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Flashcards in Exam 2 Deck (81):
1

signs/symptoms of Mono

MAIN: Fever, malaise, sore throat, white patches, and lymphadenopathy

other possible symptoms may include:
loss of appetite, headache, redness of throat, cough, chills, aches, photophobia, swollen tonsils, swollen lymph nodes, enlargement of spleen, abdominal pain, nausea

2

Mono is caused by what virus?

Epstein-Barr

3

Management of Mono

Primarily symptomatic; Lots of fluid, rest (bed rest encouraged while child is febrile), no contact sports

4

s/s Mumps

Mainly HUGE parotid swelling, fever, aches, malaise, possibly orchitis (testicle swelling) in boys -- very painful

[Parotid swelling gives you the ear infections and earaches]

Coming back due to lack of immunizations

5

Management of Mumps

(supportive) Treat symptoms.
• Acetaminophen for fever
• Oral fluids
• Ice packs to testicles with support if orchitis present
• Droplet precautions for 9 days after swelling starts
Contagious for 1-7 days prior to onset of symptoms

6

Transmission route of Pinworms

fecal-oral

7

S/s pinworm

Mainly: anal itching at night & teeth grinding at night

Also: wt. loss, enuresis (involuntary urination)

8

Diagnosis of pinworm:

clear tape to anus during nighttime - can see adult worms.

9

Management/Tx of Pinworm:

mebendazole x1 (can get OTC), then repeated in 2 weeks; treat all family in household

10

Hallmark sign of rubeola (measles)

Kopliks spots (bluish-gray spots on buccal mucosa)

11

s/s measles (rubeola)

Koplik’s spots, acute rhinitis, conjunctivitis, erythematous macropapular rash,
fever, and cough

12

Mgmt/tx measles (rubeola)

self-limiting requiring supportive therapy -- Treat symptoms

13

S/S scarlet fever

• Sunburn-like rash all over
• Fever > 101°F, aches, chills, anorexia, N & V
• Red and swollen pharynx and lymph nodes
• Coated tongue that becomes very red

14

Mgmt scarlet fever

Penicillin V, fluids, cool mist humidifier, antipyretics, popsicles ,etc

15

s/s varicella zoster (chicken pox)

Mainly just feel really bad (fever, aches, malaise) and severe itching of the lesions

Also may experience anorexia, abdominal pain

16

Nursing management of varicella zoster

Mostly supportive -- treat the symptoms (itching, etc.)
Antivirals could sometimes help but not always
Airborne and contact precautions until all crusted over


CDC recommends TWO doses of chickenpox vaccine (first at 12-15 months, second at 4-6 years)

17

s/s lyme disease

Bull's eye rash, fever, malaise, arthralgia (can be for life)

18

mgmt lyme disease

Tick removal (COMPLETE)
Antibiotics:
-older than 8 years - Doxycycline
-younger than 8 years- amoxicillin
Prevention education on going into woods

19

s/s lice

intense itching, may see adult nits

20

how long can lice live on a host
how long can they lice off host

30 days on
1-3 off

21

mgmt lice

shampoo hair with pediculicide (permethrin), comb out nits with fine-toothed comb, wash clothing in hot water

22

s/s Fifth Disease (erythema Infectiosum)

"Slapped cheek" facial appearance
May have a low grade fever
Upper respiratory 2 days before rash

Lecture: "May have a little cough before rash appears"

23

mgmt 5th disease

comfort, droplet precautions

-Can cause aplastic crisis in sickle cell patients
-No longer contagious once rash appears
Rash will resolve in 1-3 weeks

24

Main treatment for Scarlet Fever

Penicillin V

25

Whooping Cough

Pertussis

26

Primary prevention for Measles (Rubeola)

Measles Vaccine

27

3 Kinds of Conjuncvitis

Bacterial
Viral
Allergic

28

Treatment for Bacterial conjuctivitis

Will usually do a culture and culture will show + for bacteria

Treat with:
Antibiotic drops or ointment (contagious until tx x 24 hrs)

