PEDs Test #2 Flashcards
1
Q
skeletal growth is stimulated by
A
pituitary growth hormone
2
Q
growth of the long boned occurs at the
A
epiphysis
3
Q
clubfoot deformities
A
can have one or a combination of four: plantar flexion, dorsiflexion, varus deviation, valgus deviation
4
Q
varus deviation
A
foot turns in
5
Q
valgus deviation
A
foot turns out
6
Q
what causes clubfoot
A
bone deformity and malposition with soft tissue contraction
7
Q
the affected foot ic clubfoot is usually
A
smaller and shorter, with an empty heel pad and transverse plantar crease
8
Q
management of clubfoot
A
serial manipulation and casting, and if correction not achieved within 3-6 months surgery will be performed
9
Q
developmental dysplasia of the hip
A
dislocation of the hip - femoral head and acetabulum are improperly aligned
10
Q
clinical manifestation in an infant with dysplasia of the hip
A
asymmetry of the gluteal folds, short femur, limited range of motion on affected hip
11
Q
clinical manifestation in a child with dysplasia of the hip
A
same as manifestations of infant plus positive trendelenburg gait
12
Q
trendelenburg gait
A
abnormal tilting of pelvis on unaffected side when bearing weight on the affected side
13
Q
diagnostics for dysplasia of the hip
A
screening at birth with ortolans’s and Barlow’s maneuvers, ultrasound, radiography
14
Q
most important management of dysplasia of hip
A
early intervention
15
Q
management for dysplasia of hip for newborns
A
pavlik harness
16
Q
management for dysplasia of hip at 6-18 months
A
dislocation unrecognized until child begins to stand and walk; use traction and cast immobilization (Spica cast)
17
Q
management for dysplasia of hip in older child
A
operative reduction, difficult after 4 years
18
Q
nursing care for pavlik harness
A
teaching parents to keep harness on continuously, follow up appts, teach and reinforce skin care
19
Q
nursing care for spica cast
A
frequent neurovascular checks, range of motion, skin integrity, evaluate hydration status, assess elimination status daily
20
Q
bone healing and remodeling in neonatal period
A
2-3 weeks
21
Q
bone healing and remodeling in early childhood
A
4 weeks
22
Q
bone healing and remodeling in later childhood
A
6-8 weeks
23
Q
bone healing and remodeling in adolescence
A
8-12 weeks
24
Q
osteogenesis imperfecta
A
also known as brittle bone disease
25
osteogenesis imperfecta results from
a defect in the synthesis of collagen
26
most common type of osteogenesis imperfecta
autosomal-dominant inheritance pattern
27
clinical manifestations of osteogenesis imperfecta
osteoporosis, excessive bone fragility, blue sclera, discolored teeth, conductive hearing loss by age 20-30, skin may appear translucent
28
scoliosis
lateral curvature of the spine
29
muscular dystrophy clinical manifestations
waddling gait, lordosis, difficulty climbing stairs, development of gower's sign, scoliosis of the spine
30
muscular dystrophy clinical manifestations appear when?
