Pediatrics Final Exam > Test Review > Flashcards

Test Review Flashcards

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0
Q

Tonsillectomy

-Contraindications

A
  1. Active infection (can spread the infection)

2. Cleft palate

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1
Q

Tonsillectomy

-Signs of Post Op Bleeding? ***TEST

A

Monitor For:

  1. Excessive swallowing
  2. Elevated pulse; decreased blood pressure
  3. Signs of fresh bleeding in the back of the throat
  4. Vomiting bright red blood
  5. Restlessness not associated with pain
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2
Q

Tonsillectomy

-Pre-Op considerations

A
  1. Assess for allergies, difficulty breathing or airway obstructions
  2. Assess for active infection
  3. Assess for loose teeth
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3
Q

Tonsillectomy

-How to Assess Bleeding Post Op

A
  1. Use flashlight to assess bleeding
  2. DO NOT use a tongue depressor
    - ONLY USE STERILE EQUIPMENT
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4
Q

Tonsillectomy

-Post-Op Care

A
  1. Vomiting coffee grounds is common
  2. Don’t use red colored drink and meds that can be confused w/ blood
  3. Avoid citrus and carbonated drinks for 10 days
  4. Monitor bleeding and infection
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5
Q

Croup

-Caused by?

A
  1. Parainfulenza virus
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6
Q

Croup

-Signs & Symptoms

A
  1. Inspiratory stridor
  2. Harsh, bassy, barky, croupy cough
  3. Hoarseness
  4. Respiratory distress
  5. Fever (up to 104 F)
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7
Q

Croup

-Onset and Manifestations

A
  1. Often begins at night
    - May be preceded by several days of symptoms of upper respiratory tract infection
  2. Use of accessory muscles to breathe
  3. Frightened appearance
  4. Agitation
  5. Cyanosis
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8
Q

Croup

-Management

A
  1. Maintain airway
  2. Increased fluids
  3. Cool night air may relieve mucosal swelling
  4. Crying aggravates
  5. Dexamethasone
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9
Q

Bronchiolitis

A
  1. Inflammation of the bronchioles
  2. Respiratory synctial virus (RSV) is the causative agent in 50% of cases of bronchiolitis TEST
  3. Significant cause of hospitalization in children under 1 year of age
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10
Q

Bronchiolitis

-Pathophysiology

A
  1. Obstruction of bronchioles
  2. Infants small bronchioles obstruct easily
  3. Airway resistance on inspiration and expiratoin
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11
Q

Bronchiolitis

-Leads to?

A
  1. Gas exchange impaired
  2. Metabolic acidosis
  3. Ill during first 48-72 hrs
  4. Symptoms 10-14 days
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12
Q

Respiratory Synctial Virus (RSV)

-Statistics

A
  1. Infants usually acquire from older child or adult
  2. Highly communicable
  3. Nosocomial outbreaks in Ped’s hospitals are common
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13
Q

Respiratory Synctial Virus (RSV)

-How it is Transmitted?

A
  1. Contact w/ contaminated surfaces and hand to hand transmission
  2. Can live on skin and paper for 1 hour and cribs for 6 hours
  3. Contact isolation and scrupulous hand hygiene
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14
Q

Respiratory Synctial Virus (RSV)

-When Does it Happen?

A
  1. Annual epidemics
  2. Winter and early spring
  3. Immunity does not occur
    - incidence decreases w/ age
  4. Nearly 100% of children have RSV by age 2
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15
Q

Bronchiolitis/RSV

-How it Starts?

A
  1. It is usually preceded by mild upper respiratory infection
    - Nasal drainage, sneezing, low-grade fever, and anorexia for several days
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16
Q

Bronchiolitis/RSV

-Acute Respiratory Distress Phase

A
  1. Follows upper respiratory infection
  2. S/S of this phase are:
    - Tachypnea (60-80 breaths per min)
    - Tacycardia (>140)
    - wheezing, crackles, or rhonchi
    - Retractions
    - Cyanosis
    - Either hypothermic or fever up to 105 F
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17
Q

Bronchiolitis/RSV

-Treatment if Hospitalized

A
  1. Cool humidified O2 with O2 sat <90%
  2. IV if dehydrated from tachypnea
  3. Head and chest at 30-40 degrees to open airway
  4. No antibiotics unless secondary bacterial
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18
Q

Bronchiolitis/RSV

-Reason for Cool, Humidified O2 for Treatment?

A
  1. Cool, humidified O2 is given to relieve dyspnea, hypoxemia, and insensible fluid loss from tachypnea
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19
Q

Bronchiolitis/RSV

-What Does Nasal Flaring Indicate?

