mod 3 peds Flashcards
i need a cig brother SOS
1
Q
maternal history that can be associated with heart dx in infant
A
DM, lupus, rubella, obesity
2
Q
what does the inspection portion of the cardiac assessment include
A
respiratory rate and effort
cyanic, lethargic
poor weight gain (late sign)
edema
diaphoresis
clubbing of fingers (late sign)
3
Q
does a child with down syndrome have a higher risk for cardiac disease
A
true; dont be so down
4
Q
what does the palpation portion of cardiac assessment include
A
peripheral pulse
edema
cap refill
skin temp
5
Q
pre-procedure checklist for a heart cath
A
assessment, hx, pulses, baseline o2, prepare child, NPO
6
Q
post-procedure for a heart cath
A
pulse check, extremity (temp color), VS trend (EKG, BP), dressing, fluid intake, positioning, activity level
7
Q
what are the two classifications of CHD
A
acyanotic, cyanotic
8
Q
what classification is atrial septal defect
A
acyanotic
9
Q
true or false? in a ventricle septal defect is can spontaneously close in <1yr
A
TRUE, also a acyanotic CHD
10
Q
what is a atrioventricular Canal defect
A
both atrial and ventricle septal defect, and a valve insufficiency, low ASD, High VSD, LOUD murmur
11
Q
what closes the ductus arterioles and foramen ovalale
A
the babies first breath
12
Q
what is a sign of coarctation of the aorta
A
high BP in arm low BP in leg
13
Q
how is aortic stenosis characterized
A
decreased CO, fainting, hypotensive, stop eating, stop playing,
14
Q
what does the tetralogy of fallot include
A
VSD, pulmonic stenosis, right ventricular hypertrophy, overriding aorta
15
Q
how is teratology of the fallot characterized
A
acute episodes of cyanosis (tet spells)
16
Q
what characterizes truncus arteriousis
A
holosystolic murmur (prostaglandins given)
17
Q
what is a hypo plastic left heart missing
A
left ventricle, closed mitral valve (prostaglandin given)
18
Q
clinical symptoms of CHF
A
tachypnea, dyspnea, retractions, tacky at rest, activity intolerance
19
Q
what is the goal of using digoxin
A
increase CO, decrease heart size, decrease venous pressure, relief edema, rapid onset short half life, nursing precaution, education
20
Q
what is given for pediatric CHF
A
digoxin, ACE inhibitors, diretics
21
Q
assessment of hypoxemia
A
polycythemia, clubbing (late sign), fatigue with feeding, poor weight gain, tachypnea/dyspnea, hyper cyanotic spells, neurologic complication (
22
Q
what is the management of hypoxemia
A
prostaglandin
manage hyper cyanotic spells
hydration
prevent bacteria
pulmonary hygiene (IS, blowing bubbles)
appropriate activity level
23
Q
how do you pick up a post op open heart baby
A
Scoop method- hand under head and butt/back
no picking up from under arms
24
Q
what heart defect results in decrease pulmonary flow
A
tetralogy of fallot (not testable my ass)
25
what is the number one precaution for diuretics
K+ because of the risk of Dig toxicity
26
dig toxicity
vomitting, Brady, dysrhythmia, vision change, decreased urine, confusion
27
what does the neuro exam cover ?
