NU 202 - PEDS - Various topics Flashcards

Sickle-cell disease
Terms Definitions
What 3 things does a myelomeningocele contain?
1. meninges,
2. spinal fluid, and
3. a portion of the spinal cord and its nerves
What is called when a sac-like cyst on the L-S area contains meninges, spinal fluid, and spinal cord?
What lab value will you see if fetus has open neural tube defect?
^ alpha feto protein
What can ^ alpha feto protein indicate in mom?
open neural tube defect
How is spina bifida occulta different from myelomeningocele?
spina bifida occulta often has no symptoms except tuft of hair or dimple
What are the sym of myelomeningocele?
flaccid paralysis of legs, neurogenic bladder, fecal incontinence, musculoskeletal deformities, hip dislocation or subluxation, talipes varus or valgus, dribbles urine & feces continuously, 1/3 have MR
What does the following describe: flaccid paralysis of legs, neurogenic bladder, fecal incontinence, musculoskeletal deformities, hip dislocation or subluxation, talipes varus or valgus, dribbles urine & feces continuously, 1/3 have MR
What percent of L-S myelomeng. get hydrocephalus?
What sym do 90% of pt w/ myelomeng. get?
Why do surgerical closure on myelomening.?
to prevent infection and trauma to sac and
to avoid stretching over nerve roots
What 2 things that predispose to myelomeng.?
1. folic acid deficiency in mom
2. genetic predisposition
What's the typical size of a neonate's head r/t chest?
head 1" larger than chest
What might be the first sign before neuro sym in myelomeningocele?
How do you detect it?
head >1" larger than chest
How can hydrocephalus present in the eyes?
sunset eyes - eye rotated downward
What 2 sym indicating what 2 neurological changes can you assess r/t myelomen?
1. bulging anterior fontanel (= ^ ICP)
2. high pitched cry (neuro damage)
What might a high pitched cry from neonate indicate?
neuro damage
What might a bulging fontanel indicate in a neonate?
What can you assess r/t urogenital sys in kid w/ myelomen.?
neurogenic bladder (distended)
What's output like r/t neurogenic bladder?
Trickling pee
What can freq trickling pee in neonate?
neurogenic bladder r/t myelomen
Myelomeningocele - body position?
trendelenburg (if no marked hydrocephalus)
What's priority nursing care r/t Myelomeningocele?
protecting sac form injury!
What position do you put kid in w/ hydrocephalus r/t Myelomeningocele?
elevated head (to reduce ICP)
What kind of dressing on sac in myelomeningocele?
moist, sterile dressing
What's the most important assessment pre and post op r/t myelomeningocele?
What two things can cause ^ ICP r/t myelomeningocele?
What's earliest sign of ^ ICP in neonate?
tense or bulging fontanel
What 2 things are most important to stress to parents of kid r/t myelomeningocele?
freq diaper change, and
scrupulous skin care
If shunt for hydrocephalus, what position?
position flat or side-lying (to avoid to rapid decompression of IC fluid)
What's the most imp post op assessment for shunt r/t hydrocephalus?
Who has the highest incidence of ingesting poison?
2 y/o
What's the first concern r/t poisoning?
life support
What's the second concern r/t poisoning?
what kid ingested
What's an old school thing that you don't do anymore r/t poisoning?
force vomiting w/ ipecac
What category of poison are the following?:
meds, plants, cosmetics, perfume
What are four ex of noncorrosive poisons?
meds, plants, cosmetics, perfume
What are two options for Rx of noncorrosive poisons?
gastric lavage, and
activated charcoal
Within what time frame must you utilize activated charcoal after noncorrosive poisoning?
w/in 30 min
What category of poison are the following?:
toilet bowel cleaner, Drano, ammonia, Lysol, batteries
What category of poison are the following?:
gas, kerosene, fuel oil, turpentine
What category of poison are the following?:
What category of poison are the following?:
What are 5 examples of corrosive poisons?
toilet bowel cleaner, Drano, ammonia, Lysol, batteries
What are 4 ex of hydrocarbon poisons?
gas, kerosene, fuel oil, turpentine
What kind of poison did kid ingest if visible severe burns and edema of mouth, lips, tongue, and throat?
With what types of poisons do you avoid lavage and vomiting as Rx?
corrosives, and
What do you have kid do if ingested corrosive?
drink water or milk (maybe not milk)
Don't try to _____ corrosive poisoning?
What procedure might they use for kid who ingested corrosive?
What do you have to assess prior to esophagoscopy?
drooling or crying when swallows
If you see the following sym, what should you suspect?:
choking, coughing, n/v, weakness, ^ inspiration w/ retractions, grunting, and cyanosis
ingestion of hydrocarbon poisoning
What sym can you expect after ingesting hydrocarbon poison?
choking, coughing, n/v, weakness, ^ inspiration w/ retractions, grunting, and cyanosis
What sym can you expect after ingesting hydrocarbon poison?
What is a principle sym of ASA poisoning?
What ABG condition could you see r/t ASA poisoning?
respiratory alkalosis,
caused by ASA-induced hyperventilation
What could happen to temp r/t ASA poisoning?
hyperpyrexia (> 106 deg)
What would you expect to see w/ ASA poisoning, but actually is seldom seen?
bleeding problems
What's the antidote for Tylenol?
acetylcysteine (Mucomyst)
Who absorbs the most lead? (kids or adults?)
How much more?
kids absorb 3-5 x as much
What are the first kind of sym you see r/t lead poisoning?
behavioral changes
If you see a kid become the following, what should you suspect?:
progressively more irritable, aggressive, v interesting in normal play, lethargic or hyperactive
lead poisoning
If a kid loses newly acquired motor skills (used to feed self, now can't), what should you suspect?
lead poisoning
What lab results might kid w/ led poisoning present?
What lead blood level is of concern?
> 10Ug/dl
What are the following meds?:
CaEDTA, BAL (Dimercaprol), Succimer
chelating agents for lead poisoning
What are three examples of chelating agents for lead poisoning?
CaEDTA, BAL (Dimercaprol), Succimer
What two chelating agents are often used together?
Why? x2
b/c less s/e and gets lead out of brain better
What's the principle chelating agent?
What's another name for Ca-EDTA?
calcium edetate
How do you give CaEDTA? (route)
deep IM or IV
What do you give w/ CaEDTA?
procaine in syringe, and
EMLA cream 2.5 hrs before shot
What's the main toxic effect of CaEDTA?
What do you therefore check for?
assess renal function (oliguria)
Who can't you give BAL to?

kid w/ peanut allergy
Who can't you give BAL to?

