FINAL blueprint Flashcards
what do 1-6 month old infants need for adequate nutrition?
- breastfeeding
- Vitamin D (200 IU / day)
- iron-fortified formula (do not microwave)
- formula 6x daily
- iron fortified cereal (4-6 months old)
what do 6-12 month old infants need for adequate nutrition?
- formula / breastmilk 4-5 times a day
- spoon feeding by pushing food to back of tongue
- introducing solid foods one at a time
when do babies get to eat finger food?
teething crackers, fruit and vegetables
6-7 months
when can babies eat chopped table foods?
9-12 months
what are the two oral social stages among infants?
- food intake (3 -4 months)
- grasping and bring to mouth / biting
how many times do parents feed the same food to children before determining allergic reaction?
3 times one at a time
what are the stages of play?
- unoccupied
- solitary
- onlooker
- parallel
- associative
- social
unoccupied play
random movements of infants w/ no clear purpose
solitary play
- children start to play on their own
- takes no notice of other children
onlooker play
- children just watch others play
- they ask questions only
- no intention to join
parallel play
- children play side-by-side
- they pay attention to what each is playing
- no interactions
associative play
- children interact w/ each other by asking questions)
- similar goals
- no established rules
social play
- children begin to share w/ each other
- rules are established
what are the functions of play for a hospitalized child?
- provides diversion for a child
- gives the child choices and control of the situation
- gives the parents / family a break
what are the atraumatic measures in a plan of care for pediatric patients?
(7)
- use a treatment room
- avoid safe spaces for procedures
- allow for breastfeeding when possible
- use appropriate terminology
- offer choices to the child
- allow parents to stay with their children during the procedure
- incorporate play into explaining procedures–allow the child to use dolls or toys
what is NIPS (neonatal infant pain scale)?
a behavioral scale that indicates pain in full-term and pre-term infants (up to 2mos. old)
components of NIPS
- cry
- facial expression
- arms
- legs
- breathing pattern
- state of arousal
each are ranked from 0-1 (cry ranked with 0-2)
NIPS interventions
*reassessment in 30 mins appropriate
which age group is FLACC used for?
2mos. – 7 years old
definition of FLACC
Facial expression
Leg positioning
Activity
Crying
Consolability
FLACC pain scale
FACES pain scale is used for which age group?
3 years and older
what does the Hib vaccine prevent?
(4); Haemophilus Influenza Type B
- bacterial meningitis
- epiglottitis
- bacterial pneumonia
- sepsis
what are the common infectious respiratory illness among children?
(4)
- acute LTB
- epiglottitis
- pneumonia
- bronchiolitis
why is diminished or cessation of breathing noise and effort alarming for nurses?
sign of impending respiratory failure
why is epiglottitis considered an emergency?
airway obstruction & tracheal occlusion
what is epiglottitis usually caused by?
Haemophilius influenza
Hib vaccine needed
s/s of epiglottitis
(7)
- dysphonia
- dysphagia
- drooling
- tripoding
- high fever
- pain with swallowing
- edematous epiglottis
what are the diagnostic procedures for epiglottitis?
- portable lateral neck x-ray
- CBC
- blood culture (bacteremia)
what are the medications for epiglottitis?
- ABX
- corticosteroids
- antipyretics
parents are worried their child is having epiglottitis for the second time, what does the nurse say?
recurring epiglottitis is common
what are the signs of water depletion (dehydration) in children?
- weight loss
- tachycardia
- depressed fontanels
- decreased UOP
- altered LOC
- dry skin
- tacky mucous membranes
lab results for water depletion
- high urine specific gravity
- increased BUN
- increased Hct
- increased Na+
- increased serum osmolarity
- variable serum electrolytes
what are the causes of water excess?
- water intoxication
- IV overload
- incorrect feeding (parents use too much water for formula reconstitution)
- swimming lessons
- too rapid dialysis
- tap water enemas
what are the signs & symptoms of water excess?
- crackles
- increased venous pressure
- slow & bounding pulse
- weight gain
- lethargy
- increased spinal pressure
- seizures
- bulging fontanels
lab results for water excess
- low urine specific gravity
- decreased Hct
- decreased serum electrolyes
lab results for water excess
- low urine specific gravity
- decreased Hct
- decreased serum electrolyes
conditions associated with water excess
- CHF
- SIADH
- increased ICP
- oliguric renal failure
what are the signs of increased ICP?
