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Peds/OB > PEDS exam 3 > Flashcards

PEDS exam 3 Flashcards

1
Q

Congenital hypothyroidism

A

Failure of thyroid gland to migrate during fetal development
Low T3 and T4
If untreated=intellectual disability, delayed physical maturation, short stature and growth failure
Early identification=KEY

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2
Q

Physical cues-Congenital hypothyroidism

A

Poor sucking reflex, hypothermia, constipation, lethargy/hypotonia, preorbital puffiness, cool dry and scaly skin, bradycardia, RR distress, large fontnelles, delayed closure fontanelles, macroglossia, course facial features

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3
Q

Diagnostics (labs)-Congenital hypothyroidism

A

Low T3 and free T4(0.8-2.4ng/dL)
High TSH

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4
Q

Medications-Congenital hypothyroidism

A

L-thyroxine(Sythroid, Levothroid)

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5
Q

Medication management-Congenital hypothyroidism

A

Pill only- must be crushed and placed in 1-2 mL milk via bottle nipple or dropper
Missed doses may lead to developmental delay/poor growth

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6
Q

Teaching-Congenital hypothyroidism

A

Medication absorption affected by soy-based formulas, fiber, calcium, iron preparations, and antacids
Thyroid function tests to monitor

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7
Q

Growth hormone deficiency

A

Failure of anterior pituitary gland to produce sufficient GH or failure of hypothalamus to stimulate anterior pituitary gland. Impairs body’s metabolism of proteins, fat, carbs
-caused by injury to hypothalamus or pituitary gland

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8
Q

Cause of GH deficiency

A

Injury to pituitary gland or hypothalamus
-tumors, infection, infarction, CNS irradiation, congenital abnormalities, birth trauma, emotional depravation

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9
Q

Physical cues-Growth hormone deficiency

A

Large/prominent forehead, under developed jaw, high-pitched voice, delayed sexual maturation, delayed dentition/skeletal maturation, decreased muscle mass

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10
Q

Diagnostics-Growth hormone deficiency

A

Skeletal survey= 2+SD<normal in bone age
CT/MRI- tumors/rule out abnormalities
Pituitary function test to confirm

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11
Q

Medications-Growth hormone deficiency

A

Bio synthetic GH via Sub-Q injections
-0.18-0.3 mg/kg/week divided into equal daily doses

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12
Q

Medication management-Growth hormone deficiency

A

Monitor for s/e of meds
Monitor effectiveness of hormone replacement(measure height Q3-6 mo
-continued until growth rate of less than 1 in/yr or bone age >16(boys) or >14 (girls)

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13
Q

Type 1 DM

A

Deficient insulin secretion due to pancreatic beta cells damage
-quicker onset, autoimmune, Dx at younger age

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14
Q

Diagnostics-Type 1 DM

A

Blood sugar(and fasting glucose) and chemical panel, CBC, UA, oral GTT

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15
Q

Expected lab findings-Type 1 DM

A

BS>200mg/dL
Fasting glucose >126mg/dL
HbA1C:>6.5%
Chem panel: evaluate BUN/creatinine, Ca+, Mg+, PO4-, Na+
UA- presence of ketones and glucose
Oral GTT >200mg/dL at 2 hrs

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16
Q

Hypoglycemia s/s

A

Shakiness, lightheadedness, hunger, pallor, cool skin, diaphoresis, irritability, anxiety, slurred speech, tachycardia, palpitations, normal/shallow RR , seizures leading to coma, dec LOC

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17
Q

Hypoglycemia management

A

BS <60mg/mL
If child coherent- feels s/s hypo
-give glucose tab/15g of simple CHO (OJ/milk), followed by complex CHO(PB and crackers)
Incoherent:glucagon Sub-Q or IM
-under 20kg=give 0.5mg
-over 20kg= give 1 mg
-D50 IV PRN

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18
Q

Hyperglycemia S/S

A

Mental/behavior changes, weakness, fatigue, polyuria, polydipsia, polyphagia, HA, enuresis, blurred vision

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19
Q

Insulin types

A

Rapid acting,Short acting, intermediate acting, long acting

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20
Q

Rapid acting insulin

A

Novolog(aspart), Humalog(Lispro)

