NUNP 6541 Pediatric Final Exam study guide-Walden
University;(100% Correct)
Recommended treatment for RSV in a 7 month old (outpatient)
Use of saline drops and suctioning of the nares. Indications of when to use antipyretics.
Signs of respiratory distress or dehydration. Guidelines for feeding an infant with signs
of mild respiratory distress which includes smaller more frequent feedings; monitoring of
the respiratory rate; and guarding against vomiting. The parents should be educated
that the child may have the symptoms over the course of 2-3 weeks
Epiglottitis s/s
Acute and rapid onset of high fever, chills, and toxicity. Severe sore throat and drooling
saliva. Will not eat or drink, muffled (hot potato) voice, and anxiety. Sitting posture with
hyperextended neck with open-mouth breathing. Stridor, tachycardia, and tachypnea
Epiglottitis prevention
Haemophilus influenzae type B (Hib) vaccine
Steeple sign
a radiologic sign found on radiograph where the subglottic tracheal narrowing produces
a shape of a church steeple which supports a diagnosis of croup
Foreign body aspiration antibiotic?
Depends on the nature of the material aspirated, plus the location and degree of
obstruction. Bronchial or laryngeal foreign body aspiration, a bronchoscopy must be
performed for removal of the foreign body
Antibiotics for bronchiolitis?
Use of saline drops and suctioning of the nares. There is no evidence to support the
routine use of antibiotics
Antibiotics for croup?
Nebulized epinephrine, corticosteroids (dexamethasone oral or IM), blow by oxygen or
heliox in severe croup. Racemic epinephrine with the use of corticosteroids to limit
rebound swelling
Antibiotics for epiglottitis?
Establish an airway preferably by nasotracheal intubation. Administer IV antibiotics such
as rocephin to cover H.influenzae. Administer oxygen and respiratory support.
Antibiotics should be continued for 10 days. Rifampin prophylaxis 20 mg/kg in a single
dose (maximum of 600 mg) for 4 days for infants and children, 600 mg once a day for
adults for 4 days. Should be provided for household contacts who are at risk (Younger
than 4 years old who is non-immunized or incompletely immunized, children less than
12 months who have not received primary series of Hib, and immunocompromised
children.
Asthma treatment
The pharmacological management of asthma in children is based on the severity of
asthma and the child's age. After initial control, decrease treatment to the least amount
of medication needed to maintain control. Systemic corticosteroids may be needed at
any time and stepped up if there is a major flare-up of symptoms.
Step 1 Asthma management for children 0-4 years old
,Step 1: SABA (Short acting beta2-agonist) PRN: With viral respiratory symptoms short
acting beta 2-agonist should be used every 4-6 hours up to 24 hours (longer with a
physician consult). Consider short course of oral systemic corticosteroids if severe
exacerbation. Frequent use of SABA may indicate the need to step up treatment
Step 2 Asthma management for children 0-4 years old
Step 2: Consider consultation with asthma specialist. Low dose of inhaled
corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs
Step 3: Medium-dose of inhaled corticosteroids
Steps 4-6 asthma mgmt for children 0-4 yrs
Step 4: Medium-dose ICS and Long acting beta2-agonist or montelukast.
Step 5: High dose ICS and Long acting beta 2-agonist or montelukast.
Step 6: High dose of ICS and LABA or montelukast and oral corticosteroids
Steps 1-3 asthma mgmt for children 5-11 yrs
Step 1: SABA (Short acting beta 2-agonist) PRN: Increasing the use of short-acting beta
2-agonist or use greater than 2 days a week for symptom relief generally indicates
inadequate control and the need to step up treatment.
Step 2: Consider consultation with asthma specialist. Low dose of inhaled
corticosteroids.
Step 3: Low dose of inhaled corticosteroid and LABA. Or medium dose of inhaled
corticosteroids.
Steps 4-6 asthma mgmt for children 5-11 yrs
Step 4: Medium-dose ICS and LABA or medium dose of inhaled corticosteroid and
leukotriene receptor antagonist or theophylline. .
Step 5: High dose ICS and LABA or high dose of inhaled corticosteroid and leukotriene
receptor antagonist or theophylline. .
Step 6: High dose of ICS and LABA and oral corticosteroids or high dose of inhaled
corticosteroids and leukotriene receptor antagonist or theophylline and oral
corticosteroids.
** Theophylline levels must be monitored.
Differentials for patient with sore throat
Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
small-for-gestational-age infants: which type of chromosomal analysis should be
included?
, Trisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
heart defects associated with Down syndrome
Atrioventricular Septal Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
Contact sports with Down's Syndrome
Do not recommend due to atlantoaxial instability
Diagnosing Down Syndrome
Usually identified at birth by the presence of certain physical traits: low muscle tone, a
single deep crease across the palm of the hand, a slightly flattened facial profile and an
upward slant to the eyes. Because these features may be present in other babies, a
chromosomal analysis called a karyotype is done to confirm the diagnosis. To obtain a
karyotype, doctors draw a blood sample to examine the baby's cells. They photograph
the chromosomes and then group them by size, number, and shape. By examining the
karyotype, doctors can diagnose. Another genetic test called FISH can apply similar
principles and confirm a diagnosis in a shorter amount of time
Diagnosing Trisomy 18 (Edwards Syndrome)
A sample of the baby's dna is extracted from a blood sample or other bodily cells or
tissue and is cultured to examine a picture of the chromosomes called a karyotype. In
order to get this picture, the chromosomes are isolated, stained, and examined under
the microscope. Most often, this is done using the chromosomes in the white blood
cells. A picture of the chromosomes is taken through the microscope. A visible extra
18th chromosome confirms a Trisomy 18 diagnosis
Diagnosing Holt-Oram Syndrome
A diagnosis may be suspected when a person is found to have changes in the way the
bones of the wrist and other bones of the upper limb are formed. The diagnosis can be
confirmed if a person has specific bone changes and a personal or family history of an
atrial septal defect, ventricular septal defect, or cardiac conduction disease. In order to
establish the diagnosis, a doctor may order tests including an x-ray of the hands, wrists,
and arms, a echocardiogram, and an electrocardiogram. The diagnosis may also be
confirmed with genetic testing of the TBX5 gene
Diagnosing Trisomy 13
Parents who are at risk to have a translocation due to their family history can have a
blood test called a karyotype, which can determine if a translocation is present.
Prenatal testing or screening is also available to determine if a current pregnancy is at
risk for chromosome disorders.
People with a family history who are interested in learning about genetic screening or
University;(100% Correct)
Recommended treatment for RSV in a 7 month old (outpatient)
Use of saline drops and suctioning of the nares. Indications of when to use antipyretics.
Signs of respiratory distress or dehydration. Guidelines for feeding an infant with signs
of mild respiratory distress which includes smaller more frequent feedings; monitoring of
the respiratory rate; and guarding against vomiting. The parents should be educated
that the child may have the symptoms over the course of 2-3 weeks
Epiglottitis s/s
Acute and rapid onset of high fever, chills, and toxicity. Severe sore throat and drooling
saliva. Will not eat or drink, muffled (hot potato) voice, and anxiety. Sitting posture with
hyperextended neck with open-mouth breathing. Stridor, tachycardia, and tachypnea
Epiglottitis prevention
Haemophilus influenzae type B (Hib) vaccine
Steeple sign
a radiologic sign found on radiograph where the subglottic tracheal narrowing produces
a shape of a church steeple which supports a diagnosis of croup
Foreign body aspiration antibiotic?
Depends on the nature of the material aspirated, plus the location and degree of
obstruction. Bronchial or laryngeal foreign body aspiration, a bronchoscopy must be
performed for removal of the foreign body
Antibiotics for bronchiolitis?
Use of saline drops and suctioning of the nares. There is no evidence to support the
routine use of antibiotics
Antibiotics for croup?
Nebulized epinephrine, corticosteroids (dexamethasone oral or IM), blow by oxygen or
heliox in severe croup. Racemic epinephrine with the use of corticosteroids to limit
rebound swelling
Antibiotics for epiglottitis?
Establish an airway preferably by nasotracheal intubation. Administer IV antibiotics such
as rocephin to cover H.influenzae. Administer oxygen and respiratory support.
Antibiotics should be continued for 10 days. Rifampin prophylaxis 20 mg/kg in a single
dose (maximum of 600 mg) for 4 days for infants and children, 600 mg once a day for
adults for 4 days. Should be provided for household contacts who are at risk (Younger
than 4 years old who is non-immunized or incompletely immunized, children less than
12 months who have not received primary series of Hib, and immunocompromised
children.
Asthma treatment
The pharmacological management of asthma in children is based on the severity of
asthma and the child's age. After initial control, decrease treatment to the least amount
of medication needed to maintain control. Systemic corticosteroids may be needed at
any time and stepped up if there is a major flare-up of symptoms.
