Midterm Flashcards

Question

omphalocele

Answer 1

some fetal organs develop outside abdomen in a transparent sac at base of umbilical cord

Answer 2

1. medication 2. dose 3. patient 4. route 5. time 6. documentation

Answer 3

developmental milestone (along w. weight and length) - until 2 yo (WHO says 3 yo) measure lying down or sitting up with a partner to hold/measure

Answer 4

* long term ventilation * bypass obstruction, narrowing or floppiness of airway * neuromuscular disease * sustain airway in face of CNS issues * hypoventilation * brain injury

Answer 5

multi organ system dysfunction * respiratory failure * tachycardia increases * kidneys begin to shut down

Answer 6

* need spleen to get rid of pneumococcal bacteria * maintence med for sickle cell patients is penicillin VK (potassium) to prevent infection * in addition to immunizations

Answer 7

* tylenol or ibuprofen * oral antihistamines for itching * trim fingernails * soft cotton mittens * isolation precautions * vaccine: VZIG

Answer 8

differences between adults and children * size of airway * amount of alveoli * trachea - size of child's pinky (easily obstructed) * complicated by developmental behavior of putting things in their mouths * chest wall

Answer 9

* provides humidification for trach * keeps secretions thin * filter

Answer 10

* several daytime symptoms, nighttime symptoms \> 1x/week * activity extremely limited * requires baseline medications

Answer 11

* use of accessory muscles * retractions * nasal flaring * tripod in older children * belly breathing - using abdomen to move diaphragm? * faster RR

Answer 12

* faces * Oucher * poker chip * numeric rating * body outline

Answer 13

low platelet count - bleeding and clotting simultaneously

Answer 14

1. SIRS 2. Sepsis (SIRS + infection) 3. Severe sepsis (sepsis + end organ damage) 4. Septic shock (severe sepsis + hypotension)

Answer 15

* short attention span, irritability * facial grimacing, biting, pursing lips * posturing, guarding, decreased movement * drawing up knees, flexing limbs, rubbing affected area * quiet, withdrawn * sleep disturbances

Answer 16

* small amount can cause immediate severe rxn * IgE mediated or non IgE mediated * IgE - after specific food * Non IgE - cell mediated by GI tract * immune system rxn affecting +1 organ * may have subsequent late phase rxn

Answer 17

* hemorrhaging * bacteria gets to kidneys * can't put out urine * dialysis, blood products, antibiotics * after 24 hours not as infectious, but caregivers also on antibiotics * DIC - disseminated internal coagulopathy

Answer 18

* sudden ache that develops into severe pain * N/V * lack of appetite * chills * high temp * rapid HR * not passing urine or passing less than normal * abdominal swelling

Answer 19

upper airway: naso/oropharynx to glottis (above vocal cords) lower airway: below glottis (vocal cords) including bronchus and branches, lungs, alveoli

Answer 20

* concentration of solutes inside the body * human body osmolality ~ 300 mOsm/kg

Answer 21

chronic lung disease thati nflames and narrows airways...complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hypperresponsivness and inflammation most common chronic disease in children

Answer 22

* A: airways - asthma basics * S: symptoms * T: technique & triggers * H: help - where to go * M: medications - how and when * A: action plan

Answer 23

* positive PPD * no physical exam findings * CXR normal

Answer 24

fatigue and immobility

Answer 25

* shallow breaths and suppressed cough * increased sputum retention * atelectasis and hypoxemia and shunting

Answer 26

* since 1992 * CDC recommendations * under 5 (first at 2 mo) * increased risk of infection * sickle cell * immunocompromised * asplenic (w.o spleen or dysfunctional spleen) * cannot fight encapsulated organisms * HIV

Answer 27

* half of infants less than 1 yo are hospitalized * younger the infant more likely treatment will be needed * infants * pneumonia * seizures * apnea * encephalopathy * death * teens and adults * syncope or rib fracture * weight loss * loss of bladder control * passing out

Answer 28

* beta 2 agonists: albuterol, terbutaline * relaxes smooth muscle * oxygen * systemic steroids - reduce inflammation * oral, IV * anticholinergics: ipatropium bromide * anti-inflammatory inhaler * only works for the first 24-36 hours, if it works * IV fluids (worry about aspiration with oral) * *methylxanthines: theophylline (sprinkles), aminophylline (IV)* * *dilate airways, relax airway muscles* * *used frequently in past - not as much, but more aminophylline now than recently*

Answer 29

* painless GI bleeding (in stool) in children * diverticulitis (intestinal wall swelling) in young/older adults * most common Sx in children * bleeding * caused by ulcers in small intestine * most common Sx in older children/adults * bowel obstruction

Answer 30

patients respond normally to verbal commands. cognitive function and coordination may be impaired but respiratory and CV function unaffected

Answer 31

* immunization status * droplet precaution * symptom management * fluid * antibiotics/ antipyretics * +/- dexamethasone

Answer 32

* sudden, loud crying caused by abdominal pain * colicky and intermittent * comes back often * will get stronger, last longer each time * Classic Triad * vomiting, bloodys tools, colicky * other Sx * bloody, mucous-like bowel movement (currant jelly stool) * fever * shock (pale, lethargy, sweating)

Answer 33

* premature infants * down syndrome * cerebral palsy * williams syndrome * turner syndrome

Answer 34

* type/amount of nutrients * active/resolved issues that impact nutrition * parents knowledge of nutritional needs * characterize parent/family nutrition habits * educate importance of good nutrition

Answer 35

* less serious * occur outside major organs or blood * otitis media * sinusitis * non-bacteremic pneumonia

Answer 36

* 2nd most common infection among children, second to upper respiratory infection * most significant to neonates b/c of renal issues

Answer 37

* complex, usually single cell * thrives in many environments (hot, cold) * many cause little to no harm * sputum testing can identify organism or virus * macrolides for tx * symptoms up to 1 mo

Answer 38

bag that surrounds intestines and keeps them hydrated - allows for gravity to slowly pull intestines back into the child as they grow

Answer 39

increased CO2 in blood

Answer 40

* treat Group A within group beta (strep in throat) * GBS is Group B within group beta

Answer 41

pool instruction when developmentally appropriate urine specific gravity (1.000-1.0005

Answer 42

* easily digested * immune properties * balanced nutrients and bio-active factors * ~20 cal/oz * 0.27-0.3 gm protein/oz

Answer 43

child older than 1 year: 90 + (2x age in years) / 70

Answer 44

head and abdomen (handlebar) organs more exposed in children than adults because rib cage hasn't fully enclosed around them

Answer 45

* length of procedure, positioning/draping * immobility vs analgesia vs anxiolysis * providers available, location of procedure * informed consent

Answer 46

* 40% asymptomatic * FTT irritability * vomiting, diarrhea * incontinence * change in urine color

Answer 47

* compact torsos with smaller AP diameters * smaller area over which force of injury can be dissipated * larger viscera, especially liver, spleen, and bladder * extend below costal margin * less overlying fat and weaker abdominal musculature to cushion intra-abdominal structures

Answer 48

* ECF/ICF varies with age * neonates/infants have larger ECF * 45% ECF newborn, 25% infant, 10% child * infants: high daily fluid requirement w/ little fluid reserve * vulenerable to fluid loss * hats, socks, etc. * I/Os very important

Answer 49

* tic/lyme disease * children not as hospitalized as much from this * unless there are complications * classic bulls-eye rash in only 15%

Answer 50

replaces water that is normally lost throughout the day - overtime, there is a normal fluid exchange a bolus would be too much fluid in too little time

Answer 51

* optimal airway opening * trachea, pharynx, oral cavity optimally aligned * important in babies and young children

Answer 52

amount of energy expended based on: * age * weight * height * sex * temperature * others * seizures, shivering, drugs (epi)

Answer 53

* benzos * midazolam * diazepam * lorazepam * miscellaneous * ketamine * propofol * dexmedetomidine

