Peds Final - Review Flashcards
how to give meds to reluctant toddler / pre schooler
-give them a choice
-mix w/ food
-reward
-change method of delivery
Coarctation of the aorta
narrowing of aortic arch distal to the ductus so all the blood gets shunted up lower will have reduced blood flow, upper get high causing headaches, nose bleeds & bounding pulses
treated w/ prostaglandin E and surgery within first 2 years
kawasaki
body wide inflammation of veins, capillaries & coronary arteries treated with high dose aspirin for anti inflam & low dose for anti platelet and IVIG if fever is caught within 10 days
CHF
failure of the heart to supple enough blood to meet needs leading to sweating, tachy, decrease BF to kdineys, low urine output, cyanosis, SOB, edema, long cap refill
how to give digoxin
-1hr before or 2hr after eating
-check apical HR for 1 min prior
-do not mix with food or fluid
-put behind teeth then oral care
when to hold digoxin
if apical pulse is <90 in infants / young kids or <70 in older kids or low K+
if missed dose, can give within 4 hrs, but longer hold
signs of digoxin toxicity
-vomiting
-nausea
-bradycarida
-anorexia
-neurological & visional dysfunction
tetralogy of fallot
1) palmonic stenosis
2) overriding aortic arch
3) VSD
4) right ventricular hypertrophy
pre op care for cath lab
-npo for 4 to 6 hrs, clarify morning meds
-assessment including ht & wt
-assess skin can’t bring with a diaper rash or cystic ache
-mark pedal pulses
post op care for cath lab
observation of color, LOC, VS, res status, distal extremities, assess dressing for bleeding, fluids, blood sugar (esp hyper) & keep flat for 4-6hrs
bacterial endocarditis
infection of the valves and inner lining of the heart (usually occurs from a picc line or dental procedure) -> manifests w/ janeway spots, osler nodes, splinter hemorrhages under nails, petechia, anorexia, joint point & murmur
transposition of the great arteries
pulmonary artery arises from left ventricle and the aorta arises from the right ventricle -> treated w/ prostaglandin E until surgery
Hypospadias immediate post op care & teaching
urethral opening is on the ventral surface of the penis, surgical correction between 6-18mo no circ before surgery-> post opt care include assessing pressure dressing for drainage, cath care and teaching no tub baths, straddle toys, and baby cannot be carried on hip
more at risk for uti
key facts for GN
-caused by untreated strep, give abx
-S/s: headache d/t htn, coke colored urinne, facial edema
-urinalysis: hematuria, proteinuria & elevated SP w/ a negative culture
-diet: no salt, low pro
-bed rest, isolation
manual BP
key facts for acute renal failure
-caused by dehy (give fluids) or toxic meds (stop med then fluids)
-dx: low urine out, edema, classic dehy signs
-labs: bun & creatinine elevated, hypo Na, hyper K, hyper Phos
-meds: albumin then lasix
UTI teaching
wipe front to back, no tight clothes, hydrate, pee after sex, potty schedule, no bubble baths, change pads frequently
VCUG is reoccurring -> if reflux founds then abx or surgery in severe cases
key facts for NS
-S/s: massive proteinuria, rapid wt gain + generalized edema, decreased urine out, normal or slightly decreased BP, hypoalbuminemia
-bed rest & no salt, high pro if edema present + isolation
-meds: steroids & loop diuretics
key facts for HUS
-hx of GI bug + V/D, edema, oliguria, elevated BP, abdominal pain
-labs: low platelets & RBCs anemia
-Prevent: wash hands/fruits/vegs, cook & temp, avoid unpasteurized dairy & fruit juices
Downs S/s + treatment
-dx: depressed nose bridge & small nose, loose skin, large protruding tongue, wide space in between big toe, delayde sexual development, constipation
-tx: suction, antihis @6mo, blow nose, mist ; persistent feeding ; support neck & swaddle for thermal reg ; fluids & fiber
ADHD
-dx: 2 people say difficult concentrating, struggling in school and social settings
-tx: behavioral therapy 1st (front of class, low distraction, short written out task list) then meds (psychostim so clinic every couple months so assess growth & BP)
