Nu 202 - Peds - Various Topics

Front 1

What 3 things does a myelomeningocele contain?

Back 1

1. meninges,
2. spinal fluid, and
3. a portion of the spinal cord and its nerves

Front 2

What is called when a sac-like cyst on the L-S area contains meninges, spinal fluid, and spinal cord?

Back 2

myelomeningocele

Front 3

What lab value will you see if fetus has open neural tube defect?

Back 3

^ alpha feto protein

Front 4

What can ^ alpha feto protein indicate in mom?

Back 4

open neural tube defect

Front 5

How is spina bifida occulta different from myelomeningocele?

Back 5

spina bifida occulta often has no symptoms except tuft of hair or dimple

Front 6

What are the sym of myelomeningocele?

Back 6

flaccid paralysis of legs, neurogenic bladder, fecal incontinence, musculoskeletal deformities, hip dislocation or subluxation, talipes varus or valgus, dribbles urine & feces continuously, 1/3 have MR

Front 7

What does the following describe: flaccid paralysis of legs, neurogenic bladder, fecal incontinence, musculoskeletal deformities, hip dislocation or subluxation, talipes varus or valgus, dribbles urine & feces continuously, 1/3 have MR

Back 7

myelomeningocele

Front 8

What percent of L-S myelomeng. get hydrocephalus?

Back 8

90%

Front 9

What sym do 90% of pt w/ myelomeng. get?

Back 9

hydrocephalus

Front 10

Why do surgerical closure on myelomening.?

Back 10

to prevent infection and trauma to sac and
to avoid stretching over nerve roots

Front 11

What 2 things that predispose to myelomeng.?

Back 11

1. folic acid deficiency in mom
2. genetic predisposition

Front 12

What's the typical size of a neonate's head r/t chest?

Back 12

head 1" larger than chest

Front 13

What might be the first sign before neuro sym in myelomeningocele?
How do you detect it?

Back 13

hydrocephalus,
head >1" larger than chest

Front 14

How can hydrocephalus present in the eyes?

Back 14

sunset eyes - eye rotated downward

Front 15

What 2 sym indicating what 2 neurological changes can you assess r/t myelomen?

Back 15

1. bulging anterior fontanel (= ^ ICP)
2. high pitched cry (neuro damage)

Front 16

What might a high pitched cry from neonate indicate?

Back 16

neuro damage

Front 17

What might a bulging fontanel indicate in a neonate?

Back 17

^ ICP

Front 18

What can you assess r/t urogenital sys in kid w/ myelomen.?

Back 18

neurogenic bladder (distended)

Front 19

What's output like r/t neurogenic bladder?

Back 19

Trickling pee

Front 20

What can freq trickling pee in neonate?

Back 20

neurogenic bladder r/t myelomen

Front 21

Myelomeningocele - body position?
x2

Back 21

prone,
trendelenburg (if no marked hydrocephalus)

Front 22

What's priority nursing care r/t Myelomeningocele?

Back 22

protecting sac form injury!

Front 23

What position do you put kid in w/ hydrocephalus r/t Myelomeningocele?

Back 23

prone,
elevated head (to reduce ICP)

Front 24

What kind of dressing on sac in myelomeningocele?

Back 24

moist, sterile dressing

Front 25

What's the most important assessment pre and post op r/t myelomeningocele?

Back 25

^ ICP

Front 26

What two things can cause ^ ICP r/t myelomeningocele?

Back 26

meningitis,
hydrocephalus

Front 27

What's earliest sign of ^ ICP in neonate?

Back 27

tense or bulging fontanel

Front 28

What 2 things are most important to stress to parents of kid r/t myelomeningocele?

Back 28

freq diaper change, and
scrupulous skin care

Front 29

If shunt for hydrocephalus, what position?

Back 29

position flat or side-lying (to avoid to rapid decompression of IC fluid)

Front 30

What's the most imp post op assessment for shunt r/t hydrocephalus?

Back 30

^ ICP

Front 31

Who has the highest incidence of ingesting poison?

Back 31

2 y/o

Front 32

What's the first concern r/t poisoning?

Back 32

life support

Front 33

What's the second concern r/t poisoning?

Back 33

what kid ingested

Front 34

What's an old school thing that you don't do anymore r/t poisoning?

Back 34

force vomiting w/ ipecac

Front 35

What category of poison are the following?:
meds, plants, cosmetics, perfume

Back 35

noncorrosives

Front 36

What are four ex of noncorrosive poisons?

Back 36

meds, plants, cosmetics, perfume

Front 37

What are two options for Rx of noncorrosive poisons?

Back 37

gastric lavage, and
activated charcoal

Front 38

Within what time frame must you utilize activated charcoal after noncorrosive poisoning?

Back 38

w/in 30 min

Front 39

What category of poison are the following?:
toilet bowel cleaner, Drano, ammonia, Lysol, batteries

Back 39

corrosives

Front 40

What category of poison are the following?:
gas, kerosene, fuel oil, turpentine

Back 40

hydrocarbons

Front 41

What category of poison are the following?:
turpentine

Back 41

hydrocarbon

Front 42

What category of poison are the following?:
batteries

Back 42

corrosives

Front 43

What are 5 examples of corrosive poisons?

Back 43

toilet bowel cleaner, Drano, ammonia, Lysol, batteries

Front 44

What are 4 ex of hydrocarbon poisons?

Back 44

gas, kerosene, fuel oil, turpentine

Front 45

What kind of poison did kid ingest if visible severe burns and edema of mouth, lips, tongue, and throat?

Back 45

corrosive

Front 46

With what types of poisons do you avoid lavage and vomiting as Rx?

Back 46

corrosives, and
hydrocarbons

Front 47

What do you have kid do if ingested corrosive?

Back 47

drink water or milk (maybe not milk)

Front 48

Don't try to _____ corrosive poisoning?

Back 48

neutralize

Front 49

What procedure might they use for kid who ingested corrosive?

Back 49

esophagoscopy

Front 50

What do you have to assess prior to esophagoscopy?

Back 50

drooling or crying when swallows

Front 51

If you see the following sym, what should you suspect?:
choking, coughing, n/v, weakness, ^ inspiration w/ retractions, grunting, and cyanosis

Back 51

ingestion of hydrocarbon poisoning

Front 52

What sym can you expect after ingesting hydrocarbon poison?
x7

Back 52

choking, coughing, n/v, weakness, ^ inspiration w/ retractions, grunting, and cyanosis

Hint 52

cccnvwirg
vwngr3c

Front 53

What is a principle sym of ASA poisoning?

Back 53

tinnitus

Front 54

What ABG condition could you see r/t ASA poisoning?
Why?

Back 54

respiratory alkalosis,
caused by ASA-induced hyperventilation

Front 55

What could happen to temp r/t ASA poisoning?

Back 55

hyperpyrexia (> 106 deg)

Front 56

What would you expect to see w/ ASA poisoning, but actually is seldom seen?

Back 56

bleeding problems

Front 57

What's the antidote for Tylenol?

Back 57

acetylcysteine (Mucomyst)

Front 58

Who absorbs the most lead? (kids or adults?)
How much more?

Back 58

kids absorb 3-5 x as much

Front 59

What are the first kind of sym you see r/t lead poisoning?

Back 59

behavioral changes

Front 60

If you see a kid become the following, what should you suspect?:
progressively more irritable, aggressive, v interesting in normal play, lethargic or hyperactive

Back 60

lead poisoning

Front 61

If a kid loses newly acquired motor skills (used to feed self, now can't), what should you suspect?

Back 61

lead poisoning

Front 62

What lab results might kid w/ led poisoning present?

Back 62

anemia

Front 63

What lead blood level is of concern?

Back 63

> 10Ug/dl

Front 64

What are the following meds?:
CaEDTA, BAL (Dimercaprol), Succimer

Back 64

chelating agents for lead poisoning

Front 65

What are three examples of chelating agents for lead poisoning?

Back 65

CaEDTA, BAL (Dimercaprol), Succimer

Front 66

What two chelating agents are often used together?
Why? x2

Back 66

CaEDTA, BAL,
b/c less s/e and gets lead out of brain better

Front 67

What's the principle chelating agent?

Back 67

CaEDTA

Front 68

What's another name for Ca-EDTA?

Back 68

calcium edetate

Front 69

How do you give CaEDTA? (route)

Back 69

deep IM or IV

Front 70

What do you give w/ CaEDTA?

Back 70

procaine in syringe, and
EMLA cream 2.5 hrs before shot

Front 71

What's the main toxic effect of CaEDTA?
What do you therefore check for?

Back 71

nephrotoxicity,
assess renal function (oliguria)

Front 72

Who can't you give BAL to?

h

Back 72

kid w/ peanut allergy

Hint 72

Picture a kid bailing out loads of peanuts from a boat

Front 73

What can't you admin when kid on BAL?

Back 73

iron tx

Front 74

What are 3 complications from tx of lead poisoning?

Back 74

encephalopathy,
anemia,
nephrotoxicity

Front 75

What do you tell parents of kid who finishing lead poisoning tx?

Back 75

prevent re-exposure

Front 76

What's the best way of preventing lead poisoning?

Back 76

educating public

Front 77

What's the most common tracheoesophageal fistula?

Back 77

proximal esoph ends in blind pouch,
distal esoph attaches to trachea

Front 78

What is a sym mom may present if kid has tracheoesophageal fistula?

Back 78

polyhydramnios

Front 79

What should you suspect if you see constant drooling and excessive secretions in mouth & nose?

Back 79

tracheoesophageal fistula

Front 80

What should you suspect if you see coughing, choking, cyanosis?

Back 80

tracheoesophageal fistula

Front 81

What are the sym of tracheoesophageal fistula? (besides secretions from nose & mouth)

Back 81

3 c's: cough, choking, cyanosis (esp with feeding)

Front 82

Why give sterile water to neonate first?

Back 82

r/o tracheoesophageal fistula

Front 83

What do you do if you give sterile water to neonate w/ tracheoesophageal fistula?

Back 83

suction and
O2 PRN

Front 84

What's the most imp nsg intervention for tracheoesophageal fistula?

Back 84

prevent aspiration

Front 85

What are two nsg interventions to prevent complications r/t tracheoesophageal fistula?

Back 85

prevent aspiration, and
pneumonia

Front 86

What's HOB for tracheoesophageal fistula?

Back 86

30 deg

Front 87

When you see what s/s do you do tracheal suctions r/t tracheoesophageal fistula?

Back 87

when you see substernal retractions

Front 88

When you see substernal retractions r/t tracheoesophageal fistula, what do you do?

Back 88

tracheal suction

Front 89

What device might be utilized for tracheoesophageal fistula?

