Test 2 PEDS Flashcards
Explain Trisonomy 21
The extra chromosome at site 21. No known reason why this happens
Name some of the signs of down’s syndrome?
Thickened tongue. Low set ears. Extra eye flap. Bridge of nose spacing.
Down’s syndrome patients may have what defects?
Cardiac defects, GI defects (Hirschsprung)
An IQ <75 suggests what?
Subaverage intellectual development
Children with downs should be encouraged to have high fluids and high fiber foods due to?
Hirschprungs Syndrome, Decreased peristalsis in GO tract.
What percentage of Downs syndrome babies die in the first year due to defects?
45%
What is the purpose of corticosteroids for the management of nephrotic syndrome?
Stabilize glomerulus Decrease loss of protein in urine.
What are the signs of a Wilm’s tumor?
Tight Diapers, Clothes not fitting correctly, Abnormal renal functioning.
What are the consequences of Leukemia
Infection, bleeding anemia, fractures, bone pain.
congenital heart disease s/s, what meds to give?
failure to thrive, poor intake
meds:dig hold if hr less than 100 infants or 80 in toddlers
watch for dig toxicity!!! I.e-n&v and anorexia
<3 disease is dx by? and contraindicated when?
cardiac cath, contraindicated with a diaper rash or febrile illness
Tetralogy of fallot
R to L shunt, pressure builds up on R ride of the heart
Transposition of the vessels – deoxygenated blood
Pulmonary stenosis
Ventricular septae defect
Overiding aorta
Hypertrophy left ventricle
TET Spells/Blue spells
Squatting position, knee chest position (for infants mom places them like this)This is a sign of decompensation and these positions decrease the preload and
Venous return. If unsuccessful then hospitalized placed on 100% O2
Child with congenital heart disease should play / be disciplined how?
like any other child. This promotes normalcy & growth & development.
Risk factors for Rheumatic fever
Strep infection / Scarlet fever
Glomelularnephritis = complication & mitral valve disorder
Test CRP if high indicated inflammation. If decreased indicates that treatment is working
Major clinical manifestations of rheumatic fever
RF may lead to glomerulonephritis, Polyarthritis
Cardidis
Erythema Marginatum
Chorea (St. Vitus Dance, Sydenham Chorea)
Discharge Tx for rheumatic fever
Cultures done for all sore throats Take ABX (PCN to protect the heart) for 5 yrs or lifetime for invasive procedures
Classic Hemophilia
Apply pressure for 15 minutes.
X linked recessive inherited disorder of factor VIII (8)
S/S of hemophilia
Bruising
Bleeding w/circumcision
Hematoma with Vit K or Hep B vaccine
Dx test done for hemophilia & treatment
DX: PTT (clotting time study)
TX: R.I.C.E. – Rest, Ice, Compression & Elevation
DO NOT GIVE Aspirin (ASA), Over the counter drugs (OTC) or Motrin
When hemophiliac rides bike make sure to wear protective equipment.
Give factor Vlll When there is bleeding into the joint structure. The IV is reconstituted and it is given IV Push thru port.
Proper activities would include; swimming, golfing (no contact sports, no hard play areas) Physical therapy consult for ROM exercises to strengthen muscles
PKU (Phenyketonuria) DX
Guthrie Test – detects phenylalanine (a metabolic amino acid), hypothyroidism, galactosemia, hemoglobin defects like sickle cell. Must have 24-48 hrs of ingested protein before test.
Complications of PKU
Stains neurons (kernicturus) causing seizures Encephalopathy/ mental retardation accumulation of phenylalanine that cant be converted into tyrosine.
People who have PKU usually look like?
blonde hair, blue eyes, light skin (lack of melanin)
PKU diet
Lifelong
Special Formula (lofenalac or Phenex 1 (infants) Phenex-2 (children & adults)
No artificial sweeteners/aspertane
Limit proteins
Fruits & Veggie @ lib
Monitor levels s/b up to 6 in infants, 10 in children & 15 in adults
Dx test for jaundice
Amniocentesis
Coombs test – measures antibodies attached to RBC’s
(indirect on mom) (Direct on baby once born)
If (+) mom built antibodies & is sensitized, hemolysis in baby
Dx of diabetes
Hemoglobin A1C 4-6 is normal anything above, investigate
Hemolytic in uteral
(mixing of fetal & maternal blood) – Give mom rhogam shot & give baby same Rh factors as mom. This happens because 1st child was Rh+
Teaching plan priority of newly diagnosed diabetic
Insulin administration and s/s & tx of hypoglycemia (tremors, sweating, confusion)
Give fast acting carb (juice w/sugar, candy) followed by protein to stabilize
Insulin difficult to adjust in toddlers why?
because they get it before hand & you don’t know what or how much they are going to eat.
