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Pedi Final Exam
Terms in this set (113)
What is the first thing that will be altered with decreased CO?
Heart rate (tachycardia)
What does hypotonic dehydration look like?
-dough like feel to skin
What should you be careful of if you need to turn off TPN?
hypoglycemia (run D10 NS)
What is the intervention for a stage 4 infiltration?
stop fluids and elevate
What should the maximum water temperature be set to in a residential home?
Why should the room temperature be kept warm for a child that has been recently burned?
their core temperature and metabolism are resetting
What is an late/serious sign of dehydration?
What symptoms will you see with SEVERE dehydration?
-bradycardia (d/t fatigue)
What percent of body weight is lost with moderate dehydration?
What are appropriate solutions to replenish vascular volume when severely dehydrated?
isotonic solution (NS or LR)
What can you use to rehydrate orally?
What is the most common cause of low stroke volume in kids?
What is the number one cause of dehydration in healthy kids?
GI losses (vomiting and diarrhea)
What is the most consistent indicator of pain in infants?
What are types of vasogenic/distributive shock?
What will the stool of an infant with biliary atresia look like?
How often should you check abdominal girth for an infant with biliary atresia or NEC?
every 4 hours
What will the stool of a child with intussusception look like?
currant jelly (bloody, mucusy)
What will you assess in the abdomen of a child with intussusception?
What will the stools of a baby with necrotizing enterocolitis look like?
What should you do as soon as you realize a baby as NEC?
make them NPO
A baby with Hirshbaurns disease is born without these type of cells, which cause peristalsis.
How will a baby with pyloric stenosis act?
crying, hungry, irritable, wants to eat
How will a baby with GER act?
will not want food b/c it hurts their throat
What are some classic diagnostic signs of Duchenne's Muscular Dystrophy?
-Hypertrophied calf muscles (fat deposits)
What disease is self-limiting, causing an aseptic, avascular necrosis of the femoral head?
Legg Calve-perthes disease
What cardiac complications may occur with DMD?
contractility is affected (put on digoxin)
What type of problems will you start to notice in a 3 year old with DMD?
getting up and going up stairs
When will a child with DMD start to find walking more difficult?
6 years old
Around what age will a child with DMD find everday life/activities more difficult (i.e getting up from the floor, sitting)?
8 years old
What is the average age for DMD patient when walking isn't possible anymore?
When will a child with DMD find it difficult to bring their hand to their mouth?
age 14 (cough assist machines and bipap needed)
What age group does Legg Calve-perthes disease usually affect?
4-8 years old
How do you treat a newborn with a clubfoot deformity?
Scoliosis greater than how many degrees requires surgical intervention?
How does CF affect the GI system?
plugs the pancreatic duct, so pancreatic enzymes cannot be secreted and cannot break down food (need to take pancreatic enzymes with food)
What should you worry about with Flovent (inhaled corticosteroid)?
4-year-old with abrupt onset of fever, headaches, nuchal rigidity. Starts voiding an excessive amount, labs drawn which shows Na level of 170. What may be the problem?
What is the first sign of a child with decreased CO?
What congenital cardiac defect will increase pulmonary blood flow?
Ventricular Septal Defect (VSD)
WHat is the valve between the left atria and left ventricle called?
Infants with congenital heart disease require how many cal/kg to thrive?
What disorder would cause clubbing?
unrepaired pulmonary stenosis
What will happen overtime with increased pulmonary blood flow?
What disease causes a big, strawberry-red inflamed tongue?
What respiratory rate puts an infant at high risk to aspirate if orally feeding?
greater than 60
Prior GABHS illness can lead to rheumatic heart disease and cause what?
symptoms of pulmonary stenosis include what?
shortness of breath, fatigue
What will you see with unrepaired pulmonary stenosis?
-chronic cyanosis (causes clubbing)
-polycythemia b/c of hypoxia (risk for stroke)
Why do children with unrepaired pulmonary stenosis become polycythemic?
The bone marrow sense hypoxia and makes more RBCs to give more O2, however this does not work and RBCs build up
Why would you need to over-hydrate before a cardiac cath procedure?
The dye they use is a diuretic and they are at high risk for dehydration
What do you do if the site starts bleeding after a cardiac cath procedure?
-put on gloves and apply pressure (may need 15-30 minutes)
How long does a child have to lie flat after a cardiac cath?
6 hours (could throw a clot and bleed)
What will you observe about pedal pulses if a clot is present?
pedal pulses will be diminished or absent
What needs to be done if there is no flow/no pedal pulse?
limb is at risk for poor perfusion --> go to OR or five TPA to lyse clot
Where is a PDA (patent ductus arteriosus)?
between the aorta and pulmonary artery
What does a PDA cause?
mixing of red and blue blood (oxygenated and deoxygenated)
When a baby is having a TET spell, how does pulmonary and systemic resistance have to change to improve pulmonary blood flow?
What does putting a baby having a TET spell on oxygen do?
decreases pulmonary vascular resistance
What does putting the baby in a TET spell into a knee-chest position do?
increases preload and systemic vascular resistance
What does administering morphine do for a baby having a TET spell?
-helps them calm down
-decreases pulmonary vascular resistance and tachypnea
Why does too much cow's milk cause children to have iron deficiency anemia?
-Ca bind and competes with the iron stores
-fills kids up and they have poor nutrition
What can precipitate sickle cell anemia?
