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Unit IV
Pediatrics
| Question | Answer |
|---|---|
| Period of approximately 2 years that begins at the end of middle childhood and ends with the thirteenth birthday. | Preadolescence |
| Signals the beginning of the development of secondary sex characteristics. | Prepubescence |
| There is a difference of approximately ___ years between girls and boys in the age of onset of pubescence. | 2 |
| Generally, puberty begins at ___ years in girls and ___ years in boys; normal for either sex after the age of ____ years. | 10;12;8 |
| Eriksons stage of development for school age children. | Industry vs Inferiority (6-12y/o) |
| Piaget stage of cognitive development for school age children. | Concrete Operational (7-12y/o) |
| When children are able to use though processes to experience events and actions. | Concrete Operations |
| Making judgements based on what they can reason. | Conceptual Thinking |
| During school age ____ of mass is usually accomplished first, weight some time later, and volume last. | Conservation |
| What are 3 cognitive advancements of school age years. | Conservation, Classification, & Ability to read. |
| ______ ______ is an important factor in gaining independence from parents. | Peer Group |
| The school age period is the time when children have “____ ____” with whom they share secrets, private jokes, and adventures. | Best Friend |
| Refers to a conscious awareness of self perception, such as ones physical characteristics, abilities, values, self-ideals and expectancy. | Self Concept |
| Is a discipline technique that is effective for middle school age children. | Reasoning |
| These children fear death and are fascinated by all aspects of death and dying. | School Age |
| The first permanent teeth erupt by this age. | 6y/o |
| The principal oral problem in children and adolescents. | Dental Caries(Cavities) |
| The initial indication of puberty is the appearance of breast buds. | Thelarche (8-13y/o) |
| Growth of pubic hair on the mons pubis. | Adrenarche |
| The initial appearance of menstruation; which occurs about 2 years after the appearance of the first pubescent changes. | Menarche(10.5-15y/o) |
| What are the 1st pubescent changes in boys. | Testicular elargement, thinning, reddening and ↑looseness of scrotum. |
| Common during mid-puberty, occurring in up to 1/3 of boys; disappears w/in 2 years. | Gynecomastia |
| Erikson stage of development for adolescents. | Identity vs Role Conflict |
| Piaget stage of development for adolescents. | Formal Operational |
| Adolescence is considered as beginning with the gradual appearance of 2° sex characteristics at about _____ or _____ y/o and ending with cessation of body growth at _____ to ____ y/o. | 11,12 & 18-20 |
| Includes abstract thought, thinking beyond the present, logical reasoning, and a sense of idealism. | Adolescence (Cognitive Devel.) |
| Is closely related to body changes with social interactions. | Body image |
| Adolescents _______ fluctuate. | Emotions |
| What are 3 supplements adolescents may lack due to poor food choices. | Calcium, Zinc, Iron |
| The primary cause of death from injury in the adolescent years. | Motor Vehicle Injuries |
| Prepare mothers to expect more demands by _____ years. | 8 |
| Prepare father to expect ↑ admiration at ____ years; encourage father-child activities. | 10 |
| Teach bicycle safety to this age group. | School Age (Helmet) |
| During school age primary teeth are lost and replaced by _____ teeth. | Permanent |
| School age; growth is ____ than previous years, there is a steady gain in height and weight with maturation of body systems. | Slower |
| Prime elements of play during the school years. | Rules; Rituals; Cooperative Play; Teams |
| Parental concerns during middle childhood include _____, ____, _____ and social achievement. | Lying; cheating; stealing |
| Gametes, both ova and spermatozoa are haploid cells, with _____ chromosomes each. | 23 |
| An unequal addition of one (or few) chromosomes. | Aneuploidy (-somy) |
| The only monosomy that is compatible with life. | Turners Syndrome |
| Are the external and internal organs that carry out the reproductive functions(i.e. Ovaries, uterus, breasts, penis). | Primary Sex Characteristics |
| Changes that occur throughout the body as a result of hormonal changes(i.e. Voice alterations, facial and pubertal hair, fat deposits). | Secondary Sex Characteristics |
| The stages of development of secondary sex characteristics and genital development; a guide for estimating sexual maturity. | Tanner Stages (1-5 least to most) |
| The leading causes of death in children ages 5-9 y/o. | Accidents, Neoplasms, Homicide, heart disease |
| Personify death as the devil, a monster or bogeyman; ↑ fears; fear of the unknown; interested in post death services; “What happens to the body?”. | School Age(Death) |
| Have the most difficulty in coping with death; feel alone; worry about physical changes; may criticize funeral rights. | Adolescents (Death) |
| The family should be allowed to remain with the body and hold or rock the child if they desire. | After child’s death |
| School age children view death as _______ but not necessarily inevitable and may fear mutilation. | Irreversible |
| Children beyond ______ to ______ years of age realize that death is irreversible, universal, and inevitable but may resist the thought of their own death. | 12-15 |
| Only s small percentage of children have a ______ factor. | Rheumatoid |
| A chronic autoimmune inflammatory disease causing inflammation of joints and other tissue with unknown cause; <16y/o(Peak1-3);↑♀; may be triggered by virus. | JIA |
