Pediatric Nursing Certification 424 Questions with Verified Answers,100% CORRECT

Pediatric Nursing Certification 424 Questions with Verified Answers What is the State Nurse Practice Act? - CORRECT ANSWER Defines the "scope of practice" What are the 3 exceptions for HIPAA? - CORRECT ANSWER - D ...

Pediatric Nursing Certification 424 Questions with Verified Answers What is the State Nurse Practice Act? - CORRECT ANSWER Defines the "scope of practice" What are the 3 exceptions for HIPAA? - CORRECT ANSWER - Danger to self - Danger to others - Being harmed What is assent? - CORRECT ANSWER A pediatric specific term defined as an active affirmation of a desire to participate in research. Used in adjunct with consent How old must a child be to assent? - CORRECT ANSWER 7 years old What is the nurses role when there is refusal of care? - CORRECT ANSWER - Assess the rational - Educate - Advocate What is the IDEA Act? - CORRECT ANSWER Individuals with Disabilities Education Improvement Act guarantees children with disabilities will receive a "free and appropriate public education in the least restrictive environment" with reasonable accommodations for success What are examples of reasonable accommodations for success? - CORRECT ANSWER - Ramps - Communication devices - Tube feed in school setting What are the 3 main ethical principles in nursing? - CORRECT ANSWER - Beneficence: Actions taken should promote good (i.e. BENEFIT the patient - Non-maleficence: Do no harm - Justice: Treat all fairly and equally Define handoff - CORRECT ANSWER Process of transferring responsibility of care from one provider to another. Must be standardized with opportunity for Q&A What is shared governance? - CORRECT ANSWER An administrative model that provides an active role for all staff nurses in decision-making and policy formation. Examples include staff committees, where unit and hospital issues are discussed, recommendations/ decisions are made. What is the nurses responsibility for professional boundaries? - CORRECT ANSWER To establish and maintain boundaries. Define professional boundaries - CORRECT ANSWER The space between the nurse's power and the patient's vulnerability. What two ways does the nurse maintain professional boundaries? - CORRECT ANSWER - No "friending" present of former patients - Gifts should be given by the hospital and any gift received should be given to the unit rather than the individual What is the nurse's primary role for patient's and family? - CORRECT ANSWER Patient advocacy! Access resources for the families, defend, speak for, protect and safeguard the child and family to the interdisciplinary team. What is growth? - CORRECT ANSWER An increase in size that does not necessarily include development. What is development? - CORRECT ANSWER The maturation of structures and includes growth. What is anticipatory guidance? - CORRECT ANSWER Teaching parents the normal childhood growth and development parameters. What is cephalocaudally development? - CORRECT ANSWER Growth from head to toe (i.e. head control, sitting, then walking) What is proximodistal development? - CORRECT ANSWER Development from the trunk to the tips of the extremities (i.e. moving arms and legs before picking things up with fingers) How do you promote proximodistal development? - CORRECT ANSWER Using tummy time to play and back to sleep What is "general to specific" developement? - CORRECT ANSWER Crawling, then walking, then skipping. Describe then explain. What are the four principals of age? - CORRECT ANSWER - Chronological Age (years/ months) - Mental Age (Level of cognitive function) - Bone Age (tells you the growth potential) - Adjusted/Corrected Age (used for growth charting) How do you determine adjusted age? - CORRECT ANSWER Chronologic age minus number of weeks born prematurely (<37 weeks). It is only used for the first two years of life. How do you determine bone age? - CORRECT ANSWER X-ray of the tarsals and carpals (wrist/ fingers) How should toddlers height be measured? Why? - CORRECT ANSWER Laying down due to their curved spine that lengthens when lying down. After 2 years, use standing if possible. What is the typical weight gain from birth? - CORRECT ANSWER Weight at 6 months doubles (minimally) Weight at 1 year triples (minimally) What are the BMI parameters for an overweight child? - CORRECT ANSWER 85%-95% or 25-29.9. You should encourage good food choices and activity What is the average birth length? - CORRECT ANSWER 20 inches What is the general rate of growth for length/ height? - CORRECT ANSWER first year: 10 inches 2nd year: 5 inches Each year from 3rd birthday until puberty: 2.5 inches (20/10/5/2.5) What is the "red flag" for following lenght? - CORRECT ANSWER "Falling off the curve": from an established growth percentage curve to a lower percentage plot What part of an infant develops fastest? - CORRECT ANSWER The head What part of a toddler or preschooler develops fastest? - CORRECT ANSWER The trunk What part of the school aged child develops fastest? - CORRECT ANSWER The limbs What part of the adolescent develops fastest? - CORRECT ANSWER The gonads and associated tissues What is the psychosocial stage of infancy? - CORRECT ANSWER Trust vs. Mistrust The infant develops trust when needs are met by the primary caregiver What are the two key factors in the trust vs. mistrust stage? - CORRECT ANSWER Consistency and the ability to predict responses At what ages do an instinctual and social smile appear? - CORRECT ANSWER Instinctual: 2 months Social: 3 months (associated with interaction) At what age does an child first start to exhibit stranger anxiety? - CORRECT ANSWER 4-6 months At what age does a child understand and play peek-a-boo? - CORRECT ANSWER 7-9 months At what age does a child clap hands an wave bye? - CORRECT ANSWER 10-12 months At what age does a child begin to babble? - CORRECT ANSWER 3 months At what age does a child turn to rattling noises? - CORRECT ANSWER 3 months At what age does a child notice their own hands? - CORRECT ANSWER 3 months At what age does a child begin having babbling conversations? - CORRECT ANSWER 6 months At what age does a child understand cause and effect - CORRECT ANSWER 7-9 months (begins throwing rattle) At what age does a child being to point to objects when named? - CORRECT ANSWER 10-12 months At what age does a child start to say "Mama" and "Dada"? - CORRECT ANSWER 10-12 months How many words should a child be able to say by 12 months? - CORRECT ANSWER 5 words but they understand more (understanding comes before explaining) At what age does a child lift their head? - CORRECT ANSWER 2 months When should the posterior fontanel close? - CORRECT ANSWER 2 months At what age does a child track objects 180 degress with their eyes? - CORRECT ANSWER 3 months At what age does a child lift their head and neck when prone? - CORRECT ANSWER 3 months At what age does a child notice their own hands? - CORRECT ANSWER 3 months At what age does a child rake objects/ grasp rattles? - CORRECT ANSWER 4 months At what age does a child begin to roll over from stomach to back? - CORRECT ANSWER 4 months At what age can a child roll from back to stomach? - CORRECT ANSWER 5-6 months At what age does a child transfer objects from hand to hand and reach? - CORRECT ANSWER 5-6 months At what age does a child push up to knees/ hands and rock back and forth? - CORRECT ANSWER 5-6 months At what age can a child sit without support? - CORRECT ANSWER 8 months At what age does a child develop pincer grasp? - CORRECT ANSWER 9 months At what age does a child does a child begin to crawl? - CORRECT ANSWER 9 months At what age does a child pull the self to a standing position? - CORRECT ANSWER 10-12 months At what age does a child walk with support? - CORRECT ANSWER 10-12 months When do most infant reflexes disappear? - CORRECT ANSWER 4 months What is the rooting reflex? - CORRECT ANSWER When the cheek is stroked, the face turns toward the stroked cheek and the infant begins to suck What is the moro reflex? - CORRECT ANSWER When a loud noise occurs, the infant will extend limbs and spread fingers, then retract limbs What is the tonic neck reflex? - CORRECT ANSWER Occurs