Midterm Flashcards Preview

Pediatric Nursing > Midterm > Flashcards

Flashcards in Midterm Deck (434):
1

active transport

process which molecules move against the concentration gradient - energy is needed for this process

2

medical history r/t nutrition

  • birth
    • weight, length, head circumference, gestational age up to 2-3 yo (unless more pertinent)
  • tollder - adolesence
    • weight, height
  • all ages
    • previous dx states, comorbidities, hospitalizations, treatments, surgeries
  • developmental history, growth history
  • any issues r/t nutrition

3

bacterial infectious agents

  • TB and haemophilus
  • pertussis 
  • strep
  • staph
  • meningococcal

4

pediatric respiratory rate

A image thumb
5

CF overview pathophysiology

  • CFTR (transmembrane conductance regulator) gene causes abnormal chloride-ion transport, reducing flow of water across cell membranes
  • thick, dehydration mucous affects respiratory, GI, genitourinary systems

6

CRIES

  • pain measurement scale
  • crying
  • requires oxygen
  • increased vital signs
  • expression
  • sleeplessness

7

venous access for parenteral nutrition

  • CVL
  • PPN - peripheral parenteral nutrition
    • consider reason
    • consider fluid osmolality - lower than through CVL
    • consider ability to optimize PN peripherally - enough nutrients 

8

common side effects of opioids

  • sedation/sleepiness
  • mental confusion
  • N/V
  • pruritis (usually on face)
  • urinary retention
  • constipation

9

sepsis: "seeding" systemic circulation

  • infection seeds sytemic circulation
    • decreased tissue perfusion
    • can't get proper oxygen into and CO2 and toxins out of tissues
  • leads to septic picture (decreased perfusion)
  • severe sepsis, septic shock, death
    • if you can interject with appropriate antibiotics, fluids in time you can mitigate and stop in its tracks
  • potential is there once you've hit the inflammatory and decreased perfusion state

10

incision of artificial airway

  • inferior border of cricoid cartilage
  • de-cannulating
    • pull trach out
    • cover 5-7 days with gauze
    • NO ibuprofen - inhibits stoma healing
    • natural healing

11

nursing management of sepsis

  • early recognition - get help
  • IV access
    • two working peripheral IVs is best practice
  • aggressive fluid resuscitation
  • early accurate antibiotic therapy; other meds
  • ongoing VS assessment
  • monitor urinary output
  • labs
    • blood culture, urine culture prior to antibiotics
  • communicate with team and family
  • accurately document

12

sepsis and decreased blood return to heart

  • periphery not as tight as normal
  • breakdown in ability of body to maintain peripheral contractility
  • more pooling in extremities and periphery
  • decreases blood flow back to heart
  • decrease in CO
    • decrease blood flow to organs
    • vicious cycle
  • increase SV to compensate for low blood flow causes tachycardia

13

response to disturbance in acid-base equilibirum

  1. acid-base buffer systems
    1. bicarbonate-carbonic acid buffers, intracellular protein buffers, phosphate buffers
    2. immediate regulation
  2. lungs alter rate of ventilate for CO2 removal
    1. minutes, hours
  3. kindeys alter excretion of H+ or bicarbonate
    1. hours, days

14

pnuemonia physical exam findings

  • decreased/absent breath sounds
  • accessory muscles
  • adventitious breath sounds
    • wheeze, crackles, partial breath sounds on one side vs other
  • +/- abdominal pain
    • children can't discern exactly where pain is

15

parenteral nutrition

  • when patients cannot meet nutritional needs PO or enteral
  • sole of adjuntive therapy
    • inadequate GI fxn
    • inadequate oral/enteral take
    • oncologic malignancies
    • extensive burns
    • pre/post op nutrition support
    • severe malnutrition 

16

functional residual capacity (FRC)

  • volume in lung after passive expiration
  • decreased in respiratory distress
  • can cause precipitous desaturation

17

meckel's diverticulum defined

  • outpouching or bulge in lower small intestine
  • congenital and leftover from unbilical cord
  • most common congenital defect of GI tract
  • may contain cells from stomach and pancreas
    • cells from stomach secrete acid, causing ulcers and bleeding

18

all that wheezes is not asthma

  • other diagnoses
    • foreign body aspiration
    • lower airway disease
    • GE reflux
    • GERD
    • OSA
  • response to bronchodilators, CXR may help with diagnosis

19

Q image thumb

  • "steeple sign" of croup seen on CXR
  • narrowing at the top of the trachea
  • usually treated symptomatically, not with X-ray

20

types of bleeds occurring in GI

  • trauma
    • 85% blunt
  • meckels diverticulitis
  • food related?

21

UTI treatment

  • less than 3 mo - IV gent and amp, despite deafness risk with gent
  • older children - oral trimethoprim-sulfamethoxazole
  • renal/bladder ultrasound to rule out anomalies
  • voiding cystourethrogram 

22

hypotonic IVF

  • osmolarity is less than 300
  • more water, less solute
  • fluid moves from intravascular space into ECF into ICF
    • cerebral edema (cell lysis)
  • .45% NaCl (150 mOsm)

23

pertussis immunity

  • should gain immunity in a pure world, but not everyone has the vaccination and we don't have heard immunity
  • speculation that the DNA has changed - may not have lifelong immunity

24

diet history

  • usual mode of intake (PO, enteral, parenteral)
  • age-appropriateness of diet
  • food allergies/intolerances
  • vitamin/mineral supplements
  • herbal/natural supplements

25

omphalocele

some fetal organs develop outside abdomen in a transparent sac at base of umbilical cord

26

6 med admin rights

  1. medication
  2. dose
  3. patient
  4. route
  5. time
  6. documentation

27

measuring head circumference

developmental milestone (along w. weight and length) - until 2 yo (WHO says 3 yo)

measure lying down or sitting up with a partner to hold/measure

28

common reasons for tracheostomy

  • long term ventilation
  • bypass obstruction, narrowing or floppiness of airway
    • neuromuscular disease
  • sustain airway in face of CNS issues
    • hypoventilation
    • brain injury

29

MOSD

multi organ system dysfunction

  • respiratory failure
  • tachycardia increases
  • kidneys begin to shut down

30

pneumococcal disease and sickle cell

  • need spleen to get rid of pneumococcal bacteria
  • maintence med for sickle cell patients is penicillin VK (potassium) to prevent infection
  • in addition to immunizations

31

nursing interventions with chickenpox

  • tylenol or ibuprofen
  • oral antihistamines for itching
  • trim fingernails
  • soft cotton mittens
  • isolation precautions
  • vaccine: VZIG

32

A & B: aeration & breathing

differences between adults and children

  • size of airway
  • amount of alveoli
  • trachea - size of child's pinky (easily obstructed)
    • complicated by developmental behavior of putting things in their mouths
  • chest wall

33

heat moisture exchanger

  • provides humidification for trach
  • keeps secretions thin
  • filter

34

severe persistent asthma

  • several daytime symptoms, nighttime symptoms > 1x/week
  • activity extremely limited
  • requires baseline medications

35

increased WOB

  • use of accessory muscles
  • retractions
  • nasal flaring
  • tripod in older children
  • belly breathing - using abdomen to move diaphragm?
  • faster RR

36

self-report pain scales

  • faces
  • Oucher
  • poker chip
  • numeric rating
  • body outline

37

thrombocytopenia

low platelet count - bleeding and clotting simultaneously

38

progression of sepsis

  1. SIRS
  2. Sepsis (SIRS + infection)
  3. Severe sepsis (sepsis + end organ damage)
  4. Septic shock (severe sepsis + hypotension)

39

behavioral responses of pain

  • short attention span, irritability
  • facial grimacing, biting, pursing lips
  • posturing, guarding, decreased movement
  • drawing up knees, flexing limbs, rubbing affected area
  • quiet, withdrawn
  • sleep disturbances 

40

allergy/hypersensitivity

  • small amount can cause immediate severe rxn
  • IgE mediated or non IgE mediated
    • IgE - after specific food
    • Non IgE - cell mediated by GI tract
  • immune system rxn affecting +1 organ
  • may have subsequent late phase rxn

41

complications of meningitis in pediatrics

  • hemorrhaging
  • bacteria gets to kidneys
    • can't put out urine
    • dialysis, blood products, antibiotics
  • after 24 hours not as infectious, but caregivers also on antibiotics
  • DIC - disseminated internal coagulopathy

42

GI/GU assessment for peritonitis NOT r/t PID

  • sudden ache that develops into severe pain
  • N/V
  • lack of appetite
  • chills
  • high temp
  • rapid HR
  • not passing urine or passing less than normal
  • abdominal swelling

43

location of upper airway vs. lower airway illnesses

upper airway: naso/oropharynx to glottis (above vocal cords)

lower airway: below glottis (vocal cords) including bronchus and branches, lungs, alveoli

A image thumb
44

osmolality

  • concentration of solutes inside the body
  • human body osmolality ~ 300 mOsm/kg

45

asthma definition

chronic lung disease thati nflames and narrows airways...complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hypperresponsivness and inflammation

most common chronic disease in children

46

A.S.T.H.M.A. patient education

  • A: airways - asthma basics
  • S: symptoms
  • T: technique & triggers
  • H: help - where to go
  • M: medications - how and when
  • A: action plan

47

latent/dormant TB

  • positive PPD
  • no physical exam findings
  • CXR normal

48

pain measurement tools

A image thumb
49

musculoskeletal effects of unrelieved pain

fatigue and immobility

50

respiratory effects of unrelieved pain

  • shallow breaths and suppressed cough
  • increased sputum retention
  • atelectasis and hypoxemia and shunting

51

H. influenzae vaccine

  • since 1992
  • CDC recommendations
    • under 5 (first at 2 mo)
    • increased risk of infection
      • sickle cell
      • immunocompromised
      • asplenic (w.o spleen or dysfunctional spleen)
        • cannot fight encapsulated organisms
      • HIV

52

complications of pertussis

  • half of infants less than 1 yo are hospitalized
    • younger the infant more likely treatment will be needed
  • infants
    • pneumonia
    • seizures
    • apnea
    • encephalopathy
    • death
  • teens and adults
    • syncope or rib fracture 
    • weight loss
    • loss of bladder control
    • passing out

53

acute management of asthma

  • beta 2 agonists: albuterol, terbutaline
    • relaxes smooth muscle
  • oxygen
  • systemic steroids - reduce inflammation
    • oral, IV
  • anticholinergics: ipatropium bromide
    • anti-inflammatory inhaler
    • only works for the first 24-36 hours, if it works
  • IV fluids (worry about aspiration with oral)
  • methylxanthines: theophylline (sprinkles), aminophylline (IV)
    • ​dilate airways, relax airway muscles
    • used frequently in past - not as much, but more aminophylline now than recently 

