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Final Peds Flashcards

1
Q

Ages

A

Infant - birth to 1 year
Toddler - 1-3 year
Preschool - 3-6 year
School age - 6-12 years
Adolescent - 12-20

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2
Q

Age appropriate activities - Infant

A

Play soothing music, therapeutic hugging, speak in calming voice
Mobiles, noise-making, soft toys, and large blocks

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3
Q

Age appropriate activities - Todder

A

Approach carefully, use toys/books to distract, parallel play with them
Push-pull toys, Lg piece puzzle, and balls

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4
Q

Age appropriate activities - Preschool

A

Use play puppets, allow to touch equipment, allow choices, simple terms, count out loud, pretend play with them (give bear a shot)
Art & crafts, playing pretend, books

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5
Q

Age appropriate activities - School Age

A

Encourage questions, use diagrams, illustrations
Board games, action figures, models, video games

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6
Q

Age appropriate activities - Adolescent

A

Respect privacy, Do not force to talk, Use appropriate medical terms
Reading, listening to music, peer time

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7
Q

Types of Play

A

Infant - Solitary Play
Toddler - Parallel
Pres-schooler - Associated
School-Age - Cooperative

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8
Q

Infant Normal Assessment Findings

A

Wt: Birth weight Doubles by 5 months; Birth weight Triples by 1 year
Ht: Increases about 1 inch per month the first 6 months then occurs in spurts; birth length increases about 50% by 12 months of age
HC: About 10cm by 12 months of age
Respiratory variation makes them more susceptible to URI (narrow passages, etc)

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9
Q

Normal Motor Development

A

4 months - Head control, rolls from back to side, grasp objects with both hands
6 months - Rolls from back to front and holds bottle
9 months - Sits unsupported, creeps on hands/knees, and has crude pincer grasp
12 months - Sits down from standing, walks with one hand/on own, builds 2 block tower, makes simple marks on paper, and feeds self with cup and spoon

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10
Q

Feeding Recommendations

A

Breastfeeding
Breastfeed for 6 month
Iron supplement after 4 months

Bottle feeding
20 kcal/oz
10-12 mg Fe+

Progression to solids
4-6 months - Extrusion reflex
Iron fortified cereal are first food (rice, bareley, oatmeal)
New food 3-5 days

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11
Q

Toddler Health Promotion

A

Food Jags
Ritualism (same dishes or will not eat)
Physiogical Anorexia (decrease need for calories)
Picky Eaters

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12
Q

Toddler language Development

A

50-300 words by 2 yrs
Echolalia and telegraphic speech

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13
Q

Toddler Care Safety

A

Rear facing and back seat until 2 yrs

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14
Q

Pre-schooler Cognitive Development

A

Magical Thinking, imaginary friends, animism, and time

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15
Q

Pre-schooler Normal Social Development

A

Fears - loud noise, hospitalization, and mutilation of body
Imaginative play and dramatic play

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16
Q

School-Age Normal Social Development

A

Interested in peer’s perspective
Needs for acceptance (peer pressure begins)

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17
Q

School-Age Normal Assessment Findings

A

Diaphragmatic Breathing
Fontal Sinus develops by age 7
HR decrease and BP increase
Permanent teeth
Puberty - Girls 9-10 and boys 10-11

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18
Q

Adolescent Nutrition Promotion

A

Anorexia and Bulimia are common
2000 calories
Calcium 1300 mg daily
Iron - males 11 mg daily and females 15 mg daily

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19
Q

Adolescent hospitalized care

A

Develops Image disturbance
Maintain independence, participate in decisions
Encourage socialization with friends, may adhere to treatment/medication based on peer influence

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20
Q

Hypoxemia Assessment

A

First Sign is Tachypnea
Flaring of nose and ribs retraction

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21
Q

Hypoxemia Plan of Management and POC

A

Oxygen therapy (<91%), pulse oximetry, <86% life threatening, chest physiotherapy and suctioning

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22
Q

Asthma Management Medication

A

Long acting - Formoterol
Corticosteroids - Fluticasone
Mast-cell stabilizer - Cromolyn
Leukotriene - Montelukast

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23
Q

Asthma Labs/Diagnostic

A

CBC: ↑ WBC, ↑ Eosinophils
ABG: ↑ CO2, ↓O2
Allergy/RAST Testing: Identify triggers
SpO2: ↓ (normal if mild episode)
CXR: Hyperinflation/infiltrates

