PEDS Exam 3

Why does insulin resistance occur?

Pancreas overworked, causing decrease in insulin production

Risk factors of SLE

-female -fam Hx -African, Native AMerican, Asian -recnet infection -drug reaction -excessive sun exposure

Where do fetuses get T cells?

-fetal thymus produces T cells in gestation -fetal T cells sensitized to antigens that crossed via placenta -maternal T cells do not cross placenta

Physical Examination of HIV

-fever -H x W x L x head circumference -standard growth chart -inspect oral cavity for candidiasis -observe work of breathing -LOC (encephalopathy?) -palpate for enlarged lymph nodes or swollen parotid glands -palpate abd for hepatosplenomegaly

Tx of burns

-fluid resuscitation -wound care -prevention of infection -antibiotics (specific to causative organism) -may need surgery -nutrition: albumin, transferrin, carotene, retinol, copper, cholesterol, calcium, thiamine, riboflavin, pyridoxine, iron -silver cream, debridement, moisture, allograft, autograft, vacuum assisted wound therapy, pressure garments -tetanus vaccine for severe burns

NI cushing syndrome

-fluid/nutrition status -monitor weight, muscle strength, endurance -educate: corticosteroid admin

Dx/Sx of osteogenesis imperfectat

-frequent fractures -scraming a/w routine care -sclear blue/purple/gray tint -abnormalities with teeth -skin bruising -joint hypermobility with active ROM -skin biopsy or DNA testing

Duchenne muscular dystrophy sx

-generalized weakness of voluntary muscles and weakness progresses over time -hips, thighs, pelvis, shoulders initially affected -late walkers -clumsy -difficulty doing daily activities -disturbed balance

NI torticollis

-gentle neck stretches -immobilize shoulder on affected side -hold stretch for 10-30 seconds/10-15x -prevent positional plagiocephaly

NI for Glargine (Lantus)

-given at bedtime -don't mix with other insulin

Dx of Duchenne Muscular Dystrophy

-gowers sign -gait -effectiveness of cough -electromyography -serum creatine kinase elevated -muscle biopsy: determines absence of dystrophin -DNA testing reveals presence of gene

When performing a physical exam for endocrine disorders, what locations on the body would you assess?

-hair -face: eyes, mouth -neck -skin -chest -abdomen -fingers -genitals

What are s/s of precocious puberty?

-headache, n/v, visual difficulties d/t circulating hormones, acne, adult-like body odor, advanced maturation -advanced bone age -increased size of uterus -development of ovaries -presence of LH, FSH, estradiol, testosterone -emotional lability, aggression, mood swings

Every US state requires what screenings for newborns?

-hearing -pulse oximetry: for critical congenital heart disease -blood test: screens for rare genetic, endocrine, and metabolic conditions

A CBC can help evaluate what in musculoskeletal disorders?

-hemoglobin and hematocrit levels with fracture -determine toxic synovitis

Wiskott-Aldrich syndrome Tx

-high-dose steroids -azathioprine or cyclophosphamide -splenectomy to correct thrombocytopenia -hematopoietic cell transplant is only cure -IVIG can decrease bacterial infection frequency -good skincare, assess eczema

Types of bites

-human -animal -snake -insects

Types of Primary Immunodeficiencies

-humoral -cellular immunity -combination of humoral and cellular immunity -phagocytic system defects -complement

Spastic Cerebral palsy

-hypertonicity -hemi,quad,di,paraplegia

What is the difference between hypoglycemia and hyperglycemia s/s?

-hypo: diaphoresis; behavioral changes (tearafulness, irritability, naughtiness), confusion, slurred speech, beligerence; tremor; palpitations, tachycardia -hyper: dry/flushed skin; mental status changes, fatigue, weakness; blurred vision; abd cramping, n/v, fruity breath odor

If a patient has a thyroidectomy, what adverse effects could happen?

-hypoparathyroidism -hypocalcemia --> tetany -recurrent laryngeal nerve injury *and the effects of each of the above conditions; ex: hypocalcemia can cause paresthesia, muscle spasms, tetany, cramps, numbness, seizures

cretinism (congenital hypothyroidism) s/s

-hypotonia, hypoactivity, dull expression, decreased mental responsiveness -delayed growth, large fontanelles, coarse facies (short neck and limbs) -periorbital puffiness, enlarged tongue, poor sucking -skin pale with mottling, jaundice, cool/dry/scaly skin, sparse hair -bradycardia, respiratory distress, decreased pulse pressure, umbilical hernia, mass d/t constipation

How is precocious puberty treated?

-if tumor: radiation, surgery, chemo -GnRH analog: SQ injection daily, an intranasal compound 2-3x, depot injection q3-4 weeks (quarterly or yearly), which initially stimulates release but later suppresses GnRH

NI for HIV

-immunocompromised precautions -live vaccine ONLY if cell counts are adequate -emotional support

Spinal Cord INjury Sx

-inability to move or feel extremity -inability to breathe

Sx of child abuse

-inconsistent hx -delay in seeking tx -uniform appearance of burn -lack of spattering of water -stocking/gloves

Labs and Dx of hyperthyroidism

-increase in T4 and T3 -decrease in TSH

hyperthyroidism s/s

-increased metabolic rate, weight loss, muscle wasting -goiter (can also occur with iodine deficiency) -anxiety, nervousness, irritability (emotional lability), insomnia -tremor -tachycardia, finger clubbing -fine, straight hair -bulging eyes (exophthalmos or proptosis), eyelid lag, diplopia -facial flushing, moist skin -increased systolic BP, health intolerance -breast enlargement -menstrual changes (amenorrhea) -localized edema -diarrhea

Sx severe combined immunodeficiency disease

-infection: skin, virus, opportunistic -oral candidiasis -FTT (failure to thrive)

how does HIV work on the immune system?

-infects CD4 (Helper T-cells) -renders cell dysfunctional -T cells lose ability to recall antigens -->increased risk of infection -T-suppressor cells (CD8) initially increase to compensate but eventually decrease as disease progresses -causes B cells to "Forget" antigens -natural killer cells rely on secretion of cytokines from T cells (if T cells decrease, natural killer cells ineffective) -monocytes/macrophages aren't destroyed but are affected

immunosuppressants

-inhibit release of interleukin II (CyA); antagonize purine metabolism -azathioprine or cyclosporine -ind: steroid-resistant autoimmune disease -NI: monitor CBC, serum creatinine, K, MG, BP, infection, draw labs before dose; don't give with grapefruit juice

What are common endocrine disorder medications?

-insulin -oral hypoglycemics -growth hormone -octreotide acetate -corticosteroids -desmopressin acetate (DDAVP) -hormone therapy (levothyroxine) -hormone suppression (methimazole) -mineralcorticoid

SJS and Toxic Epidermal Necrolysis Tx

-isolation -fluid/electrolyte -TX of secondary infection -ophthalmologic consult if corneal ulceration, keratitis, uvelitis, panophthalmitis

Tx of DKA

-isotonic IV fluids -IV regular insulin 0.1 unit/kg/hr -BG decreased, <100mg/dL/hr -K replacement needed as BG is lowered

S/S of Juvenile Idiopathic Arthritis

-joint pain -redness, uveitis (inflamm of middle eye layer) -warmth: >39.5 C/2+weeks -stiffness: occurs after inactivity (sleep) -swelling, lymphadenopathy, splenomegaly, hepatomegaly -some forms affect eyes and organs: irritability, fussiness

s/s of hypothyroidism

-lethargy, muscle aches and weakness -slow mentation, thick tongue/slow speech -weight gain, facial and eyelid edema, -constipation -cold intolerance -slowing of body systems, anorexia -receding hairline -brittle nails and hair, dry skin -dull-blank expression

complications of dysplasia of the hip

-limited abduction of the hip and contracture muscles -avascular necrosis of the femoral head -loss of ROM -recurrently unstable hip -femoral nerve palsy -leg-length discrepancy early osteoarthritis

Dx of torticollis

-limited mvmt of neck when performing passive ROM -mass in sternocleidomastoid muscle -wryneck (tilting of head to one side)

Type 2 Diabetes

Pancreas produces insulin but body is insulin-resistant -more common with higher BMI or over 30 yrs -at risk for hyperglycemic hyperosmolar syndrome (HHS)

What is central diabetes insipidus? What are the s/s?

Pituitary gland doesn't make enough ADH, causing the kidneys to produce an excessive amount of urine -s/s: polydipsia, polyuria, noturia, enuresis, weight loss, dehydration, irritable, fever, n/v, constipation, failure to thrive, decreased tears, sunken fontanelles, decreased skin turgor, tachycardia, increased RR to compensate for decrease in fluid, hypernatremia, hypovolemia, *note: Dx is abrupt and permanent*

prevention of contact dermatitis

-long sleeves outdoors -identify/remove offending plants -vinyl gloves, wash clothes, pets, garden/sports equipment -if contact, wash w/ soap and water -Zanfel and Tecnu Oak-N-Ivy outdoor skin cleanser prevents rash if washed after exposure -Ivy Block (organoclay)

emollient lotions and creams Tx

-lotion, gel, cream with SPF -ind: >6months

Tx of Central diabetes insipidus

-low solute (decreased sodium and protein) -daily replacement of ADH -thiazide diuretic -surgery (if d/t tumor) -DDAVP (short acting or long acting) -monitor daily weights -education about water intoxication -medical alert bracelet Goal: 1-2mL/kg/hr of urine and urine specific gravity >1.010

Hx of Immunologic disorders

-maternal HIV infection -frequent, recurrent infections -chronic cough, recurrent low-grade fever -two or more serious infections in early childhood -recurrent deep skin or organ abscesses -persistent thrush in the mouth -extensive eczema -growth failure

NI for hyperthyroidism

-measure growth frequently -monitor VS (especially BP and pulse) -promote increased caloric intake -monitor for adverse drug effects: rash, mild leukopenia, loss of taste, sore throat, GI disturbance, arthralgia -schooling may be altered d/t heat intolerance, emotional lability, eye problems -5-6 meals per day -fluid maintenance, nutritional support, electrolyte correction -monitor RBC, liver function, hypothyroidism

cerebral palsy complications

-mental impairments -seizures -growth problems -impaired vision or hearing -abnormal sensation or perception -hydrocephalus

What can PKU cause if not treated?

-mental retardation -convulsions -behavior problems -skin rash -musty body odor

Tx of hyperthyroidism

-methimazole (blocks T3/T4 production) -beta-adrenergic blockers -radiation (can cause hypothyroidism if used in excess) -surgery (thyroidectomy): if cause can be surgically removed; note: can cause hypothyroidism, hypoparathyroidism, or laryngeal nerve damage

antibiotics skin indications

-mild acne vulgaris -impetigo -folliculitis

Staphylococcal scalded skin syndrome TX

-mild-moderate: oral cephalexin, dicloxacillin, amoxicillin/clavulanic acid -severe: similar to burns w/ aggressive fluid management, IV oxacillin, clindamycin

wet dressing Tx

-moistened with lukewarm water or sterile water -ind: in presence of itching, crusting, or oozing -removes crusts

PTs with a musculoskeletal disorder are at risk for difficulty in elimination. What interventions can help?

-monitor I/O -determine any retention -daily weights -adequate hydration -monitor for distention, bowel sounds, mass (indicating impaction) -increase physical activity, D/C narcotic analgesics -adequate fiber intake

NI of DKA

-monitor VS, hydration, LOC, cardiac rhythm -frequent BG, I/O -electrolytes, ABG, s/s hypoglycemia

NI cretinism

-monitor for swollen tongue (airway obstruction) -hyperfunction -changes in VS or thermoregulation -activity level -fluid restriction or decreased NaCl

What is the purpose of water deprivation studies?

-monitors sodium and urine osmolality -Dx diabetes insipidus and distinguishes between types of DI

What is myelomeningocele?

-most severe form of spina bifida-- spina bifida cystica -spinal cord ends at point of defect (absent motor and sensory function beyond that point)

Muscle characteristics in children

-motor development begins at birth -full ROM @ birth -spinal cord more mobile -myelinization not complete until 2 years -skeleton not completely ossified -growth of bones occurs @ growth plates -bones more vascular and heal faster than adults

impetigo tx

-mupirocin ointment -soak crusts 20 min x q2-4 hours -cool compress or Burrow solution to remove crusts before topical antibiotics -isolation not necessary unless actively weeping

cause of myelomeningocele

-neural tube defects -maternal drug use -malnutrition -genetic predisposition

How to prevent injury in children with osteogenesis imperfecta?

