Final Flashcards

Question

Bodily harm Safety: School age- adolescent (5)

Answer 1

- protective equipment during sports - locked firearms - window guards to prevent falls - teach address, phone, and stranger safety - no trampoline in under 6 yr olds

Answer 2

- Abstract thinking/ imaginative - use analytical thinking to make decisions - Able to think through more than 2 variables concurrently - Evaluate own thinking and others (Able to understand how actions/factors influence others) - Idealistic

Answer 3

Identities - Personal sense of identity (coherent picture of past, present, future; autonomy from parents) - Group identity with peer group (best friends, rejection of adult group; very important) - sexual identity (Increased interest in romantic relationships, may experiment, body image)) Concepts - View themselves as invincible

Answer 4

- Non-violent video games and music - Social Media - Sports - pets - Career training programs - Reading - Social events- dances, movies, football games

Answer 5

- Poor school performance - Lack of interest/ Social isolation - Sleep or appetite disturbances (should get 9 hrs) - Expression of suicidal thoughts (suicide 3rd leading cause of death; screen ALL)

Answer 6

Equation: √((ht (cm) x wt (kg))/3600)) Units: m2

Answer 7

3mo-2 yrs Resting (awake): 80-150 beats/min Resting (sleeping): 70-120 beats/min 2yrs-10 yrs Resting (awake): 70-110 beats/min Resting (sleeping): 60-90 beats/min 10 yrs+ - 60-100 beats/min

Answer 8

1-11 mo: 30-60 breaths/min 2-6 yrs: 21-25 breaths/min 8-10 yrs: 19-21 breaths/min

Answer 9

1-2 yrs: 90/56 mm hg (measured starting at 3 routinely OR for critical care) 5 yrs: 95/56 mm Hg 10 yrs: 102/62 mm Hg 14 yrs: 110/65 mm Hg Discrepancy: Coarctation of the Aorta

Answer 10

- Warm, child-friendly room - Include time to play and become acquainted - auscultate heart, abdomen lungs early before child disturbed (infants- toddlers) - Perform distressing procedures near the end of the exam (ears and mouth; areas of pain; temp and BP) - offer choices if they exist - be quick and efficient but do not rush - record in head to toe but perform in developmentally appropriate sequence

Answer 11

- able to participate by age 7 yrs - most of information is obtained from adult present (dont assume person is mom or dad)

Answer 12

- perform with child on parent's lap (or hold confidently - assess mouth while crying - talk in quiet, unhurried, nonthreatening voice (may need high-pitched voice and smiling)

Answer 13

- Allow to sit on parent’s lap or stand near parent - Use play- count fingers, tickle toes, who can i see in here today (ears) - Introduce equipment slowly (let them play with it first; hide scary equipment) - Have parent remove outer clothing, leave underwear on until needed to remove - Explain things concretely and short sentences - Praise for cooperative behavior and use rewards

Answer 14

- Prefer parent’s closeness (Can be standing and/or sitting) - If cooperative (usually like to please), can examine head to toe - Request self-undressing. Leave underpants. - Demonstrate and let child examine equipment - Paper doll technique (demonstrate first on doll then child)

Answer 15

- Examine head to toe, genitalia last - Self-undressing, keep on underwear, provide a gown - Explain exam and findings to the child (include long-term benefits for adolescents) - Teach about body functions and care (esp sexual development) - Respect need for privacy/modesty (May or may not want parent present) - encourage them to share feelings and ask questions

Answer 16

Stepping-0-4 weeks, Sucking/rooting, palmar grasp, Moro (startle), tonic neck (fencing), 3-4 months Plantar grasp-0-8 months Babinski- 0-1 year (fanning of toes) If they do not disappear, sign of CNS impairment

Answer 17

Normal: feel soft and flat Bulging w/ crying, vomiting, increased ICP sunken w/ dehydration

Answer 18

Expected Findings - cerumen in ear - newborn blinks to sound - infant turn to sounds Unexpected Findings - foreign bodies in ear - ear infections (more common than in adults b-c close proximity Procedure - pinna down and back if under 3 (up and back if older than 3) - examine hearing in children with speech delays - use whisper test up until preschool

Answer 19

Expected - depth perception around 7-9 months (mature around 2-3 yrs) - binocularity around 6 wks (esp by 4 months) - visual acuity 20/40 in toddlers Procedures - visual screening for 3 and up (non-letter alternative to snellen for young children) - corneal light reflex test AND cover-unconver test for strabismus - check for red reflex - hold head for H test in young children

Answer 20

Expected Findings - sinus arrhythmia (HR increases w/ inspiration, sleep, waking) - S2 split on inspiration - apical pulse at 4th ICS for under 7 yrs, 5th ICS for over 7 yrs Unexpected Findings - weak lower pulses (COA) - murmurs (range from innocent (no problem) to organic (physiological conditions)) Tips - evaluate while sitting and lying down - always use apical HR for 60 seconds if < 2 yrs (best while sleep for infants) - radial pulse okay after 2 yrs

Answer 21

Expected Findings - obligatory nose breathers (up till 4 months) - diaphragmatic breathing (children under 6-7 yrs) - irregular rhythm in infants - 1:2 AP to lateral ratio by 6 yrs (barrel and 1:1 in infancy) - Hiccups Unexpected Findings - s/s of respiratory distress - allergic salute in allergy season Tips - take RR for 60 seconds - hold feeds if newborn > 60 breaths/min - take RR at end of each cry if crying b-c takes deep breath

Answer 22

Expected Findings - protuberant abdomen (large liver= fast metabolism/drug usage in toddlers) - umbilical hernia in infants Unexpected findings - sunken abdomen may be dehydration or malnutrition Tips - ticklish so place your hand over theres at first - flex knees to relax abdomen

Answer 23

Expected Findings - genu varum (bow legged) in infancy till 18 months - genu valgum (knock kneed) around 2-7 yrs Unexpected Findings - scoliosis (screening school age and beyond via leaning forward w/ knees straight) - hip dysplasia ( seen in infants via ortolani sign and barlow signs) Procedures - For leg discrepancy, compare level of malleoli OR child trendelenburg sign (place hands on illiac crest from behind and should be level) - Romberg test (child close eyes and remains standing straight for 20 sec) for coordination

Answer 24

Expected - bruising on legs when learning to walk - cyanotic extremities in newborn for first few hrs - thin skin in young children (use tape w/ caution) Unexpected - bruising on padded areas (abdomen) - diaper rash Tips - turgor on above clavicle for school age - turgor on abdomen for infants-preschool

Answer 25

- smaller and shorter airway - short straight eustachian tube - increased infections from 3-6 m when maternal antibodies leave and waiting for infant antibodies

Answer 26

- Retractions - Irregular sounds: wheezes (high pitched), stridor - Head bopping - Nasal flaring (unable to breath w/ an occluded nostril) - Mucus-y poops - Gargled speech - excessive crying - nonproductive cough

Answer 27

- Inflammatory response -> airway remodeling - Accumulation of secretions -> hypoxemia - Bronchoconstriction (Spasm of bronchi and bronchioles) -> respiratory acidosis

Answer 28

- Hacking, paroxysmal, irritative and nonproductive Cough (especially at night or early morning due to bronchial edema) - Frothy, clear, gelatinous sputum (as secretions increase) - Coarse and loud breath sounds (sonorous crackles, rhonchi, wheezing) - Prodromal itching at front of neck or upper back (seen in some children) - absent air movement and air hunger (no breath sounds, chest tightness)- medical emergency b-c sign of ventilatory failure - limited speech (unable to say more than 5 words) and anxiety - barrel chest (if repeated)

Answer 29

- frequent assessment (esp pulse ox, lung sounds, breathing) - give oxygen (nasal cannula, face mask, blow by) - Calm environment and reassurance - encourage deep breathing (via games like blow out candles or big bad wolf) - give medications (bronchodilators then steroids; use spacer for better coordination) - suction as needed (mouth then nose)

Answer 30

- Intermittent <= 2 days a week - Mild persistent: > 2 days a week, but not daily - Moderate persistent: daily, night-time symptoms 3-4 times a week - Severe persistent: several times a day, continual symptoms, night-time symptoms more than once a week less than 5 or nightly greater than 5; Use beta agonist several times a day

Answer 31

- Chest x-ray (may show hyperinflation or infiltrates)) - Pulmonary Function Test (includes spirometry (5 yrs +), bronchoprovocation (direct exposure to antigens), exercise tolerance) - Allergy Testing (skin, Eosinophilia levels, IgE levels) - ABG

Answer 32

- Peak flow meter (used in 5+ to manage asthma by measuring max flow of air forcefully exhaled in 1 second) Levels Green– keep doing regular acitivities Yellow- may need extra treatment Red- call provider or EMS

Answer 33

- Avoid triggers ( house and outdoor allergens, smoke, temp extremes) - Adherence to preventive medications (anti-inflammatories and LABA) - Exercise (best is swimming) - Hyposensitization/ allergen immunotherapy - Breathing exercises - Peak Flow Meters - use dehumidifiers or air conditioners

Answer 34

Cromolyn sodium - maintenance for 2+ Glucocorticoids (Prednisolone, Methylprednisolone) - first line for 5 yr + - usually inhaled for maintenance; systemic for acute exacerbation - may cause thrush or stunt growth Anti-leukotrienes (montelukast sodium) - for moderate persistent asthma in 12m _ Monoclonal antibodies (omalizumab) - for moderate to severe persistent in 12 yr + - black box warning for anaphylaxis so monitor for 2 hrs

Answer 35

SABAs (Albuterol, Terbutaline) - for acute relief or prevent EIB LABAs (Salmeterol) - never monotherapy, use w/ corticosteroid Anticholinergics (ipratropium, atropine) - anticholinergic effects (dry mouth, no secretions, blurry vision) - for acute relief

Answer 36

Cause: viral Key s/s: open mouth breathing (up to 3 yrs), chilling sensations The Do's - supportive care b-c no cure (raise HOB, suctioning, vaporization, acetaminophen) - reassure family colds are common till age 5 - monitor for complications (fever, dehydration, ear infection) - rule out strep The Don'ts - OTC cough suppressants (dextromethorphan w/ caution in 6 yrs and up) - Expectorants, antibiotics, antihistamines are not used

Answer 37

Patho: small airways become obstructed -> emphysema and patchy atelectasis at bronchiolar level Key s/s: - rhinorrhea - apnea (first sign in infants under 1 months besides lethargy and irritability) - low fever Prevention-palivizumab (monoclonal antibody) once a month IM (given in NICU) The Dont's of treatment - avoid Routine chest percussion and drainage - Fluids by mouth may be contraindicated - Bronchodilators rarely beneficial - no antibiotics b-c viral

Answer 38

Causative Agent: GABS S/s - pharyngitis (inflamed tonsils) - cervical lymphadenopathy - scarlet fever (erythematous sandpaper-like rash) Main risks - rheumatic fever (inflammatory of heart, CNS, joints)-- within 18 days - acute glomerulonephritis-- within 10 days

Answer 39

Contraindications: bleeding disorders, cleft palate, acute infection, under 3-4 yrs (b-c hypertrophy of lymphoid tissue possible) Post-op care - Pain management-meds (always give PO meds before IV meds run out) and ice collar - Observe for complications (s/s of hemorrhage)- such as frequent swallowing, tachycardia, pallor, bright red emesis - position for fluid drainage (prone, side lying) - expect dark brown emesis (bright red is active bleeding) - full recovery in 1-2 weeks

Answer 40

Key S/s: coarse, dry, hacking cough worse at night Diagnostics: previous URI Treatments - symptomatic (rest, analgesics, antipyretics, humidity) - antibiotics if bacterial - cough suppressants (allow rest at night but interfere w/ secretion clearance)

Answer 41

Basic pathophysiology: thick, sticky mucus due to exocrine gland dysfunction Etiology: autonomic recessive (1 in 4 chance each pregnancy if both parents are carriers)

Answer 42

- newborn screen w/ sweat chloride > 60 mEq/L (normal is 40) - absence of pancreatic enzyme - stool fat analysis (72 hr) - family history

Answer 43

- usually BID - chest physical therapy (percussion, postural drainage, flutter/handheld percussor) - Positive expiratory therapy (PEP) - Breathing against resistance to keep airway open and get around mucus so it can be expectorated) - High-frequency chest compressions (HFCC)--vibration vest assists mucus breakdown and clearance) - Exercises (stimulate mucus excretion, muscle development, pulmonary vital capacity, and sense of well-being)- encourage sports - breathing exercises (deep breathing, bubbles)

Answer 44

Mucolytics (Dornase alfa) - decreases mucus viscosity - side effects are laryngitis and minor voice alts Antibiotics - long course so need PICC or implanted port - IV vancomycin, inhaled tobramycin Bronchodilators - give before Airway clearance therapy Oxygen - w/ caution b-c often have CO2 retention

Answer 45

- high-protein, high-caloric diet - decreased fat - increased sodium - needs replacement of fat soluble vitamins - may need gastric feedings at night (growth failure despite PN may = deterioration) - remain upright post-feed to prevent Gerd

Answer 46

- chronic pneumonia (thick sputum) - emphysema (barrel chest, clubbed fingers) - recurrent URI due to bronchial obstruction Severe - pneumothorax and atelectasis - hemoptysis (from recurrent infection, emergency if > 250 ml/24 hr) - nasal polyposis (due to chronic inflammation, may need irrigation or corticosteroids)

Answer 47

- meconium ileus (intestinal obstruction) or constipation -- need stool softeners - malabsorption syndrome in pancreas (leads to steatorrhea (bulky frothy stools) and azotorrhea (foul smelling stools w/ putrefied protein)) - Reduced digestive enzymes - Cystic-fibrosis Diabetes (common and need insulin) - Portal hypertension in bile and liver (due to biliary cirrhosis) - rectal prolapse - simple use lubricated finger to put back - Chronic GERD - use H2 antagonist and GI motility

Answer 48

Musculoskeletal - Failure to Thrive due to malnutrition - bone health concerns due to pancreatic insufficiency and steroid use -- may need growth hormones Reproduction - most males are sterile - mucus blocks cervix in females but pregnancy possible (higher risk for complications)

Answer 49

Causative Agent: bacterial (abrupt onset) Key S/s: - Absence of cough - Drool (painful swallowing) - Agitation - Tripod position (sitting upright and leaning forward w/ mouth open, chin out, and tongue protruding) - stridor Main risks: severe respiratory distress Diagnostics: cherry red epiglottis

Answer 50

Causative Agent: most common croup, viral Key S/s - barky, brassy cough and horseness (worse at night and w/ crying) - stridor - prior URI - Dyspnea (due to narrow airway from inflamed mucosal lining) Main risks: respiratory acidosis -> respiratory failure

Answer 51

Causative Agent: viral w/ allergic component Key S/s - recurrent paroxysmal nocturnal attacks of laryngeal obstruction (awakes in middle of night w/ barking cough that subsides the next day) - hoarseness may remain next day - no fever Treatments - humidity or cool night air - epinephrine for severe

Answer 52

Causative Agent: bacterial of trachea Key S/s - large, thick secretions - stridor in every position - no response to LTB therapy - no drooling Treatments - intubation - suctioning (endoscopy w/ HCP) - antibiotics (erythromycins) - antipyretics

Answer 53

- Shot, bee sting --- say poke - Deaden - Take your blood pressure - Stool - Test

Answer 54

- have clear liquids >2 hours - breast milk >4 hours and infant formula >6 hours before procedure (keep eye out for dehydration) - serve liquid in small container to give illusion of a lot - keep mouth moist w/ atomizer or ice chips - keep close eye on older children who may try to sneak liquids - do not leave fluids at bedside

Answer 55

- give by gravity - check placement w/ x-ray, pH, measure mark - use 5 or 8 french tip - do in quiet calm environment - use nonnutritive sucking to improve digestion

Answer 56

1. Do not give a child a choice of the medication. 2. Allow choices the child can have some control over 3. Do not lie, saying it won’t hurt or taste bad 4. Give worst meds last (prednisone = bad taste) 5. Give brief explanations 6. Tell the child is ok to be scared. 7. Always include the child and parent when talking during med administration. 8. Be confident and positive when approaching the child (Do not use baby talk, you can just change your intonation) 9. The younger the child the shorter time between explanations and administration. Involve the parent.

