Unit 6: Nursing Care of the Sick Child Flashcards
1
Q
Refers to developmentally inappropriate degrees of inattention, impulsiveness and hyperactivity. It is one of the most common neurobehavioral disorders of childhood.
A
Attention Deficit Hyperactivity Disorder (ADHD)
2
Q
What is the main problem of ADHD?
A
Decreased Attention Span
3
Q
What is the average age of onset of ADHD?
A
7 years old
4
Q
According to the DSM 5 Criteria for ADHD, how many hyperactivity-impulsivity and inattention symptoms should be present for at least 6 months to consider if someone has ADHD?
A
6 or more
5
Q
This characteristic of ADHD refers to symptoms like being fidgety or squirms in seat, often runs about and climb when it’s not appropriate, act loudly, driven, often talks excessively.
A
Hyperactivity
6
Q
This refers to poor attention to detail, keeping up with tasks, not listening when spoken to. forgetful, easily distracted, avoid things that take effort to perform, lose things needed for a task, often do not follow instructions.
A
Inattention
7
Q
What are the symptoms of Hyperactivity?
A
- Fidgets and Squirms in their seat
- talks nonstop
- Dashes around, touching or playing with anything in sight
- trouble sitting still during dinner, school, Storytime
- Constantly in motion
- Difficulty doing quiet tasks and activity
8
Q
What are the symptoms of impulsivity?
A
- Very Impatient
- Blurts out inappropriate comments
- Shows emotion without restraint
- Acts without regard for consequences
- Difficulty waiting for things they want and waiting for their turn in games
- Often interrupts conversation and other activities
- ## May often come off as aggressive or unruly
9
Q
What are the 2 types of ADHD?
A
- Predominantly Hyperactive-Impulsive Type
- Predominantly Inattentive Type
10
Q
Under predominantly hyperactive-impulsive type. It refers to over focused, poor impulse control, difficulty sitting still, fidgeting, or squirming.
A
Rabbit Type
11
Q
It is under inattentive type which refers to sluggish, slow-moving, unmotivated, daydreamer.
A
Pooh type
12
Q
What are the different Classification of ADHD?
A
- Developmental Disorder
- Behavioral Disorder
- Disruptive Behavior
- Oppositional Defiant Disorder
- Conduct Disorder
- Antisocial DisorderW
13
Q
What is the specific cause of ADHD?
A
Unknown
14
Q
How many percent of ADHD are genetics? How about environmental factors?
A
75%: 9-20%
15
Q
According to European Food and Safety Authority what are the food that can significantly affect children with ADHD?
A
- Artificial food coloring
- preservatives
16
Q
What food increases symptoms of hyperactivity and distractibility?
A
Caffeine and Sugary Foods
17
Q
What are the drug treatments available for ADHD?
A
- Strattera
- Intuniv
- Pamelor or other tricyclic antidepressant
- Catapres or Tenex
- Wellbutrin
- Effexor
18
Q
What are the behavioral techniques for children with ADHD?
A
- Parent training in effective child management behavior methods
- classroom behavior modification technique and academic intervention
- special education placement
19
Q
What does the treatment plan FARES stands for?
A
F - Few simple rules and Firm limits
A - Avoid fatigue and overstimulation
RE - Regular daily routine
S - Structured environment
20
Q
What are the common nursing diagnosis for people with ADHD?
A
Risk for injury
21
Q
It is a stimulant used to treat ADHD and narcolepsy. Specifically it is a first line of treatment for ADHD?
A
Methylphenidate (Ritalin)
22
Q
What is the correct nursing management of nurses in the school and community setting?
A
Should work on a family in a long term basis to help plan and implement therapeutic regimens
23
Q
Why is it important as nurses to provide the type of learning disability a child has?
A
to be able to provide direction for the child, parents and teachers
24
Q
Autism is not a disability, but a different ability. True or False?
A
True
25
What does ASD stands for?
Autism Spectrum Disorder
26
What are the three key areas of ASD?
- language and other communication skills
- social awareness and interaction
- imaginative play
27
This refers to a developmental disorder that appears in the first three years of life, and affects the brains normal development of social and communication?
