Final Exam Flashcards
1
Q
1 tbsp = ____ tsp=____mL
A
1tbsp=3tsp=15mL
2
Q
1 fl oz = ___tbsp =____mL
A
fl oz = 2tbsp =30mL
3
Q
1 cup = ____ fl oz =_____mL
A
1 cup = 8 fl oz =250mL
4
Q
1 tsp = _____mL
A
1 tsp=5mL
5
Q
1mL=____ cc
A
1mL=1cc
6
Q
What ages are appropriate for use of the FACES pain scale?
A
Ages 3-8 or developmental delay
7
Q
What ages can you use the numerical pain scale?
A
Over 8 years with no developmental delay
8
Q
What vaccines should be held if a child is immunocompromised?
A
Rota virus
MMR
Varicella
Flu
9
Q
If a child has been given a steriod for over 3 weeks, does this effect vaccine schedules?
A
Yes, you would hold live vaccines
10
Q
If a child has hip dysplasia, what type of brace is used and how long do they need to wear it?
A
A pavlik brace and they need to wear it for 24 hours
11
Q
What is the rice method?
A
RICE is a mnemonic acronym for the four elements of a treatment regimen that was once recommended for soft tissue injuries: rest, ice, compression, and elevation. It
12
Q
How do you monitor a child in a cast?
A
Swelling
Capillary refill
Pain
Ability to move fingers/toes (ATI)
13
Q
In what demographic of children is impetigo common in?
A
Preschool and school age groups
14
Q
What is the causitive agent of impetigo, and what does this also put the child at risk of?
A
Impetigo is caused by strep and this also can put the child at risk for AGN
15
Q
What are the presenting symptoms of impetigo?
A
Appears as small red macules->the vesicles-> then exudate forms that appear as Honey crusted lesions
There is also another form bullous impetigo caused by s. aureus
16
Q
What is the treatment for impetigo?
A
Muprocin for facial lesions and 1st gen cephalosporings for systemic infection
17
Q
What are the nursing interventions for impetigo?
A
Educate on not touching infected areas (impetigo is highly contagious)
Keep child’s fingernails short
Emphasize hand hygiene
18
Q
Which type of tinea fugal infection involves the hair follicle?
A
Tinea capis
19
Q
What medication treats tinea capis?
A
griseofulvin
20
Q
What nursing education should be given for the tinea fungal infections?
A
Do not share clothes or towels with those infected with tinea fungal infections
21
Q
Diaper candidiasis is a ____________ __________ infection that is treated with?
A
Diaper candidiasis is a yeast diaper infection that is treated with topical nystatin
22
Q
What education is given to parents of a child with diaper candidiasis?
A
Leave the diaper open to the air
Watch for diaper candidiasis if infant is being treated with antibiotics
23
Q
What types of treatment is used for eczema?
A
Typically treated with lots of moisturizers like aquafor or topical steriods like hydrocortizone
24
Q
What is coxsackie virus?
A
Hand, foot and mouth -> involves lesions on the hands, feet and mouth
25
What is a child with coxsackie virus at risk of?
Dehydration because of sores in mouth that makes them not want to eat
26
How is coxsackie virus treated?
Give tylenol for pain relief along with popsicles and pedialight to prevent dehydration
27
What is molluscom?
Skin colored papules with a depressed center that are self limiting, but can take up to 18 months to go away
28
How is molluscum treated?
It is not treated unless it is affecting the genital/eye area
29
What is important education for patients with molluscum?
Do not share towels/washcloths
30
What are the nursing interventions for head lice?
Place all stuffed animals in plastic bags for at least 14 days
Wash linens in hot water
Use prometherin shampoo for head lice
Comb hair for lice nits
31
A child that is pale, lethargic, not eating enough with a hgb level of <11 is suspected to have?
Iron deficient anemia
32
What is the treatment for iron deficient anemia?
Iron drops served with vitamin c rich fruit
Do not give milk within 1 hr before and after administration, and limit to 3/4 cups per day
33
After treatment of iron deficient anemia is completed, what should occur?
Hgb should be rechecked in a few weeks to see if family was compliant. and one more recheck for sucess.
