Peds Final Flashcards
which conditions need IVIG?
why?
immune thrombocytopenia
Kawasaki’s (high dose)
SCID
Wiskott-Aldrich Syndrome
it provides immunoglobulins and cells needed to replenish WBCs and platelets.
- 1 to 4 weeks after a viral illness with children younger than 10 years old
hint: given prednisone, anti-D antibody, and IVIG.
immune thrombocytopenic purpura
lack of response to antigens, lymphopenia, absence of plasma cells in the bone marrow. History of recurrent, severe infections from early infancy.
what am I?
how am I treated?
Severe combined immunodeficiency syndrome
HSCT can cure this if given by 3 months
If not, IVIG is also given.
X-linked
eczema
thrombocytopenia
immunodeficiency of T and B cells
prognosis?
-what are two conditions this child is more at risk for?
treatment?
cure? (no time frame here)
what is a special component here not seen anywhere else?
Wiskott-Aldrich Syndrome
fatal if not cured with HSCT as soon as possible.
cancer and auto-immunity
IVIG, platelet transfusion, splenectomy, aggressive eczema treatment, prophylactic antibiotics, G-CSF.
the inclusion of G-CSF for neutropenia correction
bone marrow failure (Anemia)
and nutritional deficiency
–decreased RBC production for both
increased RBC loss
increased RBC destruction
aplastic anemia
epistaxis, hemophilia, DIC, Idiopathic Thrombocytopenic purpura.
SCD and thalassemia + isoimmunization, chemo, irradiation, infection.
despite hemodilution, decreased peripheral resistance, increased circulation and turbulence within the heart causing a murmur, possibly leading to cardiac failure, growth retardation, anorexia, delayed sexual maturation.
there is not what?
cyanosis
Which age group is most susceptible to Iron deficiency anemia?
why?
treatment?
when can you expect improvement?
12–36-month-olds
they can now have milk, and the parents give them this to the exclusion of other foods, and plus they can’t chew a lot of things that have an excess of iron.
give iron tablets and orange juice
in 1 month
breast fed infants need iron during which periods?
4-12 months
aplastic
hyperhemolytic
acute splenic sequestration
acute chest syndrome
what are these?
SCA
diminished production of RBCs causing a crisis.
increased RBC destruction.
pooling of blood, spleen swells dropping hgb levels, the spleen gets blocked, and it can no longer filter blood cells.
RBCs congregate and block an area in the lungs, usually combined with infection.
precautions to take with SCA pts?
penicillin prophylaxis from 2m-5y
get all the pneumococcal vaccinations (+hib and meningococcal), starting at 2 months.
give blood, fluid, and electrolyte replacement
under 5 is at the most risk, so it’s ideal to get HSCT before then.
stroke prevention
special treatment that aplastic anemia pts get?
antilymphocyte globulin (immunosuppressive) which is ALG and ATG
Tumor lysis syndrome
high phosphate, high potassium, low calcium, high uric acid.
superior vena cava syndrome
caused by Hodgkin’s or NHL or thrombotic complications of implantable IV devices.
hemorrhagic cystitis
what med is given?
to stop this irritation from chemo, increase fluid intake and void frequently and start chemo earlier in the day giving time to of this and flush the drug out of the system.
mesna (inactivates metabolite that causes damage to the bladder)
After a HSCT, what should you not do?
get a live attenuated vaccine like MMR or varicella.
wound left open to close naturally
secondary intention
thelarche
adrenarche
menarche
puberty “delay”
first two, 8-13 years.
breast buds
pubic hair growth
two years after thelarche, menstruation begins.
delay if no thelarche by 13 years.
a) penile growth, first ejaculation, axillary, groin, and facial hair, final voice change.
b) penile enlargements, voice changes, early facial hair, gynecomastia.
c) testicular enlargement and sparse pubic hair.
d) no enlargement of testes or scrotal changes by 14 years
stage 1 (9.5-14 years)
stage 3
stage 5
pubertal delay
stage 1: c
stage 3: b
stage 5: a
delay: d
Erikson’s (3-6)
(6-12)
(>12)
initiative v. guilt
industry v. inferiority
identity v. role confusion
enlarged testicular veins, resulting in pain or growth arrest of affected testicle, may impair fertility; requires surgery or embolization.
varicocele
gynecomastia is related to which condition?
varicocele
phototherapy and a radian warmer does what was fluid requirements?
what about mechanical ventilation?
increases the need
decreases the need
rapid fluid replacement is contraindicated in which type of dehydration?
hypertonic
defect in the ability to concentrate urine.
s/s?
diet?
meds?
nephrogenic diabetes insipidus
unexplained fever, hypernatremia, copious amounts of dilute urine.
low sodium/low solute diet
hydrochlorothiazide + potassium supplementation.
