OB/peds - test 2

what does flexor posturing look like and mean?

- AKA Decorticate posturing - a sign of damage to the nerve pathway in the midbrain, which is between the brain and spinal cord

describe Mono

- AKA Epstein-Barr virus - "kissing" disease - no contact sports for kids with mono

describe scarlet fever

- AKA Group A beta hemolytic Streptococci - rash is red and feels like sandpaper and the tongue may be red and bumpy - Complications = heart/kidney from untreated strep

define fifth disease

- AKA parvovirus B19 - especially common in kids ages 5 to 15 - bright red patch or rash on the child's cheeks

what is dwarfism?

- Adult height of less than 58 inches - Focus on positive self-concept, limb lengthening, growth hormones, self image

what is included in emergent care for kids with seizures?

- Airway equipment - Protect from injury - Emotional support for family - Education - Side rails up - side rail padding

explain the rule of nines (referring to burns)

The size of a burn for a baby or young child can be quickly estimated by using the "rule of nines." This method divides a baby's body surface area into percentages.

what is important for the RN to know when obtaining a blood glucose level of an infant/newborn?

the RN should stick the infant's heel, NOT finger

Name a few ways children's bones are different than adults

- Babies (300) have more bones than adults (206) - Children's bones are continuously growing - Kid's bones are more flexible - Children's bones heal faster and can remodel or reshape - Children are often more active than adults - Children's bones are smaller

why do we not start giving infants vaccines until they are 3 months old?

- Baby is protected for first 3 months of life from immunity they gained in utero - Breast-feeding gives antibodies to baby

what are the signs/symptoms of increased intracranial pressure?

- Bulging fontanels - High pitched cry - Distended scalp veins - Headache - Nausea/vomiting - Vision changes - Posturing - Seizures - Shunt problems

what does flaccid posturing look like and mean?

- a neurological condition characterized by weakness or paralysis and reduced muscle tone without other obvious cause (e.g., trauma) - this abnormal condition may be caused by disease or by trauma affecting the nerves associated with the involved muscles

what is Anencephaly?

- a serious birth defect in which a baby is born without parts of the brain and skull - it is a type of neural tube defect (NTD)

vitamin K is synthesized in the ___1___ and activated by the ___2___

1) gut 2) liver

in newborns, the liver is not mature enough to store/activate ___1___, therefore they do not have good clotting factors and ___2___ should not be done before the vitamin K shot or in premature infants

1) vitamine K 2) circumcision

Some ______________ can damage a child's permanent teeth.

antibiotics, such as tetracycline and doxycycline - They can give permanent teeth a yellowish or brownish color, and this color cannot be fixed. They most often affect children under the age of seven

what is the rescue medication for seizures?

benzodiazepines (diazepam, lorazepam, clonazepam, and midazolam)

what disorders does Marfan syndrome put a patient at risk for?

cardiac disorders

what does extensor posturing look like and mean?

- AKA Decerebrate posturing - severe injury to the brain is the usual cause

list the clinical signs of diabetes insipidus

- Cardinal signs are polyuria and polydipsia - First sign is often enuresis accompanied by insatiable thirst - Infants: irritability is relieved with feedings of water but not milk - Dehydration often occurs Labs: hypernatremia, hyperkalemia, low urine specific gravity, elevated eletrolytes in blood because urine is so DILUTED

what should a nurse know about meningitis?

- Clinical manifestations: petechial rash, s/s of ICP such as headache, neck stiffness, Kernig/Brudzinksi - Infants may have poor feeding, vomiting, bulging fontanels - Tests: Lumbar puncture/Labs - Treatment: isolate, antibiotics, VS, neuro checks, head circumference daily

list S/S of hypothyroidism

- Decelerated growth - Skin changes: dry skin, sparse hair, periorbital edema - Constipation - Sleepiness - Mental decline

name some behaviors associated with autism

- Doesn't keep eye contact or makes very little eye contact - Doesn't respond to a parent's smile or other facial expressions - Doesn't say single words by 16 months of age - Repeats exactly what others say without understanding the meaning (parroting or echoing) - Doesn't respond to name being called but does respond to other sounds (like a car horn or a cat's meow) - Doesn't start or can't continue a conversation - Doesn't use toys or other objects to represent people or real life in pretend play - stimming - Plays with parts of toys instead of the whole toy (e.g., spinning the wheels of a toy truck) - Doesn't seem to feel pain

what are the 3 alternative fetus circulation pathways?

