thera II test III peds

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thera II test III peds
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2013-05-03 14:39:02
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thera II test III peds
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  1. neonate age
    0-28days
  2. infant age
    1-12 months old
  3. child age
    1-12 years old
  4. adolescent age
    12-16 years old
  5. adult age
    > 16 years old
  6. definition of premature
    < 37 weeks gestation
  7. low birth weight
    < 2500 grams
  8. moderately low birth weight
    1501 - 2500 grams
  9. very low birth weight
    1000 - 1500 grams
  10. extremely low birth weight
    < 1000 grams
  11. definition of term gestation
    37 - 42 weeks
  12. which book is good for infusions
    teddy bear book
  13. book for infectious disease
    red book
  14. an advantage of useing lexi-comp pediatric dosing handbook
    has postnatal age and weight for dosin
  15. advantage of neofax dosing book
    uses gestational age and postnatal age
  16. harriet lane book
    had diagnostic info as well but has less detailed drug information
  17. sanford guide
    antimicrobial therapy
  18. two sources for pregnancy and lactation
    • briggs
    • hales
  19. peds vital signs
    RR
    HR
    BP
    • increased 40-60 seen often
    • increased mean heart rate at 2 wks 148beats/min
    • decreased - typical is 65-90/30-60
  20. ped lab values
    Hgb & Hct
    • newborns increased due to low arterial PO2 in utero
    • after birth, PO2 increases and erythropoesis decreases ( with increased RBC destruction)
    • Hgb lowest in term infants at 6-12 wks
    •    "physiologic anemia"
    • increases with age
  21. what does an increased retic count in infants indicate
    RBC maturation will begin to develoop
  22. levels of
    liver enzymes
    SCr
    pH
    • increased - alk phos increased from bone growth
    • decreased - decreased muscle mass
    • decreased - during first few days of life
    •    can affect the protein binding of drugs
  23. body water proportion compared to adults
    • neonate - 50% extracellular 30% intracellular
    • adult - 20% extracellular 40% intracellular
  24. order of maturation for excretion
    • glomerular filtration
    • tubular secretion
    • tubular reabsorption
    • initially all decreased
  25. which umbilical line is for monitoring
    artery UAC
  26. which umbilical line is for administering
    venous UVC
  27. device used for large volume continuous infusions
    volumetric pump with buretrol
  28. device used for intermittent infusions
    syringe pump or is precise titration of continuous infusions
  29. early onset sepsis EOS
    • < 7 days of life (majority within 24 hours)
    • commonly present as respiratory distress
    • maternal factors play a big role
  30. late onset sepsis LOS
    • > 7 days of life
    • less of a maternal impact
    • hospital and community acquisition
    • clinical presentation often focal
  31. ups and downs of neonatal sepsis in the last decade
    • decrease mortality
    • increase overall incidence
    • increase awareness
    • decrease meningitis complications
    • shift to late onset sepsis and fungal
  32. main organisms responsible for EOS
    • group B streptococcus (GBS)
    • E. Coli
  33. main organisms of LOS
    • coagulase negative strep (CONS)
    • s aureus
  34. main organisms in LLOS
    • coagulase negative strep CONS predominates
    • s aureus less common
    • large role of IV catheters and TPN
  35. 3 therapies for neonatal sepsis
    • ampicillin + gentamicin
    • cefotaxime
    • vancomycin
  36. antenatal corticosteroids for preventing RDS
    • betamethasone
    • dexamethasone
  37. antepartum antibiotics for preventing RDS
    • penicillin
    • ampicillin
  38. tocolysis for preventing RDS
    • terbutaline
    • magnesium sulfate
  39. beta2 agonist
    smooth muscle relaxant
    contiuous IV infusion or oral therapy
    monitor
      heart rate
      blood pressure
      respiratory rate
      potassium
      glucose
      pulmonary edema (rare)
    terbutaline
  40. unknown mechanism
    likely competes with calcium to reduce myometrial contractility
    continuous IV infusion
    monitor
      blood pressure
      RR
      presence of deep tendon reflexes
      arrhythmias
      serum levels
    magnesium sulfate
  41. 12mg IM q 12 h X 2
    betamethasone course
  42. 6 mg IM q12h X 4
    dexamethasone course
  43. 4 guidlelines for intrapartum antibiotic prophylaxis (IAP)
    • positive screening culture from vagina or rectum
    • given birth to an infant with early-onset GBS disease
    • GBS bacteriuria during current pregnancy
    • culture status unknown + other risk factors (fever, preterm labor, prolonged rupture of membranes)
  44. what if mother has UTI and comes in for delivery
    give ampicillin or penicillin at least 4 hours prior to delivery
  45. 2 mainstays of maternal antibiotic regimen for GBS
    • penicillin
    • ampicillin
  46. alternative regimens for penicillin allergic pts in maternal antibiotic regimen for GBS
    • cefazolin - most evidence
    • clindamycin - increase GBS resistance to
    • vancomycin
  47. 3 surfactant options for RDS
    • curosurf - poractant
    • infasurf - calfactant
    • survanta - beractant
  48. 3 treatment options for RDS
    • surfactant therapy
    • antimicrobial therapy
    • supportive therapies
    •   oxygen
    •   assisted ventilation
    •   management of acidosis
    •   fluid & electrolyte management
    •   analgesia & sedation
  49. what 3 things are you looking to cover with antimicrobial therapy
    • GBS
    • listeria
    • gram (-) enteric organisms
  50. what does ampicillin cover
    • GBS
    • listeria
  51. what does gentamicin cover
    • GBS
    • gram (-) enteric organisms
  52. what antimicrobial could be added for late onset RDS to cover staphlococci
    vancomycin
  53. what could be added for RDS if herpes simplex virus (HSV) is suspectd
    acyclovir
  54. 2 meds used for supportive therapy with analgesia & sedation
    • fentanyl
    • lorazepam or midazolam
  55. supportive therapy for RDS
    boluses should be injected slowly over 3-5 minutes
    continuous infusion may be used
    fentanyl
  56. supportive therapy for RDS
    analgesia and sedation
    PRN doses
    continuous infusion may be used
    lorazpam or midazolam
  57. viral microbial causes < 5yo
    • influenza
    • parainfluenza
    • adenovirus
    • rhinovirus
  58. bacterial microbial causes < 5 yo
    • s pneumoniae +
    • h influenzae -
    • s aureus +
    • s pyrogenes +
    • atypicals
  59. bacterial microbial causes > 5 yo
    • s pneumoniae
    • m pneumoniae - atypical
    • c pneumoniae - atypical
  60. 6 algorithm areas for Tx of CAP
    • age of child
    • immunization status
    • risk factors
    •   daycare
    •   recent antibiotic use
    • clinical severity (outpatient vs. inpatient)
    • epidemiologic factors
    • chest radiography

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