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NURS 307 Final Study Guide
1. Bronchiolitis: most common cause: RSV
2. How is RSV transmitted?: -Transmitted predominantly through direct or close contact with contaminated respiratory secretions
-Viable RSV live on environment surfaces for several hours and on hands for 30 minutes or more
3. Tonsillectomy care: -discourage from coughing frequently, clearing the throat, blowing the nose
-ice collar -pain meds at regular intervals -tetracaine lollipops or ice pops, antiemetics, such as odansetron, or scopolamine patch (ages 12+) -cool water, crushed ice, flavored ice pops, or diluted fruit juice may be given -avoid fluids with red or brown color -suction equipment and oxygen should be available
4. Bronchiolitis symptoms: *fever
*cough *rhinorrhea *wheezing -tachypnea or retractions -apneic spells -altered air exchange -diminished breath sounds
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5. RSV S/S: lethargy, poor feeding, irritability
6. Bronchiolitis: nursing care: -provide humidified oxygen
-suction nasopharynx -encourage fluid intake -contact and standard precautions
7. Bronchiolitis: preventative measure: -administer palivizumab (Synagis) to high-risk infants
-given at onset of the RSV season and then monthly in an IM injection or IV infusion for max of 5 doses
8. Candidates for Palivizumab (synagis): **prematurity, chronic lung, vent dependent, muscular dystrophy
9. Foreign body airway obstruction: -small children (1-3 years) are prone to put FBs into air passages (nose and mouth)
-i.e. beads, toys, paper clips, small magnets, or food items which can be easily aspirated into the trachea
10. Aspirated objects can obstruct the air passage, producing various changes including...: atelectasis, emphysema,
inflammation, abscess
11. FB in the air passage: S/S: choking, gagging, wheezing, or coughing
**stridor, wheezing, sternal retraction, and cough (=most common)
12. Foreign body airway obstruction: therapeutic management: -abdominal thrusts for children old than 1 year of age
-chest thrust for children younger than 1 year old
13. Diagnostic criteria for autism: -Two behavior domains:
*diflculties in social communication and social interaction *unusually restricted, repetitive behaviors, interest, or activities
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22. Respiratory failure is confirmed by assessment: severity is defined by...: capil- lary or arterial blood gas analysis
23. Infective Endocarditis: Causative factor: -Staphylococcus aureus
-viridans streptococci
24. Infective endocarditis: symptoms: **Roth spots, janeway lesions, osler nodes "FROM JANE"
- Fever -Roth Spots -Olser Nodes
- Murmur -Janeway lesions
- Anemia -Nail-bed hemorrhage
- Emboli
25. Infective endocarditis: TX: -high dose of antibiotics IV for 2 to 8 weeks
26. Infective endocarditis: Prevention: admin of prophylactic abx therapy to high risk pts prior to dental procedures (1 hr before
procedure)
27. Pulmonary HTN is defined by a:: mPAP of 25 mmHg or greater in children older than 3 mths of age
28. Pulmonary HTN: 3 causes: 1) increased pulm venous pressure (i.e. mitral stenosis, left ventricle noncompliance)
2) post-tricuspid cardiac shunts (i.e. large VSD, large PDA)
3) small pulmonary arteries
29. Pulmonary artery hypertension: S/S: -dyspnea with or w/out exercise (most common)
5 / 23 -chest pain (coronary ischemia in RV from hypertrophy) -syncope (r/t decreased CO) -RS heart dysfunction (venous congestions & edema) = poor prognosis
30. Pulmonary artery hypertension: education: -exercise prescriptions are specific to each pt
-pts should avoid high altitudes bc of the relative hypoxia -use of anticoagulants -digoxin & diuretics for RS HF
31. Pulmonary artery hypertension: prostacyclin infusion education: -cannot be inter- rupted - can cause HTN crisis
-have back up systems in place -preparation of infusion/use of equipment & maintaining sterility of central line
32. Patients with pulmonary artery hypertension are at risk for:: thromboembolic events
