Pedi ATI Flashcards

Question

CSF collection

Answer 1

empty bladder, fetal position or sitting if older, sedatives, EMLA cream L3-5, monitor for hematoma, lie flat for 4-8 hrs

Answer 2

Liver dysfunction and Cerebral edema hypoglycemia, shock No Asprin for viral illness Stage 1: lethargy, vomit, anorexia, liver dysfunction, brisk pupil rxn, can follow commands Stage 2: confusion, combative, hyperventilate, hyperreflex, sluggish pupil, responds to pain Stage 3: coma, seizures, flexion rigidity, Stage 4: deeper coma, extension rigidity, fixed large pupil, brainstem dysfunction, minimal liver dysfunction Stage 5: hypotonia, seizures, resp arrest, no liver dysfunction Increased Liver, ammonia Low hgb, hct, platelets ``` Liver biopsy (check clotting prior), NPO prior, hemorrhage and vitals post CSF ``` Fluids with I&O, position (avoid flextion and extension, head midline, elevate 30), vitamin K if bleeding, NG tube, intubation, seizure precaution, diuretic (mannitol), insulin Complications: neurological speech, hearing, CP, paralysis, developmental delays; death

Answer 3

Generalized Tonic-clonic (grand mal): aura, tonic episode, loss of conscious, clonic pisone, breathing may stop, cyanosis, biting, incontinence, confusion and sleepy Tonic: only tonic phase, does not loose conscious, few seconds Clonic: only clonic, no fatigue, Absence: common in children, lasts seconds, blank stare, function resumes after Myoclonic: brief jerk or stiffening, 1 or 2 sides, seconds Atonic-kinetic: muscle tone lost, confusion after, falling Partial: Complex: automatisms lip smack, loss of conscious, amnesia before and after Simple: no loss of conscious, unusual sensations, dejavu, autonomic abnormalities change in vitals, one sided movement, bad smell

Answer 4

lasts longer than 30 min, no postictal phase Maintain airway, O2, IV access, ECG monitor, pulse ox, ABGs, loading dose of diazepam or lorazepam, continuous infusion of dilantin or cerebyx

Answer 5

hypertension with a widened pulse pressure (systolic-diastolic) and bradycardia sign of increased ICP (normal is 10-15 mmhg)

Answer 6

8- severe head injury and coma 9-12 moderate head injury 13 up minor head trauma

Answer 7

normal is 10 - 15 mm hg to decrease it elevate head 30 degrees, avoid flexion extension and rotation of head, keep head midline, keep body in alignment, minimize suctioning, avoid cough or blowing, no straining, monitor for fluid overload to not increase it Corticosteroids decrease cerebral edema Diuretic (mannitol) Dilantin to prevent seizures Morphine or fentanyl citrate for pain

Answer 8

Myopia-nearsighted: cant see distance; biconcave lens hyperopia-farsighted: cant see close, normal until age 7; convex astigmatism: tilting head may help, uneven vision strabismus: misaligned, cant see print clearly, keeping one eye closed helps, crosseyed; patch strong eye amblyopia-lazy eye: reduced acuity in one eye

Answer 9

shortness of breath, anxiety, tachypneea, tachycardia, restless, pallor, cyanosis, adventitious breath sounds, confusion elevated BP, resp distress nasal flaring and accessory muscles.

Answer 10

elevated CO2 | restless, hypertension, headache

Answer 11

nonproductive cough, hypoventilation, nasal stuffiness, substernal pan, N&V, fatigue, headache, sore throat

Answer 12

common cold virus for 7-10 days, inflammation, rhinirrhea, cough, dry throat, sneeze, nasal voice, fever, decreased appetite, irritable

Answer 13

``` strep throat GAHBS-hemolytic streptococci inflamed throat with exudate headache, fever, abdominal pain cervical lymphadenopathy truncal, axillary, perineal rash ```

Answer 14

tracheobronchitis, With URI, self limiting, provide symptom relief persistant cough from inflammation

Answer 15

RSV, bronchi and bronchioles, rhinorhea, pharyngitis, fever, cough, wheeze, increased resp rate, nasal flare, retractions, cyanosis

Answer 16

``` Medical emergency haemophilus influenza sit with chin pointed out, mouth open, tongue out drool anxiety with resp distress no cough dysphonia (difficult speaking) dysphagia stridor on inspiration sore throat, high fever, restless ```

Answer 17

viral, self limiting | hoarseness

Answer 18

Bronchodilators albuterol, terbutaline for rapid relief; causes tachycardia and tremors; take 5 min before antiinflamatory inhaler cholinergic antagonists, ipratropium, acute bronchospasms; causes dry mouth ``` corticosteroids; fluticasone, prednisone (take with food) leukotreine modifiers (singulair), mast cell stabilizers (intal), and monoclonal antibodies (xolair) ```

