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120 Cards in this Set
- Front
- Back
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When should VZIG be administered for children?
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Within 96 hours of exposure.
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When should VZIG be administered for infants?
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Within 72 hours of exposure.
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After age 13, how many doses of VZIG is required and how far apart?
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2 doses and one month apart.
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When should immune globulin for HAV be administered?
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As soon as possible after exposure.
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When should HBIG be administered?
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Within 2 weeks of exposure.
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What OTC medications should parents be advised to avoid and why?
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Any form of aspirin (containing salicylates) because of the potential risk of developing Reye syndrome.
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Describe management of fevers.
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Antipyretic medications (acetaminophen or ibuprofen), tepid sponge baths, decreased clothing, environmental temperatures, and increased fluid intake.
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Describe the clinical manifestations of Fifth disease.
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Intense, fiery red, edematous rash on cheeks, which gives a "slapped cheek" appearance or the hx of a rash that comes and goes.
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In Fifth disease, what happens 1-4 days after the facial rash appears?
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An erythematous, maculopapular, lacy rash appears on the trunk and extremeties.
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In Fifth disease, what trigger can aggravate the rash?
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Heat, exercise, warm baths, rubbing the skin and stress.
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Discharge instructions for parents whose children have Epstein Barr.
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Bed rest, acetaminophen for controlling fever, activity restrictions, do not share food, drinks or utensils, hydration, and prepare the parents for a slow and gradual recovery.
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Why is it important for a patient with Mono to avoid contact sports?
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They have an enlarged spleen and it could rupture.
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To prevent getting Lyme disease, what should children wear?
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Tightly woven clothing, long pants tucked into socks, long-sleeves, hats and clothing should be light- colored.
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What should insect repellent containt to avoid ticks?
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DEET and permethrins.
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What can you preserve ticks in for later identification?
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Alcohol.
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When an animal bites a child, what factors must be considered?
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The geographical area, type of animal, circumstances of the bite, and the animal's vaccination record.
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How should the wound be cleaned after being bit by a potentially rabid animal?
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With copious amounts of soap and water.
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How is HRIG (human rabies immune globulin) given?
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One half of the dose if infiltrated locally at the wound and the other half is administered intramuscularly.
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When should the rabies vaccine (HDCV) be given and how?
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As soon as possible and within 48 hours. It is given in the deltoid on days 3, 7, 14, and 28.
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What kind of restraint is used for an infant post op for cleft lip repair?
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Elbow restraints (no nos)
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Describe oral care for an infant after surgical cleft lip repair.
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Do not brush teeth for 1-2 weeks. Feed a small amount of water after meals. Use a cotton swab to clean the suture line and apply anti infective ointment. No straws, pacifiers, or spoons for 7-10 days.
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Post op surgical repair of cleft lip, how should an infant be positioned to sleep?
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With blankets to prevent rolling onto abdomen.
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What is a tracheoesophaqeal fistula (TEF)?
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Failure to differentiate the foregut into the trachea and esophagus and the incomplete fusion of them into distinct organs.
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During what weeks of pregnancy does TEF occur?
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4th and 5th.
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Signs and symptoms of TEF.
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excessive drooling, salivation, choking, coughing, sneezing and possibly cyanosis.
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What factors could predispose an infant to TEF?
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Polyhydramnios.
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What is the child with lactose intolerance more at risk for?
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Calcium deficiency and Rickets????
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What should be avoided in the diet of a child with celiac disease?
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Wheat, rye, barley, and oats.
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What should a child with celiac disease include in their diet?
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Corn, rice, vitamin supplements (especially A E D)
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What is an expected outcome of a child with encopresis?
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The goal is that the child will pass 2-3 stools per day without pain for the first month.
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What is an expected outcome of the child with encopresis?
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The child will have normal bowel function as evidence by passage of soft stools without pain or incontinence.
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Large herniation of gut into umbilical cord and viscera are outside the abdominal cavity but inside the translucent sac, covered with peritoneum and amniotic membrane are clinical manifestions of what?
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Omphalocele
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Embryonal weakness in abdominal wall causing herniation of gut on one side of the umbilical cord during early development, most commonly the right side, and viscera are outside the abdominal cavity and are not covered with the sac are clinical manifestations of what?
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Gastroschisis
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Incomplete development or absence of the anus in its normal position in the perineum, failure to pass meconium stool, absence of anorectal canal, presence of an anal membrane, external fistula to the perineum, meconium in urine, abdominal distention are clinical manifestations of what?
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Imperforate anus
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Imperfect closure of umbilical ring allowing gut to push outward at umbilicus during straining and crying, viscera are inside the abdominal cavity and under the skin, hernia is usually 1-3cm and easily reduced are clinical manifestations of what?
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Umbilical hernia
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Omphalocele or Gastrochisis the viscera are NOT covered with the sac?
