NUR 4010- Pediatrics Exam II
Muscle growth is by _________ rather than ________.
muscle growth is by hypertrophy (increase in SIZE of cells) rather than hyperplasia (increase in AMOUNT of cells)
If an infant is >6 months, what should their systolic BP be?
≥80 mmHg
What is short-gut syndrome?
multiple centimeters of bowel removed; become TPN dependent
Which types of CP patients have the highest incidence of profound impairment?
-rigid CP -atonic CP -quadriparetic Cp
What are the differences between strain and sprain?
-sTrain= Tendon involvement, caused by sTress (Takes time/ gradual onset) -spRAin= ligament involvement (RApid onset)
What are examples of alterations in defense mechanisms leading to increasing UTI's?
-skin breakdown -repeated UTI's (are they colonized with this bacteria, or is this new?)
When parents are taking home a patient with clubbed feet with casts on, what must the parents do/know?
-special car seat -monitor signs of compartment syndrome
What are the symptoms of Juvenile Idiopathic Arthritis?
-stiffness -swelling -loss of mobility of specific joint -warm to touch, usually w/out erythema -tender -symptoms increase with stress -growth retardation
Formula fed babies might stool every _________ days; we get concerned about constipation when they ___________.
-stool 3-4 days -concerning constipation when infant is straining or uncomfortable
Why are we concerned about thermoregulation in infants?
-thin layer of skin -large body surface area= loss of heat to environment -cannot shiver; use Brown adipose tissue (limited storage)
How are neural tube defects diagnosed?
-ultrasound
What types of diagnostic studies are done to monitor the GU system?
-ultrasound -urinalysis -urine C&S -BUN/Creatinine -voiding cystourethrogram (VCUG/VCG)
What is the care of a UTI?
-ultrasound (if first febrile UTI) -sent home with prophylaxis: low dose Bactrim -set up appointment for a voiding cystourethrogram
What are the clinical manifestations of UTI's?
-vary depending on age -urinary frequency -febrile (in some cases) -odiferous urine -blood or blood-tinged urine (kidney involvement) *even with significant bacteria, a pediatric patient may have no symptoms or nonspecific symptoms such as fatigue or anorexia
What is the purpose of doing an ultrasound on a child with a UTI?
check anatomical features of the GU
What is Systemic Lupus Erythematous?
chronic, multi-system, autoimmune disease of connective tissues and blood vessels
What is the most frequently broken bone in childhood?
clavicle; especially in children < 10 years old
What does "crepitus" signify over a bone?
comminuted fracture (broken in several places)
How can continuous albuterol help treat complications of acute renal failure?
continuous albuterol drives K+ back into the cell
What is a helpful hint when knowing if the MAP is appropriate for an infant?
correlate the MAP with what weeks gestation they would be
Why is cough syrup not recommended in children younger than 6 years old?
coughing is a good way to clear secretions
What syndrome has a 'steeple sign' on an x-ray?
croup
The risk of UTI's ________ with alteration of defense mechanisms.
increase
What is deficient in breast fed babies?
vitamin D (supplementation at 2 months)
What is recommended to mothers to give to their newborns who exclusively breast feed?
vitamin D supplement to prevent rickets
What is the second most important newborn survival factor?
warmth!
What is physiologic nadir?
where maternal Hb is dissolving and the infant starts making its own; might be low at this time
GBS (group B-strep) sepsis only occurs____?
while they are in the hospital
What season(s) does RSV occur in?
winter and spring
When should the newborn void post birth?
within 24 hours
What is the gold standard for surgery time for myelomeningocele repair?
within 48 hours
When is an imperforate anus fixed?
within first 48 hours of birth
What is the most useful diagnostic tool for fractures?
x-ray
Which age group has better outcomes with Gullian-barre syndrome?
younger ages
What problems would spina bifida occulta patients have based on the defect at the lumbosacral area?
-cognitively okay -bowel and bladder problems -altered gait -clubbed feet
How is juvenile idiopathic arthritis diagnosed?
-via a physical exam -(90% of children will have a negative rheumatic factor) -ANA (antinuclear antibodies) are common but are not specific
If a newborn was born with bladder exstrophy, what are we most concerned with?
concerned with infection due to no skin around bladder (bladder exstrophy: bladder outside of body)
What can a paradoxical chest indicate in a newborn?
congenital diaphragmatic hernia
Maintaining thermoregulation in the neonate is an important nursing intervention because cold stress in the neonate can cause what condition?
increased oxygen consumption
When does pain occur with osteoarthritis?
increased pain with increased use
Why do you not see +nitrites on a urinalysis for an infant who has a UTI?
increased urination/frequency (unable to concentrate nitrites)
What is important to note if a patient is immobilized and takes birth control?
increases risk of DVTs
SMA type 1 occurs at what age?
infancy/toddlerhood
How must a baby w/ neural tube defect be delivered?
