Peds Test 2

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mel26704
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Peds Test 2
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2013-09-16 19:56:27
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  1. The abnormal "sucking in" of the space between the ribs or under the sternum:
    retraction
  2. Trachea tug:
    (?)  trachea rises during inspirations and lowers during expirations
  3. __________ is an obstructive respiratory process characterized by periods of exacerbation and remission.
    asthma
  4. What is the most common chronic illness in childhood?
    asthma
  5. Asthma is caused by a:
    hypersensitivity immune response
  6. Asthma usually manifests by age ___.
    Commonly affects which gender?
    • 8
    • boys
  7. Asthma flare-ups are usually associated with:
    viral infection
  8. Ways to allergy proof the house:
    • avoid odors and sprays
    • have air ducts cleaned annually
    • wash bed linens every 7-10 days in hot water
    • keep child indoors while lawn is being mowed
    • wet-mop bare floors weekly
    • use washable window shades
    • avoid using cellar/basement as a play area
  9. Asthma triggers:
    • irritants (tobacco/wood smoke, odors, sprays)
    • exercise
    • cold air
    • colds/infections
    • animals
    • strong emotions: (fear, anger, laughing, crying)
    • foods: (nuts, milk, dairy)
    • conditions: (GERD, tracheoesophageal fistula)
  10. Ways to prevent URI (infection control):
    • wash hands
    • avoid smoke and Lysol sprays
    • in the hospital:  contact precautions and limited contact with others; do not share meds from others
  11. The most common, serious, chronic, life-threatening, genetic disorder of US Caucasian children:

    common systems affected:
    airway clearance:
    • Cystic fibrosis
    • common systems affected:  respiratory & GI
    • airway clearance: mucus clearance device (flutter device) & somersaults/headstands therapeutic for resp system; teach infection prevention/home care such as chest PT, breathing exercises
  12. For a patient with cystic fibrosis, you should direct tx towards organs involved including:
    • airway assessment
    • VS
    • freq resp assessment
    • isolation if infection
    • antibiotics after C&S, CPT, & postural drainage
    • resp tx's (aerosols, Pulmozyme) 
    • humidified O2 via croupette or mask
    • pulse ox
    • TCDB
    • expectorants
    • bronchodilators
    • high-Fowler's
    • monitor WBC
    • pancreatic enzymes w/ meals/snacks
    • vitamins
    • high cal/high protein diet
    • daily weight
    • electrolyte levels (Na & Cl)
    • provide salt w/ meals prn
    • PO & IV fluids
    • tx constipation/fecal impaction prn
  13. An inflammatory viral infection of the bronchioles commonly caused by RSV:

    Characterized by:

    s/s:

    Dx:

    tx:
    • bronchiolitis
    • characterized by: mucosal edema, increased mucus secretion, bronchiolar obstruction, and over distention of the alveoli
    • s/s:  begins as URI, then apnea, fever, shallow resp, cough, tachypnea, dyspnea, tachycardia, irritability, fatigue, feeding difficulty
    • dx:  nasal wash/swab, for RSV (specimen on ice & immediately transported to lab), testing for serum RSV antibodies, CXR, WBC, pulse ox
  14. RSV tx is used for:

    Precautions:
    • antiviral med used for severely ill infants or infants who have heart/lung problems that place them at high risk for serious complications
    • admin. by fine-droplet aerosol mist while infant is in mist tent; leaves white mist in tent
    • if infant is on vent, must monitor vent tubes (may be warped by ribavirin)
    • teratogenic effects reported
    • can cause preccipitation on surface of plastics
    • caregivers w/ contacts may develop conjunctivitis
    • turn off neb to allow mist to settle before opening tent
  15. __________ causes a sudden, unexpected death of an apparently healthy infant.

    Peak age:

    Infants at higher risk:

    Most infants affected have been sleeping __________.
    • SIDS
    • 2-4 months
    • male, Native American/African Americans, low birth weight, lower SES, mother is less than 20, mother smoked during pregnancy, passive smoke exposure, multiple births, infants not firstborn, sibling of SIDS victims
    • prone
  16. CPR for infant:
    • CAB- circulation, airway, breathing; 30:2
    • 2 rescuers- 15:2
  17. What is the priority for a pt with croup?
    What should you have close by?
    • airway management (ABCs)
    • intubation/emergency equipment
  18. What could a parent do at home to help manage the symptoms of croup?run hot water in bathroom w/ door closed to create steam; let child inhale moist air for 2 mincool mist humidifier at bedsideno improvement? take to ER
    • run hot water in bathroom w/ door closed to create steam; let child inhale moist air for 2 min
    • cool mist humidifier at bedside
    • no improvement? take to ER
  19. __________ is an obstructive airway infection caused by swelling of the tissue above the vocal chords characterized by rapidly occurring inflammation of the epiglottis.

