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Parent Child NUR 246 > Test 2 (Mod 3 and 4) > Flashcards

Test 2 (Mod 3 and 4) Flashcards

1
Q

Four Heart Valves are

A

Tricuspid, Pulmonic, Mitral, Aortic

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2
Q

Tricuspid Valve links

A

Right atrium to right ventricle

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3
Q

Pulmonic Valve links

A

Right ventricle to pulmonary artery

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4
Q

Mitral Valve links

A

Left atrium to left ventricle

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5
Q

Aortic Valve links

A

Left ventricle to aorta

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6
Q

Umbilical Vein carries oxygenated blood from

A

Placenta to infant

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7
Q

In fetal circulation, blood bypasses the liver through the

A

Ductus Venosus

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8
Q

In fetal circulation, oxygenated blood flows from right to left atria through the

A

Foramen Ovale

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9
Q

Closes after birth with change in pressure in cardiac chambers

A

Foramen Ovale

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10
Q

Causes fetal circulation blood to bypass the lungs, which are nonfunctional at this time

A

Foramen Ovale

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11
Q

A fistula between aorta and pulmonary artery that allows for mixing of blood

A

Ductus Arteriosus

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12
Q

Closes after birth, sometimes with first few breaths but may take up to three days

A

Ductus Arteriosus

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13
Q

Bound to hemoglobin on red blood cells

A

Oxygen

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14
Q

Facilitate Oxygen

A

Hematocrit and hemoglobin

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15
Q

Heart rate is sensitive to

A

Oxygen level

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16
Q

Cardiac output is dependent on ________ until child is 5 years old

A

Heart rate

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17
Q

A child has an increased risk of heart failure because of

A

Immature heart that is sensitive to volume or pressure overload, and muscle fibers that are less developed

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18
Q

Reveals size and contour of heart

A

X-ray

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19
Q

Visualizes characteristics of pulmonary vascular markings

A

X-ray

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20
Q

Identifies heart structure

A

Ultrasound (Echocardiography)

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21
Q

Identifies pattern of movement, hemodynamics

A

Ultrasound (Echocardiography)

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22
Q

Records quality of major electrical activity of heart

A

Electrocardiogram (ECG)

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23
Q

Identifies dysrhythmias

A

Electrocardiogram (ECG)

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24
Q

Encourage increased fluid intake to maintain hydration to offset diuretic effect of contrast dye after

A

Cardiac Catheterization

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25
Q

Heart conditions that do not cause deoxygenation or low oxygen levels; skin and mucous membrane color is usually normal pink

A

Acyanotic heart defects

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26
Q

Atrial Septal Defect is a defect between

A

Atria

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27
Q

Septal wall defect allowing blood to flow from left atrium to right atrium, called left to right shunt

A

Atrial Septal Defect

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28
Q

Often asymptomatic if small defect, dyspnea, fatigue, poor growth, soft systolic murmur, and CHF are all assessment findings of

A

Atrial Septal Defect

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29
Q

Defect between Ventricles

A

Ventricular Septal Defect (VSD)

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30
Q

Septal wall incomplete allowing blood to flow from left ventricle to right ventricle (left to right shunt)

A

Ventricular Septal Defect

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31
Q

Tachypnea, dyspnea, poor growth, reduced fluid intake, palpable thrill, systolic murmur at lower sternal border, large septal defects detected on ECG and radiology, and signs of CHF are all assessment findings of

A

Ventricular Septal Defect

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32
Q

Teach the need for antibiotic prophylaxis to prevent subacute bacterial endocarditis with

A

Ventricular Septal Defect

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33
Q

Narrowing of descending aorta and restriction of blood flow leaving the heart are signs of

A

Coarctation of Aorta

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34
Q

Narrowing or constriction of descending aorta, often near ductus arteriosus. Progressive disorder that leads to CHF.

A

Coarctation of Aorta

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35
Q

Assessment of ________ may be asymptomatic, have blood pressure difference of 20mm between upper and lower extremities, with upper extremity pressure higher, have brachial and radial pulses full, and femoral pulses weak, have headache, vertigo, and epistaxis, have exercise intolerance, left ventricular hypertrophy, and dyspnea, and can have CVA secondary to hypertension in upper circulation

A

Coarctation of Aorta

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36
Q

Therapeutic Management for Coarctation of Aorta

A
  1. Balloon cardiac catheterization with insertion of endovascular stents. 2. Surgical resection and patch of coarctation. 3. Possible prophylaxis for endocarditis when undergoing surgical or dental procedures. 4. Prior to correction, monitor BP in upper and lower extremities. 5. Rebound hypertension occurs in immediate postoperative period.
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37
Q

Heart conditions that cause blood to contain less oxygen than required; skin and mucous membrane color is usually pale to blue

A

Cyanotic heart defects

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38
Q

Four defects that combine to allow blood flow to bypass lungs and enter left side of heart, called a right to left shunt

A

Tetralogy of Fallot

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39
Q

This heart defect leads to unoxygenated blood to enter the body circulation accounting for cyanosis

A

Tetralogy of Fallot

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40
Q

Four defects: pulmonic stenosis, right ventricular hypertrophy, ventricular septal defect, and overriding aorta, all make up _________

A

Tetralogy of Fallot

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41
Q

Deficient oxygen in the tissues leads to

A

acidosis

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42
Q

Hypercyanosis (TET) spells are

A

transient periods when there is an increase in right to left shunting of blood

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43
Q

TET spells are characterized by:

A

Hypoxia, pallor, and tachypnea, which may be precipitated by crying, defecation, and feeding; older children will assume squatting position to decrease blood return from the lower extremities.

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44
Q

Treatment for TET spell

A

place child in knee-chest position, administer morphine or propranolol and O2

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45
Q

Signs of Tetralogy of Fallot

A

Clubbing of digits, polycythemia, poor growth, exercise intolerance, systolic murmur in pulmonic area, right ventricular hypertrophy, and TET spells

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46
Q

Prostaglandin E1 is given in order to maintain open ductus arteriosus in treatment of

A

Tetralogy of Fallot

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47
Q

Aorta arises from right ventricle, and pulmonary artery arises from left ventricle

A

Transposition of the great vessels

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48
Q

Anomolies exist that increase mixing of blood between two separate circulations; these anomalies promote oxygenation. Right to left shunting occurs.

A

Transposition of the great vessels

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49
Q

Progressive cyanosis to hypoxia to acidosis. Signs and symptoms of CHF. Tachypnea. Poor feeding. Failure to grow. Echocardiogram identifies misplacement of arteries.

A

Assessment findings for Transposition of the great vessels

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50
Q

Abnormally small left ventricle noted at birth

A

Hypoplastic left heart syndrome

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51
Q

Inability of heart to supply oxygen needs of body is a description of

A

Hypoplastic Left Heart Syndrome

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52
Q

Absent or stenotic mitral and aortic valves, abnormally small left ventricle and aortic arch, major resistance to aortic flow, hypertrophy of right ventricle, with a poor prognosis, all describe

A

Hypoplastic Left Heart Syndrome

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53
Q

Tachypnea, chest retractions, dyspnea, cyanosis, decreases pulses, poor peripheral perfusion, increases right ventricular implies, echocardiogram indicating small and weak left ventricle, and CHF, are all signs of

A

Hypoplastic Left Heart Syndrome

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54
Q

Prostaglandin E1 given to prevent closure of patent ductus arteriosus, palliative surgery, transplant, are all interventions for

A

Hypoplastic left heart syndrome

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55
Q

Survival rate currently at or above 50% for

A

Hypoplastic Left Heart Syndrome

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56
Q

Systemic inflammatory disease that involves heart and joints; CNS and connective tissue involvement may also occur

A

Rheumatic Fever

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57
Q

Occurs secondary to infection by group A beta-hemolytic streptococcus; most common in children age 5 years to adolescence

A

Rheumatic Fever

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58
Q

Follows one to three weeks after a group A beta-hemolytic streptococcal infection

A

Rheumatic Fever

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59
Q

Must have presence of two major or one major and two minor criteria to diagnose __________using Jones Criteria

A

Rheumatic Fever

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60
Q

A new murmur, pericardial fruition rub, changes on the ECG; tachycardia may be noted by nurse as a pulse greater than 100 while sleeping, are all symptoms of

