Final

Question 1

increased risk of insulin omission

Answer 1

• poor metabolic control
• previous DKA episode
• adolescent girl (weight control, psychosocial concerns)
• psychiatric dx
• unstable family situation
• lower SES
  
  • limited access to services
• inuslin pump therapy
  
  • short acting insulin
  • malfunction causes immediate impact in insulin amount

Question 2

cerebral edema and intubation

Answer 2

• intubation predicts poor outcomes
  
  • CO2 levels < 22 associated with poor outcome
• avoid intubation if possible

Question 3

compartment syndrome overview

Answer 3

• myelin sheaths overlay bones and muscles
  
  • pressure can increase
• 90% due to IV infiltrate when not checked
  
  • infusing extravascularly
• can get from IVs, fractures, burns

Question 4

nursing assessment for ITP

Answer 4

• neuro - low platelets, at risk for bleeding (brain)
• skin assessent - generalized petechiae
  
  • bleeding gum sometimes 1st symptom
• home with supportive care - no sports, safety
• monitor for hematuria

Question 5

if a mom brings a child in with a focal seizure, ask:

Answer 5

• when did it start, how long?
• first time? seizure hx?
• family hx?
• fever? sick?
• fall? head injury?
• did he ingest anything? toxic dose, miss a dose? sick or spetic?

Question 6

risk factors for hip dysplasia

Answer 6

• premie
• female
• family hx
• first child
• breech during pregnancy
• large birth weight

Question 7

clinical pathway of aplastic anemia

Answer 7

• idiopathic
• low RBC
  
  • weakness and fatigue, SOB, pale skin
• low WBC
  
  • frequent or severe infections
• low platelets
  
  • easy bleeding or bruising, bleeding that is hard to stop, petechiae

Question 8

long-term sequelae of cerebral palsy

Answer 8

• airway - can’t get up to increase tidal volume (pneumonia); regurgitation/aspiration
• circulation - poor venous return, syncopal episodes, hypotension
• GI - nutrition an issue
• GU - UTIs
• Skin - dependent pressure ulcers b/c of bedrest or can’t move
• musculoskeletal
  
  • contractures
  • osteoposoris - kyphosis, scoliosis

Question 9

simple partial seizure

Answer 9

• focal seizure with no loss of consciousness
  
  • no postictal confusion
• no aura
• motor symptoms in one extremity
• sensory symptoms
  
  • paresthesias
  • auditory/olfactory/visual
  • autonomic (sweating)

Question 10

liquid tumors

Answer 10

• cancer of the blood or lymphatic system
• leukemia, lymphoma
• ALL, AML

Question 11

Wilms tumor

Answer 11

• tumor of kidney
• large, rapidly growing, vascular abdominal tumors
  
  • encapsulated, easier to remove
  • quicker but better prognosis than neuroblastoma
• peak age 2-3 yo
• may involve both kidneys

Question 12

skin complications from bed rest

Answer 12

• pressure ulcer
• dependent edema

Question 13

skin assessment of liquid tumors

Answer 13

• pallor - pale, gray overtones
  
  • usually first predictor when they come in
  • iron deficiency
• low platelets
  
  • bruising, ecchymosis unrelated to trauma

Question 14

hydrocephalus

Answer 14

• disorder in which an excessive amount of CSF accumulate in cerebral ventricles and/or subarachnoid spaces, which are dilated
• almost always associated with increased intracranial pressure
• can be due to:
  
  • obstruction (non-communicating)
  • impaired absorption (communicating)
  • excessive production (rare)

Question 15

growth hormone deficiency treatment

Answer 15

• synthetic GH
• SC injection 6-7 x/week
• given until bone fusion, decreased growth velocity
• associated with SCFE, hyperglycemia
• most benefit happens in 1st year

Question 16

incidence of Ewing’s sarcoma

Answer 16

• 200 cases/year
• risk factors
  
  • retinoblastoma
  • environmental
    
    • radiation and treatment for prior malignancies

Question 17

when to suspect acquired heart disease

Answer 17

• PMH of viral illness ~ 1 mo
• high fever
• exercise/feeding intolerance
• symptoms of CHF
  
  • cannot lie flat
  • SOB, WOB
  • diaphoresis
  • enlarged liver
  • peripheral edema
• palpitations

Question 18

T1DM overview

Answer 18

• autoimmune
• most common in childhood
• complete insulin deficiency
• needs insulin tx
  
  • recent intransal insulin not well-accepted

Question 19

truncus arteriosus

Answer 19

• PA and Ao don’t separate
  
  • includes a VSD - communication
• complete mixture of systemic and pulmonary return circulations
• decreased systemic blood flow
  
  • leads to decreased systemic oxygen transport
• at risk for coronary ischemia

Question 20

G6PD

Answer 20

lack an enzyme for RBC production that causes hemolytic crisis with fava benas or sulfa drugs

Question 21

non-accidental fractures

Answer 21

• child abuse is cause of majority of fractures in child less than 1 yo
  
  • a child who cannot walk should not have multiple bruises or fractures
  • skeletal survey or bone scan to look at whole picture

Question 22

idiopathic scoliosis incidence

Answer 22

• female to male ratio ranges 1.5:1 to 3:1
• increases with age

Question 23

tonic-clonic seizure

Answer 23

• generalized seizure (formerly grand mal)
• alternating tonic (stiff and rigid) and clonic (rhythmic jerking) phases
• impaired consciousness
• salivation
• pupil dilation and eye deviation
• tachycardia and hypertension
• apnea - chest wall rigidity
• incontinence
• postictal confusion & sleep (always)

Question 24

early treatment to prevent sickle cell crises

Answer 24

• babies tolerate hydroxyuria better
  
  • will start them early
• also on penicillin VK + PO
  
  • to prevent infection by encapsulated bacteria

Question 25

Answer 25

* no right ventricle * b/c no tricuspid valve (tricuspid atresia) * no fetal blood flow to RV, so didn't develop * single ventricle physiology

Question 26

open fracture

Answer 26

* bad, high impact fall that causes skin to break * infection control a concern, after ABC

Question 27

hemolytic crisis

Answer 27

* increased RBC destruction * seen with G6PD

Question 28

special peds considerations for fractures

Answer 28

* femur (blood loss) * ankle (growth plate) * clavicle (vessels) * common in newborns

Question 29

respiratory status of lymphoma

Answer 29

* cough, SOB, wheezing * why would they have respiratory complaints? * many lymph nodes in mediastinal cavity * may be misdiagnosed as asthma

Question 30

types of anemia

Answer 30

* RBC not made * RBC not healthy * RBC made and lost

Question 31

treating Kawasaki disease

Answer 31

* intra-venous immunoglobulin (IVIG) 2 gm/kg * ASA 80-100 mg/kg/day until afebrile for 2-3 days, then 3-5 mg/kg/day for 6-8 wks (or until ESR normal) * enoxaparin SQ 6-12 weeks

Question 32

Tx for Ewing's and osteosarcoma

Answer 32

* challenges: removal and treatment * bone doesn't compensate for removal of tumor * tx after removal * depends on location, size, how involved it was * many tx that may or may not be good * ex: rotationplasty

Question 33

4 typical patients who can benefit from palliative care

Answer 33

1. cure is possible but may fail 2. premature death inevitable, but Tx may prolong quality and quantity of life (i.e. CF) 3. progressive conditions w.o curative options where treatment is exclusively palliative, but may extend life 4. conditions that are not progressive but render vulnerable and susceptible life-limiting complications 1. severe, medically fragile CP (largest population)

Question 34

obstructive lesions overview

Answer 34

* low cardiac output * decreased perfusion to gut * shock * myocardial dysfunction * elevated left and right atrial pressures (depending on location of obstruction): * congestive heart failure, pulmonary edema (over time) * over time can lead to LV dysfunction

Question 35

definition of traumatic brain injury

Answer 35

complex injury with broad spectrum of symptoms and disabilities. impact on person and family can be devastating

Question 36

SCD symptoms of eyes

Answer 36

retinopathy, retinal detachment (diminished vision)

Question 37

hemophilia type A

Answer 37

* missing/low levels of clotting factor VIII (8) * 8/10 people have type A

Question 38

anorexia and bone loss

Answer 38

Question 39

transitioning: necessary vitals

Answer 39

* glucose stable * \< 200 mg/dL * acidosis corrected * pH \> 7.3 * HCO3 _\>_ 18 (16) * ketosis resolved * able to tolerate diet * at a mealtime is preferred * smoother transition

Question 40

fasciotomy

Answer 40

lateral incision to relieve pressure from compartment syndrome

Question 41

nausea and vomiting during chemo

Answer 41

* generally begins 2 hours after chemo starts and persists 6 hours or days post chemo cycle * increased anxiety * food aversions * persists beyond illness course, can affect nutrition * secondary issues from meds, steroids * don't give them their favorite thing until they're feeling better

Question 42

patent ductus arteriosus

Answer 42

* increased pulmonary blood flow * oxygen-rich blood from aorta flows through PDA into pulmonary artery and into the lungs * two ways to the lungs: pulmonary artery + PDA * amount depends on * size of PDA * pulmonary and * systemic resistance pressures * corrected surgically or with medication

Question 43

restoring intravascular, extracellular volume at moderate pace during DKA episode

Answer 43

* NS 10-20 mL/kg over 1 hour (closer to 10ml) * treat dehdyration * may repeat ONCE if clinically indicated * no more tahn 40 ml/kg in 1st 4 hours * fluids * 0.45-0.9% saline maintenance or 1.5 x maintenance * no more than 4L/m2/day * replace deficit over **36-48 hours** * therapy should normalize osmolality changes from vomiting and diarrhea and decrease symptoms

Question 44

primary issue with complex partial seizure patients

Answer 44

SAFETY

Question 45

anemia where RBC is made but lost

Answer 45

* spleen issues * splenic sequestration * femur fracture

Question 46

nursing interventions for septic arthritis

Answer 46

* derm and drugs and disability * antibiotics, resting, keep joint still, raise joint, cool compress for pain, exercise for healing process * fluids and electrlytes * aspirate joint fluid for cell count, gram stain, culture * MRI, ultrasound, good hx, good assessment * differentiate between osteomyelitis and septic arthritis

Question 47

TBI from child abuse

Answer 47

* usually shaking * irritable * retinal hemorrhaging

Question 48

HDL cholesterol

Answer 48

* builds/maintains cell membranes * necessary to manufacture bile * necessary to absorb fat and ADEK * insulates nerve fibers * aids in production of adrenal gland hormones * aids in production of sex hormones * helps remove LDL * carries LDL to liver for breakdown and metabolism

Question 49

assessment QUESTIONS for brain tumors

Answer 49

* how long? what makes it better? what do you do? * can you bend your neck? ruling in/out meningitis * is it worse in the morning? do you have emesis with your headache? when, how much? * tired? * photophobia? * PERRLA * Glasgow * head circumference if fontanels not fused

Question 50

other risk factors for cerebral edema r/t DKA

Answer 50

* insulin bolus \> 0.1 units/kg * more fluid and solute in 1st 6 hours * younger age * new onset * longer duration of symptoms * severity of acidosis * effective plasma osmolality drop from 300 to 285 * BUT do not see expected rise in serum Na as glucose falls

