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100 Cards in this Set

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Suck/swallow is a reflexive action for infants until around what age?

6-12 weeks

How many oz is a newborn's stomach capacity?

1/2 oz

Infant's GI motility is ___________ compared to an adult's

increased

Infant's GI enzyme function is ___________ compared to an adult's

decreased

Cleft lip repair is usually done around what age

6 months

Cleft palate repair is usually done around what age

by 18 months

Tracheoesophageal fistula (TEF)

Abnormal connection between the esophagus and trachea. Multiple different kinds. Frequently a risk for aspiration.

Signs of TEF (tracheoesophageal fistula)

Cyanosis, coughing, choking, drooling, food returning from nose or mouth

When a baby is born with TEF, what is the typical intervention?

Prompt surgical intervention to close the fistula. Likely will have a G-tube placed for the time being. May eventually have another surgery to fix the esophagus. May require TPN for some time, or at least feeding by G-tube.

Symptoms of pyloric stenosis typically will start around what age

2-8 weeks

Typical presentation of pyloric stenosis

Will start off fine, eating normally, but then start with vomiting that progressively worsens to the point of projectile exorcist vomiting. Child may still be very hungry and losing weight. Abdomen may be hard with visible peristalsis.

The 8 week old patient has been having worsening projectile vomiting, which is tinged with bile but not bloody. Does the RN suspect pyloric stenosis?

No. With pyloric stenosis there shouldn't be any bile in the emesis.

Signs of intussusception

Abrupt onset.


Pain.


Vomiting.


Currant jelly stools.

"Currant jelly stools", i.e. stools with mucus and blood, are a big indicator of what condition?

Intussusception

Treatment for intussusception

First line treatment will typically not be surgery. Will administer a barium or air enema which can both diagnose and hopefully relieve the condition somewhat. If that does not resolve it, surgery can be indicated.

What should you look for in a patient with intussusception that will indicate that the condition has resolved?

Normal stools

Hirschsprung's disease

Also called congenital aganglionic megacolon.




Condition where part of the large intestine lacks innervation, and therefor cannot function.

Congenital diaphragmatic hernia

Type of hernia where abdominal contents are coming up into the mediastinum. Can cause pulmonary hypoplasia (due to lungs having no space) and a very sick kid.

Most common cause of emergent abdominal surgery in kids

Appendicitis

Signs/symptoms of appendicitis

Abdominal pain, generally diffuse or around peri-umbilican region, which may eventually localize around the RLQ. Nausea, maybe fever.

McBurney's point

Point in the RLQ. Pain here is indicative of appendicitis.

A patient has had severe RLQ pain and nausea for a while, and suddenly in the ER seems to suddenly be feeling much better. Is this concerning?

Yes. Indicates a likely appendicitis that just ruptured.

Appendicitis that results in a rupture can result in what?

Peritonitis

Short gut syndrome

General term referring to a decreased ability to digest/absorb food. Can be due to loss of either intestinal structure or function. Can be acute or chronic.

Colic

Paroxysmal abdominal pain in infants. Typical onset is 2-6 weeks. Typical peak 6 weeks. Typically resolves by 3 months.

Gastroesophageal reflux (GER)

Common, affecting as much as half of all infants. Caused by stomach contents coming back up due to inappropriately relaxed sphincter.

At what point does GER become GERD

When it's prolonged, causes actual emesis, and results in delayed growth

Nissen fundoplication

procedure where part of the fundus of the stomach is wrapped around the lower end of the esophagus and stitched in place. Assists closing of the esophageal sphincter. Done to reduce GERD. Also done to treat hiatal hernia.

Gastroenteritis

Very common in young kids. Often viral, but can be bacterial.

How common is gastroenteritis in young children

Very. It's normal for most kids under 5 to get 1-2 episodes per year, even if they're healthy.

What would be important education for the family of a kid with gastroenteritis?

Hand washing. It'll spread easily without proper hygiene.