54

clinical pathway of Meckels

  • painless GI bleeding (in stool) in children
  • diverticulitis (intestinal wall swelling) in young/older adults
  • most common Sx in children
  • bleeding
  • caused by ulcers in small intestine
  • most common Sx in older children/adults
    • bowel obstruction
  • 55

    minimal sedation

    patients respond normally to verbal commands. cognitive function and coordination may be impaired but respiratory and CV function unaffected

    56

    nursing care of H. flu

    • immunization status
    • droplet precaution
    • symptom management
    • fluid
    • antibiotics/ antipyretics
    • +/- dexamethasone

    57

    clinical pathway of intussusception

    • sudden, loud crying caused by abdominal pain
      • colicky and intermittent
      • comes back often
      • will get stronger, last longer each time
    • Classic Triad
      • vomiting, bloodys tools, colicky
    • other Sx
      • bloody, mucous-like bowel movement (currant jelly stool)
      • fever
      • shock (pale, lethargy, sweating)

    58

    specialty growth charts

    • premature infants
    • down syndrome
    • cerebral palsy
    • williams syndrome
    • turner syndrome 

    59

    nutrition history

    • type/amount of nutrients
    • active/resolved issues that impact nutrition
    • parents knowledge of nutritional needs
    • characterize parent/family nutrition habits
    • educate importance of good nutrition

    60

    clinical pathway of non-invasive pneumococcal diseases

    • less serious
    • occur outside major organs or blood
    • otitis media
    • sinusitis
    • non-bacteremic pneumonia

    61

    urinary tract infection overview

    • 2nd most common infection among children, second to upper respiratory infection
    • most significant to neonates b/c of renal issues

    62

    bacterial pneumonia

    • complex, usually single cell
    • thrives in many environments (hot, cold)
    • many cause little to no harm
    • sputum testing can identify organism or virus
    • macrolides for tx
    • symptoms up to 1 mo

    63

    inestinal silo

    bag that surrounds intestines and keeps them hydrated - allows for gravity to slowly pull intestines back into the child as they grow

    64

    hypercapnea

    increased CO2 in blood

    65

    high HR, low RR, BP caused by...

    cardiac

    66

    types of streptococcus

    • treat Group A within group beta (strep in throat)
    • GBS is Group B within group beta

    A image thumb
    67

    nursing management of hyponatremia

    pool instruction when developmentally appropriate

    urine specific gravity (1.000-1.0005

    68

    human milk

    • easily digested
    • immune properties
    • balanced nutrients and bio-active factors
    • ~20 cal/oz
      • 0.27-0.3 gm protein/oz

    69

    quick guide to pediatric BP

    child older than 1 year:

    90 + (2x age in years) / 70

    70

    bike injuries

    head and abdomen (handlebar)

    organs more exposed in children than adults because rib cage hasn't fully enclosed around them

    71

    sedation plan

    • length of procedure, positioning/draping
    • immobility vs analgesia vs anxiolysis
    • providers available, location of procedure
    • informed consent

    72

    S/Sx of UTIs in infants

    • 40% asymptomatic
    • FTT
      irritability
    • vomiting, diarrhea
    • incontinence
    • change in urine color

    73

    differences between adult and pediatric GI systems

    • compact torsos with smaller AP diameters
      • smaller area over which force of injury can be dissipated
    • larger viscera, especially liver, spleen, and bladder
      • extend below costal margin
    • less overlying fat and weaker abdominal musculature to cushion intra-abdominal structures

    74

    electrolytes

    • ECF/ICF varies with age
      • neonates/infants have larger ECF
      • 45% ECF newborn, 25% infant, 10% child
    • infants: high daily fluid requirement w/ little fluid reserve
      • vulenerable to fluid loss
      • hats, socks, etc.
    • I/Os very important

    75

    parasitic infectious agents

    • tic/lyme disease
    • children not as hospitalized as much from this
      • unless there are complications
    • classic bulls-eye rash in only 15%

    76

    why is a hypotonic solution a common maintenance fluid?

    replaces water that is normally lost throughout the day - overtime, there is a normal fluid exchange

    a bolus would be too much fluid in too little time

    77

    sniffing position

    • optimal airway opening
    • trachea, pharynx, oral cavity optimally aligned
    • important in babies and young children

    78

    metabolic rate

    amount of energy expended based on:

    • age
    • weight
    • height
    • sex
    • temperature
    • others
      • seizures, shivering, drugs (epi)

    79

    sedation medications

    • benzos
      • midazolam
      • diazepam
      • lorazepam
    • miscellaneous
      • ketamine
      • propofol
      • dexmedetomidine 

    80

    on-going screening assessment of sepsis

    • fever or hypothermia
      • warming/cooling blankets
    • poor perfusion
      • slow cap refill, low pulse pressure, low urine output
    • hypotension
      • >2 fluid boluses given
      • started/increased vasopressors
    • altered mental status (not enough blood to brain)
      • change? decrease?
      • behavior different from baseline

    81

    therapeutic ladder for pain management

    1. nonopioid +/- adjuvant
    2. mild opioid +/- adjuvant +/- nonopioid
    3. moderate opioid +/- adjuvant +/- nonopioid

    82

    uremia

    acute kidney failure r/t blood flow obstruction

    83

    serum protein r/t nutrition

    • decreased during stress, sepsis, acute illness
    • subject to fluid shifts and synthesis of acute phase proteins

    84

    fungal infectious agents

    • thrush (yeast)
    • candida
    • ringworm (also yeast)

    85

    pyloric stenosis defined

    • narrowing of pyloric sphincter from hypertrophy or hyperplasia of muscle
    • occurs in first 6 mo of life
    • some genetic component

    86

    nursing care of RSV bronchiolitis

    • monitor cardiovascular and respiratory status
    • maintain airway patency
      • oral suctioning
    • +/- oxygen therapy
      • delivery method might make them mad and exacerbate
    • chest physiotherapy
      • can be very calming
    • monitor response to meds

    87

    "child resistant"

    80% of children can't open the bottle within 5 minutes

    LOCK medications away - don't have to worry about which developmental stage your child is at - habit

    88

    passe muir valve

    • redirects flow of air upward through vocal cords, mouth, nose
    • one-way valve
    • enables trach patient to communicate orally
      • helps with speech therapy
    • need to deflate cuff - airflow won't pass otherwise

    89

    source of E.coli 0157

    • GI tract of cattle
    • undercooked meat
    • internalized into vegetables
    • public pools

    90

    hepatic effects of malnutrition

    • enlarged w. fatty infiltrates 

    91

    causes of hyponatremia

    • IV solutions w/ D5W
    • tap water enemas
      • draws salt out
    • diluting formula
    • swallowing pool/bath water
      • one tsp can throw off electrolytes
    • excessive sweating with incorrect fluid replacement

    92

    CF GI pathophysiology

    • mucous blocks pancreatic ducts
    • decreased enzyme production
    • poor fat digestion
    • malabsorption

    93

    symptoms of croup

    • children 3 mo - 4 yo
    • sudden onset, often nighttime
    • barking cough (hallmark), hoarseness
    • rhinorrhea
    • respiratory distress
      • loud breathing, inspiratorys tridor, tachypnea
      • +/- retractions
    • in the upper airway
      • oro/nasopharynx to level of glottic of VC

    94

    symptoms of hypernatremia

    • neuro effects of too much sodium 
      • seizures, altered mental state
    • low urine output, increased urine concentration
      • 1.020-1.030

    95

    adult fluid volume distribution

    • 2/3 of body water is ICF
    • 1/3 of body water is ECF
      • 1/3 intravascular
      • 2/3 interstitial
    • ~50% of weight is water

    96

    laryngotracheobronchitis (croup) definition

    acute upper airway disease with obstruction resulting from inflammationa and edmea of larynx, trachea, subglottic area

    97

    fentanyl

    • synthetic opioid
      • 100X more potent than morphine
    • peaks immediately
    • duraiton 30-60 min
    • half life 2.4 hrs

    98

    neuro effects of malnutrition

    • variable
    • usually in less than 2 yo
    • time of rapid brain growth and development

    99

    nursing assessment for pertussis: circulation

    • listen to HR for one minute
    • auscultate heart
    • peripheral pulses
    • cap refill on all extremities
    • feel for fontanels
      • flat, not sunken or bulging

    100

    bolus

    large amount of fluid over short amount of time (10-20 minutes)

    timing depends on size of child and access (how/where the line is)

    101

    treatment of RSV bronchiolitis

    • supportive
      • hydration
      • urine output
      • oxygenation/ventilation
      • manage secretion
      • antipyretics
      • enteric tube feedings
    • treatments to consider
      • bronchodilators (some respond, some don't)
      • +/- steorids (evidence that it doesn't really help)
    • has about 7-10 day course

    102

    most common viruses causing croup

    parainfluenza types I, II, III

    103

    treatment of HUS

    • diet, fluid restrictions, high calorie, high carb, low protein, low sodium, low potassium
    • hemodialysis
    • RBC, platelet transfusion
    • daily weights, lab values, neurologic assessment
    • NO antibiotics

    104

    patient-controlled analgesia

    • > 5-7 yo
    • parent vs. nurse-controlled analgesia when patient is too young

    105

    specific pulmonary symptoms that indicate a child should be checked out

    • acute status change
      • particularly if fluid intake has changed or decreased
    • high temperature w/ respiratory distress

    106

    risk factors for infectious diseases

    • poor immune system
    • school/day care
    • poor hygiene
    • can't articulate that they're not feeling well
      • not until 9 or 10
      • sometimes just fussy - hard to manage
      • already exposed everyone in that duration

    107

    cleft lip/palate feeding

    • parental support and assistive feeding devices
    • smaller volumes with increased time to feed
    • feed with head elevated
    • frequent burping
    • breastfeeding
    • NG tube placement

    108

    management of pneumonia

    • frequent respiratory assessment
      • CXR - not every day necessarily
    • monitor VS
    • respiratory/pulmonary therapies
      • oxygen
      • antibiotics if necessary
      • respiratory tx
      • chest physiotherapy
      • hydration (insensible loss from respiration)
      • positioning
    • pain management
    • nutrition
      • NG tube but often post-pyloric and continous to avoid dumping syndrome

    109

    PO/enteral nutritional intake

    • PO best, then enteral
      • preserve intestinal function
      • prevents translocation of gut flora into blood stream
        • use trophic feeds 
      • allows normal processes and hormonal responses to nutrient intake
      • assist in immune function 

    110

    pneumonia presentation

    • fever
    • cough +/- mucous production
      • GI symptoms from ingesting
    • respiratory distress
    • +/- mild/moderate cyanosis

