PEDI EXAM 4 Flashcards Preview

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Flashcards in PEDI EXAM 4 Deck (379):
1

Urinary system maintains balance of ?

fluid and electrolytes

2

urinary system removes

waste products

3

the urinary system is functionally immature until?

puberty

4

the urinary system is composed of the

kidneys, ureters, bladder, and urethra.

5

kidneys fxn through

Function through filtration, reabsorption, and secretion

6

Nephrons

functional unit of the kidney

7

Filtration occurs at

the glomerulus, Bowman's capsule, and the basement membrane.

8

Carry waste fluid from kidneys to bladder

ureters

9

They filter water and wastes across the glomerular capillaries to maintain the body fluid level, electrolyte composition and pH.

nephrons

10

as the child grows the concentration of urine becomes?

more efficient

11

kidneys are less efficient under __ years old

2

12

urinary output per kg of body weight _______ as the child ages because the kidneys become more efficient at concentrating urine

decreases

13

stores urine

bladder

14

bladder capacity in oz is estimated by:

adding 2 to child's age

15

what results in bladder emptying

contraction of detrusor and relaxation of sphincters

16

Excretes urine

urethra

17

Urine excretion occurs around the ___ week of gestation.

12th

18

viral, bacterial, or fungal infection of the lower or upper urinary tract

UTI

19

in UTI organism enters genitourinary tract and ______ from the urethra to the bladder toward the kidney.

ascends

20

UTIs are more common in who in the first 6 months of life

males

21

ND for UTI

Impaired Urinary Elimination

Urinary Retention

Risk for Deficient Fluid Volume

22

Nursing management

Medication administration

Hydration status

Assess renal function

23

Congenital abnormalities involving abnormal location of urethral meatus

hypospadias

epispadias

24

urethral meatus located on ventral surface

hypospadias

25

urethral opening located on dorsal surface

epispadias

26

hypospadias is where?

on the bottom

27

epispadias is where?

on the top

28

what to epispadias and hypospadias result from?

failure of urethral folds to fuse completely over urethral groove

29

epispadias and hypospadias may result in

epispadias and hypospadias result

30

the extrusion of the posterior bladder wall through the lower abdominal wall.

bladder exstrophy

31

nursing management for hypospadias or epispadias

prep teaching

fluid intake and documentation

education

32

what type of education for hypospadias or epispadias

Catheter and stent care
Incision and penis care

33

post op care for hypospadias or epispadias

Protect surgical site

Pain management

Double diapering

34

protects the urinary stent after surgery for hypospadias or epispadias repair. The inner diaper collects stool, and the outer diaper collects urine.

double-diapering

35

abnormalities that result in urine backflow into the kidneys

Obstuctive uropathy and posterior urethral valves

36

what causes Obstuctive uropathy and posterior urethral valves

caused by several congenital lesions

37

nursing management of obstructive uropathy and posterior urethral valves

Monitor urine output
Pain management
Monitor for infection

38

pre and post op care for Obstuctive uropathy and posterior urethral valves

diaper placement and

ostomy care

39

retrograde flow of urine from bladder into ureters

Vesicoureteral reflux

40

reflux prevents complete emptying of bladder, reservoir for bacterial growth

Vesicoureteral reflux

41

undescended testes

Cryptorchidism

42

occurs when one or both testes fail to descend through inguinal canal into scrotum

Cryptorchidism

43

Slow, irreversible reduction in kidney function over months or years

chronic renal failure

44

chronic renal failure is caused by:

congenital defects,

cystic and inherited diseases,

glomerulonephritis,

hereditary disorders, and

acquired disorders

45

common outcome of chronic renal failure

delay in growth and development

46

food in chronic renal failure

high-quality protein diet

small, frequent feedings, attractive presentation

47

nursing management in chronic renal failure

Monitor height and weight

Assess development

Meet nutritional needs

Provide emotional support

48

children with kidney dx have a risk for?

malnutrition

49

Chronic renal failure nutrition:

Small frequent meals high in protein

High calorie intake

Adequate calcium

May require enteral feedings

Complex carbohydrates

Fruits and vegetables low in potassium

50

what to limit with CRF

limit phosphorus

potassium

sodium

51

nephrotic syndrome diet

regular protein

low-sodium diet

52

acute glomerulonephritis diet

low protein

no added salt diet

53

types of dialysis

hemodialysis

peritoneal

54

Which of the following interventions will help obtain accurate urinalysis data?

1. Provide client/parent education for specimen collection before the specimen is obtained

55

flow of urinary system

kidneys

ureters

bladder

urethra

56

At birth, an infant’s bladder can hold ?

20-50 mL

57

ϒ As adults, we can hold _____ of urine in our bladder, some can hold up to 1L

700mL

58

Which of the following sets of symptoms are characteristic of a preschool-age child with a urinary tract infection?

D. Urgency, dysuria, and fever

59

ϒ Most common cause of UTIs:

stasis of urine, infrequent voiding, poor hygiene, improper cleaning after BM (especially females), uncircumcised males, sex

60

♣ Bacteria ______ = contamination (may not have wiped well enough, may have to repeat collection of specimen)

– 4+

61

♣ Infant lower UTI:

poor eating, unexplained fever, lethargic, irritable, foul-smelling urine

62

♣ Preschool-school age lower UTI:

foul-smelling urine, frequency, dysuria, abdominal pain, fever, urgency—more classic symptoms

63

Upper UTI (such as a kidney infection):

♣ chills, fever, flank pain, nausea, and vomiting

64

♣ Start on antibiotics if there is the presence of

leukocytes and nitrites

65

Has an anesthetic action
Soothes the bladder
Stains—tints urine a bright orange color

Peridum

66

ϒ Prevention of reinfection of UTIs

♣ Avoid bubble baths
♣ Wipe front to back
♣ Cotton undies
♣ Getting them to go to the bathroom more often

pee before and after sex

67

A nurse is preparing to admit a child with possible obstructive uropathy. What labs should the nurse expect to draw on this child?

ϒ B. Blood urea nitrogen (BUN) and creatinine (indicative of kidney function)

68

structural or functional abnormalities of urinary system that interferes with urine flow resulting in urine backflow into kidneys.

obstructive uropathy

69

♣ Where renal pelvis meets the ureter

♣ Most common obstructive uropathy

♣ Stenosis causes the ureter to dilate on the way down

♣ Could be because of kidney stone or the way the ureter implants into the kidney

ϒ Ureteropelvic junction obstruction

70

♣ Distal ureteral muscle is malformed

♣ Where the ureter goes into bladder

♣ If it’s a structural problem, it is the way the ureter is implanted into the bladder when everything was developed

♣ Could also be because of kidney stones

ϒ Ureterovesicular junction obstruction

71

♣ Will detect to see if there’s a stone obstructing anywhere along the ureters
♣ Least invasive test to determine (usually try this first)
♣ Child lays on bed and is injected with dye
Dye filters through kidneys and shows any structural abnormalities or ston

ϒ Intravenous pyelogram (IVP)

72

♣ Put a catheter in, fill it with dye, and take pictures at different intervals
♣ Detects if ureters are dilated
♣ Detects dilated posterior urethra

ϒ Voiding Cystourethrogram (VCUG)

73

♣ Scope in urethra, puts water in bladder and inflates it
Hard in women, soft cord in men
♣ Can see orifice openings and if they are at the correct angles for drainage
Use dye, see urine leaving

cytoscopy

74

♣ Sometimes before baby is born, they can determine if baby has hydronephrosis

renal or bladder ultrasound

75

Following reimplantation of ureters in a child with obstructive uropathy, the nurse should monitor for bladder spasms?

true

76

ϒ Retrograde flow of urine from bladder into ureters

ϒ Reflux prevents complete emptying of bladder, reservoir for bacterial growth

vesicoureteral reflux

77

Vesicoureteral reflux can cause

ϒ pylenephritis and possible renal failure

78

how to dx vesicoureteral reflux

Voiding cystourethrogram (VCUG)

79

ϒ Repeated involuntary voiding by a child who has reached an age in which their bladder control is expected

enuresis

80

treatment of enuresis

bladder exerciss

don't drink as much @ bedtime

timed voiding

enuresis alarm

rewards

81

meds for enuresis

imipramine

desmopressin

oxybutynin

82

♣ Congenital defect bladder extrudes through the lower abdominal wall
♣ Bladder mucosa is exposed
♣ May see urine leakage onto the skin

bladder exstrophy

83

♣ could be one or both fail to descend through inguinal canal into scrotum


ϒ Cryptorchidism

84

Normally testes will descend about _____ months in utero

7-9

85

possible problems with Cryptorchidism?

infertility if testes don't descend and could cause cancer if they stay in the abdomen

86

♣ Usually testes will descend on their own in about ____ months spontaneously

3

87

goal of Cryptorchidism

maintain testicular function

88

♣ Ultrasound to detect where testes are—is it in inguinal canal or if it is up into the abdomen

orchiopexy

89

♣ May make an incision into inguinal area to dissect testicle to get it into inguinal canal—may have to stretch spermatic cord to give it length to get it down into the scrotum
♣ Start dissecting
♣ Trying to get as much length as they can to get testicle down into scrotum
♣ Tacking testicle into the scrotum so that it cannot move back up

orchiopexy

90

baths after orchiopexy

sponge bath for 2 days then tub bath

91

how to cover incision after orchiopexy

leave it open to air.

no ointments, bandaids, or gauze

92

what to avoid after orchiopexy

don't hold child on hip
no straddle toys for 2 weeks
avoid strenuous activity for 2 weeks

93

♣ Fluid-filled sac around the testicle
♣ Can get really big

ϒ Hydrocele

94

Hydrocele can be associated with

inguinal hernia

95

Hydrocele Usually resolve on their own by about ____ year old if not associated with a hernia

1

96

parents usually c/o what with child with hydrocele?

seeing this intermittent bulge in scrotal area, especially when child is straining

97

♣ Light trans illuminates (red) a hydrocele results. what about with a hernia?

A hernia won’t trans illuminate with light

98

One way to determine a hydrocele from a hernia

light trans illumination

99

With manipulation of scrotum, it may turn ?

black and blue and be swollen---this is NORMAL

100

♣ Testes twist
♣ Hurt because it is cutting off the blood flow

ϒ Testicular torsion

101

Testicular torsion is most often related to?

due to trauma

102

sx of Testicular torsion

♣ Severe pain, abdominal pain, N/V, scrotal erythema, scrotal swelling

103

Rubbing the inside of their thigh their testes will

Cremasteric reflex

104

Cremasteric reflex is what with testicular torsion

absent

105

♣ Best chance to save testes after testicular torsion is having surgery within ___ hours

6

106

reversing torsion and tacking both of them down to the correct sides

Orchiopexy to both testicles

107

urethral meatus located on ventral surface (bottom)

hypospadias

108

urethral opening located on dorsal surface (top)

epispadias

109

why don't you circumsize patients with hypospadias and epispaias

we might need this extra skin for when we are repairing the condition

110

no baths with hypospadias and epispaias until when?

completely healed and catheter is out

111

ϒ Not a specific disease, but clinical state

ϒ Symptoms:
♣ Edema, massive proteinuria
♣ Hypoproteinemia
♣ Hyperlipidemia
♣ Altered immunity

nephrotic sydrome

112

♣ Majority of cases
♣ Edema develops gradually over several weeks
♣ Usually have had an upper respiratory infection 2-3 weeks before edema onset
♣ May present with periorbital edema before awakening
♣ Frothy or foamy urine with decreased output
♣ Edema will show they’ve had a weight gain

Minimal Change Nephrotic Syndrome (MCNS)—

113

treatment goal with nephrotic syndrome

♣ Goal is to decrease proteinuria, decrease edema, improve nutrition, and prevent infection

114

treatment of nephrotic syndrome with what meds

prednisone or a corticosteroid

115

ϒ Glomeruli inflamed, often response to group A beta-hemolytic strep infection

Glomerulonephritis

116

ϒ Many kids get strep infection, recover, then start getting signs of glomerulonephritis about _____ days later

10-21

117

Sx of glomerulonephritis

many are asymptomatic

♣ flank or mid-abdominal pain, irritable, tired, running a fever, mild periorbital edema or dependent edema in feet and ankles, and tea-colored urine

118

lab problems with glomerulonephritis

♣ Serum BUN and creatinine elevated, serum protein is low

♣ Hematuria and proteinuria

♣ Anemic

♣ Problems with blood pressure (diuretic)

119

ϒ Most common cause of acute renal failure in young children

Hemolytic Uremic Syndrome

120

Hemolytic Uremic Syndrome is Preceded by

gastroenteritis with diarrhea, URI, or UTI

121

about half of Hemolytic Uremic Syndrome kids develop ?

renal failure

122

sx of Hemolytic Uremic Syndrome

♣ They have hemolytic anemia
♣ Thrombocytopenia
♣ Hematuria
♣ Proteinuria
♣ High BP
♣ Pale
♣ Bruising
♣ Oliguria
♣ Fever
♣ Vomiting
♣ Diarrhea

123

Hemolytic Uremic Syndrome is linked to?

to bacterial or viral e. Coli strain

124

♣ When child has cysts that form in collecting ducts that obstruct urine flow

ϒ Polycystic Kidney Disease

125

As child grows, so do cysts, and they become

fibrotic

126

♣ Polycystic Kidney Disease Also have other issues:

Low-set ears
Small jaw
Flat nose
HTN
Respiratory distress
Feeding problems
Oliguria

127

tx of Polycystic Kidney Disease

Diuretics for HTN
Antibiotics for UTI
Maybe growth hormones
Maybe dialysis
Ultimately kidney transplant

128

Sudden loss of adequate renal function

Occurs suddenly-over days or weeks

May be reversible

acute renal failure

129

Prerenal factors with acute renal failure

ϒ decreased perfusion to kidney along with a systemic condition

130

Postrenal factors with acute renal failure

urologic anomalies that cause obstructed urine flow from both kidneys

131

goal for acute renal failure

Goal is to minimize permanent renal damage while maintaining fluid and electrolyte balance and managing any problems that may arise

132

sx of acute renal failure

ϒ dark urine or gross hematuria, headache, edema, fatigue, crackles, gallop heart rhythm, hypertension, hematuria, lethargy, nausea and vomiting, oliguria

133

what types of drugs to avoid with acute renal failure

nephrotic drugs

134

Progressive irreversible reduction in kidney function

chronic renal failure

135

chronic renal failure results with?

End-Stage Renal Disease

136

End-Stage Renal Disease is the Result of

developmental abnormalities of kidney or urinary tract, or hereditary disease

137

urea crystals on the skin

Uremic frost (sx of end stage renal disease)

138

sx of chronic renal failure

ϒ Fatigue, malaise, poor appetite, nausea and vomiting, failure to thrive or short stature, may have oliguria or polyuria. Headache, decreased mental alertness or ability to concentrate, chronic anemia, hypertension, edema, fractures with minimal trauma, rickets, valgus deformity.

139

Goal for treatment of chronic renal failure

slow progression of kidney disease, prevent complications, promote growth and development

140

2 types of dialysis

peritoneal dialysis and hemodialysis

141

ϒ Catheter inserted into peritoneal cavity through abdomen

peritoneal dialysis

142

complications of peritoneal dialysis

infection, peritonitis

143

2 types of peritoneal dialysis:

♣ Continuous Ambulatory Peritoneal Dialysis
♣ Automated Peritoneal dialysis



(CAPD, APD)

144

Done 4-5 times a day over 4-8 hours each time

♣ Continuous Ambulatory Peritoneal Dialysis
(CAPD)

145

Done overnight
Automated cycler that instills and drains dialysate
Overnight over a 10-hour period
Used most often in children

♣ Automated Peritoneal dialysis
(APD)

146

ϒ Blood flows from pt. through machine that filters toxins from blood
ϒ Utilized when peritoneal dialysis not possible or repeated peritonitis or family isn’t able to do peritoneal dialysis safely

hemodialysis

147

hemodialysis is done how often?

3X a week. 3-4 hours each time

148

complication of hemodialysis:

ϒ hypotension, abdominal cramps, dizziness, problems with rapid fluid and electrolyte exchange: muscle cramps, n/v; equilibrium syndrome: restless, headache, n/v, blurred vision

149

At what age does LH stimulate testosterone production in boys and progesterone secretion in girls and FSH stimulate sperm production in boys and estrogen secretion in girls

A. 13.5-14 y/o with boys and 11-13 y/o with girls

150

• Anterior pituitary gland secretes

FSH and LH

151

♣ Stimulates secretion of estrogen; stimulates follicle maturation in ovaries; also critical for sperm production in males

o Follicle-stimulating hormone

152

♣ Stimulates secretion of androgens in males and progesterone in females

o Luteinizing hormone

153

ovaries secrete

estrogen
progesterone

154

♣ Stimulates development of breasts and ova

estrogen

155

♣ Stimulates breast glandular development; acts to maintain pregnancy

progesterone

156

puberty for girls

9 years old

157

FSH and LH secretion at __-___ years old in girls

11-13

158

♣ Stimulates production of sperm, development of secondary sex characteristics, and closure of epiphysis

TESTOSTERONE

159

where do you start to see secondary sex characteristics

underarm and pubic hair

160

puberty for boys

11 years old

161

FSH and LH secretion begins at ___-___ years old in boys

13.5-14 years old

162

• Facial characteristics with endocrine condition

o Protuberant tongue
o Eyes
o Moon face
o Do they have a baby face even though they are older

163

A nurse is caring for a child with growth hormone deficiency. Which assessment finding would be most characteristic of this disorder?

o Decreased muscle mass

164

• Decreased activity of pituitary

Growth Hormone Deficiency

165

stimulates linear growth and bone mineral density

• Growth hormone

166

causes of growth hormone deficiency

o Infarction of the pituitary gland
o Central nervous system disease
o Tumors of the pituitary gland or hypothalamus
o Other brain tumors
o Cranial irradiation
o Brain trauma
o Chemotherapy
o Psychosocial deprivation

167

• Clinical manifestations of growth hormone deficiency

o Normal birth weight and lengths, but by about 1 year old they start to fall below the 3rd percentile on the growth chart
o “Cherubic” appearance
o Decreased muscle mass
o Higher pitched voices
o Grow less than 2 inches in a year

168

– young facial features for their age

“Cherubic” appearance

169

tx of growth hormone def

growth hormone replacement

170

• A disorder, in which excessive secretion of growth hormone increases the growth rate, is rare in children.

Growth Hormone Excess

171

• If GH excess happens after the epiphyseal plates closes:

acromegaly

172

abnormally large hands and feet, protruding brow an lower jaw

acromegaly

173

• Treatment of GH excess

o If it is because of a tumor on the gland hopefully they can remove it or use radiation therapy

o High doses of sex hormones/steroids to close the epiphyseal plates

174

• The appearance of any secondary sexual characteristics before 8 years of age in girls (breast development, pubic hair), and 9 years old in boys (pubic hair or genial development)
• More common in females than males

Precocious puberty

175

Children with central precocious puberty have an

advanced bone age and appear unusually tall for their age

176

in precocious puberty: hormones (sex hormones) stimulate early closure of the epiphyseal plates, resulting in

short stature.

177

sx of precocious puberty

thelarche
menarche
adrenarche

178

♣ Breast development and start of menstrual cycle but don’t have any other signs of sexual development

o Thelarche

179

♣ Pubic and axillary hair before 8 in girls and 9 in boys

o Adrenarche

180

o Few clinical signs 1st weeks of life but if they are untreated they will have cretinoid features

• Congenital hypothyroidism

181

o Manifestations (if left untreated) of Congenital hypothyroidism

♣ Cretinoid features
♣ Umbilical hernia
♣ Dull appearance
♣ Hypothermia
♣ Mottling of the skin
♣ Cool extremities
♣ Hoarse cry
♣ Not eating right
♣ Could have intellectual disabilities which are irreversible if they are not treated

182

♣ Cretinoid features in the first few months of life include:

• Thickened, large tongue
• Thick lips
• Dull appearance

183

♣ congenital hypothyroidism is Usually detected in the newborn screening, which is mandatory in all 50 states:

T4 and TSH levels

184

o If congenital hypothyroidism is not corrected they could develop

mental issues

185

o Same s/s as adult:
♣ Decreased appetite
♣ Dry skin
♣ Coolness
♣ Thinning hair or hair loss
♣ Deep tendon reflexes will be depressed
♣ Issues with constipation
♣ Very sensitive to cold temperatures
♣ May have a goiter

acquired hypothyroidism

186

acquired hypothyroidism sx that are unique to children

♣ Changes in their past normal growth patterns with a weight increase
♣ Muscle hypertrophy and muscle weakness
♣ May also have precocious puberty or delayed puberty

187

o Major complication of hypothyroidism
o Can be life threatening
o Thyroid levels become very low

myxedema

188

sx of myxedema


♣ Non-pitting edema
♣ Puffy face and tongue
♣ Hypothermia
♣ Progress to hypoglycemia
♣ Hypotension
♣ Could cause cardiac arrest or coma

189

tx for hypothyroidism

levothyroid (synthroid)

190

how long will they take synthroid

lifetime

191

♣ If the baby is on a soy formula their thyroid levels will be monitored because ?

this can interfere with the absorption of T4

192

secrete the hormone glucagon, which accelerates liver glycogenolysis to increase blood glucose

alpha cells

193

conversion of glycogen to glucose

glycogenolysis

194

o acts as an antagonist to the hormone insulin, the hormone responsible for glucose metabolism

glucagon

195

o produce insulin, which promotes glucose, protein, and fatty acid transport into the cells.

beta cells

196

Insulin also accelerates the movement of _______ and _______ ions through the cell membranes with glucose, which reduces blood glucose levels and increases glucose metabolism

potassium and phosphate

197

produce somatostatin, the hormone that inhibits secretion of insulin and glucagons

Delta cells

198

• If you have a lack of insulin then the glucose is not available for energy, so your body will start to break down _____ and ______to use for energy

fat and protein

199

o When your body breaks down fat, this will turn to

ketones

200

Diabetes results from

defects in insulin secretion, insulin action, or both

201

The nurse is assessing a 10 year old for signs of type I diabetes. Which of the following would be most indicative of this problem?

• A fasting serum glucose level of 130 mg/dl

202

normal range of glucose for children

60-100 mg/dl

203

• Destruction of beta cells; fail to secrete insulin in which type

Type 1

204

sx of type 1 dm

polyuria
polydipsia
polyphagia
tired all the time
loosing weight
HA and stomach aches
yeast infections
enuresis
DKA

205

dx of type 1 depends n

fasting blood glucose level greater than 126

oral glucose test greater than 200

random glucose level greater than 200

A1C levels greater than 6.5%

206

♣ Looks at glucose bound to the hemoglobin – looking back and seeing what their glucose levels have been

o Hemoglobin A1C (snapshot of 3 months)

207

% of food eaten needs to come from

• 50% needs to come from carbs
• 30% from fat (avoid saturated and trans fat)
• 10-20 % from protein

208

• 1 carb choice = ____ grams of carbs

15

209

• 1 unit of insulin usually covers ____ grams of carbs

15

210

type 1 dm and artificial sweeteners

• They can have aspartame
Not sorbitol or xylitol

211

♣ Do we want to tell these kids that they are on a diabetic diet?

• NO, this puts a stigma to it – they do have to follow a diet
• Diet indicates a temporary thing, this is lifestyle change

212

♣ Maintaining their glycemic control by:

• 3 meals a day with 3 snacks a day – snacks in between meals (just as important as the actual meals themselves)

• Carb counting, collaborate with dietician

213

o Monitor blood glucose level ___-____ times a day

4-8

214

♣ ____ year old can start learning how to participate in the medication process (getting the supplies, etc.)

3

215

o Insulin is more rapidly absorbed in the _____ or ______ during exercise

abdomen or extremities

216

10-30 minutes

rapid acting insulin

217

0.5-1 hours

short acting (regular) insulin

218

1-3 hours

intermediate

219

1-2 hours

very long acting insulin

220

o Potentially life threatening
o Mainly occurs in children with type I diabetes

DKA

221

kids with DKA will have

hyperglycemia

222

DKA will have hyperglycemia so they will have?

o ketoacidosis, dehydration, and metabolic acidosis

223

o Causes of DKA

♣ Incorrect or missed insulin dose
♣ Insulin administered incorrectly
♣ Illness, trauma or surgery
♣ New onset diabetes

224

o Clinical manifestations of DKA

♣ 3 P’s
♣ Weight loss
♣ Abdominal pain
♣ N/V
♣ Dehydrated
♣ Dry mucous membranes
♣ Flushed face and cheeks
♣ Acetone or fruity smell to their breath
♣ Decreased LOC
♣ Keytones and glucose in their urine

225

The nurse is instructing a school-aged child about managing his DM. Which of the following situations is likely to precipitate a hypoglycemic reaction in a child with DM

• Participation in a soccer game

226

hypoglycemia is a blood glucose below

70

227

causes of hypoglycemia

♣ Could happen if they have a rapid growth rate
♣ Unpredictable eating habits (toddlers)
♣ Dosage error (too much insulin)
♣ Missing a meal
♣ Insulin injection into muscle
♣ Exercising and not taking in enough calories

228

sx of hypoglycemia

♣ Pale
♣ Moist mucous membranes
♣ Irritable
♣ Shaky
♣ Confused
♣ Difficulty concentrating
♣ Sweating

229

with hypoglycemia you give glucose immediately such as

♣ Low fat carb snack
♣ Drink
♣ Sugar gel
♣ Glucose tablet or paste
♣ Glucagon
♣ No hard candy because it is not fast acting and they may choke!
♣ If unconscious Give glucagon by injection

230

what type of drink for hypoglycemia

OJ or regular soda

231

• Insulin resistance

• Body produces more insulin due to the increased body weight to overcome the insulin resistance but eventually your body will not be able to keep up with this so they end up developing diabetes.

type 2 dm

232

• Risk factors for type 2 DM

o Obesity
o Decreased physical activity
o High fat diet
o Race and family history

233

sx of DM

o Some of the same symptoms as type I but slower onset
o 3 P’s (may see this, may not)
o Acanthosis nigricans
o The child usually is obese with a high waist circumference
o Heavy snacking on calorie dense foods, skipping meals, and sedentary activities such as using the computer, watching TV excessively, and playing video games.

234

hyperpigmentation (thickening of the skin) – associated with an insulin resistance


♣ Usually on the back of the neck
♣ Skin folds
♣ Medial aspect of the thighs and axillae

o Acanthosis nigricans

235

• Diagnosis of type 2 dm

o Fasting, A1C, still looking at the 200mg/dl if they aren’t fasting & 126 mg/dl if they are fasting
o Cholesterol issues (high)
o Heart issues
o BP issues (high)
o Kidney issues
o High triglycerides

236

• The nurse is doing an assessment on a 4-month-old infant. Which of the following assessment findings would the nurse consider abnormal?

A. The posterior fontanel is open

237

• Brain and spinal cord forming by ____ week gestation

4th

238

posterior fontanel closes when?

3 months of age

239

anterior fontanel?

18-24 months of age

240

o Won’t be until ____ years of age until their sutures and skull is ossified

8

241

o The brain will continue to grow until about ___-___ years old

12-14

242

• Myelination is not

complete at birth

243

o Helps with the fine and gross motor control
o Refine as child gets older

myelination

244

allow for more sliding in an infant so they are at an increased risk for injury

o C1 and C2

245

- most important indicator of neurological dysfunction

• Level of consciousness

246

components of consciousness

alertness and cognitive power

247

• Ability to respond
• Arousal
• Ability to react to stimuli
• AAO

alertness

248

• Ability to process information
• Able to respond verbally/physically to you

cognitive power

249

o Brain is not able to respond to any stimuli

• Unconsciousness

250

o disoriented time, place, person. Simple questions.

confusion

251

disoriented, fearful, irritable, agitated.

delirium

252

decreased alertness and environment interest, slow stimulus response.

obtunded

253

-arouses with moderate stimuli, but sleeps easily after stimulus removed.

o Lethargy

254

o arouses with repeated vigorous stimuli (pain), but unresponsive with removal of stimuli.

stupor

255

o -unconscious, cannot be aroused with painful stimuli.

coma

256

o -has reflex responses only (eyes opening spontaneously).

persistent vegitattive state

257

flexor posturing, characterized by rigid flexion, is associated with lesions above the brainstem in the corticospinal tracts.

Decorticate

258

: extensor posturing, distinguished by rigid extension, is associated with lesions of the brainstem.

Decerebrate

259

-force exerted by brain tissue, CSF, and blood in cranial vault.

• Intracranial pressure

260

early sx of increased ICP

♣ Headache
♣ Visual disturbances, diplopia
♣ N/V
♣ Dizziness/vertigo
♣ Irritable
♣ Slight change in LOC
♣ Pupils not as reactive or unequal
♣ Slight change in vital signs
♣ Sunsetting eyes
♣ Seizures

261

infant signs of increased ICP

♣ High-pitch, catlike cry
♣ Bulging fontanel
♣ Wide sutures, increased head circumference
♣ Dilated scalp veins

262

late signs of increased ICP

♣ Significant decrease in LOC
♣ Pupils fixed/dilated
♣ Seizures
♣ Cushing’s triad:

263

cushing's triad:

• Increased systolic BP & widened pulse pressure
• Bradycardia
• Irregular respirations

264

• *DO NOT DO _____ _____ with increased ICP* - could cause brain herniation

Lumbar puncture

265

Used to assess coma in infants and children

Glasgow coma scale -

266

3 categories of Glasgow coma scale -

o Eye-opening
o Verbal response
o Motor response

267

best response of Glasgow coma scale -

15

268

outcome of death/severe disability with Glasgow coma scale -

5

269

total neurological unresponsiveness, worst score in glasgow coma scale

3

270

ϖ A child with a total score of 5 from the Glasgow Coma Scale indicates:

A. Disability with pediatric brain injury

271

Keep at bedside of child with altered level of consciousness

o suction apparatus, O2, resuscitation bag & mask, & extra endotracheal or tracheostomy tubes

272

o decrease ICP

mannitol

273

♣ Pulls fluid out of the brain tissue and puts it back into circulation

mannitol

274

o Monitor their ______ status with altered LOC because you may have to give them pain medications or sedatives to help comfort them and keep them sedated. If they are on a vent they will be on some type of sedation to decrease their intracranial pressure

respiratory

275

_____ precautions for altered LOC

seizure

276

if they have increased ICP don't give _____ because it can make them retain fluids

corticosteroids

277

HOB at what angle for increased ICP

15-30 degrees

278

electrical discharges in brain, cause involuntary movement and sensory alterations

• Seizure-

279

chronic disorder, recurrent seizures, underlying brain abnormality

• Epilepsy-

280

ϖ Which type of seizure is represented by brief losses of consciousness in clusters and a glazed appearance?

absense

281

Types of seizures

partial or focal seizures

generalized seizures

282

o Start in 1 hemisphere or specific area of cerebral cortex

may have aura

may or may not have LOC

lip smacking

partial or focal seizures

283

o Both sides of hemispheres
o Bilateral and symmetric movements and spasms.

Generalized seizures

284

2 types of generalized seizures

tonic clonic

petiti mal

285

♣ Unconscious muscle contraction
♣ Stiffness alternating with muscle relaxation
♣ Their eyes may roll back, pupils become dilated, they drool, foam out of the mouth, and they also may have incontinence (urine, feces or both)
♣ They may have an aura
♣ Shake, jerky movements
♣ They often experience an postictal experience after the seizure meaning that their level of consciousness is decreased, they’re worn out, lethargic, etc.

o Tonic clonic (grand mal seizure)

286

period after the seizure

o Postictal period=

287

♣ Onset about 3-12 years of age with a remission into adolescence

♣ When video games talk about the flashing lights causing seizures, this is the type they are talking about

♣ You may not realize they are having a seizure because they may just be blinking or staring off into space. (may label child as not co-operative/defiant, begins testing)

♣ Verbal and touch cannot interrupt these seizures

♣ Can have multiple ones a day (50-100)

o Absence seizure (petit mal)

288

febrile seizures are with a temp over?

102

289

febrile seizures usually happen within 24 hours of an

URI or ear infection

290

febrile seizures are common in ?

younger kids

(14-18 months, can happen as young as 9 months to five years of age)

291

o Tonic-clonic type movements with brief postictal period
o Usually do not recur within 24 hours
o Usually does not last longer than 15 minutes

febrile seizures

292

if febrile seizure lasts longer than 15 minutes....

theres a good chance it will reoccur

293

o A seizure lasting longer than 20 minutes or a series of seizures where they don’t regain consciousness
o Want to note the length of the seizure, the child can become hypoxic during a seizure
o Airway is a big concern; they could become hypoxic

• Status epilepticus

294

tx of febrile seizure

o Acetaminophen and Ibuprofen around the clock to keep their temperature down and keep the child in cool clothing

295

for tx of seizures.....starts with?

anticonvulsant

296

anticonvulsants:

diazepam
dilantin
phenobarital

297

is occasionally performed to disconnect the two cerebral hemispheres when seizures are intractable and disabling, and the brain area responsible for seizures is very large.

o Hemispherectomy to corpuscallosotomy

298

is implanted in the chest, and the leads are threaded under the skin and wrapped around the L vagus nerve. The pulse generator is programmed to stimulate the vagus nerve.

o A pulse generator

299

o A strong ____ can be passed across the skin over the pulse generator to prevent or stop a seizure.

magnet

300

o Used when they have intractable seizure = seizures that continue even though kids are on 3 or more different medications

ketogenic diet

301

ketogenic diet =

HIGH fat

adequate protein

low carb

302

inflammation of the meninges (membranes that cover the brain and spinal cord)

Meningitis

303

o Can occur secondary to otitis media, sinusitis, pharyngitis, pneumonia, or brain trauma
Sudden onset or over couple days

bacterial meningitis

304

infant bacterial meningitis

• Sometimes kids may not run fever; may have hypothermia

• Changing in eating habits

• Vomiting

• Diarrhea

• Telltale sign: rocking will only irritate more, rather than soothe when crying

• When lying down, wants head hyperextended

• Restless or lethargic

• Very fussy

305

older child bacterial meningitis

• Confused
• Not acting like normally would
• Irritable
• Lethargic
• Muscle/joint pain
• Vomiting
• Hemorrhagic rash – clear tumbler test: when you press a clear glass over the rash it doesn’t blanch
• Headache
• Back pain
• Photophobia
• Stiff neck
• Positive kernig or Brudzinski sign pg. 1167

306

dx of bacterial meningitis

♣ CBC, Blood culture, serum electrolytes & osmolality, clotting factors

307

they may also do a ____ ____ to detect bacteria in CSF

lumbar puncture

308

tx of bacterial meningitis

ATB for 7-21 days

corticosteroids

309

____ isolation for bacterial meningitis

DROPLET

310

o Many same symptoms as bacterial meningitis

o Maculopapular rash, but they do not appear as ill as the child with bacterial meningitis

viral meningitis

311

until the dx is confirmed, the child with viral meningitis is treated aggressively with?

ATB until the labs confirm viral

312

o Acute inflammation of the brain

♣ Depend on the causative organism and the location of the infection within the brain

encephalitis

313

classic sx of encephalitis

♣ Acute onset of Febrile illness with neurological signs

314

♣ May have severe headache and fever, followed by altered mental status or focal neurological signs (behavior changes)

♣ In some cases, the child may have fever, vomiting, and altered mental status or coma as presenting signs

encephalitis

315

nursing care for encephalitis

check body for insect bites, immunizations, herpes virus infection

316

• Acute encephalopathy caused by a toxic, inflammatory or anoxic injury (aspirin)

• Characterized by cerebral edema, hypoglycemia and a large, fatty, poorly functioning liver

reyes syndrome

317

why is reyes syndrome less prevalent now?

b/c most parents now give acetaminophen or ibuprofen and do not use aspirin for viral illnesses and flulike symptoms and children are immunized against varicella

318

ϖ A 24-month-old child is brought to the ER with weakness and paresthesias to the feet and legs. The physical exam reveals absent patellar tendon reflexes. Based on these symptoms, the nurse suspects this child has:

A. Guillain Barre syndrome

319

• Peripheral neuropathy with acute onset of rapid symmetric motor weakness, bottom to top

• Immune response d/t infectious organism usually within 1-3 weeks of symptoms of a respiratory or GI illness

Guillain-Barre syndrome

320

tx of guillain-barre syndrome

o IV IG infusions (usually IgG) for 5 days when the child is not able to walk – rapid recovery

321

• Imbalance between production and absorption of CSF which leads to an increased volume of CSF

hydrocephalus

322

– CSF is flowing freely but problem with absorption

• Communicating hydrocephalus

323

– something impeding flow of CSF (tumor, Chiari malformation – Respiratory issues {apnea, respirations, hold their breath when crying, weak cry, difficulty swallowing})

• Non-communicating hydrocephalus

324

tx of hydrocephalus

remove tumor

shunt in ventricle

325

• Vertebral defect where spinal cord contents protrude, often with meningeal sac

Spina Bifida or Myelodysplasia

326

most common area for Spina Bifida or Myelodysplasia

lumbar/sacral area

327

Spina Bifida or Myelodysplasia
will have surgery within ____ hrs after birth

24-48

328

• A group of permanent disorders of movement and posture

• Characterized by abnormal muscle tone and lack of coordination

• They can have cognitive and communication (visual/hearing) problems as well

Cerebral Palsy

329

Clinical therapy focus of cerebral palsy

help child develop to max level of independence and perform their ADLs

330

♣ May require surgery to help with any ankle or knee movement; some have problems with knees and ankles so may require surgery to relieve tendons to help with flexibility

Cerebral Palsy

331

• Blunt force or penetrating injury to the head that disrupts normal brain function

• Most common injuries in childhood & leading cause of death and disability during childhood

Traumatic Brain Injury

332

The blow to the head transfers energy through the _____ and _____ to the brain.

skull and meninges

333

infants and traumatic brain injury

o shaken baby syndrome, child abuse, falls, MVAs (motor vehicle accidents).

334

Toddlers/ preschooler and traumatic brain injury

o learning to walk and not paying attention, falls down stairs, out of a window, or from climbing; transportation related injuries, pedestrian vs. motor vehicle, and MVAs.

335

school-age and traumatic brain injury

o MVAs (pedestrians or passengers), bicycle crashes, in-line skating, scooter, or skateboard, assaults, being struck by an object

336

adolescents and traumatic brain injury

o MVAs, often involving alcohol or drugs, struck by an object, sports related, firearm injuries, assault

337

o brief loss of consciousness or they could remain conscious. May have a slight headache that won’t go away, memory problems, issues with balance, tired all the time, increased sensitivity to light or sound

mild injury

338

o loss of consciousness for 5-10 minutes, amnesia for up to 24 hours, headache, N/V

moderate injury

339

: loss of consciousness for longer than 10 minutes, may be in a coma, amnesia, increased ICP as well

severe injury

340

• Increased elasticity of spine predisposes child to injury

• Majority of injuries related to motor vehicle crashes, sports, ATV’s, diving accidents

spinal cord injuries

341

the higher the injury on the spine.....

the more neurological damage

342

o can be a medical emergency. Sit them upright, loosen any tight clothing, empty their bladder, eliminate any of the precipitating stimulus that caused this, monitor HR and BP and they may be given anti-hypertensive medications if BP does not come down

Autonomic dysreflexia

343

provide framework for body, protect internal organs, stabilize & support body, produce RBC in bone marrow, store mineral salts

• Bones

344

long bones are where most child growth occurs these are:

fibula, tibia, humorous, femur

345

short bones are found in?

wrist and ankle

346

found in skull, sternum, and ribs even though ribs contain lg amts of cartilage even when mature.

Flat bones

347

are vertebra, pelvic bones, and scapula.

o Irregular bones

348

are the articulation where adjoining bones meet.

• Joints

349

little movement

fibrous joints

350

slight movement

cartilaginous joints

351

movable joints

synovial joints

352

are fibrous tissue that proved movement.

• Muscles

353

or voluntary muscles that involve the biceps, triceps, deltoid, gluteus maximus, and others.

skeletal (striated) muscle

354

o or involuntary muscles such as those in GI tract, lungs, and pupils of the eye.

smooth (short-fibered) muscle

355

o ensure the heart’s constant contraction and relaxation.

cardiac (striated, special function) muscle

356

connective tissues that hold bones together.

• Ligaments

357

connective tissues that connects bones and muscles.

• Tendons

358

bones in children are:

less dense

more porous and pliable

not as strong

359

• Long bones in children are less ____ than in adults, leading to higher incidence of fractures.

dense

360

• temperature, pulse, color, capillary refill, movement, pain, sensation & edema

neurovascular assessment

361

where to check child's sensation to touch

pad of finger

362

normal pulse =

2+

363

• Most common congenital foot deformity that causes the front half of the foot, or forefoot, to turn inward

• Affects female and male infants equally

Metatarsus adductus (aka metatarsus varus)

364

causes of Metatarsus adductus (aka metatarsus varus)

genetics and intrauterine positioning (breech)

and low amniotic fluid

365

• Characterized by inward turning of the forefoot (adducted)
• Often referred to as “in toeing”

Metatarsus adductus (aka metatarsus varus)

366

most cases of metatarsus adductus resolve in?

3 mos of age (w/out treatment)

367

• A congenital abnormality in which the foot is twisted out of its normal position; the mid food points downward (equinus), with the toes turned inward (adduction) and the botton of the foot twisted inward (varus).


more in males

Clubfoot - (Talipes equinovarus)

368

3 areas of deformity in clubfoot

midfoot--downward
hindfoot--inward
forefoot--curls toward the heel

369

tx of clubfoot

Serial casting

370

• the femoral head and the acetabulum are inappropriately aligned with an unstable connection

• Females more than males

Developmental Dysplasia of the Hip

371

displacement of the bone from articulation with the joint

o Dislocation:

372

incomplete dislocation (partial)

o Subluxation:

373

abnormal cellular or structural development leading to instability

o Dysplasia:

374

♣ one knee lower than the other when flexed

Allis' sign

375

♣ Place middle fingers over greater trochanters (outer upper legs)
♣ Position thumbs on medial sides of knees
♣ Abduct the thigh to 90° by applying lateral pressure w/ thumb
♣ Move knee medially and then replace knee in starting position

ortolani-barlow maneuver

376

♣ If there is a “clunk,” the hip may be

dislocatable

377

♣ If there is a “click,” the hip may be

subluxable

378

: a dynamic splint that allows movement

♣ Pavlik Harness

379

• a self-limiting condition in which there is avascular necrosis of the femoral head

affects boys more

Perthes disease: