Final Exam Flashcards
What type of Insulin should be used in pediatrics?
Short-acting
What are normal Pediatric A1c levels?
0 - 6 yr: 7.5 to 8.5
6 - 12 yr: <8
13 - 19: <7.5
What age range is typical for Type-1 Diabetes onset?
10 - 15 years old
What are the Classic S/S for diabetes?
Polydipsia, Polyphagia, Polyuria**
- Weight loss
- Hyperglycemia
- Fatigue
Is glycosuria diagnostic for diabetes?
NO
What is diagnostic for diabetes?
8 hour fasting glucose >126
Random blood glucose >200 with s/s of diabetes
Oral glucose test >200 after 2 hours
Infant to Diabetic Mother (IDM)
S/S:
- Large baby (macrosomia)
- Baby hypoglycemic at birth d/t glucose supply drop
Exercise and Diabetes
Don’t restrict exercise
- Need a snack before exercise/play
- Exercise promotes insulin sensitivity
DKA
Extremely high BG (>200)
Too little insulin; may result in death; treatment is critical
DKA: S/S
- Altered mental status
- Tachycardia
- Tachypnea
- Kussmaul Respirations*
- Lethargy/weakness
- Fever
- Acetone breath (fruity)
DKA: Diagnostics
- Blood glucose >200
- Ketonuria
- Ketonemia
- Metabolic Acidosis
DKA: Nursing Care
- Restore fluid volume (1st priority)
- Return to normal BG level
- Replace electrolytes lost
- Correct acidosis
Hypoglycemia in Pediatrics
S/S:
-weak, dizzy, shaking
Tx:
-Sugary snack/juice (simple carb)
Follow up with protein, i.e. peanut butter (complex carb)
Hyperpituitarism: Treatment
Administer Gonadotropin-releasing Hormone (GnRH) to slow down growth
Hyperpituitarism: Results
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
What does the Pituitary Gland excrete?
Growth Hormone
Hypopituitarism: Treatment
Administer Growth Hormone (GH) - “Somatrim”
- Give until child reaches normal growth level - Give at night (natural GH secretion time)
What does the Thyroid secrete?
T3 & T4, TSH
Alterations can cause goiter
Hypothyroidism: Labs
TSH increased; T3 and T4 decreased
Hypothyroidism: Therapy
- Give Thyroid replacement hormone
- May give iodine supplements
- Educate parents on follow-up blood tests
Hypothyroidism: S/S Infant
Prolong newborn jaundice* Poor feeding* Cool, mottled skin* Increased sleepiness Decreased crying Enlarged tongue
Hypothyroidism: S/S Child
Slow HR* Tiredness* Inability to tolerate the cold Puffiness in the face Impaired memory
Hyperthyroidism (Graves’ Disease): Labs
T3 and T4 increased; TSH decreased
Hyperthyroidism/Graves’ Disease: Cause
1 Cause = Lymphocytic Thyroiditis (Hashimoto’s)
Hyperthyroid (Graves’ Disease): S/S
- Goiter
- Skin is raised, thickened, swollen, and reddish
- Exophthalmos
Hyperthyroid (Graves’ Disease): Treatments
-Give anti-thyroid medication (PTU-propylthiouracil)
Can decrease WBC (infection precautions)
-Radioactive iodine therapy
-Thyroidectomy
-Beta-blocking agents (Inderal)
-Education of family
Diabetes Insipidus: S/S
Polyuria and Polydipsia (no polyphagia)
Enuresis (1st sign)
Infant irritability only resolved with water, no formula
Diabetes Insipidus: Cause
Posterior pituitary issue
Hyposecretion of ADH -> uncontrolled diuresis
Diabetes Insipidus: Nursing Care
- Patient must wear ID bracelet
- Administer Desmopressin (DDAVP)
- Administer Chlorothiazide (Diuril)
- Low solute diet
- Daily weights
Diabetes Insipidus: Nursing Management
- Accurate Input and Output tracking*
- Observe for signs of fluid overload*
- Seizure precautions
- Administer ADH-antagonizing drugs
Hypoparathyroidism: S/S
Low calcium
- Seizures
- Positive Chvostek’s and Trousseau’s Signs
- Dry, scaly skin