Answer 57

- orange tips = oral syringe - use nipple for infants to suck - chewables are good for preschoolers - give capsules w/ small amount of food or liquid - never mix in bottle b-c may not drink it all or not want to drink if nasty - place syringe on side of mouth (spraying at back can cause aspiration) - chase bad tasting w/ water, juice, ice pop (nondairy) - small puff in face can cause swallow reflex

Answer 58

Gauge: 22-25 Vastus lateralis and ventrogluteal Size: 5/8 - 1 inch Max volume: 0.5 for infant, 2 ml small child Deltoid Size: 1/2 - 1 inch Max volume: 0.5-1 ml

Answer 59

- assess site q1-2 hrs - use 22-24 gauge for small veins - usually by IV pump ( if bolus, 20 ml/kg okay) - children 5 and up can use PCA pump (family version available too) - Use superficial hand, wrist, forearm, foot, or ankle veins in small infants - Avoid foot veins in children learning to walk or walking - Use scalp veins in infants up to 9 months after other sites have failed

Answer 60

Enema - done if NPO due to vomiting or mental status - contraindicated in immunosuppressed or thrombocytopenia - max volumes (120-240 for infant, 240-360 small child) - No soapsuds Intraosseous - done in pediatric resuscitation if IV not possible after 3 attempts or 90 seconds

Answer 61

- Axillary preferred in infant to 2 years - Rectal temps if accuracy needed (age over 1 month) - 2-5 years axillary or TM - Can take orally when child can hold under tongue (5+)

Answer 62

* NIPS- Neonatal Infant Pain Scale-birth -1 month * FLACC Pain Scale- 2 month -7 years Face Legs Arms/Activitiy Crying Consolability For non-verbal child * Oucher Scale 0-5 scale; have child place faces in order then choose * Faces Pain Scale- 3 years and older * Numeric Pain Scale- Children 5 -7 years and older

Answer 63

Infants - Pre-verbal (physiologic response, crying, difficulty sleeping, feeding, relaxing) - Facial expression most reliable - Older infant may push or pull away Toddlers - loud cry - words that indicate pain - stay very still

Answer 64

- verbal report as young as 3 yrs for pain, location, and degree - Views pain as a punishment for thoughts/behavior - Regression to earlier behaviors (bed wetting, thumb sucking, crying, kicking) - Denies pain – fear of pain relieving measures “shots” - Avoid telling child to be “brave” or good boy or girl after procedure - Fears body mutilation (Need all their parts; Band-aids are important, magical thinking)

Answer 65

School-age - Describes pain and can quantify intensity (if scale is explained in simple terms) - Awareness of death - Bargains or tries to “make a deal” (I’ll let you change my dressing after this tv show) Adolescent - understands cause and effect - quantifies and describes pain

Answer 66

- Ice - Vapocoolant Sprays (may cause some constriction or may not be liked) - TENS units (stimulate nerves above location) - EMLA (eutectic mixture of lidocaine) cream- or Lidocaine- apply 60 minutes before poke) - Shot Blocker or buzzy (yellow thing which blocks some of the nerves or (distracts nerves) - sedation for infants or young children sometimes - change needle if pierced rubber stopper - apply pressure 10 sec before

Answer 67

Infants - Nonnutritive sucking (pacifier, Sweet ease) - touch, holding, rocking Toddlers and preschoolers - distraction (books, videos, music, bubbles--use child life) School-age and Adolescents - guided imagery - breathing exercises

Answer 68

- emancipated minors or parents of children give informed consent - assent given by children over 7 which says they permit and understand the procedure but this is not legally binding

Answer 69

- Use calm and neutral words (here I go vs here comes the sting) - Do not give in Dorsogluteal site (potential for nerve damage and less immunity) - give multiple immunizations at same time in separate sites or at least 1 inch apart - Do not manually stimulate injection site - children do not need to restart series after dose missed, just continue where they left off - vastus lateralis (preferred) or ventrogluteal (okay for 2m+) - wake up sleeping children or may fear going back to sleep

Answer 70

- Emotional well-being (coping, mood regulation, mental health, sexuality, Suicidal ideation) - Physical growth and development (physical and dental health, body image, healthy nutrition, physical activity) - Social and academic competence (relationships with peers and family, school performance, interpersonal relationships) - Risk reduction (tobacco, alcohol, other drugs, pregnancy, STIs)-- important in adolescence b-c risk taking behavior - Violence and injury prevention (safety belt and helmet use, substance abuse and riding in a vehicle, interpersonal violence, bullying)-- encourage safe driving

Answer 71

- Moisturized air (useful with hoarseness or laryngeal involvement) for 10-15 minutes - Steamed vaporizers, kettles, and boiling water are discouraged - Steam in shower is good method - Use nasal aspiratory or bulb syringe for young infants before feeding and sleeping - Saline nose drops (1/2 tsp salt, 1 cup water) useful - Topical vapor rub for 2 yrs and older ( never give orally or under the nose)

Answer 72

Causative Agent: viral or bacterial, often w/ pharyngitis S/s - edematous tonsils (difficult breathing, swallowing, hearing (if adenoids)) - snoring and mouth breathing (noctural dyspnea) - foul mouth odor - persistent cough Treatments - Saline gargles, lozenges, non opioid pain meds - soft to liquid diet - If severe and not resolved by other methods, tonsillectomy or adenoidectomy

Answer 73

Diagnostics: rapid test to screen for strep and do throat culture if screen negative Treatments - Warm saline gargles - Penicillin or macrolide antibiotic (infectious for 24 post initiation of antibiotic; no longer contagious after 24 hrs so can return to school) - unless viral - cool drinks and foods (ice cream, ice chips) - chloraseptic or acetaminophen or ibuprofen, for pain (liquid or chewable)

Answer 74

The Dont's Post-op - Avoid fluids until child alert and can swallow - Citrus juice can cause discomfort - Milk, ice cream and pudding not offered until clear tolerated because can cause child to clear throat - Avoid gargle, coughing, suctioning, straws, nose blowing - No red products or red dyes in fluids

Answer 75

Causative Agent: EBV, viral Key S/s: - Sore throat (Exudative pharyngitis w/ petechiae) - Lymphadenopathy - Hepatosplenomegaly Main risks: neurological (meningitis, seizures), Severe S/s to report to HCP - severe sore throat (unable to eat or drink) - severe abdominal pain - difficulty breathing - respiratory stridor

Answer 76

Diagnostics - heterophil antibody test (positive up to 6m post exposure in 4 yrs and up) - mono spot test (earlier diagnosis) - increased WBC (atypical leukocytes) Treatments - symptomatic (mild elixir analgesic, gargles, troches, warm drinks) - corticosteroids - avoid strenuous activities (contact sports until splenomegaly resolved) - contagious (just don’t share hygiene products and drinks) - viral so no antibiotics

Answer 77

Treatments - maintain airway (prep for intubation) - keep calm (in parent's lap) - give IV cephalosporins (Ceftriaxone/cefotaxime or vancomycin ) - do not examine throat if suspected (need provider and resuscitation equipment prior to throat exam) - Humidified oxygen via mask or blow-by to reduce agitation - Corticosteroids (can reduce edema early) - Droplet precautions 24 hrs after initiation of antibiotics Prevention: Hib vaccine

Answer 78

Treatments - Cool mist (or cool car ride if no stridor at rest) - Racemic Epinephrine Tx (short-term relief for moderate or severe croup—rapid onset but short duration) - Frequent assessment - Corticosteroids (dexamethasone PO)—standard treatment - Heliox (helium with oxygen): moderate to severe croup - Avoid aggravating child b-c can worsen respiratory distress

Answer 79

- Contact or droplet Isolation- lives 1 hr on hands - Ribavirin-antiviral agent- inhalations (VERY DANGEROUS so limited use) - Heated high-flow nasal cannula (HHFNC)- extra humidity with oxygen administration and CPAP - CPAP, BiPAP, or intubation required if respiratory acidosis present) - Suctioning (Nasal aspiration with aspirator to remove secretions; best treatment) - IV fluids for acute phase - Nebulized Hypertonic (3%) saline for those hospitalized more than 3 days to help w/ mucociliary clearance

Answer 80

Status Asthmatics: an episode of severe asthma that does not respond to normal treatment. S/s: profuse sweating, sitting upright and refuses to lie down Treatment - same as asthma (cardiorespiratory and pulse oximetry monitoring, humidified oxygen, Inhaled SABA, systemic corticosteroid, anticholinergic) - IV magnesium sulfate (Muscle relaxant to decrease inflammation and improve pulmonary function) - Heliox (helium and oxygen)- decreases airway resistance and work of breathing via nonrebreathing face mask - Ketamine (Dissociative anesthetic causes smooth muscle relaxation)

Answer 81

Pancreatic Enzymes (Pancrease) - enteric-coated given at every meal and snack (powder form in applesauce for infants) - increase dose if fatty stools Nebulized hypertonic saline - only for 6 yrs + and severe b-c may cause bronchospasms - increases mucus clearance and airway hydration CFTR Modulator (cystic fibrosis transmembrane conductance regulator)-- Ivacaftor - for 2 yrs and up w/ specific mutation - reduces likelihood of sticky mucus development

Answer 82

Optic - put pressure on lacrimal duct after administration for 1 minute to wash tear duct and prevent medicine from draining into body - ointment goes inner to outer canthus - give drops prior to ointment (3 mins apart) - if eyes clenched, put in nasal corner and it will go in once eyes open Otic - warm to room temp to prevent vertigo Nasal - hyperextend head to prevent strangling sensation from trickling

Answer 83

Cerebral edema- increased brain size, fluid accumulation Increased intracranial pressure- sustained pressures, trauma, Decreased cerebral perfusion pressure (bleeding r/t hemorrhagic stroke)

Answer 84

Increased systolic blood pressure (widened pulse pressure) Decreased pulse rate (bradycardia) Decreased respirations (irregular) Note: effects opposite those of shock

Answer 85

Indications - Glasgow Coma Scale score < 8 - TBI w/ abnormal CT scan - Deteriorating neurological condition - Subjective judgment regarding clinical appearance and response Care - Do not change dressings daily - keep drainage bag for direct ventricular pressure measurement at level of ventricles

Answer 86

- Skull fracture (requires great force) - Contusions: visible bruising coup (at impact pt) OR contrecoup (opposite impact pt)-- shaken baby syndrome - Intracranial hematoma - Diffuse injury - Laceration (tearing of tissue) - Concussion (alteration in neurologic function w/ or w/o loss of consciousness; may have amnesia/confusion but transient)

Answer 87

Epidural hemorrhage (death likely) - Bleeding b/w skull and dura lead to tentorial herniation rapidly Subdural hemorrhage - Bleeding b/w dura and arachnoid membrane over brain due to vein tearing or direct trauma - slow development Cerebral edema - Associated with TBI - Increased cytotoxic or vasogenic edema leads to herniation

Answer 88

Basilar: post- Battle sign (bleeding posterior neck, mastoid area), raccoon eyes, leakage of CSF from ears and nose Diastatic: transverses the sutures and widens sutures. Comminuted: split into multiple pieces Linear: does not cross suture lines Open: leads to rhinorrhea or otorrhea of CSF Depressed: locally broken into irregular fractures

Answer 89

- Neuroimaging (MRI, CT) (Check for allergies if contrast dye to be used; child must be still) - Skull radiograph - EEG (flat = brain death) - Brain biopsy - Lumbar puncture (contraindicated w/ increased ICP; lie still)-- diagnostic for meningitis - Lab tests (hyperglycemia in increased ICP; low HCt, low Platelet, high WBC in head injury)

Answer 90

Poor feeding High-pitched cry, difficult to soothe, irritable Tense, bulging fontanels Separated cranial sutures (increased frontooccipital circumference) Distended Scalp veins Macewen (cracked-pot) sign (Bones of skull thin and sutures palpably separated to produce cracked-pot sound on percussion of skull Setting-sun sign (Sclera visible above iris due to eyes being rotated downward)

Answer 91

- Headache - Forceful NV - Seizures - Irritability - Diminished physical activity (drowsy, lethargy, Inability to follow simple command) - Slurred speech - Visual changes (diplopia, blurred vision) - Inappropriate for age reflexes i.e. primitive and babinski)

Answer 92

Bradycardia Decreased motor response to a command Decreased sensory response to painful stimuli Alterations in pupil size and reactivity Decortication (Rigid flexion w/ arms close to body, flexed elbows and wrists, plantar flexed feet, legs extended & internally rotated) Decerebrate (rigid extension and pronation of arms and legs, flexed wrists, clenched jaw, extended neck; arched back) Cushing’s triad-decreased HR. RR. & widening or increased BP (pulse pressure) Cheyne-Stokes respirations (prolonged apnea, paradoxical chest movement, ataxic breathing, hyperventilation) Papilledema (optic disc swelling, hemorrhages, tortuosity of vessels, absence of venous pulsations)- develops in 24-48 hrs

Answer 93

Full consciousness Confusion: impaired decision making Disorientation: to time and place Lethargy: sluggish speech Obtundation: arouses with stimulation; respond to voice or pain Stupor: responds only to vigorous and repeated stimulation Coma: no motor or verbal response to noxious stimuli i.e voice nor pain Persistent vegetative state: permanent loss of function of cerebral cortex

Answer 94

- ABC (vitals q15 mins) - NPO - neck stabilization(use jaw thrust vs chin lift for airways) - minimize environmental noise, stimulation - reduce suctioning - position (HOB 30 degrees and avoid neck vein compression) - Prevent straining i.e. cough, vomit, defecation, Valsalva maneuver - Use vibration instead of cough b-c it does not increase ICP - provide thermoregulation (light covering, antipyretics, hypothermia blanket)

Answer 95

- Stool softeners - Analgesics (pain increases ICP but pain meds decrease LOC so controversial; acetaminophen, NSAIDs, opioids, paralytics (vecuronium))) - IV hypertonic NS (no dextrose if on keto; avoid overhydration) - manage SIADH (NS and diuretics) or DI (vasopressor or fluid replacement) if present - corticosteroids (for inflammation and edema)- watch for hyperglycemia, infection; don't give if for head trauma - osmotic diuretic (Mannitol) - reduce ICP

Answer 96

Antiepileptics –phenytoin, fosphenytoin, Carbamazepine (Tegretol) - Look for CBC changes and SJS - used for seizures Sedation or amnesic anxiolytics (Propofol, Lorazepam) - agitation can increase ICP Barbiturates (controversial)- induce coma to decrease metabolic rate and protect brain when reduced cerebral perfusion pressure Paralytic agents

Answer 97

- Impaired absorption, production, or flow of CSF within the subarachnoid space - Communicating or non-communicating (obstructive) - Increased CSF in ventricles leads to dilated ventricles and compresses brain tissue

Answer 98

Complications: infection, malfunction, subdural hematoma, peritonitis Nursing care - keep head flat to prevent rapid drainage (flex head prior to shunt placement; place on unoperated side - shunt is for life and revised when growth - do not pump shunt - educate family on name and model of shunt - no scalp IVs - test any drainage for glucose (CSF leak)

Answer 99

Infections: Septicemia, Bacterial endocarditis, Wound infection, Meningitis Treatment - massive-dose antibiotics - shunt externalization (at level of auditory meatus, clamp during ambulation) - shunt removal

Answer 100

Acute inflammation of the meninges and CSF which spreads via vascular dissemination (due to Hib, GBS, Meningococcal) Seasonal variation: late winter and early spring Prevention: Hib vaccine; prophylaxis in pregnancy Diagnosis: Lumbar puncture unless increased ICP then CT scan Severe complications: seizures, subdural effusions, deafness (from CN VIII damage), sepsis, obstructive hydrocephalus, hemiparesis (r/t thrombi in veins)

Answer 101

* Fever, chills * Nuchal rigidity * Photophobia * + Brudzinski’s sign (neck stiffness causes hip and knees to flex when neck flexed) * + Kernig's sign (unable to straighten leg >135 degrees w/o pain) * Joint problems * s/s of increased ICP (poor feeding, vomiting, irritability, seizures, high pitched cry)

