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What dietary teachings should be offered to an infant's parents regarding iron supplements ?
- - Formula fortified w/ iron by age 6 mos
- - Iron fortified cereals or iron drops (for breastfed infants)
- -Limit cow's milk to 24 oz/day.
- -Limit fast food
- -Iron rich foods: red meat, tuna, salmon, eggs, enriched grains, leafy vegetables)
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What dz is this?
-DDAVP (a synthetic form of vasopressin) can increase a factor that this dz is missing 2-4x. Only for mild cases
-Dry heat is a home intervention
-Avoid contact sports, but swimming is OK
Hemophilia A
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What is the drug of choice for pain management of SCA?
Morphine.
Do not give Demerol!!!
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What are some interventions for the administration of iron supplements?
- -Place liquid behind teeth (b/c iron can stain teeth): via straw, syringe
- -Give with citrus fruit or juice (since iron absorbs well in acid environment)
- -DO NOT give it with milk-Increase fluid & fiber since iron can cause constipation.
- -If given IM, use Z-track method. Do not massage.
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What should you teach the parents to observe for when iron dose is adequate?
-Tarry green stool is when dose is adequate
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During bleeding episodes in a hemarthrosis patient, what should the nurse do?
- 1. Elevate immobilize joint
- 2. Ice & analgesics
- 3. ROM & exercises after bleeding stops to prevent contractures
- 4. PT
- 5. Teach to avoid obesity to minimize joint stress
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1. Children born to an HIV positive mothers should receive a 6-week course of _________ therapy
2. Can the mother still breastfeed?
1. ZIDOVUDINE
2. NO
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What are some teachings for an SLE infant's family?
- 1. apply sunscreen
- 2. protect against cold weather
- 3. fingers & toes should be inspected for discoloration
- 4. watch for development of nephritis
- 5. vision screening
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What is the drug of choice for lyme disease for a 10 y.o pt.?
What is the drug of choice for lyme disease for a 3 y.o pt.?
1. Doxycycline
2. Amoxicillin
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Is cough a symptom of epiglottis?
What are some things a nurse should not do when taking care of a case of epiglottis?
1. Epiglottis pts don't experience cough as a symptom
2. DO NOT attempt to visualize throat, do not leave patient unattended, do not place patient in supine position
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How do you know when to take your kids to the ER if kid's been having croup?
If kid breathes faster, has reatractions, or difficulty breathing.
If nostrils flare or lips or nails have bluish tint
If cough or stridor does not improve with exposure to moist air
If child is confused
If child bgins to drool or cannot swallow
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What do they do in ER for kids w/ croup?
- Give single dose of corticosteroid to reduce inflammation
- Give aerosol nebulizer to reduce edema
- Give IV fluids
- Monitor at least 3 hours after receiving rx for rebound.
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What is one noted difference between the symptoms of viral strep pharyngitis & bacterial pharyngitis?
- With bacterial, there's NO nasal symptom.
- With viral, you experience nasal congestion, sore throat, URI sx
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What's a test to diagnose strep pharyngitis?
Throat Swab/Culture. Do both at the same time!!!
If swab is positive, then you don't send off culture. You treat it
If swab is negative, then you send off culture.
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The Dr. had decided to prescribe penicillin to the strep pharyngitis pt. because his swab was positive.
You are to make sure he takes the whole course of his abx, stay hydrated, acetaminophen if fever or pain, and gargle his saline every now & then.
What if your patient is allergic to penicillin?
Give him azithromycin
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What's the first thing you would do for a severe dehydrated pt, giving that you have standing orders?
- 1. Start 20ml/kg NS or LR until BP comes back up.
- 2. Initial rehydration should be 20-40 ml/kg over 2-4 hours. ORT is 5-10ml every 1-2 min = 150-300ml/hr
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What is the patho for Hirschsprung dz?
Lack of ganglion cells in the bowel causes inadequate motility in the part of the intestine. These ganglion cells can be absent from the rectosigmoid colon all the way into the small intestine.
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The 9 y.o child is constipated. What would you recommend his fiber intake should be?
His age + 10 g daily.
9+10 g = 19 g daily
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What is the classic sign of Meckel's diverticulum?
What do you see most in their HPI?
What are some tests ordered for Meckel's
How do you treat Meckel's?
1. Currant-jelly stool
2. h/o of bleeding & anemia.
3. abd xrays, CBC, stool tests, Meckel's scan for colloid or RBC
4.. Treat anemia as ordered. Then surgery to remove diverticulum.
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What's a test to r/o constipation?
KUB
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What are some of the sx seen in a Crohn's pt?
- 1. Acute onset
- 2. Positive Hemoccult.
- 3. Diarrhea. N/V (anorexia, weightloss)
- 4. Fever, malaise
- 5. Anemia, joint pain, liver involvement, eye involvement
- 6. Mouth ulcerations
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What is the patho of Meckel's diverticulum?
incomplete fusion of the omphalmesenteric duct.
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Children with neutropenia & fever must be started on what w/o delay to avoid overwhelming sepsis?
