final exam Flashcards
(166 cards)
1
Q
when should dornase alfa be given to a a patient with CF?
A
prior to chest PT
(it loosens the secretions so they can be expelled)
2
Q
what play is expected for an infant?
A
solitary
3
Q
what play is expected fir a toddler?
A
parallel
4
Q
what play is expected for a pre-schooler?
A
associative
5
Q
what play is expected for a school-age?
A
cooperative
6
Q
what atraumatic care techniques can be utilized for an infant?
A
- soothing music
- therapeutic hugging
- speak in calm tone
7
Q
what atraumatic care techniques can be utilized for a toddler?
A
- approach carefully
- use toys/book to distract
- parallel play
8
Q
what atraumatic care techniques can be utilized for a pre-schooler?
A
- puppets
- allow to touch equipment
- allow choices
- count out loud
- give bear a shot
9
Q
what atraumatic care techniques can be utilized for a school-age?
A
- encourage questions
- use diagrams
- illustrations
10
Q
what atraumatic care techniques can be utilized for an adolescent?
A
- respect privacy
- don’t force talk
- use appropriate medical terms
11
Q
what activities should be utilized for an infant?
A
- mobiles
- noise-makers
- soft toys
- large blocks
12
Q
what activities should be utilized for a toddler?
A
- push-pull toys
- lg-piece puzzles
- balls
13
Q
what activities should be utilized for an adolescent?
A
- reading
- listening to music
- peer time
14
Q
what activities should be utilized for a pre-schooler?
A
- arts/crafts
- play pretend
- books
15
Q
what activities should be utilized for a school age?
A
- board games
- action figures
- models
- video games
16
Q
what motor skills are expected by 4m?
A
- back to side
- head control
- grasps objects w/both hands
17
Q
what motor skills are expected by 6m?
A
- back to front
- holds bottle
18
Q
what motor skills are expected by 9m?
A
- unsupported sit
- creeps on hands/knees
- crude pincer grasp
19
Q
what motor skills are expected by 12m?
A
- sits down from standing
- walks w/one hand or on own
- 2 block tower
- simple marks on paper
- feeds self w/cup/spoon
20
Q
at what month should birth weight be doubled?
A
5 m
21
Q
what does birth weight do by 1 yr old?
A
triples
22
Q
how much should the heigh increase for the first 6 m?
A
1in/m
23
Q
how much should the birth length increase by 12 m?
A
50%
24
Q
how big should head be by 12m?
A
10cm
25
what resp differences are expected in infants?
- lack of IgA
- narrow nasal passages
- trachea and chest wall more compliant
- shorter bronchioles/bronchi
- funnel-shape larynx
- larger tongue
- fewer alveoli
26
what is recommended at 4m to infants who are exclusively breastfed?
iron supplementation
27
how long should cows milk be avoided?
1st year
28
what type of formulas should be used for bottle fed infants? how many calories/oz?
- iron fortified formulas (10-12mg/liter)
- 20kcal/oz
29
what reflex must be extinguished to start solid foods around 4-6m?
extrusion
30
what should be first solid food?
iron-fortified infant cereal (rice, barley, oatmeal)
31
what are the infant new food rules?
1st - cereal
2nd veggies
3rd fruit
- new food every 3-5 days
32
how many words are expected by the end of age 2 (toddler)?
50-300 words
33
what care seat safety education should be provided for toddler?
- read facing, back seat
- forward facing after age 2
- disabled airbag for front seat
34
what are 3 expected nutritional differences with toddlers?
- physiologic anorexia
- food jags
- ritualism
35
what is the TAMI mnemonic for cognitive development in pre-schoolers?
T ime
A nimism
M agical thinking
I maginary friend
36
what are 3 social development cues expected in the pre-schooler?
- fears
- imaginative play
- dramatic play (dress up)
37
what type of breathing pattern is expected in the school-ager?
diaphragmatic breathing
38
what are 3 nutritional requirements specific to the adolescent?
- calcium 1300 mg/day
- iron - 11mg (male); 15 mg (female)
- 2000 calories
39
what are 2 nursing care techniques for the hospitalized adolescent?
- maintain independence
- encourage socialization w/friends
40
what is often the first sign of resp distress (hypoxia/hypoxemia)?
tachypnea
41
what are some signs of resp distress?