when newborn's head is turned to the side, the arm on that side will extend while the opposite arm will contract - prepares the infant for voluntary reaching and may be a precursor to hand/eye coordination. What is the Babinski reflex? - CORRECT ANSWER When stroking the sole of the foot upwards from the heel causes toes to hyperextend - disappears within 2 years What reflex develops at 5-6 months and is retained? - CORRECT ANSWER Parachute Reflex: When slowly lowering the infant face and head down, infant extends both arms as to protect from falling What is the psychosocial stage of the toddler - CORRECT ANSWER Autonomy vs shame and doubt The child becomes independent when encourage to master new things; egocentric How many words can an 18 month old say? - CORRECT ANSWER 50 words How many words can an 24 month old say? - CORRECT ANSWER 400 words, 2-3 word phrases At what age should a child climb stairs? - CORRECT ANSWER 21 months At what age should a child begin to show interest in toilet training? - CORRECT ANSWER 18-24 months At what age should a child run and jump? - CORRECT ANSWER 24 months At what age should a child begin to show interest in toilet training? - CORRECT ANSWER 18-24 months At what age does a child's bladder have the concentration and sphincter control to an adult? - CORRECT ANSWER 24 months (the earliest age to start toilet training) At what age should a child achieve day time dryness? - CORRECT ANSWER 2-3 years At what age should a child achieve night time dryness? - CORRECT ANSWER 3-5 years What type of play is characteristic of a child between the ages of 18 months and 3 years? - CORRECT ANSWER Parallel Play: Where a child plays beside another, but not together What is the psychosocial stage of the preschooler? - CORRECT ANSWER Initiative vs Guilt The child develops a conscience when initiative is promoted According to Piaget, what cognitive stage is the preschooler in? - CORRECT ANSWER Pre operational thinking: where though is non-logical and non-linear When does the child begin to share, take turns and follow rules - CORRECT ANSWER 3-5 years; awareness of others increases at this age and childrenbecome people pleasers. What are the typical fears of the preschooler? - CORRECT ANSWER - Body integrity - Pain - Loss of control How many words does a 3 year olf use in a sentence? - CORRECT ANSWER 3-4 words How many words does a 5 year old use in a sentence? - CORRECT ANSWER 5-6 words At what age does a child begin to develop modesty? - CORRECT ANSWER Preschool At what age can a child ride a tricycle and build a tower of 6 or more blocks? - CORRECT ANSWER 3 years At what age does a child dress themselves? - CORRECT ANSWER 3; dresses themself well at 5 At what age can a child throw a ball overhead and hop/stand on one foot for 5 seconds - CORRECT ANSWER 4 years At what age can a child run, jump, skip, and do somersaults - CORRECT ANSWER 5 years What type of play is characteristic of the preschooler? - CORRECT ANSWER Imaginative and dramatic What is the psychosocial stage of the school aged child? - CORRECT ANSWER Industry vs inferiority (the focus on achievement) What are the ket factors associated with achieving industry in school-age? - CORRECT ANSWER - School achievement - Friendship - Competition and compromise - Learning rules According to Piaget, what cognitive stage is the school age child in? - CORRECT ANSWER Concrete operations At what age does a child develop a sense of right and wrong? - CORRECT ANSWER 6-9 years What is characteristic of concrete operations? - CORRECT ANSWER - Thought becomes logical, linear, concrete and tangible - The child is also able to consider other's points of views Why is the school age child prone to fractures - CORRECT ANSWER Bones grow faster than muscles What type of play is characteristic of the school age child? - CORRECT ANSWER - Games with strategies - Cooperative with common goals, collaboration and rules. Cheating is not common - Team plat where rules are enforces by an authority figure List the signs of pubetry for females in the order of appearance: - CORRECT ANSWER - Breast development - Pubic hair - Growth spurt - Menarche List the signs of puberty for males in the order of appearance: - CORRECT ANSWER - Testicular enlargement - Pubic Hair - Height spurt (2 years later than women) What is the average age of breast development? - CORRECT ANSWER 10 years What is the average age of pubic hair development? - CORRECT ANSWER 11 for females; 12 for males What is the average age of menarche? - CORRECT ANSWER 13 years What is the average age of testicular enlargement? - CORRECT ANSWER 11 years When is the average age of a growth spurt? - CORRECT ANSWER 12 in females, 14 in males What is the psychosocial stage of an adolescent? - CORRECT ANSWER Identity vs Confusion The focus is on identifying and integratnig their own values into society and determining how they see themselves in the world. According to Piaget, what cognitive stage is the adolescent in? - CORRECT ANSWER Formal operations: Thinking becomes adaptable and flexible. Abstract thought develops. When is iron introduced to breast-fed infants? - CORRECT ANSWER 4-months until solid foods are introduced. (Iron is transferred during the 3rd trimester, and typically declines after 4 months) When should children be introduced to whole milk? Why? - CORRECT ANSWER 1-2 years; they need the fat for brain development When does a child begin teething? - CORRECT ANSWER 3-4 months When is the first primary tooth typically lost - CORRECT ANSWER 6 years How many baby teeth should be present by the age of 3? - CORRECT ANSWER 20 What type of nutrition is recommended for the first 4-6 months - CORRECT ANSWER Breast milk How often should a new born breastfeed? - CORRECT ANSWER Every 2-3 hours What is the earliest age for solid food introduction? - CORRECT ANSWER 4 months when the extrusion reflex disappears When should a sippy cup be introduced? - CORRECT ANSWER 6 months When should a child begin feeding themselves finger foods - CORRECT ANSWER 6-7 months When should an infant transition to table food? - CORRECT ANSWER 4-12 months; by 12 months they should be transferred from pureed to solid finger foods To prevent burns, what temperature should the hot water heater be set to? - CORRECT ANSWER 120 F If you discover a child has ingested toxins, what do you do? - CORRECT ANSWER Call Poison Control, do not induce vomiting due to risk of secondary injury. What are the principles of gun safety? - CORRECT ANSWER - Avoid having a gun in the home - If a gun is in the home, lock the gun and ammunition separately. YOU CAN NEVER UNDO A RISK Why is it important to discuss "Strangers" with children? - CORRECT ANSWER Kids do not perceive strangers as adults do; 2/3 of abductions involve automobiles What are the 3 top causes of mortality in children? - CORRECT ANSWER - Motor Vehicle Accident - Homicide - Suicide What are the HIGHEST risk behaviors for teens? - CORRECT ANSWER Motor vehicles What are the contraindications for live vaccines? - CORRECT ANSWER Immune compromised patients, including chemotherapy What are the "live" vaccines? - CORRECT ANSWER MMR, varicella, rotavirus, nasal influenza What are the signs and symptoms of adverse reactions to vaccinations? - CORRECT ANSWER Usually occur within the first few minutes to hours of vaccine administration; very uncommon but a medical emergency. - Difficulty breathing - Hoarseness - Wheezing - Hives - Pallor - Lethargy - Dizziness - Tachycardia What are the mild side effects of vaccine administration? - CORRECT ANSWER - Fever - Soreness at the injection site What is a good rule of thumb for how side effects in live vaccines present? - CORRECT ANSWER They mimic the actual disease and occur within 2-4 weeks What are the rotavirus vaccine side effects and how can you help prevent them? - CORRECT ANSWER - Diarrhea - Vomiting - Fussiness/irritability - Cough/ runny nose - Fever - Loss of appetite - Wash hands after diaper changes are it is spread through stool for up to 14 days Where are the vaccine administration sites for IM injections? - CORRECT ANSWER Vastus lateralis (anterior thigh) with infants and young toddlers Deltoid (arm) for 18 months and older What are the MMR vaccine contraindications and exception to the rule? - CORRECT ANSWER <12 months of age due to presence of maternal antibodies; the exception is if there is a measles outbreak and the child needs an extra does (this does not count as part of the MMR series) What are the manifestations of pertussis (Whooping Cough)? - CORRECT ANSWER - Spasmodic cough that can last weeks or months along - Respiratory distress - Anoxia with cyanoisis - Loss of consciousness during coughing spasms. How is pertussis managed? - CORRECT ANSWER - Maintain a patent airway with suction and ventilation equipment at the bedside - Hydration, antipyretic and prophylactic treatment for family - Treatment is erythromycin What are the transmission precautions for pertussis? - CORRECT ANSWER Contact/ Droplet What are the manifestations of varicella? - CORRECT ANSWER - URI - Fever/Malaise - Pruritic rash appears initially on the trunk. The lesions appear at different stages: papules, vesicles, and crusts How is varicella managed in high-risk groups? - CORRECT ANSWER This group includes immunocompromised people without evidence of immunity (e.g. toddle receiving chemo). Give varicella-zoster immune globulin (VariZIG) as soon as possible. What are the transmission precautions for varicella? - CORRECT ANSWER Airborne and contact with secretions. Communicability is 1-2 days before the appearance of a rash until scabs are crusted/ healed (6-10 days) Incubation period is 10-21 days from exposure. What are shingles? - CORRECT ANSWER Reactivation of the varicella-zoster virus (lying dormant the nerve roots) in someone who has previously had varicella. How does shingles present? - CORRECT ANSWER Painful vericalla lesion localized to a single dermatome (body area) innervated by a particular segment of the spinal cord (does not cross midline). Can Shingles be spread? - CORRECT ANSWER No: Transmission of chicken pox from contact with shingles is possible, but you cannot "catch" shingles What are the manifestations of Mononucleosis? - CORRECT ANSWER Hallmark: Splenomegaly (can persist for weeks after the acute phase) and lethargy - Malaise - Sore throat - Fever - Increased atypical lymphocytes - Lymphadenopathy How is Mononucleosis managed? - CORRECT ANSWER - Activity restrictions due to risk of splenic rupture - Acetaminophen - Throat remedies How is Mononucleosis transmitted? - CORRECT ANSWER Direct contact with oropharyngeal secretions How do you screen for tuberculosis? - CORRECT ANSWER Tuberculin skin test (TST) is for high risk groups, interferon gold - If positive, further testing and treatment are required. What are the manifestations of tuberculosis? - CORRECT ANSWER - Fever - Malaise - Poor appetite - Weight loss - Cough - Night sweats - Chills What puts you at high risk for TB? - CORRECT ANSWER - Exposure - Crowded living conditions (i.e. group homes, incarceration) - Weakened immune systems - Areas with high TB rates How do they differentiate between TB infection vs TB disease? - CORRECT ANSWER Infection: x-ray and culture are negative (latent TBI) Disease: x-ray and culture are positive What are the manifestations of Fifth Disease (Human Parvovirus B19)? - CORRECT ANSWER Intense red facial rash ("slapped face"), extremity rash starting 1 day after facial rash and lasts 1+ weeks - Sickle cell children do not have a rash, but bone marrow shits off causing profound anemia. How is Fifth Disease managed? - CORRECT ANSWER - Analgesics - Short fingernails - Oatmeal bath What are the transmission/ precautions for Fifth Disease? - CORRECT ANSWER Contact/ Droplet - In otherwise healthy children, they are contagious during the week before the rash appears - Avoid pregnant caregivers: can cause fetal demise What are the manifestations of Hand-Foot-and-Mouth Disease? - CORRECT ANSWER 1-2 after onset painful ulcers develop in the mouth, then a skin rash with flat or raised red spots and blisters. How is Hand-Foot-and-Mouth Disease managed? - CORRECT ANSWER - Shortened nail - Antipyretics - Magic mouthwash What are the transmission precautions for Hand-Foot-and-Mouth Disease? - CORRECT ANSWER Contact/ Droplet What is the early sign of Lyme Disease? - CORRECT ANSWER A bulls-eye rash typically appears 3-30 days after a tick bite. Other symptoms include fever, chills, headache, swollen lymph nodes, muscle or joint pain. What is a late sign of Lyme Disease? - CORRECT ANSWER Heart and nervous system involvement, motor and sensory nerve damage with brain inflammation How is Lyme Disease treated? - CORRECT ANSWER Oral doxycycline, amoxicillin, cefuroxime Why is early diagnosis/ treatment important for Lyme Disease? - CORRECT ANSWER Early treated patients typically have resolution of the rash within 1-2 weeks and no long term consequences How is Bacterial Conjunctivitis (Pink Eye) managed? - CORRECT ANSWER Antibiotic ophthalmic ointment or drops. Exclude from school for 24 hours after starting antibiotics. What are the manifestations of MRSA? - CORRECT ANSWER Begins with pimple-like red bumps that progress to redness, swelling, pain and pus How is MRSA transmitted? - CORRECT ANSWER Contact included gym mats, towels, etc What are some risk factors for contracting MRSA? - CORRECT ANSWER - Crowded environments - Open wounds or cuts - Invasive procedures and devices - Immunocompromise What are the interventions for MRSA? - CORRECT ANSWER - Cover skin lesions with a dry bandage until healed. (Children may attend school provided the wound is covered) - Avoid sharing personal items - Disinfect gym equipment and mats How is MRSA treated? - CORRECT ANSWER Drainage or antibiotics What is Juvenile Idiopathic Arthritis (JIA)? - CORRECT ANSWER An autoimmune disease of the connective tissue with inflammation of the synovial and possible joint destruction Why are routine eye exams important with JIA? - CORRECT ANSWER Scarring and adhesions of the iris and ciliary body (iridocyclitis) can result in cataracts and loss of vision What are the manifestations of JIA? - CORRECT ANSWER Joints: inflammation, stiffness, pain, guarding, and decreased mobility Eyes: Assess for uvetits (inflammation) How is JIA managed? - CORRECT ANSWER - Anti-inflammatory drugs - Promotion of exercise and range of motions - Warm compresses - Allow extra time, but promote normal activities of daily living. What is the main cause of HIV among children? - CORRECT ANSWER Children born to HIV infected women (>90% of HIV-infected children in the US) Immunization recommendations for HIV+ children? - CORRECT ANSWER Avoid live vaccines if possible. MMR and Varicella are recommended unless the child is immunocompromised. Prevention for HIV in children includes: - CORRECT ANSWER HIV counseling and testing for pregnant women What is the unique clinical manifestation of HIV in children? - CORRECT ANSWER - Progressive neurologic impairments - Loss of motor milestones - Language deficits What are the manifestations of HIV? - CORRECT ANSWER - Chronic diarrhea - Weight loss - Lymphadenopathy - Hepatomegaly - Splenomegaly - Recurrent opportunistic infections - Persistent oral candidasis What is the definitive exclusion of HIV infection based on? - CORRECT ANSWER 2 or more negative virologic test. 1 obtained >1 month, 1 obtained >4 months, OR 2 negative HIV antibody tests from separate specimens obtained at age >6 months What is the treatment for a baby born to an HIV positive mother? - CORRECT ANSWER Prophylactic antiretroviral (ARV) drugs. Zidovudine (AZT) is started 6-12 hours after birth. If baby is positive, chane to a combination ARV regimen How is HIV managed? - CORRECT ANSWER - Standard precautions - Minimize exposure - Nutrition counseling - Comfort measures - Psychosocial support What interventions are there for the prevention of HIV transmission from positive mothers? - CORRECT ANSWER - Antiretroviral drug therapy - Avoid breast-feeding - Avoid giving baby chewed foods What is the proper way to clean up spills of an HIV+ individual? - CORRECT ANSWER 10% bleach in water applied over 1 minutes to kill HIV outside of the body What is isotonic dehydration? - CORRECT ANSWER Sodium Loss = Water Loss Most common and safest type of