ASD or Autism Spectrum Disorder
28
Out of 110 children how many has ASP?
1
29
This is more common than pediatric cancer, aids and diabetes combines?
Autism
30
What are the signs of autism?
- wide nasal bride
- flared nasal alae
- wide mouth, full lips
- narrow forehead
- thin lateral eyebrows
- Thickened helix
- wide nasal tip
- Cupid bow upper lip
31
What are the different signs of autism?
- inappropriate playing with toys
- inability to relate to others
- hyperactivity or passiveness
- inappropriate laughing or crying
- oversensitive or under sensitive to sound
- strange attachment to objects
- poor speech or lack of speech
- difficulty dealing with changes to routine
- lack of awareness
32
What are the different spectrum of autism?
- Extreme ability in some areas
- above average I.Q.
- Average I.Q.
- Mild learning disability
- Moderate learning disability
- Severe learning disability
33
This type of autistics have distinctive abilities in art, music, mathematics or memory, 1% in the whole population.
Autistic Savants
34
7x as many people as classic autism. Average or higher I.Q. No language or Cognitive delays.
Asperger's syndrome
35
It is a type of pervasive developmental disorder (PDD) which are 2/3 of classic autism. 4 times more common in boys than girls.
Classic Autism and Kanner Autism
36
What are the cause of ASD?
- unknown
- genetic factors
- prenatal environment
37
What are the signs and symptoms of autism?
- overly sensitive in sight, hearing, touch, smell or taste
- have unusual distress when routines are changes
- perform repeated body movements
- show unusual attachment to objects
38
What are the communication problems of autism?
- cannot start or maintain a social conversation
- communicates with gestures instead of words
- develops language slowly or not at all
- does not adjust gaze at objects that others are looking it
39
What are the social interaction problems of Autism?
- Does not make friends
- Does not play interactive games
- May not respond to eye contact or smiles
- May treat others as if they are objects
40
What are the response to sensory information of Autism?
- Does not startle at loud noises
- has heightened or low senses of sight, hearing, touch, smell or taste
- May find normal noises painful and hold hands over ears
41
What are the behavioral problems of Autism?
- acts up with intense tantrum
- gets stuck on a single topic or task
- has short attention span
42
What are the play symptoms of autism?
- does not imitate others
- prefer solitary or ritualistic play
- show little pretend or imaginative play
43
What are the complications of Autism?
- mental retardation
- fragile X syndrome
- Tuberous sclerosis
44
It refers tot the growth of numerous noncancerous and benign tumors to many parts of the body.
Tuberous Sclerosis
45
What are the signs of autism in babies and toddlers?
- limited eye contact and facial expression
- no response to hearing their own name called
- limited interactions with caregivers or people around them
- becoming very distressed by certain textures
- co cooing, babbling or making any sounds
- no waving or smiling
46
A child may have autism if unable to:
- Gesturing by _____ months
- Saying single words by ______ months
- Saying two-word spontaneous phrase by _____ months
- Babbling by _____ months
- 12
- 16
- 24
- 12
47
What are the tests and diagnostics for autism?
- Hearing evaluation
- screening test for autism
- blood test (cornerstone of the diagnosis)
48
What should be the diet of people with Autism?
Low in lutein which causes inflammation of the cerebellum
49
What are the behavioral treatments and therapies for autism?
- Applied Behavioral Analysis (ABA)
- Son-Rise Program
50
What are the Communication therapies for autism?
- Sign Language
- Facilitated communication
51
What are the other therapies for autism?
- Music Therapy
- Service Dogs
52
What are the environmental therapeutic management for autism?
construction of a stable environment
53
What are the medications used or autism?
- Methylphenidate chloride
- Antidepressant such as fluroxamine
- Opiate blockers such as naltrexone
54
What is the appropriate family support for children with autism?
- parent should understand the condition of their child as they grow up
55
Write True or false for the following Nursing Management for autism
1. Parents are essential to the plan of care.
2. All children with ASD are the same thus treatment can be reused if possible.
3. Avoid Extraneous auditory and visual distractions.
4. Increasing Stimulation
5. Do not encourage patients to bring objects the child is attached as it may cause distraction and thus difficult treatment.