Answer 54

* fever or hypothermia * warming/cooling blankets * poor perfusion * slow cap refill, low pulse pressure, low urine output * hypotension * \>2 fluid boluses given * started/increased vasopressors * altered mental status (not enough blood to brain) * change? decrease? * behavior different from baseline

Answer 55

1. nonopioid +/- adjuvant 2. mild opioid +/- adjuvant +/- nonopioid 3. moderate opioid +/- adjuvant +/- nonopioid

Answer 56

acute kidney failure r/t blood flow obstruction

Answer 57

* decreased during stress, sepsis, acute illness * subject to fluid shifts and synthesis of acute phase proteins

Answer 58

* thrush (yeast) * candida * ringworm (also yeast)

Answer 59

* narrowing of pyloric sphincter from hypertrophy or hyperplasia of muscle * occurs in first 6 mo of life * some genetic component

Answer 60

* monitor cardiovascular and respiratory status * maintain airway patency * oral suctioning * +/- oxygen therapy * delivery method might make them mad and exacerbate * chest physiotherapy * can be very calming * monitor response to meds

Answer 61

80% of children can't open the bottle within 5 minutes LOCK medications away - don't have to worry about which developmental stage your child is at - habit

Answer 62

* redirects flow of air upward through vocal cords, mouth, nose * one-way valve * enables trach patient to communicate orally * helps with speech therapy * need to deflate cuff - airflow won't pass otherwise

Answer 63

* GI tract of cattle * undercooked meat * internalized into vegetables * public pools

Answer 64

* enlarged w. fatty infiltrates

Answer 65

* IV solutions w/ D5W * tap water enemas * draws salt out * diluting formula * swallowing pool/bath water * one tsp can throw off electrolytes * excessive sweating with incorrect fluid replacement

Answer 66

* mucous blocks pancreatic ducts * decreased enzyme production * poor fat digestion * malabsorption

Answer 67

* children 3 mo - 4 yo * sudden onset, often nighttime * barking cough (_hallmark)_, hoarseness * rhinorrhea * respiratory distress * loud breathing, inspiratorys tridor, tachypnea * +/- retractions * in the upper airway * oro/nasopharynx to level of glottic of VC

Answer 68

* neuro effects of too much sodium * seizures, altered mental state * low urine output, increased urine concentration * 1.020-1.030

Answer 69

* 2/3 of body water is ICF * 1/3 of body water is ECF * 1/3 intravascular * 2/3 interstitial * ~50% of weight is water

Answer 70

acute upper airway disease with obstruction resulting from inflammationa and edmea of larynx, trachea, subglottic area

Answer 71

* synthetic opioid * 100X more potent than morphine * peaks immediately * duraiton 30-60 min * half life 2.4 hrs

Answer 72

* variable * usually in less than 2 yo * time of rapid brain growth and development

Answer 73

* listen to HR for one minute * auscultate heart * peripheral pulses * cap refill on all extremities * feel for fontanels * flat, not sunken or bulging

Answer 74

large amount of fluid over short amount of time (10-20 minutes) timing depends on size of child and access (how/where the line is)

Answer 75

* supportive * hydration * urine output * oxygenation/ventilation * manage secretion * antipyretics * enteric tube feedings * treatments to consider * bronchodilators (some respond, some don't) * +/- steorids (evidence that it doesn't really help) * has about 7-10 day course

Answer 76

parainfluenza types I, II, III

Answer 77

* diet, fluid restrictions, high calorie, high carb, low protein, low sodium, low potassium * hemodialysis * RBC, platelet transfusion * daily weights, lab values, neurologic assessment * NO antibiotics

Answer 78

* \> 5-7 yo * parent vs. nurse-controlled analgesia when patient is too young

Answer 79

* acute status change * particularly if fluid intake has changed or decreased * high temperature w/ respiratory distress

Answer 80

* poor immune system * school/day care * poor hygiene * can't articulate that they're not feeling well * not until 9 or 10 * sometimes just fussy - hard to manage * already exposed everyone in that duration

Answer 81

* parental support and assistive feeding devices * smaller volumes with increased time to feed * feed with head elevated * frequent burping * breastfeeding * NG tube placement

Answer 82

* frequent respiratory assessment * CXR - not every day necessarily * monitor VS * respiratory/pulmonary therapies * oxygen * antibiotics if necessary * respiratory tx * chest physiotherapy * hydration (insensible loss from respiration) * positioning * pain management * nutrition * NG tube but often post-pyloric and continous to avoid dumping syndrome

Answer 83

* PO best, then enteral * preserve intestinal function * prevents translocation of gut flora into blood stream * use trophic feeds * allows normal processes and hormonal responses to nutrient intake * assist in immune function

Answer 84

* fever * cough +/- mucous production * GI symptoms from ingesting * respiratory distress * +/- mild/moderate cyanosis

Answer 85

* small airways obstructed * air trapping and atelectasis * ventilation/perfusion (VQ) mismatch * blood passes by atelectasis to open areas of lungs * creates non-uniform perfusion * hypoxemia ensues * leads to airway remodeling * pulmonary capillary bed becoems fibrotic with smooth muscle build-up

Answer 86

* breast feeding * how much/how long to feed * count diapers * incorrect formula preparation * incorrect concentration * prolonged diarrhea/vomiting * tube feedings * certain IV preparations

Answer 87

* use age and illness-specific assessment tools * evaluate pain in context and within the child's trajectory of illness

Answer 88

* general appearance * extremities * physical development * tanner staging and puberty * activity and alertness * mechanical/medical devices/ treatments

Answer 89

* hemolytic anemia, uremia, thrombocytopenia * caused by E.coli 0157 from cows, goats, horses * toxins cause more than 110,000 illnesses, 80 deaths per year * most common cause of acute renal failure (ARF) * children less than 4, peaks between 1-2 yo

Answer 90

* neonatal infant pain scale * expression * cry * breathing * arm and leg movement * arousal state

Answer 91

* milk sensitivity/hypersensitivity * galactosemia; lactose intolerance * vegetarian/vegan diet * ~20 cal/oz * ex: similac soy isomil, enfamil prosobee, good start soy

Answer 92

* 1 cm/month up to 12 mo * 25% adult brain size at birth * 75% by 1 yo * 100% by 7.5-8 yo

Answer 93

* better understanding of relationship between an event and pain * more complex awareness of physical and psychologic pain * may pretend comfort to project bravery * may regress with stress/anxiety * can describe intensity and location w/ miore characteristics * can describe psychologic pain

Answer 94

* extreme pain * ipsilateral loss of cremasteric reflex * stroke inside of thigh and scrotum should lift one side at a time * testicle twists spontaneously on spermatic cord, venous occlusion, arterial ischemia

Answer 95

* high risk * surface area * more than 30% of 2nd and 3rd degree burns = extremely high risk * #1 protective organ has been damaged

Answer 96

* cough +/wheeze * increase WOB * c/o chest tightness * decreased air entry * difficulty breathing * breathless at rest * speaking in words at a time vs sentences at a time * +/- retractions, nasal flaring, S/Sx of URI

Answer 97

* respiratory assessment * circulation * handwashing * hydration and nutritional assessment, blood cultures * GI - tubes, catheters, wound cultures * isolation - standard and high level precautions * chest x-ray * no immunization * topical, oral, IV antibiotics * depending on type and location

Answer 98

indiviualized numeric rating scale (for parents on their child's pain)

Answer 99

* severe pain or injury * oral, IM, IV * determine equianalgesic dose * based on drug, child's weight * avoid IM route if possible * BMI may affect response b/c of storage capacity

Answer 100

* does not understand what causes pain or why he/she is in pain * localized withdrawal, body resistance, aggression, disturbed sleep * cries, screams * cannot describe intensity or type ofpain * uses common words like ouchie and boo-boo

Answer 101

* decreased arterial oxygen concentration and increased carbon dioxide retention * acute or chronic repsiratory or neuromuscular process * acute = exacerbation of chronic issue * neuromusclar = weak thoracic cage * viral/bacterial illness puts them at higher risk * acute or chronic respiratory issue

