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Pediatrics Illness
Test 3 Wong
| Question | Answer |
|---|---|
| Doctor shopping or delaying Tx | denial |
| guilt, anger, overprotection | adjustment |
| admitting that child has a problem | denial to adjustment |
| acceptance | adjustment |
| increased comfort with daily living, chronic sorrow, realistic expectations | reintegration |
| Particularly stressful are situations in which appropriate _______ will not be in a regular class placement | Schooling (Anticipated Parental Stress points) |
| 3 Anticipated parental stress points | diagnosis of the condition; developmental milestones; start of schooling |
| 4 Anticipated parental stress points | Reaching ultimate attainment; adolescence; future placement; death of child |
| Reaching the ultimate attainment | situations such as realizing that ambulation will be impossible or that the child will not learn to read, must be handled |
| 5 Coping Patterns used by Children with Special Needs | Develops competence and optimism; Feels different and withdraws; Is irritable, moody, acts out; Complies with treatment; Seeks support |
| Children with __________ disorders cope better | more severe |
| Multiple conditions may place child at risk for | behavioral problems |
| Symptomatology NORMAL grief (5) | Sensations of Somatic distress; Preoccupation with image of deceased; Feelings of guilt; Feelings of hostility; Loss of usual patterns of conduct |
| Age: Sees death as temporary and gradual | Preschool |
| Age: Effected more by change than actual death | Infant/Toddler |
| Age: Impossible for them to comprehend absence of life | Toddler |
| Age: No understanding of universality or inevitability of death | Preschool |
| Age: May feel guilty and responsible for the death of a sibling | Preschool |
| Age: Must deny loss or death to survive impact | Preschool |
| Age: Giggling or Joking or Regression as reaction to death | Preschool |
| Last sense to fail when approaching death | Hearing |
| Death Rattle | noisy chest sounds from accumulation of pulmonary and pharyngeal secretions, a physical sign of approaching death |
| Loss of senses when approaching death | tactile sensation decreases; sensitive to light; hearing is last |
| What are the 3 components of mental retardation | intellectual functioning; functional strengths and weakness; younger than 18 years at time of diagnosis |
| Mental retardation IQ | 70-75 or below |
| How many adaptive skill areas must the child show functional impairment in for MENTAL RETARDATION | 2/10 |
| Educable/MILD Mental Retardation | IQ-50-75; 85% of all; mental age 8-12 |
| Trainable/MODERATE Mental Retardation | IQ=35-55; 10% of all; mental age 3-7 |
| Severe Mental Retardation | IQ=20-40; mental age 1-3 |
| Profound Mental Retardation | IQ= <20; mental age 0-1 |
| Prevent MR | Rubella Immun.; Genetic Counseling; Folic acid; Fetal alcohol edu.; Lead exposure edu. |
| chromosomal abnormality with multiple causality | down syndrome |
| Refers to cells with both normal and abnormal chromosomes | Mosaicism |
| most common congenital anomaly associated with down syndrome | heart defect- septal defects |
| leading cause of death in the first year of down syndrome is | heart defects coupled with respiratory infection |
| Children at risk for gastroesophageal reflux are those with... | tracheoesophageal atresia, neuro problems, scoliosis, asthma, cystic fibrosis |
| Two important symptoms of gastro reflux in INFANTS | hematemesis; apnea |
| 3 symptoms of reflux in CHILDREN | abdominal pain; chronic cough; recurrent pneumonia |
| When does GER in become pathologic | when child is not gaining weight the way they should be |
| Positioning for GER in bed | still supine to avoid sids but maybe with a pillow and propped up head |
| Drugs for GER | H2 blockers (pepcid); PPI (Prilosec); GI stimulants (REGLAN) |
| Surgical management for GER for children with severe complications such as recurrent aspiration pneumonia, apnea, severe esophagitis, failure to thrive, and for those failed to respond to everything else | Nissen Fundoplication |
| Nissen Fundoplication | passage of the gastric fundus behind the esophagus to encircle the distal esophagus |
| Failure of maxillary and median nasal processes to fuse | Cleft Lip |
| Failure of midline fissue of palate to form | Cleft Palate |
| What feeding difficulties exist with cleft palate/lip | Suction; Compression of nipple; Liquid escapes through nasal cavity; Traditional and cleft palate nipples present problems |
| First thing for nurse to do with cleft palate or lip | supportive care or grief for parent |
| Type of nipples to use for cleft lip or palate | large, soft, crosscut, or gravity flow nipples with squeezable bottle |
| ESSR method | Enlarge, Stimulate, Swallow, Rest |
| Breastfeeding for cleft p or l | place nipple back in oral cavity for tongue compression |
| Alternative to nipple for cleft lip or pal. | syringe and rubber tubing |
| difference between Z-plasty and Millard surgeries | millard doesnt cross midline |
| Post surgical for cleft lip surgery | logan bow; elbow restraints; supine or sidelying; saline and antibiotics |
| Post surgical for cleft palate surgery | may lay on stomach; oral packing 2-3 days and arm restraints; opoids --> acetaminophen; blenderized/soft diet, nothing hard; speech therapy |
