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PEDS exam 3 Flashcards

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1
Q

Congenital hypothyroidism

A

Failure of thyroid gland to migrate during fetal development
Low T3 and T4
If untreated=intellectual disability, delayed physical maturation, short stature and growth failure
Early identification=KEY

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2
Q

Physical cues-Congenital hypothyroidism

A

Poor sucking reflex, hypothermia, constipation, lethargy/hypotonia, preorbital puffiness, cool dry and scaly skin, bradycardia, RR distress, large fontnelles, delayed closure fontanelles, macroglossia, course facial features

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3
Q

Diagnostics (labs)-Congenital hypothyroidism

A

Low T3 and free T4(0.8-2.4ng/dL)
High TSH

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4
Q

Medications-Congenital hypothyroidism

A

L-thyroxine(Sythroid, Levothroid)

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5
Q

Medication management-Congenital hypothyroidism

A

Pill only- must be crushed and placed in 1-2 mL milk via bottle nipple or dropper
Missed doses may lead to developmental delay/poor growth

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6
Q

Teaching-Congenital hypothyroidism

A

Medication absorption affected by soy-based formulas, fiber, calcium, iron preparations, and antacids
Thyroid function tests to monitor

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7
Q

Growth hormone deficiency

A

Failure of anterior pituitary gland to produce sufficient GH or failure of hypothalamus to stimulate anterior pituitary gland. Impairs body’s metabolism of proteins, fat, carbs
-caused by injury to hypothalamus or pituitary gland

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8
Q

Cause of GH deficiency

A

Injury to pituitary gland or hypothalamus
-tumors, infection, infarction, CNS irradiation, congenital abnormalities, birth trauma, emotional depravation

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9
Q

Physical cues-Growth hormone deficiency

A

Large/prominent forehead, under developed jaw, high-pitched voice, delayed sexual maturation, delayed dentition/skeletal maturation, decreased muscle mass

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10
Q

Diagnostics-Growth hormone deficiency

A

Skeletal survey= 2+SD<normal in bone age
CT/MRI- tumors/rule out abnormalities
Pituitary function test to confirm

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11
Q

Medications-Growth hormone deficiency

A

Bio synthetic GH via Sub-Q injections
-0.18-0.3 mg/kg/week divided into equal daily doses

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12
Q

Medication management-Growth hormone deficiency

A

Monitor for s/e of meds
Monitor effectiveness of hormone replacement(measure height Q3-6 mo
-continued until growth rate of less than 1 in/yr or bone age >16(boys) or >14 (girls)

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13
Q

Type 1 DM

A

Deficient insulin secretion due to pancreatic beta cells damage
-quicker onset, autoimmune, Dx at younger age

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14
Q

Diagnostics-Type 1 DM

A

Blood sugar(and fasting glucose) and chemical panel, CBC, UA, oral GTT

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15
Q

Expected lab findings-Type 1 DM

A

BS>200mg/dL
Fasting glucose >126mg/dL
HbA1C:>6.5%
Chem panel: evaluate BUN/creatinine, Ca+, Mg+, PO4-, Na+
UA- presence of ketones and glucose
Oral GTT >200mg/dL at 2 hrs

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16
Q

Hypoglycemia s/s

A

Shakiness, lightheadedness, hunger, pallor, cool skin, diaphoresis, irritability, anxiety, slurred speech, tachycardia, palpitations, normal/shallow RR , seizures leading to coma, dec LOC

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17
Q

Hypoglycemia management

A

BS <60mg/mL
If child coherent- feels s/s hypo
-give glucose tab/15g of simple CHO (OJ/milk), followed by complex CHO(PB and crackers)
Incoherent:glucagon Sub-Q or IM
-under 20kg=give 0.5mg
-over 20kg= give 1 mg
-D50 IV PRN

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18
Q

Hyperglycemia S/S

A

Mental/behavior changes, weakness, fatigue, polyuria, polydipsia, polyphagia, HA, enuresis, blurred vision

