NR602 FINAL STUDY GUIDE PEDIATRICS FINAL EXAM 2024-2025 STUDY GUIDE, Exams of Nursing

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NR602 FINAL STUDY GUIDE PEDIATRICS FINAL EXAM 2024-

2025 STUDY GUIDE

NR 602 FINAL REVIEW

Eye disorders

Musculoskeletal Injuries – assessment and treatment

Rashes and Dermatologic conditions

Mongolian spots

▪ are congenital birthmarks seen most commonly over the lumbosacral area. ▪ They are bluish-green to black in color and oval to irregular in shape. ▪ They are most commonly found in individuals of African or Asian ethnic background.

Lead poisoning

▪ Lead poisoning (plumbism) is often a comorbid condition to iron deficiency anemia. A child at risk for lead exposure should be screened at 9 to 12 months of age and again at 24 months. An estimated 99% of lead-poisoned children are identified through screening procedures rather than clinical recognition. Additional screening should be done at 15 and 30 months of age based on at-risk status ▪ If the initial blood lead level is 5 mcg/dL or greater on a single visit, it is a concern for public health purposes. ▪ The United States has made great strides in reducing lead toxicity through the elimination of tetraethyl leaded gasoline, banning lead-containing solder to seal food and beverage cans, and a federal rule to limit the amount of lead allowed in paint intended for household use.

Headaches

▪ Avoid known dietary triggers ▪ Avoid aged cheeses, some nuts, onions, chocolate, aspartame, processed meats with nitrates (e.g., hot dogs/pepperoni), monosodium glutamate (MSG), refined sugar, processed carbohydrates; limit caffeine, avoid foods high in omega-6 fatty acids; ensure adequate hydration. Increase omega-3 fatty acids (wild salmon, herring, mackerel, cod, sardines; fish oil; flax and hemp seeds; walnuts; algae).

Musculoskeletal assessment of the infant

Cystic Fibrosis

Traumatic brain injury

Sickle cell anemia

Iron deficiency anemia

Anemia of prematurity

Thalassemia

Otitis media with and without Effusion

Tourette syndrome

▪ genetic disorder of synaptic neurotransmission with neurobehavioral signs including tics. ▪ Common conditions associated are obsessive-compulsive disorder, attention deficit, anxiety, mood and conduct disorder, and oppositional defiant behavior. ▪ Tourette syndrome is more common in males than females. ▪ Diagnostics: Assessment- multiple motor tics and one or more phonic tics, multiple times a day, no tic-free periods for more than 3 consecutive months. Onset usually occurs before 21 y.o. ▪ Refer to neurology for evaluation and treatment is symptomatic Urinary tract infection (UTI) Cerebral Palsy page 995

▪ There are three major types of CP: (1) spastic, (2) athetoid (or dyskinetic), and (3) ataxic. ▪ Antispasmodic medications (baclofen, tizanidine, diazepam, and dantrolene) may be used to minimize contractures and spasticity. They are appropriate for children needing only a mild decrease in their muscle tone or in those with widespread spasticity. For optimal results, dosages often need to be high, and side effects can result (drowsiness, upset stomach, high blood pressure, and possible liver damage with chronic use).

Genitourinary anomalies

Diabetes

Epilepsy

Leukemia

ADHD, Dyslexia, ODD, bipolar, depression

Illegal substance use/abuse

Pinworms page 812

▪ AKA enterobius vermicularis

Incubatio n

Signs and Symptoms

Duration of Illness

Route of Transmission

Laboratory Testing

Treatment

Peiod 1 - 2 months, or longer from ingestion to migration to perianal area

Perirectal and/or vaginal pruritus; nervous irritability, hyperactivity, insomnia; urethritis, vaginitis, salpingitis, and pelvic peritonitis have been reported

Reinfection common in children

ingested eggs from soil, water contamination, or direct fecal- oral route from fomites on bedding, clothing, toys, baths; person- to-person. Female lays eggs in perianal area and dies; ingested eggs hatch, become larvae in small intestine, and migrate to rectum.