Pulmonary Function Test (PFT): measures lung capacity and overall lung function; not useful during acute exacerbation

Peak Inspiratory Flow Rates (PIFR):Measure forcefully exhaled in 1 second

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24
Q

Asthma Medication

A

Prevention
Long acting - Formoterol
Corticosteroids - Fluticasone
Mast-cell stabilizer - Cromolyn
Leukotriene - Montelukast

Acute Exacerbation
Short acting w/ anticholinergic - Albuterol w/ ipratropium
Corticosteroids - Prednisone

Status Asthmaticus
Intubation
Theophylline, Mg sulfate IV, heliox, ketamine

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25
Q

Cystic Fibrosis Medication Management

A

Chest PT w/postural drainage
O2 as prescribed
Monitor CO2 retention
Aerosol Therapy

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26
Q

Aerosol Therapy

A

Aerosol therapy
Pulmonary enzyme (dornase alfa) – decreases the viscosity of mucus, improving lung function
Bronchodilators & anticholinergics
Anti-inflammatory
IV or Nebulized antibiotics

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27
Q

Cystic Fibrosis Diagnostics

A

Sweat Chloride Test: >40 mEQ in <3 mon; >60 mEq for all other ages
Sodium > 90 mEq/L

Deficiency of fat-soluble vitamins (A,D,E,K)
Decreased pancreatic enzymes = thick mucus(pancreatic enzymes within 30 minutes of eating a meal or snack)

KUB: detects meconium ileus
Stool analysis: presence of fat and enzymes
CXR: Hyperinflation, bronchial wall thickening, atelectasis, or infiltrates
PFT: ↓ forced vital capacity/expiratory volume
Abdominal distention or difficulty passing stool; Bulky, fatty, greasy stools (STEATORRHEA)

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28
Q

Croup Physical Cues

A

“Barking cough”, inspiratory stridor, tachypnea, respiratory distress.
Infants: nasal flaring, intercostal retractions
Usually sudden onset at night, gone in the morning, self-limiting, and lasts 3-5 days

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29
Q

Croup Management Priorities

A

Administer dexamethasone (corticosteroid) to decrease inflammation

Racemic epinephrine (ᾀ-adrenergic effect of mucosal vasoconstriction to decrease edema); effects last up to 2H and symptoms may again worsen requiring another TX

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30
Q

HF Nursing Priorities

A

Oxygenation Intervention

Nutrition
150 calories/kg/day
24-28calories/oz bottle feeding can add vegetable oil or polycouse oil
Add HMF to breastmilk to make it more caloricly dense

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31
Q

HF medication

A

Beta Blocker (metoprolol): decrease HR and BP; increase vasodilation
S/E: dizziness, hypotension, and HA

Lasix (furosemide) - manage edema
K wasting. monitor BP, I/O, and weight

Captopril/Enalapril - reduce afterload
Monitor BP before and after administration

Digoxin
Apical pulse; hold if <90 bpm infant, <70 child, and <60 adolescents
Range 0.8-2.0 ng/mL
Signs of toxicity: N/V, anorexia, bradycardia, dysrhythmias
Antidote: digoxin immune fab

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32
Q

Coarctation of Aorta Assessment finding

A

Assess all pulses
Full bounding pulses in upper extremities
Weak or absent pulses in lower extremities

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33
Q

Tetralogy of Fallout Clinical characteristics

A

TET spells (progress to anoxia) -> knee chest position or squatting

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34
Q

Tetralogy of Fallout Nursing Management

A

Promoting oxygenation &ventilation: (Upright position, O2, suction)
Promoting nutrition: Small, frequent meals or OF/NG feeds; 150 calories/kg/day

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35
Q

Kawasaki Disease Assessment Findings

A

Autoimmune vasculitis
High fever for 5 days and unresponsive to antibiotics

Mouth and throat dry, fissure lips, strawberry tongue, and pharyngeal/oral mucosa edema, peeling of fingers, toes, and perineal areas

