FINAL blueprint Flashcards
1
Q
what do 1-6 month old infants need for adequate nutrition?
A
- breastfeeding
- Vitamin D (200 IU / day)
- iron-fortified formula (do not microwave)
- formula 6x daily
- iron fortified cereal (4-6 months old)
2
Q
what do 6-12 month old infants need for adequate nutrition?
A
- formula / breastmilk 4-5 times a day
- spoon feeding by pushing food to back of tongue
- introducing solid foods one at a time
3
Q
when do babies get to eat finger food?
teething crackers, fruit and vegetables
A
6-7 months
4
Q
when can babies eat chopped table foods?
A
9-12 months
5
Q
what are the two oral social stages among infants?
A
- food intake (3 -4 months)
- grasping and bring to mouth / biting
6
Q
how many times do parents feed the same food to children before determining allergic reaction?
A
3 times one at a time
7
Q
what are the stages of play?
A
- unoccupied
- solitary
- onlooker
- parallel
- associative
- social
8
Q
unoccupied play
A
random movements of infants w/ no clear purpose
9
Q
solitary play
A
- children start to play on their own
- takes no notice of other children
10
Q
onlooker play
A
- children just watch others play
- they ask questions only
- no intention to join
11
Q
parallel play
A
- children play side-by-side
- they pay attention to what each is playing
- no interactions
12
Q
associative play
A
- children interact w/ each other by asking questions)
- similar goals
- no established rules
13
Q
social play
A
- children begin to share w/ each other
- rules are established
14
Q
what are the functions of play for a hospitalized child?
A
- provides diversion for a child
- gives the child choices and control of the situation
- gives the parents / family a break
15
Q
what are the atraumatic measures in a plan of care for pediatric patients?
(7)
A
- use a treatment room
- avoid safe spaces for procedures
- allow for breastfeeding when possible
- use appropriate terminology
- offer choices to the child
- allow parents to stay with their children during the procedure
- incorporate play into explaining procedures–allow the child to use dolls or toys
16
Q
what is NIPS (neonatal infant pain scale)?
A
a behavioral scale that indicates pain in full-term and pre-term infants (up to 2mos. old)
17
Q
components of NIPS
A
- cry
- facial expression
- arms
- legs
- breathing pattern
- state of arousal
each are ranked from 0-1 (cry ranked with 0-2)
18
Q
NIPS interventions
A
*reassessment in 30 mins appropriate
19
Q
which age group is FLACC used for?
A
2mos. – 7 years old
20
Q
definition of FLACC
A
Facial expression
Leg positioning
Activity
Crying
Consolability
21
Q
FLACC pain scale
A
22
Q
FACES pain scale is used for which age group?
A
3 years and older
23
Q
what does the Hib vaccine prevent?
(4); Haemophilus Influenza Type B
A
- bacterial meningitis
- epiglottitis
- bacterial pneumonia
- sepsis
24
Q
what are the common infectious respiratory illness among children?
(4)
A
- acute LTB
- epiglottitis
- pneumonia
- bronchiolitis
25
why is diminished or cessation of breathing noise and effort alarming for nurses?
sign of impending respiratory failure
26
why is *epiglottitis* considered an emergency?
airway obstruction & tracheal occlusion
27
what is *epiglottitis* usually caused by?
Haemophilius influenza
| Hib vaccine needed
28
s/s of *epiglottitis*
| (7)
* dysphonia
* dysphagia
* drooling
* tripoding
* high fever
* pain with swallowing
* edematous epiglottis
29
what are the diagnostic procedures for *epiglottitis*?
* portable lateral neck x-ray
* CBC
* blood culture *(bacteremia)*
30
what are the medications for *epiglottitis*?
* ABX
* corticosteroids
* antipyretics
31
parents are worried their child is having *epiglottitis* for the second time, what does the nurse say?
recurring *epiglottitis* is common
32
what are the signs of water depletion *(dehydration)* in children?
* **weight loss**
* **tachycardia**
* **depressed fontanels**
* decreased UOP
* altered LOC
* dry skin
* tacky mucous membranes
33
lab results for water depletion
* high urine specific gravity
* increased BUN
* increased Hct
* increased Na+
* increased serum osmolarity
* variable serum electrolytes
34
what are the causes of water excess?
* water intoxication
* IV overload
* incorrect feeding *(parents use too much water for formula reconstitution)*
* swimming lessons
* too rapid dialysis
* tap water enemas
35
what are the signs & symptoms of water excess?
