Exam 1

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Exam 1
2015-02-11 22:26:46
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  1. diaper rash
    satellite leasions
  2. acutane
    causes depressed mood
  3. you should always use what type of diapers
  4. acrocyanosis
    cyanosis of the hands and feet. NOrmal in newborn

    If crying makes the cyanosis better or worse, you need to know. Crying may affect a shunt in the heart if it is present
  5. what is often the first sign of heart disease
  6. Older children may have _____ present in heart failure
  7. If no lower extremity pulses, think?
    coarctation of the Aorta (narrowing of the aorta)
  8. Bounding puses in
    heart failure and PDA
  9. Hallmark of hypoplastic left heart disease
    decreased or absent pulses

    underdevelopment of the left heart
  10. Heart failure may present with what skeletal abnormatility
    barrel chest
  11. In an infant with CHD, you should suspect a
  12. Gallop rhythm is a late sign of
    heart failure

    abnormal sound caused by dilation of the ventricles. Heard as 3rd sound on auscultation. BAd sound

    heard in left to right shunts
  13. S2 is heard
    • left upper sternal border
    • listening to aortic and pulmonic valves
  14. What happens if no S2 is heard
    maybe a valve is missing
  15. Oliguria is late sign of
  16. Still Murmur
    • FUnctional, normal
    • Typically in 2-7 year olds
    • Heard LMSB-LLSB-RUSB
    • Probably due to extra chord attatched to mitral valves

    • Increased metabolic needs by the heart
    • Decreased tissue perfusion
    • Weak cry, lethargy
    • Difficulty bottle feeding
    • Sweating
    • Difficulty with activities
  17. Hyperoxia test
    For infants with respiratory disease, the administration of O2 will usually increase saturation or pO2

    If pO2 doesnt change or little change, think CHD
  18. EKG are helpful if infant has _______ but not ____________

  19. Best way to clear an infants nowe?
  20. Why do you treat strep?
    Could lead to rheumatic fever
  21. Peak respiratory flow meter
    Take highest reading
  22. CCHD test
    • Critical congenital heart disease
    • Mandated screening by law
    • Do after 24 hrs of age, but before discharge
    • Easy, inexpensive, quick
    • Great to pick up Coarctation of Aorta before signs present
    • Done with a pulse ox
  23. When can children return to school who have lice?
    after first treatment
  24. Dont wash hair for _______ after lice treatment
  25. Special rules for clothing, stuffed animals, hair accessories with lice
    • Bedding and clothing must be changed daily, washed in hot water and dried in a hot dryer for 20 minutes
    • Stuffed animals placed in plastic bag for 14 days
    • Hair accessories- discarded or soaked in hot water (130 degrees for 10 minutes)
  26. If patient has tonsillitis, will they mouth or nose breath?
    mouth breath
  27. Pharyngitis is common in

    RARE in infancy
  28. Common cold
  29. Symptoms of pharyngitis
    • sore throat
    • difficult swallowing
    • drooling
    • inability to swallow secretions
    • inflammation of pharynx
    • enlargement of tonsils
    • fever
    • vomiting
    • cough
    • HA
    • hoarseness
  30. Conductive hearing impairment
    tympanic membrane cannot fibrate freely or sounds cannot enter middle ear
  31. Sensorineural hearing impairment
    damage to cochlea or auditory nerve; may be congenital from congental rubella syndrome or aquired from ototoxic drugs. May be genetic
  32. Viral pharyngitis treatment
    • relieve symtpoms
    • soft or liquid diet
    • no citrus juices
    • acetaminophen
  33. Bacterial pharyngitis treatment
    • alagesics
    • Antibiotics (Amoxicillin)
  34. One of the most common childhood surgeries
  35. Child should be free from symtpoms of tonsillits for at least _____________ before surgery?
    one week
  36. Tonsilectomy indications
    • recurrent tonsilitis 
    • peritonsillar abcess
    • resp compromise 
    • airway obstruction
  37. DIscharge teaching for tonsilectomy
    • continue to force fluids 
    • advance soft diet as tolerated
    • avoid strenuous activity for 7-10 days
  38. Post op care for tonsilectomy
    • Analgesic and ice collar for pain
    • Dont give red popsicle, need to monitor for blood
    • CLear, chilled fluids 
    • Sore throat approx 1 week post op
  39. dont bend forward, drink hot liquids after
  40. ________________ common source of bleeding in nose bleeds
    superficial veins
  41. bronchodilator for asthma
    • albuterol 
    • epinephrine

    SE: tachycardia, restlessness, increased activity, inhaled with more rapid onset
  42. Antiinflammatory agent for asthma
    • Prednisone (Deltasone)
    • budesonide (pulmicort)

    SE: growth retardation, fluid retention, increased appetite, mood changes, inhaled have fewer SEs
  43. Acute laryngotracheobronchitis
    viral infection that causes inflammation, edema, and narrowing of larynx trachea and bronchi

    most common in infants and toddlers, affects boys more than girls

    most common of croup syndromes
  44. Meds for Acute LTB
    PO or IM dexamethosone three times daily for 72 hours to decrease inflammation and edema
  45. Education on LTB
    • symptoms worse at night, may occur for several nights
    • Can be cared for at home if able to take PO fluids and no stridor at rest
    • Cool mist humidifier and presence of parents
    • breathing labored=seek medical attention stat
  46. Assessment for Epiglotitis
    • Sudden onset of high fever (102.2)
    • Sits upright leaning on arms with chin thrust out and mouth open
    • muffled voice
    • drooling
    • cant swallow
  47. Jones criteria
    • Carditis involving mitral valve
    • chest pain caused by pericardial inflammation 

    polyarthritis in large bones, can alternate between joints

    subQ nodules on bony prominences

    Nonpuritic rash on trunk but not face and hands

    St. Vitas dance

    2 major

    1 major and 2 minor
  48. change trach tube every
    1-2 weeks
  49. Trach suctioning
    BID and PRN 

