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FINAL blueprint Flashcards

1
Q

what do 1-6 month old infants need for adequate nutrition?

A
  • breastfeeding
  • Vitamin D (200 IU / day)
  • iron-fortified formula (do not microwave)
  • formula 6x daily
  • iron fortified cereal (4-6 months old)
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2
Q

what do 6-12 month old infants need for adequate nutrition?

A
  • formula / breastmilk 4-5 times a day
  • spoon feeding by pushing food to back of tongue
  • introducing solid foods one at a time
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3
Q

when do babies get to eat finger food?

teething crackers, fruit and vegetables

A

6-7 months

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4
Q

when can babies eat chopped table foods?

A

9-12 months

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5
Q

what are the two oral social stages among infants?

A
  • food intake (3 -4 months)
  • grasping and bring to mouth / biting
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6
Q

how many times do parents feed the same food to children before determining allergic reaction?

A

3 times one at a time

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7
Q

what are the stages of play?

A
  1. unoccupied
  2. solitary
  3. onlooker
  4. parallel
  5. associative
  6. social
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8
Q

unoccupied play

A

random movements of infants w/ no clear purpose

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9
Q

solitary play

A
  • children start to play on their own
  • takes no notice of other children
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10
Q

onlooker play

A
  • children just watch others play
  • they ask questions only
  • no intention to join
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11
Q

parallel play

A
  • children play side-by-side
  • they pay attention to what each is playing
  • no interactions
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12
Q

associative play

A
  • children interact w/ each other by asking questions)
  • similar goals
  • no established rules
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13
Q

social play

A
  • children begin to share w/ each other
  • rules are established
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14
Q

what are the functions of play for a hospitalized child?

A
  • provides diversion for a child
  • gives the child choices and control of the situation
  • gives the parents / family a break
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15
Q

what are the atraumatic measures in a plan of care for pediatric patients?

(7)

A
  • 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
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16
Q

what is NIPS (neonatal infant pain scale)?

A

a behavioral scale that indicates pain in full-term and pre-term infants (up to 2mos. old)

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17
Q

components of NIPS

A
  1. cry
  2. facial expression
  3. arms
  4. legs
  5. breathing pattern
  6. state of arousal

each are ranked from 0-1 (cry ranked with 0-2)

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18
Q

NIPS interventions

A

*reassessment in 30 mins appropriate

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19
Q

which age group is FLACC used for?

A

2mos. – 7 years old

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20
Q

definition of FLACC

A

Facial expression
Leg positioning
Activity
Crying
Consolability

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21
Q

FLACC pain scale

A
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22
Q

FACES pain scale is used for which age group?

A

3 years and older

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23
Q

what does the Hib vaccine prevent?

(4); Haemophilus Influenza Type B

A
  • bacterial meningitis
  • epiglottitis
  • bacterial pneumonia
  • sepsis
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24
Q

what are the common infectious respiratory illness among children?

(4)

A
  • acute LTB
  • epiglottitis
  • pneumonia
  • bronchiolitis
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25
Q

why is diminished or cessation of breathing noise and effort alarming for nurses?

A

sign of impending respiratory failure

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26
Q

why is epiglottitis considered an emergency?

A

airway obstruction & tracheal occlusion

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27
Q

what is epiglottitis usually caused by?

A

Haemophilius influenza

Hib vaccine needed

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28
Q

s/s of epiglottitis

(7)

A
  • dysphonia
  • dysphagia
  • drooling
  • tripoding
  • high fever
  • pain with swallowing
  • edematous epiglottis
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29
Q

what are the diagnostic procedures for epiglottitis?

A
  • portable lateral neck x-ray
  • CBC
  • blood culture (bacteremia)
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30
Q

what are the medications for epiglottitis?

A
  • ABX
  • corticosteroids
  • antipyretics
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31
Q

parents are worried their child is having epiglottitis for the second time, what does the nurse say?

A

recurring epiglottitis is common

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32
Q

what are the signs of water depletion (dehydration) in children?

A
  • weight loss
  • tachycardia
  • depressed fontanels
  • decreased UOP
  • altered LOC
  • dry skin
  • tacky mucous membranes
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33
Q

lab results for water depletion

A
  • high urine specific gravity
  • increased BUN
  • increased Hct
  • increased Na+
  • increased serum osmolarity
  • variable serum electrolytes
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34
Q

what are the causes of water excess?

A
  • water intoxication
  • IV overload
  • incorrect feeding (parents use too much water for formula reconstitution)
  • swimming lessons
  • too rapid dialysis
  • tap water enemas
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35
Q

what are the signs & symptoms of water excess?