Answer 102

CSF color: cloudy, turbulent, purulent ICP Pressure: elevated Culture: positive Presence of following in CSF: WBCs: elevated esp. polymorphonuclear leukocytes Protein: elevated Glucose: Decreased

Answer 103

CSF color: clear or slightly cloudy ICP Pressure: normal or elevated Culture: negative Presence of following in CSF: WBCs: elevated Protein: normal or slight elevation Glucose: normal

Answer 104

- Droplet isolation due to nasopharyngeal secretions - 10 day Antibiotic therapy (IV) - not for viral (GIVEN ASAP TO IMPROVE PROGNOSIS) - Control fever (hydration, antipyretics) - Pain management- meds - positioning (sidelying) - Reduce ICP (elevate HOB and decreased stimulation)

Answer 105

Causative organism: virus from vector (mosquitoes and ticks) Patho: inflammation of CNS by virus Key S/s: stiff neck, headache, Ataxia, speech difficulties (also fever, malaise, NV)

Answer 106

Tonic-Clonic seizures (grand mal and most dramatic) - Tonic (stiffening, eyes roll up) - Clonic (intense jerking w/ rhythmic contraction and relaxation longer than tonic phase Absence (petitt mal): Sudden onset of brief loss of consciousness (5-10 sec), blank stare and automatisms; does not fall Atonic (drop): Sudden, momentary loss of muscle tone Myoclonic: Sudden brief, shocklike muscle movements

Answer 107

- transient disorder of childhood (rare after 5 yrs of age) - fever > 38C (100.4 C) - treat w/ antipyretics and PRN benzos at home (alongside seizure precautions) - call 911 if > 5 min

Answer 108

- clusters of Jerking of tummy, raising arms, blinks, occur every 3- 5 seconds lasting up to 30 minute - abnormal EEG w/ hyperarrhythmia - treat w/ ACTH (monitor for immunosuppression, glucose, hypertension) OR prednisolone - treat w/ ketogenic diet (monitor ketones and glucose)

Answer 109

Drug therapy (ideally monotherapy for full control; slow discontinuation) Ketogenic diet (high fat, to preserve glucose) Vagus nerve stimulation (palliative, generator in chest sends electrical impulse to Vagus nerve (CN X) at onset of seizure after activation w/ magnet) Corpus Callosotomy (ligation of area via surgery)

Answer 110

- Time and record behavior surrounding Seizure - Keep patient safe – ABCs - Oxygen - Seizure precautions (no restrain, nothing in mouth during, suction equipment at bedside, ease to floor, ) - aspiration precautions (post seizure NPO and suction; place on side)

Answer 111

Diazepam or Lorazepam (Ativan) -oral, buccal, rectal, IV Fosphenytoin- (form of phenytoin) phenytoin (DILANTIN) - Do not take w/ milk - can cause gum hyperplasia Levetiracetam (Keppra) - rash and mood swings risk Carbamazepine (Tegretol) - SJS risk Phenobarbital - for status epilepticus - take adequate vitamin D and folic acid Valproic Acid - liver toxicity

Answer 112

- bones join together too early and surgery separates them (posterior fontanel < 8 wks; anterior fontanel < 12-18 months) Treatment: Surgery Complications: Edema, Bleeding (black eyes), Infection

Answer 113

Cause: giving aspirin or Pepto bismol to children with a viral infection S/s: cerebral edema, liver involvement Diagnostics: Liver biopsy (fatty liver) Complications: Coma, Brain herniation, Death

Answer 114

Primary parenchymal lung disease ( Pneumonia, meconium aspiration syndrome) -Problem is with O2 diffusion - Responds to increased FiO2 Primary cardiac disease - combo of decreased pulmonary flow and intracardiac mixing of “blue” and “pink” blood - Doesn’t respond much to increased FiO2

Answer 115

ECG - electrical activity of heart (assess child, not monitor; takes 15 min) ECHO -ultrasound of structure, size, blood flow through heart (takes an hr and child be still) Exercise/Stress test - monitor during exercise Syncope/ Tilt Table Test- determine cause of fainting (normal: BP stable, HR increases w/ horizontal to vertical position; positive: Pt passes out, hypotension, bradycardia/tachycardia w/ horizontal to vertical position due to heart or BV problem Cardiac MRI- still and moving pics of heart and major BVs to analyze structure and function (sedation for child < 7; contraindicated w/ metal implants (pacemakers, cochlear)

Answer 116

Diagnostic- prior to surgical repair – Right and/or Left cath. Right through vein, left through artery to Helps plan for procedures - Angiogram - visualize the arteries surrounding the heart w/ contrast dye and X-ray images Interventional – repair or other intervention Electrophysiology studies – evaluate and destroy (ablate) accessory pathways that cause some tachydysrhythmias

Answer 117

- Assess dye allergy (iodine) - Age-appropriate teaching (informed consent from parent) - NPO at least 4-6 hours (IV fluids for infants) - Assessment: VS baseline cardiopulmonary, perfusion, assess and MARK all pulses, height & weight - Sedation- oral or IV - Assess for infection may be postponed if severe diaper rash

Answer 118

- Monitor blood glucose (hypoglycemia possible), VS, dressing, I & O, continuous cardiac monitoring - Bedrest for 4-6 hr, Strict. - Keep affected extremity straight for 2hr, then limited ambulation for 3 days - avoid baths and activity for 48-72 hrs - HOB flat x 2 hrs, elevate 30˚ 2 hrs after completion of procedure. - Check cath site and distal extremity pulses, color and perfusion, q15 min x 4 occurrences, then q 30 min x 4 occurrences , then q1h x 3 h, - Pulse - normal to be weaker in affected extremity for a few hours - remove dressing in 24 hrs

Answer 119

- If bleeding, apply pressure at cardiac catheter entry site (2.5 cm above entry site) - swelling - hematoma - arrhythmia (possible and reason for monitoring) - fever

Answer 120

↑ Pulmonary blood flow - Atrial Septal Defect (ASD)* - Ventricular Septal Defect (VSD)* - Patent Ductal Arteriosus (PDA)* Obstruction of blood flow (out of the heart) - Coarctation of aorta* - Pulmonic Stenosis * - Aortic Stenosis ↓ Pulmonary blood flow - Tetralogy of Fallot (TOF)* Mixed blood flow - Transposition of Great Arteries/Vessels (TGA)* - Hypoplastic Left Heart Syndrome (HLHS)

Answer 121

- Abnormal connection between 2 sides of heart increased blood volume on R side - Left to Right shunt - Decreased systemic blood flow due to increased pulmonary blood flow

Answer 122

- If small, may be asymptomatic and close spontaneously - Fatigue (poor feeding, activity intolerance) - Heart Murmur - Risk for Endocarditis - Risk for pulmonary vascular obstructive disease - risk for CHF - Growth delay (FTT, poor weight gain)

Answer 123

Abnormal opening b/ atria so L-R shunt Key S/s - usually asymptomatic - murmur (systolic w/ fixed split-second sound) - atrial dysrhythmias (r/t RA and RV enlargement) - hypertrophy of right side Complications: HF by 30-40 yrs if untreated; embolism

Answer 124

Surgical- Pericardial/Dacron patch w/ cardiac bypass Non-surgical- Amplatzer Septal Occluder placed by cardiac cath (need Low dose aspirin x 6 months)

Answer 125

Abnormal opening b/w heart ventricles (most common defect) causing higher systemic resistance and ventricle pressure Key S/s - Murmur (loud, harsh)-- best heard at left sternal border - right side hypertrophy Complications: HF

Answer 126

Palliative- PA banding to decrease pulmonary blood flow Surgical- Patch (large defect) or suture w/ cardiac bypass- preferred Non-surgical- Device closure with catheterization; more risk than ASD for complete AV block

Answer 127

failure of fetal ductus arteriosus to close at birth causing shunt from aorta to pulmonary artery S/s: Murmur (machinery like), widened pulse pressure, pulmonary arterial HTN Complications: right sided hypertrophy

Answer 128

Medical - prostaglandins to keep PDA if other defects present (side effect = apnea) - prostaglandin inhibitors (Indomethacin (Indocin) or ibuprofen) in newborns closes PDA Nonsurgical - Coiling to occlude in cath lab for > 1 yr if small Surgery (if large) - Ligation of PDA with surgery (thoracotomy) - Thoracoscopic placement of clip

Answer 129

What keeps it open: - Low pO2/ hypoxia - Prostaglandins - Nitric oxide What constricts it? - O2 - Norepinephrine, acetylcholine, bradykinin - Indomethacin, ASA

Answer 130

- Localized narrowing near the insertion of the DA - Increased pressure proximal to defect (upper extremities); left ventricle and left atrium - Decreased pressure distal to the defect (lower extremities)

Answer 131

- bounding pulses in UE’s - Weak or absent LE pulses, cool LE’s - Heart failure (acidosis and hypotension) - HTN in UE shows as dizziness, fainting, headaches, epistaxis in older children - Risk for stroke - Risk for aortic aneurysm

Answer 132

Medical - Initially, may need Prostaglandin E to maintain PDA (palliative) Nonsurgical - Balloon angioplasty - stent placement for patency of aorta Surgical - end to end anastomosis with prosthetic graft or portion of L subclavian artery - Cardiac Bypass not required, thoracotomy incision used - give mechanical ventilation and inotropic support (Digoxin) pre-op - manage HTN post-op with meds (Nitroprusside or ACE inhibitors)

Answer 133

- VSD (pressure equal in right and left ventricles) - Overriding aorta (determines blood distribution) - Pulmonic stenosis (decreases pulmonary blood flow) - Right ventricular hypertrophy

Answer 134

- Mild to severe cyanosis at birth - Murmur - Clubbing - Polycythemia/clot formation (emboli) - Failure to thrive - Tet spells (anoxia with crying, feeding -- risk for seizures, loss of consciousness, emboli, death)

Answer 135

Palliative - during Tet spell, put in knee-to-chest OR squat position - BT shunt w/ subclavian artery Complete repair - Close VSD - Resect pulmonary stenosis and patch pulmonary valve stenosis to enlarge right ventricle outflow via bypass and median sternotomy

Answer 136

- PA leaves the LV - Aorta leaves the RV - Must have other defect to allow for mixing (patent foramen ovale, PDA, or VSD)

Answer 137

- Severe cyanosis at birth with minimum communication of saturated and desaturated blood unless large VSD or PDA - Symptoms of heart failure (pulmonary congestion) - Murmur (+/-) - Cardiomegaly within a few weeks

Answer 138

Medical - Prostaglandin E to maintain PDA and O2 sat ≥75% (side effect – apnea (likely need intubation/ventilator)) - IMMEDIATELY Nonsurgical - Balloon Atrial Septostomy (BAS; Rashkind) - cath lab Surgery - arterial switch in first few weeks of life (transection of great arteries and anastomosing pulmonary artery to aorta to establish normal circulation)

Answer 139

- Air filters on IV lines to prevent R→L shunt of air bubbles - Monitoring (Central/Arterial lines, Cardiac monitor and pulse oximeter, Chest tube (strip only if cardiac), Pacemaker on abdomen)) - Ventilator usually via nose - If murmur expected, you should hear it - Strict I and O (UOP > 1 mL/kg/hr; NPO if intubated) - Monitoring Labs (K+ (never bolus potassium!), Ca+) - do not lift by arms until 6 weeks post-op (scoop instead) - maintain thermoregulation (hypothermia possible post- op so use radiant heat warmer for infants

Answer 140

inability of the heart to pump an adequate amount of blood into the systemic circulation to meet metabolic demands Causes - structural abnormalities r/t blood volume and pressure in heart (heart defects) - Myocardial failure (cardiomyopathy, dysrhythmias, electrolyte imbalance (severe)) - excessive demands on heart muscle (Sepsis, severe Anemia)

Answer 141

- Prevent crying and keep them calm - thermoregulation (radiant warmer; shivering increases demand) - cluster care to prevent sleep interruption - semi-fowler positioning

Answer 142

- Monitor apical pulse - Hold if HR under 70 bpm in older child or 90-100 in young child/infant OR sig lower than previous reading - Do not repeat dose if vomiting, notify health care team if misses more than 2 doses - Give water after dosing to prevent tooth decay

Answer 143

Therapeutic Effect - Vasodilation decreases PVR and SVR (preload) - Decreased BP and afterload - Reduces aldosterone which prevents fluid retention Side effects: angioedema, Cough, hyperkalemia, hypotension, renal dysfunction Care: Check BP before and after administration

Answer 144

- Monitor potassium (s/s hypokalemia = muscle weakness, irritability, drowsiness, tachy/bradycardia) - Potassium supplements - K+ rich foods (bran cereals, potatoes, tomatoes, bananas, oranges, leafy veggies) - Daily weights, I & O - give early in day

Answer 145

- feed when well rested at first sign of hunger b-c fatigue can decrease feeding - increased caloric needs w/ Polycose, corn oil - Preemie nipple or enlarge opening - Allow at least 30 minutes for feedings (then gavage remaining feeding) - stroke jaw to encourage sucking

Answer 146

- give oxygen w/ caution b-c can cause vasoconstriction but decreases PVR - raise HOB 45 degrees

Answer 147

Inflammatory condition impacting joints, heart, brain and skin after untreated Strep infection Incidence: 2-6 weeks after a group A streptococcal infection Complications: Rheumatic Heart Disease (mitral valve damage) Prevention of recurrence: Penicillin or erythromycin BID; or IM penicillin q28 days for 10 yrs if carditis (5 yrs w/o carditis)

Answer 148

- Antibiotics (Penicillin) - ASA for 2 weeks (aspirin to prevent clots, control inflammation, fever, discomfort) - prednisone if no response to aspirin - Bedrest initially followed by quiet activities - heart valve repair or replacement for RHD

Answer 149

- Carditis (New murmur or valve regurgitation; Cardiomegaly; Pericardial friction rub) - Polyarthritis (Swollen, hot, red, very painful joint pain); arthralgias - Chorea (Sudden aimless, irregular movements of extremities, exacerbated by stress) - Nontender SubQ nodules - Erythema marginatum (Pink nonpruritic rash) - Fever (> 38.5 C) - ESR > 60 mm or SRP > 3 mg/dL - Prolonged PR

Answer 150

infection of valves and inner lining of heart which can damage or destroy valves, deposit fibrin and platelet thrombi Transmission: Agents enter blood from any localized infection, brushing teeth, flossing, chewing, invasive procedures (GI, GU, dental, cardiac) Risk factors: CHD Complications: heart failure, dysrhythmias

Answer 151

- Heart (HF, dysrhythmias, new/changed murmur) - arthralgias - headache - weight loss - Vegetations on ECHO - inflammation signs (fever, malaise, +/- blood cultures, increased ESR, leukocytosis) - Splinter hemorrhages (thin black lines under the nails) - Osler nodes (red, painful intradermal notes on pads of phalanges) - Janeway lesions (painless hemorrhagic areas on palms and soles) - Petechiae on oral mucous membranes

Answer 152

- Prosthetic heart valve repair - History of endocarditis - Heart transplant with history of abnormal valve function - Cyanotic CHD not fully repaired (includes shunts or conduits) or for first 6 months after repair - Repaired congenital heart disease with residual defects (i.e. persisting leaks or abnormal flow near prosthetic patch or prosthetic device)

Answer 153

- Acute stage (inflammation of capillaries, arterioles, venules and pancarditis) esp coronary arteries - Progression to muscular arteries (may lead to coronary artery aneurysms or MI) - Vessels reach max enlargement in 4-6 weeks from onset of fever - disease resolves in 6-8 weeks

Answer 154

- Fever (>102.2) for 5 days - bilateral nonexudative conjunctivitis - cervical lymphadenopathy (unilateral) - rash esp trunk and perineal - mucositis (strawberry tongue, red lips) - Swelling or erythema of palms and soles (peripheral edema) - desquamation of skin (in 2-3 weeks; painless) - IRRITABILITY (last up to 2 months) - temporary arthritis, lethargy - Inflammation of myocardium (myocarditis, valvulitis, arrhythmias)

