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Peds exam 3 Flashcards

1
Q

First signs of hematologic disorder or cancer in children?

A

Skin color changes such as pallor, bruising, and flushing are often the first signs that a problem is developing
-change in mental status (lethargy) can indicate low hemoglobin levels

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2
Q

Physical examination of the child with a hematologic or neoplastic disorder includes what?

A

inspection and observation
palpation
auscultation

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3
Q

general appearance and observation of child with disorder of altered cellular regulation

A

-thin, frail appearance
-asymmetry of body parts

-altered consciousness
-child’s response to stimuli

-bleeding gums or pale mucous membranes
-assess for rectal bleeding or vaginal discharge

-pallor in nail beds, palms, and soles
-clubbing of fingers

-assess urinary output
-assess vital signs
-assess conjunctiva

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4
Q

Auscultation for children with altered cellular regulation

A

assess for any adventitious breath sounds or heart murmurs
-assess rate, rhythms, tone
-listen to bowel sounds

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5
Q

Palpation with altered cellular regulation disorders

A

Measure BP (may change with alterations in blood volume)
Measure peripheral pulses
Assess capillary refill (may be prolonged)
Palpate lymph nodes
Palpate abdomen for splenomegaly, hepatomegaly, tenderness
Assess for swelling in any parts of the body
Assess skin temp
Assess skin elasticity (turgor)
Assess if joints are tender and if ROM is limited

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6
Q

Common medical treatments for cancer and altered cellular regulation disorders

A

Blood transfusion
Leukapheresis- Removal of the blood to collect specific blood cells. The remaining blood is returned to the body.
Hematopoietic stem cell transplantation
Supplemental oxygen
Biopsy
Splenectomy
surgical removal of tumor
Radiation
Central venous catheter
Implanted port

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7
Q

Benefit to acupuncture

A

may help to decrease nausea, vomiting, and aversion to chemotherapy.

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8
Q

Adverse effects of radiation therapy vs chemotherapy

A

radiation therapy:

include
-FATIGUE,
-nausea, vomiting,
-oral mucositis,
-myelosuppression- A condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets., and
-ALTERATIONS OF SKIN INTEGRITY at the site of irradiation

chemotherapy:

-immunosuppression –>infection, myelosuppression,
-nausea, vomiting,
-CONSTIPATION,
-oral mucositis,
-ALOPECIA, and
-PAIN

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9
Q

Hemopoietic stem cell transplant indications
(cases when performed)

A

leukemias, lymphomas, sickle cell disease, aplastic anemia, thalassemia

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10
Q

hemopoietic stem cell transplant considerations (what to maintain, provide, avoid)

A

Maintain medical asepsis and isolation (prevents infection)
Provide good oral care
Avoid rectal temps or suppositories

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11
Q

indications for radiation therapy (4)

A

before or after surgical resection
leukemia
lymphoma
solid tumors

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12
Q

a-fetoprotein (AFP)
-where produced
-decreased levels by what age
-elevated in what cases
-determines what

A

produced by fetal liver and yolk sac
decreases to very low levels by age one
-usually elevated in Hodgkin disease and other cancers
-determines tumor burden

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13
Q

Urine catecholamines (VMA, HVA)
-diagnosis for what
-involves what?
-levels altered by what?

A

catabolism of catecholamines causes elevated levels in the urine
-Diagnosis of neuroblastoma
-involves 24-hour urine collection
-levels may be altered with certain foods and vigorous exercise

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14
Q

MRI in evaluating cancer

A

can identify extent of tumor or metastatic spread

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15
Q

CT in evaluating cancer

A

can identify location of tumor or metastasis

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16
Q

Ultrasound in evaluating cancer

A

identify tumor presence, especially in abdomen or kidney

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17
Q

Bone marrow aspiration and biopsy

A

evaluation for leukemia or metastasis of other cancers in bone marrow

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18
Q

Bone scan

A

identifies metastasis of bone

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19
Q

chest x-ray use

A

identifies tumor or metastasis in the thorax
*x-ray is mainly used to monitor cancer

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20
Q

Anemia

A

is a condition in which the level of RBCs is lower than the age-appropriate normal value. Anemia may develop as a result of decreased production of RBCs or loss and destruction of RBCs.