Answer 102

* anterior hypospadias have no stents and need no special treatment * more severe hypospadias use drippy stent 7-14 days * bath, diapering issues * prophylactic antibiotics, bactrim * bladder spasms tx with oxybutynin * no swimming, contact sports 14 days * no straddle toys 14 days * blood visible ins tent for 14 days

Answer 103

* incubation period: 3-12 days (begin contagious process) * prodromal period: fever, high 40.6 * three C's: conjunctivitis, cough, coryza (acute rhinitis) * Koplik spots * maculopapular rash (still contagious) * lasts 5-6 days then fades

Answer 104

* arm immobilizers * pain management * avoid crying

Answer 105

physiologic need for an agent to rpevent withdrawal symptoms

Answer 106

* lower airway, respiratory tract infection * inflammation of bronchioles and alveolar spaces * 80% of cases in children * community aquired is 40:1000 * 20% of pediatric hospitalizations * lack of sensitivity and specificity in diagnostic testing * children before 12 yo won't cough for a sample

Answer 107

* males often sterile b/c of blocked vas deferens * females have reproductive difficulties due to mucous secretion that block sperm travel in fallopian tubes

Answer 108

* decreased CO w/ cardiac muscle showing non-specific changes * pericardial effusion in recovery * enlargement of heart size r/t increasing muscle mass

Answer 109

* pyloromyotomy surgery (Ramstedt's procedure) * divides pylorus to open gastric outlet * single incision or laparoscopically

Answer 110

* weight * height/length * head circumference * mid-upper arm circumference * indicates muscle * last area to become edematous in sick child * can monitor long-term nutrition * skin folds * indicate fat stores

Answer 111

tissues are starved of oxygen

Answer 112

* extreme protein hypersensitivity * intolerance to cow's milk protein * useful in malabsorption, enteropathies * ex: neocate, neocate jr, nutramigen AA, elecare

Answer 113

state of controlled unconsciousness accompanied by a loss of protective reflexes, including ability to maintain airway independently and respond purposefully to painful stimuli

Answer 114

* cleft lip may be unilateral or bilateral * may or may not include cleft palate defect * cleft palate not apparent until palpated * continuous opening between nasal cavity and mouth * can involve hard and/or soft palate * hearing oss, otitis media, dental deformity, speech and feeding problems

Answer 115

anemia caused by destruction/rupture of red blood cells

Answer 116

* gender (more males than females) * famil hx, genetic predisposition * allergens/atopy * people w/ allergies have more asthma incidences * airway hyperreactivity * pollution

Answer 117

* consider * topical agents * diversion * procedural medications * NPO status - age-dependent * avoid delays * safe environment

Answer 118

partial collapse/some parts of the lung stuck together

Answer 119

* baby aspirin with varicella * causes encephalopathy and continual seizures

Answer 120

* increased WOB * +/- cyanosis * change in mentation, LOC

Answer 121

* humidification to decrease upper airway drying * cool air and +/- oxygen * antipyretics for temperature if present * dexamethasone (steroid) to decrease inflmmation/edema * 24-48 hours (sometimes more/less) * +/- isotonic IV fluids, encourage PO fluids * don't make them irritable with an IV * solid food intake may decrease * need to at least stay hydrated

Answer 122

* forceful vomiting * dehydration * weight loss

Answer 123

* uncommon in childhood trauma * signs can be difficult to interpret * if child is scared, traumatized * high index of suspicion is needed to identify injuries * based on child's history

Answer 124

* from nonfat cow's milk, vegetable oils and CHO * assimilated to breast milk * ~20 cal/oz * 0.42-0.54 gm protein/oz * ex: similac, advance

Answer 125

reduction in cognitive function

Answer 126

* assess CV and RR function * assess arousability * assure adequate hydration * protect from injury * falls from bed/while ambulating

Answer 127

depression of consciousness during which patients respond purposefully to verbal commands no interventions required to maintain patent airway and spontaneous ventilation is adequate CV function usually maintained

Answer 128

* skin * nails * head and hair * mouth * eyes * abdomen * musculoskeletal

Answer 129

depression of immune response

Answer 130

* complete history: ROS * physical exam * skin abnormalities * rash * petechiae * VS abnormalities * fever \> 38C or * age-related tachycardia and tachypnea * abnormal WBC * \> 12,000/uL or * 10% bands

Answer 131

* daily Sx with nighttime Sx 3-4x / month * requires baseline medication

Answer 132

* tachypnea * increased HR * lower BP * neurologic (not alert, not consolable)

Answer 133

* hypoxia * hypoxemia * hypercapnea

Answer 134

brief episodes with Sx

Answer 135

* GI distress after cereal * large, fatty, foul odor stool * cachexia

Answer 136

* D5W 0.2% NaCl * with or without KCL * D10W 0.2% NaCl

Answer 137

* homeostasis/balance between acid/bases * indicated by pH * influenced by H+ ion concentration in blood * distubances in equilibirum cause pH changes * may indicate respiratory or metabolic alterations * try to regulate disturbance * bases = carbonic acids and bicarbs * acids = hydrogen ions (primary driver)

Answer 138

* common in children * 5-10% \> 3 yo with untreated latent TB progress to disease * infants and adolescents most likely to be symptomatic * adolescents cough a lot * infants just really sick * lung most common site of infection * diagnosis made by early AM gastric washing * child won't expectorate into cup

Answer 139

movement of solutes from areas of high concentration to areas of low concentration

Answer 140

* secondary infection of upper airway after viral episode of laryngotracheitis * airway edema and obstruction r/t copious purulent secretions

Answer 141

* never use memory * include weight, age * calculated dose and mg/kg dose * no abbreviations * use of zeros * bar coding * allergy documentation

Answer 142

decreased gastric and bowel motility

Answer 143

* environment * toxins, poisons * firearms * ATVs, bikes

Answer 144

1. no eye opening 2. eye opening to pain 3. eye opening to verbal command 4. eyes open spontaneously

Answer 145

* electrolyte imbalanced due to chloride ion loss in saliva, perspiration, mucous * salty taste to skin * sodium chloride through pores

Answer 146

* abdominal distension * abdominal tenderness * generalized guarding * pelvic instability or tenderness * blood at urethral meatus * inspection of back/perineum

Answer 147

* urine * stool * skin * respiratory tract

Answer 148

can tip over a compromised patient into infection and put them at risk

Answer 149

syndrome of anamolies commonly associated with each other * Vertebral * Anal * Cardiac * TE fistula * Esophageal * Radial

Answer 150

* secondary infections * cellulitis, abscesses, sepsis, meningitis, encephalitis, pneumonia, Reye's syndrome (baby aspirin), Group A strep, necrotizing entercolitis * fatal in children who are * immunocompromised, undergoing chemo, steroid treatment, transplant therapy

Answer 151

* TCAs * SSRIs * SNRIs

Answer 152

* RR * color changes during breathing and whooping * auscultate * coarse breath sounds * ronchi * diminished breath sounds * coughing is usually productive * difficult to clear * will often use suction

Answer 153

* avoid tic habitat * dress defensively * check for tics * shower right away * hot dryer * protect pets

Answer 154

* 5mm or greater + contact with infectious case * abomdinal CXR * clinical evidence of disease * immunosuppressive conditions and/or therapy * 10 mm or greater + risk of disseminated disease * risk/presence of compromising conditions * DM, CRF, malnutrition * known frequent exposure * 15 mm or greater * children \> 4 yo * no risk factors

Answer 155

* history and PE * pulse ox to determine CO2 levels * oxygenation * radiograph of neck

Answer 156

* maintain body system functioning despite frequent illnesses * adherence to med regimen * nutrition regulation