Answer 155

Elevated ESR, CRP Anemia Leukocytosis Do Baseline Echo Platelet rises in 2nd week

Answer 156

Purpose: high dose to reduce risk of coronary artery abnormalities) Nursing Care/Pt education - usually 1 infusion - same care as blood products (2 nurse check, frequent VS) - monitor cardiac status and anaphylaxis - avoid MMRV for 11 months after admin

Answer 157

- skin (cool compress, lotion, soft cloths) - oral care (lip lubrication, soft foods, clear liquids) - Monitor VS, I & O, weight, ECG - Passive ROM to increase flexibility - environment (quiet, respite for parents)

Answer 158

Inadequate tissue perfusion to meet the metabolic needs results in cellular dysfunction and organ failure Consequences: hypotension, tissue hypoxia, metabolic acidosis

Answer 159

- VS q15 minutes; output hourly - Ventilatory support- Early endotracheal intubation - IV NS or LRs ( 20 ml/kg push) - Albumin (b-c remain in system longer than NS) - Catecholamines to improve heart pumping (Dopamine and Epinephrine) - legs flat and above heart

Answer 160

Patho: increased RBC destruction b-c sickled hgb unable to obtain oxygen causing obstruction, inflammation (local hypoxia), adhesion Types: homozygous HgbSS, heterozygous HgbSC, Beta thalassemia (seen in mediterranean) Incidence: autosomal recessive seen in AA; manifests after 4-6 months when fetal Hgb disappears

Answer 161

Vaso-occlusive crisis (ischemia and pain) – main - Painful joints and hands/feet (dactylitis) - Abdominal pain - retinal (detachment, blindness or visual changes, icteric sclera) - renal (Hematuria, dark urine, enuresis) - Priapism - AVN (avascular necrosis) of hip or shoulder - lordosis or kyphosis - leg ulcers

Answer 162

- Anything that increases body’s need for oxygen or alters transport of oxygen - Hypoxia - Fever (notify provider if > 38.5) - Infection, trauma - dehydration (b-c increases blood viscosity) - Physical and emotional stress

Answer 163

- Hydration - Hydroxyurea- ↑ Hgb F (fetal hemoglobin), lower leukocyte and reticulocyte levels - Oxybryta (decreases # of crises in 4yrs +)

Answer 164

Bleeding disorder r/t congenital deficiency of specific coagulation proteins (Factor VIII or Factor IX) Incidence: x-linked recessive so usually boys with carrier mother Diagnosis: Factor VIII and Factor IX assays; PTT, DNA testing

Answer 165

- excessive Bruising - prolonged bleeding (epistaxis) - Hemarthrosis (bleeding in joint -> bony changes and deformities) - signs: stiff, tingling, ache, inflammation signs - hematuria - hemorrhages (brain = fatal, GI = anemia) - subQ and IM hemorrhages - Hematoma (pain, swell, limited motion)

Answer 166

- Mandatory screening of all newborns - Sickledex- detects HgbS but cannot differentiate trait from disease; heel stick - Hgb electrophoresis (definitive diagnosis)- separates various forms of Hgb via fingerprint of protein - CBC- anemia

Answer 167

- Chronic Anemia (hgb 6-9 g/dl) - Susceptibility to sepsis (r/t functional asplenia) - Growth retardation - Delayed sexual maturation

Answer 168

Acute Chest Syndrome (ACS) - r/t pulmonary infiltrates - Report chest pain, fever of 38.5 C or higher, congested cough, tachycardia, dyspnea, retractions, decreased O2 sat - Call provider immediately Cerebral Vascular Accident (CVA) - r/t HgbSS blocking BVs in brain - Report seizures, abnormal behavior, weakness or inability to move an extremity, slurred speech, visual changes, vomiting, or severe headache - If hx of CVA or beta thalassemia, child may get monthly chronic transfusions for prevention

Answer 169

Sequestration crisis- RBC breaking down quickly * Hepatomegaly (jaundice) * Splenomegaly (fibrous or rupture; functional asplenia)– may need spleen removed * Circulatory collapse/shock (cardiomegaly, systolic murmur, tachycardia, Fatigue)

Answer 170

- Penicillin prophylaxis – 2m to 5yrs (prevents pneumococcal sepsis) - Vaccines (Hib, pneumococcal, meningococcal, influenza) - Transcranial Doppler annually for children 2-16 years- Identify blood clots early via measuring intracranial vascular flow

Answer 171

- Rest - Hydration -oral or IV therapy (tell parents specific amount) - Electrolyte replacement - Blood replacement (phoresis of blood or whole-blood exchange) - Antibiotics for infection - Monitoring of reticulocyte (baby RBCs) count regularly to evaluate bone marrow function - HSCT is only potential for cure (stem cell transplant) -- complications (graft rejection, immunosuppression, graft vs host disease, relapse)

Answer 172

- Factor VIII Infusions -replace missing clotting factors; every other day or 3x/week for severe - Desmopressin (DDAVP-synthetic vasopressor) (IV or nasal spray)- increases factor VIII activity for mild - Aminocaproic acid- prevents clot destruction; give Factor infusion first - Corticosteroids- for hematuria, acute hemarthrosis, chronic synovitis - Cox-2 inhibitors- for hemophilic arthropathy

Answer 173

- Wear medical ID band - Frequent rest with physical activity - Avoid contact sports with splenomegaly - avoid oxygen admin b-c can depress RBC production and worsen anemia - refer to crisis as pain episode

Answer 174

- PCA preferred - Mild: acetaminophen, Ibuprofen, codeine, toradol - Severe: opioids, ketorolac - avoid meperidine (Demerol) b-c risk for seizures and product breakdown - monitor for GI bleeds from NSAIDS - Apply heat or massage affected area - Avoid cold compresses (we want blood flow to area b-c pain from tissue anoxia)

Answer 175

- high reticulocyte count (reticulocytosis) - reduced RBC production

Answer 176

Indication: during crisis or monthly if CVA risk or Beta thalassemia Risk: infection, hyperviscosity, alloimmunization, Hemosiderosis and hemochromatosis (iron deposits with/without tissue damage) Nursing Care - Oral chelation agents (deferasirox, deforxamine) to remove excess iron - oral chelation given IV or subQ over 8-10 hours (during sleep)

Answer 177

Severe (Factor VIII activity <1%)- spontaneous bleeding without trauma Moderate (Factor VIII activity 1-5%)- bleeding with trauma Mild (Factor VIII activity 5-40%)- bleeding with severe trauma or surgery

Answer 178

- Regular exercise and PT may reduce bleeding episodes - Noncontact Sports- golf, swimming, jogging, fishing, bowling - Oral (Soft bristled toothbrush w/ warm water) - Electric shavers vs razors - SubQ instead of IM injections - Avoid aspirin or ibuprofen (NSAIDs)

Answer 179

- factor replacement - RICE- rest, ice, compression, elevation - Keep cold packs ready - Only active ROM (NO PASSIVE) for hemarthrosis

Answer 180

- Medical ID bracelet - teach child 8-12 yrs to give injections

Answer 181

Ventriculoatrial (VA) - drains fluid from ventricles into atria of the heart usually done when hx of abdominal surgery - contraindicated with CHD or elevated CSF protein Ventriculoperitoneal shunt (VP Shunt) - drains fluid from ventricles into peritoneum - preferred method b-c longer and allows growth - observe for abdominal distention (s/s of peritonitis) - contact sports prohibited

Answer 182

Therapeutic Effect - Increases force of contraction/contractility (+ inotrope)- prolonged PR - Decreases HR (- chronotropic) - reduced ventricular rate - Increases renal perfusion Toxicity - bradycardia - NV - visual changes (see halos) - poor feeding, anorexia - dysrhythmias

Answer 183

Aspirin (anti inflammatory and reduce clot formation) - given 6-8 wks; indefinitely if cardiac abnormalities - avoid chickenpox and flu to avoid Reye's - avoid contact sports b-c low platelets w/ ASA - Warfarin, Plavix (clopidogrel), lovenox (enoxaparin) if aspirin inadequate)

Answer 184

- Assessment (pain, ROM, tenderness, erythema etc.; key for diagnosis) - X-rays (Difficult to use for diagnosis because of localized swelling but accesses skeletal trauma - CT Scans and MRI (find injuries, areas of infections, and cancer) - Ca 2+ (varies w/ bone breakdown from immobility making hydration crucial) - CBC, WBC and blood cultures - ESR elevation - Alkaline phosphatase - increases with growth

Answer 185

Contusions: damage to soft tissue, subcutaneous tissue, and muscle causes escape of blood into tissues leading to ecchymosis (black-and-blue discoloration) (s/s. Swelling, pain, disability, crush injuries) Dislocation - Displacement of normal position of opposing bone ends or of bone ends to socket Strain - microscopic tear in the muscles and tendons Sprain - A ligament is torn or partially torn.

Answer 186

* Plastic deformation: bone is bent, not broken * Buckle: appears raised or bulging due to compression of porous bone * Simple or closed: does not produce a break in the skin * Greenstick: bone is angulated beyond limits of bending; compressed side bends and tension side fails leading to incomplete fracture * Open or compound: fractured bone protrudes through the skin * Complicated: bone fragments have damaged other organs or tissues * Comminuted: small fragments of bone are broken from fractured shaft and lie in surrounding tissue

Answer 187

- injury at epiphyseal plate (cartilage growth plate which is weakest point of bone) Complication: longitudinal or angular growth deformities Management - frequent surveillance if type 1 (separation of growth plate) - Surgery (open reduction and internal fixation) if type 3 (half of bone under plate broken)

Answer 188

- RICE (no heat) - splint (immobilize)- soft splint (pillow or folded towel) or rigid splint (rolled newspaper or magazine) - cover wounds w/ sterile or clean dressing - surgery (external fixation (rings to bone w/ wires), internal fixation, distraction (separate bones to encourage growth of new bones)) - calm and reassure family

Answer 189

* regain alignment and length of bony fragments (reduction) * Retain alignment (immobilization) - until callus forms * Restore function - ROM and weight bearing after site stable * Prevent deformity or injury

Answer 190

- Relieves fatigue in involved muscles - Fatigues muscles to reduce muscle spasms (rare) - Position distal and proximal bone ends (Realignment) to promote healing - Prevents deformity and contractures - Immobilize healing bone and prevent further injury

Answer 191

Neonatal period: 2-3 weeks due to thickened periosteum and more blood supply Early childhood: 4 weeks Later childhood: 6-8 weeks Adolescence: 8-12 weeks

Answer 192

* Pain – unrelieved by pain medication 1 hr after admin, especially w/ passive ROM * Pulselessness - no distal pulse palpable * Pallor - discoloration OR cyanosis; cool temp; cap refill > 3 sec * Paresthesia - tingling or burning * Paralysis – inability to move affected part; * Pressure - swelling, tenseness or warmth of affected limbs and extremities Pallor, paralysis, and pulselessness are late

Answer 193

- fasciotomy (cut skin and reduce pressure) - do not elevate - administer fluids if needed - bivalve cast if excessive edema (i.e., cut calf in half a hold w/ elastic bandage) - CALL HCP

Answer 194

- Plater of Paris dries in 2 to 48 hours - Fiberglass dries in a couple of hours - handle w/ palms until dry - let child know some warmth may be felt but no burning

Answer 195

- Diazepam (muscle relaxant for spasms) - Provide Skin care (q2h turns, braden scale, hygiene, pressure alt mattress) - Pin site Care daily or weekly (cover w/ rubber or padding; antiseptic (chlorhexidine) or topical antibiotic) - NURSES DO NOT LIFT OR DISCONTINUE WEIGHTS!!!! LET THEM HANG FREELY - prevent constipation (fluids, fiber, stool softener) - promote circulation (ROM, bandages not restrictive)

Answer 196

Manual- applied by hand placed distal to the fracture site during application of a cast or for closed reduction Skin- Buck’s (leg extended) OR Bryant (legs up 90 degree for DDH) Skeletal - pins, wire, tongs (ex. 90-90 degree (common at hip and knee) or Halo vest (cervical)

Answer 197

- Barlow (thigh adducted, and light pressure applied to femoral head to see if slips out of acetabulum then slips back when pressure is released) - unstable hip - Ortolani sign (abduct knees and put forward pressure behind trochanter than backward pressure; audible clunk/thunk if femoral slips forward into acetabulum meaning it is dislocated) - disappears when adduction contractures develop at about 6-10 weeks - Galeazzi sign: Limb shortening on affected side - Trendelenburg sign: When child stands on one foot and bears weight on affected hip, pelvis tilts downward on normal side instead of upward, as it would with normal stability - Asymmetric thigh and gluteal folds seen when prone - lordosis - waddling gait (bilateral hip dislocation

Answer 198

Birth to age 6 months - Pavlik harness for abduction of hip for 6-12 week continuously Ages 6-24 months - recognized when child begins to stand and walk - need closed reduction and spica cast - may use traction for full abduction of hip Older child (4yrs +): - need open reduction w/ preop traction - tenotomy (lengthen contracted muscles) - osteotomy ( construct acetabular roof) - correction and healing is very difficult

Answer 199

- Spontaneous movement of femoral neck from femoral head in acetabulum due to increased weight Incidence: boys before or during rapid growth Diagnosis: physical exam, hx, Anteroposterior and frog-leg hip x-ray Complications: avascular necrosis, further slippage, deformity

Answer 200

- Obese - limp on affected side w/ altered gait - internal rotation and loss of abduction of affected leg - affected limb shortens - groin, hip, and knee pain - inability to bear weight

Answer 201

- strict bedrest and Buck’s traction immediately - surgery within 24 hrs w/ pin placement OR surgical hip dislocation - post-op no weight bearing to gradual weight- bearing - Restriction from certain sports until fusion or closure of proximal femoral physis to prevent further slippage

Answer 202

- spinal deformity involving lateral curve, spinal rotation, thoracic hypokyphosis Diagnosis: x-ray to determine skeletal maturity Levels - <10 degrees = postural variation - 20 or less = may not require intervention; can do exercises or braces - Greater than 40 = requires surgery

Answer 203

- started at School Age (Screening at 10 AND 12 yrs. for girls or at 13 OR 14 yrs. for boys) - child in only underpants - Child bends at waist, trunk parallel to floor, arms hanging free - observe the back for asymmetry of hips, scapula, shoulder height, pelvic obliquity; widened angle between arm and body - Hold hips stable and have child turn left / right to assess flexibility of curve

Answer 204

Types: Boston, TLSO, Milwaukee (usually for kyphosis and has neck ring) Notes - Braces are worn for 23 hours per day - Not curative - slows or stops the progression of the curvature until child reaches skeletal maturity - discontinued once growth completed

Answer 205

- depends on degree of curvature (>45-50 degrees), pain, OR if exercise & brace fails Types - Spinal fusion is more common and less invasive than rod insertion (via posterior or anterior approach) - VEPTR (done for younger children with severe scoliosis via lengthening the ribs by using a prosthetic rib to enhance the breathing effort of children with scoliosis and straighten spine) - instrumentation

Answer 206

- Bed rest - logrolling - PCA / pain control b-c very painful surgery - Teds / SCD’s - frequent assessment (check for sensation and ileus (stool softeners), retention (foley)) - early mobility (usually by day 2; PT on 1st day) - Brace may or may not be used.

