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Peds Exam 1 > Peds Exam 1 > Flashcards

Peds Exam 1 Flashcards

1
Q

Adults w Cancer

A

-usually not metastasized at diagnosis
-involves organs
-the primary cause is environmental exposures
-usually, a long latent period, could be up to 20 years

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2
Q

Kids with Cancer

A

-about 92% of cancer develops from primitive embroyal tissue
-involves tissues
-the cancer is usually metastasised at diagnosis
-short latent period

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3
Q

Early s/s of pediatric cancer

A

-unexplained pallor
-loss of energy
-unusual mass, lump, or swelling
-sudden unexplained weight loss
-unexplained fever that doesn’t go away
-easy bruising/ bleeding
-prolonged/ongoing pain in one or more areas of the body
-limping, refusal to bear weight
-frequent headaches, especially in the morning ( the headaches are associated with vomiting)
-vision changes

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4
Q

What is the most common type of cancer in children

A

leukemia

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5
Q

Leukemia s/s

A

-petechiae
-MSK pain
-fatigue
-weight loss
-pt may present with hyperleukocytosis
-50% of pt present w/ lymphadenopathy
-50% of patients have a fever
-50% of patients present with hepatomegaly/splenomegaly

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6
Q

children with trisomy 21 are at an increased risk for

A

leukemia

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7
Q

leukemia description

A

immature lymphoblasts replace normal cells in the bone marrow which leads to pancytopenia ( anemia, neutropenia, thrombocytopenia)

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8
Q

Hodgkin Lymphoma ( HL ) is most common in which age group

A

teens, young adults

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9
Q

what is the hallmark sign of Hodgkin lymphoma

A

presence of Reed-Sternberg B cells

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10
Q

Hodgkin lymphoma description

A

malignant cells proliferate in lymph tissues which lead to lymphadenopathy which then leads to compression of nearby structures which kills healthy cells and invades surrounding lymph tissue

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11
Q

Epstein-Barr virus infection is usually associated with

A

Hodgin Lymphoma

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12
Q

Hodgin Lymphoma s/s

A

-this pt usually have non-specific symptoms
-weight loss
-fever
-night sweats
-anorexia
-fatigue
-enlarged and matted lymph nodes (supraclavicular and cervical are the most common)
-REED STERNBERG CELLS

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13
Q

Non-Hodgkin Lymphoma description

A

-all lymphomas except Hodgkin’s ( common in 48% of patients with primary immunodeficiencies)
-B and T lymphocytes mutate and increase rapidly in the DEEP tissues
-progression of symptoms occurs quickly

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14
Q

non-hodgkin lymphoma s/s

A

-pain
-lymphadenopathy
-abdominal mass
-mediastinal mass present may lead to superior vena cava syndrome since the mass is pressing into the vena cava

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15
Q

osteosarcoma description

A

most common malignancy of bone in children and adolescents
often occurs in long bones: distal femur, proximal tibia, proximal humerus

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16
Q

osteosarcoma s/s

A

-intermittent pain localized to tumor size
-tends to develop following an injury
-limping
-changes in gait
-soft tissue mass on exam that is tender to palpation
-usually metastasises in the lungs and other bones

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17
Q

Ewing Sarcoma description

A

most often in the long bones of the extremities ( predominantly the femur, tibia, fibula, and humerus) and bones of the pelvis

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18
Q

Ewing Sarcoma

A

-the trauma may incite symptoms
-intermittent pain that transitions to constant over weeks to months ( pain worsens overnight)
-there is usually edema and erythema over mass

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19
Q

Retinoblastoma

A

most common primary intraocular malignancy in children
-10% to 15% of cancers occur <1 year of age
-there are heritable and non-heritable types
-can metastasize into CNS through the optic nerve

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20
Q

retinoblastoma s/s

A

-Leukocoria
-strabismus
-nystagmus
-if you take a picture with flash, you will be able to see the difference between the pupils

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21
Q

Neuroblastoma description

A

-tumor originates from the neural crest during fetal development
-can arise anywhere throughout the SNS, the adrenal gland is the most common location and then the abdomen follows