Answer 157

* capacity for sophisticated understanding of causes of pain * recognized pain is qualitative and quantitative * can relate to pain experienced by others * wants to behave socially acceptable, controlled response * may distract self * may not complain if given cues that it should be tolerated * more sophisticated descriptions of pain * may think nurses in tune with thoughts of pain * won't verbalize it

Answer 158

1. no vocal response 2. inconsolable, agitated 3. inconsistently consolable, moaning 4. cries but is consolable, inappropriate interactions 1. crying is NORMAL but needs to be consolable 5. smiles, oreinted to sounds, follows objects, interacts

Answer 159

* 0.9% NaCl = normal saline or saline * 0.45% NaCl = half normal or half normal saline * 0.2% NaCl = quarter normal or quarter normal saline * D5W = D5 * potassium chloride = KCL or K * CHOPism = hourly maintenance fluid = stock fluid

Answer 160

* level of consciousness * seizures

Answer 161

* growth is dynamic * indicator of health, well-being, thriving * provision of nutriets necessary for growth and life * nutrition status affects chld's response to injury and illness * recognize when parents are not making nutritionally sound decisions for their children * pediatric health of a society is indicative of the sustainability and prosperity of that society

Answer 162

* decreased H+ concentration * increased pH

Answer 163

* corticosteroids * inhaled anti-inflammatory beclomethasone, fluticasone (common), budesonide * +- allergy meds * hyposensitization therapy * emergency beta 2 agonist inhaler (patient/family education) * recognition of symptoms * knowledge/understanding of meds

Answer 164

* monitor for respiratory depression * visual confirmation and O2 * monitor patient tolerance * document vitals every 15 min

Answer 165

* acid suppression due to GERD * enemas to prevent constipation

Answer 166

* pain hx on admission * pain assessed/document q4h w/ reliable measurement tools * assessment-intervention-reassessment cycle when appropriate * pain managed with psycho, bio, developmental interventions * partner with families * analgestics safely/effectively around the clock * performance metrics * most frequent pain score over past 3 days * unsatisfactory pain relief for \> 1 hr - patient or system issue?

Answer 167

* pancreatic atrophy w/ reduced insulin * increased cortisol * destroys circadian rhythm * initial increase in T4 * w/ unresolved malnutrition T4 and T3 decrease

Answer 168

* congential defect of penis * urine stream deflected r/t abnormal location of urethral meatus * dorsal surface epispadias * also associated with penile curvature s/t chordee

Answer 169

kidneys * * less able to conserve or excrete water and solutes effectively * greater risk fo acid/base imbalance * specific gravity = 1.005-1.015 * lower b/c can't concentrate urine as much r/t immature kidneys

Answer 170

* bacteremia (sepsis) * meningitis * bacteremic pneumonia

Answer 171

beginning to see it again because * life threatening * many providers have never seen it used to be challenges in getting immunized and didn't cover all types but now, we're seeing more cases again

Answer 172

sepsis + CV dysfunction

Answer 173

* poor weight gain/weight loss * +/- fever, night sweats * fatigue * cough (+/- hemoptysis) * chest pain * palpable lymph nodes * CXR changes * most often in UR lobe of lung * positive PPD

Answer 174

* lactate - precursor to bicarb - used as a buffer during bleed (acidosis) * 10-20 ml/kg per bolus * used mostly in operating room, L&D

Answer 175

suspected or documented infection caused by pathogen OR clinical syndrome associated with high probability of infection

Answer 176

* elevated RR * elevated temp * elevated HR * DO NOT depend on BP as a initial symptom * children can hold onto their BP for a while * but when it falls, it plummets

Answer 177

serum soidum

Answer 178

* pseudomonas aeruginosa * e. coli * acinetobacter * neisseria meninigitidis * see this most often in really sick kids * VLBW, premies, etc.

Answer 179

* commonly used as lab value * long half life ~ 14 days

Answer 180

* H influenzae; H flu * categories: * encapsulated * respiratory: epiglottitis, pneumonia * invasive: meningitis, cellulitis, septicemia * unencapsulated * respiratory: bronchitis, sinusitis * invasive: otitis media, conjunctivitis * transmission - respiratory droplets

Answer 181

incomplete fusion of lip and/or palate

Answer 182

* orchiopexy (suturing) * orchiectomy (removal)

Answer 183

* infants less than 6 mo old * children with: * compromised airway (lung disease) * neurological impairment, muscle weakness * kidney/liver disease * morbid obesity * specific diseases (Downs) * hx of respiratory depression/sensitivity to opioids * large dose * fast administration * concurrent use of CNS depression meds * opioid naive

Answer 184

for hourly fluid maintenance * 4 ml/kg/hr for first 10 kg * + 2 ml/kg/hr for second 10 kg * + 1 ml/kg/hr for third 10 kg

Answer 185

protrusion of organ or tissue thru abnormal opening

Answer 186

weight pre and post weights with rehydration therapy

Answer 187

* wounds dry and clean * stitch vs mesh * dermabond maybe (5-10 days) * no ointments to wound region * frequent diaper changes * sponge baths 2-5 days * no lifting, bike riding 2 weeks

Answer 188

* little dark space * thickening and mucous and exudate sitting down in lungs * why they are on frequent chest physiotherapy * to move the stuff as much/frequently as possible

Answer 189

* staph auerus * staph epidermidis * strep pyogenes * strep pneumoniae

Answer 190

* high impact/deceleration injuries * direct blows * evidence of injury above/below abdomen * unlikely to have been spared * seat-belt injuries (duodenum, pancreas) * handlebar (duodenum, spleen, pancreas) * straddle injuries (perineum, vagina, urethra) * penetrating injury * injuries suggestive of child abuse

Answer 191

* chronic inflammatory disease causing 3 hallmarks: * obstruction of airflow via mucous * airway edema * airway muscle contraction/constriction * immediate inflammatory response by mast cells that release histamines which cause * bronchospasm * mucosal edema * mucous secretion * chronicity leaves airway hyperresponsive, leading to acute exacerbations * airway remodeilng (permanent) w/ or w/o mucous

Answer 192

* intractable emesis/diarrhea * severe abdominal distension * persistent diarrhea * chronic, persistent constipation * surgical abdomen

Answer 193

O2 requirements exceed O2 intake (obstruction, injury, poor ability to oxygenate)

Answer 194

* increased H+ concentration * decreased pH

Answer 195

* group of bacteria that causes multitude of diseases * bacteria are round and bnched * illness directly by infection or indirectly by products * toxins (80 types) such as MRSA * in normal flora of skin, throat, rectum * can infect blood, pulmonary, bones, joints, skin, soft tissues, heart, GI system * thousands of deaths/year * 80% resistant to penicillins

Answer 196

* calm patient - do not separate from caregiver * airway maintenance * drug therapy * hydration * emotional/psychosocial support of patient and family

Answer 197

* burns * trauma * blood transfusion * renal failure * IV with K+ * sickle cell crisis

Answer 198

* inflammation of appendix * common cause of emergency surgery * most often occurs when blocked by feces, foregin object, tumor * lab tests, including pregnancy for females to rule out other causes

Answer 199

* 10-20 ml/kg per bolus * depending on circumstances, can ahve up to 60 ml/kg

Answer 200

* NG tube * orogastric tube * nasoduodenal tube * NJ tube

Answer 201

* osmolarity is more than 300 * less water, more solute * fluid moves out of ICF into ECF into intravascular space * brain cells shrink + brain bleed * brain collapses on itself because of shrinkage * increased BP and bounding pulses * TPN (total parenteral nutrition) or 3% saline (ICUs) * around 1000 mOsm

Answer 202

* 2.5 cm/month first 6 mo * 1.3-1.5 cm during 7-12 mo * 7-7.5 cm/year \> 12 mo until adolescent spurt

Answer 203

* catecholamine and adrenocorticoid hormone secretion * tachycardia * tachypnea * hypertension * pupil dilation * pallor * increased perspiration

Answer 204

highly contagious respiratory disease caused by bacterium bordetella pertussis

Answer 205

* upper * common cold (viral) * croup * sinusitis * lower * bronciolitis * pneumonia * asthma

