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Pediatrics: Case Files > MedU Clipp 15 and 16 > Flashcards

MedU Clipp 15 and 16 Flashcards

1
Q

What is the most accurate method of determine
dehydration status?

A
  • Subtract teh Patient’s current weight from his or her weight immediately prior to the illness
  • Convert the difference into a “Percent Dehydration”
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2
Q

What aspects of the physical exam can help you determine dehydration status?

A
  • Weight
  • Vital Signs (HR and BP)
  • HEENT exam (Fontanel, eyes sunken, mucous prod.)
  • Skin Turgor, Temp, Perfusion
  • Mental Status / Level of Activity
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3
Q

What are the (3) lvls of Dehydration?

A
  • Minimal ( 0 - 3% )
  • Mild to Moderate ( 3 - 9% )
  • Sever ( > 10% )
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4
Q

Why is Oral Rehydration better than IV therapy?

A
  • Cheaper
  • Done at Home
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5
Q

What is the best prevention against the spread of Gastroenteritis?

A

Good Handwashing

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6
Q

What is the preferred therapy for Sever Dehydration?

A
  • IV Bolus Therapy
  • 20 mL/kg of Normal Saline or Lactated Ringer’s
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7
Q

DDx for Recurrent Emesis in the Infant?

A
  • GERD
  • Viral Gastroenteritis
  • Malrotation and/or Volvulus
  • Inborn errof of Metabolism
  • Pyloric Stenosis
  • Intussusception
  • CNS disease
  • UTI
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8
Q

What provides Spanish speaking patients with an interpreter?

A
  • Title VI of the Civil Rights Act of 1964
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9
Q

What are the factors in the
Glasgow Coma Scale (GCS)?

A
  • Eye-Opening Response
  • Verbal Response
  • Motor Response
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10
Q

How is the Eye Opening Response of the GCS scored?

A
  1. NO EYE opening
  2. Eyes open w/ PAIN
  3. Eyes open w/ VERBAL command
  4. Eyes open SPONTANEOUSLY
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11
Q

How is the Verbal Response of the GSC scaled?

A
  1. NO VERBAL response
  2. INCOMPREHENSIBLE sounds
  3. INNAPROPRIATE words
  4. CONFUSED but able to answer QUESTIONS
  5. ORIENTATED
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12
Q

How is the Motor Response of teh GCS scaled?

A
  1. NO MOTOR response, flaccid
  2. Extensor response, DECEREBRATE posture
  3. Abnormal flexion, DECORTICATE posture
  4. WITHDRAWS from Pain
  5. LOCALIZES Pain
  6. OBEYS Commands
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13
Q

A GCS score of XX requires aggressive intervention?

A

8

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14
Q

Why do Children have a Higher Risk of
Dehydration than Adults?

A
  • Higher Surface Area to Body Mass ratio
    • relative area of evaporation is increased
  • Higher Basal Metabolic Rates
    • Generates Heat, Expends Water
  • Higher % of Body Mass that is Water
    • Infants 70%
    • Children 65%
    • Adults 60%
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15
Q

(8) DDx of Vomiting and Altered Mental Status?

A
  • DKA
  • Toxic Ingestion
  • Gastrointestinal Obstruction
  • Increased Intracranial Pressure (ICP)
  • Gastroenteritis
  • Appendicitis
  • Bacterial pneumonia
  • Pyelonephritis
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16
Q

(4) Diagnosing Diabetes Mellitus?

A
  • Symptoms of Diabetes (Polyuria, Polydipsia, Unexplained Weight Loss) plus Random Plasma Glucose > 200 mg/dL
  • Fasting Blood Glucose > 126 mg/dL (no caloric intake for at least 8 hours)
  • 2-hour Postload Glucose > 200 mg/dL during an Oral Glucose Tolerance Test (GTT)
  • HbA1c > 6.5% in an Adult is diagnostic of Diabetes
17
Q

Diagnosing Diabetic Ketoacidosis (DKA)?

A
  • Vomiting
  • Tachypnea
  • Mental Status Changes
  • Dehydration
  • DDx
    • Random Glucose > 200 mg/dL
    • Venous pH < 7.3 or Serum Bicarbonate < 15 mEq/L
    • Moderate / Large Ketonuria or Ketonemia
18
Q

How do you treat DKA?