* **crackles**
* increased venous pressure
* slow & bounding pulse
* **weight gain**
* lethargy
* increased spinal pressure
* seizures
* **bulging fontanels**
36
lab results for water excess
* low urine specific gravity
* decreased Hct
* decreased serum electrolyes
37
lab results for water excess
* low urine specific gravity
* decreased Hct
* decreased serum electrolyes
38
conditions associated with water excess
* CHF
* SIADH
* increased ICP
* oliguric renal failure
39
what are the signs of *increased* **ICP**?
| (7)
* bulging fontanels
* sunset eyes
* Cri du chat
* irritability
* **bradycardia**
* **vomiting**
* respiratory changes
40
what are the ***early signs*** of increased **ICP**?
* HA
* diplopia *(blurred vision)*
* NV
* confusion
41
what are the *nursing actions* to reduce **ICP**?
* HOB elevated 30
* avoid straining or coughing
* avoid bright lights
* minimize stimuli
42
what are the side effects of *Digoxin*?
* diuresis
* increased PR interval
* bradycardia
* **nystagmus**
* **NV**
* **hyperkalemia**
43
what are the pharmacological actions of *Digoxin* that cause bradycardia?
* negative chronotropic
* positive inotropic
44
what are the nursing actions for *Digoxin* before administering it to a patient with *CHF*?
***small children:*** hold when HR < 90 & do not give more than 1mL
***older children:*** hold when HR < 70
45
what is the therapeutic range for *Digoxin*?
0.8 - 2mcg/ L
46
why does the nurse need to question an order for *Digoxin* when a child's Potassium levels show less than 3.5mEq?
the effects of the medication will increase
47
*decreased pulmonary blood flow* causes ***cyanosis***
true
48
what are the cardiac defects that lead to a ***decrease*** in pulmonary blood flow?
* Tricuspid atresia
* Tetralogy of Fallot
49
***Kawasaki disease*** is the leading cause of *acquired* heart disease in children
true
50
***ecstasia*** is one of the major complications of *Kawasaki disease*, what is it?
an aneurysm caused by overdilation of coronary artery
51
s/s of *Kawasaki disease*
| (6)
* red eyes
* fever
* ring around the iris
* **strawberry tongue**
* **nonblistering rash on the perineum**
* **joint pain**
52
what are the medications for *Kawasaki disease*?
* IV globulins
* aspirin
53
what is *Kawasaki diease*?
acute systemic vasculitis that follow viral infections & toxic exposures
54
how are *Tet spells* relieved?
squatting position *(bringing knees to chest)*
55
which medication is used to keep *PDA*?
IV prostaglandin E
56
what are the s/s of *hypoxemia* r/t heart defects?
* cyanosis
* **polycythemia**
* clubbing
* **squatting**
* hypercyanotic episodes
57
what are the characteristics of asthma?
* **chronic** inflammatory disorder
* **narrow airways**
* hypersenstivity to stimuli/ irritants
58
what happens to the lungs among children with *asthma*?
* bronchial constriction
* alveolar hyperinflation
* air-trapping *(unable to exhale properly)*
* edema
* increased mucus secretion
59
what are the diagnostic tests for *asthma*?
* CXR
* PFT
* PEFR
60
what are the s/s for *asthma*?
* expiratory wheezing, crackles, or diminished
* dry cough
* sitting **retractions**
* prolonged expiration
* restlessness
* fatigue
* tachypnea
* cyanosis
* barrel chest
61
why do nurses need to avoid giving cold liquids to a pt w/ *asthma*?
avoid bronchospasms
62
what is the nursing care for a child w/ *asthma*?
* administer humidified O2
* high fowler's
* monitor pulse ox
* maintain IV access *(hydration, IV steroids)*
63
what are the medications for *asthma*?
* steroids
* oxygen
* IV fluids
* bronchodilators *(beta agonists & anticholinergics)*
64
what is more important for patient and families to know about regulating *asthma*?
* check peak flow
* keep rescue inhaler
65
LTB is usually preceded by an upper respiratory infection
| RSV most common
true
66
what is the primary cause of *bronchiolitis*?