Increased activity reduces insulin needs.
How to decrease food allergies
Introduce one food at a time every 4-7 days.
Start with rice cereal, light color fruits & veggies, then proteins
Priority Assessment for glomerolonephritis AGN
Can cause renal failure
Assess behavior, vital signs, irritability, and neuro status
Clinical manifestations of glomerolonephritis AGN
Periorbital edema (swollen eyes) Increased BP – accompanied by a headacheTea colored urine, Acute renal failure
– renal diet – low potassium, low sodium, low protein
Diet for glomerolonephritis AGN
Dx of glomerulonephritis
ASO titers ESR CRP inflammation (C-reactive protein) ANA titers **all elevated!!
During the ACUTE phase of glomeruloneph.
Usually make complete recovery home rest, home school, check BUN & creatnine, chest xray
Clinical manifestations of Nephrotic syndrome
3rd spacing edema – elevate arms/hands and give scrotal support
Decreased protein in serum (hypoproteinemia), high in urine (hyperproteinuria)
Weight gain, ascities, lethargy
Increased cholesterol, increased fats
CorticoSteroids given - to stabilize the glomerulus
Decrease protein loss in urine
Teach mother NOT to suclude the child from the outide world
treatment for Nephrotic syndrome
Diet for Nephrotic Syndrome
Increased protein decreased fat
Myelomeningocele
out pouching of menengies & spinal nerves L4-L5.
Can be prevented by taking folic acid
Dx through AFP or quad screening
Nsg Care for Myelomeningocele
Pre- op – baby lays on stomach with moist gauze over spine
Post-op – Keep supine (on back)
Check head circumference (for ICP from spinal fluid)
S/S of ICP – poor feeding, bulging fontanel, shrilling cry
Complications of myeolomeningocele
Paraplegics
bowel & bladder problems (straight cath)
Communicating Hydrocephalus- CSF absorbs normally
Caused by surgery repair of myelomeningocele, adhesions between meninges & base of brain
Non Communicating Hydrocephalus – Blocked flow of CFS
Caused by congenital, infection, tumor, aneurysm, blood clot
Nsg care for Hydrocephalus shunt
No pumping of shunt Position on opposite side of the shunt Check for abdominal distention Head circumference measured Teach mother s/s of pump failure (ICP- bulging fontanel) Strict I & O Neurological Assessment
Bacterial Meningitis
caused by HIB vaccine, H influenza
S/S –Increased temp WBC’s are up Headache Preceeded by upper resp infection- protect from resp contamination Photophobia, Nuchal rigidity
Dx/Tx for Bacterial Meningitis
–Dx: CSF examination by spinal tap/lumbar puncture
Tx:Broad spectrum ABX (24 hours isolation until affective) Dark quiet room Seizure precautions, Resp Isolation
When providing care for a child with ALL (Acute Lymphoid Leukemia) Unrestricted proliferation of immature WBC’s
Protect from child with Upper Resp infection
Neutropenic precautions – peal fruits & veggies. NO fresh flowers
Warm toothbrush to soften bristles to decrease bleeding
Nsg care (A.L.L)
Hand washing
Protect from infection
Increased Nutrition
Cleft lip Care
Pre op feeding using elongated nipple and sitting upright place on side or back after surgery to decrease manipulation of sutures (Logans bar)
Cuddle to decrease crying
Post – op feeding using formula and soft foods only NO UTENSILS
Long Nipples, infant seat used for feeding, breast feedings ok, allow breaks in feedings due to difficulty breathing
Cleft Palate Care
place on stomach to promote drainage
Faulty speech pattern, otitis media, orthodontic problems, plastic surgery needed and hearing impairment, same pre/post op as CL
Emergency surgery needed for what?