34
What are the adverse effects of iron deficient anemia treatment?
Iron drops can change the color of poop to make it bright green and can cause constipation
35
What is the number 1 complication of sickle cell disease?
Vaso-occlusive crisis
36
If a patient is experiencing a vaso-occlusive crisis, what treatment is expected?
IV fluids 1.5 to 2 times the maintenance
Morphine PCA->oxycodone->mild tylenol
37
What is a sequestration crisis in sickle cell?
When sickled cells block the blood vessels leading out of the spleen, blood stays in the spleen instead of flowing through it, causing spleen to enlarge
38
In what age does a sequestration crisis occur, and what is normally the treatment?
Normally occurs in the younger child and a splenectomy is normally the treatment
39
What are hemophilia precautions?
No NSAIDS
No contact sports *** (Stand out feature)
Bleed precautions
40
What is epistaxis?
A bloody nose normally during allergy season
41
What are the interventions for epistaxis?
Lean child forward
Apply pressure to nose for 5-10 minutes
Can use cooling rag or ice
If bleeding continues for 20 minutes, seek help
42
A child that is fatigued, complaining of pain, getting more infections than siblings, has low hbg and anemia could be suffering from?
Acute lymphoblastic Leukemia
43
What is the key diagnosing factor for acute lymphoblastic leukemia?
Bone marrow biopsy
44
What ANC level qualifies a child for neutropenic precautions?
ANC <500 or ANCE<1000 with fever
45
What are some general neutropenic precaution guidelines?
Report chills, rash, chicken pox exposure
Child should wear mask outside of room
Sign on door of patient
Monitor all labs
Private room
Strict handwashing
Replace adhesive bandages qday
IV bags & tubing changed q 24 hours
Provider wears mask and PPE
46
What are some of the guidelines for thrombocytopenia precautions?
Use soft bristled toothbrush and no floss
No NSAIDS/Aspirin
No IM injections
Report any head trauma STAT
Monitor for active bleeding
47
What are the normal WBC count levels?
4,000-15,000
48
What are the normal platelet levels?
150,000-450,000
49
Any child with leukemia that has <50,000 platelet count will be?
Placed on thromycytopenic precautions
50
What is important to remember about diet in regards to diarrhea?
It is important to have protein in the diet
51
How is dehydration combated in cases of diarrhea?
1.5-2 times maintenance fluids
52
What is the top intervention in nephrotic syndrome?
Administration of albumin
53
What is a innocent murmur?
No anatomical or physiologic abnormality exists
54
What is a functional murmur?
No anatomical cardiac defect but physical abnormality is present
55
What is an organic murmur?
A cardiac defect with or without a physical abnormality
56
What are the 4 classes of CHB?
Increased pulmonary blood flow
Decreased pulmonary blood flow
Ductal dependent/Mixed defects
Obstructive defects
57
What are the CHB defects of increased pulmonary blood flow?
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosis
Atria-ventricular canal
58
What are the CHB defects of decrease pulmonary blood flow?
Tricuspid Atresia
Tetralogy of fallot
59
What is tetralogy of fallot?
4 total defects including VSD, pulmonary stenosis, overiding aorta, RV hypertrophy
60
What are the ductal dependent/mixed defects?
Hypo-plastic left heart
Transposition of the great vessels
61
What CHB is treated with prostaglandin E?
Transposition of the great vessels to keep DA open
62
What are the CHB obstructive defects?
Aortic stenosis
Coartation of the aorta
63
Which CHB defect involves 'death spells'?
Coartation of the aorta
64
What is Kawasaki's disease?
Acute vasculitis with unknown cause that can progress to coronary artery aneurysms
65
What are the signs/symptoms of Kawasaki's disease?
(Must have 5 for diagnosis)
Fever for 5+ days
Bilateral conjuctival inflammation w/no exhudate
Oral mucosa changes such as dry, crackled lips
Strawberry tongue
Reddened oral cavity
Extremity changes (peripheral edema, erythema, or desquamination of palms, or soles)
Polymorphous rash
Cervical lymphadenopathy
66
What are the nursing interventions for Kawasaki's?
