Flash Cards From 2Nd Peds Class Of Lnp-To-Rn

Front 1

Was is another name for Wilms tumor?

Back 1

Nephroblastoma

Front 2

Was it the most common renal and intrabdonminal tumor of childhood?

Back 2

Wilms Tumor

Front 3

Which kidney does Wilms tumor favor, and why is this good news?

Back 3

The Left kidney, this is good because it is easier to operate on.

Front 4

What theory does the book present as to the origin of a Wilms tumor?

Back 4

that the tumor arises from a malignant, undifferentiated cluster of primordial cells capable of initiating the regeneration of an abnormal structure

Front 5

Why are most children brought to the practitioner in the first place with wilms tumor?

Back 5

abdomninal swelling or an abdomnial mass

Front 6

Is metastisis common or rare in children with Wilms tumor?

Back 6

Rare

Front 7

Should the abdomen of a child with Wilms tumor ever be palpated?and why?

Back 7

Never, palpation can disseminate cancer cells.

Front 8

What is the theraputic management of Wilms tumor?

Back 8

surgery and chemotherapy with possible radiation.

Front 9

how soon is surgery performed after Wilms tumor is diagnosed

Back 9

ASAP! 24-48 hours

Front 10

What is the duration for therapy for Wilms tumor?

Back 10

6 to 15 months

Front 11

Which childhood cancer has the highest survival rate?

Back 11

Wilms tumor

Front 12

Why can Wilms tumor induce hypertension?

Back 12

Excess production of renin

Front 13

How long does it take alopecia to kick in?

Back 13

2 weeks after the initial treatment regimen

Front 14

Match the cause and effect: adhesions, edema, ileus, surgery, radiation, vincristine.

Back 14

surgery-adhesions radiation-edema vincristine-ileus

Front 15

What is the common reason for avoiding contact sports and prompt detection and treatment of genitourinary bad s/sx after treatment of Wilms tumor?

Back 15

To prevent injury to the remaining kidney.

Front 16

What test is done to rule out metastasis?

Back 16

bone marrow aspiration

Front 17

Which type of lymphoma is more common in younger children, which is more common in adolescents?

Back 17

non-hodgkins in kids younger than 14, hodgkins in adolescents

Front 18

what are lymphomas?

Back 18

a group of neoplastic diseases that arise from the lymphoid and hemopoetic systems

Front 19

which disorder is characterized by fever, profoundly impaired conscienceness and disordered hepatic function?

Back 19

Reyes disease

Front 20

How is Reyes syndrome diagnosed?

Back 20

-elevated amonia levels
-clinical amnifestations
-definitively liver biopsy

Front 21

What is the most immediate threat to life from Reyes syndrome?

Back 21

Cerebral edema with increased ICP

Front 22

Why is monitoring I&O accurately and frequently so important in a patient acutely ill with reyes syndrome?

Back 22

Adjusting fluid volumes to prevent dehydration and cerebral edema

Front 23

Are liver disfunction and impaired coagulation related?

Back 23

yes

Front 24

what happens in stage 1 of reyes syndrome?

Back 24

vomitting, lethargy,liver dysfunction, follows commands and pupillary reaction swift, type one EEG

Front 25

what happens in stage 2 of reyes syndrome?

Back 25

disorientation, combativeness, delirium, hyperventalation, hyperactive reflexes, response to paintype 1 EEG, pupillary reaction sluggish

Front 26

what happens in stage 3 of reyes syndrome?

Back 26

coma, hyperventilation, decorticate posturing, sluggich pupillary reflexes type 2 EEG

Front 27

what happens in stage 4 of reyes syndrome?

Back 27

deepening coma, decerberate posturing, large fixed pupils, little liver disfunction type 3-4 EEG, brainstem malfunction

Front 28

what happens in stage 5 reyes syndrome?

Back 28

Seizures, loss of deep tendon reflexes, repiratory arrest, flaccidity, type 4 EEG, no liver disfunction

Front 29

what are the stages of hodgkins disease?

Back 29

stage 1: limited to one lymph node (or organ) area
stage 2:two or more lymph nodes (or organs) on the same side of the diaphram are affected
stage 3: lymph nodes (or organs) on each side of the diaphram are involved
stage four the cancer has metasticized throughout the body

Front 30

How is symptomatic (B) defined in hodgkins lymphoma?

Back 30

temp of 100.4 (38) for 3 days, drenching night sweats, or unexplained loss of body weight (10% or more) over the last 6 months

Front 31

What test is essential to establish histiologic diagnosis and staging in lymphoma?