    111

    acute asthma pathophysiology

    • small airways obstructed
      • air trapping and atelectasis
      • ventilation/perfusion (VQ) mismatch
        • blood passes by atelectasis to open areas of lungs
        • creates non-uniform perfusion 
    • hypoxemia ensues
    • leads to airway remodeling
      • pulmonary capillary bed becoems fibrotic with smooth muscle build-up

    112

    causes for hypernatremia

    • breast feeding
      • how much/how long to feed
      • count diapers
    • incorrect formula preparation
      • incorrect concentration
    • prolonged diarrhea/vomiting
    • tube feedings
    • certain IV preparations

    113

    pain assessment

    • use age and illness-specific assessment tools
    • evaluate pain in context and within the child's trajectory of illness

    114

    physical assessment r/t nutrition

    • general appearance
    • extremities
    • physical development
      • tanner staging and puberty
    • activity and alertness
    • mechanical/medical devices/ treatments

    115

    hemolytic uremic syndrome

    • hemolytic anemia, uremia, thrombocytopenia
    • caused by E.coli 0157 from cows, goats, horses
    • toxins cause more than 110,000 illnesses, 80 deaths per year
    • most common cause of acute renal failure (ARF)
    • children less than 4, peaks between 1-2 yo

    116

    NIPS

    • neonatal infant pain scale
    • expression
    • cry
    • breathing
    • arm and leg movement
    • arousal state

    117

    soy-based milk

    • milk sensitivity/hypersensitivity
    • galactosemia; lactose intolerance
    • vegetarian/vegan diet
    • ~20 cal/oz
    • ex: similac soy isomil, enfamil prosobee, good start soy

    118

    head circumference changes in healthy infants

    • 1 cm/month up to 12 mo
    • 25% adult brain size at birth
    • 75% by 1 yo
    • 100% by 7.5-8 yo

    119

    school-age (10-12) response to pain

    • better understanding of relationship between an event and pain
    • more complex awareness of physical and psychologic pain
    • may pretend comfort to project bravery
    • may regress with stress/anxiety
    • can describe intensity and location w/ miore characteristics
    • can describe psychologic pain

    120

    S/Sx of testicular torsion

    • extreme pain
    • ipsilateral loss of cremasteric reflex
      • stroke inside of thigh and scrotum should lift one side at a time
    • testicle twists spontaneously on spermatic cord, venous occlusion, arterial ischemia

    121

    burns and sepsis

    • high risk
    • surface area
      • more than 30% of 2nd and 3rd degree burns = extremely high risk
    • #1 protective organ has been damaged

    122

    asthma presentation

    • cough +/wheeze
    • increase WOB
    • c/o chest tightness
    • decreased air entry
    • difficulty breathing
    • breathless at rest
    • speaking in words at a time vs sentences at a time
    • +/- retractions, nasal flaring, S/Sx of URI

    123

    progression of infant feeding

    A image thumb
    124

    nursing interventions with staph

    • respiratory assessment
    • circulation
    • handwashing
    • hydration and nutritional assessment, blood cultures
    • GI - tubes, catheters, wound cultures
    • isolation - standard and high level precautions
    • chest x-ray
    • no immunization
    • topical, oral, IV antibiotics
      • depending on type and location

    125

    INRS

    indiviualized numeric rating scale (for parents on their child's pain)

    A image thumb
    126

    when to use opioids

    • severe pain or injury
    • oral, IM, IV
      • determine equianalgesic dose
      • based on drug, child's weight
      • avoid IM route if possible
    • BMI may affect response b/c of storage capacity

    127

    toddler (1-3 yo) response to pain

    • does not understand what causes pain or why he/she is in pain
    • localized withdrawal, body resistance, aggression, disturbed sleep
    • cries, screams
    • cannot describe intensity or type ofpain
    • uses common words like ouchie and boo-boo

    128

    physiology of respiratory failure

    • decreased arterial oxygen concentration and increased carbon dioxide retention
    • acute or chronic repsiratory or neuromuscular process 
      • acute = exacerbation of chronic issue
      • neuromusclar = weak thoracic cage
        • viral/bacterial illness puts them at higher risk
    • acute or chronic respiratory issue

    129

    post op care of hypospadias/epispadias

    • anterior hypospadias have no stents and need no special treatment
    • more severe hypospadias use drippy stent 7-14 days
      • bath, diapering issues
      • prophylactic antibiotics, bactrim
      • bladder spasms tx with oxybutynin
      • no swimming, contact sports 14 days
      • no straddle toys 14 days
      • blood visible ins tent for 14 days

    130

    clinical pathway of measles (rubeola)

    • incubation period: 3-12 days (begin contagious process)
    • prodromal period: fever, high 40.6
    • three C's: conjunctivitis, cough, coryza (acute rhinitis)
    • Koplik spots
    • maculopapular rash (still contagious)
      • lasts 5-6 days then fades

    131

    post-operative nursing considerations for cleft lip/palate

    • arm immobilizers
    • pain management
    • avoid crying

    132

    physiological dependence

    physiologic need for an agent to rpevent withdrawal symptoms

    133

    pneumonia overview

    • lower airway, respiratory tract infection
    • inflammation of bronchioles and alveolar spaces
    • 80% of cases in children
    • community aquired is 40:1000
    • 20% of pediatric hospitalizations
    • lack of sensitivity and specificity in diagnostic testing
      • children before 12 yo won't cough for a sample

    134

    CF GU pathophysiology

    • males often sterile b/c of blocked vas deferens
    • females have reproductive difficulties due to mucous secretion that block sperm travel in fallopian tubes

    135

    cardiovascular effects of malnutrition

    • decreased CO w/ cardiac muscle showing non-specific changes
    • pericardial effusion in recovery
      • enlargement of heart size r/t increasing muscle mass

    136

    treatment for pyloric stenosis

    • pyloromyotomy surgery (Ramstedt's procedure)
      • divides pylorus to open gastric outlet
      • single incision or laparoscopically

    137

    growth measurements

    • weight
    • height/length
    • head circumference
    • mid-upper arm circumference
      • indicates muscle
      • last area to become edematous in sick child
      • can monitor long-term nutrition 
    • skin folds
      • indicate fat stores

    138

    hypoxia

    tissues are starved of oxygen

    139

    amino acid-based formula

    • extreme protein hypersensitivity
    • intolerance to cow's milk protein
    • useful in malabsorption, enteropathies
    • ex: neocate, neocate jr, nutramigen AA, elecare

    140

    anesthesia

    state of controlled unconsciousness accompanied by a loss of protective reflexes, including ability to maintain airway independently and respond purposefully to painful stimuli

    141

    cleft lip/palate clinical pathway

    • cleft lip may be unilateral or bilateral
      • may or may not include cleft palate defect
    • cleft palate not apparent until palpated
      • continuous opening between nasal cavity and mouth
      • can involve hard and/or soft palate 
    • hearing oss, otitis media, dental deformity, speech and feeding problems 

    142

    hemolytic anemia

    anemia caused by destruction/rupture of red blood cells

    143

    asthma risk factors

    • gender (more males than females)
    • famil hx, genetic predisposition
    • allergens/atopy
      • people w/ allergies have more asthma incidences
    • airway hyperreactivity
    • pollution

    144

    normal chest radiograph

    A image thumb
    145

    before sedation procedure

    • consider
      • topical agents
      • diversion
      • procedural medications
      • NPO status - age-dependent
    • avoid delays
    • safe environment 

     

    146

    atelectasis

    partial collapse/some parts of the lung stuck together

    147

    Reye's syndrome

    • baby aspirin with varicella
    • causes encephalopathy and continual seizures

    148

    symptoms of respiratory distress

    • increased WOB
    • +/- cyanosis
    • change in mentation, LOC

    149

    treatment of croup

    • humidification to decrease upper airway drying
      • cool air and +/- oxygen
    • antipyretics for temperature if present
    • dexamethasone (steroid) to decrease inflmmation/edema
      • 24-48 hours (sometimes more/less)
    • +/- isotonic IV fluids, encourage PO fluids
      • don't make them irritable with an IV
    • solid food intake may decrease
      • need to at least stay hydrated

    150

    clinical pathway of pyloric stenosis

    • forceful vomiting
    • dehydration
    • weight loss

    151

    abdominal trauma definition

    • uncommon in childhood trauma
    • signs can be difficult to interpret
      • if child is scared, traumatized
    • high index of suspicion is needed to identify injuries
      • based on child's history

    152

    cow's milk-based formula

    • from nonfat cow's milk, vegetable oils and CHO
    • assimilated to breast milk
    • ~20 cal/oz
      • 0.42-0.54 gm protein/oz
    • ex: similac, advance

    153

    cognitive effects of unrelieved pain

    reduction in cognitive function

    154

    after sedation procedure

    • assess CV and RR function
    • assess arousability
    • assure adequate hydration
    • protect from injury
      • falls from bed/while ambulating

    155

    moderate sedation

    depression of consciousness during which patients respond purposefully to verbal commands

    no interventions required to maintain patent airway and spontaneous ventilation is adequate

    CV function usually maintained

    156

    clinical indicators of malnutrition

    • skin
    • nails
    • head and hair
    • mouth
    • eyes
    • abdomen
    • musculoskeletal

    157

    immune effects of unrelieved pain

    depression of immune response

    158

    early recognition of sepsis

    • complete history: ROS
    • physical exam
      • skin abnormalities
      • rash
      • petechiae
    • VS abnormalities
      • fever > 38C or
      • age-related tachycardia and tachypnea
      • abnormal WBC
        • > 12,000/uL or
        • 10% bands

    159

    moderate persistent asthma

    • daily Sx with nighttime Sx 3-4x / month
    • requires baseline medication

    160

    assessment of patient with hypernatremic dehydration

    • tachypnea
    • increased HR
    • lower BP
    • neurologic (not alert, not consolable)

    161

    hypoventilation of alveoli results in

    • hypoxia
    • hypoxemia
    • hypercapnea

    162

    intermitten asthma

    brief episodes with Sx

    163

    celiac disease clinical pathway

    • GI distress after cereal
    • large, fatty, foul odor stool
    • cachexia

    164

    common maintenance IVFs in young infants

    • D5W 0.2% NaCl
      • with or without KCL
    • D10W 0.2% NaCl

    165

    overview of acid-base balance

    • homeostasis/balance between acid/bases
    • indicated by pH
      • influenced by H+ ion concentration in blood
    • distubances in equilibirum cause pH changes
    • may indicate respiratory or metabolic alterations
      • try to regulate disturbance
    • bases = carbonic acids and bicarbs
    • acids = hydrogen ions (primary driver)

    166

    TB latent infection

    • common in children
      • 5-10% > 3 yo with untreated latent TB progress to disease
    • infants and adolescents most likely to be symptomatic
      • adolescents cough a lot
      • infants just really sick
    • lung most common site of infection
    • diagnosis made by early AM gastric washing
      • child won't expectorate into cup

    167

    diffusion

    movement of solutes from areas of high concentration to areas of low concentration

    168

    bacterial tracheitis

    • secondary infection of upper airway after viral episode of laryngotracheitis
    • airway edema and obstruction r/t copious purulent secretions

    169

    medication error reduction strategies

    • never use memory
    • include weight, age
    • calculated dose and mg/kg dose
    • no abbreviations
    • use of zeros
    • bar coding
    • allergy documentation

    170

    GI effects of unrelieved pain

    decreased gastric and bowel motility

    171

    what causes sepsis?