Picture a kid bailing out loads of peanuts from a boat
What can't you admin when kid on BAL?
iron tx
What are 3 complications from tx of lead poisoning?
What do you tell parents of kid who finishing lead poisoning tx?
prevent re-exposure
What's the best way of preventing lead poisoning?
educating public
What's the most common tracheoesophageal fistula?
proximal esoph ends in blind pouch,
distal esoph attaches to trachea
What is a sym mom may present if kid has tracheoesophageal fistula?
What should you suspect if you see constant drooling and excessive secretions in mouth & nose?
tracheoesophageal fistula
What should you suspect if you see coughing, choking, cyanosis?
tracheoesophageal fistula
What are the sym of tracheoesophageal fistula? (besides secretions from nose & mouth)
3 c's: cough, choking, cyanosis (esp with feeding)
Why give sterile water to neonate first?
r/o tracheoesophageal fistula
What do you do if you give sterile water to neonate w/ tracheoesophageal fistula?
suction and
What's the most imp nsg intervention for tracheoesophageal fistula?
prevent aspiration
What are two nsg interventions to prevent complications r/t tracheoesophageal fistula?
prevent aspiration, and
What's HOB for tracheoesophageal fistula?
30 deg
When you see what s/s do you do tracheal suctions r/t tracheoesophageal fistula?
when you see substernal retractions
When you see substernal retractions r/t tracheoesophageal fistula, what do you do?
tracheal suction
What device might be utilized for tracheoesophageal fistula?
gastrostomy tube
In what environ neonate w/ tracheoesophageal fistula placed?
isolette w/ high humidity
What is the g tube used for first r/t tracheoesophageal fistula?
first to allow air to escape,
then to feed
What happens in the first OR r/t tracheoesophageal fistula?
1. ligate then close distal esoph,
2. esophagostomy with pouch to drain secretions
How do you keep skin nice after esophagostomy r/t first OR for tracheoesophageal fistula?
keep clean and
protect with thin layer of
mild ointment
What do you give kid with esophagostomy?
maybe po fluids
What's a big no-no when suctioning kid w/ esophagostomy?
don't touch anastomosis area,
follow MD's mark on catheter
What are two NI for positioning and repositioning kid post op r/t tracheoesophageal fistula?
HOB 30 deg,
reposition often (for lung expansion)
Why keep HOB @ 30 for tracheoesophageal fistula post op?
prevent regurgitation into esoph
How do you prevent regurg into esoph post op for tracheoesophageal fistula?
HOB 30 deg
How do you allow for max lung expansion post op for tracheoesophageal fistula?
(besides HOB 30)
reposition often
How do you avoid post op vomiting r/t tracheoesophageal fistula?
NPO 5-7 days
How long NPO post op tracheoesophageal fistula?
5-7 days
Gastrostomy tube open or closed after tube feeding post op for tracheoesophageal fistula?
When do you start oral feeding post op tracheoesophageal fistula?
2 wks post op
What's first oral feeding post op tracheoesophageal fistula?
water (in case of aspiration)
What's a common post op complication for tracheoesophageal fistula?
esophageal stenosis
What are four signs of esophageal stenosis r/t tracheoesophageal fistula?
difficulty swallowing,
coughing with feedings,
refusal to eat
What should you expect if you see the following post op tracheoesophageal fistula?:
difficulty swallowing,
coughing with feedings,
refusal to eat
esophageal stenosis
What's HPS?
Hypertrophic Pyloric Stenosis
When do HPS occur usu?
soon after birth (2-4 wks)
What does the follow describe:
Baby well at 1st. Sym occur 2-4 wks old. 1st see regurgitation, then non-projectile vomiting, then projectile vomiting (during & after feedings). No bile, baby always hungry.
How is baby at first r/t HPS?
just fine
What are 4 first signs in order of HPS?
1. regurgitation, then
2. non-projectile vomiting, then
3. projectile vomiting,
4. baby always hungry
What does vomit contain r/t HPS?
gastric contents,
maybe blood streaks,
No bile.
What happens w/ feeding after puking r/t HPS?
will eat immediately,
and vomit again
... yummy...
What happens to BMs r/t first s/s of HPS?
stool v in freq & amt (constipation)
What presents visually on abdomen during and after feeding r/t HPS? (not olive-shaped mass)
peristaltic waves pass for L to R
What can you palpate that is part. to HPS on abdomen?
And where?
olive-shaped mass,
During feeding or after vomiting, if you can palpate an olive-shaped mass @RUQ, what might it indicate?
What are typical infant levels of the following:
Na 134-146
K 3.9-5.0
Cl 97-110
What blood levels go up and down r/t HPS?
3 up
2 down
What ABG condition does kid present r/t HPS?
metabolic alkalosis
What is the goal of nsg mngt r/t pre op for HPS?
restore F&E balance and correct dehydration
What must be corrected prior to surgery for HPS?
dehydration (poss metabolic alkalosis)
What is a primary NI post of for HPS?
provide adequate nutrition
What happens r/t vomiting post op for HPS?
still vomit 1-2 days r/t gastritis
When are feedings usu started post op for HPS?
4-6 hrs
By when usu. do you subsititute water or electrolyte solution with formula or breast milk post op HPS?
24 hours
What position for baby after feeding post op for HPS?
elevate head,
put on right side
What is the hereditary charact of sickle cell anemia?
autosomal recessive
What is the name of the pathol Hb in sickle cell anemia?
Hb S
When does Hb S morph in sickle cell?
when it's deoxygenated
What's the name of most freq and painful sickle cell crisis?
vaso-occlusive sickle cell crisis
What 2 things can happen during a vaso-occlusive sickle cell crisis?
tissue necrosis,
What blood condition does pt w/ sickle cell often have?
chronic hemolytic anemia
Why is sickle cell called a hemolytic anemia?
sickled RBCs have shorter life span
What are sym of sickle cell just after birth for neonate?
asymptomic b/c
^ levels of mom's Hb F prevent excessive sickling
At what age do problems often start for kids w/ sickle cell?
4-6 mos old
What is the life cycle of spleen r/t sickle cell?
1st - enlarged w/ sickled cells & has v funct
*spleen may rupture
2nd - small and fibrotic r/t multi infarc & can't filter bacteria
Why are sickle cell pts more susceptible to infection?
fibrotic spleen can't filter bacteria
To what infection is pt w/ sickle cell prone?
meningitis r/t dysfun'l spleen
What should you suspect if infant has swollen hands and feet?
sickle cell
What is hand-foot syndrome?
swollen hands and feet
What is often the first sym in infant w/ sickle cell?
hand-foot syndrome
If infant has priapism, what could you suspect?
sickle cell
What often precipitates vaso-occlusive crisis?
What can infection precipitate r/t sickle cell anemia?
vaso-occlusive crisis
What two effects can vaso-occlusive crisis cause (besides pain & necrosis)?
slowed circulation,
renal failure
What is a sequestration crisis?
r/t sickle cell,
large amt of blood pooled in liver and spleen
What is it called when viral or other infection causes v prod of RBC in sickle cell pt causing profound anemia?
aplastic anemia
What is it called when lrg amt of blood pools in liver and spleen r/t sickle cell?
sequestration crisis
What are the charac of the anemia caused by sickle cell?
normocytic, normochromic
What are the 2 tests you give in succession to dx sickle cell?
sickledex then
Hgb electrophoresis
What is the procedure for sickledex test?
How long do results take?
finger stick,
3 min
What tests tells if kid has sickle cell disease or trait?
Hbg electrophoresis
What are 3 primary NI to teach parents for between sickle cell crises?
1. promote tissue oxygenation
2. promote hydration
3. prevent infection
How do you prevent sickling?
promote tissue oxygenation
What are 3 things that ^ need for O2 that you should try to prevent r/t sickle cell?
strenuous activity,
What's the next most imp thing to provide for kid w/ sickle cell besides tissue oxygenation?
give adequate fluid intake
What are 4 primary NI during sickle cell crisis?
1. minimize O2 use (bedrest)
2. promote hydration
3. relieve pain
4. maybe Trental
What does Trental do?
makes RBCs slippery in sickle cell
What med makes RBCs slippery r/t sickle cell?
When can kid in sickle crisis do more than bedrest for activity?
when pain gone
Describe O2 admin during sickle crisis?
What do you assess?
no prolonged O2,
observe response r/t pain
What is the most helpful during sickle crisis?
give oral & IV fluids,
How much fluid do you give during sickle crisis?
2x normal
What is the best way to evaluate hydration during sickle crisis?
check mucus membrane
What is another way to evaluate hydration r/t sickle crisis besides wt, I&O, mucus membranes?
What are 2 methods you can't use?
serum electrolytes,
can't use amt or spec grav
What is pain med tx during sickle crisis? (when, what route, and what?)
around the clock
IV morphine
What's a non-medical Rx for pain during sickle crisis?
heat to painful areas
What's the following describe?: absence of innervation in the large intestine
Hirschsprung's disease
Why is Hirschsprung's disease called megacolon?
colon above defect enlarges
What is the classic sym of Hirschsprung's disease?
What do you suspect if ribbon-like stool?
Hirschsprung's disease
What do you suspect if fecal mass palpated in LLQ, but rectum empty?
... did i just say "but rectum"?
Hirschsprung's disease
What is stool like in Hirschsprung's disease?
foul smelling,
pellet, ribbon, or liquid
What sym does kid have w/ Hirschsprung's disease?
protuberant abdomen,
thin wasted extremities,
What may dev from malabsorption of nutrients r/t Hirschsprung's disease?
In Hirschsprung's disease, what is med mgnt if mild, chronic sym?
isotonic enemas,
stool softeners,
low residue/fiber/bulk diet
What is first surgical thing done for Hirschsprung's disease?
temporary colostomy
What do you suspect if the following?:
Child malnourished, anemic, protuberant abd, thin extremities, light weight
Hirschsprung's disease
If double-barrel colostomy, where are stomas and what comes out?
proximal (more left) = mucus
distal = stool
When is colostomy usu closed r/t Hirschsprung's disease?
1 year
Where do you take temp r/t Hirschsprung's disease?
Describe alimentation (type and timing) and preparation pre-op for Hirschsprung's disease?
24-48 prior = clear liquids,
then NPO with
NG & rectal tubes
What do you check first out of Hirschsprung's disease surgery?
What do you check after vs post op Hirschsprung's disease?
abd. dsg,
What must you check r/t I&O post op Hirschsprung's disease?
NG tube &
What do you check r/t stoma post op Hirschsprung's disease?
color change,
What do you do before dressing change or other painful procedures r/t Hirschsprung's disease post op?
pain meds
What's the usu outcome after surgery for Hirschsprung's disease?
fecal continence,
poss delayed toilet training
Why might toilet training be delayed after successful surgery for Hirschsprung's disease and fecal continence is achieved?
intermittent diarrhea,
trauma to area,
psychological associations
What are 3 ways to assist parents adjusting to kid w/ cleft lip or palate?
1. completely accept child
2. point out normal attributes
3. show before & after pics of infants w/ similar malformations
What do you use if larger cleft lip or palate for nursing?
soft nipple w/ big opening,
soft long lamb's nipples,
gravity flow nipples
What are 2 things to do when nursing kid w/ cleft?
burp freq,
feed upright
How do you get infant used to elbow or wrist restraints post op?
put 'em on periodically pre op
What position best for post op cleft lip?
on side or back,
head elevated
What position best for post op cleft palate?
on side or front
When do you repair cleft lip?

