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NURS138 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What is the onset, peak, and duration of rapid acting insulin?

A

15
30-90
5

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2
Q

What is the onset, peak, and duration of short-acting (regular) insulin?

A

30
2-4
4-8

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3
Q

What is the onset, peak, and duration of intermediate acting insulin?

A

2-6
4-14
14-20

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4
Q

What is the onset, peak, and duration of long acting insulin?

A

6-14
10-16
20-24

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5
Q

6 P’s of Compartment Syndrome

A 
Parethesis (1st subtle sign)
Pain (increases w/ elevation)
Pressure
Pallor (late)
Paralysis (Late sign)
Pulselessness (Late)
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6
Q

What happens when CO decreases?

A

Low perfusion to kidneys so hormones signal to retain H20/Na = fluid retention = increase workload of heart = congestion errywhere

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7
Q

Asymptomatic
May develop HF
Systolic murmur (sometimes w/ diastolic)
Risk of atrial dysrhythmias, pulm vascular obstruction, emboli

A

Atrial Septal Defect

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8
Q

How does Digoxin (Digitalis) improve cardiac fxn?

A

Increases CO
Decreases heart size
Decreases venous pressure
Relieves edema

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9
Q

How do ACE inhibitors (-pril) improve cardiac fxn?

A 
Blocks AngioI to AngioII
Causes vasodilation vs constriction
Decreases vasc resistance
Decreases BP
Reduces secretion of aldosterone = reduce preload, decreases risk of hypoK and fluid retention
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10
Q

How do beta blockers improve cardiac fxn?

A

Alpha/Beta receptors blocked = decreased HR, BP

Vasodilation

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11
Q

What do you need to consider with thiazides?

A

K+ replacement

Fall in K+ can = enhance of digitalis effects

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12
Q

S&S of digitalis toxcity

A

N/V
Anorexia
Bradycardia
Dysrhythmias

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13
Q

Muscle hypertrophy
HF
Loud holosystolic murmur @ left sternal border
Risk for BE/pulm vasc obstructive disease

A

Ventricular Septal Defect

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14
Q

Moderate to severe HF
Loud systolic murmur
Mild cyanosis increasing w/ crying
Risk for pulm vasc obstructive disease

A

AV septal defect

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15
Q 
Pulm congestion
RV pressure/hypertrophy
Increased workload on L side of heart
Machinery-like murmur below left clavicle
Widened pulse pressure
BE/PVOD
A

PDA

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16
Q

Normal BP/ Pulse Pressure in newborns

A

60/40

20 PP

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17
Q 
High BP/Bounding pulses in arms
Weak/absent femoral pulses
Cool lower extremities w/ lower BP
Fast deterioration in infants
Children: dizziness, headache, fainting, epitaxsis
Risks: rupture aorta, AAA, stroke
A

Coarctation of Aorta

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18
Q

Newborns: decreased CO w/ faint pulses, hypotension, tachycardia, poor feeding
Exercise intolerance, chest pain, dizziness
May sys murmur
Risk: BE, Vent dysfxn, Coronary insufficiency

A

Aortic Stenosis

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19
Q

Asymptomatic or mild cyanosis/HF
Newborns: cyanotic w/ severe narrowing
Loud sys ejection murmur @ upper L sternal border
Cardiomegaly

A

Pulmonic stenosis

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20
Q

What are the four components of Tet of Fallot?

A

VSD
Pulmonic Stenosis
Overriding Aorta
Right Ventricular Hypertrophy

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21
Q

Infants: Cyanotic at birth
Systolic murmur
Hypoxic episodes “blue spells” usually during crying/feeding
Risks: emboli, szs, LOC, sudden death

A

Tetralogy of Fallot

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22
Q 
Pulmonary artery leaves LV
Aorta leaves RV
Cyanotic
HF
Varying HS
Cardiomegaly
A

Transposition of Great Arteries (TGA)

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23
Q

Feeding goal for a child w/ CHD?

A

150kcal/kg/day

Newborns 120kcal/kg/day

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24
Q

Treatment for Kawaski’s disease

A

IVIG

Aspirin (monitor PLTs/Reyes Syndrome)

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25
Q

Treatment for Coarctation of Aorta

A

Give prostaglandin to keep PDA open

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26
Q

Normal O2 sat of Tet of Fallot pts

A

around 70’s (normal is >85)
Don’t give high O2 if they’re accustomed to this level
Similar to COPD

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27
Q

What do you do if baby’s crying or sats drop w/ a Tet of Fallot pt?