Step 1 Asthma management for children 0-4 years old
,Step 1: SABA (Short acting beta2-agonist) PRN: With viral respiratory symptoms short
acting beta 2-agonist should be used every 4-6 hours up to 24 hours (longer with a
physician consult). Consider short course of oral systemic corticosteroids if severe
exacerbation. Frequent use of SABA may indicate the need to step up treatment
Step 2 Asthma management for children 0-4 years old
Step 2: Consider consultation with asthma specialist. Low dose of inhaled
corticosteroids.
Step 3 asthma mgmt for children 0-4 yrs
Step 3: Medium-dose of inhaled corticosteroids
Steps 4-6 asthma mgmt for children 0-4 yrs
Step 4: Medium-dose ICS and Long acting beta2-agonist or montelukast.
Step 5: High dose ICS and Long acting beta 2-agonist or montelukast.
Step 6: High dose of ICS and LABA or montelukast and oral corticosteroids
Steps 1-3 asthma mgmt for children 5-11 yrs
Step 1: SABA (Short acting beta 2-agonist) PRN: Increasing the use of short-acting beta
2-agonist or use greater than 2 days a week for symptom relief generally indicates
inadequate control and the need to step up treatment.
Step 2: Consider consultation with asthma specialist. Low dose of inhaled
corticosteroids.
Step 3: Low dose of inhaled corticosteroid and LABA. Or medium dose of inhaled
corticosteroids.
Steps 4-6 asthma mgmt for children 5-11 yrs
Step 4: Medium-dose ICS and LABA or medium dose of inhaled corticosteroid and
leukotriene receptor antagonist or theophylline. .
Step 5: High dose ICS and LABA or high dose of inhaled corticosteroid and leukotriene
receptor antagonist or theophylline. .
Step 6: High dose of ICS and LABA and oral corticosteroids or high dose of inhaled
corticosteroids and leukotriene receptor antagonist or theophylline and oral
corticosteroids.
** Theophylline levels must be monitored.
Differentials for patient with sore throat
Strep pharyngitis
Peritonsillar abscess
Viral pharyngitis
Infectious mononucleosis
Epiglottitis
small-for-gestational-age infants: which type of chromosomal analysis should be
included?
, Trisomy 18
Holt-Olram
Trisomy 13
Turner Syndrome
Trisomy 21
Prader-Willi Syndrome
heart defects associated with Down syndrome
Atrioventricular Septal Defect
Ventricular Septal Defect
Persistant Ductus Arteriosus
Tetrology of Fallot
Contact sports with Down's Syndrome
Do not recommend due to atlantoaxial instability
Diagnosing Down Syndrome
Usually identified at birth by the presence of certain physical traits: low muscle tone, a
single deep crease across the palm of the hand, a slightly flattened facial profile and an
upward slant to the eyes. Because these features may be present in other babies, a
chromosomal analysis called a karyotype is done to confirm the diagnosis. To obtain a
karyotype, doctors draw a blood sample to examine the baby's cells. They photograph
the chromosomes and then group them by size, number, and shape. By examining the
karyotype, doctors can diagnose. Another genetic test called FISH can apply similar
principles and confirm a diagnosis in a shorter amount of time
Diagnosing Trisomy 18 (Edwards Syndrome)
A sample of the baby's dna is extracted from a blood sample or other bodily cells or
tissue and is cultured to examine a picture of the chromosomes called a karyotype. In
order to get this picture, the chromosomes are isolated, stained, and examined under
the microscope. Most often, this is done using the chromosomes in the white blood
cells. A picture of the chromosomes is taken through the microscope. A visible extra
18th chromosome confirms a Trisomy 18 diagnosis
Diagnosing Holt-Oram Syndrome
A diagnosis may be suspected when a person is found to have changes in the way the
bones of the wrist and other bones of the upper limb are formed. The diagnosis can be
confirmed if a person has specific bone changes and a personal or family history of an
atrial septal defect, ventricular septal defect, or cardiac conduction disease. In order to
establish the diagnosis, a doctor may order tests including an x-ray of the hands, wrists,
and arms, a echocardiogram, and an electrocardiogram. The diagnosis may also be
confirmed with genetic testing of the TBX5 gene
Diagnosing Trisomy 13
Parents who are at risk to have a translocation due to their family history can have a
blood test called a karyotype, which can determine if a translocation is present.
Prenatal testing or screening is also available to determine if a current pregnancy is at
risk for chromosome disorders.
People with a family history who are interested in learning about genetic screening or