6-12 wks old
When do you repair cleft lip?

Picture a kid mailing away in an old school catalog for his new lip... and it usu takes 6-12 wks
If cleft lip & palate, what do you repair 1st?
Wait how long for next piece?
palate after lip healed (12-18 mos)
What 3 things might you wait for to repair cleft palate?
1. healing of lip (12-18 mos)
2. advantageous palate growth
3. after teeth appear
Before what event do you want to do cleft palate repair?
learning to speak
What can you assess pre op to help post op r/t cleft things?
feeding techniques
What's a device to aid suture line in cleft lip repair?
Logan bar
What are 4 NI post op cleft lip?

1. humidification
2. pain meds or mild sedatives
3. restrain arms
4. feed on demand
What are 4 NI post op cleft lip?

admin what
you know this one
how do you keep from crying
What are 2 things to prevent from infant post op cleft anything?
prevent crying, and
fingering surgery site
What do you feed with first out of cleft lip surgery?
What do you feed him?
rubber-tipped dropper or Breck feeder,
clear liquids, the formula or breast milk
What's a big rule post op cleeft palate?
no sticking anything in the mouth (no spoons, nipples, fingers, etc.)
What is imp to check for post op cleft palate?
What should you suspect if you see the following post op cleft palate?:
freq swallowing, restless, hematemesis, ^ pulse)
What are 4 signs of bleeding post op cleft palate?
freq swallowing,
^ pulse
What's position for irrigating post op cleft palate?
head tilted forward
How long do you restrain elbows post op cleft palate?
3 wks
What kind of infections are kids prone to post op cleft palate?
respiratory infections,
otitis media w/ loss of hearing
What are 3 poss s/e post op cleft palate?
malpositioned teeth,
dental decay,
impaired speech
What Rx might a kid need long term post op cleft palate?
speech tx
What might you see on butt of kid w/ hip dysplasia?
deeper or extra folds on affected side
What could it mean if you see extra or deeper folds on butt or inner things of infant?
congenital hip dysplasia
What's Galeazzi sign?
short limb on affected side r/t hip dysplasia
What do you want to know about condition of hip dislocation r/t dysplasia?
if dislocates
What might you feel if infant hip dislocates?
What's it called?
How long is test affective?
clunky feeling or clicking.
Ortolani's maneuver,
most effective up to 3 mos old
If kid has hip dysplasia, what will unaffected hip do if he stands on affected leg?
What's it called?
tilt downward instead of upward,
Trendelenberg's sign
How intense is the rx for congenital hip dysplasia if caught in first 6 mos?
When and what results are expected?
conservative Rx results in
normal hip by the time walking
What Rx for congenital hip dysplasia for birth - 6 mos? x3
How long
legs are gently flexed,
externally rotated,
held in abduction.
~ 6 wks
What are 3 options for devices for congenital hip dysplasia for birth - 6 mos?
Pavlik harness
What's a no-no old school trick for congenital hip dysplasia for birth - 6 mos that causes hip extension?
double or triple diapers
What are the 3 steps to Rx for newly dx unrelocatable hip in 6-18 mos old?
1. skin traction
2. hip reduced
3. spica cast
How often do you change spica cast for 6 - 18 mos old?
q 6 wks
What's priority care if skeletal traction used r/t hip dysplasia?
pin care aimed at preventing osteomyelitis
What do you use and what's a no-no when trying to prevent irritation under spica cast?
yes: clothing
no: lotion or powder
What's imp re: position when hip device removed to teach parents r/t cong hip dysp?
keep hips abducted
What can you use to relieve itching under cast?
blow-dryer on cool
What's another name for talipes equinovarus?
congenital clubfoot
clubfoot - another name?
talipes equinovarus
What's the imp assessment re: dx of clubfoot?
differentiate from IU position deformity
How is IU position deformity different from clubfoot?
IU position def = only muscular and can be passively manipulated past midline
What do you start Rx for clubfoot?
ASAP after birth
How often casts replaced for club foot?
For how long?
q 1-2 wks
for ~6wks
What's goal of casting clubfoot?
over correction
What might be used instead of or after overcorrection of cast r/t clubfoot?
Denis Browne splint
What should you do r/t angle of shoes on Denis Browne splint bar? x2
should not be repositioned,
only tightened against bar if loose
What are the body's px responses to CHD?
Babbling heart (murmurs)
Additional RBCs (polycythemia vera)
Decreased exercise tolerance & dyspnea

Hypoxia of tissues
Elevated P & RR
Azure (cyanotic)
Recurrent respiratory infections
Taken out heart (CHF)
Slow growth
What kind of ABG condition occurs r/t CHD?
metabolic acidosis r/t tissue hypoxia
If you see clubbing of fingers, what might it point to?
What pathology should you suspect if in knee chest position, squatting?
What position is common to get into r/t CHD?
knee-chest position, squatting
What's most common drug for CHF?
What's the most common type of cardiac cath for children?
What's the path?
R-heart cath,
thru femoral vein into R atrium
What should you expect from inserting cardiac cath in leg?
pressure or pushing feeling
What do you feel when dye injected into cardiac cath?
How long does cardiac cath take once dye injected?
2 to several hours
How often do you check color and VS after cardiac cath?
q 15 min
What is a critical ass post cardiac cath?
check incision & dsg for bleeding or hematoma
What do you do if bleeding at cardiac cath site?
direct pressure for several min and
report stat
What are two things to try to implement for kid post cardiac cath for 6-8 hours?
keep quiet in bed,
keep arm or leg straight
How should dsg appear post cardiac cath?
clean and dry
What are 3 things to tell parents post cardiac cath?
How long?
no tub baths,
no strenuous activity,
no school
for at least 3 days
What are 3 actions to teach kids w/ CHD during episodes of cyanosis and dyspnea ?
place on abdomen;
place on side, knee-chest pos (squatting);
loosen tight clothing
Prevent what from kid if CHD?
Prevent what and Rx immediately r/t CHD?
resp infection
What do you give CHD pt prior to even minor surgery?
prophylactic antibiotics
How do parents feel when caring for kid w/ CHD?
question parenting ability b/c kid never satisfied
What does kid w/ CHD have difficulty dealing with?
difficult situations b/c
few opportunities to do so.
What is the most prevalent nutritional disorder in the USA?
iron deficiency anemia
What age is iron deficiency anemia esp prevalent?
6-25 month olds,
What are charac of RBCs w/ iron deficiency anemia?
What do the following sym indicate?:
waxy pallor, irritable, listless, anorexic, constipation
iron deficiency anemia
What are 2 poss issues w/ heart r/t iron deficiency anemia?
systolic murmur
What are kids w/ iron deficiency anemia prone to?
Why might kid w/ iron deficiency anemia be delayed in G&D?
poor muscle dev,
reluctant to explore
What are 3 poss conditions r/t eating if kid has iron deficiency anemia?
milk baby,
What are sym of iron deficiency anemia?
Pallor waxy
Systolic murmur
Constipation, maybe