RSV
67
*RSV* is most prevalent during the first 2 years of life
true
68
what is *cystic fibrosis*?
increased production of thick mucus in bronchioles and small intestines, & pancreatic and bile ducts
69
what is the etiology of *CF*?
inherited autosomal *recessive trait* from both parents
70
what is the role of **pancreatic enzymes** in the body?
they catabolize fats, carbohydrates & protein
71
what is the pathophysiology of *CF*?
* increased viscosity of secretions
* atelectasis
* clogged pancreatic ducts *(–> absent enzymes)*
72
what are the diagnostic tests for *CF*?
| (6)
* sweat chloride test
* CXR
* prenatal DNA testing *(from amniotic fluid)*
* AXR *(meconium ileus)*
* PFT
* stool analysis *(72 hours fecal fat)*
73
how does a child with *CF* present?
* coughing
* **dyspnea**
* **crackles**
* cyanosis
* clubbing
* **steatorrhea** *(frothy, foul smelling)*
* low SpO2
74
how can a nurse care for a child with *CF*?
* provide high calories & high protein
* administer pancreatic enzymes *(w/ meals)*
* administer vitamins A, E, D, K *(fat soluble)*
* increase hydration
75
what are the medications for *CF*?
* **mucolytics**
* bronchodilators
* ABX
* **pancreatic enzymes**
* **fat-soluble vitamins**
76
proper education for families with a child with *CF*
* avoid respiratory illness & infection
* **chest percussion**
* postural drainage
* **high calorie & high protein**
* physical activity *(loosens secretions)*
* genetic counseling
77
what is the major cause of hospitalizations among infants?
bronchiolitis
78
what is *bronchiolitis*?
inflammation of bronchioles with edema & excess accumulation of mucus due to RSV
79
why does air trapping & atelectasis occur in *bronchiolitis*?
increased airway resistance from obstructed bronchioles
80
how is *bronchiolitis* spread?
contact with contaminated objects*(droplet precautions must be in place)*
81
what are the diagnostic procedures for *bronchiolitis*?
* nasopharyngeal swab
* CXR
82
what are the symptoms of *bronchiolitis*?
* worsening upper respiratory infections
* tachypnea
* retractions
* low-grade **fever**
* anorexia
* thick nasal secretions
* wheezing / crackles
83
how can a nurse care for a child with *bronchiolitis*?
* **encourage feeding**
* nasal suctioning PRN
* **increase fluid intake**
* daily weights *(I&O)*
* pulse ox
* humidified O2
* **contact precautions**
84
medications for bronchiolitis
* ABX
* fluids
* steroids
85
what is most important for families to know in caring for their child with *bronchiolitis*?
* use of **bulb syringe**
* notify HCP when anorexic or **worsened breathing**
86
what are the ages of a *preschooler*?
3-6 years old
87
what are the *gross motor skills* typically learned during the **preschool** years?
* rides tricycle
* up stairs alternating feet
* hop on one foot & alternate feet
* dress independently
* throws & catches a ball
88
what are *fine motor skills* preschoolers learn?
* **lace shoes up**
* **use of scissors & pencils**
* can **draw** cross, circle, diamond, & triangle
* count numbers
* write a few letters
89
what type of play are preschoolers engaged in?
associative play
90
imaginary friends are common among *preschoolers*
true
91
*preschoolers* are more socially aware with knowledge & less egocentric
true
92
which phase of Piaget are *preschoolers* in?
preoperational phase
| Stage 2
93
what is a hallmark of preschooler's cognitive development?
language *(being able to express themselves sufficiently)*
94
*preschoolers* cannot reason beyond the observable
true
| literal language, not figurative
95
*preschoolers* have a lack of reversibility
true
96
which stage of *Erikson's* are preschoolers in?
initiative vs. guilt
| Stage 3
## Footnote
exercise autonomy, feeling guilty for unfulfilling tasks
97
what does the nurse tell a preschooler's parent who is worried about their child's stuttering and stammering
it is a normal characteristic of language development
98
treatment for ***hypertensive*** *AKI*
* anti-HTN
* limit fluids
* limit salt
99
manifestations of *Wilms tumor*
* aniridia
* HTN
* hematuria
* hemihypertrophy
* overgrowth syndrome *(Beckwith-Wiedemann)*
100
diagnostic procedures for *Wilms tumor*
* radiographic studies *(x-ray)*
* ABD U/S
* hematologic & biochem studies
* UA
101
why should nurses not palpate the protrusion in *Wilms tumor*?
to avoid rupturing the tumor
102
what is the treatment for *Wilms tumor*?
surgical removal of tumor, affected kidney, & adjacent adrenal gland
103
what is the triad for *HUS*?
