FINALE Flashcards
How to dx asthma?
-chest x ray
-pulm function test
S/Sx of asthma?
- Wheezing and dry cough, prolonged expiration, restlessness, fatigue, tachypnea, cyanosis, marked respiratory distress
-barrel chest from chronic asthma
Nursing care for asthma?
- Assess resp status, administer humidified oxygen prn, monitor pulse ox
- Maintain IV access,
-avoid cold liquids to avoid bronchospasm - Position high-fowlers and cluster nursing care
- Sudden cessation of wheezing and decreased breath sounds indicates WORSENING
What are important nursing considerations for cleft palate repair?
6 - 18 months; before 2 years of age
- Position on side or back after surgery
- Cool mist tent
- Blended diet
- Elbow restraints: 4 - 6 weeks
- No straws, pacifiers, spoons, or fingers in or around mouth for 7-10 days.
- No oral temps.
Dx of cystic fibrosis?
- Sweat test
- 72 hours fecal fat
- Chest x-ray
- Prenatal DNA of amniotic fluid
Tx of cystic fibrosis?
- Antibiotics – treat pulmonary infection
- Pancreatic enzymes – for fat absorption
-Fat-soluble vitamins A,E,D,K - Mucolytics – to decrease viscosity of sputum
- Bronchodilators – to improve lung function
-high calorie, high protein foods
S/Sx of bronchiolitis?
- Worsening of an upper respiratory tract infection with tachypnea, retractions, low-grade fever, anorexia, thick nasal secretions, and increasingly labored breathing
- Older infants may have a frequent, dry cough
- Lungs reveal wheezing or crackles
Meds for bronchiolitis?
- Bronchodilators (may not help)
- Steroids
- IV fluids
Nursing care for bronchiolitis?
- Complete respiratory assessment
- Provide humidified oxygen
- Pulse oximetry
- Clear nasal passages with bulb syringe or deep nasal suctioning
- Cluster nursing care
- IV fluid, I & O, Weigh daily
- Contact precautions
What is the primary causative factor for bronchiolitis?
RSV. most prominent in first 2 years of life
post-op nursing care for tonsillectomy?
- Provide patient with ice collar for inflammation and pain.
- Assess for frequent swallowing or throat clearing as this may be a sign of bleeding.
- Avoid red food/liquids, straw, coughing, or blowing nose forcefully.
What kind of precautions does pertussis require?
droplet
S/Sx of pertussis?
Runny nose, cough that becomes more severe and spasms, flushing, cyanosis, vomiting,
Treatment: antibiotics, steroids
S/Sx of celiac disease?
- Abdominal distention, vomiting
- Anorexia, muscle wasting
- Diarrhea with a foul odor
What are S/Sx of pyloric stenosis?
projectile vomiting, moveable olive-shaped mass in epigastrium
Tx of pyloric stenosis?
- Pyloromyotomy - laparotomy - relatively uncomplicated surgery
- Feeding 4 - 6 hours postop, progressing from glucose or electrolyte fluid to formula within 24 hours of surgery
- Discharge home 2nd postop day
Tx of GERD?
- Depends on severity
- Avoid foods that intensify reflux (citrus, caffeine, etc.)
- Weight control
- Small frequent meals
- Thickened feeds
- Elevate HOB for 1 hour after feed
- PPI’s-omeprazole, H2 receptor inhibitors-ranitidine
- Surgical management-nissen fundoplication
Early signs of increased ICP?
-Headaches
-Diplopia (blurred vision)
-Nausea & Vomiting
-Vertigo
-Seizures
Late Signs of increased ICP?
-Bradycardia
- LOC
-Decreased motor response
-Diminished response to pain
-Cushing reflex (slow pulse and increased BP, irregular respirations)
S/Sx of Kawaski?
High fever
Red eyes
Ring around iris
Strawberry tongue
Rash (desquamates - skin flakes off)
Serious = MI
Signs of increased ICP in infants?
-wide sutures
-high pitched cry
-tense or bulging fontanels
-sun-setting signs
Rheumatic fever treatment?