Tracheosophageal Fistula (TEF)
s/s: Chocking, coughing, cyanosis
Drooling of saliva
Abdominal distention
Apnea (period of no breathing)
PRE-op TEF surgery
NPO IV Warm baby Increase HOB Catheter to suction secretions
POSTop TEF surgery
Gtube – gravity drainage Gtube feedings (up to 10 days) Reintroduce bottle
Regerg of formula causes metabolic alkalosis
Progressive projectile vomiting then immensely hungry
Failure to thrive – weight loss
Dehydration
Hypertrophied pylorus
Olive like mass
PYLORIC STENOSIS
Pyloromyotomy Post op mngment
Restore fluids – electrolyte balance May vomit 24-48 hrs after IV fluids Begin feeding 4-6hrs after surgery Increase HOB
Kawasaki TX
– ASA, Anticoagulants, IVIG (Intravenous Immunoglobulin)Defer immunizations
Long term complications –Kawasaki
Coronary Artery Anurysms
S/S – red hands & feet, rash, strawberry tongue, painful joints, heart failure & irritability for 2-3 weeks.
Ryes Syndrome – Liver & CNS involvement
Causes – ASA, viruses (varicella, influenza)
S/S – Same as ICP
Care – Supportive
SIDS
(age 2-4months) Allow parents to express themselves
carditis s/s
tachycardia at rest, cardiomegaly, CP, Give Dig!
clinical manifestations of TEF
excessive salivation and drooling, **coughing choking, cyanosis **
3 C’s!!!!!!
Nsg care for TEF
NPO, IV fluids, suction, elevate HOB Ambu bag, possible surgery
When an NG tube into the stomach meets resistance and cannot be advanced this is a dx of what?
TEF
TEF is usually identified when?
after their first feeding if they cough choke & become cyanotic this is why nurses feed the baby their 1st meal!
Hypertrophic Pyloric Stenosis
constriction of the pyloric sphincter with obstruction to gastric outlet, more in boys usually dx 2-5 wks old that are bottle fed
Abdominal Ultrasound
confirms dx of pyloric sphincter, determines diameter and length of pyloric muscle
Pyloric sphincter (HPS) clinical manifes.
presents w/ PROJECTILE VOMITTING sour smelling bc no bile, dehydrated (lack of tears dry mucus membranes sunken fontanels decreased output poor skin turgor, wt loss) FTT, lethargic, dec na, k, cl, increased BUN,pH ,bicarbonate (hco3)
METABOLIC ALKALOSIS
when is feeding begun after a pylorotomy for HPS?
a few hours after, clear liquid diet, increase amount q 1/2 hour! start w/ 5 mL and increase slowly
STRICT FEEDING SCHEDULE
if there are massive amounts of protein in urine, dec serum protein albumin, increased cholesterol levels, dec BP, and edema in diaper area or abdomen this indicates?
Nephrotic syndrome
when is nephrotic syndrome usually dx?
bet 2-7 years old usually males often after an upper respiratory infec. (2-3 days)
For nephrotic syndrome what is the treatment?
steroids *first line (prednisone), diuretics for the edema, 25% albumin for severe edema, antibx if infection, monitor i&o, daily wts, check for edema, monitor vs (low bp) monitor for protein in urine and spec gravity, keep away from infections (steroids may cause), keep warm and dry
Acute Glomerulonephrotis (AGN)
immune complex r/t group A beta hemolytic strep (GABHS) POST STREP!! seen 10-21 days after pharyngitis
BASEMENT MEMBRANE
Clinical Manifestations of AGN…
hypertension, oliguria, edema, hematuria, circulatory congestion(fluid in lungs!) and a little protein in urine, elevated ASO titer, pale, HA dysuria
Managing AGN
moderate Na and fluid restriction, potassium might be restricted due to oliguria, VS, i&o, daily weights, d5.45
the two differences between nephrotic syndrome and acute glomerular nephritis?
BP will be high in AGN and hematuria
BP will be low in Nephrotic syndrome and NO hematuria
AGN patients due to their increased BP and edema are at risk for what?
STROKE!!
provide a no added salt diet , diuretics, anti hypertensives
how is diabetes usually detected?
bed wetting in a post potty trained child, also 3 P’s!
when talking to a patient or family about diabetes?
