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Peds Final Flashcards

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1
Q

which conditions need IVIG?
why?

A

immune thrombocytopenia
Kawasaki’s (high dose)
SCID
Wiskott-Aldrich Syndrome

it provides immunoglobulins and cells needed to replenish WBCs and platelets.

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2
Q
  • 1 to 4 weeks after a viral illness with children younger than 10 years old

hint: given prednisone, anti-D antibody, and IVIG.

A

immune thrombocytopenic purpura

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3
Q

lack of response to antigens, lymphopenia, absence of plasma cells in the bone marrow. History of recurrent, severe infections from early infancy.
what am I?
how am I treated?

A

Severe combined immunodeficiency syndrome

HSCT can cure this if given by 3 months
If not, IVIG is also given.

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4
Q

X-linked
eczema
thrombocytopenia
immunodeficiency of T and B cells
prognosis?
-what are two conditions this child is more at risk for?
treatment?
cure? (no time frame here)
what is a special component here not seen anywhere else?

A

Wiskott-Aldrich Syndrome
fatal if not cured with HSCT as soon as possible.
cancer and auto-immunity
IVIG, platelet transfusion, splenectomy, aggressive eczema treatment, prophylactic antibiotics, G-CSF.

the inclusion of G-CSF for neutropenia correction

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5
Q

bone marrow failure (Anemia)
and nutritional deficiency
–decreased RBC production for both

increased RBC loss

increased RBC destruction

A

aplastic anemia

epistaxis, hemophilia, DIC, Idiopathic Thrombocytopenic purpura.

SCD and thalassemia + isoimmunization, chemo, irradiation, infection.

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6
Q

despite hemodilution, decreased peripheral resistance, increased circulation and turbulence within the heart causing a murmur, possibly leading to cardiac failure, growth retardation, anorexia, delayed sexual maturation.

there is not what?

A

cyanosis

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7
Q

Which age group is most susceptible to Iron deficiency anemia?
why?
treatment?
when can you expect improvement?

A

12–36-month-olds
they can now have milk, and the parents give them this to the exclusion of other foods, and plus they can’t chew a lot of things that have an excess of iron.

give iron tablets and orange juice
in 1 month

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8
Q

breast fed infants need iron during which periods?

A

4-12 months

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9
Q

aplastic
hyperhemolytic
acute splenic sequestration
acute chest syndrome

what are these?

A

SCA
diminished production of RBCs causing a crisis.
increased RBC destruction.
pooling of blood, spleen swells dropping hgb levels, the spleen gets blocked, and it can no longer filter blood cells.
RBCs congregate and block an area in the lungs, usually combined with infection.

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10
Q

precautions to take with SCA pts?

A

penicillin prophylaxis from 2m-5y
get all the pneumococcal vaccinations (+hib and meningococcal), starting at 2 months.
give blood, fluid, and electrolyte replacement
under 5 is at the most risk, so it’s ideal to get HSCT before then.
stroke prevention

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11
Q

special treatment that aplastic anemia pts get?

A

antilymphocyte globulin (immunosuppressive) which is ALG and ATG

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12
Q

Tumor lysis syndrome

A

high phosphate, high potassium, low calcium, high uric acid.

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13
Q

superior vena cava syndrome

A

caused by Hodgkin’s or NHL or thrombotic complications of implantable IV devices.

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14
Q

hemorrhagic cystitis
what med is given?

A

to stop this irritation from chemo, increase fluid intake and void frequently and start chemo earlier in the day giving time to of this and flush the drug out of the system.

mesna (inactivates metabolite that causes damage to the bladder)

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15
Q

After a HSCT, what should you not do?

A

get a live attenuated vaccine like MMR or varicella.

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16
Q

wound left open to close naturally

A

secondary intention

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17
Q

thelarche
adrenarche
menarche
puberty “delay”

A

first two, 8-13 years.
breast buds
pubic hair growth
two years after thelarche, menstruation begins.
delay if no thelarche by 13 years.