* anemia
* thrombocytopenia
* renal failure
104
what are the *lab results* associated with **HUS**?
* decreased Hgb & Hct
* elevated BUN
* elevated Creatinine
* elevated reticulocyte
105
what is the *nursing care* for **HUS**?
| (5)
* **monitor I&O**
* **fluid replacement**
* treat HTN
* provide **seizure precautions**
* enteral nutrition
106
what is included in **renal diet**?
* low Na+
* high carbs
* low protein
* fluid restrictions
* avoid fresh & organic produce
107
what are the implications for *AKI*?
| accumulation of waste
* azotemia
* uremia
* inability to excrete waste, concentrate urine, & conserve electrolytes
108
diagnostic results for *AKI*
* elevated BUN
* reduced GFR
* elevated creatinine
109
treatment for ***hyperkalemic*** *AKI*
Kayexalate
110
treatment for ***hypertensive*** *AKI*
* anti-HTN
* limit fluids
* limit salt
111
treatment for ***anemic*** *AKI*
PRBC
| if Hgb is < 6g/dL
112
# emesis
pyloric stenosis
projectile vomiting
113
# definition
pyloric stenosis
hypertrophy of circular muscle of pylorus
| causes obstruction & constriction
114
therapeutic procedures for *pyloric stenosis*
* pylorotomy
* laparotomy
115
hallmark signs of *pyloric stenosis*
* **moveable mass** in epigastrum
* **projectile vomiting**
* possible peristaltic wave while supine
* dehydration
116
# characteristic
celiac disease
intolerance to the protein gluten
117
what is the pathology for *Celiac disease*?
gluten-sensitive enteropathy
118
what are the common manifestations of *Celiac disease*?
* ABD distension
* vomiting
* diarrhea w/ foul odor
* chronic malabsorption syndrome
119
cleft lip/ palate feeding bottles
120
when can *cleft palate* be repaired?
between 6-12 months of age
| usually before 2 years old
121
postop nursing care for *cleft palate* repair
* elevated supine position (or on side)
* cool mist tent
* blended diet
* elbow restraints
* advice to avoid sucking for 7-10 days
* no oral temps
122
for how long do children who had their cleft palate repaired stay in elbow restraints?
4-6 weeks
123
when do posterior fontanels close?
2-3 months old
124
when do deciduous teeth erupt?
6-10 months old
125
what is the recommended dose for Acetaminophen for infants?
10-15mg / kg / dose
(max. 5 doses)
126
what do babies need for healthy & safe sleep?
* sleeping in their own bed close to parent's bed
* no soft bedding
* no smoking
* no overheating
* supine position
127
s/s of *GERD*
* excessive crying
* arching of back
* spitting up/ vomiting
* cough, wheezing, stridor, gag
* apnea
* bloody emesis
* difficulty swallowing
* CP
* heart burn
128
managements for *GERD*
* weight control
* small frequent meals
* avoid food that intensify reflux
* thickened feedings
* elevate HOB (or hold baby for ***one hour***)
129
what are the medications for *GERD*?
* Ranitidine
* Omeprazole
130
hallmark sign of *appendicitis*
pain at McBurney's point (RLQ)
131
what are the diagnostic tests that can confirm *appendicitis*?
* CBC*(WBC)*
* CT scan
* CRP*(detects inflammation)*
132
what would a CT scan show for *appendicitis*?
enlarged appendix & thickening of appendiceal wall
133
what is ***osteogenesis imperfecta***?
an inherited **connective tissue disorder** that results in bone fractures along w/ restricted growth
| "brittle bone disease"
134
what are the clinical manifestations of ***osteogenesis imperfecta***?
* multiple bone fractures
* blue sclera
* early hearing loss
* hypoplastic discolored teeth
135
what is the treatment for ***osteogenesis imperfecta***?
pamidronate IV with biphosphate
136
what is the expected MOA of ***pamidronate***?
increases bone density
137
what are the signs of ***compartment syndrome*** that occurs with *casts*?
| 5 P's
* paresthesia
* pallor
* paralysis
* pain
* pulselessness
138
what are the nursing priorities for a child with a *cast*?
regular *skin checks* & *neurovascular checks*
139
what are ***tractions*** used for?
| (4)
* provide muscle rest
* immobilization
* alignment
* prevent contractures
140
what are the *nursing actions* for **cast care** & **traction**?
| (7)
* **use a doll** or toy for *atraumatic care*
* **elevate cast** above heart level to prevent swelling
* **reposition** q2hrs to *allow air drying*
* keep extremity supported *(dependent position)*
* monitor for drainage
* notify for hot spots
* ensure weights **hang freely** *(do not lift w/o HCP supervision)*
141
what are the components of ***neurovascular assessments***?
