Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > exam 2 > Flashcards

exam 2 Flashcards

1
Q

why are infants at a higher risk for dehydration than adults? (7)

A

Higher % of H2O in ECF
immature renal function (decreased ability to concentrate urine and decreased GFR)
higher metabolic rates
unable to communicate thirst
thirst receptors are underdeveloped
Proportionally greater BSA (more loss of fluid through body surface)
Proportionally longer GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

s/s of dehydration in infants

A

-weight loss
-fewer wet diapers (shouldn’t have less than 6)
-no tears
-mouth = dry and sticky
-irritable, high pitched cry
-change in LOC
-increased RR or difficulty breathing
-sunken fontanelles, sunken eyes, sunken cheeks or abdomen
-abnormal skin color, temp, or dryness
-prolonged cap refill
-tachycardia
-hypotension
-decreased skin turgor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

intervention for mild/moderate dehydration

A

Manage at home with ORT (i.e. pedialyte)
Replace fluids q 4-6 hours
Maintain current fluid requirements
Start with 50 ml/kg of ORT, increase 100ml/kg for moderate cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

intervention for severe dehydration

A

Need IVF boluses
20 ml/kg over 5-20 mins
Isotonic IVF for replacement: NS or LR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What viral pathogen is the most common cause of dehydration in infants in the US?

A

rotavirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how should parents feed a child with GERD

A

-avoid foods that exacerbate acid reflux (citrus, tomatoes)
-thickened feedings & upright positioning
-elevate had of bed after feeding
-small, more frequent meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how to thicken feedings?

A

w/ 1 teaspoon - 1 tablespoon of rice cereal per ounce of formula to thicken → beneficial if infant is underweight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the surgery for hirschsprung disease?

A

remove Aganglionic portion of bowel
Relieves obstruction and restores normal bowel function
2 step procedure: ostomy to relieve distension, pull through procedure later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the nursing care for surgery for Hirschsprung (preop)?

A

Pull through procedure - preop empty bowels with repeated saline enemas and decrease bacterial flora with antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the post op care for hirschsprung surgery?

A

Same for any child or infant with abdominal surgery
Involve parents w/ feedings and observe for signs of wound infection
Help parent understand defect
Foster bonding
Prepare for medical surgical interventions
Assist with colostomy care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

most serious complication of hirschsprung disease

A

enterocolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should you position a child with pain due to appendicitis?

A

position of comfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What measures can be taken to care for a child post-surgery for cleft lip?

A

-protect operative site
-adequate analgesia
-feeding is resumed when tolerated
-upright seat position in immediate post op
-don’t use suction or other objects in mouth
-soft diet
-gavage feeding
-ESSR feeding technique
-Haberman bottle
-feeds under 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

3Cs to monitor in child with tracheo-esophageal fistula

A

Coughing, Choking, Cyanosis
-Excessive salivation and drooling
-Monitor for abdominal distention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

nursing care for trachea-esophageal fistula

A

maintain patent airway –> supine position, elevated 30 degrees
suctioning
NPO immediately
gastric tube placement
is a surgical emergency!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Omphalocele

A

organs are herniated out but still in a sac, viscera is herniated into umbilical cord sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the nursing care for a child with omphalocele ?

A

-infant NPO
-IV therapy
-monitor infant temp
-keep sac moist and protected
-low intermittent gastric suction via NGT
-silo used to support defect if used over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

pyloric stenosis

A

muscle of the pyloric sphincter becomes thickened resulting in narrowing of pyloric channel that connects the stomach and duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

s/s of pyloric stenosis (7)

A
  • Projectile nonbilious vomiting
    – Dehydration
    – FTT (failure to thrive) with hunger cues
    – Lethargy
    – Fluid/electrolyte disturbances
    – Upper abdomen distention with visible peristaltic waves
    – Palpable olive like mass in the upper quadrant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

intussusception

A

Portion of the bowel invaginates into a more distant portion of the bowel (telescoping)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

tx for intussusception

A

Radiologist guided pneumoenema
Ultrasound guided hydrostatic (saline) enema
If not successful surgical intervention may be needed

