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Peds > Final Peds > Flashcards

Final Peds Flashcards

1
Q

What is the psychosocial development of an infant? What is it based on? When does separation anxiety generally begin?

A

trust vs. mistrust

quality of relationship with careiver

4-8 mos

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2
Q

What are is the immunization schedule for the first 12 months?

A

birth: hep B
2 mo: Dtap, RV, IPV, Hib, PVC, Hep B
4 mo: Dtap, RV, IPV, Hib, PVC
6+ mo: Dtap, RV, IPV, Hib, PVC, Hep B
12 mo: flu

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3
Q

What are the HR ranges by age:
newborn
infant 1mo-12mo
toddler 1-2yr
preschool 3-5 yr
school 6-12yr
adolescent 13-18yr

A

n: 110-160
i: 90-160
t: 80-140
p: 70-120
s: 60-110
a: 50-100

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4
Q

What are the RR by age:
newborn
infant
toddler
preschool
school
adolescent

A

n: 30-60
i: 25-30
t: 25-30
p: 20-25
s: 20-25
a: 16-20

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5
Q

Whar are expected BP ranges for age groups?
newborn
infant
toddler
preschool
school
adolescent

(I’m making these easier to remember, they may vary a point or two)

A

n: 64/40
i: 85/50
t: 85/40
p: 90/50
s: 95/55
a: 120/80

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6
Q

What reflexes disappear by 4 months? What reflex disappears by 8 mos? What reflex disappear by 1 year? 1 month?

A

sucking
rooting
palmar
moro
tonic neck

plantar

babinski

stepping

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7
Q

What is Erikson’s stage of development for ages 1-3 years? How do the begin to express their independence? What gives them a sense of comfort as they begin to explore?

A

autonomy vs. shame/doubt

negativism

routine, ritualism and reliability

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8
Q

What is the immunization schedule for 1-3yrs?

A

12-15mos: IPV, Hib, PCV, MMR, V
12-23mos: Hep A (2 doses 6 months apart)
15-18mos: Dtap

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9
Q

How much milk should a toddler consume? Juice?

A

24-28 oz

no more than 4-6 oz

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10
Q

What is Erikson’s psychosocial development stage for preschoolers? How is manifested?

A

initiative vs. guilt

become energetic learners
guide, set appropriate limits, praise, set up for success

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11
Q

What immunizations are given between 4-6 yrs?

A

Dtap
MMR
V
IPV
flu

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12
Q

What is the psychosocial stage for school-age children? How is it manifested?

A

industry vs inferiority

sense of accomplishment
love to achieve
need challenge
complete tasks
respond to reward for mastery of skills

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13
Q

What are the immunizations for 11-12 yrs?

A

Tdap
HPV
MCV (meningococcal)

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14
Q

What is the stage of psychosocial development for adolescents? How is is manifested?

A

identity vs. role confusion

try on different roles
identify with peer groups

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15
Q

What are the cognitive stages and manifestions of each?
infant
toddler/preschool
school
adolescent

A

Infant (sensorimotor)
Object permanence

Toddler/Preschooler (preoperational)
Domestic mimicry
imitation
symbolism
egocentrism/centration
time awareness by daily events, not clocks

School-age (concrete operational)
Conservation of mass
problem-solving
tells time
decenter

Adolescent (formal operational)
Abstract thought
thought beyond current

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16
Q

What are risk factors for HIV that can affect infants/children?

A

Breast milk for HIV mother
exposure to blood products
sexual assault
risky behaviors
IV substance use

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17
Q

How is HIV diagnosed in
>18 mos
<18 mos

A

positive ELISA (enzyme linked immunosorbent assay

born to infected mothers
polymerase chain reaction
virus culture

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18
Q

What is nursing care for pediatrics and HIV?

A

encourage balanced diet, high calories, high protein

administer TPN if needed

good oral care

keep skin clean and dry

assess pain, provide mangt and non-pharm mngt

prevent infection

encourange immunizations

monitor for opportunistic infections

psychosocial support

educate on transmission

identify stressors

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19
Q

What antibiotic is administered to all infants born to HIV positive mothers?

A

trimethoprin-sulfamethoxazole

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20
Q

What are causes of diaper dermatitis? Findings? Preventative measures?

