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Pediatrics-MJ > Final: What I think is most important > Flashcards

Final: What I think is most important Flashcards

1
Q

What problem would you see a patient with acetone, fruity breath?

A

DKA (diabetes)

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2
Q

What problem would you see a patient with acetone, fruity breath?

A

DKA (diabetes)

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3
Q

What are respirations like with DKA?

A

Kussmaual respirations (increased rate and depth of breathing)

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4
Q

What electrolyte imbalance may we see with DKA?

A

Serum and tissue potassium alterations–can lead to cardiac arrest

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5
Q

DKA: Widening QT?

A

HYPOkalemia

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6
Q

DKA: Shortening QT?

A

HYPERkalemia

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7
Q

DKA: How serious?

A

Very—ICU

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8
Q

What is blood glucose level for DKA?

A

> 300 mg/dl

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9
Q

What can happen if a person ignores HYPOglycemia too long?

A

Insulin shock

  • Low blood sugar
  • Weakness
  • Convulsions
  • Possible coma
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10
Q

Blood gluose level for hypoglycemia?

A

Less than 60 mg/dl

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11
Q

What is respirations like for HYPOglycemia? pulse?

A

Respirations: Shallow, normal

Pulse: Tachycardia, palpitations

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12
Q

What are late signs of HYPOglycemia?

A 
Hyperreflexia
Dilated pupils
Seizure
Shock
Coma
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13
Q

What is blood glucose level for HYPERglycemia?

A

> 250 mg/dl

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14
Q

What is output like–early to late for HYPERglycemia?

A

Polyuria is early–oliguria is late

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15
Q

Which diabetic problem has flushed skin and sign of dehydration; also mucous membranes dry and crusty: hypo or hyperglycemia?

A

Hyperglycemia

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16
Q

What are respirations and pulse like for HYPERglycemia?

A

Respirations: Deep, rapid (KUSSMAUL)

Pulse: Less rapid, weak

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17
Q

What effect does exercise have on the child with diabetes?

A

Exercise gives feelings of week being and aids in utilization of food and often results in a REDUCTION of insulin requirments

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18
Q

If a diabetic child is active in team sports, when should they get a snack?

A

30 min prior to anticipated activity

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19
Q

Ketonuria in the presence of hyperglycemia is an early sign of ketoacidosis. Can a child exercise if they are at this state?

A

NO–This is a contraindication to exercise!!!

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20
Q

Sick children and diabetes. What needs to be done?

A
  • Monitor BG 13h
  • Test urine for ketones q3h
  • KEEP taking the insulin and meds
  • SUGAR FREE LIQUIDS for dehydration!!
  • Carb snacks and rest
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21
Q

What is an acceptable level for children with diabetes for HgbA1C?

A

6.5-8%, target being less than 7%

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22
Q

What indicates diabetes after 8 hour fasting BG (blood glucose) level?

A

126 mg/dl or more

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23
Q

What indicates diabetes for a random BG test?

A

200 mg/dL or more + classic signs of diabetes

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24
Q

What indicates diabetes for oral glucose tolerance test?

A

200 mg/dL in the 2 hr sample

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25
Q

What condition may we see exophthalmos, wide-eyed stare?

A

Grave’s Disease

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26
Q

Graves Disease: Not a lot of motion or excessive? Explain

A

Excessive

  • Irritability
  • Hyperactivity
  • Short attention span
  • Tremors
  • Insomnia
  • Emotional lability
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27
Q

Graves: What is weight like?

A

Gradual weight loss despite a voracious appetite (occurs in 1/2 cases)

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28
Q

What problem gets the drug Somatropin?

A

Growth hormone deficiency

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29
Q

How is somatropin administered?

A
  • Most effective at bedtime
  • Administer SQ
  • Caution to those receiving insulin
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30
Q

Why is the PKU test done in newborns?

A

Check whether newborn baby has enzyme phenylalanine in body, which is an amino acid that is needed for normal G&D

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31
Q

What is urine like with PKU?

A

Lots of metabolites are excreted, one being phenyl ketones–so gives a MUSTY ODOR to urine

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32
Q

How do most children with PKU appear?

