Final Exam Study Guide & Tutoring Flashcards
1
Q
Signs & Symptoms of Respiratory Distress
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Respiratory
A
MILD
* Restlessness
* Tachypnea
* Tachycardia
* Diaphoresis
MODERATE
* Nasal flaring
* Retractions
* Grunting / wheezing
* HTN
* anxiety, irritable, mood changes, confusion
SEVERE
* Dyspnea
* Bradycardia
* Cyanosis (LATE sign)
* Stupor, coma
2
Q
What position do children with severe respiratory distress often sit in?
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Respiratory
A
Tripod: leaning forward w/ arms on the legs. Head & neck are extended with jaw thrust foward
- helps them open their airway
3
Q
Thumb sign on x-ray is indicative of what disease?
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Respiratory
A
Epiglottitis – inflammation & swelling of the epiglottis & larynx
4
Q
What is epiglottitis & what is the key sign?
KNOW THIS!!!!
Respiratory
A
Inflammation & swelling of the epiglotis & larynx
Key Sign = THUMB SIGN on X-RAY
5
Q
Asthma (Cause / Patho)
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Respiratory
A
Persistent inflammation of the airway causing hyper-responsiveness that leads to excess mucous, swelling, & muscle contraction
6
Q
Asthma Triggers
Respiratory
A
- environmental
- exercise
- viruses
- allergens
- smoke
- dander
- feces
- air pollutants
7
Q
Medications to Treat Asthma
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Respiratory
A
Short-Acting Beta Agonist (SABA)
* albuterol
Corticosteroids
* decadron, prednisone, solumedrol
Anticholinergics
* ipatropium
Adjuncts
* duoneb: albuterol/ipatropium, magnesium sulfate
8
Q
5-10-5 Rule
Respiratory
A
How to use a Spacer for Asthma:
- Tilt head back & breath in for 5 seconds
- Hold breath for 10 seconds
- Breathe out for 5 seconds
9
Q
Asthma Rule of Twos
Respiratory
A
- Do you use your quick-relief inhaler more than 2 times per week?
- Do you awaken at night due to asthma more than 2 times per month?
- Do you refill a quick-relief inhaler prescription more than 2 times per year?
10
Q
Cystic Fibrosis
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Respiratory
A
Reduced water movement across cell membranes = blocked airways
- Inherited disorder, CFTR recessive gene mutation
- Can cause damage to the lungs, pancrease, gallblader, & liver
Dx: sweat test
11
Q
How is cystic fibrosis diagnosed?
Respiratory
A
Sweat test
12
Q
Cystic Fibrosis can also cause damage to what organs?
Respiratory
A
- lungs
- pancrease
- gallbladder
- liver
13
Q
Croup
Respiratory
A
Broad class of upper airway illnesses that reslt in inflammation & swelling of the epiglottis & larynx, swelling extends into the trachea & larynx
Cause: can be viral or bacterial
* common in ages 3 months - 3 years
Dx: CXR with steeple sign
14
Q
Steeple sign is the key CXR finding for the diagnosis of what?
KNOW THIS!!!!