C-section
What lab test is used to check for muscle breakdown?
CPK (Creatine phosphokinase)
What cultures are drawn for neonatal sepsis?
CSF, blood, urine, CBC, Hb, Hct
What are the first 3 lines of defense in infants?
-1st= skin and mucous -2nd= immunologic system (neutrophils, eosinophils, lymphocytes) -3rd= antibody formation (passive immunity via breast milk, and DTaP in 3rd trimester)
What are general signs of botulism?
-weakness -dizziness -HA -diplopia -speech difficulties -vomiting -progressive, life-threatening respiratory paralysis -loss of head control -feeding difficulty -weak cry -hypotonia
When should a peak level be drawn?
1-2 hours after medication was given (depends on half-life of medication)
What is the normal urine output for infants?
1-2 mL/kg/hr
If you needed/wanted to give the infant water at 6 months, how much would be appropriate?
1-2 oz/day (really limited!!)
You should opt for a ______ scan once the fontanelles close when needing to visualize the cerebrum.
CT scan
What is periodic breathing in the newborn?
10-15 second pause in breathing; only normal if infant does not become cyanotic
Approximately how much of a newborns body weight is water?
73% (adults= 58%)
What is the normal amount of proteins in a UA?
< 20mg/dL
Infants under _____ months should have NO free water.
< 6 months
What percentile is SGA (small for gestational age)?
<10th%
What age group more commonly get RSV?
<3 years
A preterm baby is < ____ weeks of gestation?
<36 completed weeks
At what GFR is considered renal failure?
<75 mL
What is considered apnea?
>20 seconds
What are the diagnostic's to diagnose colic?
>3 hours/day 3 days a week >3 weeks
Why do infants grunt?
"creates additional time for exchange O2 and CO2" in the alveoli
What is the therapeutic management of Lupus?
**Therapy compliance** (don't stop steroids!) -body image concerns (due to steroids and Cushing syndrome)
What is important to note about bone healing?
*inverse relationship with age (i.e. the younger the patient the quicker the bone will heal)
When performing a neuro assessment, which test is normal in infants until 12 months, but not normal in adults?
+ Babinski
In a urinalysis, what is the most significant finding that would diagnose a UTI?
+ nitrites--they are a byproduct of E. coli
A postterm infant is >____ weeks of gestation?
>42 completed weeks
How can you tell the difference between bacterial and viral pharyngitis?
-Bacterial pharyngitis: white spots on tonsils, swollen uvula, and gray furry tongue -Viral: red swollen tonsils and red throat
What occurs in nephrotic syndrome?
-Damage to the glomerulus -spilling of protein into urine -decreases oncotic pressure -increased urination/hypovolemia -third-spacing/edema -hyperlipidemia
What are the frequent causative 'bugs' that cause pyelonephritis?
-E. coli -Proteus -Klebsiella -Enterobactor
When a patient has nephrotic syndrome, what is unusual about the level of albumin?
-HIGH albumin in urine -LOW albumin in blood
What problems can a neonate have if vaginally birthed with a mother with active HSV-2?
-HSV encephalitis -lethargy, poor feeding, irritability, and local or generalized seizures (appears 2-4 weeks of life)
if a baby <6 months comes in with seizures, what are the usual causes?
-HSV encephalitis -thyroid issue -underlying metabolism disorder
When are Eustachian tubes placed?
>6 ear infections
What percentile is LGA (large for gestational age)?
>90th%
What is the difference between a food allergy and food intolerance?
-Food allergy is immunoglobulin (IgE) mediated immune response -Food intolerance is non IgE (lactose intolerance)
What is the difference in stool of an infant who drinks formula vs. breast fed infant?
-Formula stool= brown, smell, large amount -Breast fed stool= small amounts, yellow, seedy, no smell
What is considered upper and lower respiratory tract?
-Upper: nose, pharynx, larynx, upper trachea -Lower: lower trachea, bronchi, bronchioles, alveoli
What is the difference between meningocele vs. myelomeningecele?
-Menigocele= no neurologic deficit -Myelomeningecele= meninges in sac
What are the clinical manifestations of Lupus?
-N/V/D -**BUTTERFLY facial rash -generalized weakness, joint pain and stiffness -serositis (chest pain)
What is the treatment for necrotizing enterocolitis (NEC)?