(7)
- bulging fontanels
- sunset eyes
- Cri du chat
- irritability
- bradycardia
- vomiting
- respiratory changes
what are the early signs of increased ICP?
- HA
- diplopia (blurred vision)
- NV
- confusion
what are the nursing actions to reduce ICP?
- HOB elevated 30
- avoid straining or coughing
- avoid bright lights
- minimize stimuli
what are the side effects of Digoxin?
- diuresis
- increased PR interval
- bradycardia
- nystagmus
- NV
- hyperkalemia
what are the pharmacological actions of Digoxin that cause bradycardia?
- negative chronotropic
- positive inotropic
what are the nursing actions for Digoxin before administering it to a patient with CHF?
small children: hold when HR < 90 & do not give more than 1mL
older children: hold when HR < 70
what is the therapeutic range for Digoxin?
0.8 - 2mcg/ L
why does the nurse need to question an order for Digoxin when a child’s Potassium levels show less than 3.5mEq?
the effects of the medication will increase
decreased pulmonary blood flow causes cyanosis
true
what are the cardiac defects that lead to a decrease in pulmonary blood flow?
- Tricuspid atresia
- Tetralogy of Fallot
Kawasaki disease is the leading cause of acquired heart disease in children
true
ecstasia is one of the major complications of Kawasaki disease, what is it?
an aneurysm caused by overdilation of coronary artery
s/s of Kawasaki disease
(6)
- red eyes
- fever
- ring around the iris
- strawberry tongue
- nonblistering rash on the perineum
- joint pain
what are the medications for Kawasaki disease?
- IV globulins
- aspirin
what is Kawasaki diease?
acute systemic vasculitis that follow viral infections & toxic exposures
how are Tet spells relieved?
squatting position (bringing knees to chest)
which medication is used to keep PDA?
IV prostaglandin E
what are the s/s of hypoxemia r/t heart defects?
- cyanosis
- polycythemia
- clubbing
- squatting
- hypercyanotic episodes
what are the characteristics of asthma?
- chronic inflammatory disorder
- narrow airways
- hypersenstivity to stimuli/ irritants
what happens to the lungs among children with asthma?
- bronchial constriction
- alveolar hyperinflation
- air-trapping (unable to exhale properly)
- edema
- increased mucus secretion
what are the diagnostic tests for asthma?
- CXR
- PFT
- PEFR
what are the s/s for asthma?
- expiratory wheezing, crackles, or diminished
- dry cough
- sitting retractions
- prolonged expiration
- restlessness
- fatigue
- tachypnea
- cyanosis
- barrel chest
why do nurses need to avoid giving cold liquids to a pt w/ asthma?
avoid bronchospasms
what is the nursing care for a child w/ asthma?
- administer humidified O2
- high fowler’s
- monitor pulse ox
- maintain IV access (hydration, IV steroids)
what are the medications for asthma?
- steroids
- oxygen
- IV fluids
- bronchodilators (beta agonists & anticholinergics)
what is more important for patient and families to know about regulating asthma?
- check peak flow
- keep rescue inhaler
LTB is usually preceded by an upper respiratory infection
RSV most common
true
what is the primary cause of bronchiolitis?
RSV
RSV is most prevalent during the first 2 years of life
true
what is cystic fibrosis?
increased production of thick mucus in bronchioles and small intestines, & pancreatic and bile ducts
what is the etiology of CF?
inherited autosomal recessive trait from both parents
what is the role of pancreatic enzymes in the body?
they catabolize fats, carbohydrates & protein
what is the pathophysiology of CF?
- increased viscosity of secretions
- atelectasis
- clogged pancreatic ducts (–> absent enzymes)
what are the diagnostic tests for CF?
(6)
- sweat chloride test
- CXR
- prenatal DNA testing (from amniotic fluid)
- AXR (meconium ileus)
- PFT
- stool analysis (72 hours fecal fat)
how does a child with CF present?
- coughing
- dyspnea
- crackles
- cyanosis
- clubbing
- steatorrhea (frothy, foul smelling)
- low SpO2
how can a nurse care for a child with CF?
- provide high calories & high protein
- administer pancreatic enzymes (w/ meals)
- administer vitamins A, E, D, K (fat soluble)
- increase hydration
what are the medications for CF?
