Peds Exam 4 - review game Flashcards

1
Q

Amblyopia S/S

A

reduced visual acuity in one eye
asymmetry of corneal light reflex

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2
Q

Amblyopia is caused by what?

A

Strabismus, trauma, cataracts, or ptosis

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3
Q

Amblyopia Managment

A

Patching (the stronger eye) for several hours a day

atropine drops in the stronger eye daily, vision therapy, or eye muscle surgery

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4
Q

Amblyopia Reminder

A

Playing pirate for several hours a day and vision therapy makes me better (eye patch)

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5
Q

Congenital Cataracts

A

Opacity of the optic lens preventing light from entering into eye - lead to severe amblyopia if not treated

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6
Q

Congenital Cataracts can cause

A

leading cause of visual impairment & blindness

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7
Q

Congenital Cataracts - Nursing Assessment

A

Cloudy cornea
Absent red reflex in affected eye

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8
Q

leading cause of visual impairment & blindness?

A

CONGENITAL CATARACTs

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9
Q

Congenital Cataracts Managment

A

surgical removal of cataract and placing of implantable lens

Patching of normal eye after surgical eye has healed to strengthen vision

Sunglasses when outside to protect against UV rays

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10
Q

Surgical removal of cataract Post op teaching

A

Eye patching, Elbow restraints, Antibiotic & steroid drops

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11
Q

Otitis media with effusion (OME) - physical findings:

A

*Transient hearing loss and balance disturbances
Feeling of fullness in the ear
TM looks dull, opaque, orangish, visible fluid level, & air bubbles
Decreased tympanic movement
Vague findings including rhinitis, cough, diarrhea

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12
Q

OME Nursing Managment

A

antihistamines, steroids, and decongestants DO NOT HELP
usually goes away on its own but should be rechecked every 4 weeks
Do not feed in a supine position and avoid bottle propping

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13
Q

What if OME persists for >3 months?

A

refer to ENT and assess carefully for hearing loss or speech delay

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14
Q

If a child has hearing loss, what do we do?

A

Turn off music or TV
Position yourself in front of child within 3 feet, and face child
Use visual cues
Speak clearly in slightly raised volume only

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15
Q

Acute Otitis Media (AOM) - Physical Findings:

A

Rubbing/pulling on ear
TM will be dull, red, bulging, or opaque
hearing difficulties & speech delays
poor feeding
Difficulty sleeping, crying during night

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16
Q

Decreased or no tympanic movement =

A

AOM

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17
Q

how to check ear for children?

A

< 3 yrs – pull pinna down and back

> 3 yrs – pull pinna up and back

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18
Q

Otitis media dx tool for both =

A

Pneumatic otoscope - the thing dr puts in ear with light

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19
Q

Acute Otitis Media Tx

A

Antibiotic therapy DOES HELP:
Amoxicillin & azithromycin = po 10 - 14 days
Ceftriaxone IM (x one dose)

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20
Q

Acute Otitis Media symptomatic management

A

Warm heat or cool compresses
Acetaminophen or ibuprofen 4 pain
Benzocaine drops 4 pain if TM is not ruptured
manage otalgia = pain + fever

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21
Q

Types of hearing loss?

A

Conductive

Sensorineural

Mixed

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22
Q

Conductive hearing loss:

A

transmission of sound through the middle ear is disrupted (i.e. frequent OM)

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23
Q

Sensorineural hearing loss:

A

Damage to the hair cells in the cochlea or along the auditory pathway (i.e. ototoxic medication, meningitis, CMV, rubella, excessive noise)

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24
Q

Mixed hearing loss:

A

attributed to both conductive and sensorineural problem

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25
Q

Tympanostomy Tubes - funny reminder

A

I take the pressure off
I am needed when OM visits often
I allow the infection to get out
I fall out on my own

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26
Q

Tympanostomy Tubes (PE tubes)

A

PE tubes can be indicated for a child who has multiple episodes of OM
plastic or metal tubes placed in eardrum to equalize pressure and minimize fluid collection (effusion)