A
  1. Nasal flaring is a sign of respiratory distress
  2. Infants have trouble breathing through mouth
    - Nasal flaring is usually accompanied by extra respiratory efforts.
    - Allows more air to enter as the nares flare
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20
Q

Bronchiolitis/RSV

-Signs of Dehydration

A
  1. Decreased Urine
  2. Sunken fontanels
  3. Weight loss
  4. Dry membranes
  5. Skin turgor
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21
Q

Asthma

-Definition

A
  1. A reversible obstructive airway disease characterized by
    - Airway responsiveness to a variety of stimuli
    - Bronchospasm resulting from constriction of bronchial smooth muscle
    - Inflammation and edema of mucous membranes that line small airways and subsequent accumulation of thick secretions in airways
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22
Q

Asthma

-Statistics

A
  1. Leading cause of acute and chronic illness in children
  2. Most frequent admitting diagnosis
  3. Incidence and death is increasing
  4. Prevalence of asthma is children is 9.6%
    - affects 7.1 million children
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23
Q

Asthma

-Causes?

A
  1. Genetic and environmental factors
  2. Inflammatory alteration
  3. Underlying allergy
  4. More prevalent in urban areas where children are exposed to triggers
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24
Asthma | -Immediate Reaction (Early Phase Response)
1. Allergens activate IgE 2. Release of histamine, leukotrienes, prostaglandins 3. Cause Broncho-constriction quickly 4. Resolves 1-2 hrs
25
Asthma | -Delayed Reaction Late Phase
1. Chemical mediators attract immune system cells to respiratory tract 2. Inflammatory substances damage epithelial and smooth muscle cells 3. Edema, mucous plugging of small airways 4. Broncho-constriction for several hrs 5. Can last for weeks
26
Asthma | -Manifestations
1. Increased airway resistance and respiratory distress from mucous and narrow airways 2. Difficulty EXHALING 3. Wheezing heard on exhale 4. Air becomes trapped --HYPERINFLATION OF ALVEOLI
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Asthma | -Manifestations cont..
1. Wheezing during expiratory phase is classic sign 2. Dry cough 3. SOB and non productive cough 4. Dyspnea on exertion 5. Retractions & nasal flaring 6. Tachypnea
28
Asthma | -Triggers
1. Exercise (one of the most common) 2. Cold Air 3. Cigarette smoke 4. Cockroach droppings 5. Viral infection 6. Stress
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Asthma | -In Infants and Young Children
1. The airway in infants and young children is narrower, and respiratory distress can occur quickly
30
Asthma | -Symptoms Indicating Emergency
1. Worsening wheeze, cough, SOB 2. Difficulty breathing 3. No improvement after bronchodilator use 4. Trouble with walking or talking 5. Listlessness, weak cry in infant; refusal to suck 6. Grey or blue lips or fingernails
31
Asthma | -Peak Flow Meter
1. Explain to the parents that a peak flow meter is a device used to monitor breathing capacity in the child w/ asthma
32
Otitis Media | -Definition
1. Effusion and infection or blockage of the middle ear
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Acute Otitis Media (AOM)
1. Effusion in the middle ear that occurs suddenly and is associated with other sings of illness
34
Otitis Media with Effusion (OME) | -Definition
1. The presence of fluid behind the tympanic membrane WITHOUT SIGNS OF INFECTION 2. Often follows an episode of AOM and usually resolves in 1-3 months
35
Acute Otitis Media | -Manifestations
1. Earache (otalgia); infants may pull their ears or roll their heads 2. Bulging, opaque tympanic membrane that looks red, w/ decreased mobility; diffuse light reflex; and obscured landmarks 3. Drainage, usually yellowish green, purulent, FOUL SMELLING (indicates perforation of the tympanic membrane
36
Acute Otitis Media | -Indication of Foul Smell?
1. Yellowish green, purulent, and foul smelling indicates PERFORATION OF THE TYMPANIC MEMBRANE
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Otitis Media with Effusion | -Manifestations
1. Tinnitus, popping sounds 2. Hearing loss (usually conductive) below 35 decibels 3. Mild balance disturbances
38
Otitis Media Management
1. Pain relief 2. Antibiotics 3. Reduce Risk Factors
39
Roseola