-med teaching: empty stomach, 7am and noon, no med holidays
DDH + harness
head of femur is not in hip socket so harness all the time besides baths prevent sink breakdown & avoid lotions/powders
MD
meets milestones then regression around 3-5 yrs
-brainstorm and work with family to keep them independent
-work w/ the therapies
SB
-paralyzed from waist down, incon of bowel and bladder (**high risk for uti d/t in&out cathing) + bowel training
-high risk for hydrocephalus after surgery
cast care
-neuro vascular checks + skin assessments 5 Ps
-do not stick anything into cast besides fingers
-ice for itching and swelling
-NSAIDs for pain No ibuprofen
-isometric exercises on affected side
kids are scared of removal -> ear plugs, demo on self, distraction
CP
-dx by missed milestones & persistent reflexes
-keep independent as long as possible
-support use of muscle
asthma
-proper deliver of meds (control= steroids & long beta 2s, rescue= short beta 2s, bronchodi’s & mag sulfact)
-med teaching (sit up, shake, breath out, inhale & press, hold 10 sec or spacer)
-PERF chart
croup
swelling or obstruction of airway creating horse, barky cough, stridor & res distress
viral = LTB, bacterial =epiglottis
Juvenile arthritis meds
1) NSAIDs
2) DMARDs
3) humira or enbrel (biologic agents)
4) corticosteroids
+ pt and warm baths
RSV
airway infection resulting in inflammation
-S/s: rhinorrhea, pharyngitis, intermit fever, cold symptoms -> wheezing, fever, feeding problems, increased secretions -> tachy, apneic spells, cyanosis
-tx: ribavrin, bronchdilators, cortsteroids, hydration & treat symptoms
suction the child first
vaccines only for high risk, <29wkers
pertussis
prevent! w/ Tdap
S/s: coughing so much that they cannot catch breath, decreased intake
tx: erythromycin, humidified oxygen, <6mo might need to be vented
techniques to reduce reflux
-elevate head of bed
-avoid caffeine, chocolate, mint, spicy food, high fat foods
tonsillectomy what to watch for post op
-excessive swallowing 8-10 after surgery bc that means bleeding, blood tinged sputum, discourage straws/coughing/laughing/crying
-diet: soft, no red foods, no milk products
contraindication for cleft palate, acute infections, uncontrolled systemic disease or blood dyscrasias, <4 y/o
Otitis medias
-how to prevent: limit exposure to cig smoke, no bottles in bed, breastfeed, no pacifier use beyond infancy
-allergies increases
-S/s: irritable, holds or pulls ears, may roll head, hearing loss if chronic
-tx: abx, Tylenol/Ibuprofen, warm compress
gastroschisis tx before surgery
no sac around organs
c section -> loosely cover organs w/ saline -> give fluids & abx -> bring to nicu -> multiple surgery (place organs inn silo in between)
gastroschisis nursing role
-sterile, careful handling
-monitor for ileus
-support family
cleft lip post surgery
z plasty in first weeks of life, after surgery place child on back or side use restraints so they don’t pick at sutures and suction only if necessary
cleft palate post surgery
close palate w/ obturators between 12-18months, after surgery place on their bellies w/ restrains and suction only if necessary
how to feed baby with cleft lip/palate
caused by inheritance, teratogens during pregnancy, maternal smoking -> long nipple & stim suck reflex , upright, lots of burping, stop after 30-45min
calculate fluid needs
-1st ten kg (100 x kg)
-2nd ten (50 x kg)
-20+ (20 x kg)
divide by 24 to get per hour
ways to prevent and reverse constipation
-child should have 5g of fiber + their age & fluids and potty schedule
tx: water -> add fruit juice into water -> miralax
if intestines expanded, keep them cleared out for 6 mo
how to care for a child w/ HIV
-aggressive antibiotics & prophylactic in the future
-modify immunization schedule
-very irritable so be calm and supportive
-can go to school but if bodily fluids then gloves
-increase kcals & protein
how to prevent HIV
-safe sex
-do not share needles
-take meds during pregnancy + c section
how to give iron
-acidic environment
