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4040 maternal child > Module 2 Kiddos > Flashcards

Module 2 Kiddos Flashcards

1
Q

Diagnostic eval of appendicitis

A

Mcburney point, CBC, UA, CT/MRI

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2
Q

Therapeutic mgnt of appendicitis

A

ruptured appendix can occur w/in 48 hr, peritonitis, ileus
surgery

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3
Q

What are the complications of Meckel diverticulum (congenital malformation), an extra potch in the GI tract

A

PAINLESS ANAL BLEEDING
currant jelly stool
abd pain
bleeding
obstruction
inflammation

This mf need surgery fr fr trust trust

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4
Q

Describe the dx eval of IBD

A

ESR, CBC, CRP, Stool samples, biopsy, endoscopy, colonoscopy

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5
Q

what causes IBD

A

gut microbiome, environmental factors, stress, autoimmune

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5
Q

what is the management of IBD

A

induce and maintain remission
HIGH PROTEIN HIGH CAL
Sx options- subtotal colectomy, ileostomy

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6
Q

what are some meds for IBD

A

mesalamine, olsalazine, steroids, immunomodulators

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7
Q

Skip lesions are associated with what IBD

A

Crohn’s

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8
Q

S/S of IBD

A

joint pain, weight loss, anorexia, rectal bleeding

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9
Q

what can cause hepatitis

A

Epstein- Barr
CMV- no pregnant people around if positive
chemicals
drugs

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10
Q

what are the special precautions for hepatitis

A

special drug dosing

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11
Q

acute hepatitis s/s

A

jaundice, fatigue, malaise, RUQ pain, n.v

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12
Q

biliary atresia can lead to what

A

biliary fibrosis -> obstruction

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13
Q

persistent jaundice for 2 weeks leads to a suspicion of what

A

biliary atresia

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14
Q

what does the stool of biliary atresia

A

grey stools (absence of bile)

these mf are also super itchy

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15
Q

what is the management of biliary atresia

A

nutritional support
Kasai

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16
Q

what are some tests for biliary atresia

A

cbc, liver, TORCH, US, Hida,

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17
Q

parvovirus B19 is the cause of what disease

A

fifths disease (red cheeks)

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18
Q

Cleft lip/palate happens when

A

embryonic development

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19
Q

when is surgery for the repair of the cleft lip/palate recommended

A

2-3 months; at minimum before 12 months of age due to the possible affect ont the speech

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20
Q

cleft palate can be breastfed. true of false

A

FALSE- nook nipples with wide base,

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21
Q

cleft lip can be breastfed. True or false?

A

TRUE- SNS feeding system

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22
Q

what are education points for parents of cleft lip/palate

A

no pacifiers, no straw, NO SUCTION

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23
Q

hypertrophic pyloric stenosis s/s

A

PROJECTILE VOMITING 30-60 MIN AFTER THEY FEED
can be bilious or not
US- olive-like mass
metabolic alkalosis

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24
Q

after surgery what is expected for hypertrophic pyloric stenosis

A

vomiting for 24-48 hr

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25
Q

intussusception s/s

A

SEVERE PAIN
kids tend to curl up into ball
cramping, abd mass, currant jelly stools

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26
Q

management of Intuss

A

hydrostatic reduction- the sx was successful when you have normal brown stools

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27
Q

what are 4 characteristics of celiacs

A

steatorrhea
general malnutrition
ABD distension
secondary vitamin definitely
rare to see in AA and Asian
more likely to get if already autoimmune

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27
Q

celiac disease is AKA

A

gluten-induced enteropathy
celiac sprue

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28
Q

Nursing ed for diet in a pt with celiac

A

AVOID HIGH FIBER AND LACTOSE (severe mucosal damage) if bowel is inflammed

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29
Q

what is the minimum piss in a day for a kiddo

A

3 times a day

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30
Q

fever and vomiting with no cold symptoms can lead to a suspicion of what

A

UTI

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31
Q

what is lower UTI involving

A

urethra and bladder

upper is ureters, renal pelvis, calyces, renal parenchyma

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32
Q

if a boy has UTI s/s but doesn’t have one what is the cause of these s/s

A

constipation

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33
Q

what is phimosis

A

stenosis of foreskin around the glans of the penis DONT TRY TO MOVE THAT FORESKIN