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21
Q

Short acting insulin

A

Regular (Humulin R, Novolin R)

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22
Q

Intermediate acting insulin

A

NPH(Humulin N, Novolin N)

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23
Q

Long acting insulin

A

Glargine(Lantus)DO NOT MIX, detemir(levemir), degludec (Tresiba)

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24
Q

Proper insulin administration

A

Sub-Q, self administer 2 times or more/day. rotating sites Q 4-6 injections. 2 in from Umbilicus=best absorption.
Draw up short acting (clear) first then longer-acting insulin (cloudy)
-90 degree angle, pinch up skin if thin

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25
Q

DKA

A

Diabetic ketoacidosis
Acute life threatening condition, untreated hyperglycemia- rapid onset
Untreated=coma which can progress to death, high mortality

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26
Q

Physical and lab cues-DKA

A

Dehydration N/V, fruity breath, BS>330mg/dL, dyspnea, confusion, ketonuria

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27
Q

Management-DKA

A

Priority=stabilize glucose, rehydration, electrolyte balance

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28
Q

Nursing actions-DKA

A

-BGL monitoring-prevent from falling <100mg/dL/hr(causes cerebral edema)
-IVFs for dehydration tx, correct Na+ and K+, improve peripheral perfusion
-IV regular insulin drip and sliding scale

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29
Q

Trisomy 21

A

-Extra copy of chromosome 21
-Most common chromosomal abnormality associated with generalized syndrome
-medical conditions accompany: congenital heart malformation, hypotonicity, immune system dysfunction, thyroid dysfunction, leukemia

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30
Q

Trisomy 21 features

A

-upslanting palpebral fissures
-low-set , small folded ears
-flattened nasal bridge
-epicanthal fold
-small, typically white, spots arranged in a ring of iris(brushfield spots)
-short neck
-single palmar crease

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31
Q

Complications-trisomy 21

A

Aspiration, FTT, hypothyroidism, atlantoaxial instability, cardiopulmonary issues, hearing/vision impairments, behavioral problems, anemia, leukemia, frequent OM, sleep apnea

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32
Q

Trisomy 21 risk factors

A

Advanced maternal age >35, paternal age greater than 55 years

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33
Q

Priorities of care-trisomy 21

A

Preventing complications, promoting nutrition, G&D support and education

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34
Q

Neuro assessment

A

LOC, motor function, pupils

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35
Q

LOC-Neuro assessment

A

Pediatric coma scale
Lower the score, less responsive the child

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36
Q

Motor function-Neuro assessment

A

Decorticate, decerebrate, opisthotonic posturing

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37
Q

Decorticate posturing

A

Damage to cerebral cortex/lesion to corticospinal tracts above brainstem
-rigid flexion of arms held tightly to body; flexed elbows and wrists/fingers, plantar flexed feet, legs extended and internally rotated
-fine tremors or intense stiffness

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38
Q

Decerebrate posturing

A

Damage to brainstem and extrapyramidal tracts
-rigid extension and pronation of arms/legs, flexed wrists and fingers, clenched jaw, extended neck, possibly arched back

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39
Q

Opisthotonic posturing

A

Abnormal posturing caused by severe muscle spasms
-primarily affects infants and children due to immature nervous system

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40
Q

Pupils-Neuro assessment

A

Pinpoint, sunset, unilateral sudden dilation, anisocoria, dilated and reactive, dilated and fixed(mydriasis)

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41
Q

Pinpoint pupils

A

Poisonings, brain stem dysfunction and opiate use

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42
Q

sunset eyes

A

Sign of increased ICP- often associated with hydrocephalus

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43
Q

Dilated and reactive pupil

A

Seen after seizures

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44
Q

Mydriasis

A

Fixed and dilate pupils- brain stem herniation due to increased ICP

45
Q

unilateral sudden dilation-pupils

A

Associated with intracranial mass (tumor)

46
Q

anisocoria

A

Benign condition- naturally different sized pupils

47
Q

Hydrocephalus

A

Not a specific brain disorder, but caused by an underlying condition
-excessive CSF within cerebral ventricles/subarachnoid spaces= ventricular dilation and IICP