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22
Q

Neuroblastoma s/s

A

-non-tender abdominal mass and or asymmetry
-abdominal pain
-constipation
-back pain/ weakness from spinal cord compression
-fever
-weight loss
-anemia
-bone pain
-bowel and bladder dysfunction
-ecchymoses above the eyes
-facial edema if it reaches the skull

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23
Q

Kids with cancer considerations

A

-encourage vaccines ( NOT LIVE ONES)
-do not take rectal temperatures
-notify oncologist/bring child to ER if kid becomes febrile

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24
Q

Neutropenic precautions

A

-if ANC is less than 1000, the patient is neutropenic
-pt needs a private room and to close the door
-frequent hand hygiene
-no rectal temps
-avoid invasive procedures
-no fresh fruits, veggies
-should be no plants in the room

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25
Q

Hematopoietic Stem Cell Transplant

A

-bone marrow transplant
autologous: child’s own stem cells are removed so the patient can undergo chemo and then the cells are restored after treatment
allogeneic: donor’s stem cells

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26
Q

Pre-transplant (HSCT)

A

-prophylactic ABX, antifungals, antivirals
-regular CHG bath
-give blood products PRN
-give G-CSF if ordered

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27
Q

Post-transplant (HSCT)

A

-prophylactics
-maculopapular rash
-the patient may need systemic steroids if GVHD occurs
-manage GI s/s
-bleeding and pancytopenia may occur
-give G-CSF PRN for autologous HSCT recipients
(filgrastim may be given IV or injection)

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28
Q

Superior Vena Cava Syndrome description

A
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29
Q

s/s of Superior Vena Cava Syndrome

A

-dyspnea
-cyanosis
-wheezing
-diminished breath sounds

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30
Q

Management of Superior Vena Cava Syndrome

A

-intubation
-ventilation
-surgery
-comfort measures

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31
Q

Neutropenic Enterocolitis (Typhlitis)

A

-life-threatening
-necrotizing enterocolitis
-occurs mainly in patients with blood cancers following the induction of chemo
-there is a disruption of intestinal mucosa which allows for opportunities pathogens to cause an infection and necrosis of the intestinal wall

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32
Q

s/s of neutropenic entercolitis

A

-abdominal pain
-nausea and vomiting
-anorexia
-blood emesis
-diarrhea

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33
Q

Oncologic Emergencies: increased ICP

A

-brain tumor or brain mets that compress the brain and can lead to herniation

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34
Q

s/s of increased ICP

A

-HA
-vomiting
-altered LOC
-irritability
-seizures
-Cushing’s triad

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35
Q

Spinal Cord Compression description

A

-tumor or mets compresses the cord

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36
Q

s/s of spinal cord compression

A

-autonomic or sensory dysfunction
-back, leg, neck pain
-paralysis
-weakness

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37
Q

Tumor Lysis Syndrome description

A

therapy which causes rapid lysis of tumor cells ( like chemo and radiation) which leads to intracellular contents releasing into systemic circulation

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38
Q

complications of tumor lysis syndrome

A

-hyperkalemia
-hyperphosphatemia
-secondary hypocalcemia
-hyperuricemia
-AKI

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39
Q

s/s of tumor lysis syndrome

A

-diarrhea
-anorexia
-lethargy
-muscle cramps
-dysrhythmias
-HF
-seizures
-tetany
-syncope
-hematuria

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40
Q

Prevention of TLS

A

-give hypouricemic agents prophylactically and during chemo/radiation treatment
-IVFs at 2x maintenance
-frequent F and E monitoring
-limit Potassium intake, give glucose with insulin or calcium gluconate to decrease the risk of dysrhythmias
-aggressive hydration

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41
Q

When does the production of RBC begin?