| Chronic inflammation of the synovium with joint effusion and erosion, destruction and fibrosis of the articular cartilage. | JIA (Patho) |
| Children with arthritis in _____ or fewer joints had the greatest likelihood for sustained remission. | Four |
| Can cause permanent vision loss if undiagnosed and not aggressively treated. | Acute Uveitis (JIA) |
| ≦4 joints usually small joints. | Pauciarticular |
| ≧5 joints usually larger joints knee/elbow. | Polyarticular |
| Is arthritis in one or more joints associated with at least 2weeks of quotidian fever, rash, lymphadenopathy, hepatosplenomegaly, and serositis. | Systemic Arthritis |
| Onset <16y/o, arthritis in one or more joints for 6weeks or longer, and exclusion of other causes. | JIA (Diagnosis) |
| ______ is frequently present during exacerbations of systemic JIA. | Leukocytosis |
| The ____ may or may not be elevated. | ESR |
| Are common in JIA but are not specific for arthritis; however, they help identify children who are at greatest risk for uveitis. | Antinuclear Antibodies (ANA) |
| Control pain, preserve ROM, ↓inflammation, and promote normal growth. | JIA (Goal) |
| First line drug therapy for JIA. | NSAID’s(Naproxen, ibuprofen, tolmetin, indomethacin, celecoxib, meloxican) |
| Is the second-line med used in children who have failed with NSAID’s alone. | Methotrexate (Teratogenic) |
| Potent immunosuppressives used for life-threatening complications; incapacitating arthritis, and uveitis. | Corticosteroids |
| A tumor necrosis factor-a (TNF-a) receptor blocker and an effective drug for children with JIA unresponsive to Methotrexate. | Entanercept (Biological Agent) |
| Is excellent therapy because it allows freedom of movement with support and minimal gravitational pull. | Exercise in Pool |
| Is the presence of a new pulmonary infiltrate and may be associated with chest pain, fever, cough, tachypnea, wheezing, and hypoxia. | Acute Chest Syndrome (ACS) |
| Is a sudden and severe complication, often with no related illness. | CVA; stroke |
| Because levels of HbS are low at birth, Hgb ______ or toher tests that measure Hgb concentrations are indicated. | Electrophoresis |
| Frequently used because it can be performed on blood from finger-stick and yields accurate results in 3min. | Sickle-Turbidity Test (Sickledex) |
| (“Finger printing of the protein”) an accurate, rapid , and specific test for detecting the homo and hetero forms of the disease as well as the percentages of the various types of Hgb. | Hemoglobin Electrophoresis |
| Hand-foot Syndrome. | Dactylitis |
| Administration of _______ and _______ vaccines is recommended for SCA pts, because of their susceptibility to infection as a result of functional asplenia. | Pneumococcal; Meningococcal (Yearly Flu Vacc) |
| O₂ therapy is of little therapeutic value unless the patient has _____. | Hypoxia |
| A successful, rapid method of ↓ the number of circulating sickle cells and therefore slowing down the vicious cycle of hypoxia, thrombosis, tissue ischemia, and injury. | Exchange Transfusion(Used to prevent ACS & CVA) |
| Test identifies the child with SCD who is at ↑risk for developing CVA by monitoring intracranial vascular flow. | Transcranial Doppler (TCD) [2-16y/o yearly] |
| Multiple blood transfusions ↑risk of this. | Hemosiderosis, Rxn’s, Hyperviscosity |
| For recurrent life-threatening splenic sequestration. | Splenectomy |
| Are recommended for Tx of splenic sequestration and stroke. | Packed RBC transfusions |
| Mild to mod pain VOC. | Ibuprofen, Ketorolac, or Tylenol |
| Severe pain r/t VOC. | Morphine or Dilaudid |
| Physical and sexual maturation are ______ in adolescents with SCA. | Delayed(Problem for adolescents) |
| Approved med that ↑ the production of HbF, ↓ endothelial adhesion of sickle cell, ↑ sickle cell hydration, ↑NO₂(Vasodilator) and ↓leukocytosis, ↓retic count. | Hydroxyurea |
| Offers a curative approach for some children with SCD with event free survival of 95%. | HSCT |
| Prevents sickling and to delay the adhesion-stasis-thrombosis-ischemia cycle. | Adequate Hydration |
| Three manifestations of SCD that may appear in the first 2 years. | Dactylitis, Severe Anemia, Leukocytosis |
| Practitioners may recommend night-time _______ to help minimize pain and reduce flexion deformity. | Splinting |
| Places additional stress on affected joints (JIA), need to avoid. | Excessive Weight Gain(Obesity) |
| ______ has been shown to be beneficial to children with arthritis. | Heat(morning bath) |
| One of a group of diseases collectively termed hemoglobinopahties in which normal adult Hgb A is partly or completely replaced by abnormal sickle Hgb; 1:4 change; Autosomal Recessive trait. | Sickle Cell Anemia (SCA) |
| SCA is believed by some to be the result of selective protection afforded trait carriers against one type of _______. | Malaria |
| How do you know ADHD med is working. | Kid has a GF |
| The clinical features of SCA are primarily the result. | Obstruction, Vascular inflammation, ↑RBC destruction. |
| Is characterized by ischemia causing mild to severe pain that may last from minutes to days. | Vasoocclusive Crisis(VSO) |
| A pooling of a large amount of blood usually in the spleen and infrequently in the liver that causes a ↓ blood volume and ultimately shock. | Sequestration Crisis |
| Diminished RBC production usually caused by viral infection that may result in profound anemia. | Aplastic Crisis |
| An accelerated rate of RBC destruction characterized by anemia, jaundice, and reticulocytosis. | Hyperhemolytic Crisis |
