Peds Exam 4 - review game Flashcards
1
Q
Amblyopia S/S
A
reduced visual acuity in one eye
asymmetry of corneal light reflex
2
Q
Amblyopia is caused by what?
A
Strabismus, trauma, cataracts, or ptosis
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
4
Q
Amblyopia Reminder
A
Playing pirate for several hours a day and vision therapy makes me better (eye patch)
5
Q
Congenital Cataracts
A
Opacity of the optic lens preventing light from entering into eye - lead to severe amblyopia if not treated
6
Q
Congenital Cataracts can cause
A
leading cause of visual impairment & blindness
7
Q
Congenital Cataracts - Nursing Assessment
A
Cloudy cornea
Absent red reflex in affected eye
8
Q
leading cause of visual impairment & blindness?
A
CONGENITAL CATARACTs
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
10
Q
Surgical removal of cataract Post op teaching
A
Eye patching, Elbow restraints, Antibiotic & steroid drops
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
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
13
Q
What if OME persists for >3 months?
A
refer to ENT and assess carefully for hearing loss or speech delay
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
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
16
Q
Decreased or no tympanic movement =
A
AOM
17
Q
how to check ear for children?
A
< 3 yrs – pull pinna down and back
> 3 yrs – pull pinna up and back
18
Q
Otitis media dx tool for both =
A
Pneumatic otoscope - the thing dr puts in ear with light
19
Q
Acute Otitis Media Tx
A
Antibiotic therapy DOES HELP:
Amoxicillin & azithromycin = po 10 - 14 days
Ceftriaxone IM (x one dose)
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
21
Q
Types of hearing loss?
A
Conductive
Sensorineural
Mixed
22
Q
Conductive hearing loss:
A
transmission of sound through the middle ear is disrupted (i.e. frequent OM)
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)
24
Q
Mixed hearing loss:
A
attributed to both conductive and sensorineural problem
25
Tympanostomy Tubes - funny reminder
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
26
Tympanostomy Tubes (PE tubes)
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)
27
Tympanostomy Tubes Nursing Tx
Scheduled as OP surgery under general anesthesia (~15 minute surgery); PACU recover, discharged home same day
28
Tympanostomy Tubes post op teaching
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
29
how long do PE tubes remain in pace
remain in place for several months; usually fall out spontaneously (~8-18 months)
30
Infantile glaucoma funny reminders
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
31
Infantile glaucoma physical cues?
Keeping eyes closed
Frequent eye rubbing
Spasmodic winking
Corneal clouding
Enlargement of eyeball
Excessive tearing or conjunctivitis
**Red reflex may appear gray or green**
32
Infantile glaucoma surgery post op care?
Protect surgical site: Elbow restraints: Maintain eye patch and bedrest; provide distraction activities
33
Infantile glaucoma surgery Discharge teaching:
Teach parents how to administer eye medications; No rough-housing or contact sports for 2 weeks
34
Infantile glaucoma first line Tx
Surgery – 3-4 surgeries may be needed
35
Infantile glaucoma
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
36
Tips for Interacting with Visually Impaired Child
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
37
Cues of Hearing Loss in infants?
Wakes only to touch, not room noise
Does not babble by 6 months
38
Cues of Hearing Loss in young children?
Does not speak by age 2 years
Communicates needs through gestures
Focuses on facial expressions when communicating
Does not respond to doorbell or telephone
39
Cues of Hearing Loss in other children?
Often asks for statements to be repeated
Inattentive or daydreams
Poor school performance
Monotone speech
40
Types of Skin Lesions?
Macule
Papule
Annular
Vesicle
Pustule
41
Macule
- circular, flat discoloration <1cm
42
Papule
– superficial, solid, elevated <0.5 cm
43
Annular
– ring-like with central clearing
44
Vesicle
– circular collection of free fluid < 1 cm
45
Pustule
– vesicle containing pus
46
Intentional Skin Injuries - poem to remember
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
47
Risk Factors for intentional skin injuries
Poverty
Prematurity; (<1yr)
Chronic illness
Intellectual disability
Parent w/abuse history; unrelated partner
Alcohol/substance abuse
Extreme stressors
48
Be Suspicious of abuse if…
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
49
BURNS - remember saying
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
50
Burns primary survey:
AIRWAY:
Respiratory effort, symmetry of breathing, breath sounds; Pulse oximetry, ABG, carboxyhemoglobin levels, skin coclor,
hr, pulse strength, perfusion status
51
BURN Secondary survey
Burn depth
Body Surface Area (BSA)
Other traumatic injuries
52
BURN Stages?
53
Sunscreen/Sunburn Prevention - remember quote
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
54
Sunscreen/Sunburn education?
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
55
What is another name for Atopic dermatitis?
Eczema
56
Atopic dermatitis (Eczema) - remember me
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
57
Atopic dermatitis (Eczema) Physical cues
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)
58
Atopic dermatitis (Eczema) Meds
Topical corticosteroids & Immune modulators-tacrolimus
59
what do we avoid with Atopic dermatitis (Eczema)?
avoid: hot water and soaps that contain perfumes, dyes, or fragrances
avoid synthetic clothing/bedding and wool
avoid long finger nails- keep short
60
Atopic dermatitis (Eczema) teachings
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)
61
2 types of Diaper dermatitis
Non-candida
Candida
62
Non-candida
red, shiny; affects skin on buttocks, thighs, abdomen & waist, usually not in the creases or folds
63
Candida
deep red lesions, scaly with satellite lesions (outside of diaper area), usually in the creases & folds
64
Diaper Dermatitis Managment
Change diapers frequently
Avoid rubber pants, harsh soaps, and baby wipes with fragrance or preservatives
65
Candida diaper dermatitis management?
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
66
Candida diaper dermatitis Med?
Antifungal (Nystatin)
67
Non-Candida diaper dermatitis Med?
Skin barriers (zinc oxide + A, D & E ointments + petroleum)
68
Non-candida diaper dermatitis management?
Skin barriers (zinc oxide, A,D & E ointments, petroleum
69
15 year-old male presents with areas of commodones on forehead and cheeks and scattered pustules on back with hypertrophic scaring
Acne Vulgaris
70
Acne Vulgaris History
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
71
Acne Vulgaris physical cues?
Presence of comedones (papules - blackheads or whiteheads), pustules, nodules, and hypertrophic scarring (occurs on face, chest and back)
*oily skin or hair
72
Acne Vulgaris education:
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
73
Acne Vulgaris med
topical meds - may take 4-6 weeks
Tretinion
Benzoyl peroxide (OTC products)
Topical antibacterials
Isotretinoin
Oral contraceptives
74
Tretinion
– interrupts abnormal keratinization that causes microcomedones
75
Benzoyl peroxide (OTC products)
– inhibits growth of P. acnes
Proprionibacterium
76
Topical antibacterials
Clindamycin
OR
Oral = Tetracycline, Erythromycin
77
Isotretinoin
4 severe, derm dr prescribes, teratogenic
78
Oral contraceptives
Decreases endogenous androgen production
79
ACNE complications
acne is severe = depression --> counseling
Complications: Infection & Cellulitis
80
comodones
papules – blackheads or whiteheads
basically a zit
81
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?
idk go see answer choices
82
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?
D. The lesion is a macule
83
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. Apply a topical corticosteroid ointment to the affected area
84
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?
B. Inhibits growth of Proprionibacterium acnes
85
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. Full thickness (3rd degree)
B. Deep partial thickness
C. Superficial partial thickness
D. Deep full thickness (4th degree)
86
HISTORY CUES OF IMMUNO- DEFICIENCY
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
LAB CUES OF IMMUNODEFICIENCY/ INFECTION
WBC DIFFERENTIAL COMPONENTS
Neutrophil - fights bacterial infections
B+T-lymphocyte - fights viral infections
esinoprol - alleric reactions
88
IgA
1st line of defense against respiratory, GI, GU pathogens
Infants begin producing ~ 3 months of age
89
IgE
Increases in allergic states, parasitic infections & hypersensitivity reactions
Level measured during allergy testing
90
IgG
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
IgM
Most important component in a primary immune response
Presence indicates an active infection
Infants start producing own before IgA
92
Severe Combined Immune Deficiency
(SCID)
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
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?
ELISA & WESTERN BLOT
94
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?
PCR & VIRAL CULTURE
95
Juvenile Idiopathic Arthritis (JIA)
An autoimmune or autoinflammatory disease that causes the body to release inflammatory chemicals that attack the synovium (tissue lining around a joint).
96
HIV Physical findings
regression
motor deficits
lymphadenopathy
oral candidiasis
recurrent URI
anemia, & herpes
97
What is regression?
found in HIV kids
loss of previously attained developmental milestones
98
HIV priority of care?
**prevent infection**
99
HIV diagnostic labs?**
≥ 18 months =
+ ELISA and + western blot
Infants < 18 months & born to infected mother = + PCR and viral culture
100
Juvenile Idiopathic Arthritis (JIA) - remember
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
Juvenile Idiopathic Arthritis (JIA) lab cues
CBC: Mild to moderate anemia; Elevated WBC
Elevated ESR and CRP
+ ANA in young children
+ Rheumatoid Factor (may indicate more serious case)
102
Juvenile Idiopathic Arthritis diagnostic findings?
RACE (+ rheumatoid factor, +ANA, C-reactive protein,
Elevated erythrocyte)
mild to moderate anemia and elevated WBC
103
Juvenile Idiopathic Arthritis Assessment findings
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
Latex Allergy
105
Latex Allergy - cross sensitivity
kiwi, bananas, peach, avocado, chestnut, fig, bell pepper, tomato, white potato
106
Latex Allergy manifestations
107
Latex allergy Nursing care and interventions
108
Allergic and anaphylactic reactions physical cues?
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
Management of allergic and anaphylactic reactions?
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
Rubeola (Measles) number one sign
KOPLIK SPOTS
111
Rubeola (Measles) assessment findings?
koplik spots, maculopapular rash (starts on face and then travels down neck, arms, legs, feet)
fever
cough & nasal inflammation
malaise
conjunctivitis
112
Rubeola (Measles) nursing care?
bedrest
fluids & humidification
post exposure vaccination up to 72 hours or IgG within 6 days
113
Rubeola (Measles) meds?
Antipyretics
vitamin A for hospitalized children 6m-2yr or if immunocompromised
114
Rubeola (measles) precaution
Airborne precautions until 4 days after onset of rash
115
Pertussis AKA
WHooping cough
116
Pertussis physical findings?
paroxysmal cough accompanied by red face,
cyanosis and protruding tongue
whooping cough, tearing eyes, drooling, copious secretions from nose and mouth
117
Paroxysmal cough
coughing 10 - 30x in a row
118
Pertussis (whooping cough) Medications?
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
Pertussis precautions
droplet/standard precautions
120
Management for pertussis
high humidity environment
observe for airway obstruction
push fluids
abx compliance
121
Treating fever in children
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
Treating fever nursing interventions?
assess temp every 4-6 hr, 30-60 min after antipyretic administration, and with any change in condition.
123
Another name for Lyme disease
borrelia burgdorferi
124
Lyme Disease quote
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
Lyme disease Stages
Stage 1 (3-30 days)
Stage 2 (3-10 weeks)
Stage 3 (2-12 months)
126
Stage 1
(3-30 days) - erythema migrans at site of bite, chills, fever, HA, stiff neck, weakness
127
stage 2
(3-10 weeks) - systemic involvement (neuro, cardio, musculoskeletal), paralysis or
weakness in face, muscle pain, swelling in large joints, fever fatigue splenomegaly
128
Stage 3
(2-12 months) - advanced systemic involvement, ms pain, arthritis, deafness, cardiac complications, encephalopathy, speech problems
129
Lyme disease meds
doxycycline if > 8 yrs
amoxicillin if < 8 yr to prevent teeth discoloration or cefuroxime allergy
abx tx for 14-28 days
130
Lyme disease teaching
prevent future tick bites
appropriate tick
removal education
131
Lyme disease Physical Findings?
hx of tick bite
firm, discrete, pruritic nodule
urticaria or localized edema
132
Pediculosis capitis AKA
Head lice
133
Pediculosis capitis funny quote
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
Pediculosis capitis Physical cues
extreme pruritus is most common; small red bumps on scalp; white specks attached to hair shaft
Dx by visible eggs and lice
135
Pediculosis capitis Management?
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
Pediculosis precaution
contact precautions
137
Acute Lymphoblastic Leukemia
(ALL) Patho:
Over-production of immature leukoblast cells (WBC) with infiltration of organs and tissues
138
Leukemia (ALL) history:
persistent or intermittent fevers & recurrent infections
fatigue reports of joint/bone pain (leg)
reports of abdominal pain n/v
139
Leukemia lab cues
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
Lymphoma Patho
Mutation of B and T lymphocytes affecting lymph nodes deeper in body
141
Hodgkin Lymphoma History
History of immunodeficiency; frequent infections; Epstein-Barr infection
Family history of lymphoma
Unintentional weight loss, loss of appetite
Reports of night sweats
142
reed Sternberg
Hodgkin
143
Lymphoma – Hodgkin Disease remember this:
A 16-year-old presents with…
Painless, enlarged cervical lymph nodes
Fever & reports of night sweats
20% weight loss
Biopsy results: reed sternburg
144
Hodgkin - Lymphoma Physical cues
enlarged lymph nodes
Fever (unexplained)
Cough + SOB
Pruritis (cytokine release)
Splenomegaly/hepatomegaly
**Painless, enlarged supraclavicular or cervical lymph nodes (“sentinel nodes”)
145
Lymphoma Lab cues
Confirmation of diagnosis via biopsy, BMA, CT of lungs and abdomen, and LP
146
Brain tumor remember
The brain is my aim
Medulloblastoma…Astrocytoma…glioma are some of my names
Increased ICP…I can explain
Surgery & chemotherapy to detain
147
Brain tumors Pre op care:
Monitor for ↑ ICP and manage accordingly
steroids to decrease intracranial swelling
pre-op teaching/Emotional support
148
Brain tumors Post op care:
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
Wilm’s Tumor (nephroblastoma) Patho?
Malignancy that occurs in the abdomen (kidneys)
usually unilateral and deep in the flank –
most common on right side
150
Wilm’s Tumor (nephroblastoma) remember!!!
3-year-old presents to clinic with reported abdominal asymmetry, vomiting and weight loss. Abdominal ultrasound reveals a renal mass.
151
WILM’S TUMOR physical cues
Firm, nontender abdominal swelling/MASS
weight loss + vomiting?
abdominal asymmetry
Hematuria (gross or microscopic)
Hypertension
152
Wilm’s Tumor (nephroblastoma) labs
**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
What is the contact precaution
LICE aka Pediculosis capitis
154
What is the droplet precaution
Pertussis AKA whoooping cough
155
What is the airborne precaution
Rubeola AKA Measles
156
Bone marrow aspirate position?
Prone
157
Bone marrow aspirate bone of choice
Iliac crest
158
Bone marrow aspirate equipment?
BM procedure tray/needle
159
Bone marrow aspirate Meds?
Local/topical anesthetic & Conscious sedation meds: (Fentanyl/Versed)
160
Bone marrow aspirate pre procedure priorities
Explain procedure, comfort,
**infection prevention
161
Bone marrow aspirate post procedure priorities?
monitor for bleeding after
apply pressure for 5-10 mins directly after procedure
then apply a pressure dressing
162
Neutropenic precautions
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
ADVERSE EFFECTS OF CHEMOTHERAPY
Neutropenia & Thrombocytopenia
Anemia
N/V/Anorexia
164
Neutropenia to knows:
Infection Risk!!
*Prophylactic* antibiotics
Absolute Neutrophil Count
(ANC) <1000 = bad
165
Thrombocytopenia to knows:
Avoid rectal temps & meds
Avoid IMs or LPs
Avoid ASA & NSAIDS
– give Acetaminophen instead
166
Anemia to knows:
Limit blood draws
eat Fe-rich foods
Use of synthetic Erythropoietin (Epoetin)
167
N/V/Anorexia to knows:
Offer bland, dry foods
Offer small & frequent meals
Offer ice, carbonated drinks, and popsicles throughout day
Complimentary remedies (relaxation, guided imagery)
168
Common complications of radiation therapy?
altered skin integrity
169
Radiation therapy teaching?
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
Iron Deficiency Anemia findings?
Irritability & HA
Unsteady gait, Weakness, & Fatigue
Dizziness & SOB
Pallor skin, MM, & conjunctiva
Assess for difficulty feeding, pica
Spooning of nails
171
Iron Deficiency Anemia management?
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
Fe+ supplements Teaching:
Place behind teeth to avoid teeth stains
Cause constipation – increase fluids and may need stool softeners
Cause dark, green stools – this is normal
173
Iron deficient Anemia Labs:
ALL DECREASE including RBC
except
RDW (red cell distribution width) increase
174
HEMOPHILIA A
Deficiency of Factor VIII which is essential to activate factor X, which converts prothrombin to thrombin, without it, platelets cannot make clots
175
Hemophilia causes
bleeding episodes due to lack of VIII
176
Managment of bleeding in hemophilia
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
Hemophilia Physical Cues?
Swollen or stiff joints (Hemarthrosis)
Multiple bruises
Hematuria
Bleeding gums
Bloody sputum or emesis
Black tarry stools
Chest or abdominal pain (internal bleeding)
178
What is Sickle cell vaso-occlusive crisis?
When the circulation of blood vessels is obstructed by abnormally shaped RBCs causing ischemia & infarction.
179
Sickle Cell Disease Labs
3 down: HGB, HCT, & ESR
3 up:
Platelet, Bilirubin, & Reticulocyte count
180
Physical Cues of sickle cell?
idk dawg its the same as all the others
181
Managing Vaso-occlusive Episodes?
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
Lead Poisoning remember mes
Serum lead level of 48 ug/dL
History of developmental delay
Irritability
Lives in home built in 1956
Un-coordinated gross motor movements
183
Lead Poisoning Risk factors?
Age
Live in older home (paint, pipes, soil)
Live near busy road
Toys/Imported products
Poverty/malnutrition
Pica
184
Chelation therapy
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