___albuminemia
____proteinuria
hyper________
edema
give which two meds?
cause?
hypoalbuminemia
massive proteinuria
hyperlipidemia
edema
loop diuretics (d/t hypoalbuminemia)
steroids (need immunosuppressants b/c helps with inflammation and reduces additional damage)
varied, not d/t immune complexes, that is glomerulonephritis
leukemias
most common childhood form?
s/s?
r/t condition?
diagnostics?
prognosis?
ALL
bone pain, lymphadenopathy, hepatosplenomegaly, fever, bleeding.
aplastic anemia
blood smear, low blood counts, bone marrow aspiration/biopsy, then LP to determine CNS involvement.
80-90%
all that goes into clinical staging and prognosis of Acute Leukemias
name the basics:
immunophenotyping of the T and B lineage, myeloid antigens.
–they decide who is most at risk and assign them into risk-based groups where they can receive specialized treatment.
dx based on WBC count, CNS involvement found at LP, testicular involvement, Down syndrome (compromised immune system), sex, race, ethnicity, nutritional status, leukemic cell characteristics.
of course, the response to treatment which determines the prognosis.
3 phases of chemotherapy
remission induction, consolidation/intensification, maintenance (continuation–so they keep levels low)
HL or NHL, which is more common in children? Which is caused by the Epstein-Barr Virus?
NHL
HL
what has improved the dx of lymphomas?
risk group stratification, systemic staging (Ann-Arbor), and improved treatment protocols.
lymphomas
s/s?
dx?
anorexia, wt loss, night sweats, pruritus, low-grade fever, cough (tendency to move to the mediastinal area), and abdominal pain (mesenteric area).
total body imaging (to hit all the lymphatic drop off areas)
H&P (for risk group stratification)
+bone marrow aspiration and LP (d/t lymphoma relation to hemopoietic cells)
use immunophenotyping, cytogenics, and FISH.
use risk adapted chemo (b/c survival is not 80%)
surgery is applicable for NHL
brain tumors
s/s?
no LP if___?
dx?
tx?
most clinical manifestations are related to their anatomical location, tumor size, rate of growth, child’s age/developmental stage.
mostly: bulging fontanel, increased head circumference, headache, vomiting, nystagmus, ataxia, dysarthria, dysmetria (inability to control distance, speed, ROM)
increased ICP
MRI is gold standard
will use surgery, chemo, radiation (before surgery) to lessen this solid tumor and ultimately remove it in surgery. (note: this can have serious long-term consequences)
brain tumor post op complications
watch out for meningitis, testing reflexes, hand grip, cranial nerves, pupils, LOC, response to stimuli, dressing (drainage)
-for the dressing, avoid putting pressure against it.
-reduce ICP
-avoid aspiration.
-regulate fluids because cerebral edema and increased ICP fucks it up.
comfort with: low stim environment, eye drops, prevent strain (stool softener and antiemetics), suction, ice compress for facial edema.
from neural crest cells in adrenal medulla.
firm, nontender, irregular mass in the abdomen that crosses the midline; pain, vomiting, anorexia, urinary frequency or retention (compression of kidneys and ureters by tumor)
tumors excrete catecholamines.
“silent rumor”–70% detected after metastasis.
HSCT and myloablative therapy (during consolidation phase, in high-risk patients)
recognize poor prognosis
neuroblastoma
mass in abdomen combined to one side?
how about at midline?
Wilm’s tumor
neuroblastoma
bone tumors
bone marrow biopsy is used with which of the tumor types?
radiation is more common with which tumor type?
surgery? which type is more likely to get it?
