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Peds final ugh Flashcards

1
Q

A 6-month-old is playing by themselves with a soft stuffed animal. What type of play is this?

A

Solitary play

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2
Q

Three 2-year-olds are in the same room, playing. One is playing with puzzles, the other is playing with large crayons, and the last one is playing with push-pull toys. What type of play is this?

A

Parallel play

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3
Q

Two 6-year-olds are playing with legos, but one is making a tower and the other is making a house. What type of play is this?

A

Associative play

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4
Q

A group of 11-year-olds are playing the same videogame using the TV. What type of play is this?

A

Cooperative play

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5
Q

Which age group will benefit this best if the nurse demonstrates what they are going to do on the doll first?

A

Pre-schooler

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6
Q

Which age group requires approaching carefully/approaching parents first before talking/touching?

A

Toddlers

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7
Q

Which age group will benefit the most when the nurse uses diagrams and illustrations to explain things?

A

School-age

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8
Q

What are the expected findings of an infant’s weight?

A

X2 of birth weight by 5 months
X3 of birth weight by 12 months

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9
Q

How rapidly should the infant grow?

A

+1 in/month until 6 months
+ 50% of birth length by 12 months

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10
Q

What is the expected HC increase rate in infants?

A

Rapid increase until 6 months
+ 10cm by 12 months

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11
Q

What makes infants susceptible to upper respiratory infections?

A

Lack of IgA in upper respiratory lining
Funnel-shaped larynx
Narrow nasal passageway
Bronchi & bronchioles shorter & narrower
Few alveolis
Large tongue

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12
Q

When should you expect infants to control their head, roll from back to side, and grasp objects with both hands?

A

4 months

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13
Q

What motor development is expected at 6 months of age?

A

Rolls back to front
Holds bottle

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14
Q

What motor development is expected at 9 months of age?

A

Crude pincer grasp
Sit unsupported
Creeps with hands and knees

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15
Q

What motor development is expected at 12 months of age?

A

Feeds self with cup and spoon
Standing to sitting
2 block tower

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16
Q

When can solid foods be started?

A

4-6 months; when extrusion reflex is gone

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17
Q

A patient just delivered a baby and would like to breastfeed. What feeding recommendation can be given?

A

Breastfeed primarily for first 6 months
After 4 months, start iron supplements

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18
Q

A 38 week pregnant mom wants to bottle feed her baby. What feeding recommendation can be given?

A

Use iron fortified formula

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19
Q

What are some characteristics of toddler’s eating?

A

Physiologic anorexia
Food jag
Ritualism

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20
Q

How many words should a toddler know by 2 years of age?

A

50 to 200

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21
Q

What kind of language/language pattern do toddlers use?

A

Echolalia
Telegraphic language

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22
Q

How can you prepare toddler’s food to make them eat?

A

At or near room temperature
Small, bite side, soft food

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23
Q

When can kids sit front-facing in the car?

A

2 years old

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24
Q

What kind of cognitive development should occur in pre-schoolers?

A

Magical thinking
Animism
Imaginary friend
Can tell time in relation to daily events

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25
Q

What kind of play can help with social development in pre-schoolers?

A

Pretend play, dress up, role play. Get to explore different roles, emotions, characters

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26
Q

What are some normal assessment findings in school age?

A

Frontal sinus develop (at 7 yrs)
Tonsil size decrease but still large
Puberty; girls 9-10, boys 10-11
Permanent teeth

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27
Q

What social development occur at school age?

A

Peer pressure
Feelings of acceptance
Body image
Clubs and BFFs

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28
Q

What 2 supplements should adolescents take due to rapid growth?

A

Iron & Calcium
Iron: girls 15mg, boys 11mg
Calcium 1300mg

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29
Q

About how much calories should adolescents eat per day?

A

2000 calories

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30
Q

What are some important factors to consider when caring for an adolescent in the hospital?

A

Maintain privacy and independence
Encourage them to participate & socialize with friends
Identify any deficits in knowledge or self-care and provide resources

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31
Q

What is the first sign of hypoxemia in children?

A

Tachypnea

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32
Q

A 3-year-old presents to the ED with nasal flaring, grunting, retractions, head bobbing, clubbed fingers, restlessness, abnormal lung sounds, and cyanosis. What do you think the patient is experiencing?

