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 *NURSING > STUDY GUIDE > Concepts Of Maternal-Child Nursing And Families (NUR 4130) Study guide contains comprehensive summary of the new information found in the final exam for Dr. Newman's OB portion of this course. Includes information about the newborn including assessment and disease processes. (All)

 Health Care > STUDY GUIDE > ATI MATERNAL NEWBORN PROCTORED EXAM 1 & 2 2019 STUDY GUIDE (All)

 *NURSING > STUDY GUIDE > NUR 2633 Maternal Child Health Study Guide – Test 4 (Final Exam) Questions /Answers (All)

 *NURSING > STUDY GUIDE > NR 602 Quiz 3 Study Guide Respiratory Infections - Leading cause of morbidity and mortality in children - Respiratory failure can develop rapidly with ominous symptoms - Be able to recognize key respiratory sounds o Croup cough vs. other coughs *Sound bit croup cough: see link under Croup* o Inspiratory stridor *Sound bit: (https://www.easyauscultation.com/heart-lung-soundsdetails/140/Stridor) o Wheezing * Sound bit: (https://www.easyauscultation.com/heart-lung-soundsdetails/71/Wheeze) - Critical Sign: Tachypnea! o Respiratory Rates:  Infants (birth to 12 months): 30-53 bpm (RR > 60 requires further evaluation)  Toddlers (1-2 yrs): 22-37 bpm (RR > 40 requires further evaluation)  Preschool (3-5 yrs): 20-28 bpm  School Age (6-9 yrs): 18-25 bpm  Pre-Adolescent (10-11 yrs): 18-25 bpm  Adolescent (12yrs and older): 12-20 bpm o Red Flags: Tachypnea +  grunting,  nasal flaring,  use of accessory muscles - Upper Respiratory Infections are the most common (common cold) o Most often Viral  Rhinovirus, Parainfluenza, RSV, Coronavirus, human metapneumovirus  Self-limiting lasting 7-10days o Peak: Spring and Winter o Common Sxs: (gradual onset)  Low grade fever  Nasal Congestion  Sore throat, hoarseness  *Hallmark: Rhinorrhea (clear at first, progresses to purulent)  Cough/Sneezing o Clinical Findings:  Conjunctiva: mild injection  Erythematous nasal mucosa with mucus  Erythematous posterior oropharynx  Anterior cervical lymphadenopathy - Diagnostics: o ONLY if in doubt of URI: sore throat without drainage or cough  Rapid antigen detection test (RADT): rapid strep  Throat culture if RADT negativeo Treatment: Supportive Care  Hydration  OTC antipyretics as directed (weight dose)  Normal saline nasal rinse  Topical menthol  NO Antibiotics prophylactically o Complications: secondary infection  Bacterial infection  Otitis media  Sinusitis  Asthma exacerbation - Pharyngitis, Tonsillitis, and Tonsillopharyngitis o Inflammation of mucosal lining of the throat structures o Infectious or noninfectious causes  Viral or bacterial  Viral (most common): adenovirus (pharyngitis primary sx), Epstein-Barr (EBV), herpes simplex (HSV), cytomegalovirus (CMV), enterovirus, parainfluenza, HIV o Upper nasal symptoms, cough and rhinorrhea, hoarseness, conjunctivitis, rash, diarrhea o Occur year round, except adenovirus which is predominantly summer (contaminated swimming pools)  Bacterial: GABHS (most common in 5-13 year olds), gonococcal (15-19 year olds), Corynebacterium diphtheria (RARE), Arcanobacterium haemolyticum, Neisseria gonorrheae(adolescents), Chlamydia trachomatis (adolescents), Francisella tularensis, Mycoplasma pneumonia, Group C & G Strep o GABHS: typically late winter and early spring o Acute abrupt onset: sore throat, headache, nausea, vomiting, abdominal pain, myalgia, arthralgia, malaise  Respiratory irritants (smoke) o Clinical Findings:  Erythematous tonsils and pharynx  EBV: exudates on tonsils, petechiae on soft palate, diffuse adenopathy  Adenovirus: follicular pattern on pharynx  Enterovirus: vesicles or ulcers on tonsillar pillars, coryza, vomiting, diarrhea  Herpes: anterior ulcers, adenopathy  Parainfluenza and RSV: lower respiratory sx, stridor, rales, and wheezing  Influenza: cough, fever, systemic sxs  M. pneumo & Chlamydophila pneumo: cough, pharyngitis  GABHS: exudative Erythematous pharyngitis with follicular pattern without presence of cough or nasal symptoms, swollen beefy red uvula, enlarged tonsillopharyngeal tissue, anterior cervical