ES (Ewing sarcoma)–bone marrow spaces can be targeted with biopsy and radiation.
surgery resulting in amputation is more often in Osteosarcoma due to it often affecting osseous tissue and infecting long bones.
nephroblastoma or?
age group most affected? times they are screened?
s/s?
CT and Chest XR is looking for what?
what condition is associated with this?
mechanisms of treatment?
Wilm’s tumor
<5, 3m-8y
HTN, hematuria–anemia, wt loss, fever, swelling or mass in the abdomen, firm, nontender, confined to one side and deep in the flank.
lung metastasis
von Willebrand disease
surgery immediately, postop chemo, radiation for advanced stages.
tumor arising from mesenchymal cells, which normally develop into muscles, but go to other sites like orbit, nasopharynx, paranasal sinuses, middle ear, retroperitoneal area, perineum.
ages 1-9 with the best prognosis
rhabdomyosarcoma
what’s the survival rate of retinoblastoma?
10 year survival rate of 90%
encephalitis
etiology
s/s (think of the mnemonic chatgpt made)
implications of condition
either direct invasion (by enterovirus) or postinfectious involvement after a viral disease.
malaise, headache, dizziness, apathy, nuchal rigidity, n/v, ataxia, tremors, hyperactivity, speech difficulties
apathy..but hyperactivity
Monitor for ICP, especially if a LP is used.
long-term complications: learning difficulties, epilepsy.
details of rabies
tx?
virus multiples in muscles, incubates for 1-3m, but can be as short as 5 days or as long as 6m.
inactivated rabies vaccine, 4 doses over 2 weeks.
globulins added with the first dose of rabies vaccine (1/4 help)
toxic encephalopathy
-preceded usually by varicella, influenza.
fever
profuse vomiting
neurologic impairment
disordered hepatic function
aggressive supportive therapy.
what should parents know?
Reye syndrome
don’t give salicylates to children every time they have flu-like symptoms.
two or more unprovoked seizures more than 24 hours apart.
epilepsy
what is the initial manifestation for generalized seizures?
a loss of consciousness
tonic?
clonic?
tonic-clonic?
prolonged stiffening of muscles
jerky movements of limbs
stiffness first and then prolonged and rhythmic jerky movements of limbs.
infantile spasms, onset between 4-8 months, rarely occurs after 2 years; some degree of cognitive impairment.
West syndrome
20-50% with infantile spasms go on to develop _____ which includes multiple sz types, intellectual disability, slow spike wave discharges on EEG.
Lennox-Gastaut syndrome
secretion of catecholamines, autosomal dominant.
HTN/hypertensive attacks, tachycardia, headache, anorexia, wt loss, hyperglycemia, hyperventilation, nervousness, diaphoresis.
surgical removal of tumor–bilateral adrenalectomy–then give lifelong glucocorticoid and mineralocorticoid therapy.
pheochromocytoma
what do you not do in the case of pheochromocytoma?
palpate the mass, preoperative palpation of the mass releases catecholamines which can stimulate severe hypertension and tachyarrhythmias.
problems of acute adrenocortical insufficiency
hyponatremia (seizures, n/v/d) + irritability, poor feeding, weakness, headache–also due to low glucose, infection risk, low body fluids.
-also, fever, tachypnea, cyanosis.
destruction of adrenal gland would cause lower glucose, lower bodily fluids, low cortisol.
begins as a reddish macule
becomes vesicular
ruptures easily, leaving superficial, moist erosion.
exudate dries to form heavy, honey-colored crusts.
pruritis common.
use bactericidal ointment, oral or parenteral abx if severe.
autoinoculable and contagious. Heals with scarring.
impetigo
molluscum contagiosum
description:
cause:
tx?
spread?
flesh-colored papules with a central caseous plug (umbilicated) that occur on trunk, face and extremities; may be transmitted by sexual contact.
takes months to go away, 18 m, but won’t keep the kids from school.
b/c it’s viral, there isn’t much treatment The ones there are painful–curettage, electrodessication, or cryotherapy. Plus a bunch of creams–chemical removing agents.
common in school age children, outbreaks have been reported at childcare centers.
urushiol
sumac
sensitizing agent
primary irritant
irritates only those who are allergic to it
irritating for everyone
systemic effect of a drug eruption is seen as what?