What's diet hx usu have r/t IDA?
lrg milk intake
What's a "milk baby" look like? x3
poor muscle dev
What will blood levels be r/t IDA?:
Hgb: <11
Hct: <33
What 6 lab values will be down in IDA?
Hgb, Hct, MCV, MCH, MCHC, serum iron
How often and how long do you screen kids for IDA?
yearly until end of adolescents
What do you report immediately r/t IDA? x2
What do you do if tachycardia, tachypnea r/t IDA occurs?
(not call MD)
O2 prn
What can cause CNS signs of tissue hypoxia (irritability, fussiness, short attention span, low frustration tolerance, h/a, fatigue)?
Who can be roomate for kid w/ IDA?
unaffected kid, b/c of lowered resistance
Give iron w/ what?
vit C
What poop charac show iron supplements working?
green tarry
What do you do if kid vomits from iron supplements?
call MD
What will MD do if vomiting from iron sulfate?
^ dose and
give w/ meals
When and how can you tell if iron supplements correcting anemia? (specifically what lab results?)
7 days after iron started,
^ reticulocyte count indicates
RBC proliferation
boys or girls more prone to scoliosis?
When is scoliosis usu dx?
13 - 15 y/o
Suspect what if you see forward thrusting of head, asymmetrical rib cage, nipples shoulders hips not horizontal?
What position is best for detecting scoliosis?
bent forward at waist,
head and arms hanging
What spine curvature can be held in place by brace?
How long every day do you wear brace for scoliosis?
23 hours
Until when do you wear scoliosis brace?
6 mos after px maturity
What's worn under scoliosis brace?
shirt or stockinette
How do you prevent atrophy & strengthen muscles of the torso r/t scoliosis?
What's a Harrington rod?
metal rod installed near spine for scoliosis
How do you fuse Harrington rod to spine?
use bone from iliac crest
When is only time you should remove brace r/t scoliosis?
bath and exercise
What's most therapeutic sport r/t scoliosis?
What's priority ass in ICU r/t scoliosis?
resp function
How do you check blood loss after scoliosis surgery?
How do you turn kid w/ scoliosis post op?
log roll
When is tonsillectomy indicated? x2
only difficulty eating or extreme breathing discomfort
What can happen if adenoids are enlarged? x2
eustachian tubes blocked,
recurrent otitis media
What might you MD suggest if recurrent otitis media?
When in adenoidectomy indicated?
recurrent otitis media
What might bad breath suggest?
Therefore what else?
mouth breathing,
adenoid hypertrophy
What are most important labs to check r/t pre op tonsillectomy/adenoidectomy?
bleed & clotting time,
What's the last little thing to check for pre op for tonsillectomy/adenoidectomy (not bleeding)?
loose teeth
What position is best post op tonsillectomy/adenoidectomy?
abdomen or side
What two things to you tell kid pre op about what to expect post op tonsillectomy/adenoidectomy?
abd or side position,
sore throat
What is imp to check for post op tonsillectomy/adenoidectomy?
When is tonsillectomy indicated? x2
only difficulty eating or extreme breathing discomfort
What can happen if adenoids are enlarged? x2
eustachian tubes blocked,
recurrent otitis media
What might you MD suggest if recurrent otitis media?
When in adenoidectomy indicated?
recurrent otitis media
What might bad breath suggest?
Therefore what else?
mouth breathing,
adenoid hypertrophy
What are most important labs to check r/t pre op tonsillectomy/adenoidectomy?
bleed & clotting time,
What's the last little thing to check for pre op for tonsillectomy/adenoidectomy (not bleeding)?
loose teeth
What position is best post op tonsillectomy/adenoidectomy?
abdomen or side
What two things to you tell kid pre op about what to expect post op tonsillectomy/adenoidectomy?
abd or side position,
sore throat
What is imp to check for post op tonsillectomy/adenoidectomy?
What are 2 most obvious early signs of post op hemorrhage r/t tonsillectomy/adenoidectomy?
freq swallowing,
blood trickle from site
What do you do at 1st sign of hemorrhage post op tonsillectomy/adenoidectomy?
turn on side,
call MD
What part change in VS indicates hemorrhage post op tonsillectomy/adenoidectomy?
^ pulse from norm or
> 120 bpm
Offer what to hydrate post op tonsillectomy/adenoidectomy?
How often?
chipped ice,
15-30 mL,
How and how much liquid do you offer post op tonsillectomy/adenoidectomy?
give large amounts,
take in small amounts freq
How is it best to drink to cause less pain when drinking post op tonsillectomy/adenoidectomy?
take large gulps
Don't offer what 3 things r/t liquids post op tonsillectomy/adenoidectomy?
nothing red or brown,
no straws,
no gargling
What's a unique way to offer pain relief post op tonsillectomy/adenoidectomy?
tetracaine lollipops
How long does pt have significant pain post op tonsillectomy/adenoidectomy?
24 hours
How long, no firm foods post op tonsillectomy/adenoidectomy?

2 wks
How long, no firm foods post op tonsillectomy/adenoidectomy?

Picture kid begging for surgery before Xmas break (2 wks) so he can just eat ice cream the whole time
What do you teach re: mouth odor post op tonsillectomy/adenoidectomy?
may be present for a few days
What do you tell parents who call saying sm amt of bright red blood occured a week post op tonsillectomy/adenoidectomy?
When should they call MD?
normal from scab being shed,
call if more than 1 tsp
When can reg activity be resumed post op tonsillectomy/adenoidectomy?
1-2 wks
G&D, how old no head lag?
4 mo
G&D, how old no head lag?
4 mo
G&D, how old turn front to back?
4 mo
G&D, how old turn front to back?
4 mo
G&D, What two things should happen by 4 mos old?
no head lag,
turn front to back
G&D, What two things should happen by 4 mos old?
no head lag,
turn front to back
G&D, how old turn back to front?
5 mos
G&D, how old turn back to front?
5 mos
When should infant double birthweight?
6 mos
When should infant double birthweight?
6 mos
When should infant sit alone steadily?
8 mos
When should infant sit alone steadily?
8 mos
What age does stranger anxiety begin for infant?
8 mos
What age does stranger anxiety begin for infant?
8 mos
When should infant triple birth weight?
12 mos.
When should infant triple birth weight?
12 mos.
When should baby walk alone?
13-15 mos
When should baby walk alone?
13-15 mos
When should kid explore all over house?
16-24 mos
When should kid explore all over house?
16-24 mos
When should anterior fontanelle close?
18 mos
How much ahead in px dev are girls than boys?
~ 2 years
What are two fears of children 2-3 y/o?
fear of the unknown,
being alone
What are 3 (+ ex) fears of child 4-6 y/o?
body mutilation,
threatened body integrity
ex invasive procedures
What's the mnemonic for Immunization sched?
(both the mnemonic & what it stands for)
"HE Really Hates Putting Drugs In Veins, MoM HAs More HuTzpa"

Hep B
Hep A
What's the full Immunizations sched?

Hep B ... 0, 2, ... 6-18
RV ........... 2, 4, 6
HiB .......... 2, 4, 6, 12-15
Pneumo ... 2, 4, 6, 12-15
DTaP ....... 2, 4, 6, ..... 15-18 ....... 4-6 yrs
IPV .......... 2, 4, 6, ...................... 4-6 yrs
Varicella .............. 12-15 ............. 4-6 yrs
MMR ................... 12-15 ............. 4-6 yrs
Hep A .................. 12----->24 (x2)
Mening *** 11-12 yrs
HPV ****** 11-12 yrs (x3)
TDaP ***** 11-12 yrs (q10y)
What's the full Immunizations sched?