Answer 206

* bleeding * inflammation * obstruction * motility * congenital * malabsorptive * infections

Answer 207

* no understanding of pain - responds to parental anxiety * generalized body movements, chin quivering, facial grimacing, poor feeding * cries

Answer 208

* gut ischemia * prolonged, profound hypotension * critical illness with \>2 vasoactive meds and/or escalaing vasoactive med * malabsorption * surgical abdomen * intra-abodminal HTN

Answer 209

* respiratory assessment + oxygen * neuro * antibiotics and fluids * lumbar puncture * glucose and protein: low glucose, high protein is symptom * isolation for 24 hours * identify close contacts and give prophylactic antibiotics * vaccine: menactra/MCV4 (serotypes A,C,D,Y)

Answer 210

* understands simple relationships between pain and disease * understands need for painful treatments * may associate pain with feeling bad/angry * may recognize psychologic pain r/t grief * passive resistance, clenches fists, holds body still, suffers emotional withdrawal, engages in plea bargaining * can specify location and intensity * describe physical characteristics in relation to body parts

Answer 211

* pain perception can be inhibited/changed when competing non-pain impulse is sent along same pathway * stimulation of larger A-beta fibers causes substantia gelatinosa in dorsal horn of spinal cord to "close the gate" and decrease pain transmission to brain * rubbing something that hurts

Answer 212

* incubation period 14-21 * enters through respiratory tract and conjunctiva * replicates at site of entry in nasopharynx and in regional lymph nodes * acute onset of mild fever, malaise, anorexia * macular rash for few hours that progresses to pruritic vesicular lesions for 1-5 days. up to 500 lesions of all stages * crusts may remain 1-3 weeks * ulcerative lesions in mucous membranes * transmission: both airbone and direct lesion contact * contagious state continues until all lesions are crusted over

Answer 213

* parainfluenza I, II, III * adenovirus * rhinovirus * novovirus * human metapneumovirus * mycoplasma pneumonia

Answer 214

* weather * exposure to known/unknown allegens * dust mites * mold * pet dander * URI * airway/respiratory irritants * tobacco smoke * aerosol sprays * exercise * pre-medicate

Answer 215

* stimulate patient * give oxygen * stop opioid * anesthesia STAT or code blue if needed * notify the primary service and pain treatment service * give naloxone as needed

Answer 216

* tests for TB * put NG tube at night before they sleep * aspirate before/as they wake up in the morning * 3 days in a row

Answer 217

* urinalysis and urine culture * catheter (most reliable) vs bag/clean catch * any number of colonies in culture is significant * with bagged collection \>100,000 single organisms significant * for boys, 1,000 ucf is positive

Answer 218

* loss of equal amounts of sodium and water * 80% of dehydration incidents

Answer 219

* accumulation of fluid around testicle * communicating: no bowel, just peritoneal fluid * noncommunicating: no connection to peritoneum * rare in children * more common in adolescents from fluid from lining of tunica vaginalis * fluids will go away, become absorbed

Answer 220

* leading cause of serious illness around the world * caused by bacterium Streptococcus pneumoniae * can attack different body parts * illnesses include: * pneumonia * meningitis * middle ear and sinus infection * issue with sickle cell disease

Answer 221

placing temporary enteral tube tip of **N**ose, inferior attachment of **E**ar lobe, **M**id-way between xiphoid and **U**mbilicus

Answer 222

* stunting * osteopenia

Answer 223

* pain ease spray * emila cream * LMX -4 cream * local cirulatory changes * blanching, vasoconstriction * lidocaine toxicity * prolonged administration or large surface area

Answer 224

* hygiene * baths, no bubbles, no lotions * increase fluids * no holding urine * voiding after sex * long term low dose antibiotics?

Answer 225

* can't fully exhale in asthma exacerbation * breaths on top of breaths * lungs expand beyond normal

Answer 226

* gastric tube * gastric-jejunal tube * jejunal tube

Answer 227

* disease of lower airway caused by RSV invading cell mucosa in smal airways * inflammation of bronchioles * leads to epithelial necrosis * constriction and obstruction of small distal airways * air trapping, atelectasis * can progress to RSV pneumonia

Answer 228

* 0-5 mo: * 4 hours solids * 3 hours breast milk * 2 hours clears * 5-36 mo: * 6 hours solids * 3 hours breast milk * 2 hours clears * 3+ years: * 8 hours solids * 2 hours clears

Answer 229

* also from immunosuppression * commonly in mouth * contamination from mom (full thrush possible) * lot of kids with cancer have oral thrush * can't eat, drink, swallow * painful * goes down entire esophagus

Answer 230

* varied S/Sx in children - hard to diagnose * first Sx usually pain around belly button * moves to RLQ ~ 12-24 hrs after illness starts * if appendix ruptures * less pain for a while, followed by: * chills and shaking * hard stools or diarrhea * fever, N/V

Answer 231

depression of consciousness during which patients cannot be easily aroused but respond purposefully after repeated or painful stimuli. ability to independently maintain respiratory function may be impaired. require assistance to maintain patent airway and spontaneous ventilation may be inadequate CV function usually maintained

Answer 232

* inability to maintain effective exchange of oxygen and carbon dioxide * hypoventilation of alveoli

Answer 233

* A: aeration * B: breathing and brain * C: circulation * D: disabilities and drugs * E: expose the patient and electrolytes * F: fluids

Answer 234

* inflammation and edema of epiglottis that can occlude trachea * presents with acute illness * H influenzae - type B * strep pneumoniae * staph aureus * LIFE THREATENING - DO NOT EVALUATE AIRWAY

Answer 235

* 10 or 20 meq concentrations in IV bags * not to be confused with KCL boluses AKA riders * kidneys regulate potassium levels and have poor ability to conserve potassium * when patient is NPO, KCL should be added to fluids * IVF bag with KCL should never be given to patient who has not demonstrated adequate urine output (kidneys)

Answer 236

mutlifactorial - strong genetic influence

Answer 237

* significant malabsorption * short gut, CF, biliary atresia, protracted diarrhea * poor taste - introduce prior to bitter taste development * ex: nutramigen, pregestimil, good start genlte plus, similac expert care alimentum

Answer 238

* diarrhea * wound drainage * eating disorders * renal disease

Answer 239

* end product of organs functioning and muscle contractility is lactate * if you can't clear it b/c of decreased blood flow and CO * buildup of lactate in blood * acidic environment

Answer 240

* avoid measurement errors * examiner error * proper training * standardized techniques * instrument error * precise, calibrated instruments * measurement difficulty resutling in inacuracy * repeated measurements on same subject

Answer 241

* usually prior to 18 mo * closure allows better seal around nipple * multidisciplinary management * plastic surgery * dentistry * hearing * speech/feeding therapy

Answer 242

1. increased body surface area 2. increased metabolic rate (growing) 3. immature kidney function

Answer 243

* has pain memory; responsive to parental anxiety * reflex withdrawal to stimulus, facial grimacing, disturbed sleep, irritability, restlessness * cries

Answer 244

inflammation of peritoneum

Answer 245

1. insult/injury 2. inflammatory mediators --\> SIRS response 3. tissue injury --\> infection --\> decreased tissue perfusion --\> sepsis 4. severe sepsis --\> septic shock --\> death

Answer 246

* pancreatic enzymes to aide digestion * balanced diet w/ increased caloric intake

Answer 247

* respiratory syncytial virus (RSV) * influenza A or B * adenovirus * rubeola (measles)

Answer 248

* infection * increased capillary blood flow, inflammation * burns * increased capillary permeability * cardiac failure * venous congestion, R side heart failure * nephrotic syndrome * increased albumin excess * tumors * blocked lymphatic drainage * surgery * lymphedema