Question 51

contracoup

Answer 51

opposite side of brain from impact of TBI

Question 52

electrolyte complications from bedrest

Answer 52

high creatinine from muscle breakdown

Question 53

nursing interventions for osteomyelitis

Answer 53

* blood culture * skin care * asceptic technique when changing dressings * support affected limb * pain meds * antibiotics * well balanced diet to promote healing

Question 54

The B symptoms of lymphoma

Answer 54

* fever * significant weight loss * drenching night sweats * indicates poorer prognosis of Hodgkins' lymphoma

Question 55

Answer 55

* no inferior vena cava * big VSD * translocation of aorta and pulmonary artery * total anomalous pulmonary venous return

Question 56

downside of pump + CGM

Answer 56

* \< 15% downloaded data more often than 1x month * 41% discontinued use within 1 year

Question 57

aortic stenosis

Answer 57

* obstructive lesion * blocking blood from coming out of left ventricle into systemic circulation * if there's no communication to right side: * blood backs up in LV to LA to pulmonary veins and back into lungs * overcirculation into lungs * tachypnic, may or may not be blue * can have same symptoms from other defects, however

Question 58

pulmonary stenosis

Answer 58

* narrowing/stenosis of pulmonic valve * increased work on RV * severity of defect determines presentation * can be severe in infants, causing cyanosis * treatment * initial - balloon valvotomy * surgery

Question 59

musculoskeletal complications from bedrest

Answer 59

* lose 1-2% of muscle every day * decreased strength * decreased ROM * muscle weakness

Question 60

pathophysiology and treatment of hypercanotic spells (TET spells) in tetrology of fallot

Answer 60

* occur b/c of change in blood flow. try to: * increase systemic vascular resistance * decrease pulmonary vascular resistance * kids will instinctively squat to push up blood to heart (especially from liver) * put babies in fetal position

Question 61

humalog (insulin lispro)

Answer 61

* rapid acting * onset 5-15 minutes * peak 1-2 hours * duration of action 3-4 hours * 10 units/mL for children \< 15 kg

Question 62

restrictive cardiomyopathy: treatment

Answer 62

* none specific * CHF * symptom tx options * diruetics * digitalis * vasodilators * antiarrhythmics * lifestyle changes

Question 63

CNS pathophysiology of drowning

Answer 63

* 2 minutes to lose consciousness * 4 minutes for irreversible brain damage * cerebral edema * hyperglycemia * seizures * cause you to swallow water

Question 64

receiving clotting factor for hemophilia

Answer 64

* can get it at home * possibly prophylactically to reduce risk * often only after trauma or before surgery * don't want bleeds * especially in joint or head

Question 65

LDL cholesterol

Answer 65

* clogs arteries * coronary heart disease * heart attack * stroke * death * contributes to plaque buildup, athersoclerosis, peripheral artery disease

Question 66

anemia where RBC made but unhealthy

Answer 66

* sickle cell * thalassemia * malnutrition * not enough iron capability

Question 67

causes of pediatric cancer

Answer 67

* usually unknown * familial cancers rare in children * viral - some associated with Epstein-Barr virus (EBV) * 3/1000 develops cancer before age 20 * leading cause of death from disease in US children * cure rates continue to improve * secondary cancer from tx * radiation * chemo

Question 68

risk factors for osteomyelitis

Answer 68

* poor blood supply * recent injury * use of injected illegal drugs * asplenic patients

Question 69

bone marrow draw

Answer 69

* drawn from iliac crest or femur with big hollow needle * can also infuse fluid into marrow * intraosseus line * for kids without good veins (short term)

Question 70

pathophysiology of TBI

Answer 70

edema compresses brian and causes increased intracranial pressure, hypoxia, or impaired perfusion headache does not rule in or out a TBI

Question 71

cardiac physiology

Answer 71

CO = stroke volume X heart rate influenced by: * preload * afterload * compliance * contractility

Question 72

breathing and brain assesment for SCD

Answer 72

* increased WOB * acute chest * pneumonia then crisis, or crisis then pneumonia? * wheezing, atelectasis, no aeration * assess lungs w/o clothes and auscultate all fields

Question 73

nutritional therapy management for pediatric cancer patients

Answer 73

* many patients malnourished * increased metabolic demands * lost appetite from side effect of medicines or depression * nutritional support for 5% of wt loss * monitor albumin and prealbumin levels * teach patient to use nutritional supplements * enteral or parenteral nutrition may be needed

Question 74

central nervous system tumors

Answer 74

* requires aggressive, multimodal therapy * tumor location is important * dictates presenting symptoms * determines extent of surgical resection that is safely possible * suggests pathological diagnosis

Question 75

inducing fetal hemoglobin

Answer 75

* can help with sickle cell crises * hydroxyuria (chemo drug) * bone marrow suppression * hair loss * fatigue

Question 76

causes of increased intracranial pressure

Answer 76

* hydrocephalus - increased fluid * head trauma

Question 77

unique nursing assessments of neuroblastomas throughout body

Answer 77

* sinus or orbits of eyes * periorbital bruising, proptosis (eye drooping) * thoracic/abdominal cavity * hypertension * bladder/bowel function * dyspnea

Question 78

mixed cardiac lesions

Answer 78

* truncus arteriosus * transposition of great vessels * double outlet right ventricle (DORV)

Question 79

osteoblasts

Answer 79

build bone

Question 80

bicarb in DKA

Answer 80

* as metabolic acidosis develops, bicarb used as buffer * results in increased anion gap

Question 81

SCD symptoms of spleen

Answer 81

* infarct in the spleen leads to fibrosis * nonfunctioning spleen * increased number of infections

Question 82

think like a plumber: pressure, resistance, flow

Answer 82

* blockage or absence of flow * create new pathways * where passage is too small * enlarge pathway * where flow is going the wrong way * redirect the flow

Question 83

renal pathophysiology of drowning

Answer 83

* hypovolemia * poor perfusion

Question 84

nutritional status among pediatric cancer patients

Answer 84

* hematological malignancies vs solid tumors * solid tumors have most weight loss and nutritional deprivation * liquid tumors - drugs cause hunger and odd food cravings * assess: questions * how frequently do they eat? diet?

Question 85

Salter classification

Answer 85

ways to classify growth plate injuries (I - IV)

Question 86

treatment of familila hypercholesterolemia

Answer 86

* diet is 1st step * DASH - dietary approach to stop HTN * fruits, veggies, whole grains, low fat milk, decreased sugar * portion intake, dietary fiber, limit Na intake * lower LD - dietary fiber, plant sterols * lower TG - dietary fiber * statins for _\>_ 8 yo * lovastatin, simvastatin, rosuvastatin

Question 87

cardiac output

Answer 87

Question 88

causes of aplastic anemia

Answer 88

* congential (eg Faconi's) * autoimmune * toxins * viral

Question 89

staging of Hogkin's lymphoma

Answer 89

* Stage 1 or 2: lymphadenopathy above diaphragm * Stage 3 or 4: lymphadenpathy below diaphragm * staging laparotomy * open child from xiphoid to pubis to take many lymph node biopsies * figure out how many nodes involved and where they are in relation to diaphragm

Question 90

differences between Ewing's and osteosarcoma

Answer 90

* time to present symptoms: 8 mo (E) vs 5 mo (O) * age: 12 (E) vs 15 (O) * fracture * pain, localized, pain at rest * fever * weight loss * challenges with location * Ewing's and extraosseous location

Question 91

things to remember on cardiac physical exam

Answer 91

* all 4 extremity pulses and BP's * tachypnea (RR \> 50) in a baby may be a sign of too much pulmonary blood flow * crackles one of last signs of HF in children * be patient, take as much time as needed * ask for help/2nd opinion * DOCUMENT

Question 92

tumor lysis syndrome

Answer 92

* cells rupture and burst from toxic drugs * risk factors: high WBC and certain chemo agents * electrolyte side effects * hyperkalemia * hypocalcemia * hyperuricemia * hyperphosphatemia * complications * acute renal failure * cardiac issues * neurologic issues * early recognition is KEY

Question 93

complex partial seizure

Answer 93

* focal seizure w/ change/loss of consciousness * postictal amnesia * motor and sensory symptoms * aura (taste or odor) * anxiety, fear, deja vu * automatisms (lip smacking, chewing, sucking)

Question 94

tricuspid atresia

Answer 94

* missing or abnormal tricuspid valve * obstructed flow from RA to RV - backs up in RA * decreased pulmonary blood flow * foramen ovale or atrial septal defect often there * if not, created temporarily by cath lab * otherwise, NO circulation through heart * creates mixing of blood - blue babies * often occurs with other defects * symptoms: cyanosis, dyspnea, tachypnea, growth failure

Question 95

septic arthritis definition

Answer 95

* inflammation of joint due to a bacterial or fungal infection. * septic arthritis that is due to bacteira that cause gonorrhea has different symptoms and is called gonococcal arthritis

Question 96

differential diagnosis of paroxysmal episodes in children

Answer 96

* breath holding * migraine * sleep disorder * night terrors * movement disorders (tics) * toxins and drugs * psychological problems * don't have electrical disturbances in brain that would classify them as seizures

Question 97

secondary symptoms of Kawasaki disease

Answer 97

* cardiac: new murmur, abnormality in conductive electricity * GI: V/D, abdominal pain, jaundice * blood: leukocytosis, thrombocytosis * GU: proteinuria * respiratory: URI symptoms, cough, rhinorrhea * musculoskeletal: joint pain * CNS: seizure, facial palsy, paralysis of extremities

Question 98

interrupted aortic arch

Answer 98

* surgical emergency * prenatal care and ultrasounds can prevent this * HR will be different, poor APGARS * can't sustain systemic circulation AND/OR getting blue blood

Question 99

nursing assessment for Perthe

Answer 99

* first symptom is often limping, usually painless * may be some mild intermittent pain * other symptoms include: * hip stiffness that limits movement * knee pain * limited ROM * persistent thigh/groin pain * short leg * muscle loss in upper thigh

Question 100

long term toxicity of cancer therapy

Answer 100

* vincristine induced neuropathy * osteonecrosis * myelosuppression * impairment of function * risk of obesity * infertility * myocardial infarct (esp with mediastinal radiation)

Question 101

ongoing hemodynamic assessments of single ventricle physiology

Answer 101

* pressures * rhythm - cannot afford to have dysrhythmia * rate * saturations * voltage * need to keep preload high to help R ventricle with some passive flow and reduce intensity of workload on RV

Question 102

cardiomyopathy: treatment

Answer 102

* fluid, Na restriction * decrease cardiac workload * preload increases and pools * can get in but not out * compliance decreases * cannot constrict down to normal size * DVT prophylaxis * risk of clots and emboli b/c of pooling * transplantation * depending on cause and severity

Question 103

congential adrenal hyperplasia

Answer 103

* females may have ambiguous genitalia * autosomal recessive, enzyme deficiency * inadequate production of cortisol, aldosterone * requires lifelong glucocorticoid replacement * any stress causes dysregulation * surgery, infection, life stress * risk for severe hyponatremia (seizure/shock) * baseline steroid dose increased 2-3X usual * parents and school taught to give IM hydrocortisone in emergency