Answer 207

- inflammation in joints for > 6 weeks causing pain, swelling, and scar tissue (limited ROM) Incidence: autoimmune condition in girls < 16; total remission in most by adulthood Classification: dependent on joints affected, systemic symptoms, and presence of absence of rheumatoid factors

Answer 208

Joint signs - limp - favoring an extremity - inflammation (pain, swelling, edema, redness) Systemic signs - Rash - fever - lymphadenopathy - splenomegaly and hepatomegaly - uveitis (inflammation in anterior chamber of eye; diagnosed by slit lamp eye exam)

Answer 209

- Ibuprofen (NSAIDs)- GI bleeds - Aspirin (NSAIDs)- be wary of viral illness b-c reyes syndrome - Methotrexate or Sulfasalazine (DMARD) - teratogenic, hepatotoxic, Bone marrow suppression - Corticosteroids (given intra-articular) - risk for infection, adrenal insufficiency, avascular necrosis, cushingoid, osteoporosis, HTN, diabetes - Etanercept or Adlimulmab (Biologic DMARDs) - infection risk

Answer 210

Goal of therapy - NO CURE - preserve joint function - limit abnormalities and deformity - promote normal growth and development - decrease the discomfort (relieve symptoms)

Answer 211

- DNA analysis (genetic detection of absence of dystrophin (muscle protein product due to muscle fiber degeneration)) - possible at 12 weeks gestation - Serum CK (elevated in first 2 yrs of life) - EMG (decreased amplitude and duration of motor unit potentials) - Muscle Biopsy

Answer 212

- waddles (due to weak butt muscles) causes frequent falls - lordosis (sway back, awkwardly holds shoulders back; due to weak pelvis - Gower’s sign (walking hands up knees and legs to stand up) - Mild to moderate mental impairment (Decrease in verbal skills) - Higher emotional disturbance - fatty muscle hypertrophy (thigh, calf, upper arm)

Answer 213

- osteoporosis and fractures - contractures - scoliosis - obesity - respiratory infection r/t reduced pulmonary vital capacity from weak respiratory muscles; also difficult clearing secretions via cough b-c weak muscles - cardiopulmonary issues due to respiratory, oropharyngeal and facial muscle involvement (heart failure and sleep apnea) - disuse atrophy

Answer 214

- encourage normalcy - okay to grieve since chronic fatal disease - Guilt from passing this to son lies on woman - Genetic counseling for female relatives, siblings - provide for rest periods ( child can self-regulate activity tolerance) - prevent infections ( avoid crowds; get pneumococcal and influenza vacs)

Answer 215

- Prevent contractures (passive ROM, soft casts, surgery, braces) - Promote pulmonary function ( breathing exercises, incentive spirometer q4h; mechanically assisted coughing) - Position changes when in wheelchair (allow for time to lie flat) - Keep active as long as possible (don't wheelchair confine early)

Answer 216

- Elevate initially w/ pillow (do not let stay dependent for long) - Encourage use of unaffected muscles - No coat hangers or straws in cast - Use fan or cool air to circulate air if high humidity (no heated air) - for spica, use cast petaling (tape edges w/ waterproof tape around perineal) - if open cast, cut out window to view wound AND outline any blood - Crutches should fit properly w/ soft rubber tip to prevent slipping and well padded (support on hand grips NOT axilla)

Answer 217

- reassure muscle atrophy will go away as strength regained - avoid cold temps after removal - use sunscreen after removal - apply mineral oil or lotion to remove - Soak in bathtub - Do not pull or forcibly remove w/ vigorous scrubbing (may cause excoriation and bleeding)

Answer 218

- infection (hot spots on dried cast or foul smell) - Loose cast (no longer useful and can lead to skin irritation or pressure sores) - Compartment syndrome – medical emergency

Answer 219

- Avoid lotions and powders because they can cake and irritate the skin. - Always place the diaper under the straps - Gently massage healthy skin under the straps once a day to stimulate circulation - Do not adjust harness

Answer 220

- Positional: primarily from IUGR; no bony abnormality; responds to simple passive exercise and casting - Congenital (idiopathic): in normal child w/ wide range of rigidity & prognosis; Requires casting w/ surgical intervention (heel-cord tenotomy) - Syndromic (teratologic): seen w/ anomalies (such as myelomeningocele or arthrogryposis); requires surgical correction and resistant to treatment

Answer 221

- Affected foot or feet smaller - shorter, empty heel bed - midfoot medial creases - If unilateral, affected limb shorter and calf atrophy present - Foot pointed down (plantar flexed) and inward

Answer 222

- Weekly gentle manipulation and stretching of medial side of foot w/ serial long leg casts ideal shortly after birth - Casting (6-10 weeks) followed by percutaneous heel-cord tenotomy (corrects equinus deformity) - After tenotomy, long leg cast for 3 weeks - After casting, Ponseti sandals w/ bar set in abduction to maintain correction and prevent recurrent - surgery at 6m-1 yr if casting fails

Answer 223

* Neurologic injury or spinal cord injury * hypotension from acute blood loss * SIADH * Superior mesenteric artery syndrome( due to duodenal compression by aorta and superior mesenteric artery leading to obstruction; causes epigastric pain, copious NV, and eructation(belch); alleviated w/ left lateral or prone position (worsened by supine)

Answer 224

- 10% have positive rheumatoid factor - ESR/CRP elevated - Leukocytosis w/ exacerbations of systemic JIA - Antinuclear antibodies common but not specific to JIA (can identify those at risk for uveitis) - Radiographs – best to show soft-tissue swelling and joint space widening from increased synovial fluid

Answer 225

Corticosteroids (prednisone, deflazacort) - Increased muscle strength, bulk, power and decreased progression of weakness (Prolonged ambulation) - decreased incidence of scoliosis and cardiomyopathy) - Increased pulmonary function Oral albuterol - increase lean body mass and decrease fat mass - no change in strength

Answer 226

- Physical therapy (strengthen joints and prevent deformities) - pain relief (usually avoid opioids unless severe) - moist heat ( hot pack, warm bath) - exercise - promote general health and nutrition (match caloric intake to energy needs) - allow child to rest as needed - promote independence ( parent only help when necessary)

Answer 227

Muscle atrophy and fatty infiltrates on extremities leads to progressive degeneration of muscle fibers Incidence: x-linked; often wheelchair bound by 12 yrs

Answer 228

- Unusual mass or swelling - Anemia (Pallor and fatigue) - thrombocytopenia (Petechiae, Sudden easy tendency to bruise) - Persistent, localized pain or limping - Prolonged, unexplained fever or illness - Frequent headaches, often with vomiting - Sudden eye or vision changes (leukocoria in retinoblastoma; squinting, strabismus, swelling if solid eye tumor) - Excessive, rapid weight loss - enlarged firm lymph nodes

Answer 229

Patho: unrestricted proliferation of immature white blood cells (blasts) in the blood-forming tissues of the body Most affected extramedullary areas: spleen and liver b-c highly vascular

Answer 230

- Bone marrow (anemia, thrombocytopenia, leukopenia; bone and joint pain) - Physiologic fractures r/t increased pressure in bone - Enlarged spleen, liver, lymph nodes r/t infiltration -> can become fibrotic - Leukemic meningitis r/t CNS infiltration - Cellular Starvation r/t hypermetabolism

Answer 231

CBC - immature leukocytes (blasts) present - Low blood counts (WBC, RBC, platelets) Bone marrow biopsy and/or aspiration - Definitive diagnosis to differentiate b/w ALL and ALM - Shows infiltration of blast cells - Often sedation for pediatrics b-c must remain still Lumbar Puncture (LP) - Determination of CNS involvement (metastasis, brain tumors)

Answer 232

- Surgery (palliative or curative) - Chemotherapy (primary) - Targeted therapy (tyrosine kinase inhibitors (TKIs), monoclonal antibodies, proteasome inhibitors) - Radiotherapy - Hematopoietic Stem Cell Transplant (HSCT) or Bone Marrow Transplant (BMT)

Answer 233

- combo drug regimen used b-c optimal cell destruction with minimum toxic effects - Not selectively cytotoxic for malignant cells (kills fast growing healthy cells i.e. bone marrow, hair, skin, and GI tract)

Answer 234

Pros - fewer reactions vs chemo (no hair loss or mucositis) - alters immune system to recognize cancer cells by attaching to proteins Cons - anaphylaxis common so premedicate w/ steroids or benadryl

Answer 235

- Requires a double check from a second RN - PPE (gloves, gowns, masks/face shield if splashes possible)- including gauze when in contact w/ drug - Often need central line or infusion port - DO NOT crush or alter chemotherapy drugs - Stop infusion immediately if s/s of infiltration (pain, stinging, swelling, redness) - Observe child for 1 hr after infusion for signs of anaphylaxis (rash, urticaria, hypotension, wheezing, NV)

Answer 236

Action: Alters relationship b/w tumor and host by changing the host’s biologic response to tumor cells. Examples - Monoclonal antibodies - Chimeric Antigen Receptor T-cell Inhibitors (CAR-T) - Angiogenesis inhibitors - Colony-stimulating factors (CSFs)- G-CSF (filgrastim, pegfilgrastim) - checkpoint inhibitors (block pathways that allow cancer cells to escape immune system)

Answer 237

Side effects (based on area) - neck (hypothyroidism ) - chest (reduced lung function, heart damage) - obesity and metabolic syndrome ( hormone-producing organs) - ovaries and testes (infertility) - GI (anorexia, mucosal ulceration, NVD) - Skin (alopecia, dry or moist desquamation, hyperpigmentation) - Head (NV(stimulation of vomiting center), alopecia, mucositis, parotitis, sore throat, loss of taste, xerostomia, GH deficiency, cognitive deficits, hearing loss) - bladder (cystitis) - Bone marrow (myelosuppression)

Answer 238

Nursing Care - Encourage fluids & nutritional intake (Light, small, frequent meals) - get I&O and Daily weights - Do not refer to skin changes as burns b-c implies too much radiation use Patient Education - Use mild soap - Do not remove skin markings - Avoid creams or lotions - Loose-fitting clothing over irradiated area to minimize skin irritation - Protect area from sunlight and sudden temp changes (ice or heating packs)

Answer 239

Indication - malignancies unable to be cured by other means - replacement of dysfunctional bone marrow Risks: infection, relapse, Graft vs Host disease(due to HLA mismatch) Pre-op: High dose chemo and radiation – to reduce ANC to nadir (0) (irreversible)

Answer 240

Related to: neutropenia (ANC < 500), altered nutrition (prolongs neutropenia) Education: - Avoid crowds and sick individuals - wear a mask in public - Low bacterial diet ( no fresh fruits, no soft serve; fully cooked foods, no deli meats) - Avoid fresh flowers, live plants

Answer 241

Related to: chemo, BRMs Nursing Care - pre-medicate if ordered - Monitor patient closely (vital signs, and assessment) - Assess for hx of anaphylaxis with certain meds - discontinue drug if happens and maintain patency of IV line w/ NS - Obtain crash cart give emergency drugs (epinephrine, dopamine) - administer supplemental O2 (call RRT)

Answer 242

Related to: thrombocytopenia (<20K) Nursing Care - Administer platelets as ordered (no need for cross matching; peak: 1 hr, Duration:1-3 days) - Avoid invasive procedures and skin punctures - Gentle mouth and perineal care (wipes front to back) - AVOID rectal temperatures and suppositories - Educate patient to avoid contact sports, bike or skateboard riding if < 100,000 - avoid aspirin products - Frequent turns and pressure-reducing mattress under bony prominences to prevent pressure sores and decubital ulcers

Answer 243

- Monitor for s/sx of anemia (pallor, fatigue, tachycardia, increased cap refill) - Allow for frequent periods of rest (regulated by child - Transfuse PRBCs if ordered (to increase Hgb > 10 g/dL) - Administer G-CSF (filgrastim, pegfilgrastim)

Answer 244

Related to: bone marrow involvement (acute, chronic, neuropathic) Nursing Care - Assess pain frequently w/ age-appropriate pain scale - Administer pain meds PRN (IV (morphine or hydromorphone PCA), PO, transdermal patches (Fentanyl, lidocaine), nerve blocks/epidurals_ - Involve interdisciplinary teams (quality of life team; pain team)

Answer 245

Nursing Care (prevention is key) - administer meds (ondansetron, lorazepam, diphenhydramine, dronabinol, granisetron, hydrocortisone) 30-60 min prior to admin of chemo and for 24 hrs after - give metoclopramide w/ diphenhydramine if severe b-c metoclopramid has extrapyramidal effects - Monitor I&O, daily weight, albumin/prealbumin (increased risk of dehydration and electrolyte disturbances) - Fortify foods with nutritious supplements (High protein, high calorie) - use NGT and TPN as needed

Answer 246

Nursing Care for mouth lesions - Encourage frequent oral care (q2-4 hrs w/ soft sponge toothbrush) and Lubricate lips PRN - Alkaline saline mouth rinses, viscous lidocaine, chlorhexidine mouth rinse (No lidocaine for under 2 yrs b-c diminishes gag reflex) - Avoid alcohol rinse, lemon glycerin swabs and hydrogen peroxide b-c drying effects and acidity of lemon is irritating - Administer nystatin for thrush as indicated - Encourage a bland, moist, soft diet Nursing Care for rectal lesions - AVOID suppositories and rectal temps - Daily CHG wipes/baths, Sitz bath as needed - Occlusive ointments

Answer 247

- Foot drop (Encourage use of foot board or high-top tennis shoes when in bed) - severe constipation (use stool softeners, activity, laxatives) - Peripheral neuropathy (Give antidepressants (TCAs), AEDs - Jaw pain (use repetitive gum chewing or suck hard candy) - Developmental delays - Post irradiation syndrome (somnolence, anorexia, N/V, fever; 5-8 wks after CNS radiation lasting 4-15 days) (indicator of neurologic sequelae)

Answer 248

Related to: urinary stasis r/t radiation and chemo Nursing Care - Monitor for hematuria and blood clots in urine - Ensure adequate oral or parenteral fluid intake (1.5x daily fluid requirement (2L/m2/day)) - Monitor strict I&O and ensure frequent voiding around the clock every 2 hrs until 24 hrs after last dose - Administer bladder protectant (mesna) after certain chemo - give chemo early in day to allow adequate flushing and fluids throughout day

Answer 249

Related to: - alopecia (all body hair) - weight changes, steroids (cushingoid) - body additions (CVAD, IV lines) - body changes (scars, amputations) Nursing Care - Encourage shorter haircuts prior to hair falling out b-c falls out in clumps - Provide emotional support Patient education - Educate on options such as wigs, scarves, and bandanas - Educate that hair grows back in 3-6 months

Answer 250

Related to: rapid release of intracellular contents seen in lysis of cells in ALL or burkitt lymphoma S/s - hyperkalemia (NV) - hyperuricemia (flank pain, lethargy, renal failure) - hyperphosphatemia (muscle cramps, pruritus) - hypocalcemia (tetany, seizures)

Answer 251

Purpose - Regulate reproduction, maturation and function of blood cells. - Decreases duration of neutropenia Care - Discontinued when ANC > 10,000 - watch for bone pain, fever, rash, malaise, headache

Answer 252

- Avoid admin of live, attenuated vaccines (polio, MMR) due to immunosuppression - Avoid exposure to childhood diseases such as chickenpox then give antivirals (acyclovir, valgancyclovir) if child develops varicella or is exposed - If vaccinated 2 weeks prior to starting chemotherapy or during treatment, consider child unimmunized b-c immune system not strong enough for developing active immunity. - Revaccinate or administer live virus vaccines 6 months after treatment is stopped.

