NRNP 6820 FINAL EXAM
Management of Complex Pediatric
Conditions
ANSWERED
2023/2024
, 1. What are the common causes and complications of bronchiolitis in infants? How would you assess and
manage a child with severe bronchiolitis?
- The common causes of bronchiolitis are respiratory syncytial virus (RSV), rhinovirus, adenovirus, and
influenza virus. The complications include respiratory failure, dehydration, apnea, and secondary bacterial
infections.
- To assess a child with severe bronchiolitis, you would look for signs of respiratory distress, such as
tachypnea, retractions, nasal flaring, grunting, cyanosis, and hypoxia. You would also monitor the child's
vital signs, oxygen saturation, hydration status, and level of consciousness.
- To manage a child with severe bronchiolitis, you would provide oxygen therapy, fluid replacement,
suctioning of secretions, and supportive care. You would also consider the use of bronchodilators, steroids,
or antivirals depending on the etiology and severity of the condition.
2. What are the indications and contraindications for mechanical ventilation in children with acute
respiratory distress syndrome (ARDS)? What are the main goals and principles of mechanical ventilation in
ARDS?
- The indications for mechanical ventilation in children with ARDS are hypoxemia that is refractory to
oxygen therapy, hypercapnia that causes respiratory acidosis, respiratory muscle fatigue, or hemodynamic
instability.
- The contraindications for mechanical ventilation in children with ARDS are irreversible brain damage,
terminal illness, or lack of consent from the family or legal guardian.
- The main goals of mechanical ventilation in ARDS are to improve oxygenation, reduce lung injury, and
optimize lung recruitment. The principles of mechanical ventilation in ARDS are to use low tidal volumes,
high positive end-expiratory pressure (PEEP), permissive hypercapnia, and lung protective strategies.
3. What are the risk factors and clinical manifestations of diabetic ketoacidosis (DKA) in children? How
would you diagnose and treat a child with DKA?
- The risk factors for DKA in children are type 1 diabetes mellitus, insulin omission or underdosing,
infection, stress, trauma, surgery, or puberty.
- The clinical manifestations of DKA in children are polyuria, polydipsia, polyphagia, weight loss,
dehydration, nausea, vomiting, abdominal pain, Kussmaul breathing, fruity breath odor, lethargy, confusion,
coma, or seizures.
- To diagnose a child with DKA, you would measure the blood glucose level (>200 mg/dL), serum ketones
(positive), blood gas analysis (metabolic acidosis with anion gap), electrolytes (hyponatremia,
hyperkalemia), and urine analysis (glucose and ketones positive).
- To treat a child with DKA, you would initiate fluid resuscitation with isotonic saline to correct dehydration
and shock. You would then start insulin infusion at a low dose to lower the blood glucose level and reverse
ketosis. You would also monitor and replace electrolytes as needed to prevent complications such as
cerebral edema or cardiac arrhythmias.
Management of Complex Pediatric
Conditions
ANSWERED
2023/2024
, 1. What are the common causes and complications of bronchiolitis in infants? How would you assess and
manage a child with severe bronchiolitis?
- The common causes of bronchiolitis are respiratory syncytial virus (RSV), rhinovirus, adenovirus, and
influenza virus. The complications include respiratory failure, dehydration, apnea, and secondary bacterial
infections.
- To assess a child with severe bronchiolitis, you would look for signs of respiratory distress, such as
tachypnea, retractions, nasal flaring, grunting, cyanosis, and hypoxia. You would also monitor the child's
vital signs, oxygen saturation, hydration status, and level of consciousness.
- To manage a child with severe bronchiolitis, you would provide oxygen therapy, fluid replacement,
suctioning of secretions, and supportive care. You would also consider the use of bronchodilators, steroids,
or antivirals depending on the etiology and severity of the condition.
2. What are the indications and contraindications for mechanical ventilation in children with acute
respiratory distress syndrome (ARDS)? What are the main goals and principles of mechanical ventilation in
ARDS?
- The indications for mechanical ventilation in children with ARDS are hypoxemia that is refractory to
oxygen therapy, hypercapnia that causes respiratory acidosis, respiratory muscle fatigue, or hemodynamic
instability.
- The contraindications for mechanical ventilation in children with ARDS are irreversible brain damage,
terminal illness, or lack of consent from the family or legal guardian.
- The main goals of mechanical ventilation in ARDS are to improve oxygenation, reduce lung injury, and
optimize lung recruitment. The principles of mechanical ventilation in ARDS are to use low tidal volumes,
high positive end-expiratory pressure (PEEP), permissive hypercapnia, and lung protective strategies.
3. What are the risk factors and clinical manifestations of diabetic ketoacidosis (DKA) in children? How
would you diagnose and treat a child with DKA?
- The risk factors for DKA in children are type 1 diabetes mellitus, insulin omission or underdosing,
infection, stress, trauma, surgery, or puberty.
- The clinical manifestations of DKA in children are polyuria, polydipsia, polyphagia, weight loss,
dehydration, nausea, vomiting, abdominal pain, Kussmaul breathing, fruity breath odor, lethargy, confusion,
coma, or seizures.
- To diagnose a child with DKA, you would measure the blood glucose level (>200 mg/dL), serum ketones
(positive), blood gas analysis (metabolic acidosis with anion gap), electrolytes (hyponatremia,
hyperkalemia), and urine analysis (glucose and ketones positive).
- To treat a child with DKA, you would initiate fluid resuscitation with isotonic saline to correct dehydration
and shock. You would then start insulin infusion at a low dose to lower the blood glucose level and reverse
ketosis. You would also monitor and replace electrolytes as needed to prevent complications such as
cerebral edema or cardiac arrhythmias.