LOC, Glasgow coma scale, pupil size, reactivity, reflexes, posturing
28
diagnostics for infective endocarditis
cbc, esr, cultures (x3 at different times), echo, UA (hematuria, proteinuria)
29
management of endocarditis
prophylactic abx for high risk pt (amox, ampicillin, clindimyocym if allergic to penicillin) IV abx at home (2-8 weeks), blood cultures
talk to the dentist about risk factors
30
rheumatic fever caused by what and how long is the latency
strep infection -> valve damage (most often the mitral valve)
2-6 weeks latency
31
diagnostics for rheumatic fever
jones criteria (two major or one major one minor), ASO titer, ESR, CRP
32
s/s of rheumatic fever
chorea (difficulty with fine motor skills, focusing and some dance goes away on its own), tachy, chest pain, polyrhythmic, new murmur, or change in preexisting murmur
33
management of rheumatic fever
PCN for 28 days
alternatives for PCN- erythromycin
salicylates (ASA 80-100g/kg/day)
Naproxen (20mg/kg/day)
prednisone
34
Kawasaki's disease has three phases
acute- high fever that doesn't respond to NSAIDs
convalescent phase- no s/s labs get better
35
s/s of Kawasaki
erythema of palms and soles, desquamation (peeling) of hands and feet, bilateral conjunctival injection, strawberry tongue, maculopapular rash, cervical lymphadenopathy, erythematous lips
36
management of Kawasaki
IV IG over 10-12 hours, ASA therapy for febrile 100mg/kg/day
ASA therapy when afebrile is 3-5 mg/kg/day
37
D/C teaching for Kawasaki
arthritis(temporary but do passive ROM), live immunizations(for 11 months), temp checks
38
nursing care for Kawasaki
monitor for signs of HF, s/e of IVIG (HA and nausea), skin care(cold compress, soft sheets), mouth care (, parental support
39
early signs of shock
tachy, decreased UOP, anxiety, impending doom, thirsty, good bp (LOW BP IS A LATE SIGN)
40
s/s of hypotensive phase of shock
narrow pulse pressure, sluggish cap refill, confusion, lethargy,
41
management of shock
o2, vent, fluids, blood transfusion, epi, dopamine
42
s/s of anemia
decreased PVR (not as many RBC), pallor, HA, fatigue, SOB, Pica
43
nursing care for anemia
diet, admin education( Vit C, usually increased Hbg in 1 month, do not give IM, avoid dairy products), cow milk (too much leads to this), safe storage
44
who are at higher risk for sickle cell anemia
AA, hispanics, Italian, greek, Iranian, Caribbean, asian Indian
45
management of sickle cell
rest, hydration, antbx, vaccines (pnomoccal, Flu, Hib) , o2, therapy, blood transfusion, pain med, hydroxyurea, HSCT
45
diagnostics for sickle cell
universal screening, sickledex, Hbg electrophoresis
46
what is the cure for sickle cell
HSCT
47
80% of cases of hemophilia are x linked. True or false?
TRUE
48
what are factor IX deficiency
Hemophilia B, or Christmas disease
49
What are the factor VIII deficiency
hemophilia A or classic hemophilia
50
Von Willebrand disease is the absence of protein. True or False
TRUE
51
clinical manifestation of sickle cells
1 obstruction of sickled RBC
2 vascular inflammation
3 increased RBC destruction
52
exacerbation of sickle cells can be called
vascooculsive
sequestrian (pooling of blood in spleen or liver leads to shock)
aplastic
hyperhemolysis (jaundice, anemia, reticulocytosis)
Acute chest syndrome (PNA, fever, malaise, increase WBC, SOB, chest pain)
CVA
53
management of hemophilia
factor VIII, DDAVP (only for classic hemophilia), avoid ASA, certain NSAIDs, corticosteroids for hematuria and chronic synovitis, avoid IM injection
54
education of hemophilia
decreasing risk of injury, recognizing bleeding episodes, inform school nurse, osteoarthritis, cold pack ready to use
55
characteristics of immune thrombocytopenia
thrombocytopenia, signs of bleeding, megakarocytes, and eosinophils
56
what leads to immune thrombocytopenia
1-4 wks after viral illness
57
Tx of immune thrombocytopenia
mainly supportive, IVIG, prednisone, anti-D antibody, splenectomy (Chronic, vaccine prior)
58
what is the onset of intellectual disability
<18 years
59
what are the functional impairments
communication, home living, self care, social skills, functional academics, work, self direction health and safety, leisure, community use
60
signs of cognitive impairment
no response to contact, voice or movement
irritability
poor//slow feeding
poor eye contact during feeding
diminished spontaneous activity
61
what can cause cognitive impairment
intrauterine infection/intoxicatio
trauma
matabolic or endocrine disorders
inadequate nutrition
postnatal brain disease
chromosomal anomalies
prematurity, low birth weight, post maturity
enviormental influence
unknown prenatal influence
psych disorders
62
primary prevention of cognitive impairment
support preterm or high risk infant
rubella immunization
genetic counseling
maternal counseling (folic acid, alcohol, lead)
63
nursing interventions for cognitive impairment
educate child and family
teach children self care
encourage play and exercise
establish discipline
encourage socialization
provide information on sexuality
64
what are some physical charatericis of DS
protruding tongue, small nose with flat bridge, hypotonia (atlantoaxial instability)
65