A
Croup
15
Q
Bronchiolitis
Respiratory
A
Inflammation & obstruction of the bronchioles
* viral or bacterial lower respiratory infection
* #1 cause of RSV
16
Q
Respiratory Syncytial Virus (RSV)
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Respiratory
A
- highly contaious viral respiratory infection
- major cause of bronchiolitis
- from syncytia or large masses of cells that clog & irritate the airway
17
Q
Pneumonia
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Respiratory
A
Inflammation of bronchioles & alveoli
- TYPES: viral, bacterial, mycoplasmal (atypical)
*
Signs & Symptoms:
* crackles / rhonchi
* chest pain
* retractions / nasal flaring / grunting
* SOB
* lethargy
18
Q
Age ranges associated with each of the following developmental groups:
- Infant
- Toddler
- Preschooler
- School Aged
- Adolesence
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Growth & Development
A
- Infant = 0 - 12 months
- Toddler = 1 - 3 years
- Preschooler = 3 - 6 years
- School Age = 6 - 12 years
- Adolescence = 12 - 18 years
19
Q
4 Types of Parenting Styles
Growth & Development
A
1.) Authoritarian
2.) Authoritative
3.) Permissive
4.) Indifferent
20
Q
List the different types of play
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Growth & Development
A
- Solitary play
- Parallel play
- Associative play
- Cooperative play
- Onlooker play
21
Q
Associative Play
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Growth & Development
A
Play with same toy side-by-side, and ENGAGE with each other
- toddler to preschool years (1 - 6 years)
22
Q
Parallel Play
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Growth & Development
A
Play side-by-side with similar toys, but do NOT engage with eachother
- toddlers (1-3)
23
Q
Solitary Play
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Growth & Development
A
Independent Play
24
Q
Expected Weight gain in infants
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Growth & Development
A
- 2x birth weight by 5-6 months
- 3x birth weight by 1 year
25
**Erickson's Developmental Theory Stages**
| **KNOW THIS!!!!!**
## Footnote
**Growth & Development**
**M**y **S**exy **G**irl **I**n **R**ed
*
* **M**istrust vs. Trust **= 0 - 1 years**
* **S**hame vs. Autonomy **= 1-3 years**
* **G**uilt vs. Initiative **= 3 - 6 years**
* **I**ndustry vs. inferiority **= 6 - 12 years**
* **R**ole confusion vs. Identity **= 12 - 18 years**
26
**Toddler Milestones** (1-3)
| **KNOW THIS!!!!!**
## Footnote
**Growth & Development**
* **Anterior fontanelle Closes (12-18 months)**
* build tower with 4 blocks by age 2
* shows growing ability to walk & walk with ease
* **Dresses self**
* **Jumps**
* draws circles & other forms
27
**Preschooler Milestones** (3-6)
| **KNOW THIS!!!!!**
## Footnote
**Growth & Development**
* **Brushes teeth**
* **Uses utensiles to eat**
* **Rides a tricycle**
* **Associative & Dramatic Play**
28
**School Age Milestones** (6-12)
| **KNOW THIS!!!!!**
## Footnote
**Growth & Development**
* **Rides 2 wheeler bike**
* **Reads**
* **Develops hobbies like musical instrument, board games, video games, etc.**
* mature use of language
* can concentrate for longer periods
29
**Adolescent Milestones** (12-18)
| **KNOW THIS!!!!!**
## Footnote
**Growth & Development**
* **Some lack of coordination** (common during growth spurt)
* New sport / muscle development continues
* **Increasing communication & time with peers**
* variation in age of growth spurts
* **Applys abstract thought & analysis in conversations**