A

Hypoxemia

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33
Q

How do you manage hypoxemia?

A

O2 therapy
Chest physiology
Suction
Pulse Ox

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34
Q

A 6-year-old presents to the ED with dyspnea, SOB, nonproductive cough. After assessment, you notice inspiratory wheeze, use of accessory muscles to breathe, and low O2 sats. What is the patient likely to experience?

A

Asthma

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35
Q

How can you manage asthma?

A

Avoid triggers
Use of maintenance meds

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36
Q

What labs/diagnostics are used to identify asthma?

A

PFT (lung volume capacity & overall function)
PIFR (Used daily to monitor management & signs of acute exacerbation)
Elevated WBC, eosinophil
Elevated CO2, low O2
CXR, Allergy/RAST test

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37
Q

What medications are used for acute exacerbation of asthma?

A

Albuterol (short acting beta agonist)
Ipratropium (anticholinergic)
Prednisone (corticosteroid)

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38
Q

What medications can you expect to be prescribed to a patient who is discharged from having an acute asthma attack to maintain asthma?

A

Formoterol (long acting vasodilator)
Fluticasone (inhaled corticosteroid)
Cromolyn (mast-cell stabilizer)
Montelukast (leukotriene receptor antagonist)

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39
Q

What medications are used to manage cystic fibrosis?

A

Dornase alfa (decrease viscosity)
Anticholinergics
Bronchodilators
Antiinflammtory
IV/nebulized abx
Fat soluble vit A, D, E, K
Pancreatic enzyme

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40
Q

When should pancreatic enzyme administered?

A

Within 30 minutes of eating

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41
Q

Why is abx used to manage cystic fibrosis?

A

All the mucus is sitting in the respiratory tract, which bacteria will grow.
Nasty.

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42
Q

What tests are done to diagnose cystic fibrosis?

A

Sweat chloride test
KUB
Stool analysis (greasy poop)
CXR
PFT

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43
Q

What values from sweat chloride test indicates cystic fibrosis?

A

Cl >40 in infants <3 month old, >60 for other
Na >90

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44
Q

A 5-year-old presented to the ED with barking cough, inspiratory stridor, tachypnea, and respiratory distress. Mom states that he’s find during the day but coughs bad at night, and it has been lasting for 4 days now. What condition is this patient in?

A

CROUP

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45
Q

What medications are given to manage CROUP?

A

Betamethasone (decrease inflammation)
Racemic epi (nebulizer; only lasts 2 hr)

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46
Q

How is CROUP managed?

A

Usually outpatient
Cool humidifier, steamy bathroom
Educate on increased s/s of respiratory distress

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47
Q

What are the nursing priorities of heart failure?

A

Oxygenation/ventilation
Promote rest
Adequate nutrition (150cal/kg/day)

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48
Q

How should kids with heart failure fed?

A

20 min feeding time
If anything remaining, goes through NG/OG

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49
Q

What 4 medications are used to manage heart failure?

A

Metoprolol (decrease HR and BP & vasodilate)
Lasix (edema)
Captopril/Enalapril (decrease afterload by vasodilation)
Digoxin (increase cardiac contractility)

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50
Q

A 3-year-old presents to the ED. Upon assessment, you notice full, bounding pulse on UEs but weak/absent pulse on LEs. You also notice higher BP in UE and lower BP in LE. With that, there’s soft systolic murmur at base. What condition is this kid likely to have?

A

Coarctation of the aorta

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51
Q

What’s tetralogy of fallot?

A

Hole between ventricles, so both oxygenated and unoxygenated blood is being pumped to the body, resulting in poor perfusion

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52
Q

What are the s/s of tetralogy of fallot?

A

Fainting
Color change with feeding, activity, crying
Loud, harsh systolic murmur

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53
Q

What’s a TET spell?

A

Hypoxemia, dyspnea, agitation leading to anoxia and unresponsiveness
Especially in the morning

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54
Q

How can you break TET spell?

A

Knee to chest
Squatting

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55
Q

What nursing management is required for tetralogy of fallot patient?