A

Carditis

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61
Q

Involves involuntary movement of limbs; emotional lability and slurred speech may occur; this symptom tends to have a latent period of two months or more from strep infection

A

Chorea (CNS symptom of Rheumatic Fever)

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62
Q

An erythematous, macular rash that occurs primarily on trunk and proximal limbs; frequently associated with carditis

A

Erythema Marginatum

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63
Q

non-tender nodules that develop on skin over flexor surfaces of joints and vertebrae

A

Subcutaneous Nodules

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64
Q

Planning and Interventions for Rheumatic Fever

A
  1. Bedrest until ESR returns to normal 2. Use ASA and prednisone as ordered anti-inflammatory agents to reduce inflammation; aspirin will also promote comfort from painful joints. 3. Give PCN as ordered in either an oral daily dose or monthly long-acting injection after recovery from rheumatic heart disease to reduce risk of recurrence of strep infection; erythromycin given if allergic to PCN. 4. Design nursing activities to promote rest and to encourage diversional activities which do not stress heart; maintain bed rest with bathroom privileges.
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65
Q

A multisystem disorder involving vasculitis, also called mucocutaneous lymph node syndrome. Leading cause of acquired heart disease in children

A

Kawasaki’s Disease

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66
Q

Inflammation of tunica intima or inner lining of arteries and veins

A

Vasculitis

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67
Q

Acute, systems inflammatory illness involving arteries, unknown cause but generally affects young children; most frequently affected are boys under 5 years of age

A

Kawasaki’s Disease

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68
Q

Three phases of Kawasaki’s Disease

A

Acute, subacute, and convalescent

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69
Q

Characterized by fever, conjunctival hyperemia, swollen hands and feet, rash, and enlarged cervical lymph nodes

A

Acute phase of Kawasaki’s disease

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70
Q

characterized by cracking lips, desquamation of skin on tips of fingers and toes, cardiac disease, and thrombocytosis

A

Subacute phase of Kawasaki’s disease

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71
Q

Has lingering signs of inflammation

A

Convalescent phase of Kawasaki’s disease

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72
Q

Fever lasting longer than five days that is unresponsive to antipyretics, conjunctivitis, crusted and fissured lips, swelling of hands and feet, erythema, lymphadenopathy, are all signs of

A

Stage one Kawasaki’s. (one to two weeks)

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73
Q

Fever diminishes, irritability, anorexia, desquamation of hands and feet, arthritis and arthralgia, cardiovascular manifestations

A

Subacute stage of Kawasaki’s (two to four weeks)

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74
Q

Drop in ESR and diminishing signs of illness

A

Convalescent stage of Kawasaki’s (six to eight weeks)

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75
Q

A condition that causes swollen glands and can be caused by infection or cancer

A

Lymphadenopathy

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76
Q

Treatment for Kawasaki’s Disease

A

Administer 80 to 100 mg/kg/day ASA as anti platelet agent. Wean child over time to decrease risk of bleeding. Administer gamma globulin (IVIG) once as ordered to reduce risk of coronary artery lesions and aneurysms; may be repeated if fever does not decrease

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77
Q

Nursing management of Kawasaki’s Disease

A

Promote comfort, small frequent feedings, passive range of motion to extremities, cool baths, gentle oral care, encourage fluids, monitor for complications such as aneurysms, side effects of aspirin therapy: bleeding, GI upset, side effects of IVIG therapy: elevated blood pressure, facial flushing, tightness in chest, monitor temperature, and monitor eyes for conjunctivitis.

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78
Q

noted when clients head is flexed while in the supine position, resulting in involuntary flexion of knees or hips; a positive result is a common sign in meningitis.

A

Brudzinski’s Sign

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79
Q

level of consciousness in which client cannot be aroused even with painful stimuli

A

Coma

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80
Q

a late sign of increased intracranial pressure characterized by widening pulse pressure (rising systolic blood pressure with a stable diastolic pressure), bradycardia, and irregular respirations

A

Cushing’s Triad

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81
Q

bleeding between the dura and the cranium

A

Epidural Hematoma

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82
Q

force exerted by brain tissue, cerebrospinal fluid, and blood within cranial vault; normal is 4 to 12 mm Hg and is dependent on age in childhood

A

Intracranial Pressure (ICP)

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83
Q

demonstrated when client’s leg is raised with knee flexed and any resistance or pain is felt; it is a common finding that indicates meningeal irritation in meningitis

A

Kernig’s Sign

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84
Q

a measure of degree of responsiveness of mind to sensory stimuli; lower levels indicate decreased neurologic functioning; levels can be categorized (in order of decreasing level of function) as confusion, delirium, obtunded, stupor, and coma

A

Level of Consciousness (LOC)

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85
Q

fibrous membrane that covers brain and lines vertebral canal; consists of three layers: dura, arachnoid, and pia matter

A

Meninges

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86
Q

a sheath made of a fatty substance that covers axon process of neuron or nerve fibers and increases speed and accuracy of nerve impulses; accounts for gradual development of fine and gross motor skills during early childhood

A

Myelin

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87
Q

refers to a lack of innervation to an organ

A

Neurogenic

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88
Q

stiffness of neck or resistance to neck flexion, often seen in infections of central nervous system

A

Nuchal Rigidity

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89
Q

Client positions self with hyperextension of head and neck; this is seen in meningitis and felt to relieve some discomfort from meningeal irritation

A

Opisthotonus

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90
Q

Sensitivity to light, seen in some clients with migraine headaches or viral infections such as measles, meningitis, and encephalitis

A

Photophobia

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91
Q

difference in systolic and diastolic blood pressure

A

Pulse Pressure

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92
Q

bleeding between dura and cerebrum

A

Subdural Hematoma

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93
Q

tenseness of muscles, uncoordinated, stiff movements; can be seen as scissoring or crossing of legs; exaggerated reflex reactions

A

Spasticity

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94
Q

term frequently used to describe characteristics of certain seizures, involving continuous muscle contractions, and alternating contraction and relaxation of muscles

A

Tonic Clonic

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95
Q

Brain and spinal cord develop during

A

First trimester

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96
Q

Not mature at birth, but as numbers of glial cells and dendrites increase, refinement continues until about 4 years of age

A

Nervous system

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97
Q

Posturing seen with severe dysfunction of cerebral cortex; it includes adduction of arms at shoulders, arms flexed at chest, wrists flexed, hands fisted, and lower extremities flexed

A

Decorticate Posturing

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98
Q

Posturing seen with dysfunction at level of midbrain; it includes rigid extension and pronation of arms and legs

A

Decerebrate Posturing

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99
Q

Corneal, pupillary, muscle-stretch, superficial, and plantar reflexes are all absent in

A

Deep Coma

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100
Q

A nonprogressive motor disorder of central nervous system (CNS) resulting in alteration in movement and posture

A

Cerebral Palsy (CP)

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101
Q

Classified as spastic, athetoid, or mixed

A

Cerebral Palsy

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102
Q

Causes of ________ may include trauma, hemorrhage, anoxia, or infection before, during, or after birth

A

Cerebral Palsy

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103
Q

One-third of children with this disease will also have some degree of mental retardation, while the other two thirds do not

A

Cerebral Palsy

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104
Q

Many clients with this disease may require increased caloric intake because of spasticity or increased motor functioning

A

Cerebral Palsy

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105
Q

Use of adaptive feeding devices and positioning during feedings to decrease risk of aspiration, and the use of a gastrostomy tube may be needed for

A

Cerebral Palsy

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106
Q

Develop during the first trimester of fetal development; defects can occur at any place along spinal canal

A

Neural tube defects

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107
Q

Unknown etiology, but may be associated with maternal dietary folic acid deficiency; incidence has decreased with emphasis on folic acid supplementation during pregnancy; the degree of disability is determined by location of defect and amount of spinal nerves encased in sac; the higher the defect, the greater the neurologic dysfunction

A

Neural Tube Defects

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108
Q

Neural Tube Defects are also known as

A

Spina Bifida, or Myelodysplasia

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109
Q

Posterior vertebral arches fail to fuse, but there is not herniation of spinal cord or meninges; no loss of function

A

Spina bifida occulta

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110
Q

Posterior vertebral arches fail to fuse, and there is a saclike protrusion at some point along posterior vertebrae; sac contains meninges and CSF but not spinal cord