A
  • crackles
  • increased venous pressure
  • slow & bounding pulse
  • weight gain
  • lethargy
  • increased spinal pressure
  • seizures
  • bulging fontanels
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36
Q

lab results for water excess

A
  • low urine specific gravity
  • decreased Hct
  • decreased serum electrolyes
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37
Q

lab results for water excess

A
  • low urine specific gravity
  • decreased Hct
  • decreased serum electrolyes
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38
Q

conditions associated with water excess

A
  • CHF
  • SIADH
  • increased ICP
  • oliguric renal failure
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39
Q

what are the signs of increased ICP?

(7)

A
  • bulging fontanels
  • sunset eyes
  • Cri du chat
  • irritability
  • bradycardia
  • vomiting
  • respiratory changes
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40
Q

what are the early signs of increased ICP?

A
  • HA
  • diplopia (blurred vision)
  • NV
  • confusion
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41
Q

what are the nursing actions to reduce ICP?

A
  • HOB elevated 30
  • avoid straining or coughing
  • avoid bright lights
  • minimize stimuli
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42
Q

what are the side effects of Digoxin?

A
  • diuresis
  • increased PR interval
  • bradycardia
  • nystagmus
  • NV
  • hyperkalemia
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43
Q

what are the pharmacological actions of Digoxin that cause bradycardia?

A
  • negative chronotropic
  • positive inotropic
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44
Q

what are the nursing actions for Digoxin before administering it to a patient with CHF?

A

small children: hold when HR < 90 & do not give more than 1mL
older children: hold when HR < 70

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45
Q

what is the therapeutic range for Digoxin?

A

0.8 - 2mcg/ L

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46
Q

why does the nurse need to question an order for Digoxin when a child’s Potassium levels show less than 3.5mEq?

A

the effects of the medication will increase

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47
Q

decreased pulmonary blood flow causes cyanosis

A

true

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48
Q

what are the cardiac defects that lead to a decrease in pulmonary blood flow?

A
  • Tricuspid atresia
  • Tetralogy of Fallot
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49
Q

Kawasaki disease is the leading cause of acquired heart disease in children

A

true

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50
Q

ecstasia is one of the major complications of Kawasaki disease, what is it?

A

an aneurysm caused by overdilation of coronary artery

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51
Q

s/s of Kawasaki disease

(6)

A
  • red eyes
  • fever
  • ring around the iris
  • strawberry tongue
  • nonblistering rash on the perineum
  • joint pain
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52
Q

what are the medications for Kawasaki disease?

A
  • IV globulins
  • aspirin
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53
Q

what is Kawasaki diease?

A

acute systemic vasculitis that follow viral infections & toxic exposures

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54
Q

how are Tet spells relieved?

A

squatting position (bringing knees to chest)

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55
Q

which medication is used to keep PDA?

A

IV prostaglandin E

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56
Q

what are the s/s of hypoxemia r/t heart defects?

A
  • cyanosis
  • polycythemia
  • clubbing
  • squatting
  • hypercyanotic episodes
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57
Q

what are the characteristics of asthma?

A
  • chronic inflammatory disorder
  • narrow airways
  • hypersenstivity to stimuli/ irritants
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58
Q

what happens to the lungs among children with asthma?

A
  • bronchial constriction
  • alveolar hyperinflation
  • air-trapping (unable to exhale properly)
  • edema
  • increased mucus secretion
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59
Q

what are the diagnostic tests for asthma?

A
  • CXR
  • PFT
  • PEFR
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60
Q

what are the s/s for asthma?

A
  • expiratory wheezing, crackles, or diminished
  • dry cough
  • sitting retractions
  • prolonged expiration
  • restlessness
  • fatigue
  • tachypnea
  • cyanosis
  • barrel chest
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61
Q

why do nurses need to avoid giving cold liquids to a pt w/ asthma?

A

avoid bronchospasms

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62
Q

what is the nursing care for a child w/ asthma?

A
  • administer humidified O2
  • high fowler’s
  • monitor pulse ox
  • maintain IV access (hydration, IV steroids)
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63
Q

what are the medications for asthma?

A
  • steroids
  • oxygen
  • IV fluids
  • bronchodilators (beta agonists & anticholinergics)
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64
Q

what is more important for patient and families to know about regulating asthma?

A
  • check peak flow
  • keep rescue inhaler
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65
Q

LTB is usually preceded by an upper respiratory infection

RSV most common

A

true

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66
Q

what is the primary cause of bronchiolitis?

