Peds Exam 2

Question 1

What is Kawasaki

Answer 1

Inflammation of blood vessels (hence strawberry tongue) causes coronary artery aneurysms AND cardiomyopathy

Question 2

Kawasaki disease S/S

Answer 2

Bright red chapped lips & conjunctivitis
Extreme irritability
High fever and peeling rash
Enlarged spleen and lymph nodes
Desquamation of finger, toes, palm, sole

Question 3

Kawasaki labs

Answer 3

Elevated ESR, CRP, and Platelet

Question 4

Kawasaki Treatment

Answer 4

IVIG - high dose 2gm/Kg IV over 8-12 hrs
^improves immune response^
Aspirin - high 80-100 mg/kg/day Q6Hrs
Low dose (3-5 mg/kg/day) after fever breaks
^prevents coagulation^
Acetaminophen - treats fever
(10-15 mg/kg/dose)

Question 5

Kawasaki nursing action

Answer 5

IVF, IVIG, and PO fluids as order: i&o
Aceto: fever and cool clothes if tolerated
Clear liquids and soft food
Lip lubricants and mouth care

Question 6

Cleft lip palate - post op care

Answer 6

Prevent injury - no rubbing sutures by restraint or swaddling
Minimize crying and NOTHING in mouth
No pacifier, spoons, or straw, avoid suctioning
Position on side or supine with HOB elevated immediate post op to avoid aspiration

Question 7

Cleft lip - pre op care

Answer 7

Adequate nutrition & infant-parent bond

Question 8

What is Hypospadias?

Answer 8

Abnormal urethral opening on VENTRICLE surface of penis

Question 9

Ventral

Answer 9

Below

Question 10

Hypospadias TX

Answer 10

Surgery

Question 11

Hypospadias post op care

Answer 11

Urethral stent/drainage tubing taped with penis upright to prevent stress on urethras incision
Analgesics for pain/bladder spasms
DOUBLE DIAPER -> protects stent

Question 12

Hirschsprung

Answer 12

Failure to pass meconium
ABSENCE OF GANGLION CELLS
Complication of Enterocolitis

Question 13

Hirschsprung TX

Answer 13

Need for 4 stage surgery with ileostomy or colostomy

Question 14

Enterocolitis

Answer 14

Fever
Abdominal distension
Explosive stool
Rectal bleeding

Question 15

Difference between pediatric and adult pulmonary anatomy

Question 16

Tetralogy of Fallot

Answer 16

Characterized by the fatal 4

Question 17

Fatal Four

Answer 17

1) VSD
2) pulmonary stenosis
3) hypertrophy of right ventricle
4) overriding aorta

Question 18

Tetralogy of Fallot S/S

Answer 18

Dyspnea, easy fatigue, color changes with feeding
Loud harsh systolic murmur
TET spells - baby blues
Polycythemia

Question 19

Tetralogy of Fallot: LABS

Answer 19

Polycythemia; elevated H&H & RBCs

Question 20

Tetralogy of Fallot DX

Answer 20

CXR = boot shaped heart 🤍🤎

Question 21

Tetralogy of Fallot DX

Answer 21

CXR = boot shaped heart 🤍🤎

Question 22

Tetralogy of Fallot TX

Answer 22

Knee to chest for TET spells

Prostaglandins to keep PDA open (Increases pulmonary blood flow)

Surgical repair

Question 23

Hypertrophic pyloric stenosis

Answer 23

Forceful projectile, vomiting, followed by hunger soon after

Question 24

Hypertrophic pyloric stenosis S/S

Answer 24

Olive shaped movable mass in RUQ
WEIGHT LOSS
Abnormal electrolytes and metabolic alkalosis from dehydration

Question 25

Hypertrophic pyloric stenosis Nursing Priority’s

Answer 25

IV fluids Preop: NGT for decompression, NPO, I&O Postop: wound care/IVF, PO 1-2 days after