48
Q

Physical findings/cues-Hydrocephalus

A

-Lethargy, irritability
-poor feeding, vomiting
-altered, diminshed, change in LOC
-wide open, bulging fontanelles(infants)
-c/o HA (older children)
Macewen sign: “cracked pot”, suture separation with percussion

49
Q

Macewen sign

A

“Cracked pot”- suture separations with percussion

50
Q

VP shunt

A

Tx for hydrocephalus

51
Q

VP shunt placement

A

Infection most common 1-2 months after placement

52
Q

VP shunt assessments

A

Monitor for s/s infection, shunt malfunction(vomiting, drowsiness, HA), increased ICP

53
Q

VP shunt complications

A

Blockage and infection(1-2mo after placement):
- inc VS, poor feeding/vomiting, dec responsiveness, seizures, local inflammation at shunt insertion site
-vomiting, drowsiness, HA typically r/t shunt malfunction

54
Q

VP shunt complication tx

A

Infection: IV abx
If persistent s/s, shunt removed and external ventricular drain (EVD) placed until CSF=sterile

55
Q

Increased ICP

A

normal=15-20mmHg

56
Q

Early Clinical manifestations-Increased ICP

A

Headache, vomiting (projectile), blurred vision, dizziness, tachycardia, irritability, changes in LOC
Infants: bulging tense fontanelle, wide sutures and inc HC, dilated scalp veins, high-pitched cry

57
Q

Late increased ICP manifestations

A

Posturing, fixed and dilated pupils, Cushing’s triad(irregular breathing, HTN, bradycardia)

58
Q

Cushing’s triad

A

Irregular breathing, bradycardia, HTN

59
Q

Cushing’s triad-Increased ICP

A

Late sign of brain stem herniation warning

60
Q

Nursing actions-Increased ICP

A

Normal 5-15 mmHg
-keep head midline with HOB at 30 degrees
-minimal oral sx,NO nasal sx
-avoid coughing, sneezing, blowing nose
-stool softener to prevent valsalva
-calm,quiet .limit visitors, seizure precautions
-I&O’s

61
Q

Monitoring-Increased ICP

A

Sensing device inserted through cranium to detect ICP; monitored closely, alarms on at all times, measures to dec ICP

62
Q

Seizures

A

Three types
Seizure precautions (pad bed rails, O2 and suction at bedside)
-phenytoin
-fosphenytoin

63
Q

Seizure types

A

Tonic-clonic, absence, febrile

64
Q

Generalized seizures

A

Tonic-clonic, absence

65
Q

Tonic-clonic seizures

A

Stiffening of limbs and violent jerking
-loss of swallow reflex
-piercing cry with LOC
-incontinence
-apnea/cyanosis
Post-ictal period=30min-2hrs of deep sleep; sore muscles; no recollection

66
Q

Absence seizures

A

LOC 5-10 sec, motionless blank stare’ resembles daydreaming; may lip smack or twitch eyes/face; immediately resume previous activities

67
Q

Febrile seizures

A

Rapid rise in temp to 102.2 or higher, lasting 15-20 sec once in 24 hr period without CNS infection, brief post-ictal period

68
Q

Labs/diagnostics-seizures

A

Glucose, electrolytes, Ca+=rule out dec BS and dec Ca+
LP=rule out meningitis or encephalitis
Skull XR= fracture or trauma
CT/MRI= ID abnormality, bleeds, tumors
EEG= evaluate seizure type
Video EEG= evaluate behavior and “catch a SZ”

69
Q

Nursing actions during seizures

A

Seizure precautions (pad side rails, O2, suction at bedside) phenytoin and fosphenytoin

70
Q

Nursing actions post seizure

A

Maintain side-laying position
Suction mouth as needed
Reorient/calm child
LOC assessment
Assess WOB,VS,head position and tongue, injuries?
DO NOT OFFER FOOD/FLUIDS UNTIL FULLY AWAKE AND SWALLOW REFLEX HAS RETURNED

71
Q

Medication management- seizures

A

Primary treatment=med therapy with single-drug therapy at lowest dose possible, doses change as child grows
Do not stop medications-breakthrough seizures

72
Q

Phenytoin

A

IV or PO, NO IM
Monitor levels to ensure therapeutic dosing, gingival hyperplasia. Monitor Ca, Mg, folate; IV form in NS ONLY

