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Fam Med > Peds exam 3 > Flashcards

Peds exam 3 Flashcards

1
Q

First signs of hematologic disorder or cancer in children?

A

Skin color changes such as pallor, bruising, and flushing are often the first signs that a problem is developing
-change in mental status (lethargy) can indicate low hemoglobin levels

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2
Q

Physical examination of the child with a hematologic or neoplastic disorder includes what?

A

inspection and observation
palpation
auscultation

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3
Q

general appearance and observation of child with disorder of altered cellular regulation

A

-thin, frail appearance
-asymmetry of body parts

-altered consciousness
-child’s response to stimuli

-bleeding gums or pale mucous membranes
-assess for rectal bleeding or vaginal discharge

-pallor in nail beds, palms, and soles
-clubbing of fingers

-assess urinary output
-assess vital signs
-assess conjunctiva

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4
Q

Auscultation for children with altered cellular regulation

A

assess for any adventitious breath sounds or heart murmurs
-assess rate, rhythms, tone
-listen to bowel sounds

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5
Q

Palpation with altered cellular regulation disorders

A

Measure BP (may change with alterations in blood volume)
Measure peripheral pulses
Assess capillary refill (may be prolonged)
Palpate lymph nodes
Palpate abdomen for splenomegaly, hepatomegaly, tenderness
Assess for swelling in any parts of the body
Assess skin temp
Assess skin elasticity (turgor)
Assess if joints are tender and if ROM is limited

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6
Q

Common medical treatments for cancer and altered cellular regulation disorders

A

Blood transfusion
Leukapheresis- Removal of the blood to collect specific blood cells. The remaining blood is returned to the body.
Hematopoietic stem cell transplantation
Supplemental oxygen
Biopsy
Splenectomy
surgical removal of tumor
Radiation
Central venous catheter
Implanted port

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7
Q

Benefit to acupuncture

A

may help to decrease nausea, vomiting, and aversion to chemotherapy.

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8
Q

Adverse effects of radiation therapy vs chemotherapy

A

radiation therapy:

include
-FATIGUE,
-nausea, vomiting,
-oral mucositis,
-myelosuppression- A condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets., and
-ALTERATIONS OF SKIN INTEGRITY at the site of irradiation

chemotherapy:

-immunosuppression –>infection, myelosuppression,
-nausea, vomiting,
-CONSTIPATION,
-oral mucositis,
-ALOPECIA, and
-PAIN

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9
Q

Hemopoietic stem cell transplant indications
(cases when performed)

A

leukemias, lymphomas, sickle cell disease, aplastic anemia, thalassemia

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10
Q

hemopoietic stem cell transplant considerations (what to maintain, provide, avoid)

A

Maintain medical asepsis and isolation (prevents infection)
Provide good oral care
Avoid rectal temps or suppositories

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11
Q

indications for radiation therapy (4)

A

before or after surgical resection
leukemia
lymphoma
solid tumors

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12
Q

a-fetoprotein (AFP)
-where produced
-decreased levels by what age
-elevated in what cases
-determines what

A

produced by fetal liver and yolk sac
decreases to very low levels by age one
-usually elevated in Hodgkin disease and other cancers
-determines tumor burden

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13
Q

Urine catecholamines (VMA, HVA)
-diagnosis for what
-involves what?
-levels altered by what?

A

catabolism of catecholamines causes elevated levels in the urine
-Diagnosis of neuroblastoma
-involves 24-hour urine collection
-levels may be altered with certain foods and vigorous exercise

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14
Q

MRI in evaluating cancer

A

can identify extent of tumor or metastatic spread

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15
Q

CT in evaluating cancer

A

can identify location of tumor or metastasis

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16
Q

Ultrasound in evaluating cancer

A

identify tumor presence, especially in abdomen or kidney

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17
Q

Bone marrow aspiration and biopsy

A

evaluation for leukemia or metastasis of other cancers in bone marrow

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18
Q

Bone scan

A

identifies metastasis of bone

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19
Q

chest x-ray use

A

identifies tumor or metastasis in the thorax
*x-ray is mainly used to monitor cancer

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20
Q

Anemia

A

is a condition in which the level of RBCs is lower than the age-appropriate normal value. Anemia may develop as a result of decreased production of RBCs or loss and destruction of RBCs.

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21
Q

What can cause anemia?

A

related to lack of dietary intake of the nutrients needed to produce the cells, alterations in the cell structure, or malfunctioning tissues (e.g., bone marrow), toxin exposure, medication, trauma

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22
Q

Anemias related to nutritional deficiency

-may be related to what?

