Peds Exam 3

adolescent period
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Terms in this set (133)
adolescent period
10 to 21
Adolescent Early:
10 to 13
Adolescent Middle:
14 to 17
Adolescent Late:
18 to 21
Big Adolescent change
Increase in risk-taking behaviors
Adolescent healthy BMI
between 5th and 85th percentile
Adolescent Erikson stage
identity vs. role confusion
identity vs. role confusion
Self-conscious about changing body and concerned with attractiveness
Adolescent Cognitive stage
Formal operational stage
Adolescent are able to think abstractly without manipulating concrete objects but are also
Egocentric
Adolescent require _______ of sleep per night7 to 8 hoursAcne medsBenzoyl Peroxide or Salicylic AcidVessel which goes from the pulmonary artery to the aortaLarge ductus arteriosusOne way valve between the right and left atriumPatent foramen ovaleIt is what get oxygen from the placenta to the babyPatent ductus venosusassess blood pressure using the _________, preferablyright armDuctus arteriosus fails to close allowing blood to flow between the pulmonary artery and the aorta. This results in increase blood flow to the pulmonary systemPatent Ductus Arteriosushole in the wall between the two atria. Deoxygenated blood and oxygenation blood mix as a result of greater pressuresAtrial Septal Defect (ASD)uHole between the ventricles. L>R shunting (because of higher pressures on the left) results in the mixing of oxygenated and deoxygenated blood.Ventricular Septal Defect (VSD)VSD InterventionsCould close on its own, medications to control heart failure (digoxin, Lasix). VSD patchA large hole involving all four chambers and valves. Because of pressure in the heart L>R, some left right shunting is present, but shunting may be bidirectional.AV CanalObstruction between the right ventricle and the pulmonary artery resulting in the decreased flow of blood to the lungs.Pulmonic Stenosiscomplete failure of the tricuspid valve. No communication between the right ventricle and the right atrium. An ASD is present with R>L shunting, allows blood to come from the body into the left atrium to the left ventricle. Right ventricle is essentially not used. Left ventricle become overworked- hypertrophied, and has decreased functionTricuspid AtresiaTricuspid Atresia InterventionKeep the Ductus arteriosus open to provide a shunt- prostaglandins, then extensive three part surgical procedurefour defects-pulmonic stenosis, RVH, VSD, overriding aorta. Can be cyanotic or acyanotic based on the size of the VSD and degree of pulmonary stenosis. Allows unoxygenated blood to mix with oxygenated blood, causing cyanosis. If PDA is present, then symptoms are less severeTetralogy of FallotNarrowing of the descending aorta, impedes circulation to the lower extremities, kidneys, bowel. More blood gets to the upper extremities than the lower, resulting in higher BP in arms and lower BP in legsCoarctation of the Aortaleft side of the heart underdeveloped. Mitral valve and the aortic valve are affected. Left ventricle is hypoplastic, reducing the force of contraction. Systemic flow is greatly reduced. In the RV, oxygenated and unoxygenated blood mix. If the PDA is open, then that allows for systemic circulationHypoplastic Left Heart SyndromeThe aorta and the pulmonary artery are connected to the wrong ventricles. The lungs get the oxygenated blood and the unoxygenated blood is pumped to the body. Necessary blood flow is present because of either a VSD, ASD, or patent DA. Cyanosis is present because blood circulated is mixed.Transposition of the Great Arteriesa single great artery is present. The pulmonary artery and the aorta fail to differentiate. There is one artery pumping both oxygenated and unoxygenated blood to the body. A large VSD is also present. L>R or bidirectional shunting is present. Aortic and pulmonic valve are fused, forming one large valve. Cyanosis and pulmonary over circulation exist. This results in Pulmonary HTN and heart failureTruncus ArteriosusPulmonary venous congestion, Systemic venous congestion, Impaired cardiac output, Increased metabolic demandHeart Failure ManifestationsTachypnea, labored breathing during feeding, cough, crackles, grunting, cyanosis, diaphoresis during feedingPulmonary venous congestionPeripheral edema, fluid retention, ascites, enlarged liver, jugular venous distensionSystemic venous