EXAM 2 Flashcards
(160 cards)
1
Q
Describe the SHARE acronym for shared decision making
A
SEEK pt participation
HELP you pt explore tx options
ASSES pt values/preferences
REACH a decision w/ your pt
EVALUATE pt’s decision
2
Q
define Cognitive Impairment
A
Cognitive impairment” (CI) is a general term that encompasses
any type of mental difficulty or deficiency
Used synonymously with “intellectual disability”
Diagnosis
◦ Made after a period of suspicion by family or health
professionals
◦ In some instances, made at birth
3
Q
To be Dx w/ an Intellectual disability, you must…
A
Have an IQ of 70-75 or below
Impairment in 2 of 10 adaptive skills
Younger than age 18 at the time of diagnoses
4
Q
Diagnosis of mildly impaired characterizes __% of the
population with cognitive impairment
A
85
Can be in school and become educated
5
Q
Diagnosis of moderately impaired characterizes __% of the population with
A
10
6
Q
what are two Measures to Prevent Cognitive
Impairment
A
rubella immunization
folic acid supplementation
6
Q
What is the Most common
chromosome
abnormality
A
Down Syndrome
slanted, upturned eyes
small ears
flat nose bridge
short neck
square head
tongue poking out
6
Q
What are down syndrome causes
A
Extra chromosome 21 in 95% of cases
Maternal age
◦ Age 35: risk is 1 per 350 births
◦ Age 40: risk is 1 per 100 births
6
Q
What are some physical problems children with down syndrome may experience
A
◦ Congenital heart disease
◦ Hypothyroidism
◦ Leukemia
◦ Atlanto-axial instability @ c-spine
7
Q
The second most common genetic cause
of cognitive impairment after Down
syndrome
A
Fragile X Syndrome
Large ears, long face, big forehead, intellectual disability
8
Q
Fragile X Syndrome is caused by
A
Caused by abnormal gene on the
lower end of the long arm of the X
chromosome
14
9
Q
Fragile X Syndrome:
Classic Behavioral Features
A
Mild to severe cognitive impairment
Delayed speech and language
Hyperactivity
Hypersensitivity to taste, sounds, and touch
Autistic-like behaviors
Aggressive behaviors
9
Q
Fragile X Syndrome:
Therapeutic Management
A
Tegretol/Prozac for behavioral control
Stimulants for hyperactivity (similar to management of attention
deficit/hyperactivity disorder)
Referral to early intervention program
10
Q
Slight to moderately severe hearing impairment
A
Residual hearing with the use of an aid
11
Q
Severe to profound hearing loss
A
Cannot process linguistic information
12
Q
What are two common hearing impairment causes
A
chronic ear infections and environment
13
Q
Conductive hearing loss affects the…
A
middle ear
14
Q
Sensorineural hearing loss reflects damage to the…
A
inner ear or auditory
nerve
15
Q
Mixed conductive-sensorineural loss: interfers with…
A
transmission of sound
16
Q
what are Manifestations of hearing impairment in Infancy
A
Lack of startle reflex
Absence of reaction to auditory stimuli
Absence of well-formed syllables by age 11 months
General indifference to sound
Lack of response to spoken word
17
Q
what are Manifestations of hearing impairment in childhood
A
If not detected in infancy, identified upon entry into school
Abnormalities in speech development
Learning disabilities
18
Q
partially sighted children have a visual acuity of…
A
20/70 to 20/200
19
Q
legally blind children have a visual acuity of…
A
Acuity of 20/200 or poorer
20
Q
what are some disorders that can cuase visual impairment in children
A
◦ Sickle cell disease
◦ Juvenile rheumatoid arthritis
◦ Tay-Sachs disease
21
Suspect visual impairment in a child of any age when...
pupils do
not react to light
22
The Most common congenital malignant intraocular tumor in children is...
Retinoblastoma
Manifestations
◦ WHITE EYE REFLEX
◦ Strabismus
◦ Blindness
23
Describe Esotropia
eye looks to center
24
Describe Exotropia
eye looks to outside
25
Describe Hypertropia
eye looks up
26
Describe Hypotropia
eye looks down
27
Children with autism display uncharacteristic behaviors in regards to..