| Initial enlargement of scrotum and testes; reddening and textural changes of scrotal skin; sparse growth of long, straight, downy and slightly pigmented hair at base of penis. | Stage 2(pubertal) |
| Breast bud stage-small area of elevation around papilla; enlargement of areolar diameter. | Stage 2(pubertal) |
| Projection of areola and papilla to form a secondary mound (May not occur in all girls). | Stage 4 |
| In about ___ cases of hemophilia, the inheritance pattern is demonstrated as X-linked recessive. | 80% |
| The most common type of Hemophilia 80%. | Factor VIII deficiency(Hemophilia A or Classic) |
| Unlike hemophilia, ___ affects both males and females. | vWD |
| The most frequent type of internal bleeding in hemophiliac pts. | Hemarthrosis |
| Swelling, warmth, redness, pain and loss of movement. | Signs of Hemarthrosis |
| ______ _______ can have fatal consequences and is one of the major causes of death in Hemophilia. | Intracranial Hemorrhage |
| The primary therapy for hemophilia. | Replace Missing Factors |
| Increases plasma factor VIII activity and is the treatment of choice in mild hemophilia and certain types of vWD if the child shows an appropriate response. | DDAVP |
| These are given for hematuria, acute hemarthrosis, & chronic synovitis. | Corticosteroids |
| PO administration; prevents clot destruction; limited to mouth trauma sxg with a dose of factor concentrate given first. | E-aminocaproic Acid (Amicar) |
| ______ activity w/in reasonable limits strengthens muscles around joints and may decrease the number of spontaneous bleeding episodes. | Physical |
| The child can learn to self administer AHF by this age. | 8-12y/o |
| This has proven effective in hemophilia pts in preventing bleeding complications by administrating periodic factor replacement. | Primary prophylaxis |
| Involves the infusion of factor VIII concentrate on a regular basis after the child experiences his or her first joint bleed. | Secondary Prophylaxis |
| THis alternative may be a cost-effective alternative to primary prophylaxis, but prophylaxis decreases the development of joint disease. | On-Demand Factor Replacement |
| Can think in terms if future. | Adolescent (think) |
| Teens need peer groups for sense of ______• | Belonging |
| ___% of teenager deaths are involving vehicles | 40 |
| Side effects include Nervousness, decrease appetite, insomnia, HTN | Ritalin |
| Track down all sexual partners and treat w/ Abx | Gonorrhea (chlamydia) |
| Asthma in infants is commonly _____. | Viral |
| Long term steroid use can lead to ____ growth. | Slowed |
| Swollen hands and feet, joint pain; needs hydration and analgesics. | SCD Crisis |
| Hemophilia A or Classic hemophilia. | Factor VIII deficiency |
| Hemophilia B or Christmas disease. | Factor IX deficiency |
| Is a chronic inflammatory disorder of the airways characterized by recurring symptoms, airway obstruction, and bronchial hyperresponsiveness. | Asthma |
| Continual symptoms throughout the day. | Severe Persistent Asthma |
| Daily symptoms. | Moderate Persistent Asthma |
| Symptoms >2 times/wk but <1 time/day. | Mild Persistent Asthma |
| Symptoms ≤2 days/wk. | Intermittent Asthma |
| Studies of children with asthma indicate that _____ influence both the persistence and severity of the disease. | Allergies |
| Is the strongest identifiable predisposing factor for developing asthma. | IgE response(Atopy) |
| A key component of asthma therapy. | Anti-inflammatory agents (Corticosteroids) |
| What are the 3 classic manifestations of asthma. | dyspnea, wheezing and coughing. |
| Chronic cough in the absence of infection or diffuse wheezing during the expiratory phase of respirations is sufficient to establish a diagnosis. | Diagnosing Asthma |
| Provide an objective method of evaluating the presence and degree of lung disease , as well as the response to therapy. | Pulmonary Function Tests |
| _______ can generally be performed reliably on children by the age of 5 or 6 years old. | Spirometry |
| Signals all clear; asthma is under reasonably good control; no symptoms present. | Green (80-100%PB) |
| Signals caution; asthma is not well controlled an acute exacerbation may be present; maintenance therapy may need to be increased. | Yellow(50-79%PB) |
| Signals medical alert; severe airway narrowing may be occurring; short-acting bronchodilator should be administered. | Red(<50%PB) |
| Measures the maximum flow of air that can be forcefully exhaled in 1sec. | Peak Expiratory Flow Rate |
| Test for allergen-specific sIgE may be used to identify environmental allergens which trigger asthma. | Skin Prick Testing (SPT) |
| An MDI should always be attached to a _____ when an inhaled corticosteroid is administered to prevent yeast infections in the mouth. | Spacer |
| Are used as first-line therapy in children older than 5y/o with Asthma. | Corticosteroids ( |
| Budesonide and Fluticasone. | Inhaled Corticosteroids |
| Short Acting; primarily Albuterol, Levabuterol[Xopenex], & Terbutaline are used for Tx of acute exacerbations & prevention of exercise-induced bronchospasms. | B-Adrenergic Agonists |
| A long acting B-agonist(bronchodilator); prevents symptoms specially at night and exercise induced bronchospasms. | Salmeterol (Serevent) |
| Relieve symptoms and prevent asthma attacks; used primarily in the ED when the child is not responding to maximal therapy. | Theophylline |
| A medication used in maintenance therapy for asthma; inhibits the acute airway narrowing after exposure to exercise, cold air, and sulfur dioxide. | Cromolyn Sodium |
| Zafilukast(Accolate) & Montelukast Sodium (Singulair) block inflammatory and bronchospasm effects. | Leukotriene Modifiers |