Conjunctivitis w/out exudate

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36
Q

Kawasaki Labs

A

CBC: Mild-Moderate Anemia Elevated WBCs
Thrombocytosis (↑ platelets) (acute phase)
Hypoalbuminemia – from vascular permeability
ESR/CRP: Elevated (inflammatory markers)
Angiogram: aneurysm formation – “string of beads”
Echocardiogram: Establish baseline for repeat

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37
Q

Kawasaki Treatment/Nursing Management

A

IV IG
Acetaminophen
High dose aspirin

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38
Q

Sinus Tachycardia Characteristics and Management

A

Characteristics
Infants rate is <220 bpm (160-220), in children < 180 bpm (130-180)

Management
Treatment is focused on the underlying cause

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39
Q

Sinus Bradycardia Characteristics and Management

A

HR <60
Children with a life-threatening bradyarrhythmia will have HR <60 with signs of altered perfusion (respiratory compromise, hypoxia, shock), EKG changes
Sustained bradycardia is commonly associated with arrest and is an ominous sign

Management
Usually recover spontaneously

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40
Q

SVT Characteristics and Management

A

Characteristics
Infants rate is >220 bpm, in children > 180 bpm with abrupt onset and termination, P wave are flattened, QRS narrow

Management
Compensated (alert): Vagal maneuvers (ice or blowing through a straw); adosine
Uncompensated (AMS): adenosine or cardioversion

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41
Q

Oral Dehydration

A

Attempted first for mild and moderate cases of dehydration

Management (over 4 hrs)
Mild: 50 ml/kg oral rehydration solution (ORS) within 4 hours
Moderate: 100 ml/kg ORS within 4 hrs
Replacement of diarrhea losses: 10 ml/kg for each stool

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42
Q

IV Rehydration

A

Severe Cases - Initiated when child has severe case of dehydration or is unable to tolerate oral fluids to correct fluid losses (persistent vomiting)

Bolus of 20 mL/Kg

Maintanance Fluid
100 ml/kg for first 10 kg
50 ml/kg for next 10 kg
20 ml/kg for remaining kg
Add for total ml needed per 24 hour period

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43
Q

Pyloric Stenosis Def

A

Pylorus muscle hypertrophies and thickens on the luminal side of the pyloric canal causing gastric outlet obstruction

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44
Q

Pyloric Stenosis Nursing Assessment

A

Forceful, projectile vomiting in first 3-6 wks of life
Olive mass in RUQ

Physical cues: dehydration, olive shaped moveable mass in RUQ, metabolic alkalosis

45
Q

Pyloric Stenosis Nursing Priorities

A

Pre-repair
IV fluids, NG tube, NPO, I&Os

Post op (pyloromyotomy)
Wound care
Resume PO feedings in 1-2 days

46
Q

Hirschsprung’s Definition

A

Resection and re-anastomosis surgery is necessary to restore proper bowel function typically done in four stages

47
Q

Hirschsprung’s Expected Findings

A

Failure to pass meconium 24-48 hrs after birth, vomit bile, abd distention, and refusal to eat

Foul smelling/ribbon like stool

48
Q

Hirschsprung’s Treatment

A

Surgical resection and anastomosis
Broad Abx, IVF, rectal washout

Nursing Management
Monitor signs of enterocolitis: fever, abdominal distention, chronic diarrhea or explosive stool, rectal bleeding, or straining – notify provider immediately

49
Q

Acute Glomerulonephritis Diagnostics

A

Recent Strep/pharyngitis or skin infection
Tea color urine

Positive ASO titer (strep antibodies), hematuria, proteinuria, elevated BUN/creatinine, and elevated ESR

50
Q

Acute Glomerulonephritis Nursing management

A

Manage HTN w/ diuretics and HTN meds, abx for infection
Monitor renal/neuro and fluid status

51
Q

Hemolytic Uremic Syndrome Findings

A

Three features: hemolytic anemia, thrombocytopenia, acute renal failure
s/s: Pallor or toxic appearance, edema, oliguria, or anuria

Labs
Proteinuria, hematuria, leukocytes, casts
Elevated BUN/creat
Mild-severe thrombocytopenia
Hyponatremia/kalemia

52
Q

Hemolytic Uremic Syndrome

A

PRBCs and platelets (only for active bleeding or severe thrombocytopenia); IVIG may be considered

Maintaining fluid balance, managing HTN, acidosis, & electrolyte abnormalities

53
Q

Hypospadiea Physical Findings

A

Abnormal urethral opening on ventral surface of penis (penis hole is below)