Answer 19

life threatening, unresponsive to other trtmnt, wheeze, labored breathing, accesory muscle, distended neck veins, risk for cardiac and resp arrest Intubation, humidified O2, 3 nebulizer trtmts 20-30 mins apart; beta2-agonist and ipatropium, iv access, ABGs and electrolytes, corticosteroids, magnesium sulfate to relax smooth muscle, ketamine, nonrebreather mask

Answer 20

``` autosomal recessive-both parents carriers absence pancreatic enzymes fatty stools chloride sweat > 60 meq CPT before meals pancreatic enzymes with all food adequate fluid and sodium intake hypoglycemic agents bronchodilators antibiotics dornase alfa: thins mucus, nubulizer once day GI complications: meconium ileus, pancreatic fibrosis, obstruction High calorie and high protein ADEK vitamins (water soluable forms) stool softners and laxatives ```

Answer 21

VSD ASD PDA

Answer 22

pulmonary stenosis VSD Overriding aorta R ventricular hypertrophy squatting position

Answer 23

myocardial contractility hold if infants pulse <70 toxicity: bradycardia, dysrhythmias, N&V, anorexia monitor levels q 12 hrs, do not miss, do not give again if vomits, rinse after oral,

Answer 24

potassium wasting diuretic, rids excess sodium and water monitor I&O hypokalemia: muscle weakness, irritable, drowsy, abnormal HR, eat potassium foods: bran, potato, tomato, bananna, melon, oranges weigh daily

Answer 25

GABHS infection of throat, within 2-6 wks URI hx, fever, fatigue, sore throat, activity intolerance, poor appetite, tachycardia, new murmur, chest pain, large joints, rash on trunk and inner extremeties (erythema marginatum), CNS involvement - chorea, irritable rising ASO titer Two major criteria or one major and two minor for dx Major: carditis, subcutaneous nodules, polyarthritis, erythema marginatum, chorea Minor: fever, arthralgia Pcn V or Erythromycin for 10-14 days prophylactic trtmnt: Pcn 200000U bid, a monthly PCN G injection, sulfadiazine 1g po daily for a minimum of 5 yrs

Answer 26

give with vitamin C not with milk or antacids diarrhea, constipation, nausea, tarry stools normal empty stomach if tolerable give with straw and rinse to prevent teeth staining Z-track Increase fiber

Answer 27

Africans, autosomal recessive, may pass down if just trait hemoglobin electrophoresis definitive test transcranial doppler done annually for risk for CVA Fluids, pain meds, oxygen, blood products, rest and nutrition,

Answer 28

Isotonic: water and sodium lost equally, reduced circulating fluid, hypovolemic shock may result, serum sodium in normal limits 130-150 Hypotonic: electrolyte loss is greater than water loss, ECF to ICF, Smaller fluid loss but more severe physical manifestations, sodium less than 130 Hypertonic: water loss greater than electrolyte, ICF to ECF, Shock is not likely, neurological changes may occur, sodium greater than 150

Answer 29

Mild: weight loss is 5% in infants, 3 to 4% in children. Capillary refill greater than two seconds, slight thirst, specific gravity greater than 1.02 Moderate: weight loss is 10% in infants, 6 to 8% in children. capillary refill 2 to 4 seconds, thirsty, irritable, slight increase in pulse, orthostatic blood-pressure, dry mucous membranes and tears, decreased skin turgor, specific gravity >1.020 Severe: weight loss 15% in infants, 10% in children. Capillary refill greater than four seconds, tachycardia, orthostatic blood pressure, shock, extreme thirst, dry membranes and tented skin, anterior fontanelle sunken, oliguria or anuria

Answer 30

pee pants 2x week for 3 months, at least 5 yrs old rule out other causes Antidiuretic desmopressin at bedtime, avoid fluids after dinner, Tricyclic antidepressants tofranil 1 hr before bed Anticholinergic ditropan reduces bladder contractions Bladder stretching by holding fluid

Answer 31

most common is from streptococcal infection APSGN 6-7 yrs old, renal manifestations 10-21 days after strep infection decreased glomerular filtration rate>decreased urine anorexia, pallor, pain, dyspnea, orthopnea, crackles, distended neck veins, edema, HTN, eliminate sodium in the diet, possible potassium, possible fluid restriction, monitor BP and weight daily ABX, diuretics, antihypertensives

Answer 32