-never push/pull extremity -do not bend extrem @ awkward position -life baby by placing one hand under legs and butt and one hand under shoulders, head, neck -don't lift legs by ankles to change diaper -don't life baby from under armpits -provide supported positioning -handle suspected fracture minimally

Labs and Diagnostics of Endocrine Disorders

-newborn metabolic screening -serum chemistry -random and timed serum hormone testing -growth hormone stimulation testing -blood glucose, HgA1C -urine testing -genetic testing -water deprivation study -bone age radiographs -imaging studies--CT, MRI, nuclear medicine, ultrasonography -physical exam

Tx of congenital adrenal hyperplasia

-newborn screening -lifelong glucocorticoid/mineralcorticoid use (reducing ACTH secretion) -salt to formula -give more meds/salt during stressful times -adrenalectomy

Dx and assessment of slipped capital femoral epiphysis

-obesity -rapid growth spurt -Trendelenburg gait -pain in hip and referred to groin, medial thigh, or knee -dec ROM in hip with external rotation -X ray, bone scan (rules out avascular necrosis), CT

Complications of systemic lupus erythematosus

-ocular -CVA, pericarditis, valvular heart disease, CAD -transverse myelitis, seizures, psychosis -immune complex-mediated glomerulonephritis

Acne Neonatorum Sx

-oily face or scalp -inflammatory papules and pustules -absence of fever

Degludec (Long Acting) Pharmacokinetics

-onset 0.5-1.5 hours -peak: none -duration >42 hours

Short Acting Insulin Pharmacokinetics

-onset: 0.5-1 hour -peak: 2-4 hours -duration: 5-8 hours

Detemir (Long Acting) PHarmacokinetics

-onset: 1-2 hours -peak 4-7 hours -duration 20-24 hours

Intermediate acting insulin pharmacokinetics

-onset: 2-4 hours -peak 4-12 hours -duration 12-24 hours

Glargine (Long Acting) Pharmacokinetics

-onset: 2-4 hours -peak: 8-12 hours -duration 22-24 hours

Rapid acting insulin pharmacokinetics

-onset: w/i 15 minutes -peak: 1-3 hours -duration 3-5 hours

Sx of anaphylaxis

-oral: oral itchy/swelling -cutaneous: hives, flushing, itchy, angioedema -resp: nasal itchy, congestion, sneeze, rhinorrhea, stridor, tightness in throat, dysphagia, dysphonia, hoarseness, SOB, dyspnea, tight chest, wheezing, bronchospasm -CV: tachycardia, angina, arrhythmia, hypotension -Neuro: syncope, faintness, aura of doom, lethargy, disorientation -GI: bloating, abd pain, n/v/d *SUMMARY: swelling, itchy, anything r/t pulmonary collapse; REMEMBER A, B, C!!!!

hypoglycemia s/s

-pallor, sweating, tremors -dizziness, numb lips/mouth -confusion, irritability, altered LOC

complications of myelomeningocele

-paralysis -orthopedic deformities -bladder and bowel incontinence -inc risk of UTI, pyelonephritis, hydronephrosis, renal damage -hydrocephalus -latex allergy -seizures -sac ruptures; CSF leak -infection

hypothermia tx

-passive vs. active rewarming -humified warm O2 -warm IV fluids or lavage -bear huggers -warm packs to core -treat hypoglycemia -don't overheat too fast

Hx of musculoskeletal disorder

-past med Hx -mother's pregnancy -fam Hx -OLDCARTS -tx from home -OTC meds and prescription -prematurity, difficult birth, infection, changes in gait, falls, etc

Types of juvenile idiopathic arthritis

-pauciarticular (oligoarticular) -polyarticular -systemic

Type IV Allergic Reaction conditions

-poison ivy -contact dermatitis -graft vs. host disease -TB

DM2 Sx

-polydipsia, polyuria, polyphagia -blurred vision, acanthosis nigricans -obesity, HTN, dyslipidemia

Labs and Dx for HIV

-polymerase chain reaction (PCR): test for HIV genetic material (DNA,RNA) -enzyme-linked immunosorbent assay (ELISA): tests for HIV antibodies -platelet count: <30,000 requires Tx -CD4 and ANC counts: low in HIV infection

NI for severe combined immunodeficient disease

-positive pressure ventilation -strict precaution and sterile technique -no live vaccines -skin care -nutrition/fluid intake -admin IVIG and antibiotics

Tx septic arthritis

-prevent destruction of joint cartilage and maintain function, motion and strength -joint aspiration or arthrotomy -IV antibiotics

Mild Acne Sx

-primarily noninflammatory lesions (comedones)

Examination of Burns

-primary survey: ABC -secondary survey: evaluation of burns and other injuries

NI Duchenne Muscular Dystrophy

-promote mobility -cardiopulmonary function: thru proper coughing technique and positioning -maximize quality of life -don't provide TOO much rest -education vs. homeschooling

NI for cerebral palsy

-promote mobility -promote nutrition

Extensive burns Tx

-promoting O2 and ventilation -restoring fluid -preventing hypothermia -cleansing burn -preventing infection -pain management -tx infected burns -burn rehab

Tx for HIV

-prophylaxis against P. jiroveci pneumonia until >1 year -antiretroviral therapy (ART) with CBC, CD4, HIV RNA levels, lipid panel -increased calorie formula, high protein meals/snacks, supplemental protein note: NO CURE; best chance of survival is thru ART--prevents progression of illness and HIV encephalopathy

coal tar preparation skin indications

-psoriasis -atopic dermatitis

How can irradiation or administration of radioactive iodine treat endocrine disorders?

-radiation causes decreased hormone secretion -ind: hyperfunction of endocrine gland note: child must be >10 years old; can cause hypothyroidism

Dx of cretinism (congenital hypothyroidism)

-radioimmunoassay: decreased T3 and T4 circulation -ultrasound, radioiodine uptake, thyroid-bound globulin -test 24-48 hours after feeding in newborns

SJS and Toxic Epidermal necrolysis and Sx

-rash like erythema multiforme with addition of inflammation bullae on at least 2 types of mucosa (lips, oral, bulbar conjunctivae, anogenital region) -mortality rate 10% -SJS --> skin detachmen </= 10% -TEN --> </=30%

Type II Allergic Reaction s/s

-rash, hives, swelling, fever, organ damage

GH replacement therapy nursing education

-report s/s of headaches, rapid weight gain, increased thirst/urination, or painful joints -monitor q3-6 months -success = adherence

complications of clubfoot

-residual deformity -rocker-bottom foot -awkward gate -weight bearing on lateral portion of foot -disturbance to epiphysis

How does the reaction of urticaria occur?

-response to antigen causes histamine release from mast cells -vasodilation and increased vascular permeability -erythema and wheals

Why would a nurse need a serum chemistry test?

-rule out chronic renal failure or other chronic illnesses -to monitor effects of Tx

NI for hydrocortisone

-same time -never abruptly stop -increase doses when ill -inject when vomiting/diarrhea -emergency kit

complications of contact dermatitis

-secondary bacterial skin infection -Lichenification or hyperpigmentation

tinea versicolor tx

-selenium sulfide shampoo all over body and overnight, rinse in morning 1x/week x 4 weeks*** -topical antifungals in imidazole family -normal skin pigmentation takes several months ***may cause irritation

Example disorders of Type III allergic reaction

-serum sickness -lupus -arthritis

Dx of acquired hypothyroidism

-serum thyroid function studies -serum thyroid antibodies to confirm autoimmune thyroiditis -MRI -thyroid uptake test

s/s of Turner syndrome

-short stature, infertility, edematous hands and feet (newborn), webbed neck -low hairline, high-arched palate, small jaw, low-set ears -droopy eyelids, short fourth toe, short fingers -broad chest, wide nipples -congenital heart defects, hearing loss, kidney issues, ophthalmic abnormalities -scoliosis/osteoporosis, learning disabilities

Duchenne musuclar dystrophy complications

-spinal curvatures-lordosis -contractures -pulmonary/urinary/systemic infection -depression -behavioral/learning disorders -aspiration pneumonia -cardiac dysrhythmias -respiratory insufficiency and failure

Tx of fracture

-splinting -casting -traction -cold therapy to reduce swelling in first 48 hours

Aggravating factors of Myasthenia Gravis that could lead to myasthenic crisis

-stress -exposure to extreme temps -infections

Late s/s of hypothyroidism

-subnormal temp -bradycardia -weight gain -decreased LOC -thickened skin -cardiac complications

What is the purpose of oral hypoglycemics?

-sulfonylureas/meglitinides/nateglinide: insulin secretion -biguanides (metformin): decrease glucose production from liver -insulin sensitizers: decrease insulin resistance -alpha-Glucosidase inhibitors: slow digestion of starch

Tx of type 1 allergic reaction

-supine -aiway support (O2 and albuterol) -Iv fluid boluses 20 mL/kg NS -GIVE EPINEPHRINE IM ASAP: epipen or drawn up from vial q5 minutes x2 IM in vastus lateralis -antihistamine

NI of congenital adrenal hyperplasia

-support -expect gender identity discussions -"your beautiful baby" instead of "your girl/boy" -counsel on hydrocortisone

Tx of erythema multiforme

-supportive, resolves itself -discontinue food/Mycoplasma if cause -treat mycoplasma -oral hydration -oral analgesics and antihistamine PRN -oral lesions debrided with hydrogen peroxide

tx for cushing syndrome

-surgery -medication: corticosteroid -radiotherapy

TX of slipped capital femoral epiphysis

-surgery -situ pinning: pin or screw into femoral head -osteotomy -enforce bed rest and activity restriction

How can we treat endocrine disorders?

-surgery (if presence of tumor/cyst) -irradiation/radioactive iodine -glucose monitoring -dietary intervention -medication note: Tx is balancing hormone production

Tx of myelomeningocele

-surgery to minimize loss of function -shunt -therapy and rehab -skin assessment -continuous monitoring for hydrocephalus or leakage -genitourinary-related: catheter, UTI tx -proper nutrition -avoid anything that puts pressure on sac -proper positioning (prone so urine/feces flow away and don't hold baby when feeding)

What is desmopressin acetate (DDAVP)?

-synthetic ADH hormone -promotes reabsorption of water -ind: control diabetes insipidus

NI for allergies

-teach use of epipen -have mergency plan in case of reaction

Physical Assessment characteristics of Juvenile Idiopathic Arthritis

-temp incr -skin for evanescent, pale red, nonpruritic macular rash -gait: limping or guarding of joint -positioning of joints -mild-moderate anemia, increase ESR -may be positive ANA or positive rhematoid factor

spina bifida occulta complications

-tethered cord -syringomyelia -diastematomyelia

Hx of burn

-time, date, cause -determine if smoke inhalation or if associated fall may have occurred -any tx provided by caretaker -determine if abuse is involved (inconsistent story or symmetrical burns)

crutch NI

-top of crutch 2-3 fingers below axillae to prevent nerve palsy

Tinea cruris Tx

-topical antifungal -cotton underwear and loose clothing -maintain good hygiene

Acne Tx

-topical creams, washes -isotretinoin (teratogenic)

Diaper candidiasis Tx

-topical nystatin with diaper changes for several days

Musculoskeletal disorder causes

-trauma or hypoxia to brain/spinal cord -genetic dysfunction -structural abnormality

Tx of insect bite

-tx of anaphylactic reaction -antihistamines and corticosteroids for pruritus, pain, edema -bacterial superinfection can be complication and result of scratching -cleanse site

Type III allergic reaction Sx

-urticaria -fever -joint pain

Assessment of acne vulgaris

-use of corticosteroids, androgens, lithium, phenytoin, isoniazid -HX of endocrine disorders (espeically hyperandrogenism) -worsening acne 2-7 days before period -note presence and distribution -nodules or cysts -hypertrophic scarring -oily skin and hair

Tinea capitis tx

-wash sheets/clothes in hot water -antifungals: fluconazole, itraconazole -oral griseofulvin 4-6 weeks -selenium sulfide shampoos dec contagiousness -no school for 1 week post Tx

s/s of Addison's disease - adrenal insufficiency?

-weakness, fatigue, hypotension, dizziness -weight loss, n/v/d/c, abd pain, salt cravings (d/t hyponatremia) -hypoglycemia, hyponatremia, hyperkalemia -hyperpigmentation, joint pain - SUGAR (glucocorticoids), SALT (mineralcorticoids), SEX (androgens) will all be decreased -if salt is decreased, potassium will be increased :)

Education for HIV

-wear gloves when in contact with body fluids -wash hands after contact with body fluids -avoid others with infection -bleach disinfectant -avoid foodborne illness (separate cutting board for meat) -no sponges -check water regularly -no natural honey

What are s/s of cushing syndrome?

-weight gain (too much aldosterone), slow lineaer growth, moon face/prominent cheeks, hirsutism, acne -deepened voice, delayed puberty, irregular menses, emotional issues -HTN, headaches, weakness, pathologic fractures, hyperglycemia (buffalo hump, poor wound healing, frequent infection) -skin thin/fragile

DM2 Tx

-weight loss -exercise -PO metformin

common medical Tx for skin issues

-wet dressing -occlusive dressings -emollient lotions and creams -therapeutic bathing

who is at risk for developmental dysplasia of the hip?

-women -oligohydramnios or breech birth -a/w lower limb deformity, metatarsus adductus, hip asymmetry, torticollis, congenital musculoskeletal deformity

Dx of developmental dysplasia of the hip

-x ray -ultrasound

Dx of scoliosis

-xray -MRI -CT

Usual urine output for child:

0.5-2 ml/kg/hr

What is the correct order of these steps in the anaphylactic response? 1. exposure to allergen 2. circulatory collapse 3. bronchoconstriction 4. rapid immune response 5. vasodilation

1, 4, 5, 3, 2

What are DM2 TX in order of prescription?

1. diet/exercise 2. oral diabetic meds (oral hypoglycemics) 3. insulin injection

How to use an epipen?

1. grip pen firmly and remove safety cap 2. swing and push pen into middle of outer thigh at 90 degree angle 3. keep pen pressed firmly against thigh for 10 seconds 4. remove pen and massage injection area AFTER USE: -ER, make sure second injection is nearby if Sx continue, antihistamine note: inject thru clothes, carry extra dose for severe reactions

What 5 physiologic processes does the endocrine system influence?

1. growth and development 2. metabolic processes 3. sexual maturation and reproduction 4. response to stress 5. maintenance of internal homeostasis

The pituitary gland and hypothalamus controls what 5 areas of the endocrine system?

1. thyroid 2. parathyroid 3. adrenal 4. gonads (ovaries and testes) 5. islets of langerhans located in pancreas

Normal Fasting glucose for DM1 pediatrics

100-125 mg/DL

Normal 2 hour post-load glucose for DM1 pediatrics

140-199 mg/dL

When must mandatory newborn screenings be collected?

24-48 hours (and IF baby has begun feeding)

When does the neural tube of the embryo begin to differentiate into the brain and spinal cord?

3-4 weeks gestation -infection, trauma, malnutrition, or teratogen exposure during this period could cause brain/spinal cord development to be altered

Magnetic resonance imaging (MRI)

3D view of body part being scanned using magnetic waves -ind: assess inflammation, congenital abnormalities, musculoskeletal diseases

When does edema subside after being burned?

48-72 hours; lymphatics reabsorb edema fluid, causing diuresis

Assessment of fracture

5 Ps -pain -pulselessness -pallor -paresthesia -paralysis

How long before Sx of anaphylaxis appear?

