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Exam 2 Flashcards

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1
Q

Ipratropium (Atrovent)

A

bronchodilator used to control symptoms of asthma, chronic bronchitis, and emphysema

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2
Q

Albuterol (Proventil)

A

bronchodilator for asthma

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3
Q

Montelukast( Singulair)

A

leukotriene receptor antagonist. Prevents asthma attacks

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4
Q

Magnesium Sulfate

A

bronchodilator used to relieve shortness of breath, for flare-ups of asthma

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5
Q

Pancrelipase (Creon)

A

Used for children with cystic fibrosis

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6
Q

Tobramycin

A

antibiotics that are given aerosolized for cystic fibrosis

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7
Q

Dornase Alfa (Pulmozyme)

A

Cystic fibrosis medication; medication for the management of respiratory and gastrointestinal effects of CF

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8
Q

Corticosteroids

A

Long term management for asthma. First line for management of nephrotic syndrome.

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9
Q

Ibuprofen

A

Common painkiller used to treat cold symptoms or toothache

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10
Q

Dexamethasone (Decatron)

A

Corticosteroid used to treat acute laryngotracheobronchitis

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11
Q

Palivizumab (synagis)

A

Given IM for prevention of RSV for chronically ill infants and preemies

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12
Q

DTaP

A

Given to prevent pertussis at 2,4,6,15 to 18 months, 4-6 years and TdaP given at 13-18 year; every 10 years

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13
Q

Meningococcal Conjugate MCV4

A

Protects against meningitis. Given to preteens 11-13 years old.

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14
Q

ASO Titers

A

a blood test to measure antibodies against streptolycin

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15
Q

Serum Osmolality

A

The concentration of dissolved solutes (NA+ and others) in your serum

  • main contributor is Sodium (Na+)
  • Second most important is Glucose

High osmolality= more particles in your serum (sodium high)

Low osmolality= particles are more dilute (less Na+)

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16
Q

Urine Specific Gravity

A

Urine specific gravity is a laboratory test that shows the concentration of all chemical particles in the urine.

-The normal range for urine specific gravity is 1.005 to 1.030.

Low specific gravity suggests that urine is too diluted. The person may be drinking too much fluid or have a condition that makes them thirsty.

High specific gravity suggests urine is too concentrated indicating dehydration

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17
Q

Physiologic and Developmental causes for increased risk in infants

A
  • Higher % of total body foudi
  • Immature renal system
  • Higher % of ECF
  • Higher Metabolic Rate
  • Greater Body Surface Area
  • Unable to communicate Thirst
  • Immature Gastrointestinal system
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18
Q

Earliest Signs of Dehydration and most reliable signs of Dehydration

A

Earliest Sign: Tachycardia
Worst Signs: Hypotension
Best Way: Weight (weigh every single day at the same time using same scale)

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19
Q

Stable Patient Moderently dehydrated (bolus)- RAPID Neg

A

Bolus over 5-20 min

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20
Q

Unstable Patient- Severely Dehydration (RAPID POSITIVE)

A

Bolus over 5-10 min.
Do NOT give K+ unless patient is stable. If no peeing potassium just builds up. If Cardiac issues: 5-10 ml/kg over 10-20 min)

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21
Q

IV Maintenance Fluids

A

1st 10 kg of weight: # of kg x 100 mL
Next 10 kg of weight: # of kg x 50 mL
Leftover kg of Weight: # of kg x 20 mL

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22
Q

RAPID

A 
R: high HR
A: altered color
P: pee nonexistent
I: Inability to interact
D: decreased BP
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23
Q

Moderately Dehydrated

A 
Weight: Infants: 6-9%
              Children: 6-8%
Pulse: Mildly increased
RR: slight tachypnea
Blood Pressure: Normal to orthostatic less than 10 mm HG change
Anterior Fontanel: Normal to sunken
Skin: Cap Refill 2-4 seconds / low turgor
Urine: Oliguria
Behavior: Irritable and thirsty
Mucous Membranes: Dry
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24
Q

