Final: What I think is most important part 2 Flashcards
What are some causes of CP?
- Brain injury
- Maternal chorioamnionitis
- Extremely LBW
- LBW (low birth weight)
- Mutltiple births
- Placenta didn’t provide developing fetus with enough oxygen and nutrient
- Kernicterus (high levels of bilirubin in neonatal period)
- Shaken baby syndrome surivors
What are some long term problems associated with CP?
- Visual and hearing impairment
- Communication and speech difficulities
- Seizures
- Intelectual impairment
- ADHD
- Dental caries
- Drooling
- Nystagmus
The most common chromosomal abnormality of a generalized syndrome?
Down syndrome
97% of all down syndrome are attributable to what?
An extra chromosome 21 group
What pregs are more at risk for down syndrome baby?
Those over 35
DS: What kind of separation in suture? How is head look?
Separated sagittal suture
Enlarged anterior fontanel
Small, rounded head
Flat face profile
DS: What are eyes like?
Upward, outward slant
DS: What is nose like?
Small nose, depressed nasal bridge (saddle nose)
DS: How are ears?
Small with short pinna
DS: How is mouth?
High, arched, narrow palate
Protruding tongue
DS: What is chest like?
Shortened rib cage
DS: How does abdomen look?
Protruded
DS: What are hands like?
Broad, short hands and stubby fingers
DS: What are feet like?
Wide space between big and second toes
Plantar crease between big and second does
DS: Musculoskeletal signs noted?
Hyperflexibility and hyptonia
DS: Increased risk for what cancer?
Leukemia
A viral infection in which the virus affects the t-lymphs, causing immune dysfunction, which leads to organ dysfunction and a variety of opportunistic illnesses in a weakened host
HIV
What kind of HIV/AIDs infection will we see children with Kaposi sarcoma?
Severely symptomatic infection
What is the main therapy for HIV?
HAART
What antibiotic do we administer to all infants who are born to infected mothers with HIV?
Give TMZ-SMZ until HIV infection is excluded
Why would IV gamma globulin be given to HIV pts?
To prevent recurrent or serious bacterial infections
What are priority nursing problems for child with HIV?
- Infection (hand-washing, deep breathing/coughing, and needing to get PCV and flu vaccine)
- Education: They cannot miss a dose of their med!! and it needs to be taken on regular schedule!! Adolescents need to under stand high risk sexual behaviors can infect others!!!
What bacteria can cause UTI?
E. coli (just an example, there are others)
What does urinalysis look like for UTI?
pH: weak acid or neutral alkaline
Protein, glucose, ketones, leukocytes, and nitrates: ALL POSITIVE in urine
Note: Normal urine should be NEGATIVE for protein!!
UTI infants: Feeding like? How do they take it?
Poor feeding
Vomiting
Failure to gain weight
UTI infants: Increase or decrease in thirst?
Increase
UTI infants: Infrequent or frequent urination?
Frequent–staining with urination and foul smelling
UTI infants: Fever? Diaper rash? Blood in urine? Swelling of face, edema? Seizure, pallor? Dehydration?
Infants:
Fever: yes
Diaper rash: yes
Blood in urine: No (this is in children though!)
Swelling of face, edema: No (this is in children though)
Seizure, pallor: yes
Dehydration: Yes
UTI children: How is appetite?
Poor–vomiting
UTI children: How is growth?
Slowed
UTI children: Increase or decrease in thirst?
Increase–eneuresis; frequent urination
UTI children: Is there swelling anywhere?
Yes, face–also edema
UTI children: Tired? Hypotension or hypertension?
Yes fatigued, hypertension; also have tetany
UTI children: What kind of urine
Foul smelling or blood in urine?
Blood in urine
What are some antibiotics given for UTI?
Penicillins
Sulfonamide
Cephs
Nitrourantoin
What kind of underwear for UTI: cotton or nylon?
Suggest use of cotton
What should we instruct sexually active adolescents to do to prevent UTI?