dehydration What are the causes of isotonic of dehydration? - CORRECT ANSWER - Vomiting - Diarrhea - NPO status - Burns What is hypotonic dehydration? - CORRECT ANSWER Na Loss > Water Loss (Na <135) Water moves into the cells What are the most common causes of hypotonic dehydration? - CORRECT ANSWER Watering down/ diluting formula (leads to seizures); water intoxication What is hypertonic dehydration? - CORRECT ANSWER Water Loss > Na Loss (Na>145) Water moves outside of the cell What are the causes of hypertonic dehydration? - CORRECT ANSWER - Excessive sweating - Ketoacidosis - Malnutrition - Diabetes insipidous Clever saying to rememeber fluid replacement? - CORRECT ANSWER IF THE GUT WORKS, USE IT. What are the CDC guidelines for management of mild/moderate dehydration? - CORRECT ANSWER Oral Rehydration: Using a rehydration therapy (Pedialyte) giving 2-5mL ever 2-3 minutes What are the CDC guidelines for severe dehydration? - CORRECT ANSWER IV fluid replacement with 20mL/kg of an isotonic solution (D5 1/2) What is cystitis? - CORRECT ANSWER Bladder Infection What is urethritis? - CORRECT ANSWER Urethra infection What is pyelonephritis? - CORRECT ANSWER Kidney infection What makes women more susceptible to UTIs? - CORRECT ANSWER The placement and size of the urethra What are the risk factors for a UTI? - CORRECT ANSWER - Bubbles baths - Poor hygiene - Incomplete bladder emptying - Vesicoureteral reflux What is vesicoureteral reflux? - CORRECT ANSWER When urine enters the bladder and the refluxes back up the ureters to the kidneys, lading to both inflammation of the ureters and the kidneys. What is hypospadias? - CORRECT ANSWER A congenital anomaly of the penis in which the urethral meatus opens on the central surface (underside) How is hypospadias managed? - CORRECT ANSWER Anticipate avoidance of circumcision (the foreskin may be used later for surgical repair between 1-4 years) What testing is needed with undescended testes? - CORRECT ANSWER Kidney functioning tests; kidneys arise from the same germ tissue. How are undescended testes managed? - CORRECT ANSWER Surgical intervention to prevent sterility. What are the manifestations of Nephrotic Syndrome? - CORRECT ANSWER - Proteinuria - Hypoproteinemia (due to third spacing) - Hypovolemia - Abnormal urine (Dark, foamy, frothy, increased specific gravity) - Edema - Hypokalemia - Fatigue/ lethargy How is Nephrotic Syndrome managed? - CORRECT ANSWER Administration of corticosteroids to supress autoimmune response - Elevated head of the bed, reposition frequently, skin care for edematous skin, test first void of the day, strict I&O What is Acute Glomerulonephritis? - CORRECT ANSWER An autoimmune immune-complex disorder occuring 1-2 weeks after Group-A Strep (Antibodies are made against the toxin of the strep but attack the glomerulus because of the similarities in their antigenic markers). The glomerulus lose permiability and allow RBC and protein in. What are the manifestations of Acute Glomerulonephritis? - CORRECT ANSWER - Abnormal urine (hematuria, smoky/ cola-colored, decreased output) - Hypertension - Edema - Anemia - Increased sed rate What is the hallmark manifestation of Impetigo? - CORRECT ANSWER Honey-colored crust from ruptures vesicles What are the manifestations of Scabies? - CORRECT ANSWER - Intense itching, worsening at night - Skin "burrows" with papules, vesicles and crusting What are the interventions for Scabies? - CORRECT ANSWER Apply scabicide (Elimite) to areas below the neck and leave on for 8-12 hours; then wash off; repeat 1 week later. - Treat all close contacts - Wash all clothing and linens in hot water - If you cannot wash, seal in a bag for 3 week What is Tinea Capitis? - CORRECT ANSWER Lesions in the scalp; patchy, scaly with areas of alopecia What is Tinea Corporis? - CORRECT ANSWER Lesions on the body; round or oval, may involve the nails What is Tinea Cruris? - CORRECT ANSWER "Jock Itch" Appears like tinea corporis; pruritic What is Tinea Pedis? - CORRECT ANSWER "Athlete's Foot" Lesions may be fissures between toes or patches with vesicles What is Pediculosis Capitis? - CORRECT ANSWER Head Lice! Caused by a blood-obligate parasite; the parasites must feed at least once a day therefore living close to the scalp. What are the manifestations of head lice? - CORRECT ANSWER - Itching - White egg nits firmly attached to the base of the hair shafts - Scratch marks or inflammatory papules on the scalp What interventions are used for head lice? - CORRECT ANSWER - Application of permethrin 1% cream rinse (Nix( or pyrethin with piperonyl butoxie (RID) - Manual removal of nit cases How is transmission prevented for head lice? - CORRECT ANSWER - No sharing of head fear, combs, brushes - Avoid head to head contact (selfies) - Children do not need to stay out of school; lice do not cause disease and are not contagious if contact is prevented What are the manifestations of Stevens-Johnson Syndrom? - CORRECT ANSWER - Begins with flu like symptoms - Painful red or purplish rash that develops through the body (including palsm and soles - Skin sloughing due to blistering of the rash and skin death How is Steven's Johnson's Syndrome managed? - CORRECT ANSWER - Discontinue all medications - Treat similar to a burn patient (NS, moist wound dressings, magic mouthwash, etc) At what age should a child be screened for anemia? - CORRECT ANSWER 12 months What are the manifestations of acute anemia? - CORRECT ANSWER - Muscle weakness - Fatigue - Fatigue - Pallor - Headache/ Lightheadedness - Tachycardia What are the manifestations of chronic anemia? - CORRECT ANSWER - Growth retardation - Delayed sexual maturation - Tachycardia - Hear murmur What is a normal hemoglobin level? - CORRECT ANSWER 11.5-14.5 What instructions should be given when providing iron supplementation education? - CORRECT ANSWER - Use a dropper with the medication and brush teeth after its administration - Absorption is best between meals and with citrus fruit/ juice - Stools will become tarry green. black What is the pathophysiolofy of sickle cell disease? - CORRECT ANSWER Dehydration and hypoxia lead red blood cells to sickle and become trapped in the vasculature. What is the normal lifespan of a red blood cell in chronic hemolytic anemia? - CORRECT ANSWER 20 days What interventions are used in managing a vaso-occlusive crisis? - CORRECT ANSWER Un-sickle red blood cells with adequte oxygen and hydration What is the first sign of bactermia in the child with sickle cell disease? - CORRECT ANSWER Fever; usually caused by splenic failure and the decreased ability to fight infection Why does splenic failure lead to bacteremia? - CORRECT ANSWER The spleen protects against encapsulated organisms. What is a normal platelet count? - CORRECT ANSWER 150K-400K What is Immune/Idiopathic Thrombocytopenic Purpura (ITP)? - CORRECT ANSWER An acquired hemorrhagic disorder that results in the autoimmune destruction of platelets in the spleen. (Production is fine) What are the manifestations of ITP? - CORRECT ANSWER - Decreased platelets <20K - Petechiae - Bruising and bleeding What interventions are used in managing ITP? - CORRECT ANSWER - Steroids to reduce platelet destruction - IVIG - Splenectomy for chronic, unresponsive ITP - Bleeding precautions (avoid trauma injections, ibuprofen and contact sports) What is Hemophilia? - CORRECT ANSWER A group of bleeding disorders in which there is a deficiency of one of the factors necessary for coagulation of the blood What is DIC? - CORRECT ANSWER Disseminated intravascular coagulation: when consumption of clotting factors and platelets leads to massive bleeding from multiple sites resulting in hypovolemia What are the manifestations of a hemolytic blood transfusion reaction? - CORRECT ANSWER - Fever/ chills - Flank pain - Severe headache - Dyspnea - Shock - Renal failure What is Leukemia? - CORRECT ANSWER An abnormal proliferation of white blood cells invading the bone marrow. There are two types Acute Lymphoid Leukemia (ALL) and Acute Myelogenous Leukemia (AML) What are the manifestations of Leukemia? - CORRECT ANSWER - Bone pain from bone marrow hypertrophy - Anemia - Bleeding disorders (petechia, ecchymosis) - Lymphadenopathy - Immunosuppression What is the most common reason for death with leukemia? - CORRECT ANSWER Death usually follows an overwhelming infection What are the manifestations of a brain tumor in a child? - CORRECT ANSWER - Headache upon waking up -Vomiting - Seizures - Abnormalities in coordination, gait, reflex, speech What are Lymphomas? - CORRECT ANSWER A group of neoplastic diseases that develop from the lymphoid and hemopoietic systems. The two types are Hodgkin's and Non-Hodgkin's What are the manifestations of Hodgkin's Lymphoma? - CORRECT ANSWER - Painless enlargement of lymph nodes - Weight loss - Fever - Night sweats - Characterized by giant, multi-nucleated Reed-Sternberg Cells What are the manifestations fo Non-Hodgkin's Lymphoma? - CORRECT ANSWER - Swelling in abdomen or neck - Congestion/ URI symptoms - Weight loss - Fever - Night sweats What is a Wilm's Tumor? - CORRECT ANSWER An embryonal cancer of the kidney originating during fetal life; typically found by caregivers during close contact (i.e. baths, hug, etc) What are the manifestations of a Wilm's Tumor? - CORRECT ANSWER - Non-tender mass, usually mindline near liver - Abdominal pain - Hypertension - Hematuria - Anemia - Constipation What are the interventions for a Wilm's Tumor? - CORRECT ANSWER - Avoid palpation of abdomen - Nephrectomy within 24-48 hrs of diagnosis - Chemotherapy What is Tumor Lysis Syndrome? - CORRECT ANSWER A serious metabolic disorder occurring within 72h hrs following starting chemotherapy resulting in elevated uric acid, potassium, and electrolyte management. What is the biggest risk with Tumor Lysis Syndrome? - CORRECT ANSWER Sudden death due to dysrhythmias What are the dietary recommedations for Tumor Lysis Syndrome? - CORRECT ANSWER Potassium restriction What is the toddlers concept of death and dying? - CORRECT ANSWER No concept of time or space; fear is related to separation from parents What is the preschoolers concept of death and dying? - CORRECT ANSWER Death is temporary like sleep; fears separation from parents What is the school-age child's concept of death and dying? - CORRECT ANSWER Understands permanance and causality; fear pain and abandonment What is the adolescents concept of death and dying? - CORRECT ANSWER Past experiences play a role in understanding and coping; may express anger What is the difference between hospice care and palliative care? - CORRECT ANSWER - Hospice intent is comfort care without curative intent delivered in the home setting. - Palliative intent is comfort care with or without curative intent delivered in the hospital setting. What is the most common cause of diarrhea and gastroenteritis? - CORRECT ANSWER Rotavirus and c. difficile; diagnosis What complications can diarrhea cause? - CORRECT ANSWER - Metabolic acidosis (ass-idosis) - Dehydration What are some complications of vomiting? - CORRECT ANSWER - Dehydration - Metabolic Alkalosis - Aspiration What intervention could be necessary for a patient with severe vomiting? - CORRECT ANSWER With-holding feeds for 4-6 hours while administering IV Fluids (the gut doesn't work: don't use it) What is pyloric stenosis? - CORRECT ANSWER Thickening of abdominal muscle around the circular pylorus muscle that causes obstruction of the gastric outlet. (Medical emergency) What are the manifestations of pyloric stenosis? - CORRECT ANSWER - Presents between 1-3 months - Non-bilious projectile vomiting - Dehydration - Palpation of an olive-like mass What is the treatment for pyloric stenosis? - CORRECT ANSWER Surgical correction via a pyloromyotomy: splitting the overdeveloped muscle around the pyloric valve of the stomach, thereby spreading open the muscle and enlarging the pylorus to relive the obstruction What is gastroesophageal reflux? - CORRECT ANSWER The passage of abdominal contents to the esophagus from an incompetent or poorly developed lower esophageal sphincter. How is GERD managed? - CORRECT ANSWER - Small frequent feedings - Upright for 30 minutes post feeding - Antacids or PPIs - Fundo What is necrotizing enterocolitis? - CORRECT ANSWER NEC occurs when the blood flow to the GI tract is compromised and the bowl mucosa becomes necrotic What are the early signs of NEC? - CORRECT ANSWER - Abdominal distention - Increased gastric residual volumes - Vomiting What are late signs of NEC? - CORRECT ANSWER - Bloody stools - Glucose positive stool - Lethargy - Bradycardia - Hypotension - Temperature instability How is NEC managed? - CORRECT ANSWER - Bowel rest - Decompress abdomen - Antibiotics - Reduce stress (cluster cares, maintain temperature) What are interventions for cleft lip and palate? - CORRECT ANSWER - Feed slowly in upright position - Frequent burping - Use a specialty nipples (specialty) - Psychological support for parents - Surgery (Lip: 1-4 months; Palate: 6-12 months) What are the post operative interventions for the child with a repair of a cleft palate? - CORRECT ANSWER - Observe for respiratory distress - Prevent trauma to the suture line - Nothing inside the mouth - Resume feedings with an open cup, soft- tip sippy or syringe - Use elbow restraints in hospital and home until palate is healed - Speech therayp What is esophageal atresia? - CORRECT ANSWER When the proximal end of the esophagus ends in a blind pinch; food cannot enter the stomach What is tracheoesophageal fistual? - CORRECT ANSWER When there is a connection between the esophagus and the trachea What are the signs of EA and TEF? - CORRECT ANSWER - Maternal history of polyhdramnios - Excessive oral secretions in the newborn - Coughing, choking, or cyanosis during feeding - Abdominal distention What are the interventions for EA and TEF? - CORRECT ANSWER - NPO - Maintain a patent airway - Surgical repair What is McBurney's point? - CORRECT ANSWER It is the right lower quadrant of the abdomen, where pain localizes during appendicitis What symptom occurs when the appendix ruptures? - CORRECT ANSWER Sudden relief of pain followed by diffuse pain What are the clinical manifestations of celiac disease? - CORRECT ANSWER - Steatorrhea (fat stools) - Abdominal distention - Failure to thrive and malnutrition - Muscle wasting What substitutes are good for patients with celiac disease? - CORRECT ANSWER - Corn - Rice - Potato - Soy What is Hirshsprung's disease? - CORRECT ANSWER A congenital anomaly when an absence of ganglionic cells in the distal bowel leads to decreased motility resulting in mechanical obstruction of the intestine What are the manifestations of Hirshsprung's? - CORRECT ANSWER - Abdominal distention - Constipation - Ribbon-like stools How is Hirshsprung's managed? - CORRECT ANSWER - Enemas (to evacuate the bowel) - Bowel irrigation with GoLYTELY - High fiber diet - Stool softener - Antibiotics - Surgery with temporary ostomy prior to repair What is intussusception? - CORRECT ANSWER "Intestinal telescope" Occurs when one portion of the intestine telescopes into another leading to ischemia, mucous backflow into the intestine What is the hallmark sign of intussusception? - CORRECT ANSWER Currant jelly-like stools What is the gold standard diagnosis for intussusception? - CORRECT ANSWER Barium-Enema How is intussusception managed? - CORRECT ANSWER - Barium enema with water-soluble contrast with air pressure - Manual reduction with or without resection What is encopresis? - CORRECT ANSWER Fecal soiling of underwear in a child older than 4 years; often due to a resistance to having bowel movements What is the management for encoporeis? - CORRECT ANSWER - Clearing impacted stool (stool softeners, lubricants, suppositorites, etc) - On-going prevention: high-fiber diet, encourage fluids, psychological support What is the difference between Ulcerative Colitis and Crohn's disease? - CORRECT ANSWER Ulcerative colitis inflammation affects the mucosa and submucosa of the colon and rectum only. Crohn's disease inflammation afects all layers of the bowel wall and can involve all parts of the GI tract (including the mouth). What are the clinical manifestations of Inflammatory Bowel Disease? - CORRECT ANSWER - Blood diarrhea - Abdominal cramps and pain - Weight losss - Growth retardation What nutritional