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Block 4 > Peds Exam 2 > Flashcards

Peds Exam 2 Flashcards

1
Q

What are the two lives vaccines?

A

MMR and Varicella

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2
Q

At what age can children receive the MMR and Varicella?

A

12 months

Because they are live vaccine

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3
Q

What is the Hib Vaccine given for?

A

To prevent pertussis and whooping cough

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4
Q

What allergies contraindicate getting vaccines?

A

Neomycin, gelatin, or the vaccine itself

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5
Q

Can pregnant women receive MMR or Varicella?

A

NO

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6
Q

Can breastfeeding women receive MMR or Varicella vaccine>

A

Yes- live vaccines do not cross the breast milk

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7
Q

What is important when administering vaccines?

A

Refrigerated, document the lot #, manufacturer, and exp date

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8
Q

Considerations when giving multiple vaccines?

A

Least painful first

Save MMR and Varicella for last bc they hurt the most

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9
Q

What is important to obtain in the health history pertaining communicable diseases?

A

Any travel outside the country, immunization hx

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10
Q

What is important about obtaining health history on pets at home?

A

Lizards/turtles- carry diseases

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11
Q

Fifth Disease (Human Parvovirus) symptoms?

A

Starts with low grade fever, children get weird rash, spike high fever, swollen lymph nodes. Common in children under 10

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12
Q

What precautions taken for children with fifth disease?

A

Contact isolation

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13
Q

Stomatitis

A

Inflammation of oral mucosa, due to excess acidity

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14
Q

Symptoms of Stomatitis

A

Dehydration- oral sores are too sore to drink water

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15
Q

Management of Stomatitis

A

Miracle Mouthwash- Maalox, lidocaine, and benadryl

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16
Q

Intestinal parasitic disease

A

Worms (pinworms)

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17
Q

Diagnostic test for worms?

A

Tape Test

Obtain fecal specimen

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18
Q

Symptoms of intestinal parasitic disease (worms)

A

Diarrhea, vomiting, anorexia, failure to thrive, cramps, stools that are malodorous, pale, greasy

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19
Q

Treatment for intestinal parasitic disease (worms)

A

Drugs; Metronidazole (Flagyl) and tinidazole (Tindamax)

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20
Q

Example of bacterial infection

A

Scaled skin syndrome- staph eating bacteria

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21
Q

Biggest thing to watch for with Scalded skin syndrome?

A

Temps!! Bacterial infection- causes fevers

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22
Q

Nursing management of bacterial infection

A

*Airway support- throat swelling
Change clothes/sheets daily
daily bathing

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23
Q

What is sloughing skin?

A

Shedding of the skin layer

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24
Q

Treatment for cellulitis?

A

Warm compress- brings stuff to the surface

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25
Q

Giardia Intestinalis

A

Contaminated water lake/ swimming pools

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26
Q

Pediculosis capitis

A

Lice

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27
Q

Education for parents on pediculosis capitis

A

does NOT indicate socioeconomic class

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28
Q

Management for lice?

A

Machine wash in hot water and dry x20min
Soak combs/brush for 10min boiling water
Wash and bag stuffed animals

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29
Q

Lyme Disease

A

Tick-borne disorder

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30
Q

Manifestations of lyme disease

A

Tick bite 3-30 days before erythema

Large ring with a raised donut like border and bulls eye appearance

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31
Q

Treatment for Lyme disease

A

> 8 years old = Doxycycline

<8 years old = Amoxicillan or cefuroxime

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32
Q

What is important to know about Doxycyline?

A

It is harsh on the stomach

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33
Q

What is important to obtain about the history of a patient with lyme disease?

A

Recent travel to places such as flagstaff

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34
Q

Hypopituitarism

A

Decrease secretion of pituitary hormone
LOW GH
LOW TSH

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35
Q

Hyperpituitarism

A

Excessive growth hormone PRIOR to closure of epiphyseal shafts resulting in overgrowth of long bones
HIGH GH
HIGH ACTH

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36
Q

Hypothyroidism

A

Low thyroid hormone
HIGH TSH
LOW T3/T4

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37
Q

Hyperthyroidism

A

High thyroid hormone
LOW TSH
HIGH T3/T4

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38
Q

Pituitary

A

MASTER GLAND

Example- Oxytocin released from pituitary, if not triggered from the pituitary gland then the uterus will not contract

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39
Q

How much insulin does the pancreas normally secrete in a day?