1 cm long white, threadlike worms can be visualized at anus during night after child has been asleep for 2 - 3 h. Microscopic examination: Use transparent adhesive tape applied to anus to collect any eggs or pinworms present on three consecutive nights or mornings before child arises. Direct stool examination usually not productive.

Mebendazole, pyrantel pamoate, or albendazole an d repeated in 2 weeks; also treat family members; vaginitis is self- limiting. Easily spread among family members, in day care settings, and institutions (up to 50% infestation rates in these populations). Preventive: Morning baths, change bedding, hand hygiene, clip fingernails, avoid scratching perianal region, avoid nail biting. Day care precautions include hand hygiene, proper handling of underwear and diapers.

Congenital Heart Defects in Children page 717

▪ Many congenital heart defects may be recognized by a detailed fetal ultrasound and known before delivery. Critical congenital heart defects may be detected in the immediate postdelivery period by using pulse oximetry screening ▪ Examples include…Congestive heart failure, left-to-right shunting (atrial septal defect) congenital heart disease, Right-to left shunting (ventricular septal defect)

Kawasaki Disease page 560

▪ coronary artery vasculitis

▪ consulted by cardiologist ▪ presents as an acute febrile illness and is the leading cause of acquired heart disease

Rheumatic Fever

▪ Rheumatic fever is an inflammatory disease that can develop when strep throat or scarlet fever isn't properly treated. Strep throat and scarlet fever are caused by an infection with streptococcus bacteria.

RSV Bronchiolitis page 683

▪ Bronchiolitis is the most common respiratory infection in infancy, causing cell death and necrosis of respiratory epithelial cells lining small airways. ▪ Bronchiolitis is characterized by the insidious onset of URI symptoms, decreased feeding, and mild fever, with apnea as a possible presentation in the younger infant. ▪ In 50% to 80% of patients with bronchiolitis, the causative agent is RSV

Croup

▪ Croup (laryngotracheobronchitis) is the most common cause of upper airway obstruction in children. It is an acute, inflammatory disease of the larynx, trachea, and bronchi that clinically presents with a brassy cough that sounds like a bark and is associated with varying degrees of inspiratory stridor, hoarseness, and respiratory distress. ▪ The clonus elasticus, the lower portion of the laryngeal membrane that is plastic and thicker, is prone to edema due to its lax mucosal attachment, which is the reason why the subglottic region is the most narrowed area despite edema of upper airway and trachea. ▪ Laryngotracheobronchitis (LTB) causes disease in children younger than 6 years old. The Westley scale developed in the 1970s is still used as an objective way to assess severity. ▪ Viral croup is most common in children between 6 and 36 months old (60% are younger than 24 months) and occurs most often in fall and winter

Asthma – all levels of severity page 523; Asthma is characterized by varying degree of airflow obstruction that presents as coughing, wheezing, chest tightness, breathlessness, and respiratory distress.

Classification and Step Symptoms a^ Nighttime Symptoms Lung Function

Step 1: Intermittent

Symptoms two times or less per week Asymptomatic and normal PEF between exacerbations Requires SABA 2 days/week Exacerbations brief (few hours or days); varying intensity No interference with normal activity

Two times or less per month

FEV 1 >80% predicted Normal FEV 1 between exacerbations

Step 2: Mild persistent

Symptoms more than two times per week but less than one time per day

Three to four times per month

FEV 1 >80% predicted

Classification and Step Symptoms a^ Nighttime Symptoms Lung Function

Requires SABA more than 2 days/week but not more than one per day Exacerbations may affect activity (minor)

Step 3: Moderate persistent

Daily symptoms Daily use of inhaled SABA Some limitations Exacerbations affect activity, two times or more per week; may last days

More than one time per week but not nightly

FEV 1 >60% but <80% predicted

Step 4: Severe persistent

Continual symptoms Requires SABA several times/day Extremely limited physical activity Frequent exacerbations

