Pediatrics Exam 1 study guide

Isotonic dehydration

equal loss of fluid and electrolytes

Failure to thrive

< 5th percentile in weight

Good control of HgbA,C

<7

Primary clinical manifestation of Hypertrophic Pyloric Stenosis (HPS)

projectile vomitting

BRATT diet is contraindicated for

diarrhea due to poor nutritional value

If poisoning is suspected ...

do NOT induce vomiting

Positioning for GERD

elevate HOB 30 degrees during feeding and for 1 hour after

If shock is imminent what should a nurse do?

elevate the legs, restrict activity and keep warm

Intussusception is an ___________.

emergency

Greatest danger of German measles if nurse or family member is pregnant?

teratogenic effect on fetus

What autosomal disorder is similar to Type 2 diabetes mellitus?

Maturity Onset Diabetes of the Young (MODY)

Whooping cough (pertussis) is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.

bacterial; droplet or contact; 6-20

BRATT diet

bananas, rice, applesauce, toast, tea

Tip for parents with children diagnosed with Failure to thrive:

be persistent through 10-15 minutes of food refusal

Atraumatic care goal

first do no harm

Empowerment

giving the family the skills to care

What is the major determinant of neonatal death in the US?

Birth weight

Celiac disease definition

intolerance to gluten, BROW (barley, rye, oat, wheat)

Immunization

is part of primary prevention of disease

Denial of chronic illness by family member is considered maladapative only if ...

it delays treatment

The L in the FLACC pain scale for infants stands for:

legs (normal, relaxed, tense, kicking, drawn up)

Hypotonic dehydration

lose more electrolytes than fluid

Chicken pox(varicella) is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ weeks.

viral; airborne; 2-3

Hypertonic dehydration

lose more fluid than electrolytes

Treatment for a hydrocarbon poison ingestion

maintain airway

Mumps

fever, headache, malaise, parotitis (may lead to orchitis & meningoencephalitis

Rubella (measles)

flushed cheeks, white strawberry tongue, rash shows increased density on neck and groin and transverse lines on elbow, Koplik's spots

Identifying kids with GERD

frequent spit ups or acid smelling breath, some have respiratory symptoms instead of any of these symptoms

In terms of nutrition, toddlers are considered ___________

grazers

Poorly controlled HgbA,C

greater than equal to 8

What is the #1 cause of death in children > 1 year?

injury

Treat severe dehydration with

IV rehydration is necessary

Vitamin A

decreases morbidity and mortality in rubella (measles)

Detachment phase of separation anxiety

denial or resignation but not contentment; may seriously affect attachment to parent after separation

Manifestations of failure to thrive

developmental delays, apathy, withdrawn behavior, no fear of strangers, avoidance of eye contact, wide eyed gaze & continual scan of environment, stiff & inyielding or flaccid & unresponsive, minimal smiling

Treatment for a corrosive poison ingestion

dilute with water or milk

Peanuts can be easily ___________

aspirated

Despair stage of separation anxiety

crying stops, evidence of depression

Primary clinical manifestation of intussusception?

currant jelly stools

Whooping Cough (pertussis)

short rapid cough followed by crowing of "whoop" sound

The F in the FLACC pain scale for infants stands for:

facial expression

Enabling

families are given the opportunity to display caring

Hirschsprung Disease

congenital aganglionic megacolon, accumulation of stool with distension

What leads to cretinism, mental retardation and growth retardation?

congenital hypothyroidism

What organ needs close monitoring with sickle cell anemia?

spleen

Sickle cell anemia

splenic sequestration, RBC's clump in the spleen and it may become engorged and rupture

Celiac disease signs and symptoms

steatorrhea (fatty stools), general malnutrition, abdominal distension, vitamin deficiencies (A,D,E,K)

Avoid what in the mouth for patients with cleft lip/palate following a palatoplasty to maintain the integrity of the surgically repaired palate?

suction, tongue depressors, themometers, pacifiers, spoons, straws

Intussusception

telescoping or invagination of one portion of intestine into another

The incidence of Vitamin C deficiency is increased with exposure to what?

tobacco smoke

If a corrosive poison is ingested what symptoms will the child present with?

tongue edema, mouth sores, pharynx problems

Mumps is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.

viral; droplet or contact; 14-21

Rubella (measles) is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.

viral; droplet; 10-20

If Esophageal Atresia (EA)/Transesophageal Fistual (TEF) is suspected, place child on immediate ____________.