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Gastroschisis
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What are clinical manifestations of intussesceptions?
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blood mucus, "currant jelly", stool and diarrhea with alternating periods of comfort, abrupt onset of acute abdominal pain, and vomiting.
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Around what age does intussesceptions usually occur?
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6 months.
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If obstruction resulting from intususceptions last longer than 12-24 hrs what can happen and how may the child appear?
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Symptoms of shock and sepsis. The child may be listless.
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A child exhibiting growth failure, below the 25th percentile, diarrhea, abdominal distention, vomiting, anemia, irritability, anorexia, muscle wasting, edema and folate deficiency is likely to have what?
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Celiac disease.
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When do symptoms of Celiac disease usually first occur?
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3-6 months after the introduction of grains to the diet, usually at 6-9 months old.
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Where does gas exchange occur in fetal circulation?
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at the placenta
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What are the fetal shunts?
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ductus venosus, foramen ovale, and ductus arteriosus
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What causes the fetal shunts to close?
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The pressure changes in the systemic and pulmonary circulations and increased blood oxygen content.
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In the neonate, what increases the workload of the left ventricle, thus allowing the neonatal heart to function on its own?
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The clamping of the umbilical cord and placental separation.
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Which shunt does fetal blood travel through into the inferior vena cava?
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ductus venosus
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Which shunt does fetal blood travel though into the left atrium?
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foramen ovale
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What are the 2 most oxygen-needy organ systems in the fetus?
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Coronary arteries and the brain
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Why is resistance in fetal pulmonary circulation high?
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Because the lungs are collapsed and filled with fluid.
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Which shunt does fetal blood travel through into the descending aorta?
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ductus arteriosus
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How many arteries and veins are there in the umbilicus?
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2 arteries, one vein
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How should a childs leg be positioned after insertion of a cardiac cath?
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The affected leg should be straight for 4-6 hours.
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After insertion of a cardiac cath, at what degree should you raise the HOB?
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20
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After insertion of cardiac cath, how often should vitals be obtained?
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q 5-15 min for first hr, with continuous initial monitoring
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After insertion of cardiac cath, how often should you inspect the insertion site?
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q5-15 min during the early post-procedure hrs
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After insertion of cardiac cath, what can the nurse expect when assessing peripheral perfusion?
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The affected extremity will frequently be mottled in appearance and cooler to touch, but distal pulses should still be palpable.
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What affect does Digoxin (Lanoxin) have on the heart?
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increased force of ventricular contractions (positive inotropic effect) and slows the heart rate to allow for more filling time.
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What is the therapeutic range for Digoxin?
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0.8-2.0
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What 2 conditions can potentiate Digoxin toxicity?
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hypokalemia and hypomagnesia
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When should Digoxin be given?
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20-30 min before meals
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What should a child/infant's HR be above before administering Digoxin?
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70/100 bpm
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What consideration should be taken when feeding a child with CHF?
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Feed small meals or concentrated formula to increase caloric intake. They tire easily when eating.
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What medication are children with CHF usually on and what are potential side effects?
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Diuretics- hyperkalemia or hypokalemia
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At what degree should the HOB be raised for a child with CHF?
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30-45
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What murmur is a machinery-like one that can be heard throughout both systole and diastole.
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Patent ductus arteriosus (PDA)
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What are clinical manifestations of PDA?
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poor feeding, weight gain, frequent respiratory tract infections, fatigue and diaphoresis.
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What murmur is loud and harsh and can be heard over the entire systole. It may not be heard in the newborn. It can have an associated palpable thrill.
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Ventricular Septal Defect (VSD)
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What are clinical manifestations of VSD?
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poor feeding and failure to thrive.
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What are the expected findings of a child with coarctation?
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signs or poor lower body perfusion, metabolic acidosis, CHF, differential cyanosis, pulse disparity, systolic murmur
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What clinical manifestation is most commonly seen with chronic hypoxia in children?
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Polycythemia- risk for bleeding
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Which murmur is caused by an opening between the right and left ventricles and is a left to right shunt?
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VSD
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Which murmur is caused by failure of the fetal ductus arteriosus to completely close after birth?
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PDA
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What can VSD lead to overtime?
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Pulmonary HTN
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What murmur is caused by an abnormal opening between the atria?
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ASD
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What can ASD lead to overtime?
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enlarged right atrium and ventricle
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What factors must there be in order for there to be a right to left shunt?
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an opening or passage between the atria, ventricles, and/or great vessels and the right heart pressure must be higher than the left and/or the shunt has a one way valvular opening.
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What is the most common cause of right to left shunt?
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Tetratolagy of Fallot
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What does left to right shunting result in?
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volume overload in the right side of the heart and in the pulmonary artery- leads to increased cardiac workload- CHF
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What are risk factors for primary HTN in children?