◦ Socialization
◦ Communication
◦ Behavior
◦ Difficulty with eye and body contact
◦ Language delay
Diagnosis often delayed until age 2-3 years
28
Although autism isn't curable, doing things like ___ will help the pt manage daily activities
◦ Attempt behavior modification
◦ Provide a structured routine
◦ Decrease unacceptable behavior
29
______ _____ _ ________ is good source of information for parents with autisitc children
Autism Society of America
30
What are indications a child may have ADHD or another learning disorder
Developmentally inappropriate inattention, impulsivity, and
hyperactivity
31
What do you test to determine if a kid had ADHD/LD
IQ
Hand-eye coordination
Visual and auditory perception
Comprehension
Memory
32
Name the three types of medications used for ADHD
Stimulants, Tricyclic Antidepressants, and Norepinephrine transport inhibition
33
◦ Dexedrine
◦ Methylphenidate (Concerta, Metadate, Ritalin)
◦ Dextroamphetamine (Adderall)
◦ Dexmethylphenidate (Focalin)
34
Examples of tricyclic antidepressants used to treat ADHD
◦ Clonidine
◦ Guanfacine (Intuniv)
35
Examples of Norepinephrine transport inhibition used to treat ADHD
◦ Atomexatine (Straterra)
36
The Upper respiratory tract anatomically consists of the...
▶ Oronasopharynx, pharynx
▶ Larynx, upper trachea
37
The Lower respiratory tract anatomically consists of the...
▶ Lower trachea, bronchi
▶ Bronchioles, alveoli
3
38
The nurse is discussing sexuality with the parents of an adolescent girl with moderate cognitive impairment. What should the nurse consider when dealing with this issue?
Individuals with cognitive impairment need a well-defined, concrete code of sexual conduct.
39
What are the Five stages of coping (for Children with Special Needs)
Develops competence and optimism
Feels different and withdraws
Irritable, moody, acting out
Complies with treatment
Seeks support
40
T/F: Alway pair a bolus feed through a G/J tube with a pacifier
True.
sucking = as belly get full, it helps the infant realize satiation
41
Describe a 6 month old and younger's Understanding and Reaction to Death
unaffected
42
Describe a 6 month old and older's Understanding and Reaction to Death
affected by loss
43
Describe a toddler's Understanding and Reaction to Death
egocentric, more affected by change in lifestyle
44
Describe a preschool age child's Understanding and Reaction to Death
magical thinking, powerful thinking, death isn’t permanent- just sleeping
45
at what age do children develop permanence that death is final
around age 9
46
Describe a School age child's Understanding and Reaction to Death
seen as a punishment or evil thing
once they turn 9 they have an adult understanding of death
47
Can a child designate themselves as a DNR/DNI?
A DNR may be placed by a physician's who has the consent of the patient or, if the patient is a minor or is otherwise incapable of making an informed decision regarding consent for such an order, upon the request of and with the consent of the person authorized to consent on the patient's behalf.
48
How should you act after a patient's family begins to mourn terrible news
Stay with family
Sit quietly
Avoid judgmental statements, rationalizations, or artificial consolation
49
Name 5 infectious agents that cause pediatric URIs
Respiratory syncytial virus (RSV)
Group A β-hemolytic streptococci
Staphylococci
Haemophilus influenzae
Chlamydia trachomatis
50
At what age is there an increase in Mycoplasma pneumoniae and β-hemolytic streptococcal infections
5 years and up
51
How long do maternal antibodies last for
0-3 months
52
what seasons have the most URIs/RSV
winter and spring
53
Which URI is most common in fall and winter
Mycoplasmal infections
54
Infection-related asthma: more frequent in ___ weather
cold
55
__mo – __yr respond more to resp infections
6mo – 3 yr
56
Describe symptoms of Meningism found in children with an URI
Meningism is defined as signs of meningeal irritation occurring without other features of meningitis or noninflammatory meningeal involvement (eg, in a patient with high-grade fever unrelated to a central nervous system [CNS] disorder).
