Module 2 Kiddos Flashcards
1
Q
Diagnostic eval of appendicitis
A
Mcburney point, CBC, UA, CT/MRI
2
Q
Therapeutic mgnt of appendicitis
A
ruptured appendix can occur w/in 48 hr, peritonitis, ileus
surgery
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
4
Q
Describe the dx eval of IBD
A
ESR, CBC, CRP, Stool samples, biopsy, endoscopy, colonoscopy
5
Q
what causes IBD
A
gut microbiome, environmental factors, stress, autoimmune
5
Q
what is the management of IBD
A
induce and maintain remission
HIGH PROTEIN HIGH CAL
Sx options- subtotal colectomy, ileostomy
6
Q
what are some meds for IBD
A
mesalamine, olsalazine, steroids, immunomodulators
7
Q
Skip lesions are associated with what IBD
A
Crohn’s
8
Q
S/S of IBD
A
joint pain, weight loss, anorexia, rectal bleeding
9
Q
what can cause hepatitis
A
Epstein- Barr
CMV- no pregnant people around if positive
chemicals
drugs
10
Q
what are the special precautions for hepatitis
A
special drug dosing
11
Q
acute hepatitis s/s
A
jaundice, fatigue, malaise, RUQ pain, n.v
12
Q
biliary atresia can lead to what
A
biliary fibrosis -> obstruction
13
Q
persistent jaundice for 2 weeks leads to a suspicion of what
A
biliary atresia
14
Q
what does the stool of biliary atresia
A
grey stools (absence of bile)
these mf are also super itchy
15
Q
what is the management of biliary atresia
A
nutritional support
Kasai
16
Q
what are some tests for biliary atresia
A
cbc, liver, TORCH, US, Hida,
17
Q
parvovirus B19 is the cause of what disease
A
fifths disease (red cheeks)
18
Q
Cleft lip/palate happens when
A
embryonic development
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
20
Q
cleft palate can be breastfed. true of false
A
FALSE- nook nipples with wide base,
21
Q
cleft lip can be breastfed. True or false?
A
TRUE- SNS feeding system
22
Q
what are education points for parents of cleft lip/palate
A
no pacifiers, no straw, NO SUCTION
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
24
after surgery what is expected for hypertrophic pyloric stenosis
vomiting for 24-48 hr
25
intussusception s/s
SEVERE PAIN
kids tend to curl up into ball
cramping, abd mass, currant jelly stools
26
management of Intuss
hydrostatic reduction- the sx was successful when you have normal brown stools
27
what are 4 characteristics of celiacs
steatorrhea
general malnutrition
ABD distension
secondary vitamin definitely
rare to see in AA and Asian
more likely to get if already autoimmune
27
celiac disease is AKA
gluten-induced enteropathy
celiac sprue
28
Nursing ed for diet in a pt with celiac
AVOID HIGH FIBER AND LACTOSE (severe mucosal damage) if bowel is inflammed
29
what is the minimum piss in a day for a kiddo
3 times a day
30
fever and vomiting with no cold symptoms can lead to a suspicion of what
UTI
31
what is lower UTI involving
urethra and bladder
upper is ureters, renal pelvis, calyces, renal parenchyma
32
if a boy has UTI s/s but doesn't have one what is the cause of these s/s
constipation
33
what is phimosis
stenosis of foreskin around the glans of the penis DONT TRY TO MOVE THAT FORESKIN
34
Phimosis leads to balanitis. what is it
bacterial/fungal infection
Tx- steroid cream BID x one month
35
hydrocele resolves on its own. T or F
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
36
what are some mgmt of cryptorchism
orchiopexy (sx) after 6 mnth of age ->decrease risk of torsion. no straddle toy for 2-4 weeks
37
hypospadias is managed by how
surgery 6-12 months (NO CIRCUMCISION)
bladder spasms are managed with oxybutynin
38
what is a chordee
the ventral curve of PENIS
39
When is testicular torsion most common
13 years
40
S/S of testicular torsion
swelling, pain, warm, immobile, n/v, ABSENT CREMASTERIC REFLEX
in epididymitis the cremaster reflex is present
41
When does sex differentiation occur in gestation
7 wks
42
S/S of congenital adrenal hyperplasia (CAH)
