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Pediatrics-Final
| Question | Answer |
|---|---|
| Disease symptoms: hoarseness, barky cough, stridor, resp. distress; symptoms often occur at night | croup |
| cause of croup? | virus; majority of cases-parainfluenza |
| treatment: corticosteroids, bronchodilators (racemic epinephrine nebulizer), cool air humidification, take to ER if begins to drool and can't swallow | croup |
| fast/abrupt onset; sore throat, fever, 4 Ds (drooling, dysphagia, dysphonia, distressed inspiratory airway), irritable/restless/anxious (may cause tachycardia and tachypnea), muffled voice | epiglottitis |
| cause of epiglottitis? | most often Hib; strep or staph bacteria |
| treatment: ATBs (if bacterial), IV fluids, emotional support to frightened patient and family, instruct on Hib vaccination | epiglottitis |
| first rhinorrhea and sneezing, then increased cough and wheezing, tachypnea, retractions, nasal flaring, apnea, cyanosis | bronchiolitis |
| How is bronchiolitis contracted? | direct contact of resp. secretions |
| diagnosed by: low pulse ox, CXR, blood gases (carbon dioxide retention and hypoxemia), ELISA or IFA nasally | bronchiolitis |
| treatment: less severe--antipyretics, hydration, observation; more severe-- cardio/resp monitoring, pulse ox, O2 with humidity; pulmonary hygiene (ie suctioning); rest | bronchiolitis |
| autosomal recessive disorder | cystic fibrosis |
| Cystic Fibrosis affects _______ glands, resulting in: | exocrine; excessive mucous production, excessive chloride production by sweat glands |
| failure to thrive, meconium ileus, poor growth, bulky/greasy stools, frequent colds or bouts of pneumonia, clubbing | Cystic Fibrosis |
| diagnosed by: positive sweat test (chloride), absence of pancreatic enzymes, newborn screening, DNA identification of mutant genes | Cystic Fibrosis |
| nonpharm. treatments: promote removal of lung secretions, prevent and treat lung infections, manage pulmonary complications, postural drainage, cupping, chest physiotherapy | Cystic Fibrosis |
| pharm. treatments: bronchodilators, inhaled recombinant human DNase (Pulmozyme), ATBs, pancreatic enzymes and Vitamins A, D, E, K (to promote adequate digestion and absorption of nutrients) | Cystic Fibrosis |
| cardiac disorders that increase pulmonary blood flow | ASD, VSD, PDA |
| heart murmur, few symptoms in children, SOB, poor growth | ASD |
| surgical closure, closure with cardiac cath, patch repair, follow up with cardiologist | ASD |
| a holosystolic harsh murmur is heard along left sternal border | VSD |
| repair with a patch pulmonary artery banding | VSD |
| harsh continuous machine-like murmur under left clavicle | Patent Ductus Arteriosus (PDA) |
| treatments are: indomethacin, insertion of Coils to occlude during heart cath, thoracoscopic | Patent Ductus Arteriosus (PDA) |
| 4 defects of Tetralogy of Fallot | "PROV" Pulmonary stenosis Right ventricular hypertrophy Overriding aorta Ventricular septal defect |
| tet spells, squatting, clubbing, increased irritability, poor growth, systolic murmur | Tetralogy of Fallot |
| Tetralogy of Fallot must have surgical repair by how old? | Within first year of life |
| narrowing of aorta obstructs flow | Coarctation of Aorta |
| increased B/P in upper extremities, decreased B/P in lower extremities, few symptoms, headache | Coarctation of Aorta |
| cardiac cath, balloon dilation, stent placement | Coarctation of Aorta |
| underdeveloped left side of heart, aorta, aortic valve, left ventricle, and mitral valve | Hypoplastic Left Heart Syndrome |
| symptoms: ashen in color, difficulty breathing, symptoms appear when PDA closes | Hypoplastic Left Heart Syndrome |
| prostaglandin E to keep PDA open until surgical repair; surgery in 3 stages shortly after birth | Hypoplastic Left Heart Syndrome |
| Thickening occurs of the pyloric sphincter creating an obstruction | pyloric stenosis |
| Sx: projectile vomiting, olive-shaped mass in upper right abdomen, failure to gain weight | pyloric stenosis |
| Ultrasound reveals an elongated, sausage-shaped mass or elongated pyloric area | pyloric stenosis |
| surgery for pyloric stenosis | Pylorotomy by Laparoscope |
| A part of the intestine telescopes into another part, resulting in lymphatic and venous obstruction along with ischemia or increased mucus in the intestine | Intussusception |
| currant jelly stools, sudden abdominal pain, drawing knees to chest-screaming, stools mixed with blood and mucus, vomiting, diarrhea, fever or dehydration | Intussusception |