Back 31

lymph node biopsy

Front 32

what is a lymphangiography?

Back 32

a visualization of the lymphatic circulationby way of radiopaque medium injected into the feet or hands

Front 33

What are the 4 histologic stages that classify hodgkins lymphoma?

Back 33

1) lymphocytic predomniance 2)nodular sclerosis 3)mixed cellularity 4)lymphocytic depletion

Front 34

What is the main theraputic management of hodgkins lymphoa?

Back 34

radiation and chemotherapy, alone or in combination

Front 35

In children who have had a splenectomy, what is done prophylacticly? (2)

Back 35

1)indefinite antibiotics 2)immunizations for pneumoccocci and meningoccocci

Front 36

what is the most common side effect of radiation?

Back 36

fatigue

Front 37

what are two concerns sexually for minors being treated with chemo and radiation?

Back 37

1)sterility
2)delayed puberty

Front 38

Is non-hodgkins lymphoma more or less diffuse than hodgkins lymphoma?

Back 38

more diffuse

Front 39

Is mediatinal and invasion of the meninges common or uncommon in non-hodgkins lymphoma?

Back 39

common

Front 40

What is the treatment of Non-hodgkins lymphoma?

Back 40

aggressive use of chemotherapy and radiation

Front 41

survival rate of how long is concidered cured for non-hodgkins lymphoma?

Back 41

24 mopnths

Front 42

what is the most common form of childhood cancer?

Back 42

leukemia

Front 43

what is the definition of leukemia?

Back 43

a cancer of the blood forming tissues

Front 44

What re the three main consequences of infiltration of the bone marrow in leukemia?

Back 44

1)anemia from decreased RBCs
2)infection from netropenia
3)bleeding from decreased platelet production

Front 45

what happens when leukemic cells invade organs?

Back 45

enlargement and fibrosis

Front 46

What are three elements of diagnosing leukemia?

Back 46

flow cytometry (identifies specific type of blast cell), bone marrow aspiration, lumbar punture (to determine CNs involvement)

Front 47

What are the 4 fases of chemotherapy used to treat leukemia?

Back 47

1)induction (complete remission or <5%) 2)CNs prophylactic 3)intensification therapy eradicates residual cells 4)maintenence therpary (maintain the remission phase

Front 48

what sources can supply hemapoetic stem cell transplantation?

Back 48

bone marrow and umbillicle cord blood

Front 49

What risks accompany hemopoetic stem cell transplantation?

Back 49

graft-versus-host disease, overwhelming infection, severe organ damage

Front 50

Dosages of opioids are ajusted or titrated______ and administered ________ for optimum pain control

Back 50

1)to the childs needs
2)around the clock

Front 51

The use of which drug has reduced the incidence and duration of infection in children recieving treatment for cancer?

Back 51

granulocyte stimulating factor

Front 52

which vaccines should the child with cancer not recieve?

Back 52

measles, rubella, mumps, and polio

Front 53

when is the child with leukemia allowed to go back to school (WBC count)?

Back 53

>500/mm3, though they may be sent home if there is an outbreak of an infectious disease

Front 54

How are most bleeding episodes controlled or prevented in children with leukemia?

Back 54

administration of platelet concentrates or platelet rich plasma

Front 55

what are the most common bleeding episodes for children with leukemia?

Back 55

epitaxis and gingival bleeding

Front 56

for how many minutes should the child be observed after infusion of chemotheraputic drugs and for what?

Back 56

20, minutes for signs of anyphylaxis,

Front 57

When should antiemetic medications be administered? before, during, or after chemotheraputic agents? &why?

Back 57

before to prevent any naseua or vomitting whatsoever, to prevent anticipitory symptoms

Front 58

What are interventions for ulceration of oral mucosa assosiated with chemotherapy?

Back 58

1)provide a bland, moist, soft diet
2)use soft spongue toothbrushes
3)provide frequent mouthwashes with normal saline
4)use local anesthetics

Front 59

what agents should not be used in the management of somatitis?

Back 59

glycerine swabs, hydrogen peroxide, milk of magnesia

Front 60

What are interventions for rectal ulcers?

Back 60

warm sitz bath after every bowel movement, occlusive ointment or dressing applied to the ulcer, stool softeners

Front 61

What are four interventions to prevent sterile hemorrhagic cystitis that results from cyclophosphamide?

Back 61

1)liberal fluid intake
2)frequent voiding, after feeling the urge, before going to bed, and after rising
3)administering the drug early enough in the day
4)dministering mesna, an agent that provides protection to the bladder

Front 62

when will hair grow back after falling out due to cancer treatment, and what changes will occur?

