Final Peds Exam Flashcards
(174 cards)
1
Q
What atraumatic care is appropriate for infants and what play do they do
A
play pat a cake, therapeutic hugging, soft voice,
solitary play
2
Q
fine motor skill for 3 month old
A
grasp objects in their hand
3
Q
fine motor skill for 6 month old
A
hold their bottle
4
Q
fine motor skill for 9 month old
A
pincer grasp
5
Q
fine motor skill for 12 month old
A
turn pages, spoon feed themselves
6
Q
gross motor skill for 3 month old
A
roll back to side, head control
7
Q
gross motor skill for 6 month old
A
roll from back to front
8
Q
gross motor skills for 9 month old
A
sit unsupported
9
Q
gross motor skills for 12 month old
A
sit from stand
10
Q
height changes for infant
A
1 in/month for 1st 6 months
double by 12 months1
11
Q
weight changes for infant
A
double by 12 months, triple by 2 years
12
Q
HC infant
A
increase 10 cm by 12 months
13
Q
nutrition for infants
A
when the extrusion reflex goes away at around 4-6 months, they can start solids, starting with iron fortified cereal and then veggies and then fruits, new food 3-5 days (allergies)
14
Q
car safety for toddlers
A
back seat rear facing until age 2
if no back seat, turn air bag off
15
Q
what is telegraphic speech and what age group is it seen
A
want cookie
seen in toddlers
16
Q
iron deficient anemia is common in what age group and why
A
toddlers, changing from formula to cows milk which is low in iron
also picky eaters
17
Q
Why are preschoolers subject to nightmares
A
big imagination, animism (toy story)
also fear the dark
18
Q
what are some atraumatic care strategies for preschoolers
A
puppets, story telling,
simple instructions, choices
19
Q
what congitive development stage are preschoolers in
A
initiative v guilt - put them in environment they can explore, if this is suppressed, that causes guilt
20
Q
what do preschoolers know about time
A
bath time is near bedtime when it gets dark
21
Q
when do girls hit puberty
A
9-10
22
Q
when do boys hit puberty
A
10-11
23
Q
how much calcium should adolescents consume
A
1300 mg / day
24
Q
how much iron should an adolescent girl consume per day
A
15 mg
25
how much iron should an adolescent male consume
11 mg
26
what is the average calories an adolescent consume per day
2000 / day
27
what are the signs of hypoxemia
tachypnea #1, cyanosis, resp distress, stridor, wheezing, weak peripheral pulses
28
what is the plan of care with hypoxemia
o2
pulse oximetry
chest pt
suctioning
29
what is the golden standard test for CF and what are the parameters
sweat chloride test
>40 in infant <3m
>60 all other ages
>90 sodium
30
What are symptoms of cystic fibrosis
thick tenacious secretions
clubbing, barrel chest, steatorrhea, ADEK deficiency
31
what are the meds and nutrition supplements for CF
dornase alfa: thin secretions
ADEK replacement
high calories
high protein
32
what should be given to the child with cystic fibrosis anytime they eat
pancreatic enzymes within 30 minutes
33
what are signs of asthma
non productive hacking cough, clubbing of fingernails, barrel chest, wheezing, can't finish symptoms
34
what is an ominous sign with asthma
silent chest
35
what are acute asthma meds
short acting bronchodilator: albuterol
IV or PO corticosteroids: methylprednisone or prednisone
36
what are chronic asthma meds
long acting bronchodilator: formoterol
leukotriene modifier: montelukast
inhaled corticosteroids: fluticasone
37
What test is done daily with asthma patients to measure efficacy of medications
peak expiratory flow rate
38
what test is not useful during a acute asthma exacerbations
pulmonary function test
39
what is the meds given for status asthmaticus
theophylline
mag sulfate
heliox
intubation?