Question 104

nursing assessments for hemophilia

Answer 104

* **neuro - glasgow** * full assessment to look fo rhematomas elsewhere * cerebral * joint assessment - full ROM * brusing assessment

Question 105

non-hodgkin's lymphoma

Answer 105

* lymphoblastic lymphoma * burkitts lymphoma * large cell lymphoma

Question 106

vitals of complex partial seizure

Answer 106

* AIRWAY * SAFETY * high or low HR * high or low RR, maybe some apnea * random vitals * needs assessment (HR, RR, O2, temp) * most of the tiem: * slow, less labored breathing with apnic spells (worrisome) * issue with children - need to maintain respiratory system

Question 107

growth plate damage

Answer 107

* suspect even if X-ray is negataive * need MRI to confirm * infection can spread from growht plate * common because bones are stronger than plates in children

Question 108

priorities for tonic-clonic seizure

Answer 108

* **airway** * b/c of apnea and RR need **oxygen right away** * always in child who loses consciousness * can't bag - blow by or nasal cannula * may not hear aeration in bases of lungs * safety

Question 109

SCD symptoms of brain

Answer 109

* cerebrovascular accident * headache * aphasia * convulsions * visual disturbances

Question 110

thalassemia assessment

Answer 110

* similar to sickle cell * skin - color, breakdown * joint pain * different presentation

Question 111

nursing assessment for septic arthritis

Answer 111

* newborns/infants: * cries with infected joint is moved * fever * inability to move limb (pseudoparalysis) * irritability * children/adults * inability to move limb * joint swelling, redness, intense pain * fever

Question 112

ventricular septal defect (VSD)

Answer 112

* most common * left to right shunt * left side pressure higher than right side * hole in septum between ventricles * surgical correction, depending on size and patient status * without correction * CHF * pulmonary hypertension * growth failure * lower down its more muscular but higher up it's more membranous and won't repair on their own (lower ones may if they're small)

Question 113

complications and side effects of chemo and associated medications?

Answer 113

* generalized hypersensitivity * benadryl * stop medications if affecting respiratory system

Question 114

SCD symptoms of extremities

Answer 114

* vaso-occlusion and chronic ischemia * peripheral neuropathy * weakness * arthralgia

Question 115

diabetes insipudus overview

Answer 115

* central (neurogenic) * trauma, tumor, neurosurgical procedures * ADH deficiency

Question 116

S/Sx of hydrocephalus

Answer 116

* bulging/full fontanels * head circumference * irritability (young child) * headache (older child) * photophobia possibly

Question 117

circulation assessment during chemo

Answer 117

* assess: heart rate, peripheral perfusion (many chemo meds are cardiotoxic) * interventions: * cardiac monitor * +/- IV fluids (depends on cardiac ejection fraction, echo) * assess I&Os

Question 118

nervous system complications from bedrest

Answer 118

* depression * example: * women who have a history of depression have a higher incidence of hip fractures

Question 119

treatments for cerebral palsy

Answer 119

* botulinum toxin * oral antispastic drugs * benzos, baclofen * orthopedic * long limb lengthening, shin guards, crutches * physical therapy * feeding and nutrition * skin care * GOAL is to stop spasms

Question 120

absence seizures

Answer 120

* generalized (formerly petit mal or lapses) * almost always in childhood (4-12 years) * remission in adolescence * no warning/aura * brief 10-15 seconds * motor Sx: lip smacking, eye/face twitch, slight hand movements * no postictal confusion or sleepiness * minimal/no change in muscle tone * may drop object, rarely falls * may cluster * often misdiagnosed * inattention, daydreaming, ADD/ADHD * need EEG to confirm presence of seizure activity

Question 121

cardiac exam: heart

Answer 121

* rate * rhythm * sounds * distinct vs muffled * loud vs weak * murmurs * clicks * palpable PMI

Question 122

types of decreased pulmonary blood flow lesions

Answer 122

* pulmonary atresia * tricuspid atresia * tetrology of fallot

Question 123

single ventricle physiology: treatment

Answer 123

* palliation / staged repair * 3 stages * neonatal * 5-7/8 mo * ~ 4 yo * long term medical and surgical management * family education and support

Question 124

causes of bleeding dx

Answer 124

* imbalance in clotting factors * bad/inadequate platelets

Question 125

osteosarcoma

Answer 125

* type of cancerous bone tumor that usually develops in teenagers when bone is growing rapidly * average age at diagnosis is 15 * sometimes presents as fracture r/t growing tumor

Question 126

intra-venous immunoglobulin

Answer 126

* for Kawasaki disease * neutralizes circulating antibodies * suppresses inducer T & B cells; supports suppressor T cells * blocks some macrophage receptors * promotes re-myelination * reduce prevalence of coronary abnormalities

Question 127

DKA bicarb Tx

Answer 127

DO NOT USE * acidosis * will correct with insulin and fluid * rarely causes hemodynamic instability * may increase hepatic ketone production * increases likelihood of hypokalemia * may increase tissue hypoxia * may cause paradoxic acidosis of CSF * associated w/ risk of cerebral edema

Question 128

if a patient comes in with a complex partial seizure, what questions to ask?

Answer 128

* when did this start, how long? * what precipitated? * seizure hx? * meds (miss a dose, too much of it? sick and meds won't work)? * falls? * primary issues * **safety - patients unfocused** * neuro assessment * patient teaching at discharge

Question 129

assessing neuroblastoma in abdomen

Answer 129

* decreased urine output * constipation * abdominal tenderness * compromised lung expansion

Question 130

differentiate neuroblastoma from Wilms tumor

Answer 130

* neuroblastoma of abdomen has a lot of secondary S/Sx * 24 hour urine sample for uric acid (neuroblastoma) * labs - high potassium, catecholamines (neuroblastoma) * ultrasounds, CAT scans

Question 131

where to treat DKA

Answer 131

* Consensus Statement recommends general, PICU or other unit with capacity to * support frequent assessment/labs * have nursing staff experienced in caring for patient population (low staffing ratio) * has written guidelines

Question 132

history questions to ask about seizures

Answer 132

* what was the child doing * did the child complain of being ill or feeling funny * trauma * medications, poisons * arm/leg movements, one side or both sides * chewing, automatisms * pupils dilated or deviated * change in color * incontinent * aware and able to respond * how long did it last * lethargic, weak, uncoordinated after waking up * loss of memory, confusion

Question 133

nursing interventions for aplastic anemia

Answer 133

* **hand washing to prevent infection** * provide safe environment so they don't bleed or fall * assess for bleeding * blood products * cellular stimulating factor to make more WBCs * platelet transfusion * possibly antibiotics

Question 134

atrial septal defect (ASD)

Answer 134

* left to right shunting * higher pressure on left side * hole in wall that separates atria * possibly foramen ovale * possibly defect in week 16

Question 135

risk factors for febrile seizures

Answer 135

* male * first born * family hx * risks until 5th birthday

Question 136

interrelations between siblings and parents in families living with children with cancer

Answer 136

* stressful * social * adjustments * unpredictable * separation * life changes

Question 137

coarctation of the aorta

Answer 137

* narrowing/pinching of aorta * often at level of PDA (not always) * blood backs up behind coarct and flows back to pulmonary artery via PDA * if PDA closes, baby is in shock * increased blood flow to head and upper body * decreased systemic circulation * bounding upper pulses, decreased or non-palpable lower pulses * systolic BP difference between UE and LE ~ 15-30 mmHg * hypotension and acidosis (not enough CO to oxygenate tissues) * can cause hypertrophy of LV w/o correction (usually w/in first few days of life)

Question 138

what is congenital heart disease (CHD)?

Answer 138

* structural malformation or absence of one or more heart chambers AND/OR * deformity of major intrathoracic blood vessel(s) AND/OR * postnatal persistence of fetal cardiac structures(s) AND/OR * absent or non-functional intracardiac valves

Question 139

tetrology of fallot

Answer 139

* 4 things wrong * pulmonary stenosis * RV hypertrophy b/c of working hard * ventricular septal defect for some circulation * overriding aorta * overrides septum and gets blood from both sides of heart

Question 140

types of obstructive lesions

Answer 140

* coarcted aorta * interrupted aortic arch * aortic stenosis

Question 141

diagnosing seizures and epilepsy

Answer 141

* positron emission tomography scan (PET) * electrencephalogram (EEG) - doesn't always confirm * MRI * CT scan * can diagnose type, epilepsy syndromes * normal EEG does not exclude diagnosis of epilepsy * need history in conjunction

Question 142

cardiomyopathy overview

Answer 142

* disease of heart muscle * idiopathic or related to systemic disease that affects cardiac muscle * three types * dilated * hypertrophic * restrictive (rare in children)

Question 143

assessment of tumor lysis syndrome/electrolytes during chemo

Answer 143

* assess: * cardiac - stress, fluid overload * skin, edema, peripherals * interventions: * cardiac monitor always * neuro checks * high flow fluids and strict I&Os * not restricted, just monitored

Question 144

nursing assessment for idiopathic scoliosis

Answer 144

* school screenings vs primary care visits * psychosocial * measuring curve

Question 145

dyskinetic cerebral palsy

Answer 145

* affects term infants and usually results from severe, acute perinatal asphyxia * neonatal presentation includes * encephalopathy * lethargy * decreased spontaneous movement * hypotonia * suppressed primitive reflexes

Question 146

cortex

Answer 146

rich in nerves and vasculature, heals faster

Question 147

Kawasaki disease overview

Answer 147

* vasculitis aka mucocutaneous lymph node syndrome * "infection" of vascular system that weakens walls of vessels * one of two leading causes of acquired heart disease in US children * etiology unknown * 80% children 1-5 yrs * pathophysiology * acute, diffuse, vasculities of medium size arteries and small vessels of body, particularly coronary arteries * potential for coronary artery aneurysm (or anywhere)

Question 148

airway, breathing, brain assessment during chemo

Answer 148

* assess: respiratory rate, aeration, chest pain, SOB * intervention: oxygen, cardiac monitor, pulse ox, pristine exam * assess: neurological status - Glasgow * intervention: Glasgow, seizure precautions (rails up, O2, cardiac monitor)

Question 149

early pathophysiology of DKA

Answer 149

Question 150

common DKA complications

Answer 150

* hypoglycemia * hypokalemia

Question 151

bone scarring

Answer 151

* thickening or irregularity on x-ray * when fracture not taken care of properly, there is an irregular line * osteoclasts try to come in and clean it up but because it's not set properly, they can't do a good job * can inject a dye to see metabolically active areas * osteoclasts trying to heal, get rid of scarring

Question 152

buckle fracture

Answer 152

* "toddler fractures" * little nub or area where there was a bruise or break * shor term fiberglass cast (2-3 weeks) * kids may be missed * challenging pick-up * but will heal very well

Question 153

best control of diabetes

Answer 153

* use of inuslin pump * BG checks \> 5x /day * bolus before meals * use an insulin/carb ration based on meal * insulin dose for snacks

Question 154

DKA assessment

Answer 154

* severe DKA * dehydration * buffer system overwhelmed (bicarb low) - primary mechanism * elevated RR * hyperglycemic * K+ high normal * low bicarb