- mucolytics
- bronchodilators
- ABX
- pancreatic enzymes
- fat-soluble vitamins
proper education for families with a child with CF
- avoid respiratory illness & infection
- chest percussion
- postural drainage
- high calorie & high protein
- physical activity (loosens secretions)
- genetic counseling
what is the major cause of hospitalizations among infants?
bronchiolitis
what is bronchiolitis?
inflammation of bronchioles with edema & excess accumulation of mucus due to RSV
why does air trapping & atelectasis occur in bronchiolitis?
increased airway resistance from obstructed bronchioles
how is bronchiolitis spread?
contact with contaminated objects(droplet precautions must be in place)
what are the diagnostic procedures for bronchiolitis?
- nasopharyngeal swab
- CXR
what are the symptoms of bronchiolitis?
- worsening upper respiratory infections
- tachypnea
- retractions
- low-grade fever
- anorexia
- thick nasal secretions
- wheezing / crackles
how can a nurse care for a child with bronchiolitis?
- encourage feeding
- nasal suctioning PRN
- increase fluid intake
- daily weights (I&O)
- pulse ox
- humidified O2
- contact precautions
medications for bronchiolitis
- ABX
- fluids
- steroids
what is most important for families to know in caring for their child with bronchiolitis?
- use of bulb syringe
- notify HCP when anorexic or worsened breathing
what are the ages of a preschooler?
3-6 years old
what are the gross motor skills typically learned during the preschool years?
- rides tricycle
- up stairs alternating feet
- hop on one foot & alternate feet
- dress independently
- throws & catches a ball
what are fine motor skills preschoolers learn?
- lace shoes up
- use of scissors & pencils
- can draw cross, circle, diamond, & triangle
- count numbers
- write a few letters
what type of play are preschoolers engaged in?
associative play
imaginary friends are common among preschoolers
true
preschoolers are more socially aware with knowledge & less egocentric
true
which phase of Piaget are preschoolers in?
preoperational phase
Stage 2
what is a hallmark of preschooler’s cognitive development?
language (being able to express themselves sufficiently)
preschoolers cannot reason beyond the observable
true
literal language, not figurative
preschoolers have a lack of reversibility
true
which stage of Erikson’s are preschoolers in?
initiative vs. guilt
Stage 3
exercise autonomy, feeling guilty for unfulfilling tasks
what does the nurse tell a preschooler’s parent who is worried about their child’s stuttering and stammering
it is a normal characteristic of language development
treatment for hypertensive AKI
- anti-HTN
- limit fluids
- limit salt
manifestations of Wilms tumor
- aniridia
- HTN
- hematuria
- hemihypertrophy
- overgrowth syndrome (Beckwith-Wiedemann)
diagnostic procedures for Wilms tumor
- radiographic studies (x-ray)
- ABD U/S
- hematologic & biochem studies
- UA
why should nurses not palpate the protrusion in Wilms tumor?
to avoid rupturing the tumor
what is the treatment for Wilms tumor?
surgical removal of tumor, affected kidney, & adjacent adrenal gland
what is the triad for HUS?
- anemia
- thrombocytopenia
- renal failure
what are the lab results associated with HUS?
- decreased Hgb & Hct
- elevated BUN
- elevated Creatinine
- elevated reticulocyte
what is the nursing care for HUS?
(5)
- monitor I&O
- fluid replacement
- treat HTN
- provide seizure precautions
- enteral nutrition
what is included in renal diet?
- low Na+
- high carbs
- low protein
- fluid restrictions
- avoid fresh & organic produce
what are the implications for AKI?
accumulation of waste
- azotemia
- uremia
- inability to excrete waste, concentrate urine, & conserve electrolytes
diagnostic results for AKI
- elevated BUN
- reduced GFR
- elevated creatinine
treatment for hyperkalemic AKI
Kayexalate
treatment for hypertensive AKI
- anti-HTN
- limit fluids
- limit salt
treatment for anemic AKI
PRBC
if Hgb is < 6g/dL
emesis
pyloric stenosis
projectile vomiting
definition
pyloric stenosis
hypertrophy of circular muscle of pylorus
causes obstruction & constriction
therapeutic procedures for pyloric stenosis
- pylorotomy
- laparotomy
hallmark signs of pyloric stenosis
- moveable mass in epigastrum
- projectile vomiting
- possible peristaltic wave while supine
- dehydration
characteristic
celiac disease
intolerance to the protein gluten
what is the pathology for Celiac disease?
gluten-sensitive enteropathy
what are the common manifestations of Celiac disease?
