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349 Peds Exam 3 > proper study guide flashcards based on all the information textbook and her words in videos > Flashcards

proper study guide flashcards based on all the information textbook and her words in videos

1
Q

The beginning part of this long study guide flashcards will be about anemia

then it’ll go into cerebral dysfunction

then lastly it’ll go into endocrine disorders

please use this study flashcards the most to prepare for the test as it will contain all the information from textbook and from the video based presentation.

A
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2
Q

What are the anemia types we are going to talk about ? (7)

A

Anemia
Iron deficiency anemia
Sickle-cell anemia
B-thalssemia
Hemophilia
Von Willebrand Disease
ITP

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3
Q

How long is the life of a red blood cell in a pediatric patient?

A

100 days

In an adult, it’s usually 120 days

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4
Q

Where is the red blood cell produce typically in pediatrics patients?

A

Red bone marrow

In adults, typically this is found to be in the spleen

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5
Q

What is the hemoglobin level in an infant?

A

17-18g

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6
Q

What is hematocrit level in an infant?

A

45-50%

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7
Q

How much red blood cell is produced at birth of an infant?

A

5 million

Compared to an adult
That is 1 million more

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8
Q

What are your 3 low hemoglobin level complications?

A

Kidney disease
Anemia
Liver disease

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9
Q

What are your 3 elevated hemoglobin levels complications?

A

Chronic lung disease
DeHydration
Heart failure

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10
Q

What does anemia mean?

A

A reduction in red blood cell mass per volume and or hemoglobin concentration compared with normal values of age and gender

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11
Q

Red blood cell morphology
The following terms below, tell me what they mean?

Normocytes
Microcytes
Macrocytes

Spherocytes
Drepanocytes

Normochromic
Hypochromic
Hyperchromic

A

Normal cell size
Smaller than normal cell size
Larger than normal cell size

Globular cells
Sickle-shaped cells

Sufficient-normal amount of hemoglobin per RBC

Reduced amount of hemoglobin per RBC

Increase amount of hemoglobin per RBC

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12
Q

What are the 2 main causes of anemia?

A

Inadequate production of RBC/components for RBC

Increased destruction of RBC/loss through hemorrhage

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13
Q

What are some sighs and symptoms of anemia with decreased red blood cell production?(6)
decreaSed

A

Pallor
Tachycardia
Fatigue, headache
Muscle weakness
Systolic heart murmur
Frontal bossing

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14
Q

What are some signs and symptoms of anemia that has increased red blood cell destruction (7)

Think of the I in increased and follow that

A

Icteric sclera, jaundice
Fatigue
Headache
Tachycardia
Dark urine
Spelnomegaly
Hepatomegaly
Low blood pressure (late sign shock)

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15
Q

What are signs and symptoms of anemia with increased red blood cell loss? (7)
Think of L in cooL

A

Pallor
Fatigue, headache
Muscle weakness
Cool skin
Tachycardia
Decreased peripheral pulses
Low blood pressure ( late sign shock)

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16
Q

What are your diagnostic evaluation for anemia?

A

Typically look like CBC tests
Bone marrow aspiration
Peripheral smear
History & physical examination

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17
Q

What is the therapeutic management of anemia?

How are we going to treat it?

A

It really all depends on what type of anemia it may be like

Iron = iron supplements
Blood loss = transfusions

Oxygenation & IV fluids

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18
Q

In the book it mentions that a viral nursing care is to listen to the parents signs and symptoms with the way they talk, so what 2 phrases do you think might indicate to us that something may be wrong and leans towards the idea of anemia?

A

My child drinks a lot of milk

My teenage is on liquid/vegetarian diet

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19
Q

What are some question we might ask a parent to tell us about the history of a child that could help identify anemia and intervene properly?

A

Nutrition
Past history of chronic infections
Eating habits
Bowel habits - dark tarry stool - blood
Family history of anemia

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20
Q

It’s very important to assess a child energy level, why you may ask? Because child tend to show a lot in behavior that we as adults usually speak about. What might you think will indicate good anemia behavior and bad anemia behavior?

A

Child energy level and tolerance to activity’s usually is a great indicator of treatment or illness

Good = good oxygen = better “anemia” = lots of energy

Bad = no oxygen = bad “anemia”
= fatigue and no energy

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21
Q

How are we going to prevent anemia?

A

It really all depends on the type of anemia
But mainly we are going to provide great hydration and nutrition to our kids

Limit infection by hand washing

Providing good oxygenation

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22
Q

What is iron deficiency anemia ?

A

Anemia caused by inadequate supply or loss of iron

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23
Q

Is iron deficiency anemia the most common in the world to have?

A

Yes

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24
Q

What is the cause behind iron deficiency anemia?
Dont over think it

A

Decrease supply,
impair absorption,
increase body need for iron

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25
Q

What is the biggest cause of anemia in children? (2)

A

Excessive milk intake
Poor iron intake

It’s very vital to note that iron deficiency can also occur in patients with GI issues like lactose intolerance chronic diarrhea and those who also have a ton of blood loss

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26
Q

What is the pathophysiology behind iron deficiency anemia?

A

Iron is required for the production of hemoglobin

Iron binds to hemogloblin

We have decreased hemoglobin level and reduced oxygen carrying capacity of the blood

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27
Q

What are some common sources/food of iron patient can get? (5)

A

Egg
Red meat
Beans
Pomegranate
Sesame seeds

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28
Q

What type of diet is very famous for having been associated with iron deficiency anemia that can be mainly found in teenagers?

A

Vegetarian diet

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29
Q

What type of food/drink is famous for causing the lack of absorption of iron in patients? (2)

A

Calcium
Tea

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30
Q

What are your 3 big clinical manifestation behind iron deficiency anemia?

A

Koilonychia ( concave/spoon nails )
Glossitis
Pallor

  • tachycardia fatigue and irritability is also included
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31
Q

What are the diagnostic evaluation of iron deficiency anemia

How does the RBC look like?

A

CBC test is typically performed

Microcytic

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32
Q

What is the therapeutic management behind iron deficiency anemia?

A

Primary goal is to achieve optimal nutrition and appropriate iron supplements

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33
Q

What type of food would you think to include in the administration of iron supplements ?

A

Orange juice ! ( vitamin C )

The reason behind this is that ingested iron is absorbed largely from the duodenum and absorption is facilitated by an acid environment

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34
Q

What interferes with iron metabolism that results in the low iron absorption ?

So think of what we are going to educate patients on to avoid what having iron supplements?

A

Calcium

( dairy products must be avoided ! )

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35
Q

It’s very important warn patients about two things when on iron supplements ?
This is when they are administration

Think about the liquid version
Think about the excretion

A

Liquid version = stain teeth
Poops will be dark and tarry !!

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36
Q

Since the patient is given a liquid supplement and we understand it can stain the teeth, what are we going to tell patients?

A

Use a straw and place it in the back of the mouth to avoid staining the teeth

If stained teeth occurs, decay may be the long term complication with these kids

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37
Q

Sickle cell anemia what is it?

A

Sickle cell anemia is when patients have an additional hemoglobin, named hemoglobin S, that causes other red blood cells to stick together and cause poor circulation
( Vaso-occlusion )

This is usually hereditary

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38
Q

Sickle cell anemia mainly affects who?

A

African Americans

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39
Q

Once again to review, sickle cell anemia has what type of extra hemoglobin?

A

Hemoglobin S

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40
Q

Dr. Rickerby describes sickle cell anemia blood to be what? (2)

A

Crescent shape- sickling
Sticky!!

