Peds Exam 4 Flashcards
cancer, skin, burns, immunity, sensory (152 cards)
1
Q
What is the word for farsightedness
A
hyperopia
2
Q
what is the term for nearsightedness
A
myopia
3
Q
The medical term for lazy eye is what
A
amblyopia
4
Q
What is the management for amblyopia
A
patching the stronger eye to force the brain to receive input from the affected eye and strengthen the muscles
atropine drops daily in the stronger eye
visual therapy
eye muscle surgery
5
Q
What happens if amblyopia goes untreated
A
blindness in one or both eyes
6
Q
what are the 2 different types of hearing loss
A
conduction
sensorineural
7
Q
What is conductive hearing loss and what is it caused by
A
transmission of sound through the middle ear is disrupted caused by frequent ear infections
8
Q
What is sensorineural hearing loss and what is it caused by
A
damage to the hair like cells in the cochlea caused by a meningitis, rubella, or ototoxic meds
9
Q
What should the nurse do before touching or approaching a child with visual impairment
A
announce themselves,
explain their surroundings, explain procedures
10
Q
What is acute otitis media
A
infection of the middle ear structures , bacterial (strep), or viral (RSV, influenza)
11
Q
What is the treatment for acute otitis media
A
amoxicilliin or augmentin , azythromicin, ibuprofen or acetaminophen for pain, benzocaine drops if TM is intact
12
Q
How should the nurse install eardrops
A
place the child where the affected ear is straight up
<3 pull pinna down and back
>3 pull pinna up and back
massage the tragus cartilage
keep the child in this position for 2-5 minutes
13
Q
What are the symptoms of acute otitis media
A
pain in ear, pulling at ear, low grade fever, irritability or crying, lymphadenopathy, difficulty sleeping
tm: red, dull, decreased/no movement, bulging
14
Q
What is otitis effusion
A
when there is no infection or inflammation, only fluid related to enlarged adenoids or allergies
15
Q
What does the TM look like with otitis effusion
A
dull orange discoloration, air bubbles, decreased movement
16
Q
what are symptoms of otitis effusion
A
feeling of fullness, transient hearing loss possible
17
Q
what is the treatment for otitis effusion
A
resolve on its own
contact ENT if lasts more than 3 months
assess hearing or speech delay
18
Q
what is another term for otitis externa
A
swimmers ear
19
Q
what is otitis externa
A
infection in the ear canal from a bacteria or fungus
20
Q
what are signs of otitis externa
A
white or colored discharge, edematous ear canal, ear pain or itching, fullness
21
Q
what is the treatment for otitis externa
A
ciprodex drops for 7 days, analgesics, warm compress, keep ear dry after swimming or bathing
22
Q
what are history cues with otitis externa
A
swimming or playing in the bathtub
23
Q
What are tympanostomys used for
A
child with recurrent ear infections
24
Q
what do tympanostomies do
A
balance the pressure between the inner and outer ear to allow movement of the TM to improve speech through better healing development
25
how does the nurse teach the parents about tympanostomies
these tubes will come out on their own
the surgery only takes about 15 minutes
pain is not common
use ear plugs when swimming and if water gets into the ear allow it to dry
call dr with any drainage
26
What are the symptoms in infants associated with hearing loss
wakes to touch only
no babble by 6 months
27
What are the symptoms of hearing loss in a young child
does not speak by age 2
communicates needs through gestures
does not respond to doorbell or telephone
28
what are symptoms of hearing loss seen in the older child
ask statements to be repeated
inattentive or daydream
poor school performance
mono toned speech
29
what are the different types of skin injuries
abrasion- superficial rub or wearing off of the skin from friction, mainly epidermis
laceration- injury that penetrates skin and soft tissue
30
what are risk factors for skin injuries
poverty, premature, chronic illness, intellectual disability, parent with abuse history, alcohol or substance abuse, stressors
31
1st degree burn
only to the epidermis
painful, blanchable
pink to red with no blisters
32