*Nonoperative reductions are successful in 80% of cases
*Recurrence of condition post treatment occurs in 1 out of 10 patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

risk of TPN

A

long term use - liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

nursing mgmt for TPN

A

Skin integrity (always goes in a central line so you use occlusive sterile dressing)
Infection control
Monitor infusion rate very carefully (has a lot of glucose so important to monitor BS)
Vital sign assessment (fever?)
Strict I&O - fluid balance is extremely important (monitor for tachycardia, hypotension etc)
Overfeeding syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

meds for IBD

A

Aminosalicylates
Corticosteroids
Immunomodulators
Antibiotics
Biologics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

normal age for beginning of sexual development in girls

A

b/w 10 and 14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

normal age for beginning of sexual development in boys

A

b/w 12 and 16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Precocious puberty

A

Any secondary sex change before 8 years in girls and 9 years in boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

tx for precocious puberty

A

synthetic luteinizing hormone (d/c at age when normal puberty would occur)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the nursing care for children who receive daily injections of biosynthetic growth Hormone?

A

rotating sites
child’s body image

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the relationship of exercise to glucose levels in children with diabetes?

A

exercise lowers blood sugar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

s/s of hypoglycemia (10)

A

Shaking
Sweating
Anxious
Dizziness
Hunger
Fast heartbeat
Impaired vision
weakness/fatigue
Headache
Irritable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

s/s of DKA

A

hyperglycemia
dehydration –> can lead to shock
acidosis d/t lipolysis
rapid deep respirations (kussmal)
can lead to coma d/t hyperosmolality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

At what age can children give their own injections?

A

Around 10-12 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

tx for ketones in urine of child with diabetes: negative urine ketones, blood ketones under 0.6

A

no extra insulin, give correction every 3 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

tx for ketones: small urine ketones, blood ketones 0.6-1.5

A

increase correction by 5% and recheck BG in 3 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

tx for ketones: moderate urine ketones, blood ketones 1.5-3

A

increase correction by 10% and consult with nurse or MD, check blood glucose in 3 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

tx for ketones: large urine ketones, blood ketones over 3

A

increase correction by 20% and consult with nurse or MD, check bg in 3 hours

38
Q

what is a concussion?

A

Results from trauma to the head
Most common head injury
Instantaneous loss of awareness and responsiveness lasting for minutes to hours
Transient And reversible
Does not show up on CT scan

39
Q

hallmark signs of a concussion

A

confusion and amnesia

40
Q

s/s of post concussive syndrome

A

Fatigue
Poor concentration
Dizziness
Headache
Mood swings - behavior

*Can develop within hours to days after a mild head injury but also can occur after moderate to severe head injury
* can last for several days to several months

41
Q

s/s of hydrocephalus in neonate

A

Head growth at abnormal rate
Bulging fontanelle
Scalp veins are dilated
Sutures become palpably separated to produced a cracked pot sound (Macewen sign) on percussion
Pupils are sluggish with unequal response to light - setting sun sign
Increased occipitofrontal circumference
irritability
high pitched cry

42
Q

What is the difference between the adult and the infant Glasgow Coma scale?

A

Infant scale has extra section for <2 years for best response to auditory and/or visual stimulus

43
Q

what does score of 15 mean on GCS

A

unaltered

44
Q

what does a score of 3 mean on GCS?

A

extremely decreased LOC (worst possible score on scale)

45
Q

3 parts of GCS

A

Eyes
Verbal response
Motor response

46
Q

What actions should be taken when a child is experiencing a seizure?

A

Try to be calm
Time the episode
Ease child to floor
Place pillow or blanket under child’s head
Loosen restrictive clothing
Remove eye glasses
Clear hazards
Allow seizures to end w/o interference

47
Q

Which vaccinations decrease the risk of meningitis?

A

Decreased incidence following Hib and pneumococcal vaccines
Meningococcal conjugate vaccine given ages 11-18

48
Q

What nursing assessments are necessary when a child is admitted with a head injury?

A

Neurologic exam focusing on mental status, pupillary responses and motor responses
Assessment for spinal cord injury

49
Q

How do you assess a child’s level of consciousness (LOC)?

A

pediatric GCS

50
Q

what developmental abilities can be observed at Mild ID 50-75 and what mental age does this correlate to?

A

mental age 8-12
social and vocational skills, some guidance and support as adult

51
Q

what dev abilities can be observed at moderate ID: 40-50 and what mental age does this correlate to?

