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Paediatric EXAM REVIEW Flashcards

1
Q

When assessing a child’s appearance, the TICLS acronym is used. What does it stand for?

A 
T -Tone (muscle)
I - INteractivity
C - Consolability
L - Look/Gaze
S - Speech/Cry
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2
Q 
Which of the following would be an abnormal visual assessment on a child?
A/ Open Eyes
B/ Alertness
C/ Fear
D/ Irritability
E/ Speaking
A

D/ Irritability

  • Marks a specific cause of irritation or pain
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3
Q

A 8 month old comes to the ER for assessment. Which of the following vital signs is of concern?

129 bpm HR
22 Resp/min
74/44 BP

A

Respirations

Should be 30-60/min

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4
Q

a 7 year old girl comes to the ER for assessment. Which of the following vital signs is of concern?

56 bpm HR
28 Resp/min
73/57 BP

A

Pulse and Blood pressure

Norms for 6-12 yr

18-30 resp
75-100 bpm
>90 Systolic BP

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5
Q

A neonate is presented to the ER for assessment. Which of the following vital signs is of concern?

52 Resp/min
163 Bpm
69 systolic BP

A

None. They are all within normal range for a neonate.

Resp = 40-60/min
HR 140-170
Sys BP = 60

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6
Q

A 16 year old punk-ass kid comes into the ER for assessment. Which of the following vital signs is of concern?

13 Resp/min
114 BPM HR
117/79 BP

A

Heart Rate (Tachycardia)

Should be 60-90

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7
Q

When assessing cardiac function in a child, what are all the components that you must assess?

A 
Skin Colour
Temp
HR
Heart Rhythm
BP
Pulses
Cap refill
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8
Q

You come a across a 5 year old patient who recently had a change in LOC and is not awake. What assessment should you use? *If the assessment yielded no results, what should you do next?
(AVPU)

A

A - Check to see if they are awake.
V - See if they respond to verbal stimulation
P - See if they respond to Pain
U - If not, they are unresponsive

*Check oxygenation, ventilation and perfusion, check pupils/reaction to light.

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9
Q

How long does it take for the foramen ovale to close on a neonate?

A

3-4 days

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10
Q

What causes to ductus arteriosus to close in a neonate?

A

Increased Oxygen and prostaglandin levels

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11
Q

Why are neonates more prone to acidosis than adults?

A

Their metabolism functions at 2x the pace of an adult and they cannot concentrate urine yet.

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12
Q

Mørten is ony 5 minutes old, and scored an apgar score of 2. What is this score indicative of?

A

SEVERE DISTRESS

MØRTEN IS GOING TO DIE

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13
Q

What is a “Ballard Score” in neonates?

A

Determines gestational age in weeks by assessment.

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14
Q

Why is vitamin K given to neonates?

A

Prevent bleeding (few clotting factors)

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15
Q 
Which of the Following is NOT a red flag for a neonate?
A/ Cyanosis
B/ Ø void in 12 hours
C/ Weak Cry
D/ Grunting
E/ Twitching
A

B/ It is a concern if it’s been 24 hours without voiding… NOT 12 hours

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16
Q

Which one is worse?

Jaundice in the first 24 hours… or Jaundice after 24 hours old?

A

First 24 hours

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17
Q

Why are Infants predisposed to dehydration?

A

Immature renal system

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18
Q

What does Erikson say about the developing Infant?

A

They are establishing a sense of trust, and a caregiver relationship.

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19
Q

What does Piaget say about infant development?

A

They develop sensory and motor skills and establish Object permanence: The existence of objects after they disappear.

They also develop the ability to imitate, play and affect.

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20
Q

What are some important nursing interventions/teachings for parents with a infant?

A

Encourage non-nutritive sucking

Hold and remain with infant

Provide them with toys to stimulate learning and interest.

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21
Q

What are the typical age- milestones for the following?

Walking
Running
Walking up stairs
Jumping

A

Walking 12-13 months
Running 18 months
Walking up stairs 2 years
Jumping 2.5 years

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22
Q

What does Erikson say about the development of a toddler?

