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ABSN Cohort 19 > Peds Exam 2 > Flashcards

Peds Exam 2 Flashcards

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1
Q

GI function, newborn capacity, 1 year old capacity

A

ingests, absorbs, eliminates waste
10 - 20 mL
210 - 360 mL

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2
Q

Pediatric Differences in GI (6)

A 
Poor swallowing
↑ Peristalsis
↓ metabolic functions (enzyme levels, bili conjugaiton, gluconeogenesis, etc.)
↑ metabolic rate,
↑ surface area
↑ sensitivity
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3
Q

6 Types of GI Disorders

A 
Structural
Motility
Feeding
Inflammation
Parasitic
Hepatic
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4
Q

5 Structural GI Disorders

A 
Cleft Lip/Palate
Esophageal Atresia
Tracheoesophageal Fistula
Pyloric Stenosis
GER
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5
Q

Cleft Lip/Palate WT

A

hole in lip/soft palate

immobilization and steristrip incision

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6
Q

Esophageal Atresia/Tracheoesophageal Fistula WT

A

underdeveloped esophagus and/or hole between eso and trach

maintain airway with suction, surgery needed.

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7
Q

Pyloric Stenosis WSDT

A

hypertrophy of pyloric channel r/in regurgitation/projectile vomit ↑ 3 feet from infant.
Dx with blood test/ultrasound
Tx with fluid/electrolyte balance and surgery

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8
Q

GER WST

A

gastric contents into esophagus b/c relaxation of lower sphincter r/in regurgitation, vomiting, irritability, weight loss.
Tx with thickened feeds and surgical placement of valve

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9
Q

6 Motility GI Disorders

A 
Diarrhea
Vomiting
GER
Gastroenteritis
Constipation
Encopresis (involuntary pooping r/t stress)
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10
Q

2 Types and 5 Feeding GI Disorders

A

Retention - colic (crying)/rumination (regurgitation)

Malabsorption - celiac, lactose intolerance, short bowel syndrome

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11
Q

Short Bowel Syndrone SBS W2S

A

Occurs when surgical removal of small intestines due to other dz r/in it being too short!
Newborns - necrotizing enterocolitis
Adults - Intussusception

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12
Q

5 Inflammatory GI Disorders

A 
Appendicitis
Necrotizing Enterocolotis
Mekel's Diverticulus (omphalomescenteric duct to yolk sac)
Crohns Dz
Ulcers
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13
Q

Parasitic GI Disorders Tx

A

preventative education (hand washing) and medication

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14
Q

4 Hepatic GI Disorders

A

Hyperbilirubinemia
Biliary Atresia (duct closure)
Viral Hepatitis
Cirrhosis (CT buildup in liver)

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15
Q

Omphalocele/Gastroschisis W2T

A

herniation of food through umbilical cord or protrusion of whole intestine through abdominal wall
protect organs, correct defect

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16
Q

Intussusception W2T

A

when intestine invaginates self b/c inflammation/upper respiratory infection
Tx with fluid/electrolyte balance and nasogastric tube to decompress

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17
Q

Vollvulus and Hirschsprung Disease WS

A

malrotation of intestine during 7 - 12 trimester r/in poor blood flow to bowel. MEDICAL EMERGENCY
absence of aganglionic cell, r/in obstruction, diarrhea, constipation

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18
Q

Anorectal Malformations causes VACTERL and Tx

A 
Vertebral anomaly
Anal artresia
Congenital ♥ Dz
Tracheoesophageal Fistula
Renal anomaly
Limb Defects

Ostomy w/ education

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19
Q

Hernia W3T

A

protrusion of organ through abdominal wall

Keep infant calm, VS q30min, elevate head from abdomen

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20
Q

Appendicitis, McBurney’s Point W4ST

A

inflammation of appendix r/in periumbilical cramps, pain @ point, N/V, fever.
Tx with post-op formula

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21
Q

Necrotizing Enterocolitis WS3T

A

Inflammatory dz in intestinal track which ↑ r/o SEPSIS

Assess for hypo/erthermia, jaundice, respiratory distress

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22
Q

Most UTI’s are from what bacteria?