A

20-40 units

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40
Q

Where is leftover glucose stored?

A

In the liver as glycogen

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41
Q

What happens when the liver is at full capacity of glycogen?

A

Remaining glucose is converted to fat (lipogenesis) and stored as adipose tissue

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42
Q

When should you administer insulin to children?

A

AFTER meals, bc unsure how much/if they will eat

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43
Q

How to monitor Type I diabetes in babies?

A

History taking- monitor the # of wet diapers to indicate frequent urination

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44
Q

Signs of hyperglycemia

A

Extreme thirst, excessive urination, dry skin, hunger, blurred vision, drowsy, nausea

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45
Q

Signs children with undiagnosed or poorly controlled diabetes

A

Restless, apathetic, having trouble functioning at school, *weight loss (3-5%)
Sometimes DKA and coma may be the first sign of Type I

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46
Q

Target blood sugar for children

A

150-180

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47
Q

CHO RATIO?

A

15g CHO to 1 Unit

Wait with needle in for 10 seconds for best absorption

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48
Q

A1C normal level?

A

< 5.7%

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49
Q

When is Lantus administered?

A

hs (bedtime), long acting-no peak

DO NOT HOLD LANTUS

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50
Q

Signs of hypoglycemia

A

Nervous, difficulty speaking, shaky, dizzy, sweaty, tachy, normal urine output

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51
Q

What chart is important to compare trends?

A

Growth chart

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52
Q

Growth hormone deficiency

A

Normal at birth- but them falls behind on ht/wt, delayed puberty

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53
Q

Hypopituitarism nursing considerations

A

Child should wear medic alert bracelet- steroid dependent

Medications necessary for regulation of hormones

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54
Q

Signs and symptoms of hypopituitarism

A 
Regression or absence of sex characteristics
Delay in tooth eruption
Increased thirst and urination
Fatigue and intolerance to stress
Stunted growth after 1 year of life
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55
Q

Hypopituitarism treatment

A

Hormone replacement, steroid therapy (provide teaching for injections)

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56
Q

Precocious puberty

A

Puberty too quick

Development of breast or pubic hair before age 8

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57
Q

Which chart is used to track puberty?

A

Tanner chart (4-5 is not good, indicates growing too fast)

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58
Q

Management of precocious puberty

A

Factrel- synthetic LH releasing hormone

Synarel by IM or nasal spray (delays future development)

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59
Q

Congenital Hypothyroidism

A

Mental and physical retardation if not caught early

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60
Q

How is congenital hypothyroidism detected?

A

Newborn scrrening

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61
Q

Which assessment is extremely important in assessing for congenital hypothyroidism?

A

Anterior fontanel closes at 12-18 months

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62
Q

Treatment of congenital hypothyroidism

A

Lifelong therapy of synthetic thyroid hormone (Levothyroxine oral)

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63
Q

Graves Disease

A

Hyperthyroidism

Increased T3 and T4 levels

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64
Q

At what age is graves disease typically diagnosed?

A

6-12 months

Gradual onset of symptoms

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65
Q

Symptoms of graves disease

A

Protruding eyes
large neck
irritability
*increased appetite with weight loss

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66
Q

Sign of vitamin D toxicity?

A

Weakness

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67
Q

Management of hypoparathyroidism

A

Medical management to maintain normal serum calcium and phosphate levels, Vitamin D therapy

68
Q

Which vitamin does a breastfed infant receive?

A

Vitamin D- given to prevent PTH deficiency

69
Q

Nursing considerations for hypoparathyroidism

A

Seizure precautions, monitor for resp difficulty- stridor and laryngeal spasms

70
Q

What is most important to monitor on adrenocortical insufficiency (Addisons) patients?

A

Blood pressure- important to monitor on pt with adrenal issues

71
Q

Treatment for Addisons disease

A

Cortisol replacement (IV hydrocortisone)

72
Q

Ambiguous genitalia

A

Common with Addisons disease

73
Q

Normal HR for infants

A

100-160

74
Q

Normal resp rate for infants

A

30-60

75
Q

Normal HR for toddlers

A

90-150

76
Q

Normal resp rate for toddlers

A

24-40

77
Q

Normal HR for preschool age

A

80-140

78
Q

Normal resp rate for preschool age

A

22-34

79
Q

Normal HR for school age

A

70-120

80
Q

Normal resp rate for school age

A

18-30

81
Q

Normal HR for adolescent

A

60-100

82
Q

Normal resp rate for adolescent

A

12-16

83
Q

Physical exam consideratoins

A

Watch for decrease in weight

Watch for change in eating and sleeping habits

84
Q

What is the most common cause of death within the first year (besides prematurity)

