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NUR720 FNP Review > PEDIATRIC DISORDERS > Flashcards

PEDIATRIC DISORDERS Flashcards

1
Q

Auscultatory area of the aortic valve

A

Right upper sterna border (RUSB)

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2
Q

Auscultatory area of the pulmonic valve

A

Left upper sternal border (LUSB), 2nd intercostal space

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3
Q

Auscultatory area of the aortic or mitral valve

A

Apex (erbs point)

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4
Q

Auscultatory area of a ventricular septal defect or tricuspid valve

A

left lower sternal border (LLSB)

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5
Q

How does blood flow through the heart?

A

From the body, through the superior vena cava ->right atrium->tricuspid valve->right ventricle->pulmonic valve->pulmonary artery->lungs->pulmonary veins->left atrium->mitral valve->left ventricle->aortic valve-> body

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6
Q

What does S1 signify

A

mitral/ tricuspid (AV) valves closure

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7
Q

What does S2 signify

A

Aortic/ pulmonic (semilunar) valves closure

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8
Q

When is systole heard

A

Period between S1 and S2

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9
Q

When is diastole heard

A

Period between S2 and S1

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10
Q

What does S3 sound like and what does it mean

A

“Ken-tuck-y”, increased fluid states

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11
Q

What does S4 sound like and what does it mean

A

“Ten-ne-ssee” and means stiff ventricular wall, or normal in athlete

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12
Q

What does Ventricular septal defect sound like?

A

thrill (think tetralogy of fallout)

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13
Q

What does an obstructive defect sound like?

A

ejection click due to turbulence, may be referred or radiate

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14
Q

Where is the blood shunting with acyanotic lesions?

A

left to right to shunting

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15
Q

Where is the blood shunting in cyanotic heart lesions?

A

Right to left shunting

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16
Q

The 3 types of heart defects

A

acyanotic, cyanotic, and obstructive

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17
Q

What kind of defect is this?

A

Transposition of the great arteries

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18
Q

What kind of heart defect is this?

A

acyanotic defect, ventricular septal defect

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19
Q

What kind of heart defect is this?

A

acyanotic defect, Patent ductus arteriosis

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20
Q

What kind of heart defect is this?

A

cyanotic defect, transposition of the great arteries

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21
Q

What kind of heart defect is this?

A

obstructive lesions, aortic stenosis

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22
Q

What kind of heart defect is this?

A

obtructive lesion, pulmonic stenosis

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23
Q

What kind of heart defect is this?

A

obstructuve lesion, Coarctation of the aorta

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24
Q

What kind of heart defect is this?

A

acyanotic defect, atrial septal defect

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25
Q

What kind of heart defect is this?

A

cyanotic defect, tetralogy of fallot

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26
Q

Where is an atrial septal defect murmer heard best?

A

HEard best at the left upper sternal border (LUSB)

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27
Q

What does the ECG show for a Atrial Septal defect?

A

Right ventricular hypertrophy (RVH)

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28
Q

WHat is the most common heart defect?

A

Ventricular septal defect (VSD)

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29
Q

What kind of thrill will be felt with a Ventricular septal defect (VSD)

A

A holosystolic thrill, may be felt at the LLSB

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30
Q

What will the ECG show for a ventricular septal defect?

What will X-ray show?

A

Left ventricular hypertrophy (LVH) progressing to biventricular hypertrophy if large VSD

xray will show cardiomegaly, increased pulmonary vascular markings

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31
Q

What is a common congential heart defect in premature infants?

A

patent ductus arteriosis (PDA)

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32
Q

What does the murmer for Patent Ductus arteriosis sound like?

A

Murmer is in the LUSB

Grade II to IV/VI holosystolic

“machinery” sound

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33
Q

What does the murmer sound like for Transposition of the Great arteries?

What might the xray look like?

A

Grade II to V/VI systolic ejection murmer

xray might look like “egg on a tring” with cardiomargaly and increased pulmonary vascular markings

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34
Q

What are the 4 defects in tetralogy of fallot?