support is important for inflammatory bowel disease? - CORRECT ANSWER - High protein, high calorie diets - Low fiber diets during flare ups - Vitamin supplementation with multi-vit, folic acid, and iron What medications are often used for inflammatory bowel disease? - CORRECT ANSWER - Analgesics and antispasmadics - Corticosteroids for inflammation - Immunomodulators - Remicade What is the difference between unconjugated and conjugated bilirubin? - CORRECT ANSWER Unconjugated/Indirect Bilirubin: biproduct of RBC breakdown that passes the blood brain barrier in newborns. Conjugated is formed when ibdirect bili travels to the liver and is conjugated with glucuronic acid What is biliary atresia? - CORRECT ANSWER A congenital anomaly involving the obstruction, obliteration or absence of extrahepatic biliary structures that can lead to liver failure and death. What are the manifestations of biliary atresia? - CORRECT ANSWER - Jaundice - Pruritis - Pale/Gray stools - Failure to thrive - Poor weight gain - Ascities -Splenomegaly -Hepatomegaly How is biliary atresia managed? - CORRECT ANSWER - Fat soluble vitamins (ADEK) - Kasai procedure - Liver transplant What is the dosage for acetaminophen administration? - CORRECT ANSWER 10-15 mg/kg every 4 hours How is acetaminophen overdose treated? - CORRECT ANSWER N-acetylcysteine (Mucomyst) Why is acetaminophen/codeine not recommended in children? - CORRECT ANSWER Codeine metabolizes in the liver and is converted to Morphine; but due to genetic differences it can cause too much morphine creation in some kids leading to death What are the normal values in an ABG? - CORRECT ANSWER pH: (Base)7.35-7.45 (Acid) PaCO2: (Alk 35-45 (Acid) HCO3: (Acid) 22-26 (Alk) What are some causes of alkalosis? - CORRECT ANSWER If it's coming out of your mouth, it's alkalosis (think LInguistics) PaCO2<35: respiratory alkalosis aka hyperventilation HCO3: metabolic acidosis: vomiting What are some causes of acidosis? - CORRECT ANSWER PaCO2>45: respiratory acidosis: respiratory distress/arrest HCO3 <22: metabolic acidosis: diarrhea, kidney failure, DKA Why is otitis media more common in children? - CORRECT ANSWER They have a shorter, wider, less angled eustachian tube How do you administer ear drops in children under 3 years? - CORRECT ANSWER 0-3: pull the ear down and back 3+: Pull the canal up and back What are the manifestations of otitis media? - CORRECT ANSWER - Buldging, red tympanic membranes - Pain - Rubbing the ear - Fever - Upper respiratory infection What are the prevention measuress for otitis media according to the AAP? - CORRECT ANSWER - Breastfeed for the first 6 months of life - Feed in upright position - Discontinue.reduce pacifier after 6 motnhs - Pneumococcal vaccine - Avoid exposure to passive smoke What is the definition of asthma? - CORRECT ANSWER A chronic inflammatory lung disease characterized by reversible episodes of airway narrowing cause by an increase reaction of the airway to various stimuli What are the manifestations of asthma? - CORRECT ANSWER - Cough - Chest tightness ("heavy" chest) - Shortness of breath - Wheezing - Respiratory distress How is asthma managed? - CORRECT ANSWER - Individualized Asthma Management plan - Monitor peak flow meter rates - Avoid triggers - Medication management What is bronchiolitis? - CORRECT ANSWER Lower respiratory tract infection often caused by RSV How is bronchilolitis transmitted? - CORRECT ANSWER Spread by contact with secretions and inhalation of droplets. (Contact/ Droplet precautions) Whatis considered a "high risk" group for RSV? - CORRECT ANSWER - Infants <6 months - Infants in daycare - Infants with a history of prematurity How is bronchiolitis managed? - CORRECT ANSWER Outpatient: - Aspirate nasal secretions with feeds - Small, frequent feedings - Elevated HOB - Antipyretics Inpatient: - Supplemental oxygen - IV hydration - Nebulized hypertonic saline What are the manifestations of carbon monoxide poisoning? - CORRECT ANSWER From early to late: - Dull headache - Dizziness - Fatigue - Nausea - Confusion - Loss of consciousness - Death *think slow affixia* What is bronchopulmonary dysplasia? - CORRECT ANSWER A chronic lung disease thought to be caused by injury to a premature lung Who is at risk for bronchopulmonary dysplasia? - CORRECT ANSWER - Gestational age <30 weeks - Neonatal mechanical ventilation - High inhaled oxygen concentrations What are the manifestations of bronchopulmonary dysplasia ? - CORRECT ANSWER - Inability to wean oxygen - Tachypnea - Nasal flaring - Wheezing crackles, rhonchi - Grunting respirations How is bronchopulmonary dysplasia managed? - CORRECT ANSWER - Supplemental oxygen - Positive airway pressure - Small, frequent feedings - High calorie formula - Medications such as corticosteroids, bronchodilators, diuretics What is laryngotracheobronchitis? - CORRECT ANSWER More commonly known as croup: Inflammation of the upper airway most commonly caused by parainfluenza virus in the autumn/ winter What are the manifestations of croup? - CORRECT ANSWER - Barky, brassy cough - Inspiratory stridor - Respiratory distress How is croup managed? - CORRECT ANSWER - Keep child calm - IVF - Antipyretics - Nebulized epinephrine - Corticosteroids What is the epiglottitis? - CORRECT ANSWER A life-threatening bacterial infection of the epiglottis resulting in rapid progress of respiratory obstruction caused by H. influenzae What are the manifestations of epiglottitis? - CORRECT ANSWER - Fever - Painful swallowing - Drooling and tongue protrusion - Refusal to drink - Cough, stridor, respiratory distress - Anxiety/ irritability - Tripod position How is epiglottitis managed? - CORRECT ANSWER - Emergency equipment for intubation/ tracheostomy - IV corticosteroids (Prevention: vaccinations especially HIB) What are the manifestations of tonsillitis? - CORRECT ANSWER - Red, swollen tonsils with exudate - Sore throat with frequent swallowing - Lymph gland tenderness - Fever - Foul smelling breath What are the postoperative cares for a tonsillectomy? - CORRECT ANSWER - Position to promote drainage - Analgesics - Clear, cool fluids - Check for signs of hemorrhaging (frequent swallowing, restlessness, fast/ thready pulse, vomiting red blood) What is cystic fibrosis? - CORRECT ANSWER An inherited autosomal recessive disorder of the exocrine glands; Most common genetic disorder in the U.S. What are the respiratory manifestations of cystic fibrosis? - CORRECT ANSWER - Wet, chronic cough - Wheezing respirations - Dyspnea - Clubbing of the fingernails - Barrel chest - Sinusitis - Nasal polyps - Increased viscosity of bronchial mucus with decreased ciliary action How is cystic fibrosis managed in relation to respiratory symptoms? - CORRECT ANSWER - Chest percussion - Deep breathing and coughing - Flutter mucous clearance device - ThAIRapy vest - Aerosolized Pulmozyme What are the gastrointestinal manifestations of cystic fibrosis? - CORRECT ANSWER - Meconium ileus - Bulky, foul smelling stools - Impaired nutrient absorption - Decreased endocrine function resulting in diabetes - Increased LFT's and gallstones How is cystic fibrosis managed in relation to gastrointestional symptoms? - CORRECT ANSWER - Pancreatic enzymes with meals and snacks to increases absorption of fat-soluble vitamins - High protein, high calorie diet - Multivitamins - Extra enzymes for high fat foods How is amblyopia treated? - CORRECT ANSWER Patch the healthy eye, and refer for treamtnet before age 6 What is cerebal palsy? - CORRECT ANSWER A non-progressive neuromuscular disorder that affects movement and posture What are the manifestations of cerebal palsy? - CORRECT ANSWER - Abnormal muscle coordination and tone - Vision, hearing, and speech disturbances - Seizures - Intellectual disability What are the manifestations of down syndrome? - CORRECT ANSWER - Intellectual disabilites - Flat, broad forehead - Low-set ears - Protruding tongue - Hypotonia - Short stature - Simian crease What are some interventions for down syndrome? - CORRECT ANSWER Small, straight handled spoon due to small oral cavity - Communicate with the child based on their mental age not chronological What is important to do during a seizure? - CORRECT