-NPO for 24-48 hours -NG tube for decompression -IV antibiotics, parental fluids, TPN
What is the major difference between nephrotic syndrome and glomerulonephritis?
-Nephrotic= symptoms/issues are OUTSIDE of kidney -Glomerulonephritis= symptoms/issues are INSIDE kidney
What are the 5 P's or assessing fractures?
-Pain (not relieved by medication) -Pulse (thready) -Pallor -Paresthesia (sensation distal to the fracture) -Paralysis (movement distal to the fracture)
What is the difference between spina bifida cystic vs. occulta?
-SB cystica has a visible sac -SB occulta: is under the skin
What newborns are high risk?
-SGA -LGA (hypoglycemia) -Preterm -LBW (thermoregulation problem) -IUGR (thermoregulation problem)
What is the age group/types of patients who can get botulism?
-ages 1 month to 12 months -immunocompromised -ulcerative colitis
What is the second period of reactivity in the newborn?
-awakens from deep sleep -HR and RR increase -feeding and passing of MEC -physiologic system, activity, and sleep patterns stabilize
What are the interventions for CP?
-braces and supportive devices -antispasmodics -botox -analgesia -anti-epileptics
If a baby was vacuumed or had forceps used for aiding the birthing process, what problems could they endure?
-caput succedaneum -cephalohematoma -overriding sutures
If periodic breathing is paired with cyanosis what should it be concerned with what condition(s)?
-cardiac -respiratory
If the BRUE is cardiac, what are the usual signs/symptoms?
-cyanosis -hepatomegaly -murmur
What are considered lower tract infections of the GU system?
-cystitis -urethritis
What are signs/symptoms of cow's milk intolerance?
-diarrhea -vomiting -colic -abdominal pain
What is the difference between a diastolic murmur vs a systolic murmur? (other than the obvious)
-diastolic murmur= cardiac problem -systolic murmur= normal
Give examples of lower airway sounds.
-diminished -wheezing -crackles
What are signs/symptoms of respiratory distress syndrome?
-dynpnea -retractions -grunting -nasal flaring -cyanosis
What should the pulse oximetry be after 24 hours of age?
>95%; if lower must rule out congenital cardiac defects
What are the signs/symptoms of septic arthritis?
-fever -leukocytosis -increased ESR and CRP -warm, tender, painful and swollen joint
What is a voiding cystourethrogram?
-fill child's bladder with dye -monitor for retrograde flow of bladder dye into the ureters -reflux is graded
What are the signs/symptoms of glomerulonephritis?
-generalized edema -oligura (due to kidneys not functioning) -HTN -blood in urine -Coca Cola urine
How to treat nephrotic syndrome?
-give steroids (to reduce immune response) -give albumin -then lasix
How is CP diagnosed?
-history -neuro exam -MRI -metabolic and genetic testing (if a syndrome is involved)
What are possible triggers for Lupus?
-hormonal imbalance -immune disorders -environmental exposure to drugs -infection -stress -chemical agents
What is the therapeutic management of bacterial tracheitis?
-humidified oxygen -antipyretics -antibiotics -possible intubation
What are the complications of acute renal failure?
-hyperkalemia** -hypertension -anemia -seizures -cardiac failure with pulmonary edema
What are the signs of spastic CP?
-hypertonia -most common -rigid -contractures
What factors stimulate breathing in an infant?
-hypoxemia -hypercarbia/hypercapnia -low pH (acidosis)
What are the consequences of cold stress?
-hypoxia -metabolic acidosis -hypoglycemia
What is the first period of reactivity in the newborn?
-in first 30 minutes of life, infant is very alert -decreased HR and RR -after initial alertness and activity, infant will sleep for 2-6 hours
Where does the infection occur with septic arthritis?
-in the fluid in the joint -can involve any joint, but most commonly in the hip, knee, or shoulder
What is failure to thrive?
-inadequate caloric intake (incorrect formula) -inadequate absorption (i.e. CF) -increased metabolism -defective utilization (congenital defect)
What can help alleviate colic?
-investigate all GI problems -remove milk from diet -massage abdomen -swaddle
How do we rid the body of excess K+?
-kayexalate -dialysis -insulin w/ Ca Gluconate -continuous albuterol
What are the neonatal signs of HSV encephalitis?
-lethargy -poor feeding -irritability -local or generalized seizures -then a rash
What should you encourage your patient with SLE (Lupus) to do while taking steroids?
-limit salt -do not abruptly stop steroids
What are the clinical manifestation of slipped capital femoral epiphysis (SCFE)?