A

Promote oxygenation/ventilation (O2, upright position, suctioning)
Adequate nutrition (small, frequent meals or NG/OG, 150 cal/kg/day)
Avoid crying

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56
Q

What are the symptoms of Kawasaki diesease?

A

High fever for at least 5 days
Unresponsive to abx
Desquamation of fingers, toes, peri area
Significant bilat. conjunctivitis w/o exudate
Mouth & throat dry, fissured lips, strawberry tongue, pharyngeal/oral MM edema

57
Q

How is Kawasaki disease treated/managed?

A

High dose aspirin (prevent aneurysm)
Acetaminophen (fever)
Oral care
IVIG (increase immune)
Strict I&Os, daily weight

58
Q

BPM under what number is considered life-threatening in peds?

A

< 60

59
Q

What’s the range of sinus tachycardia in peds?

A

Infants (160-220)
Children (130-180)

60
Q

What causes sinus tachycardia in peds?

A

Usually fever, dehydration, pain, hypoxia

61
Q

How is sinus tachycardia treated?

A

By treating the underlying cause

62
Q

What’s the range for SVT in peds?

A

Infants >220bpm
Children >180bpm

63
Q

How does SVT look like on the EKG strip?

A

Flat P wave
Narrow QRS

64
Q

How is compensated SVT treated?

A

Vagal maneuver
If vagal fails, adenosine

65
Q

How is uncompensated SVT treated?

A

Adenosine or synchronized cardioversion

66
Q

What are the assessment findings when a child is dehydrated?

A

Dry MM
Sunken fontanel
Tearless
Sunken eyes
Poor skin turgor
Oliguria
Hypotension
Tachycardia
Tachypnea
Sudden weight loss

67
Q

Can you use tap water for oral hydration replacement therapy?

A

No. Pedialyte only

68
Q

When is oral hydration used?

A

For mild-moderate dehydration

69
Q

How much Pedialyte should be consumed to treat mild dehydration?

A

50mL/kg within 4 hours

70
Q

How much Pedialyte should be consumed to treat moderate dehydration?

A

100mL/kg within 4 hours

71
Q

How much Pedialyte should be consumed if a child had 3 diarrhea?

A

10mL/kg/stool
Therefore 30mL/kg

72
Q

When is IV rehydration initiated?

A

For severe dehydration or unable to tolerate PO rehydration

73
Q

How much IVF should you administer to help with severe dehydration?

A

20mL NS bolus + maintenances
100mL/kg for 1st 10kg
50mL/kg for 2nd 10kg
20mL/kg for rest of kg

74
Q

A 2-year-old presented to the ED with projectile vomiting. Upon assessment, you notice olive-shaped mass in RUQ, and pt reports hunger right after vomiting. A few labs were done, and the result showed electrolyte imbalance and metabolic alkalosis. What condition is this pt likely to be in?

A

Pyloric stenosis

75
Q

What nursing management should be done when caring for a pyloric stenosis patient?

A

NG tube to decompress stomach
NPO
Prepare for surgery
IVF for electrolyte and dehydration
Post-op incision care

76
Q

When can post-op pyloric stenosis patient resume PO feeding?

A

1-2 days after

77
Q

What are the expected findings of Hirschsprung’s disease in newborns?

A

Not passing meconium in 24-48 hours
Vomiting bile
Refusal to eat
Abd distention

78
Q

What are the expected findings of Hirschsprung’s in infants/child?

A

Constipation
N/V/D
Foul-smelling, ribbon-like poop
Abd distention
Visible peristalsis
Palpable fecal mass

79
Q

How is Hirschsprung’s treated?

A

Surgery; colostomy or ileostomy

80
Q

A 8-year-old presented to the ED with fever, decreased urine output, hematuria, abdominal pain, anorexia, and edema. Upon assessment, pt has HTN, proteinuria, s/s of fluid overload and CHF. Pt stated that she recently had a strep throat. What is this patient likely to have?

A

Acute glomerulonephritis

81
Q

What are the nursing priorities when treating acute glomerulonephritis?

A

Monitor fluid status/volume
Manage HTN
Abx for strep infection
Monitor VS, renal, neuro changes
Monitor urine output

82
Q

Robin is having watery diarrhea with cramps, a bit of blood in stool, vomiting, not peeing much, and looks pale and toxic. He recently went to a petting zoo and ate a hamburger with ground beef in it. What condition is Robin likely to experience right now?

