Final: What I think is most important part 2

Question 1

What are some causes of CP?

Answer 1

• Brain injury
• Maternal chorioamnionitis
• Extremely LBW
• LBW (low birth weight)
• Mutltiple births
• Placenta didn’t provide developing fetus with enough oxygen and nutrient
• Kernicterus (high levels of bilirubin in neonatal period)
• Shaken baby syndrome surivors

Question 2

What are some long term problems associated with CP?

Answer 2

• Visual and hearing impairment
• Communication and speech difficulities
• Seizures
• Intelectual impairment
• ADHD
• Dental caries
• Drooling
• Nystagmus

Question 3

The most common chromosomal abnormality of a generalized syndrome?

Answer 3

Down syndrome

Question 4

97% of all down syndrome are attributable to what?

Answer 4

An extra chromosome 21 group

Question 5

What pregs are more at risk for down syndrome baby?

Answer 5

Those over 35

Question 6

DS: What kind of separation in suture? How is head look?

Answer 6

Separated sagittal suture
Enlarged anterior fontanel
Small, rounded head
Flat face profile

Question 7

DS: What are eyes like?

Answer 7

Upward, outward slant

Question 8

DS: What is nose like?

Answer 8

Small nose, depressed nasal bridge (saddle nose)

Question 9

DS: How are ears?

Answer 9

Small with short pinna

Question 10

DS: How is mouth?

Answer 10

High, arched, narrow palate

Protruding tongue

Question 11

DS: What is chest like?

Answer 11

Shortened rib cage

Question 12

DS: How does abdomen look?

Answer 12

Protruded

Question 13

DS: What are hands like?

Answer 13

Broad, short hands and stubby fingers

Question 14

DS: What are feet like?

Answer 14

Wide space between big and second toes

Plantar crease between big and second does

Question 15

DS: Musculoskeletal signs noted?

Answer 15

Hyperflexibility and hyptonia

Question 16

DS: Increased risk for what cancer?

Answer 16

Leukemia

Question 17

A viral infection in which the virus affects the t-lymphs, causing immune dysfunction, which leads to organ dysfunction and a variety of opportunistic illnesses in a weakened host

Answer 17

HIV

Question 18

What kind of HIV/AIDs infection will we see children with Kaposi sarcoma?

Answer 18

Severely symptomatic infection

Question 19

What is the main therapy for HIV?

Answer 19

HAART

Question 20

What antibiotic do we administer to all infants who are born to infected mothers with HIV?

Answer 20

Give TMZ-SMZ until HIV infection is excluded

Question 21

Why would IV gamma globulin be given to HIV pts?

Answer 21

To prevent recurrent or serious bacterial infections

Question 22

What are priority nursing problems for child with HIV?

Answer 22

1. Infection (hand-washing, deep breathing/coughing, and needing to get PCV and flu vaccine)
2. Education: They cannot miss a dose of their med!! and it needs to be taken on regular schedule!! Adolescents need to under stand high risk sexual behaviors can infect others!!!

Question 23

What bacteria can cause UTI?

Answer 23

E. coli (just an example, there are others)

Question 24

What does urinalysis look like for UTI?

Answer 24

pH: weak acid or neutral alkaline

Protein, glucose, ketones, leukocytes, and nitrates: ALL POSITIVE in urine

Note: Normal urine should be NEGATIVE for protein!!

Question 25

UTI infants: Feeding like? How do they take it?

Answer 25

Poor feeding Vomiting Failure to gain weight

Question 26

UTI infants: Increase or decrease in thirst?

Answer 26

Increase

Question 27

UTI infants: Infrequent or frequent urination?

