor for hemophilia
A
- can get it at home
- possibly prophylactically to reduce risk
- often only after trauma or before surgery
- don’t want bleeds
- especially in joint or head
65
Q
LDL cholesterol
A
- clogs arteries
- coronary heart disease
- heart attack
- stroke
- death
- contributes to plaque buildup, athersoclerosis, peripheral artery disease
66
Q
anemia where RBC made but unhealthy
A
- sickle cell
- thalassemia
- malnutrition
- not enough iron capability
67
Q
causes of pediatric cancer
A
- usually unknown
- familial cancers rare in children
- viral - some associated with Epstein-Barr virus (EBV)
- 3/1000 develops cancer before age 20
- leading cause of death from disease in US children
- cure rates continue to improve
- secondary cancer from tx
- radiation
- chemo
68
Q
risk factors for osteomyelitis
A
- poor blood supply
- recent injury
- use of injected illegal drugs
- asplenic patients
69
Q
bone marrow draw
A
- drawn from iliac crest or femur with big hollow needle
- can also infuse fluid into marrow
- intraosseus line
- for kids without good veins (short term)
70
Q
pathophysiology of TBI
A
edema compresses brian and causes increased intracranial pressure, hypoxia, or impaired perfusion
headache does not rule in or out a TBI
71
Q
cardiac physiology
A
CO = stroke volume X heart rate
influenced by:
- preload
- afterload
- compliance
- contractility
72
Q
breathing and brain assesment for SCD
A
- increased WOB
- acute chest
- pneumonia then crisis, or crisis then pneumonia?
- wheezing, atelectasis, no aeration
- assess lungs w/o clothes and auscultate all fields
73
Q
nutritional therapy management for pediatric cancer patients
A
- many patients malnourished
- increased metabolic demands
- lost appetite from side effect of medicines or depression
- nutritional support for 5% of wt loss
- monitor albumin and prealbumin levels
- teach patient to use nutritional supplements
- enteral or parenteral nutrition may be needed
74
Q
central nervous system tumors
A
- requires aggressive, multimodal therapy
- tumor location is important
- dictates presenting symptoms
- determines extent of surgical resection that is safely possible
- suggests pathological diagnosis
75
Q
inducing fetal hemoglobin
A
- can help with sickle cell crises
- hydroxyuria (chemo drug)
- bone marrow suppression
- hair loss
- fatigue
76
Q
causes of increased intracranial pressure
A
- hydrocephalus - increased fluid
- head trauma
77
Q
unique nursing assessments of neuroblastomas throughout body
A
- sinus or orbits of eyes
- periorbital bruising, proptosis (eye drooping)
- thoracic/abdominal cavity
- hypertension
- bladder/bowel function
- dyspnea
78
Q
mixed cardiac lesions
A
- truncus arteriosus
- transposition of great vessels
- double outlet right ventricle (DORV)
79
Q
osteoblasts
A
build bone
80
Q
bicarb in DKA
A
- as metabolic acidosis develops, bicarb used as buffer
- results in increased anion gap
81
Q
SCD symptoms of spleen
A
- infarct in the spleen leads to fibrosis
- nonfunctioning spleen
- increased number of infections
82
Q
think like a plumber: pressure, resistance, flow
A
- blockage or absence of flow
- create new pathways
- where passage is too small
- enlarge pathway
- where flow is going the wrong way
- redirect the flow
83
Q
renal pathophysiology of drowning
A
- hypovolemia
- poor perfusion
84
Q
nutritional status among pediatric cancer patients
A
- hematological malignancies vs solid tumors
- solid tumors have most weight loss and nutritional deprivation
- liquid tumors - drugs cause hunger and odd food cravings
- assess: questions
- how frequently do they eat? diet?
