Pediatric Nsu Nursing Test 3 Questions

Front 1

congenital Hypothyroidism Patho

Back 1

The thyroid is controlled by the pituitary gland which releases TSH.
TSH produces T4 and T3.
After a newborn birth TSH is increased greatly. within 1st week of life TSH gradually falls. Underdevelopment of Thyroid leads to low T4 levels.
If T4 thyroxine is not fixed it leads to growth, developmental and brain retardation. Although it can be avoided with hormone replacement thearpy

Front 2

congenital Hypothyroidism manifestations and evaluation

Back 2

Manifestations: Skin mottling, large fontanel, large tongue, hypotonia, slow reflexes, distended ABD and prolonged jaundice.
Thyroid=metabolism
Evaluation: TSH test between 2-6 days any sooner you will get a false high TSH level.

HIGH TSH with LOW T4 (thyroxine) confirms diagnosis

Front 3

congenital Hypothyroidism Management

Back 3

Lifelong thyroid hormone replacement thearpy usually Levothyroxine and titrated until T4 levels are WNL

Front 4

Congenital Hypothyroidism Nursing assessment and interventions

Back 4

Assessment: Growth and development, adhearence to Rx regime head circumference each visit
Interventions: Instruct family importance of Rx regime. can give meds in little forumla or food. Need to teach s/s hypo/hyperthyrodism because too much levothyroxine can cause hyperthyroidism

Front 5

Acquired Hypothyroidism (Hashimoto thyroiditis) Patho

Back 5

Antibodies called thyroid-blocking-immunoglobins decrease T3 and T4 levels. Antibodies bind to the TSH receptor. Antibody cause is unknown

Front 6

Acquired Hypothyroidism manifestations and evaluation

Back 6

Goiter (one lobe larger than the other) dry thick skin; dull hair, fatigue cold intolerance, weight gain, edema of face, feet, eyes and hands, iregular or delayed mensus

Front 7

Acquired hypothyroidism Management

Back 7

Thyroid replacement hormones until T3 and T4 levels are normal

Front 8

Acquired Hypothyroidism nursing assessment and interventions

Back 8

Thyroid levels checked q 3-4 months.
Interventions: Instruct family importance of Rx regime. Need to teach s/s of hypo/hyperthyrodism because too much levothyroxine can cause hyperthyroidism

Front 9

Hypothyroidism nursing diagnosis

Back 9

Deficient knowlege r/t congenital/acquired disorder
Constipation r/t decreased metabolic rate
Activity/cold intolerance

Front 10

Hyperthyroidism (Graves disease) Patho

Back 10

Antibodies stimulate over production of thyroid. antibodies stimulate too much T3 and T4 levels with TSH levels being low. (classic hypothyrodism diagnostic evaluation) These antibodies are transfered through the placenta to the fetus

Front 11

congenital Hypothyroidism Patho

Back 11

The thyroid is controlled by the pituitary gland which releases TSH.
TSH produces T4 and T3.
After a newborn birth TSH is increased greatly. within 1st week of life TSH gradually falls. Underdevelopment of Thyroid leads to low T4 levels.
If T4 thyroxine is not fixed it leads to growth, developmental and brain retardation. Although it can be avoided with hormone replacement thearpy

Front 12

congenital Hypothyroidism manifestations and evaluation

Back 12

Manifestations: Skin mottling, large fontanel, large tongue, hypotonia, slow reflexes, distended ABD and prolonged jaundice.
Thyroid=metabolism
Evaluation: TSH test between 2-6 days any sooner you will get a false high TSH level.