5-10 minutes of exposure

Normal HgA1C for DM1 peds

5.7%-7.5%

Pauciarticular JIA

<4 joints; knee usually; most common type -nonjoint Sx: eye inflamm., malaise, poor appetite, poor weight gain -SE: iritis, uveitis, uneven leg bone growth

hypothermia

<95F/35C -can be d/t loss of protective SQ fat -exposure to cold -vasoconstriction, shunting to core, coagulation -mental status changes, skin color changes, low bp, dilated pupils

Polyarticular JIA

>5 joints (think poly is many) -frequently involves small joints and affects body symmetrically -nonjoint Sx: malaise, lymphadenopathy, organomegaly, poor growth -SE: rapidly progressing joint damage; rheumatoid nodules

When should you introduce the common food allergens to children to decrease the risk of allergies?

@8 months (or in textbook 10 months) -c/i: eczema and family Hx

The nurse is assisting with skin testing for allergies in a client. What will the nurse do to ensure the results are accurate? a. be certain child has not received antihistamines in the past 8 hours b. read the test results within 40 minutes of admin c. inject the allergens into the muscle of the forearm d. apply topical diphenhydramine cream to site following each injection

A

club foot

A birth defect in which the foot is twisted out of shape or position.

Second degree Burn

A partial-thickness burn involving the epidermis and the dermis. -heals w/i 2 weeks -painful, edematous, wet appearance or blisters

IgM is responsible for

ABO blood grouping and rheumatoid factor- elevated in many infections -early stages of immunity

What is gestational diabetes?

Abnormal blood glucose maintenance during pregnancy

The RN and a UAP are caring for a ped client with an immune disorder receiving a stem cell transplant. Which action by UAP will cause the RN to intervene? a. UAP takes rectal temp b. UAP assists client to ambulate c. UAP places lunch tray in room d. UAP wears a mask when entering room

a

The nurse is caring for a child with suspected child abuse (child mistreatment)-induced burns. Which assessment findings would support this? a .burn to the entire right hand up to 2 cm above wrist with consistent edges b. consistent history given by all caregivers c. splattered-looking, small burned areas to both legs d. 911 called immediately after the burn occurred

a

The nurse is caring for a young child with HIV. Which nursing intervention is a priority for this child? a. administer prescribed medications b. assist the child with daily activities c. assess pain after invasive procedures d. review lab CD4 counts daily

a

What is growth hormone stimulation testing?

accurate test that identifies specific Dx after preliminary serum assessment to determine specific deficiency

Anaphylaxis

acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening

Erythema Multiforme

acute, self limiting hypersensitivity reaction -response to viral infection (adenovirus or Epstein-Barr virus) -mycoplasma pneumoniae infection -drug or food reaction -SJS and Toxic epidermal necrolysis are severe forms (response to Mycoplasma Pneumonia or meds)

Occurring at puberty, _____________ is marked by changes such as pubic hair developement.

adrenarche

Tinea corporis and Sx

affecting any of other parts of body (usually arms, legs) -SX: annular lesion with raised peripheral scaling and central clearing (looks like ring)

Tinea pedis and SX

affecting the feet -SX: red, scaling rash on soles and between toes

Tinea cruris and Sx

affecting the groin -SX: erythema, scaling, maceration in inguinal creases and inner thighs (penis/scrotum spared)

ataxic cerebral palsy

affects balance and depth perception

When can you expect a Sx from Type 1 Allergic Reaction?

after a few minutes, up to 2 hours after exposure

IgE

against parasitic worms and allergic reactions

folliculitis tx

aggressive hygiene: warm compresses after washing -wash several x / day -topical mupirocin -oral antibiotics

pneumothorax

air in the pleural cavity

what does ABC stand for?

airway, breathing, circulation also alone, back, crib

Diaper candidiasis and SX

aka monilial diaper rash -fiery red lesions, scaling in skin folds, and satellite lesions

Remember that children with musculoskeletal disorders are at risk for which of the following? Select all that apply a. dehydration b. impaired skin integrity c. constipation d. nutritional imbalance e. deficiency in self-care

all of the answers

Medications that affect thyroid function/tests

amiodarone, aspirin, diazepam, estrogen, furosemide, flucocorticoids, lithium, phenytoin, anticonvulsants, propranolol

corticosteroids

anti-inflammatory and immunosuppressive action

Humoral Immunity

antibodies produced by native B-cell lymphocytes

Cellular Immunity

antibodies produced by native T-cell lymphocytes

Passive immunity

antibodies received from an external source (mother to baby, IVIG)

Type III Allergic Reaction (Immune complex mediated)

antibody bound with antigen floating in blood (soluble) -immune complexes attach and stimulate generalized inflammation

benzodiazepines

anticonvulsant, relief of muscle spasm -diazepam or lorazepam -also treats anxiety short term

cold therapy

application of ice or cold compress -ind: acute injuries; vasoconstriction d/t cold causes dec in pain and swelling

Casting

application of plaster or fiberglass material to form rigid apparatus to immobilize a body part -ind: fracture reduction, dislocations, correction of deformity

Systemic Lupus Erythematosus (SLE) patho

autoantibodies react with self-antigens forming immune complexes -immune complexes inc in tissues/organs causing inflamm response -inflammatory response causes vasculitis which causes injury/pain -autoimmune response preceded by drug reaction, infection, excessive sun exposure

What causes acquired hypothyroidism?

autoimmune chronic lymphocytic (hashimoto) thyroiditis -antibodies develop against the thyroid gland, causing the gland to become inflamed, infiltrated, destroyed -pituitary/hypothalamic disease, exposure to antithyroid meds, anticonvulsants, lithium, amiodarone, radiation, thyroidectomy, hemangiomas, iodine deficiency/excess

What is graves disease?

autoimmune disorder that causes excessive amounts of thyroid hormone to be released in response to human thyroid stimulator immunoglobulin (TSI) -more likely in girls

Juvenile Idiopathic Arthritis (JIA)

autoimmune disorder: autoantibodies target joints -cause inflammatory response -healthy periods vs. flare-ups

Wiskott-Aldrich syndrome complications

autoimmune hemolytic anemia, neutropenia, skin or cerebral vasculitis, arthritis, inflammatory bowel disease, renal disease

serum free T4 lab value

confirms abnormal TSH, metabolic status

What two endocrine disorders can cause adrenal crisis?

congenital adrenal hyperplasia and Addisons

_______________ _________________ is a hereditary pattern of late onset puberty.

constitutional delay

What is the cause of delayed puberty

constitutional delay OR hypogonadism -also irradiation, infection, trauma, or genetic syndromes like Turner or Klinefelter

ossification

conversion of cartilage to bone

What are corticosteroids and mineralcorticosteroids?

cortisol replacement; promotes reabsorption of Na/K -ind: congenital adrenal hyperplasia, absence of adrenal glands, epiphyseal plate closure in hyperpituitarism, adrenal insufficiency

fissure

crack or split

Type II diabetes is associated with what endocrine disorder?

cushing syndrome

A nurse is reviewing with an 8 year old how to self-administer insulin. Which of the following is proper injection technique for insulin injections? a. place needle with bevel facing down b. spread skin c. aspirate syringe for blood return d. elevate the Subcutaneous tissue before injection

d

People with HIV, AIDS, or are immunocompromised are now susceptible to a. opportunistic infections b. flu c. covid d. all of the above

d

The nurse is assessing a child who presents with patches of scaling on the scalp and central hair loss. What fungal rash does this condition signify? a. tinea cruris b. tinea versicolor c. tinea corporis d. tinea capitis

d

The nurse is educating a child with a peanut allergy about the signs and symptoms of an anaphylactic reaction. The nurse realizes additional teaching is needed when the child identifies with s/s? a. nausea b. anxiety c. itchy mouth d. constipation

d

The nurse knows that which condition is caused by excessive levels of circulating cortisol? a. addisons b. graves c. turner d. cushing

d

A child is admitted to medical unit for diagnosis of SIADH. Child experiences typical s/s of this disorder. Which concern will the nurse include in care planning? a. delayed growth and development risk b. altered nutrition risk c. noncompliance because of difficulty coping d. excess fluid volume risk

d remember ABC (c is for circulation :)

What causes Addison's disease - adrenal deficiency?

damage/destruction of adrenal glands caused by infections, HIV-related infections, hemorrhage, surgical removal of both glands, dysfunction of hypothalamus/pituitary

hypo/hyperpigmentation

dark or light spots after acne (or skin condition) has resolved

hypogonadism

decrease/lack of hormones from the gonads d/t dysfunction or tumor in hypothalamus/pituitary -causes a decrease in testosterone or estradiol

When burned, a pt will initially experience a ___________ in cardiac output. A __________________ response causes cardiac out to ______________, causing the pt to be at risk for _______________ resistance and increased _____________ catabolism. Also, the pt will experience _______________ levels of Hematocrit and WBC.

decrease; hypermetabolic; increase; insulin; protein; increased

A high urine specific gravity indicates _______________ and a low urine specific gravity indicates __________________.

dehydration; dilution ex: SIADH has a high urine specific gravity because retention of water = retention of electrolytes and waste ex: DI has a low urine specific gravity because constant urination = low levels of electrolytes and waste in bladder

s/s of diabetes

depends on level of hyper/hypo -3 Ps (polyuria, polydipsia, polyphagia) -weakness, fatigue, paresthesias, slow healing wounds -long-term s/s: nephropathy, neuropathy, retinopathy, CV compromise

How to estimated severity of a burn?

depth, BSA (body surface area) affected, body part affected

Type 1 Diabetes

destruction of beta cells and no insulin secretion -viral, genetic, immunologic -rapid onset -supplemental insulin -poor diabetic control can cause DKA

virologic assay

detects HIV RNA/DNA

food-specific igE antibody testing

determines food allergies

erythrocyte sedimentation rate (ESR)

determines presence of infection or inflammation

What is the cardinal symptom of graves disease?

development of a goiter d/t increased size of thyroid

Myelinization

development stages: myelin gradually cover individual axons and electrically insulate them from one another to improve the conductivity of the nerve -complete @ 2 years -head and neck control before extremities and trunk -as myelinization proceeds, speed and accuracy of nerve impulses increase

Graft vs. Host Disease and Sx

donor cells attack host cells -Sx: maculopapular rash on palms and soles; abd cramps; N/V/D, jaundice

crust

dried serum or exudate on skin

water intoxication s/s

drowsiness, listlessness, headache, confusion, sudden weight gain, anuria

Protease inhibitor

drug that treats AIDS by blocking the production of protease, a proteolytic enzyme that helps create new viral pieces for HIV -amprenavir, ritonavir, saquinavir

scaling plaques

dry, flaky skin

What factors are allergic reactions dependent on?

duration, rate, and amount of exposure

Oral challenge

eat the food over 1 hours, record VS and note presence/absence of allergic Sx

wheal

edematous, transitory, plaque, may last few hours

acromegaly

enlargement of the extremities r/t too much growth hormone

Glycosuria occurs when the amount of glucose in the blood _________ the renal threshold.

exceeds

What is the cause of cushings syndrome?

excessive glucocorticoid administration

IV immunoglobulins

exogenous or synthetic IgG antibodies -ind: primary immune deficiencies, HIV, myasthenia gravis -NI: don't mix with other IV meds, don't give IM or SQ, watch for adverse reactions, admin antipyretic or antihistamine, epinephrine ready for emergencies

plasmapheresis

extracorporeal (outside body) removal/return/exchange of blood or components

T or F: Height and weight below the 25th percentile or above the 75th percentile is a key physical assessment finding related to endocrine probems.

false

Slipped Capital Femoral Epiphysis

femoral head dislocates from neck and shaft of the femur at the epiphyseal plate leve -chronic SCFE causes shortness of leg and thigh atrophy

what is the function of the spleen?

filter blood and help fight infections

IgM

first antibody produced

Hormone control is developed during the _____________________ trimester of gestation but takes _____________ to become fully developed.

first; years

pes planus

flat foot -arch develops over time

macule

flat, colored spot on the skin <1cm

What is Tx of SIADH?

fluid restriction, IV NaCL to correct hyponatremia

What is a wood lamp used for?

fluoresce yellow-green if Microsporum fungus is involved -ind: tinea capitis

what supplement helps prevent neural tube defects?

folic acid

leading cause of anaphylaxis

food allergies, bee/wasp stings, penicillin, NSAIDs, radiopaque dyes and latex

common causes of urticaria

foods, drugs, animal stings, infections, environmental stimuli, stress

traumatic force to the epiphysis causes ______________

fracture

dysfunctional immunity causes an increase in _______________ and ________________ of infection

frequency; severity

Tinea is what kind of infection?

fungal

Tinea versicolor and Sx

fungus affecting trunk and extremities -SX: superficial tan or hypopigmented oval scaly lesions -more noticeable in summer with tanning of unaffected areas

Spinal Muscular Atrophy

genetic motor neuron inability to communicate with muscles -cause muscles to lose function over time -including respiratory and cardiac muscles -type 1: ventilator dependent -type 2: paradoxical breathing (without intercostal muscle support)

Marfan syndrome

genetic syndrome (autosomal dominant) affecting connective tissue

The endocrine system is composed of ________________, ______________, or clusters of _______________ that produce and release hormones in a negative feedback system involving the _____________ and ________________ system

glands; tissues; cells; hypothalamus; nervous

What do you give for severe hypoglycemia?

glucagon

Children are at a ___________ risk for carbon monoxide poisoning than adults

greater

Cerebral palsy is nonprogressive but the clinical manifestations change d/t child _________________

growth -some improve, some plateau, some worsen

torticollis

head tilt due to shortening or spasm of one sternomastoid muscle

What is the cause of central diabetes insipidus?

head trauma, cranial surgery to remove hypothalamic-pituitary tumors (craniopharyngioma) -other: genetic mutation, granulomatous disease, infections, vascular anomalies, congenital malformations, infiltrative disease (leukemia), drugs that inhibit vasopressin (phenytoin)