A

Hemolytic uremic syndrome

83
Q

Robin was admitted to the hospital. He has Hemolytic uremic syndrome, and VS revealed that he has HTN. The nurse is creating a care plan on him. What should the nurse include?

A

Manage HTN
Maintain fluid electrolyte balance
Contact precaution (E.coli)
Monitor for bleeding, pallor, fatigue
Strict I&Os
Possible PRBC & platelet if Robin actively bleeding and it’s not stopping
Possible IVIG

84
Q

What’s hypospadias?

A

Abnormal urethral opening on ventral surface of penis (below glandis penis)

85
Q

How is hypospadias treated?

A

Urethral stent/drainage tubing.
Taped with penis upright to prevent stress on the incision site
Double diaper to keep poop away
Analgesics for pain

86
Q

What indicates GH deficiency?

A

Short stature
High-pitched voice
Delay in sexual, skeletal maturation, dentition
Large, prominent forehead
Underdeveloped jaw
Decreased muscle mass

87
Q

How is GH deficiency treated?

A

Biosynthetic GH; SubQ daily

88
Q

How often should you check height for GH effectiveness?

A

Q 3-6 months

89
Q

When is GH therapy stopped?

A

When growing < 1in/yr
Bone age > 16 in boys, > 14 in girls

90
Q

What are the manifestations of congenital hypothyroidism?

A

Hypothermia
Poor sucking reflex
Constipation
Lethargy/hypotonia
Periorbital puffiness
Cool, dry, scaly skin
Bradycardia
RR distress
Large fontanel, delayed closure

91
Q

What are the symptoms of DKA?

A

> 330
Polyuria, dipsia, phagia
Kussmals breathing; rapid, deep, fruity
Warm, dry, flushed skin
Dry MM
Confusion, lethargy, weak
Weak pulse, diminished reflexes

92
Q

How is DKA managed?

A

ICU admission
Q1H BS check
IV regular insulin drip & sliding scale
IVF for dehydration

93
Q

Why is it important to check BS Q1H in DKA pt?

A

Rapid decline in BS level (>100/hr) will lead to cerebral edema

94
Q

What are the physical cues of hydrocephalus?

A

Wide, open, bulging fontanel
Sunset eyes
Large head/recent change in HC
Thin, shiny scalp with prominent, visible scalp veins
Vision/gait change
Projectile vomit
Change in LOC

95
Q

How is hydrocephalus managed?

A

VP shunt

96
Q

How do you know is VP shunt is infected/obstructed?

A

Increased ICP; fever, headache, stiff neck, bulging fontanel, dilated pupil, increase HC

97
Q

What’s the cushing’s triad for increased ICP?

A

HTN
Bradycardia
Irregular RR

98
Q

How do you manage increased ICP?

A

Decrease stimulation
Elevated HOB, head midline, body alignment
Avoid suctioning, coughing, blowing nose
Stool softener

99
Q

How is bacterial meningitis managed?

A

ICU admit with strict droplet until 24 hr of abx or ordered to be off
Ventilator
Manage hyperthermia (NSAIDs, cooling)
Abx after cultures

100
Q

What lab findings are expected in bacterial meningitis?

A

LP: high WBC, low glucose, high protein, cloudy
CBC: high WBC
Kernig & Brudzinski sign

101
Q

What are the s/s of Reye syndrome?

A

Liver failure
Encephalopathy
Cerebral edema
Severe, continual vomiting
s/s increased ICP
Hyperreflexia
Red, macular rash may be present
Hyperammonemia
Hypocoagulability
Hypoglycemia

102
Q

What’s the priority of care in Reye syndrome?

A

Decrease ICP
Manage liver failure
Hope for the best

103
Q

What medication is given to help hyperammonemia?

A

Lactulose
Poop it out

104
Q

What can be given to help with hypocoagulability?

A

Fresh frozen plasma
Vitamin K

105
Q

What’s most important when caring for a spina bifida patient?

A

Sac care
Keep is moist with NS gauze
Keep baby under warmer since we can’t swaddle them
Prone position
Monitor HC & ICP
Promote child-parent bond

106
Q

What medications are used to manage cerebral palsy?