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34
Q

Phimosis leads to balanitis. what is it

A

bacterial/fungal infection

Tx- steroid cream BID x one month

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35
Q

hydrocele resolves on its own. T or F

A

true; it is the presence of peritoneal fluid in the scrotum

if it persists past 12 months then sx is an option, no straddle toy

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36
Q

what are some mgmt of cryptorchism

A

orchiopexy (sx) after 6 mnth of age ->decrease risk of torsion. no straddle toy for 2-4 weeks

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37
Q

hypospadias is managed by how

A

surgery 6-12 months (NO CIRCUMCISION)
bladder spasms are managed with oxybutynin

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38
Q

what is a chordee

A

the ventral curve of PENIS

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39
Q

When is testicular torsion most common

A

13 years

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40
Q

S/S of testicular torsion

A

swelling, pain, warm, immobile, n/v, ABSENT CREMASTERIC REFLEX

in epididymitis the cremaster reflex is present

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41
Q

When does sex differentiation occur in gestation

A

7 wks

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42
Q

S/S of congenital adrenal hyperplasia (CAH)

A

adrenal insufficiency, hypoglycemia, hypovolemia, hyponatremia, hyperkalemia

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43
Q

What are the different types of ambiguous genitalia

A

bilateral cryptorchidism, perineal hypospadias with bifid scrotum, clitoralmegaly, posterior labial fusion

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44
Q

primary enuresis
secondary enuresis

A

primary- always been pissing
secondary- new onset of pissing in bed

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45
Q

when is a medical eval recommended for enuresis

A

1 time a month for three months

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46
Q

managment of eruresis

A

rule of organic causes, elimination of fluids after evening meals, bedwetting alarm, meds (desmopressin, oxybutynin, tofranil), avoiding caffeine or sugar, no shaming or scolding

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47
Q

desmopressin s/e

A

HA, nausea, hyponatremia

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48
Q

Nephrotic syndrome s/s

A

2-7 years age
albumin is lost in urine
massive protein in the urine
facial edema in the morning
abd swelling, diarrhea/anorexia

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49
Q

management of nephrotic

A

corticosteroids are first-line (behavioral issues, decreased immune, weight gain, Cushing, cyclosporine, salt restriction, fluid restriction)
educate about pneumonia vax

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50
Q

what is the cause of acute glomerulonephritis

A

pneumococcal, streptococcal and viral infections

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51
Q

s/s of acute glomerulonephritis

A

cola/tea/cloudy/smoky urine
3+4+ protein in urine
hematuria
facial edema that spread to extremities
high BP
increased BUN, Cr

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52
Q

test for acute glomerulonephritis

A

throat culture, ASO titer, chest x ray

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53
Q

hemolytic uremic syndrome (HUS) is the most common cause of what in kiddos

A

AKI

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54
Q

what is associated with diarrhea in children

A

rickettsia (tick), e coli, pnemoccoci, sheglla

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55
Q

management of HUS

A

dialysis, FFP, Blood transfusion

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56
Q

AKI principle feature

A

oliguria

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57
Q

complications of AKI

A

hyperkalemia, water intoxication, hyponatremia, HTN(antihypertensive drug), seizure, anemia, seizure

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57
Q

the diet recommended for AKI

A

high carb low fat

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58
Q

CKD

A

more than 50% of kidney function is gone

59
Q

manifestation of CKD

A

increase BUN, Cr
h2o and Na++ retention
hyperkalemia
Ca and Phos disturbance
anemia
metabolic acidosis

