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6TH SEMESTER > PEDI EXAM 2 > Flashcards

PEDI EXAM 2 Flashcards

1
Q

• are prone to dehydration easier then adults, but can bounce back quicker

A

KIDS

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2
Q

the younger the child, the greater the ___ and the lower the ____.

A

ECF & ICF

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3
Q

is lost from the body more easily

A

ECF

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4
Q

is their fluid reserve

A

ICF

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5
Q

o Infant’s ____ is a big proportion in relation to their entire body

A

head

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6
Q

In relation to height & weight, children under about 2 years old have a greater

A

body surface area

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7
Q

kids immature kidneys=

A

unable to conserve or excrete water efficiently

can dehydrate rather quickly

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8
Q

metabolic rate is higher in?

A

young children

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9
Q

Which of the following would you do to assess a 5 month old for dehydration?

A

assess the fontanel

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10
Q

3 types of dehydration

A

isotonic
hypotonic
hypertonic

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11
Q

♣ Serum sodium level usually normal

A

isotonic

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12
Q

isotonic dehydration causes?

A

vomiting & diarrhea

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13
Q

♣ Losing more sodium than water serum sodium low

A

hypotonic dehydration

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14
Q

causes of hypotonic dehydration

A

severe & prolonged vomiting and diarrhea, burns, renal dx

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15
Q

♣ Losing more water than sodium serum sodium high

A

hypertonic dehydration

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16
Q

causes of hypertonic dehydration

A

♣ diabetes Insipidus,

highly concentrated tube feedings or iv fluids, tube feedings without adequate water intake, or improper formula mixture

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17
Q

is LOC changed in mild dehydration?

A

NO

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18
Q

severe dehydration LOC?

A

confusion, irritable, fatigue

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19
Q

fontanels and dehydration

A

♣ start out normal with mild dehydration, sunken appearance as dehydration progresses

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20
Q

• Measuring output for children in diapers:

A

o Weigh dry diaper THEN weigh each subsequent wet diaper without wipes

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21
Q

1 gram =

A

o 1 mL fluid

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22
Q

• Normal output for children

A

0.5ml/kg/hr

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23
Q

normal output for infants

A

2ml/kg/hr

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24
Q

Assess skin turgor where

A

o (abdomen, chest, upper thigh)

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25
Q

VITAL SIGNS OF DEHYDRATION

A

BP decreases

HR decreases

RR increases

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26
Q

If they lost a kg, they lost how much fluid

A

1L

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27
Q

Oral Rehydration solutions

A

pedialyte

juice or colas

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28
Q

do not use what type of fluid?

A

diet colas

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29
Q

volume of fluids?

A

1-3 tsp of fluid every 10-15 min

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30
Q

fluids while vomiting?

A

gradually increase amy as child stops vomiting

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31
Q

diarrhea and fluids?

A

continue with age-appropriate diet

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32
Q

when to seek medical attention with oral rehydration?

A

if child is not getting better or condition worsens after 4 hours of oral rehydration therapy

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33
Q

start with what type of IV fluids?

A

isotonic to replenish sodium (LR)

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34
Q

then switch to what IV fluids?

A

o ¼ Normal Saline’s or 1/2NS

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35
Q

arm IV sites for kids?

A

start lower and work up to AC

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36
Q

what gauges used for angiocaths?

A

23,24,25,27

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37
Q

how often to monitor IV site for kids?

A

every hour

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38
Q

use what size solution for kids?

A

250 or 500 instead of 1000

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39
Q

used instead of what you would use for adult for IV fluids

A

microdrip tubing (60gtt/ml)

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40
Q

do you rotate IV site every 72 hours for kids?

A

NO

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41
Q

Child is retaining sodium & water

A

fluid volume excess

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42
Q

causes of fluid volume excess

A

o Conditions of excessive aldosterone secretion: Adrenal tumors

o CHF, Cirrhosis of liver, Chronic renal failure, renal failure,

o Long-term steroid usage

Overload of IV solutions

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43
Q

o Weight gain of ______ a day is usually due to fluid excess

A

0.5 kg or 1lb

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44
Q

♣ 0.5kg of weight gain over the night =

A

500ml saline retention

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45
Q

lung sounds with excess fluid

A

crackles

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46
Q

jugular vein distention may not be evident in infants so check where for fluid vol. excess?

A

abdomen

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47
Q

give cold or warm fluids for fluid vol. excess?

A

cold in insulated up.

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48
Q

normal sodium level

A

134-143

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49
Q

o Most common sodium imbalance in kids

A

• HYPONATREMIA

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50
Q

• HYPONATREMIA level

A

below 134/135

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51
Q

causes of HYPONATREMIA

A

too dilute formula

excessive swallowing of pool water

use of diuretics

V&D

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52
Q

manifestations of hyponatrema

A
  • Decreased LOC, become lethargic, confused
  • N/V
  • Headache
  • Muscle weakness
  • Agitation
  • May have seizures
  • Eventually cardiac arrest
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53
Q

cells in hyponatremia

A

SWELL

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54
Q

• HYPERNATREMIA levels

A

above 135

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55
Q

o Losing more Na than water or gaining more Na than water

A

• HYPERNATREMIA

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56
Q

ex of HYPERNATREMIA

A

eating Chinese food

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57
Q

causes of HYPERNATREMIA

A

♣ Limited or no access to water

♣ Inability to communicate thirst

♣ Not diluting infant formula enough

♣ Inadequate amount of breast milk

♣ Diarrhea / vomiting

♣ Excessive sweating without fluid replacement

♣ Tube feeding with no water intake

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58
Q

manifestations of hypernatremia

A

thirsty

decreased urine output

Confusion,

lethargy,

possible seizures

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59
Q

cells in hypernatremia

A

SHRINK

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60
Q

normal potassium levels

A

3,7-5.0

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61
Q

hypokalemia level

A

below 3.7

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62
Q

causes of hypokalemia

A

V & D
excessive stopping with bulimia
NG suction
eating lg. amt of black licorice

certain meds:
(potassium depleting diuretics, laxatives)

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63
Q

o MANIFESTATIONS of hypokalemia

A

♣ Involve muscle responsiveness

♣ constipation,

♣ abdominal distention, can lead to paralytic ileus

♣ Skeletal muscle weakness: flaccid to paralysis

Respiratory & Cardiac muscles may be impaired:

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64
Q

hyperkalemia levels

A

5.5

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65
Q

causes of hyperkalemia

A 
renal insufficiency
IV push
blood infusions
crush injuries
sickle-cell anemia
DM
Diarrhea
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66
Q

normal calcium level

A

4.36-5.36

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67
Q

we need vit. ___ for calcium absorption

A

D

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68
Q

hypocalcemia levels

A

below 4.3

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69
Q

causes of hypocalcemia

A

♣ General malnutrition
♣ Low Vit. D intake
♣ Calcium dieting
♣ Chronic diarrhea

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70
Q

manifestations of hypocalcemia

A

Increased muscular excitability

cramping, spasms, tetany, twitching, tingling in the fingers & around mouth

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71
Q

hypercalcemia levels

A

above 5.3

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72
Q

causes of hypercalcemia

A

♣ Increased intake of calcium or increased absorption
♣ Mega-doses of Vit D & A
♣ Ingesting large amounts of Ca+ foods along with antacids
♣ Too much calcium in the TPN
♣ Prolonged immobilization
♣ Medications—thiazide diuretics & lithium
♣ Some malignancies such as leukemia

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73
Q

pH levels

A

7.27-7.49

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74
Q

PCO2 levels

A

32-48

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75
Q

HCO3 levels

A

18-25

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76
Q

PO2 levels

A

80-108

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77
Q

how do we remove acid

A

breathing
peeing
puking

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78
Q

if we’re vomiting we’re loosing

A

acid

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79
Q

urinating is loosing

A

acid

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80
Q

diarrhea is loosing

A

alkaline or base

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81
Q
  1. What is the fluid maintenance needs for a child weighing 33lbs?
A

