Comprehensive Study Guide for Pediatrics - CNM

What are premature infant risks?

susceptible to heat loss, hypoglycemia if NPO, over stimulation affecting vital signs

Describe neonate

0-3 months of age, can cry, sensitive to rhythms (rocking/tapping), enjoy being wrapped up tightly (support, maintain body heat, security)

Describe infant

3months to 1 yr, fine/gross motor skills begin to develop, enjoy tightly wrapped, cry looking for response, need calming techniques

Describe toddler

1-3yrs, short attention spaces, concept of time is NOW, parents can help with position and distracting patient

Describe preschool child

4-6yrs, language develops, explain what you're doing, touch things to understand

Describe school age child

6-12yrs, develop intellectual and coping skills, fears, talk directly to child, expect cooperation

Describe adolescent

12-18yrs, concerned about self image, treat with respect, have few people present during procedure

Describe how parents can be

best friend or worst enemy, can keep patient calm, be confident cause parents lose trust in you fast

What imaging techniques can we do for children?

brigh colors, posters, TV, stuffed animals, praise child with stickers/toys

What collimators could be better for children?

converging or pinhole

What are some immobilization techniques for children?

tightly wrapped, sandbags, blankets, papoose boards (IV), have parent present

What are some injection techniques for children?

tops of hands and feet, solely rely on sight, don't adjust needle or draw back (collapse easy), use 3 way stopclock, EMLA cream

What is clarks rule?

(weight in lbs * adult dose)/150lbs

What is websters rule?

(age (yrs) + 1)/(age + 7) * adult dose

What is youngs rule?

age (yrs)/(age + 12) * adult dose

What is body surface area?

(adult dose * child BSA)/1.73m^2

What is BSA?

body surface area

Explain pediatric sedation

last case scenario, never as punishment, must have nurse present to do and monitor sedation, PARENTAL consent

What are dietary precautions for infants 0-5months old?

no milk or solids for 4hrs

What are dietary precautions for infants 6-36months old?

no milk or solids for 6 hrs

What are dietary precautions for children older than 36months?

no milk or solids for 8hrs

What is versed duration?

20-60mins

What is versed onset of action?

3-5mins IV or 15min IM

What is versed dose?

0.1mg/kg

What is demerol duration?

2-4hrs

What is demerol onset of action?

10-45mins IV or 10-20min IM

What is demerol dose?

0.75-1.5 mg/kg

What is nembutal (pentobarbital) duration?

depends on patient

What is pentobarbital onset of action?

almost immediately given IV in 1/3

What is nembutal dose?

2-6 mg/kg

What is Wilms Tumor (nephroblastoma)

kidney cancer commonly affecting children 3-8yrs old

What is retinoblastoma?

retina cancer

What is Ewings Sarcoma?

malignant bone tumor arising in bone marrow

What is osteosarcoma?

malignant primary tumor of bone composed of malignant connective tissue

What is neuroblastoma?

cancer of nervous system commonly affecting children under 10 yrs old

What is Hodkins lymphoma?

cancerous lymphocytes single or multiple

Why do we do a renal scan with lasix for children?

usually children with hydronephrosis

What is hydronephrosis?

the distention or dilation of the renal pelvis which is usually caused by the obstruction of the free flow of urine from the kidneys

What is DMSA renal scan for children?

pyleonephritis or scarring/permanent damage to kidney(vesicourethral reflux)

What is pyleonephritis?

bacterial infection of one or both of the kidneys (ascending urinary tract infection)

What is a DMSA renal scan procedure?

inject DMSA, scan 3-4hrs later, take POST, RAO< LAO and pinholes of each kidney

What is a cystogram for?

looking for vesicourethral reflux

What is a cystogram procedure?

place catheter in patients bladder, give 0.5mCi of TcO4- mixed with saline, begin filling patients bladder with saline mixture and begin dynamic, pre and post void images

What a GFR study?

to see the volume of fluid filtered from renal glomerular capillaries into bowman's capsules per unit time

What does GFR meausre?

renal function

When is GFR done?

before and after chemotherapy

What is GFR procedure?

use Tc-99m DTPA within 1hr of preparation, draw up 400-600µCi and patients dose, inject patient and note the time, image injection site and measure syringe after injection, inject standard into 500cc flask filled with water and measure standard syringe for remaining activity, patient returns 2, 2.5, and 3hrs, each time draw 3cc of blood to tube which restricts clotting, centrifuge tubes and pipette the plasma and stand into test tubes

What is normal GFR?

90-120mL/min/1.7m^2

What is GE reflux?

the presence of gastric contents in teh esophagus

What is GE reflux procedure?

Tc-99m Sulfur Colloid added to patients milk and then dynamic imaging

How is a gastric emptying performed on child?

radiopharm put in milk or formula

What is meckels diverticulum?

a small pouch in the wall of intestine near the junction of the small and large intestines

What are indications for mechels diverticulum?

abdominal pain, GI bleed, males under 2

What radiopharm used for mechels diverticulum?

TcO4-

What will you see in a children's skeletal scan?

epiphyseal growth plates

What are indications for a bone scan?

metastasis, legg calve perthes disease, synovitis, osteomyelitis

What is metastasis?

spread of cancer to the bones

What is Legg Calve Perthes Disease?

destruction of the growth plate in the neck of the femur caused by poor blood supply

What is synovitis?

inflammation of the joint lining causing pain with movement

What is osteomyelitis?

inflammation of bone caused by production of pus within an organism

What scan do we want for stress fractures?

3 phase bone scan

What is biliary atresia?

bile duct fails to develop which can lead to jaundice

What is Kawaski disease?

a viral or infectious agent causes inflammation of teh coronary arteries which affects blood flow to the myocardium

What is congenital hypothryoid?

sublingual thyroid that may not have descended into the throat after birth

What is testicular torsion?

twisting of the spermatic cord which affects blood flow to the testicles

What is crohns disease?

a chronic inflammatory bowel disease