A

Four defects:

1) Large VSD
2) Pulmonary stenosis
3) overiding aorta
4) RVH

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35
Q

What does the murmer sound like for tetralogy of fallot?

A

Loud systolic ejection click at the middle and upper left sternal border (M-LUSB)

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36
Q

What will the ECG show is Tetralogy of fallot?

A

Right axis deviation and right ventricular hypertrophy

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37
Q

What does the x-ray show for tetralogy of fallot?

A

boot-shaped heart, no cardiomegaly or pulmonary markings

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38
Q

What are TET SPELLS

A

hypercynotic episodes.

hypoxia- kids pull up knees or squat when SOB to increase peipheral vascular resistance and slow down blood return to the heart

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39
Q

Where will the murmer be heard best in aortic stenosis?

A

Systolic thrill at the right upper sternal border (RUSB), systolic ejection click present which does not vary with respirations

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40
Q

What does pulmonic stenosis murmer sound like

A

Systolic, loudest at the LUSB, grade II to V/VI ejection click, intensity of click decreases with inspiration and inreases with expiration, thrill at the LUSB radiating to the back and sides

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41
Q

Corarctation fo the Aorta murmer

A

Grade II to II/VI systolic ejection murmer with radiation to the left interscapular area

May have ejection click at the apex and RUSB if the bicuspid valve is involved

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42
Q

xray findings for coarctation of the aorta

A

cardiomegaly, RIB NOTCHING DUE TO COLLATERAL CIRCULATION

43
Q

What kind of BP findings and pulse ox findings will you find in coarctation of the aorta

A

BP in lower extremities will be lower than in upper extremitiesand

44
Q

What to do if suspected cadriac defect

A

draw labs (CMP, CBC), CXR then refer

45
Q

Innocent murmers

A

AKA functional, benign, or physiologic, not associated with symptoms, failure to thrive, or cyanosis.

Occurs in >50% of children

Are low intensity systolic murmers (grades I-III)

May vary with positional changes (sit>standing)

No radiation to neck/back

46
Q

Most common inncocent murmer

A

Stills murmer

Musical systolic murmer

HEard best between LLSB and apex

Due to turbulense in the left ventricular outflow tract

47
Q

Venous hum

A

Innocent, Continuous humming murmer

RUSB

Hear best in the sitting position, disappears in the supine position

Also obliterated by turning head and or compressing neck ipsilaterally -same side

48
Q

Definition for hypertension

A

A persistent elevation of average systolic/ diastolic BP >95th percentile with measurements obtained on at least 3 separate occassions per published tables for age and sex. In children, is secondary

49
Q

labs/ diagnostics for HTN

A

CXR (PA and lateral)

plasma aldosterone level to rule out aldosteronism

morning and evening cortisol level to rule out cushings

UA, BMP, CBC, cholesterol, and triglycerides

ECG for dysrhythmias, BBB or LVH

50
Q

Rhematic fever/ heart disease definition and cause

A

A post infectious inflammatory disease that can affect the heart, joints and central nervous system

Rheumatic fever followsa group A strep infection of the upper respiratory tract and is most common in ages 6-15

51
Q

Jone’s criteria

A

diagnosis of an initial attack for rheumatic fever plus 2 major or 1 major and 2 minor Jone’s criteria

MAJOR CRITERIA:

Carditis, polyathritis, chorea (involuntary jerky movements) erythema marginatum, subcutaneous nodules

MINOR CRITERIA:

Arthralgia without objective inflammation, fever >102.2F, elevated ESR and CRP, prolonged PR interval on ECG with evidence of a group A Bhemolytic streptococcus infection

52
Q

Kawasaki disease definition

A

acute febrile syndrome causing vasculitis

53
Q

Diagnositic criteria for kawasaki disease

A

The patient MUST have a fever as well as 4 of the following criteria:

1) Fever for >5 days
2) Bilateral conjunctival injections without exudate
3) Polymorphous rash (urticarial or pruitic)
4) Inflammatory changes of the lips or oral cavity (strawberry tongue)
5) Changes in extremities (eg erythema, edema, ect)
6) cervical lymphadenopathy