lymphadenopathy, bad breath, scarlatiniform rash, strawberry tongue A. haemolyticum: exudative pharyngitis, marked erythema and pruritic, fine scarlatiniform rash o Diagnostics:  RADT and/or throat culture if >3 years old with pharyngitis or if someone in household is + Strep  Culture if RADT negative, or suspect A. haemolyticum, N. gonorrhea or C. diphtheria  If suspect Mononucleosis: CBC o Treatment:  Supportive care: ibuprofen, acetaminophen  Hydration  GABHS with + RADT or + culture: antibiotics  PCN V potassium – 1st choice  Amoxicillin suspension  Benzathine pcn G IM  Allergy to PCN: o Cephalexin o Cefadroxil o Clindamycin (1st choice if chronic symptomatic carriage of GABHS) o Azithromycin o clarithromycin  If CMV or EBV: beta-lactam antibiotic causes diffuse morbilliform skin eruption  Discard/Clean: bathroom cups, toothbrush, orthodontic devices  Return to school when afebrile or on antibiotic for 24 hours  Tonsillectomy/adenoidectomy:  if > 7 throat infections in past year, >5 throat infections in past 2 years, >3 throat infections per year x 3 years  sleep apnea  adenoid hypertrophy  unresponsive rhinosinusitis  chronic otitis media (post tympanostomy tube placement) Sinusitis/Rhinosinusitis - URI lasting 10 to 14 days with no symptoms improvement or worsening symptoms o Acute (ARS): lasting as long as 4 weeks o Chronic (CRS): persist 12 weeks or more - Inflammation and edema of mucous membranes lining the sinuses - Bacterial: Strep pneumo., H. influenza, Moraxella catarrhalis, Staph. Aureus (less often) - Risk factors: o Preceding infection o Environmental irritants/allergies o Anatomic problems (septal deviation, nasal polyps, facial trauma)o GERD o CF, ciliary dyskinesia o Immunodeficiency - Clinical Findings: o Thick, yellow discharge o Worsening symptoms after initial improvement from URI o Sx: headache, fatigue, decreased appetite o Bad breath (halitosis) o Facial pain* o Facial/nasal congestion and fullness* o Purulent postnasal drainage and nasal discharge o Cough o Ear pain/fullness/pressure - Treatment: o Watchful waiting: do not over use antibiotics  Symptom management: ibuprofen, acetaminophen  Rest  Reassess after 72 hours o Chronic: referral to ENT o Antibiotics Criteria per AAP Guidelines:  URI with persistent nasal discharge, daytime cough, lasting >10 days without improvement  URI with worsening symptoms, new onset of fever, nasal discharge, or daytime cough after initial improvement  Fever > 102.2 F (39 C) with purulent nasal discharge for at least 3 days and sinusitis  Amoxicillin – 1st line x10-28 days or 7 days past symptom resolution  45 mg/kg divided into 2 doses/day  S. pneumo: 80-90 mg/kg/day (max: 1000 mg/dose)  Child < 2 yrs, daycare attendee, recent antibiotic use, or severe illness: Augmentin 80-90 mg/kg/day of amoxicillin part (max: 2 grams/dose)  Vomiting: ceftriaxone 50 mg/kg IV or IM  PCN allergy type I: 3rd generation cephalosporin (cefdinir, cefpodoxime, cefuroxime) Bronchitis/ Bronchiolitis/ Respiratory Syncytial Virus (RSV) - inflammatory process of the bronchus, or bronchioles (small airways) - most commonly caused by a Virus o MOST Common: Respiratory Syncytial Virus (RSV) o Others: influenza, parainfluenza, adenovirus, enterovirus, bocavirus, and rhinovirus o Rarely: can have rare bacterial cause: Mycoplasma pneumonia - Highly CONTAGIOUS - Direct Contact and Droplet Transmission o Incubation period before symptoms start- High Risk: children with o Prematurity o Chronic lung disease o Immunocompromised o Participating in Day Care - Symptoms: o Starts as URI o Worsening cough o Rhinorrhea o *HALLMARK: Wheezing - Exam Findings: o Increased work of breathing o Prolonged expiration o Intercostals retraction o Grunting o Nasal flaring o Wheezes and crackles *Sound bit: polyphonic wheeze found in RSV: (https://www.easyauscultation.com/heart-lung-sounds-details/144/Wheeze-Polyphonic), crackles (https://www.easyauscultation.com/heart-lung-sounds-details/72/Crackles-Fine- (Rales)) o Abdominal distention, palpable liver and spleen o Chest X-ray (not typically done): hyperinflation, atelectasis, flattening