Neck stiffness, back pain when lying and flexing leg/chin upwards
57
What symptoms could mean something more serious in children with a URI
Deterioration
Increase respiratory distress
Increase RR
increase HR
Worsening hypoxia
Poor perfusion
Decrease LOC
Lethargy
58
A child should be voiding at least (_ml/kg/h <__kg and __ml/h >__kg)
Voiding (1ml/kg/h <30kg and 30ml/h >30kg)
59
How can you make a child with a URI more comfortable
Moisturized air
FluiNose drops/throat garles
Nasal aspirator/bulb syringe
Vapor rubs (>2 yo)
Teach children how to cough/sneeze
Controlling fever important for comfort
60
Name signs/sx of ACUTE STREPTOCOCCAL PHARYNGITIS in children
skin (impetigo/pyoderma)
61
What infection can cause rheumatic fever (inflammatory disease of the heart, joints & CNS) & acute glomerulonephritis
Group A β-hemolytic streptococcal infection
62
What are the symptomatic differences between a strep and viral URI
STREP:
Sudden onset
Fever: 103-104
c/o Sore throat, erythema, exudate, tonsillitis, abd pain, HA
Positive RST, high elevation of WBC
VIRAL
Gradual onset
Low grade fever
c/o slight sore throat, less erythema, hoarseness, cough, rhinitis
Negative RST, slight elevation of WBC
63
Continuous swallowing in children could be a sign of
bleeding from tonsillectomy
Hemorrhage unusual but could occur btwn 5-10 days
64
How do you cure tonsilitis
Tonsillectomy and adenoidectomy
65
What medication can you give children with the flu
Oseltamivir all ages, start within 2 days onset of s/s
66
OTITIS MEDIA OM is the inflammation of the...
middle ear without infectious process present
67
OTITIS MEDIA AOM is the inflammation of the...
middle ear with rapid onset of S&S of acute infection (ie, fever & otalgia)
68
OTITIS MEDIA OME is the inflammation of the...
middle ear space without symptoms of acute infection
69
OTITIS MEDIA is most common in what age group
first 2 years of life
70
When would you consider TM tubes +/- adenoidectomy
>3 episodes in <6 months
71
What age group does croup affect the most
Generally affects children <5 years of age (3 months – 3 years)
72
Croup is Most often caused by
H. influenzae type B
73
What are the two famous symptoms of croup
Inspiratory stridor, seal like cough
74
How do you treat croup
Maintaining the airway
Maintain hydration, orally or intravenously
Nebulized mist with supplemental O2
Nebulizer treatments
Epinephrine
Steroids
75
Describe ACUTE SPASMODIC LARYNGITIS
Also known as “spasmodic croup”
Paroxysmal attacks of laryngeal obstruction
Occurs chiefly at night
Inflammation: mild or absent
Most often affects children 1-3 years of age
Therapeutic management
Similar to that for infectious croup
Hot shower running in bathroom
76
BACTERIAL TRACHEITIS has similar sx to croup (and is often a result of it) expect for...
Thick, purulent secretions that result in respiratory distress
Vigorous management
Humidified oxygen
Antipyretics
Antibiotics
Possible need for intubation
Mechanical ventilation
77
Describe ACUTE EPIGLOTTITIS
A MEDICAL EMERGENCY
Might lose their airway
Sx include Sore throat, pain, tripod positioning
Drooling, difficulty swallowing
Inspiratory stridor, mild hypoxia, distress
Increased HR & RR. Substernal, suprasternal, intercostal retractions. Nasal flaring & increased restlessness
78
T/F: Cartilaginous support not fully developed until adolescence
True
79
The most frequent cause of hospitalization for those under 2 years is
RESPIRATORY SYNCYTIAL VIRUS
80
T/F: Risk factor for asthma later if severe RSV infection in first year of life
True
81
What medication can you take for RSV
Ribarvirin – inhaled antiviral (controversial)
** Synagis prevention for high risk infants
82
Whooping cough is caused by
Bordetella pertussis
83
TB test 5mm means
recent contact w/ TB positive person
84
TB test 5mm means
Has had TB in the past 5 years but is asymptomatic
85
TB test 5mm means
They have TB
86
SX FOREIGN BODY ASPIRATION include
dyspnea, cough, stridor, hoarseness, cyanosis
87
Name some substances that can cause severe aspiration pneumonia if aspirated
Hydrocarbons, lipids
Solvents
Talcum powder
88
what are risk factors for asthma
Atopy
Heredity
Gender
Smoking exposure
Maternal smoking in pregnancy
Ethnicity
Low birth weight
Being overweight
89
What is considered when deciding the classification of Asthma?
