NURS 535 UPDATED EXAM SCRIPT QUESTIONS AND
SOLUTIONS RATED A+
✔✔Phototherapy - ✔✔Converts bilirubin to a water soluble form that is easily excreted
Forms:
Fluorescent lighting
Fiberoptic blankets
Goal is to decrease TSB by 4-5 mg/dL or < 15 mg/dL total
✔✔Complications of neonatal jaundice - ✔✔Early: Lethargy, poor feeding, high-pitched
cry, and hypotonia
Late: Irritability, opisthotonos, seizures, apnea, oculogyric crisis, hypertonia, fever
Chronic: Athetoid cerebral palsy, high-frequency hearing loss, paralysis of upward gaze,
dental dysplasia, mild mental retardation
✔✔Clinical risk factors for severe hyperbilirubinemia - ✔✔Jaundice in the first 24 hours
Visible jaundice at discharge
Previous jaundiced sibling
Near term gestation 35-38 weeks
Exclusive breastfeeding
East Asian (4), Mediterranean (1), African origin (12) (G6PD deficiency), 19/61
kernicterus cases = G6PD
Bruising, cephalohematoma, birth trauma
Hemolysis risk, O + maternal blood type, sepsis
✔✔G6PD deficiency - ✔✔Low NADPH leads to hemolytic anemia (free radicals) with
bite cells and heinz bodies
Fava beans, sulfonamides, primiquine, dapsone
X-linked recessive
✔✔G6PD Physical Exam - ✔✔Jaundice
Back pain
Hemoglobinuria (dark urine)
Signs & symptoms of anemia
- Hemoglobin can precipitously drop 2-5 gm
✔✔G6PD Triggers - ✔✔Sulfonamides
-Bactrim, Septra, Gantrisin, trimethoprim
-Oral Hypoglycemics(Orinase)
Chlorampenicol
,Anti-malarials
Nitrofurantoin (Macrodantin, Macrobid, Furalan, Furadantin)
Analgesics
-Aspirin (Excedrin, Anacin, Bufferin)
-Phenacetin (Phrenalin)
-Pepto-Bismol
-Propoxphene (Darvon)
Thiazides
-Chlorothiazide (Diuril)
-Hydrochlorothiazide (Hydroduiril)
✔✔iron deficiency anemia - ✔✔Anemia caused by inadequate iron intake
✔✔iron deficiency anemia - RF, Causes, Diagnosis - ✔✔Age Between 6 mo - 4 yrs and
adolescence
Risk Factors:
-Low socioeconomic status (age 6-24mos)
-Premature infants
-Twins/Triplets
-Adolescents
Causes:
-Excessive whole milk intake in a child over 12 mos. of age
-Impaired iron absorption
-Blood loss
-Inadequate intake of iron
Diagnosis:
-H/H low
-Serum Ferritin low
✔✔iron deficiency anemia treatment - ✔✔Correction of the underlying problem
Replacement of depleted iron stores
-Dietary sources: Counsel foods high in Fe
-Supplements: 6 mg/kg/day of elemental Fe, divided into 1-2 doses
-Give the prescribed medication as ordered
Issues with food:
1. Absorbed best in high acid environment
2. Administer on empty stomach or with citrus juice
,3. Fe can stain teeth: give with a straw or dropper
4. Foods interfere with absorption, but sometimes needed due to unpalatable taste
5. Small frequent feedings if necessary-may decrease N/V/D
Frequent rest periods
-Monitor the child's fatigue level
✔✔Lead Poisoning - ✔✔A medical condition caused by toxic levels of the metal lead in
the blood
✔✔Lead Poisoning Pathophysiology - ✔✔Exposure occurs through inhalation, ingestion
or occasionally skin contact.
Lead may be taken in through direct contact with mouth, nose, and eyes (mucous
membranes), and through breaks in the skin.
Lead absorption is higher in infants and children
The main body compartments that store lead are the blood, soft tissues, and bone; the
half-life of lead in these tissues is measured in weeks for blood, months for soft tissues,
and years for bone.
Lead has no known physiologically relevant role in the body, and its harmful effects are
myriad.
Lead and other heavy metals create reactive radicals which damage cell structures
including DNA and cell membranes.