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27
Q

Tympanostomy Tubes Nursing Tx

A

Scheduled as OP surgery under general anesthesia (~15 minute surgery); PACU recover, discharged home same day

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28
Q

Tympanostomy Tubes post op teaching

A

Postop pain is not common
Teach ear drop administration if prescribed
Ear plugs recommended when swimming; if water enters ear, allow it to drain out
If any drainage is noted while PE tubes are in place -> see provider

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29
Q

how long do PE tubes remain in pace

A

remain in place for several months; usually fall out spontaneously (~8-18 months)

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30
Q

Infantile glaucoma funny reminders

A

I like to get in way of the aqueous humor flow
I cause optic nerve damage and vision loss
may see a gray or green light reflex in one eye
Surgery makes me go away

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31
Q

Infantile glaucoma physical cues?

A

Keeping eyes closed
Frequent eye rubbing
Spasmodic winking
Corneal clouding
Enlargement of eyeball
Excessive tearing or conjunctivitis
Red reflex may appear gray or green

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32
Q

Infantile glaucoma surgery post op care?

A

Protect surgical site: Elbow restraints: Maintain eye patch and bedrest; provide distraction activities

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33
Q

Infantile glaucoma surgery Discharge teaching:

A

Teach parents how to administer eye medications; No rough-housing or contact sports for 2 weeks

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34
Q

Infantile glaucoma first line Tx

A

Surgery – 3-4 surgeries may be needed

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35
Q

Infantile glaucoma

A

Autosomal recessive disorder with obstruction of aqueous humor flow and high intraocular pressure

Vision loss occurs as a result of retinal scarring and optic nerve damage

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36
Q

Tips for Interacting with Visually Impaired Child

A

Use child’s name to gain attention; Identify your presence first before touching child
describe people/objects to make child aware
Discuss upcoming activities
Use touch and tone of voice appropriate to the situation
Use simple and specific directions
Use parts of the child’s body as reference points for location of items
Encourage exploration of objects through touch

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37
Q

Cues of Hearing Loss in infants?

A

Wakes only to touch, not room noise
Does not babble by 6 months

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38
Q

Cues of Hearing Loss in young children?

A

Does not speak by age 2 years
Communicates needs through gestures
Focuses on facial expressions when communicating
Does not respond to doorbell or telephone

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39
Q

Cues of Hearing Loss in other children?

A

Often asks for statements to be repeated
Inattentive or daydreams
Poor school performance
Monotone speech

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40
Q

Types of Skin Lesions?

A

Macule
Papule
Annular
Vesicle
Pustule

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41
Q

Macule

A
  • circular, flat discoloration <1cm
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42
Q

Papule

A

– superficial, solid, elevated <0.5 cm

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43
Q

Annular

A

– ring-like with central clearing

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44
Q

Vesicle

A

– circular collection of free fluid < 1 cm

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45
Q

Pustule

A

– vesicle containing pus

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46
Q

Intentional Skin Injuries - poem to remember

A

Location…Location…Location
Mom says this, Dad says that of how I came to BE
Poverty, prematurity & chronic illness can lead to ME
The buttocks, back & thighs are hiding places of THEE
Pattern markings can be KEY

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47
Q

Risk Factors for intentional skin injuries

A

Poverty
Prematurity; (<1yr)
Chronic illness
Intellectual disability
Parent w/abuse history; unrelated partner
Alcohol/substance abuse
Extreme stressors

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48
Q

Be Suspicious of abuse if…

A

Injuries in uncommon locations
Bruises in infants <9 months (immobile child)
Multiple injuries other than LEs
Frequent ED visits; delay in seeking care
Inconsistent stories
Unusual caregiver - child interaction

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49
Q

BURNS - remember saying

A

Stages 1-4 are how I appear to BE
Thermal, chemical & electrical are common types of ME
I cause capillaries to be permeable and protein to leak
Total Body Surface Area (TBSA) is necessary to critique
To know what nursing actions to treat

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50
Q

Burns primary survey:

A

AIRWAY:
Respiratory effort, symmetry of breathing, breath sounds; Pulse oximetry, ABG, carboxyhemoglobin levels, skin coclor,
hr, pulse strength, perfusion status

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51
Q

BURN Secondary survey

A

Burn depth
Body Surface Area (BSA)
Other traumatic injuries

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52
Q

BURN Stages?