A

Baclofen
Botox
Carbidopa
All 3 for muscle relaxing to promote mobility

107
Q

What type of fx is common in kids?

A

Greenstick or buckle (compression injury)

108
Q

What are some common places for child fx?

A

Wrist
Midclavicular, humerus, femur -> birth trauma

109
Q

What are some uncommon place for child fx?

A

Scapula
Femur in immobile kid
Ribs
Pelvic
Hip
Sternal
Any bilateral fx

110
Q

What are the 2 complications of fx?

A

Compartment syndrome
Osteomyelitis

111
Q

How long is acute otitis media treatment?

A

10-14 days if PO abx
1 dose IM

112
Q

What are the s/s of pertussis?

A

Paroxysmal cough
Face red, body cyanotic
Teary eyes, drooling, copious secretions

113
Q

What meds are used to treat pertussis?

A

Macrolides (mycins)
< 1 month - Azithromycin

114
Q

What meds are used to treat Lyme disease?

A

Doxycycline for > 8 yrs
Amoxicillin for < 8 yrs
For 14-28 days

115
Q

What’s most important for burn patients for first 24 hours?

A

Fluid resuscitation to prevent hypovolemic shock

116
Q

How is required fluid amount calculated in peds burn patient?

A

Using the parkland formula; fluid calculated based on total body surface area burned)

117
Q

What chart is used to determine total body surface area burned in peds?

A

Lund & Browder chart

118
Q

How much urine output is considered adequate during fluid resuscitation?

A

1-2mL/kg/hr

119
Q

What nutritional factors are needed in burn patients?

A

Increased calorie, protein
Vit A & C for cell
Zinc for wound healing

120
Q

What medications are used to treat atopic dermatitis?

A

Topical corticosteroids
Antihistamine at night
Immune modulator (tacrolimus)

121
Q

How is SCID treated?

A

IVIG
Bone marrow transplant

122
Q

Elevated neutrophils indicate

A

Acute bacterial infection

123
Q

Elevated eosinophil indicate

A

Allergic reaction or chronic bacterial infection

124
Q

Elevated lymphocyte indicate

A

Viral infection

125
Q

What does IgG protect against?

A

Virus, bacteria, toxins

126
Q

What does IgA do?

A

1st line defense for respiratory, GI, GU pathogens

127
Q

What does IgM indicate?

A

Active infection

128
Q

What does IgE indicate?

A

Allergic state, parasitic infection

129
Q

What does elevated complement C3 mean?

A

Means that Immune system is active from an infection/injury

130
Q

How is hemophilia managed?

A

Administer Factor VIII
External bleeding - direct pressure
Internal bleeding - ice/cold pack & elevate unless contraindicated
If mild, use desmopressin

131
Q

What does desmopressin do?

A

Triggers blood vessels to make factor VIII

132
Q

What are the assessment findings of iron deficiency anemia?

A

Fatigue
Pallor
SOB
PICA
Spooning of nails
Dizziness

133
Q

What are the diagnostic cues of iron deficiency anemia?

A

Low RBC, Hgb, Hct, MCV, MCH, ferritin
High RDW

134
Q

What are the s/s of sickle cell vaso-occlusive crisis?

A

Splenomegaly
Severe pain (abd, thorax, joints, digits)
Dactylitis
Increase WOB, fever, tachypnea, hypoxia
Jaundice

135
Q

When should you start applying O2 on sickle cell vaso-occlusive crisis pt?

A

When SpO2 < 92%

136
Q

How often should you check for s/s infection in pt in neutropenic precaution?

A

Q8H

137
Q

How is N/V/Anorexia managed?

A

Bland, dry foods
Offer carbonated drinks, popsicles, ice throughout the day
Room temp food
Small, frequent

138
Q

What are the s/s of acute lymphoblastic leukemia (ALL)?

A

Enlarged liver & lymph nodes
Low grade fever
Petechiae, bruising
s/s of infection
Pallor

139
Q

What are the lab/diagnostic findings in ALL?

A

Low RBC, Hct, Hgb, platelet
Low/normal/high WBC
BMA is most definite when diagnosing ALL

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