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Flashcards in PEDI EXAM 2 Deck (213):
1

• are prone to dehydration easier then adults, but can bounce back quicker

KIDS

2

the younger the child, the greater the ___ and the lower the ____.

ECF & ICF

3

is lost from the body more easily

ECF

4

is their fluid reserve

ICF

5

o Infant’s ____ is a big proportion in relation to their entire body

head

6

In relation to height & weight, children under about 2 years old have a greater

body surface area

7

kids immature kidneys=

unable to conserve or excrete water efficiently

(can dehydrate rather quickly)

8

metabolic rate is higher in?

young children

9

Which of the following would you do to assess a 5 month old for dehydration?

assess the fontanel

10

3 types of dehydration

isotonic
hypotonic
hypertonic

11

♣ Serum sodium level usually normal

isotonic

12

isotonic dehydration causes?

vomiting & diarrhea

13

♣ Losing more sodium than water serum sodium low

hypotonic dehydration

14

causes of hypotonic dehydration

severe & prolonged vomiting and diarrhea, burns, renal dx

15

♣ Losing more water than sodium serum sodium high

hypertonic dehydration

16

causes of hypertonic dehydration

♣ diabetes Insipidus,
highly concentrated tube feedings or iv fluids, tube feedings without adequate water intake, or improper formula mixture

17

is LOC changed in mild dehydration?

NO

18

severe dehydration LOC?

confusion, irritable, fatigue

19

fontanels and dehydration

♣ start out normal with mild dehydration, sunken appearance as dehydration progresses

20

• Measuring output for children in diapers:

o Weigh dry diaper THEN weigh each subsequent wet diaper without wipes

21

1 gram =

o 1 mL fluid

22

• Normal output for children

0.5ml/kg/hr

23

normal output for infants

2ml/kg/hr

24

Assess skin turgor where

o (abdomen, chest, upper thigh)

25

VITAL SIGNS OF DEHYDRATION

BP decreases

HR decreases

RR increases

26

If they lost a kg, they lost how much fluid

1L

27

Oral Rehydration solutions

pedialyte
juice or colas

28

do not use what type of fluid?

diet colas

29

volume of fluids?

1-3 tsp of fluid every 10-15 min

30

fluids while vomiting?

gradually increase amy as child stops vomiting

31

diarrhea and fluids?

continue with age-appropriate diet

32

when to seek medical attention with oral rehydration?

if child is not getting better or condition worsens after 4 hours of oral rehydration therapy

33

start with what type of IV fluids?

isotonic to replenish sodium (LR)

34

then switch to what IV fluids?

o ¼ Normal Saline’s or 1/2NS

35

arm IV sites for kids?

start lower and work up to AC

36

what gauges used for angiocaths?

23,24,25,27

37

how often to monitor IV site for kids?

every hour

38

use what size solution for kids?

250 or 500 instead of 1000

39

used instead of what you would use for adult for IV fluids

microdrip tubing (60gtt/ml)

40

do you rotate IV site every 72 hours for kids?

NO

41

Child is retaining sodium & water

fluid volume excess

42

causes of fluid volume excess

o Conditions of excessive aldosterone secretion: Adrenal tumors

o CHF, Cirrhosis of liver, Chronic renal failure, renal failure,

o Long-term steroid usage

Overload of IV solutions

43

o Weight gain of ______ a day is usually due to fluid excess

0.5 kg or 1lb

44

♣ 0.5kg of weight gain over the night =

500ml saline retention

45

lung sounds with excess fluid

crackles

46

jugular vein distention may not be evident in infants so check where for fluid vol. excess?

abdomen

47

give cold or warm fluids for fluid vol. excess?

cold in insulated up.

48

normal sodium level

134-143

49

o Most common sodium imbalance in kids

• HYPONATREMIA

50

• HYPONATREMIA level

below 134/135

51

causes of HYPONATREMIA

too dilute formula

excessive swallowing of pool water

use of diuretics

V&D

52

manifestations of hyponatrema

• Decreased LOC, become lethargic, confused
• N/V
• Headache
• Muscle weakness
• Agitation
• May have seizures
• Eventually cardiac arrest

53

cells in hyponatremia

SWELL

54

• HYPERNATREMIA levels

above 135

55

o Losing more Na than water or gaining more Na than water

• HYPERNATREMIA

56

ex of HYPERNATREMIA

eating Chinese food

57

causes of HYPERNATREMIA


♣ Limited or no access to water

♣ Inability to communicate thirst

♣ Not diluting infant formula enough

♣ Inadequate amount of breast milk

♣ Diarrhea / vomiting

♣ Excessive sweating without fluid replacement

♣ Tube feeding with no water intake

58

manifestations of hypernatremia

thirsty

decreased urine output

Confusion,

lethargy,

possible seizures

59

cells in hypernatremia

SHRINK

60

normal potassium levels

3,7-5.0

61

hypokalemia level

below 3.7

62

causes of hypokalemia

V & D
excessive stopping with bulimia
NG suction
eating lg. amt of black licorice

certain meds:
(potassium depleting diuretics, laxatives)

63

o MANIFESTATIONS of hypokalemia

♣ Involve muscle responsiveness

♣ constipation,

♣ abdominal distention, can lead to paralytic ileus

♣ Skeletal muscle weakness: flaccid to paralysis

Respiratory & Cardiac muscles may be impaired:

64

hyperkalemia levels

5.5

65

causes of hyperkalemia

renal insufficiency
IV push
blood infusions
crush injuries
sickle-cell anemia
DM
Diarrhea

66

normal calcium level

4.36-5.36

67

we need vit. ___ for calcium absorption

D

68

hypocalcemia levels

below 4.3

69

causes of hypocalcemia

♣ General malnutrition
♣ Low Vit. D intake
♣ Calcium dieting
♣ Chronic diarrhea

70

manifestations of hypocalcemia

Increased muscular excitability


(cramping, spasms, tetany, twitching, tingling in the fingers & around mouth)

71

hypercalcemia levels

above 5.3

72

causes of hypercalcemia

♣ Increased intake of calcium or increased absorption
♣ Mega-doses of Vit D & A
♣ Ingesting large amounts of Ca+ foods along with antacids
♣ Too much calcium in the TPN
♣ Prolonged immobilization
♣ Medications—thiazide diuretics & lithium
♣ Some malignancies such as leukemia

73

pH levels

7.27-7.49

74

PCO2 levels

32-48

75

HCO3 levels

18-25

76

PO2 levels

80-108

77

how do we remove acid

breathing
peeing
puking

78

if we're vomiting we're loosing

acid

79

urinating is loosing

acid

80

diarrhea is loosing

alkaline or base

81

1. What is the fluid maintenance needs for a child weighing 33lbs?

1250

82

1. The nurse notes the following changes in the past 24 hours in a child with heart failure. Which finding is the most significant in assessing the child for fluid volume overload?

weight gain of .4kg

83

1. Following a motor vehicle accident and successful cardiopulmonary resuscitation, arterial blood gases are drawn from a 13-year-old patient. The nurse utilizes the results of the test to identify the patients:

a. Acid-base balance

84

proteins that work against antigens

antibodies

85

the foreign substances that trigger the immune response

antigens

86

is composed of the defenses present at birth, such as intact skin,
body pH, natural antibodies from the mother, and inflammatory and phagocytic properties

natural immunity

87

consists of humoral (antibody mediated) and cell mediated
immunity and is not fully developed until a child is about 6 years of age

acquired immunity

88

: 5 different types of proteins that antibodies are a type of (IgM, IgG,
IgA, IgD, IgE)

immunoglobulins

89

3 day process when a child is first exposed to an antigen,
the B-lymphocyte system begins to produce antibodies that react specifically to that antigen

primary immune response

90

subsequent encounters with the antigen trigger memory
cells within 24 hours

secondary immune response

91

proteins that carry messages for immune system function

cytokines

92

a series of immunologic reactions in response to transplanted
cells

graft-versus-host disease

93

a state of decreased responsiveness of the immune system, can
occur to varying degrees in response to any number of events

imunodeficiency

94

: those caused by normally nonpathogenic organisms in persons
who lack normal immunity

opportunistic infections

95

: from their mothers transplacentally or during delivery

vertical transmission

96

pathologic conditions in which the body directs the immune
response against self – identifying “self” as “non-self”

autoimmune disorders

97

is an abnormal or altered reaction to an antigen

allergy

98

antigens responsible for clinical manifestations of allergy

allergens

99

: an overreaction of the immune system, is responsible for
allergic reactions


hypersensitivity response

100

1. The nurse is caring for child who is experiencing respiratory difficulty following the administration of a medication. What drug should the nurse initially plan to administer to this child if indicated?