USE A MATTER OF FACT APPROACH
I’m DM l, what are they at risk for??
DKA! (same as adults) demonstrated with kussmauls, ketonuria, so Metabolic Ass (acidosis)
normal HgA1c
4-6%
question Anything above
***one of the study guide I read said 1.8-4.0 so not sure
highest risk age for DKA and why?
adolescents bec they lie, they wanna be like peers and fit in
things to pick on a test for food to give in a hypoglycemic episode
CHEESE, CRACKERS, MILK
protein
Insulin should or shouldn’t be omitted ?
NEVER omitted, may need to be adjusted based on findings
ex. if they are gonna have a big meal or work out GIVE LESS
Magical thinking occurs among which age group
PRESCHOOLERS
Atopy
allergy with a hereditary tendency
food sensitivities include?
milk eggs wheat nuts soy shellfish chocolate
NEVER GIVE AN INFANT HONEY BEC AT RISK FOR BOTULISM R/t honey
it is best to breast feed or give formula as opposed to cows milk until what age
12 months
PKU is an autosomal recessive metabolic disease that lacks what enzyme that’s needed to metabolize amino acids
Phenylalanine (hyperphenylalaninemia)
too much protein they can’t break it down
PKU may lead to?
Mental retardation
Guthrie blood test is used to dx what?
PKU and is most reliable if blood sample is taken after infant has recently ingested protein
children with PKU should have what diet modifications?
special formula for infants (lofenalac or phenex 1)
Phenex 2 for children and adults
LIMIT ALL NATURAL FOODS WITH PHENYLALANINE
avoid artificial sweeteners with ASPARTAME
Diet is LIFELONG
Hemophilia A is a deficiency in what?
Factor Vlll
Treatment of the bleed in a hemophilia begins when?
at home!, apply pressure for 15 min, RICE, ROM and PT after the bleeding stops
to prevent isoimmunization administer RHIG RHOGAM) to all Rh negative moms with an Rh positive fetus when?
28 weeks into pregnancy
photo therapy may control what
bilirubin levels in mild cases
heart murmur is indicative of?
often 1st sign of a heart defect, get an EKG and BP of all 4 extremities
most common congenital heart defect?
VSD Ventricular septal defect which is a major cause of death in infants under 1 year
with coarctation of the aorta what to assess for
BP and pulse q4 extremities it’s usually higher in upper extremities and lower in lower
what is a TET spell?
an anoxic spell when o2 requirements > blood supply!
when you’re starting an IV they turn blue, put em in a knee chest position(squat down) to reduce systemic blood flow return to the heart! in infants have their moms hold them in this way
Med Management with a mixed blood flow defect
IV administration of Prostaglandin E to help keep ductus arteriosis open
Kawasaki Disease
an acute self limiting systemic vasculitis of unknown cause
Kawasaki is treated with
high dose IV IgG 2g/kg over 10-12 hrs, ASA 80-100 mg/day–fever then 3-5mg/kg/day —anti platelet !
be careful when giving ASA can cause Reye
rheumatic fever treatment
cultures done for all sore throats
take ABX (PCN) to protect the heart for 5 years or for life if having an invasive procedure
Chorea
abnormal neuromuscular (kids get clumsy) sudden involuntary movement of limbs due to inflammation of the basal ganglia
if jaundice is not treated (too much bilirubin that can’t be converted from indirect bilirubin to direct and liver can not excrete it ) what can occur?
encephalopathy or mental retardation
in pathological jaundice hemolysis in utero may occur this is dx by amniocentesis Coombs test,when the blood transfusion is performed who is the compatible blood matched to mom or baby?
MOMMY!
cephalocaudal assessment is done how?
starts at head and goes down, heels from feet up
hemolysis in utero occurs when
mom is rH - and her first born is Rh + the first baby is ok but the second baby will experience the hemolysis is Rh+
s/s of hypoglycemia
tremors sweating confusion (loc)
a fast acting carb and then a protein is given for hypoglycemia what are some examples
fast acting carb: juice w/ sugar or candy then protein: cheese eggs milk etc.
increased activity requires more/less insulin
LESS
Glomerulonephrotis (AGN) can cause renal failure what are the main assessments
behavior, VS, neuro status and irritability, electrolytes, BUN and Creatine
acute phase of Glomerulonephrotis (AGN) if treated may result in?
complete recovery! rest, home school, BUN and Creatine checked routinely, chest x-rays done
Goal for a Down’s syndrome child
function at highest level possible, not their chronological age, their highest developmental ability!