Symptom frequency day
Nighttime symptoms (waking)
PEF
Use of rescue inhaler (short acting b agonist)
Interference of normal activity
90
CLASSIFICATION OF ASTHMA SEVERITY
IN CHILDREN AGED 5 YEARS & OLDER Step 1:
mild, intermittent asthma
91
CLASSIFICATION OF ASTHMA SEVERITY
IN CHILDREN AGED 5 YEARS & OLDER Step 2:
mild, persistent asthma
92
CLASSIFICATION OF ASTHMA SEVERITY
IN CHILDREN AGED 5 YEARS & OLDER Step 3 or 4:
moderate, persistent asthma
93
CLASSIFICATION OF ASTHMA SEVERITY
IN CHILDREN AGED 5 YEARS & OLDER Step 5 or 6:
severe, persistent asthma
94
Name 6 DRUG THERAPies FOR ASTHMA
Albuterol, metaproterenol, terbutaline
Long-term bronchodilators (salmeterol [Serevent])
Theophylline: monitor serum levels
Leukotriene modifiers
Cromolyn sodium
95
What is Peak Flow Rate
The maximum flow rate that can be generated during a forced expiratory maneuver with full inflated lungs (L/min)
96
What is the "green zone" of Peak Flow Rate
80-100% of personal best, avoid things that make it worse
97
What is the "yellow zone" of Peak Flow Rate
50-80% of personal best, take medication to relieve episodes
98
What is the "red zone" of Peak Flow Rate
<50% of personal best, call MD or seek care immediately
99
describe STATUS ASTHMATICUS
Medical emergency
Respiratory failure and death if untreated
Continuation of respiratory distress despite vigorous therapeutic measures
Concurrent infection in some cases
Therapeutic intervention
Improving ventilation
Pharmacologic agents
100
what are 3 signs of chronic allergy
Allergic salute 🡪 transverse crease on upper nose
Dark circle under eyes
Post nasal drip
101
Describe the signs of CYSTIC FIBROSIS
Increased viscosity of mucous gland secretions
Elevation of sweat electrolytes
Increase in enzymatic constituents of saliva
Autonomic nervous system abnormalities
Delayed puberty in girls
Sterility in boys
Parents’ report: child’s skin tastes “salty”
Dehydration
Hyponatremic/hypochloremic alkalosis
Hypoalbuminemia
102
How do you diagnose cystic fibrosis
Sweat chloride test
Newborn screening
DNA identification of mutant genes
Abnormal measurement of nasal potential difference
103
Describe the symptoms of CYSTIC FIBROSIS
Wheezing respiration, dry nonproductive cough
Generalized obstructive emphysema
Patchy atelectasis
Cyanosis
Clubbing of fingers and toes
Repeated bronchitis and pneumonia
Meconium ileus
Distal intestinal obstruction syndrome
Excretion of undigested food in stool; increased bulk, frothiness, and foul odor
Wasting of tissues
Prolapse of the rectum
104
Describe the long term effects of cystic fibrosis
Chronic hypoxemia: causes contraction/hypertrophy of muscle fibers in pulmonary arteries/arterioles
Pulmonary hypertension
Cor pulmonale
Pneumothorax
Hemoptysis
Eventually pancreatic fibrosis occurs;
diabetes mellitus may result
Focal biliary obstruction results in multilobular biliary cirrhosis
Pancreatic enzyme deficiency
Sweat gland dysfunction
Failure to thrive
Increased weight loss despite increased appetite
105
How do you manage cystic fibrosis
Airway clearance therapies
Bronchodilator medication
Physical exercise
Aggressive treatment of pulmonary infections
Aerosolized antibiotics
Home intravenous antibiotic therapy
Replacement of pancreatic enzymes