In cases of trauma or suspected trauma, do not perform any assessment that involves movement of the ____________ and ____________ until _____________ injury is ruled out

head; neck; cervical

SE of oral hypoglycemics

headache, dizziness, flatulence, GI distress, edema, liver enzyme elevation

What can thyroid storm lead to if left untreated?

heart failure and shock

Third Degree frostbite Sx

hemorrhagic blisters

What are influencing factors for autoimmune disease?

heredity, hormones, self-marker molecules, environmental influences (viruses and drugs)

myelomeningocele

hernia of the spinal cord and meninges

how is HIV transmitted

horizontal and vertical

what is supplemental hormone therapy?

hormone replacement -levothyroxine: thyroid hormone replacement for hypothyroidism -GH: used for GH deficiency; stimulates linear bone, skeletal muscle, and organ growth

What main electrolyte event occurs with hyperparathyroidism?

hypercalcemia (if PTH is high, then calcium secretion will be high)

If fluid regimen for DI is not properly followed, what could happen?

hypernatremia and then seizures

What main electrolyte event occurs with hypoparathyroidism?

hypocalcemia (regulates calcium secretion, if PTH is low, calcium secretion will be low as well)

What is Type 1 Allergic Reaction?

immediate, anaphylactic, IgE mast cells release histamine -requires previous exposure to allergen to prime immune system

In cases of trauma, maintain complete _______________ of the ___________ spine until ____________ injury is ruled out

immobilization; cervical; cervical

Hypothyrodisim

inadequate secretion of thyroid hormones -congenital or acquired -certain populations at risk (Downs, maternal hypothyroidism) -decreased thyroid hormones -decreased T3, T4, T3 resin uptake -TSH usually elevated -lifelong thyroid supplementation

what is immunodeficiency?

incapacity to mount an appropriate immune response

biphosphonate

increase bone mineral density, decrease incidence of fractures in moderate/severe osteogenesis imperfecta

spasticity

increased muscle tone

why should you discourage use of baby powder?

increased risk of aspiration

What is the cause of SIADH?

infection (meningitis), head trauma, brain tumors, intracranial surgery, analgesics, barbiturates, chemo, excess admin of ADH during DI Tx

osteomylitis and Sx

infection of bone, often in bloodstream -SX: pain, swelling, dec mobility, redness, limp, rapid onset

Staphylococcal scalded skin syndrome and SX

infection where S. aureus --> exfoliation SX: abrupt onset, diffuse erythema, skin tenderness, flat bullae that rupture w/i hours, red/weeping surface on face/groin/neck/axillary -rare, usually <5 years

folliculitis and Sx

inflammation of the hair follicles -d/t occlusion of follicle, poor hygiene, prolonged contact with contaminated water, excess moisture, incorrect hair products Sx: red, raised hair follicles

toxic synovitis

inflammatory condition characterized by a painful hip joint accompanied by an antalgic gait and limp.

Muscular dystrophy

inherited conditions causing progressive muscle weakness and wasting -absence/decrease of specific muscle protein -skeletal muscle fibers affected, no structural abnormalities in spinal cord or nerves

What is Phenylketonuria (PKU)?

inherited error in metabolism; the body cannot convert phenylalanine (common protein amino acid) to energy, causing toxic levels of phenylalanine to build up

What is the primary cause of growth hormone deficiency?

injury/destruction of anterior pituitary or hypothalamus -idiopathic: altered carbs, proteins, fat metabolism, hypoglycemia, glucose intolerance, diabetes, slipped capital femoral epiphysis, pseudotumor cerebri, leukemia, recurrence of CNS tumors -tumors, infection, infarction, CNS irradiation, abnormal formation in utero, damage during/after birth -genes: Prader-Willi, Turner, genetic mutation/deletion

Pancreas secretes what two things and what are their functions?

insulin: helps metabolize sugar glucagon: stimulates liver to release stored glucose

cytotoxic medications

interferes with normal function of DNA by alkylation -cyclophosphamide -ind: severe SLE -NI: cause bone marrow suppression, monitor for infection

pruritus

itching

complications of Legg-Calve-Perthes Disease

joint deformity, early degenerative joint disease, persistent pain, loss of motion or function, gait disturbance

Systemic JIA

joint involvement and fever/rash -nonjoint Sx: enlarged spleen, liver, lymph nodes, myalgia, severe anemia -SE: pericarditis, pericardial effusion, pleuritis, pulmonary fibrosis

genu valgum

knock knees

ataxia

lack of coordination of muscle movements

Severe acne Sx

lesions similar to moderate acne but more widespread, and/or presence of cysts or nodules. A/w scarring

what is immunoglobulin electrophoresis?

levels of immunoglobulins -ind: immune deficiency or autoimmune disorders

Tx of cretinism

levothyroxine (thyroid replacement) -thyroid function tests q 2 weeks -best Tx before 3 months

Tx of acquired hypothyroidism

levothyroxine: maintains T4 and suppresses TSH

Hormone supplementation is a _________ requirement for TX of many of the endocrine disorders.

lifelong

excoriation

linear erosion

cellulitis and Sx

localized infection and inflammation of skin and SQ tissue, preceded by skin trauma -periorbital: eyelids and tissue around eye -blood cultures indicated SX: redness, swelling, infiltration

spina bifida occulta Sx

location: lumbosacral area -dimpling -abnormal patches of hair -discoloration of skin

erosion

loss of epidermis superficial; part or all of epidermis has been lost

Osteogenesis imperfecta

low bone mass, increased fragility of bones, and other connective tissue problems such as joint hypermobility (causing instability of joints) -increased fracture occurrence -defect of collagen type 1 gene

What functions do newborns possess in regards to cellular immunity?

lymph system passively filters plasma for bacteria/foreign material before returning it to the blood stream and heart -WBC cause lymph nodes to swell and attack foreign substances nuhynb

morbilliform

maculopapular lesions that becomes confluent on the face and body.

Newborns receive passive immunity from where?

maternal antibodies via placenta and breastfeeding

What is lymphocyte immunophenotyping T-cell quantification?

measures levels of T cells, B cells, natural killer cells in blood -ind: for immune disorders

delayed hypersensitivity skin test:

measures presence of activated t cells that recognize certain substances -for immune disorders

nerve conduction velocity

measures speed of nerve conduction. electrodes attached to skin @ nerve locations -ind: differentiation of muscular disorders

what is IgG subclasses test?

measures subclasses of IgG -determines immune deficiency level

What is meningocele?

meninges herniate through a defect in the vertebrae -less serious form of spina bifida

Hormones, also referred to as chemical ______________, help maintain internal homeostasis.

messengers

metatarsus adductus

middle bones of the foot pointing in toward the body -d/t utero positioning -if forefoot is flexible past neutral manipulation, it's ok -if forefoot is flexible only to neutral manipulation, sttretching may be beneficial -if forefoot is rigid and not flexible to neutral manipulation, serial casting may be required

skeletal or cervical traction indications

minimize trauma to spinal cord, fracture reduction, dislocations, correction of deformities

topical immune modulators skin indication

moderate to severe atopic dermatitis

TSH level test

monitor for need of thyroid replacement therapy

What is chemotaxis?

movement of neutrophils to microorganisms -immature at birth

IgA

mucosal immunity

Arthrography

multiple x-ray images of joint after injection with radiopaque substance -ind: assess ligaments, muscles, tendons, cartilage after injury

baclofen

muscle relaxant

s/s of thyrotoxicosis

muscle weakness, diaphoresis, tachycardia, tremor, palpitations, diarrhea, irritability, nervousness, anxiety

What is immunity

natural/induced resistance to infection

What is a patch or skin allergy test?

needle prick testing with allergens -ind: atopic or contact dermatitis

Botulin toxin

neurotoxin to block neuromuscular conduction -ind: cerebral palsy, torticollis

frank dislocation

no contact between the femoral head and acetabulum

computed tomography (CT)

noninvasive x-ray; looks at tissue density and structures -ind: congenital abnormalities, neural tube defects, fractures, demyelinization, inflammation, extent of Legg-Calve-Perthes disease, slipped capital femoral epiphysis

Closed reduction

nonsurgical realignment of broken bone ends and splinting of bone -spica cast worn for 12 weeks -after cast, abduction brace full time until acetabulum is normal

CD4 count:

number of CD4 (helper T) in blood -ind: determine antiretroviral therapy response to HIV

neurogenic clubfoot

occurs in infants with myelomeningocele

Slipped capital femoral epiphysis

occurs when the head of the femur becomes displaced due to a separation at the growth plate

postural clubfoot

often resolves with a short series of manipulative casting

Tx of Addison's disease - Adrenal insufficiency

oral glucocorticoids and fludrocortisone acetate

kyphosis

outward curvature

hyperthyrodisim

oversecretion of thyroid hormones -mostly seen as graves disease -excessive T3, T4, and T3 resin uptake -TSH usually low -treated by destruction of thyroid gland

subluxation

partial dislocation -acetabulum is not fully seated within the hip joint

Tx of torticollis

passive stretching exercises -PT and tubular orthosis collar

Tinea capitis

patches of scaling in scalp/eyebrows/eyelashes with central hair loss -risk of kerion development (inflamed, boggy mass filled with pustules) -hair grows back 3-12 months

vertical transmission

perinatal or breast milk transmission

erythematous

pertaining to redness of the skin

What is phagocytosis?

phagocytes break down microorganisms

external fixation

pins or wires inserted into bone and then attached to external frame -ind: complicated fractures, open fractures with soft tissue damage

What is cushing's disease?

pituitary tumor secretes excessive ACTH; in infants, adrenocorticol tumor

3 P's of Diabetes

polyuria, polydipsia, polyphagia

S/s DM1

polyuria, polydipsia, polyphagia, weight loss, metabolic acidosis

rheumatoid factor

presence of RF in blood -ind: juvenile idiopathic arthritis, SLE

antinuclear antibody (ANA)

presence of autoantibodies that react against nuclear material -ind: SLE

Polydactyly

presence of extra digits on hand or foot or both

genetic testing

present of gene for disease or carrier status -ind: muscular disorder

Cellular immunity is ________________ at birth and is used until _________________ immunity develops

present; humoral

Immune structures are __________________ at birth but are __________________.

present; immature

Thyroid Gland

produces hormones that regulate metabolism, body heat, and bone growth -Thyroxine (T4): metabolism -Triiodothyronine (T3): metabolism -Calcitonin: reduces plasma levels of Ca *TSH controls T3 and T4 function if levels are low

Emergent complications of anaphylaxis

pulmonary collapse, bronchospasm, syncope, death

radioallergosorbent test (RAST)

quantity of IgE in blood -ind: asthma and food allergies

Fluoroscopy

radiographic examination that uses continuous x-rays to show live, real-time images -ind: assessment of cervical spine instability during movement

Radiographs (x-rays)

radiographic image; 2 views -ind: detect fractures and other anomalies

What are the four insulin types?

rapid, short, intermediate, long

clonus

rapidly alternating involuntary contraction and relaxation of a muscle in response to sudden stretch -may be present in children with cerebral palsy after forced dorsiflexion

electromyography

recording electrode in muscle and electrical activity is recorded -ind: determines type of muscular disorder (neuro in origin)

creatine kinase

reflects muscle damage: leaks from muscle into plasma as muscles deteriorate -ind: Dx of muscular dystrophy, spinal muscular atrophy

muscle biopsy

removal of piece of tissue by needle or open biopsy -ind: Dx type of muscular dystrophy or spinal muscular atrophy

Tx of urticaria

remove cause and provide antihistamines or corticosteroids -topical antipruritics as prescribed -should resolve w/i few days -if >6 weeks, go to hospital -medical alert bracelet if reaction is severe

IgG is responsible for

resistance against many viruses, bacteria, and bacterial toxins

Acne Neonatorum

response to presence of maternal androgens or to transient androgen production in newborn -immediately after birth or btwn 2-4 weeks

RICE

rest, ice (20-30 minutes) compression, elevation

Surgical reduction

restoration to a normal position or level through surgical excision

What is a potassium hydroxide prep

reveals branching hyphae (fungus) when viewed under microscope -ind: identify fungal infection

annular

ring-shaped

NI for proper site selection for injections

rotate sites

Duchenne muscular dystrophy

shortened life expectancy -absence of dystrophin (maintenance of muscle cells) -mainly boys, women carriers

contracture

shortening and hardening of muscles, tendons, or tissues leading to fixated and stiff joints

MRSA and SX

skin/soft tissue infection (cellulitis or abscess) -risk factors: turf burns, towel sharing, participation in team sports, attendance @ daycare or outdoor camps -cultured SX: pus formation, fever, swelling, tenderness around area of infection

disease-modifying antirheumatic drugs (DMARDs)

slow progression of joint destruction in arthritis by inhibiting a substance that triggers inflammation

papule

small, solid skin elevation <0.5 cm

rickets

softening or weakening of bones

B cells make antibodies and these antibodies bind to antigens to eliminate toxins. This is all part of what type of immunity?

specific/humoral

bone marrow or stem cell transplantation

stem cells from donor or healthy bone marrow to recipient -ind: Wiskott-Aldrich syndrome, SCID -NI: medical asepsis, protective isolation, monitor for graft vs. host disease, oral care, avoid rectal temp/suppositories

Graft vs. Host Disease Tx

steroids (prednisone)

What are people with Addison's disease deficient of that causes them to not be able to handle stress?

steroids: mineralcorticoids (aldosterone) and glucocorticoids (cortisone)

what is the responsibility of Growth hormones?

stimulate linear growth, bone mineral density, and growth in all body tissues

What factors increase risk of developing diabetic ketoacidosis?

stress, sick, surgery *decreased insulin sensitivity, increase glucose production

intrathecal space

subarachnoid space -area between spinal cord and thin membranes that surround it

plaque

superficial elevated solid flat topped lesion >1 cm

First degree Frost BIte s/s

superficial white plaques with surrounding erythema

what is hormone suppression therapy?

