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Pediatrics Exam 2 > KNOW THESE!!!! > Flashcards

KNOW THESE!!!! Flashcards

1
Q

How do the following age groups experience pain?

  • Infant
  • Toddler
  • Preschooler
  • School-Age
  • Adolescent

KNOW THIS!!!!

A

Infant (0-12 months): have no understanding of pain
* cry, facial grimacing, poor feeding, restlessness, irritable, disturbed sleep

Toddler (1-3 years): lack understanding of cause of pain & why it occurs
* aggressive behavior, cry, cannot describe pain intensity or type

Preschooler (3-6 years): pain = hurt; do not relate pain to illness, but may relate pain to injury
* physical resistance, aggressive behavior, easily frustrated; can identify location & intensity of pain
* may deny pain

School-Age (7-12 years): understand relationships between event / disease & pain
* clench fists, plea bargaining, may regress w/ stress & anxiety
* * can specify location & intensity of pain; able to describe physical characteristics

Adolescent (13-18 years): sophisticated & complex understanding of the causes of pain
* may immerse self in activity to distract from pain; may not express their pain to a nurse

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2
Q

NIPS Pain Scale

KNOW THIS

A

Pain assessment for Infants

  • > 3 or higher = pain

  • Categories = facial expression, crying, breathing, arms, legs, alertness
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3
Q

FLACC Pain Scale

KNOW THIS!!!!

A

Pain scale for children up to 4 years old

  • 3 or above = intervention required

  • categories = face, legs, activity, cry, consolability
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4
Q

FACES Pain Scale

KNOW THIS!!!!!

A

Pain scale for ages 4-5 years or older

  • Child points to faces based on how bad their pain is
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5
Q

Numerical Pain Scale

KNOW THIS!!!!

A

Pain scale from 1-10

  • used for most ages; 4-5 + OR if they can distinguish between larger & smaller numbers
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6
Q

Body Pain Scale

KNWO THIS!!!!!

A

Have the child color in the area where it hurts

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7
Q

Safe dose & age requirement for Motrin (ibuprofen)

KNOW THIS!!!!

A
  • NOT under 6 months of age

10 mg/kg Q6h

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8
Q

Safe Dose for Motrin (ibuprofen)

KNOW THIS!!!!

A

10 mg/kg q6h

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9
Q

Safe Dose for Tylenol (acetaminophen)

KNOW THIS!!!!!

A

15 mg/kg q4-6 hours

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10
Q

Nonpharmacological Pain Management

A
  • distraction
  • guided imagery
  • breathing techniques
  • cutanoeus stimulation
  • sucrose / sugar
  • heat or cold
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11
Q

Principles of Pain Assessment in Children (QUESTT)

KNOW THIS!!!!!

A
  • Question the child
  • Use a pain rating scale
  • Evaluate behavioral & physiologic changes
  • Secure parent’s involvement
  • Take the cause of pain into account
  • Take action & evaluate results
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12
Q

Conjunctivitis Nursing Management

A
  • Contact precautions
  • Keep eye dry & clean
  • Administer ophthalmic medication
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13
Q

3 Types of Conjunctivitis & Symptoms

KNOW THIS!!!!!

A

Bacterial (“Pink Eye”)
* purulent drainage; inflammed / red conjunctiva, swollen lids

Viral
* serous (watery drainage), edema of the eyelid, inflammed conjunctiva

Allergic
* intense itching,, watery to thick drainage, swollen eyes

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14
Q

Viral Conjunctivitis

KNOW THIS!!!!!

A

Cause: adenovirus (respiratory infection)

S/S: serous (watery) drainage, eyelid edema, inflammed conjunctiva

Tx: antivirals & supportive care

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15
Q

Allergic Conjunctivitis

KNOW THIS!!!!!

A

Cause: allergies

S/S: intense itching, watery to thick drainage, swollen eyelids

Tx: antihistamines, decongestants, lubricants

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16
Q

Bacterial Conjunctivitis

KNOW THIS!!!!

A

“Pink Eye”

S/S: Purulent drainage, inflammed / red conjunctiva, swollen lids

Tx: erythromycin antibotic drops

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17
Q

What is Opthalmia Neonatorum & what is the cause?

KNOW THIS!!!!

A

Conjunctivitis of the newborn (< 30 days old)

Causes: acquired vaginally from birth infections (gonorrhea, chlamydia, HSV)

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18
Q

Eye Drop Administration

A
  • Adequate immobilization is needed to avoid injury.
  • Nurse’s hand can be stabilized by resting the wrist on the child’s head
  • Explanations & therapeutic play can be used with children old enough to explain the process of administration
  • Have the medication at room temperature
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19
Q

What is periorbital cellulitis & what are the signs & symptoms?