- Ductus venosus: connects umbilical vein to inferior vena cava - Foramen ovale: small opening between the right and left atrium of the heart, permits shunting of the blood from the right atrium to the left atrium and bypassing the lungs - Ductus arteriosus: connects pulmonary artery and descending aorta

what is Developmental displasia of the hip?

- Femoral head and acetabulum are improperly aligned - Risk factors: breech, female, first born - Nursing management: Assess from birth until 2 y/o, cast care, pain control if surgery is required, Pavlik harness care/parent education, look for asymmetry of fat rolls and legs

what is Osteogenesis Imperfecta?

- Fragile bones - Brittle teeth - Frequent fractures

what is hydrocephalus?

- Imbalance between the production and absorption of CSF - Symptoms: increased ICP, BP, and decreases HR, chance in LOC, irritability & vomiting

what should an RN document when she/he gives a vaccine?

- LOT #, expiration date, where it was given and any reaction - Record in GRITS (Georgia Registry of Immunizations)

Which vaccines are live?

- MMR - Varicella

What is muscular dystrophy?

- Muscle fiber degeneration and muscle wasting - Dx with muscle biopsy, elevated CK levels - Presentation depends on type (delayed walking, falls, fatigue easily) - Classic sign = GOWERS sign - No effective treatment

what is cerebral palsy?

- Permanent disorders of movement and posture development that causes activity limitations - Caused by lack of O2 during delivery or child abuse (shaken baby syndrome/brain injury) - Characterized by lack of muscle tone and lack of coordination with spasticity found in most cases - does not progress

what is Microcephaly?

- Small brain - Cognitive impairment

explain the Parkland Formula for fluid resuscitation

- The Parkland formula for the total fluid requirement in 24 hours is as follows: 1) 4ml x TBSA (%) x body weight (kg) 2) 50% given in first eight hours 3) 50% given in next 16 hours. - Children receive maintenance fluid in addition, at an hourly rate of: 1) 4ml/kg for the first 10kg of body weight plus 2) 2ml/kg for the second 10kg of body weight plus 3) 1ml/kg for >20kg of body weight.

describe diabetes insipidus

- The principal disorder of the posterior pituitary gland - Results from under secretion of antidiuretic hormone - Produces uncontrolled diuresis

what are the 2 phases of a febrile seizure?

- Tonic phase: unconsciousness and continuous muscle contractions - Clonic phase: alternating contraction and relaxation

Hypopituitarism leads to a deficiency in growth hormone. How is this treated?

- Treatment of growth hormone deficiency involves daily injections of synthetic human growth hormone - Treatment usually lasts several years, although results are often seen as soon as three to four months after the injections are started. - The earlier the treatment for growth hormone deficiency is started, the better chance the child will have of attaining her normal or near-normal adult height - not all children respond well to growth hormone treatment.

what is Juvenile Rheumatoid Arthritis?

- Universal classification system that is based according to its own criteria/exclusions - It's a diagnosis of exclusion - No cure - Goal of therapy: reduce pain, preserve joint ROM/function

list contraindications for vaccines

- VERY sick (more than the common cold) - chemo - immunocompromised

describe hand, foot, and mouth disease

- a mild, contagious viral infection common in young children (under age 5) - characterized by sores in the mouth and a rash on the hands and feet - most commonly caused by a coxsackie virus

describe RN management of SIADH

- accurate I&O - observe for signs of fluid overload (listen to lungs, vital signs, edema) - seizure precautions (caused by BS being too high or low, imbalanced electrolytes) - administer ADH-antagonizing medications - fluid restriction - 3% hypertonic saline - EKG, vital signs - neuro checks

how does a person acquire active immunity?

- acquired = vaccines - natural = exposure to antigens

What areas do you focus on with an unconscious child?