suppresses hormone release -methimazole: suppresses GH release and is an antithyroid drug -ind: acromegaly, hyperthyroidism

tx for cushing disease

surgery, irradiation

tenotomy

surgical incision to release the achilles tendon, fixing club foot

fixation

surgical reduction of fracture or skeletal deformity with internal/external pin or device -ind: fractures, skeletal deformities

What is a thyroidectomy?

surgical removal of portions of the thyroid gland -a/w removal/devascularization of the parathyroid gland tissue -parathyroid gland is responsible for calcium secretion/inhibition

To palpate the thyroid on physical exams, ask pt to do what?

swallow (thyroid moves upwards when swallowing) -place hands on pt's lower neck -palpate for size, shape, symmetry, swelling, consistency, and presence of tenderness

What is the difference between Cushing's syndrome and Cushing's disease?

syndrome: d/t excess cortisol (glucocorticoids) disease: tumor secretes excess Adrenocorticotropic hormone

Splinting

temporary stiff support of injured area -ind: temporary fracture reduction, sprain

spina bifida definition

term referring to all neural tube disorders that affect the spinal cord

How are babies tested for PKU?

tested within the mandatory newborn screening: between 24-48 hours after beginning feedings retest in 7-10 days to catch earlier false negatives

muscle tone

the state of balanced muscle tension that makes normal posture, coordination, and movement possible

Burn types

thermal, chemical, electrical, radioactive

lichenification

thickening of the epidermis seen with exaggeration of normal skin lines

Torticollis and Sx

tightness of sternocleidomastoid muscle -infant's head tilted to one side while supine -d/t utero positioning or difficult birth -can cause plagiocephaly

Type II Allergic Reaction (Cytotoxic)

tissue specific immune response -antigens bind to host cells -destruction of cells or interruption of function (15-30 minutes)

Tinea corporis Tx

topical antifungal cream for at least 4 weeks

Tinea pedis TX

topical antifungal cream, powder spray -appropriate foot hygiene: clean and dry, rinse with water or water-vinegar -cotton socks and breathable shoes

complement assay

total complement levels and C3/C4 in blood -ind: monitor SLE and complement deficiency

How is IgG acquired?

transplacentally

T or F: Hemoglobin A1c monitors long-term control of blood sugars and diabetes

true

T or F: In precocious puberty, the child develops sexual characteristics before the usual age of pubertal onset.

true

T or F: Toddlers with diabetes are at an increased risk for hypoglycemia due to the increased change of inconsistent food intake.

true

what is the difference between Turner and Klinefelter syndrome?

turner is missing some/all of one X chromosome (girls) Klinefelter is extra X chromosome (boys)

Stocking or glove burns

uniform distribution of burns to child's extremities -caretaker punishment by dipping extremities under hot water

Erythema Multiforme SX

-HX of fever, malaise, achiness -onset and progression of rash, presence of pruritus and burning -VS (especially temp) altered -lesions on hands, feet, extensor parts of extremities w/ spread to trunk -erythematous macules to papules, plaques, vesicles, and target lesions (aka multiforms of disease)

Assessment for Wiskott-Aldrich Syndrome

-Hx of petechiae -bloody diarrhea or bleeding in first 6 months of life -Hx of hematemesis or intracranial or conjunctival hemorrhage -eczema (worsens over time and becomes secondarily infected) -low IgM, inc IgA/IgE, and normal IgG

How is precocious puberty Dx?

-Hx/physical -advanced bone age -increased size of uterus -development of ovaries -presence of LH, FSH, estradiol, testosterone -GnRH stimulation

NI for SIADH

-I/O, daily weights -frequent neuro checks: confusion or seizures -institute safety precautions if decreased LOC -indwelling urinary catheter may be incorporated for proper I/O records

NI/Tx for Klinefelter syndrome

-IM testosterone replacement @ 11-12 years

Tx of adrenal crisis

-IV steroids (hydrocortisone) -aggressive fluid restriction -5% dextrose with NS (D5NS)

tx severe combined immunodeficiency disease

-IVIG: passive antibodies and stem cells -stem cell transplant -gene therapy -special immunizations -prophylactic antibiotics

How does anaphylaxis occur?

-IgE-mediated response -histamines and secondary mediators are released from mast cells and eosinophils in response to contact with allergen -vasodilation results in rapid decrease in plasma volume

s/s of adrenal crisis

-Myalgia, malaise, emesis, fever, hypotension -Progresses to shock, coma

Tx of juvenile idiopathic arthritis

-NSAIDS (first line) -antirheumatic drugs (disease modifying) -corticosteroids -biologic response modifiers -frequent eye exams

Tx/NI of cerebral palsy

-PT,OT,ST -splinting, casting -baclofen, dantrolene sodium, diazepam -anticholinergics: decrease abnormal movement (scopolamine or glycopyrrolate) -botulinum toxin -Phenol block -rhizotomy: removing nerve that sends pain to brain

Sx of SLE

-RESP: pleurisy -CV: Raynaud phenomena, thrombocytopenia -CUTANEOUS: alopecia, weight change, painless ulcers in oral cavity, stomatitis, malar skin rash (butterfly) -GI: anemia, lupus nephritis, tender abd -MSK: arthralgia, arthritis -NEURO: fatigue, photosensitivity, fever, seizure, numbness

NI for SLE

-SPF 15 MINIMUM (prevent rashes d/t photosensitivity) -protect against cold weather (multiple layers) -if prolonged cold exposure, check extremities for discoloration -monitor nephritis: BP, serum BUN, creatinine, urine output, hematuria, proteinuria

myelomeningocele Dx

-US (obvious in utero) -x-ray -CT -myelography

Prevention of DKA

-admin insulin more frequently when sick -check levels closely with n/v, fever, abd pain -ensure insulin pump is working

Dx of Type 1 Allergies

-allergy skin-prink tests and radioallergosorbent blood tests (RASTs) -food-specific IgE testing -if episodic Sx, oral challenge

What are complications of GH deficiency and therapy?

-altered carbs, protein, and fat metabolism -hypoglycemia, glucose intolerance, diabetes -slipped capital femoral epiphysis -pseudotumor cerebri -leukemia -recurrence of CNS tumors -infection at injection site -edema and sodium retention

s/s of congenital adrenal hyperplasia

-ambiguous genitalia (newborn girls) -precocious puberty -tall stature but premature growth plate closure

Dx of turner syndrome

-amniocentesis -chorionic villi sampling -karyotype

Klinefelter syndrome s/s

-androgen deficiency, infertility -tall, small firm testes, less facial and body hair, gynecomastia -female-type pubic hair pattern -delayed milestones, low verbal IQ, reading difficulty *think: extra X --> more woman-like

Pain TX with burns

-anesthesia -sedatives (midazolam) -NSAID -acetaminophen

s/s of diabetic ketoacidosis

-anorexia, n/v, air hunger, abd pain -lethargy, stupor, altered LOC, confusion -fruity/acetone breath, Kussmaul respirations, ketones in urine/blood -tachycardia, coma, decreased skin turgor, death -polyuria, polydipsia, polyphagia

common medications for skin conditions

-antibiotics (topical, systemic) -corticosteroids (topical) -antifungals (topical, systemic) -topical immune modulators -antihistamines -isotretinoin -coal tar preparations -silver sulfadiazine 1%

Tx of Myasthenia Gravis and Myasthenic Crisis

-anticholinersterase meds (pyridostigmine): blocks breakdown of Ach -corticosteroid -immunosuppressants -plasmapheresis -IVIG -thymectomy

cause of contact dermatitis

-antigenic substance exposure -allergy to nickel or cobalt in clothing, hardware, dyes -exposure to highly allergenic plants: poison ivy, oak, sumac

Type IV Allergic Reaction (cell mediated delayed reaction)

-appears 24-72 hours after exposure -T-lymphocytes release lymphokines -phagocytize target OR create granuloma around it

NI for developmental dysplasia of the hip

-assess skin integrity -creative positioning for feeding -don't adjust straps without checking with provider -change diaper while in harness -ABC of sleeping -long knee socks and undershirt recommended -wash harness with detergent

what are hypoglycemics?

-assist body's production of insulin by stimulating B cells to secrete more insulin -ind: DM type 2 -oral and injectable

Sx of HIV

-asymptomatic at first -frequent infections, prolonged candidiasis -decreased appetite -hepatosplenomegaly, lymphadenopathy -failure to thrive -chronic or recurrent diarrhea -recurrent or persistent fever -developmental delay

corticosteroid skin indications

-atopic dermatitis -contact dermatitis

examples of Type II allergic reaction

-autoimmune hemolytic anemia -myasthenia gravis -graves' disease

NI acne vulgaris

-avoid oil-based cosmetics and hair products -cosmetic products "noncomedogenic" -headbands, helmets, hats exacerbate lesions d/t friction -dryness and peeling a/w Tx -humectant moisturizer -mild cleansing with soap and water BID -avoid excessive scrubbing and harsh chemical or alcohol based cleansers -no picking -spf 30 +

Acne Neonatorum Tx/NI

-avoid picking, squeezing --> secondary bacterial infection and cellulitis -wash affected areas daily with clear water -avoid fragrant soaps or lotions -hormones will stabilize over time

When to call the provider for a baby with a pavlik harness?

-baby's feet are swollen or blue -harness appears too small -skin is raw or rash develops -baby is unstable to actively kick legs

Risk factors for tinea

-barber -damp areas of body -Hx of tight clothes -contact sports -nonbreathable clothing

DM1 NI/Tx

-basal-bolus insulin once per day of long acting -several boluses of rapid-acting with each meal and snack -test BG before meals, once/week at 0000 and 0300 -count carbs and give insulin with correction factor -difficult to control BG in children -targer HbA1c 7.5% -monitor electrolytes, ABG -rotate sites

what causes precocious puberty?

-benign hypothalamic tumor -brain injury -radiation -Hx of infectious encephalitis, meningitis -congenital adrenal hyperplasia, tumors of ovary/adrenal gland/pituitary gland/testes

Medications for musculoskeletal disorders

-benzodiazepines -baclofen -corticosteroids -botulin toxin -acetaminophen -narcotics -NSAIDs -biphosphonate

Dx/Labs for GH deficiency

-bone age determination: >2 standard deviations below norm -growth hormone testing -CT,MRI to rule out tumors or structural abnormalities -pituitary function testing note: usually before the age of 4 years old

Scoliosis Tx

-braces -neurovascular checks -I/O -pain control -twist/bend motions restricted -surgical repair -exercise -spinal fusion

tx of tibia vara

-bracing: modified knee-ankle foot orthosis -compliance -surgery

antifungal skin indications

-candidal diaper rash -tinea

Marfan syndrome sx

-cardiac issues -pectus excavatum -long arms and digits -scliosis -elongated head -high arched palate

common tx for musculoskeletal disorders

-casting -splinting fixation -cold therapy -crutches -traction -therapies (PT/OT/ST) -orthotic and braces -post-op ortho surgery -external fixation devices

Hx of neurologic disorder

-changes in gait, clumsiness -activity level compared to peers -recent trauma -poor feeding -lethargy -fever -alteration in muscle tone -Hx of developmental milestones

NI for neurogenic bladder

-clean catheter -meds: oxybutynin chloride to improve bladder capacity -monitor for infection -surgery: vesicostomy

Acne Vulgaris Tx

-cleanse skin BID -benzoyl peroxide -salicylic acid -retinoids -topical or oral antibiotics -isotretinoin (teratogenic) -Diode laser or blue UV light therapy -CO2 lasers and dermabrasian to Tx scarring

MRSA Tx

-clindamycin -vancomycin -linezolid -daptomycin (skin only, not pneumonia) -isolation precautions

Before cast or splint application, what baseline neurovascular assessments should be performed? Why do you perform them?

-color -movement -sensation -edema -quality of pulses Comparing baseline to postimmobilization is important to ensure no loss of function has occurred during the procedure

Cause of cerebral palsy

-congenital malformation, hypoxia, maternal fever, maternal seizures, maternal bleeding, exposure to radiation, metabolic disorders -asphyxia, hypoxia, abnormal fetal presentation, sepsis, hemorrhage, chorioamnionitis -Kernicterus, asphyxia, head trauma, seizures, toxins, cerebral infarcts

Sunburn tx

-cool compress -cooling lotion -oral nonsteroidal anti-inflammatory agents

Minor burns Tx

-cool water/compress (no ice) -clean, dry, apply ointment (keep in fridge) -monitor for infection -ibuprofen for pain (10 mg/kg) -soak dressings if stick to wound -blisters

Acne caused by

-corticosteroids -androgens -phenytoin

Common food allergies in children <1 year

-cow's milk -eggs -peanuts -tree nuts -fish and shellfish -wheat -soy

Diabetes Mellitus is secondary to what conditions?

-cystic fibrosis -glucocorticoid use (Cushing syndrome) -Down syndrome -Klinefelter syndrome -Turner syndrome

isotretinoin skin indications

-cystic or severe acne

What can occur with prolonged exposure to high levels of blood glucose?

-damage to vessels and nerves -failure to grow -delayed sexual maturation -poor wound healing, recurrent infection -retinopathy, neuropathy, nephropathy -CVD, PVD

Newborn immune characteristics:

-decreased inflammatory and phagocytic responses to organisms -increased susceptibility to infection -functional spleen -generally functional cellular immunity -humoral immunity develops over time -young children have larger lymph nodes, tonsils, and thymus

What is DX of SIADH?

-decreased serum sodium and osmolality -increased sodium -urine specific gravity >1.030 *adrenal, thyroid, and renal function should be evaluated to rule out other causes of decreased sodium

pathologic drooling complications

-dehydration -dental enamel erosion -maceration of skin -odor -social stigmatization

Interventions to maximize physical mobility

-determine baseline ROM -pain relief prior to activity -encourage motor development -PT/OT/ST -passive AND active ROM exercises to prevent contractures -praise -education for home

Promoting adequate nutrition for musculoskeletal disorder -interventions

-determine heighxweight vs. intake -monitor hydration status -child may require modified feeding techniques (soft foods, modified utensils, extra time) -assess for aspiration

What is the purpose of bone age radiographs?