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being overweight, DM, hx of HTN, usually taller than kids their age
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What are clinical manifestations of primary HTN?
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dizziness, h/a, epitaxis
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What is the primary treatment for children with primary HTN?
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lifestyle modification
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What is the most important discharge teaching for parents whose children have cardiac arrythmias?
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Monitor for future S/S- poor feedings, color changes, palpitations, syncope/dizziness, respiratory distress, fatigue- also CPR, how to take apical pulse, and the child should wear a medi alert bracelet
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What is the major concern for a child with Tetralogy of Fallot?
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closure of the ductus- diminished pulmonary/systemic blood flow- monitor for signs of hypoxemia
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What is the treatment for a child with Tetralogy of Fallot?
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Potent vasodilating drug, PGE1.
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Involuntary movements of extremities and face is known as what?
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Chorea
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Chorea, fever, carditis, erythema marginatum, abdominal pain, subctaneous nodules, and polyarthritis are all clinical manifestations of what?
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Rheumatic fever.
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Red skin lesions starting on the trunk and spreading peripherally are known as what?
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Erythema marginatum
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High fever lasting longer than 5 days and is unresponsive to antibiotics is common in what phase of Kawasaki disease?
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Acute/first
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Bilateral, nonpurulent conjunctivitis is common in what phase of Kawasaki disease?
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Acute/first
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Changes in muscus membranes and peripheral extremities is common is what phase of Kawasaki disease?
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Acute/first
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Extreme irritability is common in what stage of Kawasaki disease?
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Acute/first
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Desquamation of the fingers and toes is common in what stage of Kawasaki disease?
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Subacute/second
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Arthritis/arthralgia is common in what stage of Kawasaki disease?
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Subacute/second
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Cardiovascular manifestations are common in what stage of Kawasaki disease?
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Subacute/ second
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Severe thrombosytosis is common in what stage of Kawasaki disease?
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subacute/second
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Deep transverse groove (Beau's lines) on nails is common in what stage of Kawasaki disease?
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Convalesescent/ third
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What is an appropriate way to determine motor impairment in a child?
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Ask him to wiggle his toes
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Insidious onset of knee pain and tenderness, followed by swelling of the tibial tubercle and difficulty bearing weight are clinical manifestations of what disease?
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Osgood-Schlatter
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What is appropriate teaching for the parents of a child with Legg-Clave-Parthes disease?
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Adherence with the brace- assessing the child's skin condition frequently and identify areas of friciton
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What is an appropriate goal/outcome for a child with osteogenisis imperfect?
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maintaining the integrity of the musculoskeletal system and preventing fractures- maintaining function- there is no cure
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What kind of diet is recommended for a child with juvenile arthritis?
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high fiber, protein and calcium with adequate fluid intake
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Why should a child with juvenile arthritis have regular visits to the ophthalmologist?
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to prevent complications from uveitis
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What are nonpharmacological pain relief measures for a child with juvenile arthritis?
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diversion, splinting, heat/cold, imagery, meditation
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When should a child with juvenile arthritis meds be given?
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First thing in the morning
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What are clinical manifestations of osteomylitis in infants?
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fever, irritability, feeding difficulties- possible signs of sepsis
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What are clinical manifestations of osteomylitis in older children?
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pain, warmth and tenderness over site, favoring the affected extremity, erythema, limited ROM, fever, lethargy, possible sepsis
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What are the clinical manifestations of osteogenisis imperfecta?
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osteoporosis, excess bone fragility, blue sclera, discolored teeth and deafness by 20-30 years old
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How often should a Pavlik harness be worn?
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23hr/day
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What should a child with T1DM do if exercising?
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add 15-30g of CHO for each 45-60 min of exercise
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What are the S/S of ketoacidosis?
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hyperglycemia signs plus abdominal pain, chest pain, Kussmaul respirations, n/v, acetone breath odor
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What is the BS level for a child with ketoacidosis?
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>300 mg/dL
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what is he serum pH for a child with ketoacidosis?
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<7.25
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Does a child with ketoacidosis have high or low phosphorous?
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low
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Does a child with ketoacidosis have high or low serum CO2?
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low
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What type of hearing loss is often temporary and reversible?
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Conductive
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What type of hearing loss is caused by damage, inflammation or obstruction to the outer or middle ear?
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conductive
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What type of hearing loss mainly affects the inner ear and/or auditory nerve and can be the result of heredity or environmental factors?
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Sensorineural
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What is a significant cause of acquired sensorineural hearing loss in children?
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Menegitis
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What are the two methods for treating amblyopia (lazy eye)?
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Atropine, patching
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What does atropine do to help with lazy eye?
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paralyzs the ciliary muscles to dilate the eye- it blurs the vision in the stronger eye
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