KNOW THIS!!!!!

A

Bacterial infection of the eyelids & surrounding tissue

S/S:
* erythema
* tenderness
* painful movement
* fever
* red / purple eyelids

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20
Q

What is the difference in pediatric ears from adults?

KNOW THIS!!!!

A

Eustachian tube is shorter & wider

  • TM is easily injured
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21
Q

What is otitis media? What are the signs & symptoms & what is the treatment?

KNOW THIS!!!!!

A

inflammation of the middle ear

S/S: redness (over portions of the ear drum), bulging TM, fluid w/ no movement or excessive movement

Tx: antibiotics, tympanostomy, tube placement

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22
Q

Otitis Externa: what is it?

KNOW THIS!!!!

A

Inflammation of the outer ear; “swimmer’s ear”

Causes: placing things in the ears

Tx: abx ear drops or steroid drops

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23
Q

What is Epistaxis & how is it treated?

KNOW THIS!!!!

A

Nose Bleed

Tx: head upright & tilted forward;
* squeeze nares below nasal bone for 10 minutes
* cotton ball with epi, thrombin, or lidocaine

  • Causes: nose picking, dryness, foreign bodies, allergies, coughing, blunt trauma
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24
Q

Tonsilectomy Nursing Care

KNOW THIS!!!!

A
  • Promote fluids (popsicles, ice cream, slurpees)
  • Ice for discomfort
  • Watch for bleeding / infection
  • Normal for white / yellow exudate 7 days following
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25
Q

Signs & Symptoms of Mild Respiratory Distress

KNOW THIS!!!!

A
  • Restlessness
  • ↑ RR (Tachypnea)
  • ↑ HR (Tachycardia)
  • Diaphoresis

  • Child is trying to compensate for 0-2 deficits & airway blockages
  • vitals reflect compensation & beginning hypoxia
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26
Q

Signs & symptoms of Moderate respiratory distress w/ early decompensation

KNOW THIS!!!!

A
  • Nasal flaring
  • Retractions
  • Grunting / Wheezing
  • HTN
  • Anxiety, irritability, mood changes, confusion
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27
Q

Signs & Symptoms of Severe Respiratory Distress (respiratory failure / imminent arrest)

KNOW THIS!!!!

A
  • SOB (Dyspnea)
  • ↓ HR (Bradycardia)
  • Cyanosis (late sign)
  • Stupor (near unconsciousness) or coma
  • child may be in a tripod position to help with breathing
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28
Q

What is croup

KNOW THIS!!!!

A

Broad class of upper airway illnesses that results in inflammation & swelling of the epiglottis & larynx, swelling extends into the trachea & larynx

Cause: can be viral or bacterial

Dx: CXR w/ Steeple sign

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29
Q

Signs & Symptoms of Croup

KNOW THIS!!!!

A
  • Fever
  • Barking / croupy cough
  • Insipratory stridor
  • Retractions
  • Hoarse cry
  • Cyanosis
  • ↓ LOC
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30
Q

Treatment for Croup (laryngotracheitbronchitis / LTB)

KNOW THIS!!!

A
  • Oral dexamethasone
  • Nebulized epinephrine
  • Supplemental O2 (if hypoxic)
  • Antipyretics (PRN)
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31
Q

Croup (/ LTB - laryngotracheitbronchitis)

  • What is croup?
  • Key diagnostic sign
  • Signs & symptoms
  • Treatment

KNOW THIS!!!!

A

Inflammation & swelling of the epiglottis & larynx that extends into the trachea & larynx

Diagnostic Finding: Steeple Sign on chest x-ray

S/S: fever, croupy / barking cough, inspiratory stridor, retractions

  • Tx: oral dexamethasone, nebulized epinephrine, supplemental O2 (if hypoxic), antipyretics (PRN)
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32
Q

What is a stridor?

A

High-pitched sound generated from partially obstructed air flow in the upper airway

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33
Q

Key finding on chest x-ray to diagnose epiglottitis

Know this

A

Thumb’s sign

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34
Q

Key finding on chest-xray to diagnose croup

KNOW THIS!!!!

A

Steeple sign!!!!!

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35
Q

What is Respiratory Syncytial Virus (RSV)? What are the key signs & symptoms of RSV? What is the treatment?

KNOW THIS!!!

A

Highly contagious respiratory virus that is a major cause of bronchiolitis (inflammation of the bronchioles)

Signs & Symptoms
* Retractions / nasal flaring / grunting
* Dehydration (dry lips, ↑ HR, lethargy)
* Crackles & wheezing

  • Tx: antibiotics, nebulized albuterol, chest physiotherapy (CPT), & synagis (immunoglobulin for kids < 32 weeks old)
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36
Q

What is a high flow nasal cannula (HFNC) and how high can you put it up to?