-determines a child's potential based on density and tissue -If bone age is consistent with chronological age, we can rule out GH deficiency or hypothryoidism

Overuse syndrome

-disorders result from repeated force applied to normal tissue -tissue breakdown -pain -ice -NSAIDs -heel cups in athletic shoes -proper stretching

How can you treat nephrogenic (normal) diabetes insipidus?

-diuretics, high fluid intake, decreased sodium diet, increased protein diet

Levothyroxine NI

-don't mix in formula (bb might not drink it all, altered with soy/fiber/iron formulas) -measure thyroid levels @ regular intervals -missed dose=delayed growth -taken 30-60 minutes before meal for optimal absorption

Dx of cerebral palsy

-electroencephalogram -cranial x ray or US: cerebral asymmetry -MRI or CT: damage or abnormal development -CMP and DNA

Tx of snake bite

-elevate -cold compress -calm child -remove constricting items -monitor neurovascular status -antivenom (from horse serum)

NI for post op thyroidectomy

-elevate HOB to 30 degrees -airway kit available (because sore throat, airway swelling, pain, difficulty swallowing from surgery) -IV calcium gluconate -watch for signs of thyrotoxicosis

NI for casts

-elevate extremity above heart -ice for first 24-48 (20-30 minutes x off 1-2 hours)hours after casting PRN -teach proper crutch use -pain meds -assess swelling and function of part -never insert anything in cast for scratching -no lotion or powder -protect the cast from water -if cast gets wet, blow dry with cold setting -change position q2 hours -check skin for irritation

After partial/total thyroidectomy why should the nurse look out for thyrotoxicosis?

-elevated amounts of circulating thyroid hormones that are not processed in the thyroid as much anymore because thyroid has been partially/fully removed

NI for meningocele

-ensure proper covering and no threat to child -assess neuro status -report leaking of CSF -adequate hydration -monitor for Sx of constipation, bladder dysfunction (d/t increasing size of lesion) -monitor for hydrocephalus and Sx of Inc ICP

Infant Skin considerations

-epidermis thinner, less SQ fat, loses heat faster -BV closer to surface, substances easily absorbed thru skin -skin contains more water, friction easily causes breakdown -less pigmented: increased risk for UV damage -adult thickness in late teens -darker-skinned babies have altered pigmentation, may have hypertrophic scarring and keloids -sebaceous, sweat glands immature @birth

causes of skin disorders

-exposure to microorganisms -hypersensitivity reactions -hormonal influences -genetic predisposition -injuries

what are emergency signs in a child with a cast?

-extremity is cool to touch, blue, pale, or swollen -numbness -severe pain -drainage or foul smell -severe itching -fever for longer than 24 hours -skin edges red and swollen with breakdown -rubbing or burning under cast -cast gets wet, doesn't dry, cracks, splits, softens

Complications of DM

-failure to grow -delayed sexual maturation -poor wound healing, recurrent infections -retinopathy, neuropathy, vascular complications, nephropathy -CVD, PVD, cerebrovascular disease

s/s of acquired hypothyroidism

-fatigue, weakness, weight gain -constipation, muscle weakness, muscle hypertrophy -dry skin, goiter, face/eyes/hands edematous, thinning/coarse hair -delayed or precocious puberty

s/s of type 1 allergic reaction

-CV: hypotension, flushing, CV collapse -Resp: wheezing, laryngospasm, stridor -cutaneous: hives, angioedema, burning in mouth/throat, flushing -GI: bloating, n/v/d, runny nose, abd pain -neuro: changes in LOC *remember ABC; swelling of any kind can impair airway and breathing

causes of secondary immunodeficiency

-Chronic illness -Malignancy and chemotherapy -Use of immunosuppressive medication (lowers the immune response) -Malnutrition or protein-losing state -Prematurity -HIV infection

NI/Tx for turner syndrome

-GH admin -estrogen and progesterone

TX for GH deficiency

-GH replacement therapy: SQ injections 6-7x/week -GH replacement therapy stopped when achieves height of growing <1"/year OR bone age of 14 (girl)/16 (boy) -monitor height increase q3-6 months and plot growth on chart

Myasthenia gravis

(chronic) autoimmune disorder that attacks Ach receptors and other proteins at the neuromuscular junction, inhibiting normal neuromuscular transmission -progressive weakness and fatigue of skeletal muscles -no cure

syndromic clubfoot

- Associated with congenital anomalies - Often more severe and resistant to treatment

Types of traction

- Bryant - Buck's - Russell's - Cervical - Halo - balanced suspension

Prevention of diaper dermatitis

- change diapers frequently - wash with warm water after change - dry area thoroughly - apply protectants - avoid rubber pants, harsh soaps, baby wipes with fragrance or preservatives - may have to go diaperless to allow ay rash to heal - blow-dry diaper area - vitamin A,D,E, zinc oxide, petrolatum

congenital anomalies of musculoskeletal system

- pectus excavatum - pectus carinatum - limb deficiencies - polydactyly or syndactyly - metatarsus adductus - congenital clubfoot - osteogenesis imperfecta

Structural disorders of neural tube

- spina bifida occulta - meningocele - myelomeningocele

s/s of thyroid storm

-(extreme VS) hyperthermia, HTN, tachydysrhythmias, severe tachycardia -delirium, severe restlessness and irritability -vomiting, abdominal pain, hyperglycemia,

antihistamine skin indications

--hypersensitivity -atopic dermatitis -contact dermatitis that is severely pruritic

When to take labs for suspected HIV

-14-21 days, 1-2 months, 4-6 months -Dx excluded after 2 negative antibody tests at 6 months or older -0-18 months PCR or viral culture -18 months+ ELISA and western blot

hypoglycemia tx

-15g glucose, check in 15 minutes until 80 mg/dL, then snack -IV push dextrose infusion -glucagon IM (if unconscious)

What are s/s of growth hormone deficiency?

-<3rd percentile by 12 months -hypoglycemia, hyponatremia -jaundice -micropenis, undescended testicles -delayed sexual maturation, delayed dentition, delayed skeletal maturation -"cherubic" appearance: child-like face with large forehead -poor growth and short stature -higher weight vs. height -prominent SQ fat, decreased muscle mass

Dx of DM1

-A1c >/= 6.5% -fasting (>8 hr) plasma glucose: 126 mg/dL -2 hour plasma glucose >/= 200 mg/dL during oral glucose tolerance test -random plasma glucose >/= 200 mg/dL + hyperglycemia s/s

Dx of DKA

-BG >250 mg/dL -serum ketones -glycosuria -ketonuria -low blood pH <7.3, low Co2, low HCO3 <15 mEq/L -high BUN and creatinine

What does serum chemistry test for?

-BUN -creatinine -sodium -potassium -glucose -calcium -phosphorus -alkaline phosphatase

osteomylitis dx

-CBC -ESR -CRP -imaging -blood culture -aspiration of joint

Dx tests for skin

-CBC -ESR -IgE -culture and sensitivity of wound drainage -Potassium hydroxide prep -patch or skin allergy testing -wood lamp -skin biopsy

Labs/Dx for SLE

-CBC (dec Hgb, Hct) -platelet count dec -WBC dec -complement levels dec -ANA titer (nonspecific but usually positive)

Labs for muscular disorders

-CBC, creatinine kinase -radiographs -fluoroscopy, arthrography -myelography, electromyography, muscle biopsy -never conduction testing -CT, MRI, ultrasound -genetic testing

Dx of Central DI

-CT, MRI, ultrasound of skull or kidney can find tumors or lesions -urinalysis: if osmolality <3,000 mOsm/L and specific gravity <1.005, decreased sodium, serum osmolaility >300 -fluid deprivation measures vasopressin release from pituitary

What is the Addison Crisis Pathway?

Adrenal Glands don't function -->cortisol and aldosterone is low -->decrease in liver, stomach, kidney, and heart function --> low sugar, n/v/d, abd cramps, hypovolemia, low BP -->extremely low sugar and shock -->brain--coma and death

LUnd and Browder chart

An accurate way of calculating/estimating extent of burns, used especially for children, based on age

Acne Vulgaris

Androgens --> sebaceous glands -->sebum--> papules d/t inflammation

Rapid acting insulin examples

Aspart (Novolog) Lispro (humalog) Glulisine (Apidra)

What is Hashimoto's thyroiditis?

Autoimmune disease causing disruption of the function of the thyroid gland (antibodies attack the thyroid)

The nurse is caring for a child with diabetes insipidus. Which of the following clinical manifestations would be expected for this child? a. urine specific gravity greater than 1.005 b. serum osmolallity greater than 300 mOsm/kg c. increased urine osmolality d. hyponatremia

B

If you suspect severe combined immunodeficiency disease, BE SURE. What does BE SURE stand for?

B - bone abnormalities E - ear infections 8x/year S - sinus infections 2x/year U - unexplained FTT (or chronic diarrhea) R - recurrent pneumonia E - Excessive time on antibiotics note: alse look out for persistent thrush

IgD

B cell receptor; activates basophils and mast cells

HIV

B/T cells "forget" antigens and do NOT produce antibodies

Metformin

Biguanide: reduces glucose production from liver

idiopathic clubfoot

Bony abnormality almost always requiring surgical intervention

What is the safest method of delivery if a mom is infected with HIV?

C-section

Adrenal Crisis

Can be triggered by stress, surgery, infection, and trauma -Most common cause is abrupt withdrawal of exogenous glucocorticoids -keep in mind SUGAR SALT SEX

What is the difference between central and nephrogenic Diabetes insipidus?

Central DI is where pituitary doesn't make enough ADH and Nephrogenic DI is where the pituitary is desensitized to ADH.

buckle fracture

Compression injury, the bone buckles rather than breaks

cretinism (congenital hypothyroidism)

Condition caused by congenital absence or atrophy (wasting away) of the thyroid gland, resulting in hypothyroidism (dwarfism) -decreased T3 and T4 circulation -d/t genes, maternal meds, maternal-thyroid-blocking antibodies, iodine deficiency, fetal/neonatal exposure to increased iodines

T or F: The nurse caring for children with HIV knows that the ELISA test is preferred test to determine HIV infection in infants and exclude HIV infections as early as possible

F; PCR is preferred test; ELISA is positive in infants of HIV-infected mother because transplacentally received antibodies and will persist and remain detectable <24 months of age

T or F: When the fetus is born, the antibodies acquired from the mom are permanent.

False; Antibodies like IgG are catabolized between 2-6 months. This is called the hypogammaglobulinemia phase.

The nurse is caring for a child diagnosed with juvenile diabetes. Which of the following medical treatments would be appropriate for this child? a. surgery b. irradiation c. radioactive iodine d. glucose monitoring

D

What are disorders related to the posterior pituitary?

DI, SIADH secretion

What is the difference between DI and SIADH?

DI: high and dry; increased urination; hypernatremia; serum osmolality >300 mOsm/kg; urine specific gravity <1.005; decreased urine osmolality, dehydration, thirst, decreased BP SIADH: low and wet; decreased urination, hyponatremia; serum osmolality <280 mOsm/kg; urine specific gravity >1.030; increased urine osmolality; fluid retention, weight gain, increased BP

Tx of osteogenesis imperfecta

Decrease incidence of fractures and maintain mobility -biphosphonate admin (moderate/severe) -PT and OT -prevent contractures -standing with braces -lightweight splints or braces -surgical insertion of rods into long bones (severe) -encourage non-weight bearing exercise: walking, swimming, water therappy

Tx of thyrotoxicosis

Decrease levels of thyroid hormone -methimazole or PTU -Iodine (stops release of pre-formed hormone)

How does Uncontrolled Diabetes Mellitus Type 1 cause Diabetic Ketoacidosis?

Decreased insulin --> inability of cellular uptake of glucose -->hyperglycemia-->kidney compensation --> glycosuria and polyuria; protein/fat breakdown for energy ---> ketone buildup and acidosis

Function of calcitonin

Decreases blood calcium levels by inhibiting osteoclasts; secreted by the thyroid.

Type 1 DM

Deficiency of insulin secretion d/t pancreatic B-cell damage

What is precocious puberty?

Defined as sexual development before age 9 in boys and before age 8 in girls. -Occurs more frequently in girls but cause is unknown -cause in boys is d/t CNS abnormality

TX for graves disease (Hyperthyroidism)

Destruction of the Thyroid Gland: -decrease thyroid hormones -antithyroid medication -radioactive iodine therapy -subtotal thyroidectomy -methimazole (blocks T3 and T4 production)

HIV encephalopathy

Disease of the brain (dementia) caused by infection with the human immunodeficiency virus (HIV), which causes AIDS (acquired immunodeficiency syndrome). -can cause acquired microcephaly, motor deficit, loss of developmental milestone

epiphysis

End of a long bone -in children, this is cartilaginous and ossifies over time

What 3 organisms are responsible for tinea?

Epidermophyton, Microsporum, Trichophyton

What is cushing's syndrome?

Excess serum levels of glucocorticoids (especially cortisol) -cortisol regulates BG -aldosterone regulates sodium

T/F tibia vara and genu varum are different conditions

F

T/F: Nurse is assessing a child for acne vulgaris and notes comedones plus papules localized on the face. This is classified as mild acne.

F. Moderate acne

T or F: The nurse teaching parents of a child with diabetes about insulin administration correctly informs them that short-acting insulin has an onset within 15 minutes and lasts for 3-5 hours.

F. Short-acting insulin has an onset of 30-60 minutes and lasts for 5-8 hours

Contact dermatitis is contagious T/F

False; not contagious, doesn't spread via scratching but causes skin damage or secondary infection

Why do nurses take fasting glucose?

Fasting forces the body to produce glucagon, which causes the release of glucose. In a healthy child, the body will respond by releasing insulin, therefore lowering blood glucose and preventing hyperglycemia -detects hyperglycemia r/t diabetes, Cushings, or liver/kidney disease

What is the purpose of imaging studies in regards to endocrine disorders?