Answer 253

Tumors of the peripheral lymph nodes, thymus, or abdominal organs such as the bowel. Key s/s: tumors compressing organs (intestinal or airway obstruction, CN palsies, spinal paralysis) Classifications: Lymphoblastic, Burkitt/Non-Burkitt (mature B-cell), Large Cell/anaplastic Treatment: chemo, radiation (emergencies), surgery (Burkitt or anaplastic)

Answer 254

progressive enlargement of affected lymph nodes and sometimes spread to the spleen, liver, bone marrow, bones, mediastinum, or lungs Key s/s - Enlarged, firm, nontender, movable lymph nodes in supraclavicular or cervical areas - Mediastinal lymphadenopathy – persistent nonproductive cough - Enlarged retroperitoneal nodes – unexplained abdominal pain - splenomegaly/hepatomegaly - Systemic symptoms: low or intermittent fever, anorexia, nausea, weight loss, night sweats, pruritus Diagnostic: Lymph node biopsy shows Reed Sternberg cells (seen in mono as well) Treatment: radiation and chemo

Answer 255

originate from embryonic neural crest cells (neuroblasts) which form adrenal medulla and SNS and cause abdomen (arising from adrenal gland) OR head, neck, chest, or pelvis tumor Diagnosis - usually after metastasis (silent tumor)- lymph node, bone, liver (lymphadenopathy, bone pain, hepatomegaly) - Metaiodobenzylguanidine (MIBG) scan – biopsy and aspirate of bone marrow to evaluate metastasis - CT or MRI to locate primary tumor Treatment: chemo, radiation, surgery (primary)

Answer 256

Solid tumor of the kidneys from immature kidney cells Key s/s - UNILATERAL firm, nontender swelling or abdominal mass (does not move w/ respiration) - hematuria - HTN (due to excess renin secretion by tumor) Diagnosis - Metastasis is rare (Pulmonary metastasis (dyspnea, cough, SOB, pain in chest) - CBC may show polycythemia if tumor secretes excess erythropoietin Treatment - DO NOT PALPATE (appropriate signage in room) - surgical resection of tumor, adrenal gland, kidney (transplant if stage 5) - radiation (maybe post-op depending on stage) - chemo

Answer 257

Arises from bone-forming mesenchyme in osseous tissue of metaphyseal region of long bones Key S/s - Pain, swelling, and sometimes decreased joint motion and limp (relieved pain w/ flexion) - inability to hold heavy items - occasional fracture at the tumor site if tumor presses on bone - palpable mass

Answer 258

- small, round cell tumors that arise in marrow spaces of bone or in soft tissues (extraosseous-pelvis, femur, tibia, fibula, humerus, ulna, vertebra, scapula, ribs, and skull Key s/s - Localized pain w/ limp - spinal cord compression (back pain, sensation change, extremity weakness, loss of bowel or bladder function, respiratory insufficiency) - respiratory distress (metastasis to lungs) Diagnostic Testing - X-ray (involvement of diaphysis w/ detachment of periosteum from bone (Codman triangle)) - CT/MRI of primary site and CT chest - bone marrow aspiration and biopsy Treatment: Chemotherapy, *high dose radiation*, surgery (limb salvage more likely)

Answer 259

Intraocular malignancy usually unilateral and nonhereditary Key s/s - Leukocoria (whitish pupil glow) esp in flash photo - Strabismus (due to poor fixation of visually impaired eye esp if tumor in macular (area of sharpest visual acuity) - Late: blindness, pain, orbital cellulitis, glaucoma - High risk for secondary malignancy (osteosarcoma)

Answer 260

- Based on child weight i.e. 100 (first 10 kg)+ 50 (2nd 10kg) + 20 (remaining kg) Output - q2h - subtract weight of dry diaper from wet diaper (unable to distinguish stool from urine) - minimum 1 mL/kg/hr (30 mL/hr if > 30 kg) - Bladder capacity (oz) = Age (years) + 2

Answer 261

- balanced loss of electrolytes and water from ECF Treatment: isotonic fluids (NS, LRs)

Answer 262

- electrolyte deficit (low Na) > water deficit so water goes into ICF Treatment: hypertonic fluids (D5NS, 3NS)

Answer 263

- water deficit > electrolyte deficit (Na> 150) due to water loss or increased electrolytes; fluid goes from ICF to ECF Treatment: D5W, 1/2 NS (DO NOT GIVE RAPID b-c risk for water intoxication

Answer 264

- Normal pulse, respiration, blood pressure, behavior, mucus membranes, fontanel - Slight thirst - Cap refill 2 sec - Urine SG ›1.020

Answer 265

- Slight increased HR, RR, normal to orthostatic BP - Irritable - Dry mucous membranes - Moderate thirst - Decreased tears - Normal or sunken fontanel - Cap refill 2-4 seconds, decreased turgor - Oliguria

Answer 266

- Very tachycardia and hyperpnea - decreased BP/shock - Lethargic to hyperirritable - Parched mucus membranes and intense thirst - Absent tears w/ sunken eyes - Sunken fontanel - Cap refill › 4 seconds, cool skin, mottled, acrocyanotic, tenting - Oliguria, anuria

Answer 267

- Enhance the reabsorption of Na and water via reducing vomiting, diarrhea, and duration of illness (stomatitis, emesis) Choices - Use Centralyte, Pedialyte, Rehydrate w/ 50 mEq/L - Add unsweetened Kool-Aid to ORS - Low sugar popsicles - do not give fruit juice, soft drinks, gelatin (high carb, low electrolyte, high osmolarity) - do not give chicken or beef broth or gatorade (excess sodium, low carb) - Avoid BRAT diet (contraindicated b-c little value (low protein, low energy, high carb, low electrolytes)

Answer 268

Mild dehydration- 50 mL/kg within 4 hours Moderate dehydration- 100 mL/kg within 4 hours Severe dehydration- IV fluids 40 mL/kg/hr until HR and LOC normal, then IV or oral rehydration solution Amount Variations - Add 10 ml/kg of ORT fluid for every loose stool or episode of vomiting - If vomiting, ORT frequently in small amounts (5- 10 ml syringe q1-5 min)

Answer 269

Risk: infection due to hyperglycemia risk or hypoglycemia Nursing Care - Administer in central venous catheter - Filtered tubing to remove particulate matter - “Ramp up” and “Ramp down” rate of infusion slowly to prevent dysregulation of glucose - Monitor glucose, electrolytes, liver function tests, triglycerides, albumin, renal function - Daily weights

Answer 270

Acute - Timing: self-limited under 14 days usually in under 5 yrs old - Cause: infectious agent (C.diff (antibiotic use), rotavirus (immunization), Giardia lamblia (day cares)) esp. URI, UTI, antibiotics, or laxatives Chronic - Timing: over 14 days - Cause: malabsorption syndromes, IBD, immunodeficiency, food allergy, lactose intolerance, CNSD

Answer 271

Cause: due to weakened Sphincter at entry of stomach until 6-12 months of age esp in bottle-fed Treatment - Frequent burping before/after feedings - Minimum handling during/after feedings - Position child on right side with head slightly elevated after feeding (stomach drains better) - NEVER overfeed ~ more frequent smaller feedings - meds (rare but Ondansetron (few side effects) is okay; Avoid promethazine and metoclopramide b-c somnolence, nervousness, irritability, and dystonic reactions)

Answer 272

Cause: inappropriate relaxation of lower esophageal sphincter causes damage due to variety of conditions (hermia, G-tube, neurological disorders, respiratory disorders, gastric distention) Complications - FTT - respiratory difficulties (dysphagia, pneumonia, laryngitis) - Barrett's esophagus (premalignant; esophageal strictures)

Answer 273

- Passive regurgitation/emesis & vomiting - Anorexia/ feeding refusal - respiratory problems (e.g., cough, wheeze, stridor, gagging, choking with feedings) - Odynophagia (painful swallowing)- Arching of the back - Irritability, excessive crying - Hematemesis -> anemia

Answer 274

- Intermittent vomiting (preschool) - Heartburn - Regurgitation and Re-swallowing - Hematemesis and melena - > anemia - Respiratory problems (Chronic cough, hoarse voice, Dysphagia, Asthma)

Answer 275

- Surgery (nissan fundoplication) - severe/last resort (post-op: NGT decompression, vent G-tube) Medications - PPIs (omeprazole (Prilosec), lansoprazole (Prevacid)) - Histamine antagonists (Famotidine (Pepcid) - Erythromycin (low dose to help w/ gastric emptying) Feeds - Thickened formulas- w/ rice cereal - Positioning (upright or prone post-feeding unless sleeping) - Small, frequent feedings - Avoid caffeine, citrus, tomatoes, alcohol, tobacco, peppermint, spicy or fried foods

Answer 276

Cause: hypertrophy of pylorus leads to gastric outlet obstruction and compensatory dilation, hypertrophy, and hyperperistalsis of stomach usually at 3-6 weeks of life Labs - Hyperbilirubinemia r/t decreased glucuronyl transferase - Decreased Na, K, Cl but hemoconcentration may mask - metabolic alkalosis (elevated HCO3) - Increased BUN r/t dehydration

Answer 277

- Post-prandial emesis (projectile and nonbilious) - Hunger - weight loss (malnourished or dehydrated) - jaundice - palpable olive-shaped mass - gastric wave

Answer 278

Pre-op: correct f/e balance - IV fluids (NS bolus, D51/2 NS at 1.5x maintenance over 24-48 hrs) - NPO and NGT decompression - labs: BMP, CBC - Watch for apnea b-c risk for aspiration w/ vomiting Post-op - Feeding (Pedialyte, formula) 4-5 hrs post op (full feeds at 48 hrs) - Some emesis or spitting up expected- Not projectile

Answer 279

- Developmental delay (Non-vocal, Infantile posturing – stiffens and arches back, no stranger anxiety) - Poor Hygiene - GI and respiratory infections - Withdrawn (Dislikes physical contact, No eye contact, unresponsive facial expressions) - Self-stimulating behavior: rocking, excessive sucking, head-banging - Fussy, irritable - Abdominal distention-Constipation - Generalized weakness-Decreased muscle mass

Answer 280

- Increase calories – formula with 24 cal/ounce and lipids - Limit juices, water – offer milk and formula - Do not force feed (offer for 35 minutes q2-3 hrs) - Consistent meal times - Feed in quiet environment - Establish eye contact - If severe, NG tube

Answer 281

- congenital anomaly Involves 1 or more clefts in upper lip w/ varying degrees of nasal distortion Repair: Surgical by 3-6 months of age; Cosmetic procedures modified later -4-5 years Early repair promotes bonding and eases feeding

Answer 282

- congenital anomaly from soft palate defect which may include hard palate & portions of maxillary sinus Repair: multistage surgery at 6-8 months depending on severity (tonsils not removed) Early repair enables more normal speech pattern development

Answer 283

- Monitor respiratory status while feeding - Feed in upright position - Feed slowly and burp every 1-2 ounces - Rest after each swallow of formula to allow for complete swallowing - Remove oral secretions carefully (Milk may come out nose) - Encourage bonding: touch-cuddle-hold

Answer 284

- Monitor for respiratory distress - Keep objects out of mouth for 7-10 days including tooth brush - Arm restraints to prevent touching face - Feed child to reduce injury (liquids from a cup, soft foods from side of spoon) - Cleanse lip and suture line after feedings and PRN - Antimicrobial ointment (Neosporin) to suture line - Speech therapy referral

Answer 285

Cause: failure of esophagus to fully develop leading to abnormal communication b/w trachea and esophagus 3 C's - coughing (frothy cough, excessive drooling) - choking (aspiration pneumonia, inability to pass NG tube) - cyanosis w/ feeding (Respiratory distress (pneumothorax, atelectasis, laryngeal edema, tracheomalacia(weakness r.t compression by blind pouch)

Answer 286

Preoperative care - Suction: continuous to blind pouch to reduce stomach distention - Elevate HOB into anti-reflux position (30 degrees) - O2 - NPO immediately w/ IV I & O Postoperative (depends on stage of repair) - G-tube care and feedings (do not clamp or flush; elevate to air) - Contrast study or esophagram done before oral feedings to determine integrity of esophageal anastomosis - Monitor: aspiration, respiratory distress, infection - 4 pre-op care items continue

Answer 287

Cause: autoimmune gluten sensitive enteropathy e.g. wheat, oats, rye, barley S/s - Bulky, malodorous, fatty, and frothy stools - General malnutrition (FTT, muscle wasting, fatigue, anemia, anorexia, growth retardation) - Behavioral changes (irritable, uncooperative, apathy) - Abdominal distention and pain (aphthous ulcers)

Answer 288

Cause: inflammation and obstruction of appendiceal lumen due to harden fecal material; swollen lymphoid tissue; or pinworms Diagnostics - CBC (> 10000 WBC, elevated % of bands (left shift)) - C-Reactive Protein (elevated > 10) - CT - KUB (Kidney, Ureters, Bladder) x-ray - Ultrasound (enlarged appendiceal diameter, wall thickening, inflammatory changes (fat streaks, phlegmon, fluid collection, and extraluminal gas)

Answer 289

- Periumbilical pain that migrates to the RLQ - pain is colicky constant, not intermittent (child may jump up and down) - Fever (typically low-grade)-- no sore throat, no headache - abdominal distention and palpable mass - rebound tenderness at McBurney's point (b/w anterosuperior iliac spine and umbilicus) - No appetite (anorexia, NV) - stooped posture

Answer 290

Complications - sepsis and hypovolemic shock (tachycardia, fever, tachypnea, - necrosis (perforation or rupture w/ contamination of peritoneal cavity) - s/s: sudden relief then diffuse pain, pallor)-> abscess formation - peritonitis (rigid abdomen and guarding) Treatment - Appendectomy: recommended (Laparoscopic vs Open Appendectomy); delayed 6-8 wks if unable to safely remove or difficulty expected - Conservative management: antibiotics and IV fluids; avoid palpation unless necessary

Answer 291

Cause: Telescoping or invagination of the distal intestine which leads to obstructive symptoms in the proximal portion (may be r/t viral illness) S/s - Colicky abdominal pain - NV - Currant jelly stools or sausage-shaped mass - Lethargy and hypersomnia - Dance signs (empty RLQ) - Knees to chest positioning

Answer 292

- IV Fluids and NGT decompression for stabilization - Air contrast enema - Surgical reduction with possible bowel resection if failed air reduction enema, Bowel perforation, or Shock/hemodynamic instability

Answer 293

- Bilious Emesis = pyloric stenosis - Twisted Bowel- If it is twisted, you have 6 hours to save it - Rigid abdomen = peritonitis - Free air visible on x-ray in abdominal cavity = perforation

Answer 294

irritable colon of childhood and toddlers’ diarrhea which may be r/t sorbitol (artificial sweeteners) or excessive juice for > 14 days Effects: no blood in stools, no enteric infection, no malnutrition

Answer 295

- Watery explosive stools = glucose intolerance - Foul-smelling greasy bulky stools = fat malabsorption - Diarrhea after cow’s milk, fruits, cereal intro = enzyme deficiency or protein intolerance - Neutrophils or RBCs in stool = bacterial gastroenteritis or IBD - Eosinophils = protein intolerance or parasitic infection - Gross blood or occult blood = shigella, campylobacter, E-coli

Answer 296

- Modified Barium Swallow (MBS) Study - Upper GI series for anatomic abnormalities - 24-hr intraesophageal pH monitoring – not helpful for weak acid (4-7 pH seen in kids) - Endoscopy w/ biopsy for esophagitis, strictures, Barrett esophagus; excludes Crohn’s - Scintigraphy for radioactive substances in esophagus to assess gastric emptying (determine if aspiration from reflux OR poor oropharyngeal muscle coordination) - CBC (anemia) - hypoproteinemia

Answer 297

Diagnostic: - Tissue Transglutaminase IgG or IgA Antibody - Endoscopy (flattened villi) Management - Gluten free diet (No wheat, rye, barley, and oats; cereal, baked goods; READ LABELS) - Substitute rice, corn, millets for grains - Avoid high fiber (nuts, raisins, raw veggies, and fruits) while bowel inflamed

Answer 298

Diagnostic Testing - ophthalmoscopy - Blood and tumor samples – test for RB1 gene mutations Treatment - eye enucleation (if unilateral) - chemotherapy - brachytherapy, radiation - photocoagulation (laser beam to destroy retinal BVs i.e. nutrition of tumor) - cryotherapy (freeze tumor and destroys microcirculation of tumor and cells through microcrystal formation

Answer 299

Diagnostic Testing - MRI of affected bone - Plain radiograph - Radial ossification in soft tissue gives sunburst appearance of tumor - chest CT b-c metastasis to lung usually - increased alkaline phosphatase. Treatment: - Surgery – limb salvage or amputation then Post-op care: continuous passive motion; TCA (amitriptyline) for phantom pain - Chemotherapy - Thoracotomy if pulmonary metastasis

Answer 300

- firm, nontender abdominal or chest mass that crosses midline - Compression of kidney, ureter, bladder (urinary frequency or retention) - urine catecholamines (secreted by tumor on adrenal gland) - supraorbital ecchymosis - periorbital edema (raccoon eyes) or Proptosis (bulging eyes) - chest tumor (Dyspnea, stridor, dysphagia, Horner syndrome (ptosis, miosis, anhidrosis))

Answer 301

Nursing Care - monitor frequent serum chemistries and urine pH - strict I&O - aggressive IV fluids - For hyperkalemia, furosemide - For hyperuricemia, allopurinol (decrease formation) or rasburicase (convert to soluble allantoin)