73
Q

Fosphenytoin

A

IM,IV
Less adverse effects than phenytoin; more expensive
-water soluble, does not precipitate
Quicker administration

74
Q

Bacterial meningitis

A

Infection of meninges surrounding brain and spinal cord; medical emergency- prompt ICU admission and tx

75
Q

Physical cues older children- bacterial meningitis

A

Sudden onset of S/S
-fever, chills, HA, vomiting, photophobia, stiff neck (nuchal rigidity), rash, irritability, drowsiness, lethargy, muscle rigidity , seizures

76
Q

Physical cues-infants- bacterial meningitis

A

Fever, extreme sleepiness, bulging fontanelle, crying, seizures, poor suck or feeding, weak cry and lethargy, vomiting, inconsolable, opisthotonic positioning
Pin-prick rash
Shivering
Turning away form lights
Stiff neck
Arching back
Cold hands and feet

77
Q

Labs/diagnostics-bacterial meningitis

A

Lumbar puncture
CBC
Blood/urine/NP CX
Positive Kernig and brudzinski sign
Presence of rash/purpura or Petechiae

78
Q

Lumbar puncture-bacterial meningitis

A

Increased WBCs, decreased glucose, high protein, cloudy in color

79
Q

Nursing priorities-bacterial meningitis

A

Treat infection

80
Q

Nursing actions-bacterial meningitis

A

Droplet isolation; IV abx, manage hyperthermia, reduce ICP, ventilator support

81
Q

Reye syndrome

A

Encephalopathy and liver failure associated with previous illness (viral) and ASA ingestion

82
Q

Physical and lab cues=reye syndrome

A

Stage 1-5 progression
Severe vomiting/lethargy/confusion—>stupor—> fixed and dilated pupils/decerebrate—>parallysis, no pupillary response, resp arrest, death
Lab cues=inc LFTs (AST/ALT)
Inc ammonia, bilirubin,amylase/lipase,inc PT

83
Q

Nursing management-reye syndrome

A

Supportive care (dec ICP, Kayexalate, vit K, FFP)

84
Q

Priority of care- reye syndrome

A

Decreasing ICP, bleeding precautions (Vit K and FFP)

85
Q

Spina bifida cystica

A

Visible defect with saclike protrusion of meninges, spinal fluid, and nerves with varying degrees of neuromuscular,limb, and sensory deficits

86
Q

Meningocele vs myelomeningocele-spina bifida cystica

A

Meningocele=less serious form of spina bifida cystica, meninges and spinal fluid herniate though defect in vertebrae
Myelomeningocele=most severe form, not visible sac protruding from spinal area

87
Q

Priority of care-spina bifida cystica

A

Prevent repture of sac

88
Q

Meningocele-spina bifida cystica

A
89
Q

Myelomeningocele-spina bifida cystica

A
90
Q

Fractures-neurovascular assessment

A
91
Q

Priorities of care-fractures

A

Neurovascular assessment, pain

92
Q

Complications-fractures

A

Compartment syndrome-5P’s

93
Q

5 P’s-fractures

A

Pallor, pain, paresthesia, pulselessness,

94
Q

Scoliosis

A

Lateral curvature of the spine

95
Q

Scoliosis-physical findings

A
96
Q

Post-op care: scoliosis

A
97
Q

Scoliosis procedure

A
98
Q

Developmental dysplasia of the hip (DDH)

A

Risk factors: family Hx, firstborn, female, breech position

99
Q

DDH

A

Developmental dysplasia of the hip, three kinds: dysplasia, dislocation, subluxation

100
Q

Priorities of care-DDH

A

Neurovascular assessment, skin care, parent teaching

101
Q

Assessment findings:DDH

A

Asymmetry of gluteal folds in prone position ; unequal umber of skin folds on posterior thigh; shorter affected limb, walk with limp (older child)

102
Q

Teaching guidelines-DDH

A

Pavlik harness: do not adjust straps, must wear

103
Q

Muscular dystrophy

A
104
Q

Nursing management-muscular dystrophy

A
105
Q

Priority of care- muscular dystrophy

A
106
Q

Labs and diagnostics-muscular dystrophy

A
107
Q

Cerebral palsy

A
108
Q

Nursing priorities- cerebral palsy

A

Peds/OB (11 decks)

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