ANSWER - ABC's - Safety - Observe/ Time/ Describe What are some ways to manage seizures? - CORRECT ANSWER - Antiepileptic drugs - Ketogenic diet - Neurosurgery - Vagal nerve stimulation (VNS) How long should a child with seizures be on a ketogenic diet? - CORRECT ANSWER Most children are weaned off of the diet after 2 years with reduction in or cessation of antiepileptic drugs to "reset" the brain What age range do you typically see febrile seizures? - CORRECT ANSWER 6 months to 3 years of age. It is uncommon to see after 5 years Why is activity stopped after a concussion? - CORRECT ANSWER Another head trauma could result in second impact syndrome, which can lead to sudden death What discharge teaching is important for a child with a concussion? - CORRECT ANSWER Brain test: no screen time, no contact sports, no deep concentration. When symptoms resolve gradually return to LEARN, then return to play. What is the fixed cranium space? - CORRECT ANSWER Brain 80%; CSF 10%; Blood 10% What are the manifestations of increased intracranial pressure? - CORRECT ANSWER Infants: - High-pitched cry - Extreme irritability - Bulging fontanel Children: - Headahce - Vomiting - Seizures - Decreased LOC What are the medical interventions for increased intracranial pressure? - CORRECT ANSWER - Monitor neurologic status - Limit fluids - Administer osmotic diuretic or corticosteroid - Elevated HOB 30 - Low stimulation What activities should be avoided with increased intracranial pressure? - CORRECT ANSWER - Pain - Seizures - Fever - Stress - Crying - coughing - Straining - Nontherapeutic touch What is hydrocephalus? - CORRECT ANSWER A synrome resulting from a disturbance in the dynamics of cerebral spinal fluid. What are the immediate post-operative managments of a VP shunt? - CORRECT ANSWER - Position on non-affected side or back with the head of the bed elevated 30 degrees - Measure head circumference - Strict I&O; fluid restriction - Skin care of incision site - Monitor for signs of increased ICP What is the difference between meningocele and myelomeningocele? - CORRECT ANSWER Both are neural tube defects caused by the incomplete closure of the embryonic neural tube. Meningocele: Hernial protrusion of saclike cyst containing meninges but not spinal cord Myelomeningocele/ Spina Bifida: protruding sac containing CSF, meninges, and a portion of the spinal cord What post-operative intervention should be included in assessing for a neurogenic bladder after a neural tube defect repair? - CORRECT ANSWER - Perform post void residuals; residuals greated than 20 mL show insufficient bladder emptying. - Intermittent catheterization, preventing bladder infection and kidney damage What "allergy" do all neural tube repairs have post operative? - CORRECT ANSWER Latex - Pacifiers - Feeding nipples - Elastic/ rubber pants - Chewing gum - Banana and avocado - Condoms What are the manifestations of meningitis? - CORRECT ANSWER Infants: - High-pitched cry - Bulging fontanel - Irritability Children: - Headache - Stiff neck - Vomiting - Nuchal rigidity How is a lumbar punctar diagnostic for meningitis? - CORRECT ANSWER Lumbar punctuar is definitive for bacterial meningitis. Sample will be: - Cloudy color - Increased WBC count - Increased protein level - Decreased glucose level (bacteria eats the glucose) How is bacterial meningitis managed? - CORRECT ANSWER - Antibitocs - Corticosteroids - Droplet precautions - Neurologic assessment - Seizure precautions - Decreased stimuli When is a lead serum screening completed? - CORRECT ANSWER 12 months and 24 months in high risk groups What are the manifestations of lead poisoning? - CORRECT ANSWER - Anorexia - Nausea/ Vomiting - Constipation - Abdominal pain - Pallor - Fatigue - Tachycardia - Neurologic symptoms - Stunted growth - PICA What blood lead levels require treament? - CORRECT ANSWER >45: oral or IV lead chelation; inpatient if symptomatic >70: immediate hospitalization for chelation therapy What are the manifestations of hypothyroidism? - CORRECT ANSWER Metabolic rate decreases, so everything slows down. - Impaired growth and development - Constipation - Sleepiness - Hypotonia - Hypothermia - Slow pulse - Easy weight gain How is hypothyroidism managed? - CORRECT ANSWER Thyroid replacement What are the manifestations of hyperthyroidism (Grave's Disease)? - CORRECT ANSWER Metabolic rate increases, so everything speeds up: - Irritability/ emotional lability - Hyperactivity - Short attention span - Tremors - Insomnia - Weight loss despite voracious appetite - Accelerate linear growth - Hyperactivity of GI Tract (vomiting and diarrhea) - Tachycardia - Bounding pulse How is hyperthyroidism managed? - CORRECT ANSWER Efforts are made to retard the rate of hormone secretions, treatment is contraversal and includes: - Drug therapy - Subtotal thyroidectomy - Radiation What is thyrotoxicosis? - CORRECT ANSWER Thyroid storm: A medical emergency with sudden symptoms such as rapid heart rate, blood pressure and increased body temperature (fevver). What is Cushing Syndrome? - CORRECT ANSWER A hyperfunction of the adrenal gland where high coritsol levels lead to decreased secretion of ACTH What are the two etiologies of Cushing Syndrome? - CORRECT ANSWER - Adrenocortical tumor (infants or young children) - Excessive/ Prolonged steroid therapy What are the manifestations of Cushing Syndrome? - CORRECT ANSWER - Central obesity - Moon face - Susceptibility to infection and poor wound healing - Hypertension - Osteoporosis and susceptibility to bone fractures - Hirutism - Decreased linear growth - Mood disorders How is Cushing Syndrome managed? - CORRECT ANSWER - Tapering of steroids - Surgical removal or tumor What are the sister diagnosis' of antidiuretic hormone disorders? - CORRECT ANSWER - Diabetes Insipidus (Hi and dry: High Na and dehyrdation) - SIADH (Low and too much H2O: Low Na and over volumized) How is diabetes insipidus managed? - CORRECT ANSWER - Hydration - Drug therapy (DDAVP) How is SIADH managed? - CORRECT ANSWER - Correct hyponatremia with neurological monitoring 0 Drug therapy (vasopressin, diuretics) - Fluid restrictions - Neuro checks and seizure precautions What are the manifestations of hyperglycemia? - CORRECT ANSWER - Pollyuria, Polydypsia, Polyphasia - Thin, malnourished appearance - Dry, flushed skin ("warm and dry, sugar high") - Acetone breath How is hyperglycemia managed? - CORRECT ANSWER - Rapid-acting or regular insulin - IV Fluids without sugar to flush out ketones What are the manifestations of hypoglycemia? - CORRECT ANSWER Blood glucose <70: "Cold and clammy, need some candy" - Sweaty - Shaky - Tachycardia - behavior changes (confusion, irritability, poor coordination) How is hypoglycemia managed? - CORRECT ANSWER - Fast acting carbohydrates (1/2c orange juice or soda) - Glucagon for unconsciousness What is the onsent and peak of Lispro/Humalog? - CORRECT ANSWER RAPID ACTING Onset: 5-10 minutes Peaks: 30-90 minutes What is the onset/peak of regular insulin? - CORRECT ANSWER FAST ACTING Onset: 30 minutes Peaks: 2-4 hours What is the onset/pea of NPH? - CORRECT ANSWER INTERMEDIATE ACTING Onset: 2-4 hours Peak: 8 hours How is lantus different from other insulins? - CORRECT ANSWER There are no peaks, and it is not related to meals What are the manifestations of type 2 diabetes? - CORRECT ANSWER - Obesity - Acanthosis nigricans - Hypertension - Hyperlipidemia - Sleep Apnea How is type 2 diabetes managed? - CORRECT ANSWER - Exercise - Dietary management - Metformin What are the manifestations of neonatal abstinence syndrome? - CORRECT ANSWER - High-pitched, non-stop cry - Hypertonicity, tremors - Hyperthermia - Poor feeding - Tachypnea - Apnea - Nasal congestion/ sneezing - Yawning What are the manifestations of autistic spectrum disorder? - CORRECT ANSWER - Delayed speech - Lacks reciprocity - Repetitive behaviors - Lacks anticipatory behaviors - Lack of eye contact - "Parroting" - Limited interests or activites What are the two types of ADHD? - CORRECT ANSWER Hyperactive impulse and inattentive What are the manifestations of hyperactive impulse type ADHD? - CORRECT ANSWER Quick to diagnose: - Fidgets, squirms, cannot be still - Talks