A
  • Insulin and Fluid Resuscitation
    • Insulin 0.1 units/kg/hour after initial volume expansion
    • 1 hour after fluids push insulin
    • BiCarb should not be given because of Paradoxical CNS Acidosis and Hypokalemia and BiCarb is associated w/ increased risk of Cerebral Edema, the most common DM a/ death in children
    • Only add Potassium after serum lvl evaluated
    • Admit
19
Q

Signs and Symptoms of DKA?

A
  • Vomiting
  • Weight Loss
  • Dehydration
  • Shortness of Breath
  • Abdominal Pain
  • Change in the Level of Consciousness
20
Q

Lab Values a/w DKA?

  • pH
  • Sodium
  • Potassium
  • Bicarbonate
  • Creatinine
  • Glucose
  • Serum Ketones
  • Urine Ketones
A

Lab Values a/w DKA?

  • pH - Decreased - Acidodic
  • Sodium - Decreased - Hyponatremia
  • Potassium - normal
  • Bicarbonate - Decreased - Acidodic
  • Creatinine - Elevated - PreRenal Azotemia
  • Serum Glucose - Elevated - DKA
  • Serum Ketones - Elevated -
  • Urine Ketones - Elevated - Spill Over
21
Q

Isotonic / Isonatremic?

A
  • Na = 130 - 150 mEq/L
  • Loss of both sodium and water
  • Acute Gastroenteritis and Diarrhea
  • 12 hour replacement
22
Q

Hypotonic / Hyponatremic

A
  • Na < 130 mEq/L
  • Consumption of Diluted Fluids or Water w/ Dehydration
  • A/w Adrenal Insufficiency
  • 24 hours to replace
  • Rapid Correction –> Central Pontine Myelinolysis
  • -> dmg to myelin sheath of nerve cells
  • -> dmg to pons
23
Q

Hypertonic / Hypernatremic

A
  • Na > 150 mEq/L
  • Loss of water exceed Na losses
  • High Mortality
  • A/w Breastfeeding failure, Innapropriate use of Rehydration Solutions (Boiled milk), Diabetes Insipidus
  • 48 hours to Replace
  • Too-rapid of a Correction –> Cerebral Edema
24
Q

(3) Methods for Calculating Maintenance Fluids?

A
  • Caloric Expenditure
    • Body Surface
  • Holliday-Segar method (easiest)
    • 100 mL/kg/day x the first 10 kg body weight
    • 50 mL/kg/day x the second 10 kg body weight
    • 20 mL/kg/day x each additional 1 kg body weight
25
Q

What are signs of Cerebral Edema
and Increased Intracranial Pressure?

A
  • Slowing of HR
  • Increasing BP
  • A/w DKA mgmt - before mgmt begins and up to 24 hours after initiation of treatment
  • Risk Factors:
    • High BUN
    • Prolonged Acidosis w/ Hypocapnia
    • Attenuated measured Serum Sodium
    • Administration of Bicarbonate
26
Q

Components of Admission Oders:
ADC VANDISMAL?

A
  • A - admit
  • D - Diagnoses
  • C - Condition
  • V - Vital
  • A - Activity
  • N - Nursing
  • D - Diet
  • I - IV
  • S - Studies
  • M - Medications
  • A - Allergies
  • L - Labs
27
Q

Potential Rx Managment of DM?

A
  • Metformin
    • Primary for DM2
    • Alternative for DM1
  • Pramlintide
    • Adjunctive for DM1
28
Q

Admission Orders for Patient in DKA?

A
  • Continuous Monitoring of Vitals
  • Hourly Neuro Checks
  • Monitor Fluid INs and OUTs
  • Insulin Orders
  • Serum Glucose every 60 minutes
  • Serum Calcium, Magnesium, and Phosphorus now
  • Check Serum pH (VBG) every 60 minutes
  • Urine dipstick for Ketones
29
Q

What are the signs of Cerebral Edema in DKA?

A
  • Irregular Respirations
  • Headache
  • Vomiting
  • Third Nerve Palsy
  • High Blood Pressure
30
Q

What is Cushing’s Triad of Increased
Intracranial Pressure?

A
  • HTN
  • Inappropriate Slowing of HR
  • Irregular Respirations (Cheyne-Stokes respirations)
  • Increased ICRP
  • -> Vagal Stimulation
  • -> Gastric Acid Secretion
  • -> Followed by Epigastric Discomfort, Headaches, and Non-bilious Vomiting.

Pediatrics: Case Files (16 decks)

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