85
Q
Salter classification
A
ways to classify growth plate injuries (I - IV)
86
Q
treatment of familila hypercholesterolemia
A
- diet is 1st step
- DASH - dietary approach to stop HTN
- fruits, veggies, whole grains, low fat milk, decreased sugar
- portion intake, dietary fiber, limit Na intake
- lower LD - dietary fiber, plant sterols
- lower TG - dietary fiber
- statins for > 8 yo
- lovastatin, simvastatin, rosuvastatin
87
Q
cardiac output
A
88
Q
causes of aplastic anemia
A
- congential (eg Faconi’s)
- autoimmune
- toxins
- viral
89
Q
staging of Hogkin’s lymphoma
A
- Stage 1 or 2: lymphadenopathy above diaphragm
- Stage 3 or 4: lymphadenpathy below diaphragm
- staging laparotomy
- open child from xiphoid to pubis to take many lymph node biopsies
- figure out how many nodes involved and where they are in relation to diaphragm
90
Q
differences between Ewing’s and osteosarcoma
A
- time to present symptoms: 8 mo (E) vs 5 mo (O)
- age: 12 (E) vs 15 (O)
- fracture
- pain, localized, pain at rest
- fever
- weight loss
- challenges with location
- Ewing’s and extraosseous location
91
Q
things to remember on cardiac physical exam
A
- all 4 extremity pulses and BP’s
- tachypnea (RR > 50) in a baby may be a sign of too much pulmonary blood flow
- crackles one of last signs of HF in children
- be patient, take as much time as needed
- ask for help/2nd opinion
- DOCUMENT
92
Q
tumor lysis syndrome
A
- cells rupture and burst from toxic drugs
- risk factors: high WBC and certain chemo agents
- electrolyte side effects
- hyperkalemia
- hypocalcemia
- hyperuricemia
- hyperphosphatemia
- complications
- acute renal failure
- cardiac issues
- neurologic issues
- early recognition is KEY
93
Q
complex partial seizure
A
- focal seizure w/ change/loss of consciousness
- postictal amnesia
- motor and sensory symptoms
- aura (taste or odor)
- anxiety, fear, deja vu
- automatisms (lip smacking, chewing, sucking)
94
Q
tricuspid atresia
A
- missing or abnormal tricuspid valve
- obstructed flow from RA to RV - backs up in RA
- decreased pulmonary blood flow
- foramen ovale or atrial septal defect often there
- if not, created temporarily by cath lab
- otherwise, NO circulation through heart
- creates mixing of blood - blue babies
- often occurs with other defects
- symptoms: cyanosis, dyspnea, tachypnea, growth failure
95
Q
septic arthritis definition
A
- inflammation of joint due to a bacterial or fungal infection.
- septic arthritis that is due to bacteira that cause gonorrhea has different symptoms and is called gonococcal arthritis
96
Q
differential diagnosis of paroxysmal episodes in children
A
- breath holding
- migraine
- sleep disorder
- night terrors
- movement disorders (tics)
- toxins and drugs
- psychological problems
- don’t have electrical disturbances in brain that would classify them as seizures
97
Q
secondary symptoms of Kawasaki disease
A
- cardiac: new murmur, abnormality in conductive electricity
- GI: V/D, abdominal pain, jaundice
- blood: leukocytosis, thrombocytosis
- GU: proteinuria
- respiratory: URI symptoms, cough, rhinorrhea
- musculoskeletal: joint pain
- CNS: seizure, facial palsy, paralysis of extremities
98
Q
interrupted aortic arch
A
- surgical emergency
- prenatal care and ultrasounds can prevent this
- HR will be different, poor APGARS
- can’t sustain systemic circulation AND/OR getting blue blood
99
Q
nursing assessment for Perthe
A
- first symptom is often limping, usually painless
- may be some mild intermittent pain
- other symptoms include:
- hip stiffness that limits movement
- knee pain
- limited ROM
- persistent thigh/groin pain
- short leg
- muscle loss in upper thigh
100
Q
long term toxicity of cancer therapy
A
- vincristine induced neuropathy
- osteonecrosis
- myelosuppression
- impairment of function
- risk of obesity
- infertility
- myocardial infarct (esp with mediastinal radiation)
101
Q
ongoing hemodynamic assessments of single ventricle physiology
A
- pressures
- rhythm - cannot afford to have dysrhythmia
- rate
- saturations
- voltage
- need to keep preload high to help R ventricle with some passive flow and reduce intensity of workload on RV
102
Q
cardiomyopathy: treatment
A
- fluid, Na restriction
- decrease cardiac workload
- preload increases and pools
- can get in but not out
- compliance decreases
- cannot constrict down to normal size
- preload increases and pools
- DVT prophylaxis
- risk of clots and emboli b/c of pooling
- transplantation
- depending on cause and severity
103
Q
congential adrenal hyperplasia
A
- females may have ambiguous genitalia
- autosomal recessive, enzyme deficiency
- inadequate production of cortisol, aldosterone
- requires lifelong glucocorticoid replacement
- any stress causes dysregulation
- surgery, infection, life stress
- risk for severe hyponatremia (seizure/shock)
- baseline steroid dose increased 2-3X usual
- parents and school taught to give IM hydrocortisone in emergency
104
Q