Monitor cardiac status:
Assess for signs and symptoms of heart failure
Daily weights
I&Os
Administration of fluids/meds
Supportive care
ECHO to monitor for coronary artery dilation/aneurysm formation
67
What are the medical interventions for Kawasaki's?
Give IVIG over 10-12 hours in the first 7 days of illness
Administer high dose aspirin q6hrs
68
What is endocarditis?
Infection of the endocardial layer of the heart that most often results from a bactermia/fnugal infection
69
What are the signs/symptoms of endocarditis?
Unexplained low grade fever
Anorexia/weight loss
General Malaise
New murmurs
Dysrhythmias
HF
70
What is the treatment for endocarditis?
Bed rest
Admin of organism specific antibiotic/antifungal (2-8 weeks)
Will have to take prophylactic antibiotics for the rest of their life
71
What are the antibiotic/antifungals given for endocarditis?
Gentamycin/streptomycin
Amphotericin
72
What is rheumatic fever?
Inflammatory disease that occurs within 2-6 weeks after group A beta hemolytic strep that may result in valvular damage
73
What are the signs of rheumatic fever?
joint pain
Edema
Fever
Non-itchy rash to trunk and proximal extremites
Mitral valve murmur
Chorea (little, odd movements)
74
What are the treatments for pediatric hypoglycemia?
Glucose tablets (5 g per tablet) Glucose gel (15 g per tube) Sweetened fruit juice: 12 g carbohydrate per 4 oz (120 mL)
75
What are the treatments for pediatric hyperglycemia?
Changes to your insulin program or a supplement of short-acting insulin can help control hyperglycemia. A supplement is an extra dose of insulin used to help temporarily correct a high blood sugar level.
76
Which virus causes most cases of bronchiolitis?
RSV
77
What is RSV?
Paramyxovirus that contains a single strand of RNA with 2 major subgroups A & B
78
What are the initial symptoms of RSV?
Begins with rhinorrhea and low grade fever
Cough can develop
79
What are the progressing symptoms of RSV?
Increased coughing with wheezing
Fever
Tachypnea
Retractions
Refusal to nurse/bottle feed
Copious secretions
80
What are the symptoms of severe RSV?
Tachypnea (>70 bpm)
Listlessness
Apenic spells
Poor air exchange
Poor breath sounds
Cyanosis
81
What are the diagnosing criteria for RSV?
Rapid immunofluorescent antibody direct antibody staining
Enzyme linked immunosorbent assay techniques
82
What ages is epiglotitis seen in?
Ages 2-5
83
What are the major symptoms of epiglotitis?
Dysphagia
Stridor when aggravated when supine
Drooling
Fever
Toxic appearance
Rapid pulse
Rapid respiratoion
84
What are the treatments for epiglotitis?
Airway protection (possible intubation)
Humidified oxygen
Fluids
Antibiotics
Reassurance
85
What is the difference between epiglotitis and laryngotracheobronchitis?
Absence of cough
Presence of dysphagia
Degree of toxicity
86
What are the symptoms of croup?
Characterized by:
Horseness
Resonant cough (described as barking)
Varying inspiratory stridor
Varying respiratory distress
87
Croup occurs more often in?
Boys than girls
88
When during the year is croup normally seen?
Late autumn through early winter
89
What is the causative agent of acute epiglottitis?
H. influenzae
90
What characterized respiratory distress?
Nasal flaring
Grunting
Retractions
Tachypnea
Tugging (tracheal)
Tachycardia
91
A respiratory rate of over ______ in infants indicates respiratory distress.
Over 60 breaths per minute
92
Absent seizures (also known as petite mal) are characterized by?
Staring/blinking/lip smacking/drooling lasting from 5-30 seconds that is a transient loss of consiousness that may appear confused with inattention/bored
93
A tonic clonic (also known as a grand mal) are characterized by?
Acute drop or fall to the ground with loss of conciousness, possible incontinence, flexion and extention of all muscles and have a post-ictal state
94
Why do we worry about the airway during a tonic clonic seizure?
Because tonic clonic seizures involve the flexion and extension of all muscles, including respiratory muscles we have to worry about the airway
95
What are myclonic seizures?