Often seven times per week

FEV 1 <60% predicted

Gastroenteritis

▪

GERD

▪ Common in young infants for anatomical reasons but can be present in any age group. ▪ In infants, spitting up is a common occurrence and can happen frequently after meals. It is important for the clinician to differentiate between physiologic spitting and GERD.

genu varum

▪ bowing of the legs, can be a physiologic or developmental variation of normal or a pathologic condition that involves a rotational deformity ▪ Condition is considered normal up until three years of age

Genu Varum (A) and Genu Valgum (B)

In genu varum (A), the knees are tilted away from the midline; the intercondylar (knee) distance with the ankles together is then measured. In genu valgum (B), the knees are tilted toward the midline; the intermalleolar distance with the knees approximated is then measured.

Cholesteatoma

▪ is usually the result of a chronic ear infection and involves the formation of an epidermal inclusion cyst of the middle ear or mastoid consisting of desquamated debris from the keratinizing, squamous epithelial lining of the middle ear. ▪ Cholesteatomas can be congenital, primary acquired, or secondary acquired. Congenital cholesteatomas are small and self-contained at birth and initially appear as a pearly white mass behind the TM. Primary acquired cholesteatomas arise from negative middle ear pressure that causes TM retraction and subsequent accumulation of an erosive keratin-filled cyst. Secondary acquired cholesteatomas are the result of skin ingrowth from a perforated TM or trapped epithelium due to ear trauma or a procedure. ▪ Managed surgically ▪ Patient presents with chronic otitis media with malodorous purulent otorrhea, Vertigo and hearing loss, History or presence of tympanostomy or PE tubes and a pearly white lesion is present on or behind the TM. Aural polyps are considered cholesteatomas unless proven otherwise. Congenital cholesteatomas are often in the most anteroinferior position behind the TM

Legg-Calve’-Perthes Disease – Avascular necrosis of femoral head

▪ At risk for avascular necrosis ▪ Pain in groin, knee, thigh and has decreased internal rotation ▪ Typically happens at onset of puberty in overweight boys with delayed puberty ▪ Management: refer to orthopedist, containment of femoral head in acetabulum

Idopathic Scoliosis – Hereditary

▪ Most common type of scoliosis

▪ Curvature >10 degrees ▪ Management – Physical therapy/exercise, dancing and swimming

Dysplasia of the hip

▪ Femoral head/acetabulum improper alignment o Dysplastic, subluxated, dislocatable, dislocated o Dysplasia – shallow acetabulum o Subluxation – hip unstable o Occurs congenitally or develops in infancy o Physiologic factors – maternal hormones o Mechanical factors – compression in utero o Genetic factors – positive family history o History – risk factors for DDH

Scoliosis – Three-dimensional deformity of lateral curvature of the spine

▪ Lateral curvature of the spine. High incidents in adolescent girls, onset in puberty ▪ Functional (Nonstructural) Scoliosis: 5–10-degree curvatures are functional and are monitored, curve without rotation of vertebrae, reversible – when it is caused by posture, pain, leg length discrepancy ▪ Structural scoliosis: mild-curvature > 10 degree using Cobb method ▪ <20 degree-closely observe every 3-4 mo during growth spurts. ▪ Serious cases with 25-40 degrees, refer to ortho, Milwaukee brace for 23 hours a day. ▪ Functional scoliosis is self-limiting, structural scoliosis produces prominent scapula, ribs, uneven shoulder and asymmetric waistline or back pain. F/U annually during well child exam.

Osgood-Schlatter

▪ Aseptic necrosis of the tibial tubercles and apophysis. Signs and symptoms: painful swelling of tibial tubercle, limp, intermittent pain over months, hip pain may be aggravated by extension of knee against resistance, worsens with squatting, stair walking, forceful contraction of the quadriceps, usually due to overuse injury associated with athletic activity during rapid growth of tibial tuberosity, relived by rest. ▪ More common in males. ▪ Diagnostics: X-ray, MRI if osteochondral lesion.