54
Q

Hypospadias Treatmet

A

Circumcision, urethral stent to correct chordee keep upright
Double diapering to protect stent or catheter from stool

55
Q

GH Deficiency Manifestation

A

Physical cues
Note birth hx, severe head trauma, or brain tumor
Evaluate past/current growth patterns
Caused by injury to pituitary gland or hypothalamus
Sx: large prominent forehead, high pitched voice, delayed sexual maturation, delayed dentition and skeletal maturation

Diagnostics
Skeletal survey: 2+ SD < normal in bone age
CT/MRI: rule out tumors/other abnormalities
Pituitary function test will confirm
Growth chart deviations

56
Q

GH deficiency Medication/treatment

A

Biosynthetic GH (somatropin)
Replaced via Sub-Q injections 0.18-0.3 mg/kg/week divided in equal daily doses at night time
GH continued until growth rates of less than 1 inch/year or bone age of >16/14

57
Q

Congenital Hypothyroidism Clinical Manifestation

A

Physical cues
Poor sucking, hypothermia, constipation, lethargy, hypotonia, periorbital puffiness, cool/dry/scaly skin, bradycardia, RR distress, large fontanelles/delayed closure

Diagnostics/labs
Newborn screening
Free T4: Low
TSH: High

58
Q

DKA Symptoms

A

Physical cues
Rapid onset, glucosuria, change in LOC, nausea, dry oral MM, blood sugar over >450, moderate ketones in urine

Lab cues
Metabolic acidosis, hyperkalemia, glucosuria, ketonuria

Management/Nursing actions
IV regular insulin drip, fluids, monitor blood sugar (cerebral edema)

59
Q

Hydrocephalus Physical Cues

A

Physical cues: symptoms of increased ICP (sunset eyes, bulging fontanelles, widened sutures, poor feeding, increased head circumference)

60
Q

Hydrocephalus Treatment/Management

A

Treatment: VP shunt
Placement: into the ventricle to give CSF an exit
Assessment: increased ICP sx (back to square one)

Complications: obstruction or infection; reoccurring surgical procedures to replace shunt

61
Q

Seizures Nursing Care

A

Padding of side rails, rail raised, oxygen and suction at bedside, and bracelet

Supervision during activities, use protective helmet during some activities

62
Q

Increased ICP Physical Cues

A

Infant have bulging fontanels
Early Sign: Sunset eyes, HA, blurred vision, tachycardia, and dizziness
Late signs: Cheyne-Stokes respiration, and Cushing’s triad (irregular breathing, HTN, and bradycardia)

63
Q

ICP Management

A

Decreasing ICP: Elevate head of bead 30-45º, decreased stimuli, hyperthermia management (avoid shivering), sedation, avoid coughing/blowing nose/suctioning, stool softener

Medication: mannitol (osmotic diuretic)

64
Q

Bacterial Meningitis Nursing Management

A

ICU admission with strict Droplet Isolation until 24H of antibiotics or orders to discontinue
Seizure precaution
Manage hyperthermia with NSAIDs, cooling blankets, cool compresses, and tepid baths

65
Q

Meningitis Lab Findings

A

Lumbar puncture
CSF is cloudy, elevated WBC/protein, decreased glucose, positive gram stain
LP: CSF Results: WBCs ↑ + ↓Glucose +↑Protein, cloudy in color

66
Q

Reye Syndrome

A

Physical cues (encephalopathy and increased ICP): jaundice, vomiting, lethargy, confusion, + Babinski, hyperreflexia

Lab cue
Elevated ammonia (treat with lactulose)
Elevated AST/ALT
Hypoglycemia (treat with D5)
Increased prothrombin time (treat with FFP or vit K)

67
Q

Reye Priority of Care

A

Nursing management
Maintain hydration, position client, monitor coagulation, monitor pain, seizure precautions

Priority of care
Decrease ICP and supportive care for the sequelae r/t acute liver failure

68
Q

Spina Bifida Cystica - Meningocele

A

Meningocele
Covering the spinal cord
Usually minor and no neurological deficits
Care: measures to prevent rupture of sac to include prone positioning before and after surgical repair; monitor head circumference and observe for signs of increased ICP