NPO (child may need intubated)

Treat mild to moderate dehydration with

ORS (oral rehydration solution)

What should be tested during illness and whenever glucose is greater than or equal to 240 mg/dL without illness?

urine testing for ketones every 3 hours

Normal HgbA,C

4-5.9

Diagnostic level for lead poisoning is

10 mcg/dL

Esophageal Atresia (EA)/Transesophageal Fistual (TEF)

failure of esophagus to develop as a continuous passage

What is physiological anorexia?

picky eaters with strong taste preferences, 18 months of age

German measles is a _________ disease, it is droplet/airborne/contact and has an incubation period of ____ to _____ days.

viral; direct; 14-21

Toxic dose of acetaminophen is

150 mg/kg

Physiological anorexia occurs at what age?

18 months

Low birth weight is < ______ g?

2500

The neonatal period is the first _____ days

27

The postnatal period is days _________ through __________

28 days; 1 year

The classic triad of intussusception signs and symptoms is only present in what percent of cases?

29-33%

Clinical manifestations of Esophageal Atresia (EA)/Transesophageal Fistual (TEF)

3 C's: coughing, choking, cyanosis

The second C in the FLACC pain scale for infants stands for:

consolability (content, easy or difficult to console)

Name 2 live vaccines

Chicken Pox, MMR

An infant with an excessive amount of frothy saliva in the mouth or difficulty with secretions and unexplained episodes of cyanosis should be suspected of?

Esophageal Atresia (EA)/Transesophageal Fistual (TEF)

What test is a definitive test for sickle cell anemia?

Hgb electrophoresis

Hypertrophic Pyloric Stenosis (HPS)

constriction of pyloric sphincter, palpable as an olive like mass in the upper abdomen

The first C in the FLACC pain scale for infants stands for:

cry (none, moaning, whimpering, scream)

Protest stage of separation anxiety

cry and scream, cling to parent

If child waiting for intussusception surgery passes a normal stool what should a nurse do?

Inform the physician immediately, it may have resolved itself

What vaccines should not be given to immunocompromised patients?

Live vaccines (Varicella and MMR)

The A in the FLACC pain scale for infants stands for:

activity (quiet, sqirming, arched, jercking)

What does family centered care strive to do?

address the needs of all family members

To determine daily maintenance fluid requirement calculate child's weight in kg and then:

allow 100 mL/Kg for first 10 Kg of body weight allow 50 mL/Kg for next 10 Kg of body weight allow 20 mL/Kg for remaining body weight

Signs a hydrocarbon poison has been ingested

altered sensory, respiratory symptoms due to pulmonary involvement, primary danger is bronchitis and chemical pneumonia

What is family centered care?

Recognizing the family as the constant in a child's life

A child's concept of illness is more important than intellectual maturity in predicting __________.

anxiety

Sickle cell patients are at increase risk for what?

bacterial infections due to immunocompromise (especially after splenectomy)

Aspirin poisoning

bleeding tendency, coma, diaphoresis, tinnitus

Koplik's spots

Small, irregular red spots with a bluish-white center appearing on the buccal mucosa in association with measles

When is DTAP absolutely contraindicated

When seizure occurred after previous DTAP

Classic triad of intussusception signs and symptoms

abd pain, abd mass, bloody stools

Antidote for acetaminophen

acetylcysteine (mucomyst)

Primary etiology of cleft lip/cleft palate

maternal drug use or poor maternal nutrition

Iron chelation therapy

may turn urine red or orange, mush have working kidneys, may cause hypotension or shock if given quickly

Usual cause of death with pertussis (whooping cough)?

pneumonia

3 principles of atraumatic care:

prevent separation, promote sense of control, minimize bodily injury

Guidelines for feeding a child with failure to thrive

primary core staff to feed child, quiet, unstimulating atmosphere, calm, even temperment throughout meal, give directions, be persistent (10 -15 min of meal refusal), rhythm of feeding, develop a structured routine

In terms of nutrition the ____________ of food is more important than the _____________ of food for preschoolers.

quality; quantity

Teaching for family after child underwent high rectum malformation surgery:

report changes in stool patterns to doctor, do not want firm stools

If lighter fluid (hyrdocarbon) is ingested what symptoms will the child present with?

respiratory symptoms (think fumes)

A patient with intussusception may present initially with ...

screaming, irritability, lethargy, vomitting, diarrhea, constipation, fever, dehydration and shock

Chicken Pox (varicella) complications

secondary bacterial infections, encephalitis, pneumonia, hemorrhage and chronic or transient thrombocytopenia

Signs a corrosive poison has been ingested

severe burning pain with swelling in the mouth, throat and stomach, violent vomiting, hemoptysis