    It is a life-threatening __________!

    Often caused by:  

    It is not common, but when it does occur, it most frequently affects children ages __________ and occurs any season.

    When does this usually happen? (?)
    • epiglottitis
    • medical emergency
    • Hib & PCV (vaccinations decrease incidence)
    • 3-6
    • at night
  20. Passive smoke effects:
    • ↓ birth weight/growth rate
    •  
    • ↑ risk of SIDS
    • ↑ # of resp/ear infections
    • ↑ stillbirths/premature births
    • ↑ asthma s/s & attacks
    • precursor to chronic lung disease
  21. A colorless, odorless, tasteless gas that causes injury and death by interfering with cellular respiration:
    carbon monoxide
  22. How does carbon monoxide poisoning occur?
    • interferes w/ cellular resp
    • enters bloodstream & combines w/ hemoglobin which causes tissue hypoxia.
  23. What is responsible for over 1/2 of all fatal poisonings in the US?
    carbon monoxide
  24. What are sources of CO?
    • smoke
    • fumes/heaters
    • poorly ventilated vehicles
    • gas lamps, stoves, grills
  25. The failure of eyes to direct gaze at the same object simultaneously can be defined as:
    strabismus
  26. Strabismus is caused by an imbalance of __________.
    extraocular muscles
  27. A pt with strabismus may appear to be __________.
    squinting/cross-eyed
  28. Inward deviation (toward the other eye) is:
    esotropia
  29. Outward deviation (turns away from the other eye)
    exotropia
  30. __________ is a common cause of the "lazy eye"
    strabismus
  31. If a pt has strabismus, what could you do to try to help the affected eye to improve through use?
    • cover unaffected eye with patch
    • eye exercises
  32. Strabismus may require __________ before the child starts school.
    surgery
  33. Early tx of strabismus is necessary to prevent:
    amblyopia and blindness
  34. What is the newer tx for strabismus?
    inject botulinum toxin in small doses to weaken rectus muscle to align
  35. __________ impairment is mistakenly labeled as inattentive/ less intelligent.
    hearing impairment
  36. Hearing assessment starts at __________ by assessing the __________ reflex.
    • birth
    • startle (Moro) reflex
  37. Hearing loss that involves mechanical interference with transmission of sound (e.g. ear wax, otosclerosis, infection); most common
    conductive
  38. Hearing loss that involves inner ear problems like damage to the organ of Corti, optic nerve, or brain:
    sensorineural loss
  39. How to communicate with a pt with hearing loss:
    • approach with smile
    • face child while speaking; stand close
    • keep hands away from face
    • no gum/candy
    • speak toward unaffected ear
    • eye level
    • eye contact
    • shorten sentences
    • speak clearly without over-enunciating
    • sign language
  40. Inflammation and infection in the middle ear:
    otitis media
  41. What are some s/s of otitis media?
    • severe pain in ear/earache
    • pulling/tugging at ear or rolling head side to side
    • irritability
    • fussing/crying
    • interference in hearing
    • high fever (febrile seizures)
    • h/a
    • vomiting
    • diarrhea
    • feeding problems
  42. Spontaneous __________ of the eardrum may cause a decrease in s/s of otitis media and drainage from the ear.
    rupture
  43. __________ is the microscopic incision to relieve pressure from fluid buildup in the middle ear.  (incision heals better than tear)
    myringotomy
  44. Complications of strep throat:
    • rheumatic fever
    • glomerulonephritis
    • meningitis
    • otitis media
    • sinusitis
    • peritonsillar abcess
    • pneumonia
    • mastoiditis
  45. T&A Post-op management:
    • observe for hemorrhage
    • keep throat moist
    • liquid diet (no red dye)
    • rinse mouth after milk products
    • no straws
    • no citrus fruits, carbonated beverages, hot fluids, rough foods, sour liquids
    • avoid gargling, coughing, clearing throat, sneezing, blowing nose, and overexertion
    • may give gum but no Aspergum
    • no aspirin
  46. Over-use/long term use of nasal decongestants can lead to __________ congestion.
    rebound
  47. Diaper rash prevention:
    • frequent diaper changes
    • keep skin clean and dry
    • use mild soap when cleansing/rinse well
    • disposable diapers are best
    • avoid fastening diaper too tightly
    • rinse all baby clothes/cloth diapers throughly to decrease irritants
    • avoid overdressing/over-warming baby
  48. Eczema:  4 tx goals:
    • relieve pruritus:  avoid irritants, tight clothes, overheating; admin colloid baths, dry method vs wet method
    • hydrate skin:  fluids, topical emollients, room humidifier, baths with oil
    • decrease inflammation:  topical steroids, hypoallergenic diet- add one food at a time, severe cases- antihistamines or mild sedative
    • prevent/control secondary infection:  hadnwashing, good hygiene, nails trimmed short and clean, elbow restraints prevent scratching, antibiotics as needed
  49. Eczema tx:  dry method vs wet method
    • dry method:  infrequent bathing area, apply cetaphil
    • wet method:  frequent baths, cetaphil, moist compress
  50. Eczema tx:  colloid bath
    oatmeal, cornstarch
  51. A staph/strep skin infection characterized by macules and ruptured vesicles that ooze and form honey-colored crust around the mouth and nose is:
    impetigo
  52. If impetigo is caused by strep, you should monitor the __________ and __________ closely.
    heart and kidney
  53. A pt with impetigo should be put on contact precautions because it is __________.
    contagious
  54. Impetigo tx involves careful cleansing to remove __________ tid-qid and __________ ointment if it is ordered.
    • crusts
    • antimicrobial
  55. What is the priority of the emergent phase of a burn?
    ABCs, keeping alive, prevent shock, prevent resp distress, initial wound assessment/care, detection and tx of injuries, fluid therapy
  56. What is the priority in the acute phase of a burn?
    wound care/closure, prevent infection, prevent/tx complications, nutritional support, grafting
  57. What is the priority in the rehab phase of a burn?
    prevent scars/contractures, PT/OT/rehab, functional and cosmetic reconstruction, psychosocial counseling
  58. 3rd and 4th degree burns need __________ to heal.
    skin grafts
  59. The Parkland formula for fluid resuscitation:
    • 4 mL X wt in kg X % of body burned
  60. Sunburn prevention:
    • monitor sun/UVR exposure
    • long sleeves
    • high SPF lotion
    • hat
    • sunglasses
    • avoid sun between 10a-4p
  61. Warning:  Administer Owith caution to children because high concentrations may lead to:
    carbon dioxide narcosis & retinopathy
  62. A 1 year old has about ___ teeth.