A

RSV

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67
Q

RSV is most prevalent during the first 2 years of life

A

true

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68
Q

what is cystic fibrosis?

A

increased production of thick mucus in bronchioles and small intestines, & pancreatic and bile ducts

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69
Q

what is the etiology of CF?

A

inherited autosomal recessive trait from both parents

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70
Q

what is the role of pancreatic enzymes in the body?

A

they catabolize fats, carbohydrates & protein

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71
Q

what is the pathophysiology of CF?

A
  • increased viscosity of secretions
  • atelectasis
  • clogged pancreatic ducts (–> absent enzymes)
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72
Q

what are the diagnostic tests for CF?

(6)

A
  • sweat chloride test
  • CXR
  • prenatal DNA testing (from amniotic fluid)
  • AXR (meconium ileus)
  • PFT
  • stool analysis (72 hours fecal fat)
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73
Q

how does a child with CF present?

A
  • coughing
  • dyspnea
  • crackles
  • cyanosis
  • clubbing
  • steatorrhea (frothy, foul smelling)
  • low SpO2
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74
Q

how can a nurse care for a child with CF?

A
  • provide high calories & high protein
  • administer pancreatic enzymes (w/ meals)
  • administer vitamins A, E, D, K (fat soluble)
  • increase hydration
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75
Q

what are the medications for CF?

A
  • mucolytics
  • bronchodilators
  • ABX
  • pancreatic enzymes
  • fat-soluble vitamins
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76
Q

proper education for families with a child with CF

A
  • avoid respiratory illness & infection
  • chest percussion
  • postural drainage
  • high calorie & high protein
  • physical activity (loosens secretions)
  • genetic counseling
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77
Q

what is the major cause of hospitalizations among infants?

A

bronchiolitis

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78
Q

what is bronchiolitis?

A

inflammation of bronchioles with edema & excess accumulation of mucus due to RSV

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79
Q

why does air trapping & atelectasis occur in bronchiolitis?

A

increased airway resistance from obstructed bronchioles

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80
Q

how is bronchiolitis spread?

A

contact with contaminated objects(droplet precautions must be in place)

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81
Q

what are the diagnostic procedures for bronchiolitis?

A
  • nasopharyngeal swab
  • CXR
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82
Q

what are the symptoms of bronchiolitis?

A
  • worsening upper respiratory infections
  • tachypnea
  • retractions
  • low-grade fever
  • anorexia
  • thick nasal secretions
  • wheezing / crackles
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83
Q

how can a nurse care for a child with bronchiolitis?

A
  • encourage feeding
  • nasal suctioning PRN
  • increase fluid intake
  • daily weights (I&O)
  • pulse ox
  • humidified O2
  • contact precautions
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84
Q

medications for bronchiolitis

A
  • ABX
  • fluids
  • steroids
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85
Q

what is most important for families to know in caring for their child with bronchiolitis?

A
  • use of bulb syringe
  • notify HCP when anorexic or worsened breathing
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86
Q

what are the ages of a preschooler?

A

3-6 years old

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87
Q

what are the gross motor skills typically learned during the preschool years?

A
  • rides tricycle
  • up stairs alternating feet
  • hop on one foot & alternate feet
  • dress independently
  • throws & catches a ball
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88
Q

what are fine motor skills preschoolers learn?

A
  • lace shoes up
  • use of scissors & pencils
  • can draw cross, circle, diamond, & triangle
  • count numbers
  • write a few letters
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89
Q

what type of play are preschoolers engaged in?

A

associative play

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90
Q

imaginary friends are common among preschoolers

A

true

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91
Q

preschoolers are more socially aware with knowledge & less egocentric

A

true

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92
Q

which phase of Piaget are preschoolers in?

A

preoperational phase

Stage 2

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93
Q

what is a hallmark of preschooler’s cognitive development?

A

language (being able to express themselves sufficiently)

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94
Q

preschoolers cannot reason beyond the observable

A

true

literal language, not figurative

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95
Q

preschoolers have a lack of reversibility

A

true

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96
Q

which stage of Erikson’s are preschoolers in?

A

initiative vs. guilt

Stage 3

exercise autonomy, feeling guilty for unfulfilling tasks

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97
Q

what does the nurse tell a preschooler’s parent who is worried about their child’s stuttering and stammering

A

it is a normal characteristic of language development

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98
Q

treatment for hypertensive AKI

A
  • anti-HTN
  • limit fluids
  • limit salt
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99
Q

manifestations of Wilms tumor

A
  • aniridia
  • HTN
  • hematuria
  • hemihypertrophy
  • overgrowth syndrome (Beckwith-Wiedemann)
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100
Q

diagnostic procedures for Wilms tumor

A
  • radiographic studies (x-ray)
  • ABD U/S
  • hematologic & biochem studies
  • UA
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101
Q

why should nurses not palpate the protrusion in Wilms tumor?