Question 155

complications of hyperthyroidism

Answer 155

* risk for thyrotoxic crisis * "thyroid storm" * triggers: stress, infection, surgery * hypermetabolic state - emergency * tachycardia, hyperpyrexia * Tx: beta blockers, supportive * risk for atrial fibrillation

Question 156

hypertrophic cardiomyopathy: treatment

Answer 156

* beta adrenergic agonists * calcium channel blockers * diuretics and inotrope with cauation * pacing * surgical resection

Question 157

cerebral edema r/t DKA

Answer 157

* develop in first 3-12 hours of therapy * 0.3-1% of children with DKA * rare in adults * children may have mild cerebral edema that is asymptomatic * pathophysiology not identified * recent studies support vasogenic cerebral edema, reperfusion injury * most common cause of morbidity & mortality (25%) in KDA in pediatric patient

Question 158

fracture treatments

Answer 158

* cast * plaster vs fiberglass * sling * splint * traction * operative fixation

Question 159

vitals of simple partial seizures

Answer 159

* ABCs - might not be immediately critical but always worry about airway * color, cyanosis? * distressed? * aware, awake, responsive? * perfusing? * tachypnic, w/ or w/o fever * tachycardic * O2 probably at 99 * possibly fluctuating temp if not a febrile seizure * patient usually not distressed

Question 160

pulmonary pathophysiology of drowning

Answer 160

* as little as 3 ml/kg of water can alter pulmonary gas exchange * often head injury or spinal cord inury involved in near-drowning * pulmonary vasoconstriction and hypertension * disruption of alveolar surfactant

Question 161

types of bone tumors

Answer 161

* osteosarcoma * Ewing's sarcoma * malignant round cell * can be in genitourinary tissue too * management is identical

Question 162

circulation assessment of liquid tumors

Answer 162

* poor perfusion * poor distal pulses * tachycardic - decreased RBCs

Question 163

thalassemia presentation

Answer 163

Question 164

risk factors for cerebral palsy

Answer 164

* random mutations * maternal infections * rubella, varicella, cytomegalovirus, toxoplasmosis, syphilis, toxins, **bacterial meningitis)** * premature birth * low birth weight * fetal stroke * lack of oxygen * infant infections * traumatic head injury

Question 165

normal hemoglobin

Answer 165

Hb-A (alpha2-beta2)

Question 166

dilantin side effects

Answer 166

* huge dental mess - effects eruption of future tooth growth * speech impediment * cavities * exensive dental work * bacterial endocarditis * tooth discoloration * nutrition issues

Question 167

causes of generalized seizures

Answer 167

* fever * head trauma * epilepsy * infection * sepsis, meningitis * syphilis, gonorrhea * drug ingestion * dehydration (hypo/hypernatremia) * cardiac problem/underlying dx * some meds * tumors

Question 168

diagnosis of diabetes

Answer 168

* polyuria * polydipsia * polyphagia * fasting blood sugar \> 126 mg/dl * random blood sugar \> 200 mg/dl on 2 separate occasions

Question 169

lymphoma

Answer 169

* cancer of lymph nodes or spleen * alteration in WBC production in lymph nodes * can metastasize from lymph to blood * Hodgkins or non-hodgkins

Question 170

transfusion reactions

Answer 170

* allergic: urticaria, itching, respiratory distress * hemolytic: fever, chills, hematuria, chest pain * febrile/septic: chills, fever, headache, decreased BP * volume overload: CHF benadryl could mitigate future rxns shouldn't see a change in vitals if there is NO rxn

Question 171

Novolog (insulin aspart)

Answer 171

* rapid acting * onset 10-30 minutes * peak effect 1-3 hours * duration of action 3-5 hours

Question 172

define pediatric palliative care

Answer 172

* interdisciplinary specialty * goal of ensuring best quality of life for children with life threatening illnesses * by minimizing suffering from distress * physical * psychological * emotional * spiritual

Question 173

transitional circulation

Answer 173

* **Fetal --\> Neonatal** * intracardiac shunts --\> no intracardiac shunts * High PVR --\> low PVR * Low SVR --\> High SVR * Low CO --\> High CO * gas exchange in placenta --\> gas exchange in lungs

Question 174

diabetes disparities

Answer 174

* minorities more likely to NOT have a pump * the group with the lowest pump use (after adjusting for SES) had higher A1c, more dKA, more severe hypoglycemia, 9X mortality

Question 175

bladder and bowel assessment during chemo

Answer 175

* asses: urine output and stool * complications depend on tumor location * diarrhea and hematuria from chemo, radiation * complications from metastasis * opioids and constipation * interventions * diet for diarrhea, IV fluids if persistent * urine dip for hematuria * bowel sounds

Question 176

carb:insulin ratio

Answer 176

* to adjust for carbs eaten at meals * gm carbs : 1 unit insulin * or "carb unit" - 15 gm carbs = 1 carb unit * 15:1 - for every 15 gm carbs take 1 unit rapid acting insulin * correction formula based on * actual blood glucose - goal is 50-100 * BG 150/50 * for every 50 points the blood glucose is over 150, take 1 unit rapid acting insulin

Question 177

bone remodeling

Answer 177

* osteoblast and osteoclast activity * want them in balance * increase osteoblasts by low impact exercise * weight bearing is best, but any movement * physical therapy for bed-ridden child * estrogen turns off osteoclasts * menopausal women ahve problems with osteoporosis * especially in spinal colum * especially with bad diet and/or no exercise

Question 178

concerns/complications for hyperglycemic hyperosmolar syndrome

Answer 178

* more profound dehydration * greater electrolyte deficits * higher risk for mental status changes * more frequent complications, higher mortality rate * 10X greater than with DKA

Question 179

decreased pulmonary blood flow: overview

Answer 179

* cyanotic heart disease * obstruction of flow to lungs and cannot be oxygenated * pulmonary stenosis, tetrology of fallot, tricuspid atresia * degree of cyanosis * dependent on degree of shunting or obstruction * long term problems * polycythemia, clotting abnormalities, cerebral infarcts, pulmonary vascular disease * supportive therapy * PGE1 (prostaglandins) * to keep PDA open until defect can be corrected

Question 180

leukemia

Answer 180

* cancer of blood * alteration in WBC production in bone marrow

Question 181

humulin R, novolin R insulins

Answer 181

* regular insulin * only type given IV * onset 3 minutes IV, 30 minutes SQ * peak effect 2-4 hours SQ * duration 6-8 hours SQ * prime or not prime?

Question 182

normal hemostasis pathway

Answer 182

1. damage to vessel wall 2. platelet plug 3. fibrin clot

Question 183

3 catgories of idiopathic scoliosis

Question 184

nursing teaching points to prevent crisis

Answer 184

* more frequent exacerbations and hospitalizations have poorer prognosis * education re: antibiotics and compliance * understand precipitating events * hydration, oxygenation, extreme temperature * exercise, alcohol, vomiting * fatigue, pregnancy, swimming

Question 185

SCFE is common in:

Answer 185

* 11-15 yo, especially boys * obese * growing rapidly * homrone imbalances s/t other conditions

Question 186

SIADH treatment

Answer 186

* fluid restriction (2/3 maintenance) * +/- diuretics

Question 187

canal

Answer 187

* hematopoesis - blood storage * especially in long bones (femur) * can lose liters of blood into your thigh in minutes

Question 188

nursing assessments for aplastic anemia

Answer 188

* similar to SCD and thalassemia * derm * petechiae, ecchymosis, brusing - from bleeding * GI * hematuria * heme-positive stool * low grade fever, risk for infection

Question 189

how many fractures involve growth plates?

Answer 189

20%

Question 190

spastic cerebral palsy

Answer 190

* upper motor neuron, hypertonia, hyperreflexia, extensor plantar responses and clonus * affected patients have slow effortful voluntary movements, impaired fine-motor function

Question 191

history of palliative care

Answer 191

* ~55,000 infants, children, adolescenst die in US each year of complications from prematurity, congenital defects, genetic dx, injuries, malignancies * 23,000 babies die w.in first year of life * 65% of children who die in PICU had chronic or pre-existing condition

Question 192

neuroblastoma

Answer 192

* most common solid tumor occurring outside cranium * average age: 2 years * occurs anywehre along sympathetic nervous system * abdomen, adrenal, thoracic regions * neural crest cells * why it's a neuroblastoma

Question 193

long-term brain function in children with hydrocephalus

Answer 193

usually long-term executive function problems, but not necessarily mental disabilities

Question 194

risk factors for pressure ulcers

Answer 194

* prematurity * fragile skin, little fat, don't move * critical illness * neurological issues * spinal cord injury * myelomeningocele * nutritional deficit * tubes, pressure, bed rest

Question 195

assessment for hydrocephalus

Answer 195

* vitals * worrisome = high systolic, bradycardia, apnea (late findings r/t increased intracranial pressure) * pulses LE/UE * fluid restriction * Glasgow * pupil checks - PERRLA? * prolonged increased intracranial pressure can herniate brainstem and cause full/dilated/blown pupils

Question 196

respiratory system in DKA

Answer 196

* related to metabolic acidosis * exacerbates decreased bicarb * kussmal breathing (buffer system has been overwhelmed) * moved from primary to secondary system

Question 197

fetal hemoglobin

Answer 197

* Hg-F * fetal hemoglobin is still normal even with two copies of the Hb-S gene

Question 198

blood transfusion for SCD

Answer 198

* improve oxygenation * too frequent = iron overload * iron-chelating drugs * deferoxamine

Question 199

idiopathic scoliosis definition

Answer 199

* asymmetry of shoulder height, scapular or flank shape or hip height * sideways curve of backbone or spine * often S or C shaped * most common in late childhood/early teens when growth is fast * girls more likely than boys, genetic predisposition * symptoms include leanign to one side, uneven shoulders/hips

Question 200

lantus (glargline insulin)

Answer 200

* long acting * onset 1-2 hours * peak - no pronounced peak * duration 18-24 hours

Question 201

unique assessment of retinoblastoma

Answer 201

* cat's eye * complaints of poor vision * one or both eyes turning inward or outward * pain from increased pressure as tumor grows * later finding * poor tracking * manual palpation of face - bruising, indentation * lid lag or eye deviation

Question 202

incidence of aplastic anemia

Answer 202

* 500 people diagnosed every year * more common in young adults * most cases of severe aplastic anemia are autoimmune disorders

Question 203

diabetes insipidus teaching

Answer 203

* signs of dehydration * how/when to give DDAVP (bedtime dose) * school * extra bathroom breaks, extra water/fluids

Question 204

characteristics of pediatric cancer

Answer 204

* rapidly dividing/growing cells * do not follow normal cell signals * do not self-destruct (apoptosis) * something in the patient's genes has gone awry * associated with chromosomal abnormalities

Question 205

nursing interventions for child with increased intracranial pressure

Answer 205

* neuro - Glasgow * head of bed up * strict I&Os * labs * urine output * GI * head circumference * fontanelles

Question 206

how to prevent late findings of hydrocephalus

Answer 206

* **positioning - keep head up 30-45 degrees** * vitals * neuro exam * strict I&Os * pupils * dark room, minimal stimulation

Question 207

SCD symptoms of skin

Answer 207

decreased peripheral circulation (leg ulcers)