- airway/breathing - decrease ICP (30-45 degree HOB if C-spine is cleared) - treatment of shock

list the 6 anterior pituitary hormones

- growth hormone (GH) - thyroid-stimulating hormone (TSH) - adrenocorticotropic hormone (ACTH) - follicle-stimulating hormone (FSH) - luteinizing hormone (LH) - prolactin (PRL)

Describe syndrome of inappropriate antidiuretic hormone (SIADH).

- hyper secretion of the posterior pituitary hormone = antidiuretic hormone - kidneys cannot reabsorb water --> fluid retention - Anorexia, nausea and vomiting, irritability, and personality changes - urine is hypernatremic, while blood is hyponatremic

describe the stool of a breastfed baby

- little to no smell - BM after every feeding

what should an RN know about ADHD medications?

- monitor for weight loss - give early in the day

how does a person acquire passive immunity?

- natural = placental transmission of antibodies from mother to baby - artificial = gamma globulin administration

why is it not advisable to water down formula?

- newborns/infants have a low GFR = harder to excreting water - this leads to the newborn/infant not receiving enough glucose or nutrition

what is thrush and what medications are given for it?

- oral candidiasis - Statins

describe meconium stool

- passed in the first 24-48 hours of life - sticky, thick, black

which newborns are at risk of hypothermoregulation problems and hypoglycemia?

- pre-term - small for gestational age

what should the RN teach parents as immediate interventions if a child is burned?

- remove clothing - cool clothing, cool water

describe the stool of a bottle fed baby

- smells - BM less often

what are brown fat deposits?

- specific to newborn - maintain thermoregulation - newborns cannot shiver/maintain temp so they burn brown fat to maintain temp - tends to accumulate around adrenal glands and kidneys - brown fat is very vascular and has special mitochondria (that helps it produce heat)

list the different types of bone fractures

- transverse - linear - oblique (nondisplaced or displaced) - spiral - greenstick - compound - comminuted

describe Gowers sign

- used to help diagnosis muscular dystrophy - a medical sign that indicates weakness of the proximal muscles, namely those of the lower limb. - the sign describes a patient that has to use their hands and arms to "walk" up their own body from a squatting position due to lack of hip and thigh muscle strength

Hyperpituitarism leads to an excess of growth hormone and results in overgrowth of the long bones. What other features are common?

- very large hands and feet - thick toes ad fingers - prominent jaw and forehead - coarse facial features - can reach heights of 8 feet or more - delay in fontanel closure *usually related to a nonmalignant pituitary tumor*

for a fetus in utero, deoxygenated blood leaves via the ____1____ and oxygen-rich blood goes to the fetus via the ____2____

1) 2 arteries 2) 1 vein

explain the pathophysiology of jaundice

1) Red blood cell life is shorter in infants than adults 2) When red blood cells die, they release bilirubin into the blood 3) Liver enzymes turn this bilirubin into water soluble bilirubin (Conjugated bilirubin) which can be excreted by the kidneys (urinary system) and stool 4) When these liver enzymes are not present/mature, the bilirubin cannot be excreted and builds up in the blood —> jaundice

scoliosis is characterized by ___1___ or ___2___ shaped spine curvature and should be screened for in kids aged ____3____

1) S 2) C 3) 10-13

Slipped capital femoral epiphysis occurs in _______1______ ages and in overweight _____2_____ > _____3_____

1) growth spurt 2) boys 3) girls

Scoliosis refers to curves greater than ______________

10 degrees

How does the Glasgow Coma Scale work?

3-8 = severe 9-12 = moderate, probably LOC 13-15 = mild *there is a special version for children under the age of 2*

live vaccines must be given within _____ minutes of being drawn up

30

infants lose 5-10% of their body weight in the first day of life due to diuresis If a newborn weighs 5 pounds and 8 oz at birth, then loses 10% of his body weight in the first day, how much does he now weigh?

4.95 pounds 1) convert 5 pounds and 8 oz to 5.5 pounds (NOT 5.8 pounds) 2) 10% of 5.5 pounds = 0.55 3) 5.5 pounds - 0.55 pounds = 4.95 pounds

Developmental Disability/Mental Retardation/Intellectual disability is defined by an IQ below _____

70

in newborns, what blood glucose level is considered to be hypoglycemia?