A

to avoid rupturing the tumor

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102
Q

what is the treatment for Wilms tumor?

A

surgical removal of tumor, affected kidney, & adjacent adrenal gland

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103
Q

what is the triad for HUS?

A
  • anemia
  • thrombocytopenia
  • renal failure
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104
Q

what are the lab results associated with HUS?

A
  • decreased Hgb & Hct
  • elevated BUN
  • elevated Creatinine
  • elevated reticulocyte
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105
Q

what is the nursing care for HUS?

(5)

A
  • monitor I&O
  • fluid replacement
  • treat HTN
  • provide seizure precautions
  • enteral nutrition
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106
Q

what is included in renal diet?

A
  • low Na+
  • high carbs
  • low protein
  • fluid restrictions
  • avoid fresh & organic produce
107
Q

what are the implications for AKI?

accumulation of waste

A
  • azotemia
  • uremia
  • inability to excrete waste, concentrate urine, & conserve electrolytes
108
Q

diagnostic results for AKI

A
  • elevated BUN
  • reduced GFR
  • elevated creatinine
109
Q

treatment for hyperkalemic AKI

A

Kayexalate

110
Q

treatment for hypertensive AKI

A
  • anti-HTN
  • limit fluids
  • limit salt
111
Q

treatment for anemic AKI

A

PRBC

if Hgb is < 6g/dL

112
Q

emesis

pyloric stenosis

A

projectile vomiting

113
Q

definition

pyloric stenosis

A

hypertrophy of circular muscle of pylorus

causes obstruction & constriction

114
Q

therapeutic procedures for pyloric stenosis

A
  • pylorotomy
  • laparotomy
115
Q

hallmark signs of pyloric stenosis

A
  • moveable mass in epigastrum
  • projectile vomiting
  • possible peristaltic wave while supine
  • dehydration
116
Q

characteristic

celiac disease

A

intolerance to the protein gluten

117
Q

what is the pathology for Celiac disease?

A

gluten-sensitive enteropathy

118
Q

what are the common manifestations of Celiac disease?

A
  • ABD distension
  • vomiting
  • diarrhea w/ foul odor
  • chronic malabsorption syndrome
119
Q

cleft lip/ palate feeding bottles

A
120
Q

when can cleft palate be repaired?

A

between 6-12 months of age

usually before 2 years old

121
Q

postop nursing care for cleft palate repair

A
  • elevated supine position (or on side)
  • cool mist tent
  • blended diet
  • elbow restraints
  • advice to avoid sucking for 7-10 days
  • no oral temps
122
Q

for how long do children who had their cleft palate repaired stay in elbow restraints?

A

4-6 weeks

123
Q

when do posterior fontanels close?

A

2-3 months old

124
Q

when do deciduous teeth erupt?

A

6-10 months old

125
Q

what is the recommended dose for Acetaminophen for infants?

A

10-15mg / kg / dose
(max. 5 doses)

126
Q

what do babies need for healthy & safe sleep?

A
  • sleeping in their own bed close to parent’s bed
  • no soft bedding
  • no smoking
  • no overheating
  • supine position
127
Q

s/s of GERD

A
  • excessive crying
  • arching of back
  • spitting up/ vomiting
  • cough, wheezing, stridor, gag
  • apnea
  • bloody emesis
  • difficulty swallowing
  • CP
  • heart burn
128
Q

managements for GERD

A
  • weight control
  • small frequent meals
  • avoid food that intensify reflux
  • thickened feedings
  • elevate HOB (or hold baby for one hour)
129
Q

what are the medications for GERD?

A
  • Ranitidine
  • Omeprazole
130
Q

hallmark sign of appendicitis

A

pain at McBurney’s point (RLQ)

131
Q

what are the diagnostic tests that can confirm appendicitis?

A
  • CBC(WBC)
  • CT scan
  • CRP(detects inflammation)
132
Q

what would a CT scan show for appendicitis?

A

enlarged appendix & thickening of appendiceal wall

133
Q

what is osteogenesis imperfecta?

A

an inherited connective tissue disorder that results in bone fractures along w/ restricted growth

“brittle bone disease”

134
Q

what are the clinical manifestations of osteogenesis imperfecta?