High-protein, high-calorie diet: as much as 150% recommended dietary allowance (Supplemental Vit A, D, E, K)
Relief of intestinal obstruction (ileus)
Reduction of rectal prolapse
Treatment of chronic gastrointestinal reflux
106
Describe situations in which a pt would need more fluid
Fever
Vomiting, diarrhea
High-output kidney failure
Diabetes insipidus
Diabetic ketoacidosis
Burns
Shock
Tachypnea
Radiant warmer (preterm infant)
Phototherapy (infants)
Postoperative bowel surgery
107
Describe situations in which a pt would need less fluid
Heart failure
Syndrome of inappropriate antidiuretic hormone
Mechanical ventilation
After surgery
Oliguric renal failure
Increased intracranial pressure
108
If a pt has a fever, they require __% more fluids
15
109
how do you calculate fluids for an adult
30 ML/KG
110
Describe isotonic dehydration
Water & salt are lost in equal amounts
This is the primary form of dehydration in children
Reduction of plasma volume and circulating blood volume
Shock greatest risk (hypovolemic)
111
Describe hypotonic dehydration
Loss of electrolytes (electrolyte deficit exceeds water deficit)
ECF loss is greater = physical signs more severe
Na <130 mEq/L
112
Describe hypertonic dehydration
Loss of water (larger loss of water or larger intake of electrolytes)
Most dangerous 🡪 specific fluid therapy
113
Acute ________ is leading cause of illness in children < 5 years of age
diarrhea
Of all deaths in developing countries, 24% are related to diarrhea & dehydration
114
Gastroenteritis affects the...
stomach and intestines
115
enteritis affects the...
Small intestine
116
colitis affects the...
Colon
117
enterocolitis affects the...
Colon and intestines
118
What are the 5 types of diarheas
acute, infectious, chronic, nonspecific, intractable diarrhea of infancy
119
Therapeutic Management of Diarrhea
Low sodium broth
Apple juice (not great since high CHO and low electrolyte) and water 1:1
Pedialyte or other ors
Popsicles (Pedialyte popsicles)
No BRAT little nutritional value and high CHO, low electrolytes
120
First meconium should be passed within __-___ hours after birth
24-36
121
If First meconium should be passed within 24-36 hours after birth, you should suspect one of these three things...
Intestinal atresia, stenosis
Hirschsprung disease, hypothyroidism
Meconium plug, meconium ileus (CF)
122
What re 4 interventions for Constipation during Infancy
INTERVENTIONS:
PRUNE(S)/ JUICE
INCREASE WATER INTAKE
GLYCERIN SUPP.
123
Describe Hirschsprung Disease
Also called “congenital aganglionic megacolon”
Congenital anomaly
Mechanical obstruction from inadequate motility of intestine
Incidence: 1 per 5000 live births; more common in boys and in children with down syndrome
Absence of ganglion cells in colon
123
Describe Encopresis
inappropriate passage of feces, often with soiling
124
What are the two stages of Therapeutic Management for Hirschsprung Disease
1. Temporary ostomy
Second stage: “pull-through” procedure
125
A Green, bilous vomit may be an indication of
bowel obstruction
126
Forceful vomiting is otherwise known as
pyloric stenosis
127
Headache with vomiting may be an indication of
CNS or metabolic disorder
128
Abd pain & vomit may be an indication of
appendicitis, pancreatitis, PUD
129
When Do We Worry about vomiting?
