Test 1 misc 2

Question 1

submersion injury timeline to poor outcome in normal water temp

Answer 1

4-5 min

Question 2

severe resp complication of submersion injury

Answer 2

ARDS

Question 3

Post Submersion Neuro Class

Alert, fully conscious

Answer 3

A

Question 4

Post Submersion Neuro Class

Obtunded, stuporous but arousable; purposeful response to pain; normal respiration

Answer 4

B

Question 5

Post Submersion Neuro Class

Comatose; not arousable; abnormal response to pain; abnormal resp

Answer 5

C

Question 6

Post Submersion Neuro Class

flexor to pain, cheyne stokes

Answer 6

C1

Question 7

Post Submersion Neuro Class

Extensor response to pain; central hyperventilation

Answer 7

C2

Question 8

Post Submersion Neuro Class

Flaccid; apneic

Answer 8

C3

Question 9

initial chest x ray expectation for submersion injury

Answer 9

Initial Chest x-ray can be normal, show patchy infiltrates (frequently in the periphery or bibasilar regions) or show pulmonary edema.

Question 10

what pH imbalance do you expect in submersion injury

Answer 10

resp acidosis that leads to metabolic acidosis due to lactic acid buildup

Question 11

Treating submersion injury

Answer 11

Some patients require positive pressure for 48-72 hours,
§ Antibiotics and steroids are not indicated unless the pt becomes febrile
§ Hypovolemia should be treated with isotonic crystalloids (10-20 mL/kg). inotropic support with dopamine, dobutamine or epi can be required if continued hypertension or poor perfusion are ongoing.
Abnormal CT= most likely death
§ Is the patient is symptomatic evaluation via arterial BG, and chest x-ray should be done. Also consider a CBC, coag studies, and electrolyte panel.

Question 12

submersion injury obs time and necessary orders if well appearing

Answer 12

prolonged time frame after submersion incident because even mild hypoxia can increase permeability of pulm capillaries with alveolar fluid leak and surfactant damage

Pulse oximetry monitoring
ABG if resp distress
Chest x ray (all submersion victims)

Question 13

symptoms commonly seen with submersion injury

Answer 13

anxiety, vomiting, cough, wheezing, hypothermia, altered mental status, metabolic acidosis, respiratory failure, and finally respiratory/cardiac arrest.

Kline, Andrea M.; Haut, Catherine. Lippincott Certification Review: Pediatric Acute Care Nurse Practitioner (p. 1031). Wolters Kluwer Health. Kindle Edition.

Question 14

______ should be used to prevent atelectasis and overcome intrapulmonary shunting

Answer 14

Positive end expiratory pressure

Question 15

CN impairment initially in Botulism

Answer 15

Bulbar Palsy
IX
X
XI
XII

Question 16

Treatment in Infant Botulism

Answer 16

mostly supportive by assisting in breathing

Question 17

Presentation of Infant Botulism

Answer 17

§ Usually starts from the head down, with oculobulbar muscle weakness, blurring of vision, dipoplia, ptosis, ophthalmoplegia, dysarthria, and dysphagia.

§ Infants usually present listless, feeding poorly, have a weak cry, and are constipated. This is followed by a descending pattern of weakness with the upper limbs, lower limbs, and ultimately the respiratory muscles.

§ Occurs more frequently in infants less than 6 months of age but can occur up to 1 year of age.

§ S&S- constipation, lethargy, poor feeding, excessive drooling, and increasing weakness.

§ On physical exam, general hypotonia and symmetrical cranial nerve palsies are present. Infants appear to have expressionless face. CRANIAL NERVE PALSIES ARE ALWAYS PRESENT, and part of the definitive diagnosis.

Question 18

management for infant botulism

Answer 18

§ There is an infant botulism antitoxin (BIG-IV) -Administration of human botulism immune globulin intravenous (BIG-IV).

available and if used early markedly shortens the intensive care course. Abx are not usually recommended because they will lyse bacteria and release more toxin into the circulation.
§ Feed via NG tube or NJ tube.

Question 19

bacteria that causes botulism

Answer 19

bacteria,

Kline, Andrea M.; Haut, Catherine. Lippincott Certification Review: Pediatric Acute Care Nurse Practitioner (p. 572). Wolters Kluwer Health. Kindle Edition.

Question 20

•Infants have weak cry, expressionless face, ptosis, and sluggish pupillary responses. Gag, suck, and swallow reflexes are diminished or may be absent.