29

Tx for Viral conjunctivitis

Mainly symptomatic relief:
cool moist compress, cool water rinse

30

Tx for allergic conjunctivitis

Mostly Symptomatic relief
Antihistamine and/or mast cell stabilizer drops may help
Education

31

Management for periorabital cellulitis

Abx therapy x 7 days, warm compress

32

Common complication of Otitis Media

expressive speech delay

33

gold standard for asthma treatment

steroids

34

Symptoms of Bacterial Conjunctivitis

itching
burning
yellow discharge
crusting of eyelids
really swollen conjunctiva

35

Symptoms of Viral Conjunctivitis

More redness of sclera (than bacterial)
Watery discharge (not as thick/yellow as bacterial)

(Allergic Conj. symptoms are similar to viral!)

36

Symptoms of Acute Otitis Media (AOM)

fever, ear pain, fussiness, batting or tugging at ears, poor feeding, difficulty sleeping "absolute misery"

37

Symptoms of Otitis Media with Effusion (OME)

feeling of fullness in the ear; tympanic membrane orange or opaque, bulging, may have pus sometimes

(not necessarily an infection, usually no s/s)

38

Symptoms of Otitis Externa (OE)

"Swimmer's Ear"

VERY painful, drainage, canal red and edematous
**Tx: abx drops

39

Tx/Mgmt for Otitis Media (all)

Viral: resolve spontaneously; bacterial=antibiotics (amoxicillin)

Manage Pain
Treat infection
Educate family
Myringotomy tubes may be necessary
Prevent AOM

40

Common complications from OM

hearing loss (if constant OM), speech delays (d/t hearing loss), tympanic membrane perforation (d/t so many of them)

41

Levels of Consciousness

1. Full consciousness (awake, alert, oriented)
2. Confusion (disorientation exists; alert but response inappropriate)
3. Obtunded (limited responses to environment, falls asleep unless stimulated) -- think of when people are waking up from anesthesia -- they can wake up when you tell them to.
4. Stupor (only respond to vigorous stimulation) -- would have to pinch them or give painful stimuli
5. Coma (cannot be aroused even with painful stimuli)

42

Early signs of ICP

Vomiting (often projectile)
Blurred or double vision
Pupil reaction time decreased and unequal
Sunset eyes (sclera is showing above iris)
Change in LOC
Seizure activity

Infant: bulging and tense fontanels (if open), wide sutures, increased head circumference, dilated scalp veins, high pitch cry

43

Late signs ICP

Lowered LOC
Vital sign changes**
Decreased motor and sensory responses
Bradycardia
Irregular respirations
Cheyne-stokes respirations
decerebrate or decorticate posturing
Fixed and dilated pupils

44

one form of managing epilepsy that is thought to trigger biochemical changes that eliminate seizure causing short circuit signals in the brain.

Ketogenic Diet

45

Epilepsy Treatments

Anticonvulsants (minimal -- goal is 1 drug)
Surgery (when uncontrolled)
Ketogenic diet
Vagal nerve stimulator ("pacemaker for the brain" that resets electrical charges)

46

seizure that comes on rapidly, usually with rapid rise of temperature

Febrile Seizure

47

peak ages for febrile seizure

18-24 months

48

Febrile seizures can be treated with..

rectal diazepam (can give for anxious parents)

49

Tonic-clonic seizure

LOC occurs
*May be preceded by piercing high-pitched cry*
Tonic contractions (all muscles stiffen) followed by clonic contractions (arms and legs jerk rapidly)

50

Myoclonic seizure

sudden, brief massive muscle jerks that may involve whole body or one body part
Dont usually lose consciousness (child may or may not)

51

Tonic Seizure

Sustained stiffening of the body/4 extremtities

52

Atonic Seizure

Sudden loss of all muscle tone

Safety issue because they can fall and really hurt themselves

53

Most common seizure in childhood

Absence (formerly petit mal) seizures

54

Absence Seizures

Sudden cessation of motor activity or speech with a blank facial expression or twitching of mouth/blinking of eyelids; LOC less than 30 sec/day

May go unrecognized because it looks like kid is just daydreaming

55

Status epilepticus

prolonged or clustered seizures lasting 30 minutes or more where consciousness does not return between sz.
*medical emergency

56

Treatment for status epilepticus

Rectal diazepam #1 treamtnet!!
Basic Life Support - ABCs
IV access: valium, diazepam, ativan
Anticonvulsants

57

Seizure Triggers

Light flashes, loud noises, temp changes, dehydration, fatigue

58

Onset of Diazepam and how long does it last?