60
Q

diet for CKD

A

low protein, vitamin D (suppression of parathyroid hormone)

61
Q

what is the most dangerous form of dehydration

A

hypertonic dehydration (Na+=>150)

62
Q

what is the percentage of water loss that is considered severe in infants and children

A

> 10% in infants
6% in children

63
Q

what are the s/s of dehydration

A

change in loc, decrease tear production, decrease elasticity of skin, decreased urine, increase HR, decrease BP

EARLIEST SIGN- INCREASED HR AND DRY MM

64
Q

What is the tx of dehydration

A

Oral rehydration (ORT/ORS)- pedialyte or sugar free gatorade or Powerade
Iv fluids

65
Q

what do we educate the parent about for a child that is dehydrated and need to rehydrate however they refuse to drink

A

syringe, squirt every 5-10 min

66
Q

what can acute diarrhea be associated with

A

URI, UTI, Antibiotic

67
Q

chronic diarrhea is classified by having it for how long and what is the possible cause

A

> 14 day is considered chronic
caused by gastroenteritis, rotavirus, Crohns, UC

68
Q

when a parent asks about how long the diarrhea can last how long do you respond with

A

10 days so be concerned about skin integrity and dehydration

69
Q

what can cause gastroenteritis

A

E. coli, rotavirus(mild to moderate grade fever), salmonella, c diff (antibiotic use)

70
Q

what is the difference of salomella and e coli stool and s/s

A
71
Q

what is something a pt should avoid when having diarrhea and is dehydrated

A

caffeine

72
Q

how should we instruct a parent with a dehydrated infant to rehydrate them

A

rotate between breast milk and pedialyte. for formula babies get a lactose free one and rotate as well

73
Q

if meconium is not passed within 24-36 hrs of life what is suspected

A

hirschprungs, hypothyroidism, or meconium plug

then thermometer rectal stimulation or glycerin suppository

74
Q

how long does it take for infants to adapt to solid foods in their bowl

A

weeks

75
Q

what kind of fruit make you poop

A

the ones that start with p
peaches plum pears ect

76
Q

what are common causes of constipation in childhood

A

trying to hold it too often, nutrition, stress

77
Q

can boys have UTI s/s but actually is constpation

A

yes; true

78
Q

when doing a “three day clean out” using miralax and Senna (or other stimulant laxative ; is it recommended to go to school

A

hell nah. man they going to be shitting big shits fr fr

79
Q

what is s/s of hirschsprung

A

poor feeding, vomiting, distending, can lead to enterocolitis

80
Q

what are the diagnostic eval of Hirschsprung

A

xray, barium enema, anorectal manometric exam, rectal biopsy to confirm

81
Q

what are some post op nursing thing to look out for after surgery to fix a hirschsprung

A

monitor fluid and ion, s/s of shock and bowel perforation

N/V, increase tenderness and increased abd distention, cyanosis

82
Q

biled emesis can be caused by what

A

small bowel obstruction

83
Q

curled emesis/ early emesis is caused by what

A

poor gastric emptying or high obstruction

84
Q

what age is gastroesophageal reflux (GER) most common

A

4 months of age

85
Q

trigger for GER

A

coughing sneezing overeating

86
Q

s/s of GER

A

fussy after eating, chest burn, cough,

87
Q

should we medicate GER?

A

no; as long as the patient is not losing weight

can last up to a year
if yes then H2 blockers, PPIs (30 min before feed)

88
Q

what are the stressors of hospitalization for kiddos

A

separation anxiety(more so toddlers)
lack of control (temper tantrum, magical thinking)
interruption of routine
Loss of autonomy
fear of permanent injury, death
illness viewed as punishment
separation of peer group

89
Q

what are risk factors that increase vulnerability to stressors of hospitalization

A

difficult temperament
lack of fit between child and parent
age (6 month-5yr, male)
male gender
below average intelligence
repeat hospitalization