Care: NS moistened dressing to keep sac moist and prevent rupture, monitor for signs of latex allergy, report leaking from sack, prone positioning, no diapering

Complications: skin breakdown, latex allergy, increased ICP, bladder issues, bowel issues, orthopedic issues

Surgery can be delayed as long as there is not leaking

69
Q

Myelomeningocele Management

A

Myelomeningocele
Most severe form
Enclosed in the spinal cord, varying degrees of neuromuscular deficits
Risk factors: lack of prenatal care and folic acid

Care: NS moistened dressing to keep sac moist and prevent rupture, monitor for signs of latex allergy, report leaking from sack, prone positioning, no diapering

Complications: skin breakdown, latex allergy, increased ICP, bladder issues, bowel issues, orthopedic issues

70
Q

Cerebral Palsy Definition

A

Nonprogressive impairment of motor function, abnormal perception and sensation, cognitive disability, majority of causes occur before delivery. The manifestation depends on the affected part of the brain

71
Q

Cerebral Palsy Management/ Nursing Care

A

Oxygenation/ventilation
Pain management
Baclofen, botulinum toxin A (botox), and carbidopa
Adequate nutrition, skin care, communication, psychosocial (independence), developmental
Physical, occupational, speech therapy

72
Q

Cerebral Palsy Complication

A

Seizures, delayed G&D, hydrocephalus, aspiration, and injury r/t limited mobility
Function and quality of life vary

73
Q

Fractur Complication

A

Compartment Syndrome
5 P’s: pain, paresthesia, pulselessness, pallor, and paralysis
Osteomyelitis
Infection in the bone
Sx: irritability, fever, tachy, edema, constant pain, and tenderness

74
Q

Amblyopia Therapeutic Management

A

Patching (the stronger eye) for several hours a day OR Atropine drops in the stronger eye daily
Vision therapy
Eye muscle surgery

75
Q

Acute OM assessment findings

A

NOTE: for child <3 yrs – pull pinna down and back; >3 yrs – pull pinna up and back.

On exam, tympanic membrane (TM will be dull, red, bulging, or opaque)

76
Q

Acute OM Management

A

Symptomatic management of otalgia and fever
Acetaminophen and ibuprofen
Benzocaine (Auralgan) drops may also be prescribed for pain if the TM is not ruptured
Antibiotic therapy - Amoxicillin, Amoxicillin-clavulanate (Augmentin), Azithromycin – PO (10-14 days)
Pneumatic otoscope- used to visualize the TM and assess its movement

77
Q

Bacterial Skin Infections

A

Impetigo (can turn into papules and vesicles)
Cellulitis (localized inflammation)
Staphylococcal scalded Skin Syndrome (burn-like appearance - leaves red, weeping surface)

78
Q

Impetigo Physical Cues and Management

A

Physical Cues
Common infection of superficial layers of epidermis - primary or secondary. Papules → vesicles or pustules w/honey-colored exudate/crusts; itchy or painful; honey color

Management/Education
Soak impetigo lesions in appropriate solution before applying antibiotics
Treat topically with antibiotic ointment or oral antibiotics; hygiene/linens, avoid contact

79
Q

SSSS

A

Cues
S.aureus produces a toxin that causes the skin to exfoliate causing diffuse erythema and tenderness and a burn-like appearance – leaves red, weeping surface (face, neck, axillary, groin)

Treatment/Education
Mild: Oral antibiotics
Severe: IV antibiotics, fluid management, burn treatment

80
Q

Cellulitis

A

Patho
Localized infection or inflammation; Firm, swollen, red area of skin and subcutaneous tissue (red, warm, swollen, pain, tenderness) & possible systemic effects (fever, malaise)

Treatment/Education
Oral or parenteral antibiotics
Rest and immobilize affected area

81
Q

Atopic Dermatitis (eczema) Definition

A

A chronic condition that causes dry, itchy and inflamed skin that’s common in young children. An antigen response to environmental factors, temperature changes and sweating.