nursing assessments for hemophilia
A
- neuro - glasgow
- full assessment to look fo rhematomas elsewhere
- cerebral
- joint assessment - full ROM
- brusing assessment
105
Q
non-hodgkin’s lymphoma
A
- lymphoblastic lymphoma
- burkitts lymphoma
- large cell lymphoma
106
Q
vitals of complex partial seizure
A
- AIRWAY
- SAFETY
- high or low HR
- high or low RR, maybe some apnea
- random vitals
- needs assessment (HR, RR, O2, temp)
- most of the tiem:
- slow, less labored breathing with apnic spells (worrisome)
- issue with children - need to maintain respiratory system
107
Q
growth plate damage
A
- suspect even if X-ray is negataive
- need MRI to confirm
- infection can spread from growht plate
- common because bones are stronger than plates in children
108
Q
priorities for tonic-clonic seizure
A
-
airway
- b/c of apnea and RR need oxygen right away
- always in child who loses consciousness
- can’t bag - blow by or nasal cannula
- may not hear aeration in bases of lungs
- safety
109
Q
SCD symptoms of brain
A
- cerebrovascular accident
- headache
- aphasia
- convulsions
- visual disturbances
110
Q
thalassemia assessment
A
- similar to sickle cell
- skin - color, breakdown
- joint pain
- different presentation
111
Q
nursing assessment for septic arthritis
A
- newborns/infants:
- cries with infected joint is moved
- fever
- inability to move limb (pseudoparalysis)
- irritability
- children/adults
- inability to move limb
- joint swelling, redness, intense pain
- fever
112
Q
ventricular septal defect (VSD)
A
- most common
- left to right shunt
- left side pressure higher than right side
- hole in septum between ventricles
- surgical correction, depending on size and patient status
- without correction
- CHF
- pulmonary hypertension
- growth failure
- lower down its more muscular but higher up it’s more membranous and won’t repair on their own (lower ones may if they’re small)
113
Q
complications and side effects of chemo and associated medications?
A
- generalized hypersensitivity
- benadryl
- stop medications if affecting respiratory system
114
Q
SCD symptoms of extremities
A
- vaso-occlusion and chronic ischemia
- peripheral neuropathy
- weakness
- arthralgia
115
Q
diabetes insipudus overview
A
- central (neurogenic)
- trauma, tumor, neurosurgical procedures
- ADH deficiency
116
Q
S/Sx of hydrocephalus
A
- bulging/full fontanels
- head circumference
- irritability (young child)
- headache (older child)
- photophobia possibly
117
Q
circulation assessment during chemo
A
- assess: heart rate, peripheral perfusion (many chemo meds are cardiotoxic)
- interventions:
- cardiac monitor
- +/- IV fluids (depends on cardiac ejection fraction, echo)
- assess I&Os
- interventions:
118
Q
nervous system complications from bedrest
A
- depression
- example:
- women who have a history of depression have a higher incidence of hip fractures
119
Q
treatments for cerebral palsy
A
- botulinum toxin
- oral antispastic drugs
- benzos, baclofen
- orthopedic
- long limb lengthening, shin guards, crutches
- physical therapy
- feeding and nutrition
- skin care
- GOAL is to stop spasms
120
Q
absence seizures
A
- generalized (formerly petit mal or lapses)
- almost always in childhood (4-12 years)
- remission in adolescence
- no warning/aura
- brief 10-15 seconds
- motor Sx: lip smacking, eye/face twitch, slight hand movements
- no postictal confusion or sleepiness
- minimal/no change in muscle tone
- may drop object, rarely falls
- may cluster
- often misdiagnosed
- inattention, daydreaming, ADD/ADHD
- need EEG to confirm presence of seizure activity
121
Q
cardiac exam: heart
A
- rate
- rhythm
- sounds
- distinct vs muffled
- loud vs weak
- murmurs
- clicks
- palpable PMI
122
Q
types of decreased pulmonary blood flow lesions
A
- pulmonary atresia
- tricuspid atresia
- tetrology of fallot
123
Q
single ventricle physiology: treatment
A
- palliation / staged repair
- 3 stages
- neonatal
- 5-7/8 mo
- ~ 4 yo
- 3 stages
- long term medical and surgical management
- family education and support
124
Q
causes of bleeding dx
A
- imbalance in clotting factors
- bad/inadequate platelets
125
Q
osteosarcoma
A
- type of cancerous bone tumor that usually develops in teenagers when bone is growing rapidly
- average age at diagnosis is 15
- sometimes presents as fracture r/t growing tumor
126
Q
intra-venous immunoglobulin
A
- for Kawasaki disease
- neutralizes circulating antibodies
- suppresses inducer T & B cells; supports suppressor T cells
- blocks some macrophage receptors
- promotes re-myelination
- reduce prevalence of coronary abnormalities
127
Q
DKA bicarb Tx
A
DO NOT USE
- acidosis
- will correct with insulin and fluid
- rarely causes hemodynamic instability
- may increase hepatic ketone production
- increases likelihood of hypokalemia
- may increase tissue hypoxia
- may cause paradoxic acidosis of CSF
- associated w/ risk of cerebral edema
128
Q
if a patient comes in with a complex partial seizure, what questions to ask?