Myelomenigocele (outpouching of meninges and spinal nerves (4-5)) can be prevented by what?
FOLIC ACID
Myelomenigocele is dx by what?
AFP or Quad screening
s/s of ICP
poor feeding, bulging fontanel, shrilling cry
communicating hydrocephalus (adhesions between meninges and base of brain) may occur after what?
after surgical repair of Myelomenigocele
non-communicating hydrocephalus (blocked flow of CSF) what are causes
congenital, infection, tumor, aneurysm, blood clot
ICP is indicated as the child has bulging fontanel what may have happened?
shunt pump failure
CSF is examined by what procedure
spinal tap/lumbar puncture
a child with leukemia is on what type precaution
reverse isolation
pre-op surgery (nephrectomy) for a kid with a Wilms tumor what do you post over the bed
a sign saying DO NOT PALPATE ABDOMEN because it can metastasize
for a baby with a cleft LIP repair you place then how after surgery
side lying or back to protect the suture line (Logan’s bar)
how do you place a baby after cleft palate repair?
on tummy to promote drainage! no utensils in the mouth or anything that may mess up the sutures
if a cath is done for VSD OR PULMONARY STENOSIS what will the labs show?
polycythemia high h & h and low o2 sat
with a coarctation of the arteries how will their BP read
at least 20 mmHg higher in the arms than in the legs
A child with coarctation of the aorta on assessment reveals absence of a murmur does this rule out the coarctation
No!
surgery (balloon cath/angiography) Is preformed when? for coarctation of the aorta
at age 2 usually, must be preformed before a GIRL reaches their childbearing age bec the extra blood volume during pregnancy can cause heart failure
hemophilia is a sex linked recessive disorder that occurs in which gender? and is Carried by which gender?
occurs in males, carried by females
factor VIII associated with hemophilia is intrinsic or extrinsic?
intrinsic ! diagnosed by PTT
hemophilia is usually recognized when?
what a boy infant bleeds excessively following circumcision or if a boy gets bruised very easily after any bumping into something (lower extremities)
Major causes of death in a hemophiliac?
intracranial hemorrhage or laryngeal bleeding
when a hemophiliac has a mouth trauma or surgery what med must be given to prevent clot destruction
Amicar, also corticosteroids for hematuria
NEVER GIVE NSAIDS TO A HEMOPHILIAC THEY INHIBIT PLATELET FORMATION
most important nursing intervention for a hemophiliac
PREV OF INJURY
which blood incompatibility is most severe? Rh or ABO?
Rh!!!
cleft lip deficit
inability to suck, best method for feeding is upright position using a commercial cleft lip nipple
complications of cleft palate
poor teeth alignment, risk for ear infections (post repairment) (tubes may be needed in ears to drain the fluid) speech problems before and after surgery
definitive dx of a pyloric stenosis is made by watching the infant drink and
PALPATE for a RUQ mass, it will feel it will be round and firm the size of an olive and observe for gastric peristaltic waves passing from L to R across the abdomen as the infant drinks
SONOGRAM WILL DIAGNOSE HPS
prior to laparoscopic correction in HPS what must be done
lytes must be balanced and dehydration and starvation must be reversed if tetany is present give Ca+
BEFORE GIVING K+ ALWAYS CHECK KIDNEY FX!!!
high risk for what after surgery for HPS
infection because abdominal incision is near diaper area
after HPS surgery which position do you place child in
side lying so that if they vomit there is no aspiration
in an emergency which type of insulin is used
regular insulin or lispro IV in normal saline it is the quickest
corticosteroids are given to a nephrotic syndrome patient and the parents are worried because a s/e is stunted growth what do you say?
this will not occur if prednisone (corticosteroid) is given every other day strictly teach them to mix it with applesauce and never stop it abruptly because it can cause renal insuff.
igG antibodies against streptocci are found in a patient with Glomerulonephrotis (AGN) what is this indicative of?
the illness is a result of previous strep throat infection
encephalopathy may occur in AGN if the BP reaches 100/60 what are s/s
HA, irritable, seizures, coma, lethargy, vomitting
main interventions in AGN
i&o daily weights VS, emotional support, prophylactic PCN
downs babies have how many chromosomes?
