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Child Health > Final Exam > Flashcards

Final Exam Flashcards

1
Q

What type of Insulin should be used in pediatrics?

A

Short-acting

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2
Q

What are normal Pediatric A1c levels?

A

0 - 6 yr: 7.5 to 8.5
6 - 12 yr: <8
13 - 19: <7.5

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3
Q

What age range is typical for Type-1 Diabetes onset?

A

10 - 15 years old

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4
Q

What are the Classic S/S for diabetes?

A

Polydipsia, Polyphagia, Polyuria**

  • Weight loss
  • Hyperglycemia
  • Fatigue
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5
Q

Is glycosuria diagnostic for diabetes?

A

NO

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6
Q

What is diagnostic for diabetes?

A

8 hour fasting glucose >126
Random blood glucose >200 with s/s of diabetes
Oral glucose test >200 after 2 hours

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7
Q

Infant to Diabetic Mother (IDM)

A

S/S:

  • Large baby (macrosomia)
  • Baby hypoglycemic at birth d/t glucose supply drop
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8
Q

Exercise and Diabetes

A

Don’t restrict exercise

  • Need a snack before exercise/play
  • Exercise promotes insulin sensitivity
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9
Q

DKA

A

Extremely high BG (>200)

Too little insulin; may result in death; treatment is critical

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10
Q

DKA: S/S

A
  • Altered mental status
  • Tachycardia
  • Tachypnea
  • Kussmaul Respirations*
  • Lethargy/weakness
  • Fever
  • Acetone breath (fruity)
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11
Q

DKA: Diagnostics

A
  • Blood glucose >200
  • Ketonuria
  • Ketonemia
  • Metabolic Acidosis
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12
Q

DKA: Nursing Care

A
  • Restore fluid volume (1st priority)
  • Return to normal BG level
  • Replace electrolytes lost
  • Correct acidosis
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13
Q

Hypoglycemia in Pediatrics

A

S/S:
-weak, dizzy, shaking

Tx:
-Sugary snack/juice (simple carb)
Follow up with protein, i.e. peanut butter (complex carb)

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14
Q

Hyperpituitarism: Treatment

A

Administer Gonadotropin-releasing Hormone (GnRH) to slow down growth

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15
Q

Hyperpituitarism: Results

A

Early puberty: armpit and pubic hair, BO, acne, growth spurts

Acromegaly: excess GH after closure of epiphyseal plates

Gigantism: excess GH before closure of epiphyseal plates
-Danger: heart is normal size, can’t perfuse larger body effectively

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16
Q

What does the Pituitary Gland excrete?

A

Growth Hormone

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17
Q

Hypopituitarism: Treatment

A

Administer Growth Hormone (GH) - “Somatrim”

 - Give until child reaches normal growth level
 - Give at night (natural GH secretion time)
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18
Q

What does the Thyroid secrete?

A

T3 & T4, TSH

Alterations can cause goiter

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19
Q

Hypothyroidism: Labs

A

TSH increased; T3 and T4 decreased

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20
Q

Hypothyroidism: Therapy

A
  • Give Thyroid replacement hormone
  • May give iodine supplements
  • Educate parents on follow-up blood tests
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21
Q

Hypothyroidism: S/S Infant

A 
Prolong newborn jaundice*
Poor feeding*
Cool, mottled skin*
Increased sleepiness
Decreased crying
Enlarged tongue
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22
Q

Hypothyroidism: S/S Child

A 
Slow HR*
Tiredness*
Inability to tolerate the cold
Puffiness in the face
Impaired memory
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23
Q

Hyperthyroidism (Graves’ Disease): Labs

A

T3 and T4 increased; TSH decreased

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24
Q

Hyperthyroidism/Graves’ Disease: Cause

A

1 Cause = Lymphocytic Thyroiditis (Hashimoto’s)

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25
Q

Hyperthyroid (Graves’ Disease): S/S

A
  • Goiter
  • Skin is raised, thickened, swollen, and reddish
  • Exophthalmos
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26
Q

Hyperthyroid (Graves’ Disease): Treatments

A

-Give anti-thyroid medication (PTU-propylthiouracil)
Can decrease WBC (infection precautions)
-Radioactive iodine therapy
-Thyroidectomy
-Beta-blocking agents (Inderal)
-Education of family

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27
Q

Diabetes Insipidus: S/S

A

Polyuria and Polydipsia (no polyphagia)
Enuresis (1st sign)

Infant irritability only resolved with water, no formula

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28
Q

Diabetes Insipidus: Cause

A

Posterior pituitary issue

Hyposecretion of ADH -> uncontrolled diuresis

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29
Q

Diabetes Insipidus: Nursing Care

A
  • Patient must wear ID bracelet
  • Administer Desmopressin (DDAVP)
  • Administer Chlorothiazide (Diuril)
  • Low solute diet
  • Daily weights
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30
Q

Diabetes Insipidus: Nursing Management

A
  • Accurate Input and Output tracking*
  • Observe for signs of fluid overload*
  • Seizure precautions
  • Administer ADH-antagonizing drugs
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31
Q

