Respiratory
Cardiac
Neuro & GI
Cancer
Mental Health
100
Name 5 risk factors for SIDS
Preterm, LBW, SGA, and multiple births
Native American and African American
Males
Maternal smoking, alcohol use disorder, and substance abuse
Socioeconomic disadvantages
Sleeping prone or side lying position
Bed sharing - higher risk in infants 0-3 months
Soft bedding, pillows, blankets, and stuffed animals - higher risk for infants >3 months
Overheating
Secondhand tobacco smoke exposure
100
What heart rate and rhythm would qualify as supraventricular tachycardia (SVT) in infants and children >1 years old?
Non variable at >220 for infants and >180 for children >1 years old
100
Name 3 interventions or treatments used for increased ICP.
1) Keep HOB up
2) Don't super flex lower extremities or abdomen, and avoid activities that would do that.
3) Shunt to drain from ventricle that goes down into the peritoneal area (Ventriculo-Peritoneal Shunt)
100
1) Name 3 teaching topics for home care of children with cancer.
2) If a child with cancer and neutropenia comes to the hospital with a fever Sepsis is assumed. What care would be provided?
1) Monitor temp regularly and before administering Tylenol to ensure they are not masking a fever. In a kid's with cancer a fever is an emergency and they need to be seen right away; Limited in caring for pets, eating foods like vegetables that may not be washed well, etc.; Limit exposure to public places and/or sick people
2) Will get bloodwork for CBC, CMP, will have implanted access device so want to ensure there is no infection there or other systemic infection. Goal is within 30 min arrival is fluids, blood draw, and antibiotics. Etc.
100
1) What is autism?
2) Explain what is meant by the autism spectrum.
3) What should you expect from a child with autism?
1) neurodevelopmental disorder that begins in early childhood characterized by impaired social interaction, communication, limited interests, activities, and behaviors, and repetitive patterns of behavior
2) There is a huge spectrum ranging from behaving like an average kid with a few quirks to completely unable to function on their own. Autism can often occur with other neurodevelopmental, mental, and behavioral conditions also causing manifestation to drastically vary.
3) Anything from needing lots of stimulation, movement, tactile, flapping arms to not wanting any stimulation, touch, etc. Keep kids low stim with 1 thing at a time if like this. Don’t expect them to be able to communicate but also don’t assume because they have autism they can’t communicate at all due to large spectrum.
200
1) True or False. Respiratory conditions are the most common cause of hospitalization for kids 1-17.
2) Explain why this is.
1) True
2) When pneumonia and asthma numbers are combined, children most commonly come to hospital for respiratory issues. This is because of their altered respiratory anatomy w/ a shorter neck and airway structures closer together. This also puts them more at risk for foreign-body aspirations.
200
List 3 education topics to go over with parents of a child recovering from either cardiac or respiratory surgery when taking them home?
Put padding in car seat straps
Don’t pick up from under arms
Gentle with bathing
See Ped's Case Study Week 8 for more ideas
200
Name two types of headache and the treatments for them.
1) Tension headache --> treat with OTCs like acetaminophen and ibuprofen
2) Migraine --> treat with prescriptions like IV fluids, nausea meds, and Benadryl
Review table 54-8 for other type and their S/sx
200
1) What is the most common type of cancer?
2) What are the presenting signs and symptoms and what are they caused by?
3) What is the treatment?
1) Leukemia
2) fever (possibly but not always, may even be septic), lymphadenopathy, pallor & fatigue (anemic), signs of bleeding (bruising and petechiae) --> leukemia is when immature cancerous WBC's take over the bone marrow, which then reduces normal WBC, RBC, and platelet counts leading to thrombocytopenia, anemia, and neutropenia.
3) Chemotherapy, possibly radiation, and maybe other drugs if CNS is involved
200
1) What is ADHD?
2) Name clinical manifestations of ADHD.
3) What are treatments for ADHD?
1) Attention deficit hyperactivity disorder
2) Constantly in motion, impulsive, behavioral outbursts b/c they don’t know how to cope with transmissions in day to day activities. Effects boys almost 2.5x more than girls.