A
  • multiple bone fractures
  • blue sclera
  • early hearing loss
  • hypoplastic discolored teeth
135
Q

what is the treatment for osteogenesis imperfecta?

A

pamidronate IV with biphosphate

136
Q

what is the expected MOA of pamidronate?

A

increases bone density

137
Q

what are the signs of compartment syndrome that occurs with casts?

5 P’s

A
  • paresthesia
  • pallor
  • paralysis
  • pain
  • pulselessness
138
Q

what are the nursing priorities for a child with a cast?

A

regular skin checks & neurovascular checks

139
Q

what are tractions used for?

(4)

A
  • provide muscle rest
  • immobilization
  • alignment
  • prevent contractures
140
Q

what are the nursing actions for cast care & traction?

(7)

A
  • 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)
141
Q

what are the components of neurovascular assessments?

A
  • sensation
  • skin temperature
  • skin color
  • cap refill
  • pulses
  • movement
142
Q

what are the types of skin tractions?

A
  • Bryant
  • Buck
  • Russell
143
Q

what is the most prominent etiology of cerebral palsy?

A

kernicterus

elevated bilirubin in newborns

144
Q

what is cerebral palsy?

A

a nonprogressive impairment of motor function that causes spasticity or dyskinesia (involuntary movements)

145
Q

what are the s/s of cerebral palsy?

(8)

A
  • 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
146
Q

what are the expected findings of spina bifida cystica?

(5)

A
  • flaccid muscles
  • lack of bowel control
  • rectal prolapse
  • spinal curvature abnormalities (kyphosis/ scoliosis)
  • protruding sac
147
Q

what are the nursing actions after treating hypoglycemia w/ 15g carbs & glucagon?

A
  • recheck glucose 15mins after until levels are 70mg/dL or above
  • continue to monitor for 2hrs
148
Q

what is the HgbA1c level for hyperglycemia?

A

< 6.5%

149
Q

what is the fasting BG level for hyperglycemia?

A

126mg/dL or above

150
Q

what is the starvation response in T1DM?

A

fatty acid is broken down (to obtain more energy from the body) and in the process produced ketone bodies

151
Q

starvation response over a prolonged period of time can lead to which complication?

A

diabetic ketoacidosis

152
Q

what are the s/s of DKA?

A
  • Kussmaul respirations
  • fruity breath
153
Q

what are the s/s of T1DM?

(7)

A
  • polyuria
  • polyphagia
  • polydipsia
  • flushed/ dry skin
  • confusion
  • wt loss
  • retinopathy
154
Q

what is the most concerning delay in developmental milestone found in an infant?

A

head lagging

155
Q

what does head lagging indicate?

A

cerebral palsy

156
Q

what are the supplements that pregnant women should take to prevent NTDs?

A
  • niacin
  • folate
157
Q

what is the first sign of puberty in girls?

A

breast development

158
Q

definition

animism

A

personification of inanimate objects

159
Q

what are the nursing actions for a child with a myelomeningocele preop?

A

lay on their side with the sac covered with a sterile saline gauze

160
Q

Bryant’s traction is only appropriate for children with hip dysplasia that meet which criteria?

A
  • younger than 3 yrs old
  • weighing less than 35 lbs.
161
Q

what is the first sign of puberty in boys?

A

testicular enlargement

162
Q

what is hemophilia?

A

a group of bleeding disorders characterized by difficulty controlling bleeding due to lack of clotting factors

163
Q

what are the types of hemophilia?

A
  • Hemophilia A (classic)
  • Hemophilia B
  • Von Willebrand Disease
164
Q

which clotting factor does Hemophilia A lack?

A

factor VIII

165
Q

which clotting factor does Hemophilia B lack?

A

factor IX

166
Q

which is the most common type of hemophilia?

A

Von Willbrand disease

167
Q

what is Von Willebrand hemophilia?

A

the inherited lack of the von willebrand factor protein characterized by inability of platelets to aggregate

168
Q

both Hemophilia A & B are male dominant (x-linked recessive)

A

true

169
Q

Von Willebrand disease affects both males & females

A

true

170
Q

how is hemophilia diagnosed?

A
  • hx of bleeding episodes
  • evidence of x-linked inheritance
  • PTT
  • factor assays
  • DNA testing
171
Q

what are the medications & treatment for hemophilia?

(5)

A
  • synthetic vasopressin (DDAVP)
  • steroids
  • factor VIII products
  • pooled plasma
  • recombinant products
172
Q

what is the MOA of DDAVP (Desmopressin) for Hemophilia?

A

increases plasma factor VIII (only for Hemophilia A)

173
Q

what is the nursing care for hemophilia?