-limp on affected side -inability to bear weight -pain in groin, thigh, or knee -external rotation of affected leg -shortening of extremity
What are signs/symptoms of seizures in newborns?
-lip smacking -tongue thrusting -eye rolling -arching
What are the etiologies of neural tube defects?
-low folate -maternal diabetes mellitus -low vitamin B12 -maternal hypertneramia -use of anti-epileptics
What are the clinical manifestations of Legg-Calve-Perthes disease?
-males (4-8 years) -self-limiting -idiopathic -delayed bone age
What lab values are important for diagnosing osteomyelitis?
-marked leukocytosis -elevated ESR -elevated CRP
What should you worry about if an infant has asymmetrical ROM or moro reflex?
-nerve palsy -clavicle fracture
What are considered upper tract infections of the GI system?
-pyelonephritis -vesicouretal reflux (VUR) -glomerulonephritis
What are the signs of ataxic CP?
-non spastic -walking issues -cerebellar signs
What are protective factors to reduce incidence of SIDS?
-pacifier use -breastfeeding -back to sleep
What are sign/symptoms of nephrotic syndrome?
-peri-orbital swelling -dependent edema -2+ protein in urine -facial edem -frothy/foam-like urine -increased urinary frequency -hypoalbumemia -hypercholesterolemia
What is cerebral palsy?
-permanent movement and posture disorders -attributed to disturbances that occur in fetal or infant brain -may involve sensation, perception, communication, cognition, and behavior
What are the motor signs of CP?
-persistent primitive reflexes -poor head control after 3 months -stiff or rigid limbs -arching back; pushing away -floppy tone -unable to sit without support at 8 months -clenched fists after 3 months -dominant hand if <1 years old -cant walk by 18 months
What are the different causative factors for glomerulonephritis?
-post infection (i.e. strep or pneumococcal) -systemic lupus erythematosus -sickle cell
What are the factors in the development of necrotizing enterocolitis (NEC)?
-prematurity -intestinal ischemia -colonization of pathogenic bacteria -substrate in the intestinal lumen
What is the goal of therapy for Juvenile Idiopathic Arthritis?
-preserve function -prevent deformities -relieve symptoms
What is the treatment regimen for transplant rejection?
1. increase anti-rejection medication---i.e. Tacrolimus (Prograf) 2. increase steroids
What will the NCLEX test you on about traction?
1. never adjust weights/scales 2. must be attached to a non-moveable part of the bed 3. give valium to reduce spasms
What are positive signs of a developmental dysplasia of the hip (DDH)?
1. shortened limb on affected side 2. restricted ABDuction of hip on affected side 3. unequal gluteal folds when infant is prone 4. positive Ortolani test 5. positive Barlow test
What is the normal specific gravity in a UA?
1.001 to 1.025
What is the normal resting HR for infants?
120-140 beats per min (up to 180 is crying)
Failure to thrive is when the infant drops ____ standard deviations on the growth chart.
2 SD
How long do infants have their maternal Hb running through their circulation?
2-3 months
What is the lifetime of a kidney transplant?
20-25 years
What age range is the New Ballard used for?
20-44 weeks gestation
What is the normal birth weight?
2700-4000g (6-9 lbs)
When does natural immunoglobulin production begin?
2nd month of life
What is the normal respiratory rate for infants?
30-60 breaths per minute
What is the normal temperature of an infant?
36.3-36.9 C
What is the treatment for osteomyelitis?
4-6 weeks of IV antibiotics (PICC line)
Where is the PMI located?
4th or 5th intercostal space left of the sternum, midclavicular line
Approximately what percentage of infants develop hypersensitivity to cow's milk?
60 %
What percentage of patients with cerebral palsy develop seizures?
60%
What is the mortality rate for newborns infected with HSV-2?
60% mortality
How is botulism treated?
Antitoxin; recovery takes weeks to months!
How is septic arthritis diagnosed?
Arthrocentesis- joint fluid aspiration
What was the slogan for the "Back to Sleep" campaign?
Back to sleep, prone to play
What does it indicate when a patient has glucose in their UA?
DKA
What is a common complication of PICC lines?
DVT formation
What is the organism that commonly causes UTI's?
E. coli
What are the typical infectious agents for Hemolytic Uremic syndrome?
E. coli, viral, salmonella, or recent GI infection or URI
What is the principle cause of infectious mononucleosis?
Epstein-Barr virus
What is the most common cause of a BRUE?
GI problem (reflux with over feeding)
What is the most serious viral infection in newborns?
HSV (60% mortality!)
Since infants are unable to concentrate their urine, what are they at risk for if free water is given to them?