Back 62

3-6 months, darker, thicker, and curlier

Front 63

What benefit does steroid therapy have in association with chemotherapy? (2)

Back 63

1)increased apetite
2)increased sense of wellbeing

Front 64

A deficiency in which clotting factor accounts for 80-85% of hemophilia?

Back 64

factor 8, (hemophilia A)

Front 65

what are s/sx of hemathrosis?

Back 65

pain, swelling, warmth, redness, and loss of movement

Front 66

what are two treatment methods that replace missing clotting factor?

Back 66

factor 8 concentrate (plasma or genetically engineered reconstituted with sterile water), DDVAP (a synthetic form of vasopressin that increases factor 8)

Front 67

Can AHP (factor 8) be administered at home?

Back 67

yes

Front 68

At what age are children expected to self administer AHP (factor 8)?

Back 68

by 8-12 years old

Front 69

what does primary prophylaxis prevent in hemophilia and what is it?

Back 69

prevents arthropathy, and is a regular infusion of factor 8 3 times a week.

Front 70

what is used instead of the IM route of medication administration if possible in hemophilliacs

Back 70

subcutaneous

Front 71

Are venipunctures or finger/heel puncture safer for menophilliacs?

Back 71

venipuncture

Front 72

what does RICE stand for?

Back 72

Rest
Ice
Compression
Elevation

Front 73

What are two important things to do to prevent crippling effects of hemophilia on joints?

Back 73

physical therapy (range of motion) and diet (weight control)

Front 74

What does shift to the left mean in a CBC?

Back 74

Presence of immature neutraphils due to hyperfunction of the bone marrow (can be seen during bacterial infection)

Front 75

What are the cardiac ramifications of anemia?

Back 75

decrease in periferal resistance secondary to less viscosity of RBC poor blood, creating greater blood return to the heart, creating more cardiac workload, which can lead to cardiad failure. Murmurs can also be heard due to greater turbulence.

Front 76

What are long term consequences of anemia for children? (2)

Back 76

1)growth retardation
2)delayed sexual maturation

Front 77

Hiw is anemia sometimes defined?

Back 77

Hgb level below 10 or 11.

Front 78

what are the two age groups most likely to present iron deficiency anemia?

Back 78

1-3 years
adolescents

Front 79

how many times is an infant's stool guiac tested to test for occult blood? &why?

Back 79

4-5 times for intermittant blood loss.

Front 80

Why should cows milk not be given to a child less than a year old?

Back 80

increase risk of GI blood loss due to allergy to milk protein or GI bleeding due to lack of cytochrome iron (heme protein)

Front 81

why should oral iron be given through a straw or syringe at the back of the mouth?

Back 81

Because iron can stain teeth

Front 82

is it a good or bad sign if stools are tarry or dark green after iron supplement intake?

Back 82

Good sign, bad sign if they remain normal color, may signal poor administration of the iron

Front 83

how is parenteral iron given?

Back 83

IM, using a z-tract method, and no massaging!

Front 84

After what time does breastmilk become an insufficient source of iron?

Back 84

After 5 months

Front 85

Why does sickle cell anemia only present later in infancy?

Back 85

because fetal hemoglobin dominates the infant blood the first few months.

Front 86

What is the sequence of the affect of sickling and infarction on organ structures in sickle cell anemia?

Back 86

1)stasis with enlargement
2)Infarction with ischemia and destruction
3) replacement with fibrous tissue

Front 87

what is a vaso-oclusive crisis in sickle cell anemia?

Back 87

distal ischemia and pain

Front 88

what is a sequestration crisis in sickle cell anemia?

Back 88

a pooling of blood in the liver or spleen with decreased blood volume and shock

Front 89

what is an aplastic crisis in sickle cell anemia?

Back 89

diminished RBC production resulting in profound anemia

Front 90

what is hyperhemolytic crisis in sickle cell anemia?

Back 90

accelerated rate of RBC destruction characterized by anemia, jaundice, and reticulocytosis

Front 91

What are the two aims of therapy for treating sickle cell anemia?

Back 91

1)prevent conditions that enhance suckling phenomena
2)to treat the medical emergencies of sickle cell crisis

Front 92

What are the main objectives to manage sicklecell crisis? (6)

Back 92

1)rest
2)hydration
3)electrolyte replacement
4)analgesics
5)blood replacement
6)antibiotics

Front 93

what vaccines should a child with sickle cell anemia recieve and why?