33. Carditis: S/S: -symptom of Rheumatic fever
-tachycardia out of proportion to degree of fever
- cardiomegaly -new murmurs or change in preexisting one -muffled heart sounds -pericardial friction rub -chest pain -changes in ecg (prolonged PR interval)
34. Carditis:: general inflammation of the heart
7 / 23 -Corrective surgery
42. Congenital cardiac defect(s) that increase pulmonary blood flow: - PDA
- ASD
- VSD
-AV canal -left to right shunt
43. Atrial septal defect: description: Abnormal opening between the left and right atria, allowing blood from higher pressure LA to flow into the
lower pressure RA -left to right shunt
44. ASD is what type of defect?: -acyanotic, increases pulmonary BF
45. ASD: Patho: Bc left atrial pressure slightly exceeds right atrial pressure, blood flows from the left to the right atrium causing an increased flow of
oxygenated blood into the right side of the heart
46. ASD: S/S: -May be asymp
-Murmur* (systolic murmur with wide fixed splitting of S2)
47. ASD: complications: -atrial dysrhythmias
-pulmonary vascular obstructive disease -emboli formation
48. Immunizations:
49. Labs to indicate sepsis: -cultures of blood, urine, and CSF
-CRP, serum amyloid A, procalcitonin, interleukin- 6
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50. Sepsis: blood studies show signs of:: anemia, leukocytosis, or leukopenia
-an elevated number of immature neutrophils (a left shift), decreased or increased total neutrophils, and changes in neutrophil morphology
51. Cyanotic Congenital Heart Diseases: -Pulmonary atresia
-Tricuspid atresia -Tetralogy of fallot (TOF)
52. Manifestations of cyanotic defects: -poor feeding
- murmur -poor weight gain/FTT -delayed cap refill
- polycythemia** -cyanosis (DESAT)** -RIGHT TO LEFT SHUNT
53. Encopresis is defined as: repeated bowel movements into bed or clothing at least 1x per month for a period of at least 3 months, is not due to a
physiologic condition or substance, and occurs in individual who is at least 4 years of age
54. Encopresis with constipation and overflow incontinence: requires the passage of stool less than 3x per week
55. Encopresis without constipation and overflow incontinence: where there is no evi- dence on physical examination or by
history of constipation and soiling is no more than intermittent
56. Most common cause of encopresis: CONSTIPATION which may be precipitated by environmental change, such as having a new sibling,
moving to a new house, changing schools, or even having to use new or unfamiliar toilet facilities
57. How is fecal impactation relieved?: -lubricants (i.e mineral orals)
10 / 23 -maintenance fluid therapy -reintroduction of an adequate diet -treat first with oral rehydration therapy
66. Oral rehydration solutions enhance and promote the:: reabsorption of sodium and water
67. Volvulus: the intestine twisting around itself, compromises the blood supply which results in intestinal necrosis, peritonitis, and death
68. Malrotation is caused by:: abnormal rotation of the intestine around the superior mesenteric artery during embryologic development
-most serious type because if the intestine undergoes complete volvulus
69. Hirschsprung disease: s/s: -Abdominal distention
-feeding intolerance -bilious vomiting *failure to pass meconium within 24 to 48 hours after birth
70. Volvulus S/S: -bilious vomiting
-recurrent abdominal pain, distention, or lower GI bleed
71. Necrotizing enterocolitis (NEC) is an:: acute inflammatory disease of the bowel with increased incidence in preterm infants
72. Necrotizing enterocolitis (NEC): what happens: -gas forming bacteria invade the damaged areas to produce pneumatosis intestinais
73. Necrotizing enterocolitis (NEC): increased risk w/: -freq use of AB therapy and anti acid meds
-enteral feeding of hypertonic substances
74. Necrotizing enterocolitis (NEC): diagnostic eval: -sausage shaped dilation of the intestine that progresses to marked distention
and the characteristic pneumatosis intestinalis "soap spuds"