A

detergents, soaps, or chemicals
candida

red rash on genetalia, can be smaller patches too
red scaly areas on scrotum and penis, labia
pimples, blisters, bumps, pus-filled sores

promptly remove soiled diapers
clean with a non-irritating cleanser
use superabsorbent disposable diapers
apply skin barrier

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21
Q

What is atopic dermatitis/excema? Risk factors? Findings? Nursing care?

A

integumentary disorder, pruritis, cannot be cured but can be well controlled

family Hx
previous skin disorder causing an exacerbation
exposure to a causitive agent (med, food, soap, animal)

intense pruritis
dry and rough unaffected skin
hypopigmentation
pallor around nose, mouth, ears
blue skin under eyes
infected nail beds
lymphadenopathy
wound infections
lesions
keratosis pilaris

tepid baths to hydrate
apply emollient within 3 mins of bathing to trap in moisture
cotton clothing, avoid wool and synthetics
avoid excessive heat and perspiration
avoid irritants
wash sensitive areas frequently
identify causative agents
keep nail short

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22
Q

What is rubella? Mode of transmission? How can you have artifical immunity? Who is at risk? S/S? Treatment? Precautions?

A

German measles

contact with droplets

MMR vaccine

incomplete vaccination
outbreaks, endemic areas
immunodeficiency

maculopapular rash on face then trunk and extremeties
fever
HA
malaise
URI
mild conjunctivitis
lymphadenopathy

comfort measures
antipyretics
NSAIDS

droplet

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23
Q

What is rubeola?Mode of transmission? How can you have artifical immunity? Who is at risk? S/S? Treatment? Precautions?

A

measles

droplet and airborne

MMR

very contageous
3 Cs: cough, coryza (nasal discharge) and conjunctivitis
rash that spreads from head to toe
Koplik spots: white spots in mouth
malaise, HA
GI symptoms
fever
photophobia

cofort measures
antipyretic
topical ointment

airborne

24
Q

What is Epstein-Barr? Mode of transmission? S/S? Treatment?

A

mononucleosis

contact with saliva

glandular fever
CNS complications possible
splenic rupture
hepatosplenomegaly
fever
enlarged adenoids
pharyngitis
sharp abdominal pain

acetaminophen and NSAIDs
rest
can take 3-6 months
avoid contact sports because of the spleen

25
Q

What is the patho of hemorphillia? When is it commonly identified? Where can bleeding occur? Mngt?

A

sex-linked recessive, lack a coagulation component of factor 8, affects white males most

circumcision at birth

GI tract
peritoneal cavity
CNS
nosebleeds are common
tissue

Factor 8 in blood or concentrate
desmopressin

26
Q

What is the patho of iron deficiency anemia? What is inhibited? What can affect iron absorption in young children? Symptoms? Lab findings? Tx? Nursing interventions?

A

most common anemia though on the decline
stems from inadequate dietary iron

hemoglobin cannot be incorporated into RBCs

Drinkiing too much milk, 32+oz a day
Calcium hates iron

pale conjunctiva
pallor
poop muscle tone
enlarge spleen
enlarged heart/systolic murmur
spoon shaped fingernails

Hgb <11
Hct <33%

underlying cause
ferrous sulfate
high iron
high vitamin C

administer iron on empty stomach
avoid giving with milk or tea
give with an acid like OJ
high fiber to minimize constipation
follow-up bloodwork

27
Q

Patho of sickle cell anemia? Who does it affect most? What is the patho of a crisis? When can this occur? S/S? Tx?

A

autosomal recessive, erythrocyte sickles increasing blood viscosity with dehydration or hypoxia

Black

sudden, sever sickling, pooling of sickled cells causes tissue hypoxia

GI illness
dehydration
RI
strenuous exercise
idiopathic

low Hgb
sickled cells on peripheral blood smear
elevated bilirubin and reticulocyte
elevated WBC

pale
swelling
joint pain
enlarge spleen and liver possible
acute chest syndrome (tachypnea, wheezing, cough, fever)
pneumonia
cirrhosis
scarred kidney tissue
retinal occlusions
priapism (painful prolonged erection)

pain mngt
hydration
O2
possible exchange transfusion

28
Q

What is a Wilm’s tumor? Signs? Nursing considerations? Labs? Diagnosis? Tx?