-stress to the body (flu, resp infection, etc)
-cold weather/weather changes
How can you tell where a child is sickling?
Ask where it hurts
What are the nursing interventions for sickling?
-1.5-2x maintenance fluids
comfort measures (hot packs, rest)
Nisha is admitted with VS temp 38.4 (101F), pulse 115 beats/min (tachycardia), RR 30, blood pressure 96/70. Weighs 110 lbs. Her complete WBC is 15,000. O2 sat is 89.
What are you worried about?
Acute chest syndrome
What is damage to the GI mucosa post chemo?
Parents note a flank mass while changing their babies diaper. What may be the etiology?
Adolescent wakes up from sleep with leg pain and later trips and breaks leg. Type of cancer?
What is an emergency during chemo with increased uric acid, low calcium, and high phosphorous?
tumor lysis syndrome
After child receives chemotherapy, need to wear gloves when changing diaper for how long?
48 hours (parents too)
What time is a child most at risk for infection and bleeding after chemo?
Thrombocytopenia count requiring platelets post chemo is:
What is a specific nursing intervention when caring for a child that is thrombocytopenic?
How is tumor lysis syndrome prevented?
What is the most common cancer in kids?
Treatment used as a preparation for a bone marrow transplant?
total body radiation
Which nurse is exempt from administering chemotherapy?
a non chemo-certified nurse
(OK if you are pregnant/sick as long as you take proper precautions)
When should a febrile child that is neutropenic be seen by the oncology team?
Which test is done to assess for CNS involvement?
Which is a major factor in survival rates in children with leukemia?
compliance with home medication administration
(less than 95% compliance increases mortality rate)
If a child has a brain tumor, what age can they receive brain radiation?
over 3 years old
What is the most common type of shock in children?
When would you administer a colloid solution?
Could be administered as a second line solution, or when there is hypoalbuminemia that is contributing to shock
What is hypotonic dehydration?
Losing more solute than water, water retention (specifically sodium in pediatrics)
*can cause hyponatremia if losing diluting sodium levels
What is an example of how hypotonic dehydration could occur?
parents watering down infant formula to save money (diluting the sodium concentration and increasing water consumption)
What is hypertonic dehydration?
solute losses are less than water (losing more fluid than salt)
*can cause hypernatremia if retaining sodium
What is an example of how hypertonic dehydration can happen?
having too much salt in the diet (i.e giving the child boiled milk)
What are some causes of hypotonic dehydration?
-renal water excretion
-replacing fluids with electrolyte-free fluid (i.e juice)
How does hypotonic dehydration present?
What are some causes of hypertonic dehydration?
-excessive free water loss
-decreased water intake
How does hypertonic dehydration present?
-dough like feel to skin
Why do we typically give topical antibiotics for burn victims instead of systemic?
There is a delay in perfusion to the area of the burn, and the medication will have a harder time getting to the area
What are the most common antibiotics used for burns?
How can dehydration lead to metabolic acidosis in children?
fluid losses associated with diarrhea from gastroenteritis
When would you administer a fluid bolus?
In an emergency where the fluid volume needs to be replaced immediately
A child with appendicitis has a sudden relief of pain and then complains of a more generalized pain. What would expect had happened?
The appendix ruptured and the peritoneum is inflamed (peritonitis)
What is the Foker procedure?
In the case of long gap esophageal atresia, this procedure takes the existing esophageal tissue and tries to promote natural growth and strengthening
How is long gap esophageal atresia different from normal esophageal atresia?
The esophagus grows in two separate segments that do not connect
What is tracheomalacia?
the collapse of the airway when breathing (there is a fistula between the trachea and esophagus)
What are children with tracheomalacia more at risk for?
apnea and cyanosis associated with feeding
What are the important nursing interventions for pancreatitis?
-pain and nutritional management
What is pancreatitis characterized by?
-epigastric pain that radiates to other areas of the body
-edema in the abdomen (distension)
Why would a child with NEC have blood in their stools?
The bacteria can cause irritation and inflammation of the bowel, which causes blood to be present in the stool
What are some differences between duodenal and jejunal atresia?
Duodenal: develops earlier in life, usually with other anomalies. First portion of the small intestine
Jejunal: develops later, lower region of the small intestine
What does post op care look like for a child with a cleft lip repair?
-restraints so they do not touch it
-bridge place at the lip
-HOB up to prevent aspiration
-iced NS at suture site to keep down edema
How do gastroschisis and omphalocele differ?
Gastrochisis: no membrane covering the organs, occurs on the right side, and typically occurs in young mothers
Omphalacele: has a membrane, occurs at the midline and occurs in mothers with advanced maternal age.
Glomerulonephritis can occur as a sequelae to what type of infection?
What can occur if a UTI is left untreated?
What are the massive amounts of proteinuria in nephrotic syndrome caused by?
-damage to the glomeruli in the kidneys (they are responsible for filtering the blood as it passes through the kidney)
What is the edema seen in nephrotic syndrome caused by?
third spacing as a result of proteinuria
What is the edema seen in glomerulonephritis caused by?
fluid and sodium retention as a compensation mechanism to decreased GFR and local kidney inflammation
What is hemolytic uremic syndrome (HUS)?
Classic triad of symptoms:
1. hemolytic anemia
3. acute kidney injury
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