A
- when did this start, how long?
- what precipitated?
- seizure hx?
- meds (miss a dose, too much of it? sick and meds won’t work)?
- falls?
- primary issues
- safety - patients unfocused
- neuro assessment
- patient teaching at discharge
129
Q
assessing neuroblastoma in abdomen
A
- decreased urine output
- constipation
- abdominal tenderness
- compromised lung expansion
130
Q
differentiate neuroblastoma from Wilms tumor
A
- neuroblastoma of abdomen has a lot of secondary S/Sx
- 24 hour urine sample for uric acid (neuroblastoma)
- labs - high potassium, catecholamines (neuroblastoma)
- ultrasounds, CAT scans
131
Q
where to treat DKA
A
- Consensus Statement recommends general, PICU or other unit with capacity to
- support frequent assessment/labs
- have nursing staff experienced in caring for patient population (low staffing ratio)
- has written guidelines
132
Q
history questions to ask about seizures
A
- what was the child doing
- did the child complain of being ill or feeling funny
- trauma
- medications, poisons
- arm/leg movements, one side or both sides
- chewing, automatisms
- pupils dilated or deviated
- change in color
- incontinent
- aware and able to respond
- how long did it last
- lethargic, weak, uncoordinated after waking up
- loss of memory, confusion
133
Q
nursing interventions for aplastic anemia
A
- hand washing to prevent infection
- provide safe environment so they don’t bleed or fall
- assess for bleeding
- blood products
- cellular stimulating factor to make more WBCs
- platelet transfusion
- possibly antibiotics
134
Q
atrial septal defect (ASD)
A
- left to right shunting
- higher pressure on left side
- hole in wall that separates atria
- possibly foramen ovale
- possibly defect in week 16
135
Q
risk factors for febrile seizures
A
- male
- first born
- family hx
- risks until 5th birthday
136
Q
interrelations between siblings and parents in families living with children with cancer
A
- stressful
- social
- adjustments
- unpredictable
- separation
- life changes
137
Q
coarctation of the aorta
A
- narrowing/pinching of aorta
- often at level of PDA (not always)
- blood backs up behind coarct and flows back to pulmonary artery via PDA
- if PDA closes, baby is in shock
- increased blood flow to head and upper body
- decreased systemic circulation
- bounding upper pulses, decreased or non-palpable lower pulses
- systolic BP difference between UE and LE ~ 15-30 mmHg
- hypotension and acidosis (not enough CO to oxygenate tissues)
- can cause hypertrophy of LV w/o correction (usually w/in first few days of life)
138
Q
what is congenital heart disease (CHD)?
