Pediatrics Final ATI

Most common post op complication of tonsillectomy?Correct answer- hemorrhage Risk time for hemorrhage after tonsillectomy?Correct answer- 10 days to 2 weeks post op Signs and symptoms of hemorrhage after tonsillectomy?Correct answer- restlessness, swallowing frequently, low BP (late sign) How should child lay post op to prevent hemorrhage from tonsillectomy?Correct answer- side lying or on abdomen What should the child avoid after a tonsillectomy post op?Correct answer- coughing or blowing nose How should xrays be taken to see the section of the lung behind the heart (lingual)?Correct answer- Laterally Why are lateral xrays needed to view the lingual area?Correct answer- a common site for pneumonia If a child is "barking" and has hoarseness and inspiratory stridor what might they have?Correct answer- croup What does inspiratory stridor sound like?Correct answer- a gasp If stridor reduces in a child previously showing stridor, what can that mean?Correct answer- blockage and imminent respiratory failure Do not put anything in the __________ of a child with acute epiglottitis.Correct answer- Mouth Acute LTBCorrect answer- Croup symptoms, Inflammation mucosa lining larynx & trachea causing narrowing airway-subglottic area narrowest part causes respiratory acidosis Diagnosis of Asthma isCorrect answer- peak expiratory flow (PEF) Treatment of Asthma isCorrect answer- beta agonists such as albuterol to relieve bronchospasms Preventing chronic problems with Asthma treatmentCorrect answer- anti-inflamatories such as corticosteroids treatment for an emergency with Asthma attackCorrect answer- repeat dose q15min twice, on 3rd dose call ambulance Parents need education about beta agonists, what should a nurse advise?Correct answer- don't give them around the clock, they should be prn, do not abuse Common side effects of beta agonistsCorrect answer- nervousness, tachycardia What is Cystic Fibrosis?Correct answer- Sludge, or increased viscosity of mucous, a build up of thick, sticky mucus in the lungs What diet should a patient with cystic fibrosis eat?Correct answer- high protein, high calorie Signs and symptoms of Increased Intracranial pressureCorrect answer- High pitched cry, difficult to soothe, tense and bulging fontanels, cranial sutures separated, setting sun eyes, distended scalp veins, headache, vomiting, seizures, diplopia, irritability/restlessness, drowsiness, indifference, decrease in physical activity & motor skills, complaints of fatigue, somnolence, weight loss Late signs of increased ICPCorrect answer- decreased LOC, decreased motor response to command, decreased sensory response to painful stimuli, loss of PERRLA, palliledema Decorticate positioningCorrect answer- all flexed Decorticate positioning is a dysfunction of what?Correct answer- cerebral cortex decerebrate positioningCorrect answer- all extended Decerebrate positioning is a dysfunction of what?Correct answer- mid brain Cushing's reflexCorrect answer- Reflex due to cerebral ischemia that causes an increase in blood pressure, decrease in pulse rate, and changes in breathing patterns. What is Myelomeningocele?Correct answer- the most common form of spina bifida in which the bones of the spine do not completely form, resulting in an incomplete spinal canal, causing the spinal cord and meninges to stick out of the childs back What should be done for Myelomeningocele?Correct answer- 4x4 soaked in normal saline placed over "sac", normal saline drip over 4x4 to prevent rupture until surgery Main prevention for Spina Bifida (Myelomeningocele)?Correct answer- Folic acid early in pregnancy Diagnostic indication for Neuroblastoma is?Correct answer- High catecholamines in 24 hour urine collection NeuroblastomaCorrect answer- Malignant childhood tumor originating in cells of the nervous system. RetinoblastomaCorrect answer- tumor arising from a developing retinal cell (a congenital, malignant tumor) LeukokoriaCorrect answer- aka cat's eye reflex; yellowish white reflex seen in the pupil because of a Retinoblastoma tumor behind the lens Bacterial MeningitisCorrect answer- Inflammation of the membranes covering the brain and spinal cord; caused by bacteria (e.g., meningococcus); symptoms include nasopharyngeal catarrh, headache, convulsions, vomiting, and stiff neck. Definitive diagnostic test for bacterial meningitis isCorrect answer- Lumbar puncture with decreased glucose, increased