75. Necrotizing enterocolitis (NEC): Therapeutic management: minimal enteral feedings
11 / 23 -fresh human milk has been shown to promote intestinal maturation, reduce liver dysfunction, and improve feeding tolerance -oral probiotics
76. Necrotizing enterocolitis (NEC): medical TX: -discontinuation of all oral feedings
-institution of abdominal decompression via NG suction -admin IV antibiotics -correction of extravasular volume depletion, electrolyte abnormalities, acid-base imbalances, and hypoxia -replace all oral feedings -series of abd. radiographs
77. Necrotizing enterocolitis (NEC): S/S: -distended (often shiny) abdomen
-blood in stool or gastric contents -gastric retention (undigested formula) -localized abdominal wall erythema or induration -bilious vomiting
78. Necrotizing enterocolitis (NEC): nursing care: -avoid rectal temps
-avoid pressure on distended abd -leave undiapered -position supine or on side -measure abdominal girth -measure residual gastric contents before feeding and listen for bowel sounds
79. Growth hormone (GH):
80. Diabetic ketoacidosis (DKA): what should you monitor for?: Monitor for cardiac arrhythmias, because they more
13 / 23 -broad, short feet and hands
86. Risk factor: Glomerulonephritis: -recent group A beta-hemolytic streptococcal infection
87. Glomerulonephritis: S/S: -cloudy tea colored urine
-edema (periorbital, facial)*
- anorexia -reduced UO
- HTN*
- lethargy
- irritability
- proteinuria
- hematuria
88. Glomerulonephritis: labs: proteinuria, hematuria
89. Respiratory syncytial virus:
90. Piaget's cognitive stage of formal operations: -11 to 15 years old
-adaptability and flexibility -adolescents can think in abstract terms, use abstract symbols, and draw logical conclusions from a set of observations
91. Piagets: first year of life: sensorimotor (birth to 24 mths)
92. Play in school age children: -associative play (group play in similar or identical activities but without rigid organization or rules)
-imitative, imaginative, dramatic play
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93. Freud's stages: -Oral (birth to 1 year)
-Anal (1 to 3 years) -Phallic (3 to 6 years) -Latency period (6 to 12) -Genital stage (12 years and older)
94. Motor growth and development for child (1 to 2 years old, 5 months and 8 months):
95. Motor skills: 1 to 2 years old: 12-13 mths: walk alone using a wide stance for extra balance 18 mths: try to run but fall easily
2 years: they can walk up and down stairs
96. Gross motor skills: 5 mths: -can turn from abdomen to back
-when supine puts feet to mouth
97. Fine motor skills: 5 mths:
98. Erikson's theories: -Trust vs mistrust (0-1)
-Autonomy vs shame doubt (1-3) -Initiative vs guilt (3-6) -Industry vs inferiority (6-12) -Identity vs role confusion (12-18)
99. Evidence-based practice (EBP) definition:: is the collection, interpretation, and integration of valid, important, and applicable patient-
reported, nurse observed, and research-derived information
100. Gestational diabetes: Complications during delivery: -shoulder dystocia
-respiratory distress -macrosomnia, but not premature delivery
16 / 23 *endogenous generation of thrombin and plasmin
112. Disseminated intravascular coagulation (DIC):S/S: - petechiae
- purpura -bleeding from openings in the skin (venipuncture site, surgical incisions) -bleeding from umbilicus, trachea (newborn) -evidence of GI bleeding
- hypotension -organ dysfunction from infarction and ischemia
113. Disseminated intravascular coagulation (DIC): Triggers: **SEPSIS
- hypoxia
- acidosis
- shock -endothelial damage
114. Vaso-occlusive sickle cell crisis: first appearing manifestation: -dactylitis (swelling in hands and feet)
115. Vaso-occlusive sickle cell crisis: characterized by: extreme pain caused by ischemia
116. Iron deficiency anemia:
117. Leukemia is an:: unrestricted proliferation of immature WBCs in the blood-forming tissues of the body
-no "tumor" is present but the same neoplastic properties are seen in solid cancers