    A image thumb
    172

    safety issues in pediatrics

    • environment
    • toxins, poisons
    • firearms
    • ATVs, bikes

    173

    Glasgow Coma Scale: eye response

    1. no eye opening
    2. eye opening to pain
    3. eye opening to verbal command
    4. eyes open spontaneously

    174

    CF skin pathophysiology

    • electrolyte imbalanced due to chloride ion loss in saliva, perspiration, mucous
    • salty taste to skin
      • sodium chloride through pores

    175

    focused/emphasized GI/GU exam for abdominal trauma

    • abdominal distension
    • abdominal tenderness
    • generalized guarding
    • pelvic instability or tenderness
    • blood at urethral meatus
    • inspection of back/perineum

    176

    common routes to lose fluid from body

    • urine
    • stool
    • skin
    • respiratory tract

    177

    viral infection and sepsis

    can tip over a compromised patient into infection and put them at risk

    178

    VACTER syndrome

    syndrome of anamolies commonly associated with each other

    • Vertebral
    • Anal
    • Cardiac
    • TE fistula
    • Esophageal
    • Radial

    179

    complications of chickenpox

    • secondary infections
      • cellulitis, abscesses, sepsis, meningitis, encephalitis, pneumonia, Reye's syndrome (baby aspirin), Group A strep, necrotizing entercolitis
    • fatal in children who are
      • immunocompromised, undergoing chemo, steroid treatment, transplant therapy

    180

    drugs that work on pain modulation

    • TCAs
    • SSRIs
    • SNRIs

    181

    nursing assessment for pertussis: airway and breathing

    • RR
    • color changes during breathing and whooping
    • auscultate
      • coarse breath sounds
      • ronchi
      • diminished breath sounds
    • coughing is usually productive
      • difficult to clear
      • will often use suction

    182

    prevention of tics and lyme disease

    • avoid tic habitat
    • dress defensively
    • check for tics
    • shower right away
    • hot dryer
    • protect pets

    183

    TB skin test

    • 5mm or greater + contact with infectious case
      • abomdinal CXR
      • clinical evidence of disease
      • immunosuppressive conditions and/or therapy
    • 10 mm or greater + risk of disseminated disease
      • risk/presence of compromising conditions
      • DM, CRF, malnutrition
      • known frequent exposure
    • 15 mm or greater
      • children > 4 yo
      • no risk factors

    184

    diagnosis of croup

    • history and PE
    • pulse ox to determine CO2 levels
      • oxygenation
    • radiograph of neck

    185

    goals of CF care

    • maintain body system functioning despite frequent illnesses
    • adherence to med regimen
    • nutrition regulation

    186

    adolescent (13-18) response to pain

    • capacity for sophisticated understanding of causes of pain
    • recognized pain is qualitative and quantitative
    • can relate to pain experienced by others
    • wants to behave socially acceptable, controlled response
    • may distract self
    • may not complain if given cues that it should be tolerated
    • more sophisticated descriptions of pain
      • may think nurses in tune with thoughts of pain
      • won't verbalize it

    187

    Glasgow Coma Scale: verbal response

    1. no vocal response
    2. inconsolable, agitated
    3. inconsistently consolable, moaning
    4. cries but is consolable, inappropriate interactions
      1. crying is NORMAL but needs to be consolable
    5. smiles, oreinted to sounds, follows objects, interacts

    188

    IVF lingo

    • 0.9% NaCl = normal saline or saline
    • 0.45% NaCl = half normal or half normal saline
    • 0.2% NaCl = quarter normal or quarter normal saline
    • D5W = D5
    • potassium chloride = KCL or K
    • CHOPism = hourly maintenance fluid = stock fluid

    189

    normal ranges for acid-base balance

    A image thumb
    190

    symptoms of hyponatremia

    • level of consciousness
    • seizures

    191

    nutrition and pediatrics

    • growth is dynamic
    • indicator of health, well-being, thriving
    • provision of nutriets necessary for growth and life
    • nutrition status affects chld's response to injury and illness
    • recognize when parents are not making nutritionally sound decisions for their children
    • pediatric health of a society is indicative of the sustainability and prosperity of that society

    192

    alkalosis

    • decreased H+ concentration
    • increased pH

    193

    maintenance medication therapy of asthma

    • corticosteroids
      • inhaled anti-inflammatory beclomethasone, fluticasone (common), budesonide
    • +- allergy meds
    • hyposensitization therapy
    • emergency beta 2 agonist inhaler (patient/family education)
    • recognition of symptoms
    • knowledge/understanding of meds

    194

    during sedation procedure

    • monitor for respiratory depression
      • visual confirmation and O2
    • monitor patient tolerance
    • document vitals every 15 min

    195

    CF GI care

    • acid suppression due to GERD
    • enemas to prevent constipation

    196

    standards of care related to pain

    • pain hx on admission
    • pain assessed/document q4h w/ reliable measurement tools
    • assessment-intervention-reassessment cycle when appropriate
    • pain managed with psycho, bio, developmental interventions
    • partner with families
    • analgestics safely/effectively around the clock
    • performance metrics
      • most frequent pain score over past 3 days
      • unsatisfactory pain relief for > 1 hr - patient or system issue?

    197

    endocrine effects of malnutrition

    • pancreatic atrophy w/ reduced insulin
    • increased cortisol 
      • destroys circadian rhythm
    • initial increase in T4
      • w/ unresolved malnutrition T4 and T3 decrease

    198

    hypospadias and epispadias

    • congential defect of penis
    • urine stream deflected r/t abnormal location of urethral meatus
      • dorsal surface  epispadias 
    • also associated with penile curvature s/t chordee

    199

    mechanism to restore fluid balance

    kidneys

    • less able to conserve or excrete water and solutes effectively
    • greater risk fo acid/base imbalance
    • specific gravity = 1.005-1.015
      • lower b/c can't concentrate urine as much r/t immature kidneys

    200

    clinical pathway of invasive pneumococcal diseases (IPD)

    • bacteremia (sepsis)
    • meningitis
    • bacteremic pneumonia

    201

    history of epiglottitis

    beginning to see it again because

    • life threatening
    • many providers have never seen it

    used to be challenges in getting immunized and didn't cover all types

    but now, we're seeing more cases again

    202

    septic shock definition

    sepsis + CV dysfunction

    203

    active TB

    • poor weight gain/weight loss
    • +/- fever, night sweats
    • fatigue
    • cough (+/- hemoptysis)
    • chest pain
    • palpable lymph nodes
    • CXR changes
      • most often in UR lobe of lung
    • positive PPD

    204

    lactated ringer fluid bolus

    • lactate - precursor to bicarb - used as a buffer during bleed (acidosis)
    • 10-20 ml/kg per bolus
    • used mostly in operating room, L&D

    205

    infection definition

    suspected or documented infection caused by pathogen OR clinical syndrome associated with high probability of infection

    206

    vital signs of SIRS

    • elevated RR
    • elevated temp
    • elevated HR
    • DO NOT depend on BP as a initial symptom
      • children can hold onto their BP for a while
      • but when it falls, it plummets

    207

    hyponatremic or hypotonic dehydration

    serum soidum

    208

    gram-negative bacteria associated with sepsis

    • pseudomonas aeruginosa
    • e. coli
    • acinetobacter
    • neisseria meninigitidis
      • see this most often in really sick kids
      • VLBW, premies, etc.

    209

    albumin r/t nutrition

    • commonly used as lab value
    • long half life ~ 14 days

    210

    haeomphilus influenzae

    • H influenzae; H flu
    • categories:
      • encapsulated
        • respiratory: epiglottitis, pneumonia
        • invasive: meningitis, cellulitis, septicemia
      • unencapsulated
        • respiratory: bronchitis, sinusitis
        • invasive: otitis media, conjunctivitis
    • transmission - respiratory droplets

    211

    cleft lip/palate definition

    incomplete fusion of lip and/or palate

    212

    treatment for testicular torsion

    • orchiopexy (suturing)
    • orchiectomy (removal)

    213

    opioid related respiratory depression risk factors

    • infants less than 6 mo old
    • children with:
      • compromised airway (lung disease)
      • neurological impairment, muscle weakness
      • kidney/liver disease
      • morbid obesity
      • specific diseases (Downs)
      • hx of respiratory depression/sensitivity to opioids
      • large dose
      • fast administration
      • concurrent use of CNS depression meds
      • opioid naive

    214

    4,2,1 rule

    for hourly fluid maintenance

    •    4 ml/kg/hr for first 10 kg
    • + 2 ml/kg/hr for second 10 kg
    • + 1 ml/kg/hr for third 10 kg

    215

    hernia

    protrusion of organ or tissue thru abnormal opening

    216

    4th vital sign in kids

    weight

    pre and post weights with rehydration therapy

    217

    nursing interventions for hernia and communciating hydrocele

    • wounds dry and clean
    • stitch vs mesh
    • dermabond maybe (5-10 days)
    • no ointments to wound region
    • frequent diaper changes
    • sponge baths 2-5 days
    • no lifting, bike riding 2 weeks

    218

    Q image thumb

    • little dark space
    • thickening and mucous and exudate sitting down in lungs
    • why they are on frequent chest physiotherapy
      • to move the stuff as much/frequently as possible

    219

    gram-positive bacteria associated with sepsis

    • staph auerus
    • staph epidermidis 
    • strep pyogenes
    • strep pneumoniae

    220

    risk factors for abdominal injuries

    • high impact/deceleration injuries
    • direct blows
    • evidence of injury above/below abdomen
      • unlikely to have been spared
    • seat-belt injuries (duodenum, pancreas)
    • handlebar (duodenum, spleen, pancreas)
    • straddle injuries (perineum, vagina, urethra)
    • penetrating injury
    • injuries suggestive of child abuse

    221

    chronic asthma pathophysiology

    • chronic inflammatory disease causing 3 hallmarks:
      • obstruction of airflow via mucous
      • airway edema
      • airway muscle contraction/constriction
    • immediate inflammatory response by mast cells that release histamines which cause
      • bronchospasm
      • mucosal edema
      • mucous secretion
    • chronicity leaves airway hyperresponsive, leading to acute exacerbations 
    • airway remodeilng (permanent) w/ or w/o mucous

