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Peds - NUR 122 > Test 2 > Flashcards

Test 2 Flashcards

1
Q

What are the pediatric differences in the GI system?

A

small stomach capacity. increased peristalsis. relaxed cardiac sphincter. decreased enzymes. distention from gas. immature liver.

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2
Q

What are structural disorders of the GI system?

A

cleft lip and palate
pyloric stenosis
intussusception

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3
Q

What are malabsorption disorders of the GI system?

A

celiac disease

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4
Q

What are motility disorders of the GI system?

A

acute diarrhea

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5
Q

What issues can cleft lip/palate cause?

A 
feeding difficulties
dental deformities
speech problems
otitis media
hearing problems
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6
Q

What is some preop nursing care of cleft lip/palate?

A 
support parents
modified feeding or NPO
age-appropriate preoperative education
discuss surgical expectations
multidisciplinary team support
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7
Q

How do you facilitate feedings with cleft lip/palate?

A 
special feeders
encourage breast feeding
allow extra time for feeds
burp frequently
upright position 30 min post feed
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8
Q

What is post op nursing care for cleft lip/palate?

A

pain management, maintain suture line, nutritional support, home care teaching

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9
Q

What are symptoms of pyloric stenosis?

A 
occasional emesis -> projectile vomiting
visible peristaltic waves
palpable olive-sized mass
hyperactive bowel sounds
dehydration, electrolyte imbalances
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10
Q

What is the nursing care for pyloric stenosis?

A

meet fluid and electrolyte needs - IVFs.
minimize weight loss - daily weights, I&Os, IVFs. post op, small frequent feedings. do not rock or play for 30 minutes after feeds
promote comfort - pain management, donā€™t life legs to change diaper
prevent infection - incision care, monitor temp & RR

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11
Q

What is intussusception?

A

portion of intestine prolapses and telescopes back

most common in infancy and in males

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12
Q

What are symptoms of intussusception?

A

abrupt onset. acute pain. vomiting -> bilious. brown stool -> reddish currant jelly. palpable abdominal mass

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13
Q

How is intussusception diagnosed?

A

abdominal xray/ultrasound

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14
Q

How is an intussusception treated?

A

contrast air or barium enema
stomach decompression
possible surgery

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15
Q

What is celiac disease?

A

gluten-sensitive enteropathy. immunologic disorder - intolerance of gluten

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16
Q

What are signs and symptoms of celiac disease?

A

chronic diarrhea, impaired growth, abdominal distention. decreased appetite, decreased energy, muscle wasting.

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17
Q

How is celiac disease diagnosed?

A

fecal fat, duodenal biopsy, clinical improvement, special serum antibodies.

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18
Q

How do you treat celiac disease?

A

gluten free diet

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19
Q

What to teach with celiac disease?

A

allowed foods, risks of noncompliance

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20
Q

What are some grains that contain gluten?

A

barley, bran, couscous, farina, graham flour, orzo, rye, semolina, wheat, wheat brain, wheat germ, wheat starch.

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21
Q

What is the concern with acute diarrhea?

A

alters fluids & electrolyte balance

rapid dehydration in infants & small children -> hypovolemic shock and death

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22
Q

What is the treatment for acute diarrhea?

A

slow losses and rehydrate with adequate electrolytes/nutrition

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23
Q

What is the nursing care for acute diarrhea?

A

prevent dehydration.
provide rehydration fluids
family support & teaching

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24
Q

What are pediatric differences for the GU system?

A

small bladder capacity, add 2 to their age = ounces bladder can hold

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25
Q

In the GU system, under the age of 2, children are less efficient atā€¦ ?

A

electrolyte and acid-base balance
excretion of drugs from body
concentrating urine

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26
Q

What are diagnostic procedures for GU disorders?

A 
cystoscopy
diuretic renogram
intravenous pyelogram
voiding cystourethrogram
lab tests - BUN, creatine, urinalysis
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27
Q

What do you assess in the GU system?

A

urine characteristics
pain or discomfort
edema
appearance of genitalia

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28
Q

What is the normal urine output for infants?

A

2 mL/kg/hr

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29
Q

What is the normal urine output for children?

A

0.5 to 1 mL/kg/hr

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30
Q

What is the normal urine output for adolescents?

A

40 to 80 mL/hr

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31
Q

What is hypospadias or epispadias?