KNOW THIS!!!!

A

Continuous posoitive airway pressure (CPAP)

  • up to 60 L/min
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37
Q

What is pneumonia & what are the 3 types?

KNOW THIS!!!!

A

Inflammation fo bronchioles & alveoli

  • viral, bacertial, & atypical (mycoplasmal)
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38
Q

Key signs & symptoms of pneumonia

KNOW THIS!!!!

A
  • Crackles / rhonchi
  • Chest pain
  • Retractions / nasal flaring / grunting
  • SOB
  • Lethargy
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39
Q

What are the 3 types of pneumonia?

KNOW THIS!!!!

A
  • bacterial
  • viral
  • mycoplasmal (atypical)
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40
Q

Pneumonia
* What is it?
* What are the 3 types
* What are the common s/s?

KNOW THIS!!!!

A

inflammation of the bronchioles & alveoli

Types: viral, bacterial, mycoplasmal (atypical)

S/S:
* Crackles / Rhonchi
* Chest pain
* Retractions
* Nasal flaring
* Grunting
* Tachypnea (SOB)
* Lethargy

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41
Q

Signs & symptoms of asthma

A
  • sudden onset of shortness of breath
  • wheezing (inspiratory or expiratory)
  • Retractions
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42
Q

Short-Acting Beta Agonists (SABA) for asthma

A

Albuterol

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43
Q

Corticosteroids for asthma

A
  • Decadron
  • Prednisone
  • Solumedrol
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44
Q

Anticholinergics for asthma

A

ipatropium

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45
Q

Adjuncts for asthma

A

Duoneb: albuterol/ipatroopium, magnesium sulfate

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46
Q

5-10-5 Rule for Asthma Spacers

KNOW THIS!!!!

A
  • Tilt head back & breath in for 5 seconds
  • Hold breath for 10 seconds
  • Breath out for 5 seconds
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47
Q

Cystic Fibrosis

KNOW THE BOLD!!!!

A

Reduced water movement across cell membranes = blocked airways

  • Inherited disorder, CFTR gene mutation, autosomal recessive trait
  • Causes damage to the lungs, gallbladder, pancrease, & liver
  • 30,000 in the US
  • 10 million carriers

Dx: sweat test

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48
Q

What is 1 L of fluid loss equal to in terms of weight for a child?

KNOW THIS!!!!

A

1 kg lost (weight loss)

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49
Q

**

Normal Urine Output in Children

KNOW THIS!!!!

A

0.5 - 1 mL/kg/hr

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50
Q

Normal urine output for an INFANT

KNOW THIS!!!!!

A

2 mL/kg/hr

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51
Q

Mild Dehydration

KNOW THIS!!!

A

< / = 5% OR 40-50 mL/kg loss of body weight

Signs & Symptoms:
* moist mucous membranes
* infants = irritable
* children = thirst

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52
Q

What is considered mild dehydration?

KNOW THIS!!!!

A

< / = 5% OR 40 - 50 mL/kg loss of body weight

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53
Q

Signs & Symptoms of mild dehydration in children

KNOW THIS!!!!!

A
  • Moist mucous membranes
  • Irritable (infants)
  • ↑ thirst (children)
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54
Q

Moderate Dehydration

KNOW THIS!!!!!

A

6 - 10% (60 - 90 mL/kg) loss of body weight

Signs & Symptoms
* lethargic
* ↓ skin turgor
* dark urine & ↓ output
* dry mucous membranes
* ↑ HR
* normal or ↓ BP

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55
Q

What is considered moderate dehydration in children?

KNOW THIS!!!!

A

6 - 10% or 60 - 90 mL/kg loss of body weight

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56
Q

Signs & Symptoms of moderate dehydration in children

KNOW THIS!!!!!

A
  • lethargic
  • ↓ skin turgor
  • dark urine & ↓ output
  • dry mucous membranes
  • ↑ HR
  • normal or ↓ BP
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57
Q

Severe Dehydration

KNOW THIS!!!!!

A

> / = 10% OR 100 mL/kg loss of body weight

Signs & Symptoms
* ↑ irritability
* lethargy / non-responsive
* ↓ BP
* ↑ HR
* nonelastic skin turogor
* dry mucous membranes
* ↓ or absent urine output

58
Q

What is considered severe dehydration in children?

KNOW THIS!!!!

A

> / = 10% OR 100 mL/kg loss of body weight

59
Q

Signs & Symptoms of severe dehydration in children

KNOW THIS!!!!!

A
  • ↑ irritability
  • lethargy / non-responsive
  • ↓ BP
  • ↑ HR
  • non-elastic / poor skin turgor
  • dry mucous membranes
  • ↓ or absent urine output
60
Q

4-2-1 Rule for Fluid Maintenance (holiday-segar method)

KNOW THIS!!!!

