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peds kaplan final
| Question | Answer |
|---|---|
| hep B | a. First dose at birth b. Second dose 1-2 months after first dose c. Third dose is 6-18 months of age |
| Coarctation of the Aorta | Narrowing, inc pres in head, decreased pressure LE. Inc BP, weak femoral pulse, cool LE w/ lower BP. newborns surger on mech vent & inotropic support before. children: fainting, HA, dizziness. at risk for HTN, ruptured aorta, aortic aneurysm, stroke |
| Osteomyelitis | Inoculation with a large number of organisms, presence of foreign body, bone injury, immunosuppression. S/S: 2-7 day hx pain, warmth, tenderness & dec ROM, fever, irritability and lethargy. Dehydration, rapid pulse, history of trauma to affected bone. |
| Osteomyelitis Management | long term IV antibiotics via pick line (4wk). Surgery if no response to IV therapy. Watch for adequate nutrition (prone to vomiting). Weight bearing on affected limb not permitted until healing. Physical therapy to ensure restoration of optimum function. |
| Vesicoureteral Reflux | Abnormal flow of urine from the bladder to the UUT. primary; born with a ureter not long enough, can get better or disappear. Secondary: blockage in UT, pushes urine into the ureters. S/S UTI. Treat:treat UTI & long-term antibiotics |
| Infant nutrition | 0-3mo: 110kcal/kg/day. 3-6mo: 100kcal/kg/day. 6-9mo: 95kcal/kg/day. 9-12mo: 100kcal/kg/day Fat: 15% of calories. Protein: 1.52g/kg/day. Water: 75-100ml/kg/day |
| Central Precocious puberty | Sexual development before age 9 in boys and age 8 in girls. 80% of children have central. Early maturation and development of gonads and secondary sex chara. treated with Lupron, treatment is discontinued at age for normal pubertal changes to resume. |
| Cystic fibrosis | Inherited autosomal recessive trait, child gets it from both parents 1:4. Inc viscosity of mucous gland secretions, eleva of sweat electro, Diagnos: + sweat chloride test, absence of pancreatic enzymes. deficiency ADEK. |
| Cystic fibrosis treatment | minimize pulmonary complications, ensure adequate nutrition, encourage physical activity & quality of life. Pancreatic enzymes eaten at the beginning of mal or with a snack or within 30minutes of eating; chewing or crushing destroys enteric coating. |
| HIV/AIDS | Retrovirus transmit lymphocytes, monocytes,passed through blood, semen, vaginal secretions & breast milk. Children who have HIV normally get it from their mother through birth or breast feeding. PCP is the most opportunistic infection of children (3-6mo). |
| HIV/AIDS treatment and goals | slowing the growth of the virus, preventing and treating opportunistic infections,mnutritional support, symptomatic treatment. All children should receive immunizations. antiretroviral & prophylaxis |
| Digoxin in infants | awake and alert. Hold in your lap or in infant seat. pulse <90 bpm, do not give. Do not put this drug in your infant's bottle. It may be mixed with 2 to 3 teaspoons (10 to 15 mL) of breast milk or formula. |
| heart failure | inability of the heart to pump adequate amount of blood. Treat: decrease cardiac demands (bed rest), increase tissue oxygenation (knee-chest). Tachypnea, tachycardia at rest, dyspnea, retractions, activity intolerance |
| Wilm's Tumor | Surgery 24-48hrs after admission then chemo. Dont palpate abdomen. preop monitor BP may be hypertensive from excess renin production. Postop: monitor BP, urine output, infection and instituting pulmonary hygiene to prevent postop pulmonary complications. |
| Wilms tumor | Nephroblastoma, most common malignant renal and intra-abdominal cancer in children. Peak age of diagnosis is 3y. From malignant, undifferentiated cluster or primordial cells. Mainly in the left kidney which is also easier to remove surgically. |
| Meningitis | inflammation of meninges and CSF, dec incidence with Hib vaccine. by streptococcus pneumonia and group B streptococci. Droplet infection from nasopharyngeal secretions. Appears as a bacterial infection through dissemination then spreads through the CSF |
| Meningitis | Dx spinal tap. Treat isolation precautions, antimicrobial therapy, maintenance of hydration, ventilation, control of seizures & tempe. abrupt onset, fever, chill, HA, vomiting, seizures, agitation, positive brudzinski signs. Hearing impairment common |
| Downs Syndrome | extra chromosome 21,greater risk if mother is >35y. will have a small, square head with upward slant to eyes, flat nasal bridge, protruding tongue and hypotoniab. heart malformations & mixed with RTI death by 12mo. evaluated for atlantoaxial instability |
| Intussusception | aMost common cause of acute intestinal obstruction in children <5y/o, peak age 3-9mo. portion of the bowel invaginates into a more distant portion of the bowel.edema cause obstruction of the intestine and perforation of the bowel wall can occur. |
| Intussusception | Abdominal pain, abdominal mass, bloody stools ,screaming, lethargy, vomiting, constipation, dehydration and shock. Treatment radiologist-guided. If this doesn’t work NG decompression and antibiotic therapy followed by surgery. |
| Cardiac dysrhythmias | Bradydysrrhythmias: complete artioventricular block, abnormally slow heart rate AV block: complete heart block, normally congenital or acquired after surgery to repair cardiac defects. Mostly related to edema around the conduction system & resolve on own |
| Cardiac dysrhythmias | sinus tachycardia, abnormally rapid hr, fever, anxiety, pain, anemia. STV most common in children HR 200-300bpm. S/S poor feeding, extreme irritability and pallor. Treat with Valsalva maneuver, vagal maneuver and adenosine |
| child vs | a. HR: 60-140 b. RR: 15-30 c. BP: 80-110 / 60-90 d. Temp: 36.7-37.2C |