6. Take extra precaution in administering medications and during feeding.
7. Autistic children are indiscriminate hoarders who swallow any edible or inedible items.
8. Communication should be at the child's age to encourage normalcy,
1. true
2. false
3. true
4. false
5. false
6. true
7. true
8. false
56
He was the one who termed the condition as Down Syndrome / Trisomy 21
John Langdon Down
56
Down syndrome was previously referred to as?
mongoloids
56
It is the most common chromosomal abnormality affecting children today.
Down Syndrome
57
The incidence of Down Syndrome is 1 in ______ to 1 in _____ births of all races, genders and socioeconomic classes.
800, 1000
58
Down syndrome occurs from the presence of 3 copies of chromosome ______ rather than the normal 2.
21
59
Who are at risk of conceiving a child with down syndrome?
Older Women
60
35 years is 1 in _____ live births, 40 years is 1 in ____ live births.
350, 100
61
In down syndrome...
- approximately ______% die in utero
- _______ % survive to age 1
- _______ % live longer than age 50
- 51% over age ____ present dementia
- 75
- 85
- 50
- 35
62
What are the conditions that contribute to the mortality in down syndrome?
- Congenital heart disease
- Esophageal atresia
- Hirschsprung disease
- Duodenal artresia
- Leukemia
63
in down syndrome, median age of death is increase from ___ to ___ years old from 1983 to 1987. ____ live longer than ____.
25 - 49, male, female
64
94% of the down syndrome cases.
Trisomy 21
65
This type of down syndrome is approximately 3-4% of the cases which is not related to maternal age.
Robertsonian translocation involving chromosome 21
66
It involves 2-3% of the cases of down syndrome.
Trisomy 21 mosaicism
67
What are the clinical features of the head and neck of someone with down syndrome?
- Brachycephaly
- Up-slanting palpebral fissures
- Epicanthal Folds
- Bushfield spots
- Flat nasal bridge
- Folded or dysplastic ears
- open mouth
- protruding tongue
- Excessive skin at the nape of neck
68
What are the clinical features of the extremities of someone with down syndrome?
- Short broad hands
- short finger
- incurved fifth finger
- transverse palmar crease
- space between first and second toe
- hyper flexibility of joints
69
What are the neonatal features of down syndrome?
- flat facial profile
- Poor moro reflex
- Hyptonia
- excessive skin at the nape of the neck
- slanted palpebral fissures
- hyper flexibility of joints
- Dysplasia of pelvis
- Anomalous ears
- Dysplasia of mid phalanx of fifth finger
70
Fill in the blanks
- Body weight, length and head circumference are _____ in Down Syndrome
- ______ growth rate
- ______ is less than expected for length in infants with DS, and then ______ disproportionately so that they are ______ by age 3-4 years
- prevalence of _____ is greater in DS
- less
- Reduced
- Weight, increases
- obesity
71
True or False
1. Almost all DS babies have mental retardation.
2. Retardation in DS starts in the 3rd year of life.
3. Average age of sitting is 10 months.
4. Average age of walking is 20 months
5. First words at 16 months
1. True
2. False, first year
3. False, 11 months
4. False, 26 months
5. False, 18 months
72
When does a baby with down syndrome learn to creep?
17 months
73
True or False
1. Almost all individuals with DS have a wider range of cognitive impairment.
2. IQ declines through the first 7 years of age, reaching a plateau in adolescence that continues into adulthood.
3. 64 % of the time: Language comprehension = Language production.
1. true
2. false, age of 10
3. false, language comprehension = mental age but delayed language production
74
What percent of Down syndrome patients have heart disease?
50%
75
What is the common heart disease for Down Syndrome patients?
Atrioventricular septal disease
76
What are the GI abnormalities of DS patients?
- imperforate anus
- gastroesophageal reflux disease
- celiac disease
- Hirschsprung's disease
- Duodenal Atresia
77
What are the most common eye problems in DS patients?