second degree superficial partial
painful with blisters
red
mild mod edema
blanches
33
second degree deep partial
painful, mottled, red to white with blisters
moderate edema
blanches
34
third degree burn
red, tan, black, brown, or waxy white
dry leathary
no blanching
35
fourth degree burn
dull and dry
charring
visible bone and tendons
36
what is included in primary burn assessment
airway
respiratory effort
skin color, pulse, HR
37
What is included in secondary burn assessment
burn depth and coverage
38
What is used to determine the total body surface area of a burn
lund and browder
39
what are the priorities of care with a burn
airway management
pain management
fluid volume resuscitation
40
what should the nurse do with blisters when doing wound care on a burn patient
leave them in tact, remove loose skin with surgical forceps
41
What is diaper dermatitus
caused by soaps and chemicals, diaper increases skin pH which releases an enzyme that breaks the skin down
42
what is the treatment for nonfungal diaper rash
A,D,E ointment or zinc oxide
43
what are signs of candida diaper rash
scaly, papule, that ooze, deep red in the skin folds, does not clear up with normal diaper cream
44
what is the treatment for candida diaper rash
nystain
miconazole
allow the area to be open to air for some time to dry it out
45
what is impetigo contagiosa
bacterial infection of the superficial layers of the skin from a gram positive bacteria
46
what is the classic sign of impetigo contagiosa
honey colored crust (papules burst and the exudate froms this honey colored crust with a swollen red base)
47
what are the signs of impetigo contagiosa
itchy or painful lesions, lymphadenopathy
48
what is the treatment for imeptigo contagiosa
wash the crust off with mild soap and water before applying topical antibiotics, if there are more than 5 lesions, treat with oral antibiotics
49
what precautions are used for impetigo contagiosa
contact, limit contact with others to prevent spread
50
what are the meds for acne
isotretinoin
tretinoin
benzoyl peroxide
topical antibacterial
oral contraceptives
51
how does tretinoin treat acne
interrupts abnormal keratinization
52
how does benzoyl peroxide treat acne
inhibits growth
53
what does isotretinoin do to treat acne
inhibit sebaceous gland function
54
how do oral contraceptive treat acne
decrease endogenous andrgoen production
55
Why do we order a CBC with differential
helpful in determining what is invading the body : bacterial, viral, allergic reaction
56
what are some signs of immunodeficiency
persistent thrush, 4 + ear infections in a year, FTT in infant, ulcerations, rashes
57
how do babies immune systems differ
they get their antibodies from the placenta and then from breastmilk
58
What is humoral immunity
b cells are all about antibodies
59
what does the C3 and C4 counts tells us
indicate that the immune system is activates, working, and doing its job
60
neutrophils
increase with presence of acute bacterial infection
61
eosinophils
allergic reaction
62
basophils
least common, inflammatory reaction
63
lymphocytes
viral infection or chronic bacterial infection
64
what are immunoglobulins
antibodies activated by the B cells
65
IgG
protects against viruses, bacteria, and toxins
ONLY immunoglobulin that crosses the placenta and transfers through the breastmilk
66
IgA
respiratory, GI, and GU pathogens
67
IgE
allergens, increase in allergic state
would be tested with allergy testing
68
IgD
assist in activation of B cells
69
IgM
most important component in primary immune response
indicates an active infection
70
What is SCID
severe combined immune deficiency that is potentially fatal from the lack of T or B cells
71
what are history cues with SCID
frequent severe infections like failure to thrive, pneumonia, and ear infections
72
what is the priority of care with SCID
infection prevention
IVIG
bone marrow transplant
73
what are lab cues with SCID
low or absent immunoglobulins
low or absent T and B cells
74
what test is used to diagnose HIV in children over 18 mos
(+) Western blot and (+) ELISA
75
What test is used to diagnose HIV in children less than 18 mos with HIV (+) mom?