47—–normal is 46
initially, downs is DX at birth by the physical appearance but it is confirmed with
karyotype (chromosome study) or an amniocentesis at 12-20 weeks gestation chronic villus sampling 8-13 wks, per cutaneous blood sampling @ 20 weeks
mild cognitive challenge (mental retardation) is most common what are the IQ ranges
50-70 (74)
mild mental retardation can be educated to what grade
6th
moderate mental retardation can be educated to what grade
2nd grade with an IQ of 35-49
severe mental retardation can be educated to what grade
basic hygiene and dressing skills IQ 20-34 CONSTANT SUPERVISION
profound mental retardation can be educated to what grade
IQ BELOW 20 Provide a highly structured environment very limited self care constant help and supervision
what are Brudzinskis signs and when do they occur
occurs with meningitis, occurs when child lays flat on back and flexes neck forward, with an unconscious flexion of hip knee ankle
Kernigs signs
occurs in meningitis, as the nurse flexes the child’s hip and knee as leg is extended pain resistance and spasm are noted (kid can’t straighten leg)
symptoms of meningitis in newborn
poor sucking high pitched cry lethargy
meningitis is dx by
lumbar puncture
what kind on isolation is a kid with meningitis placed on
respiratory till 24 hours after start of antibiotics
with meningitis hearing acuity is reduced why?
pressure on cranial nerve 8
first s/s of leukemia
pallor, low grade fever, lethargy, symptoms of anemia
a child with leukemia is receiving chemo which can release a high Uric acid level and can hinder kidney fx, what drug can be also given to prevent this kidney failure and release Uric acid
allopurinol (prevents)
***think of GOUT and how it had high levels of Uric acid
biggest risk in a leukemia pt receiving chemo?
infection teach parents to look for low grade fever and change in behavior. Also may be prescribed prophylactic anti bx
during the maintenance phase of therapy for leukemia children are allowed what
normal activity and go to school
SIDS occurs more freq in ..
adolescent moms preterm labor twins narcotic dependent moms
most infants that die of SIDS don’t make a sound as they die this indicates
they die of laryngospasms
a family had a baby that died of SIDS they now have another baby what is done
new baby is screened using a sleep study for the first 2 weeks of like then placed on continuous apnea monitoring
TRUE OR FALSE
kids go to home school if they have Acute Glomerular Nephritis and are secluded from outside world
kids go to public school if they have nephrotic syndrome and are encouraged to be exposed to outside world
True
TRUE OR FALSE
AGN kids are on a renal diet and are encouraged to eat low levels of protein
Nephrotic syndrome kids are encouraged to eat high levels of protein
TRUE AGAIN!
it is possible for a girl to be a hemophiliac when?
when both her father has it and her mother has it or she is a carrier !
when a hemophiliac rides a bike?
MAKE SURE THEY WEAR PROTECTIVE EQUIPMENT
when and how is factor Vlll given
when there is bleeding into a joint structure IV is reconstituted and given IV thru port PUSH
a 15 year old is diabetic and gives up on his daily insulin admin. what to do?
put him in a support group
TET spells (cyanotic) occur when
decreased blood and o2 (hypoxia) flow to the brain, usually follows prolonged crying or exertion
a child is placed in squatting position
to trap blood in the lower extremities
when there is coarctation that is slight what may be the only sign
absence of palpable femoral pulses
in coarctation of the aorta , the EKG, MRI, etc. will show
left sided heart enlargement due to back- pressure and also notching of the ribs from the enlarged collateral vessels
after surgery to correct coarctation the kid may have abdomen pain or discomfort due to abdominal muscles getting more blood than prior to surg. tell them what?
this is normal and temporary
how much factor Vlll is given when needed
1 bag per 5 kg body weight. may be repeated after 12 hrs
Which baby is anemic? the ABO incompatible baby or the Rh sensitized child?
the Rh sensitized child so this is more serious, can cause baby heart failure
when is phototherapy done for excess bilirubin
when bilirubin levels are 15mg/dl or more at 25-28 hours of age