40
what is another name for croup
laryngotrachealbronchitis
41
what are symptoms of croup
sudden onset of inspiratory stridor at night, barking cough, low grade fever
42
what meds are given for croup
deracemic epinephrine
IV dexamethasone
43
what is included in the assessment triangle with HF
work of breathing
appearance
circulation
44
what antibiotics are given for croup
none, it is viral
45
what are the priorities of care with HF
promote oxygenation and ventillation
chest pt and suctioning, positioning, O2 admin, daily weight, intake and output
46
what is the heart failure assessment triangle
work of breathing
appearance
circulation
47
what is important about nutrition with heart failure
24-28 cal/oz infant formula
can be with human milk fortifier or polycose
48
what are symptoms of coaraction of the aorta
bounding pulses, high bp, and epistaxis in upper extremities and low bp, absent pulses in lower extremities
49
what is the diagnostic used for coarctation of the aorta
chest x ray shows rib notching
50
what are the four characteristics with tetralogy of fallot
ventricular septal defect
right ventricular hypertrophy
overriding aorta
pulmonary stenosis
51
what spells happen with tetralogy of fallot and how does the nurse manage them
TET spells: the infant becomes cyanotic and then anoxic and may loose consciousness
place them in a knee chest position to force blood into the pulmonary artery
52
what do the kidneys do to compensate in tetralogy of fallot
release erythropoetin in order to make more RBC because they aren't getting enough oxygen, but this just thickens the blood and makes the problem worse
53
what artery does kawasaki disease affect mainly
coronary artery
54
what are history cues with kawasaki disease
my child has had a fever for 5 days and it hasn't broke with acetaminophen
55
what are signs and symptoms of kawasaki disease
persistent fever more than 5 days, conjuncivitis (without exudate), strawberry tongue, cracked lips, lymphadenopathy, swelling in hands and feet that leads to desquamation
56
what is the management of kawasaki disease
high dose aspirin until fever breaks, and then low dose (indefinite if there are aneurysms)
acetaminophen for fever
cooling cloths if tolerated
57
what are the characteristics of sinus bradycardia
PQRS normal
vagal stim?
58
when is bradycardia life threatnening
signs of hypoperfusion and pulse is <60
59
what are the characteristics of sinus tachycardia
infant <220
child<180
PQRS normal
60
what do we treat with sinus tachycardia
the cause- fever, pain, fear
61
what is SVT
>220 infant
>180 children
flat p waves, narrow QRS
regular rhythm
62
what is the treatment of compensated SVT
child is alert, well perfused
vagal maneuver (ice in face, blow through a straw)
adenosine
63
what is the treatment for uncompensated SVT
adenosine
if that doesn't work -- synchronized cardioversion (shock the R wave)
64
what are signs of dehydrations
tachypnea, tachycardia, sunken fontannels, no tears, dry mucous membrane, decreased turgor and capillary refill
65
what is the oral rehydration guidelines
mild: 50ml/kg
moderate: 100ml/kg
(Over 4 hours)
diarrhea: 20ml/kg/stool
66
what is IV fluid replacement bolus
severe or oral nontolerated
bolus: 20 ml/ kg
67
IVF fluid replacement maintenance formula
first 10 kg: 100ml/kg
second 10 kg: 50 ml/kg
remaining: 20 ml/kg
over a 24 hour period
68
what are signs of pyloric stenosis
projectile vomiting that is non bilious right after feedings, then followed by hungers, FTT
69
what is the hallmark sign of pyloric stenosis and requires no further labs
olive shaped palpable mass in the RUQ that is movable
70
what is the management of plyoric stenosis
IVF
NGT for decompression
NPO
71
what happened with hirshprungs disease
there are no ganglion cells which inhibits movement of stool through the intestinal tract
72
what are signs of hirsprungs disease in newborn
doesn't pass meconium in the first 24-48 hours, vomiting bile, no eating, abd distention
73
what is the signs of hirschsprungs disease in an infant or child
constipation, palpable fecal mass, ribbon like stools, abd distention
74
what is the treatment for Hirschsprung's disease
resection and reanastamosis
75
what should the nurse monitor pre op with Hirschsprung's disease
enterocolitis - fever, vomiting, diarrhea, rectal bleeding
76
what is the treatment for enterocolitis
broad spectrum antibiotics and IVF
77
what is acute glomerulonephritis
inflammation of the glomerulus after a strep infection that causes a decrease in GFR
78
what is the symptoms of glomerulonephritis
hematuria, hypertension, oliguria, elevated BUN/creatinine
79
what titer is performed if acute glomerulonephritis is suspected
ASO titer
80
what is the management for acute glomerulonephritis
treatment of hypertension, intake and output