Broad-spectrum abx.
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What are some factors that might induce sickle cell crisis?
-Anything that decreases the body's need for O2 or alter the transport of O2:
- Trauma
- Infections --> fever
- Physical & emotional tress
- Dehydration
- Hypoxia
- Hypothermia
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What are 3 types of sickle cell crisis. Use 1-2 words to describe each type.
- 1. VOC (Vaso-occlusive thrombotic): Painful
- 2. Splenic sequestration: Life-threatening, hypovolemia
- 3. Aplastic crises: triggered by viral infxn.
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What are the first physical signs of sickle cell crisis?
Painful, swollen hands & feet & joints.
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Should you give O2 to a sickle cell crisis patient?
Only if the patient is hypoxic. Otherwise, it might inhibit erythropoeisis
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What are some complications of SLE?
- 1. visual changes
- 2. CVA. Seizures. Psychosis
- 3. Transverse myelitis
- 4. Immune complex-mediated glomerulonephritis
- 5. Pericarditis. Valvular heart dz. Coronary heart dz.
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What's a classic sign of cat scratch dz?
Lymphadenopathy
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A pt. with chicken pox outbreak should be on what kind of precautions?
A pt. w/ Scarlet fever should be on what kind of precautions? When can the kid go back to school?
1. Contact & airborne precautions
2. Droplet precautions. The kid can go back to school 24 hours after abx or until afebrile
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What's the abx to treat AOM?
What's a nonpharmacological rx for AOM?
oral amoxicillin (80-90mg/kg/day BID x 10-14 days)
Application of heat or cool compress on the affected ear
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Allergic conjunctivitis sx. AFEBRILE. Bilateral swollen eyes, watery, mucous discharge, inflamed conjunctiva. What's one significant sx that's associated w/ A.C?
What's the treatment for A.C?
- itching
- rhinitis & related nose/throat sx.
Antihistamine and/or mast cell stabilizer drops
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What's a pharmalogical management for PDA? in cath lab? Surgery?
- -indomethacin (prostaglandins)- to shrink PDA
- -coil occlusion in cath lab
- -clip on ductus in surgery
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AV canal defect (a type of VSD) is common in what population?
in kids w/ downs syndrome
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If a kid vomits after taking digoxin, what should you do?
it's a s/e of digoxin. also the 1st thing u see in kids. Don't repeat the dose.
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What are some nursing interventions for a pt. w/ kawasaki dz?
1. monitor cardiac status
2. sx relief
3. ivig administration
4. emotional support
5. discharge teaching
- 1. watch for signs of CHF, watch fluid intake b/c they could go into CHF any minute when coronary is involved
- 2. skin discomfort (skin's peeling, rashes). Mouth care. Fever, irritability
- 3. watch for allergic rxn. cardiac status: watch if heart can tolerate all these fluids. same guidelines as blood products
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If it gets serious, what's going to happen to an adult w/ unrepaired ASD?
atrial dysrhythmias, pulmonary & vascular dz & emboli formation.
Can lead to stroke
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What are the qualifcations for surgery to repair ASD in children?
Repair electively by age 2-5 or earlier if
symptomatic (FTT, CHF, MR)
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The child had finished the course of abx for bacterial pneumonia yesterday. Today the mother calls to ask why her son is still very tired. She's been following all instructions given: adequate hydration, encourage her child to sit w/ HOB elevated. What should the nurse say to the mom?
Expect that the resolution for this illness is 1-2 weeks after treatment. Child might need to continue small frequent feeds, cough might persist and child might still be very tired
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What's an expected O2 sat range for a kid w/ bacterial pneumonia w/ no previous medical hx?
97% +. Once drops to 94 or 95, this could be problematic
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What is usually prescribed for epiglottis?
What is the usual cause of epiglottis?
1. dexamethasone abx
2. HiB
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What's the first CM of CF?
meconium ileus
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What's one thing that you need to evaluate every visit for CF patient?
growth & development.
Usually children w/ CF has poor weight gain
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What do you see on biopsy in a Crohn's disease patient?
Granulomas
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GI dz that would cause positive Hemoccult test are:
- 1. Crohn's
- 2. Intussception
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What are some diseases that cool mist humidifier would help?
- 1. Croup
- 2. Epiglottis
- 3. Scarlet Fever
- 4. Strep Pharyngitis
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What test is used to diagnose hemophilia?
Amniocentesis
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What rate of IV fluid should you set for a hemophilic pt.?
1.5-2x maintenance rate
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Goal for HIV pt is to prevent infection & promote nutritio. Immunization is one of the plans to prevent infxn. Can you give live vaccine to an HIV pt.?
NO
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What are some lab tests to determine Lyme dz?
- 1. Enzyme immunoassay or immunofluorescent assay
- 2. Western immunoblot
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An immunocompromised pt contracted chicken pox. What's the treatment for him?
IV acyclovir. isolation until 5 days after last lesion crust
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What should the child be immunized with to prevent OM?
Prevnar
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Treating kawasaki within ____ days can greatly reduce the chances of lasting damage
10
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