A

Meningocele

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111
Q

Posterior vertebral arches fail to fuse; saclike herniation contains meninges, CSF, as well as a portion of spinal cord or nerve roots; sometimes leakage of CSF occurs

A

Myelomeningocele

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112
Q

brain and meninges herniate through defect in skull into a sac

A

Encephalocele

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113
Q

Elevated levels of alpha-fetoprotein (AFP) in maternal serum and fluid obtained by amniocentesis, as well as ultrasound, all lead to

A

prenatal diagnosis of open spinal defects

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114
Q

Frequent, clean straight catheterization is the preferred method of management for

A

Neurogenic bladder

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115
Q

High fiber diet, adequate fluid intake, and pattern of evacuation of bowels, some cases of laxative and enema use, are all means of managing

A

Neurogenic bowel

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116
Q

A condition characterized by imbalance between CSF production and absorption resulting in enlarged ventricles and an increase in ICP; if untreated, this condition can cause permanent brain damage

A

Hydrocephalus

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117
Q

Congenital causes of this disease include Arnold Chiari malformation associated with myelomeningocele, and can be acquired from meningitis, trauma, or intraventricular hemorrhage in premature infants. Etiology is idiopathic (cause unknown) in up to 50% of cases

A

Hydrocephalus

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118
Q

Increased head circumference, split cranial sutures, high-pitched cry, bulging fontanel, irritability when awake and seizures, are all assessment findings of

A

Hydrocephalus

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119
Q

Toddlers and older children suffering from _______, may also present with setting-sun eyes, seizures, irritability, papilledema, decreased LOC, and changes in vital signs (increased BP and widening pulse pressure).

A

Hydrocephalus

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120
Q

All children with this disease can present with vomiting, lethargy, and Cheyne-Stokes respiratory pattern

A

Hydrocephalus

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121
Q

Surgical insertion of a tube or “shunt” into ventricles with other end in either the peritoneum or atrium; the most common version is ventriculoperitoneal; preoperatively position client flat and on unoperative side; if held it is important not to allow head to be elevated.

A

Treatment for Hydrocephalus

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122
Q

Alterations in firing of neurons in brain (cortical neuronal discharge); the result of this discharge depends on where in brain discharge begins and how it spreads

A

Seizures

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123
Q

Seizure that begins locally in one hemisphere of the brain

A

Partial Seizure

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124
Q

Seizure that begins in both hemispheres of the brain

A

Generalized Seizures

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125
Q

Tegretol is commonly used in children for

A

Seizures

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126
Q

Premature closure of cranial sutures in young children; there is some relationship between this and several inherited syndromes

A

Craniosynostosis

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127
Q

Premature closure of skull may lead to

A

increased ICP with subsequent brain damage

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128
Q

Fluid restriction may be prescribed in postop period; head of bed may be ordered to elevation at 30-degree angle to assist in decreasing facial swelling with this disease

A

Craniosynostosis

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129
Q

Inflammation of meninges; is most common infection of CNS; two primary classifications include viral or aseptic and bacterial

A

Meningitis

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130
Q

Clinical manifestations of this process in infants and toddlers are irritability, vomiting, and change in appetite

A

Viral Meningitis

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131
Q

Clinical manifestations for an older child with this process are usually preceded by a nonspecific febrile illness; client presents with headache, malaise, muscle aches, n/v, photophobia, and nuchal/spinal rigidity

A

Viral Meningitis

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132
Q

Clinical manifestations of this process in infants and toddlers include poor feeding/suck, vomiting, high-pitched cry, bulging fontanel, fever or hypothermia depending on maturity of infant’s neurological system, and poor muscle tone and nuchal rigidity

A

Bacterial Meningitis

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133
Q

Stiffness of the neck

A

Nuchal Rigidity

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134
Q

Hyperextension of head and neck

A

Opisthotonus

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135
Q

Positive Kernig or Brudzinski’s sign indicates

A

Meningeal irritation

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136
Q

ND for Meningitis

A

Risk for ineffective breathing pattern, pain, risk for injury, risk for ineffective thermoregulation

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137
Q

Treatment for Meningitis

A

Elevate head of bed 15 to 30 degrees, avoiding neck extention or flexion, and maintaining head in neutral position. Monitor for cerebral edema. restrict oral fluids and monitor IV fluids to prevent fluid overload

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138
Q

Syndrome of inappropriate antidiuretic hormone

A

SIADH

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139
Q

Normal CSF Values

A

ICP- 50-100 Appearance- Clear Leucocytes- 0-8 Protein- 14-45 Glucose- 35-75

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140
Q

CSF with Viral Meningitis

A

ICP- Normal or slightly elevated Appearance- Clear Leukocytes- Slightly elevated Protein- Slightly elevated Glucose- Normal or decreased

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141
Q

CSF with Bacterial Meningitis

A

ICP- Elevated Appearance- Cloudy Leukocytes- Elevated Protein- Elevated Glucose- Decreased

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142
Q

Clients with this type of meningitis will need to have transmission-based droplet precautions instituted until at least 24 hours of antibiotic therapy have been completed

A

Bacterial Meningitis

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143
Q

Complications of Meningitis

A

Seizures, hearing loss, visual alterations

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144
Q

This is treated with IV antibiotics sensitive to causative organism; treatment usually continues for 7 to 14 days; preventative care includes Hib vaccine

A

Bacterial Meningitis

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145
Q

Those in close contact with a child who has bacterial meningitis may receive

A

Rifampin (Rifadin) or ciprofloxacin (Cipro) prophylactically

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146
Q

Inflammation of brain

A

Encephalitis

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147
Q

Classic symptoms of this include an acute febrile illness with neurologic signs

A

Encephalitis

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148
Q

Usually caused by a viral organism; herpes simplex type 1 is most common cause during neonatal period; enteroviruses are frequently identified as causative agents; nonviral agents include bacteria, parasites, fungi, and rickettsiae

A

Encephalitis

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149
Q

Fever, h/a, n/v, and signs of an upper respiratory infection are all assessment findings of

A

Encephalitis

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150
Q

Neurologic symptoms of this process include those of nuchal rigidity, photophobia, and positive Kernig’s and Brudzinski’s signs

A

Encephalitis

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151
Q

Treatment for Encephalitis

A

seizure precautions, if bacterial use antibiotics, acyclovir or other antiviral agents used for herpes virus infection

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152
Q

An acutre metabolic encephalopathy of childhood; fatty degeneration of liver leads to liver dysfunction

A

Reye Syndrome

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153
Q

This process is characterized by five stages: 1. Vomiting and lethargy 2. Combativeness and confusion 3. Coma, decorticate posturing 4. Decerebrate posturing 5. Seizures, loss of deep tendon reflexes, respiratory arrest

A

Reye Syndrome

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154
Q

Ususally develops after a mild viral illness such as chickenpox

A

Reye Syndrome

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155
Q

Linked to the use of ASA in children

A

Reye Syndrome

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156
Q

Hypoglycemia is one of the earliest signs of this syndrome

A

Reye Syndrome

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157
Q

Child presents with an abrupt change in LOC; hx reveals client recovering from viral disease with sudden onset of vomiting and mental confusion

A

Reye Syndrome

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158
Q

Liver enzymes and ammonia levels are elevated; blood glucose levels are below normal and prothrombin time is prolonged; bilirubin levels remain normal; liver biopsy shows small fat deposits

A

Reye Syndrome

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159
Q

Tx for Reye Syndrome

A

ICU, monitor cerebral edema, fluid restrictions usually instituted; frequent vials and neurological assessments. Monitor lab values for elevated ammonia, acidosis, or hypoglycemia; I&O

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160
Q

Toddler ages

A

12-36 months

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161
Q

Toddler motor development

A

Slower physical growth. Reduced demand for calories. Learning to walk. Increased motor skills and lack of experience place the toddler at risk for injury. Child-proofing the home is essential.

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162
Q

Preschooler ages

A

3-5 years

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163
Q

Preschool motor development

A

Coordination and muscle strength increase rapidly. Increases in brain size and nerve myelinization. Perfects fine and gross motor skills. Engages in activities such as running cutting with scissors and drawing. By ages 4 or 5, the child is independent and can dress, eat, and go to the bathroom.