Back 93

pneumococci, menigioccocci, and yearly influenza because their splene is usually destroyed

Front 94

Why can't oxygen therapy be given long term to a child with sickle cell anemia?

Back 94

long term use depresses bone marrow.

Front 95

Are boys more at risk for febrile seizures or girls?

Back 95

boys

Front 96

is the severity or the rapidity of the temperature elevation more of the issue in a febrile seizure?

Back 96

severity of temperature

Front 97

What temperature does the seizure usually exceed?

Back 97

101.8 (38.8)

Front 98

does a febrile seizure usually occur during the rise in temperature or during a prolonged temperature?

Back 98

rise in temperature

Front 99

what kind of infections do febrile seizures usually accompany?

Back 99

upper respiratory or gastrointestinal

Front 100

who is at risk for an MMR or pertusis vaccine being a percipitating factor in febrile seizures?

Back 100

children prone to having seizures

Front 101

Do neurological disorders develop because of febrile seizures?

Back 101

in 95% of cases, no.

Front 102

Manifestations of sexual development before what age defines precocious puberty?

Back 102

before age 8 in girls and 9 in boys

Front 103

What is a cause of precocious puberty in boys?

Back 103

CNS insult or structural injury

Front 104

What are most cases of precocious pseudopuberty caused by?

Back 104

tumors of the ovary or testes

Front 105

what is a possible treatment for precocious puberty?

Back 105

monthly subcutaneous injections of Lutenizing hormone releasing hormone (Lupron) which regulates pituitary secretions

Front 106

what is the current theory about how type 1 diabetes occurs?

Back 106

it is an autoimmune disease that arises in a person with a genetic predisposition is exposed to a precipitating event such as a viral infection (dietary source, bacteria or chemical irritant)

Front 107

Describe the process in which glucose in unavailable and the body breaks fat down for energy and its consequences.

Back 107

fats are broken down into ketone bodies, these can be used by the cells as energy, but excess goes into circulation. In the blood it causes ketoacidosis. It can be found in the urine: ketonuria.

Front 108

How is ketoacidosis dealt with by the lungs?

Back 108

the respiratory system tries to eliminate the excess carbon dioxide by increased depth and rate (kussmaul respirations)

Front 109

Define glycosylation

Back 109

proteins from the blood become deposited in basement membranes of small blood vessels where they become trapped by sticky glucose compounds.

Front 110

How does neuropathy occur assosciated with diabetes?

Back 110

glycosylation occurs on sheaths of the nerves, interrupting neurotransmission of stimuli

Front 111

What values diagnose diabetes in: 8 hour fasting glucose? oral glucose tolerance test? random blood glucose value accompanied by classic diabetes sign?

Back 111

fasting>126, random>200,OGTT>200

Front 112

What is the normal strength of insulin?

Back 112

100 units/ml

Front 113

When are the two doses of twice daily insulin reginmen given?

Back 113

before breakfast and before the evening meal

Front 114

How is hyperlipidemia diagnosed?

Back 114

analysis of blood full lipid profile

Front 115

Should the child be fasting for lipid profile? How many samples are drawn? When should the turniquet be applied, and why?

Back 115

1)yes, 12 hours
2)2
3)right before drawing blood because blood stasis can affect the results

Front 116

hwat is the acceptable level of toal cholesterol in children? LDL cholesterol? add how many to be considered high?

Back 116

1)<170
2)<110
add 30, add 20

Front 117

how many calories should be saturated fats? how many fats? how many mg/day of cholesterol?

Back 117

<10%, <30%, 300mg/day

Front 118

What drugs are used to treat hyperlipidemia in children?

Back 118

Bile acid-binding resins or sequestrants cholestyramine or cholestipol.

Front 119

Why do the Bile acid-binding resins or sequestrants not pose a threat of systemic toxicity? How are they prepared? What system do the main side effects affect?

Back 119

1)they are not absorbed by the intestine.
2)powder form mixed with juice or water
3) GI

Front 120

Which vitamins do drugs for hyperlipidemia in children interfere with absorbtion of?

Back 120

fat soluble vitamins.

Front 121

which age group is the peak population for Kawasaki disease?

Back 121

toddlers

Front 122

What happens in Kawasaki disease?

Back 122

extensive inflammation of the arterioles, venules, and capillaries occurs progressing to coronary artery aneurisms.

Front 123

How do most deaths occur from Kawasaki disease?

Back 123

coronary thrombosis or severe scar formation and stenosis of the main cornary artery

Front 124

What is a possible diagnosis for a toddler with prolonged elevated temperature that is unresponsive to antibioticsand is not attributable to anyother cause?