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41
Q

What is the Vaso-occlusive crisis clinical manifestions of sickle cell anemia? (8)

A

Painful swelling hands and feet
( sickle cell dactlysis or hand and foot syndrome )

Severe pain in abdomen
Stroke
Visual disturbances
Pneumonia symptoms
Obstructive jaundice
Hematuria
Priapsism

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42
Q

What is the diagnostic evaluation of sickle cell anemia?

A

Peripheral blood smear

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43
Q

What is the management of pain of the hands and feet when it comes to sickle cell patients? (2)

A

Treat with heat
&
Typically administer an opiate

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44
Q

What are the 2 big things we want to want to promote patients to follow when they have sickle cell anemia?

A

Minimize tissue deoxygenating
Promote hydration

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45
Q

Why would promoting to decrease tissue deoxygenation be the best way to reduce sickle cell anemia?

A

Because when you don’t have oxygen you’re body is going to constrict, when it constricts these sickle blood cells will cause Vaso-occlusion

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46
Q

What are the 4 ways we are going to minimize tissue deoxygenation? Or in other word avoid hypoxia?

A

Avoid high altitude
Avoid poorly pressurized airpline
Hypoventilation
Hypothermia - cold

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47
Q

Why would hydration be a very vital thing for sickle cell patients to be doing?

A

Allows for the blood to dilated and to avoid that occlusion from occurring

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48
Q

Do we use ice with sickle cell anemia?

A

NO!
We use heat!!

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49
Q

Since sickle cell anemia is a genetic thing, what do you think would we recommend to these patients?

A

Possible screening and genetic counseling to help diagnose earlier and prevent future complications

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50
Q

What is B thalassemia ?

A

It’s a genetic disorder that results in severe anemia that is not compatible with life without transfusion support

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51
Q

What are your clinical manifestation of progressive anemia in B-thalassemia? (6)
Think of B for Bone!

A

Signs of chronic hypoxia
Headache
Precordial & bone pain
Decreased exercise tolerance
Restless
Anorexia

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52
Q

What are the major bone changes, typically in older children with B-thalassemia? (7)

A

Enlarged head
Prominent frontal & partial bosses
Prominent Malar eminences
Flat or depressed bridge of the nose
Enlarged maxilla
Protrusion of lip
Generalized osteropories

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53
Q

What is the patho behind B-thalassemia?

A

Anemia results from defective synthesis of HGB, structurally impaired RBCS and shorten life of RBC

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54
Q

What is the diagnostic evaluation of B-thalassemia?

A

High performance liquid chromatography

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55
Q

What is the therapeutic management of B-thalassemia?

A

Blood transfusions

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56
Q

What does hemophilia mean?

A

A bleeding disorder in which patients are usually missing a clotting factor

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57
Q

How is hemophilia transmitted? (2)

A

X lined recessive disorder
Unaffected male and trait carrier female

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58
Q

What is the most common hemophilia?

A

Type A

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59
Q

Hemophilia A is missing?
Hemophilia B is missing?

A

Hemophilia A is missing 8
Hemophilia B is missing 9

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60
Q

Hemophilia B is also known as your?

A

Christmas disease

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61
Q

The bleeding tendency may vary from severe, moderate and mild

However symptoms do not start showing until the child is usually this age___ and why do you think so?

A

6 months

Because children are becoming more mobile and they have more ability/access to having accidents

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62
Q

What did hemarthosis mean?

A

Bleeding into joint spaces knee, ankle and elbow, leading to impaired mobility

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63
Q

Why do you think hemoarthosis occurs in hemophilia?

A

Because of the fact that patients are missing a clotting factor, typically clotting factor 8.

So instead their body will decide to just bleed, bleeding internally and mainly go into the joints

And result in this big bleeding pool

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64
Q

What are the 3 big clinical manifestation of hemophilia?

A

Ecchymosis
Epistaxis
Bleeding from procedures

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65
Q

How do you diagnose hemophilia? (3)

A

Amniocentesis
Genetic testing - seeing that clot factor
CBC

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66
Q

What is the medical management behind hemophilia?

A

Giving them the factor they are missing through an IV with normal saline

Think of the factor to be like a blood transfusion, so give it with normal saline and administer slow

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67
Q

What are the interventions for patients, like educations wise when it comes to being diagnose with hemophilia?

Dont over think it

A

Monitor bleeding

Close supervision & safe environment

Dental procedure

Shave only with electric razor

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68
Q

If the patient is having superficial bleeding and has hemophilia what are we going to do to help them? (2)

A

Apply pressure for 15 minutes
Then use ice to vasoconstrict

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69
Q

To review
Sickle cell we use ___to help ___
Hemophilia we use ___ to help__

A

Sickle cell we use HEAT
To help VASODILUATE

Hemophilia we use ICE
to help VASOCONSTRICT

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70
Q

What is von willebrand disease?

A

A hereditary bleeding disorder characterized by the missing of
Von willebrand protein

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71
Q

What are the 5 clinical manifestation of Von willebrand disease?

A

Easy brusing
Epistaxis
Gingival bleeding
Excessive bleeding with laceration & surgeries

Menorrhagia - long period time

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72
Q

How will we diagnose von willebrand disease?

A

CBC
Prolonged bleeding
Genetic - not having protein

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73
Q

What is the 2 important treatments for Von willebrand disease?

A

DDVAP to help treat their low platelet count and help clot because it’s a bleeding disorder

IV administrion of the VW protein

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74
Q

TEST QUESTION!!

It’s important to mention that both hemophilia and Von willebrand disease are both extreme bleeding disorders, what mediation (2) would you think would be contraindicated in these patients?

And why?

A

Aspirin and NSAIDS

Because they cause patients to bleed more often

Remmeber aspirin is an anti-platelet and these conditions don’t have platelets to begin with

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75
Q

Idiopathic thrombocytopenia purpura
What is it?

A

Usually results from an infection that results the patient to have a severe reduction in platelets count

Otherwise known as
Acquired hemorrhagic

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76
Q

What are the 3 characterization of IDP?

A

Thrombocytopenia
Purpura
Normal bone marrow with increased number of immature platelets

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77
Q

TEST QUESTION
Purpura means what?
Petechiae means what?

A

Large rash
Small rash

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78
Q

What’s the biggest thing to know about IDP rashes?

A

It will not Blanche, like turn white, when you press on it

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79
Q

What is the therapeutics mangement of ITP?

A

Often self limited

IVIG and anti-D has been given though

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80
Q

TEST QUESTION
Administration of blood transfusion
What are the 5 biggest inductor to monitor when there is a reaction to blood transfusion?

A

Sudden chest pain
Shortness of breathe
Fever
Chills
Lowe back pain

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81
Q

Do you just hang blood transfusion by itself? If not, then with what?

A

No
Normal saline

Usually administer it slow

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82
Q

Let’s say the blood bank delivers you the blood early and the patient is out on a walk, how long do you have with the blood bag?

A

30mins

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83
Q

How long is the transfusion going to be when you first do it slowly?

A

15-20mins

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84
Q

What is the longest you can give blood?

A

4 hours

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85
Q

Test question
If the patient has a reaction to a blood transfusion, what are you going to do?

A

STOP THE BLOOD.

Ring the emergency bell.
DONT go out of the room, call the emergency bell on the phone

She’ll more than likely going to trick you into reading the slow transfusion, don’t pick that

ITS STOP.