A

painless, firm, mass on the kidney

fatigue, malaise, weight loss
fever
hematuria
HTN
metastasis: dyspnea, cough, SOB, chest pain

If suspected, DO NOT PALPATE

BUN, Cr
CBC
urinalysis

ultrasound
CT
inferior venacavogram
bone marrow aspiration to rule out metastasis

surgical removal of tumor an kidney
potential chemo/radiation, it depends

29
Q

What is the most common childhood cancer? Early manifestations? Late?

A

leukemia

anorexia
HA
fatigue
low-grade fever
pallor
increased bruising
enlarged liver, lymph nodes or joints
conspipation
unsteady gait

pain
hematuria
ulcerations in the mouth
enlarge kidneys or testicles
increased ICP

30
Q

What does luekemia cause? Doagnosis?

A

the production of immature WBCs which infiltrate organs and tissue. When it infiltrates the bone it crowds out the production of RBCs, platelets and mature WBCs causing anemia, neutropenia and thrombocytopenia.

CBC
bone marrow aspiration or biopsy
CSF biopsy via lumbar puncture

31
Q

What are treatments for leukemia?

A

vincristine
doxorubicin
corticosteroids
methotrexate
allogenic transplant
radiation

32
Q

What are risk factors for tonsilitis? Findings? Tx?

A

exposure to virus or bacteria
immature immune systems such as in children

sore throat
Hx of otitis media, hearin difficulties
mouth odor
moeth breathing
snoring
fever
inflammation
redness and edema
difficulty swallowing

viral: comfort measures, salt water gargles
bacterial: antibiotic

33
Q

What causes bronchiolitis? Early findings? Moderate findings? Severe? Tx?

A

RSV

rhinorrhea (load of snot)
fever
pharyngitis
ear or eye infection
coughing, sneezing, wheezing

tachypnea, retractions
refuses to bottle feed
copious secretions

tachypnea >70
listless
apnea
poor air exchange
advantageous breath sounds
cyanosis

maintain O2
fluids
mintain airway
meds: corticosteroids, bronchodilator, antibiotic (if bacterial)
No CPT
suctioning

34
Q

What are expected findings when croup has turned to epiglottitis? Tx? What are the precautions?

A

cough
drooling
agitation
chin and tongue out
dysphonia
dysphagia
stridor
retractions
fever

do not culture
protect airway
prepare for intubation
provide humidified O2
corticosteroids
fluids
antibiotic

droplet

35
Q

Risk factors for asthma? Findings?

A

family Hx
boy
exposure to smoking
low birth weight
obesity
allergens

chest tightness
dyspnea
audible wheezing
cough
mucus
restlessness
anxiety
using accessory muscles
retractions
inaudible breath sounds when severe

36
Q

Meds for asthma?

A

short acting beta blocker: albuterol
long acting beta blocker salmeterol
anticholernergic atropine, ipratroprium

37
Q

What is the patho of cystic fibrosis? risk factors? findings?

A

mutated gene that causes thick, tenacious mucus which leads to mechanical obstructions along with autonomic abnormalities

recessive trait
white

meconium ileus at birth
URI
wheezing, ronchi
dry cough
dyspnea
paroxysmal cough
emphysema and atelactasis
cyanoiss
barrel chest
clubbed fingers
bronchitis
steatorrhea
weight loss
thin arms and legs
deficiency of fat soluable vits
anemia
reflux
prolapse rectum d/t bulky stool
high salt in sweat, saliva, tears
reproductive issues
decreased insulin production

38
Q

Treatment of cystic fibrosis?

A

respiratory: CPT
GI: pancreatic enzymes with food
high protein, high calories
fat vitamin supplements
manage GERD
monitor blood glucose/insulin

39
Q

What are meds for cystic fibrosis?

A

respiratory: albuterol, ipratropium, fluticasone

to decrease viscosity of mucus: dornase alfa

antibiotics PRN

pancrelipase for pancreatic insufficiencies and food digestion

Vitamins ADEK

40
Q

What are nursing actions for cardiac catheterization?

A

assess for infection presurgery
check for allergies to idodine and shellfish
NPO 4-6 hrs prior
Baseline VS
mark pedal and posterior tibial pulses
administer pre sedation

Post:
monitor heart
assess RR
assess symmetry in pulses
asses temp and color of extremety
assess insertion site
strait flat position for 4-8 hrs
I&O
encourage clear liquids
encourage voiding

41
Q

What causes rheumatic fever? When does it occur? Findings? Complication?

