Peds - Final

Front 1

Physiological consequences of immobilization.

Back 1

Decreased ventilation! Dependent edema, negative nitrogen balance, renal calculi, osteoporosis, pressure ulcers.

Front 2

Does the nurse ever adjust the weights in traction?

Back 2

NEVER

Front 3

What is important about the ropes in traction?

Back 3

They need to be out of the child's reach; knots should be 6 inches away from pulleys/loops.

Front 4

How should the weights in traction be?

Back 4

Hanging freely; none on bed or floor.

Front 5

Purpose of traction.

Back 5

Alignment, relieve muscle spasm.

Front 6

Nursing care of a child in traction.

Back 6

Give activities - they're BORED. Monitor/ prevent skin breakdown. Watch the body's alignment (no slouching, tucked chin).

Front 7

What is the purpose of peddling a cast?

Back 7

Prevent skin breakdown from rubbing and from particles falling into cast.

Front 8

How often should a scoliosis patient wear their TLSO brace?

Back 8

23 hours a day, everyday.

Front 9

What is the most common fracture location in children?

Back 9

Clavicle (fall and try to catch self with arms out).

Front 10

What should the nurse suspect when a child has a spiral/twisted fracture?

Back 10

Child abuse.

Front 11

Who heals fractures fastest?

Back 11

Younger = faster

Front 12

What type of fracture is this?

Back 12

Greenstick

Front 13

What type of fracture is this?

Back 13

Spiral

Front 14

What type of fracture is this?

Back 14

Torus/Buckle

Front 15

Day 1 post-op scoliosis surgery: nursing care.

Back 15

Log roll q2 hrs; monitor neuro; monitor for ileus, NO WALKING/STANDING.

Front 16

Day 2 post-op scoliosis surgery: nursing care.

Back 16

Fitted for TLSO brace, NO WALKING/STANDING.

Front 17

Day 3 post-op scoliosis surgery: nursing care.

Back 17

Ambulate/physical therapy ONLY WITH BRACE.

Front 18

How can a child remove unwanted writing/markings from their plaster cast?

Back 18

White shoe polish (NO WATER)

Front 19

What does a nurse do when a child wants to keep their cast after removal?

Back 19

Remove all the padding from the inside and give them the hard outer layer.

Front 20

Nursing interventions for patients with halo traction.

Back 20

Skin care, pain, pin-site care (usually Chlorhexadine)

Front 21

Treatment for any limb fracture.

Back 21

RICE = Rest, Ice, Compression, Elevation

Front 22

Does a child have to have a Harrington rod lifelong?

Back 22

No, it can be surgically removed after they stop growing.

Front 23

What bacteria causes impetigo?

Back 23

Group A Beta Hemolytic Strep

Front 24

What does impetigo look like?

Back 24

Honey crust.

Front 25

How long is impetigo contagious after initiating antibiotics?

Back 25

24 hours

Front 26

How long is bullous impetigo contagious after initiating antibiotics?

Back 26

48 hours

Front 27

One way to screen for hip dysplasia.

Back 27

Look for symmetrical gluteal folds.

Front 28

Hip dysplasia treatment

Back 28

Paulik harness

Front 29

How do you diaper a child in a Paulik harness?

Back 29

Under the harness.

Front 30

Can parents remove the Paulik harness at any time?

Back 30

Only VERY compliant parents can remove the harness temporarily for bathing. Usually, they much keep it on constantly.

Front 31

If you suspect a child has a Wilm's tumor, what should you NOT do?

Back 31

Palpate.

Front 32

What is important to tell a parent of a child with a Wilm's tumor?

Back 32

It's not their fault; the tumors grow very rapidly.

Front 33

What is the survival rate for children with leukemia?

Back 33

80%

Front 34

What is important about the leukemia child's room at the hospital?

Back 34

Reverse isolation: no fresh flowers, no outside toys, no standing water, visitors are minimal and must wear gown/gloves/mask.

Front 35

How low must the absolute neutrophil count be to initiate reverse isolation?