| (atropine and ipratropium[Atrovent]) may be used for relief of acute brochospams. | Anticholinergics |
| When used in combination with albuterol, has been shown to be effective during acute severe asthma. | Ipratropium |
| Fairly new asthma drug; blocks binding of IgE to mast cells; eventually inhibits inflammation. | Omalizumab (Xolair) |
| Prophylactic treatment with _____ or _____ before exercise usually permits full participation in strenuous exertion. | B-adrenergic; Cromolyn sodium(Maintenance Therapy) |
| Successful treatment is continued for a minimum of 3years and then stopped. | Hyposensitization |
| A medical emergency that can result in respiratory failure & death if untreated; sweats profusely, tripod position, agitation to quietness; little relief with breathing treatments.. | Status Asthmaticus |
| A potent muscle relaxant that acts to decrease inflammation and improves pulmonary function and peak flow rate. | Magnesium Sulfate |
| Administered to decrease airway resistance & thereby decrease the WOB; delivered via non-rebreather mask; used in acute exacerbations as an adjunct to B-agonist and IV corticosteroid therapy. | Heliox |
| Risk factors that may predic the persistence of symptoms into childhood (from infancy). | Atopy, Male, Environmental tobacco, Maternal Hx of Asthma |
| Excessive cold, wind, extremes of weather, smoke (open fire/tobacco), sprays, scents, and other irritants. | Possible Allergens |
| Approximately 2-6% of children with asthma are sensitive to _____. | Aspirin |
| The most accurate way to determine how many doses remain in a n MDI. | Count & record each actuation as it is used. |
| Breath in n out; Hold 1-1.5 inch form mouth (or airtight seal w/ spacer); End of expiration Press and inhale 3-5sec. and Hold for 5-10sec.(x6 times w/ Aerochamber); remove and breath out slowly through nose; wait 1min between puffs. | Use of MDI |
| The family should obtain a ____ and learn to use this device to monitor the child's asthma if the child is 5 years of age & older. | PEFM |
| A home asthma action plan may reduce the risk of asthma death by ___%. | 70% |
| These vaccines are recommended for all children with Asthma. | Influenza & Pneumococcal |
| Refers to a group of bleeding disorders in which there is a deficiency of one of the factors (proteins) necessary for coagulation of the blood. | Hemophilia |
| Is a pathologic process involving the scap, skull, meninges or brain as a result of trauma. | Head Injury |
| The number one health risk for children & leading cause of death in children older than 1y/o | Unintentional Injuries |
| Bruising at the point of impact. | Coup |
| Brain collides with the unyielding surfaces, far removed from the point of impact. | Countercoup |
| Most common head injury; alteration in neurologic or cognitive function w/ or w/o loss of consciousness; occurs immediately after head injury. | Concussion (Resolve in 7-10days) |
| What are the hallmarks of a concussion. | Confusion & Amnesia |
| Are used to describe visible bruising & tearing of cerebral tissue. | Contusion & Laceration |
| Single fracture line that starts at the point of maximum impact but does not cross suture lines. | Linear Fx |
| Consist of multiple associated linear Fx. | Comminuted Fx |
| Hemorrhage, infection, edema, & herniation through the brainstem. | Complications of Trauma to the Head |
| Should be suspected in children with increasing drowsiness and fever who also have a basilar skull Fx. | Posttraumatic Meningitis |
| Bleeding between the dura and the skull to form a hematoma; generally arterial; Rapid. | Epidural Hemorrhage |
| Momentary unconsciousness followed by a normal period and the lethargy or coma (less evident in children). | Signs of Epidural Hemorrhage |
| Bleeding between the dura and the arachnoid membrane; usually as a result of rupture of cortical veins that bridge the subdural space. | Subdural Hemorrhage |
| Some degree of cerebral edema is expected ___ to ___ hours after craniocerebral trauma. | 24-72 |
| Is a common sequela to brain injury w or w/o loss of consciousness. | Postconcussion Syndrome |
| The most important nursing observation is assessment of the child's. | LOC |
| Seizures are common in children with head trauma; Lethargic with sluggish pupils. | Postictal (Postseizure) |
| Complex neurodevelopmental disorders of unknown etiology composed of qualitative alterations in social interaction & verbal impairment w/ repetitive, restricted & stereotype behavioral patterns. | Autism Spectrum Disorders (ASD's) |
| ASD is manifested during early childhood, primarily from __ to __ months of age. | 18-36 |
| Although etiology is unknown theories of links between hereditary, genetic, and medical problems (i.e. viral infections) have been postalized; Fragile X Chromosome; Increased risk w/ families of affected child. | Etiology for ASD |
| Hallmark characteristic of ADS person. | Inability to maintain eye contact. |
| Lack of emotional reciprocity, Failure to develop peer relationships; lack of development of spoken language; inability to sustain conversations;repetitive motor mannerisms; preoccupation w/ parts of objects. | Diagnostic Criteria for ASD |
| In ASD more Boys are affected than girls although girls are affected more ______. | Severely |
| This children excel in particular ares, such as art, music, memory, math, or perceptual skills like puzzle building. | Savants |
| Providing a _____ _____ for the child to follow is a key in the management of ASD. | Structured Routine |