90
Q

parental reposes to stressor

A

disbelief anger guilt (sudden onset of illness)
fear anxiety (the seriousness of illness)
frustration (related to the need of info, chronic illness)
depression

91
Q

sibling reaction to hospitalization

A

loneliness, fear worry
anger, resentment, jealously
guilt

92
Q

preventing and minimizing separation in the hopistal

A

family centered care
parents are not visitors
familiar items from home
presence (being close, talking quietly)
cultural beliefs

93
Q

normalizing hospital environment include what

A

maintain child routine
freedom of movement
time structuring
self care
school work
friends and visitors
provide opportunity of play

94
Q

positioning for femoral venipuncture, extremity venipuncture, lumbar puncture, bone marrow biopsy

A

femoral- frog leg position (supine)
extremity- stabilization (wrap the baby tightly)
Lumbar position- side lying or flexed (HA is common)
bone marrow/aspiration- frog leg

95
Q

med admin

A

oral- mix with apple juice or sauce (SMALL AMOUNT, HOUSE HOLD TEASPOON VARIES ALOT SO WE TEACH ABOUT A SRINGE)
IM injection (<1mL TB syringe) avoid Doral gluteal for children under 10 for danger of hitting the sciatic nerve

96
Q

how to put on a collection bag for a clean catch

A

start from the perineum and move up
Its okay for a scrotum in the bag
if you suspect UTI you can Cath them

97
Q

what are to be included for pain assessment

A

pain intensity- behavior, self reporting
satisfaction of tx
symptoms and adverse affects
emotional respons
economic factors

98
Q

what is recurrent pain

A

reoccurs every three months or more. frequently

98
Q

what is chronic pain

A

3 months or more

99
Q

what are some pain rating scale

A

FACES (Wong baker)
CRIES
NIPS
FLACC
COMFORT (unconscious neonate)
Numeric scale
pediatric pain questionaire

100
Q

young vs old infant pain response

A

young - cry, rigid, grimace, thrashing
older- may withdraw

101
Q

younger child vs school age pain response

A

younger- loud cry, and screaming attempts to push away
school age- stall tactics young child behaviors

102
Q

adolescents pain response

A

less vocal protest, less motor activity

103
Q

what is most effective non-pharm technique for need related pain

A

distraction and hypnosis

104
Q

pharmacologic two step approach is what

A

children >3month
start with non opioid 1st
morphine is opioid of choice
codeine is not recommended for children under 12

105
Q

when can a child have fent

A

> 12 years

106
Q

what two opioids go into PCA

A

morphine or hydromorphone

107
Q

how do you use refrigerant spray

A

dab on cotton ball and dab

108
Q

what are the coanalgesic drugs

A

diazepam, midazolam, amitriptyline, gabapentin

109
Q

s/s of cancer

A

pain, prolonged fever, easy bruising, swollen lympnodes, white eye refelx, wt loss, mass or swelling, HA

110
Q

when is a tumor best removed from sx

A

when it is encapsulated

111
Q

nursing considerations for chemotherapy

A

free flowing IV line, stop immediately if infiltration, known to cause anaphylaxis (monitor for a hour after )

112
Q

what is the major consideration for HSCT

A

they have to wipe out the immune system, so there is no back up you are officially fucked not even cooked

113
Q

how do you calculate absolute neutrophil count

A

ANC= total # of neutrophils (polys, seg, and band) and multiply by WBC

114
Q

when an infection is suspected in a cancer pt what is given

A

broad spectrum (bacterium a self drug) until cultures come back

115
Q

what are the most lethal organisms to cancer pt

A

varicella, HSV, herpes zoster, RSV, FLU, CMV, pseudomonas, staph,

116
Q

when a pt is anemic do we restrict activity

A

NAH they can go as tolerated

117
Q

what is given for N/V in cancer

A

promethazine (phenergan), prochlorperazine (compazine)
metoclopromide (regaln)
weed
give antiemetic within 30 min to one hour prior to chemo regularly for 24 hr after

