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Exam 2 !! Flashcards

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1
Q

signs and symptoms of kawaski disease?

A

High fever, red eyes, ring around iris, Strawberry tongue, rash (desquamates – skin flakes off)
Serious = MI
Dilation of coronary artery leads to aneurysm (“Giant”)

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1
Q

RWhat is treatment for Kawaski disease?

A

High dose IVIG and salicylate therapy
-suppport kid and families, grumpy kid

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1
Q

What is coarctation of the aorta?

A

narrowing of aorta, usually distal to ascending vessels

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2
Q

S/Sx of coarctation of the aorta?

A

Markedly higher blood pressures and pulses in the upper extremities as compared to those in the lower extremities

If left uncorrected, older children will have recurrent episodes of epistaxis and complaints of leg cramps or leg pain, especially during periods of activity

Surgical repair

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3
Q

Signs and symptoms of hypercyanotic spells?

A

Period of uncontrollable crying / irritability.
Hyperpnoea (rapid, deep respiration)
Worsening hypoxia with cyanosis/pallor.
Decreased intensity of heart murmur.
Limpness, loss of consciousness or convulsions.
Death (in severe or untreated episodes)
-becomes cyanotic when eating, crying, or playing with other children when older

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4
Q

What are nursing interventions post cath?

A

Stop bleeding
Immobilize extremity
pulses (should increase grad)
VS
Neuro checks of extremity
Dressing if bleeding pressure 1” above site
Bed rest 4-6 hours

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5
Q

History of endocarditis?

A

-deformed surfaces
-old rheumatic fever
-birth defects
-prosthetic valves
-needle drug abuse
-give antibiotics before dentistry/procedures to prevent

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6
Q

S/Sx of endocarditis?

A

Low grade, intermittent fever, malaise, arthralgias (joint pain), new murmur, chorea, rash, polyarthritis
Increased ESR, vegetation on ECHO,
Tx: Penicillin

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6
Q

When should digoxin be held?

A

Hold if HR < 90 in small child
Hold if HR < 70 in older child

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7
Q

What are signs of digoxin toxicity?

A

Bradycardia, dysrhythmias
Anorexia, N/V
If child vomits dose, do not give another dose
Instead give the next dose as scheduled
Visual disturbances

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8
Q

CHD lab results?

A
  • CXR - tells size and position of heart
  • ECG - leads / holter
  • ECHO
  • Cardiac Catheterization
  • Exercise Stress Test
  • MRI
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9
Q

What is tetralogy of fallot?m

A

most common decreased pulmonary flow defect

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10
Q

S/Sx of ToF?

A
  • TET spells, child becomes cyanotic especially when crying and while eating (infancy), and during play (older children)
  • Polycythemia, greater than normal number of circulating red blood cells
  • Clubbing of the fingers may develop due to chronic hypoxia
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11
Q

Treatment of ToF?

A
  • Surgical repair
  • Cyanosis that develops during a tet spell can be relieved when the legs and knees are bent, resulting in reduced blood flow to the lower body and improved blood flow to the vital organs
  • Infants should be placed in a knee-chest position
  • If defect has not been repaired, older children usually squat instinctively
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12
Q

What is tricuspid atresia?

A
  • A closed tricuspid valve after birth
  • No movement of blood from the right atrium to the right ventricle
  • Incompatible with life unless another defect is present that allows mixing of the blood.
  • Rapid and sustained cyanosis
  • Immediate surgical repair
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13
Q

rheumatic fever history?

A

untreated strep throat or scarlet fever

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14
Q

Blood flow through heart?

A

BODY > IVC: or HEAD > SVC >
> Right Atrium (RA) > Tricuspid Valve (TV)
> Right Ventricle (RV) > Pulmonic Valve (PA) > Pulmonary Artery (PA) > LUNGS
LUNGS > Pulmonary Veins (PV) > Left Atrium (LA) > Mitral Valve (MV) > Left Ventricle (LV) > Aortic Valve (AV) > Aorta > BODY

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15
Q

What is treatment for SIADH?

A

Fluid restriction- ¼­-½ maintenance intake
Diuretics
Declomycin
NA supplements

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16
Q

Nursing considerations for SIADH?

A

Accurate I&O
Daily weights
Monitor for fluid overload
Seizure precautions
neuro checks

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17
Q

What is normal A1c?

A

5.6 or less

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18
Q

A1c for pre-diabetes?

A

5.7-6.4

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19
Q

a1c for diabetes?

A

6.5 or greater

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20
Q

What is the first sign of diabetes insipidus?

A

bed wetting of potty-trained child

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21
Q

S/Sx of diabetic ketoacidosis?