give epi

101

1. When providing dietary guidance to a child with spina-bifida with a known allergy to latex, the nurse should make the suggestion that which foods be avoided?

kiwi fruit

bananas

avocados

102

ϖ A 3-year-old child is admitted to the hospital to rule out an infection. Which diagnostic test is likely to differentiate an infection from an allergic response?

o C. White blood cell count with differential

103

neutrophil

infection

104

esosinophil

allergic

105

immune system isn't developed until

6 years old

106

IgG

crosses the placenta

107

• Protect us from pathogens, infections, viruses, bacteria, etc.

immune system

108

o Good guys; proteins that attack antigens

antibodies

109

bad guys

antigens

110

types of WBCs

neutrophils
eosinophils
basophils

111

increase with infection/inflammation

neutrophils

112

increase with allergies

eosinophil's

113

increase with inflammation

basophils

114

first immunoglobulin produced to primary immune response

IgM

115

(crosses the placenta; reacts to viruses and bacteria)

IgA

116

o (In rhogam, has to do with RH neg/pos for baby)

IgD

117

o (Plays a role with allergic responses; test this immunoglobulin when testing for allergies)

IgE

118

type of immunity you are (born with)

natural immunity

119

subsequent exposures to antigens

secondary immune response

120

T cells

fight viruses

121

B cells

produce antibodies

122

ϖ A child is diagnosed with severe combined immunodeficiency. The nurse considers dietary instruction to parents effective if which one of the following foods are included in the child’s diet?

o B. Chicken Fingers and milkshake

123

o Secondary immunodeficiency
o Targets and destroys T cells

HIV

124

children common cause of HIV

mom breastfeeding or birth

125

teens common cause of HIV

sex & drugs

126

symptoms of HIV in neonates

asymptomatic

127

specific symptoms

thrush

weight loss

FTT

NG pneumonia

128

med therapy for HIV

prophylaxis

HAART

129

is there a cure for HIV?

NOOOOO

130

HIV pneumonia in children. check deep breathing by?

blow balloons

131

o Chronic inflammatory autoimmune disease
o Multi organ involvement

SLE

132

gradual SLE

abd. pain

headache

133

acute SLE

arthritis like symptoms

134

sx of sle

Butterfly rash
fever
joint pain and swelling
periods of exacerbation

135

periods of exacerbation:

triggered by stress (school, pressure)

URT infection

sun exposure

136

what drugs to avoid with lupus?

sulfa drugs

137

what does prednisone cause with SLE?

weight gain

more susceptible to infection

138

ϖ A child is diagnosed with lupus. Which nursing diagnosis is highest in priority?

pain (chronic)

139

o Doesn’t show up in blood work until 7 y/o
o Diagnosed before 16 y/o commonly at 1-3 years
o More common in girls then boys

juvenile idiopathic arthritis

140

juvenile idiopathic arthritis symptoms

♣ Pain
♣ Swelling in joints
♣ Not wanting to get up and move a lot
♣ Effect single or multiple joints
♣ Systemic = joints and affects organs
♣ Don’t know cause just that its autoimmune

141

treatment goal for juvenile idiopathic arthritis

manage pain/inflammation

142

best exercise for juvenile idiopathic arthritis

swimming

143

at risk children for latex allergy

child with multiple surgeries

144

latex allergies are commonly seen with

spine abifida

145

latex allergy reactions

itching
SOB
anaphylaxis

146

at birth skin is?

thin

little SubQ fat

looses heat rapidly

increased chemical absorption through skin

high water content making more susceptible to bacteria

147

adolescent skin is?

skin thickens

more resistent to bacteria

eccrine (no odor) sweat glands achieve full function

apocrine (odor) sweat glands mature

melanin at adult level serves as shield against UV rays and give color

148

♣ Dried residue of serum, pus, or blood

impetigo

crust

149

♣ Thin flake of exfoliated epidermis
♣ Dandruff, psoriasis

scale

150

♣ Thickening of skin with increased visibility of normal skin furrows
♣ Eczema

o Lichenification

151

♣ Replacement of destroyed tissue, fibrous tissue usually from surgical incision

scar

152

♣ Over development of hypertrophy of scar that extends beyond wound edge and above skin line due to excess collagen following trauma