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21
Q

What can cause anemia?

A

related to lack of dietary intake of the nutrients needed to produce the cells, alterations in the cell structure, or malfunctioning tissues (e.g., bone marrow), toxin exposure, medication, trauma

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22
Q

Anemias related to nutritional deficiency

-may be related to what?

A

iron deficiency,
folic acid deficiency, and
pernicious anemia

-maybe related to food dislikes or malabsorption issues

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23
Q

Anemia related to toxin exposure

A

example is lead poisoning

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24
Q

Hemolytic anemia

A

Anemia caused by the alteration or destruction of the RBCs

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25
Types of hemolytic anemia
sickle cell disease thalassemia
26
Therapeutic management of iron deficiency anemia
iron supplements (ferrous sulfate or ferrous fumarate) 4 to 6mg/day -take with vitamin c -teeth staining -dark stools Blood transfusions if anemia is severe Monitor labs
27
sickle cell disease pathophysiology
RBCs sickle and clump together--->preventing blood flow to tissues in the area. The sickled shaped cells can't pass through the capillaries and venules of the circulatory system-->local tissue hypoxia, ischemia
28
sickle cell disease therapeutic management
Manage pain (PCA if appropriate) NSAIDs hydration prevent infection (prophylactic antibiotics, immunizations) supplemental oxygen possible blood transfusion manage stress
29
What medication should not be given to patients with sickle cell crisis?
meperidine (Demerol)
30
first sign of sickle cell crisis?
pain
31
nursing interventions to prevent sickle cell crisis (4)
Managing pain, stress immunizations, prophylactic antibiotics
32
Idiopathic Thrombocytopenic Purpura (ITP) value monitoring
platelets
33
surgery care for patient with ITP
make sure to monitor surgery sites for bleeding
34
signs of brain tumor
headache altered mental status hypertension increased intracranial pressure blown pupils
35
Delaying cord clamping
helps with iron deficiency
36
administering intravenous immunoglobin
hydration watch for adverse reactions physical assessment before administration vital signs stay with them for first 30 minutes monitor for dehydration throughout administration
37
Therapeutic effect of immunoglobin G
hydration should improve throughout administration
38
HIV medications what to educate about MOA
educate about compliance Helps prevent infection and spread
39
SLE testing
test for ANA (antinuclear antibody) presence (blood test)
40
Managing Myasthenia Gravis
preventing infection is important
41
Signs of food allergy
anaphylactic shock rash, hives diarrhea, vomiting, cramps, bloating, nausea congestion, swelling of tongue or throat, runny nose, cough, wheezing, asthma
42
what medication to have on hand for food allergies?
epipen Benadryl
43
signs of endocrine disorder what is important
growth issues look at health history/exams *health history is important
44
growth hormone production occurs where?
pituitary gland
45
Dwarfism
Condition caused by insufficient growth hormone in childhood
46
too much growth hormone
gigantism
47
interventions for Addison's
talk to school about IEP (allowing bathroom breaks) give fluids An Individualized Education Program is a legal document under United States law that is developed for each public school child in the U.S. who needs special education. It is created through a team of the child's parent and district personnel who are knowledgeable about the child's needs.
48
congenital hypothyroidism s/s
constipation, weight gain, not thriving, fatigue SLOOWWWW
49
congenital hypothyroidism interventions
promote growth education rest breaks make sure environment is good
50
Signs of adrenal crisis
Confusion, abdominal pain, dehydration, low BP, high fever, rapid heart and breathing rate, nausea vomiting
51
managing adrenal crisis
education corticosteroid use
52
developmental issues related to diabetes education
educate child and parents about adherence and health promotion
53
education for diabetes
diet carb counting how to administer insulin/where to administer insulin risk for complications (DKA, infection)
54
primitive vs protective reflexes
55
considerations with casts- what to make sure
make sure to reposition
56
Metatarsus adductus activity
encourage ROM -prevent injury to other joints
57
developmental dysplasia of the hip
check gluteal folds Dev hip dysplasia- pelvis drops when hip raised, thigh and gluteal folds asymmetrical, knee height is unequal, Barlow and Ortollani test positive
58
Rickets
lack of vitamin D soft bones Darker pigmented skin
59
Leg-Calve-Perthes Disease what is it what to monitor
Necrosis of the femoral head monitor bone with x-ray
60
scoliosis assessment
assess compliance with brace
61
priority for seizures
safety
62
lab diagnostics for seizure
EEG
63
lab diagnostics for meningitis
lumbar puncture
64
hydrocephalus what to monitor
abnormal accumulation of fluid (CSF) in the brain -monitor shunt for infection (drowsiness, nausea, headache)
65
craniocytosis how diagnosed
diagnosed by x-ray (out of womb) can be diagnosed with ultrasound -can have surgery
66
Brudzinski's sign
Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed
67
how to tell if antibiotics are working with bacterial meningitis?
culture
68
management with meningitis
try to prevent complications
69
warning signs of head trauma
retinal hemorrhage fixed and dilated pupils confusion
70
neurological disorder meds
phenytoin benzos
71
Neurofibromatosis complications
tumor on peripheral nerves Complications: learning disorders, depression, pain
72
nursing management for neurofibromatosis
biopsy to see if it's benign or malignant
73
good way to assess child for autism
see how they play
74
Signs of ITP -what to assess?
increased bruising, epistaxis, or bleeding of the gums are signs of ITP -assess for blood in the stool -assess for petechiae on lips and buccal mucosa
75
Risk factors for ITP what to assess?
-recent viral illness, -recent MMR immunization, or -ingestion of medications that can cause thrombocytopenia. Inspect for petechiae, purpura, and bruising, which may progress rapidly within the first 24 to 48 hours of the illness
76
laboratory findings for ITP platelets wbc hbg/hct What is done to r/o leukemia?
Extremely low platelet count (less than 50,000) normal WBC normal hemoglobin and hematocrit Bone marrow aspiration may be performed to rule out leukemia
77
Nursing management for ITP what to use for pain? what to avoid?
Medical treatment might not be needed, just observation Avoid NSAIDs Use acetaminophen (tylenol) for pain avoid activities that may cause trauma/injury
78
humoral immunity
mediated by antibodies secreted by B cells
79
Cellular immunity
cell mediated immunity controlled by T cells
80
Which type of immunity is present at birth? Which type will develop as newborn is exposed to organisms?
Cellular immunity -humoral immunity will develop as newborn is exposed to organisms
81
considerations with newborn immune system
the healthy full-term infant's immune system is still immature. The newborn exhibits a decreased inflammatory response to invading organisms, --> increases his or her susceptibility to infection.
82
Thymus in young children
is quite enlarged at birth and remains so until about 10 years of age
83
Tonsils in young children
often enlarged
84
What temperature does IV immunoglobulin need to be infused at?
room temp. Can be stored in fridge
85
What labs need to be assessed before administering immunoglobulin?
Assess baseline serum blood urea nitrogen (BUN) and creatinine, as acute renal insufficiency may occur as a serious adverse reaction.
86
preparing immunoglobulin what not to do?
needs to be reconstituted needs to be administered at room temp *Do not shake bottle
87
What needs to occur before administering immunoglubulin?
-patient needs to be hydrated -may need to administer diphenhydramine or acetaminophen before infusion in some cases -baseline physical assessment and vital signs -calculate rate
88
When is diphenhydramine or acetaminophen indicated for IVIG?
-children who have never received IVIG, -have not had an infusion in more than 8 weeks, -have had a recent bacterial infection, -have a history of serious infusion-related adverse reactions, or -are diagnosed with agammaglobulinemia or hypogammaglobulinemia
89
Rate of IVIG
start infusion slowly and increase to the prescribed rate as tolerated
