Download Final Exam Review

FINAL EXAM REVIEW
PATTY SEVERT, MSN, RN
MUSCULOSKELETAL, RESPIRATORY,
IMMUNIZATIONS/ID, CHILD ABUSE, GI, ENDOCRINE
RESPIRATORY
• What is the respiratory pattern like
in a newborn?
IRREGULAR
• Pauses are normal in a newborn.
• True apnea is when the pause is 20
seconds or >
• Normal infant RR rate is 30-55 bpm
CROUP
• Caused by virus or bacteria
• What kind of cough does croup
produce?
SEAL BARK COUGH!
HOW CAN CROUP BE MANAGED AT
HOME?
1. KEEP CHILD CALM
2. COOL MIST VAPORIZER
3. SIT IN BATHROOM WITH CHILD &
TURN ON HOT WATER IN SHOWER. LET
THE CHILD BREATHE IN THE STEAM
FOR 10-15 MIN.
4. OPEN FREEZER DOOR AND LET
CHILD BREATHE IN COOL, MOIST AIR
5. TAKE CHILD OUT INTO COOL NIGHT
AIR.
6. KEEP THEM HYDRATED.
WHY IS A COOL MIST
VAPORIZER/HUMDIFIER
RECOMMENDED AT HOME VERSUS
STEAM VAPORIZERS?
THEY ARE SAFER!
• Children can get burned on the
steam vaporizers d/t the heat it
takes to generate the steam and
the hot water.
WHEN A CHILD IS IN RESPIRATORY
DISTRESS, WHAT POSITION MIGHT
YOU FIND HIM/HER IN?
TRIPOD POSITION
• child sits up, leans forward w/jaw
thrust in sniffing position; refuses to
lie down
CYSTIC FIBROSIS
• What causes this disease?
• What is the pathophysiology?
AUTOSOMAL RECESSIVE TRAIT
• EXOCRINE GLAND DYSFUNCTION WITH
MULTI-SYSTEM INVOLVEMENT
• PULMONARY
• GI
• PANCREAS
• BILIARY
• SWEAT & SALIVARY GLANDS
• REPRODUCTIVE GLANDS
PATHOPHYSIOLOGY OF CF
• Primary defect
• Faulty transport of chloride
in and out of cells
• Increased viscosity of
mucous secretions
• Results in mechanical
obstruction
HOW IS CF TREATED IN THE GI SYSTEM?
• High calorie/high protein diet
• Pancreatic enzymes with every
meal and snack to aid in digestion
• Fat soluble vitamins – A, D, E, K
WHAT IS THE RESPIRATORY
MANAGEMENT IN CF?
• Focus on infection prevention
• Chest physiotherapy to break up
mucus
WHAT IS THE COURSE OF TREATMENT
FOR A CF PATIENT HOSPITALIZED FOR
A RESPIRATORY INFECTION?
• Multiple, prolonged course of antbx
• Inhaled, PO, IV
• Aggressive respiratory treatment:
• Dornase alpha - aerosol
• Loosens, liquefies, thins secretions
• Bronchodilators - aerosol
• Chest physiotherapy – usually every 4
hours
• Oxygen therapy
• Nutrition key in healing
• High protein/high calorie diet
• Pancreatic enzymes with every meal and
snack
• Fat soluble vitamins – A, D, E, K
ASTHMA
• What is asthma?
• What are the 3 characteristics?
• Chronic inflammatory airway d/o
• 1. Airway obstruction
• 2. Bronchial hyperresponsiveness
• 3. Inflammation
HOW IS ASTHMA TREATED?
1ST – HELP IDENTIFY THE TRIGGER
• Limit exposure to triggers
• Quick relief medications:
• Bronchodilators – short-acting beta agonists
• Anticholinergics
• Corticosteroids
• Long-term control medications
•
•
•
•
•
Long-acting beta 2 agonists (salmeterol)
Inhaled corticosteroids
Leukotriene modifiers (montelukast)
Mast-cell stabilizers (cromolyn sodium)
Monoclonal antibodies (amalizumab)
WHAT ARE SOME SIDE-EFFECTS OF
THESE MEDICATIONS?
• Short-acting bronchodilator?
• Anticholinergics?
• Short-acting bronchodilator –
albuterol – tremors, tachycardia,
nervousness
• Anticholinergics – dry mouth
GASTROINTESTINAL
• What is the gold standard for
diagnosing gastroesophageal
reflux disease – GERD?
ESOPHAGEAL PH MONITORING
HOW IS GERD TREATED?