how about fixed eruption?
itching
recurrent eruption at same site (same cause, same place)
if a child has been bitten by an arthropod, what should the nurse do?
put a medication attention bracelet on.
infestation of ____ mites.
burrows into epidermis and deposits eggs and feces, inflammatory response follows.
s/s?
tx?
nursing care?
scabies mites
intense pruritis, may lead to excoriations. Maculopapular lesions, especially in intertriginous areas (Skin folds).
scabicide.
prevent transmission, treat all close contacts.
pediculosis capitis-scalp infestation, female lay eggs at night at junction of hair shaft. Eggs (nits) hatch in____to_____days
s/s?
dx?
tx?
7-10 days (Common shipping time)
itching to occiput, behind ears, nape of neck.
have to see nit on shaft of hair
pediculicide and manual removal
spirochete borrelia burgdorferi enters skin and bloodstream…what is the disease?
stage 1:
stage 2:
stage 3:
tx?
lyme disease
1: early localized disease (tick bite), within 3-30 days erythema migrans.
2: early disseminated disease. Secondary annular lesions 3-10 weeks after bite.
3: systemic involvement of neurologic, cardiac, musculoskeletal systems 2-12 months after bit.
early tx to prevent complications; doxycycline if >8 yrs, but amoxicillin if <8yrs. Take for 14-21 days.
cat scratch disease
self-limiting cause of regional lymphadenitis.
painless, nonpruritic erythematous papule near bit.
may give abx
peak occurrence of diaper dermatitis
9-12 months
atopic dermatitis (eczema)
tx?
chronic relapsing inflammatory skin disorder. Results in itching and lesions.
hydrate skin, relieve itching, reduce flare ups or inflammation. Prevent and control secondary infection. Support hygiene and symptom relief.
if an infant has eczema at 2-6 months, when does it resolve?
normal childhood years of manifestation?
preadolescent and adolescent years?
3 years
2-3 years
> 12 years
a child with eczema has just take a bath, what do you do?
give an emollient preparation before the skin has a chance to dry.
seborrheic dermatitis
s/s?
chronic, recurrent, inflammatory reaction of skin.
scalp-cradle cap
eyelids (blepharitis)
external ear canal (otitis externa)
nasolabial folds
inguinal region
acne
tx?
caused by testosterone that stimulates sebaceous glands of skin.
alterations in follicular growth.
differentiation with colonization of Propionibacterium acnes.
topical retin A/tretinoin, benzoyl peroxide, topical abx. Or systemic abx, OC, Accutane.
what is the black box warning for Accutane?
warning of suicide, depression, aggression, psychosis. Also, teratogenic= need for some form of BC and pregnancy testing.
chillbain
redness and swelling of skin when exposed to low temperatures.
complications of burns
pulmonary
excessive fluid volume
wound sepsis
a superficial partial-thickness burn heals in?
how about deep partial-thickness burn?
<21 days
> 21 days
desquamation?
the shedding of the epidermis layer of skin in a 1st degree burn.
occurs in 3-7 days.
lymphatic tissues in children
twice the adult size by age 10-12
for early childhood, how do you communicate with them?
school age children?
largely egocentric, so focus on the child. Repeat information in simple, consistent terms. Allow child to touch medical equipment.
focus on concrete explanations.
when do you use Wong-Bake pain scale?
after 4 years old, because its self-reported.
if patient is apneic?
DO NOT leave patient
DO NOT give more opioid
give O2
stimulate
ensure pulse oximetry
give narcan
call for help
be prepared to calm/comfort patient when effects of opioids are reversed.
airborne transmitted diseases?
PPE?
measles, TB, chicken pox/shingles, SARS.
N95
droplet transmitted diseases?
PPE?
contact?
pertussis, influenza, mumps, RSV, rubella
mask/eye protection.
c.diff, rotavirus, hep A
gown and gloves
what vaccines are considered live attenuated?
