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Childrens-Redman > final exam > Flashcards

final exam Flashcards

1
Q

when should dornase alfa be given to a a patient with CF?

A

prior to chest PT
(it loosens the secretions so they can be expelled)

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2
Q

what play is expected for an infant?

A

solitary

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3
Q

what play is expected fir a toddler?

A

parallel

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4
Q

what play is expected for a pre-schooler?

A

associative

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5
Q

what play is expected for a school-age?

A

cooperative

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6
Q

what atraumatic care techniques can be utilized for an infant?

A
  • soothing music
  • therapeutic hugging
  • speak in calm tone
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7
Q

what atraumatic care techniques can be utilized for a toddler?

A
  • approach carefully
  • use toys/book to distract
  • parallel play
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8
Q

what atraumatic care techniques can be utilized for a pre-schooler?

A
  • puppets
  • allow to touch equipment
  • allow choices
  • count out loud
  • give bear a shot
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9
Q

what atraumatic care techniques can be utilized for a school-age?

A
  • encourage questions
  • use diagrams
  • illustrations
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10
Q

what atraumatic care techniques can be utilized for an adolescent?

A
  • respect privacy
  • don’t force talk
  • use appropriate medical terms
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11
Q

what activities should be utilized for an infant?

A
  • mobiles
  • noise-makers
  • soft toys
  • large blocks
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12
Q

what activities should be utilized for a toddler?

A
  • push-pull toys
  • lg-piece puzzles
  • balls
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13
Q

what activities should be utilized for an adolescent?

A
  • reading
  • listening to music
  • peer time
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14
Q

what activities should be utilized for a pre-schooler?

A
  • arts/crafts
  • play pretend
  • books
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15
Q

what activities should be utilized for a school age?

A
  • board games
  • action figures
  • models
  • video games
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16
Q

what motor skills are expected by 4m?

A
  • back to side
  • head control
  • grasps objects w/both hands
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17
Q

what motor skills are expected by 6m?

A
  • back to front
  • holds bottle
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18
Q

what motor skills are expected by 9m?

A
  • unsupported sit
  • creeps on hands/knees
  • crude pincer grasp
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19
Q

what motor skills are expected by 12m?

A
  • sits down from standing
  • walks w/one hand or on own
  • 2 block tower
  • simple marks on paper
  • feeds self w/cup/spoon
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20
Q

at what month should birth weight be doubled?

A

5 m

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21
Q

what does birth weight do by 1 yr old?

A

triples

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22
Q

how much should the heigh increase for the first 6 m?

A

1in/m

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23
Q

how much should the birth length increase by 12 m?

A

50%

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24
Q

how big should head be by 12m?

A

10cm

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25
Q

what resp differences are expected in infants?

A
  • lack of IgA
  • narrow nasal passages
  • trachea and chest wall more compliant
  • shorter bronchioles/bronchi
  • funnel-shape larynx
  • larger tongue
  • fewer alveoli
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26
Q

what is recommended at 4m to infants who are exclusively breastfed?

A

iron supplementation

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27
Q

how long should cows milk be avoided?

A

1st year

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28
Q

what type of formulas should be used for bottle fed infants? how many calories/oz?

A
  • iron fortified formulas (10-12mg/liter)
  • 20kcal/oz
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29
Q

what reflex must be extinguished to start solid foods around 4-6m?

A

extrusion

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30
Q

what should be first solid food?

A

iron-fortified infant cereal (rice, barley, oatmeal)

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31
Q

what are the infant new food rules?

A

1st - cereal
2nd veggies
3rd fruit
- new food every 3-5 days

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32
Q

how many words are expected by the end of age 2 (toddler)?

A

50-300 words

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33
Q

what care seat safety education should be provided for toddler?

A
  • read facing, back seat
  • forward facing after age 2
  • disabled airbag for front seat
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34
Q

what are 3 expected nutritional differences with toddlers?

A
  • physiologic anorexia
  • food jags
  • ritualism
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35
Q

what is the TAMI mnemonic for cognitive development in pre-schoolers?