A

iron deficiency,
folic acid deficiency, and
pernicious anemia

-maybe related to food dislikes or malabsorption issues

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23
Q

Anemia related to toxin exposure

A

example is lead poisoning

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24
Q

Hemolytic anemia

A

Anemia caused by the alteration or destruction of the RBCs

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25
Q

Types of hemolytic anemia

A

sickle cell disease
thalassemia

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26
Q

Therapeutic management of iron deficiency anemia

A

iron supplements (ferrous sulfate or ferrous fumarate)
4 to 6mg/day
-take with vitamin c
-teeth staining
-dark stools

Blood transfusions if anemia is severe

Monitor labs

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27
Q

sickle cell disease pathophysiology

A

RBCs sickle and clump together—>preventing blood flow to tissues in the area. The sickled shaped cells can’t pass through the capillaries and venules of the circulatory system–>local tissue hypoxia, ischemia

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28
Q

sickle cell disease therapeutic management

A

Manage pain (PCA if appropriate)
NSAIDs
hydration
prevent infection (prophylactic antibiotics, immunizations)
supplemental oxygen
possible blood transfusion
manage stress

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29
Q

What medication should not be given to patients with sickle cell crisis?

A

meperidine (Demerol)

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30
Q

first sign of sickle cell crisis?

A

pain

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31
Q

nursing interventions to prevent sickle cell crisis (4)

A

Managing pain, stress
immunizations, prophylactic antibiotics

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32
Q

Idiopathic Thrombocytopenic Purpura (ITP) value monitoring

A

platelets

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33
Q

surgery care for patient with ITP

A

make sure to monitor surgery sites for bleeding

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34
Q

signs of brain tumor

A

headache
altered mental status
hypertension
increased intracranial pressure
blown pupils

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35
Q

Delaying cord clamping

A

helps with iron deficiency

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36
Q

administering intravenous immunoglobin

A

hydration
watch for adverse reactions
physical assessment before administration
vital signs
stay with them for first 30 minutes
monitor for dehydration throughout administration

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37
Q

Therapeutic effect of immunoglobin G

A

hydration should improve throughout administration

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38
Q

HIV medications

what to educate about
MOA

A

educate about compliance
Helps prevent infection and spread

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39
Q

SLE testing

A

test for ANA (antinuclear antibody) presence (blood test)

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40
Q

Managing Myasthenia Gravis

A

preventing infection is important

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41
Q

Signs of food allergy

A

anaphylactic shock
rash, hives

diarrhea, vomiting, cramps, bloating, nausea

congestion, swelling of tongue or throat, runny nose, cough, wheezing, asthma

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42
Q

what medication to have on hand for food allergies?

A

epipen
Benadryl

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43
Q

signs of endocrine disorder

what is important

A

growth issues
look at health history/exams
*health history is important

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44
Q

growth hormone production occurs where?

A

pituitary gland

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45
Q

Dwarfism

A

Condition caused by insufficient growth hormone in childhood

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46
Q

too much growth hormone

A

gigantism

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47
Q

interventions for Addison’s

A

talk to school about IEP (allowing bathroom breaks)
give fluids

An Individualized Education Program is a legal document under United States law that is developed for each public school child in the U.S. who needs special education. It is created through a team of the child’s parent and district personnel who are knowledgeable about the child’s needs.

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48
Q

congenital hypothyroidism s/s

A

constipation,
weight gain,
not thriving,
fatigue

SLOOWWWW

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49
Q

congenital hypothyroidism interventions

A

promote growth
education
rest breaks
make sure environment is good

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50
Q

Signs of adrenal crisis

A

Confusion, abdominal pain, dehydration, low BP, high fever, rapid heart and breathing rate, nausea vomiting

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51
Q

managing adrenal crisis

A

education
corticosteroid use

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52
Q

developmental issues related to diabetes

education

A

educate child and parents about adherence and health promotion

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53
Q

education for diabetes

A

diet
carb counting
how to administer insulin/where to administer insulin
risk for complications (DKA, infection)

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54
Q

primitive vs protective reflexes

A
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55
Q

considerations with casts- what to make sure

A

make sure to reposition

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56
Q

Metatarsus adductus activity

A

encourage ROM
-prevent injury to other joints

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57
Q

developmental dysplasia of the hip

A

check gluteal folds
Dev hip dysplasia- pelvis drops when hip raised, thigh and gluteal folds asymmetrical, knee height is unequal, Barlow and Ortollani test positive