A

Group A beta-hemolytic strep in the throat

2-6 week following infection

Hx URI
fever
tachycardia
cardiomeagly, new murmur, friction rub
SQ nodules over bony prominences
painful joints
rash on trunk
muscle weakness, involuntary movements
labile emotions
irritability, chorea (nervousness, decreased attention span, behavioral changes)

may need valve repair
heart disease
a fib
embolism

42
Q

What is kawasaki disease? Findings?

A

acute systemic vasculitis of uknown origin, usually resolves within 8 weeks

high fever
irritable
red eyes
chapped lips
strawberry tongue
swelling of hands and feet
red palm and soles
rash
bilateral joint pain
enlarged lymph nodes
myocarditis

43
Q

What is nursing care for kawasaki? Complications?

A

monitor cardiac status
assess for heart failure
I&O
daily weights
IV fluids
non acidic foods
IV gamm globulin
aspirin
comfort care

irritabiity can last 2 months
arthritis can last as well
avoid live immunizations for 11 months
heart failure

44
Q

What are s/s of heart failure?

A

tachycardia
tachypnea
failure to thrive
poor feeding
fatigue
SOB

45
Q

What happens is a patent ductus arteriosis? What happens to th blood flow? Does this cause baby to be blue? Assessment? Tx?

A

fetal shunt fails to close after a few days of life

blood flows from the aorta through the open PDA and into the pulmonary artery, increasing pulmonary blood flow

no, it’s acyanotic because the blood shunting is oxygenated

systolic murmur, 2nd intercostal

furosomide
prostaglandin inhibitor and indomethacin to fascilitate closure
increased calories
closure

46
Q

What occurs in tricuspid atresia? Assessment?

A

tricuspid valve is closed preventing blood from entering the left atrium

cyanosis
dyspnea
tachycardia
older: hypoxemia, clubbing

47
Q

What occurs with congential hypotyroidism? Cause? S/S? Tx?

A

reduced or absent function

mom was deficient in iodine
missing thyroid
family hX Hashimotos

sleepy
metabolism is SLOW
poor suck
open mouth, large tongue
obesity
hypotonia
constipation
large abdomen

levothyroxine

48
Q

What is Hyperthyroidism? Cause?

A

graves disease

most often pituitary tumor
viral/stress

tachycardia
hunger
weight loss
goiter
wide eyed, exophthalmia

beta blockers
PTU to suppress the T4 formation (propylthiouracil)

49
Q

What is PKU? Tx? Examples?

A

metabolic deficiency of liver enzyme phenylalanine hydroxylase which then fails to convert AA into tyrosine
builds up in the blood causing brain damage

restirct consumption of PKU containing foods

meat
eggs
milk

50
Q

What is the cause of acute gastroenteritis? S/S?

A

typically viral

N/V
dirrhea

51
Q

What is the most gommon cause of GERD in infants/chiildren? S/S? prevention?

A

gastroesophageal reflux

inadequate weight gain
irritability
emesis
gagging
choking
vomiting

avoid laying down after meals
elevate upper body on wedge when sleepings
avoid food triggers: acid, chocolate
eat smaller portions

52
Q

What is pyloric stenosis? findings? Tx?

A

hypertrophy or hyperplasia of the pyloric sphincter making emptying from the stomach to the duodenun difficult

vomit after feedings
projectile vomiting
sour smell
hungry after vomiting because they are not nauseated
dehydration
hypoglycemia
alkalosis/electrolyte imbalances

laprascopic correction, pyloromyotomy

53
Q

What is intussusception? When does itusually happen? Reason? findings? complication? Tx?

A

part of the intestine inverts on one another

first year of life

idiopathic

vomiting
abd pain
bloody stool like red surrant jelly
distended abd

necrosis of affected area

surgery
reduction first then surgery

54
Q

What is hirchsprnung disease? Findings? Tx? complication?

A

ansence of ganglionic innervation of a section of the bowl (ost often sigmoid section)
no parastalic wave in that section, area above it dilates
causes chronic constipation or robbon stool

meconium cannot pass
thin
undernourished

dissection of affected area
2 stages: temp. colostomy then dissection

possible colostomy

55
Q
A

Peds (5 decks)

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