protein, increased WBC's Treatment for Bacterial MeningitisCorrect answer- Give antibiotic immediately, do not wait for C&S Reye's syndromeCorrect answer- A brain inflammation that occurs in children following a viral infection, usually the flu or chickenpox. It is characterized by vomiting and lethargy and may lead to coma and death. What should be monitored with Reye's syndrome to watch for possible cerebral edema?Correct answer- I&O's Infantile seizures are usually associated with some degree of _________________.Correct answer- mental retardation There are no ____- ____ ____ in infantile spasmsCorrect answer- post-ictal drowsiness What should be done for pediatric seizures?Correct answer- side lying to keep airway patent, document exact length of seizure and any precipitating factors, do not put anything in the mouth How many concussions with in several months lead to permanent brain injury?Correct answer- 2 Signs and symptoms of cerebral palsyCorrect answer- poor head control after 3 months, unable to sit without support at age 8 months, clenched fists after age 3 mths ADHD medicationsCorrect answer- dexedrine, adderall, ritalin Side effects of ADHD medicationsCorrect answer- insomnia, anorexia, weight loss, hypertension, may suppress growth over long term 5 p's of fractureCorrect answer- pain, pulse, pallor, paresthesia, paralysis distal to point of fracture How do you handle a fresh cast?Correct answer- with palms of hands, not fingertips Osteomyelitis treatmentCorrect answer- begin IV antibiotics before C&S is done OsteomyelitisCorrect answer- infection of bone and bone marrow causing inflammation Osteomyelitis dietCorrect answer- protein - milkshake Developmental dysplasia of the hipCorrect answer- A genetic condition in which the head of the femur dislocates from the acetabulum of the pelvis. The limb on the affected side of DDH is _________.Correct answer- shortened What two tests will be positive with DDH?Correct answer- Ortolani test and Barlow test Ortolani testCorrect answer- -hip abduction w/a resulting clunk as the head relocates into the joint Barlow testCorrect answer- Detection of unstable hip by adduction and extension of hip. The "feel" of dislocation is felt as femur leaves acetabulum Signs of DDHCorrect answer- restricted abduction of hip on affected side, shortened limb, unequal gluteal folds when infant prone, positive ortolani and barlow What can juvenile Rheumatoid arthritis lead to?Correct answer- iridocyclitis and uveitis (blindness) Juvenile Rheumatoid arthritisCorrect answer- an autoimmune disorder that affects children aged 16 or less with symptoms that include stiffness, pin, joint swelling, skin rash, fever, slowed growth, and fatigue iridocyclitisCorrect answer- inflammation of the iris and ciliary body of the eye uveitisCorrect answer- inflammation of the uvea of the eye What is the best therapy for JRA?Correct answer- moist heat, warm baths Osteogenic sarcomaCorrect answer- occurs most often in femur, tibia, humerus during growth spurt of teen-age males and may metastasize to lungs What should a nurse prepare for with a patient with osteogenic sarcoma?Correct answer- possible amputation and phantom limb pain If a child is exhibiting incontinence with frequency & foul-smelling urine, they should be evaluated forCorrect answer- UTI Nephrotic syndrome definitionCorrect answer- condition in which very high levels of protein are lost in the urine and abnormally low levels of protein are present in the blood Nephrotic syndrome includes:Correct answer- proteinuria, hypoalbumenia, hyperlipidemia, edema, massive urinary protein loss How is Nephrotic syndrome diagnosed?Correct answer- urine test shows 3+ protein Treatment for neprhotic syndrome?Correct answer- low salt diet, fluid restriction, prednisone is drug of choice Wilm's tumorCorrect answer- malignant kidney tumor found most often in children Do not __________ the abdoment with Wilm's tumor.Correct answer- palpate Wilm's tumor post op instructions should include?Correct answer- no contact sports Signs of smoke inhalationCorrect answer- trunk circumferential burns, edema of face and neck, singed hair, soot in mouth, hoarseness Fluid therapy for burnsCorrect answer- 1/2 in first 8 hours, 1/4 in second 8 hours, 1/4 in third 8 hours Urinary output should beCorrect answer- 1-2 ml/kg/hr VS NewbornCorrect answer- Temp: 37.5 PR: 80-180 RR: 30-35 BP: 65-80/40-50