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SAC Peds Test #5

Ch.10,13,14

QuestionAnswer
What are neurologic soft signs? Examples? Findings that indicate the child's inability to perform activities r/t child's age; clumsy, falling down, language disturbance, change in writing
Most important neuro assessment? LOC
What is Monro-Kellie Doctrine (Closed Box Theory)? Inc ICP --> Compensatory changes to dec pressure--> ICP still inc--> Sudden inc. ICP--> shift in brain tissure r/t hypoperfusion--> herniation (poss death)
With cerebral blood flow, INCREASED in CO2 leads to what? Dilation
With cerebral blood flow, DECREASED in CO2 leads to what? Constriction
What do you see in inc. ICP in INFANTS? Head circumference, Bulging fontanel, Irritability/ restlessness, Poor feeding/vomiting, Lethargy, Distended scalp veins, Separation of sutures, High-pitched cry, Downward eye deviation, change in pain response, SZ
What do you see in inc. ICP in CHILDREN? Mood swings, Headache, Nausea/ vomiting, Diplopia, Slurred speech, Altered LOC, Memory loss, Ataxia, Papilledema, Seizures
Cushing's Response alteration in brainstem perfusion, with body attempting to improve CBF; inc. BP, widening pulse pressure, dec HR, irregular RR
Late signs of inc. ICP Tachy-->Brady, apnea, systolic HTN, decerebrate/decorticate posturing, Cushings response
Nursing interventions to dec. ICP Cluster care, dec. stress, Quiet environment, raise HOB 30-45 degrees, Appropriate position, Meds
BEFORE maintaining nutritional/ fluid needs, what needs to be done? Assess swallow ability (gag reflex)
Spina bifida occulta Neural tube defect of incomplete closure of the neural tube between L5 and S1; may have no sensory/motor deficits
Spina bifida cystica Neural tube defect of incomplete closure of the neural tube resulting in a sac-like protrusion in the lumbar or sacral region
Examples of spina bifida cystica? differences? Meningocele, Myelomeningocele (includes spinal cord)
Factors that could lead to spina bifida? Dec. intake of folic acid, teratogenic drugs
Most common cause of neurogenic bladder dysfunction in peds? Urinary retention w/ myelomeningocele
What does the location of the spina bifida indicate? The higher up the location of the defect the more severe the neuromuscular complications.
Why does hydrocephalus develop? Imbalance of production and absorption of CSF
What does inc. of CSF in hydrocephalus cause? Inc. ventricular pressure --> dilation of ventricles that press on skull
2 types of hydrocephalus? difference? Communicating = impaired absorption; Non-communicating= obstruction of flow
Ventriculoperitoneal (VP) shunt One-way pressure valve releasing CSF into peritoneal cavity where it is reabsorbed
Pre-OP and Post-Op nursing care for hydrocephalus? Dec. ICP
Diagnostic tests for spina bifida? AFP level at 16-18 wks, Fetal ultrasound, Newborn assessment, Exam of meningeal sac, CT scan after delivery
Therapeutic management for spina bifida? Fetal surgery possible, Sterile saline dressing over sac Surgical closure after birth- w/in 24-72 hrs, Possible VP shunt, Multidisciplinary Care
2 types of seizures? Partial (or focal) and generalized
Difference between primary and secondary seizures? Primary = genetics; Secondary= structural/ metabolic abnormalities
What is the precipitation factor for febrile seizures? Rapidity of temp. inc. above 102F
Common age group for febrile sz? 3mos to 5yrs
When does a sz become status epilepticus? Prolonged sz lasting >30min w/ no return to normal LOC
Meds for status epilepticus? Lorazapam, diazapam, medazwhat olam
What do you give if status epilepticus pt has no IV access? Rectal diastat