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18
Q

a) penile growth, first ejaculation, axillary, groin, and facial hair, final voice change.

b) penile enlargements, voice changes, early facial hair, gynecomastia.

c) testicular enlargement and sparse pubic hair.

d) no enlargement of testes or scrotal changes by 14 years

stage 1 (9.5-14 years)
stage 3
stage 5
pubertal delay

A

stage 1: c
stage 3: b
stage 5: a
delay: d

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19
Q

Erikson’s (3-6)
(6-12)
(>12)

A

initiative v. guilt
industry v. inferiority
identity v. role confusion

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20
Q

enlarged testicular veins, resulting in pain or growth arrest of affected testicle, may impair fertility; requires surgery or embolization.

A

varicocele

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21
Q

gynecomastia is related to which condition?

A

varicocele

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22
Q

phototherapy and a radian warmer does what was fluid requirements?

what about mechanical ventilation?

A

increases the need

decreases the need

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23
Q

rapid fluid replacement is contraindicated in which type of dehydration?

A

hypertonic

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24
Q

defect in the ability to concentrate urine.
s/s?
diet?
meds?

A

nephrogenic diabetes insipidus
unexplained fever, hypernatremia, copious amounts of dilute urine.
low sodium/low solute diet
hydrochlorothiazide + potassium supplementation.