BRB
COFFEE GROUNDS
ABSENCE OF NAUSEA
MIDDLE OF THE NIGHT OR 1ST THING IN THE AM
FTT
130
Treatment of Gastroesophageal Reflux (GER) in infants
THICKEN FEEDS
SMALLER, FREQUENT MEALS
H2 ANTAGONISTS (ZANTAC) & PPI’S (PREVACID, NEXIUM)
KEEP UPRIGHT AFTER MEALS
131
Signs of Acute Appendicitis
McBurney point (tenderness from umbilicus to RLQ)
132
Inflammatory Bowel Disease (IBD) includes these two diseases
ulcerative colitis and crohn’s disease
133
What dietary changes should you consider with Inflammatory Bowel Disease (IBD)
High protein high calorie diet (well balanced)
MVI, iron, folic acid
134
What are the difference in symptoms between ulcerative colitis and crohn’s disease
ulcerative colitis: rectal bleeding, diarrhea, no pain, some anorexia/weight loss, and mild rash/joint pain
crohns disease: no rectal bleeding, severe pain, diarrhea, severe anorexia/weight loss/growth retardation, anal lesions, fistulas, and mild rash/joint pain
135
how is Hepatitis A transmitted
fecal oral route
136
describe BILIARY ATRESIA
childhood disease of the liver in which one or more bile ducts are abnormally narrow, blocked, or absent. It can be congenital or acquired
137
CLEFT LIP AND CLEFT PALATE type A
only affects lip
138
CLEFT LIP AND CLEFT PALATE type B
affects lip and palate
139
CLEFT LIP AND CLEFT PALATE type C
y shaped, affects two parts of lip and one lie centered through palate
140
CLEFT LIP AND CLEFT PALATE type D
only affects palate
141
SURGICAL CORRECTION OF CLEFT LIP
Closure of lip defect precedes correction of the palate
Performed when patients are 2-3 months of age
Protect suture line
142
SURGICAL CORRECTION OF CLEFT palate
Typically performed when patients are 6-12 months of age
143
describe Esophageal atresia
failure of esophagus to develop as a continuous passage
144
describe TRACHEOESOPHAGEAL FISTULA (TEF)
Tef: failure of the trachea to separate into a distinct structure
145
MANAGEMENT OF TEF
Maintenance of a patent airway
Prevention of pneumonia
Gastric or blind pouch decompression
Supportive therapy
Surgical repair
146
concerns/types of HERNIA
Danger of incarceration/strangulation
Types
Diaphragmatic
Abdominal wall
Inguinal canal
147
describe **HYPERTROPHIC PYLORIC STENOSIS
Constriction of pyloric sphincter with obstruction of gastric outlet
148
describe * INTUSSUSCEPTION
Telescoping or invagination of one portion of intestine into another
Most common cause of intestinal obstruction in children aged 3 months to 3 years
Occasionally due to intestinal lesions (10%)
Cause is often unknown
Red currant jelly stool
149
describe the difference between MALROTATION AND VOLVULUS
Malrotation: abnormal rotation of intestine around the superior mesenteric artery during embryologic development
Volvulus: twisting of intestine around itself, thereby compromising blood supply to intestines
May cause necrosis, peritonitis, perforation, and death
150
Obese: generally considered when body mass index (bmi) is in ___th percentile for age, gender, and height
>95th
151
Overweight: generally considered when bmi is between the __th and 95th percentile
85
152
How can nurses teach cognitively impaired patients
these children can learn to discriminate if the cues are presented in an exaggerated, concrete form and if all extraneous stimuli are eliminated.
demonstration is preferable to verbal explanation, and learning should be directed toward mastering a skill rather than understanding the scientific principles underlying a procedure.
they need simple, one-step directions (task analysis, see how to break a task down)
positive reinforcement to encourage the accomplishment of specific tasks or behaviors.
153
you get hep a from
food and water. you can get post-exposure immunoglobins to treat. IGM means active infection, IGG means antibodies, no infection. prevent w/ vaccine and handwashing
154
describe hep b
get it from iv drug use, birth, and sex. HBSnG postive means active infection and can spread. antibodies indicate immunity, no infection
155