A

abnormal location of urethral meatus in males

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32
Q

How do you diagnose hypospadias or epispadias?

A

prenatal US or observation

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33
Q

How do you treat hypospadias or epispadias?

A

surgery

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34
Q

What is the nursing care of hypospadias or epispadias?

A

protect surgical site
encourage fluids
double diapering - second diaper catches urine from stent

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35
Q

What are the medications post op of hypospadias or epispadias repair?

A

analgesics, prophylactic antibiotics, and anticholinergics to reduce bladder spasms

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36
Q

What is cryptorchidism?

A

failure of testicle to descend

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37
Q

What are complications of cryptorchidism?

A

infertility & malignancy - testicular cancer

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38
Q

When do testicles usually descend?

A

spontaneously by 3 months

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39
Q

What is post op teaching for cryptorchidism?

A

no tub baths x2 days
keep clean & dry
avoid straddling on hip or straddle toys x 2 weeks

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40
Q

What is primary enuresis?

A

never dry, infants.
delayed neuromuscular maturation
small bladder capacity

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41
Q

What is secondary enuresis?

A

stress, UTI, DM, sleep disorder

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42
Q

What is nocturnal enuresis?

A

bedwetting

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43
Q

What is the treatment of enuresis?

A

fluid restriction, bladder exercises, timed voiding, enuresis alarms, reward systems, medications.

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44
Q

What are medications used for enuresis?

A

desmopressin - nasal spray with antidiuretic effect
imipramine - anticholinergic, reduces bladder spasms
oxybutynin - for urgency

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45
Q

What is nephrotic syndrome characterized by?

A 
edema - protein loss -> osmotic pressure change
retain sodium and water
massive proteinuria
hypoalbumninemia, hypoproteinemia
altered immunity
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46
Q

What are symptoms of nephrotic syndrome?

A

increased edema, anorexia, weight gain from retaining fluid, HTN, irritability

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47
Q

How do you diagnose nephrotic syndrome?

A

history, symptoms, labs

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48
Q

What medications are used with nephrotic syndrome?

A 
corticosteroids 12 weeks
diuretics - relieves edema
antihypertensive
antibiotics - risk for infection
iv albumin - replace low albumin levels
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49
Q

What are interventions for nephrotic syndrome?

A 
monitor side effects of meds
prevent infection
prevent skin break down
meet nutritional and fluid needs
promote rest
support and home care teaching
50
Q

What is acute glomerulonephritis?

A

most common inflammation of glomeruli of kidney

51
Q

What is acute glomerulonephritis a response to?

A

group A beta-hemolytic streptococcus or strep throat

52
Q

What are characteristics of acute glomerulonephritis?

A 
history of strep infection
signs emerge 10-21 days after
immune complex reaction on glomerular capillary wall
decreased GFR, RBC excreted
Ha, H3O retained -> edema
53
Q

What are signs and symptoms of acute glomerulonephritis?

A

acute pain, usually asymptomatic, tea colored urine

54
Q

What labs diagnose acute glomerulonephritis?

A

BUN, Creatine, GFR

55
Q

What is the treatment of acute glomerulonephritis?

A

relief of symptoms & supportive care

bed rest, treat edema, HTN

56
Q

What is the nursing care for acute glomerulonephritis?

A 
monitor fluid status
prevent infection
prevent skin break down
meet nutritional needs
provide emotional support
teaching needs
57
Q

What are some pediatric differences in the brain and spinal cord?

A

not well protected from trauma
nerve impulse development rapid
brain growth continues until age 5-8
myelination incomplete at birth

58
Q

What are pediatrics more at risk for?

A

brain injury, skill fracture, neck injury, and compression fractures

59
Q

What is hydrocephalus?

A

a structural defect of the brain, enlarged ventricles due to too much CSF.
can be congenital or acquired

60
Q

What is the diagnostic tests for hydrocephalus?

A

signs/symptoms of increasing ICP - increase in head circumference. older child - HA, vomiting, irritable

61
Q

What is the treatment for hydrocephalus?

A

remove obstruction or create bypass
ventriculoperitoneal shunt
ventriculoatrial shunt

62
Q

What are complications of surgery for hydrocephalus?

A

shunt malfunction or failure

infection

63
Q

What is pre-op nursing care for hydrocephalus?