Common age range for bacterial meningitis? 1mos - 5yrs
Meningitis s/s? Fever, nuchal regidity, severe HA, photophobia, muscle/joint pain, rash
Priority nursing actions for dx of meningitis? Put on droplet precautions, baseline neuro assessment w/ v/s, dec ICP, sz precautions
Brudzinski's Sign Pt laying flat, flex chin to chest and legs will flex to compensate
Kernig's sign Pt lays supine, flex leg at knee and extend, pain = positive sign
During conscious sedation, how often do you monitor v/s? q 5min
With meningitis, what will CSF panel show? Inc. protein, Inc. WBC, dec. glucose and cloudy
In meningitis, what do you have to do BEFORE administering antibiotics? Collect sample for analysis and culture
Most common analgesic in peds? why? Morphine, because least amount of side effects
Cardinal sign for Hirschsprungs in infants? Unable to pass mec stool w/in 24hrs of birth
S/S for Hirschsprungs in children? Chronic constipation --> Pellet or ribbon-like stool that's foul smelling
Important to tell parents about colostomy for Hirschsprungs? Temporary; 2-step surgery - colostomy w/ later pull through
Telescoping of one portion of the colon onto another? Intussusception
What GI problem has currant-like, jelly stools? Intussusception
Hydrostatic reduction Treatment for intussusception where force exerted on bowel using water-soluble contrast and air to push it apart
#1 complication for GERD? Aspiration --> Aspiration PNA
Pyloric Stenosis? Hypertrophy of pyloric sphincter, causing a narrowing/obstruction (bands pylorus)
S/S of Pyloric Stenosis? Non-bilious projectile vomiting, always hungry, wt loss from malabsorption, dehydration
3 diagnostic tests for Pyloric Stenosis? Olive shaped mass at epigastrum, String sign w/ Upper GI, Abd US
Pre-Op interventions for Pyloric Stenosis? NPO, NGT to LIS, hydration, I/O, monitor electrolytes, ↑ HOB
Post-Op interventions for Pyloric Stenosis? Assess bowel sounds, Inspect incision/ drsng. Progressive feeding
Another name for Hirschsprung Disease? Why? Aganglionic megacolon - no ganglion cells at rectum/proximal portion of Large Intestine
Where is Cleft Lip in fetal development seen? Failure of nasal & maxillary processes to fuse at 5-8 weeks gestation
Where is Cleft Palate in fetal development seen? Failure of palantine planes to fuse 7-12 weeks gestation
Why is surgery usually done before 1 year old for cleft lip/palate? So speech will not be affected
Esophageal atresia Incomplete formation of esophagus
Tracheoesophageal fistula Fistula between the trachea and esophagus
3 classic s/s of Esophageal atresia/ Tracheoesophageal fistula? coughing, choking, cyanosis
S/S of Appendicitis periumbilical pain (RLQ pain) (McBurney’s point), rebound tenderness, fever, vomiting, diarrhea, lethargy, irritability, Inc. WBCs
How many antibiotics will ruptured appy patient receive? when? 2-3 antibiotics, 24-48hrs prior to surgery
Most common organism causing gastroenteritis? Rotavirus - Targets villi in small intestine-dec. absorption function, causing malabsorption
When is growth hormone given? 6-7 days/wk, usually at bedtime, SQ
1st secondary sex characteristics to show? Breast buds (girls) and testicular growth (boys)
Precocious Puberty Early onset of puberty and sexual development occurring before age 8 in girls, and age 9 in boys.
Pituitary gland secretes what? Thyroid stimulating hormone
Thyroid gland secretes what? Thyroxin (T4) and Triiodothyronine (T3)
What is thyroid responsible for? BMR (basal metabolic rate)
What do you do if pt vomits up dose of Synthroid? Give it again
Most common early symptoms of hyperthyroidism? Emotional disturbances and increased motor activity in older children.
