NUR 430 Final Review Flashcards

Flashcards based on NUR 430 final review notes

What blood type is considered the universal donor?

O negative (O-)

What blood type is considered the universal recipient?

AB positive (AB+)

At what hemoglobin level do we typically transfuse red blood cells?

HGB < 8

At what platelet level do we transfuse platelets?

PLT < 10,000 or actively bleeding, invasive procedure (keep @ 50,000) & brain tumor

What are some common presentations of autism spectrum disorder (ASD) in children?

Distress when routine is changed, unusual attachment to objects, lack of empathy, prefers to be alone, decreased pain stimuli, heightened senses, cognitive impairments or strengths.

What are the cornerstones of effective treatment for Autism Spectrum Disorder (ASD)?

Early identification and referral to early intervention programs.

What are some nursing interventions for a child experiencing distress related to Autism Spectrum Disorder (ASD) in a hospital setting?

Bring them to a quieter room, shut the door, put up quiet zone signs, turn down alarms, allow them to touch some of the equipment, consider help of child life therapist/parents.

What is ADHD?

Neurobehavioral disorder characterized by inattentiveness with or without hyperactivity and impulsivity.

What is the recommended treatment for ADHD in children < 4 years old?

Behavior therapy ONLY

What is the recommended treatment for ADHD in children > 4 years old?

Behavior therapy AND/OR medications (e.g., Methylphenidate, Amphetamine/dextroamphetamine)

What are some nursing interventions for patient with ADHD?

Be patient, allow them time to do things they are interested in, allow them to take breaks, let them help you during procedures, give them opportunities to get up and move around.

What are some common presentations of pyloric stenosis in young infants?

Projectile vomiting, left to right peristaltic waves, palpable olive shaped mass to the right of umbilicus.

How is pyloric stenosis diagnosed?

Abdominal ultrasound

What is the treatment for pyloric stenosis?

IV fluids, NPO as soon as possible, NGT for stomach decompression, laparoscopic pyloromyotomy.

What are some nursing interventions for post-operative pyloromyotomy?

Reintroduction of feeds (begin clear diet 4-6 hours post-op then advance to full feeds), monitor vitals (at risk for apnea).

What is a worst-case scenario for pyloric stenosis?

Development of severe dehydration, electrolyte imbalance, and metabolic alkalosis, which can lead to shock and potentially death if not treated promptly.

What are some common presentations of intussusception?

Abrupt onset of severe, paroxysmal, colicky pain; currant jelly (red) stools, and nausea/vomiting; some with lethargy.

What is the treatment for intussusception?

Enemas given under imaging to reduce the defect (hydrostatic or air enema); surgery needed if enema not effective; NG tube for stomach decompression; DX: ultrasound.

What stool presentations are expected with Intussusception?

Currant JELLY (red) STOOLS

What should you educate parents on about Intussusception?

Educate parents that this may happen again!!

What is the most critical presentation of Appendicitis?

Pain around McBurney’s Point and tenderness in the RLQ

What are some common symptoms of appendicitis?

Cramping around the umbilicus, pain around McBurney’s point, right-sided pain settling on RLQ, rebound tenderness, fever, vomiting, guarding, rigidity.

What is the treatment for appendicitis?

Surgical intervention before rupture, ABX, fluids, pain control. Monitor for perforation.

What is the worst-case scenario for appendicitis?

Ruptured appendix, which requires immediate medical attention, watch for peritonitis.

What are key indicators for administering IV fluids for dehydration?

Circulatory instability/shock, altered mental status, intractable vomiting, bloody diarrhea, ileus, abnormal serum Na, glucose malabsorption.

What is the first step to give for dehydration?

Give 0.9 NS bolus 20ml /kg over 30 min

What is an indicator for Urosepsis?

Fever and vague symptoms ---- AUTOMATICALLY THINK UTI!

What are some signs and symptoms of a UTI in children under 2 years of age?

Newborn; jaundice, tachypnea, cyanosis, hypothermia, or fever, poor feeding, vomiting, diarrhea, irritability, lethargy, frequent urination.

Describe positive UTI characteristics.

Cloudy; hazy, PH: alkalotic, Leukocytosis: high, Nitrates: high, RBC’s: high

What is the treatment for Urosepsis?

ABX

What is the commonly bacteria cause of Urosepsis?

ECOLI AND STEPTOCOCUS B

What are key signs and symptoms of meningitis in newborns?

Weak cry, fever, hypothermia, poor muscle tone, poor suck, poor feeding, vomiting, bulging fontanelle and nuchal rigidity (late sign).

When do the anterior and posterior fontanelles close?

Posterior closes @ 2-3m, Anterior closes @ 12-18m

What is Meningitis?

Seizures with high pitched cry, fever, irritability, poor feeding, vomiting, bulging fontanelles

What are the key signs and symptoms of meningitis in children 2 years through adolescence?

Seizure, fever, chills, vomiting, nuchal rigidity, irritability and restlessness, petechial or purpuric rash (if meningococcal), Brudzinski and Kernig’s signs.

What are some complications of bacterial meningitis?

DIC

What findings are expected on a LP/Lumbar Puncture with bacterial meningitis?

Color: cloudy, Increased WBC, Increased protein count, Decreased glucose, Positive gram stain, Pressure elevated.

What action is required for patients suspected of having bacterial meningitis?

Isolate in private room – droplet precautions!!! After 24 hours of ABX: can come off precautions.

What is the worst-case scenario for meningitis?

Development of septic shock, disseminated intravascular coagulation (DIC), multi-organ failure, and death. It is a medical emergency that requires rapid diagnosis and aggressive treatment to improve outcomes.

Kawasaki disease affects what major organ?

Coronary Artery

What symptoms define the Acute Phase of Kawaski?

Red, irritated eyes, Red, cracked lips and strawberry tongue, Rash, Fever (mandatory for at least 5 days with 4/5 symptoms is dx), Swollen lymph nodes, Redness/ swelling of hands and feet

While administering IVIG to a patient with Kawasaki, what symptoms are expected?

Frequent Vitals Q15, titrate up Q30 min , if infusion reaction , STOP!

What medication is administered for a patient affected by the Acute Phase of Kawasaki?

HIGH DOSE ASPIRIN--- then LOW DOSE ASPIRIN until PLT count normal.

What care is important in the subacute phase of Kawasaki?

• Diarrhea, Hepatic dysfunctions(increased LFTs), Desquamation of fingers and toes, Cardiac disease manifestations: this is what we are trying to prevent!!, Thrombocytosis=(too much platelets)

What are the risk factors to be cognisant of during Kawasaki's Convalescent Stage?

REST,Still at risk of heart problems(need cardiology follow up), Limit strenuous activity in kids with aneurysm or stenosis of Coronary Artery,may need stents placed.

What is the #1 teaching to provide in a patient with Kawasaki's?

1 cause of heart disease in the US

What heart condition presents with HR > 220 in infants and >180 in children?

SVT

What are some treatments for SVT?

Vagal stimulation (ICE TO FACE!!), Medication (Adenosine, amiodarone, beta blocker, procainamide),

If Vagal stimulation and Medication is unsuccessful, what treatment is used for SVT?

cardioversion if meds fail

What is Commotio Cordis?

Blunt, non-penetrating blow to the precordium (chest) causing V-FIB and sudden death. Wrong place, wrong time in the cardiac cycle

What is the intervention needed following Commotio Cordis?

Call 911 then CPR.Deliver compressions 1/3 depth of the chest, 1 breath every 3 seconds

Plagiocephaly main treatment?

Repositioning 30-60minuted /day of tummy time (orthotics if severe)

Craniosynostosis main characteristics?

ICP, head malformation, surgery before 6m with post op helmet afterward, surgery can cause large blood loss, monitor for signs of shock and neurological changes

Microcephaly key points?

Small head no cure, increased risk for seizures, developmental delay etc.

What is the difference between Focal and Generalized Seizures?

Focal originates in one area of the brain, while generalized involves both hemispheres of the brain

What is Status Epilepticus?

A seizure lasting more than 5 minutes or multiple seizures without regaining consciousness; Medical emergency due to risk of hypoxia and brain damage.

What medications treat Status Epilepticus?

First-line: IV benzodiazepines (e.g., lorazepam), Second-line: Antiepileptics (e.g., phenytoin, fosphenytoin)

What are the actions during a seizure?

Stay with the patient and time the seizure, Protect from injury: Remove harmful objects, cushion the head, Position to maintain airway: Turn to the side if vomiting, Do NOT restrain or put anything in the mouth, Record observations: Movements, duration, and any triggers.

What is the post seizure care action to take?

Reposition to recovery position (left side), Check for injuries and vital signs, Provide reassurance and comfort, Document details of the seizure

Name seizure safety considerations

Medical ID: Wear a medical alert bracelet, Emergency Plan: Have a written plan and emergency meds available, Safety Modifications: Shower instead of bathe; avoid swimming alone, Trigger Avoidance: Lack of sleep, flashing lights, stress, Seizure First Aid: Teach family members to protect the airway and call for help if seizure lasts more than 5 minutes.

What defines a concussion?

does not cause increased pressure in brain, does not show on imaging, only involves chemical changes in brain

What can cause increased pressure in brain?

ICP

When is it deemed necessary to conduct a CT or Brian image for a patient with a bump on the head?

Mental stat change, Severe fall or mechanism of injury, Child <3m

What are the nursing Interventions with a patient with high ICP?

Elevate HOB 15-30 DEGREE, Maintain head at midline, Avoid pressure on neck veins, Avoid suctioning, Prevent constipation

What are some common signs and symptoms of type 1 diabetes in infants?

Irritability (high pitched cry), restlessness, poor feeding, listlessness

When should ketones be tested when a child is experiencing type 1 diabetes.

Need to check for urine ketones Q3hrs or with every void, CHECK KETONES IF BG IS >250.

What can the Honeymoon Phase cause with type 1 Diabetes?

Hypoglycemia with insulin

How do you address a hypoglycemic reaction with a patient who is experiencing type 1 diabetes?

If awake- 15g carbs (4oz juice, 1 cup milk, 3-4 glucose tablets), If unconscious- need IM GLUCAGON

How often should Endocrinology visits be scheduled with a T1D patient?

Endo visit Q3 months

Coarctation of the aorta causes decreased blood flow to which part of the body?

Lower extremities (LE)

What is a sign of Coarctation of Aorta?

BP difference in UE and LE systolic BP

Blood pressure differences require reporting above what levels?

If greater than 20 points between upper and lower systolic(NEED TO REPORT THIS)

Name signs and symptoms of a patient with Coarctation of the Aorta.

Diminished pulses, poor color, delayed cap refill, delayed urine output

The nurse recognizes bounding pulse, flushed and pink skin above the defect of what heart defect?

Coarctation of the Aorta (COA)

Prostaglandins keep open in Coarctation of Aorta, and this allows blood to flow from _ to .

DA, PA, Aorta

Name common medications for maintenance of patients with CoA.

Metoprolol, Digoxin, Ace inhibitors(lisinopril, enalapril), Diuretic(furosemide)

What assessment must be taken with a patient with COA, post surgical intervention?

4 extremity blood pressure

What are the four defects found with Tetralogy of Fallot?

PULOMARY STENOSIS, RIGHT VENTRICULAR HYPERTROPHY, VENTRICULAR SEPTAL DEFECT, OVERRIDING AORTA

What is Tetralogy of Fallot is defined and what are its symptoms?

Hypoxemic; Symptoms= Hypercyanotic spells, Polycythemia(at risk for blood clots), Clubbing of the fingers and toes

Name acute medications for Tetraology of Fallot.

Oxygen, Morphine with NS bolus 10ml/kg, Beta blocker, Phenylephrine

What patient position will the nurse place the tetraology patient in for hypercyanotic spell?

KNEE TO CHEST 0R SQUATTING

Prior to Cardiac Catheterization, what prep needs to be done?

Height/weight, Cardiac assessment (including pulses for baseline), Explain procedure to child and parent, Assess for any s/s of infections, Need adequate hydration due to contrast dyes

What interventions need to be taken after a cardiac catheterization?

Monitor pulses (especially those distal to Cath site), Neovascular assessment of extremities, VS, Monitor s/s of bleeding, I&O, Bed rest 6-8 hrs. post procedure with affected leg straight and flat

What are the Do's for cast care?

Elevate cast above heart, Asses for bleeding, Asses for infection, Asses for skin breakdown, Keep cast clean and dry

What are the DO NOTs for cast care?

Do not put anything in cast, Do not get cast wet, Do not scratch in cast!, No powders or lotions

Name the 6 P's for Compartment Syndrome?

Paresthesia, Pain, Pressure, Pallor, Paralysis, Pulselessness

Important facts to remember with Spina Bifida dx?

Defect that can occur anywhere in the vertebrae (the high the more complications), whatever damage done in the spinal nerves cannot be repaired in utero; RISKS: folic acid deficiency, genetic factors, alpha feta protein (HIGHH)… good indicator for this dx

List the advantages of Fetal SX for Spina Bifida.

Decreased need for shunt, Improved motor development and function, Possible bowel and bladder function, Modest improvement to QOL; Does NOT improve cognitive function.

Disadvantages of Fetal SX for Spina Bifida?

Premature birth, Risk of maternal bleeding

What is the plan of care for Spina Bifida PRE- OP?

Prone, Saline drip moist dressing, Do not remove when dry. ABX: monitor for infection, No rectal temps, Incubator warmer, Parental support

What is the key concern for the Post- OP Spina Bifida patient?

Bowel and bladder function

Worrisome fractures always need to be assessed for what?

Child Abuse

A fracture is most concerning on an infant who is not?

Walking

Fragile X has to be treated how?

developmental therapies and intervention with IEP in school

Severe Combined Immunodeficiency (SCID) is caused by:

Absent t-cell and b-cell

how to treat SCID?

Stem cell transplant

What room should a patient experiencing SCIDS be in?

Positive pressure room

Food allergy prevention order is:

4-6m-rice cereal, 6-8m -fruits and veggies, eggs/fish, PB, By 1 year old- cows milk/honey

The prevention #1 for food allergies is:

AVOID

Otitis media how to treat?

Decision to treat with ABX is based on severity (fever, pain, age, location, one or both ears)