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19
Q

Insulin types

A

Rapid acting,Short acting, intermediate acting, long acting

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20
Q

Rapid acting insulin

A

Novolog(aspart), Humalog(Lispro)

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21
Q

Short acting insulin

A

Regular (Humulin R, Novolin R)

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22
Q

Intermediate acting insulin

A

NPH(Humulin N, Novolin N)

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23
Q

Long acting insulin

A

Glargine(Lantus)DO NOT MIX, detemir(levemir), degludec (Tresiba)

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24
Q

Proper insulin administration

A

Sub-Q, self administer 2 times or more/day. rotating sites Q 4-6 injections. 2 in from Umbilicus=best absorption.
Draw up short acting (clear) first then longer-acting insulin (cloudy)
-90 degree angle, pinch up skin if thin

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25
DKA
Diabetic ketoacidosis Acute life threatening condition, untreated hyperglycemia- rapid onset Untreated=coma which can progress to death, high mortality
26
Physical and lab cues-DKA
Dehydration N/V, fruity breath, BS>330mg/dL, dyspnea, confusion, ketonuria
27
Management-DKA
Priority=stabilize glucose, rehydration, electrolyte balance
28
Nursing actions-DKA
-BGL monitoring-prevent from falling <100mg/dL/hr(causes cerebral edema) -IVFs for dehydration tx, correct Na+ and K+, improve peripheral perfusion -IV regular insulin drip and sliding scale
29
Trisomy 21
-Extra copy of chromosome 21 -Most common chromosomal abnormality associated with generalized syndrome -medical conditions accompany: congenital heart malformation, hypotonicity, immune system dysfunction, thyroid dysfunction, leukemia
30
Trisomy 21 features
-upslanting palpebral fissures -low-set , small folded ears -flattened nasal bridge -epicanthal fold -small, typically white, spots arranged in a ring of iris(brushfield spots) -short neck -single palmar crease
31
Complications-trisomy 21
Aspiration, FTT, hypothyroidism, atlantoaxial instability, cardiopulmonary issues, hearing/vision impairments, behavioral problems, anemia, leukemia, frequent OM, sleep apnea
32
Trisomy 21 risk factors
Advanced maternal age >35, paternal age greater than 55 years
33
Priorities of care-trisomy 21
Preventing complications, promoting nutrition, G&D support and education
34
Neuro assessment
LOC, motor function, pupils
35
LOC-Neuro assessment
Pediatric coma scale Lower the score, less responsive the child
36
Motor function-Neuro assessment
Decorticate, decerebrate, opisthotonic posturing
37
Decorticate posturing
Damage to cerebral cortex/lesion to corticospinal tracts above brainstem -rigid flexion of arms held tightly to body; flexed elbows and wrists/fingers, plantar flexed feet, legs extended and internally rotated -fine tremors or intense stiffness
38
Decerebrate posturing
Damage to brainstem and extrapyramidal tracts -rigid extension and pronation of arms/legs, flexed wrists and fingers, clenched jaw, extended neck, possibly arched back
39
Opisthotonic posturing
Abnormal posturing caused by severe muscle spasms -primarily affects infants and children due to immature nervous system
40
Pupils-Neuro assessment
Pinpoint, sunset, unilateral sudden dilation, anisocoria, dilated and reactive, dilated and fixed(mydriasis)
41
Pinpoint pupils
Poisonings, brain stem dysfunction and opiate use
42
sunset eyes
Sign of increased ICP- often associated with hydrocephalus
43
Dilated and reactive pupil
Seen after seizures
44
Mydriasis
Fixed and dilate pupils- brain stem herniation due to increased ICP