A
- structural malformation or absence of one or more heart chambers AND/OR
- deformity of major intrathoracic blood vessel(s) AND/OR
- postnatal persistence of fetal cardiac structures(s) AND/OR
- absent or non-functional intracardiac valves
139
Q
tetrology of fallot
A
- 4 things wrong
- pulmonary stenosis
- RV hypertrophy b/c of working hard
- ventricular septal defect for some circulation
- overriding aorta
- overrides septum and gets blood from both sides of heart
140
Q
types of obstructive lesions
A
- coarcted aorta
- interrupted aortic arch
- aortic stenosis
141
Q
diagnosing seizures and epilepsy
A
- positron emission tomography scan (PET)
- electrencephalogram (EEG) - doesn’t always confirm
- MRI
- CT scan
- can diagnose type, epilepsy syndromes
- normal EEG does not exclude diagnosis of epilepsy
- need history in conjunction
142
Q
cardiomyopathy overview
A
- disease of heart muscle
- idiopathic or related to systemic disease that affects cardiac muscle
- three types
- dilated
- hypertrophic
- restrictive (rare in children)
143
Q
assessment of tumor lysis syndrome/electrolytes during chemo
A
- assess:
- cardiac - stress, fluid overload
- skin, edema, peripherals
- interventions:
- cardiac monitor always
- neuro checks
- high flow fluids and strict I&Os
- not restricted, just monitored
144
Q
nursing assessment for idiopathic scoliosis
A
- school screenings vs primary care visits
- psychosocial
- measuring curve
145
Q
dyskinetic cerebral palsy
A
- affects term infants and usually results from severe, acute perinatal asphyxia
- neonatal presentation includes
- encephalopathy
- lethargy
- decreased spontaneous movement
- hypotonia
- suppressed primitive reflexes
146
Q
cortex
A
rich in nerves and vasculature, heals faster
147
Q
Kawasaki disease overview
A
- vasculitis aka mucocutaneous lymph node syndrome
- “infection” of vascular system that weakens walls of vessels
- one of two leading causes of acquired heart disease in US children
- etiology unknown
- 80% children 1-5 yrs
- pathophysiology
- acute, diffuse, vasculities of medium size arteries and small vessels of body, particularly coronary arteries
- potential for coronary artery aneurysm (or anywhere)
148
Q
airway, breathing, brain assessment during chemo
A
- assess: respiratory rate, aeration, chest pain, SOB
- intervention: oxygen, cardiac monitor, pulse ox, pristine exam
- assess: neurological status - Glasgow
- intervention: Glasgow, seizure precautions (rails up, O2, cardiac monitor)
149
Q
early pathophysiology of DKA
A
150
Q
common DKA complications
A
- hypoglycemia
- hypokalemia
151
Q
bone scarring
A
- thickening or irregularity on x-ray
- when fracture not taken care of properly, there is an irregular line
- osteoclasts try to come in and clean it up but because it’s not set properly, they can’t do a good job
- can inject a dye to see metabolically active areas
- osteoclasts trying to heal, get rid of scarring
152
Q
buckle fracture
A
- “toddler fractures”
- little nub or area where there was a bruise or break
- shor term fiberglass cast (2-3 weeks)
- kids may be missed
- challenging pick-up
- but will heal very well
153
Q
best control of diabetes
A
- use of inuslin pump
- BG checks > 5x /day
- bolus before meals
- use an insulin/carb ration based on meal
- insulin dose for snacks
154
Q
DKA assessment
A
- severe DKA
- dehydration
- buffer system overwhelmed (bicarb low) - primary mechanism
- elevated RR
- hyperglycemic
- K+ high normal
- low bicarb
155
Q
complications of hyperthyroidism
A
- risk for thyrotoxic crisis
- “thyroid storm”
- triggers: stress, infection, surgery
- hypermetabolic state - emergency
- tachycardia, hyperpyrexia
- Tx: beta blockers, supportive
- risk for atrial fibrillation
156
Q
hypertrophic cardiomyopathy: treatment
A
- beta adrenergic agonists
- calcium channel blockers
- diuretics and inotrope with cauation
- pacing
- surgical resection
157
Q
cerebral edema r/t DKA
A
- develop in first 3-12 hours of therapy
- 0.3-1% of children with DKA
- rare in adults
- children may have mild cerebral edema that is asymptomatic
- pathophysiology not identified
- recent studies support vasogenic cerebral edema, reperfusion injury
- most common cause of morbidity & mortality (25%) in KDA in pediatric patient
158
Q
fracture treatments
A
- cast
- plaster vs fiberglass
- sling
- splint
- traction
- operative fixation
159
Q
vitals of simple partial seizures
A
- ABCs - might not be immediately critical but always worry about airway
- color, cyanosis?
- distressed?
- aware, awake, responsive?
- perfusing?