diaphragm - Complications: may progress to o Pneumonia o Respiratory distress and hypoxia o Respiratory acidosis - Treatment: o Supportive Care  Monitory pulse oximetry and respiratory status  Supplemental Oxygen  Hydration (oral, NG, IV)  Nutrition  Suction o Hospitalization  Age < 2 months  Respiratory distress  Progressive stridor or stridor at rest  Apnea  RR > 50-60 bpm (sleeping)  Cyanosis, hypoxia  Inability to tolerate oral feeding  Depressed sensorium  Presence of chronic cardiovascular or immunodeficiency diseasePertussis “Whooping Cough” - Gram-negative bacillus: Bordetella pertussis - Hallmark: high-pitched inspiratory whoop follows by spasms of coughing *Sound bit: (https://www.youtube.com/watch?v=zuK4honWVsE) - Aerosol droplet transmission - 7-10 day incubation, most contagious during first 2 weeks - Cough lasts 6-10 weeks (possibly longer in adolescents) - Vaccination: DTaP or Tdap - Symptoms: o Most severe in infants < 6 months  Apnea  Seizures induced by hypoxemia  Cough without inspiratory whoop  Tachypnea  Poor feeding  Leukocytosis nad lymphocytosis - Diagnostics: o Gold standard: culture with Dacron or Calcium alginate swab of nasopharynx (only 12%- 60% specific) o PCR (improved sensitivity) - Treatment: o Macrolide (not in infants < 1 month due to pyloric stenosis)  Azithromycin – 1st line  Clarithromycin  Erythromycin o Macrolide allergy: Bactrim o Chemoprophylaxis in household and close contact exposure: monitor x 21 days - Prevention o “Cocooning”: vaccination of all adults and relatives close to infant and protection from environmental hazards o Vaccinate Pneumonia - Bacterial or Viral o Bacterial:  less common in childhood  S. pneumo.  Most common cause  Lobar pneumonia  Methicillin resistant Staph aureus(MRSA)  Community acquired  Empyema  Necrosiso Viral:  More common in children < 2 yrs  Gradual onset - Typical or Atypical o Typical: lobar, infection of alveolar space resulting in consolidation o Atypical: non-localized consolidation  Walking pneumonia - Risk factors: neonates o Prolonged rupture of membranes o Maternal amnionitis o Premature delivery o Fetal tachycardia o Maternal intrapartum fever o Airway anomaly - Symptoms (vary by age group): o Neonates:  *Fever,  irritability,  lethargy o Older Children:  *Cough  *Fever  Tachypnea, tachycardia, air-hunger  Downward displacement of liver and spleen  Obvious illness (lethargy, decreased appetite, look unwell) o C. trachomatis: repetitive staccato cough with tachypnea, cervical adenopathy, and crackles - Treatment: o If sxs not improving after 72 hours: Chest x-ray o Neonates: admit to hospital o Supportive care:  Antipyretics  Hydration  Rest o Antibiotics: by age and causative organism  Chlamydia: azithromycin or amoxicillin, erythromycin, ethyl succinate  C.pneumo, M. pneumo: azithromycin, macrolide+ beta-lactam  S. pneumo: 3rd generation cephalosporin  S. aureus: vancomycin, clindamycin + beta-lactam - Complications: o Respiratory Distress, pneumothorax o Meningitis o CNS abscess o Endocarditis, pericarditiso Osteomyelitis, septic arthritis - Vaccination: Prevnar 13 Rotavirus Croup - Viral infection of the middle respiratory track (Larynx and bronchial tree - Laryngotraceitis / Laryngotracheobronchitis (LTB) o Viral: parainfluenza type 1 & 2 (HPIV) o LTB more severe, occurs 5 – 7 days in to the disease - Usually children < 6 yrs - Season: fall and winter - Incubation period: 2-4 days with viral shedding up to 1 week, lasts approx. 