A

position carefully & reposition frequently
support head a& neck, HC checks daily
skin care: prevent breakdown
feedings - prone to vomiting
monitor for s/s of increased ICP

64
Q

What is post-op nursing care for hydrocephalus?

A

positioning - flat for 24 hours, gradually rise. fed on side.
aseptic technique
monitor for shunt malfunction, infection, increase ICP
teaching

65
Q

What is meningomyelocele (or spina bifida)?

A

spinal fluid-filled meningeal sac

66
Q

How must meningomyelocele be treated?

A

surgery in 24-48 hours of birth

67
Q

How is meningomyelocele diagnosed?

A

may be diagnosed prenatally

CT, MRI, and Xray

68
Q

What decreases the chance of meningomyelocele ( spina bifida)?

A

adding folic acid to diet of pregnant woman

69
Q

What are clinical manifestations of meningomyelocele?

A

spinal fluid filled meningeal sac
hydrocephalus - 85% associative
seizures
lowest - mild weakness, bowel, & bladder issues
highest - paralysis of legs, weakness, and sensory loss of trunk, loss of bowel, bladder control

70
Q

What causes neonatal abstinence syndrome?

A

maternal drug use

71
Q

What are symptoms of neonatal abstinence syndrome?

A

withdrawal.

effects CNS, ANS, GI tract

72
Q

How to treat neonatal abstinence syndrome?

A

reduce effects of withdrawal- phenabarbitol, klonadine, bundle baby, reduce stimuli.

73
Q

What is cerebral palsy?

A

a movement & posture disorder. caused by an assault on the immature brain.

74
Q

What is the focus of therapy for cerebral palsy?

A

want them as independent as possible

75
Q

What are common learning disabilities?

A

dyslexia - reading
dyscalculia - math
dysgraphia - writing
dyspraxia - motor skills

76
Q

What is the goal in treating learning disabilities?

A

maximize learning potential

maintain healthy self-esteem

77
Q

What is the goal of treating children with disabilities?

A

maximize childā€™s potential

78
Q

What scale is used to assess level of consciousness?

A

Glasgow coma scale

79
Q

What is a late cardiac sign of increased ICP?

A

bradycardia

80
Q

What urinary problem is associated with spina bifida?

A

neurogenic bladder

81
Q

What is spasticity?

A

hypertonia with uncontrolled movement seen in cerebral palsy

82
Q

What is athetosis?

A

constant involuntary writhing motions seen in cerebral palsy

83
Q

What are the respiratory differences in pediatrics?

A 
airway is smaller in diameter and shorter
increased airway resistance
fewer alveoli for gas exchange
cartilage more flexible
increased oxygen consumption
large tongue and epiglottis
84
Q

What is included in a respiratory assessment?

A

respiratory effort, color, position of comfort, behavior change, breath sounds, cough, vital signs, O2 saturation, family history.

85
Q

What are symptoms of respiratory distress in children?

A

nasal flaring, grunting, retractions, restlessness, anxiety, fearful affect, diaphoresis, decreased O2 saturation, behavioral changes, and general cyanosis.

86
Q

What are symptoms of hypoxia?

A

early - Restlessness, Anxiety, Tachycardia/Tachypnea

late- Bradycardia, Extreme restlessness, Dyspnea

87
Q

What are symptoms of hypoxia in children?

A

Feeding difficulty, Inspiratory stridor, Nasal flaring, Expiratory grunting, Sternal retractions.

88
Q

What is the treatment for respiratory distress?

A

start oxygen
position of comfort
bed rest
calm environment

89
Q

What are diagnostic tests for respiratory disorders?

A

bronchoscopy, imaging studies, sleep studies, pulse ox, spirometry/pulmonary function tests, sweat chloride tests, arterial blood gases

90
Q

What are characteristics of impaired gas exchange?

A

abnormal ABGs (hypoxia, hypercapnia)
decreased O2 sat
altered LOC
dyspnea

91
Q

What are characteristics of ineffective airway clearance?

A 
adventitious breath sounds
ineffective or absent cough
inability to remove secretions
diminished breath sounds
sputum production
92
Q

What are characteristics of ineffective breathing pattern?

A

low rate, depth, minute volume
use of accessory muscles
nasal flaring
orthopnea, dyspnea

93
Q

What are respiratory interventions?

A 
oxygen
humidity
incentive spirometer
chest physiotherapy
suction
medications
CPAP, or ventilator
94
Q

What are some respiratory medications?