A

3-7 years
can learn simple health and safety habits, live and work under sheltered conditions

52
Q

what dev abilities can be observed at severe ID (25-40) and what mental age does this correlate to?

A

1-3 years
usually walks, some language skills, can conform to daily routines and rituals, continuous supervision

53
Q

what dev abilities can be observed with profound ID and what mental age does this correlate to?

A

MA of infant
Global DD, basic emotional responses, may response to intensive training, needs complete care and supervision, some primitive speech

54
Q

What are the risks of physical activity for children who have Down syndrome?

A

15% of children with Down syndrome have atlantoaxial instability
heart defects

55
Q

What are the physical characteristics with implications for nursing care of children with Down Syndrome? (6)

A

-Hypotonicity of muscles and hyperextensibility of joints complicate positioning
-Decreased muscle tone compromises respiratory expansion
-undeveloped nasal bone → causes a chronic problem of inadequate drainage of mucus
-Protruding tongue interferes with feeding
-Decreased muscle tone affects gastric motility → predisposed to constipation
-Skin care for dry and cracking skin

56
Q

what is iron dietary supplementation for infants?

A

iron fortified commercial formula and iron fortified cereal
AAP recommends iron supplementation for breast fed infants at 3 months

57
Q

are iron rich foods an adequate sole treatment for iron deficiency?

A

no

58
Q

what are dietary iron supplementation recommendations for infants

A

Limit formula intake to 32 oz per day
Iron fortified cereals and formula
Iron supplementation for breastfed infants at 3 months

59
Q

what are dietary iron supplementation recommendations for older children

A

Dried beans and lentils
Peanut butter
Green leafy vegetables
Iron fortified breads and flour
Red meat
Vitamin c increases dietary absorption of iron

60
Q

how should oral iron supplements be given

A

Given with OJ (vitamin C containing drink) b/w meals
Don’t give milk products
Expect: green, tarry stools
If n/v: give w/ meals
May stain teeth - brush after

61
Q

Why is iron deficiency anemia common in toddlerhood?

A

Excessive intake of milk in toddlers
Malabsorption disorder
Poor dietary intake
Blood loss
Chronic disorder

62
Q

What are the symptoms of vaso-occlusive crisis in sickle cell disease?

A

Pain in areas of involvement, r/t ischemia of involved areas:
Extremities - painful swelling of hands and feet, painful joints
Abdomen - severe pain
Cerebrum - stroke, visual disturbances
Chest - pneumonia, protracted pulmonary disease
Liver - obstructed jaundice
Kidney - hematuria
Genitalia - priapism

63
Q

What is the purpose of daily penicillin for children with sickle cell disease?

A

penicillin VK
most effective against infections caused by spleen disorder s and pneumococcal infections

64
Q

What are critical complications of sickle cell disease?

A

-vaso-occulsive crisis
-splenic sequestration
-acute chest syndrome
-CVA

65
Q

what is splenic sequestration

A

sickle cells in the spleen
Massive drop in Hgb d/t sickle cells trapped in spleen

66
Q

what is acute chest syndrome

A

New infiltrate on CXR - sickle blood infiltrating into lungs
Pneumonia -Multilobar, Acute decline in hemoglobin
Risk factors: Pulmonary edema, atelectasis, hypoxemia

67
Q

What are preventative measures for children with sickle cell disease?

A

prevent anything that increase body’s need for O2 or alters transport of oxygen:
Trauma
Fever, infection
Physical and emotional stress
Increased viscosity d/t dehydration
Hypoxia (High altitude, poorly pressurized airplanes, hypoventilation vasoconstriction d/t hypothermia)

68
Q

family education and support for SCD

A

Medications
Preventions
Recognize s/s of stroke and splenic sequestration
Normalize

69
Q

What vaccines should be given with caution for children with HIV? (5)

A

Avoid live vaccines if CD4 counts are low → MMR, varicella, rotavirus, intransal flu, polio

70
Q

what is mucositis

A

Oral ulcers common w/ chemo

71
Q

how to care for child with mucositis

A

Need frequent oral care, inspect mouth for ulceration and hemorrhage, soft bristled brush and mouthwashes
soft diet
No: lidocaine, lemon glycerin swabs, hydrogen peroxide, milk of magnesia

72
Q

s/s of cancer in children

A

Pain (persistent and localized)
Anemia
Infections
Bruising
Neurologic changes: HA, vision, ambulation
Palpable mass
Unexplained fever

73
Q

advice for parents when children sleepwalk?