1250

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82
Q
  1. The nurse notes the following changes in the past 24 hours in a child with heart failure. Which finding is the most significant in assessing the child for fluid volume overload?
A

weight gain of .4kg

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83
Q
  1. Following a motor vehicle accident and successful cardiopulmonary resuscitation, arterial blood gases are drawn from a 13-year-old patient. The nurse utilizes the results of the test to identify the patients:
A

a. Acid-base balance

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84
Q

proteins that work against antigens

A

antibodies

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85
Q

the foreign substances that trigger the immune response

A

antigens

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86
Q

is composed of the defenses present at birth, such as intact skin,
body pH, natural antibodies from the mother, and inflammatory and phagocytic properties

A

natural immunity

87
Q

consists of humoral (antibody mediated) and cell mediated

immunity and is not fully developed until a child is about 6 years of age

A

acquired immunity

88
Q

: 5 different types of proteins that antibodies are a type of (IgM, IgG,
IgA, IgD, IgE)

A

immunoglobulins

89
Q

3 day process when a child is first exposed to an antigen,

the B-lymphocyte system begins to produce antibodies that react specifically to that antigen

A

primary immune response

90
Q

subsequent encounters with the antigen trigger memory

cells within 24 hours

A

secondary immune response

91
Q

proteins that carry messages for immune system function

A

cytokines

92
Q

a series of immunologic reactions in response to transplanted
cells

A

graft-versus-host disease

93
Q

a state of decreased responsiveness of the immune system, can
occur to varying degrees in response to any number of events

A

imunodeficiency

94
Q

: those caused by normally nonpathogenic organisms in persons
who lack normal immunity

A

opportunistic infections

95
Q

: from their mothers transplacentally or during delivery

A

vertical transmission

96
Q

pathologic conditions in which the body directs the immune

response against self – identifying “self” as “non-self”

A

autoimmune disorders

97
Q

is an abnormal or altered reaction to an antigen

A

allergy

98
Q

antigens responsible for clinical manifestations of allergy

A

allergens

99
Q

: an overreaction of the immune system, is responsible for

allergic reactions

A

hypersensitivity response

100
Q
  1. The nurse is caring for child who is experiencing respiratory difficulty following the administration of a medication. What drug should the nurse initially plan to administer to this child if indicated?
A

give epi

101
Q
  1. When providing dietary guidance to a child with spina-bifida with a known allergy to latex, the nurse should make the suggestion that which foods be avoided?
A

kiwi fruit

bananas

avocados

102
Q

ϖ A 3-year-old child is admitted to the hospital to rule out an infection. Which diagnostic test is likely to differentiate an infection from an allergic response?

A

o C. White blood cell count with differential

103
Q

neutrophil

A

infection

104
Q

esosinophil

A

allergic

105
Q

immune system isn’t developed until

A

6 years old

106
Q

IgG

A

crosses the placenta

107
Q

• Protect us from pathogens, infections, viruses, bacteria, etc.

A

immune system

108
Q

o Good guys; proteins that attack antigens

A

antibodies

109
Q

bad guys

A

antigens

110
Q

types of WBCs

A

neutrophils
eosinophils
basophils

111
Q

increase with infection/inflammation

A

neutrophils

112
Q

increase with allergies

A

eosinophil’s

113
Q

increase with inflammation

A

basophils

114
Q

first immunoglobulin produced to primary immune response

A

IgM

115
Q

(crosses the placenta; reacts to viruses and bacteria)

A

IgA

116
Q

o (In rhogam, has to do with RH neg/pos for baby)

A

IgD

117
Q

o (Plays a role with allergic responses; test this immunoglobulin when testing for allergies)

A

IgE

118
Q

type of immunity you are (born with)

A

natural immunity

119
Q

subsequent exposures to antigens

A

secondary immune response

120
Q

T cells

A

fight viruses

121
Q

B cells

A

produce antibodies

122
Q

ϖ A child is diagnosed with severe combined immunodeficiency. The nurse considers dietary instruction to parents effective if which one of the following foods are included in the child’s diet?

A

o B. Chicken Fingers and milkshake

123
Q

o Secondary immunodeficiency

o Targets and destroys T cells

A

HIV

124
Q

children common cause of HIV

A

mom breastfeeding or birth

125
Q

teens common cause of HIV

A

sex & drugs

126
Q

symptoms of HIV in neonates

A

asymptomatic

127
Q

specific symptoms

A

thrush

weight loss

FTT

NG pneumonia

128
Q

med therapy for HIV

A

prophylaxis

HAART

129
Q

is there a cure for HIV?