A

T ime
A nimism
M agical thinking
I maginary friend

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36
Q

what are 3 social development cues expected in the pre-schooler?

A
  • fears
  • imaginative play
  • dramatic play (dress up)
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37
Q

what type of breathing pattern is expected in the school-ager?

A

diaphragmatic breathing

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38
Q

what are 3 nutritional requirements specific to the adolescent?

A
  • calcium 1300 mg/day
  • iron - 11mg (male); 15 mg (female)
  • 2000 calories
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39
Q

what are 2 nursing care techniques for the hospitalized adolescent?

A
  • maintain independence
  • encourage socialization w/friends
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40
Q

what is often the first sign of resp distress (hypoxia/hypoxemia)?

A

tachypnea

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41
Q

what are some signs of resp distress?

A
  • restlessness
  • grunting
  • cyanosis
  • rales, wheezes, rhonchi
  • retractions
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42
Q

what 4 nursing interventions can be implemented to manage hypoxemia?

A
  • oxygen therapy
  • pulse oximetry
  • chest physiotherapy
    -suctioning
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43
Q

what lab findings are expected for asthma?

A
  • increase WBC and eosinophils
  • increase Co2
  • decrease O2
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44
Q

what is the function of the PFT? when should this assessment be avoided?

A
  • measures long volume capacity and overall lung function
  • NOT used during acute exacerbation
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45
Q

what type of measurement should be taken daily for a child with asthma?

A

PIFR (peak inspiratory flow rate)

  • used daily to monitor effectiveness of management and for signs of acute symptoms
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46
Q

what does a PIFR measure?

A
  • uses flow meter to measure the amount of air that can be forcefully exhaled in 1 second
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47
Q

what medications are used in the prevention of acute exacerbation of asthma?

A
  • formoterol (long-acting bronchodil)
  • fluticasone (inhaled corticosteroid)
  • cromolyn (mast-cell stabilizer)
  • montelukast (leukotriene antagonist)
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48
Q

what meds are used in the management of acute asthma exacerbation?

A
  • albuterol
  • ipratropium (anticholinergic)
  • prednisone (IV/PO corticosteroid)
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49
Q

what is the pathophysiology of cystic fibrosis?

A
  • epithelial cells don’t conduct chloride, altering water transport
    causing thick, tenacious mucus is resp tract, pancreas and GI tract
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50
Q

what is the primary diagnostic for cystic firbrosis?

A

sweat chloride test

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51
Q

what qualifies children under 3m for cystic fibrosis?

A

sweat chloride with chloride >40 mEq/L
sodium >90 mEq/L

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52
Q

what qualifies children over 3m for cystic fibrosis?

A

chloride >60 mEq/L
Sodium > 90 mEq/L

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53
Q

what trademark stool type is seen with cystic fibrosis?

A

steatorrhea (bulky, fatty, greasy stools)

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54
Q

what can be utilized to clear secretions and prevent infection?

A

Chest PT w/postural drainage

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55
Q

what does dornase alfa do for the CF patient?

A

decreases the viscosity of mucus, improving lung function

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56
Q

what supplements are necessary for CF patients?

A

fat-solubles (A, D, E and K)

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57
Q

when should pancreatic enzyme be given to CF patient?

A

within 30 min of eating meal/snack

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58
Q

what are the key assessment cues of croup (laryngotracheobronchitis)?

A
  • barking cough
  • inspiratory stridor
  • sudden onset @ night, gone in morning
  • tachypnea, resp distress
  • nasal flaring
  • intercostal retractions
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59
Q

what are the 2 key meds for management of croup?

A

dexamethasone and racemic epinephrine

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60
Q

what are the nursing management priorities for croup?

A
  • cool mist humidifier or steamy bathroom
  • educate on s/s of increasing resp distress
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61
Q

what should be added to breast milk for children with HF?

A

HMF (human milk fortifier) to increase calories

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62
Q

what should be given with formula-fed infants with HF?

A

polycose/vegetable oil to increase calorie

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63
Q

what is the nutritional requirement for a child with HF?