Question 208

generalized seizure

Answer 208

involve both hemispheres

Question 209

incidence of retinoblastoma

Answer 209

* 250 to 250 children/year * 4% of all cancers in children younger than 15 yo * 40% of patients have genetic defects that leads to multiple tumors in one or both eyes * hereditary or germline retinoblastoma * usually diagnosed before age 1

Question 210

pharmacologic support of single ventricle physiology

Answer 210

* catecholamines * afterload reducers * prostaglandins * diuretics * medication education

Question 211

osteoclasts

Answer 211

break down bone

Question 212

dilated cardiomyopathy: overview

Answer 212

* etiology unknown * dilated LV and systolic dysfunction * effects both systolic and diastolic function * +/- RV dysfunction * results in CHF * run risk of thrombus in legs * CO to legs is bad, venous return is bad

Question 213

family concerns r/t diabetes

Answer 213

* intial diagnosis * grieving r/t chronic diagnosis * guilt, sadness * implications for lifestyle * emergency management * planning always involved * technology experts * math wizards (counting carbs, mixed foods)

Question 214

sickle cell anemia testing

Answer 214

* newborn screening (mandated) * can prevent risk of stroke, pneumonia * genetic testing (prenatal) * 20% of children with sickle cell do not make it to their 21st birthday despite tx and management

Question 215

sickle cell hemoglobin

Answer 215

* Hb-S * still works but causes RBC to be misshaped and not flow through vessels

Question 216

diabetes insipidus pathophysiology

Answer 216

* water loss through urine * dilute: low SG, low glucose, low osmolality * younger child, more rapid dehydration * treatment * fluid replacement, including urine output * IV vasopressin initially, then DDAVP

Question 217

physical assessment of tonic-clonic seizure

Answer 217

* oxygen, blow by, nasal cannula * airway, breathing, circulation * BP, peripheral pulses, skin, cap refill * Glasgow * IV if possible, if not - suppository (valium, ativan) * don't give maintenance dose - need rescue * plus, may have had too much already * labs - tox screen, electrolytes (Na, K), CBC (infection), blood culture, D- stick in the meantime for hypoglycemia

Question 218

bedside glucose monitoring

Answer 218

* standard allowable error rate is 15-20% * ex: at glucose of 60, range = 50-70 * be aware of error range * Hct * low overestimates glucose * high underestimates glucose * other factors affecting accuracy * creatinine, bilirubin * pH * TCO2 level * high PaO2

Question 219

dermatology assessment for SCD

Answer 219

* dusky * some clubbing * hypoxia * small vasculature don't do well under low oxygenlevels * compensate to perfuse better by enlarging vessels at end of digits

Question 220

Legg-Calve-Perthes disease definition

Answer 220

* avascular necrosis of femoral head * occurs when ball of thighbone in hip does not get enough blood, causing bone to die *

Question 221

status epilepticus

Answer 221

* continuous seizure lasting more than 5 minutes or a series of seizures with no return of consciousness during 5 minute period * medical emergency * AIRWAY (ABC) * medications * benzo (ativan, valium) * phenobarbital * phenytoin (dilantin), fosphenytoin (Cerebyx)

Question 222

locating ausculation points in cardiac exam

Answer 222

Question 223

pressure ulcers in children

Answer 223

* occiput 31% * sacrum 20% * foot 19%

Question 224

drug assessment for SCD

Answer 224

* oral penicillin - compliance issue * low dose but susceptible to UTIs, secondary infections * multi-vitamin

Question 225

define hemophilia

Answer 225

* usually inherited * little or no clotting factor * type A and B

Question 226

D, E, F, G, M assessment for liquid tumors

Answer 226

* D: unsuccessful antibiotics * E: falsified high WBC - not effective or mature * at risk for infection * F: not necessary dehydrationed - maybe from low-grade fever * G: no initial effects * M: achiness - bone marrow in overdrive (painful); muscle weakness

Question 227

incidence of perthes

Answer 227

* boys 5x more than girls * 4-10 yo * bilateral 10-15% * 1 in 12,000

Question 228

cyanotic infant - respiratory or cardiac problem?

Answer 228

suggests cardiac IF: * CXR - clear lung fields AND * ECG - normal for age AND * hyperoxia test * echocardiogram * structure and function * contractility * compliance * flow in and out

Question 229

right to left shunting

Answer 229

* unoxygenated * from pulmonary circulation to systemic circulation * body receives unoxygenated blood * cyanotic

Question 230

bad prognostic finding in cancers of the blood

Answer 230

many WBCs with high % being immature

Question 231

genetics of T1DM

Answer 231

* HLA gene typing - DR3 and DR4 * sharing two haplotypes: 12-24% * sharing one haplotype: 4-7% * sharing neither haplotype: 1-2% * identical twins

Question 232

focal/partial seizures

Answer 232

involve 1 hemisphere

Question 233

electrolyte pathophysiology of drowning

Answer 233

imbalances related to salt or fresh water submersion

Question 234

* infantile 0-3 years * juvenile 4-9 years * adolescent \> 10 years

Question 235

SCFE nursing interventions

Answer 235

* bedrest for weeks * try to stabilize as minimally as possible * no pins, traction, bedrest * osteotomy if necessary * crutches, pain, post op skin assessment * nutritional issues

Question 236

preload

Answer 236

end diastolic volume: volume of blood in ventricles at end of diastole but prior to contraction

Question 237

hemophilia type B

Answer 237

missing/low levels of clotting factor IX (9)

Question 238

cardiac exam: lungs

Answer 238

* aeration * symmetry * adventitious breath sounds * presence and/or radiation of murmurs * back, axilla

Question 239

pathophysiology of CHD lesions

Answer 239

* increased pulmonary blood flow * decreased pulmonary blood flow * obstructed pulmonary and/or systemic blood flow * mixed lesions

Question 240

nursing assessment/interventions for child with cerebral palsy

Answer 240

* airway mangement * brain imaging and EEG * skin - huge issue * nutrition - often with NG tube * musculoskeletal * social, family

Question 241

anemia, pancytopenia, neutropenia during chemo

Answer 241

* uncontrollable nose bleed associated with gagging, choking, aspiration * interventions: * direct pressure, ice packs, compression up nares * cauterize * humidified air * don't pack - won't stop bleeding, will cause aspiration * can stent capillaries with foley catheter * fresh frozen plasma and RBCs for extensive bleeding

Question 242

late pathophysiology of DKA

Answer 242

Question 243

Answer 243

* no left ventricle * aorta does not get blood flow b/c of aortic stenosis * atrophies * no distal blood flow to ventricle b/c of aortic stenosis AND mitral valve atresia * single ventricle physiology

Question 244

SCD symptoms of digits

Answer 244

painful swelling of fingers and toes

Question 245

DKA glucose Tx

Answer 245

* hyperglycemia will resolve before acidosis/ketosis * when glucose 250-200: * continue insulin, add dextrose to prevent swings to hypoglycemia * decrease glucose 50-100 mg/dl/hr * faster may lead to cerebral edema and hypoglycemia

Question 246

SCD symptoms of liver

Answer 246

* impaired blood flow from capillary obstruction leads to enlargement and scarring of the liver * hepatomegaly * cirrhosis

Question 247

cat's eye

Answer 247

* white-yellow mass or glow seen through pupil * usually first noticed when flash is used w/o red eye reduction * normally eye is red in response to camera flash, but retinoblastoma causes center of eye to have a white glow

Question 248

aura

Answer 248

* specific sensation that may occur before seizures * 10 seconds to five minutes, varied * anxiety and fear before seizure * may be easier to manage or intervene

Question 249

types of increased pulmonary blood flow lesions

Answer 249

* PDA * AV canal * VSD

Question 250

Curriculum Core Topics for diabetes

Answer 250

* describe diabetes disease process and treatment options * incorporate nutritional management into lifestyle * incorporate physical activity into lifestyle * use medications safely and for maximum therapeutic effectiveness * monitor blood glucose and other parameters & interpret and use results for self-management decision-making * prevent, detect, treat acute complications * prevent, detect, and treat chronic complications * develop personal strategies to address psychoscoial issues and concerns * develop personal strategies to promote health and behavior changes

Question 251

presentation of coarctation of aorta: young children

Answer 251

* headache, irritability * children * edema in periphery and in dependent area (genital/perineum) * decreased LE pulses, difference between UE and LE pressures

Question 252

goals for diabetes management

Answer 252

* type 1 * 0-6 years * 6-12 years * 13+ years * HbA1c measure of chronicity & severity * most improved 3-6 mo after dx

Question 253

unique assessments for brain tumors

Answer 253

* increased ICP * headache * vomiting (especially in the morning) * lethargy * fontanels? * infants * delay/loss of developmental milestones * irritability * school age * decline in school performance * cranial nerve deficits (positive Babinski)

Question 254

anemia definition

Answer 254

anemia is a condition in which the body does not have enough healthy red blood cells

Question 255

SCD symptoms of lungs

Answer 255

* infection * acute chest syndrome * pain, infection * cough, fever, tachypnea * thoracic bone changes

Question 256

risk factors for infantile hydrocephalus

Answer 256

* birth weight * prematury ( * low socioeconomic status * maternal diabetes

Question 257

growth hormone deficiency

Answer 257

* decreased production by pituitary * idiopathic is most common (boys \> girls) * also tumor, cranial radiation, familial short stature * usually normal length at birth * suspect if * 2-3 SD below mean of height for age * falling off growth curve * cross a percentile after 24 months * provocative testing, IGF-1 levels

Question 258

how does radiation work?

Answer 258

* uses penetrating ionizing beams of high energy targeted directly at cancer * goal is to kill cancer cells while limiting healthy cell damage

Question 259

DI vs SIADH

Answer 259

Question 260

define retinoblastoma

Answer 260

* rare eye cancer that develops in early childhood, typically before age 5 * develops in retina (specialized light-sensitive tissue at back of eye that detects light and color) * usually only one eye (1/3 both eyes) * common first sign is cat's eye reflex (whiteness in pupil) * aka leukocoria

Question 261

cardiac physical exam - palpation

Answer 261

* body * start distally and move centrally * 4 extremity pulses for strength and quality * skin temp - variations * suprasternal notch * precordium * PMI location * precordial activity * taps or thrills

Question 262

aplastic crisis

Answer 262

* when RBC destroyed, marrow needs to keep up * acute drop in Hgb may be r/t marrow failure * low reticulocyte (immature RBC) * parvovirus (fifth disease) * major cause * no immunization

Question 263

SCFE nursing assessment

Answer 263

* ABC * ortho-specific * difficulty walking, limp * knee, hip pain * hip stiffness * outward-turning leg * restricted hip movements * DEFG

Question 264

postictal event

Answer 264

* commonly amnesia * after the seizure * timing can vary, but usually same within one person * loftiness - no idea what happened, in a fog, out of it * can reply to questions, but it's difficult

Question 265

thalassemia definition

Answer 265

* causes the body to make fewer healthy RBCs and less Hgb * two types * alpha * beta

Question 266

respiratory complications from bedrest

Answer 266

* less tidal volume * treatments: * spirometer, chest physio, cough/deep breathe * assess, pulse ox, vitals

Question 267

DKA insulin Tx

Answer 267

resolve acidosis, suppress ketosis * regular insulin 0.1 unit/kg/hour IV (0.05 for younger) * IV allows quicker onset, smooth titration * initial bolus not required * may increase risk of hypoglycemia, hypokalemia * **saturate insulin receptors**

Question 268

splenic sequestration

Answer 268

* RBC get stuck in spleen * acute abdomen * "loss" of blood volume * splenectomy * immune issues * may be prophylactically necessary

Question 269

taking history for tonic-clonic seizure

Answer 269

* undressing - full assessment * medications * is this the typical seizure? same or different * vomit? incontinent of urine or stool?