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86
Q

So our patient is having a reaction, you stop the transfusion and called for help, what is the next step?

Then let’s say help arrives, what are you going to do with the now blood bag?

A

Bolus of IV saline in order to flush out all those toxic blood

Give it to them for them to evaluate what went wrong

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87
Q

Another thing to note
With massive transfusion reaction
You’re more than likely to have renal problems, typically a patient might produce red urine

What is your thing to monitor as a nurse when this is happening in a blood transfusion?

A

Hyperkalemia

Remember kidneys and heart are best friends
If one is upset, the other will be too!

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88
Q

How do you do vital signs checks with blood transfusions?

Note
This is a dual verificafion.
TWO NURSES ARE NEEDED.

A

Before administration( vital sign )
Give blood
After giving blood ( vital sign )
Stay in the room 15mins
Do another vital sign check
Then do it every hour
Then stop transfusion at 4 hours

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89
Q

Blood transfusion reaction
What is the tempature
What is the heart rate
What is the respiratory
What is the blood pressure?

A

High temp
High heart rate, hyperkalemia
Dyspnea, high RR
Low, hypotension

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90
Q

Additional information
DIC
- condition affecting the blood ability to clot and stop bleeding
Clinical manifestations
- thrombotic manfiestions & bleeding
Treatment
- heparin & blood transfuse

Neutropnia
- low white blood cell
- infections & fevers
Diagnostic
- CBC = low WBC
Treatment
- hand washing & Iv antibiotics
- G-CSF administration

A
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91
Q

The following flashcards are going to be about the cerebral dysfunction

Cerebral dysfunction

A
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92
Q

What are the 11 topics we are going to talk about regarding children with cerebral dysfunction?

A

Increased intracranial pressure
Head injury
Shaken baby syndrome
Subversion injury
Meningitis
Encephalitis
Rabies
Reye syndrome
Seizures
Migraine/headaches
Hydrocephalus

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93
Q

At birth, the brain is __% of an adult

By age __the brain is ___of adult size

A

25%

5 is about 90%

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94
Q

CSF is __ml in a neonate
CSF is __ml in an adult

A

5ml
150ml

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95
Q

When is myelinization completed by?

A

Puberty

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96
Q

What does myelinization mean?

A

It’s a cholesterol coating that protects our nerves and allows impulses to move faster

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97
Q

What section of the spinal cord does it terminate in an infant?

A

L3

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98
Q

How much percentage does the brain make up infants body weight?

How much percentage does the brain make up in an adults body weight?

A

12%

2%

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99
Q

Are the peripheral nerves myelinated in an infant??

Are the peripheral nerves myelinated in an adult?

A

Infant no
Adult yes

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100
Q

When are the primitive reflexes gone in a child?

Can they reappear in an adult and if so how?

A

6 months of age

They shouldn’t be able too, however with severe neurological damage or disease they can occur

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101
Q

The following are reflexes that she stated she wants us to know and easy test questions ; so tell me for the following reflexes
What it does/how to do it (1)
When it comes (2)
When it disappears (3)
CNS origin (4)

Moto reflex ( startle )
Grasp reflex
Rooting reflex
Trunk incurvation reflex
Placing reflex
Tonic neck reflex (fencing pose!)
Parachute reflex

A

Motor reflex ( startle )
- extension of all limbs
Appears : birth
Disappears : 4-6 months
Origin : brain stem vestibular nuclei

Grasp reflex
- finger grabs onto something
Appears : birth
Disappears : 4-6 months
Origin : Brain stem vesicular Nuclei

Rooting reflex
- touch the cheek, they will go to you looking for food
Appears : birth
Disappears : 4-6 months
Origin : brain stem trigeminal system

Trunk incurvation
- withdrawal from stroking along the surface of the back ; so little the back will curve when you stroke them
Appears : birth
Disappears : 4-6 months
Origin : spinal cord

Placing reflex
- hold the child up as if they were walking and it stimulates it as a walk
Appears : birth
Disappears : 4-6months
Origin : cerebral cortex

Tonic neck
- fencing pose, so extend their right arm, their left arm should flex
Appears : birth
Disappears : 4-6 months
Origin : brain stem vestibular nuclei

Parachute reflex
- stimulate a falling motion = extend of the limbs to protect itself
Appears : 4-6months
Disappears : never
Origin : brain stem vestibular

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102
Q

How are you going to evaluate the neurologic status in infants and in young children?

A

Observing for spontaneous and elicited reflex responses

Ex : arm movements, resting state, extension

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103
Q

Great fact
Babies can handle a little bit more intracranial pressure, what 2 things allows for babies to do this?

A

Their fontanels aren’t closed yet

Anterior fontanel ( diamond shape )
Posterior fontanel ( y shape )

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104
Q

What is an increased intracranial pressure?

A

Pressure that may accumulate within the enclosure of the brain

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105
Q

How can increased intracranial pressure occur?

A

Really can be from any head injury

Concussion for an example

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106
Q

What are the 5 mainly associations of clinical manifestation with children who have an increased intracranial pressure?

A

Projectile vomiting
Loss of consciousnes / deteriorations
Hypertension
Headaches/dizziness
Bulging fontanel

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107
Q

When you’re first seeing an increased intracranial pressure, what are the 3 following vital signs going to be doing?
Blood pressure ?
Pulse?
Respirations?

A

Blood pressure = up
Pulse = up
Respirations = down

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108
Q

How would you assess an infant and young children for a neurological status?

Remember they can’t talk, so instead we are going to?

A

Be observing their spontaneous and elicited reflex responses

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109
Q

What type of physical or history exam will be we doing on these children with an increased intracranial pressure?

A

Physical
- observation of size of head
- spontaneous activity
- posture

History
- pregnancy complications
- delivery
- disorders/ genetic predisposition

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110
Q

What does consciousness mean?

A

Awareness
- the ability to respond to sensory stimuli and have subjective experiences

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111
Q

What does altered state of consciousness mean?

A

Refers to varying states of unconsciousness that may be momentary, or may last for hours, days or indefinitely

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112
Q

What does unsciousness mean?

A

Depressed cerebral function
- inability to respond to sensory stimuli and has subjective experiences

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113
Q

What does coma mean?

A

State of unconsciousness from which cannot be aroused, even with painful stimuli

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114
Q

What is the scale that we use to assess the mental status or neurologic state to help assess a patient?

A

Glasgow coma scale

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115
Q

What are the 3 components that Glasgow scale measure?

A

Eyes
Verbal
Motor/movement

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116
Q

How would you assess the eyes using the Glasgow coma scale ?(4)

A

4 points = moves eyes spontaneously
3 points = moves eyes to speaking
2 points = moves eyes to pain
0 points = none

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117
Q

How would you assess verbal when using the glascoma scale? (5)

A

(5) Coos, babble
(4) Irritable, crying
(3) Crying to pain
(2) Moans to pain
(0) None

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118
Q

How would you assess motor when using the glascoma scale ? (6)

A

(6) Normal movement
(5) Withdrawal from touch
(4) Withdrawal from pain
(3) Abnormal Flexion
(2) Abnormal extension
(0) None

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119
Q

What is the best number score to get when being assed when using the glascoma scale?

What is the number that would indicate a coma?

What is the number that indicates a deep coma or even death?

A

15

8

3

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120
Q

It’s important to note that GCS in itself is not sufficient to determine what type of children?

A

Those with an induced coma
Quadriplegic

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121
Q

What is the purpose of a neurologic examination?

A

To establish an accurate objective baseline of neurological function

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122
Q

Why would assessing the skin be helpful for assessing a neurological function ?

A

May offer Clues to the cause of why they are unconscious, or have ICP

Ex : bacteria infection

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123
Q

Why is posturing such an important thing for a neurologic examination ?

A

Because our body even in the deepest of pain, will try its best to protect itself by putting itself in certain positions

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124
Q

What are the 2 posture names that we need to know when assessing patient with neurologic issues?

A

Decorticate = Flexion
Decerevrate = extension

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125
Q

Out the 2 posturing, what would be the worst to have and why do you think so?

A

The decervrate because you body is extended and exposed, you’re not long protecting the vital organs

Remember deCORE = protecting the core of your body, Flexion

deCER= E would indicate extension = no longer protecting the body

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126
Q

A sudden appearance of a fixed and dilated pupil would promote us to do what?

A

Would be a neurological-surgical emergency

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127
Q

What are some diagnostic procedures we will do for patients with neurologic dysfunctions?

A

Lumbar puncture
EEG
Imaging
Radiography

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128
Q

TEST QUESTION
Dr. Rickerby states in her video that when a doctor is doing a lumbar puncture, what is the nurse vital job to do!?

A

Have the child in a
KNEE TO CHEST POSITION.

maintain the child calm and non-moving

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129
Q

What is the first thing we are going to do when a child is unconscious ?

A

Begin CPR

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130
Q

As we’re doing CPR, do you think it’s appropriate to move the child head around ? And if not why not?

A

No
Because we want to rule out that there isn’t any cervical spine injury, so using we are going to stabilize the spine and place a C-collar around them to protect their head

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131
Q

Pain management is a huge issue with these children, one because their head is going to be hurting with all that increased pressure, what do you think are the main medication we are going to give to these children ?

A

NSAIDS

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132
Q

In severe cases, opiates may be used to help aid a child with increased intracranial pressure or a potential head injury, however what is so dangerous and vital to note about the usage of opiate?

A

It will mask the signs of an alerted consciousness and depress respirations

In essence, it can affect our assessment of their neurologic function and impend their risk of respiration depression

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133
Q

Notes to know
Codeine shouldn’t be used under the age of 12 in children

Nalxone,narcan, should be on hand in order to reverse opiate overdose

Acetaminophen and IB are the best

A
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134
Q

If a patient is on a narcotic, or an opiate, what are the 2 big things we are going to be watching out?

A

Respiratory depression
Constipation

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135
Q

When a patient is constipated due to using opiates, what might we encouraged them to do ?

A

Increase fiber and fluid intake

Sometimes we may provide them with a stool softener

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136
Q

Fun fact
Do you think brains work better in a cooler environment or a warmer environment ?

A

Cooler

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137
Q

In what position do you think we should have our patients who have intracranial pressure
Like sitting up?
Like laying down and why?

A

Well in her original video she mentioned laying down
- which makes sense to me because it’s too much pressure trying to get fluid to circulate UP to the head

But in her review video she said sitting down?
- I believe I’m gonna go with the laying down though

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138
Q

What type of stimulation would be best for these kids with increased intracranial pressure to be in and why?

A

A decrease stimulation, so like close the curtains, lower the lights down

Because the minimal stimuli, the brain can relax and try to release all the pressure out

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139
Q

If a patient develops a fever, usually is a common manifestation of increased intracranial pressure, what do you think we’ll give them?

A

Antipyretics medications

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140
Q

What is the treatment of an increased intracranial pressure?

A

The usage of osmotic diuretic

Like mannitol

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141
Q

What is a head injury?

A

A pathologic process involving the scalp; skull; meninges or brain as a result of mechanical force

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142
Q

What are the 3 main causes of head injuries ?

A

Falls
Being struck by an object
Car accidents

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143
Q

What are your 3 main worries behind a head injury? Usually the common complications we’d see

A

Concussions
Contusion & lacerations
Fractures

144
Q

What are the 3 major complications of the head injuries that usually promote us as nurses to intervene more?

A

Epidural hematoma
Subdural hematoma
Cerebral edema

145
Q

What is an epidural hematoma?

A

Hemorrhage into the space between the Dura and the skull
- however the bleeding doesn’t go into the brain, it just kinda floats around it

146
Q

What is a subdural hematoma?

A

Hemorrhage between the furs and arachnoid membrane
- bleeding into the brain

147
Q

What is cerebral edema?

A

Swelling the head

148
Q

Out of epidural and subdural hematoma. What is the worser condition to have? And why?

A

Subdural hematoma
- because you’re literally bleeding into your brain

149
Q

How would you diagnose a brain injury?

A

CT
MRI
Signs and symptoms

150
Q

What are your major symptoms of a head injury? They are similar to those of ICP?

A

Vomiting
Bulging fontanel
Elevated tempetatre

  • same hypertension as well
151
Q

Nursing alert!

If a child has a head injury, it’s more than likely they are going to bleed out of their nose.

However, if they are bleeding this yellow, watery discharge.
What might that indicate to us ?

Additional, what test will we run to confirm that indication ^?

A

Cerebral spinal fluid

Glucose test -
Usually will see that halo sign

152
Q

Nursing care management behind a head injury, how often are we doing neuro exams on these patients?

A

Every 15mins

153
Q

What are the 3 important things we want to maintain adequately with these patients with a head injury?

A

Ventilation
Oxygenation
Circulation

154
Q

How are we going to prevent head injuries from occurring?

Don’t over think it

A

Seat belts
Following driving rules
Sleeping on the lower bunk bed
Identify signs of abuse

155
Q

What is the main treatment that we are going to do for our children with a head injury?

A

So typically give them mannitol- osmotic diuretic to help alleviate that fluid built up in their head

156
Q

What is shaken baby syndrome?
Or more so how do you get this to occur?

A

Shaking the baby vigorously to where the head kinda gets a double concussion; causing the head to kinda just float in the fluid after words

This can cause severe blood vessels and nerves to be detached from that rotational force

157
Q

What are the major clinical manifestation we can tell that a baby has been shaken vigorously? (3)

A

Retina detachment
Pale,blue skin
Lethargic eyes

It may include bleeding in the retina, bleeding the brain, bone fractures and bruises

158
Q

Once the baby has been shaken, the damage is already done, so what are we monitoring afterwards?

A

Again, the damage has been done to the baby, we simply do supportive care and when the swelling has decreased, we are more than likely going to treat whatever disability to child may have received from the trauma

159
Q

What is submersion injury?
Otherwise known as near drowning

A

The process of respiratory impairment from submersion/immersion in liquid

160
Q

What is the pathology behind submersion injury? (5)

A
  1. Accidental submersion
  2. Loss of normal breathing pattern, typically the last auscultatory gasp
  3. Panic,struggle & laryngospams
    3.5 pulmonary aspiration (wet/90%)
    3.5 breath holding/apnea (dry/10%)
  4. Hypoxemia
  5. Hypoxia, hypercarbia, acidosis
161
Q

With submersion injury, what is the treatment management to help aid these kids?

A

CPR

Remember they are literally drowning. They are submersion in water, they are gonna come out unconscious, we need to do CPR

162
Q

How do we prevention submersion injury from occurring?

Don’t over think it

A

Life jackets
Supervision of kids
Teach the children how to swim

163
Q

What are some common examples/causes that we see or may be the identifier of an intracranial infection ? (3)

A

Bacterial
Viral
TB

164
Q

What is bacterial meningitis?