HYPONATREMIA
How can you prevent epiglotittis?
Haemophilus influenzae type B vaccine
Why is breast milk preferred for babies with necrotizing enterocolitis (NEC)?
IgA, macrophages, and lysosomes
Which immunoglobulin is passed through mothers breast milk?
IgG
What is Gower's sign?
Indicator of muscular dystrophy; to stand, the child has to "walk" hands up legs
What is the usually problem with patients with respiratory distress syndrome?
lack of surfactant
What is concerning about erythema toxicum?
NOTHING! its normal
What is the first line treatment for Juvenile Idiopathic Arthritis?
NSAIDs (naproxen)
What is the most important factor within the first 12 months?
NUTRITION!!
What is the frequent cause of septic arthritic in sexually active teens?
Neisseria gonorrhea
What is the causative agent of croup?
Parainfluenza virus
What is the therapeutic management of soft tissue injuries?
RICE: Rest Ice Compression Elevation
When teaching parents of a neonate the proper position for sleep, the nurses stress the importance of placing the neonate on their back to reduce the risk of _________?
SIDS
Which type of SMA can have a normal life expectancy?
SMA type 3
Give examples of upper airway sounds.
STRIDOR
What is slipped capital femoral epiphysis (SCFE)?
Spontaneous dislocation of proximal femoral head disrupting the epiphyseal plate
If you catheterize a child and they have 20-50 WBCs, and 1-2+ leukocyte esterase what would you conclude?
UTI
When does pain occur with Juvenile Idiopathic Arthritis?
When they wake up
What is the highest priority in regulating the temperature of a neonate?
minimizing the energy needed for the neonate to produce heat
Is Bactrim prophylaxis a good idea in children?
a meta-analysis revealed decreased septic UTI's, but no change in renal scarring
What is a Brief Resolved Unexplained Episode (BRUE)?
a parent brings in an infant who has had an episode of apnea, changing in color, choking, gagging
What is important to note if you are taking care of a pediatric patient who has had a kidney(s) transplanted?
abdomen might be distended due to the fact that the old kidneys were not removed
What is vesicoureteral reflux (VUR)?
abnormal retrograde (backward) flow of urine from bladder into upper urinary tract
What is necrotizing enterocolitis (NEC)?
acute inflammatory disease of the bowel in preterm and high risk infants
What is happening when an infant has bulging fontanelles?
additional fluid or meningitis
When is cartilaginous support fully developed?
adolescence
When is acrocyanosis abnormal?
after the firs 24 hours of life
What is a compound fracture?
aka open fracture; where the bone protrudes through the skin
When taking initial BP on a newborn, where do we take it?
all four extremities
What is hemolytic uremic syndrome?
an acute disorder shows the following "triad": 1 hemolytic anemia 2 thrombocytopenia 3 acute renal failure
Since neural tube defect children have many surgeries throughout their lives, what must we assess for?
an allergy to latex; occurs with repeated exposure and must be the first case in the OR
What is the most common cause of miscarriages?
anencephaly
What is important to note during feedings and the infant's WOB?
any time an infant cannot coordinate breathing with eating and has subcostal retractions nasal flaring, etc. this is a sign of respiratory distress
At what age will the GFR of an infant be the same as an adult?
around 1 years old
When should the anterior fontanelle close?
around 18 months
When should the posterior fontanelle close?
around 6-8 weeks
If you do a clean catch UA, what amount of WBC's would be indicative of a UTI?
at least >50 WBC's
What is the drug of choice for pediatrics who are seizing?
ativan
What is urosepsis?
bacteria has spread to blood (rare, but very concerning)
What is the causative agent for epiglottitis?
bacterial
What would the causative agent with an increased WBC count in pneumonia?
bacterial
Latex alleriges have a cross reaction with _____, ______, & ______.
bananas avocados mangos?
Why is there no blood testing for HSV 1 and 2?
because most people have been introduced to HSV at some point and will always test positive even though they don't actively have HSV
What is important to note when an infant is suspected to have rib fractures?
because the ribs are more cartilage than ossified bone, you may only see signs of fracture on an X-ray than visual signs on the chest
Whenever a child has a UTI we consider it "pyelonephritis", why?
because their urethra and ureters are so short
Why are nitrites not always seen on a UA in an infant?
because they are urinating so much
What is the most common injury in school-aged children?
bicycle and sports injuries
What type of stool would make you think the infant had a cow's milk allergy or an allergy to formula?
blood &/or mucus in stool
What kind of stool occurs when infants have an allergy to cows milk?
blood or mucous
What is pseudomenstruation?