managing fluid volume
81
what are the history cues with hemolytic uremic syndrome
petting zoo, waterpark, consumption of undercooked ground beef
82
what are the aspects of hemolytic uremic sydnrome
hemolytic anemia
thrombocytopenia
renal failure
83
what is the management of hemolytic uremic syndrome
fluid balance, HTN, acidosis, contact precautions
intake and output- renal failure
84
when are PRBCs given with acute hemolytic uremic sydnrome
if there is an active bleed or with severe thrombocytopenia
85
what is hypospadias and how is it treated
urethral opening on the bottom/ventral side of the penis treated with a stent
86
what is taught post op with hypospadias
double diapering, monitor for infection
87
what are signs of growth hormone deficiency
delayed sexual maturation, delayed dentition, short stature
88
what is the management of growth hormone deficiency
SQ injections daily of synthetic growth hormone
89
what is the T3 or T4 levels with congential hypothyroidism
low
90
what is TSH in congenital hypothyroidism
high
91
what are symptoms of congenital hypothyroidism
poor sucking, cold skin, lethargy, periorbital puffiness
92
what is the treatment for congenital hypothyroidism
levothyroxine (can be crushed into 1 ml of formula for infants)
93
what blood glucose is associated with DKA
over 330
94
what are symptoms of DKA
polyruia, kussmaul respirations, polyphagia, lethargy, weak pulse
95
what is seen on a UA with DKA
ketonuria and glucosuria
96
what should be monitored in DKA
blood glucose hourly to prevent it dropping more than 100mg/dl/hr which would cause cerebral edema
97
what causes hydrocephalus
accumulation of CSF in the ventricles of the brain
98
what are the signs of hydrocephalus
sunset eyes, separated sutures, bulging fontannels, irritability, poor feeding, vomiting
99
what is the management of hydrocephalus
VP shunt
100
what should be monitored with a VP shunt
infection, blockage
s/s: fever, symptoms of increased ICP
101
what are seizures
disrupted electrical activity in the brain
102
what is the nursing care of a child during a seizure
keep them on their side, do not leave them, have oxygen and suction ready
103
what are seizure precautions
padded side rails, suction and oxygen ready, helmet?, medical alert bracelet
104
what is the cushings triad and when is it seen
later in increased ICP that includes irregular breathing, hypertension, bradycardia
105
what are later signs of increased ICP
decreased LOC, cushings, fixed/dilated pupils, decerebrate, decorticate
106
what are interventions to decreased ICP
head midline, decrease stimulation, no coughing or straining (stool softener), seizure precautions, I&O
107
what precautions are used with bacterial meningitis
droplet until 24 hours on abx
108
what does an LP show with bacterial meningitis
increased WBC, decreased glucose (bacteria eats it), protein increased, cloudy
109
what is the treatment of bacterial meningitis
decrease ICP
administer broad spectrum antibiotics
110
what is the kernig sign and what is it associated with
when we bend both the knee and the hip at 90 degrees and try to extend it, it causes pain
111
what is the brudzinski sign
passive neck flexion causes hip and knee flexion
112
what is going on in reyes syndrome
enchephalopathy causes cerebral edema and liver failure
113
what is the management of reyes syndrome
hyperammoniaemia- lactulose
hypocoagulability- FFP or vit K
hypoglycemia - IV with dextrose
114
what is the management of spina bifida cytica
normal saline soaked dressing over the sac to prevent drying and rupture
keep the baby prone in a warmer
no swaddling
report any leakage
115
what is a meningocele vs a myelomeningocele
a meningocele only has CSF and meninges while a myelomeningocele has nerves and spinal cord which is more likely to come with deficits
116
what are the nursing priorities with cerebral palsy
promote mobility, maintain cardiopulmonary function, prevent complications, maximize quality of life
117
what are the meds used for cerebral palsy and MOA
baclofen: central acting muscle relaxant
botox: injected in quads
carbidopa`
118
what is different about pediatric bones and this puts them at risk for
decreased mineral content and increased vasculature, which increases the risk for buckle (compression fracture) and greenstick (incomplete fracture)
119
what is the main complication of fractures
compartment sydrome
120
what are the 5 ps associated with compartment syndrome and which ones are seen later
paresthesia and pain first, then pulselessness, pallor, and paralysis seen later
121
what is amblyopia and what is the management
lazy eye caused by an eye muscle weaker than the other
patch the stronger eye for several hours per day or use atropine drops
eye muscle surgery and vision therapy
122