What do you monitor after giving this drug?

onset 3-10 minutes; duration short (minutes)

Monitor respiratory rate and level of sedation

59

1st indicator of impreovement or deterioration of neuro status

LOC

60

Asthma meds

-Leukotriene modifiers (Singulair) and combo steroid/long-acting bet agonists (Advair -- Fluticasone/salmeterol) are gold standards for asthma
-Short-acting beta agonits bronchodialators (Albuterol) great for quick relief, exercising, etc
-Anticholinergic (Atrovent)
-Sympathetic (Racemic Epi) when asthma attack
-Steroids IV or PO

61

S/S Cystic Fibrosis

wheezing
cough
dyspnea
mucus plugs
cyanosis
barrel-shaped chest
clubbing
multiple respiratory infections
meconium ileus ***earliest recognizable sign***

62

Diagnosis of CF:

sweat chloride test, chest x-ray, stool sample, PFT's

63

Management of CF:

maintain patent airway
prevent infection
maintain growth
promote family coping,
high protein and caloric diet**
fluids!**
med compliance
preparing for adulthood

64

Most important meds for CF patients

Pancreatic enzymes -- must give with every meal and every snack (allow fat and proteins to be digested)

65

What is croup?

Sudden onset (typically in the middle of the night only) of seal-like barking stridorous coughs. Very sudden

**Inspiratory Stridor**
Usually in boys ages 3-5

66

Treatments for Croup

singe dose corticosteroids
racemic epinephrine aerosols

67

S/S epiglottis

high fever, severe sore throat, muffled voice ( HOT POTATO voice) , Tripod sitting, may drool, anxious an frightened, stridor late sign, Thumb sign

68

treatment of epiglottis

emergency tracheotomy, intubation, 100% O2

69

S/S nasopharyngitis

Nasal inflammation, rhinorrhea, cough, sneezing, nasal voice.

70

Mgmt RSV Bronchiolitis (common cold to most of us)

nasal suctioning, oral hydration, inhaled bronchodilator

71

Prevention of RSV Bronchiolitis

Hand washing, disinfecting surfaces, Palivizumab (Synagis) given IM every month of the season (prevents growth of RSV)

72

Diagnosis of RSV

Main Diagnosis: nasal swab for rapid viral-RSV***

Also, pulse ox, chest xray, blood gases

73

S/S Pneumonia

High fever, cough, respiratory distress, chest pain, rhonchi, crackles, irritable, abdominal pain, N&V, pale color-cyanosis

74

Mgmt of Pneumonia

Keep affected lung up, lay on unaffected side, Hydration, Antibiotics

Antipyretics, rest, CPT, O2, pulse ox

75

S/S Viral pharyngitis

sore throat, nasal congestion

76

S/S bacterial pharyngitis

sore throat, NO nasal symptoms

77

Management pharyngitis

promoting comfort and providing family education; discard toothbrush after 24 hrs of abx, popsicles

Treat with Group A strep- penicillin

78

Tonsillectomy Post Op Care

Side-lying position
Elevate head
Assess for bleeding
Assess airway
Ice collar
ice chips, soft diet
Avoid coughing, nose blowing

79

Signs of compartment syndrome

Uncontrollable pain out of proportion with injury and use of medication

80

Treatment for clubbed feet
(usually successful if started within first 9 months of life)

serial casting

81

Tests to see if child has DDH

Imaging
- 4mos = AP and Frog X-ray