Answer 20

Botulism

Question 21

causes of meningitis in Neonates

Answer 21

Group B Strep,
E. Coli
Listeria monocytogenes
Klebsiella species

Question 22

causes of meningitis in infants 3 months-9mos

Answer 22

Strep Pneumoniae
Nesseria meningitidis (group B strep is responsible for small amounts of meningitis
H. influenzae type B

Question 23

causes of meningitis in children 10-18 yrs

Answer 23

N. meningitidis is responsible for the majority of bacterial meningitis cases.

streptococcus pneumonia

H. influenzae

Question 24

meningitis in unvaccinated children, what etiology to consider

Answer 24

IF CHILDREN ARE UNVACCINATED!!! Think possibly H. influenzae type B, also if in an underdeveloped countries.

Question 25

most common cause of viral meningoencephalitis

Answer 25

Enterovirus

Question 26

Bacterial meningitis usually involves the fluid in the ______ space

Answer 26

subarachnoid

Question 27

causes of Meningitis in 5 yr old

Answer 27

N. Meningitis | Strep pneumoniae

Question 28

Meningeal signs of meningitis

Answer 28

Severe throbbing headache Photophobia nuchal rigidity Kernig sign: Passive extension of the knee in supine position, resulting in back pain and resistance. • Brudzinski sign: • Passive flexion of the neck, resulting in involuntary flexion of the knees and hips.

Question 29

csf changes associated with bacterial meningitis

Answer 29

``` Increased WBC increased protein decreased glucose increase pressure increased lactate (>25 is indicative of bacterial meningitis ```

Question 30

abx for meningitis with recent neurosurgery or ventricular shunt

Answer 30

vancomycin + cefepime; vancomycin + ceftazidime; or vancomycin + meropenem. •

Question 31

abx for meningitis with basilar skull fx

Answer 31

vancomycin + 3rd-generation cephalosporin.

Question 32

abx for meningitis older than 1 mos

Answer 32

empirical broad-spectrum antimicrobial coverage with VANCOMYCIN, and either cefotaxime or ceftriaxone should be started. § ACYCLOVIR should be initiated for all infants and children with suspected HSV encephalitis.

Question 33

most common cause of meningitis in children

Answer 33

viral meningitis - specific agent not usually specified but (Enterovirus >80% of cases) other echovirus, coxsackievirus, arbovirus, mumps, EBV, Cytomegalovirus, Varicella, adenovirus, HSV

Question 34

csf changes in viral meningitis

Answer 34

glucose normal, slightly decreased Protein slightly increased WBC - mildly increased

Question 35

what is the gold standard for diagnosis of HSV meningitis

Answer 35

CSF PCR for HSV

Question 36

management of viral meningitis

Answer 36

self limiting - resolves in 7-10 days control seizures acyclovir if HSV meningitis is suspected

Question 37

differences/additional symptoms in HSV meningitis

Answer 37

function: ataxia, focal neurologic signs, acute encephalopathy (high suspicion). Kline, Andrea M.; Haut, Catherine. Lippincott Certification Review: Pediatric Acute Care Nurse Practitioner (p. 604). Wolters Kluwer Health. Kindle Edition.

Question 38

GBS has what shape bacteria (ie: gram neg, gram pos...)

Answer 38

gram positive cocci

Question 39

what is the gold standard test for determining if a case of meningitis is bacterial in etiology

Answer 39

CSF bacterial culture

Question 40

steroid injections make you more at risk for what kind of meningitis

Answer 40

fungal infection

Question 41

what csf test tests for fungal meningitis

Answer 41

beta-D-glucan

Question 42

suspect viral meningitis over bacterial when you see what in csf

Answer 42

normal glucose and protein levels along with a lower WBC with a monocytic predominance

Question 43

if pathogens make it into the brain parenchyma itself, the response is

Answer 43

Encephalitis

Question 44

most common cause of pure encephalitis

Answer 44

enterovirus

Question 45

temporal lobe enhancement on CT is a symptom of

Answer 45

HSV encephalitis

Question 46

presence of RBCs in CSF is suggestive of

Answer 46

Herpes Simplex encephalitis

Question 47

Ampicillin covers what type of meningitis

Answer 47

Listeria monocytogenes

Question 48

Medications to avoid with eating disorders

Answer 48

TCAs - cardiotoxicity in malnourished individuals Bupropion - increased risk of seizures in individuals with eating disorders

Question 49

complications of Bulimia nervosa

Answer 49

erotion of enamil sialadenosis (swelling of parotid gland) bad breath Russels sign - calleouses on knuckles from making yourself vomit Tears in distal esophagus or stomach itself (Mallory Weiss syndrome - abd pain and hematemesis) Amenorrhea type 2 DM

Question 50

Russels sign

Answer 50

sign of Bulimia nervosa - callous on knuckles

Question 51

Mallory weiss syndrome

Answer 51

associated with Bulimia nervosa - tears in distal esophagus or stomach resulting in abd pain and hematemesis

Question 52