90
assessing vital signs and adverse effects when administering IVIG
Assess vital signs and check for adverse reactions every 15 minutes for the first hour, then every 30 minutes throughout the remainder of the infusion
91
signs of anaphylactic reaction
-headache, -facial flushing, -urticaria,(Urticaria – also known as hives, weals, welts or nettle rash – is a raised, itchy rash that appears on the skin.) -dyspnea, -shortness of breath, -wheezing, -chest pain, -fever, -chills, -nausea, vomiting, -increased anxiety, or -hypotension
92
What supplies/meds are needed for IVIG administration in case of emergency?
Have oxygen and emergency medications such as epinephrine, diphenhydramine, and intravenous corticosteroids available in case of anaphylactic reaction
93
What can you do if pt complains of discomfort at the IV site when administering IVIG?
cold compress might help
94
Therapeutic management for HIV
the use of a combination of antiretroviral medications
95
Types of medication therapy for HIV
Medication therapy ranges from single-drug therapy in the asymptomatic HIV-exposed newborn to highly active ART, consisting of a combination of antiretroviral drugs. Medications are prescribed based on the severity of the child's illness.
96
Goal of ART- antiretroviral therapy
to prevent or arrest progressive HIV encephalopathy
97
Nursing management for HIV
-directed at avoiding infection, -promoting compliance with the medication regimen, -promoting nutrition, -providing pain management and comfort measures, -educating the child and caregivers, and -providing ongoing psychosocial support
98
signs of SLE
fatigue, fever, weight changes, pain or swelling in the joints, numbness, tingling or coolness of extremities, or prolonged bleeding, stomatitis, alopecia, anemia, seizure, Raynaud -malar rash, discoid lesions on face or neck, pigmentation change of the skin
99
lab findings for SLE wbc platelet hct/hbg complement levels (c3 c4) ANA
low hematocrit and hemoglobin low platelet low WBC Complement levels (C3 and C4) are low Antinuclear antibody (ANA) will be positive
100
What might be the first sign of juvenile idiopathic arthritis in young children/infants?
irritability/fussiness
101
Signs of juvenile idiopathic arthritis
doesn't want to play/get out of bed fever evanescent, pale red, nonpruritic macular rash mild to moderate anemia elevated ESR swollen, red, tender joints Positive ANA (young children), positive rheumatoid factor in adolescents flexed joints gait is limp or pt is guarding of a joint
102
Signs of myasthenia gravis
fatigue weakness difficulty chewing difficulty swallowing difficulty keeping head up pain with muscle fatigue ptosis (eyelid drooping) altered eye movements from partial paralysis
103
lab testing for myasthenia gravis
may involve the edrophonium (Tensilon) test, in which a short-acting cholinesterase inhibitor is used. Acetylcholine receptor (AchR) antibodies may be present in elevated quantities in the serum.
104
goals for nursing management of myasthenia gravis
include prevention of respiratory problems and providing adequate nutrition
105
Nursing management for myasthenia gravis
Administer meds (anticholinergic meds)-needs to be on time see provider if chance of infection manage stress avoid extreme temps notify provider if concerned about myasthenia crisis or cholinergic crisis encourage child to wear a medical bracelet
106
Administering anticholinergic meds
should be given 30 to 45 minutes before meals, on time and exactly as ordered
107
signs of myasthenia crisis
severe muscle weakness, respiratory difficulty, tachycardia, and dysphagia -increased muscle weakness with resultant respiratory distress
108
sign of cholinergic crisis
severe muscle weakness, sweating, increased salivation, bradycardia, and hypotension. -increased muscle weakness with resultant respiratory distress
109
signs of food allergy reaction
hives, flushing, facial swelling, mouth and throat itching, and runny nose. Many children also have a gastrointestinal reaction, including vomiting, abdominal pain, and diarrhea. In extreme cases, swelling of the tongue, uvula, pharynx, or upper airway may occur. Wheezing can be an ominous sign that the airway is edematous.
110
risk factors for food allergy reactions