(4)

A
  • monitor urine, stool, & NG fluid for occult blood
  • administer Acetaminophen instead of aspirin
  • administer injections via subQ only
  • venipunctures are preferred for blood sampling
174
Q

where is the most appropriate site for a bone marrow biopsy on a child younger than 18 months?

A

tibia

175
Q

where is the most appropriate site for a bone marrow biopsy on a child older than 18 months?

A

anterior iliac crest

176
Q

what are the nursing actions for a bone marrow biopsy?

A
  • apply pressure dressing for 24hrs
  • have the patient in side-lying position
  • place a pillow under their hips
177
Q

patients with sickle cell anemia have what type of Hgb?

A

Hgb S

predominantly; it replaces Hgb A

178
Q

which diagnostic procedure is used for sickle cell anemia?

A
  • hemoglobin electrophoresis
  • sickledex finger stick
179
Q

what are the nursing actions for a sickle cell crisis?

A
  • adequate oxygenation
  • hydration
  • transfusion
  • ABX
  • analgesics
  • FEB
180
Q

what are the s/s of vasooculsive crisis in sickle cell anemia?

(6)

A
  • pain
  • priapism
  • acute chest syndrome
  • stroke
  • severe joint pain
  • swollen joints & extremities
181
Q

what are the nursing actions for sickle cell anemia?

(8)

A
  • analgesics
  • O2
  • promote rest
  • give oral fluids
  • monitor for infection
  • administer PCV, Hib, Meningococcal vaccines
  • apply warm packs to joints
  • administer Hydroxyurea
182
Q

what is the prevention for sepsis in sickle cell anemia?

A

prophylactic Penicillin

until 5 years old

183
Q

how does hydroxyurea help manage sickle cell anemia?

A

reverts sickle cells to its original shape (promoting roundness & flexibility)

reverse sickle cell effects

184
Q

what is the nursing care for a patient experiencing sickle cell crisis (vasooclusive)?

A
  • administer analgesics (acetaminophen, ibuprofen, or opioids)
  • apply warm compress to joints
  • O2
  • bed rest
  • increase fluids
185
Q

which foods contain gluten?

A
  • barley
  • rye
  • oats
  • wheat

BROW

186
Q

what are the symptoms for pertussis?

A
  • runny nose
  • severe cough (whooping upon inspiration)
  • spasms
  • flushing
  • cyanosis
  • vomiting
187
Q

what are the precautions implemented for pertussis?

A

droplet precautions

188
Q

what is the nursing care for hemophilia?

(4)

A
  • monitor urine, stool, & NG fluid for occult blood
  • administer Acetaminophen instead of aspirin
  • administer injections via subQ only
  • venipunctures are preferred for blood sampling
189
Q

what is the MOA of DDAVP (Desmopressin)?

A

increases plasma factor VIII (only for Hemophilia A)

190
Q

how is hemophilia diagnosed?

A
  • hx of bleeding episodes
  • evidence of x-linked inheritance
  • PTT
  • factor assays
  • DNA testing
191
Q

what are the medications & treatment for hemophilia?

(5)

A
  • synthetic vasopressin (DDAVP)
  • steroids
  • factor VIII products
  • pooled plasma
  • recombinant products
192
Q

what is Rheumatic fever?

A

an inflammatory disease that occurs as a reaction to Group A strep infection

193
Q

s/s of Rheumatic fever

(7)

A
  • Aschoff bodies (tiny lesions of the heart)
  • carditis
  • murmur
  • polyarhritis
  • rash in trunk & extremities
  • subcutaneous nodules
  • CNS involvement (uncoordination + involuntary mvmnts)
194
Q

what are the medications that can treat Rheumatic fever?

A
  • penicillin G
  • sulfadiazine(ABX)
  • penicillin V
195
Q

what is the earliest sign of dehydration?

A
  • tachycardia
  • poor perfusion (cap refill)
196
Q

what are the s/s of hypoglycemia?

A
  • irritability
  • decreased LOC
  • slurred speech
  • cold & clammy
  • pallor
  • hunger
197
Q

what are the s/s hyperglycemia?

A
  • polyuria
  • polydipsia
  • polyphagia
  • NV
  • fruity breath
198
Q

what is the first intervention for dehydation in pediatrics?

A

oral rehydration therapy with Pedialyte or Gatorade ONLY

199
Q

what are the s/s of Graves disease?

(6)

A
  • hyperactive
  • hyperstimulated
  • exophthalmos
  • tachycardia
  • diaphoretic
  • weight loss
200
Q

what are the signs of compartment syndrome that occurs with casts?