• Conservative Therapy
• Positioning
• HOB 30; NO CARSEATS (increases intrabominal pressure and complicates
GERD
• Feeds
• Thickened
• Enfamil AR
• Fats, spice, citrus – if older baby, child OR breastfeeding mom
• Handling of infant – no playing or rocking for at least 30” after
feed
• Weight control – monitor for wt gain and growth and
development
• Pharmacologic Management
• Histamine receptor antagonists
•  amount of acid in gastric contents
• Zantac, Pepcid
• Proton pump inhibitors (PPI)
• Esomeprazole magnesium (Nexium)
• Lanzoprazole (Prevacid)
• Omeprazole (Prilosec)
WHAT GI D/O HAS AN OLIVE MASS
THAT CAN BE PALPATED OR SEEN ON
XRAY?
PYLORIC STENOSIS
WHAT ARE OTHER CLINICAL
MANIFESTATIONS OF PYLORIC
STENOSIS?
• Non-bilious, projectile
• Usually immediately after feeds or within
30 minutes.
• Peristalsis
• Infrequent BM
• Baby is irritable, hungry, not gaining
weight
WHAT IS THE THERAPEUTIC
MANAGEMENT FOR PYLORIC
STENOSIS?
SURGERY! PYLOROMYOTOMY
WHY ARE WE CONCERNED ABOUT
DIARRHEA IN KIDS?
DEHYDRATION
WHAT IS THE PREFERRED TREATMENT
FOR DIARRHEA/DEHYDRATION?
• Rehydration
• Oral preferred
• IV may be needed in addition to oral
• Pedialyte or other electrolyte
replacement fluid
• Smaller amounts of child’s normal
diet
• Formula
• Finger foods
• Etc.
DEHYDRATION CAN ALSO BE CAUSED
BY FREQUENT VOMITING.
• If a friend asks you what to do about
her child that is running a
temperature and “…not able to keep
anything down,” what would you
suggest?
• Should the child be taken to the
doctor? ER? Urgent care?
• Or, are there things that can be done
at home?
INITIALLY, THE CHILD SHOULD BE
TREATED AT HOME
• Encourage your friend to offer sips of
clear fluids to the child frequently –
small amounts
• Teach your friend signs of
dehydration
• Encourage if this does not get better
and signs of dehydration are
appearing, then seek medical
attention.
WHAT IS HIRSCHSPRUNG’S DISEASE?
• What is the therapeutic
management for this?
CONGENITAL AGANGLIONIC
MEGACOLON
• Lack of ganglion cells in a portion of
the bowel
• Tx – Pull-through procedure
• If at least 10 kg
• Aganglionic bowel is removed
• Next section of normal bowel pulled
down to anus
• Under 10 kg – temporary colostomy until
pull-through can be done.
MUSCULOSKELETAL
• What are the signs and symptoms
of scoliosis?
• Hx of poorly fitting skirts/pants
• S or C shaped spine
• Visuaized when bending over at the
waist
• Asymmetry of shoulders, scapula,
ribs, flank and/or hips
DOES SCOLIOSIS PRESENT WITH PAIN?
NO – NOT USALLY!
• Pain only comes if a curvature of
40% or >
• some compensatory problems
may occur such as hip and back
pain
DEVELOPMENTAL DYSPLASIA OF THE
HIP (DDH)
• Abnormal development of hip
structures
• What are the symptoms of DDH?
Limited abduction of affected hip
• Asymmetry of gluteal and
thigh fat folds
• Telescoping/pistoning of thigh
• Older child:
• Walks with significant limp
• Waddling gait (bilateral)
• Marked Lordosis (bilateral)

HOW IS DDH MANAGED?
• Pavlik harness – newborn to 6 mo
• 6mo – 18mo
• Skin traction
• Closed reduction surgery
• Spica cast
• Older child
• Open or closed reduction
• Spica cast
• Bracing
WHAT EDUCATION MUST BE GIVEN TO
PARENTS OF A CHILD WITH A PAVLIK
HARNESS?
• Wear continuously till hip proved
stable (3-5mo); can take of only
for baths
•Placed at healthcare facility;
instructions given for maintaining
position; rechecks scheduled to
ensure proper fit, maintenance of
hip position and skin condition
WHAT SHOULD BE DONE 1ST BEFORE
ANY EDUCATION CAN BE GIVEN TO A
PATIENT OR FAMILY?
• Assess learner’s preferred learning
methods
• Assess learner’s readiness
• Assess what knowledge learner
already has
WHAT IS A MAJOR COMPLICATION
CONCERN FOR FRACTURES?
COMPARTMENT SYNDROME
• What is comparment syndrome?
• MEDICAL EMERGENCY
• Increased pressure in a limited space such
as the soft tissue of an extremity
• Compresses vessels & nerves & causes
tissue ischemia
• What can alert the nurse to the
development of compartment
syndrome?
6 p’s!
• Increased pain unrelieved with
medication
•
Paresthesia or numbness (tingling,
burning)
•
Pallor (pale, gray or white skin)
•
Pressure (skin tight; cast appears tight)
•
Paralysis (weakness or inability to
move extremity)
•
Pulselessness (weak or absent)
• Also prolonged capillary refill
CLUB FOOT AKA TALIPES EQUINOVARUS
• What is club foot?