30
**Normal Temperature Range in Pediatrics**
| **KNOW THIS!!!!!**
**< 36.5°C
& ≥
38°C**
* 97.7 - 100.4 °F
31
**How do you estimate the "normal" Systolic BP for kids 1+ years old?**
| **KNOW THIS!!!!!**
90 mmHg **+ (**2 **x** age in years**)**
32
**Normal Neonate Vitals** (HR, RR, SBP)
| **KNOW THIS!!!!!**
**HR: 80 - 180**
**RR:** 30 - 60
**SBP:** < 60 mmHg
33
**Infant Vitals (0 - 1 year)** (HR, RR, SBP)
| **KNOW THIS!!!!!**
**HR: 75 - 160**
**RR:** 30 - 60
**SBP:** < 70 mmHg
34
**Toddler Vitals (1-3 years)** (HR, RR, SBP)
| **KNOW THIS!!!!!**
**HR: 60 - 110**
**RR:** 22 - 40
**SBP:** < 90 mmHg **+ (**2 **x** age in years**)**
## Footnote
3 Year old normal SBP:
90 **+ (**2 **x** 3**) =** 90 **+** 6 **= 96**
35
**School Age Vitals (6 - 12 years)** (HR, RR, SBP)
| **KNOW THIS!!!!**
**HR: 60 - 110**
**RR:** 18 - 30
**SBP:** < 90 mmHg **+ (**2 **x** age in years**)**
36
**Adolsecent Vitals (12-18 years)** (HR, RR, SBP)
| **KNOW THIS!!!!**
**HR: 50 - 90**
**RR:** 12 - 16
**SBP:** < 90 mmHg **+ (**2 **x** age in years**)**
37
**Tanner Staging**
| **KNOW THIS!!!!!**
## Footnote
**Growth & Development**
**Stage 1 (prepubertal): No pubic hair present in either sex**
* Male - small penis & testes
* Female - flat chest
**Stage 2: soft pubic hair appears**
* Male - measurable testes enlargement
* Female - breast buds appear
**Stage 3: pubic hair becomes coarser**
* Male - penis begins to enlarge in size & length
* Female - breast mounds form
**Stage 4: pubic hair begins to cover pubic area**
* Male - penis begins to widen
* Female - breast enlargement forms "mound-on-mound" breast contour
**Stage 5 (Adult): Pubic hair extends to inner thigh**
* Male - penis & testes enlarge to adult size
* Female - breast takes on adult contour
38
**Pain Scale Ages**
* NIPS
* FLACC
* Faces / Wong Baker
| **KNOW THIS!!!!!**
* **NIPS -** up to **1 year old**
* **FLACC -** up to **4 years old**
* **Faces / Wong Baker -** ages **4-5 years old**
39
**ibuprofen / Motrin Safe Dose**
| **KNOW THIS!!!!**
**10 mg/kg**
* every 6 hours
40
**acetaminophen / Tylenol Safe Dose**
| **KNOW THIS!!!!**
**15 mg/kg**
* every 4-6 hours
41
**Conjunctivitis & the 3 types**
| **KNOW THIS!!!!**
## Footnote
**HEENT**
**Inflammation of the conjunctiva**
* bacterial
* viral
* allergic
42
**Key S/S of Bacterial Conjunctivitis**
| **KNOW THIS!!!!**
## Footnote
**HEENT**
**Purulent Drainage**
* "pink eye"
43
**Key S/S of Viral Conjunctivitis**
| **KNOW THIS!!!!**
## Footnote
**HEENT**
**Serous (watery) drainage**
* commonly caused by respiratory infection
44
**Key S/S of Allergic Conjunctivitis**
| **KNOW THIS!!!!**
## Footnote
**HEENT**
**Intense Itching**
45
**Otitis Media vs. Otitis Externa**
| **KNOW THIS!!!!**
## Footnote
**HEENT**
**Otitis Media =** inflammation of the **MIDDLE** ear
* Otitis *Externa =* inflammation of the *OUTER* ear ("swimmer's ear")
46
**Otitis Externa**
| **KNOW THIS!!!!**
## Footnote
**HEENT**
Inflammation of the **OUTER** ear
* swimmer's ear
47
**Otitis Media**
| **KNOW THIS!!!!**
## Footnote
**HEENT**
Inflammation of the **MIDDLE** ear
* redness / buldging of TM
48
**Tonsillectomy**
| **KNOW THIS!!!!**
## Footnote
**HEENT**
**Surgical Removal of Tonsils**
*Nursing Care*
* fluids
* pain relief
* watch for bleeding / infection
* white / yellow exudate x7 days =1 week normal
49
**How do Short Acting Beta-2 Agonists (SABA)s work?**
| **KNOW THIS!!!!**
## Footnote
**Meds**
**Relaxes smooth muscles** leading to broncho**dilation**
50
**How do corticosteroids work?**
| **KNOW THIS!!!!**