Back 124

Kawasaki disease

Front 125

What is the acute phase of Kawasaki disease?

Back 125

Irritable with high fever, unresponsive to antibiotics, symptoms

Front 126

what hapoens in the subacute phase of Kawasakis disease?

Back 126

resolution of fever, till all symptoms disapear,child most at risk for cornary artery aneurism, irritability continues, monitored on EKG

Front 127

What happens in the convalescent stage of Kawasaki disease?

Back 127

the child has resolved symptoms, but lab values have not returned to normal

Front 128

What are diagnostic criteria for Kawasaki disease? (6)

Back 128

must meet 5/6
1)fever 5 or more days
2)bilateral conjunctival infection without exudate
3)changes in oral mucosal membranes: fissures, strawberry tongue
4)changes in extremities (edema, erythema of palms and soles, peeling of hands and feet)
5)polymorphous rash
6)Cervical lymph node larger than 1.5 cm

Front 129

What are symptoms of myocardial infarction in children? (6)

Back 129

abdominal pain, palor, restlessness, vomitting, inconsollable crying, shock

Front 130

what is the treatment of Kawasaki disease?

Back 130

IV gamma globulin and salicylate therapy.

Front 131

In Kawasaki disease Salicilates are initially given as a ____ and after the fever has subsided given as a _____?

Back 131

antiinflammatory, antiplatelet

Front 132

what drug may be given to children who have had Kawasaki disease that created giant aneurysms?

Back 132

coumadin

Front 133

What nursing care is done for a child with Kawasaki disease to minimize skin discomfort?

Back 133

cool cloths, unscented lotions, and soft loose clothing

Front 134

What is a good way to treat arthritis in children with Kawasaki disease?

Back 134

passive range of motion in the bath

Front 135

How long until live virus vaccines can be given to a child who has received gamma globulins in Kawasaki disease?

Back 135

11 months

Front 136

Over 90% of poisonings happen where?

Back 136

In the home

Front 137

How oong should you flush an eye after exxposure to a harmful substance?

Back 137

15-20 minutes

Front 138

What is the usual dose of activated charcoal (& if the dose is unknown)?

Back 138

1 g/kg

Front 139

What is the main problem with Corrosives?

Back 139

Damaging the lining of the throat: breathing obstruction. also SHOCK

Front 140

What is the main concern with Hydrocarbons?

Back 140

Chemical pneumonia

Front 141

Describe the stages of Acetaminophen poisoning?

Back 141

1) initial: sweating, vomitting
2)Latent (24-36 hrs) patient improves
3)Hepatic involvement may last up to 7 days: pain in upper right quadrant, jaundice, confusion, stupor, coagulation abnormalities
4)recovery

Front 142

What is the most common poisoning in children?

Back 142

Acetaminophen

Front 143

What is the antidote to tylenol?

Back 143

N-acetylcysteine (mucomist)

Front 144

List complications of aspirin poisoning

Back 144

dehydration/fluid overload, coma, seizures, bleeding disorders, fever

Front 145

Describe the stages of iron poisoning:

Back 145

1)initial period GI symptoms
2)latency: patient improves
3)Systemic toxicity
4)Hepatic injury
5) possibly pyloric stenosis

Front 146

What is the dangerous entry way of mercury into the body?

Back 146

inhalation

Front 147

What is the level of concern for lead blood levels?

Back 147

10mcg/dl

Front 148

What is the most dangerous symptom of high level lead poisoning? what can chronic lead levels lead to?

Back 148

1)encephelopathy
2)learning/behavioral problems

Front 149

How are most bites and stings managed? (3)

Back 149

compresses, calamine lotion, and preventing secondary infections

Front 150

What are the three arthropods who's bite/sting require direct attention?

Back 150

scorpions, black widows and brown recluses

Front 151

What is the best intervention after a bee sting?

Back 151

remove the stinger immediately, was with soap and water, apply compress, apply household liquid, administer antihistamine and get away from the area of the insects

Front 152

arthropods serve as a)infectors b)resevoirs c)both

Back 152

c both

Front 153

What is rickettsiae?

Back 153

an intracellular parasite, simalar in size to bacteria that infect alimentary tracts of a wide range of natural hosts.

Front 154

What are the 3 stages of limes diease?

Back 154

stage 1: bug bite, erythemia migrans at site of bites up to a month
stage 2: systemic involvement of neuro, muscolo, and cardiac
stage 3: musculoskeletal pain, neurological damage such as deafness or encephalopathy

Front 155

How is lymes disease treated?