congestionTachycardia, pallor, tiring with play, cool extremities, weak pulses, hypotension, oliguria, irritability, delayed capillary refillImpaired cardiac outputDiaphoresis, slow weight gain, failure to thrive, weight lossIncreased metabolic demandAutoimmune, inflammatory reaction to group A streptococcus.Rheumatic FeverInfection of endocardium (inner lining of heart). Vegetations grow in valves and lining, causing dysfunction of valves. Most caused by bacterial pathogens.Infective EndocarditisCommonly seen in Infective EndocarditisOsler nodules and Janeway lesionsfever, strawberry tongue, polymorphous rash, conjunctivitis, erythema of hands and feet, cervical lymphadenopathy, and desquamation of fingers and toesManifestations of Kawasaki DiseaseAcute, idiopathic systemic vascular inflammatory disorderKawasaki DiseaseOnly disease where children can get aspirinKawasaki DiseaseRelaxes smooth muscle to prevent patent ductus arteriosus (PDA) closureProstaglandin Eused to close PDAIndomethacinGiven in Kawasaki Disease, Reduces coronary implications. Monitor for s/s of anaphylaxis. May premedicate with diphenhydramine to prevent allergic reactionsIVIG (Immunoglobulin)elevated in bacterial infectionsneutrophilselevated in viral infectionslymphocyteselevated in later stages of the infectionMonocytesTriggered by hypoxia, acidosis, dehydration, fever, and hypothermiaSickle Cell CrisisMain treatment interventions with sickle cell kidsHydration, pain control, oxygenation and infection preventionChild with sickle cell crisis may be in danger ofstroke or silent cerebral ischemiaIncreases the level of fetal Hgb. Reduces amount of crises and promotes splenic function. Can cause neutropeniaHydroxyureaUsed if hemolysis results in high levels of free iron. Subcutaneous infusion: chelating agent to bind iron. Use with vitamin C. Monitor for side effectsDeferoxamineCan reduce number of bleeding events hemophiliacs haveDesmopressin intranasalRICE (Rest, Ice, Compression, Elevate) and physical and occupational therapy to maintain mobilityHemophilia treatmentMonitor hemophiliacs for signs ofinternal bleeding (especially intracranial).Factor VIII deficiencyHemophilia AFactor IX disorderHemophilia BCombination of Systemic coagulation due to thrombosis from stimulated thrombin AND Hemorrhage due to fibrinolysis stimulated by plasminDisseminated Intravascular Coagulation (DIC)Learning disability, which is a disorder of receptive language that creates difficulty using letters to decode written language.dyslexiastereotypy (repetitive movements), obsessive behavior, difficulty with sensory integration, echolalia (repetition of words without meaning), and avoidance of eye contact.Manifestations of autismMonitor serum liver and kidney function levels during treatment ofADHDAnorexia Nervosa should focus ongradual weight gain of 2 to 3 pounds per weekBulimia Nervosa Treatmentcognitive behavioral therapy and SSRIsSelective Serotonin Reuptake Inhibitor- Used to treat psychiatric issues related to eating disorders. Monitor for suicide riskFluoxetine (Prozac)CNS Stimulants - Monitor HR, BP, RR, Monitor for CNS side effects, monitor weight.Ritalin, ConcertaHow to describe legionsVesicular, pustular, macular, and papularImpetigohoney colored crustsWater filled blisters (e.g. Chicken pox or poison ivy)VesicularIf you remember on thing about folliculitis, rememberHot tubsWhite filled legionspustulesPustules are full ofPusimpetigo usually caused byStaphMeaslesKoplik spots and maculopapular rashMumpsparotid swellingRubella #1Avoid contact with pregnant womenVaricella (chicken pox)erythematous macular lesions that progress to pustules and vesiclesIrritant contact dermatitisRepetitive contact with an irritantT cell-mediated reaction to an antigen. First exposure results in sensitization and subsequent exposure causes reactions.Allergic contact dermatitisT cell-mediated reaction specific to nickelNickel contact dermatitisurticariahivespediculicidal agents (permethrin) and combing of the nitstreatment of liceTreat with permethrin 5%, antihistamines, and corticosteroidsScabies•Is a graft of cadaver skin •Is the graft of choice •Stimulates epithelial growthAllograft•Is a graft from a different species, often porcine •Stimulates epithelial growth •Is short term •Requires frequent replacementXenograft•Is grown using synthetic materials and living cells, the