118
Q

what are extrapyramidal side effects

A

muscle twitching, agitation, grimacing usually from phenergan, compazine

119
Q

why do you not give viscous lidocaine to kids

A

risk of aspiration

120
Q

nurse intervention for stomatitis

A

bland, moist, soft diet
chg or salt or bicarb mouth wash
sucralfate, diphenhydramine, maalox (magic mouth wash)
relax eating pressures
stool softeners warm sitz baths

121
Q

are wigs tax deductible

A

yes

122
Q

neurological effects of cancer

A

decreased bowel innervation, foot drop and weakness, numbness of extremities

123
Q

what is a possible complication from HCST

A

Graft vs host disease

124
Q

what nurse education would you give for a pt receiving HCST

A

no live vax, siblings can receive, if they received a vax 2 weeks prior they will need to be revax

125
Q

s/s of leukemia

A

cold that won’t go away, weight loss, petechia, hepatospleenomegaly

126
Q

when Is a leukemia pt considered in remission

A

lest than 5% of blast cells in bone marrow

127
Q

when is leukemia most common

A

boy>girl 2-3 yr old

128
Q

when is Hodgkins lymphoma most common

A

15-19 yr

129
Q

s/s of Hodgkins lymphoma

A

painless enlargement of lymph nodes (cervical and clavicular), nonproductive cough, unexplained abd pain, fever, anorexia, nausea, weight loss, pruritus

130
Q

what are diagnostics for Hodgkins

A

CBC, ESR, CRP, CXR, MRI, PET, +Reed stern burg cell (multinucleate immune cells)

131
Q

non-hodgkins s/s

A

burkitt lymphoma is associated with this disease
similar to Hodgkins s/s but lymphoid tissue compression of various organs may cause obstruction

132
Q

s/s of brain tumors

A

depends on location size and rate of growth
HA on wakening up, vomitting not r/t to eating, nystagmus, ataxia, dysarthria, DI, delayed/ precocious puberty, growth failure

133
Q

T or F? Brain tumors are common in kids

A

true but rule out other organic causes of s/s like glasses, screen, dehydration, sleep

134
Q

what is the gold standard for diagnostics for brain tumors

A

MRI but CT can be used if not available

135
Q

nursing intervention for post op brain surgery

A

s.s of IICP(pupils, loc, bp, HA, agitation, photophobia, coma, posturing, vomiting without nausea

never move on the side of the craniotomy

if starts vommiting Make them NPO

136
Q

where does osteosarcoma happen

A

in the long bones

s/s localized bone pain, palpable mass, limping, resist activity

137
Q

what is the tx of osteosarcoma

A

limb salvage, ambutation

this does not respond to radiation

138
Q

where is Ewing sarcoma

A

shaft of long bone, pelvis, femur, tibia, ulna, vertebrae, sacalpula, rib, skull

radiation is effective

139
Q

s/s of wilms tumor

A

swelling or mass in abd, in deep in flank, nontender

ONCE WE CONFIRM THE DIAGNOSIS DONT PALPATE THE ABDOMEN

140
Q

vincristine s/e

A

causes ileus, monitor bowel sounds

141
Q

what diagnostics for films tumor

A

abd studies, CBC to rule out polycythemia, US, CXR, chest CT

142
Q

s/s of retinoblastoma

A

leukocoria (cat eye reflex), strabismus, blindness

143
Q

metastasis is rare is retinoblastoma. T or F

A

TRUE

144
Q

what s/s is common for HIV/AIDS

A

recurrent infection (yeast, uti)

145
Q

what diagnostics are used for HIV/AIDS

A

RNA/DNA, HIV culture
18month or older need ELISA test

146
Q

HIV infant prophylaxis is mother is positive

A

IgG (no MMR vax bc it is not effective) , bacterium

4040 maternal child (6 decks)

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