A

Sense of Autonomy VS Shame and doubt

Negativism (Negative world experiences)

Rituals provide comfort

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23
Q

What does Piaget Say about the cognitive development of toddlers?

A

Awareness of cause and effect begins

They are intuitive rather than logical

Egocentric

24
Q

What are the three milestone ages for language development, and what can they say at these ages?

A

1 year - 4 words
2 years - 300 words
3 years - form simple sentances

25
What does Erikson say about the psychosocial development of a preschooler?
Developing initiative & Guilt Development of conscience and understands right and wrong
26
What does Piaget say about the cognitive development of a preschooler?
Initiative - copying parents and doing it on their own Egocentric Does not understand the concept of time Magical thinking
27
What does Erikson say about the psychosocial development of a school aged child (6-12)?
Peer pressure begins Competitiveness Concepts of success and failure are important Increasing independence Peer approval is important
28
What are some common side effects of Anorexia Nervosa?
``` Bradycardia Hypotension Dehydration Amenorrhea Hypothermia Dry Skin/Brittle hair Lanugo (Fine hair) ```
29
What are some common traits among people suffering from Bulimia Nervosa?
``` Laxative abuse Self-induced vomiting Hypokalemia (emesis) Diuretic Use Rigorous Exercise regimes ```
30
What are some therapeutic managements of Anorexia and Bulimia?
``` Restoration of healthy weight Establishment of healthy eating patterns Resolution of family patterns Psychotherapy Nutritional Therapy Pharmacological therapy ```
31
What are nursing interventions for a suicidal adolescent?
``` Establish privacy & confidentiality Assess without parents if possible Start with less threatening topics Quiet and calm environment Encourage participation in treatment decisions ```
32
Marcia is 13 years old and having annual physical examination. She is shy at first to discuss with the nurse about her sexual activity. But eventually opens up and stats that she is a slut and is having unprotected sexual intercourse with her boyfriend. What nursing interventions could you use?
Teaching on STIs, contraceptives and protection Ask age of BF Assess/teach about physical changes or abnormalities and when to seek help If partner is 5 years older, it is illegal.
33
What is Respiratory Syncytial Virus (RSV)? What are some complications of RSV?
Very contagious resp infection that can spread to lower resp systems. Can lead to acute lower airway infection, secondary bacterial infections, respiratory distress/failure or even arrest.
34
What are common Signs and Symptoms of RSV?
* Rhinorrhea/congestion * Coughing * Hoarse Cry * Fever * Wheezing * Possible Ear/eye discharge * ***Can progress to: * Tachypnea * Cyanosis * Listlessness * Apneic Spells * Resp failure
35
What are some Nursing interventions for RSV?
* ***Frequent vitals (1-2 hours) * ***Administration of Humidified O2 * Oximetry * Cardio/resp monitoring * ***HOB 30-40 degrees * Inhaled Meds * Suction PRN * Rest * Antibiotics PRN * ****Isolation & PPE * ***Maintain Fluid balance
36
What are some Nursing Interventions for Pneumonia?
* ****Ensure airway Patency * **Observe for resp distress * Oxygenation * Hydration * Vitals * Suction PRN * HOB 30-40 Degrees * Assist/perform Chest Physio
37
What is the most common early sign of Heart failure in neonates?
Tachycardia
38
What is a Patent Ductus Arteriosus? How would we treat this? What colour might this child appear?
When an opening exists between the Aorta and Pulmonary Artery; increasing Blood flow to lungs. Typically closes after birth when prostaglandin levels decrease, otherwise treat with Indomethacin to inhibit prostaglandin release. Appear pinkish due to increased blood flow to lungs
39
Explain what a Ventricular Septal Defect is, what it does, and who it can be common amongst.
Septal abnormality that displays as an opening between ventricles. Increased Pressure from LV forces oxygenated blood into RV and back to the lungs. Common in Trisomy 21 (Down's syndrome)
40
What is Coarctation of Aorta? What part of the body is affected?
Obstruction of Aorta due to decreased diameter of a section of Aorta. Typically results in decreased blood flow to lower extremities