Back 155

Penicillin

Front 156

what are the favorite places for ticks to bite?

Back 156

scalp, neck, armpits, and groin areas

Front 157

Where should DEET not be applied, and what should you do after a child having DEET on comes back inside?

Back 157

1)face, hands, and any irritated skin
2)wash with soap and water

Front 158

More than half of all animal bites happen to children under the age of?

Back 158

5

Front 159

What is the care for an animal bite?

Back 159

Rinsing the wound with copiuous amounts of Lactaters ringer or saline under high pressure and washing the surounding tisssue with soap and water, clean pressure dressing applied, extremity elevated

Front 160

what are three medical treatments that are done for an animal bite?

Back 160

tetanus toxoid, antibiotics, and rabies protocol

Front 161

What medication treats rickettsiae?

Back 161

tetracycline or chloramphenicol

Front 162

Endemic and epidemic typhus both have which vector?

Back 162

lice

Front 163

Rickettsiae cause what kind of rash?

Back 163

maculopapulor rash

Front 164

what is the treatment of a tick bite?

Back 164

grasp tick with tweezers, as close as possible to biting, pull straight up with steady force, remove any remaining part, cleanse wound and your own hands with soap and water

Front 165

Where should the involved area (stung by the scorpion) be placed relative to the body?

Back 165

below

Front 166

read 1771-3

Back 166

do!

Front 167

What is the time span typical to infantile eczema?

Back 167

starts 2-6 months and remission usually occurs by 3 years of age

Front 168

Infantile deramtitus has links to ______ predispositions, _______abnormalities, and is affected by environmental _____________

Back 168

genetic, skin, humidity, and allergens

Front 169

What are the 4 major goals for Atopic Dermatitis?

Back 169

1)hydrate the skin 2)relieve pruritis 3)reduce flareups or inflammation 4) prevent secondary infections

Front 170

Describe a bath for a child with AD, and how often would they take it, and at what time during the day

Back 170

tepid bath with mild soap, or no soap, immediately after (within 3 mins) apply emolliant, 1-2 times a day, at best at night to prevent nighttime itching

Front 171

what oral maedications help alleviate itching in AD?

Back 171

antihystamines: at night (hydroxyzine {Atarax} and diphenhydramine {benadryl}
during the day: loratidine {Claritin} or fexofenadine {Allegra}

Front 172

What are local some side effects from topical steroids?

Back 172

striae, skin atrophy, pigment changes

Front 173

Why might topical immunomodulator be used and what are the names of two?

Back 173

non-responsive to steroid treatment, to avoid facial side effects. Tacrolimus (0.03 and 0.1%) and Pimecrolimus

Front 174

What indicates infection in Atopic Dermatitus?

Back 174

honey colored crusts with surrounding redness

Front 175

Can over application of certain topical agents (ie. steroids) be harmful?

Back 175

Yes

Front 176

Is the prognosis worse for children diagnosed with Legg-Calve-Perthes disease younger or older?

Back 176

older

Front 177

How can more tenous circulation in the femoral epiphysis lead to legg-calve-perthes disease?

Back 177

ability for ischemia following trauma, inflammation, and coagulation defects

Front 178

What are s/sx of legg-calve-perthes diasease?

Back 178

limp, pain in hip, thigh, or knee, limited range of motion

Front 179

How is Legg-Calve-Perthes disease diagnosed?

Back 179

first by radiographic imaging and conclusively (able to see necrosis) by MRI

Front 180

What age and gender is legg-calve-perthes disease most likely in?

Back 180

white boys age 4-8 years old

Front 181

What are the 4 stages of legg-calve-perthes disease?

Back 181

1)Femoral head becomes more dense with possible fracture of supporting bone;
2)Fragmentation and reabsorption of bone;
3)Reossification when new bone has regrown; and
4)Healing, when new bone reshapes.

Front 182

What is the initial therapy for LCPD &why? and what is the later therapy?

Back 182

1)intially rest and non-weight bearing to reduce fractures and inflammation
2)later active motion

Front 183

What is the recory period for LCPD with surgery and without surgery?

Back 183

1)3-4 months
2)2-4 years

Front 184

How is containment of the weight bearing limb accomplished with LCPD?

Back 184

casts, slings, braces, bedrest, traction, and surgery

Front 185

what is slipped femoral Capital Epiphysis?

Back 185

the spontaneous displacement of the proximal femoral epiphysis in a posterior or inferior direction

Front 186

When does slipped femoral capital epiphysis moslty occur?

Back 186

before or during the growth spurt associated with puberty

Front 187

what 3 things can slipped femoral capital epiphysis be associated with?

Back 187

1)endocrine disorders
2)renal osteodystrophy
3)radiation therapy

Front 188

what does a radiograph of a slipped femoral capital epiphysis
show?

Back 188

the capital femoral epiphysis remains in the acitabulum remains in the acetabulum while the femoral head slips, which streaches the growth plate

Front 189

What types of surgery are used for slipped femoral capital epiphysis and what is done pre and post surgery?

Back 189

1) pins and screws and osteotomy
2)bed rest/traction before surgery, crutches, ROM after surgery

Front 190

Is Juvenile Idiopathic Arthritis more comon in girls or boys? what are the 2 peak ages of onset?

Back 190

1)girls
2)1-3 and 8-10

Front 191

Describe the pathophysiology of juvenile idiopathic arthritis:

Back 191

chronic inflammation of the synovium with joint effusion and eventual erosion, destruction, and fibrosis of the articular cartilage. then adhesions of joint surfaces and ankylosis

Front 192

In what percentage of children with JIA does the disease become inactive, and what percantage caries it into adulthood?

Back 192

70% inactivated, 30% continues

Front 193

Uveitis (inflammation of the iris and ciliary body) can a complication of which disease?

Back 193

JIA

Front 194

What are some complications of systemic onset JIA?

Back 194

fevers with late evening spikes, transient maculopaular rash, hepatosplenomegaly, pericarditis, pleuritis, and lymphadenopathy

Front 195

What are the 4 main goals of therapy for JIA?

Back 195

1)control pain
2)minimize effects of joint inflammation such as joint deformity
3)preserve joint range of motion and function
4)promote normal growth and development

Front 196

what are four classes of drugs used in treatment of JIA?

Back 196

1)NSAIDS
2)Methotrexate
3)Corticosteroids
4)Entanercept
5)Second line antirheumatic drugs

Front 197

What are the types of NSAIDs approved for use in JIA?

Back 197

ibuprofen, naproxen, tolmetin

Front 198

What is a possible side effect of naproxen?

Back 198

skin fragility

Front 199

What are the lab tests necessary for a child on (second line drug for JIA) methotrexate? what topics do you discuss with teens about this topic/

Back 199

1)CBC and liver functions.
2)Birth defects, and avoiding alcohol is necessary

Front 200

Are single intrarticular injections of corticosterois are ___ multiple injections can lead to ___

Back 200

1)affective
2)cushing syndrome, osteoporosis, increased risk for infection

Front 201

sulfasalazine, hydroxylchloroquine, gold, and D-penicillamine are all?
how long might these take to kick in?
what are they used in combination with?

Back 201

1)SSARDS slow acting antirheumatic drugs.
2) may take months
3)NSAIDS

Front 202

What is "excellent excercise" for children with JIA?

Back 202

swimming

Front 203

night-time splinting is recommended because?

Back 203

it minimizes pain and reduces flexion deformity.

Front 204

Studies show that emotional and behavioral functioning is most closely linked with maternal depression and parental distress or physical disability?

Back 204

maternal and parental distress

Front 205

Is Opiod therapy routine in JIA?
Have non-pharmacological methods proved effective in treating pain of JIA?

Back 205

1)no
2)yes

Front 206

Moist hot or cold therapy is effective?

Back 206

moist & hot.

Front 207

what two types of fractures are indicitive of abuse?

Back 207

spiral and fractures at various stages of healing

Front 208

what is the most boken bone of childhood?

Back 208

clavicle

Front 209

what is the added risk of an epiphyseal fracture and what added therapies are used?

Back 209

1)restriction of growth
2)open reduction and internal fixation

Front 210

what is a complete fracture?
incomplete?
simple/closed fracture?
open/compound fracture?
complicated fracture?
comminuted fracture?

Back 210

completely broken
still partly attached
doesn't break skin
breaks skin
harms surrounding organs
shards break off into surrounding tissue

Front 211

What accounts for the muscle tightness observed over a fracture site, and how can it be overcome?

Back 211

muscles contracting immediately after a fracture and making a physiolocial splint, can be overcome by traction or muscle relaxant (ie. anesthesia)

Front 212

What are healing times for the femur in neonates, early childhood, late childhood, and adolescence?

Back 212

2-3 weeks
4 weeks
6-8 weeks
8-12 weeks

Front 213

what should be suspected in a child who refuses to walk or crawl?