✔✔S/S of Lead poisoning - ✔✔Drowsiness, clumsiness, ataxia, seizures, coma, resp.
arrest
✔✔Lead poisoning treatment - ✔✔CaEDTA, Dimercaprol (adults), succimer (kids)
✔✔Lead poisoning prevention - ✔✔Prevention: Hand washing, remove shoes,
adequate dietary intake of Ca and Iron, hazards of renovations, clean
✔✔Sickle cell disease - ✔✔A group of genetic disorders characterized by:
-Production of hemoglobin S
-Chronic hemolytic anemia
-Acute & chronic tissue damage secondary to the blockage of blood flow by abnormally
shaped RBCs
✔✔Sickle cell pathophysiology - ✔✔Glutamic acid (hydrophilic) replaced by valine
(hydrophobic) at position 6 in beta globin chain
, ✔✔Laboratory analysis for sickle cell - ✔✔Platelet count should be high
ESR is normal
Reticulocyte level should be elevated (>5%)
LDH/AST are elevated secondary to hemolysis
✔✔Sickle cell disease - physical exam - ✔✔Growth
-May be delayed
-"Catch up" growth is common in adolescence
Common findings
-Assess spleen
-Scleral icterus
-Functional murmur
-Mild, generalized lymphadenopathy
-Slightly enlarged liver
✔✔Sickle cell crisis - ✔✔Intense pain because blood vessels can become blocked or
the defective red blood cells can damage organs in the body. HYDRATE
✔✔Types of sickle cell crisis - ✔✔(1) Vasoocclusive crisis (2) Sequestration crisis (3)
Aplastic crisis
✔✔Pain management for sickle cell disease - ✔✔Opioids or NSAIDS
✔✔SCD Infections - ✔✔6 months - 3 years are 400 times more likely to become
infected by Strep Pneumonia
✔✔SCD Fever management - ✔✔Fever > 101 requires treatment
Chemo ppx PCN from 2 months - 5 yeras
✔✔SCD Summary - ✔✔Hydration, Hydration, Hydration!
(Keep the vascular bed open!)
Oxygen
Pain management
Prophylactic antibiotics (monitor for infection)
Monitor for complications (neuro/cardio/resp)
Psychosocial support
✔✔Thalassemia - ✔✔Inherited defect in ability to produce hemoglobin
✔✔S/S of Thalassemia - ✔✔1. Pale
2. Tachycardia/Tachypnea
3. Hepatosplenomegaly
SOLUTIONS RATED A+
✔✔Phototherapy - ✔✔Converts bilirubin to a water soluble form that is easily excreted
Forms:
Fluorescent lighting
Fiberoptic blankets
Goal is to decrease TSB by 4-5 mg/dL or < 15 mg/dL total
✔✔Complications of neonatal jaundice - ✔✔Early: Lethargy, poor feeding, high-pitched
cry, and hypotonia
Late: Irritability, opisthotonos, seizures, apnea, oculogyric crisis, hypertonia, fever
Chronic: Athetoid cerebral palsy, high-frequency hearing loss, paralysis of upward gaze,
dental dysplasia, mild mental retardation
✔✔Clinical risk factors for severe hyperbilirubinemia - ✔✔Jaundice in the first 24 hours
Visible jaundice at discharge
Previous jaundiced sibling
Near term gestation 35-38 weeks
Exclusive breastfeeding
East Asian (4), Mediterranean (1), African origin (12) (G6PD deficiency), 19/61
kernicterus cases = G6PD
Bruising, cephalohematoma, birth trauma
Hemolysis risk, O + maternal blood type, sepsis
✔✔G6PD deficiency - ✔✔Low NADPH leads to hemolytic anemia (free radicals) with
bite cells and heinz bodies
Fava beans, sulfonamides, primiquine, dapsone
X-linked recessive
✔✔G6PD Physical Exam - ✔✔Jaundice
Back pain
Hemoglobinuria (dark urine)
Signs & symptoms of anemia
- Hemoglobin can precipitously drop 2-5 gm
✔✔G6PD Triggers - ✔✔Sulfonamides
-Bactrim, Septra, Gantrisin, trimethoprim
-Oral Hypoglycemics(Orinase)
Chlorampenicol
,Anti-malarials
Nitrofurantoin (Macrodantin, Macrobid, Furalan, Furadantin)
Analgesics
-Aspirin (Excedrin, Anacin, Bufferin)
-Phenacetin (Phrenalin)
-Pepto-Bismol
-Propoxphene (Darvon)
Thiazides
-Chlorothiazide (Diuril)
-Hydrochlorothiazide (Hydroduiril)
✔✔iron deficiency anemia - ✔✔Anemia caused by inadequate iron intake
✔✔iron deficiency anemia - RF, Causes, Diagnosis - ✔✔Age Between 6 mo - 4 yrs and