Answer 249

* pain is a hurt * does not relate to illness, maybe to injury * believes pain is punishment * can't understand why painful procedure will help * active physical resistance, directed aggression, strikes out physically and verbally, low frustration level * language skills to express pain on sensory level * can identify location and intensity * may deny pain * may believe his/her pain is obvious to others

Answer 250

* most common tic born illness in N. America and Europe * bacterium Borrelia burgdorferi * deer tics can harbor bacteria and spread when feeding

Answer 251

* varicella zoster virus * DNA virus and member of herpesvirus group * capacity to eprisst in body after primary infection * in sensory nerve ganglia * primary infection = chickenpox * secondary infection/reactivation = herpes zoster (shingles) * short survival time in environment * can progress to pneumonia or encephalitis

Answer 252

* bacterial * viral * chemical * lung tissue irritation * aspiration * inhaled meds/toxins/poison

Answer 253

* burning/pain with urination * frequent/urgent urination * fever * lower abdominal pain * wetting episodes * blood in urine

Answer 254

* affected by 4 wks of age * lungs filled with mucus so cilia can't move * air trapped in lower airways causes areas of pulmonary collapse * secondary bacterial infections leads to life threatening respiratory failure * most common cause of mortality * when respiratory system is affected, so are all the other systems * can't do same amount of ventilation/oxygenation

Answer 255

* surgery at 6-18 mo before toilet training and knowledge of abnormality * do not circumcise - use foreskin to cover opening * creation of normal urethral meatus and glans penis * straight penis * normal urethra * skin covering

Answer 256

* urine characteristics * pain, discomfort * edema, generalized? * apperance of genitalia

Answer 257

* collection of blood, body fluids, pus in abdomen (intra-abdominal abscess) * peritoneum is a sterile environment that reacts to pathologic stimuli with uniform inflammatory response * may be infectious or sterile peritonitis (chemical or mechanical) * intra-abdominal sepsis is inflammation of peritoneum r/t pathogenic microorganisms and products * typical causes: pelvic inflammatory disease r/t STIs

Answer 258

decreased oxygen in blood

Answer 259

diminished effectiveness of drug upon repeat administration

Answer 260

one opening where feces and urine exit

Answer 261

* capillary leak * leukocyte infiltration * erythema, edema * shininess when you see these things, SIRS should always be in the back of your mind

Answer 262

* assorted visuals * toys, books, etc. * breathing techniques * comfort measures * parent, modify environment * familiar objects * comfort holding * diversional talk

Answer 263

weight based dosing greatest error in calcuation, greatest potential for harm

Answer 264

* measles * parvovirus * chickenpox

Answer 265

* rhinorrhea with nasal congestion * cough - horase, progresses to wet * often productive - coughing and swallowing can cause emesis * WOB * tachypnea, retractions, +/- wheeze, crackles, nasal flaring, grunting, head bobbing, oral breathing * +/- temperature (may be hypothermic) * decrased activity * usually decreased appetite * apnea in young infants (

Answer 266

* palpitations * weakness * arrhythmias

Answer 267

* episodes \> 2x/week but less than daily * night episodes 1-2x / month * requires baseline medication

Answer 268

* transferrin * prealbumin * retinol-binding protein

Answer 269

* airborne * cough, sneeze, talking * breathing in bacteria

Answer 270

* maintain safety * minimize physical discomfort * AAA - analgesia, anxiolysis, amnesia * control behavior/movement * return patient to baseline

Answer 271

* no meconium for 48 hours * FTT * constipation Sx are age related

Answer 272

* won't swallow * hurts * can't breathe * will drool * tripod position

Answer 273

normal physiological loss of fluid (respiratory, skin)

Answer 274

pain and fear

Answer 275

* spectrum of systemic, inflammatory responses to infection * life-threatening * body's response to infection * up regulation of cytokines, inflammatory response * release of pro-inflammatory and anti-inflammatory mediators into systemic circulation * activate procoagulation pathways * alter CV function and tissue perfusion

Answer 276

* patient position to maximize airway for adequate air flow * assess RR and WOB, change in use of accessory muscles * monitor VS, LOC * monitor oxygen sat * check equipment * administer oxygen * ensure emergency equipment is available * monitor patient for changes

Answer 277

* e.coli * enterococcus * pseudomonas

Answer 278

* yeast infection * more incidents in hospitals * antibiotics, immunosuppressed * not sleeping as well, nutrition not as good

Answer 279

psychological syndrome characterized by compulsive drug-seeking behavior

Answer 280

* prevention! * oral antibiotics - standard treatment for early-stage disease * doxy for over 8 yo * amoxicillin for adults, younger children, pregnant/breast-feeding women * 14-21 days recommended * intravenous - later stage if involves CNS * 14-28 days * may take time to recover from symptoms * usually presents with stroke-like symptoms of paralysis

Answer 281

* increased peripheral vascular resistance * increased myocardial oxygen consumption

Answer 282

* local anesthetics * capsaicin * anticonvulsants * NSAIDs * aspirin * acetaminophen * nitrate

Answer 283

mycobacterium tuberculosis

Answer 284

the movement of water from areas that have too much water to areas that have less water

Answer 285

white salt granules inside oral mucosa

Answer 286

* airway issues (stenosis, malacia, web) * obstruction * abnormal anatomy * craniofacial anomalies (Pierre Roban - no chin, can't intubate) * vocal cord paralysis * respiratory problems * premature lungs * prolonged respiratory support * neurologic * unable to protect natural airway * neuromuscular disorders/weakness * injury

Answer 287

* primary benefits: * minimize anxiety/discomfort while reducing undesirable autonomic response to pain * help patient thru painless procedure that requires immobility for extended time period * excessive sedation/analgesia may result in RR or CV depression, hypoxia and/or cardiac arrest * inadquate sedation/analgesia may result in inaccurate/incomplete test or patient injury

Answer 288

* ABC: support for apnea, hypoxia, remain with child during coughing, when hypoxic, give oxygen if needed * D: hand hygiene, antibiotics - 5 days * droplet prectuations until 5 days after antibiotic therapy or until 3 weeks after onset of paroxysmal coughing * F: fluids, IV hydration * isolation * vaccine to unimmunized contacts under 7 yo * acellular pertussis * Tdap, DTP, DTaP, ADACEL

Answer 289

* staph aureus * group A strep * moraxella catarrhalis * haemophilus influenza

Answer 290

* invagination of part of intestine into itself * most common abdominal emergency in early childhood ( * majority of cases are idiopathic * common location: ileocecal valve

Answer 291

* encapsulated or unencapsulated * nearly all invasive are encapsulated or surrounded by polysaccharide capsule * 12 sero groups b/c of capsule * six cause majority of infections: A, B, C, W135, X, Y * incidence highest in children less than 5 and adolescents * generally passes through inhalation but can also be nasopharyngeal or through ear canal

Answer 292

* ~ 6 mo when they start eating solid food * diarrhea, distended abdomen, nutritional issues

Answer 293

* identify and minimize exposure to triggers * skin testing for allergens * education/monitoring for exacerbation symptoms * maintain regular activity/exercise * compliance w. control meds * early management when sx occur * asthma action plan * tailored to pt and family

Answer 294

* bacteria * viruses * fungal infections * parasitic infections

Answer 295

* pulmonary surfactant produced by Type II pneumocytes * betamethasone at 24-25 weeks gestation can accelerate fetal surfactant production

Answer 296

* catarrhal * 7-10 days * incubation and infectious process starts * paroxysmal * infectous period lasts 7 weeks or longer * whooping cough stage * convalescent stage * 6 weeks

Answer 297

* infected adult * at-risk populations * low income * emigration from under-resourced country * residence in place of close co-habitation of large numbers

Answer 298

* transduction * transmission * perception * modulation

Answer 299

* pediatrics always want a scale that can be used anywhere - different language, w/o equipment, replicable, understandable * 15 = perfect * awake, alert, speaking, moving * 3 categories: * eye, verbal, motor * goes down by 1 or 2 points in middle of the night (especially children) * document time