Severe Dehydration

Study These Flashcards
A 
Weight Infants: > or equal to 10%
Weight Children: 10%
Pulse: Very increased
RR: Hyperpnea (deep/rapid)
BP: Orthostatic to shock
Anterior Fontanel: Sunken
Skin: Refill > 4 seconds; Skin tenting, cool, mottled
Urine: Oliguria to Anuria
Behavior: Hyperirritable to lethargic
Mucous Membranes: Parched
25
Isotonic Dehydration: most common | Serum Sodium/ Osmolality and Symptoms
Sodium Loss= Water loss from ECF Serum Sodium: no change Serum Osmolality: no change Symptoms: dry skin/mucous membranes, decreased skin turgor, orthostatic hypotension, thirsty, dizzy, constipated, decreased urine volume, decreased tears
26
Hypotonic Dehydration: most common | Serum Sodium/ Osmolality and Symptoms
Serum Sodium: Low ( < 130) Serum Osmolality: Low Children's symptoms are more severe as they have more water than adults Symptoms: Dry skin/mucus membranes, Lower skin turgor, mental status abnormalities, shock confusion, lower bP, lower Cap refill
27
Hypertonic Dehydration: most common | Serum Sodium/ Osmolality and Symptoms
``` More water than sodium loss Serum Sodium is HIGH: > 150 Serum Osmolality is HIGH Water moves to ECF: cells shrink Symptoms: Altered mental status, low kin turgor, HR Up and BP low, lack of tears Excessive diarrhea, too many electrolytes, too much sodium. MOST DANGEROUS. Potential for cerebral water intoxication. ```
28
Calculate Normal Urine Output
Infant (up to 3)- 1.5 min-2mL/kg/hr | Children and Adolescents- 1 ML/kg/hr
29
Fluids used for oral rehydration:
Pedialyte; infalyte, rehydralyte, can add 1 tsp of unsweetened Kool-Aid to each 60-90 Ml; breast milk formula DO NOT USE: soft drinks, fruit juice, sport drinks broth, plain water
30
Mild Dehydration: Signs and Rehydration Therapy
5-6% -Increased thirst, normal to slightly dry mucous membranes ORS 50 ml/kg- within 4 hours
31
Moderate Dehydration: Signs and Symptoms and Rehydration Therapy
7-9% -loss of skin turgor, dry mucous membranes, sunken fontanel ORS 100 ml/kg within 4 hours
32
Severe Dehydration Signs and Symptoms and Rehydration Therapy
>9% - moderate dehydration signs + rapid thready pulse, cyanosis, tachypnea, lethargy or coma - IV fluids 20ml/kg over 5-10 minutes until pulse and mental status return to normal
33
Acute Glomerulonephritis
Immune Complex Disease exposed to something that triggered something. Occurs after we are exposed to streptococci infection. 10-21 days later our immune system does not shut off. Strep Test negative; but ASO titer HIGH
34
Nephrotic Syndrome
Allows Protein into the urine. Massive Proteinuria (2-3+ protein in the urine). -hypoalbuminemia: we lose protein (albumin) in urine -Edema Primary Disease: Ideopathic Nephrosis Secondary Disease: glomerular damage Congenital: Autosomal recessive disorder Drops our BP and reduces vascular fluid volume leading to hypovolemia
35
Symptoms of Nephrotic Syndrome (SOLEY)
``` HyPOtension LFT and CMP and Lip Panel Lab Pale Frothy Urin HyPERlipidemia HyPOalbuminemia (protein) Facial Edema Ascites Cause: Bac or Viral Infection HyPOvolemia Congenital High Protein in Urine 2+ Corticosteroids Increased risk of infection Weight Gain ```
36
Symptoms of AGN (SOLELY)
``` Urine: cloudy, smoky grown (due to RBC's_ HypERtension HypERvolemia autoimmune HyPOnatremia BUN and Creatinine RAISED History of Strep Periorbital edmal Headaches due to HTN CBC lab ``` Good progjosis
37
Nephrotic Interventions and Education
-Reduce excretion of protein, edema, prevent infection -Potential dietary restriction (don't do with kids), diuretics, 25% albumin infusions -Corticosteroids -relapses can be triggered by allergies or immunizations -Complications: infection, thromboembolism, hypovolemia -Daily weight/ abdominal girth, assess edema, address loss of appetite Creatinine: < 1 ok Greater than 1 TROUBLE
38
AGN interventions and education
- can be treated at home - requires hospitalization: oliguria, HTN, gross hematuria, sig edema - Daily Weights, Strict I &O, vitals - Treatment: dietary restrictions, monitor electrolytes, may need antibiotics
39
Pediatric Diff of Respiratory System
