Podcast
Questions and Answers
Which is a potential complication of VSD?
Which is a potential complication of VSD?
What is the primary risk factor for sickle cell anemia crises?
What is the primary risk factor for sickle cell anemia crises?
Which medication is used to prevent the formation of sickled RBCs in patients with sickle cell anemia?
Which medication is used to prevent the formation of sickled RBCs in patients with sickle cell anemia?
What is a common assessment finding in a patient with asthma?
What is a common assessment finding in a patient with asthma?
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Which of the following is NOT a sign of advanced cystic fibrosis?
Which of the following is NOT a sign of advanced cystic fibrosis?
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What diagnostic test is performed annually for patients with sickle cell anemia to assess the risk for stroke?
What diagnostic test is performed annually for patients with sickle cell anemia to assess the risk for stroke?
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What management step is essential for an infant with VSD?
What management step is essential for an infant with VSD?
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What is a correct management approach during a vaso-occlusive crisis in sickle cell anemia?
What is a correct management approach during a vaso-occlusive crisis in sickle cell anemia?
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What is the primary diagnostic method used for confirming Hirschsprung's Disease?
What is the primary diagnostic method used for confirming Hirschsprung's Disease?
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A 7-year-old with ALL may present with which of the following late signs?
A 7-year-old with ALL may present with which of the following late signs?
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What is a classic assessment finding in a child with pyloric stenosis?
What is a classic assessment finding in a child with pyloric stenosis?
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What are the typical characteristics of jelly-like stools associated with intussusception?
What are the typical characteristics of jelly-like stools associated with intussusception?
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Which of the following is a management strategy for enterocolitis in Hirschsprung’s Disease?
Which of the following is a management strategy for enterocolitis in Hirschsprung’s Disease?
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In the context of acute renal failure, which of the following is a pre-renal risk factor?
In the context of acute renal failure, which of the following is a pre-renal risk factor?
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What dietary management is recommended for a child diagnosed with Hirschsprung's Disease?
What dietary management is recommended for a child diagnosed with Hirschsprung's Disease?
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What is a common initial sign of acute lymphoblastic leukemia in children?
What is a common initial sign of acute lymphoblastic leukemia in children?
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What is a common expected finding in a child who is experiencing acute post-renal failure?
What is a common expected finding in a child who is experiencing acute post-renal failure?
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Which laboratory result would most likely indicate hyperkalemia in a patient?
Which laboratory result would most likely indicate hyperkalemia in a patient?
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Which medication is commonly used to help reduce elevated potassium levels in an emergency situation?
Which medication is commonly used to help reduce elevated potassium levels in an emergency situation?
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What is a primary consideration when caring for a 12-year-old with a leg fracture?
What is a primary consideration when caring for a 12-year-old with a leg fracture?
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Which of the following would NOT be an expected effect of rheumatic fever?
Which of the following would NOT be an expected effect of rheumatic fever?
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What is the most appropriate nursing intervention for a child with nephrotic syndrome?
What is the most appropriate nursing intervention for a child with nephrotic syndrome?
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Which diagnostic test is primarily used to evaluate the presence of streptococcal infection related to rheumatic fever?
Which diagnostic test is primarily used to evaluate the presence of streptococcal infection related to rheumatic fever?
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What condition does proteinuria in nephrotic syndrome primarily lead to?
What condition does proteinuria in nephrotic syndrome primarily lead to?
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Study Notes
Case Studies
-
Infant with VSD:
- A hole in the septum between the right and left ventricles increases pulmonary blood flow, requiring the pulmonary artery to work harder.
- Assessment reveals heart failure, pulmonary hypertension, lung inflammation, and potentially low weight/extra heart sounds.
- Management involves ACE inhibitors and Digoxin (at least 60mg/hr).
- The case highlights mixing of extra blood.
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8-year-old with Sickle Cell Anemia:
- Autosomal genetic disorder where abnormal Hgb S replaces Hgb A.
- Sickled red blood cells (RBCs) are more viscous, increasing occlusion risk and decreasing oxygen carrying capacity.
- Sickling occurs under stress factors like fever, dehydration, acidosis, and hypoxia.
- Diagnostic tests include CBC, sickle turbidity, and Hgb electrophoresis.
- Sickle cell crisis involves decreased Hgb, increased WBCs, bilirubin, and reticulocytes. Blood smears are also done for diagnosis.
- Annual Transcranial Doppler tests assess risk of stroke (CVA).
- Vaso-occlusive crisis is the most common type, characterized by RBC clumping, reducing blood flow to organs.
- Mild to moderate pain use acetaminophen or ibuprofen.
- Severe pain requires opioid analgesics.
- Heat packs can also help with joint pain relief
- Three or more opioid doses indicates potential need for hospitalization
- Possible complications: gallstones, stroke, eye problems, leg ulcers
- Treatment includes medications such as hydroxyurea to prevent sickled RBC formation and pain medication treatment.