A

Acute inflammation of the meninges and CSF

165
Q

What are the main clinical manifestation we will see in patients with meningitis? (6)

A

Photophobia
Phonephobis
Stiff neck
Pin-prick rash
Arching of the back
Cold hands and feet

166
Q

What is the pathology behind bacterial meningitis?

A

Usually a bacteria enters through a wound and travels up your spine into your meningitis, causing inflammation

167
Q

What is the definitive diagnostic test for meningitis ?

What does it usually reveal?

A

Lumbar puncture test

Results normally are a cloudy CSF

168
Q

What are the 2 signs that we might do to test if a patient may have mengingitis?

A

Brudzinski neck sign
Kernig sign

169
Q

What is the Brudzinski neck sign ?

What is the Kernig sign ?

A

Brud
- usually when you left the patient neck and the child will curve up their knees to the Chest

Kernig sign
- usually when you lift the child knee/leg up to see if itlll extend, but the child ends up curling up

170
Q

How would we normally treat bacterial meningitis?

A

Usually giving them anti microbial agents, typically penicillin

171
Q

Possible test question
We like to do a ___ test to help rule out the blanching features of the skin when a child has bacterial meningitis.

However most of the time the Blanche test comes out ____

A

Glass test
- so press the glass on the skin to see blanching

However it’s comes out negative

172
Q

What type of isolation is bacterial meningitis in?

A

Droplet precautions

173
Q

Is there a way we can prevent bacterial meningitis ?
And how?

A

Vaccination
HIB vaccine

174
Q

What is non bacterial (aspectic) meningitis?

A

Onset of meninges symptoms without the bacterial growth

175
Q

What is encephalitis?

A

Inflammation process of the CNS

176
Q

What is the main cause of encephalitis)

A

Enterovirus

177
Q

What is the therapeutic management behind encephalitis?

A

Typically supportive care because it’s a virus

Mainly hydration &! Nutrition

178
Q

What is rabies?

A

A viral infection that is transmitted through a bite of an animal

179
Q

What are the 4 main common animals that carry rabies virus?

A

Raccoons
Skunks
Bats
Foxes

180
Q

What is the incubation period of rabies?

A

1-3 months

181
Q

What are the big 4 clinical manifestation behind rabies?

A

Hydrophobia
Hallucinations
Hyperslavations
Flu like symptoms

182
Q

How do you diagnose rabies?
Typically 2 methods

A

The hallmark : hydrophobia

Skin biopsy of the bite

183
Q

What is the first thing you’re going to do when you get bitten by an animal, and worse case scenario a rabies carrying one?

After this of course rush to the hospital, or even do this at the hospital

A

Wash the site for 15mins with antimicrobial agents

184
Q

What is the therapy they are going to do for you when you go to the hospital being bitten by a rabies animal?

A

Vaccines & antibodies

185
Q

What are the 4 doses of vaccines that are going to be scheduled

Like what are the dates to remember

A

Day 0
Day 3
Day 7
Day 14

186
Q

TEST question
Where do we give rabies vaccines?

Where do we NOT give rabies vaccines?

A

We give it IM

We do NOT give it glutes

187
Q

What is Reye syndrome?

A

Typically associated with kids having flu like symptoms or a viral infection and being given aspirin

188
Q

What is the diagnosis behind Reye syndrome?

A

Liver biopsy

  • reason behind this is because their liver will most likely fail
189
Q

What is the treatment of Reye syndrome?

I did find this off of google as she didn’t mentioned anything about it andddd I’m too lazy to look into the book right now so

A

Help with breathing- oxygenation
Fluids- hydration

Really no cure, just aid with it

190
Q

What is a seizure?

A

Malfunction of the brain electrical system

191
Q

What does epilepsy mean?

A

Two or more unprovoked seizures more than 24 hours apart

192
Q

What is are some causes behind why children or people in general get seizures?

A

Usually underlying cause
Being struck up something
Being sick
Etc

193
Q

What is a focal seizure?

A

A seizure when you’re aware that you’re having

Remember, this is awareness of it happening, usually patients will see their arm spamsing but they are conscious

194
Q

What is a generalized seizure?

A

You will see patients go
UNCONSCIOUS.

They will typically fall over

195
Q

She mentioned this the video for review of the exam

What is a tonic seizure
What is a clonic seizure

A

Tonic = extension of the body

Clonic = Flexion/clousness of the body

196
Q

Possible test question
What is an absence seizure?

A

When you go unconscious however you’re still kinda looking normal

Kinda like that day dreaming look

197
Q

What is the most common type of seizures in kids?

A

Febrile seizure

198
Q

What’s the big characteristic behind a febrile seizure, mainly how does it occur?

A

A rapid temperature

199
Q

What does status epileptic seizures mean?

A

A seizure that does not stop and we need to intervene if not we can let our patient die

200
Q

If a seizure last more than 5mins what is that indicting to us ?

A

That it is status epileptics, and we need to take them to the hospital before brain damage and death

201
Q

She mentioned this in the review video
The first thing to go is hearing
And usually the first thing to come back as well

Just something to note about seizures

A
202
Q

What are the 4 main treatment methods we can use to help treat seizures?

A

Anti-seizure drugs
Ketogenic diet
Vagus nerve stimulation
Surgery

203
Q

When would it be indicative to give an antiseizure drug?

A

She mentioned her in her original video
That you shouldn’t give a antiseizure drug to someone who has just gotten one seizure

Instead you give to those with epilepsy or status epileptics

204
Q

In the textbook it uses the phenyoin examples as an antiseizure drug remember

PICC LINE & SLOW ADMINISTERING
DILUTE THE MEDICATION
AVOID PURPLE GLOVE SYNDROME

TELL THEM TO BRUSH THEIR TEETH!!
Gingival bleeding
Osteroporiesis
Heptatoxicity & Nephrotoxicity
CV side
- hypotension,bradycardia,V-fib
Teratogenic

A
205
Q

What is the ketogenic diet? (3)

A

A high fat
Low carbohydrate
Adequate protein

206
Q

Why is ketogenic diet successful for seizures ?

A

It makes the body use fat instead of glucose of energy

207
Q

What are the 2 main things to look out for ketogenic diet?

A

Hypoglycemia
Constipation

208
Q

How does the vagus nerve stimulation help children with seizures?

A

Help deliver precise pattern of electrical impulses

209
Q

Lastly surgery, some basic notes to know, if it’s a tumor causing the patient to have seizures

Just use surgery to remove it

Pretty basic

A
210
Q

To review
What is a febrile seizure?

And what age range does it mainly affect?

What is the main treatment?

A

High rapid in temperature

Age 6 to 60 months

Antipyretic medications, Lower that fever

211
Q

What are your safety intervention in helping with a seizure?

A

Seizure pads
Document the time it started and end
Don’t leave the room
Remove any potential hazards
Protect the head

212
Q

Are we going to restrain our patient in a seizure?

Are we going to put anything in their mouth during a seizure?

A

NO!!!

213
Q

What is a primary headache?

A

Migraine
Tension type headache

214
Q

What is a secondary headache?

A

Another condition causes it

215
Q

What are the 4 things we normally like to ask about a patient who is experiencing a headache?

A

Are you getting
Good sleep?
Good hydration?
Good eating ?
Good exercise ?

216
Q

What are the main 4 symptoms of a migraine?

A

Photophobia
Phonephobis
Nausea & fatigue

217
Q

Migraine typically are on what?