• Congenital malformation of ankle and foot
• What causes it?
• Positional - d/t intrauterine crowding
• Syndromes
• Congenital - idiopathic
HOW IS CLUBFOOT TREATED?
• Stretching and manipulation exercises
• Serial casting: long leg casts changed q 1-2 weeks for 8-12
weeks
• Surgery 3-12 months last resort
ENDOCRINE
• What are key educational topics
for newly diagnosed Type 1
diabetic and their families?
• INSULIN ADMINISTRATION
• Glucose monitoring
• Dietary changes
WHAT SHOULD BE TAUGHT ABOUT
INSULIN ADMINISTRATION?
• Rotate sites
• Inject short-acting prior to longacting insulin
• Upon admission - Begin planning
to teach parent/child
demonstration of injections and
allow practice time to learn and to
rotate sites
• Signs and sx of hypo and
hyperglycemia
HYPOGLYCEMIA
• What symptoms are displayed?
• Pale, faint, weak
• Diaphoresis
• Rapid pulse
• Irritability; sleepy
• Tremors
WHAT ARE THE SX OF
HYPERGLYCEMIA
• Extreme thirst
• Vomiting
• Abdominal pain
• Deep, rapid respirations
• Flushed
• Urine + glucose & ketones
TURNER SYNDROME
• What is this d/o?
• Most common sex chromosome
abnormality in females
• Missing or abnormal x
chromosome
• S/S: short stature, undeveloped
ovaries,
short web neck,
amenorrhea, infertility,
delayed puberty
HOW IS TURNER’S SYNDROME
TREATED?
MONITOR GROWTH, ESTROGEN
PROGESTERONE HORMONES
WHAT IS KLEINFELTER SYNDROME
• 47xxy chromosome d/o
• Single most common cause of
hypogonadism and infertility in
males
HOW IS IT TREATED?
Testosterone replacement
PRECOCIOUS PUBERTY
• What is it?
• Secondary sex characteristics
before age 8 in girls; before age 9
in boys
WHAT IS AN IMPORTANT
EDUCATIONAL TOPIC?
• Treat the child according to the
chronological age
• i.e., dress them like an 8 year old, not
a 13 y.o.
HYPOPITUITARISM
• What is this d/o?
• Growth hormone deficiency
• How is it treated?
SQ INJECTIONS OF GROWTH HORMONE
IMMUNIZATIONS/INFECTIOUS DISEASE
• What immunizations should a
nurse expect to give to a 2 month
old infant?
• What do these immunizations
protect against?
• 2 month immunizations:
• Hep B, Hib, PCV, IPV, DTaP, RV
• Protects against:
• Hepatitis B, H. influenzae,
pneumococcal pneumonia,
diptheria, tetanus, pertussis, polio,
and rotavirus
WHAT IMMUNIZATIONS ARE NOT
GIVEN UNTIL 12 MONTHS?
• MMR
• Varicella
WHAT ARE THE MOST COMMON SIDE
EFFECTS OF IMMUNIZATIONS?
LOCAL:
Pain
Erythema
Swelling
Induration
SYSTEMIC:
Fever
Fussiness/irritability
Malaise
Anorexia
Rash
Arthralgia
Adolescents:
 Syncope
 Vasovagal reaction within
15 min
• Allergic reaction:
•
•
•
•
Wheal
Urticaria
Petechiae
Anaphylaxis
WHAT NEEDS TO BE DOCUMENTED
AFTER GIVING IMMUNIZATIONS?
Date (month, day, year)
Vaccine given
Manufacture, lot #, expiration date
Route
Site (specific)
Response
Name, address, title of health-care provider
VIS given & parental consent
VAERS (Vaccine Adverse Event Reporting
System)
• Tracking
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WHAT IS CONSIDERED CHILD
MALTREATMENT OR ABUSE?
• Physical abuse or neglect
• Emotional abuse or neglect
• Sexual abuse
WHAT ARE SOME CHARACTERISTICS
OFTEN SEEN IN AN ABUSED CHILD?
• Temperament – different than parents
• Additional physical needs-ill or
disabled
• Activity level
• Degree of sensitivity to parental
needs
• Does the child recognize when the
parent is stressed, sad, frustrated, etc?
WHAT ARE THE CHARACTERISTICS OF
PARENTS THAT ABUSE?
• Survivors are 6 times more likely to
abuse
• Trouble controlling aggression,
freely express violence
• Socially isolated
• Children of teens more at risk
• Parents have low self-esteem
CHILD ABUSE
• What are some of the red flags
that may alert you to the possibility
of an abuse situation in a child?
• Injury does not match the
developmental stage/age of the
child
• Conflicting stories between
caregivers
• Injury inconsistent with history
• Child inappropriately dressed for
the season (ex: long sleeves in the
summer)
• Delay in seeking treatment
WHAT DOES A SEXUAL ABUSER RELY
ON?
SECRECY!