Back 35

< 500

Front 36

What is important to teach parents and children about the side effect of 'moon face'?

Back 36

It's not permanent.

Front 37

Diabetic patients need _____ grams of carbohydrates for every 30 min. of extra physical exertion.

Back 37

10

Front 38

Psychological consequences of immobility

Back 38

Diminished stimuli, no feedback, anxiety, depression, helplessness, regression.

Front 39

What is the major concern with epiphyseal plate injuries?

Back 39

May affect bone growth; e.g. different length limbs.

Front 40

What is an epiphyseal plate?

Back 40

Cartilage at the end of long bones (growth plates); weakest point.

Front 41

Assessment of fractures

Back 41

Five P's: Pain, Pulse, Pallor, Paresthesia, Paralysis.

Front 42

How do you handle a plaster cast in the 1st 24 hours of application?

Back 42

Use palms when touching; no fingers!

Front 43

How do you advise a patient that has an itch inside their cast?

Back 43

Scratch opposite limb; apply cool air. DO NOT insert anything inside to scratch.

Front 44

How do you clean a flaky skin from a limb that just had a cast removed?

Back 44

Soak arm in the tub; DO NOT scrub. Gently massage.

Front 45

What considerations are there for a young child with a cast?

Back 45

The child thinks it is a part of the body and that the cast saw will literally cut off their arm.

Front 46

What is distraction?

Back 46

Process of separating opposing bone to encourage regeneration of new bone in the created space.

Front 47

How do you cleanse the pin sites of external fixation?

Back 47

Clean with Chlorhexadine 2mg/mL q 6 hours x3 days, then q day (or hospital policy).

Front 48

What is the big concern when a fracture is not relieved by narcotic analgesics?

Back 48

It's a big sign of compartment syndrome.

Front 49

JRA Treatment

Back 49

Moist heat, splinting, warm waterbeds, NSAIDS, aspirin.

Front 50

What are the major goals in treating JRA?

Back 50

Promote mobility, control pain.

Front 51

What is used in children with JRA that do not respond well to NSAIDs/Aspirin?

Back 51

Methyltrexate in small doses.

Front 52

What is a major side effect of methyltrexate?

Back 52

Mucosal damage - mouth to anus.

Front 53

What is a concern when a child has a fracture in one location of the body, and a laceration in another part of the body?

Back 53

Infection; osteomyelitis.

Front 54

Treatment for osteomyelitis.

Back 54

High doses of antibiotics with PICC, no weight bearing, may need double-lumen tubes to flush out the infected bone, pain control.

Front 55

What side effects to look out for in high dosages of vancomycin and gentamicin?

Back 55

Hepatotoxicity, ototoxicity, renal toxicity.

Front 56

How often are casts changed in children with clubfoot?

Back 56

Every week to allow for growth.

Front 57

Who has a 20x greater risk of developing ALL?

Back 57

Those with Trisomy 21 (Downs)

Front 58

When can a child return to school after having chickenpox?

Back 58

When the lesions have scabbed over.

Front 59

What is Duchenne Muscular Dystrophy (DMD)?

Back 59

Slow progressive degeneration of muscle fibers.

Front 60

What type of gene is responsible for DMD?

Back 60

x-linked recessive (males have it)

Front 61

DMD S/S

Back 61

Waddling gait, lordosis, Gower's sign, contractures, weakness, pseudohypertrophy of calves.

Front 62

Pseudohypertrophy of calves.

Back 62

Large fatty deposits in place of the gastrocnemius muscles.

Front 63

When do most DMD children stop being able to walk?

Back 63

By 12 years.

Front 64

How long to DMD children usually live?

Back 64

Late teens.

Front 65

Gower's Sign

Back 65

Compensation of weak muscles: push self up with arms, climb own body with arms.

Front 66

DMD Treatment

Back 66

Steroids, prevent contractures, promote independence, C-PAP/Bi-PAP, counseling.

Front 67

What ultimately causes death in children with DMD?

