Final: What I think is most important Flashcards
What problem would you see a patient with acetone, fruity breath?
DKA (diabetes)
What problem would you see a patient with acetone, fruity breath?
DKA (diabetes)
What are respirations like with DKA?
Kussmaual respirations (increased rate and depth of breathing)
What electrolyte imbalance may we see with DKA?
Serum and tissue potassium alterations–can lead to cardiac arrest
DKA: Widening QT?
HYPOkalemia
DKA: Shortening QT?
HYPERkalemia
DKA: How serious?
Very—ICU
What is blood glucose level for DKA?
> 300 mg/dl
What can happen if a person ignores HYPOglycemia too long?
Insulin shock
- Low blood sugar
- Weakness
- Convulsions
- Possible coma
Blood gluose level for hypoglycemia?
Less than 60 mg/dl
What is respirations like for HYPOglycemia? pulse?
Respirations: Shallow, normal
Pulse: Tachycardia, palpitations
What are late signs of HYPOglycemia?
Hyperreflexia Dilated pupils Seizure Shock Coma
What is blood glucose level for HYPERglycemia?
> 250 mg/dl
What is output like–early to late for HYPERglycemia?
Polyuria is early–oliguria is late
Which diabetic problem has flushed skin and sign of dehydration; also mucous membranes dry and crusty: hypo or hyperglycemia?
Hyperglycemia
What are respirations and pulse like for HYPERglycemia?
Respirations: Deep, rapid (KUSSMAUL)
Pulse: Less rapid, weak
What effect does exercise have on the child with diabetes?
Exercise gives feelings of week being and aids in utilization of food and often results in a REDUCTION of insulin requirments
If a diabetic child is active in team sports, when should they get a snack?
30 min prior to anticipated activity
Ketonuria in the presence of hyperglycemia is an early sign of ketoacidosis. Can a child exercise if they are at this state?
NO–This is a contraindication to exercise!!!
Sick children and diabetes. What needs to be done?
- Monitor BG 13h
- Test urine for ketones q3h
- KEEP taking the insulin and meds
- SUGAR FREE LIQUIDS for dehydration!!
- Carb snacks and rest
What is an acceptable level for children with diabetes for HgbA1C?
6.5-8%, target being less than 7%
What indicates diabetes after 8 hour fasting BG (blood glucose) level?
126 mg/dl or more
What indicates diabetes for a random BG test?
200 mg/dL or more + classic signs of diabetes
What indicates diabetes for oral glucose tolerance test?
200 mg/dL in the 2 hr sample
What condition may we see exophthalmos, wide-eyed stare?
Grave’s Disease
Graves Disease: Not a lot of motion or excessive? Explain
Excessive
- Irritability
- Hyperactivity
- Short attention span
- Tremors
- Insomnia
- Emotional lability
Graves: What is weight like?
Gradual weight loss despite a voracious appetite (occurs in 1/2 cases)
What problem gets the drug Somatropin?
Growth hormone deficiency
How is somatropin administered?
- Most effective at bedtime
- Administer SQ
- Caution to those receiving insulin
Why is the PKU test done in newborns?
Check whether newborn baby has enzyme phenylalanine in body, which is an amino acid that is needed for normal G&D
What is urine like with PKU?
Lots of metabolites are excreted, one being phenyl ketones–so gives a MUSTY ODOR to urine
How do most children with PKU appear?
Blond hair
Blue eyes
Fair skin (susceptible to eczema and other dermatologic problems)
Treatment for PKU?
LOW PROTEIN
What is the disease for the surgery Percutaneous heel cord tenotomy?
Congenital clubfoot
After the percutaneous heel cord tenotomy for clubfoot, what happens?
Long leg casts for 3 weeks
After casts a Denis Browne bar with Ponseti sandals or straight leg shoes
Clubfoot: Talipes varus
Inversion
Clubfoot: Talipes valgus
Eversion
Clubfoot: Talipes calcaneus
Dorsiflexion
Clubfoot: Talipes equinus
Plantar flexion
Clubfoot: Talipes equinovarus
Toes are facing inward and lower than heel
How is hip dysplasia (DDH) diagnosed?
Ultrasound should be performed at 2 weeks go age to determine the cartilaginous head of fetus
X-ray can diagnose DDH in infants older than 4 m
DDH: What are 2 tests that are signs of hip dysplasia in an INFANT?
- Positive Ortalani test (hip is reduced by ABduction)
2. Positive Barlow test (hip is dislocated by ADDuction)
DDH: What is the sign of hip dysplasia in a CHILD?
Positive Tredelenburg sign–while bearing weight on affected side, the pelvis tilts DOWNWARD
What is given to a newborn-6 months with DDH?
Pavlik harness, in place for 12 weeks!!
What are some skin care for Pavlik harness (DDH)?
- Use an undershirt
- Use knee socks
- Assess skin and gently massage skin under straps
- AVOID lotions and powders
- Place diaper UNDER straps
DDH: What traction is this?
Hips flexed at 90 degree angle with butt raised off bed
Bryant traction (skin traction)
DDH: What cast needs to be changed to accommodate growth?
Hip Spica Cast
What traction: Pull applied directly to the skin surface and indirectly to the skeletal structures? Examples?