Back 213

a fracture

Front 214

what are the goals for fracture management?

Back 214

1) regain alignment and length of boy fragments (reduce)
2)retain alignment and length (immobilize)
3) restore function
4)prevent further injury

Front 215

is physical therapy needed for children who suffer fractures?

Back 215

rarely

Front 216

What would prevent casting and require traction in a fractured limb?

Back 216

swelling and a badly malaligned fracture

Front 217

When initially assessing a child with suspected fracture should the nurse palpate the limb immediately?

Back 217

No, let the child become comfortable with the nurse, they can wiggle their toes and talk about it, once the child is comfortable the nurse can assess pulse and test for sensation

Front 218

what are the five Ps that accompany ischemia from vascular injury?

Back 218

Pain
Pallor
Pulselessness
Paresthesia
Paralysis

Front 219

read pg. 1809 emergency box

Back 219

ok!

Front 220

What is more common plaster of paris cast of fiberglass/polyurethane cast?

Back 220

fiberglass/polyurethane cast they are lighter weight and water resistant.

Front 221

What are the pros/cons of plaster casting?

Back 221

smooth exterior, cheaper, molds closely to the body, takes longer to dry (10-72 hours), not water resistant, doesn't permit weight bearing as soon.

Front 222

What are the pros/cons of synthetic casting materials?

Back 222

dries faster (5-30) mins, material lighter, permits early weight bearing, water resistant, inability to mold closely to the body, rough exterior, more expensive

Front 223

Is a hot or cold air fan used to help dry the cast and why?

Back 223

cold air, hot air may dry outside faster than inside or cause burns to skin.

Front 224

what happens if hot spots are felt?

Back 224

a window is cut in the cast to observe that area

Front 225

What is the most effective liquid for cleaning pin sites?

Back 225

chlorhexadine 2 mg/ml solution

Front 226

study basic tractions and pg.1815 box

Back 226

yes!

Front 227

hot water scalds are most frequent in _______
flame related burns are more common in _____
10-20% of __________ is from burns
_____ accounts for 1/10 house fires

Back 227

toddlers
older children
child abuse
children playing with flame

Front 228

The extent of tissue damage in a burn is related to what 4 factors?

Back 228

intensity of the heat, duration of exposure, conductivity of tissue involved, the rate at which the heat energy is dissipated by the skin

Front 229

is an injury from a brief exposure to high intensity heat similar to that from a long exposure to less intense heat?

Back 229

yes

Front 230

A more localized electrical burn occurs when skin resistance is _______ a more systemic electrical burn occurs if the skin resistance at the site of contact if _______

Back 230

high,
low

Front 231

look over pic on 1783

Back 231

yes

Front 232

sunburn is an example of a

Back 232

mild first degree burn

Front 233

what is the major symptom of first degree (superficial) burns and when does it heal? does it usually scar?

Back 233

pain
5-10 days
no

Front 234

what burn can be described as painful, moist, red, and blistered?

Back 234

second degree partial thickness burn

Front 235

what is the wound of partial thickness burns sensitive to?

Back 235

temp changes, exposure to air, light touch

Front 236

What burn can be described as:varies in color red to tan, waxy white, brown, or black distinguished by a dry leathery apperance?

Back 236

full thickness burns

Front 237

What is a major burn and where is it treated? moderate? minor?

Back 237

1)>20%, burn center
2)10%-20% hospital burn specialist
3)outpatient

Front 238

What kind of burn hardly ever effects that tracheobronchial tree?
which burn can effect it?
why?

Back 238

1)thermal injury
2)inhalation of heated gases or toxicchemicals
3)vocal chords

Front 239

what is evidence of upper airway burns?

Back 239

singed nose hairs, laryngeal edema, burns of the face and lips

Front 240

what is evidences of respiratory involvement in a burn?

Back 240

wheezing, increasing secretions, hoarseness, wet rales, and carbonaceous secretions

Front 241

What are manifestations of respiratory injury from carbon monoxide poisoning?

Back 241

mucosal erythmia and edema, followed by sloughing of the mucosa, replaced by a mucopurulent lining

Front 242

what does an escharotomy incision relieve?

Back 242

Hypoxia resulting from chests inability to expand.

Front 243

In the post-burn period what are most pulmonary infections related to?

Back 243

noscomial exposure, immobility, and abdominal distension.

Front 244

With a systemic response to a major burn >30% how is fluid lost?

Back 244

there is a systemic increase in capillary permeability, allowing plasma proteins, fluids, and electrolytes to be lost