A
  • 150 cal/kg/day
  • small, frequent
  • 20 min max feeding
  • cut bottle nipple (decrease work)
  • semi-upright position
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64
Q

how can rest be promoted in the child with HF?

A
  • cluster care
  • provide rest periods
  • bathe PRN
  • quiet diversional activities
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65
Q

what is the mechanism of action for captopril/enalapril?

A

reduces afterload by causing vasodilation, decreasing the pulmonary and systemic vascular resistance

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66
Q

what should be monitored before and after the administration of enalapril/captopril?

A

BP

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67
Q

what med manages edema and rids body of excess fluid and sodium?

A

lasix

68
Q

what should be monitored for lasix administration?

A
  • BP
  • I and O
  • daily weight
  • s.e. - hypokalemia, N/V, dizziness, ototoxicity
69
Q

what medication for HF increases contractility of heart muscle?

A

digitalis (digoxin)

70
Q

what HR requires digoxin to be held for an infant?

A

<90 apical

71
Q

what requires digoxin to be held for a child?

A

<70 bpm apical

72
Q

what HR requires digoxin to be held in an adolescent?

A

<60 bpm

73
Q

what dig level is expected?

A

0.8- 2 ng/mL

74
Q

what are signs of dig toxicity?

A
  • anorexia
  • n/v
  • bradycardia
  • dysrhythmias
75
Q

what is dig antidote?

A

digoxin immune fab

76
Q

what are the key findings of coarctation of the aorta?

A
  • assess pulses:
  • full bounding in BLUE
  • weak/absent in BLLE
77
Q

what heart sound is heard for coarctation of aorta?

A

soft/moderately loud systolic murmur at base or left axilla

78
Q

which condition is characterized by TET spells?

A

tetralogy of fallot

79
Q

what are the 4 components of tetralogy of fallot?

A
  • pulmonary stenosis
  • overriding aorta
  • VSD
  • R. ventricular hypertrophy
80
Q

what is seen during a TET spell?

A
  • cyanosis, hypoxemia, dyspnea, agitation
  • anoxia, unresponsiveness
  • especially in AM
81
Q

what intervention is used for TET spell?

A

knee to chest

82
Q

what assessment findings are seen with tetralogy of fallot?

A
  • loud, harsh systolic murmur
  • fainting, difficulty breathing, easy fatigue
  • polycythemia (elevated RBCs)
83
Q

what are assessment findings of Kawasaki disease?

A
  • extreme irritability
  • high fever unresponsiveness to abx for 5 or > days
  • dry mouth/throat
  • strawberry tongue, fissured lips
  • desquamtion
84
Q

what are 3 meds used for tx of Kawasaki disease?

A
  • immunoglobulin (IVIG)
  • high dose aspirin
  • acetaminophen for fever
85
Q

briefly describe kawasaki disease?

A

systemic vasculitis, causing inflammation and edema in b.v., especially coronary arteries

86
Q

which cardiac arrhythmias may be caused by vagal stimulation from passing an orogastric tube?

A

sinus bradycardia

87
Q

when does a bradyarrhythmia become life-threatening?

A

HR < 60 w/ signs of altered perfusion (respiratory compromise, hypoxia, shock)

88
Q

what may be some causes for sinus tachycardia?

A
  • fever
  • pain
  • fear
  • fluid loss
    -hypoxia
89
Q

what HR defines SVT?

A

infants >220 bpm
children >180 bpm
- abrupt onset and termination, flattened P wave and narrow QRS

90
Q

what may be used for tx of compensated SVT?

A

vagal maneuvers (ice to face, blowing through straw)

91
Q

what tx is for uncompensated SVT?

A

adenosine or synchronized cardioversion

92
Q

what defines sinus tach?

A
  • infants (160 - 220); <220
  • children (130-180); <180
93
Q

what are assessment findings for dehydration?

A
  • sunken fontanelles
  • reduced LOC
  • reduced cap refill time
  • tachycardia/hypotension
  • oliguria
  • tachypnea
94
Q

when is ORS used?