HIGH TSH with LOW T4 (thyroxine) confirms diagnosis

Front 13

congenital Hypothyroidism Management

Back 13

Lifelong thyroid hormone replacement thearpy usually Levothyroxine and titrated until T4 levels are WNL

Front 14

Congenital Hypothyroidism Nursing assessment and interventions

Back 14

Assessment: Growth and development, adhearence to Rx regime head circumference each visit
Interventions: Instruct family importance of Rx regime. can give meds in little forumla or food. Need to teach s/s hypo/hyperthyrodism because too much levothyroxine can cause hyperthyroidism

Front 15

Acquired Hypothyroidism (Hashimoto thyroiditis) Patho

Back 15

Antibodies called thyroid-blocking-immunoglobins decrease T3 and T4 levels. Antibodies bind to the TSH receptor. Antibody cause is unknown

Front 16

Acquired Hypothyroidism manifestations and evaluation

Back 16

Goiter (one lobe larger than the other) dry thick skin; dull hair, fatigue cold intolerance, weight gain, edema of face, feet, eyes and hands, iregular or delayed mensus

Front 17

Acquired hypothyroidism Management

Back 17

Thyroid replacement hormones until T3 and T4 levels are normal

Front 18

Acquired Hypothyroidism nursing assessment and interventions

Back 18

Thyroid levels checked q 3-4 months.
Interventions: Instruct family importance of Rx regime. Need to teach s/s of hypo/hyperthyrodism because too much levothyroxine can cause hyperthyroidism

Front 19

Hypothyroidism nursing diagnosis

Back 19

Deficient knowlege r/t congenital/acquired disorder
Constipation r/t decreased metabolic rate
Activity/cold intolerance

Front 20

Hyperthyroidism (Graves disease) Patho

Back 20

Antibodies stimulate over production of thyroid. antibodies stimulate too much T3 and T4 levels with TSH levels being low. (classic hypothyrodism diagnostic evaluation) These antibodies are transfered through the placenta to the fetus

Front 21

Impetigo Etiology

Back 21

Cause S. aures, Beta hemolytic strep or combination of the two
Begins in an area of brake skin, such as an insect bite, allowing for a secondary infection.
The inflammatory response results in a pustular lesion. The lesion has a honey-colored fluid drainage. Nasal drainage containing the organism can erode the upper lip allowing additional entry

Front 22

Impetigo Manifestations
Two types of lesions

Back 22

Bullous: Small vesicles initially filled with serous fluid and later become pustular.
Bullae: Pustular lesions that rapidly rupture leaving a shiny. Lesions can bleed easily when crust is aggitated
Hyperpigmentation is sequela in dark skinned children.

Front 23

Impetigo Treatment

Back 23

Treatement: Topical and oral antibiotics. Wash lesions gently 3 X Q24H
Good handwashing, child should not go to day care/ school 24 hours after treatment. notify school officials

Front 24

Impetigo diagnosis and Interventions

Back 24

Impaired skin intergrity
Deficient knowledge r/t disease

Interventions: Teach parents how to soak crust then wash it 3 X daily
Apply ABX ointment after area has been air dried
Small amounts of bleeding is common.
Child should sleep alone and bathed with antimicrobial soap.
Care givers should wear gloves

Front 25

Impetigo
Critical to rember

Back 25

1. Can spread lesions by touch

2. keep fingernaiils short & wash child's hands frequent.

3. Discourage sharing family towels, combs or eating tools with the infected child

Front 26

Cellulitis Etiology

Back 26

Bacterial infection of subcutaneous tissue. Usually arrives from impaired skin, but can affect head and trunk following an URI OM, or tooth abscess.
Caused by Haemophilus influenza Type B Vaccine, Group A Strep, and S aureus

Front 27

Cellulitis Pathophysiology

Back 27

Bacteria overwhelm defensive skin defenses. resulting in deeper invasion from the superficial layer of skin to the subcutaneous layers

Front 28

Cellutis Manifestations and complications

Back 28

Manifestations: Area is hot red and indurated; Fever maliase H/A
IF H influenza is suspeced area will have purple tinge.
Lymphangitis with "red streaking" on area and reginal lymph node swelling,

Complications: Septic arthritis, meningitis, brain disease.
If periorbital cellutis is present and not treated efficiently it can lead to blindness