3) Treatments are methylphenidate (Ritalin) and behavioral therapies (reinforcing good behavior, sticker charts, awards for goals that are manageable and achievable)
300
1) What are 2 common symptoms of asthma?
2) Name 3 triggers of asthma.
3) What are 2 drugs that are commonly given for this condition?
1) Wheezing, dry-cough, SOB, frequent respiratory infections, frequent coughing (especially at night)
2) Exercise, infection, allergens, fragrances, food additives, pollutants, weather changes, emotions, and stress
3) Albuterol (SABA), prednisolone/methylprednisolone/prednisone (oral corticosteroids) fluticasone (inhaled corticosteroids), Salmeterol (LABA), and more. See page 1170-1171 for full list
300
1) Inflammation and infection of the heart is called this.
2) Signs and symptoms of this include:
1) What is endocarditis?
2) What are fever, feeling crumby, and variable HR. Also include fatigue, joint/muscle aches, loss of appetite, weight loss, diaphoresis, new heart murmur or intensified murmur, and splenomegaly.
300
1) When and how do children with pyloric stenosis present in hospital?
2) What is pyloric stenosis caused by?
1) Generally first present at 4-6 weeks of age with projectile vomiting and possibly dehydration.
2) hypertrophy of circular pylorus muscle b/w the stomach and duodenum that results in stenosis and partial obstruction of the GI lumen. Exact cause is unknown but may have a genetic factor based on gastrin blood levels.
300
1) What are the three oncologic emergency categories?
2) What are the most common emergencies seen in pediatric oncology?
1) Metabolic, hematologic, and space occupying
2) Sepsis and Tumor Lysis Syndrome (TLS) are the most common pediatric oncology emergencies, which are both metabolic oncologic emergencies.
Review page 1289-1290
300
What is Maslow's Hierarchy Of Needs?
400
!!!!!DAILY DOUBLE!!!!!
1) What respiratory condition is most likely happening if a child presents with tripod position/position of comfort, high fever, drooling b/c can’t swallow secretions, and possibly stridor?
2) What would be the priority intervention to prepare for when a child presents to emergency room like this?
3) What would you not do?
1) Epiglottitis
2) Intubation
3) Throat swab or anything that would cause more anxiety --> this would cause throat to close off completely which is a medical emergency.
400
1) How do children with SVT present?
2) What are 3 commonly used interventions for SVT in order? Explain.
1) Can vary from seem totally normal, to describing their heart feeling funny and obvious signs of decreased CO. Infants can show poor feeding, irritability, and pallor. Older kids can have palpitations, chest pain, dizziness, SOB, decreased exercise tolerance, syncope with recurrent attacks common.
2) Valsalva maneuver, amiodaron, then cardioversion. May need radio-frequency ablation or long-term meds depending on the cause.
400
1) What is the priority diagnosis for children with pyloric stenosis?
2) What would be included in pre-op management of pyloric stenosis?
3) What procedure is done to fix pyloric stenosis?
4) What would be included in post-op management of pyloric stenosis?
1) Risk for fluid/electrolye imbalances
2) Pre-op management is based around fluids and electrolytes and getting them back in balance. Will be NPO before. May recheck labs prior to surgery
3) Operation: open up stenosed area with a small slice (pyloromyotomy)
4) Post-op: then can continue feeding usually w/in 24 hrs. Ensure to manage pain (generally just with Tylenol is sufficient for these kids) but use FLACC to be sure.
400
What is the treatment of TLS?
What are the interventions of TLS?
What are priorities of TLS?
Treatment: vigorous hydration, correct electrolyte imbalances, reduce conversion of metabolic by-products to uric acid with meds, meds like Lasix to remove K, and possibly dialysis
Interventions: careful EKG monitoring, renal function monitoring with I/O's, monitor BUN, creatinine, specific gravity (keep above 1.010), and electrolytes. Will have potassium imbalances (collab). Will see hypocalcemia, hyperkalemia, hyperphosphatemia, and hyperuricemia (book).
Priorities: Need to carefully monitor cardiac function w/ an EKG; Renal function can be impaired due to all the waste products being released from cells. Maintaining kidney function is a high priority. Often 3x fluid needs to maintain kidney function and keep things flushed out.