* sensation
* skin temperature
* **skin color**
* **cap refill**
* **pulses**
* movement
142
what are the types of ***skin tractions***?
* Bryant
* Buck
* Russell
143
what is the most prominent etiology of ***cerebral palsy***?
kernicterus
| elevated bilirubin in newborns
144
what is ***cerebral palsy***?
a nonprogressive **impairment of motor function** that causes *spasticity* or *dyskinesia* (involuntary movements)
145
what are the s/s of ***cerebral palsy***?
| (8)
* persistent *Moro reflex* or *tonic neck reflex*
* failure to smile by 3 months
* persistent **tongue thrust** by 6 months
* spasticity
* **scissoring of legs**
* nystagmus
* hearing loss
* feeding difficulties
146
what are the expected findings of *spina bifida* ***cystica***?
| (5)
* **flaccid muscles**
* lack of bowel control
* rectal prolapse
* spinal curvature abnormalities *(kyphosis/ scoliosis)*
* **protruding sac**
147
what are the nursing actions after treating *hypoglycemia* w/ 15g carbs & glucagon?
* recheck glucose 15mins after until levels are 70mg/dL or above
* continue to monitor for 2hrs
148
what is the *HgbA1c* level for ***hyperglycemia***?
< 6.5%
149
what is the *fasting BG* level for ***hyperglycemia***?
126mg/dL or above
150
what is the ***starvation response*** in *T1DM*?
fatty acid is broken down *(to obtain more energy from the body)* and in the process produced *ketone bodies*
151
*starvation response* over a prolonged period of time can lead to which complication?
diabetic ketoacidosis
152
what are the s/s of *DKA*?
* ***Kussmaul respirations***
* fruity breath
153
what are the s/s of *T1DM*?
| (7)
* polyuria
* polyphagia
* polydipsia
* flushed/ dry skin
* confusion
* wt loss
* retinopathy
154
what is the most concerning delay in developmental milestone found in an infant?
head lagging
155
what does **head lagging** indicate?
cerebral palsy
156
what are the supplements that pregnant women should take to *prevent* **NTDs**?
* niacin
* folate
157
what is the first sign of **puberty** in *girls*?
breast development
158
# definition
animism
personification of inanimate objects
159
what are the nursing actions for a child with a **myelomeningocele** preop?
lay on their side with the sac covered with a sterile saline gauze
160
**Bryant's traction** is only appropriate for children with *hip dysplasia* that meet which criteria?
* younger than 3 yrs old
* weighing less than 35 lbs.
161
what is the first sign of **puberty** in *boys*?
testicular enlargement
162
what is ***hemophilia***?
a group of bleeding disorders characterized by difficulty controlling bleeding due to *lack of clotting factors*
163
what are the types of ***hemophilia***?
* Hemophilia A *(classic)*
* Hemophilia B
* Von Willebrand Disease
164
which clotting factor does ***Hemophilia A*** lack?
factor VIII
165
which clotting factor does ***Hemophilia B*** lack?
factor IX
166
which is the most common type of ***hemophilia***?
Von Willbrand disease
167
what is ***Von Willebrand*** *hemophilia*?
the inherited **lack of the *von willebrand factor* protein** characterized by inability of platelets to aggregate
168
both ***Hemophilia A*** & ***B*** are male dominant *(x-linked recessive)*
true
169
***Von Willebrand disease*** affects both males & females
true
170
how is ***hemophilia*** diagnosed?
* hx of **bleeding episodes**
* evidence of x-linked inheritance
* **PTT**
* factor assays
* DNA testing
171
what are the medications & treatment for ***hemophilia***?
| (5)
* synthetic vasopressin *(DDAVP)*
* steroids
* factor VIII products
* pooled plasma
* recombinant products
172
what is the MOA of ***DDAVP*** *(Desmopressin)* for Hemophilia?
increases plasma factor VIII *(only for **Hemophilia A**)*
173
what is the nursing care for ***hemophilia***?
| (4)
* monitor urine, stool, & NG fluid for ***occult blood***
* administer ***Acetaminophen*** instead of *aspirin*
* administer injections via subQ only
* venipunctures are preferred for blood sampling
174
where is the most appropriate site for a **bone marrow biopsy** on a child *younger than 18 months*?
tibia
175
where is the most appropriate site for a **bone marrow biopsy** on a child *older than 18 months*?
anterior iliac crest
176
what are the *nursing actions* for a **bone marrow biopsy**?