albumin passes to urine hyperlipidemia, proteinuria, hypoalbuminemia, edema 3 types: minimal change is from 2-7 yrs old, unknown cause; secondary is from glomerular damage; congenital is inherited Wt gain, anorexia, N&V, diarrhea, decreased activity, irritable, edema worse in morning, ascites, dark frothy little or no urine, elevated BP 24 hr urine - 3 or 4 plus protein, increased specific gravity biopsy if unresponsive to steroid therapy daily wt, measure abdomen daily, limit salt and fluids, increase protein in diet, rest ABX Corticosteroids 7-21 days then taper down (prone to infection) Lasix (eat K foods) 25% albumin (watch for anaphylaxis) Cyclophosphamide if steroids are not tolerated

Answer 33

most common permanent physical disability in kids manifestions from mild to sever nonprogressive impairment of motor function, muscle control, coordination, and posture. RF include brain anomalies, cerebral infection, head trauma, brain anoxia, premature or multiple births, low birth wt, perinatal asphyxia, kenicterus from hyperbilirubenemia, poor head control or no smiling at 3 months, arch back and stiff extremetires, floppy limbs, cant sit by 8 months uses only one side of body feeding difficulty, muscle spasms persistent reflexes such as moro or tonic neck MRI for dx encourage development and self care suction available for increased secretions, keep head elevated Baclofen: decrease muscle spasm, oral or intrathecally, (monitor for muscle weakness, fatigue, diaphoresis, and constipation) Valium for spasticity

Answer 34

Spastic: hypertonicity, ^deep tendon reflex, clonus, poor muscle control; one up to all extremities can be effected; scoliosis; tip toe, scissor walk, contractures dyskinetic: movements increase with stress, absent during sleep, normal reflexes, no clonus, speech impairment Athetoid: involuntary jerking of trunk face neck and tounge Dystonic: slow twisting of trunk and extremeties Ataxic: wide gait, poor coordination, cant do repetitive mvmnts, difficulty with quick or precise movements, jerky speech

Answer 35

neural tube defect, degree of dysfunction depends on level of defect Spina bifida occulta: defect not visible to eye, no manifestions, look for dimple Spina bifida cystic: meningocele: sac protrusion present with spinal fluid and meninges, no problems once repaired myelomeningocele: sac meninges, spinal fluid, and nerves slightly decreased sensation to complete paralysis possible, joint deformities, incontinence, develop delays, hydrocephalus (may need shunt placement), ^latex allergy Neural tube closes during 3-5 wks gestation, due to insufficient folic acid AFP may detect it (16-18 wks) RAST: detects latex allergy Assess sac every 2 hrs, place in prone position, moist (NACL) nonadherent dressing, passive ROM exercises, Ditropan for bladder incontinence

Answer 36

hypotonicity, heart defects, thyroid dysfunction, dysfunctional immune system, high risk for leukemia > over 35 yrs old, multifactorial small head, flat forehead, low ears, slant eyes, protrude tongue, flat nose, transverse palmar crease, space between toe AFP is low Common respiratory infections, poor mucus drainage, dry mouth from mouth breathing-rinse it frequently

Answer 37

systemic, oligoarthritis, polyarthritis, with possible rheumatoid factor before 16, lasts 6 wks or longer with no cause, peaks 1-3 yrs NSAIDS: GI discomfort of bleeding DMARDS: methotrexate slows degeneration, monitor liver and CBC, avoid alcohol, birth control Enbrel immunosupressive, 1-2 weekly subQ Corticosteroids: used for severe life threatening cases, eye solution, oral, or IV, joint injection, wt gain common, alters growth Use of heat and splints, especially at night

Answer 38

inherited with progressive deterioration loss of muscular strength Duchenne: most common, xlink recessive, 3-7 yrs onset, live to early adult usually cant walk by age 12, mild cognitive delays, wt loss, fatigue, orthopnea DNA test or muscle biopsy, CK is elevated, maintain resp function, use incentive spirometer, Prednisone: increases muscle strength, infection prone Discuss end of life care such as feeding tubes and ventilation

Answer 39

Retin-A may irritate skin, use pea size at night, avoid sun Benolyl peroxide: antibacterial, bleaches clothes but not skin Topical antibacterials: inhibits growth, avoid sun and use suncreen Accutane: prescribed by dermatologists, dry skin and mucus membranes, dry eyes, decreased night vision, headaches, photosensitive, elevated cholesterol & triglycerides, depression, suicide, monitor behavioral changes, teratogenic

Answer 40