Find tumors, cysts, structural defects

T/F Fluid loss stops after 72 hours of a burn.

Flase; fluid loss continues until the damaged surface is healed or grafted

What are disorders related to the anterior pituitary?

GH deficiency, hyperpituitarism, precocious puberty

What is von Willebrand disease?

Genetic disease that affects the function of platelets and also has a defect in clotting factor 8

Thymus

Gland in the thoracic cavity above the heart where T lymphocytes mature. -enlarged until 10 years

What does an A1C test measure?

Glycated hemoglobin reflects the percentage of hemoglobin to which glucose is attached. In the case of hyperglycemia, an increase in glycohemoglobin leads to an increase in hemoglobin A1c. This test shows the average blood glucose level for the past 2-3 months -long-term diabetes control

Precocious puberty is the premature activation of Gonadotropin releasing hormone which causes what?

GnRH --> pituitary to release LH and FSH --> increase in estrogen/testosterone

SE of Tx with IVIG

Graft vs. Host Disease -always ensure CMV negative, irradiated blood/platelets for infant transfusion

nonnucleoside analog reverse transcriptase inhibitors (NNRTIs)

HIV MED bind to HIV-1 components and block DNA polymerase activity, disrupting virus life cycle

What is the relationship between HIV and AIDS?

HIV is the virus that causes AIDS

Fourth Degree frostbite Sx

Hemorrhagic blisters that progress to necrosis and sloughing

What is the difference between Humoral and Cellular Immunity?

Humoral: Lymph B-cells; secrete antibodies; recognize antigens; antibodies mark antigen cell for destruction; crosses placenta in form of IgG Cellularl: lymp T-cells; do not recognize antigents; direct and regulate immune response (helper T cells); attack infected or foreign cells (killer T and natural killer cells)

what is a CBC

HxH, WBC, platelet, -ind: infection, inflammatory process, immunosuppression

What is the difference between hypothyroidism and hyperthyroidism?

Hyper: nervousness/anxiety, diarrhea, heat intolerance, weight loss, smooth/velvety skin Hypo: tiredness/fatigue, constipation, cold intolerance, weight gain, dry/thick skin, edema of face/eyes/hands, decreased growth

osteomylitis tx

IV antibiotics (3-6 weeks)

Legg-Clave-Perthes Disease

Idiopathic osteonecrosis of femoral head. Typically ages 4-8

warning Sx of primary immunodeficiency

If the following as occurred multiple times per year, get checked: -acute otitis media 4x in 1 year -2 or more episodes of severe sinusitis -Tx w/ antibiotics 2mo+ with little effect -2x pneumonia in one year -failure to thrive in infant -recurrent deep skin or organ abscesses -persistent oral thrush or skin candidiasis after 1 year -Hx of infections with Tx of IV antibiotics -2x serious infections like sepsis -Fam Hx of primary immunodeficiency

Which immunoglobulins don't cross the placenta?

IgA, IgD, IgE, IgM

Which immunoglobulin is related to anaphylaxis response?

IgE

When fetus is in the placenta, it produces what type of immunoglobulin because of its "antigen-free environment"?

IgM

Age considerations of diabetes

Infants: unable to vocalize s/s and are inconsistent eaters -maintain a schedule Toddlers: picky eaters; trantrums vs. s/s of hypoglycemia -maintain a schedule Preschool: "feels different than other kids"; more consequences to uncontrolled DM School-Age/Adolescent: perform own care, use schedules

Tx for duchenne muscular dystrophy

No Cure -corticosteroids slows progression--prednisone -calcium supplements and vitamin D (tx osteoporosis) -antidepressants -beta-blockers and ACE inhibitors -braces or orthoses and mobility/positioning aids

Peripheral precocious puberty

No secretion of sex hormones but grows pubic hair and breasts

Assessment of urticaria

Obtain HX of: -new foods -changes in environment (unsual stress) -skin, raised, edematous hives -hives are pruritic, blanch when pressed, migrate -angioedema, SQ edema, warmth -extremities, face, and genitalia -ABC

Trendelenburg sign/gait

Occurs with severe subluxation of one hip When the child stands on the good leg, the pelvis looks level. When the child stands on the affected leg the pelvis drops toward the good side -positive if drops -negative if lifts d/t weakness of hip abductors

Type 2 DM

Insulin resistance at skeletal muscle/liver/adipose tissue level

What does a urine test measure?

Ketones are the result of the metabolism of fat and in a healthy child are present in insignificant amount -large amounts of ketones in urine indicates diabetes -diabetic ketoacidosis is a reflection of poorly controlled diabetes--lots of ketones in urine

What factors can affect T-cell function in fetuses?

Late gestation exposure to: -viral infection -hyperbilirubinemia -drugs

Myasthenic crisis and Sx

MEDICAL EMERGENCY -exacerbation of Myasthenia Gravis; increased amount of antibodies attacking ACh, causing exacerbation of weakness -respiratory distress, dysphagia, dysarythmia, ptosis, diplopia, tachycardia, anxiety, rapidly increased weakness

Diabetic Ketoacidosis

MEDICAL EMERGENCY acidity of the blood caused by the presence of ketone bodies produced when the body is unable to burn sugar; thus, it must burn fat for energy

septic arthritis

MEDICAL EMERGENCY bacteria invades joint space -<3 years -S. aureus -can cause avascular necrosis d/t pressure on blood vessels and cartilage

spina bifida occulta Dx

MRI, x-ray or ultrasound

Tx of dysplasia of hip joint

Maintain hip joint in reduction so that the femoral head and acetabulum develops -<6 months: Pavlik harness -6months-2 years: closed reduction ->2 years: surgical reduction and casting

Tx of Legg-Calve-Perthes Disease

Maintain normal femoral head shape and restore appropriate motion. -anti-inflammatory -activity limitation -bracing, casing, traction -x-ray follow-up -surgery -osteotomy -hips in abducted position

Tx of SLE

Management is Tx of Inflammatory Response: -NSAIDs -corticosteroids -antimalarial agents (for moderate SLE) -high-dose corticosteroid therapy (severe SLE or frequent flare-ups) -end-stage renal failure occurs d/t glomerulonephritis, dialysis is necessary

Tx of contact dermatitis

Management of Itch -corticosteroids -mild/moderate: glucorticoid cream/ointment -severe: systemic steroids and high-potency prep -wash w/ soap/water, debride crusted lesions, tepid baths, weeping lesions wrapped, avoid occlusion, Burrow or Domeboro solutions w/ dressing BID x 20 minutes -OTC calamine lotion -no topical antihistamines, benzocaine, neomycin -> inc sensitization

What is a thyroid storm?

Medical emergency -thyroid releases too much thyroid hormone @ once -aka thyroid crisis or thyrotoxic crisis

Turner Syndrome

Missing some/all of one X chromosome

abduction

Movement away from the midline of the body

adduction

Movement toward the midline of the body

What dietary restrictions are required of patients with PKU?

NONE of: meat, dairy, dry beans, nuts, eggs CONSUMED IN MODERATION: cereals, fruits, vegetables

Intermediate acting insulin name

NPH (Humulin N, Novolin N)

What is a newborn metabolic screening?

Newborn blood testing to identify certain harmful or potentially fatal disorders that are otherwise not apparent at birth.

What is nephrogenic diabetes insipidus (Normal)? What are the s/s?

Pituitary sends ADH to kidneys but kidneys' sensitivity to ADH is decreased, causing water loss and sodium retention s/s: dehydration, hypernatremia note: Desmopressin acetate (DDAVP) is ineffective in Tx because it promotes water retention and increases urine osmolality

congenital clubfoot

Postural, neurogenic, syndromic, idiopathic -talipes varus: inversion of heel -talipes equinus (plantarflexion of foot; heel is raised and will not strike ground in standing position) -cavus (plantar flexion of forefoot on hindfoot) -forefoot adduction with supination (forefoot inverted and slightly upwards)

Nursing care of juvenile idiopathic arthritis

ROM exercises, pain control, heat application -splint to prevent contractures -monitor for skin breakdown -adequate sleep, exercise, nutrition -ex of modified school: 2 sets of books (1 for school and home to prevent strenuous activity)

vesicle, pustule

Raised, pus filled; acne <1 cm

pavlik harness

Reduces and stabilizes the hip by preventing hip extension and adduction -maintains hip in flexion and abduction -full-time basis

Short Acting Insulin Example

Regular Insulin (Humulin R, Novolin R)

What is the function of the parathyroid hormone?

Regulates calcium secretion; Secretes calcium when serum levels are low

A client arrives to the ER experiencing n/v, headache, seizures. Pt is diagnosed with bacterial meningitis. Other findings include a decrease in urine production, hyponatremia, and water intoxication. Which pituitary gland disorder is most associated with these symptoms? a. SIADH b. DI c. hyposecretion of somatotropin d. hypersecretion of growth hormone

SIADH

Plastic or bowing deformity

Significant bending without breaking of the bone

First Degree Burn

Superficial burns through only the epidermis. -heals w/i 4-5 days painful, dry, red, edematous (maybe)

colloid fluid

Synthetic fluids that expand volume due to oncotic drag by exerting a high oncotic pressure

T or F: a deficiency of a specific hormone is referred to as hypofunction

TRUE

Barlow test

Test for a hip that is dislocatable but not dislocated in infants. With infant supine and hip and knees flexed, push posteriorly in line with the shaft of femur. An unstable femoral head will dislocate posteriorly from acetabulum. -"clunk" sound

What is the purpose of genetic testing?

Tests for the presence of the gene for disease or carrier status

developmental dysplasia of the hip dx/tx

Tx: Cast, surgery, PT Tests: US (ultrasonogram), x-ray of hips, AROM testing of hips

What type of hypersensitivity reaction is urticaria?

Type 1

Which type of diabetes is an autoimmune disease?

Type 1 immune system attacks = destroys beta cells

What is Addison's disease - adrenal deficiency?

Under secretion of the adrenal hormones causing decreased ability to handle stress -familial or sporadic (In healthy people, Stress= inc glucose, inc BP= perfusion In people with Addison's, No adrenaline + stress= dec glucose, dec bp=shock)

When concerned about Wiskott-Aldrich Syndrome, Remember WATER:

W - Wiskott- A - Aldrich T - Thrombocytopenia E - Eczema worsens over time R - Recurrent (pyrogenic) infection

why do lymph nodes swell?

WBC infiltrate lymph nodes to attack foreign substance

A 13 year old adolescent with hyperthyroidism who takes antithyroid meds has a sore throat and a fever. The parent calls the nurse and asks what to do. What is the best response from the nurse? a. "Please take your child straight to the emergency department." b. "Fever and sore throat may be side effects of the medication." c. "give your child ibuprofen according to the instructions on the box." d. "offer your child at least 8 ounces of clear fluids and call back tomorrow."

a

Insulin deficiency, in association with increased levels of counter-regulatory hormones and dehydration, is the primary cause of: a. diabetic ketoacidosis b. ketone bodies c. ketonuria d. glucosuria

a

The nurse is explaining patterns of incidence and transmission of HIV to a group of adolescent girls. She explains that the risks for this population are much higher because of the possibility of both vertical and horizontal transmission. Horizontal transmission refers to transmission of the disease during: a. sexual contact b. feeding with breast milk c. birth d. pregnancy

a

The parent of a school-age child comments to the nurse, "Every time my child eats enchiladas at our local Mexican restaurant the child gets a rash. It just does not make sense to me." How should the nurse respond? a. "has your child ever been tested for a peanut allergy?" b. "Is your child allergic to milk?" c. "That is odd. Does anyone else in your family react that way?" d. "Maybe it is an allergy to something else and you just notice after eating there by coincidence."

a

To avoid anaphylactic reactions in children, which question would be most important to ask a parent before administering penicillin to her infant? a. "Has she ever had penicillin before?" b. "is there any family history of allergy to penicillin?" c. "what do you give her to alleviate itching?" d. "Do you have a telephone to call us immediately if she develops trouble breathing?"

a

Which client will the nurse assess first after receiving shift report? a. client with HIV whose temp is 102.2F b. client with serum sickness stating "I just feel bad all over" c. client newly diagnosed with allergic rhinitis prescribed loratadine 10 mg d. client with contact dermatitis who has blisters and mild edema on lower extremities

a

Which method should a child self-inject insulin for regular doses? a. SQ in outer thigh b. IV in chest c. IM in abd d. intradermally in outer arm

a

Which symptom would differentiate between type 1 diabetes from type 2 diabetes? a. recent weight loss b. BP 142/92 mmHg c. slow healing wounds d. loose stools

a

Hypogammaglobulinemia

a below normal concentration of gamma globulin in the blood associated with a decreased resistance to infection -BB is susceptible to disease unless is receiving passive immunity thru breast milk

third degree burn

a burn involving all layers of the skin; characterized by the destruction of the epidermis and dermis, with damage or destruction of subcutaneous tissue -may scar -change in nail, hair, skin appearance -hair follicles and sweat glands destoryed -painful, edematous, wet appearance, blisters

pectus excavatum and Sx

a chest that is hollowed out -when pectus is more pronounced CV and Pulmon. compression occurs -Shortness of breath, withdraw from activities, poor body image

pectus carinatum

a chest that protrudes like the keel of a ship

What is neonatal thyrotoxicosis?

a congenital form of hyperthyroidism occurring in infants of mothers with graves disease *MEDICAL EMERGENCY*

What is diabetes insipidus?

a disorder caused by inadequate amounts of ADH OR improper response to ADH which causes excessive water loss -normal people make 1-3 quarts of urine per day but DI people make up to 20 quarts per day (or 3L/m^2/day)

Hyperglycemic Hyperosmolar Syndrome (HHS)

a metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin

traction

a pull to the arm or leg muscles to bring a bone back into place when it is dislocated or fractured

psychosocial dwarfism

a syndrome of stunted growth in children subjected to social stress, such as abusive caregivers -s/s: bizarre eating/drinking habits and primitive speech

What is random and timed serum hormone testing?

a test to determine serum levels of various hormones

Neurogenic bladder

a urinary problem caused by interference with the normal nerve pathways associated with urination

The nurse is administering the prescribed IV immunoglobulin to a boy. What step is most important for the nurse to do? a. have epinephrine available b. monitor urine for glucose c. administer with food d. monitor for signs of cushing syndrome

a.