- Prevention of strep
- cardiac damage prevention
- recurrence prevention
- Pen G
Tx of Kawaski?
High dose IVIG and salicylate therapy
Grumpy kids, symptomatic, supportive
Increased pulm blood flow disorders?
- ASD
- VSD
- PDA
- AV Canal
What age is trust vs mistrust?
Birth to 12-18 months
What is the goal in trust vs mistrust?
sense of trust and security
What age is autonomy vs shame and doubt?
18 months-3 years
What is the goal in autonomy vs shame and doubt?
- Feelings of independence lead to belief in yourself and your abilities
What age is initiative vs guilt?
3 to 5 years
What is the goal in initiative vs guilt?
- Feelings of independence lead to belief in yourself and your abilities
What age is industry vs inferiority?
5 to 12 years
What is the goal in industry vs inferiority?
feelings of pride and accomplishment
What age is identity vs confusion?
12 to 18 years
What is the goal in identity vs confusion?
strong sense of identity, picture of future
What are some etiologies of anemia?
-Decreased blood O2-carrying ability: Cyanosis is not common in children
-Hemodilution: Heart murmur, Increased cardiac workload
-Slow growth
-Delayed sexual maturation
-Decreased RBC production
-Increased RBC loss
Increased RBC destruction
Dx of anemia?
physical exam:
-fatigue
-decreased energy
-pallor
CBC
Dx of sickle cell anemia?
-Newborn screening
-Sickledex heel/finger stick
-Hemoglobin electrophoresis
Tx for sickle cell?
-Hydroxyurea
-Penicillin
-Oxygen- only when hypoxic!
-Rest
-Pain medication
-Hydration
-Electrolytes
-Blood transfusion
-ABX
-Splenectomy
Blood flow through heart?
Body → IVC or Head → SVC → RA → TV → RV →Pulmonary valve → PA → Lungs → Pulmonary veins → LA → MV → LV → AV → aorta → body
Dx of spina bifida?
-Maternal AFP
-Ultrasound, CT, MRI
S/sx of hydrocephalus?
Sunset sign
Increased head circumference
High-pitched cry
Poor feeding if ICP too high
What is kyphosis?
CONVEX back curvature “hunch back”
Treated with with exercise and bracing
What is lordosis?
cervical or lumbar curvature beyond physiological limits
What is scoliosis?
lateral curvature of spine
What age is NIPS used?
0-2 months
What age is FLACC used?
2 months to 7 years
What age is FACES used?
used in children 3 years and older
What are altered LOC reflexes?
- Absent corneal reflex & presence of tonic neck reflex associated with severe brain damage
-Neuro “health” in young infants: presence of Moro, tonic neck, and withdrawal reflexes
- Babinski: dorsiflexion of big toe and fanning of toes – should be absent after 1 yr or locomotion
What is the HUS triad?
- Anemia (low Hgb and Hct)
- thrombocytopenia (low platelet)
- renal failure
S/sx of hypothyroidism?
- Tachycardia
- Widened pulse pressure
- Dyspnea on exertion
- Exophthalmos (protruding eyeballs)
- Wide-eyed, staring expression with eyelid lag Tremor
- Goiter (hypertrophy and hyperplasia)
- Warm, moist skin
- Accelerated linear growth
- Heat intolerance (may be severe)
- Hair fine and unable to hold a curl
- Systolic murmurs
What are the labs of hypothyroidism?
low tsh, high t3 and 4
Cms of OI?
fragile bones, deformity, fractures, blue sclerae, hearing loss, hypoplastic discolored teeth
What is HUS associated with?
e. coli, unpasteurized milk or fruit juice, lettuce, sprouts, salami, or drinking or swimming in sewage or contaminated water
CMs of Wilms tumor?
Associated with aniridia (no iris), hemihypertrophy (1 side of body larger). Beckwith-Wiedemann syndrome (overgrowth syndrome)
How to diagnose Wilms?
Dx with radiographic studies, abd ultrasound, hematologic & biochemical studies, urinalysis
Nursing care for Wilms?
Surgery asap removing tumor
DO NOT PALPATE
Post op at risk for bowel obstruction
Family and child support
What is a renal diet?