* apply pressure dressing for 24hrs
* have the patient in side-lying position
* place a pillow under their hips
177
patients with ***sickle cell anemia*** have what type of *Hgb*?
Hgb S
| predominantly; it replaces Hgb A
178
which diagnostic procedure is used for ***sickle cell anemia***?
* hemoglobin electrophoresis
* sickledex finger stick
179
what are the nursing actions for a ***sickle cell*** *crisis*?
* adequate oxygenation
* hydration
* transfusion
* ABX
* analgesics
* FEB
180
what are the s/s of *vasooculsive crisis* in ***sickle cell anemia***?
| (6)
* pain
* priapism
* acute chest syndrome
* stroke
* severe joint pain
* swollen joints & extremities
181
what are the *nursing actions* for **sickle cell anemia**?
| (8)
* analgesics
* O2
* promote rest
* give oral fluids
* monitor for infection
* administer *PCV, Hib, Meningococcal* vaccines
* apply **warm packs** to joints
* administer **Hydroxyurea**
182
what is the prevention for *sepsis* in ***sickle cell anemia***?
prophylactic Penicillin
| until 5 years old
183
how does **hydroxyurea** help manage *sickle cell anemia*?
reverts sickle cells to its original shape *(promoting roundness & flexibility)*
| reverse sickle cell effects
184
what is the nursing care for a patient experiencing **sickle cell crisis** *(vasooclusive)*?
* administer analgesics *(acetaminophen, ibuprofen, or opioids)*
* apply warm compress to joints
* O2
* bed rest
* increase fluids
185
which foods contain *gluten*?
* barley
* rye
* oats
* wheat
| BROW
186
what are the symptoms for *pertussis*?
* runny nose
* severe cough *(whooping upon inspiration)*
* spasms
* flushing
* cyanosis
* vomiting
187
what are the precautions implemented for **pertussis**?
droplet precautions
188
what is the nursing care for ***hemophilia***?
| (4)
* monitor urine, stool, & NG fluid for **occult blood**
* administer ***Acetaminophen*** instead of *aspirin*
* administer injections via subQ only
* **venipunctures** are preferred for blood sampling
189
what is the MOA of ***DDAVP*** *(Desmopressin)*?
increases plasma factor VIII *(only for **Hemophilia A**)*
190
how is ***hemophilia*** diagnosed?
* hx of bleeding episodes
* evidence of x-linked inheritance
* PTT
* factor assays
* DNA testing
191
what are the medications & treatment for ***hemophilia***?
| (5)
* synthetic **vasopressin** *(DDAVP)*
* steroids
* **factor VIII** products
* pooled plasma
* recombinant products
192
what is *Rheumatic fever*?
an inflammatory disease that occurs as a reaction to *Group A strep infection*
193
s/s of *Rheumatic fever*
| (7)
* ***Aschoff bodies*** *(tiny lesions of the heart)*
* carditis
* murmur
* ***polyarhritis***
* ***rash in trunk & extremities***
* subcutaneous nodules
* CNS involvement *(uncoordination + involuntary mvmnts)*
194
what are the medications that can treat *Rheumatic fever*?
* penicillin G
* sulfadiazine*(ABX)*
* penicillin V
195
what is the earliest sign of dehydration?
* tachycardia
* poor perfusion *(cap refill)*
196
what are the s/s of **hypoglycemia**?
* irritability
* decreased LOC
* slurred speech
* cold & clammy
* pallor
* hunger
197
what are the s/s **hyperglycemia**?