## Footnote
**Meds**
**Decrease inflammation**
## Footnote
& help with bronchodilation for asthma patients
51
**How do anticholinergics work for asthma?**
| **KNOW THIS!!!!**
## Footnote
**Meds**
**Inhibits** broncho**constriction** and **decreases mucus production**
52
**Precocious Puberty**
| **KNOW THIS!!!!!**
## Footnote
**Endocrine**
**Sexual development before age 9 in boys & 8 in girls**
* **Growth plates close sooner than expected**
* leads to an overall *stunted growth due to advanced bone age*
53
**Hypothyroidism**
| **KNOW THIS!!!!!**
## Footnote
**Endocrine**
**↓ active levels of thyroid hormone**
**Tx:** levothyroixine
## Footnote
Primary Hypothyroidism
* ↑ TSH
* ↓ T4
54
**Addison's Disease** (Adrenal Insufficiency)
| **KNOW THIS!!!!!**
## Footnote
**Endocrine**
**Hyposecretion** (↓ secretion) **of aldosterone & cortisol (ACTH)**
## Footnote
**STEROID**
* **S**odium / **S**ugar low
* **T**ired
* **E**lectrolyte imbalance
* **R**eproductive imbalance
* l**O**w BP
* **I**ncreased pigmentation
* **D**iarrhea / **d**epression
55
**Type 1 Diabetes**
| **KNOW THIS!!!!!**
## Footnote
**Endocrine**
**Insulin dependent; body's immune system attacks beta cells** (↑ glucose levels)
**S/S: P**olyuria, **P**olydipsia, **P**olyphagia
56
**Hypoglycemia in children**
| **KNOW THIS!!!!!**
## Footnote
**Endocrine**
Blood glucose **< 70 mg/dL**
57
**What is IC Ratio?**
| **KNOW THIS!!!!!**
## Footnote
**Endocrine**
**Amount of carbs 1 unit of insulin will cover**
58
**Signs & Symptoms of Hypoglycemia**
| **KNOW THIS!!!!!**
## Footnote
**Endocrine**
* **Pallor**
* **Diaphoresis**
* **Tremors**
* **Dizzy / altered mental status**
59
**Diabetic Ketoacidosis**
| **KNOW THIS!!!!!**
## Footnote
**Endocrine**
**Production of ketones (metabolic acidosis)** due to insufficient insulin for body demands
* **BG > 200** mg/dL
* **Ketonuria:** ketones in urine
* **Ketonemia:** ketones in blood
* **pH < 7.30**
*
**Signs & Symptoms: kussmaul breathing & fruity breath**
60
**Key signs & symptoms of DKA**
| **KNOW THIS!!!!!**
## Footnote
**Endocrine**
* **Kussmaul breathing**
* **Fruity breath**
61
**Hypopituitarism / Growth Hormone Deficiency**
| **KNOW THIS!!!!!**
## Footnote
**Endocrine**
**↓ pituitary gland activity = ↓ growth hormone secretion**
## Footnote
* biosynthetic hormone injections at night
62
**Mild, Moderate, & Severe Dehydration**
| **KNOW THIS!!!!!**
## Footnote
**Electrolytes / Fluid Balance**
**Mild Dehydration**
* < / = 5% (40 - 50 mL/kg) loss of body weight
**Moderate Dehydration**
* 6-10% (60 - 90 mL/kg) loss of body weight
**Severe Dehydration**
* > /= 10% (100 mL/kg) loss of body weight
63
**4-2-1 Fluid Maintenance**
| **KNOW THIS!!!!!**
## Footnote
**Electrolytes / Fluid Balance**
* **First 10 kg** = **4** mL/kg/hr
* **Next 10 kg** = **2** mL/kg/hr
* **Above 20 kg** = **1** mL/kg/hr
64
**Normal Sodium (Na+) Level in Kids**
| **KNOW THIS!!!!!**
## Footnote
**Electrolytes / Fluid Balance**
**135 - 145**
65
**Normal Potassium (K+) Levels in Kids**
| **KNOW THIS!!!!!**
## Footnote
**Electrolytes / Fluid Balance**
**3.5 - 5**
66
**Respiratory Acidosis**
| **KNOW THIS!!!!!**
## Footnote
**Electrolytes / Fluid Balance**
**↓ pH & ↑ CO2**
67
**Respiratory Alkalosis**
| **KNOW THIS!!!!!**
## Footnote
**Electrolytes / Fluid Balance**
**↑ pH & ↓ CO2**
68
**Metabolic Acidosis**
| **KNOW THIS!!!!!**
## Footnote
**Electrolytes / Fluid Balance**
**↓ pH & ↓ HCO3**
69
**Metabolic Alkalosis**
| **KNOW THIS!!!!!**