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164
Q

Cognitive and Sensory Development for Toddler

A

Consumed with curiosity. Boundless energy. Tremendous cognitive growth. Piaget’s sensorimotor period. Thinking is immature and limited in its logic. Behavior is characterized by negativsm, ritualism, and egocentrism.

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165
Q

Cognitive and Sensory Development for Preschooler

A

A critical period for the development of socialization. Children need opportunities to play with others. Learn communication skills. Play is often dramatic, imitative, and creative. Thinking is magical and egocentric. Overwhelmed by guilt if a loved one is injured or ill.

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166
Q

Psychosocial Development for Toddler

A

Characterized by the struggle for autonomy. Develops a sense of self separate from the parent Autonomy vs shame and doubt Erikson Stage Spend most of their time at play- it is the childs work.

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167
Q

Psychosocial Development for Preschooler

A

Developmental task is to gain a sense of initiative (Erikson). Busy learning how to do new things. Takes great pride in accomplishments. Encourage the preschooler’s imagination and creativity. Praise appropriate behavior.

168
Q

Psychosexual Development for Preschooler

A

Gender identity and body image are developing. Sexual curiosity, anatomic exploration, and masturbation are common. Encourage parents to answer questions simply and honestly. Children should not be shamed or punished for self-comforting behaviors.

169
Q

Discipline for Toddler

A

Firm, consistent discipline helps toddlers learn self-control.

170
Q

Discipline for Preschooler

A

Need consistent discipline. Appropriate limits setting teaches self-confidence, self-control, and normal values. Techniques include time-out, time-in, restricted choices, and diversion.

171
Q

Discipline for a Toddler

A

Must be consistent, immediate, age appropriate, and related to the incident. Clearly explain limits and give enough time for toddlers to respond to instructions. Avoid arguments and extensive explanations. Avoid withdrawing love as punishment. Separate the toddler from the behavior. Praise the toddler for good behavior.

172
Q

This many teeth by age 3

A

20 deciduous teeth

173
Q

Removes own clothes. Is willing to let go of toy. Is able to sit, squat, and walk well. Has been walking for 1 year.

A

Physical signs of readiness for toilet training

174
Q

Notices wet diaper. Indicates need for diaper change. Communicates need to go to the bathroom and can get there by self. Wants to stay dry.

A

Psychological signs of readiness for toilet training

175
Q

Children under the age of _____ should not ride in the font seat of a car that is equipped with an air bag

A

13 years

176
Q

Requirements to start and stop using a booster seat

A

More than 40 pounds to start, until they reach 4 foot 9 inches in height, and they are 8-12 years old

177
Q

Modes of Transmission of Pathogens

A

Direct contact with another infected person. Contact with animal or insect carriers. Ingestion of contaminated food or water. Contact with a contaminated object.

178
Q

Active immunity occurs either _________ or _________

A

Naturally, through vaccine administration.

179
Q

Forms of Vaccines

A

Live or attenuated. Killed or inactivated toxins. Human immune globulin. Animal serum or antitoxins.

180
Q

A severe, potentially fatal hypersensitivity reaction; histamine is released and leads to respiratory and vascular changes

A

Anaphylaxis

181
Q

A substance that possesses a unique configuration enabling immune system to recognize it as foreign; any substance that causes production of antibodies; are usually large molecular-weight proteins

A

Antigen

182
Q

Attachment of an antibody to an antigen that forms the basis for B-cell-mediated immunity

A

Antigen-antibody reaction

183
Q

A protein produced by immune system that binds to specific antigens and eliminates them from the body

A

Antibody

184
Q

A disease process where body identifies itself or a component of itself as foreign and attacks itself

A

Autoimmune Disease

185
Q

A blood test that indicates percentages of different types of white cells present in blood and is sometimes useful in identifying cause of an illness

A

Differential Blood Count

186
Q

Time between exposure to an antigen (bacterial or viral organism) and formation of first general symptoms of disease

A

Incubation period

187
Q

Resistance of body to effects of harmful organism or its toxin

A

Immunity

188
Q

Process of introducing an antigen into body, allowing immunity against a disease to develop naturally

A

Immunization

189
Q

Period of time when an illness is directly or indirectly transmittable from one person to another

A

Period of Communicability

190
Q

Period of time between initial symptoms and presence of full-blown disease

A

Prodromal Period

191
Q

A generalized infection spread throughout the body through blood stream

A

Sepsis

192
Q

An acronym for a complex of communicable diseases often present at birth

A

TORCH, which can cause teratogenic effects to unborn fetus

193
Q

TORCH stands for

A

T=toxoplasmosis O=other (such as syphilis, hepatitis) R=rubella C=cytomegalovirus H=herpes simplex

194
Q

Functional at birth. First line of defense. Reacts similarly to all invaders. Phagocytosis of foreign material by WBCs. Includes the inflammatory response.

A

Nonspecific Immunity (resistance of body to harmful organism)

195
Q

Most common type of WBC involved in acute inflammatory process

A

Polymorphonuclear leukocytes, or granulocytes

196
Q

Include B cells (B lymphocytes), T cells (T lymphocytes), and NK (Natural Killer cells)

A

Lymphocytes responsible for specific immune response

197
Q

A nonspecific response to any tissue injury aimed at maintaining homeostasis; chemicals are released from injured cells, which cause blood vessels to dilate, bringing large numbers of neutrophils and macrophages to area for phagocytosis of injured cells and foreign material, allowing healing to occur.

A

Inflammatory Response

198
Q

Second line of defense. Not functional at birth, must be learned by body. Not fully functional until a child is 6 years old.

A

Specific Immune Response

199
Q

Depends upon antibody-producing abilities of B cells

A

Humoral Immunity

200
Q

In response to antigens B cells convert into plasma cells and secrete specific antibodies (immune system proteins) to assist body in eliminating foreign proteins.

A

Humoral Immunity

201
Q

Antibacterial and antiviral antibody found in large quantities in all body fluids; can cross placenta; from mom, provides passive immunity for first 6 months of infant’s life.

A

IgG antibody

202
Q

Found in saliva, tears, bronchial secretions, mucous secretions of small intestine, vagina, and in breast milk; not present at birth and reaches normal levels at 6 to 7 years of age

A

IgA antibody

203
Q

Body’s primary antibody response to an antigen; levels are low at birth and reach adult levels by 1 year of age.

A

IgM antibody

204
Q

Role is unknown but seems to be related to B cell differentiation

A

IgD antibody

205
Q

Normally found in very small amounts and is associated with allergic reactions; elevated levels are found in individuals with an allergy and clients infected with intestinal parasites; not present at birth

A

IgE antibody

206
Q

Produced in thymus and function to protect individual from intracellular organisms, viruses, and slow-growing bacteria

A

T cells

207
Q

Responsible for rejection of foreign grafts

A

T cells

208
Q

Kill virus infected cells and depend upon IgG being bound to cell

A

Killer T cells

209
Q

Help regulate actions of B cells

A

Helper T cells

210
Q

Enzyme that responds to antigen-antibody reactions causing inflammation and destruction of foreign cells

A

Complement

211
Q

Plays a role in autoimmune diseases (body attacks itself)

A

Complement

212
Q

Levels of proteins lower in newborns than older children and adults

A

Complement

213
Q

Usually performed under local anesthesia. Postprocedure complications include bleeding and infection. Done to provide information about hematologic and immunologic disorders

A

Bone Marrow Aspiration (from iliac crest)

214
Q

As one white blood cell type increases the others decrease when dealing with

A

White blood cell differentials (differential blood found)

215
Q

Rise in response to inflammation, acute bacterial infections, and a few malignancies

A

Neutrophils

216
Q

Elevations are associated with allergies and parasitic infections as well as skin diseases such as eczema and psoriasis. Decreased in children receiving corticosteroids

A

Eosinophils

217
Q

Counts may rise in response to chronic infection and stress, and in leukemia; contribute to inflammatory process and allergic reactions because they store histamine. Decreased in allergy acute infection, collagen and chronic diseases

A

Basophils

218
Q

Active in chronic infection, increased in tuberculosis, protozoan infection and monocytic leukemia

A

Monocytes

219
Q

Increased in several infections, decreased in children with immune deficiency

A

Lymphocytes

220
Q

Looks for allergen-specific IgE antibodies in a blood sample; it is no more sensitive than other methods but does not involve risk of anaphylaxis or other allergic reactions

A

Radioallergosorbent testing (RAST)

221
Q

Can be acquired either from exposure to disease or by immunization

A

Immunity

222
Q

Involves body’s formation of antibodies in response to exposure to an antigen

A

Active Immunity

223
Q

Temporary immunity achieved by administration of antibodies produces by another individual; when antibodies pass from mother to the fetus; it is acquired

A

Passive Immunity

224
Q

Contain antigens to specific diseases; they cause body to respond with development of antibodies and active immunity

A

Vaccines

225
Q

This type of vaccine should be avoided in immunocompromised or pregnant client

A

Live vaccines

226
Q

The most severe of several different congenital disorders of immune system yielding susceptibility to infections, other forms can include B cell and T cell deficiencies.