| Because physical contact often upsets children with ASD, these measures may be necessary to avoid behavioral outbursts. | Minimal holding & eye contact |
| Because children with ASD have difficulty organizing their behavior and redirecting their energy. | They need to be told Directly what to do. |
| Instruct family on pain meds and maintaining blood level. | JIA |
| Delayed language, delay or absent imaginative play, impaired social interaction. | ASD Diagnostic Criteria** |
| ______ is a common symptom and can be associated with acquired megarectum in children with ASD. | Constipation |
| Caused by excessive and disorderly neuronal discharges in the brain; symptom of an underlying disease process. | Seizures |
| A condition characterized by two or more unprovoked seizures and can be caused by a variety of pathologic processes in the brain. | Epilepsy |
| Are associated with an acute insult such as head trauma or meningitis. | Acute Symptomatic Seizures |
| Are those w/o an immediate cause but w/ and identifiable prior brain injury (i.e. head trauma) | Remote Symptomatic Seizures |
| Are those occurring with no clear cause. | Cryptogenic Seizures |
| Seizures that are genetic in origin. | Idiopathic Seizures |
| Hallmark early systemic clinical changes during generalized seizure. | Tachycardia, HTN, Hyperglycemia, and Hypoxemia |
| Prolonged seizures can lead to these s/s | Lactic acidosis, rhabdomyolysis, hyperkalemia, hyperthermia, and hypoglycemia. |
| Have a local onset and involve a relatively small location of the brain; discharges remaining unilateral; localized motor symptoms. | Partial Seizures |
| Involve both hemispheres of the brain and are w/o local onset. | Generalized Seizures |
| Observed in children 3y/o-adolescents; Altered Behavior; Aura; drowsiness or sleep usually following seizure; Confusion & Amnesia; Stares into space; Automatism. | Complex Partial Seizure |
| Most common & most dramatic of all seizures; Occur w/o warning; Includes Tonic/Clonic phases; Postictal state | Generalized Seizure (Grand Mal) |
| Eyes roll; Falls to floor; Stiffens; LOC; arms flexed; piercing cry; Apneic; Increase salivation & loss of swallow reflex; lasts 10-20sec. | Tonic Phase |
| Violent jerking movements as the trunk & extremities undergo rhythmic contraction and relaxation; foam at the mouth; incontinent of urine and feces; lasts 30sec but varies. | Clonic Phase |
| Series of seizures at interbals too brief to allow th child to regain consciousness between the time one event ends and the next begins; lasts ≥30min. | Status Epilepticus |
| May remain semiconscious and difficult to arouse; remains confused for several hours; poor coordination; may vomit & c/o severe HA; no recollection of event. | Postictal state |
| Onset 4-12y/o, more common in Females; cease at puberty; Brief LOC; No alteration in muscle tone; May go unrecognized; abrupt onset (+20/day); may be mistaken for daydreaming; last 5-10 sec.; Does NOT Fall or incontinent; Amnesia+ | Absence Seizures (Petit Mal or Lapses) |
| Onset 2-5y/o; sudden momentary loss of muscle tone & postural control; Falls to the floor violently;LOC only momentarily; May cause facial trauma. | Atoni & Akinetic Seizures (Drop Attack) |
| Is ontained for most children with seizures and is the most useful tool for evaluating a seizure disorder; provides information on the seizure type and focus. | EEG |
| Management of epilepsy has these four treatment options. | Drugs, Ketogenic diet, VNS, epilepsy surgery |
| ______ drugs serve to raise the threshold of excitability and prevent seizures from occuring. | Antiepileptic (70-80% effective) |
| If complete seizure control is maintained on an anticonvulsant drug for ___ yrs, it is safe to D/C the drug for patients w/ no risk factors. | 2 |
| High fat, Low Carb, & adequte Protein diet; Causes induced Ketosis=using Fat as primary source for energy; Requires vitamin supps.; diarrhea, hypoglycemia, dehydration, acidosis, lethargy are long term side affects. | Ketogenic Diet |
| Uses an implantable device that reduces seizures in individuals who have not had effective control with drug therapy. | Vagus Nerve Stimulation |
| Defined as the persistence of seizures despite adequate trials of three antiepilecptic medications, alone or in combination. | Refractory Seizures |
| These two drugs are quick, effective, and safe treatmetns for home or prehospital treatment of status epilepticus. | Buccal Midazolam & Rectal diazepam |
| For in hospital management of status epilepticus; these are the first line drug of choices. | IV diazepam or lorazepam (ATIVAN)** |
| Note the ______ of the seizure with start and stop times. | Duration |
| If the nurse is able to reach the child in time, a child who is stading or seated (including a wheelchair) . | Is eased to the floor immediately (turn to side) |
| Children taking phenobarbital or phenytoin should receive these supplemental vitamins. | Vit D & Folic Acid |
| The most common factors that may trigger seizures in children. | Emotional stress, sleep deprivation, fatigue, fever, illness; flickering lights, menstrual cycle & Alcohol |
| A febrile seizure lasting more than 5min. | Call 911 (Do Not place child in car w/ active seizure) |
| Main sign of a generalized seizure. | LOC |
| The most common skin problem treated by physicians during patients' adolescence; caused by testosterone, a hormone present in boys and girls that increases during puberty. | Acne Vulgaris |
| Is the only drug that effectively interrupts the abnormal follicular keratinization that produces microcomedones, the invisible precursors of the visible comedones. | Tretinoin (Retin-A) |
