Peds Unit 4 Test

Front 1

Mild retardation

Back 1

55-70

Front 2

Moderate

Back 2

40-55

Front 3

Severe

Back 3

24-40

Front 4

Profound retardation

Back 4

<25

Front 5

S/S of Mental Retardation

Back 5

Motor delay
Cognitive delay
Delayed vision, language and hearing development

Front 6

S/S of Down's Syndrome

Back 6

Signs and symptoms
mental retardation from mild to severe
congenital heart defects
altered immune function
distinctive facial appearance
microcephaly with flat occiput
oblique palpebral fissures (upward, outward slant)
inner epicanthal folds
protruding tongue; high arched palate

Front 7

Nursing Care of Down syndrome children

Back 7

– Assist with prenatal diagnosis of Downs syndrome; aminocentesis
–Support family at time of diagnosis
–Assist family in preventing physical problems/ enroll in EIP (Early intervention program)
–Prevent respiratory infections

Front 8

Causative organisms of Otitis Media?

Back 8

Causative organisms are Haemophilus influenzae and Streptococcus pneumonaie

Front 9

Otitis Media
Pathophysiology?

Back 9

–short, horizontally positioned Eustachian tubes
–accumulation of secretions in the middle ear, Eustachian tube dysfunction allows bacterial invasion of the middle ear and obstructs drainage of secretions

Front 10

Otitis media
Signs and Symptoms?

Back 10

–pain from accumulation of purulent fluid
–malaise; irritability;
–infants are irritable, tug at ears, or roll head from side to side
–fever varies greatly; but may go as high as 104
–rhinorrhea, cough, loss of appetite, v/d
–post auricular and cervical adenopathy (enlarged lymph tissue can obstruct Eustachian tubes)

Front 11

What will you assess in otitis media?

Back 11

otoscope shows bulging tympanic membrane with no visible landmarks or light reflex; tympanic membrane may be red, and bulging
–purulent discharge

Front 12

Nursing care for otitis media?

Back 12

–antibiotics as ordered amoxicillin or ampicillin for 10-14 days; analgesics; decongestants
–encourage fluid intake
–pt teaching re: bottle with bedtime

Myringotomy with insertion of P/E (pressure equalizing) tubes

Front 13

POST OP CARE: for tonsillectomy

Back 13

Assess for signs of hemorrhage: increased pulse or respiratory rate, frequent swallowing, and clearing of throat

-discourage child from coughing or clearing throat too vigorously; avoid use of gargles, hard objects and foods that are irritating

-diet of cool, bland liquids and soft, bland foods

Front 14

Acute Laryngotracheobronchitis (LTB)

Back 14

viral infection causes: parainfluenza virus, adenovirus, RSV
-affects more boys than girls; age 6months- 8 years
-incidence peaks in winter months

Front 15

Pathophysiology of Acute Laryngotracheobronchitis (LTB)

Back 15

starts as an URI
inflammation of the larynx, trachea, and major bronchi
larynx is flexible and is susceptible to spasm, may cause complete airway obstruction

Front 16

LTB is distinguished from epiglottis by???

Diagnosis is based on??

Back 16

By a lateral neck Xray showing a normal epiglottis

-symptoms of the child

Front 17

What will you find on an assessment with Acute Laryngotracheobronchitis (LTB)

Back 17

URI
inspiratory stridor; rales, rhonchi, expiratory wheeze
substernal and suprasternal retractions
barking cough, hoarseness,sore throat
pallor; restlessness, irritability
low grade fever

Front 18

Assessment of Airway should include:

Back 18

–changes in mental status
–activity level and complaints of fatigue
–skin color changes, particularly cyanosis
–respiratory rate and pattern, presence of apnea
–intracostal retraction
–adventitious lung sounds
–cough

Front 19

Nursing care of Acute Laryngotracheobronchitis (LTB)?

Back 19

-give aerosol epinephrine a/o via nebulizer to increase vasoconstriction and to reduce airway swelling
-give corticosteroids to reduce inflammation a/o
-reduce child’s anxiety

Front 20

Epiglottitis is characterized by what?

Back 20

most life threatening

-H influenzae type B
-peak years 3-6year old
-preceded by an URI, but progresses rapidly

Front 21

Pathophysiology of Epiglottitis?