A
  • First 10 kg = 4 mL/kg/hr
  • Next 10 kg = 2 mL/kg/hr
  • Above 20 kg = 1 mL/kg/hr
61
Q

What is the bolus rate for rehydration?

KNOW THIS!!!!!!

A

20 mL/kg over 30-60 minutes

62
Q

Rehydration Example:

Jimmy is a 4 year old boy brought into the pediatric ED by his mom. He has been vomiting & having diarrhea for 4 days. You determine he has mild dehydration & your hospital recommends a sfluid deficit of 40 mL/kg/24 hours for thsi type of dehydration. He weighs 37 kg.

1.) Calculate the fluids needed to correct the deficit
2.) Calculate the bolus amount
3.) Calculate the maintenance IV fluid (MIVF) rate

A

1.) Calculate fluids needed to correct the deficit
* 40 mL/kg x 37 kg = 1480 mL

2.) Calculate the bolus amount
* 37 kg x 20 mL = 740 mL

3.) Calculate the MIVF Rate
* (10 kg x 4 mL/kg/hr) + (10 kg x 2 mL/kg/hr) + (17 x 1 mL/kg/hr) =
* 40 mL + 20 mL + 17 mL = 77 mL
* First hour he will receive 1 NS bolus of 740 mL (20 mL/kg bolus x 37 kg = 740 mL)

Then he will receive the remaining 740 mL (1480 -740 = 740) deficit over the next 23 hours
* 740 / 23 hr = 32.17 mL/hr
* 32.17 mL + 77 mL = 109 mL/hr

63
Q

Rehydration Example:

Jimmy is a 4 year old boy brought to the pediatric ED by his mom. He has been vomiting & having diarrhea for 4 days. You determine he has mild dehydration & your hospital recommends a fluid deficit of 40 mL/kg/24hr for this type of dehydration. He weighs 37 kg.

Calculate the fluids needed to correct the deficit.

A

40 mL/kg x 37 kg = 1480 mL

64
Q

Rehydration Example:

Jimmy is a 4 year old boy brought to the pediatric ED by his mom. He has been vomiting & having diarrhea for 4 days. You determine he has mild dehydration & your hospital recommends a fluid deficit of 40 mL/kg/24hr for this type of dehydration. He weighs 37 kg.

Calculate the bolus amount

A

37 kg x 20 mL = 740 mL

  • bolus is given 20 mL/kg over 30-60 minutes
65
Q

Rehydration Example:

Jimmy is a 4 year old boy brought to the pediatric ED by his mom. He has been vomiting & having diarrhea for 4 days. You determine he has mild dehydration & your hospital recommends a fluid deficit of 40 mL/kg/24hr for this type of dehydration. He weighs 37 kg.

Calculate the Maintenance IV fluid (MIVF) rate

A
  • ( 10 kg x 4 mL) + ( 10 kg x 2 mL/kg/hr) + (17 kg x 1 mL/kg/hr) =
  • 40 mL + 20 mL + 17 mL = 77 mL

Over the first hour he will receive 1 NS bolus of 740 mL (20 mL/kg bolus x 37 kg = 740 mL)

.

Then he will receive the remaining 740 mL (1480 - 740 = 740) deficit over the next 23 hours
* 740 mL / 23 hr = 32.17 mL/hr
* 32.17 mL + 77 mL (MIVF rate) = 109 mL/hr

  • first 10 kg = 4 mL/kg/hr
  • next 10 kg = 2 mL/kg/hr
  • above 20 kg = 1 mL/kg/hr
66
Q

How to Calculate IV Fluid Replacement

KNOW THIS!!!!

A

1.) Calculate deficit for 24 hours

2.) Calculate hourly maintenance IV fluids (MIVF)

3.) IV Rate = deficit + MIVF

  • Replace 50% in first 8 hours
  • Replace 50% in the next 16 hours
67
Q

Oral Rehydration (how much is given?)

KNOW THIS!!!!

A

1-2 tsp of fluid every 10-15 minutes

68
Q

4-2-1 Rule Example: Child weighs 12 kg

A

1.) first 10 = (10 kg x 4 mL/kg/hr) = 40 mL/hr

2.) second 10 = (2 kg x 2 mL/kg/hr) = 4 mL/hr

3.) Add – 40 mL/hr + 4 mL/hr = 44 mL/hr

69
Q

4-2-1 Rule Example: child weighs 35 kg

A

1.) First 10 kg = 10 kg x 4 mL/kg/hr = 40 mL/hr

2.) Second 10 kg = 10 kg x 2 mL/kg/hr = 20 mL/hr

3.) Above 20 kg = 15 kg x 1 mL/kg/hr = 15 mL/hr

4.) ADD – 40 mL/hr + 20 mL/hr + 15 mL/hr = 75 mL/hr

70
Q

Normal Sodium (Na+) level

KNOW THIS!!!!!