## Footnote
**Electrolytes / Fluid Balance**
**↑ pH & ↑ HCO3**
70
**Normal Ranges for pH, CO2, & HCO3**
| **KNOW THIS!!!!!**
## Footnote
**Electrolytes / Fluid Balance**
**pH:** 7.35 - 7.45
**pCO2:** 35 - 45
**HCO3:** 22 - 26
71
**Breastmilk Rule of 4s**
| **KNOW THIS!!!!!!**
## Footnote
**Nutrition**
* 4 hours at room temperature
* 4 days in the fridge
* 24 hours in freezer
72
**Infant Nutrition**
| **KNOW THIS!!!!!!**
## Footnote
**Nutrition**
**Fluid = 140 - 160 mL/kg/day**
73
**Toddler Nutrition**
| **KNOW THIS!!!!!!**
## Footnote
**Nutrition**
* **1 tablespoon of food per each year of age**
* **whole milk until 2 years, then 2%**
74
**Adolescent Nutritional Needs / Caloric Intake**
| **KNOW THIS!!!!!!**
## Footnote
**Nutrition**
* **Males = 3,000 calories**
* **Females = 2,000 calories**
75
**Glasgow Coma Scale (GCS)**
| **KNOW THIS!!!!!!**
## Footnote
**Neuro**
* **Eyes Open** (out of **4**)
* **Motor Response** (out of **5**)
* **Verbal Response** (out of **6**)
76
**Increased Intracranial Pressure (ICP)**
| **KNOW THIS!!!!!!**
## Footnote
**Neuro**
**Excess fluid** (blood or CSF) **or matter** (brain) **within the cranium causing pressure buildup due ot proportional imbalance**
*Causes:* tumor, infection, head injury, CSF leak, bleeding
**Dx: ICP > 15**
77
**KEY late signs of increased ICP in kids**
| **KNOW THIS!!!!!!**
## Footnote
**Neuro**
**Cushing's Triad**
* bradycardia
* irregular respirations
* widened pulse pressure
78
**Hydrocephalus**
| **KNOW THIS!!!!!!**
## Footnote
**Neuro**
**Disturbance in the ciruclation of CSF that causes increased ICP**
* overproduction fo fluid
* obstruction preventing the normal flow of CSF through the ventricles
* impaired absorption in subarachnoid space
79
**Febrile Seizures**
| **KNOW THIS!!!!!**
## Footnote
**Neuro**
**Seizures that are triggered by a fever above 101 F (38.3 C)**
80
**Non-communicating hydrocephalus**
| **KNOW THIS!!!!!!**
## Footnote
**Neuro**
**Blockage of ventricular system that prevents CSF from entering subarachnoid space**
81
**What is the main goal of treatment for hydrocephalus?**
| **KNOW THIS!!!!!**
## Footnote
**Neuro**
To reduce the intracranial pressure & preserve CNS funciton
82
**Cleft Lip/Palate Post-Op Nursing Considerations**
| **KNOW THIS!!!!!**
## Footnote
**HEENT**
* **Monitor I&Os**
* **Upright for feedings** (to prevent aspiration)
* Use special feeder / nipples
* Cleanse sutures w/ normal saline
* avoid supine position
* **Avoid straws & utensils**
83
**Pyloric Stenosis**
| **KNOW THIS!!!!!**
## Footnote
**GI**
**Hypertrophy of pyloric muscle causing obstruction of pyloric sphincter**
* **S/S:** felt like an **olive** in the epigastric region & **projectile vomiting**
*
*Nursing Considerations*
* avoid oral feedings
* IV hydration
* I&Os
* education
* NG tube
* daily weights
84
**Hirschsprung Disease**
| **KNOW THIS!!!!!**
## Footnote
**GI**
**Congenital absence of ganglion cells in wall of colon or rectum**
* causes colon to become a "megacolon"
**S/S: failure to pass meconium in first 48 hours of life, abdominal distention, feeding intolerance, bilious emesis**
**Dx:** hx, bowel pattern, barium enema, rectal suction biopsy
85
**What type of enema is used for intussusception?**
## Footnote
**GI**
**Barium enema**
86
**Enema test used for diagnosis of Hirschsprung Disease**
| **KNOW THIS!!!!!**
## Footnote
**GI**
**Barium enema**
87
**Appendicitis**
* S/S
* Tx
| **KNOW THIS!!!!!!**
## Footnote
**GI**
**Inflammation of the appendix**
* Dx = ultrasound