| Medications that may trigger an asthma attack | aspirin; NSAIDS; antibiotics; B-blockers |
| Asthma class when symptoms are >2 times per week but < 1 time per day | Mild Persistent |
| Asthma: PEF variability 20-30% | Mild Persistent |
| Asthma: Daily symptoms with nighttime symptoms > 1 night per week | Moderate Persistent |
| PEFR: Yellow 50-79% | caution; acute exacerbation; call practitioner |
| Asthma: Give hand held nebulizer with... | beta agonist and oral/IV corticosteroid |
| Asthma: if no relief from HHN give what? | sub q epinephrine @ 0.01 ml/kg with max at 0.3 ml or sub q terbutaline |
| Child must inherit defective gene of this disease from both parents | Cystic Fibrosis |
| Most devastating effects of cystic fibrosis on which to systems | respiratory and GI systems |
| Sweat chloride test positive for cystic fibrosis | greater than 60 mEq/L |
| May be first diagnostic clue of cystic fibrosis | meconium ileus (diagnosed by barium enema xray) |
| Diagnostic symptoms of cystic fibrosis | poor growth; greasy stools; frequent respiratory infections |
| What causes hypoxia, hypercapnia, acidosis in cystic fibrosis patients | decreased O2/CO2 exchange exchange |
| what causes pulmonary hypertension, cor pulmonale, respiratory failure, and death within cystic fibrosis patients | compression of pulmonary blood vessels and progressive lung dysfunction |
| lack of enzymes from pancreatic duct causes what 2 digestive impairments | steatorrhea (fat) and azotorrhea (protein) |
| Pancreatic fibrosis leads to | diabetes mellitus (in cystic fibrosis) |
| how can cystic fibrosis effect males and females | males-sterility ; females-delayed puberty |
| D-Nase does what for CF patients | decreases viscosity of mucus |
| Pancreatic enzyme admin with meals help achieve what 2 things | normal growth and 1-2 stools per day |
| how much protein for CF diet | 150% RDA ; high protein high calorie |
| life expectancy of CF | 40-50 |
| what does a febrile UTI usually indicate | pyelonephritis |
| recurrent vs. persisten UTI | recurrent = repeated episodes; persistent = bacteriuria despite antibiotics |
| who does acute glomerulonephritis primarly affect | school age 6-7 males (2:1) |
| A latent period of how many days occurs between the streptococcal infection and the onset of clinical manifestations of glomerulonephritis | 10-21 days |
| what has increased survivability of hemophilia and decreased complications | ability to treat at home with factor 8, DDAVP, transfusions |
| 1/2 of patients treated with clotting factors for hemophilia from 1979-1985 are? | HIV + |
| what is important Tx for post bleeding into joins | ROM to prevent contractures |
| Leading cause of DISEASE in children past infancy | Cancer (bllod or blood forming organs) |
| More Common for leukemia | males >1 yr; down syndrome (20 x); 2-6 yrs |
| 3 main consequences of WBC accumulation in leuikemia | anemia; infection; bleeding episodes |
| 5 symptoms of leukemia | pancytopenia; bone weakness; splenomegaly, hepatomegaly; intracranial pressure; hypermetabolism |
| Blood Slide shows what in leukemia | immature leukocytes; low blood counts (but in bone marrow high counts) |
| 4 phases of chemotherapy for leukemia | induction (usually successful and done for 4-6 weeks); prophylactic; intensification; maintenance |
| what is graft vs. host disease and what is it involved with | stem cell transplant for leukemia, donors cells attack recipients cells in skin, liver, GI and happens 50% of time |
| Stem cell cure rate | 60-70% |
| Factors for determining good prognosis of hematopoeitic stem cell transplant | WBC (low or normal); 2-9 yo; no T or B cells involved on surface; Girls; DNA |
| Preventing complications with leukemia | prevent infections (no viral vaccines); watch for hemorrhage (puncture sites, no rectal temps); Anemia (rest/O2) |
| How long do we watch child after injection of chemo agents | 20 minutes with emergency equip available to manage anaphylaxis |
| most common cardiac anomaly | ventricular septal defect |
| Pre procedure cardiac catheterization | education; assess; ht/wt; allergies; mark pulses with permanent marker; pulse ox |
| Keep extremity straight after cardiac cath for how long | 4-6 hr venous and 6-8 hr arterial |
| Home care after card. cath. | showers only; avoid exercise for several days; regular diet; follow up appt for results |
| Opening in septum between right and left ventricle that causes blood flow to pulm. artery and lungs rather than systemically | Ventricular Septal Defect |
| Surgical Tx of VSD for small holes and large holes | right ventricle via bypass, small-purse string and large-dacron patch |
| 3 things involved with CHF | Impaired myocardial function; pulmonary congestion; systemic venous congestion |
| Tx for CHF | Lasix, Digoxin (improves output and slows rate), ACEI (vasodilation), O2 |
| Digoxin | double check dosage and infants rarely recieve >1 ml or 50 mcg |
| how is fluid status monitored in CHF | edema, dehydration, fontanels, JVD, I/O, wts. specific gravity |
| Desired effects of digoxin | prolonged PR interveal and reduced ventricular rate |
Created by:
wb06
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