Skin traction
- Bryant
- Buck
- Russell
Skin traction: Hips 90 degrees with butt raised off bed
Bryant
Skin traction: Extension; legs extended; used with Legg-Calve Parvis
Buck
Skin traction: Skin traction on lower leg and padded sling under knee
Russell
Pull applied directly to the skeletal structure by means of a pin or wire inserted into or through the diameter of the bone distal to the fracture
Skeletal traction
What traction is used when significant traction pull must be applied to achieve realignment and immobilization
Skeletal traction
What traction uses tongs that are inserted into the skull?
Cervical traction
Traction is maintained on cervical vertebrae, not the skull–the skull serves as a stabilizing anchor for the traction rods
How often are pin sites check for skeletal traction?
Check pin sites frequently for signs of bleeding, inflammation, and infection
Daily after first 48-72 hours
What is the halo vest?
Used for vertebral fracture with neurologic deficit—stabilizes the cervical/spine area; permits earlier ambulation
What problem: Aseptic necrosis of the femoral head
Legg calve perthes
What are signs of Legg calve perthes?
Intermittent limp
Hip soreness, ache, or stiffness
How is Legg calve perthes diagnosed?
Radiographic exam of hip and pelvis, with the definitive diagnosis being made by MRI which demonstrates osteonecrosis
Is it ok to give NSAIDs for Legg calve perthes?
Yes
What are some non-weight bearing containment devices for Legg calve?
An abduction brace
Leg casts
Leather harness sling
Traction
What is surgery for Legg calve?
Total hip resurfacing– replaces the hip joint
What is the Adams position? What is this used for?
Adams position: Child bends forward at waist so that the trunk is parallel with the floor and arms hang free
Scoliosis
Scoliosis: Why do we use a scoliometer?
To measure trunchal rotation
Scoliosis: What s Cobb technique?
Measures angle curvatures, which establishes degree of curve
Scoliosis: What is Risser scale?
Evaluate the skeletal maturity on radiographs
What is definitive diagnosis for scoliosis?
Radiographs of the child in the standing position and use of the Cobb technique
What is a mild curve for scoliosis?
Book says 20
ATI says 25
What are nursing responsibilities when the patient with scoliosis is wearing a brace?
Assist with fitting the client with a brace
Self image
Assess skin
When does a spinal fusion with rod placement occur?
Curvatures greater than 45 degrees
Why would scoliosis pt give blood before surgery?
Spinal surgery is long and invasive and requires blood due to blood loss from surgery–clients can donate their own blood to use during surgery if they wise (or they can use other peoples blood and do the blood test and cross match and all that)
Why do we do log rolling early in post op after spinal surgery?
Prevent damage to the fusion and instrumentation
How is OI diagnosed?
Bone biopsy
OI is disorder of ____. What 3 things is it characterized by?
Disorder of connective tissue (a collagen issue)
- Mutiple bone fractures
- Blue sclera (newborn)
- Early hearing loss
Why do OI newborns have a blue sclera?
The underling veins show though–this is due to sclera being thinner than normal bc he defective type 1 is not forming correctly
Occurs when trauma to a joint is so severe that a ligament is either stretched or partially or completely torn by the force created as a joint is twisted or wrenched
Sprain
Sprain: Why do we elevate above heart?
For venous rturn
Sprain: Why do we ice?
Ice cools off its and reduces pain and muscle stretch
Sprain: What neuromuscular checks must be done?
- Cap refil
- Sensation
- Skin temp and color
- Strength
- Pulses
Fractures: What are the 5Ps?
Pain Pallor Pulselessness Paresthesia Paralysis
Is it normal to have a fever with a fracture?
No
Compression of nerves, blood vessels, and muscle inside a confined place
Compartment syndrome
If compartment syndrome is untreated, what happens?
Tissue necrosis
Chronic inflammation of the synovium with joint effusion and eventual erosion
JIA (JRA)
What is normal for JIA: Swollen? Red? Warm? Morning stiffness (gelling)?
Swollen: Normal
Red: SELDOM RED WITH JIA
Warm: Normal
Morning stiffness: NORMAL
What are the DOC for JIA?
NSAID–may be given alone or in common
NSAIDs offer immediate analgesic effect, but anti-inflammatory effect requires larger doses and more time to achieve
JRA: What are SE of NSAIDs?
Abdominal pain and blood in stool–give with food
Naproxen: skin fragility in individuals with fair skin (be careful with sun exposure!!)
JRA: What is good exercise regimen?
Encourage daily exercise, starting with gradual program of walking and SLOWLY advancing to more active play as tolerated
Swimming is good too
The most severe and most common muscular dystrophy in childhood
Duchennes
What is Gowers sign?
Duchennes—when there is a waddling gait
Who gets Duchennes more frequently: boys, girls, or equal?
BOYS—it is an inherited Xlinked recessive trait
What are some of the first sings of Duchennes?
Difficulties in running, riding bike, and climbing stairs
Duchennes: When is there loss of independent ambulation?
~9-12 years of age
Duchennes: What usually causes death in these patients?
Respiratory problems or cardiac failure
Duchennes: Where is there muscle hypertrophy?
Calf muscle in most patients; also in thighs and upper arms
What disease has a characteristic manner of rising from a squatting or sitting position on the floor
Duchennes
Should we do incentive spirmotery with Duchennes?
YES–remember respiratory problems is one of the major causes of death!!! this is done to increase and maintain vital lung capacity
Duchennes: What has been shown to prolong ambulation for 18-24 months beyond the termination of independent ambulation?
Knee-ankle-foot orthoses