A

NOOOOO

130
Q

HIV pneumonia in children. check deep breathing by?

A

blow balloons

131
Q

o Chronic inflammatory autoimmune disease

o Multi organ involvement

A

SLE

132
Q

gradual SLE

A

abd. pain

headache

133
Q

acute SLE

A

arthritis like symptoms

134
Q

sx of sle

A

Butterfly rash
fever
joint pain and swelling
periods of exacerbation

135
Q

periods of exacerbation:

A

triggered by stress (school, pressure)

URT infection

sun exposure

136
Q

what drugs to avoid with lupus?

A

sulfa drugs

137
Q

what does prednisone cause with SLE?

A

weight gain

more susceptible to infection

138
Q

ϖ A child is diagnosed with lupus. Which nursing diagnosis is highest in priority?

A

pain (chronic)

139
Q

o Doesn’t show up in blood work until 7 y/o
o Diagnosed before 16 y/o commonly at 1-3 years
o More common in girls then boys

A

juvenile idiopathic arthritis

140
Q

juvenile idiopathic arthritis symptoms

A 
♣	Pain
♣	Swelling in joints
♣	Not wanting to get up and move a lot 
♣	Effect single or multiple joints
♣	Systemic = joints and affects organs 
♣	Don’t know cause just that its autoimmune
141
Q

treatment goal for juvenile idiopathic arthritis

A

manage pain/inflammation

142
Q

best exercise for juvenile idiopathic arthritis

A

swimming

143
Q

at risk children for latex allergy

A

child with multiple surgeries

144
Q

latex allergies are commonly seen with

A

spine abifida

145
Q

latex allergy reactions

A

itching
SOB
anaphylaxis

146
Q

at birth skin is?

A

thin

little SubQ fat

looses heat rapidly

increased chemical absorption through skin

high water content making more susceptible to bacteria

147
Q

adolescent skin is?

A

skin thickens

more resistent to bacteria

eccrine (no odor) sweat glands achieve full function

apocrine (odor) sweat glands mature

melanin at adult level serves as shield against UV rays and give color

148
Q

♣ Dried residue of serum, pus, or blood

impetigo

A

crust

149
Q

♣ Thin flake of exfoliated epidermis

♣ Dandruff, psoriasis

A

scale

150
Q

♣ Thickening of skin with increased visibility of normal skin furrows
♣ Eczema

A

o Lichenification

151
Q

♣ Replacement of destroyed tissue, fibrous tissue usually from surgical incision

A

scar

152
Q

♣ Over development of hypertrophy of scar that extends beyond wound edge and above skin line due to excess collagen following trauma

A

keloid

153
Q

♣ Abrasion or scratch mark

♣ Scratched insect bite

A

excoriation

154
Q

♣ Loss of superficial epidermis, moist but does not bleed

A

fissure

155
Q

♣ Deeper loss of skin surface

♣ Bleeding or scarring can occur

A

ulcer

156
Q

♣ Plug of sebaceous and keratin material in hair follicle opening
♣ acne

A

comedone

157
Q

o
♣ Narrow raised channel caused by parasite
scabies

A

burrow

158
Q

stages of healing

A

inflammation
reconstruction
maturation

159
Q

broad term for skin changes due to varying causes

A

dermatitis

160
Q

AKA eczema

A

atopic dermatitis

161
Q
  • Chronic relapsing inflammatory skin disorder with intense itching
  • Asthma and food allergies
  • Cause: unknown
A

atopic dermatitis

162
Q

triggers for atopic dermatitis

A

♣ House mites, animal dander, pollen, mold, cockroaches, food allergies, irritants such as soap, detergent, lotion, chemical, hormonal changes and stress

163
Q

♣ Red patches that itch with exudate and crusts
♣ Seen on the:
• Face
• Neck
• AC area
• Behind their knees
• In adolescents you may see if on eyelids, ear lobes, fingertips and toes

A

acute atopic dermatitis

164
Q

♣ Skin is darkened and thickened

♣ Excoriation, dryness, and scaling

A

chronic atopic dermatitis

165
Q

when does atopic dermatitis worsen?