- ABD distension
- vomiting
- diarrhea w/ foul odor
- chronic malabsorption syndrome
cleft lip/ palate feeding bottles
when can cleft palate be repaired?
between 6-12 months of age
usually before 2 years old
postop nursing care for cleft palate repair
- elevated supine position (or on side)
- cool mist tent
- blended diet
- elbow restraints
- advice to avoid sucking for 7-10 days
- no oral temps
for how long do children who had their cleft palate repaired stay in elbow restraints?
4-6 weeks
when do posterior fontanels close?
2-3 months old
when do deciduous teeth erupt?
6-10 months old
what is the recommended dose for Acetaminophen for infants?
10-15mg / kg / dose
(max. 5 doses)
what do babies need for healthy & safe sleep?
- sleeping in their own bed close to parent’s bed
- no soft bedding
- no smoking
- no overheating
- supine position
s/s of GERD
- excessive crying
- arching of back
- spitting up/ vomiting
- cough, wheezing, stridor, gag
- apnea
- bloody emesis
- difficulty swallowing
- CP
- heart burn
managements for GERD
- weight control
- small frequent meals
- avoid food that intensify reflux
- thickened feedings
- elevate HOB (or hold baby for one hour)
what are the medications for GERD?
- Ranitidine
- Omeprazole
hallmark sign of appendicitis
pain at McBurney’s point (RLQ)
what are the diagnostic tests that can confirm appendicitis?
- CBC(WBC)
- CT scan
- CRP(detects inflammation)
what would a CT scan show for appendicitis?
enlarged appendix & thickening of appendiceal wall
what is osteogenesis imperfecta?
an inherited connective tissue disorder that results in bone fractures along w/ restricted growth
“brittle bone disease”
what are the clinical manifestations of osteogenesis imperfecta?
- multiple bone fractures
- blue sclera
- early hearing loss
- hypoplastic discolored teeth
what is the treatment for osteogenesis imperfecta?
pamidronate IV with biphosphate
what is the expected MOA of pamidronate?
increases bone density
what are the signs of compartment syndrome that occurs with casts?
5 P’s
- paresthesia
- pallor
- paralysis
- pain
- pulselessness
what are the nursing priorities for a child with a cast?
regular skin checks & neurovascular checks
what are tractions used for?
(4)
- provide muscle rest
- immobilization
- alignment
- prevent contractures
what are the nursing actions for cast care & traction?
(7)
- use a doll or toy for atraumatic care
- elevate cast above heart level to prevent swelling
- reposition q2hrs to allow air drying
- keep extremity supported (dependent position)
- monitor for drainage
- notify for hot spots
- ensure weights hang freely (do not lift w/o HCP supervision)
what are the components of neurovascular assessments?
- sensation
- skin temperature
- skin color
- cap refill
- pulses
- movement
what are the types of skin tractions?
- Bryant
- Buck
- Russell
what is the most prominent etiology of cerebral palsy?
kernicterus
elevated bilirubin in newborns
what is cerebral palsy?
a nonprogressive impairment of motor function that causes spasticity or dyskinesia (involuntary movements)
what are the s/s of cerebral palsy?
(8)
- persistent Moro reflex or tonic neck reflex
- failure to smile by 3 months
- persistent tongue thrust by 6 months
- spasticity
- scissoring of legs
- nystagmus
- hearing loss
- feeding difficulties
what are the expected findings of spina bifida cystica?
(5)
- flaccid muscles
- lack of bowel control
- rectal prolapse
- spinal curvature abnormalities (kyphosis/ scoliosis)
- protruding sac
what are the nursing actions after treating hypoglycemia w/ 15g carbs & glucagon?
- recheck glucose 15mins after until levels are 70mg/dL or above
- continue to monitor for 2hrs
what is the HgbA1c level for hyperglycemia?
< 6.5%
what is the fasting BG level for hyperglycemia?
126mg/dL or above
what is the starvation response in T1DM?
fatty acid is broken down (to obtain more energy from the body) and in the process produced ketone bodies
starvation response over a prolonged period of time can lead to which complication?
diabetic ketoacidosis
what are the s/s of DKA?
- Kussmaul respirations
- fruity breath
what are the s/s of T1DM?
(7)
- polyuria
- polyphagia
- polydipsia
- flushed/ dry skin
- confusion
- wt loss
- retinopathy
what is the most concerning delay in developmental milestone found in an infant?
head lagging
what does head lagging indicate?
cerebral palsy
what are the supplements that pregnant women should take to prevent NTDs?