(+) PCR and viral culture
76
What is HIV
the virus usually infects the CD4 (t helper cells) and replicates, which renders the cell dysfunctional
77
What are the priorities of care with HIV
infection prevention
compliance of anteroviral regimen therapy
78
what should a mom do to prevent transmission of HIV to baby
no breastfeeding
maintain regimen of Zidovudine
79
what is zidovudine
regimen that stops viral DNA replication to prevent perinatal transmission of HIV
80
what are the side effects of zidovudine
muscle weakness, SOB, HA, insomnia, rash, unusual weakness
81
what is signs of juvenile idiopathic arthritis
redness, pain, swelling, stiffness in joints, especially with inactivity in the morning, eye inflammation, organomegaly,poor weight gain, severe anemia
82
what are lab cues for JIA
anemia, increase WBC, (+) ANA, (+) RA in severe types
83
what is done for management of juvenile idiopathic arthritis
therapeutic management focuses on inflammation control, pain relief, promotion of remission and maintenance of mobility
84
what meds are used for juvenile idiopathic arthritis
NSAIDs, steroids, and antirheumatic drugs such as methotrexate depending on severity
85
What are the physical cues of anaphylaxis reactions
two or more that occur rapidly after exposure:
skin mucosal tissue involvement
respiratory compromise
reduced BP or associated s/s
persistent GI symptoms
86
What is used for anaphylactic reaction
histamine blockers or Epipen Jr
should be carried with child at all times
written emergency plan
dietary consult
87
What has cross sensitivity with latex
latex containing products and pears, peach, passion fruit, plum, pineapple
88
Which immunoglobulin would show up with a latex allergy
IgE
89
What precautions are used with pertussis
droplet precautions
90
What antibiotic is used for pertussis in an infant < 1 month and why
azythromycin- other macrolides increase the risk for pyloric stenosis
91
what antibiotic is used for pertussis in an infant > 1 month
macrolides (end in -mycin)
92
What precautions are used for measels (rubeola)
airborne precautions until 4 days after the onset of rash
93
what are the phases of measels
prodromal
eruptive
convalescence
94
What are symptoms of the prodromal phase of measels
3 Cs- conjunctivitis, cough, coryza (runny nose), high fever, malaise, koplik spots
95
what are koplik spots and what phase do they show up
they are spots that look like grains of white sand in the buccal mucosa during the prodromal phase of measels
96
What symptoms are in the eruptive phase of measels
maculopapular rash that starts behind the auricles, across the hairline, down the face, and spreads down the trunk
97
What symptoms are seen in the convalescence phase of Measels
the rash fades into brown spots and the skin peels
98
what is given to children with measels
vitamin A - Measels depletes vitamin A
99
What other things should the nurse do to support the pt with measels
antipyretics, bedrest, fluid, humidification
100
what is included in airborne precautions
negative pressure room
N95 mask
restriction of susceptible visitors
101
what rash is present with Lyme Disease
bull's eye rash 7-10 days after
102
what tests are used to diagnose Lyme disease
2 step immunoassay, if positive --- confirm with a Western Blot test
103
How is lyme disease treated for kids > than 8 years old
doxycycline
104
How is lyme disease treated for kids < 8 years old
amoxicillin
105
How long does the antibiotic regimen last for Lyme Disease
14-28 days
106
what is the first sign of pediculosis capitis
intense scratching of the scalp, then bumps on the scalp and visible nits
107
what precautions are used with pediculosis capitis
contact precautions
108
what are some basics of bone marrow aspiration
topical anesthetic may be applied 45 min prior, then concious sedation used (propofol)
post: apply pressure 5-10 min, monitor VS, bleeding, and infection
109
what are pre op considerations with brain tumors
monitor ICP and manage
emotional support
steroids decrease intracranial swelling (dexamethasone)
110
what are post op considerations with brain tumors
position on unaffected side
ICP management
VS w/ pupil and LOC
headache and pain manage
JP drain
keep head midline
111
What does the lumbar puncture show with brain tumors
positive alpha-fetoprotein
112
where do neuroblastomas typically like to appear