Thyroid storm Life threatening complication of hyperthyroidism; high fever, tachycardia
Med for hyperthyroidism? Tapazole (methimazole)
S/S of HYPOthyroidism tired/fatigue, constipation, cold, dry, thick skin, edema, wt gain, dec. growth, dec. activity, muscle hypertrophy, dec. HR
S/S of HYPERthyroidism nervous, anxious, diarrhea, heat intolerance, smooth, velvet skin, exopthalmos, inc. appetite but wt loss, high BP, muscle weakness, inc. HR
For PKU diet, what do you avoid? What's ok? Avoid high protein; foods ok: fruits/veggies, starches, special PKU formula
3 Treatments for hyperthyroid? Antithyroid drug (Tapazole), oral radioactive iodine, subtotal thyroidectomy
Triad that Hyperthyroidism is characterized by? hypersecretion of thyroid hormone, goiter, and exopthalmos
what kind of disease is hyperthyroidism? autoimmune, endocrine disorder
How long does oral radioactive tx take to work for hyperthyroid? destroys thyroid tissue in 6-18wks
What level do you watch for thyroidectomy? Ca level because parathyroid is next to it, which makes calcitonin --> may lead to seizures
When is PTU given? For Hyperthyroid if allergic to Tapazole
Why is PTU not given as much? Msny side effects; neutropenia, hepatotoxicity, infectious lesions, thrombocytopenia
What enzyme is missing in PKU? What is it supposed to do? Phenylalanine hydroxylase, supposed to convert phenylalanine to tyrosine (essential amino acid); also affects CNS development and pigmentation
When is screening for PKU? why? After 12hrs, ideally after 48hrs; because they have to have formula/breast milk first to see rise in phenylalanine
S/S of PKU? Digestive problems and vomiting (*usually first sign) Musty odor to urine, Mental retardation, Microcephaly, Seizures
What makes it Type 1 Diabetes? Inc. blood glucose + 1)no insulin production, 2) insufficient insulin, 3) body resistant to insulin
Hemoglobin A1C more realistic, long term eval of how compliant they are with taking insulin, diet, carb counting, diabetes mgmt
Range for HgbA1C norm 4-6%, goal for diabetic <6.5-7%
DKA metabolic process of severe insulin deficit leading to hyperglycemia, ketones in blood, leading to metab. acidosis
S/S of DKA pH < 7.25, N/V, Abd/chest pain, Fruity breath (acetone, Kussmal resps (deep, rapid respirations), ↓ LOC, Dehydration
Causes of HYPOglycemia? too much med, missed/delayed meal, too little food eaten compared to insulin taken, more exercise
How does exercise affect insulin? exercise enhances affect of insulin; exercise raises BMR, breaking down more glucose
S/S of HYPOglycemia? shakiness, dizziness, sweating, hunger, headache, irritability, pale skin color, sudden moodiness or behavior, changes, such as crying for no apparent reason, clumsy or jerky movements, difficulty paying attention, or confusion
What do you do if pt shows sign of hypoglycemia? Give juice, easily digestible sugar
Honeymoon phase for newly diagnosed diabetics, after treatment and d/c from hospital, insulin seems to be controlled but must continue DM regimen; may last for weeks
What do you do for severe hypoglycemia and child is unconscious or having sz? Use Glucagon Inj SQ/IM, or glucose gel in inner cheek/gums
How often do you check insulin? Before each meal and at bedtime
What can affect insulin needs? Puberty growth, stress, infection, illness
Onset, peak, duration of lispro/aspart insulin? onset=5-15min, peak=1-2hr, duration=4-6hrs
Onset, peak, duration of human regular insulin? onset=30-60min, peak=2-4hr, duration=6-10hrs
Onset, peak, duration of human NPH/Lente insulin? onset=1-2hr, peak=4-8hr, duration=10-18hrs
Onset, peak, duration of Ultralente insulin? onset=2-4hr, peak=8-14hr, duration=18-24hrs
Onset, peak, duration of Glargine (Lantus) insulin? onset=1-2hr, peak=flat, duration=24hrs
Benefit of Insulin pump? May allow child to eat as frequently and as much carbs as peers, dec. risk of severe hypoglycemia
Site vs. Location for insulin admin? Location= abd, thigh, arms; Site= quarter-size injection sites w/in location
Why do you rotate insulin sites? to limit fat deposit buildup (lipohypertrophy)at that site which delays insulin absorption
Carb counting 3 mealsand 3 snacks per day; 15g = 1 carb
How many carbs do you give w/ exercise? Add 15-30g of carbs w/ each 45-60min of exercise
When sick, how often do you check insulin? q 4hrs
Sick day rules for DM? Test glucose q 4hrs, test for ketones w/ each void, cal-free liquids, simple carb diet, rest, report vomiting
Long term goal for DM management? Maintain normal glucose level and prevent major complications to growth and development
Major reason DM patient (especially teenager)is admitted? Noncompliance
Created by: cobedad