- niacin
- folate
what is the first sign of puberty in girls?
breast development
definition
animism
personification of inanimate objects
what are the nursing actions for a child with a myelomeningocele preop?
lay on their side with the sac covered with a sterile saline gauze
Bryant’s traction is only appropriate for children with hip dysplasia that meet which criteria?
- younger than 3 yrs old
- weighing less than 35 lbs.
what is the first sign of puberty in boys?
testicular enlargement
what is hemophilia?
a group of bleeding disorders characterized by difficulty controlling bleeding due to lack of clotting factors
what are the types of hemophilia?
- Hemophilia A (classic)
- Hemophilia B
- Von Willebrand Disease
which clotting factor does Hemophilia A lack?
factor VIII
which clotting factor does Hemophilia B lack?
factor IX
which is the most common type of hemophilia?
Von Willbrand disease
what is Von Willebrand hemophilia?
the inherited lack of the von willebrand factor protein characterized by inability of platelets to aggregate
both Hemophilia A & B are male dominant (x-linked recessive)
true
Von Willebrand disease affects both males & females
true
how is hemophilia diagnosed?
- hx of bleeding episodes
- evidence of x-linked inheritance
- PTT
- factor assays
- DNA testing
what are the medications & treatment for hemophilia?
(5)
- synthetic vasopressin (DDAVP)
- steroids
- factor VIII products
- pooled plasma
- recombinant products
what is the MOA of DDAVP (Desmopressin) for Hemophilia?
increases plasma factor VIII (only for Hemophilia A)
what is the nursing care for hemophilia?
(4)
- monitor urine, stool, & NG fluid for occult blood
- administer Acetaminophen instead of aspirin
- administer injections via subQ only
- venipunctures are preferred for blood sampling
where is the most appropriate site for a bone marrow biopsy on a child younger than 18 months?
tibia
where is the most appropriate site for a bone marrow biopsy on a child older than 18 months?
anterior iliac crest
what are the nursing actions for a bone marrow biopsy?
- apply pressure dressing for 24hrs
- have the patient in side-lying position
- place a pillow under their hips
patients with sickle cell anemia have what type of Hgb?
Hgb S
predominantly; it replaces Hgb A
which diagnostic procedure is used for sickle cell anemia?
- hemoglobin electrophoresis
- sickledex finger stick
what are the nursing actions for a sickle cell crisis?
- adequate oxygenation
- hydration
- transfusion
- ABX
- analgesics
- FEB
what are the s/s of vasooculsive crisis in sickle cell anemia?
(6)
- pain
- priapism
- acute chest syndrome
- stroke
- severe joint pain
- swollen joints & extremities
what are the nursing actions for sickle cell anemia?
(8)
- analgesics
- O2
- promote rest
- give oral fluids
- monitor for infection
- administer PCV, Hib, Meningococcal vaccines
- apply warm packs to joints
- administer Hydroxyurea
what is the prevention for sepsis in sickle cell anemia?
prophylactic Penicillin
until 5 years old
how does hydroxyurea help manage sickle cell anemia?
reverts sickle cells to its original shape (promoting roundness & flexibility)
reverse sickle cell effects
what is the nursing care for a patient experiencing sickle cell crisis (vasooclusive)?
- administer analgesics (acetaminophen, ibuprofen, or opioids)
- apply warm compress to joints
- O2
- bed rest
- increase fluids
which foods contain gluten?
- barley
- rye
- oats
- wheat
BROW
what are the symptoms for pertussis?
- runny nose
- severe cough (whooping upon inspiration)
- spasms
- flushing
- cyanosis
- vomiting
what are the precautions implemented for pertussis?
droplet precautions
what is the nursing care for hemophilia?
(4)
- monitor urine, stool, & NG fluid for occult blood
- administer Acetaminophen instead of aspirin
- administer injections via subQ only
- venipunctures are preferred for blood sampling
what is the MOA of DDAVP (Desmopressin)?
increases plasma factor VIII (only for Hemophilia A)
how is hemophilia diagnosed?
- hx of bleeding episodes
- evidence of x-linked inheritance
- PTT
- factor assays
- DNA testing
what are the medications & treatment for hemophilia?