adrenal gland -- sits on top of the kidneys
113
what is the common reason a parent of a child with neuroblastoma comes into the ED before diagnosis
asymmetrical abdomen
114
what are common signs of neuroblastoma
bruising around the eyes (tumor affecting optic nerve), watery diarrhea (tumor secretes enzyme), asymmetrical abdomen, droopy eyelid, horner syndrome
115
what is included in horners syndrome
no sweating on the face, miosis, drooping eyelid, brusing around the eyes
116
what test is done to help diagnose neuroblastoma
24 hour urine screen
117
what shows up on the 24 hour urine screen with a neuroblastoma
HVA and VMA
118
What does a wilm's tumor affect
kidney
119
what are signs and symptoms of Wilms tumor
hypertension, hematuria, swollen asymmetric abdomen, (firm non tender mass)
120
what would the Wilm's tumor 24 hour urine screen show
NEGATIVE HVA and VMA
121
What is the nursing action with Wilm's Tumor
DO NOT PALPATE ABDOMEN -- rupture tumor and seed out
122
What is the treatment of wilms tumor
surgical resection and chemo
123
What are some history cues with ALL
persistent low grade fever, recurrent infections, leg pain (chaos in BM), decrease activity level (anemia)
124
What are symptoms with ALL
pallor, bruises (low platelets), temp 100.2, lymphadenopathy, enlarge liver and spleen (cells have to go somehwere)
125
what are labs with ALL
low H/H and RBC (crowded out)
blood smear (+) with lymphoblasts
BMA (+) lymphoid cells
126
What should the nurse do with the patient that has ALL
neutropenic precautions
bleeding precautions
infection prevention
127
what is the typical site for a bone marrow aspirate
anterior or posterior iliac crest
tibia in infant
128
what is included in neutropenic precautions
no fresh flowers
strict hand washing
no rectal temps
restrict visitors
no raw veggies
mask on child outside of room
soft toothbrush
129
what is shown on a BMA on a pt with ALL
(+) leukoblasts
130
what are symptoms of iron deficient anemia
pallor, irritability, fatigue, spooning of fingernails, SOB, dizziness
131
What are considerations or iron deficient anemia treatment
iron supplements may turn stool dark green or black, can cause constipation (increase fluids and stool softeners), vitamin C increases absorption
132
What formula should be used in child with iron deficient anemia
iron fortified formula and iron supplements with BM
133
What causes Hemophilia A
factor VIII deficiency
134
what are some history cues of lead poisoning
OLD home, toys, malnutrition, Pica
135
What are symptoms of lead poisoning
Low IQ / delayed G&D
abdominal pain
ataxia, dizziness, SOB
hematuria, new onset serizures
136
what is the treatment of lead poisoning
chelation therapy for blood lead >45 -- draws lead out of tissues and excretes it out through the kidneys
137
What is something to monitor with chelation therapy
kidney function and fluid intake
138
what are symptoms of sickle cell vasocclusive crisis
joint pain, tachycardia, tachypnea, splenic sequestration crisis, acute chest syndrome, dactylsis (symmetrical swelling of hands and feet)
139
what are the priorities of care with sickle cell vaso occlusive crisis
pain management
hydration (double maint fluid)
hypoxia (o2 is under 92%)
140
what is hemophilia A
lack of Factor VIII which helps blood clot
141
what are signs of hemophilia A
joint swelling, bleeds, brusining, chest or abdominal pain, low H/H
142
what is the treatment for hemophilia
give factor VIII first
THEN
ice, compress, elevate
143
what medication is given for mild cases of hemophilia A
desmopressin
144
What blood lead level requires Chelation therapy
45
145
What labs are associated with hemophilia
elevated PTT
normal PT
normal platelet count
146
what is hemarthrosis and what condition is it associated with, what is the treatment
bleeding in the joints, associated with hemophilia
RICE
147
what are history cues with hemphilia
heavy menstrual bleeding
heavy bleeding with circumcision
nosebleeds
148
If a child drinks more than 24 oz of cows milk per day, they are at risk for what
irone deficient anemia
149
PICA is a sign of what
iron deficient anemia
150
what shampoo is used for lice
permethrin
151
what is the medical term for the bullseye rash and what infection is it associated with
erythema migrans
lyme disease
152
ANC of what requires neutropenic precautions
1000