A

8 weeks in utero

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42
Q

where is erythropoietin derived from

A

the liver in the fetus, but the kidneys take over after birth

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43
Q

what are the three types of hemoglobin present at birth

A

Adult ( Hgb A and A2)– present in utero and predominate around 2 months after birth
HbF: predominate at 8 weeks gestation ( decreases to 70% by birth and disappears by 6-12 months old)

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44
Q

Iron-deficiency anemia

A

-Fe deficiency is the most common nutritional disorder in the world, with increased prevalence in developing countries
-occurs when the body does not have enough iron to produce Hgb

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45
Q

risk factors for iron-deficiency anemia

A

-prematurity or LBW
-exposure to lead
-breast-feeding beyond 4 months without iron supplementation
-cow’s milk without adequate Iron intake
-low socioeconomic status
-recent immigration from a developing country
-use of meds that interfere with iron absorption ( like antacids)

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46
Q

assessment for iron-deficiency anemia

A

-inspect mucous membranes and skin pallor
-assess for spooning of nails
-auscultate for flow murmur
-assess for splenomegaly

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47
Q

Diagnosing iron-deficiency anemia (children 6 months to 5 years)

A

ferrtin is less than 15 mg/L
hemoglobin is less than 11g/dL ( 0.5 -5 YEARS)

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48
Q

diagnosing iron-deficiency anemia ( children 5 to 12 years)

A

ferritin is les than 15 mg/L
hemoglobin is less than 11.5 g/dL

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49
Q

s/s for iron-deficiency anemia

A

-growth retardation in chronic cases
-irritability
-HA
-weakness
-pallar
-fatigue

severe s/s:
-SOB
-dizziness

less common s/s:
-pica
-muscle weakness
-unsteady gait
-difficulty feeding

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50
Q

Nursing Interventions for Fe-deficiency anemia

A

-encourage breastfeeding moms to increase Fe+ intake
-if baby is formula fed, encourage Fe-fortified formula
-for kids under a year, limit cow’s milk to less than 24oz a day ( an excess amount can cause cow’s milk colitis)
-no NSAIDS, give them Tylenol
-begin iron supplementation beginning @ 4 months

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51
Q

Considerations for Iron supplementation

A

-inform parents that stool may be black
-constipation may occur but give laxatives and stool softners PRN
-it is recommended to give 3-6mg/kd/daily an hour before a meal to increase absorption
-iron drops can stain the teeth brown/orange so give older children a straw and put the drops behind the teeth of younger children

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52
Q

Heme sources

A

-beef
-chicken
-turkey
-tuna
-crab
-halibut
-pork, shrimp

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53
Q

Non-heme sources

A

-iron-fortified cereal/oatmeal
-soybeans
-lentils
-kidney beans
-lima beans
-spinach

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54
Q

Sickle Cell Disease description

A

an autosomal recessive disorder
three most common types: HbSS ( most severe), HbSC, HBS beta thalassemia

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55
Q

hallmark s/s of sickle cell disease

A

-vaso-occlusive phenomena
-hemolytic anemia

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56
Q

how long do sickle cells last versus normal RBCS

A

20 days vs 120 days

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57
Q

things that can lead to a sickle cell crisis

A

-dehydration
-infection
-cold
-respiratory distress
-pain

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58
Q

Why are infants usually asymptomatic if they have sickle cell

A

Because the fetal hemoglobin is protecting them. When it wears off at 3-4 months, they may start to show symptoms

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59
Q

Sickle Cell Assessment findings

A

Skin: pallor, breakdown, lesions, ulcerations, jaundice
oral mucosa: pallor, dry/cracked
auscultation: murmur, adventitious breath sounds
palpation: warmth, tenderness, ROM joints, organomegaly
Vitals: fever, tachycardia, tachypnea, hypotension

60
Q

Dactylitis

A

-occlusive crisis in fingers and toes
-super inflamed and swollen hands/feet
-ulcerations
-extreme pain
-typically happens in infants ( 45% of infants with sickle cell will experience this by 2 years old)
-strickly a sickle cell complication

61
Q

Acute Chest Syndrome

A

-unique to sickle cell patients
-these pt will experience– chest pain, wheezing, hypoxemia, respiratory distress when there is pulmonary infiltrates