(5)
- synthetic vasopressin (DDAVP)
- steroids
- factor VIII products
- pooled plasma
- recombinant products
what is Rheumatic fever?
an inflammatory disease that occurs as a reaction to Group A strep infection
s/s of Rheumatic fever
(7)
- Aschoff bodies (tiny lesions of the heart)
- carditis
- murmur
- polyarhritis
- rash in trunk & extremities
- subcutaneous nodules
- CNS involvement (uncoordination + involuntary mvmnts)
what are the medications that can treat Rheumatic fever?
- penicillin G
- sulfadiazine(ABX)
- penicillin V
what is the earliest sign of dehydration?
- tachycardia
- poor perfusion (cap refill)
what are the s/s of hypoglycemia?
- irritability
- decreased LOC
- slurred speech
- cold & clammy
- pallor
- hunger
what are the s/s hyperglycemia?
- polyuria
- polydipsia
- polyphagia
- NV
- fruity breath
what is the first intervention for dehydation in pediatrics?
oral rehydration therapy with Pedialyte or Gatorade ONLY
what are the s/s of Graves disease?
(6)
- hyperactive
- hyperstimulated
- exophthalmos
- tachycardia
- diaphoretic
- weight loss
what are the signs of compartment syndrome that occurs with casts?
5 P’s
- paresthesia
- pallor
- paralysis
- pain
- pulselessness
what is the pathophysiology of nephrotic syndrome?
increasing permeability of basement membrane in kidneys leading to albumin leaks & accumulation of fluid in interstitial spaces
what is the etiology of nephrotic syndrome?
inherited autosomal recessive gene
what are the manifestations of nephrotic syndrome?
(7)
- weight gain
- periorbital edema
- ascites
- oliguria
- vomiting
- irritability
- proteinuria (15g in 24-hr urine)
children with nephrotic syndrome have an increased risk of upper respiratory infection
true
what is the nursing care for nephrotic syndrome?
(5)
- elevate legs to relieve edema
- strict I&O
- measure ABD girth daily
- monitor for proteinuria
- salt restriction
what is the treatment for nephrotic syndrome?
- low Na+ diet
- severe fluid restriction
- diuretics (due to edema)
- 25% albumin
- prednisone
what is the goal for treating nephrotic syndrome?
- reduce excretion of urinary protein
- reduce fluid retention in tissues
- prevent infection
what is osteogenesis imperfecta?
an inherited connective tissue disorder that results in bone fractures along w/ restricted growth
“brittle bone disease”
what are the clinical manifestations of osteogenesis imperfecta?
- multiple bone fractures
- blue sclera
- early hearing loss
- hypoplastic discolored teeth
what is the treatment for osteogenesis imperfecta?
pamidronate IV with biphosphate
what is the expected MOA of pamidronate?
increases bone density
what are the types of fracture in children?
- bend
- buckle
- greenstick
- complete
bend fratcures only occur in the ulna & fibula when there is a fracture in the radius & tibia
true
the most common site for a fracture in a child is the growth plates, where is it?
located on the ends of the hard bone (epiphyseal)
what are the styles of parenting?
- authoritarian
- permissive
- authoritative
what are the types of families?
(7)
- traditional
- nuclear
- blended
- extended
- single parent
- binuclear
- communal
fluid calculations
1-10 kg
100mL/kg
fluid calculations
11-20 kg
(1000mL) + (50mL / kg > 10)
fluid calculations
> 20kg
(1500mL) + (20mL/ kg > 20)
what kind of reflexes does a child with meningitis manifest?
- Brudzinsky sign
- Kernig’s sign
- Nuchal rigidity
which vaccine prevents meningitis?
Hib vaccine
which bacteria causes meningitis?
- group B strep
- Hib
what are the s/s of meningitis?
(7)
- abrupt onset fever
- vomiting
- photophobia
- HA
- Nuchal rigidity
- Kernig’s sign
- Brudzinski’s sign
what is the diagnostic procedure for meningitis?
lumbar puncture
what are the CSF characteristics for bacterial meningitis?
- elevated WBC
- cloudy color
- elevated protein
- decreased glucose
- (+) Gram stain
what are the CSF characteristics for viral meningitis?
- clear color
- elevated WBC
- normal protein content
- normal glucose
- (-) Gram stain
what is Reye syndrome?
a neurological dysfunction that causes liver dysfunction & cerebral edema
which medication is the cause for Reye syndrome heavily associated with?
Aspirin
Reye syndrome typically follows a viral illness such as flu or varicella
true
what are the emergent measures for status epilepticus?