Question 270

platelets in ITP

Answer 270

* low (500-1000) * takes 6 months to get back up to therapeutic level * at risk for bleeding * IgG - can decrease antibody production and help bone marrow rebound and start making more platelets * usually ~ 6 weeks for acute course to resolve * gamma-globulin and monitoring in the meantime

Question 271

airway assessment of liquid tumors

Answer 271

* high % of WBCs and blast cells * marrow wants to make RBCs and platelets, but can't * low RBCs and platelets * can't carry oxygen * tachypnic (b/c of anemia)

Question 272

basic rules of cardiac physiology

Answer 272

* blood takes path of least resistance * left sided heart pressures are higher than right sided heart pressures (in post-fetal hearts) * RV is not a systemic pump; physiologically differant than LV * blood flow in utero is necessary for development of distal structures and for extra uterine function

Question 273

components of diabetes management

Answer 273

* glucose monitoring * insulin * diet * exercise * emergency care * incorporation of diabetes into family life

Question 274

cardiovascular complications from bed rest

Answer 274

* circulation to extremities * clotting, DVT * stasis, decreased venous return * lower BP * lower CO

Question 275

interventions for hydrocephalus

Answer 275

* oxygen * pain * seizure precautions * safe enviornment, padded side rails, rails up, no clutter, oxygen, cardiac monitor, bed low * possibly diuretic, but not right away * depends on cause

Question 276

diagnosing Kawasaki disease

Answer 276

* no definitive lab or diagnostic test * based on CDC criteria and history * S/Sx * if one aneurysm, serial total body MRA (not just coronary arteries) * often a diagnosis of exclusion

Question 277

hyperthyroidism overview

Answer 277

* Graves Disease most common * autoimmune * adolescent females * hypersecretion of TH * often diagnosed due to school issues * mood swings, decreased attention, fidgety

Question 278

pain and disability assessment during chemo

Answer 278

* assess: * 90% complain of pain * long term pain after limb sparing surgery * phantom limb syndrome * what makes them feel better - advocacy * interventions: * pain assessment around the clock * IV PCA * epidural analgesia * local anesthetic wound catheters * continuous peripheral nerve block * sustained-release oxycodone * hypnosis, relaxation, guide imagery, acupuncture * benzos - anxiety

Question 279

alpha thalassemia

Answer 279

* especially in its alpha+ form * one gene non-functional * more widespread globally than B thalassemia * more than 50% of thalassemia population

Question 280

drowning overview

Answer 280

* distinct phases to drowning * pulmonary --\> GI --\> renal * public health issue - talk to families * most common cuase of death and permanent brain damage in school-age children and adolescents * younger child - only needs nose and mouth covered * older child - loses consciouness, mobility etc. that causes aspiration * most children who drown know how to swim but not with clothes on * only need to aspirate 2 ml for negative sequelae

Question 281

recurrent DKA: risk factors for admission

Answer 281

* 15-20 yo * diagnosis in last 2-5 years * female * severe hypoglycemia episode in last year

Question 282

left to right shunting

Answer 282

* oxygenated * systemic to pulmonary circulation * body receives oxygenated blood * acyanotic

Question 283

single ventricle physiology

Answer 283

* presentation depends on fall of pulmonary vascular resistance and any obstruction to pulmonary blood flow * pulmonary and systemic venous congestion

Question 284

ventricular septal defect

Answer 284

* flow shunts left to right * increased blood flow to right ventricle, out pulmonary valve, into pulmonary artery and into lungs * increased pulmonary blood flow * can cause hypertrophy of right ventricle

Question 285

compliance

Answer 285

ability of the chambers to contract, relax, and distend during diastole

Question 286

greenstick fracture

Answer 286

* breaks like immature tree branch * broken on one side, bent on the other * children's bones are flexible and cartilaginous * treated with fiberglass cast, 6 weeks * reduced in ER

Question 287

nursing teaching points for cerebral palsy

Answer 287

children with CP had high rates of slow growth and cognitive and motor impairment and re-hospitalizations in 18-22 months

Question 288

fluid/electrolytes

Answer 288

* dehydrated * electrolytes * low Hgb, Hct, MCV, mean corpuscular hemoglobin * high reticulocyte count (immature RBC)

Question 289

S/Sx of increased intracranial pressure

Answer 289

* confusion * amnesia * +/- headache * dizziness * ringing in ears * N/V * slurred speech * fatigue * retinal hemorraging (child abuse) * subdural hemorrhages

Question 290

transitional cardiac physiology

Answer 290

* at birth, oxygenation transitions from placenta to lungs * onset of spontaneous ventilation results in expansion of the alveoli * foramen ovale closes b/c of pressure change * causes rise in pulmonary blood flow * pulmonvary vascular resistance falls and pulmonary blood flow increases * causes rise in arterial oxygenation * combined with rise in system fascular resistance, changes to size/shape of cardiac chambers occurs

Question 291

afterload

Answer 291

systemi vascular resistance: workload the ventricles must overcome for systemic circulation, i.e. systemic pressure (BP)

Question 292

fatigue assessment during chemo

Answer 292

* multiple dimensions * cognitive, general, sleep, rest * constant verbal expression of the loss of energy * contiues at home, adolescents more so * are they playing normally? * issues with caregiver: * depression * divorce

Question 293

what is the most important role of bones?

Answer 293

to provide for mineral exchange

Question 294

variables that alter outcome for drowning

Answer 294

* length of time * temp of water * cooler can preserve CNS better * response time * CPR initiation * should be admitted for at least 24 hours

Question 295

implications for continuous glucose monitoring

Answer 295

* associated with lower HbA1c * especially in younger children * CGM users * higher education * higher household income * private health insurance * longer duration of diagnosis * use of insulin pmp

Question 296

SCD symptoms of heart

Answer 296

cardiomegaly, exercise intolerance

Question 297

criteria for diabetic ketoacidosis

Answer 297

* hyperglycemia: blood glucose \> 200 mg/dl * metabolic acidosis: * venous pH * plasma bicarb * anion gap - metabolic acidosis * hyperketosis and hyperosmolality * severity defined by degree of acidosis

Question 298

types of sickle cell crises

Answer 298

* vaso-occlusive - stuck in vessels * splenic sequestration - stuck in spleen * hemolytic - RBCs lysed * aplastic - RBCs not made

Question 299

transposition of the great vessels

Answer 299

* PA and Ao are transposed * PA from LV and Ao from RV * separate circulations * PDA is only communication usually * some communication through foramen ovale * deoxygenated blood bypasses lungs towards systemic circulation * infant is cyanotic * correction * moving the great vessels, but also need to move coronary arteries as well

Question 300

new evidence r/t DKA

Answer 300

* presence of DKA at diagnosis associated with * delayed recall * decreased attention * possible IQ impact * impact of repeat DKA episodes??

Question 301

cardiac exam: abdomen

Answer 301

* contour * liver * size, location * start at hip bone and go up * spleen (palpable?) * ascites

Question 302

cardiac physical exam - inspection

Answer 302

* general appearance (+/- cyanosis) * posture * skin color - ashen * skin temperature - warm, cool? * respiratory rate, effort, positioning, use of accessory muscles * dilated veins - neck, abdomen * = red flag * carotid pulsations - visible? * check for PMI

Question 303

kawasaki disease etiology

Answer 303

* clinical features suggest * hypersensitivity reaction to environmental toxin or infectious agent * causative pathogens include: * mites * EBV * human herpes virus 6 * retroviruses

Question 304

cardiac cycle - coronary perfusion

Answer 304

* coronary perfusion occurs during diastole * arteries come from base of aorta and supply 3-5% of blood flow to heart * if left ventricle can't contract enough, can't get systemic or coronary perfusion

Question 305

SIADH overview

Answer 305

* syndrome of inappropriate antidiuretic hormone (secretion) * hypersecrete ADH * tumor, meningitis, neurosurgery, trauma

Question 306

nursing interventions for Perthe

Answer 306

* pain * x-ray, ultrasound, bone scan * brace teaching, crutches, post-op, rehabilitation * evaluate home, provide guidance * encourage family participation * enable child to participate in normal activities * plans for continuing education * special activity arrangements * emotional support * encourage ROM exercises * bed rest to conserve energy

Question 307

anemia where RBC is not made

Answer 307

* bone marrow suppression (chemo) * no red blood cell precursors * malnutrition * thalassemia * post-strep glomerular nephritis * kidney problems

Question 308

5 Ps of compartment syndrome

Answer 308

* \*\*pain out of proportion\*\* * difficult to discern in child * pallor * pulselessness * parethesia * paralysis any one of these is suspicious

Question 309

changing profiles of pediatric epilepsy surgery candidates

Answer 309

* communication conduits in brain * 90% of patients with surgery have achieved improvement in epilepsy severity and 74% are seizure-free since surgery * over time, interval to start of AED withdrawal shortened, resulting in significantly increased AED freedom at 2 years after surgery * goal is to not have to medically manage these patients

Question 310

initial DKA epidemiology

Answer 310

* 40% of children at initial presentation * delay in primary cause * difficult to get classic hx in young child * multiple caretakers, diapered child * 15% of hospitalizations * most common presentation in diabetes in children * most frquent diabetes-related cause of death in children ( * cerebral edema (primary) * multisystem organ failure

Question 311

rule of 15's for hypoglycemic events

Answer 311

* 15 grams carbs * recheck in 15 minutes * 15 more grams if needed

Question 312

how does chemo work?