"HE Really Hates Putting Drugs In Veins, MoM HAs More HuTzpa"
What does the following describe?:
the major alteration is an increase in the permeability of the glomerular capillary wall to normal plasma proteins (esp. albumin)
nephrotic syndrome
When might you see severe proteinuria (albuminuria) and v serum albumin?
nephrotic syndrome
What do the following sym describe?:
pale, lethargic, anorexic, irritable, v activity tolerance; edema w/ ascites and wt gain; urine dark, frothy, v volume, ^ spec gravity, 4+ protein
nephrotic syndrome
What are the observable sym of nephrotic syndrome?
(skin color, activity x2, intake, mood)
pale, lethargic, anorexic, irritable, v activity tolerance
What's fluid balance sym r/t nephrotic synd?
edema w/ ascites and wt gain
What is urine like in nephrotic syndrome? x5
dark, frothy, oliguria, ^ spec grav, 4+ protein
What might there be a hx of r/t neph synd?
recent infection
What do you check every shift when managing neph synd?
How often do you monitor edema r/t neph synd?
q shift
edema in kids, assoc w/?
nephrotic syndrome
Where is there often some edema r/t neph synd?
face (esp. eye)
Puffy eyes in AM, assoc w/?
nephrotic syndrome, and
What might you see despite poor appetite r/t neph synd?
wt gain (edema)
What does BP show in neph synd?
normotensive or slightly hypotensive
Differentiate BP in glomeruloneph and neph synd?
glom neph: high BP
neph synd: low BP (or normal)
What's the best amount of activity and best position on initial Rx for neph synd?

complete bedrest,
upright position
What's the best amount of activity and best position on initial Rx for neph synd?

don't move, but don't lay on your kidneys either, don't lay down at all
What are 2 things to implement r/t diet for acute neph synd?
high protein,
small freq feedings
What's the drug of choice for neph synd?
When should proteinuria go away during neph synd tx?
first weeks
Give prednisone w/ or w/o food?
give w/ food or milk
What happens as immunoglobulins are lost in urine r/t neph synd?
What do you avoid?
susceptible to infection,
avoid infected people
Why are pt w/ neph synd susceptible to infection? x2
immunoglobulins (proteins) lost in pee,
steroids mask s/s of infections
How do you prevent skin breakdown r/t edema?
opposing skin surfaces kept clean and separate
What topic do you teach about in D/C teaching r/t neph synd?
How often neph synd relapse?
2-4 x a year for years
What do you do to detect early exacerbation r/t neph synd?
How often?
test for protein in pee
at least 2x a week
How do you treat neph synd relapse or if sensitive to steroids?
immunosuppressant ex Cytoxan
When would you use Cytoxan in neph synd Rx?
if sensitive to steroids and
during relapse
What are common s/e of cytoxan?
(blood levels, defense, inflammation)
v WBC, ^ susceptibility to infection, cystitis r/t drug accum in bladder
What does the leukemic process in bone marrow interfere with?
prod of RBCs, WBCs, & platelets
What is there a proliferation of r/t leukemia?
immature WBCs
What is the most common form of childhood leukemia?
What percent?
Leukemia causes what 3 blood dyscrasias?
What are 5 sym of anemia r/t ALL?
(strength, color, LOC, breathing, heart)
weakness, pallor, fatigue, dyspnea, cardiac sym
What do the follow symptoms indicate?:
weakness, pallor, fatigue, dyspnea, cardiac sym
anemia (r/t ALL)
What are normal RBC levels?
What are normal platelet levels?
What level are platelets if you see epistaxis and oral bleeding?
Fever in ALL due to what (not just infection)?
hypermetabolic state
What are normal WBC levels?
How is dx confirmed for leukemia?
bone marrow analysis
How long do you apply pressure after bone marrow aspiration?
5 min
What disease might you detect from lumbar puncture?
What must pt attain before medical rx for leukemia?
normal F&E balance prior to starting Rx
What can cause renal failure during rx for leukemia?
^ uric acid levels
What 3 ways can you prevent elevation of uric acid levels r/t leukemia rx?
1. IV hydration
2. alkalinize the urine
3. give allopurinol
What allopurinol for?
inhibiting uric acid production
What med inhibits uric acid production?
Encourage what when taking it?
encourage fluids
What's the leading cause of death r/t leukemia?
When do you start antibiotics if pt has leukemia?
as soon as fever starts
What often happens with prolonged use of antibiotics?
candida, fungal infection
What disease is pt w/ leukemia 10 times more likely to contract?
herpes zoster
What is pain r/t in leukemia?
disease and invasive procedures
What are drug combos of Vincristine, L-asparaginase, and Prednisone used for?
remission induction in ALL
What combo of drugs are used to induce remission in ALL?
What are 4 non-life-threatening s/e of Vincristine?
abd. pain,
What's a toxic effect of Vincristine?
peripheral neuropathy
What could be the source of the following s/e if pt has ALL is doing drug tx?:
abd. pain,
Why give methotrexate to pt w/ ALL (if not for maintenance tx)?

prophylaxis for CNS disease
Why give methotrexate to pt w/ ALL (if not for maintenance tx)?

meth heads ALL need prophylaxis or they can get syphilis (CNS disease)
What do you give pt w/ ALL to prevent CNS disease?
What drug is often used for maintenance tx r/t ALL?
What meds are contraindicate w/ methotrexate?
folic acid
Why no salicylates & sulfonamides w/ methotrexate?
v action of drug
Why no folic acid w/ methotrexate?
interferes w/ cyctoxic action of med b/c it's a folic acid antagonist
What happens re: signs of fever in kid w/ ALL?
may not show b/c unable to generate big enough WBC response
What are 3 ways to reduce fever if kid w/ ALL?
tepid sponge,
cooling blankets,
To prevent infection pt w/ ALL, how do you take temp?
no rectal
What 2 parts of the body do you assess in pt w/ ALL r/t infection?
mucus membranes & skin
What do you do if nosebleed in pt w/ ALL? (3 steps)
1. high fowler's, lean forward,
2. apply pressure for 10 min,
3. if still bleeding, cold cloth into nostrils and on bridge of nose
What do you do if bleeding in mouth occurs in pt w/ ALL?
put a dry tea bag on bleed (tannic acid v bleeding)
Pt has ALL, what do you do if reaction to transfusion? x2 steps
1. stop transfusion stat
2. KVO w/ NS
Is analgesic Tx given to Rx pain r/t ALL?
When do you admin it?
No, it's given to prevent it.
Give on regular sched around the clock
What are 3 s/e of chemo?
1. stomatitis
2. hemorrhagic cystitis
3. alopecia
What are two meds if stomatitis r/t ALL chemo?
1. topical (ex) viscous lidocaine
2. systemic analgesics
What's diet if presents stomatitis?
bland, soft, moist diet
What are 3 ways to prevent hemorrhagic cystitis in pt on chemo for ALL?
1. liberal fluid intake
2. freq voiding
3. admin chemo in AM (allows fluid intake and voiding)
When can you give live virus vaccine after finishing chemo?
3 mos. after
Bone marrow transplant, what are first two steps before treatment?