A

One side of the head

218
Q

What is migraine with aura

What is migraine without aura

A

Aura is usually something that triggers and you’re aware of it,

Example smelling a daisy, and it causes you to have a migraine

Without aura usually is just a persistent headache that grows into a migraine

219
Q

What is the best medication to give patients with migraines?

A

Advil- IB (nsaids)

220
Q

Patient education
The second a migraine is coming do you want to take the medication or delay it?

A

Take

DONT delay anything

221
Q

I don’t want to forget it
But aura can also happen with seizures as well, typically patients will start to see fuzzy lines of like be very dizzy

So that’s a great sign to prepare for a seizure

A
222
Q

What is hydrocephalus ?

A

Condition caused by an imbalance in the production and absorption of CSF

223
Q

What is the two main causes or I guess malformations that can cause hydrocephalus?

A

Chiari 1 and 2

224
Q

What are the big 3 clinical manifestation behind hydrocephalus ?

A

Mainly intracranial pressure symptoms
- vomiting
- frontal bossing
- hypertension

Other important things to note though

Macewen ( cracked pot sound )
- palpitation on the skull

Setting sun sign
- sclera may be vividly about the iris

225
Q

What is the main treatment to help with hydrocephalus?

A

A surgical treatment called
Ventriculoperintoneal shunt (VP)

226
Q

What is the dangerous things that can occur with VP Shunt? (2)

Don’t over think it

A

Infection and occlusion

227
Q

What is the biggest clinical manifestation behind VP shun occlusion?

A

Strabismus ( cross eyed children )

228
Q

The last following flashcards are going to be about the endocrine dysfunction in children

Endocrine dysfunction

A
229
Q

What are the 15 conditions we are going to be talking about when it comes to endocrine dysfunction with children

Endocrine dysfunction

A

Diabetes type 1 & 2
DKA
Hypopituitarism
Hyperpituitarism
Precocious puberty
Diabetes insipidus
SIADH
Hypothyroid
Hyperthyroid
Hypoparathyroid
Hyperparathyroid
Addision
Cushing syndrome
Hyperaldosteronism
Phenochromocytoma

230
Q

What does diabetes mean?

A

Total or partial deficient of the hormone insulin

231
Q

Diabetes usually peaks around what age for children?

Diabetes usually peaks around what age for adults ?

A

10-15 years old

45 years old, mainly African Americans

232
Q

How many types of diabetes are there?

A

Type 1
Type 2

Technical 3, with diabetes insipidus but that’s another topic

233
Q

What is type 1 diabetes mean?

A

Autoimmune condition where the patient is born with literally no insulin, or functioning pancreas

234
Q

What is type 2 diabetes ?

A

Chronic condition where patients become insulin resistant

Usually due to having a high increase in their amount of sugar intact

235
Q

Usually what type of diabetes we see in children?

A

Type 1

It was also known as juvenile diabetes

236
Q

What is the pathology behind diabetes?

A

With a deficiency in insulin, glucose is unable to enter a cell and instead remains free in the blood, otherwise known as HYPERGLYCEMIA.

When serum glucose is too high, the kidneys will end up having to glucose spill out into the urine, dashing a key identification of GLYCOSURIA.

cell breakdown the protein for conversion to glucose by the liver
Known as glucogeneis

237
Q

Test question!
What are the signs of hyperglycemia ?
Remember the anagram (6)

A

Feeling tired
Irritability
Blurred vision

Polyruia
Polydipsia
Polyphagia

FIB-PPP

238
Q

Test question
What are the 9 hypoglycemia side effects?
Think of the anagram

A

Feeling tried
Irritability
Blurred vision

Dizziness
Increased hunger
Shakiness
Headache

Paleness
Sweatiness

FIB-DISH-PS

239
Q

What are the long term complication of diabetes ?(2)
Like what type of conditions

A

Microvascular
Macrovascular issues

240
Q

What are the 2 microvascular issues with diabetes?

A

Nephropathy
Retinopathy

241
Q

What is your major macrovascular complication with diabetes?

A

Neuropathy

242
Q

What are some therapeutic management of Diabetes?
Dont over think it

A

Insulin therapy
Monitor blood sugar - A1C
Urine test for ketones
Nutrition and exercise
Teach patient how to mange
Hypoglycemia
Illness management

243
Q

What does A1C tell us?

A

Past 3 months of where your blood sugar averaged

244
Q

What is the target blood sugar in a 5 year old and typically younger?

What is the target blood sugar in a 6 year old and typically older?

A

70-200

70-150

245
Q

How often are you checking blood sugar in these patients?
So give me usually the time we’d check them (5)

A

Before breakfest
Before lunch
Before dinner
Before bedtime
Exercise

246
Q

What is the statement we use when talking about hypoglycemia?

A

Cold and clammy give me some candy!!

247
Q

What is the treatment for hyperglycemia?

A

Insulin administration

248
Q

What are some fast acting sugar examples (5)

These are based off the PowerPoint picture she had up

A

Glucose tablets (4-5)
Fruit juice (150-200ml)
Honey (1 Tablespoon)
Sugary drink (75-100ML)
Jelly beans (4-5)

249
Q

Do we give chocolate for hypoglycemia?

A

No

250
Q

TEST QUESTION
Usually after the administration of a sugary substance to patients with hypoglycemia reactions, what do we want to follow up with and why?

A

Carbohydrate

We want the sugar to stay in our body a little longer, not just spike up

251
Q

We understand that with Hyperglycemia we are going to want to administer insulin.
Name me the 3 rapid type of insulin
Onset
Peak
Duration

A

Novolog, humalog, apidra
10-15mins
60-90mins
3-4hours

252
Q

Possible test question
What’s the super important thing to note when administering rapid insulin to a patient?

A

They must have their food tray right in front of them, if not they only have 10-15mins before they become severely hypoglycemia

253
Q

What is your long acting insulin, otherwise known as your background basa
Give me the names (3)
Onset
Peak
Duration

A

Lantus,Levemir, basaglar

Doesn’t really have a peak or onset
But has a duration of 20-24hours

254
Q

TEST QUESTION
What’s the super important thing to note about long acting, background basal insulin?

A

We do not mix it another insulin

255
Q

TEST QUESTION EXAMPLE
a patient is receiving Lantus/letermir/basaglar insulin injection, should we give them a rapid insulin?

A

No!
We never mix long acting insulin with another insulin

256
Q

Do you give insulin injections in the same spot?

So what do we do?

And if you do give it in the same spot, what does it mean?

A

No

Rotate sites

Lipodystrphy, abnormal fat growth and leads to improper absorption

257
Q

Some other patients education
DM : INSULIN therapy

Nature of the disease
Meal planning
Insulin therapy
Insulin pump therapy
Glucose monitoring

Rotate the sites of injection
Have it on the thigh, the stomach left/right, upper arm
- very important to note is that the stomach has the best absorption site

A
258
Q

Just something to note
What do you think is better to have for a patient, for them be hyperglycemia or hypoglycemic? And why?

A

Hyperglycemia
Because it’s a lot easier to bring someone down with insulin, remember it’s a very slow process but that sugar is still in the brain

For hypoglycemia, it’s the worsen scenario because our body needs sugar and it takes a while for sugar to be absorbed, so it’s a lot more worse

259
Q

What is diabetic ketoacidosis (DKA)?

A

When glucose is unavailable for cellular metabolism, the body breaks down alternate sources for energy

Ketones are then release and excess ketones are eliminated in the urine (ketonuria) or by the lungs
(acetone breathe )

Ketones in the blood are strong acids that lower the serum PH

260
Q

DKA results from what?