* polyuria
* polydipsia
* polyphagia
* NV
* **fruity breath**
198
what is the first intervention for dehydation in pediatrics?
oral rehydration therapy with Pedialyte or Gatorade ONLY
199
what are the s/s of **Graves disease**?
| (6)
* hyperactive
* hyperstimulated
* exophthalmos
* tachycardia
* diaphoretic
* weight loss
200
what are the signs of ***compartment syndrome*** that occurs with *casts*?
| 5 P's
* paresthesia
* pallor
* paralysis
* pain
* pulselessness
201
what is the pathophysiology of *nephrotic syndrome*?
increasing permeability of basement membrane in kidneys leading to albumin leaks & accumulation of fluid in interstitial spaces
202
what is the etiology of *nephrotic syndrome*?
inherited autosomal recessive gene
203
what are the manifestations of *nephrotic syndrome*?
| (7)
* weight gain
* **periorbital** edema
* **ascites**
* oliguria
* vomiting
* irritability
* proteinuria *(**15g** in 24-hr urine)*
204
children with **nephrotic syndrome** have an increased risk of *upper respiratory infection*
true
205
what is the *nursing care* for **nephrotic syndrome**?
| (5)
* elevate legs to relieve edema
* strict I&O
* measure ABD girth daily
* monitor for proteinuria
* salt restriction
206
what is the treatment for *nephrotic syndrome*?
* low Na+ diet
* severe fluid restriction
* **diuretics** *(due to edema)*
* **25% albumin**
* **prednisone**
207
what is the goal for treating *nephrotic syndrome*?
* **reduce** excretion of **urinary protein**
* reduce **fluid retention** in tissues
* **prevent infection**
208
what is ***osteogenesis imperfecta***?
an inherited **connective tissue disorder** that results in bone fractures along w/ restricted growth
| "brittle bone disease"
209
what are the clinical manifestations of ***osteogenesis imperfecta***?
* multiple bone fractures
* blue sclera
* early hearing loss
* hypoplastic discolored teeth
210
what is the treatment for ***osteogenesis imperfecta***?
pamidronate IV with biphosphate
211
what is the expected MOA of ***pamidronate***?
increases bone density
212
what are the types of ***fracture*** in children?
* bend
* buckle
* greenstick
* complete
213
***bend fratcures*** only occur in the *ulna* & *fibula* when there is a fracture in the radius & tibia
true
214
the most common site for a fracture in a child is the ***growth plates***, where is it?
located on the ends of the hard bone *(epiphyseal)*
215
what are the styles of parenting?
* authoritarian
* permissive
* authoritative
216
what are the types of families?
| (7)
* traditional
* nuclear
* blended
* extended
* single parent
* binuclear
* communal
217
# fluid calculations
1-10 kg
100mL/kg
218
# fluid calculations
11-20 kg
(1000mL) + (50mL / kg > 10)
219
# fluid calculations
> 20kg
(1500mL) + (20mL/ kg > 20)
220
what kind of reflexes does a child with *meningitis* manifest?
* Brudzinsky sign
* Kernig's sign
* Nuchal rigidity
221
which vaccine prevents *meningitis*?
Hib vaccine
222
which bacteria causes *meningitis*?
* group B strep
* Hib
223
what are the s/s of *meningitis*?
| (7)
* abrupt onset fever
* vomiting
* photophobia
* HA
* **Nuchal rigidity**
* **Kernig's sign**
* **Brudzinski's sign**
224
what is the diagnostic procedure for *meningitis*?
lumbar puncture
225
what are the CSF characteristics for ***bacterial*** *meningitis*?
* elevated WBC
* cloudy color
* elevated protein
* decreased glucose
* ***(+) Gram stain***
226
what are the CSF characteristics for ***viral*** *meningitis*?
* **clear** color
* **elevated WBC**
* normal protein content
* normal glucose
* ***(-) Gram stain***
227
what is *Reye syndrome*?
a neurological dysfunction that causes **liver dysfunction & cerebral edema**
228
which medication is the cause for *Reye syndrome* heavily associated with?
Aspirin
229
***Reye syndrome*** typically follows a viral illness such as *flu or varicella*
true
230
what are the emergent measures for *status epilepticus*?
| (5)
* airway
* oxygen
* suction
* IV **ativan**
* thermoregulation
231
what are the nursing actions *prior* to a **lumbar puncture**?
* assist client to void
* apply EMLA cream
232
what are the nursing actions *after* a **lumbar puncture**?
* apply pressure dressing to site
* monitor for **bleeding, hematoma, infection**
* allow patient to lay flat
233
how is the child positioned for a **lumbar puncture**?
side lying w/ head & knees flexed
234
what is the ***starvation response*** in *T1DM*?
fatty acid is broken down *(to obtain more energy from the body)* and in the process produced *ketone bodies*
235
what are the s/s of *hyperthyroidism*?