Back 67

Respiratory/diaphragm failure (ventilator), then cardiac failure.

Front 68

What is phenylketonuria?

Back 68

Autosomal recessive; can't metabolize phenalalanine; can't convert it to Tyrosine, which is needed for epinephrine, melatonin, and thyroxine.

Front 69

PKU S/S

Back 69

Fair skin, blue eyes, musty mouse odor, mental retardation if untreated, FTT, irritable, vomiting, schizoid behavior, seizures.

Front 70

What is the most serious consequence of not treating PKU right away.

Back 70

Mental retardation

Front 71

PKU diagnostic test

Back 71

Guthrie test after ingesting protein, at 24 hours old.

Front 72

How much phenalanine can a PKU child get per day?

Back 72

30 kg

Front 73

What happens if the phenalanine level is <2?

Back 73

Catabolism

Front 74

What happens if the phenalanine level is >11?

Back 74

Brain damage

Front 75

How can you increase the calories of phenyl-free formula without adding any protein?

Back 75

Add polycose or MCT oil.

Front 76

PKU Treatment

Back 76

Restrict protein; supplement essential amino acid.

Front 77

Should pregnant women with PKU be on a special diet?

Back 77

Yes.

Front 78

Congenital hypothyroidism S/S in newborn

Back 78

Sleepy, low brow, large fontanel, poor feeding, prolonged jaundice, resp difficulty, cyanosis, bradycardia.

Front 79

Congenital hypothyroidism S/S after 6 weeks old

Back 79

Flat nasal bridge, low brow, puffy eyes, dry skin, coarse hair, large tongue, cold mottled skin, bradycardia, depressed reflexes, anemia, wide sutures.

Front 80

"She is SUCH a good baby! She never cries and sleeps through the night."

Back 80

Warning bells!!! Something isn't right!!! Possibly hypothyroid!

Front 81

Hypopituitarism S/S in infant

Back 81

Jaundice, hypoglycemic seizures, micropenis, undescended testicles, pale optic discs.

Front 82

How to diagnose hypopituitarism?

Back 82

Low 1GH-1 levels and bone age is younger than chronological age.

Front 83

What is very important to find out before initiating somatotrophin (growth hormone) treatment?

Back 83

Ensure the child has no tumors or cancer. GH wil accelerate their growth.

Front 84

How is somatotrophin (growth hormone) administered?

Back 84

SQ injection every day or every other day before bed. ROTATE INJECTION SITES.

Front 85

How should a child with hypopituitarism be encouraged to act?

Back 85

Dress age, participate in age appropriate activities.

Front 86

How to lessen the emotional trauma of daily injections with infants.

Back 86

Cuddle, love, distract.

Front 87

How to lessen the emotional trauma of daily injections with toddlers.

Back 87

Last minute; give choice.

Front 88

How to lessen the emotional trauma of daily injections with preschoolers.

Back 88

Tell them it's not their fault; play therapy.

Front 89

How to lessen the emotional trauma of daily injections with school age children.

Back 89

Educate them on how they body works; play therapy.

Front 90

What is IDDM?

Back 90

Insulin-Dependent Diabetes Mellitus; Type 1.

Front 91

What is NIDDM?

Back 91

Non-Insulin-Dependent Diabetes Mellitus; Type 2

Front 92

What type of DM do the majority of children have?

Back 92

IDDM/Type 2

Front 93

Classic S/S DM

Back 93

Three P's: Polyuria, Polydipsia, Polyphagia

Front 94

What test monitors how the glucose level has been averaging over the prior 3 months?

Back 94

HbA1C

Front 95

What is Diabetic Ketoacidosis (DKA)?

Back 95

A condition that results when the body burns fat for energy; causes metabolic acidosis.

Front 96

DKA S/S

Back 96

Dehydration, Kussmaul breathing, wight loss, tachycardia, decreased LOC, hypotension, flushed cheeks and ears.

Front 97

If left untreated, how does DKA progress?