Answer 300

* ~ 6ml/kg/min * twice that of an adult * related to baseline RR * don't have as much tidal volume - need to breathe faster

Answer 301

* 1-2 ml/kg * up to 3-4 ml/kg * dextrose is metabolized quickly, leaving "free water" * expands both ICF and ECF * other fluids expand only ECF

Answer 302

* adverse food rxn * gradual onset after large ingestion * +/- frequency of food ingestion * no immune system involvement * generally limited to GI * causes include: * lack of enzymes * irritable bowel * toxic contaminates

Answer 303

* vomiting * diarrhea * hemorrhage * burns * NG suctioning * drainage loss

Answer 304

* cardiac * replace K+

Answer 305

* verbal/self report * child's capacity to demonstrate concepts of degree, rank order, estimation, classification * parent proxy * behavioral indicators * individualized NRS (cognitively impaired) * physiologic indicators

Answer 306

* smaller diameter * anterior position * floppy epiglottis * angled vocal cords * narrowest portion is cricoid cartilage * funnel shape to the larynx * problem with increased secretions * small cricothyroid membrane * large tongue * large occiput * causes head to tip forward and airway to close when supine * but something under shoulders to open airway * large tonsils/adenoids

Answer 307

1. no motor response 2. extension to pain 3. flexion to pain 4. withdrawal from pain 5. localizing pain 6. obeys commands

Answer 308

sepsis + CV OR respiratory dysfunction OR _\>_ 2 other organ dysfunctions

Answer 309

full, sunken, or flat - we want them flat full indicates increased intracranial pressure from: infection, trauma, hydrocephalus (increased spinal fluid)

Answer 310

* consolidated maculopapular rash behind ears and then spreads to face * eyes swollen shut from drainage * irritable, febrile

Answer 311

* typical presentation of initially nonbloody, always nonbilious vomiting at 4-8 weeks of age * vomiting intensity increases towards projectile vomiting * prolonged diagnosis can lead to * dehydration, malnutrition * poor weight gain * metabolic alterations * lethargy * parents report trying different formulas b/c of intolerance

Answer 312

* common outcome is meningitis * when caused by Neisseria meningitidis * meningococcal meningitis * spread via inhalation * incubation: 2-10 days

Answer 313

falls, adverse drug reactions, infections, etc.

Answer 314

* state newborn screening * genetic testing * sweat chloride testing * definitive if _\>_ 60 mmol/L * suspect if 40-60 mmol/L

Answer 315

* highly contagious * virus in paramyxovirus family * normally passed thru direct contact and thru air * virus infects mucous membranes then spreads throughout body * human disease - does not occur in animals

Answer 316

* can be diagnosed before birth * mom will develop a lot of amniotic fluid because the baby can't swallow it * otherwise, the 3 C's * coughing * choking * cyanosis

Answer 317

age in years + 2 (oz)

Answer 318

* reduce risk of aspiration * assess for respiratory distress * ensure adequate nutrition and growth * provide feeding training for parents

Answer 319

* prototype opioid * mimics endogenous endomorphins * peaks 20 min * duration 2-4 hours * half life 2 hours

Answer 320

* symptoms vary * skin, joints, nervous system most often affected * early signs * rash - not necessarily bulls-eye * erythema migrans * flu-like symptoms * later signs * joint pain * neurological problems

Answer 321

* generally don't label a child under 2 yo with asthma * call it "reactive airways" * b/c some belief that symptomatology is r/t viral illnesses * if they make it to the hospital or ICU with these symptoms, then it is labeled asthma

Answer 322

* usually from trauma * one of few surgical emergencies in adolescent boys * issues with fertility and cosmetic appearance * need surgery within 6-8 hours

Answer 323

* sedation plan * what is required * length * painful? * consider development and hx of child * work with parents * prepare - include expected sensations

Answer 324

* highly contagious, incubation period 2-8 days * handwashing * avoid sick contacts * re-infection is common * acute illness course is 3-7 days * cough and +/- wheeze may persist * full recovery can take 3 weeks

Answer 325

* isoniazid * rifampin * pyrazinamide * ethanmbutol * daily, minimum 6 mo

Answer 326

* neurologic * altered mental status (irritable vs lethargy) - what is their norm? * extreme anxiety * respiratory * tachypnea * increased work of breathing (WOB) * CV * tachycardia * perfusion (start out and work in - different peripherally than centrally?) * development of / enhanced murmur * warm vs cold hypotension * renal funtion/output * skin

Answer 327

* opioids * alpha2-agonists * TCAs * SSRIs * SNRIs

Answer 328

* inhaled bronchodilators * inhaled steroids * corticosteroids * antibiotics (PO, IV, inhaled) * pancreatic enzymes * multivitamins (ADEK) * lactulose * ursodeoxycholate (ursodiol)

Answer 329

movement of solutes from areas of high concentration to areas of low concentration, but the molecules need a carrier to help with diffusion

Answer 330

* exercise * hard if depressed * results in muscle atrophy * aggressive chest physiotherapy * intermitten spirometry * immunizations * dysfunctioning immune system from antibiotics * will they get sicker with a live virus?

Answer 331

* uterine tenderness or * adnexal tenderness or * cervical motion tenderness

Answer 332

* concentration of solutes outside body * ex: IVF solute measurements

Answer 333

SIRS in the presence of OR as a result of suspected or documented infection

Answer 334

extremities really warm but hypotensive

Answer 335

* change in responses to pain * altered temperatures * possible altered development of pain system in infants

Answer 336

intestines and possibly other organs located outside of abdomen

Answer 337

* premature/VLBW * neonates * compromised immune status * HIV * oncologic processes/malignancy * transplant * cytotoxic, immunosuppressant agents * chromosomal disease * metabolism is often very different and not completely understood * don't know how system will react to an insult * higher index of suspicion in these patients

Answer 338

* face * legs * activity * cry * consolability

Answer 339

* sleeplessness, anxiety, fear, hopelessness * increased thoughts of suicide

Answer 340

* neurological * weakness * arrhythmias

Answer 341

* making good urine? * .5-1 ml/kl/hour in older children and adolescents * 1-2 ml/kl/hour in infants and young children * blow flow to kidneys good enough to keep making urine?

Answer 342

* gold standard: nasopharyngeal culture * can diagnose during prodromal * takes 5 days to come back * do we treat during prodromal? * do not underestimate diagnostic skills * coughing, cyanotic, and post cough emesis - probably won't wait for the culture

Answer 343

* primarily dependent on RR * slow breathing = less ventilation AND oxygenation

Answer 344

* infants experience greater pain intensity w. same stimulus * pain modifies brain * volumetric losses in cortex, corpus callosum, hippocampus, basal ganglia * lower cognitive scores * increased behavior disorders * nerve sheaths are still myelinating - dissemination of the stimuli

Answer 345

* Hgb/Hct * decrease in late Fe deficiency * can decrease for other reasons * ferritin * most sensitive - correlates to w/ total body stores * erythrocyte protoporphyrin, serum fe/total binding capacity transferring - dependent on Fe stores

Answer 346

* bowel management * surgical removal * temporary colostomy

Answer 347

EVERYTHING compensates, whereas in adults, it begins with just the heart or just one system

Answer 348

hypagque barium enema - without innervation, contrast media won't move

Answer 349

* no antibiotics * protein coat * smaller than bacteria * viral organism needs host to survive * invades cells * redirects to produce more virus, increasing viral load * improves in 1-3 weeks

Answer 350

* pain * fear * infection * dehydration

Answer 351

* urinary stasis * vesicoureteral reflex * abuse

Answer 352

intolerance to wheat and rye that causes changes in intestinal mucosa which leads to malabsorption familial, inborn error of metabolism

Answer 353

* 0.9% saline (NaCl) aka NS (normal saline) aka NSS (normal saline solution) * lactated ringers (LR) - lactate * D5W - dextrose 5% osmolarity is around 300 (same as body)