1. Human Herpesvirus 6 (HHV-6) 2. Incubation: possibly 9-10 days 3. Infectious period is unknown 4. Transmitted through: Contact w/ secretions - Saliva, CSF
40
Roseola | -Manifestations
1. Usually 6-18 months 2. Sudden high fever (103-106 F) 3. Rash appears after fever subsides 4. Pink maculopapules that blanch with pressure ***TEST 5. Cough, runny nose, abdominal pain, headache, V/D
41
Rubella (German Measles: 3 day measles)
1. Virus 2. Incubation: 14-21 days 3. Infectious period: 7-14 days after rash appears 4. Transmission: Airborne particles, direct contact w/ droplets, placenta 5. Immunity: Natural disease, Vaccine
42
Rubella (German Measles: 3 day measles) | -Incubation time?
1. 14-21 days
43
Rubella (German Measles: 3 day measles) | -Infectious Period
1. 7 days prior to 14 days after rash appears
44
Rubella (German Measles: 3 day measles) | -Transmission
1. Airborne particles 2. Direct contact w/ droplets 3. Placenta
45
Rubella (German Measles: 3 day measles) | -Immunity
1. Natural disease | 2. Vaccine
46
Rubella (German Measles: 3 day measles) | -Rash and Manifestations
1. Rash at 14-16 days 2. Asymptomatic till rash appears 3. Rash is pink maculopapular 4. Rash begins on face, scalp and neck 5. Petechiae on soft palate
47
Rubella (German Measles: 3 day measles) | -S/S
1. Nasal Drainage 2. Diarrhea & Nausea 3. Sore throat & malaise 4. Low grade fever, aches, & chills
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Maternal Rubella
1. During 1st 12 weeks of pregnancy (1st Trimester) 2. Intrauterine Growth Retardation IUGR 3. Failure to thrive 4. Pneumonia, heart defects, encephalitis and immune deficiency
49
Rubella (German Measles: 3 day measles) | -Treatment
1. Treatment is supportive | 2. Keep away from other children until 7 days after rash begins
50
Rubeola (Measles)
1. Virus 2. Incubation: 8-12 days from exposure 3. Infectious: 3-5 days before rash appears to 4 days after 4. Transmission: Direct contact with droplets: Can be airborne 5. Immunity: Natural or live attenuated vaccine
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Rubeola (Measles) | -Incubation
1. 8-12 days from exposure
52
Rubeola (Measles) | -Infectious period?
1. 3-5 days before rash appears to 4 days after
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Rubeola (Measles) | -Transmission
1. Direct contact with droplets | - Can be airborne
54
Rubeola (Measles) | -Immunity
1. Natural or live attenuated vaccine
55
Rubeola (Measles) | -Characteristics
1. Spreads slowly 2. Fever, runny nose, cough, conjunctivitis 3. Quite ill 4. photophobia 5. Koplik spots 2-4 days prior to rash
56
Rubeola (Measles) | -What to Look for during Assessment?
1. Koplik spots are found 2-4 days prior to rash
57
Rubeola (Measles) | -Disease Process
1. Begins on face 2. Spreads to trunk and extremities 3. Red rash blanches easily 4. Gradually turns brownish
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Rubeola (Measles) | -Statistics
1. 10 million cases each year | 2. 197,000 die each year
59
Rubeola (Measles) | -Treatment
1. Restrict activity - quiet bed rest 2. Acetaminophhen or ibuprofen for fever 3. Increased fluid intake 4. Lukewarm baths 5. Lubriderm & antihistamines 6. Mittens if child scratches
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Rubeola (Measles) | -Precautions
1. Airborne precautions 2. Vitamin A supplements 3. MMR vaccine 2 doses - 1st dose - 1 year - 2nd dose - 4-6 years 4. MMR vaccine may be given sooner but, at least 4 weeks from last dose)
61
MMR Vaccine
1. 1st dose - 1 year 2. 2nd dose - 4-6 years - May be given sooner but, at least 4 weeks from last dose
62
Pertussis (Whooping Cough) | -Vaccine
1. AAP in 2005 recommended a booster, called: - Tdap - recommended for children age 11 to 12 who completed a primary series of DTap 2. This replaces the first of the recommended 10-year Td boosters
63
Fifth's Disease
1. Parovirus B-19 2. Incubation: 4-14 days (up to 21 days) 3. Infectious: between 5-12 days of infection 4. Transmission: airborne particles, respiratory droplets, placenta 5. Immunity: Natural disease
64
Fifth's Disease | -Incubation
1. Caused by parovirus B-19 | 2. 4-14 days (up to 21 days)
65
Fifth's Disease | -Duration a person is Infectious
1. Between days 5-12 of infection
66
Fifth's Disease | -Transmission
1. Airborne particles 2. Respiratory droplets 3. Placenta
67
Fifth's Disease | -Immunity
1. Natural Disease
68
Fifth's Disease | -Manifestations