- Brittle hair and thin nails
Hypoparathyroidism (Low Calcium): Nursing Care
- Teach about dietary/supplemental Calcium and Vitamin D*
- Monitor for cardiac arrhythmias
- Monitor for hypotension
- Seizure precautions until Calcium level normalizes*
Hypercortisolism (Cushing’s Syndrome)
Excess cortisol d/t tumor or over-use of steroids
Cushing’s Syndrome: S/S
- Increased infection risk
- Moon face
- Increased BG
- Na retention = loss of K*
- Bruise easily
Cushing’s Syndrome: Treatment
Try to titrate steroids off
Reversible once steroids DC
Hemophilia
Males affected, females carriers
Hemophilia A
80% of cases
Decreased clotting Factor VIII
Hemophilia B
Decreased clotting Factor IX
Hemophilia: Manifestations
- Bleeding
- Bleeding into the joints
- Ecchymosis (bruises)
- Epistaxis (nosebleed)
Hemophilia: Treatment
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
B-Thalassemia: Affected population
Mediterranean: Greek, Italian, Syrian
What is B-Thalassemia?
Hgb issues = too much iron
B-Thalassemia: S/S
- Enlarged spleen
- Mild jaundice
- Growth retardation
- Moderate to severe anemia
- Bony deformities
- Increased infection risk
- Bossing of forehead
- Prominent jaw
B-Thalassemia: Nursing Care
-Blood transfusion and chelation
Deferoxamine (Desferol): triggers iron excretion
Fanconi Syndrome (Primary Aplastic Anemia)
Congenital Pancytopenia
D/t bone marrow hypoplasia
Patchy, brown skin
Aplastic Anemia
Pancytopenia
Only treatment is: stem cell transplant
Traditional s/s of infection are not seen*
Sickle Cell Anemia
Autosomal Recessive Congenital Defect of RBC structure
RBCs misshapen, sticky, and clump together -> obstruction -> hypoxia
Causes of Sickle Cell Crisis
Hypoxia Stress Trauma Fever Altitude Dehydration
Treatment of Sickle Cell
H.O.P.S
Hydrate (2nd)
Oxygenate (1st)
Pain (3rd)
Sepsis risk (watch for confusion*)
Iron-deficiency Anemia
Caused by insufficient intake
Generally preventable
Iron-deficiency Anemia: S/S
- Asymptomatic (mild)
- Decreased Hgb and Hct
- Irritability, fatigue, delayed motor development, SOB, decreased activity, and pallor
overweight can still be iron-deficient
Iron-Deficiency Anemia: Nursing Care
Primary goal is prevention**
May need iron supplements
-Squirt in back of mouth
Tastes bad
May stain teeth
-Constipation risk**Iron-Rich Foods
- Raisins*
- Red Meats*
- Green Leafy*
- Salmon
- Tuna
- Tofu
- Egg
- Enriched cereals
Graft vs. Host Disease (GvHD)
(Usually stem cell transplant)
Donor cells attack the host cells
-Can cause organ hardening -> failure
Cancer in Children: S/S
- Pain
- Fever
- Skin changes
- Anemia
- Abdominal mass
- Swollen Lymph nodes
Leukemia
Elevated WBC (40k +)
Normal WBC: 5 - 10k
Over-proliferation of immature WBC
WBC crowd out everything else = anemia and bleeding
Down’s = increased risk
Leukemia: Common cause of death
Hemorrhage or infection
Hodgkin’s Lymphoma (better lymphoma)
Usually diagnosed 15 - 19 yr
Enlarged, painless lymph nodes
Reed-Sternberg cells (MARKER)
Non-Hodgkin’s Lymphoma
Usually diagnosed <14 yr
Dissemination occurs often, early, and rapidly
Diffused, not nodule tumor
Death and Trauma: Infant/Toddler
Can’t understand, but understand seriousness and behavior changes
Death and Trauma: Pre-School
- Take things VERY literal
- Perceives own illness and testing as a punishment
- Use simple language to explain and repeat often
Death and Trauma: School Age
- Able to understand more
- Respond well to explanations about condition, drug names, etc.
