peds test 3 Flashcards
The wrong reasons for not reporting 8
Someone else will Lack of training discipline vs abuse lack of knowledge fear of legal consequences fear of loss of therapeutic relationship CPS wont help Biases
Age range for school-aged child
6-12 yrs
Weight and height for school aged kid
7lbs a year and 2.5 in/yr
When is brain growth complete?
10 yrs
four cognitive developments of a school age kid
Can see things from another point of view
can think through an action anticipating consequences
can classify and divide things
3 motor skills of school age kid
Ride a two wheel bike
jump rope
sports participation
What is the nutrition rule for school aged kids?
5210- 5 fruits and veggies 2 hours screen time 1 hour of active play 0 sweet beverages
What is the best thing to do for a kid who has a fever?
Hydrate them
Fluids and kids 4
Kids have more fluid than adults
need more fluid per body weight than adults they excrete more
Extracellular fluid is more with higher Na+ Cl-
don’t concentrate urine very well
Three abnormal signs of vomit
bilious, bloody, projectile
Explain how a virus causes diarrhea
Injury to absorptive surface resulting in decreased fluid absorption
Explain how bacteria causes diarrhea
Intestinal injury by invasion of mucosa and release of toxins
Chronic diarrhea 5 causes
milk/soy intolerance, giardia, tumors, ulcerative colitis, celiac
What should an oral rehydration solution contain?
75mmol/L NaCl and 13.5 g/L
If someone is dehydrated, why do you not want them drinking tap water?
It will cause hypoNa+
how to give oral rehydration therapy
and
What if the child vomits?
50-100mL/kg over 4 hours-give 1mL/kg every five mins
resume after 30mins
What should normal urine output be for a child?
1-2ml/kg/hr
IV replacement bolus of and time
20ml/kg over 30-60mins
What is hyper trophic pyloric stenosis?
and is it rare?
Circular muscle of the the pylorus becomes hypertrophied causing thickening of the pyloric canal this causes gastric outlet obstruction
yes
s/s of hypertrophic pyloric stenosis 5
non-bilious vomiting, projectile vomiting, hunger right after vomit, olive in RUQ, possible visible peristalsis
What is the surgery for hypertrophic pyloric stenosis?
pyloromyotomy
What is Intussusception?
Process where the proximal segment of the bowel telescopes into the more distal segment
What will intussusception cause? 6
edema, vascular compromise, obstruction, bowl rupture, paratenitis, Jelly stool
What vaccine can cause intussusception?
Rotavirus
S/s of intussusception
and one thing about it
Sudden cramping pain of abdomen
Severe pain with legs drawn up
vomiting/diarrhea
If the vomiting is bilious- it has perforated and is an emergency
What fixes intussusception?
Barium enema
A cause of appendicitis
obstruction of fecal matter impacted on the appendix
3 s/s of a appendicitis and one if it perfs
N/V, sm frequent lose stools, fever
pain goes away
what is the point for appendisitis?
Mcburneys point
2 things that would turn up on labs for appendicitis
Increased WBC and C-reactive protein
PUD 3 things
Erosion of GI mucosa from HCL and Pepsin. any point in GI tract, chronic
Manifestations of peritonitis 8
rebound tenderness, ab distention, rigidity, decrease bowel sounds, fever, increased pulse, bp, increase WBC
Functional constipation criteria one rule and 5
Must meet 2 less than 3 bowel movements a week at least 1 episode of fecal incontinence a week stool withholding behavior hard or painful BM Large poop
What is Encopresis?
Leak of lose stool around mass
What is Hirschsprung disease? and what is the other name for it?
Congenital aganglionic megacolon
movement disorder of intestinal tract that results in obstruction.
What is a sign of hirschsprung disease in a newborn?
They don’t pass meconium in the first 24hours of life.
2 things to remember about Hirschsprung disease
due to lack of ganglion cells, it is rare
s/s of celiac 1
steatorrhea
How do we diagnose celiac
auto tissue transglumtimate IgG, intestional biopsy, genetic testing
diabetes 1 connects to what disease?
Celiac
What is Biliary atresia? leads to 3 is it rare?
no excretion of bile from liver into the duodenum
leads to cholestasis, fibrosis, and cirrhosis
no
How to treat biliary atresia
Time
Kasai procedure
w/i 45 days
When do kids get hep A shot?
12 months and 6-12 month later
When do kids get hep b shot?
at Birth and 1-2months and 6-18month
What is associated with cleft lip and palate?5
Heart defects, ear malformations, skeletal deformities, genitourinary malformations, midline defects
one complication of cleft lip
otitis media
When do we start repairs of cleft lip
2-3 months
What to remember about breastfeeding an cleft lip?
It is better for growth and better than a plastic nipple because it provides a better seal .
Esophageal atresia and tracheoesophageal fistula is what
The esophagus and trachea do not separate normally during embryonic development
What is esophageal atreasia?
Distal and proximal ends of esophagus don’t connect
What is the first sign of esophageal atresia?
What are the signs after birth? 3
polydramnios
frothy mucus and drooling, ab distention
TE fistula manifestations 6
Rattling respirations, excessive salivation and droolong and 3 c-couching choking, cyanosis.