- Refractory error
- strabismus
- glaucoma
- Cataract
78
What are the common hearing loss problem of DS patients?
- Unilateral or bilateral
- Conductive or sensorineural
- Otitis media
79
What is the risk of having leukemia in DS patients?
1 to 5 percent
80
_____ percent of newborn have polycythemia resulting in hypoglycemia.
65
81
This type of leukemia exclusively affects newborn which is asymptomatic with spontaneous resolution in 2-3 months.
Transient Leukemia
82
True or False
1. In DS patients, hyperthyroidism occurs more frequently than hypothyroidism.
2. The risk of type 1 diabetes is 2x greater than that of the general population.
1. False, Hypothyroidism is greater
2. False, 3x
83
Excessive mobility of atlas (C1) and the axis (C2) may lead to what type of injury?
Spinal cord compression injury
84
Because of this common disability, patients are advised to avoid contact sports.
Atlantoaxial Instability
85
What type of sleep apnea is common in DS patient?
Obstructive sleep apnea
86
What are the common skin disorders of sleep apnea?
- Fissured tongue
- palmoplantar hyperkeratosis
- xerosis
- cutis marmorata
- seborrheic dermatitis
87
What are the prenatal screening for the diagnosis of DS?
- Amniocentesis
- Chorionic villus sampling (CVS)
- Percutaneous umbilical cord blood sampling
- Ultrasound
88
What are the 10 areas of management in Down Syndrome?
1. Growth
2. Cardiac Disease
3. Hearing
4. Eye disorders
5. Thyroid Function
6. Celiac Disease
7. Hematology
8. Atlanto-axial instability
9. X ray
10. Alzheimer's Disease
89
True or False
1. Measurements should be plotted in the appropriate growth chart for children with DS.
2. Hearing screening should be done in the newborn period, every 12 months until 3 years.
3. Eye disorder should be performed before 8 months of age
4. Thyroid function test could only be done if the child is already a toddler
5. Celiac disease screening should begin at 1 year
1. True
2. False, 6 months
3. False, 6 months
4. False, newborn and repeat at 6 and 12 months
5. False, 2 years
90
What are the appropriate counseling for the significant other of the DS patient?
- May begin wen a prenatal diagnosis is made
- Discuss the wide range of variability in manifestation and prognosis
- Medical and educational treatments need to be discussed
- Initial referrals for early intervention, informative publications, parent groups and advocacy groups.
91
It is a condition rather than a specific disease. It refers to an inadequate growth resulting from inability to obtain or use calories required for growth.
Failure to thrive
92
How to diagnose FTT?
- Drop of more than 2 percentile from the baseline
- Persistently falls below the 3rd percentile for the fifth weight and height on a standard growth chart.
93
It refers to the weight below standard.
Acute FTT
94
It refers to weight, height and length below standard.
Chronic FTT
95
What is the most common cause of FTT that results from parental poverty and ignorance?
Under feeding
96
______ % of FTT inadequate food offered or take.
95
97
What are the 2 categories of FTT
Inorganic and organic causes
98
It refers to the disturbance of parent-child relationship resulting in maternal role insufficiency.
Inorganic causes
99
It is a category of FTT which refers to diseases that could cause FTT, examples include Cardiac diseases, celiac, Crohn's, hepatic disease
Organic Causes
100
What are the classification of FTT based on pathology?
- inadequate calorie intake
- inadequate absorption
- increase metabolism
- defective utilization of calories
101
Write i if the following conditions are included in the organic causes and n when not.
1. premature birth
2. maternal smoking, alcohol use, or illicit drug use
3. Mechanical problems present
4. Unexplained poor appetite
5. Poor absorption of food
6. Inadequate intake.
7. Poor maternal-child relationship
1. I
2. I
3. I
4. I
5. I
6. I
7. N
102
What are examples of inorganic feeding?
- caused by caregiver's action
- poor feeding skills on the part of the parent
- dysfunctional family interactions
- Difficult parent-child interaction
- Lack of social support
- Lack of parenting preparation
- Family dysfunction, such as abuse or divorce
- Child neglect
- Emotional deprivation
103
What is the most common cause of FTT?
malnutrition
104
What are the prenatal causes of FTT?
