Peds Final Flashcards
Erikson’s Stages
- Trust vs. Mistrust (Birth-18 months)
- Autonomy vs. shame + doubt (18 months-3 years)
- Initiative vs. guilt (3-5 years)
- Industry vs. inferiority (5-12 years)
- Identity vs. Role confusion (12-18 years)
Isotonic dehydration
- Lose electrolytes and water equally
- Primary form in kids!!!
- Sodium levels are normal
- Biggest concern is shock!!
Hypotonic dehydration
- Lose more electrolytes than water
- Sodium levels are low (<135)
Hypertonic Dehydration
- More water is lost than electrolytes
- Most dangerous type of dehydration!!
- Sodium levels are high (>150)
- Seizures are more likely
- Tachycardia is earliest sign of dehydration
- For each 1% weight loss = 10mL/kg fluid resuscitation
Mild dehydration
- Fluid loss less than 50mL/kg
- Capillary refill less than 2 seconds
Moderate dehydration
- Fluid loss 50-90mL/kg
- Capillary refill 2-3 seconds
Severe dehydration
- Fluid loss greater than or equal to 100mL/kg
- Capillary refill greater than 3 seconds
Calculation of fluid requirements
Child who weighs 1-10kg = 100mL/kg
Child who weighs 11-20kg =
1000mL + 50mL/kg for each kg over 10 kg
Child who weighs more than 20 kg =
1500mL +20mL/kg for each kg over 20kg
Renal Diet
- Low protein
- Low phosphorus
- Low sodium
- Low potassium
- HIGH carbs
- HIGH calcium
LIMIT FRESH FRUITS + VEGGIES
Celiac diet
No gluten!!
(no wheat, rye, barely, or oats)
Signs/Symptoms of increased ICP
Early:
- Headaches, diplopia (blurry vision), N/V, vertigo, seizures
Late:
- Bradycardia, decreased LOC, decreased motor response, diminished response to pain, cushing’s triad (bradycardia, HTN, irregular respirations)
Infant:
- Wide sutures, tense/bulging fontanels, high-pitched cry, setting-sun sign
What diet for seizure prevention?
ketogenic diet:
(high fat, low carb, adequate protein)
Wilm’s tumor Nursing care
- Surgery ASAP to remove tumor, affected kidney, and adjacent adrenal gland
- DO NOT PALPATE!!!
What is wilm’s tumor and what are signs and symptoms
AKA nephroblastoma
- most common malignant renal and intra-abdominal tumor in childhood
- More common in asian and black children
Pyloric stenosis
hallmark signs
- projectile vomiting
- moveable olive-shaped mass in epigastrum
Pertussis
(aka whooping cough)
symptoms:
- runny nose
- cough that becomes more severe and spasms
- flushing or cyanosis
- vomiting
treatment:
- antibiotics
- steroids
Asthma symptoms
- wheezing and dry cough
- prolonged expiration
- restlessness + fatigue
- tachypnea
- cyanosis
- chronic use of accessory muscles for respiration can lead to barrel chest
nursing care for asthma
- assess resp. status and monitor pulse ox
- admin. humidified oxygen prn
- position high-fowlers and avoid cold liquids to avoid bronchospasm
- sudden cessation of wheezing + decreased breath sounds = worsening
- maintain IV access
Cystic fibrosis patho
- increased viscosity of secretions
- lungs atelectasis
- clogged pancreatic ducts
- absence of pancreatic enzymes in small intestines - unable to absorb fats/protein
Cystic fibrosis symptoms
- cough and sputum
- dyspnea and decreased SaO2
- crackles or wheezes
- cyanosis
- digital clubbing
- bulky, frothy, foul-smelling stools (steatorrhea)
- meconium ileus (bowel obstruction)
Nursing care and meds for cystic fibrosis
- fat soluble vitamins (A,E,D,K)
- administer pancreatic enzymes w/ meals and snacks
- avoid exposure to resp. infections
- chest percussion and postural drainage
- activity and exercise will loosen secretions
What is the main diagnostic cystic fibrosis?
if before birth:
- prenatal DNA of amniotic fluid
if after birth:
- sweat test
Vaso-occlusive crisis symptoms
- pain
- priapism
- acute chest syndrome
- stroke
Hemophilia treatment
- factor VIII
- no heat therapy
- No IM injections
- no aspirin/NSAIDS
kawasaki disease symptoms
- high fever
- red eyes
- ring around iris
- strawberry tongue
- irritability that lasts for months
Types of fractures
Bend
- ulna and fibula when there’s a fracture in the radius and tibia
Buckle
- protrusion at the end of the fracture site - usually by the epiphysis
Greenstick
- compressed side bend and makes the opposite side split - incomplete fracture
Complete
- bone is completely broken but may be held together with periosteal hinge
symptoms of hypoglycemia vs. symptoms of hyperglycemia
hypoglycemia:
- shaky/dizzy
- tachycardia
- diaphoresis
- anxiety
- polyphagia
- blurry vision
- lethargy
- headache
hyperglycemia:
- 3 polys (polyphagia, polydipsia, polyuria)
- tiredness
- blurry vision
- weight loss
NIPS pain scale
used from birth to 2 months
- cry
- facial expression
- arms
- legs
- breathing pattern
- state of arousal
FLACC scale
used 2 months to 7 years
- Face
- Legs
- Activity
- Cry
- Consolability
FACES pain scale
3 years and older
(use if child is awake and able to communicate)
Triad of hemolytic uremic syndrome
- anemia
- thrombocytopenia
- renal failure
Hemolytic uremic syndrome etiology
- primarily in 6 month to 5 years old
- associated with e. coli
- begins with gastro or uri
nephrotic syndrome
kidney disorder that causes your body to pass too much protein into your urine
Treatment:
- low salt diet
- severe cases fluid restriction
- 25% albumin
Babinski
dorsiflexion of big toe and fanning of toes - should be absent after 1 year or after beginning to walk
CM’s of bacterial meningitis (ALL BAD)
kernig’s sign: stiffness in hamstrings that prevents ability to straighten the leg
Brudzinski’s sign: major stiffness in neck that causes flexion of the hips and knees when neck is flexed
Gowers sign
child starts on hands and knees, then walks hands up legs to stands (associated with duchenne muscular dystrophy)
Graves disease
(AKA hyperthyroidism)
Labs: low TSH, high T3 and T4
Symptoms: goiter, exophthalmos, irritability, hyperactivity, short attention span, tremors, insomnia, mood swings, poor concentration, nervousness, and decreased weight
osteogenesis imperfecta
“brittle bone” disease
Symptoms: fragile bones, deformity, fractures, blue sclerae, hearing loss, hypoplastic discolored teeth