A

Blond hair
Blue eyes
Fair skin (susceptible to eczema and other dermatologic problems)

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33
Q

Treatment for PKU?

A

LOW PROTEIN

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34
Q

What is the disease for the surgery Percutaneous heel cord tenotomy?

A

Congenital clubfoot

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35
Q

After the percutaneous heel cord tenotomy for clubfoot, what happens?

A

Long leg casts for 3 weeks

After casts a Denis Browne bar with Ponseti sandals or straight leg shoes

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36
Q

Clubfoot: Talipes varus

A

Inversion

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37
Q

Clubfoot: Talipes valgus

A

Eversion

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38
Q

Clubfoot: Talipes calcaneus

A

Dorsiflexion

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39
Q

Clubfoot: Talipes equinus

A

Plantar flexion

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40
Q

Clubfoot: Talipes equinovarus

A

Toes are facing inward and lower than heel

41
Q

How is hip dysplasia (DDH) diagnosed?

A

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

42
Q

DDH: What are 2 tests that are signs of hip dysplasia in an INFANT?

A
  1. Positive Ortalani test (hip is reduced by ABduction)

2. Positive Barlow test (hip is dislocated by ADDuction)

43
Q

DDH: What is the sign of hip dysplasia in a CHILD?

A

Positive Tredelenburg sign–while bearing weight on affected side, the pelvis tilts DOWNWARD

44
Q

What is given to a newborn-6 months with DDH?

A

Pavlik harness, in place for 12 weeks!!

45
Q

What are some skin care for Pavlik harness (DDH)?

A
  • Use an undershirt
  • Use knee socks
  • Assess skin and gently massage skin under straps
  • AVOID lotions and powders
  • Place diaper UNDER straps
46
Q

DDH: What traction is this?

Hips flexed at 90 degree angle with butt raised off bed

A

Bryant traction (skin traction)

47
Q

DDH: What cast needs to be changed to accommodate growth?

A

Hip Spica Cast

48
Q

What traction: Pull applied directly to the skin surface and indirectly to the skeletal structures? Examples?

A

Skin traction

  • Bryant
  • Buck
  • Russell
49
Q

Skin traction: Hips 90 degrees with butt raised off bed

A

Bryant

50
Q

Skin traction: Extension; legs extended; used with Legg-Calve Parvis

A

Buck

51
Q

Skin traction: Skin traction on lower leg and padded sling under knee

A

Russell

52
Q

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

A

Skeletal traction

53
Q

What traction is used when significant traction pull must be applied to achieve realignment and immobilization

A

Skeletal traction

54
Q

What traction uses tongs that are inserted into the skull?

A

Cervical traction

Traction is maintained on cervical vertebrae, not the skull–the skull serves as a stabilizing anchor for the traction rods

55
Q

How often are pin sites check for skeletal traction?

A

Check pin sites frequently for signs of bleeding, inflammation, and infection

Daily after first 48-72 hours

56
Q

What is the halo vest?

A

Used for vertebral fracture with neurologic deficit—stabilizes the cervical/spine area; permits earlier ambulation

57
Q

What problem: Aseptic necrosis of the femoral head

A

Legg calve perthes

58
Q

What are signs of Legg calve perthes?

A

Intermittent limp

Hip soreness, ache, or stiffness

59
Q

How is Legg calve perthes diagnosed?

A

Radiographic exam of hip and pelvis, with the definitive diagnosis being made by MRI which demonstrates osteonecrosis

60
Q

Is it ok to give NSAIDs for Legg calve perthes?

A

Yes

61
Q

What are some non-weight bearing containment devices for Legg calve?

A

An abduction brace
Leg casts
Leather harness sling
Traction

62
Q

What is surgery for Legg calve?

A

Total hip resurfacing– replaces the hip joint

63
Q

What is the Adams position? What is this used for?

A

Adams position: Child bends forward at waist so that the trunk is parallel with the floor and arms hang free

Scoliosis

64
Q

Scoliosis: Why do we use a scoliometer?