Other Cases
-
10-year-old with Asthma:
- Narrowed/inflamed airways are a key symptom.
- Risk factors include family history of asthma and allergies, exposure to smoke, and low/overweight.
- Signs include dyspnea, cough, audible wheezing, accessory muscle use, tripod positioning.
- Diagnostics include PFTs and peak flow meters.
- Medications range from corticosteroids to albuterol to montelukast, and more intensive care may require theophylline, magnesium sulfate.
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16-year-old with Cystic Fibrosis:
- Characterized by thick mucus in the lungs.
- Early signs include wheezing, rhonchi, and a dry, non-productive cough.
- Increased signs include dyspnea, emphysema, and atelectasis. Advanced signs involve cyanosis, barrel chest, and clubbing.
- Other indicators include large, greasy, bulky, and foul-smelling stools.
- Assessment includes lung sounds, respiratory, development, PIV (Possibly intravenous?) sputum culture.
- Education focuses on high calorie, high protein diets, enzyme supplements taken 30 minutes before meals.
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3-year-old with Hirschsprung's Disease:
- A disorder characterized by missing nerve cells that control bowel function in certain bowel sections.
- Symptoms include constipation, abdominal distention, and observable peristaltic waves.
- Diagnosed via rectal biopsy and X-rays.
- Treatment typically involves surgery.
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7-year-old with ALL:
- WBCs become neoplastic (cancerous).
- Early signs include low-grade fever, pallor, bruising (petechiae), enlarged liver/lymph nodes/joints,
- Late signs manifest as pain, hematuria (blood in urine), mouth ulcers, and enlarged kidneys.
- Diagnostics will assess blood counts, anemia, thrombocytopenia, neutropenia, leukemic blasts (immature WBCs) for the assessment of the blood condition.
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4-week-old with Pyloric Stenosis:
- A condition causing a thickened pyloric sphincter, therefore narrowing and obstructing the passage between the stomach and small intestine.
- Typical symptoms include projectile vomiting and failed formula feedings, and it may lead to dehydration.
- Diagnosing frequently involves ultrasound
- Treatment focuses on correcting fluid and electrolyte imbalances.
- Consider IV fluids before surgery, a NPO (nothing by mouth) status before surgery and slow feedings after.
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12-month-old with Intussusception:
- A condition where one segment of the bowel telescopes into another segment.
- Symptoms often involve sudden, intense pain, with possible nausea and possible edema.
- Diagnosed via ultrasound.
- Treatment commonly includes an air enema procedure or, if necessary, surgery.
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5-year-old with Acute Renal Failure:
- A sudden decrease in kidney function.
- Risk factors include pre-renal issues (dehydration from diarrhea, vomiting, or shock), intrinsic (kidney damage—from glomerulonephritis or other causes), and post-renal (obstruction).
- Signs of concern, possibly including Oliguria, abrupt diuresis or edema.
- Diagnostics include lab tests to look for potassium, sodium and mineral imbalances, and possibly checking for cardiac arrhythmias.
- Treatment involves managing the underlying cause and providing supportive care (IVs, medications to manage electrolyte imbalances).
-
12-year-old with a Leg Fracture:
- Assessment includes pain, crepitus, deformity, edema, ecchymosis (bruising) and possible warmth or redness from irritation or infection in an affected area.
- Neurovascular status monitoring is fundamental for assessing for blood flow in the leg.
- Treatment should include reducing jewelry and accessories that might restrict blood flow in the area.
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5-year-old with Rheumatic Fever:
- Autoimmune inflammatory reaction typically occurring 2-4 weeks after a strep infection.
- It targets the heart, blood vessels, and joints.
- Assessment should monitor for inflammation, carditis (sign of heart inflammation), subcutaneous nodules, polyarthritis, rash, chorea.
- Diagnostics include blood tests for strep antibodies.
- Treatment and preventative measures are essential, including antibiotics.
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14-year-old with Nephrotic Syndrome:
- Characterized by excessive protein in the urine (proteinuria), causing low blood protein levels.
- Primary cause is unknown, other secondary causes can include kidney damage due to metabolic, biochemical, physicochemical disturbances in the body, for example, lupus, diabetes, and or heart failure.
- Signs include significant weight gain, edema, decreased activity, ascites.
- Diagnostics involve urine tests, blood tests (looking for albumin and other lipids), and kidney biopsy if necessary.
- Treatment focuses on reducing swelling and infection, possibly using medication like prednisone, furosemide, and 25% Albumin.
Growth Charts
- Includes age ranges for Heart Rate (HR), Respiratory Rate (RR), Systolic Blood Pressure (SBP), and possibly other relevant data.
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Description
This quiz focuses on two critical pediatric case studies: an infant with Ventricular Septal Defect (VSD) and an 8-year-old with Sickle Cell Anemia. Through these cases, explore the assessments, symptoms, management strategies, and diagnostic procedures involved. Understand the implications of these conditions and their treatments.