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25
___albuminemia ____proteinuria hyper________ edema give which two meds? cause?
hypoalbuminemia massive proteinuria hyperlipidemia edema loop diuretics (d/t hypoalbuminemia) steroids (need immunosuppressants b/c helps with inflammation and reduces additional damage) varied, not d/t immune complexes, that is glomerulonephritis
26
leukemias most common childhood form? s/s? r/t condition? diagnostics? prognosis?
ALL bone pain, lymphadenopathy, hepatosplenomegaly, fever, bleeding. aplastic anemia blood smear, low blood counts, bone marrow aspiration/biopsy, then LP to determine CNS involvement. 80-90%
27
all that goes into clinical staging and prognosis of Acute Leukemias name the basics:
immunophenotyping of the T and B lineage, myeloid antigens. --they decide who is most at risk and assign them into risk-based groups where they can receive specialized treatment. dx based on WBC count, CNS involvement found at LP, testicular involvement, Down syndrome (compromised immune system), sex, race, ethnicity, nutritional status, leukemic cell characteristics. of course, the response to treatment which determines the prognosis.
28
3 phases of chemotherapy
remission induction, consolidation/intensification, maintenance (continuation--so they keep levels low)
29
HL or NHL, which is more common in children? Which is caused by the Epstein-Barr Virus?
NHL HL
30
what has improved the dx of lymphomas?
risk group stratification, systemic staging (Ann-Arbor), and improved treatment protocols.
31
lymphomas s/s? dx?
anorexia, wt loss, night sweats, pruritus, low-grade fever, cough (tendency to move to the mediastinal area), and abdominal pain (mesenteric area). total body imaging (to hit all the lymphatic drop off areas) H&P (for risk group stratification) +bone marrow aspiration and LP (d/t lymphoma relation to hemopoietic cells) use immunophenotyping, cytogenics, and FISH. use risk adapted chemo (b/c survival is not 80%) surgery is applicable for NHL
32
brain tumors s/s? no LP if___? dx? tx?
most clinical manifestations are related to their anatomical location, tumor size, rate of growth, child's age/developmental stage. mostly: bulging fontanel, increased head circumference, headache, vomiting, nystagmus, ataxia, dysarthria, dysmetria (inability to control distance, speed, ROM) increased ICP MRI is gold standard will use surgery, chemo, radiation (before surgery) to lessen this solid tumor and ultimately remove it in surgery. (note: this can have serious long-term consequences)
33
brain tumor post op complications
watch out for meningitis, testing reflexes, hand grip, cranial nerves, pupils, LOC, response to stimuli, dressing (drainage) -for the dressing, avoid putting pressure against it. -reduce ICP -avoid aspiration. -regulate fluids because cerebral edema and increased ICP fucks it up. comfort with: low stim environment, eye drops, prevent strain (stool softener and antiemetics), suction, ice compress for facial edema.
34
from neural crest cells in adrenal medulla. firm, nontender, irregular mass in the abdomen that crosses the midline; pain, vomiting, anorexia, urinary frequency or retention (compression of kidneys and ureters by tumor) tumors excrete catecholamines. "silent rumor"--70% detected after metastasis. HSCT and myloablative therapy (during consolidation phase, in high-risk patients) recognize poor prognosis
neuroblastoma
35
mass in abdomen combined to one side? how about at midline?
Wilm's tumor neuroblastoma
36
bone tumors bone marrow biopsy is used with which of the tumor types? radiation is more common with which tumor type? surgery? which type is more likely to get it?
ES (Ewing sarcoma)--bone marrow spaces can be targeted with biopsy and radiation. surgery resulting in amputation is more often in Osteosarcoma due to it often affecting osseous tissue and infecting long bones.
37
nephroblastoma or? age group most affected? times they are screened? s/s? CT and Chest XR is looking for what? what condition is associated with this? mechanisms of treatment?
Wilm's tumor <5, 3m-8y HTN, hematuria--anemia, wt loss, fever, swelling or mass in the abdomen, firm, nontender, confined to one side and deep in the flank. lung metastasis von Willebrand disease surgery immediately, postop chemo, radiation for advanced stages.
38
tumor arising from mesenchymal cells, which normally develop into muscles, but go to other sites like orbit, nasopharynx, paranasal sinuses, middle ear, retroperitoneal area, perineum. ages 1-9 with the best prognosis
rhabdomyosarcoma
39
what's the survival rate of retinoblastoma?
10 year survival rate of 90%
40
encephalitis etiology s/s (think of the mnemonic chatgpt made) implications of condition
either direct invasion (by enterovirus) or postinfectious involvement after a viral disease. malaise, headache, dizziness, apathy, nuchal rigidity, n/v, ataxia, tremors, hyperactivity, speech difficulties apathy..but hyperactivity Monitor for ICP, especially if a LP is used. long-term complications: learning difficulties, epilepsy.
41
details of rabies tx?
virus multiples in muscles, incubates for 1-3m, but can be as short as 5 days or as long as 6m. inactivated rabies vaccine, 4 doses over 2 weeks. globulins added with the first dose of rabies vaccine (1/4 help)
42
toxic encephalopathy -preceded usually by varicella, influenza. fever profuse vomiting neurologic impairment disordered hepatic function aggressive supportive therapy. what should parents know?
Reye syndrome don't give salicylates to children every time they have flu-like symptoms.