A
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53
Q

Sunscreen/Sunburn Prevention - remember quote

A

I’m busiest in the summertime:
15 or higher is the best # to be
Broad spectrum & Oxybenzone free is the best kind of me
I do my best work before and during fun in the sun

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54
Q

Sunscreen/Sunburn education?

A

Infants <6 months out of direct sunlight, minimal sunscreen use
Hats, sun shirts
Sunscreen:
Broad spectrum (screens out UVA & UVB)
**Fragrance and oxybenzone free
*SPF 15 or higher; Zinc oxide products for nose, cheeks, ears, shoulders
Apply 30 minutes prior to sun activity, reapply at least every two hours or every 60-80 minutes while in the water
Use on sunny & overcast days

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55
Q

What is another name for Atopic dermatitis?

A

Eczema

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56
Q

Atopic dermatitis (Eczema) - remember me

A

Temperature changes and sweating makes me come out to play
I can make you wiggle and scratch all day & night
Sometimes I bring my friend wheeze
I make IgE levels rise

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57
Q

Atopic dermatitis (Eczema) Physical cues

A

Extreme itching ***
Erythema, inflammation
Variety of lesions/rash + dry scaly patches (plaques, papules, scaling, vesicles) on face, scalp, wrists or arms, elbows/antecubital, knees/popliteal areas

Elevated IgE levels
Presence of wheezing (asthma is common)

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58
Q

Atopic dermatitis (Eczema) Meds

A

Topical corticosteroids & Immune modulators-tacrolimus

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59
Q

what do we avoid with Atopic dermatitis (Eczema)?

A

avoid: hot water and soaps that contain perfumes, dyes, or fragrances
avoid synthetic clothing/bedding and wool
avoid long finger nails- keep short

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60
Q

Atopic dermatitis (Eczema) teachings

A

bathe 2X/day in warm water
Pat skin dry and leave moist while apply moisturizers
get 100% cotton bed + clothes
Antihistamines at HS may assist with itching; Behavior modification during waking hours (clickers, distraction, reward)

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61
Q

2 types of Diaper dermatitis

A

Non-candida

Candida

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62
Q

Non-candida

A

red, shiny; affects skin on buttocks, thighs, abdomen & waist, usually not in the creases or folds

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63
Q

Candida

A

deep red lesions, scaly with satellite lesions (outside of diaper area), usually in the creases & folds

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64
Q

Diaper Dermatitis Managment

A

Change diapers frequently

Avoid rubber pants, harsh soaps, and baby wipes with fragrance or preservatives

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65
Q

Candida diaper dermatitis management?

A

Antifungal (Nystatin)
Diaper-less for a period of time daily to allow healing
Blow-dry the diaper area/rash area with the dryer set on the warm (not hot) setting for 3-5 minutes

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66
Q

Candida diaper dermatitis Med?

A

Antifungal (Nystatin)

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67
Q

Non-Candida diaper dermatitis Med?

A

Skin barriers (zinc oxide + A, D & E ointments + petroleum)

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68
Q

Non-candida diaper dermatitis management?

A

Skin barriers (zinc oxide, A,D & E ointments, petroleum

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69
Q

15 year-old male presents with areas of commodones on forehead and cheeks and scattered pustules on back with hypertrophic scaring

A

Acne Vulgaris

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70
Q

Acne Vulgaris History

A

Onset of lesions and family HX (Begins as early as age 7, affecting 85% of adolescents)

Use of any medications that may exacerbate (steroids, lithium, phenytoin, isoniazid)

Date of LMP for females (worse 2-7 days prior to start of menses)

HX of endocrine disorder

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71
Q

Acne Vulgaris physical cues?