after walking is achieved (3-7 years)
31
muscular dystrophy diagnostics
positive family history, elevated serum creatine kinase, electromyography, muscle biopsy
32
therapeutic management of muscular dystrophy
maintenance of ambulation and independence, surgery, bracing, physical therapy
33
muscular dystrophy nursing considerations
Child should be immobilized for as short a period as possible to help prevent disuse atrophy- try to ambulate 3 hours a day
Frequent rest periods in a recumbent position are helpful to help reduce the incidence of scoliosis
34
muscular dystrophy diet
low calorie, high protein, high fiber and high fluid
35
Duchenne muscular dystrophy
most common hereditary neuromuscular disease
36
Duchenne muscular dystrophy is linked to
X linked recessive disorder
37
Duchenne muscular dystrophy s/s
progressive weakness with no loss of sensation
38
Duchenne muscular dystrophy usually diagnosed
3-7 yrs of age
39
treatment of Duchenne muscular dystrophy
aimed to control symptoms and improve quality of life and steroids can slow strength
40
Duchenne muscular dystrophy death occurs usually by
age 25
41
stroke volume in neonates
they cannot increase stoke volume as effectively as older children
42
heart and great vessels develop during
first 3-8 wks gestation
43
congenital heart disease (CHD)
anatomic- abnormal function present at birth
44
acquires heart disease
occurs due to disease process such as infection, autoimmune response, environmental factors, familial tendencies
45
assessment of cardiovascular dysfunction
nutrition status, color, chest deformities, clubbing
46
diagnostic evaluation of cardiovascular dysfunction
electrocardiography, echocardiography, cardiac catheterization, electrophysiology
47
major cause of death in first year of life after prematurity
congenital heart disease
48
most common anomaly of congenital heart disease
ventricular septal defect
49
survival of congenital heart disease depends on
how severe the defect is, when its diagnosed, and how its treated
50
what is acyanotic heart defect
blood is shunted (flows) from the left side of the heart to the right side of the heart due to a structural defect (hole) in the interventricular septum
51
what is cyanotic heart defect
result in a low blood oxygen level
52
bloods flows
from area of high pressure to one of low pressure and takes the path of least resistance
53
what happens with acyanotic heart defect
increase pulmonary blood flow and obstruction of blood flow from ventricles
54
what happens with cyanotic heart defect
decrease pulmonary blood flow and mixed blood flow
55
ductus arteriosus
in utero normally shunts blood from the main pulmonary artery to the descending aorta bypassing the non aerated lungs
56
normally ductus arteriosus closes
functionally within 48 hours and anatomically around 2 weeks
57
patent ductus arteriosus
medical condition in which the ductus arteriosus fails to close after birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta, which has a higher pressure, to the pulmonary artery.
58
patent ductus arteriosus manifestations
varies from asymptomatic to s/s of CHF and machinery like murmur
59
patent ductus arteriosus manifestations is dependent on
the amount of left to right shunting
60
what should be administered for patent ductus arteriosus
indomethacin
61
management for patent ductus arteriosus
surgical division of ligation of the patent vessel, coils, and indomethacin
62
ventricular septal defect
an opening in the ventricular septum in which blood flows through the defect back into the pulmonary artery
63
most common form of congestive heart disease
ventricular septal defect accounts for 20% of all cases
64
increased pulmonary resistance in VSD causes
RV hypertrophy and if RV cannot accommodate workload than the RA may also enlarge
65
VSD manifestations
s/s of failure to thrive and/or respiration infection with s/s of CHF. holosystolic murmur
66
VSD s/s based on
the size of the defect and amount of pulmonary over circulation
67
holosystolic murmur heard best at
LSB
68
VSD can ultimately lead to
pulmonary hypertension
69
VSD management
complete repair with sutures or patch
70
coarctation of the aorta
narrowing of the aorta typically near the insertion of the ductus arteriosus
71
coarctation of the aorta results in
increased pressure proximal to the defect and decreased pressure distal to the obstruction
72
coarctation of the aorta manifestations
high blood pressure and bounding pulses in the arms and absent femoral pulses with cool lower extremities. some may show signs of CHF
73
coarctation of the aorta management
resection of the coarcted portion with an end to end anastomosis or balloon angioplasty or stents
74
tetralogy of fallot includes what defects
VSD
Pulmonic stenosis: narrowing at the entrance of the pulmonary arteries