A

bronchodilators - reverse or prevent bronchospasm
anti-inflammatory agents - reduce inflammation
antimicrobials

95
Q

What are some acute respiratory conditions?

A

otitis media
tonsillitis
bronchiolitis
croup syndromes

96
Q

What is otitis media?

A

inflammation of middle ear
related to E tub dysfunction
can lead to hearing impairment

97
Q

What are risk factors for otitis media?

A

male children, day care centers, allergies, pacifier use, exposure to tobacco smoke, multiple siblings, cleft lip/palate

98
Q

What are symptoms of otitis media?

A

tympanic membrane very red, may be bulging
irritability, and pulling at ear
n/v, FEVER

99
Q

What is the treatment of otitis media?

A

observation
analgesics
antibiotics
myringotomy/tympanostomy tubes

100
Q

What is tonsillitis?

A

inflammation of tonsils

101
Q

What are symptoms of tonsillitis?

A

frequent throat infections, breathing and swallowing difficulties, persistent redness of tonsils. sleep apnea. nasal stuffiness. discharge & postnasal drip.
cough

102
Q

What is the treatment for tonsillitis?

A

antibiotics, surgery - watchful waiting

103
Q

What is bronchiolitis?

A

lower airway inflammation often caused by RSV. excessive mucus plugs airway
resembles pneumonia on xray
October to march
risk for respiratory failure

104
Q

What is the treatment of bronchiolitis?

A 
maintain droplet isolation
humidified oxygen for O2 sats <90%
CR nad puls ox monitors
nasal suctioning before feeds
nebulized salene treatments - loosens secretions
reduce anxiety
fluids
105
Q

What is croup syndrome?

A

upper air way inflammation

106
Q

What are clinical manifestations of croup syndrome?

A

inspiratory stridor
seal-like barking cough
hoarseness
worse at night

107
Q

What are the four classic ā€œDā€ signs of epiglottitis?

A

Dysphonia, Dysphagia, Drooling, Distressed respiratory effort with stridor

108
Q

What is Bronchopulmonary dysplasia (BPD)?

A

chronic lung disease of newborn

109
Q

What increases the risk for BPD?

A

use of ventilator and oxygen
less than 28 weeks gestation
less than 1000 grams
PDA, MAS

110
Q

What are the symptoms of BPD?

A 
increased respiratory effort and O2 need
failure to thrive
right-sided heart failure
growth &amp; development delays
impaired cognition
pulmonary dysfuction
111
Q

What are medications for BPD?

A 
bronchodilators
corticosteroids
diuretics
potassium chloride - replace K with diuretics
Palizumab (Synagis)
pneumococcal vaccine at age 2
112
Q

What is cystic fibrosis?

A

autosomal recessive genetic disorder of the exocrine glands.
affects transport of Cl & Na across cell membranes
results in very thick mucus which obstructs ducts of multiple organs

113
Q

What are clinical manifestations of cystic fibrosis?

A 
chronic, moist productive coughf
frequent respiratory infections
adventitious breath sounds
chronic sinus infections
clubbing and a barrel chest
poor weight gain/ FTT
bulky, smelly stools, partial small bowel obstruction
infertifility
114
Q

What are diagnostic tests for cystic fibrosis?

A

newborn screaning for trypsinogen
chromosome mutation analysis
sweat chrloride test - normal <40

115
Q

What is the treatment of cystic fibrosis?

A 
maintain respiratory function
control inflammation and infection
reduce mucus accumulation
promote optimal nutrition
prevent intestinal blockage
116
Q

What are medications for cystic fibrosis?

A 
broncodilators
dornase alfa - aerosol ( pulmozyme)
hypertonic saline
ibuprofen
antibiotics
pancreatic enzymes
multivitamins, iron
Vitamins A, D, E, K
117
Q

What are signs of asthma?

A

frequent coughing
wheezing, maybe only with auscultation
bronchoconstriction, airway swelling, mucus production

118
Q

What is asthma?

A

chronic inflammatory disease. normal protective mechanisms of the lungs overreact to a trigger

119
Q

What is the clinical therapy for asthma?

A

medications, hydration, education, and support

120
Q

What is the goal of treating asthma?

A

maintain control long term
use least amount of medication
reduce risk of adverse effects

Peds - NUR 122 (3 decks)

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