| hallmark sign is: palpate a sausage-shaped mass in the upper mid-abdomen | Intussusception |
| Air or barium enema; sometimes this cures it--makes it telescope back out. Surgeon should be avail. at time of enema in case of emergency (unsuccessful enema or perforation) | Intussusception |
| IV fluids, NG tube, assess stools, intake/output and prepare for procedures (Air enema with or without contrast by radiologist) or surgery | Intussusception |
| A structural anomaly of the GI tract caused by a lack of ganglion cells in the segments of the colon resulting in decreased motility and mechanical obstruction | Hirschsprung disease |
| diagnosed by rectal biopsy | Hirschsprung disease |
| Sx in newborns and infants: abd distension, failure to thrive, newborn--failure to pass meconium in a few days after birth, refusal to eat, vomiting (newborn-vomiting bile), constipation or watery diarrhea | Hirschsprung disease |
| Sx in older child: failure to thrive, abdominal distention, palpable fecal mass, constipation, visible peristalsis or foul-smelling ribbon-like stool. | Hirschsprung disease |
| Surgery-removal of the aganglionic section of the bowel and place a temporary colostomy | Hirschsprung disease |
| A complication resulting from failure of the omphalomesenteric duct to fuse during embryonic development | Meckel’s Diverticulum |
| abdominal pain or bloody, mucus stools or asymptomatic; diagnosed by Radionucleotide scan | Meckel’s Diverticulum |
| Nursing care: Pre- and post-op care from surgical removal | Meckel’s Diverticulum |
| An immune disorder in which gluten (found in grains) causes damage to the sm. intestine; villi of the sm. intestine are damaged d/t body’s response to digestion of gluten; malabsorption disorder occurs; actually affects 1% of population | Celiac Disease (Celiac Sprue) |
| Sx: diarrhea, steatorrhea, failure to thrive, anemia nutritional deficiencies, distended abdomen, wasted buttock, thin extremities | Celiac Disease (Celiac Sprue) |
| Diagnose- Biopsy of intestine – damaged villi | Celiac Disease (Celiac Sprue) |
| Treatment for Celiac Disease (Celiac Sprue) | gluten-free diet |
| meatus opening below the glans penis and may be a ventral curvature of the penis; treatment: surgery performed in the first year of life and male circumcision not performed | Hypospadia |
| meatus opening above the glans penis; treatment: surgery performed in the first year of life and male circumcision not performed | Epispadia |
| fluid in the scrotal sac; usually a benign and self-limiting disorder; usually noted early in infancy and often resolves spontaneously by 1 year of age | Hydrocele |
| an enlarged scrotum that may decrease in size when male is lying down; inspect scrotum for a fluid-filled appearance | Hydrocele |
| What is the most common movement disorder of childhood? | cerebral palsy |
| Sx: motor impairments including spasticity, muscle weakness, and ataxia; complications: mental impairments, seizures, growth problems, impaired vision or hearing, abnormal sensation or perception, and possibly hydrocephalus | cerebral palsy |
| Hypertonicity and permanent contractures; different types based on which limbs are affected: Hemiplegia: both extremities on one side, Quadriplegia: all four extremities, Diplegia or paraplegia: lower extremities | Spastic Cerebral Palsy |
| most common form of CP; poor control of posture/balance/movement, exaggeration of deep tendon reflexes, hypertonicity of affected extremities, continuation of primitive reflexes, in some children---failure to progress to protective reflexes | Spastic Cerebral Palsy |
| abnormal involuntary movements; infant is limp/flaccid; uncontrolled/slow/worm-like writhing or twisting movements; affects all 4 extremities and poss. face/neck/tongue; movements increase during periods of stress; dysarthria and drooling may be present | Athetoid (or dyskinetic) Cerebral Palsy |
| affects balance and depth perception, rare form of disorder, poor coordination, unsteady gait, wide-based gait | Ataxic Cerebral Palsy |
| combination of the other forms of disorder; most common is spastic and athetoid | Mixed Cerebral Palsy |
| meds for Cerebral Palsy | Baclofen (Lioresal) – can be given via implanted pump intrathecally; Diazepam (Valium) – used in older children; Botox-onset 1-3 days, peak 2 weeks, duration 3-6 months |
| most common neuromuscular disorder of childhood; is universally fatal (usually by age 20 to 25) | Duchenne muscular dystrophy |