Answer 27

Frequent--staining with urination and foul smelling

Question 28

``` UTI infants: Fever? Diaper rash? Blood in urine? Swelling of face, edema? Seizure, pallor? Dehydration? ```

Answer 28

Infants: Fever: yes Diaper rash: yes Blood in urine: No (this is in children though!) Swelling of face, edema: No (this is in children though) Seizure, pallor: yes Dehydration: Yes

Question 29

UTI children: How is appetite?

Answer 29

Poor--vomiting

Question 30

UTI children: How is growth?

Answer 30

Slowed

Question 31

UTI children: Increase or decrease in thirst?

Answer 31

Increase--eneuresis; frequent urination

Question 32

UTI children: Is there swelling anywhere?

Answer 32

Yes, face--also edema

Question 33

UTI children: Tired? Hypotension or hypertension?

Answer 33

Yes fatigued, hypertension; also have tetany

Question 34

UTI children: What kind of urine Foul smelling or blood in urine?

Answer 34

Blood in urine

Question 35

What are some antibiotics given for UTI?

Answer 35

Penicillins Sulfonamide Cephs Nitrourantoin

Question 36

What kind of underwear for UTI: cotton or nylon?

Answer 36

Suggest use of cotton

Question 37

What should we instruct sexually active adolescents to do to prevent UTI?

Answer 37

Instruct them to void immediately after intercourse

Question 38

Nephrotic Syndrome (NS): What is urinalysis like? (4)

Answer 38

- Elevated protein in urine (2+ on dipstick) - Hyaline casts - FEW RBC - Oval fat bodies

Question 39

NS: What is chemistry like? (8)

Answer 39

- Hypoalbuminism: less than 2 g/dl - Elevated Hgb, Hct - Elevated platelets: 500,000-1,000,000 - Possible hyponatremia - Decreased serum protein level (6.1-7.9) - Hyperlipidemia - Serum cholesterol: (450-1500 mg/dl) - Normal potassium

Question 40

The most common presentation of glomerular injury in children

Answer 40

Nephrotic syndrome

Question 41

In nephrotic syndrome, alterations in the glomerular membrane allow proteins, especially _____, to pass into the urine; resulting in decreased serum osmotic pressure

Answer 41

Albumin

Question 42

What is most common form of NS?

Answer 42

MCNS

Question 43

If a patient with NS has edema, what should we do?

Answer 43

RESTRICT SALT

Question 44

A non-specific upper resp. tract infection that manifestations by 4-8 days but is considered to be a precipitation factor rather than a cause of NS

Answer 44

Minimal change nephrotic syndreom (MCNS)

Question 45

What are some clinical manifestations of MCNS?

Answer 45

-Gain weight over a period of days or weeks -Puffiness of face (especially around eyes) [this is apparent on arising in am but subsides during day-->then swelling of abdomen and lower exremtieis is more prominent] -Diarrhea -Loss of appetite -Lethargic Decreased urine volume--dark, opalescent and frothy -BP NORMAL OR SLIGHTLY DECREASED

Question 46

MCNS: An acute infection may precipitate severe generalized edema..Where?

Answer 46

Periorbital edema Abdominal swelling from ascites Labial or scrotal swelling

Question 47

What is DOC for MCNS/NS? Client education?

Answer 47

Prednisone -Administer with meals

Question 48

Why would we give diuretics for MCNS/NS? Client education?

Answer 48

Eliminates excess fluid from body -Encourage child to eat foods high in K

Question 49

Why would we give 25% albumin to MCNS/NS pts?

Answer 49

To increase plasma volume and decrease edema

Question 50

What drug is given for MCNS/NS for children with frequent relapsing of MCNS or steroid resistant NS?

Answer 50

Cyclophosphamide or chlorambucil

Question 51

How does urine look for glomerulonephritis?

Answer 51

Smoky or tea colored urine

Question 52

Glomerulonephritis: What test can show presence of streptococcal antibodies?

Answer 52

Elevated ASO titer

Question 53

The glomeruli are inflamed, which impaired the kidney to filter urine properly

Answer 53

Acute glomerulonephritis (AGN)

Question 54

What VS change is anticipated with glomerulonephritis?

Answer 54

Increased BP--HTN Can give loop diuretics and anti-HTN drugs to help with this *if not treated, seizures can occur

Question 55

Glomerulonephritis: What are signs of renal failure?

Answer 55

1. Decreased urine output-first sign 2. HTN encephalopathy 3. Cardiac decompensation

Question 56

``` Glomerulonephritis: How is urine? Increased or decreased blood protein level? Low, normal, or elevated lipid level? Increased or decreased K level? ```

Answer 56

Urine: smoky, tea color (also hematuria and proteinuria) INCREASED blood protein level NORMAL lipid level INCREASED K level

Question 57

Since glomerulonephritis can have an increased K level, what foods should be avoided?

Answer 57

``` Bran cereal Potatoes Tomatoes Bananas Melons Orange OJ Yogurt Leafy greens Beans Avacodos ```

Question 58

Inappropriate urination that must occur at least 2weeks for at least 3 months--the child must be at least 5 years of age before there is consideration about diagnosis

Answer 58

Eneuresis

Question 59

What does DDAVP do?

Answer 59

An antidiuretic hormone that reduces volume of urine--given for enuresis *Can be given PO or nasal, if nasal--store in fridge

Question 60

Why would we give a child with enuresis a TCA?

Answer 60

We could give imipramine hydrochloride to INHIBIT urination. We need to make sure to monitor child for increase suicidality though This is for 6-8 weeks, with a gradual withdrawal Administer with food and 1 hr before bedtime Avoid sun exposure and OTC meds while on drug

Question 61

What anticholinergic could we give to child with enuresis?

Answer 61

Oxybutin chloride to reduce bladder contractions

Question 62

Meatus opening located on the dorsal surface of the penis

Answer 62

Epispadias Male: widened pubic symphysis, broad/spade like penis Female: Wide urethra, bifid clitoris Both: possible exstrophy of bladder

Question 63

Urethral opening located behind glans of penis or on the ventral surface of penile shaft

Answer 63

Hypospadias

Question 64

Narrowing of the preputial opening of the foreskin

Answer 64

Phimosis