A

vomiting, excessive thirst, dehydration, urinating more often than usual, kussumaul respirations, fruitty smelling breath, stomach pain/nausea, drowsiness, weight loss, increased heart rate

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22
S/Sx of graves disease?
ophthalmopathy A fine tremor of the hands or fingers. Heat sensitivity Weight loss goiter Frequent bowel movements. -low tsh, increased t3 and t4
23
What is priority treatment for status epilecticus?
Airway-Oxygen-Suction IV medications Thermoregulation
24
What are risk factors for seizures?
Acute symptomatic: head trauma or meningitis Remote symptomatic: cause identifiable injury - fever - low sodium - trauma - brain bleed / tumor
25
What are early signs of increased ICP?
Headaches Diplopia (blurred vision) Nausea & Vomiting Vertigo Seizures increased sleeping pupillary response alteration decreased sensory response
26
What are signs of increased ICP in infants?
Wide sutures Tense or bulging Fontanels High pitch cry Setting-sun sign
27
What are late signs of increased ICP?
Bradycardia decreased LOC Decreased motor response Diminished response to pain Cushing reflex (slow pulse and increased BP, irregular respirations)
28
What are considerations in dear-drowning experiences?
Outcome is impacted by length of submersion & dive reflex: cold water: shunt blood from periphery -neuron irreversible damage happens after 4-6 mins in water (hypoxia) -aspiration and hypothermia also important to watch out for
29
Priority tx for botulism?
antitoxin Hx PE, isolation of organism Botulisim IVIG - ICU Monitor muscle impairment etc FEB
30
What are assessment/development findings in cerebral palsy?
Persistent reflexes Delayed developmental milestones Apparent early preference for one hand Poor suck, tongue thrust Spasticity “difficulty with diapering” Involuntary movements Scissoring of legs Seizures
31
Maternal factors with neural tube defects?
-folate deficiency (vit b12) - certainanti-seizure medications -diabetes -obesity -opioid use during pregnancy
32
What is the blood test for NTD?
maternal AFP (alpha fetoprotein level)
33
Signs of Duchene muscle dystrophy?
gowers sign, waddling gait, clumsiness, muscle weakness
34
Guillian barre symptoms?
-paresthesias in hands and feet -symmetrical muscle weakness usually beginning in legs and then ascends -severe resp muscle weakness usually needing support -absent or depressed deep tendon reflexes
35
What are the 5 ps of ischemia in casting?
-pain -pallor -pulselessness -paresthesia -paralysis
36
What are reasons for traction?
Resist the response of the muscle Immobilization Alignment Prevent contracture
37
Osteogenesis imperfecta clinical signs?
fragile bones, deformity, fractures, blue sclerae, hearing loss, hypoplastic discolored teeth
38
How is bryants traction helpful?
the child's body and the weights are used as tension to keep the end of the femur (the large bone that goes from the knee to the hip) in the hip socket.
39
What is the gold standard for scoliosis?
bracing
40
What is care preop for myelomeningocele?
Care must be taken to protect the exposed meninges in the spinal lesion until surgical closure can be performed. The infant must be nursed prone and not dressed to prevent injury to the lesion. Use an incubator or radiant warmer. -lay on side and cover w saline soaked gauze
41
What is the most common fracture site in children?
growth plate
42
treatment for sickle cell anemia?
Hydroxyurea Penicillin Oxygen- only when hypoxic! Rest Pain medication Hydration Electrolytes Blood transfusion ABX Splenectomy
43
Diagnosis of sickle cell anemia?
Newborn screening Sickledex heel/finger stick Hemoglobin electrophoresis
44
How to diagnose anemia?
Physical exam Fatigue Decreased energy Pallor CBC
45
Treatment for anemia?
Treat underlying cause Replace deficiency RBC transfusion and fluids O2 and bed rest
46
What is beta thalassemia?
Microcytic Anemia Non-Responsive To Iron Supplementation Associated With People Of Mediterranean Origin
47
CMs of beta thalassemia?
Small stature Delayed sexual maturation Bronzed, freckled complexion Bone changes (older children): Enlarged head Prominent malar eminences Flat or depressed bridge of nose Enlarged maxilla Protrusion of the lip and upper central incisors and eventual malocclusion Generalized osteoporosis
48
What is diagnosis of beta thassalemia?
hgb electrophoresis
49
Treatment of beta thassalemia?
Blood transfusions Chelation therapy Splenectomy- when indicated
50
What is the most common form of childhood cancer?
leukemia
51
Diagnosuis of leukemia?
H&P Labs Bone marrow biopsy Blood smear Chest x-ray Lumbar puncture
51
CMs of leukemia?