-Low in protein, potassium, sodium, phosphorous
-High in carbohydrates
-Unrestricted amount of fat
-Limit fresh fruit and veggies
-High in calcium
Cms of nephrotic syndrome?
Weight gain
Edema around eyes, scrotum, labia, ankles-especially in the morning
Ascites
Poor appetite
Elevated blood pressure
Tired
Urine is frothy and decreased in volume
Tx for nephrotic syndrome?
Low salt diet
Severe cases fluid restriction
Edema=diuretics
25% albumin
Corticosteriods
Labs for dehydration?
High urine specific gravity
Increased BUN
Increased hematocrit
Increased Sodium (Na)
Variable serum electrolytes
Increased serum osmolarity
Oral intake for dehydration?
Oral Rehydration Therapy- (First)
Use Pedialyte (1/2 str Gatorade)
Not clear liquids / no caffeine
Not BRAT diet
No juice – high osmolarity
NPO – spray mouth
Intraosseous Infusion (Emergent)
Central Venous Lines – - apply pressure
Dehydration S/sx?
Weight loss **
Increased heart rate
Thirst, No tears
Variable temperature
Depressed fontanel in infant
Dry skin and mucous membranes
Poor skin turgor and skin perfusion
Fatigue, lethargy
Diminished urinary output
Altered level of consciousness
What is hemophilia a?
factor 8 deficiency
What is hemophilia b?
factor 9 deficiency
What are labs for hemophilia?
Partial Thromboplastin Time (PTT)
Factor assays
Genetic testing
Tx for hemophilia?
Factor VIII concentrates
Desmopressin (DDAVP)
Corticosteroids
Amicar
Physical therapy
Home infusion
High dose of factor for active bleeding
Most common s/sx of hemophilia?
-nosebleed
-mouth bleeds
-heavy bleeding from minor injury
-easy bruising
-joint pain and swelling
-muscle bleeds
-coughing or vomiting blood
-blood or stool in urine
-brain bleed
What is the most common site for fracture in children?
growth plate
5 Ps of ischemia?
pain
pallor
pulselessness
parasthesia
paralysis
What are signs/ symptoms of infection?
-increased WBC
-fever
-tachy
-decreased BP
-clammy skin
-positive blood culture
-persistent crying
-sleeping more than usual
-lethargy
-refusing to take bottle or breastfeed
-breathlessness
-extreme thirst
-unconsciousness
-pallor
What is the total mL of water needed for 1-10 kg child?
100 mL/kg
What is the total mL of water needed for 11-20 kg child?
1000 mL plus 50 mL/kg for each kg over 10
What is the total mL of water needed for 20+ kg child?
1500 ml plus 20 ml/kg for each kg > 20kg
What are causes of dehydration?
Fever
Vomiting / diarrhea
Diabetes
Burn
Shock
High output kidney failure
Phototherapy
Environmental heat
What are common findings for child with neuro injury?
Altered LOC
Jittery
Clonus
Pupillary changes
Bulging fontanels
Labs for nephrotic syndrome?
-proteinuria
-hypoalbuminemia
-hyperlipidemia
Dx of bronchiolitis?
-nasopharyngeal swab
-chest xray
What is the cardinal sign coarcation of the aorta?
Markedly higher blood pressures and pulses in the upper extremities compared to lower extremities
What happens if coarcation of aorta is left untreated?
recurrent epistaxis episodes and leg pain and cramping esp with activity
What are the decreaed pulm blood flow disorders?
tetralogy of fallot and tricuspid atresia
Components of ToF?
A = Pulmonic Stenosis
B = Overriding Aorta
C = VSD
D = Right Ventricular Hypertrophy
S/sx of ToF?
- TET spells, child becomes cyanotic especially when crying and while eating (infancy), and during play (older children)
- Polycythemia, greater than normal number of circulating red blood cells
- Clubbing of the fingers may develop due to chronic hypoxia
What are the increased pulm blood flow disorders?
- ASD
- VSD
- PDA
- AV Canal
What is the medication to medically close defects in PDA and ASD?
indomethacin (indocin)
Age appropriate toys for first year of life?
- Rattles
- Mobiles
- Teething toys
- Nesting toys
- Playing with balls
- Reading books
When does separation anxiety begin, peak and usually end?
9 months, 18 months, 3 years
When do the anterior fontanels close?
12-18 months
when do posterior fontanels close?
2-3 months
Biological changes in first 6 months of life?
- Birth weight doubles (on quiz)
- Grows 1’’ per month in length
- Head circumference increases by 1/2’’ per month
- Grasps as reflex, more with eyes, palmar grasp
- between 4-6 months head control established
- Tooth eruption begins
- Turns from abdomen to back at 6 months.
What are biological changes between 7-12 months?
- Birth weight triples by end of 1st year
- Grows 1/2” per month in length (mostly in trunk)
- Manipulates items: pulls to mouth, pincer grasp
- Head control > straightening of back > then sitting
- Sit alone by 7 months & sit>explore from sitting at 8 mos
What are gluten free diet safe foods?
rice, corn, egg, quinoa, fruit, popsicles, water, chicken, beef, gluten free bread
Avoid: gluten, wheat, barley, rye, oats, beer
Priority interventions for seizures?
: Turn on side, nothing in mouth time it, airway-O2-suction (when seizure is over), rectal diazepam (status epilepticus), don’t stick anything in mouth when seizing, thermoregulation.
S/sx of CF?
cough, sputum, dyspnea, decreased SaO2, crackles or wheezing in lungs, cyanosis, digital clubbing, steatorrhea, meconium ileus
S/Sx of aplastic anemia?
-overwhelming infection
-pallor and patchy brown or yellow skin
-weakness, fever, dyspnea
-uncontrolled bleeding or ecchymosis
S/sx of vaso-occlusive crisis?
-pain
-priapism
-acute chest sydrome
-stroke
Why use traction?
-resist response of muscle
-immobilization
-alignment
-prevent contracture
What is the gold standard treatment for scoliosis?
bracing
Tx for HUS?
-hemodialysis or peritoneal dialysis
-FFP and plasmaphoresis, fresh/washed packed cells
-emergency support for family and child
What are the signs that indicate bacterial meningitis?
Kernigs, Brudzinski, tonic nuchal rigidity
What is Brudzinski’s sign?
reflexive flexion of the knees and hips following passive neck flexion.
What is Kernig’s sign?
stiffness in hamstrings that prevents ability to straighten the leg
What is nuchal rigidity?
Major stiffness in neck that causes flexing in hips & knees when neck is flexed
What are the most common signs of bleeding?
-low hgb
-low hct
-high pt
-high ptt
-pain @ injured site
-swollen, tight abdomen
-N/V
-pale, clammy, sweaty skin
-breathlessness
-extreme thirst
-unconsciousness
Risk factors that may cause vaso-occlusive crisis?
-infection
-changes in altitude
-cold climate
What is the most common congenital heart defect?
VSD
What is the sign associated with muscular dystrophy?
gowers
What is gowers sign?
The child assumes the hands-and-knees position and then climbs to a stand by “walking” his hands progressively up his shins, knees, and thighs
Tx for hyperthyroidism?
-antithyroid drugs
-thyroidectomy
-radioiodine ablation
What is a bend (plastic deformation)?
ulna and fibula when there is a fracture in the radius and tibia
What is a buckle (torus fracture)?
protrusion at the fracture site-usually by the epiphysis
What is a Greenstick fracture?
compressed side bend and makes the opposite side split-incomplete fracture
What is a complete fracture?
bone is completely broken but may be held together with periosteal hinge
What are treatments for iron-deficiency anemia?
-iron oral supplements (do not take with vitamin c, do not take w milk products)
-parenteral or IM iron
-packed rbcs
-oxygen PRN
What is beta thalassemia?
non-responsive to iron supplementation associated with people of mediterranean origin
What is aplastic anemia?
rare and life-threatening bone marrow failure
Where is bone marrow biopsy done?
posterior superior illiac spine prominence
What is sickle cell disease?
hereditary disorder where the rbcs are sickle or crescent-shaped due to the presence of hemoglobin S