A

Presence of comedones (papules - blackheads or whiteheads), pustules, nodules, and hypertrophic scarring (occurs on face, chest and back)

*oily skin or hair

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72
Q

Acne Vulgaris education:

A

Avoid oil-based cosmetics and hair products; Headbands, helmets/hats may exacerbate; balanced diet

Clean skin with mild soap and water BID; Shampoo hair regularly

Avoid picking/squeezing comodones

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73
Q

Acne Vulgaris med

A

topical meds - may take 4-6 weeks
Tretinion

Benzoyl peroxide (OTC products)

Topical antibacterials

Isotretinoin

Oral contraceptives

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74
Q

Tretinion

A

– interrupts abnormal keratinization that causes microcomedones

75
Q

Benzoyl peroxide (OTC products)

A

– inhibits growth of P. acnes
Proprionibacterium

76
Q

Topical antibacterials

A

Clindamycin

OR

Oral = Tetracycline, Erythromycin

77
Q

Isotretinoin

A

4 severe, derm dr prescribes, teratogenic

78
Q

Oral contraceptives

A

Decreases endogenous androgen production

79
Q

ACNE complications

A

acne is severe = depression –> counseling

Complications: Infection & Cellulitis

80
Q

comodones

A

papules – blackheads or whiteheads
basically a zit

81
Q

The nurse is caring for an infant with a non-candidiasis diaper dermatitis. Which of the following should be included in the plan of care?

A

idk go see answer choices

82
Q

The nurse is conducting a physical examination of a 4-year-old with a circular, flat discoloration on their left upper arm, measuring 0.6 cm in diameter. How should the nurse document this finding?

A

D. The lesion is a macule

83
Q

A nurse is providing teaching to a parent of a preschooler who has atopic dermatitis. Which of the following instructions should the nurse include in the teaching?

A

A. Apply a topical corticosteroid ointment to the affected area

84
Q

The nurse is caring for a 15-year-old with acne vulgaris. The primary purpose of Benzoyl peroxide in the treatment of this condition is which of the following?

A

B. Inhibits growth of Proprionibacterium acnes

85
Q

A child is brought into the emergency department after being pulled out of a house fire. On assessment the nurse notes a burn to the child’s posterior trunk that is painful to touch, moist, red with blisters, mild edema and blanches with pressure. Which of the following burn stage should the nurse document?

A

A. Full thickness (3rd degree)
B. Deep partial thickness
C. Superficial partial thickness
D. Deep full thickness (4th degree)

86
Q

HISTORY CUES OF IMMUNO- DEFICIENCY

A

Four or more new episodes of acute otitis media in 1 year

2+ episodes of severe sinusitis
Tx w antibiotics for 2 months or longer with little effect

2+ episodes of pneumonia in 1 year

Recurrent deep skin or organ abscesses

Persistent oral thrush or skin candidiasis > 1 year of age

Hx of infections requiring IV antibiotics to clear

2+ serious infections such as sepsis

Family Hx of primary immunodeficiency

87
Q

LAB CUES OF IMMUNODEFICIENCY/ INFECTION

A

WBC DIFFERENTIAL COMPONENTS
Neutrophil - fights bacterial infections
B+T-lymphocyte - fights viral infections
esinoprol - alleric reactions

88
Q

IgA

A

1st line of defense against respiratory, GI, GU pathogens

Infants begin producing ~ 3 months of age

89
Q

IgE

A

Increases in allergic states, parasitic infections & hypersensitivity reactions

Level measured during allergy testing

90
Q

IgG

A

Protects against viruses, bacteria & toxins

Only immunoglobulin that crosses the placenta & transferred via breastmilk

Lack of IgG causes severe immunodeficiency

Infants produce own ~ 6 month – 1 yr in age

91
Q

IgM

A

Most important component in a primary immune response

Presence indicates an active infection

Infants start producing own before IgA

92
Q

Severe Combined Immune Deficiency
(SCID)

A

T or B cells are not around for me

Frequent infections & persistent thrush will be

Infection prevention is required!