``` Bulimia Nervosa: What does BP HR: Electrolytes: Ph: ```

Answer 52

Dehydration causes Hypotension (<90/50) Tachycardia HR >100 ``` Electrolytes low NA Cl Mg phosphorous K+ ``` General Metabolic Alkalosis

Question 53

Lab tests to order in Bulimia nervosa

Answer 53

``` Serum electrolytes serum creatinine BUN CBC with diff LFTs Urinalysis ```

Question 54

Pharm for Bulimia Nervosa

Answer 54

SSRI choice is Fluoxetine If they dont respond, try diff SSRI - Sertraline ``` If dont respond or tolerate -> Either tricyclic antidepressant Trazodone MAOIs Topiramate ```

Question 55

Med you cant describe for a pt with Bulimia nervosa

Answer 55

Bupropion - increased risk of seizures in individuals with eating disorders

Question 56

Binge Eating disorder treatment

Answer 56

Psychotherapy is first line second line is SSRI s third line is Topiramate Mod severe cases may benefit from Lisdexamfetamine

Question 57

what is the unintentional Food regurgitation disorder

Answer 57

called: Rumination Disorder nor due to a medical disorder not purposeful associated with mood disorders

Question 58

What diagnostics rule out other differentials for Rumination disorder

Answer 58

High resolution impedance manometry testing upper GI endoscopy

Question 59

initial management for rumination disorder

Answer 59

Education and treatment of mood disorder Diaphragmatic abd breathing immediately after a meal and for 10-15 min after

Question 60

if initial mgmt of rumination disorder doesnt work, what meds can you try

Answer 60

Baclofen increases LES tone decreases LES relaxation

Question 61

diagnostic criterion for PICA

Answer 61

strong cravings to eat non-food items >= month has to be culturally inappropriate should not happen in the context of another health condition such as schizophrenia, autism or another eating disorder

Question 62

what is PICA associated with

Answer 62

anemia (esp iron deficiency) emotional trauma malnutrition comorbid psychiatric disorders

Question 63

complications with PICA

Answer 63

``` nutritional deprivation anemia toxicity constipation intestinal obstruction parasitic infections jaw or tooth injury weight changes ```

Question 64

treatment for PICA

Answer 64

1) Nutritional rehab and psychotherapy Identify substance -> decrease exposure -> healthier alt to decrease cravings If comorbid psych disorders -> SSRIs

Question 65

significant food restrictions at least once a week for 3 months with fear of gaining weight and BMI below 18.5

Answer 65

Anorexia

Question 66

cycles of binging and purging once a week for 3 months with normal weight or over weight (BMI >18.5)

Answer 66

Bulimia

Question 67

large amounts of food that causes lots of insulin to be released which leads to cellular intake of electrolytes and produces arrhythmias

Answer 67

Refeeding syndrome

Question 68

expected weight gain in anorexia in hospitalized vs outpatient patients

Answer 68

2-3 lbs/week (hospitalized) | 0.5-1lb/week (outpatients)

Question 69

how many kcal/kg/day in anorexia treatment

Answer 69

30-40 kcal/kg/day

Question 70

in bulimia, what acid base disorder is seen

Answer 70

metabolic alkalosis

Question 71

``` Salicylate intoxication Hyperventilation Hyperthyroidism Interstitial pulmonary disease CNS diseases ``` causes what acid base imbalance

Answer 71

Resp alkalosis High pH low CO2

Question 72

diarrhea will cause what acid base imbalance

Answer 72

metabolic acidosis low pH low HCO3

Question 73

``` Methanol Uremia DKA Paraldehyde Isoniazid and iron lactic acid ethanol glycol ethanol induced ketoacidosis salicylates ``` All do what do your anion gap and give you what kind of a acid base imbalance

Answer 73

increased anion gap metabolic acidosis low pH low HCO3

Question 74

``` Loss of gastric acid due to vomiting NG suctioning Diuretic use Alterations to parenteral nutrition Excessive bicarb administration ``` all put you at risk for what kind of acid base balance

Answer 74

metabolic alkalosis high pH High bicarb