    __ above and __ below.
    • 6
    • 4 above
    • 2 below
  63. You can use the -6 rule up to __ months of age.
    24
  64. The Academy of Pediatrics Dentistry recommends that the 1st visit occur by the age of __, but most children begin seeing a dentist between 2 and 3 years.  Healthier baby teeth=healthier permanent teeth.
    1
  65. __________ is a normal response to a new baby in the house.
    Jealousy
  66. Examples of behavioral patters that may happen when a new sibling arrives:
    • temper tantrums
    • encopresis
    • enuresis
    • breath holding
    • thumb sucking
    • biting or pinching
  67. Car seats:  infants to 1 year & 22 lbs seats should be:
    facing backwards and in the middle back seat
  68. Car seats:  22 lbs & up should be in a
    forward car seat
  69. Car seats:  the youngest child should be in the __________.
    middle
  70. The posterior (triangle) fontanel should be closed at __ months.
    2
  71. The anterior (diamond) fontanel should be closed around __ to __ months.
    12-18 months
  72. What are some common allergens in children?
    • cow's milk
    • wheat
    • citrus fruits (strawberries, oranges, tomatoes)
    • eggs
    • peanuts
    • chocolate
    • fish
    • corn
  73. Based on a 1,200 cal diet:
    Grains:
    Veggies:
    Fruits:
    Dairy:
    Protein:
    • Grains:  4 oz
    • Veggies:  1½
    • Fruits: 1 cup 
    • Dairy:  2 cups
    • Protein:  3 oz
  74. Piagets theory:  __________ stage.
    • preoperational stage
    • egocentrism, concrete thinkers, magical thinking
  75. Freud's theory:  __________ stage.
    anal stage
  76. Erikson's theory:  __________ stage.
    • autonomy vs shame and doubt stage
    • limit choices
  77. Kohlberg's theory:  __________ stage.
    • moral stage
    • egocentric point of view, tests boundaries, don't know the difference between right and wrong
  78. Toilet training begins at about __ to __ months.
    18-24 months
  79. Toilet training:
    • voluntary control of anal and urethral sphincters beginning at about 18-24 months
    • bladder control and myelin sheath not fully developed until about 1 1/2 -2 years of age
    • must be willing to sit on the potty for several minutes at a time
    • use a potty chair or standard size toilet with a stool for toddler to put feet on to feel secure
    • 5-10 min practice sessions
    • bowel training usually easier
    • hand washing
    • praise for going and trying
    • do not punish for accidents
    • frequent reminders and trips to the bathroom
    • more consistency the easeir routine will be and the toddler will adapt
  80. What is the age range of a toddler?
    1-3 years
  81. 2 years of age:
    avg height:
    avg weight:
    • 34 inches
    • 27 lbs
  82. A toddler gains about __ to __ lbs a year.
    4-6
  83. A toddler's birth weight is quadrupled by __ years of age.
  84. Separation anxiety and stranger anxiety is at its peak in __________
    toddlerhood

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