62
Q

Splenic Sequestration

A

-unique to sickle cell patients
-this is when RBCs get trapped in the spleen and there is pooling RBC in the spleen
s/s: splenomegaly, hypotension, pallor, SOB
-BIG mortality rates
-if a patient gets this once, they are likely to get it again
- if patient gets a splenectomy, make sure they are vaccinated

63
Q

Sickle Cell Nursing Considerations

A

-administer hydroxyurea ( this medicine increases the amount of fetal hbg in the body so the patient has less number of sickle cells)
-NO ICE PACKS
-increase fluid
-genetic testing
-if patient is noncompliant with their med regimen, they are likely to have a crisis

64
Q

Hemophilia description

A

a defect in Factor VII or IX which causes fibrin to become jelly-like and unstable

65
Q

Hemophilia A description

A

X-linked disorder
-deficiency in factor 8
- VIII deficiency
-most common hereditary disease associated with life-threatening bleeding
-affects mostly males
-usually occurs between 20-30 yrs
-

66
Q

Hemophilia B description

A

X linked disorder
factor 9 deficiency
IX deficiency
“ Christmas disease”
Affects more males

67
Q

children with hemophilia may have

A

hemarthrosis ( a boggy feeling around the joints)

68
Q

Sickle Cell Considerations

A

-avoid contact sports
-good oral hygiene to prevent gum disease
-educate pt on how to give factor
-avoid NSAIDs since they can cause bleeding (give Tylenol instead)
-give desmopressin as ordered ( slow push)

69
Q

IgG is acquired through_____ . It reaches adult levels at what age?

A

Through the placenta & at age 7 years

70
Q

Warning signs of a primary immunodeficiency

A

-family history of primary immunodeficiency
-2+ serious infections ( like sepsis)
-history of infections that require IV antibiotics to clear
-persistent oral thrush or skin candidiasis after 1 year
-recurrent deep skin/organ abscesses
-failure to thrive
-2+ episodes of pneumonia in 1 year
-treatment with antibiotics for 2+ months and there is little effect
-2+ severe sinusitis epidoses in 1 year
-4+ acute otitis media episodes in 1 year

71
Q

HIV is spread through:

A

-sexual contact
-IV drug use
-infected blood products
-vertical transmission (mother to child, usually in embryo)

72
Q

Diagnosing HIV for kids under 18 months

A

-virologic testing
-cannot do the Western blot since it will show the mother’s information

73
Q

Diagnosing HIV for kids 18 months and older

A

Western blot

74
Q

HIV manifestations

A

in the acute/ early phase:
-fever
-lymphadenopathy
-sore throat
-HA
-rash
-myalgia/arthralgia
-diarrhea

Chronic Infection ( without AIDS)
-fatigue
-night sweats
-generalized lymphadenopathy
-HSV, HPV, Varicella
-persistent oropharyngeal/vulvovaginal candidiasis

75
Q

pauciarticular arthritis

A

-involvement of four or fewer joints
-knee is the most common joint

non-joint s/s:
-eye inflammation
-malaise
-poor appetite
-poor weight gain

76
Q

Polyarthricular arthritis

A

-involvement of 5+ joints
-usually involved smaller joints and often affects the body systemically

non-joint s/s:
-malaise
-lymphadenopathy
-organomegaly
-poor growth

77
Q

systemic arthritis

A

-in addition to join involvement, fever and rash can occur

non-joint s/s:
-enlarged spleen
-liver
-lymph nodes
-myalgia
-severe anemia

78
Q

Manifestation of JIA

A

Onset before 16 years old– has to be persistent for at least 6 weeks
-unknown etiology

infant/nonverbal child s/s:
-irritability/fussiness
-withdrawal from play
-difficulty getting up in the morning
-prolonged high fever
-red,macular rash
-limping
-guarding of extremities
-joints are warm, red, tender, stiff
-looks similar to hemarthrosis but isn’t not the same thing

