Exam 2 Peds - Summary Set X2 Flashcards
1
Q
name the 5 key parts of fetal circulation
A
(1) placenta
(2) patent foramen ovale
(3) ductus arteriosus
(4) ductus venosus
(5) lungs
2
Q
what is the function of the placenta in fetal circulation?
A
provide gas exchange
3
Q
what is the function of the patent foramen ovale in fetal circulation?
A
(1) connects the two atria
(2) provides brain perfusion
4
Q
what is the function of the ductus arteriosus in fetal circulation?
A
(1) bypasses lungs
(2) provides lower limb perfusion
5
Q
two traits of the lungs in the fetal stage are…
A
(1) the lungs are vasoconstricted
(2) the lungs have low blood flow
6
Q
what 4 respiratory changes occur at birth?
A
(1) lungs expand
(2) increased pulmonary blood flow
(3) pulmonary alveoli open up
(4) fall in pulmonary vascular resistance
7
Q
what circulatory change occurs at birth?
A
fetal shunts close
8
Q
pulmonary resistance falls for ____ after birth
A
4-6 weeks
9
Q
normal pressures of the R atrium
A
0-6 mmHg (think: Nickel)
10
Q
normal pressures of the R ventricle
A
15-30 mmHg (think: Quarter)
11
Q
normal pressures of the L atrium
A
6-12 mmHg (think: Dime)
12
Q
normal pressures of the L ventricle
A
100-140 mmHg (think: Dollar)
13
Q
how does COA present at birth?
A
cardiac collapse
14
Q
how does COA present in teens?
A
super high BP
15
Q
what is the overall goal of COA?
A
prevent end-organ damage
16
Q
define D-TGV
A
aorta and pulmonary artery are switched such that the aorta rises from the R ventricle with no opportunity to be oxygenated in the lungs
17
Q
define TAPVR
A
when the pulmonary veins have no connection to the L side of the heart
18
Q
what is the effect of TAPVR?
A
(1) increased workload on the R side of the heart
(2) inadequate blood flow to the body
19
Q
define Truncus Arteriosus
A
inadequate division of the common great vessel during fetal development
20
Q
define double inlet left ventricle
A
large L ventricle and small R ventricle such that both atria are connected to the L ventricle
21
Q
define double outlet right ventricle
A
both the aorta and pulmonary artery connect to the R ventricle, instead of the L ventricle
22
Q
define hypoplastic left heart syndrome
A
L side of the heart is underdeveloped and the aorta is reduced in size
23
Q
Tet / Hypercyanotic spells lead to significant increases in…
A
R to L shunting via VSD
24
Q
6 causes of Tet Spells:
A
(1) crying
(2) stooling
(3) feeding
(4) stressors
(5) dehydration
(6) fever
25
what is caused by an acute, febrile, systemic vasculitis?
Kawasaki Disease
26
How do you diagnose Kawasaki Disease?
Fever for 5 or more days + 4 of the following:
(1) nonspecific skin rash
(2) eye conjunctivitis
(3) buccal erythema and fissured lips; strawberry tongue
(4) cervical lymphadenopathy
(5) palmar erythema / swelling
27
most childhood cancers arise from the ___
mesoderm
28
cancer survival rates have increased to ___
85%
29
___ is associated with low birthweight / long-term TPN use
hepatoblastoma
30
cancer treatment effects in peds vs. adults
peds: decreased acute toxicity; increased long-term effects
adults: increased acute toxicity; decreased long-term effects
31
the two most common short-term effects of chemo are...
(1) bone marrow suppression
(2) mucositis
32
what are the 4 short-term effects of cancer?
(1) bone marrow suppression
(2) mucositis
(3) N/V
(4) hair loss
33
name the 5 long-term effects of chemo
(1) cognitive delays
(2) hearing problems / deficits
(3) cardiac, pulmonary, GI, and renal issues
(4) fertility and endocrine issues
(5) second malignancies
34
4 ways to manage mucositis...