A

Severe Combined Immunodeficiency Disease (SCID)

227
Q

Occurs as a result of X-linked recessive or autosomal recessive inheritance, as well as because of a spontaneous mutation

A

SCID

228
Q

Characterized by absence of both humoral and cellular immunity. Maternal antibodies may protect for a short period of time, but chronic infections become apparent around 3 months of age. Death usually occurs within first 2 years of life

A

SCID

229
Q

Assessment of this reveals initial infection often persistent thrush (oral candidiasis), followed by chronic infections. May be caused by cytomegalovirus, and Pneumocystis carinii. Failure to thrive also accompanies dx. Leukocyte counts are usually reduced

A

SCID (Severe combined immunodeficiency disease)

230
Q

Treatment for SCID

A

Protect form infection. Hand hygienic. Prevent contact with infected individuals. No live plants or fresh flowers due to mold and bacteria. Bone marrow transplant offers best hope for survival.

231
Q

Med therapy for SCID

A

Intravenous immune globulin (IVIG). Immunizations 14 days prior to or 3 months after IVIG administration. Antibiotics as needed

232
Q

Hypersensitivity to a foreign protein

A

Allergy

233
Q

Antigen-antibody reaction causes release of histamine and other chemicals into body; chemicals are responsible for symptoms. Broad group of disorders; symptoms very dependent on body cell that has been sensitized.

A

Allergies

234
Q

First exposure to antigen causes production of

A

IgE antibodies

235
Q

Subsequent exposure to an antigen causes an antigen-antibody reaction with cell damage causing

A

release of histamine and other chemicals

236
Q

Elevated eosinophil counts will be seen in

A

Allergies

237
Q

Large number of allergens can be tested quickly in about 30 minutes, if allergic a reddened wheal will form in 15 to 30 minutes. Anaphylaxis is rare but potential problem

A

Allergy Skin testing

238
Q

Med therapy for allergies

A

Antihistamines given prior or early in reactive phase; compete with histamine on receptor sites, therefore will be ineffective if given late in reaction. Bronchodilators may be given for lower respiratory symptoms. Corticosteroids may be administered systemically or topically, depending upon symptoms. Epinephrine is administered for anaphylaxis (Epi-Pen Jr for up to 65 pounds, Epi-Pen Adult for over 65 pounds)

239
Q

An acronym for a group of infections, which when acquired in utero, cause teratogenesis (fetal harm)

A

TORCH

240
Q

Red Measles

A

Rubeola

241
Q

Is a virus. Transmitted by direct or indirect contact with droplets. Incubation 10-20 days. Communicability is several days before rash appearance to 5 days after rash appearance. Immunity from vaccination or disease

A

Rubeola

242
Q

Prodromal stage shows fever and lethargy, cough, and coryza; photophobia; koplik spots on buccal mucosa. Acute stage show red flat rash lasting about a week, which begins behind ears, spreads to face, trunk, and extremities

A

Rubeola

243
Q

Management of this disease includes managing temperature, keeping room dim, and a vaporizer that may improve respiratory secretions

A

Rubeola

244
Q

Pneumonia, otitis media, encephalitis

A

Complications of Rubeola

245
Q

German or 3 day measles. Caused by virus. Transmitted by droplets. Incubation is 2-3 weeks. Communicability is 1 week before to 5 days after onset of rash. Immunity from vaccination or disease.

A

Rubella

246
Q

Prodromal stage reveals low-grade temperature, h/a, sore throat and cough. Acute stage reveals flat red rash beginning on face and spreads to rest of body. Rash lasts 3 days

A

Rubella

247
Q

Management of this disease includes non aspirin antipyretics; encourage fluid; recommend to avoid contact with all pregnant women; non immune females should be immunized before reaching childbearing age

A

Rubella

248
Q

Mumps. It is a virus. Transmitted by droplet or direct contact. Incubation is 2 to 3 weeks. Communicability 1 week before parotid swelling until 1 week after swelling begins. Immunity from vaccination or disease

A

Parotitis

249
Q

Prodromal stage reveals fever, h/a, earache that worsens with chewing. Acute stage reveals swelling of parotid glands

A

Parotitis

250
Q

Treatment of this includes non aspirin antipyretics; fluids and soft liquids are easier to swallow; avoiding sour foods

A

Complications of this disease include orchitis (testicular swelling); encephalitis, and deafness.

251
Q

Chickenpox. It is a virus. Transmitted by direct contact and airborne. Incubation is 2-3 weeks. Communicability is day(s) before rash to 1 week after first lesions crust over. Immunity from vaccination or disease

A

Varicella

252
Q

Prodromal stage reveals mild fever and malaise for 24 hours. Acute stage reveals rash that progresses from macule to vesicle to crusts; eruption lasts up to 5 days and lesions of all types will be present at one time.

A

Varicella

253
Q

Treatment of this disease includes Acyclovir or IVIG to high risk child. Nonaspirin antipyretics, calamine lotion topically, oral antihistamines, oatmeal and Aveeno baths, keep nails short, and discourage scratching.

A

Varicella

254
Q

Complication of this disease include encephalitis, Reye syndrome

A

Varicella

255
Q

Associative Play

A

play together engaging in similar type of activity without organization or goals. Rely on own wants/desires to dictate activities. May borrow toys or follow activities but no leader or rules. Characteristic of preschoolers.

256
Q

Autonomy vs. Shame and Doubt

A

1 to 3 years. Increased ability to control self and environment. Practices and attains new physical skills, and develops autonomy. Symbolizes independence by controlling body secretions, saying “no” when asked to do something, and directing motor activity. Develops self-confidence and willpower, and develops shame if criticized or unsuccessful.

257
Q

Child should be able to differentiate colors by age

A

5 years

258
Q

Child should have ______ teeth by late ________

A

32, adolescence

259
Q

Children who are immunologically compromised…

A

Should not receive live bacterial or viral vaccines

260
Q

Concept of death for 2-7 year olds

A

Death as a reversible and temporary separation

261
Q

Concept of death for 7-12 year olds

A

Death as sad and irreversible but not necessarily inevitable

262
Q

Concrete Stage of Piaget

A

Thoughts become increasingly logical and coherent. Able to shift attention from one perceptual attribute to another (decent ration). Concrete thinkers: view things as “black or white, right or wrong, no in between or gray areas.” Able to classify and sort facts, do problem solving. Acquires conservation skills.

263
Q

Cooperative Play

A

organized group play with rules, goals, and a plan. There is a leader responsible for division of labor and direction of activities. Characteristic of children and adolescents.

264
Q

Deciduous teeth erupt by

A

about six months of age

265
Q

Deciduous teeth by age 2 1/2 to 3 years

A

20

266
Q

Fine motor development for toddler (1-3 years)

A

Uses cup well by 15 months Builds a tower of two cubes or blocks by 15 mo. Holds crayon with fingers by 24-30 months Good hand-finger coordination by 30 months Copies a circle by 3 years

267
Q

Formal Operations Stage of Piaget

A

Able to logically manipulate abstract and unobservable concepts. Adaptable and flexible. Able to deal with contradictions. Uses scientific approach to problem solve. Able to conceive the distant future.

268
Q

Gross motor development for toddler (1-3 years)

A

Walks without help by 15 months Jumps in place by 18 months Goes up stairs (with 2 feet on each step) by 24 mo. Runs fairly well (wide stance) by 24 months

269
Q

Growth during school age years (6 to 12 years)

A

Weight steady slow. 5 lbs per year Height increases 1 to 2 inches per year

270
Q

Growth during Preschool years (3 to 6 years)

A

Weight is slow and steady (4 to 5 lbs per year) Height increases 2 to 3 inches per year

271
Q

Height at 2 years

A

50% of future adult height

272
Q

Industry vs. Inferiority

A

6 to 12 years. Middle years of childhood. Development of new interests and involvement in activities. Learns to follow rules. Acquires reading, writing, math, and social skills If successful, develops confidence and enjoys learning about new things. When compared to others, may feel inadequate, inferior, if too much is expected.