Question 26

Hydrocele

Answer 26

Fluid in scrotal sac Usually resolves by 12 months TRANSILLUMINATE w/ light Thank you

Question 27

Hydrocele

Answer 27

Fluid in scrotal sac Usually resolves by 12 months TRANSILLUMINATE w/ light Thank you

Question 28

Varicocele

Answer 28

“Worm like” spermatic veins - enlarged Causes low sperm count Pain with palpitation Mass on one of both side that is bluish in color Seen in adolescents

Question 29

Phimosis

Answer 29

Foreskin can’t be retracted

Question 30

Phimosis TX

Answer 30

Topical steroid cream BID x1M

Question 31

Paraphimosis

Answer 31

Restrictive band behind the glands penis (can’t retract foreskin) - can cause incarceration and necrosis

Question 32

Paraphimosis TX

Answer 32

SURGERY

Question 33

Nephrotic syndrome

Answer 33

Kidney filtration disorder were too much protein is filtered out of the blood Protein -> hyperlipidemia -> Edema

Question 34

Nephrotic Syndrome S/S

Answer 34

Frothy urine -> proteinuria Irritability or fussiness Abdominal distention and ascites N/V and sudden weight gain Facial edema upon waking -> general through out the day

Question 35

Nephrotic Syndrome - MEDS

Answer 35

Cortical steroid prednisone - SE: Cushing feature, mood swings, ^ appetite, and weight gain Diuretic furosemide (may require K+ replacement)

Question 36

Nephrotic syndrome: Nursing actions

Answer 36

Urine protein & I&O Daily weights Nutrition/dietary consult; sodium restriction when edematous Prevent infection -> can cause relapse

Question 37

Coarctation of Aorta: Labs

Answer 37

Rib notching on CXR

Question 38

Coarctation of Aorta S/S

Answer 38

Leg pain w/ activity Increased BP in upper extremeties Decreased BP in lower extremities Full bounding pulses in UE: weak pulseS in LE FREQUENT EPISTAXIS: nosebleeds

Question 39

Status asthmaticus TX/Meds

Question 40

Physical cues of dehydration

Answer 40

Sunken Fontanelle Dry mucus membrane Reduced LOC Reduce tissue turgor Tachypnea Weight loss Eyes sunken

Question 41

Acute post streptococcal glomerulonephritis

Answer 41

Injured glomeruli from immune response associated with exposure to group A beta hemolytic streptococcus

Question 42

Acute post streptococcal glomerulonephritis LABS

Answer 42

Decreased UOP & GFR Increased BUN/Creatinine + ASO titer

Question 43

Acute post streptococcal glomerulonephritis S/S

Answer 43

HTN, Edema, fever, Lethargy, HA, abdominal pain, vomiting, anorexia

Question 44

Acute post streptococcal glomerulonephritis CAUSE:

Answer 44

Recent pharyngitis/strep throat or skin infection

Question 45

Acute post streptococcal glomerulonephritis PRIORITY OF CARE

Answer 45

Manage fluid volume ABX for strep Manage hypertension: diuretics and anti-hypertensives

Question 46

Ventricular septal defect S/S

Answer 46

Holistic harsh murder along left sternal border Palpable thrill in chest Opening between the ventricles

Question 47

Asthma Exacerbation S/S

Answer 47

Low O2, use of accessory muscles, sweating, wheezing, crackles, Dyspnea, SOB Hacking cough worse at night that is nonproductive Tripod positioning

Question 48

Ominous sign of Asthma Exacerbation

Answer 48

Silent chest (no air movement)

Question 49

Asthma Exacerbation - first thing to do

Answer 49

Start O2 or admin bronchodilator

Question 50

Oral rehydration

Answer 50

Attempted first for mild or moderate Always Pedialyte

Question 51

Oral rehydration solutions

Answer 51

Mild: 50 mL/kg Moderate: 100 mL/kg Diarrhea: 10 mL/kg for each stool

Question 52

Enuresis

Question 53

Patent Ductus arteriosus