Repeated muscle contractions with no post ictal state
96
Both simple and complex focal seizures include?
A specific area of the brain that is being affected
Slurred speech
Can inlcude sensory aura
97
A sensory aura is?
A warning/precursor to a seizure
Can identify the area of the brain that the seizure is occuring
98
What age group do we tend to see febrile seizures?
Under 5
99
What are the characteristics of a febrile seizure?
T>101.8 degrees with rapid rise
Seizures normally last under a few minutes
100
____% of children will have a febrile seizure
3%
101
What is status epilepticus?
Seizures that last over 30 minutes that have a concern of brain damage due to hypoxia
102
What are the important nursing education points for chronic seizures
Daily medication adherence is the priority
Ketogenic diet can be implemented to reduce seizures
Sleep and adequate hydration is important
103
What are the labs for seizures?
CSF-indicated if seizures are thought to be a sign of infection like meningitis
BMP-to check electrolytes for sodium levels
MRI-to check for tumors/abnormalities in the brain
CT-to check for head trauma for first time seizures
EEG: can be standard 30 min or 24/48hrs
104
What is the first line seizure medications and why?
Benzodiazapams such as Ativan
-Most common due to decrease respiratory effects
-Duration lasts minutes not hours
-Can give up to 3 doses before moving to 2nd line
105
What are the second line seizure medications and why?
Phenobarbital IV
-Can lead to respiratory distress
Phenytoin (Dilatin)IV
-5 to 30 minute onset
-12-24 hr duration
-loading dose normally given
106
What are the chronic seizure medications?
Valproic acid (can cause hepatoxicity)
Phenytoin (dilatin)
Others such as topomax, trileptal, clonazepam, keppra, neurotin
107
What are the adverse effects of phenytoin (dilatin)?
Steven-Johnson syndrome
Osteoporosis
Ataxia
108
What is the goal in the treatment of cerebral palsy?
to maximize the child's priorities
109
How is cerebral palsy normally diagnosed?
Delays in reaching developmental milestones as well as gross motor skills and tone
110
What are the treatments for cerebral palsy?
Orthotic/mobilization devices
OT/speech
Socialization
Family support
111
What is spina bifida (myelomeningocele)?
Spinal bones fail to close properly around the spinal cord in utero
112
What is the pre-op management of spina bifida?
Use sterile dressings to cover the exposed meningies
Keep side lying or prone
113
What is important precautions are taken in the treatment of spina bifida cases?
Latex precautions because these children have a high risk of a latex rxn
114
What is the scoring for the glascow coma scale?
Severe 3-8
Moderate 9-12
Mild 12-15
115
What are the ratings for eyes in the Glascow Coma scale?
4-open
3-to voice
2-to pain
1-no response
116
What are the ratings for motor in the Glascow Coma Scale?
6-normal movement/follows commands
5-withdrawl to touch/localized pain
4-withdrawl to pain
3-decorticate flexion
2-decerebrate extension
1-no response
117
What are the types of neurological diagnostic testing?
Spinal tap/lumbar puncture
Possible Blood culture
Brain CT scan
Brain MRI
EEG
Electrolytes and CBC
118
Neuro testing:
What does a spinal tap/lumbar puncture test for?
Pressure (measured with needle)
Cell Count-no RBC, little to no WBC, glucose and protein should be not be present in spinal fluid, if seen, it means that it has been compromised
119
Neuro testing:
What does a blood culture test for?
It allows us to assess for sepsis with neuro changes
120
Neuro testing:
What is a brain CT used to test for?
Used to test for acute injury
Can show swelling
121
Neuro testing:
What is a brain MRI used to test for?
Looking for long term problems or tumors
122
Neuro testing:
What is an EEG used to test for?
It is used to look for electrical activity in the brain
Can not tell us about the past-but can show the present and risk for future activity
123
Neuro testing:
What do electrolyte and CBC test for?
If something metabolic is occuring that is affecting neurological functioning
124
What is a epidural hematoma?
A rapid bleed that is rare in children under 4
125
If a child has head pain that is described as the "worst headache ever" what could they be experiencing?