45
unilateral sudden dilation-pupils
Associated with intracranial mass (tumor)
46
anisocoria
Benign condition- naturally different sized pupils
47
Hydrocephalus
Not a specific brain disorder, but caused by an underlying condition -excessive CSF within cerebral ventricles/subarachnoid spaces= ventricular dilation and IICP
48
Physical findings/cues-Hydrocephalus
-Lethargy, irritability -poor feeding, vomiting -altered, diminshed, change in LOC -wide open, bulging fontanelles(infants) -c/o HA (older children) Macewen sign: “cracked pot”, suture separation with percussion
49
Macewen sign
“Cracked pot”- suture separations with percussion
50
VP shunt
Tx for hydrocephalus
51
VP shunt placement
Infection most common 1-2 months after placement
52
VP shunt assessments
Monitor for s/s infection, shunt malfunction(vomiting, drowsiness, HA), increased ICP
53
VP shunt complications
Blockage and infection(1-2mo after placement): - inc VS, poor feeding/vomiting, dec responsiveness, seizures, local inflammation at shunt insertion site -vomiting, drowsiness, HA typically r/t shunt malfunction
54
VP shunt complication tx
Infection: IV abx If persistent s/s, shunt removed and external ventricular drain (EVD) placed until CSF=sterile
55
Increased ICP
normal=15-20mmHg
56
Early Clinical manifestations-Increased ICP
Headache, vomiting (projectile), blurred vision, dizziness, tachycardia, irritability, changes in LOC Infants: bulging tense fontanelle, wide sutures and inc HC, dilated scalp veins, high-pitched cry
57
Late increased ICP manifestations
Posturing, fixed and dilated pupils, Cushing’s triad(irregular breathing, HTN, bradycardia)
58
Cushing’s triad
Irregular breathing, bradycardia, HTN
59
Cushing’s triad-Increased ICP
Late sign of brain stem herniation warning
60
Nursing actions-Increased ICP
Normal 5-15 mmHg -keep head midline with HOB at 30 degrees -minimal oral sx,NO nasal sx -avoid coughing, sneezing, blowing nose -stool softener to prevent valsalva -calm,quiet .limit visitors, seizure precautions -I&O’s
61
Monitoring-Increased ICP
Sensing device inserted through cranium to detect ICP; monitored closely, alarms on at all times, measures to dec ICP
62
Seizures
Three types Seizure precautions (pad bed rails, O2 and suction at bedside) -phenytoin -fosphenytoin
63
Seizure types
Tonic-clonic, absence, febrile
64
Generalized seizures
Tonic-clonic, absence
65
Tonic-clonic seizures
Stiffening of limbs and violent jerking -loss of swallow reflex -piercing cry with LOC -incontinence -apnea/cyanosis Post-ictal period=30min-2hrs of deep sleep; sore muscles; no recollection
66
Absence seizures
LOC 5-10 sec, motionless blank stare’ resembles daydreaming; may lip smack or twitch eyes/face; immediately resume previous activities
67
Febrile seizures
Rapid rise in temp to 102.2 or higher, lasting 15-20 sec once in 24 hr period without CNS infection, brief post-ictal period
68
Labs/diagnostics-seizures
Glucose, electrolytes, Ca+=rule out dec BS and dec Ca+ LP=rule out meningitis or encephalitis Skull XR= fracture or trauma CT/MRI= ID abnormality, bleeds, tumors EEG= evaluate seizure type Video EEG= evaluate behavior and “catch a SZ”
69
Nursing actions during seizures
Seizure precautions (pad side rails, O2, suction at bedside) phenytoin and fosphenytoin
70
Nursing actions post seizure
Maintain side-laying position Suction mouth as needed Reorient/calm child LOC assessment Assess WOB,VS,head position and tongue, injuries? DO NOT OFFER FOOD/FLUIDS UNTIL FULLY AWAKE AND SWALLOW REFLEX HAS RETURNED
71
Medication management- seizures
Primary treatment=med therapy with single-drug therapy at lowest dose possible, doses change as child grows Do not stop medications-breakthrough seizures