previous exposure to the food, history of poorly controlled asthma, or an increase in atopic dermatitis flare-ups in relation to food intake.
111
food allergy testing
Allergy skin-prick tests and radioallergosorbent blood tests (RASTs) -food specific IGE test -For an oral challenge, the child slowly eats a serving of the offending food over the period of 1 hour. Record vital signs and note the presence or absence of allergic symptoms.
112
Medications for food allergy reaction
histamine blockers and, in anaphylactic reactions, epinephrine.
113
pt education for food allergy
have written plan in case of emergency teach how to administer meds teach that it's important to read food labels teach about food substitutes signs and symptoms of reaction Refer families to Food Allergy and anaphylaxis network
114
Therapeutic management of anaphylaxis
focuses on assessment and support of the airway, breathing, and circulation
115
Nursing management for anaphylaxis
ABCs oxygen through mask or bag mask bronchodilator if pt is having bronchospasm IV fluids Observe child for 4 to 6 hours
116
Foods that cross react with latex
pear, peach, passion fruit, plum, pineapple, kiwi, fig, grape, cherry, melon, nectarine, papaya, apple, apricot, banana, chestnut, carrot, celery, avocado, tomato, or potato.
117
clinical manifestations of endocrine disorders occur as the result of?
as a result of the altered control of the bodily processes normally regulated by the gland or hormone.
118
Health history for endocrine disorders
look at growth and development look at family trees see how child is interacting with other kids assess behavior or moods assess if child is having excessive thirst, frequent urination, vomiting, inactivity, fatigue
119
GH deficiency pathophysiology
failure of pituitary and hypothalamus
120
Signs of GH deficiency
higher weight to height ratio large face higher subq fat deposits in abdomen high pitch voice delayed sexual maturation decreased muscle mass
121
Ways to diagnose GH deficiency
x-rays of bones (bone age) CT/MRI to rule out tumors Pituitary function testing
122
pituitary function testing
This test consists of providing a GH stimulant such as glucagon, clonidine, insulin, arginine, or L-dopa to stimulate the pituitary to release a burst of GH -confirms diagnosis
123
signs of diabetes insipidus
abrupt signs of dehydration (irritability) polyuria polydipsia intermittent fever vomiting constipation frequent trips to the bathroom, enuresis, nocturia
124
nursing management for DI
Promoting hydration promoting activity (bathroom breaks, have fluids by child) education
125
Nursing assessment of SIADH
decreased urine output and weight gain, or GI symptoms such as anorexia, nausea, and vomiting. Assess neurologic status, noting lethargy, behavioral changes, headache, altered level of consciousness, seizure, or coma -Neuro symptoms develop as sodium level decreases (lethargy)
126
complications of congenital hypothyroidism
intellectual disability failure to thrive
127
Congenital Adrenal Hyperplasia (CAH)
management focuses on stopping the excessive adrenal secretion. usually given hydrocortisone, fluticocortisone will try to correct external genitalia
128
signs of acute adrenal crisis
persistent vomiting, dehydration, hyponatremia, hyperkalemia, hypotension, tachycardia, and shock -IV steroids, fluids, dextrose
129
signs of shunt infection
elevated vital signs, poor feeding, vomiting, decreased responsiveness, seizure activity, and signs of local inflammation along the shunt tract
130
signs of shunt malfunction
vomiting, drowsiness, and headache
131
nml hct
36-52
132
nml creatinine
0.6-1.2
133
nml BUN
6-24
134
nml hbg
12-18 f: 12-16 M: 14-18
135
nml platelets
150,000-450,000 <40,000 be very concerned!
136
nml wbc
4.5-11
137
nml ca
9-11
138
nml phosphorus
2.5-4.5
139
nml cloride
95-105
140
mom --> son K(evin) mom --> daughter Turner
141
low estrogen --> osteoporosis
142
get culture first --> give broad spectrum
143
ADHD - nonstimulants ADD- stimulants
144
wilm's tumour- don't palpate abdomen
145
primitive: born with moro- suck root babinski palmar grasp plantar grasp the step protective: permanent parashchute riding
146
atypical trazadone- depression
147
hispanic- high risk for lymphoma

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