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58
Q

Rickets

A

lack of vitamin D
soft bones
Darker pigmented skin

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59
Q

Leg-Calve-Perthes Disease

what is it
what to monitor

A

Necrosis of the femoral head
monitor bone with x-ray

60
Q

scoliosis assessment

A

assess compliance with brace

61
Q

priority for seizures

A

safety

62
Q

lab diagnostics for seizure

A

EEG

63
Q

lab diagnostics for meningitis

A

lumbar puncture

64
Q

hydrocephalus

what to monitor

A

abnormal accumulation of fluid (CSF) in the brain
-monitor shunt for infection (drowsiness, nausea, headache)

65
Q

craniocytosis

how diagnosed

A

diagnosed by x-ray (out of womb)
can be diagnosed with ultrasound
-can have surgery

66
Q

Brudzinski’s sign

A

Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed

67
Q

how to tell if antibiotics are working with bacterial meningitis?

A

culture

68
Q

management with meningitis

A

try to prevent complications

69
Q

warning signs of head trauma

A

retinal hemorrhage
fixed and dilated pupils
confusion

70
Q

neurological disorder meds

A

phenytoin
benzos

71
Q

Neurofibromatosis

complications

A

tumor on peripheral nerves
Complications: learning disorders, depression, pain

72
Q

nursing management for neurofibromatosis

A

biopsy to see if it’s benign or malignant

73
Q

good way to assess child for autism

A

see how they play

74
Q

Signs of ITP

-what to assess?

A

increased bruising, epistaxis, or bleeding of the gums are signs of ITP
-assess for blood in the stool
-assess for petechiae on lips and buccal mucosa

75
Q

Risk factors for ITP

what to assess?

A

-recent viral illness,
-recent MMR immunization, or
-ingestion of medications that can cause thrombocytopenia.

Inspect for petechiae, purpura, and bruising, which may progress rapidly within the first 24 to 48 hours of the illness

76
Q

laboratory findings for ITP

platelets
wbc
hbg/hct

What is done to r/o leukemia?

A

Extremely low platelet count (less than 50,000)
normal WBC
normal hemoglobin and hematocrit
Bone marrow aspiration may be performed to rule out leukemia

77
Q

Nursing management for ITP

what to use for pain?

what to avoid?

A

Medical treatment might not be needed, just observation
Avoid NSAIDs
Use acetaminophen (tylenol) for pain
avoid activities that may cause trauma/injury

78
Q

humoral immunity

A

mediated by antibodies secreted by B cells

79
Q

Cellular immunity

A

cell mediated immunity controlled by T cells

80
Q

Which type of immunity is present at birth?

Which type will develop as newborn is exposed to organisms?

A

Cellular immunity
-humoral immunity will develop as newborn is exposed to organisms

81
Q

considerations with newborn immune system

A

the healthy full-term infant’s immune system is still immature.
The newborn exhibits a decreased inflammatory response to invading organisms, –> increases his or her susceptibility to infection.

82
Q

Thymus in young children

A

is quite enlarged at birth and remains so until about 10 years of age

83
Q

Tonsils in young children

A

often enlarged

84
Q

What temperature does IV immunoglobulin need to be infused at?

A

room temp.
Can be stored in fridge

85
Q

What labs need to be assessed before administering immunoglobulin?

A

Assess baseline serum blood urea nitrogen (BUN) and creatinine, as acute renal insufficiency may occur as a serious adverse reaction.

86
Q

preparing immunoglobulin

what not to do?

A

needs to be reconstituted
needs to be administered at room temp
*Do not shake bottle

87
Q

What needs to occur before administering immunoglubulin?

A

-patient needs to be hydrated
-may need to administer diphenhydramine or acetaminophen before infusion in some cases
-baseline physical assessment and vital signs
-calculate rate

88
Q

When is diphenhydramine or acetaminophen indicated for IVIG?

A

-children who have never received IVIG,
-have not had an infusion in more than 8 weeks,
-have had a recent bacterial infection,
-have a history of serious infusion-related adverse reactions, or
-are diagnosed with agammaglobulinemia or hypogammaglobulinemia

89
Q

Rate of IVIG

A

start infusion slowly and increase to the prescribed rate as tolerated

90
Q

assessing vital signs and adverse effects when administering IVIG

A

Assess vital signs and check for adverse reactions every 15 minutes for the first hour, then every 30 minutes throughout the remainder of the infusion

91
Q

signs of anaphylactic reaction

A

-headache,
-facial flushing,
-urticaria,(Urticaria – also known as hives, weals, welts or nettle rash – is a raised, itchy rash that appears on the skin.)
-dyspnea,
-shortness of breath,
-wheezing,
-chest pain,
-fever,
-chills,
-nausea, vomiting,
-increased anxiety, or -hypotension

92
Q

What supplies/meds are needed for IVIG administration in case of emergency?