- Help maintain control over own body (self-worth, independence, etc.)
Death and Trauma: Adolescents
Least likely age group to accept death, especially their own
Testicular Cancer
Generally malignant (easy to treat) Most common cancer for males 15 - 44
Risk factor: premature birth with undescended testicles
Wilms Tumor (nephroblastoma)
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
Retinoblastoma
Positive Cat’s Eye Sign
Chemotherapy Information
- Very Vesicant
- Ensure IV patency
- DC immediately if infiltrates
Pediatrics Vital Signs
RR and HR higher; BP Lower
Approach the normals as they age
Dehydration S/S
-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
-LethargicReflexes (Moro, Babinski, Parachute)
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
Gross Motor Development
- 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)
Growth Chart
Should be 5th to 9th percentile
Atrial Septal Defect (ASD): S/S
- May have a murmur, heave, or thrill
- Right atrial enlarged
ASD: Nursing Care
- Closes spontaneously or may need surgery
- May be symptomatic until teens
- Good prognosis
Nocturnal Enuresis
Indicates possible UTI or DI
self-image problems may arise (may physical problem or regression in response to stressor)
Epiglottitis: S/S
- Croaking and drooling*
- Sore throat
- Pain
- Tripod sitting
- Retractions
- Stridor on inspiration
- Mild hypoxia
Epiglottitis: Prevention
Hib Vaccine
Epiglottitis: Nursing Care
NO TONGUE BLADES
Trach set at bedside, keep airway open
Cystic Fibrosis
Most common LETHAL GENETIC ILLNESS in WHITE children (95%)
Exocrine dysfunction = excess mucus production
Cystic Fibrosis: Patho
Excess mucus production and viscosity
Forms obstructions via concretions
Mainly affects respiratory tract and pancreas
Cystic Fibrosis: Diagnostic Tests
Sweat Chloride Test** (>60 in CF)
Cystic Fibrosis: GI Effects
Prevents pancreatic enzymes from reaching duodenum
- Impaired fat digestion -> steatorrhea - Impaired protein digestion -> azotorrhea
Cystic Fibrosis: Treatment
- Chest Physiotherapy/”drumming” on chest (at meals and b4 bed)
- Postural Draining
Respiratory Syncytial Virus (RSV)
1 admission. Can occlude airway and cause respiratory distress
- WBC elevated
- Respiratory Acidosis
RSV Precautions
Standard, Contact, Droplet
Gloves
Mask within 3 feet
Gown if contact anticipated
Dedicated equipment
RSV: Nursing Care
NO PREGNANT NURSES - Teratogenic
- Keep O2 >96%
- Elevate HOB
- No feeding if RR too high
- Sit up for feedings
- IVF
Asthma
1 cause = allergies
- Wheezing
- Tachycardia
- Retractions
- Nasal flaring
Status Asthmaticus
Normal asthma treatments aren’t working
May need to intubate for a little while
Pyloric Stenosis
Opening (pylorus) b/w stomach and small intestine affected
Projectile vomiting**
Requires surgery
Fetal Alcohol Syndrome: S/S
- Long philtrum
- Flattened midface
- Small, wide-set eyes
- Low nasal bridge w/ short upturned nose
Low birth weight, failure to thrive, encephalopathy
Input and Output
1 g = 1ml of output for weighing diapers
1 oz = 30 ml
1 T = 15 ml
1 tsp = 5 ml