A

Congenital heart disease (CHD)

85
Q

Risk factors of CHD

A

Meds, toxins, infections, *Maternal diabetes, PKU, family hx

86
Q

Pediatric considerations for ECG/EKG

A

Frequently check lead placement

Educate parents that nurse will monitor ECG

87
Q

Pediatric considerations for ECHO

A

Have parents at bedside to reduce stress

88
Q

Which test is used to detect cardiac dysfunction

A

ECHO

89
Q

Cardiac Cath

A

Invasive procedure, catheter inserted into femoral vein into the heart

90
Q

Assessments during cardiac cath

A

Assess heart rate, temp, resp rate

91
Q

Risk factors following cardiac cath procedure

A

Increased bleeding, stroke, loss of pulse, cardiac tamponade, anxiety/stress

92
Q

Post-cardiac cath considerations

A

Watch for bleeding- apply pressure to site

No bath for a week after- showers are okay

93
Q

Which position helps most with perfusion?

A

Supine

94
Q

What are the 4 defects of Tetralogy of Fallot?

A

Ventricle septal defects (VSD)
Pulmonary stenosis
Overriding aorta
Right ventricle hypertrophy

95
Q

What are tetralogy of fallot patients prone to?

A

Blue spells or tet spells

96
Q

What are Blue spells/ tet spells?

A

Occurs when oxygen demands exceed supply

97
Q

When do blue spells typically occur?

A

When crying, eating, stooling, stressful situations, morning time

98
Q

Age of blue spells

A

2 months- 1 year

99
Q

Treatment for blue spells

A

Positioning knee-chest
Calming
Oxygen
Morphine- to reduce spasm

100
Q

Comfort care for blue spells

A

Comfort holds by parent
Lidocaine- J Tip for IV insertion
Sweeties
Pacifier

101
Q

Typical Digoxin dose

A

0.05mg/ml
Infant doses calculated in MCG
1000mcg=1mg

102
Q

Education for digoxin

A

Teach parents to count apical HR

103
Q

S/Sx of digoxin toxicity

A

Vomiting, Hypotension, Slow HR

104
Q

CHF management

A

Fluid balance
Diuretics
Strict I & Os (weight diapers)
Daily weights (same time daily)

105
Q

CHF diagnostic tests

A

Clinical symptoms
Chest X Ray
ECG
ECHO

106
Q

S/Sx of bacterial endocarditis

A

Splinter hemorrhages in fingernails
Olser nodes
Janeway lesions

107
Q

Common with fever, pain, anemia. dehydration

A

Supraventricular tachycardia (200-300bpm)

108
Q

Kawasaki disease

A

Acute systemic vasculitis

109
Q

Kawasaki disease treatment

A

IVIG
Long term Aspirin
Repeat cardiac ECHO

110
Q

Tell tale sign of Kawasaki disease

A

Fever lasting over 5 days

111
Q

Which defect results in increased pulmonary blood flow?

A

Atrial Septal Defect (ASD)

112
Q

Which structural defects constitute tetralogy of Fallot?

A

Pulmonic stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

113
Q

What is best described as the inability of the heart to pump an adequate amount of blood to the systemic circulation at normal filling pressures?

A

Congestive heart failure (CHF)

114
Q

A beneficial effect of administering digoxin (Lanoxin) is that it:

A

Decreases edema

115
Q

The nurse is evaluating a child who is taking digoxin for her cardiac condition. The nurse is cognizant that a common sign of digoxin toxicity is:

A

Vomiting

116
Q

S/Sx of Digoxin toxicity?

A

Vomiting, hypotension, slow HR

117
Q

An 8-month-old infant has a hypercyanotic spell while blood is being drawn. The nurse’s first action should be to

A

Place the child in knee to chest position

118
Q

What is a cardiac tamponade

A

Blood or fluid in the pericardial space, constricting the heart

119
Q

The most common causative agent of bacterial endocarditis is:

A

Streptococcus viridans

120
Q

Which painful, tender, pea-sized nodules may appear on the pads of the fingers or toes in bacterial endocarditis?

A

Olsers nodes

121
Q

The primary nursing intervention necessary to prevent bacterial endocarditis is to:

A

Counsel parents of high risk children about prophylactic antibiotics.