<40

Which of the following are signs of scoliosis? A. uneven shoulders B. one hip higher than the other C. one arm hangs out farther from the torso D. waist fold difference E. thoracic (rib) prominence F. lumbar (low back) prominence

ALL of the above

Who determines if the child has scoliosis? A. screener B. parent C. physician

C. physician

What area of the brain affects what symptoms/signs you may see??

Cerebellum - coordination, balance, posture Pineal body - melatonin and endocrine Thalamus - alertness Hypothalamus - hormone and temp (link between nervous system and endocrine) Frontal lobe - organize, plan, make good decisions, personality, fully developed in late teens-early 20s Temporal lobe - object recognition

Why is screening for adolescent idiopathic scoliosis important? A. Screening takes place place when children are at risk for developing scoliosis. B. Curves need to be found when they are small curves. C. Adolescents will have problems in adult life if severe curves are not treated. D. All of the above

D. All of the above

TRUE/FALSE: Back pain is a symptom that indicates scoliosis in adolescents.

FALSE

TRUE/FALSE: Backpacks cause scoliosis.

FALSE

TRUE/FALSE: Bad posture can cause scoliosis.

FALSE

TRUE/FALSE: Scoliosis is similar to osteoporosis.

FALSE

TRUE/FALSE: Adult hemoglobin carries more oxygen than fetal hemoglobin.

FALSE Fetal hemoglobin carries more oxygen than adult hemoglobin.

what is the most common cause of hyperthyroidism in children?

Graves' Disease

What is the most common cause of an altered LOC in children?

Increased inter-cranial pressure - head injury, CNS infection, tumor, excess CSF

what education should the RN give to the parents of a child who is about to receive a vaccine about normal/expected reactions?

Low grade temp, soreness and/or itching at site for 24-28 hours is normal

What causes spina bifida?

Mom's folic acid deficiency

what are the first line drugs used for Juvenile Rheumatoid Arthritis?

NSAIDS

What are the 6 P's of extremity injury assessment?

Pain Pallor Paralysis Paresthesia Pulselessness Poilothermia

TRUE/FALSE: Maternal and fetus blood should never mix.

TRUE

TRUE/FALSE: Scoliosis is mostly idiopathic (having no known cause).

TRUE

TRUE/FALSE: Psychiatric medication should not be used alone.

TRUE The use of medication should be based on a comprehensive psychiatric evaluation and be one part of a comprehensive treatment plan.

TRUE/FALSE: It is appropriate to ask a suicidal child/adolescent if he/she has a plan.

TRUE This question allows the RN/other healthcare professional to determine if the child/adolescent has access to drugs (to OD), a gun, etc.

Put the steps in the scoliosis screening process in the proper order. ______ A. Child faces away from the screener. ______ B. Child bends forward. ______ C. Child turns to the side and bends forward. ______ D. Child faces the screener. ______ E. Child bends forward with the child's back to the screener.

___3___ A. Child faces away from the screener. ___2___ B. Child bends forward. ___5___ C. Child turns to the side and bends forward. ___1___ D. Child faces the screener. ___4___ E. Child bends forward with the child's back to the screener.

What is encephalocele?

a neural tube defect characterized by sac-like protrusions of the brain and the membranes that cover it through openings in the skull

what is non-shivering thermogenesis?

a newborn's use of brown fat to maintain body temp

babies form from the _________ _________

head down

it is important to teach children to NOT __________ when scared, there's a fire, etc.

hide

the harder the baby has to work to keep his/her temperature up, the more oxygen and glucose he/she uses... this can lead to what conditions?

hypoglycemia and hypoxia

What is osteomyelitis?

infection of bone *serious*

what is the IQ scale?

intelligence quotient (IQ) is a total score derived from a set of standardized or subtests designed to assess human intelligence *see photo*

the placenta is the fetus's "__________"

lungs

the anterior pituitary gland = "__________" gland

master

we diagnose autism by ________ the child's behavior and development

observing

What causes Reye's syndrome in children?

overdose of aspirin

why is it important to dry babies quickly after they are born?

prevents evaporation of amniotic fluid (drops body temp) and stimulates them

define transition (referring to newborns)

the process of physiologic change in the newborn infant that begins in utero as the child prepares for transition from intrauterine placental support to extrauterine self-maintenance