273
Q

Infant and Toddler Responses to Pain

A

Infants will have increases in BP and HR, and decrease in arterial O2 saturation. Harsh, tense, or loud crying. Facial grimacing, flinching, thrashing of extremities. Toddlers will verbally indicate discomfort. Generalized restlessness, uncooperative, clings to family member.

274
Q

Initiative vs. Guilt

A

3 to 6 years. Explores the physical world with all senses, initiates new activities, and considers new ideas. Demonstrates initiative by being able to formulate and carry out a plan of action. Develops a conscience. If successful, develops direction and purpose. If criticized, leads to feelings of guilt and a lack of purpose.

275
Q

Intellectual development

A

learn colors, shapes, sizes, textures, and significance of objects. Association of words with objects, abstract meaning and spatial relationships (up down over) play helps them understand the world and distinguish between fantasy and reality

276
Q

Lose first deciduous teeth at age

A

Six. By age 12 has all permanent teeth, except final molars

277
Q

Most important consideration for the successful assessment of a child

A

Developmental Level

278
Q

Motor development of preschooler (3 to 6 years)

A

Skips and hops on one foot by 4 years Rides tricycle by 3 years Throws and catches ball well by 5 years Balances on alternate feet by 5 years Knows 2100 words by 5 years Increased strength and refinement of fine and gross motor abilities

279
Q

Nursing Interventions for Preschooler Fears

A

Encourage parents to participate in child care. Allow child to express feeling. Give simple explanations. Avoid Med Terms. Provide therapeutic play. Allow child to manipulate and play with equipment. Maintain trusting relationship with parents and child. Allow time for questions. Praise child, focus on desired behavior, and give rewards.

280
Q

Onlooker

A

play children watch older children but do not attempt to interact

281
Q

Pain assessment in preschoolers

A

Cry and struggle. May deny pain.

282
Q

Pain assessment in school age children

A

Stiff body posture. Withdrawn.

283
Q

Pain assessment in toddlers

A

Generalized restlessness. Guarding of the painful site. Excessive crying.

284
Q

Parallel play

A

play that is not influenced by other children playing in the same area. Play beside and not with each other with similar toys. Characteristic of toddlers.

285
Q

Physical Assessment Approach for Preschoolers

A

Allow to handle equipment. Head to toe if cooperative. Same as toddler if uncooperative.

286
Q

Physical Assessment Approach for Toddlers

A

Minimal contact initially. Allow to inspect equipment. Assess heart and lungs while quiet, then head to toe. Eyes, ears, and mouth last.

287
Q

Physical Assessment Approach for School Age

A

Respect Privacy. Explain procedures. Head to toe. Genitalia last.

288
Q

Preferred site for IM vaccines to infants and children

A

Anterolateral thigh, or the deltoid in older children

289
Q

Preoperational Stage of Piaget

A

Forms symbolic thought. Exibits Egocentrism- unable to put oneself in the place of another. Unable to understand conservation. Increasing ability to use language. Play becomes more socialized. Can concentrate on only one characteristic of an object at a time (cent ration).

290
Q

Preschool Nutritional Requirements

A

90 kcal/kg/day 13 grams/day Protein

291
Q

Preschool Play

A

Enjoys imitative and dramatic play Imitates same-sex role in play Provide toys to develop motor and coordination skills (tricycle, clay, paints, swings, sliding board) Parental supervision of tele vision Enjoys sing along songs with rhythm

292
Q

Preschoolers Fears to Illness and Hospitalization

A

Major fears are mutilation and intrusive procedures. Perceives illness as punishment. Some separation anxiety will still exist.

293
Q

Preschoolers Response to Pain

A

Major fear of needles, will deny pain to avoid injection. Restlessness, irritability, cries, kicks with experiences of pain. Able to describe the location and intensity of pain.

294
Q

Regression in Infant or Toddler

A

use of behavior that is more appropriate to an earlier stage of development, often used to cope with stress or anxiety. HELP PARENTS understand changes in behavior, and avoid punishment

295
Q

Ritualism

A

A toddlers need to maintain sameness and reliability; provides sense of comfort

296
Q

School Age Play (cooperative)

A

Comprehends rules and rituals of games Enjoys team play Enjoys athletic activities Provide construction toys, puzzles, erector sets, Legos.

297
Q

School Age Safety (6 to 12 years)

A

Teach sex education Injury prevention- bike safety, firearms, smoking, hobbies

298
Q

School age vision

A

20/20 by age 6 to 7 years Myopia may appear by age 8

299
Q

Secondary sex characteristics begin at:

A

10 years in girls 12 years in boys

300
Q

Self-awareness

A

active exploration of their body, separation from mother and developing self identity, test own ability, try roles, learn behavior with others.

301
Q

Sense pleasure play

A

non-social interactive stimulating experience, reacting to environment- light, color, taste, odors, textures. Pleasurable experiences are derived through touch, body motion and use of senses and abilities.

302
Q

Sensorimotor Development

A

all ages but major type of infancy, for muscle development and energy release. Exploration through senses and development of movement of body.

303
Q

Sensorimotor Stage of Piaget

A

An infant learns about world through senses and motor activity. Progresses from reflex activity through simple repetitive behaviors to imitative behaviors. Develops a sense of “cause and effect.” Curiosity, experimentation, and exploration result in the learning process. Object permanence is fully developed

304
Q

Sensory Development for toddler (1-3 years)

A

Binocular vision well developed by 15 months Knows one name by 12 months; refers to self Follows simple directions by 2 years Identifies geometric forms by 18 months Uses short sentences by 18 months to 2 years Remembers and repeats 3 numbers by 3 years Able to speak 300 words by 2 years

305
Q

Should have _____ deciduous teeth by age 2 1/2

A

20

306
Q

Skill play

A

using new discovered skills of grasp and manipulation children practice over and over for proficiency but may lead to frustration along the way until they succeed.

307
Q

Social affective play

A

interacting with people as a reaction to attention and provoking interaction through smiling cooing etc.

308
Q

Solitary play

A

independent play, no effort is made to interact with other children

309
Q

Stages of Erickson’s Theory of Psychosocial Development

A
  1. Trust vs. Mistrust (birth to 1 year) 2. Autonomy vs. Shame (1 to 3 years) 3. Initiative vs. Guilt (3 to 6 years) 4. Industry vs. Inferiority (6 to 12 years) 5. Identity vs. Role Confusion (12 to 18 years)
310
Q

Stages of Grief

A

“DABDA” Denial Anger Bargaining Depression Acceptance

311
Q

Stages of Piaget’s Theory of Cognitive Development

A
  1. Sensorimotor (birth to 2 years) 2. Preoperational (2 to 7 years) 3. Concrete Operational (7 to 11 years) 4. Formal Operations (11 years to death)
312
Q

Stages of Separation Anxiety

A
  1. Protest- child appears sad, agitated, angry, inconsolable, watches desperately for parents to return. 2. Despair- child appears sad, hopeless, withdrawn; acts ambivalent when parents return. 3. Detachment- child appears happy, interested in environment, becomes attached to staff members; may ignore parents
313
Q

Teeth begin to fall out around

A

age six

314
Q

To medicate a preschooler

A

Offer choices

315
Q

To medicate a school age child

A

provide choices, explanations, distraction, and support

316
Q

To medicate a toddler

A

use play, minimize restraint, and give praise and stickers as rewards

317
Q

Toddler Nutritional Requirements

A

102 kcal/kg/day 11 grams/day Protein

318
Q

Toddler Play

A

Begins as imaginative and make-believe play; may imitate adult in play Provide blocks, wheel toys, push toys, puzzles, crayons to develop motor and coordination abilities Toddlers enjoy repetitive stories and short songs with rhythm

319
Q

Trust vs. Mistrust

A

Birth to 1 year. Establish trust in people providing care. Mistrust develops if basic needs are inconsistently or inadequately met.