    • Infants 60-100
    • Children 100-110
  50. What is most common cause of Broncholitis?
  51. RSV most prevelent
    first 2 years of life, more common in spring and winter
  52. RSV, assess respiratory how often?.
  53. Perform ____________ to obtain resp secretions in RSV
  54. _________ used to prevent RSV for high risk under 2 year olds
  55. Nutrition for CF
    • Pancreatic enzymes with every meal
    • High calorie, high protein diet
    • Promote breatfeedings 
    • Gavage feedings may be necessary for infants
    • Suppress GI acid
    • May need salty snacks
  56. amplyopia
    most common cause is untreated strabismus
  57. leading cause of decreased vision in children
    amblyopia (lazy eye)
  58. strabismus
    • cross eyed
    • occlussion therapy 1-2 hr/day
  59. Otitis media
    • Inflammation of middle ear
    • 70% of infants will have before 1 year of age
    • Occurs more frequently in : Boys, children in day care, kids with allergies, kids exposed to smoke, prequent pacifier use, cleft lip, downs
    • Less likely in breast fed
  60. Associative play
    Interacts with others during play 

  61. Preschooler should be able to
    • Brush teeth
    • Button clothes
    • Tie shoes
    • Draw 6 part person
    • Draw circles, cross, square
    • use fork
  62. Preschoolers behavior
    • should feel guilty if misbehaves 
    • Actions based on reward/punishment
    • Begin to understand justice and fairness at 6 yrs
    • Compare themselves with peers
    • Little to no separation anxiety
  63. neonatal period
    • wt: 6-8 lbs. gains 5-7 oz/week x 6 months
    • ht: 20 in.  grows 1 in/mo x 6 months

    head circ greater than chest circ
  64. pulsations in anterior not
  65. posterior fontanel closes
    2-3 months
  66. Anterior fontanel closes
    12-18 months

    after 18 months evaluate
  67. infancy
    1-12 months

    head grwoth rapid
  68. ht increases by _________ by age 1
  69. wt doubles birth wt in _______
    5-6 months
  70. Weight _________ after 1 year
  71. 1 month
    • demonstrates head lag
    • has a grasp reflex
  72. 2 moths
    • lifts head of mattress when prone
    • holds hands in open position
  73. 3 motnths
    • Raises head and shoulders off mattress when prone 
    • only slight head lag

    • No longer has grasp reflex
    • Keeps hands loosely open
  74. 4 months
    • Rolls from back to side
    • Places objects in mouth
  75. 5 months
    Rolls from front to back Uses palmar grasp dominantly
  76. 7 months
    • bears full weight on feet 
    • moves objects from hand to hand
  77. 8 months
    • sits unsupported
    • begins using pincer grasp
  78. 9 months
    • stands holding furniture
    • has crude pincer grasp
  79. 10 motns
    • crawls with abdomen on floor 
    • rasps rattle by handle
  80. 11 months
    • creeps with abdomen off floor
    • places objects into a container 
    • neat pincer grasp
  81. 12 months
    • walks with one hand held
    • tries to build a two block tower w/o success
  82. cruises
    10-12 months
  83. 6 months
    • rolls back to abd
    • holds bottle
  84. sucking and rooting reflexes
    gone by 4 months
  85. Palmar grasp reflex
    gone by 3 months
  86. Plantar grasp reflex
    gone by 8 months
  87. Moro reflex
    gone by 4 months
  88. Tonic neck feflex
    gone by 3-6 months
  89. Babinki reflex
    gone by 1 year
  90. startle refelx
    gone by 4 months
  91. Stepping reflex
    gone by 4 weeks
  92. Iron fortified formulas used for bottle feeding recommended for ________ if not breastfed
    first 12 months
  93. NO solids before
    6 months
  94. Cooked chopped table food by
    9 months
  95. No citrus fruits, meat and eggs until
    6 months
  96. limit 100% fruit juice to ____________ after 6 monts
    4-6 oz/day
  97. Vegetables and fruits between
    6-8 months
  98. Iron fortified rice cereal at
    4-6 months
  99. rearfacing car seat until
    2 years
  100. do not place rear facing car seats where?
    front seat with airbag
  101. crib rails should be no more than
    2 3/8 in apart
  102. Separation Anxiety happens when
    • between 6-30 months
    • peaks around 15 months
  103. Stages of separation anxiety
    • protest: appears sad, agitated, agnry, inconsolable, watches desperately for parents to return 
    • despair: appears sad, hopeless, withdrawn, acts ambivalent when parents return 
    • detachment: appears happy, interested in environment. Becomes attatched to caregivers, may ignore parents
  104. Tetralogy of Fallot
    exhbit bluish skin during episodes of crying or feeding
  105. Kawasaki's disease
    • Multisystem disorder involving vasculitis 
    • AKA mucocutaneous lymph node syndrome
    • Leading cause of aquired heart disease in children 

    Stage one (1-2 wk) fever lasting > 5 days unresponsive to antipyretics, conjunctivitis, crusted and fissured lips, swelling of hands and feet, erythema, lymphadenopathy

    Subacute stage (2-4 wk) fever lowers, irritability, anorexia, desquamation of hand and feet, arthritis, cardiovascular

    Convalescent stage (6-8 wk) drop in ESR and diminishing signs of illness
  106. Asprin used in