First 24 hrs Hgb & hct are elevated due to loss and 3rd spacing Sodium decreased due to 3rd spacing Potassium increased due to cell destruction ``` After 48-72 hrs, fluid mobilization Hgb Hct decreased due to fluid shift back sodium decreased renal and wound loss potassiumm decreased renal loss and movement into cells WBC increased and then left shift Blood glucose elevated from stress ABGs hypoxic, metabolic acidosis Protein and albumin low ``` NS or LR first 24 hrs, colloid with albumin or plasma expanders after 24 hrs; urine output of 1-2 ml-kg-hr, 30 ml-hr if over 66 lbs No plants or flowers cuz of psuedomonas infections, increase calories and protein, Silver nitrate, silvadene, mafenide acetate, bacitracin

Answer 41

15 g carbs equal to 1 carbohydrate exchange When sick monitor glucose every 3-4 hrs, stay hydrated, test for ketones, rest, call in BG >240, fever >102 and tylenol doesnt help hypoglycemia: shaky, sweaty, anxiety, irritable, nervous, chills, nausea, headache, weak, confusion. 15-20g carbs, recheck BG in 15 min, if 250, test ketones. Can be caused by infection and stress

Answer 42

Rapid; lispro humalog; 15, 30-60; 3-4 Short; Humulin R; 30-6-; 2-3; 5-7 Intermediate; NPH Humulin N; 1-2, 4-12, 18-24 Long; lantus glargine; 1, none, 10-24 Do not mix

Answer 43

>300, breakdown fat and accumulation of ketones. Rapid onset, mortality high insufficient insulin, acute stress trauma or surgery, poor management of illness N&V, abdominal pain, 3Ps, confusion, dehydration, kussmaul resp rapid and deep fruity smell, provide rapid NS, followed by hypotonic .45%NS, when glucose is down to 250 add glucose to IV to reduce cerebral edema from drastic changes; IV bolus insulin 0.1 unit-kg followed by continuous regular insulin at 0.1unit-kg-hr; monitor BG hourly montor K levels, initally elevated, when insulin given they are low, make sure urine output is good when giving K ph<7 acidosis, give sodium bicarb slow IV

Answer 44

AOM acute infection, yellow or red TM, purulent drainage, OME effusion, no infection, orange TM, rhinitis, cough, diarrhea Either one could cause long term speech delays Tylenol, Amoxicillin, Augmentin, zithromax for 10-14 days Benzocaine ear drops Myringotomy or tympanoplasty; avoid water

Answer 45

For HIV AIDS uses 3-4 meds enfuvirtide helps decrease the virus and limit spread Nucleoside reverse transcriptase inhibitors NRTIs- retrovir NonNRTIs NNRTIs rescriptor and sustiva Protease inhibitors Norvir, Agenerase, Viracept Monitor labs, CBC, WBC, liver, hDL, cholesterol and triglycerides Antibiotics Trimethoprim sulfamethoxazole - prophylactic trtmnt for PCP in newborns Zovirax for herpes Amphotericin B for fungal

Answer 46

bone marrow supression with anemia, neutropenia, thrombocytopenia often side effect of chemo bleeding precautions ``` Filgrastim (neupogen) stimulates WBCs, subQ daily epoetin alfa (procrit) stimulates RBCs, subQ 2-3x week oprelvekin (interleukin 11, nuemega) stimulates platelets, subQdaily ```

Answer 47

ALL acute lymphoid (most common in kids) AML acute myelogenous or nonlymphoid leukemia bone marrow dysfunction>anemia, neutropenia, increased production of immature WBCs most common childhood cancer, bone marrow biopsy needed, CSF with lumbar puncture to determine CNS involvement, sonograms, liver and kidney functions Chemo in four phases: induction, CNS prophylactic, intensification, maintenance HCST transplant, bone marrow or stem cells, protective isolation, mask glove gown, no flowers, bleeding and infection precautions

Answer 48

from paint or remodeling dust low dose exposure: distracted, impulsive, hyperactive, hearing impaired, mild intelectual difficulty high dose: mental retardation, blindness, paralysis, coma, seizures, death Other manfestations: renal impairment, impaired calcium function, anemia Trtmnt: chelation therapy using calcium EDTA

Answer 49

``` bran cereal potato tomato banana melon oranges ```

Answer 50

``` dried fruit chicken red meat legumes nuts green leafy veggies iron fortified bread and flour give with empty stomach and vitamin C do not take with milk ```

Answer 51

``` banana avocado kiwi chestnut diapers elastic ```

Answer 52

Name, norm, abnormal ``` Sweat chloride 60 indicates CF sodium 130-150 hypoglycemia 250 fasting BG >126 HbA1c 4-6%, >8% is not good, target is <7% ``` ``` hgb hct 2 months 9-14; 28-42 6-12 yrs 11.5-15.5; 35-45 12-18 male 13-16; 37-49 12-18 female 12-16; 36-46 ``` Platelets