-use straw to push past teeth then oral care
-increase fluids and fiber
-do not mix with foods
what is the first sign of a sickle cell crisis
swelling & s/s of anemia
joints for vaso occlusive, spleen for splinic
s/s of anemia
pale, bruise easily
what triggers a sickle cell crisis
-dehydration
-hypoxia / increased O2 needs
-infection
-trauma
-physical and emotional stress
-high altitudes
effects of chemo
-immunosuppression
-hair loss
-N/V, decrease appetite & intake
DKA treatment
BS >300, fruit breath, lethargy
1)fluid replacement w/ 10mL/kg 0.9% NS IV priority- 1st hr
2)lyte replacement over 48hr (0.9% NS + 20 mEq/L KPhos + 20 mEq/L KCl) 2nd hr
3)insulin therapy 0.1u/kg/hr drip 2nd hr (do not give bolus)
-begin dextrose infusion when BG reaches 250-300 (D5 0.45% NS + 20 mEq/L KPhos + 20 mEq/L KCl)
4)careful monitoring, D/c fluids when pt tolerates oral fluids & then give SubQ insulin and stop the drip
DM key points
-aspart (novolog), lispro (humalog) are rapid acting, glargine & detemir are long
-carb count, no restrictions besides high sugar
-when sick stay on insulin routine, check urine ketones, stay hydrated, check BS often
-biggest complication is DKA and then cerebral edema if we drop BG too fast
PKU diet
-no meat or dairy
-limit fruits & vegetables
-limit grains
most nutrition comes from pku formula
can be breast fed
cong hypothyroid med admin
oral thyroid hormone replacement -> start low and then slowly increase
will need to see dr and correct often d/t growth changes
teaching for growth hormones
-administer at night subQ 5-7x/wk
-can ice area before to decrease pain
-squeeze fat
not making super tall, just to predicted height
in a DKA pt, what do we flush the insulin line with
insulin
how do we know if the cancer has spread into the brain
high risk in leukemia
headache, persistent nausea & vomiting, irritability, dizziness, seizures, behavioral changes, lateral eye movement
what does digoxin do
allows hard to contract harder
tet spell
be calm & comforting
-knees to chest
-100% oxygen by face mask
-give morphine
-IV fluid replacement
-repeat morphine
**do one at a time & do not advance in list unless needed)
bacterial endocarditis therapeutic mgt
-IV antibiotics for 2 to 8 wks
-surgical removal of significant emboli and/or valve replacement
how to prevent bacterial endocarditis
prophylactic antibiotics 1hr before risky procedure for high risk kids
Kawasaki clinical manifestations
-fever that is unresponsive to meds
-rash & dry lips
-strawberry tongue
-bilateral pink eye w/o junk
-swollen palms
most dangerous when symptoms free in recovery phase bc embolism can form increasing risk for MI
Autism
-dx: social+communication+behavior, abnormal eye contact, flaps, repeating phrases
-tx: non verbal com, dim lights, limit ppl in room, calm, talk to caregivers, what to do vs what not to do
SB procedure immediately after birth
baby on belly -> apply non adherence sterile dressing over the sac -> NICU -> sedate & intubate -> surgery
reflexes time frame
-rooting & moro: 4mo
-tonic & grasping: 6mo
-babinski: 2yr
LTB
-slowly progressives and sounds worse than it is
-home mgt as long as not inn distress
-barky cough
-high humidity, fluids, & racemic epinephrine
-bed rest and continuous observation
avoid cough syrup/cold meds, bronchodilators & antibiotics
epiglottitis
life threatening d/t losing airway
-abrupt onset, open mouth, tongue out, drooling & agitated, looks sick & wants to be upright
-tx: no tongue blades or looking at throat, portal x ray if needed, sedate -> intubate -> abx - extubate
long term consequences of cleft L/P
-altered speech, dentition and hearing
-ear infections
teach good oral care, watch the ears and promote speech
CF key facts
always suction or pulmonary toilet or vest first
-lose extra salt, dehydration
-dx: pilocarpine electrophoresis (salt chloride) >60
-tx: CFTR modulators, abx, hydration, pancreatic enzymes
-diet: full fat, high kcal
hyperthyroid med : PTU
makes you immunocompromised so if pt gets a sore throat or infection, see medical professional immediately