(1) oral care BID
(2) special rinses
(3) pain management
(4) maintain intake
35
name at least 3 ways to manage neuropathies
(1) pain meds for neuropathic pain
(2) footboard to prevent foot drop
(3) high-top shoes
(4) encourage mobilization
36
if you are going to give a laxative, you also need to give a ____
stool softener
37
___ and ___ cancers have very poor patient outcomes
DIPG; high-grade gliomas
38
severe neutropenia is when neutrophil count is
<500
39
thrombocytopenia is when platelet count is
<25,000
40
anemia with a hgb < ____ requires a transfusion
7-8
41
if sickle cell is not treated, it can lead to:
(1) dehydration
(2) hypovolemic shock
(3) CVA
(4) stroke
(5) acute chest syndrome
42
jaundice, hematuria, headache, and SOB are s/s of ___
sickle cell
43
the key nursing education for hemophilia is
teaching parents how to administer exogenous factor and blood products
44
anterior pituitary secretes
(1) ACTH
(2) FSH
(3) LH
(4) TSH
(5) Prolactin
(6) GH
45
posterior pituitary secretes
(1) vasopressin
(2) oxytocin
46
what are the causes of congenital hypothyroidism?
(1) underdeveloped thyroid gland
(2) poor TSH secretion by the pituitary
47
name at least 4 s/s of congenital hypothyroidism
(1) hypotonia
(2) large tongue
(3) slow reflexes
(4) large anterior fontanelle
(5) skin mottling
(6) distended abdomen
48
the key risk associated with congenital hypothyroidism is ____
irreversible cognitive impairment
49
____ is an autosomal recessive disorder
congenital adrenal hyperplasia
50
the 4 s/s of congenital adrenal hyperplasia are:
(1) dehydration
(2) hyponatremia
(3) hyperkalemia
(4) failure to thrive
51
salt wasting and ambiguous female genitalia are effects of
congenital adrenal hyperplasia
52
coarse hair, fatigue, and constipation are s/s of
acquired hypothyroidism
53
tachycardia, weight loss, loose stools, and tachypnea are s/s of
acquired hyperthyroidism
54
what is the effect of acquired precocious puberty?
causes growth limitations
55
how do you treat GH deficiency?
(1) daily SubQ GH injections
(2) support body image / self-esteem
56
the onset of hypoglycemia is ____
rapid
57
hypoglycemia in peds is blood glucose of ___
<60 mg/dL
58
hyperglycemia in peds is blood glucose of ___
>160 mg/dL
59
emotionally labile, headache, and hunger are changes related to ____
hyperglycemia
60
onset of DKA is
slow
61
will UO in DKA be increased or decreased?
decreased
62
sunken eyes, increased HR, and increased RR are s/s of
DKA
63
DKA blood glucose in peds is ___
>200 mg/dL
64
short-acting insulin peak
30-60 minutes
65
regular insulin peak
2-3 hours
66
NPH insulin peak
10-14 hours
67
lantus is a ___ insulin
long-acting
68
apidra is a ____ insulin
rapid-acting
69
which is NOT part of the TOF?
a. VSD
b. overriding aorta
c. PDA
d. right ventricular hypertrophy
c
69
T/F: After a repair, VSD stil has a high mortality rate
False
70
what are IV prostaglandins used for during pre-op for D-TGV?
keep the PDA open
71
avoid strenuous exercise with which cardiac abnormality?
long QT syndrome
72
what position is used to treat a Tet spell?
knee-chest
73
following heart surgery requiring sternotomy, the RN should instruct the caregivers NOT to...
pick up the child under the arms
74
T/F: all pediatric heart murmurs are pathologic
F
75
which of the following is not a function of the endocrine system?
a. stimulates mature immunity
b. regulates growth and development
c. metabolism regulation
d. enables sexual reproduction
a
76
what part of the body is the main regulator for hormone regulation?
pituitary
77
name at least 3 s/s of Grave's disease
(1) weight loss
(2) heat intolerance
(3) weakness
(4) increased HR
78
a child has a low sensory threshold, high anxiety, and poor reaction to stimuli. what is the most likely diagnosis?
autism spectrum disorder
79
a child has oppositional defiant disorder. which should you assess for?