    222

    S/Sx when enteral nutrition is not tolerated

    • intractable emesis/diarrhea
    • severe abdominal distension
    • persistent diarrhea
    • chronic, persistent constipation
    • surgical abdomen

    223

    hypoventilation definition

    O2 requirements exceed O2 intake (obstruction, injury, poor ability to oxygenate)

    224

    acidosis

    • increased H+ concentration
    • decreased pH

    225

    definition of staphylococcus

    • group of bacteria that causes multitude of diseases
    • bacteria are round and bnched
    • illness directly by infection or indirectly by products
      • toxins (80 types) such as MRSA
    • in normal flora of skin, throat, rectum
    • can infect blood, pulmonary, bones, joints, skin, soft tissues, heart, GI system
    • thousands of deaths/year
    • 80% resistant to penicillins

    226

    nursing management of epiglottitis

    • calm patient - do not separate from caregiver
    • airway maintenance
    • drug therapy
    • hydration
    • emotional/psychosocial support of patient and family

    227

    causes of hyperkalemia

    • burns
    • trauma
    • blood transfusion
    • renal failure
    • IV with K+
    • sickle cell crisis

    228

    appendicitis defined

    • inflammation of appendix
    • common cause of emergency surgery
    • most often occurs when blocked by feces, foregin object, tumor
    • lab tests, including pregnancy for females to rule out other causes

    229

    normal saline fluid bolus

    • 10-20 ml/kg per bolus
    • depending on circumstances, can ahve up to 60 ml/kg

    230

    modes of nutritional intake when PO doens't work but gut does

    • NG tube
    • orogastric tube
    • nasoduodenal tube
    • NJ tube

    231

    hypertonic IVF 

    • osmolarity is more than 300
    • less water, more solute
    • fluid moves out of ICF into ECF into intravascular space
      • brain cells shrink + brain bleed 
      • brain collapses on itself because of shrinkage
      • increased BP and bounding pulses
    • TPN (total parenteral nutrition) or 3% saline (ICUs)
      • around 1000 mOsm

    232

    height gain in health infants

    • 2.5 cm/month first 6 mo
    • 1.3-1.5 cm during 7-12 mo
    • 7-7.5 cm/year > 12 mo until adolescent spurt

    233

    physiologic S/Sx of acute pain

    • catecholamine and adrenocorticoid hormone secretion
    • tachycardia
    • tachypnea
    • hypertension
    • pupil dilation
    • pallor
    • increased perspiration

    234

    definition of pertussis

    highly contagious respiratory disease caused by bacterium bordetella pertussis

    235

    illnesses associated with upper vs. lower airway illnesses

    • upper
      • common cold (viral)
      • croup
      • sinusitis
    • lower
      • bronciolitis
      • pneumonia
      • asthma

     

    236

    how to approach GI system

    • bleeding
    • inflammation
    • obstruction
    • motility
    • congenital
    • malabsorptive
    • infections

    237

    infant

    • no understanding of pain - responds to parental anxiety
    • generalized body movements, chin quivering, facial grimacing, poor feeding
    • cries

    238

    contraindications to enteral nutrition

    • gut ischemia
    • prolonged, profound hypotension
    • critical illness with >2 vasoactive meds and/or escalaing vasoactive med
    • malabsorption
    • surgical abdomen
    • intra-abodminal HTN

    239

    nursing interventions for meningococcemia

    • respiratory assessment + oxygen
    • neuro
    • antibiotics and fluids
    • lumbar puncture
      • glucose and protein: low glucose, high protein is symptom
    • isolation for 24 hours
    • identify close contacts and give prophylactic antibiotics
    • vaccine: menactra/MCV4 (serotypes A,C,D,Y)

    240

    school-age (7-9 yo) response to pain

    • understands simple relationships between pain and disease
    • understands need for painful treatments
    • may associate pain with feeling bad/angry
    • may recognize psychologic pain r/t grief
    • passive resistance, clenches fists, holds body still, suffers emotional withdrawal, engages in plea bargaining
    • can specify location and intensity
    • describe physical characteristics in relation to body parts

    241

    gate control of pain

    • pain perception can be inhibited/changed when competing non-pain impulse is sent along same pathway
    • stimulation of larger A-beta fibers causes substantia gelatinosa in dorsal horn of spinal cord to "close the gate" and decrease pain transmission to brain
    • rubbing something that hurts

    242

    clinical pathway of chickenpox

    • incubation period 14-21
    • enters through respiratory tract and conjunctiva
      • replicates at site of entry in nasopharynx and in regional lymph nodes
    • acute onset of mild fever, malaise, anorexia
    • macular rash for few hours that progresses to pruritic vesicular lesions for 1-5 days. up to 500 lesions of all stages
      • crusts may remain 1-3 weeks
    • ulcerative lesions in mucous membranes
    • transmission: both airbone and direct lesion contact
    • contagious state continues until all lesions are crusted over

    243

    agents seen in conjunction with RSV bronchiolitis 

    • parainfluenza I, II, III
    • adenovirus
    • rhinovirus
    • novovirus
    • human metapneumovirus
    • mycoplasma pneumonia 

    244

    asthma triggers

    • weather
    • exposure to known/unknown allegens
      • dust mites
      • mold
    • pet dander
    • URI
    • airway/respiratory irritants
      • tobacco smoke
      • aerosol sprays
    • exercise
      • pre-medicate

    245

    what to do during opioid-induced respiratory depression

    • stimulate patient
    • give oxygen
    • stop opioid
    • anesthesia STAT or code blue if needed
    • notify the primary service and pain treatment service
    • give naloxone as needed

    246

    AM gastric wash/lavage

    • tests for TB
    • put NG tube at night before they sleep
    • aspirate before/as they wake up in the morning
    • 3 days in a row

    247

    evaluation of UTI

    • urinalysis and urine culture
    • catheter (most reliable) vs bag/clean catch
    • any number of colonies in culture is significant
    • with bagged collection >100,000 single organisms significant
    • for boys, 1,000 ucf is positive

    248

    isonatremic or isotonic dehydration

    • loss of equal amounts of sodium and water
    • 80% of dehydration incidents

    249

    hydrocele definition

    • accumulation of fluid around testicle
    • communicating: no bowel, just peritoneal fluid
    • noncommunicating: no connection to peritoneum
      • rare in children
      • more common in adolescents from fluid from lining of tunica vaginalis
        • fluids will go away, become absorbed

    250

    definition of pneumococcal disease

    • leading cause of serious illness around the world
    • caused by bacterium Streptococcus pneumoniae
      • can attack different body parts
    • illnesses include:
      • pneumonia
      • meningitis
      • middle ear and sinus infection
    • issue with sickle cell disease

    251

    NEMU method

    placing temporary enteral tube

    tip of Nose, inferior attachment of Ear lobe, Mid-way between xiphoid and Umbilicus 

    252

    musculoskeletal effects of malnutrition

    • stunting
    • osteopenia 

    253

    topical sedation therapies

    • pain ease spray
    • emila cream
    • LMX -4 cream
    • local cirulatory changes
      • blanching, vasoconstriction
    • lidocaine toxicity 
      • prolonged administration or large surface area

    254

    prevention of UTIs

    • hygiene
    • baths, no bubbles, no lotions
    • increase fluids
    • no holding urine
    • voiding after sex
    • long term low dose antibiotics?

    255

    stacking breaths

    • can't fully exhale in asthma exacerbation
    • breaths on top of breaths
    • lungs expand beyond normal

    256

    long-term enteral feeding devices

    • gastric tube
    • gastric-jejunal tube
    • jejunal tube

    257

    respiratory syncytial virus (RSV) bronchiolitis

    • disease of lower airway caused by RSV invading cell mucosa in smal airways
      • inflammation of bronchioles
        • leads to epithelial necrosis
      • constriction and obstruction of small distal airways
      • air trapping, atelectasis 
      • can progress to RSV pneumonia

    258

    NPO status before sedation

    • 0-5 mo:
      • 4 hours solids
      • 3 hours breast milk
      • 2 hours clears
    • 5-36 mo:
      • 6 hours solids
      • 3 hours breast milk
      • 2 hours clears
    • 3+ years:
      • 8 hours solids
      • 2 hours clears

    259

    thrush

    • also from immunosuppression
    • commonly in mouth
    • contamination from mom (full thrush possible)
    • lot of kids with cancer have oral thrush
      • can't eat, drink, swallow
      • painful
      • goes down entire esophagus 

    260

    clinical pathway of appendicitis

    • varied S/Sx in children - hard to diagnose
    • first Sx usually pain around belly button
      • moves to RLQ ~ 12-24 hrs after illness starts
    • if appendix ruptures
      • less pain for a while, followed by:
        • chills and shaking
        • hard stools or diarrhea
        • fever, N/V

    261

    deep sedation

    depression of consciousness during which patients cannot be easily aroused but respond purposefully after repeated or painful stimuli.

    ability to independently maintain respiratory function may be impaired. require assistance to maintain patent airway and spontaneous ventilation may be inadequate

    CV function usually maintained

    262

    definition of respiratory failure

    • inability to maintain effective exchange of oxygen and carbon dioxide 
    • hypoventilation of alveoli

    263

    systematic assessment of child

    • A: aeration
    • B: breathing and brain
    • C: circulation
    • D: disabilities and drugs
    • E: expose the patient and electrolytes
    • F: fluids

    264

    epiglottitis

    • inflammation and edema of epiglottis that can occlude trachea
    • presents with acute illness
      • H influenzae - type B
      • strep pneumoniae
      • staph aureus
    • LIFE THREATENING - DO NOT EVALUATE AIRWAY

    265

    potassium chloride - KCL

    • 10 or 20 meq concentrations in IV bags
      • not to be confused with KCL boluses AKA riders
    • kidneys regulate potassium levels and have poor ability to conserve potassium
    • when patient is NPO, KCL should be added to fluids
    • IVF bag with KCL should never be given to patient who has not demonstrated adequate urine output (kidneys)

    266

    causes of cleft lip/palate

    mutlifactorial - strong genetic influence

    267

    extensively hydrolyzed formula

    • significant malabsorption 
      • short gut, CF, biliary atresia, protracted diarrhea
    • poor taste - introduce prior to bitter taste development
    • ex: nutramigen, pregestimil, good start genlte plus, similac expert care alimentum

    268

    causes of hypokalemia

    • diarrhea
    • wound drainage
    • eating disorders
    • renal disease

    269

    sepsis and lactic acidosis

    • end product of organs functioning and muscle contractility is lactate
    • if you can't clear it b/c of decreased blood flow and CO
      • buildup of lactate in blood
      • acidic environment