320
Q

Visual Acuity at 4-6 years

A

20/30 to 20/20

321
Q

Visual Acuity at 7 years

A

20/20

322
Q

Weight Gain for toddler (1-3 years)

A

4 times birth rate by 2 1/2 years

323
Q

Rocky Mountain Spotted Fever

A

Rickettsial

324
Q

Prevention is most important with imiting exposure and contact with sources of diesase.

Early detection of tick through assessment after possible contact and tick removal.

Assessment and treatment if reaction is detected.

Treatment with appropriate course as soon as possible with antibiotic treatment

A

Lyme Disease

325
Q

Causes a widespread spectrum of illnesses in children.

Symptoms range from mild to severe.

Can be spread by unprotected sexual activity, sharing needles, an infected mother to her baby, breastfeeding, and open wounds if there is blood to blood contact.

A

HIV

326
Q

Treatment of this disease includes a modified immunization program, antiretroviral therapy, pneumocystis carinii pneumonia (PCP) prophylaxis, and aggressive use of antibiotics

A

HIV

327
Q

A child taking these meds will have both immunosuppressive and antiinflammatory properties. During cessation of therapy, gradually taper the dose to allow for a gradual return or adrenal function

A

Corticosteroids

328
Q

Immediate (anaphylactic) hypersensitivity.

Examples include allergic rhinitis, acute anaphylaxis, haves, eczema, asthma

A

Type I allergic reaction

329
Q

Cytotoxic hypersensitivity.

Examples include transfusion reaction after receiving incompatible blood

A

Type II allergic reaction

330
Q

Arthus hypersensitivity (immune complex).

Examples include serum sickness, glomerulonephritis

A

Type III allergic reaction

331
Q

Delayed cell-mediated hypersensitivity.

Exampes include contact dermatitis (poison ivy)

A

Type IV allergic reaction

332
Q

Sneezing, tightness, tingling of mouth or face, with subsequent swelling of lips and tongue, severe flushing, urticaria and itching, sepecially on head and upper trunk, rapid development of erythema, sense of impending doom are all signs of

A

Impending Anaphylaxis

333
Q

The infant kidney is ______; however, it is proportionately ________ than the adults.

A

Small.

Larger.

334
Q

Kidneys reach near adult function at what age

A

6-12 months of age

335
Q

Manifestations of this can vary widely in relation to age, gender, underlying anatomic or neurologic abnormalities, frequency of recurrence, and vesicoureteral reflu (VUR)

A

UTI

336
Q

Personal hygience, increased fluid intake, regular emptying of the bladder, and wearing cotton underwear, are all ways to prevent

A

UTI’s

337
Q

Complete or almost complete cessation of urine produciton by kidneys

A

Anuria

338
Q

Retention of excess nitrogenous wastes in blood

A

Azotemia

339
Q

Ventral curvature of penis caused by a fibrous band of tissue

A

Chordee

340
Q

Operation to remove part or all of prepuce (foreskin) of penis

A

Circumcision

341
Q

Substance produced daily in body; found in blood, muscle, and urine; measurement of its excretion is used to evaluate kidney function

A

Creatinine

342
Q

Failure of one or both testes to descend

A

Cryptorchidism

343
Q

Inflammation or urinary bladder

A

cystitis

344
Q

A malformation in which urethra opens on dorsum of penis; frequently associated with extrophy of bladder

A

Epispadias

345
Q

Congenital eversion of a hollow organ; a congenital gap in anterior wall of bladder and abdominal wall in front of it, with posterior wall of bladder being exposes

A

Extrophy

346
Q

Inflammation of glomerulus of nephron

A

Glomerulonephritis

347
Q

A tuft formed of capillary loops at beginning of each nephric tubule in kidney; this tuft with its capsule (Bowman’s capsule) constitutes the corpusculum renis

A

Glomerulus

348
Q

Filtering of blood to remove toxins (nitrogenous wastes)

A

Hemodialysis

349
Q

A malformation in which urethra opens on ventral aspect of penis; frequently associated with congenital chordee

A

Hypospadias

350
Q

Act of urinating

A

Micturition

351
Q

A long, convoluted tubular structure in kidney, consisting of renal corpuscle, proximal convoluted tubule, nephronic loop, and distal convoluted tubule

A

Nephron

352
Q

A urine output of less than 0.5-1.0 mL/kg/hour

A

Oliguria

353
Q

Filtering blood to remove toxins via a catheter inserted into peritoneal cavity

A

Peritoneal Dialysis

354
Q

Free fold of skin that covers glans penis

A

Prepuce

355
Q

Inflammation of renal parenchyma, calyces, and pelvis, particularly due to local bacterial infection

A

Pyelonephritis

356
Q

Excess of urea and other nitrogenous waste products in blood

A

Uremia

357
Q

Inflammation of a ureter

A

Ureteritis

358
Q

Inflammation of the urethra

A

Urethritis

359
Q

Forms and excretes urine.

Regulates fluid and electrolyte balance within body

Regulates acid-base balance within body

Regulates blood pressure.

Stimulates production of erythropoietin, which promotes production of red blood cells (RBCs) in bone marrow

Regulates calcium metabolism in body

A

Functions of the Renal System

360
Q

Innervation of stretch receptors in bladder wall does not occur before the age of

A

2 years old

361
Q

Congenital defect in which urinary meatus is not at end of penis but is located on lower or underside of shaft

A

Hypospadias

362
Q

Congenital defect in which urinary meatus is not at end of penis but on upper side of penile shaft; less common than hypospadias

A

Epispadias

363
Q

Care and treatment for Hypo or Epispadias

A

Surgical correction before 18 months of age.

Post op care includes urethral stent in place and wrapped with pressure dressing.

Arm and leg restraints may be needed to prevent accidental removal of the stent.

Encourage increased fluid intake to maintain urine output and stent patency.

Call provider if no urine output for one hour; there could be kinks in the system or occlusion by sediment.

Med therapy includes antibiotics until stent falls out, Tylenol for pain, and anticholinergics such as oxybutynin (Ditropan) for bladder spasms.

364
Q

Postsurgical instructions for Hypo or Epispadias

A

Double diapering to protect stent.

Limit activity for two weeks.

Med administration.

Monitor for signs of infection.

Call provider if urine leaks from anywhere but penis.

Urine will be blood-tinged for several days- this is normal.

365
Q

Lower portion of abdominal wall and anterior bladder wall are missing, resulting in bladder being open and exposed on abdomen

A

Exstrophy of Bladder

366
Q

Treatment of Exstrophy of Bladder

A

Bladder closure is corrected during first 48 to 72 hours of life.

Preoperative covering of bladder with sterile plastic wrap and maintaining skin integrity of surrounding area using skin sealant to protect it from excoriating effects of urine.

Post op care may include Bryant’s traction to facilitate healing, avoiding abduction of legs, changing dressings as ordered, monitoring urine output, bladder spasms, and urine or blood draining from meatus.

367
Q

A failure of one or both testes to descend from inguinal canal into scrotum. More frequently seen in premature infants, exposes testes to heat of body, leading to low sperm counts at sexual maturity, and leads to a greater risk of torsion and trauma, and higher incidence of cancer, and inguinal hernias

A

Cryptorchidism

368
Q

Treatment for Cryptorchidism

A

If testes do not descend by first year of life, hCG hormone is given to induce descent. If this does not work, then an orchiopexy is performed before age 2.

A prosthesis may be placed in scrotum if testes are damaged or absent.

Use ice post op, analgesics for pain, and monitor for infection.

369
Q

A disease process that affects primarily the glomerulus of kidney

A

Acute Glomerulonephritis

370
Q

Elevated BUN, indicating impaired renal function; elevated erythrocyte sedimentation rate (ESR) indicates inflammation in body; elevated anti-streptolysin O (ASO) titer indicates a previous streptococcal infection; renal ultrasound shows enlarged kidneys, while urine exams demonstrate gross hematuria, proteinuria, and red blood cell casts; serum samples may also display azotemia

A

Acute Glomerulonephritis

371
Q

Treatement for Acute Glomerulonephritis

A

Bedrest during acute period.

Monitor fluid and electrolyte imbalances; I&O, dialy weight, fluid restriction if ordered, sodium, potassium, and possible protein intake will be limited; monitor dietary intake to optimize calories consumed.