Second leading cause of death worldwide in children under 5 years old

Gastroenteritis

What kinds of fluids should be avoided when treating gastroenteritis?

Sugary stuff. It can cause more gas and diarrhea.

Encopresis

the soiling of the underwear with stool by children who are past the age of toilet training.

Giardia

Parasite. Protozoan that can be spread by water. Reproduce in the GI tract of animals and can cause Giardiasis.

Pinworms

Parasites. Once infected, eggs can be found around the anus. Any contact with this, followed by contact with the mouth, can spread the infection.




Symptoms are typically itching around the anus.

What types of health care providers are mandated reporters?

All licensed ones

As an RN, during what times are you a mandated reporter?

24/7

A school nurse suspects child abuse. She reports it to the principal, who says that it's not enough to file a report, and orders her not to. Does the nurse still have to report it?

Yes. Mandated reporting supersedes institutional policies.

CPS cases considered "Emergent Response" make up what % of cases

15-20

CPS cases considered "Emergent Response" warrant a response within ____ hours

24

CPS cases considered "Emergent Response" warrant a decision on how to proceed within ____ hours

72

CPS cases considered "Non-emergent Response" warrant response within ____ hours

72

Most common presentation of physical abuse in kids

Bruises or burns

Leading cause of head injury in kids

Abuse

Is baby skin thicker or thinner than an adult's skin?

Thinner

How do babies absorb topical medications differently than adults?

Their skin is thinner, so they will absorb it faster.

A baby's __________ glands are functional, but their ________ glands are not, making them less effective at sweating.

eccrine; aprocrine

Eczema is also known as what

atopic dermatitis.

Atopic dermatitis

Eczema. A type of inflammation of the skin (dermatitis). It results in itchy, red, swollen, and cracked skin. Clear fluid may come from the affected areas, which often thicken over time

Contact dermatitis.

Skin inflammation, typically on a specific area where it came into contact with an allergen/irritant.

Diaper dermatitis

Skin inflammation in newborns. Occurs from contact with urine, feces, moisture, or friction. Can progress to thrush.

Seborrheic dermatitis

Chronic, relapsing and usually mild dermatitis that occurs where there are a lot of sebaceous glands. In infants seborrheic dermatitis is called cradle cap.

Acne

Chronic inflammatory disorder of the pilosebaceous hair follices. Glands become clogged and inflammed.

Impetigo

A bacterial infection that involves the superficial skin. The most common presentation is yellowish crust on the face, arms, or legs. Less commonly there may be large blisters which affect the groin or armpits. The lesions may be painful or itchy.




Very contagious.

A child has been diagnosed with impetigo. The parent wants to know if she should keep her son out of school for this, and for how long?

Child should be kept out of school for 48 hours after treatment.

Pediculosis

Infection of lice.

Scabies

A contagious skin infestation by the mite Sarcoptes scabiei. The most common symptoms are severe itchiness and a pimple-like rash. Occasionally tiny burrows may be seen in the skin.

Ringworm

Tinea corporis. Skin infection that is caused by fungi.

With what degree burns can the tissue regenerate, and with what degree can it not?

1st and 2nd - tissue can regenerate.


3rd - cannot.

What type of burns are not painful?

Third degree (partial thickness).




Because the nerve endings have been destroyed.

Burns to what body areas are considered major

Face, hands, feet, perineum, and circumferential

How can you prevent sunburns in kids <6 months of age

Avoid prolonged sunlight, or cover them up as much as possible. Avoid a lot of sunscreen when this young, as their skin is thin.

Around what age do teeth typically first erupt

6 months

The esophageal sphincter in an infant is _________ compared to adults

more relaxed.




Babies will regurgitate more often.

Most common cause of organic failure to thrive

Gastroesophageal reflux

Young kids have ________ melanin than adults

less

Atopic dermatitis is _______________ mediated

immune; T-cell

Seborrheic dermatitis is often characterized by what type of plaques

yellow-red patches

Can scabies be seen with the naked eye?

No

Types of ringworm. Tinea corporis, cruris, pedis, capitus. What do they mean.