Febrile Seizures

▪ In children less than 90 days old, tympanic, and temporal artery measures of temperature are accurate, rectal should be the method of choice. In children older than 6 mo. of age, tympanic methods can be used if the correct positioning of the ear can be maintained and if the ear canal is not filled with wax. ▪ In children older than 6 months of age, oral methods can be used if the correct positioning and holding of the oral thermometer can be maintained. ▪ Tympanic measure is a convenient method and requires little time or discomfort to children, but in situations where the child is quite ill or precision is needed, this method has been found to vary and should not be used.

▪ When a temperature is reported to a healthcare office by a parent or guardian, the following information should be noted: time of day, method, whether the parent added any numbers to the measure (straight measure is preferred) site, whether the child had any antipyretic medication in the previous 4 hours maximum level of fever at home, and how long the temperature has been elevated

Testicular Torsion

▪ Testicular Torsion the result of twisting of the spermatic cord, which subsequently compromises the blood supply to the testicle ▪ The left side is twice as likely to be involved because of the longer spermatic cord. ▪ Occasionally manual reduction can be performed, but surgery should follow within 6 to 12 hours to prevent retorsion, preserve fertility, and prevent abscess and atrophy

Wilm’s Tumor –

▪ The most common malignancy of the GU tract is typically found as a firm, smooth mass in the abdomen or flank. It is staged as follows: o Stage I: The tumor is limited to the kidney and can be completely excised with the capsular surface intact. o Stage II: The tumor extends beyond the kidney but can still be completely excised. o Stage III: There is postsurgical residual nonhematogenous extension confined to the abdomen. o Stage IV: There is hematogenous metastasis, most frequently to the lung. o Stage V: There is bilateral kidney involvement ▪ Wilms tumors occur in children between 2 and 5 years old.

Turner Syndrome – Sex chromosome disorder that only affects females

▪ a condition that affects only females, results when one of the X chromosomes (sex chromosomes) is missing or partially missing. ▪ Monitor growth using syndrome-specific growth chart; short stature is expected; GH treatment typically begun early (∼4-5 years of age). ▪ Nonverbal (e.g., math) learning disabilities are common. ▪ Annual hearing exam; recurrent otitis media; progressive midfrequency sensorineural hearing loss. ▪ Ongoing vision assessment; strabismus. ▪ Early onset osteo-penia/-porosis; vitamin D supplementation; appropriate estrogen therapy; exercise. ▪ Monitor BP (hypertension). ▪ Annual thyroid screen (hypo-/hyperthyroidism); monitor for celiac disease. ▪ Ongoing assessment for celiac disease (tissue transglutaminase immunoglobulin A). ▪ Careful early monitoring for kyphosis, scoliosis, lordosis. ▪ Increased risk of hyperlipidemia; cardiac defects (e.g., aortic root dilatation; bicuspid aortic value; coarctation of aorta) and renal anomalies (e.g., horseshoe kidney, double collecting system, increased urinary tract infection [UTI]).

▪ Supplemental estrogen therapy for sexual development and preservation of bone mineral density (late childhood/early adolescence). ▪ Tendency to form keloids.

Down Syndrome – Chromosomal Disorder with chromosome 21 (Trisomy)

▪ Down syndrome occurs when an individual has a full or partial extra copy of chromosome 21 ▪ Careful review of newborn screen for hypothyroidism. Annual and/or systematic screening for hypothyroidism. ▪ Careful review of newborn critical congenital heart disease (CCHD) with ongoing cardiac evaluations. ▪ Monitor growth using syndrome-specific growth chart. ▪ Ongoing ophthalmologic exam for cataracts. ▪ Careful review of newborn hearing screening, followed by ongoing otologic/hearing evaluation. ▪ Monitor for obstructive sleep apnea. ▪ Increased risk for duodenal atresia. ▪ High risk for atlantoaxial instability; if any signs of cervical myelopathy, obtain radiograph, refer to neurosurgery. ▪ Monitor for neurologic conditions (e.g., infantile spasms, seizures, Moyamoya malformation). ▪ Systematic screening for celiac disease (CD). ▪ Increased risk for leukemia.