keloid

153

♣ Abrasion or scratch mark
♣ Scratched insect bite

excoriation

154

♣ Loss of superficial epidermis, moist but does not bleed

fissure

155

♣ Deeper loss of skin surface
♣ Bleeding or scarring can occur

ulcer

156

♣ Plug of sebaceous and keratin material in hair follicle opening
♣ acne

comedone

157

o
♣ Narrow raised channel caused by parasite
scabies

burrow

158

stages of healing

inflammation
reconstruction
maturation

159

broad term for skin changes due to varying causes

dermatitis

160

AKA eczema

atopic dermatitis

161

• Chronic relapsing inflammatory skin disorder with intense itching
• Asthma and food allergies
• Cause: unknown

atopic dermatitis

162

triggers for atopic dermatitis

♣ House mites, animal dander, pollen, mold, cockroaches, food allergies, irritants such as soap, detergent, lotion, chemical, hormonal changes and stress

163

♣ Red patches that itch with exudate and crusts
♣ Seen on the:
• Face
• Neck
• AC area
• Behind their knees
• In adolescents you may see if on eyelids, ear lobes, fingertips and toes

acute atopic dermatitis

164

♣ Skin is darkened and thickened
♣ Excoriation, dryness, and scaling

chronic atopic dermatitis

165

when does atopic dermatitis worsen?

cold & dry weather

166

• Skin inflammation caused by direct contact of skin with allergen/irritant

contact dermatitis

167

irritants for contact dermatitis

o Soap, detergents, fabric softeners, bleaches, lotions, urine or stools

Sweat/friction enhance skin damage

168

manifestations of contact dermatitis

o Rash develops within a few hours of contact

o Redness, erythema, pruritus, edema, vesicles or bulla that rupture, crust/ooze

169

s/s are seen when for contact dermatitis?

12-24 hours after exposure & peak at 3-5 days

170

o rash can last ____ weeks after the treatment and is only present on areas that have come in contact with the irritant

3-4

171

tx for Contact dermatitis

o remove irritant & avoid it in the future
o calamine lotion
o cool compression
o oatmeal baths
o aluminum acetate
o burrows solution
o antihistamines to help relieve the itching
o topical corticosteroids if it is a small area; can’t put on any open lesions
o Oral corticosteroids for 7-10 days then taper dose for 7-10 days
o Educate parents how to apply medications/take medications and make sure they take them as directed

172

• Primary reaction to urine, feces, moisture or friction
• Secondary infection with candida albicans (yeast) common complication

diaper dermatitis

173

diaper dermatitis can develop to?

yeast infection

174

• Manifestations of diaper dermatitis:

o Raw, moist, red, weeping macules and papules of the skin
o Will be present on the areas in contact with the diaper

♣ Perineum
♣ Genitals
♣ Buttocks
♣ Skinfolds are spared

175

o Manifestations of candida albicans:

♣ rash has a bright red beefy plaques with sharp margins
♣ white areas
♣ Needs and antifungal – nystatin

176

tx of diaper dermatitis

o Apply a protective barrier with zinc oxide in it such as Boudreaux’s butt paste zinc oxide
o Leave rash exposed to help heal
o If also have yeast, apply Nystatin, Nystatin first then barrier cream

177

• Recurrent inflammatory skin condition caused by overgrowth of Malassezia furfur yeast
• Hormones are a possible influence

seborrheic dermatitis

178

s/s of seborrheic dermatitis

o Pruritus and a mildly erythematous, adherent waxy scaling of the scalp (or “dandruff”).
o Yellow-red patches with greasy scaling may be present, typically on the scalp and nasolabial folds on the face, behind the ears, on the upper chest, and sometimes on the intertriginous areas (skinfolds of the neck, axillae, antecubital fossa)
o Itching is less intense than in atopic dermatitis

179

• treatment of cradle cap:

♣ daily shampooing with baby shampoo for cradle cap
♣ medicated shampoo (need doctor permission)
♣ emollient (can use baby oil) for 20 min to soften scales then softly remove scales by brushing with fingertips, baby brush, toothbrush, etc. and then rinse the hair

180

tx of lesions on the body:

♣ head and shoulders dandruff shampoo or selsun blue
♣ continue several days after the rash is gone
♣ topical corticosteroids on face (not on eyes)
♣ teach parents to wash hair with each bath

181

o Chronic inflammatory disorder of pilosebaceous hair follicles located on the face and the trunk
o Most common skin disorder of pediatric patients

acne

182

acne is triggered by:

♣ androgen production at puberty
♣ oil based cosmetics
♣ friction from hairbands
♣ helmets
♣ hats
♣ menstrual cycle
♣ over production of sebum

183

tx of acne

retin-a
benzoyl peroxide
antibiotics
oral contraceptives
accutane

184

#1 concern with burns

airway

185

types of burns

thermal
chemical
electrical radioactive

186

Burn severity determined by

depth, percentage of body surface area (BSA)

187

1st degree burns

redness

188

2nd degree burns

blisters; subQ involved

189

3rd degree burn?

underlying tissues involved

190

is considered a major burn

involvement of the face, eyes, ears, hand, feet, perineum,

burns complicated by inhalation injury

191

thermal burns need to be reassessed ____ after to assess extent of injury

24-48

192

tx of minor burns

topical antibiotic--bacitracin

193

fluid moves out of vascular system and into interstitial system (3rd spacing) with which type of burn

major burn

194

3rd spacing can result in

hypovolemic shock

195

pressure garments may be worn over the area which helps to ?

reduce scarring and contractures

196

o Cause: group A beta- hemolytic strep and staph aureus
o Highly contagious
o Often seen around the mouth, hands, neck and extremities

impetigo

197

impetigo results from a minor skin injury such as:

insect bite
dermatitis
a child rubbing or picking their nose

198

impetigo spread by?

direct contact

199

manifestations of impetigo

♣ Red macules become vesicles – easily rupture becoming moist erosions – dries making a honey colored crust. Golden crust

200

tx of impetigo

isolate from other children
don't share any linens
systemic antibiotics
topical antibiotics

201

o superficial inflammation of pilosebaceous follicle from infection, trauma, irritation or inadequately chlorinated pool or hot tub
o Tenderness localized swelling, dome-shaped yellowish pustules and red papules with pain, pruritus, local swelling.
o Caused by staph and pseudomonas
o Common in children and teens because increased sweat production

folliculitis

202

manifestations for folliculitis

♣ Seen in clusters on their face, scalp, trunk and extremities or in the area covered by the bathing suit
♣ Tiny dome-shaped, yellowish pustules and red papules at follicular openings with surrounding erythema
♣ Pain and itching

203

tx of folliculitis

wash with topical antibacterial cleanser

shower immediately after exercise

wear loose cotton clothing

wash bathing suit before wearing it again

204

o Acute inflammation of dermis and underlying connective tissue.
o Often seen on the face and extremities d/t trauma, compromised skin barrier (lesion/surgery) or abscess
o Rapid onset
o Result of trauma, break in skin (impetigo, otitis media, and surgery), insect bite, scratch, etc.
o Staph and strep

cellulitis

205

manifestations of cellulitis

♣ Warm, red, swollen skin; tender,
♣ Edematous around the site
♣ Distinct border
♣ fever, chills, enlargement of and tenderness of lymph nodes, malaise, lymphengitis that can lead to septicemia

206

treatment of cellulitis

♣ They may be in the hospital for IV antibiotics or analgesics especially if it is on the face or for severe cases
♣ Mild cases will be treated with oral antibiotics for 10 days

207

cellulitis get to where if it infects the eye

the brain

208

♣ Pearl-like, flesh colored papule on trunk, axillae, AC area, and behind knees
♣ May have pruritus or become plugged and then they have this cheesy material that can come out of it
o Caused by pox virus
o Spread by direct contact (sexual) or with contaminated clothing

• Molluscum Contagiosum

209

remove what to treat • Molluscum Contagiosum

lessions

210

when does • Molluscum Contagiosum usually resolve?

spontaneously within about 6 months but new lesions may appear over 2-4 years

211

how to reduce transmission of • Molluscum Contagiosum

♣ Avoid public pools, hot tubs, showers because virus is transmitted when skin is wet
♣ Wash daily with fragrant free soaps
May be sent to dermatologist

212

♣ Common warts on any skin surface
♣ Plantar warts on feet that are papules and plaques on bottom of feet painful
♣ Skin-colored, rough, scaly, papules, and nodules on exposed skin surfaces
o Very contagious
o Immune compromised are more susceptible

• Papillomavirus (warts)

213

• Papillomavirus (warts) is transmitted by?

o skin to skin contact, mucous membrane contact, or from surfaces