adrenal insufficiency, hypoglycemia, hypovolemia, hyponatremia, hyperkalemia
43
What are the different types of ambiguous genitalia
bilateral cryptorchidism, perineal hypospadias with bifid scrotum, clitoralmegaly, posterior labial fusion
44
primary enuresis
secondary enuresis
primary- always been pissing
secondary- new onset of pissing in bed
45
when is a medical eval recommended for enuresis
1 time a month for three months
46
managment of eruresis
rule of organic causes, elimination of fluids after evening meals, bedwetting alarm, meds (desmopressin, oxybutynin, tofranil), avoiding caffeine or sugar, no shaming or scolding
47
desmopressin s/e
HA, nausea, hyponatremia
48
Nephrotic syndrome s/s
2-7 years age
albumin is lost in urine
massive protein in the urine
facial edema in the morning
abd swelling, diarrhea/anorexia
49
management of nephrotic
corticosteroids are first-line (behavioral issues, decreased immune, weight gain, Cushing, cyclosporine, salt restriction, fluid restriction)
educate about pneumonia vax
50
what is the cause of acute glomerulonephritis
pneumococcal, streptococcal and viral infections
51
s/s of acute glomerulonephritis
cola/tea/cloudy/smoky urine
3+4+ protein in urine
hematuria
facial edema that spread to extremities
high BP
increased BUN, Cr
52
test for acute glomerulonephritis
throat culture, ASO titer, chest x ray
53
hemolytic uremic syndrome (HUS) is the most common cause of what in kiddos
AKI
54
what is associated with diarrhea in children
rickettsia (tick), e coli, pnemoccoci, sheglla
55
management of HUS
dialysis, FFP, Blood transfusion
56
AKI principle feature
oliguria
57
complications of AKI
hyperkalemia, water intoxication, hyponatremia, HTN(antihypertensive drug), seizure, anemia, seizure
57
the diet recommended for AKI
high carb low fat
58
CKD
more than 50% of kidney function is gone
59
manifestation of CKD
increase BUN, Cr
h2o and Na++ retention
hyperkalemia
Ca and Phos disturbance
anemia
metabolic acidosis
60
diet for CKD
low protein, vitamin D (suppression of parathyroid hormone)
61
what is the most dangerous form of dehydration
hypertonic dehydration (Na+=>150)
62
what is the percentage of water loss that is considered severe in infants and children
>10% in infants
>6% in children
63
what are the s/s of dehydration
change in loc, decrease tear production, decrease elasticity of skin, decreased urine, increase HR, decrease BP
EARLIEST SIGN- INCREASED HR AND DRY MM
64
What is the tx of dehydration
Oral rehydration (ORT/ORS)- pedialyte or sugar free gatorade or Powerade
Iv fluids
65
what do we educate the parent about for a child that is dehydrated and need to rehydrate however they refuse to drink
syringe, squirt every 5-10 min
66
what can acute diarrhea be associated with
URI, UTI, Antibiotic
67
chronic diarrhea is classified by having it for how long and what is the possible cause
>14 day is considered chronic
caused by gastroenteritis, rotavirus, Crohns, UC
68
when a parent asks about how long the diarrhea can last how long do you respond with
10 days so be concerned about skin integrity and dehydration
69
what can cause gastroenteritis
E. coli, rotavirus(mild to moderate grade fever), salmonella, c diff (antibiotic use)
70
what is the difference of salomella and e coli stool and s/s
71
what is something a pt should avoid when having diarrhea and is dehydrated
caffeine
72
how should we instruct a parent with a dehydrated infant to rehydrate them
rotate between breast milk and pedialyte. for formula babies get a lactose free one and rotate as well
73
if meconium is not passed within 24-36 hrs of life what is suspected
hirschprungs, hypothyroidism, or meconium plug
then thermometer rectal stimulation or glycerin suppository
74
how long does it take for infants to adapt to solid foods in their bowl
weeks
75
what kind of fruit make you poop
the ones that start with p
peaches plum pears ect
76