Back 97

Electrolyte disturbances, arrhythmias, and shock from dehydration.

Front 98

DKA labs.

Back 98

Hyperglycemia >300, glucosuria, ketonuria, pH <7.30, HCO1 < 15.

Front 99

Hypoglycemia S/S

Back 99

Irritability, shallow breathing, tachycardia, pallor, sweating, tremors, shaking, headaches, numb lips, confusion, seizure, unconsciousness, photophobia.

Front 100

Common causes for hypoglycemia

Back 100

Error in insulin dose, inadequate calories, exercise without corresponding caloric intake.

Front 101

Regular Insulin Onset, Peak, Duration

Back 101

Onset: 30 min, Peak: 2-3 hrs, Duration: 4-6 hours

Front 102

NPH Onset, Peak, Duration

Back 102

Onset: 2 hrs, Peak: 6-8 hrs, Duration: 12-16 hrs

Front 103

What do you advise parents of a diabetic child who has another illness.

Back 103

Keep insulin dose the same; give 8 oz. of liquid per hour, check urine for ketones.

Front 104

What is an autologous bone marrow transfusion?

Back 104

A transfusion using the patient's own disease-free tissue.

Front 105

What is the biggest problem with Hematopoietic Stem Cells Transplantation (HSCT)?

Back 105

Least desirable treatment: Graft-versus-host disease (GVHD); significant risk of mortality and morbidity; risk of overwhelming infection, severe organ damage.

Front 106

Cure rate after HSCT.

Back 106

60-70%

Front 107

Cancer S/S

Back 107

Pain, fever (FUO), skin changes, anemia, abdominal mass, lymphadenopathy.

Front 108

Neupogen Use

Back 108

Increase Leukocytes

Front 109

Neumega Use

Back 109

Increase neutrolphils and platelets

Front 110

Epo Alpha Use

Back 110

Increase RBCs

Front 111

Cytoxan major SE

Back 111

Hemhorragic Cystitis

Front 112

Adriamycin major SE

Back 112

Arrhythmia

Front 113

Vincritine Major SE

Back 113

nerVe damage; ileus

Front 114

Chemo drugs SEs, generally

Back 114

GI signs, Decrease WBCs, Decreased RBCs, Decreased platelets

Front 115

How should IV chemo be administered?

Back 115

Through a central line; they are vesicants.

Front 116

First sign of DMD?

Back 116

Muscle weakness at 3-7 years old.

Front 117

What is one of the risks of intrathecal cancer treatment?

Back 117

Developmental delay, some have personality change.

Front 118

Parents of child with cancer; when should they call the hospital/MD?

Back 118

Fever >38 C, port gets infected, exposure to illness, oral ulcer, vomiting, diarrhea, pain with elimination

Front 119

What is leukemia?

Back 119

An unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Liver and spleen are most severely effected.

Front 120

How is HIV diagnosed in children >18 months?

Back 120

ELISA and Western Blot

Front 121

How is HIV diagnosed in children <18 months?

Back 121

PCR

Front 122

How do you determine whether the child is responding well to the antiretroviral drugs for HIV?

Back 122

CD4 lymphocyte counts and viral loads.

Front 123

What prophylactic treatment do infants born to HIV+ mothers receive and why?

Back 123

Bactrim and Septra for 1 year to prevent Pneumocystitis Carinii

Front 124

Who is at high risk for latex allergy?

Back 124

Spina bifida patients (80%), urogenital abdnormalities, VADER, TEF, pts with multiple surgeries, healthcare workers.

Front 125

Cross reactions to latex allergy.

Back 125

Milk, kiwi, bananas, avocado, chestnuts, pineapple.

Front 126

Best pain reliever for otitis media.

Back 126

Tylenol

Front 127

Are antibiotic ear drops effective for otitis media?

Back 127

No, they are not effective.

Front 128

Are pain relief ear drops effective for otitis media?

Back 128

Yes, they are effective.

Front 129

What does 5ths disease look like?

Back 129

"Slapped cheek"