79
Q

Nursing Considerations for JIA

A

-NSAIDS
-glucocorticoids
-antirhetumatic durgs
-children can start taking ibuprofen at 6 months

80
Q

Kawasaki Disease description

A

-boys are more affects than females
-usually more Asains

81
Q

complications of Kawasaki disease

A

-coronary artery abnormalities
-long term: HF, MI, arrthymias

82
Q

for a child to have this disease, they MUST present with

A

-fever
-inflammation of the mucous membrane
-strawberry tongue
-dry, cracked lips
-rashes on palms and feet
-vasculitis
-polymorphous rash

83
Q

Nursing Care Kawasaki disease

A

-administer IVIG (most effective first 7-10 days, single infusion over 8 to 12 hours)
-give aspirin
-monitor for arrthymias
-NO LIVE VACCINES until at least 11 months after IVIG, flu vaccine ( d/t risk for reye from aspirin) – keep lips moisturized, give them popsicles, or other cool liquids

84
Q

infant vitals

A

HR: 80-150
RR: 25-55

85
Q

toddler vitals

A

HR: 70-120
RR: 20-30

86
Q

pre-school vitals

A

HR: 65-110
RR: 20-25

87
Q

School-age vitals

A

HR: 60-100
RR: 14-22

88
Q

adolescent vitals

A

HR: 55-95
RR: 12-18

89
Q

infant age

A

one month- twelve months

90
Q

toddler age

A

one to three years

91
Q

preschool age

A

three to six years

92
Q

school age

A

six to twelve years

93
Q

adolescent

A

12 to 20 years

94
Q

infant experiences (Erikson)

A

trust vs mistrust

95
Q

toddler experiences (Erikson)

A

autonomy vs shame/doubt

96
Q

preschoolers’ experience (Erikson)

A

initiative vs guilt

97
Q

school-age experiences (Erikson)

A

Industry vs inferiority

98
Q

adolescent experiences ( Erikson)

A

Identity vs role confusion

99
Q

what is the most common cause of illnesses in children and why

A

respiratory and because they have smaller airways

100
Q

airway differences between children and adults

A

-babies are nose breathers until about 4 weeks old (the reflex to open your mouth when your nares are obstructed are not there until about 3-4 months)
-proportionally, their tongues,tonsils, and adenoids are larger
-children under 10 years old have laryngeal narrowing
-they have fewer alveoli
-infant chest walls are flexible and soft

101
Q

oxygen moves from ______ to ______

A

from the alveolar air to the blood

102
Q

CO2 moves from _____ to _____

A

blood to the alveolar air

103
Q

what is the first sign of respiratory distress

A

tachypnea

104
Q

where does cyanosis usually start

A

around the mouth and then as it progresses, it becomes more central

105
Q

what type of population ( outside of respiratory will you see cyanosis)

A

anemic kids; kids with cardiac conditions

106
Q

where is a suprasternal retraction located

A

above the sternum

107
Q

where is a clavicular retaction located

A

by the clavicle

108
Q

where is a intercoastal retraction located

A

between the ribs

109
Q

where is a substernal retracton location

A

below the sternum

110
Q

how do you keep children’s nose clean and how after do you clean

A

saline and suction to keep their nose clear. only saline every diaper change. saline and suction before feeds

111
Q

wheezing occurs because of

A

obstruction of lower trachea or bronchioles

112
Q

rales occur because of

A

alveoli are fluid-filled like in pneumonia

113
Q

Early, MIddle, and Late signs of hypoxia

A

tachypnea, nasal flaring, cyanosis

114
Q

What does deterioration in kids look like?