A

Have oxygen and emergency medications such as epinephrine, diphenhydramine, and intravenous corticosteroids available in case of anaphylactic reaction

93
Q

What can you do if pt complains of discomfort at the IV site when administering IVIG?

A

cold compress might help

94
Q

Therapeutic management for HIV

A

the use of a combination of antiretroviral medications

95
Q

Types of medication therapy for HIV

A

Medication therapy ranges from single-drug therapy in the asymptomatic HIV-exposed newborn to highly active ART, consisting of a combination of antiretroviral drugs. Medications are prescribed based on the severity of the child’s illness.

96
Q

Goal of ART- antiretroviral therapy

A

to prevent or arrest progressive HIV encephalopathy

97
Q

Nursing management for HIV

A

-directed at avoiding infection, -promoting compliance with the medication regimen,
-promoting nutrition,
-providing pain management and comfort measures,
-educating the child and caregivers, and
-providing ongoing psychosocial support

98
Q

signs of SLE

A

fatigue, fever, weight changes, pain or swelling in the joints, numbness, tingling or coolness of extremities, or prolonged bleeding, stomatitis, alopecia, anemia, seizure, Raynaud
-malar rash, discoid lesions on face or neck, pigmentation change of the skin

99
Q

lab findings for SLE

wbc
platelet
hct/hbg
complement levels (c3 c4)
ANA

A

low hematocrit and hemoglobin
low platelet
low WBC
Complement levels (C3 and C4) are low
Antinuclear antibody (ANA) will be positive

100
Q

What might be the first sign of juvenile idiopathic arthritis in young children/infants?

A

irritability/fussiness

101
Q

Signs of juvenile idiopathic arthritis

A

doesn’t want to play/get out of bed
fever
evanescent, pale red, nonpruritic macular rash
mild to moderate anemia
elevated ESR
swollen, red, tender joints
Positive ANA (young children), positive rheumatoid factor in adolescents
flexed joints
gait is limp or pt is guarding of a joint

102
Q

Signs of myasthenia gravis

A

fatigue
weakness
difficulty chewing
difficulty swallowing
difficulty keeping head up
pain with muscle fatigue
ptosis (eyelid drooping)
altered eye movements from partial paralysis

103
Q

lab testing for myasthenia gravis

A

may involve the edrophonium (Tensilon) test, in which a short-acting cholinesterase inhibitor is used. Acetylcholine receptor (AchR) antibodies may be present in elevated quantities in the serum.

104
Q

goals for nursing management of myasthenia gravis

A

include prevention of respiratory problems and providing adequate nutrition

105
Q

Nursing management for myasthenia gravis

A

Administer meds (anticholinergic meds)-needs to be on time
see provider if chance of infection
manage stress
avoid extreme temps
notify provider if concerned about myasthenia crisis or cholinergic crisis
encourage child to wear a medical bracelet

106
Q

Administering anticholinergic meds

A

should be given 30 to 45 minutes before meals, on time and exactly as ordered

107
Q

signs of myasthenia crisis

A

severe muscle weakness, respiratory difficulty, tachycardia, and dysphagia
-increased muscle weakness with resultant respiratory distress

108
Q

sign of cholinergic crisis

A

severe muscle weakness, sweating, increased salivation, bradycardia, and hypotension.
-increased muscle weakness with resultant respiratory distress

109
Q

signs of food allergy reaction

A

hives, flushing, facial swelling, mouth and throat itching, and runny nose. Many children also have a gastrointestinal reaction, including vomiting, abdominal pain, and diarrhea. In extreme cases, swelling of the tongue, uvula, pharynx, or upper airway may occur. Wheezing can be an ominous sign that the airway is edematous.

110
Q

risk factors for food allergy reactions

A

previous exposure to the food, history of poorly controlled asthma, or an increase in atopic dermatitis flare-ups in relation to food intake.

111
Q

food allergy testing

A

Allergy skin-prick tests and radioallergosorbent blood tests (RASTs)
-food specific IGE test
-For an oral challenge, the child slowly eats a serving of the offending food over the period of 1 hour. Record vital signs and note the presence or absence of allergic symptoms.