Body part affected.


Corporis - body.


Cruris - groin area.


Pedis - foot.


Capitus - scalp.

Gynecomastia is caused by

imbalance of estrogen vs testosterone

What is the prognosis for gynecomastia

It is typically self-limiting over 1-2 years. Will reduce on its own.

Primary amenorrhea

Menstrual cycles never begin. Defined as having no menstruation at all by age 14, and pt has no sex characteristics as well

Secondary amenorrhea

Menstrual cycles cease. Most common cause would be pregnancy, but could also be due to hormonal disturbance, anorexia, or premature menopause.

Dysmenorrhea

painful menstruation. Common.

Primary vs secondary dysmenorrhea

Primary - normal, idiopathic. Secondary - due to an underlying condition.

Primary dysmenorrhea is often caused by what

Prostaglandin secretion, which causes often painful uterine contracting. With primary dysmenorrhea, this process may be more active than normal.

What is a common treatment for primary dysmenorrhea?

An NSAID, taken right before menstruation begins. Will inhibit prostaglandin production, which will reduce painful uterine processes.

Signs/symptoms of hypothyroidism in a newborn

Excessive sleeping, reduced interest in nursing, poor muscle tone, low or hoarse cry, infrequent bowel movements, exaggerated jaundice, and inability to regulate body temperature

Phenylketonuria (PKU)

Inherited metabolism defect where the body cannot breakown phenylalanine. Almost always screened for. If untreated, can cause intellectual disability, seizure, and other mental effects.

What is the treatment for PKU

Keeping pt on a diet without phenylalanine as much as possible.

When is PKU testing done?

Easy answer is at birth, but not quite. You can't screen for it if the baby hasn't been exposed to phenylalanine yet. Thus, baby needs to feed first before testing.

Galactosemia

Condition characterized by inability to breakdown galactose. As galactose is one half of lactose, if the patient consumes lactose it can cause a dangerous buildup in their system. Can cause a variety of sequela.

Fatty acid oxidation disorder

Disorder characterized by inability to oxide fatty acids. Leaves the body unable to produce energy from fatty acid sources.




Basically, patient cannot tolerate hypoglycemia. Typically, though, they can live a normal life with dietary modification.

Renal threshold for glucose

180 mg/dL

Can insulin pumps be used on little kids under 6 years old?

Sure they can

HA1C goals by age

For kids <6 years, up to 8.5 may be goal. As they get to around 12 years, it should be <8. Up to 19 years, it should be <7.5.

Why is the HA1C goal for kids higher than for adults?

Kids dont tolerate hypoglycemia well, and being a bit more hyperglycemic is often alright. We basically dont want them getting hypoglycemic.

The ADA suggests that diabetic kids should be able to independently poke/test themselves at what age

8-10 years

The ADA suggests that diabetic kids should be able to independently adjust their insulin doses and administer it at what age

14-16 years

Treatment procedure for hypoglycemia

Give 15 mg of carbs and recheck in 15 minutes. If still <70, give another 15 g and wait another 15 minutes. Repeat until above 70.




Follow with a high-protein snack if their next meal is >30 min away.




If unable to remedy with PO carbs, give glucagon injection.

A patient is hypoglycemic and is too lethargic to take anything down PO. What's the treatment option at that point?

Glucagon injection

Acanthosis nigricans

Dark, velvety spots on the neck, armpits, and other areas where the skin creases. Often indicates an individual with T2DM.

A fasting blood sugar above what indicates T2DM?

126

How is T2DM often initially treated in kids

Lifestyle changes

SIADH

Syndrome of inappropriate antidiuretic hormone secretion. The increase in blood volume (hypervolemia) often results in dilutional hyponatremia in which the plasma sodium levels are lowered and total body fluid is increased.

SIADH results in a/n ____________ in blood volume.

increase

SIADH causes ___________ urination.

decreased

What will a urinalysis typically show in a patient with DI?

Low specific gravity. Typically low osmolality as well. No sugar.