A

mild to moderate cases of dehydration

95
Q

when should IVF rehydration be used?

A

severe dehydration or intolerance of ORS (persistent vomiting)

96
Q

which condition is characterized by hypertrophy and thickening of the pylorus muscle that leads to gastric outlet obstruction?

A

hypertrophic pyloric stenosis

97
Q

what are the cues of hypertrophic pyloric stenosis?

A
  • forceful, projectile, nonbilious vomiting
  • olive-shaped moveable mass in RUQ
  • abnormal electrolytes and metabolic alkalosis due to GI losses
98
Q

what are the priorities of care for hypertrophic pyloric stenosis?

A
  • correct F/E imbalances
  • NGT decompression
  • NPO
  • strict I/O
  • post-op wound care
  • resume PO in 1-2 days
99
Q

what signs of enterocolitis should the nurse monitor for the patient with Hirschsprungs?

A
  • fever
  • abdominal distension
  • chronic diarrhea/explosive stool
  • rectal bleeding
  • straining
  • notify provider immediately
100
Q

what type of surgical intervention is expected with hirshprungs disease?

A

ileo/colostomy

101
Q

what PMH is expected with acute poststreptococcal glomerulonephritis?

A

strep throat or strep skin infection

102
Q

what lab changes are seen with acute poststreptococcal glomerulonephritis?

A
  • hematuria
  • proteinuria
  • elevated BUN/Creat
  • elevated ESR
    + ASO titer (strep antibodies)
103
Q

what may be noted of past hx for HUS?

A
  • ingestion of ground beef
  • visit to water park/public pool
  • petting zoo

one of these prior to developing diarrhea

104
Q

what are assessment findings for HUS?

A
  • toxic appearance
  • edema
  • oliguria or anuria
  • seizures/ altered LOC/coma
  • HTN
105
Q

what are the priorities of care for HUS?

A
  • maintain fluid balance
  • manage HTN/acidosis/electrolyte abnormalities
  • PRBCs and platelets
  • IVIG
106
Q

what condition is marked by abnormal urethral opening on the ventral surface of penis?

A

hypospadias

107
Q

what are clinical manifestations seen with growth hormone deficiency?

A
  • retarded bone growth
  • large/prominent forehead, underdeveloped jaw
  • high-pitch voice
  • delayed sexual maturation
  • delayed dentition/skeletal maturation
  • decreased muscle mass
108
Q

what is the tx for growth hormone deficiency?

A
  • Sub-Q biosynthetic GH replacement
  • daily doses
109
Q

what levels are seen in the newborn blood screening with hypothyroidism?

A

Low FT4 and high TSH

110
Q

what are the clinical cues of congenital hypothyroidism?

A
  • poor sucking reflex
  • hypothermia
  • constipation
  • lethargy/hypotonia
  • periorbital puffiness
  • cool, dry, scaly skin
  • bradycardia, resp distress
  • lg fontanelles, delayed closure
111
Q

what med if used to manage congenital hypothyroidism?

A
  • L-thyroxine (synthroid, levothyroid) daily
112
Q

what are the s/s of DKA?

A
  • BS >330 mg/ dL
  • Kussmauls
  • warm, dry, flushed
  • 3 P’s
113
Q

what are the management priorities for DKA?

A
  • hourly BG monitoring (prevent BS falling more than 100 mg/ dL/hr)
  • PICU admission
  • IVFs for dehydration
  • IV regular insulin drip
114
Q

what are the physical cues of hydrocephalus?

A

gait changes, sun-set eyes, projectile vomiting, change in LOC, enlarged ventricles/obstructed CSF flow (CT/MRI)

115
Q

what condition is ventriculoperitoneal shunt used for?

A

hydrocephalus

116
Q

what are the s/s of VP shunt obstruction/infection?

A
  • increased ICP
  • fever >101
  • headache/stiff neck/bulging fontanelle
  • poor feeding/vomiting
  • increased head circumference
  • dilated pupils on same side as pressure build up
  • high pitch cry
117
Q

what are the seizure precautions?