IVIG can help but a bone marrow transplant is desired

93
Q

19-month-old presents to clinic with history of recurrent infections and fever of 102.4. HIV is suspected. What diagnostic tests would the nurse expect to be ordered for this child?

A

ELISA & WESTERN BLOT

94
Q

9-month-old infant born to a mother with HIV presents to clinic with history of recurrent infections and fever of 102.4. What diagnostic tests would the nurse expect to be ordered for this child to check HIV status?

A

PCR & VIRAL CULTURE

95
Q

Juvenile Idiopathic Arthritis (JIA)

A

An autoimmune or autoinflammatory disease that causes the body to release inflammatory chemicals that attack the synovium (tissue lining around a joint).

96
Q

HIV Physical findings

A

regression
motor deficits
lymphadenopathy
oral candidiasis
recurrent URI
anemia, & herpes

97
Q

What is regression?

A

found in HIV kids

loss of previously attained developmental milestones

98
Q

HIV priority of care?

A

prevent infection

99
Q

HIV diagnostic labs?**

A

≥ 18 months =
+ ELISA and + western blot

Infants < 18 months & born to infected mother = + PCR and viral culture

100
Q

Juvenile Idiopathic Arthritis (JIA) - remember

A

The Synovium Club is my favorite hang out
I make getting out of bed no fun
ESR and CRP are on the rise with me around
NSAIDS and steroids calm me down

101
Q

Juvenile Idiopathic Arthritis (JIA) lab cues

A

CBC: Mild to moderate anemia; Elevated WBC

Elevated ESR and CRP

+ ANA in young children

+ Rheumatoid Factor (may indicate more serious case)

102
Q

Juvenile Idiopathic Arthritis diagnostic findings?

A

RACE (+ rheumatoid factor, +ANA, C-reactive protein,
Elevated erythrocyte)

mild to moderate anemia and elevated WBC

103
Q

Juvenile Idiopathic Arthritis Assessment findings

A

irritability or fussiness may be first sign**
withdrawal from play or difficulty getting out of bed
joint stiffness and pain usually after inactivity/sleep
fever (>103 for > 2 weeks –
systemic type)

pale red, nonpruritic, macular rash (systemic)
limping gait, guarding of joint, joint edema, warmth, erythema, tenderness
eye inflammation

104
Q

Latex Allergy

A
105
Q

Latex Allergy - cross sensitivity

A

kiwi, bananas, peach, avocado, chestnut, fig, bell pepper, tomato, white potato

106
Q

Latex Allergy manifestations

A
107
Q

Latex allergy Nursing care and interventions

A
108
Q

Allergic and anaphylactic reactions physical cues?

A

Hives, flushing, angioedema (lips, tongue, eyelids), mouth/throat itching, runny nose, GI distress, anaphylaxis (respiratory compromise, low BP, skin-mucosal tissue involvement, GI
symptoms)

109
Q

Management of allergic and anaphylactic reactions?

A

antihistamine +epinephrine

airway management comfort measures

written emergency plan for child’s allergy

ensure epi pen access
+ how to recognize signs
of allergic reaction

avoid triggers

110
Q

Rubeola (Measles) number one sign

A

KOPLIK SPOTS

111
Q

Rubeola (Measles) assessment findings?

A

koplik spots, maculopapular rash (starts on face and then travels down neck, arms, legs, feet)

fever
cough & nasal inflammation

malaise
conjunctivitis

112
Q

Rubeola (Measles) nursing care?

A

bedrest

fluids & humidification

post exposure vaccination up to 72 hours or IgG within 6 days

113
Q

Rubeola (Measles) meds?

A

Antipyretics

vitamin A for hospitalized children 6m-2yr or if immunocompromised

114
Q

Rubeola (measles) precaution

A

Airborne precautions until 4 days after onset of rash

115
Q

Pertussis AKA

A

WHooping cough

116
Q

Pertussis physical findings?