5 P’s

A
  • paresthesia
  • pallor
  • paralysis
  • pain
  • pulselessness
201
Q

what is the pathophysiology of nephrotic syndrome?

A

increasing permeability of basement membrane in kidneys leading to albumin leaks & accumulation of fluid in interstitial spaces

202
Q

what is the etiology of nephrotic syndrome?

A

inherited autosomal recessive gene

203
Q

what are the manifestations of nephrotic syndrome?

(7)

A
  • weight gain
  • periorbital edema
  • ascites
  • oliguria
  • vomiting
  • irritability
  • proteinuria (15g in 24-hr urine)
204
Q

children with nephrotic syndrome have an increased risk of upper respiratory infection

A

true

205
Q

what is the nursing care for nephrotic syndrome?

(5)

A
  • elevate legs to relieve edema
  • strict I&O
  • measure ABD girth daily
  • monitor for proteinuria
  • salt restriction
206
Q

what is the treatment for nephrotic syndrome?

A
  • low Na+ diet
  • severe fluid restriction
  • diuretics (due to edema)
  • 25% albumin
  • prednisone
207
Q

what is the goal for treating nephrotic syndrome?

A
  • reduce excretion of urinary protein
  • reduce fluid retention in tissues
  • prevent infection
208
Q

what is osteogenesis imperfecta?

A

an inherited connective tissue disorder that results in bone fractures along w/ restricted growth

“brittle bone disease”

209
Q

what are the clinical manifestations of osteogenesis imperfecta?

A
  • multiple bone fractures
  • blue sclera
  • early hearing loss
  • hypoplastic discolored teeth
210
Q

what is the treatment for osteogenesis imperfecta?

A

pamidronate IV with biphosphate

211
Q

what is the expected MOA of pamidronate?

A

increases bone density

212
Q

what are the types of fracture in children?

A
  • bend
  • buckle
  • greenstick
  • complete
213
Q

bend fratcures only occur in the ulna & fibula when there is a fracture in the radius & tibia

A

true

214
Q

the most common site for a fracture in a child is the growth plates, where is it?

A

located on the ends of the hard bone (epiphyseal)

215
Q

what are the styles of parenting?

A
  • authoritarian
  • permissive
  • authoritative
216
Q

what are the types of families?

(7)

A
  • traditional
  • nuclear
  • blended
  • extended
  • single parent
  • binuclear
  • communal
217
Q

fluid calculations

1-10 kg

A

100mL/kg

218
Q

fluid calculations

11-20 kg

A

(1000mL) + (50mL / kg > 10)

219
Q

fluid calculations

> 20kg

A

(1500mL) + (20mL/ kg > 20)

220
Q

what kind of reflexes does a child with meningitis manifest?

A
  • Brudzinsky sign
  • Kernig’s sign
  • Nuchal rigidity
221
Q

which vaccine prevents meningitis?

A

Hib vaccine

222
Q

which bacteria causes meningitis?

A
  • group B strep
  • Hib
223
Q

what are the s/s of meningitis?

(7)

A
  • abrupt onset fever
  • vomiting
  • photophobia
  • HA
  • Nuchal rigidity
  • Kernig’s sign
  • Brudzinski’s sign
224
Q

what is the diagnostic procedure for meningitis?

A

lumbar puncture

225
Q

what are the CSF characteristics for bacterial meningitis?

A
  • elevated WBC
  • cloudy color
  • elevated protein
  • decreased glucose
  • (+) Gram stain
226
Q

what are the CSF characteristics for viral meningitis?

A
  • clear color
  • elevated WBC
  • normal protein content
  • normal glucose
  • (-) Gram stain
227
Q

what is Reye syndrome?

A

a neurological dysfunction that causes liver dysfunction & cerebral edema

228
Q

which medication is the cause for Reye syndrome heavily associated with?

A

Aspirin

229
Q

Reye syndrome typically follows a viral illness such as flu or varicella

A

true

230
Q

what are the emergent measures for status epilepticus?

(5)

A
  • airway
  • oxygen
  • suction
  • IV ativan
  • thermoregulation
231
Q

what are the nursing actions prior to a lumbar puncture?

A
  • assist client to void
  • apply EMLA cream
232
Q

what are the nursing actions after a lumbar puncture?

A
  • apply pressure dressing to site
  • monitor for bleeding, hematoma, infection
  • allow patient to lay flat
233
Q

how is the child positioned for a lumbar puncture?

A

side lying w/ head & knees flexed

234
Q

what is the starvation response in T1DM?