1. protective isolation
2. immunosupression
Bone marrow transplant, what are first two steps before treatment?

all about protecting, protect on the outside from other people germs,
protect on the inside from own body guards
you want him alone
What makes it extra difficult for parents when one kid gets bone marrow transplant?
often end up with two kids (sick kid, and donor kid) in hospital
1. How many days are req for donor marrow to engraft and begin to proliferate mature cells?
2. What condition is kid in during this period?
3. What should family do?
1. 10-20 days,
2. child has no ability to fight infection,
3. strictly follow protective isolation
How is diarrhea dx given:
stool freq, amount, or consistency
consistency (not amt or freq)
Who develops diarrhea more freq?
How serious is it for them?
infants, more serious manifestations than older children
When do you report infant having diarrhea?
after diarrhea > once
What are 3 categories of causes of diarrhea?
food intake,
GI infection,
What can cause diarrhea r/t food intake?
new food,
too much sugar
What are two common organisms that cause diarrhea?
How is shigella transmitted?
person to person
What diarrhea-causing organism is transmitted person to person?
What can shigella cause?
What can rotavirus cause?
What hx do you ask for r/t diarrhea?
1. food intake in last 24 hours
2. recent travel
3. behavior before & during BM
What behavior is significant to ask about r/t diarrhea?
did kid have cramps (crying, flexed knees, clutched abdomen)?
What kind of ABG should you assess for if kid has diarrhea?
metabolic acidosis
What really bad thing can dehydration from diarrhea cause?
hypovolemic shock
What nutritional things do you give for diarrhea?
oral rehydration tx (ORT),
oral rehydration solution (ORS)
What's an example of ORS?
After rehydration tx, how do you give nutrition to a kid who had diarrhea?
alternate ORS w/
water or breast milk (low Na fluid), and
resume usu. diet
What's an alternative to post-diarrhea diet that's a little more old school?
What's the problem with it?
clear fluids, then
* ^ CHO & v electrolytes
Skin care for diarrhea? x2
1. change diaper as soon as soiled
2. no soap on diarrhea area
What do you implement before any other nursing actions r/t diarrhea?
enteric precautions:
gown & gloves
If kid was seriously ill w/ diarrhea, what dietary actions do you take?
NPO for 24-48 hrs to rest GI tract
What do you administer during emergency/initial phase of parenteral rehydration r/t diarrhea?
give fluid rapidly
to improve circulation and renal function
What do you administer during second phase of parenteral rehydration r/t diarrhea?
What about it?
K given w/ caution if output is ok
ex wet diaper
What do you have to check before giving K?
What's the best way to tell effectiveness of rehydration?
daily wt
What do you check for during rehydration?
s/s of fluid overload
What are the signs of fluid overload?
x6-ish or more
moist rales, ^ BP, DNV, SOB, marked wt gain, v urine spec gravity
What's the following describe?:
generalized dysfunction of exocrine glands characterized by thickened and tenacious secretions that occlude glandular ducts
Is CF hereditary?
What is the hereditary characteristics of CF?
autosomal recessive trait
What are the chances of kid getting CF if both parents are heterozygous for the trait?
What are parts of the body prone to pathology r/t CF?
respiratory tract,
intestinal tract
Describe cough in CF pt if contract resp infection?
at first, dry hacking cough;
then, loose and productive
How does CF disrupt digestion?
v pancreatic enzymes b/c plugged ducts lead to panc fibrosis
What are 2 common intestinal problems r/t CF?
meconium ileus, and
maldigestion of foods, esp fats
What are stool like r/t CF?
steatorrhea (large, bulky, frothy),
azotorrhea (foul smelling)
What is most common complication of GI tract in un-RX child w/ CF?
prolapse of rectum
What's happens w/ sweat in CF?
salty taste,
salt "frosting" on skin
If kid has salt "frosting" on skin, what might it indicate?
What's the highest priority NDx for CF?
ineffective airway clearance
What disease uses sweat test?
What dx test is key to CF?
sweat test
When is sweat test unreliable?
first 2 wks of life,
NB don't sweat
What is the chemical in sweat that sweat test checks for CF dx?
What are ranges for sweat chloride r/t CF:
normal = < 40 mEq/L
suggestive = 40-60 mEq/L
positive CF = > 60 mEq/L
What is common response from parents when asked if child eats a lot r/t CF?
"He always eats, but never gains weight"
If parent says, "my kid always eats, but doesn't gain weight," what dx might it indicate?
What do you suspect if when taking child hx you note:
- failure to thrive
- recurrent resp infections,
- lrg bulky stools?
What are 3 typical elements in medical hx of kid with CF?
- failure to thrive
- recurrent resp infections,
- lrg bulky stools
What do you you need to provide to clear secretions and control resp infections for CF? (general category of tx)
pulmonary tx
How do you take temp in CF pt?
What are 3 pulmonary tx for CF?
aerosol Rx,
mist tent,
chest PT
What's chest PT?
chest physiotherapy,
postural and percussion to thorax to loosen secretions
What do you do before postural drainage in CF pt?
aerosol Rx
How often and how long to you do aerosol Rx for CF?
10 min BID
What do you use in aerosol rx for CF?
NS or include meds (bronchdilators, mucolytics)
Why do mist tent for CF?
reduce viscosity of secretions
In CF, what can you do to reduce viscosity of secretions?
mist tent
How can you remove thick secretions from lungs r/t CF?
Chest PT to all lobes
How often do you do chest PT?
Q1D and more if resp infection
When do you do chest PT?
one hour before meals
What are 3 creative ways to do Chest PT?
stand on head,
hang by knees
What are 3 NI r/t medication types for CF?
(what do you give x2, and not give x1)
give Bronchodilators,
may give expectorants,
no antitussives
How much can kid exercise with CF?
as tolerated
Diet r/t CF? x5
high protein,
high CHO,
high calorie,
maybe low fat,
maybe extra salt PRN
How's the appetite r/t CF?
What are two things to supplement in diet r/t CF?
pancreatic digestive enzymes,
vit ADEK
What do you give along with pancreatic enzymes?
In what form and how do you give Vit ADEK r/t CF?
water soluble form,
double dose
What usu. causes death r/t CF?
pulmonary complications
What pathology increases as CF life expectancy increases?
insulin dependent DM
What increases as women w/ CF get pregnant?
risk of perinatal and maternal morbidity r/t resp problems
What does the following describe?:
a chronic inflammatory disorder of the airways assoc w/ reversible, episodic airway obstruction
bronchial asthma
Asthma triggers include what foods?
chocolate, nuts, dairy;
food additives;
food dyes
What are two highly allergenic food products?
Peanuts and food dyes
What kind of breath sounds do you hear r/t asthma?
crackles and wheezes
on expiration
What spasms during asthma attack?
bronchi and bronchioles
What causes v in pO2 during asthma attack?
trapped air in alveoli blocks fresh air
What are two types of asthmatic kids?
1. continually symptomatic w/ episodes of severe airway obstruction
2. no SOB or wheezing, only chronic cough (esp at night)
What's the progression of asthma attack?
1. usu. dry, hacking cough
2. then frothy, clear mucus
3. then SOB and tight feeling in chest
4. RR ^, expiratory phase longer, expiratory wheezes
What state is kid in as airway obstruction progresses?
Why does kid w/ asthma attack sit w/ shoulders hunched forward?
to facilitate use of accessory muscles
How does a kid facilitate use of accessory muscles during asthma attack?
sits w/ shoulders hunched forward
What might you see in kid w/ chronic asthma?
growth delays, and
barrel chest
What's a good test to check how kid w/ asthma is doing?
Peak expiratory flow rate (PEFR)
What's PEFR?
(what's it stand for and how do you do it?)
peak expiratory flow rate,
measures the max flow of air that can be forcefully pushed out in 1 second
How often should you measure PEFR?
What's that called?
every day,
to know the usual for child,
personal best value
What are the ranges for the zones of peak flow rate?
Green zone: 80-100%
Yellow zone: 50-80%
Red zone: below 50%
What are sym of green zone of peak flow rate?
usu. sym free
What might it mean if kid is in yellow zone of peak flow rate?
asthma attack may be starting
What might it mean if kid is in red zone of peak flow rate?
is experiencing asthma exacerbation
What two types of meds does asthmatic have?
preventer meds,
rescue meds
What's the definition of "preventer meds" for kids with asthma?
long-term control meds,
control inflammation
What's the definition of "rescue meds" for kids with asthma?
quick relief meds,
treat sym and exacerbations
How do you use MDI?
use spacer,
give one puff at a time,
wait 1 min between puffs
If kid too young for MDI, what can they use?
What routes can asthmatic take steroids?
parenteral, oral, or aerosol
What are two complications of long-term use of steroids for kids w/ asthma?
Cushing's syndrome, and
growth suppression
What med does asthmatic take before exercise or cold exposure?
cromolyn sodium
What drug category is Cromolyn sodium?
Why is it used for asthma?
inhibits airway narrowing (during exercise or in cold)
What are two ex of B-adrenergic agonist meds for asthma?
albuterol, terbutaline
What are the category and uses of albuterol and terbutaline?
(1 cat, 2 uses)
used in acute attacks and
to prevent exercise-induced asthma
What is the expected theophylline blood range?
What is best position for acute asthma?
High Fowler's
What meds do you give during acute asthma?
nebulized albuterol and corticosteroids, usu.
Why use spacer w/ asthma meds?
prevents oral yeast infection
What do you give as acute asthma begins to improve?
oral fluids
What temp for oral fluids for recovering acute asthma?
warm or room temp (cold can trigger bronchospasm)
What do you give for unresponsive status asthmaticus?
subcut epinephrine
How can you teach kid w/ asthma to breathe to v chance of attack?
thru nose, not mouth;
cover nose and mouth w/ scarf or cupped hands
What can you teach to practice breathing for kid w/ asthma?
practice pursed lip and diaphragmatic exercises
What are some examples of pursed lip and diaphragmatic exercises?
blow bubbles,
blow cotton balls or ping pon balls on a table,
blow pin wheel,
prevent tissue from falling by blowing it against a wall
What are 3 better sports to try for asthmatic?
swimming, baseball, gymnastics
What do the following describe?:
an antigen-antibody reaction that follows an infection caused by group A beta-hemolytic step (not ARF)
Acute glomerulonephritis
What precedes acute glomerulonephritis?
group A strep infection
What are two examples of group A strep that can cause Acute Glom neph?
strep throat,
What might the following signs indicate?:
- hx of URI or skin infection
- cola urine
- eye edema
- loss of appetite
- ^ temp
- ^ BP
acute glom neph
What are the nsg ass of acute glom neph? x6