Back 89

gastrostomy tube

Front 90

In what environ neonate w/ tracheoesophageal fistula placed?

Back 90

isolette w/ high humidity

Front 91

What is the g tube used for first r/t tracheoesophageal fistula?
second?

Back 91

first to allow air to escape,
then to feed

Front 92

What happens in the first OR r/t tracheoesophageal fistula?

Back 92

1. ligate then close distal esoph,
2. esophagostomy with pouch to drain secretions

Front 93

How do you keep skin nice after esophagostomy r/t first OR for tracheoesophageal fistula?

Back 93

keep clean and
protect with thin layer of
mild ointment

Front 94

What do you give kid with esophagostomy?

Back 94

pacifier,
maybe po fluids

Front 95

What's a big no-no when suctioning kid w/ esophagostomy?

Back 95

don't touch anastomosis area,
follow MD's mark on catheter

Front 96

What are two NI for positioning and repositioning kid post op r/t tracheoesophageal fistula?

Back 96

HOB 30 deg,
reposition often (for lung expansion)

Front 97

Why keep HOB @ 30 for tracheoesophageal fistula post op?

Back 97

prevent regurgitation into esoph

Front 98

How do you prevent regurg into esoph post op for tracheoesophageal fistula?

Back 98

HOB 30 deg

Front 99

How do you allow for max lung expansion post op for tracheoesophageal fistula?
(besides HOB 30)

Back 99

reposition often

Front 100

How do you avoid post op vomiting r/t tracheoesophageal fistula?

Back 100

NPO 5-7 days

Front 101

How long NPO post op tracheoesophageal fistula?

Back 101

5-7 days

Front 102

Gastrostomy tube open or closed after tube feeding post op for tracheoesophageal fistula?

Back 102

open

Front 103

When do you start oral feeding post op tracheoesophageal fistula?

Back 103

2 wks post op

Front 104

What's first oral feeding post op tracheoesophageal fistula?

Back 104

water (in case of aspiration)

Front 105

What's a common post op complication for tracheoesophageal fistula?

Back 105

esophageal stenosis

Front 106

What are four signs of esophageal stenosis r/t tracheoesophageal fistula?

Back 106

difficulty swallowing,
choking,
coughing with feedings,
refusal to eat

Front 107

What should you expect if you see the following post op tracheoesophageal fistula?:
difficulty swallowing,
choking,
coughing with feedings,
refusal to eat

Back 107

esophageal stenosis

Front 108

What's HPS?

Back 108

Hypertrophic Pyloric Stenosis

Front 109

When do HPS occur usu?

Back 109

soon after birth (2-4 wks)

Front 110

What does the follow describe:
Baby well at 1st. Sym occur 2-4 wks old. 1st see regurgitation, then non-projectile vomiting, then projectile vomiting (during & after feedings). No bile, baby always hungry.

Back 110

HPS

Front 111

How is baby at first r/t HPS?

Back 111

just fine

Front 112

What are 4 first signs in order of HPS?

Back 112

1. regurgitation, then
2. non-projectile vomiting, then
3. projectile vomiting,
4. baby always hungry

Front 113

What does vomit contain r/t HPS?
x4

Back 113

gastric contents,
mucus,
maybe blood streaks,
No bile.

Front 114

What happens w/ feeding after puking r/t HPS?

Back 114

will eat immediately,
and vomit again
... yummy...

Front 115

What happens to BMs r/t first s/s of HPS?

Back 115

stool v in freq & amt (constipation)

Front 116

What presents visually on abdomen during and after feeding r/t HPS? (not olive-shaped mass)

Back 116

peristaltic waves pass for L to R

Front 117

What can you palpate that is part. to HPS on abdomen?
And where?

Back 117

olive-shaped mass,
RUQ

Front 118

During feeding or after vomiting, if you can palpate an olive-shaped mass @RUQ, what might it indicate?

Back 118

HPS

Front 119

What are typical infant levels of the following:
Na?
K?
Cl?

Back 119

Na 134-146
K 3.9-5.0
Cl 97-110

Front 120

What blood levels go up and down r/t HPS?
3 up
2 down

Back 120

Decreased:
Na
K
Cl
Increased:
pH
bicarbonate

Front 121

What ABG condition does kid present r/t HPS?

Back 121

metabolic alkalosis

Front 122

What is the goal of nsg mngt r/t pre op for HPS?
x2

Back 122

restore F&E balance and correct dehydration

Front 123

What must be corrected prior to surgery for HPS?

Back 123

dehydration (poss metabolic alkalosis)

Front 124

What is a primary NI post of for HPS?

Back 124

provide adequate nutrition

Front 125

What happens r/t vomiting post op for HPS?
why?

Back 125

still vomit 1-2 days r/t gastritis

Front 126

When are feedings usu started post op for HPS?

Back 126

4-6 hrs

Front 127

By when usu. do you subsititute water or electrolyte solution with formula or breast milk post op HPS?

Back 127

24 hours

Front 128

What position for baby after feeding post op for HPS?

Back 128

elevate head,
put on right side

Front 129

What is the hereditary charact of sickle cell anemia?

Back 129

autosomal recessive

Front 130

What is the name of the pathol Hb in sickle cell anemia?

Back 130

Hb S

Front 131

When does Hb S morph in sickle cell?

Back 131

when it's deoxygenated

Front 132

What's the name of most freq and painful sickle cell crisis?

Back 132

vaso-occlusive sickle cell crisis

Front 133

What 2 things can happen during a vaso-occlusive sickle cell crisis?

Back 133

tissue necrosis,
pain

Front 134

What blood condition does pt w/ sickle cell often have?

Back 134

chronic hemolytic anemia

Front 135

Why is sickle cell called a hemolytic anemia?

Back 135

sickled RBCs have shorter life span

Front 136

What are sym of sickle cell just after birth for neonate?
Why?

Back 136

asymptomic b/c
^ levels of mom's Hb F prevent excessive sickling

Front 137

At what age do problems often start for kids w/ sickle cell?

Back 137

4-6 mos old

Front 138

What is the life cycle of spleen r/t sickle cell?

Back 138

1st - enlarged w/ sickled cells & has v funct
*spleen may rupture
2nd - small and fibrotic r/t multi infarc & can't filter bacteria

Front 139

Why are sickle cell pts more susceptible to infection?

Back 139

fibrotic spleen can't filter bacteria

Front 140

To what infection is pt w/ sickle cell prone?
Why?

Back 140

meningitis r/t dysfun'l spleen

Front 141

What should you suspect if infant has swollen hands and feet?

Back 141

sickle cell

Front 142

What is hand-foot syndrome?

Back 142

swollen hands and feet

Front 143

What is often the first sym in infant w/ sickle cell?

Back 143

hand-foot syndrome

Front 144

If infant has priapism, what could you suspect?

Back 144

sickle cell

Front 145

What often precipitates vaso-occlusive crisis?

Back 145

infection

Front 146

What can infection precipitate r/t sickle cell anemia?

Back 146

vaso-occlusive crisis

Front 147

What two effects can vaso-occlusive crisis cause (besides pain & necrosis)?

Back 147

slowed circulation,
renal failure

Front 148

What is a sequestration crisis?

Back 148

r/t sickle cell,
large amt of blood pooled in liver and spleen

Front 149

What is it called when viral or other infection causes v prod of RBC in sickle cell pt causing profound anemia?

Back 149

aplastic anemia

Front 150

What is it called when lrg amt of blood pools in liver and spleen r/t sickle cell?

Back 150

sequestration crisis

Front 151

What are the charac of the anemia caused by sickle cell?

Back 151

normocytic, normochromic

Front 152

What are the 2 tests you give in succession to dx sickle cell?

Back 152

sickledex then
Hgb electrophoresis

Front 153

What is the procedure for sickledex test?
How long do results take?

Back 153

finger stick,
3 min

Front 154

What tests tells if kid has sickle cell disease or trait?

Back 154

Hbg electrophoresis

Front 155

What are 3 primary NI to teach parents for between sickle cell crises?

Back 155

1. promote tissue oxygenation
2. promote hydration
3. prevent infection

Front 156

How do you prevent sickling?

Back 156

promote tissue oxygenation

Front 157

What are 3 things that ^ need for O2 that you should try to prevent r/t sickle cell?

Back 157

strenuous activity,
cold,
stress

Front 158

What's the next most imp thing to provide for kid w/ sickle cell besides tissue oxygenation?

Back 158

hydration,
give adequate fluid intake

Front 159

What are 4 primary NI during sickle cell crisis?

Back 159

1. minimize O2 use (bedrest)
2. promote hydration
3. relieve pain
4. maybe Trental

Front 160

What does Trental do?

Back 160

makes RBCs slippery in sickle cell

Front 161

What med makes RBCs slippery r/t sickle cell?

Back 161

Trental

Front 162

When can kid in sickle crisis do more than bedrest for activity?

Back 162

when pain gone

Front 163

Describe O2 admin during sickle crisis?
What do you assess?

Back 163

no prolonged O2,
observe response r/t pain

Front 164

What is the most helpful during sickle crisis?

Back 164

give oral & IV fluids,

Front 165

How much fluid do you give during sickle crisis?

Back 165

2x normal

Front 166

What is the best way to evaluate hydration during sickle crisis?

Back 166

check mucus membrane

Front 167

What is another way to evaluate hydration r/t sickle crisis besides wt, I&O, mucus membranes?
What are 2 methods you can't use?

Back 167

serum electrolytes,
can't use amt or spec grav

Front 168

What is pain med tx during sickle crisis? (when, what route, and what?)

Back 168

around the clock
IV morphine

Front 169

What's a non-medical Rx for pain during sickle crisis?

Back 169

heat to painful areas

Front 170

What's the following describe?: absence of innervation in the large intestine

Back 170

Hirschsprung's disease

Front 171

Why is Hirschsprung's disease called megacolon?

Back 171

colon above defect enlarges

Front 172

What is the classic sym of Hirschsprung's disease?

Back 172

constipation

Front 173

What do you suspect if ribbon-like stool?

Back 173

Hirschsprung's disease

Front 174

What do you suspect if fecal mass palpated in LLQ, but rectum empty?
... did i just say "but rectum"?

Back 174

Hirschsprung's disease

Front 175

What is stool like in Hirschsprung's disease?

Back 175

foul smelling,
pellet, ribbon, or liquid

Front 176

What sym does kid have w/ Hirschsprung's disease?

Back 176

malnourished,
anemic,
protuberant abdomen,
thin wasted extremities,
hypoproteinemia

Front 177

What may dev from malabsorption of nutrients r/t Hirschsprung's disease?

Back 177

hypoproteinemia

Front 178

In Hirschsprung's disease, what is med mgnt if mild, chronic sym?
x3

Back 178

isotonic enemas,
stool softeners,
low residue/fiber/bulk diet

Front 179

What is first surgical thing done for Hirschsprung's disease?

Back 179

temporary colostomy

Front 180

What do you suspect if the following?:
Child malnourished, anemic, protuberant abd, thin extremities, light weight

Back 180

Hirschsprung's disease

Front 181

If double-barrel colostomy, where are stomas and what comes out?

Back 181

proximal (more left) = mucus
distal = stool

Front 182

When is colostomy usu closed r/t Hirschsprung's disease?

Back 182

1 year

Front 183

Where do you take temp r/t Hirschsprung's disease?

Back 183

axillary

Front 184

Describe alimentation (type and timing) and preparation pre-op for Hirschsprung's disease?

Back 184

24-48 prior = clear liquids,
then NPO with
NG & rectal tubes

Front 185

What do you check first out of Hirschsprung's disease surgery?

Back 185

vs

Front 186

What do you check after vs post op Hirschsprung's disease?
x4

Back 186

LOC,
I&O
abd. dsg,
stoma

Front 187

What must you check r/t I&O post op Hirschsprung's disease?

Back 187

NG tube &
colostomy

Front 188

What do you check r/t stoma post op Hirschsprung's disease?

Back 188

color change,
edema,
d/c,
bleeding

Front 189

What do you do before dressing change or other painful procedures r/t Hirschsprung's disease post op?

Back 189

pain meds

Front 190

What's the usu outcome after surgery for Hirschsprung's disease?

Back 190

fecal continence,
poss delayed toilet training

Front 191

Why might toilet training be delayed after successful surgery for Hirschsprung's disease and fecal continence is achieved?
x3

Back 191

intermittent diarrhea,
trauma to area,
psychological associations

Front 192

What are 3 ways to assist parents adjusting to kid w/ cleft lip or palate?

Back 192

1. completely accept child
2. point out normal attributes
3. show before & after pics of infants w/ similar malformations

Front 193

What do you use if larger cleft lip or palate for nursing?
x4

Back 193

soft nipple w/ big opening,
nursettes,
soft long lamb's nipples,
gravity flow nipples

Front 194

What are 2 things to do when nursing kid w/ cleft?

Back 194

burp freq,
feed upright

Front 195

How do you get infant used to elbow or wrist restraints post op?

Back 195

put 'em on periodically pre op

Front 196

What position best for post op cleft lip?

Back 196

on side or back,
head elevated

Front 197

What position best for post op cleft palate?

Back 197

on side or front

Front 198

When do you repair cleft lip?

h

Back 198

6-12 wks old

Hint 198

Picture a kid mailing away in an old school catalog for his new lip... and it usu takes 6-12 wks

Front 199

If cleft lip & palate, what do you repair 1st?
Wait how long for next piece?

Back 199

lip,
palate after lip healed (12-18 mos)

Front 200

What 3 things might you wait for to repair cleft palate?

Back 200

1. healing of lip (12-18 mos)
2. advantageous palate growth
3. after teeth appear

Front 201

Before what event do you want to do cleft palate repair?

Back 201

learning to speak

Front 202

What can you assess pre op to help post op r/t cleft things?

Back 202

feeding techniques

Front 203

What's a device to aid suture line in cleft lip repair?

Back 203

Logan bar

Front 204

What are 4 NI post op cleft lip?

h

Back 204

1. humidification
2. pain meds or mild sedatives
3. restrain arms
4. feed on demand

Hint 204

environment,
admin what
you know this one
how do you keep from crying

Front 205

What are 2 things to prevent from infant post op cleft anything?

Back 205

prevent crying, and
fingering surgery site

Front 206

What do you feed with first out of cleft lip surgery?
What do you feed him?

Back 206

rubber-tipped dropper or Breck feeder,
clear liquids, the formula or breast milk

Front 207

What's a big rule post op cleeft palate?

Back 207

no sticking anything in the mouth (no spoons, nipples, fingers, etc.)

Front 208

What is imp to check for post op cleft palate?

Back 208

bleeding

Front 209

What should you suspect if you see the following post op cleft palate?:
freq swallowing, restless, hematemesis, ^ pulse)

Back 209

bleeding

Front 210

What are 4 signs of bleeding post op cleft palate?

Back 210

freq swallowing,
restless,
hematemesis,
^ pulse

Front 211

What's position for irrigating post op cleft palate?

Back 211

head tilted forward

Front 212

How long do you restrain elbows post op cleft palate?

Back 212

3 wks

Front 213

What kind of infections are kids prone to post op cleft palate?
x2

Back 213

respiratory infections,
otitis media w/ loss of hearing

Front 214

What are 3 poss s/e post op cleft palate?

Back 214

malpositioned teeth,
dental decay,
impaired speech

Front 215

What Rx might a kid need long term post op cleft palate?

Back 215

medical,
surgical,
dental,
speech tx

Front 216

What might you see on butt of kid w/ hip dysplasia?

Back 216

deeper or extra folds on affected side

Front 217

What could it mean if you see extra or deeper folds on butt or inner things of infant?

Back 217

congenital hip dysplasia

Front 218

What's Galeazzi sign?

Back 218

short limb on affected side r/t hip dysplasia

Front 219

What do you want to know about condition of hip dislocation r/t dysplasia?

Back 219

if dislocates

Front 220

What might you feel if infant hip dislocates?
What's it called?
How long is test affective?

Back 220

clunky feeling or clicking.
Ortolani's maneuver,
most effective up to 3 mos old

Front 221

If kid has hip dysplasia, what will unaffected hip do if he stands on affected leg?
What's it called?

Back 221

tilt downward instead of upward,
Trendelenberg's sign

Front 222

How intense is the rx for congenital hip dysplasia if caught in first 6 mos?
When and what results are expected?

Back 222

conservative Rx results in
normal hip by the time walking

Front 223

What Rx for congenital hip dysplasia for birth - 6 mos? x3
How long

Back 223

legs are gently flexed,
externally rotated,
held in abduction.
~ 6 wks

Front 224

What are 3 options for devices for congenital hip dysplasia for birth - 6 mos?

Back 224

splint,
brace,
Pavlik harness

Front 225

What's a no-no old school trick for congenital hip dysplasia for birth - 6 mos that causes hip extension?

Back 225

double or triple diapers

Front 226

What are the 3 steps to Rx for newly dx unrelocatable hip in 6-18 mos old?

Back 226

1. skin traction
2. hip reduced
3. spica cast

Front 227

How often do you change spica cast for 6 - 18 mos old?

Back 227

q 6 wks

Front 228

What's priority care if skeletal traction used r/t hip dysplasia?

Back 228

pin care aimed at preventing osteomyelitis

Front 229

What do you use and what's a no-no when trying to prevent irritation under spica cast?

Back 229

yes: clothing
no: lotion or powder

Front 230

What's imp re: position when hip device removed to teach parents r/t cong hip dysp?

Back 230

keep hips abducted

Front 231

What can you use to relieve itching under cast?

Back 231

blow-dryer on cool

Front 232

What's another name for talipes equinovarus?

Back 232

congenital clubfoot

Front 233

clubfoot - another name?

Back 233

talipes equinovarus

Front 234

What's the imp assessment re: dx of clubfoot?

Back 234

differentiate from IU position deformity

Front 235

How is IU position deformity different from clubfoot?

Back 235

IU position def = only muscular and can be passively manipulated past midline

Front 236

What do you start Rx for clubfoot?

Back 236

ASAP after birth

Front 237

How often casts replaced for club foot?
For how long?

Back 237

q 1-2 wks
for ~6wks

Front 238

What's goal of casting clubfoot?

Back 238

over correction

Front 239

What might be used instead of or after overcorrection of cast r/t clubfoot?

Back 239

Denis Browne splint

Front 240

What should you do r/t angle of shoes on Denis Browne splint bar? x2

Back 240

should not be repositioned,
only tightened against bar if loose

Front 241

What are the body's px responses to CHD?

Back 241

Babbling heart (murmurs)
Additional RBCs (polycythemia vera)
Decreased exercise tolerance & dyspnea

Hypoxia of tissues
Elevated P & RR
Azure (cyanotic)
Recurrent respiratory infections
Taken out heart (CHF)
Slow growth

Front 242

What kind of ABG condition occurs r/t CHD?
Why?

Back 242

metabolic acidosis r/t tissue hypoxia

Front 243

If you see clubbing of fingers, what might it point to?

Back 243

CHD

Front 244

What pathology should you suspect if in knee chest position, squatting?

Back 244

CHD

Front 245

What position is common to get into r/t CHD?

Back 245

knee-chest position, squatting

Front 246

What's most common drug for CHF?

Back 246

Digoxin

Front 247

What's the most common type of cardiac cath for children?
What's the path?

Back 247

R-heart cath,
thru femoral vein into R atrium

Front 248

What should you expect from inserting cardiac cath in leg?

Back 248

pressure or pushing feeling

Front 249

What do you feel when dye injected into cardiac cath?

Back 249

warmth

Front 250

How long does cardiac cath take once dye injected?

Back 250

2 to several hours

Front 251

How often do you check color and VS after cardiac cath?

Back 251

q 15 min

Front 252

What is a critical ass post cardiac cath?

Back 252

check incision & dsg for bleeding or hematoma

Front 253

What do you do if bleeding at cardiac cath site?
x2

Back 253

direct pressure for several min and
report stat

Front 254

What are two things to try to implement for kid post cardiac cath for 6-8 hours?

Back 254

keep quiet in bed,
keep arm or leg straight

Front 255

How should dsg appear post cardiac cath?

Back 255

clean and dry

Front 256

What are 3 things to tell parents post cardiac cath?
How long?

Back 256

no tub baths,
no strenuous activity,
no school
for at least 3 days

Front 257

What are 3 actions to teach kids w/ CHD during episodes of cyanosis and dyspnea ?

Back 257

place on abdomen;
place on side, knee-chest pos (squatting);
loosen tight clothing

Front 258

Prevent what from kid if CHD?

Back 258

crying

Front 259

Prevent what and Rx immediately r/t CHD?

Back 259

resp infection

Front 260

What do you give CHD pt prior to even minor surgery?

Back 260

prophylactic antibiotics

Front 261

How do parents feel when caring for kid w/ CHD?

Back 261

question parenting ability b/c kid never satisfied

Front 262

What does kid w/ CHD have difficulty dealing with?
Why?

Back 262

difficult situations b/c
few opportunities to do so.

Front 263

What is the most prevalent nutritional disorder in the USA?

Back 263

iron deficiency anemia

Front 264

What age is iron deficiency anemia esp prevalent?

Back 264

6-25 month olds,
adolescents

Front 265

What are charac of RBCs w/ iron deficiency anemia?

Back 265

microcytic,
hypochromic

Front 266

What do the following sym indicate?:
waxy pallor, irritable, listless, anorexic, constipation

Back 266

iron deficiency anemia

Front 267

What are 2 poss issues w/ heart r/t iron deficiency anemia?

Back 267

megaly,
systolic murmur

Front 268

What are kids w/ iron deficiency anemia prone to?

Back 268

infection

Front 269

Why might kid w/ iron deficiency anemia be delayed in G&D?
x2

Back 269

poor muscle dev,
reluctant to explore

Front 270

What are 3 poss conditions r/t eating if kid has iron deficiency anemia?

Back 270

milk baby,
anorexic,
pica

Front 271

What are sym of iron deficiency anemia?

Back 271

Pallor waxy
Listless
Anorexic
Systolic murmur
Tired
Irritable
Constipation, maybe

"PLASTIC"

Front 272

What's diet hx usu have r/t IDA?

Back 272

lrg milk intake

Front 273

What's a "milk baby" look like? x3

Back 273

obese,
pale,
poor muscle dev

Front 274

What will blood levels be r/t IDA?:
Hgb?
Bct?

Back 274

Hgb: <11
Hct: <33

Front 275

What 6 lab values will be down in IDA?

Back 275

Hgb, Hct, MCV, MCH, MCHC, serum iron

Front 276

How often and how long do you screen kids for IDA?

Back 276

yearly until end of adolescents

Front 277

What do you report immediately r/t IDA? x2

Back 277

tachycardia,
tachypnea

Front 278

What do you do if tachycardia, tachypnea r/t IDA occurs?
(not call MD)

Back 278

O2 prn

Front 279

What can cause CNS signs of tissue hypoxia (irritability, fussiness, short attention span, low frustration tolerance, h/a, fatigue)?

Back 279

IDA

Front 280

Who can be roomate for kid w/ IDA?
Why?

Back 280

unaffected kid, b/c of lowered resistance

Front 281

Give iron w/ what?

Back 281

vit C

Front 282

What poop charac show iron supplements working?

Back 282

green tarry

Front 283

What do you do if kid vomits from iron supplements?

Back 283

call MD

Front 284

What will MD do if vomiting from iron sulfate?

Back 284

^ dose and
give w/ meals

Front 285

When and how can you tell if iron supplements correcting anemia? (specifically what lab results?)

Back 285

7 days after iron started,
^ reticulocyte count indicates
RBC proliferation

Front 286

boys or girls more prone to scoliosis?

Back 286

girls

Front 287

When is scoliosis usu dx?

Back 287

13 - 15 y/o

Front 288

Suspect what if you see forward thrusting of head, asymmetrical rib cage, nipples shoulders hips not horizontal?

Back 288

scoliosis

Front 289

What position is best for detecting scoliosis?

Back 289

bent forward at waist,
head and arms hanging

Front 290

What spine curvature can be held in place by brace?

Back 290

20-45°

Front 291

How long every day do you wear brace for scoliosis?

Back 291

23 hours

Front 292

Until when do you wear scoliosis brace?

Back 292

6 mos after px maturity

Front 293

What's worn under scoliosis brace?

Back 293

shirt or stockinette

Front 294

How do you prevent atrophy & strengthen muscles of the torso r/t scoliosis?

Back 294

exercises

Front 295

What's a Harrington rod?

Back 295

metal rod installed near spine for scoliosis

Front 296

How do you fuse Harrington rod to spine?

Back 296

use bone from iliac crest

Front 297

When is only time you should remove brace r/t scoliosis?

Back 297

bath and exercise

Front 298

What's most therapeutic sport r/t scoliosis?

Back 298

swimming

Front 299

What's priority ass in ICU r/t scoliosis?

Back 299

resp function

Front 300

How do you check blood loss after scoliosis surgery?

Back 300

UO

Front 301

How do you turn kid w/ scoliosis post op?

Back 301

log roll

Front 302

When is tonsillectomy indicated? x2

Back 302

only difficulty eating or extreme breathing discomfort

Front 303

What can happen if adenoids are enlarged? x2

Back 303

eustachian tubes blocked,
recurrent otitis media

Front 304

What might you MD suggest if recurrent otitis media?

Back 304

adenoidectomy

Front 305

When in adenoidectomy indicated?

Back 305

recurrent otitis media

Front 306

What might bad breath suggest?
Therefore what else?

Back 306

mouth breathing,
adenoid hypertrophy

Front 307

What are most important labs to check r/t pre op tonsillectomy/adenoidectomy?

Back 307

bleed & clotting time,
pro-time

Front 308

What's the last little thing to check for pre op for tonsillectomy/adenoidectomy (not bleeding)?

Back 308

loose teeth

Front 309

What position is best post op tonsillectomy/adenoidectomy?

Back 309

abdomen or side

Front 310

What two things to you tell kid pre op about what to expect post op tonsillectomy/adenoidectomy?

Back 310

abd or side position,
sore throat

Front 311

What is imp to check for post op tonsillectomy/adenoidectomy?

Back 311

hemorrhage

Front 312

When is tonsillectomy indicated? x2

Back 312

only difficulty eating or extreme breathing discomfort

Front 313

What can happen if adenoids are enlarged? x2

Back 313

eustachian tubes blocked,
recurrent otitis media

Front 314

What might you MD suggest if recurrent otitis media?

Back 314

adenoidectomy

Front 315

When in adenoidectomy indicated?

Back 315

recurrent otitis media

Front 316

What might bad breath suggest?
Therefore what else?

Back 316

mouth breathing,
adenoid hypertrophy

Front 317

What are most important labs to check r/t pre op tonsillectomy/adenoidectomy?

Back 317

bleed & clotting time,
pro-time

Front 318

What's the last little thing to check for pre op for tonsillectomy/adenoidectomy (not bleeding)?

Back 318

loose teeth

Front 319

What position is best post op tonsillectomy/adenoidectomy?

Back 319

abdomen or side

Front 320

What two things to you tell kid pre op about what to expect post op tonsillectomy/adenoidectomy?

Back 320

abd or side position,
sore throat

Front 321

What is imp to check for post op tonsillectomy/adenoidectomy?

Back 321

hemorrhage

Front 322

What are 2 most obvious early signs of post op hemorrhage r/t tonsillectomy/adenoidectomy?

Back 322

freq swallowing,
blood trickle from site

Front 323

What do you do at 1st sign of hemorrhage post op tonsillectomy/adenoidectomy?

Back 323

turn on side,
call MD

Front 324

What part change in VS indicates hemorrhage post op tonsillectomy/adenoidectomy?

Back 324

^ pulse from norm or
> 120 bpm

Front 325

Offer what to hydrate post op tonsillectomy/adenoidectomy?
How often?

Back 325

chipped ice,
15-30 mL,
Q15min

Front 326

How and how much liquid do you offer post op tonsillectomy/adenoidectomy?

Back 326

give large amounts,
take in small amounts freq

Front 327

How is it best to drink to cause less pain when drinking post op tonsillectomy/adenoidectomy?

Back 327

take large gulps

Front 328

Don't offer what 3 things r/t liquids post op tonsillectomy/adenoidectomy?

Back 328

nothing red or brown,
no straws,
no gargling

Front 329

What's a unique way to offer pain relief post op tonsillectomy/adenoidectomy?

Back 329

tetracaine lollipops

Front 330

How long does pt have significant pain post op tonsillectomy/adenoidectomy?

Back 330

24 hours

Front 331

How long, no firm foods post op tonsillectomy/adenoidectomy?

h

Back 331

2 wks

Hint 331

Picture kid begging for surgery before Xmas break (2 wks) so he can just eat ice cream the whole time

Front 332

What do you teach re: mouth odor post op tonsillectomy/adenoidectomy?

Back 332

may be present for a few days

Front 333

What do you tell parents who call saying sm amt of bright red blood occured a week post op tonsillectomy/adenoidectomy?
When should they call MD?

Back 333

normal from scab being shed,
call if more than 1 tsp

Front 334

When can reg activity be resumed post op tonsillectomy/adenoidectomy?

Back 334

1-2 wks

Front 335

G&D, how old no head lag?

Back 335

4 mo

Front 336

G&D, how old no head lag?

Back 336

4 mo

Front 337

G&D, how old turn front to back?

Back 337

4 mo

Front 338

G&D, how old turn front to back?

Back 338

4 mo

Front 339

G&D, What two things should happen by 4 mos old?

Back 339

no head lag,
turn front to back

Front 340

G&D, What two things should happen by 4 mos old?

Back 340

no head lag,
turn front to back

Front 341

G&D, how old turn back to front?

Back 341

5 mos

Front 342

G&D, how old turn back to front?

Back 342

5 mos

Front 343

When should infant double birthweight?

Back 343

6 mos

Front 344

When should infant double birthweight?

Back 344

6 mos

Front 345

When should infant sit alone steadily?

Back 345

8 mos

Front 346

When should infant sit alone steadily?

Back 346

8 mos

Front 347

What age does stranger anxiety begin for infant?

Back 347

8 mos

Front 348

What age does stranger anxiety begin for infant?

Back 348

8 mos

Front 349

When should infant triple birth weight?

Back 349

12 mos.

Front 350

When should infant triple birth weight?

Back 350

12 mos.

Front 351

When should baby walk alone?

Back 351

13-15 mos

Front 352

When should baby walk alone?

Back 352

13-15 mos

Front 353

When should kid explore all over house?

Back 353

16-24 mos

Front 354

When should kid explore all over house?

Back 354

16-24 mos

Front 355

When should anterior fontanelle close?

Back 355

18 mos

Front 356

How much ahead in px dev are girls than boys?

Back 356

~ 2 years

Front 357

What are two fears of children 2-3 y/o?

Back 357

fear of the unknown,
being alone

Front 358

What are 3 (+ ex) fears of child 4-6 y/o?

Back 358

body mutilation,
abandonment,
threatened body integrity
ex invasive procedures

Front 359

What's the mnemonic for Immunization sched?
(both the mnemonic & what it stands for)

Back 359

"HE Really Hates Putting Drugs In Veins, MoM HAs More HuTzpa"

Hep B
RV
HiB
Pneumo
DTaP
IPV
Varicella
MMR
Hep A
Mening
HPV
TDaP

Front 360

What's the full Immunizations sched?

h

Back 360

Hep B ... 0, 2, ... 6-18
RV ........... 2, 4, 6
HiB .......... 2, 4, 6, 12-15
Pneumo ... 2, 4, 6, 12-15
DTaP ....... 2, 4, 6, ..... 15-18 ....... 4-6 yrs
IPV .......... 2, 4, 6, ...................... 4-6 yrs
Varicella .............. 12-15 ............. 4-6 yrs
MMR ................... 12-15 ............. 4-6 yrs
Hep A .................. 12----->24 (x2)
Mening *** 11-12 yrs
HPV ****** 11-12 yrs (x3)
TDaP ***** 11-12 yrs (q10y)

Hint 360

"HE Really Hates Putting Drugs In Veins, MoM HAs More HuTzpa"

Front 361

What does the following describe?:
the major alteration is an increase in the permeability of the glomerular capillary wall to normal plasma proteins (esp. albumin)

Back 361

nephrotic syndrome

Front 362

When might you see severe proteinuria (albuminuria) and v serum albumin?

Back 362

nephrotic syndrome

Front 363

What do the following sym describe?:
pale, lethargic, anorexic, irritable, v activity tolerance; edema w/ ascites and wt gain; urine dark, frothy, v volume, ^ spec gravity, 4+ protein

Back 363

nephrotic syndrome

Front 364

What are the observable sym of nephrotic syndrome?
(skin color, activity x2, intake, mood)

Back 364

pale, lethargic, anorexic, irritable, v activity tolerance

Front 365

What's fluid balance sym r/t nephrotic synd?

Back 365

edema w/ ascites and wt gain

Front 366

What is urine like in nephrotic syndrome? x5

Back 366

dark, frothy, oliguria, ^ spec grav, 4+ protein

Front 367

What might there be a hx of r/t neph synd?

Back 367

recent infection

Front 368

What do you check every shift when managing neph synd?

Back 368

edema

Front 369

How often do you monitor edema r/t neph synd?

Back 369

q shift

Front 370

edema in kids, assoc w/?

Back 370

nephrotic syndrome

Front 371

Where is there often some edema r/t neph synd?

Back 371

face (esp. eye)

Front 372

Puffy eyes in AM, assoc w/?

Back 372

nephrotic syndrome, and
glomerulonephritis

Front 373

What might you see despite poor appetite r/t neph synd?

Back 373

wt gain (edema)

Front 374

What does BP show in neph synd?

Back 374

normotensive or slightly hypotensive

Front 375

Differentiate BP in glomeruloneph and neph synd?

Back 375

glom neph: high BP
neph synd: low BP (or normal)

Front 376

What's the best amount of activity and best position on initial Rx for neph synd?

h

Back 376

complete bedrest,
upright position

Hint 376

don't move, but don't lay on your kidneys either, don't lay down at all

Front 377

What are 2 things to implement r/t diet for acute neph synd?

Back 377

high protein,
small freq feedings

Front 378

What's the drug of choice for neph synd?

Back 378

prednisone

Front 379

When should proteinuria go away during neph synd tx?

Back 379

first weeks

Front 380

Give prednisone w/ or w/o food?

Back 380

give w/ food or milk

Front 381

What happens as immunoglobulins are lost in urine r/t neph synd?
What do you avoid?

Back 381

susceptible to infection,
avoid infected people

Front 382

Why are pt w/ neph synd susceptible to infection? x2

Back 382

immunoglobulins (proteins) lost in pee,
steroids mask s/s of infections

Front 383

How do you prevent skin breakdown r/t edema?

Back 383

opposing skin surfaces kept clean and separate

Front 384

What topic do you teach about in D/C teaching r/t neph synd?

Back 384

relapse

Front 385

How often neph synd relapse?

Back 385

2-4 x a year for years

Front 386

What do you do to detect early exacerbation r/t neph synd?
How often?

Back 386

test for protein in pee
at least 2x a week

Front 387

How do you treat neph synd relapse or if sensitive to steroids?

Back 387

immunosuppressant ex Cytoxan

Front 388

When would you use Cytoxan in neph synd Rx?

Back 388

if sensitive to steroids and
during relapse

Front 389

What are common s/e of cytoxan?
(blood levels, defense, inflammation)

Back 389

v WBC, ^ susceptibility to infection, cystitis r/t drug accum in bladder

Front 390

What does the leukemic process in bone marrow interfere with?

Back 390

prod of RBCs, WBCs, & platelets

Front 391

What is there a proliferation of r/t leukemia?

Back 391

immature WBCs

Front 392

What is the most common form of childhood leukemia?
What percent?

Back 392

ALL,
80%

Front 393

Leukemia causes what 3 blood dyscrasias?

Back 393

anemia,
thrombocytopenia,
neutropenia

Front 394

What are 5 sym of anemia r/t ALL?
(strength, color, LOC, breathing, heart)

Back 394

weakness, pallor, fatigue, dyspnea, cardiac sym

Front 395

What do the follow symptoms indicate?:
weakness, pallor, fatigue, dyspnea, cardiac sym

Back 395

anemia (r/t ALL)

Front 396

What are normal RBC levels?

Back 396

4.31

Front 397

What are normal platelet levels?

Back 397

150k-400k

Front 398

What level are platelets if you see epistaxis and oral bleeding?

Back 398

20k

Front 399

Fever in ALL due to what (not just infection)?

Back 399

hypermetabolic state

Front 400

What are normal WBC levels?

Back 400

4,500-13,500

Front 401

How is dx confirmed for leukemia?

Back 401

bone marrow analysis

Front 402

How long do you apply pressure after bone marrow aspiration?

Back 402

5 min

Front 403

What disease might you detect from lumbar puncture?

Back 403

leukemia

Front 404

What must pt attain before medical rx for leukemia?

Back 404

normal F&E balance prior to starting Rx

Front 405

What can cause renal failure during rx for leukemia?

Back 405

^ uric acid levels

Front 406

What 3 ways can you prevent elevation of uric acid levels r/t leukemia rx?

Back 406

1. IV hydration
2. alkalinize the urine
3. give allopurinol

Front 407

What allopurinol for?

Back 407

inhibiting uric acid production

Front 408

What med inhibits uric acid production?
Encourage what when taking it?

Back 408

allopurinol,
encourage fluids

Front 409

What's the leading cause of death r/t leukemia?

Back 409

infection

Front 410

When do you start antibiotics if pt has leukemia?

Back 410

as soon as fever starts

Front 411

What often happens with prolonged use of antibiotics?

Back 411

candida, fungal infection

Front 412

What disease is pt w/ leukemia 10 times more likely to contract?

Back 412

herpes zoster

Front 413

What is pain r/t in leukemia?

Back 413

disease and invasive procedures

Front 414

What are drug combos of Vincristine, L-asparaginase, and Prednisone used for?

Back 414

remission induction in ALL

Front 415

What combo of drugs are used to induce remission in ALL?

Back 415

Vincristine,
L-asparaginase,
Prednisone

Front 416

What are 4 non-life-threatening s/e of Vincristine?

Back 416

abd. pain,
n/v,
alopecia,
constipation

Front 417

What's a toxic effect of Vincristine?

Back 417

peripheral neuropathy

Front 418

What could be the source of the following s/e if pt has ALL is doing drug tx?:
abd. pain,
n/v,
alopecia,
constipation

Back 418

Vincristine

Front 419

Why give methotrexate to pt w/ ALL (if not for maintenance tx)?

h

Back 419

prophylaxis for CNS disease

Hint 419

meth heads ALL need prophylaxis or they can get syphilis (CNS disease)

Front 420

What do you give pt w/ ALL to prevent CNS disease?

Back 420

methotrexate

Front 421

What drug is often used for maintenance tx r/t ALL?

Back 421

methotrexate

Front 422

What meds are contraindicate w/ methotrexate?
x3

Back 422

ASA,
sulfonamides,
folic acid

Front 423

Why no salicylates & sulfonamides w/ methotrexate?

Back 423

v action of drug

Front 424

Why no folic acid w/ methotrexate?

Back 424

interferes w/ cyctoxic action of med b/c it's a folic acid antagonist

Front 425

What happens re: signs of fever in kid w/ ALL?

Back 425

may not show b/c unable to generate big enough WBC response

Front 426

What are 3 ways to reduce fever if kid w/ ALL?

Back 426

tepid sponge,
cooling blankets,
Tylenol

Front 427

To prevent infection pt w/ ALL, how do you take temp?

Back 427

no rectal

Front 428

What 2 parts of the body do you assess in pt w/ ALL r/t infection?

Back 428

mucus membranes & skin

Front 429

What do you do if nosebleed in pt w/ ALL? (3 steps)

Back 429

1. high fowler's, lean forward,
2. apply pressure for 10 min,
3. if still bleeding, cold cloth into nostrils and on bridge of nose

Front 430

What do you do if bleeding in mouth occurs in pt w/ ALL?

Back 430

put a dry tea bag on bleed (tannic acid v bleeding)

Front 431

Pt has ALL, what do you do if reaction to transfusion? x2 steps

Back 431

1. stop transfusion stat
2. KVO w/ NS

Front 432

Is analgesic Tx given to Rx pain r/t ALL?
When do you admin it?

Back 432

No, it's given to prevent it.
Give on regular sched around the clock

Front 433

What are 3 s/e of chemo?

Back 433

1. stomatitis
2. hemorrhagic cystitis
3. alopecia

Front 434

What are two meds if stomatitis r/t ALL chemo?

Back 434

1. topical (ex) viscous lidocaine
2. systemic analgesics

Front 435

What's diet if presents stomatitis?

Back 435

bland, soft, moist diet

Front 436

What are 3 ways to prevent hemorrhagic cystitis in pt on chemo for ALL?

Back 436

1. liberal fluid intake
2. freq voiding
3. admin chemo in AM (allows fluid intake and voiding)

Front 437

When can you give live virus vaccine after finishing chemo?

Back 437

3 mos. after

Front 438

Bone marrow transplant, what are first two steps before treatment?

h

Back 438

1. protective isolation
2. immunosupression

Hint 438

all about protecting, protect on the outside from other people germs,
protect on the inside from own body guards
you want him alone

Front 439

What makes it extra difficult for parents when one kid gets bone marrow transplant?

Back 439

often end up with two kids (sick kid, and donor kid) in hospital

Front 440

1. How many days are req for donor marrow to engraft and begin to proliferate mature cells?
2. What condition is kid in during this period?
3. What should family do?

Back 440

1. 10-20 days,
2. child has no ability to fight infection,
3. strictly follow protective isolation

Front 441

How is diarrhea dx given:
stool freq, amount, or consistency

Back 441

consistency (not amt or freq)

Front 442

Who develops diarrhea more freq?
How serious is it for them?

Back 442

infants, more serious manifestations than older children

Front 443

When do you report infant having diarrhea?

Back 443

after diarrhea > once

Front 444

What are 3 categories of causes of diarrhea?

Back 444

food intake,
GI infection,
antibiotics

Front 445

What can cause diarrhea r/t food intake?

Back 445

overfeeding,
new food,
too much sugar

Front 446

What are two common organisms that cause diarrhea?

Back 446

rotavirus,
shigella

Front 447

How is shigella transmitted?

Back 447

person to person

Front 448

What diarrhea-causing organism is transmitted person to person?

Back 448

Shigella

Front 449

What can shigella cause?

Back 449

diarrhea

Front 450

What can rotavirus cause?

Back 450

diarrhea

Front 451

What hx do you ask for r/t diarrhea?
X3

Back 451

1. food intake in last 24 hours
2. recent travel
3. behavior before & during BM

Front 452

What behavior is significant to ask about r/t diarrhea?

Back 452

did kid have cramps (crying, flexed knees, clutched abdomen)?

Front 453

What kind of ABG should you assess for if kid has diarrhea?

Back 453

metabolic acidosis

Front 454

What really bad thing can dehydration from diarrhea cause?

Back 454

hypovolemic shock

Front 455

What nutritional things do you give for diarrhea?

Back 455

oral rehydration tx (ORT),
oral rehydration solution (ORS)

Front 456

What's an example of ORS?

Back 456

pedialyte

Front 457

After rehydration tx, how do you give nutrition to a kid who had diarrhea?
x3

Back 457

alternate ORS w/
water or breast milk (low Na fluid), and
resume usu. diet

Front 458

What's an alternative to post-diarrhea diet that's a little more old school?
What's the problem with it?

Back 458

clear fluids, then
BRAT
* ^ CHO & v electrolytes

Front 459

Skin care for diarrhea? x2

Back 459

1. change diaper as soon as soiled
2. no soap on diarrhea area

Front 460

What do you implement before any other nursing actions r/t diarrhea?

Back 460

enteric precautions:
gown & gloves

Front 461

If kid was seriously ill w/ diarrhea, what dietary actions do you take?
Why?

Back 461

NPO for 24-48 hrs to rest GI tract

Front 462

What do you administer during emergency/initial phase of parenteral rehydration r/t diarrhea?
Why?

Back 462

give fluid rapidly
to improve circulation and renal function

Front 463

What do you administer during second phase of parenteral rehydration r/t diarrhea?
What about it?

Back 463

K given w/ caution if output is ok
(CHECK OUTPUT FIRST!)
ex wet diaper

Front 464

What do you have to check before giving K?

Back 464

OUTPUT!!!

Front 465

What's the best way to tell effectiveness of rehydration?

Back 465

daily wt

Front 466

What do you check for during rehydration?

Back 466

s/s of fluid overload

Front 467

What are the signs of fluid overload?
x6-ish or more

Back 467

moist rales, ^ BP, DNV, SOB, marked wt gain, v urine spec gravity

Front 468

What's the following describe?:
generalized dysfunction of exocrine glands characterized by thickened and tenacious secretions that occlude glandular ducts

Back 468

CF

Front 469

Is CF hereditary?

Back 469

yup

Front 470

What is the hereditary characteristics of CF?

Back 470

autosomal recessive trait

Front 471

What are the chances of kid getting CF if both parents are heterozygous for the trait?

Back 471

25%

Front 472

What are parts of the body prone to pathology r/t CF?

Back 472

respiratory tract,
pancreas,
intestinal tract

Front 473

Describe cough in CF pt if contract resp infection?

Back 473

at first, dry hacking cough;
then, loose and productive

Front 474

How does CF disrupt digestion?

Back 474

v pancreatic enzymes b/c plugged ducts lead to panc fibrosis

Front 475

What are 2 common intestinal problems r/t CF?

Back 475

meconium ileus, and
maldigestion of foods, esp fats

Front 476

What are stool like r/t CF?

Back 476

steatorrhea (large, bulky, frothy),
azotorrhea (foul smelling)

Front 477

What is most common complication of GI tract in un-RX child w/ CF?

Back 477

prolapse of rectum

Front 478

What's happens w/ sweat in CF?

Back 478

salty taste,
salt "frosting" on skin

Front 479

If kid has salt "frosting" on skin, what might it indicate?

Back 479

CF

Front 480

What's the highest priority NDx for CF?

Back 480

ineffective airway clearance

Front 481

What disease uses sweat test?

Back 481

CF

Front 482

What dx test is key to CF?

Back 482

sweat test

Front 483

When is sweat test unreliable?
Why?

Back 483

first 2 wks of life,
NB don't sweat

Front 484

What is the chemical in sweat that sweat test checks for CF dx?

Back 484

chloride

Front 485

What are ranges for sweat chloride r/t CF:
normal?:
suggestive?:
positive?:

Back 485

normal = < 40 mEq/L
suggestive = 40-60 mEq/L
positive CF = > 60 mEq/L

Front 486

What is common response from parents when asked if child eats a lot r/t CF?

Back 486

"He always eats, but never gains weight"

Front 487

If parent says, "my kid always eats, but doesn't gain weight," what dx might it indicate?

Back 487

CF

Front 488

What do you suspect if when taking child hx you note:
- failure to thrive
- recurrent resp infections,
- lrg bulky stools?

Back 488

CF

Front 489

What are 3 typical elements in medical hx of kid with CF?

Back 489

- failure to thrive
- recurrent resp infections,
- lrg bulky stools

Front 490

What do you you need to provide to clear secretions and control resp infections for CF? (general category of tx)

Back 490

pulmonary tx

Front 491

How do you take temp in CF pt?

Back 491

axillary

Front 492

What are 3 pulmonary tx for CF?

Back 492

aerosol Rx,
mist tent,
chest PT

Front 493

What's chest PT?

Back 493

chest physiotherapy,
postural and percussion to thorax to loosen secretions

Front 494

What do you do before postural drainage in CF pt?

Back 494

aerosol Rx

Front 495

How often and how long to you do aerosol Rx for CF?

Back 495

10 min BID

Front 496

What do you use in aerosol rx for CF?

Back 496

NS or include meds (bronchdilators, mucolytics)

Front 497

Why do mist tent for CF?

Back 497

reduce viscosity of secretions

Front 498

In CF, what can you do to reduce viscosity of secretions?

Back 498

mist tent

Front 499

How can you remove thick secretions from lungs r/t CF?

Back 499

Chest PT to all lobes

Front 500

How often do you do chest PT?

Back 500

Q1D and more if resp infection

Front 501

When do you do chest PT?

Back 501

one hour before meals

Front 502

What are 3 creative ways to do Chest PT?

Back 502

wheelbarrow,
stand on head,
hang by knees

Front 503

What are 3 NI r/t medication types for CF?
(what do you give x2, and not give x1)

Back 503

give Bronchodilators,
may give expectorants,
no antitussives

Front 504

How much can kid exercise with CF?

Back 504

as tolerated

Front 505

Diet r/t CF? x5

Back 505

high protein,
high CHO,
high calorie,
maybe low fat,
maybe extra salt PRN

Front 506

How's the appetite r/t CF?

Back 506

voracious

Front 507

What are two things to supplement in diet r/t CF?

Back 507

pancreatic digestive enzymes,
vit ADEK

Front 508

What do you give along with pancreatic enzymes?

Back 508

antacids

Front 509

In what form and how do you give Vit ADEK r/t CF?

Back 509

water soluble form,
double dose

Front 510

What usu. causes death r/t CF?

Back 510

pulmonary complications

Front 511

What pathology increases as CF life expectancy increases?

Back 511

insulin dependent DM

Front 512

What increases as women w/ CF get pregnant?

Back 512

risk of perinatal and maternal morbidity r/t resp problems

Front 513

What does the following describe?:
a chronic inflammatory disorder of the airways assoc w/ reversible, episodic airway obstruction

Back 513

bronchial asthma

Front 514

Asthma triggers include what foods?

Back 514

chocolate, nuts, dairy;
food additives;
food dyes

Front 515

What are two highly allergenic food products?

Back 515

Peanuts and food dyes

Front 516

What kind of breath sounds do you hear r/t asthma?

Back 516

crackles and wheezes
on expiration

Front 517

What spasms during asthma attack?

Back 517

bronchi and bronchioles

Front 518

What causes v in pO2 during asthma attack?

Back 518

trapped air in alveoli blocks fresh air

Front 519

What are two types of asthmatic kids?

Back 519

1. continually symptomatic w/ episodes of severe airway obstruction
2. no SOB or wheezing, only chronic cough (esp at night)

Front 520

What's the progression of asthma attack?

Back 520

1. usu. dry, hacking cough
2. then frothy, clear mucus
3. then SOB and tight feeling in chest
4. RR ^, expiratory phase longer, expiratory wheezes

Front 521

What state is kid in as airway obstruction progresses?

Back 521

irritable

Front 522

Why does kid w/ asthma attack sit w/ shoulders hunched forward?

Back 522

to facilitate use of accessory muscles

Front 523

How does a kid facilitate use of accessory muscles during asthma attack?

Back 523

sits w/ shoulders hunched forward

Front 524

What might you see in kid w/ chronic asthma?
x2

Back 524

growth delays, and
barrel chest

Front 525

What's a good test to check how kid w/ asthma is doing?

Back 525

Peak expiratory flow rate (PEFR)

Front 526

What's PEFR?
(what's it stand for and how do you do it?)

Back 526

peak expiratory flow rate,
measures the max flow of air that can be forcefully pushed out in 1 second

Front 527

How often should you measure PEFR?
Why?
What's that called?

Back 527

every day,
to know the usual for child,
personal best value

Front 528

What are the ranges for the zones of peak flow rate?

Back 528

Green zone: 80-100%
Yellow zone: 50-80%
Red zone: below 50%

Front 529

What are sym of green zone of peak flow rate?

Back 529

usu. sym free

Front 530

What might it mean if kid is in yellow zone of peak flow rate?

Back 530

asthma attack may be starting

Front 531

What might it mean if kid is in red zone of peak flow rate?

Back 531

is experiencing asthma exacerbation

Front 532

What two types of meds does asthmatic have?

Back 532

preventer meds,
rescue meds

Front 533

What's the definition of "preventer meds" for kids with asthma?

Back 533

long-term control meds,
control inflammation

Front 534

What's the definition of "rescue meds" for kids with asthma?

Back 534

quick relief meds,
treat sym and exacerbations

Front 535

How do you use MDI?
x3

Back 535

use spacer,
give one puff at a time,
wait 1 min between puffs

Front 536

If kid too young for MDI, what can they use?

Back 536

nebulizer

Front 537

What routes can asthmatic take steroids?

Back 537

parenteral, oral, or aerosol

Front 538

What are two complications of long-term use of steroids for kids w/ asthma?

Back 538

Cushing's syndrome, and
growth suppression

Front 539

What med does asthmatic take before exercise or cold exposure?

Back 539

cromolyn sodium

Front 540

What drug category is Cromolyn sodium?
Why is it used for asthma?

Back 540

NSAID,
inhibits airway narrowing (during exercise or in cold)

Front 541

What are two ex of B-adrenergic agonist meds for asthma?

Back 541

albuterol, terbutaline

Front 542

What are the category and uses of albuterol and terbutaline?
(1 cat, 2 uses)

Back 542

bronchodilators,
used in acute attacks and
to prevent exercise-induced asthma

Front 543

What is the expected theophylline blood range?

Back 543

5-15

Front 544

What is best position for acute asthma?

Back 544

High Fowler's

Front 545

What meds do you give during acute asthma?

Back 545

nebulized albuterol and corticosteroids, usu.

Front 546

Why use spacer w/ asthma meds?

Back 546

prevents oral yeast infection

Front 547

What do you give as acute asthma begins to improve?

Back 547

oral fluids

Front 548

What temp for oral fluids for recovering acute asthma?

Back 548

warm or room temp (cold can trigger bronchospasm)

Front 549

What do you give for unresponsive status asthmaticus?

Back 549

subcut epinephrine

Front 550

How can you teach kid w/ asthma to breathe to v chance of attack?
x2

Back 550

thru nose, not mouth;
cover nose and mouth w/ scarf or cupped hands

Front 551

What can you teach to practice breathing for kid w/ asthma?

Back 551

practice pursed lip and diaphragmatic exercises

Front 552

What are some examples of pursed lip and diaphragmatic exercises?

Back 552

blow bubbles,
blow cotton balls or ping pon balls on a table,
blow pin wheel,
prevent tissue from falling by blowing it against a wall

Front 553

What are 3 better sports to try for asthmatic?

Back 553

swimming, baseball, gymnastics

Front 554

What do the following describe?:
an antigen-antibody reaction that follows an infection caused by group A beta-hemolytic step (not ARF)

Back 554

Acute glomerulonephritis

Front 555

What precedes acute glomerulonephritis?

Back 555

group A strep infection

Front 556

What are two examples of group A strep that can cause Acute Glom neph?

Back 556

strep throat,
impetigo

Front 557

What might the following signs indicate?:
- hx of URI or skin infection
- cola urine
- eye edema
- loss of appetite
- ^ temp
- ^ BP

Back 557

acute glom neph

Front 558

What are the nsg ass of acute glom neph? x6

h

Back 558

- hx of URI or skin infection
- cola urine
- eye edema
- loss of appetite
- ^ temp
- ^ BP

Hint 558

hx,
pee,
face,
nutrition,
2x vs

Front 559

How recently would pt have had URI or impetigo before acute glom neph?

Back 559

1-3 wks

Front 560

3 words describing pee colorf in glom neph?

Back 560

cola, tea, smoke

Front 561

When is eye edema worse in glom neph?

Back 561

AM

Front 562

What can temp reach in glom neph?

Back 562

104 deg

Front 563

What's imp to assess freq with glom neph?

Back 563

BP

Front 564

What's a major complication of glom neph?

Back 564

hypertensive encephalopathy

Front 565

When is hypertensive encephalopathy an issue with glom neph?

Back 565

during acute phase,
if BP high and
output poor

Front 566

What can hypertensive encephalopathy result in with glom neph (general and specific)?
x4

Back 566

neuro sym:
dizzy, h/a, photophobia

Front 567

What are visible s/s r/t urine in glom neph?
x2

Back 567

oliguria,
hematuria

Front 568

What do u/a say if glom neph?

Back 568

+ albumin, RBC, WBC, casts, ^ spec grav

Front 569

What lab value differentiates glom neph from nephrotic synd?

Back 569

u/a + for RBC

Front 570

What blood lab values indicate glom neph?

Back 570

^ BUN,
^ ESR,
^ Creatinine,
ASO titer ^

Front 571

What is the most spec lab value for renal failure?

Back 571

^ creatinine

Front 572

What's activity during acute glom neph?

Back 572

bedrest

Front 573

Protect from what in acute glom neph? (r/t temp, activity, & precautions)
x3

Back 573

chilling,
fatigue,
infections

Front 574

How often check vs in acute glom neph?

Back 574

q 4 h

Front 575

Report what two things in acute glom neph?

Back 575

^ BP, and
s/s cerebral ischemia

Front 576

Glom neph, if marked edema or ^ BP, do what r/t diet?

Back 576

moderate Na restriction

Front 577

Glom neph, if severe kidney involvement, do what r/t diet?

Back 577

may limit protein

Front 578

Glom neph, if output way down, do what r/t diet?

Back 578

restrict fluids (ice chips)

Front 579

D/C teaching, what two things r/t

Back 579

1. avoid or treat any resp or skin infections
2. avoid fatigue and sports (until neg labs for hematuria or proteinuria)

Front 580

What is the 'ventral surface' of the penis?

Back 580

underside

Front 581

What is hypospadias?

Back 581

hole on ventral surface of penis

Front 582

What is the name for a hole on ventral surface of penis?

Back 582

hypospadias

Front 583

Why do surgery on hypospadias? x3

Back 583

1. give normal appearance
2. help peeing while standing
3. help reproductive capability

Front 584

When do you do the hypospadias surgery?

Back 584

6-18 mos. before child develops castration and body image anxiety

Front 585

Why no circumcision for hypospadias?

Back 585

use foreskin for reconstruction

Front 586

What do you avoid doing for boy born with hypospadias?

Back 586

circumcise

Front 587

What can you admin to pt to help prior to hypospadias surgery?
Why?

Back 587

male hormones to achieve bigger penis to help surgery

Front 588

What is one way to identify boy with hypospadias?

Back 588

abnormal urinary stream

Front 589

If admitted for surgery of hypospadias, what do you assess?

Back 589

child's perception of surgery and
what he calls his penis

Front 590

How do you prepare child for hypospadias surgery?

Back 590

use doll and put bandage and catheter on its penis (remind that penis is still there

Front 591

What terms do you want to avoid for kid going into hypospadias surgery?

Back 591

'cut off'

Front 592

What do you do if pre-op med is IM for child?

Back 592

mention it shortly before giving (less time to worry)

Front 593

What are 3 NI post-op for hypospadias?

Back 593

1. check urine CCA
2. assess visible penis
3. Teach parents

Front 594

Why cath hypospadias child?
x3

Back 594

1. keep area dry
2. promote healing
3. maintain patency of new urethra portion

Front 595

What are two charact. of urine post-op hypospadias that should be noted?
What might they mean?

Back 595

hematuria or cloudiness,
could mean unexpected bleeding or exudate

Front 596

What color and consistency should urine be post-op hypospadias?

Back 596

clear yellow

Front 597

What two charact of penis might you expect post-op hypospadias?

Back 597

1. some edema
2. misshapen if 1st of 2 surg

Front 598

What behavior can you expect from kid post-op hypospadias?
Why might he do that?

Back 598

shows everyone dressing,
reassures him penis is still there

Front 599

What two things can you teach parents post-op hypospadias?

Back 599

1. normal for kid to be preoccupied with penis
2. If parents show matter-of-fact-ness about it, should decrease gradually

Front 600

What is the leading cause of acquired heart disease in children?

Back 600

ARF

Front 601

What is ARF thought to be?
What does it affect?

Back 601

autoimmune
affecting connective tissues, such as in
heart, joints, CNS

Front 602

What childhood disease is thought to be autoimmune and affects heart, joints, and CNS?

Back 602

ARF

Front 603

What's another name for Group A beta-hemolytic streptococci?

Back 603

Streptococcal pharyngitis, or
Strep throat

Front 604

What's another name for Strep Throat?

Back 604

Group A beta-hemolytic strep

Front 605

What can Group A strep cause?

Back 605

ARF

Front 606

What causes ARF?

Back 606

Group A beta-hemolytic strep

Front 607

Is ARF contagious?

Back 607

no

Front 608

What's used to dx ARF?

Back 608

Jones Criteria (revised)

Front 609

With what are the following sym associated?:
migratory polyarthritis, carditis, chorea, erythema marginatum, subcut nodules

Back 609

ARF

Front 610

What are 5 major Jones Criteria for ARF?

Back 610

migratory polyarthritis, carditis, chorea, erythema marginatum, subcut nodules

Front 611

What's the most common dx for ARF?

Back 611

migratory polyarthritis

Front 612

What does the following describe?:
joints inflam, swollen, painful, limited ROM. Lasts a few days then moves joints.

Back 612

migratory polyarthritis

Front 613

Describe the sym of migratory polyarthritis?
x4

Back 613

1. joints inflam, swollen, painful, limited ROM
2. Occurs during 1st 1-2 wks of ARF
3. Lasts in certain joints a few days then moves
4. Favors large joints (knees, hips, elbows)

Front 614

What is the only sum in Jones Criteria that can cause perm. damage?

Back 614

carditis

Front 615

What's one way you can id carditis from ARF?

Back 615

tachycardia (not from fever),
esp during sleep

Front 616

What can it indicate if child has tachycardia out of proportion to fever esp at night?

Back 616

Carditis,
major criteria of ARF

Front 617

What does it indicate if you see involuntary, sudden muscular movements of the extremities; involuntary facial grimacing; muscle weakness; emotional lability; speech disturbance?

Back 617

chorea,
major criteria of ARF

Front 618

What's the sym of chorea? x5

Back 618

see involuntary, sudden muscular movements of the extremities;
involuntary facial grimacing;
muscle weakness;
emotional lability;
speech disturbance

Front 619

What can it indicate of child has maculars that eventually join to give chicken wire appearance?

Back 619

erythema marginatum,
major criteria of ARF

Front 620

Chicken wire rash - assoc w/?

Back 620

erythema marginatum,
major criteria of ARF

Front 621

Tachycardia at night - assoc w/?

Back 621

Carditis,
major criteria of ARF

Front 622

Subcutaneous nodules of ARF - describe?

Back 622

small, non-tender nodules over bony prominences

Front 623

small, non-tender nodules over boney parts - assoc w/?

Back 623

subcutaneous nodules of ARF

Front 624

What are the sym representing one of the Jones Minor Criteria for ARF?
x3

Back 624

arthralgia,
low-grade fever (highest in afternoon),
fatigue

Front 625

What are two blood test results that represent one of the Jones Minor Criteria?