| Start with pea-sized dot of med; wait 20-30min after washing face; Avoid sun; apply at Night; use sunscreen(SPF 15or >) | Application of Retin-A |
| Anti-bacterial agent that inhibits growth of P. acnes organisms; First line agent. | Benzoyl Peroxide |
| When inflammatory lesions accompany the comedones; these agents are used to prevent new lesions & to treat preexisting acne. | Topical Antibacterial Agents |
| Are used when moderate to severe acne does not respond to topical treatments. | Systemic Abx Therapy |
| Young women with mild to moderate acne mayy respond well to topical treatment and the addition of an _______ pill. | Oral Contraceptive |
| A potent and effective oral agent that is reserved for severe cystic acne that has not responded to other treatments; affects factor involved in the development of acne; 20wk course; Teratogenic. | Isotretinoin, 13-cis-retinoic acid (Accutane) |
| Causes dry mm; nasal irritation, dry eyes, decreased night vision, photosensitivity, arthralgia, HA mood changes, violent behaviors, Depression, & Suicidal Ideation. | Side effects of Accutane |
| Is due to the loss of fluid from the vascular compartment into the area of injury; Fluid shifts from intravascular spaces into extravascular spaces. | Burn Shock |
| Infusion of Ringer's Lactate. | >2 years of age |
| Infusion of D5LR. | <2 years of age |
| The fluid formula for the first 24 hours post burn | 3-4mL IV fluid/Kg/TBSA + Maintenance Fluid |
| Maintenance fluid requirements. | 100, 50, 20 |
| Give 1/2 during first __ hrs. | 8 |
| Give 2nd half during subsequent ___hrs. | 16 |
| Urine output for children <30kg. | 1ml/kg/hr |
| Urine output for children >30kg | 30-50mL/hr |
| The extent of a burn is expressed as a percentage of the ____. | TBSA |
| Usually minor; Sunburn; involves epidermal layer only; NO blistering; heals in 5-10 days. | Superficial (First-degree) |
| Involve the epidermis & varying degrees of the dermal layer; painful, red, Blistering; sweat glands and hair follicles remain intact; heals in 14-21days. | Partial-thickness (second degree) |
| Dry, leathery; involve the entire epidermis & dermis & extend into Sub-Q tissue; nerve endings, sweat glands; and hair follicles are destroyed.. | Full-thickness (third-degree) |
| Are full-thickness burns that involve underlying structures such as muscle, fascia, and bone. | Fourth-degree burns |
| Evidence of direct thermal injury to the upper airway includes. | Burns to face/lips; Nasal hairs; laryngeal edema |
| Can cause restriction of chest excursion as a result of edema & inelastic eschar formation. | Encircling burns (Thorax) |
| Maximum edema formation in small burn wounds occurs __ to __ hours after injury. | 8;12 |
| There is a systemic response involving an increase in cap. permeability, allowing plasma proteins, fluids and electrolytes to be lost. | ≥30% TBSA |
| Results from pulmonary capillary damage and leakage of fluid into the interstitial spaces of the lung. | Acute Respiratory Distress Syndrome (ARDS) |
| First step in emergency treatment of any burn. | Stop the Burning process |
| Two Early signs of wound sepsis. | Decreased LOC & Lethargy |
| Require continuous flushing with large amounts of water before transport to a medical facility. | Chemical Burns |
| The burn wound should be covered with a clean ___ cloth to prevent contamination. | Dry |
| _______ 0f the chest relieves this constriction and improves ventilation. | Escharotomy |
| A high protein, high calorie diet is encouraged. | Nutrition for Burn Patient |
| To facilitate growth and proliferation of epithelial cells; and increase wound healing. | Vitamin A, C, and Zinc |
| Is the drug of choice for severe burn injuries. | Morphine Sulfate (Versed & Fentanyl also used in conjunction) |
| The use of these short-acting anesthetic agents has proven beneficial in eliminating procedural pain. | propofol(Diprivan) & Nitrous Oxide |
| ______ and ______ are also needed for itching that occurs after whilpool and debridement. | Hydroxyzine; diphenhydramine |
| Is used to cleanse the wound and involves soaking i a tub or showering at least once a day for no more than 20min. | Hydrotherapy |
| Skin is obtained from human cadavers that are screened for communicable diseases; body rejects in 3-4wks. | Allograft (homograft) |
| Used from a variety of species most notably pigs; needs replacement every 1 to 3 days. | Xenograft |
| Are available for the management of partial-thickness burn wounds; readily available; indefinite shelf life; and relatively inexpensive. | Synthetic Skin Coverings |
| May be sheet graft or mesh graft; permanent coverage of deep partial and full thickness burns; use a Dermatome. | Split-thickness skin grafts |
| A sheet of skin removed from the donor site is placed intact over the recipient site and sutured in place(Good cosmetic outcome). | Sheet Graft |
| A sheet of skin is removed from the donor site and passed through a mesher, which produces a larger surface area of material (Less desirable cosmetic). | Mesh Graft |
| A product that allows the dermis to regenerate, has produced significant improvement in burn wound healing and decreased scar formation. | Integra |
| The single most important element of infection control of burn patients. | Frequent hand & forearm washing |
| Causes Urethritis (Dysuria w/ profuse yellow discharge, frequency, urgency, nocturia) or pharyngitis. | Gonorrhea Male |
| Meatal erythema, tenderness, itching, dysuria, urethral discharge; or no symptoms and in females: mucopurulent cervical exudate with erythema, edema, congestion; or no symptoms. | Chlamydia |