- restlessness
- grunting
- cyanosis
- rales, wheezes, rhonchi
- retractions
42
what 4 nursing interventions can be implemented to manage hypoxemia?
- oxygen therapy
- pulse oximetry
- chest physiotherapy
-suctioning
43
what lab findings are expected for asthma?
- increase WBC and eosinophils
- increase Co2
- decrease O2
44
what is the function of the PFT? when should this assessment be avoided?
- measures long volume capacity and overall lung function
- NOT used during acute exacerbation
45
what type of measurement should be taken daily for a child with asthma?
PIFR (peak inspiratory flow rate)
- used daily to monitor effectiveness of management and for signs of acute symptoms
46
what does a PIFR measure?
- uses flow meter to measure the amount of air that can be forcefully exhaled in 1 second
47
what medications are used in the prevention of acute exacerbation of asthma?
- formoterol (long-acting bronchodil)
- fluticasone (inhaled corticosteroid)
- cromolyn (mast-cell stabilizer)
- montelukast (leukotriene antagonist)
48
what meds are used in the management of acute asthma exacerbation?
- albuterol
- ipratropium (anticholinergic)
- prednisone (IV/PO corticosteroid)
49
what is the pathophysiology of cystic fibrosis?
- epithelial cells don't conduct chloride, altering water transport
causing thick, tenacious mucus is resp tract, pancreas and GI tract
50
what is the primary diagnostic for cystic firbrosis?
sweat chloride test
51
what qualifies children under 3m for cystic fibrosis?
sweat chloride with chloride >40 mEq/L
sodium >90 mEq/L
52
what qualifies children over 3m for cystic fibrosis?
chloride >60 mEq/L
Sodium > 90 mEq/L
53
what trademark stool type is seen with cystic fibrosis?
steatorrhea (bulky, fatty, greasy stools)
54
what can be utilized to clear secretions and prevent infection?
Chest PT w/postural drainage
55
what does dornase alfa do for the CF patient?
decreases the viscosity of mucus, improving lung function
56
what supplements are necessary for CF patients?
fat-solubles (A, D, E and K)
57
when should pancreatic enzyme be given to CF patient?
within 30 min of eating meal/snack
58
what are the key assessment cues of croup (laryngotracheobronchitis)?
- barking cough
- inspiratory stridor
- sudden onset @ night, gone in morning
- tachypnea, resp distress
- nasal flaring
- intercostal retractions
59
what are the 2 key meds for management of croup?
dexamethasone and racemic epinephrine
60
what are the nursing management priorities for croup?
- cool mist humidifier or steamy bathroom
- educate on s/s of increasing resp distress
61
what should be added to breast milk for children with HF?
HMF (human milk fortifier) to increase calories
62
what should be given with formula-fed infants with HF?
polycose/vegetable oil to increase calorie
63
what is the nutritional requirement for a child with HF?
- 150 cal/kg/day
- small, frequent
- 20 min max feeding
- cut bottle nipple (decrease work)
- semi-upright position
64
how can rest be promoted in the child with HF?
- cluster care
- provide rest periods
- bathe PRN
- quiet diversional activities
65
what is the mechanism of action for captopril/enalapril?
reduces afterload by causing vasodilation, decreasing the pulmonary and systemic vascular resistance
66
what should be monitored before and after the administration of enalapril/captopril?
BP
67
what med manages edema and rids body of excess fluid and sodium?
lasix
68
what should be monitored for lasix administration?
- BP
- I and O
- daily weight
- s.e. - hypokalemia, N/V, dizziness, ototoxicity
69
what medication for HF increases contractility of heart muscle?
digitalis (digoxin)
70
what HR requires digoxin to be held for an infant?
<90 apical
71
what requires digoxin to be held for a child?
<70 bpm apical
72
what HR requires digoxin to be held in an adolescent?
<60 bpm
73
what dig level is expected?
0.8- 2 ng/mL
74
what are signs of dig toxicity?
- anorexia
- n/v
- bradycardia
- dysrhythmias
75
what is dig antidote?
digoxin immune fab
76
what are the key findings of coarctation of the aorta?