A

fatty acid is broken down (to obtain more energy from the body) and in the process produced ketone bodies

235
Q

what are the s/s of hyperthyroidism?

A
  • irritability
  • hyperactivity
  • exophthalmos
  • goiter
  • wt loss
236
Q

what is Grave’s disease?

A

a form of hyperthyroidism that is usually an autoimmune response to TSH receptors

237
Q

hyperthyroidism is more common in girls (at least 5x more likely)

A

true

238
Q

what are the s/s of Grave’s disease?

A
  • fever
  • enlarged thyroid gland
  • exophthalmos
  • urticaria
  • vasculitis
  • agranulocytosis
239
Q

children can become hyperthermic when in a toxic coma

A

true

240
Q

what are the preoperative actions for a patient who is scheduled for a meningocele sac closure?

A
  • 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
241
Q

what are the postperative actions for a patient who had a meningocele sac closure?

(6)

A
  • monitor weight
  • monitor I&O
  • resume oral feedings
  • provide ROM
  • assess for bulging fontanels
  • measure head circumference
242
Q

what are the appropriate client education for a patient with a meningocele?

A
  • avoid objects with latex
  • monitor for bladder infection or dysfunction
  • monitor widening head circumference
243
Q

which lack of vitamins during gestation can cause spina bifida?

A
  • folate
  • niacin
  • cobalamine
244
Q

what are the diagnostic tests to determine spina bifida during gestation?

A
  • AFP
  • amniocentesis
  • U/S
245
Q

elevated AFP levels indicate spina bifida

A

true

246
Q

what are the treatments for seizure?

(6)

A
  • Ketogenic diet
  • antiepileptic drugs
  • vagus nerve stimulation
  • focal resection
  • hemispherectomy
  • corpus callostomy
247
Q

what is included in a Ketogenic diet?

A
  • high fat
  • low carbs
  • adequate protein
248
Q

what are the emergent measures for status epilepticus?

(5)

A
  • airway
  • oxygen
  • suction
  • IV access (-zepam & phenobarbital)
  • thermoregulation
249
Q

what are the types of anemias?

A
  • iron deficiency
  • sickle cell
  • B-Thalassemia(Cooley)
  • aplastic
250
Q

what are the various reasons for anemia?

A
  • decreased RBC production
  • increased loss of RBC (from bleeding)
  • increased hemolysis
251
Q

what are common clinical manifestations of anemia?

A
  • fatigue
  • pallor
  • decrease in Hgb
252
Q

what are the clinical manifestations of Cooley anemia?

B-Thalassemia

A
  • small stature
  • splenomegaly
  • hepatomegaly
  • decreased H&H
  • abnormal blood smear
253
Q

what is aplastic anemia?

A

a bone marrow failure condition in which formed elements of the blood are simultaneously depressed

254
Q

what are the conditions associated with aplastic anemia?

A
  • anemia
  • leukopenia
  • thrombocytopenia
255
Q

what are the manifestations of coarctation of the aorta?

(5)

A
  • elevated BP in upper extermities (> 20mmHg difference)
  • bounding pulses in upper extremities
  • cool skin in lower extremities
  • nosebleeds (epistaxis)
  • absent femoral pulses
256
Q

what is the hallmark heart sound the nurse will hear in aortic stenosis?

A

bruit

257
Q

what are the congenital mixed defects that can be found in children?

A
  • transposition of the great vessels
  • total anomalous pulmonary venous return
  • truncus arteriosus
  • hypoplastic left heart syndrome
258
Q

what are the congenital heart defects that increase pulmonary blood flow?

A
  • atrial septal defect
  • ventricular septal defect
  • patent ductus arteriosus
  • atrioventricular canal
259
Q

what are the obstructive defects of the heart?

A
  • coarctation of the aorta
  • aortic stenosis
  • pulmonary stenosis
260
Q

auscultory landmarks of the heart

A

be mindful of STERNAL BORDERS & MIDCLAVICULAR

261
Q

what are the conditions that are included under Tetralogy of Fallot?

(4)

A
  • pulmonary stenosis
  • overriding aorta
  • right ventricular hypertrophy
  • VSD
262
Q

s/s of ToF

(5)

A
  • cyanotic spells (Tet spells)
  • polycythemia
  • systolic murmur
  • clubbing
  • tachypnea
263
Q

what is the treatment for ToF?

A
  • O2
  • Morphine (induce slower RR)
  • squatting (knees to chest)
264
Q

what is the nursing action when a child has > 60mg/kg of iron?

A

administer Deferoxamine

PEDS (11 decks)

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