Ortolani sign

abducting the thighs and applying gentle pressure forward over the greater trochanter produces a 'clunk" sound

What does growth hormone deficiency impair?

ability to metabolize protein, fat, and carbs

lordosis

abnormal anterior curvature of the lumbar spine (sway-back condition) -inward curvature

developmental dysplasia of the hip and Sx

abnormal development of the hip joint found that is congenital -Sx: fat rolls asymmetrical, abnormal leg length, AROM limited

Developmental Dysplasia of the Hip

abnormal development of the hip joint found that is congenital -dislocation -subluxation -dysplasia -femoral head has abnormal relationship to acetabulum

Dyskinetic or athetoid cerebral palsy

abnormal involuntary movements

Scoliosis

abnormal lateral curvature of the spine -idiopathic, congenital, a/w other disorders

cerebral palsy and Sx

abnormal motor pattern and postures caused by nonprogressive abnormal brain function -SX: motor impairments, spasticity, muscle weakness, ataxia

Severe combined immunodeficiency disease (SCID)

absent T/B cell function (humoral and cellular immunity) -genetic -EMERGENCY INTERVENTION @ DX; won't survive a year w/o Tx

Legg-Calve-Perthes Disease and Sx

avascular necrosis of femoral head -interruption of blood supply to femoral head causing bone death -spherical shape of femoral head lost -swelling of soft tissues around hip -Period of revascularization: new blood vessels develop, allowing bone resorption and deposition -bone likely to fracture

A child and her parents are being seen in the office after discharge from the hospital with a new diagnosis of type 2 diabetes. Which statement by the nurse is true? a. "You are lucky you didn't have to learn how to give yourself a shot" b. "kids usually can be managed with an oral agent, meal planning, and exercise." c. "This will rectify itself if you follow all of the doctor's directions." d. "a weight-loss program should be implemented and maintained"

b

A nurse is reinforcing the diagnosis of constitutional delay by the provider to a male adolescent. Which is the best approach for this teen? a. "I would be worried about your short stature too and get a second opinion." b. "you will not need medication because your hormone levels are normal. I would be glad to discuss these findings with you." c. "If you think you want testosterone shots, then I will get them scheduled for you." d. "It really doesn't matter how tall your dad is. The provider looks at your height to make this diagnosis."

b

A pregnant client who is HIV positive asks the nurse if she will be able to breastfeed the newborn. Which response by the nurse is most appropriate? a. "breastfeeding passes protective immunity along to your newborn" b. "breastfeeding will increase your newborn's risk of contracting HIV." c. "since your newborn will have HIV, it is okay for you to breastfeed." d. "you should speak to your primary health care provider about breastfeeding."

b

Prior to discharging an infant with congenital hypothyroidism to home with parents, what should the nurse emphasize regarding the care that this child will need going forward? a. Vitamin K admin until school age b. admin of levothyroxine indefinitely c. increased intake calcium immediately d. admin of vitamin C

b

The nurse is caring for a child with GH deficiency. Which of the following would be prescribed for the child? a. Short-term aldosterone provocation b. injections of GH c. oral admin of somatotropin d. long-term blocking of beta cells

b

The nurse is caring for a school-age child recently diagnosed with an allergy to peanuts. Which nursing action is a priority? a. advise parents the child may benefit from skin testing b. include the child when discussing foods that contain peanuts c. offer the parents information about a community support group d. remind parents to report the allergy to the child's school teacher

b

The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation? a. screening for STI b. screening for HIV c. prophylactic Tx for HIV d. proper nutrition

b

The nurse is providing education to the parents of a child prescribed oral cyclophosphamide. Which statement by the parent indicates additional teaching is needed? a. "I will monitor my child closely for signs of an infection." b. "I need to give this medication to my child at bedtime." c. "I will wear rubber gloves if I need to clean up any of my child's body fluids." d. "My child needs to drink plenty of fluids while taking this medication."

b

The nurse is teaching a child with type 1 DM to administer insulin. The child is receiving a combo of short-acting and long-acting insulin. The nurse knows that the child has appropriately learned the technique when the child: a. administers insulin into a doll at a 30-degree angle b. draws up short-acting insulin first c. wipes off the needle with an alcohol swab d. administers the insulin IM

b

The nurse is teaching a group of caregivers of children diagnosed with diabetes. The nurse is explaining insulin shock and the caregivers make the following statements. Which statement indicates the best understanding of a reason an insulin reaction might occur? a. "if my child eats as much as their older brother eats, they could have an insulin reaction." b. "My child measures their own medication but sometimes doesn't administer the correct amount." c. "My child monitors their glucose levels to keep them from going too high." d. "On the weekends, we encourage our child to participate in lots of sports activities and stay busy so they don't have an insulin reaction."

b

The nurse is caring for a child with severe atopic dermatitis. Which of the following medications would be recommended for this condition? a. retinoids b. topical immune modulators c. silver sulfadiazine 1% d. systemic corticosteroids

b. retinoids used for severe acne vulgaris, silver sulfadiazine 1% used for burns, systemic corticosteroids for contact dermatitis

impetigo

bacterial skin infection characterized by isolated pustules that become crusted and rupture -nonbullous and bullous -honey crusts -usually staphyloccocus aureus

Bone marrow is functional at _______________________. Bone marrow produces __________________ cells that eventually become __________________ ________________ cells

birth; stem; red blood

Second degree frostbite Sx

blistering, erythema, edema

how do you diagnose delayed puberty?

blood levels of reproductive hormones

Congenital adrenal hyperplasia

body lacks 21-OH (enzyme) so adrenal gland hormone cant make cortisol and aldosterone -extra hormone components made into androgen

What is Syndrome of Inappropriate Antidiuretic Hormone (SIADH)?

body makes too much antidiuretic hormone -causes fluid retention-->decreased sodium -->hemodilution and extracellular fluid volume expansion

greenstick fracture

bone breaks incompletely

complete fracture

bone is broken all the way through

genu varum

bow legged

tibia vara

bowing of the legs -blount disease -risk factor: early walking and obesity -untreated causes: growth place of upper tibia to stop growing, asymmetric growth at knee, severe degenerative arthritis

What is delayed puberty?

breasts not developed by 12 years OR no testicular enlargement by 14 years

Developmental dysplasia of the hip is a/w what type of delivery?

breech

fourth degree burn

burn in which full thickness of the skin and underlying muscle and bone is damaged -circumferential burns results in ischemia from loss of blood flow -contractures and limited function make occur -skin grafts -painful, numb, pain-free (in some areas), red, edematous, leathery, dry, waxy, peeling or charred skin

silver sulfadiazine 1% skin indication

burns -bactericidal against gram +/- bacteria and yeasts

Which type of burn is at an increased risk for respiratory injury?

burns during an indoor fire or a chemical fire -children who have aspirated hot liquids (more at risk for airway-altering edema)

A toddler is at the office for a follow-up visit and has excessive hormone levels in recent bloodwork. The parents question why this wasn't found sooner. What is the best response by the nurse? a. "It takes time to determine the level of functioning of endocrine glands." b. "Have there been signs and symptoms that you should have reported to the doctor?" c. "as endocrine functions become mores table throughout childhood, alternations become more apparent." d. "endocrine disorders are hard to detect and you are lucky that we have found it when we did."

c

The nurse is providing education in response to questions from new parents concerned about keeping their child safe from infections. Which phrase would be most appropriate for the nurse to include in the teaching plan? a. The baby's immune system is fully developed at birth b. The child must be kept away from everyone but parents until the child has a fully functional immune system. c. breastfeeding provides passive immunity to the infant that formulas cannot provide d. the baby has specialized cells called phagocytes that can protect the newborn from infections

c

The parents of a 10 year old with HIV have never told their child that he has HIV. The child asks the nurse why he is on so many medications. What action should the nurse take? a. the nurse should explain the infection to the child b. the nurse should tell the parents when they enter the child's room that their child has a question for them c. the nurse should encourage the child to talk to his parents about his medications d. the nurse should suggest the child speak to the doctor

c

What is a primary prevention strategy for AIDS? a. refer at-risk community members to the clinic for HIV/AIDS screening b. increase number of schools with indoor air management system c. provide education to sexually active females about proper condom usage d. reduce baseline level of allergens in dust within homes and buildings

c

The nurse reviews a 6- year old clien'ts lab results and notes the client's hemoglobin A1C level is 7.7% (0.077). Which action by the nurse is approrpiate? a. perform a serum glucose check b. admin insulin c. continue to monitor d. notify the provider

c Toddlers/Preschoolers range: 7.5-8.55 School age: <8% Adolescents: <7.5% Adults: <7%

The nurse is providing teaching for the parents of a child with a latex allergy. The nurse tells the client to avoid which food? a. blueberries b. pumpkins c. bananas d. pomegranates

c. Some foods like avocado, banana, chestnut, kiwi, passionfruit, plum, strawberry, and tomato contain the same proteins that are in latex that cause the latex allergy

chondrolysis

cartilage necrosis

Cellulitis Tx

cephalexin* dicloxacillin cindamycin or erythromycin if PCN allergic -elevate, warm compress

what factors trigger or aggravate SLE?

certain drugs, infection, excessive sun exposure

growers sign

child trys to stand up off floor and will plantar grade and slide hand up the thighs to stand upright

Dx klinefelter syndrome

chromosomal analysis

Klinefelter syndrome

chromosomal disorder where males have an extra X chromosome

Systemic Lupus Erythematosus

chronic autoimmune disorder affecting humoral and cellular immunity -any organ system -Dx ~ puberty -more prominent in non-caucasians -young people at inc risk of death -exacerbation and remission periods

Seborrhea Sx and Tx

chronic inflammatory dermatitis that is on skin or scalp -in infants, referred to cradle cap -resolves weeks/months -Tx with corticosteroid creams, lotions, antidandruff shampoos with selenium sulfide, ketoconazole, or tar

Acne

chronic inflammatory issue of pilosebaceous follices -androgen production --> sebum --> blockage and bacterial growth

Psoriasis

chronic inflammatory skin disease (remission and exacerbation) -hyperproliferation of epidermis, rash at sites of mechanical, thermal, or physical trauma; thick plaque-like silvery scale -TX: skin hydration with emollient cream, tar, topical corticosteroids, UV light, salicylic acid

nodule

circular, elevated, solid lesion >1 cm

bulla

circumscribed collection of free fluid >1cm

patch

circumscribed flat discoloration >1 cm

Tx of animal bite

cleansing and irrigating the wound -wound suture/staple if necessary -topical or systemic antibiotic therapy -rabies prophylaxis if status of animal is unknown -prevention of secondary bacterial infection

Burned tissue begins to _______________ after injury and this causes blood vessels to __________________. The result is increased ________________ pressure in the capillaries, which leads __________________ to leak out of the affected part, causing ________________. After 48-72 hours, ______________ occurs, ridding the body of excess fluid.

coagulate; vasodilate; hydrostatic; water; edema; diuresis

If a person with Addison's disease refuses treatment, has a flare up and are unable to physically/emotionally handle stress, what are they at risk for?

coma

mixed cerebral palsy

combination of any type of cerebral palsy

Moderate acne Sx

comedomes plus inflammatory lesions such as papules or pustules (localized to face or back)

What is opsonization?

complement proteins "flag" the microorganism for phagocytosis --> microorganisms more susceptible to phagoccytosis -immature at birth

therapeutic bathing and ind

use of lukewarm water (w/ or w/o soap) to bathe -ind: itchy and irritating skin conditions

ultrasound

use of sound waves to locate depth and structure w/i soft tissues and fluid -ind: spinal abnormalities, dx Legg-Calve-Perthes disease; slipped capital femoral epiphysis, fractures, ligament or soft tissue injury

Raynaud Phenomenon/Disease

vasospasms of small arteries/arterioles in extremities -abnormal temperature tolerance/responses -numbness -a/w sytemic lupus erythematosus

pustule

vesicle containing pus (inflammatory cells)

horizontal transmission

via nonsterile needles or sex

common childhood rashes

viral exanthems, eczema, contact dermatitis, diaper dermatitis, hand foot mouth, tinea, urticaria, abscesses and cellulitis

syndactyly

webbed fingers or toes

A school nurse is called to the school cafeteria after a 13-year-old child is reported to have sudden difficulty breathing. The child has a history of asthma and allergies to peanuts. The focused nursing assessment reveals difficulty breathing, inspiratory and expiratory wheezing, swelling of lips, and a rash on the face. The child reports feeling nauseated, having chest tightness, and feeling faint. Complete the following sentence(s) by choosing from the lists of options. The nurse should first address the child's _________________ (wheezing, nausea or rash) and then __________________ (chest tightness, feeling faint, or swelling of lips).

wheezing; swelling of lips

Tinea capitis dx

wood lamp or plucked hair

Wiskott-Aldrich syndrome

x-linked genetic disorder: immunodeficiency, eczema, thrombocytopenia -affects males only -defective gene is called Wiskott-Aldrich syndrome protein (WASp)

Myelography

x-ray study of the spinal cord allowing visualization of the cord, nerve roots, and surrounding meninges -ind: detection of lesions of spinal cord; find neural tube defects; determine extend of injury

skin care after cast removal

• Brown, flaky skin is normal and occurs as dead skin and secretions accumulate under the cast. • New skin may be tender. • Soak with warm water daily. • Wash with warm soapy water, avoiding excessive rubbing, which may traumatize the skin. • Discourage the child from scratching the dry skin. • Apply moisturizing lotion to relieve dry skin. • Encourage activity to regain strength and motion of extremity.