Back 21

may lead to complete upper airway obstruction
-hypoxia, hypercapnia and acidosis
-ET tube is performed to maintain an airway. swelling usually decreases after 24 hours, and the child is usually extubated by the third day.

Front 22

Tx of Epiglottits?

Back 22

ltx: antibiotics for 7 to 10 days

Front 23

Assessment of Epiglottits?

Back 23

Assessment
-sudden onset of symptoms, preceded by an URI sore throat, pain on swallowing, refuses to eat; Dysphagia
-high fever> 102.2

Front 24

What will you see in a child with Epiglottits?

Back 24

characteristic positioning: sitting upright, leaning forward, chin outthrust, mouth open and tongue protruding (tripod position)

Front 25

What are some S/S you will on assessment with Epiglottits?

Back 25

drooling
-irritable, restlessness
-wheezy, inspiratory stridor and froglike croaking sound on inspiration
-suprasternal and substernal retractions
-tachycardia, thready pulse

Front 26

Tell me about assessing a child with Epiglottits?

Back 26

on inspection, throat appears red and inflamed with a large, cherry-red edematous epiglottis. throat inspection should only be done by a trained person with equipment ready for endotracheal intubation or tracheostomy since exam may precipitate complete airway obstruction

Front 27

What's the Dx with Epiglottitis?

Back 27

-lateral neck film showing epiglottal enlargement -elevated white blood cell count and increased bands and neutrophils on diff identification of causative bacteria through blood cultures

Front 28

What is a chronic, episoic, obstructive disorder characterized by airway narrowing due to bronchospasms, increased mucous secretion, and mucosal edema

Back 28

Asthma

Front 29

Tell me about the incidence of asthma?

Back 29

commonly results from allergic hyperresponsiveness of the trachea and bronchi to irritants
–familial tendency is seen
–tends to be more severe in younger children, improvement seen in adolescence

Front 30

What is the pathophysiology of Asthma?

Back 30

Pathophysiology
–Bronchospasm
–accumulation of bronchial secretions
–edema of bronchial mucosa

Front 31

What are the S/S you will find in assessing someone with Asthma?

Back 31

Assessment
–dyspnea, air hunger, nasal flaring
–anxiety
–hacking non productive cough
–wheeze (expiratory)
–fatigue
–c/o chest tight
–tachypnea
–substernal, suprasternal and intercostal retractions
–diaphoresis

Front 32

For the nursing care with Asthma...what do the beta-adrenergics...name some examples

Back 32

to promote bronchodilitation in acute attacks by relaxing smooth muscles (epinephrine, albuterol, terbutaline)

Front 33

What other meds can you give for asthma?

Back 33

Low dose inhaled corticosteroid- to reduce inflammation;
–risk for death from asthma reduced =20%

-antihistamines- to decrease post nasal drip which may lead to bronchospasm

Front 34

What are some other nursing interventions for a child with Asthma?

Back 34

-administer prescribed meds a/o
-methylxanthines
-cromolyn sodium if out of vogue
-antibiotics- if respiratory infection is present

–perform CPT and suctioning as needed
–promote rest. schedule activities to prevent fatigue
–prevent dehydration by encouraging fluids, I&O, daily wts, asses for signs of dehydration

Front 35

What are Methylxanthines?

Name some examples?

Back 35

Methylxanthines produce bronchial smooth muscle relaxation which helps to dilate constricted airways, stimulates diuresis to help relieve congestion, and acts as a mild cardiac and central nervous system stimulant

Ex:
-aminophylline
Slo-bid, Theo-Dur, Theo-24 theophylline

Front 36

What do you teach to a pt with Asthma?

Back 36

-diagnosis; sign and symptoms of acute attacks and treatment
-ways to identify and eliminate specific allergens
-promote overall physical and psychological well being
-keep hydration to keep secretions from thickening
-physical activities equal to child’s capability
-breathing exercises, inhalation therapy, and chest physiotherapy

Front 37

What is a chronic inherited disorder of the exocrine glands characterized by abnormally thick respiratory secretions and other multi-system affects?

Back 37

Cystic fibrosis

Front 38

Pathophysiology of Cystic Fibrosis?