118. Leukemia: which organs are most severely affected: -liver and spleen
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119. Leukemia: destruction takes place by...: infiltration and subsequent competition for metabolic components
120. Leukemia: S/S early in the disease: -petechial hemorrhages
-wt loss -bruising without a cause -joint pain
121. Leukemia: Consequences: -Anemia from decreased RBCs
-Infection from neutropenia -Bleeding tendencies from decreased platelet production -Spleen, liver, and lymph glands show marked infiltration, enlargement, and fibrosis
122. Wilm's tumor: Manifestations: -usually asymp than the mass
-form, lobated mass on one side or midline of the abdomen -if symptomatic HTN (caused by secretion of excess amounts of renin), abdominal pain, and/or hematuria
123. Wilm's tumor: 2 staging systems: -favorable histology
-anaplastic (unfavorable) histology
124. Ewing sarcoma originates in:: the shaft of long and trunk bones, mostly attecting the pelvis, femur, tibia, fibula, humerus, ulna, vertebra, scapula,
ribs, and skull
125. Unlike osteosacoma, Ewing sarcoma peak incidence is:: 5-30 years, not during years of rapid growth
-appears in the marrow spaces of the bone
126. Ewing sarcoma: manifestations: -deep bone pain
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136. Strawberry hemangiomas: -may not be apparent at birth but may appear within a few weeks and enlarge considerably during the first year
of life then begin to involute spontaneously
137. Cavernous venous hemangiomas involve: deeper vessels in the dermis and have a bluish red color and poorly defined margins
138. Stevens-Johnson Syndrome (SJS): caused by what meds and infections: -po- tentially life threatening hypersensitivity
reaction -severe form of erythema multiforme -allopurinol, anticonvulsants, sulfonamides, acetaminophen, ibuprofen, aleve) or infections such as pneumonia and HIV
139. Toxic epidermal necrolysis (ten): hypersensitivity reaction associated with erythema and steven johnson syndrome
-first the erythema and it leads into TEN s/s sloughing of the skin, blisters, itch and burn **involves more than 30% of the skin surface and extensive damage to the mucous membranes
140. TEN & SJS from medications such as:: - cephalosporins
- NSAIDs
- acetaminophen
- penicillin
141. Pediculosis capitis: itching, caused by the crawling insect and saliva on the skin, is usually the only symptom
142. Erythema multiforme minor: will progress to SJS if left intreated
143. Subdural hematoma is a:: hemorrhage between the dura and the arachnoid membrane that overlies the brain and subarachnoid space
144. Subdural hematoma: most often it is the result of...: assaults or violent shaking
145. Urinary tract infection (UTI): most common cause: E.coli
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146. Seizure disorder:
147. Minimal-change nephrotic syndrome: **decreased UO, ascites, hyperlipidemia, yellow nasal discharge
- proteinuria
- hypoalbuminemia
- edema *damage to the glomerular basement membrane, the permeability is damaged, allowing protein to leak through
148. Hemolytic-uremic syndrome (HUS):
149. Glasgow Coma Scale: LOC scale
150. Glasgow Coma Scale: Consists of a three part assessment: -eye opening
-verbal response -motor response
151. Severely injured children (GCS<8) may have:: a consistent grading of motor response, verbal response, and eye opening
152. Ventriculoperitoneal shunt and care: -shunt down to peritoneal cavity-post op, do not turn shunt on for two days-infant is positioned
carefully on the unoperated side to prevent pressure on the shunt valve-the child remains flat
153. Traumatic brain injury: *When entering the room start questioning the child to check for altered levels of consciousness, PERRLA,
disorientation, confusion*Expect those to range from confusion to disorientation, to comatose, keep assessing
154. Type 2 diabetes mellitus (DM): increased thirst, frequent urination, hunger, fatigue, and blurred vision
155. Celiac Disease: S/S: -Failure to thrive