Overriding aorta
RV hypertrophy
75
the degree cyanosis of tetralogy of fallot is directly related to
severity of the Pulmonic stenosis
76
tetralogy of fallot manifestations
systolic murmur, tet spells, acutely cyanotic at birth others may have progressive cyanosis as PS worsens
77
tet spells
anoxic spells when O2 requirement exceed blood supply
78
tetralogy of fallot management
complete repair during 1st year of life and blalock trussing shunt
79
complete repair of tetralogy of fallot
closure of the VSD, resection, and patch of PS which requires open thoracotomy/sternotomy and bypass
80
blalock-taussig shunt
provides blood flow to the pulmonary arteries via a tube graft (palliative tetralogy of fallot)
81
hypoplastic left heart syndrome
underdevelopment of the left side of the heart
82
hypoplastic left heart syndrome manifestations
mild cyanosis until PDA closes the rapid progressive deterioration
83
decreased cardiac output during hypo plastic left heart syndrome leads to
cardiovascular collapse
84
hypo plastic left heart syndrome management
transplantation, prostaglandin infusion, multiple stage procedure
85
prostaglandin infusion
helps maintain ductal latency until surgical intervention
86
heart failure
inability of the heart to pump an adequate amount of blood to the systemic circulation
87
in children heart failure occurs
most frequently secondary to structural abnormalities
88
right sided heart failure
RV is unable to pump blood into the pulmonary artery which increases RA pressure =, systemic venous hypertension
89
left sided heart failure
LV is unable to pump blood into the systemic circulation which increase LA pressure and pulmonary venous pressure
90
management of heart failure
improve cardiac function, remove accumulated fluid and sodium, decrease cardiac demands, improve tissue oxygenation
91
evaluation of heart failure
CXR, ECG, and echo
92
CXR
shows for cardiomegaly and increased pulmonary blood flow
93
ECG shows for
ventricular hypertrophy
94
echo helps
determine the cause of heart failure
95
digoxin toxicity manifests with
slow pulse, vomiting, and arrhythmia
96
what can increase risk of digoxin
hypokalemia and hypomagnesemia
97
what med is effective for heart failure
digoxin
98
bradydysrhythmias can be attributed to
hyper vagal tone and response to hypoxia and hypotension from the influence of the autonomic nervous system
99
meds for CHF
diuretics, furosemide, spironolactone (potassium sparing diuretic)
100
tachydysrhythmia can be from
fever, anxiety, pain, anemia, dehydration
101
supraventricular tachycardia beats per minute
HR 200-300+ beats per min
102
supraventricular tachycardia
sudden onset, variable duration, and may end abruptly and convert back to normal without intervention
103
supraventricular tachycardia s/s
poor feeding, extreme irritability, pallor, dizziness, chest pain, palpitations
104
treatment of supraventricular tachycardia
vagal maneuvers, adenosine, synchronized cardioversion, and long term management with digoxin, propranolol, amiodarone, or ablation
105
adenosine
impairs AV conduction
106
Kawasaki disease
acute systemic vasculitis of unknown cause
107
75% of Kawasaki disease occurs in
children with a peak incidence in toddlers
108
increased incidence of Kawasaki disease in
late winter and early spring
109
treatment of Kawasaki disease
acute disease is self limiting
110
20% of children with Kawasaki disease develop
coronary artery dilation or aneurysm without treatment
111
what is Kawasaki disease
extensive inflammation of arterioles, venues, and capillaries
112
Kawasaki disease manifestation
fever for more than 5 days with changes in extremities, bilateral conjunctival injection, changes in oral mucous membranes, polymorphous rash, and cervical lymphadenopathy (must have 4 of the five)
113
Changes in oral mucous membranes in Kawasaki disease
erythema of the lips, oropharyngeal reddening, “strawberry tongue” large exposed papillae
114
changes in extremities with kawasaki disease
edema, erythema of palms and soles, periungual desquamation of the hands and feet
115
kawasaki disease management
high dose intravenous immunoglobulins (IVIG) and salicylates
116
what do high dose IVIG do
reduces the risk of coronary artery abnormalities
117
incubation period
the time between exposure to the disease and disease outbreak; during this time the child may be contagious
118
period of communicability
the period when the organism can move from the host to another individual
119
prodromal period
the time between the initial symptoms and the presence of the full-blown disease
120
symptoms of viral infection
rash, fever, and color or flu-like symptoms
121
viral infection transmission
direct contact with droplets or airborne particles which can be prevented with immunization