- hx of URI or skin infection
- cola urine
- eye edema
- loss of appetite
- ^ temp
- ^ BP
What are the nsg ass of acute glom neph? x6

2x vs
How recently would pt have had URI or impetigo before acute glom neph?
1-3 wks
3 words describing pee colorf in glom neph?
cola, tea, smoke
When is eye edema worse in glom neph?
What can temp reach in glom neph?
104 deg
What's imp to assess freq with glom neph?
What's a major complication of glom neph?
hypertensive encephalopathy
When is hypertensive encephalopathy an issue with glom neph?
during acute phase,
if BP high and
output poor
What can hypertensive encephalopathy result in with glom neph (general and specific)?
neuro sym:
dizzy, h/a, photophobia
What are visible s/s r/t urine in glom neph?
What do u/a say if glom neph?
+ albumin, RBC, WBC, casts, ^ spec grav
What lab value differentiates glom neph from nephrotic synd?
u/a + for RBC
What blood lab values indicate glom neph?
^ BUN,
^ ESR,
^ Creatinine,
ASO titer ^
What is the most spec lab value for renal failure?
^ creatinine
What's activity during acute glom neph?
Protect from what in acute glom neph? (r/t temp, activity, & precautions)
How often check vs in acute glom neph?
q 4 h
Report what two things in acute glom neph?
^ BP, and
s/s cerebral ischemia
Glom neph, if marked edema or ^ BP, do what r/t diet?
moderate Na restriction
Glom neph, if severe kidney involvement, do what r/t diet?
may limit protein
Glom neph, if output way down, do what r/t diet?
restrict fluids (ice chips)
D/C teaching, what two things r/t
1. avoid or treat any resp or skin infections
2. avoid fatigue and sports (until neg labs for hematuria or proteinuria)
What is the 'ventral surface' of the penis?
What is hypospadias?
hole on ventral surface of penis
What is the name for a hole on ventral surface of penis?
Why do surgery on hypospadias? x3
1. give normal appearance
2. help peeing while standing
3. help reproductive capability
When do you do the hypospadias surgery?
6-18 mos. before child develops castration and body image anxiety
Why no circumcision for hypospadias?
use foreskin for reconstruction
What do you avoid doing for boy born with hypospadias?
What can you admin to pt to help prior to hypospadias surgery?
male hormones to achieve bigger penis to help surgery
What is one way to identify boy with hypospadias?
abnormal urinary stream
If admitted for surgery of hypospadias, what do you assess?
child's perception of surgery and
what he calls his penis
How do you prepare child for hypospadias surgery?
use doll and put bandage and catheter on its penis (remind that penis is still there
What terms do you want to avoid for kid going into hypospadias surgery?
'cut off'
What do you do if pre-op med is IM for child?
mention it shortly before giving (less time to worry)
What are 3 NI post-op for hypospadias?
1. check urine CCA
2. assess visible penis
3. Teach parents
Why cath hypospadias child?
1. keep area dry
2. promote healing
3. maintain patency of new urethra portion
What are two charact. of urine post-op hypospadias that should be noted?
What might they mean?
hematuria or cloudiness,
could mean unexpected bleeding or exudate
What color and consistency should urine be post-op hypospadias?
clear yellow
What two charact of penis might you expect post-op hypospadias?
1. some edema
2. misshapen if 1st of 2 surg
What behavior can you expect from kid post-op hypospadias?
Why might he do that?
shows everyone dressing,
reassures him penis is still there
What two things can you teach parents post-op hypospadias?
1. normal for kid to be preoccupied with penis
2. If parents show matter-of-fact-ness about it, should decrease gradually
What is the leading cause of acquired heart disease in children?
What is ARF thought to be?
What does it affect?
affecting connective tissues, such as in
heart, joints, CNS
What childhood disease is thought to be autoimmune and affects heart, joints, and CNS?
What's another name for Group A beta-hemolytic streptococci?
Streptococcal pharyngitis, or
Strep throat
What's another name for Strep Throat?
Group A beta-hemolytic strep
What can Group A strep cause?
What causes ARF?
Group A beta-hemolytic strep
Is ARF contagious?
What's used to dx ARF?
Jones Criteria (revised)
With what are the following sym associated?:
migratory polyarthritis, carditis, chorea, erythema marginatum, subcut nodules
What are 5 major Jones Criteria for ARF?
migratory polyarthritis, carditis, chorea, erythema marginatum, subcut nodules
What's the most common dx for ARF?
migratory polyarthritis
What does the following describe?:
joints inflam, swollen, painful, limited ROM. Lasts a few days then moves joints.
migratory polyarthritis
Describe the sym of migratory polyarthritis?
1. joints inflam, swollen, painful, limited ROM
2. Occurs during 1st 1-2 wks of ARF
3. Lasts in certain joints a few days then moves
4. Favors large joints (knees, hips, elbows)
What is the only sum in Jones Criteria that can cause perm. damage?
What's one way you can id carditis from ARF?
tachycardia (not from fever),
esp during sleep
What can it indicate if child has tachycardia out of proportion to fever esp at night?
major criteria of ARF
What does it indicate if you see involuntary, sudden muscular movements of the extremities; involuntary facial grimacing; muscle weakness; emotional lability; speech disturbance?
major criteria of ARF
What's the sym of chorea? x5
see involuntary, sudden muscular movements of the extremities;
involuntary facial grimacing;
muscle weakness;
emotional lability;
speech disturbance
What can it indicate of child has maculars that eventually join to give chicken wire appearance?
erythema marginatum,
major criteria of ARF
Chicken wire rash - assoc w/?
erythema marginatum,
major criteria of ARF
Tachycardia at night - assoc w/?
major criteria of ARF
Subcutaneous nodules of ARF - describe?
small, non-tender nodules over bony prominences
small, non-tender nodules over boney parts - assoc w/?
subcutaneous nodules of ARF
What are the sym representing one of the Jones Minor Criteria for ARF?
low-grade fever (highest in afternoon),
What are two blood test results that represent one of the Jones Minor Criteria?
^ ESR,
^ C-reactive protein
ESR - means?
erythrocyte sedimentation rate
What is the most reliable evidence that a child has had a strep infection?
^ ASO titer
ASO - means?
antistreptolysin O (antibody)
What two classes of meds do you give for ARF?
anti-inflammatory meds,
What two anti-inflammatory drugs do you give for ARF?
When do you take them?
aspirin & corticosteroids,
give both with meals
What route do you give penicillin for ARF?
What do you give if child sensitive to penicillin IM for ARF?
erythromycin PO
What's the regimen for penicillin for kid with ARF?
10 days to kill bug,
then for years prophylactically
Why give penicillin for years if hx of ARF?
to prevent serious cardiac damage, or
a recurrence of rheumatic fever
What do you do prior to surgery for pt w/ hx of rheumatic fever?
^ PCN doses to prevent bacterial endocarditis
What's the highest priority NI for rheumatic fever?
bedrest to minimize cardiac damage
Pt. w/ ARF, what do you do when pt allowed OOB?
assess tolerance by checking AP
When is pt w/ ARF allowed OOB? x2 labs
ESR returns to normal,
C-reactive protein disappears
What are the two painful sym of ARF?
What do you give for pain r/t polyarthritis and carditis (ARF)?
anti-inflammatory as ordered
How do you prevent injury from chorea?
no forks
What are 4 ways to evaluate regression or progression of ARF?
What's highest priority assessment?
1. assess remission of sym
2. Check I & O
3. daily weight
4. vs
***sleeping AP
When do you teach ARF parents to let kid do school work?
morning (r/t afternoon fever)
What characterizes croup syndrome?
(what's the resulting condition, where's it occur, what's its most common characteristics)
Acute infections of larynx or trachea causing hoarse cough and dyspnea
What usually causes croup?
What causes epiglottitis?
HIB (hamophilus influenzae bacteria)
What type of croup is not caused by a virus?
What is likely to occur if a child contracts a particular kind of croup?
same kind of croup is likely to recur
How fast is onset of sym for epiglottitis?
rapid onset
What are the sym of the epiglottitis form of croup?
Emergent if acute
Pulse ^
Inspiratory stidor
Gagged (muffled voice)
Lacks cough and hoarseness
Obstructed airway
Tripod position
Tossing and turning (restless)
Indigo skin (cyanosis)
Temp ^
In a panic (frightened)
Severe soar throat
Why is acute epiglottitis an emergent condition?
rapid total airway obstruction may occur w/in minutes
What's are two signs a kid might have a sore throat?
drools saliva,
tripod position (leaned forward, mouth wide, tongue out)
What is tripod position?
Why do infants do it?
while sitting up, leans forward with mouth open and tongue out;
sore throat
What's the characteristic and the name of the breath sound you hear from a kid with epiglottitis?
rapidly increasing inspiratory stridor
What's the sound of stridor in pt w/ epiglottitis?
frog-like croaking sound
What's immediate Rx for kid with epiglottitis? 2x
child upright,
maybe 02
What is kept with epiglottitis pt AT ALL TIMES?
intubation equip.
What is main way to dx epiglottitis?
x-ray neck
What must be readily available as MD does direct visualization of epiglottis?
resuscitation equip.
Besides x-ray, what's another way to dx epiglottitis?
Who can do it?
Direct visualization of epiglottis,
done only my MD
What two meds do you give for epiglottitis?
antibiotics and
How do you give antibiotics for epiglottitis?
For how long?
IV, then PO
total of 7-10 days
Why are steroids given to epiglottitis pt?
v edema
When does swelling go down after beginning antibiotics for pt. w/ epiglottitis?
24 hours
What's LTB?
What's the lay term for it?
acute laryngotracheobronchititis,
viral croup
What kind of onset to symptoms of LTB have?
When does LTB often occur?
with or after URI
What type of croup syndrome has no cough associated w/ it?
With any form of croup, what do you need to keep near the child at all times?
intubation equip.
What are three types of croup?
1. epiglottitis
2. LTB
3. spasmodic (midnight) croup
What are sym of LTB?
Vociferous cough (barking/brassy cough)
Increasing inspiratory stridor, gradual
Achromatic (pallor)
Labored respirations