adolescence
Risk Factors:
-Low socioeconomic status (age 6-24mos)
-Premature infants
-Twins/Triplets
-Adolescents
Causes:
-Excessive whole milk intake in a child over 12 mos. of age
-Impaired iron absorption
-Blood loss
-Inadequate intake of iron
Diagnosis:
-H/H low
-Serum Ferritin low
✔✔iron deficiency anemia treatment - ✔✔Correction of the underlying problem
Replacement of depleted iron stores
-Dietary sources: Counsel foods high in Fe
-Supplements: 6 mg/kg/day of elemental Fe, divided into 1-2 doses
-Give the prescribed medication as ordered
Issues with food:
1. Absorbed best in high acid environment
2. Administer on empty stomach or with citrus juice
,3. Fe can stain teeth: give with a straw or dropper
4. Foods interfere with absorption, but sometimes needed due to unpalatable taste
5. Small frequent feedings if necessary-may decrease N/V/D
Frequent rest periods
-Monitor the child's fatigue level
✔✔Lead Poisoning - ✔✔A medical condition caused by toxic levels of the metal lead in
the blood
✔✔Lead Poisoning Pathophysiology - ✔✔Exposure occurs through inhalation, ingestion
or occasionally skin contact.
Lead may be taken in through direct contact with mouth, nose, and eyes (mucous
membranes), and through breaks in the skin.
Lead absorption is higher in infants and children
The main body compartments that store lead are the blood, soft tissues, and bone; the
half-life of lead in these tissues is measured in weeks for blood, months for soft tissues,
and years for bone.
Lead has no known physiologically relevant role in the body, and its harmful effects are
myriad.
Lead and other heavy metals create reactive radicals which damage cell structures
including DNA and cell membranes.
✔✔S/S of Lead poisoning - ✔✔Drowsiness, clumsiness, ataxia, seizures, coma, resp.
arrest
✔✔Lead poisoning treatment - ✔✔CaEDTA, Dimercaprol (adults), succimer (kids)
✔✔Lead poisoning prevention - ✔✔Prevention: Hand washing, remove shoes,
adequate dietary intake of Ca and Iron, hazards of renovations, clean
✔✔Sickle cell disease - ✔✔A group of genetic disorders characterized by:
-Production of hemoglobin S
-Chronic hemolytic anemia
-Acute & chronic tissue damage secondary to the blockage of blood flow by abnormally
shaped RBCs
✔✔Sickle cell pathophysiology - ✔✔Glutamic acid (hydrophilic) replaced by valine
(hydrophobic) at position 6 in beta globin chain
, ✔✔Laboratory analysis for sickle cell - ✔✔Platelet count should be high
ESR is normal
Reticulocyte level should be elevated (>5%)
LDH/AST are elevated secondary to hemolysis
✔✔Sickle cell disease - physical exam - ✔✔Growth
-May be delayed
-"Catch up" growth is common in adolescence
Common findings
-Assess spleen
-Scleral icterus
-Functional murmur
-Mild, generalized lymphadenopathy
-Slightly enlarged liver
✔✔Sickle cell crisis - ✔✔Intense pain because blood vessels can become blocked or
the defective red blood cells can damage organs in the body. HYDRATE
✔✔Types of sickle cell crisis - ✔✔(1) Vasoocclusive crisis (2) Sequestration crisis (3)
Aplastic crisis
✔✔Pain management for sickle cell disease - ✔✔Opioids or NSAIDS
✔✔SCD Infections - ✔✔6 months - 3 years are 400 times more likely to become
infected by Strep Pneumonia
✔✔SCD Fever management - ✔✔Fever > 101 requires treatment
Chemo ppx PCN from 2 months - 5 yeras
✔✔SCD Summary - ✔✔Hydration, Hydration, Hydration!
(Keep the vascular bed open!)
Oxygen
Pain management
Prophylactic antibiotics (monitor for infection)
Monitor for complications (neuro/cardio/resp)
Psychosocial support
✔✔Thalassemia - ✔✔Inherited defect in ability to produce hemoglobin
✔✔S/S of Thalassemia - ✔✔1. Pale
2. Tachycardia/Tachypnea
3. Hepatosplenomegaly