122
complication of viral infection
encephalitis
123
firth disease is also called
erythema infectiosum
124
fifth disease manifestations
maculopapular rash on truck and extremities. fiery red, edematous rash on cheeks "slapped cheek"
125
fifth disease may be passed to
the fetus and cause severe anemia or fetal death
126
fifth disease is caused by
human parvovirus B-19
127
Group B enterovirus-nonpolio is also called
coxsackie virus, hand foot and mouth
128
s/s of coxsackie virus
fever, cold symptoms, sore throat, vesicles in mouth palms and feet
129
spreading of coxsackie virus
fecal - oral virus through direct contact
130
causative agent of mumps
paramyxovirus
131
complications of mumps
aseptic meningitis, encephalitis, deafness, orchitis, sterility, glomerulonephritis, myocarditis
132
transmission of mumps
oral and nasal secretions
133
mumps treatment
isolation for 5 days and supportive care, acetaminophen, bland foods, hydration, ice packs
134
pump patients should not have
aspirin due to risk of reye syndrome
135
prevention of mumps
MMR vaccine
136
complications of mumps
hearing loss, orchitis, oophoritis, arthritis
137
mumps affects the
salivary glands
138
s/s mumps
swelling of the neck chin area
139
sixth disease is called
roseola infantum
140
sixth disease is caused by
human herpes virus 6
141
roseola infantum (sixth disease) s/s
erythematous maculopapular rash that shows up when fever goes away
142
prodromal stage of of roseola
sudden high fever above 103 for 3-7 days
143
German measles =
rubella
144
rubella rash
pinkish rose maculopapular exanthema that begins on face, neck and spreads downward to include the entire body within 1-3 days
145
most devastating form of rubella
congenital rubella
146
congenital rubella can result in
mental retardation, cataracts, retinopathy and cardiac anomalies, deafness, miscarriage and fetal death
147
prevention of rubella
teach importance of vaccine (MMR) before childbearing years
148
three Cs of measles
coryza, cough and conjunctivitis
149
s/s of measles
kopek spots and deep red macular rash that begins on face and neck and spreads
150
koplik spots
on buccal mucosa appear prior to the rash and lasts for 3 days
151
complications of measles
encephalitis, mental retardation, OM, pneumonia, seizures, death
152
measles treatment
isolation for 5 days
153
what should you do to the lights with measles
dim the lights due to photophobia
154
leading cause of preventable blindness
vitamin A deficiencies
155
varicella
chx pox
156
zoster
shingles
157
infectious period of varicella zoster
1-2 days before onset of rash
158
varicella rash stage
all stages present at same time: macule, papule, vesicle, and crust
159
zoster rash
unilateral, macular/papular and follow dermatome
160
family education for varicella zoster
do not give aspirin because of risk of Reyes, child contagious until lesions are crusted over, varicella vaccine, prevent scraping to avoid developing secondary infection
161
zika virus associated with
flaviviridae virus which is related to west nile virus
162
strep throat is related to
scarlet fever
163
what bacteria is related to strep throat
group A beta-hemolytic streptococcus (GAS)
164
scarlet fever
strep throat with a rash
165
complications with scarlet fever
rheumatic fever and post streptococcal glomerulonephritis
166
manifestations of scarlet fever
sandpaper rash and strawberry tongue
167
impetigo is caused by
staphylococcus aureus or group A beta hemolytic streptococci or a combination of both
168
impetigo lesions
common around nose and mouth
169
impetigo incubation period
7-10 days and may spread to other body parts or to other people
170
treatment of impetigo
topical antibiotic but if more extensive oral antibiotics needed
171
cellulitis
inflammation of the skin and SQ tissue with redness, swelling, and firm infiltration
172
what can be involved with cellulitis
regional lymph node involvement is common
173
treatment of cellulitis
requires oral or parenteral antibiotics
174
MRSA can be treated with
outpatient care
175
MRSA prevention
careful hand hygiene after changing bandages
176
diaper dermatitis
Candida albicans produces perianal inflammation and maculopapular rash
177
tinea
infection caused by dermatophytes
178
dermatophytes
a unique group of fungi capable of infecting nonviable keratinized cutaneous structures including stratum corneal, nails, and hair
179
tinea is classified according to
the part of the body that it is affecting
180
tinea capitis
fungal infection of the scalp from recent exposure to infected person or animals
181
tinea capitis management
requires oral anti fungal
182
tinea corporis treatment
topical usually effective
183
tinea pedis treatment
topical over the counter
184
pediculosis capitus
head lice
185
treatment for head lice