54
Q

Management for Kawasaki disease

A

Immediate referral to cardiovascular specialist, high dose ASA therapy

55
Q

Labs/diagnositics for kawasoki disease

A

CBC, ESR, postivie c reactive protein, ECG changes- prolonged PR or QT interval

56
Q

Mild dehydration in pediatrics- BP, pulse, CAP refill, SKin turgor, fontanel, urine

A

Mild is 3%-5%

BP-normal

Pulse-normal

CAP refill- WNL

SKin turgor- normal

Fontanel- NOrmal

Urine- slightly decreased

57
Q

Moderate dehydration in pediatrics- BP, pulse, CAP refill, skin turgor, fontanel, urine

A

Moderate (6%-9%)

BP- normal

pulse- increased

CAP refill- WNL

skin turgor- decreased

fontanel- sunken in (slightly)

urine- <1ml/kg/hour

58
Q

heart valve affected by rheumatic fever

A

mitral valve

59
Q

Severe dehydration in pediatrics- BP, pulse, CAP refill, skin turgor, fontanel, urine

A

Severe(>10%)

BP- normal or decreased

Pulse- Severe, decreased

CAP refill- prolonged(>3 seconds)

Skin turgor- decreased

Fontanel- sunken

Urine- <1m/kg/hr

60
Q

Heart defect with DiGeourge syndrome syndrome

A

Aortic arch abnormalities

61
Q

Heart defects with trisomies

A

Trisomy 18/ edwards

Trisomy XXI/down syndrome-Atrioventricular septal defects, VSD

62
Q

Heart defect with marfans syndrome

A

Aortic regurgitation, mitral valve prolapse (leads to anurysm)

63
Q

heart defect with Turner syndrome

A

Coarctation of the aorta, bicuspid aortic valve

64
Q

When to work up gastroenteritis

A

None indicated unless symptoms persist more than 72 hours or bloody stool present

65
Q

Oral rehydration therapy for moderate dehydration

A

50ml/hr

66
Q

Oral rehydration for severe dehydration

A

100ml/hr

67
Q

When to consider antibiotic therapy for gastroenteritis and what antibiotic

A

consider when more than 8-10 stools daily.

trimethroprim/ sulfamethoxazole (TMP/SMZ), bactrim

68
Q

definition of GERD

A

A condition in which gastric contents pass into the esophagus form the stomach though the lower esophageal sphincter (LES)

69
Q

The three classes of GERD

A

Physiological: Infrequent, episodix

Functional: Painless, effortless vomitting with no physical sequelae

Pathological: frequent vomiting with alteration in physical functioning such as FTT and aspiration PNA (worrisome)

70
Q
A
71
Q

When will GERD resolve for premature and low birth weight

A

typucally by 18months

72
Q

first and second line tx for pediatric GERD

A

first line- Histamine H2 receptor anatgonist to inhibit gastric scid secretion caused by histamine (ranitidine, famotidine)

Second line- proton pump inhibtor (PPIs) to block gastric acid secretion caused by histamine, acetylcholine or gastrin (omeprazole)

73
Q

Definition of pyloric stenosis

A

Obstruction resulting from the thickening of the cicular muscle of the pylorus

74
Q

s/sx of pyloric stenosis

A

3 weeks to 4 months old

Projectile non-bilious vomiting after eating

Hungry after vomiting

poor weight gain or weight loss

Eventual dehydration

Visible peristaltic waves

Palpable mass (pyloric olive) after vomiting

75
Q

Diagnostics for pyloric stenosis

A

abdominal US, if nondiagnostic, do upper GI imaging, will show a “string sign” or a narrowed pyloric channel

76
Q

Definition of intussusception

A

Acute prolapse (telescoping) of one part of the intestine into another adjacent segment of the intestine

77
Q

Signs/symptoms of intussusception

A

Previously healthy infant develops acute colicky pain, bilious vs non-bilious vomiting, progressive lethargy, currant jelly stool: late presentation, sausage shaped mass in the right upper quadrant, progressive distention/tenderness, if not reduced, perforation and shock may occur

78
Q

Diagnostic for intussuseption

A

U/S or radiograph, barium enema

79
Q

S/SX of hirschsprung’s disease (aganglionic megacolon)