Answer 312

* disrupts cell division * kills rapidly dividing cells

Question 313

nursing interventions for ITP

Answer 313

* NO PLATELETS * virus will continue to tag/attack them * teaching - low risk situation * come back frequently for platelet checks * helmets for younger children * assessing joints and joint discomforts * resolve more than 80% of time

Question 314

GI/GU complications from bedrest

Answer 314

* higher risk for UTIs * catheter * no gravity, not hydrated * slowed peristalsis, constipation

Question 315

risk factors for drowning

Answer 315

* age (youth) * peaks at 2 and then at 16-18 * location (pools, bathtubs) * sex: male 3:1 * drugs * trauma * predisposing illnesses (epilepsy) * warm weather months

Question 316

cast care

Answer 316

* neurovascular status * vital signs * smells, drainage * avoid lotions, powders * avoid affected extremity in dependent position * protect edges if child is incontinent

Question 317

DKA management recommendations

Answer 317

* cardiac * high frequency of prolonged QT interval * O2 if indicated for shock * 2 IVs * one for blood sampling (glucose) * avoid central lines * increased risk for thrombosis r/t dehydration * hourly VS, neuro, I&Os, blood glucose * VBG, electrolytes q 2-4 hours * BUN, Cr, Hct q 6-8 hrs * urine ketones until cleared

Question 318

nursing assessments for hip dysplasia for child who can walk

Answer 318

* waddling, limping * one shorter leg, so walk on toes on one side * lower back is rounded inward

Question 319

nursing assessments for osteomyelitis

Answer 319

* vital signs, febrile * bone pain, swelling of affected area, pain * localized pain, febrile, able to ambulate or perform pasive ROM * normally have full ROM in joints because joint is not affected * tender to the touch

Question 320

normal cardiac anatomy and blood flow

Answer 320

Question 321

nursing assessment for wilms tumor

Answer 321

* abdominal exam * often asymptomatic mass * pain * hematuria * hypertension

Question 322

fetal circulation

Answer 322

* 1 vein from placenta * fetal arterial oxygen tension is decreased * tolerate decreased oxygen (hypoxemia) due to increased CO and high fetal Hgb * ~ 2/3 blood flows to brain, coronary arteries, descending Ao * fetal lungs are collapsed: PVR \> SVR * PVR high in fetus and starts to fall after the 1st week of life * returns to placenta via 2 arteries

Question 323

incidence of osteosarcoma

Answer 323

* 4.5 million males, 3 million females (2x more males) * 4th most common cancer * 80% in femur or tibia

Question 324

cerebral palsy definition

Answer 324

* dx of movement, muscle tone (conduction), or posture caused by insult to immature, developing brain * ischemic or anoxic event * cell death - as if child had stroke * most often before birth * effect on functional abilities varies greatly * generally does not worsen, except if degenerative from clots (more anoxic events)

Question 325

treating hydrocephalus

Answer 325

* diagnosed by ultrasound * treated with ventriculoperitoneal (VP) shunt, ventriculostomy, VA shunt (into pleural space of heart - could increase risk of heart failure) * can also shunt into bladder * complications * mechanical * infection * herniated brainstem

Question 326

ataxic cerebral palsy

Answer 326

* characterized by ataxic movements and speech * widespread disorders of motor function

Question 327

SCD symptoms of kidneys

Answer 327

* ischemia of kidneys * enuresis * hematuria * inability to concentrate urine * chronic renal failure

Question 328

aspirin for Kawasaki disease

Answer 328

* decrease inflammation * inhibit platelet aggregation * decrease venous stasis and thrombus formation * at risk for: * bleeding, seizures * Reye's syndrome * platelet dysfunction (bleeding anywhere in body)

Question 329

presentation of coarctation of aorta: neonates

Answer 329

* dependent on PDA for blood flow down aorta * present in shock due to PDA closure * marked difference in BP between UE and LE * may be unable to palpate LE pulses

Question 330

diabetes education topics

Answer 330

* activity * coping * monitoring * medications * nutrition * problem solving * risk control * endocrinologist, NP, psychologist, dietician, diabetic nurse educator - 3 months to feel in control (9 w/ pump)

Question 331

osteomyelitis etiology

Answer 331

* usually caused by bacteria, but also by fungi or other * may spread to bone from infected skin, muscles, tendons * can occur under a skin sore * can start in another part of body and spread to bone through blood * can start after bone surgery, especially with metal rods or plates * in children, long bones of arms or legs most often involved * in adults, feet, spine, and hips most affected

Question 332

common risk factors for cerebral edema r/t DKA

Answer 332

* elevated BUN * profound hypocapnia at presentation * bicarb administration

Question 333

epilepsy

Answer 333

* disorder in which seizures recur because of a chronic underlying pathology that invariably is initiated in the CNS * no identifiable causes in 50% of cases * other causes: * genetic * trauma * tumor * infectious disese (meningitis, syphilis) * prenatal injury

Question 334

risk factors for DKA at initial presentation

Answer 334

* * lack of private health insurance * lower SES * misdiagnosis

Question 335

cardiac physical exam - auscultation

Answer 335

heart sounds * S1 - closing of tricuspid & mitral valves; ventricular contraction * single heart sound * apex/mitral; tricuspid * S2 - closing of pulmonary and aortic valves * RR influences timing of valve closure * usually a single sound, can be heard as 2 sounds (split S2) * aortic; pulmonic

Question 336

glucose in DKA

Answer 336

* hyperglycemic * fluid pulled from extravascular to intravascular space * Na diluted due to increased intravascular fluid * correction formula for Na during DKA episode

Question 337

7 basic treatment goals of DKA

Answer 337

* restore extracellualr volume at moderate, reasonable pace * restore intravascular volume * improve perfusion * gradually decrease effective plasma osmolality * otherwise, neurological problems * stop ketogenesis * correct electrolyte disturbances * avoid complications * individualize therapy

Question 338

side effects of chemo

Answer 338

* N/V/D/C * sterility * mucositis * neuropathy * alopecia * bone marrow suppression * carcinogenic * photosensitivity * cardiotoxic

Question 339

anion gap

Answer 339

* difference between measured cations and anions * nmeasured anions (phosphate, sulfate, protein) account for gap * normal = 10-14 * Na - (Cl + HCO3) * 139 - (113 + 4) = 22

Question 340

S/Sx of cerebral palsy

Answer 340

* motor tone, orthopedic dx * urinary dx * reflexes * still muscles with normal reflexes (rigidity) * stiff muscles with exaggerated reflexes (spasticity) * lack of muscle coordination (ataxia) * seizures * not meeting developmental milestones * eating issues, oral pharyngeal * difficulty grasping * vision, hearing, speech * pain - often can't communicate

Question 341

alopecia

Answer 341

hair loss - be sensitive to patient and family

Question 342

idiopathic thrombocytopenic pupura

Answer 342

* ~5/100,000 with peak age of 5 * aka autoimmune thrombocytopenic purpura * destruction of platelets in spleen * follows a virus * autoantibodies bind to platelet antigens * actual production of platelets in the spleen is fine * platelets foreign for the duration of the virus

Question 343

differentiate between ITP and trauma

Answer 343

* pain * swelling * talk to the family * viral illness * no trauma

Question 344

beta thalassemia

Answer 344

* three main forms * thalassemia major/Cooleys (most common) * thalassemia intermedia * thalassemia minor * thalassemia major * present within first two years of life with severe anemia requiring regular RBC transfusions * growth retardation, pallor, jaundice, poor musculature in poorly transfused or untreated individuals

Question 345

effective osmolality in DKA

Answer 345

* high glucose level, dehydration increase osmolality * calculated as * 2 X (Na + K) +[(glucose mg/dL)/18] * normal osmolality = 300

Question 346

airway assessment for SCD

Answer 346

* tachypnea * low pulse ox

Question 347

trabeculum

Answer 347

* mineral metabolism * honeycomb - where blood is stored * osteoblast and osteoclast activity

Question 348

hypertrophic cardiomyopathy: overview

Answer 348

* increased myocardial mass, especially LV * decreased ventricular cavity size * blood flow obstructed * hypertrophic tissue * left ventricular outflow tract obstruction * big, thick, ugly heart * decreased preload, contractility, and CO

Question 349

3-2-1 rule of DKA

Answer 349

Question 350

suspect CHD when

Answer 350

* murmur AND cyanosis * cyanosis WITHOUT respiratory distress * crying WORSENS cyanosis * abnormal WEIGHT LOSS, poor weight gain, feeding w. tachypnea, diaphoretic with feeding * DISCORDANT UE/LE pulses * infants appear SEPTIC * diangosed with a SYNDROME * many syndromes go hand in hand with cardiac defects

Question 351

nursing assessments for hip dysplasia in newborn

Answer 351

* leg with hip problem may turn out more * reduced movement on that side of the body * Ortolani-Barlow test * shorter leg on that side * uneven skin folds of thigh or buttocks * after 3 mo, leg may turn out or be shorter

Question 352

enoxaparin for Kawasaki disease

Answer 352

for aneurysms

Question 353

causes of hydrocephalus

Answer 353

* congenital * neural tube defects, infection, hemorrhage, genetic defects, teratogens, Chiari malformations, Dandy-Walker malformation * acquired * infections, tumors

Question 354

contractility

Answer 354

strenght of the squeeze of the cardiac muscle

Question 355

bone physiology

Answer 355

3 tasks, 3 areas 1. cortex 2. canal 3. trabeculum

Question 356

pump + CGM benefits

Answer 356

* lifestyle flexibility * birthday parties, social activities * school safety * improved sleep * increased self-efficacy * young child * fewer mealtime behavior issues

Question 357

antiepileptic drugs (AEDs)

Answer 357

* levetiracetam (Keppra) * carbamazepine (Tegretol) * phenobarbital * phenytoin (Dilantin/Fosphenytoin) * valproate (Depakote)

Question 358

diagnosing DKA without access to venous pH testing

Answer 358

* bicarb alone * *

Question 359

family teaching for febrile seizures

Answer 359

* may happen again * do they give them motrin or tylenol? how much, how often? * thermometer? * give family one valium suppository * nothing PO * should not last more than 4 minutes * time the seizures * more than 5 min = status epilepticus

Question 360

nursing interventions for hip dysplasia

Answer 360

* pavlik harniss * flexion and abduction (less than 6 mo) * spica cast (older than 6 mo) * surgery, casting, bracing (older than 18 mo)

Question 361

dilated cardiomyopathy: treatment

Answer 361

* positive inotropic agents - slow/strengthen heart contractility * diuretics - decrease afterload * vasodilators - decrease systemic vascular resistance to reduce workload * but still need venous return * afterload reduction - take away workload on heart * prioritize perfusion of brain, heart, lungs

Question 362

primary symptoms of Kawasaki disease

Answer 362

* fever \> 5 days * erythema of palms and soles with indurative edema (peeling) * rash - polymorphous exanthema; peeling * strawberry tongue, red lips * bilateral conjunctival congestion * sometimes first S/Sx * cerical lympadenopathy

Question 363

GI/GU/musculosketal assessment for SCD

Answer 363

* bowel sounds * some present in crisis in joints * ROM test

Question 364

coup

Answer 364

point of impact of TBI

Question 365

why is there long-term impairment in brain tumors?