5 days - HALLMARK: Barking Cough *Sound bit: 1, 2, 3 (https://mommyhood101.com/croup-audioclips - Diagnosis: made by symptoms/clinical presentation - Symptoms: o Low grade fever o URI symptoms- gradual onset (rhinorrhea, congestion) o Barking Cough o Hoarseness o Dyspnea o Respiratory Distress (Intercostal retraction, tachypnea, cyanosis, accessory muscles, nasal flaring) - Clinical Findings: o Tachypnea o Prolonged inspiration o Inspiratory stridor (as airway obstruction worsens) *Sound bit: 4, 5 (https://mommyhood101.com/croup-audio-clips) o Wheezing (if lower airway involved) o Chest X-Ray (not typically done): subglottic narrowing – Steeple Sign - Treatment: o Supportive Care: Symptom Management  Cold air  Hydration o Glucocorticoids: reduce airway swelling  Dexamethasone 0.6 mg/kg to1 mg/kg IM PO o Aerosolized racemic epinephrine: reduce swelling of larynx and subglottis o Bronchodilator o Hospitalization:  RR > 70 bpm Stridor at rest  Temperature > 102.2 F (39C) - Complications: o Pneumonia o Respiratory distress Epiglottitis - Inflammation of epiglottis, aryepiglottic folds, and ventricular bands at the base of the epiglottis - Cause: H. influenza type B (HiB) - Prevention: HiB vaccine - Typically age 1-5 yrs (most under 2 yrs) - Symptoms: o Abrupt onset fever o Severe sore throat o Dyspnea o Inspiratory distress without stridor o *drooling o Toxic look - Clinical Findings: Emergent- Death within hours o * If epiglottitis is suspected: do NOT examine throat, do NOT place in supine position, Immediately transfer to ER o Expiratory stridor o Drooling o Aphonia (muffled, „hot potatoe‟ voice) o Rapid progression of respiratory obstruction o High fever o Flaring ala nasi and retraction of supraclavicular, intercostals, and subcostal spaces o Hyperextension of the neck - Diagnostic: o Blood culture o Lateral neck radiograph: absence of „thumb‟ sign rules out condition o Confirmed in OR - Treatment: o Establish airway (possible intubation or tracheostomy) o Start antimicrobials IV broad spectrum  Rifampin prophylaxis to all household members (20 mg/kg, max: 600 mg, x 4 days) o O2/ respiratory support Foreign Body Occlusion/ Aspiration Nasal Occlusion - Symptoms: o Recurrent, unilateral purulent nasal dischargeo Foul odor o Epistaxis o Nasal obstruction/ mouth breathing - Detection of FB in nasal passageway - Removal: o Alligator forceps o Suction with narrow tips o Cotton tipped applicators w/ or w/o topical vasoconstrictor o Hook or curette o 5-Fr catheter balloon inflation behind FB o Refer to ENT Laryngeal FB Aspiration - Symptoms: o Rapid onset hoarseness o Croupy cough o Aphonia Tracheal FB Aspiration - Symptoms: o Brassy cough o Hoarseness o dyspnea Bronchial FB Aspiration - Symptoms: o Unilateral wheeze, usually aspirated into *Right lung o Recurrent pneumonia o HX of Choking episode - Clinical Findings: o Cyanosis o Hemoptysis, blood streaked sputum o Decreased vocal fremitus o Limited chest expansion o Diminished breath sounds o Unilateral wheezes  Tracheal: homophonic wheeze: wheeze with audible „slap‟ and palpable „thud‟ on expiration - Diagnostic: o Inspiratory and forced expiratory chest radiographs o Chest fluoroscopy - Treatment: Referral to Pulmonary Specialist - Complications:o If vegetable matter: severe condition  Fever, sepsis-like sxs, dyspnea, cough o Lobar pneumonia o Status asthmaticus o Emphysema, atelectasis - Prevention: Education on high risk foods/objects: o Carrots, nuts, popcorn, hot dog chunks o Small toys, coins, buttons, etc Restrictive Airway Diseases - Less common in pediatrics - Decreased lung compliance with relatively normal flow rates - HALLMARK: tachypnea and decreased tidal volume/capacity - Causes: o Neuromuscular weakness o Lobar pneumonia o Pleural effusion or mass o Severe pectus excavatum o Abdominal distention Asthma *Know Levels of severity* Cystic Fibrosis (CF) - Genetic disorder, autosomal recessive, mutation of CFTR protein on chromosome 7 - Multisystem, progressive disease: COPD, GI disturbances, *exocrine dysfunction - Life expectancy: 41 yrs - Symptoms: o Respiratory: chronic airway inflammation and lung infections, viscous mucus, *mucociliary transport dysfunction, chronic cough, and *excess sputum production, respiratory failure o GI: meconium ileus, pancreatic insufficiency, rectal prolapsed, GI obstruction, failure to thrive, edema, hypoproteinemia, steatorrhea, poor muscle mass, GERD, *vitamin deficiencies (A, K, E, D) o Hepatic: biliary cirrhosis, jaundice, ascites, hematemesis, esophageal varices, cholelithiasis o Endocrine: recurrent acute pancreatitis, CF related diabetes (CFRD) o Musculoskeletal: osteoporosis o Reproductive: delayed sexual