- smaller nasopharynx (can occlude) - Lymph tissue (tonsils and adenoids grow rapid in childhood - Smaller Nares (can occlude) - Small oral cavity and large tongue - long floppy epiglottis vulnerable to swelling - larynx and glottis are higher in neck can cause aspiration - Thyroid, cricoid, and tracheal cartilages are immature and can collapse if neck flexed - Fewer muscles are functional in airway and is less able to compensate for edema or trauma - Large amounts of soft tissue and loosely anchored mucous membranes line airway and increase risk of edema or obstruction - RR higher at baseline. We can only breath hard for so long and can cause Cardiac arrest - sleep more than adults reduces functional capacity (air left in lung) - increased potential for atelectasis (lung collapse) - Peep: positive end expiratory pressure: the risidual pressure that keep them open just a smidge after exhalation - fewer and smaller alveoli; walls of alveoli are thicker - premature cilia (cilia move mucus out of nose and trachea)
40
Newborn airway size
4mm
41
Retraction locations
Suprasternal: above sternum Intercostal: between ribs Substernal: below sternum Subcostal: below ribs
42
Cardinal Sign of Respiratory Distress
Restlessness, tachycardia, diaphoresis, Tachypnea
43
Respiratory Arrest
complete absence of respirations
44
Cynosis located where?
Circumoral, chest and umbilicus
45
Grunting:
When patient takes a deep breath in and upon expiratory grunting sounds; the child is trying to create peep in their alveoli
46
Signs and Symptoms of Asthma attack
Expiratory wheezing, breathlessness, chest tightness, cough (tend to present at night or after recess)
47
Peak Flow Meter
Measure how fast air can be expelled from lungs 3 zones: Green (under control) Yellow ( asthma is not well controlled) Red: severe narrowing of airway may be occurring
48
Treatment of Asthma
Control Allergins and remove such as carpet and humidifiers, air conditioners Quick relief: Beta Adrenergic Agonists: albuterol Anticholinergics: (higher side effects): Atrovent Number 1 trigger: second-hand smoke!
49
Cystic Fibrosis
Due to defective/mutated gene on the arm of chromosome seven. This gene carries the code for a protein known as CFTR Lungs: mucus becomes viscous, thick, clogs airways
50
Cystic Fibrosis Treatment
-Airway clearance therapies, continuous postural therapy, percussion and postural drainage, high frequency chest compressions, exercise, huffing - Medication: * maintenance meds (aerosolized medications such as bronchodilators) GIVE FIRST * Antibiotics (for respiratroy infections: Tobramycin (usually aerosolized) 02 CAUTIOUSLY; due to chronic CO2 retention, can cause bone marrow depression
51
Cystic Fibrosis related to diabetes
Effects on pancreas of abnormal mucus secretion and obstruction: pancreatic insufficiency due to blockage of pancreatic ducts due to mucus - lack of pancreatic enzymes and treated with (CREON): helps them to absorb the fat - CF related to diabetes (CFRD): presents challenges with diet, additional insult to respiratory, 50% of those over 30 have CFRD, BOTH INSULIN RESISTANT AND DEFICIENT
52
Nursing Education
Monitor patient tolerance to procedures, encourage medication compliance in child AND adult Diet: need good fat and high protein Patients Self-Image
53
Creon
Adjust based on how many stools child had. Creon helps absorb fat Supplement the diet with fat soluble vitamins (A, D, E,K) give with enzymes and a high fat meal to help the body absorb those vitamins
54
RSV
Caused by a virus at bronchiolar level ( a LOWER) respiratory inflammation of lungs. Infection causes cells to die and those cells fuse together to create a mass of dead cells
55
RSV Symptoms
Rhinorrhea, low grade fever (usually first), then coughing, wheezing, retractions, tachypnea; most commonly preset with apnea.
56
RSV Risk Factors:
Males, birth within 6 months of RSV season, multiple births, premature babies, non-breastfed infants, young mothers, mothers who smoke, babies in crowded living conditions
57
RSV Vaccine:
Palivizumab (Synagis) : given to chronically ill infants and premature babies IM once a month
58
Epiglottitis
Obstructive Inflammatory process; supraglottic obstruction. MEDICAL EMERGENCY

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