NURS 629 -Exam 4
Diagnostic testing for pyloric stenosis - US, upper GI series which can show a "string sign" which is
a fine elongated pyloric canal
"olive mass" palpable in epigastric area to right of midline
Treatment is surgery (pyloromyotomy)
Diagnostic for scoliosis - upright posteroanterior and lateral view that include the cervical spin and
pelvis pg. 2670 AAP book
Atonic seizures - muscles suddenly become limp
eyelids may droop
head may drop forward
fall risk
typically lasts <15 seconds
Atypical absent seizures - starts with patient staring off, change muscle tone and movement
blinking repeatedly
smacking lips or chewing movements
rubbing fingers together or making other hand motions
lasts longer than absent >20 seconds
Blood glucose goals - Ages <= 6 yo keep to 100-180 and may need to give insulin after meals;
HBA1c 8.5%
Ages 7-12 tighten control to 90-180 before meals; HBA1c 8%
Adolescents tighten control to 70-150: HBA1c 7.5%
per PP and pg 1856 of AAP book
**other study guide states ideal glucose level for 4 yo is 90-130
,Characterization of Type 1 DM - child/adolescent
lean habitus
no acanthosis
5% family hx
most common in Caucasians
DKA is common/rapid
lifelong insulin dependence
common autoimmunity
Characterization of type 2 DM - adolescent or older
heavy habitus
acanthosis
positive family hx (75-100%)
likely non-caucasian
DKA is uncommon/insiduous
insulin dependence is episodic
autoimmunity uncommon
Clinical findings for Osgood-Sclatter disease - pain, swelling, tenderness at tibial tuberosity
knee pain that worsens with activity
tightness of the surrounding muscles, especially quads
pain varies from mild with activity to nearly constant and debilitating
Criteria to dx diabetes - symptoms of diabetes plus random plasma glucose >= 200 mg/dl
OR
fasting plasma glucose >=126 mg/dl
OR
, 2 hr plasma glucose >= 200 ml/dl during OGTT (1.75 gm/kg or max 75 gm glucose in water)
Diagnostic for depression - PHQ-9 can be used for ages 11 and up
-insomnia or hypersomnia, just like our adults; psychomotor agitation or retardation observable by
others; fatigue or loss of energy; feelings of worthlessness or excessive or inappropriate guilt; diminished
ability to think or concentrate or indecisiveness; and recurrent thoughts of death is another
characteristic
-criteria to meet the diagnosis of depression is 5 or more symptoms, most of the day nearly every day,
have been present during the same 2-week period
Diagnostic for SCFE - x-ray
Absent seizures - very quick, <10 seconds- often missed
generalized onset involving both sides of the brain at the same time
most common type
stops all activity then patient stares off
eyes may roll up
eyelids flutter
Diagnostic testing for appendicitis - CBC w/ diff- look for shift to left, *elevated WBCs usually 10-
20, neutrophils, elevated bands
UA
CT w/ contrast- highest accuracy
may use US/MRI
**surgery referral, emergent
Diagnostic testing for GERD - CBC w/ diff to r/o anemia and infection
upper GI series
Diagnostic testing for UTI - UA w/ culture
*E.Coli most common cause
Diagnostic testing for pyloric stenosis - US, upper GI series which can show a "string sign" which is
a fine elongated pyloric canal
"olive mass" palpable in epigastric area to right of midline
Treatment is surgery (pyloromyotomy)
Diagnostic for scoliosis - upright posteroanterior and lateral view that include the cervical spin and
pelvis pg. 2670 AAP book
Atonic seizures - muscles suddenly become limp
eyelids may droop
head may drop forward
fall risk
typically lasts <15 seconds
Atypical absent seizures - starts with patient staring off, change muscle tone and movement
blinking repeatedly
smacking lips or chewing movements
rubbing fingers together or making other hand motions
lasts longer than absent >20 seconds
Blood glucose goals - Ages <= 6 yo keep to 100-180 and may need to give insulin after meals;
HBA1c 8.5%
Ages 7-12 tighten control to 90-180 before meals; HBA1c 8%
Adolescents tighten control to 70-150: HBA1c 7.5%
per PP and pg 1856 of AAP book
**other study guide states ideal glucose level for 4 yo is 90-130
,Characterization of Type 1 DM - child/adolescent
lean habitus
no acanthosis
5% family hx
most common in Caucasians
DKA is common/rapid
lifelong insulin dependence
common autoimmunity
Characterization of type 2 DM - adolescent or older
heavy habitus
acanthosis
positive family hx (75-100%)
likely non-caucasian
DKA is uncommon/insiduous
insulin dependence is episodic
autoimmunity uncommon
Clinical findings for Osgood-Sclatter disease - pain, swelling, tenderness at tibial tuberosity
knee pain that worsens with activity
tightness of the surrounding muscles, especially quads
pain varies from mild with activity to nearly constant and debilitating
Criteria to dx diabetes - symptoms of diabetes plus random plasma glucose >= 200 mg/dl
OR
fasting plasma glucose >=126 mg/dl
OR
, 2 hr plasma glucose >= 200 ml/dl during OGTT (1.75 gm/kg or max 75 gm glucose in water)
Diagnostic for depression - PHQ-9 can be used for ages 11 and up
-insomnia or hypersomnia, just like our adults; psychomotor agitation or retardation observable by
others; fatigue or loss of energy; feelings of worthlessness or excessive or inappropriate guilt; diminished
ability to think or concentrate or indecisiveness; and recurrent thoughts of death is another
characteristic
-criteria to meet the diagnosis of depression is 5 or more symptoms, most of the day nearly every day,
have been present during the same 2-week period
Diagnostic for SCFE - x-ray
Absent seizures - very quick, <10 seconds- often missed
generalized onset involving both sides of the brain at the same time
most common type
stops all activity then patient stares off
eyes may roll up
eyelids flutter
Diagnostic testing for appendicitis - CBC w/ diff- look for shift to left, *elevated WBCs usually 10-
20, neutrophils, elevated bands
UA
CT w/ contrast- highest accuracy
may use US/MRI
**surgery referral, emergent
Diagnostic testing for GERD - CBC w/ diff to r/o anemia and infection
upper GI series
Diagnostic testing for UTI - UA w/ culture
*E.Coli most common cause
