Set the Language

We weren't able to detect the audio language on your flashcards. Please select the correct language below.

Front

Back

Related Flashcards

Flashcards
»
Pedi exam guide

Pedi Exam Guide

by Ashly-Mendieta, Jul. 2014

Subjects: Skin, Metabolic, Communicable, Emotional/Behavioral

Favorite

Add to folder

Flag

Shuffle
Toggle On

Toggle Off
Alphabetize
Toggle On

Toggle Off
Front First
Toggle On

Toggle Off
Both Sides
Toggle On

Toggle Off
Read
Toggle On

Toggle Off

Reading...

Front

Card Range To Study

through

Play button

Progress

1/37

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

37 Cards in this Set

Front
Back
3rd side (hint)

	S/S of hypoglycemia/ nx	Teach the child and parents how to recognize hypoglycemia and what may cause it to occur. S & S – tremors, sweating, nervousness, hunger and palpitations initially and progressing to inability to concentrate, confusion slurred speech and double vision to disorientation, loss of consciousness and seizures. CAUSES of hypoglycemia include: Increased or unplanned exercise Not eating enough food Taking incorrect insulin amount TREATMENT of hypoglycemia A. Obtain FSBS to determine blood sugar 70 mg/dl is considered the low level of a blood sugar. B. Administer simple carbohydrates (15g) to raise blood sugar which could be… 3-4 glucose tablets, 4-6 oz. fruit juice or regular soda, 6-10 Life Savers or hard candy, candy or 2-3 tsp. sugar or honey. C. Severe hypoglycemia may require Glucagon given S.C. or I.M. or 50% Dextrose in water 25-50ml’s I. V.
	s/s of hyperglycemia/nx	S & S include: Polyuria, polydipsia, blurred vision, weakness, headache, weak, rapid pulse, nausea and vomiting, to acetone breath (fruity odor) to mental status changes and Kussmaul respirations which is diabetic ketoacidosis (DKA) DKA is a life-threatening condition which involves dehydration, electrolyte loss (K and Na) and acidosis. Glucosteroids, thiazide diuretics, thyroid agents, oral contraceptive and estrogen increase blood sugar levels. Causes include : Decreased or missed insulin, illness or infection, stress or untreated diabetes. Treatment includes:  Determine blood sugar which can vary from 300mg/dl to 800mg/dl or higher.  Administer Regular insulin Hospitalized -Treat dehydration with IV 0.9% or 0.45% N/S and electrolytes
	Insulin administration technique	Insulin increases glucose transport into cells and promotes conversion of glucose to glycogen, decreasing serum glucose levels. Insulin is given subcutaneous with 27 to 29 gauge needle and syringe or other administration device. Draw up shorter –acting insulin first if mixing and administer within 15 minutes. Avoid exposure to extremes in temperature and direct sunlight. Room temperature before injection. Injection sites should be rotated. Heat, massage and exercise of the area can cause increase in absorption.
	DM teaching/dietary teaching	Chronic metabolic syndrome in which body is unable to use carbohydrates due to lack of insulin produced from the pancreas or resistance to the insulin produced by the pancreas causes the inability to transport glucose into the cells properly. Leads to inability to store fats properly and causes a decrease in protein synthesis When blood glucose becomes dangerously high, glucose spills into the urine and diuresis occurs. Incomplete fat metabolism produces ketone bodies that accumulate in the blood (ketonemia) and in the urine (ketonuria) Disease requires lifestyle alterations (diet, glucose monitoring, and insulin administration) Serious complications can occur if the disease is not managed effectively: blindness, circulatory problems, kidney disease and neuropathy Tx is designed to optimize normal growth and development and minimize complications Type 2 is: Involves a resistance to insulin Aggravated by sedentary lifestyle and obesity Ethnic predisposition: African American and Pacific Islanders Acanthosis nigricans considered to be a cutaneous marker indicating insulin resistance Lifestyle intervention is cornerstone of prevention or delay of onset Signs and Symptoms More common between 5-7 and 11 -13 years S & S – polydipsia, polyuria, polyphagia appears more rapidly in children Lethargy, weakness, weight loss Enuresis Ketoacidosis and infection may be first S & S of disease as young children to not demonstrate “textbook” symptomology Imbalanced Nutrition: Less than body requirements related to inability to metabolize glucose AEB loss of weight. Risk of impaired skin related to nutritional status. Risk for deficient fluid volume related to osmotic diuresis Risk for injury related to hyper-hypoglycemia AEB S/S of elevated or low blood sugar. Deficient knowledge related to lack of information by parents to control blood sugar. Goal: Blood sugar will remain in normal values with control by insulin, diet and exercise. Infants and toddlers may have hydration problems School age may grieve over condition Adolescence often resent the condition and rebel against treatments. Children need to assume their own care Teaching for parents and children should include: A. Disease process B. Blood glucose monitoring C. Diet D. Administration of insulin E. Regular exercise Children’s Medical Center excellent source of care and resources: http://www.childrens.com/specialties/diabetes/ Diet DM management consists of well-balanced diet, precise insulin administration and regular exercise Consistency in amount and time of meals is important There is no scientific evidence that persons with diabetes require special foods Rec intake is 55% CHO, 30% fats, and 15% protein Most of CHO should consist of complex carbs Do not use sugar substitutes containing sorbitol and xylitol Increase fiber- slows rate of absorption of sugar and reduce blood glucose levels Occasional excesses for birthdays and other special occasions can be accommodated to prevent rebellion and promote compliance The goals of nutritional management in children are to: Ensure normal growth and development Distribute food intake so that it aids in metabolic control Individualize the diet in accordance with the child’s background, age, sex, weight, activity, family economics and food preferences Glycemic index of selected foods has an impact on the manipulation of dietary needs DM increases risk of atherosclerosis Rec consuming less beef and pork and more chicken, turkey, fish and low fat milk (depending on age of child) and vegetable proteins Less processed foods are best- fresh fruit vs canned Combinations of foods have a bearing on their responses in the body-ie. Milk is not recommended alone as a snack but when combined with graham crackers as a snack it is acceptable American Diabetes Association-GREAT resource! http://www.diabetes.org/
	Insulin onsets/peaks/duration	Short –acting insulin- Humulin Regular onset is 30 min to 1 hour and lasts 5-8 hours. (Peak is 2-5 hours) Regular Insulin can be administered IV. Rapid- acting insulin – Humalog onset is 15 to 30 minutes and duration is 3-5 hours. (Peak is 30-90 min) Intermediate-acting Insulin – Humulin NPH onset is 1-2 hours and lasts 14-24 hours (Peak is about 4-12 hours) Long-acting insulin- Levemir onset is 1-2 hours and lasts 36 hours. (Peak is flat) Insulin increases glucose transport into cells and promotes conversion of glucose to glycogen, decreasing serum glucose levels. Insulin is given subcutaneous with 27 to 29 gauge needle and syringe or other administration device. Draw up shorter –acting insulin first if mixing and administer within 15 minutes. Avoid exposure to extremes in temperature and direct sunlight. Room temperature before injection. Injection sites should be rotated. Heat, massage and exercise of the area can cause increase in absorption. Assess for local allergic reaction and signs of lipoatrophy or lipohypertrophy (rotate sites!) Aspirin, oral anticoagulants, beta blockers (BP), tricyclic antidepressants, tetracycline increase the hypoglycemic effect of insulin.
	Dawn phenomenon teaching	early morning elevated blood sugar due to growth hormones secreted in the early morning hours. Test at 3am to differentiate between the two Both make regulation of blood sugar difficult in children
	Diabetes insipitus - Vasopressin teaching/assessment	Hereditary (autosomal dominant) or acquired as the result of a head injury or tumor causing decreased secretion of vasopressin, the antidiuretic hormone from pituitary gland This results in uncontrolled diuresis. Kidney does not concentrate urine during dehydration episodes Signs and Symptoms Uncontrolled diuresis with polydipsia, polyuria. Prefers water to milk/formula resulting in loss of weight, growth failure and dehydration Interventions Vasopressin (DDAVP or desmopressin acetate) per subcutaneous injection or nasal spray for life Check for S & S of water intoxication Should wear medical ID bracelet Allow child to go to the restroom when needed. (inform school personnel) Notify school nurse and PE teachers regarding child’s condition and needs Monitor I & O
	Dose considerations of thyroid replacement medications	x
	S/S hypothyroidism	Sluggish, lethargic, sleepy Enlarged tongue, dry skin and hair Hypotonia– flaccid muscle tone & can cx constipation May have bulging soft mass in the belly button (umbilical hernia)
	S/S hyperthyroidism	x
	Immunization schedules- tetanus/MMR	tetanus 5 doses=2,4,6 mo, 15-18mo, 4-6y MMR= 2 doses---- 12-15mo, 4-6y
	Immunization contraindications	Allergy to neomycin: notify physician before taking inactivated poliovirus vaccine, MMR, & varicella (chickenpox) Allergy to eggs: report before receiving MMR or varicella, or influenza vaccines Epinephrine needs to be available upon administration Serious allergy to baker’s yeast: report before receiving recombinant hepatitis B immunization Rotavirus vaccine is a live attenuated oral vaccine Hepatitis A vaccine not to be given before age 2 Reporting system National Vaccine Adverse Events Reporting System: phone number & website National Childhood Vaccine Injury Act of 1986: enables compensation for specific vaccine injuries Assess allergies, such as to Latex, eggs, etc. Emergency drug (epinephrine) on hand Contraindications to Live Virus Administration Immunocompromised state of child or caregiver Pregnancy Bacteremia or meningitis Corticosteroid therapy History of high fever > 105F after previous vaccines
	Communicable disease precautions	Medical aseptic technique: purpose is to prevent spread of infection Disinfect: killing microorganisms by physical/chemical means All children suspected of having a communicable disease are:  Placed on standard & transmission-based precautions until definite diagnosis is made Placed in a private room or negative-pressure room Use of disposable items CDC recommends “standard precautions” for ALL patients Transmission-based precautions include three types: Droplet- for diseases such as pertussis and influenza. Contamination can spread within a three foot radius of the patient Airborne- for diseases such as tuberculosis, varicella, and rubeola (measles). Airborne particles are present through the room. N95 masks are required with negative pressure rooms Contact- transmission via skin to skin or skin to fomite. Gloves and cover gown are worn during close contact with patients Note that some diseases have more than one mode of transmission so more than one precaution must be used Reverse isolation Used for patients with lowered resistance to infection Therefore are highly susceptible to infection All persons who enter must wear a gown, mask and gloves Explanation and teaching to child and family is important
	Communicable periods of chicken pox	x
	Chicken pox-- S/S / teaching/precautions	x
	Immunization teaching	x
	HIV precautions	Acquired via Contact with infected mother at birth (90%) Sexual contact with infected person Use of contaminated needles Education in schools: sex & risky behaviors Infectious but not highly contagious Circumstances for acquiring it are specific Some infant’s systems become clear of antibodies in about 15 mos Some eventually become symptomatic acquiring HIV Due to transference of maternal antibodies, standard linked immunosorbent assays ie ELISA & Western blot are less reliable until past the 15 mos Prevention Education of adolescents should include: Methods of transmission Hazards of IV and illicit drug use Safe sex practices Strict use of standard precautions when caring for patients Health education curriculum in elementary school for students and staff to include info on HIV/AIDS prevention Encourage high risk adolescents to seek counseling and testing
	Rubeola precautions	Susceptible HCWs should not enter room if immune caregivers are available. No recommendation for wearing face protection (e.g., a surgical mask) if immune. Pregnant women who are not immune should not care for these patients 17, 33. Administer vaccine within three days of exposure to non-pregnant susceptible individuals. Place exposed susceptible patients on Droplet Precautions; exclude susceptible healthcare personnel from duty from day 5 after first exposure to day 21 after last exposure, regardless of post-exposure vaccine
	Obsessive compulsive disorder -S/S	Recurrent persistent repetitive thoughts invade the conscious mind May include Touching an object Saying a certain word Washing hands OCD is r/t depression and other psychiatric disorders such as Tourette’s syndrome At high risk for suicide Obsessions  happen even though you don't want them to really difficult to get rid of no matter how hard you try Compulsions/rituals Feeling of having to do something over and over again even though not wanting to do it and it might not even make sense Sometimes feel very upset or worried until they have done them Obsessional problems can get so bad that people don't have time to do anything else Differs from adults in that the sx are usually not part of an obsessive personality Does not involve impairment of cognitive function or interpersonal relationships Genetic origin Children are usually aware of the compulsive behavior and may voluntarily control themselves while in school with peers If untreated, problem grows to interfere with total functioning May become withdrawn/isolated from peers Poor school performance r/t OCD Clomipramine: to control behavior Fluoxetine & fluvoxamine: alter serotonin uptake Behavior therapy combined with medication is best Child must be motivated and capable of following directions
	ADHD medication s/e	Receptive language: listening/understanding Expressive language: inability to express Information processing: differentiating words that sound alike Memory: remembering personal information or spelling Motor coordination: copying forms, printing, writing Orientation: confusing left or right Behavioral problems: difficulty in concentrating, impatient Manifestations of ADHD Inattention (at least 3 of the following) Easily distracted Needs calm atmosphere Fails to complete work Doesn’t appear to listen Difficulty concentrating unless instruction is one-on-one Needs information repeated Impulsivity (at least 3 of the following) Disruptive with other children Talks out in class Extremely excitable Cannot wait turn Overly talkative Requires lots of supervision Hyperactivity (at least 2 of the following) Climbs on furniture Fidgets Always on the go Cannot stay seated Does things in a loud & noisy way Dexedrine Ritalin amphetamine most often prescribed by doctors to treat children with ADHD Enables the child to focus on learning tasks while calming their hyperactivity
	ADHD testing	Einstein Evaluation of School Related Skills It tests: Reading Math Auditory memory Language Visual function Motor function Used from K – 5th graders
	Anorexia nervosa nx	Failure to maintain minimum normal weight for age & height (less than 85% of expected body weight) Intense fear of gaining weight Excess influence of body weight on self-evaluation Amenorrhea Etiology may be genetic Average to superior intelligence Overachievers expecting to be perfect Own emerging sexuality is threatening Anxiety & guilt over imagined or real fear of intimacy Low self-esteem Obedient Shy Non-assertive Primary symptom is severe weight loss Adolescents who wish to be fashion models, Participate in sports, dance, gymnastics, etc. On physical exam may see: Dry skin Amenorrhea Lanugo hair on back & extremities Cold intolerance Low blood pressure Abdominal pain Constipation There is: Disturbed body image Lack of self identity Remains egocentric and is unable to complete normal tasks Preoccupied with food even though starving Complains of bloating & abdominal pain after eating small amounts of food May require hospitalization Correct Fluid/Elec imbalance Stabilize weight Establish minimum restoration of nutrients Time away from dysfunctional homelife Individual/family therapy-must continue after discharge Behavior therapy Antidepressant Rx Non-punitive, relaxed atmosphere Education Follow-up is essential Most gain weight in hospital setting Not indication of future success Complications gastritis cardiac arrhythmias inflammation of the intestine kidney problems Can be fatal- esp if goes untreated Approx 50% are cured; 30% improve but continue with dysfunctional eating problems and distorted body image; 15% remain chronically ill through adulthood
	Bulimia r/f	Misuse of laxatives and/or diuretics Dysfunctional family dynamics Mother-daughter relationships distant or strained Depression or alcoholism may be present in family Binge/purge cycle is coping mechanism for dealing with guilt, depression, & low self esteem Impulsive behaviors are characteristic of adolescents with bulimia Leads to: Erosion of tooth enamel & eventual tooth loss Electrolyte imbalance d/t laxative use and vomiting Muscle weakness d/t use of emetics to cause vomiting
	Eating disorder nx	x
	Autism S/S & teaching	Developmental disorder manifested by motor-sensory, cognitive and behavior dysfunctions Involves impaired social interaction, communication, & interests Defect as a fetus or abnormal neurochemical status Occurs in 3-4/10,000 children More common in males Usually diagnose by age 4 Refers to one of five disorders including: development disorder, autistic disorder, Asperger’s, Rett syndrome, and disintegrative disorder. Often referred to as autism spectrum disorder Lack of pointing or gesturing at an early age Failure to make eye contact and look at others Poor attention behavior Poor orientation to his/her name Disinterest in other children Difficulty engaging in pretend play Prefer playing alone Early identification, referral and intervention Astute nursing assessment and recognition Checklist for autism in toddlers (CHAT) can be done at 18 months of age Treatment Well-structured home/school/hospital Behavior modification Safety is a priority Medication: not for a cure, but management of disruptive behaviors Haloperidol- calms without sedating Stimulants- decrease hyperactivity Goal of therapy is to maximize ability to live independently Approach the child at a slow pace and with few distractions Allow the child to become familiar with the office, room or equipment Ask permission of the child before touching him/her Sudden movements or loud noise should be avoided Safety and family support are priorities
	Pregnancy/STD prevention teaching	x
	Staphylococcus nx	primary infections of newborns at umbilicus/circumsision, scaled skin syndrome, s/s small pustules indicates staph, isolate/iv abx topical abt creams
	Diaper rash interventions	x
	Accutane teaching	x
	Burn care intervention/ teaching	skin thinner so burn deeper, larger body surface area results in greater loss of f/e, iommature response systems cause shock and HF, ^bmr= ^protien/calorie needs, smaller muscle mass and fat results in ^ protien calorie needs, skin more elastic and pulling on scarring causes larger formation of scar tissue, immature immune system predis the child to developing infections, prolonged immobilization affects growth and development, TBSA- size of burn is calculated as a % of TBSA,charts are used according ot age not rule of 9's as in adult, burn either partial/full thickness] First/superficial tx is to immerse in cold water to stop burning and apply antimicrobial or silvadene ointment second/partial thickness- blistered moist pink/red tx is same as superficial if small area/deep dermal burn if larger area deep dermal/deep partial is mottled ran tan or dulll white w blisters and is painful, immerse in cold water cover with sterile dressing/clean cloth, do not break blisters and seek medical attention third/full thickness leathery and tough dry skin does not refull or blanch, dull brown tan black pearly white and painless, immerse in cold h20/wrap and apply sheet or sterile dressing, do not tx have client lay down and activate EMS Firsts 48h after burn watch hyponatremia and ^k+ Diag- Will see ^ HCT, decreased HGB, ^ WBC, monitor ABGS, STAGES IN TX OF BURNS- emergent/recisitative stage begins with burn and continues until fluid recusuitation is stable, includes estimating extent of the burn, initial first aid and fluid recisitation and assess for shock and possible transport 1 stop burning 2. eval injury and establish airway first esp if smoke inhalation 3. cover burn 4 transport to ER Superficial burn care- ointment dressings, silvadene unless allergic to sulfa NX- hospital major burns, resp status, elev hob 30 open airway for intubation o2 lfow face mask for ABG's, may need ventillator for assist and sedation, npo at first and guidelines are used to replace the extensive fluid/e lossess, fluid replacement necessary all burns 20% or more TBSA, colloids/crystalloids, blood/blood products are used for fliod replacement, (cystalloid: amin 2 large bore periph or CV line to maintain urinary output to 30 to 50 ml/h; lactated ringers: isotonic is IV due to closeness to extracellular fluids, may require hemodynamic monitoring)I&o closely wewight q day, pain meds IV usually smaller amts more freq. wound care: open= antimicrob tx; closed= dressings, asess for s/s infections STAGE 2:Diuresis----closure of burns, tx of hydrotherapy, debridement exission and grafting of full thickness wounds, enternal/parenteral feedings, topical/systemic antimicrobial agents to prevent infection--nx 4k-6k calories q day due to excessive protien breakdown, enternal feedings with NG tube are started within 24-48j to prevent hypermetabolism and improve nitrogen balance, weight and I&o, Vitamins, Enternal feedings contrain in curling ulcers/bowel obstruc/ feedig intol/pancreatitiis/septic ileus- asess BS x4; if unable to tolerate feedings-subclavian cath is inserted and TPN is admin Assess VS frew , I&o 30ml/h admin tetanus toxoid to prevent tetanus in wound if wound on face= clean with NS,mechanical debridement during hydrotherapy, enzymatic debridemtn with Elase, surgical debridement called escarotomy, open wound care- apply sulfamylon abx prevent infec, caution with renal pulmon clients will feel pain with application, 1-3q day; With silvadene monitor for WBC for leukopenia, 1-2 q day completely cover, CLOSED usually bid, wet dressings soaked every 2h STAGE 3 long recovery for children, active passive ROM by pt in hydrotherapy and q 2h, early ambulation, splints to immobilize,
	Lice S/S & treatment	aka pediculosis- capitus (head) common in children, corporis is on body, pubis is pubic area aka crabs, trans via contam items, s/s white rice looking parasite, matted hair and pustules on face tx- rid nix or kwell shampoo and repeat in 1wk, vinegar 1:1 to clean combs, petroleum to eyebrows
	Eczema teaching	usually during first 2 y, s/s local vasodilation in affected area usually face with vesicles that weep. nx- relieve puritis inflam and prevent infec, emollen baths/wet compresses, soap substitutes, cortisone creams, hypoallergic formulas, new drug elidel advertised
	Strawberry nevus teaching	dilated capillaries in dermal space that occurs a few weeks after birth usually on head or face, becomes raised, 60% disappear by 5y and 90% by 9y, if not excision/laser
	Cradle cap care	remove with shampoo and soft rag or dandruff shamp for older child
	Endocrine system	One of the control systems of body which uses hormones to target glands Primarily responsible for growth, maturation and reproduction and response of the body to stress Hormonal control is immature until at least 18 months of age Infants are more prone to problems related to the function of the endocrine system Maternal endocrine dysfunction can affect the fetus In-depth maternal history is a valuable assessment tool Newborn is supplemented by maternal hormones that cross the placental barrier as evidenced by genital changes Hormone disturbances may cause disruption of growth patterns Most inborn errors of metabolism can be detected by clinical signs or screening tests performed in utero Lethargy, poor feeding, failure to thrive, vomiting and enlarged liver may be early signs of a disorder When clinical signs are not evident in the neonatal period an infection or other body stress can precipitate sx of a latent defect in the older child Unexplained mental retardation, developmental delay, convulsions, an odor to the body or urine, or episodes of vomiting may be subtle signs of a metabolic dysfunction
	Diag tests	PKU is an important screening device for identifying enzyme deficiency Lab tests: Serum electrolytes and calcium Glucose testing to include: Fasting, 2 hour, glucose tolerance, HgbA1c Urine tests and 24 hour urine Chromosomal studies Thyroid function tests: TSH, T3 and T4 Tissue biopsy Thyroid function and uptakes Ultrasound to determine size and character of adrenal glands, ovaries and other organs X-rays to determine bone growth and bone age Sexual maturation and skin texture, pigment and temperature Diag burns- eval of renal perfusion/nutritional status; with assmt of nitrogen loss is measured in 24h total nitrogen, urea nitrogen, amino acid nitrogen, protienuria, elevated urine specific gravity.
	Vals	sodium 135-145 K 3.5-5

Share This Flashcard Set

Set the Language

Related Flashcards

Pedi Exam Guide

Add to Folders

Upgrade to Cram Premium

Card Range To Study

37 Cards in this Set