A

E. Coli

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23
Q

Neurogenic Bladder
Vesicoureteral Reflex
Hydronephrosis

A

poor nerve supply in bladder = poor sense
backflow if urine into ureters = ↑ r/o UTI
accumulation of urine in renal pelvis b/c obstruction

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24
Q

UTI 3 S/S and 4 Tx

A

ill appearance, fever, poor feeding
Assess VS, abdomen
Tx with antibiotics/pyretics and encourage fluid intake

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25
Azotemia Oliguria Anuria Uremia
Nitrogen in P less urine no urine TOO MUCH URINE!!!
26
UTI 4 Lab ▲ and 2 pharmacological Tx
↓ filtration = ↑ BUN, Creatinine, WBC, and fever | Tx with diuretics (Lasix/furosemide) and antibiotics if UTI present
27
Acute Glomerulonephritis W
inflammation of kidneys
28
Acute Renal Failure WS(acute v. chronic and 3 labs)
acute kidney injury r/in poor filtration Acute = dark urine, fatigue, crackles Chronic = fatigue, N/V, failure to thrive ↑ K ↓ Na, Ca
29
``` Bladder exstrophy Hypo/Epispadias Tight Chordee Cryptorchidism Testicular Torsion ```
bladder is showing penis hole too low/high low penis hole r/in in curvature to cut at 6 - 9 months undescending testicles, tx with hormones/surgery rotating balls r/in twisting, surgery or DIE
30
Hemodialysis
machine filtration of blood to remove excess for ppl w/ Ø kidney fx
31
Consciousness... Alertness Cognitive Power
ability to react to stimuli | ability to process and respond to data
32
``` Confusion Delirium Lethargy Stupor Coma ```
disorientation to time, place, person fear, irritability, agitation profound slumber (mod stimulation wakes but will fall asleep easily) deep sleep (vigorous stim wakes but will sleep when stopped) no wakey even w/ stim
33
Glasgow Coma assesses 3 things, score, purpose
Eyes, Verbal, Motor (5/5) = 15/15 | Level of Consciousness
34
Posturing... Decorticate Decerebrate
rigid flexion of arms, clenched fists, extended legs | rigid arms/legs straight out, toes downwards
35
Pediatric Neurologic Differences (2)
Top heavy, poor neck muscles = prone to injury | Excessive spinal mobility, cartilaginous vertebral bodies = ↑r/o C1 - C2 compression fracture
36
Example of... Congenital Aquired Infectious Neuro Dz
Cerebral palsy Head Injury Meningitis
37
Pathologic process of neurologic Dz
processes ↑ ICP. Brain needs ↓ Cerebral perfusion pressure to oxygenate
38
3 Early, 3 Late, and 3 Infant S/S of Neuro Dz's
headache, diplopia, sunsetting LoC, ↑ BP, respiratory ▲ bulging fontanels, wide sutures, high-pitched cat cry
39
Seizures WHAT and 3 CAUSES
uncontrolled neuronal discharge r/t CNS defects caused by infections, toxins, tumors
40
2 Partial Seizures
Simple - 1 hemisphere (▲ motor/autonomic) | Complex - 1 to both (LoC and lip smacks)
41
6 Generalized Seizures
Abscence (petit mal) - ok posture, lip smacks Myoclonic - involuntary muscle group movement Clonic - opposing muscle group rhythmic contractions Tonic - continuous contracted state Tonic/Clonic - tonic 20 - 40 sec followed by clonic postictal/seizure Atonic - DROP/FALL BACK HELMET PLZ
42
Status Epilepticus Febrile Intractable Seizures
> 5 minutes, intermittent for >15, MEDICAL EMERGENCY Fever + seizures, sepsis eval, dx with lumbar puncture reqs. > 2 antiepileptic drugs
43
Seizure Tx 5 and 3 Dx
calm, airway, Øinjury, keep warm, support, document | EEG, electrolytes, MRI unless Febrile
44
Meningitis WHAT and 2 Types
inflammation of meninges of brain Viral b/c mumps, measles - CSF clear Bacterial b/c upper respiratory infx, injury - CSF cloudy w/ WBC, protein, ↓ glucose
45
Meningitis S/S in... Newborn (3) 2 mo - 2 yr (4) 2 yr - adolescent (+2)
poor tone, weak cry, bulging fontanels = late seizures, fevers, cat cry, nuchal rigidity All previous + Brudzinski and Kernig sign
46
Brudzinski and Kernig
Head forward, knees up | Can't straighten leg @ 90º angle
47
Meningitis Nursing Management (5)
``` Seizure precautions Isolation for 24 hrs VS and neurochecks Fluid monitoring Head circumference ```
48
Meningitis Medicaitons (4)
IV antibiotics - bacteria Corticosteroids - inflammation Anticonvulsants - seizures Analgesics - pain
49
Meningitis 2 key/fatal S/S
retinal hemorrhages and slow bleeds
50
Meningitis 3 Post-Infection Syndromes