    270

    anthropometrics

    • avoid measurement errors
    • examiner error
      • proper training
      • standardized techniques
    • instrument error
      • precise, calibrated instruments
    • measurement difficulty resutling in inacuracy
      • repeated measurements on same subject 

    271

    clept lip/palate repair

    • usually prior to 18 mo
    • closure allows better seal around nipple
    • multidisciplinary management
      • plastic surgery
      • dentistry
      • hearing
      • speech/feeding therapy

    272

    reasons why young pediatric patients are prone to fluid loss

    1. increased body surface area
    2. increased metabolic rate (growing)
    3. immature kidney function

    273

    infant 6-12 mo response to pain

    • has pain memory; responsive to parental anxiety
    • reflex withdrawal to stimulus, facial grimacing, disturbed sleep, irritability, restlessness
    • cries

    274

    peritonitis defined

    inflammation of peritoneum

    275

    pathophysiology of pediatric sepsis

    1. insult/injury
    2. inflammatory mediators --> SIRS response
    3. tissue injury --> infection --> decreased tissue perfusion --> sepsis
    4. severe sepsis --> septic shock --> death

    276

    CF nutrition care

    • pancreatic enzymes to aide digestion
    • balanced diet w/ increased caloric intake

    277

    less common viruses causing croup

    • respiratory syncytial virus (RSV)
    • influenza A or B
    • adenovirus
    • rubeola (measles)

    278

    fluid volume overload caused by:

    • infection
      • increased capillary blood flow, inflammation
    • burns
      • increased capillary permeability
    • cardiac failure
      • venous congestion, R side heart failure
    • nephrotic syndrome
      • increased albumin excess
    • tumors
      • blocked lymphatic drainage
    • surgery
      • lymphedema

    279

    preschooler (3-6 yo) response to pain

    • pain is a hurt
    • does not relate to illness, maybe to injury
    • believes pain is punishment
    • can't understand why painful procedure will help
    • active physical resistance, directed aggression, strikes out physically and verbally, low frustration level
    • language skills to express pain on sensory level
      • can identify location and intensity
      • may deny pain
      • may believe his/her pain is obvious to others

    280

    definition of lyme disease

    • most common tic born illness in N. America and Europe
    • bacterium Borrelia burgdorferi
    • deer tics can harbor bacteria and spread when feeding

    281

    definition of chickenpox (varicella)

    • varicella zoster virus
    • DNA virus and member of herpesvirus group
    • capacity to eprisst in body after primary infection
      • in sensory nerve ganglia
    • primary infection = chickenpox
    • secondary infection/reactivation = herpes zoster (shingles)
    • short survival time in environment
    • can progress to pneumonia or encephalitis 

    282

    etiology of pneumonia

    • bacterial
    • viral
    • chemical
      • lung tissue irritation
      • aspiration
      • inhaled meds/toxins/poison

    283

    symptoms of UTIs in older children

    • burning/pain with urination
    • frequent/urgent urination
    • fever
    • lower abdominal pain
    • wetting episodes
    • blood in urine

    284

    CF respiratory pathophysiology

    • affected by 4 wks of age
    • lungs filled with mucus so cilia can't move
    • air trapped in lower airways causes areas of pulmonary collapse
    • secondary bacterial infections leads to life threatening respiratory failure
    • most common cause of mortality 
    • when respiratory system is affected, so are all the other systems
      • can't do same amount of ventilation/oxygenation

    285

    treatment of hypospadias and epispadias

    • surgery at 6-18 mo before toilet training and knowledge of abnormality
      • do not circumcise - use foreskin to cover opening
    • creation of normal urethral meatus and glans penis
    • straight penis
    • normal urethra
    • skin covering

    286

    general GU assessment

    • urine characteristics
    • pain, discomfort
    • edema, generalized?
    • apperance of genitalia

    287

    causes of peritonitis

    • collection of blood, body fluids, pus in abdomen (intra-abdominal abscess)
    • peritoneum is a sterile environment that reacts to pathologic stimuli with uniform inflammatory response
      • may be infectious or sterile peritonitis (chemical or mechanical)
    • intra-abdominal sepsis is inflammation of peritoneum r/t pathogenic microorganisms and products
    • typical causes: pelvic inflammatory disease r/t STIs

    288

    hypoxemia

    decreased oxygen in blood

    289

    tolerance

    diminished effectiveness of drug upon repeat administration

    290

    cloaca

    one opening where feces and urine exit

    291

    endotheliopathy of SIRS

    • capillary leak
    • leukocyte infiltration
    • erythema, edema
      • shininess

    when you see these things, SIRS should always be in the back of your mind

    292

    behavioral interventions before sedation procedure

    • assorted visuals
      • toys, books, etc.
    • breathing techniques
    • comfort measures
      • parent, modify environment
      • familiar objects
      • comfort holding 
    • diversional talk

    293

    pediatric medications

    weight based dosing

    greatest error in calcuation, greatest potential for harm

    294

    viral infectious agents

    • measles
    • parvovirus
    • chickenpox

    295

    symptoms of RSV bronchiolitis

    • rhinorrhea with nasal congestion
    • cough - horase, progresses to wet
      • often productive - coughing and swallowing can cause emesis
    • WOB
      • tachypnea, retractions, +/- wheeze, crackles, nasal flaring, grunting, head bobbing, oral breathing
    • +/- temperature (may be hypothermic)
    • decrased activity
    • usually decreased appetite
    • apnea in young infants (

    296

    symptoms of hyperkalemia

    • palpitations
    • weakness
    • arrhythmias

    297

    mild persistent asthma

    • episodes > 2x/week but less than daily
    • night episodes 1-2x / month
    • requires baseline medication

    298

    other protein lab values r/t nutrition

    • transferrin
    • prealbumin
    • retinol-binding protein

    299

    spread of TB

    • airborne
    • cough, sneeze, talking
    • breathing in bacteria

    300

    sedation goals

    • maintain safety
    • minimize physical discomfort
    • AAA - analgesia, anxiolysis, amnesia
    • control behavior/movement
    • return patient to baseline

    301

    S/Sx of Hirschsprungs

    • no meconium for 48 hours
    • FTT
    • constipation Sx are age related

    302

    behavioral presentation of epiglottitis

    • won't swallow
      • hurts
      • can't breathe
    • will drool
    • tripod position

    303

    insensible loss

    normal physiological loss of fluid (respiratory, skin)

    304

    increased HR, RR, BP caused by...

    pain and fear

    305

    what is sepsis?

    • spectrum of systemic, inflammatory responses to infection
    • life-threatening
    • body's response to infection
      • up regulation of cytokines, inflammatory response
      • release of pro-inflammatory and anti-inflammatory mediators into systemic circulation
      • activate procoagulation pathways
      • alter CV function and tissue perfusion

    306

    nursing management of respiratory distress

    • patient position to maximize airway for adequate air flow
    • assess RR and WOB, change in use of accessory muscles
    • monitor VS, LOC
    • monitor oxygen sat 
      • check equipment
    • administer oxygen
    • ensure emergency equipment is available
    • monitor patient for changes

    307

    common UTI bacteria

    • e.coli
    • enterococcus
    • pseudomonas

    308

    diaper rash

    • yeast infection
    • more incidents in hospitals
      • antibiotics, immunosuppressed
      • not sleeping as well, nutrition not as good

    309

    addiction

    psychological syndrome characterized by compulsive drug-seeking behavior

    310

    nursing interventions for lyme disease

    • prevention!
    • oral antibiotics - standard treatment for early-stage disease
      • doxy for over 8 yo
      • amoxicillin for adults, younger children, pregnant/breast-feeding women
      • 14-21 days recommended
    • intravenous - later stage if involves CNS
      • 14-28 days
      • may take time to recover from symptoms
      • usually presents with stroke-like symptoms of paralysis

    311

    cardiovascular effects of unrelieved pain

    • increased peripheral vascular resistance
    • increased myocardial oxygen consumption

    312

    drugs that work on pain transduction

    • local anesthetics
    • capsaicin
    • anticonvulsants
    • NSAIDs
    • aspirin
    • acetaminophen
    • nitrate

    313

    causative organism of TB

    mycobacterium tuberculosis

    314

    osmosis

    the movement of water from areas that have too much water to areas that have less water

    315

    Koplik spots

    white salt granules inside oral mucosa

    316

    reasons for tracheostomy

    • airway issues (stenosis, malacia, web)
      • obstruction
      • abnormal anatomy
    • craniofacial anomalies (Pierre Roban - no chin, can't intubate)
    • vocal cord paralysis
    • respiratory problems
      • premature lungs
      • prolonged respiratory support
    • neurologic
      • unable to protect natural airway
      • neuromuscular disorders/weakness
    • injury

    317

    procedural sedation

    • primary benefits:
      • minimize anxiety/discomfort while reducing undesirable autonomic response to pain
      • help patient thru painless procedure that requires immobility for extended time period
    • excessive sedation/analgesia may result in RR or CV depression, hypoxia and/or cardiac arrest
    • inadquate sedation/analgesia may result in inaccurate/incomplete test or patient injury

    318

    nursing interventions for pertussis

    • ABC: support for apnea, hypoxia, remain with child during coughing, when hypoxic, give oxygen if needed
    • D: hand hygiene, antibiotics - 5 days
      • droplet prectuations until 5 days after antibiotic therapy or until 3 weeks after onset of paroxysmal coughing
    • F: fluids, IV hydration
    • isolation
    • vaccine to unimmunized contacts under 7 yo
      • acellular pertussis
      • Tdap, DTP, DTaP, ADACEL

    319

    common organisms of bacterial tracheitis

    • staph aureus
    • group A strep
    • moraxella catarrhalis
    • haemophilus influenza

    320

    intussusception defined

    • invagination of part of intestine into itself
    • most common abdominal emergency in early childhood (
    • majority of cases are idiopathic
    • common location: ileocecal valve

    321

    N. meningitidis bacterium

    • encapsulated or unencapsulated
      • nearly all invasive are encapsulated or surrounded by polysaccharide capsule
    • 12 sero groups b/c of capsule
      • six cause majority of infections: A, B, C, W135, X, Y
    • incidence highest in children less than 5 and adolescents
    • generally passes through inhalation but can also be nasopharyngeal or through ear canal

    322

    celiac disease presentation

    • ~ 6 mo when they start eating solid food
    • diarrhea, distended abdomen, nutritional issues

    323

    management of asthma

    • identify and minimize exposure to triggers
      • skin testing for allergens
    • education/monitoring for exacerbation symptoms
    • maintain regular activity/exercise
    • compliance w. control meds
    • early management when sx occur
    • asthma action plan
      • tailored to pt and family

    324

    types of infectious agents

    • bacteria
    • viruses
    • fungal infections
    • parasitic infections

    325

    respiratory physiology at 24 weeks

    • pulmonary surfactant produced by Type II pneumocytes
    • betamethasone at 24-25 weeks gestation can accelerate fetal surfactant production

    326

    clinical pathway

    • catarrhal
      • 7-10 days
      • incubation and infectious process starts
    • paroxysmal
      • infectous period lasts 7 weeks or longer
      • whooping cough stage
    • convalescent stage
      • 6 weeks

    327

    children usually acquire TB from...