* irritability
* hyperactivity
* ***exophthalmos***
* goiter
* wt loss
236
what is *Grave's disease*?
a form of ***hyperthyroidism*** that is usually an autoimmune response to TSH receptors
237
*hyperthyroidism* is more common in girls *(at least 5x more likely)*
true
238
what are the s/s of ***Grave's disease***?
* **fever**
* **enlarged thyroid gland**
* exophthalmos
* urticaria
* vasculitis
* agranulocytosis
239
children can become *hyperthermic* when in a ***toxic coma***
true
240
what are the *preoperative* actions for a patient who is scheduled for a **meningocele sac closure**?
* place infant in warmer
* apply sterile, moist, & non-adhering dressing on the sac *(re-wet when dry)*
* administer IV ABX as prescribed
* **avoid rectal temperatures**
241
what are the *postperative* actions for a patient who had a **meningocele sac closure**?
| (6)
* monitor weight
* monitor I&O
* resume oral feedings
* **provide ROM**
* **assess for bulging fontanels**
* measure head circumference
242
what are the appropriate *client education* for a patient with a **meningocele**?
* avoid objects with **latex**
* monitor for **bladder infection** or dysfunction
* monitor widening head circumference
243
which lack of vitamins during gestation can cause **spina bifida**?
* folate
* niacin
* cobalamine
244
what are the *diagnostic tests* to determine **spina bifida** during gestation?
* AFP
* amniocentesis
* U/S
245
elevated AFP levels indicate **spina bifida**
true
246
what are the treatments for *seizure*?
| (6)
* **Ketogenic diet**
* **antiepileptic drugs**
* **vagus nerve stimulation**
* focal resection
* hemispherectomy
* corpus callostomy
247
what is included in a **Ketogenic diet**?
* high fat
* low carbs
* adequate protein
248
what are the emergent measures for *status epilepticus*?
| (5)
* airway
* oxygen
* suction
* IV access *(-zepam & phenobarbital)*
* thermoregulation
249
what are the types of ***anemias***?
* iron deficiency
* sickle cell
* B-Thalassemia*(Cooley)*
* aplastic
250
what are the various reasons for ***anemia***?
* decreased RBC production
* increased loss of RBC *(from bleeding)*
* increased hemolysis
251
what are common clinical manifestations of ***anemia***?
* fatigue
* pallor
* decrease in Hgb
252
what are the clinical manifestations of ***Cooley anemia***?
| B-Thalassemia
* small stature
* splenomegaly
* hepatomegaly
* decreased H&H
* abnormal blood smear
253
what is ***aplastic anemia***?
a bone marrow failure condition in which formed elements of the blood are simultaneously depressed
254
what are the conditions associated with ***aplastic anemia***?
* anemia
* leukopenia
* thrombocytopenia
255
what are the manifestations of *coarctation of the aorta*?
| (5)
* elevated BP in upper extermities *(> 20mmHg difference)*
* bounding pulses in upper extremities
* cool skin in lower extremities
* nosebleeds *(epistaxis)*
* absent femoral pulses
256
what is the hallmark heart sound the nurse will hear in *aortic stenosis*?
bruit
257
what are the congenital ***mixed defects*** that can be found in children?
* transposition of the great vessels
* total anomalous pulmonary venous return
* truncus arteriosus
* hypoplastic left heart syndrome
258
what are the *congenital heart defects* that ***increase*** pulmonary blood flow?
* atrial septal defect
* ventricular septal defect
* patent ductus arteriosus
* atrioventricular canal
259
what are the ***obstructive defects*** of the heart?
* coarctation of the aorta
* aortic stenosis
* pulmonary stenosis
260
auscultory landmarks of the heart
| *be mindful of* **STERNAL BORDERS** & **MIDCLAVICULAR**
261
what are the conditions that are included under *Tetralogy of Fallot*?
| (4)
* pulmonary stenosis
* overriding aorta
* right ventricular hypertrophy
* VSD
262
s/s of *ToF*
| (5)
* ***cyanotic spells*** *(Tet spells)*
* ***polycythemia***
* systolic murmur
* clubbing
* tachypnea
263
what is the treatment for **ToF**?
* O2
* Morphine *(induce slower RR)*
* squatting *(knees to chest)*
264
what is the nursing action when a child has > 60mg/kg of **iron**?
administer **Deferoxamine**