Hypoparathyroidism: S/S

A

Low calcium

  • Seizures
  • Positive Chvostek’s and Trousseau’s Signs
  • Dry, scaly skin
  • Brittle hair and thin nails
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32
Q

Hypoparathyroidism (Low Calcium): Nursing Care

A
  • Teach about dietary/supplemental Calcium and Vitamin D*
  • Monitor for cardiac arrhythmias
  • Monitor for hypotension
  • Seizure precautions until Calcium level normalizes*
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33
Q

Hypercortisolism (Cushing’s Syndrome)

A

Excess cortisol d/t tumor or over-use of steroids

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34
Q

Cushing’s Syndrome: S/S

A
  • Increased infection risk
  • Moon face
  • Increased BG
  • Na retention = loss of K*
  • Bruise easily
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35
Q

Cushing’s Syndrome: Treatment

A

Try to titrate steroids off

Reversible once steroids DC

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36
Q

Hemophilia

A

Males affected, females carriers

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37
Q

Hemophilia A

A

80% of cases

Decreased clotting Factor VIII

38
Q

Hemophilia B

A

Decreased clotting Factor IX

39
Q

Hemophilia: Manifestations

A
  • Bleeding
  • Bleeding into the joints
  • Ecchymosis (bruises)
  • Epistaxis (nosebleed)
40
Q

Hemophilia: Treatment

A

Factor VIII replacement (PRN or regularly)
DDAVP given before surgery (may teach family how to administer)

If bleeding into joints -> elevate and ice

Bleeding precautions

41
Q

B-Thalassemia: Affected population

A

Mediterranean: Greek, Italian, Syrian

42
Q

What is B-Thalassemia?

A

Hgb issues = too much iron

43
Q

B-Thalassemia: S/S

A
  • Enlarged spleen
  • Mild jaundice
  • Growth retardation
  • Moderate to severe anemia
  • Bony deformities
  • Increased infection risk
  • Bossing of forehead
  • Prominent jaw
44
Q

B-Thalassemia: Nursing Care

A

-Blood transfusion and chelation

Deferoxamine (Desferol): triggers iron excretion

45
Q

Fanconi Syndrome (Primary Aplastic Anemia)

A

Congenital Pancytopenia
D/t bone marrow hypoplasia

Patchy, brown skin

46
Q

Aplastic Anemia

A

Pancytopenia

Only treatment is: stem cell transplant

Traditional s/s of infection are not seen*

47
Q

Sickle Cell Anemia

A

Autosomal Recessive Congenital Defect of RBC structure

RBCs misshapen, sticky, and clump together -> obstruction -> hypoxia

48
Q

Causes of Sickle Cell Crisis

A 
Hypoxia
Stress
Trauma
Fever
Altitude
Dehydration
49
Q

Treatment of Sickle Cell

A

H.O.P.S

Hydrate (2nd)
Oxygenate (1st)
Pain (3rd)
Sepsis risk (watch for confusion*)

50
Q

Iron-deficiency Anemia

A

Caused by insufficient intake

Generally preventable

51
Q

Iron-deficiency Anemia: S/S

A
  • Asymptomatic (mild)
  • Decreased Hgb and Hct
  • Irritability, fatigue, delayed motor development, SOB, decreased activity, and pallor

overweight can still be iron-deficient

52
Q

Iron-Deficiency Anemia: Nursing Care

A 
Primary goal is prevention**
May need iron supplements
     -Squirt in back of mouth
          Tastes bad
          May stain teeth
     -Constipation risk**
53
Q

Iron-Rich Foods

A
  • Raisins*
  • Red Meats*
  • Green Leafy*
  • Salmon
  • Tuna
  • Tofu
  • Egg
  • Enriched cereals
54
Q

Graft vs. Host Disease (GvHD)

A

(Usually stem cell transplant)

Donor cells attack the host cells
-Can cause organ hardening -> failure

55
Q

Cancer in Children: S/S

A
  • Pain
  • Fever
  • Skin changes
  • Anemia
  • Abdominal mass
  • Swollen Lymph nodes
56
Q

Leukemia

A 
Elevated WBC (40k +)
     Normal WBC: 5 - 10k

Over-proliferation of immature WBC
WBC crowd out everything else = anemia and bleeding

Down’s = increased risk

57
Q

Leukemia: Common cause of death

A

Hemorrhage or infection

58
Q

Hodgkin’s Lymphoma (better lymphoma)

A

Usually diagnosed 15 - 19 yr

Enlarged, painless lymph nodes
Reed-Sternberg cells (MARKER)

59
Q

Non-Hodgkin’s Lymphoma

A

Usually diagnosed <14 yr

Dissemination occurs often, early, and rapidly
Diffused, not nodule tumor

60
Q

Death and Trauma: Infant/Toddler

A

Can’t understand, but understand seriousness and behavior changes

61
Q

Death and Trauma: Pre-School

A
  • Take things VERY literal
  • Perceives own illness and testing as a punishment
  • Use simple language to explain and repeat often
62
Q