Answer 365

* brain growing and developing * misdiagnosis/undetected for a long time * can't always get rid of it * maybe if it's encapsulated

Question 366

potassium in DKA

Answer 366

* K moves out of cell d/t decreased insulin concentration, acidosis * total body K is depleted * with Tx, serum K will rapidly decrease as addition of insulin and correction of acidosis drives K intracellular

Question 367

causes of hip dysplasia

Answer 367

unknown. low levels of amniotic fluid may increase risk

Question 368

DKA: two bag system

Answer 368

* two identical fluid bags MINUS dextrose content * A: 0.45-.9% saline with 20 meq/L K Phos **or** 20 meq/L KCL **or** k acetate * B: **D10** 0.45-9% saline with 20 meq/L k Phos **or** 20 meq/L KCl **or** K acetate * before starting K, ensure renal fxn, K * replace depleted phosphate (why K phos is more common) * facilitates efficiency, timeliness, flexibility * can go back and forth easily, if you overshoot the mark

Question 369

early indicators of cerebral edema

Answer 369

* age inappropriate incontinence * HR decrease of 20 bpm or more NOT attributable to * improved intravascular volume status * sleep * altered LOC * lower pH, younger age are ONLY independent predictors of decreased LOC

Question 370

PICU should be considered in cases of DKA when:

Answer 370

* severe DKA * decreased LOC * shock * children at risk for cerebral edema * * low pH * low total CO2 (shows extreme "mixed" acidosis with respiratory and metabolic components) * high BUN

Question 371

circulation assessment for SCD

Answer 371

* tachycardic - low iron * decreased peripheral pulses * cardiac issues in general from low baseline oxygenation * enlarged valves from compensation for low oxygen levels

Question 372

distal humerus (supracondyler) fracture

Answer 372

* common b/c put in propeller-type motion to catch themselves on ground * lot of nerves in that area * neurovascular check * periphral pulses, skin appearance, moving extremities, sensation * maintain circulation, perfusion * localized edema * RICE * pain meds

Question 373

causes of TBI

Answer 373

* bump, blow, jolt to head or penetrating injury that disrupts normal fxn of brain * not all blow or jolts result in TBI * severity ranges from: * mild: brief change in mental status or consciousness * severe: extended period of unconsciousness or amnesia

Question 374

DKA presentation

Answer 374

* polyuria, polydipsia * weight loss * abdominal pain * nausea and vomiting * abdominal tenderness, decreased bowel sounds * ileus d/t acidosis, decreased K (muscle fxn), decreased gut perfusion * tachycardia * decreased peripheral perfusion * tachypnea (response to metabolic acidosis)

Question 375

nursing interventions for hemophilia

Answer 375

* IF neuro is clear, very focused * treat joint/area - factor * peripheral pulses * ROM * monitor for compartment syndrome * pain out of proportion

Question 376

SIADH teaching

Answer 376

* sources of fluid * popsicles, jello, medications * odd places thirsty children will find fluid

Question 377

treatments for chemo-related N/V

Answer 377

* relaxation * antiemetics before chemo * first gen 5-HT receptor antagonists * Palonosetron (Aloxi), Ondestetron * NK1 antagonists - Aprepitat * different rxn than 1st gen * corticosteroids * benzodiazepine * other strategies + support team

Question 378

side effects of AEDs

Answer 378

* CNS active drug - can affect all aspects of brain * sedation, hyperacticity, increased/decreased appetite, mood changes) * leech calcium by increasing percentage of osteoclasts * most mineral exchange in hips and spine * unique side effects: * dilantin: hirsuitism, gum hypertrophy * lamictal: Steven Johnson rash * benzos: sedation, memory storage * depakote: hepatotoxicity, pancreatitis, decreased platelets, neural tube defects (menarchal - folic acid)

Question 379

familial hypercholesterolemia overview

Answer 379

* autosomal dominant * defect on chromosome 19 * defective clearance of LDL cholerstol * risk for atherosclerosis * prevlance ranges from 1 in 200-500 * increasing occurence in children

Question 380

brain tumor definition

Answer 380

* neoplasms * most common solid tumors in children and adolescents * significant long-term impairment to intellectual and neurological function is possible * life threatening if not treated promptly

Question 381

hemoglobin S

Answer 381

* causes RBC to sickle and not flow through capillaries * changes in appearance often randomly

Question 382

signs and symptoms of congestive heart failure (CHF)

Answer 382

* tachypnea, wheeze, crackles * increased WOB, retractions, grunt, cough * Hx of frequent respiratory infections * tachycardia, decreased pulses, hypotension, \> 3 sec cap refill * exercise/activity intolerance * rest periods during feeds - red flag for families * poor weight gain, growth failure * diaphoresis, cool extremities * frequent emesis - swallowing air * irritable

Question 383

aplastic anemia defined

Answer 383

* blood dx in which body's bone marrow doesn't make enough new blood cells * makes stem cells that develop into RBC, WBC, platelets

Question 384

diabetes insipidus signs and symptoms

Answer 384

* extrem thirst * huge urine output * new onset bedwetting

Question 385

rare DKA complications

Answer 385

* cerebral edema (biggest implication) * pulmonary edema * CNS hemorrhage/thrombosis * large vessel thrombosis * cardiac arrhythmias * pancreatitis * renal failure * intestinal necrosis * rhinocerebral & pulmonary mucormycosis (rare fungal infection)

Question 386

social support during chemo

Answer 386

* child life * social work * anticipatory guidance * school

Question 387

Hodgkin's lymphoma

Answer 387

* nontender, firm lymphadenopathy * supraclavicular and cervical nodes and in mediastinal area * worrisome: * 2+ supraclavicular nodes that are long-standing * supraclavicular nodes \> 2mm * femoral/inguinal nodes that are long-standing and more than 15 mm * lymph node biopsy reveals Reed-Sternberg cells * classic cell differentiation from non-Hodgkin's * staging of disease

Question 388

SIADH signs

Answer 388

* low urine output, sodium, osmolality * high urine osmolality * seizures, altered mental status

Question 389

diabetes survival skills

Answer 389

* initial hospitalization 2-3 days * teach information needed to be safe * basic pathophysiology * psychomotor skills * insulin injection * BG meter use * hypoglycemia reognition and treatment * calculation skills

Question 390

nursing interventions for SCD

Answer 390

* OXYGEN - low Hgb, not oxygenating tissues * IV * pain meds * labs (CBC with differential, type and cross for transfusion, sickledex, potassium, bilirubin) * blood transfusion * cardiac monitor * I&Os, bowel sounds * skin assessment * ask family * what works? distraction, massage, heat packs

Question 391

osteomyelitis definition

Answer 391

* bone infection caused by bacteria, other germs * more localized, not septic * tender, sore, swollen, low fever, hx of previous infection maybe * home care with PICC line for 6 weeks

Question 392

recurrent DKA epidemiology

Answer 392

* 5% per year * insulin omission = primary cause * adolescents = primary group at risk * illness * need sick day plan * infection * pump malfunction

Question 393

SCFE definition

Answer 393

slipped capital femoral epiphysis is a separation of the ball of the hip joint from the thigh bone (femur) at the upper growing end (growth plate) of the bone

Question 394

diagnostic testing for child experiencing seizures

Answer 394

* MRI * CT * lumbar puncture * labs * EEG * nurses can help/prepare child

Question 395

nursing assessment for child who experiences drowning

Answer 395

safety, teaching, prevention 5 ft fences on all sides of pool, trained CPR guards

Question 396

multifactorial process of diabetes

Answer 396

Question 397

Ewing's sarcoma

Answer 397

* can occur anytime in childhood or young adulthood * usually during puberty when bones growing rapidly * 10X as common in caucasians as African-American, African, Asian children * long bones, pelvis, chest, skull or flat bones

Question 398

pulmonary valve stenosis or atresia

Answer 398

* right to left shunt between ventricles * abnormality/absent pulmonary valve * deoxygenated blood moves from right to left and into systemic circulation * constriction at pulmonary artery so blood and pressure builds up in right ventricle * can't go through valve, so will go through hole (SVD)

Question 399

SCD symptoms of penis

Answer 399

microcirculatory obstruction and engorgement of penis (priapism)

Question 400

nursing treatment for SCD patients at home

Answer 400

* **prophylactic antibiotics - PO penicillin VK** * parental education and compliance * folic acid daily * hydration * strict hand-washing * infection control

Question 401

SCD symptoms of bones

Answer 401

* chronic ieschemia of bones leads to susceptibility to infection and bone degeneration * osteoporosis, osteomyelitis * spinal deformitis * aseptic necrosos of the femoral head, gait abnormality

Question 402

cardiac cycle

Answer 402

Question 403

if DKA acidosis does not correct

Answer 403

* inadquate insulin infusion * or IV not patent * inadequate rehydration * renal failure * increased risk with time * sepsis

Question 404

hip dysplasia definition

Answer 404

developmental dysplasia of the hip (DDH) is a dislocation at birth because hip socket does not develop properly found in babies and young children

Question 405

cardiomyopathy: clinical manifestations

Answer 405

* cardiomegaly on CXR * symptoms: asymptomatic initially * murmur * poor perfusion * CHF * low CO * decreased urinary output, alteration in LOC, syncope, thromboembolic events, arrythmias

Question 406

increased pulmonary blood flow

Answer 406

* left sided pressures \> right sided pressures * most blood shunts left to right * first 3 months, PVR decreases and SVR increases * *presumed* hypermetabolic state * don't gain weight or feed well - need a lot of calories * increased pulmonary blood flow causes tachypnea to breathe through all the circulation * more likely to cause CHF

Question 407

cyanotic lesions

Answer 407

* mostly during neonatal period * fail hyperoxia test * dependent on PDA * monitor for PGE1 side effects * presentation varies depending on degree of abnormality * requires intervention immediatley after birth

Question 408

seizure definition

Answer 408

* sudden abnormal electrical discharge from neurons within the cerebral cortex that produces a disturbance in behavior, sensation or motor function * an een that may be initiated by either a CNS process, such as a head injury or lead poisoning, or a process external to the central nervous system such as fever, drug withdrawal, electroconvulsive therapy

Question 409

gold standard diagnostic tool for liquid tumors

Answer 409

bone marrow biopsy

Question 410

assessment of skin/derm during chemo

Answer 410

* assess: PO, oral hygiene * Interventions: * dental care - soft brush * miracle mouth wash with lidocaine * oral exam with light * oral medications to prevent breakdown * IV narcotics, pain management * start oral care BEFORE ulceration occurs so they know it's part of their care * b/c they won't like it * ulcerations can go all the way down to the rectum

Question 411

define sickle cell disease

Answer 411

* group of inherited RBC disorders * abnormal hemoglobin * hemoglobin S or sickle hemoglobin in RBCs * two abnormal hemoglobin genes * in all cases, one of two abnormal genes causes hemoglobin S * two genes = hemoglobin SS (sickle cell anemia) * most common and severe kind is SCD

Question 412

vaso-occlusive sickle cell crisis

Answer 412

* sickled cells get stuck * blood flow impeded * generalized or local or in lungs (acute chest) * cells starve * pain from ischemia - lack of oxygen r/t obstruction * death * avascular necrosis * CVA * acute chest * heat packs can help * X-ray or MRI to rule out septic arthritis

Question 413

nursing interventions for thalassemia

Answer 413

* similar to sickle cell * + transfuion and accompanying meds to bring down iron * relevant to nursing = **transfusion reaction**

Question 414

seizures and injury

Answer 414

* more fractures * more thermal injuries * twice risk of poisonings (medicinal) * NURSING TEACHING POINT

Question 415

hyperglycemic hyperosmolar syndrome

Answer 415

* aka hyperglycemic hyperosmolar non-ketotic syndrome * people at risk * children with T2DM * adolescents

Question 416

recommendations for Tx of cerebral edema

Answer 416

* ensure adequate mean arterial pressure to ensure adequate cerebral perfusion pressure * autoregulation may be impaired due to hyperemia and vasogenic edema * avoid hyperventilation, hypercapnia * mannitol or 3% saline

Question 417

components of palliative care

Answer 417

* quality of life * pain and symptom management * communication * ethical decision making * advance care planning * grief and bereavement * spiritual and religious needs * body language and honesty * availability and attentiveness among nurses and doctors