| Early childhood (usually 3–6 years); affects primarily males; generalized weakness, muscle wasting---limb and trunk first | Duchenne muscular dystrophy |
| A hallmark finding of this disorder is the presence of the Gowers sign (child cannot rise from the floor in standard fashion because of increasing weakness) | Duchenne muscular dystrophy |
| Promoting mobility (give corticosteroids and calcium; perform passive stretching and strengthening exercises); Maintain CP function (teach deep breathing exercises, perform chest physical therapy); Prevent complications and maximizing quality of life | Duchenne muscular dystrophy |
| this form of muscular dystrophy is the most common neuromuscular disorder of childhood, and is universally fatal (usually by the teens or 20s) | Duchenne muscular dystrophy |
| T or F? The nurse working in the ER knows that trauma or unintentional injury is a leading cause of childhood morbidity and mortality in the United States. | True |
| abnormalities of the developing hip that include dislocation, subluxation, and dysplasia of the hip joint; femoral head has an abnormal relationship to the acetabulum | developmental dysplasia of hip |
| Sx: leg may appear shorter on the side of the disorder; leg on affected side may turn outward; folds in the skin of the thigh or buttocks may appear uneven; space between the legs may look wider than normal | developmental dysplasia of hip |
| treatments: nonsurgical positioning device or placement of a Pavlik harness; casting; closed reduction surgery | developmental dysplasia of hip |
| lateral curvature of the spine that exceeds 10 degrees; may be congenital, associated with other disorders, or idiopathic | scoliosis |
| symptoms: most are mild with few symptoms; some develop spine deformities that get more severe as they grow; severe form can be painful and disabling; may experience pain in back, leaning to one side, muscle spasms, physical deformity, or uneven waist | scoliosis |
| treatment: depends on severity; often no treatment is necessary; sometimes back brace or surgery (bone grafting, spinal fusion) is needed; physical exercise; therapies--stretching | scoliosis |
| HA, vomiting (possibly projectile), blurred vision/diplopia, dizziness, decreased HR/RR, increased B/P or pulse pressure, pupil reaction time decreased/unequal, sunset eyes, changes in LOC, irritability, seizure activity | early signs of increased intracranial pressure |
| infant: bulging/tense fontanel, wide sutures and increased head circumference, dilated scalp veins, high-pitched cry | early signs of increased intracranial pressure |
| lowered LOC, decreased motor and sensory responses, bradycardia, irregular respirations, Cheyne–Stokes respirations, decerebrate or decorticate posturing, fixed and dilated pupils | late signs of increased intracranial pressure |
| positions for lumbar punctures | newborn: positioned upright with head flexed forward; child or older infant: positioned on the side with head flexed forward and knees flexed to abdomen |
| The nurse is assisting with testing on a child suspected of having a neural tube defect. Which of the following diagnostic tests would be used to confirm this condition? a. ultrasound b. electroencephalogram c. fluoroscopy d. computed tomography | d. computed tomography |
| shunt placement | To treat hydrocephalus, a ventriculoperitoneal (VP) shunt catheter is placed in an enlarged ventricle. Shunt diverts flow of CSF within the CNS to the peritoneum, where CSF is now absorbed across the peritoneal membrane into the body's circulation. |
| S/Sx of shunt infection | Elevated vital signs Poor feeding Vomiting Decreased responsiveness Seizure activity Signs of local inflammation along the shunt tract |
| occurs with damage of the cerebral cortex or spinal tract; extremely rigid muscle tone | Decorticate posturing (flexor) |
| occurs with damage at the level of the midbrain/brain stem; extremely rigid muscle tone | Decerebrate posturing (extensor) |
| An inflammation of the CSF and connective tissues that cover the brain and the spinal cord. Can be viral or bacterial | Meningitis |
| Requires supportive care for recovery. Caused by viruses like: cytomegalovirus, adenovirus, mumps, herpes simplex virus, and arbovirus. | viral (or aseptic) meningitis |
| Very contagious. Treatment needs initiated quickly. Caused by: Neisseria menigitidis, Streptococcus pneumonia, Haemophilus influenza type B (Hib), Escherichia coli | bacterial (or septic) meningitis |