A

135 - 145

71
Q

Causes of Hyponatremia

KNOW THIS!!!!

A
  • diarrhea
  • vomiting
  • CHF
  • inadequate salt intake
  • GI suctioning
  • diuretics

↓ Na+ (< 135)

72
Q

Signs & Symptoms of Hyponatremia

KNOW THIS!!!!!

A
  • NEURO CHANGES
  • ↓ BP
  • Dry mucosa
  • Headache
  • Confusion
  • Lethargy
  • Poor skin turgor
  • Muscle weakness
  • ↓ deep tendon reflexes (DTRs)

Na = Neuro changes

↓ Na+ (< 135)

73
Q

Causes of Hypernatremia

KNOW THIS!!!!

A
  • inadequate breastfeeding intake w/ normal output
  • Diabetes Insipidus (DI)
  • excesive sweating
  • ↑ aldosterone
  • Diarrhea or vomiting

↑ Na+ (> 145)

74
Q

Signs & Symptoms of Hyeprnatremia

KNOW THIS!!!!

A
  • NEURO CHANGES
  • ↑ thirst
  • ↓ urine output (unless ↑ Na is caused by DI)
  • ↓ LOC (confusion, lethargy, coma)
  • Seizures

Na = Neuro changes

↑ Na (> 145)

75
Q

Normal Potassium (K+) Levels

KNOW THIS!!!!!

A

3.5 - 5

76
Q

Causes of Hypokalemia

KNOW THIS!!!!!

A
  • GI losses (vomiting / diarrhea)
  • Medications
  • poor dietary intake (starvation)
  • ↑ aldosterone (hyperaldosteronism, CHF, cirrhosis)
  • ↑ cortisol (Cushing disease)
  • alkalosis

↓ K+ (< 3.5)

77
Q

Signs & Symptoms of Hypokalemia

KNOW THIS!!!!

A
  • Muscle weakness
  • fatgieu
  • anorexia
  • Adominal distension / constipation
  • nausea / vomiting
  • Dysrhythmias

↓ K+ (< 3.5)

78
Q

Causes of Hyperkalemia

KNOW THIS!!!!!

A
  • Impaired renal function
  • crush injury
  • burns
  • metabolic acidosis

↑ K+ (> 5)

79
Q

Signs & Symptoms of Hyperkalemia

KNOW THIS!!!!

A
  • Cardiac changes & dysrhythmias
  • lethargy
  • GI symptoms (cramps & diarrhea)
  • Muscle weakness
  • ↓ BP

↑ K+ (> 5)

80
Q

Normal Calcium (Ca+) Levels

KNOW THIS!!!!

A

2.8 - 2.86

81
Q

Causes of Hypocalcemia

KNOW THIS!!!!!

A
  • Malabsorption (poor diet, vitamin D deficiency)
  • alkalosis
  • Chronic diarrhea

↓ Ca+ (< 2.8)

82
Q

Signs & Symptoms of Hypocalcemia

KNOW THIS!!!!!

A
  • NEUROMUSCULAR EXCITABILITY
  • laryngospasm
  • Cardiac arrhytmias
  • dyspnea
  • Trousseau’s Sign
  • seizures
  • Chvostek’s Sign

↓ Ca+ (< 2.8)

83
Q

Causes of Hypercalcemia

KNOW THIS!!!!!

A
  • Bone tumors & other cancer
  • ↑ calcium absorption
  • vitamin D overdose
  • Infants w/ very low birth weight who have inadequate phosphorus intake
  • Children receiving TPN

↑ Ca+ (> 2.86)

84
Q

Signs & Symptoms of Hypercalcemia

KNOW THIS!!!!!

A
  • Muscle Weakness
  • incoordination
  • polyuria
  • ↓ neuromuscular excitability
  • ↑ thirst
  • confusion
  • Constipation & N/V
  • lethargy
  • ↓ attention span
  • Dysrhythmias

↑ Ca+ = ↓ neuromuscular excitability

↑ Ca+ (> 2.86)

85
Q

Normal Magnesium (Mg+) Levels

KNOW THIS!!!!

A

1.6 - 2.4

86
Q

Causes of Hypomagnesemia

KNOW THIS!!!!!!

A
  • GI losses (N/V, diarrhea)
  • enteral or parenteral feeding deficient in magnesium
  • ↓ Mg Absorption (due to chronic diarrhea, short bowel syndrome, malabsorption syndromes, & steatorrhea)
  • Can also be caused by DKA, sepsis, burns, & hypothermia
  • Prolonged NG Suctioning

↓ Mg+ (< 1.6)

87
Q

Signs & Symptoms of Hypomagnesemia

KNOW THIS!!!!!!