a. child abuse history
b. diet
c. physical activity
d. ability to perform well in school
a
80
a break in which bone is most indicative of a pattern of abuse?
rib
81
a nurse is most concerned with which as a potential sign of abuse?
a. 2-week old with flat, dark blud/gray discoloration on sacrum
b. 2.5 yo with tibia fracture
c. 15-month old with bilateral bruising on shins
d. 18-month old with bilateral bruising on outer ears
d
82
with esophageal atresia (EA) and tracheoesophageal fitula (TEF), think:
regurgitation, coughing, constant saliva
83
congenital diaphragmatic hernia requires ____
mechanical ventilation
84
oomphalocele & gastroschesis is when ___
baby is born with some abdominal contents outside their body
85
imperforate anus is when ___
opening to the anus is completely missing, misplaced, or closed off
86
sources of fluid loss in children include:
(1) higher body SA
(2) higher RR
(3) higher metabolic rates
87
the 4 red flags in diarrhea are
(1) blood
(2) fever
(3) poor growth
(4) severe belly pain
88
with Crohn's, think...
constipation, night sweats, tenesmus, loss of menstrual cycle
89
with UC, think...
pus or blood in stools; rectal bleeding
90
with appendicitis, think...
RLQ pain
91
with short bowel syndrome (SBS), think...
watery stool, failure to thrive or gain weight b/c can't absorb anything
92
oral thrush is common in
(1) infants
(2) immune disorders
(3) diabetes
(4) abx overuse
93
hand foot mouth treatment is ___
supportive care; no actual treatment
94
what are the precautions for fifths disease?
droplet
95
high fever and flat rash on trunk and neck is ____
roseola
96
strawberry tongue, sore throat, and high fever is ___
scarlet fever / strep rash
97
Spinosad, Malathion, and Ivermectin are used to treat ___
head lice
98
congenital heart defects typically occur in ____ weeks of fetal life
4th to 7th
99
what is the function of the ductus venosus in fetal circulation?
allows oxygenated blood to bypass the liver
100
is the pulse oximeter reading an arterial saturation or a venous saturation?
arterial
101
____ allows blood flow around a blocked artery and protects the heart tissue from injury
collateral circulation
102
at what phase of the cardiac cycle are the coronary arteries perfused?
diastole
103
how do we manage PDA in premature infants and larger kids?
premature infants - fluid restriction, diuretics, digoxin, indomethacin
larger kids - occlusion / surgery
104
ASD and VSD lead to...
an increased workload on the R side of the heart
105
___ and ___ determine the magnitude of symptoms of VSD
size of defect; pressure in the lungs
106
Insulin considerations
(1) clear before cloudy
(2) roll don't shake
(3) keep in a cool dark place / refrigerate
(4) site rotation
(5) abdomen is fastest absorption
(6) thighs / vastus lateralis is slowest absorption
107
why does indomethacin work for PDA?
because it's an NSAID that stops the production of prostaglandins
108
name at least 3 s/s of tet spells
(1) tachypnea
(2) dyspnea
(3) cyanosis
(4) lethargy
109
Highest survival rate cancers are
(1) non-Hodgkin's lymphoma
(2) Hodgkin's lymphoma
(3) acute lymphoblastic leukemia
(4) Wilms tumor
110
main consideration for monoclonal antibodies is...
pain management because it's very painful!
111
what population do you not want to use radiation with?
children under 3 yo b/c it harms developing cells
112
VSD is often present in _____
double outlet right ventricle
113
in hypoplastic left heart syndrome, blood flow to the body is supplied by ____
ductus arteriosus
114
how do you treat Kawasaki Disease?
(1) anti-inflammatory meds - high-dose aspirin
(2) 6-8 weeks of low-dose aspirin to prevent clots
(3) IVIG w/in 10 day of symptom onset
115
we administer IVIG within 10 days of symptom onset in Kawasaki Disease to...
help prevent the disease from affecting the coronary arteries
116
low-dose aspirin is provided in Kawasaki Disease to...
prevent clots in coronaries