| Since the introduction of these two vaccines, bacterial meningitis has decreased with the exception of infants under age 2 months | Hib and pneumonia vaccines |
| meds for meningitis | bacterial-IV ATBs and corticosteroids (dexamethasone/Decadron); both-analgesics (acetaminophen/Tylenol) |
| poor muscle tone, weak cry, poor suck, refuses feeding, and vomiting or diarrhea; possible fever or hypothermia; neck is supple without nuchal rigidity (stiff neck); bulging fontanels are a late sign. | signs of meningitis in newborns |
| seizures with a high-pitched cry, fever and irritability, bulging fontanels, possible nuchal rigidity (stiff neck), poor feeding, vomiting, Brudzinski’s and Kernig’s signs not reliable for diagnosis | signs of meningitis in 3 months to 2 years |
| seizures (often initial sign), drowsy->delirium->stupor->coma, nuchal rigidity (stiff neck), positive Brudzinski’s sign and Kernig’s sign, fever, chills, vomiting, petechia rash, draining ear | signs of meningitis in 2 years through adolescence |
| lab tests for meningitis | blood culture, CBC, CSF analysis (bacterial-cloudy, viral-clear), WBC (up), protein (up), glucose (bacterial-decreased, viral-normal), gram stain (bacterial-positive, viral-negative) |
| diagnostic tests for meningitis | lumbar puncture, CT or MRI---checks for increased ICP and/or abscesses |
| type of isolation for pt with meningitis | droplet |
| Monitor : VS, I&O, pain level, neuro status, and head circ. for infants. NPO if decreased LOC; then clear liquids and then diet as tol. Decrease environ. stimuli; cool room; no pillow, slightly elevate HOB. Side lying for stiff neck. seizure precautions | Meningitis |
| treatment and goals for meningitis | Eradicate virus or bacteria- Be free of infection and inflammation. Continue to get appropriate vaccines: Hib and PCV to prevent |
| flexion of extremities occurring with deliberate flexion of the neck | positive Brudzinski’s sign |
| resistance to extension of the child’s leg from a flexed position | positive Kernig’s sign |
| lumbar puncture...happens between which vertebrae? measures and collects what? | Insertion of a spinal needle into the subarachnoid space between L3 and L4 or L4 and L5 vertebral spaces; measures spinal fluid pressure and collects CSF for analysis |
| steps for lumbar puncture | empty bladder; EMLA cream 45-mins to 3-hours prior to procedure; poss. sedation--fentanyl and Versed; provider will clean site and inject local anesthetic; provider will take pressure readings and collect 3-5 tubes of CSF; pressure DRSG to site |
| client education post-lumbar puncture | Instruct the client to remain in bed for 4 to 8 hrs in a flat position to prevent leakage and a resulting spinal headache. This may not be possible for an infant, toddler, or preschooler. |
| bladder and/or bowel incontinence; partial or complete lack of sensation; partial or complete paralysis of the legs; weakness of the hips, legs, or feet of a newborn; abnormal feet or legs (ie clubfoot); hydrocephalus | symptoms of myelomeningocele |
| surgery within first few days, ATBs (to prevent infections such as meningitis or UTIs), long-term---bladder and bowel programs, PT/OT, braces, wheelchair | myelomeningocele |
| myelomeningocele, meningocele, anencephaly, and encephalocele | neural tube defects |
| a defect in brain development resulting in small or missing brain hemispheres, skull, and scalp | Anencephaly |
| a protrusion of the brain and meninges through a skull defect; results from failure of the anterior portion of the neural tube to close | Encephalocele |
| birth defect---an external sac-like protrusion that encases the meninges, spinal fluid, and in some cases nerves, is present on the spine; most severe form of neural tube defect; is a type of spina bifida | myelomeningocele |
| a neuro disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, assoc. with abnormal electrical activity in the brain; risk factors: can be from family history, brain injury; cause is often unknown | epilepsy |
| treatment for seizure disorders | anticonvulsants (ie-phenytoin, phenobarbital, valproic acid), surgery (to interrupt the impulses), ketogenic diet, vagal nerve stimulator |
| The nurse observes a child for neurologic disorders. What is the earliest indicator of improvement or deterioration of neurologic status? a. vital signs b. level of consciousness c. motor function d. reflexes | b. level of consciousness |
Created by:
nurse savage
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