72
Phenytoin
IV or PO, NO IM Monitor levels to ensure therapeutic dosing, gingival hyperplasia. Monitor Ca, Mg, folate; IV form in NS ONLY
73
Fosphenytoin
IM,IV Less adverse effects than phenytoin; more expensive -water soluble, does not precipitate Quicker administration
74
Bacterial meningitis
Infection of meninges surrounding brain and spinal cord; medical emergency- prompt ICU admission and tx
75
Physical cues older children- bacterial meningitis
Sudden onset of S/S -fever, chills, HA, vomiting, photophobia, stiff neck (nuchal rigidity), rash, irritability, drowsiness, lethargy, muscle rigidity , seizures
76
Physical cues-infants- bacterial meningitis
Fever, extreme sleepiness, bulging fontanelle, crying, seizures, poor suck or feeding, weak cry and lethargy, vomiting, inconsolable, opisthotonic positioning Pin-prick rash Shivering Turning away form lights Stiff neck Arching back Cold hands and feet
77
Labs/diagnostics-bacterial meningitis
Lumbar puncture CBC Blood/urine/NP CX Positive Kernig and brudzinski sign Presence of rash/purpura or Petechiae
78
Lumbar puncture-bacterial meningitis
Increased WBCs, decreased glucose, high protein, cloudy in color
79
Nursing priorities-bacterial meningitis
Treat infection
80
Nursing actions-bacterial meningitis
Droplet isolation; IV abx, manage hyperthermia, reduce ICP, ventilator support
81
Reye syndrome
Encephalopathy and liver failure associated with previous illness (viral) and ASA ingestion
82
Physical and lab cues=reye syndrome
Stage 1-5 progression Severe vomiting/lethargy/confusion—>stupor—> fixed and dilated pupils/decerebrate—>parallysis, no pupillary response, resp arrest, death Lab cues=inc LFTs (AST/ALT) Inc ammonia, bilirubin,amylase/lipase,inc PT
83
Nursing management-reye syndrome
Supportive care (dec ICP, Kayexalate, vit K, FFP)
84
Priority of care- reye syndrome
Decreasing ICP, bleeding precautions (Vit K and FFP)
85
Spina bifida cystica
Visible defect with saclike protrusion of meninges, spinal fluid, and nerves with varying degrees of neuromuscular,limb, and sensory deficits
86
Meningocele vs myelomeningocele-spina bifida cystica
Meningocele=less serious form of spina bifida cystica, meninges and spinal fluid herniate though defect in vertebrae Myelomeningocele=most severe form, not visible sac protruding from spinal area
87
Priority of care-spina bifida cystica
Prevent repture of sac
88
Meningocele-spina bifida cystica
89
Myelomeningocele-spina bifida cystica
90
Fractures-neurovascular assessment
91
Priorities of care-fractures
Neurovascular assessment, pain
92
Complications-fractures
Compartment syndrome-5P’s
93
5 P’s-fractures
Pallor, pain, paresthesia, pulselessness,
94
Scoliosis
Lateral curvature of the spine
95
Scoliosis-physical findings
96
Post-op care: scoliosis
97
Scoliosis procedure
98
Developmental dysplasia of the hip (DDH)
Risk factors: family Hx, firstborn, female, breech position
99
DDH
Developmental dysplasia of the hip, three kinds: dysplasia, dislocation, subluxation
100
Priorities of care-DDH
Neurovascular assessment, skin care, parent teaching
101
Assessment findings:DDH
Asymmetry of gluteal folds in prone position ; unequal umber of skin folds on posterior thigh; shorter affected limb, walk with limp (older child)
102
Teaching guidelines-DDH
Pavlik harness: do not adjust straps, must wear
103
Muscular dystrophy
104
Nursing management-muscular dystrophy
105
Priority of care- muscular dystrophy
106
Labs and diagnostics-muscular dystrophy
107
Cerebral palsy
108
Nursing priorities- cerebral palsy

Peds/OB (12 decks)

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