Reye's - acute encephalopathy b/c tylenol OD/influenza N/V, ▲ mentality, ↓ responsiveness Gullaine-Barre - acute inflammatory demyelination of spinal roots r/in muscle weakness, areflexia Encephalitis - inflammation of brain b/c virus (ie. West nile)
51
Hydrocephalus WST and associated w/ what Dz?
↑ CSF in space of brain b/c obstruction flow/absorption in arachnoid space, r/in... Bulging ANTERIOR fontanel Sun sign Glowy skull Tx w/ shunt draining CSF to other part of body (red = shunt ineffective) Associated w/ myelomeningocele
52
Myelomeningocele/Myelodysplasia/Spina Bifida W3ST
Neural tube defect when vertebral laminae Ø close, Spinal cord protrudes back and r/in... SAC IN BACK, latex allergies, developmental delays Sterile moist dressing to prep for surgery
53
3 Levels of Spina Bifida
Thoracic - leg paralysis/trunk weakness Lumbar 1 -2 - hip control, Ø knee movement Lumbar 3 - can flex hips/knees LOWER THE BETTER
54
Cerebral Palsy WT
Non-progressive impairment of MS development/function | Work with community to accomodate child
55
Bachy/Plagio/Scaphocephaly
wide, flat back asymmetrical long
56
Concussions r/in... 2 (+concept), important assessments 3!
May LoC, headache, BRICK HEAD Assess... Neuro, VS, report ↓ oxygenation IMMEDIATELY
57
Near Drowning (3 longers, !location, and tx)
longer = worse prognosis longer time w/out BLS (10 min)/pulse (25 min) = worse prognosis ↑% with infants is in bathtub educate on safety precautions
58
Mental Health
Sense of personal well-being, health, and psychologic stability. #2 reason for hospitalization of 10 - 21 yr olds.
59
Cognition
▲ in thought, intelligence, and language as life progresses
60
7 Mental Health Treatment Modalities
``` Evidence-Based - studies show Individual - child to therapist Family - relationships Group - relatable people Therapeutic Strats - (see card) Imagery - imagination Hypnosis - tx phys. S/S, easier with kids! ```
61
Psychodrama and Cognitive Therapy
role playing to ↑ understanding | recognize/counter negative thinking
62
Play, Art, Cognitive Behavioral Therapy
dolls/fantasy to relieve stress drawing provides objective image promote + thinking patterns (structured environments and educate adults)
63
``` Generalized Anxiety Separation Anxiety Panic Obsessive Compulsive Conversion Reaction PTSD School/Social Phobia ```
``` uncertainty/helplessness uneasy w/ new things > 2 weeks unexpected attack of fear/discomfort 1 hr rituals w/ obsessive thoughts (+fx serotonin in basal ganglia) ↓ physial fx r/t neurologic/somatic dz reliving event > 1 month post-event fear of social interaction ```
64
4 External forces which insult Brain Development and OVERALL FX on child
Drugs/alcohol Poor nutrition Traumatic Brain injury Lack of emotional nurturing Fx child's ability to COPE
65
Autism ADD/ADHD Depression Bipolar/Mania 4 Nursing Managements
neurodevelopmental (aspergers, Rett's, Child Disintegrative Disorder) ADD = CNS + behavior, ADHD = hyperactivity, impulsivity psychologic distress extreme ▲ in affect Evaluate risk, survey, social support, refer to resources if needed.
66
2 Cognitive Alternations... Learning Disability Intellectual Disability
poor processing w/ developmental delays (NOT LOW IQ) | retarded - ↓ IQ, intellect, ↓Syndrome, and Fetal Alcohol Syndrome
67
Anorexia vs. Bulimia
Ø eat b/c = fat | eat but PURGE b/c Ø PURGE = fat
68
Munchausen by Proxy
when parent abuses/seeks unneeded medical attention of child r/t personality disorders
69
``` # bones in body, 2 examples of... long, short, flat, irregulat ```
tibula, fibula wrist, ankle, skull, sternum vertebrae, pelvic
70
3 Types of Muscles example
``` Skeletal/striated bicep - voluntary Smooth/short-fibered stomach - involuntary Cardiac/striated w/ special fx ♥ - contract/relaxation ```
71
Pediatric Bone differences (3)
↑ porous, ↑ pliable = flexible Grow from Epiphyseal plate which -> Line Ligaments/Tendons stronger than bone until puberty
72
Infant Skull skull growth time and fontanel closing time
Growth complete @ 2 years | Fontanels close @ 18 months
73
4 Disorders of the Feet and Legs
``` Club foot (talipes equinovarus) Metatarsus Adductus - congenital inward turning of forefoot @ tarsometatarsal joints Genu Valgum (knock-knees) Genu Varum (bowlegs) ```
74
Varus vs. Valgus
Inward/towards midline bending vs. | Outwar/away from midline bending
