Pediatrics Exam 4 Study Guide – Comprehensive Review Notes and Exam Preparation Material

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Pediatrics Exam 4 Study Guide
Grief and Loss:




 Reactions to Death:
o Toddlers: More affected by change in lifestyle – may go on as if
deceased is still alive
o Pre-School: Believe the deceased is only “sleeping”
o School-Age: Better understanding of death, personify death as a
monster and fear punishment. Fear of the unknown. Asks a lot of
questions. May be curious about what happens to the body.
o Adolescents: Criticize funeral ceremonies, think they are
barbaric.



Hematology and Oncology:


 Hemophilia:
o S/S: Prolonged/excessive bleeding, hemarthrosis (bleeding in the
joints, treat with RICE), excessive bruising
o TX: No contact sports (can do swimming/golf/bowling), control
bleeding (RICE for vasoconstriction)
 Wilm’s Tumor:
o S/S: Unilateral mass in abdomen, may have HTN. Most common
kidney tumor.




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o TX: Nephrectomy – infection concern, monitor for elevated WBCs
and fever
 DO NOT palpate abdomen d/t risk of rupture and spread of
cancer
 Monitor BP. Monitor bowel sounds (if absent, notify MD),
observe for distention/vomiting

 Neuroblastoma
o S/S: Most common cancer in infants. Firm, irregular mass crosses
midline in abdomen.
 Retinoblastoma:
o S/S: Cat’s eye reflex – white glow in pupil when exposed to light.
o TX: Enucleation – surgically implanted sphere keeps shape of eye
to maintain facial symmetry. Face will be swollen/bruised
 Iron deficiency anemia
o Give iron-fortified cereal at 6 months
o Breastfed babies will need iron by 4 months
o Give with Vitamin C
o Do not give iron with milk (no cow’s milk until 1 year of age)
o Liquid iron stains teeth-give through straw or syringe
o Black stool is normal
 Sickle Cell Crisis
o Types:
 Vaso-occlusive – painful
 Splenic sequestration – pooling of blood in spleen
 Aplastic – decreased production of RBCs
o Can be caused by infection, stress, dehydration
o Oral/IV hydration (have fluids available at all times – enuresis is
possible) Pain management is essential- most commonly with
morphine (if showing signs of opioid overdose, admin naloxone)
o Infection prevention - immunizations
 Leukemia
o Decrease infection risk – private room, handwashing, no sick
visitors, no live plants.
 Ewing Sarcoma
o Limb more likely to be preserved
o Radiation can lead to skin irritation
 Wear loose-fitting clothing over irradiated area




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 Protect area from sunlight or sudden temp changes
(heating pads/ice packs)
 Use affected limb as tolerated to preserve function



 Osteosarcoma
o Found in long bones near growth plate - most commonly the
sternum
o May limp on affected side, often confused with growing pains



Neurosensory

 Abuse/Maltreatment
o TEN4 Rule – bruising to Trunk, Ears, Neck found in under 4 years
old
o Frequent visits to the ER with no problems = notify CPS
 ADHD
o Major manifestation is distractibility
o Have difficulty completing tasks
o Takes stuff from others without asking
o Safety measures due to impulsivity
 Submersion Injury
o Brain suffers irreversible damage after 4 mins without oxygen,
heart and lungs after 30 mins
o O2 ASAP
o Monitor for 6-8 hours after injury
o Educate on prevention
 Down Syndrome
o S/S: Low birth weight, short stature, depressed nasal bridge,
short digits, hypotonicity (not a sign of poor bonding),
hyperflexibility, protruding tongue, upward slanted eyes, wide
space between big and second toe




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 Cerebral Palsy




 Myelomeningocele:



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