A

Progressive deterioration with
Dehydration
Electrolytes imbalance
Acidosis
Coma
Death

261
Q

Is DKA a pediatric emergency?

A

Yes

262
Q

What are the 3 big clinical manifestations that you will in patients with DKA?

A

Fruit smelling breath
Kussmal breathing
Very low ph- aciditiy

263
Q

If the patient were to get a urine dipstick done when they are in DKA what will show?

A

It’ll be the color pink
Indicting there is ketones

264
Q

What does kussmual respirations mean?

And why does this happen in DKA?

A

Fast shallow breathing,
deep labored breathing

In order to get rid of the excess CO2 in the body

265
Q

What is the only type of insulin that can be given to patients, like DKA?

And why do you think that?

A

Regular insulin

Because of the method it’s given, IV Drip with normal saline, fastest way of absorption

266
Q

TEST QUESTION
If a patient is in DKA, or very high blood sugar and you wanna bring that sugar down, what are you going to ?

A

Regular insulin IV drip

267
Q

Can you give regular insulin with normal saline?

A

Yes
This is the protocol typically to use both of them

268
Q

Something I forgot to note
If you’re patient is hypoglycemia And is unconscious, what are you going to give them!?
- what if it’s in the hospital?

A

Glucogon

Typically dextrose 50%

269
Q

Kids carb count when diabetic!
Using the bread example in the picture

5g - top half of the bread
5g - middle half of the bread
5g - end half of the bread

Let’s say a kid has for every 5g he eats, he will need 1 unit of insulin

He eats the top, and middle portion of a singular piece of bread, how much units do you think he needs?

Alright what about a kid is for every 15g and he needs 1 unit, let’s see he eats the entire piece of bread, how much units will he need?

A

2units

1unit

270
Q

Just some patient education
We don’t want to say to patients that they can’t eat anything, instead we tell them?

A

Eat with moderation

271
Q

What is the function of the endocrine system?

A

Controls and regulated metabolic process

272
Q

What is the “big boss” for the entire endocrine system ?
- which helps regular your?

A

Hypothalamus

Pituitary gland

273
Q

The pituitary gland has two lobes, which are?

A

Anterior and posterior

274
Q

What is the function of the pituitary?

A

Controls several hormonal glands in the body

275
Q

What are the 6 hormones anterior pituitary lobe controls ?

A

GH growth hormone
ACTH - adrenal
TSH - thyroid
FSH/LH - gonads
PRL - prolactin - mammary
MSH - skin

276
Q

What are the 2 hormones the posterior pituitary controls?

A

ADH - kidneys
Oxytocin - mammary gland

277
Q

What are the 3 main endocrine organs we are mainly going to be focusing on during this chapter?

A

Thyroid
Parathyroid
Adrenal glands

278
Q

What is hypopituitarism mean?

A

Growth hormone deficiency

279
Q

Since within hypopituitarism we don’t have the growth hormone and or lack it, how are kids going to be presenting ?
Like physically wise!

A

In short stature

280
Q

How would we diagnose or more so become concern with their growth hormone deficiency in kids, typically with the assessment or observation of what in their chart?

A

When they deviate by 2 sections away from their normal growth curve

281
Q

So it’s obvious with hypopituitarism, children are more than like going to need _______ therapy in order to meet the demands of the body.

A

Growth hormone replacement therapy

Or growth hormone medication

282
Q

However if growth hormone deficient is caught on later in life, let say teenager years, what’s the very important thing to note about this?

A

Usually by this time their bone plates are slowly closing away day by day, meaning if we don’t act quickly,

Growth hormone replacement won’t do anything

So again
We need plates to use growth hormone, so we can grow into these plates!!

283
Q

What is pituitary hyperfunction ?

Otherwise known as your?

A

Excess amount of growth hormone
Acromegaly

284
Q

What is the most common cause of pituitary hyperfunction, or Acromegaly is what?

A

An adenoma or benign tumor on the pituitary gland

285
Q

Test question
What is the 2 big manifestation we will see with patients with acromegaly?

A

prominent chin & jaw
Large hands

It may also include
Joint pain
Voice changes
Sweeting

286
Q

Remmeber for acromegaly, these children are producing a ton of ____so it results then to grow really really tall

But you know, these platelets are going to end up closed eventually, what symptoms will you see out of this?

What is the biggest thing about girls about this though ?

A

Growth hormone

Again you’d see that prominent jaw and chin

Thyell have a lot of testosterone and eventually it can stop their period!!

287
Q

What is the treatment for pituitary hyperfunction or acromegaly?

A

Usually the removal of the adenoma or tumor

288
Q

What is precocious puberty mean?

ages we use to identify this
Boy
White girl
African American girl

A

Defined by early sexual development
( reaching puberty too soon )

Boy= 9 years old
White girl = 7 years old
African American girl = 6 years old

289
Q

What type of scale do we use to help assess the sexual maturity or more so puberty signs on kids?

A

Tanner scale

290
Q

So what do you think we’ll see on these kids with precocious puberty?

Dont over think it

A

Usually pubic hair
Or breast buds for example
At a very very young age

291
Q

What is the treatment for precocious puberty?

And what is it doing?

A

Leuprolide acetate (lupron Depot)

Helps slow down prepubertal growth to normal rates

292
Q

When do you stop giving lupron to children?

A

When the child reaches an appropriate age for pubertal changes

Typically 11-12 years old

293
Q

What is diabetes insidious?
Otherwise known as water diabetes

A

Too little ADH

Meaning they are not able to hold fluid, so they are peeing a lot

294
Q

What is the main manifestation of diabetes insipidus?

What does it look like?

A

Diuresis

A very clear white urine
- clearer than clear she says

295
Q

What type of children do we normally see have diabetes insipidus?

A

Usually those with some form of brain damage or near death

296
Q

Possible tests question
What are the 7D’s to remmeber for diabetes insipidus?

A

Diuresis
Diluted urine (1.005)
Dry inside
Drinking
Dehydration
Decreased blood pressure
Desmopressin

297
Q

What is the treatment for diabetes insipidus ?

A

DDVAP (ADH)
Giving this hormone to help stop the diuresis

298
Q

What is syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

A

When you have TOO MUCH ADH
- kidneys hold onto their pee and Edema usually occurs

299
Q

What are the 3 S causes for SIADH?

A

Small cell lung cancer
Severe brain tumor
Sepsis infections of the brain

300
Q

Possible test question
What are the 7s to remember for SIADH?

A

Stop urination
Sticky & thick urine 1.030 gravity
Soaked inside
Sodium low
Seizures
Severe high blood pressure
Stop all fluids

301
Q

What is the treatment for SIADH?

A

Fluid restriction

More than likely a diuretic to help pee it out

302
Q

TEST QUESTION
Difference of DI and SIADH
Which does it belong to

HIGH ADH - water intoxication
LOW ADH

LOW OU, olugiria
HIGH OU, Polyuria

HIGH SODIUM
LOW SODIUM

High osmolaity - weight loss
Low osmolality - weight gain

Risk : seizures
Risk : Hypovolemic

Treatment : DDVAP (ADH)
Treatment : Fluid restriction

A

SIADH
DI

SIADH
DI

DI
SIADH

DI
SIADH

SIADH
DI

DI
SIADH

303
Q

Diabetes insipidus has ___sodium
SIADH has ___sodium

A

DI = High sodium = Hypernatremia
SIADH = low sodium = hyponatremia

304
Q

What is the serum gravity of urine for diabetes insipidus?