Back 625

^ ESR,
^ C-reactive protein

Front 626

ESR - means?

Back 626

erythrocyte sedimentation rate

Front 627

What is the most reliable evidence that a child has had a strep infection?

Back 627

^ ASO titer

Front 628

ASO - means?

Back 628

antistreptolysin O (antibody)

Front 629

What two classes of meds do you give for ARF?

Back 629

anti-inflammatory meds,
penicillin

Front 630

What two anti-inflammatory drugs do you give for ARF?
When do you take them?

Back 630

aspirin & corticosteroids,
give both with meals

Front 631

What route do you give penicillin for ARF?

Back 631

IM

Front 632

What do you give if child sensitive to penicillin IM for ARF?

Back 632

erythromycin PO

Front 633

What's the regimen for penicillin for kid with ARF?

Back 633

10 days to kill bug,
then for years prophylactically

Front 634

Why give penicillin for years if hx of ARF?

Back 634

to prevent serious cardiac damage, or
a recurrence of rheumatic fever

Front 635

What do you do prior to surgery for pt w/ hx of rheumatic fever?
Why?

Back 635

^ PCN doses to prevent bacterial endocarditis

Front 636

What's the highest priority NI for rheumatic fever?

Back 636

bedrest to minimize cardiac damage

Front 637

Pt. w/ ARF, what do you do when pt allowed OOB?

Back 637

assess tolerance by checking AP

Front 638

When is pt w/ ARF allowed OOB? x2 labs

Back 638

ESR returns to normal,
C-reactive protein disappears

Front 639

What are the two painful sym of ARF?

Back 639

polyarthritis,
carditis

Front 640

What do you give for pain r/t polyarthritis and carditis (ARF)?

Back 640

anti-inflammatory as ordered

Front 641

How do you prevent injury from chorea?

Back 641

no forks

Front 642

What are 4 ways to evaluate regression or progression of ARF?
What's highest priority assessment?

Back 642

1. assess remission of sym
2. Check I & O
3. daily weight
4. vs
***sleeping AP

Front 643

When do you teach ARF parents to let kid do school work?

Back 643

morning (r/t afternoon fever)

Front 644

What characterizes croup syndrome?
(what's the resulting condition, where's it occur, what's its most common characteristics)

Back 644

Acute infections of larynx or trachea causing hoarse cough and dyspnea

Front 645

What usually causes croup?

Back 645

virus

Front 646

What causes epiglottitis?

Back 646

HIB (hamophilus influenzae bacteria)

Front 647

What type of croup is not caused by a virus?

Back 647

epiglottitis

Front 648

What is likely to occur if a child contracts a particular kind of croup?

Back 648

same kind of croup is likely to recur

Front 649

How fast is onset of sym for epiglottitis?

Back 649

rapid onset

Front 650

What are the sym of the epiglottitis form of croup?

Back 650

Emergent if acute
Pulse ^
Inspiratory stidor
Gagged (muffled voice)
Lacks cough and hoarseness
Obstructed airway
Tripod position
Tossing and turning (restless)
Indigo skin (cyanosis)
Temp ^
In a panic (frightened)
Severe soar throat

Front 651

Why is acute epiglottitis an emergent condition?

Back 651

rapid total airway obstruction may occur w/in minutes

Front 652

What's are two signs a kid might have a sore throat?

Back 652

drools saliva,
tripod position (leaned forward, mouth wide, tongue out)

Front 653

What is tripod position?
Why do infants do it?

Back 653

while sitting up, leans forward with mouth open and tongue out;
sore throat

Front 654

What's the characteristic and the name of the breath sound you hear from a kid with epiglottitis?

Back 654

rapidly increasing inspiratory stridor

Front 655

What's the sound of stridor in pt w/ epiglottitis?

Back 655

frog-like croaking sound

Front 656

What's immediate Rx for kid with epiglottitis? 2x

Back 656

child upright,
maybe 02

Front 657

What is kept with epiglottitis pt AT ALL TIMES?

Back 657

intubation equip.

Front 658

What is main way to dx epiglottitis?

Back 658

x-ray neck

Front 659

What must be readily available as MD does direct visualization of epiglottis?

Back 659

resuscitation equip.

Front 660

Besides x-ray, what's another way to dx epiglottitis?
Who can do it?

Back 660

Direct visualization of epiglottis,
done only my MD

Front 661

What two meds do you give for epiglottitis?

Back 661

antibiotics and
steroids

Front 662

How do you give antibiotics for epiglottitis?
For how long?

Back 662

IV, then PO
total of 7-10 days

Front 663

Why are steroids given to epiglottitis pt?

Back 663

v edema

Front 664

When does swelling go down after beginning antibiotics for pt. w/ epiglottitis?

Back 664

24 hours

Front 665

What's LTB?
What's the lay term for it?

Back 665

acute laryngotracheobronchititis,
viral croup

Front 666

What kind of onset to symptoms of LTB have?

Back 666

gradual

Front 667

When does LTB often occur?

Back 667

with or after URI

Front 668

What type of croup syndrome has no cough associated w/ it?

Back 668

epiglottitis

Front 669

With any form of croup, what do you need to keep near the child at all times?

Back 669

intubation equip.

Front 670

What are three types of croup?

Back 670

1. epiglottitis
2. LTB
3. spasmodic (midnight) croup

Front 671

What are sym of LTB?

Back 671

Vociferous cough (barking/brassy cough)
Increasing inspiratory stridor, gradual
Retractions
Achromatic (pallor)
Labored respirations

Croaky (hoarse)
Restlessness
Off-color (cyanosis)
Unrestful (restless)
Pyrosis is mild (low grade fever)

Front 672

What type of croup has rapid or sudden onset?

Back 672

epiglottitis and
midnight croup

Front 673

What type of croup has gradual onset?

Back 673

LTB

Front 674

What croup is Rx with humidity?

Back 674

viral croup (LTB and spasmodic croup)

Front 675

What is the NI for viral croup besides keeping intubation equip. close?

Back 675

high humidity cool mist

Front 676

What is Rx for viral croup if stridor at rest?

Back 676

racemic epinephrine

Front 677

1. Why is epi given for viral croup?
2. What does this reduce the need for?
3. In how long does it work?
4. When do sym often recur?

Back 677

1. v edema
2. reduces need for trache or intubation
3. 10-15 min
4. recur in 2 hrs

Front 678

What type of croup may utilize epinephrine?

Back 678

viral croup (LTB and spasmodic croup)

Front 679

With spasmodic croup, of what are there paroxysmal attacks?

Back 679

laryngeal obstruction

Front 680

What are the symptoms of spasmodic croup related to LTB?

Back 680

same as LTB, except no fever

Front 681

What's another name for spasmodic croup?

Back 681

midnight croup

Front 682

When and how long do sym of spasmodic croup occur?

Back 682

often last several hours at night

Front 683

What sym might a kid with spasmodic croup wake up with in the morning?

Back 683

cough and hoarseness

Front 684

When and how long do sym of spasmodic croup usu. recur?

Back 684

next 1-2 nights

Front 685

What type of peds disorder might be relieved if taken out into the cool night air to go to ER?

Back 685

spasmodic croup

Front 686

What type of humidity is best for viral croup, cool or steamy?

Back 686

cool

Front 687

What is the cause of half of the cases of bronchiolitis?

Back 687

RSV (respiratory syncytial virus)

Front 688

How contagious is bronchiolitis?

Back 688

very

Front 689

What does RSV cause?

Back 689

bronchiolitis

Front 690

Who is at high risk for RSV? 3x

h

Back 690

preemies OR
kids with lung issues OR
kids with heart issues

Hint 690

Think of an RV w/ teeny tiny kid driving, a kid w/ his head out the window sucking in the air, and a kid using engine parts to fix his heart

Front 691

What's the Rx for bronchiolitis caused by RSV?

Back 691

Ribavirin

Front 692

What does Ribavirin Rx?

Back 692

RSV

Front 693

Pregnant nurses should not Rx kids taking what med?

Back 693

Ribavirin

Front 694

How is Ribavirin given? (also, w/ what 3 methods)

Back 694

mist
(via mask, tent or hood)

Front 695

In what age range does bronchiolitis usually occur?
When is the peak incidence?

Back 695

usually 2-12 months,
peaks at 6 mos.

Front 696

What's often the first sign of hypoxia?

Back 696

restlessness

Front 697

What are symtoms of bronchiolitis? x12

Back 697

Bone-dry (dehydrated)
Restlessness
O-shaped chest (barrel-shaped)
Nonproductive...
...Cough
Hypoxia and dyspnea
Irritability
Obstructed breathing
Lung sounds (fine rales, expiratory wheezes)
Intercostal retractions
Tachypnea
Impending resp failure
Schnoz flaring

Hint 697

B - picture bone in the bronchioles... eesh
R - and a kid thrashing b/c of it

Front 698

What's a resp rate you may expect with bronchiolitis?

Back 698

60-80

Front 699

What are two signs of impending respiratory failure with bronchiolitis?

Back 699

severe inspiratory retractions, and
sudden diminished or absent inspiratory breath sounds

Front 700

What is it important to check for r/t inability to suck well?

Back 700

dehydration

Front 701

What are 7 signs of dehydration in infant?

Back 701

weight loss, v urine output, ^ urine specific gravity, poor skin turgor, dry mucus membrane, depressed anterior fontanel, no tears with crying

Front 702

What isolation precautions do you use for pt w/ bronchiolitis?
What materials does that include? x3

Back 702

airborne (respiratory);
gown, gloves, mask

Front 703

What do you implement for all infants with breathing problems?

Back 703

airborne isolation precautions

Front 704

What do you implement do help liquefy secretions and facilitate removal for pt with bronchiolitis?

Back 704

high humidity, cool environment

Front 705

What 3 things should you do regarding the high humidity environment of bronchiolitis pt?

Back 705

wipe down canopy,
have extra linens on mattress,
change clothes & linens frequently

Front 706

How often do you wipe down canopy for pt with bronchiolitis?

Back 706

Q2 hours

Front 707

How do you calculate micro drip?

Back 707

cc/hr = gtts/min

Front 708

What's the best way to measure fluid loss or gain for infant with bronchiolitis?

Back 708

daily weight

Front 709

Why is no unnecessary handling implemented for pt w/ bronchiolitis?

Back 709

to promote rest

Front 710

What are five interventions for pt w/ bronchiolitis?

Back 710

isolation, humidity, hydration, rest, HOB

Front 711

What elevation do you put the head of the crib for pt w/ bronchiolitis?
What's an alternative to raising HOB?

Back 711

30-40 degree; or
use infant seat