Esophageal atresia and TE fistula management 6
Immediate surg HOB 30-45 NPO IV fluids 02 Prevent respiratory distress
What causes omphalocele and gastroschisis
and how are they detected? 2
Malformation of abdominal wall
During prenatal ultrasound or increased alpha-fetoprotein
Management of omphalocele and gastroschisis?4
Prevent hypotherm, fluid loss, keep covered, sterile
Infant and child urine capacity
30ml
270ml
What is bladder extropy?
Bladder is outside of the body at birth
How to tx bladder extropy
Cover with sterile gauze, antibiotics, surgery w/I 48 hours
what is Hypospadias?
Urinary meatus on the underside of the penis
One thing to remember about hypospadias and epispadias
don’t circumcise until after fixed
Epispadias
Urinary meatus on upper surface of penis
what is Chordee and what is associated with it?
Penial ventral curvature due to fibrous tether
hypospadias
What is cryptorchid? what is the surgery called?
Undescended testicles
Orchiopexy
What is hydrocele?
Excessive fluid in the scrotal sac
What is an inguinal hernia?
Happens when in inguinal canal does not close and intestines protrude into the canal and can become incarcerated
Epididymitis cause can cause 3
Bacterial usually STD
Scrotal abscess, testicular infarction, infertility
s/s for epididymitis 6
Painful, edema, erythema, dysuria, fever, enlarged inguinal lymph
Tx for epididymitis 4
Elevation of scrotum, cold packs, NSAIDS, antibiotics
What is testicular torsion?
And it is….one
Twisting of the spermatic cord that can cut off the blood supply to the testicle
EMERGENCY
s/s of testicular torsion 1
Sudden and severe pain
How do they treat testicular Torsion
time?
manual detorsion but probably need surgery
6 hours-can spare testi but can’t after 12
Phimosis
how to treat it?
Foreskin of penis cannot be retracted
Steroid cream
Phimosis s/s 4
foul smell, smegma irritation, pruritus
What is Paraphimosis
Foreskin is retracted past the glands and is immobile it becomes a tourniquet
What can cause ambiguous genitalia?
Increased androgen production in new born girls
How long does a circumcision take to heal?
7-10 days
What is a labial adhesion? when is it most common?
Partial or complete adherence of the labia minora
3months to 4 yrs old
What can a labial adhesion tx 2
Topical estrogen cream and vaseline gel for one month
What is Vulvovaginitis?
usually caused by 2
inflammation of the vagina and vulva
Bacteria or yeast overgrowth
5 s/s of UTI that you don’t know
Jaundice, FTT, Respiratory distress, constipation, HTN
What in enuresis?
Involuntary urination
Nocturnal enuresis common in 2
Family history and boys
tx of nocturnal enuresis 2 you don’t know
diet change, constipation prevention
What are the meds used for Nocturnal enuresis 4
Desmopessin/ADH
ditropan drugs that decrease bladder spasms
What is vesicoureteral reflux?
Retrograde flow of urine from the bladder up into ureters
VUR testing 4
Culture, ultrasound, voiding cystrourethrogram , nuclear scan
How is VUR graded?
1-5 5 severe
Nephrotic synrome what is it called?
What is it?
Nephritis
Increased glomerular basement membrane permeability which causes abnormal loss of protein in urine.
What to remember about congenital Nephrotic syndrome?
It has poor prognosis unless they get a transplant
What would cause secondary Nephrotic syndrome? 3
Henoch-schnlein syndrome, Purpura, diabetes.
Two things to remember about idiopathic nephrotic syndrome
hint-One is another name for it.
Most common
also called change nephrotic syndrome
What are the complications of nephrotic syndrome 6
Anemia, infection, poor growth, peritonitis, thrombosis, renal failure.
What are the manifestations of Nephrotic syndrome 5
EDEMA!, LUOP, Hyperlipidemia, FTT, HTN
What is the best treatment for Nephrotic syndrome? What about vaccines with this disease?
Corticosteroids
No live until 2 weeks
Acute Glomerulonephritis caused by 2
POST strep group a beta hemolytic strep from an antibody antigen reaction.
Staph or other infections
Acute Glomerulonephritis can cause 2
Uremia and kidney failure (Both a acute and chronic)
Acute Glomerulonephritis manifestations 7
hematuria, high fever, HA, CVA tenderness, HTN, perorbital edema, Elevated BUN/Creatinine
Acute Glomerulonephritis tx 4
manage HTN, sodium restriction, antibiotics, No NSAIDS
Nursing care for Acute Glomerulonephritis 6
Daily weights, UO, Edema care, hypertension care, neuro stat, activity restrictions.
Hemolytic-uremic syndrome is defined as three features, what are they?
What happens before this disease?
When is this most common ages?
- Hemolytic anemia
- Thrombocytopenia
- Acute renal failure
Usually diarrhea
6months to 4yrs
Bacteria causes HUS but give 3 examples
E coli, strep pneuminiae, shigella
HUS progression 3 things
Diarrhea-Hemorrhagic colitis-triad
What causes the triad symptoms in HUS
Microthrombi and ischemic changes in the organs.
Manifestations of HUS 10
fever, pallor, prupura/petechia, signs of kidney failure, edema, low UO, hypervolemia, increased BP, change in LOC, Seizures.
how long does ecoli spred?
up to 17 days
How can you tell when meat is cooked
155 degrees, Juices are clear, meat is no longer pink
Avoid HUS one thing
Avoid unpasterurized apple cider
Acute kidney failure in kids is mostly caused from?
2
Hypovolemic shock or sepsis
Tx for acute renal failure 2
Fluids, and treatment of underlying cause