(5)
- airway
- oxygen
- suction
- IV ativan
- thermoregulation
what are the nursing actions prior to a lumbar puncture?
- assist client to void
- apply EMLA cream
what are the nursing actions after a lumbar puncture?
- apply pressure dressing to site
- monitor for bleeding, hematoma, infection
- allow patient to lay flat
how is the child positioned for a lumbar puncture?
side lying w/ head & knees flexed
what is the starvation response in T1DM?
fatty acid is broken down (to obtain more energy from the body) and in the process produced ketone bodies
what are the s/s of hyperthyroidism?
- irritability
- hyperactivity
- exophthalmos
- goiter
- wt loss
what is Grave’s disease?
a form of hyperthyroidism that is usually an autoimmune response to TSH receptors
hyperthyroidism is more common in girls (at least 5x more likely)
true
what are the s/s of Grave’s disease?
- fever
- enlarged thyroid gland
- exophthalmos
- urticaria
- vasculitis
- agranulocytosis
children can become hyperthermic when in a toxic coma
true
what are the preoperative actions for a patient who is scheduled for a meningocele sac closure?
- place infant in warmer
- apply sterile, moist, & non-adhering dressing on the sac (re-wet when dry)
- administer IV ABX as prescribed
- avoid rectal temperatures
what are the postperative actions for a patient who had a meningocele sac closure?
(6)
- monitor weight
- monitor I&O
- resume oral feedings
- provide ROM
- assess for bulging fontanels
- measure head circumference
what are the appropriate client education for a patient with a meningocele?
- avoid objects with latex
- monitor for bladder infection or dysfunction
- monitor widening head circumference
which lack of vitamins during gestation can cause spina bifida?
- folate
- niacin
- cobalamine
what are the diagnostic tests to determine spina bifida during gestation?
- AFP
- amniocentesis
- U/S
elevated AFP levels indicate spina bifida
true
what are the treatments for seizure?
(6)
- Ketogenic diet
- antiepileptic drugs
- vagus nerve stimulation
- focal resection
- hemispherectomy
- corpus callostomy
what is included in a Ketogenic diet?
- high fat
- low carbs
- adequate protein
what are the emergent measures for status epilepticus?
(5)
- airway
- oxygen
- suction
- IV access (-zepam & phenobarbital)
- thermoregulation
what are the types of anemias?
- iron deficiency
- sickle cell
- B-Thalassemia(Cooley)
- aplastic
what are the various reasons for anemia?
- decreased RBC production
- increased loss of RBC (from bleeding)
- increased hemolysis
what are common clinical manifestations of anemia?
- fatigue
- pallor
- decrease in Hgb
what are the clinical manifestations of Cooley anemia?
B-Thalassemia
- small stature
- splenomegaly
- hepatomegaly
- decreased H&H
- abnormal blood smear
what is aplastic anemia?
a bone marrow failure condition in which formed elements of the blood are simultaneously depressed
what are the conditions associated with aplastic anemia?
- anemia
- leukopenia
- thrombocytopenia
what are the manifestations of coarctation of the aorta?
(5)
- elevated BP in upper extermities (> 20mmHg difference)
- bounding pulses in upper extremities
- cool skin in lower extremities
- nosebleeds (epistaxis)
- absent femoral pulses
what is the hallmark heart sound the nurse will hear in aortic stenosis?
bruit
what are the congenital mixed defects that can be found in children?
- transposition of the great vessels
- total anomalous pulmonary venous return
- truncus arteriosus
- hypoplastic left heart syndrome
what are the congenital heart defects that increase pulmonary blood flow?
- atrial septal defect
- ventricular septal defect
- patent ductus arteriosus
- atrioventricular canal
what are the obstructive defects of the heart?
- coarctation of the aorta
- aortic stenosis
- pulmonary stenosis
auscultory landmarks of the heart
be mindful of STERNAL BORDERS & MIDCLAVICULAR
what are the conditions that are included under Tetralogy of Fallot?
(4)
- pulmonary stenosis
- overriding aorta
- right ventricular hypertrophy
- VSD
s/s of ToF
(5)
- cyanotic spells (Tet spells)
- polycythemia
- systolic murmur
- clubbing
- tachypnea
what is the treatment for ToF?
- O2
- Morphine (induce slower RR)
- squatting (knees to chest)
what is the nursing action when a child has > 60mg/kg of iron?
administer Deferoxamine