75
Club foot (talipes equinovarus) W4S2T
foot is twisted out of normal position Short Achilles, atrophied lower leg muscles, leg length NORMAL, Ø SOLVE WITH EXERCISE Serial casting (▲ q1-2wks for 8-12wks) Surgery (@ 3-12 months w/ casting for 6-12wks following)
76
Club foot 3 Types of Deformity
Equinus - midfoot downward Varus - hindfoot inward Adduction - forefoot curls toward heels
77
Club food post-surgical care (4) Tx
neuro check q2hrs ice bags w/ elevation pain meds q4-8hrs popliteal/epidural blocks ok
78
Genu Valgum (knock-knees) WT
knees close together with lower legs valgus'd Tx with braces DAY and NIGHT anime school girl
79
Genu Varum (bowlegs) WT
knees widely separated w/ ankles close b/c legs varus'd | Tx with braces @ NIGHT
80
Genus Valgum/Varum expectation, optional Tx, 2 common causes (with WS), and diagnoses
Normal until > 4-5 yrs old Tx with osteotomy Blount Dz - ↑ growth medial prximal tibia r/t ↓ VitD and being black Rickets - ↓ mineralization r/t ↓ Ca and VitD (aquired but CAN be congenital via X-linked autosomal dom/reces. Diagnose w/ radiology (MRI/CT)
81
3 Disorders of the Hips
Developmental Dysplasia of the Hip (DDH) Leg-Calve Perthes Dz Slipped Capital Femoral Epiphysis
82
4 Reason for DDH
Hip instability Dislocation Subluxation - partial dislocation Dysplasia - abnormal cellular/structural development
83
Primary cause DDH, gestation occurrence, and alternative cause
Primarily genetic 12 - 18 weeks gestation Mild cases caused by mechanical force (breech)
84
DDH 3S4T
↓abduction of hip, asymmetry of folds, limp 60 - 80% resolve by 2 mo. old ↓ 3 months = Palvik Hardness ↑ 6 months = Closed surgery w/ spica cast ↑ 18 months = Open/Closed surgery w/ casting + bracing
85
Slipped Capital Femoral Epiphysis W2S2T and ages for ♂/♀
Fracture of physis r/in top of femur slipping through growth plate posteriorly pain, asymmetry No sitting, surgery w/ casting ♂ 10 - 16 ♀ 10 - 14
86
4 Disorders of the Spine W2S2T
Scoliosis - S or C > 10º Torticollis - head tilt r/t cervical/visual insult Kyphosis - hunchback Lordosis - U shape Unequal back, pain not normal. Masses should be investigated, Tx with braces
87
2 Disorders of the Muscles WS (with age onsets)
Duchennes - mutations in DMD gene r/in progressive muscle weakness ( 3 - 7 yrs old) Muscular Dystrophy - inherited degeneration of muscles ( onset 3 y/o, immobile by 9 - 11, dead by 20 b/c respiratory failure)
88
5 Disorders of the Bones/Joints WT
Skeletal TB - spasms, atrophy, swelling @ joints Tx with antibiotics Septic Arthritis - paint w/ local inflammation Tx with antibiotics/drainage Achondroplasia (Dwarfism) - ugly and short Tx with self-esteem and short adaptation Marfan Syndrome - CT manifesations r/t autosomal dominant gene (▲ cardiac, skeletal, ocular, and respiratory) Tx Ø Osteogenesis Imperfecta - (see card)
89
Osteogenesis Imperfecta (W and 4 Types)
Brittle bone disease, hits both ♂♀ equally 1. most common, fragile, blue sclerae 2. rib involved, likely to die in utero 3. numerous fractures, kyphoscoliosis 4. all above + bowlegs, structural deformities that improve @ puberty
90
Sprain Fracture Traction (2)
tearing of ligaments partial/complete break in bone Skin and Skeletal (sterile, check q4hrs)
91
Cast and Brace Tx
Cast - 2 days to dry, elevate, check cap refil/neuro q2hr | Brace - snug, but Ø cut circulation, do as above.
92
Types of Fractures
``` Complete Transverse Spiral Open Closed Green-stick - compression Comminuted - shatter! ```
93
Leg-Calve Perthes Disease W3S4T
Self limiting avascular necrosis of femoral head r/t injury, ↑ thyroid, ↓ Somatomedin C. Tx with traction, surgery, anti-inflammatories, and PT
94
5 Stages of Leg-Calve Perthes
Prenecrosis - ↓ blood supply @ femoral head Necrosis - 3 - 6 months, graphs normal, asymptomatic Revascularization - 1 - 4 years, +graphs, pain w/ move Bone Healing - re-ossification, pain Remodeling - Dz over, Ø pain, ↑ joint fx
95
Salter-Harris Classification (5)
Type 1 - plate undisturbed Type 2 - most common, disturbance rare Type 3 - less common, serious threat to growth Type 4 - serious threat to growth Type 5 - rare, crush injury arrests growth/length, deformities may result

ABSN Cohort 19 (28 decks)

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