Front 29

Cellutis assessment/ nursing diagnosis

Back 29

Ask parent about ear infections, dental carries, or skin trauma.
Impaired skin intergity
Acute pain
Deficient knowledge

Front 30

Cellutis interventions

Back 30

1. bed rest, elevate the affected extremity & splint
2. Warm moist scoks Q 4 H to increase circulation
3. Monitor S/S of sepsis (increased fever, chills)

Front 31

Lice Infection etiology

Back 31

Called: Pediculosos Small blood sucking insects on scalp or face.
Is not associated with poor hygine.
Transmitted by direct/indirect contact
Girls 2x likely than boys

Front 32

Pediculosis capitus (lice)

Back 32

Lice can only live 48 hours off the human host. Eggs of louses incubate for 1 week
Pediculosis pubis usually sexually transmitted.
Pubic lice causes intense pruritis (blue spots) may be seen on thighs and trunk.

Lice on eyebrows or eyelashes in preadolescent signals potential abuse

Front 33

Pediculosis Evaluation/ treatment

Back 33

1. Identifications of nits or lice on scalp, CROWN, behind ears, nape of the neck

RX: Lindane neurotoxic if absorbed through skin
OTC: RID tripple X

Front 34

Pediculosis Interventions

Back 34

Teach: remove nits by back combing when hair is damp
Apply petrolatum to eyelashes Q12 H x 8 Days. Clean home with antilice sprays: wash sheets. Examine other family members.

Front 35

ACNE Patho

Back 35

Sebacous glands stimulated by androgens during puberty secrete large amounts of sebum. Glands become plugged and diliated, eventually leading to rupture r/t pressure.

Front 36

Acne etiology

Back 36

Abnormal sloughing of skin, overgrowth of normal bacteria. Foods do not cause or increase ACNE

Front 37

Acne Manifestations and Treatment

Back 37

Closed white heads, black heads, papules, pustules, nodules or cysts.

Treatment is individually based and individual type of acne.

Goal of treatment: prevent scarring and promote postitive self image in the adolescent.

Initial improvement usually seen 4-6 weeks after thearpy.

3-5 months are needed for optimal results

Front 38

Acne diagnosis and interventions

Back 38

Impaired skin r/t increase sebaceous secretions.
Risk for infection
Disturbed body image
Deficient body image

Teaching: long term condition need to provide support and encouragement.
Provide written instructions.
Do not scrub hard which can rupture ducts and cause secondary infections.
Do not over use creams.
ONLY WATER BASED makeup

Front 39

Atopic Dermatitis (Eczema)
Patho

Back 39

caused by allergic reaction. Affected children release more histamine than regular children. Histamine triggers the inflammatory response resulting in erythema, edema and intense pruritis. Scratching increases itching
S. aureus and secondary infections can occur. Viruses herpes occur frequently

Front 40

Actopic dermatitis (Eczema)
Signs and symptoms and evaluation

Back 40

Erythematous, oozing, and crusting areas first on the cheeks then forehead then to arms and legs. INTENSLY PRURITIC. Manifestations of symptoms occur around ages 1-4 months.
EVAL: diagnosis based upon INTENSE PRURITIS appearence of & patterns of lesions, familial history. Esnophils are usually elevated indicating an allergen induced reaction

Front 41

Atopic Dermatitis Eczema
Treatment

Back 41

Goal to control itching, scratching, moisturize the skin and prevent secondary infections.
Avoid enviormental triggers
Oral histimaines
Wet compresses and creams and ointments are mainstream of treatment.
Corticosteroid creams: administer after bath for best absorption

Front 42

Atopic Dermatitis Eczema
Diagnosis and Interventions

Back 42

Impaired skin integrity/Pain
Risk for infection/ Knowledge, family, body image distrubance

Interventions: Keep skin hydrated, apply creams several times a day and after baths.
Avoid wool use cotton. Wash clothes in mild detergent. Keep fingernails clean.
Avoid using soap, use bath oil