excessively, interrupts - Difficulty taking turns What are the manifestations of inattentive type ADHD? - CORRECT ANSWER Often goes undiagnosed: - Inattentive to details - Difficulty following directions and listening - Difficulty organizing tasks - Easily distracted, forgetful How is ADHD managed? - CORRECT ANSWER - Psycho-stimulant medications - Behavioral/ Environmental interventions What are the manifestations of anorexia? - CORRECT ANSWER - Refusal to eat - Prolonged Q-T syndrome - Electrolyte imbalance - Amenorrhea - Mood changes - Bradycardia What are the manifestations of Bulimia? - CORRECT ANSWER - History of laxatives, diet pills, enemas - Metabolic Alkalosis - Dental decay - Irritated knuckles What is the difference between cyanotic and acyanotic? - CORRECT ANSWER Cyanotic: Cyanosis of lips and digits or a "dusty look" with abnormal oxygen saturations Acyanotic: Pink baby with normal oxygen saturations What is Tetralogy of Fallot? - CORRECT ANSWER A cyanotic heart defect involving the mixing of oxygenated and deoxygenated blood for transport to the systemic circulation What are the clinical manifestations of tetralogy of fallot? - CORRECT ANSWER - Acute episodes of cyanosis and hypoxia called "tet spells" - Polycythemia - Signs of chronic hypoxia (dyspnea, clubbing of the digits, failure to thrive, exercise intolerance) What support can be done during a tet spell? - CORRECT ANSWER Position with knees to chest to help increase systemic vascular resistance which increases pulmonary blood flow and improves oxygenation. What is a ventricular septal defect? - CORRECT ANSWER An acyanotic defect where blood enters the aorta completely oxygenated but the heart pump is affected, leading to an insufficient amount of blood entering the systemic circulation. Creates a "left-to-right shunting of blood" What are the manifestations of Ventricular Septal Defect (VSD)? - CORRECT ANSWER - Signs of congestive heart failure with right ventricular hypertrophy - Tachycardia - Diaphoresis - Tachypnea - Fatigue - Failure to Thrive - Exercise/activity intolerance - Recurrent respiratory infections How is VSD managed? - CORRECT ANSWER - Digoxin administration - Fluid restrictions - Diuretic administration - High calorie diet - Surgical correction What are the signs of digoxin toxicity? - CORRECT ANSWER - Bradycardia - Dysrhtymias - Anorexia - Nausea - Vomiting What is coarctation of the aorta? - CORRECT ANSWER A narrowing of the aortic arch which decreases blood flow to the trunk and lower extremities while increasing blood flow to the head and arms What are the manifestations of coarctation of the aorta? - CORRECT ANSWER - Full, bounding pulses in the arms with weak/ absent pulses in the legs - Increased blood pressure on the arms and decreased blood pressure in the legs - Warm upper body and cool lower body How is coarctation of the aorta managed? - CORRECT ANSWER Mild: cardiac cath Severe: open-heart surgery What are the manifestations of rheumatic fever? - CORRECT ANSWER - Fever - Fatigue - Joint pain with swelling, redness, and warmth - Chorea - Erythema marginatum (Disk-shaped red macules that are non-pruritic and faded in the center How is rheumatic fever managed? - CORRECT ANSWER - Prevention is key: penicillin with strep throat infections - Promote bed rest - Anti-inflammatory medications What is Kawasaki disease? - CORRECT ANSWER An acute systemic vasculitis of unknown origin What major complications are related to Kawasaki disease? - CORRECT ANSWER It is the leading cause of acquired heart disease in children. - Myocardial infarction related to thrombosis and stenosis - Fluid overload - Congestive heart failure What are the manifestations of the acute phase of Kawasaki disease? - CORRECT ANSWER *Must have at least 5/6 symptoms* - High, persistent fever unresponsive to medications - Swelling of conjunctiva without drainage - Inflammation of the mouth, lips, tongue "Strawberry tongue" - Rash - Swollen, red hands and feet - Cervical lymphadenopathy What are the manifestations of the subacute phase of Kawaski disease? - CORRECT ANSWER - Resolution of fever - Hands and feet peel - Irritability How is Kawasaki disease managed? - CORRECT ANSWER Within the first 10 days: - IVIG to reduce incidence of coronary artery abnormalities - Aspirin therapy - Symptom relief What is a cardiac catheterization? - CORRECT ANSWER Contrast dye is injected through a catheter inserted in an artery or vein that is threaded to the heart. It is used to diagnose and treat cardiovascular conditions. Post cardiac catheterization management? - CORRECT ANSWER - Immobilize affected extremity after procedure to prevent hemorrhage - Monitor vitals to evaluate signs of anemia and hemorrhage What is a greenstick fracture? - CORRECT ANSWER Occur in long bones due to flexibilty of growing bones What is a spiral fracture? - CORRECT ANSWER Associated with a twisting force; more closely associated with child abuse than other fractures but also seen in sports injuries What is a compound fracture? - CORRECT ANSWER When bone breaks skin What is a comminuted fracture? - CORRECT ANSWER When the bone is broken into pieces What are the two types of casts? - CORRECT ANSWER Plaster and fiberglass What do you assess with a cast? - CORRECT ANSWER - Color - Pulses - Sensation - Movement - Temperature - Edema What is compartment syndrome? - CORRECT ANSWER Swelling or bleeding that occurs within a compartment leading to increased pressure and disruption of blood flow to the muscles and nerves. It has the potential to lead to tissue death and permanent disability What is the neurovascular assessments for compartment syndrome? - CORRECT ANSWER 5 P's: - Pallor - Pain (worse than initial injury) - Pulse - Paralysis - Paresthesia What are the two types of traction? - CORRECT ANSWER Skin: uses adhesive, moleskin, elastic bandage to pull indirectly on the skeleton Skeletal: uses pins and tongs to pull on the skeleton directly What is developmental dysplasia of the hip (DDH)? - CORRECT ANSWER Abnormal development of the hip socket causing the head of the femur to come out of the hip socket What are the manifestations of DDH? - CORRECT ANSWER - Ortolani Click/ Barlow sign - Shortened limb on the affected side - Asymmetrical skin folds in gluteus and thighs How is DDH managed? - CORRECT ANSWER - Pavlik harness continuously for 6-12 weeks - Surgical reduction with his-spica casting What is a hip-spica cast? - CORRECT ANSWER Cast that extends from mid-chest to legs that abducts the legs with a bar between them. What interventions are important with a hip-spica cast? - CORRECT ANSWER - Place a disposable diaper under edges to prevent cast from getting soiled - Elevate head of the bed so urine and stool drain downward - Reposition frequently to reduce pressure What is osteogenesis imperfecta? - CORRECT ANSWER A genetic disorder characterized by bones that break easily due to a collagen defect What are the manifestations of osteogenesis imperfecta? - CORRECT ANSWER - Bones fracture easily - Sclera is ablue tint - Brittle teeth - Thin skin - Small stature - Spinal curvature What is osteomyelitis? - CORRECT ANSWER An infection in a bone spreading from the bloodstream, adjacent tissue, or bone injury. Most commonly caused by staphylococcus bacteria How is osteomyelitis managed? - CORRECT ANSWER 4-6 weeks course of antibiotics What is scoliosis? - CORRECT ANSWER A lateral curvature of the spine that may occur in the thoracic, lumbar, or thoracolumbar spinal segment What are the four complications of scoliosis? - CORRECT ANSWER - Impaired growth and development - Impaired mobility - Pain - Respiratory compromise How is the curve different in non-structural scoliosis and structural scoliosis? - CORRECT ANSWER Non-structural: C-shaped curvature that disappears when the child bends at the waist Structural: S-shaped curvature that does not disappear when the child bends at the waist How is mild-moderate scoliosis managed? - CORRECT ANSWER - Prolonged bracing - Traction - Electrical stimulation How is severe scoliosis managed? - CORRECT ANSWER Curvature >40 degrees: - Surgical rods to realign and fuse the spine (Harrington rods) - Spinal fusion