43
two or more unprovoked seizures more than 24 hours apart.
epilepsy
44
what is the initial manifestation for generalized seizures?
a loss of consciousness
45
tonic? clonic? tonic-clonic?
prolonged stiffening of muscles jerky movements of limbs stiffness first and then prolonged and rhythmic jerky movements of limbs.
46
infantile spasms, onset between 4-8 months, rarely occurs after 2 years; some degree of cognitive impairment.
West syndrome
47
20-50% with infantile spasms go on to develop _____ which includes multiple sz types, intellectual disability, slow spike wave discharges on EEG.
Lennox-Gastaut syndrome
48
secretion of catecholamines, autosomal dominant. HTN/hypertensive attacks, tachycardia, headache, anorexia, wt loss, hyperglycemia, hyperventilation, nervousness, diaphoresis. surgical removal of tumor--bilateral adrenalectomy--then give lifelong glucocorticoid and mineralocorticoid therapy.
pheochromocytoma
49
what do you not do in the case of pheochromocytoma?
palpate the mass, preoperative palpation of the mass releases catecholamines which can stimulate severe hypertension and tachyarrhythmias.
50
problems of acute adrenocortical insufficiency
hyponatremia (seizures, n/v/d) + irritability, poor feeding, weakness, headache--also due to low glucose, infection risk, low body fluids. -also, fever, tachypnea, cyanosis. destruction of adrenal gland would cause lower glucose, lower bodily fluids, low cortisol.
51
begins as a reddish macule becomes vesicular ruptures easily, leaving superficial, moist erosion. exudate dries to form heavy, honey-colored crusts. pruritis common. use bactericidal ointment, oral or parenteral abx if severe. autoinoculable and contagious. Heals with scarring.
impetigo
52
molluscum contagiosum description: cause: tx? spread?
flesh-colored papules with a central caseous plug (umbilicated) that occur on trunk, face and extremities; may be transmitted by sexual contact. takes months to go away, 18 m, but won't keep the kids from school. b/c it's viral, there isn't much treatment The ones there are painful--curettage, electrodessication, or cryotherapy. Plus a bunch of creams--chemical removing agents. common in school age children, outbreaks have been reported at childcare centers.
53
urushiol
sumac
54
sensitizing agent primary irritant
irritates only those who are allergic to it irritating for everyone
55
systemic effect of a drug eruption is seen as what? how about fixed eruption?
itching recurrent eruption at same site (same cause, same place)
56
if a child has been bitten by an arthropod, what should the nurse do?
put a medication attention bracelet on.
57
infestation of ____ mites. burrows into epidermis and deposits eggs and feces, inflammatory response follows. s/s? tx? nursing care?
scabies mites intense pruritis, may lead to excoriations. Maculopapular lesions, especially in intertriginous areas (Skin folds). scabicide. prevent transmission, treat all close contacts.
58
pediculosis capitis-scalp infestation, female lay eggs at night at junction of hair shaft. Eggs (nits) hatch in____to_____days s/s? dx? tx?
7-10 days (Common shipping time) itching to occiput, behind ears, nape of neck. have to see nit on shaft of hair pediculicide and manual removal
59
spirochete borrelia burgdorferi enters skin and bloodstream...what is the disease? stage 1: stage 2: stage 3: tx?
lyme disease 1: early localized disease (tick bite), within 3-30 days erythema migrans. 2: early disseminated disease. Secondary annular lesions 3-10 weeks after bite. 3: systemic involvement of neurologic, cardiac, musculoskeletal systems 2-12 months after bit. early tx to prevent complications; doxycycline if >8 yrs, but amoxicillin if <8yrs. Take for 14-21 days.
60
cat scratch disease
self-limiting cause of regional lymphadenitis. painless, nonpruritic erythematous papule near bit. may give abx
61
peak occurrence of diaper dermatitis
9-12 months
62
atopic dermatitis (eczema) tx?
chronic relapsing inflammatory skin disorder. Results in itching and lesions. hydrate skin, relieve itching, reduce flare ups or inflammation. Prevent and control secondary infection. Support hygiene and symptom relief.
63
if an infant has eczema at 2-6 months, when does it resolve? normal childhood years of manifestation? preadolescent and adolescent years?
3 years 2-3 years >12 years
64
a child with eczema has just take a bath, what do you do?
give an emollient preparation before the skin has a chance to dry.
65
seborrheic dermatitis s/s?
chronic, recurrent, inflammatory reaction of skin. scalp-cradle cap eyelids (blepharitis) external ear canal (otitis externa) nasolabial folds inguinal region
66
acne tx?
caused by testosterone that stimulates sebaceous glands of skin. alterations in follicular growth. differentiation with colonization of Propionibacterium acnes. topical retin A/tretinoin, benzoyl peroxide, topical abx. Or systemic abx, OC, Accutane.
67
what is the black box warning for Accutane?
warning of suicide, depression, aggression, psychosis. Also, teratogenic= need for some form of BC and pregnancy testing.
68
chillbain
redness and swelling of skin when exposed to low temperatures.
69
complications of burns
pulmonary excessive fluid volume wound sepsis
70
a superficial partial-thickness burn heals in? how about deep partial-thickness burn?
<21 days >21 days
71
desquamation?
the shedding of the epidermis layer of skin in a 1st degree burn. occurs in 3-7 days.
72
lymphatic tissues in children
twice the adult size by age 10-12
73