- Prematurity
- exposure in utero toxic agents
- intrauterine growth restriction from any causes
105
What are the postnatal causes of FTT?
- inadequate caloric intake
- inadequate absorption
- increase caloric requirement
- defective utilization of calories
106
Fill in the blanks.
- Height, weight and head circumference _______ match standard growth chart
- Weight lower than _______ percentile
- Growth may have _______ or _______ after previously established growth curve
- Physical skills such as rolling over, sitting, standing and walking ________
- Mental and social skills _______
- Secondary sexual characteristics _________ in adolescents.
- Constipation
- Excessive crying
- Excessive sleepiness
- Irritability
- Minimal Smiling
- ______ of eye contact
- Unresponsive
- Do not
- 3rd
- slowed or stop
- decreased
- decreased
- delayed development
- avoidance
107
In diagnosing FTT, ____ hr dietary recall or hx of food consumption _____ days
24, 3-5
108
What are the examination test for children with FTT?
- Physical examination
- Denver Developmental Screening Test
- CBC
- X-ray
- Electrolyte imbalance
- Growth Chart
- Occult Blood
109
Fill in the blanks for FTT Management
1. Catch up growth is ______ to _______ times greater rate for age.
2. Correction of any underlying ______.
3. Childs _______ stimulation
4. Improvement of _______ skills.
5. _________ and ________ follow up
6. Treatment may also involve improving _____________ relationship and ________ conditions.
7. ___________ (Physician, Dietician and Nurse)
8. Feeding interval should not be greater than _____ hours and maximum time allowed for sucking should be _______ minutes.
9. Eliminate _______ events
10. Avoid excessive ________.
11. For older and younger children meals should last for _____ minutes, ______ foods should be offered before ______.
12. ___________ distraction should be minimize.
1. 2, 3
2. disease
3. developmental
4. caregiver
5. regular, effective
6. familial, living
7. Health professionals
8. 4, 20
9, distracting
10. fruit juices
11. 30, solid, liquid
12. Environmental
110
What are the Nursing Management of FTT?
1. Optimum nutrition
2. A consistent, warm and caring environment
3. Maintenance of daily dietary record
4. Prenatal support and education
5. Discharge planning
111
True or False
1, Normal growth and development may be affected if a child fails to thrive for a long time.
2. Normal growth and development may not continue if the child has failed to thrive for a short time, and the cause is determined and treated.
1. True
2. False
112
What are the Possible complication of FTT?
- Mental
- Emotional
- Physical
113
_________ seizures that occur between the age of ______ months and ________ months with temperature of ________ C or higher, that are not results of _______or ________.
1. Febrile
2.. 6
3. 60
4. 38
5. CNS infection
6, Metabolic Imbalance
114
What is the other term for febrile seizure?
Febrile Convulsion
115
Having nor risk factors for febrile seizure carries a recurrence of risk of about _____ %
- 1 risk factors, _______ - __________ %
- 2 risk factors. _______ - _________ %
- 3 or more, ________ - _________ %
1. 12
2. 25, 50
3. 50, 59
4. 73, 100
116
What are the types of febrile seizures?
- Simple Febrile Seizure
- Complex Febrile Seizure
- Febrile Status Epilepticus
117
This is the most common type of febrile seizures? ______ which lasts less than ______ minutes. Does not reoccur within _____ hours or period in which your child has an illness.
1, Simple
2. 15
3. 24
118
Simple febrile seizure is also termed as the?
Tonic-Clonic
119
What refers tot he stiffening of the muscles with generalized contraction of the entire body?
Tonic
120
It refers to the incidence where rigidity is replaced by intense jerking movements.
Clonic
121
This type of febrile seizure is less common? _______. _____ out of ______ cases.
1. Complex
2. 2
3. 10
122
How long does complex febrile seizure lasts? When does it reoccur?
lasts longer than 15 minutes, Within 24 hours
123
Symptoms of complex Febrile Seizure is only present in one part of the body.
Partial or focal seizure
124