1. Red cheeks 2. Rash that comes and goes 3. May be asymptomatic 4. Rash may last 2-39 days 5. Headache, runny nose, fever
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Fifth's Disease | -Rash Characteristics
1. Rash on trunk and extremities after face
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Fifth's Disease | -Aggravating factors
1. Heat 2. Exercise 3. Warm Bath
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Fifth's Disease | -Protecting Pregnant Women?
1. Identify pregnant family members and teachers 2. Intrauterine infection causes FETAL DEATH 3. 15% increased risk of miscarriage if infected during 1st 20 weeks
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Chickenpox | -Nursing Interventions
1. Antihistamines for itching 2. Acetaminophen for fever 3. Acyclovir for severe cases - works well if started early in window 4. PRIVATE ROOM W/ STRICT ISOLATION 5. Bag contaminated materials and label 6. Nurse should not be assigned to immunocompromised pt at the same time
73
Sudden Infant Death Syndrome (SIDS) | -Definition
1. Deaths in infants less than 1 year of age that occur suddenly and unexpectedly, and whose cause of death are not immediately obvious prior to investigation
74
Sudden Infant Death Syndrome (SIDS) | -Statistics
1. Occurs most frequently in the 2-4th month 2. 95% before age 6 months 3. More common in boys and low birth weight 4. Lower socioeconomic 5. Winter 6. American Indians followed by African Americans
75
Sudden Infant Death Syndrome (SIDS) | -Intrinsic (Non-modifiable Risk Factors)
1. Genetic 2. Male 3. Prematurity 4. Prenatal exposure to cigarettes or alcohol
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Sudden Infant Death Syndrome (SIDS) | -Extrinsic (Modifiable) Risk Factors
1. Prone sleeping 2. Bed sharing 3. Use of soft bedclothes or mattresses 4. Putting infant to sleep on upholstered furniture or adult mattress 5. Exposure to cigarette smoke
77
Sudden Infant Death Syndrome (SIDS) | -Ways to Prevent SIDS
1. Breastfeed as much and for as long as you can 2. Schedule and go to all well-child visits 3. Keep baby away from smokers and places where people smoke 4. Do not let your baby get too hot 5. Offer a pacifier at nap time and bed time
78
Sudden Infant Death Syndrome (SIDS) | -Common autopsy findings
1. Pulmonary edema (fluid) 2. Vascular congestion 3. Pulmonary inflammation 4. Retarded postnatal growth
79
Leukemia
1. Most common childhood cancer 2. Group of malignancies that affect the bone marrow and lymphatic system 3. Classified by type of WBC's that become neoplastic
80
Leukemia | -2 Groups
1. ALL - Acute lymphoid leukemia 2. AML/ANLL - Acute myelogenous or non-lymphoid leukemia
81
Acute Lymphocytic Leukemia (ALL) | -Characteristics
1. A fast-growing cancer in which the body produces a large number of immature WBC's (lymphocytes)
82
Acute Lymphocytic Leukemia (ALL) | -Statistics
1. ALL makes up 80% of childhood acute leukemias 2. Most cases occur in children ages 3-7 3. The disease may also occur in adults
83
Acute Lymphocytic Leukemia (ALL) | -Patho
1. In acute leukemia, cancerous cells multiply quickly and replace normal cells 2. Cancerous cells take over normal parts of the bone marrow, often causing low blood counts
84
Acute Lymphocytic Leukemia (ALL) | -Risk Factors
1. Most cases of ALL have no obvious cause 2. The following may play a role in development of leukemia: - Chromosome problems - Radiation exposure & past chemo - Bone marrow transplant - Toxins such as benzene // Down syndrome and other genetic disorders
85
Acute Lymphocytic Leukemia (ALL) | -Symptoms of ALL
1. A person with ALL is more likely to bleed and have infections because there are fewer normal blood cells and platelets 2. Shortage of RBC's and normal WBC's
86
Acute Lymphocytic Leukemia (ALL) | -Shortage of RBC's results in?
1. Shortage of RBC's causes symptoms of anemia including: - Fatigue or weakness - Dizziness - Feeling cold - Light-headedness and SOB
87
Acute Lymphocytic Leukemia (ALL) | -Shortage of Normal WBC's causes?
1. Fever | 2. Recurring infections
88
Acute Lymphocytic Leukemia (ALL) | -Treatment Statistics
1. Majority of children go into remission and remain symptom free when treatment is completed 2. Children dx with the most common form of leukemia, ALL, can almost always achieve remission, with a 5-year disease-free survival rate approaching 85%
Pediatrics Final Exam
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