development, nonfunctional vas deferens (male sterility), undescended testes, hydrocele, demale decreased fertility, cervicitis o Sweat: *“taste salty”, hypochloremic alkalosis, dehydration - Diagnostic: o Newborn screening performedo Gold Standard: pilocarpine iontophoresis sweat test  Only ordered if child has more than one clinical feature of CF  Sweat chloride concentration > 60 mmol/L (age > 6 months), > 30 mmol/L (in infants) o PFTs o Glycosylated hemoglobin (elevated) - Treatment: complicated, require multidisciplinary team o Pulmonary: promote airway clearance  Inhaled dornase alfa :reduce mucus viscosity  Hypertonic saline: thins mucus  Postural drainage (cycle: active breathing, autogenic drainage, percussion, positive expiratory pressure, exercise, high frequency chest wall oscillation) BID  High dose Ibuprofen: reduce airway inflammation  Azithromycin 3x/week (ibuprofen decreases neutrophil mitigation)  Lung transplant o GI:  Pancreatic enzyme supplementation  Vitamin replacement and serum monitoring (A, D, E, K)  Osmotic laxatives, Gastrografin enemas o Endocrine  Glucose tolerance test  Diabetes management Salmonella Clostridium difficile Cryptosporidium Pyloric Stenosis Pinworms Gastric Esophageal Reflux (GERD) - Common in young infants: anatomical reasons o Spitting up after mealsForeign Body Ingestion - Common in children exploring their environment with mouths and hands - Common locations: o Thoracic inlet, pyloris, ileocecal junction - Common Culprits: Coins o Most pass without problem; 10-20% need surgery - Symptoms: o Dysphagia o odynophagia, o drooling, o regurgitation, o abdominal pain, o difficulty breathing Urinary Tract Infection - More common in females > uncircumcised male > circumcised males o Girls who have > 2 UTIs, urology consult is recommended o Boys who have >1 UTIs, urology consult is recommended - Lower UTI: uncomplicated, bladder and urethra - Upper UTI: complicated, urethra, bladder, ureters, kidneys o May require hospitalization  Fluid stabilization  Treatment  Monitoring for sepsis - Risk Factors: o Perineal irritation (soaps, bubble baths, fragrances, wipes) o Not wiping front to back o uncircumcised - Symptoms: o Infants:  Fever/hypothermia  Jaundice  Poor feeding  Irritability  Vomiting  Strong smelling urine  Failure to thrive  Sepsis o Children:  Abdominal/ flank pain  Urinary frequency  Dysuria Urgency  Enuresis  Vomiting  Fever - Diagnostics: o Urinalysis o Urine culture and sensitivity o Gram stain o Hydration status and electrolyte values - Most common cause: E. coli (85%) o Others: Klebsiella, Proteus, Enterococcus, Staphylococcus, and Streptococcus - Treatment: dependent on culture, child‟s age, and clinical guidelines Primary Enuresis Glomerulonephritis - Result of renal insult caused by immunoglobulin damage to the kidney - Red Flag: hematuria - Types: o Post-infection: most common  Post-streptococcal infection: occurs 10 to 14 days post-primary infection  Sx: edema, renal insufficiency  Dark, tea-colored urine o Membranoproliferative o IgA nephropathy o Henoch – Schonlein purpura (HSP):  Most common cause of small vessel vasculitis in children 2-7 yrs old  Sx: itching, urticaria, maculopapular rash with purpura on legs, buttocks, and elbows  Joint pain  50% chance of renal involvement o Systemic lupus o Alport syndrome Osgood-Schlatter Juvenile Rheumatoid Arthirits OsteomyelitisTranscient Synovitis of the Hip Legg-Calve’ – Perthes Disease Idiopathic Scoliosis (All)

 Health Care > STUDY GUIDE > ATI RN Maternal Newborn Proctored 2019 Retake 1 - Study Guide (All)

 *NURSING > STUDY GUIDE > ATI Maternal Newborn Proctored Study Guide (All)

 *NURSING > STUDY GUIDE > NURSING 2633 Study Guide for Maternal Child Exam 1,100% CORRECT (All)

 *NURSING > STUDY GUIDE > ATI Maternal NB|Health promotion Quiz|Complete solution{2020} (All)

 *NURSING > STUDY GUIDE > ATI MATERNAL NEWBORN REMEDIATION |Latest Winter 2020, Complete solution Guide. (All)

 Health Care > STUDY GUIDE > 2023 [REVISED] ATI MATERNAL NEWBORN PROCTORED EXAM 2019 RETAKE 2 – 60 QUESTIONS AND ANSWERS (VERIFIED ANSWERS) (All)