400
1) Signs and symptoms of depression in pediatrics that are criteria for diagnosis?
2) Risk factors for depression?
3) Protective factors for depression?
1) Grades falling, sleep disturbances (lots of very little), lack of hygiene, not caring, changes in behavior and affect. Sometimes will see increased aggression or anger and feeling generally emotional. Also increased willingness to participate in high risk activities.
2) Lack of social support, ability to participate, being at home all the time, being in an environment of drugs/alcohol/abuse/neglect, etc.
3) someone stable in their life (family or peer), social support
500
When a child has croup there are various severities. Explain the signs & symptoms and treatments for both mild croup and severe croup.
Mild croup: parents report child had high-pitched noise on inspiration (stridor) and barky cough then when they get to the emergency room they seem better. The treatment was just the moist outside air. Can also treat with taking a hot steamy shower or putting face over pot of hot water.
Severe croup: high-pitched noise on inspiration (stridor) and barky cough with increased WOB. Will be given nebulized racemic epinephrine over 3-5 min and dexamethasone (strong steroid). If stridor comes back after epi child will need to be admitted for observation and treatment.
500
1) What cardiac condition would a child be prescribed a calcium channel blocker for?
2) Signs of symptoms of this condition?
3) What is the goal of a calcium channel blocker therapy when given to kids with this condition?
1) What is CHF?
2) What are fluid overload (close monitoring of I/O's and weights needed), activity intolerance, sweaty and fatigued when eating w/ babies?
3) What is wanting the heart to not have to work as hard to produce the same cardiac output. The hope is they can then tolerate ADLs better. If its working they can tolerate ADL's.
500
1) What is Zofran's other name?
2) What is Zofran used for and how does it work?
3) What is a potential but rare adverse effect of Zofran? Who is more at risk for this adverse effect?
4) What routes and forms can Zofran be given in? Does it have to be with food?
1) Ondansetron
2) Zofran was originally made for chemotherapy induced nausea but is now broadly used for nausea caused by basically anything
3) Prolonged QT; more common in kids with undiagnosed cardiac issues. Additionally there may be a link between Zofran and cleft lip/palate but not fully explored yet.
4) Zofran can be given IV or oral as a liquid or dissolving tablet.
500
1) What is HSCT?
2) What is the prep for HSCT?
3) What is post-op care after a HSCT?
1) Hematopoietic Stem Cell Transplant: when stem cells are taken from either bone marrow, cord blood, or peripheral blood and of either the patient or a donor and then infused in just like a blood product would be.
2) Must have 7-10 days of chemotherapy and sometimes radiation to wipe out all diseased bone marrow and circulating blood cells. Kept on special strict isolation. Called immunosuppression procedure.
3) Post op care continues for 2-4 weeks as the body begins to produce new healthy blood cells, during which time pancytopenia (<RBCs, WBCs, and platelets) occurs and child needs to treated for anemia, infections, and bleeding. Rejection is a major threat at 2-4 weeks. Assess skin, MM, GI/Resp/Cardiac funx. Lots of bone pain as cells take hold so manage pain closely. Maintain nutrition and hydration and provide psychosocial support. Lengthy treatment. Even after transplant when they go home, lots of teaching for families. Usually homeschooled to avoid sources of infection. Monitoring temp and not taking care of pets.
Review page 1273-1274 and health promotion box on 1274
500
DAILY DOUBLE!!!
1) Name 1 atypical antipsychotic used for aggression & what routes it is given.
2) Name 1 stimulant used for kids w/ ADHD and what to monitor as an adverse effect of this med.
3) Name 2 meds used for antianxiety in pediatrics and note which one is most common
1) Olanzapine (Zyprexa): atypical antipsychotic to manage aggression we can’t handle in another way. Disinigrating tablet or IM if they won’t agree
2) Methylphenidate (Ritilin): used for ADHD. Is a stimulant but has opposite effects on ADHD kids. Monitor weight b/c suppresses appetite. Watch the growth curve and ensure proper nutrtion education
3) Lorazepam (most common for antianxiety) & Metoprolol/Propranolol (indication r/t mental health concerns)