    • infected adult
    • at-risk populations
      • low income
      • emigration from under-resourced country
      • residence in place of close co-habitation of large numbers

    328

    pain pathophysiology

    • transduction
    • transmission
    • perception
    • modulation

    329

    Glasgow Coma scale overview

    • pediatrics always want a scale that can be used anywhere - different language, w/o equipment, replicable, understandable
    • 15 = perfect
      • awake, alert, speaking, moving
    • 3 categories:
      • eye, verbal, motor
    • goes down by 1 or 2 points in middle of the night (especially children)
      • document time

    330

    oxygen consumption of infant

    • ~ 6ml/kg/min
    • twice that of an adult
    • related to baseline RR
    • don't have as much tidal volume - need to breathe faster

    331

    D5 fluid bolus

    • 1-2 ml/kg
    • up to 3-4 ml/kg
    • dextrose is metabolized quickly, leaving "free water"
      • expands both ICF and ECF
      • other fluids expand only ECF

    332

    intolerance/sensitivity

    • adverse food rxn
    • gradual onset after large ingestion
    • +/- frequency of food ingestion
    • no immune system involvement
    • generally limited to GI
    • causes include:
      • lack of enzymes
      • irritable bowel
      • toxic contaminates

    333

    dehydration caused by:

    • vomiting
    • diarrhea
    • hemorrhage
    • burns
    • NG suctioning
    • drainage loss

    334

    nursing management of child with hypokalemia

    • cardiac
    • replace K+

    335

    assessing pain

    • verbal/self report
      • child's capacity to demonstrate concepts of degree, rank order, estimation, classification
    • parent proxy
    • behavioral indicators
    • individualized NRS (cognitively impaired)
    • physiologic indicators

    336

    characteristics of pediatric airway

    • smaller diameter
    • anterior position
    • floppy epiglottis
    • angled vocal cords
    • narrowest portion is cricoid cartilage
      • funnel shape to the larynx
      • problem with increased secretions
    • small cricothyroid membrane
    • large tongue
    • large occiput
      • causes head to tip forward and airway to close when supine
      • but something under shoulders to open airway
    • large tonsils/adenoids

    337

    Glasgow Coma Scale: motor response

    1. no motor response
    2. extension to pain
    3. flexion to pain
    4. withdrawal from pain
    5. localizing pain
    6. obeys commands

    338

    severe sepsis definition

    sepsis + CV OR respiratory dysfunction OR > 2 other organ dysfunctions

    339

    fontanelles in systematic assessment

    full, sunken, or flat - we want them flat

    full indicates increased intracranial pressure from: infection, trauma, hydrocephalus (increased spinal fluid)

    340

    classic presentation of measles

    • consolidated maculopapular rash behind ears and then spreads to face
    • eyes swollen shut from drainage
    • irritable, febrile

    341

    focused GI/GU assessment for pyloric stenosis

    • typical presentation of initially nonbloody, always nonbilious vomiting at 4-8 weeks of age
    • vomiting intensity increases towards projectile vomiting
    • prolonged diagnosis can lead to
      • dehydration, malnutrition
      • poor weight gain
      • metabolic alterations
      • lethargy
    • parents report trying different formulas b/c of intolerance 

    342

    definition of meningococcal infections

    • common outcome is meningitis
    • when caused by Neisseria meningitidis
      • meningococcal meningitis
    • spread via inhalation
    • incubation: 2-10 days

    343

    D: drugs and disabilities

    falls, adverse drug reactions, infections, etc.

    344

    CF diagnostic testing

    • state newborn screening
    • genetic testing
    • sweat chloride testing
      • definitive if > 60 mmol/L
      • suspect if 40-60 mmol/L

    345

    definition of measles (rubeola)

    • highly contagious
    • virus in paramyxovirus family
    • normally passed thru direct contact and thru air
    • virus infects mucous membranes then spreads throughout body
    • human disease - does not occur in animals

    346

    diagnosis of esophageal atresia/TEF

    • can be diagnosed before birth
      • mom will develop a lot of amniotic fluid because the baby can't swallow it
    • otherwise, the 3 C's
      • coughing
      • choking
      • cyanosis

    347

    calculating pediatric bladder capacity

    age in years + 2 (oz)

    348

    pre-operative nursing considerations for cleft lip/palate

    • reduce risk of aspiration
    • assess for respiratory distress
    • ensure adequate nutrition and growth
    • provide feeding training for parents

    349

    morphine

    • prototype opioid
    • mimics endogenous endomorphins
    • peaks 20 min
    • duration 2-4 hours
    • half life 2 hours

    350

    clinical pathway of lyme disease

    • symptoms vary
    • skin, joints, nervous system most often affected
    • early signs
      • rash - not necessarily bulls-eye
        • erythema migrans
      • flu-like symptoms
    • later signs
      • joint pain
      • neurological problems

    351

    asthma under 2 yo

    • generally don't label a child under 2 yo with asthma
      • call it "reactive airways"
    • b/c some belief that symptomatology is r/t viral illnesses
      • if they make it to the hospital or ICU with these symptoms, then it is labeled asthma

    352

    testicular torsion

    • usually from trauma
    • one of few surgical emergencies in adolescent boys
    • issues with fertility and cosmetic appearance
    • need surgery within 6-8 hours

    353

    prepare for sedation procedure

    • sedation plan
      • what is required
      • length
      • painful?
    • consider development and hx of child
    • work with parents
    • prepare - include expected sensations

    354

    RSV bronchiolitis education

    • highly contagious, incubation period 2-8 days
      • handwashing
      • avoid sick contacts
    • re-infection is common
    • acute illness course is 3-7 days
    • cough and  +/- wheeze may persist
    • full recovery can take 3 weeks

    355

    TB medications

    • isoniazid
    • rifampin
    • pyrazinamide
    • ethanmbutol
    • daily, minimum 6 mo

    356

    patient assessment/physical exam for sepsis

    • neurologic
      • altered mental status (irritable vs lethargy) - what is their norm?
      • extreme anxiety
    • respiratory
      • tachypnea
      • increased work of breathing (WOB)
    • CV
      • tachycardia
      • perfusion (start out and work in - different peripherally than centrally?)
      • development of / enhanced murmur
      • warm vs cold hypotension
    • renal funtion/output
    • skin

    357

    drugs that work on pain perception

    • opioids
    • alpha2-agonists
    • TCAs
    • SSRIs
    • SNRIs

    358

    common CF medications

    • inhaled bronchodilators
    • inhaled steroids
    • corticosteroids
    • antibiotics (PO, IV, inhaled)
    • pancreatic enzymes
    • multivitamins (ADEK)
    • lactulose
    • ursodeoxycholate (ursodiol)

    359

    facilitated diffusion

    movement of solutes from areas of high concentration to areas of low concentration, but the molecules need a carrier to help with diffusion

    360

    CF respiratory care

    • exercise
      • hard if depressed
      • results in muscle atrophy
    • aggressive chest physiotherapy
    • intermitten spirometry
    • immunizations
      • dysfunctioning immune system from antibiotics
      • will they get sicker with a live virus?

    361

    GI/GU focused assessment for peritonitis r/t PID

    • uterine tenderness or
    • adnexal tenderness or
    • cervical motion tenderness

    362

    osmolarity

    • concentration of solutes outside body
    • ex: IVF solute measurements

    363

    sepsis definition

    SIRS in the presence of OR as a result of suspected or documented infection

    364

    warm shock

    extremities really warm but hypotensive

    365

    developmental effects of unrelieved pain

    • change in responses to pain
    • altered temperatures
    • possible altered development of pain system in infants

    366

    gastroschisis defined

    intestines and possibly other organs located outside of abdomen

    367

    patients at risk for pediatric sepsis

    • premature/VLBW
    • neonates
    • compromised immune status
      • HIV
      • oncologic processes/malignancy
      • transplant
      • cytotoxic, immunosuppressant agents
      • chromosomal disease
        • metabolism is often very different and not completely understood
        • don't know how system will react to an insult
    • higher index of suspicion in these patients

    368

    FLACC

    • face
    • legs
    • activity
    • cry
    • consolability

    369

    effects of unrelieved pain on quality of life

    • sleeplessness, anxiety, fear, hopelessness
    • increased thoughts of suicide

    370

    symptoms of hypokalemia

    • neurological
    • weakness
    • arrhythmias

    371

    renal output and sepsis

    • making good urine?
    • .5-1 ml/kl/hour in older children and adolescents
    • 1-2 ml/kl/hour in infants and young children
    • blow flow to kidneys good enough to keep making urine?

    372

    diagnosing pertussis

    • gold standard: nasopharyngeal culture
      • can diagnose during prodromal
      • takes 5 days to come back
      • do we treat during prodromal?
    • do not underestimate diagnostic skills
      • coughing, cyanotic, and post cough emesis - probably won't wait for the culture

    373

    ventilation of alveolar

    • primarily dependent on RR
    • slow breathing = less ventilation AND oxygenation

    374

    pain in infants vs adults

    • infants experience greater pain intensity w. same stimulus
    • pain modifies brain
      • volumetric losses in cortex, corpus callosum, hippocampus, basal ganglia
      • lower cognitive scores
      • increased behavior disorders
    • nerve sheaths are still myelinating - dissemination of the stimuli

    375

    iron status r/t nutrition

    • Hgb/Hct
      • decrease in late Fe deficiency
      • can decrease for other reasons
    • ferritin
      • most sensitive - correlates to w/ total body stores
    • erythrocyte protoporphyrin, serum fe/total binding capacity transferring - dependent on Fe stores

    376

    treatment of Hirschsprung's

    • bowel management
    • surgical removal
    • temporary colostomy

    377

    declining respiratory system in a child leads to...

    EVERYTHING compensates, whereas in adults, it begins with just the heart or just one system

    378

    identification of Hirschsprung's disease

    hypagque barium enema - without innervation, contrast media won't move

    379

    viral pneumonia

    • no antibiotics
    • protein coat
    • smaller than bacteria
    • viral organism needs host to survive
    • invades cells
      • redirects to produce more virus, increasing viral load
    • improves in 1-3 weeks

    380

    increased HR caused by...