what are common causes of constipation in childhood
trying to hold it too often, nutrition, stress
77
can boys have UTI s/s but actually is constpation
yes; true
78
when doing a "three day clean out" using miralax and Senna (or other stimulant laxative ; is it recommended to go to school
hell nah. man they going to be shitting big shits fr fr
79
what is s/s of hirschsprung
poor feeding, vomiting, distending, can lead to enterocolitis
80
what are the diagnostic eval of Hirschsprung
xray, barium enema, anorectal manometric exam, rectal biopsy to confirm
81
what are some post op nursing thing to look out for after surgery to fix a hirschsprung
monitor fluid and ion, s/s of shock and bowel perforation
N/V, increase tenderness and increased abd distention, cyanosis
82
biled emesis can be caused by what
small bowel obstruction
83
curled emesis/ early emesis is caused by what
poor gastric emptying or high obstruction
84
what age is gastroesophageal reflux (GER) most common
4 months of age
85
trigger for GER
coughing sneezing overeating
86
s/s of GER
fussy after eating, chest burn, cough,
87
should we medicate GER?
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
what are the stressors of hospitalization for kiddos
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
what are risk factors that increase vulnerability to stressors of hospitalization
difficult temperament
lack of fit between child and parent
age (6 month-5yr, male)
male gender
below average intelligence
repeat hospitalization
90
parental reposes to stressor
disbelief anger guilt (sudden onset of illness)
fear anxiety (the seriousness of illness)
frustration (related to the need of info, chronic illness)
depression
91
sibling reaction to hospitalization
loneliness, fear worry
anger, resentment, jealously
guilt
92
preventing and minimizing separation in the hopistal
family centered care
parents are not visitors
familiar items from home
presence (being close, talking quietly)
cultural beliefs
93
normalizing hospital environment include what
maintain child routine
freedom of movement
time structuring
self care
school work
friends and visitors
provide opportunity of play
94
positioning for femoral venipuncture, extremity venipuncture, lumbar puncture, bone marrow biopsy
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
med admin
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
how to put on a collection bag for a clean catch
start from the perineum and move up
Its okay for a scrotum in the bag
if you suspect UTI you can Cath them
97
what are to be included for pain assessment
pain intensity- behavior, self reporting
satisfaction of tx
symptoms and adverse affects
emotional respons
economic factors
98
what is recurrent pain
reoccurs every three months or more. frequently
98
what is chronic pain
3 months or more
99
what are some pain rating scale
FACES (Wong baker)
CRIES
NIPS
FLACC
COMFORT (unconscious neonate)
Numeric scale
pediatric pain questionaire
100
young vs old infant pain response
young - cry, rigid, grimace, thrashing
older- may withdraw
101
younger child vs school age pain response
younger- loud cry, and screaming attempts to push away
school age- stall tactics young child behaviors
102
adolescents pain response
less vocal protest, less motor activity
103
what is most effective non-pharm technique for need related pain
distraction and hypnosis
104
pharmacologic two step approach is what
children >3month
start with non opioid 1st
morphine is opioid of choice
codeine is not recommended for children under 12
105
when can a child have fent
>12 years
106
what two opioids go into PCA
morphine or hydromorphone
107
how do you use refrigerant spray
dab on cotton ball and dab
108
what are the coanalgesic drugs
diazepam, midazolam, amitriptyline, gabapentin
109
s/s of cancer
pain, prolonged fever, easy bruising, swollen lympnodes, white eye refelx, wt loss, mass or swelling, HA