Answer 302

Related to: chemo, radiation, steroids (increased appetite) Parental education - avoid strong smells - relax pressure placed on eating. - Allow child to be involved in preparation and selection to make food appealing - give chemo at night

Answer 303

- Handwashing - Monitor s/s of infection or sepsis (fever) - G-CSF Injections if ANC < 500 - Cultures and antibiotics as soon as possible for 7-10 days - Protective isolation - Prophylaxis against Pneumocystis pneumonia (trimethoprim-sulfamethoxazole)

Answer 304

Procedure - Transfuse PRBCs, and platelets as indicated - Autologous (self-donation) vs Allogeneic (family or volunteer, umbilical cord blood) stem cells Post transplant - Give G-CSF if ANC still low - give calcineurin inhbitor w/ chemo to prevent graft versus host disease - Minimize pressure in dependent areas (frequent movement, pressure-relieving) - Promote healing (frequent sitz baths to perianal area and protective skin barriers i.e hydrocolloid dressing or occlusive ointments)

Answer 305

- Antihistamines- diphenhydramine, hydroxyzine - Anti Inflammatory- hydrocortisone creams (topical for allergic dermatitis and pruritus) - Antibiotics (topical or parenteral after empiric therapy; or shampoo or lotion)- same for antivirals, antifungals - Emollients (lotion, cream, ointment)- retain moisture in skin (gel or powder if too much moisture already); mupirocin (nares) - Silver sulfadiazine - antimicrobial to increase healing of burns

Answer 306

Risk factors - antibiotic use (r/t diarrhea side effect and altering of stool microbials) - moist areas (urine promote fecal enzyme activity; increased friction, abrasion damage, microbial counts) - exposure to irritants (urine, feces, soap, wipes, ointments) S/s: red and bumpy rash (maculopapular) on convex surfaces due to candida Treatment/Prevention - observe closely for liquid stools - Protective ointment (zinc oxide, cornstarch) - no talcum powder; no need to remove completely w/ diaper change - Keep area dry (superabsorbent diapers - Apply clotrimazole (Med for Candida Albicans- Yeast)

Answer 307

Cause: Malassezia yeast due to increased sebum production in early infancy or during puberty Locations - Scalp (cradle cap- most common) - Eyelids (blepharitis) - External ear canal (otitis externa) - Nasolabial folds - Inguinal region Diagnosis: based on appearance and location or crust or scales (thick, adherent, yellowish, scaly, oily patches w/ or w/o pruritus) Treatment - Mild or baby shampoo daily w/ mild soap and brush - If severe, medicated shampoo (sulfa and salicylic acid)

Answer 308

Cause: sumac from poison oak or poison ivy after two exposures (not spread person-to-person) S/s: red, raised pinkish-reddish pruritic papules Treatment - Cool compress - Treat pruritus (Antihistamines OR Topical or oral steroids) - Rinse immediately with cold water to remove irritant b-c penetrates more the longer it stays - lesions heal w/o treatment in 10-14 days - DO NOT harshly scrub exposed skin b-c will remove protective skin oil and dilute urushiol and allow spreading - Do not allow child to scratch lesion b-c can cause secondary infection

Answer 309

Cause (not contagious) - stress - weather (better in humidity; worse in fall and winter) - autoimmune (esp. IgE elevation) - fam hx of AD, asthma, allergies (food, rhinitis) S/s: - inflammation (red, swelling, pain) - pruritus - dry/rough/thick skin

Answer 310

Infantile - begins at 2-6 months; resolves at any age usually 3 yrs - Generalized, esp. cheeks, scalp, trunk, and extensor surfaces of extremities Childhood -begins around 2-3 yrs., usually seen by 5 years - Flexural areas (antecubital & popliteal fossa, neck) plus wrists, ankles, & feet Preadolescent/ Adolescent - Begins at 12 years and may continue indefinitely - Mainly face, sides of neck, hands, feet, - on antecubital and popliteal fossae to lesser extent

Answer 311

Cause: bacterial (strep or staph) infection of skin r/t scratching S/s: - honey-crusted vesicle - pruritus - inflammation (red, swelling) Transmission: contact (from place to place & person to person) Treatment - antibiotics (PO penicillin, IV, and occasionally topical mupirocin) - Avoid scratching b-c can cause spread and is contagious - For pruritus, use hydroxyzine (Atarax) or diphenhydramine.

Answer 312

Treatment (may take months) - Topical meds–Monistat, Lotrimin - Oral – Griseofulvin (take w/ high fat food; watch for leukopenia, liver, photosensitivity, insomnia)) - Itraconazole- (Sporanox- watch liver) - return to school after treatment has begun - avoid sharing hygiene products - Selenium sulfide shampoos, ( decrease infection and fungal shedding)

Answer 313

S/s: - inflammation (Erythema, edema, and heat) - pruritus - White patches in mouth (thrush) - red, discrete diaper rash (diaper dermatitis) Treatment - Nystatin (Mycostatin)-liquid or oral, do not feed after giving) - Amphotericin B for advanced cases

Answer 314

Cause: tick infected with Borrelia burgdorferi bites for 1-2 hrs Treatment - antibiotic (2‑ to 3‑week course) for clients who have confirmed disease - doxycycline (may use erythromycin too) for children older than 8 years - amoxicillin or cefuroxime for children under 8 years. (cefuroxime for children who have an allergy to penicillin) - observe for at least 30 days - remove tick w/ forceps or tissue Prevention - use repellents (diethyltoluamide (Deet) and permethrin) - Vaccine approved for 15-70-year-olds

Answer 315

Stage 1 - 3 to 30 days following bite - erythema migrans(bulls eye rash) at site - chills, fever, itching, headache, fainting, stiff neck, muscle weakness Stage 2 - occurs 3 to 10 weeks following bite - Systemic involvement begins (neurologic, cardiac and musculoskeletal) - paralysis or weakness in the face, muscle pain, swelling in large joints (knees), fever, fatigue, splenomegaly Stage 3 - 2 to 12 months following bite - Systemic involvement is advanced (musculoskeletal pain that includes the muscles, tendons, bursae and synovial); possible arthritis, abnormal muscle movement and weakness, numbness and tingling - late neurological problems and cardiac complications (cerebral ataxia, encephalopathy, deafness, speech problems)

Answer 316

Cause: tick bite leads to infestation caused by Rickettsia rickettsii Symptoms - fever - Headache - anorexia - rash (incubation 2-14 days) Major complication - hemorrhagic lesion (if untreated rash) - risk for thrombus, necrosis, edema, death Treatment: Chloramphenicol (drug of choice) or tetracycline

Answer 317

- Wear long-sleeved shirts, long pants tucked into long socks, and hat when walking in tick-infested areas - Wear light-colored clothing to make ticks more visible if they get onto child - Check children for the presence of ticks after being in high-risk or tick-infested areas (save tick for later ID) - Follow paths vs walking in tall grass and shrub areas - Apply insect repellents w/ diethyltoluamide (DEET) and permethrin before possible exposure to areas where ticks are found; also use on pets (use with caution in infants and small children) - Keeping yards at home trimmed and free of accumulating leaves and other brush

Answer 318

Cause: Scabies mites that burrows into the stratum corneum of epidermis and deposits eggs and excrement. S/s: itching; black dot at end of burrow in intertriginous areas (b/w digits, antecubital, popliteal, inguinal) Treatment - anti-scabies med (Elimite (permethrin cream) or Lindane (Kwell))) - lindane is neurotoxic and contraindicated - Apply over body, head and neck multiple times and overnight - for pruritus, oral antihistamines or topical corticosteroid creams - Treat family members and environment b-c spread by contact

Answer 319

Dose - EpiPen Jr (0.15 mg) IM for child 8 to 25 kg (17.5-55 lbs.) - EpiPen (0.3 mg) IM for child > 25 kg (55 lbs.) Side effects - tachycardia - hypertension and headache - irritability and tremors - nausea Notes - give ASAP then send to hospital

Answer 320

Patho: Infestation on lice and eggs usually in scalp. S/s - Scratching (may be only symptom) - Nits- ¼ - ½ inch from scalp (grayish or whitish) - red lesions on scalp Transmission: direct contact (can jump but not fly) via sharing personal items

Answer 321

S/s - lesions (macular, papular, vesicles, pustules, crust (MPVPC)) which are red and itchy in clusters - flu-like symptoms Transmission - contact, airborne, droplet - contagious 1-2 days before onset until lesions are crusted (5-7 days) - Incubation: 2-3 weeks; 14-21 days

Answer 322

Complications - Pneumonia, - Encephalitis, - Diarrhea - Obstructive laryngitis (croup) Treatment - Stay home and isolate - supportive w/ vitamin A therapy

Answer 323

Transmission - Incubation 14-21 - Isolation- contact and Droplet (Nasopharyngeal secretions and body fluids) Complications (less severe than rubeola unless pregnant): - arthritis or arthralgia - Congenital Rubella- growth delays, blindness, cardiac problems, deafness, intellectual disabilities (TERATOGENIC) Treatment: supportive

Answer 324

Cause: Human Herpesvirus 6 in 3-36 month olds S/s - abrupt high fever (risk for febrile seizures) for 3-5 days - maculopapular rash (after fever starting at neck and spreading up and down) disappears after 1-2 days - Other: lymphadenopathy, cough, coryza Transmission - contact and droplet - Incubation 5-15 days Treatment: Antipyretics (avoid aspirin b-c viral infection and risk for reyes)

Answer 325

Cause- GABHS carried by direct contact S/s - Rash- red, fine located in groin, neck and axillary - Strawberry tongue Treatment: complete antibiotics & supportive therapy Complications (spread of infection) - Sinusitis - Abscess - Meningitis - Osteomyelitis - Rheumatic fever - AGN

Answer 326

Cause: parvovirus S/s: - slapped cheek appearance - fever - runny nose Incubation: 14-21 days Complication: aplastic crisis esp in pregnant, sickle cell, or immunocompromised

Answer 327

Cause: bacterial, viral, or allergic Transmission: direct contact if viral or bacterial Treatment - avoid scratching or touching eye - If viral, clears on its own in 7 to 14 days. - If bacterial, Starts in one eye, spreads to the other so clear with antibiotics - If Allergic, clears with allergy medications. - use warm moist cloth to remove crusted secretions (inner to outer canthus)

Answer 328

Cause: obstruction or partial obstruction of eustachian tube and nose leads to accumulation of secretions in middle ear which impairs ciliary transport in tube and inhibits drainage Risk factors - smoking - bottle propping during feeding (breastfeeding is protective) - Conditions (down syndrome, cleft palate) - viral infection esp EBV and influenza - enlarged adenoids or tonsil tumors

Answer 329

Treatment - Amoxicillin Clavulanate 80-90 mg/kg/day OR Azithromycin - Cephalosporins (2nd line) - Myringotomy, Tympanoplasty, pressure equalizing tube (PET)- if chronic (tubes fall out on therir own) - keep ears dry (sterile alcohol cotton swab) - For symptoms, corticosteroid or benzocaine drops, pain relievers Prevention - avoid lakes and shampoos - Pneumococcal Vaccine- Prevnar, HIB, strep - influenza vaccine for > 6 m

Answer 330

UVA: shorter, high frequency cause aging UVB: r/t tanning and burning Prevention - Avoid midday exposure (10am-2pm) - Use a high SPF - Wear protective clothing (Wide brimmed hat, cotton with a tight weave clothing) - avoid sunscreens <6 months (just keep them out of sun)

Answer 331

- Extent of injury (Life threatening if 10% TBSA; If >30% TBSA, systemic response w/ capillary permeability) - Depth of injury - Location of wounds - Age (poor in tiny baby b-c thin skin esp under 6 months) - General health (chronic illness complicate healing) - Causative agent - Respiratory involvement - Concomitant injuries

Answer 332

Wound appearance - epidermis intact w/o blisters - erythema - blanches w/ pressure Wound Sensation: painful w/o systemic effects Course of Healing - discomfort for 48-72 hrs - desquamation in 3-7 days w/o scaring

Answer 333

Wound appearance - wet, shiny, weeping surface - blisters - blanches w/ pressure Wound Sensation - very painful and sensitive to touch and air currents - systemic effects (capillary damage and edema, anemia, SNS activation) Course of Healing - superficial heals < 21 days (> 21 for deep) - various amounts of scarring

Answer 334

Wound appearance - variable color (deep red, white, black, brown) - thrombosed vessels visible (nerves, sweat glands, hair follicles destroyed) - no blanching Wound Sensation: insensate (decreased pinprick sensation) Course of Healing: needs autograting

Answer 335

Wound appearance - color variable w/ dull and dry wound - extremity movement limited - charring visible in deepest areas (involves bone, muscle, fascia) Wound Sensation: insensate Course of Healing - amputation likely - autograft for healing

Answer 336

- Stop burning (smother flames, place horizontally, roll; remove clothes and jewelry) - Airway management (NPO, O2 therapy) - Fluid Replacement (lots of diuresis w/ burns; IV fluids of crystalloid then colloid) - Prevent infection (Cover wound; high cal/protein diet w/ zinc, vit A and C; topical antimicrobials; tetanus toxoid; debride) - Cover the burn with a clean and dry cloth to prevent hypothermia, decrease pain from air contact, and prevent contamination (do not let two burned surfaces touch) - Pain management (after other stuff; use IV vs subQ/IM b-c circulatory collapse and edema)

Answer 337

- Stop the burning process AND Remove clothing or jewelry - Apply cool water soaks or cool water (no ice b-c can cause burns AND circulatory collapse - Flush chemical burns with large amounts of water - Clean with mild soap/tepid water (keep wound bed clean and moist and cover w/ clean cloth) - Use antimicrobial ointment (silver sulfadiazine, neosporin) - No greasy lotions or butter - Provide warmth - Provide analgesia!!! - Immunize for tetanus if > than 5 years since last shot

Answer 338

- respiratory tract injury (erythema, pulmonary edema, hoarseness, bacterial pneumonia - burn shock (fluid loss, reduced cardiac output, hypotension, tachycardia, decreased LOC, hyperthermia to hypothermia) - local or systemic sepsis r/t fertile field for bacterial growth - increased intra-abdominal pressure r/t larger than calculated number of fluids in resuscitation

Answer 339

- Cholesteatoma (epithelial lining forms scales and erodes middle ear) - Tympanosclerosis (eardrum scarring) - Adhesive OM (thickening of mucous membranes) - Meningitis - Mastoiditis - hearing loss

Answer 340

- Fever (risk for febrile seizures) - otalgia (ear pain)- pulling at ear, turning head side to side - Purulent discharge (otorrhea) - bulging tympanic membrane seen w/ otoscope (feeling of fullness)

Answer 341

- Rash (on face spreads cephalocaudally) for 2-3 days - lymphadenopathy) - forchheimer spots on soft palate - coryza (Nasopharyngeal secretions and body fluids) - headache and eye pain - Other: fever, nausea, anorexia, sore throat

Answer 342

Cause: RNA virus S/s - 3 C’s: coryza (runny nose), bad cough, conjunctivitis (red eyes) - white Koplik spots in mouth - rash at hairline spreads cephalocaudally over 3 days Transmission - contact and droplet isolation - Incubation: 8-12 days incubation - infectious 3-5 days before and 4 days after rash

Answer 343

Complications: encephalitis, internal chicken pox, shingles Treatment: - avoid scratching to prevent superinfections - For pruritus, Antihistamine (diphenhydramine or hydroxyzine) - For Immunocompromised or severe cases, use Acyclovir or immune globulin (VZIG) within first 96 hours

Answer 344

- wash hair w/ Permethrin (NIX) or Pyrethrum (RID) OTCand leave for a while then comb nits out (malathion Rx for severe) - Wash everything in hot water - spray down everything except child in insecticide - put stuffed animals and non washable items in bags then in heat for 14 days

Answer 345

Locations (round w/ central clearing) - Tinea corporis = RINGWORM OF SKIN - Tinea capitis = SCALP - Tinea cruris = JOCK ITCH - Tinea pedis = ATHLETE’S FOOT (maceration and fissuring b/w toes) Transmission: person-to-person OR animal-to-person