A

sleepwalking also called somnambulism
Parent teaching:
Reassure parents that it goes away
Reintroduce nap
Don’t wake - causes more confusion
Guide back to bed
Safety proofing; bell on bedroom door, motion detectors, gates, locks, etc.
Consider scheduled awakenings

74
Q

What is advice for parents when toddlers engage in negative behavior?

A

Use a firm, direct approach
Ignore temper tantrums
Use distraction techniques
Restrain adequately
Reduce the opportunity for a no answer
Using rewards for good behavior

75
Q

safety advice for parents when toddlers are into everything

A

Supervision and safeguarding environment

76
Q

atraumatic care techniques when administering vaccines to a 4 year old

A

Demonstrating on a doll/let them practice on you with needle capped
Be honest - if they need 4 tell them they need 4
Offer rewards
Parent is present and holding child in lap
Comforting child with toy or favorite book

77
Q

What are best practices for reducing communicable disease in children?

A

Primary prevention = immunization
Control measures to prevent spread =
Reduce risk of cross transmission b/w patients
Good hand washing
Using tissues

78
Q

What information about a child who has fallen can you find from a CT scan?

A

CT scanning is imaging of the brain (direct injury on the tissues)
A CT scan is going to show the actual damage that can come from an injury
swelling, fractures
Concussion you WILL NOT see the damage on the CT

79
Q

characteristics of epilepsy

A

the patient must have two or more unprovoked seizures (no known triggers) that are at least 24 hours apart

Stiff muscles.
Uncontrollable jerking movements of the arms and legs.
Loss of consciousness or awareness. Psychological symptoms such as fear, anxiety or deja vu.

80
Q

seizure classifications

A

Partial: Simple partial with motor signs, Simple partial with sensory signs Complex partial (psychomotor)
Generalized: Tonic-clonic (formerly grand mal)
Absence: (formerly petit mal)
Atonic and Akinetic: Drop attacks
Myoclonic
Infantile spasms

81
Q

What are appropriate activities for children with Down syndrome?

A

-boy and girl scout activities
-inclusion in family, school and town activities
-exercise - walking, bike riding, swimming
-craft activities geared toward abilities

82
Q

what is the pharm therapy for IBD

A

ranitidine (zantac)

83
Q

what is the surgery for IBD

A

nissen fundoplication: surgeon wraps the top of the stomach around the lower esophagus. This reinforces the lower esophageal sphincter, making it less likely that acid will back up in the esophagus.

84
Q

ESSR feeding technique

A

Enlarged nipple
Stimulate suck reflex
Swallow appropriately
Rest when infant signals with facial expression

85
Q

at what rate do you want blood glucose to decrease in DKA?

A

Target: glucose falls <= 100 mg/dl/hr

86
Q

nursing interventions post seizure

A

Time the postictal period
Check for breathing
Check position of head and tongue
Reposition head if hyperextended
Rescue breathing if necessary
Keep child on side
Remain with child
Do not give foods or liquids until child is alert and can swallow
Look for medical identification
Check head and body for injuries
Check inside mouth to see if tongue or lips have been bitten

87
Q

when to call EMS: seizure

A

Child stops breathing
Evidence of injury or diabetic or pregnant
Seizures continue for more than 10 mins after rescue meds
Pupils are not equal after seizure
Child vomits continuously 30 mins after seizure has ended
Child cannot be awakened or is unresponsive after seizure has ended
Seizure occurs in water
Child’s first seizure

88
Q

what is encopresis

A

fecal incontinence

89
Q

Gastroschisis

A

intestines are born outside of the body

90
Q

Intussusception s/s

A

Abdominal pain
* Abdominal mass (Palpable sausage shaped)
* Bloody stools with mucous (red currant jelly)
– Screaming
– Irritability,
- Lethargy
– Vomiting
– Diarrhea or constipation
– Fever
– Dehydration
– Shock

Pediatrics (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions