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Flashcards in peds Deck (89):
1

anterior fontanel closes

12 - 18 months

2

posterior fontanel closes

2 - 3 months

3

earlobe positioned to view auditory canal in child

down and back

4

cups of milk 15 mo toddler should consume daily

2 - 3

5

best friend stage occurs at what stage

9 - 10

6

major causes of accidents in children up to 1 year x3

falls
poisoning
burn

7

major cause of accidents 6 - 12 years

motor vehicle accident (more active)

8

school age child requires how many calories per day on average

2400

9

how much earlier do girls experience onset of adolescence

1 - 2 years

10

obtaining vitals (peds)

least invasive first, observe before touching/talking

RR *
HR *
BP
T

* count for 1 full minute (irregularities)

11

temperature routes (peds) x4

rectal ( under 2 )
axillary ( alt to oral )
oral ( start 5 - 6 )
tympanic ( all )

12

observable signs of respiratory dysfunction (peds)

- accessory muscle use
- nasal flaring
- circumoral pallor (around mouth)
- sternal retraction
- cap refill greater than 3 seconds

13

if child is grunting do what?

assist into position of comfort (tripoding)

14

laryngotracheobronchitis

most common type of croup experienced by peds admitted to hospital

primary affects kids under 5; viral

15

causative viruses of laryngotracheobronchitis

parainfluenza
adenovirus
RSV

16

laryngotracheobronchitis s/s

slight to severe dyspnea
barking / brassy cough
increased temperature

amount of distress depends on degree of airway obstruction

17

laryngotracheobronchitis treatment (mild)

at home
- steam (hot showers)
- night car rides, windows down
- cool-temp therapy (constricts edematous blood vessels)

18

laryngotracheobronchitis treatment (severe)

hospitalization

nebulized epinephrine (racemic epi) = vasoconstrict edematous blood vessels

corticosteroids (decrease airway inflammation)

19

epiglottitis

serious obstructive inflammatory process in 2 - 5 yo

20

epiglottitis key s/s

absence of cough
dysphagia
rapid progression to severe resp distress

21

epiglottitis vs laryngotracheobronchitis kids

epiglottitis kids look worse than they sound
laryngotracheobronchitis kids sounds worse than they look

22

nebulized epinephrine

aka racemic epinephrine; vasoconstriction of edematous blood vessels in kids with severe laryngotracheobronchitis

rapid onset
improvement in 10 - 15 minutes
(observe for relapse; ~2 hours)

23

respiratory syncytial virus

acute viral infection affecting bronchioles

RSV bronchiolitis or RSV pneumonia

more serious in very young (leading cause lower resp tract illness in under 2)

24

RSV is more serious in who?

very young

25

leading cause of lower respiratory tract illness in children less than 2 years

RSV

26

RSV s/s

important to know onset bc will become worse on days 2 - 3

progressively worse:
URI
snot
mild fever
dyspnea
non-prod cough
tachypnea (flaring nares)
retraction, possible wheezing

27

RSV will become worse...

on days 2 - 3

28

pneumonia

disease marked by inflammation of lungs

29

viral pneumonia (peds)

RSV, adenovirus, parainfluenza

30

bacterial pneumonia (peds)

usually strep pneumo
children under 4 = greatest % attacks

31

mycotic pneumonia (peds)

"walking pneumo" - mostly adolescents
mycoplasma pneumonia

32

aspiration pneumonia

something other than air has gotten into lungs

33

pneumonia s/s (peds)

fine crackles/rhonchi + cough that is prod or not

decreased or absent breath sounds

abd distension

back pain

fever (usually very high)

chest pain

34

pneumonia tx (peds)

depends on type
1. ABCs always priority
2. oxygen
3. fluids - hydrate to move secretions
4. abx for bacterial
5. supportive care: hydration, antipyretics, nebulizers (appropriate for viral)

35

asthma

inflammation and constriction of airways resulting in obstruction

36

asthma s/s

cough
sob
audible wheeze
prolonged expiratory wheeze
restless and cyanosis

37

what is prolonged in asthma

expiratory wheeze

38

most important thing in proactive care for asthma patient

education, especially id-ing triggers

39

cystic fibrosis

respiratory and gi impacted
give pancreatic enzymes to improve digestion
diet: well-balanced, low fat, high calorie, high protein

40

pancreatic enzymes for + how

cystic fibrosis
take within 30 minutes of eating, do not crush or chew

41

vitamins for CF patient

ADEK are fat soluble but need to make them water soluble since CF kids can't process fat

42

diagnostic test for CF

sweat chloride

43

electrolyte imbalance child with CF at risk for

hyponatremia

44

earliest sign of CF (newborn)

meconium ileus (can't pass; thick and sticky)

45

CF inheritance

autosomal recessive

46

CF stools

steatorrhea

47

down syndrome kids prone to infection where?

respiratory - poor immune system

48

most common type of defect associated with down syndrome

heart

49

in peds, HF usually due to

congenital heart defects

50

s/s early heart failure (peds)

increased HR at rest + with slight exertion
increased RR
scalp sweating (infants @ feeding)
fatigue
sudden weight gain (greater than 1lb/day)

FLUID RETENTION THINK HEART PROBLEMS FIRST

51

main signs of digoxin toxicity

bradycardia, vomiting (earliest sign)

52

digoxin: hold for ? in infants, children

infants: HR less than 110
kids: HR less than 70

53

normal digoxin level

0.8 - 2.0

54

infants rarely get more than ? of digoxin

1.0 mL per dose

55

give digoxin to infants when?

1 hour before or 2 hours after feeding

56

nursing considerations for digoxin admin to peds x2

ALWAYS check with another nurse
if 2 doses in a row missed, call provider

57

good feeding schedule for a heart baby

q 3 hours, do not prolong feedings past 30 minutes

58

blue spells aka tet spells

hypercyanotic spells often seen in infants with Tetralogy of Fallot

59

ace-i in kids, watch for

decreased BP
kidney problems
cough (dry) -- d/c ASAP

60

treatment for tet spell

infant: knee-chest position
100% O2
morphine (sedate)
loose clothes, diapers
quiet play
no stress
respond to crying quickly
treat infections promptly (can't handle fever)

61

why knee-chest position for infants with tet spell?

decrease venous return from LE
increase systemic resistance to divert blood to pulmonary artery (increases O2 in blood)

62

polycythemia

increased red blood cells in response to chronic hypoxia; body senses hypoxia, increases RBC production, no more O2 to carry, blood gets thick

so many RBCs no room for platelets

63

polycythemia treatment

hydration - keep blood thinned out

64

s/s chronic hypoxia

clubbing (late sign)
poor growth, development
squatting

65

congenital heart defects (peds)

structural or functional defect of heart or great vessels present at birth

classified by blood flow patterns
- increased or decreased pulmonary blood flow
- obstructive defects

66

tetralogy of fallot

Ventricular Septal Defect
Stenosis of Pulmonary Artery
Overriding Aorta
-- directly over VSD instead of LV
Right Ventricular Hypertrophy

67

post cleft lip repair (peds)

on back or side-lying
- protect suture line (NOT PRONE)
clean suture with saline
elbow no nos

68

best time for cleft palate repair to be done

before speech develops, between 1 - 2

69

GER vs GERD

GER = passage of gastric contents into esophagus

GERD = tissue damage to respiratory structures, which can lead to pneumonia and bronchospasms

70

pyloric stenosis s/s x3

projectile vomiting, usually after feeding
- pressure behind vomitus

olive shaped mass in epigastric region near umbilicus (enlarged pylorus)

pressure build up in stomach = pyloric ultrasound

71

intussusception key s/s (peds)

sudden onset
cramping, intermittent abd pain, inconsolable

drawing up of knees

currant jelly stools!

72

intussusception poo

currant jelly stools

73

celiac disease

celiac sprue is a genetic malabsorption disorder where there is permanent intestinal intolerance to gluten

74

celiac patients can't have (mnemonic)

b arley
r ye
o ats
w heat

75

hirschsprung's disease

congenital anomaly known as aganglionic megacolon - results in mechanical obstruction; usually affects sigmoid colon

no nerves, no peristalsis = constipation + abdominal distention

remove disease bowel - give intestines time to heal (maybe 2 sx)

76

hirschprung's poo

foul smelling and ribbon-like

77

sickle cell disease

hereditary disorder in which hemoglobin is partly or complete replaced with sick-shaped hgb
- reduced O2 carrying cap as result of shape

78

#1 tx to stop sickling process

HYDRATION!!

79

FLACC

face
legs
activity
crying
consolability

80

numerical pain scale starting at age

5

81

hydrocephalus

disturbance of ventricular circulation of cerebral spinal fluid in brain; increased icp

often associated with myelomeningocele

82

myelomeningocele

type of spina bifida, sac on the back
- prone
- moist sterile normal saline dressing
- surgery ASAP

83

spina bifida

any birth defect involving incomplete closure of the spine

84

pinworms: transmission, test, treatment

hand to mouth
tape test (rectal itching)
whole family treatment; mebendazole

85

infectious mononucleosis: causative agent

epstein barr virus

86

positioning post tonsillectomy

side + elevated hob
or
prone

87

tonsillectomy post-op risk for hemorrhage up to

10 days (scabs slough 7 - 10)

88

otitis media

eustachian tubes (middle ear) blocked
usually follows upper respiratory infection
bulging and bright red tympanic membrane
lie on affected side to promote drainage

89

cleft lip/palate epi

American Indians, Asians
boys