Download MVU NURS 629 Exam 4 | 100% Correct Answers | Verified | Latest 2024 Version and more Exams Pediatrics in PDF only on Docsity!
MVU NURS 629 Exam 4 | 100% Correct
Answers | Verified | Latest 2024 Version
What is physiological jaundice? - ✔✔
- occurs when baby accumulates bilirubin
- secondary to immature liver in newborns
- common first 2-4 days of life and resolves by 2 weeks What level is conjugated hyperbilirubinemia? - ✔✔serum conjugated bilirubin concentration greater than 1 mg/dL if the total bilirubin is less than 5.0 mg/dL or more than 20% of the total bilirubin if the the total bilirubin is greater than 5 mg/dL (p. 862 AAP book) What is breastfeeding jaundice? - ✔✔
- due to poor intake that causes lack of stools and urine output
- common in first week and resolves once milk comes in and infant is feeding well-more stools and urinary output
- peaks around 2-3 weeks How do you diagnose jaundice? - ✔✔
- dx with a bili level of 5 mg/dL
- 12 mg/dL threshold for all newborns having jaundiced appearance
- direct/indirect bili levels
- CBC
- reticulocyte count How do you treat jaundice? - ✔✔ increased intake indirect sunlight phototherapy
IV fluids What are other causes of jaundice? - ✔✔abnormal blood cell shapes (like sickle cell) Rh incompatibility cephalohematoma polycythemia (increased RBCs, SGA infants, twins) infection specific enzyme disorders What is biliary atresia? - ✔✔-life-threatening condition causing a blockage of bile ducts inside or outside of liver
- leads to build-up of toxins (like bilirubin)
- malabsorption of fat-soluble vitamins A,D,E,K
- scaring of the liver, loss of tissue, cirrhosis
- not inherited What are the two types of biliary atresia? - ✔✔fetal- noted in womb (other defects like heart, spleed, intestines) perinatal- appears 2-4 weeks after birth What causes biliary atresia? - ✔✔-infection after birth (cytomegalovirus or rotavirus)
- autoimmune disorder
- developmental issue in womb
- exposure to toxic substances What are symptoms of biliary atresia? - ✔✔jaundice dark urine light to white stools poor wt gain and growth
What is acute emesis? - ✔✔short-term abrupt onset What is recurrent emesis? - ✔✔at least 3 episodes over 3 months chronic, relatively mild that occurs frequently What is cyclic emesis? - ✔✔recurrent, intense episodes separated by asymptomatic periods How do you treat emesis? - ✔✔NPO for 1-2 hrs **rehydrate with small/frequent amounts of clear liquids avoid dairy and solids for 4-6 hrs and then add bland foods slowly What are causes of diarrhea? - ✔✔-primarily viral (most common) or bacterial
- bacterial pathogens are usually C. difficile, salmonella, Giardia, Campylobacter **always serious in infancy due to small ECF reserve, and can dehydrate quickly Patho of diarrhea - ✔✔1. retention of water w/in the intestine (malabsorptive syndrome, lactose intolerance)
- excessive secretion of water and electrolytes into the intestinal lumen (cholera, e. coli, chrohn's, laxatives)
- release of protein and fluid into the intestinal mucosa (ulcerative colitis, Crohn's. infections)
- altered intestinal motility resulting in rapid transport through the colon (IBS, scleroderma) What is acute diarrhea? - ✔✔most likely to be an infectious agent sudden onset frequent, loose, watery stools bloody stools abdominal cramping thirst
decreased urination dizziness fatigue What is chronic diarrhea? - ✔✔1 or more liquid to semi-solid stools passed per day for 14+days What are causes of chronic diarrhea? - ✔✔latrogenic- excessive fluids; <25% of calories from fat infants- formula protein intolerance toddlers- chronic, nonspecific; usually resolves by 5 years of age children/adolescents- acquired lactose intolerance viral or bacterial Diagnostics for diarrhea - ✔✔Acute- stool cultures, CMP, CBC (if indicated by usually resolves on own) Chronic- stool cultures, CBC w/diff, CMP, ESR, lactose tolerance test What is GERD? - ✔✔neuromuscular problem where lower esophagus and and GE sphincter (cardiac sphincter) are lax and allow for easy reguritation of gastric contents What are the three classifications of GERD? - ✔✔1. physiologic- infrequent/episodic vomiting
- functional- painless, effortless
- pathologic- frequent with alteration in physical functioning (up to 70% of infants <1700g have this type with 85% being symptoms free by 1 yr) What are s/sx of GERD? - ✔✔recurrent regurgitation w/wo vomiting heartburn gas/abdominal pain failure to thrive ruminative behavior hematemesis
after a few weeks, vomits more frequently and projectile after all feeds wt loss, dehydration, constipation Diagnostic testing for pyloric stenosis - ✔✔US, upper GI series which can show a "string sign" which is a fine elongated pyloric canal "olive mass" palpable in epigastric area to right of midline Treatment is surgery (pyloromyotomy) What is appendicitis? - ✔✔inflammation/infection of the vermiform appendix- small appendage arising from the cecum most common 6-19 yo What causes appendicitis? - ✔✔obstruction of the appendiceal lumen (inside of appendix) usually by fecalith (fecal stone) or lymphoid hyperplasia (#of lymphocytes)
- may also be caused by inspissated secretion of CF
- may also be caused by parasitic tumor or foreign body Symptoms of appendicitis - ✔✔initial- dull, steady periumbilical pain for 4-6 hrs shifts to RLQ as peritoneal inflammation develops 24 - 36 hrs- rupture likely- may have initial decrease in pain with worsening shortly after *N/V pain awakens from sleep decreased appetite likely no fever before perforation Diagnostic testing for appendicitis - ✔✔CBC w/ diff- look for shift to left, *elevated WBCs usually 10-20, neutrophils, elevated bands UA CT w/ contrast- highest accuracy may use US/MRI
**surgery referral, emergent What is Markle's sign? - ✔✔Appendicitis abdominal assessment- heel drop jarring test, on toes for 15 sec, dropping down forcefully on heels will elicit RLQ pain What is rebound tenderness? - ✔✔Appendicitis abdominal assessment- involuntary guarding over McBurney's point on abdominal exam What is Rosving's sign? - ✔✔Appendicitis abdominal assessment- pressure deep in the LLQ with sudden release elicits pain in the RLQ which strongly suggests peritoneal irritation What is Psoas sign? - ✔✔Appendicitis abdominal assessment- patient lays on left side and provider flexes right thigh backward, if pain is elicited then this is a positive sign What is obturator sign? - ✔✔Appendicitis abdominal assessment- flex patient's right leg to have both 90 degrees at knee and hip, the provider then holds the patient's ankle with one hand and knee with the other and internally rotates the hip by moving the patient's ankle away from the body while allowing the knee to move inward- if this elicits pain the positive sign What are uncomplicated UTI symptoms? - ✔✔common symptoms- dysuria, urgency, frequency, no fever What are complicated UTI symptoms? - ✔✔fever, toxicity, dehydration, child <6 months, structural abnormality Diagnostic testing for UTI - ✔✔UA w/ culture *E.Coli most common cause dipstick= leukocytes, nitrates, RBCs if pyelo suspected- CBC, ESR, BUN, creatinine Treatment for UTI - ✔✔trimethoprim/sulfamethoxazole 8-10 mg/kg/day (>2 months) *first drug of choice
reduced hip ROM How do you diagnose Legg-Calve-Perthes? - ✔✔x-ray- AP & frog leg lateral will show increased density of the femoral head **BEST to dx MRI may show osteonecrosis Treatment for Legg-Calve-Perthes - ✔✔referral and surgery observation if <6 yo who maintains up to 40-45 degree abduction What are primary headaches? - ✔✔neurologic basis: migraine tension-type cluster other primary neuralgias What are secondary headaches? - ✔✔infectious vascular traumatic mass or lesion What are red flags for headaches? - ✔✔S- systemic symptoms or disease N- neurologic s/sx O- onset sudden O- onset before age 5 or after age 50 P- pattern changes from prior headaches Diagnostics for headaches - ✔✔headache diary CT only if tumor suspected
Treatment for headaches - ✔✔NSAIDs prophylactic CCBs, tricyclic antidepressants abortive: triptans not approved in children nonpharmacologic- reduce triggers What are seizures? - ✔✔paroxysmal events thought to represent abnormal electrical activity in cerebral neurons usually idiopathic Tonic clonic seizure - ✔✔tonic-entire body becomes rigid, first phase clonic- uncontrolled jerking may cry, groan, fall risk, bite inside of tongue/cheek, incontinent Tonic seizure - ✔✔body becomes tense, usually lasts less than 20 seconds usually occurs with patient is sleeping and involve most or all of the brain Absent seizures - ✔✔very quick, <10 seconds- often missed generalized onset involving both sides of the brain at the same time most common type stops all activity then patient stares off eyes may roll up eyelids flutter Atypical absent seizures - ✔✔starts with patient staring off, change muscle tone and movement blinking repeatedly smacking lips or chewing movements rubbing fingers together or making other hand motions lasts longer than absent >20 seconds
What are observed s/sx of concussion? - ✔✔amnesic to event appears dazed/stunned confusion moves clumsily answers slowly loses consciousness shows mood, behavior, personality changes Diagnostics for concussion - ✔✔based on symptoms all children with moderate head trauma (GCS 9-12) and severe (GCS 3-8) needs CT Signs of normal cognition development in toddlers - ✔✔emerging empathy understanding social rules constructing narratives reciprocity in play What are symptoms of ADHD? - ✔✔attention deficit hyperactivity disorder inattention hyperactivity impulsivity How do you diagnose ADHD? - ✔✔have to have at least 6 hyperactivity/impulse symptoms and 6 inattention symptoms DSM IV What is treatment for ADHD? - ✔✔stimulants- methylphenidate, amphetamine/dextroamphetamine What are symptoms of sensory processing disorder in adolescents? - ✔✔overly sensitive to touch, noise, smell, or other people
poor self-esteem afraid of failing at new tasks lethargic and slow always on the go impulsive distractible clumsy, slow, poor motor skills or handwriting can't find this in the book or in PP from brenda lee's study guide What are comorbidities of depression? - ✔✔anxiety disorder can correlate with depression ADHD conduct, learning, and oppositional defiant disorders SAD eating disorders stress What are risk factors for depression? - ✔✔attention, conduct, learning disorders chronic illnesses abuse/neglect trauma *separation anxiety Diagnostic for depression - ✔✔PHQ-9 can be used for ages 11 and up
- insomnia or hypersomnia, just like our adults; psychomotor agitation or retardation observable by others; fatigue or loss of energy; feelings of worthlessness or excessive or inappropriate guilt; diminished ability to think or concentrate or indecisiveness; and recurrent thoughts of death is another characteristic
- criteria to meet the diagnosis of depression is 5 or more symptoms, most of the day nearly every day, have been present during the same 2-week period
Tx- walking cast for 3-4 weeks, PT, ankle brace How do you assess for injury or anterior or posterior cruciate ligament? - ✔✔elicit a positive anterior/posterior drawer sign What is a slipped capital femoral epiphysis? - ✔✔SCFE sudden or gradual displacement of the femoral head typically occurs during adolescent growth spurt What are risk factors for SCFE? - ✔✔obesity male sports femoral retroversion hypothyroidism average age is 12 yo girls and 13 yo boys What are symptoms of SCFE? - ✔✔limping, knee, hip pain pain worse with activity-localize to anterior thigh or knee may be unable to wt bear loss of internal rotation of hip with flexion affected extremity is shorter by 1-3 cm loss of abduction and extension Diagnostic for SCFE - ✔✔x-ray Treatment for SCFE - ✔✔referral to pediatric ortho keep non-wt bearing until surgical eval What is scoliosis? - ✔✔lateral curvature of the spine >10 degrees accompanied by vertebral rotation
idiopathic scoliosis- multigene dominant condition with no clear cause secondary scoliosis- multiple cases What is the most common type of scoliosis? - ✔✔idiopathic Diagnostic for scoliosis - ✔✔upright posteroanterior and lateral view that include the cervical spin and pelvis pg. 2670 AAP book What are the features of growth hormone deficiency? - ✔✔short, slow growth childlike facies with prominent forehead Diagnostics for growth hormone deficiency - ✔✔CBC, sed rate, UA, TSH, free T Growth factors (IGF-1 and IGFBP-3) **screen for hypglycemia and GI illness Treatment for growth hormone deficiency - ✔✔referral to pediatric endocrinology (low IGF-1 and IGFBP-
What is precocious puberty? - ✔✔early onset of puberty before age 8- girls and before ages 9-10 in boys What causes precocious puberty? - ✔✔early release of sex hormones (gonadotropins) from the pituitary gland those affect the sex organs may be caused by abnormality in the pituitary or hypothalamus Precocious puberty symptoms - ✔✔boys develop facial, underarm, pubic hair penis lengthens girls start menstruation, develop breasts, develop pubic/underarm hair Both: body odor changes, height increases rapidly- stops at early age
likely non-caucasian DKA is uncommon/insiduous insulin dependence is episodic autoimmunity uncommon Criteria to dx diabetes - ✔✔symptoms of diabetes plus random plasma glucose >= 200 mg/dl OR fasting plasma glucose >=126 mg/dl OR 2 hr plasma glucose >= 200 ml/dl during OGTT (1.75 gm/kg or max 75 gm glucose in water) Who gets screened for diabetes? - ✔✔symptomatic child (polyuria, polydipsia, wt loss, fatigue, emesis, abd pain, kussmaul breathing, lethargy, confusion) asymptomatic but at risk (age 10 or onset of puberty, overweight, family hx, high-risk ethnicity, signs of insulin resistance) Screening for diabetes - ✔✔obtain random plasma glucose
- if >= 200 mg/dl and has symptoms then diabetes
- if 140-199 mg/dl and fasting glucose is >= 126 then diabetes
- if <140 mg/dl likely other cause and if high risk start lifestyle modifications Is this Type 1 or Type 2? RPG > +ketones positive GAD antibodies Islet cell antigen (512) - ✔✔Type 1 Is this type 1 or type 2 diabetes? RPG >
+/- ketones acanthosis nigricans high triglycerides family history - ✔✔type 2 Treatment for type 1 diabetes - ✔✔replacement of insulin- coordinate with food intake individualize therapy teach "survival" education: C- carb counting H- hypoglycemia tx U- urine ketones when glucose high M- monitor blood glucose S- shots Treatment for Type 2 diabetes - ✔✔lifestyle changes wt control and exercise if pharmacologic therapy: biguanides, insulin Blood glucose goals - ✔✔Ages <= 6 yo keep to 100-180 and may need to give insulin after meals; HBA1c 8.5% Ages 7-12 tighten control to 90-180 before meals; HBA1c 8% Adolescents tighten control to 70-150: HBA1c 7.5% per PP and pg 1856 of AAP book **other study guide states ideal glucose level for 4 yo is 90- 130 What is congential hypothyroidism? - ✔✔may be asymptomatic at birth newborn screening in all 50 states all abnormal newborn screenings should be confirmed with FT4 and TSH refer to peds endocrine