| ADHD | inappropriate degrees of inattention, impulsiveness and hyperactivity. Symptoms must be present before age 7. Treatment: Ritalin & Dexedrine (CNS stimulants). Decrease external stimuli and distractions, be consistent in routine. Take meds in morning |
| BP cuff | Width 40% of the arm circumference, 80-100% of the circumference. A wrong cuff size can show a false increase or decrease in BP |
| language development | Infants learn sign language before vocal language. walk: attach a name to objects and persons. Nouns and verbs are first (“go”), then combination. Next adjectives and adverbs, later pronouns and gender words “he, she”, school use 5-7 word sentences |
| Idiopathic thrombocytopenia purpura (Itp) | Acquired hemorrhagic disorder characterized by thrombocytopenia and purpura. Acute: self-limiting; follows a upper respiratory or other infection. Chronic >6mo. Management is unknown cause, diagnosed by platelet count <20,000/mm3. |
| Idiopathic thrombocytopenia purpura (Itp) | use of prednisone, IV immune globulin & anti-D antibody. anti-D observe for 1h, maintain patent IV line. baseline vitals 5, 20, 60 minutes after infusion. most children have a self-limiting course w/o complication. A splenoectomy will be asymptomatic |
| Ulcerative Colitis | Inflammation limited to the colon and rectum. mild to severe depending on extent of mucosal inf. S/S: diarrhea, rectal bleeding, abdominal pain, w/ tensemus and urgency. can result in shortening of the colon and strictures. |
| Osteogenesis Imperfecta | heterogenous inherited disorders of connective tissue, fragility and bone defects.Class I: mild bone fragility w/ blue sclera 2/3 of cases. Class II: lethal, stillborn or die early. Class III: severe, normal sclera. Class IV: mild-moderate 6% of cases |
| Osteogenesis Imperfecta | supportive care mainly. Bone marrow transplant still experimental. Bisphosphonate therapy with pamidronate to promote increased bone density and prevent fractures. Lightweight braces and splints help support limbs. Lots of family education |
| SIDS | Sudden death of an infant <1y unexplained after postmortem examination. Maternal smoking during pregnancy, sleeping prone, cosleeping are all suggested factors. The parents need education about safe sleep before discharge from the hospital. |
| otitis media | antibiodics after a 72hr for resolution in healthy infants >6mo. Do not wai <2y who have persistent fever and severe ear pain. relieve pain, facilitate drainage, prevention of complications, educating in care, providing emotional support |
| Group A A-Hemolytic streptococcus Pharyngitis | Bacterial infection 5-10% of pharyngitis cases, Group A most common. + rapid antigen detection test; prevention complications, abatement of clinical S/S, reduction of bacterial transmission and minimization of antimicrobial adverse effects.penicillin |
| Atrial septal defect | Abnormal opening between the artia, blood from LA flow into RA. Although there is a right atrial and ventricular enlargement, cardiac failure is unusual in an uncomplicated ASD. Pulmonary vascular changes occur after several decades if left unrepaired. |
| Pyloric stenosis | a. Projective vomiting during or after feedings. Olive-shaped bulge below right costal margin, distention of upper abdomen, failure to thrive and dehydration b. Treat with insertion of a NG tube for gastric decompression and surgery |
| Congenital heart defect | medications, angioplasty in some conditions, surgery. monitor vs & heart rhythm, support, prepare procedure, I&O, admin digoxin, iron, diuretics, potassium, feed infants small amounts q2h using enlarged nipple hole and diet low NA and high in K |
| infant dehydration | rapid weak pulse, rapid rr, hypotension, sunken eyes, weight loss, emaciation, dry mucous membranes, and increased hematocrit. forcing fluids, providing isotonic IV fluids, I&O, hourly output, weight, VS, skin turgor, oral rehydration solutions (ORS) |
| cerebral pasley | neuromuscular disorder resulting from damage in control motor function. Lioresal pump to treat spasticity, oral muscle relaxants, braces or splints and special appliances. ROM and exercise, Dilantin and Bellatal, high-calorie diet |
| Scoliosis | lateral curvature of the spine >10 degrees. one shoulder higher than the other, prominent scapula, uneven waistline, rib hip. bracing (worn 23hrs), spinal fusion surgery, lifts in shoes to treat unequal length in legs, exercise and ROM. |
| Hip spica cast | Bradford frame elevated on blocks with a bedpan. cast dry and change diapers often. Turn child q2h and q4h at night, check color, sensation and motion of legs and feet.stimuli to promote growth & development, benadryl ,watch for signs of outgrowing cast |
| Hemophilia | bleeding disorder caused by X-linked recessive trait found in males. Administer Tylenol for pain (no aspirin), during bleeding episodes maintain bed-rest with joint elevation, immobilization, ice packs and ROM after bleeding stops. |
| Turners syndrome | Occurs in females, one X chromosome is missing from all cells;low posterior hairline, widely spaced nipples and edema of the hands and feet.web neck and short stature noted; diagnosed in puberty of the short stature, sexual infantilism and amenorrhea. |
| Developmental dysplasia of the hip | acetabulum unable to hold head of femur.reduced by manipulation, splinted femur centered in flexion, Pavlik harness 3-6mo. 6-18mo gradual reduction by traction, cast for immobilization. older child preliminary traction, open reduction & hip spica cast |
| Epilepsy | c. Nursing: observing and documenting type and progress of seizure activity and postictal behavior, O2 and suction at bedside, post-seizure, position on back with head turned to side or position on side to prevent aspiration and promote. |
Created by:
smarti13