Answer 354

* ABCs and daily weights * assess skin * IV replacement (if diarrhea/vomitiing), strict I/O * labs for electrolytes, BUN, creatinine * fluids, specific gravity * support mom with breastfeeding

Answer 355

clean catch yields \> 100,000 units

Answer 356

brings nutrients (glucose) and takes away wastes

Answer 357

advocate - make it hurt as little as possible apologize to the child afterwards

Answer 358

* fontanelles and neuro * vital signs and cap refill * mucous membranes and thirst * extremities * urine output, diarrhea, specific gravity

Answer 359

* several variations of incomplete anal opening * pouch that does not connect with colon * openings to other structures * urethra, bladder, base of penis/scrotum/vagina * narrowing of anus or no anus * VACTER syndrome sometimes

Answer 360

* infant: 2 ml/kg/hr * child: 1-2 ml/kg/hr * adolescent: .5-1 ml/kg/hr *minimum* output - signifies hydration is adequate small reduction in urine volume could indicate significant compromise in renal perfusion or function

Answer 361

* recent upper respiratory illness * recent diarrheal illness * CF * chronic indwelling GI tubes

Answer 362

face and genitalia

Answer 363

* partially hydrolyzed * allergies (IgE mediated) * severe GERD * prevention of atopic dermatitis * ex: carnation good start, good start gentle, peptamen Jr

Answer 364

* congenitally interrupted esophagus * one or more fistulas may be present between malformed esophagus and trachea * surgical emergency * failure of esophagus to develop as continuous tube

Answer 365

* severe gastroenteritis with bloody diarrhea * upper respiratory infection or UTI before HUS * HTN, pallor, bruising, oliguria

Answer 366

* IV access * monitoring * oxygen, EKG/BP * ventilation * equipment * suction, oxygen * airway, bag-valve mask * antagonists * flumazenil (for benzos) * nalaxone

Answer 367

* developmentally appropriate * easy to use and quickly understood by patients * easily scored and recorded * available in various languages * reasonable validity and reliability

Answer 368

* 20-30 g/day first 6 mo; double birthweight by 5-6 mo * 10-20 g/day 6-12 mo: triple birthweight by 12 mo * 8-10 g/day \> 1 yr

Answer 369

* airway - oxygen therapy * fluid - may progress to inotropic support * antibiotics (within 1 hr if suspicion) * usually vanco + cyclosporin * monitor urine output b/c vanco is nephrotoxic * ceftriaxone in ED * blood * trauma? bleeding? low hgb (iron carrying capactity)? * part of fluid therapy * supportive measures - imaging studies * nutrition * feed as quickly as possible * use working GI system if they have one

Answer 370

* lactase diminished condition * intolerance of cow's milk/soy based formulas * ~20 cal/oz * ex: similac sensitive; enfamil gentlease

Answer 371

bad oxygen exchange in tissues

Answer 372

* how does child typically express pain * previous experience with pain * copes with pain * works best to relieve pain * parent and child preferences

Answer 373

* upper * congestion * rhinorrhea * cough * poor appetite * +/- febrile * lower * SOB * increased WOB, tachypnea * +/- wheezing and retractions * febrile

Answer 374

* osmolarity ~ 300 mOsm * no fluid shift between ICF/ECF b/c of equal concentrations of solutes and water * 0.9% NaCl or lactated ringers

Answer 375

* Systemic Inflammatory Response Syndrome * inflammatory feedback to illness/injury * local rxn at site of injury OR systemic response to infection * up-regulation of innate and adaptive immunity of natural physiology * clinical manifestations * tissue edema * hypoperfusion * cell proliferation

Answer 376

* airborne droplet * direct contact w/ infected fluids * inhaled organism (bacilli) goes directly to alveoli * breaks open in lung and multiplies * surrouned and isoalted by macrophages * 3 mo for cellular response * positive TB skin test * 3% false positive * partially positive - check w/ CXR

Answer 377

* PPD test * if active: * airbone TB isolation - N95 mask * monitor respiratory status * monitor hydration * med admin * report to public health department * isolate family * hand hygiene * negative pressure room isolation * long term follow up with infectious disease and pulmonary * follow nutritional status

Answer 378

* spread via respiratory secretions * abrupt onset of fever, chills, malaise, vomiting * neurologic signs: * decreased mental status, seizures, coma * bulging fontaneles, severe headache, stiff neck * photophobia, nuchal rigidity * maculopaular rash - then petechial and maybe to purpura and sepsis * septic shock is a complication

Answer 379

* produces insulin and glucagon normally * can't regulate glucose homeostasis * can't fight infection, digest food, hormone regulation

Answer 380

* uncontrollable, violent coughing that makes it hard to breathe * after coughing fits, someone with pertussis needs to take deep breathings ("whooping") * commonly affects infants and young children * can be fatal, especially less than 1 yo * less than 6 mo have an absent cough (not enough intercostal muscles) * apnea is a symptom * not as worried once they walk and develop intercostal muscles * 100 day cough * 3-3.5 months to resolve once symptoms develop

Answer 381

* congenital aganglionic megacolon * absence of nerves in part of intestine * usually identified in first two months of life * less severe cases later in childhood

Answer 382

* antibiotics within first 1-2 days of catarrhal (may not know they have it) can help eliminate symptoms * once they start paroxysmal coughing, antibiotics won't help child * but can help people they interact with

Answer 383

* increased severity of WOB * accessory muscles * dyspnea * change in LOC * stupor * obtunded - LOC

Answer 384

* antipyretics; no antibiotics unless secondary infection * IV for hydration; assess nutrition * negative air pressure * isolation precautions for 3 days * until fever is gone for 3 days, rash completely gone, cleared by infectious disease doctor and pediatrician * depends on child and if they have immunocompromised children in their classroom * cool mist vaporizer; cool liquid frequently * suction gently * vaccine: MMR 12 mo and 4-6 yo * required to call public health department

Answer 385

* cognition and communication * safety issues * physiological

Answer 386

* observation * lump, bulge * crying, straining * lights used for mass vs. fluid

Answer 387

* mutually beneficial partnership between patients, families, healthcare team * formal method of delivering best care * ensure health and well being of patients of all ages * families are valued members of Health Care Team * supports key principles * dignity and respect * information sharing * participation and collaboration * care coordination and access to care

Answer 388

* D5W 0.45% NaCl * with or without KCL * less common * D5W 0.9% NaCl with or without KCL * all IVF rates, except TPN, based on weight (4,2,1 rule) unless weight is greater than 50 kg

Answer 389

* 1/2 body water is ECF * 1st three months, 70-80% of weight is water * ECF ratios match adults by 2-3 yo * before age 3, 60% body weight is water

Answer 390

* peripherally * local anesthetics * opioids * dorsal root ganglion * local anesthetics * alpha2-agonists

Answer 391

* greater loss of water than sodium * serum sodium is elevated * side effect of high sodium r/t dehydration = seizures

Answer 392

normal physiological loss due to urine and stool

Answer 393

* serum sodium \> 150 = greater loss of water than sodium * hormonal - peeing a lot

Answer 394

*probably* starts with vasodilation and increased permeability, but who knows?

Answer 395

* derease diaphragmatic fxn * response to hypoxia is blunted * not blunted for hypercapnia

Answer 396

differences between adults and children * head circumference * fontanelles * spinal cord * measurements, scoring * reflexes

Answer 397

* nutrition * wet diapers? how often? * how much eating, how frequently? * emesis after feeds, or some feeds? * NG tube if they can't eat well * may vomit after coughing * can complicate breathing process * maintains hydration and prevents hypernatremia or hyperkalemia (seizures and cardiac arrhythmia)

Answer 398

* altered cell mediated immunity * IgG repsonse is normal * IgA may increase

Answer 399

extremities really cold but hypotensive

Answer 400

increased risk for renal scarring

Answer 401

* ABCs and daily weights * skin breakdown (turn every 2 hours) * labs * fluid restriction? * specific gravity?

Midterm Flashcards

(434 cards)