A
  • ↑ NEUROMUSCULAR EXCITABILITY
  • hyperactive reflexes
  • muscle cramps
  • tremors / twitches
  • Cardiac arrhythmias

↓ Mg = ↑ neuromuscular excitability

↓ Mg+ (< 1.6)

88
Q

Causes of Hypermagnesemia

KNOW THIS!!!!

A
  • Renal failure (oliguric renal failure & adrenal insufficiency)
  • DKA
  • excessive administration fo Mg
  • aspiration of sea water (drowning)
  • Addison Disease

↑ Mg+ (> 2.4)

89
Q

Signs & Symptoms of Hypermagnesemia

KNOW THIS!!!!!

A
  • ↓ NEUROMUSCULAR EXCITABILITY
  • drowsiness
  • lethargy
  • ↓ BP
  • weak / absent deep tendon reflexes
  • ↓ HR

↑ Mg+ = ↓ Neuromuscular excitability

↑ Mg+ (>2.4)

90
Q

Respiratory Acidosis

KNOW THIS!!!!!

A

↓ pH, ↑ CO2

Causes:
* severe asthma
* pneumonia
* hypoventilation

91
Q

Respiratory Alkalosis

KNOW THIS!!!!!

A

↑ pH, ↓ CO2

Causes:
* hyperventilation
* panic attack
* aspirin toxicity

92
Q

Metabolic Acidosis

KNOW THIS!!!!!

A

↓ pH, ↓ HCO3

Causes:
* DKA
* lactic acidosis
* EtOH

93
Q

Metabolic Alkalosis

KNOW THIS!!!!!

A

↑ pH, ↑ HCO3

Causes:
* vomiting = loss of acid

94
Q

Daily Fluid Maintenance (based on weight of child in kg)

KNOW THIS!!!!!

A
  • Usual weight: up to 10 kg → 100 mL/kg/24 hr
  • Usual weight: 11 - 20 kg → 1000 mL + (50 mL/kg for weight above 10 kg)/24 hr
  • Usual weight: > 20 kg → 1500 mL + (20 mL/kg for weight above 20 kg) / 24 hr
95
Q

Daily Fluid Maintenance for a child who weighs up to 10 kg

KNOW THIS!!!!!

A

100 mL/kg/24 hr

Kid is 9.5 kg

Daily Fluids = 100 mL x 9.5 kg = 950 mL / 24 hr

96
Q

Daily Fluid Maintenance for a child who weighs 11-20 kg

KNOW THIS!!!!!

A

1000 mL + (50 mL/kg for each kg over 10 kg) / 24 hr

Kid is 16.5 kg

Daily Maintenance = 1000 mL + (50 mL/kg x 6.5 kg)

Daily Maintenance = 1,325 mL / 24 hr

97
Q

Daily Fluid Maintenance for a child who weighs over 20 kg

KNOW THIS!!!!!

A

1500 mL +20 mL/kg for each kg over 20 kg) / 24 hr

Kid weighs 55 kg

Daily Maintenance = 1500 mL + (20 mL/kg x 35 kg) / 24 hr

Daily Maintenance = 2,200 mL / 24 hr

98
Q

Hypopituitarism (GHD)

KNOW THIS!!!!

A

↓ pituitary gland activity = ↓ growth hormone secretion

99
Q

When should treatment of hypopituitarism be done?

A

At night when normal hormones are secreted

100
Q

Precocious Puberty

KNOW THIS!!!!!!!

A

Sexual development before age 9 in boys & before age 8 in girls
* advanced bon egrowth makes them taller
* can result in stunted growth if growth plates close too soon

Causes: disorders of gonads, adrenals, hypothalamus releases GnRH (gonadotropin-releasing hormone)
* 80-90% of girls = no cause

Treatment: GnRH agonist like Lupron (breast cancer drug) to slow growth to normal rates
* tx is discontinued at age fro normal pubertal changes to resume
* failure to treat may result in stunted growth as children with precoscious puberty have advanced bone age

101
Q

What is Percocious Puberty?

KNOW THE DEFINITION

A

Puberty onset / sexual development before age 9 in boys & before age 8 in girls

102
Q

Treatment of Precocious Puberty. What happens if precocious puberty is not treated?

KNOW THIS!!!!

A

GnRH agonist like Lupron (breast cancer drug) which slows growth to normal rates

  • Failure to treat may result in stunted growth as children with precocious puberty have advanced bone age
103
Q

Precocious Puberty Nursing

KNOW THIS!!!!!

A
  • Promote Positive Body Image - child appropriate terms
  • Provide family education - emotional support
104
Q

Hypothyroidism

KNOW THIS!!!!!!