latter of which may be autologous or allogenic •Allows for regeneration of the dermal layerBioengineered SkinNursing Interventions for Burns #1Airway, Oxygenation, Fluid and Paindressing changes for burn patients are extremelypainful. make sure to pre medicateNursing Interventions for Burns #2Promote wound healing, Prevent infection, Provide psychosocial supportInfection of burn wounds can quickly lead tosepsisFever Decreased level of consciousness Lethargy Decreased capillary refill Diminished pulses Decreased bowel sounds Impaired wound healing Decreased white blood cell countSigns of sepsis. Report immediately•topical antibiotic used to treat staph (impetigo)Mupirocin (Bactroban)Oral antibiotic for treatment of cellulitisCephalexinanti viral- used to treat varicella if needed- need to begin therapy within 48-72 hours of onset of symptoms to be effectiveAcyclovirFinding: Growth failure (failure to thrive)Immunodeficiency disorderFinding: AtaxiaNeurological alterations (such as in HIV)Finding: Adventitious lung soundsRecurrent respiratory infections, pneumoniaFinding: Wheezing or whistling, cough, or shortness of breathInflammation/allergic reactionFinding: Eczema, hives, rash, or other skin lesionsAllergic disorders, Wiskott-Aldrich syndromeFinding: ThrushImmunodeficiencyFinding: Enlarged, tender, firm, warm lymph nodesLocal or widespread inflammationFinding: FeverInfection or inflammationFinding: Diminished LOCEncephalopathy (HIV)Finding: HepatosplenomegalyImmune disorderFinding: Sneezing, congestion, swelling, rhinorrhea, and drainage in the nose and throatAllergiesFinding: HypotensionAllergies, other abnormalities affecting the cardiovascular systemFinding: Pruritus in the eyes, nose, and palateAllergiesFinding: Abnormal results on the funduscopic exam or visual fields testOcular damage due to long-term use of antimalarial drugs or corticosteroidsThe test that measures cell-mediated immune response to specific antigens... This tests immune functionAllergy skin testThe test that measures the presence of infection or inflammation... This tests for immune disorder and autoimmune diseaseESRAutoimmune disorder characterized by inflammation primarily affecting joints. Autoantibodies primarily target synovial joints. Three types: pauciarticular, polyarticular, and systemic.Juvenile Idiopathic ArthritisWith kids and lupus, look forSplenic (abdominal) enlargementpauciarticular Juvenile Idiopathic Arthritisup to 4 joints involvedPolyarticular juvenile idiopathic arthritisMore than 4 joints involvedSystemic juvenile idiopathic arthritisMore than just joints involvedWhat do you see with juvenile idiopathic arthritisStiff and swollenAnaphylaxis treatmentepinephrinecombination of medications used for treatment of HIV. Has improved quality of life in HIV patientsHAART therapy(Antimalarial) used to treat Autoimmune disorders -Lupus - can cause cardiac issuesHydroxychloroquineUsed to treat JIA. Effects of Methotrexate can take up to 6 weeks. Do not administer live vaccines, assess for s/s of infectionCorticosteroids, MethotrexateAnticholinergic used to increase heart rate and cardiac outputAtropineIncrease blood glucose levelsDextroseIncreases heart rate and myocardial contractilityDobutamineIncreases cardiac output and blood pressureDopamineIncreases heart rate and systemic vascular resistanceEpinephrineReverses respiratory depression and hypotension related to narcotic effectsNaloxoneReduction in tissue perfusion resulting in decreased oxygen delivery to tissues and decrease removal of harmful by-products of metabolismShockTachycardia, tachypnea, and warm or cool skinCompensated shockCool skin, decreased peripheral pulses, decreased urinary output, extremely high heart rate, altered neurological status, and hypotension.Decompensated shockBradycardia, hypotension unresponsive to treatment, and evidence of end-organ damageIrreversible shockLoss of plasma or blood from intravascular spaceHypovolemic ShockAbnormal distribution of blood volume secondary to vasodilation and/or capillary permeability --> Less blood returned to the heartDistributive ShockMechanical blockage of blood into the heart and major vesselsObstructive ShockImpaired myocardial function / Heart unable to maintain cardiac output and tissue perfusionCardiogenic ShockSickle cell patients present with this which could mean strokealtered level of consciousness