for early childhood, how do you communicate with them? school age children?
largely egocentric, so focus on the child. Repeat information in simple, consistent terms. Allow child to touch medical equipment. focus on concrete explanations.
74
when do you use Wong-Bake pain scale?
after 4 years old, because its self-reported.
75
if patient is apneic?
DO NOT leave patient DO NOT give more opioid give O2 stimulate ensure pulse oximetry give narcan call for help be prepared to calm/comfort patient when effects of opioids are reversed.
76
airborne transmitted diseases? PPE?
measles, TB, chicken pox/shingles, SARS. N95
77
droplet transmitted diseases? PPE? contact?
pertussis, influenza, mumps, RSV, rubella mask/eye protection. c.diff, rotavirus, hep A gown and gloves
78
what vaccines are considered live attenuated?
MMR, varicella/chicken pox, rotavirus.
79
stomatitis
hand-foot-and-mouth disease can be dangerous to newborns. relief of pain using topical anesthetic before eating, "magic mouthwash", no lidocaine for young children.
80
pinworms
given pyrantel pamoate, no subscription needed, and need a second dose to ensure eggs not killed don't hatch and reinfect patient.
81
what vaccines are given at 2 months?
hep B (2nd dose) rotavirus DTaP Hib Pneumococcal conjugate inactivated poliovirus RSV vaccine (given immediately for immuno-compromised NICU babies. )
82
fifth disease
slapped cheek disease human parvovirus B19 rashes look like smaller, and more dispersed erythema migrans.
83
APGAR
heart rate respiratory effort muscle tone response color
84
new ballard scale
for 20-44 weeks, but is best done immediately after birth and in babies >26 weeks.
85
return to birth weight in how many days?
10-14 days
86
marked lag in head control can indicate what?
down syndrome, hypoxic ischemic episode, or other neuromuscular compromise.
87
___% weight loss in the first week is normal and needs no intervention.
10
88
erythema toxicum neonatorum
baby acne
89
late preterm infant premature baby
34 0/7 and 36 0/7 weeks of gestation <37 weeks
90
jaundice onset within 24 hours
hemolytic disease
91
LGA babies
macrosomia abundant vernix polycythemia listless and lethargic jitteriness hypoglycemia poor feeding hyperbilirubinemia
92
TORCH complex
toxoplasmosis other (parovirus, hep B, west nile) rubella, cytomegalovirus.
93
Apnea Change in color or muscle tone Choking, gagging, or coughing Usually involves significant intervention
BRUE
94
when is chelation therapy considered for lead poisoning?
levels greater than 20mcg.
95
bradycardia decreased motor response to command decreased sensory response to painful stimuli. alterations in pupil size and reactivity. extension or flexion posturing Cheyne-stokes respirations. papilledema decreased consciousness coma
late signs in infants and children
96
concerning family history when evaluating neurologic status
recurrent miscarriages family members who died at an early age. developmental delay, deafness, blindness, unusual movements, weakness, stroke, ataxia, progressive mental deterioration.
97
pediatric Glasgow coma scale 15 <8 3= 5
unaltered LOC accepted as definition of coma deep coma or death scores of 5 or less are associated with poor outcomes.
98
for children with CHF, what are mothers advised to do, due to the weakness of the infants?
feed at first sign of hunger. + (gavage feeding if needed, increase calorie feeding)
99
three key reflexes from infants in a neurologic examination are?
Moro, tonic neck, withdrawal.
100
severe dysfunction of the cerebral cortex or with lesions to corticospinal tracts above the brainstem.
flexion posturing.
101
dysfunction at the level of the midbrain or lesions to the brainstem.
extension posturing
102
when is a lumbar puncture delayed?
if intracranial hemorrhage is suspected or if there is increased ICP because there is a risk for potential brainstem herniation.
103
in a 2-hour sample of an oral glucose tolerance test, what is a level that confirms diabetes?
>200
104
in a random glucose test, what confirms a DM diagnosis?
>200 levels with classic signs of DM.
105
in an 8-hour fasting blood glucose, what is a level that confirms DM?
>126
106
A1c levels that confirm DM?
>6.5%
107
With an external ventricular drainage system, what are some things to consider?
keep at the level of the ventricles or below to decrease ICP, it also prevents infection risk.
108
head injuries epidural? subdural? when does cerebral edema develop? the sequelae of TBI?
most often higher in mortality, assault or abuse in infants and children, MVA in adolescents, and it progresses rapidly. Most common in infants/children as a result of assault or violent Shaking, and can possibly occur b/c of labor and delivery. Chronic form is more common. 24-72 hrs after delivery. post-concussion syndrome, post-traumatic HAs, post-traumatic seizures, hydrocephalus.
109
head injury precautions
keep child NPO stabilize neck and spine immediately. use jaw thrust, not chin lift, to open airway. assess pain but give no analgesics or sedatives. check LOC and pupillary reaction every 4 hours (twice during the night) for 48 hours.
110
after a submersion injury, what should the nurse watch out for?
seizure activity blood glucose (fluctuates in acute conditions) effects from cerebral hypoxia.
111
meningococcal sepsis
B. meningitis complication. severe, sudden, and rapid-overwhelming septic shock, DIC, massive bilateral adrenal hemorrhage, purpura.
112
with myelomeningocele there is a high risk for what?
latex allergy or hypersensitivity

Acute (7 decks)

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