- assess pulses:
- full bounding in BLUE
- weak/absent in BLLE
77
what heart sound is heard for coarctation of aorta?
soft/moderately loud systolic murmur at base or left axilla
78
which condition is characterized by TET spells?
tetralogy of fallot
79
what are the 4 components of tetralogy of fallot?
- pulmonary stenosis
- overriding aorta
- VSD
- R. ventricular hypertrophy
80
what is seen during a TET spell?
- cyanosis, hypoxemia, dyspnea, agitation
- anoxia, unresponsiveness
- especially in AM
81
what intervention is used for TET spell?
knee to chest
82
what assessment findings are seen with tetralogy of fallot?
- loud, harsh systolic murmur
- fainting, difficulty breathing, easy fatigue
- polycythemia (elevated RBCs)
83
what are assessment findings of Kawasaki disease?
- extreme irritability
- high fever unresponsiveness to abx for 5 or > days
- dry mouth/throat
- strawberry tongue, fissured lips
- desquamtion
84
what are 3 meds used for tx of Kawasaki disease?
- immunoglobulin (IVIG)
- high dose aspirin
- acetaminophen for fever
85
briefly describe kawasaki disease?
systemic vasculitis, causing inflammation and edema in b.v., especially coronary arteries
86
which cardiac arrhythmias may be caused by vagal stimulation from passing an orogastric tube?
sinus bradycardia
87
when does a bradyarrhythmia become life-threatening?
HR < 60 w/ signs of altered perfusion (respiratory compromise, hypoxia, shock)
88
what may be some causes for sinus tachycardia?
- fever
- pain
- fear
- fluid loss
-hypoxia
89
what HR defines SVT?
infants >220 bpm
children >180 bpm
- abrupt onset and termination, flattened P wave and narrow QRS
90
what may be used for tx of compensated SVT?
vagal maneuvers (ice to face, blowing through straw)
91
what tx is for uncompensated SVT?
adenosine or synchronized cardioversion
92
what defines sinus tach?
- infants (160 - 220); <220
- children (130-180); <180
93
what are assessment findings for dehydration?
- sunken fontanelles
- reduced LOC
- reduced cap refill time
- tachycardia/hypotension
- oliguria
- tachypnea
94
when is ORS used?
mild to moderate cases of dehydration
95
when should IVF rehydration be used?
severe dehydration or intolerance of ORS (persistent vomiting)
96
which condition is characterized by hypertrophy and thickening of the pylorus muscle that leads to gastric outlet obstruction?
hypertrophic pyloric stenosis
97
what are the cues of hypertrophic pyloric stenosis?
- forceful, projectile, nonbilious vomiting
- olive-shaped moveable mass in RUQ
- abnormal electrolytes and metabolic alkalosis due to GI losses
98
what are the priorities of care for hypertrophic pyloric stenosis?
- correct F/E imbalances
- NGT decompression
- NPO
- strict I/O
- post-op wound care
- resume PO in 1-2 days
99
what signs of enterocolitis should the nurse monitor for the patient with Hirschsprungs?
- fever
- abdominal distension
- chronic diarrhea/explosive stool
- rectal bleeding
- straining
- notify provider immediately
100
what type of surgical intervention is expected with hirshprungs disease?
ileo/colostomy
101
what PMH is expected with acute poststreptococcal glomerulonephritis?
strep throat or strep skin infection
102
what lab changes are seen with acute poststreptococcal glomerulonephritis?
- hematuria
- proteinuria
- elevated BUN/Creat
- elevated ESR
+ ASO titer (strep antibodies)
103
what may be noted of past hx for HUS?
- ingestion of ground beef
- visit to water park/public pool
- petting zoo
one of these prior to developing diarrhea
104
what are assessment findings for HUS?
- toxic appearance
- edema
- oliguria or anuria
- seizures/ altered LOC/coma
- HTN
105
what are the priorities of care for HUS?
- maintain fluid balance
- manage HTN/acidosis/electrolyte abnormalities
- PRBCs and platelets
- IVIG
106
what condition is marked by abnormal urethral opening on the ventral surface of penis?
hypospadias
107
what are clinical manifestations seen with growth hormone deficiency?
- retarded bone growth
- large/prominent forehead, underdeveloped jaw
- high-pitch voice
- delayed sexual maturation
- delayed dentition/skeletal maturation
- decreased muscle mass
108
what is the tx for growth hormone deficiency?