- tachypnic, w/ or w/o fever
- tachycardic
- O2 probably at 99
- possibly fluctuating temp if not a febrile seizure
- patient usually not distressed
160
Q
pulmonary pathophysiology of drowning
A
- as little as 3 ml/kg of water can alter pulmonary gas exchange
- often head injury or spinal cord inury involved in near-drowning
- pulmonary vasoconstriction and hypertension
- disruption of alveolar surfactant
161
Q
types of bone tumors
A
- osteosarcoma
- Ewing’s sarcoma
- malignant round cell
- can be in genitourinary tissue too
- management is identical
162
Q
circulation assessment of liquid tumors
A
- poor perfusion
- poor distal pulses
- tachycardic - decreased RBCs
163
Q
thalassemia presentation
A
164
Q
risk factors for cerebral palsy
A
- random mutations
- maternal infections
- rubella, varicella, cytomegalovirus, toxoplasmosis, syphilis, toxins, bacterial meningitis)
- premature birth
- low birth weight
- fetal stroke
- lack of oxygen
- infant infections
- traumatic head injury
165
Q
normal hemoglobin
A
Hb-A (alpha2-beta2)
166
Q
dilantin side effects
A
- huge dental mess - effects eruption of future tooth growth
- speech impediment
- cavities
- exensive dental work
- bacterial endocarditis
- tooth discoloration
- nutrition issues
212
Q
dilated cardiomyopathy: overview
A
- etiology unknown
- dilated LV and systolic dysfunction
- effects both systolic and diastolic function
- +/- RV dysfunction
- results in CHF
- run risk of thrombus in legs
- CO to legs is bad, venous return is bad
222
Q
locating ausculation points in cardiac exam
A
242
Q
late pathophysiology of DKA
A
243
Q
A
- no left ventricle
- aorta does not get blood flow b/c of aortic stenosis
- atrophies
- no distal blood flow to ventricle b/c of aortic stenosis AND mitral valve atresia
- single ventricle physiology
259
Q
DI vs SIADH
A
283
Q
single ventricle physiology
A
- presentation depends on fall of pulmonary vascular resistance and any obstruction to pulmonary blood flow
- pulmonary and systemic venous congestion
284
Q
ventricular septal defect
A
- flow shunts left to right
- increased blood flow to right ventricle, out pulmonary valve, into pulmonary artery and into lungs
- increased pulmonary blood flow
- can cause hypertrophy of right ventricle
299
Q
transposition of the great vessels
A
- PA and Ao are transposed
- PA from LV and Ao from RV
- separate circulations
- PDA is only communication usually
- some communication through foramen ovale
- deoxygenated blood bypasses lungs towards systemic circulation
- infant is cyanotic
- correction
- moving the great vessels, but also need to move coronary arteries as well
304
Q
cardiac cycle - coronary perfusion
A
- coronary perfusion occurs during diastole
- arteries come from base of aorta and supply 3-5% of blood flow to heart
- if left ventricle can’t contract enough, can’t get systemic or coronary perfusion
320
Q
normal cardiac anatomy and blood flow
A
348
Q
hypertrophic cardiomyopathy: overview
A
- increased myocardial mass, especially LV
- decreased ventricular cavity size
- blood flow obstructed
- hypertrophic tissue
- left ventricular outflow tract obstruction
- big, thick, ugly heart
- decreased preload, contractility, and CO
349
Q
3-2-1 rule of DKA
A
362
Q
primary symptoms of Kawasaki disease
A
- fever > 5 days
- erythema of palms and soles with indurative edema (peeling)
- rash - polymorphous exanthema; peeling
- strawberry tongue, red lips
- bilateral conjunctival congestion
- sometimes first S/Sx
- cerical lympadenopathy
368
Q
DKA: two bag system
A
- two identical fluid bags MINUS dextrose content
- A: 0.45-.9% saline with 20 meq/L K Phos or 20 meq/L KCL or k acetate
- B: D10 0.45-9% saline with 20 meq/L k Phos or 20 meq/L KCl or K acetate
- before starting K, ensure renal fxn, K
- replace depleted phosphate (why K phos is more common)
- facilitates efficiency, timeliness, flexibility
- can go back and forth easily, if you overshoot the mark
396
Q
multifactorial process of diabetes
A
398
Q
pulmonary valve stenosis or atresia
A
- right to left shunt between ventricles
- abnormality/absent pulmonary valve
- deoxygenated blood moves from right to left and into systemic circulation
- constriction at pulmonary artery so blood and pressure builds up in right ventricle
- can’t go through valve, so will go through hole (SVD)
402
Q
cardiac cycle
A
