Pediatrics 3 Flashcards
Epiglottitis (1008)
Caused by H. influenzae. HiB vaccine. Presents with fever, muffled voice, drooling, respiratory distress. Tx with intubation, tracheostomy, and epinephrine (vasoconstriction).
Therapy for a newly diagnosed child with CF (1012)
Pulmonary therapy.
CPT (secretion removal), chest wall oscillations, expectorants, mucolytic agents, DNase.
How to check output on a dehydrated infant (1017)
Body weight to determine level of dehydration.
Assess output by weighing wet/dry diapers.
Foods easy on the bowel for a child trying to rehydrate (1019)
BRAT diet, cereal, crackers, toast, pretzels.
Questions to ask a parent about a child with chronic constipation (1020)
About bowel patterns.
High fat, protein. Inadequate fluids. Medications. Iron Supplements. Anti-convulsant therapy all exacerbate things.
Pyloric stenosis (1021)
Obstruction at the end of the gastric outlet.
Hypertrophied pyloric muscle.
Presents with projectile vomiting.
Symptoms of intussuception (1023)
Currant jelly stools.
Feces mixed with blood and mucus from the intestinal mucosa rubbing together.
Diagnostic tests to confirm TB in a child (1011)
Positive bacterial sputum culture.
Skin test (TST) is not diagnostic.
SS of dehydration in an infant (1018)
Dry mucous membranes, sunken eyes, sunken fontanelles, lethargy, rapid weak pulse, low BP.
Regurgitation after every feeding is a sign of what condition (1020, 1021)
Gastroesophageal reflux (GER)
Incompetent cardiac sphincter causes regurgitation of gastric contents into the esophagus or oropharynx.
SS of croup (1008)
Barking cough.
Also difficulty breathing and laryngeal spasms.
SS of bronchitis (1010)
Retractions, tachypnea, nasal flaring, paroxysmal nonproductive coughing, and wheezing.
SS of serious complications of intussuception (1023)
Peritonitis, intestinal ischemia, infarction, perforation, and shock.
Care for a child with Wilm’s tumor (1029)
Prepare child and parents for surgery. Monitor bowel sounds and kidney function.
Medical management for an infant with a persistent umbilical hernia (1026)
Surgical closure if persists after 5yo or larger than 2cm.
Medical management for a hypertrophic pyloric stenosis (1022)
Surgical correction by Fredet-Ramstedt procedure (pyloromyotomy).
Cut pylorus muscle down to create a larger lumen.
Intussuception (1023)
Telescoping intestine (at the ileocecal valve) causing the mucosal walls to rub together. Presents with abdominal pain, vomiting, and currant jelly stools.
Definition of a hernia (1025)
Protrusion of (portion) an organ through a structural defect or weakened muscle.
Best treatment to rehydrate a breastfed infant (1019)
Continue breast feeding in addition to oral rehydration solutions (Pedilyte, Infalyte).
In severe cases, IV therapy of D5saline.
Percent of dehydration in a child (1017)
Mild - 5%
Moderate - 10%
Severe - 15%
Abnormality of urine with nephrosis (1027)
Proteinuria (protein in the urine).
SS of decreased O2 with CF (1011)
Hypoxia, clubbing of fingers and toes, cyanosis, barrel chest.
Presents with chronic cough, wheezing, sputum production, and dyspnea.
Nephrotic syndrome, fluid loss and sodium retention (1027)
Glomerular damage -> glomerulus permeable to protein -> proteinuria -> hypoprteinemia -> lowered osmotic pressure in capillaries -> hyper-permeabiliy of the capillaries -> edema -> hypovolemia -> kidneys retain Na and water -> hypernatremia
Wilm’s tumor (1028, 1029)
Tumor most commonly effects the left kidney. Metastasizes to the lungs, lymph nodes, liver, brain, and bone.
Presents as a firm abdominal mass.
Dx definitive with surgical biopsy. Do not palpate more than necessary.
Tx with surgical resection.
Common transmission methods for MMR (1059, 1061)
Rubeola (measles) - Respiratory secretions.
Rubella (german measles) - Respiratory secretions and transplacental transmission.
Mumps - Respiratory secretions.
How long is a chid with Varicella contagious for (1060, 1061)
Varicella is communicable from [1 day before eruption] until all lesions are crusted over [1 week after onset].
Best treatment for all the itching with Varicella (1059)
Apply pressure rather than scratching and use mittens.
Loose clothing, daily baths without soap, keep nails short.
Risk factors for SIDS (1006)
Sleeping prone, using soft pillows, adult bedding, and lower socioeconomic classes.
Respiratory dysfunction, smoking, and drug use. Premature with low birth weight and low APGAR scores, multiple births, and CNS dysfunction.
How to obtain a sputum sample from a 3 year old (1011)
Gastric aspirations.
Toddlers and children tend to swallow their respiratory mucus rather than spitting them up.
Hirschsprung’s disease (1024)
Megacolon. Intestinal obstruction by absence of ganglion cells in a portion of the colon. More typical for those with Trisomy 21. Presents with bowel distention and diagnosed with barium enema.
What are undescended testicles and how can they be treated (1030)
Administration of human chorionic gonadotropin.
Orchiopexy - surgical fixation of a testes with care to prevent testicular damage.
What nursing findings would be consistent with a diagnosis of bacterial pneumonia (1005)
Streptococcal, staphylococcal, pneumococal, and H. influenzae.
Elevation in WBC count. C/S of respiratory secretions and blood.
Coughing, wheezing, respiratory distress, anorexia, lethargy, headache, fever, abdominal pain, and nasal discharge.
Best time to administer pancreatic enzymes for CF patient (1012)
Before meals and snacks.
Most important aspect to treatment for a child with CF (1012)
Pulmonary therapy.
Chest physiotherapy (CPT).
High frequency chest wall oscillations.
Primary medical management for an infant with pyloric stenosis (1022, 1023)
Fredet-ramstedt procedure (pyloromyotomy) to create a larger lumen.
Characteristics of currant jelly (1023)
Mucosa of intestinal cells rub against each other. Blood and mucus from the mucosa leak into the intestinal lumen.
Presents as feces mixed with blood and mucus.
Term for undescended testicles (1030)
Cryptorchidism.
Failure of the testes to descend into the scrotum.
Medications for a child with gastroesophageal reflux (1021)
H2-Histamine receptor agonists to reduce the amount of acid.
(Zantac, Pepcid, Tagamet)
Acceleration of gastric emptying (Reglan).
Dramatic decrease in the incidence of SIDS during the 1990’s (1006)
“Back to Sleep” campaign encouraging parents to put their infants to sleep on their backs.
Recommended age to receive first measles’ vaccine (CDC)
12-15 months
What is the highest concern post-op for spina bifida (1047)
Bleeding and infection.
SS of meningitis in a toddler (1041)
Kernig’s Sign - resistance to knee extension.
Brudzinski Sign - Neck flex, hip flex.
Nuchal rigidity, opisthotonos, lowered LOC, and seizures.