    • pain
    • fear
    • infection
    • dehydration

    381

    causes of UTI

    • urinary stasis
    • vesicoureteral reflex
    • abuse

    382

    celiac disease defined

    intolerance to wheat and rye that causes changes in intestinal mucosa which leads to malabsorption

    familial, inborn error of metabolism 

    383

    fluids that can be bolused

    • 0.9% saline (NaCl) aka NS (normal saline) aka NSS (normal saline solution)
    • lactated ringers (LR) - lactate
    • D5W - dextrose 5%

    osmolarity is around 300 (same as body)

    384

    nursing management of hypernatremia

    • ABCs and daily weights
    • assess skin
    • IV replacement (if diarrhea/vomitiing), strict I/O
    • labs for electrolytes, BUN, creatinine
    • fluids, specific gravity
    • support mom with breastfeeding

    385

    UTI defined

    clean catch yields > 100,000 units

    386

    normal water movement in and out of cell...

    brings nutrients (glucose) and takes away wastes

    387

    what to do when something is going to hurt?

    advocate - make it hurt as little as possible

    apologize to the child afterwards

    388

    fungus associated with sepsis

    candida

    389

    assessing for dehydration

    • fontanelles and neuro
    • vital signs and cap refill
    • mucous membranes and thirst
    • extremities
    • urine output, diarrhea, specific gravity

    390

    imperforate anus defined

    • several variations of incomplete anal opening
      • pouch that does not connect with colon
      • openings to other structures
        • urethra, bladder, base of penis/scrotum/vagina
      • narrowing of anus or no anus
    • VACTER syndrome sometimes

    391

    urine output

    • infant: 2 ml/kg/hr
    • child: 1-2 ml/kg/hr
    • adolescent: .5-1 ml/kg/hr

    minimum output - signifies hydration is adequate

    small reduction in urine volume could indicate significant compromise in renal perfusion or function

    392

    causes of intussusception

    • recent upper respiratory illness
    • recent diarrheal illness
    • CF
    • chronic indwelling GI tubes

    393

    first places that present as edematous r/t fluid overload

    face and genitalia 

    394

    protein hydrolysate formula

    • partially hydrolyzed
      • allergies (IgE mediated)
      • severe GERD
      • prevention of atopic dermatitis
    • ex: carnation good start, good start gentle, peptamen Jr

    395

    esophageal atresia / tracheoesophageal fistula (TEF) defined

    • congenitally interrupted esophagus
    • one or more fistulas may be present between malformed esophagus and trachea
    • surgical emergency
    • failure of esophagus to develop as continuous tube

    396

    nursing assessment of HUS

    • severe gastroenteritis with bloody diarrhea
    • upper respiratory infection or UTI before HUS
    • HTN, pallor, bruising, oliguria

    397

    safety measures before sedation

    • IV access
    • monitoring
      • oxygen, EKG/BP
      • ventilation
    • equipment
      • suction, oxygen
      • airway, bag-valve mask
    • antagonists
      • flumazenil (for benzos)
      • nalaxone 

    398

    ideal pain instrument

    • developmentally appropriate
    • easy to use and quickly understood by patients
    • easily scored and recorded
    • available in various languages
    • reasonable validity and reliability

    399

    weight gain in healthy infants

    • 20-30 g/day first 6 mo; double birthweight by 5-6 mo
    • 10-20 g/day 6-12 mo: triple birthweight by 12 mo
    • 8-10 g/day > 1 yr

    400

    management of pediatric sepsis

    • airway - oxygen therapy
    • fluid - may progress to inotropic support
    • antibiotics (within 1 hr if suspicion)
      • usually vanco + cyclosporin
      • monitor urine output b/c vanco is nephrotoxic
      • ceftriaxone in ED
    • blood
      • trauma? bleeding? low hgb (iron carrying capactity)?
      • part of fluid therapy
    • supportive measures - imaging studies
    • nutrition
      • feed as quickly as possible
      • use working GI system if they have one

    401

    lactose-free milk

    • lactase diminished condition
    • intolerance of cow's milk/soy based formulas
    • ~20 cal/oz
    • ex: similac sensitive; enfamil gentlease

    402

    sepsis and tissue hypoxia

    bad oxygen exchange in tissues

    403

    FLACC scoring

    A image thumb
    404

    pain history

    • how does child typically express pain
    • previous experience with pain
    • copes with pain
    • works best to relieve pain
    • parent and child preferences

    405

    symptoms of upper vs lower airway illnesses

    • upper
      • congestion
      • rhinorrhea
      • cough
      • poor appetite
      • +/- febrile
    • lower
      • SOB
      • increased WOB, tachypnea
      • +/- wheezing and retractions
      • febrile

    406

    isotonic IVF

    • osmolarity ~ 300 mOsm
    • no fluid shift between ICF/ECF b/c of equal concentrations of solutes and water
    • 0.9% NaCl or lactated ringers

    407

    what is SIRS?

    • Systemic Inflammatory Response Syndrome
    • inflammatory feedback to illness/injury
    • local rxn at site of injury OR systemic response to infection
    • up-regulation of innate and adaptive immunity of natural physiology
    • clinical manifestations
      • tissue edema
      • hypoperfusion
      • cell proliferation

    408

    TB precautions

    • airborne droplet
    • direct contact w/ infected fluids
      • inhaled organism (bacilli) goes directly to alveoli
        • breaks open in lung and multiplies
        • surrouned and isoalted by macrophages
      • 3 mo for cellular response
        • positive TB skin test
          • 3% false positive
          • partially positive - check w/ CXR

    409

    TB nursing care

    • PPD test
    • if active:
      • airbone TB isolation - N95 mask
      • monitor respiratory status
      • monitor hydration
      • med admin
      • report to public health department
    • isolate family
    • hand hygiene
    • negative pressure room isolation
    • long term follow up with infectious disease and pulmonary
    • follow nutritional status

    410

    clinical pathway of meningococcemia

    • spread via respiratory secretions
    • abrupt onset of fever, chills, malaise, vomiting
    • neurologic signs:
      • decreased mental status, seizures, coma
      • bulging fontaneles, severe headache, stiff neck
      • photophobia, nuchal rigidity
    • maculopaular rash - then petechial and maybe to purpura and sepsis
    • septic shock is a complication

    411

    pancreatitis and sepsis

    • produces insulin and glucagon normally
    • can't regulate glucose homeostasis
    • can't fight infection, digest food, hormone regulation

    412

    classic presentation of pertussis

    • uncontrollable, violent coughing that makes it hard to breathe
    • after coughing fits, someone with pertussis needs to take deep breathings ("whooping")
    • commonly affects infants and young children
      • can be fatal, especially less than 1 yo
      • less than 6 mo have an absent cough (not enough intercostal muscles)
        • apnea is a symptom
        • not as worried once they walk and develop intercostal muscles
    • 100 day cough
      • 3-3.5 months to resolve once symptoms develop

    413

    Hirschsprung's disease defined

    • congenital aganglionic megacolon
    • absence of nerves in part of intestine
    • usually identified in first two months of life
      • less severe cases later in childhood

    414

    pertussis and antibiotics

    • antibiotics within first 1-2 days of catarrhal (may not know they have it) can help eliminate symptoms
    • once they start paroxysmal coughing, antibiotics won't help child
      • but can help people they interact with

    415

    symptoms of impending respiratory failure

    • increased severity of WOB 
      • accessory muscles
    • dyspnea
    • change in LOC
    • stupor
    • obtunded - LOC

    416

    nursing interventions with measles

    • antipyretics; no antibiotics unless secondary infection
    • IV for hydration; assess nutrition
    • negative air pressure
    • isolation precautions for 3 days 
      • until fever is gone for 3 days, rash completely gone, cleared by infectious disease doctor and pediatrician
      • depends on child and if they have immunocompromised children in their classroom
    • cool mist vaporizer; cool liquid frequently
    • suction gently
    • vaccine: MMR 12 mo and 4-6 yo
    • required to call public health department 

    417

    kids are different

    • cognition and communication
    • safety issues
    • physiological

    418

    nursing assessment of hernia

    • observation
    • lump, bulge
    • crying, straining
    • lights used for mass vs. fluid

    419

    family-centered care

    • mutually beneficial partnership between patients, families, healthcare team
    • formal method of delivering best care
    • ensure health and well being of patients of all ages
    • families are valued members of Health Care Team
    • supports key principles
      • dignity and respect
      • information sharing
      • participation and collaboration
      • care coordination and access to care

    420

    common maintenance IVFs in pediatrics

    • D5W 0.45% NaCl
      • with or without KCL
    • less common
      • D5W 0.9% NaCl with or without KCL
    • all IVF rates, except TPN, based on weight (4,2,1 rule) unless weight is greater than 50 kg

    421

    infant/toddler fluid volume distribution

    • 1/2 body water is ECF
    • 1st three months, 70-80% of weight is water
    • ECF ratios match adults by 2-3 yo
    • before age 3, 60% body weight is water

    422

    drugs that work on pain transmission

    • peripherally
      • local anesthetics
      • opioids
    • dorsal root ganglion
      • local anesthetics
      • alpha2-agonists

    423

    hypernatremia/hyperotnic dehydration

    • greater loss of water than sodium
    • serum sodium is elevated
    • side effect of high sodium r/t dehydration = seizures

    424

    sensible loss

    normal physiological loss due to urine and stool

    425

    hypernatremic or hypotonic dehydration

    • serum sodium > 150 = greater loss of water than sodium
    • hormonal - peeing a lot

    426

    vicious circle of shock

    probably starts with vasodilation and increased permeability, but who knows?

    A image thumb
    427

    respiratory effects of malnutrition

    • derease diaphragmatic fxn
    • response to hypoxia is blunted
      • not blunted for hypercapnia 

    428

    B: Brain

    differences between adults and children

    • head circumference
    • fontanelles
    • spinal cord
    • measurements, scoring
    • reflexes

    429

    nursing assessment for pertussis: gastrointestinal

    • nutrition
    • wet diapers? how often?
    • how much eating, how frequently?
    • emesis after feeds, or some feeds?
    • NG tube if they can't eat well
      • may vomit after coughing
      • can complicate breathing process
      • maintains hydration and prevents hypernatremia or hyperkalemia (seizures and cardiac arrhythmia)

    430

    immune effects of malnutrition

    • altered cell mediated immunity
    • IgG repsonse is normal
    • IgA may increase 

    431

    cold shock

    extremities really cold but hypotensive

    432

    UTIs in less than 1 yo

    increased risk for renal scarring

    433

    faces of pain

    A image thumb
    434

    nursing management of fluid volume overload

    • ABCs and daily weights
    • skin breakdown (turn every 2 hours)
    • labs
    • fluid restriction?
    • specific gravity?