A

paroxysmal cough accompanied by red face,
cyanosis and protruding tongue

whooping cough, tearing eyes, drooling, copious secretions from nose and mouth

117
Q

Paroxysmal cough

A

coughing 10 - 30x in a row

118
Q

Pertussis (whooping cough) Medications?

A

macrolide abx (- mycins) for infants > 1month

azithromycin if < 1 month

TMP-SMZ abx as an alternative to macrolides

pertussis vaccine for all contacts < 7 who are unvaccinated or under vaccinated

abx treat fever in children

119
Q

Pertussis precautions

A

droplet/standard precautions

120
Q

Management for pertussis

A

high humidity environment
observe for airway obstruction
push fluids
abx compliance

121
Q

Treating fever in children

A

use same site and device for temperature measurement

assess fluid intake and
encourage oral intake

admin IV fluid per order

keep linens and clothing clean and dry

122
Q

Treating fever nursing interventions?

A

assess temp every 4-6 hr, 30-60 min after antipyretic administration, and with any change in condition.

123
Q

Another name for Lyme disease

A

borrelia burgdorferi

124
Q

Lyme Disease quote

A

A walk in the woods can bring me on
Erythema migranes you may come upon

Fever, HA, neck stiffness and joint pain as I progress
+
Doxycycline makes me less

125
Q

Lyme disease Stages

A

Stage 1 (3-30 days)

Stage 2 (3-10 weeks)

Stage 3 (2-12 months)

126
Q

Stage 1

A

(3-30 days) - erythema migrans at site of bite, chills, fever, HA, stiff neck, weakness

127
Q

stage 2

A

(3-10 weeks) - systemic involvement (neuro, cardio, musculoskeletal), paralysis or
weakness in face, muscle pain, swelling in large joints, fever fatigue splenomegaly

128
Q

Stage 3

A

(2-12 months) - advanced systemic involvement, ms pain, arthritis, deafness, cardiac complications, encephalopathy, speech problems

129
Q

Lyme disease meds

A

doxycycline if > 8 yrs

amoxicillin if < 8 yr to prevent teeth discoloration or cefuroxime allergy

abx tx for 14-28 days

130
Q

Lyme disease teaching

A

prevent future tick bites

appropriate tick
removal education

131
Q

Lyme disease Physical Findings?

A

hx of tick bite

firm, discrete, pruritic nodule

urticaria or localized edema

132
Q

Pediculosis capitis AKA

A

Head lice

133
Q

Pediculosis capitis funny quote

A

The scalp is my aim, infestation is my game
Pruritis & red bumps are my mark while laying eggs in the dark
Permethrin & combs make me leave the scene
Gowns & gloves are a good idea around me

134
Q

Pediculosis capitis Physical cues

A

extreme pruritus is most common; small red bumps on scalp; white specks attached to hair shaft

Dx by visible eggs and lice

135
Q

Pediculosis capitis Management?

A

follow directions on pediculicide (permethrin, lindane);
comb out hair every 2-3
days, soak combs/brushes in treatment solution, hot water or shampoo, treat all items in environment
with hot water, dry clean items, & seal in plastic bag

136
Q

Pediculosis precaution

A

contact precautions

137
Q

Acute Lymphoblastic Leukemia
(ALL) Patho:

A

Over-production of immature leukoblast cells (WBC) with infiltration of organs and tissues

138
Q

Leukemia (ALL) history:

A

persistent or intermittent fevers & recurrent infections

fatigue reports of joint/bone pain (leg)

reports of abdominal pain n/v

139
Q

Leukemia lab cues

A

CBC - Low Hgb, Low Hct, Low RBCs, low/normal/high WBCs, low platelets

Blood Smear - may reveal blasts
LP – whether leukemic cells in CNS
CXR – to detect PNA or mediastinal mass

**BMA (bone marrow aspirate)

140
Q

Lymphoma Patho

A

Mutation of B and T lymphocytes affecting lymph nodes deeper in body

141
Q

Hodgkin Lymphoma History

A

History of immunodeficiency; frequent infections; Epstein-Barr infection
Family history of lymphoma
Unintentional weight loss, loss of appetite
Reports of night sweats