Pallor Listless Irritable Febrile Weight loss Bone/joint pain Petechiae Bruising Anemia Bleeding
51
Treatment of leukemia?
Remission induction Consolidation/Intensification Maintenance Chemotherapy Radiation therapy Chemotherapy with stem cell transplant Targeted therapy
52
Hodgkin lymphoma CMs?
Painless enlarged lymph nodes Depends on the location of involvement Systemic symptoms Low-grade fever Anorexia Nausea Weight loss Night sweats Pruritus
53
Risk factors for NHL?
EBV infection Inherited or acquired immunodeficiency DNA repair syndromes Previous cancer
53
CMs of NHL?
Painless enlarged lymph nodes Depends on the location of involvement Systemic symptoms Low-grade fever Anorexia Nausea Weight loss Night sweats Pruritus
54
What are the decreased pulmonary blood flow defects?
1. tetralogy of fallot 2. tricuspid atresia -blood bypasses pulm system
55
What are the increased pulm blood flow defects?
ASD, VSD, PDSA, AV canal
56
Patent Ductus arteriosis important shit?
-fetal duct fails to close between pulm artery and aorta -may close on its own or indomethacin may be used to medically close
57
What is ventricular septal defect?
-most common congenital heart defect -hole between ventricles -may close on own, indomethacin if not
58
What defects does tetralogy of fallot involve ?
VSD, right ventricular hypertrophy, pulm stenosis, overriding aorta
59
CMs of hyperkalemia?
Muscle weakness, twitching, bradycardia, V Fib, oliguria, apnea
60
CMs of hypokalemia?
Muscle weakness Hypotension, Dysrthymias (tachy or bradycardia) Irritability Drowsiness
61
Tx of rheumatic fever?
Prevention of strep cardiac damage prevention recurrence prevention Pen G
62
Repair for aortic and pulmonic stenosis?
balloon angioplasty or surgical repair
63
Heart pressures and blood flow?
Pressure on the right side of the heart is lower than that on the left Blood flow from high pressure to low Bigger the hole (defect) more blood goes in that direction
64
What kind of posturing is decorticate?
flexion
65
What kind of posturing is decerebrate?
extension
66
What vaccines can prevent bacterial meningitis?
Hib vaccine, group b streptococci
67
What is kernigs sign?
Resistance to extension of the child's leg from a flexed osition
68
What is brudzinski sign?
Flexion of extremities occuring with deliberate flexion of the child's neck
69
What is nuchal rigidity?
inability to flex neck and place chin on chest
70
What are the reflexes that can help diagnose bacterial meningitis?
Kernig sign, nuchal rigidity, brudzinski
71
What is onset, peak, duration of rapid-acting insulin? (Novolog)
15 mins, 30-90 mins, 5 hrs
72
O, P, D of short acting insulin? (Novolin R)
30, 2-4, 4-8
73
What is O,P, D of intermediate insulin? (Novolin N)
2-6 hrs, 4-14, 14-20
74
What is O,P, D of long-acting? (lantus)
6-14, none to very small peak at 10-16 20-24 hrs
75
Nursing care of guillian barre syndrome?
-vent -IVIG -steroids, pain control -plasmapheresis -DVT prevention
76
What are causes of botulism?
honey, corn syrup in infant -improperly sterilized food
77
Symptoms of botulism?
blurred vision, dizziness, vomiting, dysphagia, paralysis, dyspnea
78
Tx of CHF?
-oxygen -ace inhibitors, digoxin, diuretics
79
What is therapeutic range of digoxin?
0.8-2.0
80
How is SIADH diagnosed?
-sodium <120 -low serum osmolality -elevated urine osmolality
81
Reflexes that can indicate altered LOC?
-Absent corneal reflex & presence of tonic neck reflex-severe damage -young infants: presence of Moro, tonic neck, and withdrawal reflexes - Babinski: dorsiflexion of big toe and fanning of toes – should be absent after 1 yr or locomotion
82
S/Sx of hydrocephalus?
-caused by arnold chiari syndrome -signs: sunset signs, increased head circumference, high pitched cry, poor feeding if ICP too high -surgical repair using shunt is fix, infection highest priority
83
What is teaching for iron deficiency anemia medication?
-take with vitamin c -do not take with milk products
84
What are CMs of vaso-occlusive crisis?
-pain -priapism -acute chest sydrome -stroke
85
What is aplastic anemia?
rare and life-threatening bone marrow failure where formed elements of the blood are depressed
86
S/Sx of aplastic anemia?
Overwhelming infection Pallor and patchy brown or yellow skin Weakness, fever, and dyspnea Uncontrolled bleeding and ecchymosis
87
Risk factors for vaso-occlusive crisis?
Cold climates, changes in altitude, and Infection
88
S/Sx of tetanus?
-lockjaw -painful muscular rigidity involving neck muscles
89
Nursing care for tetanus?
-quiet environment -sedatives -pavulon -F/E management -OG feedings -IV therapy

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