Back 38

Pathophysiology
–inherited autosomal recessive
–defect is related to protein or enzyme alteration
–increased viscosity of bronchial mucous leading to obstruction and bacterial growth
–chronic progressive pulmonary fibrosis
–disturbed absorption of fat and protein, leads to excessive fat and protein in stool
–pancreatic deficiency of digestive enzymes
–elevation in sweat electrolytes

Front 39

What are the Respiratory manifestations seen in cystic fibrosis?

Back 39

has wheezing and dry, nonproductive cough -progressive obstruction with secondary infections
-increased dyspnea and cough
-repeated episodes of bronchitis and pneumonia
-obstructive emphysema; barrel shaped chest, cyanosis, clubbing of fingers

Front 40

What are the gastrointestinal dysfunctions seem in Cystic Fibrosis?

Back 40

Gastrointestinal Dysfunction
-meconium ileus in newborns; small intestine
-obstruction of pancreatic ducts and absence of pancreatic enzymes (trypsin, amylase, and lipase)
-decreased intestinal absorption of fats and protein with increased stool production
chronic diarrhea with large, frothy, foul-smelling stools
-steatorrhea
-abd cramps, weight loss despite increased appetite
-overall malnourished and vitamin deficient state
-obstruction of bile ducts manifested as cirrhosis, leading to portal hypertension with
-splenomegaly and esophageal varices

Front 41

What 2 electrolytes are increased in Cystic Fibrosis?

Back 41

increased sodium and chloride excretion;

-child tastes salty when kissed

Front 42

What will you find in the Diagnosis of Cystic Fibrosis?

Back 42

Diagnosis
–elevated sodium and chloride levels on sweat test
–absence of pancreatic enzyme activity
–steatorrhea bulky and frothy
–xray show obstructive emphysema

Front 43

Nursing care
–respiratory with Cystic Fibrosis?:

Back 43

Nursing care
–respiratory:
-encourage pulmonary measures to aid sputum expectoration;
-chest physiotherapy, postural drainage, aerosol treatment with bronchodilator and breathing exercises,
-aggressive treatment of respiratory infection with antibiotics

Front 44

What kind of nutrition is necessary with Cystic Fibrosis?

Back 44

nutrition:
-diet is high calories and high protein with fats as tolerated and increased salt intake during hot weather or febrile periods
-pancreatic enzymes with food (pancrease and Cotazym-S)
-encourage adequate fluid intake

Front 45

What is an acute inflammation of the lungs (bronchioles, alveolar ducts, alveolar sacs and alveoli) that impairs gas exchange

Back 45

Pneumonia

Front 46

Is pneumonia caused by bacteria or a virus?

Back 46

viral, bacterial, mycoplasma or foreign body aspiration
–viral: RSV, H. influenza and parinfluenza viruses
–bacterial: pneumococci, strepticocci, staphylococci

Front 47

What is seen in the lab data and assessment with a pneumonia patient?

Back 47

-diminished breath sounds, rales, rhonchii
-subcostal and sternal retractions
-elevated white blood cell count
–blood cultures show causative agent

Front 48

What is the nursing care for a pt with pneumonia?

Back 48

Nursing care
–assess for resp. distress
–ease respiratory efforts
–Promote rest by maintaining bedrest and organizing nursing care to minimize disturbances
–administer meds a/o - PenG for pneumococcal and streptococci pneumonia
–anti pyretics for fever

Front 49

What is the definition of Dehydration?

How is it expressed?

Back 49

significant loss of water and electrolytes from decreased fluid intake or vomiting, diarrhea. fluid output>fluid intake

-expressed as a % of body weight lost

Front 50

deficiency of fluid and electrolytes in approximately equal proprotions; most common type, linked to 70% of the cases...this is a type of dehydration

Back 50

Isotonic!

Front 51

What will you find in the assessment of a child dehydrated?