Croaky (hoarse)
Off-color (cyanosis)
Unrestful (restless)
Pyrosis is mild (low grade fever)
What type of croup has rapid or sudden onset?
epiglottitis and
midnight croup
What type of croup has gradual onset?
What croup is Rx with humidity?
viral croup (LTB and spasmodic croup)
What is the NI for viral croup besides keeping intubation equip. close?
high humidity cool mist
What is Rx for viral croup if stridor at rest?
racemic epinephrine
1. Why is epi given for viral croup?
2. What does this reduce the need for?
3. In how long does it work?
4. When do sym often recur?
1. v edema
2. reduces need for trache or intubation
3. 10-15 min
4. recur in 2 hrs
What type of croup may utilize epinephrine?
viral croup (LTB and spasmodic croup)
With spasmodic croup, of what are there paroxysmal attacks?
laryngeal obstruction
What are the symptoms of spasmodic croup related to LTB?
same as LTB, except no fever
What's another name for spasmodic croup?
midnight croup
When and how long do sym of spasmodic croup occur?
often last several hours at night
What sym might a kid with spasmodic croup wake up with in the morning?
cough and hoarseness
When and how long do sym of spasmodic croup usu. recur?
next 1-2 nights
What type of peds disorder might be relieved if taken out into the cool night air to go to ER?
spasmodic croup
What type of humidity is best for viral croup, cool or steamy?
What is the cause of half of the cases of bronchiolitis?
RSV (respiratory syncytial virus)
How contagious is bronchiolitis?
What does RSV cause?
Who is at high risk for RSV? 3x

preemies OR
kids with lung issues OR
kids with heart issues
Who is at high risk for RSV? 3x

Think of an RV w/ teeny tiny kid driving, a kid w/ his head out the window sucking in the air, and a kid using engine parts to fix his heart
What's the Rx for bronchiolitis caused by RSV?
What does Ribavirin Rx?
Pregnant nurses should not Rx kids taking what med?
How is Ribavirin given? (also, w/ what 3 methods)
(via mask, tent or hood)
In what age range does bronchiolitis usually occur?
When is the peak incidence?
usually 2-12 months,
peaks at 6 mos.
What's often the first sign of hypoxia?
What are symtoms of bronchiolitis? x12
Bone-dry (dehydrated)
O-shaped chest (barrel-shaped)
Hypoxia and dyspnea
Obstructed breathing
Lung sounds (fine rales, expiratory wheezes)
Intercostal retractions
Impending resp failure
Schnoz flaring
What are symtoms of bronchiolitis? x12
B - picture bone in the bronchioles... eesh
R - and a kid thrashing b/c of it
What's a resp rate you may expect with bronchiolitis?
What are two signs of impending respiratory failure with bronchiolitis?
severe inspiratory retractions, and
sudden diminished or absent inspiratory breath sounds
What is it important to check for r/t inability to suck well?
What are 7 signs of dehydration in infant?
weight loss, v urine output, ^ urine specific gravity, poor skin turgor, dry mucus membrane, depressed anterior fontanel, no tears with crying
What isolation precautions do you use for pt w/ bronchiolitis?
What materials does that include? x3
airborne (respiratory);
gown, gloves, mask
What do you implement for all infants with breathing problems?
airborne isolation precautions
What do you implement do help liquefy secretions and facilitate removal for pt with bronchiolitis?
high humidity, cool environment
What 3 things should you do regarding the high humidity environment of bronchiolitis pt?
wipe down canopy,
have extra linens on mattress,
change clothes & linens frequently
How often do you wipe down canopy for pt with bronchiolitis?
Q2 hours
How do you calculate micro drip?
cc/hr = gtts/min
What's the best way to measure fluid loss or gain for infant with bronchiolitis?
daily weight
Why is no unnecessary handling implemented for pt w/ bronchiolitis?
to promote rest
What are five interventions for pt w/ bronchiolitis?
isolation, humidity, hydration, rest, HOB
What elevation do you put the head of the crib for pt w/ bronchiolitis?
What's an alternative to raising HOB?
30-40 degree; or
use infant seat
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