**Signs & Symptoms** (**PAIN**)
* **P**ain (Mcburney's Rovsing's, Psoas, Obturator) **(RLQ pain)**
* **A**norexia
* **N**ausea
* **T**emperature
* increased WBC, neutrophil, C-reactive protein
**Treatment**
* surgical removal
88
**Acute Post-Infectious Glomerulonephritis (APG)**
| **KNOW THIS!!!!!**
## Footnote
**GU**
**Inflammation of the glomeruli in the kidneys;** commonly caused by **group A beta-hemolytic strep**
* **+ protein & blood in urine**
* Tx = supportive care
89
**Hypospadias**
| **KNOW THIS!!!!!**
## Footnote
**GU**
Uretral metaus (opening) located on the **ventral (bottom) surface of the penis**
90
**Nephrotic Syndrome**
| **KNOW THIS!!!!!**
## Footnote
**GU**
**Alteration in kidney function due to ↑ membrane permeability to proteins**
*Signs & Symptoms:*
* periorbital edema
* proteinuria
* hematuria & ↓ urine output
* irritability
* malaise / anorexia
* HTN
**Tx: steroids & BP meds**
91
**Scoliosis**
| **KNOW THIS!!!!**
## Footnote
**MSK**
**Lateral curvature of the spine; greater than 10 degrees**
* noticible after *preadolescent growth*
**S/S:** trunk asymmetry, uneven shoulders & hips, one sided rib hump, prominent scapula
* **mild:**10-20% curvature
* **moderate:** 20-40% curvature
* **severe:** 40-50% curvature
92
**Osteomyelitis**
| **KNOW THIS!!!!!**
## Footnote
**MSK**
**Infection of the bone** from bacteremia or trauma; most common pathogen is **staph A**
* **S/S: erythema, edema, tenderness, limp/refusal to bear weight or use extremity** fever, chills, vomiting
**Tx: IV abx, surgery**
93
**Slipped Capital Femoral Epiphysis (SCFE)**
| **KNOW THIS!!!!!**
## Footnote
**MSK**
**Head of femur separates from epiphysis & slips backwards w/ potential or complete dislocation**
* common in *teens, males, & obese individuals*
**Dx: "ice cream slipping off cone" on pelvic x-ray**
94
**Legg-Calve-Perthes Disease**
| **KNOW THIS!!!!!**
## Footnote
**MSK**
Condition where the **proximal femoral epiphysis** has a temporary **interruption in blood supply**; leads to bone necrosis; common in males 4-8 years old
Dx: x-ray of pelvis & MRI
**S/S: hip pain on affected side, different leg lengths,** internal rotation & abduction are limited
95
**Parkland Formula**
| **KNOW THIS!!!!!!**
## Footnote
**Skin**
**Fluids required in first 24 hours**
* 4 mL **x** body weight (KG) **x** % surface area burned
96
**Tinea Corporis**
| **KNOW THIS!!!!!!**
## Footnote
**Skin**
**pink, scaly, circular patch w/ raised border & clear center**
* acquired from human, animal, or contaminated objects
97
**Tinea Capitus**
| **KNOW THIS!!!!!!**
## Footnote
**Skin**
**Ring Worm --** scaly pustular bald area; yellow, red, or lighter than skin color, **broken hairs** look like black dots on the scalp
* **Kerion:** purulent, boggy mass on scalp with drainage
98
**Scabies**
| **KNOW THIS!!!!!!**
## Footnote
**Skin**
**Caused by mites**
* treat everyone
99
**Rule of Palm**
| **KNOW THIS!!!!!!**
## Footnote
**Skin**
Estimating burns using palm of hand
* 1% = size of palm
100
**Superficial Burn (1st degree)**
| **KNOW THIS!!!!!!**
## Footnote
**Skin**
**Burn to the outermost layers of the skin**
* minor to moderate pain; red; heals in few days
**SUNBURN**
101
**Partial Thickness (2nd Degree) Burn**
| **KNOW THIS!!!!!!**
## Footnote
**Skin**
**Burns epidermis & part of the dermis**
* **blistering**
* heals in **10-14 days**
102
**Full Thickness (3rd degree) Burn**
| **KNOW THIS!!!!!!**
## Footnote
**Skin**
**Burns all of the epidermis & dermis**
* **nerve endings are destroyed; need skin graft**