what are the symptoms of acute otitis media
red, bulging TM with little movement
fever, pulling at ear, pain, lymphadenopathy
123
what is the treatment for acute otitis media
amoxicillin PO
benzocaine drops if TM in tact
124
what is otitis effusions
no infection, caused by large adenoids or allergies
TM is dull orange with bubbles and little movement
125
treatment for otitis effusions
will resolve on own
126
what is otitis externa
swimmers ear, bacteria or fungus in ear canal from pool or bathtub
white or colored drainage coming from ear, feeling of fullness
127
what is the treatment for otitis externa
ciprodex drops 4 gtt/day/7days
128
how to administer ear drops
<3 pull pinna down and back
>3 pull pinna up and back
ear upright for 2-5 minutes
pump tragus cartilage
129
what is the signs of rubeola
prodromal: koplik spots, lymphadenopathy, high fever, 3 Cs (cough, coryza, conjunctivitis)
eruptive: maculopapular rash
convalescence: turn brown and peel
130
what is the treatment for rubeola measels
vitamin A
airborne precautions until 4 days after the onset of rash
supportive measures
131
what are the signs of pertussis
whooping paroxysmal cough
132
what precautions are used for pertussis
droplet
133
what is used to treat pertussis
macrolides
must be azithromycin if under 1-month bc of the risk for pyloric stenosis
134
what is the rash with lyme disease
erythema migrans 7-10 days after bite
135
what labs are ran for lyme disease
2 step immunoassay confirmed with a western blot
136
what med is used for a child > 8 with lyme disease
doxycycline
137
what med is used for child < 8 with lyme disease
amoxicillin bc of the risk of teeth staining
138
how long is the abx regimen for lyme disease
14-28 days
139
what is missing inn SCID
t cells and b cells
140
what is the priority with SCID
infection prevention
141
what is administered to SCID pt
IVIG
142
what is the ideal treatment for SCID
bone marrow transplant
143
What labs are associated with juvenile idiopathic arthritis
ESR/CRP up, ANA, positive RF, anemia
144
what are the symptoms of juvenile idiopathic arthritis
morning stiffness longer than 1 hour, pallor, joint inflammation
145
what is the treatment of juvenile idiopathic arthritis
NSAIDs and acetaminophen for pain management
methotrexate if severe
146
IgG
crosses the placenta and breastmilk, protects against virus, bacteria, and toxins
147
IgA
GI, GU, respiratory
148
IgM
primary response
149
IgE
allergy, anitbody antigen response
150
what formula is used for fluid calculation based on TBSA
Parkland
151
what formula is used to calculate TBSA
Lund and Browder
152
how much urine output do we want with burns fluid volume resuscitation
1-2 ml/kg/h
153
what is the fluid volume replacement for burns
double maintenance 150ml/kg/hr
154
How do we assess if fluid volume replacement is adequate in a burn patient
urine output
155
burn wound care
medicate 30-45 min prior
remove loose skin with sterile scissors
blisters remain in tact
156
burn healing
increase calories and protein
vitamin c and a for cell growth
zinc for wound healing
157
what is the hallmark symptom of impetigo contagiosa
honey colored crust
lymphaedenopathy
158
what is the treatment for impetigo
wash off the crust with mild soap and water
abx ointment on lesions
if >5 lesions, oral abx
159
what precautions are used for impetigo
contact `
160
what are physical cues of hemophilia
hemarthrosis, nose bleeds, bruising
161
what is lacking in hemophilia
factor VIII
162
what is the treatment of hemophilia
factor VIII administration and then RICE
163
what med is given for mild hemophilia prophylaxis
desmopressin
164
what are the signs of iron deficient anemia
pallor, spooning of nails, SOB, unsteady gait
165
ferrous sulfate
given behind the teeth or through a straw
with vitamin c to increase absorption
can cause constipation (increase fluids and fiber)
166
what is the biggest contributor to iron deficient anemia in children
cows milk --- limit to 24 oz per day
167
what are the signs of sickle cell vaso-oclusive crisis
pain, spenomegaly, acute chest syndrome
168
what is the management of sickle cell anemia
pain management (opioids on a regular schedule)
hydration (double maintenance)
airway (encourage incentive spirometer and keep O2 above 92 with supplementation)
169
bone marrow aspirate
prone, iliac crest
fentanyl or versed used for concious sedation
monitor after for bleeding and infection
apple pressure for 5-10 minutes
170
what is the ANC for neutropenic precautions
less than 1000
171
what is nadir
after chemo when the wbc count reaches a significant low
172
acute lymphoblastic leukemia
bruising, bone pain, infections, thrombocytopenia, anemia
173
priority of care in ALL
infection prevention
174
what is the definitive diagnosis with ALL
bone marrow aspiration