110
when is a tumor best removed from sx
when it is encapsulated
111
nursing considerations for chemotherapy
free flowing IV line, stop immediately if infiltration, known to cause anaphylaxis (monitor for a hour after )
112
what is the major consideration for HSCT
they have to wipe out the immune system, so there is no back up you are officially fucked not even cooked
113
how do you calculate absolute neutrophil count
ANC= total # of neutrophils (polys, seg, and band) and multiply by WBC
114
when an infection is suspected in a cancer pt what is given
broad spectrum (bacterium a self drug) until cultures come back
115
what are the most lethal organisms to cancer pt
varicella, HSV, herpes zoster, RSV, FLU, CMV, pseudomonas, staph,
116
when a pt is anemic do we restrict activity
NAH they can go as tolerated
117
what is given for N/V in cancer
promethazine (phenergan), prochlorperazine (compazine)
metoclopromide (regaln)
weed
give antiemetic within 30 min to one hour prior to chemo regularly for 24 hr after
118
what are extrapyramidal side effects
muscle twitching, agitation, grimacing usually from phenergan, compazine
119
why do you not give viscous lidocaine to kids
risk of aspiration
120
nurse intervention for stomatitis
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
are wigs tax deductible
yes
122
neurological effects of cancer
decreased bowel innervation, foot drop and weakness, numbness of extremities
123
what is a possible complication from HCST
Graft vs host disease
124
what nurse education would you give for a pt receiving HCST
no live vax, siblings can receive, if they received a vax 2 weeks prior they will need to be revax
125
s/s of leukemia
cold that won't go away, weight loss, petechia, hepatospleenomegaly
126
when Is a leukemia pt considered in remission
lest than 5% of blast cells in bone marrow
127
when is leukemia most common
boy>girl 2-3 yr old
128
when is Hodgkins lymphoma most common
15-19 yr
129
s/s of Hodgkins lymphoma
painless enlargement of lymph nodes (cervical and clavicular), nonproductive cough, unexplained abd pain, fever, anorexia, nausea, weight loss, pruritus
130
what are diagnostics for Hodgkins
CBC, ESR, CRP, CXR, MRI, PET, +Reed stern burg cell (multinucleate immune cells)
131
non-hodgkins s/s
burkitt lymphoma is associated with this disease
similar to Hodgkins s/s but lymphoid tissue compression of various organs may cause obstruction
132
s/s of brain tumors
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
T or F? Brain tumors are common in kids
true but rule out other organic causes of s/s like glasses, screen, dehydration, sleep
134
what is the gold standard for diagnostics for brain tumors
MRI but CT can be used if not available
135
nursing intervention for post op brain surgery
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
where does osteosarcoma happen
in the long bones
s/s localized bone pain, palpable mass, limping, resist activity
137
what is the tx of osteosarcoma
limb salvage, ambutation
this does not respond to radiation
138
where is Ewing sarcoma
shaft of long bone, pelvis, femur, tibia, ulna, vertebrae, sacalpula, rib, skull
radiation is effective
139
s/s of wilms tumor
swelling or mass in abd, in deep in flank, nontender
ONCE WE CONFIRM THE DIAGNOSIS DONT PALPATE THE ABDOMEN
140
vincristine s/e
causes ileus, monitor bowel sounds
141
what diagnostics for films tumor
abd studies, CBC to rule out polycythemia, US, CXR, chest CT
142
s/s of retinoblastoma
leukocoria (cat eye reflex), strabismus, blindness
143
metastasis is rare is retinoblastoma. T or F
TRUE
144
what s/s is common for HIV/AIDS
recurrent infection (yeast, uti)
145
what diagnostics are used for HIV/AIDS
RNA/DNA, HIV culture
18month or older need ELISA test
146
HIV infant prophylaxis is mother is positive
IgG (no MMR vax bc it is not effective) , bacterium