Death and Trauma: School Age

A
  • Able to understand more
  • Respond well to explanations about condition, drug names, etc.
  • Help maintain control over own body (self-worth, independence, etc.)
63
Q

Death and Trauma: Adolescents

A

Least likely age group to accept death, especially their own

64
Q

Testicular Cancer

A 
Generally malignant (easy to treat)
Most common cancer for males 15 - 44

Risk factor: premature birth with undescended testicles

65
Q

Wilms Tumor (nephroblastoma)

A

On top of the kidney
NEVER PALPATE MASS - will pop and metastasize

3x more common in African-Americans
Greater chance in males and twins

Tx: chemo and radiation

66
Q

Retinoblastoma

A

Positive Cat’s Eye Sign

67
Q

Chemotherapy Information

A
  • Very Vesicant
  • Ensure IV patency
  • DC immediately if infiltrates
68
Q

Pediatrics Vital Signs

A

RR and HR higher; BP Lower

Approach the normals as they age

69
Q

Dehydration S/S

A 
-Sunken Fontanelles (up to 2 yr)
     Anterior: closes 18-24 months
     Posterior: closes 2-4 months
-Weight loss
-Turgor changes (tenting)
-Long cap refill
-Tachycardia
-Dry mucus membranes
-Lethargic
70
Q

Reflexes (Moro, Babinski, Parachute)

A

Moro/Startle (birth - 4 months): issue may indicate hearing trouble

Babinski (birth - 12 months): stroke foot, toes splay

Parachute (lifetime): “fall,” reach out to catch themselves

71
Q

Gross Motor Development

A
  • Head control, hold at midline (3 months)
  • Rolls from abd to back (4-5 months)
  • Sits unassisted (7 months)
  • Prone to sitting (10 months)
  • Grasp rattle (5 months)
  • Gross Pincer (8 months)
  • Fine Pincer (10 months)
72
Q

Growth Chart

A

Should be 5th to 9th percentile

73
Q

Atrial Septal Defect (ASD): S/S

A
  • May have a murmur, heave, or thrill

- Right atrial enlarged

74
Q

ASD: Nursing Care

A
  • Closes spontaneously or may need surgery
  • May be symptomatic until teens
  • Good prognosis
75
Q

Nocturnal Enuresis

A

Indicates possible UTI or DI

self-image problems may arise (may physical problem or regression in response to stressor)

76
Q

Epiglottitis: S/S

A
  • Croaking and drooling*
  • Sore throat
  • Pain
  • Tripod sitting
  • Retractions
  • Stridor on inspiration
  • Mild hypoxia
77
Q

Epiglottitis: Prevention

A

Hib Vaccine

78
Q

Epiglottitis: Nursing Care

A

NO TONGUE BLADES

Trach set at bedside, keep airway open

79
Q

Cystic Fibrosis

A

Most common LETHAL GENETIC ILLNESS in WHITE children (95%)

Exocrine dysfunction = excess mucus production

80
Q

Cystic Fibrosis: Patho

A

Excess mucus production and viscosity
Forms obstructions via concretions

Mainly affects respiratory tract and pancreas

81
Q

Cystic Fibrosis: Diagnostic Tests

A

Sweat Chloride Test** (>60 in CF)

82
Q

Cystic Fibrosis: GI Effects

A

Prevents pancreatic enzymes from reaching duodenum

 - Impaired fat digestion -> steatorrhea
 - Impaired protein digestion -> azotorrhea
83
Q

Cystic Fibrosis: Treatment

A
  • Chest Physiotherapy/”drumming” on chest (at meals and b4 bed)
  • Postural Draining
84
Q

Respiratory Syncytial Virus (RSV)

A

1 admission. Can occlude airway and cause respiratory distress

  • WBC elevated
  • Respiratory Acidosis
85
Q

RSV Precautions

A

Standard, Contact, Droplet

Gloves
Mask within 3 feet
Gown if contact anticipated
Dedicated equipment

86
Q

RSV: Nursing Care

A

NO PREGNANT NURSES - Teratogenic

  • Keep O2 >96%
  • Elevate HOB
  • No feeding if RR too high
  • Sit up for feedings
  • IVF
87
Q

Asthma

A

1 cause = allergies

  • Wheezing
  • Tachycardia
  • Retractions
  • Nasal flaring
88
Q

Status Asthmaticus

A

Normal asthma treatments aren’t working

May need to intubate for a little while

89
Q

Pyloric Stenosis

A

Opening (pylorus) b/w stomach and small intestine affected

Projectile vomiting**
Requires surgery

90
Q

Fetal Alcohol Syndrome: S/S

A
  • Long philtrum
  • Flattened midface
  • Small, wide-set eyes
  • Low nasal bridge w/ short upturned nose

Low birth weight, failure to thrive, encephalopathy

91
Q

Input and Output

A

1 g = 1ml of output for weighing diapers
1 oz = 30 ml
1 T = 15 ml
1 tsp = 5 ml

Child Health (9 decks)

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