| Chancre, a hard, painless, red, sharply defined lesion with indurated base, raised border; secondary stage: systemic influenza-like symptoms; give Penicillin-G. | Syphilis |
| For a patient positive for STI. | Tx all sexual partners |
| Ensure vaccination for ____, ____, and ______. | Hep A, B; HPV |
| This disease is of major concern to nurses because of its devastating effects on the reproductive system. | Pelvic Inflammatory Disease |
| A group of permanent disorders of the development of movemen and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. | Cerebral Palsy (Definition) |
| It has been estimated that as many as ___ of CP cases are attributed to unidentified prenatal factor. | 80% |
| Is also associated with a later diagnosis of CP. | Perinatal Ischemic Stroke |
| Additional factors that contribute to these disease: B. Meningitis, multiple births, viral encephalitis, MVA, and child abuse. | Factors for CP |
| Appears to play the most significant role in the pathologic state of brain damage, which is often secondary to other causative mechanisms. | Anoxia |
| Persistent primitive reflexes, positive Babinski reflex, anle clonus, exaggerated stretch reflexes, development of contractures; 80% of cases most Common type. | Spastic CP |
| All extremities affected; lower more than upper (30-40% of spastic CP). | Diplegia |
| All four extremities involved; legs and trunk, mouth, pharynx, and toungue (10-15% Spastic CP) | Tetraplegia |
| Three limbs involved. | Triplegia |
| Only one limb involved. | Monoplegia |
| Motor dysfunction on one side of the body; upper extremity more affected than lower (2-30% of spastic CP). | Hemiplegia |
| Involves Athetoid, Dystonic; involvement of the pharyngeal, laryngeal, and oral muscles causing drooling and dysarthria (imperfect speech articulation). | Dyskinetic (Nonspastic, Extrapyramidal) |
| Chorea; slow, wormlike, writhing movements that usually involve the extremities, trunk, neck, facial muscles, and tongue. | Athetoid |
| Slow, twisting movements of the trunk or extremities; abnormal posture. | Dystonic |
| Wide-based gait; rapid, repetitive movements performed poorly; disintegration of movements of the upper extremities when the child reaches for objects. | Ataxic |
| Combination of spastic CP and dyskinetic CP. | Mixed CP |
| More often diagnosis cannot be confirmed until the age of ___ years because motor tone abnormalities may be indicative of another neuromuscular illness. | 2 y/o (CP Dxg) |
| Delay in all motor accomplishments; rigid and unbending at the hip and knee joints when pulled to sitting position; elbows flexed; hands fisted; Persistence of primitive infantile reflexes; seizures. | Dxg CP signs |
| Persistent primitive reflexes such Moro, atonic neck; Poor head control; stiff; scissoring legs; clenched fists; Floppy or limp posture; cant sit w/o support by 8mo; after 6mo tongue pushing; failure to smile by 3mo; lack of interest. | Early Signs of CP |
| Are worn by many children with CP and are used to help prevent or reduce deformity, increase the energy efficiency of gait, and control alignment. | Ankle-foot orthoses (AFO's, braces) |
| Procedure involves selectively cutting dorsal column sensory rootlets that have an abnormal response to electrical stimulation. | Dorsal Rhizotomy |
| Drug used to reduce spasticity in targeted muscles (commonly quadriceps, gastrocnemius, or medial hamstrings). | Botulinum Toxin A (Botox) |
| This therapy is best suited for children with severe spasticity that interferes with ADL's and ambulation. | Intrathecal baclofen |
| Head cooling or whole-body cooling within 6 hours of birth improved survival without CP by approximately 40%. | Therapeutic Hypothermia (offers Neuroprotection) |
| Middle finger of the nonfeeding hand is placed posterior to the bony portion of the chin, the index finger is placed on the chin below the lower lip & the thumb is placed obliquely across the cheek to provide lateral jaw stabilization. | Manual Jaw control Side |
| The middle finger of the nonfeeding hand is placed posterior to the body portion of the chin, the thumb is placed below the bottom lip, & the index finger is placed parallel to the child's mandible. | Manual Jaw control Anteriorly |
| A complex spinal deformity; involving curvature, spinal rotation causing rib asymmetry, and thoracic hypokyphosis; common during growth spurt in early adolescence; ill-fitting clothes. | Idiopathic Scoliosis |
| Observation is performed behind an undressed (in undergarments), standing child, noting shoulder height, scapular or flank shape, and hip height and alignment; w/ hanging arms. | Screening for Scoliosis |
| What is the definitive diagnosis for scoliosis patients. | Standing Radiograph (Cobb technique) |
| Radiograph curves of at least ___ degrees for diagnosing scoliosis. | 10 |
| Require observation; exercise; exam every 3-6mo. | Curve <20 degrees |
| Require orthosis with Milwaukee, Boston; or Halo brace; also electrical stimulation. | Curve 20 to 40 degrees |
| Require Sxg or if unacceptable cosmetic appearance; or failure of brace Tx. | Curve > 40 degrees |
| ______ is the standard treatment for moderate curvatures in growing children. | Bracing |
| ______ are of benefit when used in conjunction with bracing to maintain and strengthen spinal and abdominal muscles during treatment. | Exercise |
| Patients are monitored in an acute care setting and ____ ____ when changing position to prevent damage to the fusion and instrumentation. | Log-rolled |
| May occur several days after surgery; this involves duodenal compression by the aorta and superior mesenteric artery. | Superior Mesenteric Artery Syndrome |