An epidural hematoma
126
What is a slow bleed that is more common and can take hours to develop? Shaken baby syndrome is an example?
Slow subdural hematoma
127
Which hormone that exerts it's effects on the kidneys can be affected by head injuries?
SIADH can be effected from head injuries.
Watch for increased urine output
128
What are the labs/diagnostics that can be used to detect head injuries?
Labs:
ABGS
Alcohol level, drug level (if neuro levels are unexplained)
CBC with differential (to see signs of infection with acute neuro changes)
Diagnostics:
CT scan
MRI
ICP
C-spine X rays
129
What is the most common, usually transient brain injury that has a brief LOC and confusion?
Brain injuries
130
What are the common sequelae from brain injuries?
Hypoxic brain injury
Increased ICP/Cerebral
Edema
Infection
131
What is decorticate posturing?
Arms are curled in (think deCORE)
132
What is decerebrate posturing?
Arms are out to side
133
A progression from ________________ to ______________- can indicate further deterioration of neurological status.
A progression from decorticate to decerebrate
134
What is Brudzinki's sign?
When patients neck is flexed, both hips and knees flex too and it can indicate meningitis
135
What is a linear fracture predetermined by?
Site
Impact
Velocity
Bone Strength
136
Where is a basilar fracture located, and what does this indicate?
Located at the base of the skull, can indicate child abuse
137
What causes 'raccoon' eyes in regards to basilar fracture?
Bruising occuring at the brainstem can present as raccoon eyes
138
What are the characteristics of a depressed fracture?
Skull is broken locally
Pieces are pushed inwards
Normally indicative of blunt force to the head over and over (child abuse)
139
What is one of the most important nursing interventions in regards to ICP?
Measuring the head circumference especially those 2 and under
140
What is cerebral edema?
Increase/shift in fluid & sodium content in the head
141
Why do we normally wait to give a neurological diagnosis in cases of head trauma?
In cases of head trauma, we expect some level of edema that can take months to resolve
142
What are the signs of increased intracranial pressure?
Hypoxia
Fever
Seizures
Hypotension
Hypercapnia
143
What are the behavioral manifestations of increased ICP in infants?
Irritability
Poor Feeding
Apenic Episodes
Vomitting
High pitched cry
Difficult to sooth
144
Why do cases of increased ICP sometimes involve vomiting?
The vomiting center of the brain is located in the brainstem
145
What are the physical manifestations of increased ICP in infants?
Tense, bulging fontanels
Separated cranial sutures
Setting sun sign in eyes
Distended scalp veins
Macelen's sign
146
What is "setting sun sign eyes"?
The pupils are turned down, infant cannot look up because there is too much pressure
147
What are the physiolgical manifestations of ICP in children?
Headache
Vomiting
Seizures
Diplopia
Blurred vision
148
What are the behavioral signs of increasing ICP in children?
Irritability
Restlessness
Drowsiness
Indifference
Decrease in physical activity/motor skills
Complaints of fatigue
Inability to follow commands
Memory loss
149
What are the LATE signs of increasing ICP?
Decreased:
LOC
Motor response
Sensory response
Decerebrate/decorticate posturing
Bradycardia
Irregular respirations (cheyne-stokes respirations)
Fixed and dilated pupils
150
_______ care is prioritized over skin breakdown.
ICP Care
151
What are the nursing interventions for increasing ICP?
If able:
-Turn q2 hours using footboards/splints
-Keep HOB at 30-45 degrees for good venous flow
Monitor airway
Assess neuro status
Place on seizure Precautions
152
Increasing ICP:
What are the nursing considerations for airway/breathing?
Less than 8, intubate
Have suction and ambu bag at bedside
153
Increasing ICP:
What are the nursing considerations for thermoregulation?
Can see wide swings in temperature that are not related to infection
Can place cooing blanket and bear hugger and turn on opposite times to regulate temp
154
What is Cushing's sign and what does it indicate?
Low HR and high BP
It indicates increasing ICP
155
What are the diagnostics for hydrocephalus?
MRI
EEG
Spinal Taps
156
What is the difference between communicating hydrocephalus and non communicating hydrocephalus?