nix or rid - over the counter
186
scabies
mites transmitted by close personal contact with infected person. mite burrows in skin and lays eggs
187
clinical manifestations of scabies
intense itching especially at night, in older children lesions often found in webs of fingers, elbows, axillae, groin and waist
188
scabies treatment
elimite prescription, antihistamine, antibiotics if infection develops
189
child with scabies my return back to school
the day after treatment
190
type 1 hypersensitivity reaction
anaphylaxis
191
type 2 hypersensitivity reactions
tissue specific reactions - IgG or IgM antibodies
192
type 3 hypersensitivity reaction
immune complex reaction such as glomerulonephritis
193
type 4 hypersensitivity reaction
delayed reaction that causes inflammation and tissue damage
194
anaphylaxis occurs when
allergens binds to IgE on mast cells
195
anaphylaxis in pediatrics
due to immaturity of GI tract, large proteins can be absorbed and mistaken from antigen and they can present with flushing skin instead of hives
196
latex has a cross reactivity with
kiwi, chestnut, avocado, tomato, potato, and banana
197
decrease in family size and better hygiene may be contributing to
an increase in environmental and food allergies in Western Culture
198
when should parents introduce solid foods
by 4-6 months parents should look for signs that baby is ready to eat and introduce one food at a time and wait 2-3 days between each food
199
to come up with a plan to treat dehydration what most be determined
degree of dehydration, type of dehydration, initial Na levels, HCO3 levels, and electrolyte and acid/base imbalance
200
mild dehydration s/s
watery diarrhea, cap refill less than 2 sec, slight increase in thirst, normal urine specific gravity
201
moderate dehydration s/s
abnormal skin turgor, 2-4 sec cap refill, thirst, increase in pulse, dry mucous membrane
202
severe dehydration s/s
tented skin, sunken fontanel, cap refill greater than 4 sec, extreme thirst, tachycardia, anuria
203
mild dehydration wt loss in infants and children
infants - 3-5%
| children 3-4%
204
moderate dehydration wt loss in infants and children
infants - 6-9%
| children - 6-8%
205
severe dehydration wt loss in infants and children
10% weight loss in infants and children
206
VS of severe dehydration
pulse increase, BP down, RR up
207
children with severe volume depletion should be given
isotonic fluid bolus
208
when should you use IV rehydration
when child is unable to ingest sufficient amounts of fluid and electrolytes in order to meet ongoing daily loses, replace previous loses, and replace ongoing loses
209
pt who are dehydrated should avoid
sports drinks, fruit juices, sodas and gelatin due to high % of sugar which can further aggravate diarrhea
210
leading cause of illness in children younger than 5 years old
diarrhea
211
diarrhea can be associated with
URI, UTI, antibiotic use and laxative use
212
infectious diarrhea is usually caused by
viral - ROTOVIRUS but can be by a variety of bugs
213
two categories of vomiting
bilious and nonbilious
214
bilious vomitting implies
disorder of motility or distal blockage
215
vomiting treatment
usually self limiting unless bilious vomiting or dehydration occurs
216
if vomiting do not use______ unless absolutely necessary
antiemetic
217
manifestations of GERD
spitting, vomiting, crying, weight loss, cough, choking, apnea
218
GERD management
depends on severity but elevating HOB, thickened feeds, and H2 receptor antagonist/PPI can help
219
what surgical intervention can be performed with bad GERD
nissen fundoplication
220
Hirschsprung disease
congenital aganalionic megacolon - results in mechanical obstruction on the intestine
221
who is more likely to get Hirschsprung disease
4x more common in males and follows a familial pattern
222
the absence of what causes Hirschsprung disease
absence of ganglion cells results in loss of nervous system stimulation
223
diagnoses of Hirschsprung disease
happens in the first few months of life - confirmed with full thickness rectal biopsy with absence of ganglion cells
224
s/s of Hirschsprung disease
distended abdomen, feeding intolerance, bilious vomiting, delay in passage of meconium or constipation since birth
225
management of Hirschsprung disease
removal of ganglionic portion of bowel and majority require colostomy/mucous fistula
226
most common cause of emergency abd surgery in childhood
acute appendicitis
227
peak incidence of acute appendicitis
12-18 years of age
228
acute appendicitis occurs more during what time of year
fall and winter
229
classic first sign of acute appendicitis
pain in periumbilical area followed by nausea, RLQ pain and later vomiting with fever
230
during acute appendicitis most intense pain site
McBurneys point
231