Instruct them to void immediately after intercourse
Nephrotic Syndrome (NS): What is urinalysis like? (4)
- Elevated protein in urine (2+ on dipstick)
- Hyaline casts
- FEW RBC
- Oval fat bodies
NS: What is chemistry like? (8)
- Hypoalbuminism: less than 2 g/dl
- Elevated Hgb, Hct
- Elevated platelets: 500,000-1,000,000
- Possible hyponatremia
- Decreased serum protein level (6.1-7.9)
- Hyperlipidemia
- Serum cholesterol: (450-1500 mg/dl)
- Normal potassium
The most common presentation of glomerular injury in children
Nephrotic syndrome
In nephrotic syndrome, alterations in the glomerular membrane allow proteins, especially _____, to pass into the urine; resulting in decreased serum osmotic pressure
Albumin
What is most common form of NS?
MCNS
If a patient with NS has edema, what should we do?
RESTRICT SALT
A non-specific upper resp. tract infection that manifestations by 4-8 days but is considered to be a precipitation factor rather than a cause of NS
Minimal change nephrotic syndreom (MCNS)
What are some clinical manifestations of MCNS?
-Gain weight over a period of days or weeks
-Puffiness of face (especially around eyes) [this is apparent on arising in am but subsides during day–>then swelling of abdomen and lower exremtieis is more prominent]
-Diarrhea
-Loss of appetite
-Lethargic
Decreased urine volume–dark, opalescent and frothy
-BP NORMAL OR SLIGHTLY DECREASED
MCNS: An acute infection may precipitate severe generalized edema..Where?
Periorbital edema
Abdominal swelling from ascites
Labial or scrotal swelling
What is DOC for MCNS/NS? Client education?
Prednisone
-Administer with meals
Why would we give diuretics for MCNS/NS? Client education?
Eliminates excess fluid from body
-Encourage child to eat foods high in K
Why would we give 25% albumin to MCNS/NS pts?
To increase plasma volume and decrease edema
What drug is given for MCNS/NS for children with frequent relapsing of MCNS or steroid resistant NS?
Cyclophosphamide or chlorambucil
How does urine look for glomerulonephritis?
Smoky or tea colored urine
Glomerulonephritis: What test can show presence of streptococcal antibodies?
Elevated ASO titer
The glomeruli are inflamed, which impaired the kidney to filter urine properly
Acute glomerulonephritis (AGN)
What VS change is anticipated with glomerulonephritis?
Increased BP–HTN
Can give loop diuretics and anti-HTN drugs to help with this
*if not treated, seizures can occur
Glomerulonephritis: What are signs of renal failure?
- Decreased urine output-first sign
- HTN encephalopathy
- Cardiac decompensation
Glomerulonephritis: How is urine? Increased or decreased blood protein level? Low, normal, or elevated lipid level? Increased or decreased K level?
Urine: smoky, tea color (also hematuria and proteinuria)
INCREASED blood protein level
NORMAL lipid level
INCREASED K level
Since glomerulonephritis can have an increased K level, what foods should be avoided?
Bran cereal Potatoes Tomatoes Bananas Melons Orange OJ Yogurt Leafy greens Beans Avacodos
Inappropriate urination that must occur at least 2weeks for at least 3 months–the child must be at least 5 years of age before there is consideration about diagnosis
Eneuresis
What does DDAVP do?
An antidiuretic hormone that reduces volume of urine–given for enuresis
*Can be given PO or nasal, if nasal–store in fridge
Why would we give a child with enuresis a TCA?
We could give imipramine hydrochloride to INHIBIT urination. We need to make sure to monitor child for increase suicidality though
This is for 6-8 weeks, with a gradual withdrawal
Administer with food and 1 hr before bedtime
Avoid sun exposure and OTC meds while on drug
What anticholinergic could we give to child with enuresis?
Oxybutin chloride to reduce bladder contractions
Meatus opening located on the dorsal surface of the penis
Epispadias
Male: widened pubic symphysis, broad/spade like penis
Female: Wide urethra, bifid clitoris
Both: possible exstrophy of bladder
Urethral opening located behind glans of penis or on the ventral surface of penile shaft
Hypospadias
Narrowing of the preputial opening of the foreskin
Phimosis