Answer 346

Treatment - Hydrate skin ~cool or warm tepid baths, mild soap, emollient (Eucerin), humidifier - Relieve pruritus ~oral antihistamine; avoid scratching - Reduce flare-ups ~ topical corticosteroids, systemic antibiotics, coal tar - Cool wet compresses ( soothing and antiseptic protection) - Avoid heat Prevent/control infection - reduced exposure to allergens (i.e wool, rough fabrics, latex) - topical immunomodulators (i.e., tacrolimus)- give prior to flare up - avoid scratching

Answer 347

Treatment - hygiene (hand hygiene, clean wounds, chlorine bath) - avoid (scratching, squeezing, sun, and other irritants) - cool compress (or warm) -treat causative organism- antibiotics, antifungal, antiviral, anti (organism) - stay hydrated - Treat Fever (antipyretics, avoid heat) - Treat pruritus (antihistamine-topical OR oral (do not overdose)- Diphenhydramine, Hydroxyzine); oatmeal baths; steroids)

Answer 348

- Headache - Stomachache - Enuresis - Encopresis (fecal incontinence) - Self-harm - Physical Violence - Psychosocial- anxiety, depression, anger, irritable

Answer 349

- Play - Exercise - Breathing exercises - Meditation/prayer - Talking to adult or peer - Journaling or drawing

Answer 350

- Experiencing or witnessing violence, abuse, or neglect - Exposure to mental illness (including suicide), substance abuse, or incarceration. Impact: - Mental health (depression, suicidality, stress) - Physical health (poor self- rated health, heart disease, cancer, chronic pulmonary disease, skeletal fractures, liver disease, obesity) - Health-related behaviors (alcoholism, illicit drug abuse, smoking, high numbers of sexual partners, adolescent pregnancy)

Answer 351

Physiological Safety Love/belonging Esteem Self-actualization

Answer 352

- mandated reporter (Do not make promises you cannot keep) - Remove the child from potential harm (priority) - Observe (Bruises of different stages and unusual areas; Glove or stocking like burns; Spiral fractures; head injury) - use Clear and objective documentation (pictures) - Forensic Interview parents and child separately - Be direct, honest, professional, supportive to child and family (avoid asking the child probing questions) - Do not express shock or criticism - do full head to toe assessment if physical abuse

Answer 353

- Physical abuse (abusive head trauma) - physical neglect (Deprivation of food, clothing, shelter, supervision, medical care, and education) - Emotional neglect (Lack of affection, attention, and emotional nurturance) - Emotional abuse or psychological maltreatment (Destruction or impairment of child’s self-esteem ) - Sexual abuse (s/s: substance use, depression, withdrawn mood, suicidal, somatic complaints) - Medical Abuse (Munchausen by proxy)

Answer 354

- parental (Negative childhood, social isolation, Low self esteem) - environmental (Chronic stress, Unemployment, Divorce, Poverty, Drug Addiction) - child (disability, < 1 yrs old, premature)

Answer 355

- Physical evidence including previous injuries (various stages of healing) - Conflicting stories about the “accident” or inconsistent history with injury observed (esp. if does not match developmental level) - Cause of injury blamed on sibling or other party - chief complaint other than the one associated with signs of abuse (e.g., cold when there is evidence of first- and second-degree burns) - Inappropriate response of caregiver (exaggerated or absent emotional response, refusal to sign for additional tests or agree to necessary treatment, excessive delay in seeking treatment, or absence of parents for questioning) - Inappropriate response of child (little or no response to pain, fear of being touched, excessive or lack of separation anxiety, indiscriminate friendliness to strangers) - Repeated visits to emergency facilities with injuries (or previous reports of abuse) - Parent or caregiver report of being gone and finding the child unresponsive, indicating absence during the supposed event that resulted in harm

Answer 356

S/s: apnea, cyanosis, lack of muscle tone or choking Risk factors: gastric reflux, seizures, infections Diagnostics: Blood cultures, urine cultures, CBC, glucose, electrolytes, EEG, EKG, sleep study for apnea Nursing Care - Prepare for tests - Monitor for events esp apnea monitor

Answer 357

Diagnosis: exclusion Risk Factors - Maternal health (substance abuse, poor prenatal care) - maternal age less than 20 years - Twins - Premature or SGA, LBW - Respiratory or CNS distress (Persistent apnea, Bronchopulmonary dysplasia (BPD)) - Family history - Environmental risk factors (unsafe environment)

Answer 358

- Foreign object- Do not remove penetrating objects - Chemical burns- rinse for 20 minutes - Hematoma- use flashlight to check for gross hyphema

Answer 359

S/s- burning from mouth and GI tract, drooling, edema of lips Treatment - Assess child then call poison control - Dilute with water or milk - Do not neutralize or cause emesis

Answer 360

S/s: respiratory symptoms (gag, cough, choke), chemical pneumonia Treatment - Assess child then call Poison control - Only gavage with cuffed ET tube in place - Treat symptomatically

Answer 361

ASA/Aspirin - Gastric decontamination/lavage (Ipecac- NO LONGER USED) - Sodium Bicarbonate for acidosis - Activated charcoal (airway must be intact) Acetaminophen - N-acetylcysteine (mucomyst) Narcotics - Naloxone Benzodiazepine - Flumazenil Iron - Gastric decontamination/lavage - chelation Lead - chelation

Answer 362

Cause: - lead paint deterioration in old home (ingestion or inhalation) - ingestion (hot water dissolves lead fast, open cans, more absorbed on empty stomach - vertical transfer Impact - GI (NV, constipation, abdominal pain) - Renal - CNS (developmental delay, low IQ, behavioral problems - Hematologic (iron deficiency anemia b-c interferes w/ iron binding) - stored in bones and teeth (competition w/ calcium)

Answer 363

- BLL of 10 mcg/dl or greater (level of concern) - BLL > 20 mcg/dl (Clinical management – find source) - BLL > 45 mcg/dl (Chelation therapy-Ca EDTA and succimer, or BAL; assess urine output and renal function *no BAL if peanut allergy or liver problem - BLL >70 immediate management in hospital is required

Answer 364

Types * Meningocele—Hernial protrusion of a saclike cyst of meninges filled with spinal fluid but no neural elements (incomplete paralysis w/ neurogenic bladder(overflow w/ drippling) and bowel dysfunction) * Myelomeningocele (meningomyelocele)—Hernial protrusion of a saclike cyst containing meninges, spinal fluid, and a portion of the spinal cord with nerves (Abnormal body function w/ malformations at or below lesion)- more severe Prevention - folic acid begin 3 prior to pregnancy and continue in 1st trimester - detect in utero w/ CVS if elevated AFP

Answer 365

- Keep sac free of stool and urine (no infection) - keep sac free from drying (Sterile, saline soaked gauze) - Position baby on stomach with knees flexed under or elevate foot of bed w/o clothes or diaper (no pressure) - Assess neurological function (movement of extremities, skin response, anal reflex, head circumference) - Promote parent-infant bonding (caress, stroking) - Keep baby NPO for surgery in first 24-72 hrs - No rectal temps b-c risk for irritation or prolapse - ALWAYS Latex precautions (b-c increased risk for latex allergies; no kiwi, banana, avocado, milk)

Answer 366

- realistic goals - GU-Clean intermittent catheterization and antispasmodics - GI-Bowel training program - Neurological: Developmental delays, Increased ICP,epilepsy - Musculoskeletal- ambulation, ROM, splints, walking assistance (risk for tethered cord, club foot, scoliosis/kyphosis)

Answer 367

Non-progressive injury to the motor centers of the brain causing neuromuscular problems of spasticity or dyskinesia (ID and seizures risk) Incidence - Most common cause of chronic disability - diagnosed in first 1-2 yrs

Answer 368

- Anoxic injury before, during, after birth (brain malformations, NAT) - Maternal infections (perinatal infection (i.e. ToRCH)) - Kernicterus (high levels of unbound bilirubin- yellow staining of brain cells may result in encephalopathy) - Trauma (MVA, abuse, intrauterine insults) - Prematurity (most common), LBW - Postnatal infections (encephalitis, meningitis)

Answer 369

Spastic (may be Hemiplegia) - rigidity, hypertonia - exaggerated DTR, primitive reflexes, contractures and spinal deformities Dyskinetic - Athetoid—Chorea (involuntary, irregular, jerking); slow, wormlike, writhing movements; poor voluntary muscle control - Dystonic—Slow, twisting movements; arched back - Involvement of the pharyngeal, laryngeal, and oral muscles = drooling and dysarthria (imperfect speech articulation) Ataxia - Wide-based gait - Rapid, repetitive movements performed poorly

Answer 370

- Persistent neonatal reflexes after 6 months (Moro, palmar plantar, tonic neck) - Delayed developmental milestones (may have normal intelligence. Know your patients’ baseline) - early preference for one hand - Poor suck/ tongue thrust - Spasticity w/ scissoring of legs or toe walking: trouble diapering - Involuntary &/or asymmetrical movements

Answer 371

- Baclofen- muscle relaxant for spasticity - Diazepam (Valium)- for seizures - Botulism toxin A- release tight muscles to allow ambulation w/ orthoses - Anti-epileptics (Tagretol, Depakote, gabapentin)- if had seizure in past

Answer 372

- Musculoskeletal (Contractures, fractures, deformities (upper, spinal, foot), Hip subluxation/dislocation, gait disorders) - Neurological (seizures, ADHD) - Sensary (Hyper or hypo, visual, hearing) - Respiratory (risk for aspiration r/t poor oral musculature) - Immobility sequelae (skin breakdown, constipation) - Nutrition (FTT r/t dysarthria; may need G-tube)

Answer 373

Deaf: a person whose hearing disability precludes processing linguistic information with or without hearing aid Hard of hearing: generally able to hear with hearing aid Diagnosis - Profound deafness likely to be diagnosed in infancy (does not follow when someone speaks; no startle or blink reflex to noise) - FOR CHILDREN 6-19 yrs, diagnosis usually at entry into school - Failure to localize a source of sound by 6 months old - Absence of babble or voice inflections by 7 months old - Absence of well-formed syllables (da, an, yaya) by 11 months - Failure to develop intelligible speech by 24 months old

Answer 374

All - Prenatal preventive measures (prenatal care, avoid infections) - Early and periodic Screening - MMR vaccine Hearing - treat otitis media - Avoid exposure to noise pollution (high or continuous noise)

Answer 375

- Lip reading - Cued speech (hand signals to help child distinguish b/w words that look alike from lips) - Speech language therapy - Additional aids (sign language, picture board, flashing lights, dogs, TTD) - Supplement with visual and tactile media - make sure they can see you before any procedure

Answer 376

- Partially sighted (Acuity of 20/70 to 20/200): education usually in public school system - Legal blindness (Acuity of 20/200 or less): legal as well as medical term

Answer 377

Myopia- nearsighted (refraction error where light falls in front of retina)- Tx: glasses Hyperopia- farsighted (refraction error where light falls beyond retina)- Tx: glasses Strabismus (may or may not be refractive)- testing important in children, cover uncover, corneal light reflex (Tx- vision occlusion therapy, surgery) Amblyopia- lazy eye Astigmatism –unequal curves

Answer 378

- Screen all children for visual acuity - Suspect in a child whose pupils do not react to light - Education (Braille, Audio books and learning materials) - Provide reassurance during all treatments - Orient child to surroundings - consistent Treatment team members - provide safe environment (remove clutter, do not rearrange furniture) - encourage nonvisual affection in parents

Answer 379

Characterized by - significant limitations in both Intellectual functioning (IQ < 70) and Adaptive behavior (conceptual, social, and practical skills) - Originates before age 22 - Functional impairment in 2 or more areas (Communication/social, Self-care/direction, Home living, Use of community resources , work/academics, leisure, health and safety)

Answer 380

Screening Tools - Bayley Scales of Infant Development - Wechsler Intelligence Scale for Children for school-agers - Environmental Screening in Home esp for tobacco, lead, family assessment Goal of Care - To promote optimum social, physical, cognitive, and adaptive development as individuals within a family and community - provide guidance for establishing acceptable social behavior - provide guidance for establishing Personal feelings of self-esteem, worth, and security

Answer 381

- Avoidance of prenatal rubella infection—keep immunizations current - Genetic counseling, esp risk of Down or fragile X syndrome or PKU - Use of folic acid supplements (neural tube defects) - Education (dangers of smoking or alcohol use during pregnancy and ingesting lead during childhood) - Reduction of head injuries

Answer 382

- Prenatal diagnosis or carrier detection of disorders such as Down syndrome - Newborn screening for treatable inborn errors of metabolism (Congenital hypothyroidism, Phenylketonuria (PKU), Galactosemia) - monitoring of developmental milestones

Answer 383

- Treatment of coexisting problems to minimize long term consequences - Programs for infant stimulation, parent training, preschool education - Counseling services to preserve the family unit

Answer 384

- No response to contact, voice, movement - Irritability - Poor/slow feeding - Poor eye contact during feeding - Diminished spontaneous activity - Persistent primitive reflexes (stepping, palmar, plantar, rooting, babinski)

Answer 385

- severe, chronic mental and/or physical disability which originated at birth or during childhood (before age 22) - expected to continue indefinitely - Substantially restricts the individual’s functioning in 3 or more of the following major life activities: self-care/direction; receptive and expressive language; learning; mobility; economic self-sufficiency)

Answer 386

Any significant lag or delay in physical, cognitive, behavioral, emotional, or social development Diagnosis - Routine developmental screening can assist in early identification Treatment - Emphasizes abilities, environments, supports, and empowerment b-c underlying assumption: function improves with support

Answer 387

- Promote independence in self-care - encourage socialization and play - provide discipline as needed (Simple, consistent limit setting that is appropriate for child’s mental age) - Involve parent and child - communicate with child based on developmental level

Answer 388

- Eyes (Slanted palpebral fissures at eyes, brushfield spots(iris speckles) in eye, Inner epicanthal folds) - Mouth and nose (High-arched palate, Small nose w/flat nasal bridge, protruding tongue; periodontal disease) - Neck (Excess skin in neck folds) - Head (Separated sagittal sutures) - Hypotonia and hyperflexible (poor moro reflex) - Hand (Hypoplasia of fifth finger (shorter);Simian crease (transverse line on palm)) - Feet (Plantar crease between big and 2nd toe; Wide space between big and 2nd toe) - Development (normal initially then declines; social development > mental age)

Answer 389

Types - Nonfamilial trisomy 21 – usual (Increased risk w/ maternal age > 35 yrs) - Translocation of chromosomes 15 and 21 or 22 due to hereditary causes - Mosaicism (mixture of normal and abnormal chromosomes) Prenatal Testing - Cell free DNA for screening - Chorionic Villus sampling and amniocentesis for diagnosis

Answer 390

- Tracheoesophageal fistula - Congenital heart defect: 50% - Altered immune function = Early senescence (aging) (risk for URI and otitis media common) - Atlantoaxial instability of 1st and 2nd cervical vertebrae (no contact sports and no hyperextension of neck if stress on head and neck b-c spinal cord compression (urgent!))- need surgery - Sensory: 75% hearing issues and visual issues - Growth: weight vs. height - Hypothyroidism 10% - Small intestinal blockage or Hirschsprung 4% - Rare form of leukemia 1%

Answer 391

- Positioning- poor muscle tone so be more careful - Nutrition/Feeding- tongue big and thrusts out (refeed feedings) - Promote Attachment (family support) - Prevent respiratory problems (may be mouth breathers due to underdeveloped nasal bone)- need bulb suctioning, mouth rinses - Prevent dry skin (lots of lubricants needed)

Answer 392

- Inattention, impulsiveness, and hyperactivity w/ typical onset before age 7 - symptoms in more than one setting Care - Classroom (Vary learning activities; more test time, reduce assignment, difficult work in morning) - Behavioral therapy and/or psychotherapy for child - Environmental manipulation- not too many distractions; control overstimulation; structured

Answer 393

- Stimulant( Dexedrine, Adderall, Ritalin, methylphenidate) Side effects - Insomnia (give in morning) - anorexia/weight loss (give prior to eating) - hypertension - long-term use may suppress growth (give drug holiday)

Final Flashcards

(418 cards)