- Sub-Q biosynthetic GH replacement
- daily doses
109
what levels are seen in the newborn blood screening with hypothyroidism?
Low FT4 and high TSH
110
what are the clinical cues of congenital hypothyroidism?
- poor sucking reflex
- hypothermia
- constipation
- lethargy/hypotonia
- periorbital puffiness
- cool, dry, scaly skin
- bradycardia, resp distress
- lg fontanelles, delayed closure
111
what med if used to manage congenital hypothyroidism?
- L-thyroxine (synthroid, levothyroid) daily
112
what are the s/s of DKA?
- BS >330 mg/ dL
- Kussmauls
- warm, dry, flushed
- 3 P's
113
what are the management priorities for DKA?
- hourly BG monitoring (prevent BS falling more than 100 mg/ dL/hr)
- PICU admission
- IVFs for dehydration
- IV regular insulin drip
114
what are the physical cues of hydrocephalus?
gait changes, sun-set eyes, projectile vomiting, change in LOC, enlarged ventricles/obstructed CSF flow (CT/MRI)
115
what condition is ventriculoperitoneal shunt used for?
hydrocephalus
116
what are the s/s of VP shunt obstruction/infection?
- increased ICP
- fever >101
- headache/stiff neck/bulging fontanelle
- poor feeding/vomiting
- increased head circumference
- dilated pupils on same side as pressure build up
- high pitch cry
117
what are the seizure precautions?
- padding
- side rails raised
- O2 and suction @ bedside
- supervision (bathing, ambulation, etc)
- protective helmet during activity
- medical alert bracelet
118
what are the cues of increased ICP?
- HA, vomiting, blurred vision, dizziness, tachycardia
- lowered LOC
- cheyne-stokes resps
- posturing
- fixed and dilated pupils, sunset eyes
119
what is included in the cushing triad of increased ICP ?
- irregular breathing
- HTN
- bradycardia
120
what are the interventions for increased ICP?
- head midline w/bed @ 30 degrees
- keep body in alignment
- low stimuli (calm, limited visitors)
- avoid coughing, blowing nose
- stool softeners
- seizure precautions
- monitor I and O
121
what findings are seen in the LP for bacterial meningitis?
- increase WBCs
- low glucose
- increase protein
- cloudy color
122
what is the nursing management of bacterial meningitis?
- ICU admission
- droplet isolation until 24 h of abx or order to discontinue
- IV abx
- ventilator support
- seizure precautions
123
what are 2 physical signs of bacterial meningitis?
- kernig (knee flex elicits pain)
- brudzinski (passive neck flexion elicits hip and knee flexion)
124
what are nursing priorities for reyes?
- decrease ICP
- supportive care r/t liver failure
125
what is the focus of nursing care for cerebral palsy?
- promote mobility
- maintain cardiopulmonary function
- prevent complications
- maximize quality of life
126
what meds are used in cerebral palsy management?
- Baclofen
- Botox (botolinum toxin A)
- carbidopa
127
what are 2 complications of fractures?
- compartment syndrome
- osteomyelitis
128
what is therapeutic management of amblyopia?
patching or atropine drops in STRONGER eye
129
how does the tympanic membrane appear with acute otitis media?
dull, red, bulging or opaque
purulent drainage
130
what tx measures are indicated for acute otitis media?
- tylenol, ibuprofen
- benzocaine (auralgan) drops
- warm/cool compromises
- abx therapy PO for 10-14 days or 1 IM dose
131
what is best practice for ear drop administration for <3yr?
pull pinna down and back
132
what is best practice for ear drop administration for >3yr?
pull pinna up and back
133
what respiratory condition is marked by a paroxysmal cough?
pertussis
134
what type of abx are used for pertussis?
- macrolides (-mycins) for infants >1m
- azithromycin if < 1m
135
what precautions are indicated for pertussis?
droplet and standard precautions
136
what are the physical findings of lyme disease?
- onset of rash 7-10 days after bite
- erythema migrans at site of bite
- fever, malaise, HA, joint/muscle pain
137
what is tx for lyme disease?