A

Failure to pass meconium, BILIOUS vomiting, jaundice, infrequent, explosive bowel movements, progressive abdominal distention, tight anal sphincter with empty rectum, failure to thrive, malnutrition

80
Q

S/SX of appendicitis

A

Begins with vague, colicky umbilical pain. After several hours pain shifts to right lower quadrants of the abdomen (RLQ), psoas sign, rebound tenderness, obtrurator sign, McBurneys point tenderness, pain worsens and localizes with cough, nausea with 1-2 episodes of vomiting, sense of constipation, infrequently diarrhea, fever

81
Q

What are the 2 confirmtatory tests for appendicitis?

A

Psoas sign and obturator sign

82
Q

Psoas sign

A

confirmatory test for appendicits, Pain with right thigh extension

83
Q

obturator sign

A

confirmatory test for appendicitis, pain with internal rotation of the right thigh

84
Q

McBurneys point tenderness

A

One-third the distance from the anterior superior iliac spine to the umbilicus

85
Q

Labs/ Diagnostics for appendicitis

A

CT is diagnositc, WBC 10-20, ESR elevated, US

86
Q

Malabsorption definition

A

Impaired intestinal absorption of essential nutrients and electrolytes caused by enzymatic deficiencies (eg cycstic fibrosis), celiac disease (sprue), gluten intolerance, infectious agents, and abnormalities of the intestinal mucosa

87
Q

S/Sx of malabsoption

A

FTT

Severe, chronic diarrhea

Bulky, foul stool (steatorrhea) CYSTIC FIBROSIS

Vomitting

Abdominal pain

Protuberant abdomen

Associated with vitmain deficiency of malabroption: pallor, fatigue, hair and derm abnormalities, cheilosis, peripheral neuropathy

88
Q

labs/ diagnositics for malabsorption

A

stool (culture, hemoccult, O&P)

Serum Ca, Phos, alk phos, total protein, ferritin, folate, and LFTS

Bone age

Lactose and sucrose breath hydrogen testing (Hpylori)

Sweat chloride test if clinical suspicion of cystic fibrosis

89
Q

cystic fibrosis test

A

Sweat chloride

90
Q

Celiac disease diet modification

A

No wheat, oats, rye, barley

91
Q

Cystic fibrosis dietary modifications

A

pancreatic enzyme replacement: Lipase, amylase, tripsan

Fat soluble vitamins: A, D, E, K

92
Q

When it comes to hepatitis, most children are _____, so infections frequently go unnoticed

A

Anicteric

93
Q

pre-icteric state of hepatitis S/SX

A

fatigue, malaise, anorexia, n/v, headache, aversion to second-hand smoke and alcohol odors

94
Q

Icteric state of hepatitis s/sx

A

weight loss, jaundice, pruritus, right upper quadrant abdominal pain (RUQ), clay colored stool, dark urine

95
Q

AST and ALT____ prior to onset of jaundice and will ____ after jaundice presents

A

rise, fall

96
Q

Neuroblastoma definition

A

Tumor arising form neural tissue, frequently from the adrenal gland and can spread to bone marrow, liver, lymph nodes, skin, and orbits of the eyes

97
Q

Serology for Acute Hepatitis A

A

Anti-HAV, IgM

98
Q

Serology for recovered hepatitis A

A

anti-HAV, IgG

99
Q

Active hepatitis B serology

A

HBsAg, HBeAg, Anti-HBc, IgM

100
Q

chronic hepatitis B serology

A

HBsAg, Anti-HBc, Anti-Hbe, IgM, IgG

101
Q

Recovered hepatitis B (also vaccinated and seroconverted)

A

Anti-HBc, Anti-HBsAg, IgG +

102
Q

Serology for both acute and chronic hepatitis C

A

Anti-HCV, HCV RNA

103
Q

how high indicated fever in an infant?

A

rectal temp of 100.4

104
Q

what temp can fever convulsions occur?

A

101F, but more how quickley the fever rises not how high it goes

NUR720 FNP Review (24 decks)

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