A

-increased WOB
-fatigue
-change in mental status
-new onset of not eating or drinking

115
Q

Acute nasopharyngitis — “ the common cold”

A

causes: RSV, rhinovirus, adenovirus, enterovirus, flu
s/s: more severe in infants and children than in adults; abundance amount of nasal mucus which causes the child to mouth breathe; irritability; fever;

116
Q

Acute Otitis Media — MIDDLE EAR INFECTION

A
117
Q

s/s of acute otitis media

A

-fever
-pain

118
Q

How to help decrease the risk of acute otitis media

A

-breastfeed infants if possible
-avoid 2nd hand smoke
-routine childhood immunizations

119
Q

cause of the flu

A

-the spread of inhalation of droplets or contact with fine-article aerosols

120
Q

s/s of the flu

A

-fever
-chills
-body aches
-runny nose
-cough
-diarrhea
-fatigue

121
Q

acute infectious pharyngitis

A

cause: multiple viruses
s/s: pharyngitis, HA, fever, abdominal pain

122
Q

painless hematuria is a hallmark sign of which disease

A

Group A strep

123
Q

Group A strep s/s

A

-inflamed tonsils with exudate
-sandpaper rash ( scarlatina): cervical lymphadenopathy with tenderness and pain

124
Q

Mononucleosis cause

A

Epstein-Barr virus, oral secretions

125
Q

s/s of Mononucleosis

A

-fever
-VERY TIRED
-malaise
-sore throat
-lymphadenopathy

126
Q

complications of mononucleosis

A

-splenic rupture
(no contact sports for 3 weeks)
-aseptic meningitis
-viral hepatitis
-rash if the patient is on antibiotics

127
Q

Croup description

A

primarily affects 3 months to 3 years old
causes: parainfluenza but also other viruses

128
Q

croup s/s

A

-usually occur at night
-lasts about 3 to 5 days

129
Q

management of croup

A

-cool mist vaporizer
-saline to nose if there is congestion
-can give pt steroids

130
Q

Epiglottitis

A

MEDICAL EMERGENCY
caused by H influenza
more common now that vaccination rates are decreasing

131
Q

epiglottitis s/s

A

-abrupt onset that usually starts with fever and sore throat
-progresses to drooling, anxiety, irritability, and respiratory distress

132
Q

if child presents with tripod breathing and drooling, make sure to ask them about their vaccination history because you can suspect

A

epiglottitis

133
Q

Epiglottitis Considerations

A

-always have intubation ready
-positioning is important
-oxygen at the least invasive manner
-prevention is the Hib vaccine

134
Q

Pertussis – “Whopping Cough”

A

-highly contagious acute respiratory disorder
s/s: copious secretions
children under 1 year are most susceptible since they have small airways and they have not gotten all their vaccines
“100 day cough”
they may need intubation from 6-21 days

135
Q

Bronchiolitis

A

cause: viral
most often occurs in winter and spring
s/s:
-rhinorhea
-pharngitis
-coughing
-wheezing
-LOTS OF MUCUS
-low grade fever
-retractions
-NIGHT SWEATS AND UNEXPLAINED WEIGHT LOSS

136
Q

diagnosing Bronchiolitis

A

-ELISA assay
-IFA staining
-chest x ray that shows hyperinflammation on lungs

137
Q

with what condition would you give palzumab

A

bronchiolitis

138
Q

complications of pertussis

A

-hypoxia
-apnea
-pneumonia
-seizures
-death
-encephalopathy

139
Q

whooping cough considerations

A

-droplet precautions
-monitor oxygenation

140
Q

tuberculosis

A

cause: contagious, inhalation of droplets of mycobacterium
incubation period of 2 to 10 weeks

141
Q

tuberculosis s/s

A

-fever
-malaise
-anorexia
-weight loss
-cough
-diminished breath sounds
-pallor
-night sweats

142
Q

what are the three A’s for asthma

A

atopic dermatitis, allergies, asthma

143
Q

what can cause aggression in children

A

Montelukast for asthma management

144
Q

Cystic Fibrosis S/S

A

-salty taste of skin
-alterations in electrolyte imbalance
-meconium ileus
-bulky, greasy stools
-pancreatic enzyme activity is lost which leads to malabsorption of nutrients
-failure to thrive ( many of them need feeding tubes)
-mucus plus in small airways
-decreased fertility
-chronic/recurrent respiratory infections

145
Q

what is the diagnostic test for cystic fibrosis

A

sweat chloride test

Peds Exam 1 (1 decks)

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