A
  • padding
  • side rails raised
  • O2 and suction @ bedside
  • supervision (bathing, ambulation, etc)
  • protective helmet during activity
  • medical alert bracelet
118
Q

what are the cues of increased ICP?

A
  • HA, vomiting, blurred vision, dizziness, tachycardia
  • lowered LOC
  • cheyne-stokes resps
  • posturing
  • fixed and dilated pupils, sunset eyes
119
Q

what is included in the cushing triad of increased ICP ?

A
  • irregular breathing
  • HTN
  • bradycardia
120
Q

what are the interventions for increased ICP?

A
  • head midline w/bed @ 30 degrees
  • keep body in alignment
  • low stimuli (calm, limited visitors)
  • avoid coughing, blowing nose
  • stool softeners
  • seizure precautions
  • monitor I and O
121
Q

what findings are seen in the LP for bacterial meningitis?

A
  • increase WBCs
  • low glucose
  • increase protein
  • cloudy color
122
Q

what is the nursing management of bacterial meningitis?

A
  • ICU admission
  • droplet isolation until 24 h of abx or order to discontinue
  • IV abx
  • ventilator support
  • seizure precautions
123
Q

what are 2 physical signs of bacterial meningitis?

A
  • kernig (knee flex elicits pain)
  • brudzinski (passive neck flexion elicits hip and knee flexion)
124
Q

what are nursing priorities for reyes?

A
  • decrease ICP
  • supportive care r/t liver failure
125
Q

what is the focus of nursing care for cerebral palsy?

A
  • promote mobility
  • maintain cardiopulmonary function
  • prevent complications
  • maximize quality of life
126
Q

what meds are used in cerebral palsy management?

A
  • Baclofen
  • Botox (botolinum toxin A)
  • carbidopa
127
Q

what are 2 complications of fractures?

A
  • compartment syndrome
  • osteomyelitis
128
Q

what is therapeutic management of amblyopia?

A

patching or atropine drops in STRONGER eye

129
Q

how does the tympanic membrane appear with acute otitis media?

A

dull, red, bulging or opaque
purulent drainage

130
Q

what tx measures are indicated for acute otitis media?

A
  • tylenol, ibuprofen
  • benzocaine (auralgan) drops
  • warm/cool compromises
  • abx therapy PO for 10-14 days or 1 IM dose
131
Q

what is best practice for ear drop administration for <3yr?

A

pull pinna down and back

132
Q

what is best practice for ear drop administration for >3yr?

A

pull pinna up and back

133
Q

what respiratory condition is marked by a paroxysmal cough?

A

pertussis

134
Q

what type of abx are used for pertussis?

A
  • macrolides (-mycins) for infants >1m
  • azithromycin if < 1m
135
Q

what precautions are indicated for pertussis?

A

droplet and standard precautions

136
Q

what are the physical findings of lyme disease?

A
  • onset of rash 7-10 days after bite
  • erythema migrans at site of bite
  • fever, malaise, HA, joint/muscle pain
137
Q

what is tx for lyme disease?

A
  • doxycycline >8yr old
  • amoxicillin for < 8yr
  • tx for 14-28 days
138
Q

what therapeutic interventions are utilized for SCID (absent T and B cell function)?

A
  • bone marrow transplant
  • IVIG
139
Q

what type of prevention is essential for SCID?

A

infection prevention

140
Q

what nursing actions would be beneficial for SCID to prevent infection?

A
  • teach good handwashing
  • no exposure to infected persons
  • prophylactic abx
  • no live vaccines
  • promote adequate nutrition (possibly enteral)
141
Q

what are physical cues of JIA (juvenile idiopathic arthritis)?

A
  • hx of irritability/fussiness
  • difficulty getting out of bed
  • joint stiffness/pain
  • systemic fever >103
  • limping gait, joint guarding
  • eye inflammation
142
Q

what are the lab diagnostics for JIA?