- doxycycline >8yr old
- amoxicillin for < 8yr
- tx for 14-28 days
138
what therapeutic interventions are utilized for SCID (absent T and B cell function)?
- bone marrow transplant
- IVIG
139
what type of prevention is essential for SCID?
infection prevention
140
what nursing actions would be beneficial for SCID to prevent infection?
- teach good handwashing
- no exposure to infected persons
- prophylactic abx
- no live vaccines
- promote adequate nutrition (possibly enteral)
141
what are physical cues of JIA (juvenile idiopathic arthritis)?
- hx of irritability/fussiness
- difficulty getting out of bed
- joint stiffness/pain
- systemic fever >103
- limping gait, joint guarding
- eye inflammation
142
what are the lab diagnostics for JIA?
- mild to moderate anemia
- elevated WBCs
- +RF
- +ANA
- elevated ESR
- elevated CRP
143
how is the adequacy of fluid replacement determined for burns?
evaluating urinary output
144
what actions should be taken to promote nutrition for a burn client?
- increase calories
- increase protein
- enteral/parenteral nutrition
- vitamin a & c
- zinc
145
how much urine output should be maintained for a burn patient?
1-2 mL/kg/hr
146
what are the assessment findings for atopic dermatitis (eczema)?
- elevated IgE
- wheezing
- dry, itchy, red skin
147
what meds are used for eczema?
- topical corticosteroids
- tacrolimus (immune modulators)
148
what are the interventions for eczema?
- no hot water
- bathe 2x/day in warm water
- avoid soaps w/perfumes, dyes and fragrances
- apply moisturizer while skin is still moist
- 100% cotton
- short fingernails
- antihistamines
149
what type of skin injury is characterize d by superficial rub/wearing off of skin and is usually due to friction?
abrasion
150
what are the risk factors for skin injuries?
- poverty
- prematurity (<1yr)
- chronic illness
- intellectual disability
- parent w//abuse hx
- alcohol/substance abuse
- extreme stressors
151
what are some suspicious signs of skin injury?
- injuries in uncommon locations
- bruises in infants <9m
- multiple injuries other than LEs
- frequent ED visits
- delayed care
- inconsistent stories
- unusual caregiver-child interaction
152
which lab is affected with hemophilia a?
prolonged PTT ~42 (25-35 sec)
153
what are the physical cues r/t hemophilia?
- hemarthrosis (swollen, stiff joints)
- multiple bruises
- hematuria
- bleeding gums
- bloody sputum/emesis
- black, tarry stools
- chest/abd pain (internal bleeding)
154
what is the 1st line tx for bleeding episode of a patient w/hemophilia?
factor VIII admin slow IV push
155
what nursing action should be taken for a joint bleeding w/hemophilia?
- direct pressure to external bleeding
- ice or cold compress
- elevate extremity
156
what is used for hemophilia bleeding prophylaxis or for mild cases of bleeding?
DDAVP (desmopressin)
157
what s/s are seen with iron deficiency anemia?
- spooning on nails
- pica
- irritability
- HA
- unsteady gait, weakness, fatigue, dizziness, SOB, pallor
158
what are the signs seen with a sickle cell vaso-occlusive crisis?
- extreme fatigue/irritability
- pain (abd, thorax, joints, digits)
- c=dactylitis
- cough, inc WOB, fever, tachypnea, hypoxia
- splenomegaly
- jaundice
159
what are the 3 priorities to address during a sickle cell vaso occlusive crisis?
- pain
- hydration
- hypoxia
160
what position is used for BMA?
prone
161
what is the bone of choice for BMA?
iliac crest
162
what meds are expected to be ordered for a BMA?
- local/topical anesthetic
- conscious sedation (fentanyl/versed)
163
what are the pre-procedure actions to take prior to a BMA?
- explain
- comfort
- prevent infection
164
what are the priorities after a BMA?
- hold pressure
- pressure dressing
- monitor for bleeding and infection
165
Guess the precaution:
- mask on child outside of room
- no raw fruits/vegs/flowers/live plants
- soft toothbrush
- avoid rectal temp/enema/supp/cath
- VS Q4
- assess for signs of infection Q8H and PRN
- hand hygiene (before and after)
- private room
neutropenic precautions
166
what does an ANC of < 1000 indicate?
neutropenia