Back 51

Assessment
–urine output
–weight
–I/O
–skin turgor, fontanels in the infant, tenting
–tears, eyeballs, thirts, mucous membranes
–assess lethargy, irritability, feeding behaviors

Front 52

Rehydration measures of a dehydrated child

Back 52

–IV fluids if child is hospitalized
–oral rehydration solutions such as Pedialyte –fluid replacements such as flat noncarbonated soda, gatorade

DO NOT give solutions with a high sodium content, like milk or broth

Front 53

Interventions for a child with GER

Back 53

feed the child in upright position
–provide thickened formula (1tbs cereal/ 1 oz formula)
–administer medication 30 minutes before meals
–give small frequent feedings
–Reglan
–surgical intervention Nissen fundoplication

Front 54

What is congenital failure of the bone and tissue of the upper jaw and palate to fuse completely

–may be partial or complete, unilateral or bilateral, and may just involve the lip, palate or both

Back 54

Cleft lip and cleft palate

Front 55

______ ______ can vary from slight notch to a complete separation from the floor of the palate to the nose

Back 55

cleft lip

Front 56

______ ______ can include nasal distortion, midline or bilateral cleft, with variable extensions into the uvula and soft and hard palate

Back 56

cleft palate

Front 57

Causes of Cleft lip and cleft palate ?

Back 57

Causes include genetic, hereditary, and environmental factors

Front 58

What do you find in assessment with a Cleft lip and cleft palate infant?

Back 58

assess the ability to suck, swallow and breathe
–assess ability to handle normal secretions

Front 59

Implementations of nursing measures Cleft lip and cleft palate infant?

Back 59

Implementations of nursing measures
–Modify feeding techniques to facilitate growth: ESSR method of feeding
-ENLARGE the nipple to allow food to be delivered to back of throat without sucking
-STIMULATE sucking by rubbing the nipple on the lower lip
-SWALLOW
-REST

Front 60

What are some Nursing Dx for Cleft lip and cleft palate infant in regards to feeding?

Back 60

Increased risk of aspiration & upper respiratory infection and Otitis media

Front 61

______ ______ is usually repaired around age 4 weeks; may be done earlier with cosmetic modifications

Back 61

cleft lip

Front 62

_____ _____ repair is done between 6 months and 2 years

Back 62

cleft palate

Front 63

What are some long term care interventions that may need to be instituted?

Back 63

long term my require EIP; address speech defects, dental, nasal defects and hearing problems and orthodontic problems; may cause shock and guilt and grief for the parents and may block parental bonding with the child

Front 64

What is an inability to tolerate foods containing gluten...?

How does it result?

Back 64

Celiac disease

-result from an inborn error or metabolism or an abnormal immunologic response

Front 65

Celiac disease results from results in accumulation of the amino acid _________ which is toxic to intestinal mucosal cells

Back 65

glutamine

Front 66

What is the Pathophysiology of Celiac disease?

Back 66

-inability to digest gluten found in wheat, barley, rye and oats –results in accumulation of the amino acid glutamine which is toxic to intestinal mucosal cells –intestinal villi atrophy = reduces absorptive surface of small intestine and affects absorption of ingested nutrients

Front 67

What are the S/S of Celiac disease?

Back 67

Symptoms
–frequent bulky, greasy , malodorous stools with frothy appearance due to fat, protein and carbohydrates
–abd distention, vomiting, abd pain
–characterized by flare ups of symptoms caused by infections, fasting, ingestion of gluten

Front 68

What is the Tx with Celiac disease?

Back 68

-Promote optimal nutrition through education and support of dietary restrictions:
-gluten free diet
-supplemental vitamin, calcium, iron and folate

Front 69

Name some Foods prohibited with Celiac disease:

Back 69

Foods prohibited:
–milk, grains, like bread, cookies, cakes, crackers, cereals, spaghetti, beer, ale, soups

Front 70

What is a congenital anomaly resulting in mechanical intestinal obstruction due to inadequate motility in an intestinal segment

Back 70

Hirschsprung’s disease (congenital aganglionic megacolon)

Front 71

Hirschsprung’s disease is 4X more common in ______ & is associated with _______ _______

Back 71

males; Down syndrome

Front 72

Pathophysiology of Hirschsprung’s disease:

absence of _______ _______ _______ in one segment of colon causes lack of innervation in that segment

Back 72

autonomic parasympathetic ganglion

Front 73

Pathophysiology Hirschsprung’s disease:

absence of,_______ _______ causes accumulation of intestine contents and distention of bowel (Megacolon)

Back 73

propulsive movements

Front 74

Hirschsprung’s disease: Assessment
found Newborns=

Back 74

failure to pass meconium, reluctant to ingest fluids, abd distention

Front 75

Hirschsprung’s disease: Assessment
found infants=

Back 75

Failure to Thrive (FTT), constipation, abd distention, vomiting, diarrhea

Front 76

Hirschsprung’s disease: Assessment
found toddlers/older children=

Back 76

chronic constipation, foul smelling stools, abd distention, visible peristalsis, palpable fecal mass, malnourishment,anemia

Front 77

What is the Tx for Hirschsprung’s disease?