A

Tend to them and put in squatting position

McRobert’s maneuver: Knees to Chest

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28
Q

HR parameters for administering Digoxin

A

DON’T GIVE:
<100 in babies
<70 in kids

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29
Q

Early and late signs of shock in children

A

Early: Cry, lethargy, tachypnea, poor feeding, low activity
Late: BP
Profound blood loss 3mL/kg/3hrs

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30
Q

Treatment for infant in shock

A

IV bolus 20ml/kg x3/hr
Abx
Assess UO

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31
Q

How does LOC deteriorate in children?

A 
Irritable but consolable
Irritably inconsolable
Lethargic
Needs stimulation to wake up
No response to touch
No response to pain
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32
Q

Pinpoint eyes indicates

A

poisoning or brainstem dysfxn

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33
Q

Dilated but fixed indicates

A

paralysis of cranial nerve 3 d/t pressure from herniation of brain through tentorium

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34
Q

Dilated non-reactive

A 
hypothermia
anoxia
ischemia
poisoning w/ atropine-like substances
Dilated in general could = postictal effect
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35
Q

Bilateral fixed >5 sec

A

Brainstem damage

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36
Q

What is a late sign of ICP?

A

HTN (Widening PP)
Bradycardia
Bradypnea
(Cushing’s Triad)

37
Q

Increased ICP treatment

A 
elevations of > 20-25mmHg
Osmotic Diuretics: Mannitol
Hypertonic Sol: NS 3-23%
NO adrenocorticosteroids if head trauma induced edema
Vibrations to release secretions
38
Q

Medications preferred in unconscious children

A

Fentanyl
Midazolam
Vecuronium (Norcuron)

39
Q

First sign of meningococcal meningitis

A

Petechia

Children: Sz

40
Q

Medications for Bacterial Meningitis

A

Abx: Cephalosporins
Corticosteroids: Dexamethasone questionable

41
Q

Other interventions for Bacterial Meningitis

A 
Monitor:
Neuro
Na/fluid levels/I&amp;Os
Droplet/Contact precautions
Follow up hearing tests
42
Q 
Fatty changes in liver
Brain swelling = ^ ICP (Priority!)
Neuro impairment
Affects coag/liver panel
Must be cautious w/ salicylates
A

Reye’s Syndrome

43
Q

Treatment for szs

A

IV diazepam or lorazepam (Ativan)
Fosphenytoin + Phenobarbital, Valproate if ineffective
Ketogenic diet - supplements necessary
Vagus Nerve Stimulation

44
Q

Edu for families w/ sz child

A

Buccal Midazolam/Rectal Diazepam

If taking phenobarbital/phenytoin, adequate Vit D/Folic Acid and DON’T take w/ milk

45
Q

Medical Management of Neurogenic Bladder in pts w/ spina bifida

A 
Oxybutynin Chloride (Ditropan)
Tolterodine (Detrol)
46
Q

Management of Bowel Problems w/ pts w/ Spina Bifida

A

Fiber - 10g/day

Antegrade Continence Enema (ACE)

47
Q 
Persistent primitive reflexes
Ankle Clonus
Exaggerated stretch reflexes
Eventual development of contractures
Impairment of fine/gross motor skills
A

Spastic Cerebral Palsy

48
Q

All extremities effected, lower more than upper

A

Diplegia

49
Q

Slow, wormlike, writhing movements

Chorea

A

Athetoid Diskinetic Cerebral Palsy

50
Q

Slow, twisting movements of trunk or extremities

Abnormal Posture

A

Dystonic Diskinetic Cerebral Palsy

51
Q

Wide based gait
Rapid repetitive movements performed poorly
Disintegration of upper extremity movements when reaching for objects

A

Ataxic Cerebral Palsy

52
Q

Management of Cerebral Palsy

A 
Baclofen: decreases spasms
Pump care, withdraw slowly
NO infant mobile walkers or jumping seats
Sometimes Botox injections
AFOs/KAFOs
53
Q

Promotes calcium re-absorption/excretion of phosphorus

A

Parathyroid Hormone (PTH)

54
Q

Treatment for thyroid storm

A

Decrease activity
Avoid infection
Treat w/ Beta-adrenergic blocking agents (propranolol)
Anti-thyroid drugs: Methimazole, Propylthiouracil

55
Q

Signs of hypoparathyroidism

A

Chvostek Sign
Trousseu sign
Tetany

56
Q

How should you test for GH malfunctions

A

Give pharmacological stimulus to get GH to kick in, then obtain blood sample

57
Q

Ways to diagnose Congenital Adrenal Hyperplasia

A 
Physical Assessment
Newborn screen- measure cortisol precursor 17-hydroxyprogesterone
Increased 17-ketosteroid levels
Loss of serum Na/Cl
Elevation of K+
US
58
Q

Diagnosis of Diabetes?