A

↓ active levels of thyroid hormone

  • newborn screen for T3/T4 (hypothyroidism can be congenital)
105
Q

What is the difference in primary & central hypothyroidism?

KNOW THIS!!!!

A
  • Primary: thyroid problem (↑ TSH, ↓ T4)
  • Central: hypothalamus problem (normal TSH, ↓ T4)
106
Q

Primary Hypothyroidism

KNOW THIS!!!!1

A

THYROID problem

  • ↑ TSH
  • ↓ T4
107
Q

Central Hypothyroidism

KNOW THIS!!!!!

A

HYPOTHALAMUS problem

  • normal TSH
  • ↓ T4
108
Q

Signs & Symptoms of Hypothyroidism in INFANTS

KNOW THE BOLD

A
  • thick tongue
  • Hypotonia
  • umbilical hernia
  • hoarse cry
  • constipation
  • Large fontanelles
109
Q

Signs & Symptoms of Hypothyroidism (or acquired thyroid dysfunction) in Children

KNOW THE BOLD!!!!

A
  • ↓ appetite
  • dry, cool skin
  • hair thinning
  • ↓ HR (bradycardia)
  • constipation
  • ↓ DTRs
  • cold temperature sensitivity
  • abnormal menses
  • goiter (enlarged thyroid)
110
Q

Hypothyroidism Treatment

KNOW THIS!!!!!

A

Levothyroxine, 15 mcg/kg/day

111
Q

Type 1 DM

KNOW THIS!!!!

A

Body’s immune system attacks beta cells & ↑ glucose level

  • Bimodal Peaks: diagnosis around ages 4-6 & 10-14
112
Q

Signs & Symptoms of Type 1 DM

KNOW THE BOLD!!!!!

A
  • Polyuria (↑ urination)
  • Polydipsia (↑ thirst)
  • Polyphagia (↑ hunger)
  • glucosuria (glucose in urine)
  • glucogenesis (breaking down protein/fat for energy)
  • dry skin
  • rapid weight loss
  • drowsiness/fatigue
  • irritability
  • abdominal discomfort
  • ketoacidosis
113
Q

Type 1 DM Bimodal Peaks

KNOW THIS!!!!

A

Diagnosis around ages 4-6 & ages 10-14

114
Q

Type 2 DM

KNOW THIS!!!!

A

Insulin resistance caused by prolonged exposure to elevated glucose levels

  • controlled with diet & exercise
  • Often obese or comorbid conditions such as PCOS, lipid disorders, & HTN
115
Q

Rapid Acting Insulin

KNOW THIS!!!!!

A

Onset = 15 minutes

  • Novolog & Humalog (-log)
  • eat immediately after; for meal dosing
116
Q

Intermediate Insulin

KNOW THIS!!!!!

A

Onset = 1-3 hours

  • NPH or Humulin N
  • is cloudy
  • not often used in children
117
Q

Long Acting Insulin

KNOW THIS!!!!

A

Insulin acts over 12-24 hours

  • glargine (Lantus) or detemir (Levemir)
  • injections are usually done in the morning or at night
  • can NOT be mixed with other insulin
118
Q

What is IC Ratio?

KNOW THIS!!!!!

A

Amount of carbs 1 unit of insulin will cover

Ex: 1 unit of insulin covers 15 g of carbs = 1:15 IC ratio

119
Q

How do you calculate IC ratio?

KNOW THIS!!!!

A

1.) Calculate the total gram of carbs in the meal

2.) Divide total grams of carbs in the meal by the ratio

120
Q

IC Ratio Example:

A patient orders 45 grams of carbs for lunch. The IC ratio is 1:15. How many units of insulin should the patient receive for this meal?

A

45 / 15 = 3 units

121
Q

What is Correction Factor (CF)?

KNOW THIS!!!!!!

A

Determines insulin coverage based on target glucose

Example:
* target glucose = 150
* current glucose = 300

1.) high BG - goal BG
* 300 - 150 = 150
2.) Divide by CF (CF = 50)
* 150 / 50 = 3 units of insulin

122
Q

Correction Factor Example:

Mary has Type 1 DM. Her order reads IC ratio of 1:20 & her target blood sugar is 150 with a CF of 50. You are her nurse & she is ready to order lunch. She orders a pizza slice & millk. Dietary reports that her total carbs for the meal are 85. You obtain her blood glucose & it is 300. How much insulin do you anticipate the pediatric NP to order?

A

1.) Insulin needed for the meal = Carbs / IC ratio
* 85 carbs / 20 = 4.25 units

2.) Insulin needed for higher blood sugar = (Current BG - Target BG) / CF
* (300 - 150) / 50
* 150 / 50 = 3 units

3.) Add the insulin needed for the meal to the insulin needed for the higher blood sugar
* 4.25 units + 3 units = 7 units (round to nearest whole number)

123
Q

What level of glucose is considered to be hypoglycemia in children & neonates?