Back 77

Treatment

–children with mild symptoms may be managed conservatively, with enemas, stool softeners and a low residue diet

–manual dilatation of the anus, enemas, diet, then surgery to remove the aganglionic segment of the colon and temporary colostomy

Front 78

What is Intussusception?

Back 78

-invagination of one portion of the intestine into adjacent distal portion, causing obstruction
–invagination commonly begins with hyperactive peristalsis in an intestinal segment, often at the ileocecal valve

Front 79

What is the Tx of Intussusception?

Back 79

Tx: barium enema, surgery

-if left untreated, bowel strangulation may occur

Front 80

What is a protrusion of the bowel through an abnormal opening in the abd wall; most commonly at the _____ and the ______ canal

Back 80

Hernia

umbilicus; inguinal

Front 81

_______ _______ is an incomplete closure of the umbilical ring results in protrusion of portions of the omentum and intestine. The defect usually closes spontaneously by the age of ____ to ____ years surgical correction is necessary if closure doesn’t occur

Back 81

umbilical hernia; 3 to 4 yrs

Front 82

What is narrowing of the pyloric sphincter at the outlet of the stomach?

There is hypertrophy and hyperplasia of the circular pyloric muscle and the muscle may grow to twice its normal size.

There is obstruction of the pyloric sphincter with gastric distention, dilatation,and hypertrophy

Back 82

Pyloric Stenosis

Front 83

During Assessment with Pyloric Stenosis....

with increasing force and frequency of vomiting leads to.....

ferocious appetite and _____ evidence of pain

______ loss

______ ______ shaped mass in the epigastrium just to the right of the umbilicus

______ gastric peristaltic waves moving from left to right

Back 83

increasing force and frequency of vomiting; leading to projectile vomiting

–ferocious appetite and NO evidence of pain

–weight loss

–palpable olive shaped mass in the epigastrium just to the right of the umbilicus

–visible gastric peristaltic waves moving from left to right

Front 84

Tx of Pyloric Stenosis....

Back 84

TX: surgery; pyloromyotomy

Front 85

What is the return of gastric contents into the esophagus from an incompetent or poorly developed esophageal sphincter?

–occurs almost immediately after eating and typically affects _______ infants and young children with spastic cerebral palsy due to decreased muscle tone

Back 85

GER; premature

Front 86

Pathophysiology of GER?

Back 86

Area of lower esophageal sphincters (LES) relax

Front 87

What type of GER has emesis that occurs infrequently?

Back 87

Physiologic reflux-

Front 88

What type of GER has emesis that occurs more frequent; not associated with other symptoms such as FTT, pulmonary problems or pain (effortless)

Back 88

Functional reflux

Front 89

Diagnosis of GER

Back 89

Diagnosis
–Upper GI series; esophageal pH probe monitoring

Front 90

Nursing Interventions of GER

Back 90

Interventions
–feed the child in upright position
–provide thickened formula (1tbs cereal/ 1 oz formula)
–administer medication 30 minutes before meals
–give small frequent feedings
–Reglan
–surgical intervention Nissen fundoplication

Front 91

what is a condition that interferes with daily function for more than 3 months in a year and cause hospitalization of more than 1 month in a year

Back 91

Chronic illness

Front 92

what is any mental and/or physical disability that is manifested before the age 22 years and is likely to continue indefinitely

Back 92

developmental disability

Front 93

what should you focus on in regards to a child with special needs?

Back 93

focus on developmental level rather age or diagnosis, focus on normalizing experiences, adapting to the environment, and promote coping skills.

focus on family's needs to

Front 94

what should the nurse focus on in regards to building a successful therapeutic relationship with the family?

Back 94

recognize the parent's expertise with regard to childs condition and needs.

Front 95

goal in family centered care?

Back 95

maintain the integrity of the leadership role and support the family during times of crisis or stress