A

To measure trunchal rotation

65
Q

Scoliosis: What s Cobb technique?

A

Measures angle curvatures, which establishes degree of curve

66
Q

Scoliosis: What is Risser scale?

A

Evaluate the skeletal maturity on radiographs

67
Q

What is definitive diagnosis for scoliosis?

A

Radiographs of the child in the standing position and use of the Cobb technique

68
Q

What is a mild curve for scoliosis?

A

Book says 20

ATI says 25

69
Q

What are nursing responsibilities when the patient with scoliosis is wearing a brace?

A

Assist with fitting the client with a brace
Self image
Assess skin

70
Q

When does a spinal fusion with rod placement occur?

A

Curvatures greater than 45 degrees

71
Q

Why would scoliosis pt give blood before surgery?

A

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)

72
Q

Why do we do log rolling early in post op after spinal surgery?

A

Prevent damage to the fusion and instrumentation

73
Q

How is OI diagnosed?

A

Bone biopsy

74
Q

OI is disorder of ____. What 3 things is it characterized by?

A

Disorder of connective tissue (a collagen issue)

  • Mutiple bone fractures
  • Blue sclera (newborn)
  • Early hearing loss
75
Q

Why do OI newborns have a blue sclera?

A

The underling veins show though–this is due to sclera being thinner than normal bc he defective type 1 is not forming correctly

76
Q

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

A

Sprain

77
Q

Sprain: Why do we elevate above heart?

A

For venous rturn

78
Q

Sprain: Why do we ice?

A

Ice cools off its and reduces pain and muscle stretch

79
Q

Sprain: What neuromuscular checks must be done?

A
  • Cap refil
  • Sensation
  • Skin temp and color
  • Strength
  • Pulses
80
Q

Fractures: What are the 5Ps?

A 
Pain
Pallor
Pulselessness
Paresthesia
Paralysis
81
Q

Is it normal to have a fever with a fracture?

A

No

82
Q

Compression of nerves, blood vessels, and muscle inside a confined place

A

Compartment syndrome

83
Q

If compartment syndrome is untreated, what happens?

A

Tissue necrosis

84
Q

Chronic inflammation of the synovium with joint effusion and eventual erosion

A

JIA (JRA)

85
Q 
What is normal for JIA:
Swollen?
Red?
Warm?
Morning stiffness (gelling)?
A

Swollen: Normal
Red: SELDOM RED WITH JIA
Warm: Normal
Morning stiffness: NORMAL

86
Q

What are the DOC for JIA?

A

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

87
Q

JRA: What are SE of NSAIDs?

A

Abdominal pain and blood in stool–give with food

Naproxen: skin fragility in individuals with fair skin (be careful with sun exposure!!)

88
Q

JRA: What is good exercise regimen?

A

Encourage daily exercise, starting with gradual program of walking and SLOWLY advancing to more active play as tolerated

Swimming is good too

89
Q

The most severe and most common muscular dystrophy in childhood

A

Duchennes

90
Q

What is Gowers sign?

A

Duchennes—when there is a waddling gait

91
Q

Who gets Duchennes more frequently: boys, girls, or equal?

A

BOYS—it is an inherited Xlinked recessive trait

92
Q

What are some of the first sings of Duchennes?

A

Difficulties in running, riding bike, and climbing stairs

93
Q

Duchennes: When is there loss of independent ambulation?

A

~9-12 years of age

94
Q

Duchennes: What usually causes death in these patients?

A

Respiratory problems or cardiac failure

95
Q

Duchennes: Where is there muscle hypertrophy?

A

Calf muscle in most patients; also in thighs and upper arms

96
Q

What disease has a characteristic manner of rising from a squatting or sitting position on the floor

A

Duchennes

97
Q

Should we do incentive spirmotery with Duchennes?

A

YES–remember respiratory problems is one of the major causes of death!!! this is done to increase and maintain vital lung capacity

98
Q

Duchennes: What has been shown to prolong ambulation for 18-24 months beyond the termination of independent ambulation?

A

Knee-ankle-foot orthoses

Pediatrics-MJ (61 decks)

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