bloody vaginal discharge r/t maternal hormones
What is a normal finding of the eye with patients who have Osetogenesis Imperfecta?
blue sclera
What is a comminuted fracture?
bone breaks into many fragments
What is a complicated fracture?
bone fragments have damaged other organs or tissues
What is a contusion?
bruise; damage to soft tissue, subcutaneous tissue, and muscle
If a patient develops peritonitis while receiving peritoneal dialysis, how can we treat it?
by putting vancomycin into the peritoneal solution
What can be given to infants in the NICU to help stimulate them when they have bradycardia and continual desaturations?
caffeine (withdrawal slowly)
What can happen if the mother takes an ARB (angiotensin receptor blocker) while pregnant?
can cause kidney failure in the infant
If the lower limb BP's are NOT higher than the upper limb BP's, what could this mean?
cardiac defect
If an infant has peri-oral cyanosis or central cyanosis when feeding, what can this indicate?
cardiac issues
What is meconium?
dark, tarry first stool a baby passes within 24 hours after birth
What is myositis ossificans?
deep contusions to the biceps or quadriceps in which bone is displaced into the msucle
Why is cow's milk indigestible in infants?
deficiency of pancreatic lipase for fat absorption
A patient with a negative glucose, but positive ketones in UA, what does this indicate?
dehydration
What does an elevated specific gravity (>1.025) indicative of?
dehydration
Due to their immature kidneys, what are infants more prone to?
dehydration, acidosis, and over hydration
What is happening when an infant has sunken fontanelles?
dehydrations
What does a decreased specific gravity (<1.001) indicative of?
dilute (did you fluid resuscitate? well hydrated?)
What is important to note about the consistency of what an infants ribs/bones are made of?
more cartilage
What is important to do when the taking a pulse ox measurement of a baby to check if they have a cardiac issue?
do Pre and post-ductal saturations (i.e. put a pulse ox on an upper limb (pre) and place another one on a lower limb (post))
While assessing a 2-hour-old neonate, nurse observes acrocyanosis, what should she/he do?
document, and know this is normal
What are the clinical manifestation of epiglottitis?
drooling, tachycardia, restlessness, stridor, retractions, sore throat
With SMA, the onset is variable, but early or late onset would have the poorest prognosis?
early onset has the poorest prognosis
If we are thinking they have congenital hypothyroidism, do they have elevated or decreased TSH?
elevated TSH; no factor to convert TSH to T4
What is the en face position?
emotional bonding between parents and newborn; "falling in love" with the newborn
If the BRUE is neurologic, what are the usual causes?
encephalitis or seizures
If an infant has ambiguous genitalia, what body system should be assessed?
endocrine (i.e. adrenal hyperplasia)
When assessing a newborns skin, the nurse observes small white papule surrounded by erythematous dermatitis?
erythema toxicum
What is ecchymosis?
escape of blood into tissue causing black and blue discoloration
Infant has a higher ratio of ___________ fluid than an adult?
extracellular
How is Lupus passed on?>
familial tendency
What can speech therapy assist with for CP patients?
feeding
What are the signs/symptoms of transplant rejection?
fever, swelling, pain/tenderness over graft area, decreased urine output, elevated BP, elevated serum creatinine & BUN
What is the treatment & prevention for neural tube defects?
folic acid
Why are frequent ear infections a problem?
frequent infections can delay speech and cause other disabilities
If a child under 2 months comes into the ER with a fever, what must be done?
full septic workup (cultures and lumbar puncture)
What is SMA?
genetic disease which degeneration in the spinal cord and brainstem, resulting in atrophy of skeletal muscles
What is muscular dystrophy?
genetic origin with gradual degeneration of the muscle fibers, progressive weakness and wasting of the skeletal muscles
When does asthmatic bronchitis typically occur?
more frequent in cold weather
When there is a lack of attachment, who needs the most help?
mother; look for PP depression
Why do hyponatremic seizures occur in infants?
given free water; kidneys cannot concentrate the urine so excess water in circulatory system dilutes the Na in the body
What are the clinical manifestations of croup?
hoarseness, barking cough, inspiratory stridor, and various degree of respiratory distress
How would an infant get botulism?
honey and light or dark corn syrup
What are important for assessment of fontanelles in infants?
hydration status (sunken= dehydrated)
What level of serum Ca would a patient have who is immobile?
hypercalcemia--due to Ca being released from the bones
What must you consider when giving albumin to a patient with nephrotic syndrome?
hypersensitivity reaction
Hyperglycemia or hypoglycemia can cause seizures?
hypoglycemia
What can occur if parents give free water to an infant under 6 months of age?