372
Q

Med therapy for Acute Glomerulonephritis

A

Antihypertensives, such as hydralazine (Apresoline)

Diuretics, such as furosemide (Lasix)

373
Q

Features of Acute Glomerulonephritis

A

Caused by immune reaction to group A beta-hemolytic streptococcal infection.

Onset is abrupt.

Hematuria is grossly bloody

Proteinuria is 3+ or 4+, not massive.

Edema is mild.

Hypertension is marked.

Hyperlipidemia is rare or mild.

Peak age frequency is 5-10 years of age.

Interventions include limited activity, anti-hypertensives as needed, symptomatic therapy if CHF occurs.

Diet is normal for age; no added salt if child is hypertensive.

Prevention through treatment of group A beta-hemolytic streptococcal infections

Course is acute 2-3 weeks

374
Q

Features of Nephrotic Syndrome

A

Cause is idiopathic; possible a hypersensitivity reaction.

Onset is insidious.

Hematuria is rare.

Proteinuria is massive.

Edema is massive.

Hypertension is mild.

Hyperlipidemia is marked.

Peak age frequency is 2-3 years of age.

Interventions include bedrest during edema stage; corticosteroid administration.

Diet is nutritious for age; no added salt; small, frequent meals may be desirable.

Prevention is not known.

Course is chronic- may have relapses.

375
Q

Clinical state characterized by edema, massive proteinuria, and hyperlipidemia

A

Nephrotic Syndrome

376
Q

Sudden onset of diminished renal function.

Occurs suddenly and is often reversible; generally follows ischemic or toxic trauma to the kidney.

A

Acute Renal Failure (ARF)

377
Q

Assessment findings for ARF

A

Hyperkalemia, hyponatremia, hypocalcemia, BUN and serum creatinine are elevated.

Pt will appear pale and lethargic with edema; hypertension occurs secondarily to fluid volume overload.

378
Q

Treatment of ARF

A

Restrict sodium, potassium, and phosphorus as needed.

Parenteral or enteral nutrition may be needed initially.

Dialysis may be required to correct electrolyte and fluid balances while eliminating wastes.

Monitor I&O and weigh daily.

Monitor BP.

379
Q

Med tx for ARF

A

Antibiotic therapy.

Avoid nephrotoxic drugs (such as aminoglycosides, cephalosporins, sulfonamides, tetracycline, contrast dye with iodine, indomethacin, ASA, and heavy metals)

380
Q

An irreversible loss of kidney function over months to years.

Families that are affected require multidisciplinary care.

Kidney transplantation

A

Chronic Renal Failure

381
Q

Manifestations of this disease include poor weight gain, failure to thrive, tachycardia, cardiomegaly, galloping rhythm, poor perfusion, liver and spleen enlargement, and weight gain

A

Heart failure

382
Q

Feeding Children with CHF

A

feed in relaxed environment; frequent small feedings may be less tiring.

Hold infant in upright position for less stomach compression and improve respiratory effort.

If child is unable to consume appropriate amount during 30 minute feeding every three hours, then and NG feeding tube needs to be considered.

Monitor for increased tachypnea, diaphoresis, or feeding intolerance (vomiting).

Concentrating formula to 30kcal/oz may increase caloric intake without increasing infants work

383
Q

Manifestations of this disease include migratory polyarthritis, carditis, chorea, erythema marginatum, subcutaneous nodules, and erythema marginatum

A

Rheumatic Fever

384
Q

When infusing IV antihypertensive Meds

A

Infuse very slowly.

Maintain an arterial line for monitoring.

Observe for hypotension.

385
Q

The ability of RBCs to carry oxygen is dependent upon sufficient circulating

A

Iron

386
Q

A group of congenital disorders:

Sickled hemoglobin

Chronic hemolytic anemia

Ischemic tissue injury

Found in 8% of persons of African descent

Also prevalent in persons of Mediterranean, Middle Eastern, Indian, Caribbean and Central and South American Decent

A

Sickle Cell Disease (SCD)

Autosomal Recessive Condition

387
Q

Treatment of Pain related to Sickle Cell Disease

A

Opioids (Morphine)

Nonsteroidal Antiinflammatories

388
Q

Frontal bossing (prominent and protruding forehead), maxillary prominence, wide-set eyes with a flattened nose, hepatosplenomegaly, greenish-yellow skin tone, one inherited gene=mild anemia (minor), two inherited genes=severe anemia (major), are all characteristics of

A

Child with Beta-thalassemia (autosomal recessive)

389
Q

Treatment for Beta-thalassemia

A

Erythrocyte transfusion

Chelation therapy

Splenectomy

Bone marrow transplantation is the only available cure for thalassemia at this time

390
Q

A lifelong hereditary blood disorder usually seen in males, but if gene is passed by both parents to a femal, she could be affected

A

Hemophilia (X linked autosomal recessive)

391
Q

Treatment of a bleed in hemophilia

A

Factor prophylaxis

RICE (Rest, ice, compression, and elevation)

392
Q

Bruising and Petechiae may be seen with

A

Hemophilia

Von Willebrand’s disease

Immune thrombocytopenic purpura (ITP)

Disseminated intravascular coagulation (DIC)

Aplastic Anemia

393
Q

Hours of sleep for 6-7 year olds

A

12 hours.

Nap or quiet time may still be needed

394
Q

Sleep for 12 year olds

A

9-10 hours

395
Q

Therapy for childhood cancers.

Allogenic bone marrow (matched donor)

Autologous peripheral stem cells (child’s own)

Umbilical cord blood stem cells

A

Bone Marrow Transplantation (BMT) / HSCT

396
Q

GVHD

A

Graft versus host disease.

Monitor for this post bone marrow transplant

397
Q

May cause bone marrow suppression, alopecia, malaise/fatigue, n/v, anorexia, stomatitis

A

Chemotherapy

398
Q

May cause skin reactions, fatigue, bone marrow suppression, n/v, anorexia, mucositis

A

Radiation

399
Q

The most common childhood cancer

A

Leukemia

400
Q

Manifestations of this include fever, pallor, excessive bruising, bone or joint pain, lymphadenopathy, hepatosplenomegaly, and abnormal WBC counts

A

Leukemia

401
Q

Treatment for Leukemia

A

Once medically stable, most chemo is given outpatient

85% can achieve remission with a 5 year disease free survival rate

402
Q

Second most common childhood cancer

A

Brain Tumors

403
Q

Manifestations of this include H/A, morning vomiting, seizures, focal symptoms, and neurologic deficits

A

Brain Tumors

404
Q

Surgical removal of tumor

A

At risk for increased ICP

Edema

Hydrocephalus

Hemorrhage

Nursing care includes

Frequent vitals, mental staus, and neurologic status checks

405
Q

Child with Type I DM needs to add an extra 15 to 30 grams of carbohydrate snack for each

A

45-60 minutes of exercise

406
Q

This will present with severe hyperglycemia, ketones in the blood, metabolic acidosis

A

Diabetic Ketoacidosis

407
Q

Management of this requires intensive care to lower glucose, reverse acidosis, and correct fluid and electrolyte imbalance

A

Diabetic Ketoacidosis

408
Q

Signs of this include personality changes, slurred speech, decreased level of consciousness, trembling, sweating, tachycardia, pallor, and clammy skin

A

Hypoglycemia

409
Q

Signs of this include increased urine output, thirst and hunger, fatigue, blurred vision, h/a, emotional lability

A

Hyperglycemia

410
Q

Congenital neural tube defects classified by incomplete closure of the vertebrae

A

Spina Bifida

411
Q

No herniation of the spinal cord or meninges; vertebral arches between L5 and S1 fail to fuse; may be noted as a dimple at the level of L5-S1

A

Occulta Spina Bifida

412
Q

Posterior vertebral arches fail to fuse; saclike protrusion containing meninges and CSF at some point along the posterior vertebrae

A

Cystica Spina Bifida

413
Q

Posterior vertebral arches fail to fuse; saclike herniation contains meninges, CSF, and a portion of spinal cord or nerve roots

A

Meningocele Spina Bifida

414
Q

Seizure lasting more than 30 minues is considered

A

Status Epilepticus

415
Q

Drugs used to decrease ICP in cerebral edeam

A

Mannitol and furosemide

416
Q
A

Parent Child NUR 246 (3 decks)

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