KNOW THIS!!!!

A

Children: blood glucose < 70 mg/dL

Neonates: blood glucose < 60 mg/dL

124
Q

Signs & Symptoms of Hypoglycemia

A
  • Blurred vision
  • ↑ HR
  • sweating
  • tremors / shaking
  • ↑ hunger
  • confusion / difficulty concentrating
125
Q

What is the treatment for hypoglycemia?

KNOW THIS!!!!!

A

If Awake = Oral Glucose (juice, sweetner, raisins, glucose tabs)
* recheck glucose in 15 minutes

Unconscious = IM, SQ, nasal glucagon OR glucose paste on gums

126
Q

Diabetic Ketoacidosis (DKA)

KNOW THIS!!!!

A

INSUFFICIENT INSULIN for the body’s demands in a diabetic patient that results in production of ketones (metabolic acidosis)

  • Blood Glucose > 200
  • Ketonuria
  • Ketonemia
  • pH < 7.30
127
Q

Lab results that indicate Diabetic Ketoacidosis (DKA)

KNOW THESE

A

Blood glucose > 200 mg/dL
* Ketonuria
* Ketonemia
* pH < 7.3

128
Q

Signs & Symptoms of Diabetic Ketoacidosis (DKA)

KNOW THIS!!!!

A
  • signs of dehydration
  • flushed ears / cheeks
  • ↑ HR
  • Kussmaul breathing
  • Fruity breath
  • altered mental status
  • ↓ BP
  • ↑ hunger
  • ↑ thirst
  • ↑ urination

  • if not treated can lead to dehydration, electrolyte imbalances, coma, & death
129
Q

Monitoring & Nursing management for patients with Diabetic Ketoacidosis (DKA)

KNOW THE BOLD!!!!

A
  • Hourly blood glucose checks
  • ABG checks
  • Serum electrolytes checks
  • Serum ketone checks
  • Osmolarity / urine ketones checks
  • Use SQ insulin when pH & HCO3 are normal
130
Q

Turner Syndrome

A

A chromosomal disorder in females where either an X is missing, making the person XO instead of XX, or part of one X chromosome is deleted

131
Q

Signs & Symptoms of Turner Syndrome

A
  • Webbed neck
  • Low hairline
  • Small jaw
  • Short stature
  • Broad chest & widely separated nipples
132
Q

Klinefelter Syndrome

KNOW THIS!!!!

A

A chromosomal disorder in which males have an extra X chromsome, making them XXY instead of XY

133
Q

Signs & Symptoms of Klinefelter Syndrome

KNOW THIS!!!!

A
  • Gynecomastia is a characteristic finding (↑ breast gland tissue in boys)
  • Puberty is delayed or an abnormal progression is evident
  • Small & firm testes
  • Less facial & body hair may develop
134
Q

Addison’s Disease (Adrenal Insufficiency)

KNOW THIS!!!!!

A

↓ secretion (hyposecretion) of aldosterone & cortisol (ACTH)

135
Q

Signs & Symptoms of Addison’s Disease

KNOW THIS!!!!!!

A

STEROID

  • Sodium / sugar low (↓ Na / sugar)
  • Tired
  • Electrolyte imbalance
  • Reproductive changes
  • lOw BP (↓ BP)
  • Increased pigmentation
  • Diarrhea / depression
136
Q

Addisonian Crisis (Adrenal crisis / acute adrenal insufficiency)

KNOW THIS!!!!!

A

5 S’s

  • Severe pain
  • Syncope
  • Shock
  • Super low BP (↓↓↓ BP)
  • Severe vomiting / diarrhea

TX: IV cortisol

137
Q

What is the treatment for Addisonian Crisis?

KNOW THIS!!!!

A

IV Cortisol

138
Q

Signs & Symptoms of Addisonian Crisis

KNOW THIS!!!!!

A

5 S’s

  • Severe pain
  • Syncope
  • Shock
  • Super low BP (↓↓↓ BP)
  • Severe vomiting / diarrhea
139
Q

Cushing’s Disease

KNOW THIS!!!!

A

Hypersecretion (↑) of cortisol (ACTH)

140
Q

Signs & Symptoms of Cushing’s Disease

KNOW THIS!!!!

A

STRESSED

  • Skin fragile
  • Truncal obesity
  • Rounded face
  • Ecchymosis
  • Striae
  • Sugar extremely high (↑ glucose)
  • Excessive bodoy hair
  • buffalo hump
  • Depression

Pediatrics Exam 2 (8 decks)

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