41
What is Tetralogy of Fallot? What is a common sign?
Predominantly shown by a Ventricular septal defect that enables to Aorta to collect blood from both ventricles. This causes a pulmonic valve stenosis due to decreased activity, and RV hypertrophy due to increased pumping. Common sign is clubbing of digits and cyanosis.
42
What is Transposition of Great Arteries? What might be a presenting sign?
When the Aorta and Pulmonic Artery are reversed. Aorta takes blood from RV to the lungs, and Pulmonary Artery takes blood from LV to body. Cyanosis occurs.
43
What might be some common signs and symptoms of a congenital Heart defect?
* Dyspnea * Tachypnea * Difficulty breathing * Exercise/activity intolerance * Recurrent Resp. Infections * Heart Murmur * Cyanosis * Apneic Spells * Bounding Pulses * Edema
44
What is Kawasaki Disease? What are common symptoms?
Systemic Vasculitis, typically inflammation of small and medium-sized blood vessels, with the coronary arteries most commonly affected. The cause is unknown. Symptoms include: * Fever >4 days * Reddened Conjunctiva * Red, cracked lips & Tongue * Swelling and redness in hands and feet * Red Rash * Swollen lymph nodes * Irritability * Aneurysms * Myocardial Infarction
45
How do you treat Kawasaki Disease? What are some nursing interventions?
``` IV Immunoglobulins Aspirin Therapy *Assess temp and cardiac function *Reduce discomfort *Improve skin integrity (Basically treat symptoms as they come) ```
46
What clinical manifestations might an infant with GERD present? What are some nursing interventions?
* Regurgitation & Emesis * Irritability * Arching of back/Stiffening * Respiratory problems with feeding * Abdominal pain Monitor weight gain Assess resp status during feeding Educate parents on feeding, positioning, medications
47
What is Intussusception? What are common signs and symptoms?
Obstruction of the bowel that telescopes into another part of the bowel. Causes increased blood flow to area and edema. * Severe Abdominal Pain * Bile-emesis * Blood/mucous in stood * Fever * Firm abdomen * Signs of Shock
48
How do you treat Intussusception? Nursing interventions?
Ultrasound-guided reduction enemas IV Fluids & antibiotics NG Tube Decompression Surgical (PRN) * Vitals * Anagesics * Monitor Hemodynamic status * Assess feces * Perform NG decompression of Stomach
49
A 3 year old comes into the ER with Edema and abdominal distension. Upon a Urine test, they were found to have increased protein in their urine, and they are hypolipidemic. What is wrong with them? WHat would you do for them?
Nephrotic syndrome (Glomerular injury) ``` Monitor In and outs Vitals and hemodynamic status Assess edema Measure abdominal girth and weight Promote nutrition ```
50
Grëtel is a 6 year old in the ER who has RSV, but is not presenting heavy Lethargy, followed by seizures and vomiting. Increased WBC, and irritability were noted. What is her issue? What is a nursing intervention for her?
MENIGITIS (Bacterial) Vitals Maintain quiet environment Neuro assessment Assess seizures
51
If you are performing a Kerigns or Brustrinkis Sign... what are you assessing for?
MENIGITIS
52
Sigurd is a 18 month old who is presenting a Red rash, Fever, cracked lips, and is very irritable. What is wrong with him and what would you do as a nurse?
KAWASAKI DISEASE Oral care Maintain Hydration Monitor Vitals/Fever Assess Cardiac Functioning
53
Tørbjorn is a 4 month old who was presented to the ER with: Blood-tinged vomit, stiffening of back, and guarded abdomen. What is Tørbjorn's problem? Nursing intervention?
GERD Monitor Weight Monitor Resp while eating Educate parents on food options & positions
54
Åstrid is a 18 month old who is in the ER with Bloody stool, firm abdomen, fever, and symptoms indicative of shock. What is her issue? Nursing interventions?
Intussusception ``` Analgesics Vitals NPO Abdominal assessment Perform NG decompression of Stomach ```
55
Jasper is a 6 year old, presenting with a High fever, malaise, tachypnea, decreased breath sounds and Yellow sputum. What is his issue? Nursing Interventions?
BACTERIAL PNEUMONIA ``` Patency of Airway***** Oxygenation Cultures and swabs Meds Encourage deep breathing Monitor vitals HOB 30-40 degrees ```

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