hyponatremic seizures
What is the first sign of sepsis among infants?
hypothermia
How do know the child has pyelonephritis vs. UTI?
if an older child tells you they have back pain
When would an EKG or x-ray be done on a patient who presents with BRUE?
if suspected cardiac or respiratory issue
How to tell if a baby is seizing or just jittery?
if you touch the infant and they respond and calm down, its jitteriness
Why can't infants concentrate their urine?
immature kidneys
When is the New Ballard scale used?
immediately post delivery period for highest accuracy if the infant is more than 26 weeks' gestational age
What triggers Guillian-Barre syndrome?
immunologic trigger, usually viral (i.e. flu shot)
What will a CSF culture show us?
infected meninges
What does it indicate when a patient has WBC's or leukocyte esterase?
infection
What complication specific to Juvenile Idiopathic Arthritis requires treatment by an ophthalmologist?
inflammation of the iris and ciliary body
What is the most critical adaptation in the infant when they are transitioning to life?
initiation of respiration
What is the etiology of cerebral palsy?
intrauterine hypoxia or asphyxia
Any time there is stenosis of a ureter, what happens to the kidney?
it becomes smaller, "hydronephrosis"
Why is muscular dystrophy more common in boys?
it is x-linked
What is important to note about the ascending paralysis that occurs in Guillian-Barre?
it must be symmetrical
What does it indicate when a patient has Hb or RBC's in their UA?
kidney injury (could have small amounts and be trauma from catheterization)
What should we suspect when there is blood-tinged urine?
kidney involvement
What does it indicate when a patient has casts in their UA?
kidney stones; along with lower back pain
What is acute renal failure?
kidneys are suddenly unable to regulate the volume and composition of urine
What anatomy is affected during croup?
larynx, trachea, and bronchi
What hormone is limited which increases the risk of dehydration in the infant?
limited antidiuretic hormone (vasopressin)
With myelomeningocele, what determines the nature and extent of impairment?
location and magnitude of defect/neural involvement
Why does bronchopulmonary dysplasia occur?
long term ventilation (intubated and on ventilator with high pressures)
What is the concern with CP population as it grows?
long-term placement?
What is noted about the skin color of a newborn compared to later in life?
low amount of melanin at birth, lighter skin tone early in life, UV light susceptibility
What is the biggest influence factor for neural tube defects?
low folate levels
What is important to note about upper and lower limb extremity BP's?
lower extremities should be higher than the upper limbs due to the higher amount of pressure the lower limbs have to face when pumping back to the heart
What is the most common area where myelomeningocele's occur?
lumbar and lumbosacral areas
When a patient comes into the ER with a suspected spinal cord injury, what is the first thing the nurse should do?
maintain C-spine protocol
When taking a blood pressure on an infant, what number is most important and why?
mean blood pressure; MAP is more accurate on circulation
What is important during the treatment regime of a patient who is taking anti-rejection medications?
medications are time sensitive and critical to receive for life
What is contained in the sac of a myelomeningocele?
meninges, spinal fluid, and nerves
What are we focusing on for postnatal infections?
meningitis and encephalitis
Why is spina bifida and myelomeningecele interchangeable terms?
meningocele doesn't have long term effects
What is important to note about placement of a cast/soft cast?
must have room for swelling
What does the APGAR score measure?
neonates prognosis for future health conditions
What are the signs of dyskinetic CP?
non spastic, extrapyramidal
If the BRUE is metabolic, what is the usually cause?
not gaining weight
When is it okay to give an infant cows milk?
not until 12 months, where they have the enzymes to tolerate cows milk
What type of children are more commonly found to have slipped capital femoral epiphysis (SCFE)?
obese children; usually after activity
What is the principle feature in acute renal failure?
oliguria
Why does retinopathy of prematurity occur?
oxygen toxicity
What is the nursing management of SMA?
palliative care
What is the problem with patients on prophylaxis Bactrim?
patient might present with an illness, but the UA doesn't show infection (must wait 24 hr for urine culture)
What is the drug of choice for neonates who are seizing?
phenobarbital
What type of bone/fracture is common in patients with osteogenesis imperfecta?
plastic deformation
What occurs in Hemolytic Uremic syndrome?
platelets deposited into the lining of the small glomerular arterioles, which become swollen and occluded
If a newborn is born with a myelomeningocele, and has surgery what do you monitor?
pre and post op mobility
What is the most important body organ that must be protected when a patient has a myelomeningocele?
prevent infection near area
If you were to draw a trough level, when would you draw?
prior to administration of medication
What is the extrusion reflex?