| Is diminished or deficient secretion of pituitary hormones. | Hypopituitarism |
| Refers to a method of assessing skeletal maturity by comparing the appearance of representative epiphyseal centers obtained on x-ray exam w/ age-appropriate published standards. | Bone Age (X-ray Hand-wrist) |
| Children w/ poor linear growth, delayed bone age, and abnormal GH stimulation tests. | Growth Hormone Deficient |
| Optimum dosing is often achieved when GH is administered at ______. | Bedtime |
| Over-secretion of GH occurs after epiphyseal closure, growth is in the transverse direction. | Acromegaly |
| Manifestations of sexual development before age 9y/o in boys or age 8 in girls. | Precocious Puberty |
| More common in Girls; pubertal development is activated by the hypothalamic gonadotropin-releasing hormone. | Central Precocious Puberty (CPP) |
| May be caused by congenital anomalies; Infections; Radiotherapy; Trauma; Neoplasms. | Etiology of Precocious Puberty |
| If needed, precocious puberty of central origin is managed with monthly injections. | Leuteinizing hormone-releasing hormone (Lupron Depot) |
| Refers to developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity. | ADHD |
| The symptoms must have been present in children 4 to 18 y/o and must be present in more than one major setting. | Dxg ADHD |
| Learning disabilities and ADHD affect every aspect of the child's life but are most obvious in the ______. | Classroom |
| Affect the child's written and adaptive skills, social status, and self esteem. | Characteristics of ADHD |
| The most frequently used Stimulants for ADHD. | Ritalin and Dexedrine |
| Children who receive stimulants should be monitored carefully for the development of ___. | Tics |
| Focuses on the prevention of undesired behavior. | Behavioral Therapy (Used w/ Meds) |
| The use of pharmacotherapy and behavioral intervention as well as close follow-up and feedback. | Multimodal Treatment |
| _______ and _______ is especially important in children with ADHD. | Consistency; Structure |
| Appetite suppression,HA, irritability, abdominal pain, N/V, Slowed growth, and sleep disturbances. | Side effects of Stimulants |
| Psycho-stimulants should be administered ____ in the day. | Early |
| PPrecocious puberty (central), needs monthly injections. | LH (9 for girls, 11 for boys) |
| Characterized by destruction of pancreatic B cells, which produce insulin; this usually l/t absolute insulin deficiency; can be autoimmune or idiopathic. | Type 1 DM |
| Is a chronic disorder of metabolism characterized by a partial or complete deficiency of the hormone insulin. | Diabetes Mellitus (Definition) |
| Usually arises because of insulin resistance in which the body fails to use insulin properly combined with relative insulin deficiency. | Type 2 DM |
| Influenza, gastroenteritis, and appendicitis are conditions that may _____ signs of DM. | Mask |
| 3 "P's", weight loss, Enuresis irritability, short attention span, dry skin, Blurred vision, poor wound healing, fatigue, flushed skin, HA, hyperglycemia. | Signs of Type 1 DM |
| School-age children are able to administer their own ______. | Insulin |
| Adrenergic; sweating and trembling. | Early Hypoglycemia |
| Illness, emotional upset, stress, physical response to immunizations; steroids; menses. | Factors for Hyperglycemia |
| Give 3-6oz of OJ, followed by starch protein snack. | Tx for mild Hypoglycemia |
| The focus of type __ DM is insulin replacement, diet and exercise. | 1 |
| ***Vaccines; no _______ between receiving vaccines and risk for autism. | Correlation |
| These two STI are Tx at the same time. | Gonorrhea & Chlamydia |
| This STI can cause blindness in newborns. | Gonorrhea |
| Curling ulcer in GI tract, wound sepsis, CO2 inhalation, B. Pneumonia. | Complications of burns. |
| Burn patients may benefit from this vaccine to prevent anaerobic organisms from growing underneath the wound. | Tetanus vaccine |
| Asthma is considered ___ in children under 2y/o | RAD |
| ***Tx with anti-TNF same pain but had lower disease activity, w some having no pain at all. May be causal relationship with cognition affects perception of pain. | Study for JIA |
| Must wait __ hours to take long term asthma med after quick relief has been administered. | 4 |
| Emergency medication for status asthmaticus. | Epinephrine |
| Lowers estrogen level; slows prepubertal growth to a normal rate; stop when normal. | Lupron |
| ***Liquid hydroxyurea for pain; function of kidneys and spleen did not improve but significant decrease in pain with this drug. | Study on SCA |
| Monitor ______ count regularly to evaluate bone marrow function is patients with SCA. | Reticulocyte |
| Normal boy, Normal girl, Girl w Trait, Boy w disease. | Genetic outcome for Hemophilia (1:4) |
| Dxg on basis of Hx, PTT, low levels of Factor VIII or IX; can be Dxg i through amniocentesis; Elective abortion an option. | Dxg Hemophilia |
| Must be given through a warming coil or a warming machine; avoids central hypothermia. | Blood Transfusion |
| If a reaction to blood or blood products occurs. | STOP; take V/S, maintain patent IV, Notify MD |
| Tx for a concussion. | Brain Rest |
| Traumatic Fx separation of cranial sutures. | Diastatic Fx |
| What other drugs may be given to children with ADHD besides stimulants. | Beta Blockers |
| ***Cairo study; exercise on trunk muscles significant improvement in posture; Forward head movement. | Study on Scoliosis |
| Preterm _____ of ELBW & VLBW is single most important determinant of CP. | Birth |
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BOjangles1006
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