82
Q

Atopic Dermatitis (eczema) Physical Cues and Diagnostic

A

Physical cues
Extreme itching
Erythema, inflammation
Variety of lesions/rash (plaques, papules, scaling, vesicles) on face, scalp, wrists or arms, elbows/antecubital, knees/popliteal areas

Diagnostic findings
Elevated IgE levels
Presence of wheezing

83
Q

Atopic Dermatitis Management

A

Medications: Topical corticosteroids & Immunomodulators-tacrolimus
Avoid hot water and bathe 2X/day in warm water
Avoid soaps containing perfumes, dyes, or fragrances (Dove, Caress, Cetaphil, Aquanil)
Pat skin dry and leave moist while apply moisturizers (Eucerin, Aquaphor, Vaseline, Crisco) multiple times daily
100% cotton clothing and bed linens, avoiding synthetics and wool; Keep fingernails short
Antihistamines at HS may assist with itching; Behavior modification during waking hours (clickers, distraction, reward)

84
Q

Skin lesion Risk Factor

A

Poverty, prematurity (<1 yr), chronic illness, intellectual disability, parent w/ abuse history, unrelated partner, alcohol/substance abuse, and extreme stressor

85
Q

Tinea Locations

A

Pedis – feet
Corporis – arms or legs
Versicolor – hypopigmented areas on neck, trunk, proximal arms
Capitis – scalp, eyebrows, or eyelashes
Cruris – inguinal creases and inner thighs

86
Q

Tinea Treatment

A

Tinea capitis: Oral griseofulvin
Other Tinea: Topical antifungal (clotrimazole) at least 4 weeks; Linens and clothing must be washed in hot water to reduce spread.

87
Q

Hemophilia Definition

A

Deficiency of Factor VIII which is essential to activate factor X, which converts prothrombin to thrombin, without it, platelets cannot make clots

88
Q

Hemophilia Physical Cues and Labs

A

Physical Cues
Joint swelling, pain, bruising, bleeding (nose, gums, hemoptysis, hematemesis, heavy menstrual); chest or abdominal pain (internal bleeding)
Lab Cues
CBC – possible low Hgb & Hct
Coags – PTT prolonged; normal PT & Platelets

89
Q

Hemophilia Management

A

FIRST - Factor VIII administration
Apply direct pressure to external bleeding; if joint bleeding, apply ice or cold compresses and elevate extremity unless contraindicated by causing further injury
Desmopressin (DDAVP) (in mild cases) – triggers the endothelium of bld vessels to release Factor VIII

90
Q

Iron Deficiency Anemia Assessment

A

Assessment Findings:
Irritability, HA
Unsteady gait, weakness,fatigue
Dizziness, sob, pallor skin, mm, conjunctiva assess for difficulty feeding, pica spooning of nails

Lab Cues
Decrease
RBC, Hgb, Hct, MCV, MCH, and Ferritin
Increase
RDW

Causes
Blood loss or iron depletion

91
Q

Iron Deficiency Anemia Management

A

Nutrition (Fe+ rich food)
Red meant, tuna, salmon, eggs, tofu, enriched grains, dried beans and peas, dried fruits, leafy green vegetables, and Fe+ fortified cereal

Give with vitamin C, do not give with milk, color stools and black urine may be normal, , stain teeth, drink with straw, and may cause constipation

92
Q

Sickle Cell Vaso-o-occlusive Crisis

A

Management
Priority of care
Pain control (NSAIDS and opioids)
Hydration (double maintenance fluid 150ml/kg/day)
Hypoxia (maintain O2 >92%)
O2 via NC if < 92%

93
Q

Bone Marrow Aspiration

A

Procedure
Prone position
Iliac crest

Fentanyl/Versed (anesthetic/sedation
Pre-procedure
Infection prevention

Post-procedure
Hold pressure on dressing and monitor for bleeding and infection

94
Q

General Neutropenic Precation

A

Private room
Meticulous hand hygiene before and after care
VS Q4H and assess for signs of infection Q8H and PRN
Avoid rectal temps, enemas, suppositories, urinary catheters, and invasive procedures
Restrict visitors
No raw fruits, vegetables, fresh flowers, or live plants in room
Mask on child when outside room
Soft toothbrush

95
Q

Common Cancer Treatment

A

Anemia
Thrombocytopenia
Neutropenia
Management of N/V and anorexia

96
Q

Radiation Therapy AE/Common complication/Management

A

Wash skin with mild soap & water
Avoid lotions/powders/ointments
Avoid sun or heat exposure
Diphenhydramine or hydrocortisone cream for itching
Antimicrobial cream to desquamation
Moisturize with aloe vera