not reliable sign of acute appendicitis
rebound tenderness and it is extremely painful
232
s/s acute appendicitis
fever, abd pain, and leukocytosis
233
management of acute appendicitis
IV fluids, antibiotics, NG tube for decompression, surgery
234
what antibiotics for acute appendicitis
3rd generation cephalosporin
235
most common cause of intestinal obstruction in children between 3 months and 3 years
intussusception
236
what happens with intussusception
occurs when a proximal segment of bowel invades into the distal segment
237
as edema builds up from obstruction during intussusception
pressure is applied to the arterial system and leads to ischemia
238
sign of intussusception
stool that looks like currant jelly
239
most serious type of intestinal obstruction
malrotation especially if it goes on to complete volvulus
240
malrotation and volvulus is caused by
abnormal rotation of the intestine
241
malrotation and volvulus can cause
necrosis, peritonitis, perforation, and death
242
most common congenital deformity in US
cleft lip/palate
243
cleft lip results from
failure of the maxillary and nasal process to fuse
244
cleft palate results from
failure of the two palatal processes to fuse
245
diagnosis of cleft lip/palate
20-30% can be diagnosed through prenatal ultrasound and others will be apparent at birth
246
cleft lip and feeding
typically have no difficulty feeding
247
surgical correction of cleft lip occurs
between 2-3 months
248
surgical correction of cleft palate occurs
by 6-12 months
249
cleft palate and feeding
have difficulty with all feeding types
250
post op care for cleft lip/palate surgery pt
elbow immobilizers for 7-10 days and syringe feeding
251
Hypertrophic Pyloric Stenosis
The circumferential muscle of the pyloric sphincter becomes thickened, resulting in a narrowing of the pyloric channel and obstruction
252
Hypertrophic Pyloric Stenosis usually develops within
2-5 weeks of life
253
Hypertrophic Pyloric Stenosis causes
projectile nonbilious vomiting, dehydration, metabolic alkalosis and failure to thrive
254
Hypertrophic Pyloric Stenosis more common in
males, full term infants, and caucasians
255
diagnosis of Hypertrophic Pyloric Stenosis
olive like mass that is easily palpated, non bilious vomiting 30-60 min after eating, ultrasound
256
ABG with Hypertrophic Pyloric Stenosis
hypochloremic metabolic alkalosis
257
management of Hypertrophic Pyloric Stenosis
pyloromyotomy, NGT for decompression, resume feeding 3-6 hrs after surgery
258
pyloromyotomy
an operation to loosen the tight muscle causing the blockage between the stomach and small intestine. do this after rehydration and correction of alkalosis
259
primary cause of fatal ingestions in children younger than 5yrs
Button or disk batteries
260
who should you call after ingestion/poisoning
American Association of Poison Control Centers
| 1800 222 1222
261
after ingestion of poison what is the most important principle
treat the child not the poison
262
enuresis
Common troublesome disorder defined as the intentional or involuntary passage of urine into the bed, usually at night
263
enuresis more common in
boys
264
highest prevalence of UTI in children occurs in
uncircumcised male infants
265
diagnosis for UTI
straight Cath, clean catch, urine dipstick, CBC, chem panel
266
vesicoureteral reflux (VUR)
Abnormal retrograde flow of urine into ureters likely to be associated with kidney infections
267
s/s of vesicoureteral reflux
high fevers, vomiting, and chills
268
most common cause of renal scaring in children
vesicoureteral reflux
269
what shows up with nephrotic syndrome
increased glomerular permeability to plasma protein, proteinuria, hypoalbuminemia, hyperlipiemmia, and edema
270
nephrotic syndrome predominantly occurs at
2-7 years old and greater in males
271
meds for nephrotic syndrome
corticosteroids and immunosuppressant
272
acute glomerulonephritis
disorder that occurs suddenly and are characterized by hematuria, proteinuria, edema, and renal insufficiency
273
nephrotic syndrome
a kidney disorder characterized by proteinuria, hypoalbuminemia, and edema
274
lab results acute glomerulonephritis
elevated BUN, erythrocyte sedimentation rate, ASO titer, creatinine, and electrolyte imbalance
275
ASO titer
blood test for strep
276
lab results with nephrotic syndrome
protein in urine, hematruia, elevated cholesterol, elevated triglycerides, elevated hemoglobin and hematocrit, elevated platelets
277
wilms tumor
nephroblastoma which is the most common malignant renal and intraadbdominal tumor of childhood
278
wilms tumor usually occur in the
left kidney
279
manifestations of wilms tumor
abdominal swelling, hematuria, fatigue, weight loss, fever
280
diagnosis for wilms tumor
abdominal ultra sounds and CT
281
wilms tumor treatment
radiation, chemo, nephrectomy