142
Q

reed Sternberg

A

Hodgkin

143
Q

Lymphoma – Hodgkin Disease remember this:

A

A 16-year-old presents with…
Painless, enlarged cervical lymph nodes
Fever & reports of night sweats
20% weight loss
Biopsy results: reed sternburg

144
Q

Hodgkin - Lymphoma Physical cues

A

enlarged lymph nodes

Fever (unexplained)
Cough + SOB
Pruritis (cytokine release)

Splenomegaly/hepatomegaly

**Painless, enlarged supraclavicular or cervical lymph nodes (“sentinel nodes”)

145
Q

Lymphoma Lab cues

A

Confirmation of diagnosis via biopsy, BMA, CT of lungs and abdomen, and LP

146
Q

Brain tumor remember

A

The brain is my aim
Medulloblastoma…Astrocytoma…glioma are some of my names

Increased ICP…I can explain

Surgery & chemotherapy to detain

147
Q

Brain tumors Pre op care:

A

Monitor for ↑ ICP and manage accordingly

steroids to decrease intracranial swelling

pre-op teaching/Emotional support

148
Q

Brain tumors Post op care:

A

Monitor for ↑ ICP ** and I&Os

frequent VS with pupil and LOC checks;
treat hyperthermia with antipyretics

pain management;
HA is common; treat with analgesics

position on unaffected side at level ordered by provider;
JP drain monitoring & care, keep head midline

149
Q

Wilm’s Tumor (nephroblastoma) Patho?

A

Malignancy that occurs in the abdomen (kidneys)

usually unilateral and deep in the flank –

most common on right side

150
Q

Wilm’s Tumor (nephroblastoma) remember!!!

A

3-year-old presents to clinic with reported abdominal asymmetry, vomiting and weight loss. Abdominal ultrasound reveals a renal mass.

151
Q

WILM’S TUMOR physical cues

A

Firm, nontender abdominal swelling/MASS

weight loss + vomiting?
abdominal asymmetry

Hematuria (gross or microscopic)

Hypertension

152
Q

Wilm’s Tumor (nephroblastoma) labs

A

24-hour urine NEGATIVE for homovanillic acid (HVA) and vanillylmandelic acid (VMA)

CT or MRI of abdomen
CBC (anemia)
UA (may be + for WBCs or RBCs)

153
Q

What is the contact precaution

A

LICE aka Pediculosis capitis

154
Q

What is the droplet precaution

A

Pertussis AKA whoooping cough

155
Q

What is the airborne precaution

A

Rubeola AKA Measles

156
Q

Bone marrow aspirate position?

A

Prone

157
Q

Bone marrow aspirate bone of choice

A

Iliac crest

158
Q

Bone marrow aspirate equipment?

A

BM procedure tray/needle

159
Q

Bone marrow aspirate Meds?

A

Local/topical anesthetic & Conscious sedation meds: (Fentanyl/Versed)

160
Q

Bone marrow aspirate pre procedure priorities

A

Explain procedure, comfort,

**infection prevention

161
Q

Bone marrow aspirate post procedure priorities?

A

monitor for bleeding after

apply pressure for 5-10 mins directly after procedure

then apply a pressure dressing

162
Q

Neutropenic precautions

A

Private room & hand hygiene
Restrict visitors
Mask on child when outside room

VS Q4H and assess for signs of infection Q8H and PRN

Avoid rectal temps, enemas, suppositories, urinary catheters, and invasive procedures

No raw fruits, vegetables, fresh flowers, or live plants in room

Soft toothbrush

163
Q

ADVERSE EFFECTS OF CHEMOTHERAPY

A

Neutropenia & Thrombocytopenia
Anemia
N/V/Anorexia

164
Q

Neutropenia to knows:

A

Infection Risk!!
Prophylactic antibiotics

Absolute Neutrophil Count
(ANC) <1000 = bad

165
Q

Thrombocytopenia to knows:

A

Avoid rectal temps & meds

Avoid IMs or LPs

Avoid ASA & NSAIDS
– give Acetaminophen instead

166
Q

Anemia to knows:

A

Limit blood draws

eat Fe-rich foods

Use of synthetic Erythropoietin (Epoetin)

167
Q

N/V/Anorexia to knows:

A

Offer bland, dry foods

Offer small & frequent meals

Offer ice, carbonated drinks, and popsicles throughout day

Complimentary remedies (relaxation, guided imagery)

168
Q

Common complications of radiation therapy?

A

altered skin integrity

169
Q

Radiation therapy teaching?

A

Wash skin with mild soap & water
Avoid lotions/powders/ointments
Avoid sun or heat exposure

Diphenhydramine or hydrocortisone cream for itching
Antimicrobial cream to desquamation

Moisturize with aloe vera

170
Q

Iron Deficiency Anemia findings?

A

Irritability & HA

Unsteady gait, Weakness, & Fatigue

Dizziness & SOB

Pallor skin, MM, & conjunctiva

Assess for difficulty feeding, pica

Spooning of nails

171
Q

Iron Deficiency Anemia management?

A

Feed only formula fortified with Fe+

Fe+ supplementation for breast-fed infants by 4-5 months

Encourage breastfeeding mothers to increase Fe+ in their diet

Limit cow’s milk in children >1yr. to 24oz/day

Encourage Fe+ rich foods

172
Q

Fe+ supplements Teaching:

A

Place behind teeth to avoid teeth stains

Cause constipation – increase fluids and may need stool softeners

Cause dark, green stools – this is normal

173
Q

Iron deficient Anemia Labs:

A

ALL DECREASE including RBC

except

RDW (red cell distribution width) increase

174
Q

HEMOPHILIA A

A

Deficiency of Factor VIII which is essential to activate factor X, which converts prothrombin to thrombin, without it, platelets cannot make clots

175
Q

Hemophilia causes

A

bleeding episodes due to lack of VIII

176
Q

Managment of bleeding in hemophilia

A

FIRST - Factor VIII administration (slow IV push)

Apply direct pressure to external bleeding; if joint bleeding, apply ice or cold compresses and elevate extremity unless contraindicated by causing further injury

Mild cases: Desmopressin – triggers the endothelium of blood vessels to release Factor VIII

177
Q

Hemophilia Physical Cues?

A

Swollen or stiff joints (Hemarthrosis)

Multiple bruises
Hematuria
Bleeding gums
Bloody sputum or emesis
Black tarry stools
Chest or abdominal pain (internal bleeding)

178
Q

What is Sickle cell vaso-occlusive crisis?

A

When the circulation of blood vessels is obstructed by abnormally shaped RBCs causing ischemia & infarction.

179
Q

Sickle Cell Disease Labs

A

3 down: HGB, HCT, & ESR

3 up:
Platelet, Bilirubin, & Reticulocyte count

180
Q

Physical Cues of sickle cell?

A

idk dawg its the same as all the others

181
Q

Managing Vaso-occlusive Episodes?

A

Pain Control - child pain scale
opioid for moderate + on a normal schedule or via PCA
NSAIDS if less severe & warm compress

Hydration - double the maintenance fluid requirements

Hypoxia - O2 via NC if SpO2 is < 92%

182
Q

Lead Poisoning remember mes

A

Serum lead level of 48 ug/dL

History of developmental delay

Irritability

Lives in home built in 1956

Un-coordinated gross motor movements

183
Q

Lead Poisoning Risk factors?

A

Age

Live in older home (paint, pipes, soil)

Live near busy road

Toys/Imported products

Poverty/malnutrition

Pica

184
Q

Chelation therapy

A

used for blood lead levels >45 ug/dL – removes lead from soft tissue & bone then excreted via kidneys

PO or IV – Succimer/Dimercaprol/Adetate calcium disodium
Ensure adequate fluid intake & monitor I&Os