97
Q

ALL Clinical Manifestation and Lab Findings

A

Priority of Care
Preventing infection, treating pain, anemia, preventing bleeding

Lab Cues
Bone Marrow Aspirate (BMA) - most definitive test, determines lymphoid or myeloid and cell types, and prolific quantities of blasts. (Determine MLL or ALL)
CBC - Low Hgb, Low Hct, Low RBCs, low/normal/high WBCs
Blood Smear - may reveal blasts
LP – whether leukemic cells in CNS
CXR – to detect PNA or mediastinal mass

98
Q

Treating Fever in Children

A

Infant
100.4 F

Child
102.2

Older Child
Appears sick, rash, V/D, signs of dehydration, and chronic medical problem

99
Q

Fever in children Nursing Care

A

Assess temp q4-6hr; 30-60 min after medication
Use same site for temp
Experiencing discomfort or cannot keep up with the metabolic demands of the fever
Tylenol – po Q 4-6 hrs
Ibuprofen – Q 6-8 hrs (>6 mo.)
I/O and hydration

100
Q

IGs

A

IgG – the only one that crosses the placenta + breastmilk. Protects against viruses, bacteria + toxins.
IgA – Defense against respiratory, GI, GU pathogens
IgM – indicates active infection
IgE – Increased in allergic states + severe allergic reactions + parasitic reactions

101
Q

Lyme Disease Therapeutic and Nursing Management

A

Doxycycline if started early (age >8 yrs)
Amoxicillin should be given if <8 yrs to prevent teeth discoloration or cefuroxime if allergic
Treatment for 14-28 days

102
Q

Pertusis Physical Cues and Therapeutic Management

A

Causes swelling & irritation of airways - Cold symptoms for 7-10 days followed by cough for up to 4 weeks, with recovery taking weeks to months

Physical Cues
Paroxysmal cough (coughing 10-30 times in a row) - “whooping cough”
Red face, cyanosis, and protruding tongue, and increase secretion
Cold symptoms for 7-10 days and 4 wks of cough

Management
Macrolide (“mycins”) antibiotics for infants >1 month
Azithromycin if <1 month
Pertussis vaccine for all contacts <7 that are unvaccinated or undervaccinated

Nursing Management
Tdap Vaccine
Airway obstruction, antibiotic compliance
Droplet precation

103
Q

SCID Management and Treatment

A

Absent T and B cell function

Management/Treatment
Bone marrow transplant
IVIG to prevent bacterial prevention
Infection prevention

104
Q

Juvenile Idiopathic Arthritis Assessment and Diagnostics

A

Assessment/Diagnostics
Irritability and fussiness may be first signs
Withdrawal from play, joint stiffness and pain in after sleep, guarding of joint, limping, inflammation at joint, and fever and rashes if systemic

Labs
Elevated WBC, EST, and CRP
+ANA and Rheumatoid factor
Moderate anemia

105
Q

Lab Cues of Immunodeficiency/WBC types

A

Neutrophils – presence of acute bacterial infection or severe stressor
Eosinophils – allergic reactions
Lymphocytes (B&T) elevated in viral infections or chronic bacterial infection
Erythrocyte Sedimentation Rate (ESR) - inflammation marker
C-reactive protein (CRP) - inflammation marker
Complement C3 – when elevated, indicates immune system is active from an infection or injury

106
Q

Rubeola (Measles) – Assessment cues & nursing actions

A

Physical Cues
Maculopapular rash: starts on face > neck > trunk > arms > legs > feet
Fever, Koplik spots, cough, nasal inflammation, malaise, conjunctivitis

Nursing Actions
Antipyretics, bedrest, fluids, humidification
Airborne Precautions until 4 days after the onset of rash
Vaccination within 72 hours or immune globulin (IgG) within six days
Vitamin A for hospitalized children 6 months to 2 years or if immunocompromised

107
Q

Latex Allery Cross sensativity

A

Cross Sensitivity (35% to one of the food)
Kiwi, banana, peach, avocado, chestnut, fig, bell pepper, tomato. and white potato
Waxy fruits (?), the proteins in these fruits/others are also present in latex

108
Q

Latex Allergy Management

A

Allergy intervention

Peds (4 decks)

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