MMR, varicella/chicken pox, rotavirus.
stomatitis
hand-foot-and-mouth disease can be dangerous to newborns.
relief of pain using topical anesthetic before eating, “magic mouthwash”, no lidocaine for young children.
pinworms
given pyrantel pamoate, no subscription needed, and need a second dose to ensure eggs not killed don’t hatch and reinfect patient.
what vaccines are given at 2 months?
hep B (2nd dose)
rotavirus
DTaP
Hib
Pneumococcal conjugate
inactivated poliovirus
RSV vaccine (given immediately for immuno-compromised NICU babies. )
fifth disease
slapped cheek disease
human parvovirus B19
rashes look like smaller, and more dispersed erythema migrans.
APGAR
heart rate
respiratory effort
muscle tone
response
color
new ballard scale
for 20-44 weeks, but is best done immediately after birth and in babies >26 weeks.
return to birth weight in how many days?
10-14 days
marked lag in head control can indicate what?
down syndrome, hypoxic ischemic episode, or other neuromuscular compromise.
___% weight loss in the first week is normal and needs no intervention.
10
erythema toxicum neonatorum
baby acne
late preterm infant
premature baby
34 0/7 and 36 0/7 weeks of gestation
<37 weeks
jaundice onset within 24 hours
hemolytic disease
LGA babies
macrosomia
abundant vernix
polycythemia
listless and lethargic
jitteriness
hypoglycemia
poor feeding
hyperbilirubinemia
TORCH complex
toxoplasmosis
other (parovirus, hep B, west nile)
rubella, cytomegalovirus.
Apnea
Change in color or muscle tone
Choking, gagging, or coughing
Usually involves significant intervention
BRUE
when is chelation therapy considered for lead poisoning?
levels greater than 20mcg.
bradycardia
decreased motor response to command
decreased sensory response to painful stimuli.
alterations in pupil size and reactivity.
extension or flexion posturing
Cheyne-stokes respirations.
papilledema
decreased consciousness
coma
late signs in infants and children
concerning family history when evaluating neurologic status
recurrent miscarriages
family members who died at an early age.
developmental delay, deafness, blindness, unusual movements, weakness, stroke, ataxia, progressive mental deterioration.
pediatric Glasgow coma scale
15
<8
3=
5
unaltered LOC
accepted as definition of coma
deep coma or death
scores of 5 or less are associated with poor outcomes.
for children with CHF, what are mothers advised to do, due to the weakness of the infants?
feed at first sign of hunger.
+ (gavage feeding if needed, increase calorie feeding)
three key reflexes from infants in a neurologic examination are?
Moro, tonic neck, withdrawal.
severe dysfunction of the cerebral cortex or with lesions to corticospinal tracts above the brainstem.
flexion posturing.
dysfunction at the level of the midbrain or lesions to the brainstem.
extension posturing
when is a lumbar puncture delayed?
if intracranial hemorrhage is suspected or if there is increased ICP because there is a risk for potential brainstem herniation.
in a 2-hour sample of an oral glucose tolerance test, what is a level that confirms diabetes?
> 200
in a random glucose test, what confirms a DM diagnosis?
> 200 levels with classic signs of DM.
in an 8-hour fasting blood glucose, what is a level that confirms DM?
> 126
A1c levels that confirm DM?
> 6.5%
With an external ventricular drainage system, what are some things to consider?
keep at the level of the ventricles or below to decrease ICP, it also prevents infection risk.
head injuries
epidural?
subdural?
when does cerebral edema develop?
the sequelae of TBI?
most often higher in mortality, assault or abuse in infants and children, MVA in adolescents, and it progresses rapidly.
Most common in infants/children as a result of assault or violent Shaking, and can possibly occur b/c of labor and delivery. Chronic form is more common.
24-72 hrs after delivery.
post-concussion syndrome, post-traumatic HAs, post-traumatic seizures, hydrocephalus.
head injury precautions
keep child NPO
stabilize neck and spine immediately.
use jaw thrust, not chin lift, to open airway.
assess pain but give no analgesics or sedatives.
check LOC and pupillary reaction every 4 hours (twice during the night) for 48 hours.
after a submersion injury, what should the nurse watch out for?
seizure activity
blood glucose (fluctuates in acute conditions)
effects from cerebral hypoxia.
meningococcal sepsis
B. meningitis complication.
severe, sudden, and rapid-overwhelming septic shock, DIC, massive bilateral adrenal hemorrhage, purpura.
with myelomeningocele there is a high risk for what?
latex allergy or hypersensitivity