who passes fragile x syndrome
mom and dad
66
fragile X syndrome physical manifestation
large head, long face, large ears, prognathism, hypotonic, large testes (macrorchidism)
67
what are classic features of fragile x syndrome
mild to severe cognive impairment
delayed speech and language
hypersensitivity
autistic like behaviors
intolerance to routine change
68
what meds are given to fragile x syndrome
fluoxetine, clonidine, melatonin
69
management of fragile x syndrome
serotonin agents for havioral control
stimulants for hyperactivity
protein replacement and gene therapy options are being investigate
referral to an early intervention program
70
71
72
what are causes for hearing impairment
low birth weight, ototoxic drugs (gent), chronic ear infection, perinatal asphyxia, perinatal infection, cerebral palsy, incubators, guns
72
manifestation of hearing impairment
lack of startle reflex, not talking or making noise, indifference to sound, lack of response to spoken work
73
what causes visual impairment
gonorrhea, clamidyia, rubella, syphillis, toxoplasmosis, retinopathy (high o2), trauma, conjunticitis
74
is the MMR vax or vax with thimerosal linked to autism
Nah man that dude was full of shit
75
what are some of the criteria with ASD
social interaction, communication, restricted repetitive, interest. activities, delays or abnormal functioning with onset before 3 tears
76
what are lacerations in a head injury associated with
penetrating or depressed skull fractures
77
s/s of bacterial meningitis
photophobia, poor feeding, vomitting, nuchal rigidity, positive kernig and brudzinski, petechial/ pupuric rashes
78
manamgent of bacterial menegitis
cephalosporin, vanc, hydration, isolation, low stim
79
80
81
what does the care of an unconscious child include
regular assessment of neuro, temp monitoring, LOC, pain management, respiratory, ICP monitoring
82
s/s of concussion
confusion, HA, amnesia
83
when does bone demineralization happen
when you don't move around
83
What happens to the metabolism due to immobility
decrease metabolic rate, negative nitrogen balance, hypercalcemia, decreased stress hormone
84
effects of decreased mobility on the cardiovascular
decreased efficiency of orthostatic neuromuscular reflexes, diminished vasopressor
85
effects of immobility on respiratory system
diminished vital compact, poor abdominal tone and distention, mechanical or biochemical secretion retention, loss of respiratory muscle strength
86
what is a sprain
ligament is partially or completely torn, may have blood vessel damage, muscle, tendons and nerves
strain is a microscopic tear
87
how long should ICE be used for
30 min at a time max
88
buck is short term for things like contractors. T or F?
TRUE, WEIGHTS ARE HANGNING
89
what are the 5 p's of fracture
pain, pulse, pallor, parathesia, paralysis (pressure)
90
What is done with hip dysplaisia
palivk harness for newborn to 6 months only, o
steps go over the diaper, parents do no move them
91
what are the s.s for infant DDH
shortened limb (galeazzi), restricted abduction at hip, unequal gluteal folds, positive ortolani, Barlow test
92
DDH in older children s.s
one leg is shorter, trendelenburg sign, lordosis, waddling gait
93
what is the treatment of clubfoot (talipes Equinovarus)
seal casting, heel cord tenotomy, long leg cast
94
s/s of egg-calve-perthes disease
AVASCULAR NECROSIS OF THE FEMORAL HEAD, limping , pain
management with rest, sx, traction,
95
child around puberty age (8-15) \, and obese with limp, hip and groin, thigh or knee pain is what
slipped capital femoral epiphysis
96
what is the treatment for slipped capital femoral epiphysis
sx, in stitu pinning
97
hyperlordsis and kyphosis is common in infant and obesity
ye s
98
what can cause osteomyolitis
GBS and other infection
99
management of osteomyolytis
need a PICC line, ABx for 3-4 weeks, nafcillin, clinda, vanc
100
JIA peak ages
1-3 yr, 8-10 yr before 16 yr with more then 1 joints for more then 6 weeks
101
meds for JIA
methotrexate (no pregnant, no alcohol), sulfasalazine, etanercept, infliximab, glucocorticoids
102
s.s of CP
delayed gross motor development, unilateral hand use, tongue thrust, abdominal posture, primitive relfex, ADHD symptoms
103
s/s of encephalitis
HA, dizzy, nuchal rigidity, tremor, hyperactivity, high fever, spasticity
104
tx of encephalitis
corticosteroids, plasma phersis, acyclovir (for only HSV caused),
105
what is the diagnosis of rabies test
skin biopsy
106
what is the rabies vx series days
1-7-14
immunoglobulin is given within the first 7 days of rabies contraction and after the receiving the vax
107
what can lead to reye syndrome
influenza and varicella and giving ASA
108
what has a hidden salicylate
PEPTO- you goin to get REYE Dumbass
109
what labs are watched in Reye syndrome
clotting factor
110
what is the diet recommended for seizures
key toe
111
how long does a child have to stay in the hospital after a drowning injury
24 hr in the hospital
112
what can cause hydrocephalus
TORCH
113
s/s of hydrocephalus
dialed scalp veins, mace wan sign (cracked pot sounds), papilledema, sun setting irritable
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