112
Q

Medications for food allergy reaction

A

histamine blockers and, in anaphylactic reactions, epinephrine.

113
Q

pt education for food allergy

A

have written plan in case of emergency
teach how to administer meds
teach that it’s important to read food labels
teach about food substitutes
signs and symptoms of reaction
Refer families to Food Allergy and anaphylaxis network

114
Q

Therapeutic management of anaphylaxis

A

focuses on assessment and support of the airway, breathing, and circulation

115
Q

Nursing management for anaphylaxis

A

ABCs
oxygen through mask or bag mask
bronchodilator if pt is having bronchospasm
IV fluids
Observe child for 4 to 6 hours

116
Q

Foods that cross react with latex

A

pear, peach, passion fruit, plum, pineapple, kiwi, fig, grape, cherry, melon, nectarine, papaya, apple, apricot, banana, chestnut, carrot, celery, avocado, tomato, or potato.

117
Q

clinical manifestations of endocrine disorders occur as the result of?

A

as a result of the altered control of the bodily processes normally regulated by the gland or hormone.

118
Q

Health history for endocrine disorders

A

look at growth and development
look at family trees
see how child is interacting with other kids
assess behavior or moods
assess if child is having excessive thirst, frequent urination, vomiting, inactivity, fatigue

119
Q

GH deficiency pathophysiology

A

failure of pituitary and hypothalamus

120
Q

Signs of GH deficiency

A

higher weight to height ratio
large face
higher subq fat deposits in abdomen
high pitch voice
delayed sexual maturation
decreased muscle mass

121
Q

Ways to diagnose GH deficiency

A

x-rays of bones (bone age)
CT/MRI to rule out tumors
Pituitary function testing

122
Q

pituitary function testing

A

This test consists of providing a GH stimulant such as glucagon, clonidine, insulin, arginine, or L-dopa to stimulate the pituitary to release a burst of GH
-confirms diagnosis

123
Q

signs of diabetes insipidus

A

abrupt
signs of dehydration (irritability)
polyuria
polydipsia
intermittent fever
vomiting
constipation
frequent trips to the bathroom, enuresis, nocturia

124
Q

nursing management for DI

A

Promoting hydration
promoting activity (bathroom breaks, have fluids by child)
education

125
Q

Nursing assessment of SIADH

A

decreased urine output and weight gain, or GI symptoms such as anorexia, nausea, and vomiting. Assess neurologic status, noting lethargy, behavioral changes, headache, altered level of consciousness, seizure, or coma
-Neuro symptoms develop as sodium level decreases (lethargy)

126
Q

complications of congenital hypothyroidism

A

intellectual disability
failure to thrive

127
Q

Congenital Adrenal Hyperplasia (CAH)

A

management focuses on stopping the excessive adrenal secretion.
usually given hydrocortisone, fluticocortisone
will try to correct external genitalia

128
Q

signs of acute adrenal crisis

A

persistent vomiting, dehydration, hyponatremia, hyperkalemia, hypotension, tachycardia, and shock
-IV steroids, fluids, dextrose

129
Q

signs of shunt infection

A

elevated vital signs, poor feeding, vomiting, decreased responsiveness, seizure activity, and signs of local inflammation along the shunt tract

130
Q

signs of shunt malfunction

A

vomiting, drowsiness, and headache

131
Q

nml hct

A

36-52

132
Q

nml creatinine

A

0.6-1.2

133
Q

nml BUN

A

6-24

134
Q

nml hbg

A

12-18
f: 12-16
M: 14-18

135
Q

nml platelets

A

150,000-450,000

<40,000 be very concerned!

136
Q

nml wbc

A

4.5-11

137
Q

nml ca

A

9-11

138
Q

nml phosphorus

A

2.5-4.5

139
Q

nml cloride

A

95-105

140
Q

mom –> son K(evin)
mom –> daughter Turner

A
141
Q

low estrogen –> osteoporosis

A
142
Q

get culture first –> give broad spectrum

A
143
Q

ADHD - nonstimulants
ADD- stimulants

A
144
Q

wilm’s tumour- don’t palpate abdomen

A
145
Q

primitive: born with
moro-
suck
root
babinski
palmar grasp
plantar grasp
the step

protective: permanent
parashchute
riding

A
146
Q

atypical trazadone- depression

A
147
Q

hispanic- high risk for lymphoma

A

Fam Med (11 decks)

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