122
Q

A common, serious complication of rheumatic fever is:

A

Cardiac valve damage

123
Q

When caring for the child with Kawasaki disease, the nurse should understand that:

A

Therapeutic management includes administration of gamma globulin and aspirin

124
Q

The nurse assessing a premature newborn infant auscultates a continuous machinery-like murmur. This finding is associated with which congenital heart defect?

A

The classic murmur associated with patent ductus arteriosus (PDA) is a machinery-like one that can be heard throughout both systole and diastole.

125
Q

What is an expected assessment finding in a child with coarctation of the aorta?

A

Disparity in blood pressure between the upper and lower extremities

126
Q

Surgical closure of the ductus arteriosus would:

A

Prevent the return of oxygenated blood to the lungs.

127
Q

A nurse is teaching nursing students the physiology of congenital heart defects. Which defect results in decreased pulmonary blood flow?

A

Tetralogy of Fallot results in decreased blood flow to the lungs.

128
Q

At what age does the infection rate increase the most?

A

3-6 months

129
Q

Nasopharyngitis

A

Common cold

VIRAL

130
Q

How is Nasopharyngitis spread?

A

Droplet

Approx radius of droplet is 3 feet

131
Q

Education on Nasopharyngitis

A

Teach parents to be careful with over the counter meds.

132
Q

Pharyngitis

A

Bacteria in back of throat

Viral OR bacterial

133
Q

What organism causes pharyngitis

A

Group A beta hemolytic streptococcal (GABHS)

134
Q

What can untreated GABHS lead to?

A

Rheumatic fever

Acute glomerulonephritis

135
Q

Tonsillitis

A

Inflammation or infection of lymph tissue

136
Q

When is the highest risk for bleeding post tonsilectomy?

A

1-2 weeks

137
Q

Prevention of influenza

A

All children over 6 months old should be vaccinated

138
Q

Tamiflu

A

Given to minimize symptoms of the flu

Start within first 48 hours of onset to be effective

139
Q

Otitis media

A

Ear infection

Viral or bacterial

140
Q

How do you administer ear drops in children

A

Pull earlobe DOWN and BACK

141
Q

Infectious Mononucleosis

A

epstein barr virus (EBV)
“kissing disease”
most common in adolescents

142
Q

What is something major to watch for in infectious mononucleosis?

A

Splenomegaly!
Causes inflammation/enlargement of spleen
Avoid impact sports/activities

143
Q

How is Mono spread?

A

Droplet

144
Q

What is a cardinal diagnostic test sign for croup?

A

Steeple sign on neck XRAY

145
Q

What does the Hib vaccine prevent?

A

Epiglottis

146
Q

What bacteria causes Epiglottis?

A

Haemophilus influenzae Type B bacteria

147
Q

Tracheomalacia

A

Soft or floppy trachea

Congenital

148
Q

Examples of chronic lower respiratory tract issues

A

Asthma and Cystic fibrosis

149
Q

Bronchitis

A

Inflammation of the large airway

150
Q

What is the most common viral infection requiring hospitalization <1 old?

A

Bronchiolitis/ RSV

151
Q

What contact prec is RSV?

A

Droplet

152
Q

1 treatment for RSV?

A

Suctioning

153
Q

What is pneumonia usually associated with?

A

Otitis media and pleural effusion

154
Q

Treatment for pneumonia?

A

Ambulate and move! TCDB

155
Q

Asthma controller meds

A

Budesonide, flucticasone, montelukast

156
Q

Asthma reliever meds

A

Albuterol, levaalbuterol, methyloprednisone

157
Q

Pediatric CPR with two people

A

15 compressions- 2 breaths

158
Q

Pediatric CPR with one person

A

30 compressions- 2 breaths

159
Q

Best position to improve breathing in children

A

Rolled towel under shoulders to open up airway

160
Q

Least invasive oxygen delivery

A

Blow-by-o2

161
Q

How many liters nasal canula?

A

0.1-4L

162
Q

How many liters face mask

A

5-15L

163
Q

What oxygen method is the bridge between regular oxygen and intubation?

A

HFNC

164
Q

Signs and symptoms of respiratory distress?

A 
Altered mental status
Restless/fussy
Stridor/gasping/grunting
Tachypnea/tachycardia
Retractions
165
Q

Complication post op tonsillectomy

A

Flash pulmonary edema-medical emergency

Monitor for first 24 hours post op

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