Peds Exam II

Question 1

Digoxin Therapeutic range:

Answer 1

0.8-2

Question 2

S&S of digoxin toxicity

Answer 2

EARLY: vomitting

GI S&S: abdominal pain

Question 3

Digoxin MOI:

Answer 3

decreases HR

increases CO

Question 4

What do you have to check before administering Digoxin?

Answer 4

K+ level

apical pulse for 1 min

Question 5

When should you NOT give Digoxin?

Answer 5

bradycardic

vomiting

Question 6

What can increase Digoxin toxicity?

Answer 6

Low K+

Question 7

Lasix MOI:

Answer 7

blocks reabsorption of sodium and water

Diuretic

Question 8

Lasix considerations:

Answer 8

check chloride and potassium level - it’s a K wasting diuretic and can worsen digoxin toxicity

Question 9

Expected urine output for all ages:

Answer 9

infant - 2mL/kg/hr
children - 0.5-1 mL/kg/hr
adults - 40-80 mL/hr

Question 10

Which UTI gives fever and costovertebral angle pain (p! with kidney palp)

Answer 10

Pyelonephritis

Question 11

S&S of acute vs chronic otitis media:

Answer 11

acute - hallmark is pulling at ear and inflammation

chronic - NO inflammation and fluid behind membrane

Question 12

Prevention for otitis media:

Answer 12

avoid second hand smoke

YES:
breastfeeding
vaccinations
smaller daycare
avoid bottle propping

Question 13

Range for amoxicillin for otitis media:

Answer 13

80-100 mg/kg/day

Question 14

What are the INCREASED pulmonary blood flow defects?

Answer 14

VSD - most common
ASD
PDA
AV Canal

Question 15

What are the DECREASED pulmonary blood flow defects?

Answer 15

Pulmonary Stenosis
Tetralogy of Fallot
Tricuspid + Pulmonary Atresia

Question 16

S&S of increased vs decreased pulmonary blood flow:

Answer 16

Increased: 
TACHYpnea
TACHYcardia
weight gain r/t edema 
sweating c minimal activity (with eating)
retractions 

Decreased: 
CYANOSIS
clubbing (chronic hypoxia)
hyper cyanotic spells ("tet spells")
Polycythemia (increased RBC)

Question 17

Characteristics of increased vs decreased pulmonary blood flow defects:

Answer 17

increased:
blood shunt from left to right
kids are NOT cyanotic

decreased:
blood shunt from right to left
kids ARE cyanotic

Question 18

Interventions for hyper cyanotic “tet” spells:

Answer 18

squat to improve blood flow

Question 19

What is the treatment for decreased pulmonary blood flow defects?

Answer 19

keep PDA open with prostaglandins until surgery

Question 20

What is the treatment for increased pulmonary blood flow defects?

Answer 20

conservatively tx with digoxin and diuretics until the defect closes - THEN surgery

Question 21

Post op care of a cardiac catheterization:

Answer 21

leg must be straight for 4-6 hours with NO movement (can apply sandbags)
assess dressing Q15min for bleeding for the first hour

Question 22

Etiology, S&S and tx of Infective endocarditis:

Answer 22

etiology: strep and staph
S&S: fever and CHF symptoms
Tx: antibiotics, maintain dental hygiene, potential surgery

Question 23

Etiology of Rheumatic fever:

Answer 23

etiology: beta hemolytic strep
S&S: nocturnal dyspnea (always cardiac, NOT respiratory), Jones criteria
Tx: Antibiotics
Anti-inflammatory meds

Question 24

Etiology of Kawasaki:

Answer 24

idiopathic
S&S: strawberry tongue, dry lips
Tx: IVIG for 10 days and Aspirin 100mg/kg/day

Question 25

Testicular torsion -

Answer 25

sudden severe pain must have surgery within 6 hours EMERGENCY

Question 26

Nursing management for GER vs. GERD

Answer 26

GER - long term H2 antagonists and PPIs GERD - upper GI series, pH probe and thickened feedings with rice cereal

Question 27

Which glycemic crisis is rapid onset?

Answer 27

HYPO is rapid | HYPER is gradual

Question 28

S&S and tx of omphalocele vs. Gastroschisis:

Answer 28

Omphalocele - (sac) keep that sac intact by covering with moist, sterile gauze Gastrochisis - (no sac) temperature regulation is #1

Question 29

Should you feed a baby with Omphalocele?

Answer 29

NO NO NO

Question 30

What is intrasusception? S&S and Tx?

Answer 30

telescoping of one part of the intestine into the other S&S: abrupt pain, bilious emesis (green/yellow vomit), currant jelly stools (LATE), sausage mass in RUQ Tx: air or barium enema

Question 31

How do you know if an air/barium enema worked?

Answer 31

if they pass a brown stool

Question 32

Bacterial/Viral/Allergic Conjuntivitis S&S:

Answer 32

bacterial - unilateral c purulent discharge viral - bilateral c watery discharge allergic - cobblestone eyeballs

Question 33

Patient teaching with conjunctivitis:

Answer 33

prevent the spread | do NOT force a crusty eye open

Question 34

Pt teaching for cleft palate baby:

Answer 34

ESSR method to feed (enlarged nipple, stimulate sucking, swallow, rest) They are more prone to ear infections

Question 35

Visual Development for bbs : the facts

Answer 35

2 months - can track moving objects | 4 months - able to see in color

Question 36

S&S of glaucoma

Answer 36

tearing, corneal clouding, progressive eye enlargement

Question 37

Amblyopia S&S and Tx:

Answer 37

lazy eye S&S - reduced vision in one or both eyes, squinting, close one eye to see Tx: patch of the GOOD eye or glasses

Question 38

Eye drop administration:

Answer 38

``` wash hands warm meds pull lower lid down keep the eye closed for a few seconds wash yah hands again ```

Question 39

S&S of of rotavirus. Tx?

Answer 39

explosive diarrhea that smells like wet grass Tx: balance those electrolytes and hydrate

Question 40

Short bowel syndrome etiology, tx:

Answer 40

etiology - malabsorption | tx: TPN, central line lipids, serial transverse enteroplasty (to lengthen the bowel)

Question 41

Hischsprung Disease: etiology, S&S, Tx

Answer 41

etiology - megacolon S&S - no meconium, constipation, and distention, failure to gain weight, ribbon stools Tx: colostomy care

Question 42

congenital HYPOthyroidism S&S:

Answer 42

decreased thyroid hormones lead to irreversible intellectual disability ``` S&S: jaundice thick, floppy tongue HYPOtonia (floppy baby) dry skin hoarse cry large fontanelles ```

Question 43

Rule of Stools:

Answer 43

ribbon stools or anal leakage - Hirschprung's Currant jelly stools (blood/mucus) - Intussusception floating stool - malabsorption (Celiac)

Question 44

Bladder entropy S&S:

Answer 44

split clit | small penis