pushing the bottle away with their tongue when they are finished eating
When you are suspecting the patient to have ___________, you should check for CVA tenderness.
pyelonephritis
Where is the most accurate temperature taken on an infant?
rectally (more accurate and only taken in the ED or emergent situations), normally will take temp via axillary
How do we measure height/length for children 3 years and under?
recumbent (head to heel); better consistency
If the BRUE is a GI problem what are the usual causes?
reflux w/ over feeding
What is the cause of death in patients with SMA?
respiratory failure
Why would death occur in Gullian-barre?
respiratory failure
What is the priority while a patient is actively going through a Guillian-barre 'crisis'?
respiratory/breathing
What lab value would you check to see if the bone marrow is producing RBC's?
reticulocyte (%)
Why do infants have projectile vomiting?
reverse fast peristalsis
What can recurring episodes of pyelonephritis cause?
scarred, poorly functioning kidney and chronic pyelonephritis
If we know mom has HSV-2 with active lesions, what should be ordered before infant is born?
scheduled C-section
What is the most common reason acute renal failure occurs in pediatrics?
severe dehydration
What is sterile pyuria?
small amount of bacteria in urine
What is a tethered cord?
spina bifida occulta
What is the treatment for croup?
steroids and racemic epinephrine (Vapo)
What is the first line of treatment for Systemic Lupus Erythematous?
steroids!
What is the first line therapy for nephrotic syndrome?
steroids!
What is the first line of treatment for Gullian-barre?
steroids! (as well as IVIG, heparin, stool softener, analgesics)
What is the first line treatment for post streptococcal glomerulonephritis?
steroids; immune mediated complex
What is the first line treatment for Hemolytic Uremic syndrome?
steroids; immune mediated syndrome
What critical factor is missing in premature babies that doesn't give them good lung compliance?
surfactant
What is the treatment for slipped capital femoral epiphysis (SCFE)?
surgical (Pinning in situ, Osteotomy, or hip arthroscopy)
What is important to look for when you elicit the moro reflex?
symmetry of extremities
How do you use tactile factors to stimulate breathing?
tapping on feet, rubbing torso, or suctioning
If you had a patient with a kidney transplant and then a bone marrow transplant, would they still require immunosuppression?
technically no, b/c the bone marrow would accept the kidney as its own
What are the signs/symptoms of short-gut syndrome?
tender, distended abdomen
Why is it dangerous if the fontanelles close too soon?
the brain can no longer develop
What is important to teach to the mother if her baby has thrush?
the fungal infection can be transmitted to her breast, so placing the drops onto breast to help prevent and treat the co-infection
If a 3-4 month old has a palpable liver, what should be assessed next?
the heart; hepatomegaly is the first sign of heart failure
What is the most commonly transplanted organ?
the kidneys
Why are children prone to ear infections?
their Eustachian tubes are short and angled/open (allows organisms to rapidly move down into them)
Why do patients with muscular dystrophy have lordosis?
they exert their core to assist with standing
What is the major therapeutic goal for Osteogenesis Imperfecta?
to help bones reuptake Ca
What is the purpose of skin-to-skin?
to help the infant promote thermal regulation
What is the purpose of surfactant?
to reduce surface tension in the lungs
What is urethral stenosis related to?
trauma
How do you treat middle ear infections?
treat with systemic antibiotics
Since infants have a rate of metabolism that is twice that of an adult, what can occur?
twice as much acid formation leading to increased and rapid development of acidosis
With which SMA type does pectus excavated occur?
type 2
What is a greenstick fracture?
type of fracture where the bone bends and splits, causing a crack or incomplete break
What diagnostic tool do we use when a child comes in with a suspected/confirmed UTI?
ultrasound of the kidneys
If you have a patient who is <2 years old with a febrile UTI, what must be done per guidelines?
ultrasound; make sure anatomy is normal
What type of children are at higher risk for a UTI <2 years?
uncircumcised males
What is concerning for multiple birthmarks (i.e. café-au-lait, hemangioma, or port-wine stain)?
underlying neurologic problem
What causes necrotizing enterocolitis (NEC)?
unknown
What is the normal amount of urobilinogen in a UA?
up to 1 mg/dL
Up until what age do we measure a head circumference?
up to 2 years; until fontanelles are closed
If an infant male has hypospadias, why is this concerning?
urethra is not midline, and circumcision is with held until child is older
What is the most important host factors for a UTI in pediatrics?
urinary stasis (also diarrhea= e.Coli closer to urethra)
What is Legg-Calve-Perthes disease?
vascular necrosis of the femoral head