A
  • mild to moderate anemia
  • elevated WBCs
  • +RF
  • +ANA
  • elevated ESR
  • elevated CRP
143
Q

how is the adequacy of fluid replacement determined for burns?

A

evaluating urinary output

144
Q

what actions should be taken to promote nutrition for a burn client?

A
  • increase calories
  • increase protein
  • enteral/parenteral nutrition
  • vitamin a & c
  • zinc
145
Q

how much urine output should be maintained for a burn patient?

A

1-2 mL/kg/hr

146
Q

what are the assessment findings for atopic dermatitis (eczema)?

A
  • elevated IgE
  • wheezing
  • dry, itchy, red skin
147
Q

what meds are used for eczema?

A
  • topical corticosteroids
  • tacrolimus (immune modulators)
148
Q

what are the interventions for eczema?

A
  • no hot water
  • bathe 2x/day in warm water
  • avoid soaps w/perfumes, dyes and fragrances
  • apply moisturizer while skin is still moist
  • 100% cotton
  • short fingernails
  • antihistamines
149
Q

what type of skin injury is characterize d by superficial rub/wearing off of skin and is usually due to friction?

A

abrasion

150
Q

what are the risk factors for skin injuries?

A
  • poverty
  • prematurity (<1yr)
  • chronic illness
  • intellectual disability
  • parent w//abuse hx
  • alcohol/substance abuse
  • extreme stressors
151
Q

what are some suspicious signs of skin injury?

A
  • injuries in uncommon locations
  • bruises in infants <9m
  • multiple injuries other than LEs
  • frequent ED visits
  • delayed care
  • inconsistent stories
  • unusual caregiver-child interaction
152
Q

which lab is affected with hemophilia a?

A

prolonged PTT ~42 (25-35 sec)

153
Q

what are the physical cues r/t hemophilia?

A
  • hemarthrosis (swollen, stiff joints)
  • multiple bruises
  • hematuria
  • bleeding gums
  • bloody sputum/emesis
  • black, tarry stools
  • chest/abd pain (internal bleeding)
154
Q

what is the 1st line tx for bleeding episode of a patient w/hemophilia?

A

factor VIII admin slow IV push

155
Q

what nursing action should be taken for a joint bleeding w/hemophilia?

A
  • direct pressure to external bleeding
  • ice or cold compress
  • elevate extremity
156
Q

what is used for hemophilia bleeding prophylaxis or for mild cases of bleeding?

A

DDAVP (desmopressin)

157
Q

what s/s are seen with iron deficiency anemia?

A
  • spooning on nails
  • pica
  • irritability
  • HA
  • unsteady gait, weakness, fatigue, dizziness, SOB, pallor
158
Q

what are the signs seen with a sickle cell vaso-occlusive crisis?

A
  • extreme fatigue/irritability
  • pain (abd, thorax, joints, digits)
  • c=dactylitis
  • cough, inc WOB, fever, tachypnea, hypoxia
  • splenomegaly
  • jaundice
159
Q

what are the 3 priorities to address during a sickle cell vaso occlusive crisis?

A
  • pain
  • hydration
  • hypoxia
160
Q

what position is used for BMA?

A

prone

161
Q

what is the bone of choice for BMA?

A

iliac crest

162
Q

what meds are expected to be ordered for a BMA?

A
  • local/topical anesthetic
  • conscious sedation (fentanyl/versed)
163
Q

what are the pre-procedure actions to take prior to a BMA?

A
  • explain
  • comfort
  • prevent infection
164
Q

what are the priorities after a BMA?

A
  • hold pressure
  • pressure dressing
  • monitor for bleeding and infection
165
Q

Guess the precaution:
- mask on child outside of room
- no raw fruits/vegs/flowers/live plants
- soft toothbrush
- avoid rectal temp/enema/supp/cath
- VS Q4
- assess for signs of infection Q8H and PRN
- hand hygiene (before and after)
- private room

A

neutropenic precautions

166
Q

what does an ANC of < 1000 indicate?

A

neutropenia

Childrens-Redman (7 decks)

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