A

cold & dry weather

166
Q

• Skin inflammation caused by direct contact of skin with allergen/irritant

A

contact dermatitis

167
Q

irritants for contact dermatitis

A

o Soap, detergents, fabric softeners, bleaches, lotions, urine or stools

Sweat/friction enhance skin damage

168
Q

manifestations of contact dermatitis

A

o Rash develops within a few hours of contact

o Redness, erythema, pruritus, edema, vesicles or bulla that rupture, crust/ooze

169
Q

s/s are seen when for contact dermatitis?

A

12-24 hours after exposure & peak at 3-5 days

170
Q

o rash can last ____ weeks after the treatment and is only present on areas that have come in contact with the irritant

A

3-4

171
Q

tx for Contact dermatitis

A

o remove irritant & avoid it in the future
o calamine lotion
o cool compression
o oatmeal baths
o aluminum acetate
o burrows solution
o antihistamines to help relieve the itching
o topical corticosteroids if it is a small area; can’t put on any open lesions
o Oral corticosteroids for 7-10 days then taper dose for 7-10 days
o Educate parents how to apply medications/take medications and make sure they take them as directed

172
Q
  • Primary reaction to urine, feces, moisture or friction

* Secondary infection with candida albicans (yeast) common complication

A

diaper dermatitis

173
Q

diaper dermatitis can develop to?

A

yeast infection

174
Q

• Manifestations of diaper dermatitis:

A

o Raw, moist, red, weeping macules and papules of the skin
o Will be present on the areas in contact with the diaper

♣ Perineum
♣ Genitals
♣ Buttocks
♣ Skinfolds are spared

175
Q

o Manifestations of candida albicans:

A

♣ rash has a bright red beefy plaques with sharp margins
♣ white areas
♣ Needs and antifungal – nystatin

176
Q

tx of diaper dermatitis

A

o Apply a protective barrier with zinc oxide in it such as Boudreaux’s butt paste zinc oxide
o Leave rash exposed to help heal
o If also have yeast, apply Nystatin, Nystatin first then barrier cream

177
Q
  • Recurrent inflammatory skin condition caused by overgrowth of Malassezia furfur yeast
  • Hormones are a possible influence
A

seborrheic dermatitis

178
Q

s/s of seborrheic dermatitis

A

o Pruritus and a mildly erythematous, adherent waxy scaling of the scalp (or “dandruff”).
o Yellow-red patches with greasy scaling may be present, typically on the scalp and nasolabial folds on the face, behind the ears, on the upper chest, and sometimes on the intertriginous areas (skinfolds of the neck, axillae, antecubital fossa)
o Itching is less intense than in atopic dermatitis

179
Q

• treatment of cradle cap:

A

♣ daily shampooing with baby shampoo for cradle cap
♣ medicated shampoo (need doctor permission)
♣ emollient (can use baby oil) for 20 min to soften scales then softly remove scales by brushing with fingertips, baby brush, toothbrush, etc. and then rinse the hair

180
Q

tx of lesions on the body:

A

♣ head and shoulders dandruff shampoo or selsun blue
♣ continue several days after the rash is gone
♣ topical corticosteroids on face (not on eyes)
♣ teach parents to wash hair with each bath

181
Q

o Chronic inflammatory disorder of pilosebaceous hair follicles located on the face and the trunk
o Most common skin disorder of pediatric patients

A

acne

182
Q

acne is triggered by:

A 
♣	androgen production at puberty 
♣	oil based cosmetics 
♣	friction from hairbands
♣	helmets
♣	hats
♣	menstrual cycle  
♣	over production of sebum
183
Q

tx of acne

A 
retin-a
benzoyl peroxide
antibiotics
oral contraceptives
accutane
184
Q

1 concern with burns

A

airway

185
Q

types of burns

A

thermal
chemical
electrical radioactive

186
Q

Burn severity determined by

A

depth, percentage of body surface area (BSA)

187
Q

1st degree burns

A

redness

188
Q

2nd degree burns

A

blisters; subQ involved

189
Q

3rd degree burn?