What is the serum gravity of urine for SIADH?

A

1.005

1.030

305
Q

What precautions are we going to patients with SIADH?

A

Seizure precautions

306
Q

What is the function of the thyroid hormone?

A

Regulates the basal metabolic rate (BMR)

307
Q

Fun fact
Thyroid is the only organ in the body that has the ability to do what?

A

Store excess amount of hormone for later usage

308
Q

What is hypothyroidism?

What is the TSH level
What is T3 and T4 level

A

Little thyroid is being produced

HIGH TSH
Low T3 & T4

309
Q

What are the 3 main causes behind hypothyroidism?

A

Congenital
Acquired
Iodine insufficiency

310
Q

What are the clinical manifestation of hypothyroidism?
Remember low and slow!

A

Weight gain
Delayed puberty
Lose hair
Constipation
Dry skin
Heat sensitivities

311
Q

What is the worst case scenario of hypothyroid call? Like the condition ?

A

Hashimoto disease

312
Q

What is hashimoto disease?

A

An autoimmune diseases when you have critically low thyroid that it forms a goiter, so a damage thyroid

313
Q

What is the treatment for hypothyroidism ?

When do you take?
Full or empty stomach?
How long do you wait for food?

A

Synthroid, Levothyroxine
Morning pill
Empty stomach
1 hour

314
Q

With hashimoto disease. We have that goiter, what if it is too bad even with medication, what are we going to do?

A

Usually remove the entire thyroid & life long thyroid pill

315
Q

What is hyperthyroidism?
What are the following ranges
TSH?
T3 & T4?

A

When you have too much thyroid being produced

Low TSH
High T3 & T4

316
Q

What are you clinical manifestation of hyperthyroidism ?
Think of fast and hyper!

However just 1 big clinical manifestation that is super important to note is)

A

Tachycardia
Diarrhea
Hungery!
Weight loss

Exophtalamos - big eyes !!!!

317
Q

What is the severe form of hyperthyroidism that results in a goiter?

A

Graves disease

318
Q

What is Graves’ disease?

A

An autoimmune condition When the body produces way too much thyroid hormone and attacks itself, resulting in a goiter

319
Q

What is the peak incidence of Graves’ disease?

A

12-14years old

320
Q

What is the treatment for hyperthyroidism? (3)

A

Proplythiouricil (PTU) medication
Thyroidecomty
Radioiodine therapy

321
Q

What is a goiter?
And what makes it so special ?

A

Usually a result from a thyroid hormone imbalance, either from hypo or hyper !

322
Q

How can you diagnose a goiter?
Think about a physical exam?

A

Enlarged throat

323
Q

What is thyrotoxicosis?
Otherwise know as
Thyroid crisis or storm

A

Sudden release of hormone,
too much hormone

324
Q

What might cause thyrotoxicosis? (3$

A

Stopping antithyroid therapy
Infection
Surgery

325
Q

What is the 2 important treatment for thyrotoxicosis?

A

Antithyroid drugs
Propanolol ( beta blocker )

326
Q

Additional notes
Hashimoto disease usually ranges what from what age?

A

6 years and older

327
Q

What is the function of the parathyroid?

A

Maintain serum calcium levels

328
Q

How does the parathyroid hormone maintain serum calcium levels?(3)

A

Increasing the release of calcium and phosphate from bone demineralization

Increasing the absorption of calcium and excretion of phosphate by the kidney

Promoting calcium absorption in the GI tract

329
Q

What is hypoparathyrdoism?

A

When you have too little PTH

330
Q

What by the the 2 causes of hypoparathyrdoism?

A

Congenital
Psudohypoparathyrdoism

331
Q

She mentioned that psydophypoparsyhydoism may be related to patients what?

A

Having an X-linked dominant trait

332
Q

What are the big 3 characteristics of hypoparathyroidism?

A

LOW PTH
Hypocalcemia
Hyperphosphatemia

333
Q

What are your 5 clinical manifestation of hypocalcemia in your hypoparathyroid patients?

A

Tetany
Chvostek sign - facial nerve
Trousseau sign - carpal spasm BP
Paraesthestisia - hand and feet
Prolonged QT interval

334
Q

What is the 4 treatment of hypoparathydoism?

A

Add foods in rich magnesium
Take OTC vitaimin D
Eat a calcium rich diet
Reduce phosphors intake

335
Q

Why would we have vitamin D in hypoparathyroid?

Why do we not want phosphorus in hypoparathyroid?

A

Vitamin D helps increase calcium

Phosphate decreases calcium

336
Q

Notes
Hyperparathyroid
Too much PTH

Clinical manifestation
GI upset - nausea vomit
CNS - confusion, hallucination
Polyruia

Treatment ; surgically remove

A
337
Q

What are the 3 things the adrenal gland helps secrete?

A

Glucocorticoids ( cortisol, corticosterone)

Mineralocorticoids ( aldosterone )

Sex steroids ( androgens, estrogens, progestins )

338
Q

What is adrenal crisis caused by?

A

Hemorrhage into the gland from trauma, fulminating infections, abrupt withdrawal of exogenous cortisone and failure to increase cortisone during times of stress

339
Q

What is Addison disease?

A

Chronic adrenocortisol insufficiency

340
Q

How does Addison disease occur?
Like what is the main cause?

A

Neoplasm or lesion on the adrenal gland

341
Q

When do symptoms of Addison disease normally start to show up?

A

When 90% of the adrenal tissue is nonfunctional

342
Q

What is your big manifestation to know about Addison disease?

Then 4 more

So 5 in total

A

Hyperpigmentation - bronze skin

Low blood pressure
Weakness
Weight loss
A lot of GI issues
Vitiligo

343
Q

TEST QUESTIONS
Patient has bronze sign, what might be the disease?

A

Addison disease

344
Q

Addision disease patients have a craving of what?

And do we allow them to eat this craving?

A

Salt

Yes they need it

345
Q

What is the treatment for Addison disease?

A

Steroid replacement

Like cortisol replacement pills

346
Q

What is Cushing syndrome?

A

Excessive circulating free cortisol

347
Q

What is the 2 main cause of Cushing syndrome?

A

An adrenal tumor
Excessive prolong steroid therapy

348
Q

What is the 3 biggest clinical finding to know about Cushing syndrome?

A

Moon shape face
Buffalo hump
Purple straie

349
Q

What is the treatment for Cushing syndrome?

A

Surgery to remove that adenoma

350
Q

What is hyperaldosyeronism ?

And what is it caused by?

A

Too much aldoserton

Adrenal tumor

351
Q

Test question
What is the 3 clinical manifestation to know about hyper aldosterone?

A

Hypertension
Hypokalemia
Polyuria - low ADH

352
Q

What is the 2 treatment for hyperaldosterone?

A

Replacement of potassium
Administration of spironolactone
( K+ sparing diuretic )

353
Q

What is phenochromocytoma ?

A

Adrenal tumor that secrets catecholamines
- pretty much a tumor that releases so much epinephrine that causes you to have a sympathetic nervous system symptom

354
Q

What is your major clinical manifestation of phenochromocytoma?

A

High blood pressure!!

Everything is sympathetic nervous system

355
Q

What is your treatment for phenochromocytoma?

A

Surgical removal of the tumor

Adrenalectomy
- usually life long cortisol therapy

349 Peds Exam 3 (3 decks)

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