Communicating hydrocephalus-fluid is able to flow and move
Non-communicating hydrocephalus-Fluid is stopped
157
What is the treatment of hydrocephalus?
Surgical shunt
Ventriculostomy
158
When do you withhold digoxin in children? When in neonate?
In children <70
In neonates <60
159
When is indomethacin used?
Indomethacin is indicated for patent ductus arterious (PDA) closure
160
What is prostaglandin E used?
Patency of ductus
161
What are the adverse effects of Dilantin?
Steven-johnson-syndrome
Severe hypotension
IV site irritation
GI upset if oral drug is taken without food
162
What is the therapeutic dose of dilantin?
serum levels of 10-20mcg/mL
163
What is the top medication used in nephrotic syndrome?
Albumin
164
What is the difference between short and long acting asthma medication?
Short acting: used as relief from sudden, unexpected attacks of breathlessness
Long acting: Used regular to control breathlessness in asthma and COPD
165
What is Kayexalate?
A medication used to control high potassium levels in the blood, and I&Os must be monitored
166
What are the interventions for parental chemo?
Monitoring IV site
Monitor temp
Handwashing
Limited visitors
167
What are the nursing interventions for lasix?
Lung sounds
Strict I &Os
168
What are the symptoms of shock?
BP decreases
Pulse increases
Respirations increase
Temperature decreases
Pulse pressure decreases
LOC decreases
169
What are the symptoms of IICP?
BP increases
Pulse decreases
Respirations decrease
Temp goes up and down
Pulse pressure increases
LOC decreases
170
What are the development milestones for walking?
6-9 crawling
12months-first steps
15 months-walking without help
30 months-running/jumping
3 years-tricycle
4 years- skips/hops, throws ball
5 years-walks backwards, throws ball and catches
171
What are the development milestones for words?
9-12 months: First words
12 months: 3-5 new words
18 months: 10+ words
24 months: 300 words
172
What are the triggers for seizures?
Stress
Fatigue
Dehydration
Lights/strobes
Temperatures
173
What are the interventions for seizures?
Loose clothing
O2
Medication
Suctioning PRN
Side lying
No tongue depressors
Reorient
Document
174
What assessment is contraindicated in spina bifida?
No rectal temperatures due to prolapase or irritation
175
What are the preop/post op spina bifida dressing interventions?
Pre-op sterile dressing with saline
Post-op dry sterile dressing
176
Besides Brudzinki's, what is another postural sign of meningitis?
Kernig's
When laying flat, knee cannot be straightened
177
What levels do you monitor when administering Griseofulvin?
LFTS, CBC
Take with fatty foods
178
What is Tinea Corporis?
Dermatophyte infections of face and other parts
Enlarging erythematous plaques
Annular lesions raised borders
179
What are the treatment medications for Mollluscum if it is treated?
Cimetidine x 1-4mo
Imiquimod (topical)
180
What is the #1 cause of death in sickle cell?
Infection
181
What is the treatment for ALL?
Allopurinol
182
If a child's ANC count is >1500, what are they able to do?
Go to school
183
What are the gross motor developmental milestones according to Annie?
Lifts head – 2 to 3 months
Rolls – 4 to 6 months
Sits up unsupported – 8 months
Begins to crawl – 6 to 9 months
Begins cruising – 11 months
First steps – 12 months
Walks without assistance – 15 months
Can jump and run - 30 months
Knows how to ride a tricycle (peddling) - 3 years
Hop on one foot and throws a ball
184
What are the vocabulary milestones according to annie?
social smile – 2 months
Coos and babbles – 3 months
Stranger anxiety – 6 to 9 months
Mama/dada - 9 to 12 months
3 to 5 words – 12 months
10+ word vocabulary – 18 months
300+ word vocabulary and uses small phrases – 24 months
185
What are the symptoms of scabies?
PRURITIS, erythematous papular rash, Grey-brown threadlike burrow w/ black dot at end. , Frequently in creases: fingers, wrist, elbow
186
What is the treatment of scabies?
Elimite or Lindane cream 8 hours on and wash off, soothing creams