A

underlying tissues involved

190
Q

is considered a major burn

A

involvement of the face, eyes, ears, hand, feet, perineum,

burns complicated by inhalation injury

191
Q

thermal burns need to be reassessed ____ after to assess extent of injury

A

24-48

192
Q

tx of minor burns

A

topical antibiotic–bacitracin

193
Q

fluid moves out of vascular system and into interstitial system (3rd spacing) with which type of burn

A

major burn

194
Q

3rd spacing can result in

A

hypovolemic shock

195
Q

pressure garments may be worn over the area which helps to ?

A

reduce scarring and contractures

196
Q

o Cause: group A beta- hemolytic strep and staph aureus
o Highly contagious
o Often seen around the mouth, hands, neck and extremities

A

impetigo

197
Q

impetigo results from a minor skin injury such as:

A

insect bite
dermatitis
a child rubbing or picking their nose

198
Q

impetigo spread by?

A

direct contact

199
Q

manifestations of impetigo

A

♣ Red macules become vesicles – easily rupture becoming moist erosions – dries making a honey colored crust. Golden crust

200
Q

tx of impetigo

A

isolate from other children
don’t share any linens
systemic antibiotics
topical antibiotics

201
Q

o superficial inflammation of pilosebaceous follicle from infection, trauma, irritation or inadequately chlorinated pool or hot tub
o Tenderness localized swelling, dome-shaped yellowish pustules and red papules with pain, pruritus, local swelling.
o Caused by staph and pseudomonas
o Common in children and teens because increased sweat production

A

folliculitis

202
Q

manifestations for folliculitis

A

♣ Seen in clusters on their face, scalp, trunk and extremities or in the area covered by the bathing suit
♣ Tiny dome-shaped, yellowish pustules and red papules at follicular openings with surrounding erythema
♣ Pain and itching

203
Q

tx of folliculitis

A

wash with topical antibacterial cleanser

shower immediately after exercise

wear loose cotton clothing

wash bathing suit before wearing it again

204
Q

o Acute inflammation of dermis and underlying connective tissue.
o Often seen on the face and extremities d/t trauma, compromised skin barrier (lesion/surgery) or abscess
o Rapid onset
o Result of trauma, break in skin (impetigo, otitis media, and surgery), insect bite, scratch, etc.
o Staph and strep

A

cellulitis

205
Q

manifestations of cellulitis

A

♣ Warm, red, swollen skin; tender,
♣ Edematous around the site
♣ Distinct border
♣ fever, chills, enlargement of and tenderness of lymph nodes, malaise, lymphengitis that can lead to septicemia

206
Q

treatment of cellulitis

A

♣ They may be in the hospital for IV antibiotics or analgesics especially if it is on the face or for severe cases
♣ Mild cases will be treated with oral antibiotics for 10 days

207
Q

cellulitis get to where if it infects the eye

A

the brain

208
Q

♣ Pearl-like, flesh colored papule on trunk, axillae, AC area, and behind knees
♣ May have pruritus or become plugged and then they have this cheesy material that can come out of it
o Caused by pox virus
o Spread by direct contact (sexual) or with contaminated clothing

A

• Molluscum Contagiosum

209
Q

remove what to treat • Molluscum Contagiosum

A

lessions

210
Q

when does • Molluscum Contagiosum usually resolve?

A

spontaneously within about 6 months but new lesions may appear over 2-4 years

211
Q

how to reduce transmission of • Molluscum Contagiosum

A

♣ Avoid public pools, hot tubs, showers because virus is transmitted when skin is wet
♣ Wash daily with fragrant free soaps
May be sent to dermatologist

212
Q

♣ Common warts on any skin surface
♣ Plantar warts on feet that are papules and plaques on bottom of feet painful
♣ Skin-colored, rough, scaly, papules, and nodules on exposed skin surfaces
o Very contagious
o Immune compromised are more susceptible

A

• Papillomavirus (warts)

213
Q

• Papillomavirus (warts) is transmitted by?

A

o skin to skin contact, mucous membrane contact, or from surfaces

6TH SEMESTER (22 decks)

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