A

8 hr fasting BG: >126
Random BG: >200
Oral Glucose Tolerance Test: “ in 2 hrs

59
Q

Hypoglycemia
Crowded teeth
<5% on growth chart

A

Clinical Manifestations of GH deficiency

60
Q 
Cretinism w/ delayed mental response
High TSH
Prolonged Jaundice
Swollen Eyelids
Large Fontanels
Umbilical Hernia
A

Some manifestations of Congenital Hypothyroidism

61
Q

Special med considerations with congenital hypothyroidism

A

Crush pills and dissolve in solution for infants
No grapefruit juice
Give on EMPTY stomach 2 hrs before or after meals

62
Q

Clinical management of Congenital Adrenal Hyperplasia

A

Replace cortisol:
Dexamethasone (or hydrocortisone)
Glucocorticoids

PRIORITY: AVOID DEHYDRATION ALDOSTERONE REPLACEMENT for salt wasting CAH
-Fludrocortisone (Florinef)

63
Q

Ketoacidosis treatment

A 
Fluid replacement (SLOWLY to avoid brain damange)
Insulin
64
Q

Ligament torn/stretched from twisting or wrenched
Damage to vessels, muscle, tendons, nerves
Usually ankles/knees
Swelling
Loose joints
“Snap, pop, tearing” sound

A

sPrain

Treated w/ arthroscopy/immobilization

65
Q

MusculoTENDINOUS tear

Gradual

A

sTrain

66
Q

Dx of Hip Dysplasia

A

Ortolani (abd)
Barlow (add)
Galeazzi sign (shortening of limb on affected side)
US

67
Q

Treatment of Hip Dysplasia

A

0-6 months: Pavlik Harness, Bryant’s traction, Brace
6-24 months: Open/Closed Red, Spica cast/Abd orthosis
Older: Operative reduction, Osteotomy

68
Q 
Most common congenital foot deformity
Adduction of toes/forefoot
Usually inversion
Heel/ankle in neutral
Pigeon-toed gait
A

Metatarsus Adductus (Varus)

69
Q

Treatment of OI

A

Biphosphate therapy: IV pamidronate
Lift child by butt when diapering (fragile)
Braces/splints
PT

70
Q

Aseptic necrosis of the femoral head

A

Legg-Calvé-Perthes (Coxa Plana/ Osteochondritis deformans juvenilis)

71
Q

How to address skeletal affects of immobilization?

A

Admin Ca-mobilizing drugs (diphosphonates)

72
Q

Progressive weakness/wasting of skeletal muscles caused by degeneration of anterior horn cells
Restrictive lung disease most serious complication

A

Type 1 Spinal Muscular Atrophy (Werdig-Hoffmans Disease)

73
Q

Lordosis
Progression of muscle weakness; possible death
Waddling gait
Gower’s sign
Pseudohypertrophy, woody on palpation from fat

A

Duchenne muscular dystrophy

74
Q

Treatment of Muscular Dystrophy

A

Corticosteroid: Prednisolone (Deltasone), Deflazacort
Priority: Maintaining optimal function in all muscles for as long as possible
Secondary: Prevent contractures

75
Q

Most common fracture in children <10

A

Clavicles

76
Q

Most common fracture in school aged children

A

Distal forearm (playground falls, bicycle/automobile/skateboard)

77
Q

Type of fracture w/ break in skin

A

Open/ Compound

78
Q

Type of fracture that causes damage to other organs/tissue

A

Complicated

79
Q

Occurs when bone is bent not broken

A

Plastic Deformations

80
Q

Caused by compression of porous bone
Appears as raised or bulging projection
More common in young children

A

Buckle, torus Fracture

81
Q

Central gray matter destruction and preservation of peripheral tracts; tetraplegia with sacral sparing common; some motor recovery gained

A

Central Cord Syndrome

82
Q

Complete motor and sensory loss with trunk and lower extremity proprioception and sensation of pressure

A

Anterior Cord Syndrome

83
Q

Loss of sensation, pain, and proprioception with normal cord function, including motor function; able to move extremities but have difficulty controlling such movements

A

Posterior Cord Syndrome

84
Q

Transient loss of neural function below the level of the acute spinal cord lesion, resulting in flaccid paralysis and loss of tendon, autonomic, and cutaneous reflex activity; may last hours to weeks

A

Spinal Cord Concussion

85
Q

Injury of what nerve paralyzes the diaphragm, leaving the child dependent on mechanical vent

A

Phrenic Nerve

86
Q

MARKED HTN

flushing face, sweating forehead, pupillary constriction, headache, and bradycardia

A

Autonomic Dysreflexia

Relieve bladder

87
Q

Management of Spinal Cord Injuries

A
  1. ABCs: Jaw thrust method, Inotropic meds - optimize BP
  2. Immobilize
  3. CT/MRI
  4. IV methylprednisolone w/n 1st 8 hrs - 23/48 hrs
88
Q

What do you treat neuropathic pain w/?

A

Gabapentin

NURS138 (2 decks)

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